00-8215. Office of Inspector General; Medicare Program; Prospective Payment System for Hospital Outpatient Services  

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    AGENCY:

    Health Care Financing Administration (HCFA), HHS, and Office of Inspector General (OIG), HHS.

    ACTION:

    Final rule with comment period.

    SUMMARY:

    This final rule with comment period implements a prospective payment system for hospital outpatient services furnished to Medicare beneficiaries, as set forth in section 1833(t) of the Social Security Act. It also establishes requirements for provider departments and provider-based entities, and it implements section 9343(c) of the Omnibus Budget Reconciliation Act of 1986, which prohibits 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 an arrangement with the hospital. In addition, this rule establishes in regulations the extension of reductions in payment for costs of hospital outpatient services required by section 4522 of the Balanced Budget Act of 1997, as amended by section 201(k) of the Balanced Budget Refinement Act of 1999.

    DATES:

    Effective date: July 1, 2000, except that the changes to § 412.24(d)(6), new § 413.65, and the changes to § 489.24(h), § 498.2, and § 498.3 are effective October 10, 2000.

    Applicability date: For Medicare services furnished by all hospitals, including hospitals excluded from the inpatient prospective payment system, and by community mental health centers, the applicability date for implementation of the hospital outpatient prospective payment system is July 1, 2000.

    Comment date: Comments on the provisions of this rule resulting from the Balanced Budget Refinement Act of 1999 will be considered if we receive them at the appropriate address, as provided below, no later than 5 p.m. on June 6, 2000. We will not consider comments concerning provisions that remain unchanged from the September 8, 1998 proposed rule or that were revised based on public comment.

    See section VIII for a more detailed discussion of the provisions subject to comment.

    ADDRESSES:

    Mail written comments (one original and three copies) to the following address ONLY: Health Care Financing Administration, Department of Health and Human Services, Attention: HCFA-1005-FC, P.O. Box 8013, Baltimore, MD 21244-8013.

    If you prefer, you may deliver, by courier, your written comments (one original and three copies) to one of the following addresses:

    Room 443-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201, or

    C5-14-03, Central Building, 7500 Security Boulevard, Baltimore, MD 21244-1850.

    Comments mailed to those addresses may be delayed and could be considered late.

    Because of staffing and resource limitations, we cannot accept comments by facsimile (FAX) transmission. In commenting, please refer to file code HCFA-1005-FC.

    Comments received timely will be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, in Room 443-G of the Department's offices at 200 Independence Avenue, SW., Washington, DC, on Monday through Friday of each week from 8:30 a.m. to 5 p.m. (Phone (202) 690-7890).

    For comments that relate to information collection requirements, mail a copy of comments to:

    Health Care Financing Administration, Office of Information Services, Security and Standards Group, Division of HCFA Enterprise Standards, Room N2-14-26, 7500 Security Boulevard, Baltimore, MD 21244-1850, Attn: John Burke, HCFA-1005-FC; and

    Lauren Oliven, HCFA Desk Officer, Office of Information and Regulatory Affairs, Room 3001, New Executive Office Building, Washington, DC 20503.

    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 by faxing to (202) 512-2250. The cost for each copy is $8. 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.

    Start Further Info

    FOR FURTHER INFORMATION CONTACT:

    Janet Wellham, (410) 786-4510 or Chuck Braver, (410) 786-6719 (for general information)

    Joel Schaer (OIG), (202) 619-0089 (for information concerning civil money penalties)

    Kitty Ahern, (410) 786-4515 (for information related to the classification of services into ambulatory payment classification (APC) groups)

    George Morey (410) 786-4653 (for information related to the determination of provider-based status)

    Janet Samen (410) 786-9161 (for information on the application of APCs to community mental health centers)

    End Further Info End Preamble Start Supplemental Information

    SUPPLEMENTARY INFORMATION:

    To assist readers in referencing sections contained in this document, we are providing the following table of contents. Within each section, we summarize pertinent material from our proposed rule of September 8, 1998 (63 FR 47552) followed by public comments and our responses.

    Table of Contents

    I. Background

    A. General and Legislative History

    B. Summary of Provisions of the Balanced Budget Act of 1997 (the BBA 1997)

    1. Prospective Payment System (PPS)

    2. Elimination of Formula-Driven Overpayment

    3. Extension of Cost Reductions

    C. The September 8, 1998 Proposed Rule

    D. Overview of Public Comments

    E. Summary of Relevant Provisions in the Balanced Budget Refinement Act of 1999 (the BBRA 1999)

    1. Outlier Adjustment

    2. Transitional Pass-Through for Additional Costs of Innovative Medical Devices, Drugs, and Biologicals

    3. Budget Neutrality Applied to New Adjustments

    4. Limitation on Judicial Review

    5. Inclusion in the Hospital Outpatient PPS of Certain Implantable Items

    6. Payment Weights Based on Mean Hospital Costs

    7. Limitation on Variation of Costs of Services Classified Within a Group

    8. Annual Review of the Hospital Outpatient PPS Components

    9. Coinsurance Not Affected by Pass-Throughs Start Printed Page 18435

    10. Extension of Cost Reductions

    11. Clarification of Congressional Intent Regarding Base Amounts Used in Determining the Hospital Outpatient PPS

    12. Transitional Corridors For Application of Outpatient PPS

    13. Limitation on Coinsurance for a Procedure

    14. Reclassification of Certain Hospitals

    II. Prohibition Against Unbundling of Hospital Outpatient Services

    A. Background

    B. Office of Inspector General (OIG) Civil Money Penalty Authority and Civil Money Penalties for Unbundling Hospital Outpatient Services

    C. Summary of Final Regulations on Bundling of Hospital Outpatient Services

    D. Comments and Responses

    III. Hospital Outpatient Prospective Payment System (PPS)

    A. Hospitals Included In or Excluded From the Outpatient PPS

    B. Scope of Facility Services

    1. Services Excluded from the Scope of Services Paid Under the Hospital Outpatient PPS

    a. Background

    b. Comments and Responses

    c. Payment for Certain Implantable Items Under the BBRA 1999

    d. Summary of Final Action

    2. Services Included Within the Scope of the Hospital Outpatient PPS

    a. Services for Patients Who Have Exhausted Their Part A Benefits

    b. Partial Hospitalization Services

    c. Services Designated by the Secretary

    d. Summary of Final Action

    3. Hospital Outpatient PPS Payment Indicators

    C. Description of the Ambulatory Payment Classification (APC) Groups

    1. Setting Payment Rates Based on Groups of Services Rather than on Individual Services

    2. Packaging Under the APC System

    a. Summary of Proposal

    b. General Comments and Responses (Supporting or Objecting to Packaging)

    c. Packaging of Casts and Splints

    d. Packaging of Observation Services

    e. Packaging Costs of Procuring Corneal Tissue

    f. Packaging Costs of Blood and Blood Products

    g. Packaging Costs for Drugs, Pharmaceuticals, and Biologicals

    h. Summary of Final Action

    3. Treatment of Clinic and Emergency Department Visits

    a. Provisions of the Proposed Rule

    b. Comments and Responses

    4. Treatment of Partial Hospitalization Services

    5. Inpatient Only Procedures

    6. Modification of APC Groups

    a. How the Groups Were Constructed

    b. Comments on Classification of Procedures and Services Within APC Groups

    c. Effect of the BBRA 1999 on Final APC Groups

    d. Summary of APC Modifications

    e. Exceptions to the BBRA 1999 Limit on Variation of Costs Within APC Groups

    7. Discounting of Surgical Procedures

    8. Payment for New Technology Services

    a. Background

    b. Comments and Responses

    D. Transitional Pass-Through for Innovative Medical Devices, Drugs, and Biologicals

    1. Statutory Basis

    2. Identifying Eligible Pass-Through Items

    a. Drugs and Biologicals

    b. Medical Devices

    3. Criteria to Define New or Innovative Medical Devices Eligible for Pass-through Payments

    4. Determination of “Not Insignificant” Cost of New Items

    5. Calculating the Additional Payment

    6. Process to Identify Items and to Obtain Codes for Items Subject to Transitional Pass-Throughs

    E. Calculation of Group Weights and Conversion Factor

    1. Group Weights (Includes Table 1, Packaged Services by Revenue Center)

    2. Conversion Factor

    a. Calculating Aggregate Calendar Year 1996 Medicare and Beneficiary Payments for Hospital Outpatient Services (Pre-PPS)

    b. Sum of the Relative Weights

    F. Calculation of Coinsurance Payments and Medicare Payments Under the PPS

    1. Background

    2. Determining the Unadjusted Coinsurance Amount and Program Payment Percentage

    a. Calculating the Unadjusted Coinsurance Amount for Each APC Group

    b. Calculating the Program Payment Percentage (Pre-deductible Payment Percentage)

    3. Calculating the Medicare Payment Amount and Beneficiary Coinsurance Amount

    a. Calculating the Medicare Payment Amount

    b. Calculating the Coinsurance Amount

    4. Hospital Election to Offer Reduced Coinsurance

    G. Adjustment for Area Wage Differences

    1. Proposed Wage Index

    2. Labor-Related Portion of Hospital Outpatient Department PPS Payment Rates

    3. Adjustment of Hospital Outpatient Department PPS Payment and Coinsurance Amounts for Geographic Wage Variations

    4. Special Rules Under the BBRA 1999

    H. Other Adjustments

    1. Outlier Payments

    2. Transitional Corridors/Interim Payments

    3. Cancer Centers and Small Rural Hospitals

    I. Annual Updates

    1. Revisions to APC Groups, Weights and the Wage and Other Adjustments

    2. Annual Update to the Conversion Factor

    3. Advisory Panel for APC Updates

    J. Volume Control Measures

    K. Claims Submission and Processing and Medical Review

    L. Prohibition Against Administrative or Judicial Review

    IV. Provider-Based Status

    A. Background

    B. Provisions of the Proposed Rule

    C. Comments and Responses

    D. Requirements for Payment

    V. Summary of and Response to MedPAC Recommendations

    VI. Provisions of the Final Rule

    VII. Collection of Information Requirements

    VIII. Response to Comments

    IX. Regulatory Impact Analysis

    A. Introduction

    B. Estimated Impact on the Medicare Program

    C. Objectives

    D. Limitations of Our Analysis

    E. Hospitals Included In and Excluded From the Prospective Payment System

    F. Quantitative Analysis of the Impact of Policy Changes on Payment Under the Hospital Outpatient PPS: Basis and Methodology of Estimates

    G. Estimated Impact of the New APC System (Includes Table 2, Annual Impact of Hospital Outpatient Prospective Payment System in CY2000-CY2001)

    X. Federalism

    XI. Waiver of Proposed Rulemaking Regulations Text

    Addenda

    Addendum A—List of Hospital Outpatient Ambulatory Payment Classification Groups with Status Indicators, Relative Weights, Payment Rates, and Coinsurance Amounts

    Addendum B—Hospital Outpatient Department (HOPD) Payment Rates and Payment Status by HCPCS, and Related Information

    Addendum C—Hospital Outpatient Payment for Procedures by APC

    Addendum D—1996 HCPCS Codes Used to Calculate Payment Rates That Are Not Active CY 2000 Codes

    Addendum E—CPT Codes Which Will Be Paid Only As Inpatient Procedures

    Addendum F—Status Indicators

    Addendum G—Service Mix Indices by Hospital

    Addendum H—Wage Index for Urban Areas

    Addendum I—Wage Index for Rural Areas

    Addendum J—Wage Index for Hospitals That Are Reclassified

    Addendum K—Drugs, Biologicals, and Medical Devices Subject to Transitional Pass-Through Payment

    Alphabetical List of Acronyms Appearing in the Final Rule

    APC Ambulatory payment classification

    APG Ambulatory patient group

    ASC Ambulatory surgical center

    AWP Average wholesale price

    BBA 1997 Balanced Budget Act of 1997

    BBRA 1999 Balanced Budget Refinement Act of 1999

    CAH Critical access hospital

    CAT Computerized axial tomography

    CCI [HCFA's] Correct Coding Initiative

    CCR Cost center specific cost-to-charge ratio

    CCU Coronary care unit

    CMHC Community mental health center

    CMP Civil money penalty

    CORF Comprehensive outpatient rehabilitation facility

    CPI Consumer Price Index

    CPT [Physicians'] Current Procedural Terminology, 4th Edition, 2000, Start Printed Page 18436copyrighted by the American Medical Association

    DME Durable medical equipment

    DMEPOS DME, orthotics, prosthetics, prosthetic devices, prosthetic implants and supplies

    DRG Diagnosis-related group

    DSH Disproportionate share hospital

    EACH Essential access community hospital

    EBAA Eye Bank Association of America

    ED Emergency department

    EMS Emergency medical services

    EMTALA Emergency Medical Treatment and Active Labor Act

    ENT Ear/Nose/Throat

    ESRD End-stage renal disease

    FDA Food and Drug Administration

    FDO Formula-driven overpayment

    FQHC Federally qualified health center

    HCPCS HCFA Common Procedure Coding System

    HHA Home health agency

    HRSA Health Resources and Services Administration

    ICD-9-CM International Classification of Diseases, Ninth Edition, Clinical Modification

    ICU Intensive care unit

    IHS Indian Health Service

    IME Indirect medical education

    IOL Intraocular lens

    JCAHO Joint Commission on Accreditation of Healthcare Organizations

    LTH Long-term hospital

    MDH Medicare-dependent hospital

    MedPAC Medicare Payment Advisory Commission

    MRI Magnetic resonance imaging

    MSA Metropolitan statistical area

    NECMA New England County Metropolitan Area

    OBRA Omnibus Budget Reconciliation Act

    OT Occupational therapy

    PPO Preferred provider organization

    PPS Prospective payment system

    RFA Regulatory Flexibility Act

    RHC Rural health clinic

    RPCH Rural primary care hospital

    RRC Rural referral center

    SCH Sole community hospital

    SGR Sustainable growth rate

    SNF Skilled nursing facility

    TEFRA Tax Equity and Fiscal Responsibility Act of 1982

    TPA Tissue Plasminogen Activator

    Y2K Year 2000

    I. Background

    A. General and Legislative History

    When the Medicare program was first implemented, it paid for hospital services (inpatient and outpatient) based on hospital-specific reasonable costs attributable to serving Medicare beneficiaries. Later, the law was amended to limit payment to the lesser of a hospital's reasonable costs or its customary charges. In 1983, section 601 of the Social Security Amendments of 1983 (Pub. L. 98-21) completely revised the cost-based payment system for most hospital inpatient services by enacting section 1886(d) of the Social Security Act (the Act). This section provided for a prospective payment system (PPS) for acute hospital inpatient stays, effective with hospital cost reporting periods beginning on or after October 1, 1983.

    Although payment for most inpatient services became subject to the PPS, Medicare hospital outpatient services continued to be paid based on hospital-specific costs, which provided little incentive for hospitals to furnish outpatient services efficiently. At the same time, advances in medical technology and changes in practice patterns were bringing about a shift in the site of medical care from the inpatient to the outpatient setting. During the 1980s, the Congress took steps to control the escalating costs of providing outpatient care. The Congress amended the statute to implement across-the-board reductions of 5.8 percent and 10 percent to the amounts otherwise payable by Medicare for hospital operating costs and capital costs, respectively, and enacted a number of different payment methods for specific types of hospital outpatient services. These methods included fee schedules for clinical diagnostic laboratory tests, orthotics, prosthetics, and durable medical equipment (DME); composite rate payment for dialysis for persons with end-stage renal disease (ESRD); and payments based on blends of hospital costs and the rates paid in other ambulatory settings such as separately certified ambulatory surgical centers (ASCs) or physician offices for certain surgery, radiology, and other diagnostic procedures. However, Medicare payment for services performed in the hospital outpatient setting remains largely cost-based.

    In the Omnibus Budget Reconciliation Act of 1986 (OBRA 1986) (Pub. L. 99-509), the Congress paved the way for development of a PPS for hospital outpatient services. Section 9343(g) of OBRA 1986 mandated that fiscal intermediaries require hospitals to report claims for services under the HCFA Common Procedure Coding System (HCPCS). Section 9343(c) of OBRA 1986 extended the prohibition against unbundling of hospital services under section 1862(a)(14) of the Act to include outpatient services as well as inpatient services. The HCPCS coding enabled us to determine which specific procedures and services were being billed, while the extension of the prohibition against unbundling ensured that all nonphysician services provided to hospital outpatients would be billed only by the hospital, not by an outside supplier, and, therefore, would be reported on hospital bills and captured in the hospital outpatient data that could be used to develop an outpatient PPS.

    A proposed rule to implement section 9343(c) was published in the Federal Register on August 5, 1988. However, those regulations were never published as a final rule, so we included them in the hospital outpatient PPS proposed rule published in the Federal Register on September 8, 1998 (63 FR 47552) and will implement them as part of this final rule.

    Section 1866(g) of the Act, as added by section 9343(c) of OBRA 1986, and amended by section 4085(i)(17) of the Omnibus Budget Reconciliation Act of 1987 (OBRA 1987) (Pub. L. 100-203), authorizes the Department of Health and Human Services' Office of Inspector General to impose a civil money penalty (CMP), not to exceed $2,000, against any individual or entity who knowingly and willfully presents a bill in violation of an arrangement (as defined in section 1861(w)(1) of the Act).

    In section 9343(f) of the OBRA 1986 and section 4151(b)(2) of the Omnibus Budget Reconciliation Act of 1990 (Pub. L. 101-508), the Congress required that we develop a proposal to replace the current hospital outpatient payment system with a PPS and submit a report to the Congress on the proposed system.

    The Secretary submitted a report to the Congress on March 17, 1995, summarizing the research we conducted searching for a way to classify outpatient services for purposes of developing an outpatient PPS. The report cited ambulatory patient groups (APGs), developed by 3M-Health Information Systems (3M-HIS) under a cooperative grant with HCFA, as the most promising classification system for grouping outpatient services and recommended that APG-like groups be used in designing a hospital outpatient PPS.

    The report also presented a number of options that could be used, once a PPS was in place, for addressing the issue of rapidly growing beneficiary coinsurance. As a separate issue, we recommended that the Congress amend the provisions of the law pertaining to the blended payment methods for ASC surgery, radiology, and other diagnostic services to correct an anomaly that resulted in a less than full recognition of the amount paid by the beneficiary in calculating program payment (referred to as the formula-driven overpayment).

    Three sections of the Balanced Budget Act of 1997 (the BBA 1997) (Pub. L. 105-33), enacted on August 5, 1997, affect Medicare payment for hospital outpatient services. Section 4521 of the BBA 1997 eliminates the formula-driven overpayment for ambulatory surgical Start Printed Page 18437center procedures, radiology services, and diagnostic procedures furnished on or after October 1, 1997. In November 1998, we issued cost report instructions (Provider Reimbursement Manual, Part II, Chapter 36, Transmittal 4) that implemented this provision for services furnished on or after October 1, 1997. Section 4522 of the BBA 1997 amends section 1861(v)(1)(S)(ii) of the Act by extending cost reductions in payment for hospital outpatient operating costs and hospital capital costs, 5.8 percent and 10 percent respectively, before January 1, 2000. Section 4523 of the BBA 1997 amends section 1833 of the Act by adding subsection (t), which provides for implementation of a PPS for outpatient services. (Under Section 4523 of the BBA 1997 the outpatient PPS does not apply to cancer hospitals before January 1, 2000.) Set forth below in section I.B is a detailed description of the changes made by the BBA 1997.

    On November 29, 1999, the Balanced Budget Refinement Act of 1999 (the BBRA 1999), Pub. L. 106-113, was enacted. This Act made major changes that affect the proposed hospital outpatient PPS. The legislative changes are summarized in section I.E, below. More specific details on individual provisions that we are implementing in this final rule with comment period are included under the various sections of this preamble.

    B. Summary of Provisions in the Balanced Budget Act of 1997 (the BBA 1997)

    1. Prospective Payment System (PPS)

    Section 4523 of the BBA 1997 amended section 1833 of the Act by adding subsection (t), which provides for a PPS for hospital outpatient department services. (The following citations reflect the statute as enacted by the BBA 1997.) Section 1833(t)(1)(B) of the Act authorizes the Secretary to designate the hospital outpatient services that would be paid under the PPS. That section also requires that the hospital outpatient PPS include hospital inpatient services designated by the Secretary that are covered under Part B for beneficiaries who are entitled to Part A benefits but who have exhausted them or otherwise are not entitled to them. Section 1833(t)(1)(B)(iii) of the Act specifically excludes ambulance, physical and occupational therapy, and speech-language pathology services, for which payment is made under a fee schedule.

    Section 1833(t)(2) of the Act sets forth certain requirements for the hospital outpatient PPS. The Secretary is required to develop a classification system for covered outpatient services that may consist of groups arranged so that the services within each group are comparable clinically and with respect to the use of resources.

    Section 1833(t)(2)(C) of the Act specifies data requirements for establishing relative payment weights. The weights are to be based on the median hospital costs determined by 1996 claims data and data from the most recent available cost reports. Section 1833(t)(2)(D) of the Act requires that the portion of the Medicare payment and the beneficiary coinsurance that are attributable to labor and labor-related costs be adjusted for geographic wage differences in a budget neutral manner.

    The Secretary is authorized under section 1833(t)(2)(E) of the Act to establish, in a budget neutral manner, other adjustments, such as outlier adjustments or adjustments for certain classes of hospitals, that are necessary to ensure equitable payments. Section 1833(t)(2)(F) of the Act requires the Secretary to develop a method for controlling unnecessary increases in the volume of covered outpatient services.

    Section 1833(t)(3) of the Act specifies how beneficiary deductibles are to be treated in calculating the Medicare payment and beneficiary coinsurance amounts and requires that rules be established regarding determination of coinsurance amounts for covered services that were not furnished in 1996. The statute freezes beneficiary coinsurance at 20 percent of the national median charges for covered services (or group of covered services) furnished during 1996 and updated to 1999 using the Secretary's estimated charge growth from 1996 to 1999.

    Section 1833(t)(3) of the Act also prescribes the formula for calculating the initial conversion factor used to determine Medicare payment amounts for 1999 and the method for updating the conversion factor in subsequent years.

    Sections 1833(t)(4) and (t)(5) of the Act describe the method for determining the Medicare payment amount and the beneficiary coinsurance amount for services covered under the outpatient PPS. Section 1833(t)(5)(B) of the Act requires the Secretary to establish a procedure whereby hospitals may voluntarily elect to reduce beneficiary coinsurance for some or all covered services to an amount not less than 20 percent of the Medicare payment amount. Hospitals are further allowed to disseminate information on any such reductions of coinsurance amounts. Section 4451 of the BBA 1997 added section 1861(v)(1)(T) to the Act, which provides that any reduction in coinsurance must not be treated as a bad debt.

    Section 1833(t)(6) authorizes periodic review and revision of the payment groups, relative payment weights, wage index, and conversion factor.

    Section 1833(t)(7) of the Act describes how payment is to be made for ambulance services, which are specifically excluded from the outpatient PPS under section 1833(t)(1)(B) of the Act.

    Section 1833(t)(8) of the Act provides that the Secretary may establish a separate conversion factor for services furnished by cancer hospitals that are excluded from hospital inpatient PPS.

    Section 1833(t)(9) of the Act prohibits administrative or judicial review of the hospital outpatient PPS classification system, the groups, relative payment weights, wage adjustment factors, other adjustments, calculation of base amounts, periodic adjustments, and the establishment of a separate conversion factor for those cancer hospitals excluded from hospital inpatient PPS.

    Section 4523(d) of the BBA 1997 made a conforming

    amendment to section 1833(a)(2)(B) of the Act to provide for payment under the hospital outpatient PPS for some services described in section 1832(a)(2) that are currently paid on a cost basis and furnished by providers of services, such as comprehensive outpatient rehabilitation facilities (CORFs), home health agencies (HHAs), hospices, and community mental health centers (CMHCs). This amendment provides that partial hospitalization services furnished by CMHCs be paid under the PPS.

    2. Elimination of Formula-Driven Overpayment

    Before enactment of section 4521(b) of the BBA 1997, using the blended payment formulas for ASC procedures, radiology, and other diagnostic services, the ASC or physician fee schedule portion was calculated as if the beneficiary paid 20 percent of the ASC rate or physician fee schedule amount instead of the actual amount paid, which was 20 percent of the hospital's billed charges. Section 4521(b), which amended sections 1833(i)(3)(B)(i)(II) and 1833(n)(1)(B)(i) of the Act, corrects this anomaly by changing the blended calculations so that all amounts paid by the beneficiary are subtracted from the total payment in the calculation to determine the amount due from the program. Effective for services furnished on or after October 1, 1997, payment for surgery, radiology, and other diagnostic services calculated by blended payment methods is now calculated by Start Printed Page 18438subtracting the full amount of coinsurance due from the beneficiary (based on 20 percent of the hospital's billed charges).

    3. Extension of Cost Reductions

    Section 1861(v)(1)(S)(ii) of the Act was amended by section 4522 of the BBA 1997 to require that the amounts otherwise payable for hospital outpatient operating costs and capital costs be reduced by 5.8 percent and 10 percent, respectively, through December 31, 1999.

    C. The September 8, 1998 Proposed Rule

    We published a proposed rule in the Federal Register on September 8, 1998 (63 FR 47552) setting forth the proposed PPS for hospital outpatient services. In that proposed rule, we explained that, due to Year 2000 (Y2K) systems concerns, implementation of the new payment system would be delayed until after January 1, 1999. (The statement in the rule that the statute requires implementation “effective January 1, 1999,” and other similar statements in other rules, were not intended to mean that the statute requires retroactive implementation of the hospital outpatient PPS. As noted elsewhere in this rule, the statute does not impose such a requirement.) As noted in that document, the scope of systems changes required to implement the hospital outpatient PPS is so enormous as to be impossible to accomplish concurrently with the critical work that we, our contractors, and our provider-partners had to perform to ensure that all of our respective systems were Y2K compliant. Section XI of the proposed rule (63 FR 47605) explains in greater detail the reasons for delaying implementation.

    The proposed rule originally provided for a 60-day comment period. However, the comment period was extended four times, ultimately ending on July 30, 1999. (See 63 FR 63429, November 13, 1998; 64 FR 1784, January 12, 1999; 64 FR 12277, March 12, 1999; and 64 FR 36320; July 6, 1999.)

    On June 30, 1999, we published a correction notice (64 FR 35258) to correct a number of technical and typographical errors contained in the September 8, 1998 proposed rule. The numerical values in the proposed rule reflected incorrect data and data programming. Among other corrections, the notice set forth revised numerical values for the current payment, total services (total units), relative weights, proposed payment rates, national unadjusted coinsurance, minimum unadjusted coinsurance, and service-mix index.

    D. Overview of Public Comments

    We received approximately 10,500 comments in response to our September 8, 1998 proposed rule. That count includes the numerous requests from hospital and other interested groups and organizations that we extend the public comment period to allow additional time for analysis of the impact of our proposals. As we explain above, we extended the comment period four times, to end finally on July 30, 1999.

    In addition to receiving comments from a number of organizations representing the full spectrum of the hospital industry, we received comments from beneficiaries and their families, physicians, health care workers, individual hospitals, professional associations and societies, legal and nonlegal representatives and spokespersons for beneficiaries and hospitals, members of the Congress, and other interested citizens. The majority of comments addressed our proposals regarding payment for: Corneal tissue; payment for high-cost technologies, both existing and future; payment for blood and blood products; and payment for high cost drugs, including chemotherapy agents. We also received numerous comments addressing: Our approach to ratesetting using the ambulatory payment classification (APC) system; our method of calculating the payment conversion factor; and the potentially negative impact of the proposed hospital outpatient PPS on hospital revenues. In addition, we received many comments concerning the proposed regulations for provider-based entities.

    We carefully reviewed and considered all comments received timely. The many modifications that we made to our proposed regulations in response to commenters' suggestions and recommendations are reflected in the provisions of this final rule. Comments and our responses are addressed by topic in the sections that follow.

    E. Summary of Relevant Provisions in the Balanced Budget Refinement Act of 1999 (the BBRA 1999)

    As noted above, subsequent to publication of the proposed rule, the BBRA 1999 was enacted on November 29, 1999. The BBRA 1999 made major changes that affect the proposed hospital outpatient PPS. Because these changes are effective with the implementation of the PPS, we have had to make some revisions from the September 8, 1998 proposed rule. The provisions of the BBRA 1999 that we are implementing in this final rule with comment period follow.

    1. Outlier Adjustment

    Section 201(a) of the BBRA 1999 amends section 1833(t) by redesignating paragraphs (5) through (9) as paragraphs (7) through (11) and adding a new paragraph (5). New section 1833(t)(5) of the Act provides that the Secretary will make payment adjustments for covered services whose costs exceed a given threshold (that is, an outlier payment). This section describes how the additional payments are to be calculated and caps the projected outlier payments at no more than 2.5 percent of the total projected payments (sum of both Medicare and beneficiary payments to the hospital) made under hospital outpatient PPS for years before 2004 and 3.0 percent of the total projected payments for 2004 and subsequent years.

    2. Transitional Pass-Through for Additional Costs of Innovative Medical Devices, Drugs, and Biologicals

    Section 201(b) of the BBRA 1999 adds new section 1833(t)(6) to the Act, establishing transitional pass-through payments for certain medical devices, drugs, and biologicals. This provision does the following: Specifies the types of items for which additional payments must be made; describes the amount of the additional payment; limits these payments to at least 2 years but not more than 3 years; and caps the projected payment adjustments annually at 2.5 percent of the total projected payments for hospital outpatient services each year before 2004 and no more than 2.0 percent in subsequent years. Under this provision, the Secretary has the authority to reduce pro rata the amount of the additional payments if, before the beginning of a year, she estimates that these payments would otherwise exceed the caps.

    3. Budget Neutrality Applied to New Adjustments

    Section 201(c) of the BBRA 1999 amends section 1833(t)(2)(E) of the Act to require that the establishment of outlier and transitional pass-through payment adjustments is to be made in a budget neutral manner.

    4. Limitation on Judicial Review

    Section 201(d) of the BBRA 1999 amends redesignated section 1833(t)(11) of the Act by extending the prohibition of administrative or judicial review to include the factors for determining outlier payments (that is, the fixed multiple, or a fixed dollar cutoff amount, the marginal cost of care, or applicable total payment percentage), and the determination of additional payments for certain medical devices, Start Printed Page 18439drugs, and biologicals, the insignificant cost determination for these items, the duration of the additional payment or portion of the PPS payment amount associated with particular devices, drugs, or biologicals, and any pro rata reduction.

    5. Inclusion in the Hospital Outpatient PPS of Certain Implantable Items

    Section 201(e) of the BBRA 1999 amends section 1833(t)(1)(B) of the Act to include as covered outpatient services implantable prosthetics and DME and diagnostic x-ray, laboratory, and other tests associated with those implantable items.

    6. Payment Weights Based on Mean Hospital Costs

    Section 201(f) of the BBRA 1999 amends section 1833(t)(2)(C) of the Act, which specifies data requirements for establishing relative payment weights, to allow the Secretary the discretion to base the weights on either the median or mean hospital costs determined by data from the most recent available cost reports.

    7. Limitation on Variation of Costs of Services Classified Within a Group

    Section 201(g) of the BBRA 1999 amends section 1833(t)(2) of the Act to limit the variation of costs of services within each payment classification group by providing that the highest median (or mean cost, if elected by the Secretary) for an item or service within the group cannot be more than 2 times greater than the lowest median (or mean) cost for an item or service within the group. The provision allows the Secretary to make exceptions in unusual cases, such as for low volume items and services.

    8. Annual Review of the Hospital Outpatient PPS Components

    Section 201(h) of the BBRA 1999 amends redesignated section 1833(t)(8) of the Act to require at least annual review of the groups, relative payment weights, and the wage and other adjustments made by the Secretary to take into account changes in medical practice, the addition of new services, new cost data, and other relevant information and factors. That section of the Act is further amended to require the Secretary to consult with an expert outside advisory panel composed of an appropriate selection of provider representatives who will review the clinical integrity of the groups and weights and advise the Secretary accordingly. The panel may use data other than those collected or developed by the Department of HHS for the review and advisory purposes.

    9. Coinsurance Not Affected by Pass-Throughs

    Section 201(i) of the BBRA 1999 amends redesignated section 1833(t)(7) of the Act to provide that the beneficiary coinsurance amount will be calculated as if the outlier and transitional pass-throughs had not occurred; that is, there will be no coinsurance collected from beneficiaries for the additional payments made to hospitals by Medicare for these adjustments.

    10. Extension of Cost Reductions

    Section 201(k) of the BBRA 1999 amends section 1861(v)(1)(S)(ii) of the Act to extend until the first date that the hospital outpatient PPS is implemented, the 5.8 and 10 percent reductions for hospital operating and capital costs, respectively.

    11. Clarification of Congressional Intent Regarding Base Amounts Used in Determining the Hospital Outpatient PPS

    Section 201(l) of the BBRA 1999 provides that, “With respect to determining the amount of copayments described in paragraph (3)(A)(ii) of section 1833(t) of the Social Security Act, as added by section 4523(a) of the BBA, Congress finds that such amount should be determined without regard to such section, in a budget neutral manner with respect to aggregate payments to hospitals, and that the Secretary of Health and Human Services has the authority to determine such amount without regard to such section.” Pursuant to this provision, we are calculating the aggregate PPS payment to hospitals in a budget neutral manner.

    12. Transitional Corridors for Application of Outpatient PPS

    Section 202 of the BBRA 1999 amends section 1833(t) of the Act by redesignating paragraphs (7) through (11) as paragraphs (8) through (12), and adding a new paragraph (7), which provides for a transitional adjustment to limit payment reductions under the hospital outpatient PPS. More specifically, for the years 2000 through 2003, a provider, including a CMHC, will receive an adjustment if its payment-to-cost ratio for outpatient services furnished during the year is less than a set percentage of its payment-to-cost ratio for those services in its cost reporting period ending in 1996 (the base year). Two categories of hospitals, rural hospitals with 100 or fewer beds and cancer hospitals, will be held harmless under this provision. Small rural hospitals, for services furnished before January 1, 2004, will be maintained at the same payment-to-cost ratio as their base year cost report if their PPS payment-to-cost ratio is less. The hold-harmless provision applies permanently to cancer centers. Section 202 also requires the Secretary to make interim payments to affected hospitals subject to retrospective adjustments and requires that the provisions of this section do not affect beneficiary coinsurance. Finally, this provision is not subject to budget neutrality.

    13. Limitation on Coinsurance for a Procedure

    Section 204 of the BBRA 1999 amends redesignated section 1833(t)(8) of the Act to provide that the coinsurance amount for a procedure performed in a year cannot exceed the hospital inpatient deductible for that year.

    14. Reclassification of Certain Hospitals

    Section 401 of the BBRA 1999 adds section 1886(d)(8)(E) to the Act to permit reclassification of certain urban hospitals as rural hospitals. Section 401 adds section 1833(t)(13) to the Act to provide that a hospital being treated as a rural hospital under section 1886(d)(8)(E) also be treated as a rural hospital under the hospital outpatient PPS.

    II. Prohibition Against Unbundling of Hospital Outpatient Services

    A. Background

    Sections 9343(c)(1) and (c)(2) of OBRA 1986 amended sections 1862(a)(14) and 1866(a)(1)(H) of the Act, respectively. As revised, section 1862(a)(14) of the Act prohibits payment for nonphysician services furnished to hospital patients (inpatients and outpatients), unless the services are furnished by the hospital, either directly or under an arrangement (as defined in section 1861(w)(1) of the Act). As revised, section 1866(a)(1)(H) of the Act requires each Medicare-participating hospital to agree to furnish directly all covered nonphysician services required by its patients (inpatients and outpatients) or to have the services furnished under an arrangement (as defined in section 1861(w)(1) of the Act). Section 9338(a)(3) of OBRA 1986 affected implementation of the bundling mandate by amending section 1861(s)(2)(K) of the Act to permit services of physician assistants to be covered and billed separately. Sections 4511(a)(2)(C) and (D) of the BBA 1997 further revised sections 1862(a)(14) and 1866(a)(1)(H) of the Act, respectively, to exclude services of nurse practitioners Start Printed Page 18440and clinical nurse specialists, described in section 1861(s)(2)(K)(ii) of the Act, from the bundling requirement.

    B. Office of Inspector General (OIG) Civil Money Penalty Authority and Civil Money Penalties for Unbundling Hospital Outpatient Services

    In order to deter the unbundling of nonphysician hospital services, section 9343(c)(3) of OBRA 1986 added section 1866(g) to the Act to provide for the imposition of civil money penalties (CMPs), not to exceed $2,000, against any person who knowingly and willfully presents, or causes to be presented, a bill or request for payment for a hospital outpatient service under Part B of Medicare that violates the requirement for billing under arrangements specified in section 1866(a)(1)(H) of the Act. In addition, section 1866(g) includes authorization to impose a CMP, in the same manner as other CMPs are imposed under section 1128A of the Act when arrangements should have been made but were not. Section 4085(i)(17) of OBRA 1987 amended section 1866(g) of the Act by deleting all references to hospital outpatient services under Part B of Medicare. The result of this amendment is that the CMP is now applicable for services furnished to hospital patients, whether paid for under Medicare Part A or B.

    In order to implement section 1866(g) of the Act, we proposed in our August 5, 1988 proposed rule that the OIG would impose a CMP against any person who knowingly and willfully presents, or causes to be presented, a bill or request for payment for a hospital outpatient service under Part B of Medicare that violates the billing arrangement under section 1866(a)(1)(H) of the Act or the requirement for an arrangement. The amount of the CMP is to be limited to $2,000 for each improper bill or request, even if the bill or request included more than one item or service.

    C. Summary of Final Regulations on Bundling of Hospital Outpatient Services

    In our September 8, 1998 proposed rule, we proposed to make final most of the provisions of the August 5, 1988 proposed rule but with a number of revisions that we describe in detail in the proposed rule (63 FR 47558 through 47559). We are adopting as final regulations what we proposed in the September 8, 1998 rule with the following additional changes:

    • We are adding a new paragraph (b)(7) to § 410.42 (Limitations on coverage of certain services furnished to hospital outpatients) to provide an exception to the hospital bundling requirements for services hospitals furnish to SNF residents as defined in § 411.15(p). (Section 410.42 has been redesignated from § 410.39 in the proposed rule.)
    • We are making a minor change to newly redesignated paragraph (m)(2) (this language was formerly included in paragraph (m)(1)) in § 411.15 (Particular services excluded from coverage) to make it clearer that the exclusion discussed in this section is referring to excluding certain services from coverage.
    • Except for minor wording changes in introductory paragraph (b) of § 1003.102 (Basis for civil money penalties and assessments), that section remains as it appeared in the August 5, 1988 proposed rule. Paragraph (b)(15) is redesignated from proposed paragraph (b)(4) in the August 5, 1988 proposed rule and (b)(14) in the September 8, 1998 proposed rule. Paragraphs (b)(12) through (b)(14) of § 1003.102 are reserved.
    • We are adding a new paragraph (k) to § 1003.103 (Amount of penalty) to indicate that the OIG may impose a penalty of not more than $2,000 for each bill or request for items and services furnished to hospital patients in violation of the bundling requirements.
    • We are also amending § 1003.105 (Exclusion from participation in Medicare, Medicaid and other Federal health care programs) by revising paragraph (a)(1)(i) to reflect that the basis for imposition of a CMP is also a basis for exclusion from participation in Medicare, Medicaid and other Federal health care programs.

    D. Comments and Responses

    Comment: One association requested that we clarify whether lab tests are subject to the bundling requirement or whether those services are included in the definition of diagnostic tests that are not required to be bundled. If lab tests are bundled, the association asked that we seek a legislative change to permit a provider, other than the lab that performs the test, to bill for the test.

    Response: Laboratory tests, like all other services furnished to hospital patients, must be provided directly or under arrangements by the hospital and only the hospital may bill the program. Section 1833(h)(5)(A)(iii) of the Act provides an exception to the requirement that payment for a clinical diagnostic lab may be made only to the person or entity that performed or supervised the performance of the test. This section provides that in the case of a clinical diagnostic laboratory test provided under arrangement made by a hospital or CAH, payment is made to the hospital.

    All diagnostic tests that are furnished by a hospital, directly or under arrangements, to a registered hospital outpatient during an encounter at a hospital are subject to the bundling requirements. The hospital is not responsible for billing for the diagnostic test if a hospital patient leaves the hospital and goes elsewhere to obtain the diagnostic test.

    Comment: The same association asked us to clarify that services billed to skilled nursing facilities (SNFs) under the consolidated billing requirement would be exempt from the bundling requirement for hospital outpatient services.

    Response: We agree that in situations where a beneficiary receives outpatient services from a Medicare participating hospital or CAH while temporarily absent from the SNF, the beneficiary continues to be considered a SNF resident specifically with regard to the comprehensive care plan required under § 483.20(b). Such services are, therefore, subject to the SNF consolidated billing provision and should be exempt from the hospital outpatient bundling requirements. The final regulations at § 410.42(b)(7) reflect this exception.

    We note that the SNF consolidated billing requirements, under § 411.15(p)(3)(iii), do not apply to a limited number of exceptionally intensive hospital outpatient services that lie well beyond the scope of care that SNFs would ordinarily furnish, and thus beyond the ordinary scope of SNF care plans. The hospital outpatient services that are currently included in this policy are: Cardiac catheterization; computerized axial tomography (CAT) scans; MRIs; ambulatory surgery involving the use of an operating room; emergency room services; radiation therapy; angiography; and lymphatic and venous procedures. When a hospital or CAH provides these services to a beneficiary, the beneficiary's status as a SNF resident ends, but only with respect to these services. The beneficiary is now considered to be a hospital outpatient and the services are subject to hospital outpatient bundling requirements. In November 1998, we issued Program Memorandum transmittal number A-98-37, which provides additional clarification on this exclusion as well as a list of specific HCPCS codes that identify the services that are excluded from SNF consolidated billing but subject to hospital outpatient bundling.

    Comment: One commenter understood that the proposed rule Start Printed Page 18441would permit payment for all diagnostic tests that are furnished by a hospital or other entity if the patient leaves the hospital and obtains the service elsewhere; however, the commenter requested clarification as to the treatment of “outsourced” hospital departments. The commenter stated that hospitals are increasingly outsourcing departments to providers that can furnish services efficiently. Often these providers do not operate as “under arrangements” providers to the hospital, but as free-standing providers offering outpatient services on hospital grounds. The commenter specifically asked whether a free-standing entity providing outpatient services on hospital grounds, but operated independently of the hospital is able to bill separately for services furnished or is the entity considered to be part of the hospital and required to furnish services “under arrangement.”

    Response: A free-standing entity, that is, one that is not provider-based, may bill for services furnished to beneficiaries who do not meet the definition of a hospital outpatient at the time the service is furnished. Our bundling requirements apply to services furnished to a “hospital outpatient,” as defined in § 410.2, during an “encounter,” also defined in § 410.2.

    Comment: One commenter indicated that while the proposed revision to § 1003.102(b) accurately reflected the statutory directive that the basis for imposing a CMP is a “bill or request for payment,” the proposed amendment to § 1003.103(a) regarding the appropriate penalty amount to be imposed for bundling violations was in error. The commenter indicated that the OIG lacks the authority to impose a CMP in the amount of $10,000 for these violations, and that such a penalty should be not more than $2,000 for each violation.

    Response: The commenter is correct. While section 231(c) of the Health Insurance Portability and Accountability Act of 1996, Pub. L. 104-191, increased the CMP maximum amount from $2,000 to $10,000, the statute sets forth “items or services” as the basis upon which a higher CMP amount may be assessed. However, with regard to bundling violations, the Secretary may impose a CMP only on the basis of a “bill or request for payment” rather than “for each item and service” as stated in the proposed revision to § 1003.103. We are correcting this error by adding a new § 1003.103(k) to indicate that the OIG may impose a penalty of not more than $2,000 for each bill or request for items and services furnished to hospital patients in violation of the bundling requirements.

    III. Hospital Outpatient Prospective Payment System (PPS)

    In this section, we designate the services for which Medicare will make payment under the hospital outpatient PPS, the payment rates set for those services, and the method by which we determined the outpatient PPS payment and coinsurance amounts.

    We explain the structure of the hospital outpatient PPS, respond to comments that we received about the proposed PPS, and describe modifications that we made to the proposed PPS in response to comments, such as provisions we are making to expedite appropriate payment for new technologies and provisions to pay for blood and blood products.

    In this section, we also discuss how we will implement requirements enacted by the BBRA 1999, including transitional payment corridors and other payment adjustments such as outliers and transitional pass-throughs.

    A. Hospitals Included In or Excluded From the Outpatient PPS

    This PPS applies to covered hospital outpatient services furnished by all hospitals participating in the Medicare program, except as noted below. Partial hospitalization services in community mental health centers (CMHCs) are also paid under this PPS. Exclusions from outpatient PPS are different and more limited than exclusions from inpatient PPS. Thus, hospitals or distinct parts of hospitals that are excluded from the inpatient PPS are included in the outpatient PPS, to the extent that the hospital or distinct part furnishes outpatient services. For example, we will make payment under the outpatient PPS for outpatient psychiatric services. The outpatient services provided by hospitals of the Indian Health Service (IHS) will continue to be paid under separately established rates which are published annually in the Federal Register. We intend to develop a plan that will help these facilities transition to the PPS and will consult with the IHS to develop this plan.

    The following hospitals are excluded from the outpatient PPS:

    • Certain hospitals in Maryland qualify under section 1814(b)(3) of the Act for payment under the State's payment system. The excluded services are limited to those paid under the State's payment system as described in section 1814(b)(3) of the Act. Any other outpatient services furnished by the hospital are paid under the outpatient PPS.
    • Critical access hospitals that are paid under a reasonable cost based system, as required under section 1834(g) of the Act.

    Comment: National and State associations representing children's hospitals and a number of individual children's hospitals located across the country strongly recommended that their hospitals be excluded from the hospital outpatient PPS just as they have been excluded from the hospital inpatient PPS. These commenters argued that the exclusion should apply to outpatient services furnished by children's hospitals because these hospitals treat a unique patient group whose health needs are different from those of adult beneficiaries entitled to Medicare benefits. The commenters further argued that services to Medicare patients are, on average, only 1 percent of the total inpatient and outpatient services that children's hospitals furnish and that these services are largely ESRD services that are already excluded from the hospital outpatient PPS. The commenters were concerned that the resources required to implement and comply with the new system would be disproportionately high relative to the small number of patients who would be affected by the new system. In addition, the impact analysis that accompanied the proposed rule estimated that children's hospitals would lose more than 20 percent of their Medicare revenues under the new system. Commenters expressed great concern about this loss of revenue.

    Response: Our most recent analysis of the impact on hospitals of the PPS shows a negative effect for children's hospitals of 11.9 percent, which is significantly less than what we estimated in the proposed rule. However, the transitional corridor payments provided by the BBRA 1999 will protect these hospitals from even this level of loss through 2004. The estimated loss for CY 2000-2001 for children's hospitals is only 3.2 percent. (See Table 2 in section IX of this preamble.) As we discuss in section III.H.2 below, we will conduct extensive analyses during the first years of implementation of the PPS to determine whether we should propose adjustments for certain types of hospitals, including children's hospitals, when the transitional corridor provision expires. In the meantime, we are not excluding any special class of hospital from the PPS.

    B. Scope of Facility Services

    Section 1833(t)(1)(B)(i) of the Act gives us the authority to designate the services to be covered under the hospital outpatient PPS. In this section of the final rule, we designate the types Start Printed Page 18442of services included or excluded under the hospital outpatient PPS.

    1. Services Excluded From the Scope of Services Paid Under the Hospital Outpatient PPS

    a. Background

    In developing a hospital outpatient PPS, we want to ensure that all services furnished in a hospital outpatient setting will be paid on a prospective basis. We have already been paying, in part, for some hospital outpatient services such as clinical diagnostic laboratory services, orthotics, and end-stage renal disease (ESRD) dialysis services based on fee schedules or other prospectively determined rates that also apply across other sites of ambulatory care. Rather than duplicate existing payment systems that are effectively achieving consistency of payments across different service delivery sites, we proposed to exclude from the outpatient PPS those services furnished in a hospital outpatient setting that were already subject to an existing fee schedule or other prospectively determined payment rate. The similar payments across various settings create a more level playing field in which Medicare makes virtually the same payment for the same service, without regard to where the service is furnished.

    We therefore proposed to exclude from the scope of services paid under the hospital outpatient PPS the following:

    • Services already paid under fee schedules or other payment systems including, but not limited to: screening mammographies, services for patients with ESRD that are paid for under the ESRD composite rate; the professional services of physicians and non-physician practitioners paid under the Medicare physician fee schedule; laboratory services paid under the clinical diagnostic laboratory fee schedule; and DME, orthotics, prosthetics, and prosthetics devices, prosthetic implants, and supplies (DMEPOS) paid under the DMEPOS fee schedule when the hospital is acting as a supplier of these items. An item such as crutches or a walker that is given to the patient to take home, but that may also be used while the patient is at the hospital, would be billed to the DME regional carrier rather than paid for under the hospital outpatient PPS.
    • Hospital outpatient services furnished to SNF inpatients as part of his or her resident assessment or comprehensive care plan (and thus included under the SNF PPS) that are furnished by the hospital “under arrangements” but billable only by the SNF, regardless of whether or not the patient is in a Part A SNF stay.
    • Services and procedures that require inpatient care.

    The statute excludes from the definition of “covered OPD services” ambulance services, physical and occupational therapy, and speech-language pathology services, specified in section 1833(t)(1)(B)(iii) of the Act (redesignated as section 1833(t)(1)(B)(iv) by section 201(e) of the BBRA 1999). These services are to be paid under fee schedules in all settings.

    b. Comments and Responses

    Comment: One commenter urged that we exclude services furnished to ESRD patients from the scope of the hospital outpatient PPS.

    Response: Services furnished to ESRD patients include dialysis, Epoietin (EPO), drugs, and supplies provided outside the composite rate, surgery specific to access grafts, and many other medical services related to renal disease or to other coexisting conditions. We will continue to base payment for dialysis services on the composite rate, and we will continue to pay for EPO based on the current rate established for that service. The drugs and supplies that are used within a dialysis session, but for which payment is not included in the composite rate, are paid outside that rate. We have to conduct further analyses in order to develop appropriate APC groups upon which to base payment. In the meantime, we will continue to pay on a reasonable cost basis for dialysis related drugs and supplies that are paid outside the composite rate.

    Comment: A hospital industry association took exception to the requirement that hospitals obtain a separate supplier number, post a bond, and bill separately to the DME regional carrier for DME supplies such as crutches. They believe that this is an unnecessary requirement that results in additional costs for small rural hospitals. The commenter recommended that we include within the PPS rate supplies such as crutches that are directly related to the provison of the hospital outpatient services or that we permit hospitals to bill under the DME fee schedule without having to obtain a DME supplier number or post a bond.

    Response: Section 1834(j)(1)(A) of the Act provides that no payment may be made for items furnished by a supplier of medical equipment and supplies unless the supplier obtains a supplier number. Section 1834(a)(1)(C) of the Act provides that payment for DME can be made only under the DME fee schedule. Therefore, to receive payment for DME under Medicare, a hospital must obtain a supplier number and must meet the other requirements set by applicable Medicare rules and regulations.

    Comment: Several major hospital associations and a number of other commenters opposed our proposal to exclude from payment certain procedures that we designate as “inpatient only.” Other commenters, including a physician professional society, agree that many of the procedures that we designated in the proposed rule as “inpatient only” are currently performed appropriately and safely only in the inpatient setting. However, these commenters believe that our explicit exclusion of individual procedures, besides being unnecessary, could have an adverse effect on advances in surgical care. Some commenters alleged that we provided no concrete support for designating procedures as “inpatient only.” A number of commenters argued that medicine is not practiced uniformly across the nation and that some services listed among the exclusions are currently being performed on an outpatient basis in various parts of the country with positive outcomes.

    An industry association stated that we failed to consider surgical judgment and patient choice in determining the appropriate treatment setting for certain services that we proposed to exclude from coverage. Other commenters believe that the appropriate site for performing a medical service is best determined by physicians and their patients. One professional society stated that case law including medical malpractice case law is sufficient to ensure that medical services are delivered in the appropriate treatment setting and in conformance with prevailing medical standards.

    Response: We recognize and acknowledge that our assigning “inpatient only” status to certain services and procedures raises numerous questions and concerns, and that some individual determinations can be reasonably debated. However, section 1833(t)(1)(B) of the Act explicitly authorizes the Secretary to designate which hospital outpatient services are to be “covered OPD services” subject to payment under the hospital outpatient PPS. Therefore, we have had to select from the universe of possible services those that we determine are reasonable, necessary, and appropriate for Medicare payment under the hospital outpatient PPS. We note that our designation of a service as “inpatient only” does not necessarily preclude the service from being furnished in a hospital outpatient Start Printed Page 18443setting, but means only that Medicare will not make payment for the service were it to be furnished to a Medicare beneficiary in that setting. This unfortunately leaves the beneficiary liable for payment if the procedure is in fact performed in the outpatient setting. We hope that hospitals will advise beneficiaries of the consequences if procedures on the inpatient list are provided as outpatient services (that is, denial of Medicare payment with concomitant beneficiary liability). In section III.C.5 of this preamble, we discuss in greater detail our rationale for designating specific procedures as “inpatient only.” In response to comments, we have removed the “inpatient only” status from a number of services, which will allow them to be paid under the hospital outpatient PPS. We emphasize our intention to review annually, in consultation with hospital and professional societies and associations and the expert outside advisory panel mandated by the BBRA 1999, those procedures classified as “inpatient only” to ensure that the designation remains consistent with current standards of practice.

    Comment: One industry association contends that the statutory and regulatory authorities that we cite in the proposed rule (section 1862(a)(1)(A) of the Act and 42 CFR 411.15(k)(1), respectively) do not support the proposed medical services exclusions. The commenter argues that those provisions are the basis for prohibiting coverage for services that are not reasonable and necessary for the diagnosis or treatment of an illness or injury or to improve the functioning of a malformed body member. The commenter states that these provisions are not the basis upon which we identified services for the “inpatient only” list. The commenter further states that use of these provisions as a basis for denying coverage of the services would be confusing to beneficiaries.

    Response: The commenter is correct that the proper citations are not section 1862(a)(1) of the Act and 42 CFR 411.15(k)(1). In fact, the basis for our designating certain procedures as “inpatient only” is dependent on medical judgment regarding the proper site of service, and the proper citation for such designation is section 1833(t)(1)(B) of the Act. In some instances, the identification of services to be included or excluded from this PPS was perfectly clear. For example, emergency departments (EDs) are outpatient departments of hospitals. Thus emergency services rendered in EDs qualify as outpatient services. On the other hand, coronary artery bypass graft surgery (CABG) requires many hours in surgery, part of the time with the patient's life being sustained by artificial means; a period of hours, if not days, in the surgical intensive care unit (ICU); and further care in an inpatient unit with frequent nursing attention. It clearly cannot be an outpatient procedure, and it would not be reasonable to consider it for inclusion in this PPS. There are many procedures which require similar intensity of care, including periods in specialty ICUs and several days of intense nursing attention.

    Some procedures formerly performed only in the inpatient setting, however, have moved to the outpatient site of service. This movement has taken place due to new, less-invasive surgical techniques, such as laparoscopy, or new anesthesia agents that clear from the body more rapidly, allowing some patients to have general anesthesia in the morning and return home that afternoon. Thus we have had to decide which procedures may reasonably be performed in the outpatient setting, and which cannot. We have been guided in this decision by our medical advisors' clinical judgment regarding what is reasonable in various settings, comments we received in response to the proposed rule, and bill data which shows movement from one site to another. In section III.C.5, we discuss the criteria we considered in defining “inpatient only” procedures.

    Comment: One hospital asked how we would pay a hospital that routinely performs on an outpatient basis a procedure that we proposed to designate as “inpatient only.” The commenter recommended that a specific billing mechanism be used to guarantee payment in these situations.

    Response: Services designated as “inpatient only” will be excluded from Medicare payment under the hospital outpatient PPS. If the service is performed on an outpatient basis and a claim is submitted, the claim will be denied, and the beneficiary may be billed for the service. We would consider this a very poor policy on the hospital's part, and would hope that hospitals decide to abide by the constraints of the inpatient list.

    Comment: One commenter noted that hospital outpatient departments have never been limited to a list of approved procedures as are Medicare participating ASCs. The commenter stated that the “inpatient only” policy would exclude payment for a significant number of procedures that have traditionally been performed in the hospital outpatient setting. The commenter stated that some of the excluded procedures incorporate an observation stay in a recovery care center. The commenter contended that many of the excluded procedures could be safely performed in the outpatient setting particularly if a 24 to 72 hour recovery care center is part of the outpatient surgical care provided.

    Response: Routinely billing an observation stay for patients recovering from outpatient surgery is not allowed under current Medicare rules nor will it be allowed under the hospital outpatient PPS. As we state in section III.C.5 of this preamble, one of the primary factors we considered as an indicator for the “inpatient only” designation is the need for at least 24 hours of postoperative care.

    Comment: One commenter asked what option a hospital has if a beneficiary's secondary insurer requires that a procedure included on the Medicare inpatient only list be performed on an outpatient basis.

    Response: Upon implementation, the provisions of this final rule will govern payment for Medicare covered outpatient services furnished by hospitals to Medicare beneficiaries. Medicare payment policy and rules are not binding on employer-provided retiree coverage that may supplement Medicare coverage. Medigap insurers, however, must follow Medicare's coverage determinations.

    c. Payment for Certain Implantable Items Under the BBRA 1999

    In the course of identifying items and services whose costs we proposed to designate for payment under the hospital outpatient PPS, we gave considerable thought to including implantable items and services because these items and services are such an integral part of the procedure by which they are inserted or implanted. However, a number of the more common implants such as aqueous shunts, hallux valgus implants, infusion pumps, and neurostimulators, are classified as implantable prosthetics or DME. The statutory language governing payment for DMEPOS provides that, notwithstanding any other provision of the Medicare statute, DMEPOS must be paid for using the DMEPOS fee schedule. Therefore, under the proposed rule, the scope of services paid under the hospital outpatient PPS did not include implantable prosthetics and DME paid under the DMEPOS fee schedule. However, we did propose to package payment for implanted items such as stents, vascular catheters, and venous ports within the APC payment rate for the procedure related to the insertion of these items because we Start Printed Page 18444define these items as supplies rather than as prosthetic implants or implantable DME.

    Section 201(e) of the BBRA 1999 amends section 1833(t)(1)(B) of the Act to provide that “covered OPD services” include implantable items described in paragraph (3), (6), or (8) of section 1861(s) of the Act. The conference report accompanying the BBRA 1999, H. R. Rep. No. 436 (Part I), 106th Cong., 1st Sess. (1999), expresses the belief of the conferees that the current DMEPOS fee schedule is not appropriate for certain implantable medical items such as pacemakers, defibrillators, cardiac sensors, venous grafts, drug pumps, stents, neurostimulators, and orthopedic implants as well as items that come into contact with internal human tissue during invasive medical procedures, but are not permanently implanted. In the conference report agreement, the conferees state their intention that payment for these items be made through the outpatient PPS, regardless of how these products might be classified on current HCFA fee schedules. The implantable items affected by this BBRA 1999 requirement include prosthetic implants (other than dental) that replace all or part of an internal body organ (including colostomy bags and supplies directly related to colostomy care and including replacement of these devices); implantable DME; and implantable items used in performing diagnostic x-rays, diagnostic laboratory tests, and other diagnostic tests.

    Comment: A number of commenters disagreed with our proposal to pay under the DMEPOS fee schedule for implantable items and devices that require surgical insertion. We received comments on specific implantable items, including Vitrasert (a drug delivery system that is implanted in the eye); cochlear devices, which allow the profoundly deaf to hear sound and in some cases recognize speech; nerve stimulators that treat intractable epilepsy and other diseases; new technology intraocular lenses implanted following cataract surgery; and access devices for dialysis treatment. Commenters were also concerned that the costs of some implantable devices not paid under the DMEPOS fee schedule, which we packaged in our proposed rule, were not properly recognized in the APC payment.

    Response: As we explain above, the amendments made to the statute by section 201(e) of the BBRA 1999 provide for payment to be made under the hospital outpatient PPS for implantable items that are part of diagnostic x-rays, diagnostic laboratory tests, and other diagnostic tests; implantable durable medical equipment; and implantable prosthetic devices (other than dental). This BBRA 1999 provision requires that an implantable item be classified to the group that includes the service to which the item relates. Thus, under this final rule with comment period, we are including within the scope of the hospital outpatient PPS items such as aqueous shunts that would, absent the BBRA 1999 provision, have been paid under the DMEPOS fee schedule. Because implantable items are now packaged into the APC payment rate for the service or procedure with which they are associated, certain items may be candidates for the transitional pass-through payment, which is discussed in detail in section III.D of this preamble. The APC rates may not in every case perfectly recognize the cost of implantable items. We will continue to review the impact of packaging implantables in future updates.

    d. Summary of Final Action

    We are modifying proposed § 419.22 to remove prosthetic implants from the list of services excluded from payment under the hospital outpatient PPS. We are adding subparagraphs (9), (10), and (11) to proposed § 419.2(b), to include the following in the list of items and services whose costs are included in hospital outpatient PPS payment rates: prosthetic implants (other than dental) that replace all or part of an internal body organ (including colostomy bags and supplies directly related to colostomy care), and including replacement of these devices; implantable DME; and implantable items used in performing diagnostic x-rays, diagnostic laboratory tests, and other diagnostic tests.

    2. Services Included Within the Scope of the Hospital Outpatient PPS

    We proposed to include three categories of services within the scope of the outpatient PPS, as follows:

    a. Services for Patients Who Have Exhausted Their Part A Benefits

    Section 1833(t)(1)(B)(ii) of the Act provides for Medicare payment under the hospital outpatient PPS for certain services designated by the Secretary that are furnished to inpatients who have exhausted their Part A benefits or who are otherwise not in a covered Part A stay. Examples of services covered under this provision include diagnostic x-rays and certain other diagnostic services and radiation therapy covered under section 1832 of the Act.

    b. Partial Hospitalization Services

    Section 1833(a)(2)(B) of the Act provides that partial hospitalization services furnished in CMHCs be paid under the hospital outpatient PPS. Partial hospitalization is a distinct and organized intensive psychiatric outpatient day treatment program, designed to provide patients who have profound and disabling mental health conditions with an individualized, coordinated, comprehensive, and multidisciplinary treatment program.

    c. Services Designated by the Secretary

    We proposed to designate the following services to be paid under the hospital outpatient PPS:

    • All hospital outpatient services, except those that are identified as excluded, above, in section III.B.1 of this final rule. The types of services subject to payment under the hospital outpatient PPS include the following: surgical procedures; radiology, including radiation therapy; clinic visits; emergency department visits; diagnostic services and other diagnostic tests; partial hospitalization for the mentally ill; surgical pathology; and cancer chemotherapy.
    • Specific hospital outpatient services furnished to a beneficiary who is admitted to a Medicare-participating SNF but who is not considered to be a SNF resident, for purposes of SNF consolidated billing, with respect to those services that are beyond the scope of SNF comprehensive care plans. The specific hospital outpatient services that are excluded from SNF consolidated billing are cardiac catheterization, computerized axial tomography (CAT) scans, MRIs, ambulatory surgery involving the use of an operating room, emergency room services, radiation therapy, angiography, and lymphatic and venous procedures.
    • Supplies such as surgical dressings used during surgery or other treatments in the hospital outpatient setting that are also paid under the DMEPOS fee schedule. Payment for these supplies, when they are furnished in a hospital outpatient setting, is packaged into the APC payment rate for the procedure or service with which the items are associated.
    • Certain preventive services furnished to healthy persons, such as colorectal cancer screening.

    Section 4523(d)(3) of the BBA 1997 amended section 1833(a)(2)(B) of the Act to provide that we discontinue reasonable cost based payment and instead make Part B payment under the hospital outpatient PPS for certain medical and other health services when Start Printed Page 18445they are furnished by other providers such as hospices, SNFs, and HHAs. Specifically, we proposed to pay under the hospital outpatient PPS for the following medical and other health services when they are furnished by a provider of services:

    • Antigens (as defined in 1861(s)(2)(G) of the Act);
    • Splints and casts (1861(s)(5) of the Act);
    • Pneumococcal vaccine, influenza vaccine, hepatitis B vaccine (1861(s)(10) of the Act).

    Upon implementation of the hospital outpatient PPS, we would make Part B payment for the above services under the outpatient PPS when they are furnished by an HHA or hospice program. We would also make payment for antigens and the vaccines under the PPS when they are furnished by CORFs. (Splints and casts furnished by CORFs are paid under the rehabilitation fee schedule.) However, this provision would not apply to services furnished by a CORF that fall within the definition of CORF services at section 1861(cc)(1) of the Act. It also would not apply to services furnished by a hospice within the scope of the hospice benefit. Nor would it apply to services furnished by HHAs to individuals under an HHA plan of treatment within the scope of the home health benefit.

    d. Summary of Final Action

    We received no comments about the services we proposed to include within the scope of the hospital outpatient PPS. As noted in the preceding section III.B.1, we added certain implantable items to § 419.2(b) to implement section 201(e) of the BBRA 1999.

    3. Hospital Outpatient PPS Payment Indicators

    In the September 8, 1998 proposed rule in the Federal Register, we proposed a payment status indicator for every code in the HCPCS to identify how the service or procedure described by the code would be paid under the hospital outpatient PPS. We received no comments on our proposal to assign a payment status indicator to every HCPCS code. (In section III.C.6, below, we respond to commenters who disagreed with the payment status indicator that we proposed for individual codes.) Therefore, we are implementing payment status indicators as part of the hospital outpatient PPS. Addendum B displays the final payment status indicator for each HCPCS code, including codes for incidental services that are packaged into APC payment rates. Addendum E identifies the HCPCS codes to which we have assigned payment status indicator “C” to identify inpatient services that are not payable under outpatient PPS as implemented by this final rule. We respond below, in section III.C.5, to public comments about the specific codes we classified as inpatient services in the proposed rule and our final determination regarding the payment status of those codes.

    The following are the payment status indicators and description of the particular services each indicator identifies:

    • We use “A” to indicate services that are paid under some other method such as the DMEPOS fee schedule or the physician fee schedule.
    • We use “C” to indicate inpatient services that are not paid under the outpatient PPS.
    • We use “E” to indicate services for which payment is not allowed under the hospital outpatient PPS. In some instances, the service is not covered by Medicare. In other instances, Medicare does not use the code in question, but does use another code to describe the service.
    • We use “F” to indicate corneal tissue acquisition costs, which are paid separately.
    • We use “G” to indicate a current drug or biological for which payment is made under the transitional pass-through.
    • We use “H” to indicate a device for which payment is made under the transitional pass-through.
    • We use “J” to indicate a new drug or biological for which payment is made under the transitional pass-through.
    • We use “N” to indicate services that are incidental, with payment packaged into another service or APC group.
    • We use “P” to indicate services that are paid only in partial hospitalization programs.
    • We use “S” to indicate significant procedures for which payment is allowed under the hospital outpatient PPS but to which the multiple procedure reduction does not apply.
    • We use “T” to indicate surgical services for which payment is allowed under the hospital outpatient PPS. Services with this payment indicator are the only services to which the multiple procedure payment reduction applies.
    • We use “V” to indicate medical visits for which payment is allowed under the hospital outpatient PPS.
    • We use “X” to indicate ancillary services for which payment is allowed under the hospital outpatient PPS.

    The table below lists types of services, the hospital outpatient PPS payment status indicator assigned to each type of service, and the basis for Medicare payment for the service.

    Medicare Hospital Outpatient PPS Payment Status Indicators: How Medicare Pays for Various Services When They Are Billed for Hospital Outpatients

    IndicatorServiceStatus
    APulmonary Rehabilitation; Clinical TrialNot paid.
    CInpatient ProceduresNot paid.
    AOrthotics, and Non-implantable Durable Medical Equipment and ProstheticsDMEPOS Fee Schedule.
    ENonallowed Items and ServicesNot paid.
    APhysical, Occupational and Speech TherapyRehab Fee Schedule.
    AAmbulanceReasonable cost or charge or, when implemented, Ambulance Fee Schedule.
    AEPO for ESRD PatientsNational Rate.
    AClinical Diagnostic Laboratory ServicesLab Fee Schedule.
    APhysician Services for ESRD PatientsBill to Carrier.
    AScreening MammographyLower of Charge or National Rate.
    NIncidental Services, Packaged into APC RatePackaged; No Additional Payment Allowed.
    PPartial Hospitalization ServicesPaid Per Diem.
    SSignificant Procedure, Not Reduced When Multiple Procedures PerformedPaid Under Hospital Outpatient PPS (APC Rate).
    TSignificant Procedure, Multiple Procedure Reduction AppliesHospital Paid Under Outpatient PPS (APC Rate).
    Start Printed Page 18446
    VVisit to Clinic or Emergency DepartmentPaid Under Hospital Outpatient PPS (APC Rate).
    XAncillary ServicePaid Under Hospital Outpatient PPS (APC Rate).
    FAcquisition of Corneal TissuePaid at reasonable cost.
    GCurrent Drug/Biological Pass-ThroughAdditional payment.
    HDevice Pass-ThroughAdditional payment.
    JNew Drug/Biological Pass-ThroughAdditional payment.

    C. Description of the Ambulatory Payment Classification (APC) Groups

    1. Setting Payment Rates Based on Groups of Services Rather Than on Individual Services

    In our March 17, 1995 report to Congress, we recommended that groups similar to the ambulatory patient groups (APGs) developed by 3M Health Information Systems (3M) be used as the basis for the hospital outpatient PPS. We made this recommendation after examining a number of other payment systems that were already in place or under development, including DRGs that are the basis for Medicare payment for hospital inpatient services, the Medicare physician fee schedule that was implemented in 1992, and the payment groups that have been the basis for Medicare payments for ambulatory surgical center (ASC) facility services since 1982.

    As provided by the BBA 1997, section 1833(t)(2)(A) of the Act requires the Secretary to develop a classification system for covered outpatient services. Section 1833(t)(2)(B) provides that this classification system may be composed of groups, so that services within each group are comparable clinically and with respect to the use of resources. The statute refers to “each such service (or group of services),” confirming that the Secretary may choose or not choose to group services.

    We explain in our proposed rule that we revised the APGs, based on more recent Medicare data than that used by 3M, to create the ambulatory payment classification (APC) system. We proposed to group services identified by HCPCS codes and descriptors within APC groups as the basis for setting payment rates under the hospital outpatient PPS. We indicated that we organized the APC groups so that the services within each group would be homogeneous both clinically and in terms of resource utilization. We invited comments on our proposal to set rates on the basis of groups of services rather than on individual codes.

    Comments: Some commenters claimed that basing payment on APC groups rather than on individual services would result in underpayment for services that are more resource intensive, causing hospitals with a more resource intensive case mix to lose money. An organization representing physicians strongly opposed the use of APCs, because it believes that it is not possible to achieve an incentive-neutral, “level playing field” payment system using groups of codes or services. This organization favored replacing the APC system with a fee schedule based on individual services, similar to the Medicare physician fee schedule, as MedPAC recommends in its 1999 report to Congress. (We address the MedPAC recommendation later in this section.) The same physician organization is concerned that the broad range of services included in each APC will create an incentive for hospitals to provide lower cost services, even though a patient might require higher cost services. This organization expressed concern about the negative impact on physicians if a payment methodology similar to the APC system were applied to payment for physician services. To facilitate pricing new codes using individual services rather than APC groups, the same organization suggested that we establish a “relative value relationship in direct costs” between the new code and a comparable code, or that we consult AMA's Specialty Society RVS Updating Committee (RUC) for advice on relative cost relationships.

    One major hospital association expressed its preference for a service-specific fee schedule because of the wide variation in costs represented by groups of codes. Another hospital association advocated using individual services rather than groups of services as the basis for ratesetting, but recommended, if we were to use some form of grouping, that we apply tight limits on the variations of costs for services within a group.

    Response: We understand the concerns of commenters that setting payment weights using groups of services rather than individual services could result in payment for particular services that might not fully offset the costs that hospitals incur when they furnish expensive, resource-intensive services. However, we believe these concerns are in large measure addressed by the provisions of this final rule. As we explain in section III.C.6, we significantly restructured the proposed APC groups, first in response to comments and, second, to comply with section 1833(t)(2) of the Act, as amended by the BBRA 1999, which limits the variation of costs of services classified within a group. The result is more APC groups with fewer codes and a narrower range of costs in each group. In addition, other provisions of the BBRA 1999, such as the transitional pass-throughs (see section III.D, below), and outlier payments and transitional corridors (see section III.H, below) protect hospital revenues while hospitals gain experience with the PPS.

    Medicare Payment Advisory Commission (MedPAC) Recommendation

    In both its March 1998 and March 1999 reports to the Congress on Medicare payment policy, MedPAC recommends that payment rates under the hospital outpatient PPS be based upon costs of individual services rather than groups of similar services to help ensure consistent payments across ambulatory settings. In its March 1999 report, MedPAC asserts its belief that the burden imposed by our proposed APC system outweighs its benefits in ambulatory settings. MedPAC gives several reasons to support its position.

    • The use of groups to calculate weights masks questionable cost data for low volume and new procedures.
    • Different classes of hospitals face disproportionate impacts, suggesting APC groups may not be as homogeneous as we believe.
    • Grouping services will likely create additional administrative burdens for hospitals, because hospitals may have to purchase or develop new software and will experience additional education and training costs.

    Response: We carefully reviewed the concerns about using groups of services Start Printed Page 18447expressed by MedPAC in its March 1998 report, and we responded to those concerns in our proposed rule (63 FR 47562). Even though MedPAC concedes in its March 1999 report that using groups to set rates has certain potential advantages, MedPAC continues to oppose using groups because, according to MedPAC, they entail considerable costs and drawbacks and necessitate “a much more complicated design logic” than would be required using a service-level fee schedule.

    We do not share MedPAC's concerns. We have a high level of confidence in the ratesetting method using APC groups that we implement in this final rule with comment period. As we explain below, in section III.C.6, we have extensively restructured the APC groups to respond to comments on the proposed rule, to incorporate specific provisions of the BBRA 1999, and to correct some errors that had come to our attention. We believe that by using median costs in the calculation of group weights, we limit the extent to which infrequently performed services with suspect costs can affect the payment rate of an APC group.

    As discussed below in the impact analysis (section IX of this preamble), the provisions of this final rule with comment period, which include setting rates using APC groups, alleviate to a large extent the disproportionate impacts on different classes of hospitals estimated in our proposed rule. In addition, as we explain in section III.C.6, when we restructured the APC groups, we were particularly attentive to the degree of provider concentration associated with the individual services within a group in order to avoid biasing the payment system against any subset of hospitals.

    Finally, none of the commenters cited increased administrative burden as an argument against using groups. Even though we are using APC groups to set rates under the hospital outpatient PPS, hospitals will bill for services using HCPCS codes (not APCs) using the same claims forms that they use currently. Although to receive payment under the new system, hospitals will have to more fully code the services they furnish, they will not have to know to which APC the service is assigned in order to determine the payment amount. We are publishing the payment rate applicable to each HCPCS code in Addendum B of this final rule. Any burdens on hospitals necessitating additional technical assistance, training, or systems changes are more a function of implementing an entirely new payment system than of our setting rates on the basis of groups of services.

    Final Action: The payment rates implemented by this final rule with comment period are determined based on APC groups that use HCPCS codes to describe individual services. The codes assigned to an APC group are comparable clinically and in terms of resource use.

    2. Packaging Under the APC System

    a. Summary of Proposal

    In our proposed rule, we described packaged services as those items or services that we recognized as contributing to the cost of the procedures or services in an APC group, and for which we would not make separate payment. We proposed to include as packaged services use of the operating room and recovery room, anesthesia, medical/surgical supplies, pharmaceuticals, observation, blood, intraocular lenses, casts and splints, the costs of acquiring tissue such as corneal tissue for surgical insertion and various incidental services such as venipuncture. We packaged the services (and their costs) within the APC group of procedures with which they were delivered in the base year. For a list of proposed packaged services grouped by hospital revenue centers, refer to the June 30, 1999 correction notice (64 FR 35258).

    b. General Comments and Responses (Supporting or Objecting to Packaging)

    Comment: Few commenters disagreed with our proposal to aggregate into one payment the costs for a “package” of services variously related to a procedure or to the principal service being furnished. However, many commenters did object to our packaging costs for certain specific items such as expensive drugs and pharmaceuticals, observation services in the emergency department, blood and blood products, corneal tissue acquisition costs, and chemotherapy and supportive drugs. Commenters, fearful that packaging items and services will result in lower payments that do not offset the high costs of particularly expensive items, raised the prospect of dire consequences such as forcing hospitals to use only the cheapest drugs, being unable to employ oncology nurses, eliminating otherwise clinically necessary ancillary services, or not being able to hold emergency room patients for observation.

    Response: We are persuaded by commenters' arguments that packaging payment for certain expensive items and services into an APC group rate could have such a potentially negative impact as to jeopardize beneficiary access to these items and services in the hospital outpatient setting. Therefore, in response to comments, we are not packaging within an APC payment rate the costs associated with certain specified items and services. Instead, we will make a separate APC payment for these particular items and services under the outpatient PPS. However, as we explain in section III.C.2.d, we do not concur with commenters who urge separate payment for observation services; rather, we are packaging the costs in the APC for each service with which observation services were billed in our 1996 database. We discuss in further detail below, in section III.C.2.d through section III.C.2.g, and in section III.C.6, the changes that we are making to the packaging we originally proposed. We address in section III.B.1, above, the BBRA 1999 provision that requires us to package into APC group rates payment for certain implantable items and devices. In section III.D, below, we describe additional payments for certain packaged medical devices, drugs, and biologicals that are provided as transitional pass-throughs under section 201(b) of the BBRA 1999.

    As we gain experience with and collect additional cost data under the hospital outpatient PPS, we will review our policy to pay separately for certain items and services that would otherwise be packaged into the APC payment. Should we decide to modify this policy, we will do so through the rulemaking process as part of our annual hospital outpatient PPS update.

    MedPAC Recommendation: In its March 1999 report to the Congress, MedPAC cites two models that Medicare uses to define a unit of payment: the DRG-based payment model for hospital inpatient services, and the Medicare physician fee schedule. MedPAC contends that services provided in the hospital outpatient setting more closely parallel those furnished in an office-based setting than those furnished as part of a hospital inpatient admission. Therefore, MedPAC recommends that, in establishing ambulatory care prospective payment systems in general, we define the unit of payment for ambulatory care facilities as an individually coded service, consisting of the primary service that is the reason for the encounter, and the necessary and essential ancillary services and supplies integral to it, including limited follow-up care if it is integral to the primary service, but not including physicians' services. MedPAC further recommends that the unit of payment be defined consistently across all ambulatory care settings. Start Printed Page 18448

    Response: The packaging that we proposed as the basis for determining APC payment rates and that we will implement under the hospital outpatient PPS is generally consistent with MedPAC's recommendation. However, we did not propose to include “limited follow-up services” in our packaged groups under the hospital outpatient PPS because of the difficulty of matching in our database the costs of these services with their associated primary encounter. For now, hospitals are to bill follow-up care, such as suture removal, using an appropriate medical visit code. We did not propose, nor have we included in this final rule with comment period, provision for a global period for hospital outpatient services analogous to the global period affecting payments for professional services made under the Medicare physician fee schedule.

    c. Packaging of Casts and Splints

    Comment: One commenter stated that we should not package costs for casts and splints with other procedures.

    Response: We proposed to assign payment status indicator “N” to CPT codes for strapping and casting services (CPT codes 29000-29750) to designate that these are incidental services for which payment is packaged into the APC rate for another service or procedure, in this case, the repair or reduction of a fracture or dislocation. After further review, we determined that strapping and casting services can be performed independently, for example, when a cast placed as a part of a procedure must later be replaced with another cast. Therefore, we have decided that strapping and casting services will not be packaged and we are creating two APCs (0058 and 0059) to pay for these services. The BBA 1997 required that we pay under the outpatient PPS for casting and strapping services furnished in HHAs and hospices, to the extent that these services are provided and are not within the patient's plan of care.

    d. Packaging of Observation Services

    We received many comments urging us to pay separately for observation services, particularly when patients are seen in the emergency department. Observation service is placing a patient in an inpatient area, adjacent to the emergency department, or, according to some comments, in the intensive care unit (ICU) or coronary care unit (CCU), in order to monitor the patient while determining whether he or she needs to be admitted, have further outpatient treatment, or be discharged. After 1983, many hospitals began to rely heavily on the use of observation services when peer review organizations questioned admissions under the hospital inpatient prospective payment system. However, in some cases, patients were kept in “outpatient” observation for days or even weeks at a time. This resulted in excess payments both from the Medicare program and from beneficiaries who generally paid a higher coinsurance. In response to this practice, in November 1996, we issued instructions limiting covered observation services to no more than 48 hours except in the most extreme circumstances. However, the cost data upon which the APC system is based contain all costs for observation in 1996, including those that exceeded the 48-hour limit imposed at the end of that year. We have packaged those costs into the service with which they were furnished in the base year. Thus, APC payments for emergency room visits include the costs of observation within the payment.

    Comment: Some commenters acknowledged that being paid separately for observation following a surgical procedure was not necessary; the packaged recovery room and observation services were sufficient. However, a major concern of commenters was observation of patients with chest pain who had equivocal results on initial diagnostic testing. Commenters were concerned that the APC payment for these cases would not be adequate.

    Response: We assume that chest pain patients, such as those described by the commenters, are sent to the CCU or ICU for observation. We believe that, in general, if a patient needs to be monitored in the ICU or CCU for any length of time, then that patient should be admitted as an inpatient. Furthermore, we have never considered care furnished in an ICU or CCU to be outpatient services. Existing cost reporting instructions allow for the use of these specialty beds during a shortage of regular inpatient beds, but charges are to reflect routine care, not intensive care.

    Although, as noted above, we received many comments urging that observation services be covered as a separate APC, we continue to believe that these services have been used so inappropriately in the past that we will have to gather data under the PPS before considering constructing a separate APC. We have packaged observation wherever it was billed. Roughly $139 million was identified by revenue code 762 as representing observation services. An additional $253 million was identified in revenue codes 760, 761, and 769, which could be used for either observation or treatment room use. That $253 million is also packaged. (Both figures are in 1996 dollars.)

    Further analyses will be necessary on the use of observation as an adjunct to emergency treatment, as in the case of chest pain. In order to ensure that we will have sufficient data for our future analyses, hospitals must continue to bill for observation using revenue center 762 and showing hours in the units field. Observation that is billed must represent some level of active monitoring by medical personnel. It must not be billed as a way to capture room and board for outpatients. During our first review of the APC groups, we will assess whether patients with certain conditions use observation services that should be separately recognized. Thus, correct diagnosis coding is required.

    e. Packaging Costs of Procuring Corneal Tissue

    Comment: We received about 2,000 comments from physicians, eye banks, and health care associations opposing our proposal to package corneal tissue acquisition costs into the APC payment for corneal transplant procedures. Most commenters argued that the payment for the procedures in proposed APC group 670, Corneal transplant, is grossly inadequate and that we have failed to recognize the high costs associated with tissue screening and testing procedures required by the Food and Drug Administration that are reflected in the fees charged by eye banks. In addition, commenters contended that we failed to recognize the wide variation in tissue acquisition costs resulting from the level of philanthropic contributions in different areas of the country and in different years. Commenters asserted that by packaging corneal tissue acquisition costs with the payment for corneal transplant surgery, we would limit beneficiary access to quality care, force eye banks that are nonprofit, low-cost operations to close, provide disincentives for philanthropic contributions, and impede our goal to increase tissue availability.

    As part of their comments, the Eye Bank Association of America (EBAA) submitted a report of a study the EBAA commissioned on corneal tissue acquisition costs. The study was conducted by the Lewin Group which collected and analyzed data on corneal tissue acquisition costs incurred by 74 of EBAA's 100 members that are charitable nonprofit organizations. The report states that these 74 eye banks supplied approximately 82 percent of the corneal tissue distributed Start Printed Page 18449throughout the United States in 1997. Based on the data that they collected, the Lewin Group found that the median gross acquisition cost per transplant is $1,689 in 1999 dollars. Of this amount, approximately $233 represents the national median value of donated in-kind services such as volunteer staff. The Lewin Group concluded that the proposed hospital outpatient PPS payment of $1,583 did not adequately reflect the cost of procuring corneal tissue.

    Additionally, the report states that “fund raising and in-kind service values are not as well centered on their median values as the underlying cost data. Variability in fund raising and in-kind contributions not only exists between eye banks, but from year to year, within the same eye bank.” According to the study, charitable contributions in the form of cash and in-kind services represented 28 percent of the eye banks' total gross cost for tissues furnished in 1997. The Lewin Group finds that “If HCFA were to move to fee schedule or other fixed-payment rate, and pays the adjusted median Gross cost Per Transplant * * * payment of $1689, HCFA would overpay some banks and underpay others, depending on philanthropy and in-kind services which varies from community to community and from year to year. The variation is too extreme to determine a fair rate-based system, without destroying the philanthropy the community is built upon.”

    Response: Based on the concerns raised by the commenters and the data presented in the Lewin Group study, we have decided not to package payment for corneal tissue acquisition costs with the APC payment for corneal transplant surgical procedures at this time. Instead, we will make separate payment, based on the hospital's reasonable costs incurred to acquire corneal tissue. Final payment will be subject to cost report settlement. To receive payment for corneal acquisition costs, hospitals must submit a bill using HCPCS code V2785, Processing, preserving and transporting corneal tissue, and indicate the acquisition cost rather than the hospital's charge on the bill. We intend to review this policy after we have acquired updated data on corneal procedures.

    f. Packaging Costs of Blood and Blood Products

    Comment: Many commenters, including the American Red Cross, a major medical association, teaching hospitals, and community oncology centers, believe that the payments we proposed for blood and blood-related products and for APCs that required the use of blood and blood-related products, were too low. Commenters claimed that the proposed payments are so much lower than actual costs that hospitals might be forced to stop providing a range of blood services, especially those more complex than a simple transfusion. The commenters were concerned that our proposed payment would not allow hospitals to furnish the most clinically appropriate blood products and services. The commenters also stated that blood and blood product exchange were not assigned to appropriate APCs, thus skewing payment rates and not recognizing the true costs of services with which blood and blood product exchange are associated. Commenters attributed this deficiency to the fact that certain blood-related products were incorrectly billed in the 1996 data we used as the basis for pricing APCs. Commenters were also concerned that we excluded procedures whose costs fell outside 3 standard deviations of the mean cost. One major organization recommended that we separate payment for blood and blood products from the service with which it is associated. This commenter also recommended separate payment for infusible blood-derived drugs, and that we base payment for transfusable blood products on costs. Some commenters recommended a transition period prior to full implementation of the proposed PPS.

    Response: Based on the recommendations of commenters, we have created separate APC groups to pay for blood and blood products. We agree with the commenters that blood use varies enough that packaging blood units with their administration could lead to inequities. Because we were not able to capture enough claims data in the base year to accurately price the blood and blood-product APCs, we have based payment rates for these APCs on data provided by commenters, including suppliers of blood and blood products. We have based payment on current costs rather than 1996 costs so that we recognize the costs of recently developed blood safety tests. The safety of the nation's blood supply is a major concern of the Department of Health and Human Services, and we want to encourage appropriate testing and follow-up care.

    g. Packaging Costs for Drugs, Pharmaceuticals, and Biologicals

    We proposed to package the cost of drugs, pharmaceuticals, and biologicals with APC groups because we believe drugs are usually provided in connection with some other treatment or procedure. We collected aggregate cost data on all drugs that were billed with HCPCS codes and those billed with revenue center codes, whether or not a HCPCS was entered. By so doing, we captured historical patterns of drug use within the APC groups with which the drugs were billed during the base year. However, because we did not require HCPCS coding of drugs, we could not isolate costs associated with individual drugs, some of which are very expensive even though they are rarely used and may be used by only a few hospitals. As a result, we acknowledge that our proposed APC payment rates may not fully reflect costs of very expensive drugs or biologicals.

    We also proposed to create separate drug groups for chemotherapeutic agents because those were separately identified in the APG system designed by 3M. However, because we did not have bills that were coded to identify drugs individually, we were concerned that the APC groups for chemotherapeutic groups may not have completely reflected the costs of these drugs.

    Comment: Many commenters criticized the proposed APC payment rates because they were developed using cost data from 1996 that do not reflect the cost of many new drugs, pharmaceuticals, and biologicals. Some commenters expressed particular concern about oncology drugs such as paclitaxil (Taxol) and topotecan. Some advised that Taxol and carboplatin chemotherapy have become the standard treatment for ovarian carcinoma. A number of commenters believe that our proposal did not provide sufficient financial incentives to dissuade hospitals from using the older less effective chemotherapy regimens even though there is significantly greater toxicity and reduced chances of favorable outcomes associated with their use. Many commenters strongly suggested that we carve out new drugs and biologicals and those introduced after 1996 from the PPS and pay for them on a reasonable cost basis. Several commenters asserted that packaging drugs and pharmaceuticals within the APC groups understates their cost to hospitals and their value to patients.

    Response: We believe the commenters' concerns have, to a great extent, been addressed by implementation of the BBRA 1999 pass-through provisions for drugs and biologicals. Addendum K includes a complete list of all drugs, biologicals, and medical devices that are eligible for pass-through payments. We encourage interested parties to follow the process outlined below in section III.I.4 of this Start Printed Page 18450preamble to submit requests for consideration of drugs, biologicals, and medical devices that may be eligible for additional payment under the transitional pass-through provision but that are not listed in Addendum K.

    h. Summary of Final Action

    After consideration of comments received about packaging of services and of the requirements set forth in the amendments made to section 1833(t) of the Act by section 201(b) and section 201(e) of the BBRA 1999, we have revised the package of services directly related and integral to performing a procedure or furnishing a service on an outpatient basis whose costs will determine the national payment rate for that procedure or service under the hospital outpatient PPS.

    • We will package into the APC payment rate for a given procedure or service any costs incurred to furnish the following items and services: Use of an operating suite, procedure room or treatment room; use of the recovery room or area; use of an observation bed; anesthesia; medical and surgical supplies and equipment; surgical dressings; supplies and equipment for administering and monitoring anesthesia or sedation; intraocular lenses; capital-related costs; costs incurred to procure donor tissue other than corneal tissue; and, various incidental services such as venipuncture.
    • In general, we will package the cost of drugs, pharmaceuticals and biologicals into the APC payment rate for the primary procedure or treatment with which they are used. Additional payment for some drugs, pharmaceuticals, and biologics may be allowed under the transitional pass-through provisions, which we explain below, in section III.D.
    • We will not package payment for corneal tissue acquisition costs into the payment rate for corneal transplant surgical procedures at this time. We will make separate payment for these acquisition costs based on the hospital's reasonable costs incurred to acquire corneal tissue.
    • We will not package into the APC payment rate for another procedure or service costs incurred to furnish the following items and services: blood and blood products, including anti-hemophilic agents; casting, splinting, and strapping services; immunosuppressive drugs for patients following organ transplant; and certain other high cost drugs that are infrequently administered. We have created new APC groups for these items and services, which allows separate payment to be made for them.

    3. Treatment of Clinic and Emergency Department Visits

    a. Provisions of the Proposed Rule

    As we discussed in our proposed rule, determining payment for hospital clinic and emergency department (ED) visits requires a variety of considerations such as the following:

    • The impact of packaging on setting payment rates.
    • How to code visits in a manner that recognizes variations in service intensity and levels of resource consumption.
    • How to keep the system administratively manageable.
    • How to define critical care in terms of facility as opposed to physician input.
    • Data problems associated with identifying costs from claims that list multiple services.
    • How to move toward greater uniformity of payments across ambulatory settings so as to remove payment as an incentive for determining site of service.

    The major issue we faced in determining payment for hospital clinic and ED visits is whether to include diagnosis as well as Physicians' Current Procedural Terminology (CPT) codes in setting payment rates.

    In our proposed rule, we considered several approaches to setting prospective payment rates for hospital clinic and ED visits. Potential options included: (1) Using diagnosis codes only; (2) using CPT codes only; and (3) using a CPT-diagnosis code hybrid. We solicited comments on these approaches to setting payment rates for clinic and ED visits as well as comments on alternative approaches that we did not set forth in the proposed rule. In the proposed rule, we discussed in detail our assessment of the advantages and disadvantages of each approach.

    In addition, we proposed to create a HCPCS code that would be used to bill when a patient presents to an ED, requests a screening, and is screened in accordance with section 1867(a) of the Act. Payment for this new code would be minimal because we included no treatment costs in the screening service. Payment for the screening APC would be made only when no additional services were furnished by the emergency department. If nonemergency treatment was furnished, the appropriate emergency department visit would be billed, and not the screening. Similarly, if the screening reveals that an emergency does exist and treatment is instituted immediately, the screening would not be billed because we would consider payment to be subsumed into the payment for further treatment.

    We proposed paying for critical care as the highest level of “visit.” In our proposed rule, we stated that hospitals would use CPT code 99291 to bill for outpatient encounters in which critical care services are furnished.

    We used the CPT definition of “critical care” which is the evaluation and management of the critically ill or injured patient. Under the outpatient PPS, we would allow the hospital to use CPT code 99291 in place of, but not in addition to, a code for a medical visit or for an emergency department service. Although the CPT system allows the physician to bill in 30-minute increments following the first 74-minute period of providing critical care, we proposed to pay separately for only the initial period (CPT code 99291), packaging the few instances in which the 30-minute increments (CPT code 99292) were billed. If other services, such as surgery, x-rays, or cardiopulmonary resuscitation, were furnished on the same day as the critical care services, we would allow the hospital to bill for them separately.

    b. Comments and Responses

    Comment: The major hospital associations argued that none of our three proposed approaches fully explains facility resource use in connection with clinic and emergency visits. Hospitals did not see a clear benefit in the payment ranges created by using the CPT and diagnosis hybrid approach. A major medical association adamantly opposed the use of diagnosis codes. One major HMO that does not currently use CPT codes was opposed to the use of CPT codes to describe clinic and emergency visits.

    Response: In this final rule, we are not using patient diagnosis codes to compute payment rates for medical visits to clinics and emergency departments under the outpatient PPS because a number of concerns were raised about basing payment for medical visits on both HCPCS codes and ICD-9 diagnosis codes. The final payment groups for medical visits are constructed using CPT procedure codes only, which is consistent with our overall PPS grouping strategy and with the approach we have followed to establish payment groups for surgical and diagnostic services. However, we will continue to require hospitals to provide accurate diagnosis coding on claims for payment. We will continue to assess the value of using patient diagnosis for application Start Printed Page 18451to our payment system for possible use in the future.

    In developing medical visit APCs based on CPT procedure codes only (a change from the proposed rule), we are collapsing 31 CPT codes that define clinic and emergency visits into six groups, three each for the clinics and the emergency department. The final APC groups for clinic and emergency visits are as follows: APC 0600, Low Level Clinic Visits; APC 0601, Mid-Level Clinic Visits; APC 0602, High Level Clinic Visits; APC 0603, Interdisciplinary Team Conference; APC 0610, Low Level Emergency Visits; APC 0611, Mid-Level Emergency Visits; APC 0612, High Level Emergency Visits; and APC 0620, Critical Care.

    When basing payment on CPT codes alone, the range of costs reflects hospitals' billing patterns in increasing level of intensity. However, those increasing increments are due largely to hospitals' use of “chargemaster” systems, which generate bills using predetermined charges for codes. Thus, billing patterns reflect standard bills, not the resources used in any particular case.

    We had been concerned that certain hospitals' use of the lowest level code, CPT code 99201, to bill for all clinic visits would distort the data, causing inflation in both the volume and cost of low-level clinic visits, and a corresponding underreporting of mid- and high-level visits. (Costs for mid- and high-level visits would presumably have been correct, because individual hospitals would have reported appropriate charges with these codes; there simply would have been fewer reported visits at those levels.)

    We have developed the weights for clinic visits by using claims data only from a subset of hospitals that billed a wider range of visits rather than relying solely on claims with CPT code 99201. We chose to use this subset of hospitals (for this purpose only) because we do not know what CPT code 99201 indicates when hospitals use it exclusively to bill all visits.

    We emphasize the importance of hospitals assessing from the outset the intensity of their clinic visits and reporting codes properly based on internal assessment of the charges for those codes, rather than failing to distinguish between low-and mid-level visits “because the payment is the same.” The billing information that hospitals report during the first years of implementation of the hospital outpatient PPS will be vitally important to our revision of weights and other adjustments that affect payment in future years. We realize that while these HCPCS codes appropriately represent different levels of physician effort, they do not adequately describe nonphysician resources. However, in the same way that each HCPCS code represents a different degree of physician effort, the same concept can be applied to each code in terms of the differences in resource utilization. Therefore, each facility should develop a system for mapping the provided services or combination of services furnished to the different levels of effort represented by the codes. (The meaning of “new” and “established” pertain to whether or not the patient already has a hospital medical record number.)

    We will hold each facility accountable for following its own system for assigning the different levels of HCPCS codes. As long as the services furnished are documented and medically necessary and the facility is following its own system, which reasonably relates the intensity of hospital resources to the different levels of HCPCS codes, we will assume that it is in compliance with these reporting requirements as they relate to the clinic/emergency department visit code reported on the bill. Therefore, we would not expect to see a high degree of correlation between the code reported by the physician and that reported by the facility.

    Hospitals are required to use HCPCS code 99291 to report outpatient encounters in which critical care services are furnished. (See the American Medical Association's CPT 2000 coding manual for the definition of this code.) The hospital is required to use HCPCS code 99291 in place of, but not in addition to, a code for a medical visit or for an emergency department service.

    We will work with the American Hospital Association and the American Medical Association to propose the establishment of appropriate facility-based patient visit codes in time for the next proposed rule.

    Comment: Several commenters expressed concern that resources expended in the emergency department are not fully explained by the codes at their disposal. One commenter pointed out that some hospitals use internal coding systems to capture differing charges based on whether or not a case requires one-on-one nursing care.

    Response: While we share commenters' concerns on this point, we remind hospitals that they can receive additional payment under the outpatient PPS for services such as diagnostic testing and administration of infused drugs, and for therapeutic procedures including resuscitation that are furnished during the course of an emergency visit. We will also pay separately for certain high cost drugs, such as the expensive “clotbuster” drugs that must be given within a short period of time following a heart attack or stroke, if these drugs are furnished during an emergency visit. Even though some ED patients will be transferred to another hospital for inpatient treatment, the hospital that administers the drugs will be paid for them. Cases that fall far outside the normal range of costs will be eligible for an outlier adjustment established by section 201(a) of the BBRA 1999. (See section III.H, below.) In addition, one of the first topics of review to be addressed by the expert outside advisory panel, required by section 201(h)(1)(B) of the BBRA 1999, will be to determine if emergency department visits can be categorized in a way that better recognizes the underlying resources, especially nursing resources, involved in the visit.

    Comment: Several commenters expressed concern about the appropriate level of payment for patients who die in the ED. One commenter believes that services furnished to these patients are resource-intensive and recommends that we continue to pay for the services on a reasonable cost basis.

    Response: We are directing fiscal intermediaries to use the following guidelines in determining how to make payment when a patient dies in the ED or is sent directly to surgery and dies there.

    • If the patient dies in the ED, make payment under the outpatient PPS for services furnished.
    • If the ED 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 ED services.

    Comment: Some commenters objected to our proposal to restrict payment for critical care services to CPT code 99291 and not allow payment for CPT code 99292. One commenter recommended that we create an APC group for the additional increments of time a physician spends in critical care for which the physician may bill. Start Printed Page 18452

    Response: We do not believe that paying hospitals for incremental time as critical care would better reflect facility resources. The most resource-intensive period for the hospital is generally the first hour of critical care. In addition, we believe it would be burdensome for hospitals to keep track of minutes for billing purposes. Therefore, we will pay for critical care as the most resource-intensive visit possible as defined by CPT code 99291. Critical care services will be assigned to APC 0620.

    Comment: Several commenters advised that a screening code was not necessary because an emergency visit code could be billed for ED screening services.

    Response: We agree with the commenters, and we will instead use the appropriate emergency department codes for screening services (as defined in section 1867(a) of the Act). If no treatment is furnished, we would expect screening to be billed with a low-level emergency department code.

    Comment: Some commenters expressed concern about our proposal to allow hospitals to create a separate claim for each visit when two or more medical visits occur on the same day for different diagnoses. Commenters feared that this would result in our paying under the outpatient PPS for clinic care furnished at sites other than hospital outpatient departments, and that we are promoting fragmented care. One commenter was concerned that, to the extent that patients see multiple specialists, tests will be repeated unnecessarily, hospitalizations will rise, and beneficiaries and the Medicare program will be burdened with additional, unnecessary costs.

    Response: Our decision not to use diagnosis codes as a factor in determining payment for clinic visits largely negates these concerns because the need to prepare different claims for visits for different diagnoses has been eliminated. When patients are seen in different clinics on the same day, hospitals should bill using the proper codes for the level of the visits, using the units field if appropriate to reflect more than one visit at the same level.

    However, we note that the comment did prompt us to develop a code for billing those visits during which numerous physicians see a patient concurrently, for example, a surgeon, medical oncologist, and radiation oncologist for a cancer patient, to discuss treatment options and to ensure that the patient is fully informed. In this instance, each physician is addressing the patient's care from a unique perspective. If several physicians see a patient concurrently in the same clinic for the same reason, the hospital would bill for one clinic visit using an appropriate visit code even though each physician would bill individually for his or her professional services. We have established a code for hospitals to use in reporting a scheduled medical conference with the patient involving a combination of at least three health care professionals, at least one of whom is a physician. That code is G0175, Scheduled interdisciplinary team conference (minimum of three, exclusive of patient care nursing staff) with patient present.

    4. Treatment of Partial Hospitalization Services

    As we explained in the proposed rule, partial hospitalization is an intensive outpatient program of psychiatric services provided to patients in lieu of inpatient psychiatric care. Partial hospitalization may be provided by a hospital to its outpatients or by a Medicare-certified community mental health center (CMHC). It is important to note that the services of physicians, clinical psychologists, clinical nurse specialists (CNSs), nurse practitioners (NPs), and physician assistants (PAs) furnished to partial hospitalization patients would continue to be billed separately to the carrier as professional services and are not considered to be partial hospitalization services. Thus, payment for partial hospitalization services 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 payment is made to the provider. Including CSW and OT services reflects historical patterns of treatment billed during the base year.

    Because a day of care is the unit that defines the structure and scheduling of partial hospitalization services, we proposed a per diem payment methodology for the partial hospitalization 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. As noted in the June 30, 1999 correction notice, this analysis resulted in a proposed APC payment rate of $206.71 per day, of which $46.78 is the beneficiary's coinsurance.

    We also solicited comments on a number of issues related to partial hospitalization. We asked for information on the mix of services that constitute a typical partial hospitalization day and average duration of a partial hospitalization episode, whether we should impose a minimum number of services for each covered partial hospitalization day, and whether we should establish a limit on routine outpatient mental health services furnished on a given day to equal the partial hospitalization per diem amount. Finally, we indicated that we are considering specifying a timeframe for physician recertification of need for partial hospitalization services as a method of ensuring that a patient's condition continues to require the intensity of a partial hospitalization program.

    We did not receive a significant number of public comments on this issue. A summary of the comments we received and our responses follow.

    Comment: We received many similar comments from rural hospitals that operate partial hospitalization programs. The hospitals indicated that the proposed per diem amount does not cover their direct cost of providing services. Each commenter included an estimate of their partial hospitalization program cost (without depreciation or allocation of overhead costs). The estimates range from $270 to $325 per patient per day. The commenters indicated that approximately 65 to 70 percent of the costs are personnel-related.

    Response: The commenters did not indicate why their costs were higher than the per diem amount, but only that a significant proportion of their costs are related to personnel. In the future, we are committed to assessing the extent to which the per diem reflects special needs of rural hospitals. In the meantime, the BBRA 1999 includes provisions that offer relief to rural hospitals during the early years of the outpatient PPS. (See section III.H of this preamble.)

    Comment: We received several other comments regarding the proposed per diem amount. One commenter stated that the proposed per diem rate is equivalent to 3.3 psychotherapy units. The commenter believed this is an inadequate level of therapy for partial hospitalization patients and suggested that a per diem rate equal to 4 psychotherapy units would provide payment for a more appropriate level of service intensity. Several other commenters suggested that we set a single rate using a therapeutic hour of treatment (for example, the group psychotherapy APC rate) as the unit of service coupled with an overall aggregate limit for a course of treatment. These commenters estimated that a typical partial hospitalization day costs $275. Another commenter, a national association, conducted a survey of its Start Printed Page 18453member hospitals which showed that the median cost per day of treatment was approximately $210. Other commenters urged us to establish separate per diem amounts for partial hospitalization programs serving geriatric beneficiaries and those serving disabled beneficiaries under age 65. They indicated that programs designed to serve geriatric beneficiaries consist of different treatment modalities that are costlier than programs that serve younger beneficiaries. One commenter stated that programs serving younger beneficiaries typically average high patient volume and therefore have much lower costs per patient day than do the programs that serve geriatric patients. Other commenters urged us to establish a half day rate, although some stated that a half-day benefit does not reduce administrative costs appreciably.

    Response: In accordance with section 1833(t)(2)(C) of the Act, the proposed per diem amount represents the national median cost of providing partial hospitalization services. We used all the data from hospital bills that included the condition code 41, which identifies the claim as partial hospitalization. Because providers do not report on the claim the specific services provided each day, we do not currently have data that would permit us to establish an aggregate limit for a course of treatment or to analyze differences in the mix of services provided to various populations. As discussed in the preamble to the proposed rule and in Transmittal 7 of the CMHC Manual (issued November 1999) and Transmittal 747 of the Hospital Manual (issued December 1999), beginning April 1, 2000, hospitals and CMHCs will be required to indicate line item dates of service on claims. Once we have accumulated these data, we will be better able to determine if refinements to the per diem methodology are warranted, including the extent to which half-days are utilized.

    Comment: Several commenters expressed concern that no CMHC data were used to establish the partial hospitalization per diem payment rate. The commenters stated that CMHC costs are significantly different from hospital-based programs and urged us to collect CMHC cost data and base payments to CMHCs on CMHC-specific information. Another commenter stated that implementing PPS for partial hospitalization services provided by CMHCs is intended to contain costs and urged us to track the impact of the PPS on CMHCs. Still another commenter expressed concern that the per diem amount is insufficient for CMHCs to provide quality services. The commenter admitted, however, that historically their service area has had limited resources to provide minimum support for the persistent and chronically mentally ill. Two commenters expressed concern about certification requirements for CMHCs. One urged us to require accreditation by a national accrediting body and another commenter noted that reliance on the statutory definition established for CMHCs under the Public Health Service Act in 1963 is no longer appropriate and urged us to redefine a CMHC for Medicare certification purposes.

    Response: Partial hospitalization services are covered services under the hospital outpatient PPS. Section 1833(a)(2)(B) of the Act provides that partial hospitalization services furnished by CMHCs are to be paid under the hospital outpatient PPS. And, 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 data and data from the most recent available cost reports. As stated above, we are committed to analyzing future data from hospitals and CMHCs to determine if refinements to the per diem are warranted. As we noted in the proposed rule, the Medicare partial hospitalization benefit is designed to furnish services to patients who have been discharged from inpatient psychiatric care, and partial hospitalization services are provided in lieu of continued inpatient treatment, and for patients who exhibit disabling psychiatric/psychological symptoms or experience an acute exacerbation of a severe and persistent mental disorder. Because the statute requires a physician to certify that the patient would otherwise require inpatient psychiatric care in the absence of the partial hospitalization services, we do not believe the Medicare partial hospitalization benefit was intended to provide support for the persistent and chronically mentally ill except when they are in an acute phase of their mental illness. With regard to accreditation requirements for CMHCs and substantively revising the definition of a CMHC, this final rule is not the appropriate vehicle in which to address these issues. We are, however, amending § 410.2 to remove an obsolete provision from the definition of a CMHC.

    Comment: Several commenters questioned whether the proposed per diem approach meets the definition of an APC, that is, a group of services that are comparable clinically and in resource use. They believed that partial hospitalizations vary widely in their treatment approach and cost. Therefore, creating one payment amount for all partial hospitalization days is not consistent with our proposed classification system.

    Response: We continue to believe that the structure of the average partial hospitalization day is more similar than the commenters believe. We followed the basic analytical methodology used to establish all the APC payment amounts, except that we determined that, for partial hospitalization services, the unit of service is a day. Nonetheless, requiring providers to submit claims by date of service and by service provided will allow for future analysis to determine if the APC grouping for partial hospitalization can be improved.

    Comment: One commenter expressed concern about the use of 1996 data as the basis for the per diem amount. They referenced testimony by the Inspector General that indicated a significant improvement in the accuracy of provider billing in 1998 audits. They urged us to use 1997 or 1998 cost reports by region to develop the APC rate.

    Response: Section 1833(t)(2)(C) of the Act requires that we use 1996 claims data and the most recent cost reports as the basis for ratesetting under the hospital outpatient PPS. For purposes of the final rule, we primarily used cost reports for periods beginning in FY 1997.

    Comment: Several commenters, including national industry associations, expressed concern that partial hospitalization programs are required by their individual fiscal intermediaries to meet different medical necessity and programmatic requirements. For this reason, programs vary widely in program content and resultant cost. The commenters urged us to establish national coverage criteria before implementing a PPS for partial hospitalization services. Another commenter urged us to rely on more recent claims data that identify all services provided on each date of service in order to determine the relative resource cost of various outpatient mental health treatment programs.

    Response: Section 1833(a)(2)(B) of the Act provides that partial hospitalization services are paid under section 1833(t). We will refine the system, as needed, based on our review of more specific bill data. Movement to a per diem payment methodology will necessitate changes in the medical review approach used by fiscal intermediaries. It will become necessary to ensure that all patients receive the level of service their Start Printed Page 18454individual condition requires. Some patients will require days of service that cost the provider more than the per diem payment amount. Other patients may require less intensive days of service during an acute episode of partial hospitalization care or as they transition out of the partial hospitalization program. We will be developing medical review guidance for fiscal intermediaries, which we believe will lead to more consistency in medical review.

    Comment: One commenter noted that, in the past, a daily or partial-day payment approach was commonly used and was abandoned in favor of component billing for each partial hospitalization service. The commenter now believes that component billing provides a more accurate indication of the services provided to individual patients.

    Response: We believe that a per diem payment approach is a more appropriate methodology than billing for each program component. This approach is supported by the major industry groups involved with partial hospitalization and is used by other governmental and private insurers to pay for partial hospitalization program services. A per diem approach also incorporates and recognizes the cost of services that are not separately billable as outpatient psychiatric services, such as nursing services, training and education services, activity therapy, and support staff costs.

    Comment: Several commenters requested additional information on the HCPCS codes to which the partial hospitalization indicator applies and questioned how codes will group to APC 20 rather than grouping to psychotherapy APCs 91 through 94. They also asked whether substance abuse day programs will group to APC 20.

    Response: We issued revised billing instructions for partial hospitalization services provided by CMHCs in November 1999 and for hospital programs in December 1999. We instructed CMHCs to use HCPCS codes to bill for their partial hospitalization services; we required hospitals and CMHCs to report line item dates of service; and we established new HCPCS codes for occupational therapy and training and educational services furnished as a component of a partial hospitalization treatment program. We included in the instructions a complete listing of the revenue codes and HCPCS codes that may be billed as partial hospitalization services as follows:

    Revenue codesDescriptionHCPCS code
    43XOccupational Therapy (Partial Hospitalization)G0129.
    904Activity Therapy (Partial Hospitalization)Q0082.
    910Psychiatric General Services90801, 90802, 90875, 90876, 90899, or 97770.
    914Individual Psychotherapy90816, 90818, 90821, 90823, 90826, or 90828.
    915Group Psychotherapy90849, 90853, or 90857.
    916Family Psychotherapy90846, 90847, or 90849.
    918Psychiatric Testing96100, 96115, or 96117.
    942Education Training (Partial Hospitalization)G0172.

    To bill for partial hospitalization services under the hospital outpatient PPS, hospitals are to use these HCPCS and revenue codes and are to specify condition code 41 on the HCFA-1450 claim form. Before assigning a claim for payment to APC 0033 (the final APC for partial hospitalization services), the outpatient code editor (OCE) will check for errors; for example, the OCE will verify that the claim includes a mental health diagnosis, and at least three partial hospitalization HCPCS codes for each day of service, one of which must be a psychotherapy HCPCS code (other than brief). Claims that do not pass the OCE edits will undergo further prepayment review.

    With regard to the comments regarding substance abuse day programs, the Medicare benefit category is partial hospitalization services. Because there is no separate benefit category for substance abuse programs, any such program would have to meet requirements established for partial hospitalization programs in order for claims to group to APC 0033, including the requirements that a physician certify that the patient would otherwise require inpatient psychiatric care in the absence of the partial hospitalization services and that the program provides active treatment.

    Comment: In regard to physician recertification, we received several comments expressing support for establishing a specific timeframe and recommending a range from 7 to 31 days.

    Response: We agree that physicians should initially certify a patient's need for partial hospitalization services and recertify continued need for this intensive level of treatment. Because partial hospitalization is the outpatient substitute for inpatient psychiatric care, we believe it is appropriate to adopt the standard currently used for inpatient psychiatric care. Therefore, in this final rule, we are amending § 424.24(e) to establish physician recertification requirements for partial hospitalization services. The initial physician certification establishing the need for partial hospitalization must be received by the partial hospitalization program upon admission. Thus, services provided to establish a patient's need for partial hospitalization services would continue to be billed to the carrier as professional services. The first recertification is required as of the 18th day of services and subsequent recertifications are required no less frequently than every 30 days. Each recertification must address the patient's response to the intensive, therapeutic interventions provided by the active treatment program which make up partial hospitalization services, changes in functioning and status of the serious psychiatric symptoms that place the patient at risk of hospitalization, and treatment plan and goals for coordination of services such as community supports and less intensive treatment options to facilitate discharge from the partial hospitalization program.

    Comment: We received several comments regarding our proposal to limit payment for less intensive outpatient mental health treatment at the partial hospitalization per diem rate. One commenter did not believe the law supports establishment of a payment ceiling and that any such action is arbitrary. Other commenters believe that treatment should be determined by the clinical needs of each patient. However, the commenters conceded that additional requirements may have to be added to the final rule to prevent duplication or overlap of partial Start Printed Page 18455hospitalization and routine outpatient mental health services.

    Response: Our rationale for this proposal was that the costs associated with administering a partial hospitalization program represent the most resource intensive of all outpatient mental health treatment and, therefore, we should not pay more for a day of individual services. We are also concerned that a provider may disregard a patient's need for the intensive active treatment offered by a partial hospitalization program and opt to bill for individual services. In addition, the per diem amount represents the cost of an average day of partial hospitalization because the data used to calculate the per diem were derived from all the partial hospitalization data and include the most and the least intensive days. It would not be appropriate for a provider to obtain more payment through component billing.

    Comment: Several commenters expressed concern about staffing services that are bundled in the per diem payment and other staffing issues. One commenter stated that due to increased medical review by the fiscal intermediary, no partial hospitalization services may be furnished by unlicensed personnel. The commenter urged that the necessity for upgrades in staffing be taken into consideration in establishing a per diem rate. One commenter believes that all services, except for physician services, should be bundled into the per diem rate.

    Response: The list of covered partial hospitalization services is located in section 1861(ff) of the Act. The list includes several services such as patient education and training and activity therapy that may be provided by unlicensed but qualified staff who are specifically trained to work with the mentally ill. We note that the billing instructions issued in November 1999 (for CMHCs) and in December 1999 (for hospitals) announced a new HCPCS code for patient training and education services as a component of a partial hospitalization program. (A HCPCS code for activity therapy as part of a partial hospitalization program has been in place for several years.) Although the list also specifically references the services of social workers, trained psychiatric nurses, and other staff trained to work with psychiatric patients, there are no specific HCPCS codes for these services. Certain other partial hospitalization services, for example, individual and group psychotherapy, family counseling, occupational therapy (OT), and diagnostic services, must be provided by licensed staff, authorized by the State to provide these services.

    With regard to the content and staffing of partial hospitalization programs, we believe that all the covered services listed in section 1861(ff) of the Act and the disciplines of the staff who provide the services, that is, the multidisciplinary team, are an important element in creating the therapeutic milieu that distinguishes partial hospitalization programs from other outpatient mental health treatment. We believe it would be inappropriate if providers no longer offered the full range of partial hospitalization services, especially services such as OT that continue to be bundled in the per diem amount. We plan to monitor the extent to which providers change their programming in response to implementation of the PPS. Because the data on which the per diem was based included the full range of services and the use of certain bundled professionals, we will monitor changes in services or increased use of unbundled practitioners to evaluate and update the per diem rate. In response to the comment recommending that we bundle more professional services into the per diem rate, we captured historical patterns of treatment and staffing during the base year. Thus, the partial hospitalization per diem amount is limited to the provider's overhead costs, support staff, and the services of clinical social workers and occupational therapists, whose professional services are defined as partial hospitalization services. We have amended § 410.43(b) to update the list of services that are not paid as partial hospitalization services.

    Comment: One commenter took issue with our characterizing partial hospitalization to be the result of an acute exacerbation of a beneficiary's severe and persistent mental illness for which partial hospitalization services are provided in lieu of an inpatient psychiatric admission. They urged us to clarify that admission to a partial hospitalization is based on a physician certification that the patient would otherwise require inpatient psychiatric care, but continued stay in a partial hospitalization program would serve as a maintenance program for the chronically mentally ill. The commenter raised many other concerns about how we described partial hospitalization in the proposed rule, noting specific concern with regard to active treatment, community-based support, and frequency and duration of services.

    Response: It was not our intention in the proposed rule to generate public comment on the nature and coverage of partial hospitalization under the Medicare program. Rather, the information presented has appeared in various program memoranda and was included to describe the benefit and explain the per diem payment methodology. We continue to believe that partial hospitalization is a covered Medicare benefit category only when provided as an alternative to inpatient psychiatric care for acutely mentally ill beneficiaries.

    Result of Evaluation of Comments

    We are adopting as final our proposal to—

    • Establish a per diem payment of $202.19 for the partial hospitalization APC (APC 0033); and
    • Limit the payment for outpatient mental health treatment furnished on a day of services to the partial hospitalization APC payment amount.

    In addition, we are amending § 424.24(e) to establish requirements for physician recertification for partial hospitalization services.

    5. Inpatient Only Procedures

    In our proposed rule, we assigned payment status indicator “C” to 1,803 codes that represent procedures that our medical advisors and staff determined require inpatient care because of the invasive nature of the procedure, the need for postoperative care, or the underlying physical condition of the patient who would require the surgery. We did not assign these procedures to an APC group, and we proposed to make no payment for these services under the hospital outpatient PPS. Above, in section III.B.1.b of this preamble, we respond to the numerous general comments we received challenging both our classification of various procedures as inpatient procedures and our exclusion of these procedures from the scope of services paid under the hospital outpatient PPS.

    Comment: Commenters objected on the grounds that medical practice and new technology have allowed many procedures that formerly were performed only in the inpatient setting to be safely and effectively performed on an outpatient basis. In addition, they believe we are making decisions that should be left to the discretion of surgeons and their patients. Finally, the commenters believe that it is better for the patient if procedures are performed on an outpatient basis whenever possible. Commenters requested that we remove the payment status indicator of “inpatient only” from 195 codes and include them in an appropriate APC.

    Response: Under section 1833(t)(1)(B)(i) of the Act, the Secretary has broad authority to designate which Start Printed Page 18456services fall within the definition of “covered OPD [outpatient department] services” that will be subject to payment under the prospective payment system. We believe that certain surgically invasive procedures on the brain, heart, and abdomen, such as craniotomies, coronary-artery bypass grafting, and laparotomies, indisputably require inpatient care, and therefore are outside the scope of outpatient services. Certain other procedures that we proposed as “inpatient only” may not be so clearly classified as such, but they are performed virtually always on an inpatient basis for the Medicare population. We acknowledge that emerging new technologies and innovative medical practice are blurring the difference between the need for inpatient care and the sufficiency of outpatient care for many procedures, although we are concerned that some of the procedures that commenters claim to be performing on an outpatient basis may actually have been performed with overnight postoperative care furnished in observation units. And, regardless of how a procedure is classified for purposes of payment, we expect, as we stated in our proposed rule, that in every case the surgeon and the hospital will assess the risk of a procedure or service to the individual patient, taking site of service into account, and will act in that patient's best interests.

    After a careful review of comments by our medical advisors and staff, we have assigned to APC groups certain procedures that we had proposed as inpatient only. We made some changes because we were convinced by commenters' arguments that certain procedures are often performed safely in the outpatient setting; others because we believe that the simplest procedure described by the code may be performed safely in the outpatient setting; and yet others because they were related to codes we moved (for example, the radiologic part of an interventional cardiology procedure). The procedures we moved to the outpatient APCs include codes from within the following families: Explorations of penetrating wounds; repairs of some cranial and facial fractures; planned tracheostomies; diagnostic thoracoscopies; some insertion/removal/replacement of pacemakers, pulse generators, electrodes and cardioverter-defibrillators; embolectomies and thrombectomies; transluminal balloon angioplasty and peripheral atherectomy; transcatheter therapies; bone marrow transplantation; gastrostomies; percutaneous nephrostolithotomy; surgical laparoscopies, including cholecystectomies; ovarian biopsies; and surgeries on the orbit. Although we are moving these procedures into APC groups and they can receive outpatient payment, we emphasize that we expect only the simplest and least resource intensive procedures of each type to be performed in the outpatient setting. For example, several codes could be used to describe initial insertion of a pacemaker or replacement of the pacemaker or its electrodes. We believe most initial pacemaker insertions are performed on an inpatient basis, so codes billed in this range are most likely to be for replacement of a pacemaker, which requires fewer facility resources.

    Because of the risk involved with invasive cardiovascular procedures, including angioplasty and atherectomy, we are placing an additional requirement on their performance that we do not think is necessary with other procedures. That is, Medicare will pay for these procedures only in those settings in which the patient can immediately be placed on cardiopulmonary bypass in the event of a complication such as perforation of a coronary artery, which would require an immediate thoracotomy.

    When our medical advisors and staff disagreed with the recommendation of commenters to reclassify a particular procedure, they based their decision to retain a procedure as “inpatient only” on several considerations. In general terms, as stated above, we define inpatient procedures as those that require inpatient care because of the invasive 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 who would require the surgery. In other words, inpatient procedures are those that, in the judgment of our medical advisors and staff, would not be safe, appropriate, or considered to fall within the boundaries of acceptable medical practice if they were performed on other than a hospital inpatient basis.

    Among the procedures cited by commenters that we believe should remain as “inpatient only” are: Breast reconstruction using myocutaneous flaps; radical resections of tumors of the mandible; open treatment of certain craniofacial fractures; osteotomies of the femur and tibia; sinus endoscopy with repair of cerebrospinal fluid leaks; carinal reconstruction; surgical thoracoscopies; pacemaker procedures by thoracotomy; certain thromboendarterectomies; excision of mediastinal cysts and tumors; excisions of stomach tumors; enterostomies; hepatotomies; ureterotomies and ureteral endoscopies through ureterotomies; transcranial approaches to the orbit; and laminectomies. Our medical advisors and staff, as well as consulting physicians, believe these procedures are too invasive (for example, thoracotomies), too extensive (for example, breast reconstruction with myocutaneous flaps), or too risky by virtue of proximity to major organs (for example, repairs of spinal fluid leaks and carinal reconstruction) to be performed on an outpatient basis. The procedures that we exclude from outpatient payment because we believe they should be performed on an inpatient basis are listed in Addendum E. This list represents national Medicare policy and is binding on fiscal intermediaries and peer review organizations as well as on hospitals and Medicare participating ASCs. Note, however, that services included in outpatient PPS and assigned to an APC may be performed on an inpatient basis when the patient's condition warrants inpatient admission.

    In the future, as part of our annual update process, we will be working with professional societies and hospital associations, as well as with the expert outside advisory panel that we will be convening as required by new section 1833(t)(9)(A) of the Act, to reevaluate procedures on the “inpatient only” list and we will propose to move procedures to the outpatient setting whenever we determine it to be appropriate. For example, a decreasing length of inpatient stay for a procedure may signal that it is appropriate for consideration for payment under the outpatient PPS. If hospitals find that surgeons are discharging patients successfully on the day of surgery, they should bring this to our attention as well, because hospitals may become aware of this trend before our payment data disclose it. Thus, assignment of a “C” payment status indicator in this final rule should not be considered as a permanent or irrevocable designation.

    Comment: One professional society recommended that we assign payment status indicator “C” to CPT codes 21343, open treatment of depressed frontal sinus fracture, 42842, radical resection of tonsil, tonsillar pillars, and/or retromolar trigone—without closure, and 69150, radical excision external auditory canal lesion—without neck dissection, because these procedures require inpatient care.

    Response: We accepted the commenters' recommendation that these CPT codes should not be performed in an outpatient setting. We also reclassified as an inpatient procedure Start Printed Page 18457CPT code 94762, noninvasive ear or pulse oximetry for oxygen saturation; by continuous overnight monitoring (separate procedure), because it requires an overnight stay.

    Comment: One commenter noted that, to the extent that we require that certain surgical procedures be performed in an inpatient setting in order to receive Medicare payment, the beneficiary will incur the higher deductible associated with a hospital inpatient service.

    Response: The commenter is correct that the Part A hospital inpatient deductible amount that a beneficiary will have to pay may be higher than coinsurance and deductibles the beneficiary would have paid as an outpatient for a surgical procedure. However, our decisions concerning whether to pay for certain surgical procedures under the PPS are based on patient safety concerns and the medical appropriateness of performing the procedures in the hospital inpatient versus outpatient setting.

    Final Action

    Under the hospital outpatient PPS, we will not make payment for procedures that are designated as “inpatient only.” We have, however, revised the list of procedures that are designated as “inpatient only” based on comments. (See Addendum E.)

    6. Modification of APC Groups

    a. How the Groups Were Constructed

    Section 1833(t)(2)(A) of the Act requires the Secretary to develop a classification system for covered outpatient services. Within that classification system, the Secretary is given the authority under section 1833(t)(2)(B) of the Act to establish groups of covered services so that the services within each group are comparable clinically and with respect to the use of resources. In the proposed rule, we explain how we constructed the APC groups that are the basis for ratesetting under the hospital outpatient PPS.

    Our medical advisors and staff used the ambulatory patient groups (APGs) developed by 3M-Health Information Systems as a starting point for the APC groups, but we modified the APGs to take into account 1996 outpatient claims data, data collected in a 1994 survey of ambulatory surgical center (ASC) costs and charges, data collected in 1995 and 1996 to establish resource-based practice expense relative values under the Medicare physician fee schedule, and comments offered by a broad range of professional and trade societies and associations. For a more detailed discussion of this process, see section V.B of the proposed rule (63 FR 47561).

    b. Comments on Classification of Procedures and Services Within APC Groups

    In the proposed rule, we invited comments on the composition of the APC groups, and we requested that commenters support their recommendations for changes with resource cost data and clinical arguments. We received a large number of comments on our proposed grouping of individual procedures and services. The most common comment was that the APC groups generally lacked consistency in terms of clinical characteristics and resource utilization. Below, in section III.C.6.d of this preamble, we address recommendations from commenters that specific HCPCS codes be assigned to a group other than the one we proposed. In addition to reviewing the APC groups that were the subject of comments, our medical advisors and staff reviewed every APC group to take into account the effect across all related groups of commenters' recommended changes.

    Criteria for Evaluating Changes Recommended by Commenters

    In determining whether or not to accept a recommended change, we focused on five criteria that are fundamental to the definition of a group within the APC system. The decision to accept or decline a modification to an APC group was measured by whether the change enhanced, detracted from, or had no effect on the integrity of an APC group within the context of these five criteria. The five criteria are as follows:

    • Resource Homogeneity

    The amount and type of facility resources, for example, operating room time, medical surgical supplies, and equipment, that are used to furnish or perform the individual procedures or services within each APC should be homogeneous. That is, the resources used are relatively constant across all procedures or services even though resource use may vary somewhat among individual patients. If the procedures within an APC require widely varying resources, it would be difficult to develop equitable payment rates. Aggregated payments to a facility that performed a disproportionate share of either the expensive or inexpensive procedures within an APC would be distorted. Further, the facility might be encouraged to furnish only the less costly procedures within the APC, resulting in a potential access problem for the more costly services.

    It is important to note that procedures within an individual HCPCS code can vary widely in resource use. The coefficient of variation of cost for the procedures within one HCPCS code can be as high as the overall coefficient of variation across all the HCPCS codes that comprise an APC group. Thus, a significant amount of the variability in resource use within some APC groups can be attributed to the variability of resources within individual HCPCS codes. Nevertheless, if resource use is reasonably homogeneous among the HCPCS codes within an APC group, the average pattern of resource use among a group of cases in an APC can be accurately predicted. In section III.C.6.c, below, we discuss the BBRA 1999 provision that sets limits on the variation in resource cost within an APC.

    • Clinical Homogeneity

    The definition of each APC group should be “clinically meaningful,” that is, the procedures or services included within the APC group relate generally to a common organ system or etiology, have the same degree of extensiveness, and utilize the same method of treatment, for example, surgical, endoscopic, etc. The definition of clinical meaningfulness is, of course, dependent on the goal of the classification system. For APCs, the definition of clinical meaningfulness relates to the medical rationale for differences in resource use. If, on the other hand, classifying patient prognosis were the goal, the definition of patient characteristics that were clinically meaningful might be different.

    • Provider Concentration

    We considered the degree of provider concentration associated with the individual services that comprise the APC. If a particular service is offered only in a limited number of hospitals, then the impact of payment for the service is concentrated in a subset of hospitals. Therefore, it is particularly important to have an accurate payment level for services with a high degree of provider concentration. Conversely, the accuracy of payment levels for services that are routinely offered by most hospitals does not bias the payment system against any subset of hospitals. Thus, differences in the resource requirements for individual services within an APC are of less significance if all the services within the APC are routinely offered by most hospitals because the impact of the difference should average out at the hospital level.

    • Frequency of Service

    Unless we found a high degree of provider concentration, we avoided creating separate APC groups for Start Printed Page 18458services that are infrequently performed. It is difficult to establish reliable payment rates for low volume APC groups. Therefore, we assigned the HCPCS codes to the APC that was the most similar in terms of resource use and clinical coherence.

    Some procedures, such as craniotomies, are clearly inpatient procedures, and are rarely performed in an outpatient setting. However, there are some procedures that, while they are normally performed on an inpatient basis, can also be safely performed on an outpatient basis. The performance of those procedures on an outpatient basis is infrequent and is limited to the simplest cases. Therefore, when we included these procedures in APC groups, we assumed a level of resource use that would apply only to the simplest cases rather than that typical of more complex cases that would be performed on an inpatient basis.

    • Minimal Opportunities for Upcoding and Code Fragmentation

    The APC system is intended to discourage using a code in a higher paying group to define a case. That is, putting two related codes, such as the codes for excising a lesion of 1.1 cm and one of 1.0 cm, in different APC groups may create an incentive to exaggerate the size of the lesions in order to justify the incrementally higher payment. APC groups based on subtle distinctions would be susceptible to this kind of upcoding. Therefore, we kept the APC groups as broad and inclusive as possible without sacrificing resource or clinical homogeneity.

    In general, HCPCS codes that are nonspecific (such as 20999, “unlisted procedure, musculoskeletal system, general”) were assigned to the lowest paying APC that was consistent with the clinical characteristics of the service. In the case of 20999, the codes to which it is related are in the range 20000-20979. The APCs to which they group range from 0004, with a payment rate of $89.22, to 0050, with a payment rate of $1,024.53. We placed 20999 in the lowest paying, related group, 0004.

    c. Effect of the BBRA 1999 on Final APC Groups

    Section 201(g) of the BBRA 1999 amends section 1833(t)(2) of the Act to limit the variation in resource use among the procedures or services within an APC group. Specifically, section 1833(t)(2) of the Act now provides that the items and services within a 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. The Secretary is to use either the mean or median cost of the item or service. We are using the median cost because we have continued to set the relative payment weights for each APC based on median hospital costs in this final rule. (See the discussion in section III.E of this preamble.)

    Section 1833(t)(2) of the Act as amended also allows 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, although we may not make such an exception 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. See the discussion of the classification of orphan drugs in section II.D of this preamble and the discussion of APC groups that we excepted from the “2 times” limit in section III.C.6.e.

    We applied the limit on variation on median costs required by section 201(g) to the revised APC groups. (See section C.6.d, below.) As a result of our analysis of the array of median costs within the revised APC groups, we had to split some otherwise clinically homogeneous APC groups into smaller groups. We are concerned that this further subdivision of groups may create vulnerabilities for upcoding, which conflicts with one of the five criteria described above that we used to evaluate the construction of the APC groups. We will be examining the extent to which the APC reorganization due to the “2 times” rule results in upcoding.

    d. Summary of APC Modifications

    In this section, we summarize and explain our response to comments on individual or serial APCs. We use the APC number that appeared in the proposed rule to identify a group that was changed. In most instances, we moved a HCPCS code from its proposed APC group to a different APC group either in response to comments or to comply with section 1833(t)(2)(C) of the Act. In some cases, we moved codes when a change in response to a comment or the cost variation limit resulted in a grouping that seriously compromised one of the criteria we used to evaluate changes recommended by commenters. Because we made so many changes in the APC groups, we renumbered all the groups and, in many cases, renamed groups. In our response to comments in connection with an APC, the final designation for a HCPCS code corresponds to the renumbered APC group found in the addenda.

    APC 121: Level I Needle Biopsy/Aspiration

    Comment: One specialty society commented that there was significant variation in resource consumption for the procedures performed in this APC and that the proposed payment rate of $33.95 for APC 121 does not accurately reflect the preparation, examination, and consultation expenses for a pathologist to thoroughly perform these procedures. The commenter recommended including CPT codes 85095, 85102, 88170, and 88171 in proposed APC 122.

    Response: The procedures we proposed to classify in APC 121 were considered sufficiently similar from a clinical perspective. We found no provider concentration associated with the procedures proposed for this APC. Therefore, any variation in cost across the procedures in this APC should average out at the hospital level. However, to be consistent with the BBRA 1999 “two times” provision concerning comparable resources, we have moved CPT codes 85095 and 85102 to final APC 0003, and CPT codes 88170 and 88171 remain in final APC 0002.

    APC 122: Level II Needle Biopsy/Aspiration

    Comment: A number of commenters indicated that there was significant variation in resource consumption for the procedures proposed in this APC group. For example, one commenter stated that although all the codes within this group are needle biopsies, they range dramatically in complexity, they are quite dissimilar in terms of resource use, they are not clinically similar, and the proposed grouping results in inappropriate payment for the more complex procedures.

    Response: We decided that CPT code 67415, Fine needle aspiration of orbital contents, was more appropriately grouped from a clinical perspective with ophthalmic procedures in final APC 0239. We further divided the codes in proposed APC groups 121 and 122 for needle biopsy/aspiration into final APC groups 0002, 0003, 0004, and 0005 to be consistent with the BBRA 1999 “two times” requirement.

    APC 131: Level I incision & drainage

    Although we received no comments on proposed APC group 131, based on internal review of this APC, we moved CPT code 11976, Removal, implantable contraceptive capsules, to final APC 019 because this procedure represents an excision rather than an incision. We divided proposed APC 131 into final Start Printed Page 18459APC groups 0006, 0007, and 0008 to be consistent with the BBRA 1999 “two times” requirement.

    APC 141: Level I Destruction of lesion

    APC 142: Level II Destruction of lesion

    Comment: One commenter questioned our proposed assignment of CPT codes 17106 through 17108, which describe destruction of cutaneous vascular proliferative lesions, to APC groups 141 and 142.

    Response: We moved CPT code 17106 to final APC 0011 because its median cost is significantly higher than the other codes in 0010. However, the median cost for that code is greater than we would have expected it to be. We will review the appropriateness of this placement in the course of future updates of the APC groups.

    APC 151: Level I debridement/destruction

    APC 152: Level II debridement/destruction

    Comment: We received general comments questioning the resource homogeneity of the proposed skin APC groups. One commenter recommended including removal of skin lesion with laser on other body parts in proposed APC 152 rather than restricting the APC to vulva, anus, and penis procedures. The commenter believes that removal of these benign lesions, including papillomas, should include other areas of the body.

    Response: We agree with commenters' general concerns about resource homogeneity. We reclassified the codes in proposed APCs 151 and 152 into final APC groups 00012 through 00017 to better differentiate resource use and clinical characteristics and to be consistent with the “two times” BBRA 1999 requirement. We also moved CPT code 42809, Removal of foreign body from pharynx, to final APC 251 because it is an otorhinolaryngology (Ear/Nose/Throat (ENT)) procedure.

    APC 161: Level I excision/biopsy

    APC 162: Level II excision/biopsy

    APC 163: Level III excision/biopsy

    Comment: Numerous commenters were concerned about the variation of resource use among the procedures in proposed APC groups 161, 162, and 163. Commenters requested that we consider classifying procedures in these groups based on anatomic location where functionality is of high importance in combination with the size of excision.

    Response: We made a number of modifications to the excision APC groups to satisfy the BBRA 1999 “two times” requirement, resulting in final APC groups 0018 through 0022. We reclassified CPT codes 11043 and 11044 to APC groups 0016 and 0017 because these codes describe debridement of skin, subcutaneous tissue, muscle, and bone.

    In the final excision/biopsy APC groups, we endeavored to make distinctions based on the location and size of the excision. For example, excisions of malignant lesions from the face, ears, eyelids, nose, lips greater than 4 cm were placed in an APC requiring more resource use than excisions of malignant lesions from the trunk, arms or legs greater than 4 cm because “functionality” is of greater importance when the site is the face, ears, eyelids, nose, or lips. We moved excisions involving the eye to ophthalmic procedure APCs. We did not make grouping distinctions between benign and malignant lesions of the same size and location because resource use for both types is similar.

    We moved benign and malignant excisions larger than 2 cm to final APC group 0020 because these excisions require more resources than, for example, excisions smaller than 1 cm.

    We moved CPT code 20220, superficial biopsy of bone (e.g., ilium, sternum, spinous process, ribs) with trocar or needle, to final APC 0019, because the resources used in connection with this procedure are similar to those required for excisions of small benign or malignant lesions.

    As noted above, we classified two debridement procedures (CPT codes 11043 and 11044) to final APC groups 0016 and 0017, respectively.

    We also moved seven codes from proposed APC 162 to the ophthalmic APC groups.

    APC 181: Level I skin repair

    APC 182: Level II skin repair

    APC 183: Level III skin repair

    APC 184: Level IV skin repair

    Comment: We received numerous comments expressing concern about the consistency of resource use and clinical homogeneity of the procedures in the four proposed skin repair APC groups. Many commenters recommended moving more complex procedures, such as large layer closures, to an APC with a higher payment rate because the procedures require more operating room and recovery time. Some commenters recommended moving some of the skin repair codes to other body systems.

    Response: Our review of proposed APC groups 181, 182, 183, and 184 resulted in our regrouping the skin repair codes based more on cost than on clinical considerations. The volume of claims in most of the codes, however, is quite low. In addition, we moved CPT code 33222, Revision or relocation of skin pocket for pacemaker, from proposed APC 360 to final APC 0026, because this procedure is so similar to the other skin repair procedures in terms of clinical content and resource consumption. We will review these groups carefully as data become available.

    APC 197: Incision/excision breast

    APC 198: Breast reconstruction/mastectomy

    Comment: One commenter observed that the procedures in proposed APC group 198 are related both to the definitive treatment of breast cancer and to plastic and reconstructive operations of the breast. The commenter recommended moving CPT code 19162, Mastectomy, partial with axillary lymphadenectomy, and CPT code 19182, Mastectomy, subcutaneous, into an APC group with a higher payment rate because both procedures are more complex and involve more time and resources than the other procedures in proposed APC group 198. Another commenter stated that CPT code 19162, and CPT code 19318, Reduction mammoplasty, require significantly longer operating times than the other procedures in proposed APC group 198. The same commenter further observed that CPT code 19162 essentially involves performing two procedures.

    Response: Our medical advisors and staff carefully reviewed the comments submitted in connection with the procedures in proposed APC group 198 within the context of the criteria that we discuss at the beginning of this section. They concluded that, although reduction mammoplasty (CPT code 19318) could require slightly more resources, a reduction mammoplasty is still fundamentally similar to other procedures in proposed APC 198 such as CPT code 19162, Partial mastectomy with axillary lymphadenectomy. Our medical advisors and staff concluded that the procedures in proposed APC groups 197 and 198 were sufficiently similar clinically and in terms of resource use to retain the proposed groupings. Therefore, we are retaining our proposed grouping in final APC groups 0029 and 0030.

    APC 207: Closed treatment fracture finger/toe/trunk

    Although we did not receive comments about this APC group, our medical advisors and staff determined that treatment of closed fractures Start Printed Page 18460pertaining to the larynx should be moved to the ENT APC groups because they are more similar from a clinical and resource use perspective to ENT procedures. The larynx procedures do not involve casts and, more importantly, they require completely different resources and ancillary personnel than, for example, the setting of a finger fracture. Proposed APC 207 is renumbered final APC 0043.

    APC 209: Closed treatment fracture/dislocation except finger/toe/trunk

    Comment: One commenter objected to including multiple procedures for dislocation and fractures in proposed APC group 209, when the cost of drugs and supplies alone for these procedures probably exceeds $100. The commenter believed that the proposed payment rate for APC 209 was $71.00.

    Response: We note that the proposed payment for APC 209 was $98.75, rather than $71.00, as the commenter quoted. Although we included in proposed APC 209 some procedures that could involve considerable time and resources, only the simplest cases of these potentially more complex procedures would be performed on an outpatient basis, with proportionally lower costs than would be incurred when the procedures are performed in an inpatient setting. Therefore, we retained in final APC 0044 the codes in proposed APC 209, except we moved CPT code 31586, Treatment of closed laryngeal fracture, to final APC 0256, because this is primarily an ENT procedure.

    APC 216: Open/percutaneous treatment fracture or dislocation

    Comment: Numerous commenters took issue with the variation in resource use among the procedures that include the open treatment of almost all bone fractures, ranging from relatively simple finger and toe fractures to major long bone fractures.

    Response: We expect that only the simplest of the procedures proposed in APC group 216 would be performed on an outpatient basis. Therefore, we kept open/percutaneous treatment of fractures in one APC rather than splitting these procedures into multiple APCs. We find it unlikely that one provider would specialize in, for example, only open fractures of fingers or only open fractures of long bones. Because the CPT code descriptors for so many procedures in this APC group indicate “with and/or without internal fixation,” it is impossible to make distinctions based on whether or not internal fixation is applied. Proposed APC 216 is renumbered final APC 0046.

    APC 226: Maxillofacial prostheses

    APC 231: Level I skull and facial bone procedures

    APC 232: Level II skull and facial bone procedures

    Although we did not receive specific recommendations for these APCs, our medical advisors and staff determined that the procedures in these groups are more similar to ENT procedures from a clinical and resource use perspective. Therefore, we moved all of the procedures in these proposed APC groups to the final APCs 0251 through 0256, the ENT APCs.

    APC 251: Level I Musculoskeletal Procedures

    APC 252: Level II Musculoskeletal Procedures

    Comment: One commenter expressed concerns about the clinical homogeneity of the codes in these two groups. The commenter stated that proposed APC 251 contains 77 widely disparate procedures, including CPT code 23100 and CPT code 24100, which describe arthrotomies with biopsies, CPT code 25248, Exploration with removal of deep foreign body, forearm or wrist, and CPT code 27704, Removal of ankle implant. The commenter further stated that proposed APC 252 contains equally diverse procedures ranging from: CPT code 20900, Bone graft, any donor area; minor or small, to CPT code 25251, Removal of wrist prosthesis; complicated, including “total wrist,” to CPT codes 27396, 27580, and 27665, which are different types of tendon procedures. The commenter recommended that procedures that require specialized equipment and more operating room time be moved into a group with a higher payment rate.

    Response: Our medical advisors and staff, after careful consideration of the commenter's concerns and after reviewing alternative groupings of the numerous codes in these two proposed musculoskeletal APC groups, concluded that splitting these groups to address the disparities cited by the commenter would result in too many small, low-volume groups for which we would be unable to establish reliable payment rates. The broad inclusiveness of these two APC groups is in part a reflection of the magnitude of the musculoskeletal system. Given the homogeneity of resource use across the many procedures within each group, we concluded that the factors supporting retention of the two groups outweighed the concerns raised by the commenter. We did, however, move CPT code 27086, Removal of foreign body, pelvis or hip; subcutaneous tissue, to final APC 0019.

    APC 280: Diagnostic Arthroscopy

    APC 281: Level I Surgical Arthroscopy

    APC 282: Level II Surgical Arthroscopy

    Comment: A number of commenters expressed concerns about the homogeneity of codes in the proposed surgical arthroscopy APC groups. In particular, commenters stated that while an arthroscope is needed for all the procedures assigned to proposed APC group 281, the nature of the repair may mandate different additional equipment and differing times to complete. Commenters did not find the procedures in proposed APC 281 to be homogeneous with respect to the time required to perform the procedures nor their associated costs. Commenters specifically recommended transferring complex elbow and wrist procedures represented by CPT codes 29826, 29838, 29839, 29846, 29847, 29848, 29861, 29862, and 29863 into an APC group with a higher payment rate.

    Response: Upon revisiting the assignment of codes to proposed APC groups 280, 281, and 282, and considering the concerns expressed by commenters, our medical advisors and staff concluded that collapsing the three proposed APC groups into a single group would result in a more homogeneous grouping in terms of resource use. Hence, final APC 0041 contains the codes proposed as APC groups 280, 281, and 282. The relatively low volume of many of the procedures in the proposed APCs supports combining them into a single group. Further, we found that, from a facility perspective, the resource use for all the codes in final APC 0041 is similar. For example, we had proposed to place CPT code 29881, Arthroscopy, knee, surgical; with meniscectomy (medial or lateral, including any meniscal shaving), and CPT code 29882, Arthroscopy, knee, surgical; with meniscus repair (medial or lateral), in two different APC groups. However, the resources required for these two procedures is sufficiently comparable to warrant placing both into the same APC.

    APC 286: Arthroscopically-Aided Procedures

    We considered including the procedures in proposed APC group 286 with the other arthroscopic procedures in final APC 0041 because they are so infrequently performed in an outpatient setting for Medicare beneficiaries. However, the resources required to perform the procedures in proposed Start Printed Page 18461APC 286 are so strikingly distinct from those used in connection with the procedures in final APC group 0041 as to warrant being retained in a separate group. Further, it is unlikely that an individual provider specializes in the particular type of arthroscopic procedure contained in this APC, so separating all of the codes in final APC 042 from those in APC 041 should not disadvantage any one hospital.

    APC 311: Level I ENT Procedures

    APC 312: Level II ENT Procedures

    APC 313: Level III ENT Procedures

    APC 314: Level IV ENT Procedures

    We received numerous comments about the composition of the four proposed ENT APC groups. After careful review of the comments, our medical advisors and staff recognized the need for a major reorganization of the groups we proposed for ENT procedures. The outcome of our review was the creation of five final APC groups for ENT procedures: APC groups 0251, 0252, 0253, 0254, and 0256. We moved a large number of bone procedures involving the facial and ENT areas from musculoskeletal groups to ENT groups. We transferred some codes out of the ENT groups altogether, and we shifted codes among the five final ENT groups to comply with the BBRA 1999 “two times” requirement. We respond to recommendations regarding specific codes below.

    Comment: One commenter observed that CPT codes 31603 and 31605, emergency tracheostomy procedures, are risky and life-threatening no matter how quickly they are performed, and, as such, they should not be grouped with procedures for removing a foreign body from the ear canal or removing cerumen (proposed APC 311).

    Response: We agree. We created new APC group 0340 to which we assigned CPT code 69200, removal of foreign body from external auditory canal; without general anesthesia, and CPT code 69210, Removal impacted cerumen (separate procedure), one or both ears. We shifted these two procedures to the Minor Ancillary Procedures APC group because of their relative high frequency, their low cost in terms of resource use with low disposable equipment cost, and because these procedures generally do not require scheduling. Removing CPT code 69210 from the final ENT groups also corrects any pricing distortions that may have resulted from the disproportionately high volume of that procedure.

    We also moved the tracheostomy emergency procedures to final APC 0254.

    We moved several other procedures such as CPT code 41870, Periodontal mucosal grafting, to final APC 0253, a group with higher cost procedures.

    We moved several abscess drainage procedures such as CPT code 41800, Drainage of abscess, cyst, hematoma from dentoalveolar structures, to final APC group 0251 because of their relatively low cost.

    Comment: One commenter stated that all the procedures in proposed APC 312 appear to be reasonably priced with the exception of CPT code 69436, Tympanostomy (requiring insertion of ventilating tube), general anesthesia. In the view of the commenter, the extra supplies and time required for this procedure necessitate a higher payment.

    Response: We moved CPT code 69433, Tympanostomy (requiring insertion of ventilating tube, local or topical anesthesia), to final APC 0252 because of its lower resource use relative to CPT code 69436. CPT code 69436 is assigned to final APC 0253.

    We moved a large number of procedures such as CPT code 42335, Sialolithotomy; submandibular (submaxillary), complicated, intraoral from original APC 313 to final APC 0253 to reflect a similarity of resource use. In terms of resource use, CPT code 30115, Excision, nasal polyp(s), extensive, is more similar to CPT code 42300, Drainage of abscess, parotid, simple, than it is to CPT 42410, Excision of parotid tumor or parotid gland; lateral lobe without nerve dissection.

    We shifted CPT code 21040, Excision of benign cyst or tumor of mandible, from the musculoskeletal group to final APC 0253 with other ENT procedures.

    Comment: One commenter stated that procedures directed towards cancer treatment were inappropriately assigned to proposed APC 313. As examples, the commenter cited CPT codes 30150 and 30160, rhinectomy procedures; CPT code 41120, Glossectomy; less than one-half tongue; and CPT code 69210, Excision external ear, complete amputation. The commenter also indicated concern that proposed APC group 313 includes a disproportionately large percentage of resource-consuming ENT procedures and commonly performed sinus procedures. Other commenters recommended that more complex otorhinolaryngology procedures in the group that have longer operating and recovery room times be moved to a group with a higher payment rate.

    Response: We moved CPT code 69210 to final APC group 0340, and we assigned CPT codes 30150, 30160, and 41120 to final APC group 0256. We also moved CPT code 42215, Palatoplasty for cleft palate; major revision to final APC group 0256.

    Comment: One commenter suggested placing certain thyroid procedures in the ENT groups.

    Response: While we agree that CPT code 60280, Thyroglossal cyst excisions, is somewhat similar to CPT code 42440, Excision of submandibular, submaxillary gland, we nonetheless believe that the former type of excision is more appropriately placed from a clinical perspective with other thyroid procedures.

    APC 318: Nasal Cauterization/Packing

    Comment: A number of commenters addressed generally the range of resource use among the procedures within this proposed APC. One commenter observed that CPT code 30901 is almost always a simple office procedure within the context of an otolaryngology practice. The same commenter indicated that CPT codes 30903, 30905, and 30906 frequently require several hours of direct physician contact and monitoring and recommended that we consider reclassifying CPT codes 30903, 30905, and 30906 to proposed APC group 332, Level II Endoscopy Upper Airway. Another commenter was concerned that CPT codes 30905 and 30906 stand out as inappropriate for this APC level because they require much more time and expertise and are used in more life-threatening situations than the other codes in the group.

    Response: While there is a range of procedures in this APC pertaining to control of nasal hemorrhage, hospitals normally treat the entire range of these procedures, and there is no concentration of certain of these procedures in a subset of hospitals. Our medical advisors and staff also found that there can be a range of resource consumption within many of the procedures themselves as well as across procedures in this APC. We therefore are not reassigning the codes.

    We did, however, move CPT codes 30999 and 42999 for unlisted procedures to final APC 0251 and 0252, respectively, to be consistent with our policy of placing unlisted codes in the lowest paid related group.

    APC 331: Level I Endoscopy Upper Airway

    Comment: One commenter noted that the relative weight and payment rate proposed for APC group 331 approximated the relative weight and payment rate proposed for APC groups 997 or 987. The commenter stated that CPT codes 31575 and 31579 should have a higher relative weight and Start Printed Page 18462payment rate than that proposed for APC 331 because both procedures require more time, higher skill levels, and more equipment than the procedures in APC 997 or 987. A professional association, echoing the first commenter, noted that CPT codes 31575 and 31579 are the most complex of all noninvasive laryngeal diagnostic procedures performed by otolaryngologists and speech language pathologists, further justifying a higher relative weight and payment rate for these procedures.

    Response: Proposed APC groups 997 and 987, Manipulation therapy and Subcutaneous chemotherapy, respectively, are clinically very different from proposed APC group 331. The professional skill and expertise of the physician performing the laryngoscopy are recognized separately and are not costs that are packaged with the payment rate for services furnished by the hospital in connection with the procedure. Further, it is very unlikely that there will be systematic differences among facilities with some only doing the most difficult of the basic laryngoscopies that are contained in this group and others only specializing in the simplest variety. However, we have reorganized the proposed endoscopy, upper airway groups into final APC groups 0071 through 0075 to be consistent with the BBRA 1999 “two times” requirement.

    APC 341: Level I Needle and Catheter Placement

    APC 342: Level II Needle and Catheter Placement

    APC 343: Level III Needle and Catheter Placement

    APC 347: Injection Procedures for Interventional Radiology

    Based on our cost data, our medical advisors and staff determined that the codes in these proposed APC groups should be assigned status indicator “N,” which designates incidental services whose costs are packaged into the APC payment rate. Injection procedures themselves are low cost but, more importantly, they are an integral portion of another procedure. The needle and catheter placement are typically an integral portion of interventional radiology procedures. An exception was made for CPT code 36420, cutdown on a child under age one, which was placed in final APC 0032, to recognize its infrequent use but high median cost.

    APC 360: Removal/Revision, Pacemaker/Vascular Device

    Comment: Most commenters recommended changing a number of pacemaker codes from “inpatient only” payment status to allow payment under the hospital outpatient PPS. One commenter noted that whereas we proposed to exclude most pacemaker and implantable cardioverter defibrillator (ICD) replacement procedures from the outpatient PPS, we did include pacemaker revision/removal procedures in proposed APC 360 even though both types of procedures require very similar steps to perform. The commenter is concerned that by not paying for pacemaker replacement procedures under the outpatient PPS, we are forcing physicians to perform these replacement procedures on an inpatient basis. By so doing, the commenter suggested that we are adding costs to the entire system that could be saved, because the pacemaker replacement procedures can be safely performed in the outpatient setting, with less inconvenience to the patient.

    Response: After careful consideration of commenters' recommendations, our medical advisors and staff agreed that paying for pacemaker insertion or replacement codes under the outpatient PPS is appropriate if the outpatient setting is determined to be reasonable and medically necessary for the individual beneficiary. We assigned procedures for revising or removing implanted infusion pumps and venous access ports in proposed APC 360 and pacemaker insertion or replacement codes payable under the outpatient PPS to final APCs 0089 and 0090. Also, we moved CPT code 33222, Revision or relocation of skin pocket for pacemaker, and CPT code 33223, Revision or relocation of skin pocket for implantable cardioverter-defibrillator, to final APC 0026 because the resource use for these two procedures is similar to that of the skin repair procedures in APC 0027.

    APC 367: Vascular Ligation

    Comment: One commenter wrote that the procedures in proposed APC 367 include ligation of major arteries and veins, which are usually performed as emergencies in the inpatient setting, and elective ligation and stripping of lower extremity varicose veins of variable complexity. The commenter contended that costs for these procedures vary dramatically, with simple ligation and division of the saphenous vein at the low end of the cost scale, and the stripping of long and saphenous veins at the high end.

    Response: We split proposed APC 367 into two groups, final APCs 0091 and 0092, to conform with the BBRA 1999 “two times” requirement. Although we are not sure to which codes the comment refers, codes 37780 and 37730 are now in different groups. These represent ligation and division of the short saphenous vein, and ligation, division and stripping of long and short saphenous veins, respectively.

    APC 368: Vascular Repair/Fistula Construction

    Comment: Commenters disagreed with the codes assigned to proposed APC 368, especially services related to insertion of implantable hemodialysis access ports. Commenters did not find the services in APC 368 to be comparable clinically. In particular, they recommended moving cannula insertion and declotting procedures to proposed APC groups 341, 342, and 343, which consist of needle and catheter placement procedures.

    Response: We split the codes in proposed APC 368 into APC groups 0088, 0090, 0092, and 0093. The resulting classifications are more clinically homogeneous, and they meet the BBRA 1999 “two times” requirement. We also moved CPT code 35875, Thrombectomy of arterial or venous graft (other than hemodialysis graft or fistula), into final APC 0088.

    APC 369: Blood and Blood Product Exchange

    Comments: As we noted in section III.C.2.f, above, many commenters disagreed with both our proposed payment rates and our proposed classification for blood and blood-related products. Most commenters disagreed with our classifying in one APC group therapeutic apheresis, stem cell procedures, and blood transfusion services. The commenters stated that therapeutic apheresis and stem cell procedures are very costly and resource intensive procedures which cost more than 3 times the proposed payment rate for APC 369, yet we are proposing to pay a median amount for these services that is appropriate for blood transfusions only. Commenters questioned whether we had taken into account the costs associated with the specialized equipment, supplies and personnel that are required to perform therapeutic apheresis and stem cell procedures. Commenters stated that the payment rate proposed for APC 369 would not offset the costs hospitals incur to furnish therapeutic apheresis services because outpatient apheresis procedures often combine dissimilar kinds and combinations of plasma replacement products, causing widely differing costs per service.

    A major association representing community cancer centers stated that our data for stem cell harvesting claims (CPT 38231) include a range of costs so Start Printed Page 18463large as to suggest that there are errors in the data. The commenter believes that the very small sample of claims (reduced by HCFA's exclusion of multiple procedure claims and claims without codes) further renders the data unreliable. The same commenter cited bone marrow harvesting (CPT 38230) as an example to argue that our data, which indicates a median cost of $18.00 for what is normally a lengthy procedure performed under general anesthesia, are problematic.

    Some commenters stated that the proposed payment rate was not sufficient for transfusion services if the rate was supposed to pay for both the blood product and the transfusion procedure, because even though outpatient transfusion services are relatively simple and low-cost, they are associated with a costly blood product that is far more variable.

    Commenters expressed concern that the proposed payment rate for APC 369 was insufficient to pay for extracorporeal photopheresis (CPT 36522), whose actual cost is approximately $1,000, and would have an especially negative impact for patients with cutaneous T-cell lymphoma.

    A major organization recommended that we separate payment for a service from payment for the blood product associated with that service. The same commenter also recommends separate payment for infusible blood-derived drugs, and that payment for transfusable blood products be based on costs. This organization recommends that APC 369 be split into several APCs because payment for services such as transfusion services, therapeutic apheresis, stem cell collection, Staph column pheresis, and others are distinct, and deserve separate APC payments. The same commenter also recommended that we accelerate the HCPCS coding process for blood-related products.

    Response: In response to commenters' recommendations, we are creating different APC groups for blood-related procedures and transfusions, and we are paying for blood and blood products separately, instead of packaging them with the procedures or services with which they are associated. We were convinced by commenters' illustrations of the variability in the use of blood and blood products in various procedures, and by our desire to recognize the costs of tests now being performed on donated blood that were not captured in our 1996 data. The procedures we proposed in APC 369 are split among final APC groups 0109, 0110, 0111, and 0112. We have also created individual APC groups for blood and blood related products. The final APC 0109 that we created to capture bone marrow harvesting and bone marrow/stem cell transplant had a median cost of only $15.00. This is due to the few, highly variable claims in our database. Based on the information available to us at this time, we have assigned a rate of $200.00, and will adjust the rate to reflect actual claims as we collect data under PPS.

    APC 407: Esophagoscopy

    APC 417: Diagnostic Upper GI Endoscopy

    APC 418: Therapeutic Upper GI Endoscopy

    Comment: Commenters were concerned about low payment rates set for these three proposed APC groups.

    Response: Our medical advisors reviewed the proposed groups and determined that combining the codes into a single APC group for upper gastrointestinal endoscopic procedures conformed with the criteria we used to define APC coherence and resulted in a reasonable payment rate supported by cost data. Resource use for all procedures in final APC 0141 is similar because each procedure involves an endoscopic examination. In addition, most of the procedures involve diagnostic and therapeutic tests such as brushings or fulgurations.

    APC 426: Diagnostic Lower GI Endoscopy

    APC 427: Therapeutic Lower GI Endoscopy

    Comment: Commenters were concerned that the payment rates proposed for APC groups 426 and 427 were too low to offset costs incurred to perform these procedures. One commenter indicated that a diagnostic colonoscopy (CPT code 45379), without any mark up or consideration of room time and equipment use, costs $350, with additional costs if a polyp has to be removed ($155 just for a bicap). The commenter indicated that the current cost of a hot biopsy forceps is $45. Given these costs, the provider would necessarily incur a loss when performing these procedures.

    Response: Our medical advisors and staff, after reviewing the cost data for these two proposed groups, combined the diagnostic and therapeutic APCs into a single group, final APC 0143. Resource use for the procedures in this APC is similar because they all involve an endoscopic examination. More importantly, even though resource use may vary relative to the clinical requirements of individual cases, facilities are not likely to specialize in just therapeutic or diagnostic endoscopic services. Therefore, costs should even out across all cases.

    Comment: One commenter found the low rate proposed for CPT code 45378, Diagnostic colonoscopy, to be inconsistent with our major policy initiative to screen persons at high risk for colorectal cancer.

    Response: We moved HCPCS code G0105, Colorectal Cancer Screening: Colonoscopy,to its own group, final APC 0158, because it is preventive rather than diagnostic or therapeutic in nature.

    APC 446: Diagnostic Sigmoidoscopy

    APC 447: Therapeutic Proctosigmoidoscopy

    APC 448: Therapeutic Flexible Sigmoidoscopy

    We reassigned the different types of sigmoidoscopy procedures into two groups, final APC 0146 and final APC 0147. The procedures within each group are similar both clinically and in terms of resource use. We moved HCPCS code G0104, CA screening; flexible sigmoidoscopy, to its own group, final APC 0159, because it is preventive rather than diagnostic or therapeutic in nature.

    APC 451: Level I Anal/Rectal Procedures

    APC 452: Level II Anal/Rectal Procedures

    To conform with the BBRA 1999 “two times” requirement, our medical advisors and staff reclassified procedures in the proposed APC groups resulting in final APC groups 0148 and 0149. We believe the final APC groups are more consistent both clinically and in terms of resource use.

    APC 470: Tube Procedures

    Comments: We split the codes in proposed APC group 470 into final APC groups 0121, 0122, and 0123 to conform with the BBRA 1999 “two times” requirement. Also, we moved CPT code 50398, Change of nephrostomy or pyelostomy tube, from proposed APC 521 to final APC 0122.

    APC 523: Level III Cystourethroscopy and Other Genitourinary Procedures

    Comment: A number of commenters recommended moving CPT code 52240, Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; large bladder tumor(s), to the APC for Level IV Cystourethroscopy and other Genitourinary Procedures because the magnitude of the procedure most Start Printed Page 18464closely resembles that of the codes in the higher payment group.

    Response: We agree with commenters' recommendations; we moved CPT code 52240 to final APC group 0163 because of the extensive time and equipment required to perform the procedure.

    Comment: One commenter recommended placing CPT codes 52335 through 52338 in their own group, given the complexity and technical demands of these ureteroscopic procedures. The same commenter suggested as an acceptable alternative placing these codes in the APC group for Level IV Cystourethroscopy and other Genitourinary Procedures, to reflect more accurately their cost, complexity, and need for expensive single use items such as dilation balloons, baskets and stents. Other commenters recommended moving CPT codes 51020 through 51880 (cystotomy procedures) to the APC group for Level IV Cystourethroscopy and other Genitourinary Procedures.

    Response: After a careful review of comments and our cost data, our medical advisors and staff concluded that the cystotomy codes are similar enough in terms of equipment and the time required to perform the procedures to justify keeping them together in final APC 162. Our medical advisors and staff also concluded that the facility equipment and time duration for CPT code 52335, Cystourethroscopy, with ureteroscopy and/or pyeloscopy (includes dilation of the ureter and/or pyeloureteral junction by any method), was sufficiently similar to be retained with the other procedures in final APC 0162.

    APC 524: Level IV Cystourethroscopy and other Genitourinary Procedures

    Comment: Numerous commenters were concerned that the payment rate proposed for APC 524 was insufficient to offset the costs associated with CPT code 53850, Transurethral destruction of prostate tissue, by microwave thermotherapy (TUMT). The commenters argue that TUMT is a very expensive procedure due to its high capital equipment costs and the need to construct a special microwave area, the high cost of disposable probes and other disposable supplies required for the procedure, and the need for specially trained nursing staff. The commenters urged us to establish a unique APC group for this procedure and to provide a payment rate that is consistent with its anticipated costs, which they predict would total approximately $2,200.

    Response: After careful consideration of comments and available cost data, our medical advisors and staff determined that CPT code 53850 satisfies the criteria discussed below, in section III.C.8, as a new technology service. Payment for this procedure will be made under new technology APC 0980.

    APC 529: Simple Urinary Studies and Procedures

    Comment: A number of commenters proposed that we classify CPT code 51726, Complex cystometrogram, to its own unique APC and keep the other urinary study procedures together in proposed APC 529.

    Response: After a careful review of comments and our data, our medical advisors and staff agreed with commenters' concerns and subdivided proposed APC group 529. The resulting final APC groups 0164 and 0165 are more homogeneous both in terms of clinical coherence and resource use. We also added simple anal procedures such as CPT code 91122, Anorectal manometry, to final APC 0165 because of the similarity of resource use.

    APC 546: Testes/Epididymis Procedures

    Comment: A number of commenters disagreed with our classification of scrotal procedures with inguinal procedures in proposed APC group 546. The commenters observed that the scrotal procedures vary considerably from the inguinal procedures in terms of resource usage. The commenters recommended that we move CPT codes 54530, 54550, 54640, 55520, 55530, 55535 and 55540 to proposed APC 466, Hernia/Hydrocele Procedures, because they all involve operating on vessels at the internal ring, and are therefore similar to a hernia repair.

    Response: We agree with comments that these procedures are similar to hernia repairs. We moved CPT codes 54530, 54550, 54640, 55535, and 55540 to final APC group 0154.

    APC 551: Level I Laparoscopy

    APC 552: Level II Laparoscopy

    Comment: We received two categories of comments pertaining to laparoscopic procedures: Numerous commenters disagreed with our proposal to define certain laparoscopic procedures as inpatient only, and numerous commenters claimed that the resource costs among the procedures within proposed APC groups 551 and 552 varied too greatly for the groups to be considered homogeneous. Most commenters stated that the costs associated with the procedures in proposed APC groups 551 and 552 exceed their respective proposed payment rates because of the expensive equipment and disposable supplies and the length of time required to perform laparoscopic procedures.

    Response: Our medical advisors and staff, after a thorough review and consideration of comments, agreed with commenters who claimed that most laparoscopic procedures can and are being safely and appropriately performed in an outpatient setting. We therefore moved most of the laparoscopic codes to which we proposed to assign a payment status indicator “C,” indicating that the procedures would not be covered under the hospital outpatient PPS, into an APC group with a payment status indicator “T” (significant procedure, multiple procedure reduction applies, payable under the outpatient PPS). In order to absorb these additional procedures within the APC system, we created a third laparoscopic APC group in order to accommodate the wide range of resource use and time that is required to perform the expanded list of laparoscopic procedures.

    Although the AMA revised the coding of laparoscopic procedures in CPT 2000, in order to set rates for the laparoscopy APC groups, we used the codes that were in our database of 1996 claims. That is, we moved CPT codes 56362 and 56363 to the Level I laparoscopic group, final APC group 0130, because the resources used in connection with these procedures are less compared to the Level II procedures generally. For example, CPT code 56362, Laparoscopy with guided transhepatic cholangiography, primarily involves the laparoscopy without any associated removal of tissue. Conversely, we shifted CPT codes 56303 and 56304 from Level I to Level II (final APC 0131). CPT code 56303, Laparoscopy, surgical, with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface, requires more resources than, for example, CPT code 56300, Diagnostic laparoscopy, the most common laparoscopic procedure within Level I, final APC group 0130.

    The new Level III laparoscopy group, final APC group 0132, consists largely of laparoscopic procedures that we had proposed to classify as inpatient. In addition, we moved CPT code 56312, Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy, and CPT code 56313, Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling (biopsy), single or multiple, to final APC group 0132 because of the extensive resources and time involved in performing these procedures. Refer to Current Procedural Terminology 2000, published by the American Medical Association, for a summary of coding Start Printed Page 18465changes and crosswalks for laparoscopic procedures.

    APC 561: Level I Female Reproductive Procedures

    APC 562: Level II Female Reproductive Procedures

    APC 563: Level III Female Reproductive Procedures

    Comment: One commenter expressed concern that the payment rate for proposed APC group 563 would have a negative effect on certain treatment options for women suffering with incontinence. The commenter contrasted the proposed payment of $848 with a current median cost calculated at $1,931 for CPT code 57288, Sling operation for stress incontinence (e.g., fascia or synthetic).

    Response: After reviewing the procedures in proposed APCs 561, 562, and 563, and to be consistent with the BBRA 1999 “two times” requirement, we split the proposed groups into final APCs 0191 through 0195. The cost of CPT code 57288, to which the commenter refers, is still at the high end of the highest weighted group, but the volume of claims for that service is so low that splitting the group again would be problematic. If these more intense surgeries move to the outpatient setting in greater numbers, we will be able to price them more precisely.

    APC 601: Level I Nervous System Injections

    APC 602: Level II Nervous System Injections

    Comment: Commenters contended that there are no similarities among the procedures in the proposed APC groups for nervous system injections.

    Response: We disagree. We find the range of services included within each APC group to be generally consistent from a clinical perspective. And, even though an injection into the subarachnoid space may be a more complex injection than some of the others in the group, no institution is likely to specialize solely in one kind of injection. Because all the services within the APC group are offered by most hospitals, the impact of the variation in resource consumption among the different codes should average out at the hospital level. Therefore, we are keeping intact in final APC groups 0211 and 0212 the two levels of nervous system injections that we proposed, with the exception of CPT codes 62194 and 62225, which we moved to final APC group 0121 because they are catheter replacement procedures.

    APC 616: Implantation of Neurostimulator Electrodes

    APC 617: Revision/Removal Neurological Device

    APC 618: Implantation of Neurological Device

    Comment: One commenter was concerned that the payment rate proposed for APC group 616 falls far short of the costs incurred to implant a neurostimulator system that embodies a vagus nerve stimulator for the treatment of patients with refractory epilepsy. The commenter estimated that hospitals incur costs between $2,000 and $5,000 to surgically insert the Neurocybernetic Prosthesis system (NCP), which includes an implantable neurostimulator, pulse generator, and implantable electrodes. The commenter stated that the NCP costs $9,100. The commenter recommended that we create a separate APC group for the procedure to ensure appropriate payment. The commenter also expressed concern that the broad range of procedures in proposed APC 618 results in inappropriate payment rates. The commenter noted that the median cost of the procedures in proposed APC group 618 varies from a low of $269.44 to a high of $3,890.70, with a proposed payment rate of $1,274.

    Another commenter stated that vagus nerve stimulation, approved by the FDA in 1997, which can sometimes be performed as an outpatient procedure, would be inappropriately paid under our PPS. The commenter stated that the reported cost for the device is $6,900 for the implantable neurostimulator pulse generator and $2,030 for the implantable vagus nerve stimulator leads. A manufacturer of this new system, which is used in treating intractable epilepsy, also expressed concern that the proposed PPS will underpay hospitals for new technologies such as its system and deny beneficiaries access to them.

    Response: In response to these and other comments, we made several changes in proposed APC groups 616, 617, and 618. We moved CPT code 63650, Percutaneous implantation of neurostimulator electrodes, peripheral, to final APC 0224 because the procedure is less time intensive and uses fewer facility resources than the implant procedures in final APC 0225. We also shifted CPT codes 64585 and 64595 to final APC 0225. We will re-evaluate APCs 0223, 0224, and 0225 as we accumulate data and will incorporate our findings in a subsequent hospital outpatient PPS rule. Additionally, we will determine whether the implantable neurostimulator system is eligible for treatment as a “pass-through” device under section 201(b) of the BBRA 1999. The criteria for assessing a medical device's eligibility for additional payment under this provision are discussed in section III.D.4, below.

    Ophthalmic Procedures: We received numerous comments concerning the APC groups proposed for eye procedures. Based on their analysis of these comments and recommended changes, a review of our data, and consideration of the limit on variation within a group required by section 201(g) of the BBRA 1999, our medical advisors and staff have significantly restructured the ophthalmic APC groups. Eye procedures and services are assigned to final APC groups 0230 through 0248.

    APC 930: Minor Eye Examinations

    APC 931: Level I Eye Tests

    APC 932: Level II Eye Tests

    We assigned to final APC groups 0230 and 0231 the procedures in proposed APC groups 930, 931, and 932 in addition to codes from proposed APC groups 681, 682, and 683 that are either tests or minor ophthalmologic procedures requiring relatively low resource use.

    APC 651: Level I Anterior Segment Eye Procedure

    APC 652: Level II Anterior Segment Procedure

    Comment: We received a number of comments about these proposed APC groups. Commenters were primarily concerned that the payment rates proposed for the two levels of anterior segment eye procedures are significantly less than the costs incurred to perform the procedures assigned to these groups, especially those for glaucoma surgery (CPT codes 66150 through 66170). One commenter indicated that the rate proposed for CPT 66180 is acceptable only if separate payment is made for the aqueous shunt and patch graft.

    Response: Based on their review of comments and to be consistent with the BBRA 1999 “two times” requirement, our medical advisors and staff added a third APC group for anterior segment eye procedures. The anterior segment eye procedures are assigned to final APC groups 0232, 0233, and 0234. We made a number of code changes among the three groups. We moved CPT codes 66155, 66160, 66165, and 66170 for glaucoma surgery to final APC group 0234. We shifted CPT code 65800, Paracentesis of anterior chamber of eye (separate procedure) with diagnostic aspiration of aqueous, from proposed APC 683 to final APC 0232 because the Start Printed Page 18466instruments used in connection with CPT code 65800 are similar to those used in all procedures that are primarily paracentesis and because operating room time is likewise similar.

    APC 667: Cataract Procedures

    APC 668: Cataract Procedures With IOL Insert

    Based on our data, the median cost for final APC group 0245 (cataract extraction without lens insert) was slightly higher than that for final APC group 0246 (cataract extraction with lens insertion). We attribute the discrepancy to poor coding, and we have increased the payment rate for APC group 0246 to equal the payment rate for APC group 0245. Proper coding in the future should result in better differentiated costs between these two groups.

    Comment: One commenter objected to assigning payment status indicator “T,” Significant procedure, multiple procedure reduction applies, to the procedures in proposed APC group 668. The commenter contended that CPT code 66984, Cataract removal with lens insertion, is often performed in conjunction with other procedures such as CPT code 67010, partial removal of eye fluid, CPT code 65875, incise inner eye adhesions, and 66170, Glaucoma surgery, which also have a “T” payment status indicator. The commenter believes that the multiple procedure reduction would undercompensate for these services and that all these procedures should be given an “S” payment status indicator, which would not subject them to the multiple procedure discount.

    Response: We disagree. When more than one surgical procedure is performed during a single operative session, full Medicare payment and the full beneficiary coinsurance payment are made for the procedure that has the highest payment rate. The costs associated with anesthesia, operating and recovery room use, and other services for any additional procedures are incremental and are accounted for within the discounted additional payment.

    APC 670: Corneal Transplant

    Comment: The numerous comments that we received about this proposed APC focused on our proposal to package the cost of procuring corneal tissue as part of the costs associated with corneal transplant surgery. Commenters feared that this fixed payment method would underpay some hospitals while overpaying others because hospitals acquire corneal tissue from eye banks whose charges are dependent upon the amount of philanthropic contributions the bank receives during the course of a year. A national association representing eye banks reported that fee data from different member facilities show that the corneal tissue acquisition fee alone nearly consumes or, in some cases, exceeds, the entire payment rate proposed for APC group 670. Commenters expressed great concern that we would significantly reduce the supply of corneas available for transplant if we were to package corneal tissue acquisition costs within the APC rate.

    Response: Given the current basis for pricing corneal tissue, we are accepting commenters' recommendations that corneal tissue acquisition costs be paid separately and in addition to the payment rate for corneal transplant procedures. At least until we gather data regarding costs associated with the acquisition of corneal tissue, this will ensure that individual hospital's reasonable corneal tissue procurement costs are covered under the PPS. Corneal transplant procedures are in final APC group 0244.

    APC 676: Posterior Segment Eye Procedures

    Comment: Commenters were concerned that the payment rate for proposed APC group 676 was too low given the costs incurred to perform a number of procedures in the group. For example, one commenter noted that CPT code 67005 requires the same draping as a cataract extraction.

    Response: In response to commenters' concerns and to be consistent with the BBRA 1999 “two times” requirement, we split the procedures in proposed APC group 676 into final APC groups 0235 through 0237. We also moved procedures such as CPT code 67025, Replace eye fluid, and CPT code 67027, Implant eye drug system, to final APC 0237 because of the similarity of resource use. CPT code 67025 involves injection of a vitreous substitute, usually gas, silicone, or a similar substance, and the procedure may also involve an aspiration.

    APC 681: Level I Eye Procedure

    APC 682: Level II Eye Procedure

    APC 683: Level III Eye Procedure

    APC 684: Level IV Eye Procedure

    Comment: Commenters were concerned about the wide variation of resource use and clinical characteristics among the procedures within proposed APC groups 681, 682, 683, and 684. Commenters noted that the surgical complexity of individual procedures in proposed APC group 684 ranges from simple suturing (CPT code 67914, Repair of ectropion; suture) to complex eyelid reconstructions with full thickness tarsoconjunctival flap transfer (CPT code 67971). Commenters recommended that these proposed APC groups be revised and that the more complex procedures that require longer operating room time be paid a higher rate.

    Response: We agree. Guided by commenters' recommendations as well as the “two times” limit on cost variation required by the BBRA 1999, we created several new groups and we completely reorganized the procedures in proposed APC groups 681, 682, 683, and 684 into the final APC groups 0230 through 0234 and 0238 through 0242.

    APC 690: Vitrectomy

    Comment: Several commenters were concerned that the cost of an intravitreal implant ($4,000, according to one commenter) would not be adequately recognized if payment for the device were to be packaged with payment for the insertion procedure (CPT code 67027, Implant eye drug system). Commenters were concerned that beneficiary access to this implant would be restricted if we did not make adequate payment. Commenters supported our proposal to make separate payment for the intravitreal implant.

    Response: We assigned all of the procedures in proposed APC 690 to final APC group 0237. As we explain in section III.B.1.c, above, section 201(e) of the BBRA 1999 requires us to classify implantable items to the group that includes the service to which the item relates. However, the intravitreal implant that dispenses ganciclovir is an orphan drug that qualifies for a transitional pass-through payment under the BBRA 1999, which is explained in section III.D, below. Thus, we have assigned the entire drug delivery system to its own APC, 0913. We believe that the payment rate set for CPT code 67027 combined with the additional payment for ganciclovir results in an appropriate payment for this service.

    APC 700: Plain Film

    Comment: We received numerous comments about the structure of proposed APC group 700. Commenters recommended breaking down the proposed APC group into a number of smaller, more congruous groups. For example, one commenter found no justification for the assumption that resource costs are the same for all plain films listed in APC 700, noting that Start Printed Page 18467there is a significant difference in capital costs, room costs, and maintenance costs between an x-ray room that is designed to take chest x-rays compared to an x-ray room with a table used to take abdominal x-rays. The commenter pointed out that there is a substantial increase in cost when cineradiography capabilities are added. The same commenter questioned our assumption that therapeutic radiology port films are clinically similar to diagnostic radiology films or that bone density studies are clinically similar to and have the same resource costs as plain film radiography.

    Response: We agree with commenters' concerns about the composition of proposed APC group 700. In response to commenters' recommendations and applying the “two times” limit on cost variation required by the BBRA 1999, we split proposed APC group 700 into final APC groups 0260 through 0262. We assigned CPT code 70300, Radiologic examination, teeth; single view; CPT code 70310, Radiologic examination, teeth; partial examination, less than full mouth; and, CPT code 70320, Radiologic examination, teeth; complete, full mouth, to their own group, final APC group 0262, because these procedures require minimal time and relatively little radiographic film and technical equipment. We classified the remaining codes to final APC groups 0260 and 0261. We believe that these two groups are sufficient to distinguish clinical consistency and similar resource use. Facilities perform, relatively, a similar proportion of the different plain film procedures, and hospitals do not systematically use one type of plain film over another type, with the exception of dental films, which we moved to a separate group. The absolute magnitude of the difference in resource use among different plain films is not as significant as the difference between dental and other types of plain film. Additionally, our data indicate minimal differences in the amount of resource use between bone density measurement tests and plain films.

    APC 706: Miscellaneous Radiological Procedures

    Comment: A number of commenters found the tests grouped in proposed APC group 706 to vary significantly in the amount of time, effort, and costs required to provide the service.

    Response: As a result of applying the “two times” limit on cost variation required by the BBRA 1999, we divided proposed APC 706 into two levels: final APC 0263 and final APC 0264. We also moved CPT code 76075, Bone Density Study, one or more sites, to final APC 0261. We explain below, in section III.C.6.e, why we are making an exception to the BBRA 1999 “two times” limit on cost variation in the case of final APC group 264.

    APC 710: Computerized Axial Tomography

    APC 720: Magnetic Resonance Angiography

    APC 726: Magnetic Resonance Imaging

    Comment: A number of commenters believe that assigning all computerized axial tomography (CAT) to a single group and all magnetic resonance imaging (MRI) to a single group results in a lack of homogeneity among the procedures within each group. These commenters were concerned that we ignored the cost of contrast materials, labor, and equipment within proposed APC group 710 and proposed APC group 726 and that combining contrast and non-contrast studies represents an inconsistency in resource use because an examination that uses contrast will be more costly than one without contrast. One commenter observed that an MRI examination with the use of contrast material requires approximately 30 percent more time and effort than an examination performed without contrast material and that a bilateral examination requires 50 percent more staff time and effort to complete. The same commenter expressed concern that proposed APC 720 consists of only one procedure, CPT code 70541, Magnetic image, head (MRA). The commenter recommended that we place this code and the other MRA codes that we now cover into two APC groups, one with and the other without contrast. A number of commenters recommended that we pay separately for contrast material, as a cost pass-through. One commenter believes that including diagnostic studies with placement of radiation therapy fields in proposed APC 710 violates the “clinically similar” criterion.

    Response: Our medical advisors and staff carefully reviewed our data for the procedures in proposed APC group 710, proposed APC group 720, and proposed APC group 726 in light of commenters' concerns about the extent to which these groups take into account the costs associated with the use of contrast material. We concluded that costs associated with the use of contrast material are reflected in the payment rate in proportion to its frequency of use. We believe it is reasonable to have the CAT scans and MRIs with and without contrast together in their respective APC groups because facilities do not specialize based on whether or not they use contrast material. Further, the cost of contrast material relative to the overall inherent cost of CAT scans and MRI procedures alone is small. Moreover, the use of contrast material with CAT scans and MRI procedures differs significantly when compared to the use of contrast with plain films. Contrast comprises a significant portion of the cost of plain film services, and not all facilities perform plain films with contrast. A plain film can be ordered without being scheduled, but any plain film with contrast has to be scheduled. This scheduling distinction does not apply to a CAT or MRI scan with or without contrast. We did find that applying the “two times” limit on cost variation required by the BBRA 1999 resulted in the creation of two CAT groups, final APC groups 0282, to which we assigned CPT codes 70486, 76370, 76375, and 76380, and final APC 0283, to which the remaining codes in proposed APC group 710 are assigned. We further eliminated proposed APC group 720 and combined CPT code 70541, Magnetic image, head (MRA), with the other MRI procedures in final APC group 0284 because the base procedure, magnetic resonance imaging, is the same.

    APC 716: Fluoroscopy

    Comment: A number of commenters recommended that we pay separately for the fluoroscopy portion of procedures that include this radiologic service.

    Response: We have assigned payment status indicator “X” to the procedures in final APC groups 0272 and 0273 to indicate that these are ancillary services that are paid separately under the hospital outpatient PPS.

    Comment: A professional society commented that CPT code 74340, X-ray guide for GI tube, requires approximately 10 times the amount of radiologic technologist and room time, approximately 15 times the amount of film and many more supplies than does CPT code 71023, Chest x-ray and fluoroscopy. The commenter recommended that we divide proposed APC 716 into three separate and distinct levels based on the extent of the procedures and that we recalculate the relative weight and associated payment rate for the resulting groups.

    Response: We disagree with the commenter. Our medical advisors and staff, after reviewing the procedures in proposed APC group 716, concluded that the fluoroscopic portion of these procedures is sufficiently similar in terms of clinical characteristics and resource requirements to be grouped together. However, applying the “two times” limit on cost variation required Start Printed Page 18468by the BBRA 1999 results in the formation of two groups, final APC groups 0272 and 0273.

    APC 728: Myelography

    Comment: Commenters objected to assigning the same payment amount to procedures regardless of whether or not a contrast agent is used. One commenter was concerned that this payment policy will dissuade hospitals from utilizing contrast agents even in cases where the use of contrast is medically appropriate.

    Response: We agree that median costs vary more among the procedures in proposed APC 728 than their clinical similarities would suggest. However, although we found that final APC group 0274 did not satisfy the “two times” limit on cost variation required by the BBRA 1999, we are making an exception in this case as we explain below, in section III.C.6.e., and we are retaining all myelographic procedures in final APC 0274.

    APC 730: Arthrography

    Comment: Some commenters suggested reassigning various arthrographic procedures that were assigned to proposed APC 730.

    Response: We find the procedures in this group to be sufficiently homogeneous in terms of clinical definition and resource use. The procedures are comparable with respect to the use of resources in that the highest median cost procedure is less than twice the lowest median cost procedure, consistent with the standard set by the BBRA 1999. Therefore, we are retaining the proposed grouping of arthrographic procedures in final APC 0275.

    APC 736: Digestive Radiology

    To be consistent with the limit on cost variation required by section 201(g) of the BBRA 1999, we divided the procedures in proposed APC 736 into final APC groups 0276 and 0277.

    APC 738: Therapeutic Radiologic Procedures

    To be consistent with the limit on cost variation required by section 201(g) of the BBRA 1999, we split the procedures in proposed APC 738 into final APC groups 0296 and 0297.

    APC 739: Diagnostic Angiography and Venography

    Comment: Numerous commenters expressed concern about the lack of homogeneity among procedures in proposed APC 739. One commenter recommended that we divide proposed APC 739 into three groups: one for CPT code 75790, Angiography, arteriovenous shunt; one for all other angiography procedures; and one for venography procedures.

    Response: In response to these comments, we created final APC group 0281, Venography of Extremity, to reflect the significant clinical and resource consumption differences between venographic procedures performed on extremities and diagnostic angiography and venography performed on other parts of the body. Venographic procedures on the extremities consume less time and fewer resources than other angiography and venography procedures. To be consistent with the limit on cost variation required by the BBRA 1999, we split the other procedures in proposed APC 739 into final APC groups 0279 and 0280. With respect to final APC group 0279, we explain in section III.C.6.e why we are making an exception to the BBRA 1999 limit on cost variation.

    APC 747: Diagnostic Ultrasound Except Vascular

    Comment: A number of commenters suggested that we restructure proposed APC group 747 according to body site because the APC criterion of clinical homogeneity is violated by including within one group body sites that range from the eye to the pregnant uterus to the scrotum and contents.

    Response: Our medical advisors and staff carefully weighed the suggestion of commenters that clinical homogeneity would be better served if the procedures in proposed APC group 747 were divided into groups according to body site. We concluded that resource costs based on the type of technology used are what primarily dictates the definition of groups for various diagnostic services. Thus, we did not assign plain film of the chest in the same APC group with MRI of the chest. Because ultrasound is the type of technology common to all procedures in proposed APC group 747 and because resource use for the various procedures is similar irrespective of body site, we did not break this group up according to body site. However, to be consistent with the limit on cost variation required by the BBRA 1999, we split the procedures in proposed APC 747 into final APC groups 0265 and 0266.

    APC 749: Guidance Under Ultrasound

    Although there is a range of sites for the procedures in proposed APC group 749, as we explain above in our response to the comments submitted in connection with proposed APC 747, we are keeping this group intact in final APC group 0268 because the base procedure, ultrasonography, is the same for all procedures. Also, the procedures in final APC group 0268 are comparable with respect to the use of resources in accordance with the “two times” limit on cost variation.

    APC 750: Therapeutic Radiation Treatment Planning

    Comment: Commenters were concerned that radiation physics services are not appropriately recognized in proposed APC group 750. One commenter observed that proposed APC 750 lacks clinical homogeneity by including HCPCS codes for calculations and computer-based treatment planning with codes for the construction of treatment devices. Another commenter objected to including CPT codes 77261, 77262, 77263, 77431, and 77432 in proposed APC 750 because these codes are for professional services only and do not include a technical or facility component. As such, there are no facility costs associated with the codes. The commenter noted that if these codes were removed from proposed APC group 750, three medical physics consultation codes, CPT codes 77336, 77370, and 77399 would remain in the group. The commenter suggested that the resource requirements for two of the three remaining codes are dramatically different.

    Response: We agree with commenters' concerns about proposed APC group 750, and we modified this group accordingly. First, we assigned payment status indicator “E,” which designates certain items and services that are not paid under the hospital outpatient PPS, to five codes that describe professional services, which would not be billed by hospitals: CPT code 77261, Therapeutic radiology treatment planning; simple; CPT code 77262, Therapeutic radiology treatment planning; intermediate; CPT code 77263, Therapeutic radiology treatment planning; complex; CPT code 77431, Radiation therapy management with complete course of therapy consisting of one or two factions only; and CPT code 77432, Stereotactic radiation treatment management of cerebral lesion(s) (complete course of treatment consisting of one session).

    We renamed the remaining group of codes as final APC 0311, Radiation Physics Services. The codes specific to radiation physics that we classified in this APC are CPT code 77336, Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose delivery, and review of patient treatment documentation in support of the radiation oncologist, reported per week of therapy; CPT code 77370, Special medical radiation physics Start Printed Page 18469consultation; and CPT code 77399, Unlisted procedure, medical radiation physics, dosimetry and treatment devices, and special services.

    APC 751: Level I Therapeutic Radiation Treatment Preparation

    APC 752: Level II Therapeutic Radiation Treatment Preparation

    Comment: One commenter objected to including CPT code 77295, Therapeutic radiology simulation-aided field setting; three-dimensional, in proposed APC 752 because this service has dramatically different resource requirements than the other CPT codes in group. Another commenter believes that the resources used in connection with simple intracavitatory applications, which are normally performed with re-usable Cs-137 sources, are totally dissimilar from the resources required for remote afterloading high intensity brachytherapy in proposed APC 751. This commenter noted that the equipment and room costs associated with remote afterloading high intensity brachytherapy may well exceed $500,000.

    Response: We agree. In response to commenters' concerns, we made a number of modifications to proposed APC group 751 and proposed APC group 752. First, we assigned payment status indicator “E,” which designates certain items and services that are not paid under the hospital outpatient PPS, to CPT code 77299, Unlisted procedure, therapeutic radiology clinical treatment planning, thereby removing it from an APC group.

    We created final APC group 0303, which consists of the following three codes: CPT code 77332, Unlisted procedure, therapeutic radiology clinical treatment planning; CPT code 77333, Treatment devices, design and construction; intermediate (multiple blocks, stents, bite blocks, special bolus); and, CPT code 77334, Treatment devices, design and construction; complex (irregular blocks, special shields, compensators, wedges, molds or casts). We created final APC 0303 because the resources needed for device construction are unique. We decided to put these three codes together in one group rather than assigning each to its own individual group because we could make no clear cost distinctions among the three codes and because we expect that facilities do not specialize in one type of device over another, but rather construct all of the types of devices encompassed within the three codes.

    We created final APC group 0310, to which we assigned CPT code 77295, Therapeutic radiology simulation-aided field setting, three-dimensional. We assigned CPT code 77295 to its own individual APC group because it requires significantly greater resource consumption than the procedures in either final APC group 0304 or final APC group 0305.

    We assigned the codes remaining in proposed APC groups 751 and 752 to final APC groups 0304 and 0305. Both APC groups 0304 and 0305 are comparable with respect to the use of resources in accordance with the “two times” requirement set by the BBRA 1999.

    APC 757: Radiation Therapy

    Comment: We received a number of comments about the assignment to proposed APC 757 of CPT code 61793, Stereotactic radiosurgery, particle beam, gamma ray or linear accelerator, one or more sessions. Commenters indicated that CPT code 61793 is clinically distinct from other forms of radiation treatment delivery and that this service generally involves significantly greater treatment time and costs. One commenter stated that if we were to keep CPT code 61793 in proposed APC 757, we would be prejudicing use of this new, proven technology. Another commenter contended that radiation therapy is not the same as a surgical procedure. The commenter urged us to separate stereotactic radiation therapy (SRT) and intensity-modulated radiation therapy (IMRT) services from the conventional radiation therapy procedures in APC 757 and to assign them a higher payment rate due to their higher cost.

    Response: We created final APC group 0302, to which we assigned stereotactic radiosurgery, which requires significantly more costly resources than the procedures assigned to final APC groups 0300 and 0301. Note that we have created two codes, G0173 and G0174, to use in place of CPT code 61793. They represent stereotactic radiosurgery completed in one session, and that which requires multiple sessions, respectively. We also assigned CPT code 77470 to APC 0302, since we believe it requires resources similar to those required for radiosurgery. We will continue to track the data for these codes to ensure their proper placement. The procedures in final APC group 300 and in final APC group 301 are comparable with respect to the use of resources in accordance with the “two times” limit on cost variation.

    APC 759: Brachytherapy and Complex Radioelement Applications

    Comment: One commenter expressed concern because we did not identify a payment amount for the radioactive seeds used in brachytherapy. Another commenter referred to low dose rate interstitial brachytherapy that is used to treat complex gynecologic tumors, prostate cancers, and head and neck cancers, noting that this type of radiation therapy employs single-use radioactive sources (iodine, gold, iridium, and palladium seeds) and various disposable applicators. The commenter pointed out that only a limited number of vendors produce these radioactive sources and that the seeds cost as much as $200 each with the number of implants varying depending on the size, stage, and location of the cancer. The commenter stated that some patients with prostate cancer may require as many as 100 to 150 seeds. The commenter asserted that we have not captured the costs of these radiopharmaceuticals in the APC payment.

    Response: We have changed how we pay for brachytherapy and the other services we proposed to classify to APC 759 in response both to comments and to the provisions of section 201(b) of the BBRA 1999, which provide for an additional payment to be made for innovative medical devices, including “a (current) device of brachytherapy.” (See section III.D., below.) Within this framework, we recognize the seeds provided during brachytherapy. For bill processing purposes, we have assigned brachytherapy seeds to APC 0918. We will make payment for brachytherapy seeds under the transitional pass-through rules explained in section III.D., below.

    Based on commenters' suggestions, a review of our data, and the BBRA 1999 “two times” requirement, we have classified the procedures in proposed APC 759 in final APC 0312, Radioelement Applications, and final APC 0313, Brachytherapy. APC 0313 consists of CPT code 77781, Remote afterloading high intensity brachytherapy; 1-4 source positions or catheters; CPT code 77782, Remote afterloading high intensity brachytherapy; 5-8 source positions or catheters; CPT code 77783, Remote afterloading high intensity brachytherapy; 9-12 source positions or catheters; CPT code 77784, Remote afterloading high intensity brachytherapy; over 12 source positions or catheters; and, CPT code 77799, Unlisted procedure, clinical brachytherapy. Because these Start Printed Page 18470procedures are all different types of brachytherapy, final APC 313 is more coherent clinically than was proposed APC 759.

    We moved CPT code 77750, Infusion or instillation of radioelement solution, to final APC 301, Level II Radiation Therapy, and CPT code 77789, Surface application of radioelement, were moved to final APC 300, Level I Radiation Therapy. The remaining procedures from proposed APC 759 constitute final APC 312, Radioelement Applications. The procedures in final APC group 312 and in final APC group 313 are comparable with respect to the use of resources in accordance with the “two times” limit on cost variation.

    APC 761: Standard Non-Imaging Nuclear Medicine

    APC 762: Complex Non-Imaging Nuclear Medicine

    APC 771: Standard Planar Nuclear Medicine

    APC 772: Complex Planar Nuclear Medicine

    APC 781: Standard SPECT Nuclear Medicine

    APC 782: Complex SPECT Nuclear Medicine

    APC 791: Standard Therapeutic Nuclear Medicine

    APC 792: Complex Therapeutic Nuclear Medicine

    Comment: We received numerous comments about the proposed nuclear medicine APC groups. Commenters addressed what they believe to be discrepancies in the payment weights among the proposed groups. Commenters also asserted that the proposed payment levels are inadequate to offset the cost of radiopharmaceuticals. They believe, in part, that our use of single-procedure claims in constructing our database failed to capture the costs associated with the various radiopharmaceuticals that may be used in combination during multiple procedures performed during a single session on various patients. One commenter disagrees with our decision to consider therapeutic radiopharmaceuticals and radionuclides as incidental services, bundling their costs into nuclear medicine and radiation therapy procedures. The commenter recommended that we develop unique APC groups for radiopharmaceuticals and radionuclides. One manufacturer expressed particular concern about our proposed payment for a radiopharmaceutical used to relieve the pain of bone metastasis (CPT code 79400) that we proposed to package into APC 791 for which the proposed payment was $758. The commenter stated that this new radiopharmaceutical, which has generated a very high clinical response rate, costs more than $2,000 per dose.

    Response: In response to these and other comments, as well as the changes made by the BBRA 1999 to the outpatient PPS, our medical advisors and staff have reconstructed the nuclear medicine APC groups. First, we have placed radiopharmaceuticals into a separate set of APC groups that are listed in Addendum K. As we state above, new section 1833(t)(6) of the Act provides for additional payment for current and new radiopharmaceuticals. We list in Addendum K those radiopharmaceuticals that are eligible for additional payment effective with services furnished on or after July 1, 2000. In accordance with the process outlined below, in section III.D.4, we invite requests to consider other radiopharmaceuticals as potential candidates for additional pass-through payments.

    Next, we reconfigured the nuclear medicine APC groups based on the resources required for the procedures themselves, exclusive of costly radiopharmaceuticals. We took into account the fact that SPECT equipment, which costs significantly more than the non-SPECT equipment that was initially used most frequently for planar medicine, is now commonly used to conduct planar studies. As a final step, we further reorganized the groups to satisfy the requirement set by the BBRA 1999 “two times” requirement, resulting in final APC groups 0286, 0290, 0291, 0292, 0294, and 0295.

    Comment: We received a number of comments concerning the clinical efficacy of iodine 131 tositumomab in the treatment of cancer. One commenter stated that iodine 131 tositumomab, which was reported to be pending final FDA approval, has the potential to be the first radioimmunotherapeutic agent to be approved for the treatment of cancer. The commenter expected this pharmaceutical to be the first in its class, and characterized it as neither a chemotherapeutic agent nor a radiopharmaceutical. The commenter stated that the cost of this pharmaceutical will be significantly higher than the payment amount proposed for any of the APC groups containing drugs used for cancer therapies. The commenter believes that we should have proposed an outlier policy to ensure equitable payment for pharmaceuticals such as iodine 131 tositumomab.

    Response: If iodine 131 tositumomab receives final FDA approval, we strongly encourage interested parties to submit the appropriate materials to us for determination of this product's eligibility for additional payment under the pass-through provision as described below in section II.D.6.

    Comment: One commenter finds our method of paying for new products to be flawed. The commenter sees it as highly probable that a new product will be inserted into an APC procedure category where the payment rate is significantly lower than the actual cost of the newly developed product. The commenter cites our proposed payment for a new product, In-111 Octreo Scan, which is used for tumor imaging. The product costs four times the payment rate for proposed APC 772, Complex Planar Nuclear Medicine. The commenter believes that this enormous discrepancy will discourage hospital outpatient departments from utilizing procedures that require this product and that Medicare beneficiaries may be denied access to the most appropriate care available as a result.

    Response: We are firmly committed to ensuring that the provisions of the hospital outpatient PPS do not in any way obstruct or limit Medicare beneficiaries' access to reasonable medically necessary and appropriate care. We further recognize that the development of new technology and products is a highly dynamic enterprise that is constantly evolving and changing the character and cost of current diagnostic and treatment modalities. New section 1833(t)(6) of the Act provides for an additional transitional pass-through payment for certain innovative medical devices, drugs, and biologicals. We are also creating a series of transitional APCs for the express purpose of providing appropriate payment for new technology services when they emerge into the marketplace while we collect data to enable us ultimately to incorporate the new technology service within an APC group, making payment adjustments as needed. We expect to continue working closely with hospitals and their representatives throughout this process to ensure that payment does not inhibit beneficiary access to appropriate care. We discuss the transitional pass-through payment groups in greater detail in section III.D and provisions for payment for new technology in section III.C.8. Start Printed Page 18471

    APC 881: Level I Pathology

    APC 882: Level II Pathology

    APC 883: Level III Pathology

    Comment: We received numerous comments on the proposed pathology APC groups. One commenter expressed concern that our proposed assignment of tests among the three groups may create an incentive for physicians to order complex and unnecessary tests when simpler, less comprehensive tests may be adequate, because we have grouped together and are paying the same amount for tests that are clinically similar but that are comprehensively more difficult than one another.

    Response: Our medical advisors and staff reviewed and completely reorganized the grouping of pathology tests in light of commenters' concerns and the BBRA 1999 “two times” requirement. Pathology tests are in final APC groups 0342, 0343, and 0344.

    APC 906: Infusion Therapy Except Chemotherapy

    APC 907: Intramuscular Injections

    Comment: We received many comments about proposed APC groups 906 and 907. The commenters were generally concerned that packaging payment for nonchemotherapeutic infused and injected drugs in the payment rates for the administration of nonchemotherapy drugs does not take into account the great variation among these products with regard to their indication/application and cost nor the cost of new drugs that have been introduced since 1996. Commenters fear that we will underpay hospitals and inhibit the introduction of new drugs into the system.

    Response: In response to the concerns expressed by commenters, we have created additional groups for certain expensive pharmaceuticals. These high-cost, nonchemotherapy, nonorphan drugs are captured in the following APCs: 0886-0891, 0907, 0908, 0911, 0914, 0915, 0917, 7007, 7036, and 7042. We have set the rates for these high-cost drug APCs based on data we obtained from a contracted study of drug costs. In section III.D, below, we discuss the process for pricing new high cost drugs as they are introduced into the marketplace to assure adequate payment until these new drugs can be assigned to an appropriate APC. Final APC 120, Infusion Therapy Except Chemotherapy, and final APC 359, Intramuscular injections, are priced based on the resources used to perform the procedures, including many less expensive drugs that are packaged into the two APCs.

    APC 957: Echocardiography

    Comment: Numerous commenters remarked on the lack of homogeneity in resource consumption in this APC. One commenter objected to our not distinguishing between procedures performed with or without contrast agents. Another commenter contends that proposed APC 957 does not account for the diversity of services in costs based on type of equipment, use of conscious sedation medication, and use of contrast agents.

    Response: Conscious sedation and contrast media were packaged where they were used in the base year. We believe that packaging of items into the payment amount is appropriate because hospitals do not specialize in providing only services with or only services without sedation or contrast. To the extent that different equipment is used for different procedures, and has different costs, those differing costs are captured and recognized in our payment algorithm.

    Comment: Several commenters referred to the fact that some of the echocardiograms are part of more comprehensive codes pertaining to echocardiograms that are in the same APC. For example, one commenter noted that CPT code 93880, the basic vascular ultrasound service, is defined as a “duplex scan.” The commenter stated that all duplex vascular ultrasound codes involve three components and that, to the extent all three components are incorporated into this single vascular code, a provider is paid for only one procedure. On the other hand, CPT code 93307, the basic echocardiography service, incorporates only one of the three types of services included in the basic vascular service, CPT code 93880. Other codes, CPT 93320 and 93325 are used to bill for the other services that are a standard part of all vascular ultrasound procedures like CPT code 93880. This approach results in a provider receiving three separate payments for an echocardiogram with Doppler and color flow mapping as compared to a single payment for an equivalent vascular study.

    Response: We agree that duplex vascular ultrasound scanning procedures include two dimensional and doppler signal display. However, for the example cited by the commenter, there is no separate code that includes both the two dimensional and the doppler ultrasound spectral analysis. To report a duplex vascular ultrasound of the heart, the only codes available are CPT codes 93307, 93320 and 93325, unlike the duplex vascular ultrasound scan of the extracranial arteries, which is coded with CPT code 93880. We agree that this limitation of the coding system affects the payment system, since the APC system is based on charges associated with each of the codes. We will bring this issue to the attention of the American Medical Association's CPT Editorial Panel.

    However, in those instances where there is a code for the comprehensive service and separate codes for services that are inherent components of the comprehensive service, the Correct Coding Initiative (CCI) edits, which we are incorporating into the hospital outpatient PPS claims processing system, will address this concern. The CCI edits have been in place in the Part B claims processing system since January 1996. These edits detect when codes representing component services are reported with the code for the more comprehensive service. For example, there is an edit that prohibits the payment of CPT code 93875, a doppler study of the extracranial arteries when reported with CPT code 93880, the duplex scan of the extracranial arteries.

    APC 960: Cardiac Electrophysiologic Tests/Procedures APC

    Comment: Many commenters cited extreme variations in resource use among the procedures in proposed APC 960. One commenter noted that the procedures involve the use of one or more catheters, and argued that the proposed payment does not cover the cost of even one catheter. Another commenter claims that, at a minimum, the total cost of the four diagnostic catheters and one ablation catheter used in performing these procedures is $1,955.

    Response: In response to these concerns, we moved CPT code 93660, Evaluation of cardiovascular function with tilt table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention, to final APC 0101, and CPT code 93724, Electronic analysis of antitachycardia pacemaker system, to final APC 0100. We reclassified the remaining procedures in proposed CPT 960 into final APC groups 0084, 0085, 0086, and 0087 to be consistent with the BBRA 1999 “two times” requirement.

    APC 966: Electronic Analysis of Pacemakers/Other Devices

    Comment: A number of commenters stated that the procedures in proposed APC 966 are not related clinically or in terms of resource cost. One commenter indicated that analyzing a spine infusion pump or neuroreceiver is a very different process from analyzing a Start Printed Page 18472pacemaker or cardio/defibrillator and hence uses very different resources.

    Response: Although the devices that are the subject of electronic analysis in proposed APC group 966 differ, we believe that the resource use among the services in the group is, on average, relatively similar. We determined that the procedures in proposed APC 966 meet the “two times” test for comparability with respect to the use of resources set by the BBRA 1999. In addition, we find it unlikely that facilities will specialize in one particular type of electronic analysis of pacemakers/other devices to the exclusion of others. Therefore, we did not change the procedures in final APC group 102 from what we had proposed.

    APC 968: Vascular Ultrasound

    Comment: One commenter recommended removing CPT code 93875, Non-invasive physiologic studies of extracranial arteries, complete bilateral study (for example, periorbital flow direction with arterial compression, ocular pneumoplethysmography, Doppler ultrasound spectral analysis), from proposed APC 968 because this study is a physiologic procedure and should be in the same group with other noninvasive physiologic vascular studies.

    Response: We agree. We moved CPT code 93875 to final APC 0096.

    Comment: One commenter recommended creating additional APC groups for CAT, MRI, and general ultrasound procedures to distinguish between diagnostic procedures that utilize contrast media and those that do not. The commenter believes that additional APC groups that properly recognize the resources required for contrast agents will encourage hospitals to use the procedures most suitable for the clinical needs of different patients.

    Response: As we explained above, in our response to comments about proposed APC groups 710, 720, and 726, our medical advisors and staff carefully reviewed our data and concluded that costs associated with the use of contrast material are reflected in the payment rate for vascular ultrasound procedures in proportion to its frequency of use. We believe it is reasonable to have vascular ultrasound procedures with and without contrast together in one group because facilities do not specialize based on whether or not they use contrast material. Further, the cost of contrast material is small relative to the overall cost of the ultrasound. Moreover, facilities are not likely to schedule ultrasound according to whether or not contrast is used. Therefore, with the exception of moving CPT code 93875, we did not further change the procedures in final APC group 0267. Final APC group 0267 is within the limit on cost variation required by the BBRA 1999.

    APC 969: Hyperbaric Oxygen

    Comment: Many commenters were concerned that our cost data for hyperbaric oxygen therapy are flawed because of poor coding, and that the proposed payment rate is, as a consequence, inadequate. One commenter suggested that we did not use a common definition of hyperbaric oxygen therapy across all hospitals and that, due to ambiguity in codes, there is wide variation in how hyperbaric oxygen therapy services are defined for billing purposes.

    Response: We cannot subdivide final APC 0031 because we have no mechanism for creating clinically distinct groups related to differences in resource consumption among facilities within a single CPT code. However, we explain below, in section III.H, that we intend to make adjustments in future years to APC group weights, once the hospital outpatient PPS is implemented. If commenters believe that current codes are inadequate to describe these services, they should seek new CPT codes from the American Medical Association.

    Comment: One commenter was concerned about not only the low payment rate proposed for hyperbaric oxygen therapy, but also the fact that the proposed national unadjusted coinsurance amount exceeds the proposed total payment rate for the service.

    Response: We calculated the payment rate and coinsurance amount for APC 0031 using the same method that we followed for the other APC groups. Charges for hyperbaric oxygen are much higher than their costs, which accounts for the unusually high national unadjusted coinsurance rate relative to the total payment rate for CPT code 99183. Note, however, that hospitals may elect to offer a reduced coinsurance rate for the service as described below in section III.F.4.

    APC 971: Level 1 Pulmonary Tests

    APC 972: Level II Pulmonary Tests

    APC 973: Level III Pulmonary Tests

    Comment: Commenters generally questioned the clinical consistency of procedures in the proposed pulmonary test APC groups and expressed concern about the variability of resources required to perform the procedures within each group. One commenter disagreed with our combining procedures before and after medication with procedures before rest and after exercise.

    Response: After carefully reviewing the assignment of codes among the three proposed pulmonary test groups, our medical advisors and staff made a number of changes. To better recognize their median costs, we moved CPT code 94060, Bronchospasm evaluation before and after bronchodilator, and CPT code 94260, Thoracic gas volume, to final APC group 0368, and classified CPT code 94720, Carbon monoxide diffusing capacity, to final APC group 0367. We made additional changes among the three groups to ensure comparability of resources within each pulmonary test APC group in accordance with the “two times” standard set by the BBRA 1999.

    APC 976: Pulmonary Therapy

    Comment: Commenters generally questioned the clinical consistency of procedures in the proposed pulmonary therapy APC group and expressed concern about the variability of resources required to perform the procedures within the group. One professional association wrote that the respiratory therapy procedures in proposed APC group 976 are significantly different in complexity and require significantly different equipment and expertise to perform. The same commenter noted that CPT code 94657, Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing, subsequent days; CPT code 94660, Continuous positive airway pressure ventilation (CPAP), initiation and management; and, CPT code 94662, Continuous negative pressure ventilation (CNP), initiation and management, all require close monitoring, more costly equipment, and, often, more expertise than do other therapies in proposed APC group 976.

    Response: We agree with the commenter. We moved the CPT codes describing ventilation initiation and management (CPT codes 94657, 94660, 94662) into their own APC, final APC 0079, Ventilation Initiation and Management, to recognize that these procedures represent a completely different type of clinical service and because they utilize resources that are materially different from those used in connection with other pulmonary therapy procedures. We further divided the procedures in proposed APC 976 to meet the definition of comparable resources required by the BBRA 1999, resulting in final APC groups 0077 and 0078. Start Printed Page 18473

    APC 979: Extended EEG Studies and Sleep Studies

    APC 980: Electroencephalogram

    APC 981: Level I Nerve and Muscle Tests

    APC 982: Level II Nerve and Muscle Tests

    Comment: One commenter expressed concern about our grouping sleep medicine services in proposed APC 979 with EEG and Epilepsy diagnostic services. Another commenter is concerned about the clinical homogeneity of our proposed groups for the numerous different neurologic and neuromuscular diagnostic codes that are encompassed within the range of services described by CPT code 95805 through CPT code 95958. The commenter believes that our proposed groups do not make appropriate distinctions among the many different tests relating to different parts of the body, taking different amounts of time, using different equipment, and measuring different outcomes. One commenter asked that we add two codes created in 1998 for sleep services to the list of procedures in the APC system. The commenter recommended assigning CPT 95811, Polysomnography with CPAPP, to proposed APC group 979. The commenter also recommended that CPT code 95806, Sleep study, unattended by a technologist, not be assigned to proposed APC group 979 to avoid creating an incentive for hospitals to use that procedure, which the commenter asserts is both less costly and less conclusive than other studies in proposed APC 979, in place of more comprehensive tests. One commenter claimed that the variety of neurological and neuromuscular diagnostic tests warrants an expansion of the number of APCs for these procedures to six, because the resources used vary widely. The commenter prefers that payments be made on a per service rather than on a per group basis. However, if we retain groups, the commenter recommended, on the basis of cost-based practice expenses, separate APCs for sleep and polysomnography services, for EEG studies, for EEG monitoring codes, for EMG codes, for nerve conduction and H reflex tests, and for sensory evoked potential and autonomic nerve function tests.

    Response: Our medical advisors and staff decided that CPT codes 95806 and 95811 are both most appropriately assigned to final APC 0213. While sleep studies unattended by a technologist may consume less resources than those studies which involve the presence of a technologist, we believe that physicians are likely to order a mix of sleep studies, and that institutions are unlikely to specialize in sleep studies with or without the presence of a technologist. We added CPT code 95951 to APC group 0213. We believe the codes we proposed in APC groups 979 and 980 are sufficiently comparable clinically and in terms of resource use not to require further subdivision into smaller groups. Therefore, we retained our proposed classification in final APC groups 213 and 214.

    We created a third APC group for the nerve and muscle test codes, and we split the codes in proposed APCs 981 and 982 among final APC groups 0215, 0216, and 0217 to ensure comparability of resources within each of the three nerve and muscle test APC groups in accordance with the “two times” requirement set by section 201(g) of the BBRA 1999.

    APC 987: Subcutaneous or Intramuscular Chemotherapy

    APC 988: Chemotherapy except by Extended Infusion

    APC 989: Chemotherapy by Extended Infusion

    APC 990: Photochemotherapy

    Comments: We received numerous comments that criticized our proposed payments for chemotherapy services. The commenters argued that the proposed payment for chemotherapy and radiation therapy would severely reduce payments to hospitals and create perverse incentives for hospitals to substitute the older, less effective therapies for the newer ones. The commenters asserted that the proposed payment would not cover the costs of supportive care such as drugs to control nausea and vomiting. They expected that low payment rates to hospitals would force them to discontinue chemotherapy services, and that patients would be faced with trips to distant facilities to obtain services.

    Response: We believe that the concerns raised by the commenters have been addressed through the transitional pass-through provision set forth in section 1833(t)(6) of the Act, as added by section 201(b) of the BBRA 1999. In accordance with that provision, we have separately identified current drugs and biologicals used in the treatment of cancer. These are listed in Addendum K of this final rule, and are eligible for additional payment under this provision. We have obtained codes for any anticancer, supportive, or adjunctive drugs we could identify. Thus, we will pay for chemotherapy by recognizing the mode(s) of administration and each of the covered drugs given, whether they are to treat the cancer, to protect the patient against the toxic effects of the treatment, or to relieve the side effects of treatment. In section III.D.4, below, we discuss how to request codes for new drugs.

    Note that we moved CPT-based chemotherapy infusion codes into the “E” (noncovered) category because HCPCS “Q” codes for these services will be used to identify chemotherapy infusions. Hospitals had been instructed in the past not to bill using the CPT codes.

    APC 999: Therapeutic Phlebotomy

    Comment: One commenter is concerned that facilities will lose money because the proposed payment rate does not cover the cost incurred to provide the nursing care, phlebotomy bag and other supplies, overhead, scheduling time and disposal of hazardous waste that are all required to furnish this service.

    Response: We have carefully reviewed the costs associated with APC 999 and believe that the CPT code 99195 was mistakenly used to report simple venipuncture in some cases, thus lowering the cost of proposed APC 999. However, we believe it is appropriate to base payment for this APC on the median amount billed, since CPT code 99195 was billed more than 20,000 times. Hospitals must use this code only when therapeutic phlebotomy is furnished, and charge an appropriate rate for the resources involved. Appropriate reporting will enable us to determine a more precise weight for this APC in future years.

    Final APC 081: Non-Coronary Angioplasty or Atherectomy

    Final APC 082: Coronary Atherectomy

    Final APC 083: Coronary Angioplasty

    We created these three new APC groups to accommodate atherectomy and angioplasty procedures that we originally proposed to classify as inpatient only. We discuss in section III.C.5 our response to commenters' concerns about our proposing to designate certain procedures as “inpatient only” and our final decision to change the status of these atherectomy and angioplasty procedures.

    Final APC 058: Strapping

    Final APC 059: Casting

    We proposed to assign the procedures in these new APC groups a payment status indicator “N” as incidental services for which payment is packaged into the APC rate for another service or procedure. However, we determined Start Printed Page 18474that the procedures in the final APC groups 0058 and 0059 could be performed independently, that is, the procedures for which a strapping has been previously applied and/or a new cast has previously been placed. We explain in more detail in section III.C.2.c our rationale for not packaging the costs associated with these services. We therefore created APC groups 0058 and 0059 for these codes to which we assigned payment status indicator “S” to indicate that these are significant procedures paid under the hospital outpatient PPS to which the multiple procedure discount does not apply.

    e. Exceptions to BBRA 1999 Limit on Variation of Costs Within APC Groups

    As we note above, section 201(g) of BBRA 1999 amends section 1833(t)(2) of the Act to define what constitutes comparable use of resources among the procedures or services within an ambulatory payment classification group under the hospital outpatient PPS. The standard set by section 1833(t)(2) of the Act is that the items and services within a group cannot be considered comparable with respect to the use of resources if the highest median (elected by the Secretary, as opposed to the mean) cost item or service within a group is more than 2 times greater than the lowest median cost item or service within the same group (the “two-times” requirement).

    Section 1833(t)(2) of the Act allows the Secretary to make exceptions to the “two-times” requirement in unusual cases, such as low volume items and services, although the Secretary may not make such an exception 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. As we explain in the preceding section of this preamble, after we had modified the composition of the APC groups based on the recommendations of commenters, we made numerous additional changes to the APC groups to conform with the BBRA 1999 “two times” requirement. In the resulting groups, we found certain anomalies that were irreconcilable with the principles underlying formation of the APC groups. After carefully evaluating the various combinations resulting from further subdividing groups or reassigning codes to other groups to resolve the anomalies, and after reviewing our data, we decided to maintain the composition of certain APC groups, as exceptions to the “two times” requirement. We based exceptions on factors such as low procedure volume, suspect or incomplete cost data, concerns about inaccurate or incorrect coding, or compelling clinical arguments. We believe that as hospitals gain experience under the hospital outpatient PPS, and as they refine their coding of services, a number of the apparent anomalies within the groups that we are treating as exceptions to the “two times” will be resolved.

    Below we list the APC groups that are exceptions to the “two times” requirement, and our reasons for the exception. We use the final APC number to identify the group.

    APC 0016: Level IV Debridement and Destruction

    We are retaining CPT code 56501 in final APC group 0016, even though its median cost exceeds the “two times limit.” We believe the higher costs that are reflected in the data are the result of incorrect coding. The descriptor for CPT code 56501 defines the procedure as the simple destruction of skin and superficial subcutaneous tissues. In the judgment of our medical advisors, costs associated with simple destruction of skin and superficial subcutaneous tissues are typically within the range of costs associated with the other procedures in final APC group 0016, and the median cost that our data attribute to CPT code 56501 is higher than the code description warrants.

    APC 0030: Breast Reconstruction/Mastectomy

    Although the range of costs for procedures in final APC group 0030 exceeds the “two times limit,” we believe that only the simplest breast procedures will be done in the outpatient setting. Most of the procedures with median costs over $1000 used observation services in order to provide an overnight stay. We expect these cases to revert to the more appropriate inpatient setting.

    APC 0058: Level I Strapping/Casting

    The codes in final APC group 0058 are the simpler casting, splinting, and strapping procedures. Costs associated with the more resource-intensive procedures in final APC group 0059 are fairly uniform, but the median costs of procedures in final APC group 0058 vary widely. We are excepting final APC group 0058 from the “two times limit” until we can review the data for the first year of the outpatient PPS.

    APC 0060: Manipulation Therapy

    Taken collectively, the codes in final APC group 0060 are low in volume and erratically priced. For example, although the number of areas treated increases within the range of CPT codes 98925 through 98929, suggesting progressively increasing resource utilization, our data show median costs associated with the codes in the range 98925-98929 as $38, $11, $16, $17, and $19, respectively. Although costs associated with treating 9 to 10 body regions might not be 5 to 10 times greater than treating one or two regions, we would still expect costs for the more extensive procedures to be higher than those for the less extensive procedures, and certainly not lower as suggested by our data. Nor do we expect a hospital to specialize in treating more or fewer body areas. Therefore, the median payment set for final APC 0060 should average out, providing adequate payment for any number of body areas treated.

    APC 0079: Ventilation Initiation and Management

    These codes all represent respiratory treatment and support within the outpatient setting. Their costs should be roughly the same, even though our data suggest otherwise. We are excepting final APC group 0079 from the “two times limit” at this time, pending the collection of more conclusive cost data.

    APC 0080: Diagnostic Cardiac Catheterization

    The data for CPT code 93524 reflect costs that are lower than we would expect. We can find no apparent explanation for the wide variation in costs among the cardiac catheterization codes, although we suspect that the accuracy of the chargemaster system, when assigning charges in other than the surgical suite, may be problematic. We expect costs to even out once hospitals decide which cases may be handled on an outpatient basis without requiring an overnight stay.

    APC 0081: Non-Coronary Angioplasty

    We are excepting final APC group 0081 from the “two times limit” because of the low volume of cases for the codes in the group. For some of the codes in this group, the data reflect lower than expected median costs, which we attribute to low volume and to miscoding, which would account for the erratic sequences of costs found in our data.

    APC 0093: Vascular Repair/Fistula Construction

    We believe the median costs for CPT codes 36530 and 36810 are aberrant. These codes are very similar clinically to the other codes in APC 0093, and we would expect their costs to be similar. We believe low volume may account for the variability in cost. Start Printed Page 18475

    APC 0094: Resuscitation and Cardioversion

    We believe the median costs for CPT codes 92953 and 31500 are aberrant, perhaps due to misuse of the codes. Therefore, we are excepting this APC group from the “two times limit,” until we collect and analyze more accurate data once the hospital outpatient PPS is implemented.

    APC 210: Spinal Tap

    The two CPT codes that comprise this group are essentially the same procedure, one performed for diagnostic reasons and the other therapeutic. We suspect the disparity in median costs is attributable to the much higher volume of diagnostic spinal taps. Therefore, we are excepting this APC group from the “two times limit,” until we collect and analyze more accurate data once the hospital outpatient PPS is implemented.

    APC 0233: Level II Anterior Segment Eye

    We are excepting final APC group 233 from the “two times limit” because many of the codes in this APC are low volume and the coding seems erratic. For example, CPT designates a number of codes that are in final APC group 0233 as “relatively small” surgical procedures, which suggests that miscoding may have resulted in inflated cost data.

    APC 0251: Level I ENT Procedures

    A combination of low volume and unlisted codes obscures the fact that this APC represents the least intense ENT procedures. Because there are so many ENT codes, consistent agreement on what the codes represent may be difficult to achieve. Therefore, we are excepting this APC group from the “two times limit,” until we collect more accurate data under outpatient PPS.

    APC 0264: Level II Miscellaneous Radiology Procedures

    In the judgment of our medical advisors, the median costs for CPT codes 74740 and 76102 are aberrant. These procedures would be underpaid if they were paid separately and on the basis of what our data show to be their median cost. Therefore, we are excepting this APC group from the “two times limit,” until we collect more accurate cost data under outpatient PPS.

    APC 0274: Myelography

    In the judgment of our medical advisors, the median costs for CPT codes 70010 and 70015 are aberrant. These codes would be underpaid if they were moved to their own APC and paid on the basis of their median cost. All codes in this APC should cluster around the same cost. Therefore, we are excepting this APC group from the “two times limit,” until we collect more accurate cost data under outpatient PPS.

    APC 0279: Level I Diagnostic Angiography

    We believe the median costs for the codes at the low end of this APC may be inaccurate, because, clinically, these codes are homogeneous. Therefore, we are excepting this APC group from the “two times limit,” until we collect more accurate cost data under outpatient PPS.

    APC 0302: Level III Radiation Therapy

    We are retaining CPT code 77470 in final APC group 302, because the median cost seems low for the code description, possibly because this code may have been billed improperly in the past. We are also uncertain of the appropriate median cost of CPT code 61793, because we have been told that CPT code 61793 was used for both single-session gamma knife procedures and for each of multiple sessions of treatment with linear accelerators. Therefore, we have created two codes to be used in place of CPT code 61793, in order to collect more reliable data: G0173 (Stereotactic radiosurgery, complete course of therapy in one session), and G0174 (Stereotactic radiosurgery, requiring more than one session).

    We will initially pay both codes at the same rate; however, we expect differences in cost would become apparent during the first year or 18 months of the outpatient PPS.

    APC 0311: Radiation Physics Services

    We are retaining CPT code 77370 in final APC group 0311, because we believe a special medical radiation physics consultation (outside the weekly management of a patient) is probably more costly than our data indicate.

    APC 0341: Immunology Tests

    We think the variation in costs among the procedures within final APC group 0341 may be the result of erratic coding. Because these services are so similar clinically, we would expect their individual costs to cluster around the median. Therefore, we are excepting this APC group from the “two times limit,” until we collect more accurate cost data under outpatient PPS.

    APC 0371: Allergy Injections

    We attribute the variation in median costs among the procedures within final APC group 0371 to erratic coding. Because these services are so similar clinically, we would expect their individual costs to cluster around the median. Therefore, we are excepting this APC group from the “two times limit,” until we collect more accurate cost data under outpatient PPS.

    APC 0373: Neuropsychological Testing

    With one exception, the codes in final APC group 0373 are billed per hour, so facility costs should all cluster around the median. Therefore, we are excepting this APC group from the “two times limit,” until we collect more accurate cost data under outpatient PPS.

    7. Discounting of Surgical Procedures

    To be consistent with Medicare policy and regulations governing payment for ambulatory surgical services furnished in a physician's office and in an ASC, we proposed under the hospital outpatient PPS to discount payment amounts when more than one procedure is performed during a single operative session or when a surgical procedure is terminated prior to completion. Specifically, we proposed that when more than one surgical procedure with payment status indicator “T” is performed during a single operative session, we would pay the full Medicare payment and the beneficiary would pay the coinsurance for the procedure having the highest payment rate. Fifty percent of the usual Medicare PPS payment amount and beneficiary coinsurance amount would be paid for all other procedures performed during the same operative session to reflect the savings associated with having to prepare the patient only once and the incremental costs associated with anesthesia, operating and recovery room use, and other services required for the second and subsequent procedures.

    We also proposed to require hospitals to use modifiers on bills to indicate procedures that are terminated before completion. Modifier -73 (Discontinued Outpatient Procedure Prior to Anesthesia Administration) would identify a procedure that is terminated after the patient has been prepared for surgery, including sedation when provided, and taken to the room where the procedure is to be performed, but before anesthesia is induced (for example, local, regional block(s), or general anesthesia). Modifier-52 (Reduced Services) would be used to indicate a procedure that did not require anesthesia, but was terminated after the patient has been prepared for the procedure, including sedation when provided and taken to the room where the procedure is to be performed. We proposed to pay 50 percent of the usual Medicare PPS payment amount and Start Printed Page 18476beneficiary coinsurance amount for a procedure terminated before anesthesia is induced. Modifier-74 (Discontinued Procedure) would be used to indicate that a surgical procedure was started but discontinued after the induction of anesthesia (for example, local, regional block, or general anesthesia), or after the procedure was started (incision made, intubation begun, scope inserted) due to extenuating circumstances or circumstances that threatened the well-being of the patient. To recognize the costs incurred by the hospital to prepare the patient for surgery and the resources expended in the operating room and recovery room, the hospital will receive full payment for a procedure that was started but discontinued after the induction of anesthesia or after the procedure was started, as indicated by a modifier-74. The elective cancellation of procedures would not be reported. If multiple procedures were planned, only the procedure actually initiated would be billed.

    Comment: Some commenters asked us to clarify how the policy would be applied. For example, one commenter asked whether the surgical discounting methodology would apply in the following situation: Contrast x-ray of lower spine (CPT code 72265) is followed by contrast CAT of the spine (CPT code 72132). Both procedures have related surgical codes (CPT codes 62270 and 62284). Other commenters provided examples that were similar in nature but involved other codes.

    Response: We proposed to apply the reduced payment for multiple procedures to surgical procedures only, that is, those CPT codes that have a payment status indicator “T.” Therefore, services such as CPT codes 72265 and 72132 that have a payment status indicator of “S” would not be subject to the multiple procedure discount, whereas CPT codes 62270 and 62284, which are surgical procedures and have a payment status indicator of “T,” would be subject to the multiple procedure discount. Hypothetically, if all four codes were provided in a single operative session, as suggested by this commenter, then the reduced payment would apply only to the surgical procedure with the lower payment rate. (For the record, we have responded to the commenter's example in order to clarify how the multiple procedure discount would apply in a hypothetical situation. However, we question whether the suggested combination of codes would be covered if actually performed during the course of a single patient encounter.)

    Comment: Commenters asked what factors guided our assignment of payment status indicator “T” to a code.

    Response: We generally assigned the payment status indicator “T” to surgical services. Our medical advisors and staff will continue to review the designation of status indicators and we may propose revisions in the future.

    Comment: A variety of commenters stated that the reduced payments for multiple procedures would inappropriately reduce payments for a second procedure. Some were concerned that application of the multiple procedure discount could result in hospitals being less likely to offer procedures assigned the payment status indicator “T.” These commenters recommended that we change all “T” payment indicators to a different indicator such as “S,” which we define as a significant procedure not reduced when multiple, until we have had an opportunity to collect reliable cost data upon which to base payment decisions about discounting.

    Response: We continue to believe that the proposed reduced payment for multiple surgical procedures is reasonable. We disagree that hospitals would be less likely to provide these services. We believe there clearly are savings achieved when more than one surgical procedure is performed during a single operative session. The patient has to be prepared for surgery only once, and the costs associated with anesthesia, operating and recovery room use, and other services required for the second procedure are incremental.

    Comment: Some commenters questioned whether the reduced payment for multiple procedures applied to the beneficiary coinsurance as well as to the Medicare program payment. Others did not understand how this reduced payment was accounted for in determining the conversion factor.

    Response: The reduced payment for multiple procedures would apply to both the beneficiary coinsurance and the Medicare payment. In order to do this in a “budget neutral” manner, we increased the conversion factor to account for the reduced payments for multiple procedures. In this way, total payments in the aggregate are not affected.

    Comment: One commenter believes we should exclude from the multiple-procedure discount those procedures that were subject to a 50 percent reduction under the previous cost-based system because those procedures were recognized as being an adjunct to a primary procedure. The commenter believes that we had already factored these discounts into our cost determinations and would therefore be inappropriately reducing payment even further for these procedures.

    Response: We disagree with the commenter. In determining the weights for the APC groups, we included only single procedure claims. Multiple procedure reductions existing under the previous cost-based system would not have been reflected in these single procedure claims, and, therefore, do not affect the APC payment weights.

    Final Action

    Under the hospital outpatient PPS, we will discount payment amounts for surgical procedures when more than one procedure is performed during a single operative session or when a surgical procedure is terminated prior to completion. Parallel discounts will apply to beneficiary coinsurance amounts.

    8. Payment for New Technology Services

    a. Background

    We proposed to price a new item or service that was assigned a new HCPCS code by classifying the new code to whichever existing APC group most closely resembled the item or service in terms of its clinical characteristics and estimated resource use. We proposed to use the group weight, payment rate, and coinsurance amount established for the existing APC to price the new code for at least 2 years to give us an opportunity to collect cost data for the new item or service.

    After we published our proposed rule, the Congress expressed concern in the conference report accompanying the BBRA 1999, that our proposed PPS does not adequately address “issues pertaining to the treatment of * * * new technology.” (See H. R. Rep. No. 436 (Part I), 106th Cong., 1st Sess. 868 (1999).) Therefore, the Congress enacted “transitional pass-throughs” in section 201(b) of the BBRA 1999 that provide an additional payment for “new medical devices, drugs, and biologicals” that do not otherwise meet the definition of current orphan drugs, or current cancer therapy drugs and biologicals and brachytherapy, or current radiopharmaceutical drugs and biological products. (See section III.D of this preamble for a discussion of how we are implementing the transitional pass-throughs.)

    b. Comments and Responses

    Comment: The most frequent commenters regarding our treatment of new technology under the proposed Start Printed Page 18477hospital outpatient PPS were device manufacturers and pharmaceutical companies and their trade associations. Commenters were concerned because the proposed APC payment rates were developed using 1996 cost data that do not reflect the cost of many new technologies introduced subsequent to 1996. Commenters believe that the proposed method of ratesetting under the APC system lacks the flexibility needed to recognize emergent technologies in a timely manner. In the view of the commenters, assigning new technologies to existing APC groups pending the collection of cost data would result in underpayment, thereby discouraging the adoption of new technologies.

    Commenters further stated that the proposed payment rates for current yet relatively new devices were too low and would favor continued use of older, less effective regimens on the basis of financial pressures rather than on the improved clinical outcomes of newer technology. Some commenters, concerned that we will not update codes or payment rates quickly enough to allow hospitals to pay for new technologies, recommended that we assign HCPCS codes as soon as products become available and alter APC group weights to account for a new technology. These commenters believe that the time lapse between coding updates is a barrier to innovation because it can take several years for a code to be issued for a new surgical technique, and until a new code is issued, facilities must bill for new surgical techniques as “unlisted procedures” resulting in the lowest payment rate for the category of surgery.

    One commenter urged that we implement a payment carve-out for certain drug and biological therapies and pay for these items on a reasonable cost basis in order to provide timely patient access to many new pharmaceutical and biotechnology products. The same commenter recommended that if we reject a complete carve-out, then, at a minimum, we should pay for new products introduced after 1996 on a reasonable cost basis for 1 year to adequately compensate companies for developing new and more effective products. Another commenter recommended that we increase the number of APC groups to better reflect services with similar cost structures.

    One professional association recommended abandoning the APC group system altogether and pricing services individually because assigning new technology and most costly procedures to APC groups with established lower cost procedures creates a strong disincentive for hospitals to provide new or improved items or services and, in the case of newer, higher cost drugs, encourages hospitals to develop formularies and practice patterns based on financial considerations rather than on the medical value of drugs.

    Technologies that commenters cited as being inadequately addressed by the proposed outpatient PPS include new technologies based on molecular genetics; gamma knife procedures used in radiation surgery; and prostatic microwave thermotherapy (transurethral microwave thermotherapy (TUMT)) which a commenter said has a direct cost of $1,918 and, factoring in indirect costs, a total cost of $2,623.

    Response: The concerns expressed by commenters regarding new technology items and services highlight two issues. The first is specific to the data used to construct APC groups and calculate their prices at the start of the PPS. As required by section 1833(t)(2)(C) of the Act, we are using claims data from 1996 as the basis for determining APC group weights and payment rates under the new system. The 1996 data do not capture items and services that have emerged since that time and that are now in use. The second issue relates to new items and services that will be introduced in the future, after the outpatient PPS is implemented. Postponing the adjustment of APC groups and weights for several years to allow for the collection of cost data would potentially inhibit the dissemination of medically desirable innovations.

    We recognize the concerns raised by commenters about our proposed treatment of new codes under the hospital outpatient PPS. We therefore have developed a process that we believe will allow us to recognize new technologies on an ongoing basis as expeditiously as our systems permit. We expect that this process, which we explain below, combined with the transitional pass-throughs established by section 201(b) of the BBRA 1999 (which we describe in section III.D of this preamble), will provide additional payment for a significant share of new technologies.

    In this final rule, we have created special APC groups to accommodate payment for new technology services. In contrast to the other APC groups, the new technology APC groups do not take into account clinical aspects of the services they are to contain, but only their costs. We will assign new items and services that we determine cannot appropriately be placed in existing APC groups for established procedures and services to the new technology APC groups.

    The new technology APC groups, which are now largely unpopulated, are already defined in our claims processing system for the outpatient PPS, and we have established payment rates for the APC groups based on the midpoint of ranges of possible costs, for example, the payment amount for a new technology APC group reflecting a range of costs from $300 to $500 would be set at $400. The cost range for the groups reflects current cost distributions, and we reserve the right to modify the ranges as we gain experience under the outpatient PPS. The final APC groups for new technology are groups 0970 through 0984 and cover a range of costs from less than $50 to $6,000. Upon implementation of the outpatient PPS, we will make payment for the following new technology services under the new technology APCs:

    53850 Transurethral destruction of prostate tissue; by microwave thermotherapy

    53852 Transurethral destruction of prostate tissue; by radiofrequency thermotherapy

    96570 Photodynamic therapy, first 30 minutes

    96751 Photodynamic therapy, each additional 15 minutes

    G0125 PET lung imaging of solitary pulmonary nodules, using 2-(Fluorine-18)-Fluoro-2-Deoxy-D-Glucose (FDG), following CT (71250/71260 or 71270)

    G0126 PET lung imaging of solitary pulmonary nodules, using 2-(Fluorine-18)-Fluoro-2-Deoxy-D-Glucose (FDG), following CT (71250/71260 or 71270); initial staging of pathologically diagnosed non-small cell lung cancer

    G0163 Positron emission tomography (PET), whole body, for recurrence of colorectal metastatic cancer

    G0164 Positron emission tomography (PET), whole body, for staging and characterization of lymphoma

    G0165 Positron emission tomography (PET), whole body, for recurrence of melanoma or melanoma metastatic cancer

    G0166 External counterpulsation, per treatment session

    G0168 Wound closure by adhesive

    The new technology APC groups give us a mechanism for initiating payment at an appropriate level within a relatively short timeframe, and certainly less than the 2 or 3 years that we contemplated in our proposed rule. As in the case of items qualifying for the transitional pass-through payment, placement in a new technology APC will be temporary. After we gain information about actual hospital costs incurred to furnish a new technology service, we will move it to a clinically-related APC group with comparable resource costs. If we cannot move the new technology service to an existing Start Printed Page 18478APC because it is dissimilar clinically and with respect to resource costs from all other APCs, we will create a separate APC for such service. We will retain a service within a new technology APC group for at least 2 years, but no more than 3 years, consistent with the time duration allowed for the transitional pass-through payments. Movement from a new technology APC to a clinically-related APC would occur as part of the annual update of APC groups. Beneficiary coinsurance amounts for items and services in the new technology APC groups are 20 percent of the payment rate set for the new technology APCs.

    We ask that interested parties take the following steps to bring to our attention services that they believe merit consideration for pricing using the new technology APC groups. Mail requests for consideration of possible new technology services that have established HCPCS codes to the following address ONLY: PPS New Tech/Pass-Throughs, Division of Practitioner and Ambulatory Care, Mailstop C4-03-06, Health Care Financing Administration, 7500 Security Boulevard, Baltimore, MD 21244-1850.

    To be considered, requests MUST include the following information:

    • Trade/brand name of item.
    • A detailed description of the clinical application of the item, including HCPCS code(s) to identify the procedure(s) with which the item is used.
    • Current cost of the item to hospitals (i.e., actual cost paid by hospitals net of all discounts, rebates, and incentives in cash or in-kind). In other words, submit the best and latest information available that provides evidence of the hospital's actual cost for a specific item.
    • If the item is a service, itemize the costs required to perform the procedure, e.g., labor, equipment, supplies, overhead, etc.
    • If the item requires FDA approval/clearance, submit information that confirms receipt of FDA approval/clearance and the date obtained.
    • If the item already has an assigned HCPCS code, include the code and its descriptor in your submission plus a dated copy of the HCPCS code “recommendation application” previously submitted for this item.
    • If the item does not have an assigned HCPCS code, follow the procedure discussed, below, for obtaining HCPCS codes and submit a copy of the application with our payment request.
    • Name, address, and telephone number of the party making the request.
    • Other information as HCFA may require to evaluate specific requests.

    We believe some items not yet known to us do not yet have assigned HCPCS codes. We expect to use national HCPCS codes in the hospital outpatient PPS to the greatest extent possible. These codes are established by a well-ordered process that operates on an annual cycle, starting with submission of information by interested parties due by April 1 and leading to announcement of new codes in October of each year. This process is described, and relevant application forms are available, on the following HCFA website: http://www.hcfa.gov/​medicare/​hcpcs.htm.

    Considering the exigencies of implementing a new system, we intend to establish temporary codes in 2000 to permit implementation of additional payments for other eligible items effective beginning October 1, 2000. The process for submitting information will be the same as for national codes.

    For new technology services that DO NOT have established HCPCS codes, submit the regular application for a national HCPCS code in accordance with the instructions found on the internet at http://www.hcfa.gov/​medicare/​hcpcs.htm. Send applications for national HCPCS codes to: C. Kaye Riley, HCPCS Coordinator, Health Care Financing Administration, Mailstop C5-08-27, 7500 Security Boulevard, Baltimore, Maryland 21244-1850. A fuller discussion of the HCPCS process and schedule is in section III.D.6 of this preamble.

    Because of staffing and resource limitations, we cannot accept requests by facsimile (FAX) transmission. Because of claims processing systems constraints, a new technology payment rate can only be initiated at the start of a calendar quarter. Since we will update our outpatient PPS quarterly to include new technology additional services, October 1, 2000 is the earliest date that we will implement payment for additional new technology services other than for those items beginning on July 1, 2000. In general, we expect to be able to complete action on requests to assign an item or service to a new technology APC group in about 6 months from the date we receive the request.

    In order to be considered for assignment to a new technology APC group, an item or service must meet the following criteria:

    • The item or service is one that could not have been billed to the Medicare program in 1996 or, if it was available in 1996, the costs of the item or service could not have been adequately represented in 1996 data.
    • The item or service does not qualify for an additional payment under the transitional pass-through provided for by section 1833(t)(6) of the Act, as amended by section 201(b) of the BBRA 1999, and 42 CFR 419.43(e) as a current orphan drug, as a current cancer therapy drug or biological or brachytherapy, as a current radiopharmaceutical drug or biological product, or as a new medical device, drug, or biological.
    • The item or service has a HCPCS code. (See section III.D for additional information about obtaining HCPCS codes.)
    • The item or service falls within the scope of Medicare benefits under section 1832(a) of the Act.
    • The item or service has been determined to be reasonable and necessary in accordance with section 1862(a)(1)(A) of the Act.

    Final Action

    We are initiating a method to pay for new technology services that are not addressed by the transitional pass-through provisions of the BBRA 1999.

    D. Transitional Pass-Through for Innovative Medical Devices, Drugs, and Biologicals

    1. Statutory Basis

    Section 201(b) of the BBRA 1999 amended section 1833(t) of the Act by adding a new section 1833(t)(6). This provision requires the Secretary to make additional payments to hospitals for a period of 2 to 3 years for specific items. The items designated by the law are the following: current orphan drugs, as designated under section 526 of the Federal Food, Drug, and Cosmetic Act; current drugs, biologic agents, and brachytherapy devices used for treatment of cancer; current radiopharmaceutical drugs and biological products; and new medical devices, drugs, and biologic agents, in instances where the item was not being paid for as a hospital outpatient service as of December 31, 1996, and where the cost of the item is “not insignificant” in relation to the hospital outpatient PPS payment amount. In this context, “current” refers to those items for which hospital outpatient payment is being made on the first date the new PPS is implemented.

    Section 1833(t)(6)(C)(i) of the Act sets the additional payment amounts for the drugs and biologicals as the amount by which the amount determined under section 1842(o) of the Act (95 percent of the average wholesale price (AWP)) exceeds the portion of the otherwise applicable hospital outpatient department fee schedule amount that Start Printed Page 18479the Secretary determines to be associated with the drug or biological. Section 1833(t)(6)(C)(ii) provides that the additional payment for medical devices be the amount by which the hospital's charges for the device, adjusted to cost, exceed the portion of the otherwise applicable hospital outpatient department fee schedule amount determined by the Secretary to be associated with the device. Under section 1833(t)(6)(D), the total amount of pass-through payments for a given year cannot be projected to exceed an “applicable percentage” of total payments. For a year (or a portion of a year) before 2004, the applicable percentage is 2.5 percent; for 2004 and subsequent years, the applicable percentage is 2.0 percent. If the Secretary estimates that total pass-through payments would exceed the caps, the statute requires the Secretary to reduce the additional payments uniformly to ensure the ceiling is not exceeded.

    Section 201(c) of the BBRA amended section 1833(t)(2)(E) of the Act to require that these pass-through payments be made in a budget neutral manner. In accordance with section 1833(t)(7) of the Act, as amended by section 201(i) of the BBRA 1999, these additional payments do not affect the computation of the beneficiary coinsurance amount.

    Implementation of this pass-through provision requires us to—

    • Identify eligible pass-through items;
    • Designate a Billing Code for each;
    • Determine the term “not insignificant” in the context of determining whether an additional payment is appropriate;
    • Determine an appropriate cost-to-charge ratio to use to adjust the hospital's charges for a new medical device to cost;
    • Determine the portion of the applicable APC that would be associated with the drug, biological or device; and
    • Determine the additional payment amount.

    As with other provisions of this final rule that reflect implementation of the BBRA 1999, we are soliciting comments on our implementation of the transitional pass-through payments, as set forth below.

    2. Identifying Eligible Pass-Through Items

    a. Drugs and Biologicals

    Section 1833(t)(6)(A) of the Act establishes definitions and examples of the drugs and biologicals that are candidates for pass-through payments. As indicated above, these drugs and biologicals are characterized as both current and new. Current refers to those drugs and biologicals for which payment is made on the first date the hospital outpatient PPS is implemented, that is, on July 1, 2000. They include the following:

    1. Orphan drugs. These are drugs or biologicals that have been designated as an orphan drug under section 526 of the Federal Food, Drug and Cosmetic Act.

    2. Cancer therapy drugs, biologicals, and brachytherapy. These items are those drugs or biologicals that are used in cancer therapy, including (but not limited to) chemotherapeutic agents, antiemetics, hematopoietic growth factors, colony stimulating factors, biological response modifiers, bisphosphonates, and a device of brachytherapy.

    3. Radiopharmaceutical drugs and biological products. These are radiopharmaceutical drug or biological products used in nuclear medicine for diagnostic, monitoring, or therapeutic purposes.

    A new drug or biological is defined as a product that was not paid as a hospital outpatient service prior to January 1, 1997 and for which the cost is not insignificant in relation to the payment for the APC to which it is assigned. These items are not reflected in the 1996 claims data we are required to use in developing the outpatient PPS. Before payment can be made for these new drugs and biologicals, a determination must be made that these items are reasonable and necessary for the diagnosis or treatment of an illness or injury or to improve the functioning of a malformed body member as required by section 1862(a)(1)(A) of the Act. Drugs that can be self-administered are not covered under Part B of Medicare (with specific exemptions for certain oral chemotherapeutic agents and antiemetics, blood-clotting factors, immunosuppressives, and erythropoietin for dialysis patients).

    b. Medical Devices

    Under section 201(b) of the BBRA 1999, for purposes of making pass-through payments, a new or innovative medical device is one for which payment as a hospital outpatient service was not being made as of December 31, 1996 and for which the cost of the device “is not insignificant” in relation to the hospital outpatient department fee schedule amount payable for the service involved. For the purpose of identifying “new medical devices” that may be eligible for pass-through payments, we are excluding equipment, instruments, apparatuses, implements or items that are generally used for diagnostic or therapeutic purposes, that are not implanted or incorporated into a body part, and that are used on more than one patient (that is, are reusable). This material is generally considered to be hospital overhead costs and the depreciation expenses associated with them are reflected in the APC payments. The unit of payment for the outpatient PPS is a service or procedure. Equipment or instrumentation is a method or means of delivering that service. We are not establishing separate APC payments for equipment, instruments, apparatuses, implements, or items because payment for these types of devices is packaged in the APC payment for the service or item with which they are used. However, as we discuss above in section III.C.8, we have created new technology APCs to accommodate new technology services that may be performed using equipment or instrumentation that is capitalized and depreciated and used on more than one patient. An example of a new technology service is CPT code 53850, Transurethral destruction of prostate tissue; by microwave thermotherapy. We have assigned this procedure to new technology APC 0980. (See section III.C.8 of this preamble for further discussion of payment for new technology under the hospital outpatient PPS.)

    Section 201(e) of the BBRA 1999 amends section 1833(t)(1)(B) of the Act to include as “covered OPD services” implantable items described in paragraphs (3), (6), or (8) of section 1861(s) of the Act. Paragraph (3) refers to diagnostic tests including diagnostic x-rays, mammographies, laboratory tests, and other diagnostic tests. Paragraph (6) refers to implantable durable medical equipment (DME), and paragraph (8) refers to prosthetic devices that replace all or part of an internal body organ (including colostomy bags and supplies directly related to colostomy care). Implantables are not mentioned specifically in these paragraphs, but we consider a prosthetic device that replaces all or part of an internal body organ that is mentioned in section 1861(s)(8) to be an implantable. The BBRA 1999 Conference Report lists pacemakers, defibrillators, cardiac sensors, venous grafts, drug pumps, stents, neurostimulators, and orthopedic implants, as well as items that come in contact with human tissue during invasive procedures as examples of implantable items.

    Implantable items covered under section 201(e) of the BBRA 1999 may be considered eligible for the transitional pass-through payments allowed under Start Printed Page 18480section 201(b) of the BBRA 1999 to the extent that these implantables meet the statutory requirements set forth in section 201(b) and the criteria established in this final rule for payment of these devices.

    Although we are recognizing the implantable items identified in section 201(e) of the BBRA 1999 for possible pass-through payments, we are not applying the pass-through provision to any DME, orthotics, and prosthetic devices that are not covered under section 201(e) of the BBRA 1999. Rather, we will pay for these items under the DMEPOS fee schedule when the hospital is acting as a supplier.

    3. Criteria To Define New or Innovative Medical Devices Eligible for Pass-Through Payments

    In summary, we will make pass-through payment for new or innovative medical devices that meet the following criteria:

    a. They were not recognized for payment as a hospital outpatient service prior to 1997.

    b. They have been approved/cleared for use by the FDA.

    c. They are determined to be reasonable and necessary for the diagnosis or treatment of an illness or injury or to improve the functioning of a malformed body part, as required by section 1862(a)(1)(A) of the Act. We recognize that some investigational devices are refinements of existing technologies or replications of existing technologies and may be considered reasonable and necessary. We will consider devices for coverage under the outpatient PPS if they have received an FDA investigational device exemption (IDE) and are classified by the FDA as Category B devices. (See §§ 405.203 to 405.215.) However, in accordance with § 405.209, payment for a nonexperimental investigational device “is based on, and may not exceed, the amount that would have been paid for a currently used device serving the same medical purpose that has been approved or cleared for marketing by the FDA.”

    d. They are an integral and subordinate part of the procedure performed, are used for one patient only, are surgically implanted or inserted, and remain with that patient after the patient is released from the hospital outpatient department.

    e. The associated cost is not insignificant in relation to the APC payment for the service in which the innovative medical equipment is packaged. (See section III.D.4 below for the definition of “not insignificant.”)

    f. They are not equipment, instruments, apparatuses, implements, or such items for which depreciation and financing expenses are recovered as depreciable assets as defined in Chapter 1 of the Medicare Provider Reimbursement Manual (HCFA Pub. 15-1). (As indicated above, these costs are considered overhead expenses that have been factored into the APC payment.)

    g. They are not materials and supplies such as sutures, clips, or customized surgical kits furnished incident to a service or procedure.

    h. They are not materials such as biologicals or synthetics that may be used to replace human skin.

    Comment: Some commenters asked how we would pay for new technology intraocular lenses (IOLs) under the hospital outpatient PPS.

    Response: We will use the same criteria established in the June 16, 1999 final rule (64 FR 32198) titled “Medicare Program; Adjustment in Payment Amounts for New Technology Intraocular Lenses Furnished by Ambulatory Surgical Centers” to identify IOLs that may be considered new technology and eligible for pass-through payments. In accordance with that rule, IOLs must first be approved by the FDA before they can be considered as a new technology IOL. The rule establishes only one criterion for distinguishing new technology IOLs from other IOLs. Specifically, all claims of the IOL's clinical advantages and superiority over existing IOLs must have been approved by the FDA for labeling and advertising purposes. For further discussion on the reasons for relying on the FDA's determination, we refer the reader to the IOL proposed rule published on September 4, 1997 (62 FR 46700 through 46701). We recognize that this criterion has been developed to define the characteristics that distinguish a new technology IOL from other IOLs in order to comply with section 141(b) of the Social Security Act Amendments of 1994 (Pub. L. 103-432) that is specific to IOLs furnished in ASCs and not hospital outpatient departments. However, we believe that it is appropriate to rely on an established approach to assist us in distinguishing this new technology since more than 1 million IOLs are inserted annually during or subsequent to cataract surgery performed in the outpatient setting. Moreover, we believe that consistent application of the criterion in both the ASC and hospital outpatient prospective payment systems is less burdensome to those requesting recognition of new technology IOLs. Therefore, when IOLs that are recognized as “new technology IOLs” in accordance with the provisions of the June 16, 1999 final rule are furnished in a hospital outpatient setting, we will pay for such new technology IOLs in accordance with the hospital outpatient PPS method for determining additional payments under the pass-through provision set forth in this final rule.

    Comment: We received many comments urging that we establish appropriate payments for brachytherapy seeds used in the treatment of prostate cancer.

    Response: In accordance with section 1833(t)(6)(A)(ii), as added by section 201(b) of the BBRA 1999, we will provide additional payments for brachytherapy seeds as an implanted device. The brachytherapy device is assigned to APC 0918.

    4. Determination of “Not Insignificant” Cost of New Items

    Section 1833(t)(6)(A)(iv)(II) of the Act, as added by section 201(b) of the BBRA 1999 provides that the transitional pass-throughs apply to new drugs, biologicals, and devices whose cost is not insignificant in relation to the hospital outpatient PPS payment amount. Section 1833(t)(6)(C) defines the additional payment as the difference between an amount specified by the law and the portion of the applicable fee schedule amount determined to be associated with the item. The objective of this section is to prevent the hospital outpatient PPS from creating disincentives for the diffusion of valuable new technology by initially paying a rate significantly below the costs of these items. We believe that the “not insignificant” criterion was included in recognition that: (1) The costs of some new technologies would not be large enough relative to the fee schedule amount to provide disincentives for their use in the short run; and (2) that an excessive number of pass-through items could place a substantial burden on the claims processing systems of both HCFA and individual hospitals in a way that could hamper the rapid processing of pass-through payments for those items that would be significantly more costly than the applicable fee schedule amount. Therefore, in order to be consistent with the objectives of this section, we are establishing the following criteria for determining whether the costs of drugs, biologicals, and devices are “not insignificant” relative to the hospital outpatient department fee schedule amount:

    (1) Its expected reasonable cost exceeds 25 percent of the applicable fee schedule amount for the associated service. Start Printed Page 18481

    (2) The expected reasonable cost of the new drug, biological, or device must exceed the portion of the fee schedule amount determined to be associated with the drug, biological, or device by 25 percent.

    (3) The difference between the expected, reasonable cost of the item and the portion of the hospital outpatient department fee schedule amount determined to be associated with the item exceed 10 percent of the applicable hospital outpatient department fee schedule amount.

    The following illustrates the application of these three criteria.

    Example: Let us assume that the reasonable cost of the new device ZZ is $32.00. ZZ is associated with HCPCS code 00000 assigned to APC 0001. The fee schedule amount for APC 0001 is $100.00. The portion of the fee schedule amount included in APC 0001 that represents the cost associated with the former device is $25.00.

    1. (a) Multiply the fee schedule amount for APC 0001 by 25 percent

    $100.00 × .25 = $25.00

    (b) Compare the reasonable cost for ZZ to the product derived in Step 1

    $32.00 > $25.00

    Finding: The first criterion is met.

    2. (a) Multiply the portion of the fee schedule amount for APC 0001 that is associated with a device by 25 percent

    $25.00 × .25 = $6.25

    (b) Subtract the portion of the fee schedule amount for APC 0001 attributable to a device from the reasonable cost for ZZ

    $32.00 − $25.00 = $7.00

    (c) Compare the remainder in Step 4 to the product in Step 2(a)

    $7.00 > $6.25

    Finding: The second criterion is met.

    3. (a) Multiply the fee schedule amount for APC 0001 by 10 percent

    $100.00 × .10 = $10.00

    (b) Compare the remainder in Step 3 to the product derived in Step 3(a)

    $7.00 < $10.00

    Finding: The third criterion is not met. Therefore, new device ZZ is not eligible for transitional pass-through payment.

    5. Calculating the Additional Payment

    Section 1833(t)(6)(C)(i) of the Act requires that for drugs, biologicals, and radiopharmaceuticals, the additional payment be determined as the difference between the amount determined under section 1842(o) of the Act (95 percent of AWP) and the portion of the hospital outpatient department fee schedule amount determined by the Secretary to be associated with those items. For devices, the additional payment is the difference between the hospital's charges adjusted to costs and the portion of the applicable hospital outpatient department fee schedule amount associated with the device. Under section 1833(t)(7) of the Act, as added by section 201(i) of the BBRA 1999, the coinsurance amounts for beneficiaries are not affected by pass-through payments.

    We will determine, on an item-by-item basis, the amount of the applicable fee schedule amount associated with the relevant drug, biological, or device. To the extent possible, hospital outpatient department claims data will be used to make these estimates. When necessary, external data pertaining to the costs of the drugs, biologicals and devices already included in the fee schedule amounts will be used to make these determinations.

    Before January 1, 2002, charges for devices eligible for pass-throughs will be adjusted to cost on each claim by applying the individual hospital's average cost-to-charge ratio across all outpatient departments. The 1996 data do not allow for determination of which revenue center-specific ratios might be used for this purpose. We will examine claims for the latter half of 2000 and for 2001 in order to determine if a revenue center-specific set of cost-to-charge ratios should be used for 2002 and beyond.

    A one-time exception to the general methodology described above pertains to current drugs and biologicals that will be eligible for transitional pass-throughs when the PPS is implemented. For this final rule, we revised many APC groups by removing, to the extent possible, many of these drugs and radiopharmaceuticals. Therefore, the payment rates for the APC groups with which these drugs are associated exclude the costs of these drugs and the total amount paid to hospitals for the drugs will be 95 percent of the applicable AWP. In order to be able to determine a coinsurance amount for these drugs, we needed to estimate what portion of this payment would have been included as part of the APC payment amount associated with these drugs and what portion would be the pass-through amount. Using an external survey of hospitals' drug acquisition costs, we determined the APC payment amount for many of these drugs as their average acquisition cost adjusted to year 2000 dollars. Where valid cost data were not available for individual drugs, we applied the following average ratios of acquisition cost to AWP calculated from the survey to determine the fee schedule amount: .68 for drugs with one manufacturer, .61 for multi-source drugs, and .43 multi-source drugs with generic competitors. In either case, the coinsurance amounts were determined as 20 percent of these fee schedule amounts. It is important to note that these estimates do not affect the total payment to hospitals for these drugs (95 percent of AWP).

    Because claims data are not available for most items that will be eligible for transitional pass-through payments for 2000 and 2001, it is extremely difficult to project expenditures under this provision. For this reason, and because many eligible items will be added after the system's implementation, we cannot estimate if, and to what extent, these payments would exceed 2.5 percent of total payments in 2000 and 2001. Therefore, there will be no uniform reduction factor applied to these payments during this period.

    6. Process To Identify Items and To Obtain Codes for Items Subject to Transitional Pass-Throughs

    We have identified a large number of items subject to the transitional pass-through payment through our own data-gathering activities or through comments on the proposed rule. Many of them already have HCPCS codes, and we are taking steps to establish temporary codes for the remaining items. We will make additional payments for these items when the hospital outpatient PPS system is implemented on July 1. A list of the items already known to us is set forth in Addendum K.

    Other items potentially eligible for additional pass-through payments may not be known to us at this time. Because of systems limitations, if we do not know about an item, we will not be able to make additional payments for those items beginning on July 1, 2000. However, we will update our outpatient PPS on a quarterly basis beginning October 1, 2000 to add other items that are eligible for pass-through payments. Therefore, implementation of additional payment for any such item must wait until a later release of systems instructions, that is, in October 2000, January 2001 (annual update), or later.

    A manufacturer or other interested party who wishes to bring items that may be eligible for additional transitional pass-through payments to our attention should mail requests for consideration of items to the following address ONLY: PPS New Tech/Pass-Throughs, Division of Practitioner and Ambulatory Care, Mailstop C4-03-06, Health Care Financing Administration, Start Printed Page 184827500 Security Boulevard, Baltimore, MD 21244-1850.

    To be considered, requests MUST include the following information:

    • Trade/brand name of item.
    • A detailed description of the clinical application of the item, including HCPCS code(s) to identify the procedure(s) with which the item is used. If the item replaces or improves upon an existing item, identify the predecessor item by trade/brand name and HCPCS code.
    • Current cost of the item to hospitals (i.e., actual cost paid by hospitals net of all discounts, rebates, and incentives in cash or in-kind). In other words, submit the best and latest information available that provides evidence of the hospital's actual cost for a specific item.
    • Date of sale of first unit.
    • For drugs, submit the most recent average wholesale price (AWP) of the drug and the date associated with the AWP quote.
    • If the item requires FDA approval/clearance, submit information that confirms receipt of FDA approval/clearance and the date obtained.
    • If the item already has an assigned HCPCS code, include the code and its descriptor in your submission plus a dated copy of the HCPCS code “recommendation application” previously submitted for this item.
    • If the item does not have an assigned HCPCS code, follow the procedure discussed, below, for obtaining HCPCS codes and submit a copy of the application with your payment request.
    • Name, address, and telephone number of the party making the request.
    • Other information as HCFA may require to evaluate specific requests.

    We believe some items not yet known to us do not yet have assigned HCPCS codes. We expect to use national HCPCS codes in the hospital outpatient PPS to the greatest extent possible. These codes are established by a well-ordered process that operates on an annual cycle, starting with submission of information by interested parties due by April 1 and leading to announcement of new codes in October of each year. This process is described, and relevant application forms are available, on the following HCFA website: http://www.hcfa.gov/​medicare/​hcpcs. htm.

    Considering the exigencies of implementing a new system, we intend to establish temporary codes in 2000 to permit implementation of additional payments for other eligible items effective beginning October 1, 2000. The process for submitting information will be the same as for national codes.

    For items that might be candidates for additional transitional pass-through payments but that DO NOT have established HCPCS codes, submit the regular application for a national HCPCS code in accordance with the instructions found on the internet at http://www.hcfa.gov/​medicare/​hcpcs.htm. Send applications for national HCPCS codes to: C. Kaye Riley, HCPCS Coordinator, Health Care Financing Administration, Mailstop C5-08-27, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

    Because of staffing and resource limitations, we cannot accept requests by facsimile (FAX) transmission.

    As indicated in the instructions posted at our website address cited above, the deadline for submission of applications for a national HCPCS code for the CY 2001 cycle is April 1, 2000. The HCPCS process will proceed to assign national codes as warranted, and we expect these codes will be used in the hospital outpatient PPS starting January 1, 2001. Because the coding application will contain information vital to determining a specific item or product's eligibility for pass-through payments, we are requesting that a copy of the application be sent concurrently to ATTN: PPS New Tech/Pass-Throughs at the address shown above.

    This year, we plan to implement additional payment for appropriate items on October 1, 2000. Requests submitted to us with appropriate information will be evaluated for payment effective October 1. We will use the same submissions made for national HCPCS codes as the basis for making temporary code assignments. However, a very large volume of requests or systems constraints could affect our ability to achieve this goal.

    Any applications for HCPCS codes that are received after April 1 will be retained for the next cycle of the national HCPCS code assignment process starting the following April 1. We will also consider these items for assignment of temporary codes that might take effect in January or later in the next year.

    How quickly additional payment for a new item can be implemented will depend on processing and systems constraints; it will in general require at least 6 months and may require as many as 9 or more months. Thus, a submission that we receive in May (which is too late for October implementation) might be assigned a temporary code to be used for implementing additional payments starting the following January.

    As previously stated, pass-through payment for each item is temporary. After we obtain information about actual hospital costs incurred to furnish a pass-through item, we will package it into the service with which it is clinically associated.

    Comment: A number of commenters expressed concern about the extensive amount of time required to obtain HCPCS codes for new items or services. They argued that the lag-time in coding updates creates a barrier to innovation, claiming that it can be several years before a code is issued for a new surgical technique or product. Some commenters noted that when facilities are forced to code new surgical techniques as “unlisted procedures,” pending issuance of a specific code for the procedure, it would result in the facility receiving payment for the lowest related APC group. Some commenters recommended that we assign HCPCS codes as soon as products become available.

    Response: We recognize the urgency expressed by commenters. We believe the process we have outlined above will assist interested parties in obtaining HCPCS codes for new items and services in the most expeditious manner possible within the constraints imposed by our system requirements.

    E. Calculation of Group Weights and Conversion Factor

    1. Group Weights (Includes Table 1, Packaged Services by Revenue Center)

    Section 1833(t)(2)(C) of the Act requires the Secretary to establish relative payment weights for covered hospital outpatient services. That section requires that the weights be developed using data on claims from 1996 and data from the most recent available hospital cost reports. Before enactment of the BBRA 1999, we were required to base the relative payment weights on median hospital costs. Section 201(f) of the BBRA 1999 amended section 1833(t)(2)(ii) of the Act to authorize the Secretary to base the relative payment weights on either the median or mean hospital costs. In constructing the database for the outpatient PPS proposed rule group weights and conversion factor, we used a universe of approximately 98 million calendar year 1996 final action claims for hospital outpatient department services received through June 1997 to match to the most recent hospital cost reports available. We have decided to continue to base the relative payments weights in this final rule on median (as opposed to mean) costs because, among other things, reconstructing our database to evaluate the impact of using mean costs after the BBRA 1999 was Start Printed Page 18483enacted would have delayed implementation of the hospital outpatient PPS.

    To derive weights based on median hospital costs for services in the hospital outpatient APC groups, we converted billed charges to costs and aggregated them to the procedure or visit level. To accomplish this, we first identified the cost-to-charge ratio that was specific to each hospital's cost centers (“cost center specific cost-to-charge ratios” or CCRs). We then developed a crosswalk to match the hospital's CCRs to revenue centers used on the hospital's 1996 outpatient bills. The CCRs included operating and capital costs but excluded costs associated with direct graduate medical education and allied health education.

    To determine the hospital CCRs, the most recent available cost report from each hospital was identified. For the proposed rule, we used cost reports from cost reporting periods beginning on or after October 1, 1994 and before October 1, 1995 (referred to as PPS-12) or earlier. For this final rule, more recent cost reports were available for hospitals. We used cost reports from cost reporting periods beginning on or after October 1, 1996 and before October 1, 1997 (PPS-14) for approximately 94 percent of the hospitals in our database.

    If the most recent available cost report for a hospital was one that had been submitted but not settled, we calculated a factor to adjust for the differences that generally exist between settled and “as submitted” cost reports. The adjustment factor was determined by dividing the outpatient department cost-to-charge ratio from the hospital's most recent settled cost report by the outpatient department cost-to-charge ratio from the hospital's “as submitted” cost report for the same period. The resulting ratio was used to adjust each of the CCRs in the hospital's most recent “as submitted” cost report. We repeated this process for every hospital for which the most recent available cost report was a cost report that had not been settled.

    The Office of Inspector General (OIG) for DHHS is concerned that the cost reports we are using may reflect some unallowable costs. Therefore, the OIG, in conjunction with HCFA, is proposing to examine the extent to which the cost reports used reflect costs that were inappropriately allowed. If this examination reveals excessive inappropriate costs, we will address this issue in a future proposed rule, or perhaps seek legislation to adjust future payment rates downward.

    We next eliminated from the hospital CCR database 258 hospitals that we have identified as having reported charges on their cost reports that were not actual charges (for example, they make uniform charges for all services). These excluded hospitals were Kaiser, New York Health and Hospital Corporation, and all-inclusive rate hospitals. After removing these hospitals, we calculated the geometric mean of the total operating CCRs of hospitals remaining in our CCR database. We identified 58 hospitals whose total operating CCR exceeded the geometric mean by more than 3 standard deviations. These hospitals were also removed from our CCR database.

    After assembling and editing our new CCR database, we matched revenue centers from approximately 80 million claims to CCRs of approximately 5,700 hospitals. We excluded from the crosswalk approximately 15 million claims in which the bill type denoted services that would not be covered under the PPS (for example, bill type 72X for dialysis services for patients with ESRD). We also excluded almost 3 million claims from the hospitals that we had removed or trimmed from the hospital CCR database. The table below shows the five cost reporting periods used and the percentage of the cost reports within each PPS period for which we were able to match 1996 claims.

    Reporting periodPercentage of cost reports matched
    PPS-15 (cost reporting period beginning on or after 10/1/97 and before 10/1/98)0.1
    PPS-14 (cost reporting period beginning on or after 10/1/96 and before 10/1/97)94.2
    PPS-13 (cost reporting period beginning on or after 10/1/95 and before 10/1/96)3.7
    PPS-12 (cost reporting period beginning on or after 10/1/94 and before 10/1/95)1.7
    PPS-11 (cost reporting period beginning on or after 10/1/93 and before 10/1/94)0.3
    Total100.0

    Next, we took the estimated 80 million claims that we had matched with a cost report and separated them into two distinct groups: Single-procedure claims and multiple-procedure claims. Single-procedure claims were those that included 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 included more than one HCPCS code that could be mapped to an APC. There were approximately 45.4 million single-procedure claims and 34.6 million multiple-procedure claims.

    To calculate median costs for services within an APC, we used only the single-procedure bills. (Of the roughly 45.4 million single-procedure claims, about 24 million were excluded from the conversion process largely because the only HCPCS codes reported on the claims were for laboratory procedures or other outpatient services not paid under the outpatient PPS.) This approach was taken because the information on claims does not enable us to specifically allocate charges or costs for packaged items and services such as anesthesia, recovery room, drugs, or supplies to a particular procedure when more than one significant procedure or medical visit was billed on a claim. Use of the single-procedure bills minimizes the risk of improperly assigning costs to the wrong procedure or visit. Although we used only single-procedure/visit bills to determine APC relative payment weights, we used multiple-procedure bills in the conversion factor and service mix calculations, regressions, and impact analyses.

    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 the appropriate cost center did not exist for a given hospital, we crosswalked the revenue center to a secondary cost center when possible, or to 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 this PPS (for example, laboratory, ambulance, and therapy services).

    To calculate the per-procedure or per-visit costs, we used the charges shown in the revenue centers that contained items integral to performing the procedure or visit. These included those items that we previously discussed as being subject to our proposed packaging provision. For instance, in calculating the surgical procedure cost, 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 organ. For medical visit cost estimates, we included charges for items such as medical and surgical supplies, drugs, and observation. A complete listing of the revenue centers that we used is shown below in Table 1, Packaged Services by Revenue Center.Start Printed Page 18484

    Table 1.—Packaged Services by Revenue Center

    ASC AND OTHER 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
    276 INTRAOCULAR LENS
    279 OTHER M&S SUPPLIES
    370 ANESTHESIA
    379 OTHER ANESTHESIA
    390 BLOOD STORAGE AND PROCESSING
    399 OTHER BLOOD STORAGE AND PROCESSING
    630 DRUGS REQUIRING SPECIFIC IDENTIFICATION, GENERAL CLASS
    631 SINGLE SOURCE DRUG
    632 MULTIPLE SOURCE DRUG
    633 RESTRICTIVE PRESCRIPTION
    700 CAST ROOM
    709 OTHER CAST ROOM
    710 RECOVERY ROOM
    719 OTHER RECOVERY ROOM
    720 LABOR ROOM
    721 LABOR
    723 CIRCUMCISION
    762 OBSERVATION ROOM
    810 ORGAN ACQUISITION
    819 OTHER ORGAN ACQUISITION
    890 OTHER DONOR BANK
    891 BONE
    892 ORGAN
    893 SKIN
    899 OTHER DONOR BANK
    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
    630 DRUGS REQUIRING SPECIFIC IDENTIFICATION, GENERAL CLASS
    631 SINGLE SOURCE DRUG
    632 MULTIPLE SOURCE DRUG
    633 RESTRICTIVE PRESCRIPTION
    700 CAST ROOM
    709 OTHER CAST ROOM
    762 OBSERVATION ROOM
    OTHER DIAGNOSTIC (BLENDED SERVICES)
    254 PHARMACY INCIDENT TO OTHER DIAGNOSTIC
    372 ANESTHESIA INCIDENT TO OTHER DIAGNOSTIC
    622 SUPPLIES INCIDENT TO OTHER DIAGNOSTIC
    710 RECOVERY ROOM
    719 OTHER RECOVERY ROOM
    762 OBSERVATION ROOM
    RADIOLOGY SUBJECT TO THE FEE SCHEDULE AND OTHER RADIOLOGY
    255 PHARMACY INCIDENT TO RADIOLOGY
    371 ANESTHESIA INCIDENT TO RADIOLOGY
    621 SUPPLIES INCIDENT TO RADIOLOGY
    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
    630 DRUGS REQUIRING SPECIFIC IDENTIFICATION, GENERAL CLASS
    631 SINGLE SOURCE DRUG
    632 MULTIPLE SOURCE DRUG
    633 RESTRICTIVE PRESCRIPTION
    762 OBSERVATION ROOM

    We then applied to these cost estimates an adjustment to calibrate the costs to calendar year 1996 for those services in hospitals whose CCRs were calculated using FY 1997 or later cost reports. On average, hospital charges were rising faster than costs in FY 1997. We therefore made this adjustment for the calculation of the weights, as well as for the hospital costs used in the conversion factor and impact model, to ensure that we did not underestimate costs and payments. We based this hospital specific CCR adjustment on the observed change in each hospital's overall CCR (total operating + total capital) from the proposed rule cost report database to the new final rule database. If applicable, we then calculated a monthly rate of change and applied it based on the number of months past 1996 encompassed in a hospital's cost reporting period; if a hospital's period coincided completely within calendar year 1996, no adjustment was made.

    After calibrating the costs to calendar year 1996, 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 FY 2000 hospital inpatient prospective payment system wage index published in the Federal Register on July 30, 1999 (64 FR 41585). As in the proposed rule and correction notice, we used 60 percent to represent our estimate of that portion of costs attributable, on average, to labor. A more detailed discussion of wage index adjustments is found below in section III.G of this document.

    The standardized labor-related cost and the nonlabor-related cost component were summed for each billed item to derive the total standardized cost for each procedure or medical visit. Extremely unusual costs that appeared to be errors in the data were trimmed from standardized procedure and visit costs. This trimming methodology is analogous to that used in calculating the DRG weights for the inpatient PPS: eliminate any bills with costs outside of 3 standard deviations from the geometric mean. We used the geometric mean and the associated standard deviation because the distribution of costs more closely resembles a lognormal distribution than a normal distribution: There are no negative costs, and the average cost is greater than the median cost. Use of the geometric mean minimizes the impact of the most unusual bills in the determination of the mean. The geometric mean is calculated by taking the mean of the natural logarithm cost. Because the distribution of the natural logarithms of a set of numbers is more compact than the distribution of the numbers themselves, bills with extreme costs do not appear as extreme as they would if non-logged costs were examined. This ensures that only the most aberrant data will be removed from the calculation.

    After trimming the procedure and visit level costs, we mapped each procedure or visit cost to its assigned APC and calculated the median cost for each APC weighted by procedure volume. Using the median APC costs, we calculated the relative payment weights for each APC. We scaled all the relative payment weights to APC 601, a mid-level clinic visit, because it is one of the most frequently performed services. This approach is consistent with that used in developing relative value units for the Medicare physician fee schedule. By assigning APC 601 a relative payment weight of 1.0, hospitals can easily compare the relative relationship of one APC to another. Next, we divided the median cost for each APC by the median cost for a mid-level clinic visit, APC 601, to derive the relative payment weight for each APC. Start Printed Page 18485The median cost for APC 601 is $47.00. In the proposed rule, we also used a mid-level clinic visit, APC 91336, which had a median cost of $54.00, as the scaler of APC weights. On average, due to the reduced value of the scaler used for this notice, the final weights will be higher than those published in the proposed rule.

    Comment: Some commenters believe that the ratesetting methodology does not reflect complex cases because we eliminate statistical “outlier” claims from the calculation of the median costs and the weights.

    Response: As noted above, we trimmed claims with estimated costs that were outside of three standard deviations from the geometric mean. Because we removed claims above or below the mean, we corrected for data errors that would have skewed the estimates of median costs and group weights upward or downward. We believe this trim is a valid method of removing extremely unusual costs that are most likely associated with data submission errors and do not represent actual costs. In addition, it is consistent with the method we use to set inpatient hospital diagnosis-related group (DRG) weights.

    Comment: Numerous commenters disagreed with our use of single-procedure claims only in the calculation of the relative payment weights. One commenter was concerned that we could be masking differences in resource use attributable to patient characteristics by using only single-procedure claims to calculate relative weights.

    Response: We used single-procedure claims to calculate the relative weight for each APC because we could not accurately allocate costs to a particular procedure when the costs were part of a bill for multiple procedures. Bills with a single major procedure provided are, in most cases, the best estimate of relative procedure costs. It is important to note that for all other calculations, including calculation of the conversion factor, we used both single-procedure and multiple-procedure bills.

    We do not believe that using single-procedure bills biases the relative cost of any particular procedure. Although patients with more complex healthcare needs might have several procedures performed, hospital charges for an individual procedure would not be greater. Our most significant concern was that distribution of single bill procedures within an APC would not reflect the correct distribution of those procedure on all bills. However, careful statistical analyses demonstrated that the distribution of procedures within an APC group did not differ when single bill procedure frequencies were compared with all bills. It is also important to note that when items or services were to be packaged with a major procedure, we added their costs to that procedure prior to making the single bill determination. Therefore, the costs of contrast media, for example, are included in the relative weights. In some cases, we agreed with the commenters that this approach needed to be modified. For example, for chemotherapy, we are not grouping drugs, but rather paying for each one separately. Moreover, as a result of the transitional pass-through provisions of the BBRA 1999, radiopharmaceuticals will be paid separately from the nuclear medicine APCs.

    Comment: Several commenters expressed concern that the 1996 claims data are insufficient or inadequate to develop the PPS model. For example, some commenters asserted that the 1996 data are not recent enough to reflect the current mix of outpatient services. Some commenters also argued that undercoding in the data would lead to underestimates of median costs. Other commenters recommended that we address alleged inadequacies in the data by gathering cost data on new procedures and by basing payment on these data until we can determine whether to place a new procedure in an existing APC or create a new APC.

    Response: While we acknowledge limitations of setting payment rates with historical claims data, section 1833(t)(2)(C) of the Act requires us to use 1996 claims in developing the PPS. We discuss how we will price new procedures that are not reflected in our database in section III.C.8 of this preamble.

    Comment: Commenters were concerned about the cost-to-charge ratios used to estimate median APC costs and pre-BBA payments. For example, one medical organization recommended that we account for the capital-intensive nature of radiology services by adjusting the cost-to-charge ratios applicable to these services for the step-down methodology that allocates capital expenses by square footage. The belief is that these allocation methods underestimate radiological equipment costs and certain cost-to-charge ratios, leading to underestimates of the median costs for relevant APC groups.

    Response: Although capital-related costs may be allocated to routine and ancillary service cost centers using the step-down methodology based on square footage, as an alternative, the “dollar value” method may be used by hospitals. This method is made available to hospitals in Worksheet B-1 of the hospital cost report (HCFA 2552-96). The dollar value method more accurately distributes the capital costs associated with equipment to the revenue-producing cost center to which the equipment is assigned. We are not able to adjust the cost-to-charge ratios of those hospitals that allocate equipment based on square footage because we have no way of knowing which specific equipment costs should be allocated to revenue-producing cost centers in each hospital.

    2. Conversion Factor

    Section 1833(t)(3)(C)(i) of the Act requires that we establish a conversion factor for 1999 to determine the Medicare payment amounts for each covered group of services. For the proposed rule as corrected, we derived the conversion factor from a base amount of payments described in section 1833(t)(3)(A) of the Act, as enacted in the BBA 1997. Such base amount was calculated for the services included in the outpatient PPS as an estimate of the sum of (1) total payments that would be payable from the Trust Fund under the current (non-PPS) payment system in 1999, plus (2) the beneficiary coinsurance that would have been paid under the new (PPS) system in 1999. For the final rule, however, we derived the conversion factor from a base amount that includes beneficiary coinsurance that would have been made under the current (non-PPS) system rather than the proposed (PPS) system. Section 201(l) of the BBRA 1999 states: “With respect to determining the amount of copayments described in paragraph (3)(A)(ii) of section 1833(t) of the Social Security Act, as added by section 4523(a) of the BBA, Congress finds that such amount should be determined without regard to such section, in a budget neutral manner with respect to aggregate payments to hospitals, and that the Secretary of Health and Human Services has the authority to determine such amount without regard to such section.”

    Section 1833(t)(2)(C) of the Act requires us to project utilization for hospital outpatient services. We were unable to make precise projections of increases in the volume and intensity of services because we were not able to quantify some of the factors that affect utilization. For instance, we would anticipate that Medicare beneficiaries who choose to migrate to managed care plans may be healthier than those who choose to stay in fee-for-service plans. Thus, we could assume a decrease in the volume of services coupled with an increase in the intensity of services Start Printed Page 18486furnished for Medicare beneficiaries in the fee-for-service program. Another factor that we believe will affect future utilization is the incentive to code billed services more accurately. Currently, hospitals are paid for the majority of the outpatient services they furnish on a cost basis, and inaccurate or improper coding does not necessarily affect the amount of payment. In contrast, under the PPS, hospitals are required to use HCPCS codes in order to receive payment. We expect that the frequency of some services may increase as a result of the coding requirements. We believe each of these assumptions will affect the reporting of volume and intensity of services, although we are not able to quantify them individually to project 1999 utilization. Therefore, we used what we believe to be a more reliable and valid approach to computing the conversion factor under the methodology described below.

    Comment: A large national trade association commented that the exclusion of claims for unclassified services (for example, those claims for which we cannot identify the service to be paid) from the PPS model could bias the conversion factor downward if the excluded claims have a disproportionate number of services with high payment to cost ratios, such as clinic and emergency room visits.

    Response: In order to set the conversion factor as accurately as possible, we used only claims for which the costs and volume of services could be identified on the bill. As noted by the commenter, this decision resulted in the exclusion of claims with unclassifiable services. Upon examination of these claims, we have determined that services with high payment to cost ratios (those that would gain under the PPS system) were not disproportionately represented. Therefore, we believe the exclusion of unclassifiable services does not bias the conversion factor.

    Setting the Rates

    In order to convert the relative weights determined for each APC (see section III.E.1) into payment rates, we calculated a conversion factor that would result in total estimated payments to hospitals under the PPS in 1999 equal to the total estimated payments that would have been payable from the Trust Fund in 1999 if PPS had not been enacted plus estimated beneficiary coinsurance for the same services during the same period. The prospective payment rate for each APC is calculated by multiplying the APC's relative weight by the conversion factor. For the calculation of the conversion factor, we have excluded all data from the 58 Maryland providers that qualify under section 1814(b)(3) of the Act for payment under the State's payment system. We computed the conversion factor by first adding together the aggregate Medicare hospital outpatient payments made under the cost-based payment system (referred to in this section as pre-PPS payments) for calendar year 1996, plus the estimated beneficiary coinsurance amounts made under pre-PPS law for the same services. We then divided that amount by a wage-adjusted sum of the relative weights for all APCs under the hospital outpatient PPS. The methodology we used to determine current law Medicare hospital outpatient payments and beneficiary coinsurance is discussed below in section III.E.2.a. A discussion of the sum of the relative weights follows in section III.E.2.b.

    a. Calculating Aggregate Calendar Year 1996 Medicare and Beneficiary Payments for Hospital Outpatient Services (Pre-PPS)

    To calculate Medicare hospital outpatient payment amounts before implementation of the PPS, we first identified calendar year 1996 single and multiple procedure bills for all the services that we will recognize under the outpatient PPS. As we identified services that will be paid under the outpatient PPS, we eliminated invalid or noncovered HCPCS codes.

    Hospital payments include both operating and capital costs for the HCPCS coded services for which payment is to be made under the outpatient PPS. We summed these two types of costs by HCPCS code at the provider level. Consolidating the data in this manner allowed us to simulate provider payment on an aggregate basis. Then (as required by section 1861(v)(1)(S)(ii) of the Act as amended by section 201(k) of the BBRA 1999), we applied the capital cost reductions of 10 percent and operating cost reductions of 5.8 percent.

    We determined for each HCPCS code the applicable payment methodology under the current system. Payment before implementation of PPS for procedures in the baseline was calculated using one of the following equations, as appropriate:

    • For radiology procedures paid for under the radiology fee schedule, we determined payment in the aggregate for each provider as the lower of the cost, charge, or blended amount. We use the following equation to determine the radiology blended amount: (0.42 × lower of cost or charge minus beneficiary coinsurance) + (0.58 × ((0.62 × global physician fee schedule amount) − beneficiary coinsurance)).
    • For surgical procedures for which Medicare pays an ASC facility fee, we determined payment in the aggregate for each provider as the lower of the cost, charge, or blended amount. We used the following equation to determine the ASC blended amount: (0.42 × lower of cost or charge minus beneficiary coinsurance) + (0.58 × (ASC payment rate − beneficiary coinsurance)).
    • For diagnostic procedures paid for under the diagnostic fee schedule, we determined payment in the aggregate for each provider as the lower of the cost, charge, or blended amount. We used the following equation to determine the blended amount for diagnostic procedures: (0.50 × lower of cost or charge minus beneficiary coinsurance) + (0.50 × ((0.42 × global physician fee schedule amount) − beneficiary coinsurance)).

    For all other covered services not subject to one of the blended payment method categories, we determined payment as the lower of costs or charges less beneficiary coinsurance. Because the formula-driven overpayment (FDO) was corrected beginning October 1, 1997, the blended equations eliminate FDO.

    We then determined the Medicare payment amount for each provider by summing the aggregate amounts computed for each of the four types of payment methodologies discussed above. In addition, we determined the amount of the beneficiary coinsurance for each provider using the beneficiary coinsurance amounts that would have been paid before implementation of PPS. The total amount (Medicare and beneficiary payments) reflects the amount hospitals would be paid under the PPS and is the numerator in the equation for calculating the unadjusted conversion factor.

    b. Sum of the Relative Weights

    Next we summed the discounted relative weights for services that are within the scope of the outpatient PPS. (See discussion of discounting for surgical procedures in section III.C.7.) Specifically, we multiplied (using single and multiple procedure claims in a hospital) the discounted volume of procedures or visits in each APC group by the relative weights for each APC group; we wage-adjusted 60 percent of this total by each hospital's wage index, and we then summed the wage-adjusted and nonadjusted weights across all hospitals. (The wage indices used are included in Addenda H, I, and J.) The resulting sum equals the denominator in the calculation of the conversion factor. Start Printed Page 18487We calculated the conversion factor by dividing the sum of the discounted relative weights into the total payment explained in section III.E.2.a, above, including both Medicare payment and beneficiary coinsurance. We then adjusted the conversion factor so that the outlier and pass-through payments are implemented in a budget neutral manner, as described in sections III.H.1 and III.D. The adjusted calendar year 1996 conversion factor is $43.023. To inflate the 1996 conversion factor to 1999, our Office of the Actuary estimated an update factor of 1.106. Therefore, the adjusted 1999 conversion factor is $47.583.

    For calendar year 2000, we updated the conversion factor as specified in section 1833(t)(3)(C)(iii) of the Act. The update is the market basket percentage increase applied to hospital discharges occurring during the fiscal year ending in calendar year 2000 minus 1 percentage point. For 2000, the updated conversion factor is $48.487.

    Comment: A number of commenters suggested that we remove the behavioral offset that we proposed to apply to the conversion factor. As proposed, the intent of the offset was to adjust for hospital coding changes that take place in response to reductions in beneficiary coinsurance.

    Response: We have decided not to include a behavioral offset to the conversion factor in this final rule. Hospital coding changes are expected to occur under the outpatient PPS; however, we believe changes that occur during the first PPS years will result from hospitals billing more accurately under the new system. A behavioral offset implemented in the initial PPS years may distort the incentives to bill accurately. We may reconsider implementation of a behavioral offset in future years as we gather data and gain experience under the new system.

    Comment: A large national trade association expressed concern that application of the 5.8 percent and 10.0 percent reduction to costs for all hospital outpatient services included in the PPS model underestimates the conversion factor. They recommended that we exclude the Part B services provided to inpatients who exhaust their Part A benefits from the reductions.

    Response: Our analysis shows that fewer than 5,000 of the more than 80 million claims used to set the conversion factor were associated with these types of services. Total costs associated with these claims were less than $1.4 million, which is too small to have a measurable effect on the conversion factor.

    Comment: Many commenters strongly argued that we misinterpreted the provisions of section 1833(t)(3) of the Act in calculating beneficiary coinsurance for purposes of setting the base amount of the conversion factor. The commenters noted that this methodology contributed significantly to the estimated 5.7 percent reduction in Medicare outpatient payments to hospitals reflected in the proposed rule. Most commenters further argued that the Congress did not intend for this loss to occur and that we had the authority to interpret the methodology described in the statute so that no net change in payments would result from the conversion factor.

    Response: Section 1833(t)(3)(A) of the Act, as added by the BBA 1997, states that, for purposes of calculating the base amount used to determine the conversion factor, the Secretary shall calculate “the total amount of copayments estimated to be paid under this subsection. * * *” (Emphasis added.) For the proposed rule, we estimated the coinsurance that would be paid under PPS. In section 201(l) of the BBRA 1999, the Congress addressed the calculation of the base amount, stating, “With respect to determining the amount of copayments described in paragraph (3)(A)(ii) of section 1833(t) of the Social Security Act, as added by section 4523(a) of the BBA, Congress finds that such amount should be determined without regard to such section, in a budget neutral manner with respect to aggregate payments to hospitals, and the Secretary of Health and Human Services has the authority to determine such amount without regard to such section.” Therefore, for this final rule, we estimated the coinsurance that would have been paid if PPS had not been enacted.

    F. Calculation of Coinsurance Payments and Medicare Program Payments Under the PPS

    1. Background

    In section III.E, above, we explained how we determined APC group weights, calculated an outpatient PPS conversion factor, and determined national prospective payment rates, standardized for area wage variations, for the APC groups. We will now explain how we calculated beneficiary coinsurance amounts for each APC group.

    The outpatient PPS established by section 1833(t) of the Act includes a mechanism designed to eventually achieve a beneficiary coinsurance level equal to 20 percent of the prospectively determined payment rate established for the service. As discussed in the proposed rule, for each APC we calculate an amount referred to in section 1833(t)(3)(B) of the Act as the “unadjusted copayment amount.” The unadjusted coinsurance amount is calculated by taking 20 percent of the national median charges billed in 1996 for the services that are in the APC, trended forward to 1999; however, the coinsurance amount cannot be less than 20 percent of the APC payment rate. The unadjusted coinsurance amount for an APC remains frozen, while the payment rate for the APC is increased by adjustments based on the Medicare market basket. As the APC rate increases and the coinsurance amount remains frozen, the unadjusted coinsurance amount will eventually become 20 percent of the payment rate for all APC groups. Once the unadjusted coinsurance amount is 20 percent of the payment amount, both the APC payment rate and the unadjusted coinsurance amount will be updated by the annual market basket adjustment.

    In the proposed rule, we proposed to not adopt new APCs for new procedures or services for at least 2 years, but instead assign them to existing groups while accumulating data on their costs. In the final rule we do provide for APCs for new procedures that do not fit well into another APC. When an APC is added that consists of HCPCS codes for which we do not have 1996 charge data upon which to calculate the unadjusted coinsurance amount, coinsurance will be calculated as 20 percent of the APC payment amount.

    There is an exception to the coinsurance provisions for screening colonoscopies and screening sigmoidoscopies. Section 4104 of the BBA 1997 provided coverage for colorectal screening. This section, in part, added new sections 1834(d)(2) and (3) to the Act, which provide that for covered screening sigmoidoscopies and colonoscopies performed in hospital outpatient departments and ambulatory surgical centers (ASCs), payment is to be based on the lesser of the hospital or the ASC payment rates and coinsurance for both screening colonoscopies and screening sigmoidoscopies is to be 25 percent of the rate used for payment.

    Section 4104 of the BBA 1997 also allows, at the Secretary's discretion, coverage of screening barium enemas as a colorectal cancer screening tool. We are including screening barium enemas as a covered service under the hospital outpatient PPS. The payment rate for screening barium enemas is the same as for diagnostic barium enemas. Coinsurance for a screening barium enema is based on 20 percent of the APC payment rate. Start Printed Page 18488

    Sections 201(a) and (b) of the BBRA 1999 amend section 1833(t) of the Act to provide for additional payments to hospitals for outlier cases and for certain medical devices, drugs, and biologicals. These additional payments to hospitals will not affect coinsurance amounts. Redesignated section 1833(t)(8)(D) of the Act, as amended by section 201(i) of the BBRA 1999, provides that the coinsurance amount is to be computed as if outlier adjustments, adjustments for certain medical devices, drugs, and biologicals, as well as any other adjustments we may establish under section 1833(t)(2)(E) of the Act, had not occurred. Section 202 of the BBRA 1999 adds a new section 1833(t)(7) to the Act to provide transitional corridor payments to certain hospitals through calendar year 2003 and indefinitely for certain cancer centers.

    Section 1833(t)(7)(H) of the Act provides that the transitional corridor payment provisions will have no effect on determining copayment amounts.

    Section 204(a) of the BBRA 1999 amended redesignated section 1833(t)(8)(C) of the Act to provide that the coinsurance amount for a hospital outpatient procedure cannot exceed the amount of the inpatient hospital deductible for that year. The inpatient hospital deductible for calendar year 2000 is $776.00. We will apply the limitation to the wage adjusted coinsurance amount (not the unadjusted coinsurance amount) after any Part B deductible amounts are taken into account. Therefore, although the published unadjusted coinsurance amount for any APC may be higher or lower than $776.00 in 2000, the actual coinsurance amount for an APC, determined after any deductible amounts and adjustments for variations in geographic areas are taken into account, will be limited to the Medicare inpatient hospital deductible. Any reductions in copayments that occur in applying the limitation will be paid to hospitals as additional program payments. (See section III.F.3.a, below, for discussion of calculating the Medicare payment amount.)

    MedPAC Comment: In its March 1999 report to the Congress, MedPAC expressed concern that the statute's approach to addressing the reduction in coinsurance could mean that it will be decades before coinsurance is 20 percent of all APC payment rates. MedPAC recommended that the Secretary seek and the Congress legislate a more rapid phase-in and that the cost be financed by increases in program spending, rather than through additional reductions in payments to hospitals. MedPAC agrees that the approach to calculating the coinsurance delineated in section 1833(t) of the Act is methodologically sound, but they recommend a shorter period to complete the coinsurance reduction.

    Response: The coinsurance reductions enacted by the BBA 1997 already provide significantly higher levels of financial protection for beneficiaries than have existed in the past. While an acceleration of this protection might be desirable, the costs of such a policy must be balanced against other needs for increased Medicare spending and protection of the trust funds. The President's budget for FY 2001 does not contain such a proposal.

    Comment: Three commenters discussed the delay in implementing the outpatient PPS until after January 1, 2000. A hospital association stated that it strongly believes that the outpatient PPS should not be implemented until all systems are ready, and suggested that implementation occur at the start of a calendar year so that Medigap insurers did not receive an unearned windfall by reason of a midyear decrease in beneficiary coinsurance amounts. Stating that the delay in implementation was of serious concern to it, an insurance group strongly urged us to implement the outpatient PPS as soon as possible. Finally, a beneficiary advocacy group stated that it is deeply concerned about the delay in implementation. While stating that it understood the magnitude of the Y2K problem, this group urged us to find a way to proceed with the phase-down of beneficiary coinsurance or, failing that, to offer our assurance that the phase-down will not be delayed beyond January 1, 2000.

    Response: As noted elsewhere in this final rule, we intend to implement the outpatient PPS effective for services furnished on or after July 1, 2000. As noted in the proposed rule, we concluded that attempting to make the massive computer changes required to implement PPS at the same time we were trying to ensure that Medicare's computers were Y2K compliant would have jeopardized the compliance effort, which was HCFA's highest priority. Now that HCFA's efforts to make its computer systems, and those of its contractors, Y2K compliant are complete, we believe that July 1, 2000 is the earliest date on which we can feasibly implement the PPS. Pursuant to HCFA's contracts with the contractors responsible for maintaining its computer systems, HCFA makes programming changes such as those required to implement the outpatient PPS at the beginning of fiscal quarters. Thus, pursuant to this practice, after January 1, 2000, there are only three dates in 2000 on which the programming changes necessary to implement outpatient PPS can be put into effect—April 1, 2000, July 1, 2000 and October 1, 2000.

    The first step in changing HCFA's computer systems to allow for implementation of the outpatient PPS is to expand the claim record of several HCFA and contractor systems to accept and retain specific information related to how a service is being paid or why it is denied. The claim record expansion is an indispensable prerequisite to implementation of outpatient PPS. Once expansion of the claim form is completed, we can then make the remaining programming changes necessary to implement the outpatient PPS. As we noted in the proposed rule, 63 FR 47605, these are massive changes that will require extensive testing. We anticipate that these software coding changes cannot be completed before the end of the second quarter of 2000. Therefore, the earliest possible date on which they can be installed and made operational is July 1, 2000.

    We do not believe that it is technically feasible to complete installation of both the claims-form line item expansion and the coding changes needed to implement PPS any sooner than July 1, 2000. Each of these two stages of preparing HCFA's computer system for PPS constitutes major systems changes in and of itself. To attempt to make both changes simultaneously would be to run the risk that the system would not function properly at all, potentially requiring implementation to be delayed beyond July 1, 2000. We believe that the two-stage approach discussed above is the only feasible way to make the systems changes necessary to implement PPS and to be certain that they will work. The soonest date on which PPS can be implemented after the millennium is therefore July 1, 2000.

    Despite one commenter's request that we implement the outpatient PPS at the start of a calendar year, we do not believe it would be appropriate to delay implementation beyond July 1, 2000. We see no reason to delay implementation beyond the time necessary for HCFA to have completed its Y2K efforts and make all the systems changes necessary for PPS. As with all of the other aspects of PPS, we believe that the beneficiary coinsurance reform contained in the outpatient PPS should be put into effect as soon as possible, so that beneficiaries can be subject to the lower coinsurance amounts under the new payment methodology at the Start Printed Page 18489earliest date. We believe that this consideration outweighs any concern that Medigap insurers might receive a windfall because they set premiums for a given year assuming coinsurance amounts would be at one level only to see those amounts decrease in the middle of the year. In addition, we note that, if insurers received a large enough windfall for the reasons described by the commenter, the insurers might be required to refund premiums to beneficiaries or offer them a credit on premiums pursuant to section 1882(r) of the Act.

    While none of the commenters specifically requested that we do so, we have considered the possibility of applying the outpatient PPS payment methodology retroactively to services furnished on or after January 1, 1999. We have decided not to make these retroactive payments for the reasons described below.

    The first reason is the practical problem that the information needed to implement PPS retroactively does not exist in a usable form. Under current payment methodologies for many outpatient services, hospitals submit bills for furnished services based on their charges for the services. For these services, HCFA does not require hospitals to submit bills containing the HCPCS code for the furnished service and other data (such as the dates of service of multiple services submitted on the same bill) necessary to process bills under the new prospective payment methodology. Without the HCPCS code for a given service, we would be unable to determine retroactively into which APC group the service should be placed for payment under PPS. In turn, that would mean that we could not determine the appropriate payment amount for the service. Thus, given the information currently available to us, we could not now simply reprocess bills for outpatient services that had been furnished between January 1, 1999 and July 1, 2000 and recompute payment and coinsurance amounts for these services. As a result, the data needed to implement PPS retroactively do not exist in a form that would allow for such implementation.

    Nor would it have been feasible to attempt to capture the information necessary for retroactive application during 1999. As noted above, we concluded that it would not have been prudent to make the computer programming changes necessary to implement PPS until our Y2K efforts were complete. Those same changes would have been necessary to allow us to capture the more detailed claims data needed to perform a retroactive application of PPS back to January 1, 1999 once the system was implemented prospectively. Because we delayed those changes out of concern that they would interfere with our Y2K efforts, no automated process existed for the period January 1, 1999 through July 1, 2000 by which we could have captured the more detailed claims data necessary to effect an eventual retroactive implementation of PPS. Publication of a final rule before January 1, 1999 would not have altered this situation. Even if we had published such a rule, it could not have become effective until we could make the computer changes necessary to implement PPS—the functional equivalent of what we have done through publication of the proposed rule and this final rule—and until we could make those changes, we could not compile by computer the data needed to later reprocess claims under PPS.

    In theory, we might have been able to implement PPS retroactively despite the lack of an automated method of compiling the data necessary to do so. But it simply would not have been practicable to maintain and later process by hand such data for the period between January 1, 1999 and July 1, 2000, given the millions of claims for outpatient services submitted during that period. (Based on the latest data available, we process approximately 160 million claims for outpatient services over an 18-month period.) Neither HCFA nor its contractors have the staff needed to accomplish such a task.

    We might also have conceivably required hospitals to maintain the data required for a later retroactive implementation of PPS, but this approach has practical difficulties. First, during the interim period between January 1, 1999 and implementation of PPS, hospitals themselves were exerting significant efforts to ensure the Y2K compliance of their own automated Medicare billing systems, and it is doubtful that those systems could have accommodated the necessary programming changes any more than Medicare's systems could have. Even if hospitals could have maintained the information (or if HCFA could have maintained it by hand or could obtain it from any source now), the burden associated with attempting to implement the new prospective payment methodology both retroactively and prospectively at the same time would have been prohibitive. As noted in the proposed rule and in this final rule, effecting the transition between the old payment methodologies and the new prospective payment methodology constitutes a massive programmatic undertaking. Any effort to reprocess the huge number of bills for outpatient services that would be involved in any attempt to retroactively implement PPS would compete for the same resources needed to implement PPS prospectively, and would compromise our ability to ensure the smoothest prospective implementation.

    This is especially so if paper records of claims from the interim period would have to be manually input into Medicare's automated payment systems in order to make retroactive payments for services furnished on or after January 1, 1999. Undertaking an effort, once PPS is implemented, to review hospital records of every outpatient service furnished between January 1, 1999 and July 1, 2000; translate those records into the data needed to process a Medicare claim for the service under PPS; and issue a retroactive payment reflecting the PPS rate for the service would cause a huge backlog of current bills to be processed (and of other carrier tasks), and thus would not be practicable. Therefore, there was no feasible way to have captured the information necessary to make PPS apply retroactively.

    In addition to the practical problems described above, the statute does not require retroactive application of PPS. The statutory requirement to implement the PPS for services furnished on or after January 1, 1999 is ambiguous. While section 1833(t)(1)(A)'s reference to outpatient services “furnished during a year beginning with 1999” might be read as imposing such a requirement, it is also true that section 1833(t)(1)(B)(i) does not expressly set a time limit for HCFA to designate which services are “covered” outpatient services for purposes of payment under PPS. Nor does it set a deadline for HCFA to issue regulations implementing the outpatient PPS. As a result, the statute can also be read to require implementation of PPS for services furnished in a year beginning in 1999 if HCFA has designated in its implementing regulations those services as covered services for purposes of PPS. The better reading is that the system applies prospectively only.

    We recognize that, under section 1833(a)(2)(B), Congress arguably made the old payment methodologies for outpatient services inapplicable to services furnished on or after January 1, 1999. Again, though, Congress imposed no corresponding limit on the time within which HCFA must designate the services that would be “covered” services for purposes of PPS. While it is therefore possible to read the statute in such a way that an outpatient service Start Printed Page 18490furnished after January 1, 1999 but not yet designated as a covered outpatient service by HCFA for purposes of PPS would have no payment methodology applicable to it, we do not believe that Congress intended such a result. We believe that where HCFA, because of significant Y2K concerns, has not yet designated a given outpatient service as a covered service for purposes of PPS, the most appropriate reading of section 1833(t)(1)(A) is that it authorizes the Secretary to continue to pay for the service under the existing methodology until PPS can be implemented. If the Congress had known about the Y2K problem at the time it enacted the PPS statute, this is the only rational approach it could have adopted.

    We believe that a clear expression of Congressional intent not to require retroactive application of PPS can be found in the legislative history of amendments to section 1833(t) of the Act, enacted as sections 201, 202, and 204 of the BBRA 1999. In each instance, the legislation provides that the “amendments made by this section shall be effective as if included in the enactment of the BBA,” that is, the original enactment of PPS in section 1833(t) (sections 201(m), 202(b), and 204(c) of the BBRA 1999). This language was taken from the House version of the bill (H.R. Rep. No. 436 (Part I), 106th Cong., 1st Sess. 14, 16 (1999)). The House Report stated that the outpatient payment reforms contained in the BBRA 1999 (and hence in the BBA 1997) were intended to take effect “upon implementation of the hospital prospective payment system” by HCFA, id. at 52, 55, 56, not on January 1, 1999. The House Conference Committee Report reiterated the understanding that the payment and coinsurance provisions of the BBA and BBRA do not take effect until after implementation by HCFA. H. Conf. Rep. No. 479, 106th Cong., 1st Sess. 866 (1999) (”[c]urrently, beneficiaries pay 20% of charges for outpatient services,” but “[u]nder the outpatient PPS, beneficiary coinsurance will be limited to frozen dollar amounts based on 20% of national median charges for services in 1996, updated to the year of implementation of the PPS”); id. at 867 (“[t]he conferees fully expect that the beneficiary coinsurance phase-down will commence, as scheduled, on July 1, 2000”); 870 (“[h]ospital outpatient PPS is to be implemented simultaneously and in full for all services and hospitals (estimated for July 2000)”).

    Both the House Report and the Conference Report expressly acknowledge, without disapproval, HCFA's decision to delay implementation of the outpatient PPS until after January 1, 2000. H.R. Rep. No. 436 (Part I) at 51 (stating that Secretary “delayed implementation of the new system until after the start of CY 2000 in order to ensure that ‘year 2000' data processing problems are fully resolved before the new system is implemented” and that “HCFA currently estimates that the outpatient department prospective payment system will be implemented in July 2000”); 145 Cong. Rec. at H12529 (daily ed. Nov. 17, 1999) (H. Conf. Rep. No. 479) (acknowledging “[t]here has already been a one-year delay in implementation of the BBA 97 provision” and stating that conferees “fully expect” that the outpatient prospective payment system “will commence, as scheduled, on July 1, 2000”). These statements indicate Congressional intent that payments and coinsurance for covered hospital outpatient services would be governed prospectively by PPS only after HCFA promulgated and made effective final implementing regulations.

    Finally, there is a serious question as to whether retroactive implementation of PPS might constitute prohibited retroactive rulemaking. In Bowen v. Georgetown University Hospital, 488 U.S. 204, 208 (1988), the Supreme Court stated that a statutory grant of legislative rulemaking authority does not encompass the power to promulgate retroactive rules unless that power is conveyed by Congress in express terms, even where some substantial justification for retroactive rulemaking might exist. The Court then declined to find this express authorization for retroactive rulemaking in the Medicare statute's general grant of rulemaking authority.

    We do not find this express authorization in section 1833(t) or any other statutory provision concerning the outpatient PPS. Section 1833(t)(1) requires that payment for outpatient services that are furnished during any calendar year beginning after January 1, 1999 and that are designated by HCFA as “covered” outpatient services shall be made under a prospective payment system. While Congress may have presumed, when it enacted section 1833(t) as part of the BBA, that HCFA would be able to designate covered outpatient services and implement the outpatient PPS by January 1, 1999, Congress did not foresee at that time that Y2K concerns would prevent the agency from doing so. As a result, the statute is silent as to what was to occur if HCFA was unable to designate covered outpatient services and implement PPS by January 1, 1999. We do not believe that this silence constitutes the express authorization of retroactive rulemaking required by the Supreme Court's Georgetown decision.

    Comment: Several commenters contended that the proposed rules for beneficiary coinsurance are overly complex and that the phase-in period is too long. One commenter asked HCFA to consider a less involved method and a more aggressive time period for implementation. Another commenter suggested using a 5-year phase-in period. One commenter requested that we recommend a legislative change to the Congress to reduce beneficiary coinsurance to 20 percent by January 1, 2003. Still another commenter expressed concern that calculations of coinsurance amounts for each hospital will be particularly burdensome to Medicare fiscal intermediaries and, as a result of the increased workload, errors may occur. The commenter also recommended a more rapid reduction of coinsurance to 20 percent of the payment amount.

    Response: We agree that the rules governing how coinsurance is to be calculated under the PPS are complex, and the phase-in to 20 percent coinsurance is a lengthy one. However, the methods for calculating coinsurance are dictated by the statute. The legislative changes were made in order to put some control on rapidly increasing beneficiary coinsurance payments, to begin to decrease the proportion of beneficiary liability for hospital outpatient services, and to continue to reduce beneficiary liability over time. As we have stated, the impetus to accelerate the reduction of beneficiary coinsurance has to be viewed within the context of other needs for increased Medicare expenditures and long-term protection of the trust funds. The delay in implementing the hospital outpatient PPS past the statutory effective date was unavoidable due to systems constraints imposed by Y2K compliance requirements.

    Comment: One commenter noted that the proposed rule set beneficiary coinsurance at 20 percent of median charges, but the commenter believes that coinsurance amounts should be recalculated to equal 20 percent of the average charge for the applicable APC group. The commenter indicates that such a change would provide some financial relief to hospitals.

    Response: Section 1833(t)(3)(B)(i) of the Act requires that unadjusted coinsurance amounts be calculated as 20 percent of the national median of the charges for services within the APC group. Start Printed Page 18491

    Comment: One commenter stated that because coinsurance is based on the median charges of the APC, some beneficiaries would pay a higher coinsurance than they would under the current system. The commenter believes that beneficiaries who require less intensive services in an APC group will essentially subsidize other beneficiaries who receive more intensive services within the group. The commenter asserted that fairness would dictate beneficiaries be charged coinsurance amounts that more appropriately reflect the services received, not an amount based on a median of multiple services they did not receive.

    Response: Section 1833(t)(3)(B)(ii) of the Act provides that the unadjusted coinsurance amounts are based on the national median of the charges for the “services within” an APC. Because an APC group consists of services that are both clinically similar and similar with respect to the resources required to perform the service, we would expect that charges for the services should also be fairly homogeneous. We believe that services within a group are homogeneous enough to warrant a single payment amount and a single coinsurance amount.

    In the following sections, we describe how we determined the beneficiary coinsurance amount and the Medicare program payment amount for services paid for under the hospital outpatient PPS.

    2. Determining the Unadjusted Coinsurance Amount and Program Payment Percentage

    To calculate Medicare program payment amounts and beneficiary coinsurance amounts, we first determined for each APC group two base amounts, in accordance with statutory provisions:

    • An unadjusted copayment amount, described in section 1833(t)(3)(B) of the Act; and
    • The predeductible payment percentage, which we call the program payment percentage, described in section 1833(t)(3)(E) of the Act.

    a. Calculating the Unadjusted Coinsurance Amount for Each APC Group

    In the proposed rule, we described the specific steps used to calculate the unadjusted coinsurance amounts for each APC group as follows:

    (i) We determined the national median of the charges billed in 1996 for the services that constitute an APC group after standardizing charges for geographic variations attributable to labor costs. (To determine the labor adjustment, we divided the portion of each charge that we estimated was attributable to labor costs (60 percent) by the hospital's inpatient wage index value and added the result to the nonlabor portion of the charge (40 percent)).

    (ii) We updated charge values to projected 1999 levels by multiplying the 1996 median charge for the APC group by 13.0 percent (increased to 14.7 percent in this final rule), which the HCFA Office of the Actuary estimates to be the rate of growth of charges between 1996 and 1999.

    (iii) To obtain the unadjusted coinsurance amount for the APC group, we multiplied the estimated 1999 national median charge for the APC group by 20 percent. The unadjusted coinsurance amount is frozen at the 1999 level until such time as the program payment percentage (as determined below) equals or exceeds 80 percent (section 1833(t)(3)(B)(ii) of the Act).

    b. Calculating the Program Payment Percentage (Predeductible Payment Percentage)

    In the proposed rule and in this final rule, we use the term “program payment percentage” to replace the term “pre-deductible payment percentage,” which is referred to in section 1833(t)(3)(E) of the Act. The program payment percentage is calculated annually for each APC group, until the value of the program payment percentage equals 80 percent. To determine the program payment percentage for each APC group, we—

    (i) Subtract the APC group's unadjusted coinsurance amount from the payment rate set for the APC group; and

    (ii) Divide the difference (APC payment rate minus unadjusted coinsurance amount) by the APC payment rate, and multiply by 100.

    The program payment percentage will be recalculated each year because APC payment rates will change when APC rates are increased by annual market basket updates and whenever we revise an APC.

    Comment: One commenter expressed concern about how the coinsurance amounts are determined. The commenter stated that the calculation is flawed and penalizes beneficiaries in those States where charges for services tend to be lower than in other States. The commenter alleged that if the hospitals in those States where charges for services tend to be lower accept a reduced coinsurance in order to hold beneficiaries harmless, the hospitals will be penalized. The commenter also asserted that Medigap policies and Medicaid programs will also be affected. The commenter further stated that coinsurance should be based on regional, not national, charges. The commenter contended that the provision does not achieve the intended outcome of equalizing payment across the nation.

    Response: Sections 1833(t)(3) and (t)(8) of the Act prescribe how coinsurance amounts are to be calculated under the PPS. Our method of calculating unadjusted coinsurance amounts for each APC group based on 20 percent of national median charges follows the requirements of section 1833(t)(3)(B) of the Act.

    Comment: A number of commenters believe that the payment system as proposed would create gross anomalies in coinsurance for particular chemotherapy drugs. For example, the proposed $36.61 coinsurance for fluorouracil is 10 times the hospital's cost to purchase that drug. The commenters asserted that this excessive coinsurance represents an abuse of patients and would undermine beneficiary confidence in the new system. They recommended that coinsurance be limited to 20 percent of the payment amount for each drug.

    Several other commenters noted that classifying drugs with widely varying costs in the same APC will have a significant negative effect on beneficiary coinsurance, and in some cases beneficiaries could be required to pay a greater percentage of coinsurance for less effective therapies. For example, one commenter alleged that the coinsurance for the drug 5-FU, which the commenter believes has a current coinsurance of approximately $1, would increase to $40 under the proposed system.

    Response: The coinsurance anomalies for chemotherapy drugs that appeared in the proposed rule are not an issue under this final rule. Unlike the proposed chemotherapy drug APCs, which grouped all chemotherapy drugs under four APCs, in this final rule, each chemotherapy drug is assigned to a separate APC. As discussed in section III.D.5 of this preamble, the unadjusted coinsurance amounts for these APCs is calculated as 20 percent of the APC payment rate.

    Comment: One commenter noted that the proposed national unadjusted coinsurance amounts for cardiovascular stress testing and perfusion imaging result in beneficiaries bearing 85 percent of the total payment for stress testing and 60 percent for perfusion imaging, which many beneficiaries will be unable to afford. Another commenter Start Printed Page 18492requested that we either exclude cataract procedures and angioplasty from the hospital outpatient PPS or create an outlier policy that affords special treatment for these procedures in order to protect beneficiaries from excessive coinsurance amounts.

    Response: Coinsurance amounts, by law, are based on 20 percent of the median of the charges actually billed in 1996 (updated to 1999) for the services within an APC. The fact that coinsurance is a larger proportion of the total payment for some APCs than for others reflects the differences in hospital charging practices for different services. For example, in examining departmental cost-to-charge ratios reflected on hospital cost reports, we have found that most hospitals have higher mark-ups in charges for radiology and diagnostic services than they do for clinic visits.

    3. Calculating the Medicare Payment Amount and Beneficiary Coinsurance Amount

    a. Calculating the Medicare Payment Amount

    The national APC payment rate that we calculate for each APC group is the basis for determining the total payment (subject to wage-index adjustment) the hospital will receive from the beneficiary and the Medicare program. (A hospital that elects to reduce coinsurance, as described below in section III.F.4, may receive a total payment that is less than the APC payment rate.) The Medicare payment amount takes into account the wage index adjustment and the beneficiary deductible and coinsurance amounts. In addition, the amount calculated for an APC group applies to all the services that are classified within that APC group. The Medicare payment amount for a specific service classified within an APC group under the outpatient PPS is calculated as follows:

    (i) Apply the appropriate wage index adjustment to the national payment rate that is set annually for each APC group.

    (ii) Subtract from the adjusted APC payment rate the amount of any applicable deductible as provided under § 410.160.

    (iii) Multiply the adjusted APC payment rate, from which the applicable deductible has been subtracted, by the program payment percentage determined for the APC group or 80 percent, whichever is lower. This amount is the preliminary Medicare payment amount.

    (iv) If the wage-index adjusted coinsurance amount for the APC is reduced because it exceeds the inpatient deductible amount for the calendar year, add the amount of this reduction to the amount determined in (iii) above. The resulting amount is the final Medicare payment amount.

    b. Calculating the Coinsurance Amount

    A coinsurance amount is calculated annually for each APC group. The coinsurance amount calculated for an APC group applies to all the services that are classified within the APC group. The beneficiary coinsurance amount for an APC is calculated as follows:

    Subtract the APC group's Medicare payment amount from the adjusted APC group payment rate less deductible; for example, coinsurance amount = (adjusted APC group payment rate less deductible)—APC group preliminary Medicare payment amount. If the resulting amount does not exceed the annual hospital inpatient deductible amount for the calendar year, the resulting amount is the beneficiary coinsurance amount. If the resulting amount exceeds the annual inpatient hospital deductible amount, the beneficiary coinsurance amount is limited to the inpatient hospital deductible. For example, assume that the wage-adjusted payment rate for an APC is $300; the program payment percentage for the APC group is 70 percent; the wage-adjusted coinsurance amount for the APC group is $90; and the beneficiary has not yet satisfied any portion of his or her $100 annual Part B deductible.

    (A) Adjusted APC payment rate: $300.

    (B) Subtract the applicable deductible:

    $300-$100 = $200

    (C) Multiply the remainder by the program payment percentage to determine the preliminary Medicare payment amount:

    0.7 × $200 = $140

    (D) Subtract the Medicare payment amount from the adjusted APC payment rate less deductible to determine the coinsurance amount, which cannot exceed the inpatient hospital deductible for the calendar year:

    $200 − $140 = $60

    (E) Calculate the final Medicare payment amount by adding the preliminary Medicare payment amount determined in step (C) to the amount that the coinsurance was reduced as a result of the inpatient hospital deductible limitation.

    $140 + $0 = $140

    In this case, the beneficiary pays a deductible of $100 and a $60 coinsurance, and the program pays $140, for a total payment to the hospital of $300. Applying the program payment percentage ensures that the program and the beneficiary pay the same proportion of payment that they would have paid if no deductible were taken.

    If the annual Part B deductible has already been satisfied, the calculation is:

    (A) Adjusted APC payment rate: $300.

    (B) Subtract the applicable deductible:

    $300 − 0 = $300

    (C) Multiply the remainder by the program payment percentage to determine the preliminary Medicare payment amount:

    0.7 × $300 = $210

    (D) Subtract the Medicare payment amount from the adjusted APC payment rate less deductible to determine the coinsurance amount. The coinsurance amount cannot exceed the amount of the inpatient hospital deductible for the calendar year:

    $300 − $210= $90

    (E) Calculate the final Medicare payment amount by adding the preliminary Medicare payment amount determined in step (C) to the amount that the coinsurance was reduced as a result of the inpatient hospital deductible limitation.

    $210 + $0 = $210

    In this case, the beneficiary makes a $90 coinsurance payment, and the program pays $210, for a total payment to the hospital of $300.

    The following example illustrates a case in which the inpatient hospital deductible limit on coinsurance amounts applies. Assume that the wage-adjusted payment rate for an APC is $2,000; the wage-adjusted coinsurance amount for the APC is $900; the program payment percentage is 55 percent; the inpatient hospital deductible amount for the calendar year is $776 and the beneficiary has not yet satisfied any portion of his or her $100 Part B deductible.

    (A) Adjusted APC payment rate: $2,000.

    (B) Subtract the applicable deductible:

    $2000 − $100 = $1,900

    (C) Multiply the remainder by the program payment percentage to determine the preliminary Medicare payment amount:

    0.55 × $1,900 = $1,045

    (D) Subtract the preliminary Medicare payment amount from the adjusted APC payment rate less deductible to determine the coinsurance amount. The coinsurance amount cannot exceed the inpatient hospital deductible amount of $776:

    $1,900 − $1,045 = $855, but coinsurance limited to $776

    (E) Calculate the final Medicare payment amount by adding the Start Printed Page 18493preliminary Medicare payment amount determined in step (C) to the amount that the coinsurance was reduced as a result of the inpatient hospital deductible limitation ($855 − $776 = $79).

    $1,045 + $79 = $1,124

    In this case, the beneficiary pays a deductible of $100 and coinsurance that is limited to $776. The program pays $1,124 (which includes the amount of the reduction in beneficiary coinsurance due to the inpatient hospital deductible limitation) for a total payment to the hospital of $2,000.

    4. Hospital Election To Offer Reduced Coinsurance

    For most APCs, the transition to the standard Medicare coinsurance rate (20 percent of the APC payment rate) will be gradual. For those APC groups for which coinsurance is currently a relatively high proportion of the total payment, the process will be correspondingly lengthy. The law offers hospitals, but not CMHCs, the option of electing to reduce coinsurance amounts and permits hospitals to disseminate information on their reduced rates. In this section, we discuss the procedure by which hospitals can elect to offer a reduced coinsurance amount, and the effect of the election on calculation of the program payment and beneficiary coinsurance.

    Section 1833(t)(5)(B) of the Act, as added by section 4523 of the BBA 1997, requires the Secretary to establish a procedure under which a hospital, before the beginning of a year, may elect to reduce the coinsurance amount otherwise established for some or all hospital outpatient services to an amount that is not less than 20 percent of the hospital outpatient prospective payment amount. The statute further provides that the election of a reduced coinsurance amount will apply without change for the entire year, and that the hospital may disseminate information on its reduced copayments. Section 1833(t)(5)(C) of the Act, as added by the BBA 1997, provides that deductibles cannot be waived. Finally, section 1861(v)(1)(T) of the Act (as added by section 4451 of the BBA 1997) provides that no reduction in coinsurance elected by the hospital under section 1833(t)(5)(B) of the Act may be treated as a bad debt. We note that section 1833(t)(5) of the Act has been redesignated as section 1833(t)(8) of the Act by sections 201(a) and 202(a) of the BBRA 1999.

    Elections to reduce coinsurance will not be taken into account in calculating transitional corridor payments to hospitals (discussed in section III.H.2 of this preamble). That is, a hospital's transitional corridor payment will be determined as if the hospital received unreduced coinsurance amounts from beneficiaries.

    In the proposed rule, we stated that we would require that hospitals make the election to reduce coinsurance on a calendar year basis. The proposed rule required that the hospital must notify its fiscal intermediary of its election to reduce coinsurance no later than 90 days prior to the date the PPS is implemented or 90 days prior to the start of any subsequent calendar year and that the hospital's notification must be in writing. It must specifically identify the APC groups to which the hospital's election will apply and the coinsurance amount (within the limits identified below) that the hospital has elected for each group. The election of reduced coinsurance must remain in effect and unchanged during the year for which the election is made. Because the law states that hospitals may disseminate information on any reduced coinsurance amounts, we provided in the proposed rule that hospitals would be allowed to publicly advertise this information.

    The proposed regulations provided that a hospital may elect to reduce the coinsurance amount for any or all APC groups. A hospital may not elect to reduce the coinsurance amount for some, but not all, services within the same APC group.

    As proposed, a hospital may not elect a coinsurance amount for an APC group that is less than 20 percent of the adjusted APC payment rate for that hospital. In determining whether to make such an election, hospitals should note that the national coinsurance amount under this system, based on 20 percent of national median charges for each APC, may yield coinsurance amounts that are significantly higher or lower than the coinsurance that the hospital previously has collected. This is because the median of the national charges for an APC group, from which the coinsurance amount is ultimately derived, may be higher or lower than the hospital's historic charges. Therefore, in determining whether to elect lower coinsurance and the level at which to make the election, we advise that hospitals carefully study the wage-adjusted coinsurance amounts for each APC group in relation to the coinsurance amount that the hospital has previously collected.

    As discussed in section III.F.1, under sections 1834(d)(2)(C)(ii) and 1834(d)(3)(C)(ii) of the Act the coinsurance for screening sigmoidoscopies furnished by hospitals and screening colonoscopies furnished by hospital outpatient departments and ASCs is 25 percent of the applicable payment rate. The payment rate for these colorectal cancer screening tests is the lower of the hospital outpatient rate or the ASC payment rate. The payment rate for screening barium enemas is the same as that for diagnostic barium enemas. However, the coinsurance amount for screening barium enemas is 20 percent of the APC payment rate. Hospitals may not elect to reduce coinsurance for screening sigmoidoscopies, screening colonoscopies, or screening barium enemas.

    Calculation of coinsurance amounts on the basis of a hospital's election of reduced coinsurance is similar to the formula described in section III.F.3. For example, assume that the adjusted APC payment rate is $300; the program payment percentage for the APC group is 60 percent; the hospital has elected a $60 reduced coinsurance amount for the APC group; and the beneficiary has not satisfied the annual Part B deductible.

    (A) Adjusted APC payment rate: $300.

    (B) Subtract the applicable deductible:

    $300 − $100 = $200

    (C) Multiply the remainder by the program payment percentage to determine the Medicare payment amount:

    0.6 × $200 = $120

    (D) Beneficiary's coinsurance is the difference between the APC payment rate reduced by any deductible amount and the Medicare payment amount, but not to exceed the lesser of the reduced coinsurance amount or the inpatient hospital deductible amount:

    $200 − $120 = $80 (limited to $60 because of the hospital-elected reduced coinsurance amount)

    (E) Calculate the final Medicare payment amount by adding the preliminary Medicare payment amount determined in step (C) to the amount that the coinsurance was reduced as a result of the inpatient hospital deductible limitation.

    $120 + $0 = $120

    In this case, Medicare makes its regular payment of $120, and the beneficiary pays a $100 deductible and a reduced coinsurance amount of $60. The hospital receives a total payment of $280 instead of the $300 that it would have received if it had not made its election to reduce coinsurance.

    Comment: One commenter stated that it is currently illegal to accept lower coinsurance amounts from beneficiaries and asked for an explanation as to how Start Printed Page 18494we could propose to encourage hospitals to lower coinsurance.

    Response: Although Medicare, in general, has prohibitions against reducing beneficiary coinsurance, redesignated section 1833(t)(8)(B) of the Act specifically provides the legal authority for hospitals to make elections to reduce coinsurance amounts for purposes of the outpatient PPS. However, those coinsurance amounts cannot be reduced below 20 percent of the adjusted APC payment rate for the hospital.

    Comment: One commenter asked whether, in view of our proposal to allow hospitals to elect lower coinsurance, Medigap insurance plans will be permitted to offer a waiver of a participating hospital's coinsurance. That is, can a Medigap plan act as a preferred provider organization (PPO) with a financial incentive to select those hospitals that elect to reduce coinsurance?

    Response: There are two kinds of Medigap policies—regular Medigap and Medicare SELECT. While regular Medigap policies must pay full supplemental benefits on all claims that are submitted by all Medicare providers and are approved by Medicare carriers and intermediaries, Medicare SELECT plans, which are a managed care form of Medigap, may restrict payment of supplemental benefits to network providers. Thus, by design, Medicare SELECT plans are permitted to negotiate selectively with hospitals. Ordinarily, Medicare SELECT plans contract with certain hospitals to waive the hospital deductible for inpatient services.

    Since the Congress has expressly permitted hospitals to reduce outpatient coinsurance to no less than 20 percent of the PPS payment amount, a Medicare SELECT plan is free to contract selectively with these hospitals. We note that a hospital's election to reduce coinsurance under redesignated section 1833(t)(8)(B) of the Act requires that the reduction be across-the-board for some or all APC groups. Thus, an agreement between a Medicare SELECT plan and a hospital to reduce coinsurance would result in coinsurance reductions for all beneficiaries who receive those APC group services at the hospital, whether or not they are enrolled in the Medicare SELECT plan.

    Comment: One commenter requested that we seek a legislative change to offer hospitals more flexibility under the coinsurance reduction provision by permitting them to review and revise coinsurance amounts every 3 months.

    Response: We believe that there would be a significant impact on contractors if hospitals were allowed to revise their reduced coinsurance more often than annually. More frequent coinsurance changes may also be confusing to beneficiaries. Because we do not have a good estimate of how many hospitals will make the elections and we do not yet know whether those hospitals that do make elections will elect to reduce coinsurance for just a few or for a significant number of APCs, we do not support allowing hospitals to make or change elections more often than annually. However, we may reconsider our position after we gain more experience under the PPS and can better assess what the impact of more frequent elections would be on hospitals, beneficiaries, and HCFA and its contractors.

    Comment: One commenter noted that if we intend to publish a final rule no more than 90 days before implementation of the PPS, hospitals would not have sufficient time to make coinsurance election decisions. The commenter recommended that hospitals be permitted to make the election 60 days before implementation of the system.

    Response: This final rule will not be published more than 90 days before the date of implementation of the PPS. Therefore, the final regulations require that hospitals inform their fiscal intermediaries (FIs) of their elections to reduce coinsurance not later than June 1, 2000. Beginning with elections for calendar year 2001, elections are required to be made by December 1 preceding the calendar year. At this time, we do not know how many hospitals will choose to reduce coinsurance or for how many APCs these hospitals will elect reductions. While we want to provide hospitals sufficient time to make their elections, we also must provide fiscal intermediaries with enough time to incorporate the elections into their systems.

    Comment: Several commenters disagreed with our proposal to allow hospitals to advertise reduced coinsurance amounts. They noted that, although the BBA 1997 provision with respect to hospitals' election to reduce coinsurance amounts provides that hospitals may “disseminate information” on their reductions, we have interpreted that to mean that hospitals may “advertise” their reductions. Two commenters stated that disseminating information is not synonymous with granting one category of hospitals the unique opportunity to advertise to attract customers. They believe that this interpretation is antithetical to the spirit underlying provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) that prohibit beneficiary inducements and may conflict with State anti-kickback laws. Some commenters were also concerned that under our proposal to allow hospitals to advertise, hospitals may issue a general advertisement of reduced coinsurance when the reduction may apply only to certain services. Other commenters were concerned that hospital advertising may lead Medicare beneficiaries to believe that hospital outpatient care is more economical than other ambulatory settings, even when that is not the case, or beneficiaries may become confused and believe that all ambulatory providers have the ability to reduce coinsurance. These commenters asked us to reconsider our proposal to allow hospitals to advertise rather than to disseminate information. In addition, they asked us to establish additional requirements for hospitals' dissemination of information concerning coinsurance reductions so that beneficiaries are made aware that reduced coinsurance applies only to certain specified services, that it applies only to coinsurance billed by hospitals for those services, and that the law does not permit reduced coinsurance for other Part B services such as physician services.

    Several other commenters stated that for the election to reduce coinsurance to be effective, hospitals must have the right to advertise and, therefore, the commenters supported our proposal to permit hospitals to advertise coinsurance reductions.

    Response: We believe that hospitals must be able to advertise their coinsurance reductions in order to achieve what we believe to be the intent of the BBA provision, that is, to provide hospitals with some ability to compete with other ambulatory settings (where coinsurance is already 20 percent of the applicable Medicare payment rate) and to reduce beneficiary coinsurance liability.

    Hospitals would have less incentive to reduce coinsurance if they could not advertise. In addition, beneficiaries need to be fully informed so that they can make informed decisions. We believe that advertising as a way of disseminating information has merit.

    We were persuaded by some commenters' concerns that beneficiaries may not understand that reduced coinsurance applies to specific hospital outpatient services furnished by specific hospitals that choose to elect reductions and that similar reductions cannot be made by other providers of ambulatory services. We, therefore, are amending the regulations to require that all Start Printed Page 18495advertisements or other information furnished to beneficiaries must specify that the coinsurance reductions advertised apply only to the specified services of that hospital and that these coinsurance reductions are available only where a hospital elects to reduce coinsurance for hospital outpatient services and reductions are not allowed in other ambulatory settings or physician offices.

    Comment: One commenter, noting the complexity of the PPS coinsurance requirements, requested that we provide a phase-in period in the final rule to allow hospitals sufficient time to implement the changes necessary to meet the requirements.

    Response: The method required to be used in calculating coinsurance under the PPS results in an overall decrease in the total coinsurance amounts beneficiaries pay for hospital outpatient services. Total coinsurance is somewhat reduced in the first year of implementation and will be reduced even more in future years, until coinsurance for all PPS services equal 20 percent of the applicable APC payment rate. It is only by fully implementing the coinsurance provisions under section 1833(t)(3)(B) of the Act that beneficiaries will realize these reductions. We, therefore, do not support a phase-in period.

    Comment: One commenter recommended that we include, as part of the public record, year by year estimates of the total economic burden placed on beneficiaries by the prolonged coinsurance phase-in period, assuming hospitals charge the maximum and minimum coinsurance amounts. The commenter believes these estimates would be useful as a basis for future discussions of how to remedy the coinsurance problem.

    Response: As a rule, we develop estimates of impacts for legislative proposals that are under consideration by the Congress and for final legislation as we are developing regulations to implement the law. Although we do not have the resources available to model any number of other data analyses that may have merit, our data are made available to the public, so the commenter and any other interested party may perform the coinsurance analysis.

    Comment: One commenter stated that the proposed PPS creates new complexities for Medicare beneficiaries in that they will have to wait for hospitals to do the calculations necessary to determine coinsurance. The beneficiaries will also receive multiple bills and explanations of benefits for multiple hospital visits occurring on the same day. The commenter stated that we will need to have an extensive process in place to explain why, in most cases, beneficiaries are paying 50 to 70 percent of their outpatient services and why they are receiving separate statements when they have multiple visits on the same day.

    Response: In the proposed rule, we assigned medical visits, that is, clinic and emergency room visits, to APCs based on both the level of visit as defined by a HCPCS code and the diagnosis of the patient. In order to implement that type of APC assignment, we would have to require hospitals to submit a separate bill for each medical visit that occurred on the same day; however, under the final rule, medical visits are assigned to APCs based solely on the HCPCS code, and it will be possible for hospitals to bill for multiple medical visits on the same bill. We agree that the way coinsurance is determined under the PPS is a significant change. We are developing a brochure for beneficiaries that will explain the new system and the policies under the outpatient PPS that will affect them.

    Comment: One commenter recommended that we make information available to beneficiaries that compares the average coinsurance for high volume procedures performed at hospitals in a particular geographic area so that beneficiaries can make informed health care decisions about their care.

    Response: We believe that beneficiaries will be informed about the coinsurance reductions elected by hospitals in their area through advertisements and other information made available by hospitals.

    Comment: One commenter asked whether the EOMB (Explanation of Medicare Benefits) notice to the beneficiary will clearly explain that a hospital's decision to reduce coinsurance applies to a specific service furnished at that specific hospital.

    Response: We are reviewing the EOMB in light of the changes in Medicare payments and coinsurance amounts under the PPS, but we have not yet finalized our work. We will take the commenter's suggestion into consideration as we investigate changes we will make to the EOMB.

    G. Adjustment for Area Wage Differences

    1. Proposed Wage Index

    Under section 1833(t)(2)(D) of the Act, the Secretary is required to determine a wage adjustment factor to adjust, in a budget-neutral manner, the portion of the payment rate and the coinsurance amount that is attributable to labor-related costs for relative differences in labor and labor-related costs across geographic regions. As stated in the proposed rule, we considered several options and we proposed using the hospital inpatient PPS wage index as the source of an adjustment factor for geographic wage differences for the hospital outpatient department PPS. We believe that using the hospital inpatient PPS wage index is both reasonable and logical, given the inseparable, subordinate status of the outpatient department within the hospital overall. Use of a hospital outpatient-specific wage index was not required by the Congress and we did not have either the time or resources necessary to construct one. We explained in our proposed rule that there are several possible versions of the hospital inpatient wage index that can be developed by extracting the basic wage and salary data from hospital cost reports, depending on the methodology that is applied to the data. For the hospital outpatient PPS, we proposed to adopt the same version that is used to determine payments to hospitals under the hospital inpatient PPS to adjust for relative differences in labor and labor-related costs across geographic areas. This version reflects the effect of hospital redesignation under 1886(d)(8)(B) of the Act and hospital reclassification under 1886(d)(10) of the Act.

    By statute, we implement the annual updates of the hospital inpatient PPS on a fiscal year basis. However, we proposed to update the hospital outpatient department PPS on a calendar year basis. Therefore, the hospital inpatient PPS wage index values that are updated annually on October 1 would be implemented for the hospital outpatient department PPS on the January 1 immediately following. We proposed this schedule so that wage index changes will be implemented on a calendar year basis concurrently with other revisions and updates, such as the conversion factor update or changes in the APC groups resulting from new or deleted CPT codes. Subsequent to our proposal, section 201(h) of the BBRA 1999 amended section 1833(t)(8)(A) of the Act (as redesignated by section 201(a) of the BBRA 1999) to require the Secretary to review and revise the outpatient PPS wage index adjustment factor at least annually rather than on a periodic basis. (This section of the Act was further redesignated as section 1833(t)(9)(A) by section 202(a) of the BBRA 1999.) Start Printed Page 18496

    2. Labor-Related Portion of Hospital Outpatient Department PPS Payment Rates

    We proposed to recognize 60 percent of the hospital's outpatient department costs as labor-related costs that would be standardized for geographic wage differences. We initially estimated this percentage by comparing the percentage of costs attributed to labor by other systems (that is, hospital inpatient PPS and ASC) and by considering health care market factors such as the shift in more complex services from the inpatient to the outpatient setting, which could influence labor intensity and costs. We stated that 60 percent represented a reasonable estimate of outpatient costs attributable to labor, as it fell between the hospital inpatient PPS operating cost labor factor of 71.1 percent and the ASC labor factor of 34.45 percent, and is close to the labor-related costs under the hospital inpatient operating cost PPS attributed directly to wages, salaries, and employee benefits (61.4 percent) under the rebased 1992 hospital market basket that was used to develop the fiscal year 1997 update factor for inpatient PPS rates (published August 30, 1996 at 61 FR 46187).

    We confirmed our estimate through regression analysis. Using this approach, we analyzed the percentage change in hospital costs attributable to a 1 percent increase in the wage index as expressed by the hospital wage index coefficient. The coefficient from a fully specified payment regression of the hospital cost per unit, standardized for the service mix on the wage index, disproportionate share patient percentage, modified teaching, rural, and urban variables, is approximately 0.60, suggesting a labor share of 60 percent. Even though we decided not to propose additional adjustments, we believed that the coefficient from this specification provided the best estimate of the labor share for the proposed PPS. This judgment was based on a policy to use a labor share that reflects the relationship between the wage index and costs, rather than the effects of correlated factors.

    After calculating 60 percent of each hospital's total operating and capital costs, we divided that amount by the hospital's FY 1998 hospital inpatient PPS wage index value to standardize costs to remove the differences that are attributable to geographic wage differences. Therefore, as we explained in the proposed rule, the total cost of performing a procedure or visit would include standardized operating and capital costs, as well as related costs (for example, operating room time, medical/surgical supplies, anesthesia, recovery room, observation) and minor ancillary procedures such as venipuncture that we packaged.

    Comment: Some commenters urged that we annually update the wage index applied to the outpatient PPS as we do under the hospital inpatient PPS.

    Response: We proposed to update the wage index annually, on a calendar year basis. In addition, section 1833(t)(9)(A) of the Act, redesignated and amended by the BBRA 1999, requires us to review and revise the wage adjustment at least annually.

    Comment: A professional society recommended eliminating the “regional variation for radiologic technologists working in small and rural practices” and applying the “same wage scale” used for their urban counterparts. The commenter asserted that our wage index methodology is biased against rural hospital radiology departments that must compete with the urban areas to attract and retain radiologic technologists. The commenter stated that hospitals are operating in a very competitive labor market in which rural facilities are forced to match or exceed wages paid in the urban areas for reduced workloads. The commenter further stated that the impact of higher hourly technologist wages does not result in a corresponding increase in a higher wage index for radiologic technologists in rural hospitals because these wages are averaged with those for all other hospital inpatient personnel working in the same area.

    Response: The commenter is correct that the wage index is calculated based upon all of the wages paid and hours worked of hospital personnel within areas of the hospital that are paid under the inpatient PPS. The wages and hours are then totaled for a particular labor market area (defined as a Metropolitan Statistical Area [MSA] or all of the counties of a State that are not part of an MSA). We believe the inpatient wage index is an appropriate measure of the relative costs of labor across geographic areas for purposes of outpatient PPS.

    Currently, we do not have data available that would allow us to calculate the wage index for the costs of employing staff in particular occupational categories. Collecting these data would require significant recordkeeping and reporting efforts for hospitals, and the impacts of adjusting the wage index using the data are uncertain. Although some analyses have indicated that the wage indices of rural areas could rise as a result of such an adjustment, these findings are limited by the lack of a national database through which to fully assess the impacts.

    Comment: Several commenters viewed our proposal to establish a 60 percent labor share as an arbitrary decision for which we provided no rational support. One commenter stated that “Congress did not expect HCFA to invent a number.”

    Response: As we explained in the proposed rule (63 FR 47581), we used a statistical tool, that is, regression analysis, to validate the percentage of costs that we had initially estimated could be attributed to labor and, therefore, subject to the wage adjustment. We adopted this approach because we did not have adequate and appropriate data readily available through a reputable source from which we could derive a hospital outpatient labor share within the time allotted to develop our new system. While hospital outpatient costs, including labor costs, are reported annually on the hospital cost report, they are not reported in a manner and format that allow us to capture the statistical and cost data necessary to calculate a precise hospital outpatient labor share. Therefore, we decided to use regression analysis to test our estimate of that labor share. Within the constraints imposed by a lack of accessible, reliable data and the compressed timeframe under which we were working to develop the outpatient PPS, we believe our approach was appropriate and the best available option.

    Comment: Several commenters urged us to use more current hospital cost report data to determine the appropriate hospital outpatient labor share.

    Response: As stated above, at this time the Medicare hospital cost report is not a feasible data source for determining a hospital outpatient labor share.

    Comment: One commenter asserted that setting the labor-related share at 60 percent fails to recognize all labor costs associated with the delivery of hospital outpatient services. The commenter stated that the labor-related percentage for the outpatient PPS should be the same as that used for the hospital inpatient PPS, that is, 71.1 percent. Another commenter supported 60 percent as a “maximum” labor percentage on an interim basis and suggested that we reconsider our decision to use the inpatient PPS hospital wage index to adjust the outpatient PPS payments because of the commenter's concerns about flaws inherent in the system used to derive the inpatient PPS wage index values. A third commenter proposed that the Start Printed Page 18497labor-related portion should be closer to the 34.45 percent currently applied to adjust ASC payment for wage variation. The latter commenter contended that apportioning 60 percent of the outpatient PPS payment rate for wage adjustment would adversely affect rural hospitals because the wage index values for these areas are generally below 1.0.

    Response: We note that commenters' opinions regarding an appropriate labor percentage are mixed. However, beyond expressing a preference for a percentage other than 60 percent, none of the commenters provided data to assist us in re-evaluating our proposal. We realize that rural hospitals would benefit from using a labor share that is less than 60 percent and that some other hospitals would derive advantages from a labor share greater than 60 percent. However, we believe the approach that we used to determine the labor share that will be applied to all hospitals paid under our new system is reasonable and the best option available at this time. We will re-evaluate our decision as we gain more experience with the new system and as new data become available.

    3. Adjustment of Hospital Outpatient Department PPS Payment and Coinsurance Amounts for Geographic Wage Variations

    In the proposed rule, we noted our intent to use fiscal year 1999 hospital inpatient PPS wage index values to compute the initial outpatient PPS rates. However, we have decided to use fiscal year 2000 inpatient PPS wage index values in determining the payment rates set forth in this final rule. The rationale for using the fiscal year 2000 wage index includes availability of the more recent wage index, that it is more current than the 1999 wage index would have been, and that it is being used to calculate FY 2000 payments under the hospital inpatient PPS.

    We proposed to use the annually updated hospital inpatient PPS wage index values to adjust both program payment and coinsurance amounts under the outpatient PPS for area wage variations. Under our proposal, when intermediaries calculate actual payment amounts, they would multiply the prospectively determined APC payment rate and coinsurance amount by that labor-related percentage to determine the labor-related portion of the base payment rate and coinsurance amount that is to be adjusted using the applicable wage index factor. We proposed that the labor-related portion would then be multiplied by the hospital's inpatient PPS wage index factor, and the resulting wage-adjusted labor-related portion would be added to the nonlabor-related portion, resulting in wage-adjusted payment and coinsurance rates. The wage-adjusted coinsurance amount would then be subtracted from the wage-adjusted APC payment rate, and the remainder would be the Medicare payment amount for the service or procedure. Note that even if a hospital elects to reduce the coinsurance or if the coinsurance is capped at the inpatient deductible, the full coinsurance is assumed for purposes of determining the Medicare payment percentage. (See section III.F.3 for a discussion on how Medicare program payments are calculated when the Part B deductible applies.)

    The following is an example of how an intermediary would calculate the Medicare payment for a surgical procedure with a hypothetical APC payment rate of $300 that is performed in the outpatient department of a hospital located in Heartland, USA. The coinsurance amount for the procedure is $120. The hospital inpatient PPS wage index value for hospitals located in Heartland, USA is 1.0234. The labor-related portion of the payment rate is $180 ($300 × 60 percent), and the nonlabor-related portion of the payment rate is $120 ($300 × 40 percent). The labor-related portion of the unadjusted coinsurance amount is $72 ($120 × 60 percent), and the nonlabor-related portion of the unadjusted coinsurance amount is $48 ($120 × 40 percent). It is assumed that the beneficiary deductible has been met.

    Wage-Adjusted Payment Rate (rounded to nearest dollar):

    = ($180 × 1.0234) + $120

    = $184 + $120

    = $304

    Wage-Adjusted Coinsurance Amount (rounded to nearest dollar):

    = ($72 × 1.0234) + $48

    = $74 + $48

    = $122

    Calculate Medicare Program Payment Amount:

    $304−$122 = $182

    4. Special Rules Under the BBRA 1999

    We issued the federal fiscal year (FY) 2000 hospital inpatient PPS wage index values in the Federal Register on July 30, 1999, in a final rule titled “Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2000 Rates” (64 FR 41490). Subsequent to that publication, section 152 of the BBRA 1999 reclassified certain counties and labor market areas for purposes of payment under the Medicare hospital inpatient PPS; section 153 of the BBRA 1999 enacted a “wage index correction”; and section 154 of the BBRA 1999 provided for the calculation and application of a wage index floor for a specified area. These changes are effective for FY 2000 and will be explained in detail in an interim final rule with comment that we expect to issue in the Federal Register shortly. The wage index values in Addendum H, Addendum I, and Addendum J reflect the changes made by the BBRA 1999.

    H. Other Adjustments

    1. Outlier Payments

    Section 1833(t)(2)(E) of the Act, as enacted by the BBA 1997, authorized, but did not require, an outlier adjustment. In the proposed rule, we discussed our reasons for not implementing an outlier adjustment policy. We explained that we had reached that decision after carefully evaluating several factors. For the following reasons, we believed an outlier policy was not necessary: (a) in the proposed PPS, unlike the hospital inpatient PPS, we would use limited packaging of services and allow payment for multiple services delivered to a given patient on a given day; (b) payment for critical care services would reflect the intensity and higher costs associated with providing this type of medical care; and (c) we would make higher payment for serious medical cases even if critical care were not provided and additional payments would be made for any other laboratory work, x-rays, or surgical interventions resulting from medical visits to the emergency room.

    Section 201(a) of the BBRA 1999 amended section 1833(t) of the Act by adding an outlier adjustment provision, section 1833(t)(5). Under this new provision, the statute now requires that we make an additional payment (that is, an outlier adjustment) for outpatient services for which a hospital's charges, adjusted to cost, exceed a fixed multiple of the outpatient PPS payment as adjusted by pass-through payments. The Secretary determines this fixed multiple and the percent of costs above the threshold that is to be paid under this outlier provision. The statute sets a limit on projected aggregate outlier payments. Under the statute, projected outlier payments may not exceed an “applicable percentage” of projected total payments. The applicable percentage means a percentage specified by the Secretary (projected percentage of outlier payments relative to total payments), subject to the following limits: for years before 2004, the projected percentage that we specify cannot exceed 2.5 percent; for 2004 and later, the projected percentage cannot Start Printed Page 18498exceed 3.0 percent. Section 201(c) of the BBRA 1999 amended section 1833(t)(2)(E) of the Act to require that these payments be budget neutral.

    Section 1833(t)(5)(D) of the Act grants the Secretary authority until 2002 to identify outliers on a bill basis rather than on a specific service basis and to use an overall hospital cost-to-charge ratio (CCR) to calculate costs on the bill rather than using department-specific CCRs for each hospital.

    To set the threshold or fixed multiple and the payment percent of costs above that multiple for which an outlier payment would be made, we first had to determine what specified percentage of total program payment, up to 2.5 percent, we should select. We decided to set the outlier target at 2.0 percent. In order to set the fixed multiple outlier threshold and payment percentage, we simulated PPS payments, as described below in section G of the preamble. As explained further below, we calibrated the threshold and the payment percentage applying an iterative process so that the simulated outlier payments were 2.5 percent of simulated total payments. For purposes of the simulation, we set a “target” of 2.5 percent (rather than 2.0 percent), because we believe that a given set of numerical criteria would result in a higher percentage of outlier payments under the simulation using 1996 data than under the PPS. This is because we believe that the 1996 data reflects undercoding of services, which means simulated total payments would likely be understated and it in turn means the percentage of outlier payments would be overstated. In addition, we are unable to fully estimate the amount and distribution of pass-through payments using the 1996 data. Our inability to make these estimates further understates the total payments under the simulation. We believe that a set of numerical criteria that results in simulated outlier payments of 2.5 percent using the 1996 data would result in outlier payments of 2.0 percent under PPS. The difference arises from the effect of undercoding in the historical data and the payment of pass-throughs under PPS. Under the budget neutrality requirement in section 1833(t)(2)(E) of the Act, as amended by section 201(c) of the BBRA 1999, we make a corresponding 2.0 percent reduction to the otherwise applicable conversion factor. We will monitor outlier payment and make any necessary refinements to the outlier methodology when we set outlier policies for CY 2002.

    After setting the outlier target percentage and reducing the unadjusted conversion factor to reflect the 2 percent outlier reduction and the 2.5 percent pass-through adjustment (see discussion in section III.D), we identified those claims in our 1996 database with at least one payable service under the PPS system. For these bills, we first calculated the total PPS payment for the bill using the reduced conversion factor. Next, we calculated for each claim the total charges attributed to services being paid under the PPS system. These charges were then adjusted to cost, using a hospital-specific CCR. We used the sum of the hospital's total operating CCR and total capital CCR as the hospital specific CCR. These CCRs were calculated from the most current cost report data available and were adjusted to calendar year 1996.

    We also identified all bills for the 1,800-plus hospitals that we had previously identified as having coded only the lowest level clinic visit code (CPT code 99201) for all visits. For these hospitals, we isolated those claims with at least one service with the CPT code 99201 and one or more additional PPS covered service. Due to the undercoding on these bills and the inherent problem in determining a possible outlier condition, we excluded these bills from the calculation process but set aside a proportional amount of outlier payments based on the proportional cost of these bills to the total cost of all bills used in the outlier calculation.

    After determining the PPS payment and the cost for all 42 million claims for which there was at least one billable service under the PPS system, we experimented with several combinations of thresholds or fixed multiples and payment percent of costs over these multiples. We found that the combination of using a multiple of 2.5 for the threshold and the use of a payment percent of 75 percent of cost over this threshold achieved our target of a 2.5 percent outlier payment. Approximately 1.6 million claims in our 1996 claims database had calculated bill costs that exceeded the PPS payments on the claim by more than 2.5 times and thus qualified for an outlier payment in our model.

    Comment: We received several comments that supported our proposal not to create outlier payments. However, most commenters opposed it and supported including an outlier policy. Several commenters disagreed that multiple payment for multiple services furnished during a given visit would absolve the need for outliers. One commenter stated that outlier payments are necessary because of the limited number of APC groups. Several commenters believe that outlier payments are necessary to recognize variability in APC groups stemming from treatment options and patient complexity. Some argued that our own data demonstrate that an outlier policy is necessary to ensure equitable payments. Several commenters stated that the data trimming algorithm that we used, excluding from our PPS database claims that were greater than three standard deviations from the geometric mean, probably eliminated claims that included high cost items and services that should have been reflected in our data and that may have been associated with the later technologies. A professional association noted that an examination of our PPS data indicated that “20 percent of outpatient services subject to the PPS (excluding clinic and emergency room visits) include maximum costs that are at least 10 times higher than the corresponding rate; 100 services have maximum costs that are at least 40 times higher than the corresponding payment rate.”

    One commenter believes that an outlier policy is necessary for a payment system based on averaging to provide additional payments for potentially variable and expensive items such as pharmaceuticals and supplies. Several commenters suggested that outlier payments would be necessary if we did implement their option to carve out all pharmaceuticals and certain supplies from the hospital outpatient PPS and pay them separately based on reasonable costs or average wholesale price (AWP). Most commenters who urged establishing outlier payments advocated them for high cost drugs, supplies, and new technologies. Some commenters advised that a drug such as Activase administered to a cardiac patient in the emergency room prior to inpatient admission or transfer to another hospital for inpatient admission would be costly. One commenter estimated that the cost for two doses of the drug would exceed $4,000. One commenter urged an outlier policy that would adequately pay for iodine I 131 tositomomab. Another commenter recommended that we make an outlier payment for Hemophilia Factor Concentrate that could be packaged in APC 906 (Infusion Therapy, except Chemotherapy) or APC 907 (Intramuscular Injections) and Tissue Plasminogen Activator (TPA) and IV therapy drugs as outliers.

    A professional association expressed the need for an outlier policy for tests whose costs exceed a reasonable range of costs for similar procedures. They identified CPT codes 95951 and 95956 as examples of those tests. Another association recommended adoption of Start Printed Page 18499an outlier policy to recognize higher costs associated with new technologies. The commenter suggested that the policy remain in effect a full year after the hospital outpatient PPS is implemented to allow us adequate time to collect the appropriate data for use in updating the payment rates. Several other commenters believe that we may need to adopt an outlier policy on an interim basis while data are collected to determine the appropriate assignment of certain services and items to an APC. One commenter advocated outlier payments for hospitals whose aggregate costs exceed total payments under the hospital outpatient PPS in a given year. A number of other commenters stated that the hospital outpatient PPS outlier policy should be similar to that currently used for the inpatient PPS.

    Response: As we discussed above, section 201(a) of the BBRA 1999 amended the Act by adding a new section 1833(t)(5). This provision now requires the Secretary to make an additional outlier payment for outpatient services for which a hospital's or a CMHC's charges, adjusted to cost, exceed a fixed multiple of the new PPS payment as adjusted by pass-through payments. The Secretary is required to determine the fixed multiple and the percent of costs above the threshold that is to be paid under the outlier provision. As we explain above, to implement the outlier adjustment, we have determined that an outlier payment will be made when calculated bill costs exceed the PPS payments on a claim by more than 2.5 times. In addition, the provision of transitional pass-throughs under section 201(b) of the BBRA 1999, which requires the Secretary to make an additional payment for certain high cost medical devices, drugs, and biologicals, constitutes a kind of outlier adjustment (see section III.D of this preamble), and our decision to create special transitional payments for new technology items and services (see section III.C.8) will also provide additional payments to hospitals that incur higher costs under the outpatient PPS.

    2. Transitional Corridors/Interim Payments

    As we developed the proposed rule, we conducted extensive regression analysis of the relationship between outpatient hospital costs and several factors that affect costs, such as teaching intensity and disproportionate share percentage, as part of the analysis to determine whether payment adjustments should be proposed for the outpatient PPS. Ultimately, we did not propose any adjustments other than the wage index used to adjust for local variation in labor costs. One of the main reasons we did not propose any special adjustments was that the estimated effects of measured factors on costs were small and, in most cases, not statistically significant. In addition, we believe that the negative impacts estimated in the proposed rule for certain classes of hospitals were partially attributable to undercoding and coding variations in the data because coding did not affect the payment of many services under the current payment system, especially medical visits.

    Since publication of our proposed policy, section 202(a)(3) of the BBRA 1999 added new paragraph (7) to section 1833(t) of the Act to require the Secretary to make payment adjustments during a transition period to limit the decline in payments under PPS for hospitals. These additional payments are to be implemented without regard to budget neutrality and are in effect through 2003.

    Under paragraphs (A), (B), and (C) of section 1833(t)(7) of the Act, the amount of the payment adjustment for an individual hospital depends on the difference between the hospital's “PPS amount” and the hospital's “pre-BBA amount.” Section 1833(t)(7)(E) of the Act defines the “PPS amount” as the amount payable under PPS for the hospital's covered outpatient department services, excluding the effects of the transitional corridor and including coinsurance and deductibles. For purposes of calculating the PPS amount, we include the full copayment amounts; if a hospital chooses to reduce the copayment for some or all of the services that it furnishes, we will count the full copayment amounts rather than the reduced copayment amounts. Section 1833(t)(7)(F) of the Act defines the “pre-BBA amount” for a period as the amount equal to the product of (1) the hospital's reasonable cost for covered outpatient department services, and (2) the base outpatient department payment-to-cost ratio for the hospital. The statute defines “base payment-to-cost ratio” as the ratio of (1) the hospital's reimbursement for covered outpatient department services during the cost reporting period ending in 1996, to (2) the reasonable cost of the services for the period. The base payment-to-cost ratio will be calculated as if the amendments to sections 1833(i)(3)(B)(i)(II) and 1833(n)(1)(B)(i) of the Act made by section 4521 of the BBA 1997, to require that the full amount beneficiaries paid as coinsurance under section 1862(a)(2)(A) of the Act are taken into account in determining Medicare Part B Trust Fund payment to the hospital, were in effect in 1996.

    For calendar years 2000 and 2001, payment to hospitals whose PPS payment is less than 100 percent, but is at least 90 percent, of the pre-BBA payment, is increased by 80 percent of the difference. Hospitals whose PPS payment is less than 90 percent, but is at least 80 percent, of the pre-BBA payment, will receive additional payment equal to the amount by which 71 percent of the estimated pre-BBA payment exceeds 70 percent of the PPS payment. Hospitals whose PPS payment is less than 80 percent, but is at least 70 percent, of the pre-BBA payment will receive additional payment equal to the amount by which 63 percent of the pre-BBA payment exceeds 60 percent of the PPS payment. Payments to hospitals whose PPS payment is less than 70 percent of the pre-BBA payment will be increased by 21 percent of the pre-BBA payment. For calendar years 2001 through 2003, the number of corridors and the associated percentage increases decline over time. As required by statute, interim payments will be made subject to retrospective adjustments. Section 1833(t)(7) of the Act provides special transition payments for cancer centers and small rural hospitals, which are discussed below in section III.H.3.

    Comment: Hundreds of commenters, including associations, hospitals, and entities providing goods and services to hospitals, expressed grave concerns about the estimated impact of our proposed system on certain classes of hospitals. Many commenters noted that the case mix and service mix for specific classes of hospitals such as rehabilitation, cancer, children's, rural, and teaching hospitals are different than for other hospitals. They argued that a number of these hospitals deal with patients who typically require more resources. The commenters noted that we have authority under the statute to make adjustments for specific classes of hospitals. Some reasoned that given our estimates of substantial losses for certain classes of hospitals under the proposed hospital outpatient PPS, we should use our authority to exclude these classes of hospitals from the outpatient PPS for 2 years, require proper coding of bills from those hospitals, and have an opportunity to analyze the results of the improved coding. These commenters urged that we examine reasons other than coding that may contribute to the disparity. Many commenters recommended that a separate conversion factor be developed Start Printed Page 18500for the hospitals whose payments are adversely affected by the new system.

    Response: As discussed above, section 1833(t)(7) of the Act, as added by section 202(a) of the BBRA 1999, provides that, for several years, additional payments be made to any facility for which the PPS payment is less than an estimate of the hospital's pre-PPS payment and that these payments are in addition to the total payments under the PPS. Our estimate of the impacts of this change in policy along with other payment-related provisions of the BBRA 1999 (discussed in further detail in section IX) show improved payments under PPS relative to pre-BBRA law for nearly all classes of hospitals. Our simulations show that hospitals overall receive an additional 4.6 percent in payments under PPS compared to pre-PPS law. Long-term care and children's hospitals show losses (1.7 percent and 3.2 percent, respectively). Moreover, urban hospitals with no indirect teaching or disproportionate share inpatient adjustments show a loss of 0.3 percent. In addition, we reexamined and reestimated the multivariate regression specifications described in the proposed rule to reflect the changes described in this rule. Based on the results of regression analysis, we believe further adjustments are not warranted at this time. We found, for example, the disproportionate share percentage did not have a statistically significant effect on unit costs standardized by service mix. In addition, positive and significant results did not occur for most teaching variables that we specified. For instance, positive and significant results did not occur for hospitals whose ratio of residents to inpatient and outpatient days was less than .28. Hospitals with a large number of residents to inpatient and outpatient days did demonstrate slightly higher standardized costs, but only when the regression model included independent variables for urban/rural location. Moreover, the parameter estimate was small and payment was not greatly improved when a corresponding adjustment was made to these teaching hospitals. Therefore, we are not making such adjustments for these hospital groups. We do not believe that this action will restrict beneficiary access to care because the projected losses are relatively small and could reflect undercoding on the part of these hospitals before PPS.

    We will begin comprehensive analyses of cost and payment differentials between different classes of hospitals as soon as there is a sufficient amount of claims data submitted under the PPS. We will use data from the initial years of the PPS to conduct regression and simulation analyses. In addition, we will carefully track and analyze the additional payment made to hospitals under section 1833(t)(7) of the Act. These analyses will be used to consider and possibly propose adjustments in the system, particularly beginning in 2004 when the BBRA 1999 transition provisions expire.

    Comment: Commenters from organizations representing teaching hospitals recommended that we include a budget-neutral payment adjustment for certain classes of hospitals such as teaching hospitals. For example, the concern is that PPS payments are not adequate for academic medical centers because they provide more resource-intensive outpatient services than other hospital types.

    Response: As noted above, we are not making adjustments for specific classes of hospitals in this final rule. The primary reason for this decision is that section 1833(t)(7) of the Act requires additional payments through 2003 to all hospitals whose PPS payment falls below estimates of pre-PPS payment. We will conduct analyses and studies of cost and payment differential among different classes of hospitals, including teaching facilities, when sufficient data under the PPS have been submitted. We will carefully consider whether permanent adjustments should be made in the system once the BBRA 1999 transition provisions expire.

    3. Cancer Centers and Small Rural Hospitals

    Cancer Centers

    In the BBA 1997, the Congress did not exclude from the hospital outpatient PPS the 10 cancer centers that are currently excluded from the inpatient PPS, but section 1833(t)(8) of the Act (as enacted in the BBA 1997) provides special consideration for these hospitals under the outpatient PPS. More specifically, that section provides that the outpatient PPS would not apply to the 10 cancer centers before January 1, 2000, and that the Secretary may establish a separate conversion factor for cancer centers to take into account the unique costs they incur due to their patient population and the intensity of their services.

    In the proposed rule, we stated that, because we had no choice but to delay implementation of the PPS for all hospitals until sometime after January 1, 2000 due to Y2K concerns, we would begin paying cancer centers under hospital outpatient PPS at the same time. Also, we did not propose a separate conversion factor for cancer centers. Although our proposed impact analysis indicated that, under the PPS, the cancer centers could lose 32 percent of their current outpatient Medicare payments, we proposed to do additional work to try to explain the impact before we provided for a separate conversion factor or other payment adjustment.

    Section 1833(t)(7)(D)(ii) of the Act, as added by the BBRA 1999, provides that the 10 cancer centers excluded from the inpatient PPS are permanently held harmless with respect to their pre-BBA 1997 amount.

    Comment: The cancer centers commented that they are unlike other hospitals in that they treat the most difficult cases (patients often referred by community hospitals) and they are usually the first hospitals to use the latest technology related to cancer treatments. They also pointed out that their clinic visits often involve consultations with a number of physicians and therefore are longer and require more hospital resources than clinic visits in other hospitals. They believe that our proposed payments for clinic visits would seriously underpay them for their more comprehensive visits. The cancer centers also stated that any delay in recognizing and paying appropriately for new technology would affect them more adversely than it would other hospitals.

    During the comment period for the proposed rule, the cancer centers submitted for our consideration an alternative payment methodology. Under their methodology, we would calculate a separate conversion factor for each of the 10 centers based on their individual base year Medicare payments and service mix. Subsequently, the conversion factors would be updated using the Congressionally determined update factor applicable to all hospitals. Hospitals would be paid interim payment amounts during the year, but payment would ultimately be based on the lesser of—

    • The PPS payments they would receive using their individual conversion factor; or
    • The payments they would receive based on their cost reports by applying the current (that is, pre-PPS) outpatient services payment methodology.

    Capital costs would be excluded from this comparison and be paid on a reasonable cost pass-through basis. The proposal also envisioned some payment penalties and incentives similar to the penalties and incentives provided under the reasonable payment cost limit methodology applicable to hospitals excluded from the inpatient PPS. Start Printed Page 18501

    Response: As noted above, new section 1833(t)(7)(D)(ii) of the Act holds cancer centers harmless on a permanent basis by providing that, in instances where Medicare payment to a cancer center under the hospital outpatient PPS would be lower than a specified pre-BBA Medicare payment for the same services, we are to pay the full pre-BBA amount. Therefore, an alternative approach to paying cancer centers under the hospital outpatient PPS is no longer needed.

    Small Rural Hospitals

    We noted in the proposed rule that rural hospitals generally receive a relatively high percentage of their Medicare income from outpatient services (greater than the national average), which compounds the impact of the reduction in Medicare payments to rural hospitals that we projected would result upon implementation of the hospital outpatient PPS. We attributed these reduced revenues to undercoding, lack of economies of scale, and reliance on the median instead of the geometric mean in the calculation of APC weights. Because our impact analysis revealed that low-volume rural hospitals that are sole community hospitals or Medicare-dependent hospitals could experience a considerable reduction in revenues under the outpatient PPS, we solicited comments in the proposed rule on two possible approaches to phasing in the outpatient PPS for these types of hospitals.

    Section 1833(t)(7)(D)(i) of the Act provides that hospitals located in a rural area with 100 or fewer beds are held harmless with respect to their pre-BBA 1997 amount for outpatient services furnished before January 1, 2004. For purposes of implementing this provision, bed size will be determined in the same way it is for inpatient PPS for the indirect medical education adjustment as defined in § 412.105(b), Determination of number of beds. A hospital's location in a rural area will also be determined as it is in the inpatient PPS; see § 412.63(b), Geographic classifications.

    Comment: Many commenters were concerned that the projected negative impact of the proposed outpatient PPS on rural hospitals would be magnified because outpatient revenues make up such a large part of rural hospitals' total revenues. Some commenters believe that our proposed PPS ratesetting method favors high volume, urban hospitals. Some commenters supported phasing in the outpatient PPS for rural disproportionate share hospitals because those facilities may not have the resources to improve their coding in the near future. One association opposed phasing in the PPS because doing so would postpone but not resolve the financial jeopardy imposed on rural hospitals by the hospital outpatient PPS. Some commenters recommended that we provide an “add-on” to the prospective rate for emergency services in low-volume sole community and rural disproportionate share hospitals. One commenter expressed concern about the numerous factors contributing to rural hospitals' negative margins that limit their ability to absorb losses, including a disproportionately high share of Medicare, Medicaid, and indigent patients, significant problems recruiting practitioners, low population density, and limited patient volume. Numerous commenters recommended that we establish a payment floor for low-volume rural hospitals. One association requested that we either revise the payment methodology or put in place a payment floor that guarantees health care services will continue to be available to Medicare beneficiaries served by rural hospitals.

    Response: As we discuss above, in order to limit potential reductions in payment to hospitals under the outpatient PPS, section 1833(t)(7) of the Act, as added by section 202(a)(3) of the BBRA 1999, requires us to establish payment adjustments for hospitals whose PPS payments are less than our estimate of the hospital's pre-BBA payments. These additional payments are to be implemented in a non-budget neutral manner and are to be paid through 2003. Section 1833(t)(7)(D)(i) of the Act includes a special “hold harmless” provision, which is to be paid through 2003, for hospitals that are located in a rural area and that have no more than 100 beds. Under section 1833(t)(7)(D)(i) of the Act, as added by the BBRA 1999, small rural hospitals will be paid a predetermined pre-BBA amount for services covered under the outpatient PPS if payment under the PPS would be less than the pre-BBA amount. This hold harmless provision establishes a payment floor until January 1, 2004 for small rural hospitals. During this period, we will collect and analyze data under the PPS in order to assess whether any special adjustments will need to be made for rural hospitals once the hold harmless provision expires.

    I. Annual Updates

    1. Revisions to APC Groups, Weights and the Wage and Other Adjustments

    Prior to enactment of the BBRA 1999, section 1833(t)(6)(A) of the Act required the Secretary to periodically review and revise the APC groups, the relative payment weights, and the wage and other adjustments to take into account changes in medical practice, changes in technology, the addition of new services, new cost data, and other relevant information and factors.

    In the proposed rule, we described our plan to update the various components of the outpatient PPS. We proposed to keep the composition of all the APC groups essentially intact from one year to the next, with the exception of the few changes that may be necessary as a consequence of annual revisions to HCPCS and ICD-9-CM (International Classification of Diseases, Ninth Edition, Clinical Modification) codes. We stated that we did not plan to routinely reclassify services and procedures from one APC to another. We proposed to make these changes based on evidence that a reassignment would improve the group(s) either clinically or with respect to resource consumption. However, we specifically solicited comments on how frequently to recalibrate the APC weights and on the method and data that should be used. We defined recalibration as the updating of all the APC group weights based on more recent information.

    We proposed to update the wage index values used to calculate program payment and coinsurance amounts on a calendar year basis, adopting, effective for services furnished each January 1, the wage index value established for a hospital under the inpatient PPS the previous October 1. The first update to the wage index values will be effective for calendar year 2001 beginning January 1, 2001.

    Section 201(h)(1)(A) of the BBRA 1999 amended section 1833(t)(8)(A) of the Act (as redesignated by section 201(a) of the BBRA 1999) to require the Secretary to review the components of the outpatient PPS not less often than annually and revise the groups, the relative payment weights, and the wage and other adjustments to take into account changes in medical practice, changes in technology, and the addition of new services, new cost data, and other relevant information and factors. (Section 202(a) of the BBRA 1999 further redesignated section 1833(t)(8) as section 1833(t)(9).)

    Section 201(h)(1)(B) of the BBRA 1999 further amended this section of the Act to require that the Secretary consult Start Printed Page 18502with an expert outside advisory panel composed of an appropriate selection of representatives of providers to review (and advise the Secretary concerning) the clinical integrity of the groups and weights. This provision allows these experts to use data other than those collected or developed by us during our review of the APC groups and weights. Section 201(h)(2) of the BBRA 1999 requires the Secretary to initiate the annual review process beginning in 2001 for the PPS payments that would take effect January 1, 2002.

    Comment: A number of commenters urged that we adopt an annual update cycle for APC recalibration. Some commented that the APC update frequency should not be less often than the annual cycles that we have instituted for both the hospital inpatient PPS and physician fee schedule payment system. Many commenters maintained that annual updating is necessary to ensure that the APCs appropriately reflect changes in new technologies, standards of care, and other marketplace patterns. Several commenters stated that an annual update cycle is needed to take into account changes in drug prices and appropriately reflect advancements in nuclear medicine. Some commenters believe that updating the APCs less frequently than annually would adversely impact hospitals that would incur financial losses attributable to inappropriate payment for new technologies. Some commenters contended that infrequent updating would be a disincentive for manufacturers to develop new outpatient therapies.

    Response: In accordance with the amendments enacted by the BBRA 1999, we will review and update annually, for implementation effective January 1 of each year, the APC groups, the relative payment weights, and the wage and other adjustments that are components of the outpatient PPS, beginning with the update to be effective January 1, 2002.

    2. Annual Update to the Conversion Factor

    We stated in the proposed rule that section 1833(t)(3)(C)(ii) of the Act requires us to update annually the conversion factor used to determine APC payment rates. Section 1833(t)(3)(C)(iii) of the Act provides that the update be equal to the hospital inpatient market basket percentage increase applicable to hospital discharges under section 1886(b)(3)(B)(iii) of the Act, reduced by one percentage point for the years 2000, 2001, and 2002. The Secretary also has the option (under section 1833(t)(3)(C)(iii) of the Act) of developing a market basket that is specific to hospital outpatient services. We advised in our proposed rule that we are considering this option, and specifically invited comments on possible sources of data that are suitable for constructing a market basket specific to hospital outpatient services. We did not receive any comments regarding potential data sources for constructing a hospital outpatient-specific market basket. Therefore, we will update the conversion factor annually by the hospital inpatient market basket increase (as specified in section 1886(b)(3)(B) of the Act), reduced by one percentage point for the years 2000, 2001, and 2002.

    3. Advisory Panel for APC Updates

    As stated above, section 1833(t)(9)(A) of the Act (as redesignated by section 201(a) of the BBRA 1999 and further redesignated by section 202(a) of the BBRA 1999) requires the Secretary, beginning in 2001, to consult with an expert outside advisory panel of appropriately selected provider representatives when annually reviewing and updating the APC groups and the relative group weights. The statute specifies that the expert panel will act in an advisory capacity on matters pertaining to the clinical integrity of the groups and weights and that it may use data other than those developed or collected by us in executing this function. We will initiate this review process in 2001 for the hospital outpatient PPS payments that will take effect for services furnished on or after January 1, 2002. We will adopt a process for identifying and appropriately selecting provider representatives to serve as members of an expert advisory panel. We anticipate informing the hospital community of the formation of an expert advisory panel through timely notice in the Federal Register.

    J. Volume Control Measures

    Section 1833(t)(2)(F) of the Act requires the Secretary to develop a method for controlling unnecessary increases in the volume of covered outpatient department services. Section 1833(t)(6)(C) of the Act, as added by the BBA 1997, authorizes the Secretary to adjust the update of the conversion factor if we determine that the volume of services paid for under the outpatient PPS increases beyond amounts we establish under section 1833(t)(2)(F) of the Act.

    In the proposed rule, we proposed a volume control measure for services furnished in CY 2000 only. We discussed several long-term alternatives to control volume for services furnished in subsequent years, and we solicited comments on those options. We stated that we would propose an appropriate volume control mechanism for services furnished in CY 2001 and beyond after we completed further analysis. Given the complexities of developing an appropriate volume control mechanism for hospital outpatient services, we believed additional study was necessary.

    For CY 2000, we proposed to use a modified version of the physician sustainable growth rate system (SGR), which is required under section 1848(d)(3) of the Act, for purposes of the hospital outpatient PPS. As we stated in the proposed rule, this appeared to be the most feasible initial approach. Using this approach, we proposed to update the target amount specified under section 1833(t)(3)(A) for CY 1999 as an expenditure target for services furnished in CY 2000. We stated that we would update the CY 1999 target for inflation (based on the projected change in the hospital market basket minus one percentage point), estimate changes in the volume and intensity of hospital outpatient services, and estimate Part B fee-for-service changes in enrollment. If volume exceeded the target for CY 2000, we proposed to adjust the update to the conversion factor for CY 2002. We further stated that we would compare the CY 2000 target to an estimate of CY 2000 actual payments to hospitals as determined by our Office of the Actuary using the best available data. We proposed that if unnecessary volume increases, as reflected by expenditure levels, caused payment to exceed the target, we would determine the percentage by which the target is exceeded, and adjust the CY 2002 update to the conversion factor by the same percentage.

    We indicated that we would respond in the final rule to comments on our proposed volume control measure for services furnished in CY 2000, but not to comments about volume control options for services furnished after CY 2000, which will be addressed in a later proposed rule.

    Comment: We received many comments opposing our proposed use of an SGR-like system to control unnecessary volume increases under the hospital outpatient PPS. Most commenters strongly urged us to exercise the discretionary authority allowed under section 1833(t)(9)(C) of the Act (as redesignated) not to adjust the update to the conversion factor. A few commenters endorsed the provision Start Printed Page 18503of the “President's Plan to Modernize and Strengthen Medicare for the 21st Century” (issued July 2, 1999) to delay adoption of a volume control measure in order to give hospitals additional time to adjust to the new system. Several commenters, including one national physicians' association, contended that we did not have the statutory authority to establish and use an expenditure target in the manner that we had proposed. The physicians' association stated that the law limits use of the SGR system to physician services. Some commenters believe that we lack the expertise needed to set an accurate target amount. Others argued that an expenditure target is not a reliable way to distinguish the growth of necessary versus unnecessary services and that our proposal would therefore have consequences not intended by the statute (that is, affecting all services rather than only those that would be considered unnecessary). Some commenters stated that expenditure caps only work when they directly affect those who control the volume. These commenters contended that a volume control measure is unfair to hospitals because it is physicians, not hospitals, who order services and therefore control volume. Some commenters were concerned that adopting a volume control measure would penalize hospitals for increases in outpatient volume attributable to technological changes that appropriately shift service delivery from the inpatient to outpatient setting. In addition, numerous organizations recommended that we not implement the volume expenditure targets and control measures because payments would be reduced to inadequate levels and affect beneficiary access to care.

    Response: We are delaying implementation of a volume control mechanism as suggested by the “President's Plan to Modernize and Strengthen Medicare for the 21st Century” (the statute does not specify an implementation date). This delay gives hospitals time to adjust to the PPS, and it gives us additional time to study appropriate methods of controlling outpatient volume over the long term. We are currently working with a contractor to study options for volume control measures for outpatient services. In the future, before we make any final decision, we will publish a notice in which we will discuss our proposal and will provide a public comment period.

    K. Claims Submission and Processing and Medical Review

    Comment: Numerous commenters expressed a variety of concerns related to information exchange processes required by the new PPS. Several commenters stated that the remittance advice documents will need to reflect all of the components used in calculating payment for each claim, as well as possible coinsurance reductions. The commenters also were concerned that, with the complexity of the APC system, hospitals will need the ability to verify payment. One health system that had experience with 3M's APGs offered the experience of their member hospitals to assist us by providing input on the data needed by hospitals to manage APCs. This same commenter stated that hospitals must be given detailed instructions on claims submission, changes to the UB-92, and changes to the Correct Coding Initiative (CCI) in advance to ensure that systems and personnel can comply with Medicare requirements.

    Response: We released specific hospital billing instructions that address line item reporting and reporting of service units on December 23, 1999 (Transmittals 1787 and 747). We will be issuing final instructions for implementation of this PPS in a program memorandum to fiscal intermediaries. The program memorandum addresses a range of issues such as appropriate use of revenue center/HCPCS codes for compliance with Medicare requirements and changes to Remittance Advice messages and Medicare Summary Notices/EOMBs.

    All current correct coding initiative (CCI) edits with the exception of laboratory and anesthesiology edits have been incorporated in the outpatient code editor (OCE) that fiscal intermediaries use to process claims for hospital outpatient services for payment. We will address OCE changes in a program memorandum to fiscal intermediaries. The effective date of these edits is July 1, 2000.

    We have decided not to pursue changes to the UB-92 claim form to allow line item diagnosis because, as we discuss in section III.C.3, we will not be using diagnosis to determine payments for clinic and emergency visits when the PPS is first implemented. Diagnosis codes, however, are still required to be reported on hospital outpatient bills.

    Medical Review Under the Hospital Outpatient PPS

    We have received inquiries regarding the anticipated medical review process for hospital outpatient PPS claims. The methodology of review for outpatient claims does not change under the PPS. The goal of medical review is to identify inappropriate billing and to ensure that payment is not made for noncovered services. Contractors may review any claim at any time, including requesting medical records, to ensure that payment is appropriate. In accordance with this final rule, Medicare will make payment under the PPS for hospital outpatient services including partial hospitalization services; certain Part B services furnished to inpatients who have no Part A coverage; partial hospitalization services furnished by CMHCs; vaccines, splints, casts and antigens provided by HHAs and CORFs that provide medical and other health services; and splints, casts and antigens provided to hospice patients for the treatment of a nonterminal illness. In addition, we expect focused reviews will include the adjustments we have made to the hospital outpatient PPS as a result of the enactment of the BBRA 1999, especially the transitional pass-through payments for innovative drugs, biologicals, and medical devices that are discussed in section III.D. Fiscal intermediaries will continue focused and random review of services such as ambulance, clinical diagnostic laboratory, orthotics, prosthetics, take home surgical dressings, chronic dialysis, screening mammographies, and outpatient rehabilitation (physical therapy including speech language pathology and occupational therapy) even though these services are excluded from the scope of services paid under the hospital outpatient PPS.

    L. Prohibition Against Administrative or Judicial Review

    Section 1833(t)(9) of the Act, as added by the BBA 1997, prohibits administrative or judicial review of the development of the PPS classification system, the groups, relative payment weights, wage adjustment factors, other adjustments, volume control methods, calculation of base amounts, periodic control methods, periodic adjustments, and the establishment of a separate conversion factor for cancer hospitals. Section 201(a) of the BBRA 1999 redesignates this section as section 1833(t)(11) of the Act, and section 201(d) of the BBRA 1999 amends the section by adding the following to the list of adjustments subject to the limitation on judicial review: the factors used to determine outlier payments, that is, the fixed multiple, or a fixed dollar cutoff amount; the marginal cost of care, or applicable total payment percentage; and the factors used to determine additional payments for certain medical devices, drugs, and biologicals such as the determination of insignificant cost, the duration of the additional payments, the portion of the outpatient PPS Start Printed Page 18504payment amount associated with particular devices, drugs, or biologicals, and any pro rata reduction. Section 202(a) of the BBRA 1999 further redesignates section 1833(t)(11) as section 1833(t)(12).

    IV. Provider-Based Status

    A. Background

    The Medicare law (section 1861(u) of the Act) lists the types of facilities that are regarded as providers of services, but does not use or define the term “provider-based.” However, from the beginning of the Medicare program, some providers, which we refer to in this section as “main providers,” have owned and operated other facilities, such as SNFs or HHAs, that were administered financially and clinically by the main provider. The subordinate facilities may have been located on the main provider campus or may have been located away from the main provider. In order to accommodate the financial integration of the two facilities without creating an administrative burden, we have permitted the subordinate facility to be considered provider-based. The determination of provider-based status allowed the main provider to achieve certain economies of scale. To the extent that overhead costs of the main provider, such as administrative, general, housekeeping, etc., were shared by the subsidiary facility, these costs were allowed to flow to the subordinate facility through the cost allocation process in the cost report. This was considered appropriate because these facilities were also operationally integrated, and the provider-based facility was sharing the overhead costs and revenue producing services controlled by the main provider.

    Before implementation of the hospital inpatient PPS in 1983, there was little incentive for providers to affiliate with one another merely to increase Medicare revenues or to misrepresent themselves as being provider-based, because at that time each provider was paid primarily on a retrospective, cost-based system. At that time, it was in the best interest of both the Medicare program and the providers to allow the subordinate facilities to claim provider-based status, because the main providers achieved certain economies, primarily on overhead costs, due to the low incremental nature of the additional costs incurred.

    In the proposed rule, we pointed out the increase of provider-based facilities and the financial and organizational incentives for that increase since 1983. A variety of factors such as the emergence of integrated delivery systems and the pressure to enhance revenues have combined to create incentives for providers to affiliate with one another and to acquire control of nonprovider treatment settings, such as physician offices.

    We noted in the proposed rule that it is essential that we make decisions regarding provider-based status appropriately, and that we have clear rules for identifying provider-based entities. By failing to distinguish properly between provider-based and free-standing facilities or organizations, we risk increasing program payments and beneficiary coinsurance with no commensurate benefit to the Medicare program or its beneficiaries and we jeopardize the delivery of safe and appropriate health care services to our beneficiaries.

    Although there is no direct statutory requirement to maintain explicit criteria for determination of provider-based status, there are statutory references acknowledging the existence of this payment outcome. For example, section 1881(b) of the Act provides for separate payment rates for hospital-based ESRD facilities. There is currently no general definition of “provider-based facility” in the CFR. However, in the proposed rule, we cited issuances that do contain provisions for recognition of specific types of entities as provider-based, including Program Memorandum A-96-7, published on August 27, 1996, which pulled together instructions for specific entity types from previously published documents and consolidated them into a general instruction for the designation of provider-based status for all facilities or organizations. That Program Memorandum was subsequently reissued, without substantive change, as Program Memoranda A-98-15 and A-99-24 and, in October 1999, was manualized by the Provider Reimbursement Manual, Part I, Transmittal 411 (adding new section 2446), and the State Operations Manual, Transmittal 11 (replacing previous section 2003 and adding new section 2004). Our policy will continue to follow the principles we articulated in Program Memorandum A-96-7 and the Provider Reimbursement Manual and State Operations Manual sections cited above until October 10, 2000. After that date, we shall apply the policies set forth in these final regulations.

    B. Provisions of the Proposed Rule

    We announced our intention to implement §§ 413.24(d)(6)(i) and (ii), 413.65, 489.24(b), and 498.3, as revised based on our consideration of public comments, with respect to services furnished on or after 30 days following publication of a final rule. We describe these sections below and explain that we have now provided a 6-month delay in the effective date of the regulations on provider-based status.

    We proposed to add a new § 413.65 on the determination of provider-based status. In paragraph (a), we proposed to define the following terms: department of a provider, free-standing facility, main provider, provider-based entity, and provider-based status. In paragraph (b), we proposed that a facility or organization would not be entitled to be treated as provider-based simply because it or the provider believe it to be provider-based. The facility or organization, or the provider, would have to contact HCFA and obtain an affirmative provider-based determination before billing of the facility's or organization's costs through the main provider, or inclusion of those costs on the main provider's cost report, is initiated. Further, we proposed to presume a facility not located on the campus of a hospital and used as a site of physician services of the kind ordinarily furnished in physician offices to be a free-standing facility unless we determined it to have provider-based status.

    We proposed to require, in paragraph (c), that a main provider that acquires a facility or organization for which it wishes to claim provider-based status must report its acquisition of the facility or organization to us if the facility or organization is off the campus of the main provider, or is located on the campus of the main provider and, if acquired, would increase the main provider's costs by 5 percent or more. The main provider must also furnish all information needed for a determination as to whether the facility or organization meets the criteria in this section for provider-based status. A main provider that has had one or more facilities or organizations determined to have provider-based status also must report to us any material change in the relationship between it and any department or provider-based entity, such as a change in ownership of the entity or entry into a new or different management contract, that could affect the provider-based status of the department or entity.

    In paragraph (d), we proposed the requirements for a determination of provider-based status. In paragraph (d)(1), we proposed to set forth licensure requirements for facilities or organizations seeking provider-based status.

    In paragraph (d)(2), we proposed to require that a facility or organization be Start Printed Page 18505under the ownership and control of the main provider.

    In paragraph (d)(3), with respect to administration and direct supervision of the main provider, we proposed to require that a facility or organization seeking provider-based status have a reporting relationship to the main provider that is characterized by the same frequency, intensity, and level of accountability that exists in the relationship between the main provider and one of its departments.

    In paragraph (d)(4), we proposed that a facility or organization seeking provider-based status and the main provider share integrated clinical services, as evidenced by privileging of the professional staff of the department or entity at the main provider, and the main provider's maintenance of the same monitoring and oversight of the department or entity as of other departments. Also, the medical director of the department or entity would be required to maintain a day-to-day reporting relationship with the chief medical officer (or equivalent) of the main provider, and be under the same supervision as any other director of the main provider.

    In paragraph (d)(5), we proposed to require that the department or entity and the main provider be fully financially integrated within the main provider's financial system, as evidenced by the sharing of income and expenses. The department's or entity's costs should be reported in a cost center of the provider, and the department's or entity's financial status should be incorporated into, and readily identifiable in, the main provider's trial balance.

    In paragraph (d)(6), we proposed to require that the main provider and the facility seeking status as a department of the provider be held out to the public as a single entity, so that when patients enter the department they are aware that they are entering the provider and will be billed accordingly. (This requirement would not apply to a provider-based entity that is itself a provider, such as a SNF.)

    In paragraph (d)(7), we proposed to require that the department of a provider or provider-based entity and the main provider be located on the same campus, except where requirements relating to service to the same patient population are met.

    Paragraph (e) would specifically prohibit the approval of provider-based status for any proposed department or entity that is owned by two or more providers engaged in a joint venture.

    In proposed paragraph (f), we proposed to state that facilities or organizations operated under management contracts would be considered provider-based only if specific requirements are met related to: Staff employment, administrative functions, day-to-day control of operations, and holding of the management contract by the provider itself rather than by a parent organization.

    In proposed paragraph (g), we proposed to specify nine obligations of hospital outpatient departments and hospital-based entities. We explained that these obligations ensure that facilities seeking recognition as hospital outpatient departments or hospital-based entities are in fact what they represent themselves to be, and are not simply the private offices of individual physicians or of physicians in group practices.

    We also proposed to preclude any facility or organization that furnishes all services under arrangements from qualifying as provider-based. We believe the provision of services under arrangement was intended to be allowed only to a limited extent, in situations where cost-effectiveness or clinical considerations, or both, necessitate the provision of services by someone other than the provider's own staff. The “under arrangement” provision in section 1861(w)(1) of the Act and § 409.3 is not intended to allow a facility merely to act as a billing agent for another.

    Proposed paragraph (h) states that, if we learn of a provider that has inappropriately treated a facility or organization as provider-based, before obtaining our determination of provider-based status, we would reconsider all payments to that main provider for those periods subject to reopening, and we would investigate to determine whether the designation was appropriate.

    In proposed paragraph (i), we would apply the principles in paragraph (h) to situations involving inappropriate billing for services furnished in a physician's office or other facility or organization as if they had been furnished in a hospital outpatient or other department of a provider or in a provider-based entity.

    We also proposed to add a new paragraph (j) that would allow us to review past determinations. If we find that a designation was in error, and the facility or organization in question does not meet the requirements of this section, we will notify the main provider that the provider-based status will cease as of the first day of the next cost report period following notification of the redetermination.

    In addition, we proposed to add to § 413.24(d) new paragraphs (6)(i) and (6)(ii) to clarify that main providers, in completing their Medicare cost reports, may not allocate overhead costs to the provider-based or other cost centers that incur similar costs directly through management contracts or other arrangements. These changes are needed to prevent misallocation of management costs, which would result in excessive payment to those types of providers paid on a reasonable cost basis.

    To provide an administrative appeals process for entities that have been denied provider-based status, we proposed to revise the regulations on provider appeals at § 498.3. As revised, these rules would specify that a provider seeking a determination that a facility or an organization is a department of the provider or a provider-based entity under proposed § 413.65 would be included in the definition of “prospective provider” for purposes of part 498, and would be afforded the same appeal rights as a prospective provider, such as a hospital or SNF, that we have found not to qualify for participation as a provider.

    C. Comments and Responses

    In response to our proposals, we received approximately 120 letters of comment, most of which raised a number of issues. Included among the commenters were hospitals and hospital and other provider associations, physicians, attorneys, and other individuals. Here we respond to comments submitted on the proposed rule.

    General Comments

    Many comments were not directed to a specific provision or criterion, but concerned the implementation of the regulations or the application of provider-based criteria to specific types of facilities. These are summarized below.

    Effective Date

    Comment: A commenter requested clarification as to when the parts of the final rule setting forth criteria for provider-based status would be effective, and a number of commenters requested an extended grace period or a delay in effective date of the final rules, with some commenters requesting delays as long as 12 to 18 months. Various reasons were cited, including the pressures on providers to prepare their systems and staff for the outpatient PPS, the need to bring operations into compliance with the provider-based criteria, and the anticipated workloads of HCFA regional offices that may Start Printed Page 18506receive a large number of requests for provider-based determinations. Commenters argued that it is unrealistic to expect that a hospital would engage in a full-blown analysis of its provider-based arrangements and modify each arrangement until it knows against which exact criteria it is measuring those arrangements. Any changes in status will require hospitals to implement billing and other operational changes. Thus, commenters argued that it is not reasonable to expect hospitals to complete such steps within a 30-day period.

    Response: We agree, and are providing a delay in the effective date until October 10, 2000. Moreover, as stated in our response to comments on proposed § 413.65(j) below, any redetermination of provider-based status that finds the facility or organization not to be provider-based will not take effect for at least 6 months after the date the provider is notified of the redetermination.

    Application to Specific Facilities

    Comment: One commenter stated that under the Balanced Budget Act of 1997 (the BBA 1997) long-term hospitals established on or before September 30, 1995 are entitled to retain their long-term hospital classification notwithstanding their location in the same building or campus of another hospital. In the commenter's view, these hospitals should not now have this classification revoked by this proposed regulation.

    Response: The provision referred to by the commenter, section 4417(a) of the BBA 1997, is codified in section 1886(d)(1)(B) of the Act and is implemented under regulations at § 412.22(f). That provision authorizes certain hospitals to continue being excluded from the Medicare hospital inpatient prospective payment system (PPS) based on their exclusion status and configuration on or before September 30, 1995, even though they would not otherwise qualify for this exclusion. The criteria for provider-based status do not conflict with or even directly relate to the section 4417(a) provision, and we have therefore not made any change in the regulations based on this comment.

    Comment: The commenter believes that rural health clinics (RHCs) should be exempted from provider-based designation requirements if they meet the intent of the enabling regulation. The commenter requested that an RHC be granted provider-based status if it meets one of the following criteria: Is the sole source of primary care for the community; has traditionally served the community with an open door policy; or treats a disproportionate share of the community's Medicare and Medicaid population.

    Response: We share the commenter's concern, but believe the criteria suggested are overly inclusive and could lead to a proliferation of RHCs in areas where there are no true shortages of care. While we do not believe a blanket exemption from the criteria is warranted, we have developed a special provision for RHCs affiliated with small rural hospitals, as described below in our responses to comments on § 415.65(d)(7), Location in immediate vicinity.

    Comment: A commenter stated that there may be instances where the Medicare regulations related to provider-based definitions conflict with the Medicaid provider-based regulations, and asked whether Medicaid will be required to comply with the new Medicare provider-based regulations.

    Response: Because hospitals under Medicaid are required to meet the same standards as Medicare facilities, these final rules would affect the Medicaid definition of these facilities as well as the Medicare definitions.

    Comment: Commenters stated that the reasons cited for establishing provider-based requirements that are found in the preamble do not apply to clinical laboratories and thus these requirements should not apply. The commenters asked that we explicitly state in the final regulations that the provider-based requirements are not applicable to clinical laboratories. They believe the regulations have little bearing where, as with clinical laboratory services, reimbursement is under a fee schedule amount, and neither the Medicare program nor the beneficiary will pay anyone differently as a result of the treatment of the laboratory in the manner proposed.

    Response: As explained more fully in the preamble to the proposed rule, our objective in issuing specific criteria for provider-based status is to ensure that higher levels of Medicare payment and increases in beneficiary liability for deductibles or coinsurance (which can all be associated with provider-based status) are limited to situations where the facility or organization is clearly and unequivocally an integral and subordinate part of a provider. Under this principle, we agree with the commenter's view that it would not be either necessary or appropriate to make provider-based determinations with respect to facilities or organizations if by law their status (that is, provider-based or free-standing) would not affect either Medicare payment levels or beneficiary liability. However, we believe that it is not necessary to specify in the regulations that specific facility types are excluded, since these facilities or organizations are unlikely to seek a provider-based determination. We will be careful to clarify this policy in program operating instructions.

    Comment: A commenter stated that the proposed provider-based requirements seem to preclude the possibility of a Comprehensive Outpatient Rehabilitation Facility (CORF) meeting these new requirements. The commenter believes that in the past, CORFs have been permitted to be either provider-based or free-standing and asked whether the final rules will give CORFs the option of being either free-standing or provider-based.

    Response: As explained more fully in the preamble to the proposed rule, our objective in issuing specific criteria for provider-based status is to ensure that higher levels of Medicare payment and increases in beneficiary liability for deductibles or coinsurance (which can all be associated with provider-based status) are limited to situations where the facility or organization is clearly and unequivocally an integral and subordinate part of a provider. We are aware that, under the cost-based payment system that applied to CORFs prior to January 1, 1999, approximately 17 percent of participating CORFs claimed provider-based status. However, effective January 1, 1999, in accordance with the BBA 1997, payment for all CORF services is made no longer on the basis of cost reimbursement but on the basis of the physician fee schedule. Beneficiary liability is also determined under the fee schedule, regardless of the organizational structure or affiliations of the CORF. The switch to fee schedule payment from a cost-based system eliminates or removes any payment incentives to be a provider-based rather than a free-standing CORF. Thus, as in the case of the preceding comment, we agree with the commenter's view that it would not be either necessary or appropriate to make provider-based determinations with respect to facilities or organizations if by law their status (that is, provider-based or free-standing) would not affect either Medicare payment levels or beneficiary liability. We also note that existing regulations at § 413.174 specify rules for determining whether ESRD facilities are independent or hospital-based, and we have revised § 413.65(a) to state that determinations with respect to ESRD facilities will continue to be made under § 413.174, Start Printed Page 18507not § 413.65. However, we believe that it is not necessary to specify in the regulations that most specific facility types are excluded, since these facilities or organizations are unlikely to seek a provider-based determination. We will be careful to clarify this policy in program operating instructions.

    Application to Specific Facilities—Indian Health Service (IHS)

    Comment: Several commenters requested an exception or exemption from the rules for IHS and tribal facilities. One commenter was concerned that the implementation of these proposed regulations will have the effect of denying Medicare participation as provider-based entities to a number of IHS facilities that are currently operated by Indian tribes under the auspices of Public Law 93-638. They will also cause a disruption of the coordinated health care delivery system(s) that exist between IHS and numerous tribes, and jeopardize statutorily authorized contracting and compacting relationships between the IHS and these tribes due to the conflict between these proposed regulations and the statutory opportunities for self-determination by the Indian tribes. The IHS strongly recommended that these proposed regulations not apply to IHS and tribal health systems as written. Recommendations were also made to deem satellite facilities within a discrete Indian reservation as meeting the definition of a provider-based entity as well as satellite facilities within a historical service unit. Finally, the IHS recommended that the current system be “grandfathered” to meet the definition of provider-based entity.

    Response: We share many of these concerns and have provided special treatment for IHS and tribal facilities as described below.

    Comment: A commenter was concerned that the proposed regulations would severely restrict a number of IHS satellite clinics from receiving reimbursement for the provision of Medicare Part B services. The commenter believes that a number of the requirements that must be met before an entity can be designated as provider-based for Medicare payment purposes are unrealistic for IHS satellite clinics, which are often the only Medicare providers on remote tribal lands. The commenter recommended that HCFA provide for an exemption for IHS satellite facilities that are generally located on a main hospital campus or within a short distance of a hospital. Also, the commenter recommended that the final rule clarify that IHS and tribal outpatient departments or satellite clinics are eligible to receive designation as a department of a provider or a provider-based entity and are eligible for Part B reimbursement.

    Response: We share many of these concerns and have provided special treatment for IHS and tribal facilities as described below.

    Comment: Many tribes have acquired operations of outpatient facilities and are in the process of acquiring the affiliated hospitals. The commenter stated that this trend, coupled with the complexities of the Indian Self-Determination Act (Pub. L. 93-638), the Indian Health Care Improvement Act (Pub. L. 94-437), and a moratorium on tribal compacting and contracting, requires special consideration by HCFA. The commenter requested that facilities be recognized as provider-based if—

    (1) The outpatient facility is owned and operated by the tribe that owns the majority of the tribal shares utilized in funding the main hospital;

    (2) The tribe has previously compacted programs that were historically administered by the hospital and are now administered through a committee or board comprised of medical staff of both facilities;

    (3) The outpatient facility is in the same State as the hospital;

    (4) There is coordination and integration of services, to the extent practicable, between the outpatient facility seeking provider-based status and the main provider.

    Response: We recognize that the provision of health services to members of Federally recognized Tribes is based on a special and legally recognized relationship between Indian tribes and the United States Government. To address this relationship, the IHS has developed an integrated system to provide care that has its foundation in IHS hospitals. Because of these special circumstances, not present in the case of private, non-Federal facilities and organizations that serve patients generally, we agree that it would not be appropriate to apply the provider-based criteria to IHS facilities or organizations or to most tribal facilities or organizations. Therefore, we have revised the final rule to state that facilities and organizations operated by the IHS or Tribes will be considered to be departments of hospitals operated by the Indian Health Service or Tribes if, on or before April 7, 2000, they furnished only services that were billed as if they had been furnished by a department of a hospital operated by the Indian Health Service or a Tribe and they are: (1) owned and operated by the IHS; (2) owned by the Tribe but leased from the Tribe by the IHS under the Indian Self-Determination Act in accordance with applicable regulations and policies of the Indian Health Service in consultation with Tribes: or (3) owned by the IHS but leased and operated by the Tribe under the Indian Self-Determination Act in accordance with applicable regulations and policies of the Indian Health Service in consultation with Tribes. Facilities or organizations that are neither leased nor owned by the IHS would not be eligible for this special treatment, even if operated on Tribal land by members of the Tribe. These facilities would, of course, be eligible to participate in Medicare as FQHCs if applicable requirements in our regulations at 42 CFR part 405, subpart X are met. We did not adopt the conditions recommended by one commenter because we believe they may not apply to all Tribes.

    Application to Specific Facilities—Federally Qualified Health Centers (FQHCs)

    Comment: A commenter stated that despite specific acknowledgment of the eligibility of FQHCs to qualify as provider-based entities, certain proposed ownership, governance, and supervision criteria in connection with the determination of provider-based status would effectively prohibit entities from maintaining concurrent provider-based and FQHC designations. The commenter believe the criteria should be modified, or some other special provision created, to allow FQHCs to be departments of a provider.

    Response: We understand the commenter's concerns and have provided special treatment for FQHCs as described below.

    Comment: The commenter, a hospital that is affiliated with a number of off-site community health centers, believes the criteria in the proposed rule would deny provider-based status to community controlled, urban tax-exempt health centers operated under the license of a “main provider.” Several of the commenter's health centers are FQHCs that must fulfill certain criteria to maintain this status. In the commenter's view, it is not feasible to require the “main provider” to own and control these health centers or to require that the health centers and the “main provider” strictly meet all of the requirements set forth in the proposed rule. The commenter asked that the final rule be revised to take into account these historical relationships and “grandfather” the provider-based status of health centers that have been on the license of a disproportionate share hospital for at least 10 years. The recommended “grandfathering” Start Printed Page 18508provisions also could, in the commenter's view, require common Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accreditation, integration of clinical care committees, main provider approval of clinical guidelines and protocols, and financial oversight and review by the main provider.

    Response: We share many of these concerns and have provided special treatment for FQHCs as described below.

    Comment: A commenter requested that we provide a transition period of at least five years for health centers that have been treated as provider-based entities for a significant period of time (for example, 10 years or more), so that the centers will have adequate time to achieve compliance with the provider-based criteria. In the commenter's view, an extended time period for compliance would permit continuity of care to the populations served by the health centers while granting the affected health centers an opportunity to find alternative funding streams.

    Response: We recognize that FQHC qualification criteria effectively require these facilities to be governed by community-based boards independent of hospitals and other providers, while our provider-based criteria require facilities seeking provider-based status to be operated under the ownership and control of the main provider, and to be under the direct supervision of that provider. This does not preclude an FQHC from participating in Medicare as a free-standing entity; on the contrary, this participation is entirely appropriate. However, it does preclude the facility from qualifying as a department of a hospital or other provider under our criteria.

    Despite the difference between HRSA and HCFA requirements, we are aware that some FQHCs may have been treated by hospitals as departments for purposes of Medicare and Medicaid billing, and we are concerned that an abrupt change in status for them could force some or all to close, leading to shortages of care in some areas. Therefore, we plan to establish special provisions for FQHCs and FQHC “look-alikes” (facilities that are structured like FQHCs and meet all requirements for grant funding, but have not actually received these grants). Specifically, we have revised the regulations to state that if a facility has since April 7, 1995 furnished only services that were billed as if they had been furnished by a department of a provider and either (1) received a grant before 1995 under section 330 of the Public Health Service Act or, before 1995, received funding from such a grant under a contract with the recipient of such a grant and meets the requirements to receive a grant under section 330 of the Public Health Service Act; or (2) based on the recommendation of the PHS, was determined by HCFA before 1995 to meet the requirements for receiving such a grant, the facility will continue to be treated, for purposes of this section, as a department of the provider without regard to whether it complies with the criteria for provider-based status in § 413.65. We note that both types of facilities would be obligated, for as long as they are treated as a department of a provider, to comply with the applicable requirements for departments of providers as stated in § 413.65(g).

    Application of Standards

    Comment: One commenter believes that the proposed rule did not make clear how it would apply to existing entities, because some language in the rule could be read to require that existing entities would not receive provider-based status until we have issued a determination letter. Another commenter requested that we clarify whether we expect to review all clinics prospectively or just new clinics. The commenter stated that requirements that only new clinics seek designation does not preclude us from auditing currently designated clinics. Another commenter asked if there will be a set time frame during which current providers with provider-based departments or entities under Program Memorandum A-96-7 must contact us and receive an official designation in order to continue billing as they currently do. More specifically, the commenter asked whether, if there is such a time frame, compliance with the criteria in the Program Memorandum would constitute a good faith effort as referred to in § 413.65(i)(2). Additional guidance was also requested as to what providers should do now to demonstrate that they have made a good faith effort.

    Response: We plan to review all new requests for provider-based status. At present, we have no plans to systematically review all providers to determine whether they may be claiming provider-based status for some facilities or organizations inappropriately. However, we will review the status of specific facilities or organizations in response to complaints or any other credible information that indicates that provider-based status requirements are not being met. If the regional office determines that this is the case, it will take action in accordance with the rules in new § 413.65(h) and (i). In response to the comment about possible retroactive application of the new regulations, we note that they will apply only on or after their effective date of October 10, 2000. We will not apply the provider-based criteria in the new regulations to periods prior to that date; on the contrary, decisions for such periods will be reviewed only under the criteria in effect at the time, as stated in Program Memoranda and the Provider Reimbursement Manual and State Operations Manual.

    Comment: Two commenters pointed out the proposed rules do not state whether the required approval status is retroactive to when the provider applied or to when we granted approval. These commenters believe it should be retroactive to the date of the provider's application for the determination.

    Response: We plan to make provider-based status applicable as of the earliest date on which a request for provider-based status has been made and all requirements for provider-based status are shown to have been met, not on the date of our determination. Thus, if a provider requests provider-based status for a facility on May 1 and demonstrates that applicable criteria were met on that date, but the regional office did not make a formal determination until June 1, the determination would be effective on May 1.

    Comment: The commenter stated that we should not have published important provider-based policies in a Federal Register document that some providers, such as skilled nursing facilities and home health agencies, may not have read. The commenter recommended that we re-issue these proposed rules separately from the proposed hospital outpatient prospective payment rules.

    Response: We do not agree that the proposed rules were published in an obscure location. On the contrary, the number of written comments received, many of them from providers other than hospitals, indicates that our proposals were widely known among providers that could be affected. Therefore, we do not intend to republish the proposed rules.

    Comment: A commenter expressed concern that these provider-based provisions are unnecessarily restrictive and will unreasonably limit practice arrangements. The commenter went on to state that in the current health care environment, physicians and hospitals need flexibility to adapt to local market conditions and participate in a variety of practice arrangements to provide cost effective, high quality care. An unnecessary strict definition of Start Printed Page 18509“provider-based entity” could have a chilling effect on the evolution of new care delivery structures that would expand access to care, especially in rural areas.

    Response: We share the commenter's concern with preserving Medicare beneficiaries' access to care, but do not agree that the provider-based rules will limit access. We note that the rules do not prohibit hospitals from purchasing physician practices or taking other actions to enhance access to care in remote rural areas; they only set minimum standards for the type of affiliations that will be recognized for provider-based designation.

    For example, an institutional provider such as a hospital or SNF may elect to use part of its institutional complex to house physician offices or other facilities that provide services complementing those of the provider. Those facilities'costs will have to be included in the trial balance of the institutional complex, in order to allow costs to be allocated accurately to all parts of the complex, and permit the costs of the provider to be determined. However, inclusion of such facilities' costs on the institutional complex trial balance does not make the facilities provider-based. On the contrary such facilities would have to meet the criteria in § 413.65 to qualify for provider-based status.

    Comment: Different views were expressed on how much

    discretion regional offices should have in applying the provider-based criteria. One commenter asked that we make the rules as clear and concise as possible. The commenter argued that rules allowing for great latitude in interpretation could be dangerous for the provider community. On the other hand, another commenter stated that we should allow Medicare regional offices greater latitude for determining when sufficient integration exists for a facility to qualify as provider-based, and should avoid adopting regulations that “micro-manage” a hospital's operations. Another commenter suggested that rather than requiring that all criteria must be met to achieve provider-based status, we change the test to substantially all. There may be circumstances where criteria are not fully met, but an overall assessment supports a provider-based determination. This same commenter recommended that a “pending” status be incorporated into the evaluation process, whereby hospitals not meeting the criteria for provider-based status would be afforded an opportunity to make the modifications necessary. Another commenter asked that instead of meeting all criteria, we permit the regional offices to evaluate a facility's status with respect to the main provider with input from local government and the fiscal intermediary. Another commenter also suggested that the standards only be enforced to the extent that they are applicable and relevant, consistent with state laws, and relate to practices that are subject to the control of the particular provider.

    Response: We have tried to balance the need to apply standards that can be adapted to fit particular circumstances, and agree that the standards should not be overly prescriptive, but rely on regional judgment to ensure appropriate decision making. Because provider-based status is a matter of extreme importance to many facilities, published standards provide a basis for advance assessment and planning of particular organizational and financial arrangements. Therefore, we have decided that a facility or organization will be found to be provider-based only when it is in compliance with all standards set forth in these final rules.

    With respect to the comment regarding situations in which all but a few criteria for provider-based status are met, we note that nothing prohibits the main provider from re-applying for approval of provider-based status for a facility or organization after having made the changes necessary to come into compliance. Regional offices would in such cases only need to verify compliance with whatever criteria had not been previously met, unless the amount of time that elapses between requests, or other factors, make a full re-evaluation necessary. Because facilities have this flexibility under the rules as proposed, we did not make any changes based on this comment.

    Comment: One commenter believes that we had not fully addressed the impact of these rules on service delivery. The commenter suggested that changes would affect deemed status, survey and certification requirements, state licensure requirements, physician referral requirements, and a host of related issues. Another commenter stated that the new requirement regarding administration and supervision found in § 413.65(d)(3) could impact more than our estimated 105 providers. The commenter believes that if providers are required to convert management firm employees to hospital employees and then revert back when outpatient PPS becomes effective, this could impact 5,000 inpatient PPS hospitals.

    Response: We again reviewed our requirements, but do not believe they will have the far-reaching effects envisioned by these commenters. In particular, to the extent a facility or organization that claims to be a department of a provider must be accredited, surveyed, or licensed as a part of that provider, or must adapt to the physician referral requirements of the main provider, that result does not flow from the existence of criteria for provider-based status, but instead is a direct result of the provider's decision to claim the facility or entity as a department. We also do not think it is reasonable to assume that any significant number of hospitals will restructure themselves repeatedly because of the final rules set forth below. As noted earlier, both the proposed and final rules closely parallel policies that have been stated explicitly on program instructions since 1996, and we are providing a 6-month delay in effective date for the final rule. Thus, hospitals and other providers have had ample time to assess the impact of any changes and to make necessary adjustments in an orderly way.

    Comment: A commenter requested clarification as to how the proposed rules would apply to two hospitals seeking consolidation into a single provider. The commenter also asked whether two small PPS hospitals located approximately 15 to 25 miles apart in separate towns within a metropolitan statistical area (MSA) who wish to consolidate would be prohibited from doing so because of patient population or licensure requirements. Furthermore, if these two hospitals are already certified as a single provider, would the proposed rules require them to separate and create separate providers? Another commenter requested that the final regulatory text state that the provider-based requirements do not apply to any facility where there are inpatient beds since such a facility would be viewed as a “main provider.” The provider-based requirements should apply only to facilities or organizations other than main providers.

    Response: Although the Program Memorandum and proposed rules were issued in response to situations primarily involving outpatient facilities, we believe the policies set forth in these documents are equally applicable to inpatient facilities, and should be applied in the many cases in which a determination about inpatient facilities must be made. The rules would not prohibit two previously separate hospitals from merging to become a single provider. However, for either facility to be considered provider-based with respect to the main provider, the facility would have to meet the criteria Start Printed Page 18510in this final rule. To clarify the scope of application of these regulations, we have added a definition of “remote location of a hospital” and a reference to hospital satellite facilities to § 413.65(a) Definitions, and have clarified the wording of several later sections by including references to remote locations and satellites. We have defined a “remote location of a hospital” as a facility or an organization that is either created by, or acquired by, a hospital that is a main provider for the purpose of furnishing inpatient hospital services under the name, ownership, and financial and administrative control of the main provider, in accordance with the provisions of this section. A remote location of a hospital may not be licensed to provide inpatient hospital services in its own right, and Medicare conditions of participation do not apply to a department as an independent entity. The term “remote location of a hospital” does not include a satellite facility as defined in § 412.22(h)(1) and § 412.25(e)(1). Hospitals may acquire remote locations by various means, but often do so by mergers or acquisitions, in which a single hospital purchases other, previously separate hospitals, and operates them as remote locations that are not separately organized as departments, but instead furnish the same types of services as the original hospital. For example, a long-term care or other specialty hospital might acquire one or more other hospitals, terminate their separate participation in Medicare, but continue to use them as sites of the same type of care as the original hospital. Satellite facilities are currently defined in our regulations at § 412.22(h)(1) (for hospitals) and § 412.25(e)(1) (for units). In general, a satellite facility is a part of a hospital (or of a hospital unit) that provides services in a building also used by another hospital, or in one or more buildings on the same campus as buildings also used by another hospital. Satellite status always involves co-location with another hospital, while remote locations are not co-located with other hospitals' facilities.

    Comment: A commenter requested clarification that the provider-based requirements apply only to providers who are paid under the reasonable cost methodology. The preamble language in section VI implies that these requirements would also apply to providers under the outpatient PPS. The commenter believe that if this were the case, the requirements found in §§ 413.24(d)(6) and 413.65 would be appropriately placed in Subchapter E (for example, Part 482, Conditions of Participation for Hospitals).

    Response: The rules set forth below are not limited in their scope to providers paid on a reasonable cost basis but, except where specifically stated in the text of the rules, apply to all providers and facilities seeking Medicare payment. While many of the problems associated with inappropriate accordance of provider-based status relate to cost reimbursement, the different payment systems used for various providers may produce some unintended incentives for one type of facility to gain an unfair payment advantage by misrepresenting itself. The specific requirements cited do not, like the Medicare conditions of participation, implement section 1861(e) of the Act, nor do they primarily concern patient health and safety. Therefore, we did not adopt the suggestion that the section be relocated to part 482.

    Comment: A commenter would support a provision that prohibits hospitals from acquiring free-standing physician practices and converting them to hospital-based entities.

    Response: We understand the commenter's concern, but do not have authority under the Medicare law to prohibit this practice. We do believe that the rules set forth below will keep hospitals from misrepresenting physicians' practices as hospital outpatient departments.

    Section 413.24(d)(6) Adequate cost data and cost finding: Management contracts

    Comment: The proposed cost reporting requirements state that if an overhead administrative cost center does not perform services for the off-site clinic or department, no costs should be allocated to that function. The commenter pointed out that this contradicts generally established Medicare cost reporting principles that have always required that the administrative costs be allocated to allowed and nonallowed cost centers.

    Response: Our position, as expressed in the Provider Reimbursement Manual, Part II, Chapter 36 for hospitals, is to allow the provider to bypass the allocation of overhead through the cost report to avoid inappropriate allocations. An example of this would be lab services under arrangement, where there is obviously no administrative activity by the main provider. Our electronic cost report systems are set up to “skip” that particular cost center and to re-allocate the costs to the remaining cost centers. Likewise, where administrative costs such as billing are performed by the subordinate provider, no billing cost from the main provider should be allocated to that cost center from the main provider.

    Comment: Several commenters suggested clarification of “like” costs by adding a definition or providing examples. Also, a commenter stated that since the main concern is costs, this provision should be applied when management costs exceed the hospital's operating costs of the department by 10 percent on a comparable basis. Another commenter stated that: (1) Management services benefit only the specific department to which they are expensed, and provide no direct services to other hospital departments; (2) A department under the management contract receives necessary services from other hospital overhead departments; (3) such overhead departments do not represent duplicate services provided under the management contract. Since management agreements can be drastically diverse, the commenter believes this clarification would assist in avoiding any confusion, as well as allow for consistency with generally accepted cost finding principles. Another commenter stated that most entities that contract to manage an area of a hospital manage just that area. Therefore, if they offer assistance with a particular function, it is only for that area and not for the whole hospital. The commenter believes the same principles of reimbursement should be applied whether the hospital provides the service directly or contracts for the service to be provided.

    Response: Examples of similar costs when management contracts provide services also available through the main provider are the following: billing services, computer services, accounting services, and, possibly, general administrative staff. When the same services are included in the administrative and general costs of the main provider, and allocated down to subordinate cost centers or providers incurring and reporting these same costs in the trial balance, the result is a duplication of costs to the subordinate cost center or provider. As long as the main provider has the ability to identify these “like” service costs, these costs should be re-allocated to the remaining reimbursable and non-reimbursable cost centers in proportion to each cost center's total costs as prescribed in the Provider Reimbursement Manual, Part II, Chapter 36. However, if the main provider is not able to identify the costs of these same services to permit the exclusion of allocation to the subordinate providers or cost centers, Start Printed Page 18511the cost of the management contract of the subordinate provider or cost center must be reclassified to the main provider's administrative and general cost center, and allocated down to all reimbursable and non-reimbursable cost centers in proportion to each cost center's total cost.

    Comment: With regard to the language in paragraph (d)(6)(ii), Medicare principles of reimbursement require that, when two entities are related, and one contracts from the other, reimbursement for these services is at cost due to the “related party principle.” The commenter stated that the cost of a service is both direct and indirect; Medicare reimbursement has a longstanding methodology concerning nonrevenue producing costs and their allocation on a provider's cost report. A separate work paper should not be required. The appropriate methodology for stepping down administrative costs should be based on the cost of the entity utilizing the service. The cost of the free-standing entity must be placed on the main provider's cost report to step down cost appropriately. Additional work papers would allow room for error and would delay any necessary adjustments.

    Response: The intent of § 413.24(d)(6)(ii) was to require the main provider to report costs of related party entities that would not be reported through their accounting system on the main provider's books and records, for example, trial balance. Consequently, when there is a sharing of administrative services, for example, managerial staff, the related entity escapes any administrative overhead allocation when that same related entity is not reported on the main provider's trial balance of the cost report. While the commenter is correct regarding the proper reporting of related transactions at cost of the related entity, this regulation section goes further to require the main provider to develop the total cost of the related entity, utilizing and maintaining workpapers to justify the amount to be reported, and to report those costs by the main provider on the cost report trial balance.

    Section 413.65(a) Definitions (retitled in this final rule as Section 413.65(a) Scope and definitions)

    Comment: Two commenters requested that a definition be provided for “a provider's campus.” A definition would be important since the proposed regulation specifies additional requirements for off-campus locations.

    Response: We agree that location on or off a hospital's campus is important. To provide a clear standard, we have revised the final rule to define “campus” as “the physical area immediately adjacent to the provider's main buildings, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings, and any other areas determined on an individual case basis, by our regional office, to be part of the provider's campus.” This definition would encompass not only institutions that are located in self-contained, well-defined settings, but other locations, such as in central city areas, where there may be a group of buildings that function as a campus but are not strictly contiguous and may even be crossed by public streets. This would also allow the regional offices to determine, on a case-by-case basis, what comprises a hospital's campus. We believe allowing regional office discretion to make these determinations will allow us to take a flexible and realistic approach to the many physical configurations that hospitals and other providers can adopt.

    Comment: The commenter expressed concern regarding the definition of provider-based facilities as many hospital-owned outpatient services are often provided with leased employees with ambulatory care experience. It is not clear that such an arrangement would satisfy the intent of the regulation.

    Response: The regulations do not explicitly prohibit the use of leased employees, and each situation will be evaluated relative to the criteria in the regulations set forth below.

    Comment: One commenter stated that the difference between “department of a provider” and “provider-based entity” is not clear from the definitions given of those terms. The commenter requested that we clarify in the regulations text whether a provider-based entity must be certified in its own right, and what type of certification this encompasses. The commenter also requested clarification in the regulations text concerning whether the term “provider” in the definition is intended to mean only entities that satisfy the Medicare definition of “provider” contained in § 400.202.

    Response: We have clarified § 413.65(a) to state that a “department of a provider” is a facility or organization that could not by itself be qualified to participate in Medicare as a provider under § 489.2, while a “provider-based entity” could be so qualified. For example, a skilled nursing facility (SNF) could be a “provider-based entity,” whereas an entity that furnishes ambulatory surgical services could not be a provider-based entity, and could participate in Medicare (for example, receive Medicare payment for services furnished to beneficiaries), only as a department of a provider, as a physician office, or as an ambulatory surgical center approved by Medicare under part 416, if at all. We have further revised the final rule to clarify that a department of a provider furnishes services of the same type as the main provider (for example, a department of a hospital furnishes hospital services), while a provider-based entity furnishes services of a different type from those of the main provider (for example, a hospital-based RHC furnishes RHC services, not hospital services).

    Comment: A commenter believes the proposed rule should be revised for medically underserved populations and health manpower shortage areas to allow the referral of beneficiaries back to their community for treatment of community-based therapy providers. Therapy services provided under such a referral would be included under the provider-based designation.

    Response: We do not oppose use of such referrals where they are medically appropriate, but believe that referral arrangements should not be equated to provider-based status.

    Comment: A commenter questioned the requirement that services be furnished “under the name” of the main provider entity. The commenter argued that the requirement is inconsistent with the commenter's view that health care in the late 1990s is, and in many markets must be, “marketed” in a highly competitive environment. The commenter's view is that having provider-based status turn on the names used will inevitably invite micro-management of the way the main provider's name is used by the department or other hospital-based entity.

    Response: We disagree with any suggestion that health care is merely a generic commodity that can be repackaged under another name for marketing purposes. On the contrary, we believe that operating under the name of the main provider, and holding oneself forward to patients under that name, is an important indicator of status as an integral and subordinate part of that provider. Therefore, we did not make any changes in the regulation based on this comment.

    Section 413.65(b) Responsibility for obtaining provider-based determinations

    Comment: A commenter stated that the proposed rule does not state clearly enough whether our approval is required in order to permit billing each Start Printed Page 18512time a provider sets up a new service, regardless of whether the service is acquired, managed, new, located on the main campus, or off the main campus. Some commenters stated that if approval is required in all instances, it will cause a significant paperwork backlog and will be quite costly to administer.

    Response: Section 413.65(b) states explicitly that a determination by us that a facility or organization is provider-based is required before the main provider may treat the facility or organization as provider-based for billing or cost reporting purposes. We recognize that this may generate some administrative cost, but believe the cost will be much less than the amounts that would be spent improperly if payment were made to a free-standing facility as if it were provider-based.

    Comment: A commenter urged that the new determination process be applied to all current as well as new hospital-based services.

    Response: We have no plans at present to review all hospitals and other providers with respect to provider-based criteria, but will look into any situations that come to our attention in which it appears that a facility does not meet the requirements of the new regulations but is being treated as provider-based. If the facility or organization does not qualify as provider-based, action will be taken as described later in this preamble and in § 413.65(i).

    Comment: A commenter stated that there should be some mechanism in place for a long-term hospital (LTH) to seek an advance determination or advisory ruling that a proposed LTH satellite will be granted provider-based status. Because establishing an LTH requires a huge expenditure of time and human resources, an LTH main provider needs to know in advance whether or not its proposed satellite will receive a favorable provider-based determination. It is suggested that we institute a system by which advance rulings or determinations are available before the satellite is established.

    Response: We understand the commenter's concern, but do not have the staff or facilities to provide advance approvals of restructuring proposals. We suggest that providers review the new criteria carefully and avoid forms of organization that are not clearly in compliance with them.

    Comment: Two commenters suggested that we provide guidance on the application process providers must complete in order to receive a provider-based determination. In addition, time limits for approval of these determinations should be established. Furthermore, existing provider-based entities should not be required to change their billing and accounting procedures. A commenter also asked for clarification as to whether the intermediary and regional office is to be the contact, and who will make the actual determination of provider-based status.

    Response: We are developing an application process and intend to have it in place and ready for use before the effective date of the regulation. We expect that determinations of provider-based status will be made by our regional offices. Involvement by other entities, such as fiscal intermediaries or State survey agencies, will be for information-gathering purposes and under the direction of the regional office.

    Comment: A commenter suggested that if a determination goes against the provider, the provider should be given the option to come into compliance with the requirements or file an appeal.

    Response: As noted earlier, the regulations do not prohibit a provider that meets most but not all criteria from taking action to fully meet the criteria, thus qualifying a facility or organization for provider-based status. In the case of a provider that believes that the determination of the regional office is incorrect, an appeals process is provided under part 498.

    Comment: A commenter stated that the requirement in paragraph (b)(3) establishes an adverse presumption against provider status for “off-campus” physician practice sites, and that the focus on “campus” boundaries will prove elusive, and serve no real policy purpose.

    Response: As explained later, we believe location in the immediate vicinity is an important indicator of provider-based status, and that location can be a good basis for identifying facilities for further scrutiny.

    Section 413.65(c) Reporting

    Comment: Several commenters pointed out that the regulatory language does not reflect the preamble language regarding off-campus entities and the five percent increase in a provider's costs.

    Response: We have revised the final rule to correct this oversight.

    Comment: One commenter asked whether this language applies only to entities that are applying for provider-based status, or also applies to entities that have already achieved provider-based status.

    Response: The requirement applies to both types of providers, but providers that have entities with provider-based status are required to report only newly created or acquired facilities or organizations.

    Comment: Two commenters stated that the five percent and off-campus criteria with regard to provider-based status do not take into account the characteristics of rural and frontier areas, and could lead to lower payments to some facilities, thus reducing the flow of Federal money into rural areas and possibly creating a shortage of care. In addition, considering the small budget of RHCs and other rural facilities, 5 percent is an inappropriately low and unreasonable growth limit.

    Response: We understand the commenter's concern but do not agree that a 5 percent threshold for reporting is too low. Therefore, we made no change based on this comment.

    Comment: A commenter asked whether this reporting requirement also applies to all newly developed services (that is, department on the campus of the hospital).

    Response: The requirement applies to all newly developed on-campus services that could increase the costs of the provider by 5 percent or more.

    Comment: A commenter requested clarification that a main provider that “creates” as well as “acquires” a facility or organization is responsible for reporting to us. The commenter also suggested specific items to be included in the reporting and approval process. These include specific data elements to be reported by the main provider, specifying our component with primary responsibility; specifying our approval process; adding a preliminary conditional approval process; adding a specific time period for our approval; and adding requirements for the effective date that the costs of the provider-based entity can be included on the main provider's cost report.

    Response: We have revised the regulation to clarify that it applies to facilities or organizations created by the main provider, as well as those ongoing operations acquired by purchase or other means. We have not included the procedural detail requested by the commenter in regulations, but will consider including it in program instructions.

    Comment: A commenter stated that the use of the phrase “any material change” in paragraph (c)(2) of this section is too vague and open to interpretation. It is suggested that the section be revised to clearly designate changes of ownership and new management agreements as the only two material changes that require reporting by provider-based entities. Start Printed Page 18513

    Response: We do not agree that the range of reportable events should be limited in this way. On the contrary, we intend to require reporting of any change that could have a significant (“material”) effect on compliance with the provider-based criteria.

    Comment: A commenter asked if the reporting requirements are coordinated with the notification of change of ownership requirements at § 489.18(b), where notice is to be given in advance, and whether there should be a cross reference or clarification with respect to the change in ownership regulation and this proposed regulation.

    Response: We believe this suggestion has merit, and will consider revising our program instructions to specify that a report under § 489.18(b) should be reviewed for its applicability to provider-based determinations.

    Section 413.65(d) Requirements

    Comment: A commenter suggested that we clarify whether all requirements, or only a majority of the requirements, must be met to obtain provider-based status.

    Response: We have revised the first sentence of paragraph (d) to state that all of the stated requirements must be met by a facility or organization that wishes to be classified as provider-based.

    Section 413.65(d)(1) Licensure

    Comment: Many commenters objected to the requirement that provider-based facilities share a common license with the main provider unless the State requires separate licensure for the subordinate facility. One commenter listed several reasons for this concern. First, in the commenter's opinion, licensure determinations may be made based on factors that are different from those that would be important for provider-based determinations. Another reason cited by the commenter is that State licensure laws may vary from State to State. Some State hospital licensure definitions are building specific, and do not include off-site outpatient facilities, thus giving what the commenter argues is undue weight to physical location in evaluating provider-based status. Finally, the commenter believes that requiring common licensure will create a situation where some States may have a large number of provider-based entities and others will have few or none, thus leading to inconsistent application of our rules. One commenter recommended that the same licensure requirement be waived for States with idiosyncratic licensure requirements. An alternative would be accreditation with the provider as a deemed status for meeting a common license requirement. The commenter suggested that the proposed language could be reworded to clarify that offsite clinics would not have to be licensed or operated under the same license as the provider in those States that do not license them.

    Response: We recognize that licensure may not be an appropriate indicator of provider-based status in all States, and have therefore revised the regulations to require common licensure only in States with laws that permit common licensure of the provider and the prospective provider-based department under a single license. This means that in States that do not allow licensure of certain types of facilities, such as those providing ambulatory care or those located off the provider's main campus, the licensure criterion would not be applied. We do not agree that JCAHO or other accreditation should be accepted in lieu of licensure, since such accreditation may not necessarily reflect an on-site evaluation of the prospective provider-based department. In recognition of the fact that some hospitals are not licensed by the State because they are Indian Health Service (Federal) hospitals or are located on Tribal lands, we also will not apply the licensure requirement to departments of those hospitals.

    Comment: Under paragraph (d)(1) as proposed, clinics in another State from the main provider could not be under the hospital's license. Several commenters argued that this requirement would arbitrarily affect rural and urban health care delivery, where the main provider is close to a State line. A commenter recommended that close proximity be used instead, where a hospital-based clinic is in another State from the main provider. For urban hospitals in large metropolitan statistical areas that cross State boundaries, the commenter believes that the market area of the main provider should be the primary determinant of the potential for integration with the main provider.

    Response: Under the regulations as revised based on the comments summarized above, common licensure would not be required of facilities located across State lines if the law of the State in which the main provider is located does not allow such licensing. However, see the discussion, later in this preamble, of § 413.65(d)(7)(ii).

    Comment: A commenter pointed out that the proposed rule appears to limit the licensure requirement to “departments” of the main provider. The commenter asked whether this requirement only applied to “provider-based entities.” The commenter also suggested that where a State has two licensure schemes for the same type of facility, we should not prefer one licensure scheme over the other for purposes of determining the provider-based status of the facility.

    Response: The commenter is correct in noting that the common licensure requirement in the proposed rule would have applied only to provider-based departments. We did not propose to apply a common licensure requirement to provider-based entities such as SNFs and HHAs, because they are providers of services in their own right, and typically would be separately licensed without regard to their affiliation with the provider. We disagree with the commenter's view that licensure should not be viewed as an indicator of integration. On the contrary, our view is that if a facility could be licensed as part of a main provider but chooses not to be, the facility cannot reasonably be seen as an integral and subordinate part of that provider.

    Comment: With regard to the proposed requirement that states that our determination regarding provider-based status will be based on a State health facilities' review commission, one commenter argued that relying on the commission's criteria for purposes of making provider-based determinations is arbitrary and inappropriate. The commenter believes imposing this criterion could disadvantage providers and discourage expansion to off-site locations, thus indirectly leading to shortages of care. Another commenter requested that there be a delay in implementation during which time changes can be made to the commission's definition of what rates it can regulate.

    Response: We continue to believe it would be inappropriate for a facility to claim to be separate from the provider for State rate-setting purposes while also claiming to be an integral and subordinate part of the provider for Medicare purposes. To allow this practice would authorize providers to misrepresent their structures and affiliations in whatever way will yield the highest payment. Thus, we did not make changes to reflect the comment.

    Section 413.65(d)(2) Operation under the ownership and control of the main provider

    Comment: Regarding § 413.65(d)(2), the commenter suggested that the regulations provide a separate set of criteria that would allow a provider that is operated within one legal entity to be provider-based to a provider that is operated within another legal entity, as long as the two entities are under common control. Another commenter Start Printed Page 18514stated that this ownership and control requirement is unnecessarily rigid, since a hospital-based clinic, which was strictly an administrative division of the hospital, might qualify while another similar clinic, wholly owned by the hospital with slightly different governing bodies and documents, would not be eligible.

    Response: We do not agree that common control of two separate entities by the same parent organization should be sufficient to meet a requirement for ownership and control by the main provider. While this arrangement may be an appropriate way to manage two separate entities, it does not establish provider-based status for either. With respect to the second comment, we agree that the form of administration of an entity can determine whether or not the entity is found to be provider-based. We believe this would be an appropriate result, since it would help ensure that only facilities that are organized as provider-based entities or departments of a provider are given this status.

    Comment: One commenter believes it is unrealistic to require a potential provider-based facility or organization to be owned by the main provider and share bylaws and an identical governing body. The commenter stated that in the present business climate an entity can operate as a provider-based entity without meeting these criteria. It is recommended that we replace the proposed 100 percent ownership standard with a majority standard, require only overlapping governing bodies, and eliminate the requirement for organization under the same organizational documents. Another commenter believes that the key consideration should be whether the provider is in control of the day-to-day operations of that portion of the facility in which the provider seeks provider-based status, and not necessarily whether the building is 100 percent owned by the provider. The commenter believes we should rephrase this provision to require that the operations of that portion of the facility or organization in which the provider is seeking provider-based status be controlled by the provider.

    Response: In response to the first comment, we recognize that many organizations enter into business relationships that involve overlapping of ownership, governance, and applicability of bylaws. However, this degree of collaboration does not mean that one facility is an integral and subordinate part of another. Therefore, we made no change based on this comment. Regarding the second comment, we wish to clarify that it is ownership of the business enterprise, not of the buildings or other physical assets of the enterprise, that is required under paragraph (b)(1). We have therefore revised the regulation text to refer to ownership of the business enterprise.

    Comment: A commenter stated that the requirements contained in paragraph (d)(2) would preclude entities that are jointly owned through legitimate joint ventures or those separately organized subordinate facilities from qualifying for provider-based status. Additionally, to require the level of integration suggested by our proposed rule would prevent providers from establishing efficient systems of delegation and management, solely to qualify for provider-based status.

    Response: We agree that this criterion would have the stated effect. As explained further in our discussion of comments on proposed § 413.65(e), facilities operated jointly by two or more providers cannot appropriately be considered integral and subordinate parts of either provider. With respect to the second comment, we do not oppose systems of operation that stress separate, decentralized operation where this leads to greater efficiency. However, we believe such facilities or organizations should be recognized as the separate enterprises that they are, not considered integral and subordinate parts of another institution.

    Comment: A commenter suggested that the requirement under paragraph (d)(2) be modified for medically underserved populations and health manpower shortage areas.

    Response: We are also concerned that our criteria not limit access to care for any vulnerable populations and have, to avoid this potential problem, created special provisions for FQHCs and IHS and tribal facilities. As described later in this preamble, we have also created an exception to the location requirements in paragraph (d)(7), which is designed to help avoid restricting access to primary care furnished by RHCs in remote, underserved areas. In view of these provisions, we do not believe it is necessary to also modify our requirement relating to ownership of the facility or organization.

    Comment: A commenter stated that the proposed requirements in paragraph (d)(2) are inherently inconsistent with section 330 of the Public Health Service Act statutory and regulatory requirements and the Bureau of Primary Health Care expectations necessary to obtain and maintain section 330 funding (and FQHC status). The commenter believes HCFA should not require FQHCs to be 100 percent owned by the main provider or share a common governing body and common bylaws with the main provider. The commenter also suggested that we accept appropriate reporting relationships and satisfaction of other criteria (for example, licensure, quality assurance, integration of certain administrative and clinical functions, such as billing, purchasing, retention of medical records, quality assurance and utilization review procedures; and public awareness of the relationship between the health center and the main provider) as a sufficient basis for provider-based status.

    Response: As described earlier, we have provided a special transition period for FQHCs. We believe this period will be adequate to avoid the problems envisioned in this comment.

    Section 413.65(d)(3) Administration and supervision

    Comment: A commenter recommended that the daily reporting relationship stated in § 413.65(d)(3) should be replaced with the standard of having the reporting relationships have the same intensity as on-site departments. The commenter stated that in practice at the hospital, there may be very little day-to-day contact between medical directors of various hospital services. Also, the commenter believes it is unlikely that departmental directors report directly to the chief executive officer, but rather to a chief operating officer or other designee. Finally, the commenter argued that under the common governance requirement, while all hospital employees are theoretically accountable to the governing body, the accountability may be directed through the CEO, and multiple executives may not have an independent reporting with the board. Another commenter also believes that the standards for the provider-based entity should mirror those of the main facility; personnel reporting structure needs to be respected within the regulations. Still another commenter found “intensity” to be a subjective standard and asked how it will be measured.

    Response: We agree that reporting need not be daily in all cases, and have revised the final rule to state that the reporting relationship between the facility or organization seeking provider-based status and the main provider must have the same frequency, intensity, and level of accountability that exists in the relationship between the main provider and one of its departments. We agree with the commenter that the intensity of supervision will have to be assessed on a case-by-case basis, but do not believe Start Printed Page 18515this will lead to imprecise or poorly reasoned decisions.

    Comment: Several commenters believe that this requirement limits the flexibility of the entity to operate efficiently and effectively in the current environment, since hospitals frequently turn to many specialized management companies to operate more efficiently and effectively than with hospital resources. Another commenter stated that whether the administrative department utilizes employees at one location and contracts at another location should be irrelevant as long as the function is integrated with the main provider, follows the policies and procedures of the main provider, and is accountable to the governing body of the main provider as is any other department. Still another disagreed, and believes that it may be appropriate to require that the main provider manage such contracts.

    Response: We do not agree that the provision unreasonably limits hospital flexibility. Paragraph (3)(iii)(B) explicitly allows different management contracts to be used for the facility or organization and the main provider, as long as the provider manages the contracts. Thus, we did not make any changes in the proposal based on these comments.

    Comment: A commenter asked whether the administrative functions listed in paragraph (d)(3)(iii) are the only services that must be integrated between the main provider and the subordinate facility.

    Response: The commenter was correct in understanding that the functions listed are the only administrative functions that must be integrated. There are also requirements for integration of certain financial functions, as described below.

    Comment: One commenter posed several questions concerning this proposed requirement. First, in a certain situation, the facility fee is billed to the intermediary by the hospital billing department using the provider number, while the professional fee is billed to the Part B carrier by the faculty practice billing organization under its physician group number. The commenter asked if the different provider number and tax identification impact on the provider-based status, and if there is a more appropriate way to obtain billing numbers for hospital-based clinics. Also, the commenter asked if clinic space can be shared by two clinics, when one is provider-based and one is free-standing, without impacting the provider-based status of the first clinic.

    Response: In the circumstances described, the use of separate billing and tax identification numbers for provider and physician services would not adversely affect a facility's request for provider-based status, since such billings are required under Medicare to be separate in the case of services in hospitals. The question regarding sharing of space, however, can be answered only in the context of a specific case, and we expect that such decisions will be made by our regional offices.

    Comment: With respect to the oversight of contracts under paragraph (3)(B)(iii)(B), several commenters stated that it is common for hospitals to subcontract out the billing for different departments, especially the hospital outpatient department, due to the complexity and number of claims. These commenters stated that while it may be appropriate to require the main provider to manage such contracts, departments other than the billing department should be permitted to perform this management function. One commenter suggested revising the criterion on billing under the integration of administrative functions to state, “common billing or the contract for billing services is held by the provider where it is based.”

    Response: We agree that departments other than the main provider's billing department may appropriately manage billing contracts, and have revised the criterion to state that the contract for a provider-based facility or organization must be managed by the main provider.

    Section 413.65(d)(4) Clinical services

    Comment: A commenter asked for clarification of paragraph (4)(iv) of this section, specifically concerning whether this language would require a Medicare certified HHA's improvement activities to be overseen by hospital medical staff, rather than the advisory committee as is now being done. The commenter believes that having the hospital medical staff overseeing the quality assurance activities of a HHA may not be appropriate or cost effective and may even slow the process of performance changes.

    Response: The commenter is correct in understanding that compliance with this criterion would require oversight of a hospital-based HHA's quality improvement activities by the hospital's medical staff. We do not agree with the commenter that the outcome would be to substitute the judgment of the hospital for the HHA's own committee or that it would be inappropriate. The hospital conditions of participation contain a number of separate requirements that must be read together to make complete sense of this provision. Conditions spelled out at § 482.12 (Governing body), § 482.21 (Quality assurance), and § 482.22 (Medical staff) establish a chain of accountability in a hospital for the quality of care it provides. The requirements are clearly applicable to any activity (for example, provider-based entity) that is an integral part of the hospital. Thus, a quality improvement activity of the HHA is likely to be firmly grounded in the hospital's operating and governance fabric even when the group is “established” by the HHA, and staffed by employees and physicians who work primarily in home health. We would expect the linkages to be formal (that is, known to the governing bodies and medical staffs of both providers), and the quality assurance mechanisms interrelated to the extent that shared patients are the subject of the effort.

    Comment: Regarding paragraph (d)(4)(v) of this provision, some commenters requested clarification of what is meant by a “unified retrieval system,” or for guidance as to what types of cross referencing are acceptable. Another commenter asked for an explanation of the practical expectations regarding the maintenance of medical records. Finally, a commenter expressed support for the requirement for a unified retrieval system (or cross references), saying the latter system would be used in States that mandate a unified system.

    Response: We would like to clarify that what is intended is that a system be maintained under which both the potential provider-based entity or department of a provider and the main provider have access to the beneficiary's record, so that practitioners in either location can obtain relevant medical information about care in the other setting. We did not, however, make any changes in the requirement based on these comments.

    Comment: A commenter believes that functions of operations should not be regulated to dissuade cost efficiency, and that laundry and housekeeping would be examples where shared services may not be the most effective manner of operation.

    Response: We agree that in some cases it may be less expensive for a facility to obtain services independently, but continue to believe such separateness is an indicator that the facility is not an integral and subordinate part of a provider.

    Comment: With regard to paragraph (d)(4)(vi) requiring integration of services of the main and provider-based entity, the commenter expressed concern about the potential impact of Start Printed Page 18516this section on a patient's freedom of choice. The commenter believes that the entity's efforts to meet this standard would limit a patient's freedom of choice. The commenter suggested that we clarify our position so that providers acting in good faith will not be sanctioned for attempting to comply with this requirement.

    Response: Paragraph (d)(4)(vi) requires only that patients have access to the services of the main provider and that they be referred to it where the referral is appropriate. We wish to clarify that these criteria are not intended to restrict patient freedom of choice or the practitioner's freedom to refer patients to other locations, where doing so will result in better care for the patient.

    Section 413.65(d)(5) Financial integration

    Comment: A commenter believes that § 413.65(d)(5), which requires full integration of financial operations, is too rigid. An alternative approach is suggested that would allow managers of provider-based entities to retain some control over both the resources and information required to administer these units.

    Response: Section 413.65(d)(5) requires that there be financial integration of the potential provider-based facility or organization and the main provider, but does not preclude normal management control of resources. Thus, we made no change in the regulation based on this comment.

    Comment: A commenter stated that the criteria for common resource usage of building, equipment, and service personnel is not even relevant for multi-campus systems or even buildings that are across the street from each other, much less off-site hospital outpatient departments.

    Response: Although the provider-based program memoranda required that there be significant common resource usage of buildings, equipment, and service personnel on a daily basis, this requirement does not appear in the proposed rule. Thus, we made no change in the regulation based on this comment.

    Comment: One commenter stated that the requirement for financial integration seems unnecessary in light of the requirement for 100 percent ownership by the main provider. The commenter stated that some providers may wish to segregate the operations of certain departments in their financial systems, and expressed the view that as long as the costs of a department can be adequately identified on the cost report, the practice should be acceptable.

    Response: We do not believe that these two requirements are duplicative. On the contrary, in some cases a provider may own 100 percent of another facility or organization, but not be financially integrated with it, either because the other facility or organization is engaged in a different, non-health care activity, or because it is organized and operated separately from the main provider. In these circumstances, we believe the criteria on financial integration apply appropriately to deny provider-based status to separate facilities or organizations.

    Section 413.65(d)(6) Public awareness

    Comment: Section 413.65(d)(6) requires that provider-based entities be identified as part of the main provider organization. The commenter did not understand the importance of this criterion, particularly when the provider-based organization is licensed and Medicare certified separately from the main provider.

    Response: The proposed rule would not apply this criterion to provider-based entities (which may participate separately as providers), but only to provider-based departments. In the latter case, we think it is not unreasonable for such a department to be expected to identify itself with the provider of which it claims to be a part.

    Section 413.65(d)(7) Location in immediate vicinity

    Comment: A commenter stated that if off-site RHCs cannot be considered provider-based, it will be much harder to deliver care in rural areas. The commenter asked that RHCs be allowed to continue as provider-based RHCs even though they are off campus.

    Response: We continue to believe close physical proximity is an important indicator of provider-based status. We note, however, that paragraph (d)(7) does allow off-campus facilities to be treated as provider-based if they meet the criterion relating to service to the same patient population.

    Comment: Many commenters believe that more specific tests of service to the same patient population are needed. One commenter suggested that an appropriate criterion would be that the proposed provider-based facility or organization be located within the same geographic area that accounts for a high percentage of patients in the main provider. The commenter believes this test is consistent with Program Memorandum No. 96-7 and with the qualification requirements for sole community hospitals. Other commenters suggested that the main provider's geographical service area be considered the area from which the main provider drew 80 percent of its Medicare inpatients for the previous three years.

    Response: We agree that more precise criteria are needed. Therefore, we have revised the regulations to provide that a prospective provider-based facility or organization will be considered to serve the same patient population as the main provider if, during the 12-month period immediately preceding the first day of the month in which the application for provider-based status is filed with us, at least 75 percent of the patients served by the facility or organization seeking provider-based status reside in the same zip code areas as at least 75 percent of the patients served by the main provider. As an alternative, we would consider a facility or organization to serve the same patient population if, during the same 12-month period described above, at least 75 percent of the patients served by the prospective provider-based facility or organization who required the type of care furnished by the main provider received that care from the main provider. We require this “same patient population” test to be met for the 12-month period used to support an initial determination of provider-based status, and it must continue to be met for each subsequent 12-month period to justify a continuation of provider-based status. Application of population/geographic standards to newly established facilities or organizations is discussed below.

    Comment: Commenters suggested we show some flexibility with regard to the definition of patient population for teaching hospitals. The commenter stated that it will not always be the case that the patient populations for the teaching program will be the same as the overall mix or patient population for the main provider.

    Response: We recognize that patient populations will not be identical in all cases, and thus have adopted a patient population criterion under which there may be a divergence of up to 25 percent between the main provider and the facility or organization seeking provider-based status. We believe this provides a reasonable allowance for differences in patient population. Moreover, we note that under section 1886 of the Act, Medicare provides much flexibility for teaching hospitals in other ways, for example, under section 1886(h)(4)(E), permitting the counting of residents for purposes of payment to teaching hospitals for the time the residents spend in nonhospital settings. Start Printed Page 18517

    Comment: Two commenters suggested that the criterion on service to the same patient population be dropped. One commenter believes the criterion is overly vague, could limit access to care as facilities seek to control their service patterns, and, in general, represents a geographically based approach that is out of keeping with modern technology and communications. Another commenter stated that the criterion is unclear, and providers could find it burdensome to assemble the data to show compliance. Other commenters shared the second commenter's concern, but instead of recommending elimination of the criterion, they suggested that a more administrable solution would be to use regional or state standards to define “same geographic area,” such as, health systems area, a specified mileage amount, or our wage area.

    Response: As described above, we have developed a more precisely stated test of service to the same patient population. We believe that test will be clear and understandable, not impose unrealistic burdens on providers, and allow provider-based designations that parallel service patterns.

    Comment: With respect to paragraph (d)(7)(i), a commenter asserted that many currently operating facilities that are treated as provider-based by us provide types of service that are the same as those of the main provider, but serve patient populations from different geographic areas. The commenter believes these entities provide care under the direction of, and utilize substantial services from, the main provider. An example would be the geographically separate campuses of a single parent hospital that are located at various sites throughout a region. The commenter suggested that such campuses be presumed to be provider-based if they provide substantially the same services as the main provider, do not exceed the size of the main provider, and comply with all other provider-based requirements. Another commenter stated that the “same patient population” requirement should not apply to multi-campus long term care hospital locations. These locations are fundamentally different from other provider-based entities that the regulation addresses, since a long-term care hospital main provider and its remote campus furnish the same services, and offer the same programs of care, but operate in slightly different geographic areas. The commenter suggested that so long as all of the strict financial and administrative integration requirements of the proposed provider-based regulation are satisfied, the “same patient population” requirements should not apply to long-term care hospitals. The result of this criterion would be that satellites will not be established in many underserved areas where long term services are needed. Another commenter believes a specialty facility, such as a long-term care hospital, should be exempt from the geographic proximity requirement if it can demonstrate that it will improve the quality of patient care, and offer services that are not otherwise provided in that area.

    Response: We recognize that there may be some cases in which a hospital and another facility seeking provider-based status as a remote location of that hospital may meet most or all other criteria in § 413.65, yet not qualify because the two facilities serve different patient populations. However, we do not agree that this result should lead us to abandon the “same patient population” test. On the contrary, we continue to believe that criterion is a valid indicator of provider-based status. Thus, we did not revise the regulation based on this comment. In this context, we note that there is no Medicare rule that would prohibit a hospital from setting up another hospital in another area. We do not agree with the commenter's assumption that because the program memorandum and proposed rule were issued in response to situations primarily involving outpatient facilities, they can apply only to such facilities. On the contrary, we believe the policies set forth in these documents are equally applicable to inpatient facilities, and should be applied in the many cases in which a determination about inpatient facilities must be made. In particular, the rules apply to remote locations of long-term care and other hospitals that are main providers, as well as to satellite facilities of hospitals and hospital units that are excluded from the hospital inpatient prospective payment system. Remote locations and satellite facilities are discussed more fully earlier in this preamble, and “satellite facilities” are specifically described in our regulations in §§ 412.22(h) and 412.25(e). (As explained in that document, we are concerned that establishment of satellites by hospitals and units excluded from the inpatient PPS could lead to payment abuses, such as circumvention of certain payment caps mandated by section 4414 of the Balanced Budget Act of 1997, and we have therefore established special payment rules for those facilities. Facilities seeking to qualify as “satellites” under the inpatient payment criteria in §§ 412.22(h) and 412.25(e) would first need to comply with the provider-based requirements before being eligible for satellite status.) We have revised the final rule to clarify its application to remote locations of hospitals and satellite facilities.

    Comment: The commenter believes that flexibility in the definition of “located in the immediate vicinity” needs to be met with additional considerations when viewing rural and underserved areas; for example, it should not be our intention to eliminate the provider-based designation of a rural health clinic (RHC), when the purpose of the RHC is to be an outreach to geographically isolated areas.

    Response: We share the commenter's concern and have developed a special provision for RHCs, as described below.

    Comment: A commenter believes that the requirement that provider-based entities serve the same population as the main provider could cause significant problems for RHCs. The unique situations addressed by hospital-based RHCs attempting to satisfy the health care needs of medically underserved areas should be considered as exceptions to the proposed rule.

    Response: We continue to believe close physical proximity is an important indicator of provider-based status; however, we recognize that small rural hospitals and their RHCs may not be able to demonstrate that a substantial number of clinic patients receive services from the main provider. Small rural hospitals typically provide limited inpatient care compared to their urban counterparts, which may cause the RHC patients to seek inpatient service from other providers. In light of this, we believe small rural hospitals (less than 50 beds) that own and operate RHCs should not be expected to demonstrate that they serve the same patient population as the main provider. Therefore, we are revising the regulation to allow off-campus RHCs affiliated with small rural hospitals (less than 50 beds) to retain their provider-based status without satisfying that requirement.

    Comment: Several commenters opposed the inclusion of paragraph (d)(7)(ii), since they view a State border as an arbitrary boundary inhibiting a hospital's ability to serve patients, which seems counterproductive. They also argued that a regulation that fails to recognize the operation of health care systems that function across State lines is unrealistic. Another commenter suggested that we rely on the proposal concerning serving the same patient population. It was also stated that in one case a provider can be located in a city Start Printed Page 18518split by the State border with its related facility located one mile away, but in another state, while in another case, the provider and its subordinate facility can be a mile apart and in the same State. Another commenter believes that, since Medicare beneficiaries often cross borders for health care services, disallowing hospitals in these areas from establishing provider-based entities eliminates choices and prohibits the development of new services. The commenter recommended that we revise or eliminate this criterion. Another commenter suggested that LTHs and their satellites not be subject to this requirement if the main provider and its satellite are located in two contiguous States. Alternatively, the commenter suggested that we consider using the wage index areas as guidelines for the areas to be served by provider-based entities even if that area crosses State lines.

    Response: After reviewing these comments, we have decided to revise the regulations to allow providers in one State to have provider-based facilities in an adjacent State, if doing so is not inconsistent with the law of either State, and other criteria are met, including those related to service to the same patient population.

    Comment: With regard to paragraph (d)(7)(i), while the proposed rule permits a provider to show that a “high percentage” of patients of the main provider and the facility come from the same geographic region, new facilities would not have any historical data upon which to base this assertion, and therefore would fail to be able to demonstrate the criteria prior to operation. Another commenter believes the requirement may pose an impediment to new facilities being located in underserved or outlying areas. Thus, the commenters believe the same patient population requirement should not apply to new facilities, including new long-term care hospital satellites.

    Response: We agree that it would be appropriate to establish a criterion that could be met by new facilities or organizations, and therefore have revised the final rule to include a special provision for new facilities or organizations. Under this revision, a new facility or organization, (one that has not been in operation for all of the 12-month period immediately preceding the first day of the month in which the application for provider-based status is filed with us), may be considered to meet the criterion on service to the same patient population, if it is located in a zip code area included among those that (during the 12-month period described above) accounted for at least 75 percent of the patients served by the main provider. We note that this provision would not be limited to long-term care hospitals' satellites or their remote locations, but would be available to all new facilities or organizations.

    Section 413.65(e) Provider-based status not applicable to joint ventures

    Comment: Several commenters expressed concern that this criterion would prohibit the use of joint ventures for entities that want to participate as provider-based entities, and argued that such a prohibition would unnecessarily restrict hospital flexibility. One believes this provision should be eliminated. Another commenter suggested modification of paragraph (d)(2) of the rule to establish majority ownership as the standard rather than 100 percent ownership. Still other commenters suggested that provider-based status for facilities or organizations run as joint ventures should be permitted, as long as the hospital at which the facility is located has the equipment or service under its control.

    Response: We reviewed these comments carefully, but did not make any changes in the regulations based on them. When a facility or organization is run as a joint venture of two or more providers, it is by definition under their joint control, and therefore cannot be an integral and subordinate part of any individual provider. We have no interest in discouraging such ventures, but continue to believe they do not qualify as provider-based.

    Section 413.65(f) Management contracts

    Comment: Several commenters expressed the view that the criterion under which the staff of the facility or organization must be employed by the provider or another organization other than a management company is too restrictive, and should be deleted. One commenter argued that, if the written contract maintains the responsibility and control for services in the hands of the main provider, the employer of the staff working at the site is not relevant. Another believes the criterion will discourage economic efficiencies. If a provider is able to demonstrate integration and subordination of the off-site facility based upon other provider-based criteria, the fact that a hospital chooses to provide certain services either directly through its own employees or indirectly through an independent contractor/management arrangements is irrelevant. Another commenter argued that the proposed criterion is inconsistent with: the provision of the Medicare statute that expressly permits coverage of “services under arrangement”; with the hospital conditions of participation that recognize that contractors may be used to furnish patient care services; and with the Provider Reimbursement Manual, which recognizes that providers commonly contract for management services and the costs of the contract services may be allowed under Medicare principles of reimbursement. Still another commenter believes the proposed criterion would negatively impact the therapy profession, and could impact the health and safety of Medicare beneficiaries.

    Response: We do not believe the criterion is overly restrictive, nor do we agree that employment of the staff of a facility or organization is irrelevant to the question of whether that facility or organization is an integral and subordinate part of a provider. On the contrary, employment of the staff of such a facility or organization will normally give the provider significant control over it, thus promoting integration. Conversely, if a facility or organization is staffed by personnel who are employed by another entity that has only a contractual relationship with the provider, the facility or organization may well be an integral and subordinate part of the management company, not of the provider.

    We also do not agree that the criterion is inconsistent with section 1861(w)(1) of the Act, which permits providers to make arrangements for the provision of specific health services, nor do we believe adopting this criterion will undercut the ability of providers to have selective services provided under arrangements. In this regard, we point out that existing Medicare policy, stated in section 207 of the Medicare Hospital Manual (HCFA Publication 10), emphasizes the need for the hospital to exercise professional responsibility for the arranged-for services, not merely to serve as a billing mechanism for the other party. This is consistent with our view that section 1861(w)(1) was intended to allow specific health care services to be furnished under arrangements, but was never meant to be a vehicle by which a provider could nominally operate a facility or organization, but, in fact, contract out its operation to another entity. Finally, we note that while there are various sections of the hospital conditions of participation and the Provider Reimbursement Manual that recognize the possibility that specialized health care services or management services may be provided under contract, this does not indicate that providers may Start Printed Page 18519contract out entire departments or services while claiming them as provider-based. To clarify the scope of the requirement on contracted services, we have revised it to state that management staff of the facility or organization (rather than health care or support staff) need not be employed directly by the provider. We have also revised the rule to clarify that if staff of the facility or organization (other than management staff) are employed by an organization other than the management company or the provider, it must be the same organization that also employs the staff of the main provider.

    Section 413.65(g) Obligations of hospital outpatient departments and hospital-based entities

    Section 413.65(g)(1)

    Because of the direct relationship between the proposed changes in this section and those in § 489.24(b), comments on both proposals are discussed later, under § 489.24(b), “Special responsibilities of Medicare hospitals in emergency cases.”

    Comment: A commenter requested clarification as to the application of the anti-dumping requirement in the home health setting.

    Response: Section 413.65(g)(1) states that the EMTALA requirements apply to hospital outpatient departments. EMTALA requirements would not apply to off-campus provider-based entities that are not hospital departments, such as home health agencies.

    Section 413.65(g)(2)

    Comment: While one commenter agreed with the requirement under § 413.65(g)(2) for billing of physician services with the appropriate site-of-service indicator, another commenter also believes there should be clarification that correct billing is the responsibility of the entity performing the billing function. Both commenters suggested that the hospital notify physicians who do their own billing that they must use the correct indicator; they agree that it should not be the responsibility of the hospital.

    Response: We agree that physicians (or those to whom they assign their billing privileges) are responsible for appropriate billing, but note that physicians who practice in hospitals, including off-site hospital departments, do so under privileges granted by the hospital. Thus, we believe the hospital has a role in ensuring proper billing.

    Section 413.65(g)(5)

    Comment: Presently, provider-based clinics bill Medicare for the facility charge on a UB-92 form, and the physician fee is billed separately on a HCFA-1500 form, while other payers may accept a single bill for both charges. A commenter believes it is inappropriate to mandate that two bills be submitted for all patients, as long as charges for similar services are uniform regardless of payer.

    Response: As explained further below, we have revised the final rule to eliminate the part of this criterion relating to billing of services to non-Medicare patients. We believe this responds to this commenter's concern.

    Comment: Many commenters stated that Medicare should treat a facility that claims a facility fee as being provider-based even when other payers do not do so, reasoning that as long as the hospital claims that the patient is an outpatient for Medicare purposes, the practices of other payers, with respect to similar patients, are not significant, and should be ignored. Another commenter believes this requirement should be eliminated, because, in the commenter's view, it has no bearing on the outpatient services delivered to Medicare beneficiaries, and therefore does not affect Medicare reimbursement. To illustrate, a large commercial insurer does not have the capability to accept certain types of outpatient claims from hospitals; therefore, it requires claims for those services to be billed on a physician claim form, so hospitals will receive the proper reimbursement. If this criteria is retained as proposed, many hospital-based departments would not meet our criteria due to the nuances of other payers' policies, that are often contractual issues with providers. Still another commenter believes that we should reexamine the proposal made in paragraph (g)(5), and at a minimum, clarify what it means by its proposal mandating uniform “treatment of all patients, for billing purposes, as hospital outpatients.” If we are proposing to mandate that all outpatients be billed on the same basis, this would effectively extend Medicare direct billing or rebundling rules to all payers. In addition, this proposed requirement would not only be contrary to past policy and practice, but would affect departments that have differentiated billing practices. Another commenter stated that payers typically determine payments based upon how they define a particular service or their individual market power; Medicare certification of outpatient departments should not be influenced by how unrelated third parties pay for services to the patients they cover at these sites. Moreover, this criterion would be very difficult to implement, because hospitals can have hundreds of contracts with insurance companies and the providers that subcontract for part of the risk for plans.

    Response: After review of the comments on this section, we have decided to revise it to restrict the requirement for uniform billing to Medicare patients only, thus allowing hospitals to bill other payers in whatever manner is appropriate under those payers' rules. As revised, § 413.65(g)(6) states that hospital outpatient departments (other than RHCs) must treat all Medicare patients, for billing purposes, as hospital outpatients. The department must not treat some Medicare patients as hospital outpatients and others as physician office patients.

    Comment: A commenter stated that there appears to be some confusion as to whether this requirement applies to “departments” or all facilities and organizations seeking provider-based status. Also, the commenter asked if there is a provision of the proposed rule that mandates that a facility fee be charged to patients of facilities and organizations receiving provider-based status.

    Response: As noted earlier, the proposed rule would not apply this criterion to provider-based entities (which may participate separately as providers) but only to provider-based departments. Regarding the second issue, we have, as described in response to the preceding comment, revised the final rule to eliminate the criterion regarding billing of payers other than Medicare.

    Section 413.65(g)(7)

    Comment: A commenter stated that requiring written notice for each patient (presumably signed by the patient), would be an overly burdensome requirement, and requested that the requirement allow for a clear, prominently displayed sign in lieu of individual notice. Another commenter believes that the proposed requirement would apply a standard to hospital outpatient departments that is not applied to any other site of service.

    Response: First, we emphasize that notice is required only for Medicare beneficiaries, not for all patients. We recognize that providing notice will generate some burden for the provider, but believe that the protection it affords to patients warrants the requirement. We considered allowing the notice requirement to be satisfied through the posting of signs, as recommended by one commenter, but concluded that use of individual written notices would more effectively ensure that each Start Printed Page 18520beneficiary receives the necessary information. In response to the comment concerning settings other than hospital outpatient departments, we note that in other settings, a patient is unlikely to be misled as to what type of facility is the site of treatment, so provision of notice is not required. To avoid confusion as to when the requirement applies, we have revised the final rule to state that notice is required only if the hospital outpatient department or provider-based entity is not located on the campus of the hospital that is the main provider. We have revised this final rule to specify that the notice must be in writing, must be one the beneficiary can read and understand, and must be given to the beneficiary's authorized representative if the beneficiary is unconscious, under great duress, or for any other reason unable to read a written notice and understand and act on his or her own rights.

    Section 413.65(g)(9) (redesignated in this final rule as Section 413.65(h), Furnishing all services under arrangement)

    Comment: A commenter observed that § 413.65(g)(9) does not preclude an outpatient facility from obtaining a certain type of service from an off-site supplier. If this is correct, if the service is provided on-site in the hospital's outpatient facility, it is not clear how the proposed regulations are intended to be applied. It would appear that if the facility is looked at as a whole, all services are not provided “under arrangements”; therefore, paragraph (g)(9) of this section would not preclude the facility from being recognized as provider-based. However, in this case, the commenter stated that both licensure and ownership requirements would be difficult to satisfy. In most cases, that portion of the facility that is operated “under arrangements” with the hospital will not be on the hospital's license, nor will that portion necessarily be owned by the hospital. Thus, the commenter urged that the “under arrangements” portion of an outpatient facility be excluded from the licensure and ownership analyses.

    Response: We agree that where a facility offers a variety of services, provision of a single type of service under arrangement would not prevent the facility from meeting this criterion. The criterion could not, of course, be met by a facility that furnished only a specific type of service (such as physical therapy), and provided that service only under arrangement. In the case envisioned by the second commenter, the facility would be out of compliance with licensure and ownership requirements, as well as the requirement involving services under arrangement, and we would agree that it could not be provider-based.

    Comment: A commenter asked for clarification of “under arrangements”, in reference to our other regulations that contain these terms. Also, the commenter requested clarification on the types of services to which this standard applies, that is, direct patient care as opposed to facility related services.

    Response: The term “arrangements” is defined in section 1861(w)(1) of the Act and the Medicare regulations § 409.3, in that “arrangements” refers to arrangements that provide that Medicare payment made to the provider that arranged for the services discharges the liability of the beneficiary or any other person to pay for the services. We wish to emphasize that the provision will apply to patient care services, not housekeeping, security, billing, or other services that are not patient care services but are needed to support their provision.

    Section 413.65(h) Inappropriate treatment of a facility or organization as provider-based (redesignated in this final rule as paragraph (i))

    Comment: This section establishes sanctions that may be used to address a main provider that has treated an entity as provider-based without our review and approval. A commenter believes that the investigation phase should precede the review of payments to the main provider. A commenter was also concerned that the individuals involved in these reviews and investigations are properly trained to make the required determinations.

    Response: We believe review of payments will encompass two activities—investigation to determine whether applicable provider-based requirements were met, and a calculation of the amount of overpayment if they were not. Thus, investigation necessarily precedes recovery, but is a part of the overall effort, which is to reconsider payment amounts. To respond more effectively to concerns about how the review and recovery activities will occur, and to clarify the specific actions we will take in cases of inappropriate billing, we have reorganized paragraph (i) to deal separately with the processes of determination and review, recovery of overpayments, and the good faith effort exception. With respect to determination and review, we state that if we learn that a provider has treated a facility or organization as provider-based and the provider had not obtained a determination of provider-based status under this section, we will review current payments and, if necessary, take action in accordance with the rules on inappropriate billing in paragraph (j), investigate and determine whether the requirements for provider-based status in paragraph (d) of § 413.65 (or, for periods prior to October 10, 2000, the requirements in applicable program instructions) were met, and review all previous payments to that provider for all cost reporting periods subject to re-opening in accordance with § 405.1885 and § 405.1889 of this chapter. With respect to recovery of overpayments and the good faith exception, we have clarified that we will recover only the difference between the amount of payments that actually were made and the amount of payments that we estimate should have been made in the absence of a determination of provider-based status, and that recovery will not be made for any period prior to the effective date of these final rules if during all of that period the management of the entity made a good faith effort to operate it as a provider-based facility or organization, as described in paragraph (h)(3) of § 413.65. In response to the comment about the competence of individuals involved in these activities, we wish to emphasize that we will ensure that staff involved in these activities have the necessary expertise.

    Comment: A commenter believes that it would be unfair to apply the proposed regulations retroactively, that is, to periods before the effective date of the final rule. Even though paragraphs (h) and (i) provide for a good faith exception, it is still unfair to provide that the conditions for this exception will apply prior to the effective date of the final regulation. The commenter requested that these sections be revised to provide that the period of recovery will not extend to any period prior to the effective date of the final regulations. Another commenter also believes that any payment changes be prospective (unless the hospital did not make a good faith effort to operate the site as provider-based).

    Response: We agree that it would be inappropriate to apply the rules in paragraph (h) to any period prior to their effective date, and have revised the final rule to clarify that for such periods, we will make determinations based on the program memoranda or other instructions in effect at the time. However, the criteria in paragraph (i) that form the basis for a good faith exception were in effect prior to the issuance of these regulations. Regarding Start Printed Page 18521the last comment, we cannot agree to ignore possible overpayments resulting from noncompliance with published criteria in effect at that time.

    Comment: A commenter believes that the term “good faith effort” should be defined to provide more direction and opportunity to comply. Also, entities making “good faith efforts” should be given an opportunity to correct those factors or criteria that render it out of compliance with the provider-based requirements.

    Response: The conditions under which a provider will be found to have made a good faith effort were clarified in § 413.65(i)(2), and have been restated in the final rule.

    Section 413.65(i) Inappropriate billing (redesignated in this final rule as paragraph (j))

    Comment: A commenter believes that suspending all payments for outpatient services to facilities that have billed inappropriately as provider-based entities until the provider can demonstrate that payments are proper is too onerous. Instead, the commenter suggested that we consider suspending the reimbursement differential between a provider-based entity and a nonprovider-based entity until a determination is made or the facility has had a reasonable opportunity to comply.

    Response: We understand the commenter's concern and have revised the final rule to authorize partial suspension of payment (that is, a reduction in payment) to the extent needed to prevent creation of an overpayment to the provider. This rule will allow payment to continue at a reduced rate, thus avoiding creation of financial hardship for the provider. To describe more clearly how we will deal with instances of inappropriate billing, we have reorganized paragraph (j) of § 413.65 to spell out more clearly the actions we will take, and the extent to which payment will be adjusted. Specifically, we state that if we find that a facility or organization is being treated as provider-based without having obtained a determination of provider-based status under this section, we will notify the provider, adjust future payments, review previous payments, determine whether the facility or organization qualifies for provider-based status under this paragraph, and continue payments only under specific conditions. The notice to the provider will explain that payments for past cost reporting periods may be reviewed and recovered, that future payments for services in or of the facility or organization will be adjusted, and that a determination of provider-based status will be made.

    We further state that we will not stop all payment in such cases, but instead, will adjust future payments to approximate as closely as possible the amounts that would be paid in the absence of a provider-based determination, if all other requirements for billing were met. We also explain that we will review previous payments and, if necessary, take action in accordance with the rules on inappropriate treatment of a facility or organization described above. The regulation states that we will determine whether the facility or organization qualifies for provider-based status under the criteria in this section. If we determine that the facility or organization qualifies for provider-based status, future payment for services at or by the facility or organization will be adjusted to reflect that determination. Even if the facility or organization does not qualify for provider-based status, however, we will continue paying, at an appropriately adjusted level, for a limited time period in order to avoid disruption of services to program beneficiaries at that site and to allow an orderly transition to freestanding status.

    The notice of denial of provider-based status sent to the provider will ask the provider to notify us in writing, within 30 days of the date the notice is issued, as to whether the facility or organization (or, where applicable, the practitioners who staff the facility or organization) will be seeking to enroll and meet other requirements to bill for services in a free-standing facility. If the provider indicates that the facility, organization, or practitioners will not be seeking to enroll, or if we do not receive a response within 30 days of the date the notice was issued, all payment will end as of the 30th day after the date of notice. If the provider indicates that the facility or organization, or its practitioners, will be seeking to enroll and meet other requirements for billing for services in a free-standing facility, payment for services of the facility or organization will continue, at the adjusted amounts described in paragraph (j)(2) of this section for as long as is required for all billing requirements to be met (but not longer than 6 months) if—

    • The facility or organization, or its practitioners, submit a complete enrollment application and provide all other required information within 90 days after the date of notice, and
    • The facility or organization, or its practitioners, furnish all other information we need to process the enrollment application and verify that other billing requirements are met.

    If the necessary applications or information are not provided, we will terminate all payment to the provider, facility, or organization as of the date we issue notice that necessary applications or information have not been submitted. We have clarified the final rule to state that these reductions will occur where inappropriate billing is or has been taking place.

    Comment: A commenter believes that there are already existing mechanisms for overpayment and recoupment that may be used in the situations described in this section. At the very least, administrative actions of this type should be subject to time frames in order to protect providers from the impact of extended investigations.

    Response: We plan to conduct any recovery efforts in accordance with applicable law and regulations on overpayment recovery. However, investigations may be complex and require examination of many records, and we do not agree that they should be limited by additional, self-imposed restrictions.

    Comment: A commenter stated that a facility or organization that requests a provider-based determination prior to the effective date of the final rule, and meets the good faith requirements, should not be subject to recovery of overpayment for periods either before or after the effective date of the final rule. This will prevent disruptions to existing arrangements that meet the good faith exception during the time that the request is being processed.

    Response: If we were to adopt this proposal, we would be guaranteeing an overpayment to providers who, for a specific time period, knowingly billed for services as those of provider-based entities, even though they met only a few of the provider-based criteria. Thus, we did not adopt this comment.

    Comment: A commenter requested that the requirement found at paragraph (i)(2)(iii) be clarified to state that management is only responsible for professional services billed by the hospital.

    Response: As explained earlier, we believe hospitals' privileging mechanisms give them adequate leverage to prevent inappropriate billing by practitioners using their facilities. Therefore, we did not adopt this comment.

    Comment: As to the good faith criteria found in paragraph (i)(2), a commenter questioned why requirements related to public awareness were chosen for inclusion. An organization can represent itself to the public in any number of inaccurate ways in order to mislead our officials and others. The Start Printed Page 18522commenter believes that we should focus our attention on more tangible expressions of good faith efforts to operate a provider based entity.

    Response: We believe inclusion of this requirement is needed to help ensure that beneficiaries are protected from unexpected deductible and coinsurance liability. While we agree with the commenter that some providers may misrepresent the status of off-site facilities, we believe such providers cannot reasonably be said to have acted in good faith, and should not receive favorable treatment with respect to past overpayments.

    Section 413.65(j) Correction of errors (redesignated in this final rule as paragraph (k))

    Comment: A commenter disagreed with the language in this subsection that would allow us to review and rescind, if appropriate, any past determinations. The commenter believes that this subsection should be removed and any previous determinations should be grandfathered in under the new regulations. Other commenters recommended that we grandfather facilities or organizations that had previously been determined by the regional office to be provider-based, or that have not received such a determination but have been billing as provider-based without a determination for a period of at least ten years, so that those facilities or organizations could retain provider-based status even though they do not meet the criteria in the regulations.

    Response: We do not agree that it would be appropriate to grandfather existing facilities or organizations, since this would in effect create an ongoing double standard, under which some facilities or organizations are held to higher standards than others. Moreover, the fact that improper billing may have continued undetected for a long period is not a reason to continue to permit such billing. As explained in the response to the following comment, however, any adverse determination regarding provider-based status of facilities or organizations which we previously determined were provider-based will not be effective until the start of the cost reporting period after the period in which the provider is notified of the redetermination, or for at least 6 months, whichever date is later.

    Comment: A commenter believes that our proposal that we may review past provider-based determinations inserts needless uncertainty into the process for making provider-based designations. The commenter is concerned that providers may file before the final rule is published in order to avoid a crush of applications and subsequent disruption in payment, if they do not have a determination within 30 days of the rule becoming final. The commenter stated that providers need to be able to receive prompt determinations on which they can rely.

    Response: We understand the concern about avoiding the need to process a large number of applications in a short time, and agree that it would not be appropriate to make abrupt changes in provider-based status. To avoid a possible crush of applications within a 30-day period, as envisioned by the commenter, we are providing the delayed effective date described earlier in this document. In addition, under § 413.65(j) of these regulations, when a facility or organization that previously was determined to be provider-based is found to no longer qualify for provider-based status, treatment of the facility or organization as provider-based will not cease until the first day of the first cost reporting period following notification of the redetermination, but not less than 6 months after the date the provider is notified of the redetermination. If there has been no prior determination of provider-based status, and a facility or organization is later found not to meet the criteria, that determination may be effective up to 6 months after the date the provider is notified of the determination, if within 30 days of the determination, the provider indicates that the facility or organization, or its practitioners, will enroll separately and, within 90 days, the facility or organization, or its practitioners, take other necessary action to enroll.

    Section 489.24(b) Special responsibilities of Medicare hospitals in emergency cases

    Comment: One commenter disagreed strongly with the proposed revisions to the regulation defining “comes to the emergency department,” and in particular expressed the view that patients arriving on the campus, sidewalk, driveway, or parking lot of hospital facilities should not be considered to have come to the emergency department. The commenter stated the view that an obligation under section 1867 of the Act (sometimes referred to as the Emergency Medical Treatment and Active Labor Act (EMTALA), after the original title of the legislation adding section 1867) and our regulations at §§ 489.20(l), (m), (q), and (r), and § 489.24 should be triggered only by a presentation to the emergency department, and that only in exceptional situations should EMTALA apply to someone not technically in the emergency department. The commenter recommended that the regulations be revised to state that in these cases, the hospital may rely on a variety of transport options, consistent with the individual's condition and established policies that are applied in a nondiscriminatory manner. The commenter also recommended that the statute be interpreted as requiring only that hospitals with emergency departments have policies and procedures to assure that a person who presents to the hospital requesting emergency services is provided a medical screening examination and, if needed, stabilization or an appropriate transfer.

    Another commenter raised several arguments against the proposed change. The commenter stated that there is a legal and ethical conflict in requiring hospital personnel to leave an area of patient care and furnish assistance to another patient in a remote area of the hospital. The commenter also believes that ED personnel are not well-trained or practiced in immobilization or scene safety, and patients and staff may be put at risk if staff are asked to go into the field and render aid to a victim who needs the expert care and experience for which field emergency medical services (EMS) personnel are trained. Finally, the commenter expressed concern about possible increases in the liability insurance cost to hospitals as a result of the proposed change.

    Response: We do not agree that the proposed language inappropriately extends the scope of hospitals' EMTALA responsibilities. On the contrary, existing regulations at § 489.24 make it clear that EMTALA applies to hospitals that offer services for emergency medical conditions, and we believe it would defeat the purpose of EMTALA if we were to allow hospitals to rely on narrow, legalistic definitions of “comes to the emergency department” or of “emergency department” to escape their EMTALA obligations. We would also note, as discussed further below, that there is no requirement that all areas of the hospital be equipped to provide emergency care or that treatment always be provided outside the emergency area or department. Similarly, there is no prohibition of appropriate transfers to other facilities where such a transfer is conducted in accordance with § 489.24. On the contrary, the intent of the revised regulation is to ensure that patients who come to the hospital and request examination or treatment for what may be an emergency medical condition are not denied EMTALA protection simply because they enter the Start Printed Page 18523wrong part of the hospital or fail to make their way to the emergency room.

    Comment: Two commenters recommended clarification of the applicability of section 1867 of the Act regarding transfer requirements to scheduled patients at an “off-campus” hospital site, to ensure that the movement of scheduled patients unexpectedly requiring a higher level of care to another site of the same hospital is not construed as a “transfer” under the emergency access law, and that only those patients taken from one hospital's off-campus facility to another hospital's emergency department or inpatient unit be considered “transfers” that must be in accordance with the requirements of section 1867.

    Response: We agree that movement of a patient from one part of a hospital to another, including movement from a remote location to a main hospital campus, does not constitute a “transfer” for EMTALA purposes, nor does it require compliance with the appropriate transfer requirements in § 489.24(d). The final regulations at § 489.24(i)(3)(i) clarify this policy.

    Comment: A commenter expressed the view that the proposed revision to § 489.24 does not recognize the role that EMS personnel play in emergency situations and the true medical benefit provided by EMS personnel to patients in emergency situations. The commenter recommended that language be included in the regulation to authorize hospitals' use of EMS in responding to emergency situations on hospital grounds.

    Response: We agree that EMS personnel can play a valuable role in transporting patients to appropriate sources of emergency care. A hospital may not, however, meet its EMTALA obligations merely by summoning EMS personnel. EMS may be used appropriately in conjunction with an appropriate hospital response to treat and move an individual who is already on hospital property. We therefore did not make any change to these regulations to authorize exclusive use of EMS to respond to emergency situations on hospital property.

    Comment: A number of commenters stated that the anti-dumping rules implemented under section 1867 of the Act (EMTALA requirements) and our regulations at §§ 489.20(l), (m), (q), and (r), and § 489.24 should apply to the hospital's main campus and to all emergency departments. However, they argued that it is not reasonable to apply these rules to outpatient departments located off-campus that would not be set up to provide emergency services. In the commenters' view, it should suffice that patients in an emergency situation be directed to the hospital's emergency room. Another commenter stated that EMTALA obligations should be limited to those hospital entities that hold themselves out as providing emergency services, and should not be enforceable anywhere outside the emergency department or anywhere on hospital property, including an outpatient department or provider-based entity. Another commenter stated that the enforcement of this requirement would lead to the elimination of service-specific outpatient departments located off a main campus, and asked that we reconsider our policy. One commenter expressed concern that patients identifying a facility as a hospital-based department could mistakenly assume it is equipped to handle emergency cases. Another commenter believes that hospitals should be required to have policies and procedures in place to assure that all parts of the hospital are prepared to deal with getting an individual the appropriate medical screening.

    Response: Existing regulations at § 489.24(b) define “hospital with an emergency department” to include all hospitals that offer services for emergency medical conditions, not just those that have organized emergency rooms or departments. To the extent a hospital acquires or creates an off-campus location, identifies it to us and to the public as a part of that hospital, and claims payment for services at that location as hospital services, we believe it is not unreasonable to expect that hospital also to assume the obligations, including compliance with EMTALA requirements, which flow from hospital status. This principle does not mean, of course, that a hospital must have a fully equipped and staffed emergency department at each location. It also does not mean that every appearance by an individual at an off-campus hospital department that does not offer services for emergency medical conditions will necessarily trigger an EMTALA obligation on the part of the hospital. Individuals come to these departments for many medical purposes which may not involve potential emergency medical conditions. Under these circumstances, the hospital would not have an EMTALA obligation with respect to that individual. This principle does mean, however, that if an individual comes to an off-campus department of a hospital and a request is made for examination or treatment for a potential emergency medical condition, the hospital incurs an obligation to provide, within its capability, an appropriate medical screening examination and necessary stabilizing treatment. In some cases, the patient may need to be taken back to the main hospital campus for a full screening and/or stabilizing treatment. Under these circumstances, the hospital is responsible for moving the patient or arranging his or her safe transport, but this movement would not be considered a “transfer” under § 489.24(b), since the patient is merely going from one part of the hospital to another. If it is necessary to transfer the patient to another medical facility, the hospital must provide an appropriate transfer in accordance with § 489.24(d).

    After review of the comments on this issue, we have decided to revise the regulations to state more clearly the extent of a hospital's EMTALA obligations with respect to patients who come to a hospital department located off the hospital's main campus. Provider-based entities, such as SNFs or HHAs, located off the hospital campus would not, of course, be subject to EMTALA since a patient coming to such an entity would not have come to the hospital. We will require that each off-campus hospital department, during its regular hours of operation, have in effect procedures for: (1) assessing the possibility that an emergency medical condition exists, and providing such screening (as defined in § 489.24(a) and (b)) and necessary stabilization (as defined in § 489.24(c)) at the off-campus site); (2) transporting the patient to the hospital's emergency room or department for screening and necessary stabilization meeting the requirements of § 489.24; or (3) providing an appropriate transfer to another facility in accordance with the requirements in § 489.24(c). To meet these requirements, the hospital will need to develop procedures that permit staff of the off-campus department to contact emergency physicians or other qualified emergency practitioners at the main hospital campus, to obtain advice and direction regarding the handling of any potential emergencies, and to obtain prompt medical transport, by hospital-owned or other ambulance or other appropriate vehicle, either to the main hospital campus or, where an appropriate transfer is being provided, to another medical facility.

    Specifically, we are adding new paragraph (i) to § 489.24 to describe a hospital's obligations. The paragraph states that, if an individual comes to a facility or organization that is located off the main hospital campus as defined in § 413.65(b), but has been determined under § 413.65 of this chapter to be a department of the hospital, and a Start Printed Page 18524request is made on the individual's behalf for examination or treatment of a potential emergency medical condition as otherwise described in paragraph (a) of § 489.24, the hospital is obligated to provide the individual with an appropriate medical screening examination and any necessary stabilizing treatment.

    The capability of the hospital includes that of the hospital as a whole, not just the capability of the off-campus facility or organization. Except for cases described in paragraph (i)(3)(iii) (those in which the main hospital campus does not have the specialized capability or facilities needed to treat the individual, or the individual's condition is deteriorating so rapidly that transport to the main campus would significantly jeopardize the life or health of the individual), the obligation of a hospital under this section must be discharged within the hospital as a whole. However, the hospital is not required to locate additional personnel or staff to off-site locations to be on standby for possible emergencies.

    In § 489.24(i)(2), Protocols for off-campus departments, we further state that the hospital must establish protocols for the handling of potential emergency cases at off-campus departments. These protocols must include provision for direct contact between personnel at the off-campus department and emergency personnel at the main hospital campus, and may provide for dispatch of practitioners, when appropriate, from the main hospital campus to the off-campus department to provide screening or stabilization services. The intent of these requirements is to ensure timely exchange of information between the two sites, and to allow the hospital the flexibility to bring emergency personnel to the patient, rather than the opposite, where doing so is the best medical approach to meeting the patient's needs.

    Under the final rule, if the off-campus department is an urgent care center, primary care center, or other facility that is routinely staffed by physicians, RNs, or LPNs, these personnel must be trained, and given appropriate protocols, for the handling of emergency cases. At least one individual on duty at the off-campus department during its regular hours of operation must be designated as a qualified medical person as described in paragraph (d). The qualified medical person must initiate screening of individuals who come to the off-campus department with a potential emergency medical condition, and may be able to complete the screening and provide any necessary stabilizing treatment at the off-campus department, or to arrange an appropriate transfer.

    The final rule further states that if the off-campus department is a physical therapy, radiology, or other facility not routinely staffed with physicians, RNs, or LPNs, the department's personnel must be given protocols that direct them to contact emergency personnel at the main hospital campus for direction. Under this direction, and in accordance with protocols established in advance by the hospital, the personnel at the off-campus department must describe patient appearance and reported symptoms and, if appropriate, arrange transportation of the individual to the main hospital campus (if the main hospital campus has the capability required by the individual, and movement to the main campus would not significantly jeopardize the individual's life or health), or assist in an appropriate transfer. Movement of the individual to the main campus of the hospital is not considered a transfer under this section, since the individual is simply being moved from one department of a hospital to another department or facility of the same hospital.

    Finally, specific rules apply if the individual's condition warrants movement to a facility other than the main hospital campus, either because the main hospital campus does not have the specialized capability or facilities required by the individual, or because the individual's condition is deteriorating so quickly that taking the time required to move the individual to the main hospital campus could place the life or health of the individual in significant jeopardy. Under these circumstances, personnel at the off-campus department must, in accordance with protocols established in advance by the hospital, assist in arranging an appropriate transfer of the individual to a medical facility other than the main hospital. The hospital must have protocols to ensure that the movement is an appropriate transfer in accordance with paragraph (d)(2) of this section. The protocol must include procedures and agreements established in advance with other hospitals or medical facilities in the area of the off-campus department to facilitate these anticipated transfers. We note that the interpretive guidelines for enforcement of EMTALA requirements will be revised to conform to these new rules.

    Section 498.3 Scope and applicability

    Comment: A commenter asked for clarification as to whether appeal rights would be available in the event of revocation by us of provider-based status.

    Response: We have revised § 489.3(b)(2) to specify that a determination that a facility or organization no longer qualifies for provider-based status is an initial determination, thus providing an administrative appeals mechanism for these decisions.

    D. Requirements for Payment

    We proposed to revise § 410.27, Outpatient Hospital Services and Supplies Incident to a Physician Service: Conditions, to require that services furnished at a location other than an RHC or an FQHC that we designate as having provider-based status under § 413.65 must be under the direct supervision of a physician as defined in § 410.32(b)(3)(ii).

    Comment: Several commenters requested clarification of what we mean by “direct supervision.” One commenter asked that we further define the nature and extent of the supervision needed to comply with our proposal. One commenter asked whether the supervision requirement would be met if a physician is in the hospital or whether the physician must be in the department while the procedure is being performed. The same commenter asked whether the physician billing for the incident to services must be of the same specialty as the procedure being performed. A large trade association stated that we appear to be replacing our current policy in section 3112.4(A) of the Intermediary Manual, which states that we assume the physician supervision requirement to be met when incident to services are furnished on hospital premises, with a policy requiring direct physician supervision at all times, in all outpatient departments, regardless of whether or not they are located on the hospital campus. The commenter recommended that if we retain a direct supervision requirement, it should be limited to outpatient departments located off-site of the main provider. One commenter stated that facilities and organizations accorded provider-based status that are located on the main provider's campus should be subject to the same physician supervision requirements that apply to “incident to” services provided elsewhere on the campus.

    Response: We regret that our proposal to define “direct supervision” by referring to the definition of “direct supervision of a physician” given at § 410.32(b)(3)(ii) may have been confusing to some commenters. Section 410.32(b)(3)(ii) defines “direct supervision” within (a physician) office Start Printed Page 18525setting as meaning that the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. The definition at § 410.32(b)(3)(ii) goes on to state that “direct supervision” does not mean that the physician must be present in the room when the procedure is performed.

    Our intention in the proposed rule was to define “direct supervision” of hospital outpatient services incident to physician services when they are furnished at a department of a hospital to mean that a physician must be present on the premises of the entity accorded status as a department of the hospital and, therefore, immediately available to furnish assistance and direction for as long as patients are being treated at the site. By “direct supervision” we do not mean that the physician must physically be in the room where a procedure or service is furnished. Nor does the supervising physician necessarily have to be of the same specialty as the procedure or service that is being performed. We emphasize that our proposed amendment of § 410.27 to require direct supervision of hospital services furnished incident to a physician service to outpatients applies to services furnished at an entity that is located off the campus of a hospital that we designate as having provider-based status as a department of a hospital in accordance with the provisions of § 413.65. Our proposed amendment of § 410.27 to require direct supervision of hospital services furnished incident to a physician service to outpatients does not apply to services furnished in a department of a hospital that is located on the campus of that hospital. For hospital services furnished incident to a physician service to outpatients in a department of a hospital that is located on the campus of the hospital, we assume the direct supervision requirement to be met as we explain in section 3112.4(A) of the Intermediary Manual. The requirement at § 410.27 does not affect the definition of physician supervision in section 3112.4(A) of the Intermediary Manual. In response to these comments, we have revised our definition of “direct supervision by a physician” in the final regulation.

    Comment: A major trade association asserted that requiring a physician to be on-site at a provider-based entity throughout the performance of all “incident to” services would be burdensome and costly for hospitals where there are a limited number of physicians available to provide coverage, particularly in rural settings. Another commenter believes that entities with provider-based status should not be subject to physician supervision requirements that are more stringent than those applicable to free-standing facilities. A third commenter believes that this requirement is unnecessary because the requirements for integration with the hospital and other requirements for provider-based status include adequate checks and balances to ensure quality care. The commenter recommended that this proposal be omitted from the final rule with the potential for a separate, better defined, proposal at a later date.

    Response: We disagree with commenters who believe the proposed supervision requirement is not necessary or that it would be burdensome to the hospital. First, the supervision requirement is separate from and independent of the provider-based requirements, and hospitals and physicians already have to meet a direct supervision of “incident to” services requirement that is unrelated to provider-based issues. That is, we require that hospital services and supplies furnished to outpatients that are incident to physician services be furnished on a physician's order by hospital personnel and under a physician's supervision (Intermediary Manual, section 3112.4(A)). We assume the physician supervision requirement is met on hospital premises because staff physicians would always be nearby within the hospital. The effect of the regulations in this final rule is to extend this assumption to a department of a provider that is located on the campus of a hospital. However, the regulation does not extend the assumption of supervision to a department of a hospital that is located off the campus of the hospital. We would not extend this assumption to a provider-based entity, regardless of its location, because the “incident to” requirement in § 410.27(a)(1)(iii) applies only to hospitals. Also, as we state above, satisfying the requirements to be designated provider-based is unrelated to our requirement that hospital services furnished incident to a physician service to outpatients at an entity that has provider-based status be under the direct supervision of a physician. Finally, this supervision requirement is entirely consistent with the direct supervision requirements currently set forth in the Medicare Carriers Manual, Part 3, section 2050.1(B).

    Comment: One commenter suggested that partial hospitalization services furnished by a hospital to its outpatients be exempt from the outpatient department “incident to” requirements, or that other requirements be drafted that would, in the commenter's opinion, be more appropriate to the nature of this care.

    Response: Section 1861(s)(2)(B) restricts coverage of partial hospitalization services furnished by a hospital to its outpatients to services that meet “incident to” requirements. We do not have the discretion to ignore this statutory restriction.

    Comment: One commenter asked that we provide an exception to the direct supervision requirement in the case of physical therapy services. The commenter questioned why therapists who furnish the same services in a provider-based entity that they would furnish in an independent practice should be subject to direct physician supervision in one setting and not the other.

    Response: The provision on coverage for outpatient physical therapy and occupational therapy services does not require that they be “incident to” physician services (see section 1861(s)(2)(D) of the Act). Therefore, there is no need to exempt them from the supervision requirement for outpatient hospital services incident to a physician service that is furnished at a provider-based entity. We therefore made no change in the final regulation based on this comment.

    Comment: One commenter suggested that we modify our proposed regulation to waive the direct supervision requirement in entities with provider-based status for certain procedures for which we already waive the direct supervision requirement when the procedures are performed on homebound patients, as set forth in section 2051 of the Medicare Carriers Manual. The commenter believes that general supervision is sufficient for these waived services, for example, the physician need not be present, but the services must be performed under a physician's overall supervision and control, and ordered by a physician.

    Response: Under section 2050.2 of the Medicare Carriers Manual, subject to certain requirements, we waive the direct supervision requirement when the following services are furnished to homebound patients: injections; venipuncture; EKGs; therapeutic exercises; insertion and sterile irrigation of a catheter; changing of catheters and collection of catheterized specimen for urinalysis and culture; dressing changes, for example, the most common chronic conditions that may need dressing changes are decubitus care and gangrene; replacement and/or insertion of nasogastric tubes; removal of fecal Start Printed Page 18526impaction, including enemas; sputum collection for gram stain and culture, and possible acid-fast and/or fungal stain and culture; paraffin bath therapy for hands and/or feet in rheumatoid arthritis or osteoarthritis; and, teaching and training the patient for the care of colostomy and ileostomy, the care of permanent tracheostomy, testing urine and care of the feet (diabetic patients only), and blood pressure monitoring. While we believe the commenter's suggestion has merit, we do not believe it would be appropriate to adopt it before we have had time to analyze the issue further. Therefore, we did not revise the final rule based on this comment.

    In our proposed rule, we proposed to require that the same supervision levels established for diagnostic x-ray and other diagnostic tests in accordance with § 410.32(b)(3) be required when these tests are furnished at an entity that has been accorded provider-based status by us.

    Comment: A large industry federation generally favored our requiring that diagnostic tests be furnished at provider-based entities under levels of physician supervision that we specify, consistent with the definitions of general, direct, and personal supervision established at § 410.32(b)(3). The commenter suggested that we modify the definition of general supervision to make it clear that the training of nonphysician personnel and the maintenance of necessary equipment and supplies are the responsibility of the hospital, not the physicians.

    Response: We agree and we will modify our regulation accordingly.

    Comment: Numerous commenters, including radiology and imaging specialty groups, neurologists, vascular technologists, and sonographers, questioned the level of supervision required for various specific diagnostic tests and services.

    Response: Our model for this proposed requirement was the requirement for physician supervision for diagnostic tests payable under the Medicare physician fee schedule that was issued in the October 31, 1997 physician fee schedule final rule (for CY 1998) (62 FR 59048). There have been issues raised about the appropriate level of supervision for some specific diagnostic services, similar to the comments we received about our proposed regulation. We have not yet resolved these issues, and this final rule is not the place to convey decisions about appropriate supervision levels for specific diagnostic tests and services by individual HCPCS code. In January 1998, we sent a memorandum to all Associate Regional Administrators advising them to instruct carriers to follow their existing policies on physician supervision of diagnostic tests until we provide further instruction. We intend to instruct hospitals and intermediaries to use the October 31, 1997 physician supervision requirements as a guide, pending issuance of updated requirements. In the meantime, fiscal intermediaries, in consultation with their medical directors, will define appropriate supervision levels for services not listed in the October 31, 1997 final rule when those services are furnished at an entity with provider-based status in order to determine whether claims for these services are reasonable and necessary.

    V. Summary of and Response to MedPAC Recommendations

    The following are additional recommendations contained in the report on Medicare payment policy that the Medicare Payment Advisory Commission submitted to the Congress in March 1999. (MedPAC, Report to the Congress: Medicare Payment Policy, March 1999.) We respond to recommendations that are specifically related to a particular component of the hospital outpatient PPS in the appropriate section of this preamble.

    MedPAC Recommendation: MedPAC recommends that the Secretary evaluate payment amounts under the hospital outpatient PPS and the ambulatory surgical center (ASC) PPS along with the practice expense payments under the Medicare physician fee schedule for services furnished in physicians' offices to ensure that the differing payments made under the three payment systems do not create unwarranted financial incentives regarding site of care.

    Response: We agree that the three payment systems should avoid creating unnecessary financial incentives to deliver care in particular settings. We will consider this matter further and evaluate differences in payments.

    MedPAC Recommendation: MedPAC recommends that the Secretary study means of adjusting base prospective payment rates across ambulatory settings for patient characteristics such as age, frailty, comorbidities and coexisting conditions, and other measurable traits. Under this approach, payment would be less dependent on the type of facility and more dependent on the relative costliness of furnishing specific services to individual patients. MedPAC notes that no viable patient-level adjuster currently exists that could be used in this fashion.

    As an interim measure, MedPAC recommends, with reservations, that HCFA evaluate facility-level adjustments in order to preserve access to care for particularly vulnerable segments of the Medicare population.

    Response: The underlying premise in this recommendation, as MedPAC states, is that HCFA should move toward development of a more unified and rational payment system for ambulatory care. Many powerful arguments favor such a system, but the challenges of creating and implementing it are substantial. We will give further consideration to the recommendation to study possible adjustments that could be used in various settings.

    We agree that we should evaluate the need for facility-level adjustments. We believe the best course is to evaluate the need for these adjustments during the next several years as we gain actual experience with the operation of the hospital outpatient PPS and are able to observe the effects on particular provider groups. In consideration of the transitional protections provided by the BBRA 1999, we have not adopted facility-level adjustments, other than an adjustment for local labor costs, at this time.

    MedPAC Recommendation: MedPAC recommends that the Secretary seek legislation to develop and implement a single update mechanism that would link conversion factor updates to volume growth across all ambulatory care settings. These settings include hospital outpatient departments, physicians' offices, and ASCs, as well as other specific settings mentioned.

    Response: We believe that this proposal requires further study to determine its feasibility and possible impact. Therefore, we are not prepared to seek legislation at this time.

    MedPAC Recommendation: MedPAC recommends that we not use patient diagnosis to calculate relative weights or make payments for medical visits, “given the current state of the available data and the lack of definitive rules for reporting patients' diagnoses under the proposed system.”

    Response: As discussed in section III.C.3, we have dropped diagnosis from our characterization of medical visit APCs. We hope to develop procedure codes for medical visits that are more descriptive of hospital outpatient resource use, rather than physician services. Once we revise procedure coding to better reflect hospital services, we will assess whether accurate diagnosis coding further improves recognition of resources.

    MedPAC Recommendation: MedPAC recommends that the Secretary closely Start Printed Page 18527monitor the use of hospital outpatient services to ensure that beneficiary access to care is not compromised.

    Response: We plan to evaluate the operation of the new PPS to address a variety of issues, including beneficiary access to care. We note that the provisions of the BBRA 1999 should mitigate substantially any payment reductions and hence the possibility of reduced access.

    MedPAC Recommendation: MedPAC recommends that the Secretary consider making payment adjustments in addition to the proposed adjustment for local area wages under the new system. These adjustments should be tied to patient characteristics. The facility-level adjustments that are made until the time that a patient-level adjuster is available should reflect the population of Medicare patients treated by facilities identified to receive the adjustments.

    MedPAC points out that HCFA, in setting Medicare payment rates for hospital inpatient services, adjusts payments based on the costs or provider characteristics of hospitals (for example, sole community hospitals). Rather than continuing this practice in the outpatient setting, MedPAC recommends that HCFA move toward making adjustments based on patient characteristics and the relative costliness of resources required in furnishing care to differing patients. Any differences in the payment of the same ambulatory care service should be based on patient characteristics, rather than on the setting. MedPAC recommends that HCFA evaluate any relationships between immutable patient characteristics and the cost of furnishing care.

    Response: Other than those adjustments specified in sections 201 and 202 of the BBRA 1999, we have made no additional adjustments in this final rule. We will consider the possibility of adjustments in the future once we have actual experience with operation of the hospital outpatient PPS and can examine its effects. The extent to which adjustments at the level of patient characteristics will be feasible is unclear and would require further study.

    VI. Provisions of the Final Rule

    The provisions of this final rule reflect the provisions of the September 8, 1998 proposed rule, except as noted elsewhere in this preamble. Following is a synopsis of the major changes we have made, either in response to comments or in order to implement provisions of the BBRA 1999 that apply to the hospital outpatient prospective payment system.

    For our proposal to adjust the CY 2002 update of the conversion factor by the percentage that actual CY 2000 payments exceed the estimated CY 2000 expenditure target, we are delaying implementation of the volume control mechanism for 2 years.

    For our proposal to package costs that are directly related and integral to performing a procedure or furnishing a service on an outpatient basis, we are making the following changes:

    • We are creating separate APC groups to pay for blood, blood products, and anti-hemophilic factors, for splints and casts, and for certain very costly drugs that are not included in the transitional pass-through payment provision.
    • We are paying separately, at cost, for the acquisition of corneal tissue.
    • As required by section 201(e) of the BBRA 1999, we are not paying for certain implantable items under the DMEPOS fee schedule, but are including them as covered outpatient services. We are packaging the costs of these items into the APC payment rate for the procedures or services with which they are associated. These include implantable items used in connection with diagnostic tests, implantable DME, and implantable prosthetic devices.

    For our proposal to base payment for medical visits to clinics and emergency departments on diagnosis codes as well as HCPCS codes, we are not using diagnosis codes at this time.

    For our proposal to classify a new technology procedure or service within the APC group that it most closely resembles in terms of clinical characteristics and resource utilization, pending collection of additional pricing data, we are creating separate APC groups to which we can temporarily classify new technology services while we gather additional data and gain pricing experience. We are also creating a process under which interested parties may submit requests for consideration of services that may be eligible for payment as new technology.

    For our proposal to pay for drugs, pharmaceuticals, and biologicals (except for cancer therapy drugs and certain infrequently used but very expensive drugs) as part of the APC payment for the service or procedure with which they are used, we are establishing transitional pass-through payments, as directed by section 201(b) of the BBRA 1999. Under this provision, an additional payment will be made for current orphan drugs, current cancer therapy drugs, biologicals, and brachytherapy, and current radiopharmaceutical drugs and biological products.

    For our proposal to classify a new or innovative medical device, drug or biological (for which we were not making payment as of December 31, 1996) within the APC group that it most closely resembles in terms of clinical characteristics and resource utilization, pending collection of additional pricing data, we are establishing transitional pass-through payments. Under this provision, as directed by section 201(b) of the BBRA 1999, an additional payment will be made for new or innovative devices, drugs, and biologicals whose cost is not insignificant in relation to the APC payment for the group of services with which they are used.

    For our proposal not to establish an outlier adjustment, as directed by section 201(a) of the BBRA 1999, we will make an outlier payment when calculated bill costs exceed 2.5 times the PPS payment for a service.

    For our proposal to determine comparability of resources and clinical characteristics among the codes within an APC group based on our claims data and the analyses and judgment of our medical advisors, supported by comments from medical specialty societies and trade associations, as provided in section 201(g) of the BBRA 1999, we are limiting the variation so that the highest median cost of an item or service in an APC group is no more than two times the lowest median cost of an item or service within that group. We will also consult with an expert outside advisory panel regarding the clinical integrity of the APC groups and weights as part of our update of the PPS.

    For our proposal to periodically review and update payment weights, APC groups, and other elements of the hospital outpatient PPS, as required by section 201(h) of the BBRA 1999, we will annually review the groups, relative payment weights, and the wage and other adjustments that are a part of the PPS.

    For our proposal to implement the hospital outpatient PPS fully and in its entirety for all hospitals beginning as early as possible in CY 2000, with no phase-in period, as required by section 202(a) of the BBRA 1999, we are establishing transitional corridors for services furnished before January 1, 2004 to limit losses facilities might otherwise face.

    For our proposal not to make any adjustments for any specific classes of hospitals, we are holding small rural hospitals harmless through CY 2003 in accordance with the requirements set by section 202(a)(3) of the BBRA 1999, Start Printed Page 18528which added section 1833(t)(7)(D)(i) to the Act. Also, we are holding cancer centers permanently harmless in accordance with the requirements set by section 202(a)(3) of the BBRA 1999.

    For our proposal on beneficiary coinsurance payment amounts, we are limiting the coinsurance amount for a procedure to be no more than the hospital inpatient deductible, as specified in section 204(a)(3) of the BBRA 1999.

    The following is a synopsis of the principal changes that we are making in the provider-based requirements:

    For our proposal to require main providers and provider-based entities to share a common license, we will require common licensure only where State law permits it. Where State law prohibits it or is silent, we will not apply the licensure requirement. We will also exempt IHS facilities and facilities located on Tribal lands from this requirement.

    For our proposal requiring a main provider and a provider-based entity to serve a common service area indicated largely by overlapping patient populations, we have redefined “common service area” to mean a 75 percent threshold of patients who reside in a zip code area that is common to the main provider and the provider-based entity.

    For our proposal to require provider-based entities to be in the same State as the main provider, we will allow providers in one State to have provider-based facilities in an adjacent State, if doing so is consistent both with the law of the affected States and with other criteria, including those related to a common service area.

    For our proposal to require that a provider-based outpatient department bill all payers as an outpatient department, we have rescinded this requirement.

    For our proposal to require FQHCs that have been billing Medicare as hospital outpatient departments to comply with the provider-based requirements, we are grandfathering both FQHCs and FQHC “look-alikes” (facilities that are organized as FQHCs but do not receive grants) so that these facilities will be considered departments of providers without having to meet § 413.65 requirements.

    For our proposal to apply the provider-based requirements to Indian Health Service (including tribally operated) entities, we are creating a permanent exception for those entities that were billing as departments of IHS or Tribal hospitals on or before October 10, 2000.

    For our proposal to consider provider-based entities to be part of the hospital for Emergency Medical Treatment and Active Labor Act (EMTALA) (“anti-dumping” purposes), we are maintaining the principle that off-site hospital facilities are subject to EMTALA. We have clarified the obligations of hospitals with respect to these locations to ensure they are consistent with staffing patterns and resources.

    For our proposal to apply provider-based criteria to inpatient facilities such as multi-campus hospitals created by mergers and satellites of PPS-excluded hospitals that are created by hospitals leasing space in other hospitals, we have clarified the applicability of provider-based criteria to remote locations of hospitals and hospital satellite facilities.

    VII. Collection of Information Requirements

    Under the Paperwork Reduction Act (PRA) of 1995, we are required to provide 30-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 PRA requires that we solicit comment on the following issues:

    • 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.

    We are soliciting public comment on each of these issues for the provisions summarized below that contain information collection requirements:

    Section 413.24 Adequate cost data and cost finding

    Section 413.24(d)(6)(ii) states that a provider must develop detailed work papers showing the exact cost of the services (including overhead) provided to or by the free-standing entity and show those carved out costs as nonreimbursable cost centers in the provider's trial balance. While these information collection requirements are subject to the PRA, the burden associated with these requirements is captured under §§ 413.65(c)(1) and (c)(2) below.

    Section 413.65 Requirements for a determination that a facility or an organization is a department of a provider or a provider-based entity

    Section 413.65(b)(2) states that a provider or a facility or organization must contact HCFA and the facility or organization must be determined by HCFA to be provider-based before the main provider begins billing for services of the facility or organization as if they were furnished by a department of the provider-based entity, or before it includes costs of those services on its cost report. While these information collection requirements are subject to the PRA, the burden associated with these requirements is captured under §§ 413.65(c)(1) and (c)(2) below.

    Sections 413.65(c)(1) and (c)(2) state that a main provider that acquires a facility or organization for which it wishes to claim provider-based status, including any physician offices that a hospital wishes to operate as a hospital outpatient department or clinic, must report its acquisition of the facility or organization to HCFA and must furnish all information needed for a determination as to whether the facility or organization meets the requirements in paragraph (d) of this section for provider-based status, if the facility or organization is located off the campus of the provider or would increase the provider's total costs by at least 5 percent. Furthermore, a main provider that has had one or more entities considered provider-based also must report to HCFA any material change in the relationship between it and any provider-based facility or organization, such as a change in ownership of the facility or organization or entry into a new or different management contract that could affect the provider-based status of the facility or organization.

    The burden associated with this requirement is the time for the main provider to report its acquisition to HCFA, furnish all information needed for a determination, report to HCFA any material change in the relationship between it and any provider-based facility or organization, such as a change in ownership of the facility or organization or entry into a new or different management contract that could affect the provider-based status of the facility or organization. It is estimated that 105 main providers will take 10 hours for a total of 1,050 hours.

    Section 413.65(d)(4)(v) states that medical records for patients treated in a facility or organization must be integrated and maintained into a unified retrieval system (or cross reference) of the main provider. The burden Start Printed Page 18529associated with this requirement is the time required for the main provider to maintain medical records in a unified retrieval system. While this requirement is subject to the PRA, we believe this requirement is a usual and customary business activity and the burden associated with this requirement is exempt from the PRA, as stipulated under 5 CFR 1320.3(b)(2) and (b)(3).

    Section 413.65(d)(7)(i) requires that for a facility or organization and the main provider that is not located on the same campus, the facility or organization must demonstrate a high level of integration with the main provider by showing that it meets all of the other provider-based criteria, and demonstrates that it serves the same patient population as the main provider, by submitting records showing that, during the 12-month period immediately preceding the first day of the month in which the application for provider-based status is filed with HCFA, and for each subsequent 12-month period meet the requirements of paragraphs (d)(7)(i)(A), (B), or (C) of this section. While the information collection requirements listed below are subject to the PRA, the burden associated with these requirements is captured under §§ 413.65(c)(1) and (c)(2).

    Section 413.65(g)(7) states that when a Medicare beneficiary is treated in a hospital outpatient department or hospital-based entity, the hospital has a duty to notify the beneficiary, prior to the delivery of services, of the beneficiary's potential financial liability (that is, a coinsurance liability for a facility visit as well as for the physician service).

    The burden associated with this requirement is the time for the provider to disseminate information to each beneficiary of the beneficiary's potential financial liability (that is, a coinsurance liability for a facility visit as well as for the physician service). It is estimated that 750 providers will make on average 667 disclosures on an annual basis, at 3 minutes per disclosure, for a total annual burden of 25,013 hours.

    Section 413.65(j)(5) requires that upon notice of denial of provider-based status sent to the provider by HCFA, the notice will ask the provider to notify HCFA in writing, within 30 days of the date the notice is issued, of whether the facility or organization (or, where applicable, the practitioners who staff the facility or organization) will be seeking to enroll and meet other requirements to bill for services in a free-standing facility. This requirement is exempt from the PRA as stipulated under 5 CFR 1320.4(a)(2).

    Further, if the provider indicates that the facility or organization, or its practitioners, will be seeking to meet enrollment and other requirements for billing for services in a free-standing facility, the facility or organization must submit a complete enrollment application and provide all other required information within 90 days after the date of notice; and the facility or organization, or its practitioners, furnish all other information needed by HCFA to process the enrollment application and verify that other billing requirements are met. The requirements and burden associated with the provider enrollment process are currently approved under OMB control number 0938-0685, with a current expiration date of September 30, 2001.

    Section 424.24 Requirements for Medical and Other Health Services Furnished by Providers Under Medicare Part B

    Section 424.24(e)(3)(i) requires that when a partial hospitalization service occurs the physician recertification must be signed by a physician who is treating the patient and has knowledge of the patient's response to treatment. While this signature requirement is subject to the PRA, the overall requirements associated with physician recertification, as currently referenced in HCFA regulation number HCFA-1006, published in the Federal Register on June 5, 1998, have not yet been approved by OMB under the PRA. Therefore, we continue to solicit comment on all of the requirements and associated burden referenced in § 424.24.

    Section 419.42 Hospital Election To Reduce Copayment

    Sections 419.42(b) and (c) state that a hospital must notify its fiscal intermediary of its election to reduce copayments no later than June 1, 2000 prior to the date the PPS is implemented or for subsequent calendar years, beginning with elections for calendar year 2001, no later than December 1 of the preceding calendar year. The hospital's election must be properly documented. It must specifically identify the ambulatory payment classification to which it applies and the coinsurance amounts (within the limits identified within this regulation) that the hospital has elected for each group.

    The burden associated with these requirements is the time it takes a hospital to compile, review, and analyze data for both revenues and coinsurance; prepare and present the data to the hospital board; make a business decision as to whether the hospital would elect to reduce coinsurance; and then notify its fiscal intermediary of its election. A hospital would notify its fiscal intermediary of its election to reduce coinsurance only if there were other providers, in close proximity, that would attract a majority of the hospital's business if they did not reduce their coinsurance. Since hospitals do not want to lose money by absorbing coinsurance, we anticipate that this requirement will affect 750 hospitals and take them 10 hours each for a total of 7,500 hours.

    Section 419.42(e) states that the hospital may advertise and otherwise disseminate information concerning the reduced level(s) of coinsurance that it has elected. All advertisements and information furnished to Medicare beneficiaries must specify that the coinsurance reductions advertised apply only to the specified services of that hospital and that these coinsurance reductions are available only for hospitals that choose to reduce coinsurance for hospital outpatient services and are not applicable in any other ambulatory settings or physician offices.

    The burden associated with this requirement is the time for the hospital to disseminate information concerning its coinsurance election. It is estimated that 750 hospitals will each take 10 hours annually to disseminate this information via newsletters and information sessions at senior citizen centers for a total of 7,500 hours.

    We have submitted a copy of this final rule to OMB for its review of the information collection requirements. These requirements are not effective until they have been approved by OMB. A notice will be published in the Federal Register when approval is obtained.

    If you comment on any of these information collection and record keeping requirements, please mail copies directly to the following:

    Health Care Financing Administration, Office of Information Services, Information Technology Investment Management Group, Division of HCFA Enterprise Standards, Room C2-26-17, 7500 Security Boulevard, Baltimore, MD 21244-1850, Attn: John Burke HCFA-1005-FC/R-240,

      and

    Office of Information and Regulatory Affairs, Office of Management and Budget, Room 10235, New Executive Office Building, Washington, DC 20503, Attn.: Allison Herron Eydt, HCFA-1005-FC. Start Printed Page 18530

    VIII. Response to Comments

    Because of the large number of items of correspondence we normally receive on Federal Register documents published for comment, we are not able to acknowledge or respond to them individually. Comments on the provision of this final rule that implement provisions of the BBRA 1999 will be considered if we receive them by the date and time specified in the DATES section of this preamble. We will not consider comments concerning provisions that remain unchanged from the September 8, 1998 proposed rule or that were changed based on public comments.

    IX. Regulatory Impact Analysis

    A. Introduction

    Section 804(2) of title 5, United States Code (as added by section 251 of Pub. L. 104-121), specifies that a “major rule” is any rule that the Office of Management and Budget finds is likely to result in—

    • An annual effect on the economy of $100 million or more;
    • A major increase in costs or prices for consumers, individual industries, Federal, State, or local government agencies, or geographic regions; or
    • Significant adverse effects on competition, employment, investment productivity, innovation, or on the ability of United States based enterprises to compete with foreign-based enterprises in domestic and export markets.

    We estimate, based on a simulation model, that the effect on hospitals participating in the Medicare program associated with this final rule would be to increase Medicare payments by $600 million in calendar year 2000. This figure includes beneficiary copayments. We estimate that the additional expenditures to hospitals from the Part B Trust Fund associated with this final rule will be $490 million in fiscal year 2000. Therefore, this rule is a major rule as defined in Title 5, United States Code, section 804(2).

    We have examined the impacts of this final rule as required by Executive Order 12866, the Unfunded Mandates Reform Act of 1995, and the Regulatory Flexibility Act (RFA) (Public Law 96-354). Executive Order 12866 directs agencies to assess all costs and benefits of available regulatory alternatives and, when 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). Because the projected spending resulting from this final rule is expected to exceed $100 million, it is considered a major rule for purposes of the RFA.

    The Unfunded Mandates Reform Act of 1995 also requires (in section 202) that agencies prepare an assessment of anticipated costs and benefits for 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 $100 million. This final rule does not mandate any requirements for State, local, or tribal governments.

    We generally prepare a regulatory flexibility analysis that is consistent with the RFA (5 U.S.C. 601 through 612), unless we certify that a final rule will not have a significant economic impact on a substantial number of small entities. For purposes of the RFA, we consider all hospitals to be small entities.

    Also, section 1102(b) of the Social Security Act requires us to prepare a regulatory impact analysis for any final rule that may have a significant impact on the operations of a substantial number of small rural hospitals. Such an analysis must conform to the provisions of section 604 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 with fewer than 100 beds that is located outside of a Metropolitan Statistical Area (MSA) 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 proposed prospective payment system, we classify these hospitals as urban hospitals.

    B. Estimated Impact on the Medicare Program

    Our Office of the Actuary projects that the additional benefit expenditures from the Part B Trust Fund resulting from implementation of the hospital outpatient PPS for hospital outpatient services furnished on or after July 1, 2000, and the hospital outpatient provisions enacted by the BBRA 1999, are as follows:

    Fiscal yearImpact (In millions of dollars)
    2000490
    20013,030
    20023,520
    20034,230
    20044,670

    C. Objectives

    The primary objective of the hospital outpatient prospective payment system is to simplify the payment system and encourage hospital efficiency in providing outpatient services, while at the same time ensuring that payments are sufficient to compensate hospitals adequately for their legitimate costs. Another important goal of the new system is to reduce beneficiaries' share of outpatient payment to hospitals by freezing coinsurance amounts at an absolute level until they equal 20 percent of the total payment amounts.

    We believe that implementation of the final PPS will ultimately further each of these goals while maintaining the financial viability of the hospital industry and ensuring access to high quality health care for Medicare beneficiaries. We expect that the provisions of this final rule with comment period will ensure that the outcomes of the PPS are reasonable and equitable while avoiding or minimizing unintended adverse consequences.

    D. Limitations of Our Analysis

    The following quantitative analysis presents the projected effects of our policy changes resulting from comments, as well as statutory changes enacted by the BBRA 1999, on various hospital groups. We use the best data available. In addition, we do not make adjustments for future changes in such variables as volume and intensity. For this final rule with comment period, we are soliciting comments and information about the anticipated effects of the changes on hospitals resulting from implementation of the hospital outpatient provisions of the BBRA 1999, and our methodology for estimating them.

    E. Hospitals Included In and Excluded From the Prospective Payment System

    The outpatient prospective payment system encompasses nearly all hospitals that participate in the Medicare program. However, Maryland hospitals that are paid under a cost containment waiver in accordance with section 1814(b)(3) of the Act are excluded from the PPS. Critical access hospitals (CAHs) are also excluded and are paid at cost under section 1834(g) of the Act. Start Printed Page 18531

    F. Quantitative Analysis of the Impact of Policy Changes on Payment Under the Hospital Outpatient PPS: Basis and Methodology of Estimates

    We have analyzed the impact on hospital payment under the outpatient PPS. Our analysis compares the payment impact of PPS compared to current law. The definition and calculation of current law used in the impact analysis is the same used in estimating the conversion factor. That is, current law reflects pre-PPS payment methodologies in effect on January 1, 2000, and prior to July 1, 2000, which include the elimination of the formula-driven overpayment and application of the capital and operating cost reductions. A detailed explanation of the current law calculation can be found in section III.E.2.a.

    The data used in developing the quantitative analyses presented below are taken from the CY 1996 cost and charge data and the most current provider-specific file that is used for payment purposes. Our analysis has several qualifications. First, we draw upon various sources for the data used to categorize hospitals in Table 2, below. In some cases, there is a degree of variation in the data from the different sources. We have attempted to construct these variables with the best available source overall. For individual hospitals, however, some miscategorizations are possible.

    Using CY 1996 cost and charge data, we simulated payments using the pre-PPS and PPS payment methodologies. Although we used only single-procedure/visit bills to determine APC relative payment weights, we used both single and multiple-procedure bills in the conversion factor and service mix calculations, regressions, and impact analyses. Both pre-PPS and PPS payment estimates include operating and capital costs, adjusted to the calendar year 1996 cost reporting period. We excluded Kaiser, New York Health and Hospital Corporation, and all-inclusive providers because reported charges on their cost reports are not actual charges. Cost-to-charge ratios for these hospitals are not comparable to all other hospitals. The excluded Maryland hospitals were not included in the calculation of the conversion factor and the simulations; however, we did include the 10 cancer hospitals that will be paid under the PPS.

    We also trimmed outlier hospitals from the impact analysis because inclusion of hospitals with extremely high and low unit costs would not allow us to assess the impacts among the various classes of hospitals accurately. First, we identified all of the outlier hospitals by using an edit of 3 standard deviations from the mean of the logged unit costs. Trimming the data in this manner ensures that only the hospitals with aberrantly high and low costs are eliminated from the impact analysis. In doing this, we removed 97 hospitals of which 41 hospitals had extremely low unit costs and 56 hospitals had extremely high unit costs. We conducted a thorough analysis of these hospitals to ensure that we did not remove any particular type of hospital (for example, teaching hospitals) that would further harm the integrity of the data. We speculate that many of these hospitals are not coding accurately, and we will continue to perform further analysis in this area following implementation of the PPS.

    After we removed the 58 excluded Maryland hospitals, the all-inclusive rate hospitals, the statistical outlier hospitals, and hospitals for which we could not identify payment variables, we used the remaining 5,362 hospitals as the basis for our analysis. Table 2, Annual Impact of Outpatient Prospective Payment System in CY2000-CY2001, below, demonstrates the results of our analysis. The table categorizes hospitals by various geographic and special payment consideration groups to illustrate the varying impacts on different types of hospitals. The first column represents the number of hospitals in each category. The second column shows the hospitals' Medicare outpatient payments under the current (non-PPS) payment system as a percentage of the hospitals' total Medicare payment. The third and fourth columns show the impact of the PPS excluding the transitional corridor payments enacted by the BBRA 1999. Column three shows the percentage change in total Medicare outpatient payments comparing pre-PPS payments with payments under the PPS. The fourth column shows the change in total (outpatient and inpatient) Medicare payments resulting from implementation of the PPS for outpatient services. The fifth and sixth columns show the impact of the PPS including the transitional corridor payments enacted by the BBRA 1999. Column five shows the percentage change in Medicare outpatient payments comparing pre-PPS payments with payments under the PPS. Column six shows the change in total (outpatient and inpatient) Medicare payments resulting from implementation of the PPS for outpatient services.

    The first row of Table 2 shows the overall impact on the 5,362 hospitals included in the analysis. We included as much data as possible to the extent that we were able to capture all the provider information necessary to determine payment. Our estimates include the same set of services for both pre-PPS and PPS payments so that we could determine the impact of the PPS as accurately as possible. Because payment under the hospital outpatient PPS can only be determined if bills are accurately coded, the data upon which the impacts were developed do not reflect all CY 1996 hospital outpatient services, but only those that were coded using valid HCPCS codes.

    The second row of Table 2 shows the overall impact of the PPS on the 4,828 hospitals that remain when we exclude psychiatric, long-term care, children's, and rehabilitation hospitals.

    The next four rows of the table contain hospitals categorized according to their geographic location (all urban, which is subdivided into large urban and other urban, and rural). We include 2,665 hospitals located in urban areas (MSAs or NECMAs) in our analysis. Among these, 1,505 hospitals are located in large urban areas (populations over 1 million), and 1,160 hospitals are located in other urban areas (populations of 1 million or less). In addition, we include 2,160 hospitals located in rural areas in our analysis. The next two groupings are by bed-size categories, shown separately for urban and rural hospitals. The next category groups urban and rural hospitals by volume of outpatient services. We then show the distribution of urban and rural hospitals by regional census divisions.

    The next three categories group hospitals according to whether or not they have residency programs (teaching hospitals that receive an indirect medical education (IME) adjustment), receive disproportionate share hospital (DSH) payments, or some combination of these two adjustments. In our analysis we show the impact of the PPS on the 3,738 nonteaching hospitals, the 821 teaching hospitals with fewer than 100 residents, and the 269 teaching hospitals with 100 or more residents.

    In the DSH categories, hospitals are grouped according to their DSH payment status. The next category groups hospitals considered urban after geographic reclassification, in terms of whether they receive the IME adjustment, the DSH adjustment, both, or neither. The next five rows examine the impacts of the changes on rural hospitals by special payment groups (rural referral centers (RRCs), sole community hospitals/essential access community hospitals (SCHs/EACHs), Medicare dependent hospitals (MDHs), and hospitals that are both SCHs and Start Printed Page 18532RRCs), as well as rural hospitals not receiving a special payment designation. The RRCs (164), SCH/EACHs (634), MDHs (358), and SCH and RRCs (56) shown here were not reclassified for purposes of the standardized amount.

    The next grouping is based on type of ownership. These data are taken primarily from the FY 1996 Medicare cost report files, if available; otherwise, earlier cost report data are used.

    The final two groups are specialty hospitals. The first set includes eye and ear hospitals, trauma hospitals (hospitals having a level one trauma center), and cancer hospitals, which are TEFRA hospitals. The last group lists all other TEFRA hospitals, specifically, rehabilitation, psychiatric, long-term care, and children's hospitals.

    G. Estimated Impact of the New APC System (Includes Table 2, Annual Impact of Hospital Outpatient Prospective Payment System in CY2000-CY2001)

    Column 3 compares our estimate of PPS payments without application of the BBRA 1999 transitional corridors, but incorporating policy changes and all other BBRA 1999 provisions contained in this final rule, to our estimate of payments under the current system. The percent differences shown in columns 3 and 4 between current and PPS payment (without the BBRA 1999 transitional corridors) reflect the impact of the BBRA 1999 outlier and pass-through payment adjustments and nonbudget-neutral hold-harmless provisions for cancer hospitals, as well as distributional differences attributable to variation in cost and charge structures among hospitals.

    The percent changes in columns 5 and 6 are the result of comparing our estimate of PPS payments with application of the BBRA 1999 transitional corridors, as well as the statutory and policy changes contained in this final rule, to our estimate of payments under the pre-PPS system. Percent differences between the pre-PPS and the PPS payment (with the BBRA 1999 transition) reflect the combined impact of the transitional corridor adjustments, outlier and pass-through payment adjustments and the hold-harmless provision for cancer hospitals, in addition to distributional differences attributable to variation in cost and charge structures among hospitals.

    Basing the conversion factor on pre-PPS program and pre-PPS beneficiary payments and on budget-neutral outlier and pass-through adjustments results in no net change in payments to hospitals overall relative to pre-PPS payments. (As noted above, in section III.E.2 of this preamble, pursuant to section 201(l) of the BBRA 1999, we set the conversion factor by estimating pre-PPS rather than PPS copayments.) However, the BBRA hold-harmless provision for cancer hospitals results in a 0.2 percent increase in payments to hospitals overall because this provision is not budget neutral. Including the BBRA 1999 transitional corridor adjustments further increases payment to hospitals overall. We estimate that in calendar year 2000, payment will increase by an annual rate of 4.6 percent under the PPS compared to the pre-PPS payments.

    Without the BBRA 1999 transitional corridor payments, the impact on short-term acute care hospitals is negative for a substantial number of hospital classifications. That is, for certain groups of hospitals, payments under the PPS without the transitional corridor payments would be several percentage points below pre-PPS payments. For nearly all of these hospital groups, the BBRA 1999 transitional corridor payments mitigate this negative impact. In addition, hospital groups that experience net gains without the BBRA 1999 transitional corridor payments experience even greater gains with them. The reason is that even though the average impact for hospitals in these groups is positive, some individual hospitals experience net losses in payments and, thus, benefit from the transitional corridor payments. The hospital groups that gain without the transitional corridor payments receive even greater increases in payments with the transitional corridor payments. The following discussion highlights some of the changes in payments among hospital classifications.

    Comparing the pre-PPS and PPS payment estimates, payment to low-volume hospitals would decrease substantially without the BBRA 1999 transitional corridor payments (12.2 percent annually for rural and 7.7 percent annually for urban hospitals with fewer than 5,000 units of service). These hospitals experience a net gain with the BBRA 1999 transitional corridor payments (2.5 percent annually and 0.2 percent annually for low-volume rural and urban hospitals, respectively), although these payment increases are relatively small compared to the 4.6 percent annual increase for hospitals overall. We believe several factors contribute to this outcome, including undercoding, lack of economies of scale, and the reliance on the median instead of the geometric mean in the calculation of APC weights. The majority of these hospitals (about 75 percent) are rural. For these small hospitals, some of the higher standardized unit costs could be attributed to economies of scale. These low-volume rural hospitals also receive a greater percentage of their Medicare income (18.5 percent) from outpatient services than the national average (9.9 percent).

    Major teaching hospitals, whose payments would decrease annually by 3.7 percentage points without the BBRA 1999 transitional corridor payments, gain 2.6 percent annually with the BBRA 1999 transitional corridor payments relative to pre-PPS payments. Major teaching hospitals receive less of their total Medicare income (9.1 percent) from outpatient services than the national average. This results in a 0.2 percent annual gain in their total Medicare payments. Minor teaching and nonteaching hospitals would experience marginal gains in outpatient payment without the BBRA 1999 transitional corridor payments. Payment to both hospital groups increases by 5.0 percent annually relative to the pre-PPS payment system.

    Without the BBRA 1999 transitional corridor payments, hospitals with a high percentage of low-income patients (disproportionate share patient percentage greater than or equal to 0.35) would have a 2.5 percent annual decrease in payment relative to pre-PPS payments. But payments to these hospitals increase annually by 3.5 percent relative to pre-PPS payments with the BBRA 1999 transitional corridor payments. These hospitals have lower than average volume, and, like major teaching hospitals, receive a smaller than average percentage of their Medicare income from outpatient services. Thus, their total Medicare payments increase marginally, by 0.3 percent, with the BBRA 1999 transitional corridor payments.

    Without the BBRA 1999 adjustments, payment to rural hospitals would decrease 1.8 percent annually and payment to large urban hospitals would decrease 0.3 percent annually, while payment to other urban hospitals would increase 1.8 percent annually relative to pre-PPS payments. These hospitals all experience net gains in PPS payment with the BBRA 1999 transitional corridor payments, at an annual rate of 4.4 percent, 4.3 percent, and 5.1 percent, respectively. Even though rural hospitals receive a greater percentage of their Medicare income (14.7 percent) from outpatient services compared to the national average, their total Medicare payments increase by only a fraction, 0.6 percent.

    Negative impacts for urban hospitals in the Mid-Atlantic and the West North Central regions are also reversed under Start Printed Page 18533the BBRA 1999 transitional corridor payments, changing from −3.4 percent to 2.4 percent on an annual basis, and from −3.5 percent to 2.5 percent on an annual basis, respectively. Similarly, rural hospitals in nearly all census regions experience net increases in payment relative to pre-PPS payments with the BBRA 1999 transitional corridor payments.

    The impact on TEFRA hospitals is shown separately at the end of the table. The TEFRA hospitals were not included in determining the impact on any of the other categories discussed above (for example, geographic location, bed size, volume, etc.). These hospitals demonstrated a very low service mix, but an average unit cost that approximates the national average. We believe that undercoding or billing an all-inclusive rate could account for their low-volume, low-service mix, and average cost per unit. We expect that once these hospitals begin to code services accurately under the PPS, payments will more closely approximate pre-PPS payments.

    If the effect of the BBRA 1999 transition payments were removed, differences between pre-PPS payments and PPS payments among hospitals would still exist. These distributional differences are the result of many factors. First, cost variations among hospitals result in differences between pre-PPS payments and PPS payments, and charge structure variations result in differences between pre-PPS payments and PPS beneficiary copayment amounts. Hospitals whose costs are low relative to payment would gain under the PPS even without the BBRA 1999 transitional corridor payments. Because the transitional corridor payments are not budget neutral, these hospitals continue to gain relative to pre-PPS payments.

    Redistributions may also occur as a result of current payment methods. Total Medicare outpatient payments are less than reported total costs because (in addition to the 5.8 and 10 percent reductions for operating and capital costs) the blended payment methods applicable to many surgical and diagnostic services often result in payments that are less than reported costs. Other services such as medical visits, chemotherapy services, and non-ASC approved surgeries are paid based on hospital costs. The new system redistributes the current total Medicare payments, based in part on cost-based payments and in part on blended payment amounts, across all services. Hospitals, in the aggregate, will receive proportionately less for services that are currently paid based on costs, and more for services that had been paid under blended payment methods.

    Table 2. Annual Impact Of Hospital Outpatient Prospective Payment System In CY2000-CY2001

    Number of hospitalsOutpatient percentExcluding BBRA transitional corridors 1Including BBRA transitional corridors
    Percent change in Medicare outpatient payments 3Percent change in total Medicare paymentsPercent change in Medicare outpatient payments 3Percent change in total Medicare payments
    (1)(2)(3)(4)(5)(6)
    ALL HOSPITALS5,3629.90.20.04.60.5
    NON-TEFRA HOSPITALS4,828100.10.04.60.5
    URBAN HOSPS 22,6659.30.60.14.60.4
    LARGE URBAN 2 (GT 1 MILL.)1,5059.1−0.30.04.30.4
    OTHER URBAN 2 (LE 1 MILL.)1,1609.71.80.25.10.5
    RURAL HOSPS2,16014.7−1.8−0.34.40.6
    BEDS (URBAN): 2
    0—99 BEDS67214.90.60.14.60.7
    100-199 BEDS92410.51.30.15.20.5
    200-299 BEDS5339.20.80.14.40.4
    300-499 BEDS3998.51.80.25.20.4
    500 + BEDS1378.4−2.9−0.22.80.2
    BEDS (RURAL):
    0—49 BEDS1,17019.5−8.5−1.73.30.6
    50-99 BEDS61515.5−2.7−0.44.40.7
    100-149 BEDS22313.3−0.20.03.80.5
    150-199 BEDS81132.50.35.50.7
    200 + BEDS7111.62.70.36.10.7
    VOLUME (URBAN):
    LT 5,00034912−7.7−0.90.20.0
    5,000-10,9995049.80.00.04.20.4
    11,000-20,9995969.10.10.04.40.4
    21,000-42,9997738.81.30.14.90.4
    GT 42,9994439.70.40.04.60.4
    VOLUME (RURAL):
    LT 5,0001,04918.5−12.2−2.32.50.5
    5,000-10,99959515.2−5.2−0.82.90.4
    11,000-20,99932213.80.10.04.70.6
    21,000-42,99917313.62.40.35.70.8
    GT 42,9992113.23.00.46.80.9
    REGION (URBAN): 3
    NEW ENGLAND14610.73.80.46.70.7
    MIDDLE ATLANTIC3938.4−3.4−0.32.40.2
    SOUTH ATLANTIC4018.60.30.04.20.4
    EAST NORTH CENT.46510.71.00.14.50.5
    Start Printed Page 18534
    EAST SOUTH CENT.1617.91.80.14.60.4
    WEST NORTH CENT.1839.50.90.14.90.5
    WEST SOUTH CENT.3359.7−2.7−0.32.50.2
    MOUNTAIN12310.23.10.36.10.6
    PACIFIC4239.45.60.58.60.8
    PUERTO RICO356.610.80.713.20.9
    REGION (RURAL):
    NEW ENGLAND5317.2−3.2−0.63.30.6
    MIDDLE ATLANTIC8013.67.11.010.11.4
    SOUTH ATLANTIC28511.8−1.8−0.23.60.4
    EAST NORTH CENT.28215.7−1.2−0.24.30.7
    EAST SOUTH CENT.26011.10.10.04.90.5
    WEST NORTH CENT.50819.8−5.2−1.03.00.6
    WEST SOUTH CENT.33714.2−5.7−0.83.00.4
    MOUNTAIN21316.9−3.4−0.64.70.8
    PACIFIC14015.90.70.16.31.0
    PUERTO RICO26.632.12.132.12.1
    TEACHING STATUS:
    NON-TEACHING3,73811.30.50.15.00.6
    MINOR8219.11.60.15.00.5
    MAJOR2699.1−3.7−0.32.60.2
    DSH PATIENT PERCENT:
    010110.9−5.8−0.60.70.1
    GT 0—0.101,13910.50.80.14.60.5
    0.10-0.16986112.00.25.60.6
    0.16-0.2388010.10.80.14.90.5
    0.23-0.358559.5−1.5−0.13.70.4
    GE 0.358679.2−2.5−0.23.50.3
    URBAN IME/DSH: 2
    IME & DSH9949−0.40.04.10.4
    IME/NO DSH179.2−3.6−0.31.10.1
    NO IME/DSH1,6119.91.90.25.40.5
    NO IME/NO DSH4314.7−8.2−1.2−0.30.0
    RURAL HOSP. TYPES:
    NO SPECIAL STATUS86415−2.2−0.34.40.7
    RRC16412.35.00.67.30.9
    SCH/EACH63416.5−7.7−1.32.20.4
    MDH35818.3−5.4−1.03.50.6
    SCH AND RRC5613.9−1.4−0.23.10.4
    TYPE OF OWNERSHIP:
    VOLUNTARY2,8169.90.60.14.70.5
    PROPRIETARY7528.3−0.10.04.70.4
    GOVERNMENT1,26012.2−2.3−0.33.60.4
    SPECIALTY HOSPITALS:
    EYE AND EAR1031.120.16.320.26.3
    TRAUMA1599.1−1.2−0.14.00.4
    CANCER10220.80.20.80.2
    TEFRA HOSPITALS (NOT INCLUDED ON OTHER LINES):
    REHAB1473.7−9.4−0.31.70.1
    PSYCH281921.31.927.92.5
    LTC653.7−15.3−0.6−1.7−0.1
    CHILDREN4116.5−11.9−2.0−3.2−0.5
    Notes:
    1 Includes all BBRA provisions except the transitional corridor provisions that expire 01/01/04.
    2 Does not include impact of reclassifications as allowed under section 401 of the BBRA 1999.
    3 Estimate of change compared to pre-PPS payments, which reflect the payment methodologies in effect as of January 1, 2000, and prior to July 1, 2000.
    Start Printed Page 18535

    X. Federalism

    We have examined this rule in accordance with Executive Order 13132, Federalism, and have determined that this final rule will not have any negative impact on the rights, roles, and responsibilities of State, local or Tribal governments.

    XI. Waiver of Proposed Rulemaking

    We ordinarily publish a notice of proposed rulemaking in the Federal Register and invite public comment on the proposed rule. The notice of proposed rulemaking includes a reference to the legal authority under which the rule is proposed, and the terms and substance of the proposed rule or a description of the subjects and issues involved. This procedure can be waived, however, if an agency finds good cause that a notice-and-comment procedure is impracticable, unnecessary, or contrary to the public interest, and incorporates a statement of the finding and its reasons in the rule. We find that the circumstances surrounding this rule make it impracticable to pursue a process of notice-and-comment rulemaking before the provisions of this rule take effect.

    The BBRA 1999 was enacted on November 29, 1999. This final rule incorporates the following hospital outpatient PPS provisions in the BBRA 1999: outlier adjustment for high cost cases; transitional pass-through payment adjustments for additional costs (over the payments for APCs otherwise made) for new medical devices, drugs, and biologicals; definition of APCs so that the variation of costs of items within an APC is subject to certain limits; establishment of “transitional corridors” for the first 31/2 years of the new system that limit losses hospitals might otherwise face; payment for implantable devices under the hospital outpatient PPS, rather than under the Durable Medical Equipment Fee Schedule; limitation of the copayment on an outpatient procedure to the amount of the inpatient hospital deductible; requirement to review annually the APC groups, relative weights, and wage and other adjustments; and calculation of the conversion factor in a budget-neutral manner, eliminating the 5.7 percent reduction indicated in the proposed rule.

    As discussed earlier in this rule, July 1, 2000 is the earliest date on which we can feasibly implement the PPS. The provisions of the BBRA 1999, enacted on November 29, 1999, made numerous refinements to the PPS. With respect to the BBRA 1999 provisions, it would have been impracticable to complete notice and comment procedures by July 1, 2000. Given the limited timeframe, given the nature and scope of the BBRA 1999 refinements, and given the time required to complete notice and comment rulemaking (to develop proposed policies, draft the proposed rule, provide a 60-day public comment period, consider public comments, develop final policies, draft a final rule), it would not have been possible to issue this document as a proposed rule and issue a final rule by July 1.

    In addition, it would not be feasible to implement the hospital outpatient PPS without the BBRA 1999 provisions, not only because of the nature of the BBRA 1999 provisions, but also because section 201(m) of the BBRA 1999 states: “Except as provided in this section, the amendments made by this section shall be effective as if included in the enactment of BBA.” Therefore, if we undertook prior notice and comment procedures with respect to the BBRA 1999 provisions, then (because such procedures could not be completed by July 1, 2000) the PPS would not be implemented by July 1, 2000.

    Accordingly, we find good cause to waive the procedures for prior notice and comment with respect to the provisions of this document that implement the BBRA 1999 refinements to hospital outpatient PPS. We are providing a 60-day period for public comment with respect to the provisions of this final rule with comment period that implement the BBRA refinements. We are not accepting comments with respect to the other aspects of this document (for which the public has already had an extensive opportunity to comment).

    Start List of Subjects

    List of Subjects

    42 CFR Part 409

    • Health facilities
    • Medicare

    42 CFR Part 410

    • Health facilities
    • Health professions
    • Kidney diseases
    • Laboratories
    • Medicare
    • Rural areas
    • X-rays

    42 CFR Part 411

    • Kidney diseases
    • Medicare
    • Reporting and recordkeeping requirements

    42 CFR Part 412

    • Administrative practice and procedure
    • Health facilities
    • Medicare
    • Puerto Rico
    • Reporting and recordkeeping requirements

    42 CFR Part 413

    • Health facilities
    • Kidney diseases
    • Medicare
    • Puerto Rico
    • Reporting and recordkeeping requirements

    42 CFR Part 419

    • Health facilities
    • Hospitals
    • Medicare

    42 CFR Part 424

    • Emergency medical services
    • Health facilities
    • Health professions
    • Medicare

    42 CFR Part 489

    • Health facilities
    • Medicare
    • Reporting and recordkeeping requirements

    42 CFR Part 498

    • Administrative practice and procedure
    • Health facilities
    • Health professions
    • Medicare
    • Reporting and recordkeeping requirements

    42 CFR Part 1003

    • Administrative practice and procedure
    • Archives and records
    • Grant program—social programs
    • Maternal and Child Health
    • Medicaid
    • Medicare
    • Penalties
    End List of Subjects

    For the reasons set forth in the preamble, 42 CFR chapter IV is amended as follows:

    Start Part

    PART 409—HOSPITAL INSURANCE BENEFITS

    End Part Start Amendment Part

    A. Part 409 is amended as set forth below:

    End Amendment Part Start Amendment Part

    1. The authority citation for part 409 continues to read as follows:

    End Amendment Part Start Authority

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh).

    End Authority

    Subpart B—Inpatient Hospital Services and Inpatient Critical Access Hospital Services

    Start Amendment Part

    2. In § 409.10, paragraph (b) is revised to read as follows:

    End Amendment Part
    Included services.
    * * * * *

    (b) Inpatient hospital services does not include the following types of services:

    (1) Posthospital SNF care, as described in § 409.20, furnished by a hospital or a critical access hospital that has a swing-bed approval.

    (2) Nursing facility services, described in § 440.155 of this chapter, that may be furnished as a Medicaid service under title XIX of the Act in a swing-bed hospital that has an approval to furnish nursing facility services.

    (3) Physician services that meet the requirements of § 415.102(a) of this chapter for payment on a fee schedule basis.

    (4) Physician assistant services, as defined in section 1861(s)(2)(K)(i) of the Act.

    (5) Nurse practitioner and clinical nurse specialist services, as defined in section 1861(s)(2)(K)(ii) of the Act. Start Printed Page 18536

    (6) Certified nurse mid-wife services, as defined in section 1861(gg) of the Act.

    (7) Qualified psychologist services, as defined in section 1861(ii) of the Act.

    (8) Services of an anesthetist, as defined in § 410.69 of this chapter.

    Start Part

    PART 410—SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS

    End Part Start Amendment Part

    B. Part 410 is amended as set forth below:

    End Amendment Part Start Amendment Part

    1. The authority citation for part 410 continues to read as follows:

    End Amendment Part Start Authority

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh).

    End Authority

    Subpart A—General Provisions

    Start Amendment Part

    2. In § 410.2, the introductory text is republished, the definition of “Community mental health center (CMHC)” is revised, and the definitions of “Encounter” and “Outpatient” are added in alphabetical order to read as follows:

    End Amendment Part
    Definitions.

    As used in this part—

    Community mental health center (CMHC) means an entity that—

    (1) Provides outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically mentally ill, and residents of its mental health service area who have been discharged from inpatient treatment at a mental health facility;

    (2) Provides 24-hour-a-day emergency care services;

    (3) Provides day treatment or other partial hospitalization services, or psychosocial rehabilitation services;

    (4) Provides screening for patients being considered for admission to State mental health facilities to determine the appropriateness of this admission; and

    (5) Meets applicable licensing or certification requirements for CMHCs in the State in which it is located.

    Encounter means a direct personal contact between a patient and a physician, or other person who is authorized by State licensure law and, if applicable, by hospital or CAH staff bylaws, to order or furnish hospital services for diagnosis or treatment of the patient.

    * * * * *

    Outpatient means a person who has not been admitted as an inpatient but who is registered on the hospital or CAH records as an outpatient and receives services (rather than supplies alone) directly from the hospital or CAH.

    * * * * *

    Subpart B—Medical and Other Health Services

    Start Amendment Part

    3. In § 410.27:

    End Amendment Part Start Amendment Part

    A. The section heading is revised;

    End Amendment Part Start Amendment Part

    B. The introductory text to paragraph (a) is revised;

    End Amendment Part Start Amendment Part

    C. The introductory text to paragraph (a)(1) is republished;

    End Amendment Part Start Amendment Part

    D. The word “and” at the end of paragraph (a)(1)(i) is removed; and

    End Amendment Part Start Amendment Part

    E. New paragraphs (a)(1)(iii), (e), and (f) are added to read as follows:

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    Outpatient hospital services and supplies incident to a physician service: Conditions.

    (a) Medicare Part B pays for hospital services and supplies furnished incident to a physician service to outpatients, including drugs and biologicals that cannot be self-administered, if—

    (1) They are furnished—

    * * * * *

    (iii) In the hospital or at a location (other than an RHC or an FQHC) that HCFA designates as a department of a provider under § 413.65 of this chapter; and

    * * * * *

    (e) Services furnished by an entity other than the hospital are subject to the limitations specified in § 410.42(a).

    (f) Services furnished at a location (other than an RHC or an FQHC) that HCFA designates as a department of a provider under § 413.65 of this chapter must be under the direct supervision of a physician. “Direct supervision” means the physician must be present and on the premises of the location and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed.

    Start Amendment Part

    4. In § 410.28, paragraph (a)(4) is removed, paragraph (c) is redesignated as paragraph (d), and new paragraphs (c) and (e) are added to read as follows:

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    Hospital or CAH diagnostic services furnished to outpatients: Conditions.
    * * * * *

    (c) Diagnostic services furnished by an entity other than the hospital or CAH are subject to the limitations specified in § 410.42(a).

    * * * * *

    (e) Medicare Part B makes payment under section 1833(t) of the Act for diagnostic services furnished at a facility (other than an RHC or an FQHC) that HCFA designates as having provider-based status only when the diagnostic services are furnished under the appropriate level of physician supervision specified by HCFA in accordance with the definitions in § 410.32(b)(3)(i), (b)(3)(ii), and (b)(3)(iii). Under general supervision at a facility accorded provider-based status, the training of the nonphysician personnel who actually perform the diagnostic procedure and the maintenance of the necessary equipment and supplies are the continuing responsibility of the facility.

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    5. A new § 410.42 is added to read as follows:

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    Limitations on coverage of certain services furnished to hospital outpatients.

    (a) General rule. Except as provided in paragraph (b) of this section, Medicare Part B does not pay for any item or service that is furnished to a hospital outpatient (as defined in § 410.2) during an encounter (as defined in § 410.2) by an entity other than the hospital unless the hospital has an arrangement (as defined in § 409.3 of this chapter) with that entity to furnish that particular service to its patients. As used in this paragraph, the term “hospital” includes a CAH.

    (b) Exception. The limitations stated in paragraph (a) of this section do not apply to the following services:

    (1) Physician services that meet the requirements of § 415.102(a) of this chapter for payment on a fee schedule basis.

    (2) Physician assistant services, as defined in section 1861(s)(2)(K)(i) of the Act.

    (3) Nurse practitioner and clinical nurse specialist services, as defined in section 1861(s)(2)(K)(ii) of the Act.

    (4) Certified nurse mid-wife services, as defined in section 1861(gg) of the Act.

    (5) Qualified psychologist services, as defined in section 1861(ii) of the Act.

    (6) Services of an anesthetist, as defined in § 410.69.

    (7) Services furnished to SNF residents as defined in § 411.15(p) of this chapter.

    Start Amendment Part

    6. In § 410.43, paragraph (b) is revised to read as follows:

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    Partial hospitalization services: Conditions and exclusions.
    * * * * *

    (b) The following services are separately covered and not paid as partial hospitalization services:

    (1) Physician services that meet the requirements of § 415.102(a) of this chapter for payment on a fee schedule basis. Start Printed Page 18537

    (2) Physician assistant services, as defined in section 1861(s)(2)(K)(i) of the Act.

    (3) Nurse practitioner and clinical nurse specialist services, as defined in section 1861(s)(2)(K)(ii) of the Act.

    (4) Qualified psychologist services, as defined in section 1861(ii) of the Act.

    (5) Services furnished to SNF residents as defined in § 411.15(p) of this chapter.

    Start Part

    PART 411—EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT

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    C. Part 411 is amended as set forth below:

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    1. The authority citation for part 411 continues to read as follows:

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    Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh).

    End Authority

    Subpart A—General Exclusions and Exclusion of Particular Services

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    2. In § 411.15:

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    A. The introductory text is republished;

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    B. The section heading to paragraph (m) is revised;

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    C. Paragraph (m)(1) is revised;

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    D. Paragraph (m)(2) is redesignated as paragraph (m)(3);

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    E. The introductory text to newly redesignated paragraph (m)(3) is republished;

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    F. Newly redesignated paragraphs (m)(3)(iii), (m)(3)(iv), and (m)(3)(v) are redesignated as paragraphs (m)(3)(iv), (m)(3)(v), and (m)(3)(vi), respectively; and

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    G. New paragraphs (m)(2) and (m)(3)(iii) are added to read as follows:

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    Particular services excluded from coverage.

    The following services are excluded from coverage:

    * * * * *

    (m) Services to hospital patients— (1) Basic rule. Except as provided in paragraph (m)(3) of this section, any service furnished to an inpatient of a hospital or to a hospital outpatient (as defined in § 410.2 of this chapter) during an encounter (as defined in § 410.2 of this chapter) by an entity other than the hospital unless the hospital has an arrangement (as defined in § 409.3 of this chapter) with that entity to furnish that particular service to the hospital's patients. As used in this paragraph (m)(1), the term “hospital” includes a CAH.

    (2) Scope of exclusion. Services subject to exclusion from coverage under the provisions of this paragraph (m) include, but are not limited to, clinical laboratory services; pacemakers and other prostheses and prosthetic devices (other than dental) that replace all or part of an internal body organ (for example, intraocular lenses); artificial limbs, knees, and hips; equipment and supplies covered under the prosthetic device benefits; and services incident to a physician service.

    (3) Exceptions. The following services are not excluded from coverage:

    * * * * *

    (iii) Nurse practitioner and clinical nurse specialist services, as defined in section 1861(s)(2)(K)(ii) of the Act.

    * * * * *
    Start Part

    PART 412—PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES

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    D. Part 412 is amended as set forth below:

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    1. The authority citation for part 412 continues to read as follows:

    End Amendment Part Start Authority

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh).

    End Authority

    Subpart C—Conditions for Payment Under the Prospective Payment Systems for Inpatient Operating Costs and Inpatient Capital-Related Costs

    Start Amendment Part

    2. In § 412.50, paragraphs (a) and (b) are revised to read as follows:

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    Furnishing of inpatient hospital services directly or under arrangements.

    (a) The applicable payments made under the prospective payment systems, as described in subparts H and M of this part, are payment in full for all inpatient hospital services, as defined in § 409.10 of this chapter. Inpatient hospital services do not include the following types of services:

    (1) Physician services that meet the requirements of § 415.102(a) of this chapter for payment on a fee schedule basis.

    (2) Physician assistant services, as defined in section 1861(s)(2)(K)(i) of the Act.

    (3) Nurse practitioner and clinical nurse specialist services, as defined in section 1861(s)(2)(K)(ii) of the Act.

    (4) Certified nurse mid-wife services, as defined in section 1861(gg) of the Act.

    (5) Qualified psychologist services, as defined in section 1861(ii) of the Act.

    (6) Services of an anesthetist, as defined in § 410.69 of this chapter.

    (b) HCFA does not pay any provider or supplier other than the hospital for services furnished to a beneficiary who is an inpatient, except for the services described in paragraphs (a)(1) through (a)(6) of this section.

    * * * * *
    Start Part

    PART 413—PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES

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    E. Part 413 is amended as set forth below:

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    1. The authority citation for part 413 continues to read as follows:

    End Amendment Part Start Authority

    Authority: Secs. 1102, 1812(d), 1814(b), 1815, 1833(a), (i), and (n), 1871, 1881, 1883, and 1886 of the Social Security Act (42 U.S.C. 1302, 1395f(b), 1395g, 1395l, 1395l(a), (i), and (n), 1395x(v), 1395hh, 1395rr, 1395tt, and 1395ww).

    End Authority

    Subpart A—Introduction and General Rules

    [Amended]
    Start Amendment Part

    2. In § 413.1, paragraph (a)(2)(viii) is removed.

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    Subpart B—Accounting Records and Reports

    Start Amendment Part

    3. In § 413.24, the heading to paragraph (d) is republished, and a new paragraph (d)(6) is added to read as follows:

    End Amendment Part
    Adequate cost data and cost finding.
    * * * * *

    (d) Cost finding methods. * * *

    (6) Management contracts. (i) If the main provider purchases services for a department of the provider or a provider-based entity through a management contract or otherwise directly assigns costs to the department or entity, the like costs of the main provider must be carved out to ensure that they are not allocated to the department of the provider or provider-based entity. However, if the like costs of the main provider cannot be separately identified, the costs of the services purchased through a management contract must be included in the main provider's administrative and general costs and allocated among the provider's overall statistics.

    (ii) Costs of free-standing entities may not be shown in the provider's trial balance for purposes of stepping down overhead costs to these entities. The provider must develop detailed work papers showing the exact cost of the services (including overhead) provided to or by the free-standing entity and show those carved out costs as Start Printed Page 18538nonreimbursable cost centers in the provider's trial balance.

    * * * * *

    Subpart E—Payments to Providers

    Start Amendment Part

    4. A new § 413.65 is added to read as follows:

    End Amendment Part
    Requirements for a determination that a facility or an organization has provider-based status.

    (a) Scope and definitions. (1) Scope. This section applies to all facilities or organizations for which provider-based status is sought, including remote locations of hospitals, as defined in paragraph (a)(2) of this section and satellite facilities as defined in § 412.22(h)(1) and § 412.25(e)(1) of this chapter, other than ESRD facilities. Determinations for ESRD facilities are made under § 413.174 of this chapter.

    (2) Definitions. In this subpart E, unless the context indicates otherwise—

    Campus means the physical area immediately adjacent to the provider's main buildings, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings, and any other areas determined on an individual case basis, by the HCFA regional office, to be part of the provider's campus.

    Department of a provider means a facility or organization or a physician office that is either created by, or acquired by, a main provider for the purpose of furnishing health care services of the same type as those furnished by the main provider under the name, ownership, and financial and administrative control of the main provider, in accordance with the provisions of this section. A department of a provider may not be licensed to provide health care services in its own right, may not by itself be qualified to participate in Medicare as a provider under § 489.2 of this chapter, and Medicare conditions of participation do not apply to a department as an independent entity. For purposes of this part, the term “department of a provider” does not include an RHC or, except as specified in paragraph (m)(1) of this section, an FQHC.

    Free-standing facility means an entity that furnishes health care services to Medicare beneficiaries and that is not integrated with any other entity as a main provider, a department of a provider, remote location of a hospital, satellite facility, or a provider-based entity.

    Main provider means a provider that either creates, or acquires ownership of, another entity to deliver additional health care services under its name, ownership, and financial and administrative control.

    Provider-based entity means a provider of health care services, or an RHC or an FQHC as defined in § 405.2401(b) of this chapter, that is either created by, or acquired by, a main provider for the purpose of furnishing health care services of a different type from those of the main provider under the name, ownership, and administrative and financial control of the main provider, in accordance with the provisions of this section.

    Provider-based status means the relationship between a main provider and a provider-based entity or a department of a provider, remote location of a hospital, or satellite facility, that complies with the provisions of this section.

    Remote location of a hospital means a facility or an organization that is either created by, or acquired by, a hospital that is a main provider for the purpose of furnishing inpatient hospital services under the name, ownership, and financial and administrative control of the main provider, in accordance with the provisions of this section. A remote location of a hospital may not be licensed to provide inpatient hospital services in its own right, and Medicare conditions of participation do not apply to a remote location of a hospital as an independent entity. For purposes of this part, the term “remote location of a hospital” does not include a satellite facility as defined in § 412.22(h)(1) and § 412.25(e)(1) of this chapter.

    (b) Responsibility for obtaining provider-based determinations. (1) A facility or organization is not entitled to be treated as provider-based simply because it or the main provider believe it is provider-based.

    (2) A main provider or a facility or organization must contact HCFA and the facility or organization must be determined by HCFA to be provider-based before the main provider bills for services of the facility or organization as if the facility or organization were provider-based, or before it includes costs of those services on its cost report.

    (3) A facility that is not located on the campus of a hospital and is used as a site of physician services of the kind ordinarily furnished in physician offices will be presumed to be a free-standing facility, unless it is determined by HCFA to have provider-based status.

    (c) Reporting. (1) A main provider that creates or acquires a facility or organization for which it wishes to claim provider-based status, including any physician offices that a hospital wishes to operate as a hospital outpatient department or clinic, must report its acquisition of the facility or organization to HCFA if the facility or organization is located off the campus of the provider, or inclusion of the costs of the facility or organization in the provider's cost report would increase the total costs on the provider's cost report by at least 5 percent, and must furnish all information needed for a determination as to whether the facility or organization meets the requirements in paragraph (d) of this section for provider-based status.

    (2) A main provider that has had one or more facilities or organizations considered provider-based also must report to HCFA any material change in the relationship between it and any provider-based facility or organization, such as a change in ownership of the facility or organization or entry into a new or different management contract that could affect the provider-based status of the facility or organization.

    (d) Requirements. An entity must meet all of the following requirements to be determined by HCFA to have provider-based status.

    (1) Licensure. The department of the provider, remote location of a hospital, or satellite facility and the main provider are operated under the same license, except in areas where the State requires a separate license for the department of the provider, remote location of a hospital, or satellite facility, or in States where State law does not permit licensure of the provider and the prospective department of the provider, remote location of a hospital, or satellite facility under a single license. If a State health facilities' cost review commission or other agency that has authority to regulate the rates charged by hospitals or other providers in a State finds that a particular facility or organization is not part of a provider, HCFA will determine that the facility or organization does not have provider-based status.

    (2) Operation under the ownership and control of the main provider. The facility or organization seeking provider-based status is operated under the ownership and control of the main provider, as evidenced by the following:

    (i) The business enterprise that constitutes the facility or organization is 100 percent owned by the provider.

    (ii) The main provider and the facility or organization seeking status as a department of the provider, remote location of a hospital, or satellite facility have the same governing body.

    (iii) The facility or organization is operated under the same organizational documents as the main provider. For Start Printed Page 18539example, the facility or organization seeking provider-based status must be subject to common bylaws and operating decisions of the governing body of the provider where it is based.

    (iv) The main provider has final responsibility for administrative decisions, final approval for contracts with outside parties, final approval for personnel actions, final responsibility for personnel policies (such as fringe benefits/code of conduct), and final approval for medical staff appointments in the facility or organization.

    (3) Administration and supervision. The reporting relationship between the facility or organization seeking provider-based status and the main provider must have the same frequency, intensity, and level of accountability that exists in the relationship between the main provider and one of its departments, as evidenced by compliance with all of the following requirements:

    (i) The facility or organization is under the direct supervision of the main provider.

    (ii) The facility or organization is operated under the same monitoring and oversight by the provider as any other department of the provider, and is operated just as any other department of the provider with regard to supervision and accountability. The facility or organization director or individual responsible for daily operations at the entity—

    (A) Maintains a reporting relationship with a manager at the main provider that has the same frequency, intensity, and level of accountability that exists in the relationship between the main provider and its departments; and

    (B) Is accountable to the governing body of the main provider, in the same manner as any department head of the provider.

    (iii) The following administrative functions of the facility or organization are integrated with those of the provider where the facility or organization is based: billing services, records, human resources, payroll, employee benefit package, salary structure, and purchasing services. Either the same employees or group of employees handle these administrative functions for the facility or organization and the main provider, or the administrative functions for both the facility or organization and the entity are—

    (A) Contracted out under the same contract agreement; or

    (B) Handled under different contract agreements, with the contract of the facility or organization being managed by the main provider.

    (4) Clinical services. The clinical services of the facility or organization seeking provider-based status and the main provider are integrated as evidenced by the following:

    (i) Professional staff of the facility or organization have clinical privileges at the main provider.

    (ii) The main provider maintains the same monitoring and oversight of the facility or organization as it does for any other department of the provider.

    (iii) The medical director of the facility or organization seeking provider-based status maintains a reporting relationship with the Chief Medical Officer or other similar official of the main provider that has the same frequency, intensity, and level of accountability that exists in the relationship between the medical director of a department of the main provider and the Chief Medical Officer or other similar official of the main provider, and is under the same type of supervision and accountability as any other director, medical or otherwise, of the main provider.

    (iv) Medical staff committees or other professional committees at the main provider are responsible for medical activities in the facility or organization including quality assurance, utilization review, and the coordination and integration of services, to the extent practicable, between the facility or organization seeking provider-based status and the main provider.

    (v) Medical records for patients treated in the facility or organization are integrated into a unified retrieval system (or cross reference) of the main provider.

    (vi) Inpatient and outpatient services of the facility or organization and the main provider are integrated, and patients treated at the facility or organization who require further care have full access to all services of the main provider and are referred where appropriate to the corresponding inpatient or outpatient department or service of the main provider.

    (5) Financial integration. The financial operations of the facility or organization are fully integrated within the financial system of the main provider, as evidenced by shared income and expenses between the main provider and the facility or organization. The costs of the facility or organization are reported in a cost center of the provider, and the financial status of the facility or organization is incorporated and readily identified in the main provider's trial balance.

    (6) Public awareness. The facility or organization seeking status as a department of a provider, remote location of a hospital, or satellite facility is held out to the public and other payers as part of the main provider. When patients enter the provider-based facility or organization, they are aware that they are entering the main provider and are billed accordingly.

    (7) Location in immediate vicinity. The facility or organization and the main provider are located on the same campus, except where the following requirements are met:

    (i) The facility or organization demonstrates a high level of integration with the main provider by showing that it meets all of the other provider-based criteria, and demonstrates that it serves the same patient population as the main provider, by submitting records showing that, during the 12-month period immediately preceding the first day of the month in which the application for provider-based status is filed with HCFA, and for each subsequent 12-month period—

    (A) At least 75 percent of the patients served by the facility or organization reside in the same zip code areas as at least 75 percent of the patients served by the main provider;

    (B) At least 75 percent of the patients served by the facility or organization who required the type of care furnished by the main provider received that care from that provider (for example, at least 75 percent of the patients of an RHC seeking provider-based status received inpatient hospital services from the hospital that is the main provider); or

    (C) If the facility or organization is unable to meet the criteria in paragraph (d)(7)(i)(A) or (d)(7)(i)(B) of this section because it was not in operation during all of the 12-month period described in the previous sentence, the facility or organization is located in a zip code area included among those that, during all of the 12-month period described in the previous sentence, accounted for at least 75 percent of the patients served by the main provider.

    (ii) A facility or organization is not considered to be in the “immediate vicinity” of the main provider unless the facility or organization and the main provider are located in the same State or, where consistent with the laws of both States, adjacent States.

    (iii) A rural health clinic that is otherwise qualified as a provider-based entity of a hospital that is located in a rural area, as defined in § 412.62(f)(1)(iii) of this chapter, and has fewer than 50 beds, as determined under § 412.105(b) of this chapter, is not subject to the criterion in this paragraph (d)(7).

    (e) Provider-based status not applicable to joint ventures. A facility or Start Printed Page 18540organization cannot be considered provider-based if the entity is owned by two or more providers engaged in a joint venture. For example, where a hospital has jointly purchased or jointly created free-standing facilities under joint venture arrangements, neither party to the joint venture arrangement can claim the free-standing facility as a provider-based entity.

    (f) Management contracts. Facilities and organizations that otherwise meet the requirements of paragraph (d) of this section, but are operated under management contracts, must also meet all of the following criteria:

    (1) The staff of the facility or organization, other than management staff, are employed by the provider or by another organization, other than the management company, which also employs the staff of the main provider.

    (2) The administrative functions of the facility or organization are integrated with those of the main provider, as determined under criteria in paragraph (d)(3)(iii) of this section.

    (3) The main provider has significant control over the operations of the facility or organization as determined under criteria in paragraph (b)(3)(ii) of this section.

    (4) The management contract is held by the main provider itself, not by a parent organization that has control over both the main provider and the facility or organization.

    (g) Obligations of hospital outpatient departments and hospital-based entities. (1) Hospital outpatient departments located either on or off the campus of the hospital that is the main provider must comply with the anti-dumping rules in §§ 489.20(l), (m), (q), and (r) and § 489.24 of this chapter. If any individual comes to any hospital-based entity (including an RHC) located on the main hospital campus, and a request is made on the individual's behalf for examination or treatment of a medical condition, as described in § 489.24 of this chapter, the hospital must comply with the anti-dumping rules in § 489.24 of this chapter.

    (2) Physician services furnished in hospital outpatient departments or hospital-based entities (other than RHCs) must be billed with the correct site-of-service indicator, so that applicable site-of-service reductions to physician and practitioner payment amounts can be applied.

    (3) Hospital outpatient departments must comply with all the terms of the hospital's provider agreement.

    (4) Physicians who work in hospital outpatient departments or hospital-based entities are obligated to comply with the non-discrimination provisions in § 489.10(b) of this chapter.

    (5) Hospital outpatient departments (other than RHCs) must treat all Medicare patients, for billing purposes, as hospital outpatients. The department must not treat some Medicare patients as hospital outpatients and others as physician office patients.

    (6) In the case of a patient admitted to the hospital as an inpatient after receiving treatment in the hospital outpatient department or hospital-based entity, payments for services in the hospital outpatient department or hospital-based entity are subject to the payment window provisions applicable to PPS hospitals and to hospitals and units excluded from PPS set forth at § 412.2(c)(5) of this chapter and at § 413.40(c)(2), respectively.

    (7) When a Medicare beneficiary is treated in a hospital outpatient department or hospital-based entity (other than an RHC) that is not located on the main provider's campus, the hospital has a duty to provide written notice to the beneficiary, prior to the delivery of services, of the amount of the beneficiary's potential financial liability (that is, of the fact that the beneficiary will incur a coinsurance liability for an outpatient visit to the hospital as well as for the physician service, and of the amount of that liability). The notice must be one that the beneficiary can read and understand. If the beneficiary is unconscious, under great duress, or for any other reason unable to read a written notice and understand and act on his or her own rights, the notice must be provided, prior to the delivery of services, to the beneficiary's authorized representative.

    (8) Hospital outpatient departments must meet applicable hospital health and safety rules for Medicare-participating hospitals in part 482 of this chapter.

    (h) Furnishing all services under arrangement. A facility or organization may not qualify for provider-based status if all patient care services furnished at the facility are furnished under arrangement.

    (i) Inappropriate treatment of a facility or organization as provider-based. (1) Determination and review. If HCFA learns that a provider has treated a facility or organization as provider-based and the provider had not obtained a determination of provider-based status under this section, HCFA will—

    (i) Review current payments and, if necessary, take action in accordance with the rules on inappropriate billing in paragraph (j) of this section;

    (ii) Investigate and determine whether the requirements in paragraph (d) of this section (or, for periods prior to October 10, 2000, the requirements in applicable program instructions) were met; and

    (iii) Review all previous payments to that provider for all cost reporting periods subject to re-opening in accordance with § 405.1885 and § 405.1889 of this chapter.

    (2) Recovery of overpayments. If HCFA finds that payments for services at the facility or organization have been made as if the facility or organization were provider-based, even though HCFA had not previously determined that the facility or organization qualified for provider-based status, HCFA will recover the difference between the amount of payments that actually were made and the amount of payments that HCFA estimates should have been made in the absence of a determination of provider-based status, except that recovery will not be made for any period prior to October 10, 2000 if during all of that period the management of the entity made a good faith effort to operate it as a provider-based facility or organization, as described in paragraph (h)(3) of this section.

    (3) Exception for good faith effort. HCFA determines that the management of a facility or organization has made a good faith effort to operate it as a provider-based entity if—

    (i) The requirements regarding licensure and public awareness in paragraphs (d)(1) and (d)(6) of this section are met;

    (ii) All facility services were billed as if they had been furnished by a department of a provider, remote location of a hospital, satellite facility, or a provider-based entity of the main provider; and

    (iii) All professional services of physicians and other practitioners were billed with the correct site-of-service indicator, as described in paragraph (g)(2) of this section.

    (j) Inappropriate billing. If HCFA finds that a facility or organization is being treated as provider-based without having obtained a determination of provider-based status under this section, HCFA will notify the provider, adjust future payments, review previous payments, determine whether the facility or organization qualifies for provider-based status under this paragraph, and continue payments only under specific conditions, as described in paragraphs (j)(1), (j)(2), (j)(3), and (j)(4) of this section.

    (1) Notice to provider. If HCFA finds that inappropriate billing has occurred or is occurring since no provider-based Start Printed Page 18541determination has been made by HCFA, HCFA will issue written notice to the provider that payments for past cost reporting periods may be reviewed and recovered as described in paragraph (i) of this section, that future payments for services in or of the facility or organization will be adjusted as described in paragraph (j)(2) of this section, and that a determination of provider-based status will be made.

    (2) Adjustment of payments. If HCFA finds that inappropriate billing has occurred or is occurring since no provider-based determination has been made by HCFA, HCFA will adjust future payments to the provider, the facility or organization, or both, to approximate as closely as possible the amounts that would be paid, in the absence of a provider-based determination, if all other requirements for billing were met.

    (3) Review of previous payments. If HCFA finds that inappropriate billing has occurred or is occurring since no provider-based determination has been made by HCFA, HCFA will review previous payments and, if necessary, take action in accordance with the rules on inappropriate treatment of a facility or organization as provider-based in paragraph (h) of this section.

    (4) Determination regarding provider-based status. If HCFA finds that inappropriate billing has occurred or is occurring since no provider-based determination has been made by HCFA, HCFA will determine whether the facility or organization qualifies for provider-based status under the criteria in this section. If HCFA determines that the facility or organization qualifies for provider-based status, future payment for services at or by the facility or organization will be adjusted to reflect that determination. If HCFA determines that the facility or organization does not qualify for provider-based status, future payment for services at or by the facility or organization will be made only in accordance with the rules in paragraph (i)(5) of this section.

    (5) Continuation of payment. The notice of denial of provider-based status sent to the provider will ask the provider to notify HCFA in writing, within 30 days of the date the notice is issued, of whether the facility or organization (or, where applicable, the practitioners who staff the facility or organization) will be seeking to enroll and meet other requirements to bill for services in a free-standing facility. If the provider indicates that the facility, organization, or practitioners will not be seeking to enroll, or if HCFA does not receive a response within 30 days of the date the notice was issued, all payment under this paragraph (i)(5) will end as of the 30th day after the date of notice. If the provider indicates that the facility or organization, or its practitioners, will be seeking to meet enrollment and other requirements for billing for services in a free-standing facility, payment for services of the facility or organization will continue, at the adjusted amounts described in paragraph (j)(2) of this section for as long as is required for all billing requirements to be met (but not longer than 6 months) if the facility or organization, or its practitioners, submit a complete enrollment application and provide all other required information within 90 days after the date of notice; and the facility or organization, or its practitioners, furnish all other information needed by HCFA to process the enrollment application and verify that other billing requirements are met. If the necessary applications or information are not provided, HCFA will terminate all payment to the provider, facility, or organization as of the date HCFA issues notice that necessary applications or information have not been submitted.

    (k) Correction of errors. HCFA may review a past determination of provider-based status for a facility or organization or may review the status of a facility or organization (that is, whether the facility or organization is provider-based) if no determination regarding provider-based status has previously been made, if HCFA believes that status may be inappropriate, based on the provisions of this section. If HCFA determines that a previous determination was in error, and the entity should not be considered provider-based, HCFA notifies the main provider. Treatment of the facility or organization as provider-based ceases with the first day of the next cost report period following notification of the redetermination, but not less than 6 months after the date of notification.

    (l) Status of Indian Health Service and Tribal facilities and organizations. Facilities and organizations operated by the Indian Health Service or Tribes will be considered to be departments of hospitals operated by the Indian Health Service or Tribes if, on or before April 7, 2000, they furnished only services that were billed as if they had been furnished by a department of a hospital operated by the Indian Health Service or a Tribe and they are:

    (1) Owned and operated by the Indian Health Service;

    (2) Owned by the Tribe but leased from the Tribe by the IHS under the Indian Self-Determination Act (Pub. L. 93-638) in accordance with applicable regulations and policies of the Indian Health Service in consultation with Tribes: or

    (3) Owned by the Indian Health Service but leased and operated by the Tribe under the Indian Self-Determination Act (Pub. L. 93-638) in accordance with applicable regulations and policies of the Indian Health Service in consultation with Tribes.

    (m) FQHCs and “look-alikes”. A facility that has, since April 7, 1995, furnished only services that were billed as if they had been furnished by a department of a provider will continue to be treated, for purposes of this section, as a department of the provider without regard to whether it complies with the criteria for provider-based status in this section, if the facility—

    (1) Received a grant before 1995 under section 330 of the Public Health Service Act, or is receiving funding from such a grant under a contract with the recipient of such a grant and meets the requirements to receive a grant under section 330 of the Public Health Service Act; or

    (2) Based on the recommendation of the Public Health Service, was determined by HCFA before 1995 to meet the requirements for receiving such a grant.

    (n) Effective date of provider-based status. Provider-based status for a facility or organization is effective on the earliest date on which a request for provider-based status has been made, and all requirements of this part have been met.

    Subpart F—Specific Categories of Costs

    Start Amendment Part

    5. In § 413.118, the heading to paragraph (d) is republished, and a new paragraph (d)(5) is added to read as follows:

    End Amendment Part
    Payment for facility services related to covered ASC surgical procedures performed in hospitals on an outpatient basis.
    * * * * *

    (d) Blended payment amount. * * *

    (5) For portions of cost reporting periods beginning on or after October 1, 1997, for purposes of calculating the blended payment amount under paragraph (d)(4) of this section, the ASC payment amount is the sum of the standard overhead amounts reduced by deductibles and coinsurance as defined in section 1866(a)(2)(ii) of the Act.

    * * * * *
    Start Amendment Part

    6. In § 413.122:

    End Amendment Part Start Amendment Part

    A. The heading to paragraph (b) is republished

    End Amendment Part Start Amendment Part

    B. A new paragraph (b)(5) is added

    End Amendment Part Start Amendment Part

    C. The heading to paragraph (c) is republished; and Start Printed Page 18542

    End Amendment Part Start Amendment Part

    D. A new paragraph (c)(4) is added to read as follows:

    End Amendment Part
    Payment for hospital outpatient radiology services and other diagnostic procedures.
    * * * * *

    (b) Payment for hospital outpatient radiology services. * * *

    (5) For hospital outpatient radiology services furnished on or after October 1, 1997, the blended payment amount is equal to the sum of—

    (i) 42 percent of the hospital-specific amount; and

    (ii) 58 percent of the fee schedule amount calculated as 62 percent of the sum of the fee schedule amounts payable for the same services when furnished by participating physicians in their offices in the same locality, less deductible and coinsurance as defined in section 1866(a)(2)(A)(ii) of the Act.

    (c) Payment for other diagnostic procedures. * * *

    (4) For other diagnostic services furnished on or after October 1, 1997, the blended payment amount is equal to the sum of—

    (i) 50 percent of the hospital-specific amount; and

    (ii) 50 percent of the fee schedule amount calculated as 42 percent of the sum of the fee schedule amounts payable for the same services when furnished by participating physicians in their offices in the same locality less deductible and coinsurance as defined in section 1866(a)(2)(A)(ii) of the Act.

    Start Amendment Part

    7. In § 413.124, paragraph (a) is revised to read as follows:

    End Amendment Part
    Reduction to hospital outpatient operating costs.

    (a) Except for sole community hospitals, as defined in § 412.92 of this chapter, and critical access hospitals, the reasonable costs of outpatient hospital services (other than capital-related costs of these services) are reduced by 5.8 percent for services furnished during portions of cost reporting periods occurring on or after October 1, 1990 and until the first date that the prospective payment system under part 419 of this chapter is implemented.

    * * * * *

    Subpart G—Capital-Related Costs

    Start Amendment Part

    8. In § 413.130, the heading to paragraph (j) and the introductory text to paragraph (j)(1) are republished, and paragraph (j)(1)(ii) is revised to read as follows:

    End Amendment Part
    Introduction to capital-related costs.
    * * * * *

    (j) Reduction to capital-related costs. (1) Except for sole community hospitals and critical access hospitals, the amount of capital-related costs of all hospital outpatient services is reduced by—

    * * * * *

    (ii) 10 percent for portions of cost reporting periods occurring on or after October 1, 1991 and until the first date that the prospective payment system under part 419 of this chapter is implemented.

    * * * * *
    Start Amendment Part

    F. A new part 419, consisting of §§ 419.1, 419.2, 419.20, 419.21, 419.22, 419.30, 419.31, 419.32, 419.40, 419.41, 419.42, 419.43, 419.44, 419.50, 419.60, and 419.70, is added to read as follows:

    End Amendment Part Start Part

    PART 419—PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES

    Subpart A—General Provisions

    419.1 419.2

    Subpart B—Categories of Hospitals and Services Subject to and Excluded From the Hospital Outpatient Prospective Payment System

    419.20 419.21 419.22

    Subpart C—Basic Methodology for Determining Prospective Payment Rates for Hospital Outpatient Services

    419.30 419.31 419.32

    Subpart D—Payments to Hospitals

    419.40 419.41 419.42 419.43 419.44

    Subpart E—Updates

    419.50

    Subpart F—Limitations on Review

    419.60

    Subpart G—Transitional Corridors

    419.70 Start Authority

    Authority: Secs. 1102, 1833(t), and 1871 of the Social Security Act (42 U.S.C. 1302, 1395l(t), and 1395hh).

    End Authority End Part Start Part

    PART 419—PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES

    Subpart A—General Provisions

    Basis and scope.

    (a) Basis. This part implements section 1833(t) of the Act by establishing a prospective payment system for services furnished on or after July 1, 2000 by hospital outpatient departments to Medicare beneficiaries who are registered on hospital records as outpatients.

    (b) Scope. This subpart describes the basis of payment for outpatient hospital services under the prospective payment system. Subpart B sets forth the categories of hospitals and services that are subject to the outpatient hospital prospective payment system and those categories of hospitals and services that are excluded from the outpatient hospital prospective payment system. Subpart C sets forth the basic methodology by which prospective payment rates for hospital outpatient services are determined. Subpart D describes Medicare payment amounts, beneficiary copayment amounts, and methods of payment to hospitals under the hospital outpatient prospective payment system. Subpart E describes how the hospital outpatient prospective payment system may be updated. Subpart F describes limitations on administrative and judicial review. Subpart G describes the transitional payment adjustments that are made before 2004 to limit declines in payment for outpatient services.

    Basis of payment.

    (a) Unit of payment. Under the hospital outpatient prospective payment system, predetermined amounts are paid for designated services furnished to Medicare beneficiaries. These services are identified by codes established under the Health Care Financing Administration Common Procedure Coding System (HCPCS). The prospective payment rate for each service or procedure for which payment is allowed under the hospital outpatient prospective payment system is Start Printed Page 18543determined according to the methodology described in subpart C of this part. The manner in which the Medicare payment amount and the beneficiary copayment amount for each service or procedure are determined is described in subpart D of this part.

    (b) Determination of hospital outpatient prospective payment rates: Included costs. The prospective payment system establishes a national payment rate, standardized for geographic wage differences, that includes operating and capital-related costs that are directly related and integral to performing a procedure or furnishing a service on an outpatient basis. In general, these costs include, but are not limited to—

    (1) Use of an operating suite, procedure room, or treatment room;

    (2) Use of recovery room;

    (3) Use of an observation bed;

    (4) Anesthesia, certain drugs, biologicals, and other pharmaceuticals; medical and surgical supplies and equipment; surgical dressings; and devices used for external reduction of fractures and dislocations;

    (5) Supplies and equipment for administering and monitoring anesthesia or sedation;

    (6) Intraocular lenses (IOLs);

    (7) Incidental services such as venipuncture;

    (8) Capital-related costs;

    (9) Implantable items used in connection with diagnostic X-ray tests, diagnostic laboratory tests, and other diagnostic tests;

    (10) Durable medical equipment that is implantable;

    (11) Implantable prosthetic devices (other than dental) which replace all or part of an internal body organ (including colostomy bags and supplies directly related to colostomy care), including replacement of these devices; and

    (12) Costs incurred to procure donor tissue other than corneal tissue.

    (c) Determination of hospital outpatient prospective payment rates: Excluded costs. The following costs are excluded from the hospital outpatient prospective payment rates:

    (1) Medical education costs for approved nursing and allied health education programs.

    (2) Corneal tissue acquisition costs incurred by hospitals that are paid for on a reasonable cost basis.

    (3) Costs for services listed in § 419.22.

    Subpart B—Categories of Hospitals and Services Subject to and Excluded From the Hospital Outpatient Prospective Payment System

    Hospitals subject to the hospital outpatient prospective payment system.

    (a) Applicability. The hospital outpatient prospective payment system is applicable to any hospital participating in the Medicare program, except those specified in paragraph (b) of this section, for services furnished on or after July 1, 2000.

    (b) Hospitals excluded from the outpatient prospective payment system. (1) Those services furnished by Maryland hospitals that are paid under a cost containment waiver in accordance with section 1814(b)(3) of the Act are excluded from the hospital outpatient prospective payment system.

    (2) Critical access hospitals (CAHs) are excluded from the hospital outpatient prospective payment system.

    Hospital outpatient services subject to the outpatient prospective payment system.

    Except for services described in § 419.22, effective for services furnished on or after July 1, 2000, payment is made under the hospital outpatient prospective payment system for the following:

    (a) Medicare Part B services furnished to hospital outpatients designated by the Secretary under this part.

    (b) Services designated by the Secretary that are covered under Medicare Part B when furnished to hospital inpatients who are either not entitled to benefits under Part A or who have exhausted their Part A benefits but are entitled to benefits under Part B of the program.

    (c) Partial hospitalization services furnished by community mental health centers (CMHCs).

    (d) The following medical and other health services furnished by a comprehensive outpatient rehabilitation facility (CORF) when they are provided outside the patient's plan (of care); or by a home health agency (HHA) to patients who are not under an HHA plan or treatment; or by a hospice program furnishing services to patients outside the hospice benefit:

    (1) Antigens.

    (2) Splints and casts.

    (3) Pneumococcal vaccine, influenza vaccine, and hepatitis B vaccine.

    Hospital outpatient services excluded from payment under the hospital outpatient prospective payment system.

    The following services are not paid for under the hospital outpatient prospective payment system:

    (a) Physician services that meet the requirements of § 415.102(a) of this chapter for payment on a fee schedule basis.

    (b) Nurse practitioner and clinical nurse specialist services, as defined in section 1861(s)(2)(K)(ii) of the Act.

    (c) Physician assistant services, as defined in section 1861(s)(2)(K)(i) of the Act.

    (d) Certified nurse-midwife services, as defined in section 1861(gg) of the Act.

    (e) Services of qualified psychologists, as defined in section 1861(ii) of the Act.

    (f) Services of an anesthetist as defined in § 410.69 of this chapter.

    (g) Clinical social worker services as defined in section 1861(hh)(2) of the Act.

    (h) Outpatient therapy services described in section 1833(a)(8) of the Act.

    (i) Ambulance services, as described in section 1861(v)(1)(U) of the Act, or, if applicable, the fee schedule established under section 1834(l).

    (j) Except as provided in § 419.22(b)(11), prosthetic devices, prosthetics, prosthetic supplies, and orthotic devices.

    (k) Except as provided in § 419.2(b)(10), durable medical equipment supplied by the hospital for the patient to take home.

    (l) Clinical diagnostic laboratory services.

    (m) Services for patients with ESRD that are paid under the ESRD composite rate and drugs and supplies furnished during dialysis but not included in the composite rate.

    (n) Services and procedures that the Secretary designates as requiring inpatient care.

    (o) Hospital outpatient services furnished to SNF residents (as defined in § 411.15(p) of this chapter) as part of the patient's resident assessment or comprehensive care plan (and thus included under the SNF PPS) that are furnished by the hospital “under arrangements” but billable only by the SNF, regardless of whether or not the patient is in a Part A SNF stay.

    (p) Services that are not covered by Medicare by statute.

    (q) Services that are not reasonable or necessary for the diagnosis or treatment of an illness or disease.

    Subpart C—Basic Methodology for Determining Prospective Payment Rates for Hospital Outpatient Services

    Base expenditure target for calendar year 1999.

    (a) HCFA estimates the aggregate amount that would be payable for Start Printed Page 18544hospital outpatient services in calendar year 1999 by summing—

    (1) The total amounts that would be payable from the Trust Fund for covered hospital outpatient services without regard to the outpatient prospective payment system described in this part; and

    (2) The total amounts of coinsurance that would be payable by beneficiaries to hospitals for covered hospital outpatient services without regard to the outpatient prospective payment system described in this part.

    (b) The estimated aggregate amount under paragraph (a) of this section is determined as though the deductible required under section 1833(b) of the Act did not apply.

    Ambulatory payment classification (APC) system and payment weights.

    (a) APC groups. (1) HCFA classifies outpatient services and procedures that are comparable clinically and in terms of resource use into APC groups. Except as specified in paragraph (a)(2) of this section, items and services within a group are not comparable with respect to the use of resources if the highest median cost for an item or service within the group is more than 2 times greater than the lowest median cost for an item or service within the group.

    (2) HCFA may make exceptions to the requirements set forth in paragraph (a)(1) in unusual cases, such as low volume items and services, but may not make such an exception 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.

    (3) The payment rate determined for an APC group in accordance with § 419.32, and the copayment amount and program payment amount determined for an APC group in accordance with subpart D of this part, apply to every HCPCS code classified within an APC group.

    (b) APC weighting factors. (1) Using hospital outpatient claims data from calendar year 1996 and data from the most recent available hospital cost reports, HCFA determines the median costs for the services and procedures within each APC group.

    (2) HCFA assigns to each APC group an appropriate weighting factor to reflect the relative median costs for the services within the APC group compared to the median costs for the services in all APC groups.

    (c) Standardizing amounts. (1) HCFA determines the portion of costs determined in paragraph (b)(1) of this section that is labor-related. This is known as the “labor-related portion” of hospital outpatient costs.

    (2) HCFA standardizes the median costs determined in paragraph (b)(1) of this section by adjusting for variations in hospital labor costs across geographic areas.

    Calculation of prospective payment rates for hospital outpatient services.

    (a) Conversion factor for 1999. HCFA calculates a conversion factor in such a manner that payment for hospital outpatient services furnished in 1999 would have equaled the base expenditure target calculated in § 419.30, taking into account APC group weights and estimated service frequencies and reduced by the amounts that would be payable in 1999 as outlier payments under § 419.43(d) and transitional pass-through payments under § 419.43(e).

    (b) Conversion factor for calendar year 2000 and subsequent years. (1) Subject to paragraph (b)(2) of this section, the conversion factor for a calendar year is equal to the conversion factor calculated for the previous year adjusted as follows:

    (i) For calendar years 2000, 2001, and 2002, by the hospital inpatient market basket percentage increase applicable under section 1886(b)(3)(B)(iii) of the Act reduced by one percentage point.

    (ii) For calendar years 2003 and subsequent years, by the hospital inpatient market basket percentage increase applicable under section 1886(b)(3)(B)(iii) of the Act.

    (2) Beginning in calendar year 2000, HCFA may substitute for the hospital inpatient market basket percentage in paragraph (b) of this section a market basket percentage increase that is determined and applied to hospital outpatient services in the same manner that the hospital inpatient market basket percentage increase is determined and applied to inpatient hospital services.

    (c) Payment rates. The payment rate for services and procedures for which payment is made under the hospital outpatient prospective payment system is the product of the conversion factor calculated under paragraph (a) or paragraph (b) of this section and the relative weight determined under § 419.31(b).

    (d) Budget neutrality. HCFA adjusts the conversion factor as needed to ensure that updates and adjustments under § 419.50(a) are budget neutral.

    Subpart D—Payments to Hospitals

    Payment concepts.

    (a) In addition to the payment rate described in § 419.32, for each APC group there is a predetermined beneficiary coinsurance amount as described in § 419.41(a). The Medicare program payment amount for each APC group is calculated by applying the program payment percentage as described in § 419.41(b).

    (b) For purposes of this section—

    (1) Coinsurance percentage is calculated as the difference between the program payment percentage and 100 percent. The coinsurance percentage in any year is thus defined for each APC group as the greater of the following: the ratio of the APC group unadjusted copayment amount to the annual APC group payment rate, or 20 percent.

    (2) Program payment percentage is calculated as the lower of the following: the ratio of the APC group payment rate minus the APC group unadjusted coinsurance amount, to the APC group payment rate, or 80 percent.

    (3) Unadjusted coinsurance amount is calculated as 20 percent of the wage-adjusted national median of charges for services within an APC group furnished during 1996, updated to 1999 using an actuarial projection of charge increases for hospital outpatient department services during the period 1996 to 1999.

    (c) Limitation of coinsurance amount to inpatient hospital deductible amount. The coinsurance amount for a procedure performed in a year cannot exceed the amount of the inpatient hospital deductible established under section 1813(b) of the Act for that year.

    Calculation of national beneficiary coinsurance amounts and national Medicare program payment amounts.

    (a) To calculate the unadjusted coinsurance amount for each APC group, HCFA—

    (1) Standardizes 1996 hospital charges for the services within each APC group to offset variations in hospital labor costs across geographic areas;

    (2) Identifies the median of the wage-neutralized 1996 charges for each APC group; and

    (3) Determines the value equal to 20 percent of the wage-neutralized 1996 median charge for each APC group and multiplies that value by an actuarial projection of increases in charges for hospital outpatient department services during the period 1996 to 1999. The result is the unadjusted beneficiary coinsurance amount for the APC group.

    (b) HCFA calculates annually the program payment percentage for every APC group on the basis of each group's unadjusted coinsurance amount and its payment rate after the payment rate is adjusted in accordance with § 419.32.

    (c) To determine payment amounts due for a service paid under the hospital Start Printed Page 18545outpatient prospective payment system, HCFA makes the following calculations:

    (1) Makes the wage index adjustment in accordance with § 419.43.

    (2) Subtracts the amount of the applicable Part B deductible provided under § 410.160 of this chapter.

    (3) Multiplies the remainder by the program payment percentage for the group to determine the preliminary Medicare program payment amount.

    (4) Subtracts the program payment amount from the amount determined in paragraph (c)(2) of this section to determine the coinsurance amount.

    (i) The coinsurance amount for an APC cannot exceed the amount of the inpatient hospital deductible established under section 1813(b) of the Act for that year.

    (ii) The coinsurance amount is computed as if the adjustments under § 419.43(d) and (e) (and any adjustment made under § 419.43(f) in relation to these adjustments) had not been paid.

    (5) Adds the amount by which the coinsurance amount would have exceeded the inpatient hospital deductible for that year to the preliminary Medicare program payment amount determined in paragraph (c)(3) of this section to determine the final Medicare program payment amount.

    Hospital election to reduce coinsurance.

    (a) A hospital may elect to reduce coinsurance for any or all APC groups on a calendar year basis. A hospital may not elect to reduce copayment for some, but not all, services within the same group.

    (b) A hospital must notify its fiscal intermediary of its election to reduce coinsurance no later than—

    (1) June 1, 2000, for coinsurance elections for the period July 1, 2000 through December 31, 2000; or

    (2) December 1 preceding the beginning of each subsequent calendar year.

    (c) The hospital's election must be properly documented. It must specifically identify the APCs to which it applies and the coinsurance amount (within the limits identified below) that the hospital has selected for each group.

    (d) The election of reduced coinsurance remains in effect unchanged during the year for which the election was made.

    (e) In electing reduced coinsurance, a hospital may elect a level that is less than that year's wage-adjusted coinsurance amount for the group but not less than 20 percent of the APC payment rate as determined in § 419.32.

    (f) The hospital may advertise and otherwise disseminate information concerning the reduced level of coinsurance that it has elected. All advertisements and information furnished to Medicare beneficiaries must specify that the coinsurance reductions advertised apply only to the specified services of that hospital and that coinsurance reductions are available only for hospitals that choose to reduce coinsurance for hospital outpatient services and are not allowed in any other ambulatory settings or physician offices.

    Adjustments to national program payment and beneficiary coinsurance amounts.

    (a) General rule. HCFA determines national prospective payment rates for hospital outpatient department services and determines a wage adjustment factor to adjust the portion of the APC payment and national beneficiary coinsurance amount attributable to labor-related costs for relative differences in labor and labor-related costs across geographic regions in a budget neutral manner.

    (b) Labor-related portion of payment and copayment rates for hospital outpatient services. HCFA determines the portion of hospital outpatient costs attributable to labor and labor-related costs (known as the “labor-related portion” of hospital outpatient costs) in accordance with § 419.31(c)(1).

    (c) Wage index factor. HCFA uses the hospital inpatient prospective payment system wage index established in accordance with part 412 of this chapter to make the adjustment referred to in paragraph (a) of this section.

    (d) Outlier adjustment—(1) General rule. Subject to paragraph (d)(4) of this section, HCFA provides for an additional payment for each hospital outpatient service (or group of services) for which a hospital's charges, adjusted to cost, exceed the following:

    (i) A fixed multiple of the sum of—

    (A) The applicable Medicare hospital outpatient payment amount determined under § 419.32(c), as adjusted under § 419.43 (other than for adjustments under this paragraph (d) or paragraph (e) of this section); and

    (B) Any transitional pass-through payment under paragraph (e) of this section.

    (ii) At the option of HCFA, a fixed dollar amount.

    (2) Amount of adjustment. The amount of the additional payment under paragraph (d)(1) of this section is determined by HCFA and approximates the marginal cost of care beyond the applicable cutoff point under paragraph (d)(1) of this section.

    (3) Limit on aggregate outlier adjustments— (i) In general. The total of the additional payments made under this paragraph (d) for covered hospital outpatient department services furnished in a year (as estimated by HCFA before the beginning of the year) may not exceed the applicable percentage specified in paragraph (d)(3)(ii) of this section of the total program payments (sum of both the Medicare and beneficiary payments to the hospital) estimated to be made under this part for all hospital outpatient services furnished in that year. If this paragraph is first applied to less than a full year, the limit applies only to the portion of the year.

    (ii) Applicable percentage. For purposes of paragraph (d)(3)(i) of this section, the term “applicable percentage” means a percentage specified by HCFA up to (but not to exceed)—

    (A) For a year (or portion of a year) before 2004, 2.5 percent; and

    (B) For 2004 and thereafter, 3.0 percent.

    (4) Transitional authority. In applying paragraph (d)(1) of this section for hospital outpatient services furnished before January 1, 2002, HCFA may—

    (i) Apply paragraph (d)(1) of this section to a bill for these services related to an outpatient encounter (rather than for a specific service or group of services) using hospital outpatient payment amounts and transitional pass-through payments covered under the bill; and

    (ii) Use an appropriate cost-to-charge ratio for the hospital or CMHC (as determined by HCFA), rather than for specific departments within the hospital.

    (e) Transitional pass-through for additional costs of innovative medical devices, drugs, and biologicals— (1) General rule. HCFA provides for an additional payment under this paragraph for any of the following that are provided as part of a hospital outpatient service (or group of services):

    (i) Current orphan drugs. A drug or biological that is used for a rare disease or condition with respect to which the drug or biological has been designated as an orphan drug under section 526 of the Federal Food, Drug and Cosmetic Act if payment for the drug or biological as an outpatient hospital service under this part was being made on the first date that the system under this part is implemented.

    (ii) Current cancer therapy drugs and biologicals and brachytherapy. A drug or biological that is used in cancer therapy, including, but not limited to, a chemotherapeutic agent, an antiemetic, Start Printed Page 18546a hematopoietic growth factor, a colony stimulating factor, a biological response modifier, a bisphosphonate, and a device of brachytherapy, if payment for the drug, biological, or device as an outpatient hospital service under this part was being made on the first date that the system under this part is implemented.

    (iii) Current radiopharmaceutical drugs and biological products. A radiopharmaceutical drug or biological product used in diagnostic, monitoring, and therapeutic nuclear medicine procedures if payment for the drug or biological as an outpatient hospital service under this part was being made on the first date that the system under this part is implemented.

    (iv) New medical devices, drugs, and biologicals. A medical device, drug, or biological not described in paragraph (e)(1)(i), (e)(1)(ii), or (e)(1)(iii) of this section if—

    (A) Payment for the device, drug, or biological as an outpatient hospital service under this part was not being made as of December 31, 1996; and

    (B) The cost of the device, drug, or biological is not insignificant (as defined in paragraph (e)(1)(iv)(C) of this section) in relation to the hospital outpatient fee schedule amount (as calculated under § 419.32(c)) payable for the service (or group of services) involved.

    (C) The cost of the device, drug, or biological is considered not insignificant if it meets all of the following thresholds:

    (1) Its expected reasonable cost exceeds 25 percent of the applicable fee schedule amount for the associated service.

    (2) The expected reasonable cost of the new drug, biological, or device must exceed the current portion of the fee schedule amount determined to be associated with the drug, biological, or device by 25 percent.

    (3) The difference between the expected reasonable cost of the item and the portion of the hospital outpatient fee schedule amount determined to be associated with the item exceeds 10 percent of the applicable hospital outpatient fee schedule amount.

    (2) Limited period of payment. The payment under this paragraph (e) with respect to a medical device, drug, or biological applies during a period of at least 2 years, but not more than 3 years, that begins—

    (i) On the first date this section is implemented in the case of a drug, biological, or device described in paragraphs (e)(2)(i), (e)(2)(ii), or (e)(2)(iii) of this section and in the case of a device, drug, or biological described in paragraph (e)(1)(iv) of this section and for which payment under this part is made as an outpatient hospital service before the first date; or

    (ii) In the case of a device, drug, or biological described in paragraph (e)(1)(iv) of this section not described in paragraph (e)(2)(i) of this section, on the first date on which payment is made under this part for the device, drug, or biological as an outpatient hospital service.

    (3) Amount of additional payment. Subject to paragraph (e)(4)(iii) of this section, the amount of the payment under this paragraph is—

    (i) In the case of a drug or biological, the amount by which the amount determined under section 1842(o) of the Act for the drug or biological exceeds the portion of the otherwise applicable Medicare hospital outpatient fee schedule amount that HCFA determines is associated with the drug or biological; or

    (ii) In the case of a medical device, the amount by which the hospital's charges for the device, adjusted to cost, exceeds the portion of the otherwise applicable Medicare hospital outpatient fee schedule amount that HCFA determines is associated with the device.

    (4) Limit on aggregate annual adjustment—(i) General rule. The total of the additional payments made under this paragraph for hospital outpatient services furnished in a year, as estimated by HCFA before the beginning of the year, may not exceed the applicable percentage specified in paragraph (e)(4)(ii) of this section of the total program payments estimated to be made under this section for all hospital outpatient services furnished in that year. If this paragraph is first applied to less than a full year, the limit applies only to the portion of the year.

    (ii) Applicable percentage. For purposes of paragraph (e)(4)(i) of this section, the term “applicable percentage” means—

    (A) For a year (or portion of a year) before 2004, 2.5 percent; and

    (B) For 2004 and thereafter, a percentage specified by HCFA up to (but not to exceed) 2.0 percent.

    (iii) Uniform prospective reduction if aggregate limit projected to be exceeded. If HCFA estimates before the beginning of a year that the amount of the additional payments under this paragraph (e) for the year (or portion thereof) as determined under paragraph (e)(4)(i) of this section without regard to this paragraph (e)(4)(iii) would exceed the limit established under this paragraph (e)(4)(iii), HCFA reduces pro rata the amount of each of the additional payments under this paragraph for that year (or portion thereof) in order to ensure that the aggregate additional payments under this paragraph (as so estimated) do not exceed the limit.

    (f) Budget neutrality. Outlier adjustments under paragraph (d) of this section and transitional pass-through payments under paragraph (e) of this section are established in a budget-neutral manner.

    Payment reductions for surgical procedures.

    (a) Multiple surgical procedures. When more than one surgical procedure for which payment is made under the hospital outpatient prospective payment system is performed during a single surgical encounter, the Medicare program payment amount and the beneficiary copayment amount are based on—

    (1) The full amounts for the procedure with the highest APC payment rate; and

    (2) One-half of the full program and the beneficiary payment amounts for all other covered procedures.

    (b) Terminated procedures. When a surgical procedure is terminated prior to completion due to extenuating circumstances or circumstances that threaten the well-being of the patient, the Medicare program payment amount and the beneficiary copayment amount are based on—

    (1) The full amounts if the procedure is discontinued after the induction of anesthesia or after the procedure is started; or

    (2) One-half of the full program and the beneficiary coinsurance amounts if the procedure is discontinued after the patient is prepared for surgery and taken to the room where the procedure is to be performed but before anesthesia is induced.

    Subpart E—Updates

    Annual review.

    (a) General rule. Not less often than annually, HCFA reviews and updates groups, relative payment weights, and the wage and other adjustments to take into account changes in medical practice, changes in technology, the addition of new services, new cost data, and other relevant information and factors.

    (b) Consultation requirement. HCFA will consult with an expert outside advisory panel composed of an appropriate selection of representatives of providers to review (and advise HCFA concerning) the clinical integrity of the groups and weights. The panel may use data collected or developed by entities and organizations (other than the Department of Health and Human Services) in conducting the review. Start Printed Page 18547

    (c) Effective dates. HCFA conducts the first annual review under paragraph (a) of this section in 2001 for payments made in 2002.

    Subpart F—Limitations on Review

    Limitations on administrative and judicial review.

    There can be no administrative or judicial review under sections 1869 and 1878 of the Act or otherwise of the following:

    (a) The development of the APC system, including—

    (1) Establishment of the groups and relative payment weights;

    (2) Wage adjustment factors;

    (3) Other adjustments; and

    (4) Methods for controlling unnecessary increases in volume.

    (b) The calculation of base amounts described in section 1833(t)(3) of the Act.

    (c) Periodic adjustments described in section 1833(t)(9) of the Act.

    (d) The establishment of a separate conversion factor for hospitals described in section 1886(d)(1)(B)(v) of the Act.

    (e) The determination of the fixed multiple, or a fixed dollar cutoff amount, the marginal cost of care, or applicable percentage under § 419.43(d) or the determination of insignificance of cost, the duration of the additional payments (consistent with § 419.43(e)), the portion of the Medicare hospital outpatient fee schedule amount associated with particular devices, drugs, or biologicals, and the application of any pro rata reduction under § 419.43(e).

    Subpart G—Transitional Corridors

    Transitional adjustment to limit decline in payment.

    (a) Before 2002. Except as provided in paragraph (d) of this section, for covered hospital outpatient services furnished before January 1, 2002, for which the prospective payment system amount (as defined in paragraph (e) of this section) is—

    (1) At least 90 percent, but less than 100 percent, of the pre-BBA amount (as defined in paragraph (f) of this section), the amount of payment under this part is increased by 80 percent of the amount of this difference;

    (2) At least 80 percent, but less than 90 percent, of the pre-BBA amount, the amount of payment under this part is increased by the amount by which the product of 0.71 and the pre-BBA amount exceeds the product of 0.70 and the prospective payment system amount;

    (3) At least 70 percent, but less than 80 percent, of the pre-BBA amount, the amount of payment under this part is increased by the amount by which the product of 0.63 and the pre-BBA amount, exceeds the product of 0.60 and the PPS amount; or

    (4) Less than 70 percent of the pre-BBA amount, the amount of payment under this part shall be increased by 21 percent of the pre-BBA amount.

    (b) For 2002. Except as provided in paragraph (d) of this section, for covered hospital outpatient services furnished during 2002, for which the prospective payment system amount is—

    (1) At least 90 percent, but less than 100 percent, of the pre-BBA amount, the amount of payment under this part is increased by 70 percent of the amount of this difference;

    (2) At least 80 percent, but less than 90 percent, of the pre-BBA amount, the amount of payment under this part is increased by the amount by which the product of 0.61 and the pre-BBA amount exceeds the product of 0.60 and the prospective payment system amount; or

    (3) Less than 80 percent of the pre-BBA amount, the amount of payment under this part is increased by 13 percent of the pre-BBA amount.

    (c) For 2003. Except as provided in paragraph (d) of this section, for covered hospital outpatient services furnished during 2003, for which the prospective payment system amount is—

    (1) At least 90 percent, but less than 100 percent, of the pre-BBA amount, the amount of payment under this part is increased by 60 percent of the amount of this difference; or

    (2) Less than 90 percent of the pre-BBA amount, the amount of payment under this part is increased by 6 percent of the pre-BBA amount.

    (d) Hold harmless provisions— (1) Temporary treatment for small rural hospitals. For covered hospital outpatient services furnished in a calendar year before January 1, 2004 for which the prospective payment system amount is less than the pre-BBA amount, the amount of payment under this part is increased by the amount of that difference if the hospital—

    (i) Is located in a rural area as defined in § 412.63(b) of this chapter or is treated as being located in a rural area under section 1886(d)(8)(E) of the Act; and

    (ii) Has 100 or fewer beds as defined in § 412.105(b) of this chapter.

    (2) Permanent treatment for cancer hospitals. In the case of a hospital described in § 412.23(f) of this chapter for which the prospective payment system amount is less than the pre-BBA amount for covered hospital outpatient services, the amount of payment under this part is increased by the amount of this difference.

    (e) Prospective payment system amount defined. In this paragraph, the term “prospective payment system amount” means, with respect to covered hospital outpatient services, the amount payable under this part for these services (determined without regard to this paragraph or any reduction in coinsurance elected under § 419.42), including amounts payable as copayment under § 419.41, coinsurance under section 1866(a)(2)(A)(ii) of the Act, and the deductible under section 1833(b) of the Act.

    (f) Pre-BBA amount defined— (1) General rule. In this paragraph, the “pre-BBA amount” means, with respect to covered hospital outpatient services furnished by a hospital or a community mental health center (CMHC) in a year, an amount equal to the product of the reasonable cost of the provider for these services for the portions of the provider's cost reporting period (or periods) occurring in the year and the base provider outpatient payment-to-cost ratio for the provider (as defined in paragraph (f)(2) of this section).

    (2) Base payment-to-cost-ratio defined. For purposes of this paragraph, HCFA shall determine these ratios as if the amendments to sections 1833(i)(3)(B)(i)(II) and 1833(n)(1)(B)(i) of the Act made by section 4521 of the BBA, to require that the full amount beneficiaries paid as coinsurance under section 1862(a)(2)(A) of the Act are taken into account in determining Medicare Part B Trust Fund payment to the hospital, were in effect in 1996. The “base payment-to-cost ratio” for a hospital or CMHC means the ratio of—

    (i) The provider's payment under this part for covered outpatient services furnished during the cost reporting period ending in 1996, including any payment for these services through cost-sharing described in paragraph (e) of this section; and

    (ii) The reasonable cost of these services for this period, without applying the cost reductions under section 1861(v)(1)(S) of the Act.

    (g) Interim payments. HCFA makes payments under this paragraph to hospitals and CMHCs on an interim basis, subject to retrospective adjustments based on settled cost reports.

    (h) No effect on coinsurance. No payment made under this section affects the unadjusted coinsurance amount or the coinsurance amount described in § 419.41.

    (i) Application without regard to budget neutrality. The additional payments made under this paragraph— Start Printed Page 18548

    (1) Are not considered an adjustment under § 419.43(f); and

    (2) Are not implemented in a budget neutral manner.

    End Part Start Part

    PART 424—CONDITIONS FOR MEDICARE PAYMENT

    End Part Start Amendment Part

    G. Part 424 is amended as set forth below:

    End Amendment Part Start Amendment Part

    1. The authority citation for part 424 continues to read as follows:

    End Amendment Part Start Authority

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh).

    End Authority Start Amendment Part

    2. In § 424.24, the heading to paragraph (e) is republished, and a new paragraph (e)(3) is added to read as follows:

    End Amendment Part
    Requirements for medical and other health services furnished by providers under Medicare Part B.
    * * * * *

    (e) Partial hospitalization services: Content of certification and plan of treatment requirements

    * * * * *

    (3) Recertification requirements.

    (i) Signature. The physician recertification must be signed by a physician who is treating the patient and has knowledge of the patient's response to treatment.

    (ii) Timing. The first recertification is required as of the 18th day of partial hospitalization services. Subsequent recertifications are required at intervals established by the provider, but no less frequently than every 30 days.

    (iii) Content. The recertification must specify that the patient would otherwise require inpatient psychiatric care in the absence of continued stay in the partial hospitalization program and describe the following:

    (A) The patient's response to the therapeutic interventions provided by the partial hospitalization program.

    (B) The patient's psychiatric symptoms that continue to place the patient at risk of hospitalization.

    (C) Treatment goals for coordination of services to facilitate discharge from the partial hospitalization program.

    * * * * *
    Start Part

    PART 489—PROVIDER AGREEMENTS AND SUPPLIER APPROVAL

    End Part Start Amendment Part

    H. Part 489 is amended as set forth below:

    End Amendment Part Start Amendment Part

    1. The authority citation to part 489 continues to read as follows:

    End Amendment Part Start Authority

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh).

    End Authority

    Subpart B—Essentials of Provider Agreements

    Start Amendment Part

    2. In § 489.20, the introductory text to the section is republished; the introductory text to paragraph (d) is revised; paragraphs (d)(3), (d)(4), and (d)(5) are redesignated as paragraphs (d)(4), (d)(5), and (d)(6), respectively; and a new paragraph (d)(3) is added to read as follows:

    End Amendment Part
    Basic commitments.

    The provider agrees to the following:

    * * * * *

    (d) In the case of a hospital or a CAH that furnishes services to Medicare beneficiaries, either to furnish directly or to make arrangements (as defined in § 409.3 of this chapter) for all Medicare-covered services to inpatients and outpatients of a hospital or a CAH except the following:

    * * * * *

    (3) Nurse practitioner and clinical nurse specialist services, as defined in section 1861(s)(2)(K)(ii) of the Act.

    * * * * *
    Start Amendment Part

    3. In § 489.24, the definition for “Comes to the emergency department” in paragraph (b) is revised, and a new paragraph (i) is added to read as follows:

    End Amendment Part
    Special responsibilities of Medicare hospitals in emergency cases.
    * * * * *

    (b) * * *

    Comes to the emergency department means, with respect to an individual requesting examination or treatment, that the individual is on the hospital property. For purposes of this section, “property” means the entire main hospital campus as defined in § 413.65(b) of this chapter, including the parking lot, sidewalk, and driveway, as well as any facility or organization that is located off the main hospital campus but has been determined under § 413.65 of this chapter to be a department of the hospital. The responsibilities of hospitals with respect to these off-campus facilities or organizations are described in paragraph (i) of this section. Property also includes ambulances owned and operated by the hospital even if the ambulance is not on hospital grounds. An individual in a nonhospital-owned ambulance on hospital property is considered to have come to the hospital's emergency department. An individual in a nonhospital-owned ambulance off hospital property is not considered to have come to the hospital's emergency department even if a member of the ambulance staff contacts the hospital by telephone or telemetry communications and informs the hospital that they want to transport the individual to the hospital for examination and treatment. In these situations, the hospital may deny access if it is in “diversionary status,” that is, it does not have the staff or facilities to accept any additional emergency patients. If, however, the ambulance staff disregards the hospital's instructions and transports the individual on to hospital property, the individual is considered to have come to the emergency department.

    * * * * *

    (i) Off-campus departments. If an individual comes to a facility or organization that is located off the main hospital campus but has been determined under § 416.35 of this chapter to be a department of the hospital and a request is made on the individual's behalf for examination or treatment of a potential emergency medical condition as otherwise described in paragraph (a) of this section, the hospital is obligated in accordance with the rules in this paragraph to provide the individual with an appropriate medical screening examination and any necessary stabilizing treatment or an appropriate transfer.

    (1) Capability of the hospital. The capability of the hospital includes that of the hospital as a whole, not just the capability of the off-campus department. Except for cases described in paragraph (i)(3)(ii) of this section, the obligation of a hospital under this section must be discharged within the hospital as a whole. However, the hospital is not required to locate additional personnel or staff to off-campus departments to be on standby for possible emergencies.

    (2) Protocols for off-campus departments. The hospital must establish protocols for the handling of individuals with potential emergency conditions at off-campus departments. These protocols must provide for direct contact between personnel at the off-campus department and emergency personnel at the main hospital campus and may provide for dispatch of practitioners, when appropriate, from the main hospital campus to the off-campus department to provide screening or stabilization services.

    (i) If the off-campus department is an urgent care center, primary care center, or other facility that is routinely staffed by physicians, RNs, or LPNs, these department personnel must be trained, and given appropriate protocols, for the handling of emergency cases. At least one individual on duty at the off-campus department during its regular hours of operation must be designated Start Printed Page 18549as a qualified medical person as described in paragraph (d) of this section. The qualified medical person must initiate screening of individuals who come to the off-campus department with a potential emergency medical condition, and may be able to complete the screening and provide any necessary stabilizing treatment at the off-campus department, or to arrange an appropriate transfer.

    (ii) If the off-campus department is a physical therapy, radiology, or other facility not routinely staffed with physicians, RNs, or LPNs, the department's personnel must be given protocols that direct them to contact emergency personnel at the main hospital campus for direction. Under this direction, and in accordance with protocols established in advance by the hospital, the personnel at the off-campus department must describe patient appearance and report symptoms and, if appropriate, either arrange transportation of the individual to the main hospital campus in accordance with paragraph (i)(3)(i) of this section or assist in an appropriate transfer as described in paragraphs (i)(3)(ii) and (d)(2) of this section.

    (3) Movement or appropriate transfer from off-campus departments—(i) If the main hospital campus has the capability required by the individual and movement of the individual to the main campus would not significantly jeopardize the life or health of the individual, the personnel at the off-campus department must assist in arranging this movement. Movement of the individual to the main campus of the hospital is not considered a transfer under this section, since the individual is simply being moved from one department of a hospital to another department or facility of the same hospital.

    (ii) If transfer of an individual with a potential emergency condition to a medical facility other than the main hospital campus is warranted, either because the main hospital campus does not have the specialized capability or facilities required by the individual, or because the individual's condition is deteriorating so rapidly that taking the time needed to move the individual to the main hospital campus would significantly jeopardize the life or health of the individual, personnel at the off-campus department must, in accordance with protocols established in advance by the hospital, assist in arranging an appropriate transfer of the individual to a medical facility other than the main hospital. The protocols must include procedures and agreements established in advance with other hospitals or medical facilities in the area of the off-campus department to facilitate these appropriate transfers. Such a transfer would require—

    (A) That there be either a request by or on behalf of the individual as described in paragraph (d)(1)(ii)(A) of this section or a certification by a physician or a qualified medical person as described in paragraph (d)(1)(ii)(B) or (d)(1)(ii)(C) of this section; and

    (B) That the transfer comply with the requirements described in paragraph (d)(2) of this section.

    (iii) If the individual is being appropriately transferred to another medical facility from the off-campus department, the requirement for the provision of medical treatment in paragraph (d)(2)(i) of this section would be met by provision of medical treatment within the capability of the transferring off-campus department.

    Start Part

    PART 498—APPEALS PROCEDURES FOR DETERMINATIONS THAT AFFECT PARTICIPATION IN THE MEDICARE PROGRAM AND FOR DETERMINATIONS THAT AFFECT THE PARTICIPATION OF ICFs/MR AND CERTAIN NFs IN THE MEDICAID PROGRAM

    End Part Start Amendment Part

    I. Part 498 is amended as set forth below:

    End Amendment Part Start Amendment Part

    1. The authority citation for part 498 continues to read as follows:

    End Amendment Part Start Authority

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh).

    End Authority Start Amendment Part

    2. In § 498.2, the introductory text is republished, and the definition of “Provider” is revised to read as follows:

    End Amendment Part
    Definitions.

    As used in this part—

    * * * * *

    Provider means a hospital, critical access hospital (CAH), skilled nursing facility (SNF), comprehensive outpatient rehabilitation facility (CORF), home health agency (HHA), or hospice, that has in effect an agreement to participate in Medicare, that has in effect an agreement to participate in Medicaid, or a clinic, rehabilitation agency, or public health agency that has a similar agreement but only to furnish outpatient physical therapy or outpatient speech pathology services, and prospective provider means any of the listed entities that seeks to participate in Medicare as a provider or to have any facility or organization determined to be a department of the provider or provider-based entity under § 413.65 of this chapter.

    * * * * *
    Start Amendment Part

    3. In § 498.3, the introductory text to paragraph (b) is republished; paragraphs (b)(2) through (b)(15) are redesignated as paragraphs (b)(3) through (b)(16), respectively; and a new paragraph (b)(2) is added to read as follows:

    End Amendment Part
    Scope and applicability.
    * * * * *

    (b) Initial determinations by HCFA. HCFA makes initial determinations with respect to the following matters:

    * * * * *

    (2) Whether a prospective department of a provider, remote location of a hospital, satellite facility, or provider-based entity qualifies for provider-based status under § 413.65 of this chapter, or whether such a facility or entity currently treated as a department of a provider, remote location of a hospital, satellite facility, or a provider-based entity no longer qualifies for that status under § 413.65 of this chapter.

    * * * * *
    Start Part

    PART 1003—CIVIL MONEY PENALTIES, ASSESSMENTS AND EXCLUSIONS

    End Part Start Amendment Part

    J. Part 1003 is amended as set forth below:

    End Amendment Part Start Amendment Part

    1. The authority citation for part 1003 is revised to read as follows:

    End Amendment Part Start Authority

    Authority: 42 U.S.C. 1302, 1320-7, 1320a-7a, 1320a-7e, 1320b-10, 1395u(j), 1395u(k), 1395cc(g), 1395dd(d)(1), 1395mm, 1395nn(g), 1395ss(d), 1396(m), 11131(c), and 11137(b)(2).

    End Authority Start Amendment Part

    2. Section 1003.100 is amended by revising paragraph (a), by republishing the introductory text to paragraphs (b) and (b)(1), by revising paragraphs (b)(1)(xi) and (b)(1)(xii), and by adding paragraph (b)(1)(xiii) to read as follows:

    End Amendment Part
    Basis and purpose.

    (a) Basis. This part implements sections 1128(c), 1128A, 1128E, 1140, 1866(g), 1876(i), 1877(g), 1882(d) and 1903(m)(5) of the Social Security Act, and sections 421(c) and 427(b)(2) of Pub. L. 99-660 (42 U.S.C. 1320a-7, 1320a-7a, 1320a-7e, 1320a-7c, 1320b-10, 1395cc(g), 1395mm, 1395ss(d), 1396(m), 11131(c), and 11137(b)(2)).

    (b) Purpose. This part—

    (1) Provides for the imposition of civil money penalties and, as applicable, assessments against persons who—

    * * * * *

    (xi) Are physicians or entities that enter into an arrangement or scheme that they know or should know has as a principal purpose the assuring of referrals by the physician to a particular entity that, if made directly, would violate the provisions of § 411.353 of this title; Start Printed Page 18550

    (xii) Violate the Federal health care programs' anti-kickback statute as set forth in section 1128B of the Act; or

    (xiii) Knowingly and willfully present, or cause to be presented, a bill or request for payment for nonphysician services furnished to hospital patients (unless the services are furnished by the hospital, either directly or under an arrangement) in violation of sections 1862(a)(14) and 1866(a)(1)(H) of the Act.

    * * * * *
    Start Amendment Part

    3. Section 1003.102 is amended by republishing the introductory text to paragraph (b), by adding and reserving paragraphs (b)(12) through (b)(14), and by adding a new paragraph (b)(15) to read as follows:

    End Amendment Part
    Basis for civil money penalties and assessments.
    * * * * *

    (b) The OIG may impose a penalty, and where authorized, an assessment against any person (including an insurance company in the case of paragraphs (b)(5) and (b)(6) of this section) whom it determines in accordance with this part—

    * * * * *

    (15) Has knowingly and willfully presented, or caused to be presented, a bill or request for payment for items and services furnished to a hospital patient for which payment may be made under the Medicare or another Federal health care program, if that bill or request is inconsistent with an arrangement under section 1866(a)(1)(H) of the Act, or violates the requirements for such an arrangement.

    * * * * *
    Start Amendment Part

    4. Section 1003.103 is amended by revising paragraph (a), by adding and reserving paragraphs (i) and (j), and by adding a new paragraph (k) to read as follows:

    End Amendment Part
    Amount of penalty.

    (a) Except as provided in paragraphs (b) and (d) through (k) of this section, the OIG may impose a penalty of not more than $10,000 for each item or service that is subject to a determination under § 1003.102.

    * * * * *

    (k) For violations of section 1862(a)(14) of the Act and § 1003.102(b)(15), the OIG may impose a penalty of not more than $2,000 for each bill or request for payment for items and services furnished to a hospital patient.

    Start Amendment Part

    5. Section 1003.105 is amended by republishing the introductory text to paragraph (a)(1) and by revising paragraph (a)(1)(i) to read as follows:

    End Amendment Part
    Exclusion from participation in Medicare, Medicaid and other Federal health care programs.

    (a)(1) Except as set forth in paragraph (b) of this section, in lieu of or in addition to any penalty or assessment, the OIG may exclude from participation in Medicare, Medicaid and other Federal health care programs the following persons for a period of time determined under § 1003.107—

    (i) Any person who is subject to a penalty or assessment under § 1003.102(a), (b)(1) through (b)(4), or (b)(15).

    * * * * *
    Start Signature

    (Catalog of Federal Domestic Assistance 93.774, Medicare—Supplementary Medical Insurance Program)

    Dated: March 3, 2000.

    Nancy-Ann Min DeParle,

    Administrator, Health Care Financing Administration.

    Dated: March 28, 2000.

    June G. Brown,

    Inspector General, Department of Health and Human Services.

    Approved: March 29, 2000.

    Donna E. Shalala,

    Secretary.

    End Signature

    Note:

    The following addenda will not appear in the Code of Federal Regulations.

    Note to Addenda A, B, C, E and F:

    Addenda A, B, and C have a number of errors in the following columns: APC, status indicator, payment rate, and national unadjusted coinsurance and minimum unadjusted coinsurance. We identified these errors too late in preparing this rule for publication to correct them. Some of the errors are related to the status codes assigned to the HCPCS codes and APCs.

    Some errors affect addenda B, C, and E. Several of these errors involve procedures incorrectly identified as inpatient procedures, and one inpatient procedure incorrectly identified as an outpatient procedure. Certain PET scan codes and other codes are shown in incorrect APCs. Screening sigmoidoscopy and colonoscopy APCs have the wrong HCPCS codes and incorrect payment rates and coinsurance amounts. Certain dental codes were inadvertently identified as errors, so their correct APC assignments, payment rate and coinsurance amounts were not shown in the addenda. Two breath tests are subject to the clinical diagnostic lab fee schedule. We have listed below the corrections that have payment implications.

    Addendum F does not include status indicators G and H which identify items that are eligible for pass-through payments. (See section III.B.3 of the preamble for a complete description of all status indications used in conjunction with this final rule.)

    We also note that the word “proposed” should not appear on any Addenda contained in this final rule such as on Addendum A or C.

    The fiscal intermediaries will receive the necessary changes to process outpatient PPS claims correctly. We will post the corrected Addendum B on our Website and publish a correction document in the Federal Register.

    Our Website address is http://www.hcfa.gov/​medicare/​hopsmain.htm.

    List Accompanying Note To Addenda A, B, C, E and F

    CPT/ HCPCSHOPD Status IndicatorDescriptionAPCRelative WeightProposed Payment RateNational Unadjusted CoinsuranceMinimum Unadjusted Coinsurance
    20979EUS bone stimulation
    31375CPartial removal of larynx
    35481TAtherectomy, open008119.36$938.71$434.25$187.74
    61795SBrain surgery using computer03028.21$398.08$216.55$79.62
    61886TImplant neurostim arrays022225.48$1,235.45$780.07$247.09
    75945SIntravascular us02672.72$131.88$80.06$26.38
    75946SIntravascular us add-on02672.72$131.88$80.06$26.38
    78267ABreath test attain/anal, c-14
    78268ABreath test analysis, c-14
    92978SIntravasc us, heart add-on02672.72$131.88$80.06$26.38
    92979SIntravasc us, heart add-on02672.72$131.88$80.06$26.38
    96570TPhotodynamic Tx, 30 min09735.16$250.19$50.04
    96571TPhotodynamic Tx, addl 15 min09735.16$250.19$50.04
    D0277SVert bitewings-sev to eight03301.51$73.22$14.64$14.64
    D0472SGross exam, prep & report03301.51$73.22$14.64$14.64
    Start Printed Page 18551
    D0473SMicro exam, prep & report03301.51$73.22$14.64$14.64
    D0474SMicro w exam of surg margins03301.51$73.22$14.64$14.64
    D0480SCytopath smear prep & report03301.51$73.22$14.64$14.64
    D4268SSurgical revision procedure03301.51$73.22$14.64$14.64
    G0104SCA screen; flexible sigmoidscope01592.83$137.22$34.31
    G0105SColorectal screen; high risk ind01587.98$386.93$96.73
    G0122SColon ca scrn; barium enema01571.79$86.79$17.36
    G0125SLung Image (PET)098146.40$2,249.80$449.96
    G0126SLung Image (PET) staging098146.40$2,249.80$449.96
    G0163SPET for rec of colorectal cancer098146.40$2,249.80$449.96
    G0164SPET for lymphoma staging098146.40$2,249.80$449.96
    G0165SPET, rec of melanoma/met cancer098146.40$2,249.80$449.96
    G0168TWound closure by adhesive09700.52$25.21$5.04
    G0169TRemoval tissue; no anesthesia00130.91$44.12$17.66$8.82
    G0170TSkin biograft00253.74$181.34$70.66$36.27
    G0171TSkin biograft add-on00253.74$181.34$70.66$36.27
    —————————— 1 Not subject to national coinsurance. Minimum unadjusted coinsurance is 25% of the payment rate. The Payment rate is the lower of the HOPD payment rate or the Ambulatory Surgical Center payment.   2 Not subject to national coinsurance. 3 Eligible for pass-through payments. See Preamble for payment rate determination. See Addendum K for complete list of pass-through codes. Start Printed Page 18551

    Addendum A.—List of Hospital Outpatient Ambulatory Payment Classes With Status Indicators, Relative Weights, Payment Rates, and Coinsurance Amounts

    APCGroup TitleStatus IndicatorRelative WeightPayment RateNational Unadjusted CoinsuranceMinimum Unadjusted Coinsurance
    0001PhotochemotherapyS0.47$22.79$8.49$4.56
    0002Fine needle Biopsy/AspirationT0.62$30.06$17.66$6.01
    0003Bone Marrow Biopsy/AspirationT0.98$47.52$27.99$9.50
    0004Level I Needle Biopsy/Aspiration Except Bone MarrowT1.84$89.22$32.57$17.84
    0005Level II Needle Biopsy/Aspiration Except Bone MarrowT5.41$262.32$119.75$52.46
    0006Level I Incision & DrainageT2.00$96.97$33.95$19.39
    0007Level II Incision & DrainageT3.68$178.43$72.03$35.69
    0008Level III Incision & DrainageT6.15$298.20$113.67$59.64
    0009Nail ProceduresT0.74$35.88$9.63$7.18
    0010Level I Destruction of LesionT0.55$26.67$9.86$5.33
    0011Level II Destruction of LesionT2.72$131.88$50.01$26.38
    0012Level I Debridement & DestructionT0.53$25.70$9.18$5.14
    0013Level II Debridement & DestructionT0.91$44.12$17.66$8.82
    0014Level III Debridement & DestructionT1.50$72.73$24.55$14.55
    0015Level IV Debridement & DestructionT1.77$85.82$31.20$17.16
    0016Level V Debridement & DestructionT3.53$171.16$74.67$34.23
    0017Level VI Debridement & DestructionT12.45$603.66$289.16$120.73
    0018Biopsy Skin, Subcutaneous Tissue or Mucous MembraneT0.94$45.58$17.66$9.12
    0019Level I Excision/BiopsyT4.00$193.95$78.91$38.79
    0020Level II Excision/BiopsyT6.51$315.65$130.53$63.13
    0021Level III Excision/BiopsyT10.49$508.63$236.51$101.73
    0022Level IV Excision/BiopsyT12.49$605.60$292.94$121.12
    0023Exploration Penetrating WoundT1.98$96.00$40.37$19.20
    0024Level I Skin RepairT2.43$117.82$44.50$23.56
    0025Level II Skin RepairT3.74$181.34$70.66$36.27
    0026Level III Skin RepairT12.11$587.18$277.92$117.44
    0027Level IV Skin RepairT15.80$766.10$383.10$153.22
    0029Incision/Excision BreastT12.85$623.06$303.50$124.61
    0030Breast Reconstruction/MastectomyT20.19$978.95$523.95$195.79
    0031Hyperbaric OxygenS3.00$145.46$140.85$29.09
    0032Placement Transvenous Catheters/Arterial CutdownT5.40$261.83$119.52$52.37
    0033Partial HospitalizationP4.17$202.19$48.17$40.44
    0040Arthrocentesis & Ligament/Tendon InjectionT2.11$102.31$40.60$20.46
    0041ArthroscopyT24.57$1,191.33$592.08$238.27
    0042Arthroscopically-Aided ProceduresT29.22$1,416.79$804.74$283.36
    0043Closed Treatment Fracture Finger/Toe/TrunkT1.64$79.52$25.46$15.90
    0044Closed Treatment Fracture/Dislocation Except Finger/Toe/TrunkT2.17$105.22$38.08$21.04
    0045Bone/Joint Manipulation Under AnesthesiaT11.02$534.33$277.12$106.87
    0046Open/Percutaneous Treatment Fracture or DislocationT22.29$1,080.78$535.76$216.16
    0047Arthroplasty without ProsthesisT22.09$1,071.08$537.03$214.22
    0048Arthroplasty with ProsthesisT29.06$1,409.03$725.94$281.81
    0049Level I Musculoskeletal Procedures Except Hand and FootT15.04$729.25$356.95$145.85
    0050Level II Musculoskeletal Procedures Except Hand and FootT21.13$1,024.53$513.86$204.91
    0051Level III Musculoskeletal Procedures Except Hand and FootT27.76$1,346.00$675.24$269.20
    0052Level IV Musculoskeletal Procedures Except Hand and FootT36.16$1,753.29$930.91$350.66
    0053Level I Hand Musculoskeletal ProceduresT11.32$548.87$253.49$109.77
    0054Level II Hand Musculoskeletal ProceduresT19.66$953.26$472.33$190.65
    0055Level I Foot Musculoskeletal ProceduresT15.47$750.10$355.34$150.02
    0056Level II Foot Musculoskeletal ProceduresT17.30$838.83$405.81$167.77
    Start Printed Page 18552
    0057Bunion ProceduresT21.00$1,018.23$496.65$203.65
    0058Level I Strapping and Cast ApplicationS1.09$52.85$19.27$10.57
    0059Level II Strapping and Cast ApplicationS1.74$84.37$29.59$16.87
    0060Manipulation TherapyS0.77$37.34$7.80$7.47
    0070Thoracentesis/Lavage ProceduresT3.64$176.49$79.60$35.30
    0071Level I Endoscopy Upper AirwayT0.55$26.67$14.22$5.33
    0072Level II Endoscopy Upper AirwayT1.26$61.09$41.52$12.22
    0073Level III Endoscopy Upper AirwayT4.11$199.28$91.07$39.86
    0074Level IV Endoscopy Upper AirwayT13.61$659.91$347.54$131.98
    0075Level V Endoscopy Upper AirwayT18.55$899.44$467.29$179.89
    0076Endoscopy Lower AirwayT8.06$390.81$197.05$78.16
    0077Level I Pulmonary TreatmentS0.43$20.85$12.62$4.17
    0078Level II Pulmonary TreatmentS1.34$64.97$29.13$12.99
    0079Ventilation Initiation and ManagementS3.18$154.19$107.70$30.84
    0080Diagnostic Cardiac CatheterizationT25.77$1,249.51$713.89$249.90
    0081Non-Coronary Angioplasty or AtherectomyT19.36$938.71$434.25$187.74
    0082Coronary AtherectomyT40.34$1,955.97$859.56$391.19
    0083Coronary AngiosplastyT45.79$2,220.22$1,322.95$444.04
    0084Level I Electrophysiologic EvaluationS10.70$518.81$177.79$103.76
    0085Level II Electrophysiologic EvaluationS27.06$1,312.06$654.48$262.41
    0086Ablate Heart Dysrhythm FocusS47.62$2,308.95$1,265.37$461.79
    0087Cardiac Electrophysiologic Recording/MappingS9.53$462.08$214.72$92.42
    0088ThrombectomyT26.49$1,284.42$678.68$256.88
    0089Level I Implantation/Removal/Revision of Pacemaker, AICD or Vascular DeviceT6.49$314.68$130.07$62.94
    0090Level II Implantation/Removal/Revision of Pacemaker, AICD or Vascular DeviceT20.96$1,016.29$573.04$203.26
    0091Level I Vascular LigationT14.79$717.12$348.23$143.42
    0092Level II Vascular LigationT20.21$979.92$505.37$195.98
    0093Vascular Repair/Fistula ConstructionT17.95$870.34$422.33$174.07
    0094Resuscitation and CardioversionS4.51$218.68$105.29$43.74
    0095Cardiac RehabilitationS0.64$31.03$16.98$6.21
    0096Non-Invasive Vascular StudiesS2.06$99.88$61.48$19.98
    0097Cardiovascular Stress TestS1.62$78.55$62.40$15.71
    0098Injection of Sclerosing SolutionT1.19$57.70$20.88$11.54
    0099Continuous Cardiac MonitoringS0.38$18.43$14.68$3.69
    0100Continuous ECGS1.70$82.43$71.57$16.49
    0101Tilt Table EvaluationS4.47$216.74$128.84$43.35
    0102Electronic Analysis of Pacemakers/other DevicesS0.45$21.82$12.62$4.36
    0109Bone Marrow Harvesting and Bone Marrow/Stem Cell TransplantS4.13$200.25$40.05$40.05
    0110TransfusionS5.83$282.68$122.73$56.54
    0111Blood Product ExchangeS14.17$687.06$300.74$137.41
    0112Extracorporeal PhotopheresisS39.60$1,920.09$663.65$384.02
    0113Excision Lymphatic SystemT13.89$673.49$326.55$134.70
    0114Thyroid/Lymphadenectomy ProceduresT19.56$948.41$493.78$189.68
    0116Chemotherapy Administration by Other Technique Except InfusionS2.34$113.46$22.69$22.69
    0117Chemotherapy Administration by Infusion OnlyS1.84$89.22$71.80$17.84
    0118Chemotherapy Administration by Both Infusion and Other TechniqueS2.90$140.61$72.03$28.12
    0120Infusion Therapy Except ChemotherapyS1.66$80.49$42.67$16.10
    0121Level I Tube changes and RepositioningT2.36$114.43$52.53$22.89
    0122Level II Tube changes and RepositioningT5.04$244.37$114.93$48.88
    0123Level III Tube changes and RepositioningT13.89$673.49$350.75$134.70
    0130Level I LaparoscopyT25.36$1,229.63$659.53$245.93
    0131Level II LaparoscopyT41.81$2,027.24$1,089.88$405.45
    0132Level III LaparoscopyT48.91$2,371.50$1,239.22$474.30
    0140Esophageal Dilation without EndoscopyT4.74$229.83$107.24$45.97
    0141Upper GI ProceduresT7.15$346.68$184.67$69.34
    0142Small Intestine EndoscopyT7.45$361.23$162.42$72.25
    0143Lower GI EndoscopyT7.98$386.93$199.12$77.39
    0144Diagnostic AnoscopyT2.23$108.13$49.32$21.63
    0145Therapeutic AnoscopyT7.46$361.71$179.39$72.34
    0146Level I SigmoidoscopyT2.83$137.22$65.15$27.44
    0147Level II SigmoidoscopyT6.26$303.53$149.11$60.71
    0148Level I Anal/Rectal ProcedureT2.34$113.46$43.59$22.69
    0149Level II Anal/Rectal ProcedureT12.86$623.54$293.06$124.71
    0150Level III Anal/Rectal ProcedureT17.68$857.25$437.12$171.45
    0151Endoscopic Retrograde Cholangio-Pancreatography (ERCP)T10.53$510.57$245.46$102.11
    0152Percutaneous Biliary Endoscopic ProceduresT8.22$398.56$207.38$79.71
    0153Peritoneal and Abdominal ProceduresT19.62$951.32$496.31$190.26
    0154Hernia/Hydrocele ProceduresT22.43$1,087.57$556.98$217.51
    2 0157Colorectal Cancer Screening: Barium EnemaS1.79$86.79$17.36
    1 0158Colorectal Cancer Screening: ColonoscopyS7.98$386.93$96.73
    1 0159Colorectal Cancer Screening: Flexible SigmoidoscopyS7.98$137.22$34.31
    Start Printed Page 18553
    0160Level I Cystourethroscopy and other Genitourinary ProceduresT5.43$263.28$110.11$52.66
    0161Level II Cystourethroscopy and other Genitourinary ProceduresT10.94$530.45$249.36$106.09
    0162Level III Cystourethroscopy and other Genitourinary ProceduresT17.49$848.04$427.49$169.61
    0163Level IV Cystourethroscopy and other Genitourinary ProceduresT28.98$1,405.16$792.58$281.03
    0164Level I Urinary and Anal ProceduresT2.17$105.23$33.03$21.05
    0165Level II Urinary and Anal ProceduresT3.89$188.61$91.76$37.72
    0166Level I Urethral ProceduresT10.17$493.11$218.73$98.62
    0167Level II Urethral ProceduresT21.06$1,021.14$555.84$204.23
    0168Level III Urethral ProceduresT24.94$1,209.27$536.11$241.85
    0169LithotripsyT46.72$2,265.32$1,384.20$453.06
    0170Dialysis for Other Than ESRD PatientsS6.68$323.89$72.26$64.78
    0180CircumcisionT13.62$660.39$304.87$132.08
    0181Penile ProceduresT32.37$1,569.53$906.36$313.91
    0182Insertion of Penile ProsthesisT52.11$2,526.66$1,525.05$505.33
    0183Testes/Epididymis ProceduresT18.26$885.37$448.94$177.07
    0184Prostate BiopsyT4.94$239.53$122.96$47.91
    0190Surgical HysteroscopyT17.85$865.49$443.89$173.10
    0191Level I Female Reproductive ProceduresT1.19$57.70$17.43$11.54
    0192Level II Female Reproductive ProceduresT2.38$115.40$35.33$23.08
    0193Level III Female Reproductive ProceduresT8.93$432.99$171.13$86.60
    0194Level IV Female Reproductive ProceduresT16.21$785.98$395.94$157.20
    0195Level V Female Reproductive ProceduresT18.68$905.74$483.80$181.15
    0196Dilatation & CurettageT14.47$701.61$357.98$140.32
    0197Infertility ProceduresT2.40$116.37$49.55$23.27
    0198Pregnancy and Neonatal Care ProceduresT1.34$64.97$33.03$12.99
    0199Vaginal DeliveryT11.20$543.06$157.83$108.61
    0200Therapeutic AbortionT13.89$673.49$373.23$134.70
    0201Spontaneous AbortionT13.00$630.33$329.65$126.07
    0210Spinal TapT3.00$145.46$62.40$29.09
    0211Level I Nervous System InjectionsT3.32$160.98$74.78$32.20
    0212Level II Nervous System InjectionsT3.64$176.49$88.78$35.30
    0213Extended EEG Studies and Sleep StudiesS11.15$540.63$290.42$108.13
    0214ElectroencephalogramS2.32$112.49$58.50$22.50
    0215Level I Nerve and Muscle TestsS1.15$55.76$30.05$11.15
    0216Level II Nerve and Muscle TestsS2.87$139.16$64.69$27.83
    0217Level III Nerve and Muscle TestsS5.87$284.62$156.68$56.92
    0220Level I Nerve ProceduresT13.96$676.88$326.21$135.38
    0221Level II Nerve ProceduresT18.36$890.22$463.62$178.04
    0222Implantation of Neurological DeviceT25.48$1,235.45$780.07$247.09
    0223Level I Revision/Removal Neurological DeviceT6.34$307.41$153.24$61.48
    0224Level II Revision/Removal Neurological DeviceT15.94$772.88$374.61$154.58
    0225Implantation of Neurostimulator ElectrodesT3.43$166.31$64.46$33.26
    0230Level I Eye TestsS0.98$47.52$22.48$9.50
    0231Level II Eye TestsS2.64$128.01$59.87$25.60
    0232Level I Anterior Segment EyeT6.04$292.86$134.66$58.57
    0233Level II Anterior Segment EyeT13.79$668.64$331.60$133.73
    0234Level III Anterior Segment Eye ProceduresT20.64$1,000.77$502.16$200.15
    0235Level I Posterior Segment Eye ProceduresT2.94$142.55$78.91$28.51
    0236Level II Posterior Segment Eye ProceduresT6.70$324.86$147.96$64.97
    0237Level III Posterior Segment Eye ProceduresT33.96$1,646.62$852.68$329.32
    0238Level I Repair and Plastic Eye ProceduresT2.80$135.76$58.96$27.15
    0239Level II Repair and Plastic Eye ProceduresT6.26$303.53$123.42$60.71
    0240Level III Repair and Plastic Eye ProceduresT13.47$653.12$315.31$130.62
    0241Level IV Repair and Plastic Eye ProceduresT16.60$804.89$384.47$160.98
    0242Level V Repair and Plastic Eye ProceduresT23.70$1,149.14$597.36$229.83
    0243Strabismus/Muscle ProceduresT17.99$872.28$431.39$174.46
    0244Corneal TransplantT32.88$1,594.26$851.42$318.85
    0245Cataract Procedures without IOL InsertT26.55$1,287.33$623.85$257.47
    0246Cataract Procedures with IOL InsertT26.55$1,287.33$623.85$257.47
    0247Laser Eye Procedures Except RetinalT4.89$237.10$112.86$47.42
    0248Laser Retinal ProceduresT4.19$203.16$94.05$40.63
    0250Nasal Cauterization/PackingT2.21$107.16$38.54$21.43
    0251Level I ENT ProceduresT1.68$81.46$27.99$16.29
    0252Level II ENT ProceduresT5.18$251.16$114.24$50.23
    0253Level III ENT ProceduresT12.02$582.81$284.00$116.56
    0254Level IV ENT ProceduresT12.45$603.66$272.41$120.73
    0256Level V ENT ProceduresT25.40$1,231.57$623.05$246.31
    0257Implantation of Cochlear DeviceT115.31$5,591.04$3,498.58$1,118.21
    0258Tonsil and Adenoid ProceduresT18.62$902.83$462.81$180.57
    0260Level I Plain Film Except TeethX0.79$38.30$22.02$7.66
    0261Level II Plain Film Except Teeth Including Bone Density MeasurementX1.38$66.91$38.77$13.38
    0262Plain Film of TeethX0.40$19.39$10.90$3.88
    Start Printed Page 18554
    0263Level I Miscellaneous Radiology ProceduresX1.68$81.46$45.88$16.29
    0264Level II Miscellaneous Radiology ProceduresX3.83$185.71$108.97$37.14
    0265Level I Diagnostic Ultrasound Except VascularS1.17$56.73$38.08$11.35
    0266Level II Diagnostic Ultrasound Except VascularS1.79$86.79$57.35$17.36
    0267Vascular UltrasoundS2.72$131.88$80.06$26.38
    0268Guidance Under UltrasoundX2.23$108.13$69.51$21.63
    0269Echocardiogram Except TransesophagealS4.40$213.34$114.01$42.67
    0270Transesophageal EchocardiogramS5.55$269.10$150.26$53.82
    0271MammographyS0.70$33.94$19.50$6.79
    0272Level I FluoroscopyX1.40$67.88$39.00$13.58
    0273Level II FluoroscopyX2.49$120.73$61.02$24.15
    0274MyelographyS4.83$234.19$128.12$46.84
    0275ArthrographyS2.74$132.85$72.26$26.57
    0276Level I Digestive RadiologyS1.79$86.79$49.78$17.36
    0277Level II Digestive RadiologyS2.47$119.76$69.28$23.95
    0278Diagnostic UrographyS2.85$138.19$81.67$27.64
    0279Level I Diagnostic Angiography and Venography Except ExtremityS6.30$305.47$174.57$61.09
    0280Level II Diagnostic Angiography and Venography Except ExtremityS14.98$726.34$380.12$145.27
    0281Venography of ExtremityS4.40$213.34$115.16$42.67
    0282Level I Computerized Axial TomographyS2.38$115.40$94.51$23.08
    0283Level II Computerized Axial TomographyS4.89$237.10$179.39$47.42
    0284Magnetic Resonance ImagingS8.02$388.87$257.39$77.77
    0285Positron Emission Tomography (PET)S15.06$730.22$415.21$146.04
    0286Myocardial ScansS7.28$352.99$200.04$70.60
    0290Standard Non-Imaging Nuclear MedicineS1.94$94.06$55.51$18.81
    0291Level I Diagnostic Nuclear Medicine Excluding Myocardial ScansS3.15$152.73$93.14$30.55
    0292Level II Diagnostic Nuclear Medicine Excluding Myocardial ScansS4.36$211.40$126.63$42.28
    0294Level I Therapeutic Nuclear MedicineS5.13$248.74$144.06$49.75
    0295Level II Therapeutic Nuclear MedicineS19.85$962.47$609.17$192.49
    0296Level I Therapeutic Radiologic ProceduresS3.57$173.10$100.25$34.62
    0297Level II Therapeutic Radiologic ProceduresS6.13$297.23$172.51$59.45
    0300Level I Radiation TherapyS1.98$96.00$47.72$19.20
    0301Level II Radiation TherapyS2.21$107.16$52.53$21.43
    0302Level III Radiation TherapyS8.21$398.08$216.55$79.62
    0303Treatment Device ConstructionX2.83$137.22$69.28$27.44
    0304Level I Therapeutic Radiation Treatment PreparationX1.49$72.25$41.52$14.45
    0305Level II Therapeutic Radiation Treatment PreparationX4.06$196.86$97.50$39.37
    0310Level III Therapeutic Radiation Treatment PreparationX13.98$677.85$339.05$135.57
    0311Radiation Physics ServicesX1.32$64.00$31.66$12.80
    0312Radioelement ApplicationsS4.09$198.31$109.65$39.66
    0313BrachytherapyS7.89$382.56$164.02$76.51
    0314Hyperthermic TherapiesS5.88$285.10$150.95$57.02
    0320Electroconvulsive TherapyS3.68$178.43$80.06$35.69
    0321Biofeedback and Other TrainingS1.26$61.09$29.25$12.22
    0322Brief Individual PsychotherapyS1.32$64.00$14.22$12.80
    0323Extended Individual PsychotherapyS1.85$89.70$22.48$17.94
    0324Family PsychotherapyS1.87$90.67$20.19$18.13
    0325Group PsychotherapyS1.55$75.16$19.96$15.03
    0330Dental ProceduresS1.51$73.22$14.64$14.64
    0340Minor Ancillary ProceduresX1.04$50.43$12.85$10.09
    0341Immunology TestsX0.13$6.30$3.67$1.26
    0342Level I PathologyX0.26$12.61$8.03$2.52
    0343Level II PathologyX0.45$21.82$12.16$4.36
    0344Level III PathologyX0.79$38.30$23.63$7.66
    2 0354Administration of Influenza VaccineX0.13$6.19
    0355Level I ImmunizationsX0.19$9.21$5.05$1.84
    0356Level II ImmunizationsX0.36$17.46$4.82$3.49
    0357Level III ImmunizationsX1.85$89.70$38.31$17.94
    0358Level IV ImmunizationsX6.98$338.44$126.74$67.69
    0359InjectionsX0.96$46.55$9.31$9.31
    0360Level I Alimentary TestsX1.38$66.91$34.75$13.38
    0361Level II Alimentary TestsX3.53$171.16$88.09$34.23
    0362Fitting of Vision AidsX0.51$24.73$9.63$4.95
    0363Otorhinolaryngologic Function TestsX2.83$137.22$53.22$27.44
    0364Level I AudiometryX0.68$32.97$13.31$6.59
    0365Level II AudiometryX1.47$71.28$22.48$14.26
    0366Electrocardiogram (ECG)X0.38$18.43$15.60$3.69
    0367Level I Pulmonary TestX0.83$40.24$20.65$8.05
    0368Level II Pulmonary TestsX1.66$80.49$42.44$16.10
    0369Level III Pulmonary TestsX2.34$113.46$58.50$22.69
    0370Allergy TestsX0.57$27.64$11.81$5.53
    0371Allergy InjectionsX0.32$15.52$3.67$3.10
    0372Therapeutic PhlebotomyX0.43$20.85$10.09$4.17
    Start Printed Page 18555
    0373Neuropsychological TestingX3.21$155.64$44.96$31.13
    0374Monitoring Psychiatric DrugsX1.17$56.73$13.08$11.35
    0600Low Level Clinic VisitsV0.98$47.52$9.50$9.50
    0601Mid Level Clinic VisitsV1.00$48.49$9.70$9.70
    0602High Level Clinic VisitsV1.66$80.49$16.29$16.10
    0603Interdisciplinary Team ConferenceV1.66$80.49$16.29$16.10
    0610Low Level Emergency VisitsV1.34$64.97$20.65$12.99
    0611Mid Level Emergency VisitsV2.11$102.31$36.47$20.46
    0612High Level Emergency VisitsV3.19$154.67$54.14$30.93
    0620Critical CareS8.60$416.99$152.78$83.40
    3 0701StrontiumX$84.76
    3 0702SamariamX$139.06
    3 0704Satumomab PendetideX$63.13
    3 0705Tc99 TetrofosminX$71.08
    3 0725Leucovorin CalciumX$1.07
    3 0726Dexrazoxane HydrochlorideX$18.81
    3 0727Injection, Etidronate DisodiumX$9.31
    3 0728Filgrastim (G-CSF)X$25.21
    3 0730Pamidronate DisodiumX$30.93
    3 0731Sargramostim (GM-CSF)X$16.97
    3 0732MesnaX$2.42
    3 0733Epoetin AlphaX$1.75
    3 0750Dolasetron Mesylate 10 mgX$1.94
    3 0754Metoclopramide HCLX$.19
    3 0755Thiethylperazine MaleateX$.68
    3 0761Oral Substitute for IV AntiemticX$.10
    3 0762DronabinolX$.48
    3 0763Dolasetron Mesylate 100 mg OralX$8.53
    3 0764Granisetron HCL, 100 mcgX$2.33
    3 0765Granisetron HCL, 1mg OralX$3.20
    3 0768Ondansetron Hydrochloride per 1 mg InjectionX$.87
    3 0769Ondansetron Hydrochloride 8 mg oralX$2.62
    3 0800Leuprolide Acetate per 3.75 mgX$68.56
    3 0801CyclophosphamideX$.19
    3 0802EtoposideX$3.10
    3 0803MelphalanX$.19
    3 0807Aldesleukin single use vialX$65.07
    3 0809BCG (Intravesical) one vialX$19.78
    3 0810Goserelin Acetate Implant, per 3.6 mgX$59.74
    3 0811Carboplatin 50 mgX$13.96
    3 0812Carmustine 100 mgX$10.57
    3 0813Cisplatin 10 mgX$4.56
    3 0814Asparaginase, 10,000 unitsX$8.34
    3 0815Cyclophosphamide 100 mgX$.48
    3 0816Cyclophosphamide, Lyophilized 100 mgX$1.16
    3 0817Cytrabine 100 mgX$.68
    3 0818Dactinomycin 0.5 mgX$1.75
    3 0819Dacarbazine 100 mgX$1.26
    3 0820Daunorubicin HCI 10 mgX$11.64
    3 0821Daunorubicin Citrate, Liposomal Formulation, 10 mgX$7.76
    3 0822Diethylstibestrol Diphosphate 250 mgX$2.13
    3 0823Docetaxel 20 mgX$34.72
    3 0824Etoposide 10 mgX$.58
    3 0826Methotrexate Oral 2.5 mgX$.29
    3 0827Floxuridine 500 mgX$18.81
    3 0828Gemcitabine HCL 200 mgX$9.31
    3 0830Irinotecan 20 mgX$14.16
    3 0831Ifosfamide per 1 gramX$13.58
    3 0832Idarubicin Hydrochloride 5 mgX$46.45
    3 0833Interferon Alfacon-1, Recombinant, 1 mcgX$.19
    3 0834Interferon, Alfa-2A, Recombinant 3 million unitsX$3.20
    3 0836Interferon, Alfa-2B, Recombinant, 1 million unitsX$1.36
    3 0838Interferon, Gamma 1-B, 3 million unitsX$22.79
    3 0839Mechlorethamine HCI 10 mgX$1.65
    3 0840Melphalan HCI 50 mgX$44.71
    3 0841Methotrexate Sodium 5 mgX$.10
    3 0842Fludarabine Phosphate 50 mgX$30.84
    3 0843Pegaspargase per single dose vialX$178.72
    3 0844Pentostatin 10 mgX$133.73
    3 0847Doxorubicin HCL 10 mgX$2.81
    3 0849Rituximab, 100 mgX$51.40
    3 0850Streptozocin 1 gmX$14.64
    3 0851Thiotepa 15 mgX$9.50
    Start Printed Page 18556
    3 0852Topotecan 4 mgX$73.22
    3 0853Vinblastine Sulfate 1 mgX$.39
    3 0854Vincristine Sulfate 1 mgX$2.23
    3 0855Vinorelbine Tartrate per 10 mgX$9.60
    3 0856Porfimer Sodium 75 mgX$34.62
    3 0857Bleomycin Sulfate 15 unitsX$48.29
    3 0858Cladribine, 1mgX$8.24
    3 0859FluorouracilX$.19
    3 0860Plicamycin 2.5 mgX$1.36
    3 0861Leuprolide Acetate 1 mgX$19.39
    3 0862Mitomycin, 5mgX$19.88
    3 0863Paclitaxel, 30mgX$30.16
    3 0864Mitoxantrone HCl, per 5mgX$25.80
    3 0865Interferon alfa-N3, 250,000 IUX$1.07
    3 0884Rho (D) Immune Globulin, Human one dose packX$3.78
    2 0886Azathioprine, 50 mg oralX0.02$.97$.19
    2 0887Azathioprine, Parenteral 100 mg, 20 ml each injectionX1.40$67.88$13.58
    2 0888Cyclosporine, Oral 100 mgX0.08$3.88$.78
    2 0889Cyclosporine, ParenteralX0.36$17.46$3.49
    2 0890Lymphocyte Immune Globulin 50 mg/ml, 5 ml eachX3.79$183.77$36.75
    2 0891Tacrolimus per 1 mg oralX3.15$152.73$30.55
    3 0892Daclizumab, Parenteral, 25 mgX$54.11
    3 0900Injection, Alglucerase per 10 unitsX$5.14
    3 0901Alpha I, Proteinase Inhibitor, Human per 10mgX$15.22
    3 0902Botulinum Toxin, Type A per unitX$56.05
    3 0903CMV Immune GlobulinX$54.11
    3 0905Immune Globulin per 500 mgX$6.40
    3 0906RSV Immune GlobulinX$85.53
    2 0907Ganciclovir Sodium 500 mg injectionX0.51$24.73$4.95
    2 0908Tetanus Immune Globulin, Human, up to 250 unitsX0.90$43.64$8.73
    3 0909Interferon Beta—1a 33 mcgX$28.70
    3 0910Interferon Beta—1b 0.25 mgX$8.44
    2 0911Streptokinase per 250,000 iuX1.64$79.69$15.94
    3 0913Ganciclovir 4.5 mg, ImplantX$701.51
    2 0914Reteplase, 37.6 mg (Two Single Use Vials)X38.20$1,852.21$370.44
    2 0915Alteplase recombinant, 10mgX5.85$283.70$56.74
    3 0916Imiglucerase per unitX$.58
    2 0917Dipyridamole, 10mg Adenosine 6MGX0.36$17.46$3.49
    3 0918Brachytherapy Seeds, Any type, EachS$9.99
    3 0925Factor VIII (Antihemophilic Factor, Human) per iuX$.19
    3 0926Factor VIII (Antihemophilic Factor, Porcine) per iuX$.19
    3 0927Factor VIII (Antihemophilic Factor, Recombinant) per iuX$.19
    3 0928Factor IX, ComplexX$.08
    3 0929Other Hemophilia Clotting Factors per iuX$.27
    3 0930Antithrombin III (Human) per iuX$.19
    3 0931Factor IX (Antihemophilic Factor, Purified, Non-Recombinant)X$.04
    3 0932Factor IX (Antihemophilic Factor, Recombinant)X$.10
    2 0949Plasma, Pooled Multiple Donor, Solvent/Detergent Treated, FrozenS3.49$169.22$33.84
    2 0950Blood (Whole) For TransfusionS2.08$101.02$20.20
    2 0952CryoprecipitateS0.70$33.92$6.78
    2 0953Fibrinogen UnitS0.48$23.27$4.65
    2 0954Leukocyte Poor BloodS2.83$137.21$27.44
    2 0955Plasma, Fresh FrozenS2.26$109.35$21.87
    2 0956Plasma Protein FractionS1.26$61.09$12.22
    2 0957Platelet ConcentrateS0.98$47.46$9.49
    2 0958Platelet Rich PlasmaS1.16$56.25$11.25
    2 0959Red Blood CellsS2.04$99.04$19.81
    2 0960Washed Red Blood CellsS3.81$184.53$36.91
    2 0961Infusion, Albumin (Human) 5%, 500 mlX2.77$134.31$26.86
    2 0962Infusion, Albumin (Human) 25%, 50 mlX1.38$66.91$13.38
    2 0970New Technology—Level I ($0-$50)T0.52$25.21$5.04
    2 0971New Technology—Level II ($50-$100)S1.55$75.16$15.03
    2 0972New Technology—Level III ($100-$200)T3.09$149.83$29.97
    2 0973New Technology—Level IV ($200-$300)T5.16$250.19$50.04
    2 0974New Technology—Level V ($300-$500)T8.25$400.02$80.00
    2 0975New Technology—Level VI ($500-$750)T12.90$625.48$125.10
    2 0976New Technology—Level VII ($750-$1000)T18.05$875.19$175.04
    2 0977New Technology—Level VIII ($1000-$1250)T23.20$1,124.90$224.98
    2 0978New Technology—Level IX ($1250-$1500)T28.36$1,375.09$275.02
    2 0979New Technology—Level X ($1500-$1750)T33.51$1,624.80$324.96
    2 0980New Technology—Level XI ($1750-$2000)S38.67$1,875.00$375.00
    2 0981New Technology—Level XII ($2000-$2500)T46.40$2,249.80$449.96
    2 0982New Technology—Level XIII ($2500-$3500)T61.87$2,999.90$599.98
    Start Printed Page 18557
    2 0983New Technology—Level XIV ($3500-$5000)T87.65$4,249.89$849.98
    2 0984New Technology—Level XV ($5000-$6000)T113.43$5,499.89$1,099.98
    3 7000Amifostine, 500 mgX$41.99
    3 7001Amphotericin B lipid complex, 50 mg, InjX$12.12
    3 7002Clonidine, HCl, 1 MGX$4.17
    3 7003Epoprostenol, 0.5 MG, injX$2.23
    3 7004Immune globulin intravenous human 5g, injX$45.48
    3 7005Gonadorelin hcI, 100 mcgX$9.12
    2 7007Milrinone lacetate, per 5 ml, injX0.47$22.79$4.56
    3 7010Morphine sulfate concentrate (preservative free) per 10 mgX$.68
    3 7011Oprelevekin, inj, 5 mgX$30.35
    3 7012Pentamidine isethionate, 300 mgX$8.73
    3 7014Fentanyl citrate, inj, up to 2 mlX$.19
    3 7015Busulfan, oral 2 mgX$.19
    3 7019Aprotinin, 10,000 kiuX$2.42
    3 7021Baclofen, intrathecal, 50 mcgX$.10
    3 7022Elliotts B Solution, per mlX$19.20
    3 7023Treatment for bladder calculi, I.e. Renacidin per 500 mlX$4.46
    3 7024Corticorelin ovine triflutate, 0.1 mgX$45.77
    3 7025Digoxin immune FAB (Ovine), 10 mgX$14.06
    3 7026Ethanolamine oleate, 1000 mlX$2.13
    3 7027Fomepizole, 1.5 GX$141.29
    3 7028Fosphenytoin, 50 mgX$.78
    3 7029Glatiramer acetate, 25 mgX$3.59
    3 7030Hemin, 1 mgX$.10
    3 7031Octreotide Acetate, 500 mcgX$5.43
    3 7032Sermorelin acetate, 0.5 mgX$53.34
    3 7033Somatrem, 5 mgX$28.03
    3 7034Somatropin, 1 mgX$5.04
    3 7035Teniposide, 50 mgX$20.85
    2 7036Urokinase, inj, IV, 250,000 I.U.X0.73$35.40$7.08
    3 7037Urofollitropin, 75 I.U.X$8.24
    3 7038Muromonab-CD3, 5 mgX$89.60
    3 7039Pegademase bovine inj 25 I.U.X$1.16
    3 7040Pentastarch 10% inj, 100 mlX$2.04
    2 7041Tirofiban HCL, 0.5 mgX0.02$.97$.19
    3 7042Capecitabine, oral 150 mgX$.19
    3 7043Infliximab, 10 MGX$6.89
    3 7045Trimetrexate GlucoronateX$8.15
    3 7046Doxorubicin Hcl LiposomeX$39.18
    —————————— CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All rights reserved. 1 Not subject to national coinsurance. Minimum unadjusted coinsurance is 25% of the payment rate. The payment rate is the lower of the HOPD payment rate or the Ambulatory Surgical Center payment. ÿ09ÿ09ÿ09ÿ09  ÿ09 2 Not subject to national coinsurance.ÿ09ÿ09ÿ09ÿ09ÿ09ÿ09 3 Eligible for pass-through payments. See Preamble for payment rate determination. See Addendum K for complete list of pass-through codes.

    Addendum B.—Hospital Outpatient Department (HOPD) Payment Status by HCPCS Code and Related Information

    CPT/ HCPCSHOPD Status IndicatorDescriptionAPCRelative WeightPayment RateNational Unadjusted CoinsuranceMinimum Unadjusted Coinsurance
    00100NAnesth, salivary gland
    00102NAnesth, repair of cleft lip
    00103NAnesth, blepharoplasty
    00104NAnesth, electroshock
    00120NAnesth, ear surgery
    00124NAnesth, ear exam
    00126NAnesth, tympanotomy
    00140NAnesth, procedures on eye
    00142NAnesth, lens surgery
    00144NAnesth, corneal transplant
    00145NAnesth, vitrectomy
    00147NAnesth, iridectomy
    00148NAnesth, eye exam
    00160NAnesth, nose/sinus surgery
    00162NAnesth, nose/sinus surgery
    00164NAnesth, biopsy of nose
    00170NAnesth, procedure on mouth
    00172NAnesth, cleft palate repair
    00174CAnesth, pharyngeal surgery
    00176CAnesth, pharyngeal surgery
    00190NAnesth, facial bone surgery
    00192CAnesth, facial bone surgery
    00210NAnesth, open head surgery
    00212NAnesth, skull drainage
    Start Printed Page 18558
    00214CAnesth, skull drainage
    00215CAnesth, skull fracture
    00216NAnesth, head vessel surgery
    00218NAnesth, special head surgery
    00220NAnesth, spinal fluid shunt
    00222NAnesth, head nerve surgery
    00300NAnesth, head/neck/ptrunk
    00320NAnesth, neck organ surgery
    00322NAnesth, biopsy of thyroid
    00350NAnesth, neck vessel surgery
    00352NAnesth, neck vessel surgery
    00400NAnesth, skin, ext/per/atrunk
    00402NAnesth, surgery of breast
    00404CAnesth, surgery of breast
    00406CAnesth, surgery of breast
    00410NAnesth, correct heart rhythm
    00450NAnesth, surgery of shoulder
    00452CAnesth, surgery of shoulder
    00454NAnesth, collar bone biopsy
    00470NAnesth, removal of rib
    00472NAnesth, chest wall repair
    00474CAnesth, surgery of rib(s)
    00500NAnesth, esophageal surgery
    00520NAnesth, chest procedure
    00522NAnesth, chest lining biopsy
    00524CAnesth, chest drainage
    00528NAnesth, chest partition view
    00530CAnesth, pacemaker insertion
    00532NAnesth, vascular access
    00534NAnesth, cardioverter/defib
    00540CAnesth, chest surgery
    00542CAnesth, release of lung
    00544CAnesth, chest lining removal
    00546CAnesth, lung, chest wall surg
    00548NAnesth, trachea, bronchi surg
    00560CAnesth, open heart surgery
    00562CAnesth, open heart surgery
    00580CAnesth heart/lung transplant
    00600NAnesth, spine, cord surgery
    00604CAnesth, surgery of vertebra
    00620NAnesth, spine, cord surgery
    00622CAnesth, removal of nerves
    00630NAnesth, spine, cord surgery
    00632CAnesth, removal of nerves
    00634CAnesth for chemonucleolysis
    00670CAnesth, spine, cord surgery
    00700NAnesth, abdominal wall surg
    00702NAnesth, for liver biopsy
    00730NAnesth, abdominal wall surg
    00740NAnesth, upper gi visualize
    00750NAnesth, repair of hernia
    00752NAnesth, repair of hernia
    00754NAnesth, repair of hernia
    00756NAnesth, repair of hernia
    00770NAnesth, blood vessel repair
    00790NAnesth, surg upper abdomen
    00792CAnesth, part liver removal
    00794CAnesth, pancreas removal
    00796CAnesth, for liver transplant
    00800NAnesth, abdominal wall surg
    00802CAnesth, fat layer removal
    00810NAnesth, low intestine scope
    00820NAnesth, abdominal wall surg
    00830NAnesth, repair of hernia
    00832NAnesth, repair of hernia
    00840NAnesth, surg lower abdomen
    00842NAnesth, amniocentesis
    00844CAnesth, pelvis surgery
    00846CAnesth, hysterectomy
    00848CAnesth, pelvic organ surg
    00850CAnesth, cesarean section
    00855CAnesth, hysterectomy
    00857CAnalgesia, labor & c-section
    Start Printed Page 18559
    00860NAnesth, surgery of abdomen
    00862NAnesth, kidney/ureter surg
    00864CAnesth, removal of bladder
    00865CAnesth, removal of prostate
    00866CAnesth, removal of adrenal
    00868CAnesth, kidney transplant
    00870NAnesth, bladder stone surg
    00872NAnesth kidney stone destruct
    00873NAnesth kidney stone destruct
    00880NAnesth, abdomen vessel surg
    00882CAnesth, major vein ligation
    00884CAnesth, major vein revision
    00900NAnesth, perineal procedure
    00902NAnesth, anorectal surgery
    00904CAnesth, perineal surgery
    00906NAnesth, removal of vulva
    00908CAnesth, removal of prostate
    00910NAnesth, bladder surgery
    00912NAnesth, bladder tumor surg
    00914NAnesth, removal of prostate
    00916NAnesth, bleeding control
    00918NAnesth, stone removal
    00920NAnesth, genitalia surgery
    00922NAnesth, sperm duct surgery
    00924NAnesth, testis exploration
    00926NAnesth, removal of testis
    00928CAnesth, removal of testis
    00930NAnesth, testis suspension
    00932CAnesth, amputation of penis
    00934CAnesth, penis, nodes removal
    00936CAnesth, penis, nodes removal
    00938NAnesth, insert penis device
    00940NAnesth, vaginal procedures
    00942NAnesth, surgery on vagina
    00944CAnesth, vaginal hysterectomy
    00946NAnesth, vaginal delivery
    00948NAnesth, repair of cervix
    00950NAnesth, vaginal endoscopy
    00952NAnesth, hysteroscope/graph
    00955CAnalgesia, vaginal delivery
    01120NAnesth, pelvis surgery
    01130NAnesth, body cast procedure
    01140CAnesth, amputation at pelvis
    01150CAnesth, pelvic tumor surgery
    01160NAnesth, pelvis procedure
    01170NAnesth, pelvis surgery
    01180NAnesth, pelvis nerve removal
    01190CAnesth, pelvis nerve removal
    01200NAnesth, hip joint procedure
    01202NAnesth, arthroscopy of hip
    01210NAnesth, hip joint surgery
    01212CAnesth, hip disarticulation
    01214CAnesth, replacement of hip
    01220NAnesth, procedure on femur
    01230NAnesth, surgery of femur
    01232CAnesth, amputation of femur
    01234CAnesth, radical femur surg
    01250NAnesth, upper leg surgery
    01260NAnesth, upper leg veins surg
    01270NAnesth, thigh arteries surg
    01272CAnesth, femoral artery surg
    01274CAnesth, femoral embolectomy
    01320NAnesth, knee area surgery
    01340NAnesth, knee area procedure
    01360NAnesth, knee area surgery
    01380NAnesth, knee joint procedure
    01382NAnesth, knee arthroscopy
    01390NAnesth, knee area procedure
    01392NAnesth, knee area surgery
    01400NAnesth, knee joint surgery
    01402CAnesth, replacement of knee
    01404CAnesth, amputation at knee
    01420NAnesth, knee joint casting
    Start Printed Page 18560
    01430NAnesth, knee veins surgery
    01432NAnesth, knee vessel surg
    01440NAnesth, knee arteries surg
    01442CAnesth, knee artery surg
    01444CAnesth, knee artery repair
    01462NAnesth, lower leg procedure
    01464NAnesth, ankle arthroscopy
    01470NAnesth, lower leg surgery
    01472NAnesth, achilles tendon surg
    01474NAnesth, lower leg surgery
    01480NAnesth, lower leg bone surg
    01482NAnesth, radical leg surgery
    01484NAnesth, lower leg revision
    01486CAnesth, ankle replacement
    01490NAnesth, lower leg casting
    01500NAnesth, leg arteries surg
    01502CAnesth, lwr leg embolectomy
    01520NAnesth, lower leg vein surg
    01522NAnesth, lower leg vein surg
    01610NAnesth, surgery of shoulder
    01620NAnesth, shoulder procedure
    01622NAnesth, shoulder arthroscopy
    01630NAnesth, surgery of shoulder
    01632CAnesth, surgery of shoulder
    01634CAnesth, shoulder joint amput
    01636CAnesth, forequarter amput
    01638CAnesth, shoulder replacement
    01650NAnesth, shoulder artery surg
    01652CAnesth, shoulder vessel surg
    01654CAnesth, shoulder vessel surg
    01656CAnesth, arm-leg vessel surg
    01670NAnesth, shoulder vein surg
    01680NAnesth, shoulder casting
    01682NAnesth, airplane cast
    01710NAnesth, elbow area surgery
    01712NAnesth, uppr arm tendon surg
    01714NAnesth, uppr arm tendon surg
    01716NAnesth, biceps tendon repair
    01730NAnesth, uppr arm procedure
    01732NAnesth, elbow arthroscopy
    01740NAnesth, upper arm surgery
    01742NAnesth, humerus surgery
    01744NAnesth, humerus repair
    01756CAnesth, radical humerus surg
    01758NAnesth, humeral lesion surg
    01760NAnesth, elbow replacement
    01770NAnesth, uppr arm artery surg
    01772CAnesth, uppr arm embolectomy
    01780NAnesth, upper arm vein surg
    01782CAnesth, uppr arm vein repair
    01784NAnesth, av fistula repair
    01810NAnesth, lower arm surgery
    01820NAnesth, lower arm procedure
    01830NAnesth, lower arm surgery
    01832NAnesth, wrist replacement
    01840NAnesth, lwr arm artery surg
    01842CAnesth, lwr arm embolectomy
    01844NAnesth, vascular shunt surg
    01850NAnesth, lower arm vein surg
    01852CAnesth, lwr arm vein repair
    01860NAnesth, lower arm casting
    01904CAnesth, skull x-ray inject
    01906NAnesth, lumbar myelography
    01908NAnesth, cervical myelography
    01910NAnesth, skull myelography
    01912NAnesth, lumbar diskography
    01914NAnesth, cervical diskography
    01916NAnesth, head arteriogram
    01918NAnesth, limb arteriogram
    01920NAnesth, catheterize heart
    01921NAnesth, vessel surgery
    01922NAnesth, cat or MRI scan
    01990CSupport for organ donor
    Start Printed Page 18561
    01995NRegional anesthesia, limb
    01996NManage daily drug therapy
    01999NUnlisted anesth procedure
    10040TAcne surgery of skin abscess00062.00$96.97$33.95$19.39
    10060TDrainage of skin abscess00062.00$96.97$33.95$19.39
    10061TDrainage of skin abscess00062.00$96.97$33.95$19.39
    10080TDrainage of pilonidal cyst00062.00$96.97$33.95$19.39
    10081TDrainage of pilonidal cyst00073.68$178.43$72.03$35.69
    10120TRemove foreign body00062.00$96.97$33.95$19.39
    10121TRemove foreign body00206.51$315.65$130.53$63.13
    10140TDrainage of hematoma/fluid00073.68$178.43$72.03$35.69
    10160TPuncture drainage of lesion00062.00$96.97$33.95$19.39
    10180TComplex drainage, wound00073.68$178.43$72.03$35.69
    11000TDebride infected skin00151.77$85.82$31.20$17.16
    11001TDebride infected skin add-on00151.77$85.82$31.20$17.16
    11010TDebride skin, fx002212.49$605.60$292.94$121.12
    11011TDebride skin/muscle, fx002212.49$605.60$292.94$121.12
    11012TDebride skin/muscle/bone, fx002212.49$605.60$292.94$121.12
    11040TDebride skin, partial00151.77$85.82$31.20$17.16
    11041TDebride skin, full00151.77$85.82$31.20$17.16
    11042TDebride skin/tissue00163.53$171.16$74.67$34.23
    11043TDebride tissue/muscle00163.53$171.16$74.67$34.23
    11044TDebride tissue/muscle/bone001712.45$603.66$289.16$120.73
    11055TTrim skin lesion00151.77$85.82$31.20$17.16
    11056TTrim skin lesions, 2 to 400151.77$85.82$31.20$17.16
    11057TTrim skin lesions, over 400151.77$85.82$31.20$17.16
    11100TBiopsy of skin lesion00180.94$45.58$17.66$9.12
    11101TBiopsy, skin add-on00180.94$45.58$17.66$9.12
    11200TRemoval of skin tags00151.77$85.82$31.20$17.16
    11201TRemove skin tags add-on00151.77$85.82$31.20$17.16
    11300TShave skin lesion00130.91$44.12$17.66$8.82
    11301TShave skin lesion00130.91$44.12$17.66$8.82
    11302TShave skin lesion00141.50$72.73$24.55$14.55
    11303TShave skin lesion00151.77$85.82$31.20$17.16
    11305TShave skin lesion00130.91$44.12$17.66$8.82
    11306TShave skin lesion00130.91$44.12$17.66$8.82
    11307TShave skin lesion00141.50$72.73$24.55$14.55
    11308TShave skin lesion00151.77$85.82$31.20$17.16
    11310TShave skin lesion00130.91$44.12$17.66$8.82
    11311TShave skin lesion00130.91$44.12$17.66$8.82
    11312TShave skin lesion00151.77$85.82$31.20$17.16
    11313TShave skin lesion00163.53$171.16$74.67$34.23
    11400TRemoval of skin lesion00194.00$193.95$78.91$38.79
    11401TRemoval of skin lesion00194.00$193.95$78.91$38.79
    11402TRemoval of skin lesion00194.00$193.95$78.91$38.79
    11403TRemoval of skin lesion00206.51$315.65$130.53$63.13
    11404TRemoval of skin lesion00206.51$315.65$130.53$63.13
    11406TRemoval of skin lesion00206.51$315.65$130.53$63.13
    11420TRemoval of skin lesion00194.00$193.95$78.91$38.79
    11421TRemoval of skin lesion00194.00$193.95$78.91$38.79
    11422TRemoval of skin lesion00194.00$193.95$78.91$38.79
    11423TRemoval of skin lesion00206.51$315.65$130.53$63.13
    11424TRemoval of skin lesion00206.51$315.65$130.53$63.13
    11426TRemoval of skin lesion002212.49$605.60$292.94$121.12
    11440TRemoval of skin lesion00194.00$193.95$78.91$38.79
    11441TRemoval of skin lesion00194.00$193.95$78.91$38.79
    11442TRemoval of skin lesion00194.00$193.95$78.91$38.79
    11443TRemoval of skin lesion00206.51$315.65$130.53$63.13
    11444TRemoval of skin lesion00206.51$315.65$130.53$63.13
    11446TRemoval of skin lesion002212.49$605.60$292.94$121.12
    11450TRemoval, sweat gland lesion002212.49$605.60$292.94$121.12
    11451TRemoval, sweat gland lesion002212.49$605.60$292.94$121.12
    11462TRemoval, sweat gland lesion002212.49$605.60$292.94$121.12
    11463TRemoval, sweat gland lesion002212.49$605.60$292.94$121.12
    11470TRemoval, sweat gland lesion002212.49$605.60$292.94$121.12
    11471TRemoval, sweat gland lesion002212.49$605.60$292.94$121.12
    11600TRemoval of skin lesion00194.00$193.95$78.91$38.79
    11601TRemoval of skin lesion00194.00$193.95$78.91$38.79
    11602TRemoval of skin lesion00194.00$193.95$78.91$38.79
    11603TRemoval of skin lesion00206.51$315.65$130.53$63.13
    11604TRemoval of skin lesion00206.51$315.65$130.53$63.13
    11606TRemoval of skin lesion002110.49$508.63$236.51$101.73
    11620TRemoval of skin lesion00194.00$193.95$78.91$38.79
    Start Printed Page 18562
    11621TRemoval of skin lesion00194.00$193.95$78.91$38.79
    11622TRemoval of skin lesion00194.00$193.95$78.91$38.79
    11623TRemoval of skin lesion00206.51$315.65$130.53$63.13
    11624TRemoval of skin lesion00206.51$315.65$130.53$63.13
    11626TRemoval of skin lesion002212.49$605.60$292.94$121.12
    11640TRemoval of skin lesion00194.00$193.95$78.91$38.79
    11641TRemoval of skin lesion00194.00$193.95$78.91$38.79
    11642TRemoval of skin lesion00194.00$193.95$78.91$38.79
    11643TRemoval of skin lesion00206.51$315.65$130.53$63.13
    11644TRemoval of skin lesion00206.51$315.65$130.53$63.13
    11646TRemoval of skin lesion002212.49$605.60$292.94$121.12
    11719TTrim nail(s)00090.74$35.88$9.63$7.18
    11720TDebride nail, 1-500090.74$35.88$9.63$7.18
    11721TDebride nail, 6 or more00090.74$35.88$9.63$7.18
    11730TRemoval of nail plate00130.91$44.12$17.66$8.82
    11732TRemove nail plate, add-on00120.53$25.70$9.18$5.14
    11740TDrain blood from under nail00090.74$35.88$9.63$7.18
    11750TRemoval of nail bed00194.00$193.95$78.91$38.79
    11752TRemove nail bed/finger tip002212.49$605.60$292.94$121.12
    11755TBiopsy, nail unit00194.00$193.95$78.91$38.79
    11760TRepair of nail bed00242.43$117.82$44.50$23.56
    11762TReconstruction of nail bed00242.43$117.82$44.50$23.56
    11765TExcision of nail fold, toe00151.77$85.82$31.20$17.16
    11770TRemoval of pilonidal lesion002110.49$508.63$236.51$101.73
    11771TRemoval of pilonidal lesion002212.49$605.60$292.94$121.12
    11772TRemoval of pilonidal lesion002212.49$605.60$292.94$121.12
    11900TInjection into skin lesions00120.53$25.70$9.18$5.14
    11901TAdded skin lesions injection00130.91$44.12$17.66$8.82
    11920TCorrect skin color defects00242.43$117.82$44.50$23.56
    11921TCorrect skin color defects00242.43$117.82$44.50$23.56
    11922TCorrect skin color defects00242.43$117.82$44.50$23.56
    11950TTherapy for contour defects00242.43$117.82$44.50$23.56
    11951TTherapy for contour defects00242.43$117.82$44.50$23.56
    11952TTherapy for contour defects00242.43$117.82$44.50$23.56
    11954TTherapy for contour defects00242.43$117.82$44.50$23.56
    11960TInsert tissue expander(s)002612.11$587.18$277.92$117.44
    11970TReplace tissue expander002612.11$587.18$277.92$117.44
    11971TRemove tissue expander(s)002212.49$605.60$292.94$121.12
    11975EInsert contraceptive cap
    11976TRemoval of contraceptive cap00194.00$193.95$78.91$38.79
    11977ERemoval/reinsert contra cap
    11980EImplant hormone pellet(s)
    12001TRepair superficial wound(s)00242.43$117.82$44.50$23.56
    12002TRepair superficial wound(s)00242.43$117.82$44.50$23.56
    12004TRepair superficial wound(s)00242.43$117.82$44.50$23.56
    12005TRepair superficial wound(s)00242.43$117.82$44.50$23.56
    12006TRepair superficial wound(s)00242.43$117.82$44.50$23.56
    12007TRepair superficial wound(s)00242.43$117.82$44.50$23.56
    12011TRepair superficial wound(s)00242.43$117.82$44.50$23.56
    12013TRepair superficial wound(s)00242.43$117.82$44.50$23.56
    12014TRepair superficial wound(s)00242.43$117.82$44.50$23.56
    12015TRepair superficial wound(s)00242.43$117.82$44.50$23.56
    12016TRepair superficial wound(s)00242.43$117.82$44.50$23.56
    12017TRepair superficial wound(s)00242.43$117.82$44.50$23.56
    12018TRepair superficial wound(s)00242.43$117.82$44.50$23.56
    12020TClosure of split wound00242.43$117.82$44.50$23.56
    12021TClosure of split wound00242.43$117.82$44.50$23.56
    12031TLayer closure of wound(s)00242.43$117.82$44.50$23.56
    12032TLayer closure of wound(s)00242.43$117.82$44.50$23.56
    12034TLayer closure of wound(s)00242.43$117.82$44.50$23.56
    12035TLayer closure of wound(s)00242.43$117.82$44.50$23.56
    12036TLayer closure of wound(s)00242.43$117.82$44.50$23.56
    12037TLayer closure of wound(s)002612.11$587.18$277.92$117.44
    12041TLayer closure of wound(s)00242.43$117.82$44.50$23.56
    12042TLayer closure of wound(s)00242.43$117.82$44.50$23.56
    12044TLayer closure of wound(s)00242.43$117.82$44.50$23.56
    12045TLayer closure of wound(s)00242.43$117.82$44.50$23.56
    12046TLayer closure of wound(s)00242.43$117.82$44.50$23.56
    12047TLayer closure of wound(s)002612.11$587.18$277.92$117.44
    12051TLayer closure of wound(s)00242.43$117.82$44.50$23.56
    12052TLayer closure of wound(s)00242.43$117.82$44.50$23.56
    12053TLayer closure of wound(s)00242.43$117.82$44.50$23.56
    12054TLayer closure of wound(s)00242.43$117.82$44.50$23.56
    Start Printed Page 18563
    12055TLayer closure of wound(s)00242.43$117.82$44.50$23.56
    12056TLayer closure of wound(s)00242.43$117.82$44.50$23.56
    12057TLayer closure of wound(s)002612.11$587.18$277.92$117.44
    13100TRepair of wound or lesion00253.74$181.34$70.66$36.27
    13101TRepair of wound or lesion00253.74$181.34$70.66$36.27
    13102TRepair wound/lesion add-on00253.74$181.34$70.66$36.27
    13120TRepair of wound or lesion00253.74$181.34$70.66$36.27
    13121TRepair of wound or lesion00253.74$181.34$70.66$36.27
    13122TRepair wound/lesion add-on00253.74$181.34$70.66$36.27
    13131TRepair of wound or lesion00253.74$181.34$70.66$36.27
    13132TRepair of wound or lesion00253.74$181.34$70.66$36.27
    13133TRepair wound/lesion add-on00253.74$181.34$70.66$36.27
    13150TRepair of wound or lesion002612.11$587.18$277.92$117.44
    13151TRepair of wound or lesion00253.74$181.34$70.66$36.27
    13152TRepair of wound or lesion00253.74$181.34$70.66$36.27
    13153TRepair wound/lesion add-on00253.74$181.34$70.66$36.27
    13160TLate closure of wound002612.11$587.18$277.92$117.44
    14000TSkin tissue rearrangement002612.11$587.18$277.92$117.44
    14001TSkin tissue rearrangement002612.11$587.18$277.92$117.44
    14020TSkin tissue rearrangement002612.11$587.18$277.92$117.44
    14021TSkin tissue rearrangement002612.11$587.18$277.92$117.44
    14040TSkin tissue rearrangement002612.11$587.18$277.92$117.44
    14041TSkin tissue rearrangement002612.11$587.18$277.92$117.44
    14060TSkin tissue rearrangement002612.11$587.18$277.92$117.44
    14061TSkin tissue rearrangement002612.11$587.18$277.92$117.44
    14300TSkin tissue rearrangement002612.11$587.18$277.92$117.44
    14350TSkin tissue rearrangement002612.11$587.18$277.92$117.44
    15000TSkin graft002612.11$587.18$277.92$117.44
    15001TSkin graft add-on002612.11$587.18$277.92$117.44
    15050TSkin pinch graft002612.11$587.18$277.92$117.44
    15100TSkin split graft002612.11$587.18$277.92$117.44
    15101TSkin split graft add-on002612.11$587.18$277.92$117.44
    15120TSkin split graft002612.11$587.18$277.92$117.44
    15121TSkin split graft add-on002612.11$587.18$277.92$117.44
    15200TSkin full graft002612.11$587.18$277.92$117.44
    15201TSkin full graft add-on002612.11$587.18$277.92$117.44
    15220TSkin full graft002612.11$587.18$277.92$117.44
    15221TSkin full graft add-on002612.11$587.18$277.92$117.44
    15240TSkin full graft002612.11$587.18$277.92$117.44
    15241TSkin full graft add-on002612.11$587.18$277.92$117.44
    15260TSkin full graft002612.11$587.18$277.92$117.44
    15261TSkin full graft add-on002612.11$587.18$277.92$117.44
    15350TSkin homograft002612.11$587.18$277.92$117.44
    15351TSkin homograft add-on002612.11$587.18$277.92$117.44
    15400TSkin heterograft002612.11$587.18$277.92$117.44
    15401TSkin heterograft add-on002612.11$587.18$277.92$117.44
    15570TForm skin pedicle flap002612.11$587.18$277.92$117.44
    15572TForm skin pedicle flap002612.11$587.18$277.92$117.44
    15574TForm skin pedicle flap002612.11$587.18$277.92$117.44
    15576TForm skin pedicle flap002612.11$587.18$277.92$117.44
    15600TSkin graft002612.11$587.18$277.92$117.44
    15610TSkin graft002612.11$587.18$277.92$117.44
    15620TSkin graft002612.11$587.18$277.92$117.44
    15630TSkin graft002612.11$587.18$277.92$117.44
    15650TTransfer skin pedicle flap002612.11$587.18$277.92$117.44
    15732TMuscle-skin graft, head/neck002715.80$766.10$383.10$153.22
    15734TMuscle-skin graft, trunk002715.80$766.10$383.10$153.22
    15736TMuscle-skin graft, arm002715.80$766.10$383.10$153.22
    15738TMuscle-skin graft, leg002715.80$766.10$383.10$153.22
    15740TIsland pedicle flap graft002715.80$766.10$383.10$153.22
    15750TNeurovascular pedicle graft002715.80$766.10$383.10$153.22
    15756CFree muscle flap, microvasc
    15757CFree skin flap, microvasc
    15758CFree fascial flap, microvasc
    15760TComposite skin graft002715.80$766.10$383.10$153.22
    15770TDerma-fat-fascia graft002715.80$766.10$383.10$153.22
    15775THair transplant punch grafts002612.11$587.18$277.92$117.44
    15776THair transplant punch grafts002612.11$587.18$277.92$117.44
    15780TAbrasion treatment of skin002212.49$605.60$292.94$121.12
    15781TAbrasion treatment of skin002212.49$605.60$292.94$121.12
    15782TAbrasion treatment of skin002212.49$605.60$292.94$121.12
    15783TAbrasion treatment of skin00151.77$85.82$31.20$17.16
    15786TAbrasion, lesion, single00130.91$44.12$17.66$8.82
    Start Printed Page 18564
    15787TAbrasion, lesions, add-on00163.53$171.16$74.67$34.23
    15788TChemical peel, face, epiderm00130.91$44.12$17.66$8.82
    15789TChemical peel, face, dermal00151.77$85.82$31.20$17.16
    15792TChemical peel, nonfacial00163.53$171.16$74.67$34.23
    15793TChemical peel, nonfacial00163.53$171.16$74.67$34.23
    15810TSalabrasion00163.53$171.16$74.67$34.23
    15811TSalabrasion002212.49$605.60$292.94$121.12
    15819TPlastic surgery, neck002612.11$587.18$277.92$117.44
    15820TRevision of lower eyelid002612.11$587.18$277.92$117.44
    15821TRevision of lower eyelid002612.11$587.18$277.92$117.44
    15822TRevision of upper eyelid002612.11$587.18$277.92$117.44
    15823TRevision of upper eyelid002612.11$587.18$277.92$117.44
    15824TRemoval of forehead wrinkles002715.80$766.10$383.10$153.22
    15825TRemoval of neck wrinkles002612.11$587.18$277.92$117.44
    15826TRemoval of brow wrinkles002715.80$766.10$383.10$153.22
    15828TRemoval of face wrinkles002715.80$766.10$383.10$153.22
    15829TRemoval of skin wrinkles002612.11$587.18$277.92$117.44
    15831TExcise excessive skin tissue002715.80$766.10$383.10$153.22
    15832TExcise excessive skin tissue002715.80$766.10$383.10$153.22
    15833TExcise excessive skin tissue002715.80$766.10$383.10$153.22
    15834TExcise excessive skin tissue002715.80$766.10$383.10$153.22
    15835TExcise excessive skin tissue002612.11$587.18$277.92$117.44
    15836TExcise excessive skin tissue002715.80$766.10$383.10$153.22
    15837TExcise excessive skin tissue002715.80$766.10$383.10$153.22
    15838TExcise excessive skin tissue002212.49$605.60$292.94$121.12
    15839TExcise excessive skin tissue002715.80$766.10$383.10$153.22
    15840TGraft for face nerve palsy002715.80$766.10$383.10$153.22
    15841TGraft for face nerve palsy002715.80$766.10$383.10$153.22
    15842TGraft for face nerve palsy002715.80$766.10$383.10$153.22
    15845TSkin and muscle repair, face002715.80$766.10$383.10$153.22
    15850TRemoval of sutures00130.91$44.12$17.66$8.82
    15851TRemoval of sutures00130.91$44.12$17.66$8.82
    15852TDressing change, not for burn00120.53$25.70$9.18$5.14
    15860NTest for blood flow in graft
    15876TSuction assisted lipectomy002715.80$766.10$383.10$153.22
    15877TSuction assisted lipectomy002715.80$766.10$383.10$153.22
    15878TSuction assisted lipectomy002715.80$766.10$383.10$153.22
    15879TSuction assisted lipectomy002715.80$766.10$383.10$153.22
    15920TRemoval of tail bone ulcer002212.49$605.60$292.94$121.12
    15922TRemoval of tail bone ulcer002715.80$766.10$383.10$153.22
    15931TRemove sacrum pressure sore002212.49$605.60$292.94$121.12
    15933TRemove sacrum pressure sore002212.49$605.60$292.94$121.12
    15934TRemove sacrum pressure sore002715.80$766.10$383.10$153.22
    15935TRemove sacrum pressure sore002715.80$766.10$383.10$153.22
    15936TRemove sacrum pressure sore002715.80$766.10$383.10$153.22
    15937TRemove sacrum pressure sore002715.80$766.10$383.10$153.22
    15940TRemove hip pressure sore002212.49$605.60$292.94$121.12
    15941TRemove hip pressure sore002212.49$605.60$292.94$121.12
    15944TRemove hip pressure sore002715.80$766.10$383.10$153.22
    15945TRemove hip pressure sore002715.80$766.10$383.10$153.22
    15946TRemove hip pressure sore002715.80$766.10$383.10$153.22
    15950TRemove thigh pressure sore002212.49$605.60$292.94$121.12
    15951TRemove thigh pressure sore002212.49$605.60$292.94$121.12
    15952TRemove thigh pressure sore002715.80$766.10$383.10$153.22
    15953TRemove thigh pressure sore002715.80$766.10$383.10$153.22
    15956TRemove thigh pressure sore002715.80$766.10$383.10$153.22
    15958TRemove thigh pressure sore002715.80$766.10$383.10$153.22
    15999TRemoval of pressure sore002212.49$605.60$292.94$121.12
    16000TInitial treatment of burn(s)00151.77$85.82$31.20$17.16
    16010TTreatment of burn(s)00151.77$85.82$31.20$17.16
    16015TTreatment of burn(s)001712.45$603.66$289.16$120.73
    16020TTreatment of burn(s)00151.77$85.82$31.20$17.16
    16025TTreatment of burn(s)00141.50$72.73$24.55$14.55
    16030TTreatment of burn(s)00151.77$85.82$31.20$17.16
    16035TIncision of burn scab00206.51$315.65$130.53$63.13
    17000TDestroy benign/premal lesion00100.55$26.67$9.86$5.33
    17003TDestroy lesions, 2-1400100.55$26.67$9.86$5.33
    17004TDestroy lesions, 15 or more00112.72$131.88$50.01$26.38
    17106TDestruction of skin lesions00112.72$131.88$50.01$26.38
    17107TDestruction of skin lesions00112.72$131.88$50.01$26.38
    17108TDestruction of skin lesions00112.72$131.88$50.01$26.38
    17110TDestruct lesion, 1-1400100.55$26.67$9.86$5.33
    17111TDestruct lesion, 15 or more00112.72$131.88$50.01$26.38
    Start Printed Page 18565
    17250TChemical cautery, tissue00141.50$72.73$24.55$14.55
    17260TDestruction of skin lesions00130.91$44.12$17.66$8.82
    17261TDestruction of skin lesions00130.91$44.12$17.66$8.82
    17262TDestruction of skin lesions00130.91$44.12$17.66$8.82
    17263TDestruction of skin lesions00130.91$44.12$17.66$8.82
    17264TDestruction of skin lesions00151.77$85.82$31.20$17.16
    17266TDestruction of skin lesions00163.53$171.16$74.67$34.23
    17270TDestruction of skin lesions00151.77$85.82$31.20$17.16
    17271TDestruction of skin lesions00130.91$44.12$17.66$8.82
    17272TDestruction of skin lesions00130.91$44.12$17.66$8.82
    17273TDestruction of skin lesions00151.77$85.82$31.20$17.16
    17274TDestruction of skin lesions00151.77$85.82$31.20$17.16
    17276TDestruction of skin lesions00151.77$85.82$31.20$17.16
    17280TDestruction of skin lesions00151.77$85.82$31.20$17.16
    17281TDestruction of skin lesions00151.77$85.82$31.20$17.16
    17282TDestruction of skin lesions00151.77$85.82$31.20$17.16
    17283TDestruction of skin lesions00151.77$85.82$31.20$17.16
    17284TDestruction of skin lesions00163.53$171.16$74.67$34.23
    17286TDestruction of skin lesions00163.53$171.16$74.67$34.23
    17304TChemosurgery of skin lesion00206.51$315.65$130.53$63.13
    17305T2nd stage chemosurgery00206.51$315.65$130.53$63.13
    17306T3rd stage chemosurgery00206.51$315.65$130.53$63.13
    17307TFollowup skin lesion therapy00206.51$315.65$130.53$63.13
    17310TExtensive skin chemosurgery00206.51$315.65$130.53$63.13
    17340TCryotherapy of skin00120.53$25.70$9.18$5.14
    17360TSkin peel therapy00163.53$171.16$74.67$34.23
    17380THair removal by electrolysis00163.53$171.16$74.67$34.23
    17999TSkin tissue procedure00041.84$89.22$32.57$17.84
    19000TDrainage of breast lesion00041.84$89.22$32.57$17.84
    19001TDrain breast lesion add-on00041.84$89.22$32.57$17.84
    19020TIncision of breast lesion00086.15$298.20$113.67$59.64
    19030NInjection for breast x-ray
    19100TBiopsy of breast00055.41$262.32$119.75$52.46
    19101TBiopsy of breast002912.85$623.06$303.50$124.61
    19110TNipple exploration002912.85$623.06$303.50$124.61
    19112TExcise breast duct fistula002912.85$623.06$303.50$124.61
    19120TRemoval of breast lesion002912.85$623.06$303.50$124.61
    19125TExcision, breast lesion002912.85$623.06$303.50$124.61
    19126TExcision, addl breast lesion002912.85$623.06$303.50$124.61
    19140TRemoval of breast tissue002912.85$623.06$303.50$124.61
    19160TRemoval of breast tissue003020.19$978.95$523.95$195.79
    19162TRemove breast tissue, nodes003020.19$978.95$523.95$195.79
    19180TRemoval of breast003020.19$978.95$523.95$195.79
    19182TRemoval of breast003020.19$978.95$523.95$195.79
    19200CRemoval of breast
    19220CRemoval of breast
    19240CRemoval of breast
    19260CRemoval of chest wall lesion
    19271CRevision of chest wall
    19272CExtensive chest wall surgery
    19290TPlace needle wire, breast002912.85$623.06$303.50$124.61
    19291TPlace needle wire, breast002912.85$623.06$303.50$124.61
    19316TSuspension of breast003020.19$978.95$523.95$195.79
    19318TReduction of large breast003020.19$978.95$523.95$195.79
    19324TEnlarge breast003020.19$978.95$523.95$195.79
    19325TEnlarge breast with implant003020.19$978.95$523.95$195.79
    19328TRemoval of breast implant003020.19$978.95$523.95$195.79
    19330TRemoval of implant material003020.19$978.95$523.95$195.79
    19340TImmediate breast prosthesis003020.19$978.95$523.95$195.79
    19342TDelayed breast prosthesis003020.19$978.95$523.95$195.79
    19350TBreast reconstruction003020.19$978.95$523.95$195.79
    19355TCorrect inverted nipple(s)003020.19$978.95$523.95$195.79
    19357TBreast reconstruction003020.19$978.95$523.95$195.79
    19361CBreast reconstruction
    19364CBreast reconstruction
    19366TBreast reconstruction003020.19$978.95$523.95$195.79
    19367CBreast reconstruction
    19368CBreast reconstruction
    19369CBreast reconstruction
    19370TSurgery of breast capsule003020.19$978.95$523.95$195.79
    19371TRemoval of breast capsule003020.19$978.95$523.95$195.79
    19380TRevise breast reconstruction003020.19$978.95$523.95$195.79
    19396TDesign custom breast implant002912.85$623.06$303.50$124.61
    Start Printed Page 18566
    19499TBreast surgery procedure002912.85$623.06$303.50$124.61
    20000TIncision of abscess00062.00$96.97$33.95$19.39
    20005TIncision of deep abscess004915.04$729.25$356.95$145.85
    20100TExplore wound, neck00231.98$96.00$40.37$19.20
    20101TExplore wound, chest002612.11$587.18$277.92$117.44
    20102TExplore wound, abdomen002612.11$587.18$277.92$117.44
    20103TExplore wound, extremity00231.98$96.00$40.37$19.20
    20150TExcise epiphyseal bar005127.76$1,346.00$675.24$269.20
    20200TMuscle biopsy00206.51$315.65$130.53$63.13
    20205TDeep muscle biopsy002110.49$508.63$236.51$101.73
    20206TNeedle biopsy, muscle00055.41$262.32$119.75$52.46
    20220TBone biopsy, trocar/needle00194.00$193.95$78.91$38.79
    20225TBone biopsy, trocar/needle00206.51$315.65$130.53$63.13
    20240TBone biopsy, excisional002212.49$605.60$292.94$121.12
    20245TBone biopsy, excisional002212.49$605.60$292.94$121.12
    20250TOpen bone biopsy004915.04$729.25$356.95$145.85
    20251TOpen bone biopsy004915.04$729.25$356.95$145.85
    20500TInjection of sinus tract02525.18$251.16$114.24$50.23
    20501NInject sinus tract for x-ray
    20520TRemoval of foreign body00194.00$193.95$78.91$38.79
    20525TRemoval of foreign body002212.49$605.60$292.94$121.12
    20550TInject tendon/ligament/cyst00402.11$102.31$40.60$20.46
    20600TDrain/inject, joint/bursa00402.11$102.31$40.60$20.46
    20605TDrain/inject, joint/bursa00402.11$102.31$40.60$20.46
    20610TDrain/inject, joint/bursa00402.11$102.31$40.60$20.46
    20615TTreatment of bone cyst00041.84$89.22$32.57$17.84
    20650TInsert and remove bone pin004915.04$729.25$356.95$145.85
    20660CApply, remove fixation device
    20661CApplication of head brace
    20662CApplication of pelvis brace
    20663CApplication of thigh brace
    20664CHalo brace application
    20665NRemoval of fixation device
    20670TRemoval of support implant002110.49$508.63$236.51$101.73
    20680TRemoval of support implant002212.49$605.60$292.94$121.12
    20690TApply bone fixation device005021.13$1,024.53$513.86$204.91
    20692TApply bone fixation device005021.13$1,024.53$513.86$204.91
    20693TAdjust bone fixation device004915.04$729.25$356.95$145.85
    20694TRemove bone fixation device004915.04$729.25$356.95$145.85
    20802CReplantation, arm, complete
    20805CReplant, forearm, complete
    20808CReplantation hand, complete
    20816CReplantation digit, complete
    20822CReplantation digit, complete
    20824CReplantation thumb, complete
    20827CReplantation thumb, complete
    20838CReplantation foot, complete
    20900TRemoval of bone for graft005021.13$1,024.53$513.86$204.91
    20902TRemoval of bone for graft005021.13$1,024.53$513.86$204.91
    20910TRemove cartilage for graft002612.11$587.18$277.92$117.44
    20912TRemove cartilage for graft002612.11$587.18$277.92$117.44
    20920TRemoval of fascia for graft002612.11$587.18$277.92$117.44
    20922TRemoval of fascia for graft002612.11$587.18$277.92$117.44
    20924TRemoval of tendon for graft005021.13$1,024.53$513.86$204.91
    20926TRemoval of tissue for graft002612.11$587.18$277.92$117.44
    20930CSpinal bone allograft
    20931CSpinal bone allograft
    20936CSpinal bone autograft
    20937CSpinal bone autograft
    20938CSpinal bone autograft
    20950TFluid pressure, muscle00086.15$298.20$113.67$59.64
    20955CFibula bone graft, microvasc
    20956CIliac bone graft, microvasc
    20957CMt bone graft, microvasc
    20962COther bone graft, microvasc
    20969CBone/skin graft, microvasc
    20970CBone/skin graft, iliac crest
    20972CBone/skin graft, metatarsal
    20973CBone/skin graft, great toe
    20974AElectrical bone stimulation
    20975TElectrical bone stimulation004915.04$729.25$356.95$145.85
    20979TUs bone stimulation004915.04$729.25$356.95$145.85
    20999NMusculoskeletal surgery
    Start Printed Page 18567
    21010TIncision of jaw joint025412.45$603.66$272.41$120.73
    21015TResection of facial tumor025412.45$603.66$272.41$120.73
    21025TExcision of bone, lower jaw025625.40$1,231.57$623.05$246.31
    21026TExcision of facial bone(s)025625.40$1,231.57$623.05$246.31
    21029TContour of face bone lesion025625.40$1,231.57$623.05$246.31
    21030TRemoval of face bone lesion025412.45$603.66$272.41$120.73
    21031TRemove exostosis, mandible025312.02$582.81$284.00$116.56
    21032TRemove exostosis, maxilla025312.02$582.81$284.00$116.56
    21034TRemoval of face bone lesion025625.40$1,231.57$623.05$246.31
    21040TRemoval of jaw bone lesion025312.02$582.81$284.00$116.56
    21041TRemoval of jaw bone lesion025625.40$1,231.57$623.05$246.31
    21044TRemoval of jaw bone lesion025625.40$1,231.57$623.05$246.31
    21045CExtensive jaw surgery
    21050TRemoval of jaw joint025625.40$1,231.57$623.05$246.31
    21060TRemove jaw joint cartilage025625.40$1,231.57$623.05$246.31
    21070TRemove coronoid process025625.40$1,231.57$623.05$246.31
    21076TPrepare face/oral prosthesis025412.45$603.66$272.41$120.73
    21077TPrepare face/oral prosthesis025625.40$1,231.57$623.05$246.31
    21079TPrepare face/oral prosthesis025625.40$1,231.57$623.05$246.31
    21080TPrepare face/oral prosthesis025625.40$1,231.57$623.05$246.31
    21081TPrepare face/oral prosthesis025625.40$1,231.57$623.05$246.31
    21082TPrepare face/oral prosthesis025625.40$1,231.57$623.05$246.31
    21083TPrepare face/oral prosthesis025625.40$1,231.57$623.05$246.31
    21084TPrepare face/oral prosthesis025625.40$1,231.57$623.05$246.31
    21085TPrepare face/oral prosthesis025312.02$582.81$284.00$116.56
    21086TPrepare face/oral prosthesis025625.40$1,231.57$623.05$246.31
    21087TPrepare face/oral prosthesis025625.40$1,231.57$623.05$246.31
    21088TPrepare face/oral prosthesis025625.40$1,231.57$623.05$246.31
    21089TPrepare face/oral prosthesis025312.02$582.81$284.00$116.56
    21100TMaxillofacial fixation025625.40$1,231.57$623.05$246.31
    21110TInterdental fixation025412.45$603.66$272.41$120.73
    21116NInjection, jaw joint x-ray
    21120TReconstruction of chin025412.45$603.66$272.41$120.73
    21121TReconstruction of chin025412.45$603.66$272.41$120.73
    21122TReconstruction of chin025412.45$603.66$272.41$120.73
    21123TReconstruction of chin025412.45$603.66$272.41$120.73
    21125TAugmentation, lower jaw bone025412.45$603.66$272.41$120.73
    21127TAugmentation, lower jaw bone025625.40$1,231.57$623.05$246.31
    21137TReduction of forehead025412.45$603.66$272.41$120.73
    21138TReduction of forehead025625.40$1,231.57$623.05$246.31
    21139TReduction of forehead025625.40$1,231.57$623.05$246.31
    21141CReconstruct midface, lefort
    21142CReconstruct midface, lefort
    21143CReconstruct midface, lefort
    21145CReconstruct midface, lefort
    21146CReconstruct midface, lefort
    21147CReconstruct midface, lefort
    21150CReconstruct midface, lefort
    21151CReconstruct midface, lefort
    21154CReconstruct midface, lefort
    21155CReconstruct midface, lefort
    21159CReconstruct midface, lefort
    21160CReconstruct midface, lefort
    21172CReconstruct orbit/forehead
    21175CReconstruct orbit/forehead
    21179CReconstruct entire forehead
    21180CReconstruct entire forehead
    21181TContour cranial bone lesion025412.45$603.66$272.41$120.73
    21182CReconstruct cranial bone
    21183CReconstruct cranial bone
    21184CReconstruct cranial bone
    21188CReconstruction of midface
    21193CReconstruct lower jaw bone
    21194CReconstruct lower jaw bone
    21195CReconstruct lower jaw bone
    21196CReconstruct lower jaw bone
    21198TReconstruct lower jaw bone025625.40$1,231.57$623.05$246.31
    21206TReconstruct upper jaw bone025625.40$1,231.57$623.05$246.31
    21208TAugmentation of facial bones025625.40$1,231.57$623.05$246.31
    21209TReduction of facial bones025625.40$1,231.57$623.05$246.31
    21210TFace bone graft025625.40$1,231.57$623.05$246.31
    21215TLower jaw bone graft025625.40$1,231.57$623.05$246.31
    21230TRib cartilage graft025625.40$1,231.57$623.05$246.31
    Start Printed Page 18568
    21235TEar cartilage graft025412.45$603.66$272.41$120.73
    21240TReconstruction of jaw joint025625.40$1,231.57$623.05$246.31
    21242TReconstruction of jaw joint025625.40$1,231.57$623.05$246.31
    21243TReconstruction of jaw joint025625.40$1,231.57$623.05$246.31
    21244TReconstruction of lower jaw025625.40$1,231.57$623.05$246.31
    21245TReconstruction of jaw025625.40$1,231.57$623.05$246.31
    21246TReconstruction of jaw025625.40$1,231.57$623.05$246.31
    21247CReconstruct lower jaw bone
    21248TReconstruction of jaw025625.40$1,231.57$623.05$246.31
    21249TReconstruction of jaw025625.40$1,231.57$623.05$246.31
    21255CReconstruct lower jaw bone
    21256CReconstruction of orbit
    21260TRevise eye sockets025625.40$1,231.57$623.05$246.31
    21261TRevise eye sockets025625.40$1,231.57$623.05$246.31
    21263TRevise eye sockets025625.40$1,231.57$623.05$246.31
    21267TRevise eye sockets025625.40$1,231.57$623.05$246.31
    21268CRevise eye sockets
    21270TAugmentation, cheek bone025625.40$1,231.57$623.05$246.31
    21275TRevision, orbitofacial bones025625.40$1,231.57$623.05$246.31
    21280TRevision of eyelid025625.40$1,231.57$623.05$246.31
    21282TRevision of eyelid025312.02$582.81$284.00$116.56
    21295TRevision of jaw muscle/bone025312.02$582.81$284.00$116.56
    21296TRevision of jaw muscle/bone025412.45$603.66$272.41$120.73
    21299TCranio/maxillofacial surgery025312.02$582.81$284.00$116.56
    21300TTreatment of skull fracture025312.02$582.81$284.00$116.56
    21310TTreatment of nose fracture025312.02$582.81$284.00$116.56
    21315TTreatment of nose fracture025312.02$582.81$284.00$116.56
    21320TTreatment of nose fracture025312.02$582.81$284.00$116.56
    21325TTreatment of nose fracture025312.02$582.81$284.00$116.56
    21330TTreatment of nose fracture025412.45$603.66$272.41$120.73
    21335TTreatment of nose fracture025412.45$603.66$272.41$120.73
    21336TTreat nasal septal fracture004622.29$1,080.78$535.76$216.16
    21337TTreat nasal septal fracture025312.02$582.81$284.00$116.56
    21338TTreat nasoethmoid fracture025412.45$603.66$272.41$120.73
    21339TTreat nasoethmoid fracture025412.45$603.66$272.41$120.73
    21340TTreatment of nose fracture025625.40$1,231.57$623.05$246.31
    21343CTreatment of sinus fracture
    21344CTreatment of sinus fracture
    21345TTreat nose/jaw fracture025412.45$603.66$272.41$120.73
    21346CTreat nose/jaw fracture
    21347CTreat nose/jaw fracture
    21348CTreat nose/jaw fracture
    21355TTreat cheek bone fracture025625.40$1,231.57$623.05$246.31
    21356CTreat cheek bone fracture
    21360CTreat cheek bone fracture
    21365CTreat cheek bone fracture
    21366CTreat cheek bone fracture
    21385CTreat eye socket fracture
    21386CTreat eye socket fracture
    21387CTreat eye socket fracture
    21390CTreat eye socket fracture
    21395CTreat eye socket fracture
    21400TTreat eye socket fracture02525.18$251.16$114.24$50.23
    21401TTreat eye socket fracture025312.02$582.81$284.00$116.56
    21406TTreat eye socket fracture025625.40$1,231.57$623.05$246.31
    21407TTreat eye socket fracture025625.40$1,231.57$623.05$246.31
    21408CTreat eye socket fracture
    21421TTreat mouth roof fracture025412.45$603.66$272.41$120.73
    21422CTreat mouth roof fracture
    21423CTreat mouth roof fracture
    21431CTreat craniofacial fracture
    21432CTreat craniofacial fracture
    21433CTreat craniofacial fracture
    21435CTreat craniofacial fracture
    21436CTreat craniofacial fracture
    21440TTreat dental ridge fracture025312.02$582.81$284.00$116.56
    21445TTreat dental ridge fracture025412.45$603.66$272.41$120.73
    21450TTreat lower jaw fracture02511.68$81.46$27.99$16.29
    21451TTreat lower jaw fracture025412.45$603.66$272.41$120.73
    21452TTreat lower jaw fracture025312.02$582.81$284.00$116.56
    21453TTreat lower jaw fracture025625.40$1,231.57$623.05$246.31
    21454TTreat lower jaw fracture025412.45$603.66$272.41$120.73
    21461TTreat lower jaw fracture025625.40$1,231.57$623.05$246.31
    Start Printed Page 18569
    21462TTreat lower jaw fracture025625.40$1,231.57$623.05$246.31
    21465TTreat lower jaw fracture025625.40$1,231.57$623.05$246.31
    21470TTreat lower jaw fracture025625.40$1,231.57$623.05$246.31
    21480TReset dislocated jaw02511.68$81.46$27.99$16.29
    21485TReset dislocated jaw025312.02$582.81$284.00$116.56
    21490TRepair dislocated jaw025625.40$1,231.57$623.05$246.31
    21493TTreat hyoid bone fracture02525.18$251.16$114.24$50.23
    21494TTreat hyoid bone fracture02525.18$251.16$114.24$50.23
    21495CTreat hyoid bone fracture
    21497TInterdental wiring025312.02$582.81$284.00$116.56
    21499THead surgery procedure025312.02$582.81$284.00$116.56
    21501TDrain neck/chest lesion00086.15$298.20$113.67$59.64
    21502TDrain chest lesion005021.13$1,024.53$513.86$204.91
    21510CDrainage of bone lesion
    21550TBiopsy of neck/chest00194.00$193.95$78.91$38.79
    21555TRemove lesion, neck/chest002212.49$605.60$292.94$121.12
    21556TRemove lesion, neck/chest002212.49$605.60$292.94$121.12
    21557CRemove tumor, neck/chest
    21600TPartial removal of rib005021.13$1,024.53$513.86$204.91
    21610TPartial removal of rib005021.13$1,024.53$513.86$204.91
    21615CRemoval of rib
    21616CRemoval of rib and nerves
    21620CPartial removal of sternum
    21627CSternal debridement
    21630CExtensive sternum surgery
    21632CExtensive sternum surgery
    21700TRevision of neck muscle00086.15$298.20$113.67$59.64
    21705CRevision of neck muscle/rib
    21720TRevision of neck muscle00086.15$298.20$113.67$59.64
    21725TRevision of neck muscle00086.15$298.20$113.67$59.64
    21740CReconstruction of sternum
    21750CRepair of sternum separation
    21800TTreatment of rib fracture00431.64$79.52$25.46$15.90
    21805TTreatment of rib fracture004622.29$1,080.78$535.76$216.16
    21810CTreatment of rib fracture(s)
    21820TTreat sternum fracture00431.64$79.52$25.46$15.90
    21825CTreat sternum fracture
    21899TNeck/chest surgery procedure02525.18$251.16$114.24$50.23
    21920TBiopsy soft tissue of back00206.51$315.65$130.53$63.13
    21925TBiopsy soft tissue of back002212.49$605.60$292.94$121.12
    21930TRemove lesion, back or flank002212.49$605.60$292.94$121.12
    1935TRemove tumor, back002212.49$605.60$292.94$121.12
    22100CRemove part of neck vertebra
    22101CRemove part, thorax vertebra
    22102CRemove part, lumbar vertebra
    22103CRemove extra spine segment
    22110CRemove part of neck vertebra
    22112CRemove part, thorax vertebra
    22114CRemove part, lumbar vertebra
    22116CRemove extra spine segment
    22210CRevision of neck spine
    22212CRevision of thorax spine
    22214CRevision of lumbar spine
    22216CRevise, extra spine segment
    22220CRevision of neck spine
    22222CRevision of thorax spine
    22224CRevision of lumbar spine
    22226CRevise, extra spine segment
    22305TTreat spine process fracture00431.64$79.52$25.46$15.90
    22310TTreat spine fracture00431.64$79.52$25.46$15.90
    22315TTreat spine fracture00431.64$79.52$25.46$15.90
    22318CTreat odontoid fx w/o graft
    22319CTreat odontoid fx w/graft
    22325CTreat spine fracture
    22326CTreat neck spine fracture
    22327CTreat thorax spine fracture
    22328CTreat each add spine fx
    22505TManipulation of spine004511.02$534.33$277.12$106.87
    22548CNeck spine fusion
    22554CNeck spine fusion
    22556CThorax spine fusion
    22558CLumbar spine fusion
    22585CAdditional spinal fusion
    Start Printed Page 18570
    22590CSpine & skull spinal fusion
    22595CNeck spinal fusion
    22600CNeck spine fusion
    22610CThorax spine fusion
    22612CLumbar spine fusion
    22614CSpine fusion, extra segment
    22630CLumbar spine fusion
    22632CSpine fusion, extra segment
    22800CFusion of spine
    22802CFusion of spine
    22804CFusion of spine
    22808CFusion of spine
    22810CFusion of spine
    22812CFusion of spine
    22818CKyphectomy, 1-2 segments
    22819CKyphectomy, 3 or more
    22830CExploration of spinal fusion
    22840CInsert spine fixation device
    22841CInsert spine fixation device
    22842CInsert spine fixation device
    22843CInsert spine fixation device
    22844CInsert spine fixation device
    22845CInsert spine fixation device
    22846CInsert spine fixation device
    22847CInsert spine fixation device
    22848CInsert pelv fixation device
    22849CReinsert spinal fixation
    22850CRemove spine fixation device
    22851CApply spine prosth device
    22852CRemove spine fixation device
    22855CRemove spine fixation device
    22899TSpine surgery procedure00431.64$79.52$25.46$15.90
    22900TRemove abdominal wall lesion002212.49$605.60$292.94$121.12
    22999TAbdomen surgery procedure002212.49$605.60$292.94$121.12
    23000TRemoval of calcium deposits002110.49$508.63$236.51$101.73
    23020TRelease shoulder joint005127.76$1,346.00$675.24$269.20
    23030TDrain shoulder lesion00086.15$298.20$113.67$59.64
    23031TDrain shoulder bursa00086.15$298.20$113.67$59.64
    23035CDrain shoulder bone lesion
    23040TExploratory shoulder surgery005021.13$1,024.53$513.86$204.91
    23044TExploratory shoulder surgery005021.13$1,024.53$513.86$204.91
    23065TBiopsy shoulder tissues002110.49$508.63$236.51$101.73
    23066TBiopsy shoulder tissues002212.49$605.60$292.94$121.12
    23075TRemoval of shoulder lesion002110.49$508.63$236.51$101.73
    23076TRemoval of shoulder lesion002212.49$605.60$292.94$121.12
    23077TRemove tumor of shoulder002212.49$605.60$292.94$121.12
    23100TBiopsy of shoulder joint004915.04$729.25$356.95$145.85
    23101TShoulder joint surgery005021.13$1,024.53$513.86$204.91
    23105TRemove shoulder joint lining005021.13$1,024.53$513.86$204.91
    23106TIncision of collarbone joint005021.13$1,024.53$513.86$204.91
    23107TExplore treat shoulder joint005021.13$1,024.53$513.86$204.91
    23120TPartial removal, collar bone005127.76$1,346.00$675.24$269.20
    23125CRemoval of collar bone
    23130TRemove shoulder bone, part005127.76$1,346.00$675.24$269.20
    23140TRemoval of bone lesion004915.04$729.25$356.95$145.85
    23145TRemoval of bone lesion005021.13$1,024.53$513.86$204.91
    23146TRemoval of bone lesion005021.13$1,024.53$513.86$204.91
    23150TRemoval of humerus lesion005021.13$1,024.53$513.86$204.91
    23155TRemoval of humerus lesion005021.13$1,024.53$513.86$204.91
    23156TRemoval of humerus lesion005021.13$1,024.53$513.86$204.91
    23170TRemove collar bone lesion005021.13$1,024.53$513.86$204.91
    23172TRemove shoulder blade lesion005021.13$1,024.53$513.86$204.91
    23174TRemove humerus lesion005021.13$1,024.53$513.86$204.91
    23180TRemove collar bone lesion005021.13$1,024.53$513.86$204.91
    23182TRemove shoulder blade lesion005021.13$1,024.53$513.86$204.91
    23184TRemove humerus lesion005021.13$1,024.53$513.86$204.91
    23190TPartial removal of scapula005021.13$1,024.53$513.86$204.91
    23195CRemoval of head of humerus
    23200CRemoval of collar bone
    23210CRemoval of shoulder blade
    23220CPartial removal of humerus
    23221CPartial removal of humerus
    23222CPartial removal of humerus
    Start Printed Page 18571
    23330TRemove shoulder foreign body00194.00$193.95$78.91$38.79
    23331TRemove shoulder foreign body002212.49$605.60$292.94$121.12
    23332CRemove shoulder foreign body
    23350NInjection for shoulder x-ray
    23395CMuscle transfer, shoulder/arm
    23397CMuscle transfers
    23400CFixation of shoulder blade
    23405TIncision of tendon & muscle005021.13$1,024.53$513.86$204.91
    23406TIncise tendon(s) & muscle(s)005021.13$1,024.53$513.86$204.91
    23410TRepair of tendon(s)005236.16$1,753.29$930.91$350.66
    23412TRepair of tendon(s)005236.16$1,753.29$930.91$350.66
    23415TRelease of shoulder ligament005127.76$1,346.00$675.24$269.20
    23420TRepair of shoulder005236.16$1,753.29$930.91$350.66
    23430TRepair biceps tendon005236.16$1,753.29$930.91$350.66
    23440CRemove/transplant tendon
    23450TRepair shoulder capsule005236.16$1,753.29$930.91$350.66
    23455TRepair shoulder capsule005236.16$1,753.29$930.91$350.66
    23460TRepair shoulder capsule005236.16$1,753.29$930.91$350.66
    23462TRepair shoulder capsule005236.16$1,753.29$930.91$350.66
    23465TRepair shoulder capsule005236.16$1,753.29$930.91$350.66
    23466TRepair shoulder capsule005236.16$1,753.29$930.91$350.66
    23470CReconstruct shoulder joint
    23472CReconstruct shoulder joint
    23480TRevision of collar bone005127.76$1,346.00$675.24$269.20
    23485TRevision of collar bone005127.76$1,346.00$675.24$269.20
    23490TReinforce clavicle005127.76$1,346.00$675.24$269.20
    23491TReinforce shoulder bones005127.76$1,346.00$675.24$269.20
    23500TTreat clavicle fracture00431.64$79.52$25.46$15.90
    23505TTreat clavicle fracture00431.64$79.52$25.46$15.90
    23515TTreat clavicle fracture004622.29$1,080.78$535.76$216.16
    23520TTreat clavicle dislocation00431.64$79.52$25.46$15.90
    23525TTreat clavicle dislocation00431.64$79.52$25.46$15.90
    23530TTreat clavicle dislocation004622.29$1,080.78$535.76$216.16
    23532TTreat clavicle dislocation004622.29$1,080.78$535.76$216.16
    23540TTreat clavicle dislocation00431.64$79.52$25.46$15.90
    23545TTreat clavicle dislocation00431.64$79.52$25.46$15.90
    23550TTreat clavicle dislocation004622.29$1,080.78$535.76$216.16
    23552TTreat clavicle dislocation004622.29$1,080.78$535.76$216.16
    23570TTreat shoulder blade fx00431.64$79.52$25.46$15.90
    23575TTreat shoulder blade fx00431.64$79.52$25.46$15.90
    23585TTreat scapula fracture004622.29$1,080.78$535.76$216.16
    23600TTreat humerus fracture00442.17$105.22$38.08$21.04
    23605TTreat humerus fracture00442.17$105.22$38.08$21.04
    23615TTreat humerus fracture004622.29$1,080.78$535.76$216.16
    23616TTreat humerus fracture004622.29$1,080.78$535.76$216.16
    23620TTreat humerus fracture00442.17$105.22$38.08$21.04
    23625TTreat humerus fracture00442.17$105.22$38.08$21.04
    23630TTreat humerus fracture004622.29$1,080.78$535.76$216.16
    23650TTreat shoulder dislocation00431.64$79.52$25.46$15.90
    23655TTreat shoulder dislocation004511.02$534.33$277.12$106.87
    23660TTreat shoulder dislocation004622.29$1,080.78$535.76$216.16
    23665TTreat dislocation/fracture00442.17$105.22$38.08$21.04
    23670TTreat dislocation/fracture004622.29$1,080.78$535.76$216.16
    23675TTreat dislocation/fracture00442.17$105.22$38.08$21.04
    23680TTreat dislocation/fracture004622.29$1,080.78$535.76$216.16
    23700TFixation of shoulder004511.02$534.33$277.12$106.87
    23800TFusion of shoulder joint005127.76$1,346.00$675.24$269.20
    23802TFusion of shoulder joint005127.76$1,346.00$675.24$269.20
    23900CAmputation of arm & girdle
    23920CAmputation at shoulder joint
    23921TAmputation follow-up surgery002612.11$587.18$277.92$117.44
    23929TShoulder surgery procedure00431.64$79.52$25.46$15.90
    23930TDrainage of arm lesion00086.15$298.20$113.67$59.64
    23931TDrainage of arm bursa00086.15$298.20$113.67$59.64
    23935TDrain arm/elbow bone lesion004915.04$729.25$356.95$145.85
    24000TExploratory elbow surgery005021.13$1,024.53$513.86$204.91
    24006TRelease elbow joint005021.13$1,024.53$513.86$204.91
    24065TBiopsy arm/elbow soft tissue00206.51$315.65$130.53$63.13
    24066TBiopsy arm/elbow soft tissue00206.51$315.65$130.53$63.13
    24075TRemove arm/elbow lesion002110.49$508.63$236.51$101.73
    24076TRemove arm/elbow lesion002212.49$605.60$292.94$121.12
    24077TRemove tumor of arm/elbow002212.49$605.60$292.94$121.12
    24100TBiopsy elbow joint lining004915.04$729.25$356.95$145.85
    Start Printed Page 18572
    24101TExplore/treat elbow joint005021.13$1,024.53$513.86$204.91
    24102TRemove elbow joint lining005021.13$1,024.53$513.86$204.91
    24105TRemoval of elbow bursa004915.04$729.25$356.95$145.85
    24110TRemove humerus lesion004915.04$729.25$356.95$145.85
    24115TRemove/graft bone lesion005021.13$1,024.53$513.86$204.91
    24116TRemove/graft bone lesion005021.13$1,024.53$513.86$204.91
    24120TRemove elbow lesion004915.04$729.25$356.95$145.85
    24125TRemove/graft bone lesion005021.13$1,024.53$513.86$204.91
    24126TRemove/graft bone lesion005021.13$1,024.53$513.86$204.91
    24130TRemoval of head of radius005021.13$1,024.53$513.86$204.91
    24134TRemoval of arm bone lesion005021.13$1,024.53$513.86$204.91
    24136TRemove radius bone lesion005021.13$1,024.53$513.86$204.91
    24138TRemove elbow bone lesion005021.13$1,024.53$513.86$204.91
    24140TPartial removal of arm bone005021.13$1,024.53$513.86$204.91
    24145TPartial removal of radius005021.13$1,024.53$513.86$204.91
    24147TPartial removal of elbow005021.13$1,024.53$513.86$204.91
    24149CRadical resection of elbow
    24150CExtensive humerus surgery
    24151CExtensive humerus surgery
    24152CExtensive radius surgery
    24153CExtensive radius surgery
    24155TRemoval of elbow joint005127.76$1,346.00$675.24$269.20
    24160TRemove elbow joint implant005021.13$1,024.53$513.86$204.91
    24164TRemove radius head implant005021.13$1,024.53$513.86$204.91
    24200TRemoval of arm foreign body00194.00$193.95$78.91$38.79
    24201TRemoval of arm foreign body002110.49$508.63$236.51$101.73
    24220NInjection for elbow x-ray
    24301TMuscle/tendon transfer005021.13$1,024.53$513.86$204.91
    24305TArm tendon lengthening005021.13$1,024.53$513.86$204.91
    24310TRevision of arm tendon004915.04$729.25$356.95$145.85
    24320TRepair of arm tendon005127.76$1,346.00$675.24$269.20
    24330TRevision of arm muscles005127.76$1,346.00$675.24$269.20
    24331TRevision of arm muscles005127.76$1,346.00$675.24$269.20
    24340TRepair of biceps tendon005127.76$1,346.00$675.24$269.20
    24341TRepair arm tendon/muscle005127.76$1,346.00$675.24$269.20
    24342TRepair of ruptured tendon005127.76$1,346.00$675.24$269.20
    24350TRepair of tennis elbow005021.13$1,024.53$513.86$204.91
    24351TRepair of tennis elbow005021.13$1,024.53$513.86$204.91
    24352TRepair of tennis elbow005021.13$1,024.53$513.86$204.91
    24354TRepair of tennis elbow005021.13$1,024.53$513.86$204.91
    24356TRevision of tennis elbow005021.13$1,024.53$513.86$204.91
    24360TReconstruct elbow joint004722.09$1,071.08$537.03$214.22
    24361TReconstruct elbow joint004829.06$1,409.03$725.94$281.81
    24362TReconstruct elbow joint004829.06$1,409.03$725.94$281.81
    24363TReplace elbow joint004829.06$1,409.03$725.94$281.81
    24365TReconstruct head of radius004722.09$1,071.08$537.03$214.22
    24366TReconstruct head of radius004829.06$1,409.03$725.94$281.81
    24400TRevision of humerus005021.13$1,024.53$513.86$204.91
    24410TRevision of humerus005021.13$1,024.53$513.86$204.91
    24420TRevision of humerus005127.76$1,346.00$675.24$269.20
    24430TRepair of humerus005127.76$1,346.00$675.24$269.20
    24435TRepair humerus with graft005127.76$1,346.00$675.24$269.20
    24470TRevision of elbow joint005127.76$1,346.00$675.24$269.20
    24495TDecompression of forearm005021.13$1,024.53$513.86$204.91
    24498TReinforce humerus005127.76$1,346.00$675.24$269.20
    24500TTreat humerus fracture00442.17$105.22$38.08$21.04
    24505TTreat humerus fracture00442.17$105.22$38.08$21.04
    24515TTreat humerus fracture004622.29$1,080.78$535.76$216.16
    24516TTreat humerus fracture004622.29$1,080.78$535.76$216.16
    24530TTreat humerus fracture00442.17$105.22$38.08$21.04
    24535TTreat humerus fracture00442.17$105.22$38.08$21.04
    24538TTreat humerus fracture004622.29$1,080.78$535.76$216.16
    24545TTreat humerus fracture004622.29$1,080.78$535.76$216.16
    24546TTreat humerus fracture004622.29$1,080.78$535.76$216.16
    24560TTreat humerus fracture00442.17$105.22$38.08$21.04
    24565TTreat humerus fracture00442.17$105.22$38.08$21.04
    24566TTreat humerus fracture004622.29$1,080.78$535.76$216.16
    24575TTreat humerus fracture004622.29$1,080.78$535.76$216.16
    24576TTreat humerus fracture00442.17$105.22$38.08$21.04
    24577TTreat humerus fracture00442.17$105.22$38.08$21.04
    24579TTreat humerus fracture004622.29$1,080.78$535.76$216.16
    24582TTreat humerus fracture004622.29$1,080.78$535.76$216.16
    24586TTreat elbow fracture004622.29$1,080.78$535.76$216.16
    Start Printed Page 18573
    24587TTreat elbow fracture004622.29$1,080.78$535.76$216.16
    24600TTreat elbow dislocation00442.17$105.22$38.08$21.04
    24605TTreat elbow dislocation004511.02$534.33$277.12$106.87
    24615TTreat elbow dislocation004622.29$1,080.78$535.76$216.16
    24620TTreat elbow fracture00442.17$105.22$38.08$21.04
    24635TTreat elbow fracture004622.29$1,080.78$535.76$216.16
    24640TTreat elbow dislocation00442.17$105.22$38.08$21.04
    24650TTreat radius fracture00442.17$105.22$38.08$21.04
    24655TTreat radius fracture00442.17$105.22$38.08$21.04
    24665TTreat radius fracture004622.29$1,080.78$535.76$216.16
    24666TTreat radius fracture004622.29$1,080.78$535.76$216.16
    24670TTreat ulnar fracture00442.17$105.22$38.08$21.04
    24675TTreat ulnar fracture00442.17$105.22$38.08$21.04
    24685TTreat ulnar fracture004622.29$1,080.78$535.76$216.16
    24800TFusion of elbow joint005127.76$1,346.00$675.24$269.20
    24802TFusion/graft of elbow joint005127.76$1,346.00$675.24$269.20
    24900CAmputation of upper arm
    24920CAmputation of upper arm
    24925TAmputation follow-up surgery004915.04$729.25$356.95$145.85
    24930CAmputation follow-up surgery
    24931CAmputate upper arm & implant
    24935TRevision of amputation005236.16$1,753.29$930.91$350.66
    24940CRevision of upper arm
    24999TUpper arm/elbow surgery00442.17$105.22$38.08$21.04
    25000TIncision of tendon sheath004915.04$729.25$356.95$145.85
    25020TDecompression of forearm004915.04$729.25$356.95$145.85
    25023TDecompression of forearm005021.13$1,024.53$513.86$204.91
    25028TDrainage of forearm lesion004915.04$729.25$356.95$145.85
    25031TDrainage of forearm bursa004915.04$729.25$356.95$145.85
    25035TTreat forearm bone lesion004915.04$729.25$356.95$145.85
    25040TExplore/treat wrist joint005021.13$1,024.53$513.86$204.91
    25065TBiopsy forearm soft tissues00206.51$315.65$130.53$63.13
    25066TBiopsy forearm soft tissues002212.49$605.60$292.94$121.12
    25075TRemoval of forearm lesion00206.51$315.65$130.53$63.13
    25076TRemoval of forearm lesion002212.49$605.60$292.94$121.12
    25077TRemove tumor, forearm/wrist002212.49$605.60$292.94$121.12
    25085TIncision of wrist capsule004915.04$729.25$356.95$145.85
    25100TBiopsy of wrist joint004915.04$729.25$356.95$145.85
    25101TExplore/treat wrist joint005021.13$1,024.53$513.86$204.91
    25105TRemove wrist joint lining005021.13$1,024.53$513.86$204.91
    25107TRemove wrist joint cartilage005021.13$1,024.53$513.86$204.91
    25110TRemove wrist tendon lesion004915.04$729.25$356.95$145.85
    25111TRemove wrist tendon lesion005311.32$548.87$253.49$109.77
    25112TReremove wrist tendon lesion005311.32$548.87$253.49$109.77
    25115TRemove wrist/forearm lesion004915.04$729.25$356.95$145.85
    25116TRemove wrist/forearm lesion004915.04$729.25$356.95$145.85
    25118TExcise wrist tendon sheath005021.13$1,024.53$513.86$204.91
    25119TPartial removal of ulna005021.13$1,024.53$513.86$204.91
    25120TRemoval of forearm lesion005021.13$1,024.53$513.86$204.91
    25125TRemove/graft forearm lesion005021.13$1,024.53$513.86$204.91
    25126TRemove/graft forearm lesion005021.13$1,024.53$513.86$204.91
    25130TRemoval of wrist lesion005021.13$1,024.53$513.86$204.91
    25135TRemove & graft wrist lesion005021.13$1,024.53$513.86$204.91
    25136TRemove & graft wrist lesion005021.13$1,024.53$513.86$204.91
    25145TRemove forearm bone lesion005021.13$1,024.53$513.86$204.91
    25150TPartial removal of ulna005021.13$1,024.53$513.86$204.91
    25151TPartial removal of radius005021.13$1,024.53$513.86$204.91
    25170CExtensive forearm surgery
    25210TRemoval of wrist bone005419.66$953.26$472.33$190.65
    25215TRemoval of wrist bones005419.66$953.26$472.33$190.65
    25230TPartial removal of radius005021.13$1,024.53$513.86$204.91
    25240TPartial removal of ulna005021.13$1,024.53$513.86$204.91
    25246NInjection for wrist x-ray
    25248TRemove forearm foreign body004915.04$729.25$356.95$145.85
    25250TRemoval of wrist prosthesis005021.13$1,024.53$513.86$204.91
    25251TRemoval of wrist prosthesis005021.13$1,024.53$513.86$204.91
    25260TRepair forearm tendon/muscle005021.13$1,024.53$513.86$204.91
    25263TRepair forearm tendon/muscle005021.13$1,024.53$513.86$204.91
    25265TRepair forearm tendon/muscle005021.13$1,024.53$513.86$204.91
    25270TRepair forearm tendon/muscle005021.13$1,024.53$513.86$204.91
    25272TRepair forearm tendon/muscle005021.13$1,024.53$513.86$204.91
    25274TRepair forearm tendon/muscle005021.13$1,024.53$513.86$204.91
    25280TRevise wrist/forearm tendon005021.13$1,024.53$513.86$204.91
    Start Printed Page 18574
    25290TIncise wrist/forearm tendon005021.13$1,024.53$513.86$204.91
    25295TRelease wrist/forearm tendon004915.04$729.25$356.95$145.85
    25300TFusion of tendons at wrist005021.13$1,024.53$513.86$204.91
    25301TFusion of tendons at wrist005021.13$1,024.53$513.86$204.91
    25310TTransplant forearm tendon005127.76$1,346.00$675.24$269.20
    25312TTransplant forearm tendon005127.76$1,346.00$675.24$269.20
    25315TRevise palsy hand tendon(s)005127.76$1,346.00$675.24$269.20
    25316TRevise palsy hand tendon(s)005127.76$1,346.00$675.24$269.20
    25320TRepair/revise wrist joint005127.76$1,346.00$675.24$269.20
    25332TRevise wrist joint004722.09$1,071.08$537.03$214.22
    25335TRealignment of hand005127.76$1,346.00$675.24$269.20
    25337TReconstruct ulna/radioulnar005127.76$1,346.00$675.24$269.20
    25350TRevision of radius005127.76$1,346.00$675.24$269.20
    25355TRevision of radius005127.76$1,346.00$675.24$269.20
    25360TRevision of ulna005021.13$1,024.53$513.86$204.91
    25365TRevise radius & ulna005021.13$1,024.53$513.86$204.91
    25370TRevise radius or ulna005127.76$1,346.00$675.24$269.20
    25375TRevise radius & ulna005127.76$1,346.00$675.24$269.20
    25390CShorten radius or ulna
    25391CLengthen radius or ulna
    25392CShorten radius & ulna
    25393CLengthen radius & ulna
    25400TRepair radius or ulna005021.13$1,024.53$513.86$204.91
    25405CRepair/graft radius or ulna
    25415TRepair radius & ulna005021.13$1,024.53$513.86$204.91
    25420CRepair/graft radius & ulna
    25425TRepair/graft radius or ulna005127.76$1,346.00$675.24$269.20
    25426TRepair/graft radius & ulna005127.76$1,346.00$675.24$269.20
    25440TRepair/graft wrist bone005127.76$1,346.00$675.24$269.20
    25441TReconstruct wrist joint004829.06$1,409.03$725.94$281.81
    25442TReconstruct wrist joint004829.06$1,409.03$725.94$281.81
    25443TReconstruct wrist joint004829.06$1,409.03$725.94$281.81
    25444TReconstruct wrist joint004829.06$1,409.03$725.94$281.81
    25445TReconstruct wrist joint004829.06$1,409.03$725.94$281.81
    25446TWrist replacement004829.06$1,409.03$725.94$281.81
    25447TRepair wrist joint(s)004722.09$1,071.08$537.03$214.22
    25449TRemove wrist joint implant004722.09$1,071.08$537.03$214.22
    25450TRevision of wrist joint005127.76$1,346.00$675.24$269.20
    25455TRevision of wrist joint005127.76$1,346.00$675.24$269.20
    25490TReinforce radius005127.76$1,346.00$675.24$269.20
    25491TReinforce ulna005127.76$1,346.00$675.24$269.20
    25492TReinforce radius and ulna005127.76$1,346.00$675.24$269.20
    25500TTreat fracture of radius00442.17$105.22$38.08$21.04
    25505TTreat fracture of radius00442.17$105.22$38.08$21.04
    25515TTreat fracture of radius004622.29$1,080.78$535.76$216.16
    25520TTreat fracture of radius00442.17$105.22$38.08$21.04
    25525TTreat fracture of radius004622.29$1,080.78$535.76$216.16
    25526TTreat fracture of radius004622.29$1,080.78$535.76$216.16
    25530TTreat fracture of ulna00442.17$105.22$38.08$21.04
    25535TTreat fracture of ulna00442.17$105.22$38.08$21.04
    25545TTreat fracture of ulna004622.29$1,080.78$535.76$216.16
    25560TTreat fracture radius & ulna00442.17$105.22$38.08$21.04
    25565TTreat fracture radius & ulna00442.17$105.22$38.08$21.04
    25574TTreat fracture radius & ulna004622.29$1,080.78$535.76$216.16
    25575TTreat fracture radius/ulna004622.29$1,080.78$535.76$216.16
    25600TTreat fracture radius/ulna00442.17$105.22$38.08$21.04
    25605TTreat fracture radius/ulna00442.17$105.22$38.08$21.04
    25611TTreat fracture radius/ulna004622.29$1,080.78$535.76$216.16
    25620TTreat fracture radius/ulna004622.29$1,080.78$535.76$216.16
    25622TTreat wrist bone fracture00442.17$105.22$38.08$21.04
    25624TTreat wrist bone fracture00442.17$105.22$38.08$21.04
    25628TTreat wrist bone fracture004622.29$1,080.78$535.76$216.16
    25630TTreat wrist bone fracture00442.17$105.22$38.08$21.04
    25635TTreat wrist bone fracture00442.17$105.22$38.08$21.04
    25645TTreat wrist bone fracture004622.29$1,080.78$535.76$216.16
    25650TTreat wrist bone fracture00442.17$105.22$38.08$21.04
    25660TTreat wrist dislocation00442.17$105.22$38.08$21.04
    25670TTreat wrist dislocation004622.29$1,080.78$535.76$216.16
    25675TTreat wrist dislocation00442.17$105.22$38.08$21.04
    25676TTreat wrist dislocation004622.29$1,080.78$535.76$216.16
    25680TTreat wrist fracture00442.17$105.22$38.08$21.04
    25685TTreat wrist fracture004622.29$1,080.78$535.76$216.16
    25690TTreat wrist dislocation00442.17$105.22$38.08$21.04
    Start Printed Page 18575
    25695TTreat wrist dislocation004622.29$1,080.78$535.76$216.16
    25800TFusion of wrist joint005127.76$1,346.00$675.24$269.20
    25805TFusion/graft of wrist joint005127.76$1,346.00$675.24$269.20
    25810TFusion/graft of wrist joint005127.76$1,346.00$675.24$269.20
    25820TFusion of hand bones005311.32$548.87$253.49$109.77
    25825TFuse hand bones with graft005419.66$953.26$472.33$190.65
    25830TFusion, radioulnar jnt/ulna005127.76$1,346.00$675.24$269.20
    25900CAmputation of forearm
    25905CAmputation of forearm
    25907TAmputation follow-up surgery004915.04$729.25$356.95$145.85
    25909CAmputation follow-up surgery
    25915CAmputation of forearm
    25920CAmputate hand at wrist
    25922TAmputate hand at wrist004915.04$729.25$356.95$145.85
    25924CAmputation follow-up surgery
    25927CAmputation of hand
    25929TAmputation follow-up surgery002612.11$587.18$277.92$117.44
    25931CAmputation follow-up surgery
    25999TForearm or wrist surgery00442.17$105.22$38.08$21.04
    26010TDrainage of finger abscess00062.00$96.97$33.95$19.39
    26011TDrainage of finger abscess00073.68$178.43$72.03$35.69
    26020TDrain hand tendon sheath005311.32$548.87$253.49$109.77
    26025TDrainage of palm bursa005311.32$548.87$253.49$109.77
    26030TDrainage of palm bursa(s)005311.32$548.87$253.49$109.77
    26034TTreat hand bone lesion005311.32$548.87$253.49$109.77
    26035TDecompress fingers/hand005311.32$548.87$253.49$109.77
    26037TDecompress fingers/hand005311.32$548.87$253.49$109.77
    26040TRelease palm contracture005419.66$953.26$472.33$190.65
    26045TRelease palm contracture005419.66$953.26$472.33$190.65
    26055TIncise finger tendon sheath005311.32$548.87$253.49$109.77
    26060TIncision of finger tendon005311.32$548.87$253.49$109.77
    26070TExplore/treat hand joint005311.32$548.87$253.49$109.77
    26075TExplore/treat finger joint005311.32$548.87$253.49$109.77
    26080TExplore/treat finger joint005311.32$548.87$253.49$109.77
    26100TBiopsy hand joint lining005311.32$548.87$253.49$109.77
    26105TBiopsy finger joint lining005311.32$548.87$253.49$109.77
    26110TBiopsy finger joint lining005311.32$548.87$253.49$109.77
    26115TRemoval of hand lesion002212.49$605.60$292.94$121.12
    26116TRemoval of hand lesion002212.49$605.60$292.94$121.12
    26117TRemove tumor, hand/finger002212.49$605.60$292.94$121.12
    26121TRelease palm contracture005419.66$953.26$472.33$190.65
    26123TRelease palm contracture005419.66$953.26$472.33$190.65
    26125TRelease palm contracture005419.66$953.26$472.33$190.65
    26130TRemove wrist joint lining005311.32$548.87$253.49$109.77
    26135TRevise finger joint, each005419.66$953.26$472.33$190.65
    26140TRevise finger joint, each005311.32$548.87$253.49$109.77
    26145TTendon excision, palm/finger005311.32$548.87$253.49$109.77
    26160TRemove tendon sheath lesion005311.32$548.87$253.49$109.77
    26170TRemoval of palm tendon, each005311.32$548.87$253.49$109.77
    26180TRemoval of finger tendon005311.32$548.87$253.49$109.77
    26185TRemove finger bone005311.32$548.87$253.49$109.77
    26200TRemove hand bone lesion005311.32$548.87$253.49$109.77
    26205TRemove/graft bone lesion005419.66$953.26$472.33$190.65
    26210TRemoval of finger lesion005311.32$548.87$253.49$109.77
    26215TRemove/graft finger lesion005311.32$548.87$253.49$109.77
    26230TPartial removal of hand bone005311.32$548.87$253.49$109.77
    26235TPartial removal, finger bone005311.32$548.87$253.49$109.77
    26236TPartial removal, finger bone005311.32$548.87$253.49$109.77
    26250TExtensive hand surgery005311.32$548.87$253.49$109.77
    26255TExtensive hand surgery005419.66$953.26$472.33$190.65
    26260TExtensive finger surgery005311.32$548.87$253.49$109.77
    26261TExtensive finger surgery005311.32$548.87$253.49$109.77
    26262TPartial removal of finger005311.32$548.87$253.49$109.77
    26320TRemoval of implant from hand00206.51$315.65$130.53$63.13
    26350TRepair finger/hand tendon005419.66$953.26$472.33$190.65
    26352TRepair/graft hand tendon005419.66$953.26$472.33$190.65
    26356TRepair finger/hand tendon005419.66$953.26$472.33$190.65
    26357TRepair finger/hand tendon005419.66$953.26$472.33$190.65
    26358TRepair/graft hand tendon005419.66$953.26$472.33$190.65
    26370TRepair finger/hand tendon005419.66$953.26$472.33$190.65
    26372TRepair/graft hand tendon005419.66$953.26$472.33$190.65
    26373TRepair finger/hand tendon005419.66$953.26$472.33$190.65
    26390TRevise hand/finger tendon005419.66$953.26$472.33$190.65
    Start Printed Page 18576
    26392TRepair/graft hand tendon005419.66$953.26$472.33$190.65
    26410TRepair hand tendon005311.32$548.87$253.49$109.77
    26412TRepair/graft hand tendon005419.66$953.26$472.33$190.65
    26415TExcision, hand/finger tendon005419.66$953.26$472.33$190.65
    26416TGraft hand or finger tendon005419.66$953.26$472.33$190.65
    26418TRepair finger tendon005311.32$548.87$253.49$109.77
    26420TRepair/graft finger tendon005419.66$953.26$472.33$190.65
    26426TRepair finger/hand tendon005419.66$953.26$472.33$190.65
    26428TRepair/graft finger tendon005419.66$953.26$472.33$190.65
    26432TRepair finger tendon005311.32$548.87$253.49$109.77
    26433TRepair finger tendon005311.32$548.87$253.49$109.77
    26434TRepair/graft finger tendon005419.66$953.26$472.33$190.65
    26437TRealignment of tendons005311.32$548.87$253.49$109.77
    26440TRelease palm/finger tendon005311.32$548.87$253.49$109.77
    26442TRelease palm & finger tendon005419.66$953.26$472.33$190.65
    26445TRelease hand/finger tendon005311.32$548.87$253.49$109.77
    26449TRelease forearm/hand tendon005419.66$953.26$472.33$190.65
    26450TIncision of palm tendon005311.32$548.87$253.49$109.77
    26455TIncision of finger tendon005311.32$548.87$253.49$109.77
    26460TIncise hand/finger tendon005311.32$548.87$253.49$109.77
    26471TFusion of finger tendons005311.32$548.87$253.49$109.77
    26474TFusion of finger tendons005311.32$548.87$253.49$109.77
    26476TTendon lengthening005311.32$548.87$253.49$109.77
    26477TTendon shortening005311.32$548.87$253.49$109.77
    26478TLengthening of hand tendon005311.32$548.87$253.49$109.77
    26479TShortening of hand tendon005311.32$548.87$253.49$109.77
    26480TTransplant hand tendon005419.66$953.26$472.33$190.65
    26483TTransplant/graft hand tendon005419.66$953.26$472.33$190.65
    26485TTransplant palm tendon005419.66$953.26$472.33$190.65
    26489TTransplant/graft palm tendon005419.66$953.26$472.33$190.65
    26490TRevise thumb tendon005419.66$953.26$472.33$190.65
    26492TTendon transfer with graft005419.66$953.26$472.33$190.65
    26494THand tendon/muscle transfer005419.66$953.26$472.33$190.65
    26496TRevise thumb tendon005419.66$953.26$472.33$190.65
    26497TFinger tendon transfer005419.66$953.26$472.33$190.65
    26498TFinger tendon transfer005419.66$953.26$472.33$190.65
    26499TRevision of finger005419.66$953.26$472.33$190.65
    26500THand tendon reconstruction005311.32$548.87$253.49$109.77
    26502THand tendon reconstruction005419.66$953.26$472.33$190.65
    26504THand tendon reconstruction005419.66$953.26$472.33$190.65
    26508TRelease thumb contracture005311.32$548.87$253.49$109.77
    26510TThumb tendon transfer005419.66$953.26$472.33$190.65
    26516TFusion of knuckle joint005419.66$953.26$472.33$190.65
    26517TFusion of knuckle joints005419.66$953.26$472.33$190.65
    26518TFusion of knuckle joints005419.66$953.26$472.33$190.65
    26520TRelease knuckle contracture005311.32$548.87$253.49$109.77
    26525TRelease finger contracture005311.32$548.87$253.49$109.77
    26530TRevise knuckle joint004722.09$1,071.08$537.03$214.22
    26531TRevise knuckle with implant004829.06$1,409.03$725.94$281.81
    26535TRevise finger joint004722.09$1,071.08$537.03$214.22
    26536TRevise/implant finger joint004829.06$1,409.03$725.94$281.81
    26540TRepair hand joint005311.32$548.87$253.49$109.77
    26541TRepair hand joint with graft005419.66$953.26$472.33$190.65
    26542TRepair hand joint with graft005311.32$548.87$253.49$109.77
    26545TReconstruct finger joint005419.66$953.26$472.33$190.65
    26546TRepair nonunion hand005419.66$953.26$472.33$190.65
    26548TReconstruct finger joint005419.66$953.26$472.33$190.65
    26550TConstruct thumb replacement005419.66$953.26$472.33$190.65
    26551CGreat toe-hand transfer
    26553CSingle transfer, toe-hand
    26554CDouble transfer, toe-hand
    26555TPositional change of finger005419.66$953.26$472.33$190.65
    26556CToe joint transfer
    26560TRepair of web finger005311.32$548.87$253.49$109.77
    26561TRepair of web finger005419.66$953.26$472.33$190.65
    26562TRepair of web finger005419.66$953.26$472.33$190.65
    26565TCorrect metacarpal flaw005419.66$953.26$472.33$190.65
    26567TCorrect finger deformity005419.66$953.26$472.33$190.65
    26568TLengthen metacarpal/finger005419.66$953.26$472.33$190.65
    26580TRepair hand deformity005419.66$953.26$472.33$190.65
    26585TRepair finger deformity005419.66$953.26$472.33$190.65
    26587TReconstruct extra finger005311.32$548.87$253.49$109.77
    26590TRepair finger deformity005419.66$953.26$472.33$190.65
    Start Printed Page 18577
    26591TRepair muscles of hand005419.66$953.26$472.33$190.65
    26593TRelease muscles of hand005311.32$548.87$253.49$109.77
    26596TExcision constricting tissue005419.66$953.26$472.33$190.65
    26597TRelease of scar contracture005419.66$953.26$472.33$190.65
    26600TTreat metacarpal fracture00442.17$105.22$38.08$21.04
    26605TTreat metacarpal fracture00442.17$105.22$38.08$21.04
    26607TTreat metacarpal fracture00442.17$105.22$38.08$21.04
    26608TTreat metacarpal fracture004622.29$1,080.78$535.76$216.16
    26615TTreat metacarpal fracture004622.29$1,080.78$535.76$216.16
    26641TTreat thumb dislocation00442.17$105.22$38.08$21.04
    26645TTreat thumb fracture00442.17$105.22$38.08$21.04
    26650TTreat thumb fracture004622.29$1,080.78$535.76$216.16
    26665TTreat thumb fracture004622.29$1,080.78$535.76$216.16
    26670TTreat hand dislocation00442.17$105.22$38.08$21.04
    26675TTreat hand dislocation004511.02$534.33$277.12$106.87
    26676TPin hand dislocation004622.29$1,080.78$535.76$216.16
    26685TTreat hand dislocation004622.29$1,080.78$535.76$216.16
    26686TTreat hand dislocation004622.29$1,080.78$535.76$216.16
    26700TTreat knuckle dislocation00431.64$79.52$25.46$15.90
    26705TTreat knuckle dislocation004511.02$534.33$277.12$106.87
    26706TPin knuckle dislocation00442.17$105.22$38.08$21.04
    26715TTreat knuckle dislocation004622.29$1,080.78$535.76$216.16
    26720TTreat finger fracture, each00431.64$79.52$25.46$15.90
    26725TTreat finger fracture, each00431.64$79.52$25.46$15.90
    26727TTreat finger fracture, each004622.29$1,080.78$535.76$216.16
    26735TTreat finger fracture, each004622.29$1,080.78$535.76$216.16
    26740TTreat finger fracture, each00431.64$79.52$25.46$15.90
    26742TTreat finger fracture, each00442.17$105.22$38.08$21.04
    26746TTreat finger fracture, each004622.29$1,080.78$535.76$216.16
    26750TTreat finger fracture, each00431.64$79.52$25.46$15.90
    26755TTreat finger fracture, each00431.64$79.52$25.46$15.90
    26756TPin finger fracture, each004622.29$1,080.78$535.76$216.16
    26765TTreat finger fracture, each004622.29$1,080.78$535.76$216.16
    26770TTreat finger dislocation00431.64$79.52$25.46$15.90
    26775TTreat finger dislocation004511.02$534.33$277.12$106.87
    26776TPin finger dislocation004622.29$1,080.78$535.76$216.16
    26785TTreat finger dislocation004622.29$1,080.78$535.76$216.16
    26820TThumb fusion with graft005419.66$953.26$472.33$190.65
    26841TFusion of thumb005419.66$953.26$472.33$190.65
    26842TThumb fusion with graft005419.66$953.26$472.33$190.65
    26843TFusion of hand joint005419.66$953.26$472.33$190.65
    26844TFusion/graft of hand joint005419.66$953.26$472.33$190.65
    26850TFusion of knuckle005419.66$953.26$472.33$190.65
    26852TFusion of knuckle with graft005419.66$953.26$472.33$190.65
    26860TFusion of finger joint005419.66$953.26$472.33$190.65
    26861TFusion of finger jnt, add-on005419.66$953.26$472.33$190.65
    26862TFusion/graft of finger joint005419.66$953.26$472.33$190.65
    26863TFuse/graft added joint005419.66$953.26$472.33$190.65
    26910TAmputate metacarpal bone005419.66$953.26$472.33$190.65
    26951TAmputation of finger/thumb005311.32$548.87$253.49$109.77
    26952TAmputation of finger/thumb005311.32$548.87$253.49$109.77
    26989THand/finger surgery00431.64$79.52$25.46$15.90
    26990TDrainage of pelvis lesion004915.04$729.25$356.95$145.85
    26991TDrainage of pelvis bursa004915.04$729.25$356.95$145.85
    26992CDrainage of bone lesion
    27000TIncision of hip tendon004915.04$729.25$356.95$145.85
    27001TIncision of hip tendon005021.13$1,024.53$513.86$204.91
    27003TIncision of hip tendon005021.13$1,024.53$513.86$204.91
    27005CIncision of hip tendon
    27006CIncision of hip tendons
    27025CIncision of hip/thigh fascia
    27030CDrainage of hip joint
    27033TExploration of hip joint005127.76$1,346.00$675.24$269.20
    27035CDenervation of hip joint
    27036CExcision of hip joint/muscle
    27040TBiopsy of soft tissues002110.49$508.63$236.51$101.73
    27041TBiopsy of soft tissues002212.49$605.60$292.94$121.12
    27047TRemove hip/pelvis lesion002212.49$605.60$292.94$121.12
    27048TRemove hip/pelvis lesion002212.49$605.60$292.94$121.12
    27049TRemove tumor, hip/pelvis002212.49$605.60$292.94$121.12
    27050TBiopsy of sacroiliac joint004915.04$729.25$356.95$145.85
    27052TBiopsy of hip joint004915.04$729.25$356.95$145.85
    27054CRemoval of hip joint lining
    Start Printed Page 18578
    27060TRemoval of ischial bursa004915.04$729.25$356.95$145.85
    27062TRemove femur lesion/bursa004915.04$729.25$356.95$145.85
    27065TRemoval of hip bone lesion004915.04$729.25$356.95$145.85
    27066TRemoval of hip bone lesion005021.13$1,024.53$513.86$204.91
    27067TRemove/graft hip bone lesion005021.13$1,024.53$513.86$204.91
    27070CPartial removal of hip bone
    27071CPartial removal of hip bone
    27075CExtensive hip surgery
    27076CExtensive hip surgery
    27077CExtensive hip surgery
    27078CExtensive hip surgery
    27079CExtensive hip surgery
    27080TRemoval of tail bone005021.13$1,024.53$513.86$204.91
    27086TRemove hip foreign body00194.00$193.95$78.91$38.79
    27087TRemove hip foreign body004915.04$729.25$356.95$145.85
    27090CRemoval of hip prosthesis
    27091CRemoval of hip prosthesis
    27093NInjection for hip x-ray
    27095NInjection for hip x-ray
    27096NInject sacroiliac joint
    27097TRevision of hip tendon005021.13$1,024.53$513.86$204.91
    27098TTransfer tendon to pelvis005021.13$1,024.53$513.86$204.91
    27100TTransfer of abdominal muscle005127.76$1,346.00$675.24$269.20
    27105TTransfer of spinal muscle005127.76$1,346.00$675.24$269.20
    27110TTransfer of iliopsoas muscle005127.76$1,346.00$675.24$269.20
    27111TTransfer of iliopsoas muscle005127.76$1,346.00$675.24$269.20
    27120CReconstruction of hip socket
    27122CReconstruction of hip socket
    27125CPartial hip replacement
    27130CTotal hip replacement
    27132CTotal hip replacement
    27134CRevise hip joint replacement
    27137CRevise hip joint replacement
    27138CRevise hip joint replacement
    27140CTransplant femur ridge
    27146CIncision of hip bone
    27147CRevision of hip bone
    27151CIncision of hip bones
    27156CRevision of hip bones
    27158CRevision of pelvis
    27161CIncision of neck of femur
    27165CIncision/fixation of femur
    27170CRepair/graft femur head/neck
    27175CTreat slipped epiphysis
    27176CTreat slipped epiphysis
    27177CTreat slipped epiphysis
    27178CTreat slipped epiphysis
    27179CRevise head/neck of femur
    27181CTreat slipped epiphysis
    27185CRevision of femur epiphysis
    27187CReinforce hip bones
    27193TTreat pelvic ring fracture00442.17$105.22$38.08$21.04
    27194TTreat pelvic ring fracture004511.02$534.33$277.12$106.87
    27200TTreat tail bone fracture00431.64$79.52$25.46$15.90
    27202TTreat tail bone fracture004622.29$1,080.78$535.76$216.16
    27215CTreat pelvic fracture(s)
    27216CTreat pelvic ring fracture
    27217CTreat pelvic ring fracture
    27218CTreat pelvic ring fracture
    27220TTreat hip socket fracture00442.17$105.22$38.08$21.04
    27222CTreat hip socket fracture
    27226CTreat hip wall fracture
    27227CTreat hip fracture(s)
    27228CTreat hip fracture(s)
    27230TTreat thigh fracture00442.17$105.22$38.08$21.04
    27232CTreat thigh fracture
    27235CTreat thigh fracture
    27236CTreat thigh fracture
    27238TTreat thigh fracture00442.17$105.22$38.08$21.04
    27240CTreat thigh fracture
    27244CTreat thigh fracture
    27245CTreat thigh fracture
    27246TTreat thigh fracture00442.17$105.22$38.08$21.04
    Start Printed Page 18579
    27248CTreat thigh fracture
    27250TTreat hip dislocation00442.17$105.22$38.08$21.04
    27252TTreat hip dislocation004511.02$534.33$277.12$106.87
    27253CTreat hip dislocation
    27254CTreat hip dislocation
    27256TTreat hip dislocation00442.17$105.22$38.08$21.04
    27257TTreat hip dislocation004511.02$534.33$277.12$106.87
    27258CTreat hip dislocation
    27259CTreat hip dislocation
    27265TTreat hip dislocation00442.17$105.22$38.08$21.04
    27266TTreat hip dislocation004722.09$1,071.08$537.03$214.22
    27275TManipulation of hip joint004511.02$534.33$277.12$106.87
    27280CFusion of sacroiliac joint
    27282CFusion of pubic bones
    27284CFusion of hip joint
    27286CFusion of hip joint
    27290CAmputation of leg at hip
    27295CAmputation of leg at hip
    27299TPelvis/hip joint surgery00431.64$79.52$25.46$15.90
    27301TDrain thigh/knee lesion00086.15$298.20$113.67$59.64
    27303CDrainage of bone lesion
    27305TIncise thigh tendon & fascia004915.04$729.25$356.95$145.85
    27306TIncision of thigh tendon004915.04$729.25$356.95$145.85
    27307TIncision of thigh tendons004915.04$729.25$356.95$145.85
    27310TExploration of knee joint005021.13$1,024.53$513.86$204.91
    27315TPartial removal, thigh nerve022013.96$676.88$326.21$135.38
    27320TPartial removal, thigh nerve022013.96$676.88$326.21$135.38
    27323TBiopsy, thigh soft tissues002110.49$508.63$236.51$101.73
    27324TBiopsy, thigh soft tissues002212.49$605.60$292.94$121.12
    27327TRemoval of thigh lesion002212.49$605.60$292.94$121.12
    27328TRemoval of thigh lesion002212.49$605.60$292.94$121.12
    27329TRemove tumor, thigh/knee002212.49$605.60$292.94$121.12
    27330TBiopsy, knee joint lining005021.13$1,024.53$513.86$204.91
    27331TExplore/treat knee joint005021.13$1,024.53$513.86$204.91
    27332TRemoval of knee cartilage005021.13$1,024.53$513.86$204.91
    27333TRemoval of knee cartilage005021.13$1,024.53$513.86$204.91
    27334TRemove knee joint lining005021.13$1,024.53$513.86$204.91
    27335TRemove knee joint lining005021.13$1,024.53$513.86$204.91
    27340TRemoval of kneecap bursa004915.04$729.25$356.95$145.85
    27345TRemoval of knee cyst004915.04$729.25$356.95$145.85
    27347TRemove knee cyst004915.04$729.25$356.95$145.85
    27350TRemoval of kneecap005021.13$1,024.53$513.86$204.91
    27355TRemove femur lesion005021.13$1,024.53$513.86$204.91
    27356TRemove femur lesion/graft005021.13$1,024.53$513.86$204.91
    27357TRemove femur lesion/graft005021.13$1,024.53$513.86$204.91
    27358TRemove femur lesion/fixation005021.13$1,024.53$513.86$204.91
    27360TPartial removal, leg bone(s)005021.13$1,024.53$513.86$204.91
    27365CExtensive leg surgery
    27370NInjection for knee x-ray
    27372TRemoval of foreign body002212.49$605.60$292.94$121.12
    27380TRepair of kneecap tendon004915.04$729.25$356.95$145.85
    27381TRepair/graft kneecap tendon004915.04$729.25$356.95$145.85
    27385TRepair of thigh muscle004915.04$729.25$356.95$145.85
    27386TRepair/graft of thigh muscle004915.04$729.25$356.95$145.85
    27390TIncision of thigh tendon004915.04$729.25$356.95$145.85
    27391TIncision of thigh tendons004915.04$729.25$356.95$145.85
    27392TIncision of thigh tendons004915.04$729.25$356.95$145.85
    27393TLengthening of thigh tendon005021.13$1,024.53$513.86$204.91
    27394TLengthening of thigh tendons005021.13$1,024.53$513.86$204.91
    27395TLengthening of thigh tendons005127.76$1,346.00$675.24$269.20
    27396TTransplant of thigh tendon005021.13$1,024.53$513.86$204.91
    27397TTransplants of thigh tendons005127.76$1,346.00$675.24$269.20
    27400TRevise thigh muscles/tendons005127.76$1,346.00$675.24$269.20
    27403TRepair of knee cartilage005021.13$1,024.53$513.86$204.91
    27405TRepair of knee ligament005127.76$1,346.00$675.24$269.20
    27407TRepair of knee ligament005127.76$1,346.00$675.24$269.20
    27409TRepair of knee ligaments005127.76$1,346.00$675.24$269.20
    27418TRepair degenerated kneecap005127.76$1,346.00$675.24$269.20
    27420TRevision of unstable kneecap005127.76$1,346.00$675.24$269.20
    27422TRevision of unstable kneecap005127.76$1,346.00$675.24$269.20
    27424TRevision/removal of kneecap005127.76$1,346.00$675.24$269.20
    27425TLateral retinacular release005021.13$1,024.53$513.86$204.91
    27427TReconstruction, knee005236.16$1,753.29$930.91$350.66
    Start Printed Page 18580
    27428TReconstruction, knee005236.16$1,753.29$930.91$350.66
    27429TReconstruction, knee005236.16$1,753.29$930.91$350.66
    27430TRevision of thigh muscles005127.76$1,346.00$675.24$269.20
    27435TIncision of knee joint005127.76$1,346.00$675.24$269.20
    27437TRevise kneecap004722.09$1,071.08$537.03$214.22
    27438TRevise kneecap with implant004829.06$1,409.03$725.94$281.81
    27440TRevision of knee joint004722.09$1,071.08$537.03$214.22
    27441TRevision of knee joint004722.09$1,071.08$537.03$214.22
    27442TRevision of knee joint004722.09$1,071.08$537.03$214.22
    27443TRevision of knee joint004722.09$1,071.08$537.03$214.22
    27445CRevision of knee joint
    27446CRevision of knee joint
    27447CTotal knee replacement
    27448CIncision of thigh
    27450CIncision of thigh
    27454CRealignment of thigh bone
    27455CRealignment of knee
    27457CRealignment of knee
    27465CShortening of thigh bone
    27466CLengthening of thigh bone
    27468CShorten/lengthen thighs
    27470CRepair of thigh
    27472CRepair/graft of thigh
    27475CSurgery to stop leg growth
    27477CSurgery to stop leg growth
    27479CSurgery to stop leg growth
    27485CSurgery to stop leg growth
    27486CRevise/replace knee joint
    27487CRevise/replace knee joint
    27488CRemoval of knee prosthesis
    27495CReinforce thigh
    27496TDecompression of thigh/knee004915.04$729.25$356.95$145.85
    27497TDecompression of thigh/knee004915.04$729.25$356.95$145.85
    27498TDecompression of thigh/knee004915.04$729.25$356.95$145.85
    27499TDecompression of thigh/knee004915.04$729.25$356.95$145.85
    27500TTreatment of thigh fracture00442.17$105.22$38.08$21.04
    27501TTreatment of thigh fracture00442.17$105.22$38.08$21.04
    27502TTreatment of thigh fracture00442.17$105.22$38.08$21.04
    27503TTreatment of thigh fracture00442.17$105.22$38.08$21.04
    27506CTreatment of thigh fracture
    27507CTreatment of thigh fracture
    27508TTreatment of thigh fracture00442.17$105.22$38.08$21.04
    27509TTreatment of thigh fracture004622.29$1,080.78$535.76$216.16
    27510TTreatment of thigh fracture00442.17$105.22$38.08$21.04
    27511CTreatment of thigh fracture
    27513CTreatment of thigh fracture
    27514CTreatment of thigh fracture
    27516TTreat thigh fx growth plate00442.17$105.22$38.08$21.04
    27517TTreat thigh fx growth plate00442.17$105.22$38.08$21.04
    27519CTreat thigh fx growth plate
    27520TTreat kneecap fracture00442.17$105.22$38.08$21.04
    27524CTreat kneecap fracture
    27530TTreat knee fracture00442.17$105.22$38.08$21.04
    27532TTreat knee fracture00442.17$105.22$38.08$21.04
    27535CTreat knee fracture
    27536CTreat knee fracture
    27538TTreat knee fracture(s)00442.17$105.22$38.08$21.04
    27540CTreat knee fracture
    27550TTreat knee dislocation00442.17$105.22$38.08$21.04
    27552TTreat knee dislocation004511.02$534.33$277.12$106.87
    27556TTreat knee dislocation004622.29$1,080.78$535.76$216.16
    27557CTreat knee dislocation
    27558CTreat knee dislocation
    27560TTreat kneecap dislocation00442.17$105.22$38.08$21.04
    27562TTreat kneecap dislocation004511.02$534.33$277.12$106.87
    27566TTreat kneecap dislocation004622.29$1,080.78$535.76$216.16
    27570TFixation of knee joint004511.02$534.33$277.12$106.87
    27580CFusion of knee
    27590CAmputate leg at thigh
    27591CAmputate leg at thigh
    27592CAmputate leg at thigh
    27594TAmputation follow-up surgery004915.04$729.25$356.95$145.85
    27596CAmputation follow-up surgery
    Start Printed Page 18581
    27598CAmputate lower leg at knee
    27599TLeg surgery procedure00442.17$105.22$38.08$21.04
    27600TDecompression of lower leg004915.04$729.25$356.95$145.85
    27601TDecompression of lower leg004915.04$729.25$356.95$145.85
    27602TDecompression of lower leg004915.04$729.25$356.95$145.85
    27603TDrain lower leg lesion00086.15$298.20$113.67$59.64
    27604TDrain lower leg bursa004915.04$729.25$356.95$145.85
    27605TIncision of achilles tendon005515.47$750.10$355.34$150.02
    27606TIncision of achilles tendon004915.04$729.25$356.95$145.85
    27607TTreat lower leg bone lesion004915.04$729.25$356.95$145.85
    27610TExplore/treat ankle joint005021.13$1,024.53$513.86$204.91
    27612TExploration of ankle joint005021.13$1,024.53$513.86$204.91
    27613TBiopsy lower leg soft tissue00206.51$315.65$130.53$63.13
    27614TBiopsy lower leg soft tissue002212.49$605.60$292.94$121.12
    27615TRemove tumor, lower leg004622.29$1,080.78$535.76$216.16
    27618TRemove lower leg lesion002110.49$508.63$236.51$101.73
    27619TRemove lower leg lesion002212.49$605.60$292.94$121.12
    27620TExplore/treat ankle joint005021.13$1,024.53$513.86$204.91
    27625TRemove ankle joint lining005021.13$1,024.53$513.86$204.91
    27626TRemove ankle joint lining005021.13$1,024.53$513.86$204.91
    27630TRemoval of tendon lesion004915.04$729.25$356.95$145.85
    27635TRemove lower leg bone lesion005021.13$1,024.53$513.86$204.91
    27637TRemove/graft leg bone lesion005021.13$1,024.53$513.86$204.91
    27638TRemove/graft leg bone lesion005021.13$1,024.53$513.86$204.91
    27640TPartial removal of tibia005127.76$1,346.00$675.24$269.20
    27641TPartial removal of fibula005021.13$1,024.53$513.86$204.91
    27645CExtensive lower leg surgery
    27646CExtensive lower leg surgery
    27647TExtensive ankle/heel surgery005127.76$1,346.00$675.24$269.20
    27648NInjection for ankle x-ray
    27650TRepair achilles tendon005127.76$1,346.00$675.24$269.20
    27652TRepair/graft achilles tendon005127.76$1,346.00$675.24$269.20
    27654TRepair of achilles tendon005127.76$1,346.00$675.24$269.20
    27656TRepair leg fascia defect004915.04$729.25$356.95$145.85
    27658TRepair of leg tendon, each004915.04$729.25$356.95$145.85
    27659TRepair of leg tendon, each004915.04$729.25$356.95$145.85
    27664TRepair of leg tendon, each004915.04$729.25$356.95$145.85
    27665TRepair of leg tendon, each005021.13$1,024.53$513.86$204.91
    27675TRepair lower leg tendons004915.04$729.25$356.95$145.85
    27676TRepair lower leg tendons005021.13$1,024.53$513.86$204.91
    27680TRelease of lower leg tendon005021.13$1,024.53$513.86$204.91
    27681TRelease of lower leg tendons005021.13$1,024.53$513.86$204.91
    27685TRevision of lower leg tendon005021.13$1,024.53$513.86$204.91
    27686TRevise lower leg tendons005021.13$1,024.53$513.86$204.91
    27687TRevision of calf tendon005021.13$1,024.53$513.86$204.91
    27690TRevise lower leg tendon005127.76$1,346.00$675.24$269.20
    27691TRevise lower leg tendon005127.76$1,346.00$675.24$269.20
    27692TRevise additional leg tendon005127.76$1,346.00$675.24$269.20
    27695TRepair of ankle ligament005021.13$1,024.53$513.86$204.91
    27696TRepair of ankle ligaments005021.13$1,024.53$513.86$204.91
    27698TRepair of ankle ligament005021.13$1,024.53$513.86$204.91
    27700TRevision of ankle joint004722.09$1,071.08$537.03$214.22
    27702CReconstruct ankle joint
    27703CReconstruction, ankle joint
    27704TRemoval of ankle implant004915.04$729.25$356.95$145.85
    27705TIncision of tibia005127.76$1,346.00$675.24$269.20
    27707TIncision of fibula004915.04$729.25$356.95$145.85
    27709TIncision of tibia & fibula005021.13$1,024.53$513.86$204.91
    27712CRealignment of lower leg
    27715CRevision of lower leg
    27720CRepair of tibia
    27722CRepair/graft of tibia
    27724CRepair/graft of tibia
    27725CRepair of lower leg
    27727CRepair of lower leg
    27730TRepair of tibia epiphysis005021.13$1,024.53$513.86$204.91
    27732TRepair of fibula epiphysis005021.13$1,024.53$513.86$204.91
    27734TRepair lower leg epiphyses005021.13$1,024.53$513.86$204.91
    27740TRepair of leg epiphyses005021.13$1,024.53$513.86$204.91
    27742TRepair of leg epiphyses005127.76$1,346.00$675.24$269.20
    27745TReinforce tibia005127.76$1,346.00$675.24$269.20
    27750TTreatment of tibia fracture00442.17$105.22$38.08$21.04
    27752TTreatment of tibia fracture00442.17$105.22$38.08$21.04
    Start Printed Page 18582
    27756TTreatment of tibia fracture004622.29$1,080.78$535.76$216.16
    27758TTreatment of tibia fracture004622.29$1,080.78$535.76$216.16
    27759TTreatment of tibia fracture004622.29$1,080.78$535.76$216.16
    27760TTreatment of ankle fracture00442.17$105.22$38.08$21.04
    27762TTreatment of ankle fracture00442.17$105.22$38.08$21.04
    27766TTreatment of ankle fracture004622.29$1,080.78$535.76$216.16
    27780TTreatment of fibula fracture00442.17$105.22$38.08$21.04
    27781TTreatment of fibula fracture00442.17$105.22$38.08$21.04
    27784TTreatment of fibula fracture004622.29$1,080.78$535.76$216.16
    27786TTreatment of ankle fracture00442.17$105.22$38.08$21.04
    27788TTreatment of ankle fracture00442.17$105.22$38.08$21.04
    27792TTreatment of ankle fracture004622.29$1,080.78$535.76$216.16
    27808TTreatment of ankle fracture00442.17$105.22$38.08$21.04
    27810TTreatment of ankle fracture00442.17$105.22$38.08$21.04
    27814TTreatment of ankle fracture004622.29$1,080.78$535.76$216.16
    27816TTreatment of ankle fracture00442.17$105.22$38.08$21.04
    27818TTreatment of ankle fracture00442.17$105.22$38.08$21.04
    27822TTreatment of ankle fracture004622.29$1,080.78$535.76$216.16
    27823TTreatment of ankle fracture004622.29$1,080.78$535.76$216.16
    27824TTreat lower leg fracture00442.17$105.22$38.08$21.04
    27825TTreat lower leg fracture00442.17$105.22$38.08$21.04
    27826TTreat lower leg fracture004622.29$1,080.78$535.76$216.16
    27827TTreat lower leg fracture004622.29$1,080.78$535.76$216.16
    27828TTreat lower leg fracture004622.29$1,080.78$535.76$216.16
    27829TTreat lower leg joint004622.29$1,080.78$535.76$216.16
    27830TTreat lower leg dislocation00442.17$105.22$38.08$21.04
    27831TTreat lower leg dislocation004511.02$534.33$277.12$106.87
    27832TTreat lower leg dislocation004622.29$1,080.78$535.76$216.16
    27840TTreat ankle dislocation00442.17$105.22$38.08$21.04
    27842TTreat ankle dislocation004511.02$534.33$277.12$106.87
    27846TTreat ankle dislocation004622.29$1,080.78$535.76$216.16
    27848TTreat ankle dislocation004622.29$1,080.78$535.76$216.16
    27860TFixation of ankle joint004511.02$534.33$277.12$106.87
    27870TFusion of ankle joint005127.76$1,346.00$675.24$269.20
    27871TFusion of tibiofibular joint005127.76$1,346.00$675.24$269.20
    27880CAmputation of lower leg
    27881CAmputation of lower leg
    27882CAmputation of lower leg
    27884TAmputation follow-up surgery004915.04$729.25$356.95$145.85
    27886CAmputation follow-up surgery
    27888CAmputation of foot at ankle
    27889TAmputation of foot at ankle005021.13$1,024.53$513.86$204.91
    27892TDecompression of leg004915.04$729.25$356.95$145.85
    27893TDecompression of leg004915.04$729.25$356.95$145.85
    27894TDecompression of leg004915.04$729.25$356.95$145.85
    27899TLeg/ankle surgery procedure00442.17$105.22$38.08$21.04
    28001TDrainage of bursa of foot00086.15$298.20$113.67$59.64
    28002TTreatment of foot infection004915.04$729.25$356.95$145.85
    28003TTreatment of foot infection004915.04$729.25$356.95$145.85
    28005TTreat foot bone lesion005515.47$750.10$355.34$150.02
    28008TIncision of foot fascia005515.47$750.10$355.34$150.02
    28010TIncision of toe tendon005515.47$750.10$355.34$150.02
    28011TIncision of toe tendons005515.47$750.10$355.34$150.02
    28020TExploration of foot joint005515.47$750.10$355.34$150.02
    28022TExploration of foot joint005515.47$750.10$355.34$150.02
    28024TExploration of toe joint005515.47$750.10$355.34$150.02
    28030TRemoval of foot nerve022013.96$676.88$326.21$135.38
    28035TDecompression of tibia nerve022013.96$676.88$326.21$135.38
    28043TExcision of foot lesion002110.49$508.63$236.51$101.73
    28045TExcision of foot lesion005515.47$750.10$355.34$150.02
    28046TResection of tumor, foot005515.47$750.10$355.34$150.02
    28050TBiopsy of foot joint lining005515.47$750.10$355.34$150.02
    28052TBiopsy of foot joint lining005515.47$750.10$355.34$150.02
    28054TBiopsy of toe joint lining005515.47$750.10$355.34$150.02
    28060TPartial removal, foot fascia005617.30$838.83$405.81$167.77
    28062TRemoval of foot fascia005617.30$838.83$405.81$167.77
    28070TRemoval of foot joint lining005617.30$838.83$405.81$167.77
    28072TRemoval of foot joint lining005617.30$838.83$405.81$167.77
    28080TRemoval of foot lesion005515.47$750.10$355.34$150.02
    28086TExcise foot tendon sheath005515.47$750.10$355.34$150.02
    28088TExcise foot tendon sheath005515.47$750.10$355.34$150.02
    28090TRemoval of foot lesion005515.47$750.10$355.34$150.02
    28092TRemoval of toe lesions005515.47$750.10$355.34$150.02
    Start Printed Page 18583
    28100TRemoval of ankle/heel lesion005515.47$750.10$355.34$150.02
    28102TRemove/graft foot lesion005617.30$838.83$405.81$167.77
    28103TRemove/graft foot lesion005617.30$838.83$405.81$167.77
    28104TRemoval of foot lesion005515.47$750.10$355.34$150.02
    28106TRemove/graft foot lesion005617.30$838.83$405.81$167.77
    28107TRemove/graft foot lesion005617.30$838.83$405.81$167.77
    28108TRemoval of toe lesions005515.47$750.10$355.34$150.02
    28110TPart removal of metatarsal005721.00$1,018.23$496.65$203.65
    28111TPart removal of metatarsal005515.47$750.10$355.34$150.02
    28112TPart removal of metatarsal005515.47$750.10$355.34$150.02
    28113TPart removal of metatarsal005515.47$750.10$355.34$150.02
    28114TRemoval of metatarsal heads005515.47$750.10$355.34$150.02
    28116TRevision of foot005515.47$750.10$355.34$150.02
    28118TRemoval of heel bone005515.47$750.10$355.34$150.02
    28119TRemoval of heel spur005515.47$750.10$355.34$150.02
    28120TPart removal of ankle/heel005515.47$750.10$355.34$150.02
    28122TPartial removal of foot bone005515.47$750.10$355.34$150.02
    28124TPartial removal of toe005515.47$750.10$355.34$150.02
    28126TPartial removal of toe005515.47$750.10$355.34$150.02
    28130TRemoval of ankle bone005515.47$750.10$355.34$150.02
    28140TRemoval of metatarsal005515.47$750.10$355.34$150.02
    28150TRemoval of toe005515.47$750.10$355.34$150.02
    28153TPartial removal of toe005515.47$750.10$355.34$150.02
    28160TPartial removal of toe005515.47$750.10$355.34$150.02
    28171TExtensive foot surgery005515.47$750.10$355.34$150.02
    28173TExtensive foot surgery005515.47$750.10$355.34$150.02
    28175TExtensive foot surgery005515.47$750.10$355.34$150.02
    28190TRemoval of foot foreign body00194.00$193.95$78.91$38.79
    28192TRemoval of foot foreign body002110.49$508.63$236.51$101.73
    28193TRemoval of foot foreign body00206.51$315.65$130.53$63.13
    28200TRepair of foot tendon005515.47$750.10$355.34$150.02
    28202TRepair/graft of foot tendon005617.30$838.83$405.81$167.77
    28208TRepair of foot tendon005515.47$750.10$355.34$150.02
    28210TRepair/graft of foot tendon005515.47$750.10$355.34$150.02
    28220TRelease of foot tendon005515.47$750.10$355.34$150.02
    28222TRelease of foot tendons005515.47$750.10$355.34$150.02
    28225TRelease of foot tendon005515.47$750.10$355.34$150.02
    28226TRelease of foot tendons005515.47$750.10$355.34$150.02
    28230TIncision of foot tendon(s)005515.47$750.10$355.34$150.02
    28232TIncision of toe tendon005515.47$750.10$355.34$150.02
    28234TIncision of foot tendon005515.47$750.10$355.34$150.02
    28238TRevision of foot tendon005617.30$838.83$405.81$167.77
    28240TRelease of big toe005515.47$750.10$355.34$150.02
    28250TRevision of foot fascia005617.30$838.83$405.81$167.77
    28260TRelease of midfoot joint005617.30$838.83$405.81$167.77
    28261TRevision of foot tendon005617.30$838.83$405.81$167.77
    28262TRevision of foot and ankle005617.30$838.83$405.81$167.77
    28264TRelease of midfoot joint005617.30$838.83$405.81$167.77
    28270TRelease of foot contracture005515.47$750.10$355.34$150.02
    28272TRelease of toe joint, each005515.47$750.10$355.34$150.02
    28280TFusion of toes005515.47$750.10$355.34$150.02
    28285TRepair of hammertoe005515.47$750.10$355.34$150.02
    28286TRepair of hammertoe005515.47$750.10$355.34$150.02
    28288TPartial removal of foot bone005617.30$838.83$405.81$167.77
    28289TRepair hallux rigidus005617.30$838.83$405.81$167.77
    28290TCorrection of bunion005721.00$1,018.23$496.65$203.65
    28292TCorrection of bunion005721.00$1,018.23$496.65$203.65
    28293TCorrection of bunion005721.00$1,018.23$496.65$203.65
    28294TCorrection of bunion005721.00$1,018.23$496.65$203.65
    28296TCorrection of bunion005721.00$1,018.23$496.65$203.65
    28297TCorrection of bunion005721.00$1,018.23$496.65$203.65
    28298TCorrection of bunion005721.00$1,018.23$496.65$203.65
    28299TCorrection of bunion005721.00$1,018.23$496.65$203.65
    28300TIncision of heel bone005617.30$838.83$405.81$167.77
    28302TIncision of ankle bone005617.30$838.83$405.81$167.77
    28304TIncision of midfoot bones005617.30$838.83$405.81$167.77
    28305TIncise/graft midfoot bones005617.30$838.83$405.81$167.77
    28306TIncision of metatarsal005617.30$838.83$405.81$167.77
    28307TIncision of metatarsal005617.30$838.83$405.81$167.77
    28308TIncision of metatarsal005617.30$838.83$405.81$167.77
    28309TIncision of metatarsals005617.30$838.83$405.81$167.77
    28310TRevision of big toe005515.47$750.10$355.34$150.02
    28312TRevision of toe005515.47$750.10$355.34$150.02
    Start Printed Page 18584
    28313TRepair deformity of toe005515.47$750.10$355.34$150.02
    28315TRemoval of sesamoid bone005515.47$750.10$355.34$150.02
    28320TRepair of foot bones005617.30$838.83$405.81$167.77
    28322TRepair of metatarsals005617.30$838.83$405.81$167.77
    28340TResect enlarged toe tissue005515.47$750.10$355.34$150.02
    28341TResect enlarged toe005515.47$750.10$355.34$150.02
    28344TRepair extra toe(s)005617.30$838.83$405.81$167.77
    28345TRepair webbed toe(s)005617.30$838.83$405.81$167.77
    28360TReconstruct cleft foot005617.30$838.83$405.81$167.77
    28400TTreatment of heel fracture00442.17$105.22$38.08$21.04
    28405TTreatment of heel fracture00442.17$105.22$38.08$21.04
    28406TTreatment of heel fracture004622.29$1,080.78$535.76$216.16
    28415TTreat heel fracture004622.29$1,080.78$535.76$216.16
    28420TTreat/graft heel fracture004622.29$1,080.78$535.76$216.16
    28430TTreatment of ankle fracture00442.17$105.22$38.08$21.04
    28435TTreatment of ankle fracture00442.17$105.22$38.08$21.04
    28436TTreatment of ankle fracture004622.29$1,080.78$535.76$216.16
    28445TTreat ankle fracture004622.29$1,080.78$535.76$216.16
    28450TTreat midfoot fracture, each00442.17$105.22$38.08$21.04
    28455TTreat midfoot fracture, each00442.17$105.22$38.08$21.04
    28456TTreat midfoot fracture004622.29$1,080.78$535.76$216.16
    28465TTreat midfoot fracture, each004622.29$1,080.78$535.76$216.16
    28470TTreat metatarsal fracture00442.17$105.22$38.08$21.04
    28475TTreat metatarsal fracture00442.17$105.22$38.08$21.04
    28476TTreat metatarsal fracture004622.29$1,080.78$535.76$216.16
    28485TTreat metatarsal fracture004622.29$1,080.78$535.76$216.16
    28490TTreat big toe fracture00431.64$79.52$25.46$15.90
    28495TTreat big toe fracture00431.64$79.52$25.46$15.90
    28496TTreat big toe fracture004622.29$1,080.78$535.76$216.16
    28505TTreat big toe fracture004622.29$1,080.78$535.76$216.16
    28510TTreatment of toe fracture00431.64$79.52$25.46$15.90
    28515TTreatment of toe fracture00431.64$79.52$25.46$15.90
    28525TTreat toe fracture004622.29$1,080.78$535.76$216.16
    28530TTreat sesamoid bone fracture00442.17$105.22$38.08$21.04
    28531TTreat sesamoid bone fracture004622.29$1,080.78$535.76$216.16
    28540TTreat foot dislocation00442.17$105.22$38.08$21.04
    28545TTreat foot dislocation004511.02$534.33$277.12$106.87
    28546TTreat foot dislocation004622.29$1,080.78$535.76$216.16
    28555TRepair foot dislocation004622.29$1,080.78$535.76$216.16
    28570TTreat foot dislocation00442.17$105.22$38.08$21.04
    28575TTreat foot dislocation004511.02$534.33$277.12$106.87
    28576TTreat foot dislocation004622.29$1,080.78$535.76$216.16
    28585TRepair foot dislocation004622.29$1,080.78$535.76$216.16
    28600TTreat foot dislocation00442.17$105.22$38.08$21.04
    28605TTreat foot dislocation004511.02$534.33$277.12$106.87
    28606TTreat foot dislocation004622.29$1,080.78$535.76$216.16
    28615TRepair foot dislocation004622.29$1,080.78$535.76$216.16
    28630TTreat toe dislocation00431.64$79.52$25.46$15.90
    28635TTreat toe dislocation004511.02$534.33$277.12$106.87
    28636TTreat toe dislocation004622.29$1,080.78$535.76$216.16
    28645TRepair toe dislocation004622.29$1,080.78$535.76$216.16
    28660TTreat toe dislocation00431.64$79.52$25.46$15.90
    28665TTreat toe dislocation004511.02$534.33$277.12$106.87
    28666TTreat toe dislocation004622.29$1,080.78$535.76$216.16
    28675TRepair of toe dislocation004622.29$1,080.78$535.76$216.16
    28705TFusion of foot bones005617.30$838.83$405.81$167.77
    28715TFusion of foot bones005617.30$838.83$405.81$167.77
    28725TFusion of foot bones005617.30$838.83$405.81$167.77
    28730TFusion of foot bones005617.30$838.83$405.81$167.77
    28735TFusion of foot bones005617.30$838.83$405.81$167.77
    28737TRevision of foot bones005515.47$750.10$355.34$150.02
    28740TFusion of foot bones005617.30$838.83$405.81$167.77
    28750TFusion of big toe joint005515.47$750.10$355.34$150.02
    28755TFusion of big toe joint005515.47$750.10$355.34$150.02
    28760TFusion of big toe joint005617.30$838.83$405.81$167.77
    28800CAmputation of midfoot
    28805CAmputation thru metatarsal
    28810TAmputation toe & metatarsal005515.47$750.10$355.34$150.02
    28820TAmputation of toe005515.47$750.10$355.34$150.02
    28825TPartial amputation of toe005515.47$750.10$355.34$150.02
    28899TFoot/toes surgery procedure00431.64$79.52$25.46$15.90
    29000SApplication of body cast00591.74$84.37$29.59$16.87
    29010SApplication of body cast00591.74$84.37$29.59$16.87
    Start Printed Page 18585
    29015SApplication of body cast00591.74$84.37$29.59$16.87
    29020SApplication of body cast00591.74$84.37$29.59$16.87
    29025SApplication of body cast00591.74$84.37$29.59$16.87
    29035SApplication of body cast00591.74$84.37$29.59$16.87
    29040SApplication of body cast00591.74$84.37$29.59$16.87
    29044SApplication of body cast00591.74$84.37$29.59$16.87
    29046SApplication of body cast00591.74$84.37$29.59$16.87
    29049SApplication of figure eight00591.74$84.37$29.59$16.87
    29055SApplication of shoulder cast00591.74$84.37$29.59$16.87
    29058SApplication of shoulder cast00591.74$84.37$29.59$16.87
    29065SApplication of long arm cast00591.74$84.37$29.59$16.87
    29075SApplication of forearm cast00591.74$84.37$29.59$16.87
    29085SApply hand/wrist cast00591.74$84.37$29.59$16.87
    29105SApply long arm splint00591.74$84.37$29.59$16.87
    29125SApply forearm splint00591.74$84.37$29.59$16.87
    29126SApply forearm splint00591.74$84.37$29.59$16.87
    29130SApplication of finger splint00591.74$84.37$29.59$16.87
    29131SApplication of finger splint00591.74$84.37$29.59$16.87
    29200SStrapping of chest00591.74$84.37$29.59$16.87
    29220SStrapping of low back00591.74$84.37$29.59$16.87
    29240SStrapping of shoulder00591.74$84.37$29.59$16.87
    29260SStrapping of elbow or wrist00591.74$84.37$29.59$16.87
    29280SStrapping of hand or finger00591.74$84.37$29.59$16.87
    29305SApplication of hip cast00591.74$84.37$29.59$16.87
    29325SApplication of hip casts00591.74$84.37$29.59$16.87
    29345SApplication of long leg cast00591.74$84.37$29.59$16.87
    29355SApplication of long leg cast00591.74$84.37$29.59$16.87
    29358SApply long leg cast brace00591.74$84.37$29.59$16.87
    29365SApplication of long leg cast00591.74$84.37$29.59$16.87
    29405SApply short leg cast00591.74$84.37$29.59$16.87
    29425SApply short leg cast00591.74$84.37$29.59$16.87
    29435SApply short leg cast00591.74$84.37$29.59$16.87
    29440SAddition of walker to cast00591.74$84.37$29.59$16.87
    29445SApply rigid leg cast00591.74$84.37$29.59$16.87
    29450SApplication of leg cast00591.74$84.37$29.59$16.87
    29505SApplication, long leg splint00581.09$52.85$19.27$10.57
    29515SApplication lower leg splint00581.09$52.85$19.27$10.57
    29520SStrapping of hip00581.09$52.85$19.27$10.57
    29530SStrapping of knee00581.09$52.85$19.27$10.57
    29540SStrapping of ankle00581.09$52.85$19.27$10.57
    29550SStrapping of toes00581.09$52.85$19.27$10.57
    29580SApplication of paste boot00581.09$52.85$19.27$10.57
    29590SApplication of foot splint00581.09$52.85$19.27$10.57
    29700SRemoval/revision of cast00581.09$52.85$19.27$10.57
    29705SRemoval/revision of cast00581.09$52.85$19.27$10.57
    29710SRemoval/revision of cast00581.09$52.85$19.27$10.57
    29715SRemoval/revision of cast00581.09$52.85$19.27$10.57
    29720SRepair of body cast00581.09$52.85$19.27$10.57
    29730SWindowing of cast00581.09$52.85$19.27$10.57
    29740SWedging of cast00581.09$52.85$19.27$10.57
    29750SWedging of clubfoot cast00581.09$52.85$19.27$10.57
    29799SCasting/strapping procedure00581.09$52.85$19.27$10.57
    29800TJaw arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29804TJaw arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29815TShoulder arthroscopy004124.57$1,191.33$592.08$238.27
    29819TShoulder arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29820TShoulder arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29821TShoulder arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29822TShoulder arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29823TShoulder arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29825TShoulder arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29826TShoulder arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29830TElbow arthroscopy004124.57$1,191.33$592.08$238.27
    29834TElbow arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29835TElbow arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29836TElbow arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29837TElbow arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29838TElbow arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29840TWrist arthroscopy004124.57$1,191.33$592.08$238.27
    29843TWrist arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29844TWrist arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29845TWrist arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29846TWrist arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    Start Printed Page 18586
    29847TWrist arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29848TWrist endoscopy/surgery004124.57$1,191.33$592.08$238.27
    29850TKnee arthroscopy/surgery004229.22$1,416.79$804.74$283.36
    29851TKnee arthroscopy/surgery004229.22$1,416.79$804.74$283.36
    29855TTibial arthroscopy/surgery004229.22$1,416.79$804.74$283.36
    29856TTibial arthroscopy/surgery004229.22$1,416.79$804.74$283.36
    29860THip arthroscopy, dx004124.57$1,191.33$592.08$238.27
    29861THip arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29862THip arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29863THip arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29870TKnee arthroscopy, dx004124.57$1,191.33$592.08$238.27
    29871TKnee arthroscopy/drainage004124.57$1,191.33$592.08$238.27
    29874TKnee arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29875TKnee arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29876TKnee arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29877TKnee arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29879TKnee arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29880TKnee arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29881TKnee arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29882TKnee arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29883TKnee arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29884TKnee arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29885TKnee arthroscopy/surgery004229.22$1,416.79$804.74$283.36
    29886TKnee arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29887TKnee arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29888TKnee arthroscopy/surgery004229.22$1,416.79$804.74$283.36
    29889TKnee arthroscopy/surgery004229.22$1,416.79$804.74$283.36
    29891TAnkle arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29892TAnkle arthroscopy/surgery004229.22$1,416.79$804.74$283.36
    29893TScope, plantar fasciotomy005515.47$750.10$355.34$150.02
    29894TAnkle arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29895TAnkle arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29897TAnkle arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29898TAnkle arthroscopy/surgery004124.57$1,191.33$592.08$238.27
    29909TArthroscopy of joint004124.57$1,191.33$592.08$238.27
    30000TDrainage of nose lesion02511.68$81.46$27.99$16.29
    30020TDrainage of nose lesion02511.68$81.46$27.99$16.29
    30100TIntranasal biopsy02525.18$251.16$114.24$50.23
    30110TRemoval of nose polyp(s)025312.02$582.81$284.00$116.56
    30115TRemoval of nose polyp(s)025312.02$582.81$284.00$116.56
    30117TRemoval of intranasal lesion025312.02$582.81$284.00$116.56
    30118TRemoval of intranasal lesion025412.45$603.66$272.41$120.73
    30120TRevision of nose025312.02$582.81$284.00$116.56
    30124TRemoval of nose lesion02525.18$251.16$114.24$50.23
    30125TRemoval of nose lesion025625.40$1,231.57$623.05$246.31
    30130TRemoval of turbinate bones025312.02$582.81$284.00$116.56
    30140TRemoval of turbinate bones025312.02$582.81$284.00$116.56
    30150TPartial removal of nose025625.40$1,231.57$623.05$246.31
    30160TRemoval of nose025625.40$1,231.57$623.05$246.31
    30200TInjection treatment of nose025312.02$582.81$284.00$116.56
    30210TNasal sinus therapy02525.18$251.16$114.24$50.23
    30220TInsert nasal septal button02525.18$251.16$114.24$50.23
    30300TRemove nasal foreign body02511.68$81.46$27.99$16.29
    30310TRemove nasal foreign body025312.02$582.81$284.00$116.56
    30320TRemove nasal foreign body025312.02$582.81$284.00$116.56
    30400TReconstruction of nose025625.40$1,231.57$623.05$246.31
    30410TReconstruction of nose025625.40$1,231.57$623.05$246.31
    30420TReconstruction of nose025625.40$1,231.57$623.05$246.31
    30430TRevision of nose025412.45$603.66$272.41$120.73
    30435TRevision of nose025625.40$1,231.57$623.05$246.31
    30450TRevision of nose025625.40$1,231.57$623.05$246.31
    30460TRevision of nose025625.40$1,231.57$623.05$246.31
    30462TRevision of nose025625.40$1,231.57$623.05$246.31
    30520TRepair of nasal septum025625.40$1,231.57$623.05$246.31
    30540TRepair nasal defect025625.40$1,231.57$623.05$246.31
    30545TRepair nasal defect025625.40$1,231.57$623.05$246.31
    30560TRelease of nasal adhesions02511.68$81.46$27.99$16.29
    30580TRepair upper jaw fistula025625.40$1,231.57$623.05$246.31
    30600TRepair mouth/nose fistula025625.40$1,231.57$623.05$246.31
    30620TIntranasal reconstruction025625.40$1,231.57$623.05$246.31
    30630TRepair nasal septum defect025412.45$603.66$272.41$120.73
    30801TCauterization, inner nose02525.18$251.16$114.24$50.23
    30802TCauterization, inner nose025312.02$582.81$284.00$116.56
    Start Printed Page 18587
    30901TControl of nosebleed02502.21$107.16$38.54$21.43
    30903TControl of nosebleed02502.21$107.16$38.54$21.43
    30905TControl of nosebleed02502.21$107.16$38.54$21.43
    30906TRepeat control of nosebleed02502.21$107.16$38.54$21.43
    30915TLigation, nasal sinus artery009114.79$717.12$348.23$143.42
    30920TLigation, upper jaw artery009220.21$979.92$505.37$195.98
    30930TTherapy, fracture of nose025312.02$582.81$284.00$116.56
    30999TNasal surgery procedure02511.68$81.46$27.99$16.29
    31000TIrrigation, maxillary sinus02511.68$81.46$27.99$16.29
    31002TIrrigation, sphenoid sinus02525.18$251.16$114.24$50.23
    31020TExploration, maxillary sinus025312.02$582.81$284.00$116.56
    31030TExploration, maxillary sinus025625.40$1,231.57$623.05$246.31
    31032TExplore sinus, remove polyps025625.40$1,231.57$623.05$246.31
    31040TExploration behind upper jaw025412.45$603.66$272.41$120.73
    31050TExploration, sphenoid sinus025625.40$1,231.57$623.05$246.31
    31051TSphenoid sinus surgery025625.40$1,231.57$623.05$246.31
    31070TExploration of frontal sinus025412.45$603.66$272.41$120.73
    31075TExploration of frontal sinus025625.40$1,231.57$623.05$246.31
    31080TRemoval of frontal sinus025625.40$1,231.57$623.05$246.31
    31081TRemoval of frontal sinus025625.40$1,231.57$623.05$246.31
    31084TRemoval of frontal sinus025625.40$1,231.57$623.05$246.31
    31085TRemoval of frontal sinus025625.40$1,231.57$623.05$246.31
    31086TRemoval of frontal sinus025625.40$1,231.57$623.05$246.31
    31087TRemoval of frontal sinus025625.40$1,231.57$623.05$246.31
    31090TExploration of sinuses025625.40$1,231.57$623.05$246.31
    31200TRemoval of ethmoid sinus025625.40$1,231.57$623.05$246.31
    31201TRemoval of ethmoid sinus025625.40$1,231.57$623.05$246.31
    31205TRemoval of ethmoid sinus025625.40$1,231.57$623.05$246.31
    31225CRemoval of upper jaw
    31230CRemoval of upper jaw
    31231TNasal endoscopy, dx00710.55$26.67$14.22$5.33
    31233TNasal/sinus endoscopy, dx00721.26$61.09$41.52$12.22
    31235TNasal/sinus endoscopy, dx007413.61$659.91$347.54$131.98
    31237TNasal/sinus endoscopy, surg007413.61$659.91$347.54$131.98
    31238TNasal/sinus endoscopy, surg007413.61$659.91$347.54$131.98
    31239TNasal/sinus endoscopy, surg007518.55$899.44$467.29$179.89
    31240TNasal/sinus endoscopy, surg007413.61$659.91$347.54$131.98
    31254TRevision of ethmoid sinus007518.55$899.44$467.29$179.89
    31255TRemoval of ethmoid sinus007518.55$899.44$467.29$179.89
    31256TExploration maxillary sinus007518.55$899.44$467.29$179.89
    31267TEndoscopy, maxillary sinus007518.55$899.44$467.29$179.89
    31276TSinus endoscopy, surgical007518.55$899.44$467.29$179.89
    31287TNasal/sinus endoscopy, surg007518.55$899.44$467.29$179.89
    31288TNasal/sinus endoscopy, surg007518.55$899.44$467.29$179.89
    31290CNasal/sinus endoscopy, surg
    31291CNasal/sinus endoscopy, surg
    31292CNasal/sinus endoscopy, surg
    31293CNasal/sinus endoscopy, surg
    31294CNasal/sinus endoscopy, surg
    31299TSinus surgery procedure02525.18$251.16$114.24$50.23
    31300TRemoval of larynx lesion025625.40$1,231.57$623.05$246.31
    31320TDiagnostic incision, larynx025625.40$1,231.57$623.05$246.31
    31360CRemoval of larynx
    31365CRemoval of larynx
    31367CPartial removal of larynx
    31368CPartial removal of larynx
    31370CPartial removal of larynx
    31375TPartial removal of larynx025625.40$1,231.57$623.05$246.31
    31380CPartial removal of larynx
    31382CPartial removal of larynx
    31390CRemoval of larynx & pharynx
    31395CReconstruct larynx & pharynx
    31400TRevision of larynx025625.40$1,231.57$623.05$246.31
    31420TRemoval of epiglottis025625.40$1,231.57$623.05$246.31
    31500SInsert emergency airway00944.51$218.68$105.29$43.74
    31502TChange of windpipe airway01212.36$114.43$52.53$22.89
    31505TDiagnostic laryngoscopy00721.26$61.09$41.52$12.22
    31510TLaryngoscopy with biopsy007413.61$659.91$347.54$131.98
    31511TRemove foreign body, larynx00721.26$61.09$41.52$12.22
    31512TRemoval of larynx lesion007413.61$659.91$347.54$131.98
    31513TInjection into vocal cord00734.11$199.28$91.07$39.86
    31515TLaryngoscopy for aspiration007413.61$659.91$347.54$131.98
    31520TDiagnostic laryngoscopy00721.26$61.09$41.52$12.22
    Start Printed Page 18588
    31525TDiagnostic laryngoscopy007413.61$659.91$347.54$131.98
    31526TDiagnostic laryngoscopy007413.61$659.91$347.54$131.98
    31527TLaryngoscopy for treatment007518.55$899.44$467.29$179.89
    31528TLaryngoscopy and dilatation007413.61$659.91$347.54$131.98
    31529TLaryngoscopy and dilatation007413.61$659.91$347.54$131.98
    31530TOperative laryngoscopy007518.55$899.44$467.29$179.89
    31531TOperative laryngoscopy007518.55$899.44$467.29$179.89
    31535TOperative laryngoscopy007518.55$899.44$467.29$179.89
    31536TOperative laryngoscopy007518.55$899.44$467.29$179.89
    31540TOperative laryngoscopy007518.55$899.44$467.29$179.89
    31541TOperative laryngoscopy007518.55$899.44$467.29$179.89
    31560TOperative laryngoscopy007518.55$899.44$467.29$179.89
    31561TOperative laryngoscopy007518.55$899.44$467.29$179.89
    31570TLaryngoscopy with injection007518.55$899.44$467.29$179.89
    31571TLaryngoscopy with injection007518.55$899.44$467.29$179.89
    31575TDiagnostic laryngoscopy00710.55$26.67$14.22$5.33
    31576TLaryngoscopy with biopsy007413.61$659.91$347.54$131.98
    31577TRemove foreign body, larynx00734.11$199.28$91.07$39.86
    31578TRemoval of larynx lesion007413.61$659.91$347.54$131.98
    31579TDiagnostic laryngoscopy00734.11$199.28$91.07$39.86
    31580TRevision of larynx025625.40$1,231.57$623.05$246.31
    31582CRevision of larynx
    31584CTreat larynx fracture
    31585TTreat larynx fracture025312.02$582.81$284.00$116.56
    31586TTreat larynx fracture025625.40$1,231.57$623.05$246.31
    31587CRevision of larynx
    31588TRevision of larynx025625.40$1,231.57$623.05$246.31
    31590TReinnervate larynx025625.40$1,231.57$623.05$246.31
    31595TLarynx nerve surgery025625.40$1,231.57$623.05$246.31
    31599TLarynx surgery procedure025312.02$582.81$284.00$116.56
    31600TIncision of windpipe025412.45$603.66$272.41$120.73
    31601TIncision of windpipe025412.45$603.66$272.41$120.73
    31603TIncision of windpipe025412.45$603.66$272.41$120.73
    31605TIncision of windpipe025412.45$603.66$272.41$120.73
    31610TIncision of windpipe025412.45$603.66$272.41$120.73
    31611TSurgery/speech prosthesis025412.45$603.66$272.41$120.73
    31612TPuncture/clear windpipe025312.02$582.81$284.00$116.56
    31613TRepair windpipe opening025412.45$603.66$272.41$120.73
    31614TRepair windpipe opening025625.40$1,231.57$623.05$246.31
    31615TVisualization of windpipe00768.06$390.81$197.05$78.16
    31622TDx bronchoscope/wash00768.06$390.81$197.05$78.16
    31623TDx bronchoscope/brush00768.06$390.81$197.05$78.16
    31624TDx bronchoscope/lavage00768.06$390.81$197.05$78.16
    31625TBronchoscopy with biopsy00768.06$390.81$197.05$78.16
    31628TBronchoscopy with biopsy00768.06$390.81$197.05$78.16
    31629TBronchoscopy with biopsy00768.06$390.81$197.05$78.16
    31630TBronchoscopy with repair00768.06$390.81$197.05$78.16
    31631TBronchoscopy with dilation00768.06$390.81$197.05$78.16
    31635TRemove foreign body, airway00768.06$390.81$197.05$78.16
    31640TBronchoscopy & remove lesion00768.06$390.81$197.05$78.16
    31641TBronchoscopy, treat blockage00768.06$390.81$197.05$78.16
    31643TDiag bronchoscope/catheter00768.06$390.81$197.05$78.16
    31645TBronchoscopy, clear airways00768.06$390.81$197.05$78.16
    31646TBronchoscopy, reclear airway00768.06$390.81$197.05$78.16
    31656TBronchoscopy, inj for x-ray00768.06$390.81$197.05$78.16
    31700TInsertion of airway catheter00721.26$61.09$41.52$12.22
    31708NInstill airway contrast dye
    31710NInsertion of airway catheter
    31715NInjection for bronchus x-ray
    31717TBronchial brush biopsy00734.11$199.28$91.07$39.86
    31720TClearance of airways00721.26$61.09$41.52$12.22
    31725CClearance of airways
    31730TIntro, windpipe wire/tube00734.11$199.28$91.07$39.86
    31750TRepair of windpipe025625.40$1,231.57$623.05$246.31
    31755TRepair of windpipe025625.40$1,231.57$623.05$246.31
    31760CRepair of windpipe
    31766CReconstruction of windpipe
    31770CRepair/graft of bronchus
    31775CReconstruct bronchus
    31780CReconstruct windpipe
    31781CReconstruct windpipe
    31785CRemove windpipe lesion
    31786CRemove windpipe lesion
    Start Printed Page 18589
    31800CRepair of windpipe injury
    31805CRepair of windpipe injury
    31820TClosure of windpipe lesion025312.02$582.81$284.00$116.56
    31825TRepair of windpipe defect025412.45$603.66$272.41$120.73
    31830TRevise windpipe scar025412.45$603.66$272.41$120.73
    31899TAirways surgical procedure00768.06$390.81$197.05$78.16
    32000TDrainage of chest00703.64$176.49$79.60$35.30
    32002TTreatment of collapsed lung00703.64$176.49$79.60$35.30
    32005TTreat lung lining chemically00703.64$176.49$79.60$35.30
    32020TInsertion of chest tube00703.64$176.49$79.60$35.30
    32035CExploration of chest
    32036CExploration of chest
    32095CBiopsy through chest wall
    32100CExploration/biopsy of chest
    32110CExplore/repair chest
    32120CRe-exploration of chest
    32124CExplore chest free adhesions
    32140CRemoval of lung lesion(s)
    32141CRemove/treat lung lesions
    32150CRemoval of lung lesion(s)
    32151CRemove lung foreign body
    32160COpen chest heart massage
    32200CDrain, open, lung lesion
    32201CDrain, percut, lung lesion
    32215CTreat chest lining
    32220CRelease of lung
    32225CPartial release of lung
    32310CRemoval of chest lining
    32320CFree/remove chest lining
    32400TNeedle biopsy chest lining00055.41$262.32$119.75$52.46
    32402COpen biopsy chest lining
    32405TBiopsy, lung or mediastinum00055.41$262.32$119.75$52.46
    32420TPuncture/clear lung00703.64$176.49$79.60$35.30
    32440CRemoval of lung
    32442CSleeve pneumonectomy
    32445CRemoval of lung
    32480CPartial removal of lung
    32482CBilobectomy
    32484CSegmentectomy
    32486CSleeve lobectomy
    32488CCompletion pneumonectomy
    32491CLung volume reduction
    32500CPartial removal of lung
    32501CRepair bronchus add-on
    32520CRemove lung & revise chest
    32522CRemove lung & revise chest
    32525CRemove lung & revise chest
    32540CRemoval of lung lesion
    32601TThoracoscopy, diagnostic00768.06$390.81$197.05$78.16
    32602TThoracoscopy, diagnostic00768.06$390.81$197.05$78.16
    32603TThoracoscopy, diagnostic00768.06$390.81$197.05$78.16
    32604TThoracoscopy, diagnostic00768.06$390.81$197.05$78.16
    32605TThoracoscopy, diagnostic00768.06$390.81$197.05$78.16
    32606TThoracoscopy, diagnostic00768.06$390.81$197.05$78.16
    32650CThoracoscopy, surgical
    32651CThoracoscopy, surgical
    32652CThoracoscopy, surgical
    32653CThoracoscopy, surgical
    32654CThoracoscopy, surgical
    32655CThoracoscopy, surgical
    32656CThoracoscopy, surgical
    32657CThoracoscopy, surgical
    32658CThoracoscopy, surgical
    32659CThoracoscopy, surgical
    32660CThoracoscopy, surgical
    32661CThoracoscopy, surgical
    32662CThoracoscopy, surgical
    32663CThoracoscopy, surgical
    32664CThoracoscopy, surgical
    32665CThoracoscopy, surgical
    32800CRepair lung hernia
    32810CClose chest after drainage
    32815CClose bronchial fistula
    Start Printed Page 18590
    32820CReconstruct injured chest
    32850CDonor pneumonectomy
    32851CLung transplant, single
    32852CLung transplant with bypass
    32853CLung transplant, double
    32854CLung transplant with bypass
    32900CRemoval of rib(s)
    32905CRevise & repair chest wall
    32906CRevise & repair chest wall
    32940CRevision of lung
    32960TTherapeutic pneumothorax00703.64$176.49$79.60$35.30
    32997CTotal lung lavage
    32999TChest surgery procedure00703.64$176.49$79.60$35.30
    33010TDrainage of heart sac00703.64$176.49$79.60$35.30
    33011TRepeat drainage of heart sac00703.64$176.49$79.60$35.30
    33015CIncision of heart sac
    33020CIncision of heart sac
    33025CIncision of heart sac
    33030CPartial removal of heart sac
    33031CPartial removal of heart sac
    33050CRemoval of heart sac lesion
    33120CRemoval of heart lesion
    33130CRemoval of heart lesion
    33140CHeart revascularize (tmr)
    33200CInsertion of heart pacemaker
    33201CInsertion of heart pacemaker
    33206TInsertion of heart pacemaker009020.96$1,016.29$573.04$203.26
    33207TInsertion of heart pacemaker009020.96$1,016.29$573.04$203.26
    33208TInsertion of heart pacemaker009020.96$1,016.29$573.04$203.26
    33210TInsertion of heart electrode00896.49$314.68$130.07$62.94
    33211TInsertion of heart electrode00896.49$314.68$130.07$62.94
    33212TInsertion of pulse generator009020.96$1,016.29$573.04$203.26
    33213TInsertion of pulse generator009020.96$1,016.29$573.04$203.26
    33214TUpgrade of pacemaker system009020.96$1,016.29$573.04$203.26
    33216TRevise eltrd pacing-defib009020.96$1,016.29$573.04$203.26
    33217TRevise eltrd pacing-defib009020.96$1,016.29$573.04$203.26
    33218TRevise eltrd pacing-defib009020.96$1,016.29$573.04$203.26
    33220TRevise eltrd pacing-defib00896.49$314.68$130.07$62.94
    33222TRevise pocket, pacemaker002612.11$587.18$277.92$117.44
    33223TRevise pocket, pacing-defib002612.11$587.18$277.92$117.44
    33233TRemoval of pacemaker system009020.96$1,016.29$573.04$203.26
    33234TRemoval of pacemaker system009020.96$1,016.29$573.04$203.26
    33235TRemoval pacemaker electrode009020.96$1,016.29$573.04$203.26
    33236CRemove electrode/thoracotomy
    33237CRemove electrode/thoracotomy
    33238CRemove electrode/thoracotomy
    33240TInsert pulse generator009020.96$1,016.29$573.04$203.26
    33241TRemove pulse generator00896.49$314.68$130.07$62.94
    33243CRemove eltrd/thoracotomy
    33244TRemove eltrd, transven009020.96$1,016.29$573.04$203.26
    33245CInsert epic eltrd pace-defib
    33246CInsert epic eltrd/generator
    33249TEltrd/insert pace-defib009020.96$1,016.29$573.04$203.26
    33250CAblate heart dysrhythm focus
    33251CAblate heart dysrhythm focus
    33253CReconstruct atria
    33261CAblate heart dysrhythm focus
    33282CImplant pat-active ht record
    33284CRemove pat-active ht record
    33300CRepair of heart wound
    33305CRepair of heart wound
    33310CExploratory heart surgery
    33315CExploratory heart surgery
    33320CRepair major blood vessel(s)
    33321CRepair major vessel
    33322CRepair major blood vessel(s)
    33330CInsert major vessel graft
    33332CInsert major vessel graft
    33335CInsert major vessel graft
    33400CRepair of aortic valve
    33401CValvuloplasty, open
    33403CValvuloplasty, w/cp bypass
    33404CPrepare heart-aorta conduit
    Start Printed Page 18591
    33405CReplacement of aortic valve
    33406CReplacement of aortic valve
    33410CReplacement of aortic valve
    33411CReplacement of aortic valve
    33412CReplacement of aortic valve
    33413CReplacement of aortic valve
    33414CRepair of aortic valve
    33415CRevision, subvalvular tissue
    33416CRevise ventricle muscle
    33417CRepair of aortic valve
    33420CRevision of mitral valve
    33422CRevision of mitral valve
    33425CRepair of mitral valve
    33426CRepair of mitral valve
    33427CRepair of mitral valve
    33430CReplacement of mitral valve
    33460CRevision of tricuspid valve
    33463CValvuloplasty, tricuspid
    33464CValvuloplasty, tricuspid
    33465CReplace tricuspid valve
    33468CRevision of tricuspid valve
    33470CRevision of pulmonary valve
    33471CValvotomy, pulmonary valve
    33472CRevision of pulmonary valve
    33474CRevision of pulmonary valve
    33475CReplacement, pulmonary valve
    33476CRevision of heart chamber
    33478CRevision of heart chamber
    33496CRepair, prosth valve clot
    33500CRepair heart vessel fistula
    33501CRepair heart vessel fistula
    33502CCoronary artery correction
    33503CCoronary artery graft
    33504CCoronary artery graft
    33505CRepair artery w/tunnel
    33506CRepair artery, translocation
    33510CCABG, vein, single
    33511CCABG, vein, two
    33512CCABG, vein, three
    33513CCABG, vein, four
    33514CCABG, vein, five
    33516CCabg, vein, six or more
    33517CCABG, artery-vein, single
    33518CCABG, artery-vein, two
    33519CCABG, artery-vein, three
    33521CCABG, artery-vein, four
    33522CCABG, artery-vein, five
    33523CCabg, art-vein, six or more
    33530CCoronary artery, bypass/reop
    33533CCABG, arterial, single
    33534CCABG, arterial, two
    33535CCABG, arterial, three
    33536CCabg, arterial, four or more
    33542CRemoval of heart lesion
    33545CRepair of heart damage
    33572COpen coronary endarterectomy
    33600CClosure of valve
    33602CClosure of valve
    33606CAnastomosis/artery-aorta
    33608CRepair anomaly w/conduit
    33610CRepair by enlargement
    33611CRepair double ventricle
    33612CRepair double ventricle
    33615CRepair, simple fontan
    33617CRepair, modified fontan
    33619CRepair single ventricle
    33641CRepair heart septum defect
    33645CRevision of heart veins
    33647CRepair heart septum defects
    33660CRepair of heart defects
    33665CRepair of heart defects
    33670CRepair of heart chambers
    33681CRepair heart septum defect
    Start Printed Page 18592
    33684CRepair heart septum defect
    33688CRepair heart septum defect
    33690CReinforce pulmonary artery
    33692CRepair of heart defects
    33694CRepair of heart defects
    33697CRepair of heart defects
    33702CRepair of heart defects
    33710CRepair of heart defects
    33720CRepair of heart defect
    33722CRepair of heart defect
    33730CRepair heart-vein defect(s)
    33732CRepair heart-vein defect
    33735CRevision of heart chamber
    33736CRevision of heart chamber
    33737CRevision of heart chamber
    33750CMajor vessel shunt
    33755CMajor vessel shunt
    33762CMajor vessel shunt
    33764CMajor vessel shunt & graft
    33766CMajor vessel shunt
    33767CMajor vessel shunt
    33770CRepair great vessels defect
    33771CRepair great vessels defect
    33774CRepair great vessels defect
    33775CRepair great vessels defect
    33776CRepair great vessels defect
    33777CRepair great vessels defect
    33778CRepair great vessels defect
    33779CRepair great vessels defect
    33780CRepair great vessels defect
    33781CRepair great vessels defect
    33786CRepair arterial trunk
    33788CRevision of pulmonary artery
    33800CAortic suspension
    33802CRepair vessel defect
    33803CRepair vessel defect
    33813CRepair septal defect
    33814CRepair septal defect
    33820CRevise major vessel
    33822CRevise major vessel
    33824CRevise major vessel
    33840CRemove aorta constriction
    33845CRemove aorta constriction
    33851CRemove aorta constriction
    33852CRepair septal defect
    33853CRepair septal defect
    33860CAscending aortic graft
    33861CAscending aortic graft
    33863CAscending aortic graft
    33870CTransverse aortic arch graft
    33875CThoracic aortic graft
    33877CThoracoabdominal graft
    33910CRemove lung artery emboli
    33915CRemove lung artery emboli
    33916CSurgery of great vessel
    33917CRepair pulmonary artery
    33918CRepair pulmonary atresia
    33919CRepair pulmonary atresia
    33920CRepair pulmonary atresia
    33922CTransect pulmonary artery
    33924CRemove pulmonary shunt
    33930CRemoval of donor heart/lung
    33935CTransplantation, heart/lung
    33940CRemoval of donor heart
    33945CTransplantation of heart
    33960CExternal circulation assist
    33961CExternal circulation assist
    33968CRemove aortic assist device
    33970CAortic circulation assist
    33971CAortic circulation assist
    33973CInsert balloon device
    33974CRemove intra-aortic balloon
    33975CImplant ventricular device
    Start Printed Page 18593
    33976CImplant ventricular device
    33977CRemove ventricular device
    33978CRemove ventricular device
    33999TCardiac surgery procedure00703.64$176.49$79.60$35.30
    34001CRemoval of artery clot
    34051CRemoval of artery clot
    34101TRemoval of artery clot008826.49$1,284.42$678.68$256.88
    34111TRemoval of arm artery clot008826.49$1,284.42$678.68$256.88
    34151CRemoval of artery clot
    34201TRemoval of artery clot008826.49$1,284.42$678.68$256.88
    34203TRemoval of leg artery clot008826.49$1,284.42$678.68$256.88
    34401CRemoval of vein clot
    34421CRemoval of vein clot
    34451CRemoval of vein clot
    34471TRemoval of vein clot008826.49$1,284.42$678.68$256.88
    34490TRemoval of vein clot008826.49$1,284.42$678.68$256.88
    34501TRepair valve, femoral vein008826.49$1,284.42$678.68$256.88
    34502CReconstruct vena cava
    34510TTransposition of vein valve008826.49$1,284.42$678.68$256.88
    34520TCross-over vein graft008826.49$1,284.42$678.68$256.88
    34530TLeg vein fusion008826.49$1,284.42$678.68$256.88
    35001CRepair defect of artery
    35002CRepair artery rupture, neck
    35005CRepair defect of artery
    35011CRepair defect of artery
    35013CRepair artery rupture, arm
    35021CRepair defect of artery
    35022CRepair artery rupture, chest
    35045CRepair defect of arm artery
    35081CRepair defect of artery
    35082CRepair artery rupture, aorta
    35091CRepair defect of artery
    35092CRepair artery rupture, aorta
    35102CRepair defect of artery
    35103CRepair artery rupture, groin
    35111CRepair defect of artery
    35112CRepair artery rupture, spleen
    35121CRepair defect of artery
    35122CRepair artery rupture, belly
    35131CRepair defect of artery
    35132CRepair artery rupture, groin
    35141CRepair defect of artery
    35142CRepair artery rupture, thigh
    35151CRepair defect of artery
    35152CRepair artery rupture, knee
    35161CRepair defect of artery
    35162CRepair artery rupture
    35180TRepair blood vessel lesion008119.36$938.71$434.25$187.74
    35182CRepair blood vessel lesion
    35184TRepair blood vessel lesion008119.36$938.71$434.25$187.74
    35188TRepair blood vessel lesion008826.49$1,284.42$678.68$256.88
    35189CRepair blood vessel lesion
    35190TRepair blood vessel lesion008119.36$938.71$434.25$187.74
    35201TRepair blood vessel lesion008119.36$938.71$434.25$187.74
    35206TRepair blood vessel lesion008119.36$938.71$434.25$187.74
    35207TRepair blood vessel lesion008826.49$1,284.42$678.68$256.88
    35211CRepair blood vessel lesion
    35216CRepair blood vessel lesion
    35221CRepair blood vessel lesion
    35226TRepair blood vessel lesion008119.36$938.71$434.25$187.74
    35231TRepair blood vessel lesion008119.36$938.71$434.25$187.74
    35236TRepair blood vessel lesion008119.36$938.71$434.25$187.74
    35241CRepair blood vessel lesion
    35246CRepair blood vessel lesion
    35251CRepair blood vessel lesion
    35256TRepair blood vessel lesion008119.36$938.71$434.25$187.74
    35261TRepair blood vessel lesion008119.36$938.71$434.25$187.74
    35266TRepair blood vessel lesion008119.36$938.71$434.25$187.74
    35271CRepair blood vessel lesion
    35276CRepair blood vessel lesion
    35281CRepair blood vessel lesion
    35286TRepair blood vessel lesion008119.36$938.71$434.25$187.74
    35301CRechanneling of artery
    Start Printed Page 18594
    35311CRechanneling of artery
    35321TRechanneling of artery008119.36$938.71$434.25$187.74
    35331CRechanneling of artery
    35341CRechanneling of artery
    35351CRechanneling of artery
    35355CRechanneling of artery
    35361CRechanneling of artery
    35363CRechanneling of artery
    35371CRechanneling of artery
    35372CRechanneling of artery
    35381CRechanneling of artery
    35390CReoperation, carotid add-on
    35400CAngioscopy
    35450CRepair arterial blockage
    35452CRepair arterial blockage
    35454CRepair arterial blockage
    35456CRepair arterial blockage
    35458CRepair arterial blockage
    35459TRepair arterial blockage008119.36$938.71$434.25$187.74
    35460TRepair venous blockage008119.36$938.71$434.25$187.74
    35470TRepair arterial blockage008119.36$938.71$434.25$187.74
    35471TRepair arterial blockage008119.36$938.71$434.25$187.74
    35472TRepair arterial blockage008119.36$938.71$434.25$187.74
    35473TRepair arterial blockage008119.36$938.71$434.25$187.74
    35474TRepair arterial blockage008119.36$938.71$434.25$187.74
    35475TRepair arterial blockage008119.36$938.71$434.25$187.74
    35476TRepair venous blockage008119.36$938.71$434.25$187.74
    35480CAtherectomy, open
    35481CAtherectomy, open
    35482CAtherectomy, open
    35483CAtherectomy, open
    35484TAtherectomy, open008119.36$938.71$434.25$187.74
    35485TAtherectomy, open008119.36$938.71$434.25$187.74
    35490TAtherectomy, percutaneous008119.36$938.71$434.25$187.74
    35491TAtherectomy, percutaneous008119.36$938.71$434.25$187.74
    35492TAtherectomy, percutaneous008119.36$938.71$434.25$187.74
    35493TAtherectomy, percutaneous008119.36$938.71$434.25$187.74
    35494TAtherectomy, percutaneous008119.36$938.71$434.25$187.74
    35495TAtherectomy, percutaneous008119.36$938.71$434.25$187.74
    35500THarvest vein for bypass008119.36$938.71$434.25$187.74
    35501CArtery bypass graft
    35506CArtery bypass graft
    35507CArtery bypass graft
    35508CArtery bypass graft
    35509CArtery bypass graft
    35511CArtery bypass graft
    35515CArtery bypass graft
    35516CArtery bypass graft
    35518CArtery bypass graft
    35521CArtery bypass graft
    35526CArtery bypass graft
    35531CArtery bypass graft
    35533CArtery bypass graft
    35536CArtery bypass graft
    35541CArtery bypass graft
    35546CArtery bypass graft
    35548CArtery bypass graft
    35549CArtery bypass graft
    35551CArtery bypass graft
    35556CArtery bypass graft
    35558CArtery bypass graft
    35560CArtery bypass graft
    35563CArtery bypass graft
    35565CArtery bypass graft
    35566CArtery bypass graft
    35571CArtery bypass graft
    35582CVein bypass graft
    35583CVein bypass graft
    35585CVein bypass graft
    35587CVein bypass graft
    35601CArtery bypass graft
    35606CArtery bypass graft
    35612CArtery bypass graft
    Start Printed Page 18595
    35616CArtery bypass graft
    35621CArtery bypass graft
    35623CBypass graft, not vein
    35626CArtery bypass graft
    35631CArtery bypass graft
    35636CArtery bypass graft
    35641CArtery bypass graft
    35642CArtery bypass graft
    35645CArtery bypass graft
    35646CArtery bypass graft
    35650CArtery bypass graft
    35651CArtery bypass graft
    35654CArtery bypass graft
    35656CArtery bypass graft
    35661CArtery bypass graft
    35663CArtery bypass graft
    35665CArtery bypass graft
    35666CArtery bypass graft
    35671CArtery bypass graft
    35681CComposite bypass graft
    35682CComposite bypass graft
    35683CComposite bypass graft
    35691CArterial transposition
    35693CArterial transposition
    35694CArterial transposition
    35695CArterial transposition
    35700CReoperation, bypass graft
    35701CExploration, carotid artery
    35721CExploration, femoral artery
    35741CExploration popliteal artery
    35761CExploration of artery/vein
    35800CExplore neck vessels
    35820CExplore chest vessels
    35840CExplore abdominal vessels
    35860CExplore limb vessels
    35870CRepair vessel graft defect
    35875TRemoval of clot in graft008826.49$1,284.42$678.68$256.88
    35876TRemoval of clot in graft008826.49$1,284.42$678.68$256.88
    35879TRevise graft w/vein008826.49$1,284.42$678.68$256.88
    35881TRevise graft w/vein008826.49$1,284.42$678.68$256.88
    35901CExcision, graft, neck
    35903CExcision, graft, extremity
    35905CExcision, graft, thorax
    35907CExcision, graft, abdomen
    36000NPlace needle in vein
    36005NInjection, venography
    36010NPlace catheter in vein
    36011NPlace catheter in vein
    36012NPlace catheter in vein
    36013NPlace catheter in artery
    36014NPlace catheter in artery
    36015NPlace catheter in artery
    36100NEstablish access to artery
    36120NEstablish access to artery
    36140NEstablish access to artery
    36145NArtery to vein shunt
    36160NEstablish access to aorta
    36200NPlace catheter in aorta
    36215NPlace catheter in artery
    36216NPlace catheter in artery
    36217NPlace catheter in artery
    36218NPlace catheter in artery
    36245NPlace catheter in artery
    36246NPlace catheter in artery
    36247NPlace catheter in artery
    36248NPlace catheter in artery
    36260TInsertion of infusion pump009317.95$870.34$422.33$174.07
    36261TRevision of infusion pump00896.49$314.68$130.07$62.94
    36262TRemoval of infusion pump00896.49$314.68$130.07$62.94
    36299TVessel injection procedure00896.49$314.68$130.07$62.94
    36400NDrawing blood
    36405NDrawing blood
    36406NDrawing blood
    Start Printed Page 18596
    36410NDrawing blood
    36415EDrawing blood
    36420TEstablish access to vein00325.40$261.83$119.52$52.37
    36425TEstablish access to vein00325.40$261.83$119.52$52.37
    36430SBlood transfusion service01105.83$282.68$122.73$56.54
    36440SBlood transfusion service01105.83$282.68$122.73$56.54
    36450SExchange transfusion service01105.83$282.68$122.73$56.54
    36455SExchange transfusion service01105.83$282.68$122.73$56.54
    36460STransfusion service, fetal01105.83$282.68$122.73$56.54
    36468TInjection(s), spider veins00981.19$57.70$20.88$11.54
    36469TInjection(s), spider veins00981.19$57.70$20.88$11.54
    36470TInjection therapy of vein00981.19$57.70$20.88$11.54
    36471TInjection therapy of veins00981.19$57.70$20.88$11.54
    36481NInsertion of catheter, vein
    36488TInsertion of catheter, vein00325.40$261.83$119.52$52.37
    36489TInsertion of catheter, vein00325.40$261.83$119.52$52.37
    36490TInsertion of catheter, vein00325.40$261.83$119.52$52.37
    36491TInsertion of catheter, vein00325.40$261.83$119.52$52.37
    36493TRepositioning of cvc00325.40$261.83$119.52$52.37
    36500NInsertion of catheter, vein
    36510CInsertion of catheter, vein
    36520SPlasma and/or cell exchange011114.17$687.06$300.74$137.41
    36521SApheresis w/adsorp/reinfuse011114.17$687.06$300.74$137.41
    36522SPhotopheresis011239.60$1,920.09$663.65$384.02
    36530TInsertion of infusion pump009317.95$870.34$422.33$174.07
    36531TRevision of infusion pump00896.49$314.68$130.07$62.94
    36532TRemoval of infusion pump00896.49$314.68$130.07$62.94
    36533TInsertion of access device009317.95$870.34$422.33$174.07
    36534TRevision of access device00896.49$314.68$130.07$62.94
    36535TRemoval of access device00896.49$314.68$130.07$62.94
    36550CDeclot vascular device
    36600NWithdrawal of arterial blood
    36620NInsertion catheter, artery
    36625NInsertion catheter, artery
    36640TInsertion catheter, artery00325.40$261.83$119.52$52.37
    36660CInsertion catheter, artery
    36680SInsert needle, bone cavity01201.66$80.49$42.67$16.10
    36800TInsertion of cannula009317.95$870.34$422.33$174.07
    36810TInsertion of cannula009317.95$870.34$422.33$174.07
    36815TInsertion of cannula009317.95$870.34$422.33$174.07
    36819TAv fusion by basilic vein009317.95$870.34$422.33$174.07
    36821TAv fusion direct any site008826.49$1,284.42$678.68$256.88
    36822CInsertion of cannula(s)
    36823CInsertion of cannula(s)
    36825TArtery-vein graft008826.49$1,284.42$678.68$256.88
    36830TArtery-vein graft008826.49$1,284.42$678.68$256.88
    36831TAv fistula excision008826.49$1,284.42$678.68$256.88
    36832TAv fistula revision008826.49$1,284.42$678.68$256.88
    36833TAv fistula revision008826.49$1,284.42$678.68$256.88
    36834CRepair A-V aneurysm
    36835TArtery to vein shunt009317.95$870.34$422.33$174.07
    36860TExternal cannula declotting009020.96$1,016.29$573.04$203.26
    36861TCannula declotting009020.96$1,016.29$573.04$203.26
    37140CRevision of circulation
    37145CRevision of circulation
    37160CRevision of circulation
    37180CRevision of circulation
    37181CSplice spleen/kidney veins
    37195CThrombolytic therapy, stroke
    37200CTranscatheter biopsy
    37201CTranscatheter therapy infuse
    37202CTranscatheter therapy infuse
    37203TTranscatheter retrieval00896.49$314.68$130.07$62.94
    37204TTranscatheter occlusion008119.36$938.71$434.25$187.74
    37205TTranscatheter stent008119.36$938.71$434.25$187.74
    37206TTranscatheter stent add-on008119.36$938.71$434.25$187.74
    37207TTranscatheter stent008119.36$938.71$434.25$187.74
    37208TTranscatheter stent add-on008119.36$938.71$434.25$187.74
    37209TExchange arterial catheter008119.36$938.71$434.25$187.74
    37250TIv us first vessel add-on008119.36$938.71$434.25$187.74
    37251TIv us each add vessel add-on008119.36$938.71$434.25$187.74
    37565TLigation of neck vein008119.36$938.71$434.25$187.74
    37600TLigation of neck artery008119.36$938.71$434.25$187.74
    Start Printed Page 18597
    37605TLigation of neck artery009114.79$717.12$348.23$143.42
    37606TLigation of neck artery009114.79$717.12$348.23$143.42
    37607TLigation of a-v fistula009220.21$979.92$505.37$195.98
    37609TTemporal artery procedure00206.51$315.65$130.53$63.13
    37615TLigation of neck artery009114.79$717.12$348.23$143.42
    37616CLigation of chest artery
    37617CLigation of abdomen artery
    37618ELigation of extremity artery
    37620CRevision of major vein
    37650TRevision of major vein009114.79$717.12$348.23$143.42
    37660CRevision of major vein
    37700TRevise leg vein009114.79$717.12$348.23$143.42
    37720TRemoval of leg vein009220.21$979.92$505.37$195.98
    37730TRemoval of leg veins009220.21$979.92$505.37$195.98
    37735TRemoval of leg veins/lesion009220.21$979.92$505.37$195.98
    37760TRevision of leg veins009114.79$717.12$348.23$143.42
    37780TRevision of leg vein009114.79$717.12$348.23$143.42
    37785TRevise secondary varicosity009114.79$717.12$348.23$143.42
    37788CRevascularization, penis
    37790TPenile venous occlusion018132.37$1,569.53$906.36$313.91
    37799TVascular surgery procedure00206.51$315.65$130.53$63.13
    38100CRemoval of spleen, total
    38101CRemoval of spleen, partial
    38102CRemoval of spleen, total
    38115CRepair of ruptured spleen
    38120TLaparoscopy, splenectomy013141.81$2,027.24$1,089.88$405.45
    38129TLaparoscope proc, spleen013025.36$1,229.63$659.53$245.93
    38200NInjection for spleen x-ray
    38230SBone marrow collection01094.13$200.25$40.05$40.05
    38231SStem cell collection011114.17$687.06$300.74$137.41
    38240SBone marrow/stem transplant01094.13$200.25$40.05$40.05
    38241SBone marrow/stem transplant01094.13$200.25$40.05$40.05
    38300TDrainage, lymph node lesion00086.15$298.20$113.67$59.64
    38305TDrainage, lymph node lesion00086.15$298.20$113.67$59.64
    38308TIncision of lymph channels011313.89$673.49$326.55$134.70
    38380CThoracic duct procedure
    38381CThoracic duct procedure
    38382CThoracic duct procedure
    38500TBiopsy/removal, lymph nodes011313.89$673.49$326.55$134.70
    38505TNeedle biopsy, lymph nodes00055.41$262.32$119.75$52.46
    38510TBiopsy/removal, lymph nodes011313.89$673.49$326.55$134.70
    38520TBiopsy/removal, lymph nodes011313.89$673.49$326.55$134.70
    38525TBiopsy/removal, lymph nodes011313.89$673.49$326.55$134.70
    38530TBiopsy/removal, lymph nodes011313.89$673.49$326.55$134.70
    38542TExplore deep node(s), neck011419.56$948.41$493.78$189.68
    38550TRemoval, neck/armpit lesion011313.89$673.49$326.55$134.70
    38555TRemoval, neck/armpit lesion011419.56$948.41$493.78$189.68
    38562CRemoval, pelvic lymph nodes
    38564CRemoval, abdomen lymph nodes
    38570TLaparoscopy, lymph node biop013141.81$2,027.24$1,089.88$405.45
    38571TLaparoscopy, lymphadenectomy013248.91$2,371.50$1,239.22$474.30
    38572TLaparoscopy, lymphadenectomy013141.81$2,027.24$1,089.88$405.45
    38589TLaparoscope proc, lymphatic013025.36$1,229.63$659.53$245.93
    38700CRemoval of lymph nodes, neck
    38720TRemoval of lymph nodes, neck011419.56$948.41$493.78$189.68
    38724CRemoval of lymph nodes, neck
    38740TRemove armpit lymph nodes011419.56$948.41$493.78$189.68
    38745TRemove armpit lymph nodes011419.56$948.41$493.78$189.68
    38746CRemove thoracic lymph nodes
    38747CRemove abdominal lymph nodes
    38760TRemove groin lymph nodes011419.56$948.41$493.78$189.68
    38765CRemove groin lymph nodes
    38770CRemove pelvis lymph nodes
    38780CRemove abdomen lymph nodes
    38790NInject for lymphatic x-ray
    38792NIdentify sentinel node
    38794NAccess thoracic lymph duct
    38999TBlood/lymph system procedure00086.15$298.20$113.67$59.64
    39000CExploration of chest
    39010CExploration of chest
    39200CRemoval chest lesion
    39220CRemoval chest lesion
    39400TVisualization of chest00768.06$390.81$197.05$78.16
    Start Printed Page 18598
    39499CChest procedure
    39501CRepair diaphragm laceration
    39502CRepair paraesophageal hernia
    39503CRepair of diaphragm hernia
    39520CRepair of diaphragm hernia
    39530CRepair of diaphragm hernia
    39531CRepair of diaphragm hernia
    39540CRepair of diaphragm hernia
    39541CRepair of diaphragm hernia
    39545CRevision of diaphragm
    39560CResect diaphragm, simple
    39561CResect diaphragm, complex
    39599CDiaphragm surgery procedure
    40490TBiopsy of lip02525.18$251.16$114.24$50.23
    40500TPartial excision of lip025312.02$582.81$284.00$116.56
    40510TPartial excision of lip025412.45$603.66$272.41$120.73
    40520TPartial excision of lip025312.02$582.81$284.00$116.56
    40525TReconstruct lip with flap025412.45$603.66$272.41$120.73
    40527TReconstruct lip with flap025412.45$603.66$272.41$120.73
    40530TPartial removal of lip025412.45$603.66$272.41$120.73
    40650TRepair lip025312.02$582.81$284.00$116.56
    40652TRepair lip025312.02$582.81$284.00$116.56
    40654TRepair lip025412.45$603.66$272.41$120.73
    40700TRepair cleft lip/nasal025625.40$1,231.57$623.05$246.31
    40701TRepair cleft lip/nasal025625.40$1,231.57$623.05$246.31
    40702TRepair cleft lip/nasal025625.40$1,231.57$623.05$246.31
    40720TRepair cleft lip/nasal025625.40$1,231.57$623.05$246.31
    40761TRepair cleft lip/nasal025625.40$1,231.57$623.05$246.31
    40799TLip surgery procedure025312.02$582.81$284.00$116.56
    40800TDrainage of mouth lesion02511.68$81.46$27.99$16.29
    40801TDrainage of mouth lesion02525.18$251.16$114.24$50.23
    40804TRemoval, foreign body, mouth02511.68$81.46$27.99$16.29
    40805TRemoval, foreign body, mouth02525.18$251.16$114.24$50.23
    40806TIncision of lip fold02511.68$81.46$27.99$16.29
    40808TBiopsy of mouth lesion02511.68$81.46$27.99$16.29
    40810TExcision of mouth lesion025312.02$582.81$284.00$116.56
    40812TExcise/repair mouth lesion02525.18$251.16$114.24$50.23
    40814TExcise/repair mouth lesion025312.02$582.81$284.00$116.56
    40816TExcision of mouth lesion025312.02$582.81$284.00$116.56
    40818TExcise oral mucosa for graft02511.68$81.46$27.99$16.29
    40819TExcise lip or cheek fold02525.18$251.16$114.24$50.23
    40820TTreatment of mouth lesion025312.02$582.81$284.00$116.56
    40830TRepair mouth laceration02511.68$81.46$27.99$16.29
    40831TRepair mouth laceration025312.02$582.81$284.00$116.56
    40840TReconstruction of mouth025412.45$603.66$272.41$120.73
    40842TReconstruction of mouth025412.45$603.66$272.41$120.73
    40843TReconstruction of mouth025412.45$603.66$272.41$120.73
    40844TReconstruction of mouth025625.40$1,231.57$623.05$246.31
    40845TReconstruction of mouth025625.40$1,231.57$623.05$246.31
    40899TMouth surgery procedure02525.18$251.16$114.24$50.23
    41000TDrainage of mouth lesion025312.02$582.81$284.00$116.56
    41005TDrainage of mouth lesion02511.68$81.46$27.99$16.29
    41006TDrainage of mouth lesion025312.02$582.81$284.00$116.56
    41007TDrainage of mouth lesion025312.02$582.81$284.00$116.56
    41008TDrainage of mouth lesion025312.02$582.81$284.00$116.56
    41009TDrainage of mouth lesion02511.68$81.46$27.99$16.29
    41010TIncision of tongue fold025312.02$582.81$284.00$116.56
    41015TDrainage of mouth lesion02525.18$251.16$114.24$50.23
    41016TDrainage of mouth lesion025312.02$582.81$284.00$116.56
    41017TDrainage of mouth lesion025312.02$582.81$284.00$116.56
    41018TDrainage of mouth lesion025312.02$582.81$284.00$116.56
    41100TBiopsy of tongue02525.18$251.16$114.24$50.23
    41105TBiopsy of tongue025312.02$582.81$284.00$116.56
    41108TBiopsy of floor of mouth02525.18$251.16$114.24$50.23
    41110TExcision of tongue lesion025312.02$582.81$284.00$116.56
    41112TExcision of tongue lesion025312.02$582.81$284.00$116.56
    41113TExcision of tongue lesion025312.02$582.81$284.00$116.56
    41114TExcision of tongue lesion025412.45$603.66$272.41$120.73
    41115TExcision of tongue fold025312.02$582.81$284.00$116.56
    41116TExcision of mouth lesion025312.02$582.81$284.00$116.56
    41120TPartial removal of tongue025625.40$1,231.57$623.05$246.31
    41130CPartial removal of tongue
    41135CTongue and neck surgery
    Start Printed Page 18599
    41140CRemoval of tongue
    41145CTongue removal, neck surgery
    41150CTongue, mouth, jaw surgery
    41153CTongue, mouth, neck surgery
    41155CTongue, jaw, & neck surgery
    41250TRepair tongue laceration02511.68$81.46$27.99$16.29
    41251TRepair tongue laceration025312.02$582.81$284.00$116.56
    41252TRepair tongue laceration025312.02$582.81$284.00$116.56
    41500TFixation of tongue025312.02$582.81$284.00$116.56
    41510TTongue to lip surgery025312.02$582.81$284.00$116.56
    41520TReconstruction, tongue fold025312.02$582.81$284.00$116.56
    41599TTongue and mouth surgery02511.68$81.46$27.99$16.29
    41800TDrainage of gum lesion02511.68$81.46$27.99$16.29
    41805TRemoval foreign body, gum025312.02$582.81$284.00$116.56
    41806TRemoval foreign body, jawbone025312.02$582.81$284.00$116.56
    41820TExcision, gum, each quadrant02525.18$251.16$114.24$50.23
    41821TExcision of gum flap02525.18$251.16$114.24$50.23
    41822TExcision of gum lesion025312.02$582.81$284.00$116.56
    41823TExcision of gum lesion025312.02$582.81$284.00$116.56
    41825TExcision of gum lesion025312.02$582.81$284.00$116.56
    41826TExcision of gum lesion025312.02$582.81$284.00$116.56
    41827TExcision of gum lesion025312.02$582.81$284.00$116.56
    41828TExcision of gum lesion025312.02$582.81$284.00$116.56
    41830TRemoval of gum tissue025312.02$582.81$284.00$116.56
    41850TTreatment of gum lesion025312.02$582.81$284.00$116.56
    41870TGum graft025312.02$582.81$284.00$116.56
    41872TRepair gum025312.02$582.81$284.00$116.56
    41874TRepair tooth socket025312.02$582.81$284.00$116.56
    41899TDental surgery procedure025312.02$582.81$284.00$116.56
    42000TDrainage mouth roof lesion02511.68$81.46$27.99$16.29
    42100TBiopsy roof of mouth02525.18$251.16$114.24$50.23
    42104TExcision lesion, mouth roof025312.02$582.81$284.00$116.56
    42106TExcision lesion, mouth roof025312.02$582.81$284.00$116.56
    42107TExcision lesion, mouth roof025412.45$603.66$272.41$120.73
    42120TRemove palate/lesion025625.40$1,231.57$623.05$246.31
    42140TExcision of uvula02525.18$251.16$114.24$50.23
    42145TRepair palate, pharynx/uvula025412.45$603.66$272.41$120.73
    42160TTreatment mouth roof lesion025312.02$582.81$284.00$116.56
    42180TRepair palate02511.68$81.46$27.99$16.29
    42182TRepair palate025625.40$1,231.57$623.05$246.31
    42200TReconstruct cleft palate025625.40$1,231.57$623.05$246.31
    42205TReconstruct cleft palate025625.40$1,231.57$623.05$246.31
    42210TReconstruct cleft palate025625.40$1,231.57$623.05$246.31
    42215TReconstruct cleft palate025625.40$1,231.57$623.05$246.31
    42220TReconstruct cleft palate025625.40$1,231.57$623.05$246.31
    42225TReconstruct cleft palate025625.40$1,231.57$623.05$246.31
    42226TLengthening of palate025625.40$1,231.57$623.05$246.31
    42227TLengthening of palate025625.40$1,231.57$623.05$246.31
    42235TRepair palate025412.45$603.66$272.41$120.73
    42260TRepair nose to lip fistula025312.02$582.81$284.00$116.56
    42280TPreparation, palate mold02511.68$81.46$27.99$16.29
    42281TInsertion, palate prosthesis025312.02$582.81$284.00$116.56
    42299TPalate/uvula surgery02511.68$81.46$27.99$16.29
    42300TDrainage of salivary gland025312.02$582.81$284.00$116.56
    42305TDrainage of salivary gland025312.02$582.81$284.00$116.56
    42310TDrainage of salivary gland02511.68$81.46$27.99$16.29
    42320TDrainage of salivary gland02511.68$81.46$27.99$16.29
    42325TCreate salivary cyst drain02525.18$251.16$114.24$50.23
    42326TCreate salivary cyst drain02525.18$251.16$114.24$50.23
    42330TRemoval of salivary stone02525.18$251.16$114.24$50.23
    42335TRemoval of salivary stone025312.02$582.81$284.00$116.56
    42340TRemoval of salivary stone025312.02$582.81$284.00$116.56
    42400TBiopsy of salivary gland00041.84$89.22$32.57$17.84
    42405TBiopsy of salivary gland025312.02$582.81$284.00$116.56
    42408TExcision of salivary cyst025312.02$582.81$284.00$116.56
    42409TDrainage of salivary cyst025312.02$582.81$284.00$116.56
    42410TExcise parotid gland/lesion025625.40$1,231.57$623.05$246.31
    42415TExcise parotid gland/lesion025625.40$1,231.57$623.05$246.31
    42420TExcise parotid gland/lesion025625.40$1,231.57$623.05$246.31
    42425TExcise parotid gland/lesion025625.40$1,231.57$623.05$246.31
    42426CExcise parotid gland/lesion
    42440TExcise submaxillary gland025625.40$1,231.57$623.05$246.31
    42450TExcise sublingual gland025312.02$582.81$284.00$116.56
    Start Printed Page 18600
    42500TRepair salivary duct025412.45$603.66$272.41$120.73
    42505TRepair salivary duct025625.40$1,231.57$623.05$246.31
    42507TParotid duct diversion025625.40$1,231.57$623.05$246.31
    42508TParotid duct diversion025625.40$1,231.57$623.05$246.31
    42509TParotid duct diversion025625.40$1,231.57$623.05$246.31
    42510TParotid duct diversion025625.40$1,231.57$623.05$246.31
    42550NInjection for salivary x-ray
    42600TClosure of salivary fistula025312.02$582.81$284.00$116.56
    42650TDilation of salivary duct02525.18$251.16$114.24$50.23
    42660TDilation of salivary duct02525.18$251.16$114.24$50.23
    42665TLigation of salivary duct025312.02$582.81$284.00$116.56
    42699TSalivary surgery procedure025312.02$582.81$284.00$116.56
    42700TDrainage of tonsil abscess02511.68$81.46$27.99$16.29
    42720TDrainage of throat abscess025312.02$582.81$284.00$116.56
    42725TDrainage of throat abscess025625.40$1,231.57$623.05$246.31
    42800TBiopsy of throat02525.18$251.16$114.24$50.23
    42802TBiopsy of throat025312.02$582.81$284.00$116.56
    42804TBiopsy of upper nose/throat025312.02$582.81$284.00$116.56
    42806TBiopsy of upper nose/throat025312.02$582.81$284.00$116.56
    42808TExcise pharynx lesion025312.02$582.81$284.00$116.56
    42809TRemove pharynx foreign body02511.68$81.46$27.99$16.29
    42810TExcision of neck cyst025312.02$582.81$284.00$116.56
    42815TExcision of neck cyst025625.40$1,231.57$623.05$246.31
    42820TRemove tonsils and adenoids025818.62$902.83$462.81$180.57
    42821TRemove tonsils and adenoids025818.62$902.83$462.81$180.57
    42825TRemoval of tonsils025818.62$902.83$462.81$180.57
    42826TRemoval of tonsils025818.62$902.83$462.81$180.57
    42830TRemoval of adenoids025818.62$902.83$462.81$180.57
    42831TRemoval of adenoids025818.62$902.83$462.81$180.57
    42835TRemoval of adenoids025818.62$902.83$462.81$180.57
    42836TRemoval of adenoids025818.62$902.83$462.81$180.57
    42842CExtensive surgery of throat
    42844TExtensive surgery of throat025625.40$1,231.57$623.05$246.31
    42845CExtensive surgery of throat
    42860TExcision of tonsil tags025818.62$902.83$462.81$180.57
    42870TExcision of lingual tonsil025818.62$902.83$462.81$180.57
    42890TPartial removal of pharynx025625.40$1,231.57$623.05$246.31
    42892TRevision of pharyngeal walls025625.40$1,231.57$623.05$246.31
    42894CRevision of pharyngeal walls
    42900TRepair throat wound025312.02$582.81$284.00$116.56
    42950TReconstruction of throat025412.45$603.66$272.41$120.73
    42953CRepair throat, esophagus
    42955TSurgical opening of throat025412.45$603.66$272.41$120.73
    42960TControl throat bleeding02502.21$107.16$38.54$21.43
    42961CControl throat bleeding
    42962TControl throat bleeding025625.40$1,231.57$623.05$246.31
    42970TControl nose/throat bleeding02502.21$107.16$38.54$21.43
    42971CControl nose/throat bleeding
    42972TControl nose/throat bleeding025312.02$582.81$284.00$116.56
    42999TThroat surgery procedure02525.18$251.16$114.24$50.23
    43020TIncision of esophagus025412.45$603.66$272.41$120.73
    43030CThroat muscle surgery
    43045CIncision of esophagus
    43100CExcision of esophagus lesion
    43101CExcision of esophagus lesion
    43107CRemoval of esophagus
    43108CRemoval of esophagus
    43112CRemoval of esophagus
    43113CRemoval of esophagus
    43116CPartial removal of esophagus
    43117CPartial removal of esophagus
    43118CPartial removal of esophagus
    43121CPartial removal of esophagus
    43122CParital removal of esophagus
    43123CPartial removal of esophagus
    43124CRemoval of esophagus
    43130CRemoval of esophagus pouch
    43135CRemoval of esophagus pouch
    43200TEsophagus endoscopy01417.15$346.68$184.67$69.34
    43202TEsophagus endoscopy, biopsy01417.15$346.68$184.67$69.34
    43204TEsophagus endoscopy & inject01417.15$346.68$184.67$69.34
    43205TEsophagus endoscopy/ligation01417.15$346.68$184.67$69.34
    43215TEsophagus endoscopy01417.15$346.68$184.67$69.34
    Start Printed Page 18601
    43216TEsophagus endoscopy/lesion01417.15$346.68$184.67$69.34
    43217TEsophagus endoscopy01417.15$346.68$184.67$69.34
    43219TEsophagus endoscopy01417.15$346.68$184.67$69.34
    43220TEsoph endoscopy, dilation01417.15$346.68$184.67$69.34
    43226TEsoph endoscopy, dilation01417.15$346.68$184.67$69.34
    43227TEsoph endoscopy, repair01417.15$346.68$184.67$69.34
    43228TEsoph endoscopy, ablation01417.15$346.68$184.67$69.34
    43234TUpper GI endoscopy, exam01417.15$346.68$184.67$69.34
    43235TUppr gi endoscopy, diagnosis01417.15$346.68$184.67$69.34
    43239TUpper GI endoscopy, biopsy01417.15$346.68$184.67$69.34
    43241TUpper GI endoscopy with tube01417.15$346.68$184.67$69.34
    43243TUpper gi endoscopy & inject01417.15$346.68$184.67$69.34
    43244TUpper GI endoscopy/ligation01417.15$346.68$184.67$69.34
    43245TOperative upper GI endoscopy01417.15$346.68$184.67$69.34
    43246TPlace gastrostomy tube01417.15$346.68$184.67$69.34
    43247TOperative upper GI endoscopy01417.15$346.68$184.67$69.34
    43248TUppr gi endoscopy/guide wire01417.15$346.68$184.67$69.34
    43249TEsoph endoscopy, dilation01417.15$346.68$184.67$69.34
    43250TUpper GI endoscopy/tumor01417.15$346.68$184.67$69.34
    43251TOperative upper GI endoscopy01417.15$346.68$184.67$69.34
    43255TOperative upper GI endoscopy01417.15$346.68$184.67$69.34
    43258TOperative upper GI endoscopy01417.15$346.68$184.67$69.34
    43259TEndoscopic ultrasound exam01417.15$346.68$184.67$69.34
    43260TEndo cholangiopancreatograph015110.53$510.57$245.46$102.11
    43261TEndo cholangiopancreatograph015110.53$510.57$245.46$102.11
    43262TEndo cholangiopancreatograph015110.53$510.57$245.46$102.11
    43263TEndo cholangiopancreatograph015110.53$510.57$245.46$102.11
    43264TEndo cholangiopancreatograph015110.53$510.57$245.46$102.11
    43265TEndo cholangiopancreatograph015110.53$510.57$245.46$102.11
    43267TEndo cholangiopancreatograph015110.53$510.57$245.46$102.11
    43268TEndo cholangiopancreatograph015110.53$510.57$245.46$102.11
    43269TEndo cholangiopancreatograph015110.53$510.57$245.46$102.11
    43271TEndo cholangiopancreatograph015110.53$510.57$245.46$102.11
    43272TEndo cholangiopancreatograph015110.53$510.57$245.46$102.11
    43280TLaparoscopy, fundoplasty013248.91$2,371.50$1,239.22$474.30
    43289TLaparoscope proc, esoph013025.36$1,229.63$659.53$245.93
    43300CRepair of esophagus
    43305CRepair esophagus and fistula
    43310CRepair of esophagus
    43312CRepair esophagus and fistula
    43320CFuse esophagus & stomach
    43324CRevise esophagus & stomach
    43325CRevise esophagus & stomach
    43326CRevise esophagus & stomach
    43330CRepair of esophagus
    43331CRepair of esophagus
    43340CFuse esophagus & intestine
    43341CFuse esophagus & intestine
    43350CSurgical opening, esophagus
    43351CSurgical opening, esophagus
    43352CSurgical opening, esophagus
    43360CGastrointestinal repair
    43361CGastrointestinal repair
    43400CLigate esophagus veins
    43401CEsophagus surgery for veins
    43405CLigate/staple esophagus
    43410CRepair esophagus wound
    43415CRepair esophagus wound
    43420CRepair esophagus opening
    43425CRepair esophagus opening
    43450TDilate esophagus01404.74$229.83$107.24$45.97
    43453TDilate esophagus01404.74$229.83$107.24$45.97
    43456TDilate esophagus01404.74$229.83$107.24$45.97
    43458TDilate esophagus01404.74$229.83$107.24$45.97
    43460CPressure treatment esophagus
    43496CFree jejunum flap, microvasc
    43499TEsophagus surgery procedure01404.74$229.83$107.24$45.97
    43500CSurgical opening of stomach
    43501CSurgical repair of stomach
    43502CSurgical repair of stomach
    43510CSurgical opening of stomach
    43520CIncision of pyloric muscle
    43600TBiopsy of stomach01417.15$346.68$184.67$69.34
    Start Printed Page 18602
    43605CBiopsy of stomach
    43610CExcision of stomach lesion
    43611CExcision of stomach lesion
    43620CRemoval of stomach
    43621CRemoval of stomach
    43622CRemoval of stomach
    43631CRemoval of stomach, partial
    43632CRemoval of stomach, partial
    43633CRemoval of stomach, partial
    43634CRemoval of stomach, partial
    43635CRemoval of stomach, partial
    43638CRemoval of stomach, partial
    43639CRemoval of stomach, partial
    43640CVagotomy & pylorus repair
    43641CVagotomy & pylorus repair
    43651TLaparoscopy, vagus nerve013248.91$2,371.50$1,239.22$474.30
    43652TLaparoscopy, vagus nerve013248.91$2,371.50$1,239.22$474.30
    43653TLaparoscopy, gastrostomy013141.81$2,027.24$1,089.88$405.45
    43659TLaparoscope proc, stom013025.36$1,229.63$659.53$245.93
    43750TPlace gastrostomy tube01417.15$346.68$184.67$69.34
    43760TChange gastrostomy tube01212.36$114.43$52.53$22.89
    43761TReposition gastrostomy tube01212.36$114.43$52.53$22.89
    43800CReconstruction of pylorus
    43810CFusion of stomach and bowel
    43820CFusion of stomach and bowel
    43825CFusion of stomach and bowel
    43830TPlace gastrostomy tube01417.15$346.68$184.67$69.34
    43831TPlace gastrostomy tube01417.15$346.68$184.67$69.34
    43832CPlace gastrostomy tube
    43840CRepair of stomach lesion
    43842CGastroplasty for obesity
    43843CGastroplasty for obesity
    43846CGastric bypass for obesity
    43847CGastric bypass for obesity
    43848CRevision gastroplasty
    43850CRevise stomach-bowel fusion
    43855CRevise stomach-bowel fusion
    43860CRevise stomach-bowel fusion
    43865CRevise stomach-bowel fusion
    43870TRepair stomach opening00253.74$181.34$70.66$36.27
    43880CRepair stomach-bowel fistula
    43999TStomach surgery procedure01212.36$114.43$52.53$22.89
    44005CFreeing of bowel adhesion
    44010CIncision of small bowel
    44015CInsert needle cath bowel
    44020CExploration of small bowel
    44021CDecompress small bowel
    44025CIncision of large bowel
    44050CReduce bowel obstruction
    44055CCorrect malrotation of bowel
    44100TBiopsy of bowel01417.15$346.68$184.67$69.34
    44110CExcision of bowel lesion(s)
    44111CExcision of bowel lesion(s)
    44120CRemoval of small intestine
    44121CRemoval of small intestine
    44125CRemoval of small intestine
    44130CBowel to bowel fusion
    44139CMobilization of colon
    44140CPartial removal of colon
    44141CPartial removal of colon
    44143CPartial removal of colon
    44144CPartial removal of colon
    44145CPartial removal of colon
    44146CPartial removal of colon
    44147CPartial removal of colon
    44150CRemoval of colon
    44151CRemoval of colon/ileostomy
    44152CRemoval of colon/ileostomy
    44153CRemoval of colon/ileostomy
    44155CRemoval of colon/ileostomy
    44156CRemoval of colon/ileostomy
    44160CRemoval of colon
    44200TLaparoscopy, enterolysis013141.81$2,027.24$1,089.88$405.45
    Start Printed Page 18603
    44201TLaparoscopy, jejunostomy013141.81$2,027.24$1,089.88$405.45
    44202CLaparo, resect intestine
    44209TLaparoscope proc, intestine013025.36$1,229.63$659.53$245.93
    44300COpen bowel to skin
    44310CIleostomy/jejunostomy
    44312TRevision of ileostomy002612.11$587.18$277.92$117.44
    44314CRevision of ileostomy
    44316CDevise bowel pouch
    44320CColostomy
    44322CColostomy with biopsies
    44340TRevision of colostomy002612.11$587.18$277.92$117.44
    44345CRevision of colostomy
    44346CRevision of colostomy
    44360TSmall bowel endoscopy01427.45$361.23$162.42$72.25
    44361TSmall bowel endoscopy/biopsy01427.45$361.23$162.42$72.25
    44363TSmall bowel endoscopy01427.45$361.23$162.42$72.25
    44364TSmall bowel endoscopy01427.45$361.23$162.42$72.25
    44365TSmall bowel endoscopy01427.45$361.23$162.42$72.25
    44366TSmall bowel endoscopy01427.45$361.23$162.42$72.25
    44369TSmall bowel endoscopy01427.45$361.23$162.42$72.25
    44372TSmall bowel endoscopy01427.45$361.23$162.42$72.25
    44373TSmall bowel endoscopy01427.45$361.23$162.42$72.25
    44376TSmall bowel endoscopy01427.45$361.23$162.42$72.25
    44377TSmall bowel endoscopy/biopsy01427.45$361.23$162.42$72.25
    44378TSmall bowel endoscopy01427.45$361.23$162.42$72.25
    44380TSmall bowel endoscopy01427.45$361.23$162.42$72.25
    44382TSmall bowel endoscopy01427.45$361.23$162.42$72.25
    44385TEndoscopy of bowel pouch01437.98$386.93$199.12$77.39
    44386TEndoscopy, bowel pouch/biop01437.98$386.93$199.12$77.39
    44388TColon endoscopy01437.98$386.93$199.12$77.39
    44389TColonoscopy with biopsy01437.98$386.93$199.12$77.39
    44390TColonoscopy for foreign body01437.98$386.93$199.12$77.39
    44391TColonoscopy for bleeding01437.98$386.93$199.12$77.39
    44392TColonoscopy & polypectomy01437.98$386.93$199.12$77.39
    44393TColonoscopy, lesion removal01437.98$386.93$199.12$77.39
    44394TColonoscopy w/snare01437.98$386.93$199.12$77.39
    44500CIntro, gastrointestinal tube
    44602CSuture, small intestine
    44603CSuture, small intestine
    44604CSuture, large intestine
    44605CRepair of bowel lesion
    44615CIntestinal stricturoplasty
    44620CRepair bowel opening
    44625CRepair bowel opening
    44626CRepair bowel opening
    44640CRepair bowel-skin fistula
    44650CRepair bowel fistula
    44660CRepair bowel-bladder fistula
    44661CRepair bowel-bladder fistula
    44680CSurgical revision, intestine
    44700CSuspend bowel w/prosthesis
    44799TIntestine surgery procedure01427.45$361.23$162.42$72.25
    44800CExcision of bowel pouch
    44820CExcision of mesentery lesion
    44850CRepair of mesentery
    44899CBowel surgery procedure
    44900CDrain app abscess, open
    44901CDrain app abscess, percut
    44950CAppendectomy
    44955CAppendectomy add-on
    44960CAppendectomy
    44970TLaparoscopy, appendectomy013025.36$1,229.63$659.53$245.93
    44979TLaparoscope proc, app013025.36$1,229.63$659.53$245.93
    45000TDrainage of pelvic abscess014912.86$623.54$293.06$124.71
    45005TDrainage of rectal abscess01482.34$113.46$43.59$22.69
    45020TDrainage of rectal abscess014912.86$623.54$293.06$124.71
    45100TBiopsy of rectum014912.86$623.54$293.06$124.71
    45108TRemoval of anorectal lesion015017.68$857.25$437.12$171.45
    45110CRemoval of rectum
    45111CPartial removal of rectum
    45112CRemoval of rectum
    45113CPartial proctectomy
    45114CPartial removal of rectum
    Start Printed Page 18604
    45116CPartial removal of rectum
    45119CRemove rectum w/reservoir
    45120CRemoval of rectum
    45121CRemoval of rectum and colon
    45123CPartial proctectomy
    45126CPelvic exenteration
    45130CExcision of rectal prolapse
    45135CExcision of rectal prolapse
    45150TExcision of rectal stricture015017.68$857.25$437.12$171.45
    45160TExcision of rectal lesion015017.68$857.25$437.12$171.45
    45170TExcision of rectal lesion015017.68$857.25$437.12$171.45
    45190TDestruction, rectal tumor015017.68$857.25$437.12$171.45
    45300TProctosigmoidoscopy01462.83$137.22$65.15$27.44
    45303TProctosigmoidoscopy01462.83$137.22$65.15$27.44
    45305TProctosigmoidoscopy & biopsy01462.83$137.22$65.15$27.44
    45307TProctosigmoidoscopy01462.83$137.22$65.15$27.44
    45308TProctosigmoidoscopy01476.26$303.53$149.11$60.71
    45309TProctosigmoidoscopy01476.26$303.53$149.11$60.71
    45315TProctosigmoidoscopy01476.26$303.53$149.11$60.71
    45317TProctosigmoidoscopy01462.83$137.22$65.15$27.44
    45320TProctosigmoidoscopy01476.26$303.53$149.11$60.71
    45321TProctosigmoidoscopy01476.26$303.53$149.11$60.71
    45330TDiagnostic sigmoidoscopy01462.83$137.22$65.15$27.44
    45331TSigmoidoscopy and biopsy01462.83$137.22$65.15$27.44
    45332TSigmoidoscopy01462.83$137.22$65.15$27.44
    45333TSigmoidoscopy & polypectomy01476.26$303.53$149.11$60.71
    45334TSigmoidoscopy for bleeding01476.26$303.53$149.11$60.71
    45337TSigmoidoscopy & decompress01476.26$303.53$149.11$60.71
    45338TSigmoidoscopy01476.26$303.53$149.11$60.71
    45339TSigmoidoscopy01476.26$303.53$149.11$60.71
    45355TSurgical colonoscopy01437.98$386.93$199.12$77.39
    45378TDiagnostic colonoscopy01437.98$386.93$199.12$77.39
    45379TColonoscopy01437.98$386.93$199.12$77.39
    45380TColonoscopy and biopsy01437.98$386.93$199.12$77.39
    45382TColonoscopy/control bleeding01437.98$386.93$199.12$77.39
    45383TLesion removal colonoscopy01437.98$386.93$199.12$77.39
    45384TColonoscopy01437.98$386.93$199.12$77.39
    45385TLesion removal colonoscopy01437.98$386.93$199.12$77.39
    45500TRepair of rectum015017.68$857.25$437.12$171.45
    45505TRepair of rectum015017.68$857.25$437.12$171.45
    45520TTreatment of rectal prolapse00981.19$57.70$20.88$11.54
    45540CCorrect rectal prolapse
    45541CCorrect rectal prolapse
    45550CRepair rectum/remove sigmoid
    45560TRepair of rectocele015017.68$857.25$437.12$171.45
    45562CExploration/repair of rectum
    45563CExploration/repair of rectum
    45800CRepair rect/bladder fistula
    45805CRepair fistula w/colostomy
    45820CRepair rectourethral fistula
    45825CRepair fistula w/colostomy
    45900TReduction of rectal prolapse01482.34$113.46$43.59$22.69
    45905TDilation of anal sphincter014912.86$623.54$293.06$124.71
    45910TDilation of rectal narrowing014912.86$623.54$293.06$124.71
    45915TRemove rectal obstruction01482.34$113.46$43.59$22.69
    45999TRectum surgery procedure01482.34$113.46$43.59$22.69
    46030TRemoval of rectal marker014912.86$623.54$293.06$124.71
    46040TIncision of rectal abscess01482.34$113.46$43.59$22.69
    46045TIncision of rectal abscess015017.68$857.25$437.12$171.45
    46050TIncision of anal abscess01482.34$113.46$43.59$22.69
    46060TIncision of rectal abscess015017.68$857.25$437.12$171.45
    46070TIncision of anal septum01482.34$113.46$43.59$22.69
    46080TIncision of anal sphincter014912.86$623.54$293.06$124.71
    46083TIncise external hemorrhoid01482.34$113.46$43.59$22.69
    46200TRemoval of anal fissure015017.68$857.25$437.12$171.45
    46210TRemoval of anal crypt014912.86$623.54$293.06$124.71
    46211TRemoval of anal crypts015017.68$857.25$437.12$171.45
    46220TRemoval of anal tab014912.86$623.54$293.06$124.71
    46221TLigation of hemorrhoid(s)01482.34$113.46$43.59$22.69
    46230TRemoval of anal tabs014912.86$623.54$293.06$124.71
    46250THemorrhoidectomy015017.68$857.25$437.12$171.45
    46255THemorrhoidectomy015017.68$857.25$437.12$171.45
    46257TRemove hemorrhoids & fissure015017.68$857.25$437.12$171.45
    Start Printed Page 18605
    46258TRemove hemorrhoids & fistula015017.68$857.25$437.12$171.45
    46260THemorrhoidectomy015017.68$857.25$437.12$171.45
    46261TRemove hemorrhoids & fissure015017.68$857.25$437.12$171.45
    46262TRemove hemorrhoids & fistula015017.68$857.25$437.12$171.45
    46270TRemoval of anal fistula015017.68$857.25$437.12$171.45
    46275TRemoval of anal fistula015017.68$857.25$437.12$171.45
    46280TRemoval of anal fistula015017.68$857.25$437.12$171.45
    46285TRemoval of anal fistula015017.68$857.25$437.12$171.45
    46288TRepair anal fistula015017.68$857.25$437.12$171.45
    46320TRemoval of hemorrhoid clot01482.34$113.46$43.59$22.69
    46500TInjection into hemorrhoids01482.34$113.46$43.59$22.69
    46600NDiagnostic anoscopy
    46604TAnoscopy and dilation01442.23$108.13$49.32$21.63
    46606TAnoscopy and biopsy01457.46$361.71$179.39$72.34
    46608TAnoscopy/remove for body01442.23$108.13$49.32$21.63
    46610TAnoscopy/remove lesion01457.46$361.71$179.39$72.34
    46611TAnoscopy01457.46$361.71$179.39$72.34
    46612TAnoscopy/remove lesions01457.46$361.71$179.39$72.34
    46614TAnoscopy/control bleeding01457.46$361.71$179.39$72.34
    46615TAnoscopy01457.46$361.71$179.39$72.34
    46700TRepair of anal stricture015017.68$857.25$437.12$171.45
    46705CRepair of anal stricture
    46715CRepair of anovaginal fistula
    46716CRepair of anovaginal fistula
    46730CConstruction of absent anus
    46735CConstruction of absent anus
    46740CConstruction of absent anus
    46742CRepair of imperforated anus
    46744CRepair of cloacal anomaly
    46746CRepair of cloacal anomaly
    46748CRepair of cloacal anomaly
    46750TRepair of anal sphincter015017.68$857.25$437.12$171.45
    46751CRepair of anal sphincter
    46753TReconstruction of anus015017.68$857.25$437.12$171.45
    46754TRemoval of suture from anus014912.86$623.54$293.06$124.71
    46760TRepair of anal sphincter015017.68$857.25$437.12$171.45
    46761TRepair of anal sphincter015017.68$857.25$437.12$171.45
    46762TImplant artificial sphincter015017.68$857.25$437.12$171.45
    46900TDestruction, anal lesion(s)00163.53$171.16$74.67$34.23
    46910TDestruction, anal lesion(s)00163.53$171.16$74.67$34.23
    46916TCryosurgery, anal lesion(s)00163.53$171.16$74.67$34.23
    46917TLaser surgery, anal lesions00141.50$72.73$24.55$14.55
    46922TExcision of anal lesion(s)001712.45$603.66$289.16$120.73
    46924TDestruction, anal lesion(s)001712.45$603.66$289.16$120.73
    46934TDestruction of hemorrhoids01482.34$113.46$43.59$22.69
    46935TDestruction of hemorrhoids01482.34$113.46$43.59$22.69
    46936TDestruction of hemorrhoids014912.86$623.54$293.06$124.71
    46937TCryotherapy of rectal lesion015017.68$857.25$437.12$171.45
    46938TCryotherapy of rectal lesion015017.68$857.25$437.12$171.45
    46940TTreatment of anal fissure014912.86$623.54$293.06$124.71
    46942TTreatment of anal fissure014912.86$623.54$293.06$124.71
    46945TLigation of hemorrhoids01482.34$113.46$43.59$22.69
    46946TLigation of hemorrhoids01482.34$113.46$43.59$22.69
    46999TAnus surgery procedure014912.86$623.54$293.06$124.71
    47000TNeedle biopsy of liver00055.41$262.32$119.75$52.46
    47001CNeedle biopsy, liver add-on
    47010COpen drainage, liver lesion
    47011CPercut drain, liver lesion
    47015CInject/aspirate liver cyst
    47100CWedge biopsy of liver
    47120CPartial removal of liver
    47122CExtensive removal of liver
    47125CPartial removal of liver
    47130CPartial removal of liver
    47133CRemoval of donor liver
    47134CPartial removal, donor liver
    47135CTransplantation of liver
    47136CTransplantation of liver
    47300CSurgery for liver lesion
    47350CRepair liver wound
    47360CRepair liver wound
    47361CRepair liver wound
    47362CRepair liver wound
    Start Printed Page 18606
    47399TLiver surgery procedure00055.41$262.32$119.75$52.46
    47400CIncision of liver duct
    47420CIncision of bile duct
    47425CIncision of bile duct
    47460CIncise bile duct sphincter
    47480CIncision of gallbladder
    47490CIncision of gallbladder
    47500NInjection for liver x-rays
    47505NInjection for liver x-rays
    47510TInsert catheter, bile duct01528.22$398.56$207.38$79.71
    47511TInsert bile duct drain01528.22$398.56$207.38$79.71
    47525TChange bile duct catheter01225.04$244.37$114.93$48.88
    47530TRevise/reinsert bile tube01212.36$114.43$52.53$22.89
    47550CBile duct endoscopy add-on
    47552TBiliary endoscopy thru skin01528.22$398.56$207.38$79.71
    47553TBiliary endoscopy thru skin01528.22$398.56$207.38$79.71
    47554TBiliary endoscopy thru skin01528.22$398.56$207.38$79.71
    47555TBiliary endoscopy thru skin01528.22$398.56$207.38$79.71
    47556TBiliary endoscopy thru skin01528.22$398.56$207.38$79.71
    47560TLaparoscopy w/cholangio013025.36$1,229.63$659.53$245.93
    47561TLaparo w/cholangio/biopsy013025.36$1,229.63$659.53$245.93
    47562TLaparoscopic cholecystectomy013141.81$2,027.24$1,089.88$405.45
    47563TLaparo cholecystectomy/graph013141.81$2,027.24$1,089.88$405.45
    47564TLaparo cholecystectomy/explr013141.81$2,027.24$1,089.88$405.45
    47570TLaparo cholecystoenterostomy013141.81$2,027.24$1,089.88$405.45
    47579TLaparoscope proc, biliary013025.36$1,229.63$659.53$245.93
    47600CRemoval of gallbladder
    47605CRemoval of gallbladder
    47610CRemoval of gallbladder
    47612CRemoval of gallbladder
    47620CRemoval of gallbladder
    47630TRemove bile duct stone01528.22$398.56$207.38$79.71
    47700CExploration of bile ducts
    47701CBile duct revision
    47711CExcision of bile duct tumor
    47712CExcision of bile duct tumor
    47715CExcision of bile duct cyst
    47716CFusion of bile duct cyst
    47720CFuse gallbladder & bowel
    47721CFuse upper gi structures
    47740CFuse gallbladder & bowel
    47741CFuse gallbladder & bowel
    47760CFuse bile ducts and bowel
    47765CFuse liver ducts & bowel
    47780CFuse bile ducts and bowel
    47785CFuse bile ducts and bowel
    47800CReconstruction of bile ducts
    47801CPlacement, bile duct support
    47802CFuse liver duct & intestine
    47900CSuture bile duct injury
    47999TBile tract surgery procedure01212.36$114.43$52.53$22.89
    48000CDrainage of abdomen
    48001CPlacement of drain, pancreas
    48005CResect/debride pancreas
    48020CRemoval of pancreatic stone
    48100CBiopsy of pancreas
    48102TNeedle biopsy, pancreas00055.41$262.32$119.75$52.46
    48120CRemoval of pancreas lesion
    48140CPartial removal of pancreas
    48145CPartial removal of pancreas
    48146CPancreatectomy
    48148CRemoval of pancreatic duct
    48150CPartial removal of pancreas
    48152CPancreatectomy
    48153CPancreatectomy
    48154CPancreatectomy
    48155CRemoval of pancreas
    48160EPancreas removal/transplant
    48180CFuse pancreas and bowel
    48400CInjection, intraop add-on
    48500CSurgery of pancreas cyst
    48510CDrain pancreatic pseudocyst
    48511CDrain pancreatic pseudocyst
    Start Printed Page 18607
    48520CFuse pancreas cyst and bowel
    48540CFuse pancreas cyst and bowel
    48545CPancreatorrhaphy
    48547CDuodenal exclusion
    48550EDonor pancreatectomy
    48554ETranspl allograft pancreas
    48556CRemoval, allograft pancreas
    48999TPancreas surgery procedure00055.41$262.32$119.75$52.46
    49000CExploration of abdomen
    49002CReopening of abdomen
    49010CExploration behind abdomen
    49020CDrain abdominal abscess
    49021CDrain abdominal abscess
    49040CDrain, open, abdom abscess
    49041CDrain, percut, abdom abscess
    49060CDrain, open, retrop abscess
    49061CDrain, percut, retroper absc
    49062CDrain to peritoneal cavity
    49080TPuncture, peritoneal cavity00703.64$176.49$79.60$35.30
    49081TRemoval of abdominal fluid00703.64$176.49$79.60$35.30
    49085TRemove abdomen foreign body015319.62$951.32$496.31$190.26
    49180TBiopsy, abdominal mass00055.41$262.32$119.75$52.46
    49200CRemoval of abdominal lesion
    49201CRemoval of abdominal lesion
    49215CExcise sacral spine tumor
    49220CMultiple surgery, abdomen
    49250TExcision of umbilicus015319.62$951.32$496.31$190.26
    49255CRemoval of omentum
    49320TDiag laparo separate proc013025.36$1,229.63$659.53$245.93
    49321TLaparoscopy, biopsy013025.36$1,229.63$659.53$245.93
    49322TLaparoscopy, aspiration013025.36$1,229.63$659.53$245.93
    49323TLaparo drain lymphocele013025.36$1,229.63$659.53$245.93
    49329TLaparo proc, abdm/per/oment013025.36$1,229.63$659.53$245.93
    49400NAir injection into abdomen
    49420TInsert abdominal drain015319.62$951.32$496.31$190.26
    49421TInsert abdominal drain015319.62$951.32$496.31$190.26
    49422TRemove perm cannula/catheter012313.89$673.49$350.75$134.70
    49423TExchange drainage catheter015319.62$951.32$496.31$190.26
    49424NAssess cyst, contrast inject
    49425CInsert abdomen-venous drain
    49426TRevise abdomen-venous shunt015319.62$951.32$496.31$190.26
    49427NInjection, abdominal shunt
    49428CLigation of shunt
    49429TRemoval of shunt012313.89$673.49$350.75$134.70
    49495TRepair inguinal hernia, init015422.43$1,087.57$556.98$217.51
    49496TRepair inguinal hernia, init015422.43$1,087.57$556.98$217.51
    49500TRepair inguinal hernia015422.43$1,087.57$556.98$217.51
    49501TRepair inguinal hernia, init015422.43$1,087.57$556.98$217.51
    49505TRepair inguinal hernia015422.43$1,087.57$556.98$217.51
    49507TRepair inguinal hernia015422.43$1,087.57$556.98$217.51
    49520TRerepair inguinal hernia015422.43$1,087.57$556.98$217.51
    49521TRepair inguinal hernia, rec015422.43$1,087.57$556.98$217.51
    49525TRepair inguinal hernia015422.43$1,087.57$556.98$217.51
    49540TRepair lumbar hernia015422.43$1,087.57$556.98$217.51
    49550TRepair femoral hernia015422.43$1,087.57$556.98$217.51
    49553TRepair femoral hernia, init015422.43$1,087.57$556.98$217.51
    49555TRepair femoral hernia015422.43$1,087.57$556.98$217.51
    49557TRepair femoral hernia, recur015422.43$1,087.57$556.98$217.51
    49560TRepair abdominal hernia015422.43$1,087.57$556.98$217.51
    49561TRepair incisional hernia015422.43$1,087.57$556.98$217.51
    49565TRerepair abdominal hernia015422.43$1,087.57$556.98$217.51
    49566TRepair incisional hernia015422.43$1,087.57$556.98$217.51
    49568THernia repair w/mesh015422.43$1,087.57$556.98$217.51
    49570TRepair epigastric hernia015422.43$1,087.57$556.98$217.51
    49572TRepair epigastric hernia015422.43$1,087.57$556.98$217.51
    49580TRepair umbilical hernia015422.43$1,087.57$556.98$217.51
    49582TRepair umbilical hernia015422.43$1,087.57$556.98$217.51
    49585TRepair umbilical hernia015422.43$1,087.57$556.98$217.51
    49587TRepair umbilical hernia015422.43$1,087.57$556.98$217.51
    49590TRepair abdominal hernia015422.43$1,087.57$556.98$217.51
    49600TRepair umbilical lesion015422.43$1,087.57$556.98$217.51
    49605CRepair umbilical lesion
    49606CRepair umbilical lesion
    Start Printed Page 18608
    49610CRepair umbilical lesion
    49611CRepair umbilical lesion
    49650TLaparo hernia repair initial013141.81$2,027.24$1,089.88$405.45
    49651TLaparo hernia repair recur013141.81$2,027.24$1,089.88$405.45
    49659TLaparo proc, hernia repair013141.81$2,027.24$1,089.88$405.45
    49900CRepair of abdominal wall
    49905COmental flap
    49906CFree omental flap, microvasc
    49999TAbdomen surgery procedure01212.36$114.43$52.53$22.89
    50010CExploration of kidney
    50020CRenal abscess, open drain
    50021CRenal abscess, percut drain
    50040CDrainage of kidney
    50045CExploration of kidney
    50060CRemoval of kidney stone
    50065CIncision of kidney
    50070CIncision of kidney
    50075CRemoval of kidney stone
    50080TRemoval of kidney stone016328.98$1,405.16$792.58$281.03
    50081TRemoval of kidney stone016328.98$1,405.16$792.58$281.03
    50100CRevise kidney blood vessels
    50120CExploration of kidney
    50125CExplore and drain kidney
    50130CRemoval of kidney stone
    50135CExploration of kidney
    50200TBiopsy of kidney00055.41$262.32$119.75$52.46
    50205CBiopsy of kidney
    50220CRemoval of kidney
    50225CRemoval of kidney
    50230CRemoval of kidney
    50234CRemoval of kidney & ureter
    50236CRemoval of kidney & ureter
    50240CPartial removal of kidney
    50280CRemoval of kidney lesion
    50290CRemoval of kidney lesion
    50300CRemoval of donor kidney
    50320CRemoval of donor kidney
    50340CRemoval of kidney
    50360CTransplantation of kidney
    50365CTransplantation of kidney
    50370CRemove transplanted kidney
    50380CReimplantation of kidney
    50390TDrainage of kidney lesion00055.41$262.32$119.75$52.46
    50392TInsert kidney drain01605.43$263.28$110.11$52.66
    50393TInsert ureteral tube01605.43$263.28$110.11$52.66
    50394NInjection for kidney x-ray
    50395TCreate passage to kidney01605.43$263.28$110.11$52.66
    50396TMeasure kidney pressure01653.89$188.61$91.76$37.72
    50398TChange kidney tube01225.04$244.37$114.93$48.88
    50400CRevision of kidney/ureter
    50405CRevision of kidney/ureter
    50500CRepair of kidney wound
    50520CClose kidney-skin fistula
    50525CRepair renal-abdomen fistula
    50526CRepair renal-abdomen fistula
    50540CRevision of horseshoe kidney
    50541TLaparo ablate renal cyst013141.81$2,027.24$1,089.88$405.45
    50544TLaparoscopy, pyeloplasty013141.81$2,027.24$1,089.88$405.45
    50546CLaparoscopic nephrectomy
    50547CLaparo removal donor kidney
    50548TLaparo-asst remove k/ureter013248.91$2,371.50$1,239.22$474.30
    50549TLaparoscope proc, renal013025.36$1,229.63$659.53$245.93
    50551TKidney endoscopy016110.94$530.45$249.36$106.09
    50553TKidney endoscopy016110.94$530.45$249.36$106.09
    50555TKidney endoscopy & biopsy016110.94$530.45$249.36$106.09
    50557TKidney endoscopy & treatment016110.94$530.45$249.36$106.09
    50559TRenal endoscopy/radiotracer016110.94$530.45$249.36$106.09
    50561TKidney endoscopy & treatment016110.94$530.45$249.36$106.09
    50570CKidney endoscopy
    50572CKidney endoscopy
    50574CKidney endoscopy & biopsy
    50575CKidney endoscopy
    50576CKidney endoscopy & treatment
    Start Printed Page 18609
    50578CRenal endoscopy/radiotracer
    50580CKidney endoscopy & treatment
    50590TFragmenting of kidney stone016946.72$2,265.32$1,384.20$453.06
    50600CExploration of ureter
    50605CInsert ureteral support
    50610CRemoval of ureter stone
    50620CRemoval of ureter stone
    50630CRemoval of ureter stone
    50650CRemoval of ureter
    50660CRemoval of ureter
    50684NInjection for ureter x-ray
    50686TMeasure ureter pressure01653.89$188.61$91.76$37.72
    50688TChange of ureter tube01212.36$114.43$52.53$22.89
    50690NInjection for ureter x-ray
    50700CRevision of ureter
    50715CRelease of ureter
    50722CRelease of ureter
    50725CRelease/revise ureter
    50727CRevise ureter
    50728CRevise ureter
    50740CFusion of ureter & kidney
    50750CFusion of ureter & kidney
    50760CFusion of ureters
    50770CSplicing of ureters
    50780CReimplant ureter in bladder
    50782CReimplant ureter in bladder
    50783CReimplant ureter in bladder
    50785CReimplant ureter in bladder
    50800CImplant ureter in bowel
    50810CFusion of ureter & bowel
    50815CUrine shunt to bowel
    50820CConstruct bowel bladder
    50825CConstruct bowel bladder
    50830CRevise urine flow
    50840CReplace ureter by bowel
    50845CAppendico-vesicostomy
    50860CTransplant ureter to skin
    50900CRepair of ureter
    50920CClosure ureter/skin fistula
    50930CClosure ureter/bowel fistula
    50940CRelease of ureter
    50945TLaparoscopy ureterolithotomy013141.81$2,027.24$1,089.88$405.45
    50951TEndoscopy of ureter016217.49$848.04$427.49$169.61
    50953TEndoscopy of ureter016217.49$848.04$427.49$169.61
    50955TUreter endoscopy & biopsy016217.49$848.04$427.49$169.61
    50957TUreter endoscopy & treatment016217.49$848.04$427.49$169.61
    50959TUreter endoscopy & tracer016217.49$848.04$427.49$169.61
    50961TUreter endoscopy & treatment016217.49$848.04$427.49$169.61
    50970CUreter endoscopy
    50972CUreter endoscopy & catheter
    50974CUreter endoscopy & biopsy
    50976CUreter endoscopy & treatment
    50978CUreter endoscopy & tracer
    50980CUreter endoscopy & treatment
    51000TDrainage of bladder01653.89$188.61$91.76$37.72
    51005TDrainage of bladder01642.17$105.23$33.03$21.05
    51010TDrainage of bladder01653.89$188.61$91.76$37.72
    51020TIncise & treat bladder016217.49$848.04$427.49$169.61
    51030TIncise & treat bladder016217.49$848.04$427.49$169.61
    51040TIncise & drain bladder016217.49$848.04$427.49$169.61
    51045TIncise bladder/drain ureter016217.49$848.04$427.49$169.61
    51050TRemoval of bladder stone016217.49$848.04$427.49$169.61
    51060CRemoval of ureter stone
    51065TRemoval of ureter stone016217.49$848.04$427.49$169.61
    51080TDrainage of bladder abscess00086.15$298.20$113.67$59.64
    51500TRemoval of bladder cyst015422.43$1,087.57$556.98$217.51
    51520TRemoval of bladder lesion016217.49$848.04$427.49$169.61
    51525CRemoval of bladder lesion
    51530CRemoval of bladder lesion
    51535CRepair of ureter lesion
    51550CPartial removal of bladder
    51555CPartial removal of bladder
    51565CRevise bladder & ureter(s)
    Start Printed Page 18610
    51570CRemoval of bladder
    51575CRemoval of bladder & nodes
    51580CRemove bladder/revise tract
    51585CRemoval of bladder & nodes
    51590CRemove bladder/revise tract
    51595CRemove bladder/revise tract
    51596CRemove bladder/create pouch
    51597CRemoval of pelvic structures
    51600NInjection for bladder x-ray
    51605NPreparation for bladder x-ray
    51610NInjection for bladder x-ray
    51700TIrrigation of bladder01642.17$105.23$33.03$21.05
    51705TChange of bladder tube01212.36$114.43$52.53$22.89
    51710TChange of bladder tube01212.36$114.43$52.53$22.89
    51715TEndoscopic injection/implant016721.06$1,021.14$555.84$204.23
    51720TTreatment of bladder lesion01653.89$188.61$91.76$37.72
    51725TSimple cystometrogram01653.89$188.61$91.76$37.72
    51726TComplex cystometrogram01653.89$188.61$91.76$37.72
    51736TUrine flow measurement01642.17$105.23$33.03$21.05
    51741TElectro-uroflowmetry, first01642.17$105.23$33.03$21.05
    51772TUrethra pressure profile01653.89$188.61$91.76$37.72
    51784TAnal/urinary muscle study01642.17$105.23$33.03$21.05
    51785TAnal/urinary muscle study01642.17$105.23$33.03$21.05
    51792TUrinary reflex study01653.89$188.61$91.76$37.72
    51795TUrine voiding pressure study01642.17$105.23$33.03$21.05
    51797TIntraabdominal pressure test01642.17$105.23$33.03$21.05
    51800CRevision of bladder/urethra
    51820CRevision of urinary tract
    51840CAttach bladder/urethra
    51841CAttach bladder/urethra
    51845CRepair bladder neck
    51860CRepair of bladder wound
    51865CRepair of bladder wound
    51880TRepair of bladder opening016217.49$848.04$427.49$169.61
    51900CRepair bladder/vagina lesion
    51920CClose bladder-uterus fistula
    51925CHysterectomy/bladder repair
    51940CCorrection of bladder defect
    51960CRevision of bladder & bowel
    51980CConstruct bladder opening
    51990TLaparo urethral suspension013141.81$2,027.24$1,089.88$405.45
    51992TLaparo sling operation013248.91$2,371.50$1,239.22$474.30
    52000TCystoscopy01605.43$263.28$110.11$52.66
    52005TCystoscopy & ureter catheter016110.94$530.45$249.36$106.09
    52007TCystoscopy and biopsy016110.94$530.45$249.36$106.09
    52010TCystoscopy & duct catheter016110.94$530.45$249.36$106.09
    52204TCystoscopy016110.94$530.45$249.36$106.09
    52214TCystoscopy and treatment016110.94$530.45$249.36$106.09
    52224TCystoscopy and treatment016110.94$530.45$249.36$106.09
    52234TCystoscopy and treatment016217.49$848.04$427.49$169.61
    52235TCystoscopy and treatment016217.49$848.04$427.49$169.61
    52240TCystoscopy and treatment016328.98$1,405.16$792.58$281.03
    52250TCystoscopy and radiotracer016217.49$848.04$427.49$169.61
    52260TCystoscopy and treatment016110.94$530.45$249.36$106.09
    52265TCystoscopy and treatment01605.43$263.28$110.11$52.66
    52270TCystoscopy & revise urethra016110.94$530.45$249.36$106.09
    52275TCystoscopy & revise urethra016110.94$530.45$249.36$106.09
    52276TCystoscopy and treatment016110.94$530.45$249.36$106.09
    52277TCystoscopy and treatment016217.49$848.04$427.49$169.61
    52281TCystoscopy and treatment016110.94$530.45$249.36$106.09
    52282TCystoscopy, implant stent016217.49$848.04$427.49$169.61
    52283TCystoscopy and treatment016110.94$530.45$249.36$106.09
    52285TCystoscopy and treatment016110.94$530.45$249.36$106.09
    52290TCystoscopy and treatment016110.94$530.45$249.36$106.09
    52300TCystoscopy and treatment016110.94$530.45$249.36$106.09
    52301TCystoscopy and treatment016110.94$530.45$249.36$106.09
    52305TCystoscopy and treatment016110.94$530.45$249.36$106.09
    52310TCystoscopy and treatment016110.94$530.45$249.36$106.09
    52315TCystoscopy and treatment016110.94$530.45$249.36$106.09
    52317TRemove bladder stone016217.49$848.04$427.49$169.61
    52318TRemove bladder stone016217.49$848.04$427.49$169.61
    52320TCystoscopy and treatment016217.49$848.04$427.49$169.61
    52325TCystoscopy, stone removal016217.49$848.04$427.49$169.61
    Start Printed Page 18611
    52327TCystoscopy, inject material016110.94$530.45$249.36$106.09
    52330TCystoscopy and treatment016217.49$848.04$427.49$169.61
    52332TCystoscopy and treatment016217.49$848.04$427.49$169.61
    52334TCreate passage to kidney016217.49$848.04$427.49$169.61
    52335TEndoscopy of urinary tract016217.49$848.04$427.49$169.61
    52336TCystoscopy, stone removal016217.49$848.04$427.49$169.61
    52337TCystoscopy, stone removal016217.49$848.04$427.49$169.61
    52338TCystoscopy and treatment016217.49$848.04$427.49$169.61
    52339TCystoscopy and treatment016217.49$848.04$427.49$169.61
    52340TCystoscopy and treatment016217.49$848.04$427.49$169.61
    52450TIncision of prostate016217.49$848.04$427.49$169.61
    52500TRevision of bladder neck016217.49$848.04$427.49$169.61
    52510TDilation prostatic urethra016110.94$530.45$249.36$106.09
    52601TProstatectomy (TURP)016328.98$1,405.16$792.58$281.03
    52606TControl postop bleeding016217.49$848.04$427.49$169.61
    52612TProstatectomy, first stage016328.98$1,405.16$792.58$281.03
    52614TProstatectomy, second stage016328.98$1,405.16$792.58$281.03
    52620TRemove residual prostate016328.98$1,405.16$792.58$281.03
    52630TRemove prostate regrowth016328.98$1,405.16$792.58$281.03
    52640TRelieve bladder contracture016217.49$848.04$427.49$169.61
    52647TLaser surgery of prostate016328.98$1,405.16$792.58$281.03
    52648TLaser surgery of prostate016328.98$1,405.16$792.58$281.03
    52700TDrainage of prostate abscess016217.49$848.04$427.49$169.61
    53000TIncision of urethra016610.17$493.11$218.73$98.62
    53010TIncision of urethra016610.17$493.11$218.73$98.62
    53020TIncision of urethra016610.17$493.11$218.73$98.62
    53025TIncision of urethra016610.17$493.11$218.73$98.62
    53040TDrainage of urethra abscess016610.17$493.11$218.73$98.62
    53060TDrainage of urethra abscess016610.17$493.11$218.73$98.62
    53080TDrainage of urinary leakage016610.17$493.11$218.73$98.62
    53085CDrainage of urinary leakage
    53200TBiopsy of urethra016610.17$493.11$218.73$98.62
    53210TRemoval of urethra016824.94$1,209.27$536.11$241.85
    53215TRemoval of urethra016824.94$1,209.27$536.11$241.85
    53220TTreatment of urethra lesion016824.94$1,209.27$536.11$241.85
    53230TRemoval of urethra lesion016824.94$1,209.27$536.11$241.85
    53235TRemoval of urethra lesion016824.94$1,209.27$536.11$241.85
    53240TSurgery for urethra pouch016824.94$1,209.27$536.11$241.85
    53250TRemoval of urethra gland016610.17$493.11$218.73$98.62
    53260TTreatment of urethra lesion016610.17$493.11$218.73$98.62
    53265TTreatment of urethra lesion016610.17$493.11$218.73$98.62
    53270TRemoval of urethra gland016721.06$1,021.14$555.84$204.23
    53275TRepair of urethra defect016610.17$493.11$218.73$98.62
    53400TRevise urethra, stage 1016824.94$1,209.27$536.11$241.85
    53405TRevise urethra, stage 2016824.94$1,209.27$536.11$241.85
    53410TReconstruction of urethra016824.94$1,209.27$536.11$241.85
    53415CReconstruction of urethra
    53420TReconstruct urethra, stage 1016824.94$1,209.27$536.11$241.85
    53425TReconstruct urethra, stage 2016824.94$1,209.27$536.11$241.85
    53430TReconstruction of urethra016824.94$1,209.27$536.11$241.85
    53440TCorrect bladder function018252.11$2,526.66$1,525.05$505.33
    53442TRemove perineal prosthesis016610.17$493.11$218.73$98.62
    53443CReconstruction of urethra
    53445TCorrect urine flow control018252.11$2,526.66$1,525.05$505.33
    53447TRemove artificial sphincter016824.94$1,209.27$536.11$241.85
    53449TCorrect artificial sphincter016824.94$1,209.27$536.11$241.85
    53450TRevision of urethra016824.94$1,209.27$536.11$241.85
    53460TRevision of urethra016824.94$1,209.27$536.11$241.85
    53502TRepair of urethra injury016610.17$493.11$218.73$98.62
    53505TRepair of urethra injury016721.06$1,021.14$555.84$204.23
    53510TRepair of urethra injury016610.17$493.11$218.73$98.62
    53515TRepair of urethra injury016824.94$1,209.27$536.11$241.85
    53520TRepair of urethra defect016824.94$1,209.27$536.11$241.85
    53600TDilate urethra stricture01642.17$105.23$33.03$21.05
    53601TDilate urethra stricture01642.17$105.23$33.03$21.05
    53605TDilate urethra stricture016110.94$530.45$249.36$106.09
    53620TDilate urethra stricture01653.89$188.61$91.76$37.72
    53621TDilate urethra stricture01642.17$105.23$33.03$21.05
    53660TDilation of urethra01642.17$105.23$33.03$21.05
    53661TDilation of urethra01642.17$105.23$33.03$21.05
    53665TDilation of urethra016610.17$493.11$218.73$98.62
    53670NInsert urinary catheter
    53675TInsert urinary catheter01642.17$105.23$33.03$21.05
    Start Printed Page 18612
    2 53850TProstatic microwave thermotx098038.67$1,875.00$375.00
    2 53852TProstatic rf thermotx098038.67$1,875.00$375.00
    53899TUrology surgery procedure01653.89$188.61$91.76$37.72
    54000TSlitting of prepuce016610.17$493.11$218.73$98.62
    54001TSlitting of prepuce016610.17$493.11$218.73$98.62
    54015TDrain penis lesion00086.15$298.20$113.67$59.64
    54050TDestruction, penis lesion(s)00130.91$44.12$17.66$8.82
    54055TDestruction, penis lesion(s)00163.53$171.16$74.67$34.23
    54056TCryosurgery, penis lesion(s)00130.91$44.12$17.66$8.82
    54057TLaser surg, penis lesion(s)001712.45$603.66$289.16$120.73
    54060TExcision of penis lesion(s)001712.45$603.66$289.16$120.73
    54065TDestruction, penis lesion(s)001712.45$603.66$289.16$120.73
    54100TBiopsy of penis00206.51$315.65$130.53$63.13
    54105TBiopsy of penis002110.49$508.63$236.51$101.73
    54110TTreatment of penis lesion018132.37$1,569.53$906.36$313.91
    54111TTreat penis lesion, graft018132.37$1,569.53$906.36$313.91
    54112TTreat penis lesion, graft018132.37$1,569.53$906.36$313.91
    54115TTreatment of penis lesion00086.15$298.20$113.67$59.64
    54120TPartial removal of penis018132.37$1,569.53$906.36$313.91
    54125CRemoval of penis
    54130CRemove penis & nodes
    54135CRemove penis & nodes
    54150TCircumcision018013.62$660.39$304.87$132.08
    54152TCircumcision018013.62$660.39$304.87$132.08
    54160TCircumcision018013.62$660.39$304.87$132.08
    54161TCircumcision018013.62$660.39$304.87$132.08
    54200TTreatment of penis lesion01653.89$188.61$91.76$37.72
    54205TTreatment of penis lesion018132.37$1,569.53$906.36$313.91
    54220TTreatment of penis lesion01653.89$188.61$91.76$37.72
    54230NPrepare penis study
    54231TDynamic cavernosometry01653.89$188.61$91.76$37.72
    54235TPenile injection01642.17$105.23$33.03$21.05
    54240TPenis study01642.17$105.23$33.03$21.05
    54250TPenis study01653.89$188.61$91.76$37.72
    54300TRevision of penis018132.37$1,569.53$906.36$313.91
    54304TRevision of penis018132.37$1,569.53$906.36$313.91
    54308TReconstruction of urethra018132.37$1,569.53$906.36$313.91
    54312TReconstruction of urethra018132.37$1,569.53$906.36$313.91
    54316TReconstruction of urethra018132.37$1,569.53$906.36$313.91
    54318TReconstruction of urethra018132.37$1,569.53$906.36$313.91
    54322TReconstruction of urethra018132.37$1,569.53$906.36$313.91
    54324TReconstruction of urethra018132.37$1,569.53$906.36$313.91
    54326TReconstruction of urethra018132.37$1,569.53$906.36$313.91
    54328TRevise penis/urethra018132.37$1,569.53$906.36$313.91
    54332CRevise penis/urethra
    54336CRevise penis/urethra
    54340TSecondary urethral surgery018132.37$1,569.53$906.36$313.91
    54344TSecondary urethral surgery018132.37$1,569.53$906.36$313.91
    54348TSecondary urethral surgery018132.37$1,569.53$906.36$313.91
    54352TReconstruct urethra/penis018132.37$1,569.53$906.36$313.91
    54360TPenis plastic surgery018132.37$1,569.53$906.36$313.91
    54380TRepair penis018132.37$1,569.53$906.36$313.91
    54385TRepair penis018132.37$1,569.53$906.36$313.91
    54390CRepair penis and bladder
    54400TInsert semi-rigid prosthesis018252.11$2,526.66$1,525.05$505.33
    54401TInsert self-contd prosthesis018252.11$2,526.66$1,525.05$505.33
    54402TRemove penis prosthesis018132.37$1,569.53$906.36$313.91
    54405TInsert multi-comp prosthesis018252.11$2,526.66$1,525.05$505.33
    54407TRemove multi-comp prosthesis018132.37$1,569.53$906.36$313.91
    54409TRevise penis prosthesis018132.37$1,569.53$906.36$313.91
    54420TRevision of penis018132.37$1,569.53$906.36$313.91
    54430CRevision of penis
    54435TRevision of penis018132.37$1,569.53$906.36$313.91
    54440TRepair of penis018132.37$1,569.53$906.36$313.91
    54450TPreputial stretching01653.89$188.61$91.76$37.72
    54500TBiopsy of testis00055.41$262.32$119.75$52.46
    54505TBiopsy of testis018318.26$885.37$448.94$177.07
    54510TRemoval of testis lesion018318.26$885.37$448.94$177.07
    54520TRemoval of testis018318.26$885.37$448.94$177.07
    54530TRemoval of testis015422.43$1,087.57$556.98$217.51
    54535CExtensive testis surgery
    54550TExploration for testis015422.43$1,087.57$556.98$217.51
    54560CExploration for testis
    Start Printed Page 18613
    54600TReduce testis torsion018318.26$885.37$448.94$177.07
    54620TSuspension of testis018318.26$885.37$448.94$177.07
    54640TSuspension of testis015422.43$1,087.57$556.98$217.51
    54650COrchiopexy (Fowler-Stephens)
    54660TRevision of testis018318.26$885.37$448.94$177.07
    54670TRepair testis injury018318.26$885.37$448.94$177.07
    54680TRelocation of testis(es)018318.26$885.37$448.94$177.07
    54690TLaparoscopy, orchiectomy013141.81$2,027.24$1,089.88$405.45
    54692TLaparoscopy, orchiopexy013248.91$2,371.50$1,239.22$474.30
    54699TLaparoscope proc, testis013025.36$1,229.63$659.53$245.93
    54700TDrainage of scrotum018318.26$885.37$448.94$177.07
    54800TBiopsy of epididymis00041.84$89.22$32.57$17.84
    54820TExploration of epididymis018318.26$885.37$448.94$177.07
    54830TRemove epididymis lesion018318.26$885.37$448.94$177.07
    54840TRemove epididymis lesion018318.26$885.37$448.94$177.07
    54860TRemoval of epididymis018318.26$885.37$448.94$177.07
    54861TRemoval of epididymis018318.26$885.37$448.94$177.07
    54900TFusion of spermatic ducts018318.26$885.37$448.94$177.07
    54901TFusion of spermatic ducts018318.26$885.37$448.94$177.07
    55000TDrainage of hydrocele00041.84$89.22$32.57$17.84
    55040TRemoval of hydrocele015422.43$1,087.57$556.98$217.51
    55041TRemoval of hydroceles015422.43$1,087.57$556.98$217.51
    55060TRepair of hydrocele018318.26$885.37$448.94$177.07
    55100TDrainage of scrotum abscess00086.15$298.20$113.67$59.64
    55110TExplore scrotum018318.26$885.37$448.94$177.07
    55120TRemoval of scrotum lesion018318.26$885.37$448.94$177.07
    55150TRemoval of scrotum018318.26$885.37$448.94$177.07
    55175TRevision of scrotum018318.26$885.37$448.94$177.07
    55180TRevision of scrotum018318.26$885.37$448.94$177.07
    55200TIncision of sperm duct018318.26$885.37$448.94$177.07
    55250TRemoval of sperm duct(s)018318.26$885.37$448.94$177.07
    55300NPrepare, sperm duct x-ray
    55400TRepair of sperm duct018318.26$885.37$448.94$177.07
    55450TLigation of sperm duct018318.26$885.37$448.94$177.07
    55500TRemoval of hydrocele018318.26$885.37$448.94$177.07
    55520TRemoval of sperm cord lesion018318.26$885.37$448.94$177.07
    55530TRevise spermatic cord veins018318.26$885.37$448.94$177.07
    55535TRevise spermatic cord veins015422.43$1,087.57$556.98$217.51
    55540TRevise hernia & sperm veins015422.43$1,087.57$556.98$217.51
    55550TLaparo ligate spermatic vein013141.81$2,027.24$1,089.88$405.45
    55559TLaparo proc, spermatic cord013025.36$1,229.63$659.53$245.93
    55600CIncise sperm duct pouch
    55605CIncise sperm duct pouch
    55650CRemove sperm duct pouch
    55680TRemove sperm pouch lesion018318.26$885.37$448.94$177.07
    55700TBiopsy of prostate01844.94$239.53$122.96$47.91
    55705TBiopsy of prostate01844.94$239.53$122.96$47.91
    55720TDrainage of prostate abscess016217.49$848.04$427.49$169.61
    55725TDrainage of prostate abscess016217.49$848.04$427.49$169.61
    55801CRemoval of prostate
    55810CExtensive prostate surgery
    55812CExtensive prostate surgery
    55815CExtensive prostate surgery
    55821CRemoval of prostate
    55831CRemoval of prostate
    55840CExtensive prostate surgery
    55842CExtensive prostate surgery
    55845CExtensive prostate surgery
    55859TPercut/needle insert, pros016217.49$848.04$427.49$169.61
    55860CSurgical exposure, prostate
    55862CExtensive prostate surgery
    55865CExtensive prostate surgery
    55870TElectroejaculation01972.40$116.37$49.55$23.27
    55899TGenital surgery procedure01642.17$105.23$33.03$21.05
    55970ESex transformation, M to F
    55980ESex transformation, F to M
    56405TI & D of vulva/perineum01922.38$115.40$35.33$23.08
    56420TDrainage of gland abscess01922.38$115.40$35.33$23.08
    56440TSurgery for vulva lesion019416.21$785.98$395.94$157.20
    56441TLysis of labial lesion(s)01938.93$432.99$171.13$86.60
    56501TDestruction, vulva lesion(s)00163.53$171.16$74.67$34.23
    56515TDestruction, vulva lesion(s)001712.45$603.66$289.16$120.73
    56605TBiopsy of vulva/perineum00194.00$193.95$78.91$38.79
    Start Printed Page 18614
    56606TBiopsy of vulva/perineum00194.00$193.95$78.91$38.79
    56620TPartial removal of vulva019518.68$905.74$483.80$181.15
    56625TComplete removal of vulva019518.68$905.74$483.80$181.15
    56630CExtensive vulva surgery
    56631CExtensive vulva surgery
    56632CExtensive vulva surgery
    56633CExtensive vulva surgery
    56634CExtensive vulva surgery
    56637CExtensive vulva surgery
    56640CExtensive vulva surgery
    56700TPartial removal of hymen019416.21$785.98$395.94$157.20
    56720TIncision of hymen01938.93$432.99$171.13$86.60
    56740TRemove vagina gland lesion019416.21$785.98$395.94$157.20
    56800TRepair of vagina019416.21$785.98$395.94$157.20
    56805CRepair clitoris
    56810TRepair of perineum019416.21$785.98$395.94$157.20
    57000TExploration of vagina019416.21$785.98$395.94$157.20
    57010TDrainage of pelvic abscess019416.21$785.98$395.94$157.20
    57020TDrainage of pelvic fluid01938.93$432.99$171.13$86.60
    57061TDestruction vagina lesion(s)019416.21$785.98$395.94$157.20
    57065TDestruction vagina lesion(s)019416.21$785.98$395.94$157.20
    57100TBiopsy of vagina01922.38$115.40$35.33$23.08
    57105TBiopsy of vagina019416.21$785.98$395.94$157.20
    57106TRemove vagina wall, partial019416.21$785.98$395.94$157.20
    57107TRemove vagina tissue, part019416.21$785.98$395.94$157.20
    57109TVaginectomy partial w/nodes019416.21$785.98$395.94$157.20
    57110CRemove vagina wall, complete
    57111CRemove vagina tissue, compl
    57112CVaginectomy w/nodes, compl
    57120CClosure of vagina
    57130TRemove vagina lesion019416.21$785.98$395.94$157.20
    57135TRemove vagina lesion019416.21$785.98$395.94$157.20
    57150TTreat vagina infection01922.38$115.40$35.33$23.08
    57160TInsert pessary/other device01911.19$57.70$17.43$11.54
    57170TFitting of diaphragm/cap01911.19$57.70$17.43$11.54
    57180TTreat vaginal bleeding01922.38$115.40$35.33$23.08
    57200TRepair of vagina019416.21$785.98$395.94$157.20
    57210TRepair vagina/perineum019416.21$785.98$395.94$157.20
    57220TRevision of urethra019518.68$905.74$483.80$181.15
    57230TRepair of urethral lesion019416.21$785.98$395.94$157.20
    57240TRepair bladder & vagina019518.68$905.74$483.80$181.15
    57250TRepair rectum & vagina019518.68$905.74$483.80$181.15
    57260TRepair of vagina019518.68$905.74$483.80$181.15
    57265TExtensive repair of vagina019518.68$905.74$483.80$181.15
    57268TRepair of bowel bulge019518.68$905.74$483.80$181.15
    57270CRepair of bowel pouch
    57280CSuspension of vagina
    57282CRepair of vaginal prolapse
    57284TRepair paravaginal defect019518.68$905.74$483.80$181.15
    57288TRepair bladder defect019518.68$905.74$483.80$181.15
    57289TRepair bladder & vagina019518.68$905.74$483.80$181.15
    57291TConstruction of vagina019518.68$905.74$483.80$181.15
    57292CConstruct vagina with graft
    57300TRepair rectum-vagina fistula019518.68$905.74$483.80$181.15
    57305CRepair rectum-vagina fistula
    57307CFistula repair & colostomy
    57308CFistula repair, transperine
    57310CRepair urethrovaginal lesion
    57311CRepair urethrovaginal lesion
    57320CRepair bladder-vagina lesion
    57330CRepair bladder-vagina lesion
    57335CRepair vagina
    57400TDilation of vagina019416.21$785.98$395.94$157.20
    57410TPelvic examination019416.21$785.98$395.94$157.20
    57415TRemove vaginal foreign body019416.21$785.98$395.94$157.20
    57452TExamination of vagina01911.19$57.70$17.43$11.54
    57454TVagina examination & biopsy01922.38$115.40$35.33$23.08
    57460TCervix excision01938.93$432.99$171.13$86.60
    57500TBiopsy of cervix01938.93$432.99$171.13$86.60
    57505TEndocervical curettage01922.38$115.40$35.33$23.08
    57510TCauterization of cervix01938.93$432.99$171.13$86.60
    57511TCryocautery of cervix01922.38$115.40$35.33$23.08
    57513TLaser surgery of cervix01938.93$432.99$171.13$86.60
    Start Printed Page 18615
    57520TConization of cervix019416.21$785.98$395.94$157.20
    57522TConization of cervix019518.68$905.74$483.80$181.15
    57530TRemoval of cervix019518.68$905.74$483.80$181.15
    57531CRemoval of cervix, radical
    57540CRemoval of residual cervix
    57545CRemove cervix/repair pelvis
    57550TRemoval of residual cervix019518.68$905.74$483.80$181.15
    57555TRemove cervix/repair vagina019518.68$905.74$483.80$181.15
    57556TRemove cervix, repair bowel019518.68$905.74$483.80$181.15
    57700TRevision of cervix019416.21$785.98$395.94$157.20
    57720TRevision of cervix019416.21$785.98$395.94$157.20
    57800TDilation of cervical canal01938.93$432.99$171.13$86.60
    57820TD & c of residual cervix019614.47$701.61$357.98$140.32
    58100TBiopsy of uterus lining01911.19$57.70$17.43$11.54
    58120TDilation and curettage019614.47$701.61$357.98$140.32
    58140CRemoval of uterus lesion
    58145TRemoval of uterus lesion019518.68$905.74$483.80$181.15
    58150CTotal hysterectomy
    58152CTotal hysterectomy
    58180CPartial hysterectomy
    58200CExtensive hysterectomy
    58210CExtensive hysterectomy
    58240CRemoval of pelvis contents
    58260CVaginal hysterectomy
    58262CVaginal hysterectomy
    58263CVaginal hysterectomy
    58267CHysterectomy & vagina repair
    58270CHysterectomy & vagina repair
    58275CHysterectomy/revise vagina
    58280CHysterectomy/revise vagina
    58285CExtensive hysterectomy
    58300EInsert intrauterine device
    58301TRemove intrauterine device01911.19$57.70$17.43$11.54
    58321TArtificial insemination01972.40$116.37$49.55$23.27
    58322TArtificial insemination01972.40$116.37$49.55$23.27
    58323TSperm washing01972.40$116.37$49.55$23.27
    58340NCatheter for hysterography
    58345TReopen fallopian tube019416.21$785.98$395.94$157.20
    58350TReopen fallopian tube019416.21$785.98$395.94$157.20
    58400CSuspension of uterus
    58410CSuspension of uterus
    58520CRepair of ruptured uterus
    58540CRevision of uterus
    58550TLaparo-asst vag hysterectomy013248.91$2,371.50$1,239.22$474.30
    58551TLaparoscopy, remove myoma013141.81$2,027.24$1,089.88$405.45
    58555THysteroscopy, dx, sep proc01911.19$57.70$17.43$11.54
    58558THysteroscopy, biopsy019017.85$865.49$443.89$173.10
    58559THysteroscopy, lysis019017.85$865.49$443.89$173.10
    58560THysteroscopy, resect septum019017.85$865.49$443.89$173.10
    58561THysteroscopy, remove myoma019017.85$865.49$443.89$173.10
    58562THysteroscopy, remove fb019017.85$865.49$443.89$173.10
    58563THysteroscopy, ablation019017.85$865.49$443.89$173.10
    58578TLaparo proc, uterus019017.85$865.49$443.89$173.10
    58579THysteroscope procedure019017.85$865.49$443.89$173.10
    58600CDivision of fallopian tube
    58605CDivision of fallopian tube
    58611CLigate oviduct(s) add-on
    58615COcclude fallopian tube(s)
    58660TLaparoscopy, lysis013141.81$2,027.24$1,089.88$405.45
    58661TLaparoscopy, remove adnexa013141.81$2,027.24$1,089.88$405.45
    58662TLaparoscopy, excise lesions013141.81$2,027.24$1,089.88$405.45
    58670TLaparoscopy, tubal cautery013141.81$2,027.24$1,089.88$405.45
    58671TLaparoscopy, tubal block013141.81$2,027.24$1,089.88$405.45
    58672TLaparoscopy, fimbrioplasty013141.81$2,027.24$1,089.88$405.45
    58673TLaparoscopy, salpingostomy013141.81$2,027.24$1,089.88$405.45
    58679TLaparo proc, oviduct-ovary013025.36$1,229.63$659.53$245.93
    58700CRemoval of fallopian tube
    58720CRemoval of ovary/tube(s)
    58740CRevise fallopian tube(s)
    58750CRepair oviduct
    58752CRevise ovarian tube(s)
    58760CRemove tubal obstruction
    58770CCreate new tubal opening
    Start Printed Page 18616
    58800TDrainage of ovarian cyst(s)019518.68$905.74$483.80$181.15
    58805CDrainage of ovarian cyst(s)
    58820TDrain ovary abscess, open019518.68$905.74$483.80$181.15
    58822CDrain ovary abscess, percut
    58823CDrain pelvic abscess, percut
    58825CTransposition, ovary(s)
    58900TBiopsy of ovary(s)019518.68$905.74$483.80$181.15
    58920TPartial removal of ovary(s)019518.68$905.74$483.80$181.15
    58925TRemoval of ovarian cyst(s)019518.68$905.74$483.80$181.15
    58940CRemoval of ovary(s)
    58943CRemoval of ovary(s)
    58950CResect ovarian malignancy
    58951CResect ovarian malignancy
    58952CResect ovarian malignancy
    58960CExploration of abdomen
    58970TRetrieval of oocyte019416.21$785.98$395.94$157.20
    58974TTransfer of embryo01972.40$116.37$49.55$23.27
    58976TTransfer of embryo01972.40$116.37$49.55$23.27
    58999TGenital surgery procedure00194.00$193.95$78.91$38.79
    59000TAmniocentesis01981.34$64.97$33.03$12.99
    59012TFetal cord puncture, prenatal01981.34$64.97$33.03$12.99
    59015TChorion biopsy01981.34$64.97$33.03$12.99
    59020TFetal contract stress test01981.34$64.97$33.03$12.99
    59025TFetal non-stress test01981.34$64.97$33.03$12.99
    59030TFetal scalp blood sample01981.34$64.97$33.03$12.99
    59050TFetal monitor w/report01981.34$64.97$33.03$12.99
    59051EFetal monitor/interpret only
    59100CRemove uterus lesion
    59120CTreat ectopic pregnancy
    59121CTreat ectopic pregnancy
    59130CTreat ectopic pregnancy
    59135CTreat ectopic pregnancy
    59136CTreat ectopic pregnancy
    59140CTreat ectopic pregnancy
    59150TTreat ectopic pregnancy013141.81$2,027.24$1,089.88$405.45
    59151TTreat ectopic pregnancy013141.81$2,027.24$1,089.88$405.45
    59160TD & c after delivery019614.47$701.61$357.98$140.32
    59200TInsert cervical dilator01911.19$57.70$17.43$11.54
    59300TEpisiotomy or vaginal repair019416.21$785.98$395.94$157.20
    59320TRevision of cervix019416.21$785.98$395.94$157.20
    59325CRevision of cervix
    59350CRepair of uterus
    59400EObstetrical care
    59409TObstetrical care019911.20$543.06$157.83$108.61
    59410EObstetrical care
    59412TAntepartum manipulation019911.20$543.06$157.83$108.61
    59414TDeliver placenta019911.20$543.06$157.83$108.61
    59425EAntepartum care only
    59426EAntepartum care only
    59430ECare after delivery
    59510ECesarean delivery
    59514CCesarean delivery only
    59515ECesarean delivery
    59525CRemove uterus after cesarean
    59610EVbac delivery
    59612TVbac delivery only019911.20$543.06$157.83$108.61
    59614EVbac care after delivery
    59618EAttempted vbac delivery
    59620CAttempted vbac delivery only
    59622EAttempted vbac after care
    59812TTreatment of miscarriage020113.00$630.33$329.65$126.07
    59820TCare of miscarriage020113.00$630.33$329.65$126.07
    59821TTreatment of miscarriage020113.00$630.33$329.65$126.07
    59830CTreat uterus infection
    59840TAbortion020013.89$673.49$373.23$134.70
    59841TAbortion020013.89$673.49$373.23$134.70
    59850CAbortion
    59851CAbortion
    59852CAbortion
    59855CAbortion
    59856CAbortion
    59857CAbortion
    59866CAbortion (mpr)
    Start Printed Page 18617
    59870TEvacuate mole of uterus020113.00$630.33$329.65$126.07
    59871TRemove cerclage suture019416.21$785.98$395.94$157.20
    59898TLaparo proc, ob care/deliver013025.36$1,229.63$659.53$245.93
    59899TMaternity care procedure01981.34$64.97$33.03$12.99
    60000TDrain thyroid/tongue cyst025312.02$582.81$284.00$116.56
    60001TAspirate/inject thyriod cyst00020.62$30.06$17.66$6.01
    60100TBiopsy of thyroid00041.84$89.22$32.57$17.84
    60200TRemove thyroid lesion011419.56$948.41$493.78$189.68
    60210TPartial thyroid excision011419.56$948.41$493.78$189.68
    60212CParital thyroid excision
    60220TPartial removal of thyroid011419.56$948.41$493.78$189.68
    60225TPartial removal of thyroid011419.56$948.41$493.78$189.68
    60240TRemoval of thyroid011419.56$948.41$493.78$189.68
    60252CRemoval of thyroid
    60254CExtensive thyroid surgery
    60260CRepeat thyroid surgery
    60270CRemoval of thyroid
    60271CRemoval of thyroid
    60280TRemove thyroid duct lesion011419.56$948.41$493.78$189.68
    60281TRemove thyroid duct lesion011419.56$948.41$493.78$189.68
    60500TExplore parathyroid glands025625.40$1,231.57$623.05$246.31
    60502CRe-explore parathyroids
    60505CExplore parathyroid glands
    60512CAutotransplant parathyroid
    60520CRemoval of thymus gland
    60521CRemoval of thymus gland
    60522CRemoval of thymus gland
    60540CExplore adrenal gland
    60545CExplore adrenal gland
    60600CRemove carotid body lesion
    60605CRemove carotid body lesion
    60650CLaparoscopy adrenalectomy
    60659TLaparo proc, endocrine013025.36$1,229.63$659.53$245.93
    60699TEndocrine surgery procedure00041.84$89.22$32.57$17.84
    61000TRemove cranial cavity fluid02123.64$176.49$88.78$35.30
    61001TRemove cranial cavity fluid02123.64$176.49$88.78$35.30
    61020TRemove brain cavity fluid02123.64$176.49$88.78$35.30
    61026TInjection into brain canal02123.64$176.49$88.78$35.30
    61050TRemove brain canal fluid02123.64$176.49$88.78$35.30
    61055TInjection into brain canal02123.64$176.49$88.78$35.30
    61070TBrain canal shunt procedure02123.64$176.49$88.78$35.30
    61105CTwist drill hole
    61107CDrill skull for implantation
    61108CDrill skull for drainage
    61120CBurr hole for puncture
    61140CPierce skull for biopsy
    61150CPierce skull for drainage
    61151CPierce skull for drainage
    61154CPierce skull & remove clot
    61156CPierce skull for drainage
    61210CPierce skull, implant device
    61215TInsert brain-fluid device022225.48$1,235.45$780.07$247.09
    61250CPierce skull & explore
    61253CPierce skull & explore
    61304COpen skull for exploration
    61305COpen skull for exploration
    61312COpen skull for drainage
    61313COpen skull for drainage
    61314COpen skull for drainage
    61315COpen skull for drainage
    61320COpen skull for drainage
    61321COpen skull for drainage
    61330TDecompress eye socket025625.40$1,231.57$623.05$246.31
    61332CExplore/biopsy eye socket
    61333CExplore orbit/remove lesion
    61334CExplore orbit/remove object
    61340CRelieve cranial pressure
    61343CIncise skull (press relief)
    61345CRelieve cranial pressure
    61440CIncise skull for surgery
    61450CIncise skull for surgery
    61458CIncise skull for brain wound
    61460CIncise skull for surgery
    Start Printed Page 18618
    61470CIncise skull for surgery
    61480CIncise skull for surgery
    61490CIncise skull for surgery
    61500CRemoval of skull lesion
    61501CRemove infected skull bone
    61510CRemoval of brain lesion
    61512CRemove brain lining lesion
    61514CRemoval of brain abscess
    61516CRemoval of brain lesion
    61518CRemoval of brain lesion
    61519CRemove brain lining lesion
    61520CRemoval of brain lesion
    61521CRemoval of brain lesion
    61522CRemoval of brain abscess
    61524CRemoval of brain lesion
    61526CRemoval of brain lesion
    61530CRemoval of brain lesion
    61531CImplant brain electrodes
    61533CImplant brain electrodes
    61534CRemoval of brain lesion
    61535CRemove brain electrodes
    61536CRemoval of brain lesion
    61538CRemoval of brain tissue
    61539CRemoval of brain tissue
    61541CIncision of brain tissue
    61542CRemoval of brain tissue
    61543CRemoval of brain tissue
    61544CRemove & treat brain lesion
    61545CExcision of brain tumor
    61546CRemoval of pituitary gland
    61548CRemoval of pituitary gland
    61550CRelease of skull seams
    61552CRelease of skull seams
    61556CIncise skull/sutures
    61557CIncise skull/sutures
    61558CExcision of skull/sutures
    61559CExcision of skull/sutures
    61563CExcision of skull tumor
    61564CExcision of skull tumor
    61570CRemove foreign body, brain
    61571CIncise skull for brain wound
    61575CSkull base/brainstem surgery
    61576CSkull base/brainstem surgery
    61580CCraniofacial approach, skull
    61581CCraniofacial approach, skull
    61582CCraniofacial approach, skull
    61583CCraniofacial approach, skull
    61584COrbitocranial approach/skull
    61585COrbitocranial approach/skull
    61586CResect nasopharynx, skull
    61590CInfratemporal approach/skull
    61591CInfratemporal approach/skull
    61592COrbitocranial approach/skull
    61595CTranstemporal approach/skull
    61596CTranscochlear approach/skull
    61597CTranscondylar approach/skull
    61598CTranspetrosal approach/skull
    61600CResect/excise cranial lesion
    61601CResect/excise cranial lesion
    61605CResect/excise cranial lesion
    61606CResect/excise cranial lesion
    61607CResect/excise cranial lesion
    61608CResect/excise cranial lesion
    61609CTransect artery, sinus
    61610CTransect artery, sinus
    61611CTransect artery, sinus
    61612CTransect artery, sinus
    61613CRemove aneurysm, sinus
    61615CResect/excise lesion, skull
    61616CResect/excise lesion, skull
    61618CRepair dura
    61619CRepair dura
    61624COcclusion/embolization cath
    Start Printed Page 18619
    61626COcclusion/embolization cath
    61680CIntracranial vessel surgery
    61682CIntracranial vessel surgery
    61684CIntracranial vessel surgery
    61686CIntracranial vessel surgery
    61690CIntracranial vessel surgery
    61692CIntracranial vessel surgery
    61700CInner skull vessel surgery
    61702CInner skull vessel surgery
    61703CClamp neck artery
    61705CRevise circulation to head
    61708CRevise circulation to head
    61710CRevise circulation to head
    61711CFusion of skull arteries
    61720CIncise skull/brain surgery
    61735CIncise skull/brain surgery
    61750CIncise skull/brain biopsy
    61751CBrain biopsy w/ct/mr guide
    61760CImplant brain electrodes
    61770CIncise skull for treatment
    61790TTreat trigeminal nerve022013.96$676.88$326.21$135.38
    61791CTreat trigeminal tract
    61793EFocus radiation beam
    61795CBrain surgery using computer
    61850CImplant neuroelectrodes
    61860CImplant neuroelectrodes
    61862CImplant neurostimul, subcort
    61870CImplant neuroelectrodes
    61875CImplant neuroelectrodes
    61880CRevise/remove neuroelectrode
    61885TImplant neurostim one array022225.48$1,235.45$780.07$247.09
    61886CImplant neurostim arrays
    61888CRevise/remove neuroreceiver
    62000CTreat skull fracture
    62005CTreat skull fracture
    62010CTreatment of head injury
    62100CRepair brain fluid leakage
    62115CReduction of skull defect
    62116CReduction of skull defect
    62117CReduction of skull defect
    62120CRepair skull cavity lesion
    62121CIncise skull repair
    62140CRepair of skull defect
    62141CRepair of skull defect
    62142CRemove skull plate/flap
    62143CReplace skull plate/flap
    62145CRepair of skull & brain
    62146CRepair of skull with graft
    62147CRepair of skull with graft
    62180CEstablish brain cavity shunt
    62190CEstablish brain cavity shunt
    62192CEstablish brain cavity shunt
    62194TReplace/irrigate catheter01212.36$114.43$52.53$22.89
    62200CEstablish brain cavity shunt
    62201CEstablish brain cavity shunt
    62220CEstablish brain cavity shunt
    62223CEstablish brain cavity shunt
    62225TReplace/irrigate catheter01212.36$114.43$52.53$22.89
    62230TReplace/revise brain shunt022415.94$772.88$374.61$154.58
    62256CRemove brain cavity shunt
    62258CReplace brain cavity shunt
    62263TLysis epidural adhesions02123.64$176.49$88.78$35.30
    62268TDrain spinal cord cyst02123.64$176.49$88.78$35.30
    62269TNeedle biopsy, spinal cord00055.41$262.32$119.75$52.46
    62270TSpinal fluid tap, diagnostic02103.00$145.46$62.40$29.09
    62272TDrain spinal fluid02103.00$145.46$62.40$29.09
    62273TTreat epidural spine lesion02123.64$176.49$88.78$35.30
    62280TTreat spinal cord lesion02123.64$176.49$88.78$35.30
    62281TTreat spinal cord lesion02123.64$176.49$88.78$35.30
    62282TTreat spinal canal lesion02123.64$176.49$88.78$35.30
    62284NInjection for myelogram
    62287TPercutaneous diskectomy022013.96$676.88$326.21$135.38
    62290NInject for spine disk x-ray
    Start Printed Page 18620
    62291NInject for spine disk x-ray
    62292TInjection into disk lesion02123.64$176.49$88.78$35.30
    62294TInjection into spinal artery02123.64$176.49$88.78$35.30
    62310TInject spine c/t02123.64$176.49$88.78$35.30
    62311TInject spine l/s (cd)02123.64$176.49$88.78$35.30
    62318TInject spine w/cath, c/t02123.64$176.49$88.78$35.30
    62319TInject spine w/cath l/s (cd)02123.64$176.49$88.78$35.30
    62350TImplant spinal canal cath02236.34$307.41$153.24$61.48
    62351CImplant spinal canal cath
    62355TRemove spinal canal catheter02236.34$307.41$153.24$61.48
    62360TInsert spine infusion device022225.48$1,235.45$780.07$247.09
    62361TImplant spine infusion pump022225.48$1,235.45$780.07$247.09
    62362TImplant spine infusion pump022225.48$1,235.45$780.07$247.09
    62365TRemove spine infusion device022415.94$772.88$374.61$154.58
    62367SAnalyze spine infusion pump01020.45$21.82$12.62$4.36
    62368SAnalyze spine infusion pump01020.45$21.82$12.62$4.36
    63001CRemoval of spinal lamina
    63003CRemoval of spinal lamina
    63005CRemoval of spinal lamina
    63011CRemoval of spinal lamina
    63012CRemoval of spinal lamina
    63015CRemoval of spinal lamina
    63016CRemoval of spinal lamina
    63017CRemoval of spinal lamina
    63020CNeck spine disk surgery
    63030CLow back disk surgery
    63035CSpinal disk surgery add-on
    63040CNeck spine disk surgery
    63042CLow back disk surgery
    63045CRemoval of spinal lamina
    63046CRemoval of spinal lamina
    63047CRemoval of spinal lamina
    63048CRemove spinal lamina add-on
    63055CDecompress spinal cord
    63056CDecompress spinal cord
    63057CDecompress spine cord add-on
    63064CDecompress spinal cord
    63066CDecompress spine cord add-on
    63075CNeck spine disk surgery
    63076CNeck spine disk surgery
    63077CSpine disk surgery, thorax
    63078CSpine disk surgery, thorax
    63081CRemoval of vertebral body
    63082CRemove vertebral body add-on
    63085CRemoval of vertebral body
    63086CRemove vertebral body add-on
    63087CRemoval of vertebral body
    63088CRemove vertebral body add-on
    63090CRemoval of vertebral body
    63091CRemove vertebral body add-on
    63170CIncise spinal cord tract(s)
    63172CDrainage of spinal cyst
    63173CDrainage of spinal cyst
    63180CRevise spinal cord ligaments
    63182CRevise spinal cord ligaments
    63185CIncise spinal column/nerves
    63190CIncise spinal column/nerves
    63191CIncise spinal column/nerves
    63194CIncise spinal column & cord
    63195CIncise spinal column & cord
    63196CIncise spinal column & cord
    63197CIncise spinal column & cord
    63198CIncise spinal column & cord
    63199CIncise spinal column & cord
    63200CRelease of spinal cord
    63250CRevise spinal cord vessels
    63251CRevise spinal cord vessels
    63252CRevise spinal cord vessels
    63265CExcise intraspinal lesion
    63266CExcise intraspinal lesion
    63267CExcise intraspinal lesion
    63268CExcise intraspinal lesion
    63270CExcise intraspinal lesion
    Start Printed Page 18621
    63271CExcise intraspinal lesion
    63272CExcise intraspinal lesion
    63273CExcise intraspinal lesion
    63275CBiopsy/excise spinal tumor
    63276CBiopsy/excise spinal tumor
    63277CBiopsy/excise spinal tumor
    63278CBiopsy/excise spinal tumor
    63280CBiopsy/excise spinal tumor
    63281CBiopsy/excise spinal tumor
    63282CBiopsy/excise spinal tumor
    63283CBiopsy/excise spinal tumor
    63285CBiopsy/excise spinal tumor
    63286CBiopsy/excise spinal tumor
    63287CBiopsy/excise spinal tumor
    63290CBiopsy/excise spinal tumor
    63300CRemoval of vertebral body
    63301CRemoval of vertebral body
    63302CRemoval of vertebral body
    63303CRemoval of vertebral body
    63304CRemoval of vertebral body
    63305CRemoval of vertebral body
    63306CRemoval of vertebral body
    63307CRemoval of vertebral body
    63308CRemove vertebral body add-on
    63600TRemove spinal cord lesion022013.96$676.88$326.21$135.38
    63610TStimulation of spinal cord022013.96$676.88$326.21$135.38
    63615TRemove lesion of spinal cord022013.96$676.88$326.21$135.38
    63650TImplant neuroelectrodes022415.94$772.88$374.61$154.58
    63655CImplant neuroelectrodes
    63660TRevise/remove neuroelectrode022415.94$772.88$374.61$154.58
    63685TImplant neuroreceiver022225.48$1,235.45$780.07$247.09
    63688TRevise/remove neuroreceiver022415.94$772.88$374.61$154.58
    63700CRepair of spinal herniation
    63702CRepair of spinal herniation
    63704CRepair of spinal herniation
    63706CRepair of spinal herniation
    63707CRepair spinal fluid leakage
    63709CRepair spinal fluid leakage
    63710CGraft repair of spine defect
    63740CInstall spinal shunt
    63741CInstall spinal shunt
    63744TRevision of spinal shunt022415.94$772.88$374.61$154.58
    63746TRemoval of spinal shunt02236.34$307.41$153.24$61.48
    64400TInjection for nerve block02113.32$160.98$74.78$32.20
    64402TInjection for nerve block02113.32$160.98$74.78$32.20
    64405TInjection for nerve block02113.32$160.98$74.78$32.20
    64408TInjection for nerve block02113.32$160.98$74.78$32.20
    64410TInjection for nerve block02113.32$160.98$74.78$32.20
    64412TInjection for nerve block02113.32$160.98$74.78$32.20
    64413TInjection for nerve block02113.32$160.98$74.78$32.20
    64415TInjection for nerve block02113.32$160.98$74.78$32.20
    64417TInjection for nerve block02113.32$160.98$74.78$32.20
    64418TInjection for nerve block02113.32$160.98$74.78$32.20
    64420TInjection for nerve block02113.32$160.98$74.78$32.20
    64421TInjection for nerve block02113.32$160.98$74.78$32.20
    64425TInjection for nerve block02113.32$160.98$74.78$32.20
    64430TInjection for nerve block02113.32$160.98$74.78$32.20
    64435TInjection for nerve block02113.32$160.98$74.78$32.20
    64445TInjection for nerve block02113.32$160.98$74.78$32.20
    64450TInjection for nerve block02113.32$160.98$74.78$32.20
    64470TInj paravertebral c/t02113.32$160.98$74.78$32.20
    64472TInj paravertebral c/t add-on02113.32$160.98$74.78$32.20
    64475TInj paravertebral l/s02113.32$160.98$74.78$32.20
    64476TInj paravertebral l/s add-on02113.32$160.98$74.78$32.20
    64479TInj foramen epidural c/t02113.32$160.98$74.78$32.20
    64480TInj foramen epidural add-on02113.32$160.98$74.78$32.20
    64483TInj foramen epidural l/s02113.32$160.98$74.78$32.20
    64484TInj foramen epidural add-on02113.32$160.98$74.78$32.20
    64505TInjection for nerve block02113.32$160.98$74.78$32.20
    64508TInjection for nerve block02113.32$160.98$74.78$32.20
    64510TInjection for nerve block02113.32$160.98$74.78$32.20
    64520TInjection for nerve block02113.32$160.98$74.78$32.20
    64530TInjection for nerve block02113.32$160.98$74.78$32.20
    Start Printed Page 18622
    64550AApply neurostimulator
    64553TImplant neuroelectrodes02253.43$166.31$64.46$33.26
    64555TImplant neuroelectrodes02253.43$166.31$64.46$33.26
    64560TImplant neuroelectrodes02253.43$166.31$64.46$33.26
    64565TImplant neuroelectrodes02253.43$166.31$64.46$33.26
    64573TImplant neuroelectrodes02253.43$166.31$64.46$33.26
    64575TImplant neuroelectrodes02253.43$166.31$64.46$33.26
    64577TImplant neuroelectrodes02253.43$166.31$64.46$33.26
    64580TImplant neuroelectrodes02253.43$166.31$64.46$33.26
    64585TRevise/remove neuroelectrode02253.43$166.31$64.46$33.26
    64590TImplant neuroreceiver022225.48$1,235.45$780.07$247.09
    64595TRevise/remove neuroreceiver02253.43$166.31$64.46$33.26
    64600TInjection treatment of nerve02113.32$160.98$74.78$32.20
    64605TInjection treatment of nerve02113.32$160.98$74.78$32.20
    64610TInjection treatment of nerve02113.32$160.98$74.78$32.20
    64612TDestroy nerve, face muscle02113.32$160.98$74.78$32.20
    64613TDestroy nerve, spine muscle02113.32$160.98$74.78$32.20
    64620TInjection treatment of nerve02113.32$160.98$74.78$32.20
    64622TDestr paravertebrl nerve l/s02113.32$160.98$74.78$32.20
    64623TDestr paravertebral n add-on02113.32$160.98$74.78$32.20
    64626TDestr paravertebrl nerve c/t02113.32$160.98$74.78$32.20
    64627TDestr paravertebral n add-on02113.32$160.98$74.78$32.20
    64630TInjection treatment of nerve02113.32$160.98$74.78$32.20
    64640TInjection treatment of nerve02113.32$160.98$74.78$32.20
    64680TInjection treatment of nerve02113.32$160.98$74.78$32.20
    64702TRevise finger/toe nerve022013.96$676.88$326.21$135.38
    64704TRevise hand/foot nerve022013.96$676.88$326.21$135.38
    64708TRevise arm/leg nerve022013.96$676.88$326.21$135.38
    64712TRevision of sciatic nerve022013.96$676.88$326.21$135.38
    64713TRevision of arm nerve(s)022013.96$676.88$326.21$135.38
    64714TRevise low back nerve(s)022013.96$676.88$326.21$135.38
    64716TRevision of cranial nerve022013.96$676.88$326.21$135.38
    64718TRevise ulnar nerve at elbow022013.96$676.88$326.21$135.38
    64719TRevise ulnar nerve at wrist022013.96$676.88$326.21$135.38
    64721TCarpal tunnel surgery022013.96$676.88$326.21$135.38
    64722TRelieve pressure on nerve(s)022013.96$676.88$326.21$135.38
    64726TRelease foot/toe nerve022013.96$676.88$326.21$135.38
    64727TInternal nerve revision022013.96$676.88$326.21$135.38
    64732TIncision of brow nerve022013.96$676.88$326.21$135.38
    64734TIncision of cheek nerve022013.96$676.88$326.21$135.38
    64736TIncision of chin nerve022013.96$676.88$326.21$135.38
    64738TIncision of jaw nerve022013.96$676.88$326.21$135.38
    64740TIncision of tongue nerve022013.96$676.88$326.21$135.38
    64742TIncision of facial nerve022013.96$676.88$326.21$135.38
    64744TIncise nerve, back of head022013.96$676.88$326.21$135.38
    64746TIncise diaphragm nerve022013.96$676.88$326.21$135.38
    64752CIncision of vagus nerve
    64755CIncision of stomach nerves
    64760CIncision of vagus nerve
    64761TIncision of pelvis nerve022013.96$676.88$326.21$135.38
    64763CIncise hip/thigh nerve
    64766CIncise hip/thigh nerve
    64771TSever cranial nerve022013.96$676.88$326.21$135.38
    64772TIncision of spinal nerve022013.96$676.88$326.21$135.38
    64774TRemove skin nerve lesion022013.96$676.88$326.21$135.38
    64776TRemove digit nerve lesion022013.96$676.88$326.21$135.38
    64778TDigit nerve surgery add-on022013.96$676.88$326.21$135.38
    64782TRemove limb nerve lesion022013.96$676.88$326.21$135.38
    64783TLimb nerve surgery add-on022013.96$676.88$326.21$135.38
    64784TRemove nerve lesion022013.96$676.88$326.21$135.38
    64786TRemove sciatic nerve lesion022118.36$890.22$463.62$178.04
    64787TImplant nerve end022013.96$676.88$326.21$135.38
    64788TRemove skin nerve lesion022013.96$676.88$326.21$135.38
    64790TRemoval of nerve lesion022013.96$676.88$326.21$135.38
    64792TRemoval of nerve lesion022118.36$890.22$463.62$178.04
    64795TBiopsy of nerve022013.96$676.88$326.21$135.38
    64802CRemove sympathetic nerves
    64804CRemove sympathetic nerves
    64809CRemove sympathetic nerves
    64818CRemove sympathetic nerves
    64820CRemove sympathetic nerves
    64831TRepair of digit nerve022118.36$890.22$463.62$178.04
    64832TRepair nerve add-on022118.36$890.22$463.62$178.04
    Start Printed Page 18623
    64834TRepair of hand or foot nerve022118.36$890.22$463.62$178.04
    64835TRepair of hand or foot nerve022118.36$890.22$463.62$178.04
    64836TRepair of hand or foot nerve022118.36$890.22$463.62$178.04
    64837TRepair nerve add-on022118.36$890.22$463.62$178.04
    64840TRepair of leg nerve022118.36$890.22$463.62$178.04
    64856TRepair/transpose nerve022118.36$890.22$463.62$178.04
    64857TRepair arm/leg nerve022118.36$890.22$463.62$178.04
    64858TRepair sciatic nerve022118.36$890.22$463.62$178.04
    64859TNerve surgery022118.36$890.22$463.62$178.04
    64861TRepair of arm nerves022118.36$890.22$463.62$178.04
    64862TRepair of low back nerves022118.36$890.22$463.62$178.04
    64864TRepair of facial nerve022118.36$890.22$463.62$178.04
    64865TRepair of facial nerve022118.36$890.22$463.62$178.04
    64866CFusion of facial/other nerve
    64868CFusion of facial/other nerve
    64870TFusion of facial/other nerve022118.36$890.22$463.62$178.04
    64872TSubsequent repair of nerve022118.36$890.22$463.62$178.04
    64874TRepair & revise nerve add-on022118.36$890.22$463.62$178.04
    64876TRepair nerve/shorten bone022118.36$890.22$463.62$178.04
    64885TNerve graft, head or neck022118.36$890.22$463.62$178.04
    64886TNerve graft, head or neck022118.36$890.22$463.62$178.04
    64890TNerve graft, hand or foot022118.36$890.22$463.62$178.04
    64891TNerve graft, hand or foot022118.36$890.22$463.62$178.04
    64892TNerve graft, arm or leg022118.36$890.22$463.62$178.04
    64893TNerve graft, arm or leg022118.36$890.22$463.62$178.04
    64895TNerve graft, hand or foot022118.36$890.22$463.62$178.04
    64896TNerve graft, hand or foot022118.36$890.22$463.62$178.04
    64897TNerve graft, arm or leg022118.36$890.22$463.62$178.04
    64898TNerve graft, arm or leg022118.36$890.22$463.62$178.04
    64901TNerve graft add-on022118.36$890.22$463.62$178.04
    64902TNerve graft add-on022118.36$890.22$463.62$178.04
    64905TNerve pedicle transfer022118.36$890.22$463.62$178.04
    64907TNerve pedicle transfer022118.36$890.22$463.62$178.04
    64999TNervous system surgery02113.32$160.98$74.78$32.20
    65091TRevise eye024223.70$1,149.14$597.36$229.83
    65093TRevise eye with implant024116.60$804.89$384.47$160.98
    65101TRemoval of eye024223.70$1,149.14$597.36$229.83
    65103TRemove eye/insert implant024223.70$1,149.14$597.36$229.83
    65105TRemove eye/attach implant024223.70$1,149.14$597.36$229.83
    65110TRemoval of eye024223.70$1,149.14$597.36$229.83
    65112TRemove eye/revise socket024223.70$1,149.14$597.36$229.83
    65114TRemove eye/revise socket024223.70$1,149.14$597.36$229.83
    65125TRevise ocular implant024013.47$653.12$315.31$130.62
    65130TInsert ocular implant024116.60$804.89$384.47$160.98
    65135TInsert ocular implant024116.60$804.89$384.47$160.98
    65140TAttach ocular implant024223.70$1,149.14$597.36$229.83
    65150TRevise ocular implant024116.60$804.89$384.47$160.98
    65155TReinsert ocular implant024223.70$1,149.14$597.36$229.83
    65175TRemoval of ocular implant024013.47$653.12$315.31$130.62
    65205SRemove foreign body from eye02312.64$128.01$59.87$25.60
    65210SRemove foreign body from eye02312.64$128.01$59.87$25.60
    65220SRemove foreign body from eye02312.64$128.01$59.87$25.60
    65222SRemove foreign body from eye02312.64$128.01$59.87$25.60
    65235TRemove foreign body from eye02326.04$292.86$134.66$58.57
    65260TRemove foreign body from eye023733.96$1,646.62$852.68$329.32
    65265TRemove foreign body from eye023733.96$1,646.62$852.68$329.32
    65270TRepair of eye wound024013.47$653.12$315.31$130.62
    65272TRepair of eye wound02326.04$292.86$134.66$58.57
    65273CRepair of eye wound
    65275TRepair of eye wound023313.79$668.64$331.60$133.73
    65280TRepair of eye wound023313.79$668.64$331.60$133.73
    65285TRepair of eye wound023420.64$1,000.77$502.16$200.15
    65286TRepair of eye wound02326.04$292.86$134.66$58.57
    65290TRepair of eye socket wound024317.99$872.28$431.39$174.46
    65400TRemoval of eye lesion02326.04$292.86$134.66$58.57
    65410TBiopsy of cornea023313.79$668.64$331.60$133.73
    65420TRemoval of eye lesion023313.79$668.64$331.60$133.73
    65426TRemoval of eye lesion023313.79$668.64$331.60$133.73
    65430SCorneal smear02312.64$128.01$59.87$25.60
    65435TCurette/treat cornea02396.26$303.53$123.42$60.71
    65436TCurette/treat cornea02326.04$292.86$134.66$58.57
    65450TTreatment of corneal lesion02326.04$292.86$134.66$58.57
    65600TRevision of cornea024013.47$653.12$315.31$130.62
    Start Printed Page 18624
    65710TCorneal transplant024432.88$1,594.26$851.42$318.85
    65730TCorneal transplant024432.88$1,594.26$851.42$318.85
    65750TCorneal transplant024432.88$1,594.26$851.42$318.85
    65755TCorneal transplant024432.88$1,594.26$851.42$318.85
    65760ERevision of cornea
    65765ERevision of cornea
    65767ECorneal tissue transplant
    65770TRevise cornea with implant024432.88$1,594.26$851.42$318.85
    65771ERadial keratotomy
    65772TCorrection of astigmatism02326.04$292.86$134.66$58.57
    65775TCorrection of astigmatism023313.79$668.64$331.60$133.73
    65800TDrainage of eye02326.04$292.86$134.66$58.57
    65805TDrainage of eye023313.79$668.64$331.60$133.73
    65810TDrainage of eye023313.79$668.64$331.60$133.73
    65815TDrainage of eye023313.79$668.64$331.60$133.73
    65820TRelieve inner eye pressure02326.04$292.86$134.66$58.57
    65850TIncision of eye023420.64$1,000.77$502.16$200.15
    65855TLaser surgery of eye02474.89$237.10$112.86$47.42
    65860TIncise inner eye adhesions02474.89$237.10$112.86$47.42
    65865TIncise inner eye adhesions023313.79$668.64$331.60$133.73
    65870TIncise inner eye adhesions023313.79$668.64$331.60$133.73
    65875TIncise inner eye adhesions023313.79$668.64$331.60$133.73
    65880TIncise inner eye adhesions02326.04$292.86$134.66$58.57
    65900TRemove eye lesion02326.04$292.86$134.66$58.57
    65920TRemove implant from eye023313.79$668.64$331.60$133.73
    65930TRemove blood clot from eye023313.79$668.64$331.60$133.73
    66020TInjection treatment of eye02326.04$292.86$134.66$58.57
    66030TInjection treatment of eye02326.04$292.86$134.66$58.57
    66130TRemove eye lesion023313.79$668.64$331.60$133.73
    66150TGlaucoma surgery023313.79$668.64$331.60$133.73
    66155TGlaucoma surgery023420.64$1,000.77$502.16$200.15
    66160TGlaucoma surgery023420.64$1,000.77$502.16$200.15
    66165TGlaucoma surgery023420.64$1,000.77$502.16$200.15
    66170TGlaucoma surgery023420.64$1,000.77$502.16$200.15
    66172TIncision of eye023420.64$1,000.77$502.16$200.15
    66180TImplant eye shunt023420.64$1,000.77$502.16$200.15
    66185TRevise eye shunt023420.64$1,000.77$502.16$200.15
    66220TRepair eye lesion02366.70$324.86$147.96$64.97
    66225TRepair/graft eye lesion023420.64$1,000.77$502.16$200.15
    66250TFollow-up surgery of eye023313.79$668.64$331.60$133.73
    66500TIncision of iris02326.04$292.86$134.66$58.57
    66505TIncision of iris02326.04$292.86$134.66$58.57
    66600TRemove iris and lesion023313.79$668.64$331.60$133.73
    66605TRemoval of iris023313.79$668.64$331.60$133.73
    66625TRemoval of iris02326.04$292.86$134.66$58.57
    66630TRemoval of iris023313.79$668.64$331.60$133.73
    66635TRemoval of iris023313.79$668.64$331.60$133.73
    66680TRepair iris & ciliary body023313.79$668.64$331.60$133.73
    66682TRepair iris & ciliary body023313.79$668.64$331.60$133.73
    66700TDestruction, ciliary body02326.04$292.86$134.66$58.57
    66710TDestruction, ciliary body02326.04$292.86$134.66$58.57
    66720TDestruction, ciliary body02326.04$292.86$134.66$58.57
    66740TDestruction, ciliary body023313.79$668.64$331.60$133.73
    66761TRevision of iris02474.89$237.10$112.86$47.42
    66762TRevision of iris02474.89$237.10$112.86$47.42
    66770TRemoval of inner eye lesion02474.89$237.10$112.86$47.42
    66820TIncision, secondary cataract02326.04$292.86$134.66$58.57
    66821TAfter cataract laser surgery02474.89$237.10$112.86$47.42
    66825TReposition intraocular lens023313.79$668.64$331.60$133.73
    66830TRemoval of lens lesion02326.04$292.86$134.66$58.57
    66840TRemoval of lens material024526.55$1,287.33$623.85$257.47
    66850TRemoval of lens material024526.55$1,287.33$623.85$257.47
    66852TRemoval of lens material024526.55$1,287.33$623.85$257.47
    66920TExtraction of lens024526.55$1,287.33$623.85$257.47
    66930TExtraction of lens024526.55$1,287.33$623.85$257.47
    66940TExtraction of lens024526.55$1,287.33$623.85$257.47
    66983TRemove cataract/insert lens024626.55$1,287.33$623.85$257.47
    66984TRemove cataract/insert lens024626.55$1,287.33$623.85$257.47
    66985TInsert lens prosthesis024626.55$1,287.33$623.85$257.47
    66986TExchange lens prosthesis024626.55$1,287.33$623.85$257.47
    66999TEye surgery procedure02474.89$237.10$112.86$47.42
    67005TPartial removal of eye fluid023733.96$1,646.62$852.68$329.32
    67010TPartial removal of eye fluid023733.96$1,646.62$852.68$329.32
    Start Printed Page 18625
    67015TRelease of eye fluid023733.96$1,646.62$852.68$329.32
    67025TReplace eye fluid023733.96$1,646.62$852.68$329.32
    67027TImplant eye drug system023733.96$1,646.62$852.68$329.32
    67028TInjection eye drug02366.70$324.86$147.96$64.97
    67030TIncise inner eye strands02366.70$324.86$147.96$64.97
    67031TLaser surgery, eye strands02474.89$237.10$112.86$47.42
    67036TRemoval of inner eye fluid023733.96$1,646.62$852.68$329.32
    67038TStrip retinal membrane023733.96$1,646.62$852.68$329.32
    67039TLaser treatment of retina023733.96$1,646.62$852.68$329.32
    67040TLaser treatment of retina023733.96$1,646.62$852.68$329.32
    67101TRepair detached retina02366.70$324.86$147.96$64.97
    67105TRepair detached retina02484.19$203.16$94.05$40.63
    67107TRepair detached retina023733.96$1,646.62$852.68$329.32
    67108TRepair detached retina023733.96$1,646.62$852.68$329.32
    67110TRepair detached retina02366.70$324.86$147.96$64.97
    67112TRerepair detached retina023733.96$1,646.62$852.68$329.32
    67115TRelease encircling material02366.70$324.86$147.96$64.97
    67120TRemove eye implant material02366.70$324.86$147.96$64.97
    67121TRemove eye implant material023733.96$1,646.62$852.68$329.32
    67141TTreatment of retina02352.94$142.55$78.91$28.51
    67145TTreatment of retina02484.19$203.16$94.05$40.63
    67208TTreatment of retinal lesion02352.94$142.55$78.91$28.51
    67210TTreatment of retinal lesion02484.19$203.16$94.05$40.63
    67218TTreatment of retinal lesion023733.96$1,646.62$852.68$329.32
    67220TTreatment of choroid lesion023733.96$1,646.62$852.68$329.32
    67227TTreatment of retinal lesion02352.94$142.55$78.91$28.51
    67228TTreatment of retinal lesion02484.19$203.16$94.05$40.63
    67250TReinforce eye wall024013.47$653.12$315.31$130.62
    67255TReinforce/graft eye wall023733.96$1,646.62$852.68$329.32
    67299TEye surgery procedure02484.19$203.16$94.05$40.63
    67311TRevise eye muscle024317.99$872.28$431.39$174.46
    67312TRevise two eye muscles024317.99$872.28$431.39$174.46
    67314TRevise eye muscle024317.99$872.28$431.39$174.46
    67316TRevise two eye muscles024317.99$872.28$431.39$174.46
    67318TRevise eye muscle(s)024317.99$872.28$431.39$174.46
    67320TRevise eye muscle(s) add-on024317.99$872.28$431.39$174.46
    67331TEye surgery follow-up add-on024317.99$872.28$431.39$174.46
    67332TRerevise eye muscles add-on024317.99$872.28$431.39$174.46
    67334TRevise eye muscle w/suture024317.99$872.28$431.39$174.46
    67335TEye suture during surgery024317.99$872.28$431.39$174.46
    67340TRevise eye muscle add-on024317.99$872.28$431.39$174.46
    67343TRelease eye tissue024317.99$872.28$431.39$174.46
    67345TDestroy nerve of eye muscle02382.80$135.76$58.96$27.15
    67350SBiopsy eye muscle02312.64$128.01$59.87$25.60
    67399TEye muscle surgery procedure024317.99$872.28$431.39$174.46
    67400TExplore/biopsy eye socket024116.60$804.89$384.47$160.98
    67405TExplore/drain eye socket024116.60$804.89$384.47$160.98
    67412TExplore/treat eye socket024116.60$804.89$384.47$160.98
    67413TExplore/treat eye socket024116.60$804.89$384.47$160.98
    67414TExplr/decompress eye socket024223.70$1,149.14$597.36$229.83
    67415TAspiration, orbital contents02396.26$303.53$123.42$60.71
    67420TExplore/treat eye socket024223.70$1,149.14$597.36$229.83
    67430TExplore/treat eye socket024223.70$1,149.14$597.36$229.83
    67440TExplore/drain eye socket024223.70$1,149.14$597.36$229.83
    67445TExplr/decompress eye socket024223.70$1,149.14$597.36$229.83
    67450TExplore/biopsy eye socket024223.70$1,149.14$597.36$229.83
    67500SInject/treat eye socket02312.64$128.01$59.87$25.60
    67505TInject/treat eye socket02382.80$135.76$58.96$27.15
    67515TInject/treat eye socket02396.26$303.53$123.42$60.71
    67550TInsert eye socket implant024223.70$1,149.14$597.36$229.83
    67560TRevise eye socket implant024116.60$804.89$384.47$160.98
    67570TDecompress optic nerve024223.70$1,149.14$597.36$229.83
    67599TOrbit surgery procedure02396.26$303.53$123.42$60.71
    67700TDrainage of eyelid abscess02382.80$135.76$58.96$27.15
    67710TIncision of eyelid02396.26$303.53$123.42$60.71
    67715TIncision of eyelid fold024013.47$653.12$315.31$130.62
    67800TRemove eyelid lesion02382.80$135.76$58.96$27.15
    67801TRemove eyelid lesions02396.26$303.53$123.42$60.71
    67805TRemove eyelid lesions02382.80$135.76$58.96$27.15
    67808TRemove eyelid lesion(s)024013.47$653.12$315.31$130.62
    67810TBiopsy of eyelid02382.80$135.76$58.96$27.15
    67820TRevise eyelashes02382.80$135.76$58.96$27.15
    67825TRevise eyelashes02382.80$135.76$58.96$27.15
    Start Printed Page 18626
    67830TRevise eyelashes02396.26$303.53$123.42$60.71
    67835TRevise eyelashes024013.47$653.12$315.31$130.62
    67840TRemove eyelid lesion02396.26$303.53$123.42$60.71
    67850TTreat eyelid lesion02396.26$303.53$123.42$60.71
    67875TClosure of eyelid by suture02396.26$303.53$123.42$60.71
    67880TRevision of eyelid02326.04$292.86$134.66$58.57
    67882TRevision of eyelid024013.47$653.12$315.31$130.62
    67900TRepair brow defect024013.47$653.12$315.31$130.62
    67901TRepair eyelid defect024013.47$653.12$315.31$130.62
    67902TRepair eyelid defect024013.47$653.12$315.31$130.62
    67903TRepair eyelid defect024013.47$653.12$315.31$130.62
    67904TRepair eyelid defect024013.47$653.12$315.31$130.62
    67906TRepair eyelid defect024013.47$653.12$315.31$130.62
    67908TRepair eyelid defect024013.47$653.12$315.31$130.62
    67909TRevise eyelid defect024013.47$653.12$315.31$130.62
    67911TRevise eyelid defect024013.47$653.12$315.31$130.62
    67914TRepair eyelid defect024013.47$653.12$315.31$130.62
    67915TRepair eyelid defect02396.26$303.53$123.42$60.71
    67916TRepair eyelid defect024013.47$653.12$315.31$130.62
    67917TRepair eyelid defect024013.47$653.12$315.31$130.62
    67921TRepair eyelid defect024013.47$653.12$315.31$130.62
    67922TRepair eyelid defect02396.26$303.53$123.42$60.71
    67923TRepair eyelid defect024013.47$653.12$315.31$130.62
    67924TRepair eyelid defect024013.47$653.12$315.31$130.62
    67930TRepair eyelid wound024013.47$653.12$315.31$130.62
    67935TRepair eyelid wound024013.47$653.12$315.31$130.62
    67938TRemove eyelid foreign body02382.80$135.76$58.96$27.15
    67950TRevision of eyelid024013.47$653.12$315.31$130.62
    67961TRevision of eyelid024013.47$653.12$315.31$130.62
    67966TRevision of eyelid024013.47$653.12$315.31$130.62
    67971TReconstruction of eyelid024116.60$804.89$384.47$160.98
    67973TReconstruction of eyelid024116.60$804.89$384.47$160.98
    67974TReconstruction of eyelid024116.60$804.89$384.47$160.98
    67975TReconstruction of eyelid024013.47$653.12$315.31$130.62
    67999TRevision of eyelid024013.47$653.12$315.31$130.62
    68020TIncise/drain eyelid lining024013.47$653.12$315.31$130.62
    68040TTreatment of eyelid lesions02396.26$303.53$123.42$60.71
    68100TBiopsy of eyelid lining02326.04$292.86$134.66$58.57
    68110SRemove eyelid lining lesion02312.64$128.01$59.87$25.60
    68115TRemove eyelid lining lesion02396.26$303.53$123.42$60.71
    68130TRemove eyelid lining lesion023313.79$668.64$331.60$133.73
    68135TRemove eyelid lining lesion02396.26$303.53$123.42$60.71
    68200STreat eyelid by injection02300.98$47.52$22.48$9.50
    68320TRevise/graft eyelid lining024013.47$653.12$315.31$130.62
    68325TRevise/graft eyelid lining024223.70$1,149.14$597.36$229.83
    68326TRevise/graft eyelid lining024116.60$804.89$384.47$160.98
    68328TRevise/graft eyelid lining024116.60$804.89$384.47$160.98
    68330TRevise eyelid lining023313.79$668.64$331.60$133.73
    68335TRevise/graft eyelid lining024116.60$804.89$384.47$160.98
    68340TSeparate eyelid adhesions024013.47$653.12$315.31$130.62
    68360TRevise eyelid lining023420.64$1,000.77$502.16$200.15
    68362TRevise eyelid lining023420.64$1,000.77$502.16$200.15
    68399TEyelid lining surgery02396.26$303.53$123.42$60.71
    68400TIncise/drain tear gland02382.80$135.76$58.96$27.15
    68420TIncise/drain tear sac024013.47$653.12$315.31$130.62
    68440TIncise tear duct opening02382.80$135.76$58.96$27.15
    68500TRemoval of tear gland024116.60$804.89$384.47$160.98
    68505TPartial removal, tear gland024116.60$804.89$384.47$160.98
    68510TBiopsy of tear gland024013.47$653.12$315.31$130.62
    68520TRemoval of tear sac024116.60$804.89$384.47$160.98
    68525TBiopsy of tear sac024013.47$653.12$315.31$130.62
    68530TClearance of tear duct024013.47$653.12$315.31$130.62
    68540TRemove tear gland lesion024116.60$804.89$384.47$160.98
    68550TRemove tear gland lesion024223.70$1,149.14$597.36$229.83
    68700TRepair tear ducts024116.60$804.89$384.47$160.98
    68705TRevise tear duct opening02382.80$135.76$58.96$27.15
    68720TCreate tear sac drain024223.70$1,149.14$597.36$229.83
    68745TCreate tear duct drain024116.60$804.89$384.47$160.98
    68750TCreate tear duct drain024223.70$1,149.14$597.36$229.83
    68760TClose tear duct opening02382.80$135.76$58.96$27.15
    68761SClose tear duct opening02312.64$128.01$59.87$25.60
    68770TClose tear system fistula024013.47$653.12$315.31$130.62
    68801SDilate tear duct opening02312.64$128.01$59.87$25.60
    Start Printed Page 18627
    68810SProbe nasolacrimal duct02312.64$128.01$59.87$25.60
    68811TProbe nasolacrimal duct024013.47$653.12$315.31$130.62
    68815TProbe nasolacrimal duct024013.47$653.12$315.31$130.62
    68840SExplore/irrigate tear ducts02312.64$128.01$59.87$25.60
    68850NInjection for tear sac x-ray
    68899STear duct system surgery02312.64$128.01$59.87$25.60
    69000TDrain external ear lesion00062.00$96.97$33.95$19.39
    69005TDrain external ear lesion00073.68$178.43$72.03$35.69
    69020TDrain outer ear canal lesion00062.00$96.97$33.95$19.39
    69090EPierce earlobes
    69100TBiopsy of external ear00194.00$193.95$78.91$38.79
    69105TBiopsy of external ear canal025312.02$582.81$284.00$116.56
    69110TRemove external ear, partial00206.51$315.65$130.53$63.13
    69120TRemoval of external ear025312.02$582.81$284.00$116.56
    69140TRemove ear canal lesion(s)025412.45$603.66$272.41$120.73
    69145TRemove ear canal lesion(s)00206.51$315.65$130.53$63.13
    69150CExtensive ear canal surgery
    69155CExtensive ear/neck surgery
    69200XClear outer ear canal03401.04$50.43$12.85$10.09
    69205TClear outer ear canal002212.49$605.60$292.94$121.12
    69210XRemove impacted ear wax03401.04$50.43$12.85$10.09
    69220TClean out mastoid cavity00120.53$25.70$9.18$5.14
    69222TClean out mastoid cavity025312.02$582.81$284.00$116.56
    69300TRevise external ear025412.45$603.66$272.41$120.73
    69310TRebuild outer ear canal025625.40$1,231.57$623.05$246.31
    69320TRebuild outer ear canal025625.40$1,231.57$623.05$246.31
    69399TOuter ear surgery procedure02525.18$251.16$114.24$50.23
    69400TInflate middle ear canal02511.68$81.46$27.99$16.29
    69401NInflate middle ear canal
    69405TCatheterize middle ear canal02525.18$251.16$114.24$50.23
    69410TInset middle ear (baffle)02525.18$251.16$114.24$50.23
    69420TIncision of eardrum02525.18$251.16$114.24$50.23
    69421TIncision of eardrum025312.02$582.81$284.00$116.56
    69424TRemove ventilating tube02525.18$251.16$114.24$50.23
    69433TCreate eardrum opening02525.18$251.16$114.24$50.23
    69436TCreate eardrum opening025312.02$582.81$284.00$116.56
    69440TExploration of middle ear025312.02$582.81$284.00$116.56
    69450TEardrum revision025625.40$1,231.57$623.05$246.31
    69501TMastoidectomy025625.40$1,231.57$623.05$246.31
    69502CMastoidectomy
    69505TRemove mastoid structures025625.40$1,231.57$623.05$246.31
    69511TExtensive mastoid surgery025625.40$1,231.57$623.05$246.31
    69530TExtensive mastoid surgery025625.40$1,231.57$623.05$246.31
    69535CRemove part of temporal bone
    69540TRemove ear lesion025312.02$582.81$284.00$116.56
    69550TRemove ear lesion025625.40$1,231.57$623.05$246.31
    69552TRemove ear lesion025625.40$1,231.57$623.05$246.31
    69554CRemove ear lesion
    69601TMastoid surgery revision025625.40$1,231.57$623.05$246.31
    69602TMastoid surgery revision025625.40$1,231.57$623.05$246.31
    69603TMastoid surgery revision025625.40$1,231.57$623.05$246.31
    69604TMastoid surgery revision025625.40$1,231.57$623.05$246.31
    69605TMastoid surgery revision025625.40$1,231.57$623.05$246.31
    69610TRepair of eardrum025312.02$582.81$284.00$116.56
    69620TRepair of eardrum025312.02$582.81$284.00$116.56
    69631TRepair eardrum structures025625.40$1,231.57$623.05$246.31
    69632TRebuild eardrum structures025625.40$1,231.57$623.05$246.31
    69633TRebuild eardrum structures025625.40$1,231.57$623.05$246.31
    69635TRepair eardrum structures025625.40$1,231.57$623.05$246.31
    69636TRebuild eardrum structures025625.40$1,231.57$623.05$246.31
    69637TRebuild eardrum structures025625.40$1,231.57$623.05$246.31
    69641TRevise middle ear & mastoid025625.40$1,231.57$623.05$246.31
    69642TRevise middle ear & mastoid025625.40$1,231.57$623.05$246.31
    69643TRevise middle ear & mastoid025625.40$1,231.57$623.05$246.31
    69644TRevise middle ear & mastoid025625.40$1,231.57$623.05$246.31
    69645TRevise middle ear & mastoid025625.40$1,231.57$623.05$246.31
    69646TRevise middle ear & mastoid025625.40$1,231.57$623.05$246.31
    69650TRelease middle ear bone025412.45$603.66$272.41$120.73
    69660TRevise middle ear bone025625.40$1,231.57$623.05$246.31
    69661TRevise middle ear bone025625.40$1,231.57$623.05$246.31
    69662TRevise middle ear bone025625.40$1,231.57$623.05$246.31
    69666TRepair middle ear structures025625.40$1,231.57$623.05$246.31
    69667TRepair middle ear structures025625.40$1,231.57$623.05$246.31
    Start Printed Page 18628
    69670TRemove mastoid air cells025625.40$1,231.57$623.05$246.31
    69676TRemove middle ear nerve025625.40$1,231.57$623.05$246.31
    69700TClose mastoid fistula025625.40$1,231.57$623.05$246.31
    69710EImplant/replace hearing aid
    69711TRemove/repair hearing aid025625.40$1,231.57$623.05$246.31
    69720TRelease facial nerve025625.40$1,231.57$623.05$246.31
    69725TRelease facial nerve025625.40$1,231.57$623.05$246.31
    69740TRepair facial nerve025625.40$1,231.57$623.05$246.31
    69745TRepair facial nerve025625.40$1,231.57$623.05$246.31
    69799TMiddle ear surgery procedure025312.02$582.81$284.00$116.56
    69801TIncise inner ear025625.40$1,231.57$623.05$246.31
    69802TIncise inner ear025625.40$1,231.57$623.05$246.31
    69805TExplore inner ear025625.40$1,231.57$623.05$246.31
    69806TExplore inner ear025625.40$1,231.57$623.05$246.31
    69820TEstablish inner ear window025625.40$1,231.57$623.05$246.31
    69840TRevise inner ear window025625.40$1,231.57$623.05$246.31
    69905TRemove inner ear025625.40$1,231.57$623.05$246.31
    69910TRemove inner ear & mastoid025625.40$1,231.57$623.05$246.31
    69915TIncise inner ear nerve025625.40$1,231.57$623.05$246.31
    69930TImplant cochlear device0257115.31$5,591.04$3,498.58$1,118.21
    69949TInner ear surgery procedure025312.02$582.81$284.00$116.56
    69950CIncise inner ear nerve
    69955TRelease facial nerve025625.40$1,231.57$623.05$246.31
    69960TRelease inner ear canal025625.40$1,231.57$623.05$246.31
    69970CRemove inner ear lesion
    69979TTemporal bone surgery02525.18$251.16$114.24$50.23
    69990NMicrosurgery add-on
    70010SContrast x-ray of brain02744.83$234.19$128.12$46.84
    70015SContrast x-ray of brain02744.83$234.19$128.12$46.84
    70030XX-ray eye for foreign body02600.79$38.30$22.02$7.66
    70100XX-ray exam of jaw02600.79$38.30$22.02$7.66
    70110XX-ray exam of jaw02600.79$38.30$22.02$7.66
    70120XX-ray exam of mastoids02600.79$38.30$22.02$7.66
    70130XX-ray exam of mastoids02600.79$38.30$22.02$7.66
    70134XX-ray exam of middle ear02611.38$66.91$38.77$13.38
    70140XX-ray exam of facial bones02600.79$38.30$22.02$7.66
    70150XX-ray exam of facial bones02600.79$38.30$22.02$7.66
    70160XX-ray exam of nasal bones02600.79$38.30$22.02$7.66
    70170XX-ray exam of tear duct02631.68$81.46$45.88$16.29
    70190XX-ray exam of eye sockets02600.79$38.30$22.02$7.66
    70200XX-ray exam of eye sockets02600.79$38.30$22.02$7.66
    70210XX-ray exam of sinuses02600.79$38.30$22.02$7.66
    70220XX-ray exam of sinuses02600.79$38.30$22.02$7.66
    70240XX-ray exam, pituitary saddle02600.79$38.30$22.02$7.66
    70250XX-ray exam of skull02600.79$38.30$22.02$7.66
    70260XX-ray exam of skull02611.38$66.91$38.77$13.38
    70300XX-ray exam of teeth02620.40$19.39$10.90$3.88
    70310XX-ray exam of teeth02620.40$19.39$10.90$3.88
    70320XFull mouth x-ray of teeth02620.40$19.39$10.90$3.88
    70328XX-ray exam of jaw joint02600.79$38.30$22.02$7.66
    70330XX-ray exam of jaw joints02600.79$38.30$22.02$7.66
    70332SX-ray exam of jaw joint02752.74$132.85$72.26$26.57
    70336SMagnetic image, jaw joint02848.02$388.87$257.39$77.77
    70350XX-ray head for orthodontia02600.79$38.30$22.02$7.66
    70355XPanoramic x-ray of jaws02600.79$38.30$22.02$7.66
    70360XX-ray exam of neck02600.79$38.30$22.02$7.66
    70370XThroat x-ray & fluoroscopy02732.49$120.73$61.02$24.15
    70371XSpeech evaluation, complex02721.40$67.88$39.00$13.58
    70373XContrast x-ray of larynx02631.68$81.46$45.88$16.29
    70380XX-ray exam of salivary gland02600.79$38.30$22.02$7.66
    70390XX-ray exam of salivary duct02631.68$81.46$45.88$16.29
    70450SCAT scan of head or brain02834.89$237.10$179.39$47.42
    70460SContrast CAT scan of head02834.89$237.10$179.39$47.42
    70470SContrast CAT scans of head02834.89$237.10$179.39$47.42
    70480SCAT scan of skull02834.89$237.10$179.39$47.42
    70481SContrast CAT scan of skull02834.89$237.10$179.39$47.42
    70482SContrast CAT scans of skull02834.89$237.10$179.39$47.42
    70486SCat scan of face/jaw02822.38$115.40$94.51$23.08
    70487SContrast CAT scan, face/jaw02834.89$237.10$179.39$47.42
    70488SContrast cat scans, face/jaw02834.89$237.10$179.39$47.42
    70490SCAT scan of neck tissue02834.89$237.10$179.39$47.42
    70491SContrast CAT of neck tissue02834.89$237.10$179.39$47.42
    70492SContrast CAT of neck tissue02834.89$237.10$179.39$47.42
    Start Printed Page 18629
    70540SMagnetic image, face/neck02848.02$388.87$257.39$77.77
    70541SMagnetic image, head (MRA)02848.02$388.87$257.39$77.77
    70551SMagnetic image, brain (MRI)02848.02$388.87$257.39$77.77
    70552SMagnetic image, brain (MRI)02848.02$388.87$257.39$77.77
    70553SMagnetic image, brain (mri)02848.02$388.87$257.39$77.77
    71010XChest x-ray02600.79$38.30$22.02$7.66
    71015XChest x-ray02600.79$38.30$22.02$7.66
    71020XChest x-ray02600.79$38.30$22.02$7.66
    71021XChest x-ray02600.79$38.30$22.02$7.66
    71022XChest x-ray02600.79$38.30$22.02$7.66
    71023XChest x-ray and fluoroscopy02721.40$67.88$39.00$13.58
    71030XChest x-ray02600.79$38.30$22.02$7.66
    71034XChest x-ray and fluoroscopy02721.40$67.88$39.00$13.58
    71035XChest x-ray02600.79$38.30$22.02$7.66
    71036XX-ray guidance for biopsy02732.49$120.73$61.02$24.15
    71040XContrast x-ray of bronchi02631.68$81.46$45.88$16.29
    71060XContrast x-ray of bronchi02631.68$81.46$45.88$16.29
    71090XX-ray & pacemaker insertion02732.49$120.73$61.02$24.15
    71100XX-ray exam of ribs02600.79$38.30$22.02$7.66
    71101XX-ray exam of ribs/chest02600.79$38.30$22.02$7.66
    71110XX-ray exam of ribs02600.79$38.30$22.02$7.66
    71111XX-ray exam of ribs/chest02611.38$66.91$38.77$13.38
    71120XX-ray exam of breastbone02600.79$38.30$22.02$7.66
    71130XX-ray exam of breastbone02600.79$38.30$22.02$7.66
    71250SCat scan of chest02834.89$237.10$179.39$47.42
    71260SContrast CAT scan of chest02834.89$237.10$179.39$47.42
    71270SContrast CAT scans of chest02834.89$237.10$179.39$47.42
    71550SMagnetic image, chest (mri)02848.02$388.87$257.39$77.77
    71555EMagnetic image, chest (mra)
    72010XX-ray exam of spine02611.38$66.91$38.77$13.38
    72020XX-ray exam of spine02600.79$38.30$22.02$7.66
    72040XX-ray exam of neck spine02600.79$38.30$22.02$7.66
    72050XX-ray exam of neck spine02611.38$66.91$38.77$13.38
    72052XX-ray exam of neck spine02611.38$66.91$38.77$13.38
    72069XX-ray exam of trunk spine02600.79$38.30$22.02$7.66
    72070XX-ray exam of thoracic spine02600.79$38.30$22.02$7.66
    72072XX-ray exam of thoracic spine02600.79$38.30$22.02$7.66
    72074XX-ray exam of thoracic spine02600.79$38.30$22.02$7.66
    72080XX-ray exam of trunk spine02600.79$38.30$22.02$7.66
    72090XX-ray exam of trunk spine02600.79$38.30$22.02$7.66
    72100XX-ray exam of lower spine02600.79$38.30$22.02$7.66
    72110XX-ray exam of lower spine02611.38$66.91$38.77$13.38
    72114XX-ray exam of lower spine02611.38$66.91$38.77$13.38
    72120XX-ray exam of lower spine02600.79$38.30$22.02$7.66
    72125SCAT scan of neck spine02834.89$237.10$179.39$47.42
    72126SContrast CAT scan of neck02834.89$237.10$179.39$47.42
    72127SContrast CAT scans of neck02834.89$237.10$179.39$47.42
    72128SCAT scan of thorax spine02834.89$237.10$179.39$47.42
    72129SContrast CAT scan of thorax02834.89$237.10$179.39$47.42
    72130SContrast CAT scans of thorax02834.89$237.10$179.39$47.42
    72131SCAT scan of lower spine02834.89$237.10$179.39$47.42
    72132SContrast CAT of lower spine02834.89$237.10$179.39$47.42
    72133SContrast cat scans, low spine02834.89$237.10$179.39$47.42
    72141SMagnetic image, neck spine02848.02$388.87$257.39$77.77
    72142SMagnetic image, neck spine02848.02$388.87$257.39$77.77
    72146SMagnetic image, chest spine02848.02$388.87$257.39$77.77
    72147SMagnetic image, chest spine02848.02$388.87$257.39$77.77
    72148SMagnetic image, lumbar spine02848.02$388.87$257.39$77.77
    72149SMagnetic image, lumbar spine02848.02$388.87$257.39$77.77
    72156SMagnetic image, neck spine02848.02$388.87$257.39$77.77
    72157SMagnetic image, chest spine02848.02$388.87$257.39$77.77
    72158SMagnetic image, lumbar spine02848.02$388.87$257.39$77.77
    72159EMagnetic image, spine (mra)
    72170XX-ray exam of pelvis02600.79$38.30$22.02$7.66
    72190XX-ray exam of pelvis02600.79$38.30$22.02$7.66
    72192SCAT scan of pelvis02834.89$237.10$179.39$47.42
    72193SContrast CAT scan of pelvis02834.89$237.10$179.39$47.42
    72194SContrast CAT scans of pelvis02834.89$237.10$179.39$47.42
    72196SMagnetic image, pelvis02848.02$388.87$257.39$77.77
    72198EMagnetic image, pelvis (mra)
    72200XX-ray exam sacroiliac joints02600.79$38.30$22.02$7.66
    72202XX-ray exam sacroiliac joints02600.79$38.30$22.02$7.66
    72220XX-ray exam of tailbone02600.79$38.30$22.02$7.66
    Start Printed Page 18630
    72240SContrast x-ray of neck spine02744.83$234.19$128.12$46.84
    72255SContrast x-ray, thorax spine02744.83$234.19$128.12$46.84
    72265SContrast x-ray, lower spine02744.83$234.19$128.12$46.84
    72270SContrast x-ray of spine02744.83$234.19$128.12$46.84
    72275SEpidurography02744.83$234.19$128.12$46.84
    72285SX-ray c/t spine disk02744.83$234.19$128.12$46.84
    72295SX-ray of lower spine disk02744.83$234.19$128.12$46.84
    73000XX-ray exam of collar bone02600.79$38.30$22.02$7.66
    73010XX-ray exam of shoulder blade02600.79$38.30$22.02$7.66
    73020XX-ray exam of shoulder02600.79$38.30$22.02$7.66
    73030XX-ray exam of shoulder02600.79$38.30$22.02$7.66
    73040SContrast x-ray of shoulder02752.74$132.85$72.26$26.57
    73050XX-ray exam of shoulders02600.79$38.30$22.02$7.66
    73060XX-ray exam of humerus02600.79$38.30$22.02$7.66
    73070XX-ray exam of elbow02600.79$38.30$22.02$7.66
    73080XX-ray exam of elbow02600.79$38.30$22.02$7.66
    73085SContrast x-ray of elbow02752.74$132.85$72.26$26.57
    73090XX-ray exam of forearm02600.79$38.30$22.02$7.66
    73092XX-ray exam of arm, infant02600.79$38.30$22.02$7.66
    73100XX-ray exam of wrist02600.79$38.30$22.02$7.66
    73110XX-ray exam of wrist02600.79$38.30$22.02$7.66
    73115SContrast x-ray of wrist02752.74$132.85$72.26$26.57
    73120XX-ray exam of hand02600.79$38.30$22.02$7.66
    73130XX-ray exam of hand02600.79$38.30$22.02$7.66
    73140XX-ray exam of finger(s)02600.79$38.30$22.02$7.66
    73200SCAT scan of arm02834.89$237.10$179.39$47.42
    73201SContrast CAT scan of arm02834.89$237.10$179.39$47.42
    73202SContrast CAT scans of arm02834.89$237.10$179.39$47.42
    73220SMagnetic image, arm/hand02848.02$388.87$257.39$77.77
    73221SMagnetic image, joint of arm02848.02$388.87$257.39$77.77
    73225EMagnetic image, upper (mra)
    73500XX-ray exam of hip02600.79$38.30$22.02$7.66
    73510XX-ray exam of hip02600.79$38.30$22.02$7.66
    73520XX-ray exam of hips02600.79$38.30$22.02$7.66
    73525SContrast x-ray of hip02752.74$132.85$72.26$26.57
    73530XX-ray exam of hip02611.38$66.91$38.77$13.38
    73540XX-ray exam of pelvis & hips02600.79$38.30$22.02$7.66
    73542SX-ray exam, sacroiliac joint02752.74$132.85$72.26$26.57
    73550XX-ray exam of thigh02600.79$38.30$22.02$7.66
    73560XX-ray exam of knee, 1 or 202600.79$38.30$22.02$7.66
    73562XX-ray exam of knee, 302600.79$38.30$22.02$7.66
    73564XX-ray exam, knee, 4 or more02600.79$38.30$22.02$7.66
    73565XX-ray exam of knees02600.79$38.30$22.02$7.66
    73580SContrast x-ray of knee joint02752.74$132.85$72.26$26.57
    73590XX-ray exam of lower leg02600.79$38.30$22.02$7.66
    73592XX-ray exam of leg, infant02611.38$66.91$38.77$13.38
    73600XX-ray exam of ankle02600.79$38.30$22.02$7.66
    73610XX-ray exam of ankle02600.79$38.30$22.02$7.66
    73615SContrast x-ray of ankle02752.74$132.85$72.26$26.57
    73620XX-ray exam of foot02600.79$38.30$22.02$7.66
    73630XX-ray exam of foot02600.79$38.30$22.02$7.66
    73650XX-ray exam of heel02600.79$38.30$22.02$7.66
    73660XX-ray exam of toe(s)02600.79$38.30$22.02$7.66
    73700SCAT scan of leg02834.89$237.10$179.39$47.42
    73701SContrast CAT scan of leg02834.89$237.10$179.39$47.42
    73702SContrast CAT scans of leg02834.89$237.10$179.39$47.42
    73720SMagnetic image, leg/foot02848.02$388.87$257.39$77.77
    73721SMagnetic image, joint of leg02848.02$388.87$257.39$77.77
    73725EMagnetic image/lower (mra)
    74000XX-ray exam of abdomen02600.79$38.30$22.02$7.66
    74010XX-ray exam of abdomen02600.79$38.30$22.02$7.66
    74020XX-ray exam of abdomen02600.79$38.30$22.02$7.66
    74022XX-ray exam series, abdomen02611.38$66.91$38.77$13.38
    74150SCAT scan of abdomen02834.89$237.10$179.39$47.42
    74160SContrast CAT scan of abdomen02834.89$237.10$179.39$47.42
    74170SContrast CAT scans, abdomen02834.89$237.10$179.39$47.42
    74181SMagnetic image/abdomen (mri)02848.02$388.87$257.39$77.77
    74185EMagnetic image/abdomen (MRA)
    74190XX-ray exam of peritoneum02631.68$81.46$45.88$16.29
    74210SContrast x-ray exam of throat02761.79$86.79$49.78$17.36
    74220SContrast x-ray, esophagus02761.79$86.79$49.78$17.36
    74230SCinema x-ray, throat/esoph02761.79$86.79$49.78$17.36
    74235SRemove esophagus obstruction02963.57$173.10$100.25$34.62
    Start Printed Page 18631
    74240SX-ray exam, upper gi tract02761.79$86.79$49.78$17.36
    74241SX-ray exam, upper gi tract02761.79$86.79$49.78$17.36
    74245SX-ray exam, upper gi tract02772.47$119.76$69.28$23.95
    74246SContrast x-ray uppr gi tract02761.79$86.79$49.78$17.36
    74247SContrast x-ray uppr gi tract02761.79$86.79$49.78$17.36
    74249SContrast x-ray uppr gi tract02772.47$119.76$69.28$23.95
    74250SX-ray exam of small bowel02761.79$86.79$49.78$17.36
    74251SX-ray exam of small bowel02772.47$119.76$69.28$23.95
    74260SX-ray exam of small bowel02772.47$119.76$69.28$23.95
    74270SContrast x-ray exam of colon02761.79$86.79$49.78$17.36
    74280SContrast x-ray exam of colon02772.47$119.76$69.28$23.95
    74283SContrast x-ray exam of colon02761.79$86.79$49.78$17.36
    74290SContrast x-ray, gallbladder02761.79$86.79$49.78$17.36
    74291SContrast x-rays, gallbladder02761.79$86.79$49.78$17.36
    74300CX-ray bile ducts/pancreas
    74301CX-rays at surgery add-on
    74305XX-ray bile ducts/pancreas02631.68$81.46$45.88$16.29
    74320XContrast x-ray of bile ducts02643.83$185.71$108.97$37.14
    74327SX-ray bile stone removal02963.57$173.10$100.25$34.62
    74328XX-ray bile duct endoscopy02643.83$185.71$108.97$37.14
    74329XX-ray for pancreas endoscopy02643.83$185.71$108.97$37.14
    74330XX-ray bile/panc endoscopy02643.83$185.71$108.97$37.14
    74340XX-ray guide for GI tube02721.40$67.88$39.00$13.58
    74350XX-ray guide, stomach tube02643.83$185.71$108.97$37.14
    74355XX-ray guide, intestinal tube02643.83$185.71$108.97$37.14
    74360SX-ray guide, GI dilation02963.57$173.10$100.25$34.62
    74363SX-ray, bile duct dilation02976.13$297.23$172.51$59.45
    74400SContrast x-ray, urinary tract02782.85$138.19$81.67$27.64
    74410SContrast x-ray, urinary tract02782.85$138.19$81.67$27.64
    74415SContrast x-ray, urinary tract02782.85$138.19$81.67$27.64
    74420SContrast x-ray, urinary tract02782.85$138.19$81.67$27.64
    74425SContrast x-ray, urinary tract02782.85$138.19$81.67$27.64
    74430SContrast x-ray, bladder02782.85$138.19$81.67$27.64
    74440SX-ray, male genital tract02782.85$138.19$81.67$27.64
    74445SX-ray exam of penis02782.85$138.19$81.67$27.64
    74450SX-ray, urethra/bladder02782.85$138.19$81.67$27.64
    74455SX-ray, urethra/bladder02782.85$138.19$81.67$27.64
    74470XX-ray exam of kidney lesion02643.83$185.71$108.97$37.14
    74475SX-ray control, cath insert02976.13$297.23$172.51$59.45
    74480SX-ray control, cath insert02976.13$297.23$172.51$59.45
    74485SX-ray guide, GU dilation02963.57$173.10$100.25$34.62
    74710XX-ray measurement of pelvis02600.79$38.30$22.02$7.66
    74740XX-ray, female genital tract02643.83$185.71$108.97$37.14
    74742XX-ray, fallopian tube02643.83$185.71$108.97$37.14
    74775SX-ray exam of perineum02782.85$138.19$81.67$27.64
    75552SMagnetic image, myocardium02848.02$388.87$257.39$77.77
    75553SMagnetic image, myocardium02848.02$388.87$257.39$77.77
    75554SCardiac MRI/function02848.02$388.87$257.39$77.77
    75555SCardiac MRI/limited study02848.02$388.87$257.39$77.77
    75556ECardiac MRI/flow mapping
    75600SContrast x-ray exam of aorta028014.98$726.34$380.12$145.27
    75605SContrast x-ray exam of aorta028014.98$726.34$380.12$145.27
    75625SContrast x-ray exam of aorta028014.98$726.34$380.12$145.27
    75630SX-ray aorta, leg arteries028014.98$726.34$380.12$145.27
    75650SArtery x-rays, head & neck028014.98$726.34$380.12$145.27
    75658SArtery x-rays, arm028014.98$726.34$380.12$145.27
    75660SArtery x-rays, head & neck02796.30$305.47$174.57$61.09
    75662SArtery x-rays, head & neck02796.30$305.47$174.57$61.09
    75665SArtery x-rays, head & neck028014.98$726.34$380.12$145.27
    75671SArtery x-rays, head & neck028014.98$726.34$380.12$145.27
    75676SArtery x-rays, neck028014.98$726.34$380.12$145.27
    75680SArtery x-rays, neck028014.98$726.34$380.12$145.27
    75685SArtery x-rays, spine02796.30$305.47$174.57$61.09
    75705SArtery x-rays, spine02796.30$305.47$174.57$61.09
    75710SArtery x-rays, arm/leg028014.98$726.34$380.12$145.27
    75716SArtery x-rays, arms/legs028014.98$726.34$380.12$145.27
    75722SArtery x-rays, kidney028014.98$726.34$380.12$145.27
    75724SArtery x-rays, kidneys028014.98$726.34$380.12$145.27
    75726SArtery x-rays, abdomen028014.98$726.34$380.12$145.27
    75731SArtery x-rays, adrenal gland028014.98$726.34$380.12$145.27
    75733SArtery x-rays, adrenals028014.98$726.34$380.12$145.27
    75736SArtery x-rays, pelvis028014.98$726.34$380.12$145.27
    75741SArtery x-rays, lung02796.30$305.47$174.57$61.09
    Start Printed Page 18632
    75743SArtery x-rays, lungs028014.98$726.34$380.12$145.27
    75746SArtery x-rays, lung02796.30$305.47$174.57$61.09
    75756SArtery x-rays, chest02796.30$305.47$174.57$61.09
    75774SArtery x-ray, each vessel028014.98$726.34$380.12$145.27
    75790SVisualize A-V shunt02814.40$213.34$115.16$42.67
    75801XLymph vessel x-ray, arm/leg02643.83$185.71$108.97$37.14
    75803XLymph vessel x-ray, arms/legs02643.83$185.71$108.97$37.14
    75805XLymph vessel x-ray, trunk02643.83$185.71$108.97$37.14
    75807XLymph vessel x-ray, trunk02643.83$185.71$108.97$37.14
    75809XNonvascular shunt, x-ray02643.83$185.71$108.97$37.14
    75810SVein x-ray, spleen/liver02796.30$305.47$174.57$61.09
    75820SVein x-ray, arm/leg02814.40$213.34$115.16$42.67
    75822SVein x-ray, arms/legs02814.40$213.34$115.16$42.67
    75825SVein x-ray, trunk02796.30$305.47$174.57$61.09
    75827SVein x-ray, chest02796.30$305.47$174.57$61.09
    75831SVein x-ray, kidney02796.30$305.47$174.57$61.09
    75833SVein x-ray, kidneys02796.30$305.47$174.57$61.09
    75840SVein x-ray, adrenal gland02796.30$305.47$174.57$61.09
    75842SVein x-ray, adrenal glands02796.30$305.47$174.57$61.09
    75860SVein x-ray, neck02796.30$305.47$174.57$61.09
    75870SVein x-ray, skull02796.30$305.47$174.57$61.09
    75872SVein x-ray, skull02796.30$305.47$174.57$61.09
    75880SVein x-ray, eye socket02796.30$305.47$174.57$61.09
    75885SVein x-ray, liver02796.30$305.47$174.57$61.09
    75887SVein x-ray, liver028014.98$726.34$380.12$145.27
    75889SVein x-ray, liver02796.30$305.47$174.57$61.09
    75891SVein x-ray, liver02796.30$305.47$174.57$61.09
    75893NVenous sampling by catheter
    75894SX-rays, transcath therapy02976.13$297.23$172.51$59.45
    75896SX-rays, transcath therapy02976.13$297.23$172.51$59.45
    75898XFollow-up angiogram02643.83$185.71$108.97$37.14
    75900CArterial catheter exchange
    75940CX-ray placement, vein filter
    75945CIntravascular us
    75946CIntravascular us add-on
    75960CTranscatheter intro, stent
    75961CRetrieval, broken catheter
    75962CRepair arterial blockage
    75964CRepair artery blockage, each
    75966CRepair arterial blockage
    75968CRepair artery blockage, each
    75970CVascular biopsy
    75978CRepair venous blockage
    75980SContrast x-ray exam bile duct02976.13$297.23$172.51$59.45
    75982SContrast x-ray exam bile duct02976.13$297.23$172.51$59.45
    75984SX-ray control catheter change02963.57$173.10$100.25$34.62
    75989XAbscess drainage under x-ray02732.49$120.73$61.02$24.15
    75992CAtherectomy, x-ray exam
    75993CAtherectomy, x-ray exam
    75994CAtherectomy, x-ray exam
    75995CAtherectomy, x-ray exam
    75996CAtherectomy, x-ray exam
    76000XFluoroscope examination02721.40$67.88$39.00$13.58
    76001XFluoroscope exam, extensive02732.49$120.73$61.02$24.15
    76003XNeedle localization by x-ray02721.40$67.88$39.00$13.58
    76005XFluoroguide for spine inject02732.49$120.73$61.02$24.15
    76006XX-ray stress view02611.38$66.91$38.77$13.38
    76010XX-ray, nose to rectum02600.79$38.30$22.02$7.66
    76020XX-rays for bone age02611.38$66.91$38.77$13.38
    76040XX-rays, bone evaluation02600.79$38.30$22.02$7.66
    76061XX-rays, bone survey02611.38$66.91$38.77$13.38
    76062XX-rays, bone survey02611.38$66.91$38.77$13.38
    76065XX-rays, bone evaluation02611.38$66.91$38.77$13.38
    76066XJoint(s) survey, single film02600.79$38.30$22.02$7.66
    76070ECT scan, bone density study
    76075XDual energy x-ray study02611.38$66.91$38.77$13.38
    76076XDual energy x-ray study02611.38$66.91$38.77$13.38
    76078XPhotodensitometry02611.38$66.91$38.77$13.38
    76080XX-ray exam of fistula02631.68$81.46$45.88$16.29
    76086XX-ray of mammary duct02631.68$81.46$45.88$16.29
    76088XX-ray of mammary ducts02631.68$81.46$45.88$16.29
    76090SMammogram, one breast02710.70$33.94$19.50$6.79
    76091SMammogram, both breasts02710.70$33.94$19.50$6.79
    Start Printed Page 18633
    76092AMammogram, screening
    76093SMagnetic image, breast02848.02$388.87$257.39$77.77
    76094SMagnetic image, both breasts02848.02$388.87$257.39$77.77
    76095XStereotactic breast biopsy02643.83$185.71$108.97$37.14
    76096XX-ray of needle wire, breast02631.68$81.46$45.88$16.29
    76098XX-ray exam, breast specimen02600.79$38.30$22.02$7.66
    76100XX-ray exam of body section02611.38$66.91$38.77$13.38
    76101XComplex body section x-ray02631.68$81.46$45.88$16.29
    76102XComplex body section x-rays02643.83$185.71$108.97$37.14
    76120XCinematic x-rays02611.38$66.91$38.77$13.38
    76125XCinematic x-rays add-on02611.38$66.91$38.77$13.38
    76140EX-ray consultation
    76150XX-ray exam, dry process02600.79$38.30$22.02$7.66
    76350NSpecial x-ray contrast study
    76355SCAT scan for localization02834.89$237.10$179.39$47.42
    76360SCAT scan for needle biopsy02834.89$237.10$179.39$47.42
    76365SCAT scan for cyst aspiration02834.89$237.10$179.39$47.42
    76370SCAT scan for therapy guide02822.38$115.40$94.51$23.08
    76375S3D/holograph reconstr add-on02822.38$115.40$94.51$23.08
    76380SCAT scan follow-up study02822.38$115.40$94.51$23.08
    76390SMr spectroscopy02848.02$388.87$257.39$77.77
    76400SMagnetic image, bone marrow02848.02$388.87$257.39$77.77
    76499XRadiographic procedure02600.79$38.30$22.02$7.66
    76506SEcho exam of head02661.79$86.79$57.35$17.36
    76511SEcho exam of eye02661.79$86.79$57.35$17.36
    76512SEcho exam of eye02661.79$86.79$57.35$17.36
    76513SEcho exam of eye, water bath02651.17$56.73$38.08$11.35
    76516SEcho exam of eye02661.79$86.79$57.35$17.36
    76519SEcho exam of eye02661.79$86.79$57.35$17.36
    76529SEcho exam of eye02651.17$56.73$38.08$11.35
    76536SEcho exam of head and neck02651.17$56.73$38.08$11.35
    76604SEcho exam of chest02661.79$86.79$57.35$17.36
    76645SEcho exam of breast(s)02651.17$56.73$38.08$11.35
    76700SEcho exam of abdomen02661.79$86.79$57.35$17.36
    76705SEcho exam of abdomen02661.79$86.79$57.35$17.36
    76770SEcho exam abdomen back wall02661.79$86.79$57.35$17.36
    76775SEcho exam abdomen back wall02661.79$86.79$57.35$17.36
    76778SEcho exam kidney transplant02661.79$86.79$57.35$17.36
    76800SEcho exam spinal canal02661.79$86.79$57.35$17.36
    76805SEcho exam of pregnant uterus02661.79$86.79$57.35$17.36
    76810SEcho exam of pregnant uterus02651.17$56.73$38.08$11.35
    76815SEcho exam of pregnant uterus02651.17$56.73$38.08$11.35
    76816SEcho exam follow-up/repeat02651.17$56.73$38.08$11.35
    76818SFetal biophysical profile02661.79$86.79$57.35$17.36
    76825SEcho exam of fetal heart02694.40$213.34$114.01$42.67
    76826SEcho exam of fetal heart02694.40$213.34$114.01$42.67
    76827SEcho exam of fetal heart02694.40$213.34$114.01$42.67
    76828SEcho exam of fetal heart02694.40$213.34$114.01$42.67
    76830SEcho exam, transvaginal02661.79$86.79$57.35$17.36
    76831SEcho exam, uterus02661.79$86.79$57.35$17.36
    76856SEcho exam of pelvis02661.79$86.79$57.35$17.36
    76857SEcho exam of pelvis02651.17$56.73$38.08$11.35
    76870SEcho exam of scrotum02661.79$86.79$57.35$17.36
    76872SEcho exam, transrectal02661.79$86.79$57.35$17.36
    76873SEchograp trans r, pros study02661.79$86.79$57.35$17.36
    76880SEcho exam of extremity02661.79$86.79$57.35$17.36
    76885SEcho exam, infant hips02661.79$86.79$57.35$17.36
    76886SEcho exam, infant hips02661.79$86.79$57.35$17.36
    76930XEcho guide for heart sac tap02682.23$108.13$69.51$21.63
    76932XEcho guide for heart biopsy02682.23$108.13$69.51$21.63
    76934XEcho guide for chest tap02682.23$108.13$69.51$21.63
    76936XEcho guide for artery repair02682.23$108.13$69.51$21.63
    76938XEcho exam for drainage02682.23$108.13$69.51$21.63
    76941XEcho guide for transfusion02682.23$108.13$69.51$21.63
    76942XEcho guide for biopsy02682.23$108.13$69.51$21.63
    76945XEcho guide, villus sampling02682.23$108.13$69.51$21.63
    76946XEcho guide for amniocentesis02682.23$108.13$69.51$21.63
    76948XEcho guide, ova aspiration02682.23$108.13$69.51$21.63
    76950XEcho guidance radiotherapy02682.23$108.13$69.51$21.63
    76960XEcho guidance radiotherapy02682.23$108.13$69.51$21.63
    76965XEcho guidance radiotherapy02682.23$108.13$69.51$21.63
    76970SUltrasound exam follow-up02651.17$56.73$38.08$11.35
    76975SGI endoscopic ultrasound02661.79$86.79$57.35$17.36
    Start Printed Page 18634
    76977SUs bone density measure02651.17$56.73$38.08$11.35
    76986SEcho exam at surgery02661.79$86.79$57.35$17.36
    76999SEcho examination procedure02661.79$86.79$57.35$17.36
    77261ERadiation therapy planning
    77262ERadiation therapy planning
    77263ERadiation therapy planning
    77280XSet radiation therapy field03041.49$72.25$41.52$14.45
    77285XSet radiation therapy field03054.06$196.86$97.50$39.37
    77290XSet radiation therapy field03054.06$196.86$97.50$39.37
    77295XSet radiation therapy field031013.98$677.85$339.05$135.57
    77299ERadiation therapy planning
    77300XRadiation therapy dose plan03041.49$72.25$41.52$14.45
    77305XRadiation therapy dose plan03041.49$72.25$41.52$14.45
    77310XRadiation therapy dose plan03041.49$72.25$41.52$14.45
    77315XRadiation therapy dose plan03054.06$196.86$97.50$39.37
    77321XRadiation therapy port plan03054.06$196.86$97.50$39.37
    77326XRadiation therapy dose plan03054.06$196.86$97.50$39.37
    77327XRadiation therapy dose plan03054.06$196.86$97.50$39.37
    77328XRadiation therapy dose plan03054.06$196.86$97.50$39.37
    77331XSpecial radiation dosimetry03041.49$72.25$41.52$14.45
    77332XRadiation treatment aid(s)03032.83$137.22$69.28$27.44
    77333XRadiation treatment aid(s)03032.83$137.22$69.28$27.44
    77334XRadiation treatment aid(s)03032.83$137.22$69.28$27.44
    77336XRadiation physics consult03111.32$64.00$31.66$12.80
    77370XRadiation physics consult03111.32$64.00$31.66$12.80
    77399XExternal radiation dosimetry03111.32$64.00$31.66$12.80
    77401SRadiation treatment delivery03001.98$96.00$47.72$19.20
    77402SRadiation treatment delivery03001.98$96.00$47.72$19.20
    77403SRadiation treatment delivery03001.98$96.00$47.72$19.20
    77404SRadiation treatment delivery03001.98$96.00$47.72$19.20
    77406SRadiation treatment delivery03001.98$96.00$47.72$19.20
    77407SRadiation treatment delivery03001.98$96.00$47.72$19.20
    77408SRadiation treatment delivery03001.98$96.00$47.72$19.20
    77409SRadiation treatment delivery03001.98$96.00$47.72$19.20
    77411SRadiation treatment delivery03012.21$107.16$52.53$21.43
    77412SRadiation treatment delivery03012.21$107.16$52.53$21.43
    77413SRadiation treatment delivery03012.21$107.16$52.53$21.43
    77414SRadiation treatment delivery03001.98$96.00$47.72$19.20
    77416SRadiation treatment delivery03012.21$107.16$52.53$21.43
    77417XRadiology port film(s)02600.79$38.30$22.02$7.66
    77427ERadiation tx management, x5
    77431ERadiation therapy management
    77432EStereotactic radiation trmt
    77470SSpecial radiation treatment03028.21$398.08$216.55$79.62
    77499ERadiation therapy management
    77520SProton beam delivery03012.21$107.16$52.53$21.43
    77523SProton beam delivery03012.21$107.16$52.53$21.43
    77600SHyperthermia treatment03145.88$285.10$150.95$57.02
    77605SHyperthermia treatment03145.88$285.10$150.95$57.02
    77610SHyperthermia treatment03145.88$285.10$150.95$57.02
    77615SHyperthermia treatment03145.88$285.10$150.95$57.02
    77620SHyperthermia treatment03145.88$285.10$150.95$57.02
    77750SInfuse radioactive materials03012.21$107.16$52.53$21.43
    77761SRadioelement application03124.09$198.31$109.65$39.66
    77762SRadioelement application03124.09$198.31$109.65$39.66
    77763SRadioelement application03124.09$198.31$109.65$39.66
    77776SRadioelement application03124.09$198.31$109.65$39.66
    77777SRadioelement application03124.09$198.31$109.65$39.66
    77778SRadioelement application03124.09$198.31$109.65$39.66
    77781SHigh intensity brachytherapy03137.89$382.56$164.02$76.51
    77782SHigh intensity brachytherapy03137.89$382.56$164.02$76.51
    77783SHigh intensity brachytherapy03137.89$382.56$164.02$76.51
    77784SHigh intensity brachytherapy03137.89$382.56$164.02$76.51
    77789SRadioelement application03001.98$96.00$47.72$19.20
    77790NRadioelement handling
    77799SRadium/radioisotope therapy03137.89$382.56$164.02$76.51
    78000SThyroid, single uptake02901.94$94.06$55.51$18.81
    78001SThyroid, multiple uptakes02901.94$94.06$55.51$18.81
    78003SThyroid suppress/stimul02901.94$94.06$55.51$18.81
    78006SThyroid imaging with uptake02913.15$152.73$93.14$30.55
    78007SThyroid image, mult uptakes02913.15$152.73$93.14$30.55
    78010SThyroid imaging02901.94$94.06$55.51$18.81
    78011SThyroid imaging with flow02901.94$94.06$55.51$18.81
    Start Printed Page 18635
    78015SThyroid met imaging02913.15$152.73$93.14$30.55
    78016SThyroid met imaging/studies02924.36$211.40$126.63$42.28
    78018SThyroid met imaging, body02924.36$211.40$126.63$42.28
    78020SThyroid met uptake02924.36$211.40$126.63$42.28
    78070SParathyroid nuclear imaging02924.36$211.40$126.63$42.28
    78075SAdrenal nuclear imaging02924.36$211.40$126.63$42.28
    78099SEndocrine nuclear procedure02901.94$94.06$55.51$18.81
    78102SBone marrow imaging, ltd02913.15$152.73$93.14$30.55
    78103SBone marrow imaging, mult02924.36$211.40$126.63$42.28
    78104SBone marrow imaging, body02924.36$211.40$126.63$42.28
    78110SPlasma volume, single02913.15$152.73$93.14$30.55
    78111SPlasma volume, multiple02913.15$152.73$93.14$30.55
    78120SRed cell mass, single02913.15$152.73$93.14$30.55
    78121SRed cell mass, multiple02913.15$152.73$93.14$30.55
    78122SBlood volume02924.36$211.40$126.63$42.28
    78130SRed cell survival study02924.36$211.40$126.63$42.28
    78135SRed cell survival kinetics02924.36$211.40$126.63$42.28
    78140SRed cell sequestration02924.36$211.40$126.63$42.28
    78160SPlasma iron turnover02924.36$211.40$126.63$42.28
    78162SIron absorption exam02924.36$211.40$126.63$42.28
    78170SRed cell iron utilization02924.36$211.40$126.63$42.28
    78172STotal body iron estimation02924.36$211.40$126.63$42.28
    78185SSpleen imaging02913.15$152.73$93.14$30.55
    78190SPlatelet survival, kinetics02913.15$152.73$93.14$30.55
    78191SPlatelet survival02913.15$152.73$93.14$30.55
    78195SLymph system imaging02924.36$211.40$126.63$42.28
    78199SBlood/lymph nuclear exam02901.94$94.06$55.51$18.81
    78201SLiver imaging02913.15$152.73$93.14$30.55
    78202SLiver imaging with flow02913.15$152.73$93.14$30.55
    78205SLiver imaging (3D)02924.36$211.40$126.63$42.28
    78206SLiver image (3D) w/flow02924.36$211.40$126.63$42.28
    78215SLiver and spleen imaging02913.15$152.73$93.14$30.55
    78216SLiver & spleen image/flow02913.15$152.73$93.14$30.55
    78220SLiver function study02924.36$211.40$126.63$42.28
    78223SHepatobiliary imaging02924.36$211.40$126.63$42.28
    78230SSalivary gland imaging02913.15$152.73$93.14$30.55
    78231SSerial salivary imaging02913.15$152.73$93.14$30.55
    78232SSalivary gland function exam02913.15$152.73$93.14$30.55
    78258SEsophageal motility study02913.15$152.73$93.14$30.55
    78261SGastric mucosa imaging02913.15$152.73$93.14$30.55
    78262SGastroesophageal reflux exam02913.15$152.73$93.14$30.55
    78264SGastric emptying study02924.36$211.40$126.63$42.28
    2 78267TBreath tst attain/anal c-1409711.55$75.16$15.03
    2 78268TBreath test analysis, c-1409700.52$25.21$5.04
    78270SVit B-12 absorption exam02901.94$94.06$55.51$18.81
    78271SVit B-12 absorp exam, IF02901.94$94.06$55.51$18.81
    78272SVit B-12 absorp, combined02913.15$152.73$93.14$30.55
    78278SAcute GI blood loss imaging02924.36$211.40$126.63$42.28
    78282SGI protein loss exam02901.94$94.06$55.51$18.81
    78290SMeckel's divert exam02913.15$152.73$93.14$30.55
    78291SLeveen/shunt patency exam02924.36$211.40$126.63$42.28
    78299SGI nuclear procedure02901.94$94.06$55.51$18.81
    78300SBone imaging, limited area02913.15$152.73$93.14$30.55
    78305SBone imaging, multiple areas02924.36$211.40$126.63$42.28
    78306SBone imaging, whole body02924.36$211.40$126.63$42.28
    78315SBone imaging, 3 phase02924.36$211.40$126.63$42.28
    78320SBone imaging (3D)02924.36$211.40$126.63$42.28
    78350XBone mineral, single photon02611.38$66.91$38.77$13.38
    78351EBone mineral, dual photon
    78399SMusculoskeletal nuclear exam02901.94$94.06$55.51$18.81
    78414SNon-imaging heart function02924.36$211.40$126.63$42.28
    78428SCardiac shunt imaging02924.36$211.40$126.63$42.28
    78445SVascular flow imaging02913.15$152.73$93.14$30.55
    78455SVenous thrombosis study02913.15$152.73$93.14$30.55
    78456SAcute venous thrombus image02913.15$152.73$93.14$30.55
    78457SVenous thrombosis imaging02913.15$152.73$93.14$30.55
    78458SVen thrombosis images, bilat02913.15$152.73$93.14$30.55
    78459EHeart muscle imaging (PET)
    78460SHeart muscle blood, single02867.28$352.99$200.04$70.60
    78461SHeart muscle blood, multiple02867.28$352.99$200.04$70.60
    78464SHeart image (3D), single02867.28$352.99$200.04$70.60
    78465SHeart image (3D), multiple02867.28$352.99$200.04$70.60
    78466SHeart infarct image02924.36$211.40$126.63$42.28
    Start Printed Page 18636
    78468SHeart infarct image (ef)02924.36$211.40$126.63$42.28
    78469SHeart infarct image (3D)02924.36$211.40$126.63$42.28
    78472SGated heart, planar, single02867.28$352.99$200.04$70.60
    78473SGated heart, multiple02867.28$352.99$200.04$70.60
    78478SHeart wall motion add-on02867.28$352.99$200.04$70.60
    78480SHeart function add-on02867.28$352.99$200.04$70.60
    78481SHeart first pass, single02867.28$352.99$200.04$70.60
    78483SHeart first pass, multiple02867.28$352.99$200.04$70.60
    78491EHeart image (pet), single
    78492EHeart image (pet), multiple
    78494SHeart image, spect02963.57$173.10$100.25$34.62
    78496SHeart first pass add-on02963.57$173.10$100.25$34.62
    78499SCardiovascular nuclear exam02924.36$211.40$126.63$42.28
    78580SLung perfusion imaging02913.15$152.73$93.14$30.55
    78584SLung V/Q image single breath02924.36$211.40$126.63$42.28
    78585SLung V/Q imaging02924.36$211.40$126.63$42.28
    78586SAerosol lung image, single02924.36$211.40$126.63$42.28
    78587SAerosol lung image, multiple02924.36$211.40$126.63$42.28
    78588SPerfusion lung image02924.36$211.40$126.63$42.28
    78591SVent image, 1 breath, 1 proj02913.15$152.73$93.14$30.55
    78593SVent image, 1 proj, gas02924.36$211.40$126.63$42.28
    78594SVent image, mult proj, gas02924.36$211.40$126.63$42.28
    78596SLung differential function02924.36$211.40$126.63$42.28
    78599SRespiratory nuclear exam02913.15$152.73$93.14$30.55
    78600SBrain imaging, ltd static02924.36$211.40$126.63$42.28
    78601SBrain imaging, ltd w/flow02924.36$211.40$126.63$42.28
    78605SBrain imaging, complete02913.15$152.73$93.14$30.55
    78606SBrain imaging, compl w/flow02924.36$211.40$126.63$42.28
    78607SBrain imaging (3D)02924.36$211.40$126.63$42.28
    78608EBrain imaging (PET)
    78609EBrain imaging (PET)
    78610SBrain flow imaging only02913.15$152.73$93.14$30.55
    78615SCerebral blood flow imaging02924.36$211.40$126.63$42.28
    78630SCerebrospinal fluid scan02924.36$211.40$126.63$42.28
    78635SCSF ventriculography02924.36$211.40$126.63$42.28
    78645SCSF shunt evaluation02924.36$211.40$126.63$42.28
    78647SCerebrospinal fluid scan02924.36$211.40$126.63$42.28
    78650SCSF leakage imaging02924.36$211.40$126.63$42.28
    78655S02924.36$211.40$126.63$42.28
    78660SNuclear exam of tear flow02913.15$152.73$93.14$30.55
    78699SNervous system nuclear exam02924.36$211.40$126.63$42.28
    78700SKidney imaging, static02913.15$152.73$93.14$30.55
    78701SKidney imaging with flow02913.15$152.73$93.14$30.55
    78704SImaging renogram02924.36$211.40$126.63$42.28
    78707SKidney flow/function image02924.36$211.40$126.63$42.28
    78708SKidney flow/function image02924.36$211.40$126.63$42.28
    78709SKidney flow/function image02924.36$211.40$126.63$42.28
    78710SKidney imaging (3D)02924.36$211.40$126.63$42.28
    78715SRenal vascular flow exam02913.15$152.73$93.14$30.55
    78725SKidney function study02913.15$152.73$93.14$30.55
    78730SUrinary bladder retention02913.15$152.73$93.14$30.55
    78740SUreteral reflux study02913.15$152.73$93.14$30.55
    78760STesticular imaging02913.15$152.73$93.14$30.55
    78761STesticular imaging/flow02913.15$152.73$93.14$30.55
    78799SGenitourinary nuclear exam02924.36$211.40$126.63$42.28
    78800STumor imaging, limited area02924.36$211.40$126.63$42.28
    78801STumor imaging, mult areas02924.36$211.40$126.63$42.28
    78802STumor imaging, whole body02924.36$211.40$126.63$42.28
    78803STumor imaging (3D)02924.36$211.40$126.63$42.28
    78805SAbscess imaging, ltd area02924.36$211.40$126.63$42.28
    78806SAbscess imaging, whole body02924.36$211.40$126.63$42.28
    78807SNuclear localization/abscess02924.36$211.40$126.63$42.28
    78810ETumor imaging (PET)
    78890NNuclear medicine data proc
    78891NNuclear med data proc
    78990NProvide diag radionuclide(s)
    78999SNuclear diagnostic exam02913.15$152.73$93.14$30.55
    79000SInit hyperthyroid therapy02945.13$248.74$144.06$49.75
    79001SRepeat hyperthyroid therapy02945.13$248.74$144.06$49.75
    79020SThyroid ablation02945.13$248.74$144.06$49.75
    79030SThyroid ablation, carcinoma02945.13$248.74$144.06$49.75
    79035SThyroid metastatic therapy02945.13$248.74$144.06$49.75
    79100SHematopoetic nuclear therapy02945.13$248.74$144.06$49.75
    Start Printed Page 18637
    79200SIntracavitary nuclear trmt029519.85$962.47$609.17$192.49
    79300SInterstitial nuclear therapy02945.13$248.74$144.06$49.75
    79400SNonhemato nuclear therapy029519.85$962.47$609.17$192.49
    79420SIntravascular nuclear ther029519.85$962.47$609.17$192.49
    79440SNuclear joint therapy02945.13$248.74$144.06$49.75
    79900NProvide ther radiopharm(s)
    79999SNuclear medicine therapy02945.13$248.74$144.06$49.75
    80048ABasic metabolic panel
    80050AGeneral health panel
    80051AElectrolyte panel
    80053AComprehen metabolic panel
    80055AObstetric panel
    80061ALipid panel
    80069ARenal function panel
    80072AArthritis panel
    80074AAcute hepatitis panel
    80076AHepatic function panel
    80090ATorch antibody panel
    80100ADrug screen
    80101ADrug screen
    80102ADrug confirmation
    80103NDrug analysis, tissue prep
    80150AAssay of amikacin
    80152AAssay of amitriptyline
    80154AAssay of benzodiazepines
    80156AAssay of carbamazepine
    80158AAssay of cyclosporine
    80160AAssay of desipramine
    80162AAssay of digoxin
    80164AAssay, dipropylacetic acid
    80166AAssay of doxepin
    80168AAssay of ethosuximide
    80170AAssay of gentamicin
    80172AAssay of gold
    80174AAssay of imipramine
    80176AAssay of lidocaine
    80178AAssay of lithium
    80182AAssay of nortriptyline
    80184AAssay of phenobarbital
    80185AAssay of phenytoin, total
    80186AAssay of phenytoin, free
    80188AAssay of primidone
    80190AAssay of procainamide
    80192AAssay of procainamide
    80194AAssay of quinidine
    80196AAssay of salicylate
    80197AAssay of tacrolimus
    80198AAssay of theophylline
    80200AAssay of tobramycin
    80201AAssay of topiramate
    80202AAssay of vancomycin
    80299AQuantitative assay, drug
    80400AActh stimulation panel
    80402AActh stimulation panel
    80406AActh stimulation panel
    80408AAldosterone suppression eval
    80410ACalcitonin stimul panel
    80412ACRH stimulation panel
    80414ATestosterone response
    80415AEstradiol response panel
    80416ARenin stimulation panel
    80417ARenin stimulation panel
    80418APituitary evaluation panel
    80420ADexamethasone panel
    80422AGlucagon tolerance panel
    80424AGlucagon tolerance panel
    80426AGonadotropin hormone panel
    80428AGrowth hormone panel
    80430AGrowth hormone panel
    80432AInsulin suppression panel
    80434AInsulin tolerance panel
    80435AInsulin tolerance panel
    80436AMetyrapone panel
    Start Printed Page 18638
    80438ATRH stimulation panel
    80439ATRH stimulation panel
    80440ATRH stimulation panel
    80500XLab pathology consultation03430.45$21.82$12.16$4.36
    80502XLab pathology consultation03430.45$21.82$12.16$4.36
    81000AUrinalysis, nonauto w/scope
    81001AUrinalysis, auto w/scope
    81002AUrinalysis nonauto w/o scope
    81003AUrinalysis, auto, w/o scope
    81005AUrinalysis
    81007AUrine screen for bacteria
    81015AMicroscopic exam of urine
    81020AUrinalysis, glass test
    81025AUrine pregnancy test
    81050AUrinalysis, volume measure
    81099AUrinalysis test procedure
    82000AAssay of blood acetaldehyde
    82003AAssay of acetaminophen
    82009ATest for acetone/ketones
    82010AAcetone assay
    82013AAcetylcholinesterase assay
    82016AAcylcarnitines, qual
    82017AAcylcarnitines, quant
    82024AAssay of acth
    82030AAssay of adp & amp
    82040AAssay of serum albumin
    82042AAssay of urine albumin
    82043AMicroalbumin, quantitative
    82044AMicroalbumin, semiquant
    82055AAssay of ethanol
    82075AAssay of breath ethanol
    82085AAssay of aldolase
    82088AAssay of aldosterone
    82101AAssay of urine alkaloids
    82103AAlpha-1-antitrypsin, total
    82104AAlpha-1-antitrypsin, pheno
    82105AAlpha-fetoprotein, serum
    82106AAlpha-fetoprotein, amniotic
    82108AAssay of aluminum
    82120AAmines, vaginal fluid qual
    82127AAmino acid, single qual
    82128AAmino acids, mult qual
    82131AAmino acids, single quant
    82135AAssay, aminolevulinic acid
    82136AAmino acids, quant, 2-5
    82139AAmino acids, quan, 6 or more
    82140AAssay of ammonia
    82143AAmniotic fluid scan
    82145AAssay of amphetamines
    82150AAssay of amylase
    82154AAndrostanediol glucuronide
    82157AAssay of androstenedione
    82160AAssay of androsterone
    82163AAssay of angiotensin II
    82164AAngiotensin I enzyme test
    82172AAssay of apolipoprotein
    82175AAssay of arsenic
    82180AAssay of ascorbic acid
    82190AAtomic absorption
    82205AAssay of barbiturates
    82232AAssay of beta-2 protein
    82239ABile acids, total
    82240ABile acids, cholylglycine
    82247ABilirubin, total
    82248ABilirubin, direct
    82251AAssay of bilirubin
    82252AFecal bilirubin test
    82261AAssay of biotinidase
    82270ATest for blood, feces
    82273ATest for blood, other source
    82286AAssay of bradykinin
    82300AAssay of cadmium
    82306AAssay of vitamin D
    Start Printed Page 18639
    82307AAssay of vitamin D
    82308AAssay of calcitonin
    82310AAssay of calcium
    82330AAssay of calcium
    82331ACalcium infusion test
    82340AAssay of calcium in urine
    82355ACalculus (stone) analysis
    82360ACalculus (stone) assay
    82365ACalculus (stone) assay
    82370AX-ray assay, calculus
    82374AAssay, blood carbon dioxide
    82375AAssay, blood carbon monoxide
    82376ATest for carbon monoxide
    82378ACarcinoembryonic antigen
    82379AAssay of carnitine
    82380AAssay of carotene
    82382AAssay, urine catecholamines
    82383AAssay, blood catecholamines
    82384AAssay, three catecholamines
    82387AAssay of cathepsin-d
    82390AAssay of ceruloplasmin
    82397AChemiluminescent assay
    82415AAssay of chloramphenicol
    82435AAssay of blood chloride
    82436AAssay of urine chloride
    82438AAssay, other fluid chlorides
    82441ATest for chlorohydrocarbons
    82465AAssay of serum cholesterol
    82480AAssay, serum cholinesterase
    82482AAssay, rbc cholinesterase
    82485AAssay, chondroitin sulfate
    82486AGas/liquid chromatography
    82487APaper chromatography
    82488APaper chromatography
    82489AThin layer chromatography
    82491AChromotography, quant, sing
    82492AChromotography, quant, mult
    82495AAssay of chromium
    82507AAssay of citrate
    82520AAssay of cocaine
    82523ACollagen crosslinks
    82525AAssay of copper
    82528AAssay of corticosterone
    82530ACortisol, free
    82533ATotal cortisol
    82540AAssay of creatine
    82541AColumn chromotography, qual
    82542AColumn chromotography, quant
    82543AColumn chromotograph/isotope
    82544AColumn chromotograph/isotope
    82550AAssay of ck (cpk)
    82552AAssay of cpk in blood
    82553ACreatine, MB fraction
    82554ACreatine, isoforms
    82565AAssay of creatinine
    82570AAssay of urine creatinine
    82575ACreatinine clearance test
    82585AAssay of cryofibrinogen
    82595AAssay of cryoglobulin
    82600AAssay of cyanide
    82607AVitamin B-12
    82608AB-12 binding capacity
    82615ATest for urine cystines
    82626ADehydroepiandrosterone
    82627ADehydroepiandrosterone
    82633ADesoxycorticosterone
    82634ADeoxycortisol
    82638AAssay of dibucaine number
    82646AAssay of dihydrocodeinone
    82649AAssay of dihydromorphinone
    82651AAssay of dihydrotestosterone
    82652AAssay of dihydroxyvitamin d
    82654AAssay of dimethadione
    Start Printed Page 18640
    82657AEnzyme cell activity
    82658AEnzyme cell activity, ra
    82664AElectrophoretic test
    82666AAssay of epiandrosterone
    82668AAssay of erythropoietin
    82670AAssay of estradiol
    82671AAssay of estrogens
    82672AAssay of estrogen
    82677AAssay of estriol
    82679AAssay of estrone
    82690AAssay of ethchlorvynol
    82693AAssay of ethylene glycol
    82696AAssay of etiocholanolone
    82705AFats/lipids, feces, qual
    82710AFats/lipids, feces, quant
    82715AAssay of fecal fat
    82725AAssay of blood fatty acids
    82726ALong chain fatty acids
    82728AAssay of ferritin
    82731AAssay of fetal fibronectin
    82735AAssay of fluoride
    82742AAssay of flurazepam
    82746ABlood folic acid serum
    82747AAssay of folic acid, rbc
    82757AAssay of semen fructose
    82759AAssay of rbc galactokinase
    82760AAssay of galactose
    82775AAssay galactose transferase
    82776AGalactose transferase test
    82784AAssay of gammaglobulin igm
    82785AAssay of gammaglobulin ige
    82787AIgg 1, 2, 3 and 4
    82800ABlood pH
    82803ABlood gases: pH, pO2 & pCO2
    82805ABlood gases W/02 saturation
    82810ABlood gases, O2 sat only
    82820AHemoglobin-oxygen affinity
    82926AAssay of gastric acid
    82928AAssay of gastric acid
    82938AGastrin test
    82941AAssay of gastrin
    82943AAssay of glucagon
    82946AGlucagon tolerance test
    82947AAssay of glucose, quant
    82948AReagent strip/blood glucose
    82950AGlucose test
    82951AGlucose tolerance test (GTT)
    82952AGTT-added samples
    82953AGlucose-tolbutamide test
    82955AAssay of g6pd enzyme
    82960ATest for G6PD enzyme
    82962AGlucose blood test
    82963AAssay of glucosidase
    82965AAssay of gdh enzyme
    82975AAssay of glutamine
    82977AAssay of GGT
    82978AAssay of glutathione
    82979AAssay, rbc glutathione
    82980AAssay of glutethimide
    82985AGlycated protein
    83001AGonadotropin (FSH)
    83002AGonadotropin (LH)
    83003AAssay, growth hormone (hgh)
    83008AAssay of guanosine
    83010AAssay of haptoglobin, quant
    83012AAssay of haptoglobins
    83013AH pylori breath tst analysis
    83014AH pylori drug admin/collect
    83015AHeavy metal screen
    83018AQuantitative screen, metals
    83020AHemoglobin electrophoresis
    83021AHemoglobin chromotography
    83026AHemoglobin, copper sulfate
    Start Printed Page 18641
    83030AFetal hemoglobin assay
    83033AFetal fecal hemoglobin assay
    83036AGlycated hemoglobin test
    83045ABlood methemoglobin test
    83050ABlood methemoglobin assay
    83051AAssay of plasma hemoglobin
    83055ABlood sulfhemoglobin test
    83060ABlood sulfhemoglobin assay
    83065AAssay of hemoglobin heat
    83068AHemoglobin stability screen
    83069AAssay of urine hemoglobin
    83070AAssay of hemosiderin, qual
    83071AAssay of hemosiderin, quant
    83080AAssay of b hexosaminidase
    83088AAssay of histamine
    83150AAssay of for hva
    83491AAssay of corticosteroids
    83497AAssay of 5-hiaa
    83498AAssay of progesterone
    83499AAssay of progesterone
    83500AAssay, free hydroxyproline
    83505AAssay, total hydroxyproline
    83516AImmunoassay, nonantibody
    83518AImmunoassay, dipstick
    83519AImmunoassay, nonantibody
    83520AImmunoassay, RIA
    83525AAssay of insulin
    83527AAssay of insulin
    83528AAssay of intrinsic factor
    83540AAssay of iron
    83550AIron binding test
    83570AAssay of idh enzyme
    83582AAssay of ketogenic steroids
    83586AAssay 17-ketosteroids
    83593AFractionation, ketosteroids
    83605AAssay of lactic acid
    83615ALactate (LD) (LDH) enzyme
    83625AAssay of ldh enzymes
    83632APlacental lactogen
    83633ATest urine for lactose
    83634AAssay of urine for lactose
    83655AAssay of lead
    83661AAssay of l/s ratio
    83662AL/S ratio, foam stability
    83670AAssay of lap enzyme
    83690AAssay of lipase
    83715AAssay of blood lipoproteins
    83716AAssay of blood lipoproteins
    83718AAssay of lipoprotein
    83719AAssay of blood lipoprotein
    83721AAssay of blood lipoprotein
    83727AAssay of lrh hormone
    83735AAssay of magnesium
    83775AAssay of md enzyme
    83785AAssay of manganese
    83788AMass spectrometry qual
    83789AMass spectrometry quant
    83805AAssay of meprobamate
    83825AAssay of mercury
    83835AAssay of metanephrines
    83840AAssay of methadone
    83857AAssay of methemalbumin
    83858AAssay of methsuximide
    83864AMucopolysaccharides
    83866AMucopolysaccharides screen
    83872AAssay synovial fluid mucin
    83873AAssay of csf protein
    83874AAssay of myoglobin
    83883AAssay, nephelometry not spec
    83885AAssay of nickel
    83887AAssay of nicotine
    83890AMolecule isolate
    83891AMolecule isolate nucleic
    Start Printed Page 18642
    83892AMolecular diagnostics
    83893AMolecule dot/slot/blot
    83894AMolecule gel electrophor
    83896AMolecular diagnostics
    83897AMolecule nucleic transfer
    83898AMolecule nucleic ampli
    83901AMolecule nucleic ampli
    83902AMolecular diagnostics
    83903AMolecule mutation scan
    83904AMolecule mutation identify
    83905AMolecule mutation identify
    83906AMolecule mutation identify
    83912AGenetic examination
    83915AAssay of nucleotidase
    83916AOligoclonal bands
    83918AAssay, organic acids quant
    83919AAssay, organic acids qual
    83925AAssay of opiates
    83930AAssay of blood osmolality
    83935AAssay of urine osmolality
    83937AAssay of osteocalcin
    83945AAssay of oxalate
    83970AAssay of parathormone
    83986AAssay of body fluid acidity
    83992AAssay for phencyclidine
    84022AAssay of phenothiazine
    84030AAssay of blood pku
    84035AAssay of phenylketones
    84060AAssay acid phosphatase
    84061APhosphatase, forensic exam
    84066AAssay prostate phosphatase
    84075AAssay alkaline phosphatase
    84078AAssay alkaline phosphatase
    84080AAssay alkaline phosphatases
    84081AAmniotic fluid enzyme test
    84085AAssay of rbc pg6d enzyme
    84087AAssay phosphohexose enzymes
    84100AAssay of phosphorus
    84105AAssay of urine phosphorus
    84106ATest for porphobilinogen
    84110AAssay of porphobilinogen
    84119ATest urine for porphyrins
    84120AAssay of urine porphyrins
    84126AAssay of feces porphyrins
    84127AAssay of feces porphyrins
    84132AAssay of serum potassium
    84133AAssay of urine potassium
    84134AAssay of prealbumin
    84135AAssay of pregnanediol
    84138AAssay of pregnanetriol
    84140AAssay of pregnenolone
    84143AAssay of 17-hydroxypregneno
    84144AAssay of progesterone
    84146AAssay of prolactin
    84150AAssay of prostaglandin
    84153AAssay of psa, total
    84154AAssay of psa, free
    84155AAssay of protein
    84160AAssay of serum protein
    84165AAssay of serum proteins
    84181AWestern blot test
    84182AProtein, western blot test
    84202AAssay RBC protoporphyrin
    84203ATest RBC protoporphyrin
    84206AAssay of proinsulin
    84207AAssay of vitamin b-6
    84210AAssay of pyruvate
    84220AAssay of pyruvate kinase
    84228AAssay of quinine
    84233AAssay of estrogen
    84234AAssay of progesterone
    84235AAssay of endocrine hormone
    84238AAssay, nonendocrine receptor
    Start Printed Page 18643
    84244AAssay of renin
    84252AAssay of vitamin b-2
    84255AAssay of selenium
    84260AAssay of serotonin
    84270AAssay of sex hormone globul
    84275AAssay of sialic acid
    84285AAssay of silica
    84295AAssay of serum sodium
    84300AAssay of urine sodium
    84305AAssay of somatomedin
    84307AAssay of somatostatin
    84311ASpectrophotometry
    84315ABody fluid specific gravity
    84375AChromatogram assay, sugars
    84376ASugars, single, qual
    84377ASugars, multiple, qual
    84378ASugars single quant
    84379ASugars multiple quant
    84392AAssay of urine sulfate
    84402AAssay of testosterone
    84403AAssay of total testosterone
    84425AAssay of vitamin b-1
    84430AAssay of thiocyanate
    84432AAssay of thyroglobulin
    84436AAssay of total thyroxine
    84437AAssay of neonatal thyroxine
    84439AAssay of free thyroxine
    84442AAssay of thyroid activity
    84443AAssay thyroid stim hormone
    84445AAssay of tsi
    84446AAssay of vitamin e
    84449AAssay of transcortin
    84450ATransferase (AST) (SGOT)
    84460AAlanine amino (ALT) (SGPT)
    84466AAssay of transferrin
    84478AAssay of triglycerides
    84479AAssay of thyroid (t3 or t4)
    84480AAssay, triiodothyronine (t3)
    84481AFree assay (FT-3)
    84482AT3 reverse
    84484AAssay of troponin, quant
    84485AAssay duodenal fluid trypsin
    84488ATest feces for trypsin
    84490AAssay of feces for trypsin
    84510AAssay of tyrosine
    84512AAssay of troponin, qual
    84520AAssay of urea nitrogen
    84525AUrea nitrogen semi-quant
    84540AAssay of urine/urea-n
    84545AUrea-N clearance test
    84550AAssay of blood/uric acid
    84560AAssay of urine/uric acid
    84577AAssay of feces/urobilinogen
    84578ATest urine urobilinogen
    84580AAssay of urine urobilinogen
    84583AAssay of urine urobilinogen
    84585AAssay of urine vma
    84586AAssay of vip
    84588AAssay of vasopressin
    84590AAssay of vitamin a
    84597AAssay of vitamin k
    84600AAssay of volatiles
    84620AXylose tolerance test
    84630AAssay of zinc
    84681AAssay of c-peptide
    84702AChorionic gonadotropin test
    84703AChorionic gonadotropin assay
    84830AOvulation tests
    84999AClinical chemistry test
    85002ABleeding time test
    85007ADifferential WBC count
    85008ANondifferential WBC count
    85009ADifferential WBC count
    Start Printed Page 18644
    85013AHematocrit
    85014AHematocrit
    85018AHemoglobin
    85021AAutomated hemogram
    85022AAutomated hemogram
    85023AAutomated hemogram
    85024AAutomated hemogram
    85025AAutomated hemogram
    85027AAutomated hemogram
    85031AManual hemogram, cbc
    85041ARed blood cell (RBC) count
    85044AReticulocyte count
    85045AReticulocyte count
    85046AReticyte/hgb concentrate
    85048AWhite blood cell (WBC) count
    85060XBlood smear interpretation03420.26$12.61$8.03$2.52
    85095TBone marrow aspiration00030.98$47.52$27.99$9.50
    85097XBone marrow interpretation03440.79$38.30$23.63$7.66
    85102TBone marrow biopsy00030.98$47.52$27.99$9.50
    85130AChromogenic substrate assay
    85170ABlood clot retraction
    85175ABlood clot lysis time
    85210ABlood clot factor II test
    85220ABlood clot factor V test
    85230ABlood clot factor VII test
    85240ABlood clot factor VIII test
    85244ABlood clot factor VIII test
    85245ABlood clot factor VIII test
    85246ABlood clot factor VIII test
    85247ABlood clot factor VIII test
    85250ABlood clot factor IX test
    85260ABlood clot factor X test
    85270ABlood clot factor XI test
    85280ABlood clot factor XII test
    85290ABlood clot factor XIII test
    85291ABlood clot factor XIII test
    85292ABlood clot factor assay
    85293ABlood clot factor assay
    85300AAntithrombin III test
    85301AAntithrombin III test
    85302ABlood clot inhibitor antigen
    85303ABlood clot inhibitor test
    85305ABlood clot inhibitor assay
    85306ABlood clot inhibitor test
    85335AFactor inhibitor test
    85337AThrombomodulin
    85345ACoagulation time
    85347ACoagulation time
    85348ACoagulation time
    85360AEuglobulin lysis
    85362AFibrin degradation products
    85366AFibrinogen test
    85370AFibrinogen test
    85378AFibrin degradation
    85379AFibrin degradation
    85384AFibrinogen
    85385AFibrinogen
    85390AFibrinolysins screen
    85400AFibrinolytic plasmin
    85410AFibrinolytic antiplasmin
    85415AFibrinolytic plasminogen
    85420AFibrinolytic plasminogen
    85421AFibrinolytic plasminogen
    85441AHeinz bodies, direct
    85445AHeinz bodies, induced
    85460AHemoglobin, fetal
    85461AHemoglobin, fetal
    85475AHemolysin
    85520AHeparin assay
    85525AHeparin
    85530AHeparin-protamine tolerance
    85535AIron stain, blood cells
    85540AWbc alkaline phosphatase
    Start Printed Page 18645
    85547ARBC mechanical fragility
    85549AMuramidase
    85555ARBC osmotic fragility
    85557ARBC osmotic fragility
    85576ABlood platelet aggregation
    85585ABlood platelet estimation
    85590APlatelet count, manual
    85595APlatelet count, automated
    85597APlatelet neutralization
    85610AProthrombin time
    85611AProthrombin test
    85612AViper venom prothrombin time
    85613ARussell viper venom, diluted
    85635AReptilase test
    85651ARbc sed rate, nonautomated
    85652ARbc sed rate, automated
    85660ARBC sickle cell test
    85670AThrombin time, plasma
    85675AThrombin time, titer
    85705AThromboplastin inhibition
    85730AThromboplastin time, partial
    85732AThromboplastin time, partial
    85810ABlood viscosity examination
    85999AHematology procedure
    86000AAgglutinins, febrile
    86003AAllergen specific IgE
    86005AAllergen specific IgE
    86021AWBC antibody identification
    86022APlatelet antibodies
    86023AImmunoglobulin assay
    86038AAntinuclear antibodies
    86039AAntinuclear antibodies (ANA)
    86060AAntistreptolysin o, titer
    86063AAntistreptolysin o, screen
    86077XPhysician blood bank service03430.45$21.82$12.16$4.36
    86078XPhysician blood bank service03440.79$38.30$23.63$7.66
    86079XPhysician blood bank service03440.79$38.30$23.63$7.66
    86140AC-reactive protein
    86147ACardiolipin antibody
    86148APhospholipid antibody
    86155AChemotaxis assay
    86156ACold agglutinin, screen
    86157ACold agglutinin, titer
    86160AComplement, antigen
    86161AComplement/function activity
    86162AComplement, total (CH50)
    86171AComplement fixation, each
    86185ACounterimmunoelectrophoresis
    86215ADeoxyribonuclease, antibody
    86225ADNA antibody
    86226ADNA antibody, single strand
    86235ANuclear antigen antibody
    86243AFc receptor
    86255AFluorescent antibody, screen
    86256AFluorescent antibody, titer
    86277AGrowth hormone antibody
    86280AHemagglutination inhibition
    86308AHeterophile antibodies
    86309AHeterophile antibodies
    86310AHeterophile antibodies
    86316AImmunoassay, tumor antigen
    86317AImmunoassay, infectious agent
    86318AImmunoassay, infectious agent
    86320ASerum immunoelectrophoresis
    86325AOther immunoelectrophoresis
    86327AImmunoelectrophoresis assay
    86329AImmunodiffusion
    86331AImmunodiffusion ouchterlony
    86332AImmune complex assay
    86334AImmunofixation procedure
    86337AInsulin antibodies
    86340AIntrinsic factor antibody
    86341AIslet cell antibody
    Start Printed Page 18646
    86343ALeukocyte histamine release
    86344ALeukocyte phagocytosis
    86353ALymphocyte transformation
    86359AT cells, total count
    86360AT cell, absolute count/ratio
    86361AT cell, absolute count
    86376AMicrosomal antibody
    86378AMigration inhibitory factor
    86382ANeutralization test, viral
    86384ANitroblue tetrazolium dye
    86403AParticle agglutination test
    86406AParticle agglutination test
    86430ARheumatoid factor test
    86431ARheumatoid factor, quant
    86485XSkin test, candida03410.13$6.30$3.67$1.26
    86490XCoccidioidomycosis skin test03410.13$6.30$3.67$1.26
    86510XHistoplasmosis skin test03410.13$6.30$3.67$1.26
    86580XTB intradermal test03410.13$6.30$3.67$1.26
    86585XTB tine test03410.13$6.30$3.67$1.26
    86586XSkin test, unlisted03410.13$6.30$3.67$1.26
    86590AStreptokinase, antibody
    86592ABlood serology, qualitative
    86593ABlood serology, quantitative
    86602AAntinomyces antibody
    86603AAdenovirus antibody
    86606AAspergillus antibody
    86609ABacterium antibody
    86612ABlastomyces antibody
    86615ABordetella antibody
    86617ALyme disease antibody
    86618ALyme disease antibody
    86619ABorrelia antibody
    86622ABrucella antibody
    86625ACampylobacter antibody
    86628ACandida antibody
    86631AChlamydia antibody
    86632AChlamydia igm antibody
    86635ACoccidioides antibody
    86638AQ fever antibody
    86641ACryptococcus antibody
    86644ACMV antibody
    86645ACMV antibody, IgM
    86648ADiphtheria antibody
    86651AEncephalitis antibody
    86652AEncephalitis antibody
    86653AEncephalitis antibody
    86654AEncephalitis antibody
    86658AEnterovirus antibody
    86663AEpstein-barr antibody
    86664AEpstein-barr antibody
    86665AEpstein-barr antibody
    86668AFrancisella tularensis
    86671AFungus antibody
    86674AGiardia lamblia antibody
    86677AHelicobacter pylori
    86682AHelminth antibody
    86684AHemophilus influenza
    86687AHtlv-i antibody
    86688AHtlv-ii antibody
    86689AHTLV/HIV confirmatory test
    86692AHepatitis, delta agent
    86694AHerpes simplex test
    86695AHerpes simplex test
    86698AHistoplasma
    86701AHIV-1
    86702AHIV-2
    86703AHIV-1/HIV-2, single assay
    86704AHep b core antibody, igg/igm
    86705AHep b core antibody, igm
    86706AHep b surface antibody
    86707AHep be antibody
    86708AHep a antibody, igg/igm
    86709AHep a antibody, igm
    Start Printed Page 18647
    86710AInfluenza virus antibody
    86713ALegionella antibody
    86717ALeishmania antibody
    86720ALeptospira antibody
    86723AListeria monocytogenes ab
    86727ALymph choriomeningitis ab
    86729ALympho venereum antibody
    86732AMucormycosis antibody
    86735AMumps antibody
    86738AMycoplasma antibody
    86741ANeisseria meningitidis
    86744ANocardia antibody
    86747AParvovirus antibody
    86750AMalaria antibody
    86753AProtozoa antibody nos
    86756ARespiratory virus antibody
    86759ARotavirus antibody
    86762ARubella antibody
    86765ARubeola antibody
    86768ASalmonella antibody
    86771AShigella antibody
    86774ATetanus antibody
    86777AToxoplasma antibody
    86778AToxoplasma antibody, igm
    86781ATreponema pallidum, confirm
    86784ATrichinella antibody
    86787AVaricella-zoster antibody
    86790AVirus antibody nos
    86793AYersinia antibody
    86800AThyroglobulin antibody
    86803AHepatitis c ab test
    86804AHep c ab test, confirm
    86805ALymphocytotoxicity assay
    86806ALymphocytotoxicity assay
    86807ACytotoxic antibody screening
    86808ACytotoxic antibody screening
    86812AHLA typing, A, B, or C
    86813AHLA typing, A, B, or C
    86816AHLA typing, DR/DQ
    86817AHLA typing, DR/DQ
    86821ALymphocyte culture, mixed
    86822ALymphocyte culture, primed
    86849AImmunology procedure
    86850ARBC antibody screen
    86860ARBC antibody elution
    86870ARBC antibody identification
    86880ACoombs test
    86885ACoombs test
    86886ACoombs test
    86890AAutologous blood process
    86891AAutologous blood, op salvage
    86900ABlood typing, ABO
    86901ABlood typing, Rh (D)
    86903ABlood typing, antigen screen
    86904ABlood typing, patient serum
    86905ABlood typing, RBC antigens
    86906ABlood typing, Rh phenotype
    86910EBlood typing, paternity test
    86911EBlood typing, antigen system
    86915ABone marrow/stem cell prep
    86920ACompatibility test
    86921ACompatibility test
    86922ACompatibility test
    86927APlasma, fresh frozen
    86930AFrozen blood prep
    86931AFrozen blood thaw
    86932AFrozen blood freeze/thaw
    86940AHemolysins/agglutinins, auto
    86941AHemolysins/agglutinins
    86945ABlood product/irradiation
    86950ALeukacyte transfusion
    86965APooling blood platelets
    86970ARBC pretreatment
    Start Printed Page 18648
    86971ARBC pretreatment
    86972ARBC pretreatment
    86975ARBC pretreatment, serum
    86976ARBC pretreatment, serum
    86977ARBC pretreatment, serum
    86978ARBC pretreatment, serum
    86985ASplit blood or products
    86999ATransfusion procedure
    87001ASmall animal inoculation
    87003ASmall animal inoculation
    87015ASpecimen concentration
    87040ABlood culture for bacteria
    87045AStool culture for bacteria
    87060ANose/throat culture, bact
    87070ACulture specimen, bacteria
    87072ACulture of specimen by kit
    87075ACulture specimen, bacteria
    87076ABacteria identification
    87081ABacteria culture screen
    87082ACulture of specimen by kit
    87083ACulture of specimen by kit
    87084ACulture of specimen by kit
    87085ACulture of specimen by kit
    87086AUrine culture/colony count
    87087AUrine bacteria culture
    87088AUrine bacteria culture
    87101ASkin fungus culture
    87102AFungus isolation culture
    87103ABlood fungus culture
    87106AFungus identification
    87109AMycoplasma culture
    87110ACulture, chlamydia
    87116AMycobacteria culture
    87117AMycobacteria culture
    87118AMycobacteria identification
    87140ACulture typing, fluorescent
    87143ACulture typing, GLC method
    87145ACulture typing, phage method
    87147ACulture typing, serologic
    87151ACulture typing, serologic
    87155ACulture typing, precipitin
    87158ACulture typing, added method
    87163ASpecial microbiology culture
    87164ADark field examination
    87166ADark field examination
    87174AEndotoxin, bacterial
    87175AAssay, endotoxin, bacterial
    87176AEndotoxin, bacterial
    87177AOva and parasites smears
    87181AAntibiotic sensitivity, each
    87184AAntibiotic sensitivity, each
    87186AAntibiotic sensitivity, MIC
    87187AAntibiotic sensitivity, MBC
    87188AAntibiotic sensitivity, each
    87190ATB antibiotic sensitivity
    87192AAntibiotic sensitivity, each
    87197ABactericidal level, serum
    87205ASmear, stain & interpret
    87206ASmear, stain & interpret
    87207ASmear, stain & interpret
    87208ASmear, stain & interpret
    87210ASmear, stain & interpret
    87211ASmear, stain & interpret
    87220ATissue exam for fungi
    87230AAssay, toxin or antitoxin
    87250AVirus inoculation for test
    87252AVirus inoculation for test
    87253AVirus inoculation for test
    87260AAdenovirus ag, dfa
    87265APertussis ag, dfa
    87270AChylmd trach ag, dfa
    87272ACryptosporidum ag, dfa
    87274AHerpes simplex ag, dfa
    Start Printed Page 18649
    87276AInfluenza ag, dfa
    87278ALegion pneumo ag, dfa
    87280AResp syncytial ag, dfa
    87285ATrepon pallidum ag, dfa
    87290AVaricella ag, dfa
    87299AAg detection nos, dfa
    87301AAdenovirus ag, eia
    87320AChylmd trach ag, eia
    87324AClostridium ag, eia
    87328ACryptospor ag, eia
    87332ACytomegalovirus ag, eia
    87335AE coli 0157 ag, eia
    87338AHpylori, stool, eia
    87340AHepatitis b surface ag, eia
    87350AHepatitis be ag, eia
    87380AHepatitis delta ag, eia
    87385AHistoplasma capsul ag, eia
    87390AHiv-1 ag, eia
    87391AHiv-2 ag, eia
    87420AResp syncytial ag, eia
    87425ARotavirus ag, eia
    87430AStrep a ag, eia
    87449AAg detect nos, eia, mult
    87450AAg detect nos, eia, single
    87470ABartonella, dna, dir probe
    87471ABartonella, dna, amp probe
    87472ABartonella, dna, quant
    87475ALyme dis, dna, dir probe
    87476ALyme dis, dna, amp probe
    87477ALyme dis, dna, quant
    87480ACandida, dna, dir probe
    87481ACandida, dna, amp probe
    87482ACandida, dna, quant
    87485AChylmd pneum, dna, dir probe
    87486AChylmd pneum, dna, amp probe
    87487AChylmd pneum, dna, quant
    87490AChylmd trach, dna, dir probe
    87491AChylmd trach, dna, amp probe
    87492AChylmd trach, dna, quant
    87495ACytomeg, dna, dir probe
    87496ACytomeg, dna, amp probe
    87497ACytomeg, dna, quant
    87510AGardner vag, dna, dir probe
    87511AGardner vag, dna, amp probe
    87512AGardner vag, dna, quant
    87515AHepatitis b, dna, dir probe
    87516AHepatitis b, dna, amp probe
    87517AHepatitis b, dna, quant
    87520AHepatitis c, rna, dir probe
    87521AHepatitis c, rna, amp probe
    87522AHepatitis c, rna, quant
    87525AHepatitis g, dna, dir probe
    87526AHepatitis g, dna, amp probe
    87527AHepatitis g, dna, quant
    87528AHsv, dna, dir probe
    87529AHsv, dna, amp probe
    87530AHsv, dna, quant
    87531AHhv-6, dna, dir probe
    87532AHhv-6, dna, amp probe
    87533AHhv-6, dna, quant
    87534AHiv-1, dna, dir probe
    87535AHiv-1, dna, amp probe
    87536AHiv-1, dna, quant
    87537AHiv-2, dna, dir probe
    87538AHiv-2, dna, amp probe
    87539AHiv-2, dna, quant
    87540ALegion pneumo, dna, dir prob
    87541ALegion pneumo, dna, amp prob
    87542ALegion pneumo, dna, quant
    87550AMycobacteria, dna, dir probe
    87551AMycobacteria, dna, amp probe
    87552AMycobacteria, dna, quant
    87555AM.tuberculo, dna, dir probe
    Start Printed Page 18650
    87556AM.tuberculo, dna, amp probe
    87557AM.tuberculo, dna, quant
    87560AM.avium-intra, dna, dir prob
    87561AM.avium-intra, dna, amp prob
    87562AM.avium-intra, dna, quant
    87580AM.pneumon, dna, dir probe
    87581AM.pneumon, dna, amp probe
    87582AM.pneumon, dna, quant
    87590AN.gonorrhoeae, dna, dir prob
    87591AN.gonorrhoeae, dna, amp prob
    87592AN.gonorrhoeae, dna, quant
    87620AHpv, dna, dir probe
    87621AHpv, dna, amp probe
    87622AHpv, dna, quant
    87650AStrep a, dna, dir probe
    87651AStrep a, dna, amp probe
    87652AStrep a, dna, quant
    87797ADetect agent nos, dna, dir
    87798ADetect agent nos, dna, amp
    87799ADetect agent nos, dna, quant
    87810AChylmd trach assay w/optic
    87850AN. gonorrhoeae assay w/optic
    87880AStrep a assay w/optic
    87899AAgent nos assay w/optic
    87999AMicrobiology procedure
    88000EAutopsy (necropsy), gross
    88005EAutopsy (necropsy), gross
    88007EAutopsy (necropsy), gross
    88012EAutopsy (necropsy), gross
    88014EAutopsy (necropsy), gross
    88016EAutopsy (necropsy), gross
    88020EAutopsy (necropsy), complete
    88025EAutopsy (necropsy), complete
    88027EAutopsy (necropsy), complete
    88028EAutopsy (necropsy), complete
    88029EAutopsy (necropsy), complete
    88036ELimited autopsy
    88037ELimited autopsy
    88040EForensic autopsy (necropsy)
    88045ECoroner's autopsy (necropsy)
    88099ENecropsy (autopsy) procedure
    88104XCytopathology, fluids03430.45$21.82$12.16$4.36
    88106XCytopathology, fluids03430.45$21.82$12.16$4.36
    88107XCytopathology, fluids03430.45$21.82$12.16$4.36
    88108XCytopath, concentrate tech03430.45$21.82$12.16$4.36
    88125XForensic cytopathology03430.45$21.82$12.16$4.36
    88130ASex chromatin identification
    88140ASex chromatin identification
    88141NCytopath, c/v, interpret
    88142ACytopath, c/v, thin layer
    88143ACytopath c/v thin layer redo
    88144ACytopath, c/v thin lyr redo
    88145ACytopath, c/v thin lyr sel
    88147ACytopath, c/v, automated
    88148ACytopath, c/v, auto rescreen
    88150ACytopath, c/v, manual
    88152ACytopath, c/v, auto redo
    88153ACytopath, c/v, redo
    88154ACytopath, c/v, select
    88155ACytopath, c/v, index add-on
    88160XCytopath smear, other source03420.26$12.61$8.03$2.52
    88161XCytopath smear, other source03430.45$21.82$12.16$4.36
    88162XCytopath smear, other source03430.45$21.82$12.16$4.36
    88164ACytopath tbs, c/v, manual
    88165ACytopath tbs, c/v, redo
    88166ACytopath tbs, c/v, auto redo
    88167ACytopath tbs, c/v, select
    88170TFine needle aspiration00020.62$30.06$17.66$6.01
    88171TFine needle aspiration00020.62$30.06$17.66$6.01
    88172XEvaluation of smear03430.45$21.82$12.16$4.36
    88173XInterpretation of smear03430.45$21.82$12.16$4.36
    88180XCell marker study03440.79$38.30$23.63$7.66
    88182XCell marker study03440.79$38.30$23.63$7.66
    Start Printed Page 18651
    88199XCytopathology procedure03420.26$12.61$8.03$2.52
    88230ATissue culture, lymphocyte
    88233ATissue culture, skin/biopsy
    88235ATissue culture, placenta
    88237ATissue culture, bone marrow
    88239ATissue culture, tumor
    88240ACell cryopreserve/storage
    88241AFrozen cell preparation
    88245AChromosome analysis, 20-25
    88248AChromosome analysis, 50-100
    88249AChromosome analysis, 100
    88261AChromosome analysis, 5
    88262AChromosome analysis, 15-20
    88263AChromosome analysis, 45
    88264AChromosome analysis, 20-25
    88267AChromosome analys, placenta
    88269AChromosome analys, amniotic
    88271ACytogenetics, dna probe
    88272ACytogenetics, 3-5
    88273ACytogenetics, 10-30
    88274ACytogenetics, 25-99
    88275ACytogenetics, 100-300
    88280AChromosome karyotype study
    88283AChromosome banding study
    88285AChromosome count, additional
    88289AChromosome study, additional
    88291ACyto/molecular report
    88299ACytogenetic study
    88300XSurgical path, gross03420.26$12.61$8.03$2.52
    88302XTissue exam by pathologist03420.26$12.61$8.03$2.52
    88304XTissue exam by pathologist03430.45$21.82$12.16$4.36
    88305XTissue exam by pathologist03430.45$21.82$12.16$4.36
    88307XTissue exam by pathologist03440.79$38.30$23.63$7.66
    88309XTissue exam by pathologist03440.79$38.30$23.63$7.66
    88311XDecalcify tissue03420.26$12.61$8.03$2.52
    88312XSpecial stains03430.45$21.82$12.16$4.36
    88313XSpecial stains03420.26$12.61$8.03$2.52
    88314XHistochemical stain03430.45$21.82$12.16$4.36
    88318XChemical histochemistry03430.45$21.82$12.16$4.36
    88319XEnzyme histochemistry03420.26$12.61$8.03$2.52
    88321XMicroslide consultation03420.26$12.61$8.03$2.52
    88323XMicroslide consultation03430.45$21.82$12.16$4.36
    88325XComprehensive review of data03430.45$21.82$12.16$4.36
    88329XPathology consult in surgery03430.45$21.82$12.16$4.36
    88331XPathology consult in surgery03430.45$21.82$12.16$4.36
    88332XPathology consult in surgery03430.45$21.82$12.16$4.36
    88342XImmunocytochemistry03440.79$38.30$23.63$7.66
    88346XImmunofluorescent study03430.45$21.82$12.16$4.36
    88347XImmunofluorescent study03440.79$38.30$23.63$7.66
    88348XElectron microscopy03440.79$38.30$23.63$7.66
    88349XScanning electron microscopy03440.79$38.30$23.63$7.66
    88355XAnalysis, skeletal muscle03440.79$38.30$23.63$7.66
    88356XAnalysis, nerve03440.79$38.30$23.63$7.66
    88358XAnalysis, tumor03440.79$38.30$23.63$7.66
    88362XNerve teasing preparations03430.45$21.82$12.16$4.36
    88365XTissue hybridization03440.79$38.30$23.63$7.66
    88371AProtein, western blot tissue
    88372AProtein analysis w/probe
    88399XSurgical pathology procedure03420.26$12.61$8.03$2.52
    89050ABody fluid cell count
    89051ABody fluid cell count
    89060AExam, synovial fluid crystals
    89100XSample intestinal contents03613.53$171.16$88.09$34.23
    89105XSample intestinal contents03601.38$66.91$34.75$13.38
    89125ASpecimen fat stain
    89130XSample stomach contents03601.38$66.91$34.75$13.38
    89132XSample stomach contents03601.38$66.91$34.75$13.38
    89135XSample stomach contents03601.38$66.91$34.75$13.38
    89136XSample stomach contents03601.38$66.91$34.75$13.38
    89140XSample stomach contents03601.38$66.91$34.75$13.38
    89141XSample stomach contents03613.53$171.16$88.09$34.23
    89160AExam feces for meat fibers
    89190ANasal smear for eosinophils
    Start Printed Page 18652
    89250AFertilization of oocyte
    89251ACulture oocyte w/embryos
    89252AAssist oocyte fertilization
    89253AEmbryo hatching
    89254AOocyte identification
    89255APrepare embryo for transfer
    89256APrepare cryopreserved embryo
    89257ASperm identification
    89258ACryopreservation, embryo
    89259ACryopreservation, sperm
    89260ASperm isolation, simple
    89261ASperm isolation, complex
    89264AIdentify sperm tissue
    89300ASemen analysis
    89310ASemen analysis
    89320ASemen analysis
    89325ASperm antibody test
    89329ASperm evaluation test
    89330AEvaluation, cervical mucus
    89350XSputum specimen collection03440.79$38.30$23.63$7.66
    89355AExam feces for starch
    89360XCollect sweat for test03440.79$38.30$23.63$7.66
    89365AWater load test
    89399XPathology lab procedure03430.45$21.82$12.16$4.36
    90281EHuman ig, im
    90283EHuman ig, iv
    90287XBotulinum antitoxin03571.85$89.70$38.31$17.94
    90288EBotulism ig, iv
    90291ECmv ig, iv
    90296XDiphtheria antitoxin03571.85$89.70$38.31$17.94
    90371XHep b ig, im03560.36$17.46$4.82$3.49
    90375XRabies ig, im/sc03571.85$89.70$38.31$17.94
    90376XRabies ig, heat treated03571.85$89.70$38.31$17.94
    90378XRsv ig, im03571.85$89.70$38.31$17.94
    90379XRsv ig, iv03571.85$89.70$38.31$17.94
    90384XRh ig, full-dose, im03571.85$89.70$38.31$17.94
    90385XRh ig, minidose, im03571.85$89.70$38.31$17.94
    90386XRh ig, iv03571.85$89.70$38.31$17.94
    90389XTetanus ig, im03560.36$17.46$4.82$3.49
    90393XVaccina ig, im03571.85$89.70$38.31$17.94
    90396XVaricella-zoster ig, im03560.36$17.46$4.82$3.49
    90399EImmune globulin
    90471NImmunization admin
    90472NImmunization admin, each add
    90476XAdenovirus vaccine, type 403560.36$17.46$4.82$3.49
    90477XAdenovirus vaccine, type 703560.36$17.46$4.82$3.49
    90581XAnthrax vaccine, sc03571.85$89.70$38.31$17.94
    90585XBcg vaccine, percut03560.36$17.46$4.82$3.49
    90586XBcg vaccine, intravesical03560.36$17.46$4.82$3.49
    90632XHep a vaccine, adult im03560.36$17.46$4.82$3.49
    90633XHep a vacc, ped/adol, 2 dose03560.36$17.46$4.82$3.49
    90634XHep a vacc, ped/adol, 3 dose03560.36$17.46$4.82$3.49
    90636XHep a/hep b vacc, adult im03571.85$89.70$38.31$17.94
    90645XHib vaccine, hboc, im03550.19$9.21$5.05$1.84
    90646XHib vaccine, prp-d, im03550.19$9.21$5.05$1.84
    90647XHib vaccine, prp-omp, im03550.19$9.21$5.05$1.84
    90648XHib vaccine, prp-t, im03550.19$9.21$5.05$1.84
    90657XFlu vaccine, 6-35 mo, im03550.19$9.21$5.05$1.84
    90658XFlu vaccine, 3 yrs, im03550.19$9.21$5.05$1.84
    90659XFlu vaccine, whole, im03550.19$9.21$5.05$1.84
    90660XFlu vaccine, nasal03550.19$9.21$5.05$1.84
    90665XLyme disease vaccine, im03571.85$89.70$38.31$17.94
    90669XPneumococcal vaccine, ped03571.85$89.70$38.31$17.94
    90675XRabies vaccine, im03571.85$89.70$38.31$17.94
    90676XRabies vaccine, id03571.85$89.70$38.31$17.94
    90680XRotovirus vaccine, oral03560.36$17.46$4.82$3.49
    90690XTyphoid vaccine, oral03560.36$17.46$4.82$3.49
    90691XTyphoid vaccine, im03560.36$17.46$4.82$3.49
    90692XTyphoid vaccine, h-p, sc/id03560.36$17.46$4.82$3.49
    90693XTyphoid vaccine, akd, sc03560.36$17.46$4.82$3.49
    90700XDtap vaccine, im03550.19$9.21$5.05$1.84
    90701XDtp vaccine, im03560.36$17.46$4.82$3.49
    90702XDt vaccine, im03550.19$9.21$5.05$1.84
    Start Printed Page 18653
    90703XTetanus vaccine, im03560.36$17.46$4.82$3.49
    90704XMumps vaccine, sc03550.19$9.21$5.05$1.84
    90705XMeasles vaccine, sc03571.85$89.70$38.31$17.94
    90706XRubella vaccine, sc03586.98$338.44$126.74$67.69
    90707XMmr vaccine, sc03560.36$17.46$4.82$3.49
    90708XMeasles-rubella vaccine, sc03586.98$338.44$126.74$67.69
    90709XRubella & mumps vaccine, sc03586.98$338.44$126.74$67.69
    90710XMmrv vaccine, sc03560.36$17.46$4.82$3.49
    90712XOral poliovirus vaccine03560.36$17.46$4.82$3.49
    90713XPoliovirus, ipv, sc03550.19$9.21$5.05$1.84
    90716XChicken pox vaccine, sc03550.19$9.21$5.05$1.84
    90717XYellow fever vaccine, sc03560.36$17.46$4.82$3.49
    90718XTd vaccine, im03560.36$17.46$4.82$3.49
    90719XDiphtheria vaccine, im03571.85$89.70$38.31$17.94
    90720XDtp/hib vaccine, im03550.19$9.21$5.05$1.84
    90721XDtap/hib vaccine, im03550.19$9.21$5.05$1.84
    90725XCholera vaccine, injectable03586.98$338.44$126.74$67.69
    90727XPlague vaccine, im03550.19$9.21$5.05$1.84
    90732XPneumococcal vaccine, adult03550.19$9.21$5.05$1.84
    90733XMeningococcal vaccine, sc03571.85$89.70$38.31$17.94
    90735XEncephalitis vaccine, sc03571.85$89.70$38.31$17.94
    90744XHep b vaccine, ped/adol, im03560.36$17.46$4.82$3.49
    90746XHep b vaccine, adult, im03560.36$17.46$4.82$3.49
    90747XHep b vaccine, ill pat, im03560.36$17.46$4.82$3.49
    90748XHep b/hib vaccine, im03586.98$338.44$126.74$67.69
    90749XVaccine toxoid03550.19$9.21$5.05$1.84
    90780EIV infusion therapy, 1 hour
    90781EIV infusion, additional hour
    90782XInjection, sc/im03590.96$46.55$9.31$9.31
    90783XInjection, ia03590.96$46.55$9.31$9.31
    90784XInjection, iv03590.96$46.55$9.31$9.31
    90788XInjection of antibiotic03590.96$46.55$9.31$9.31
    90799XTher/prophylactic/dx inject03590.96$46.55$9.31$9.31
    90801SPsy dx interview03231.85$89.70$22.48$17.94
    90802SIntac psy dx interview03231.85$89.70$22.48$17.94
    90804SPsytx, office, 20-30 min03221.32$64.00$14.22$12.80
    90805SPsytx, off, 20-30 min w/e&m03221.32$64.00$14.22$12.80
    90806SPsytx, off, 45-50 min03231.85$89.70$22.48$17.94
    90807SPsytx, off, 45-50 min w/e&m03231.85$89.70$22.48$17.94
    90808SPsytx, office, 75-80 min03231.85$89.70$22.48$17.94
    90809SPsytx, off, 75-80, w/e&m03231.85$89.70$22.48$17.94
    90810SIntac psytx, off, 20-30 min03221.32$64.00$14.22$12.80
    90811SIntac psytx, 20-30, w/e&m03221.32$64.00$14.22$12.80
    90812SIntac psytx, off, 45-50 min03231.85$89.70$22.48$17.94
    90813SIntac psytx, 45-50 min w/e&m03231.85$89.70$22.48$17.94
    90814SIntac psytx, off, 75-80 min03231.85$89.70$22.48$17.94
    90815SIntac psytx, 75-80 w/e&m03231.85$89.70$22.48$17.94
    90816SPsytx, hosp, 20-30 min03221.32$64.00$14.22$12.80
    90817SPsytx, hosp, 20-30 min w/e&m03221.32$64.00$14.22$12.80
    90818SPsytx, hosp, 45-50 min03231.85$89.70$22.48$17.94
    90819SPsytx, hosp, 45-50 min w/e&m03231.85$89.70$22.48$17.94
    90821SPsytx, hosp, 75-80 min03231.85$89.70$22.48$17.94
    90822SPsytx, hosp, 75-80 min w/e&m03231.85$89.70$22.48$17.94
    90823SIntac psytx, hosp, 20-30 min03221.32$64.00$14.22$12.80
    90824SIntac psytx, hsp 20-30 w/e&m03221.32$64.00$14.22$12.80
    90826SIntac psytx, hosp, 45-50 min03231.85$89.70$22.48$17.94
    90827SIntac psytx, hsp 45-50 w/e&m03231.85$89.70$22.48$17.94
    90828SIntac psytx, hosp, 75-80 min03231.85$89.70$22.48$17.94
    90829SIntac psytx, hsp 75-80 w/e&m03231.85$89.70$22.48$17.94
    90845SPsychoanalysis03231.85$89.70$22.48$17.94
    90846SFamily psytx w/o patient03241.87$90.67$20.19$18.13
    90847SFamily psytx w/patient03241.87$90.67$20.19$18.13
    90849SMultiple family group psytx03251.55$75.16$19.96$15.03
    90853SGroup psychotherapy03251.55$75.16$19.96$15.03
    90857SIntac group psytx03251.55$75.16$19.96$15.03
    90862XMedication management03741.17$56.73$13.08$11.35
    90865SNarcosynthesis03231.85$89.70$22.48$17.94
    90870SElectroconvulsive therapy03203.68$178.43$80.06$35.69
    90871SElectroconvulsive therapy03203.68$178.43$80.06$35.69
    90875EPsychophysiological therapy
    90876EPsychophysiological therapy
    90880SHypnotherapy03231.85$89.70$22.48$17.94
    90882EEnvironmental manipulation
    Start Printed Page 18654
    90885NPsy evaluation of records
    90887NConsultation with family
    90889NPreparation of report
    90899SPsychiatric service/therapy03221.32$64.00$14.22$12.80
    90901SBiofeedback train, any meth03211.26$61.09$29.25$12.22
    90911SBiofeedback peri/uro/rectal03211.26$61.09$29.25$12.22
    90918AESRD related services, month
    90919AESRD related services, month
    90920AESRD related services, month
    90921AESRD related services, month
    90922AESRD related services, day
    90923AEsrd related services, day
    90924AEsrd related services, day
    90925AEsrd related services, day
    90935SHemodialysis, one evaluation01706.68$323.89$72.26$64.78
    90937EHemodialysis, repeated eval
    90945SDialysis, one evaluation01706.68$323.89$72.26$64.78
    90947EDialysis, repeated eval
    90989EDialysis training, complete
    90993EDialysis training, incompl
    90997EHemoperfusion
    90999EDialysis procedure
    91000XEsophageal intubation03613.53$171.16$88.09$34.23
    91010XEsophagus motility study03613.53$171.16$88.09$34.23
    91011XEsophagus motility study03613.53$171.16$88.09$34.23
    91012XEsophagus motility study03613.53$171.16$88.09$34.23
    91020XGastric motility03613.53$171.16$88.09$34.23
    91030XAcid perfusion of esophagus03601.38$66.91$34.75$13.38
    91032XEsophagus, acid reflux test03613.53$171.16$88.09$34.23
    91033XProlonged acid reflux test03613.53$171.16$88.09$34.23
    91052XGastric analysis test03613.53$171.16$88.09$34.23
    91055XGastric intubation for smear03601.38$66.91$34.75$13.38
    91060XGastric saline load test03613.53$171.16$88.09$34.23
    91065XBreath hydrogen test03601.38$66.91$34.75$13.38
    91100XPass intestine bleeding tube03601.38$66.91$34.75$13.38
    91105XGastric intubation treatment03601.38$66.91$34.75$13.38
    91122TAnal pressure record01653.89$188.61$91.76$37.72
    91299XGastroenterology procedure03601.38$66.91$34.75$13.38
    92002VEye exam, new patient06011.00$48.49$9.70$9.70
    92004VEye exam, new patient06021.66$80.49$16.29$16.10
    92012VEye exam established pat06011.00$48.49$9.70$9.70
    92014VEye exam & treatment06021.66$80.49$16.29$16.10
    92015ERefraction
    92018SNew eye exam & treatment02312.64$128.01$59.87$25.60
    92019SEye exam & treatment02312.64$128.01$59.87$25.60
    92020SSpecial eye evaluation02300.98$47.52$22.48$9.50
    92060SSpecial eye evaluation02300.98$47.52$22.48$9.50
    92065SOrthoptic/pleoptic training02300.98$47.52$22.48$9.50
    92070NFitting of contact lens
    92081SVisual field examination(s)02300.98$47.52$22.48$9.50
    92082SVisual field examination(s)02300.98$47.52$22.48$9.50
    92083SVisual field examination(s)02300.98$47.52$22.48$9.50
    92100NSerial tonometry exam(s)
    92120STonography & eye evaluation02300.98$47.52$22.48$9.50
    92130SWater provocation tonography02300.98$47.52$22.48$9.50
    92135SOpthalmic dx imaging02312.64$128.01$59.87$25.60
    92140SGlaucoma provocative tests02312.64$128.01$59.87$25.60
    92225SSpecial eye exam, initial02300.98$47.52$22.48$9.50
    92226SSpecial eye exam, subsequent02312.64$128.01$59.87$25.60
    92230SEye exam with photos02312.64$128.01$59.87$25.60
    92235SEye exam with photos02312.64$128.01$59.87$25.60
    92240SIcg angiography02312.64$128.01$59.87$25.60
    92250SEye exam with photos02300.98$47.52$22.48$9.50
    92260SOphthalmoscopy/dynamometry02300.98$47.52$22.48$9.50
    92265SEye muscle evaluation02300.98$47.52$22.48$9.50
    92270SElectro-oculography02300.98$47.52$22.48$9.50
    92275SElectroretinography02162.87$139.16$64.69$27.83
    92283SColor vision examination02300.98$47.52$22.48$9.50
    92284SDark adaptation eye exam02312.64$128.01$59.87$25.60
    92285SEye photography02300.98$47.52$22.48$9.50
    92286SInternal eye photography02312.64$128.01$59.87$25.60
    92287TInternal eye photography02312.64$128.01$59.87$25.60
    92310EContact lens fitting
    Start Printed Page 18655
    92311XContact lens fitting03620.51$24.73$9.63$4.95
    92312XContact lens fitting03620.51$24.73$9.63$4.95
    92313XContact lens fitting03620.51$24.73$9.63$4.95
    92314EPrescription of contact lens
    92315XPrescription of contact lens03620.51$24.73$9.63$4.95
    92316XPrescription of contact lens03620.51$24.73$9.63$4.95
    92317XPrescription of contact lens03620.51$24.73$9.63$4.95
    92325XModification of contact lens03620.51$24.73$9.63$4.95
    92326XReplacement of contact lens03620.51$24.73$9.63$4.95
    92330SFitting of artificial eye02300.98$47.52$22.48$9.50
    92335NFitting of artificial eye
    92340EFitting of spectacles
    92341EFitting of spectacles
    92342EFitting of spectacles
    92352XSpecial spectacles fitting03620.51$24.73$9.63$4.95
    92353XSpecial spectacles fitting03620.51$24.73$9.63$4.95
    92354XSpecial spectacles fitting03620.51$24.73$9.63$4.95
    92355XSpecial spectacles fitting03620.51$24.73$9.63$4.95
    92358XEye prosthesis service03620.51$24.73$9.63$4.95
    92370ERepair & adjust spectacles
    92371XRepair & adjust spectacles03620.51$24.73$9.63$4.95
    92390ESupply of spectacles
    92391ESupply of contact lenses
    92392ESupply of low vision aids
    92393ESupply of artificial eye
    92395ESupply of spectacles
    92396ESupply of contact lenses
    92499SEye service or procedure02300.98$47.52$22.48$9.50
    92502TEar and throat examination02511.68$81.46$27.99$16.29
    92504NEar microscopy examination
    92506ASpeech/hearing evaluation
    92507ASpeech/hearing therapy
    92508ASpeech/hearing therapy
    92510ARehab for ear implant
    92511TNasopharyngoscopy00710.55$26.67$14.22$5.33
    92512XNasal function studies03632.83$137.22$53.22$27.44
    92516XFacial nerve function test03632.83$137.22$53.22$27.44
    92520XLaryngeal function studies03632.83$137.22$53.22$27.44
    92525AOral function evaluation
    92526AOral function therapy
    92531NSpontaneous nystagmus study
    92532NPositional nystagmus study
    92533NCaloric vestibular test
    92534NOptokinetic nystagmus
    92541XSpontaneous nystagmus test03632.83$137.22$53.22$27.44
    92542XPositional nystagmus test03632.83$137.22$53.22$27.44
    92543XCaloric vestibular test03632.83$137.22$53.22$27.44
    92544XOptokinetic nystagmus test03632.83$137.22$53.22$27.44
    92545XOscillating tracking test03632.83$137.22$53.22$27.44
    92546XSinusoidal rotational test03632.83$137.22$53.22$27.44
    92547XSupplemental electrical test03632.83$137.22$53.22$27.44
    92548XPosturography03632.83$137.22$53.22$27.44
    92551EPure tone hearing test, air
    92552XPure tone audiometry, air03640.68$32.97$13.31$6.59
    92553XAudiometry, air & bone03640.68$32.97$13.31$6.59
    92555XSpeech threshold audiometry03640.68$32.97$13.31$6.59
    92556XSpeech audiometry, complete03640.68$32.97$13.31$6.59
    92557XComprehensive hearing test03651.47$71.28$22.48$14.26
    92559EGroup audiometric testing
    92560EBekesy audiometry, screen
    92561XBekesy audiometry, diagnosis03651.47$71.28$22.48$14.26
    92562XLoudness balance test03651.47$71.28$22.48$14.26
    92563XTone decay hearing test03651.47$71.28$22.48$14.26
    92564XSisi hearing test03651.47$71.28$22.48$14.26
    92565XStenger test, pure tone03651.47$71.28$22.48$14.26
    92567XTympanometry03640.68$32.97$13.31$6.59
    92568XAcoustic reflex testing03651.47$71.28$22.48$14.26
    92569XAcoustic reflex decay test03651.47$71.28$22.48$14.26
    92571XFiltered speech hearing test03651.47$71.28$22.48$14.26
    92572XStaggered spondaic word test03651.47$71.28$22.48$14.26
    92573XLombard test03651.47$71.28$22.48$14.26
    92575XSensorineural acuity test03651.47$71.28$22.48$14.26
    92576XSynthetic sentence test03651.47$71.28$22.48$14.26
    Start Printed Page 18656
    92577XStenger test, speech03651.47$71.28$22.48$14.26
    92579XVisual audiometry (vra)03651.47$71.28$22.48$14.26
    92582XConditioning play audiometry03651.47$71.28$22.48$14.26
    92583XSelect picture audiometry03651.47$71.28$22.48$14.26
    92584XElectrocochleography03632.83$137.22$53.22$27.44
    92585SAuditory evoked potential02162.87$139.16$64.69$27.83
    92587XEvoked auditory test03632.83$137.22$53.22$27.44
    92588XEvoked auditory test03632.83$137.22$53.22$27.44
    92589XAuditory function test(s)03651.47$71.28$22.48$14.26
    92590EHearing aid exam, one ear
    92591EHearing aid exam, both ears
    92592EHearing aid check, one ear
    92593EHearing aid check, both ears
    92594EElectro hearng aid test, one
    92595EElectro hearng aid tst, both
    92596XEar protector evaluation03651.47$71.28$22.48$14.26
    92597AOral speech device eval
    92598AModify oral speech device
    92599XENT procedure/service03640.68$32.97$13.31$6.59
    92950SHeart/lung resuscitation cpr00944.51$218.68$105.29$43.74
    92953STemporary external pacing00944.51$218.68$105.29$43.74
    92960SCardioversion electric, ext00944.51$218.68$105.29$43.74
    92961SCardioversion, electric, int00944.51$218.68$105.29$43.74
    92970CCardioassist, internal
    92971CCardioassist, external
    92975CDissolve clot, heart vessel
    92977CDissolve clot, heart vessel
    92978CIntravasc us, heart add-on
    92979CIntravasc us, heart add-on
    92980TInsert intracoronary stent008345.79$2,220.22$1,322.95$444.04
    92981TInsert intracoronary stent008345.79$2,220.22$1,322.95$444.04
    92982TCoronary artery dilation008345.79$2,220.22$1,322.95$444.04
    92984TCoronary artery dilation008345.79$2,220.22$1,322.95$444.04
    92986CRevision of aortic valve
    92987CRevision of mitral valve
    92990CRevision of pulmonary valve
    92992CRevision of heart chamber
    92993CRevision of heart chamber
    92995TCoronary atherectomy008240.34$1,955.97$859.56$391.19
    92996TCoronary atherectomy add-on008240.34$1,955.97$859.56$391.19
    92997CPul art balloon repr, percut
    92998CPul art balloon repr, percut
    93000EElectrocardiogram, complete
    93005XElectrocardiogram, tracing03660.38$18.43$15.60$3.69
    93010EElectrocardiogram report
    93012STransmission of ECG00990.38$18.43$14.68$3.69
    93014EReport on transmitted ECG
    93015ECardiovascular stress test
    93016ECardiovascular stress test
    93017SCardiovascular stress test00971.62$78.55$62.40$15.71
    93018ECardiovascular stress test
    93024SCardiac drug stress test00971.62$78.55$62.40$15.71
    93040ERhythm ECG with report
    93041XRhythm ECG, tracing03660.38$18.43$15.60$3.69
    93042ERhythm ECG, report
    93224EECG monitor/report, 24 hrs
    93225SECG monitor/record, 24 hrs01001.70$82.43$71.57$16.49
    93226SECG monitor/report, 24 hrs01001.70$82.43$71.57$16.49
    93227EECG monitor/review, 24 hrs
    93230EECG monitor/report, 24 hrs
    93231SECG monitor/record, 24 hrs01001.70$82.43$71.57$16.49
    93232SECG monitor/report, 24 hrs01001.70$82.43$71.57$16.49
    93233EECG monitor/review, 24 hrs
    93235EECG monitor/report, 24 hrs
    93236SECG monitor/report, 24 hrs01001.70$82.43$71.57$16.49
    93237EECG monitor/review, 24 hrs
    93268SECG record/review01001.70$82.43$71.57$16.49
    93270SECG recording00990.38$18.43$14.68$3.69
    93271SECG/monitoring and analysis01001.70$82.43$71.57$16.49
    93272EECG/review, interpret only
    93278SECG/signal-averaged00990.38$18.43$14.68$3.69
    93303SEcho transthoracic02694.40$213.34$114.01$42.67
    93304SEcho transthoracic02694.40$213.34$114.01$42.67
    Start Printed Page 18657
    93307SEcho exam of heart02694.40$213.34$114.01$42.67
    93308SEcho exam of heart02694.40$213.34$114.01$42.67
    93312SEcho transesophageal02705.55$269.10$150.26$53.82
    93313SEcho transesophageal02705.55$269.10$150.26$53.82
    93314NEcho transesophageal
    93315SEcho transesophageal02705.55$269.10$150.26$53.82
    93316SEcho transesophageal02705.55$269.10$150.26$53.82
    93317NEcho transesophageal
    93320SDoppler echo exam, heart02694.40$213.34$114.01$42.67
    93321SDoppler echo exam, heart02694.40$213.34$114.01$42.67
    93325SDoppler color flow add-on02694.40$213.34$114.01$42.67
    93350SEcho transthoracic02694.40$213.34$114.01$42.67
    93501TRight heart catheterization008025.77$1,249.51$713.89$249.90
    93503TInsert/place heart catheter008025.77$1,249.51$713.89$249.90
    93505TBiopsy of heart lining008025.77$1,249.51$713.89$249.90
    93508NCath placement, angiography
    93510TLeft heart catheterization008025.77$1,249.51$713.89$249.90
    93511TLeft heart catheterization008025.77$1,249.51$713.89$249.90
    93514TLeft heart catheterization008025.77$1,249.51$713.89$249.90
    93524TLeft heart catheterization008025.77$1,249.51$713.89$249.90
    93526TRt & Lt heart catheters008025.77$1,249.51$713.89$249.90
    93527TRt & Lt heart catheters008025.77$1,249.51$713.89$249.90
    93528TRt & Lt heart catheters008025.77$1,249.51$713.89$249.90
    93529TRt, Lt heart catheterization008025.77$1,249.51$713.89$249.90
    93530TRt heart cath, congenital008025.77$1,249.51$713.89$249.90
    93531TR & l heart cath, congenital008025.77$1,249.51$713.89$249.90
    93532TR & l heart cath, congenital008025.77$1,249.51$713.89$249.90
    93533TR & l heart cath, congenital008025.77$1,249.51$713.89$249.90
    93536TInsert circulation assi008025.77$1,249.51$713.89$249.90
    93539NInjection, cardiac cath
    93540NInjection, cardiac cath
    93541NInjection for lung angiogram
    93542NInjection for heart x-rays
    93543NInjection for heart x-rays
    93544NInjection for aortography
    93545NInject for coronary x-rays
    93555NImaging, cardiac cath
    93556NImaging, cardiac cath
    93561NCardiac output measurement
    93562NCardiac output measurement
    93571NHeart flow reserve measure
    93572NHeart flow reserve measure
    93600SBundle of His recording00879.53$462.08$214.72$92.42
    93602SIntra-atrial recording00879.53$462.08$214.72$92.42
    93603SRight ventricular recording00879.53$462.08$214.72$92.42
    93607SLeft ventricular recording00879.53$462.08$214.72$92.42
    93609SMapping of tachycardia00879.53$462.08$214.72$92.42
    93610SIntra-atrial pacing00879.53$462.08$214.72$92.42
    93612SIntraventricular pacing00879.53$462.08$214.72$92.42
    93615SEsophageal recording00879.53$462.08$214.72$92.42
    93616SEsophageal recording00879.53$462.08$214.72$92.42
    93618SHeart rhythm pacing00879.53$462.08$214.72$92.42
    93619SElectrophysiology evaluation008527.06$1,312.06$654.48$262.41
    93620SElectrophysiology evaluation008527.06$1,312.06$654.48$262.41
    93621SElectrophysiology evaluation008527.06$1,312.06$654.48$262.41
    93622SElectrophysiology evaluation008527.06$1,312.06$654.48$262.41
    93623SStimulation, pacing heart00879.53$462.08$214.72$92.42
    93624SElectrophysiologic study00879.53$462.08$214.72$92.42
    93631SHeart pacing, mapping00879.53$462.08$214.72$92.42
    93640SEvaluation heart device008410.70$518.81$177.79$103.76
    93641SElectrophysiology evaluation008410.70$518.81$177.79$103.76
    93642SElectrophysiology evaluation008410.70$518.81$177.79$103.76
    93650SAblate heart dysrhythm focus008647.62$2,308.95$1,265.37$461.79
    93651SAblate heart dysrhythm focus008647.62$2,308.95$1,265.37$461.79
    93652SAblate heart dysrhythm focus008647.62$2,308.95$1,265.37$461.79
    93660STilt table evaluation01014.47$216.74$128.84$43.35
    93720ETotal body plethysmography
    93721SPlethysmography tracing00962.06$99.88$61.48$19.98
    93722EPlethysmography report
    93724SAnalyze pacemaker system01001.70$82.43$71.57$16.49
    93727SAnalyze ilr system01020.45$21.82$12.62$4.36
    93731SAnalyze pacemaker system01020.45$21.82$12.62$4.36
    93732SAnalyze pacemaker system01020.45$21.82$12.62$4.36
    Start Printed Page 18658
    93733STelephone analy, pacemaker01020.45$21.82$12.62$4.36
    93734SAnalyze pacemaker system01020.45$21.82$12.62$4.36
    93735SAnalyze pacemaker system01020.45$21.82$12.62$4.36
    93736STelephone analy, pacemaker01020.45$21.82$12.62$4.36
    93737SAnalyze cardio/defibrillator01020.45$21.82$12.62$4.36
    93738SAnalyze cardio/defibrillator01020.45$21.82$12.62$4.36
    93740STemperature gradient studies00962.06$99.88$61.48$19.98
    93741SAnalyze ht pace device sngl01020.45$21.82$12.62$4.36
    93742SAnalyze ht pace device sngl01020.45$21.82$12.62$4.36
    93743SAnalyze ht pace device dual01020.45$21.82$12.62$4.36
    93744SAnalyze ht pace device dual01020.45$21.82$12.62$4.36
    93760ECephalic thermogram
    93762EPeripheral thermogram
    93770NMeasure venous pressure
    93784EAmbulatory BP monitoring
    93786EAmbulatory BP recording
    93788EAmbulatory BP analysis
    93790EReview/report BP recording
    93797SCardiac rehab00950.64$31.03$16.98$6.21
    93798SCardiac rehab/monitor00950.64$31.03$16.98$6.21
    93799SCardiovascular procedure00962.06$99.88$61.48$19.98
    93875SExtracranial study00962.06$99.88$61.48$19.98
    93880SExtracranial study02672.72$131.88$80.06$26.38
    93882SExtracranial study02672.72$131.88$80.06$26.38
    93886SIntracranial study02672.72$131.88$80.06$26.38
    93888SIntracranial study02672.72$131.88$80.06$26.38
    93922SExtremity study00962.06$99.88$61.48$19.98
    93923SExtremity study00962.06$99.88$61.48$19.98
    93924SExtremity study00962.06$99.88$61.48$19.98
    93925SLower extremity study02672.72$131.88$80.06$26.38
    93926SLower extremity study02672.72$131.88$80.06$26.38
    93930SUpper extremity study02672.72$131.88$80.06$26.38
    93931SUpper extremity study02672.72$131.88$80.06$26.38
    93965SExtremity study00962.06$99.88$61.48$19.98
    93970SExtremity study02672.72$131.88$80.06$26.38
    93971SExtremity study02672.72$131.88$80.06$26.38
    93975SVascular study02672.72$131.88$80.06$26.38
    93976SVascular study02672.72$131.88$80.06$26.38
    93978SVascular study02672.72$131.88$80.06$26.38
    93979SVascular study02672.72$131.88$80.06$26.38
    93980SPenile vascular study02672.72$131.88$80.06$26.38
    93981SPenile vascular study02672.72$131.88$80.06$26.38
    93990SDoppler flow testing02672.72$131.88$80.06$26.38
    94010XBreathing capacity test03670.83$40.24$20.65$8.05
    94014XPatient recorded spirometry03692.34$113.46$58.50$22.69
    94015XPatient recorded spirometry03692.34$113.46$58.50$22.69
    94016XReview patient spirometry03692.34$113.46$58.50$22.69
    94060XEvaluation of wheezing03681.66$80.49$42.44$16.10
    94070XEvaluation of wheezing03692.34$113.46$58.50$22.69
    94150NVital capacity test
    94200XLung function test (MBC/MVV)03670.83$40.24$20.65$8.05
    94240XResidual lung capacity03681.66$80.49$42.44$16.10
    94250XExpired gas collection03670.83$40.24$20.65$8.05
    94260XThoracic gas volume03681.66$80.49$42.44$16.10
    94350XLung nitrogen washout curve03681.66$80.49$42.44$16.10
    94360XMeasure airflow resistance03681.66$80.49$42.44$16.10
    94370XBreath airway closing volume03681.66$80.49$42.44$16.10
    94375XRespiratory flow volume loop03670.83$40.24$20.65$8.05
    94400XCO2 breathing response curve03670.83$40.24$20.65$8.05
    94450XHypoxia response curve03670.83$40.24$20.65$8.05
    94620XPulmonary stress test/simple03681.66$80.49$42.44$16.10
    94621XPulm stress test/complex03692.34$113.46$58.50$22.69
    94640SAirway inhalation treatment00770.43$20.85$12.62$4.17
    94642SAerosol inhalation treatment00781.34$64.97$29.13$12.99
    94650SPressure breathing (IPPB)00770.43$20.85$12.62$4.17
    94651SPressure breathing (IPPB)00770.43$20.85$12.62$4.17
    94652CPressure breathing (IPPB)
    94656SInitial ventilator mgmt00793.18$154.19$107.70$30.84
    94657SContinued ventilator mgmt00793.18$154.19$107.70$30.84
    94660SPos airway pressure, CPAP00793.18$154.19$107.70$30.84
    94662SNeg press ventilation, cnp00793.18$154.19$107.70$30.84
    94664SAerosol or vapor inhalations00770.43$20.85$12.62$4.17
    94665SAerosol or vapor inhalations00770.43$20.85$12.62$4.17
    Start Printed Page 18659
    94667SChest wall manipulation00770.43$20.85$12.62$4.17
    94668SChest wall manipulation00770.43$20.85$12.62$4.17
    94680XExhaled air analysis, o203670.83$40.24$20.65$8.05
    94681XExhaled air analysis, o2/co203681.66$80.49$42.44$16.10
    94690XExhaled air analysis03670.83$40.24$20.65$8.05
    94720XMonoxide diffusing capacity03670.83$40.24$20.65$8.05
    94725XMembrane diffusion capacity03681.66$80.49$42.44$16.10
    94750XPulmonary compliance study03681.66$80.49$42.44$16.10
    94760NMeasure blood oxygen level
    94761NMeasure blood oxygen level
    94762CMeasure blood oxygen level
    94770XExhaled carbon dioxide test03670.83$40.24$20.65$8.05
    94772XBreath recording, infant03692.34$113.46$58.50$22.69
    94799XPulmonary service/procedure03670.83$40.24$20.65$8.05
    95004XAllergy skin tests03700.57$27.64$11.81$5.53
    95010XSensitivity skin tests03700.57$27.64$11.81$5.53
    95015XSensitivity skin tests03700.57$27.64$11.81$5.53
    95024XAllergy skin tests03700.57$27.64$11.81$5.53
    95027XSkin end point titration03700.57$27.64$11.81$5.53
    95028XAllergy skin tests03700.57$27.64$11.81$5.53
    95044XAllergy patch tests03700.57$27.64$11.81$5.53
    95052XPhoto patch test03700.57$27.64$11.81$5.53
    95056XPhotosensitivity tests03700.57$27.64$11.81$5.53
    95060XEye allergy tests03700.57$27.64$11.81$5.53
    95065XNose allergy test03700.57$27.64$11.81$5.53
    95070XBronchial allergy tests03692.34$113.46$58.50$22.69
    95071XBronchial allergy tests03692.34$113.46$58.50$22.69
    95075XIngestion challenge test03613.53$171.16$88.09$34.23
    95078XProvocative testing03700.57$27.64$11.81$5.53
    95115XImmunotherapy, one injection03710.32$15.52$3.67$3.10
    95117XImmunotherapy injections03710.32$15.52$3.67$3.10
    95120EImmunotherapy, one injection
    95125EImmunotherapy, many antigens
    95130EImmunotherapy, insect venom
    95131EImmunotherapy, insect venoms
    95132EImmunotherapy, insect venoms
    95133EImmunotherapy, insect venoms
    95134EImmunotherapy, insect venoms
    95144XAntigen therapy services03710.32$15.52$3.67$3.10
    95145XAntigen therapy services03710.32$15.52$3.67$3.10
    95146XAntigen therapy services03710.32$15.52$3.67$3.10
    95147XAntigen therapy services03710.32$15.52$3.67$3.10
    95148XAntigen therapy services03710.32$15.52$3.67$3.10
    95149XAntigen therapy services03710.32$15.52$3.67$3.10
    95165XAntigen therapy services03710.32$15.52$3.67$3.10
    95170XAntigen therapy services03710.32$15.52$3.67$3.10
    95180XRapid desensitization03700.57$27.64$11.81$5.53
    95199XAllergy immunology services03700.57$27.64$11.81$5.53
    95805SMultiple sleep latency test021311.15$540.63$290.42$108.13
    95806SSleep study, unattended021311.15$540.63$290.42$108.13
    95807SSleep study, attended021311.15$540.63$290.42$108.13
    95808SPolysomnography, 1-3021311.15$540.63$290.42$108.13
    95810SPolysomnography, 4 or more021311.15$540.63$290.42$108.13
    95811SPolysomnography w/cpap021311.15$540.63$290.42$108.13
    95812SElectroencephalogram (EEG)021311.15$540.63$290.42$108.13
    95813SElectroencephalogram (EEG)021311.15$540.63$290.42$108.13
    95816SElectroencephalogram (EEG)02142.32$112.49$58.50$22.50
    95819SElectroencephalogram (EEG)02142.32$112.49$58.50$22.50
    95822SSleep electroencephalogram02142.32$112.49$58.50$22.50
    95824SElectroencephalography02142.32$112.49$58.50$22.50
    95827SNight electroencephalogram021311.15$540.63$290.42$108.13
    95829SSurgery electrocorticogram02142.32$112.49$58.50$22.50
    95830EInsert electrodes for EEG
    95831NLimb muscle testing, manual
    95832NHand muscle testing, manual
    95833NBody muscle testing, manual
    95834NBody muscle testing, manual
    95851NRange of motion measurements
    95852NRange of motion measurements
    95857STensilon test02151.15$55.76$30.05$11.15
    95858STensilon test & myogram02151.15$55.76$30.05$11.15
    95860SMuscle test, one limb02151.15$55.76$30.05$11.15
    95861SMuscle test, two limbs02151.15$55.76$30.05$11.15
    Start Printed Page 18660
    95863SMuscle test, 3 limbs02162.87$139.16$64.69$27.83
    95864SMuscle test, 4 limbs02151.15$55.76$30.05$11.15
    95867SMuscle test, head or neck02162.87$139.16$64.69$27.83
    95868SMuscle test, head or neck02162.87$139.16$64.69$27.83
    95869SMuscle test, thor paraspinal02151.15$55.76$30.05$11.15
    95870SMuscle test, nonparaspinal02151.15$55.76$30.05$11.15
    95872SMuscle test, one fiber02151.15$55.76$30.05$11.15
    95875SLimb exercise test02175.87$284.62$156.68$56.92
    95900SMotor nerve conduction test02151.15$55.76$30.05$11.15
    95903SMotor nerve conduction test02151.15$55.76$30.05$11.15
    95904SSense/mixed n conduction tst02151.15$55.76$30.05$11.15
    95920CIntraop nerve test add-on
    95921SAutonomic nerv function test02162.87$139.16$64.69$27.83
    95922SAutonomic nerv function test02162.87$139.16$64.69$27.83
    95923SAutonomic nerv function test02162.87$139.16$64.69$27.83
    95925SSomatosensory testing02162.87$139.16$64.69$27.83
    95926SSomatosensory testing02162.87$139.16$64.69$27.83
    95927SSomatosensory testing02162.87$139.16$64.69$27.83
    95930SVisual evoked potential test02162.87$139.16$64.69$27.83
    95933SBlink reflex test02151.15$55.76$30.05$11.15
    95934SH-reflex test02151.15$55.76$30.05$11.15
    95936SH-reflex test02162.87$139.16$64.69$27.83
    95937SNeuromuscular junction test02151.15$55.76$30.05$11.15
    95950SAmbulatory eeg monitoring02175.87$284.62$156.68$56.92
    95951SEEG monitoring/videorecord021311.15$540.63$290.42$108.13
    95953SEEG monitoring/computer021311.15$540.63$290.42$108.13
    95954SEEG monitoring/giving drugs021311.15$540.63$290.42$108.13
    95955SEEG during surgery02142.32$112.49$58.50$22.50
    95956NEeg monitoring, cable/radio
    95957NEEG digital analysis
    95958SEEG monitoring/function test021311.15$540.63$290.42$108.13
    95961CElectrode stimulation, brain
    95962CElectrode stim, brain add-on
    95970SAnalyze neurostim, no prog01020.45$21.82$12.62$4.36
    95971SAnalyze neurostim, simple01020.45$21.82$12.62$4.36
    95972SAnalyze neurostim, complex01020.45$21.82$12.62$4.36
    95973SAnalyze neurostim, complex01020.45$21.82$12.62$4.36
    95974SCranial neurostim, complex01020.45$21.82$12.62$4.36
    95975SCranial neurostim, complex01020.45$21.82$12.62$4.36
    95999NNeurological procedure
    96100XPsychological testing03733.21$155.64$44.96$31.13
    96105XAssessment of aphasia03733.21$155.64$44.96$31.13
    96110XDevelopmental test, lim03733.21$155.64$44.96$31.13
    96111XDevelopmental test, extend03733.21$155.64$44.96$31.13
    96115XNeurobehavior status exam03733.21$155.64$44.96$31.13
    96117XNeuropsych test battery03733.21$155.64$44.96$31.13
    96400EChemotherapy, sc/im
    96405EIntralesional chemo admin
    96406EIntralesional chemo admin
    96408EChemotherapy, push technique
    96410EChemotherapy, infusion method
    96412EChemo, infuse method add-on
    96414EChemo, infuse method add-on
    96420EChemotherapy, push technique
    96422EChemotherapy, infusion method
    96423EChemo, infuse method add-on
    96425EChemotherapy, infusion method
    96440EChemotherapy, intracavitary
    96445EChemotherapy, intracavitary
    96450EChemotherapy, into CNS
    96520EPump refilling, maintenance
    96530EPump refilling, maintenance
    96542EChemotherapy injection
    96545EProvide chemotherapy agent
    96549EChemotherapy, unspecified
    96570TPhotodynamic tx, 30 min007518.55$899.44$467.29$179.89
    96571TPhotodynamic tx, addl 15 min007518.55$899.44$467.29$179.89
    96900SUltraviolet light therapy00010.47$22.79$8.49$4.56
    96902NTrichogram
    96910SPhotochemotherapy with UV-B00010.47$22.79$8.49$4.56
    96912SPhotochemotherapy with UV-A00010.47$22.79$8.49$4.56
    96913SPhotochemotherapy, UV-A or B00010.47$22.79$8.49$4.56
    96999SDermatological procedure00010.47$22.79$8.49$4.56
    Start Printed Page 18661
    97001APt evaluation
    97002APt re-evaluation
    97003AOt evaluation
    97004AOt re-evaluation
    97010AHot or cold packs therapy
    97012AMechanical traction therapy
    97014AElectric stimulation therapy
    97016AVasopneumatic device therapy
    97018AParaffin bath therapy
    97020AMicrowave therapy
    97022AWhirlpool therapy
    97024ADiathermy treatment
    97026AInfrared therapy
    97028AUltraviolet therapy
    97032AElectrical stimulation
    97033AElectric current therapy
    97034AContrast bath therapy
    97035AUltrasound therapy
    97036AHydrotherapy
    97039APhysical therapy treatment
    97110ATherapeutic exercises
    97112ANeuromuscular reeducation
    97113AAquatic therapy/exercises
    97116AGait training therapy
    97124AMassage therapy
    97139APhysical medicine procedure
    97140AManual therapy
    97150AGroup therapeutic procedures
    97504AOrthotic training
    97520AProsthetic training
    97530ATherapeutic activities
    97535ASelf care mngment training
    97537ACommunity/work reintegration
    97542AWheelchair mngment training
    97545AWork hardening
    97546AWork hardening add-on
    97703AProsthetic checkout
    97750APhysical performance test
    97770ACognitive skills development
    97780EAcupuncture w/o stimul
    97781EAcupuncture w/stimul
    97799APhysical medicine procedure
    98925SOsteopathic manipulation00600.77$37.34$7.80$7.47
    98926SOsteopathic manipulation00600.77$37.34$7.80$7.47
    98927SOsteopathic manipulation00600.77$37.34$7.80$7.47
    98928SOsteopathic manipulation00600.77$37.34$7.80$7.47
    98929SOsteopathic manipulation00600.77$37.34$7.80$7.47
    98940SChiropractic manipulation00600.77$37.34$7.80$7.47
    98941SChiropractic manipulation00600.77$37.34$7.80$7.47
    98942SChiropractic manipulation00600.77$37.34$7.80$7.47
    98943EChiropractic manipulation
    99000ESpecimen handling
    99001ESpecimen handling
    99002EDevice handling
    99024EPostop follow-up visit
    99025EInitial surgical evaluation
    99050EMedical services after hrs
    99052EMedical services at night
    99054EMedical servcs, unusual hrs
    99056ENon-office medical services
    99058EOffice emergency care
    99070ESpecial supplies
    99071EPatient education materials
    99075EMedical testimony
    99078EGroup health education
    99080ESpecial reports or forms
    99082EUnusual physician travel
    99090EComputer data analysis
    99100ESpecial anesthesia service
    99116EAnesthesia with hypothermia
    99135ESpecial anesthesia procedure
    99140EEmergency anesthesia
    99141NSedation, iv/im or inhalant
    Start Printed Page 18662
    99142NSedation, oral/rectal/nasal
    99170TAnogenital exam, child01922.38$115.40$35.33$23.08
    99173NVisual screening test
    99175NInduction of vomiting
    99183SHyperbaric oxygen therapy00313.00$145.46$140.85$29.09
    99185NRegional hypothermia
    99186NTotal body hypothermia
    99190CSpecial pump services
    99191CSpecial pump services
    99192CSpecial pump services
    99195XPhlebotomy03720.43$20.85$10.09$4.17
    99199ESpecial service/proc/report
    99201VOffice/outpatient visit, new06000.98$47.52$9.50$9.50
    99202VOffice/outpatient visit, new06000.98$47.52$9.50$9.50
    99203VOffice/outpatient visit, new06011.00$48.49$9.70$9.70
    99204VOffice/outpatient visit, new06021.66$80.49$16.29$16.10
    99205VOffice/outpatient visit, new06021.66$80.49$16.29$16.10
    99211VOffice/outpatient visit, est06000.98$47.52$9.50$9.50
    99212VOffice/outpatient visit, est06000.98$47.52$9.50$9.50
    99213VOffice/outpatient visit, est06011.00$48.49$9.70$9.70
    99214VOffice/outpatient visit, est06021.66$80.49$16.29$16.10
    99215VOffice/outpatient visit, est06021.66$80.49$16.29$16.10
    99217NObservation care discharge
    99218NObservation care
    99219NObservation care
    99220NObservation care
    99221EInitial hospital care
    99222EInitial hospital care
    99223EInitial hospital care
    99231ESubsequent hospital care
    99232ESubsequent hospital care
    99233ESubsequent hospital care
    99234CObserv/hosp same date
    99235CObserv/hosp same date
    99236CObserv/hosp same date
    99238EHospital discharge day
    99239EHospital discharge day
    99241VOffice consultation06000.98$47.52$9.50$9.50
    99242VOffice consultation06000.98$47.52$9.50$9.50
    99243VOffice consultation06011.00$48.49$9.70$9.70
    99244VOffice consultation06021.66$80.49$16.29$16.10
    99245VOffice consultation06021.66$80.49$16.29$16.10
    99251CInitial inpatient consult
    99252CInitial inpatient consult
    99253CInitial inpatient consult
    99254CInitial inpatient consult
    99255CInitial inpatient consult
    99261CFollow-up inpatient consult
    99262CFollow-up inpatient consult
    99263CFollow-up inpatient consult
    99271VConfirmatory consultation06000.98$47.52$9.50$9.50
    99272VConfirmatory consultation06000.98$47.52$9.50$9.50
    99273VConfirmatory consultation06011.00$48.49$9.70$9.70
    99274VConfirmatory consultation06021.66$80.49$16.29$16.10
    99275VConfirmatory consultation06021.66$80.49$16.29$16.10
    99281VEmergency dept visit06101.34$64.97$20.65$12.99
    99282VEmergency dept visit06101.34$64.97$20.65$12.99
    99283VEmergency dept visit06112.11$102.31$36.47$20.46
    99284VEmergency dept visit06123.19$154.67$54.14$30.93
    99285VEmergency dept visit06123.19$154.67$54.14$30.93
    99288EDirect advanced life support
    99291SCritical care, first hour06208.60$416.99$152.78$83.40
    99292NCritical care, addl 30 min
    99295CNeonatal critical care
    99296CNeonatal critical care
    99297CNeonatal critical care
    99298CNeonatal critical care
    99301ENursing facility care
    99302ENursing facility care
    99303ENursing facility care
    99311ENursing fac care, subseq
    99312ENursing fac care, subseq
    99313ENursing fac care, subseq
    Start Printed Page 18663
    99315ENursing fac discharge day
    99316ENursing fac discharge day
    99321ERest home visit, new patient
    99322ERest home visit, new patient
    99323ERest home visit, new patient
    99331ERest home visit, est pat
    99332ERest home visit, est pat
    99333ERest home visit, est pat
    99341EHome visit, new patient
    99342EHome visit, new patient
    99343EHome visit, new patient
    99344EHome visit, new patient
    99345EHome visit, new patient
    99347EHome visit, est patient
    99348EHome visit, est patient
    99349EHome visit, est patient
    99350EHome visit, est patient
    99354NProlonged service, office
    99355NProlonged service, office
    99356CProlonged service, inpatient
    99357CProlonged service, inpatient
    99358NProlonged serv, w/o contact
    99359NProlonged serv, w/o contact
    99360EPhysician standby services
    99361EPhysician/team conference
    99362EPhysician/team conference
    99371EPhysician phone consultation
    99372EPhysician phone consultation
    99373EPhysician phone consultation
    99374EHome health care supervision
    99375EHome health care supervision
    99377EHospice care supervision
    99378EHospice care supervision
    99379ENursing fac care supervision
    99380ENursing fac care supervision
    99381EPrev visit, new, infant
    99382EPrev visit, new, age 1-4
    99383EPrev visit, new, age 5-11
    99384EPrev visit, new, age 12-17
    99385EPrev visit, new, age 18-39
    99386EPrev visit, new, age 40-64
    99387EPrev visit, new, 65 & over
    99391EPrev visit, est, infant
    99392EPrev visit, est, age 1-4
    99393EPrev visit, est, age 5-11
    99394EPrev visit, est, age 12-17
    99395EPrev visit, est, age 18-39
    99396EPrev visit, est, age 40-64
    99397EPrev visit, est, 65 & over
    99401EPreventive counseling, indiv
    99402EPreventive counseling, indiv
    99403EPreventive counseling, indiv
    99404EPreventive counseling, indiv
    99411EPreventive counseling, group
    99412EPreventive counseling, group
    99420EHealth risk assessment test
    99429EUnlisted preventive service
    99431NInitial care, normal newborn
    99432NNewborn care, not in hosp
    99433CNormal newborn care/hospital
    99435ENewborn discharge day hosp
    99436NAttendance, birth
    99440SNewborn resuscitation00944.51$218.68$105.29$43.74
    99450ELife/disability evaluation
    99455EDisability examination
    99456EDisability examination
    99499EUnlisted e&m service
    A0021EOutside state ambulance serv
    A0030AAir ambulance service
    A0040AHelicopter ambulance service
    A0050AWater amb service emergency
    A0080ENoninterest escort in non er
    A0090EInterest escort in non er
    Start Printed Page 18664
    A0100ENonemergency transport taxi
    A0110ENonemergency transport bus
    A0120ENoner transport mini-bus
    A0130ENoner transport wheelch van
    A0140ENonemergency transport air
    A0160ENoner transport case worker
    A0170ENoner transport parking fees
    A0180ENoner transport lodgng recip
    A0190ENoner transport meals recip
    A0200ENoner transport lodgng escrt
    A0210ENoner transport meals escort
    A0225ANeonatal emergency transport
    A0300AAmbulance basic non-emer all
    A0302AAmbulance basic emergeny all
    A0304AAmb adv non-er no serv all
    A0306AAmb adv non-er spec serv all
    A0308AAmb adv er no spec serv all
    A0310AAmb adv er spec serv all
    A0320AAmb basic non-er + supplies
    A0322AAmb basic emerg + supplies
    A0324AAdv non-er serv sep mileage
    A0326AAdv non-er no serv sep mile
    A0328AAdv er no serv sep mileage
    A0330AAdv er spec serv sep mile
    A0340AAmb basic non-er + mileage
    A0342AAmbul basic emer + mileage
    A0344AAmb adv non-er no serv +mile
    A0346AAmb adv non-er serv + mile
    A0348AAdv emer no spec serv + mile
    A0350AAdv emer spec serv + mileage
    A0360ABasic non-er sep mile & supp
    A0362ABasic emer sep mile & supply
    A0364AAdv non-er no serv sep mi&su
    A0366AAdv non-er serv sep mil&supp
    A0368AAdv er no serv sep mile&supp
    A0370AAdv er spec serv sep mi&supp
    A0380ABasic life support mileage
    A0382ABasic support routine suppls
    A0384ABls defibrillation supplies
    A0390AAdvanced life support mileag
    A0392AAls defibrillation supplies
    A0394AAls IV drug therapy supplies
    A0396AAls esophageal intub suppls
    A0398AAls routine disposble suppls
    A0420AAmbulance waiting 1/2 hr
    A0422AAmbulance 02 life sustaining
    A0424AExtra ambulance attendant
    A0888ENoncovered ambulance mileage
    A0999AUnlisted ambulance service
    A4206A1 CC sterile syringe & needle
    A4207A2 CC sterile syringe & needle
    A4208A3 CC sterile syringe & needle
    A4209A5+ CC sterile syringe & needle
    A4210ENonneedle injection device
    A4211ASupp for self-adm injections
    A4212ANon coring needle or stylet
    A4213A20+ CC syringe only
    A4214A30 CC sterile water/saline
    A4215ASterile needle
    A4220AInfusion pump refill kit
    A4221AMaint drug infus cath per wk
    A4222ADrug infusion pump supplies
    A4230EInfus insulin pump non needl
    A4231EInfusion insulin pump needle
    A4232ESyringe w/needle insulin 3cc
    A4244AAlcohol or peroxide per pint
    A4245AAlcohol wipes per box
    A4246ABetadine/phisohex solution
    A4247ABetadine/iodine swabs/wipes
    A4250EUrine reagent strips/tablets
    A4253ABlood glucose/reagent strips
    A4254ABattery for glucose monitor
    A4255AGlucose monitor platforms
    Start Printed Page 18665
    A4256ACalibrator solution/chips
    A4258ALancet device each
    A4259ALancets per box
    A4260ELevonorgestrel implant
    A4261ECervical cap contraceptive
    A4262NTemporary tear duct plug
    A4263APermanent tear duct plug
    A4265AParaffin
    A4270ADisposable endoscope sheath
    A4280ABrst prsths adhsv attchmnt
    A4300ACath impl vasc access portal
    A4301AImplantable access syst perc
    A4305ADrug delivery system >=50 ML
    A4306ADrug delivery system <=5 ML
    A4310AInsert tray w/o bag/cath
    A4311ACatheter w/o bag 2-way latex
    A4312ACath w/o bag 2-way silicone
    A4313ACatheter w/bag 3-way
    A4314ACath w/drainage 2-way latex
    A4315ACath w/drainage 2-way silcne
    A4316ACath w/drainage 3-way
    A4320AIrrigation tray
    A4321ACath therapeutic irrig agent
    A4322AIrrigation syringe
    A4323ASaline irrigation solution
    A4326AMale external catheter
    A4327AFem urinary collect dev cup
    A4328AFem urinary collect pouch
    A4329AExternal catheter start set
    A4330AStool collection pouch
    A4335AIncontinence supply
    A4338AIndwelling catheter latex
    A4340AIndwelling catheter special
    A4344ACath indw foley 2 way silicn
    A4346ACath indw foley 3 way
    A4347AMale external catheter
    A4351AStraight tip urine catheter
    A4352ACoude tip urinary catheter
    A4353AIntermittent urinary cath
    A4354ACath insertion tray w/bag
    A4355ABladder irrigation tubing
    A4356AExt ureth clmp or compr dvc
    A4357ABedside drainage bag
    A4358AUrinary leg bag
    A4359AUrinary suspensory w/o leg b
    A4361AOstomy face plate
    A4362ASolid skin barrier
    A4364AOstomy/cath adhesive
    A4365AOstomy adhesive remover wipe
    A4367AOstomy belt
    A4368AOstomy filter
    A4369ASkin barrier liquid per oz
    A4370ASkin barrier paste per oz
    A4371ASkin barrier powder per oz
    A4372ASkin barrier solid 4x4 equiv
    A4373ASkin barrier with flange
    A4374ASkin barrier extended wear
    A4375ADrainable plastic pch w fcpl
    A4376ADrainable rubber pch w fcplt
    A4377ADrainable plstic pch w/o fp
    A4378ADrainable rubber pch w/o fp
    A4379AUrinary plastic pouch w fcpl
    A4380AUrinary rubber pouch w fcplt
    A4381AUrinary plastic pouch w/o fp
    A4382AUrinary hvy plstc pch w/o fp
    A4383AUrinary rubber pouch w/o fp
    A4384AOstomy faceplt/silicone ring
    A4385AOst skn barrier sld ext wear
    A4386AOst skn barrier w flng ex wr
    A4387AOst clsd pouch w att st barr
    A4388ADrainable pch w ex wear barr
    A4389ADrainable pch w st wear barr
    A4390ADrainable pch ex wear convex
    Start Printed Page 18666
    A4391AUrinary pouch w ex wear barr
    A4392AUrinary pouch w st wear barr
    A4393AUrine pch w ex wear bar conv
    A4394AOstomy pouch liq deodorant
    A4395AOstomy pouch solid deodorant
    A4397AIrrigation supply sleeve
    A4398AOstomy irrigation bag
    A4399AOstomy irrig cone/cath w brs
    A4400AOstomy irrigation set
    A4402ALubricant per ounce
    A4404AOstomy ring each
    A4421AOstomy supply misc
    A4454ATape all types all sizes
    A4455AAdhesive remover per ounce
    A4460AElastic compression bandage
    A4462AAbdmnl drssng holder/binder
    A4465ANon-elastic extremity binder
    A4470AGravlee jet washer
    A4480AVabra aspirator
    A4481ATracheostoma filter
    A4483AMoisture exchanger
    A4490EAbove knee surgical stocking
    A4495EThigh length surg stocking
    A4500EBelow knee surgical stocking
    A4510EFull length surg stocking
    A4550ESurgical trays
    A4554EDisposable underpads
    A4556AElectrodes, pair
    A4557ALead wires, pair
    A4558AConductive paste or gel
    A4560APessary
    A4565ASlings
    A4570ASplint
    A4572ARib belt
    A4575EHyperbaric o2 chamber disps
    A4580ACast supplies (plaster)
    A4590ASpecial casting material
    A4595ATENS suppl 2 lead per month
    A4611AHeavy duty battery
    A4612ABattery cables
    A4613ABattery charger
    A4614AHand-held PEFR meter
    A4615ACannula nasal
    A4616ATubing (oxygen) per foot
    A4617AMouth piece
    A4618ABreathing circuits
    A4619AFace tent
    A4620AVariable concentration mask
    A4621ATracheotomy mask or collar
    A4622ATracheostomy or larngectomy
    A4623ATracheostomy inner cannula
    A4624ATracheal suction tube
    A4625ATrach care kit for new trach
    A4626ATracheostomy cleaning brush
    A4627ESpacer bag/reservoir
    A4628AOropharyngeal suction cath
    A4629ATracheostomy care kit
    A4630ARepl bat t.e.n.s. own by pt
    A4631AWheelchair battery
    A4635AUnderarm crutch pad
    A4636AHandgrip for cane etc
    A4637ARepl tip cane/crutch/walker
    A4640AAlternating pressure pad
    A4641NDiagnostic imaging agent
    3 A4642XSatumomab pendetide per dose0704$63.13
    A4643NHigh dose contrast MRI
    A4644NContrast 100-199 MGs iodine
    A4645NContrast 200-299 MGs iodine
    A4646NContrast 300-399 MGs iodine
    A4647NSupp-paramagnetic contr mat
    A4649ASurgical supplies
    A4650ASupp esrd centrifuge
    A4655AEsrd syringe/needle
    Start Printed Page 18667
    A4660AEsrd blood pressure device
    A4663AEsrd blood pressure cuff
    A4670EAuto blood pressure monitor
    A4680AActivated carbon filters
    A4690ADialyzers
    A4700AStandard dialysate solution
    A4705ABicarb dialysate solution
    A4712ASterile water
    A4714ATreated water for dialysis
    A4730AFistula cannulation set dial
    A4735ALocal/topical anesthetics
    A4740AEsrd shunt accessory
    A4750AArterial or venous tubing
    A4755AArterial and venous tubing
    A4760AStandard testing solution
    A4765ADialysate concentrate
    A4770ABlood testing supplies
    A4771ABlood clotting time tube
    A4772ADextrostick/glucose strips
    A4773AHemostix
    A4774AAmmonia test paper
    A4780AEsrd sterilizing agent
    A4790AEsrd cleansing agents
    A4800AHeparin/antidote dialysis
    A4820ASupplies hemodialysis kit
    A4850ARubber tipped hemostats
    A4860ADisposable catheter caps
    A4870APlumbing/electrical work
    A4880AWater storage tanks
    A4890AContracts/repair/maintenance
    A4900ACapd supply kit
    A4901ACcpd supply kit
    A4905AIpd supply kit
    A4910AEsrd nonmedical supplies
    A4912AGomco drain bottle
    A4913AEsrd supply
    A4914APreparation kit
    A4918AVenous pressure clamp
    A4919ASupp dialysis dialyzer holde
    A4920AHarvard pressure clamp
    A4921AMeasuring cylinder
    A4927AGloves
    A5051APouch clsd w barr attached
    A5052AClsd ostomy pouch w/o barr
    A5053AClsd ostomy pouch faceplate
    A5054AClsd ostomy pouch w/flange
    A5055AStoma cap
    A5061APouch drainable w barrier at
    A5062ADrnble ostomy pouch w/o barr
    A5063ADrain ostomy pouch w/flange
    A5064EDrain ostomy pouch w/fceplte
    A5065EDrain ostomy pouch on fcplte
    A5071AUrinary pouch w/barrier
    A5072AUrinary pouch w/o barrier
    A5073AUrinary pouch on barr w/flng
    A5074EUrinary pouch w/faceplate
    A5075EUrinary pouch on faceplate
    A5081AContinent stoma plug
    A5082AContinent stoma catheter
    A5093AOstomy accessory convex inse
    A5102ABedside drain btl w/wo tube
    A5105AUrinary suspensory
    A5112AUrinary leg bag
    A5113ALatex leg strap
    A5114AFoam/fabric leg strap
    A5119ASkin barrier wipes box pr 50
    A5121ASolid skin barrier 6x6
    A5122ASolid skin barrier 8x8
    A5123ASkin barrier with flange
    A5126ADisk/foam pad +or- adhesive
    A5131AAppliance cleaner
    A5149AIncontinence/ostomy supply
    A5200APercutaneous catheter anchor
    Start Printed Page 18668
    A5500ADiab shoe for density insert
    A5501ADiabetic custom molded shoe
    A5502ADiabetic shoe density insert
    A5503ADiabetic shoe w/roller/rockr
    A5504ADiabetic shoe with wedge
    A5505ADiab shoe w/metatarsal bar
    A5506ADiabetic shoe w/off set heel
    A5507AModification diabetic shoe
    A5508ADiabetic deluxe shoe
    A6020ACollagen wound dressing
    A6025ESilicone gel sheet, each
    A6154AWound pouch each
    A6196AAlginate dressing <=16 sq in
    A6197AAlginate drsg >16 <=48 sq in
    A6198Aalginate dressing > 48 sq in
    A6199AAlginate drsg wound filler
    A6200ACompos drsg <=16 no border
    A6201ACompos drsg >16<=48 no bdr
    A6202ACompos drsg >48 no border
    A6203AComposite drsg <= 16 sq in
    A6204AComposite drsg >16<=48 sq in
    A6205AComposite drsg > 48 sq in
    A6206AContact layer <= 16 sq in
    A6207AContact layer >16<= 48 sq in
    A6208AContact layer > 48 sq in
    A6209AFoam drsg <=16 sq in w/o bdr
    A6210AFoam drg >16<=48 sq in w/o b
    A6211AFoam drg > 48 sq in w/o brdr
    A6212AFoam drg <=16 sq in w/border
    A6213AFoam drg >16<=48 sq in w/bdr
    A6214AFoam drg > 48 sq in w/border
    A6215AFoam dressing wound filler
    A6216ANon-sterile gauze<=16 sq in
    A6217ANon-sterile gauze>16<=48 sq
    A6218ANon-sterile gauze > 48 sq in
    A6219AGauze <= 16 sq in w/border
    A6220AGauze >16 <=48 sq in w/bordr
    A6221AGauze > 48 sq in w/border
    A6222AGauze <=16 in no w/sal w/o b
    A6223AGauze >16<=48 no w/sal w/o b
    A6224AGauze > 48 in no w/sal w/o b
    A6228AGauze <= 16 sq in water/sal
    A6229AGauze >16<=48 sq in watr/sal
    A6230AGauze > 48 sq in water/salne
    A6234AHydrocolld drg <=16 w/o bdr
    A6235AHydrocolld drg >16<=48 w/o b
    A6236AHydrocolld drg > 48 in w/o b
    A6237AHydrocolld drg <=16 in w/bdr
    A6238AHydrocolld drg >16<=48 w/bdr
    A6239AHydrocolld drg > 48 in w/bdr
    A6240AHydrocolld drg filler paste
    A6241AHydrocolloid drg filler dry
    A6242AHydrogel drg <=16 in w/o bdr
    A6243AHydrogel drg >16<=48 w/o bdr
    A6244AHydrogel drg >48 in w/o bdr
    A6245AHydrogel drg <= 16 in w/bdr
    A6246AHydrogel drg >16<=48 in w/b
    A6247AHydrogel drg > 48 sq in w/b
    A6248AHydrogel drsg gel filler
    A6250ASkin seal protect moisturizr
    A6251AAbsorpt drg <=16 sq in w/o b
    A6252AAbsorpt drg >16 <=48 w/o bdr
    A6253AAbsorpt drg > 48 sq in w/o b
    A6254AAbsorpt drg <=16 sq in w/bdr
    A6255AAbsorpt drg >16<=48 in w/bdr
    A6256AAbsorpt drg > 48 sq in w/bdr
    A6257ATransparent film <= 16 sq in
    A6258ATransparent film >16<=48 in
    A6259ATransparent film > 48 sq in
    A6260AWound cleanser any type/size
    A6261AWound filler gel/paste/oz
    A6262AWound filler dry form/gram
    A6263ANon-sterile elastic gauze/yd
    Start Printed Page 18669
    A6264ANon-sterile no elastic gauze
    A6265ATape per 18 sq inches
    A6266AImpreg gauze no h20/sal/yard
    A6402ASterile gauze <= 16 sq in
    A6403ASterile gauze>16 <= 48 sq in
    A6404ASterile gauze > 48 sq in
    A6405ASterile elastic gauze/yd
    A6406ASterile non-elastic gauze/yd
    A7000ADisposable canister for pump
    A7001ANondisposable pump canister
    A7002ATubing used w suction pump
    A7003ANebulizer administration set
    A7004ADisposable nebulizer sml vol
    A7005ANondisposable nebulizer set
    A7006AFiltered nebulizer admin set
    A7007ALg vol nebulizer disposable
    A7008ADisposable nebulizer prefill
    A7009ANebulizer reservoir bottle
    A7010ADisposable corrugated tubing
    A7011ANondispos corrugated tubing
    A7012ANebulizer water collec devic
    A7013ADisposable compressor filter
    A7014ACompressor nondispos filter
    A7015AAerosol mask used w nebulize
    A7016ANebulizer dome & mouthpiece
    A7017ANebulizer not used w oxygen
    A9150EMisc/exper non-prescript dru
    A9160EPodiatrist non-covered servi
    A9170EChiropractor non-covered ser
    A9190EMisc/expe personal comfort i
    A9270ENon-covered item or service
    A9300EExercise equipment
    A9500NTechnetium TC 99m sestamibi
    3 A9502XTechnetium TC99M tetrofosmin0705$71.08
    A9503NTechnetium TC 99m medronate
    A9504NTechnetium tc 99m apcitide
    A9505NThallous chloride TL 201/mci
    A9507NIndium/111 capromab pendetid
    3 A9600XStrontium-89 chloride0701$84.76
    3 A9605XSamarium sm153 lexidronamm0702$139.06
    A9900ESupply/accessory/service
    A9901EDelivery/set up/dispensing
    B4034AEnter feed supkit syr by day
    B4035AEnteral feed supp pump per d
    B4036AEnteral feed sup kit grav by
    B4081AEnteral ng tubing w/stylet
    B4082AEnteral ng tubing w/o stylet
    B4083AEnteral stomach tube levine
    B4084AGastrostomy/jejunostomy tubi
    B4085AGastrostomy tube w/ring each
    B4150AEnteral formulae category i
    B4151AEnteral formulae category i-
    B4152AEnteral formulae category ii
    B4153AEnteral formulae category ii
    B4154AEnteral formulae category IV
    B4155AEnteral formulae category v
    B4156AEnteral formulae category vi
    B4164AParenteral 50% dextrose solu
    B4168AParenteral sol amino acid 3.
    B4172AParenteral sol amino acid 5.
    B4176AParenteral sol amino acid 7-
    B4178AParenteral sol amino acid >
    B4180AParenteral sol carb > 50%
    B4184AParenteral sol lipids 10%
    B4186AParenteral sol lipids 20%
    B4189AParenteral sol amino acid &
    B4193AParenteral sol 52-73 gm prot
    B4197AParenteral sol 74-100 gm pro
    B4199AParenteral sol > 100gm prote
    B4216AParenteral nutrition additiv
    B4220AParenteral supply kit premix
    B4222AParenteral supply kit homemi
    B4224AParenteral administration ki
    Start Printed Page 18670
    B5000AParenteral sol renal-amirosy
    B5100AParenteral sol hepatic-fream
    B5200AParenteral sol stres-brnch c
    B9000AEnter infusion pump w/o alrm
    B9002AEnteral infusion pump w/ala
    B9004AParenteral infus pump portab
    B9006AParenteral infus pump statio
    B9998AEnteral supp not otherwise c
    B9999AParenteral supp not othrws c
    D0120EPeriodic oral evaluation
    D0140ELimit oral eval problm focus
    D0150SComprehensve oral evaluation03301.51$73.22$14.64$14.64
    D0160EExtensv oral eval prob focus
    D0170ERe-eval, est pt, problem focus
    D0210EIntraor complete film series
    D0220EIntraoral periapical first f
    D0230EIntraoral periapical ea add
    D0240SIntraoral occlusal film03301.51$73.22$14.64$14.64
    D0250SExtraoral first film03301.51$73.22$14.64$14.64
    D0260SExtraoral ea additional film03301.51$73.22$14.64$14.64
    D0270SDental bitewing single film03301.51$73.22$14.64$14.64
    D0272SDental bitewings two films03301.51$73.22$14.64$14.64
    D0274SDental bitewings four films03301.51$73.22$14.64$14.64
    D0277EVert bitewings-sev to eight
    D0290EDental film skull/facial bon
    D0310EDental saliography
    D0320EDental tmj arthrogram incl i
    D0321EDental other tmj films
    D0322EDental tomographic survey
    D0330EDental panoramic film
    D0340EDental cephalometric film
    D0350EOral/facial images
    D0415EBacteriologic study
    D0425ECaries susceptibility test
    D0460SPulp vitality test03301.51$73.22$14.64$14.64
    D0470EDiagnostic casts
    D0472EGross exam, prep & report
    D0473EMicro exam, prep & report
    D0474EMicro w exam of surg margins
    D0480ECytopath smear prep & report
    D0501SHistopathologic examinations03301.51$73.22$14.64$14.64
    D0502SOther oral pathology procedu03301.51$73.22$14.64$14.64
    D0999SUnspecified diagnostic proce03301.51$73.22$14.64$14.64
    D1110EDental prophylaxis adult
    D1120EDental prophylaxis child
    D1201ETopical fluor w prophy child
    D1203ETopical fluor w/o prophy chi
    D1204ETopical fluor w/o prophy adu
    D1205ETopical fluoride w/prophy a
    D1310ENutri counsel-control caries
    D1320ETobacco counseling
    D1330EOral hygiene instruction
    D1351EDental sealant per tooth
    D1510SSpace maintainer fxd unilat03301.51$73.22$14.64$14.64
    D1515SFixed bilat space maintainer03301.51$73.22$14.64$14.64
    D1520SRemove unilat space maintain03301.51$73.22$14.64$14.64
    D1525SRemove bilat space maintain03301.51$73.22$14.64$14.64
    D1550SRecement space maintainer03301.51$73.22$14.64$14.64
    D2110EAmalgam one surface primary
    D2120EAmalgam two surfaces primary
    D2130EAmalgam three surfaces prima
    D2131EAmalgam four/more surf prima
    D2140EAmalgam one surface permanen
    D2150EAmalgam two surfaces permane
    D2160EAmalgam three surfaces perma
    D2161EAmalgam 4 or > surfaces perm
    D2330EResin one surface-anterior
    D2331EResin two surfaces-anterior
    D2332EResin three surfaces-anterio
    D2335EResin 4/> surf or w incis an
    D2336EComposite resin crown
    D2337ECompo resin crown ant-perm
    D2380EResin one surf poster primar
    Start Printed Page 18671
    D2381EResin two surf poster primar
    D2382EResin three/more surf post p
    D2385EResin one surf poster perman
    D2386EResin two surf poster perman
    D2387EResin three/more surf post p
    D2388EResin four/more, post perm
    D2410EDental gold foil one surface
    D2420EDental gold foil two surface
    D2430EDental gold foil three surfa
    D2510EDental inlay metalic 1 surf
    D2520EDental inlay metallic 2 surf
    D2530EDental inlay metl 3/more sur
    D2542EDental onlay metallic 2 surf
    D2543EDental onlay metallic 3 surf
    D2544EDental onlay metl 4/more sur
    D2610EInlay porcelain/ceramic 1 su
    D2620EInlay porcelain/ceramic 2 su
    D2630EDental onlay porc 3/more sur
    D2642EDental onlay porcelin 2 surf
    D2643EDental onlay porcelin 3 surf
    D2644EDental onlay porc 4/more sur
    D2650EInlay composite/resin one su
    D2651EInlay composite/resin two su
    D2652EDental inlay resin 3/mre sur
    D2662EDental onlay resin 2 surface
    D2663EDental onlay resin 3 surface
    D2664EDental onlay resin 4/mre sur
    D2710ECrown resin laboratory
    D2720ECrown resin w/high noble me
    D2721ECrown resin w/base metal
    D2722ECrown resin w/noble metal
    D2740ECrown porcelain/ceramic subs
    D2750ECrown porcelain w/h noble m
    D2751ECrown porcelain fused base m
    D2752ECrown porcelain w/noble met
    D2780ECrown 3/4 cast hi noble met
    D2781ECrown 3/4 cast base metal
    D2782ECrown 3/4 cast noble metal
    D2783ECrown 3/4 porcelain/ceramic
    D2790ECrown full cast high noble m
    D2791ECrown full cast base metal
    D2792ECrown full cast noble metal
    D2799EProvisional crown
    D2910EDental recement inlay
    D2920EDental recement crown
    D2930EPrefab stnlss steel crwn pri
    D2931EPrefab stnlss steel crown pe
    D2932EPrefabricated resin crown
    D2933EPrefab stainless steel crown
    D2940EDental sedative filling
    D2950ECore build-up incl any pins
    D2951ETooth pin retention
    D2952EPost and core cast + crown
    D2953EEach addtnl cast post
    D2954EPrefab post/core + crown
    D2955EPost removal
    D2957EEach addtnl prefab post
    D2960ELaminate labial veneer
    D2961ELab labial veneer resin
    D2962ELab labial veneer porcelain
    D2970STemporary-fractured tooth03301.51$73.22$14.64$14.64
    D2980ECrown repair
    D2999SDental unspec restorative pr03301.51$73.22$14.64$14.64
    D3110EPulp cap direct
    D3120EPulp cap indirect
    D3220ETherapeutic pulpotomy
    D3221EGross pulpal debridement
    D3230EPulpal therapy anterior prim
    D3240EPulpal therapy posterior pri
    D3310EAnterior
    D3320ERoot canal therapy 2 canals
    D3330ERoot canal therapy 3 canals
    D3331ENon-surg tx root canal obs
    Start Printed Page 18672
    D3332EIncomplete endodontic tx
    D3333EInternal root repair
    D3346ERetreat root canal anterior
    D3347ERetreat root canal bicuspid
    D3348ERetreat root canal molar
    D3351EApexification/recalc initial
    D3352EApexification/recalc interim
    D3353EApexification/recalc final
    D3410EApicoect/perirad surg anter
    D3421ERoot surgery bicuspid
    D3425ERoot surgery molar
    D3426ERoot surgery ea add root
    D3430ERetrograde filling
    D3450ERoot amputation
    D3460SEndodontic endosseous implan03301.51$73.22$14.64$14.64
    D3470EIntentional replantation
    D3910EIsolation-tooth w rubb dam
    D3920ETooth splitting
    D3950ECanal prep/fitting of dowel
    D3999SEndodontic procedure03301.51$73.22$14.64$14.64
    D4210EGingivectomy/plasty per quad
    D4211EGingivectomy/plasty per toot
    D4220EGingival curettage per quadr
    D4240EGingival flap proc w/planin
    D4245EApically positioned flap
    D4249ECrown lengthen hard tissue
    D4260SOsseous surgery per quadrant03301.51$73.22$14.64$14.64
    D4263SBone replce graft first site03301.51$73.22$14.64$14.64
    D4264SBone replce graft each add03301.51$73.22$14.64$14.64
    D4266EGuided tiss regen resorble
    D4267EGuided tiss regen nonresorb
    D4268ESurgical revision procedure
    D4270SPedicle soft tissue graft pr03301.51$73.22$14.64$14.64
    D4271SFree soft tissue graft proc03301.51$73.22$14.64$14.64
    D4273SSubepithelial tissue graft03301.51$73.22$14.64$14.64
    D4274EDistal/proximal wedge proc
    D4320EProvision splnt intracoronal
    D4321EProvisional splint extracoro
    D4341EPeriodontal scaling & root
    D4355SFull mouth debridement03301.51$73.22$14.64$14.64
    D4381SLocalized chemo delivery03301.51$73.22$14.64$14.64
    D4910EPeriodontal maint procedures
    D4920EUnscheduled dressing change
    D4999EUnspecified periodontal proc
    D5110EDentures complete maxillary
    D5120EDentures complete mandible
    D5130EDentures immediat maxillary
    D5140EDentures immediat mandible
    D5211EDentures maxill part resin
    D5212EDentures mand part resin
    D5213EDentures maxill part metal
    D5214EDentures mandibl part metal
    D5281ERemovable partial denture
    D5410EDentures adjust cmplt maxil
    D5411EDentures adjust cmplt mand
    D5421EDentures adjust part maxill
    D5422EDentures adjust part mandbl
    D5510EDentur repr broken compl bas
    D5520EReplace denture teeth complt
    D5610EDentures repair resin base
    D5620ERep part denture cast frame
    D5630ERep partial denture clasp
    D5640EReplace part denture teeth
    D5650EAdd tooth to partial denture
    D5660EAdd clasp to partial denture
    D5710EDentures rebase cmplt maxil
    D5711EDentures rebase cmplt mand
    D5720EDentures rebase part maxill
    D5721EDentures rebase part mandbl
    D5730EDenture reln cmplt maxil ch
    D5731EDenture reln cmplt mand chr
    D5740EDenture reln part maxil chr
    D5741EDenture reln part mand chr
    Start Printed Page 18673
    D5750EDenture reln cmplt max lab
    D5751EDenture reln cmplt mand lab
    D5760EDenture reln part maxil lab
    D5761EDenture reln part mand lab
    D5810EDenture interm cmplt maxill
    D5811EDenture interm cmplt mandbl
    D5820EDenture interm part maxill
    D5821EDenture interm part mandbl
    D5850EDenture tiss conditn maxill
    D5851EDenture tiss condtin mandbl
    D5860EOverdenture complete
    D5861EOverdenture partial
    D5862EPrecision attachment
    D5867EReplacement of precision att
    D5875EProsthesis modification
    D5899ERemovable prosthodontic proc
    D5911SFacial moulage sectional03301.51$73.22$14.64$14.64
    D5912SFacial moulage complete03301.51$73.22$14.64$14.64
    D5913ENasal prosthesis
    D5914EAuricular prosthesis
    D5915EOrbital prosthesis
    D5916EOcular prosthesis
    D5919EFacial prosthesis
    D5922ENasal septal prosthesis
    D5923EOcular prosthesis interim
    D5924ECranial prosthesis
    D5925EFacial augmentation implant
    D5926EReplacement nasal prosthesis
    D5927EAuricular replacement
    D5928EOrbital replacement
    D5929EFacial replacement
    D5931ESurgical obturator
    D5932EPostsurgical obturator
    D5933ERefitting of obturator
    D5934EMandibular flange prosthesis
    D5935EMandibular denture prosth
    D5936ETemp obturator prosthesis
    D5937ETrismus appliance
    D5951EFeeding aid
    D5952EPediatric speech aid
    D5953EAdult speech aid
    D5954ESuperimposed prosthesis
    D5955EPalatal lift prosthesis
    D5958EIntraoral con def inter plt
    D5959EIntraoral con def mod palat
    D5960EModify speech aid prosthesis
    D5982ESurgical stent
    D5983SRadiation applicator03301.51$73.22$14.64$14.64
    D5984SRadiation shield03301.51$73.22$14.64$14.64
    D5985SRadiation cone locator03301.51$73.22$14.64$14.64
    D5986EFluoride applicator
    D5987SCommissure splint03301.51$73.22$14.64$14.64
    D5988ESurgical splint
    D5999EMaxillofacial prosthesis
    D6010EOdontics endosteal implant
    D6020EOdontics abutment placement
    D6040EOdontics eposteal implant
    D6050EOdontics transosteal implnt
    D6055EImplant connecting bar
    D6056EPrefabricated abutment
    D6057ECustom abutment
    D6058EAbutment supported crown
    D6059EAbutment supported mtl crown
    D6060EAbutment supported mtl crown
    D6061EAbutment supported mtl crown
    D6062EAbutment supported mtl crown
    D6063EAbutment supported mtl crown
    D6064EAbutment supported mtl crown
    D6065EImplant supported crown
    D6066EImplant supported mtl crown
    D6067EImplant supported mtl crown
    D6068EAbutment supported retainer
    D6069EAbutment supported retainer
    Start Printed Page 18674
    D6070EAbutment supported retainer
    D6071EAbutment supported retainer
    D6072EAbutment supported retainer
    D6073EAbutment supported retainer
    D6074EAbutment supported retainer
    D6075EImplant supported retainer
    D6076EImplant supported retainer
    D6077EImplant supported retainer
    D6078EImplnt/abut suprtd fixd dent
    D6079EImplnt/abut suprtd fixd dent
    D6080EImplant maintenance
    D6090ERepair implant
    D6095EOdontics repr abutment
    D6100ERemoval of implant
    D6199EImplant procedure
    D6210EProsthodont high noble metal
    D6211EBridge base metal cast
    D6212EBridge noble metal cast
    D6240EBridge porcelain high noble
    D6241EBridge porcelain base metal
    D6242EBridge porcelain nobel metal
    D6245EBridge porcelain/ceramic
    D6250EBridge resin w/high noble
    D6251EBridge resin base metal
    D6252EBridge resin w/noble metal
    D6519EInlay/onlay porce/ceramic
    D6520EDental retainer two surfaces
    D6530ERetainer metallic 3+ surface
    D6543EDental retainr onlay 3 surf
    D6544EDental retainr onlay 4/more
    D6545EDental retainr cast metl
    D6548EPorcelain/ceramic retainer
    D6720ERetain crown resin w hi nble
    D6721ECrown resin w/base metal
    D6722ECrown resin w/noble metal
    D6740ECrown porcelain/ceramic
    D6750ECrown porcelain high noble
    D6751ECrown porcelain base metal
    D6752ECrown porcelain noble metal
    D6780ECrown 3/4 high noble metal
    D6781ECrown 3/4 cast based metal
    D6782ECrown 3/4 cast noble metal
    D6783ECrown 3/4 porcelain/ceramic
    D6790ECrown full high noble metal
    D6791ECrown full base metal cast
    D6792ECrown full noble metal cast
    D6920SDental connector bar03301.51$73.22$14.64$14.64
    D6930EDental recement bridge
    D6940EStress breaker
    D6950EPrecision attachment
    D6970EPost & core plus retainer
    D6971ECast post bridge retainer
    D6972EPrefab post & core plus reta
    D6973ECore build up for retainer
    D6975ECoping metal
    D6976EEach addtnl cast post
    D6977EEach addtl prefab post
    D6980EBridge repair
    D6999EFixed prosthodontic proc
    D7110SOral surgery single tooth03301.51$73.22$14.64$14.64
    D7120SEach add tooth extraction03301.51$73.22$14.64$14.64
    D7130STooth root removal03301.51$73.22$14.64$14.64
    D7210SRem imp tooth w mucoper flp03301.51$73.22$14.64$14.64
    D7220SImpact tooth remov soft tiss03301.51$73.22$14.64$14.64
    D7230SImpact tooth remov part bony03301.51$73.22$14.64$14.64
    D7240SImpact tooth remov comp bony03301.51$73.22$14.64$14.64
    D7241SImpact tooth rem bony w/comp03301.51$73.22$14.64$14.64
    D7250STooth root removal03301.51$73.22$14.64$14.64
    D7260SOral antral fistula closure03301.51$73.22$14.64$14.64
    D7270ETooth reimplantation
    D7272ETooth transplantation
    D7280EExposure impact tooth orthod
    D7281EExposure tooth aid eruption
    Start Printed Page 18675
    D7285EBiopsy of oral tissue hard
    D7286EBiopsy of oral tissue soft
    D7290ERepositioning of teeth
    D7291STransseptal fiberotomy03301.51$73.22$14.64$14.64
    D7310EAlveoplasty w/extraction
    D7320EAlveoplasty w/o extraction
    D7340EVestibuloplasty ridge extens
    D7350EVestibuloplasty exten graft
    D7410ERad exc lesion up to 1.25 cm
    D7420ELesion > 1.25 cm
    D7430EExc benign tumor to 1.25 cm
    D7431EBenign tumor exc > 1.25 cm
    D7440EMalig tumor exc to 1.25 cm
    D7441EMalig tumor > 1.25 cm
    D7450ERem odontogen cyst to 1.25cm
    D7451ERem odontogen cyst > 1.25 cm
    D7460ERem nonodonto cyst to 1.25cm
    D7461ERem nonodonto cyst > 1.25 cm
    D7465ELesion destruction
    D7471ERem exostosis any site
    D7480EPartial ostectomy
    D7490EMandible resection
    D7510EI&d absc intraoral soft tiss
    D7520EI&d abscess extraoral
    D7530ERemoval fb skin/areolar tiss
    D7540ERemoval of fb reaction
    D7550ERemoval of sloughed off bone
    D7560EMaxillary sinusotomy
    D7610EMaxilla open reduct simple
    D7620EClsd reduct simpl maxilla fx
    D7630EOpen red simpl mandible fx
    D7640EClsd red simpl mandible fx
    D7650EOpen red simp malar/zygom fx
    D7660EClsd red simp malar/zygom fx
    D7670EClosd rductn splint alveolus
    D7680EReduct simple facial bone fx
    D7710EMaxilla open reduct compound
    D7720EClsd reduct compd maxilla fx
    D7730EOpen reduct compd mandble fx
    D7740EClsd reduct compd mandble fx
    D7750EOpen red comp malar/zygma fx
    D7760EClsd red comp malar/zygma fx
    D7770EOpen reduc compd alveolus fx
    D7780EReduct compnd facial bone fx
    D7810ETmj open reduct-dislocation
    D7820EClosed tmp manipulation
    D7830ETmj manipulation under anest
    D7840ERemoval of tmj condyle
    D7850ETmj meniscectomy
    D7852ETmj repair of joint disc
    D7854ETmj excisn of joint membrane
    D7856ETmj cutting of a muscle
    D7858ETmj reconstruction
    D7860ETmj cutting into joint
    D7865ETmj reshaping components
    D7870ETmj aspiration joint fluid
    D7871ELysis + lavage w catheters
    D7872ETmj diagnostic arthroscopy
    D7873ETmj arthroscopy lysis adhesn
    D7874ETmj arthroscopy disc reposit
    D7875ETmj arthroscopy synovectomy
    D7876ETmj arthroscopy discectomy
    D7877ETmj arthroscopy debridement
    D7880EOcclusal orthotic appliance
    D7899ETmj unspecified therapy
    D7910EDent sutur recent wnd to 5cm
    D7911EDental suture wound to 5 cm
    D7912ESuture complicate wnd > 5 cm
    D7920EDental skin graft
    D7940SReshaping bone orthognathic03301.51$73.22$14.64$14.64
    D7941EBone cutting ramus closed
    D7943ECutting ramus open w/graft
    D7944EBone cutting segmented
    Start Printed Page 18676
    D7945EBone cutting body mandible
    D7946EReconstruction maxilla total
    D7947EReconstruct maxilla segment
    D7948EReconstruct midface no graft
    D7949EReconstruct midface w/graft
    D7950EMandible graft
    D7955ERepair maxillofacial defects
    D7960EFrenulectomy/frenulotomy
    D7970EExcision hyperplastic tissue
    D7971EExcision pericoronal gingiva
    D7980ESialolithotomy
    D7981EExcision of salivary gland
    D7982ESialodochoplasty
    D7983EClosure of salivary fistula
    D7990EEmergency tracheotomy
    D7991EDental coronoidectomy
    D7995ESynthetic graft facial bones
    D7996EImplant mandible for augment
    D7997EAppliance removal
    D7999EOral surgery procedure
    D8010ELimited dental tx primary
    D8020ELimited dental tx transition
    D8030ELimited dental tx adolescent
    D8040ELimited dental tx adult
    D8050EIntercep dental tx primary
    D8060EIntercep dental tx transitn
    D8070ECompre dental tx transition
    D8080ECompre dental tx adolescent
    D8090ECompre dental tx adult
    D8210EOrthodontic rem appliance tx
    D8220EFixed appliance therapy habt
    D8660EPreorthodontic tx visit
    D8670EPeriodic orthodontc tx visit
    D8680EOrthodontic retention
    D8690EOrthodontic treatment
    D8691ERepair ortho appliance
    D8692EReplacement retainer
    D8999EOrthodontic procedure
    D9110NTx dental pain minor proc
    D9210EDent anesthesia w/o surgery
    D9211ERegional block anesthesia
    D9212ETrigeminal block anesthesia
    D9215ELocal anesthesia
    D9220EGeneral anesthesia
    D9221EGeneral anesthesia ea ad 15m
    D9230NAnalgesia
    D9241EIntravenous sedation
    D9242EIV sedation ea ad 30 m
    D9248ESedation (non-iv)
    D9310EDental consultation
    D9410EDental house call
    D9420EHospital call
    D9430EOffice visit during hours
    D9440EOffice visit after hours
    D9610EDent therapeutic drug inject
    D9630SOther drugs/medicaments03301.51$73.22$14.64$14.64
    D9910EDent appl desensitizing med
    D9911EAppl desensitizing resin
    D9920EBehavior management
    D9930STreatment of complications03301.51$73.22$14.64$14.64
    D9940SDental occlusal guard03301.51$73.22$14.64$14.64
    D9941EFabrication athletic guard
    D9950SOcclusion analysis03301.51$73.22$14.64$14.64
    D9951SLimited occlusal adjustment03301.51$73.22$14.64$14.64
    D9952SComplete occlusal adjustment03301.51$73.22$14.64$14.64
    D9970EEnamel microabrasion
    D9971EOdontoplasty 1-2 teeth
    D9972EExtrnl bleaching per arch
    D9973EExtrnl bleaching per tooth
    D9974EIntrnl bleaching per tooth
    D9999EAdjunctive procedure
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    E0105ACane adjust/fixed quad/3 pro
    Start Printed Page 18677
    E0110ACrutch forearm pair
    E0111ACrutch forearm each
    E0112ACrutch underarm pair wood
    E0113ACrutch underarm each wood
    E0114ACrutch underarm pair no wood
    E0116ACrutch underarm each no wood
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    E0135AWalker folding adjust/fixed
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    E0166ACommode chair mobile detach
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    E0175ACommode chair foot rest
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    E0177AWater press pad/cushion nonp
    E0178AGel pressre pad/cushion nonp
    E0179ADry pressre pad/cushion nonp
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    E0181APress pad alternating w/pum
    E0182APressure pad alternating pum
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    E0198AWater pressure pad for mattr
    E0199ADry pressure pad for mattres
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    E0205AHeat lamp with stand
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    E0215AElectric heat pad moist
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    E0218AWater circ cold pad w pump
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    E0239AHydrocollator unit portable
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    E0242EBath tub rail floor
    E0243EToilet rail
    E0244EToilet seat raised
    E0245ETub stool or bench
    E0246ATransfer tub rail attachment
    E0249APad water circulating heat u
    Start Printed Page 18678
    E0250AHosp bed fixed ht w/mattres
    E0251AHosp bed fixd ht w/o mattres
    E0255AHospital bed var ht w/mattr
    E0256AHospital bed var ht w/o matt
    E0260AHosp bed semi-electr w/matt
    E0261AHosp bed semi-electr w/o mat
    E0265AHosp bed total electr w/mat
    E0266AHosp bed total elec w/o matt
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    E0276ABed pan fracture
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    E0280ABed cradle
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    E0291AHosp bed fx ht w/o rail w/o
    E0292AHosp bed var ht w/o rail w/o
    E0293AHosp bed var ht w/o rail w/
    E0294AHosp bed semi-elect w/mattr
    E0295AHosp bed semi-elect w/o matt
    E0296AHosp bed total elect w/matt
    E0297AHosp bed total elect w/o mat
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    E0310ARails bed side full length
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    E0326AUrinal female jug-type
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    E0352ADisposable pack w/bowel syst
    E0370AAir elevator for heel
    E0371ANonpower mattress overlay
    E0372APowered air mattress overlay
    E0373ANonpowered pressure mattress
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    E0425AGas system stationary compre
    E0430AOxygen system gas portable
    E0431APortable gaseous 02
    E0434APortable liquid 02
    E0435AOxygen system liquid portabl
    E0439AStationary liquid 02
    E0440AOxygen system liquid station
    E0441AOxygen contents gas per/unit
    E0442AOxygen contents liq per/unit
    E0443APort 02 contents gas/unit
    E0444APort 02 contents liq/unit
    E0450AVolume vent stationary/porta
    E0455AOxygen tent excl croup/ped t
    E0457AChest shell
    E0459AChest wrap
    E0460ANeg press vent portabl/statn
    E0462ARocking bed w/ or w/o side r
    E0480APercussor elect/pneum home m
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    E0555AHumidifier for use w/regula
    E0560AHumidifier supplemental w/i
    E0565ACompressor air power source
    E0570ANebulizer with compression
    E0575ANebulizer ultrasonic
    E0580ANebulizer for use w/regulat
    E0585ANebulizer w/compressor & he
    E0590ADispensing fee dme neb drug
    E0600ASuction pump portab hom modl
    E0601ACont airway pressure device
    E0602ABreast pump
    E0605AVaporizer room type
    E0606ADrainage board postural
    E0607ABlood glucose monitor home
    E0608AApnea monitor
    E0609ABlood gluc mon w/special fea
    Start Printed Page 18679
    E0610APacemaker monitr audible/vis
    E0615APacemaker monitr digital/vis
    E0616ACardiac event recorder
    E0621APatient lift sling or seat
    E0625APatient lift bathroom or toi
    E0627ASeat lift incorp lift-chair
    E0628ASeat lift for pt furn-electr
    E0629ASeat lift for pt furn-non-el
    E0630APatient lift hydraulic
    E0635APatient lift electric
    E0650APneuma compresor non-segment
    E0651APneum compressor segmental
    E0652APneum compres w/cal pressure
    E0655APneumatic appliance half arm
    E0660APneumatic appliance full leg
    E0665APneumatic appliance full arm
    E0666APneumatic appliance half leg
    E0667ASeg pneumatic appl full leg
    E0668ASeg pneumatic appl full arm
    E0669ASeg pneumatic appli half leg
    E0671APressure pneum appl full leg
    E0672APressure pneum appl full arm
    E0673APressure pneum appl half leg
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    E0730ATens four lead
    E0731AConductive garment for tens/
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    E0745ANeuromuscular stim for shock
    E0746AElectromyograph biofeedback
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    E0748AElec osteogen stim spinal
    E0749AElec osteogen stim implanted
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    E0753ANeurostimulator electrodes
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    E0760AOsteogen ultrasound stimltor
    E0776AIv pole
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    E0780AMech amb infusion pump <8hrs
    E0781AExternal ambulatory infus pu
    E0782ANon-programble infusion pump
    E0783AProgrammable infusion pump
    E0784AExt amb infusn pump insulin
    E0785AReplacement impl pump cathet
    E0791AParenteral infusion pump sta
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    E0850ATraction stand free standing
    E0855ACervical traction equipment
    E0860ATract equip cervical tract
    E0870ATract frame attach footboard
    E0880ATrac stand free stand extrem
    E0890ATraction frame attach pelvic
    E0900ATrac stand free stand pelvic
    E0910ATrapeze bar attached to bed
    E0920AFracture frame attached to b
    E0930AFracture frame free standing
    E0935AExercise device passive moti
    E0940ATrapeze bar free standing
    E0941AGravity assisted traction de
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    E0943ACervical pillow
    E0944APelvic belt/harness/boot
    E0945ABelt/harness extremity
    E0946AFracture frame dual w cross
    E0947AFracture frame attachmnts pe
    E0948AFracture frame attachmnts ce
    E0950ATray
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    E0952ALoop tie
    Start Printed Page 18680
    E0953APneumatic tire
    E0954AWheelchair semi-pneumatic ca
    E0958AWhlchr att-conv 1 arm drive
    E0959AAmputee adapter
    E0961AWheelchair brake extension
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    E0963AWheelchair 2 inch cushion
    E0964AWheelchair 3 inch cushion
    E0965AWheelchair 4 inch cushion
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    E0979AWheelchair belt with velcro
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    E0992AWheelchair solid seat insert
    E0993AWheelchair back upholstery
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    E0995AWheelchair calf rest
    E0996AWheelchair tire solid
    E0997AWheelchair caster w/a fork
    E0998AWheelchair caster w/o a fork
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    E1001AWheelchair wheel
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    E1065AWheelchair power attachment
    E1066AWheelchair battery charger
    E1069AWheelchair deep cycle batter
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    E1083AHemi-wheelchair fixed arms
    E1084AHemi-wheelchair detachable a
    E1085AHemi-wheelchair fixed arms
    E1086AHemi-wheelchair detachable a
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    E1088AWheelchair lightweight det a
    E1089AWheelchair lightwt fixed arm
    E1090AWheelchair lightweight det a
    E1091AWheelchair youth
    E1092AWheelchair wide w/leg rests
    E1093AWheelchair wide w/foot rest
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    E1110AWheelchair semi-recl detach
    E1130AWhlchr stand fxd arm ft rest
    E1140AWheelchair standard detach a
    E1150AWheelchair standard w/leg r
    E1160AWheelchair fixed arms
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    E1172AWheelchair amputee detach ar
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    E1190AWheelchair amputee w/leg re
    E1195AWheelchair amputee heavy dut
    E1200AWheelchair amputee fixed arm
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    E1211AWheelchair motorized w/det
    E1212AWheelchair motorized w full
    E1213AWheelchair motorized w/det
    E1220AWhlchr special size/constrc
    E1221AWheelchair spec size w foot
    Start Printed Page 18681
    E1222AWheelchair spec size w/leg
    E1223AWheelchair spec size w foot
    E1224AWheelchair spec size w/leg
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    E1227AWheelchair spec sz spec ht a
    E1228AWheelchair spec sz spec ht b
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    E1250AWheelchair lightwt fixed arm
    E1260AWheelchair lightwt foot rest
    E1270AWheelchair lightweight leg r
    E1280AWhchr h-duty det arm leg res
    E1285AWheelchair heavy duty fixed
    E1290AWheelchair hvy duty detach a
    E1295AWheelchair heavy duty fixed
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    E1297AWheelchair special seat dept
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    E1310AWhirlpool non-portable
    E1340ARepair for DME, per 15 min
    E1353AOxygen supplies regulator
    E1355AOxygen supplies stand/rack
    E1372AOxy suppl heater for nebuliz
    E1375AOxygen suppl nebulizer porta
    E1377AOxygen concentrator to 244 c
    E1378AOxygen concentrator to 488 c
    E1379AOxygen concentrator to 732 c
    E1380AOxygen concentrator to 976 c
    E1381AOxygen concentrat to 1220 cu
    E1382AOxygen concentrat to 1464 cu
    E1383AOxygen concentrat to 1708 cu
    E1384AOxygen concentrat to 1952 cu
    E1385AOxygen concentrator > 1952 c
    E1390AOxygen concentrator
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    E1406AO2/water vapor enrich w/o he
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    E1530AAir bubble detector for dial
    E1540APressure alarm for dialysis
    E1550ABath conductivity meter
    E1560ABlood leak detector for dial
    E1570AAdjustable chair for esrd pt
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    E1580AUnipuncture control system
    E1590AHemodialysis machine
    E1592AAuto interm peritoneal dialy
    E1594ACycler dialysis machine
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    E1702ARepl measr scales jaw motion
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    E1805AAdjust wrist ext/flex device
    E1810AAdjust knee ext/flex device
    E1815AAdjust ankle ext/flex device
    E1820ASoft interface material
    E1825AAdjust finger ext/flex devc
    E1830AAdjust toe ext/flex device
    E1900ASpeech communication device
    Start Printed Page 18682
    G0001ADrawing blood for specimen
    G0002NTemporary urinary catheter
    G0004SECG transm phys review & int01001.70$82.43$71.57$16.49
    G0005SECG 24 hour recording00990.38$18.43$14.68$3.69
    G0006SECG transmission & analysis01001.70$82.43$71.57$16.49
    G0007NECG phy review & interpret
    2 G0008XAdmin influenza virus vac03540.13$6.19
    G0009NAdmin pneumococcal vaccine
    G0010NAdmin hepatitis b vaccine
    G0015SPost symptom ECG tracing00990.38$18.43$14.68$3.69
    G0016NPost symptom ECG md review
    G0025XCollagen skin test kit03430.45$21.82$12.16$4.36
    G0026AFecal leukocyte examination
    G0027ASemen analysis
    G0030SPET imaging prev PET single028515.06$730.22$415.21$146.04
    G0031SPET imaging prev PET multple028515.06$730.22$415.21$146.04
    G0032SPET follow SPECT 78464 singl028515.06$730.22$415.21$146.04
    G0033SPET follow SPECT 78464 mult028515.06$730.22$415.21$146.04
    G0034SPET follow SPECT 76865 singl028515.06$730.22$415.21$146.04
    G0035SPET follow SPECT 78465 mult028515.06$730.22$415.21$146.04
    G0036SPET follow cornry angio sing028515.06$730.22$415.21$146.04
    G0037SPET follow cornry angio mult028515.06$730.22$415.21$146.04
    G0038SPET follow myocard perf sing028515.06$730.22$415.21$146.04
    G0039SPET follow myocard perf mult028515.06$730.22$415.21$146.04
    G0040SPET follow stress echo singl028515.06$730.22$415.21$146.04
    G0041SPET follow stress echo mult028515.06$730.22$415.21$146.04
    G0042SPET follow ventriculogm sing028515.06$730.22$415.21$146.04
    G0043SPET follow ventriculogm mult028515.06$730.22$415.21$146.04
    G0044SPET following rest ECG singl028515.06$730.22$415.21$146.04
    G0045SPET following rest ECG mult028515.06$730.22$415.21$146.04
    G0046SPET follow stress ECG singl028515.06$730.22$415.21$146.04
    G0047SPET follow stress ECG mult028515.06$730.22$415.21$146.04
    G0050SResidual urine by ultrasound02651.17$56.73$38.08$11.35
    G0101VCA screen; pelvic/breast exam06011.00$48.49$9.70$9.70
    G0102EProstate ca screening; dre
    G0103EPsa, total screening
    1 G0104SCA screen; flexi sigmoidscope01587.98$386.93$96.73
    1 G0105SColorectal scrn; hi risk ind01592.83$137.22$34.31
    2 G0106SColon CA screen; barium enema01571.79$86.79$17.36
    G0107ACA screen; fecal blood test
    G0108ADiab manage trn per indiv
    G0109ADiab manage trn ind/group
    G0110ANett pulm-rehab educ; ind
    G0111ANett pulm-rehab educ; group
    G0112ANett; nutrition guid, initial
    G0113ANett; nutrition guid, subseqnt
    G0114ANett; psychosocial consult
    G0115ANett; psychological testing
    G0116ANett; psychosocial counsel
    2 G0120SColon ca scrn; barium enema01571.79$86.79$17.36
    G0121EColon ca scrn not hi rsk ind
    G0122EColon ca scrn; barium enema
    G0123EScreen cerv/vag thin layer
    G0124EScreen c/v thin layer by MD
    2 G0125TLung image (PET)098038.67$1,875.00$375.00
    2 G0126TLung image (PET) staging098038.67$1,875.00$375.00
    G0127TTrim nail(s)00090.74$35.88$9.63$7.18
    G0128ECORF skilled nursing service
    G0129PPartial hosp prog service00334.17$202.19$48.17$40.44
    G0130XSingle energy x-ray study02611.38$66.91$38.77$13.38
    G0131XCT scan, bone density study02611.38$66.91$38.77$13.38
    G0132XCT scan, bone density study02611.38$66.91$38.77$13.38
    G0141EScr c/v cyto, autosys and md
    G0143EScr c/v cyto, thinlayer, rescr
    G0144EScr c/v cyto, thinlayer, rescr
    G0145EScr c/v cyto, thinlayer, rescr
    G0147EScr c/v cyto, automated sys
    G0148EScr c/v cyto, autosys, rescr
    G0151EHHCP-serv of pt, ea 15 min
    G0152EHHCP-serv of ot, ea 15 min
    G0153EHHCP-svs of s/l path, ea 15mn
    G0154EHHCP-svs of rn, ea 15 min
    G0155EHHCP-svs of csw, ea 15 min
    Start Printed Page 18683
    G0156EHHCP-svs of aide, ea 15 min
    G0159TPerc declot dialysis graft008826.49$1,284.42$678.68$256.88
    G0160CCryo. ablation, prostate
    G0161XEcho guide for cryo probes02682.23$108.13$69.51$21.63
    2 G0163TPet for rec of colorectal ca098038.67$1,875.00$375.00
    2 G0164TPet for lymphoma staging098038.67$1,875.00$375.00
    2 G0165TPet, rec of melanoma/met ca098038.67$1,875.00$375.00
    2 G0166TExtrnl counterpulse, per tx09723.09$149.83$29.97
    G0167SHyperbaric oz tx; no md reqrd00313.00$145.46$140.85$29.09
    G0168TWound closure by adhesive002612.11$587.18$277.92$117.44
    G0169TRemoval tissue; no anesthsia002612.11$587.18$277.92$117.44
    G0170TSkin biograft002612.11$587.18$277.92$117.44
    G0171TSkin biograft add-on002612.11$587.18$277.92$117.44
    G0172PPartial hosp prog service00334.17$202.19$48.17$40.44
    G0173SStereotactic, one session03028.21$398.08$216.55$79.62
    G0174SStereotactic, mult session03028.21$398.08$216.55$79.62
    G0175VMultidisciplinary team visit06031.66$80.49$16.29$16.10
    J0120NTetracyclin injection
    J0130NAbciximab injection
    2 J0150XInjection adenosine 6 MG09170.36$17.46$3.49
    J0151EAdenosine injection
    J0170NAdrenalin epinephrin inject
    J0190NInj biperiden lactate/5 mg
    J0200NAlatrofloxacin mesylate
    3 J0205XAlglucerase injection0900$5.14
    3 J0207XAmifostine7000$41.99
    J0210NMethyldopate hcl injection
    3 J0256XAlpha 1 proteinase inhibitor0901$15.22
    J0270EAlprostadil for injection
    J0275EAlprostadil urethral suppos
    J0280NAminophyllin 250 MG inj
    J0285NAmphotericin B
    3 J0286XAmphotericin B lipid complex7001$12.12
    J0290NAmpicillin 500 MG inj
    J0295NAmpicillin sodium per 1.5 gm
    J0300NAmobarbital 125 MG inj
    J0330NSuccinycholine chloride inj
    J0340NNandrolon phenpropionate inj
    J0350NInjection anistreplase 30 u
    J0360NHydralazine hcl injection
    J0380NInj metaraminol bitartrate
    J0390NChloroquine injection
    J0395NArbutamine HCl injection
    J0400NInj trimethaphan camsylate
    J0456NAzithromycin
    J0460NAtropine sulfate injection
    J0470NDimecaprol injection
    J0475NBaclofen 10 MG injection
    3 J0476XBaclofen intrathecal trial7021$.10
    J0500NDicyclomine injection
    J0510NBenzquinamide injection
    J0515NInj benztropine mesylate
    J0520NBethanechol chloride inject
    J0530NPenicillin g benzathine inj
    J0540NPenicillin g benzathine inj
    J0550NPenicillin g benzathine inj
    J0560NPenicillin g benzathine inj
    J0570NPenicillin g benzathine inj
    J0580NPenicillin g benzathine inj
    3 J0585XBotulinum toxin a per unit0902$56.05
    J0590NEthylnorepinephrine hcl inj
    J0600NEdetate calcium disodium inj
    J0610NCalcium gluconate injection
    J0620NCalcium glycer & lact/10 ML
    J0630NCalcitonin salmon injection
    J0635NCalcitriol injection
    3 J0640XLeucovorin calcium injection0725$1.07
    J0670NInj mepivacaine HCL/10 ml
    J0690NCefazolin sodium injection
    J0694NCefoxitin sodium injection
    J0695NCefonocid sodium injection
    J0696NCeftriaxone sodium injection
    J0697NSterile cefuroxime injection
    Start Printed Page 18684
    J0698NCefotaxime sodium injection
    J0702NBetamethasone acet & sod phosp
    J0704NBetamethasone sod phosp/4 MG
    J0710NCephapirin sodium injection
    J0713NInj ceftazidime per 500 mg
    J0715NCeftizoxime sodium/500 MG
    J0720NChloramphenicol sodium injec
    J0725NChorionic gonadotropin/1000u
    J0730NChlorpheniramin maleate inj
    3 J0735XClonidine hydrochloride7002$4.17
    J0740NCidofovir injection
    J0743NCilastatin sodium injection
    J0745NInj codeine phosphate/30 MG
    J0760NColchicine injection
    J0770NColistimethate sodium inj
    J0780NProchlorperazine injection
    J0800NCorticotropin injection
    J0810NCortisone injection
    J0835NInj cosyntropin per 0.25 MG
    3 J0850XCytomegalovirus imm IV/vial0903$54.11
    J0895NDeferoxamine mesylate inj
    J0900NTestosterone enanthate inj
    J0945NBrompheniramine maleate inj
    J0970NEstradiol valerate injection
    J1000NDepo-estradiol cypionate inj
    J1020NMethylprednisolone 20 MG inj
    J1030NMethylprednisolone 40 MG inj
    J1040NMethylprednisolone 80 MG inj
    J1050NMedroxyprogesterone inj
    J1055EMedrxyprogester acetate inj
    J1060NTestosterone cypionate 1 ML
    J1070NTestosterone cypionat 100 MG
    J1080NTestosterone cypionat 200 MG
    J1090NTestosterone cypionate 50 MG
    J1095NInj dexamethasone acetate
    J1100NDexamethasone sodium phos
    J1110NInj dihydroergotamine mesylt
    J1120NAcetazolamid sodium injectio
    J1160NDigoxin injection
    J1165NPhenytoin sodium injection
    J1170NHydromorphone injection
    J1180NDyphylline injection
    3 J1190XDexrazoxane HCl injection0726$18.81
    J1200NDiphenhydramine hcl injectio
    J1205NChlorothiazide sodium inj
    J1212NDimethyl sulfoxide 50% 50 ML
    J1230NMethadone injection
    J1240NDimenhydrinate injection
    2 J1245XDipyridamole injection09170.36$17.46$3.49
    J1250NInj dobutamine HCL/250 mg
    3 J1260XDolasetron mesylate0750$1.94
    J1320NAmitriptyline injection
    3 J1325XEpoprostenol injection7003$2.23
    J1327NEptifibatide injection
    J1330NErgonovine maleate injection
    J1362NErythromycin glucep/250 MG
    J1364NErythro lactobionate/500 MG
    J1380NEstradiol valerate 10 MG inj
    J1390NEstradiol valerate 20 MG inj
    J1410NInj estrogen conjugate 25 MG
    J1435NInjection estrone per 1 MG
    J1436XEtidronate disodium inj0727$9.31
    J1438NEtanercept injection
    3 J1440XFilgrastim 300 mcg injeciton0728$25.21
    J1441EFilgrastim 480 mcg injection
    J1450NFluconazole
    J1455NFoscarnet sodium injection
    J1460NGamma globulin 1 CC inj
    J1470EGamma globulin 2 CC inj
    J1480EGamma globulin 3 CC inj
    J1490EGamma globulin 4 CC inj
    J1500EGamma globulin 5 CC inj
    J1510EGamma globulin 6 CC inj
    Start Printed Page 18685
    J1520EGamma globulin 7 CC inj
    J1530EGamma globulin 8 CC inj
    J1540EGamma globulin 9 CC inj
    J1550EGamma globulin 10 CC inj
    J1560EGamma globulin > 10 CC inj
    3 J1561XImmune globulin 500 mg0905$6.40
    3 J1562XImmune globulin 5 gms7004$45.48
    3 J1565XRSV-ivig0906$85.53
    2 J1570XGanciclovir sodium injection09070.51$24.73$4.95
    J1580NGaramycin gentamicin inj
    J1600NGold sodium thiomaleate inj
    J1610NGlucagon hydrochloride/1 MG
    3 J1620XGonadorelin hydroch/100 mcg7005$9.12
    3 J1626XGranisetron HCl injection0764$2.33
    J1630NHaloperidol injection
    J1631NHaloperidol decanoate inj
    J1642NInj heparin sodium per 10 u
    J1644NInj heparin sodium per 1000u
    J1645NDalteparin sodium
    J1650NInj enoxaparin sodium
    2 J1670XTetanus immune globulin inj09080.90$43.64$8.73
    J1690NPrednisolone tebutate inj
    J1700NHydrocortisone acetate inj
    J1710NHydrocortisone sodium ph inj
    J1720NHydrocortisone sodium succ i
    J1730NDiazoxide injection
    J1739NHydroxyprogesterone cap 125
    J1741NHydroxyprogesterone cap 250
    J1742NIbutilide fumarate injection
    3 J1745XInfliximab injection7043$6.89
    J1750NIron dextran
    3 J1785XInjection imiglucerase/unit0916$.58
    J1790NDroperidol injection
    J1800NPropranolol injection
    J1810NDroperidol/fentanyl inj
    J1820NInsulin injection
    3 J1825XInterferon beta-1a0909$28.70
    3 J1830XInterferon beta-1b/.25 MG0910$8.44
    J1840NKanamycin sulfate 500 MG inj
    J1850NKanamycin sulfate 75 MG inj
    J1885NKetorolac tromethamine inj
    J1890NCephalothin sodium injection
    J1910NKutapressin injection
    J1930NPropiomazine injection
    J1940NFurosemide injection
    3 J1950XLeuprolide acetate/3.75 MG0800$68.56
    J1955EInj levocarnitine per 1 gm
    J1956NLevofloxacin injection
    J1960NLevorphanol tartrate inj
    J1970NMethotrimeprazine injection
    J1980NHyoscyamine sulfate inj
    J1990NChlordiazepoxide injection
    J2000NLidocaine injection
    J2010NLincomycin injection
    J2060NLorazepam injection
    J2150NMannitol injection
    J2175NMeperidine hydrochl/100 MG
    J2180NMeperidine/promethazine inj
    J2210NMethylergonovin maleate inj
    J2240NMetocurine iodide injection
    J2250NInj midazolam hydrochloride
    2 J2260XInj milrinone lactate/5 ML70070.47$22.79$4.56
    J2270NMorphine sulfate injection
    J2271NMorphine so4 injection 100mg
    3 J2275XMorphine sulfate injection7010$.68
    J2300NInj nalbuphine hydrochloride
    J2310NInj naloxone hydrochloride
    J2320NNandrolone decanoate 50 MG
    J2321NNandrolone decanoate 100 MG
    J2322NNandrolone decanoate 200 MG
    J2330NThiothixene injection
    J2350NNiacinamide/niacin injection
    3 J2352NOctreotide acetate injection7031$5.43
    Start Printed Page 18686
    3 J2355XOprelvekin injection7011$30.35
    J2360NOrphenadrine injection
    J2370NPhenylephrine hcl injection
    J2400NChloroprocaine hcl injection
    3 J2405XOndansetron hcl injection0768$.87
    J2410NOxymorphone hcl injection
    3 J2430XPamidronate disodium/30 MG0730$30.93
    J2440NPapaverin hcl injection
    J2460NOxytetracycline injection
    J2480NHydrochlorides of opium inj
    J2500NParicalcitol
    J2510NPenicillin g procaine inj
    J2512NInj pentagastrin per 2 ML
    J2515NPentobarbital sodium inj
    J2540NPenicillin g potassium inj
    J2543NPiperacillin/tazobactam
    3 J2545XPentamidine isethionte/300mg7012$8.73
    J2550NPromethazine hcl injection
    J2560NPhenobarbital sodium inj
    J2590NOxytocin injection
    J2597EInj desmopressin acetate
    J2640NPrednisolone sodium ph inj
    J2650NPrednisolone acetate inj
    J2670NTotazoline hcl injection
    J2675NInj progesterone per 50 MG
    J2680NFluphenazine decanoate 25 MG
    J2690NProcainamide hcl injection
    J2700NOxacillin sodium injeciton
    J2710NNeostigmine methylslfte inj
    J2720NInj protamine sulfate/10 MG
    J2725NInj protirelin per 250 mcg
    J2730NPralidoxime chloride inj
    J2760NPhentolaine mesylate inj
    3 J2765XMetoclopramide hcl injection0754$.19
    J2780NRanitidine hydrochloride inj
    3 J2790XRho d immune globulin inj0884$3.78
    J2792NRho(D) immune globulin h, sd
    J2800NMethocarbamol injection
    J2810NInj theophylline per 40 MG
    3 J2820XSargramostim injection0731$16.97
    J2860NSecobarbital sodium inj
    J2910NAurothioglucose injeciton
    J2912NSodium chloride injection
    J2920NMethylprednisolone injection
    J2930NMethylprednisolone injection
    J2950NPromazine hcl injeciton
    J2970NMethicillin sodium injection
    2 J2994XReteplase double bolus091438.20$1,852.21$370.44
    2 J2995XInj streptokinase/250000 IU09111.64$79.69$15.94
    2 J2996XAlteplase recombinant inj09155.85$283.70$56.74
    J3000NStreptomycin injection
    3 J3010XFentanyl citrate injeciton7014$.19
    J3030NSumatriptan succinate/6 MG
    J3070NPentazocine hcl injeciton
    J3080NChlorprothixene injection
    J3105NTerbutaline sulfate inj
    J3120NTestosterone enanthate inj
    J3130NTestosterone enanthate inj
    J3140NTestosterone suspension inj
    J3150NTestosteron propionate inj
    J3230NChlorpromazine hcl injection
    J3240NThyrotropin injection
    2 J3245XTirofiban hydrochloride70410.02$.97$.19
    J3250NTrimethobenzamide hcl inj
    J3260NTobramycin sulfate injection
    J3265NInjection torsemide 10 mg/ml
    J3270NImipramine hcl injection
    3 J3280XThiethylperazine maleate inj0755$.68
    J3301NTriamcinolone acetonide inj
    J3302NTriamcinolone diacetate inj
    J3303NTriamcinolone hexacetonl inj
    3 J3305XInj trimetrexate glucoronate7045$8.15
    J3310NPerphenazine injeciton
    Start Printed Page 18687
    J3320NSpectinomycn di-hcl inj
    J3350NUrea injection
    J3360NDiazepam injection
    J3364NUrokinase 5000 IU injection
    2 J3365XUrokinase 250,000 IU inj70360.73$35.40$7.08
    J3370NVancomycin hcl injeciton
    J3390NMethoxamine injection
    J3400NTriflupromazine hcl inj
    J3410NHydroxyzine hcl injeciton
    J3420NVitamin b12 injection
    J3430NVitamin k phytonadione inj
    J3450NMephentermine sulfate inj
    J3470NHyaluronidase injection
    J3475NInj magnesium sulfate
    J3480NInj potassium chloride
    J3490NDrugs unclassified injection
    J3520EEdetate disodium per 150 mg
    J3530NNasal vaccine inhalation
    J3535EMetered dose inhaler drug
    J3570ELaetrile amygdalin vit B17
    J7030NNormal saline solution infus
    J7040NNormal saline solution infus
    J7042N5% dextrose/normal saline
    J7050NNormal saline solution infus
    J7051NSterile saline/water
    J7060N5% dextrose/water
    J7070ND5w infusion
    J7100NDextran 40 infusion
    J7110NDextran 75 infusion
    J7120NRingers lactate infusion
    J7130NHypertonic saline solution
    3 J7190XFactor viii0925$.19
    3 J7191XFactor VIII (porcine)0926$.19
    3 J7192XFactor viii recombinant0927$.19
    3 J7194XFactor ix complex0928$.08
    3 J7197XAntithrombin iii injection0930$.19
    3 J7198XAnti-inhibitor0929$.27
    J7199EHemophilia clot factor noc
    J7300EIntraut copper contraceptive
    3 J7310XGanciclovir long act implant0913$701.51
    J7315NSodium hyaluronate injection
    J7320NHylan G-F 20 injection
    2 J7500XAzathioprine oral 50mg08860.02$.97$.19
    2 J7501XAzathioprine parenteral08871.40$67.88$13.58
    2 J7502XCyclosporine oral 100 mg08880.08$3.88$.78
    2 J7504XLymphocyte immune globulin08903.79$183.77$36.75
    3 J7505EMonoclonal antibodies7038$89.60
    J7506NPrednisone oral
    2 J7507XTacrolimus oral per 1 MG08913.15$152.73$30.55
    J7508ETacrolimus oral per 5 MG
    J7509NMethylprednisolone oral
    J7510NPrednisolone oral per 5 mg
    J7513XDaclizumab, parenteral
    J7515NCyclosporine oral 25 mg
    2 J7516XCyclosporin parenteral 250mg08890.36$17.46$3.49
    J7517NMycophenolate mofetil oral
    J7599EImmunosuppressive drug noc
    J7608AAcetylcysteine inh sol u d
    J7610AAcetylcysteine 10% injection
    J7615AAcetylcysteine 20% injection
    J7618AAlbuterol inh sol con
    J7619AAlbuterol inh sol u d
    J7620AAlbuterol sulfate .083%/ml
    J7625AAlbuterol sulfate .5% inj
    J7627ABitolterolmesylate inhal sol
    J7628ABitolterol mes inhal sol con
    J7629ABitolterol mes inh sol u d
    J7630ACromolyn sodium injeciton
    J7631ACromolyn sodium inh sol u d
    J7635AAtropine inhal sol con
    J7636AAtropine inhal sol unit dose
    J7637ADexamethasone inhal sol con
    J7638ADexamethasone inhal sol u d
    Start Printed Page 18688
    J7639ADornase alpha inhal sol u d
    J7640AEpinephrine injection
    J7642AGlycopyrrolate inhal sol con
    J7643AGlycopyrrolate inhal sol u d
    J7644AIpratropium brom inh sol u d
    J7645AIpratropium bromide .02%/ml
    J7648AIsoetharine hcl inh sol con
    J7649AIsoetharine hcl inh sol u d
    J7650AIsoetharine hcl .1% inj
    J7651AIsoetharine hcl .125% inj
    J7652AIsoetharine hcl .167% inj
    J7653AIsoetharine hcl .2%/inj
    J7654AIsoetharine hcl .25% inj
    J7655AIsoetharine hcl 1% inj
    J7658AIsoproterenolhcl inh sol con
    J7659AIsoproterenol hcl inh sol ud
    J7660AIsoproterenol hcl .5% inj
    J7665AIsoproterenol hcl 1% inj
    J7668AMetaproterenol inh sol con
    J7669AMetaproterenol inh sol u d
    J7670AMetaproterenol sulfate .4%
    J7672AMetaproterenol sulfate .6%
    J7675AMetaproterenol sulfate 5%
    J7680ATerbutaline so4 inh sol con
    J7681ATerbutaline so4 inh sol u d
    J7682ATobramycin inhalation sol
    J7683ATriamcinolone inh sol con
    J7684ATriamcinolone inh sol u d
    J7699AInhalation solution for DME
    J7799ANon-inhalation drug for DME
    3 J7913XDaclizumab, Parenteral, 25 m0892$54.11
    J8499EOral prescrip drug non chemo
    3 J8510XOral busulfan7015$.19
    3 J8520XCapecitabine, oral, 150 mg7042$.19
    J8521NCapecitabine, oral, 500 mg
    3 J8530XCyclophosphamide oral 25 MG0801$.19
    3 J8560XEtoposide oral 50 MG0802$3.10
    3 J8600XMelphalan oral 2 MG0803$.19
    3 J8610XMethotrexate oral 2.5 MG0826$.29
    J8999EOral prescription drug chemo
    3 J9000XDoxorubic hcl 10 MG vl chemo0847$2.81
    3 J9001XDoxorubicin hcl liposome inj7046$39.18
    3 J9015XAldesleukin/single use vial0807$65.07
    3 J9020XAsparaginase injection0814$8.34
    3 J9031XBcg live intravesical vac0809$19.78
    3 J9040XBleomycin sulfate injection0857$48.29
    3 J9045XCarboplatin injection0811$13.96
    3 J9050XCarmus bischl nitro inj0812$10.57
    3 J9060XCisplatin 10 MG injeciton0813$4.56
    J9062ECisplatin 50 MG injeciton
    3 J9065XInj cladribine per 1 MG0858$8.24
    3 J9070XCyclophosphamide 100 MG inj0815$.48
    J9080ECyclophosphamide 200 MG inj
    J9090ECyclophosphamide 500 MG inj
    J9091ECyclophosphamide 1.0 grm inj
    J9092ECyclophosphamide 2.0 grm inj
    3 J9093XCyclophosphamide lyophilized0816$1.16
    J9094ECyclophosphamide lyophilized
    J9095ECyclophosphamide lyophilized
    J9096ECyclophosphamide lyophilized
    J9097ECyclophosphamide lyophilized
    3 J9100XCytarabine hcl 100 MG inj0817$.68
    J9110ECytarabine hcl 500 MG inj
    3 J9120XDactinomycin actinomycin d0818$1.75
    3 J9130XDacarbazine 10 MG inj0819$1.26
    J9140EDacarbazine 200 MG inj
    3 J9150XDaunorubicin0820$11.64
    3 J9151XDaunorubicin citrate liposom0821$7.76
    3 J9165XDiethylstilbestrol injection0822$2.13
    3 J9170XDocetaxel0823$34.72
    3 J9181XEtoposide 10 MG inj0824$.58
    J9182EEtoposide 100 MG inj
    3 J9185XFludarabine phosphate inj0842$30.84
    Start Printed Page 18689
    3 J9190XFluorouracil injection0859$.19
    3 J9200XFloxuridine injection0827$18.81
    3 J9201XGemcitabine HCl0828$9.31
    3 J9202XGoserelin acetate implant0810$59.74
    3 J9206XIrinotecan injection0830$14.16
    3 J9208XIfosfomide injection0831$13.58
    3 J9209XMesna injection0732$2.42
    3 J9211XIdarubicin hcl injeciton0832$46.45
    3 J9212XInterferon alfacon-10833$.19
    3 J9213XInterferon alfa-2a inj0834$3.20
    3 J9214XInterferon alfa-2b inj0836$1.36
    3 J9215XInterferon alfa-n3 inj0865$1.07
    3 J9216XInterferon gamma 1-b inj0838$22.79
    J9217ELeuprolide acetate suspnsion
    3 J9218XLeuprolide acetate injeciton0861$19.39
    3 J9230XMechlorethamine hcl inj0839$1.65
    3 J9245XInj melphalan hydrochl 50 MG0840$44.71
    3 J9250XMethotrexate sodium inj0841$.10
    J9260EMethotrexate sodium inj
    3 J9265XPaclitaxel injection0863$30.16
    3 J9266XPegaspargase/singl dose vial0843$178.72
    3 J9268XPentostatin injection0844$133.73
    3 J9270XPlicamycin (mithramycin) inj0860$1.36
    3 J9280XMitomycin 5 MG inj0862$19.88
    J9290EMitomycin 20 MG inj
    J9291EMitomycin 40 MG inj
    3 J9293XMitoxantrone hydrochl/5 MG0864$25.80
    3 J9310XRituximab cancer treatment0849$51.40
    3 J9320XStreptozocin injection0850$14.64
    3 J9340XThiotepa injection0851$9.50
    3 J9350XTopotecan0852$73.22
    J9355NTrastuzumab
    J9357NValrubicin, 200 mg
    3 J9360XVinblastine sulfate inj0853$.39
    3 J9370XVincristine sulfate 1 MG inj0854$2.23
    J9375EVincristine sulfate 2 MG inj
    J9380EVincristine sulfate 5 MG inj
    3 J9390XVinorelbine tartrate/10 mg0855$9.60
    3 J9600XPorfimer sodium0856$34.62
    J9999EChemotherapy drug
    K0001AStandard wheelchair
    K0002AStnd hemi (low seat) whlchr
    K0003ALightweight wheelchair
    K0004AHigh strength ltwt whlchr
    K0005AUltralightweight wheelchair
    K0006AHeavy duty wheelchair
    K0007AExtra heavy duty wheelchair
    K0008ACstm manual wheelchair/base
    K0009AOther manual wheelchair/base
    K0010AStnd wt frame power whlchr
    K0011AStnd wt pwr whlchr w control
    K0012ALtwt portbl power whlchr
    K0013ACustom power whlchr base
    K0014AOther power whlchr base
    K0015ADetach non-adjus hght armrst
    K0016ADetach adjust armrst cmplete
    K0017ADetach adjust armrest base
    K0018ADetach adjust armrst upper
    K0019AArm pad each
    K0020AFixed adjust armrest pair
    K0021AAnti-tipping device each
    K0022AReinforced back upholstery
    K0023APlanr back insrt foam w/strp
    K0024APlnr back insrt foam w/hrdwr
    K0025AHook-on headrest extension
    K0026ABack upholst lgtwt whlchr
    K0027ABack upholst other whlchr
    K0028AManual fully reclining back
    K0029AReinforced seat upholstery
    K0030ASolid plnr seat sngl dnsfoam
    K0031ASafety belt/pelvic strap
    K0032ASeat uphols lgtwt whlchr
    K0033ASeat upholstery other whlchr
    Start Printed Page 18690
    K0034AHeel loop each
    K0035AHeel loop with ankle strap
    K0036AToe loop each
    K0037AHigh mount flip-up footrest
    K0038ALeg strap each
    K0039ALeg strap h style each
    K0040AAdjustable angle footplate
    K0041ALarge size footplate each
    K0042AStandard size footplate each
    K0043AFtrst lower extension tube
    K0044AFtrst upper hanger bracket
    K0045AFootrest complete assembly
    K0046AElevat legrst low extension
    K0047AElevat legrst up hangr brack
    K0048AElevate legrest complete
    K0049ACalf pad each
    K0050ARatchet assembly
    K0051ACam relese assem ftrst/lgrst
    K0052ASwingaway detach footrest
    K0053AElevate footrest articulate
    K0054ASeat wdth 10-12/15/17/20 wc
    K0055ASeat dpth 15/17/18 ltwt wc
    K0056ASeat ht <17 or >=21 ltwt wc
    K0057ASeat wdth 19/20 hvy dty wc
    K0058ASeat dpth 17/18 power wc
    K0059APlastic coated handrim each
    K0060ASteel handrim each
    K0061AAluminum handrim each
    K0062AHandrim 8-10 vert/obliq proj
    K0063AHndrm 12-16 vert/obliq proj
    K0064AZero pressure tube flat free
    K0065ASpoke protectors
    K0066ASolid tire any size each
    K0067APneumatic tire any size each
    K0068APneumatic tire tube each
    K0069ARear whl complete solid tire
    K0070ARear whl compl pneum tire
    K0071AFront castr compl pneum tire
    K0072AFrnt cstr cmpl sem-pneum tir
    K0073ACaster pin lock each
    K0074APneumatic caster tire each
    K0075ASemi-pneumatic caster tire
    K0076ASolid caster tire each
    K0077AFront caster assem complete
    K0078APneumatic caster tire tube
    K0079AWheel lock extension pair
    K0080AAnti-rollback device pair
    K0081AWheel lock assembly complete
    K0082A22 nf deep cycl acid battery
    K0083A22 nf gel cell battery each
    K0084AGrp 24 deep cycl acid battry
    K0085AGroup 24 gel cell battery
    K0086AU-1 lead acid battery each
    K0087AU-1 gel cell battery each
    K0088ABattry chrgr acid/gel cell
    K0089ABattery charger dual mode
    K0090ARear tire power wheelchair
    K0091ARear tire tube power whlchr
    K0092ARear assem cmplt powr whlchr
    K0093ARear zero pressure tire tube
    K0094AWheel tire for power base
    K0095AWheel tire tube each base
    K0096AWheel assem powr base complt
    K0097AWheel zero presure tire tube
    K0098ADrive belt power wheelchair
    K0099APwr wheelchair front caster
    K0100AAmputee adapter pair
    K0101AOne-arm drive attachment
    K0102ACrutch and cane holder
    K0103ATransfer board < 25″
    K0104ACylinder tank carrier
    K0105AIv hanger
    K0106AArm trough each
    Start Printed Page 18691
    K0107AWheelchair tray
    K0108AW/c component-accessory NOS
    K0112ATrunk vest supprt innr frame
    K0113ATrunk vest suprt w/o inr frm
    K0114AWhlchr back suprt inr frame
    K0115ABack module orthotic system
    K0116ABack & seat modul orthot sys
    K0182AWater distilled w/nebulizer
    K0183ANasal application device
    K0184ANasal pillows/seals pair
    K0185APos airway pressure headgear
    K0186APos airway prssure chinstrap
    K0187APos airway pressure tubing
    K0188APos airway pressure filter
    K0189AFilter nondisposable w PAP
    K0195AElevating whlchair leg rests
    K0268AHumidifier nonheated w PAP
    K0269AAerosol compressor cpap dev
    K0270AUltrasonic generator w nebul
    K0280AExtension drainage tubing
    K0281ALubricant catheter insertion
    K0283ASaline solution dispenser
    K0407AUrinary cath skin attachment
    K0408AUrinary cath leg strap
    K0409ASterile H2O irrigation solut
    K0410AMale ext cath w/adh coating
    K0411AMale ext cath w/adh strip
    K0415ERX antiemetic drg, oral NOS
    K0416ERx antiemetic drg, rectal NOS
    K0440ANasal prosthesis
    K0441AMidfacial prosthesis
    K0442AOrbital prosthesis
    K0443AUpper facial prosthesis
    K0444AHemi-facial prosthesis
    K0445AAuricular prosthesis
    K0446APartial facial prosthesis
    K0447ANasal septal prosthesis
    K0448AUnspec maxillofacial prosth
    K0449ARepair maxillofacial prosth
    K0450ALiq adhes for facial prosth
    K0451AAdhesive remover wipes
    K0452AWheelchair bearings
    K0455APump uninterrupted infusion
    K0456AHeavyduty/xtra wide hosp bed
    K0457AHeavyduty/wide commode chair
    K0458AHeavyduty walker no wheels
    K0459AHeavy duty wheeled walker
    K0460AWC power add-on joystick
    K0461AWC power add-on tiller cntrl
    K0462ATemporary replacement eqpmnt
    K0501AAerosol compressor for svneb
    K0529ASterile H20 or nss w lv neb
    K0531AHeated humidifier used w pap
    K0532ANoninvasive assist wo backup
    K0533ANoninvasive assist w backup
    K0534AInvasive assist w backup
    L0100ACerv craniosten helmet mold
    L0110ACerv craniostenosis hel non-
    L0120ACerv flexible non-adjustable
    L0130AFlex thermoplastic collar mo
    L0140ACervical semi-rigid adjustab
    L0150ACerv semi-rig adj molded chn
    L0160ACerv semi-rig wire occ/mand
    L0170ACervical collar molded to pt
    L0172ACerv col thermplas foam 2 pi
    L0174ACerv col foam 2 piece w thor
    L0180ACer post col occ/man sup adj
    L0190ACerv collar supp adj cerv ba
    L0200ACerv col supp adj bar & thor
    L0210AThoracic rib belt
    L0220AThor rib belt custom fabrica
    L0300ATLSO flex surgical support
    L0310ATlso flexible custom fabrica
    Start Printed Page 18692
    L0315ATlso flex elas rigid post pa
    L0317ATlso flex hypext elas post p
    L0320ATlso a-p contrl w apron frnt
    L0330ATlso ant-pos-lateral control
    L0340ATlso a-p-l-rotary with apron
    L0350ATlso flex compress jacket cu
    L0360ATlso flex compress jacket mo
    L0370ATlso a-p-l-rotary hyperexten
    L0380ATlso a-p-l-rot w/pos extens
    L0390ATlso a-p-l control molded
    L0400ATlso a-p-l w interface mater
    L0410ATlso a-p-l two piece constr
    L0420ATlso a-p-l 2 piece w interfa
    L0430ATlso a-p-l w interface custm
    L0440ATlso a-p-l overlap frnt cust
    L0500ALso flex surgical support
    L0510ALso flexible custom fabricat
    L0515ALso flex elas w/rig post pa
    L0520ALso a-p-l control with apron
    L0530ALso ant-pos control w apron
    L0540ALso lumbar flexion a-p-l
    L0550ALso a-p-l control molded
    L0560ALso a-p-l w interface
    L0565ALso a-p-l control custom
    L0600ASacroiliac flex surg support
    L0610ASacroiliac flexible custm fa
    L0620ASacroiliac semi-rig w apron
    L0700ACtlso a-p-l control molded
    L0710ACtlso a-p-l control w/inter
    L0810AHalo cervical into jckt vest
    L0820AHalo cervical into body jack
    L0830AHalo cerv into milwaukee typ
    L0860AMagnetic resonanc image comp
    L0900ATorso/ptosis support
    L0910ATorso & ptosis supp custm fa
    L0920ATorso/pendulous abd support
    L0930APendulous abdomen supp custm
    L0940ATorso/postsurgical support
    L0950APost surg support custom fab
    L0960APost surgical support pads
    L0970ATlso corset front
    L0972ALso corset front
    L0974ATlso full corset
    L0976ALso full corset
    L0978AAxillary crutch extension
    L0980APeroneal straps pair
    L0982AStocking supp grips set of f
    L0984AProtective body sock each
    L0999AAdd to spinal orthosis NOS
    L1000ACtlso milwauke initial model
    L1010ACtlso axilla sling
    L1020AKyphosis pad
    L1025AKyphosis pad floating
    L1030ALumbar bolster pad
    L1040ALumbar or lumbar rib pad
    L1050ASternal pad
    L1060AThoracic pad
    L1070ATrapezius sling
    L1080AOutrigger
    L1085AOutrigger bil w/vert extens
    L1090ALumbar sling
    L1100ARing flange plastic/leather
    L1110ARing flange plas/leather mol
    L1120ACovers for upright each
    L1200AFurnsh initial orthosis only
    L1210ALateral thoracic extension
    L1220AAnterior thoracic extension
    L1230AMilwaukee type superstructur
    L1240ALumbar derotation pad
    L1250AAnterior asis pad
    L1260AAnterior thoracic derotation
    L1270AAbdominal pad
    L1280ARib gusset (elastic) each
    Start Printed Page 18693
    L1290ALateral trochanteric pad
    L1300ABody jacket mold to patient
    L1310APost-operative body jacket
    L1499ASpinal orthosis NOS
    L1500AThkao mobility frame
    L1510AThkao standing frame
    L1520AThkao swivel walker
    L1600AAbduct hip flex frejka w cvr
    L1610AAbduct hip flex frejka covr
    L1620AAbduct hip flex pavlik harne
    L1630AAbduct control hip semi-flex
    L1640APelv band/spread bar thigh c
    L1650AHO abduction hip adjustable
    L1660AHO abduction static plastic
    L1680APelvic & hip control thigh c
    L1685APost-op hip abduct custom fa
    L1686AHO post-op hip abduction
    L1690ACombination bilateral HO
    L1700ALeg perthes orth toronto typ
    L1710ALegg perthes orth newington
    L1720ALegg perthes orthosis trilat
    L1730ALegg perthes orth scottish r
    L1750ALegg perthes sling
    L1755ALegg perthes patten bottom t
    L1800AKnee orthoses elas w stays
    L1810AKo elastic with joints
    L1815AElastic with condylar pads
    L1820AKo elas w/condyle pads & jo
    L1825AKo elastic knee cap
    L1830AKo immobilizer canvas longit
    L1832AKO adj jnt pos rigid support
    L1834AKo w/0 joint rigid molded to
    L1840AKo derot ant cruciate custom
    L1843AKO single upright custom fit
    L1844AKo w/adj jt rot cntrl molded
    L1845AKo w/adj flex/ext rotat cus
    L1846AKo w adj flex/ext rotat mold
    L1847AKO adjustable w air chambers
    L1850AKo swedish type
    L1855AKo plas doub upright jnt mol
    L1858AKo polycentric pneumatic pad
    L1860AKo supracondylar socket mold
    L1870AKo doub upright lacers molde
    L1880AKo doub upright cuffs/lacers
    L1885AKnee upright w/resistance
    L1900AAfo sprng wir drsflx calf bd
    L1902AAfo ankle gauntlet
    L1904AAfo molded ankle gauntlet
    L1906AAfo multiligamentus ankle su
    L1910AAfo sing bar clasp attach sh
    L1920AAfo sing upright w/adjust s
    L1930AAfo plastic
    L1940AAfo molded to patient plasti
    L1945AAfo molded plas rig ant tib
    L1950AAfo spiral molded to pt plas
    L1960AAfo pos solid ank plastic mo
    L1970AAfo plastic molded w/ankle j
    L1980AAfo sing solid stirrup calf
    L1990AAfo doub solid stirrup calf
    L2000AKafo sing fre stirr thi/calf
    L2010AKafo sng solid stirrup w/o j
    L2020AKafo dbl solid stirrup band/
    L2030AKafo dbl solid stirrup w/o j
    L2035AKAFO plastic pediatric size
    L2036AKafo plas doub free knee mol
    L2037AKafo plas sing free knee mol
    L2038AKafo w/o joint multi-axis an
    L2039AKAFO, plstic, medlat rotat con
    L2040AHkafo torsion bil rot straps
    L2050AHkafo torsion cable hip pelv
    L2060AHkafo torsion ball bearing j
    L2070AHkafo torsion unilat rot str
    L2080AHkafo unilat torsion cable
    Start Printed Page 18694
    L2090AHkafo unilat torsion ball br
    L2102AAfo tibial fx cast plstr mol
    L2104AAfo tib fx cast synthetic mo
    L2106AAfo tib fx cast plaster mold
    L2108AAfo tib fx cast molded to pt
    L2112AAfo tibial fracture soft
    L2114AAfo tib fx semi-rigid
    L2116AAfo tibial fracture rigid
    L2122AKafo fem fx cast plaster mol
    L2124AKafo fem fx cast synthet mol
    L2126AKafo fem fx cast thermoplas
    L2128AKafo fem fx cast molded to p
    L2132AKafo femoral fx cast soft
    L2134AKafo fem fx cast semi-rigid
    L2136AKafo femoral fx cast rigid
    L2180APlas shoe insert w ank joint
    L2182ADrop lock knee
    L2184ALimited motion knee joint
    L2186AAdj motion knee jnt lerman t
    L2188AQuadrilateral brim
    L2190AWaist belt
    L2192APelvic band & belt thigh fla
    L2200ALimited ankle motion ea jnt
    L2210ADorsiflexion assist each joi
    L2220ADorsi & plantar flex ass/res
    L2230ASplit flat caliper stirr & p
    L2240ARound caliper and plate atta
    L2250AFoot plate molded stirrup at
    L2260AReinforced solid stirrup
    L2265ALong tongue stirrup
    L2270AVarus/valgus strap padded/li
    L2275APlastic mod low ext pad/line
    L2280AMolded inner boot
    L2300AAbduction bar jointed adjust
    L2310AAbduction bar-straight
    L2320ANon-molded lacer
    L2330ALacer molded to patient mode
    L2335AAnterior swing band
    L2340APre-tibial shell molded to p
    L2350AProsthetic type socket molde
    L2360AExtended steel shank
    L2370APatten bottom
    L2375ATorsion ank & half solid sti
    L2380ATorsion straight knee joint
    L2385AStraight knee joint heavy du
    L2390AOffset knee joint each
    L2395AOffset knee joint heavy duty
    L2397ASuspension sleeve lower ext
    L2405AKnee joint drop lock ea jnt
    L2415AKnee joint cam lock each joi
    L2425AKnee disc/dial lock/adj flex
    L2430AKnee jnt ratchet lock ea jnt
    L2435AKnee joint polycentric joint
    L2492AKnee lift loop drop lock rin
    L2500AThi/glut/ischia wgt bearing
    L2510ATh/wght bear quad-lat brim m
    L2520ATh/wght bear quad-lat brim c
    L2525ATh/wght bear nar m-l brim mo
    L2526ATh/wght bear nar m-l brim cu
    L2530AThigh/wght bear lacer non-mo
    L2540AThigh/wght bear lacer molded
    L2550AThigh/wght bear high roll cu
    L2570AHip clevis type 2 posit jnt
    L2580APelvic control pelvic sling
    L2600AHip clevis/thrust bearing fr
    L2610AHip clevis/thrust bearing lo
    L2620APelvic control hip heavy dut
    L2622AHip joint adjustable flexion
    L2624AHip adj flex ext abduct cont
    L2627APlastic mold recipro hip & c
    L2628AMetal frame recipro hip & ca
    L2630APelvic control band & belt u
    L2640APelvic control band & belt b
    Start Printed Page 18695
    L2650APelv & thor control gluteal
    L2660AThoracic control thoracic ba
    L2670AThorac cont paraspinal uprig
    L2680AThorac cont lat support upri
    L2750APlating chrome/nickel pr bar
    L2755ACarbon graphite lamination
    L2760AExtension per extension per
    L2770ALow ext orthosis per bar/jnt
    L2780ANon-corrosive finish
    L2785ADrop lock retainer each
    L2795AKnee control full kneecap
    L2800AKnee cap medial or lateral p
    L2810AKnee control condylar pad
    L2820ASoft interface below knee se
    L2830ASoft interface above knee se
    L2840ATibial length sock fx or equ
    L2850AFemoral lgth sock fx or equa
    L2860ATorsion mechanism knee/ankle
    L2999ALower extremity orthosis NOS
    L3000AFt insert ucb berkeley shell
    L3001AFoot insert remov molded spe
    L3002AFoot insert plastazote or eq
    L3003AFoot insert silicone gel eac
    L3010AFoot longitudinal arch suppo
    L3020AFoot longitud/metatarsal sup
    L3030AFoot arch support remov prem
    L3040AFt arch suprt premold longit
    L3050AFoot arch supp premold metat
    L3060AFoot arch supp longitud/meta
    L3070AArch suprt att to sho longit
    L3080AArch supp att to shoe metata
    L3090AArch supp att to shoe long/m
    L3100AHallus-valgus nght dynamic s
    L3140AAbduction rotation bar shoe
    L3150AAbduct rotation bar w/o shoe
    L3160AShoe styled positioning dev
    L3170AFoot plastic heel stabilizer
    L3201AOxford w supinat/pronat inf
    L3202AOxford w/supinat/pronator c
    L3203AOxford w/supinator/pronator
    L3204AHightop w/supp/pronator inf
    L3206AHightop w/supp/pronator chi
    L3207AHightop w/supp/pronator jun
    L3208ASurgical boot each infant
    L3209ASurgical boot each child
    L3211ASurgical boot each junior
    L3212ABenesch boot pair infant
    L3213ABenesch boot pair child
    L3214ABenesch boot pair junior
    L3215AOrthopedic ftwear ladies oxf
    L3216AOrthoped ladies shoes dpth i
    L3217ALadies shoes hightop depth i
    L3218ALadies surgical boot each
    L3219AOrthopedic mens shoes oxford
    L3221AOrthopedic mens shoes dpth i
    L3222AMens shoes hightop depth inl
    L3223AMens surgical boot each
    L3224AWoman's shoe oxford brace
    L3225AMan's shoe oxford brace
    L3230ACustom shoes depth inlay
    L3250ACustom mold shoe remov prost
    L3251AShoe molded to pt silicone s
    L3252AShoe molded plastazote cust
    L3253AShoe molded plastazote cust
    L3254AOrth foot non-stndard size/w
    L3255AOrth foot non-standard size/
    L3257AOrth foot add charge split s
    L3260AAmbulatory surgical boot eac
    L3265APlastazote sandal each
    L3300ASho lift taper to metatarsal
    L3310AShoe lift elev heel/sole neo
    L3320AShoe lift elev heel/sole cor
    L3330ALifts elevation metal extens
    Start Printed Page 18696
    L3332AShoe lifts tapered to one-ha
    L3334AShoe lifts elevation heel/i
    L3340AShoe wedge sach
    L3350AShoe heel wedge
    L3360AShoe sole wedge outside sole
    L3370AShoe sole wedge between sole
    L3380AShoe clubfoot wedge
    L3390AShoe outflare wedge
    L3400AShoe metatarsal bar wedge ro
    L3410AShoe metatarsal bar between
    L3420AFull sole/heel wedge btween
    L3430ASho heel count plast reinfor
    L3440AHeel leather reinforced
    L3450AShoe heel sach cushion type
    L3455AShoe heel new leather standa
    L3460AShoe heel new rubber standar
    L3465AShoe heel thomas with wedge
    L3470AShoe heel thomas extend to b
    L3480AShoe heel pad & depress for
    L3485AShoe heel pad removable for
    L3500AOrtho shoe add leather insol
    L3510AOrthopedic shoe add rub insl
    L3520AO shoe add felt w leath insl
    L3530AOrtho shoe add half sole
    L3540AOrtho shoe add full sole
    L3550AO shoe add standard toe tap
    L3560AO shoe add horseshoe toe tap
    L3570AO shoe add instep extension
    L3580AO shoe add instep velcro clo
    L3590AO shoe convert to sof counte
    L3595AOrtho shoe add march bar
    L3600ATrans shoe calip plate exist
    L3610ATrans shoe caliper plate new
    L3620ATrans shoe solid stirrup exi
    L3630ATrans shoe solid stirrup new
    L3640AShoe dennis browne splint bo
    L3649AOrthopedic shoe modifica NOS
    L3650AShlder fig 8 abduct restrain
    L3660AAbduct restrainer canvas & web
    L3670AAcromio/clavicular canvas & we
    L3675ACanvas vest SO
    L3700AElbow orthoses elas w stays
    L3710AElbow elastic with metal joi
    L3720AForearm/arm cuffs free motio
    L3730AForearm/arm cuffs ext/flex a
    L3740ACuffs adj lock w/active con
    L3800AWhfo short opponen no attach
    L3805AWhfo long opponens no attach
    L3807AWhfo w inflatable airchamber
    L3810AWhfo thumb abduction bar
    L3815AWhfo second m.p. abduction a
    L3820AWhfo ip ext asst w/mp ext s
    L3825AWhfo m.p. extension stop
    L3830AWhfo m.p. extension assist
    L3835AWhfo m.p. spring extension a
    L3840AWhfo spring swivel thumb
    L3845AWhfo thumb ip ext ass w/mp
    L3850AAction wrist w/dorsiflex as
    L3855AWhfo adj m.p. flexion contro
    L3860AWhfo adj m.p. flex ctrl & i.
    L3890ATorsion mechanism wrist/elbo
    L3900AHinge extension/flex wrist/f
    L3901AHinge ext/flex wrist finger
    L3902AWhfo ext power compress gas
    L3904AWhfo electric custom fitted
    L3906AWrist gauntlet molded to pt
    L3907AWhfo wrst gauntlt thmb spica
    L3908AWrist cock-up non-molded
    L3910AWhfo swanson design
    L3912AFlex glove w/elastic finger
    L3914AWHO wrist extension cock-up
    L3916AWhfo wrist extens w/outrigg
    L3918AHFO knuckle bender
    Start Printed Page 18697
    L3920AKnuckle bender with outrigge
    L3922AKnuckle bend 2 seg to flex j
    L3924AOppenheimer
    L3926AThomas suspension
    L3928AFinger extension w/clock sp
    L3930AFinger extension with wrist
    L3932ASafety pin spring wire
    L3934ASafety pin modified
    L3936APalmer
    L3938ADorsal wrist
    L3940ADorsal wrist w/outrigger at
    L3942AReverse knuckle bender
    L3944AReverse knuckle bend w/outr
    L3946AHFO composite elastic
    L3948AFinger knuckle bender
    L3950AOppenheimer w/knuckle bend
    L3952AOppenheimer w/rev knuckle 2
    L3954ASpreading hand
    L3956AAdd joint upper ext orthosis
    L3960ASewho airplan desig abdu pos
    L3962ASewho erbs palsey design abd
    L3963AMolded w/articulating elbow
    L3964ASeo mobile arm sup att to wc
    L3965AArm supp att to wc rancho ty
    L3966AMobile arm supports reclinin
    L3968AFriction dampening arm supp
    L3969AMonosuspension arm/hand supp
    L3970AElevat proximal arm support
    L3972AOffset/lat rocker arm w/ela
    L3974AMobile arm support supinator
    L3980AUpp ext fx orthosis humeral
    L3982AUpper ext fx orthosis rad/ul
    L3984AUpper ext fx orthosis wrist
    L3985AForearm hand fx orth w/wr h
    L3986AHumeral rad/ulna wrist fx or
    L3995ASock fracture or equal each
    L3999AUpper limb orthosis NOS
    L4000ARepl girdle milwaukee orth
    L4010AReplace trilateral socket br
    L4020AReplace quadlat socket brim
    L4030AReplace socket brim cust fit
    L4040AReplace molded thigh lacer
    L4045AReplace non-molded thigh lac
    L4050AReplace molded calf lacer
    L4055AReplace non-molded calf lace
    L4060AReplace high roll cuff
    L4070AReplace prox & dist upright
    L4080ARepl met band kafo-afo prox
    L4090ARepl met band kafo-afo calf/
    L4100ARepl leath cuff kafo prox th
    L4110ARepl leath cuff kafo-afo cal
    L4130AReplace pretibial shell
    L4205AOrtho dvc repair per 15 min
    L4210AOrth dev repair/repl minor p
    L4350APneumatic ankle cntrl splint
    L4360APneumatic walking splint
    L4370APneumatic full leg splint
    L4380APneumatic knee splint
    L4392AReplace AFO soft interface
    L4394AReplace foot drop spint
    L4396AStatic AFO
    L4398AFoot drop splint recumbent
    L5000ASho insert w arch toe filler
    L5010AMold socket ank hgt w/toe f
    L5020ATibial tubercle hgt w/toe f
    L5050AAnk symes mold sckt sach ft
    L5060ASymes met fr leath socket ar
    L5100AMolded socket shin sach foot
    L5105APlast socket jts/thgh lacer
    L5150AMold sckt ext knee shin sach
    L5160AMold socket bent knee shin s
    L5200AKne sing axis fric shin sach
    L5210ANo knee/ankle joints w/ft b
    Start Printed Page 18698
    L5220ANo knee joint with artic ali
    L5230AFem focal defic constant fri
    L5250AHip canad sing axi cons fric
    L5270ATilt table locking hip sing
    L5280AHemipelvect canad sing axis
    L5300ABk sach soft cover & finish
    L5310AKnee disart sach soft cv/fin
    L5320AAk open end sach soft cv/fin
    L5330AHip canadian sach sft cv/fin
    L5340AHemipelvectomy canad cv/fin
    L5400APostop dress & 1 cast chg bk
    L5410APostop dsg bk ea add cast ch
    L5420APostop dsg & 1 cast chg ak/d
    L5430APostop dsg ak ea add cast ch
    L5450APostop app non-wgt bear dsg
    L5460APostop app non-wgt bear dsg
    L5500AInit bk ptb plaster direct
    L5505AInit ak ischal plstr direct
    L5510APrep BK ptb plaster molded
    L5520APerp BK ptb thermopls direct
    L5530APrep BK ptb thermopls molded
    L5535APrep BK ptb open end socket
    L5540APrep BK ptb laminated socket
    L5560APrep AK ischial plast molded
    L5570APrep AK ischial direct form
    L5580APrep AK ischial thermo mold
    L5585APrep AK ischial open end
    L5590APrep AK ischial laminated
    L5595AHip disartic sach thermopls
    L5600AHip disart sach laminat mold
    L5610AAbove knee hydracadence
    L5611AAk 4 bar link w/fric swing
    L5613AAk 4 bar ling w/hydraul swig
    L5614A4-bar link above knee w/swng
    L5616AAk univ multiplex sys frict
    L5617AAK/BK self-aligning unit ea
    L5618ATest socket symes
    L5620ATest socket below knee
    L5622ATest socket knee disarticula
    L5624ATest socket above knee
    L5626ATest socket hip disarticulat
    L5628ATest socket hemipelvectomy
    L5629ABelow knee acrylic socket
    L5630ASyme typ expandabl wall sckt
    L5631AAk/knee disartic acrylic soc
    L5632ASymes type ptb brim design s
    L5634ASymes type poster opening so
    L5636ASymes type medial opening so
    L5637ABelow knee total contact
    L5638ABelow knee leather socket
    L5639ABelow knee wood socket
    L5640AKnee disarticulat leather so
    L5642AAbove knee leather socket
    L5643AHip flex inner socket ext fr
    L5644AAbove knee wood socket
    L5645AAk flexibl inner socket ext
    L5646ABelow knee air cushion socke
    L5647ABelow knee suction socket
    L5648AAbove knee air cushion socke
    L5649AIsch containmt/narrow m-l so
    L5650ATot contact ak/knee disart s
    L5651AAk flex inner socket ext fra
    L5652ASuction susp ak/knee disart
    L5653AKnee disart expand wall sock
    L5654ASocket insert symes
    L5655ASocket insert below knee
    L5656ASocket insert knee articulat
    L5658ASocket insert above knee
    L5660ASock insrt syme silicone gel
    L5661AMulti-durometer symes
    L5662ASocket insert bk silicone ge
    L5663ASock knee disartic silicone
    L5664ASocket insert ak silicone ge
    Start Printed Page 18699
    L5665AMulti-durometer below knee
    L5666ABelow knee cuff suspension
    L5667ASocket insert w lock lower
    L5668ASocket insert w/o lock lower
    L5669ABelow knee socket w/o lock
    L5670ABk molded supracondylar susp
    L5672ABk removable medial brim sus
    L5674ABk latex sleeve suspension/e
    L5675ABk latex sleeve susp/eq hvy
    L5676ABk knee joints single axis p
    L5677ABk knee joints polycentric p
    L5678ABk joint covers pair
    L5680ABk thigh lacer non-molded
    L5682ABk thigh lacer glut/ischia m
    L5684ABk fork strap
    L5686ABk back check
    L5688ABk waist belt webbing
    L5690ABk waist belt padded and lin
    L5692AAk pelvic control belt light
    L5694AAk pelvic control belt pad/l
    L5695AAk sleeve susp neoprene/equa
    L5696AAk/knee disartic pelvic join
    L5697AAk/knee disartic pelvic band
    L5698AAk/knee disartic silesian ba
    L5699AShoulder harness
    L5700AReplace socket below knee
    L5701AReplace socket above knee
    L5702AReplace socket hip
    L5704ACustom shape covr below knee
    L5705ACustm shape cover above knee
    L5706ACustm shape cvr knee disart
    L5707ACustm shape cover hip disart
    L5710AKne-shin exo sng axi mnl loc
    L5711AKnee-shin exo mnl lock ultra
    L5712AKnee-shin exo frict swg & st
    L5714AKnee-shin exo variable frict
    L5716AKnee-shin exo mech stance ph
    L5718AKnee-shin exo frct swg & sta
    L5722AKnee-shin pneum swg frct exo
    L5724AKnee-shin exo fluid swing ph
    L5726AKnee-shin ext jnts fld swg e
    L5728AKnee-shin fluid swg & stance
    L5780AKnee-shin pneum/hydra pneum
    L5785AExoskeletal bk ultralt mater
    L5790AExoskeletal ak ultra-light m
    L5795AExoskel hip ultra-light mate
    L5810AEndoskel knee-shin mnl lock
    L5811AEndo knee-shin mnl lck ultra
    L5812AEndo knee-shin frct swg & st
    L5814AEndo knee-shin hydral swg ph
    L5816AEndo knee-shin polyc mch sta
    L5818AEndo knee-shin frct swg & st
    L5822AEndo knee-shin pneum swg frc
    L5824AEndo knee-shin fluid swing p
    L5826AMiniature knee joint
    L5828AEndo knee-shin fluid swg/sta
    L5830AEndo knee-shin pneum/swg pha
    L5840AMulti-axial knee/shin system
    L5845AKnee-shin sys stance flexion
    L5846AKnee-shin sys microprocessor
    L5850AEndo ak/hip knee extens assi
    L5855AMech hip extension assist
    L5910AEndo below knee alignable sy
    L5920AEndo ak/hip alignable system
    L5925AAbove knee manual lock
    L5930AHigh activity knee frame
    L5940AEndo bk ultra-light material
    L5950AEndo ak ultra-light material
    L5960AEndo hip ultra-light materia
    L5962ABelow knee flex cover system
    L5964AAbove knee flex cover system
    L5966AHip flexible cover system
    L5968AMultiaxial ankle w dorsiflex
    Start Printed Page 18700
    L5970AFoot external keel sach foot
    L5972AFlexible keel foot
    L5974AFoot single axis ankle/foot
    L5975ACombo ankle/foot prosthesis
    L5976AEnergy storing foot
    L5978AFt prosth multiaxial ankl/ft
    L5979AMulti-axial ankle/ft prosth
    L5980AFlex foot system
    L5981AFlex-walk sys low ext prosth
    L5982AExoskeletal axial rotation u
    L5984AEndoskeletal axial rotation
    L5985ALwr ext dynamic prosth pylon
    L5986AMulti-axial rotation unit
    L5987AShank ft w vert load pylon
    L5988AVertical shock reducing pylo
    L5999ALowr extremity prosthes NOS
    L6000APar hand robin-aids thum rem
    L6010AHand robin-aids little/ring
    L6020APart hand robin-aids no fing
    L6050AWrst MLd sck flx hng tri pad
    L6055AWrst mold sock w/exp interfa
    L6100AElb mold sock flex hinge pad
    L6110AElbow mold sock suspension t
    L6120AElbow mold doub splt soc ste
    L6130AElbow stump activated lock h
    L6200AElbow mold outsid lock hinge
    L6205AElbow molded w/expand inter
    L6250AElbow inter loc elbow forarm
    L6300AShlder disart int lock elbow
    L6310AShoulder passive restor comp
    L6320AShoulder passive restor cap
    L6350AThoracic intern lock elbow
    L6360AThoracic passive restor comp
    L6370AThoracic passive restor cap
    L6380APostop dsg cast chg wrst/elb
    L6382APostop dsg cast chg elb dis/
    L6384APostop dsg cast chg shlder/t
    L6386APostop ea cast chg & realign
    L6388APostop applicat rigid dsg on
    L6400ABelow elbow prosth tiss shap
    L6450AElb disart prosth tiss shap
    L6500AAbove elbow prosth tiss shap
    L6550AShldr disar prosth tiss shap
    L6570AScap thorac prosth tiss shap
    L6580AWrist/elbow bowden cable mol
    L6582AWrist/elbow bowden cbl dir f
    L6584AElbow fair lead cable molded
    L6586AElbow fair lead cable dir fo
    L6588AShdr fair lead cable molded
    L6590AShdr fair lead cable direct
    L6600APolycentric hinge pair
    L6605ASingle pivot hinge pair
    L6610AFlexible metal hinge pair
    L6615ADisconnect locking wrist uni
    L6616ADisconnect insert locking wr
    L6620AFlexion-friction wrist unit
    L6623ASpring-ass rot wrst w/latch
    L6625ARotation wrst w/cable lock
    L6628AQuick disconn hook adapter o
    L6629ALamination collar w/couplin
    L6630AStainless steel any wrist
    L6632ALatex suspension sleeve each
    L6635ALift assist for elbow
    L6637ANudge control elbow lock
    L6640AShoulder abduction joint pai
    L6641AExcursion amplifier pulley t
    L6642AExcursion amplifier lever ty
    L6645AShoulder flexion-abduction j
    L6650AShoulder universal joint
    L6655AStandard control cable extra
    L6660AHeavy duty control cable
    L6665ATeflon or equal cable lining
    L6670AHook to hand cable adapter
    Start Printed Page 18701
    L6672AHarness chest/shlder saddle
    L6675AHarness figure of 8 sing con
    L6676AHarness figure of 8 dual con
    L6680ATest sock wrist disart/bel e
    L6682ATest sock elbw disart/above
    L6684ATest socket shldr disart/tho
    L6686ASuction socket
    L6687AFrame typ socket bel elbow/w
    L6688AFrame typ sock above elb/dis
    L6689AFrame typ socket shoulder di
    L6690AFrame typ sock interscap-tho
    L6691ARemovable insert each
    L6692ASilicone gel insert or equal
    L6693ALockingelbow forearm cntrbal
    L6700ATerminal device model #3
    L6705ATerminal device model #5
    L6710ATerminal device model #5x
    L6715ATerminal device model #5xa
    L6720ATerminal device model #6
    L6725ATerminal device model #7
    L6730ATerminal device model #7lo
    L6735ATerminal device model #8
    L6740ATerminal device model #8x
    L6745ATerminal device model #88x
    L6750ATerminal device model #10p
    L6755ATerminal device model #10x
    L6765ATerminal device model #12p
    L6770ATerminal device model #99x
    L6775ATerminal device model #555
    L6780ATerminal device model #ss555
    L6790AHooks-accu hook or equal
    L6795AHooks-2 load or equal
    L6800AHooks-aprl vc or equal
    L6805AModifier wrist flexion unit
    L6806ATrs grip vc or equal
    L6807ATerm device grip 1/2 or equal
    L6808ATerm device infant or child
    L6809ATrs super sport passive
    L6810APincher tool otto bock or eq
    L6825AHands dorrance vo
    L6830AHand aprl vc
    L6835AHand sierra vo
    L6840AHand becker imperial
    L6845AHand becker lock grip
    L6850ATerm dvc-hand becker plylite
    L6855AHand robin-aids vo
    L6860AHand robin-aids vo soft
    L6865AHand passive hand
    L6867AHand detroit infant hand
    L6868APassive inf hand steeper/hos
    L6870AHand child mitt
    L6872AHand nyu child hand
    L6873AHand mech inf steeper or equ
    L6875AHand bock vc
    L6880AHand bock vo
    L6890AProduction glove
    L6895ACustom glove
    L6900AHand restorat thumb/1 finger
    L6905AHand restoration multiple fi
    L6910AHand restoration no fingers
    L6915AHand restoration replacmnt g
    L6920AWrist disarticul switch ctrl
    L6925AWrist disart myoelectronic c
    L6930ABelow elbow switch control
    L6935ABelow elbow myoelectronic ct
    L6940AElbow disarticulation switch
    L6945AElbow disart myoelectronic c
    L6950AAbove elbow switch control
    L6955AAbove elbow myoelectronic ct
    L6960AShldr disartic switch contro
    L6965AShldr disartic myoelectronic
    L6970AInterscapular-thor switch ct
    L6975AInterscap-thor myoelectronic
    Start Printed Page 18702
    L7010AHand otto back steeper/eq sw
    L7015AHand sys teknik village swit
    L7020AElectronic greifer switch ct
    L7025AElectron hand myoelectronic
    L7030AHand sys teknik vill myoelec
    L7035AElectron greifer myoelectro
    L7040APrehensile actuator hosmer s
    L7045AElectron hook child michigan
    L7170AElectronic elbow hosmer swit
    L7180AElectronic elbow utah myoele
    L7185AElectron elbow adolescent sw
    L7186AElectron elbow child switch
    L7190AElbow adolescent myoelectron
    L7191AElbow child myoelectronic ct
    L7260AElectron wrist rotator otto
    L7261AElectron wrist rotator utah
    L7266AServo control steeper or equ
    L7272AAnalogue control unb or equa
    L7274AProportional ctl 12 volt uta
    L7360ASix volt bat otto bock/eq ea
    L7362ABattery chrgr six volt otto
    L7364ATwelve volt battery utah/equ
    L7366ABattery chrgr 12 volt utah/e
    L7499AUpper extremity prosthes NOS
    L7500AProsthetic dvc repair hourly
    L7510AProsthetic device repair rep
    L7520ARepair prosthesis per 15 min
    L7900AVacuum erection system
    L8000AMastectomy bra
    L8010AMastectomy sleeve
    L8015AExt breastprosthesis garment
    L8020AMastectomy form
    L8030ABreast prosthesis silicone/e
    L8035ACustom breast prosthesis
    L8039ABreast prosthesis NOS
    L8100ACompression stocking BK18-30
    L8110ACompression stocking BK30-40
    L8120ACompression stocking BK40-50
    L8130AGc stocking thighlngth 18-30
    L8140AGc stocking thighlngth 30-40
    L8150AGc stocking thighlngth 40-50
    L8160AGc stocking full lngth 18-30
    L8170AGc stocking full lngth 30-40
    L8180AGc stocking full lngth 40-50
    L8190AGc stocking waistlngth 18-30
    L8195AGc stocking waistlngth 30-40
    L8200AGc stocking waistlngth 40-50
    L8210AGc stocking custom made
    L8220AGc stocking lymphedema
    L8230AGc stocking garter belt
    L8239AG compression stocking NOS
    L8300ATruss single w/standard pad
    L8310ATruss double w/standard pad
    L8320ATruss addition to std pad wa
    L8330ATruss add to std pad scrotal
    L8400ASheath below knee
    L8410ASheath above knee
    L8415ASheath upper limb
    L8417APros sheath/sock w gel cushn
    L8420AProsthetic sock multi ply BK
    L8430AProsthetic sock multi ply AK
    L8435APros sock multi ply upper lm
    L8440AShrinker below knee
    L8460AShrinker above knee
    L8465AShrinker upper limb
    L8470APros sock single ply BK
    L8480APros sock single ply AK
    L8485APros sock single ply upper l
    L8490AAir seal suction reten systm
    L8499AUnlisted misc prosthetic ser
    L8500AArtificial larynx
    L8501ATracheostomy speaking valve
    L8600AImplant breast silicone/eq
    Start Printed Page 18703
    L8603ACollagen imp urinary 2.5 CC
    L8610AOcular implant
    L8612AAqueous shunt prosthesis
    L8613AOssicular implant
    L8614ACochlear device/system
    L8619AReplace cochlear processor
    L8630AMetacarpophalangeal implant
    L8641AMetatarsal joint implant
    L8642AHallux implant
    L8658AInterphalangeal joint implnt
    L8670AVascular graft, synthetic
    L8699AProsthetic implant NOS
    L9900AO&P supply/accessory/service
    M0064XVisit for drug monitoring03741.17$56.73$13.08$11.35
    M0075ECellular therapy
    M0076EProlotherapy
    M0100EIntragastric hypothermia
    M0300EIV chelationtherapy
    M0301EFabric wrapping of aneurysm
    M0302EAssessment of cardiac output
    P2028ACephalin floculation test
    P2029ACongo red blood test
    P2031EHair analysis
    P2033ABlood thymol turbidity
    P2038ABlood mucoprotein
    P3000AScreen pap by tech w md supv
    P3001EScreening pap smear by phys
    P7001ECulture bacterial urine
    2 P9010SWhole blood for transfusion09502.08$101.02$20.20
    P9011SBlood split unit
    2 P9012SCryoprecipitate each unit09520.70$33.92$6.78
    2 P9013SUnit/s blood fibrinogen09530.48$23.27$4.65
    2 P9016SLeukocyte poor blood, unit09542.83$137.21$27.44
    2 P9017SOne donor fresh frozn plasma09552.26$109.35$21.87
    2 P9018SPlasma protein fract, unit09561.26$61.09$12.22
    2 P9019SPlatelet concentrate unit09570.98$47.46$9.49
    2 P9020SPlatelet rich plasma unit09581.16$56.25$11.25
    2 P9021SRed blood cells unit09592.04$99.04$19.81
    2 P9022SWashed red blood cells unit09603.81$184.53$36.91
    2 P9023SFrozen plasma, pooled, sd09493.49$169.22$33.84
    P9603AOne-way allow prorated miles
    P9604AOne-way allow prorated trip
    P9612NCatheterize for urine spec
    P9615NUrine specimen collect mult
    2 0034XAdmin of influenza vaccine03540.13$6.19
    Q0035XCardiokymography03660.38$18.43$15.60$3.69
    Q0081SInfusion ther other than che01201.66$80.49$42.67$16.10
    Q0082PActivity therapy w/partial h00334.17$202.19$48.17$40.44
    Q0083SChemo by other than infusion01162.34$113.46$22.69$22.69
    Q0084SChemotherapy by infusion01171.84$89.22$71.80$17.84
    Q0085SChemo by both infusion and o01182.90$140.61$72.03$28.12
    Q0086APhysical therapy evaluation/
    Q0091TObtaining screen pap smear01911.19$57.70$17.43$11.54
    Q0092NSet up port x-ray equipment
    Q0111AWet mounts/w preparations
    Q0112APotassium hydroxide preps
    Q0113APinworm examinations
    Q0114AFern test
    Q0115APost-coital mucous exam
    3 Q0136XNon esrd epoetin alpha inj0733$1.75
    Q0144EAzithromycin dihydrate, oral
    2 Q0156XHuman albumin 5%09612.77$134.31$26.86
    2 Q0157XHuman albumin 25%09621.38$66.91$13.38
    3 Q0160XFactor IX non-recombinant0931$.04
    3 Q0161XFactor IX recombinant0932$.10
    3 Q0163XDiphenhydramine HCl 50mg0761$.10
    3 Q0164XProchlorperazine maleate 5mg0761$.10
    Q0165EProchlorperazine maleate10mg
    3 Q0166XGranisetron HCl 1 mg oral0765$3.20
    3 Q0167XDronabinol 2.5mg oral0762$.48
    Q0168EDronabinol 5mg oral
    3 Q0169XPromethazine HCl 12.5mg oral0761$.10
    Q0170EPromethazine HCl 25 mg oral
    Start Printed Page 18704
    3 Q0171XChlorpromazine HCl 10mg oral0761$.10
    Q0172EChlorpromazine HCl 25mg oral
    3 Q0173XTrimethobenzamide HCl 250mg0761$.10
    3 Q0174XThiethylperazine maleate10mg0761$.10
    3 Q0175XPerphenazine 4mg oral0761$.10
    Q0176EPerphenazine 8mg oral
    3 Q0177XHydroxyzine pamoate 25mg0761$.10
    Q0178EHydroxyzine pamoate 50mg
    3 Q0179XOndansetron HCl 8mg oral0769$2.62
    3 Q0180XDolasetron mesylate oral0763$8.53
    Q0181EUnspecified oral anti-emetic
    Q0183NNonmetabolic active tissue
    Q0184NMetabolically active tissue
    Q0185NMetabolic active D/E tissue
    Q0186EParamedic intercept, rural
    3 Q0187XFactor viia recombinant0929$.27
    Q1001ENtiol category 1
    Q1002ENtiol category 2
    Q1003ENtiol category 3
    Q1004ENtiol category 4
    Q1005ENtiol category 5
    Q2001ECabergoline, 0.5 mg, oral
    3 Q2002XElliot's B solution7022$19.20
    3 Q2003XAprotinin, 10,000 kiu7019$2.42
    3 Q2004XTreatment for bladder calcul7023$4.46
    3 Q2005XCorticorelin ovine triflutat7024$45.77
    3 Q2006XDigoxin immune FAB (Ovine),7025$14.06
    3 Q2007XEthanolamine oleate, 1000 ml7026$2.13
    3 Q2008XFomepizole, 1.5 G7027$141.29
    3 Q2009XFosphenytoin, 50 mg7028$.78
    3 Q2010XGlatiramer acetate, 25 mgeny7029$3.59
    3 Q2011XHemin, 1 mg7030$.10
    3 Q2012XPegademase bovine inj 25 I.U7039$1.16
    3 Q2013XPentastarch 10% inj, 100 ml7040$2.04
    3 Q2014XSermorelin acetate, 0.5 mg7032$53.34
    3 Q2015XSomatrem, 5 mg7033$28.03
    3 Q2016XSomatropin, 1 mg7034$5.04
    3 Q2017XTeniposide, 50 mg7035$20.85
    3 Q2018XUrofollitropin, 75 I.U.7037$8.24
    3 Q3001SBrachytherapy Seeds0918$9.99
    Q9920AEpoetin with hct <= 20
    Q9921AEpoetin with hct = 21
    Q9922AEpoetin with hct = 22
    Q9923AEpoetin with hct = 23
    Q9924AEpoetin with hct = 24
    Q9925AEpoetin with hct = 25
    Q9926AEpoetin with hct = 26
    Q9927AEpoetin with hct = 27
    Q9928AEpoetin with hct = 28
    Q9929AEpoetin with hct = 29
    Q9930AEpoetin with hct = 30
    Q9931AEpoetin with hct = 31
    Q9932AEpoetin with hct = 32
    Q9933AEpoetin with hct = 33
    Q9934AEpoetin with hct = 34
    Q9935AEpoetin with hct = 35
    Q9936AEpoetin with hct = 36
    Q9937AEpoetin with hct = 37
    Q9938AEpoetin with hct = 38
    Q9939AEpoetin with hct = 39
    Q9940AEpoetin with hct >= 40
    R0070NTransport portable x-ray
    R0075NTransport port x-ray multipl
    R0076NTransport portable EKG
    V2020AVision svcs frames purchases
    V2025EEyeglasses delux frames
    V2100ALens spher single plano 4.00
    V2101ASingle visn sphere 4.12-7.00
    V2102ASingl visn sphere 7.12-20.00
    V2103ASpherocylindr 4.00d/12-2.00d
    V2104ASpherocylindr 4.00d/2.12-4d
    V2105ASpherocylinder 4.00d/4.25-6d
    V2106ASpherocylinder 4.00d/>6.00d
    Start Printed Page 18705
    V2107ASpherocylinder 4.25d/12-2d
    V2108ASpherocylinder 4.25d/2.12-4d
    V2109ASpherocylinder 4.25d/4.25-6d
    V2110ASpherocylinder 4.25d/over 6d
    V2111ASpherocylindr 7.25d/.25-2.25
    V2112ASpherocylindr 7.25d/2.25-4d
    V2113ASpherocylindr 7.25d/4.25-6d
    V2114ASpherocylinder over 12.00d
    V2115ALens lenticular bifocal
    V2116ANonaspheric lens bifocal
    V2117AAspheric lens bifocal
    V2118ALens aniseikonic single
    V2199ALens single vision not oth c
    V2200ALens spher bifoc plano 4.00d
    V2201ALens sphere bifocal 4.12-7.0
    V2202ALens sphere bifocal 7.12-20.
    V2203ALens sphcyl bifocal 4.00d/.1
    V2204ALens sphcy bifocal 4.00d/2.1
    V2205ALens sphcy bifocal 4.00d/4.2
    V2206ALens sphcy bifocal 4.00d/ove
    V2207ALens sphcy bifocal 4.25-7d/.
    V2208ALens sphcy bifocal 4.25-7/2.
    V2209ALens sphcy bifocal 4.25-7/4.
    V2210ALens sphcy bifocal 4.25-7/ov
    V2211ALens sphcy bifo 7.25-12/.25-
    V2212ALens sphcyl bifo 7.25-12/2.2
    V2213ALens sphcyl bifo 7.25-12/4.2
    V2214ALens sphcyl bifocal over 12.
    V2215ALens lenticular bifocal
    V2216ALens lenticular nonaspheric
    V2217ALens lenticular aspheric bif
    V2218ALens aniseikonic bifocal
    V2219ALens bifocal seg width over
    V2220ALens bifocal add over 3.25d
    V2299ALens bifocal speciality
    V2300ALens sphere trifocal 4.00d
    V2301ALens sphere trifocal 4.12-7.
    V2302ALens sphere trifocal 7.12-20
    V2303ALens sphcy trifocal 4.0/.12-
    V2304ALens sphcy trifocal 4.0/2.25
    V2305ALens sphcy trifocal 4.0/4.25
    V2306ALens sphcyl trifocal 4.00/>6
    V2307ALens sphcy trifocal 4.25-7/.
    V2308ALens sphc trifocal 4.25-7/2.
    V2309ALens sphc trifocal 4.25-7/4.
    V2310ALens sphc trifocal 4.25-7/>6
    V2311ALens sphc trifo 7.25-12/.25-
    V2312ALens sphc trifo 7.25-12/2.25
    V2313ALens sphc trifo 7.25-12/4.25
    V2314ALens sphcyl trifocal over 12
    V2315ALens lenticular trifocal
    V2316ALens lenticular nonaspheric
    V2317ALens lenticular aspheric tri
    V2318ALens aniseikonic trifocal
    V2319ALens trifocal seg width > 28
    V2320ALens trifocal add over 3.25d
    V2399ALens trifocal speciality
    V2410ALens variab asphericity sing
    V2430ALens variable asphericity bi
    V2499AVariable asphericity lens
    V2500AContact lens pmma spherical
    V2501ACntct lens pmma-toric/prism
    V2502AContact lens pmma bifocal
    V2503ACntct lens pmma color vision
    V2510ACntct gas permeable sphericl
    V2511ACntct toric prism ballast
    V2512ACntct lens gas permbl bifocl
    V2513AContact lens extended wear
    V2520AContact lens hydrophilic
    V2521ACntct lens hydrophilic toric
    V2522ACntct lens hydrophil bifocl
    V2523ACntct lens hydrophil extend
    V2530AContact lens gas impermeable
    Start Printed Page 18706
    V2531AContact lens gas permeable
    V2599AContact lens/es other type
    V2600AHand held low vision aids
    V2610ASingle lens spectacle mount
    V2615ATelescop/othr compound lens
    V2623APlastic eye prosth custom
    V2624APolishing artifical eye
    V2625AEnlargemnt of eye prosthesis
    V2626AReduction of eye prosthesis
    V2627AScleral cover shell
    V2628AFabrication & fitting
    V2629AProsthetic eye other type
    V2630NAnter chamber intraocul lens
    V2631NIris support intraoclr lens
    V2632NPost chmbr intraocular lens
    V2700ABalance lens
    V2710AGlass/plastic slab off prism
    V2715APrism lens/es
    V2718AFresnell prism press-on lens
    V2730ASpecial base curve
    V2740ARose tint plastic
    V2741ANon-rose tint plastic
    V2742ARose tint glass
    V2743ANon-rose tint glass
    V2744ATint photochromatic lens/es
    V2750AAnti-reflective coating
    V2755AUV lens/es
    V2760AScratch resistant coating
    V2770AOccluder lens/es
    V2780AOversize lens/es
    V2781AProgressive lens per lens
    V2785ACorneal tissue processing
    V2799AMiscellaneous vision service
    V5008EHearing screening
    V5010EAssessment for hearing aid
    V5011EHearing aid fitting/checking
    V5014EHearing aid repair/modifying
    V5020EConformity evaluation
    V5030EBody-worn hearing aid air
    V5040EBody-worn hearing aid bone
    V5050EBody-worn hearing aid in ear
    V5060EBehind ear hearing aid
    V5070EGlasses air conduction
    V5080EGlasses bone conduction
    V5090EHearing aid dispensing fee
    V5100EBody-worn bilat hearing aid
    V5110EHearing aid dispensing fee
    V5120EBody-worn binaur hearing aid
    V5130EIn ear binaural hearing aid
    V5140EBehind ear binaur hearing ai
    V5150EGlasses binaural hearing aid
    V5160EDispensing fee binaural
    V5170EWithin ear cros hearing aid
    V5180EBehind ear cros hearing aid
    V5190EGlasses cros hearing aid
    V5200ECros hearing aid dispens fee
    V5210EIn ear bicros hearing aid
    V5220EBehind ear bicros hearing ai
    V5230EGlasses bicros hearing aid
    V5240EDispensing fee bicros
    V5299AHearing service
    V5336ERepair communication device
    V5362ASpeech screening
    V5363ALanguage screening
    V5364ADysphagia 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. 1 Not subject to national coinsurance. Minimum unadjusted coinsurance is 25% of the payment rate. The payment rate is the lower of the HOPD payment rate or the Ambulatory Surgical Center payment. ÿ09ÿ09ÿ09ÿ09   2 Not subject to national coinsurance.ÿ09ÿ09ÿ09ÿ09ÿ09ÿ09 3 Eligible for pass-through payments. See Preamble for payment rate determination. See Addendum K for complete list of pass-through codes.

    Addendum C.—Proposed Hospital Outpatient Department (HOPD) Payment for Procedures by APC

    APCCPT/ HCPCSHCPCS DescriptionStatus IndicatorRelative WeightPayment RateNational Unadjusted CoinsuranceMinimum Unadjusted Coinsurance
    0001PhotochemotherapyS0.47$22.79$8.49$4.56
    Start Printed Page 18707
    96900Ultraviolet light therapy
    96910Photochemotherapy with UV-B
    96912Photochemotherapy with UV-A
    96913Photochemotherapy, UV-A or B
    96999Dermatological procedure
    0002Fine needle Biopsy/AspirationT0.62$30.06$17.66$6.01
    60001Aspirate/inject thyriod cyst
    88170Fine needle aspiration
    88171Fine needle aspiration
    0003Bone Marrow Biopsy/AspirationT0.98$47.52$27.99$9.50
    85095Bone marrow aspiration
    85102Bone marrow biopsy
    0004Level I Needle Biopsy/Aspiration Except Bone MarrowT1.84$89.22$32.57$17.84
    17999Skin tissue procedure
    19000Drainage of breast lesion
    19001Drain breast lesion add-on
    20615Treatment of bone cyst
    42400Biopsy of salivary gland
    54800Biopsy of epididymis
    55000Drainage of hydrocele
    60100Biopsy of thyroid
    60699Endocrine surgery procedure
    0005Level II Needle Biopsy/Aspiration Except Bone MarrowT5.41$262.32$119.75$52.46
    19100Biopsy of breast
    20206Needle biopsy, muscle
    32400Needle biopsy chest lining
    32405Biopsy, lung or mediastinum
    38505Needle biopsy, lymph nodes
    47000Needle biopsy of liver
    47399Liver surgery procedure
    48102Needle biopsy, pancreas
    48999Pancreas surgery procedure
    49180Biopsy, abdominal mass
    50200Biopsy of kidney
    50390Drainage of kidney lesion
    54500Biopsy of testis
    62269Needle biopsy, spinal cord
    0006Level I Incision & DrainageT2.00$96.97$33.95$19.39
    10040Acne surgery of skin abscess
    10060Drainage of skin abscess
    10061Drainage of skin abscess
    10080Drainage of pilonidal cyst
    10120Remove foreign body
    10160Puncture drainage of lesion
    20000Incision of abscess
    26010Drainage of finger abscess
    69000Drain external ear lesion
    69020Drain outer ear canal lesion
    0007Level II Incision & DrainageT3.68$178.43$72.03$35.69
    10081Drainage of pilonidal cyst
    10140Drainage of hematoma/fluid
    10180Complex drainage, wound
    26011Drainage of finger abscess
    69005Drain external ear lesion
    0008Level III Incision & DrainageT6.15$298.20$113.67$59.64
    19020Incision of breast lesion
    20950Fluid pressure, muscle
    21501Drain neck/chest lesion
    21700Revision of neck muscle
    21720Revision of neck muscle
    21725Revision of neck muscle
    23030Drain shoulder lesion
    23031Drain shoulder bursa
    23930Drainage of arm lesion
    23931Drainage of arm bursa
    27301Drain thigh/knee lesion
    27603Drain lower leg lesion
    28001Drainage of bursa of foot
    38300Drainage, lymph node lesion
    38305Drainage, lymph node lesion
    38999Blood/lymph system procedure
    51080Drainage of bladder abscess
    54015Drain penis lesion
    Start Printed Page 18708
    54115Treatment of penis lesion
    55100Drainage of scrotum abscess
    0009Nail ProceduresT0.74$35.88$9.63$7.18
    11719Trim nail(s)
    11720Debride nail, 1-5
    11721Debride nail, 6 or more
    11740Drain blood from under nail
    G0127Trim nail(s)
    0010Level I Destruction of LesionT0.55$26.67$9.86$5.33
    17000Destroy benign/premal lesion
    17003Destroy lesions, 2-14
    17110Destruct lesion, 1-14
    0011Level II Destruction of LesionT2.72$131.88$50.01$26.38
    17004Destroy lesions, 15 or more
    17106Destruction of skin lesions
    17107Destruction of skin lesions
    17108Destruction of skin lesions
    17111Destruct lesion, 15 or more
    0012Level I Debridement & DestructionT0.53$25.70$9.18$5.14
    11732Remove nail plate, add-on
    11900Injection into skin lesions
    15852Dressing change, not for burn
    17340Cryotherapy of skin
    69220Clean out mastoid cavity
    0013Level II Debridement & DestructionT0.91$44.12$17.66$8.82
    11300Shave skin lesion
    11301Shave skin lesion
    11305Shave skin lesion
    11306Shave skin lesion
    11310Shave skin lesion
    11311Shave skin lesion
    11730Removal of nail plate
    11901Added skin lesions injection
    15786Abrasion, lesion, single
    15788Chemical peel, face, epiderm
    15850Removal of sutures
    15851Removal of sutures
    17260Destruction of skin lesions
    17261Destruction of skin lesions
    17262Destruction of skin lesions
    17263Destruction of skin lesions
    17271Destruction of skin lesions
    17272Destruction of skin lesions
    54050Destruction, penis lesion(s)
    54056Cryosurgery, penis lesion(s)
    0014Level III Debridement & DestructionT1.50$72.73$24.55$14.55
    11302Shave skin lesion
    11307Shave skin lesion
    16025Treatment of burn(s)
    17250Chemical cautery, tissue
    46917Laser surgery, anal lesions
    0015Level IV Debridement & DestructionT1.77$85.82$31.20$17.16
    11000Debride infected skin
    11001Debride infected skin add-on
    11040Debride skin, partial
    11041Debride skin, full
    11055Trim skin lesion
    11056Trim skin lesions, 2 to 4
    11057Trim skin lesions, over 4
    11200Removal of skin tags
    11201Remove skin tags add-on
    11303Shave skin lesion
    11308Shave skin lesion
    11312Shave skin lesion
    11765Excision of nail fold, toe
    15783Abrasion treatment of skin
    15789Chemical peel, face, dermal
    16000Initial treatment of burn(s)
    16010Treatment of burn(s)
    16020Treatment of burn(s)
    16030Treatment of burn(s)
    17264Destruction of skin lesions
    17270Destruction of skin lesions
    Start Printed Page 18709
    17273Destruction of skin lesions
    17274Destruction of skin lesions
    17276Destruction of skin lesions
    17280Destruction of skin lesions
    17281Destruction of skin lesions
    17282Destruction of skin lesions
    17283Destruction of skin lesions
    0016Level V Debridement & DestructionT3.53$171.16$74.67$34.23
    11042Debride skin/tissue
    11043Debride tissue/muscle
    11313Shave skin lesion
    15787Abrasion, lesions, add-on
    15792Chemical peel, nonfacial
    15793Chemical peel, nonfacial
    15810Salabrasion
    17266Destruction of skin lesions
    17284Destruction of skin lesions
    17286Destruction of skin lesions
    17360Skin peel therapy
    17380Hair removal by electrolysis
    46900Destruction, anal lesion(s)
    46910Destruction, anal lesion(s)
    46916Cryosurgery, anal lesion(s)
    54055Destruction, penis lesion(s)
    56501Destruction, vulva lesion(s)
    0017Level VI Debridement & DestructionT12.45$603.66$289.16$120.73
    11044Debride tissue/muscle/bone
    16015Treatment of burn(s)
    46922Excision of anal lesion(s)
    46924Destruction, anal lesion(s)
    54057Laser surg, penis lesion(s)
    54060Excision of penis lesion(s)
    54065Destruction, penis lesion(s)
    56515Destruction, vulva lesion(s)
    0018Biopsy Skin, Subcutaneous Tissue or Mucous MembraneT0.94$45.58$17.66$9.12
    11100Biopsy of skin lesion
    11101Biopsy, skin add-on
    0019Level I Excision/BiopsyT4.00$193.95$78.91$38.79
    11400Removal of skin lesion
    11401Removal of skin lesion
    11402Removal of skin lesion
    11420Removal of skin lesion
    11421Removal of skin lesion
    11422Removal of skin lesion
    11440Removal of skin lesion
    11441Removal of skin lesion
    11442Removal of skin lesion
    11600Removal of skin lesion
    11601Removal of skin lesion
    11602Removal of skin lesion
    11620Removal of skin lesion
    11621Removal of skin lesion
    11622Removal of skin lesion
    11640Removal of skin lesion
    11641Removal of skin lesion
    11642Removal of skin lesion
    11750Removal of nail bed
    11755Biopsy, nail unit
    11976Removal of contraceptive cap
    20220Bone biopsy, trocar/needle
    20520Removal of foreign body
    21550Biopsy of neck/chest
    23330Remove shoulder foreign body
    24200Removal of arm foreign body
    27086Remove hip foreign body
    28190Removal of foot foreign body
    56605Biopsy of vulva/perineum
    56606Biopsy of vulva/perineum
    58999Genital surgery procedure
    69100Biopsy of external ear
    0020Level II Excision/BiopsyT6.51$315.65$130.53$63.13
    10121Remove foreign body
    11403Removal of skin lesion
    Start Printed Page 18710
    11404Removal of skin lesion
    11406Removal of skin lesion
    11423Removal of skin lesion
    11424Removal of skin lesion
    11443Removal of skin lesion
    11444Removal of skin lesion
    11603Removal of skin lesion
    11604Removal of skin lesion
    11623Removal of skin lesion
    11624Removal of skin lesion
    11643Removal of skin lesion
    11644Removal of skin lesion
    16035Incision of burn scab
    17304Chemosurgery of skin lesion
    173052nd stage chemosurgery
    173063rd stage chemosurgery
    17307Followup skin lesion therapy
    17310Extensive skin chemosurgery
    20200Muscle biopsy
    20225Bone biopsy, trocar/needle
    21920Biopsy soft tissue of back
    24065Biopsy arm/elbow soft tissue
    24066Biopsy arm/elbow soft tissue
    25065Biopsy forearm soft tissues
    25075Removal of forearm lesion
    26320Removal of implant from hand
    27613Biopsy lower leg soft tissue
    28193Removal of foot foreign body
    37609Temporal artery procedure
    37799Vascular surgery procedure
    54100Biopsy of penis
    69110Remove external ear, partial
    69145Remove ear canal lesion(s)
    0021Level III Excision/BiopsyT10.49$508.63$236.51$101.73
    11606Removal of skin lesion
    11770Removal of pilonidal lesion
    20205Deep muscle biopsy
    20670Removal of support implant
    23000Removal of calcium deposits
    23065Biopsy shoulder tissues
    23075Removal of shoulder lesion
    24075Remove arm/elbow lesion
    24201Removal of arm foreign body
    27040Biopsy of soft tissues
    27323Biopsy, thigh soft tissues
    27618Remove lower leg lesion
    28043Excision of foot lesion
    28192Removal of foot foreign body
    54105Biopsy of penis
    0022Level IV Excision/BiopsyT12.49$605.60$292.94$121.12
    11010Debride skin, fx
    11011Debride skin/muscle, fx
    11012Debride skin/muscle/bone, fx
    11426Removal of skin lesion
    11446Removal of skin lesion
    11450Removal, sweat gland lesion
    11451Removal, sweat gland lesion
    11462Removal, sweat gland lesion
    11463Removal, sweat gland lesion
    11470Removal, sweat gland lesion
    11471Removal, sweat gland lesion
    11626Removal of skin lesion
    11646Removal of skin lesion
    11752Remove nail bed/finger tip
    11771Removal of pilonidal lesion
    11772Removal of pilonidal lesion
    11971Remove tissue expander(s)
    15780Abrasion treatment of skin
    15781Abrasion treatment of skin
    15782Abrasion treatment of skin
    15811Salabrasion
    15838Excise excessive skin tissue
    15920Removal of tail bone ulcer
    Start Printed Page 18711
    15931Remove sacrum pressure sore
    15933Remove sacrum pressure sore
    15940Remove hip pressure sore
    15941Remove hip pressure sore
    15950Remove thigh pressure sore
    15951Remove thigh pressure sore
    15999Removal of pressure sore
    20240Bone biopsy, excisional
    20245Bone biopsy, excisional
    20525Removal of foreign body
    20680Removal of support implant
    21555Remove lesion, neck/chest
    21556Remove lesion, neck/chest
    21925Biopsy soft tissue of back
    21930Remove lesion, back or flank
    21935Remove tumor, back
    22900Remove abdominal wall lesion
    22999Abdomen surgery procedure
    23066Biopsy shoulder tissues
    23076Removal of shoulder lesion
    23077Remove tumor of shoulder
    23331Remove shoulder foreign body
    24076Remove arm/elbow lesion
    24077Remove tumor of arm/elbow
    25066Biopsy forearm soft tissues
    25076Removal of forearm lesion
    25077Remove tumor, forearm/wrist
    26115Removal of hand lesion
    26116Removal of hand lesion
    26117Remove tumor, hand/finger
    27041Biopsy of soft tissues
    27047Remove hip/pelvis lesion
    27048Remove hip/pelvis lesion
    27049Remove tumor, hip/pelvis
    27324Biopsy, thigh soft tissues
    27327Removal of thigh lesion
    27328Removal of thigh lesion
    27329Remove tumor, thigh/knee
    27372Removal of foreign body
    27614Biopsy lower leg soft tissue
    27619Remove lower leg lesion
    69205Clear outer ear canal
    0023Exploration Penetrating WoundT1.98$96.00$40.37$19.20
    20100Explore wound, neck
    20103Explore wound, extremity
    0024Level I Skin RepairT2.43$117.82$44.50$23.56
    11760Repair of nail bed
    11762Reconstruction of nail bed
    11920Correct skin color defects
    11921Correct skin color defects
    11922Correct skin color defects
    11950Therapy for contour defects
    11951Therapy for contour defects
    11952Therapy for contour defects
    11954Therapy for contour defects
    12001Repair superficial wound(s)
    12002Repair superficial wound(s)
    12004Repair superficial wound(s)
    12005Repair superficial wound(s)
    12006Repair superficial wound(s)
    12007Repair superficial wound(s)
    12011Repair superficial wound(s)
    12013Repair superficial wound(s)
    12014Repair superficial wound(s)
    12015Repair superficial wound(s)
    12016Repair superficial wound(s)
    12017Repair superficial wound(s)
    12018Repair superficial wound(s)
    12020Closure of split wound
    12021Closure of split wound
    12031Layer closure of wound(s)
    12032Layer closure of wound(s)
    12034Layer closure of wound(s)
    Start Printed Page 18712
    12035Layer closure of wound(s)
    12036Layer closure of wound(s)
    12041Layer closure of wound(s)
    12042Layer closure of wound(s)
    12044Layer closure of wound(s)
    12045Layer closure of wound(s)
    12046Layer closure of wound(s)
    12051Layer closure of wound(s)
    12052Layer closure of wound(s)
    12053Layer closure of wound(s)
    12054Layer closure of wound(s)
    12055Layer closure of wound(s)
    12056Layer closure of wound(s)
    0025Level II Skin RepairT3.74$181.34$70.66$36.27
    13100Repair of wound or lesion
    13101Repair of wound or lesion
    13102Repair wound/lesion add-on
    13120Repair of wound or lesion
    13121Repair of wound or lesion
    13122Repair wound/lesion add-on
    13131Repair of wound or lesion
    13132Repair of wound or lesion
    13133Repair wound/lesion add-on
    13151Repair of wound or lesion
    13152Repair of wound or lesion
    13153Repair wound/lesion add-on
    43870Repair stomach opening
    0026Level III Skin RepairT12.11$587.18$277.92$117.44
    11960Insert tissue expander(s)
    11970Replace tissue expander
    12037Layer closure of wound(s)
    12047Layer closure of wound(s)
    12057Layer closure of wound(s)
    13150Repair of wound or lesion
    13160Late closure of wound
    14000Skin tissue rearrangement
    14001Skin tissue rearrangement
    14020Skin tissue rearrangement
    14021Skin tissue rearrangement
    14040Skin tissue rearrangement
    14041Skin tissue rearrangement
    14060Skin tissue rearrangement
    14061Skin tissue rearrangement
    14300Skin tissue rearrangement
    14350Skin tissue rearrangement
    15000Skin graft
    15001Skin graft add-on
    15050Skin pinch graft
    15100Skin split graft
    15101Skin split graft add-on
    15120Skin split graft
    15121Skin split graft add-on
    15200Skin full graft
    15201Skin full graft add-on
    15220Skin full graft
    15221Skin full graft add-on
    15240Skin full graft
    15241Skin full graft add-on
    15260Skin full graft
    15261Skin full graft add-on
    15350Skin homograft
    15351Skin homograft add-on
    15400Skin heterograft
    15401Skin heterograft add-on
    15570Form skin pedicle flap
    15572Form skin pedicle flap
    15574Form skin pedicle flap
    15576Form skin pedicle flap
    15600Skin graft
    15610Skin graft
    15620Skin graft
    15630Skin graft
    15650Transfer skin pedicle flap
    Start Printed Page 18713
    15775Hair transplant punch grafts
    15776Hair transplant punch grafts
    15819Plastic surgery, neck
    15820Revision of lower eyelid
    15821Revision of lower eyelid
    15822Revision of upper eyelid
    15823Revision of upper eyelid
    15825Removal of neck wrinkles
    15829Removal of skin wrinkles
    15835Excise excessive skin tissue
    20101Explore wound, chest
    20102Explore wound, abdomen
    20910Remove cartilage for graft
    20912Remove cartilage for graft
    20920Removal of fascia for graft
    20922Removal of fascia for graft
    20926Removal of tissue for graft
    23921Amputation follow-up surgery
    25929Amputation follow-up surgery
    33222Revise pocket, pacemaker
    33223Revise pocket, pacing-defib
    44312Revision of ileostomy
    44340Revision of colostomy
    G0168Wound closure by adhesive
    G0169Removal tissue; no anesthsia
    G0170Skin biograft
    G0171Skin biograft add-on
    0027Level IV Skin RepairT15.80$766.10$383.10$153.22
    15732Muscle-skin graft, head/neck
    15734Muscle-skin graft, trunk
    15736Muscle-skin graft, arm
    15738Muscle-skin graft, leg
    15740Island pedicle flap graft
    15750Neurovascular pedicle graft
    15760Composite skin graft
    15770Derma-fat-fascia graft
    15824Removal of forehead wrinkles
    15826Removal of brow wrinkles
    15828Removal of face wrinkles
    15831Excise excessive skin tissue
    15832Excise excessive skin tissue
    15833Excise excessive skin tissue
    15834Excise excessive skin tissue
    15836Excise excessive skin tissue
    15837Excise excessive skin tissue
    15839Excise excessive skin tissue
    15840Graft for face nerve palsy
    15841Graft for face nerve palsy
    15842Graft for face nerve palsy
    15845Skin and muscle repair, face
    15876Suction assisted lipectomy
    15877Suction assisted lipectomy
    15878Suction assisted lipectomy
    15879Suction assisted lipectomy
    15922Removal of tail bone ulcer
    15934Remove sacrum pressure sore
    15935Remove sacrum pressure sore
    15936Remove sacrum pressure sore
    15937Remove sacrum pressure sore
    15944Remove hip pressure sore
    15945Remove hip pressure sore
    15946Remove hip pressure sore
    15952Remove thigh pressure sore
    15953Remove thigh pressure sore
    15956Remove thigh pressure sore
    15958Remove thigh pressure sore
    0029Incision/Excision BreastT12.85$623.06$303.50$124.61
    19101Biopsy of breast
    19110Nipple exploration
    19112Excise breast duct fistula
    19120Removal of breast lesion
    19125Excision, breast lesion
    19126Excision, addl breast lesion
    Start Printed Page 18714
    19140Removal of breast tissue
    19290Place needle wire, breast
    19291Place needle wire, breast
    19396Design custom breast implant
    19499Breast surgery procedure
    0030Breast Reconstruction/MastectomyT20.19$978.95$523.95$195.79
    19160Removal of breast tissue
    19162Remove breast tissue, nodes
    19180Removal of breast
    19182Removal of breast
    19316Suspension of breast
    19318Reduction of large breast
    19324Enlarge breast
    19325Enlarge breast with implant
    19328Removal of breast implant
    19330Removal of implant material
    19340Immediate breast prosthesis
    19342Delayed breast prosthesis
    19350Breast reconstruction
    19355Correct inverted nipple(s)
    19357Breast reconstruction
    19366Breast reconstruction
    19370Surgery of breast capsule
    19371Removal of breast capsule
    19380Revise breast reconstruction
    0031Hyperbaric OxygenS3.00$145.46$140.85$29.09
    99183Hyperbaric oxygen therapy
    G0167Hyperbaric oz tx; no md reqrd
    0032Placement Transvenous Catheters/Arterial CutdownT5.40$261.83$119.52$52.37
    36420Establish access to vein
    36425Establish access to vein
    36488Insertion of catheter, vein
    36489Insertion of catheter, vein
    36490Insertion of catheter, vein
    36491Insertion of catheter, vein
    36493Repositioning of cvc
    36640Insertion catheter, artery
    0033Partial HospitalizationP4.17$202.19$48.17$40.44
    G0129Partial hosp prog service
    G0172Partial hosp prog service
    Q0082Activity therapy w/partial h
    0040Arthrocentesis & Ligament/Tendon InjectionT2.11$102.31$40.60$20.46
    20550Inject tendon/ligament/cyst
    20600Drain/inject, joint/bursa
    20605Drain/inject, joint/bursa
    20610Drain/inject, joint/bursa
    0041ArthroscopyT24.57$1,191.33$592.08$238.27
    29800Jaw arthroscopy/surgery
    29804Jaw arthroscopy/surgery
    29815Shoulder arthroscopy
    29819Shoulder arthroscopy/surgery
    29820Shoulder arthroscopy/surgery
    29821Shoulder arthroscopy/surgery
    29822Shoulder arthroscopy/surgery
    29823Shoulder arthroscopy/surgery
    29825Shoulder arthroscopy/surgery
    29826Shoulder arthroscopy/surgery
    29830Elbow arthroscopy
    29834Elbow arthroscopy/surgery
    29835Elbow arthroscopy/surgery
    29836Elbow arthroscopy/surgery
    29837Elbow arthroscopy/surgery
    29838Elbow arthroscopy/surgery
    29840Wrist arthroscopy
    29843Wrist arthroscopy/surgery
    29844Wrist arthroscopy/surgery
    29845Wrist arthroscopy/surgery
    29846Wrist arthroscopy/surgery
    29847Wrist arthroscopy/surgery
    29848Wrist endoscopy/surgery
    29860Hip arthroscopy, dx
    29861Hip arthroscopy/surgery
    29862Hip arthroscopy/surgery
    Start Printed Page 18715
    29863Hip arthroscopy/surgery
    29870Knee arthroscopy, dx
    29871Knee arthroscopy/drainage
    29874Knee arthroscopy/surgery
    29875Knee arthroscopy/surgery
    29876Knee arthroscopy/surgery
    29877Knee arthroscopy/surgery
    29879Knee arthroscopy/surgery
    29880Knee arthroscopy/surgery
    29881Knee arthroscopy/surgery
    29882Knee arthroscopy/surgery
    29883Knee arthroscopy/surgery
    29884Knee arthroscopy/surgery
    29886Knee arthroscopy/surgery
    29887Knee arthroscopy/surgery
    29891Ankle arthroscopy/surgery
    29894Ankle arthroscopy/surgery
    29895Ankle arthroscopy/surgery
    29897Ankle arthroscopy/surgery
    29898Ankle arthroscopy/surgery
    29909Arthroscopy of joint
    0042Arthroscopically-Aided ProceduresT29.22$1,416.79$804.74$283.36
    29850Knee arthroscopy/surgery
    29851Knee arthroscopy/surgery
    29855Tibial arthroscopy/surgery
    29856Tibial arthroscopy/surgery
    29885Knee arthroscopy/surgery
    29888Knee arthroscopy/surgery
    29889Knee arthroscopy/surgery
    29892Ankle arthroscopy/surgery
    0043Closed Treatment Fracture Finger/Toe/TrunkT1.64$79.52$25.46$15.90
    21800Treatment of rib fracture
    21820Treat sternum fracture
    22305Treat spine process fracture
    22310Treat spine fracture
    22315Treat spine fracture
    22899Spine surgery procedure
    23500Treat clavicle fracture
    23505Treat clavicle fracture
    23520Treat clavicle dislocation
    23525Treat clavicle dislocation
    23540Treat clavicle dislocation
    23545Treat clavicle dislocation
    23570Treat shoulder blade fx
    23575Treat shoulder blade fx
    23650Treat shoulder dislocation
    23929Shoulder surgery procedure
    26700Treat knuckle dislocation
    26720Treat finger fracture, each
    26725Treat finger fracture, each
    26740Treat finger fracture, each
    26750Treat finger fracture, each
    26755Treat finger fracture, each
    26770Treat finger dislocation
    26989Hand/finger surgery
    27200Treat tail bone fracture
    27299Pelvis/hip joint surgery
    28490Treat big toe fracture
    28495Treat big toe fracture
    28510Treatment of toe fracture
    28515Treatment of toe fracture
    28630Treat toe dislocation
    28660Treat toe dislocation
    28899Foot/toes surgery procedure
    0044Closed Treatment Fracture/Dislocation Except Finger/Toe/TrunkT2.17$105.22$38.08$21.04
    23600Treat humerus fracture
    23605Treat humerus fracture
    23620Treat humerus fracture
    23625Treat humerus fracture
    23665Treat dislocation/fracture
    23675Treat dislocation/fracture
    24500Treat humerus fracture
    24505Treat humerus fracture
    Start Printed Page 18716
    24530Treat humerus fracture
    24535Treat humerus fracture
    24560Treat humerus fracture
    24565Treat humerus fracture
    24576Treat humerus fracture
    24577Treat humerus fracture
    24600Treat elbow dislocation
    24620Treat elbow fracture
    24640Treat elbow dislocation
    24650Treat radius fracture
    24655Treat radius fracture
    24670Treat ulnar fracture
    24675Treat ulnar fracture
    24999Upper arm/elbow surgery
    25500Treat fracture of radius
    25505Treat fracture of radius
    25520Treat fracture of radius
    25530Treat fracture of ulna
    25535Treat fracture of ulna
    25560Treat fracture radius & ulna
    25565Treat fracture radius & ulna
    25600Treat fracture radius/ulna
    25605Treat fracture radius/ulna
    25622Treat wrist bone fracture
    25624Treat wrist bone fracture
    25630Treat wrist bone fracture
    25635Treat wrist bone fracture
    25650Treat wrist bone fracture
    25660Treat wrist dislocation
    25675Treat wrist dislocation
    25680Treat wrist fracture
    25690Treat wrist dislocation
    25999Forearm or wrist surgery
    26600Treat metacarpal fracture
    26605Treat metacarpal fracture
    26607Treat metacarpal fracture
    26641Treat thumb dislocation
    26645Treat thumb fracture
    26670Treat hand dislocation
    26706Pin knuckle dislocation
    26742Treat finger fracture, each
    27193Treat pelvic ring fracture
    27220Treat hip socket fracture
    27230Treat thigh fracture
    27238Treat thigh fracture
    27246Treat thigh fracture
    27250Treat hip dislocation
    27256Treat hip dislocation
    27265Treat hip dislocation
    27500Treatment of thigh fracture
    27501Treatment of thigh fracture
    27502Treatment of thigh fracture
    27503Treatment of thigh fracture
    27508Treatment of thigh fracture
    27510Treatment of thigh fracture
    27516Treat thigh fx growth plate
    27517Treat thigh fx growth plate
    27520Treat kneecap fracture
    27530Treat knee fracture
    27532Treat knee fracture
    27538Treat knee fracture(s)
    27550Treat knee dislocation
    27560Treat kneecap dislocation
    27599Leg surgery procedure
    27750Treatment of tibia fracture
    27752Treatment of tibia fracture
    27760Treatment of ankle fracture
    27762Treatment of ankle fracture
    27780Treatment of fibula fracture
    27781Treatment of fibula fracture
    27786Treatment of ankle fracture
    27788Treatment of ankle fracture
    27808Treatment of ankle fracture
    Start Printed Page 18717
    27810Treatment of ankle fracture
    27816Treatment of ankle fracture
    27818Treatment of ankle fracture
    27824Treat lower leg fracture
    27825Treat lower leg fracture
    27830Treat lower leg dislocation
    27840Treat ankle dislocation
    27899Leg/ankle surgery procedure
    28400Treatment of heel fracture
    28405Treatment of heel fracture
    28430Treatment of ankle fracture
    28435Treatment of ankle fracture
    28450Treat midfoot fracture, each
    28455Treat midfoot fracture, each
    28470Treat metatarsal fracture
    28475Treat metatarsal fracture
    28530Treat sesamoid bone fracture
    28540Treat foot dislocation
    28570Treat foot dislocation
    28600Treat foot dislocation
    0045Bone/Joint Manipulation Under AnesthesiaT11.02$534.33$277.12$106.87
    22505Manipulation of spine
    23655Treat shoulder dislocation
    23700Fixation of shoulder
    24605Treat elbow dislocation
    26675Treat hand dislocation
    26705Treat knuckle dislocation
    26775Treat finger dislocation
    27194Treat pelvic ring fracture
    27252Treat hip dislocation
    27257Treat hip dislocation
    27275Manipulation of hip joint
    27552Treat knee dislocation
    27562Treat kneecap dislocation
    27570Fixation of knee joint
    27831Treat lower leg dislocation
    27842Treat ankle dislocation
    27860Fixation of ankle joint
    28545Treat foot dislocation
    28575Treat foot dislocation
    28605Treat foot dislocation
    28635Treat toe dislocation
    28665Treat toe dislocation
    0046Open/Percutaneous Treatment Fracture or DislocationT22.29$1,080.78$535.76$216.16
    21336Treat nasal septal fracture
    21805Treatment of rib fracture
    23515Treat clavicle fracture
    23530Treat clavicle dislocation
    23532Treat clavicle dislocation
    23550Treat clavicle dislocation
    23552Treat clavicle dislocation
    23585Treat scapula fracture
    23615Treat humerus fracture
    23616Treat humerus fracture
    23630Treat humerus fracture
    23660Treat shoulder dislocation
    23670Treat dislocation/fracture
    23680Treat dislocation/fracture
    24515Treat humerus fracture
    24516Treat humerus fracture
    24538Treat humerus fracture
    24545Treat humerus fracture
    24546Treat humerus fracture
    24566Treat humerus fracture
    24575Treat humerus fracture
    24579Treat humerus fracture
    24582Treat humerus fracture
    24586Treat elbow fracture
    24587Treat elbow fracture
    24615Treat elbow dislocation
    24635Treat elbow fracture
    24665Treat radius fracture
    24666Treat radius fracture
    Start Printed Page 18718
    24685Treat ulnar fracture
    25515Treat fracture of radius
    25525Treat fracture of radius
    25526Treat fracture of radius
    25545Treat fracture of ulna
    25574Treat fracture radius & ulna
    25575Treat fracture radius/ulna
    25611Treat fracture radius/ulna
    25620Treat fracture radius/ulna
    25628Treat wrist bone fracture
    25645Treat wrist bone fracture
    25670Treat wrist dislocation
    25676Treat wrist dislocation
    25685Treat wrist fracture
    25695Treat wrist dislocation
    26608Treat metacarpal fracture
    26615Treat metacarpal fracture
    26650Treat thumb fracture
    26665Treat thumb fracture
    26676Pin hand dislocation
    26685Treat hand dislocation
    26686Treat hand dislocation
    26715Treat knuckle dislocation
    26727Treat finger fracture, each
    26735Treat finger fracture, each
    26746Treat finger fracture, each
    26756Pin finger fracture, each
    26765Treat finger fracture, each
    26776Pin finger dislocation
    26785Treat finger dislocation
    27202Treat tail bone fracture
    27509Treatment of thigh fracture
    27556Treat knee dislocation
    27566Treat kneecap dislocation
    27615Remove tumor, lower leg
    27756Treatment of tibia fracture
    27758Treatment of tibia fracture
    27759Treatment of tibia fracture
    27766Treatment of ankle fracture
    27784Treatment of fibula fracture
    27792Treatment of ankle fracture
    27814Treatment of ankle fracture
    27822Treatment of ankle fracture
    27823Treatment of ankle fracture
    27826Treat lower leg fracture
    27827Treat lower leg fracture
    27828Treat lower leg fracture
    27829Treat lower leg joint
    27832Treat lower leg dislocation
    27846Treat ankle dislocation
    27848Treat ankle dislocation
    28406Treatment of heel fracture
    28415Treat heel fracture
    28420Treat/graft heel fracture
    28436Treatment of ankle fracture
    28445Treat ankle fracture
    28456Treat midfoot fracture
    28465Treat midfoot fracture, each
    28476Treat metatarsal fracture
    28485Treat metatarsal fracture
    28496Treat big toe fracture
    28505Treat big toe fracture
    28525Treat toe fracture
    28531Treat sesamoid bone fracture
    28546Treat foot dislocation
    28555Repair foot dislocation
    28576Treat foot dislocation
    28585Repair foot dislocation
    28606Treat foot dislocation
    28615Repair foot dislocation
    28636Treat toe dislocation
    28645Repair toe dislocation
    28666Treat toe dislocation
    Start Printed Page 18719
    28675Repair of toe dislocation
    0047Arthroplasty without ProsthesisT22.09$1,071.08$537.03$214.22
    24360Reconstruct elbow joint
    24365Reconstruct head of radius
    25332Revise wrist joint
    25447Repair wrist joint(s)
    25449Remove wrist joint implant
    26530Revise knuckle joint
    26535Revise finger joint
    27266Treat hip dislocation
    27437Revise kneecap
    27440Revision of knee joint
    27441Revision of knee joint
    27442Revision of knee joint
    27443Revision of knee joint
    27700Revision of ankle joint
    0048Arthroplasty with ProsthesisT29.06$1,409.03$725.94$281.81
    24361Reconstruct elbow joint
    24362Reconstruct elbow joint
    24363Replace elbow joint
    24366Reconstruct head of radius
    25441Reconstruct wrist joint
    25442Reconstruct wrist joint
    25443Reconstruct wrist joint
    25444Reconstruct wrist joint
    25445Reconstruct wrist joint
    25446Wrist replacement
    26531Revise knuckle with implant
    26536Revise/implant finger joint
    27438Revise kneecap with implant
    0049Level I Musculoskeletal Procedures Except Hand and FootT15.04$729.25$356.95$145.85
    20005Incision of deep abscess
    20250Open bone biopsy
    20251Open bone biopsy
    20650Insert and remove bone pin
    20693Adjust bone fixation device
    20694Remove bone fixation device
    20975Electrical bone stimulation
    20979Us bone stimulation
    23100Biopsy of shoulder joint
    23140Removal of bone lesion
    23935Drain arm/elbow bone lesion
    24100Biopsy elbow joint lining
    24105Removal of elbow bursa
    24110Remove humerus lesion
    24120Remove elbow lesion
    24310Revision of arm tendon
    24925Amputation follow-up surgery
    25000Incision of tendon sheath
    25020Decompression of forearm
    25028Drainage of forearm lesion
    25031Drainage of forearm bursa
    25035Treat forearm bone lesion
    25085Incision of wrist capsule
    25100Biopsy of wrist joint
    25110Remove wrist tendon lesion
    25115Remove wrist/forearm lesion
    25116Remove wrist/forearm lesion
    25248Remove forearm foreign body
    25295Release wrist/forearm tendon
    25907Amputation follow-up surgery
    25922Amputate hand at wrist
    26990Drainage of pelvis lesion
    26991Drainage of pelvis bursa
    27000Incision of hip tendon
    27050Biopsy of sacroiliac joint
    27052Biopsy of hip joint
    27060Removal of ischial bursa
    27062Remove femur lesion/bursa
    27065Removal of hip bone lesion
    27087Remove hip foreign body
    27305Incise thigh tendon & fascia
    27306Incision of thigh tendon
    Start Printed Page 18720
    27307Incision of thigh tendons
    27340Removal of kneecap bursa
    27345Removal of knee cyst
    27347Remove knee cyst
    27380Repair of kneecap tendon
    27381Repair/graft kneecap tendon
    27385Repair of thigh muscle
    27386Repair/graft of thigh muscle
    27390Incision of thigh tendon
    27391Incision of thigh tendons
    27392Incision of thigh tendons
    27496Decompression of thigh/knee
    27497Decompression of thigh/knee
    27498Decompression of thigh/knee
    27499Decompression of thigh/knee
    27594Amputation follow-up surgery
    27600Decompression of lower leg
    27601Decompression of lower leg
    27602Decompression of lower leg
    27604Drain lower leg bursa
    27606Incision of achilles tendon
    27607Treat lower leg bone lesion
    27630Removal of tendon lesion
    27656Repair leg fascia defect
    27658Repair of leg tendon, each
    27659Repair of leg tendon, each
    27664Repair of leg tendon, each
    27675Repair lower leg tendons
    27704Removal of ankle implant
    27707Incision of fibula
    27884Amputation follow-up surgery
    27892Decompression of leg
    27893Decompression of leg
    27894Decompression of leg
    28002Treatment of foot infection
    28003Treatment of foot infection
    0050Level II Musculoskeletal Procedures Except Hand and FootT21.13$1,024.53$513.86$204.91
    20690Apply bone fixation device
    20692Apply bone fixation device
    20900Removal of bone for graft
    20902Removal of bone for graft
    20924Removal of tendon for graft
    21502Drain chest lesion
    21600Partial removal of rib
    21610Partial removal of rib
    23040Exploratory shoulder surgery
    23044Exploratory shoulder surgery
    23101Shoulder joint surgery
    23105Remove shoulder joint lining
    23106Incision of collarbone joint
    23107Explore treat shoulder joint
    23145Removal of bone lesion
    23146Removal of bone lesion
    23150Removal of humerus lesion
    23155Removal of humerus lesion
    23156Removal of humerus lesion
    23170Remove collar bone lesion
    23172Remove shoulder blade lesion
    23174Remove humerus lesion
    23180Remove collar bone lesion
    23182Remove shoulder blade lesion
    23184Remove humerus lesion
    23190Partial removal of scapula
    23405Incision of tendon & muscle
    23406Incise tendon(s) & muscle(s)
    24000Exploratory elbow surgery
    24006Release elbow joint
    24101Explore/treat elbow joint
    24102Remove elbow joint lining
    24115Remove/graft bone lesion
    24116Remove/graft bone lesion
    24125Remove/graft bone lesion
    24126Remove/graft bone lesion
    Start Printed Page 18721
    24130Removal of head of radius
    24134Removal of arm bone lesion
    24136Remove radius bone lesion
    24138Remove elbow bone lesion
    24140Partial removal of arm bone
    24145Partial removal of radius
    24147Partial removal of elbow
    24160Remove elbow joint implant
    24164Remove radius head implant
    24301Muscle/tendon transfer
    24305Arm tendon lengthening
    24350Repair of tennis elbow
    24351Repair of tennis elbow
    24352Repair of tennis elbow
    24354Repair of tennis elbow
    24356Revision of tennis elbow
    24400Revision of humerus
    24410Revision of humerus
    24495Decompression of forearm
    25023Decompression of forearm
    25040Explore/treat wrist joint
    25101Explore/treat wrist joint
    25105Remove wrist joint lining
    25107Remove wrist joint cartilage
    25118Excise wrist tendon sheath
    25119Partial removal of ulna
    25120Removal of forearm lesion
    25125Remove/graft forearm lesion
    25126Remove/graft forearm lesion
    25130Removal of wrist lesion
    25135Remove & graft wrist lesion
    25136Remove & graft wrist lesion
    25145Remove forearm bone lesion
    25150Partial removal of ulna
    25151Partial removal of radius
    25230Partial removal of radius
    25240Partial removal of ulna
    25250Removal of wrist prosthesis
    25251Removal of wrist prosthesis
    25260Repair forearm tendon/muscle
    25263Repair forearm tendon/muscle
    25265Repair forearm tendon/muscle
    25270Repair forearm tendon/muscle
    25272Repair forearm tendon/muscle
    25274Repair forearm tendon/muscle
    25280Revise wrist/forearm tendon
    25290Incise wrist/forearm tendon
    25300Fusion of tendons at wrist
    25301Fusion of tendons at wrist
    25360Revision of ulna
    25365Revise radius & ulna
    25400Repair radius or ulna
    25415Repair radius & ulna
    27001Incision of hip tendon
    27003Incision of hip tendon
    27066Removal of hip bone lesion
    27067Remove/graft hip bone lesion
    27080Removal of tail bone
    27097Revision of hip tendon
    27098Transfer tendon to pelvis
    27310Exploration of knee joint
    27330Biopsy, knee joint lining
    27331Explore/treat knee joint
    27332Removal of knee cartilage
    27333Removal of knee cartilage
    27334Remove knee joint lining
    27335Remove knee joint lining
    27350Removal of kneecap
    27355Remove femur lesion
    27356Remove femur lesion/graft
    27357Remove femur lesion/graft
    27358Remove femur lesion/fixation
    27360Partial removal, leg bone(s)
    Start Printed Page 18722
    27393Lengthening of thigh tendon
    27394Lengthening of thigh tendons
    27396Transplant of thigh tendon
    27403Repair of knee cartilage
    27425Lateral retinacular release
    27610Explore/treat ankle joint
    27612Exploration of ankle joint
    27620Explore/treat ankle joint
    27625Remove ankle joint lining
    27626Remove ankle joint lining
    27635Remove lower leg bone lesion
    27637Remove/graft leg bone lesion
    27638Remove/graft leg bone lesion
    27641Partial removal of fibula
    27665Repair of leg tendon, each
    27676Repair lower leg tendons
    27680Release of lower leg tendon
    27681Release of lower leg tendons
    27685Revision of lower leg tendon
    27686Revise lower leg tendons
    27687Revision of calf tendon
    27695Repair of ankle ligament
    27696Repair of ankle ligaments
    27698Repair of ankle ligament
    27709Incision of tibia & fibula
    27730Repair of tibia epiphysis
    27732Repair of fibula epiphysis
    27734Repair lower leg epiphyses
    27740Repair of leg epiphyses
    27889Amputation of foot at ankle
    0051Level III Musculoskeletal Procedures Except Hand and FootT27.76$1,346.00$675.24$269.20
    20150Excise epiphyseal bar
    23020Release shoulder joint
    23120Partial removal, collar bone
    23130Remove shoulder bone, part
    23415Release of shoulder ligament
    23480Revision of collar bone
    23485Revision of collar bone
    23490Reinforce clavicle
    23491Reinforce shoulder bones
    23800Fusion of shoulder joint
    23802Fusion of shoulder joint
    24155Removal of elbow joint
    24320Repair of arm tendon
    24330Revision of arm muscles
    24331Revision of arm muscles
    24340Repair of biceps tendon
    24341Repair arm tendon/muscle
    24342Repair of ruptured tendon
    24420Revision of humerus
    24430Repair of humerus
    24435Repair humerus with graft
    24470Revision of elbow joint
    24498Reinforce humerus
    24800Fusion of elbow joint
    24802Fusion/graft of elbow joint
    25310Transplant forearm tendon
    25312Transplant forearm tendon
    25315Revise palsy hand tendon(s)
    25316Revise palsy hand tendon(s)
    25320Repair/revise wrist joint
    25335Realignment of hand
    25337Reconstruct ulna/radioulnar
    25350Revision of radius
    25355Revision of radius
    25370Revise radius or ulna
    25375Revise radius & ulna
    25425Repair/graft radius or ulna
    25426Repair/graft radius & ulna
    25440Repair/graft wrist bone
    25450Revision of wrist joint
    25455Revision of wrist joint
    25490Reinforce radius
    Start Printed Page 18723
    25491Reinforce ulna
    25492Reinforce radius and ulna
    25800Fusion of wrist joint
    25805Fusion/graft of wrist joint
    25810Fusion/graft of wrist joint
    25830Fusion, radioulnar jnt/ulna
    27033Exploration of hip joint
    27100Transfer of abdominal muscle
    27105Transfer of spinal muscle
    27110Transfer of iliopsoas muscle
    27111Transfer of iliopsoas muscle
    27395Lengthening of thigh tendons
    27397Transplants of thigh tendons
    27400Revise thigh muscles/tendons
    27405Repair of knee ligament
    27407Repair of knee ligament
    27409Repair of knee ligaments
    27418Repair degenerated kneecap
    27420Revision of unstable kneecap
    27422Revision of unstable kneecap
    27424Revision/removal of kneecap
    27430Revision of thigh muscles
    27435Incision of knee joint
    27640Partial removal of tibia
    27647Extensive ankle/heel surgery
    27650Repair achilles tendon
    27652Repair/graft achilles tendon
    27654Repair of achilles tendon
    27690Revise lower leg tendon
    27691Revise lower leg tendon
    27692Revise additional leg tendon
    27705Incision of tibia
    27742Repair of leg epiphyses
    27745Reinforce tibia
    27870Fusion of ankle joint
    27871Fusion of tibiofibular joint
    0052Level IV Musculoskeletal Procedures Except Hand and FootT36.16$1,753.29$930.91$350.66
    23410Repair of tendon(s)
    23412Repair of tendon(s)
    23420Repair of shoulder
    23430Repair biceps tendon
    23450Repair shoulder capsule
    23455Repair shoulder capsule
    23460Repair shoulder capsule
    23462Repair shoulder capsule
    23465Repair shoulder capsule
    23466Repair shoulder capsule
    24935Revision of amputation
    27427Reconstruction, knee
    27428Reconstruction, knee
    27429Reconstruction, knee
    0053Level I Hand Musculoskeletal ProceduresT11.32$548.87$253.49$109.77
    25111Remove wrist tendon lesion
    25112Reremove wrist tendon lesion
    25820Fusion of hand bones
    26020Drain hand tendon sheath
    26025Drainage of palm bursa
    26030Drainage of palm bursa(s)
    26034Treat hand bone lesion
    26035Decompress fingers/hand
    26037Decompress fingers/hand
    26055Incise finger tendon sheath
    26060Incision of finger tendon
    26070Explore/treat hand joint
    26075Explore/treat finger joint
    26080Explore/treat finger joint
    26100Biopsy hand joint lining
    26105Biopsy finger joint lining
    26110Biopsy finger joint lining
    26130Remove wrist joint lining
    26140Revise finger joint, each
    26145Tendon excision, palm/finger
    26160Remove tendon sheath lesion
    Start Printed Page 18724
    26170Removal of palm tendon, each
    26180Removal of finger tendon
    26185Remove finger bone
    26200Remove hand bone lesion
    26210Removal of finger lesion
    26215Remove/graft finger lesion
    26230Partial removal of hand bone
    26235Partial removal, finger bone
    26236Partial removal, finger bone
    26250Extensive hand surgery
    26260Extensive finger surgery
    26261Extensive finger surgery
    26262Partial removal of finger
    26410Repair hand tendon
    26418Repair finger tendon
    26432Repair finger tendon
    26433Repair finger tendon
    26437Realignment of tendons
    26440Release palm/finger tendon
    26445Release hand/finger tendon
    26450Incision of palm tendon
    26455Incision of finger tendon
    26460Incise hand/finger tendon
    26471Fusion of finger tendons
    26474Fusion of finger tendons
    26476Tendon lengthening
    26477Tendon shortening
    26478Lengthening of hand tendon
    26479Shortening of hand tendon
    26500Hand tendon reconstruction
    26508Release thumb contracture
    26520Release knuckle contracture
    26525Release finger contracture
    26540Repair hand joint
    26542Repair hand joint with graft
    26560Repair of web finger
    26587Reconstruct extra finger
    26593Release muscles of hand
    26951Amputation of finger/thumb
    26952Amputation of finger/thumb
    0054Level II Hand Musculoskeletal ProceduresT19.66$953.26$472.33$190.65
    25210Removal of wrist bone
    25215Removal of wrist bones
    25825Fuse hand bones with graft
    26040Release palm contracture
    26045Release palm contracture
    26121Release palm contracture
    26123Release palm contracture
    26125Release palm contracture
    26135Revise finger joint, each
    26205Remove/graft bone lesion
    26255Extensive hand surgery
    26350Repair finger/hand tendon
    26352Repair/graft hand tendon
    26356Repair finger/hand tendon
    26357Repair finger/hand tendon
    26358Repair/graft hand tendon
    26370Repair finger/hand tendon
    26372Repair/graft hand tendon
    26373Repair finger/hand tendon
    26390Revise hand/finger tendon
    26392Repair/graft hand tendon
    26412Repair/graft hand tendon
    26415Excision, hand/finger tendon
    26416Graft hand or finger tendon
    26420Repair/graft finger tendon
    26426Repair finger/hand tendon
    26428Repair/graft finger tendon
    26434Repair/graft finger tendon
    26442Release palm & finger tendon
    26449Release forearm/hand tendon
    26480Transplant hand tendon
    26483Transplant/graft hand tendon
    Start Printed Page 18725
    26485Transplant palm tendon
    26489Transplant/graft palm tendon
    26490Revise thumb tendon
    26492Tendon transfer with graft
    26494Hand tendon/muscle transfer
    26496Revise thumb tendon
    26497Finger tendon transfer
    26498Finger tendon transfer
    26499Revision of finger
    26502Hand tendon reconstruction
    26504Hand tendon reconstruction
    26510Thumb tendon transfer
    26516Fusion of knuckle joint
    26517Fusion of knuckle joints
    26518Fusion of knuckle joints
    26541Repair hand joint with graft
    26545Reconstruct finger joint
    26546Repair nonunion hand
    26548Reconstruct finger joint
    26550Construct thumb replacement
    26555Positional change of finger
    26561Repair of web finger
    26562Repair of web finger
    26565Correct metacarpal flaw
    26567Correct finger deformity
    26568Lengthen metacarpal/finger
    26580Repair hand deformity
    26585Repair finger deformity
    26590Repair finger deformity
    26591Repair muscles of hand
    26596Excision constricting tissue
    26597Release of scar contracture
    26820Thumb fusion with graft
    26841Fusion of thumb
    26842Thumb fusion with graft
    26843Fusion of hand joint
    26844Fusion/graft of hand joint
    26850Fusion of knuckle
    26852Fusion of knuckle with graft
    26860Fusion of finger joint
    26861Fusion of finger jnt, add-on
    26862Fusion/graft of finger joint
    26863Fuse/graft added joint
    26910Amputate metacarpal bone
    0055Level I Foot Musculoskeletal ProceduresT15.47$750.10$355.34$150.02
    27605Incision of achilles tendon
    28005Treat foot bone lesion
    28008Incision of foot fascia
    28010Incision of toe tendon
    28011Incision of toe tendons
    28020Exploration of foot joint
    28022Exploration of foot joint
    28024Exploration of toe joint
    28045Excision of foot lesion
    28046Resection of tumor, foot
    28050Biopsy of foot joint lining
    28052Biopsy of foot joint lining
    28054Biopsy of toe joint lining
    28080Removal of foot lesion
    28086Excise foot tendon sheath
    28088Excise foot tendon sheath
    28090Removal of foot lesion
    28092Removal of toe lesions
    28100Removal of ankle/heel lesion
    28104Removal of foot lesion
    28108Removal of toe lesions
    28111Part removal of metatarsal
    28112Part removal of metatarsal
    28113Part removal of metatarsal
    28114Removal of metatarsal heads
    28116Revision of foot
    28118Removal of heel bone
    28119Removal of heel spur
    Start Printed Page 18726
    28120Part removal of ankle/heel
    28122Partial removal of foot bone
    28124Partial removal of toe
    28126Partial removal of toe
    28130Removal of ankle bone
    28140Removal of metatarsal
    28150Removal of toe
    28153Partial removal of toe
    28160Partial removal of toe
    28171Extensive foot surgery
    28173Extensive foot surgery
    28175Extensive foot surgery
    28200Repair of foot tendon
    28208Repair of foot tendon
    28210Repair/graft of foot tendon
    28220Release of foot tendon
    28222Release of foot tendons
    28225Release of foot tendon
    28226Release of foot tendons
    28230Incision of foot tendon(s)
    28232Incision of toe tendon
    28234Incision of foot tendon
    28240Release of big toe
    28270Release of foot contracture
    28272Release of toe joint, each
    28280Fusion of toes
    28285Repair of hammertoe
    28286Repair of hammertoe
    28310Revision of big toe
    28312Revision of toe
    28313Repair deformity of toe
    28315Removal of sesamoid bone
    28340Resect enlarged toe tissue
    28341Resect enlarged toe
    28737Revision of foot bones
    28750Fusion of big toe joint
    28755Fusion of big toe joint
    28810Amputation toe & metatarsal
    28820Amputation of toe
    28825Partial amputation of toe
    29893Scope, plantar fasciotomy
    0056Level II Foot Musculoskeletal ProceduresT17.30$838.83$405.81$167.77
    28060Partial removal, foot fascia
    28062Removal of foot fascia
    28070Removal of foot joint lining
    28072Removal of foot joint lining
    28102Remove/graft foot lesion
    28103Remove/graft foot lesion
    28106Remove/graft foot lesion
    28107Remove/graft foot lesion
    28202Repair/graft of foot tendon
    28238Revision of foot tendon
    28250Revision of foot fascia
    28260Release of midfoot joint
    28261Revision of foot tendon
    28262Revision of foot and ankle
    28264Release of midfoot joint
    28288Partial removal of foot bone
    28289Repair hallux rigidus
    28300Incision of heel bone
    28302Incision of ankle bone
    28304Incision of midfoot bones
    28305Incise/graft midfoot bones
    28306Incision of metatarsal
    28307Incision of metatarsal
    28308Incision of metatarsal
    28309Incision of metatarsals
    28320Repair of foot bones
    28322Repair of metatarsals
    28344Repair extra toe(s)
    28345Repair webbed toe(s)
    28360Reconstruct cleft foot
    28705Fusion of foot bones
    Start Printed Page 18727
    28715Fusion of foot bones
    28725Fusion of foot bones
    28730Fusion of foot bones
    28735Fusion of foot bones
    28740Fusion of foot bones
    28760Fusion of big toe joint
    0057Bunion ProceduresT21.00$1,018.23$496.65$203.65
    28110Part removal of metatarsal
    28290Correction of bunion
    28292Correction of bunion
    28293Correction of bunion
    28294Correction of bunion
    28296Correction of bunion
    28297Correction of bunion
    28298Correction of bunion
    28299Correction of bunion
    0058Level I Strapping and Cast ApplicationS1.09$52.85$19.27$10.57
    29505Application, long leg splint
    29515Application lower leg splint
    29520Strapping of hip
    29530Strapping of knee
    29540Strapping of ankle
    29550Strapping of toes
    29580Application of paste boot
    29590Application of foot splint
    29700Removal/revision of cast
    29705Removal/revision of cast
    29710Removal/revision of cast
    29715Removal/revision of cast
    29720Repair of body cast
    29730Windowing of cast
    29740Wedging of cast
    29750Wedging of clubfoot cast
    29799Casting/strapping procedure
    0059Level II Strapping and Cast ApplicationS1.74$84.37$29.59$16.87
    29000Application of body cast
    29010Application of body cast
    29015Application of body cast
    29020Application of body cast
    29025Application of body cast
    29035Application of body cast
    29040Application of body cast
    29044Application of body cast
    29046Application of body cast
    29049Application of figure eight
    29055Application of shoulder cast
    29058Application of shoulder cast
    29065Application of long arm cast
    29075Application of forearm cast
    29085Apply hand/wrist cast
    29105Apply long arm splint
    29125Apply forearm splint
    29126Apply forearm splint
    29130Application of finger splint
    29131Application of finger splint
    29200Strapping of chest
    29220Strapping of low back
    29240Strapping of shoulder
    29260Strapping of elbow or wrist
    29280Strapping of hand or finger
    29305Application of hip cast
    29325Application of hip casts
    29345Application of long leg cast
    29355Application of long leg cast
    29358Apply long leg cast brace
    29365Application of long leg cast
    29405Apply short leg cast
    29425Apply short leg cast
    29435Apply short leg cast
    29440Addition of walker to cast
    29445Apply rigid leg cast
    29450Application of leg cast
    0060Manipulation TherapyS0.77$37.34$7.80$7.47
    Start Printed Page 18728
    98925Osteopathic manipulation
    98926Osteopathic manipulation
    98927Osteopathic manipulation
    98928Osteopathic manipulation
    98929Osteopathic manipulation
    98940Chiropractic manipulation
    98941Chiropractic manipulation
    98942Chiropractic manipulation
    0070Thoracentesis/Lavage ProceduresT3.64$176.49$79.60$35.30
    32000Drainage of chest
    32002Treatment of collapsed lung
    32005Treat lung lining chemically
    32020Insertion of chest tube
    32420Puncture/clear lung
    32960Therapeutic pneumothorax
    32999Chest surgery procedure
    33010Drainage of heart sac
    33011Repeat drainage of heart sac
    33999Cardiac surgery procedure
    49080Puncture, peritoneal cavity
    49081Removal of abdominal fluid
    0071Level I Endoscopy Upper AirwayT0.55$26.67$14.22$5.33
    31231Nasal endoscopy, dx
    31575Diagnostic laryngoscopy
    92511Nasopharyngoscopy
    0072Level II Endoscopy Upper AirwayT1.26$61.09$41.52$12.22
    31233Nasal/sinus endoscopy, dx
    31505Diagnostic laryngoscopy
    31511Remove foreign body, larynx
    31520Diagnostic laryngoscopy
    31700Insertion of airway catheter
    31720Clearance of airways
    0073Level III Endoscopy Upper AirwayT4.11$199.28$91.07$39.86
    31513Injection into vocal cord
    31577Remove foreign body, larynx
    31579Diagnostic laryngoscopy
    31717Bronchial brush biopsy
    31730Intro, windpipe wire/tube
    0074Level IV Endoscopy Upper AirwayT13.61$659.91$347.54$131.98
    31235Nasal/sinus endoscopy, dx
    31237Nasal/sinus endoscopy, surg
    31238Nasal/sinus endoscopy, surg
    31240Nasal/sinus endoscopy, surg
    31510Laryngoscopy with biopsy
    31512Removal of larynx lesion
    31515Laryngoscopy for aspiration
    31525Diagnostic laryngoscopy
    31526Diagnostic laryngoscopy
    31528Laryngoscopy and dilatation
    31529Laryngoscopy and dilatation
    31576Laryngoscopy with biopsy
    31578Removal of larynx lesion
    0075Level V Endoscopy Upper AirwayT18.55$899.44$467.29$179.89
    31239Nasal/sinus endoscopy, surg
    31254Revision of ethmoid sinus
    31255Removal of ethmoid sinus
    31256Exploration maxillary sinus
    31267Endoscopy, maxillary sinus
    31276Sinus endoscopy, surgical
    31287Nasal/sinus endoscopy, surg
    31288Nasal/sinus endoscopy, surg
    31527Laryngoscopy for treatment
    31530Operative laryngoscopy
    31531Operative laryngoscopy
    31535Operative laryngoscopy
    31536Operative laryngoscopy
    31540Operative laryngoscopy
    31541Operative laryngoscopy
    31560Operative laryngoscopy
    31561Operative laryngoscopy
    31570Laryngoscopy with injection
    31571Laryngoscopy with injection
    96570Photodynamic tx, 30 min
    Start Printed Page 18729
    96571Photodynamic tx, addl 15 min
    0076Endoscopy Lower AirwayT8.06$390.81$197.05$78.16
    31615Visualization of windpipe
    31622Dx bronchoscope/wash
    31623Dx bronchoscope/brush
    31624Dx bronchoscope/lavage
    31625Bronchoscopy with biopsy
    31628Bronchoscopy with biopsy
    31629Bronchoscopy with biopsy
    31630Bronchoscopy with repair
    31631Bronchoscopy with dilation
    31635Remove foreign body, airway
    31640Bronchoscopy & remove lesion
    31641Bronchoscopy, treat blockage
    31643Diag bronchoscope/catheter
    31645Bronchoscopy, clear airways
    31646Bronchoscopy, reclear airway
    31656Bronchoscopy, inj for x-ray
    31899Airways surgical procedure
    32601Thoracoscopy, diagnostic
    32602Thoracoscopy, diagnostic
    32603Thoracoscopy, diagnostic
    32604Thoracoscopy, diagnostic
    32605Thoracoscopy, diagnostic
    32606Thoracoscopy, diagnostic
    39400Visualization of chest
    0077Level I Pulmonary TreatmentS0.43$20.85$12.62$4.17
    94640Airway inhalation treatment
    94650Pressure breathing (IPPB)
    94651Pressure breathing (IPPB)
    94664Aerosol or vapor inhalations
    94665Aerosol or vapor inhalations
    94667Chest wall manipulation
    94668Chest wall manipulation
    0078Level II Pulmonary TreatmentS1.34$64.97$29.13$12.99
    94642Aerosol inhalation treatment
    0079Ventilation Initiation and ManagementS3.18$154.19$107.70$30.84
    94656Initial ventilator mgmt
    94657Continued ventilator mgmt
    94660Pos airway pressure, CPAP
    94662Neg press ventilation, cnp
    0080Diagnostic Cardiac CatheterizationT25.77$1,249.51$713.89$249.90
    93501Right heart catheterization
    93503Insert/place heart catheter
    93505Biopsy of heart lining
    93510Left heart catheterization
    93511Left heart catheterization
    93514Left heart catheterization
    93524Left heart catheterization
    93526Rt & Lt heart catheters
    93527Rt & Lt heart catheters
    93528Rt & Lt heart catheters
    93529Rt, Lt heart catheterization
    93530Rt heart cath, congenital
    93531R & l heart cath, congenital
    93532R & l heart cath, congenital
    93533R & l heart cath, congenital
    93536Insert circulation assi
    0081Non-Coronary Angioplasty or AtherectomyT19.36$938.71$434.25$187.74
    35180Repair blood vessel lesion
    35184Repair blood vessel lesion
    35190Repair blood vessel lesion
    35201Repair blood vessel lesion
    35206Repair blood vessel lesion
    35226Repair blood vessel lesion
    35231Repair blood vessel lesion
    35236Repair blood vessel lesion
    35256Repair blood vessel lesion
    35261Repair blood vessel lesion
    35266Repair blood vessel lesion
    35286Repair blood vessel lesion
    35321Rechanneling of artery
    35459Repair arterial blockage
    Start Printed Page 18730
    35460Repair venous blockage
    35470Repair arterial blockage
    35471Repair arterial blockage
    35472Repair arterial blockage
    35473Repair arterial blockage
    35474Repair arterial blockage
    35475Repair arterial blockage
    35476Repair venous blockage
    35484Atherectomy, open
    35485Atherectomy, open
    35490Atherectomy, percutaneous
    35491Atherectomy, percutaneous
    35492Atherectomy, percutaneous
    35493Atherectomy, percutaneous
    35494Atherectomy, percutaneous
    35495Atherectomy, percutaneous
    35500Harvest vein for bypass
    37204Transcatheter occlusion
    37205Transcatheter stent
    37206Transcatheter stent add-on
    37207Transcatheter stent
    37208Transcatheter stent add-on
    37209Exchange arterial catheter
    37250Iv us first vessel add-on
    37251Iv us each add vessel add-on
    37565Ligation of neck vein
    37600Ligation of neck artery
    0082Coronary AtherectomyT40.34$1,955.97$859.56$391.19
    92995Coronary atherectomy
    92996Coronary atherectomy add-on
    0083Coronary AngiosplastyT45.79$2,220.22$1,322.95$444.04
    92980Insert intracoronary stent
    92981Insert intracoronary stent
    92982Coronary artery dilation
    92984Coronary artery dilation
    0084Level I Electrophysiologic EvaluationS10.70$518.81$177.79$103.76
    93640Evaluation heart device
    93641Electrophysiology evaluation
    93642Electrophysiology evaluation
    0085Level II Electrophysiologic EvaluationS27.06$1,312.06$654.48$262.41
    93619Electrophysiology evaluation
    93620Electrophysiology evaluation
    93621Electrophysiology evaluation
    93622Electrophysiology evaluation
    0086Ablate Heart Dysrhythm FocusS47.62$2,308.95$1,265.37$461.79
    93650Ablate heart dysrhythm focus
    93651Ablate heart dysrhythm focus
    93652Ablate heart dysrhythm focus
    0087Cardiac Electrophysiologic Recording/MappingS9.53$462.08$214.72$92.42
    93600Bundle of His recording
    93602Intra-atrial recording
    93603Right ventricular recording
    93607Left ventricular recording
    93609Mapping of tachycardia
    93610Intra-atrial pacing
    93612Intraventricular pacing
    93615Esophageal recording
    93616Esophageal recording
    93618Heart rhythm pacing
    93623Stimulation, pacing heart
    93624Electrophysiologic study
    93631Heart pacing, mapping
    0088ThrombectomyT26.49$1,284.42$678.68$256.88
    34101Removal of artery clot
    34111Removal of arm artery clot
    34201Removal of artery clot
    34203Removal of leg artery clot
    34471Removal of vein clot
    34490Removal of vein clot
    34501Repair valve, femoral vein
    34510Transposition of vein valve
    34520Cross-over vein graft
    34530Leg vein fusion
    Start Printed Page 18731
    35188Repair blood vessel lesion
    35207Repair blood vessel lesion
    35875Removal of clot in graft
    35876Removal of clot in graft
    35879Revise graft w/vein
    35881Revise graft w/vein
    36821Av fusion direct any site
    36825Artery-vein graft
    36830Artery-vein graft
    36831Av fistula excision
    36832Av fistula revision
    36833Av fistula revision
    G0159Perc declot dialysis graft
    0089Level I Implantation/Removal/Revision of Pacemaker, AICD or Vascular DeviceT6.49$314.68$130.07$62.94
    33210Insertion of heart electrode
    33211Insertion of heart electrode
    33220Revise eltrd pacing-defib
    33241Remove pulse generator
    36261Revision of infusion pump
    36262Removal of infusion pump
    36299Vessel injection procedure
    36531Revision of infusion pump
    36532Removal of infusion pump
    36534Revision of access device
    36535Removal of access device
    37203Transcatheter retrieval
    0090Level II Implantation/Removal/Revision of Pacemaker, AICD or Vascular DeviceT20.96$1,016.29$573.04$203.26
    33206Insertion of heart pacemaker
    33207Insertion of heart pacemaker
    33208Insertion of heart pacemaker
    33212Insertion of pulse generator
    33213Insertion of pulse generator
    33214Upgrade of pacemaker system
    33216Revise eltrd pacing-defib
    33217Revise eltrd pacing-defib
    33218Revise eltrd pacing-defib
    33233Removal of pacemaker system
    33234Removal of pacemaker system
    33235Removal pacemaker electrode
    33240Insert pulse generator
    33244Remove eltrd, transven
    33249Eltrd/insert pace-defib
    36860External cannula declotting
    36861Cannula declotting
    0091Level I Vascular LigationT14.79$717.12$348.23$143.42
    30915Ligation, nasal sinus artery
    37605Ligation of neck artery
    37606Ligation of neck artery
    37615Ligation of neck artery
    37650Revision of major vein
    37700Revise leg vein
    37760Revision of leg veins
    37780Revision of leg vein
    37785Revise secondary varicosity
    0092Level II Vascular LigationT20.21$979.92$505.37$195.98
    30920Ligation, upper jaw artery
    37607Ligation of a-v fistula
    37720Removal of leg vein
    37730Removal of leg veins
    37735Removal of leg veins/lesion
    0093Vascular Repair/Fistula ConstructionT17.95$870.34$422.33$174.07
    36260Insertion of infusion pump
    36530Insertion of infusion pump
    36533Insertion of access device
    36800Insertion of cannula
    36810Insertion of cannula
    36815Insertion of cannula
    36819Av fusion by basilic vein
    36835Artery to vein shunt
    0094Resuscitation and CardioversionS4.51$218.68$105.29$43.74
    31500Insert emergency airway
    92950Heart/lung resuscitation cpr
    92953Temporary external pacing
    Start Printed Page 18732
    92960Cardioversion electric, ext
    92961Cardioversion, electric, int
    99440Newborn resuscitation
    0095Cardiac RehabilitationS0.64$31.03$16.98$6.21
    93797Cardiac rehab
    93798Cardiac rehab/monitor
    0096Non-Invasive Vascular StudiesS2.06$99.88$61.48$19.98
    93721Plethysmography tracing
    93740Temperature gradient studies
    93799Cardiovascular procedure
    93875Extracranial study
    93922Extremity study
    93923Extremity study
    93924Extremity study
    93965Extremity study
    0097Cardiovascular Stress TestS1.62$78.55$62.40$15.71
    93017Cardiovascular stress test
    93024Cardiac drug stress test
    0098Injection of Sclerosing SolutionT1.19$57.70$20.88$11.54
    36468Injection(s), spider veins
    36469Injection(s), spider veins
    36470Injection therapy of vein
    36471Injection therapy of veins
    45520Treatment of rectal prolapse
    0099Continuous Cardiac MonitoringS0.38$18.43$14.68$3.69
    93012Transmission of ecg
    93270ECG recording
    93278ECG/signal-averaged
    G0005ECG 24 hour recording
    G0015Post symptom ECG tracing
    0100Continuous ECGS1.70$82.43$71.57$16.49
    93225ECG monitor/record, 24 hrs
    93226ECG monitor/report, 24 hrs
    93231Ecg monitor/record, 24 hrs
    93232ECG monitor/report, 24 hrs
    93236ECG monitor/report, 24 hrs
    93268ECG record/review
    93271Ecg/monitoring and analysis
    93724Analyze pacemaker system
    G0004ECG transm phys review & int
    G0006ECG transmission & analysis
    0101Tilt Table EvaluationS4.47$216.74$128.84$43.35
    93660Tilt table evaluation
    0102Electronic Analysis of Pacemakers/other DevicesS0.45$21.82$12.62$4.36
    62367Analyze spine infusion pump
    62368Analyze spine infusion pump
    93727Analyze ilr system
    93731Analyze pacemaker system
    93732Analyze pacemaker system
    93733Telephone analy, pacemaker
    93734Analyze pacemaker system
    93735Analyze pacemaker system
    93736Telephone analy, pacemaker
    93737Analyze cardio/defibrillator
    93738Analyze cardio/defibrillator
    93741Analyze ht pace device sngl
    93742Analyze ht pace device sngl
    93743Analyze ht pace device dual
    93744Analyze ht pace device dual
    95970Analyze neurostim, no prog
    95971Analyze neurostim, simple
    95972Analyze neurostim, complex
    95973Analyze neurostim, complex
    95974Cranial neurostim, complex
    95975Cranial neurostim, complex
    0109Bone Marrow Harvesting and Bone Marrow/Stem Cell TransplantS4.13$200.25$40.05$40.05
    38230Bone marrow collection
    38240Bone marrow/stem transplant
    38241Bone marrow/stem transplant
    0110TransfusionS5.83$282.68$122.73$56.54
    36430Blood transfusion service
    36440Blood transfusion service
    36450Exchange transfusion service
    Start Printed Page 18733
    36455Exchange transfusion service
    36460Transfusion service, fetal
    0111Blood Product ExchangeS14.17$687.06$300.74$137.41
    36520Plasma and/or cell exchange
    36521Apheresis w/adsorp/reinfuse
    38231Stem cell collection
    0112Extracorporeal PhotopheresisS39.60$1,920.09$663.65$384.02
    36522Photopheresis
    0113Excision Lymphatic SystemT13.89$673.49$326.55$134.70
    38308Incision of lymph channels
    38500Biopsy/removal, lymph nodes
    38510Biopsy/removal, lymph nodes
    38520Biopsy/removal, lymph nodes
    38525Biopsy/removal, lymph nodes
    38530Biopsy/removal, lymph nodes
    38550Removal, neck/armpit lesion
    0114Thyroid/Lymphadenectomy ProceduresT19.56$948.41$493.78$189.68
    38542Explore deep node(s), neck
    38555Removal, neck/armpit lesion
    38720Removal of lymph nodes, neck
    38740Remove armpit lymph nodes
    38745Remove armpit lymph nodes
    38760Remove groin lymph nodes
    60200Remove thyroid lesion
    60210Partial thyroid excision
    60220Partial removal of thyroid
    60225Partial removal of thyroid
    60240Removal of thyroid
    60280Remove thyroid duct lesion
    60281Remove thyroid duct lesion
    0116Chemotherapy Administration by Other Technique Except InfusionS2.34$113.46$22.69$22.69
    Q0083Chemo by other than infusion
    0117Chemotherapy Administration by Infusion OnlyS1.84$89.22$71.80$17.84
    Q0084Chemotherapy by infusion
    0118Chemotherapy Administration by Both Infusion and Other TechniqueS2.90$140.61$72.03$28.12
    Q0085Chemo by both infusion and o
    0120Infusion Therapy Except ChemotherapyS1.66$80.49$42.67$16.10
    36680Insert needle, bone cavity
    Q0081Infusion ther other than che
    0121Level I Tube changes and RepositioningT2.36$114.43$52.53$22.89
    31502Change of windpipe airway
    43760Change gastrostomy tube
    43761Reposition gastrostomy tube
    43999Stomach surgery procedure
    47530Revise/reinsert bile tube
    47999Bile tract surgery procedure
    49999Abdomen surgery procedure
    50688Change of ureter tube
    51705Change of bladder tube
    51710Change of bladder tube
    62194Replace/irrigate catheter
    62225Replace/irrigate catheter
    0122Level II Tube changes and RepositioningT5.04$244.37$114.93$48.88
    47525Change bile duct catheter
    50398Change kidney tube
    0123Level III Tube changes and RepositioningT13.89$673.49$350.75$134.70
    49422Remove perm cannula/catheter
    49429Removal of shunt
    0130Level I LaparoscopyT25.36$1,229.63$659.53$245.93
    38129Laparoscope proc, spleen
    38589Laparoscope proc, lymphatic
    43289Laparoscope proc, esoph
    43659Laparoscope proc, stom
    44209Laparoscope proc, intestine
    44970Laparoscopy, appendectomy
    44979Laparoscope proc, app
    47560Laparoscopy w/cholangio
    47561Laparo w/cholangio/biopsy
    47579Laparoscope proc, biliary
    49320Diag laparo separate proc
    49321Laparoscopy, biopsy
    49322Laparoscopy, aspiration
    49323Laparo drain lymphocele
    Start Printed Page 18734
    49329Laparo proc, abdm/per/oment
    50549Laparoscope proc, renal
    54699Laparoscope proc, testis
    55559Laparo proc, spermatic cord
    58679Laparo proc, oviduct-ovary
    59898Laparo proc, ob care/deliver
    60659Laparo proc, endocrine
    0131Level II LaparoscopyT41.81$2,027.24$1,089.88$405.45
    38120Laparoscopy, splenectomy
    38570Laparoscopy, lymph node biop
    38572Laparoscopy, lymphadenectomy
    43653Laparoscopy, gastrostomy
    44200Laparoscopy, enterolysis
    44201Laparoscopy, jejunostomy
    47562Laparoscopic cholecystectomy
    47563Laparo cholecystectomy/graph
    47564Laparo cholecystectomy/explr
    47570Laparo cholecystoenterostomy
    49650Laparo hernia repair initial
    49651Laparo hernia repair recur
    49659Laparo proc, hernia repair
    50541Laparo ablate renal cyst
    50544Laparoscopy, pyeloplasty
    50945Laparoscopy ureterolithotomy
    51990Laparo urethral suspension
    54690Laparoscopy, orchiectomy
    55550Laparo ligate spermatic vein
    58551Laparoscopy, remove myoma
    58660Laparoscopy, lysis
    58661Laparoscopy, remove adnexa
    58662Laparoscopy, excise lesions
    58670Laparoscopy, tubal cautery
    58671Laparoscopy, tubal block
    58672Laparoscopy, fimbrioplasty
    58673Laparoscopy, salpingostomy
    59150Treat ectopic pregnancy
    59151Treat ectopic pregnancy
    0132Level III LaparoscopyT48.91$2,371.50$1,239.22$474.30
    38571Laparoscopy, lymphadenectomy
    43280Laparoscopy, fundoplasty
    43651Laparoscopy, vagus nerve
    43652Laparoscopy, vagus nerve
    50548Laparo-asst remove k/ureter
    51992Laparo sling operation
    54692Laparoscopy, orchiopexy
    58550Laparo-asst vag hysterectomy
    0140Esophageal Dilation without EndoscopyT4.74$229.83$107.24$45.97
    43450Dilate esophagus
    43453Dilate esophagus
    43456Dilate esophagus
    43458Dilate esophagus
    43499Esophagus surgery procedure
    0141Upper GI ProceduresT7.15$346.68$184.67$69.34
    43200Esophagus endoscopy
    43202Esophagus endoscopy, biopsy
    43204Esophagus endoscopy & inject
    43205Esophagus endoscopy/ligation
    43215Esophagus endoscopy
    43216Esophagus endoscopy/lesion
    43217Esophagus endoscopy
    43219Esophagus endoscopy
    43220Esoph endoscopy, dilation
    43226Esoph endoscopy, dilation
    43227Esoph endoscopy, repair
    43228Esoph endoscopy, ablation
    43234Upper GI endoscopy, exam
    43235Uppr gi endoscopy, diagnosis
    43239Upper GI endoscopy, biopsy
    43241Upper GI endoscopy with tube
    43243Upper gi endoscopy & inject
    43244Upper GI endoscopy/ligation
    43245Operative upper GI endoscopy
    43246Place gastrostomy tube
    Start Printed Page 18735
    43247Operative upper GI endoscopy
    43248Uppr gi endoscopy/guide wire
    43249Esoph endoscopy, dilation
    43250Upper GI endoscopy/tumor
    43251Operative upper GI endoscopy
    43255Operative upper GI endoscopy
    43258Operative upper GI endoscopy
    43259Endoscopic ultrasound exam
    43600Biopsy of stomach
    43750Place gastrostomy tube
    43830Place gastrostomy tube
    43831Place gastrostomy tube
    44100Biopsy of bowel
    0142Small Intestine EndoscopyT7.45$361.23$162.42$72.25
    44360Small bowel endoscopy
    44361Small bowel endoscopy/biopsy
    44363Small bowel endoscopy
    44364Small bowel endoscopy
    44365Small bowel endoscopy
    44366Small bowel endoscopy
    44369Small bowel endoscopy
    44372Small bowel endoscopy
    44373Small bowel endoscopy
    44376Small bowel endoscopy
    44377Small bowel endoscopy/biopsy
    44378Small bowel endoscopy
    44380Small bowel endoscopy
    44382Small bowel endoscopy
    44799Intestine surgery procedure
    0143Lower GI EndoscopyT7.98$386.93$199.12$77.39
    44385Endoscopy of bowel pouch
    44386Endoscopy, bowel pouch/biop
    44388Colon endoscopy
    44389Colonoscopy with biopsy
    44390Colonoscopy for foreign body
    44391Colonoscopy for bleeding
    44392Colonoscopy & polypectomy
    44393Colonoscopy, lesion removal
    44394Colonoscopy w/snare
    45355Surgical colonoscopy
    45378Diagnostic colonoscopy
    45379Colonoscopy
    45380Colonoscopy and biopsy
    45382Colonoscopy/control bleeding
    45383Lesion removal colonoscopy
    45384Colonoscopy
    45385Lesion removal colonoscopy
    0144Diagnostic AnoscopyT2.23$108.13$49.32$21.63
    46604Anoscopy and dilation
    46608Anoscopy/remove for body
    0145Therapeutic AnoscopyT7.46$361.71$179.39$72.34
    46606Anoscopy and biopsy
    46610Anoscopy/remove lesion
    46611Anoscopy
    46612Anoscopy/remove lesions
    46614Anoscopy/control bleeding
    46615Anoscopy
    0146Level I SigmoidoscopyT2.83$137.22$65.15$27.44
    45300Proctosigmoidoscopy
    45303Proctosigmoidoscopy
    45305Proctosigmoidoscopy & biopsy
    45307Proctosigmoidoscopy
    45317Proctosigmoidoscopy
    45330Diagnostic sigmoidoscopy
    45331Sigmoidoscopy and biopsy
    45332Sigmoidoscopy
    0147Level II SigmoidoscopyT6.26$303.53$149.11$60.71
    45308Proctosigmoidoscopy
    45309Proctosigmoidoscopy
    45315Proctosigmoidoscopy
    45320Proctosigmoidoscopy
    45321Proctosigmoidoscopy
    45333Sigmoidoscopy & polypectomy
    Start Printed Page 18736
    45334Sigmoidoscopy for bleeding
    45337Sigmoidoscopy & decompress
    45338Sigmoidoscopy
    45339Sigmoidoscopy
    0148Level I Anal/Rectal ProcedureT2.34$113.46$43.59$22.69
    45005Drainage of rectal abscess
    45900Reduction of rectal prolapse
    45915Remove rectal obstruction
    45999Rectum surgery procedure
    46040Incision of rectal abscess
    46050Incision of anal abscess
    46070Incision of anal septum
    46083Incise external hemorrhoid
    46221Ligation of hemorrhoid(s)
    46320Removal of hemorrhoid clot
    46500Injection into hemorrhoids
    46934Destruction of hemorrhoids
    46935Destruction of hemorrhoids
    46945Ligation of hemorrhoids
    46946Ligation of hemorrhoids
    0149Level II Anal/Rectal ProcedureT12.86$623.54$293.06$124.71
    45000Drainage of pelvic abscess
    45020Drainage of rectal abscess
    45100Biopsy of rectum
    45905Dilation of anal sphincter
    45910Dilation of rectal narrowing
    46030Removal of rectal marker
    46080Incision of anal sphincter
    46210Removal of anal crypt
    46220Removal of anal tab
    46230Removal of anal tabs
    46754Removal of suture from anus
    46936Destruction of hemorrhoids
    46940Treatment of anal fissure
    46942Treatment of anal fissure
    46999Anus surgery procedure
    0150Level III Anal/Rectal ProcedureT17.68$857.25$437.12$171.45
    45108Removal of anorectal lesion
    45150Excision of rectal stricture
    45160Excision of rectal lesion
    45170Excision of rectal lesion
    45190Destruction, rectal tumor
    45500Repair of rectum
    45505Repair of rectum
    45560Repair of rectocele
    46045Incision of rectal abscess
    46060Incision of rectal abscess
    46200Removal of anal fissure
    46211Removal of anal crypts
    46250Hemorrhoidectomy
    46255Hemorrhoidectomy
    46257Remove hemorrhoids & fissure
    46258Remove hemorrhoids & fistula
    46260Hemorrhoidectomy
    46261Remove hemorrhoids & fissure
    46262Remove hemorrhoids & fistula
    46270Removal of anal fistula
    46275Removal of anal fistula
    46280Removal of anal fistula
    46285Removal of anal fistula
    46288Repair anal fistula
    46700Repair of anal stricture
    46750Repair of anal sphincter
    46753Reconstruction of anus
    46760Repair of anal sphincter
    46761Repair of anal sphincter
    46762Implant artificial sphincter
    46937Cryotherapy of rectal lesion
    46938Cryotherapy of rectal lesion
    0151Endoscopic Retrograde Cholangio-Pancreatography (ERCP)T10.53$510.57$245.46$102.11
    43260Endo cholangiopancreatograph
    43261Endo cholangiopancreatograph
    43262Endo cholangiopancreatograph
    Start Printed Page 18737
    43263Endo cholangiopancreatograph
    43264Endo cholangiopancreatograph
    43265Endo cholangiopancreatograph
    43267Endo cholangiopancreatograph
    43268Endo cholangiopancreatograph
    43269Endo cholangiopancreatograph
    43271Endo cholangiopancreatograph
    43272Endo cholangiopancreatograph
    0152Percutaneous Biliary Endoscopic ProceduresT8.22$398.56$207.38$79.71
    47510Insert catheter, bile duct
    47511Insert bile duct drain
    47552Biliary endoscopy thru skin
    47553Biliary endoscopy thru skin
    47554Biliary endoscopy thru skin
    47555Biliary endoscopy thru skin
    47556Biliary endoscopy thru skin
    47630Remove bile duct stone
    0153Peritoneal and Abdominal ProceduresT19.62$951.32$496.31$190.26
    49085Remove abdomen foreign body
    49250Excision of umbilicus
    49420Insert abdominal drain
    49421Insert abdominal drain
    49423Exchange drainage catheter
    49426Revise abdomen-venous shunt
    0154Hernia/Hydrocele ProceduresT22.43$1,087.57$556.98$217.51
    49495Repair inguinal hernia, init
    49496Repair inguinal hernia, init
    49500Repair inguinal hernia
    49501Repair inguinal hernia, init
    49505Repair inguinal hernia
    49507Repair inguinal hernia
    49520Rerepair inguinal hernia
    49521Repair inguinal hernia, rec
    49525Repair inguinal hernia
    49540Repair lumbar hernia
    49550Repair femoral hernia
    49553Repair femoral hernia, init
    49555Repair femoral hernia
    49557Repair femoral hernia, recur
    49560Repair abdominal hernia
    49561Repair incisional hernia
    49565Rerepair abdominal hernia
    49566Repair incisional hernia
    49568Hernia repair w/mesh
    49570Repair epigastric hernia
    49572Repair epigastric hernia
    49580Repair umbilical hernia
    49582Repair umbilical hernia
    49585Repair umbilical hernia
    49587Repair umbilical hernia
    49590Repair abdominal hernia
    49600Repair umbilical lesion
    51500Removal of bladder cyst
    54530Removal of testis
    54550Exploration for testis
    54640Suspension of testis
    55040Removal of hydrocele
    55041Removal of hydroceles
    55535Revise spermatic cord veins
    55540Revise hernia & sperm veins
    2 0157Colorectal Cancer Screening: Barium EnemaS1.79$86.79$17.36
    G0106Colon CA screen; barium enema
    G0120Colon ca scrn; barium enema
    1 0158Colorectal Cancer Screening: ColonoscopyS7.98$386.93$96.73
    G0104CA screen; flexi sigmoidscope
    1 0159Colorectal Cancer Screening: Flexible SigmoidoscopyS7.98$137.22$34.31
    G0105Colorectal scrn; hi risk ind
    0160Level I Cystourethroscopy and other Genitourinary ProceduresT5.43$263.28$110.11$52.66
    50392Insert kidney drain
    50393Insert ureteral tube
    50395Create passage to kidney
    52000Cystoscopy
    52265Cystoscopy and treatment
    Start Printed Page 18738
    0161Level II Cystourethroscopy and other Genitourinary ProceduresT10.94$530.45$249.36$106.09
    50551Kidney endoscopy
    50553Kidney endoscopy
    50555Kidney endoscopy & biopsy
    50557Kidney endoscopy & treatment
    50559Renal endoscopy/radiotracer
    50561Kidney endoscopy & treatment
    52005Cystoscopy & ureter catheter
    52007Cystoscopy and biopsy
    52010Cystoscopy & duct catheter
    52204Cystoscopy
    52214Cystoscopy and treatment
    52224Cystoscopy and treatment
    52260Cystoscopy and treatment
    52270Cystoscopy & revise urethra
    52275Cystoscopy & revise urethra
    52276Cystoscopy and treatment
    52281Cystoscopy and treatment
    52283Cystoscopy and treatment
    52285Cystoscopy and treatment
    52290Cystoscopy and treatment
    52300Cystoscopy and treatment
    52301Cystoscopy and treatment
    52305Cystoscopy and treatment
    52310Cystoscopy and treatment
    52315Cystoscopy and treatment
    52327Cystoscopy, inject material
    52510Dilation prostatic urethra
    53605Dilate urethra stricture
    0162Level III Cystourethroscopy and other Genitourinary ProceduresT17.49$848.04$427.49$169.61
    50951Endoscopy of ureter
    50953Endoscopy of ureter
    50955Ureter endoscopy & biopsy
    50957Ureter endoscopy & treatment
    50959Ureter endoscopy & tracer
    50961Ureter endoscopy & treatment
    51020Incise & treat bladder
    51030Incise & treat bladder
    51040Incise & drain bladder
    51045Incise bladder/drain ureter
    51050Removal of bladder stone
    51065Removal of ureter stone
    51520Removal of bladder lesion
    51880Repair of bladder opening
    52234Cystoscopy and treatment
    52235Cystoscopy and treatment
    52250Cystoscopy and radiotracer
    52277Cystoscopy and treatment
    52282Cystoscopy, implant stent
    52317Remove bladder stone
    52318Remove bladder stone
    52320Cystoscopy and treatment
    52325Cystoscopy, stone removal
    52330Cystoscopy and treatment
    52332Cystoscopy and treatment
    52334Create passage to kidney
    52335Endoscopy of urinary tract
    52336Cystoscopy, stone removal
    52337Cystoscopy, stone removal
    52338Cystoscopy and treatment
    52339Cystoscopy and treatment
    52340Cystoscopy and treatment
    52450Incision of prostate
    52500Revision of bladder neck
    52606Control postop bleeding
    52640Relieve bladder contracture
    52700Drainage of prostate abscess
    55720Drainage of prostate abscess
    55725Drainage of prostate abscess
    55859Percut/needle insert, pros
    0163Level IV Cystourethroscopy and other Genitourinary ProceduresT28.98$1,405.16$792.58$281.03
    50080Removal of kidney stone
    50081Removal of kidney stone
    Start Printed Page 18739
    52240Cystoscopy and treatment
    52601Prostatectomy (TURP)
    52612Prostatectomy, first stage
    52614Prostatectomy, second stage
    52620Remove residual prostate
    52630Remove prostate regrowth
    52647Laser surgery of prostate
    52648Laser surgery of prostate
    0164Level I Urinary and Anal ProceduresT2.17$105.23$33.03$21.05
    51005Drainage of bladder
    51700Irrigation of bladder
    51736Urine flow measurement
    51741Electro-uroflowmetry, first
    51784Anal/urinary muscle study
    51785Anal/urinary muscle study
    51795Urine voiding pressure study
    51797Intraabdominal pressure test
    53600Dilate urethra stricture
    53601Dilate urethra stricture
    53621Dilate urethra stricture
    53660Dilation of urethra
    53661Dilation of urethra
    53675Insert urinary catheter
    54235Penile injection
    54240Penis study
    55899Genital surgery procedure
    0165Level II Urinary and Anal ProceduresT3.89$188.61$91.76$37.72
    50396Measure kidney pressure
    50686Measure ureter pressure
    51000Drainage of bladder
    51010Drainage of bladder
    51720Treatment of bladder lesion
    51725Simple cystometrogram
    51726Complex cystometrogram
    51772Urethra pressure profile
    51792Urinary reflex study
    53620Dilate urethra stricture
    53899Urology surgery procedure
    54200Treatment of penis lesion
    54220Treatment of penis lesion
    54231Dynamic cavernosometry
    54250Penis study
    54450Preputial stretching
    91122Anal pressure record
    0166Level I Urethral ProceduresT10.17$493.11$218.73$98.62
    53000Incision of urethra
    53010Incision of urethra
    53020Incision of urethra
    53025Incision of urethra
    53040Drainage of urethra abscess
    53060Drainage of urethra abscess
    53080Drainage of urinary leakage
    53200Biopsy of urethra
    53250Removal of urethra gland
    53260Treatment of urethra lesion
    53265Treatment of urethra lesion
    53275Repair of urethra defect
    53442Remove perineal prosthesis
    53502Repair of urethra injury
    53510Repair of urethra injury
    53665Dilation of urethra
    54000Slitting of prepuce
    54001Slitting of prepuce
    0167Level II Urethral ProceduresT21.06$1,021.14$555.84$204.23
    51715Endoscopic injection/implant
    53270Removal of urethra gland
    53505Repair of urethra injury
    0168Level III Urethral ProceduresT24.94$1,209.27$536.11$241.85
    53210Removal of urethra
    53215Removal of urethra
    53220Treatment of urethra lesion
    53230Removal of urethra lesion
    53235Removal of urethra lesion
    Start Printed Page 18740
    53240Surgery for urethra pouch
    53400Revise urethra, stage 1
    53405Revise urethra, stage 2
    53410Reconstruction of urethra
    53420Reconstruct urethra, stage 1
    53425Reconstruct urethra, stage 2
    53430Reconstruction of urethra
    53447Remove artificial sphincter
    53449Correct artificial sphincter
    53450Revision of urethra
    53460Revision of urethra
    53515Repair of urethra injury
    53520Repair of urethra defect
    0169LithotripsyT46.72$2,265.32$1,384.20$453.06
    50590Fragmenting of kidney stone
    0170Dialysis for Other Than ESRD PatientsS6.68$323.89$72.26$64.78
    90935Hemodialysis, one evaluation
    90945Dialysis, one evaluation
    0180CircumcisionT13.62$660.39$304.87$132.08
    54150Circumcision
    54152Circumcision
    54160Circumcision
    54161Circumcision
    0181Penile ProceduresT32.37$1,569.53$906.36$313.91
    37790Penile venous occlusion
    54110Treatment of penis lesion
    54111Treat penis lesion, graft
    54112Treat penis lesion, graft
    54120Partial removal of penis
    54205Treatment of penis lesion
    54300Revision of penis
    54304Revision of penis
    54308Reconstruction of urethra
    54312Reconstruction of urethra
    54316Reconstruction of urethra
    54318Reconstruction of urethra
    54322Reconstruction of urethra
    54324Reconstruction of urethra
    54326Reconstruction of urethra
    54328Revise penis/urethra
    54340Secondary urethral surgery
    54344Secondary urethral surgery
    54348Secondary urethral surgery
    54352Reconstruct urethra/penis
    54360Penis plastic surgery
    54380Repair penis
    54385Repair penis
    54402Remove penis prosthesis
    54407Remove multi-comp prosthesis
    54409Revise penis prosthesis
    54420Revision of penis
    54435Revision of penis
    54440Repair of penis
    0182Insertion of Penile ProsthesisT52.11$2,526.66$1,525.05$505.33
    53440Correct bladder function
    53445Correct urine flow control
    54400Insert semi-rigid prosthesis
    54401Insert self-contd prosthesis
    54405Insert multi-comp prosthesis
    0183Testes/Epididymis ProceduresT18.26$885.37$448.94$177.07
    54505Biopsy of testis
    54510Removal of testis lesion
    54520Removal of testis
    54600Reduce testis torsion
    54620Suspension of testis
    54660Revision of testis
    54670Repair testis injury
    54680Relocation of testis(es)
    54700Drainage of scrotum
    54820Exploration of epididymis
    54830Remove epididymis lesion
    54840Remove epididymis lesion
    54860Removal of epididymis
    Start Printed Page 18741
    54861Removal of epididymis
    54900Fusion of spermatic ducts
    54901Fusion of spermatic ducts
    55060Repair of hydrocele
    55110Explore scrotum
    55120Removal of scrotum lesion
    55150Removal of scrotum
    55175Revision of scrotum
    55180Revision of scrotum
    55200Incision of sperm duct
    55250Removal of sperm duct(s)
    55400Repair of sperm duct
    55450Ligation of sperm duct
    55500Removal of hydrocele
    55520Removal of sperm cord lesion
    55530Revise spermatic cord veins
    55680Remove sperm pouch lesion
    0184Prostate BiopsyT4.94$239.53$122.96$47.91
    55700Biopsy of prostate
    55705Biopsy of prostate
    0190Surgical HysteroscopyT17.85$865.49$443.89$173.10
    58558Hysteroscopy, biopsy
    58559Hysteroscopy, lysis
    58560Hysteroscopy, resect septum
    58561Hysteroscopy, remove myoma
    58562Hysteroscopy, remove fb
    58563Hysteroscopy, ablation
    58578Laparo proc, uterus
    58579Hysteroscope procedure
    0191Level I Female Reproductive ProceduresT1.19$57.70$17.43$11.54
    57160Insert pessary/other device
    57170Fitting of diaphragm/cap
    57452Examination of vagina
    58100Biopsy of uterus lining
    58301Remove intrauterine device
    58555Hysteroscopy, dx, sep proc
    59200Insert cervical dilator
    Q0091Obtaining screen pap smear
    0192Level II Female Reproductive ProceduresT2.38$115.40$35.33$23.08
    56405I & D of vulva/perineum
    56420Drainage of gland abscess
    57100Biopsy of vagina
    57150Treat vagina infection
    57180Treat vaginal bleeding
    57454Vagina examination & biopsy
    57505Endocervical curettage
    57511Cryocautery of cervix
    99170Anogenital exam, child
    0193Level III Female Reproductive ProceduresT8.93$432.99$171.13$86.60
    56441Lysis of labial lesion(s)
    56720Incision of hymen
    57020Drainage of pelvic fluid
    57460Cervix excision
    57500Biopsy of cervix
    57510Cauterization of cervix
    57513Laser surgery of cervix
    57800Dilation of cervical canal
    0194Level IV Female Reproductive ProceduresT16.21$785.98$395.94$157.20
    56440Surgery for vulva lesion
    56700Partial removal of hymen
    56740Remove vagina gland lesion
    56800Repair of vagina
    56810Repair of perineum
    57000Exploration of vagina
    57010Drainage of pelvic abscess
    57061Destruction vagina lesion(s)
    57065Destruction vagina lesion(s)
    57105Biopsy of vagina
    57106Remove vagina wall, partial
    57107Remove vagina tissue, part
    57109Vaginectomy partial w/nodes
    57130Remove vagina lesion
    57135Remove vagina lesion
    Start Printed Page 18742
    57200Repair of vagina
    57210Repair vagina/perineum
    57230Repair of urethral lesion
    57400Dilation of vagina
    57410Pelvic examination
    57415Remove vaginal foreign body
    57520Conization of cervix
    57700Revision of cervix
    57720Revision of cervix
    58345Reopen fallopian tube
    58350Reopen fallopian tube
    58970Retrieval of oocyte
    59300Episiotomy or vaginal repair
    59320Revision of cervix
    59871Remove cerclage suture
    0195Level V Female Reproductive ProceduresT18.68$905.74$483.80$181.15
    56620Partial removal of vulva
    56625Complete removal of vulva
    57220Revision of urethra
    57240Repair bladder & vagina
    57250Repair rectum & vagina
    57260Repair of vagina
    57265Extensive repair of vagina
    57268Repair of bowel bulge
    57284Repair paravaginal defect
    57288Repair bladder defect
    57289Repair bladder & vagina
    57291Construction of vagina
    57300Repair rectum-vagina fistula
    57522Conization of cervix
    57530Removal of cervix
    57550Removal of residual cervix
    57555Remove cervix/repair vagina
    57556Remove cervix, repair bowel
    58145Removal of uterus lesion
    58800Drainage of ovarian cyst(s)
    58820Drain ovary abscess, open
    58900Biopsy of ovary(s)
    58920Partial removal of ovary(s)
    58925Removal of ovarian cyst(s)
    0196Dilatation & CurettageT14.47$701.61$357.98$140.32
    57820D & c of residual cervix
    58120Dilation and curettage
    59160D & c after delivery
    0197Infertility ProceduresT2.40$116.37$49.55$23.27
    55870Electroejaculation
    58321Artificial insemination
    58322Artificial insemination
    58323Sperm washing
    58974Transfer of embryo
    58976Transfer of embryo
    0198Pregnancy and Neonatal Care ProceduresT1.34$64.97$33.03$12.99
    59000Amniocentesis
    59012Fetal cord puncture, prenatal
    59015Chorion biopsy
    59020Fetal contract stress test
    59025Fetal non-stress test
    59030Fetal scalp blood sample
    59050Fetal monitor w/report
    59899Maternity care procedure
    0199Vaginal DeliveryT11.20$543.06$157.83$108.61
    59409Obstetrical care
    59412Antepartum manipulation
    59414Deliver placenta
    59612Vbac delivery only
    0200Therapeutic AbortionT13.89$673.49$373.23$134.70
    59840Abortion
    59841Abortion
    0201Spontaneous AbortionT13.00$630.33$329.65$126.07
    59812Treatment of miscarriage
    59820Care of miscarriage
    59821Treatment of miscarriage
    59870Evacuate mole of uterus
    Start Printed Page 18743
    0210Spinal TapT3.00$145.46$62.40$29.09
    62270Spinal fluid tap, diagnostic
    62272Drain spinal fluid
    0211Level I Nervous System InjectionsT3.32$160.98$74.78$32.20
    64400Injection for nerve block
    64402Injection for nerve block
    64405Injection for nerve block
    64408Injection for nerve block
    64410Injection for nerve block
    64412Injection for nerve block
    64413Injection for nerve block
    64415Injection for nerve block
    64417Injection for nerve block
    64418Injection for nerve block
    64420Injection for nerve block
    64421Injection for nerve block
    64425Injection for nerve block
    64430Injection for nerve block
    64435Injection for nerve block
    64445Injection for nerve block
    64450Injection for nerve block
    64470Inj paravertebral c/t
    64472Inj paravertebral c/t add-on
    64475Inj paravertebral l/s
    64476Inj paravertebral l/s add-on
    64479Inj foramen epidural c/t
    64480Inj foramen epidural add-on
    64483Inj foramen epidural l/s
    64484Inj foramen epidural add-on
    64505Injection for nerve block
    64508Injection for nerve block
    64510Injection for nerve block
    64520Injection for nerve block
    64530Injection for nerve block
    64600Injection treatment of nerve
    64605Injection treatment of nerve
    64610Injection treatment of nerve
    64612Destroy nerve, face muscle
    64613Destroy nerve, spine muscle
    64620Injection treatment of nerve
    64622Destr paravertebrl nerve l/s
    64623Destr paravertebral n add-on
    64626Destr paravertebrl nerve c/t
    64627Destr paravertebral n add-on
    64630Injection treatment of nerve
    64640Injection treatment of nerve
    64680Injection treatment of nerve
    64999Nervous system surgery
    0212Level II Nervous System InjectionsT3.64$176.49$88.78$35.30
    61000Remove cranial cavity fluid
    61001Remove cranial cavity fluid
    61020Remove brain cavity fluid
    61026Injection into brain canal
    61050Remove brain canal fluid
    61055Injection into brain canal
    61070Brain canal shunt procedure
    62263Lysis epidural adhesions
    62268Drain spinal cord cyst
    62273Treat epidural spine lesion
    62280Treat spinal cord lesion
    62281Treat spinal cord lesion
    62282Treat spinal canal lesion
    62292Injection into disk lesion
    62294Injection into spinal artery
    62310Inject spine c/t
    62311Inject spine l/s (cd)
    62318Inject spine w/cath, c/t
    62319Inject spine w/cath l/s (cd)
    0213Extended EEG Studies and Sleep StudiesS11.15$540.63$290.42$108.13
    95805Multiple sleep latency test
    95806Sleep study, unattended
    95807Sleep study, attended
    95808Polysomnography, 1-3
    Start Printed Page 18744
    95810Polysomnography, 4 or more
    95811Polysomnography w/cpap
    95812Electroencephalogram (EEG)
    95813Electroencephalogram (EEG)
    95827Night electroencephalogram
    95951EEG monitoring/videorecord
    95953EEG monitoring/computer
    95954EEG monitoring/giving drugs
    95958EEG monitoring/function test
    0214ElectroencephalogramS2.32$112.49$58.50$22.50
    95816Electroencephalogram (EEG)
    95819Electroencephalogram (EEG)
    95822Sleep electroencephalogram
    95824Electroencephalography
    95829Surgery electrocorticogram
    95955EEG during surgery
    0215Level I Nerve and Muscle TestsS1.15$55.76$30.05$11.15
    95857Tensilon test
    95858Tensilon test & myogram
    95860Muscle test, one limb
    95861Muscle test, two limbs
    95864Muscle test, 4 limbs
    95869Muscle test, thor paraspinal
    95870Muscle test, nonparaspinal
    95872Muscle test, one fiber
    95900Motor nerve conduction test
    95903Motor nerve conduction test
    95904Sense/mixed n conduction tst
    95933Blink reflex test
    95934H-reflex test
    95937Neuromuscular junction test
    0216Level II Nerve and Muscle TestsS2.87$139.16$64.69$27.83
    92275Electroretinography
    92585Auditory evoked potential
    95863Muscle test, 3 limbs
    95867Muscle test, head or neck
    95868Muscle test, head or neck
    95921Autonomic nerv function test
    95922Autonomic nerv function test
    95923Autonomic nerv function test
    95925Somatosensory testing
    95926Somatosensory testing
    95927Somatosensory testing
    95930Visual evoked potential test
    95936H-reflex test
    0217Level III Nerve and Muscle TestsS5.87$284.62$156.68$56.92
    95875Limb exercise test
    95950Ambulatory eeg monitoring
    0220Level I Nerve ProceduresT13.96$676.88$326.21$135.38
    27315Partial removal, thigh nerve
    27320Partial removal, thigh nerve
    28030Removal of foot nerve
    28035Decompression of tibia nerve
    61790Treat trigeminal nerve
    62287Percutaneous diskectomy
    63600Remove spinal cord lesion
    63610Stimulation of spinal cord
    63615Remove lesion of spinal cord
    64702Revise finger/toe nerve
    64704Revise hand/foot nerve
    64708Revise arm/leg nerve
    64712Revision of sciatic nerve
    64713Revision of arm nerve(s)
    64714Revise low back nerve(s)
    64716Revision of cranial nerve
    64718Revise ulnar nerve at elbow
    64719Revise ulnar nerve at wrist
    64721Carpal tunnel surgery
    64722Relieve pressure on nerve(s)
    64726Release foot/toe nerve
    64727Internal nerve revision
    64732Incision of brow nerve
    64734Incision of cheek nerve
    Start Printed Page 18745
    64736Incision of chin nerve
    64738Incision of jaw nerve
    64740Incision of tongue nerve
    64742Incision of facial nerve
    64744Incise nerve, back of head
    64746Incise diaphragm nerve
    64761Incision of pelvis nerve
    64771Sever cranial nerve
    64772Incision of spinal nerve
    64774Remove skin nerve lesion
    64776Remove digit nerve lesion
    64778Digit nerve surgery add-on
    64782Remove limb nerve lesion
    64783Limb nerve surgery add-on
    64784Remove nerve lesion
    64787Implant nerve end
    64788Remove skin nerve lesion
    64790Removal of nerve lesion
    64795Biopsy of nerve
    0221Level II Nerve ProceduresT18.36$890.22$463.62$178.04
    64786Remove sciatic nerve lesion
    64792Removal of nerve lesion
    64831Repair of digit nerve
    64832Repair nerve add-on
    64834Repair of hand or foot nerve
    64835Repair of hand or foot nerve
    64836Repair of hand or foot nerve
    64837Repair nerve add-on
    64840Repair of leg nerve
    64856Repair/transpose nerve
    64857Repair arm/leg nerve
    64858Repair sciatic nerve
    64859Nerve surgery
    64861Repair of arm nerves
    64862Repair of low back nerves
    64864Repair of facial nerve
    64865Repair of facial nerve
    64870Fusion of facial/other nerve
    64872Subsequent repair of nerve
    64874Repair & revise nerve add-on
    64876Repair nerve/shorten bone
    64885Nerve graft, head or neck
    64886Nerve graft, head or neck
    64890Nerve graft, hand or foot
    64891Nerve graft, hand or foot
    64892Nerve graft, arm or leg
    64893Nerve graft, arm or leg
    64895Nerve graft, hand or foot
    64896Nerve graft, hand or foot
    64897Nerve graft, arm or leg
    64898Nerve graft, arm or leg
    64901Nerve graft add-on
    64902Nerve graft add-on
    64905Nerve pedicle transfer
    64907Nerve pedicle transfer
    0222Implantation of Neurological DeviceT25.48$1,235.45$780.07$247.09
    61215Insert brain-fluid device
    61885Implant neurostim one array
    62360Insert spine infusion device
    62361Implant spine infusion pump
    62362Implant spine infusion pump
    63685Implant neuroreceiver
    64590Implant neuroreceiver
    0223Level I Revision/Removal Neurological DeviceT6.34$307.41$153.24$61.48
    62350Implant spinal canal cath
    62355Remove spinal canal catheter
    63746Removal of spinal shunt
    0224Level II Revision/Removal Neurological DeviceT15.94$772.88$374.61$154.58
    62230Replace/revise brain shunt
    62365Remove spine infusion device
    63650Implant neuroelectrodes
    63660Revise/remove neuroelectrode
    63688Revise/remove neuroreceiver
    Start Printed Page 18746
    63744Revision of spinal shunt
    0225Implantation of Neurostimulator ElectrodesT3.43$166.31$64.46$33.26
    64553Implant neuroelectrodes
    64555Implant neuroelectrodes
    64560Implant neuroelectrodes
    64565Implant neuroelectrodes
    64573Implant neuroelectrodes
    64575Implant neuroelectrodes
    64577Implant neuroelectrodes
    64580Implant neuroelectrodes
    64585Revise/remove neuroelectrode
    64595Revise/remove neuroreceiver
    0230Level I Eye TestsS0.98$47.52$22.48$9.50
    68200Treat eyelid by injection
    92020Special eye evaluation
    92060Special eye evaluation
    92065Orthoptic/pleoptic training
    92081Visual field examination(s)
    92082Visual field examination(s)
    92083Visual field examination(s)
    92120Tonography & eye evaluation
    92130Water provocation tonography
    92225Special eye exam, initial
    92250Eye exam with photos
    92260Ophthalmoscopy/dynamometry
    92265Eye muscle evaluation
    92270Electro-oculography
    92283Color vision examination
    92285Eye photography
    92330Fitting of artificial eye
    92499Eye service or procedure
    0231Level II Eye TestsS2.64$128.01$59.87$25.60
    65205Remove foreign body from eye
    65210Remove foreign body from eye
    65220Remove foreign body from eye
    65222Remove foreign body from eye
    65430Corneal smear
    67350Biopsy eye muscle
    67500Inject/treat eye socket
    68110Remove eyelid lining lesion
    68761Close tear duct opening
    68801Dilate tear duct opening
    68810Probe nasolacrimal duct
    68840Explore/irrigate tear ducts
    68899Tear duct system surgery
    92018New eye exam & treatment
    92019Eye exam & treatment
    92135Opthalmic dx imaging
    92140Glaucoma provocative tests
    92226Special eye exam, subsequent
    92230Eye exam with photos
    92235Eye exam with photos
    92240Icg angiography
    92284Dark adaptation eye exam
    92286Internal eye photography
    92287Internal eye photography
    0232Level I Anterior Segment EyeT6.04$292.86$134.66$58.57
    65235Remove foreign body from eye
    65272Repair of eye wound
    65286Repair of eye wound
    65400Removal of eye lesion
    65436Curette/treat cornea
    65450Treatment of corneal lesion
    65772Correction of astigmatism
    65800Drainage of eye
    65820Relieve inner eye pressure
    65880Incise inner eye adhesions
    65900Remove eye lesion
    66020Injection treatment of eye
    66030Injection treatment of eye
    66500Incision of iris
    66505Incision of iris
    66625Removal of iris
    Start Printed Page 18747
    66700Destruction, ciliary body
    66710Destruction, ciliary body
    66720Destruction, ciliary body
    66820Incision, secondary cataract
    66830Removal of lens lesion
    67880Revision of eyelid
    68100Biopsy of eyelid lining
    0233Level II Anterior Segment EyeT13.79$668.64$331.60$133.73
    65275Repair of eye wound
    65280Repair of eye wound
    65410Biopsy of cornea
    65420Removal of eye lesion
    65426Removal of eye lesion
    65775Correction of astigmatism
    65805Drainage of eye
    65810Drainage of eye
    65815Drainage of eye
    65865Incise inner eye adhesions
    65870Incise inner eye adhesions
    65875Incise inner eye adhesions
    65920Remove implant from eye
    65930Remove blood clot from eye
    66130Remove eye lesion
    66150Glaucoma surgery
    66250Follow-up surgery of eye
    66600Remove iris and lesion
    66605Removal of iris
    66630Removal of iris
    66635Removal of iris
    66680Repair iris & ciliary body
    66682Repair iris & ciliary body
    66740Destruction, ciliary body
    66825Reposition intraocular lens
    68130Remove eyelid lining lesion
    68330Revise eyelid lining
    0234Level III Anterior Segment Eye ProceduresT20.64$1,000.77$502.16$200.15
    65285Repair of eye wound
    65850Incision of eye
    66155Glaucoma surgery
    66160Glaucoma surgery
    66165Glaucoma surgery
    66170Glaucoma surgery
    66172Incision of eye
    66180Implant eye shunt
    66185Revise eye shunt
    66225Repair/graft eye lesion
    68360Revise eyelid lining
    68362Revise eyelid lining
    0235Level I Posterior Segment Eye ProceduresT2.94$142.55$78.91$28.51
    67141Treatment of retina
    67208Treatment of retinal lesion
    67227Treatment of retinal lesion
    0236Level II Posterior Segment Eye ProceduresT6.70$324.86$147.96$64.97
    66220Repair eye lesion
    67028Injection eye drug
    67030Incise inner eye strands
    67101Repair detached retina
    67110Repair detached retina
    67115Release encircling material
    67120Remove eye implant material
    0237Level III Posterior Segment Eye ProceduresT33.96$1,646.62$852.68$329.32
    65260Remove foreign body from eye
    65265Remove foreign body from eye
    67005Partial removal of eye fluid
    67010Partial removal of eye fluid
    67015Release of eye fluid
    67025Replace eye fluid
    67027Implant eye drug system
    67036Removal of inner eye fluid
    67038Strip retinal membrane
    67039Laser treatment of retina
    67040Laser treatment of retina
    67107Repair detached retina
    Start Printed Page 18748
    67108Repair detached retina
    67112Rerepair detached retina
    67121Remove eye implant material
    67218Treatment of retinal lesion
    67220Treatment of choroid lesion
    67255Reinforce/graft eye wall
    0238Level I Repair and Plastic Eye ProceduresT2.80$135.76$58.96$27.15
    67345Destroy nerve of eye muscle
    67505Inject/treat eye socket
    67700Drainage of eyelid abscess
    67800Remove eyelid lesion
    67805Remove eyelid lesions
    67810Biopsy of eyelid
    67820Revise eyelashes
    67825Revise eyelashes
    67938Remove eyelid foreign body
    68400Incise/drain tear gland
    68440Incise tear duct opening
    68705Revise tear duct opening
    68760Close tear duct opening
    0239Level II Repair and Plastic Eye ProceduresT6.26$303.53$123.42$60.71
    65435Curette/treat cornea
    67415Aspiration, orbital contents
    67515Inject/treat eye socket
    67599Orbit surgery procedure
    67710Incision of eyelid
    67801Remove eyelid lesions
    67830Revise eyelashes
    67840Remove eyelid lesion
    67850Treat eyelid lesion
    67875Closure of eyelid by suture
    67915Repair eyelid defect
    67922Repair eyelid defect
    68040Treatment of eyelid lesions
    68115Remove eyelid lining lesion
    68135Remove eyelid lining lesion
    68399Eyelid lining surgery
    0240Level III Repair and Plastic Eye ProceduresT13.47$653.12$315.31$130.62
    65125Revise ocular implant
    65175Removal of ocular implant
    65270Repair of eye wound
    65600Revision of cornea
    67250Reinforce eye wall
    67715Incision of eyelid fold
    67808Remove eyelid lesion(s)
    67835Revise eyelashes
    67882Revision of eyelid
    67900Repair brow defect
    67901Repair eyelid defect
    67902Repair eyelid defect
    67903Repair eyelid defect
    67904Repair eyelid defect
    67906Repair eyelid defect
    67908Repair eyelid defect
    67909Revise eyelid defect
    67911Revise eyelid defect
    67914Repair eyelid defect
    67916Repair eyelid defect
    67917Repair eyelid defect
    67921Repair eyelid defect
    67923Repair eyelid defect
    67924Repair eyelid defect
    67930Repair eyelid wound
    67935Repair eyelid wound
    67950Revision of eyelid
    67961Revision of eyelid
    67966Revision of eyelid
    67975Reconstruction of eyelid
    67999Revision of eyelid
    68020Incise/drain eyelid lining
    68320Revise/graft eyelid lining
    68340Separate eyelid adhesions
    68420Incise/drain tear sac
    Start Printed Page 18749
    68510Biopsy of tear gland
    68525Biopsy of tear sac
    68530Clearance of tear duct
    68770Close tear system fistula
    68811Probe nasolacrimal duct
    68815Probe nasolacrimal duct
    0241Level IV Repair and Plastic Eye ProceduresT16.60$804.89$384.47$160.98
    65093Revise eye with implant
    65130Insert ocular implant
    65135Insert ocular implant
    65150Revise ocular implant
    67400Explore/biopsy eye socket
    67405Explore/drain eye socket
    67412Explore/treat eye socket
    67413Explore/treat eye socket
    67560Revise eye socket implant
    67971Reconstruction of eyelid
    67973Reconstruction of eyelid
    67974Reconstruction of eyelid
    68326Revise/graft eyelid lining
    68328Revise/graft eyelid lining
    68335Revise/graft eyelid lining
    68500Removal of tear gland
    68505Partial removal, tear gland
    68520Removal of tear sac
    68540Remove tear gland lesion
    68700Repair tear ducts
    68745Create tear duct drain
    0242Level V Repair and Plastic Eye ProceduresT23.70$1,149.14$597.36$229.83
    65091Revise eye
    65101Removal of eye
    65103Remove eye/insert implant
    65105Remove eye/attach implant
    65110Removal of eye
    65112Remove eye/revise socket
    65114Remove eye/revise socket
    65140Attach ocular implant
    65155Reinsert ocular implant
    67414Explr/decompress eye socket
    67420Explore/treat eye socket
    67430Explore/treat eye socket
    67440Explore/drain eye socket
    67445Explr/decompress eye socket
    67450Explore/biopsy eye socket
    67550Insert eye socket implant
    67570Decompress optic nerve
    68325Revise/graft eyelid lining
    68550Remove tear gland lesion
    68720Create tear sac drain
    68750Create tear duct drain
    0243Strabismus/Muscle ProceduresT17.99$872.28$431.39$174.46
    65290Repair of eye socket wound
    67311Revise eye muscle
    67312Revise two eye muscles
    67314Revise eye muscle
    67316Revise two eye muscles
    67318Revise eye muscle(s)
    67320Revise eye muscle(s) add-on
    67331Eye surgery follow-up add-on
    67332Rerevise eye muscles add-on
    67334Revise eye muscle w/suture
    67335Eye suture during surgery
    67340Revise eye muscle add-on
    67343Release eye tissue
    67399Eye muscle surgery procedure
    0244Corneal TransplantT32.88$1,594.26$851.42$318.85
    65710Corneal transplant
    65730Corneal transplant
    65750Corneal transplant
    65755Corneal transplant
    65770Revise cornea with implant
    0245Cataract Procedures without IOL InsertT26.55$1,287.33$623.85$257.47
    66840Removal of lens material
    Start Printed Page 18750
    66850Removal of lens material
    66852Removal of lens material
    66920Extraction of lens
    66930Extraction of lens
    66940Extraction of lens
    0246Cataract Procedures with IOL InsertT26.55$1,287.33$623.85$257.47
    66983Remove cataract/insert lens
    66984Remove cataract/insert lens
    66985Insert lens prosthesis
    66986Exchange lens prosthesis
    0247Laser Eye Procedures Except RetinalT4.89$237.10$112.86$47.42
    65855Laser surgery of eye
    65860Incise inner eye adhesions
    66761Revision of iris
    66762Revision of iris
    66770Removal of inner eye lesion
    66821After cataract laser surgery
    66999Eye surgery procedure
    67031Laser surgery, eye strands
    0248Laser Retinal ProceduresT4.19$203.16$94.05$40.63
    67105Repair detached retina
    67145Treatment of retina
    67210Treatment of retinal lesion
    67228Treatment of retinal lesion
    67299Eye surgery procedure
    0250Nasal Cauterization/PackingT2.21$107.16$38.54$21.43
    30901Control of nosebleed
    30903Control of nosebleed
    30905Control of nosebleed
    30906Repeat control of nosebleed
    42960Control throat bleeding
    42970Control nose/throat bleeding
    0251Level I ENT ProceduresT1.68$81.46$27.99$16.29
    21450Treat lower jaw fracture
    21480Reset dislocated jaw
    30000Drainage of nose lesion
    30020Drainage of nose lesion
    30300Remove nasal foreign body
    30560Release of nasal adhesions
    30999Nasal surgery procedure
    31000Irrigation, maxillary sinus
    40800Drainage of mouth lesion
    40804Removal, foreign body, mouth
    40806Incision of lip fold
    40808Biopsy of mouth lesion
    40818Excise oral mucosa for graft
    40830Repair mouth laceration
    41005Drainage of mouth lesion
    41009Drainage of mouth lesion
    41250Repair tongue laceration
    41599Tongue and mouth surgery
    41800Drainage of gum lesion
    42000Drainage mouth roof lesion
    42180Repair palate
    42280Preparation, palate mold
    42299Palate/uvula surgery
    42310Drainage of salivary gland
    42320Drainage of salivary gland
    42700Drainage of tonsil abscess
    42809Remove pharynx foreign body
    69400Inflate middle ear canal
    92502Ear and throat examination
    0252Level II ENT ProceduresT5.18$251.16$114.24$50.23
    20500Injection of sinus tract
    21400Treat eye socket fracture
    21493Treat hyoid bone fracture
    21494Treat hyoid bone fracture
    21899Neck/chest surgery procedure
    30100Intranasal biopsy
    30124Removal of nose lesion
    30210Nasal sinus therapy
    30220Insert nasal septal button
    30801Cauterization, inner nose
    Start Printed Page 18751
    31002Irrigation, sphenoid sinus
    31299Sinus surgery procedure
    40490Biopsy of lip
    40801Drainage of mouth lesion
    40805Removal, foreign body, mouth
    40812Excise/repair mouth lesion
    40819Excise lip or cheek fold
    40899Mouth surgery procedure
    41015Drainage of mouth lesion
    41100Biopsy of tongue
    41108Biopsy of floor of mouth
    41820Excision, gum, each quadrant
    41821Excision of gum flap
    42100Biopsy roof of mouth
    42140Excision of uvula
    42325Create salivary cyst drain
    42326Create salivary cyst drain
    42330Removal of salivary stone
    42650Dilation of salivary duct
    42660Dilation of salivary duct
    42800Biopsy of throat
    42999Throat surgery procedure
    69399Outer ear surgery procedure
    69405Catheterize middle ear canal
    69410Inset middle ear (baffle)
    69420Incision of eardrum
    69424Remove ventilating tube
    69433Create eardrum opening
    69979Temporal bone surgery
    0253Level III ENT ProceduresT12.02$582.81$284.00$116.56
    21031Remove exostosis, mandible
    21032Remove exostosis, maxilla
    21040Removal of jaw bone lesion
    21085Prepare face/oral prosthesis
    21089Prepare face/oral prosthesis
    21282Revision of eyelid
    21295Revision of jaw muscle/bone
    21299Cranio/maxillofacial surgery
    21300Treatment of skull fracture
    21310Treatment of nose fracture
    21315Treatment of nose fracture
    21320Treatment of nose fracture
    21325Treatment of nose fracture
    21337Treat nasal septal fracture
    21401Treat eye socket fracture
    21440Treat dental ridge fracture
    21452Treat lower jaw fracture
    21485Reset dislocated jaw
    21497Interdental wiring
    21499Head surgery procedure
    30110Removal of nose polyp(s)
    30115Removal of nose polyp(s)
    30117Removal of intranasal lesion
    30120Revision of nose
    30130Removal of turbinate bones
    30140Removal of turbinate bones
    30200Injection treatment of nose
    30310Remove nasal foreign body
    30320Remove nasal foreign body
    30802Cauterization, inner nose
    30930Therapy, fracture of nose
    31020Exploration, maxillary sinus
    31585Treat larynx fracture
    31599Larynx surgery procedure
    31612Puncture/clear windpipe
    31820Closure of windpipe lesion
    40500Partial excision of lip
    40520Partial excision of lip
    40650Repair lip
    40652Repair lip
    40799Lip surgery procedure
    40810Excision of mouth lesion
    40814Excise/repair mouth lesion
    Start Printed Page 18752
    40816Excision of mouth lesion
    40820Treatment of mouth lesion
    40831Repair mouth laceration
    41000Drainage of mouth lesion
    41006Drainage of mouth lesion
    41007Drainage of mouth lesion
    41008Drainage of mouth lesion
    41010Incision of tongue fold
    41016Drainage of mouth lesion
    41017Drainage of mouth lesion
    41018Drainage of mouth lesion
    41105Biopsy of tongue
    41110Excision of tongue lesion
    41112Excision of tongue lesion
    41113Excision of tongue lesion
    41115Excision of tongue fold
    41116Excision of mouth lesion
    41251Repair tongue laceration
    41252Repair tongue laceration
    41500Fixation of tongue
    41510Tongue to lip surgery
    41520Reconstruction, tongue fold
    41805Removal foreign body, gum
    41806Removal foreign body, jawbone
    41822Excision of gum lesion
    41823Excision of gum lesion
    41825Excision of gum lesion
    41826Excision of gum lesion
    41827Excision of gum lesion
    41828Excision of gum lesion
    41830Removal of gum tissue
    41850Treatment of gum lesion
    41870Gum graft
    41872Repair gum
    41874Repair tooth socket
    41899Dental surgery procedure
    42104Excision lesion, mouth roof
    42106Excision lesion, mouth roof
    42160Treatment mouth roof lesion
    42260Repair nose to lip fistula
    42281Insertion, palate prosthesis
    42300Drainage of salivary gland
    42305Drainage of salivary gland
    42335Removal of salivary stone
    42340Removal of salivary stone
    42405Biopsy of salivary gland
    42408Excision of salivary cyst
    42409Drainage of salivary cyst
    42450Excise sublingual gland
    42600Closure of salivary fistula
    42665Ligation of salivary duct
    42699Salivary surgery procedure
    42720Drainage of throat abscess
    42802Biopsy of throat
    42804Biopsy of upper nose/throat
    42806Biopsy of upper nose/throat
    42808Excise pharynx lesion
    42810Excision of neck cyst
    42900Repair throat wound
    42972Control nose/throat bleeding
    60000Drain thyroid/tongue cyst
    69105Biopsy of external ear canal
    69120Removal of external ear
    69222Clean out mastoid cavity
    69421Incision of eardrum
    69436Create eardrum opening
    69440Exploration of middle ear
    69540Remove ear lesion
    69610Repair of eardrum
    69620Repair of eardrum
    69799Middle ear surgery procedure
    69949Inner ear surgery procedure
    0254Level IV ENT ProceduresT12.45$603.66$272.41$120.73
    Start Printed Page 18753
    21010Incision of jaw joint
    21015Resection of facial tumor
    21030Removal of face bone lesion
    21076Prepare face/oral prosthesis
    21110Interdental fixation
    21120Reconstruction of chin
    21121Reconstruction of chin
    21122Reconstruction of chin
    21123Reconstruction of chin
    21125Augmentation, lower jaw bone
    21137Reduction of forehead
    21181Contour cranial bone lesion
    21235Ear cartilage graft
    21296Revision of jaw muscle/bone
    21330Treatment of nose fracture
    21335Treatment of nose fracture
    21338Treat nasoethmoid fracture
    21339Treat nasoethmoid fracture
    21345Treat nose/jaw fracture
    21421Treat mouth roof fracture
    21445Treat dental ridge fracture
    21451Treat lower jaw fracture
    21454Treat lower jaw fracture
    30118Removal of intranasal lesion
    30430Revision of nose
    30630Repair nasal septum defect
    31040Exploration behind upper jaw
    31070Exploration of frontal sinus
    31600Incision of windpipe
    31601Incision of windpipe
    31603Incision of windpipe
    31605Incision of windpipe
    31610Incision of windpipe
    31611Surgery/speech prosthesis
    31613Repair windpipe opening
    31825Repair of windpipe defect
    31830Revise windpipe scar
    40510Partial excision of lip
    40525Reconstruct lip with flap
    40527Reconstruct lip with flap
    40530Partial removal of lip
    40654Repair lip
    40840Reconstruction of mouth
    40842Reconstruction of mouth
    40843Reconstruction of mouth
    41114Excision of tongue lesion
    42107Excision lesion, mouth roof
    42145Repair palate, pharynx/uvula
    42235Repair palate
    42500Repair salivary duct
    42950Reconstruction of throat
    42955Surgical opening of throat
    43020Incision of esophagus
    69140Remove ear canal lesion(s)
    69300Revise external ear
    69650Release middle ear bone
    0256Level V ENT ProceduresT25.40$1,231.57$623.05$246.31
    21025Excision of bone, lower jaw
    21026Excision of facial bone(s)
    21029Contour of face bone lesion
    21034Removal of face bone lesion
    21041Removal of jaw bone lesion
    21044Removal of jaw bone lesion
    21050Removal of jaw joint
    21060Remove jaw joint cartilage
    21070Remove coronoid process
    21077Prepare face/oral prosthesis
    21079Prepare face/oral prosthesis
    21080Prepare face/oral prosthesis
    21081Prepare face/oral prosthesis
    21082Prepare face/oral prosthesis
    21083Prepare face/oral prosthesis
    21084Prepare face/oral prosthesis
    Start Printed Page 18754
    21086Prepare face/oral prosthesis
    21087Prepare face/oral prosthesis
    21088Prepare face/oral prosthesis
    21100Maxillofacial fixation
    21127Augmentation, lower jaw bone
    21138Reduction of forehead
    21139Reduction of forehead
    21198Reconstruct lower jaw bone
    21206Reconstruct upper jaw bone
    21208Augmentation of facial bones
    21209Reduction of facial bones
    21210Face bone graft
    21215Lower jaw bone graft
    21230Rib cartilage graft
    21240Reconstruction of jaw joint
    21242Reconstruction of jaw joint
    21243Reconstruction of jaw joint
    21244Reconstruction of lower jaw
    21245Reconstruction of jaw
    21246Reconstruction of jaw
    21248Reconstruction of jaw
    21249Reconstruction of jaw
    21260Revise eye sockets
    21261Revise eye sockets
    21263Revise eye sockets
    21267Revise eye sockets
    21270Augmentation, cheek bone
    21275Revision, orbitofacial bones
    21280Revision of eyelid
    21340Treatment of nose fracture
    21355Treat cheek bone fracture
    21406Treat eye socket fracture
    21407Treat eye socket fracture
    21453Treat lower jaw fracture
    21461Treat lower jaw fracture
    21462Treat lower jaw fracture
    21465Treat lower jaw fracture
    21470Treat lower jaw fracture
    21490Repair dislocated jaw
    30125Removal of nose lesion
    30150Partial removal of nose
    30160Removal of nose
    30400Reconstruction of nose
    30410Reconstruction of nose
    30420Reconstruction of nose
    30435Revision of nose
    30450Revision of nose
    30460Revision of nose
    30462Revision of nose
    30520Repair of nasal septum
    30540Repair nasal defect
    30545Repair nasal defect
    30580Repair upper jaw fistula
    30600Repair mouth/nose fistula
    30620Intranasal reconstruction
    31030Exploration, maxillary sinus
    31032Explore sinus, remove polyps
    31050Exploration, sphenoid sinus
    31051Sphenoid sinus surgery
    31075Exploration of frontal sinus
    31080Removal of frontal sinus
    31081Removal of frontal sinus
    31084Removal of frontal sinus
    31085Removal of frontal sinus
    31086Removal of frontal sinus
    31087Removal of frontal sinus
    31090Exploration of sinuses
    31200Removal of ethmoid sinus
    31201Removal of ethmoid sinus
    31205Removal of ethmoid sinus
    31300Removal of larynx lesion
    31320Diagnostic incision, larynx
    31375Partial removal of larynx
    Start Printed Page 18755
    31400Revision of larynx
    31420Removal of epiglottis
    31580Revision of larynx
    31586Treat larynx fracture
    31588Revision of larynx
    31590Reinnervate larynx
    31595Larynx nerve surgery
    31614Repair windpipe opening
    31750Repair of windpipe
    31755Repair of windpipe
    40700Repair cleft lip/nasal
    40701Repair cleft lip/nasal
    40702Repair cleft lip/nasal
    40720Repair cleft lip/nasal
    40761Repair cleft lip/nasal
    40844Reconstruction of mouth
    40845Reconstruction of mouth
    41120Partial removal of tongue
    42120Remove palate/lesion
    42182Repair palate
    42200Reconstruct cleft palate
    42205Reconstruct cleft palate
    42210Reconstruct cleft palate
    42215Reconstruct cleft palate
    42220Reconstruct cleft palate
    42225Reconstruct cleft palate
    42226Lengthening of palate
    42227Lengthening of palate
    42410Excise parotid gland/lesion
    42415Excise parotid gland/lesion
    42420Excise parotid gland/lesion
    42425Excise parotid gland/lesion
    42440Excise submaxillary gland
    42505Repair salivary duct
    42507Parotid duct diversion
    42508Parotid duct diversion
    42509Parotid duct diversion
    42510Parotid duct diversion
    42725Drainage of throat abscess
    42815Excision of neck cyst
    42844Extensive surgery of throat
    42890Partial removal of pharynx
    42892Revision of pharyngeal walls
    42962Control throat bleeding
    60500Explore parathyroid glands
    61330Decompress eye socket
    69310Rebuild outer ear canal
    69320Rebuild outer ear canal
    69450Eardrum revision
    69501Mastoidectomy
    69505Remove mastoid structures
    69511Extensive mastoid surgery
    69530Extensive mastoid surgery
    69550Remove ear lesion
    69552Remove ear lesion
    69601Mastoid surgery revision
    69602Mastoid surgery revision
    69603Mastoid surgery revision
    69604Mastoid surgery revision
    69605Mastoid surgery revision
    69631Repair eardrum structures
    69632Rebuild eardrum structures
    69633Rebuild eardrum structures
    69635Repair eardrum structures
    69636Rebuild eardrum structures
    69637Rebuild eardrum structures
    69641Revise middle ear & mastoid
    69642Revise middle ear & mastoid
    69643Revise middle ear & mastoid
    69644Revise middle ear & mastoid
    69645Revise middle ear & mastoid
    69646Revise middle ear & mastoid
    69660Revise middle ear bone
    Start Printed Page 18756
    69661Revise middle ear bone
    69662Revise middle ear bone
    69666Repair middle ear structures
    69667Repair middle ear structures
    69670Remove mastoid air cells
    69676Remove middle ear nerve
    69700Close mastoid fistula
    69711Remove/repair hearing aid
    69720Release facial nerve
    69725Release facial nerve
    69740Repair facial nerve
    69745Repair facial nerve
    69801Incise inner ear
    69802Incise inner ear
    69805Explore inner ear
    69806Explore inner ear
    69820Establish inner ear window
    69840Revise inner ear window
    69905Remove inner ear
    69910Remove inner ear & mastoid
    69915Incise inner ear nerve
    69955Release facial nerve
    69960Release inner ear canal
    0257Implantation of Cochlear DeviceT115.31$5,591.04$3,498.58$1,118.21
    69930Implant cochlear device
    0258Tonsil and Adenoid ProceduresT18.62$902.83$462.81$180.57
    42820Remove tonsils and adenoids
    42821Remove tonsils and adenoids
    42825Removal of tonsils
    42826Removal of tonsils
    42830Removal of adenoids
    42831Removal of adenoids
    42835Removal of adenoids
    42836Removal of adenoids
    42860Excision of tonsil tags
    42870Excision of lingual tonsil
    0260Level I Plain Film Except TeethX0.79$38.30$22.02$7.66
    70030X-ray eye for foreign body
    70100X-ray exam of jaw
    70110X-ray exam of jaw
    70120X-ray exam of mastoids
    70130X-ray exam of mastoids
    70140X-ray exam of facial bones
    70150X-ray exam of facial bones
    70160X-ray exam of nasal bones
    70190X-ray exam of eye sockets
    70200X-ray exam of eye sockets
    70210X-ray exam of sinuses
    70220X-ray exam of sinuses
    70240X-ray exam, pituitary saddle
    70250X-ray exam of skull
    70328X-ray exam of jaw joint
    70330X-ray exam of jaw joints
    70350X-ray head for orthodontia
    70355Panoramic x-ray of jaws
    70360X-ray exam of neck
    70380X-ray exam of salivary gland
    71010Chest x-ray
    71015Chest x-ray
    71020Chest x-ray
    71021Chest x-ray
    71022Chest x-ray
    71030Chest x-ray
    71035Chest x-ray
    71100X-ray exam of ribs
    71101X-ray exam of ribs/chest
    71110X-ray exam of ribs
    71120X-ray exam of breastbone
    71130X-ray exam of breastbone
    72020X-ray exam of spine
    72040X-ray exam of neck spine
    72069X-ray exam of trunk spine
    72070X-ray exam of thoracic spine
    Start Printed Page 18757
    72072X-ray exam of thoracic spine
    72074X-ray exam of thoracic spine
    72080X-ray exam of trunk spine
    72090X-ray exam of trunk spine
    72100X-ray exam of lower spine
    72120X-ray exam of lower spine
    72170X-ray exam of pelvis
    72190X-ray exam of pelvis
    72200X-ray exam sacroiliac joints
    72202X-ray exam sacroiliac joints
    72220X-ray exam of tailbone
    73000X-ray exam of collar bone
    73010X-ray exam of shoulder blade
    73020X-ray exam of shoulder
    73030X-ray exam of shoulder
    73050X-ray exam of shoulders
    73060X-ray exam of humerus
    73070X-ray exam of elbow
    73080X-ray exam of elbow
    73090X-ray exam of forearm
    73092X-ray exam of arm, infant
    73100X-ray exam of wrist
    73110X-ray exam of wrist
    73120X-ray exam of hand
    73130X-ray exam of hand
    73140X-ray exam of finger(s)
    73500X-ray exam of hip
    73510X-ray exam of hip
    73520X-ray exam of hips
    73540X-ray exam of pelvis & hips
    73550X-ray exam of thigh
    73560X-ray exam of knee, 1 or 2
    73562X-ray exam of knee, 3
    73564X-ray exam, knee, 4 or more
    73565X-ray exam of knees
    73590X-ray exam of lower leg
    73600X-ray exam of ankle
    73610X-ray exam of ankle
    73620X-ray exam of foot
    73630X-ray exam of foot
    73650X-ray exam of heel
    73660X-ray exam of toe(s)
    74000X-ray exam of abdomen
    74010X-ray exam of abdomen
    74020X-ray exam of abdomen
    74710X-ray measurement of pelvis
    76010X-ray, nose to rectum
    76040X-rays, bone evaluation
    76066Joint(s) survey, single film
    76098X-ray exam, breast specimen
    76150X-ray exam, dry process
    76499Radiographic procedure
    77417Radiology port film(s)
    0261Level II Plain Film Except Teeth Including Bone Density MeasurementX1.38$66.91$38.77$13.38
    70134X-ray exam of middle ear
    70260X-ray exam of skull
    71111X-ray exam of ribs/chest
    72010X-ray exam of spine
    72050X-ray exam of neck spine
    72052X-ray exam of neck spine
    72110X-ray exam of lower spine
    72114X-ray exam of lower spine
    73530X-ray exam of hip
    73592X-ray exam of leg, infant
    74022X-ray exam series, abdomen
    76006X-ray stress view
    76020X-rays for bone age
    76061X-rays, bone survey
    76062X-rays, bone survey
    76065X-rays, bone evaluation
    76075Dual energy x-ray study
    76076Dual energy x-ray study
    76078Photodensitometry
    Start Printed Page 18758
    76100X-ray exam of body section
    76120Cinematic x-rays
    76125Cinematic x-rays add-on
    78350Bone mineral, single photon
    G0130Single energy x-ray study
    G0131CT scan, bone density study
    G0132CT scan, bone density study
    0262Plain Film of TeethX0.40$19.39$10.90$3.88
    70300X-ray exam of teeth
    70310X-ray exam of teeth
    70320Full mouth x-ray of teeth
    0263Level I Miscellaneous Radiology ProceduresX1.68$81.46$45.88$16.29
    70170X-ray exam of tear duct
    70373Contrast x-ray of larynx
    70390X-ray exam of salivary duct
    71040Contrast x-ray of bronchi
    71060Contrast x-ray of bronchi
    74190X-ray exam of peritoneum
    74305X-ray bile ducts/pancreas
    76080X-ray exam of fistula
    76086X-ray of mammary duct
    76088X-ray of mammary ducts
    76096X-ray of needle wire, breast
    76101Complex body section x-ray
    0264Level II Miscellaneous Radiology ProceduresX3.83$185.71$108.97$37.14
    74320Contrast x-ray of bile ducts
    74328X-ray bile duct endoscopy
    74329X-ray for pancreas endoscopy
    74330X-ray bile/panc endoscopy
    74350X-ray guide, stomach tube
    74355X-ray guide, intestinal tube
    74470X-ray exam of kidney lesion
    74740X-ray, female genital tract
    74742X-ray, fallopian tube
    75801Lymph vessel x-ray, arm/leg
    75803Lymph vessel x-ray, arms/legs
    75805Lymph vessel x-ray, trunk
    75807Lymph vessel x-ray, trunk
    75809Nonvascular shunt, x-ray
    75898Follow-up angiogram
    76095Stereotactic breast biopsy
    76102Complex body section x-rays
    0265Level I Diagnostic Ultrasound Except VascularS1.17$56.73$38.08$11.35
    76513Echo exam of eye, water bath
    76529Echo exam of eye
    76536Echo exam of head and neck
    76645Echo exam of breast(s)
    76810Echo exam of pregnant uterus
    76815Echo exam of pregnant uterus
    76816Echo exam follow-up/repeat
    76857Echo exam of pelvis
    76970Ultrasound exam follow-up
    76977Us bone density measure
    G0050Residual urine by ultrasound
    0266Level II Diagnostic Ultrasound Except VascularS1.79$86.79$57.35$17.36
    76506Echo exam of head
    76511Echo exam of eye
    76512Echo exam of eye
    76516Echo exam of eye
    76519Echo exam of eye
    76604Echo exam of chest
    76700Echo exam of abdomen
    76705Echo exam of abdomen
    76770Echo exam abdomen back wall
    76775Echo exam abdomen back wall
    76778Echo exam kidney transplant
    76800Echo exam spinal canal
    76805Echo exam of pregnant uterus
    76818Fetal biophysical profile
    76830Echo exam, transvaginal
    76831Echo exam, uterus
    76856Echo exam of pelvis
    76870Echo exam of scrotum
    Start Printed Page 18759
    76872Echo exam, transrectal
    76873Echograp trans r, pros study
    76880Echo exam of extremity
    76885Echo exam, infant hips
    76886Echo exam, infant hips
    76975GI endoscopic ultrasound
    76986Echo exam at surgery
    76999Echo examination procedure
    0267Vascular UltrasoundS2.72$131.88$80.06$26.38
    93880Extracranial study
    93882Extracranial study
    93886Intracranial study
    93888Intracranial study
    93925Lower extremity study
    93926Lower extremity study
    93930Upper extremity study
    93931Upper extremity study
    93970Extremity study
    93971Extremity study
    93975Vascular study
    93976Vascular study
    93978Vascular study
    93979Vascular study
    93980Penile vascular study
    93981Penile vascular study
    93990Doppler flow testing
    0268Guidance Under UltrasoundX2.23$108.13$69.51$21.63
    76930Echo guide for heart sac tap
    76932Echo guide for heart biopsy
    76934Echo guide for chest tap
    76936Echo guide for artery repair
    76938Echo exam for drainage
    76941Echo guide for transfusion
    76942Echo guide for biopsy
    76945Echo guide, villus sampling
    76946Echo guide for amniocentesis
    76948Echo guide, ova aspiration
    76950Echo guidance radiotherapy
    76960Echo guidance radiotherapy
    76965Echo guidance radiotherapy
    G0161Echo guide for cryo probes
    0269Echocardiogram Except TransesophagealS4.40$213.34$114.01$42.67
    76825Echo exam of fetal heart
    76826Echo exam of fetal heart
    76827Echo exam of fetal heart
    76828Echo exam of fetal heart
    93303Echo transthoracic
    93304Echo transthoracic
    93307Echo exam of heart
    93308Echo exam of heart
    93320Doppler echo exam, heart
    93321Doppler echo exam, heart
    93325Doppler color flow add-on
    93350Echo transthoracic
    0270Transesophageal EchocardiogramS5.55$269.10$150.26$53.82
    93312Echo transesophageal
    93313Echo transesophageal
    93315Echo transesophageal
    93316Echo transesophageal
    0271MammographyS0.70$33.94$19.50$6.79
    76090Mammogram, one breast
    76091Mammogram, both breasts
    0272Level I FluoroscopyX1.40$67.88$39.00$13.58
    70371Speech evaluation, complex
    71023Chest x-ray and fluoroscopy
    71034Chest x-ray and fluoroscopy
    74340X-ray guide for GI tube
    76000Fluoroscope examination
    76003Needle localization by x-ray
    0273Level II FluoroscopyX2.49$120.73$61.02$24.15
    70370Throat x-ray & fluoroscopy
    71036X-ray guidance for biopsy
    71090X-ray & pacemaker insertion
    Start Printed Page 18760
    75989Abscess drainage under x-ray
    76001Fluoroscope exam, extensive
    76005Fluoroguide for spine inject
    0274MyelographyS4.83$234.19$128.12$46.84
    70010Contrast x-ray of brain
    70015Contrast x-ray of brain
    72240Contrast x-ray of neck spine
    72255Contrast x-ray, thorax spine
    72265Contrast x-ray, lower spine
    72270Contrast x-ray of spine
    72275Epidurography
    72285X-ray c/t spine disk
    72295X-ray of lower spine disk
    0275ArthrographyS2.74$132.85$72.26$26.57
    70332X-ray exam of jaw joint
    73040Contrast x-ray of shoulder
    73085Contrast x-ray of elbow
    73115Contrast x-ray of wrist
    73525Contrast x-ray of hip
    73542X-ray exam, sacroiliac joint
    73580Contrast x-ray of knee joint
    73615Contrast x-ray of ankle
    0276Level I Digestive RadiologyS1.79$86.79$49.78$17.36
    74210Contrst x-ray exam of throat
    74220Contrast x-ray, esophagus
    74230Cinema x-ray, throat/esoph
    74240X-ray exam, upper gi tract
    74241X-ray exam, upper gi tract
    74246Contrst x-ray uppr gi tract
    74247Contrst x-ray uppr gi tract
    74250X-ray exam of small bowel
    74270Contrast x-ray exam of colon
    74283Contrast x-ray exam of colon
    74290Contrast x-ray, gallbladder
    74291Contrast x-rays, gallbladder
    0277Level II Digestive RadiologyS2.47$119.76$69.28$23.95
    74245X-ray exam, upper gi tract
    74249Contrst x-ray uppr gi tract
    74251X-ray exam of small bowel
    74260X-ray exam of small bowel
    74280Contrast x-ray exam of colon
    0278Diagnostic UrographyS2.85$138.19$81.67$27.64
    74400Contrst x-ray, urinary tract
    74410Contrst x-ray, urinary tract
    74415Contrst x-ray, urinary tract
    74420Contrst x-ray, urinary tract
    74425Contrst x-ray, urinary tract
    74430Contrast x-ray, bladder
    74440X-ray, male genital tract
    74445X-ray exam of penis
    74450X-ray, urethra/bladder
    74455X-ray, urethra/bladder
    74775X-ray exam of perineum
    0279Level I Diagnostic Angiography and Venography Except ExtremityS6.30$305.47$174.57$61.09
    75660Artery x-rays, head & neck
    75662Artery x-rays, head & neck
    75685Artery x-rays, spine
    75705Artery x-rays, spine
    75741Artery x-rays, lung
    75746Artery x-rays, lung
    75756Artery x-rays, chest
    75810Vein x-ray, spleen/liver
    75825Vein x-ray, trunk
    75827Vein x-ray, chest
    75831Vein x-ray, kidney
    75833Vein x-ray, kidneys
    75840Vein x-ray, adrenal gland
    75842Vein x-ray, adrenal glands
    75860Vein x-ray, neck
    75870Vein x-ray, skull
    75872Vein x-ray, skull
    75880Vein x-ray, eye socket
    75885Vein x-ray, liver
    Start Printed Page 18761
    75889Vein x-ray, liver
    75891Vein x-ray, liver
    0280Level II Diagnostic Angiography and Venography Except ExtremityS14.98$726.34$380.12$145.27
    75600Contrast x-ray exam of aorta
    75605Contrast x-ray exam of aorta
    75625Contrast x-ray exam of aorta
    75630X-ray aorta, leg arteries
    75650Artery x-rays, head & neck
    75658Artery x-rays, arm
    75665Artery x-rays, head & neck
    75671Artery x-rays, head & neck
    75676Artery x-rays, neck
    75680Artery x-rays, neck
    75710Artery x-rays, arm/leg
    75716Artery x-rays, arms/legs
    75722Artery x-rays, kidney
    75724Artery x-rays, kidneys
    75726Artery x-rays, abdomen
    75731Artery x-rays, adrenal gland
    75733Artery x-rays, adrenals
    75736Artery x-rays, pelvis
    75743Artery x-rays, lungs
    75774Artery x-ray, each vessel
    75887Vein x-ray, liver
    0281Venography of ExtremityS4.40$213.34$115.16$42.67
    75790Visualize A-V shunt
    75820Vein x-ray, arm/leg
    75822Vein x-ray, arms/legs
    0282Level I Computerized Axial TomographyS2.38$115.40$94.51$23.08
    70486Cat scan of face/jaw
    76370CAT scan for therapy guide
    763753d/holograph reconstr add-on
    76380CAT scan follow-up study
    0283Level II Computerized Axial TomographyS4.89$237.10$179.39$47.42
    70450CAT scan of head or brain
    70460Contrast CAT scan of head
    70470Contrast CAT scans of head
    70480CAT scan of skull
    70481Contrast CAT scan of skull
    70482Contrast CAT scans of skull
    70487Contrast CAT scan, face/jaw
    70488Contrast cat scans, face/jaw
    70490CAT scan of neck tissue
    70491Contrast CAT of neck tissue
    70492Contrast CAT of neck tissue
    71250Cat scan of chest
    71260Contrast CAT scan of chest
    71270Contrast CAT scans of chest
    72125CAT scan of neck spine
    72126Contrast CAT scan of neck
    72127Contrast CAT scans of neck
    72128CAT scan of thorax spine
    72129Contrast CAT scan of thorax
    72130Contrast CAT scans of thorax
    72131CAT scan of lower spine
    72132Contrast CAT of lower spine
    72133Contrst cat scans, low spine
    72192CAT scan of pelvis
    72193Contrast CAT scan of pelvis
    72194Contrast CAT scans of pelvis
    73200CAT scan of arm
    73201Contrast CAT scan of arm
    73202Contrast CAT scans of arm
    73700CAT scan of leg
    73701Contrast CAT scan of leg
    73702Contrast CAT scans of leg
    74150CAT scan of abdomen
    74160Contrast CAT scan of abdomen
    74170Contrast CAT scans, abdomen
    76355CAT scan for localization
    76360CAT scan for needle biopsy
    76365CAT scan for cyst aspiration
    0284Magnetic Resonance ImagingS8.02$388.87$257.39$77.77
    Start Printed Page 18762
    70336Magnetic image, jaw joint
    70540Magnetic image, face/neck
    70541Magnetic image, head (MRA)
    70551Magnetic image, brain (MRI)
    70552Magnetic image, brain (MRI)
    70553Magnetic image, brain (mri)
    71550Magnetic image, chest (mri)
    72141Magnetic image, neck spine
    72142Magnetic image, neck spine
    72146Magnetic image, chest spine
    72147Magnetic image, chest spine
    72148Magnetic image, lumbar spine
    72149Magnetic image, lumbar spine
    72156Magnetic image, neck spine
    72157Magnetic image, chest spine
    72158Magnetic image, lumbar spine
    72196Magnetic image, pelvis
    73220Magnetic image, arm/hand
    73221Magnetic image, joint of arm
    73720Magnetic image, leg/foot
    73721Magnetic image, joint of leg
    74181Magnetic image/abdomen (mri)
    75552Magnetic image, myocardium
    75553Magnetic image, myocardium
    75554Cardiac MRI/function
    75555Cardiac MRI/limited study
    76093Magnetic image, breast
    76094Magnetic image, both breasts
    76390Mr spectroscopy
    76400Magnetic image, bone marrow
    0285Positron Emission Tomography (PET)S15.06$730.22$415.21$146.04
    G0030PET imaging prev PET single
    G0031PET imaging prev PET multple
    G0032PET follow SPECT 78464 singl
    G0033PET follow SPECT 78464 mult
    G0034PET follow SPECT 76865 singl
    G0035PET follow SPECT 78465 mult
    G0036PET follow cornry angio sing
    G0037PET follow cornry angio mult
    G0038PET follow myocard perf sing
    G0039PET follow myocard perf mult
    G0040PET follow stress echo singl
    G0041PET follow stress echo mult
    G0042PET follow ventriculogm sing
    G0043PET follow ventriculogm mult
    G0044PET following rest ECG singl
    G0045PET following rest ECG mult
    G0046PET follow stress ECG singl
    G0047PET follow stress ECG mult
    0286Myocardial ScansS7.28$352.99$200.04$70.60
    78460Heart muscle blood, single
    78461Heart muscle blood, multiple
    78464Heart image (3d), single
    78465Heart image (3d), multiple
    78472Gated heart, planar, single
    78473Gated heart, multiple
    78478Heart wall motion add-on
    78480Heart function add-on
    78481Heart first pass, single
    78483Heart first pass, multiple
    0290Standard Non-Imaging Nuclear MedicineS1.94$94.06$55.51$18.81
    78000Thyroid, single uptake
    78001Thyroid, multiple uptakes
    78003Thyroid suppress/stimul
    78010Thyroid imaging
    78011Thyroid imaging with flow
    78099Endocrine nuclear procedure
    78199Blood/lymph nuclear exam
    78270Vit B-12 absorption exam
    78271Vit B-12 absorp exam, IF
    78282GI protein loss exam
    78299GI nuclear procedure
    78399Musculoskeletal nuclear exam
    Start Printed Page 18763
    0291Level I Diagnostic Nuclear Medicine Excluding Myocardial ScansS3.15$152.73$93.14$30.55
    78006Thyroid imaging with uptake
    78007Thyroid image, mult uptakes
    78015Thyroid met imaging
    78102Bone marrow imaging, ltd
    78110Plasma volume, single
    78111Plasma volume, multiple
    78120Red cell mass, single
    78121Red cell mass, multiple
    78185Spleen imaging
    78190Platelet survival, kinetics
    78191Platelet survival
    78201Liver imaging
    78202Liver imaging with flow
    78215Liver and spleen imaging
    78216Liver & spleen image/flow
    78230Salivary gland imaging
    78231Serial salivary imaging
    78232Salivary gland function exam
    78258Esophageal motility study
    78261Gastric mucosa imaging
    78262Gastroesophageal reflux exam
    78272Vit B-12 absorp, combined
    78290Meckel's divert exam
    78300Bone imaging, limited area
    78445Vascular flow imaging
    78455Venous thrombosis study
    78456Acute venous thrombus image
    78457Venous thrombosis imaging
    78458Ven thrombosis images, bilat
    78580Lung perfusion imaging
    78591Vent image, 1 breath, 1 proj
    78599Respiratory nuclear exam
    78605Brain imaging, complete
    78610Brain flow imaging only
    78660Nuclear exam of tear flow
    78700Kidney imaging, static
    78701Kidney imaging with flow
    78715Renal vascular flow exam
    78725Kidney function study
    78730Urinary bladder retention
    78740Ureteral reflux study
    78760Testicular imaging
    78761Testicular imaging/flow
    78999Nuclear diagnostic exam
    0292Level II Diagnostic Nuclear Medicine Excluding Myocardial ScansS4.36$211.40$126.63$42.28
    78016Thyroid met imaging/studies
    78018Thyroid met imaging, body
    78020Thyroid met uptake
    78070Parathyroid nuclear imaging
    78075Adrenal nuclear imaging
    78103Bone marrow imaging, mult
    78104Bone marrow imaging, body
    78122Blood volume
    78130Red cell survival study
    78135Red cell survival kinetics
    78140Red cell sequestration
    78160Plasma iron turnover
    78162Iron absorption exam
    78170Red cell iron utilization
    78172Total body iron estimation
    78195Lymph system imaging
    78205Liver imaging (3D)
    78206Liver image (3d) w/flow
    78220Liver function study
    78223Hepatobiliary imaging
    78264Gastric emptying study
    78278Acute GI blood loss imaging
    78291Leveen/shunt patency exam
    78305Bone imaging, multiple areas
    78306Bone imaging, whole body
    78315Bone imaging, 3 phase
    78320Bone imaging (3D)
    Start Printed Page 18764
    78414Non-imaging heart function
    78428Cardiac shunt imaging
    78466Heart infarct image
    78468Heart infarct image (ef)
    78469Heart infarct image (3D)
    78499Cardiovascular nuclear exam
    78584Lung V/Q image single breath
    78585Lung V/Q imaging
    78586Aerosol lung image, single
    78587Aerosol lung image, multiple
    78588Perfusion lung image
    78593Vent image, 1 proj, gas
    78594Vent image, mult proj, gas
    78596Lung differential function
    78600Brain imaging, ltd static
    78601Brain imaging, ltd w/flow
    78606Brain imaging, compl w/flow
    78607Brain imaging (3D)
    78615Cerebral blood flow imaging
    78630Cerebrospinal fluid scan
    78635CSF ventriculography
    78645CSF shunt evaluation
    78647Cerebrospinal fluid scan
    78650CSF leakage imaging
    78699Nervous system nuclear exam
    78704Imaging renogram
    78707Kidney flow/function image
    78708Kidney flow/function image
    78709Kidney flow/function image
    78710Kidney imaging (3D)
    78799Genitourinary nuclear exam
    78800Tumor imaging, limited area
    78801Tumor imaging, mult areas
    78802Tumor imaging, whole body
    78803Tumor imaging (3D)
    78805Abscess imaging, ltd area
    78806Abscess imaging, whole body
    78807Nuclear localization/abscess
    0294Level I Therapeutic Nuclear MedicineS5.13$248.74$144.06$49.75
    79000Init hyperthyroid therapy
    79001Repeat hyperthyroid therapy
    79020Thyroid ablation
    79030Thyroid ablation, carcinoma
    79035Thyroid metastatic therapy
    79100Hematopoetic nuclear therapy
    79300Interstitial nuclear therapy
    79440Nuclear joint therapy
    79999Nuclear medicine therapy
    0295Level II Therapeutic Nuclear MedicineS19.85$962.47$609.17$192.49
    79200Intracavitary nuclear trmt
    79400Nonhemato nuclear therapy
    79420Intravascular nuclear ther
    0296Level I Therapeutic Radiologic ProceduresS3.57$173.10$100.25$34.62
    74235Remove esophagus obstruction
    74327X-ray bile stone removal
    74360X-ray guide, GI dilation
    74485X-ray guide, GU dilation
    75984X-ray control catheter change
    78494Heart image, spect
    78496Heart first pass add-on
    0297Level II Therapeutic Radiologic ProceduresS6.13$297.23$172.51$59.45
    74363X-ray, bile duct dilation
    74475X-ray control, cath insert
    74480X-ray control, cath insert
    75894X-rays, transcath therapy
    75896X-rays, transcath therapy
    75980Contrast x-ray exam bile duct
    75982Contrast x-ray exam bile duct
    0300Level I Radiation TherapyS1.98$96.00$47.72$19.20
    77401Radiation treatment delivery
    77402Radiation treatment delivery
    77403Radiation treatment delivery
    77404Radiation treatment delivery
    Start Printed Page 18765
    77406Radiation treatment delivery
    77407Radiation treatment delivery
    77408Radiation treatment delivery
    77409Radiation treatment delivery
    77414Radiation treatment delivery
    77789Radioelement application
    0301Level II Radiation TherapyS2.21$107.16$52.53$21.43
    77411Radiation treatment delivery
    77412Radiation treatment delivery
    77413Radiation treatment delivery
    77416Radiation treatment delivery
    77520Proton beam delivery
    77523Proton beam delivery
    77750Infuse radioactive materials
    0302Level III Radiation TherapyS8.21$398.08$216.55$79.62
    77470Special radiation treatment
    G0173Stereotactic, one session
    G0174Stereotactic, mult session
    0303Treatment Device ConstructionX2.83$137.22$69.28$27.44
    77332Radiation treatment aid(s)
    77333Radiation treatment aid(s)
    77334Radiation treatment aid(s)
    0304Level I Therapeutic Radiation Treatment PreparationX1.49$72.25$41.52$14.45
    77280Set radiation therapy field
    77300Radiation therapy dose plan
    77305Radiation therapy dose plan
    77310Radiation therapy dose plan
    77331Special radiation dosimetry
    0305Level II Therapeutic Radiation Treatment PreparationX4.06$196.86$97.50$39.37
    77285Set radiation therapy field
    77290Set radiation therapy field
    77315Radiation therapy dose plan
    77321Radiation therapy port plan
    77326Radiation therapy dose plan
    77327Radiation therapy dose plan
    77328Radiation therapy dose plan
    0310Level III Therapeutic Radiation Treatment PreparationX13.98$677.85$339.05$135.57
    77295Set radiation therapy field
    0311Radiation Physics ServicesX1.32$64.00$31.66$12.80
    77336Radiation physics consult
    77370Radiation physics consult
    77399External radiation dosimetry
    0312Radioelement ApplicationsS4.09$198.31$109.65$39.66
    77761Radioelement application
    77762Radioelement application
    77763Radioelement application
    77776Radioelement application
    77777Radioelement application
    77778Radioelement application
    0313BrachytherapyS7.89$382.56$164.02$76.51
    77781High intensity brachytherapy
    77782High intensity brachytherapy
    77783High intensity brachytherapy
    77784High intensity brachytherapy
    77799Radium/radioisotope therapy
    0314Hyperthermic TherapiesS5.88$285.10$150.95$57.02
    77600Hyperthermia treatment
    77605Hyperthermia treatment
    77610Hyperthermia treatment
    77615Hyperthermia treatment
    77620Hyperthermia treatment
    0320Electroconvulsive TherapyS3.68$178.43$80.06$35.69
    90870Electroconvulsive therapy
    90871Electroconvulsive therapy
    0321Biofeedback and Other TrainingS1.26$61.09$29.25$12.22
    90901Biofeedback train, any meth
    90911Biofeedback peri/uro/rectal
    0322Brief Individual PsychotherapyS1.32$64.00$14.22$12.80
    90804Psytx, office, 20-30 min
    90805Psytx, off, 20-30 min w/e&m
    90810Intac psytx, off, 20-30 min
    90811Intac psytx, 20-30, w/e&m
    90816Psytx, hosp, 20-30 min
    Start Printed Page 18766
    90817Psytx, hosp, 20-30 min w/e&m
    90823Intac psytx, hosp, 20-30 min
    90824Intac psytx, hsp 20-30 w/e&m
    90899Psychiatric service/therapy
    0323Extended Individual PsychotherapyS1.85$89.70$22.48$17.94
    90801Psy dx interview
    90802Intac psy dx interview
    90806Psytx, off, 45-50 min
    90807Psytx, off, 45-50 min w/e&m
    90808Psytx, office, 75-80 min
    90809Psytx, off, 75-80, w/e&m
    90812Intac psytx, off, 45-50 min
    90813Intac psytx, 45-50 min w/e&m
    90814Intac psytx, off, 75-80 min
    90815Intac psytx, 75-80 w/e&m
    90818Psytx, hosp, 45-50 min
    90819Psytx, hosp, 45-50 min w/e&m
    90821Psytx, hosp, 75-80 min
    90822Psytx, hosp, 75-80 min w/e&m
    90826Intac psytx, hosp, 45-50 min
    90827Intac psytx, hsp 45-50 w/e&m
    90828Intac psytx, hosp, 75-80 min
    90829Intac psytx, hsp 75-80 w/e&m
    90845Psychoanalysis
    90865Narcosynthesis
    90880Hypnotherapy
    0324Family PsychotherapyS1.87$90.67$20.19$18.13
    90846Family psytx w/o patient
    90847Family psytx w/patient
    0325Group PsychotherapyS1.55$75.16$19.96$15.03
    90849Multiple family group psytx
    90853Group psychotherapy
    90857Intac group psytx
    0330Dental ProceduresS1.51$73.22$14.64$14.64
    D0150Comprehensve oral evaluation
    D0240Intraoral occlusal film
    D0250Extraoral first film
    D0260Extraoral ea additional film
    D0270Dental bitewing single film
    D0272Dental bitewings two films
    D0274Dental bitewings four films
    D0460Pulp vitality test
    D0501Histopathologic examinations
    D0502Other oral pathology procedu
    D0999Unspecified diagnostic proce
    D1510Space maintainer fxd unilat
    D1515Fixed bilat space maintainer
    D1520Remove unilat space maintain
    D1525Remove bilat space maintain
    D1550Recement space maintainer
    D2970Temporary-fractured tooth
    D2999Dental unspec restorative pr
    D3460Endodontic endosseous implan
    D3999Endodontic procedure
    D4260Osseous surgery per quadrant
    D4263Bone replce graft first site
    D4264Bone replce graft each add
    D4270Pedicle soft tissue graft pr
    D4271Free soft tissue graft proc
    D4273Subepithelial tissue graft
    D4355Full mouth debridement
    D4381Localized chemo delivery
    D5911Facial moulage sectional
    D5912Facial moulage complete
    D5983Radiation applicator
    D5984Radiation shield
    D5985Radiation cone locator
    D5987Commissure splint
    D6920Dental connector bar
    D7110Oral surgery single tooth
    D7120Each add tooth extraction
    D7130Tooth root removal
    D7210Rem imp tooth w mucoper flp
    Start Printed Page 18767
    D7220Impact tooth remov soft tiss
    D7230Impact tooth remov part bony
    D7240Impact tooth remov comp bony
    D7241Impact tooth rem bony w/comp
    D7250Tooth root removal
    D7260Oral antral fistula closure
    D7291Transseptal fiberotomy
    D7940Reshaping bone orthognathic
    D9630Other drugs/medicaments
    D9930Treatment of complications
    D9940Dental occlusal guard
    D9950Occlusion analysis
    D9951Limited occlusal adjustment
    D9952Complete occlusal adjustment
    0340Minor Ancillary ProceduresX1.04$50.43$12.85$10.09
    69200Clear outer ear canal
    69210Remove impacted ear wax
    0341Immunology TestsX0.13$6.30$3.67$1.26
    86485Skin test, candida
    86490Coccidioidomycosis skin test
    86510Histoplasmosis skin test
    86580TB intradermal test
    86585TB tine test
    86586Skin test, unlisted
    0342Level I PathologyX0.26$12.61$8.03$2.52
    85060Blood smear interpretation
    88160Cytopath smear, other source
    88199Cytopathology procedure
    88300Surgical path, gross
    88302Tissue exam by pathologist
    88311Decalcify tissue
    88313Special stains
    88319Enzyme histochemistry
    88321Microslide consultation
    88399Surgical pathology procedure
    0343Level II PathologyX0.45$21.82$12.16$4.36
    80500Lab pathology consultation
    80502Lab pathology consultation
    86077Physician blood bank service
    88104Cytopathology, fluids
    88106Cytopathology, fluids
    88107Cytopathology, fluids
    88108Cytopath, concentrate tech
    88125Forensic cytopathology
    88161Cytopath smear, other source
    88162Cytopath smear, other source
    88172Evaluation of smear
    88173Interpretation of smear
    88304Tissue exam by pathologist
    88305Tissue exam by pathologist
    88312Special stains
    88314Histochemical stain
    88318Chemical histochemistry
    88323Microslide consultation
    88325Comprehensive review of data
    88329Pathology consult in surgery
    88331Pathology consult in surgery
    88332Pathology consult in surgery
    88346Immunofluorescent study
    88362Nerve teasing preparations
    89399Pathology lab procedure
    G0025Collagen skin test kit
    0344Level III PathologyX0.79$38.30$23.63$7.66
    85097Bone marrow interpretation
    86078Physician blood bank service
    86079Physician blood bank service
    88180Cell marker study
    88182Cell marker study
    88307Tissue exam by pathologist
    88309Tissue exam by pathologist
    88342Immunocytochemistry
    88347Immunofluorescent study
    88348Electron microscopy Start Printed Page 18768
    88349Scanning electron microscopy
    88355Analysis, skeletal muscle
    88356Analysis, nerve
    88358Analysis, tumor
    88365Tissue hybridization
    89350Sputum specimen collection
    89360Collect sweat for test
    2 0354Administration of Influenza VaccineX0.13$6.19
    G0008Admin influenza virus vac
    Q0034Admin of influenza vaccine
    0355Level I ImmunizationsX0.19$9.21$5.05$1.84
    90645Hib vaccine, hboc, im
    90646Hib vaccine, prp-d, im
    90647Hib vaccine, prp-omp, im
    90648Hib vaccine, prp-t, im
    90657Flu vaccine, 6-35 mo, im
    90658Flu vaccine, 3 yrs, im
    90659Flu vaccine, whole, im
    90660Flu vaccine, nasal
    90700Dtap vaccine, im
    90702Dt vaccine, im
    90704Mumps vaccine, sc
    90713Poliovirus, ipv, sc
    90716Chicken pox vaccine, sc
    90720Dtp/hib vaccine, im
    90721Dtap/hib vaccine, im
    90727Plague vaccine, im
    90732Pneumococcal vaccine, adult
    90749Vaccine toxoid
    0356Level II ImmunizationsX0.36$17.46$4.82$3.49
    90371Hep b ig, im
    90389Tetanus ig, im
    90396Varicella-zoster ig, im
    90476Adenovirus vaccine, type 4
    90477Adenovirus vaccine, type 7
    90585Bcg vaccine, percut
    90586Bcg vaccine, intravesical
    90632Hep a vaccine, adult im
    90633Hep a vacc, ped/adol, 2 dose
    90634Hep a vacc, ped/adol, 3 dose
    90680Rotovirus vaccine, oral
    90690Typhoid vaccine, oral
    90691Typhoid vaccine, im
    90692Typhoid vaccine, h-p, sc/id
    90693Typhoid vaccine, akd, sc
    90701Dtp vaccine, im
    90703Tetanus vaccine, im
    90707Mmr vaccine, sc
    90710Mmrv vaccine, sc
    90712Oral poliovirus vaccine
    90717Yellow fever vaccine, sc
    90718Td vaccine, im
    90744Hep b vaccine, ped/adol, im
    90746Hep b vaccine, adult, im
    90747Hep b vaccine, ill pat, im
    0357Level III ImmunizationsX1.85$89.70$38.31$17.94
    90287Botulinum antitoxin
    90296Diphtheria antitoxin
    90375Rabies ig, im/sc
    90376Rabies ig, heat treated
    90378Rsv ig, im
    90379Rsv ig, iv
    90384Rh ig, full-dose, im
    90385Rh ig, minidose, im
    90386Rh ig, iv
    90393Vaccina ig, im
    90581Anthrax vaccine, sc
    90636Hep a/hep b vacc, adult im
    90665Lyme disease vaccine, im
    90669Pneumococcal vaccine, ped
    90675Rabies vaccine, im
    90676Rabies vaccine, id
    90705Measles vaccine, sc
    Start Printed Page 18769
    90719Diphtheria vaccine, im
    90733Meningococcal vaccine, sc
    90735Encephalitis vaccine, sc
    0358Level IV ImmunizationsX6.98$338.44$126.74$67.69
    90706Rubella vaccine, sc
    90708Measles-rubella vaccine, sc
    90709Rubella & mumps vaccine, sc
    90725Cholera vaccine, injectable
    90748Hep b/hib vaccine, im
    0359InjectionsX0.96$46.55$9.31$9.31
    90782Injection, sc/im
    90783Injection, ia
    90784Injection, iv
    90788Injection of antibiotic
    90799Ther/prophylactic/dx inject
    0360Level I Alimentary TestsX1.38$66.91$34.75$13.38
    89105Sample intestinal contents
    89130Sample stomach contents
    89132Sample stomach contents
    89135Sample stomach contents
    89136Sample stomach contents
    89140Sample stomach contents
    91030Acid perfusion of esophagus
    91055Gastric intubation for smear
    91065Breath hydrogen test
    91100Pass intestine bleeding tube
    91105Gastric intubation treatment
    91299Gastroenterology procedure
    0361Level II Alimentary TestsX3.53$171.16$88.09$34.23
    89100Sample intestinal contents
    89141Sample stomach contents
    91000Esophageal intubation
    91010Esophagus motility study
    91011Esophagus motility study
    91012Esophagus motility study
    91020Gastric motility
    91032Esophagus, acid reflux test
    91033Prolonged acid reflux test
    91052Gastric analysis test
    91060Gastric saline load test
    95075Ingestion challenge test
    0362Fitting of Vision AidsX0.51$24.73$9.63$4.95
    92311Contact lens fitting
    92312Contact lens fitting
    92313Contact lens fitting
    92315Prescription of contact lens
    92316Prescription of contact lens
    92317Prescription of contact lens
    92325Modification of contact lens
    92326Replacement of contact lens
    92352Special spectacles fitting
    92353Special spectacles fitting
    92354Special spectacles fitting
    92355Special spectacles fitting
    92358Eye prosthesis service
    92371Repair & adjust spectacles
    0363Otorhinolaryngologic Function TestsX2.83$137.22$53.22$27.44
    92512Nasal function studies
    92516Facial nerve function test
    92520Laryngeal function studies
    92541Spontaneous nystagmus test
    92542Positional nystagmus test
    92543Caloric vestibular test
    92544Optokinetic nystagmus test
    92545Oscillating tracking test
    92546Sinusoidal rotational test
    92547Supplemental electrical test
    92548Posturography
    92584Electrocochleography
    92587Evoked auditory test
    92588Evoked auditory test
    0364Level I AudiometryX0.68$32.97$13.31$6.59
    92552Pure tone audiometry, air
    Start Printed Page 18770
    92553Audiometry, air & bone
    92555Speech threshold audiometry
    92556Speech audiometry, complete
    92567Tympanometry
    92599ENT procedure/service
    0365Level II AudiometryX1.47$71.28$22.48$14.26
    92557Comprehensive hearing test
    92561Bekesy audiometry, diagnosis
    92562Loudness balance test
    92563Tone decay hearing test
    92564Sisi hearing test
    92565Stenger test, pure tone
    92568Acoustic reflex testing
    92569Acoustic reflex decay test
    92571Filtered speech hearing test
    92572Staggered spondaic word test
    92573Lombard test
    92575Sensorineural acuity test
    92576Synthetic sentence test
    92577Stenger test, speech
    92579Visual audiometry (vra)
    92582Conditioning play audiometry
    92583Select picture audiometry
    92589Auditory function test(s)
    92596Ear protector evaluation
    0366Electrocardiogram (ECG)X0.38$18.43$15.60$3.69
    93005Electrocardiogram, tracing
    93041Rhythm ECG, tracing
    Q0035Cardiokymography
    0367Level I Pulmonary TestX0.83$40.24$20.65$8.05
    94010Breathing capacity test
    94200Lung function test (MBC/MVV)
    94250Expired gas collection
    94375Respiratory flow volume loop
    94400CO2 breathing response curve
    94450Hypoxia response curve
    94680Exhaled air analysis, o2
    94690Exhaled air analysis
    94720Monoxide diffusing capacity
    94770Exhaled carbon dioxide test
    94799Pulmonary service/procedure
    0368Level II Pulmonary TestsX1.66$80.49$42.44$16.10
    94060Evaluation of wheezing
    94240Residual lung capacity
    94260Thoracic gas volume
    94350Lung nitrogen washout curve
    94360Measure airflow resistance
    94370Breath airway closing volume
    94620Pulmonary stress test/simple
    94681Exhaled air analysis, o2/co2
    94725Membrane diffusion capacity
    94750Pulmonary compliance study
    0369Level III Pulmonary TestsX2.34$113.46$58.50$22.69
    94014Patient recorded spirometry
    94015Patient recorded spirometry
    94016Review patient spirometry
    94070Evaluation of wheezing
    94621Pulm stress test/complex
    94772Breath recording, infant
    95070Bronchial allergy tests
    95071Bronchial allergy tests
    0370Allergy TestsX0.57$27.64$11.81$5.53
    95004Allergy skin tests
    95010Sensitivity skin tests
    95015Sensitivity skin tests
    95024Allergy skin tests
    95027Skin end point titration
    95028Allergy skin tests
    95044Allergy patch tests
    95052Photo patch test
    95056Photosensitivity tests
    95060Eye allergy tests
    95065Nose allergy test
    Start Printed Page 18771
    95078Provocative testing
    95180Rapid desensitization
    95199Allergy immunology services
    0371Allergy InjectionsX0.32$15.52$3.67$3.10
    95115Immunotherapy, one injection
    95117Immunotherapy injections
    95144Antigen therapy services
    95145Antigen therapy services
    95146Antigen therapy services
    95147Antigen therapy services
    95148Antigen therapy services
    95149Antigen therapy services
    95165Antigen therapy services
    95170Antigen therapy services
    0372Therapeutic PhlebotomyX0.43$20.85$10.09$4.17
    99195Phlebotomy
    0373Neuropsychological TestingX3.21$155.64$44.96$31.13
    96100Psychological testing
    96105Assessment of aphasia
    96110Developmental test, lim
    96111Developmental test, extend
    96115Neurobehavior status exam
    96117Neuropsych test battery
    0374Monitoring Psychiatric DrugsX1.17$56.73$13.08$11.35
    90862Medication management
    M0064Visit for drug monitoring
    0600Low Level Clinic VisitsV0.98$47.52$9.50$9.50
    99201Office/outpatient visit, new
    99202Office/outpatient visit, new
    99211Office/outpatient visit, est
    99212Office/outpatient visit, est
    99241Office consultation
    99242Office consultation
    99271Confirmatory consultation
    99272Confirmatory consultation
    0601Mid Level Clinic VisitsV1.00$48.49$9.70$9.70
    92002Eye exam, new patient
    92012Eye exam established pat
    99203Office/outpatient visit, new
    99213Office/outpatient visit, est
    99243Office consultation
    99273Confirmatory consultation
    G0101CA screen; pelvic/breast exam
    0602High Level Clinic VisitsV1.66$80.49$16.29$16.10
    92004Eye exam, new patient
    92014Eye exam & treatment
    99204Office/outpatient visit, new
    99205Office/outpatient visit, new
    99214Office/outpatient visit, est
    99215Office/outpatient visit, est
    99244Office consultation
    99245Office consultation
    99274Confirmatory consultation
    99275Confirmatory consultation
    0603Interdisciplinary Team ConferenceV1.66$80.49$16.29$16.10
    G0175Multidisciplinary team visit
    0610Low Level Emergency VisitsV1.34$64.97$20.65$12.99
    99281Emergency dept visit
    99282Emergency dept visit
    0611Mid Level Emergency VisitsV2.11$102.31$36.47$20.46
    99283Emergency dept visit
    0612High Level Emergency VisitsV3.19$154.67$54.14$30.93
    99284Emergency dept visit
    99285Emergency dept visit
    0620Critical CareS8.60$416.99$152.78$83.40
    99291Critical care, first hour
    3 0701StrontiumX$84.76
    A9600Strontium-89 chloride
    3 0702SamariamX$139.06
    A9605Samarium sm153 lexidronamm
    3 0704Satumomab PendetideX$63.13
    A4642Satumomab pendetide per dose
    3 0705Tc99 TetrofosminX$71.08
    Start Printed Page 18772
    A9502Technetium TC99M tetrofosmin
    3 0725Leucovorin CalciumX$1.07
    J0640Leucovorin calcium injection
    3 0726Dexrazoxane HydrochlorideX$18.81
    J1190Dexrazoxane HCl injection
    3 0727Injection, Etidronate DisodiumX$9.31
    J1436Etidronate disodium inj
    3 0728Filgrastim (G-CSF)X$25.21
    J1440Filgrastim 300 mcg injection
    3 0730Pamidronate DisodiumX$30.93
    J2430Pamidronate disodium/30 MG
    3 0731Sargramostim (GM-CSF)X$16.97
    J2820Sargramostim injection
    3 0732MesnaX$2.42
    J9209Mesna injection
    3 0733Epoetin AlphaX$1.75
    Q0136Non esrd epoetin alpha inj
    3 0750Dolasetron Mesylate 10 mgX$1.94
    J1260Dolasetron mesylate
    3 0754Metoclopramide HCLX$0.19
    J2765Metoclopramide hcl injection
    3 0755Thiethylperazine MaleateX$0.68
    J3280Thiethylperazine maleate inj
    3 0761Oral Substitute for IV AntiemticX$0.10
    Q0163Diphenhydramine HCl 50mg
    Q0164Prochlorperazine maleate 5mg
    Q0169Promethazine HCl 12.5mg oral
    Q0171Chlorpromazine HCl 10mg oral
    Q0173Trimethobenzamide HCl 250mg
    Q0174Thiethylperazine maleate10mg
    Q0175Perphenazine 4mg oral
    Q0177Hydroxyzine pamoate 25mg
    3 0762DronabinolX$0.48
    Q0167Dronabinol 2.5mg oral
    3 0763Dolasetron Mesylate 100 mg OralX$8.53
    Q0180Dolasetron mesylate oral
    3 0764Granisetron HCL, 100 mcgX$2.33
    J1626Granisetron HCl injection
    3 0765Granisetron HCL, 1mg OralX$3.20
    Q0166Granisetron HCl 1 mg oral
    3 0768Ondansetron Hydrochloride per 1 mg InjectionX$0.87
    J2405Ondansetron hcl injection
    3 0769Ondansetron Hydrochloride 8 mg oralX$2.62
    Q0179Ondansetron HCl 8mg oral
    3 0800Leuprolide Acetate per 3.75 mgX$68.56
    J1950Leuprolide acetate/3.75 MG
    3 0801CyclophosphamideX$.19
    J8530Cyclophosphamide oral 25 MG
    3 0802EtoposideX$3.10
    J8560Etoposide oral 50 MG
    3 0803MelphalanX$0.19
    J8600Melphalan oral 2 MG
    3 0807Aldesleukin single use vialX$65.07
    J9015Aldesleukin/single use vial
    3 0809BCG (Intravesical) one vialX$19.78
    J9031Bcg live intravesical vac
    3 0810Goserelin Acetate Implant, per 3.6 mgX$59.74
    J9202Goserelin acetate implant
    3 0811Carboplatin 50 mgX$13.96
    J9045Carboplatin injection
    3 0812Carmustine 100 mgX$10.57
    J9050Carmus bischl nitro inj
    3 0813Cisplatin 10 mgX$4.56
    J9060Cisplatin 10 MG injeciton
    3 0814Asparaginase, 10,000 unitsX$8.34
    J9020Asparaginase injection
    3 0815Cyclophosphamide 100 mgX$0.48
    J9070Cyclophosphamide 100 MG inj
    3 0816Cyclophosphamide, Lyophilized 100 mgX$1.16
    J9093Cyclophosphamide lyophilized
    3 0817Cytrabine 100 mgX$0.68
    J9100Cytarabine hcl 100 MG inj
    3 0818Dactinomycin 0.5 mgX$1.75
    Start Printed Page 18773
    J9120Dactinomycin actinomycin d
    3 0819Dacarbazine 100 mgX$1.26
    J9130Dacarbazine 10 MG inj
    3 0820Daunorubicin HCI 10 mgX$11.64
    J9150Daunorubicin
    3 0821Daunorubicin Citrate, Liposomal Formulation, 10 mgX$7.76
    J9151Daunorubicin citrate liposom
    3 0822Diethylstibestrol Diphosphate 250 mgX$2.13
    J9165Diethylstilbestrol injection
    3 0823Docetaxel 20 mgX$34.72
    J9170Docetaxel
    3 0824Etoposide 10 mgX$.58
    J9181Etoposide 10 MG inj
    3 0826Methotrexate Oral 2.5 mgX$.29
    J8610Methotrexate oral 2.5 MG
    3 0827Floxuridine 500 mgX$18.81
    J9200Floxuridine injection
    3 0828Gemcitabine HCL 200 mgX$9.31
    J9201Gemcitabine HCl
    3 0830Irinotecan 20 mgX$14.16
    J9206Irinotecan injection
    3 0831Ifosfamide per 1 gramX$13.58
    J9208Ifosfomide injection
    3 0832Idarubicin Hydrochloride 5 mgX$46.45
    J9211Idarubicin hcl injeciton
    3 0833Interferon Alfacon-1, Recombinant, 1 mcgX$0.19
    J9212Interferon alfacon-1
    3 0834Interferon, Alfa-2A, Recombinant 3 million unitsX$3.20
    J9213Interferon alfa-2a inj
    3 0836Interferon, Alfa-2B, Recombinant, 1 million unitsX$1.36
    J9214Interferon alfa-2b inj
    3 0838Interferon, Gamma 1-B, 3 million unitsX$22.79
    J9216Interferon gamma 1-b inj
    3 0839Mechlorethamine HCI 10 mgX$1.65
    J9230Mechlorethamine hcl inj
    3 0840Melphalan HCI 50 mgX$44.71
    J9245Inj melphalan hydrochl 50 MG
    3 0841Methotrexate Sodium 5 mgX$.10
    J9250Methotrexate sodium inj
    3 0842Fludarabine Phosphate 50 mgX$30.84
    J9185Fludarabine phosphate inj
    3 0843Pegaspargase per single dose vialX$178.72
    J9266Pegaspargase/singl dose vial
    3 0844Pentostatin 10 mgX$133.73
    J9268Pentostatin injection
    3 0847Doxorubicin HCL 10 mgX$2.81
    J9000Doxorubic hcl 10 MG vl chemo
    3 0849Rituximab, 100 mgX$51.40
    J9310Rituximab cancer treatment
    3 0850Streptozocin 1 gmX$14.64
    J9320Streptozocin injection
    3 0851Thiotepa 15 mgX$9.50
    J9340Thiotepa injection
    3 0852Topotecan 4 mgX$73.22
    J9350Topotecan
    3 0853Vinblastine Sulfate 1 mgX$.39
    J9360Vinblastine sulfate inj
    3 0854Vincristine Sulfate 1 mgX$2.23
    J9370Vincristine sulfate 1 MG inj
    3 0855Vinorelbine Tartrate per 10 mgX$9.60
    J9390Vinorelbine tartrate/10 mg
    3 0856Porfimer Sodium 75 mgX$34.62
    J9600Porfimer sodium
    3 0857Bleomycin Sulfate 15 unitsX$48.29
    J9040Bleomycin sulfate injection
    3 0858Cladribine, 1mgX$8.24
    J9065Inj cladribine per 1 MG
    3 0859FluorouracilX$0.19
    J9190Fluorouracil injection
    3 0860Plicamycin 2.5 mgX$1.36
    J9270Plicamycin (mithramycin) inj
    3 0861Leuprolide Acetate 1 mgX$19.39
    J9218Leuprolide acetate injeciton
    Start Printed Page 18774
    3 0862Mitomycin, 5mgX$19.88
    J9280Mitomycin 5 MG inj
    3 0863Paclitaxel, 30mgX$30.16
    J9265Paclitaxel injection
    3 0864Mitoxantrone HCl, per 5mgX$25.80
    J9293Mitoxantrone hydrochl/5 MG
    3 0865Interferon alfa-N3, 250,000 IUX$1.07
    J9215Interferon alfa-n3 inj
    3 0884Rho (D) Immune Globulin, Human one dose packX$3.78
    J2790Rho d immune globulin inj
    2 0886Azathioprine, 50 mg oralX0.02$.97$0.19
    J7500Azathioprine oral 50mg
    2 0887Azathioprine, Parenteral 100 mg, 20 ml each injectionX1.40$67.88$13.58
    J7501Azathioprine parenteral
    2 0888Cyclosporine, Oral 100 mgX0.08$3.88$0.78
    J7502Cyclosporine oral 100 mg
    2 0889Cyclosporine, ParenteralX0.36$17.46$3.49
    J7516Cyclosporin parenteral 250mg
    2 0890Lymphocyte Immune Globulin 50 mg/ml, 5 ml eachX3.79$183.77$36.75
    J7504Lymphocyte immune globulin
    2 0891Tacrolimus per 1 mg oralX3.15$152.73$30.55
    J7507Tacrolimus oral per 1 MG
    3 0892Daclizumab, Parenteral, 25 mgX$54.11
    J7913Daclizumab, Parenteral, 25 m
    3 0900Injection, Alglucerase per 10 unitsX$5.14
    J0205Alglucerase injection
    3 0901Alpha I, Proteinase Inhibitor, Human per 10mgX$15.22
    J0256Alpha 1 proteinase inhibitor
    3 0902Botulinum Toxin, Type A per unitX$56.05
    J0585Botulinum toxin a per unit
    3 0903CMV Immune GlobulinX$54.11
    J0850Cytomegalovirus imm IV/vial
    3 0905Immune Globulin per 500 mgX$6.40
    J1561Immune globulin 500 mg
    3 0906RSV Immune GlobulinX$85.53
    J1565RSV-ivig
    2 0907Ganciclovir Sodium 500 mg injectionX0.51$24.73$4.95
    J1570Ganciclovir sodium injection
    2 0908Tetanus Immune Globulin, Human, up to 250 unitsX0.90$43.64$8.73
    J1670Tetanus immune globulin inj
    3 0909Interferon Beta-1a 33 mcgX$28.70
    J1825Interferon beta-1a
    3 0910Interferon Beta-1b 0.25 mgX$8.44
    J1830Interferon beta-1b/.25 MG
    2 0911Streptokinase per 250,000 iuX1.64$79.69$15.94
    J2995Inj streptokinase/250000 IU
    3 0913Ganciclovir 4.5 mg, ImplantX$701.51
    J7310Ganciclovir long act implant
    2 0914Reteplase, 37.6 mg (Two Single Use Vials)X38.20$1,852.21$370.44
    J2994Reteplase double bolus
    2 0915Alteplase recombinant, 10mgX5.85$283.70$56.74
    J2996Alteplase recombinant inj
    3 0916Imiglucerase per unitX$0.58
    J1785Injection imiglucerase/unit
    2 0917Dipyridamole, 10 mg/Adenosine 6MGX0.36$17.46$3.49
    J0150Injection adenosine 6 MG
    J1245Dipyridamole injection
    3 0918Brachytherapy Seeds, Any type, EachS$9.99
    Q3001Brachytherapy Seeds
    3 0925Factor VIII (Antihemophilic Factor, Human) per iuX$0.19
    J7190Factor viii
    3 0926Factor VIII (Antihemophilic Factor, Porcine) per iuX$0.19
    J7191Factor VIII (porcine)
    3 0927Factor VIII (Antihemophilic Factor, Recombinant) per iuX$0.19
    J7192Factor viii recombinant
    3 0928Factor IX, ComplexX$0.08
    J7194Factor ix complex
    3 0929Other Hemophilia Clotting Factors per iuX$0.27
    J7198Anti-inhibitor
    Q0187Factor viia recombinant
    3 0930Antithrombin III (Human) per iuX$0.19
    J7197Antithrombin iii injection
    3 0931Factor IX (Antihemophilic Factor, Purified, Non-Recombinant)X$0.04
    Start Printed Page 18775
    Q0160Factor IX non-recombinant
    3 0932Factor IX (Antihemophilic Factor, Recombinant)X$0.10
    Q0161Factor IX recombinant
    2 0949Plasma, Pooled Multiple Donor, Solvent/Detergent Treated, FrozenS3.49$169.22$33.84
    P9023Frozen plasma, pooled, sd
    2 0950Blood (Whole) For TransfusionS2.08$101.02$20.20
    P9010Whole blood for transfusion
    2 0952CryoprecipitateS0.70$33.92$6.78
    P9012Cryoprecipitate each unit
    2 0953Fibrinogen UnitS0.48$23.27$4.65
    P9013Unit/s blood fibrinogen
    2 0954Leukocyte Poor BloodS2.83$137.21$27.44
    P9016Leukocyte poor blood, unit
    2 0955Plasma, Fresh FrozenS2.26$109.35$21.87
    P9017One donor fresh frozn plasma
    2 0956Plasma Protein FractionS1.26$61.09$12.22
    P9018Plasma protein fract, unit
    2 0957Platelet ConcentrateS0.98$47.46$9.49
    P9019Platelet concentrate unit
    2 0958Platelet Rich PlasmaS1.16$56.25$11.25
    P9020Platelet rich plasma unit
    2 0959Red Blood CellsS2.04$99.04$19.81
    P9021Red blood cells unit
    2 0960Washed Red Blood CellsS3.81$184.53$36.91
    P9022Washed red blood cells unit
    2 0961Infusion, Albumin (Human) 5%, 500 mlX2.77$134.31$26.86
    Q0156Human albumin 5%
    2 0962Infusion, Albumin (Human) 25%, 50 mlX1.38$66.91$13.38
    Q0157Human albumin 25%
    2 0970New Technology - Level I ($0-$50)T0.52$25.21$5.04
    78268Breath test analysis, c-14
    2 0971New Technology - Level II ($50-$100)S1.55$75.16$15.03
    78267Breath tst attain/anal c-14
    2 0972New Technology - Level III ($100-$200)T3.09$149.83$29.97
    G0166Extrnl counterpulse, per tx
    2 0980New Technology - Level XI ($1750-$2000)S38.67$1,875.00$375.00
    53850Prostatic microwave thermotx
    53852Prostatic rf thermotx
    G0125Lung image (PET)
    G0126Lung image (PET) staging
    G0163Pet for rec of colorectal ca
    G0164Pet for lymphoma staging
    G0165Pet, rec of melanoma/met ca
    3 7000Amifostine, 500 mgX$41.99
    J0207Amifostine
    3 7001Amphotericin B lipid complex, 50 mg, InjX$12.12
    J0286Amphotericin B lipid complex
    3 7002Clonidine, HCl, 1 MGX$4.17
    J0735Clonidine hydrochloride
    3 7003Epoprostenol, 0.5 MG, injX$2.23
    J1325Epoprostenol injection
    3 7004Immune globulin intravenous human 5g, injX$45.48
    J1562Immune globulin 5 gms
    3 7005Gonadorelin hcI, 100 mcgX$9.12
    J1620Gonadorelin hydroch/100 mcg
    2 7007Milrinone lacetate, per 5 ml, injX0.47$22.79$4.56
    J2260Inj milrinone lactate/5 ML
    3 7010Morphine sulfate concentrate (preservative free) per 10 mgX$.68
    J2275Morphine sulfate injection
    3 7011Oprelevekin, inj, 5 mgX$30.35
    J2355Oprelvekin injection
    3 7012Pentamidine isethionate, 300 mgX$8.73
    J2545Pentamidine isethionte/300mg
    3 7014Fentanyl citrate, inj, up to 2 mlX$.19
    J3010Fentanyl citrate injeciton
    3 7015Busulfan, oral 2 mgX$0.19
    J8510Oral busulfan
    3 7019Aprotinin, 10,000 kiuX$2.42
    Q2003Aprotinin, 10,000 kiu
    3 7021Baclofen, intrathecal, 50 mcgX$0.10
    J0476Baclofen intrathecal trial
    3 7022Elliotts B Solution, per mlX$19.20
    Q2002Elliot's B solution
    Start Printed Page 18776
    3 7023Treatment for bladder calculi, I.e. Renacidin per 500 mlX$4.46
    Q2004Treatment for bladder calcul
    3 7024Corticorelin ovine triflutate, 0.1 mgX$45.77
    Q2005Corticorelin ovine triflutat
    3 7025Digoxin immune FAB (Ovine), 10 mgX$14.06
    Q2006Digoxin immune FAB (Ovine),
    3 7026Ethanolamine oleate, 1000 mlX$2.13
    Q2007Ethanolamine oleate, 1000 ml
    3 7027Fomepizole, 1.5 GX$141.29
    Q2008Fomepizole, 1.5 G
    3 7028Fosphenytoin, 50 mgX$0.78
    Q2009Fosphenytoin, 50 mg
    3 7029Glatiramer acetate, 25 mgX$3.59
    Q2010Glatiramer acetate, 25 mgeny
    3 7030Hemin, 1 mgX$0.10
    Q2011Hemin, 1 mg
    3 7031Octreotide Acetate, 500 mcgX$5.43
    J2352Octreotide acetate injection
    3 7032Sermorelin acetate, 0.5 mgX$53.34
    Q2014Sermorelin acetate, 0.5 mg
    3 7033Somatrem, 5 mgX$28.03
    Q2015Somatrem, 5 mg
    3 7034Somatropin, 1 mgX$5.04
    Q2016Somatropin, 1 mg
    3 7035Teniposide, 50 mgX$20.85
    Q2017Teniposide, 50 mg
    2 7036Urokinase, inj, IV, 250,000 I.U.X0.73$35.40$7.08
    J3365Urokinase 250,000 IU inj
    3 7037Urofollitropin, 75 I.U.X$8.24
    Q2018Urofollitropin, 75 I.U.
    3 7038Muromonab-CD3, 5 mgX$89.60
    J7505Monoclonal antibodies
    3 7039Pegademase bovine inj 25 I.U.X$1.16
    Q2012Pegademase bovine inj 25 I.U
    3 7040Pentastarch 10% inj, 100 mlX$2.04
    Q2013Pentastarch 10% inj, 100 ml
    2 7041Tirofiban HCL, 0.5 mgX0.02$.97$0.19
    J3245Tirofiban hydrochloride
    3 7042Capecitabine, oral 150 mgX$0.19
    J8520Capecitabine, oral, 150 mg
    3 7043Infliximab, 10 MGX$6.89
    J1745Infliximab injection
    3 7045Trimetrexate GlucoronateX$8.15
    J3305Inj trimetrexate glucoronate
    3 7046Doxorubicin Hcl LiposomeX$39.18
    J9001Doxorubicin hcl liposome inj
    —————————— 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 D.—1996 HCPC Codes Used To Calculate Pay

    CPT/HCPCSTermination Date
    0042012/31/1999
    0100012/31/1999
    0111012/31/1999
    0124012/31/1999
    0130012/31/1999
    0146012/31/1999
    0160012/31/1999
    0170012/31/1999
    0180012/31/1999
    0190012/31/1999
    0190212/31/1999
    1105012/31/1997
    1105112/31/1997
    1105212/31/1997
    1170012/31/1996
    1170112/31/1996
    1171012/31/1996
    1171112/31/1996
    1173112/31/1998
    1330012/31/1999
    1558012/31/1999
    1562512/31/1999
    1575512/31/1996
    1604012/31/1998
    1604112/31/1998
    1604212/31/1998
    1700112/31/1997
    1700212/31/1997
    1701012/31/1997
    1710012/31/1997
    1710112/31/1997
    1710212/31/1997
    1710412/31/1997
    1710512/31/1997
    1720012/31/1997
    1720112/31/1997
    2096012/31/1996
    2097112/31/1996
    2533012/31/1996
    2533112/31/1996
    2655212/31/1996
    2655712/31/1996
    2655812/31/1996
    2655912/31/1996
    3200112/31/1999
    3324212/31/1999
    3324712/31/1999
    4288012/31/1996
    Start Printed Page 18777
    5364012/31/1996
    5630012/31/1999
    5630112/31/1999
    5630212/31/1999
    5630312/31/1999
    5630412/31/1999
    5630512/31/1999
    5630612/31/1999
    5630712/31/1999
    5630812/31/1999
    5630912/31/1999
    5631012/31/1999
    5631112/31/1999
    5631212/31/1999
    5631312/31/1999
    5631412/31/1999
    5631512/31/1999
    5631612/31/1999
    5631712/31/1999
    5631812/31/1999
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    —————————— 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 E.—CPT Codes Which Would Be Paid Only As Inpatient Procedures

    CPT/HCPCSHOPD Status IndicatorDescription
    00174CAnesth, pharyngeal surgery
    00176CAnesth, pharyngeal surgery
    00192CAnesth, facial bone surgery
    00214CAnesth, skull drainage
    00215CAnesth, skull fracture
    00404CAnesth, surgery of breast
    00406CAnesth, surgery of breast
    00452CAnesth, surgery of shoulder
    00474CAnesth, surgery of rib(s)
    00524CAnesth, chest drainage
    00530CAnesth, pacemaker insertion
    00540CAnesth, chest surgery
    00542CAnesth, release of lung
    00544CAnesth, chest lining removal
    00546CAnesth, lung, chest wall surg
    00560CAnesth, open heart surgery
    00562CAnesth, open heart surgery
    00580CAnesth heart/lung transplant
    00604CAnesth, surgery of vertebra
    00622CAnesth, removal of nerves
    00632CAnesth, removal of nerves
    00634CAnesth for chemonucleolysis
    00670CAnesth, spine, cord surgery
    00792CAnesth, part liver removal
    00794CAnesth, pancreas removal
    00796CAnesth, for liver transplant
    00802CAnesth, fat layer removal
    00844CAnesth, pelvis surgery
    00846CAnesth, hysterectomy
    00848CAnesth, pelvic organ surg
    00850CAnesth, cesarean section
    00855CAnesth, hysterectomy
    00857CAnalgesia, labor & c-section
    00864CAnesth, removal of bladder
    00865CAnesth, removal of prostate
    00866CAnesth, removal of adrenal
    00868CAnesth, kidney transplant
    00882CAnesth, major vein ligation
    00884CAnesth, major vein revision
    00904CAnesth, perineal surgery
    00908CAnesth, removal of prostate
    00928CAnesth, removal of testis
    00932CAnesth, amputation of penis
    00934CAnesth, penis, nodes removal
    00936CAnesth, penis, nodes removal
    00944CAnesth, vaginal hysterectomy
    00955CAnalgesia, vaginal delivery
    01140CAnesth, amputation at pelvis
    01150CAnesth, pelvic tumor surgery
    01190CAnesth, pelvis nerve removal
    01212CAnesth, hip disarticulation
    01214CAnesth, replacement of hip
    01232CAnesth, amputation of femur
    01234CAnesth, radical femur surg
    01272CAnesth, femoral artery surg
    01274CAnesth, femoral embolectomy
    01402CAnesth, replacement of knee
    01404CAnesth, amputation at knee
    01442CAnesth, knee artery surg
    01444CAnesth, knee artery repair
    01486CAnesth, ankle replacement
    01502CAnesth, lwr leg embolectomy
    01632CAnesth, surgery of shoulder
    01634CAnesth, shoulder joint amput
    01636CAnesth, forequarter amput
    01638CAnesth, shoulder replacement
    01652CAnesth, shoulder vessel surg
    01654CAnesth, shoulder vessel surg
    01656CAnesth, arm-leg vessel surg
    01756CAnesth, radical humerus surg
    01772CAnesth, uppr arm embolectomy
    01782CAnesth, uppr arm vein repair
    01842CAnesth, lwr arm embolectomy
    01852CAnesth, lwr arm vein repair
    01904CAnesth, skull x-ray inject
    01990CSupport for organ donor
    15756CFree muscle flap, microvasc
    15757CFree skin flap, microvasc
    15758CFree fascial flap, microvasc
    19200CRemoval of breast
    19220CRemoval of breast
    19240CRemoval of breast
    19260CRemoval of chest wall lesion
    19271CRevision of chest wall
    19272CExtensive chest wall surgery
    19361CBreast reconstruction
    19364CBreast reconstruction
    19367CBreast reconstruction
    19368CBreast reconstruction
    19369CBreast reconstruction
    20660CApply, remove fixation device
    20661CApplication of head brace
    20662CApplication of pelvis brace
    20663CApplication of thigh brace
    20664CHalo brace application
    20802CReplantation, arm, complete
    20805CReplant, forearm, complete
    Start Printed Page 18780
    20808CReplantation hand, complete
    20816CReplantation digit, complete
    20822CReplantation digit, complete
    20824CReplantation thumb, complete
    20827CReplantation thumb, complete
    20838CReplantation foot, complete
    20930CSpinal bone allograft
    20931CSpinal bone allograft
    20936CSpinal bone autograft
    20937CSpinal bone autograft
    20938CSpinal bone autograft
    20955CFibula bone graft, microvasc
    20956CIliac bone graft, microvasc
    20957CMt bone graft, microvasc
    20962COther bone graft, microvasc
    20969CBone/skin graft, microvasc
    20970CBone/skin graft, iliac crest
    20972CBone/skin graft, metatarsal
    20973CBone/skin graft, great toe
    21045CExtensive jaw surgery
    21141CReconstruct midface, lefort
    21142CReconstruct midface, lefort
    21143CReconstruct midface, lefort
    21145CReconstruct midface, lefort
    21146CReconstruct midface, lefort
    21147CReconstruct midface, lefort
    21150CReconstruct midface, lefort
    21151CReconstruct midface, lefort
    21154CReconstruct midface, lefort
    21155CReconstruct midface, lefort
    21159CReconstruct midface, lefort
    21160CReconstruct midface, lefort
    21172CReconstruct orbit/forehead
    21175CReconstruct orbit/forehead
    21179CReconstruct entire forehead
    21180CReconstruct entire forehead
    21182CReconstruct cranial bone
    21183CReconstruct cranial bone
    21184CReconstruct cranial bone
    21188CReconstruction of midface
    21193CReconstruct lower jaw bone
    21194CReconstruct lower jaw bone
    21195CReconstruct lower jaw bone
    21196CReconstruct lower jaw bone
    21247CReconstruct lower jaw bone
    21255CReconstruct lower jaw bone
    21256CReconstruction of orbit
    21268CRevise eye sockets
    21343CTreatment of sinus fracture
    21344CTreatment of sinus fracture
    21346CTreat nose/jaw fracture
    21347CTreat nose/jaw fracture
    21348CTreat nose/jaw fracture
    21356CTreat cheek bone fracture
    21360CTreat cheek bone fracture
    21365CTreat cheek bone fracture
    21366CTreat cheek bone fracture
    21385CTreat eye socket fracture
    21386CTreat eye socket fracture
    21387CTreat eye socket fracture
    21390CTreat eye socket fracture
    21395CTreat eye socket fracture
    21408CTreat eye socket fracture
    21422CTreat mouth roof fracture
    21423CTreat mouth roof fracture
    21431CTreat craniofacial fracture
    21432CTreat craniofacial fracture
    21433CTreat craniofacial fracture
    21435CTreat craniofacial fracture
    21436CTreat craniofacial fracture
    21495CTreat hyoid bone fracture
    21510CDrainage of bone lesion
    21557CRemove tumor, neck/chest
    21615CRemoval of rib
    21616CRemoval of rib and nerves
    21620CPartial removal of sternum
    21627CSternal debridement
    21630CExtensive sternum surgery
    21632CExtensive sternum surgery
    21705CRevision of neck muscle/rib
    21740CReconstruction of sternum
    21750CRepair of sternum separation
    21810CTreatment of rib fracture(s)
    21825CTreat sternum fracture
    22100CRemove part of neck vertebra
    22101CRemove part, thorax vertebra
    22102CRemove part, lumbar vertebra
    22103CRemove extra spine segment
    22110CRemove part of neck vertebra
    22112CRemove part, thorax vertebra
    22114CRemove part, lumbar vertebra
    22116CRemove extra spine segment
    22210CRevision of neck spine
    22212CRevision of thorax spine
    22214CRevision of lumbar spine
    22216CRevise, extra spine segment
    22220CRevision of neck spine
    22222CRevision of thorax spine
    22224CRevision of lumbar spine
    22226CRevise, extra spine segment
    22318CTreat odontoid fx w/o graft
    22319CTreat odontoid fx w/graft
    22325CTreat spine fracture
    22326CTreat neck spine fracture
    22327CTreat thorax spine fracture
    22328CTreat each add spine fx
    22548CNeck spine fusion
    22554CNeck spine fusion
    22556CThorax spine fusion
    22558CLumbar spine fusion
    22585CAdditional spinal fusion
    22590CSpine & skull spinal fusion
    22595CNeck spinal fusion
    22600CNeck spine fusion
    22610CThorax spine fusion
    22612CLumbar spine fusion
    22614CSpine fusion, extra segment
    22630CLumbar spine fusion
    22632CSpine fusion, extra segment
    22800CFusion of spine
    22802CFusion of spine
    22804CFusion of spine
    22808CFusion of spine
    22810CFusion of spine
    22812CFusion of spine
    22818CKyphectomy, 1-2 segments
    22819CKyphectomy, 3 or more
    22830CExploration of spinal fusion
    22840CInsert spine fixation device
    22841CInsert spine fixation device
    22842CInsert spine fixation device
    22843CInsert spine fixation device
    22844CInsert spine fixation device
    22845CInsert spine fixation device
    22846CInsert spine fixation device
    22847CInsert spine fixation device
    22848CInsert pelv fixation device
    22849CReinsert spinal fixation
    22850CRemove spine fixation device
    22851CApply spine prosth device
    22852CRemove spine fixation device
    22855CRemove spine fixation device
    23035CDrain shoulder bone lesion
    23125CRemoval of collar bone
    23195CRemoval of head of humerus
    23200CRemoval of collar bone
    23210CRemoval of shoulder blade
    23220CPartial removal of humerus
    23221CPartial removal of humerus
    23222CPartial removal of humerus
    23332CRemove shoulder foreign body
    23395CMuscle transfer, shoulder/arm
    23397CMuscle transfers
    23400CFixation of shoulder blade
    23440CRemove/transplant tendon
    23470CReconstruct shoulder joint
    23472CReconstruct shoulder joint
    23900CAmputation of arm & girdle
    23920CAmputation at shoulder joint
    24149CRadical resection of elbow
    24150CExtensive humerus surgery
    24151CExtensive humerus surgery
    24152CExtensive radius surgery
    24153CExtensive radius surgery
    24900CAmputation of upper arm
    24920CAmputation of upper arm
    24930CAmputation follow-up surgery
    24931CAmputate upper arm & implant
    24940CRevision of upper arm
    25170CExtensive forearm surgery
    25390CShorten radius or ulna
    25391CLengthen radius or ulna
    25392CShorten radius & ulna
    25393CLengthen radius & ulna
    25405CRepair/graft radius or ulna
    25420CRepair/graft radius & ulna
    25900CAmputation of forearm
    25905CAmputation of forearm
    25909CAmputation follow-up surgery
    25915CAmputation of forearm
    25920CAmputate hand at wrist
    25924CAmputation follow-up surgery
    25927CAmputation of hand
    25931CAmputation follow-up surgery
    26551CGreat toe-hand transfer
    26553CSingle transfer, toe-hand
    26554CDouble transfer, toe-hand
    26556CToe joint transfer
    26992CDrainage of bone lesion
    27005CIncision of hip tendon
    27006CIncision of hip tendons
    27025CIncision of hip/thigh fascia
    27030CDrainage of hip joint
    27035CDenervation of hip joint
    27036CExcision of hip joint/muscle
    27054CRemoval of hip joint lining
    27070CPartial removal of hip bone
    27071CPartial removal of hip bone
    27075CExtensive hip surgery
    27076CExtensive hip surgery
    27077CExtensive hip surgery
    27078CExtensive hip surgery
    27079CExtensive hip surgery
    27090CRemoval of hip prosthesis
    27091CRemoval of hip prosthesis
    27120CReconstruction of hip socket
    27122CReconstruction of hip socket
    27125CPartial hip replacement
    27130CTotal hip replacement
    27132CTotal hip replacement
    27134CRevise hip joint replacement
    27137CRevise hip joint replacement
    27138CRevise hip joint replacement
    27140CTransplant femur ridge
    27146CIncision of hip bone
    27147CRevision of hip bone
    Start Printed Page 18781
    27151CIncision of hip bones
    27156CRevision of hip bones
    27158CRevision of pelvis
    27161CIncision of neck of femur
    27165CIncision/fixation of femur
    27170CRepair/graft femur head/neck
    27175CTreat slipped epiphysis
    27176CTreat slipped epiphysis
    27177CTreat slipped epiphysis
    27178CTreat slipped epiphysis
    27179CRevise head/neck of femur
    27181CTreat slipped epiphysis
    27185CRevision of femur epiphysis
    27187CReinforce hip bones
    27215CTreat pelvic fracture(s)
    27216CTreat pelvic ring fracture
    27217CTreat pelvic ring fracture
    27218CTreat pelvic ring fracture
    27222CTreat hip socket fracture
    27226CTreat hip wall fracture
    27227CTreat hip fracture(s)
    27228CTreat hip fracture(s)
    27232CTreat thigh fracture
    27235CTreat thigh fracture
    27236CTreat thigh fracture
    27240CTreat thigh fracture
    27244CTreat thigh fracture
    27245CTreat thigh fracture
    27248CTreat thigh fracture
    27253CTreat hip dislocation
    27254CTreat hip dislocation
    27258CTreat hip dislocation
    27259CTreat hip dislocation
    27280CFusion of sacroiliac joint
    27282CFusion of pubic bones
    27284CFusion of hip joint
    27286CFusion of hip joint
    27290CAmputation of leg at hip
    27295CAmputation of leg at hip
    27303CDrainage of bone lesion
    27365CExtensive leg surgery
    27445CRevision of knee joint
    27446CRevision of knee joint
    27447CTotal knee replacement
    27448CIncision of thigh
    27450CIncision of thigh
    27454CRealignment of thigh bone
    27455CRealignment of knee
    27457CRealignment of knee
    27465CShortening of thigh bone
    27466CLengthening of thigh bone
    27468CShorten/lengthen thighs
    27470CRepair of thigh
    27472CRepair/graft of thigh
    27475CSurgery to stop leg growth
    27477CSurgery to stop leg growth
    27479CSurgery to stop leg growth
    27485CSurgery to stop leg growth
    27486CRevise/replace knee joint
    27487CRevise/replace knee joint
    27488CRemoval of knee prosthesis
    27495CReinforce thigh
    27506CTreatment of thigh fracture
    27507CTreatment of thigh fracture
    27511CTreatment of thigh fracture
    27513CTreatment of thigh fracture
    27514CTreatment of thigh fracture
    27519CTreat thigh fx growth plate
    27524CTreat kneecap fracture
    27535CTreat knee fracture
    27536CTreat knee fracture
    27540CTreat knee fracture
    27557CTreat knee dislocation
    27558CTreat knee dislocation
    27580CFusion of knee
    27590CAmputate leg at thigh
    27591CAmputate leg at thigh
    27592CAmputate leg at thigh
    27596CAmputation follow-up surgery
    27598CAmputate lower leg at knee
    27645CExtensive lower leg surgery
    27646CExtensive lower leg surgery
    27702CReconstruct ankle joint
    27703CReconstruction, ankle joint
    27712CRealignment of lower leg
    27715CRevision of lower leg
    27720CRepair of tibia
    27722CRepair/graft of tibia
    27724CRepair/graft of tibia
    27725CRepair of lower leg
    27727CRepair of lower leg
    27880CAmputation of lower leg
    27881CAmputation of lower leg
    27882CAmputation of lower leg
    27886CAmputation follow-up surgery
    27888CAmputation of foot at ankle
    28800CAmputation of midfoot
    28805CAmputation thru metatarsal
    31225CRemoval of upper jaw
    31230CRemoval of upper jaw
    31290CNasal/sinus endoscopy, surg
    31291CNasal/sinus endoscopy, surg
    31292CNasal/sinus endoscopy, surg
    31293CNasal/sinus endoscopy, surg
    31294CNasal/sinus endoscopy, surg
    31360CRemoval of larynx
    31365CRemoval of larynx
    31367CPartial removal of larynx
    31368CPartial removal of larynx
    31370CPartial removal of larynx
    31380CPartial removal of larynx
    31382CPartial removal of larynx
    31390CRemoval of larynx & pharynx
    31395CReconstruct larynx & pharynx
    31582CRevision of larynx
    31584CTreat larynx fracture
    31587CRevision of larynx
    31725CClearance of airways
    31760CRepair of windpipe
    31766CReconstruction of windpipe
    31770CRepair/graft of bronchus
    31775CReconstruct bronchus
    31780CReconstruct windpipe
    31781CReconstruct windpipe
    31785CRemove windpipe lesion
    31786CRemove windpipe lesion
    31800CRepair of windpipe injury
    31805CRepair of windpipe injury
    32035CExploration of chest
    32036CExploration of chest
    32095CBiopsy through chest wall
    32100CExploration/biopsy of chest
    32110CExplore/repair chest
    32120CRe-exploration of chest
    32124CExplore chest free adhesions
    32140CRemoval of lung lesion(s)
    32141CRemove/treat lung lesions
    32150CRemoval of lung lesion(s)
    32151CRemove lung foreign body
    32160COpen chest heart massage
    32200CDrain, open, lung lesion
    32201CDrain, percut, lung lesion
    32215CTreat chest lining
    32220CRelease of lung
    32225CPartial release of lung
    32310CRemoval of chest lining
    32320CFree/remove chest lining
    32402COpen biopsy chest lining
    32440CRemoval of lung
    32442CSleeve pneumonectomy
    32445CRemoval of lung
    32480CPartial removal of lung
    32482CBilobectomy
    32484CSegmentectomy
    32486CSleeve lobectomy
    32488CCompletion pneumonectomy
    32491CLung volume reduction
    32500CPartial removal of lung
    32501CRepair bronchus add-on
    32520CRemove lung & revise chest
    32522CRemove lung & revise chest
    32525CRemove lung & revise chest
    32540CRemoval of lung lesion
    32650CThoracoscopy, surgical
    32651CThoracoscopy, surgical
    32652CThoracoscopy, surgical
    32653CThoracoscopy, surgical
    32654CThoracoscopy, surgical
    32655CThoracoscopy, surgical
    32656CThoracoscopy, surgical
    32657CThoracoscopy, surgical
    32658CThoracoscopy, surgical
    32659CThoracoscopy, surgical
    32660CThoracoscopy, surgical
    32661CThoracoscopy, surgical
    32662CThoracoscopy, surgical
    32663CThoracoscopy, surgical
    32664CThoracoscopy, surgical
    32665CThoracoscopy, surgical
    32800CRepair lung hernia
    32810CClose chest after drainage
    32815CClose bronchial fistula
    32820CReconstruct injured chest
    32850CDonor pneumonectomy
    32851CLung transplant, single
    32852CLung transplant with bypass
    32853CLung transplant, double
    32854CLung transplant with bypass
    32900CRemoval of rib(s)
    32905CRevise & repair chest wall
    32906CRevise & repair chest wall
    32940CRevision of lung
    32997CTotal lung lavage
    33015CIncision of heart sac
    33020CIncision of heart sac
    33025CIncision of heart sac
    33030CPartial removal of heart sac
    33031CPartial removal of heart sac
    33050CRemoval of heart sac lesion
    33120CRemoval of heart lesion
    33130CRemoval of heart lesion
    33140CHeart revascularize (tmr)
    33200CInsertion of heart pacemaker
    33201CInsertion of heart pacemaker
    33236CRemove electrode/thoracotomy
    33237CRemove electrode/thoracotomy
    33238CRemove electrode/thoracotomy
    33243CRemove eltrd/thoracotomy
    33245CInsert epic eltrd pace-defib
    33246CInsert epic eltrd/generator
    33250CAblate heart dysrhythm focus
    33251CAblate heart dysrhythm focus
    33253CReconstruct atria
    Start Printed Page 18782
    33261CAblate heart dysrhythm focus
    33282CImplant pat-active ht record
    33284CRemove pat-active ht record
    33300CRepair of heart wound
    33305CRepair of heart wound
    33310CExploratory heart surgery
    33315CExploratory heart surgery
    33320CRepair major blood vessel(s)
    33321CRepair major vessel
    33322CRepair major blood vessel(s)
    33330CInsert major vessel graft
    33332CInsert major vessel graft
    33335CInsert major vessel graft
    33400CRepair of aortic valve
    33401CValvuloplasty, open
    33403CValvuloplasty, w/cp bypass
    33404CPrepare heart-aorta conduit
    33405CReplacement of aortic valve
    33406CReplacement of aortic valve
    33410CReplacement of aortic valve
    33411CReplacement of aortic valve
    33412CReplacement of aortic valve
    33413CReplacement of aortic valve
    33414CRepair of aortic valve
    33415CRevision, subvalvular tissue
    33416CRevise ventricle muscle
    33417CRepair of aortic valve
    33420CRevision of mitral valve
    33422CRevision of mitral valve
    33425CRepair of mitral valve
    33426CRepair of mitral valve
    33427CRepair of mitral valve
    33430CReplacement of mitral valve
    33460CRevision of tricuspid valve
    33463CValvuloplasty, tricuspid
    33464CValvuloplasty, tricuspid
    33465CReplace tricuspid valve
    33468CRevision of tricuspid valve
    33470CRevision of pulmonary valve
    33471CValvotomy, pulmonary valve
    33472CRevision of pulmonary valve
    33474CRevision of pulmonary valve
    33475CReplacement, pulmonary valve
    33476CRevision of heart chamber
    33478CRevision of heart chamber
    33496CRepair, prosth valve clot
    33500CRepair heart vessel fistula
    33501CRepair heart vessel fistula
    33502CCoronary artery correction
    33503CCoronary artery graft
    33504CCoronary artery graft
    33505CRepair artery w/tunnel
    33506CRepair artery, translocation
    33510CCABG, vein, single
    33511CCABG, vein, two
    33512CCABG, vein, three
    33513CCABG, vein, four
    33514CCABG, vein, five
    33516CCabg, vein, six or more
    33517CCABG, artery-vein, single
    33518CCABG, artery-vein, two
    33519CCABG, artery-vein, three
    33521CCABG, artery-vein, four
    33522CCABG, artery-vein, five
    33523CCabg, art-vein, six or more
    33530CCoronary artery, bypass/reop
    33533CCABG, arterial, single
    33534CCABG, arterial, two
    33535CCABG, arterial, three
    33536CCabg, arterial, four or more
    33542CRemoval of heart lesion
    33545CRepair of heart damage
    33572COpen coronary endarterectomy
    33600CClosure of valve
    33602CClosure of valve
    33606CAnastomosis/artery-aorta
    33608CRepair anomaly w/conduit
    33610CRepair by enlargement
    33611CRepair double ventricle
    33612CRepair double ventricle
    33615CRepair, simple fontan
    33617CRepair, modified fontan
    33619CRepair single ventricle
    33641CRepair heart septum defect
    33645CRevision of heart veins
    33647CRepair heart septum defects
    33660CRepair of heart defects
    33665CRepair of heart defects
    33670CRepair of heart chambers
    33681CRepair heart septum defect
    33684CRepair heart septum defect
    33688CRepair heart septum defect
    33690CReinforce pulmonary artery
    33692CRepair of heart defects
    33694CRepair of heart defects
    33697CRepair of heart defects
    33702CRepair of heart defects
    33710CRepair of heart defects
    33720CRepair of heart defect
    33722CRepair of heart defect
    33730CRepair heart-vein defect(s)
    33732CRepair heart-vein defect
    33735CRevision of heart chamber
    33736CRevision of heart chamber
    33737CRevision of heart chamber
    33750CMajor vessel shunt
    33755CMajor vessel shunt
    33762CMajor vessel shunt
    33764CMajor vessel shunt & graft
    33766CMajor vessel shunt
    33767CMajor vessel shunt
    33770CRepair great vessels defect
    33771CRepair great vessels defect
    33774CRepair great vessels defect
    33775CRepair great vessels defect
    33776CRepair great vessels defect
    33777CRepair great vessels defect
    33778CRepair great vessels defect
    33779CRepair great vessels defect
    33780CRepair great vessels defect
    33781CRepair great vessels defect
    33786CRepair arterial trunk
    33788CRevision of pulmonary artery
    33800CAortic suspension
    33802CRepair vessel defect
    33803CRepair vessel defect
    33813CRepair septal defect
    33814CRepair septal defect
    33820CRevise major vessel
    33822CRevise major vessel
    33824CRevise major vessel
    33840CRemove aorta constriction
    33845CRemove aorta constriction
    33851CRemove aorta constriction
    33852CRepair septal defect
    33853CRepair septal defect
    33860CAscending aortic graft
    33861CAscending aortic graft
    33863CAscending aortic graft
    33870CTransverse aortic arch graft
    33875CThoracic aortic graft
    33877CThoracoabdominal graft
    33910CRemove lung artery emboli
    33915CRemove lung artery emboli
    33916CSurgery of great vessel
    33917CRepair pulmonary artery
    33918CRepair pulmonary atresia
    33919CRepair pulmonary atresia
    33920CRepair pulmonary atresia
    33922CTransect pulmonary artery
    33924CRemove pulmonary shunt
    33930CRemoval of donor heart/lung
    33935CTransplantation, heart/lung
    33940CRemoval of donor heart
    33945CTransplantation of heart
    33960CExternal circulation assist
    33961CExternal circulation assist
    33968CRemove aortic assist device
    33970CAortic circulation assist
    33971CAortic circulation assist
    33973CInsert balloon device
    33974CRemove intra-aortic balloon
    33975CImplant ventricular device
    33976CImplant ventricular device
    33977CRemove ventricular device
    33978CRemove ventricular device
    34001CRemoval of artery clot
    34051CRemoval of artery clot
    34151CRemoval of artery clot
    34401CRemoval of vein clot
    34421CRemoval of vein clot
    34451CRemoval of vein clot
    34502CReconstruct vena cava
    35001CRepair defect of artery
    35002CRepair artery rupture, neck
    35005CRepair defect of artery
    35011CRepair defect of artery
    35013CRepair artery rupture, arm
    35021CRepair defect of artery
    35022CRepair artery rupture, chest
    35045CRepair defect of arm artery
    35081CRepair defect of artery
    35082CRepair artery rupture, aorta
    35091CRepair defect of artery
    35092CRepair artery rupture, aorta
    35102CRepair defect of artery
    35103CRepair artery rupture, groin
    35111CRepair defect of artery
    35112CRepair artery rupture, spleen
    35121CRepair defect of artery
    35122CRepair artery rupture, belly
    35131CRepair defect of artery
    35132CRepair artery rupture, groin
    35141CRepair defect of artery
    35142CRepair artery rupture, thigh
    35151CRepair defect of artery
    35152CRepair artery rupture, knee
    35161CRepair defect of artery
    35162CRepair artery rupture
    35182CRepair blood vessel lesion
    35189CRepair blood vessel lesion
    35211CRepair blood vessel lesion
    35216CRepair blood vessel lesion
    35221CRepair blood vessel lesion
    35241CRepair blood vessel lesion
    35246CRepair blood vessel lesion
    35251CRepair blood vessel lesion
    35271CRepair blood vessel lesion
    35276CRepair blood vessel lesion
    35281CRepair blood vessel lesion
    35301CRechanneling of artery
    35311CRechanneling of artery
    35331CRechanneling of artery
    35341CRechanneling of artery
    35351CRechanneling of artery
    Start Printed Page 18783
    35355CRechanneling of artery
    35361CRechanneling of artery
    35363CRechanneling of artery
    35371CRechanneling of artery
    35372CRechanneling of artery
    35381CRechanneling of artery
    35390CReoperation, carotid add-on
    35400CAngioscopy
    35450CRepair arterial blockage
    35452CRepair arterial blockage
    35454CRepair arterial blockage
    35456CRepair arterial blockage
    35458CRepair arterial blockage
    35480CAtherectomy, open
    35481CAtherectomy, open
    35482CAtherectomy, open
    35483CAtherectomy, open
    35501CArtery bypass graft
    35506CArtery bypass graft
    35507CArtery bypass graft
    35508CArtery bypass graft
    35509CArtery bypass graft
    35511CArtery bypass graft
    35515CArtery bypass graft
    35516CArtery bypass graft
    35518CArtery bypass graft
    35521CArtery bypass graft
    35526CArtery bypass graft
    35531CArtery bypass graft
    35533CArtery bypass graft
    35536CArtery bypass graft
    35541CArtery bypass graft
    35546CArtery bypass graft
    35548CArtery bypass graft
    35549CArtery bypass graft
    35551CArtery bypass graft
    35556CArtery bypass graft
    35558CArtery bypass graft
    35560CArtery bypass graft
    35563CArtery bypass graft
    35565CArtery bypass graft
    35566CArtery bypass graft
    35571CArtery bypass graft
    35582CVein bypass graft
    35583CVein bypass graft
    35585CVein bypass graft
    35587CVein bypass graft
    35601CArtery bypass graft
    35606CArtery bypass graft
    35612CArtery bypass graft
    35616CArtery bypass graft
    35621CArtery bypass graft
    35623CBypass graft, not vein
    35626CArtery bypass graft
    35631CArtery bypass graft
    35636CArtery bypass graft
    35641CArtery bypass graft
    35642CArtery bypass graft
    35645CArtery bypass graft
    35646CArtery bypass graft
    35650CArtery bypass graft
    35651CArtery bypass graft
    35654CArtery bypass graft
    35656CArtery bypass graft
    35661CArtery bypass graft
    35663CArtery bypass graft
    35665CArtery bypass graft
    35666CArtery bypass graft
    35671CArtery bypass graft
    35681CComposite bypass graft
    35682CComposite bypass graft
    35683CComposite bypass graft
    35691CArterial transposition
    35693CArterial transposition
    35694CArterial transposition
    35695CArterial transposition
    35700CReoperation, bypass graft
    35701CExploration, carotid artery
    35721CExploration, femoral artery
    35741CExploration popliteal artery
    35761CExploration of artery/vein
    35800CExplore neck vessels
    35820CExplore chest vessels
    35840CExplore abdominal vessels
    35860CExplore limb vessels
    35870CRepair vessel graft defect
    35901CExcision, graft, neck
    35903CExcision, graft, extremity
    35905CExcision, graft, thorax
    35907CExcision, graft, abdomen
    36510CInsertion of catheter, vein
    36550CDeclot vascular device
    36660CInsertion catheter, artery
    36822CInsertion of cannula(s)
    36823CInsertion of cannula(s)
    36834CRepair A-V aneurysm
    37140CRevision of circulation
    37145CRevision of circulation
    37160CRevision of circulation
    37180CRevision of circulation
    37181CSplice spleen/kidney veins
    37195CThrombolytic therapy, stroke
    37200CTranscatheter biopsy
    37201CTranscatheter therapy infuse
    37202CTranscatheter therapy infuse
    37616CLigation of chest artery
    37617CLigation of abdomen artery
    37620CRevision of major vein
    37660CRevision of major vein
    37788CRevascularization, penis
    38100CRemoval of spleen, total
    38101CRemoval of spleen, partial
    38102CRemoval of spleen, total
    38115CRepair of ruptured spleen
    38380CThoracic duct procedure
    38381CThoracic duct procedure
    38382CThoracic duct procedure
    38562CRemoval, pelvic lymph nodes
    38564CRemoval, abdomen lymph nodes
    38700CRemoval of lymph nodes, neck
    38724CRemoval of lymph nodes, neck
    38746CRemove thoracic lymph nodes
    38747CRemove abdominal lymph nodes
    38765CRemove groin lymph nodes
    38770CRemove pelvis lymph nodes
    38780CRemove abdomen lymph nodes
    39000CExploration of chest
    39010CExploration of chest
    39200CRemoval chest lesion
    39220CRemoval chest lesion
    39499CChest procedure
    39501CRepair diaphragm laceration
    39502CRepair paraesophageal hernia
    39503CRepair of diaphragm hernia
    39520CRepair of diaphragm hernia
    39530CRepair of diaphragm hernia
    39531CRepair of diaphragm hernia
    39540CRepair of diaphragm hernia
    39541CRepair of diaphragm hernia
    39545CRevision of diaphragm
    39560CResect diaphragm, simple
    39561CResect diaphragm, complex
    39599CDiaphragm surgery procedure
    41130CPartial removal of tongue
    41135CTongue and neck surgery
    41140CRemoval of tongue
    41145CTongue removal, neck surgery
    41150CTongue, mouth, jaw surgery
    41153CTongue, mouth, neck surgery
    41155CTongue, jaw, & neck surgery
    42426CExcise parotid gland/lesion
    42842CExtensive surgery of throat
    42845CExtensive surgery of throat
    42894CRevision of pharyngeal walls
    42953CRepair throat, esophagus
    42961CControl throat bleeding
    42971CControl nose/throat bleeding
    43030CThroat muscle surgery
    43045CIncision of esophagus
    43100CExcision of esophagus lesion
    43101CExcision of esophagus lesion
    43107CRemoval of esophagus
    43108CRemoval of esophagus
    43112CRemoval of esophagus
    43113CRemoval of esophagus
    43116CPartial removal of esophagus
    43117CPartial removal of esophagus
    43118CPartial removal of esophagus
    43121CPartial removal of esophagus
    43122CParital removal of esophagus
    43123CPartial removal of esophagus
    43124CRemoval of esophagus
    43130CRemoval of esophagus pouch
    43135CRemoval of esophagus pouch
    43300CRepair of esophagus
    43305CRepair esophagus and fistula
    43310CRepair of esophagus
    43312CRepair esophagus and fistula
    43320CFuse esophagus & stomach
    43324CRevise esophagus & stomach
    43325CRevise esophagus & stomach
    43326CRevise esophagus & stomach
    43330CRepair of esophagus
    43331CRepair of esophagus
    43340CFuse esophagus & intestine
    43341CFuse esophagus & intestine
    43350CSurgical opening, esophagus
    43351CSurgical opening, esophagus
    43352CSurgical opening, esophagus
    43360CGastrointestinal repair
    43361CGastrointestinal repair
    43400CLigate esophagus veins
    43401CEsophagus surgery for veins
    43405CLigate/staple esophagus
    43410CRepair esophagus wound
    43415CRepair esophagus wound
    43420CRepair esophagus opening
    43425CRepair esophagus opening
    43460CPressure treatment esophagus
    43496CFree jejunum flap, microvasc
    43500CSurgical opening of stomach
    43501CSurgical repair of stomach
    43502CSurgical repair of stomach
    43510CSurgical opening of stomach
    43520CIncision of pyloric muscle
    43605CBiopsy of stomach
    43610CExcision of stomach lesion
    43611CExcision of stomach lesion
    43620CRemoval of stomach
    43621CRemoval of stomach
    43622CRemoval of stomach
    43631CRemoval of stomach, partial
    43632CRemoval of stomach, partial
    Start Printed Page 18784
    43633CRemoval of stomach, partial
    43634CRemoval of stomach, partial
    43635CRemoval of stomach, partial
    43638CRemoval of stomach, partial
    43639CRemoval of stomach, partial
    43640CVagotomy & pylorus repair
    43641CVagotomy & pylorus repair
    43800CReconstruction of pylorus
    43810CFusion of stomach and bowel
    43820CFusion of stomach and bowel
    43825CFusion of stomach and bowel
    43832CPlace gastrostomy tube
    43840CRepair of stomach lesion
    43842CGastroplasty for obesity
    43843CGastroplasty for obesity
    43846CGastric bypass for obesity
    43847CGastric bypass for obesity
    43848CRevision gastroplasty
    43850CRevise stomach-bowel fusion
    43855CRevise stomach-bowel fusion
    43860CRevise stomach-bowel fusion
    43865CRevise stomach-bowel fusion
    43880CRepair stomach-bowel fistula
    44005CFreeing of bowel adhesion
    44010CIncision of small bowel
    44015CInsert needle cath bowel
    44020CExploration of small bowel
    44021CDecompress small bowel
    44025CIncision of large bowel
    44050CReduce bowel obstruction
    44055CCorrect malrotation of bowel
    44110CExcision of bowel lesion(s)
    44111CExcision of bowel lesion(s)
    44120CRemoval of small intestine
    44121CRemoval of small intestine
    44125CRemoval of small intestine
    44130CBowel to bowel fusion
    44139CMobilization of colon
    44140CPartial removal of colon
    44141CPartial removal of colon
    44143CPartial removal of colon
    44144CPartial removal of colon
    44145CPartial removal of colon
    44146CPartial removal of colon
    44147CPartial removal of colon
    44150CRemoval of colon
    44151CRemoval of colon/ileostomy
    44152CRemoval of colon/ileostomy
    44153CRemoval of colon/ileostomy
    44155CRemoval of colon/ileostomy
    44156CRemoval of colon/ileostomy
    44160CRemoval of colon
    44202CLaparo, resect intestine
    44300COpen bowel to skin
    44310CIleostomy/jejunostomy
    44314CRevision of ileostomy
    44316CDevise bowel pouch
    44320CColostomy
    44322CColostomy with biopsies
    44345CRevision of colostomy
    44346CRevision of colostomy
    44500CIntro, gastrointestinal tube
    44602CSuture, small intestine
    44603CSuture, small intestine
    44604CSuture, large intestine
    44605CRepair of bowel lesion
    44615CIntestinal stricturoplasty
    44620CRepair bowel opening
    44625CRepair bowel opening
    44626CRepair bowel opening
    44640CRepair bowel-skin fistula
    44650CRepair bowel fistula
    44660CRepair bowel-bladder fistula
    44661CRepair bowel-bladder fistula
    44680CSurgical revision, intestine
    44700CSuspend bowel w/prosthesis
    44800CExcision of bowel pouch
    44820CExcision of mesentery lesion
    44850CRepair of mesentery
    44899CBowel surgery procedure
    44900CDrain app abscess, open
    44901CDrain app abscess, percut
    44950CAppendectomy
    44955CAppendectomy add-on
    44960CAppendectomy
    45110CRemoval of rectum
    45111CPartial removal of rectum
    45112CRemoval of rectum
    45113CPartial proctectomy
    45114CPartial removal of rectum
    45116CPartial removal of rectum
    45119CRemove rectum w/reservoir
    45120CRemoval of rectum
    45121CRemoval of rectum and colon
    45123CPartial proctectomy
    45126CPelvic exenteration
    45130CExcision of rectal prolapse
    45135CExcision of rectal prolapse
    45540CCorrect rectal prolapse
    45541CCorrect rectal prolapse
    45550CRepair rectum/remove sigmoid
    45562CExploration/repair of rectum
    45563CExploration/repair of rectum
    45800CRepair rect/bladder fistula
    45805CRepair fistula w/colostomy
    45820CRepair rectourethral fistula
    45825CRepair fistula w/colostomy
    46705CRepair of anal stricture
    46715CRepair of anovaginal fistula
    46716CRepair of anovaginal fistula
    46730CConstruction of absent anus
    46735CConstruction of absent anus
    46740CConstruction of absent anus
    46742CRepair of imperforated anus
    46744CRepair of cloacal anomaly
    46746CRepair of cloacal anomaly
    46748CRepair of cloacal anomaly
    46751CRepair of anal sphincter
    47001CNeedle biopsy, liver add-on
    47010COpen drainage, liver lesion
    47011CPercut drain, liver lesion
    47015CInject/aspirate liver cyst
    47100CWedge biopsy of liver
    47120CPartial removal of liver
    47122CExtensive removal of liver
    47125CPartial removal of liver
    47130CPartial removal of liver
    47133CRemoval of donor liver
    47134CPartial removal, donor liver
    47135CTransplantation of liver
    47136CTransplantation of liver
    47300CSurgery for liver lesion
    47350CRepair liver wound
    47360CRepair liver wound
    47361CRepair liver wound
    47362CRepair liver wound
    47400CIncision of liver duct
    47420CIncision of bile duct
    47425CIncision of bile duct
    47460CIncise bile duct sphincter
    47480CIncision of gallbladder
    47490CIncision of gallbladder
    47550CBile duct endoscopy add-on
    47600CRemoval of gallbladder
    47605CRemoval of gallbladder
    47610CRemoval of gallbladder
    47612CRemoval of gallbladder
    47620CRemoval of gallbladder
    47700CExploration of bile ducts
    47701CBile duct revision
    47711CExcision of bile duct tumor
    47712CExcision of bile duct tumor
    47715CExcision of bile duct cyst
    47716CFusion of bile duct cyst
    47720CFuse gallbladder & bowel
    47721CFuse upper gi structures
    47740CFuse gallbladder & bowel
    47741CFuse gallbladder & bowel
    47760CFuse bile ducts and bowel
    47765CFuse liver ducts & bowel
    47780CFuse bile ducts and bowel
    47785CFuse bile ducts and bowel
    47800CReconstruction of bile ducts
    47801CPlacement, bile duct support
    47802CFuse liver duct & intestine
    47900CSuture bile duct injury
    48000CDrainage of abdomen
    48001CPlacement of drain, pancreas
    48005CResect/debride pancreas
    48020CRemoval of pancreatic stone
    48100CBiopsy of pancreas
    48120CRemoval of pancreas lesion
    48140CPartial removal of pancreas
    48145CPartial removal of pancreas
    48146CPancreatectomy
    48148CRemoval of pancreatic duct
    48150CPartial removal of pancreas
    48152CPancreatectomy
    48153CPancreatectomy
    48154CPancreatectomy
    48155CRemoval of pancreas
    48180CFuse pancreas and bowel
    48400CInjection, intraop add-on
    48500CSurgery of pancreas cyst
    48510CDrain pancreatic pseudocyst
    48511CDrain pancreatic pseudocyst
    48520CFuse pancreas cyst and bowel
    48540CFuse pancreas cyst and bowel
    48545CPancreatorrhaphy
    48547CDuodenal exclusion
    48556CRemoval, allograft pancreas
    49000CExploration of abdomen
    49002CReopening of abdomen
    49010CExploration behind abdomen
    49020CDrain abdominal abscess
    49021CDrain abdominal abscess
    49040CDrain, open, abdom abscess
    49041CDrain, percut, abdom abscess
    49060CDrain, open, retrop abscess
    49061CDrain, percut, retroper absc
    49062CDrain to peritoneal cavity
    49200CRemoval of abdominal lesion
    49201CRemoval of abdominal lesion
    49215CExcise sacral spine tumor
    49220CMultiple surgery, abdomen
    49255CRemoval of omentum
    49425CInsert abdomen-venous drain
    49428CLigation of shunt
    49605CRepair umbilical lesion
    49606CRepair umbilical lesion
    49610CRepair umbilical lesion
    49611CRepair umbilical lesion
    49900CRepair of abdominal wall
    49905COmental flap
    49906CFree omental flap, microvasc
    50010CExploration of kidney
    Start Printed Page 18785
    50020CRenal abscess, open drain
    50021CRenal abscess, percut drain
    50040CDrainage of kidney
    50045CExploration of kidney
    50060CRemoval of kidney stone
    50065CIncision of kidney
    50070CIncision of kidney
    50075CRemoval of kidney stone
    50100CRevise kidney blood vessels
    50120CExploration of kidney
    50125CExplore and drain kidney
    50130CRemoval of kidney stone
    50135CExploration of kidney
    50205CBiopsy of kidney
    50220CRemoval of kidney
    50225CRemoval of kidney
    50230CRemoval of kidney
    50234CRemoval of kidney & ureter
    50236CRemoval of kidney & ureter
    50240CPartial removal of kidney
    50280CRemoval of kidney lesion
    50290CRemoval of kidney lesion
    50300CRemoval of donor kidney
    50320CRemoval of donor kidney
    50340CRemoval of kidney
    50360CTransplantation of kidney
    50365CTransplantation of kidney
    50370CRemove transplanted kidney
    50380CReimplantation of kidney
    50400CRevision of kidney/ureter
    50405CRevision of kidney/ureter
    50500CRepair of kidney wound
    50520CClose kidney-skin fistula
    50525CRepair renal-abdomen fistula
    50526CRepair renal-abdomen fistula
    50540CRevision of horseshoe kidney
    50546CLaparoscopic nephrectomy
    50547CLaparo removal donor kidney
    50570CKidney endoscopy
    50572CKidney endoscopy
    50574CKidney endoscopy & biopsy
    50575CKidney endoscopy
    50576CKidney endoscopy & treatment
    50578CRenal endoscopy/radiotracer
    50580CKidney endoscopy & treatment
    50600CExploration of ureter
    50605CInsert ureteral support
    50610CRemoval of ureter stone
    50620CRemoval of ureter stone
    50630CRemoval of ureter stone
    50650CRemoval of ureter
    50660CRemoval of ureter
    50700CRevision of ureter
    50715CRelease of ureter
    50722CRelease of ureter
    50725CRelease/revise ureter
    50727CRevise ureter
    50728CRevise ureter
    50740CFusion of ureter & kidney
    50750CFusion of ureter & kidney
    50760CFusion of ureters
    50770CSplicing of ureters
    50780CReimplant ureter in bladder
    50782CReimplant ureter in bladder
    50783CReimplant ureter in bladder
    50785CReimplant ureter in bladder
    50800CImplant ureter in bowel
    50810CFusion of ureter & bowel
    50815CUrine shunt to bowel
    50820CConstruct bowel bladder
    50825CConstruct bowel bladder
    50830CRevise urine flow
    50840CReplace ureter by bowel
    50845CAppendico-vesicostomy
    50860CTransplant ureter to skin
    50900CRepair of ureter
    50920CClosure ureter/skin fistula
    50930CClosure ureter/bowel fistula
    50940CRelease of ureter
    50970CUreter endoscopy
    50972CUreter endoscopy & catheter
    50974CUreter endoscopy & biopsy
    50976CUreter endoscopy & treatment
    50978CUreter endoscopy & tracer
    50980CUreter endoscopy & treatment
    51060CRemoval of ureter stone
    51525CRemoval of bladder lesion
    51530CRemoval of bladder lesion
    51535CRepair of ureter lesion
    51550CPartial removal of bladder
    51555CPartial removal of bladder
    51565CRevise bladder & ureter(s)
    51570CRemoval of bladder
    51575CRemoval of bladder & nodes
    51580CRemove bladder/revise tract
    51585CRemoval of bladder & nodes
    51590CRemove bladder/revise tract
    51595CRemove bladder/revise tract
    51596CRemove bladder/create pouch
    51597CRemoval of pelvic structures
    51800CRevision of bladder/urethra
    51820CRevision of urinary tract
    51840CAttach bladder/urethra
    51841CAttach bladder/urethra
    51845CRepair bladder neck
    51860CRepair of bladder wound
    51865CRepair of bladder wound
    51900CRepair bladder/vagina lesion
    51920CClose bladder-uterus fistula
    51925CHysterectomy/bladder repair
    51940CCorrection of bladder defect
    51960CRevision of bladder & bowel
    51980CConstruct bladder opening
    53085CDrainage of urinary leakage
    53415CReconstruction of urethra
    53443CReconstruction of urethra
    54125CRemoval of penis
    54130CRemove penis & nodes
    54135CRemove penis & nodes
    54332CRevise penis/urethra
    54336CRevise penis/urethra
    54390CRepair penis and bladder
    54430CRevision of penis
    54535CExtensive testis surgery
    54560CExploration for testis
    54650COrchiopexy (Fowler-Stephens)
    55600CIncise sperm duct pouch
    55605CIncise sperm duct pouch
    55650CRemove sperm duct pouch
    55801CRemoval of prostate
    55810CExtensive prostate surgery
    55812CExtensive prostate surgery
    55815CExtensive prostate surgery
    55821CRemoval of prostate
    55831CRemoval of prostate
    55840CExtensive prostate surgery
    55842CExtensive prostate surgery
    55845CExtensive prostate surgery
    55860CSurgical exposure, prostate
    55862CExtensive prostate surgery
    55865CExtensive prostate surgery
    56630CExtensive vulva surgery
    56631CExtensive vulva surgery
    56632CExtensive vulva surgery
    56633CExtensive vulva surgery
    56634CExtensive vulva surgery
    56637CExtensive vulva surgery
    56640CExtensive vulva surgery
    56805CRepair clitoris
    57110CRemove vagina wall, complete
    57111CRemove vagina tissue, compl
    57112CVaginectomy w/nodes, compl
    57120CClosure of vagina
    57270CRepair of bowel pouch
    57280CSuspension of vagina
    57282CRepair of vaginal prolapse
    57292CConstruct vagina with graft
    57305CRepair rectum-vagina fistula
    57307CFistula repair & colostomy
    57308CFistula repair, transperine
    57310CRepair urethrovaginal lesion
    57311CRepair urethrovaginal lesion
    57320CRepair bladder-vagina lesion
    57330CRepair bladder-vagina lesion
    57335CRepair vagina
    57531CRemoval of cervix, radical
    57540CRemoval of residual cervix
    57545CRemove cervix/repair pelvis
    58140CRemoval of uterus lesion
    58150CTotal hysterectomy
    58152CTotal hysterectomy
    58180CPartial hysterectomy
    58200CExtensive hysterectomy
    58210CExtensive hysterectomy
    58240CRemoval of pelvis contents
    58260CVaginal hysterectomy
    58262CVaginal hysterectomy
    58263CVaginal hysterectomy
    58267CHysterectomy & vagina repair
    58270CHysterectomy & vagina repair
    58275CHysterectomy/revise vagina
    58280CHysterectomy/revise vagina
    58285CExtensive hysterectomy
    58400CSuspension of uterus
    58410CSuspension of uterus
    58520CRepair of ruptured uterus
    58540CRevision of uterus
    58600CDivision of fallopian tube
    58605CDivision of fallopian tube
    58611CLigate oviduct(s) add-on
    58615COcclude fallopian tube(s)
    58700CRemoval of fallopian tube
    58720CRemoval of ovary/tube(s)
    58740CRevise fallopian tube(s)
    58750CRepair oviduct
    58752CRevise ovarian tube(s)
    58760CRemove tubal obstruction
    58770CCreate new tubal opening
    58805CDrainage of ovarian cyst(s)
    58822CDrain ovary abscess, percut
    58823CDrain pelvic abscess, percut
    58825CTransposition, ovary(s)
    58940CRemoval of ovary(s)
    58943CRemoval of ovary(s)
    58950CResect ovarian malignancy
    58951CResect ovarian malignancy
    58952CResect ovarian malignancy
    58960CExploration of abdomen
    59100CRemove uterus lesion
    59120CTreat ectopic pregnancy
    59121CTreat ectopic pregnancy
    59130CTreat ectopic pregnancy
    59135CTreat ectopic pregnancy
    59136CTreat ectopic pregnancy
    59140CTreat ectopic pregnancy
    59325CRevision of cervix
    Start Printed Page 18786
    59350CRepair of uterus
    59514CCesarean delivery only
    59525CRemove uterus after cesarean
    59620CAttempted vbac delivery only
    59830CTreat uterus infection
    59850CAbortion
    59851CAbortion
    59852CAbortion
    59855CAbortion
    59856CAbortion
    59857CAbortion
    59866CAbortion (mpr)
    60212CParital thyroid excision
    60252CRemoval of thyroid
    60254CExtensive thyroid surgery
    60260CRepeat thyroid surgery
    60270CRemoval of thyroid
    60271CRemoval of thyroid
    60502CRe-explore parathyroids
    60505CExplore parathyroid glands
    60512CAutotransplant parathyroid
    60520CRemoval of thymus gland
    60521CRemoval of thymus gland
    60522CRemoval of thymus gland
    60540CExplore adrenal gland
    60545CExplore adrenal gland
    60600CRemove carotid body lesion
    60605CRemove carotid body lesion
    60650CLaparoscopy adrenalectomy
    61105CTwist drill hole
    61107CDrill skull for implantation
    61108CDrill skull for drainage
    61120CBurr hole for puncture
    61140CPierce skull for biopsy
    61150CPierce skull for drainage
    61151CPierce skull for drainage
    61154CPierce skull & remove clot
    61156CPierce skull for drainage
    61210CPierce skull, implant device
    61250CPierce skull & explore
    61253CPierce skull & explore
    61304COpen skull for exploration
    61305COpen skull for exploration
    61312COpen skull for drainage
    61313COpen skull for drainage
    61314COpen skull for drainage
    61315COpen skull for drainage
    61320COpen skull for drainage
    61321COpen skull for drainage
    61332CExplore/biopsy eye socket
    61333CExplore orbit/remove lesion
    61334CExplore orbit/remove object
    61340CRelieve cranial pressure
    61343CIncise skull (press relief)
    61345CRelieve cranial pressure
    61440CIncise skull for surgery
    61450CIncise skull for surgery
    61458CIncise skull for brain wound
    61460CIncise skull for surgery
    61470CIncise skull for surgery
    61480CIncise skull for surgery
    61490CIncise skull for surgery
    61500CRemoval of skull lesion
    61501CRemove infected skull bone
    61510CRemoval of brain lesion
    61512CRemove brain lining lesion
    61514CRemoval of brain abscess
    61516CRemoval of brain lesion
    61518CRemoval of brain lesion
    61519CRemove brain lining lesion
    61520CRemoval of brain lesion
    61521CRemoval of brain lesion
    61522CRemoval of brain abscess
    61524CRemoval of brain lesion
    61526CRemoval of brain lesion
    61530CRemoval of brain lesion
    61531CImplant brain electrodes
    61533CImplant brain electrodes
    61534CRemoval of brain lesion
    61535CRemove brain electrodes
    61536CRemoval of brain lesion
    61538CRemoval of brain tissue
    61539CRemoval of brain tissue
    61541CIncision of brain tissue
    61542CRemoval of brain tissue
    61543CRemoval of brain tissue
    61544CRemove & treat brain lesion
    61545CExcision of brain tumor
    61546CRemoval of pituitary gland
    61548CRemoval of pituitary gland
    61550CRelease of skull seams
    61552CRelease of skull seams
    61556CIncise skull/sutures
    61557CIncise skull/sutures
    61558CExcision of skull/sutures
    61559CExcision of skull/sutures
    61563CExcision of skull tumor
    61564CExcision of skull tumor
    61570CRemove foreign body, brain
    61571CIncise skull for brain wound
    61575CSkull base/brainstem surgery
    61576CSkull base/brainstem surgery
    61580CCraniofacial approach, skull
    61581CCraniofacial approach, skull
    61582CCraniofacial approach, skull
    61583CCraniofacial approach, skull
    61584COrbitocranial approach/skull
    61585COrbitocranial approach/skull
    61586CResect nasopharynx, skull
    61590CInfratemporal approach/skull
    61591CInfratemporal approach/skull
    61592COrbitocranial approach/skull
    61595CTranstemporal approach/skull
    61596CTranscochlear approach/skull
    61597CTranscondylar approach/skull
    61598CTranspetrosal approach/skull
    61600CResect/excise cranial lesion
    61601CResect/excise cranial lesion
    61605CResect/excise cranial lesion
    61606CResect/excise cranial lesion
    61607CResect/excise cranial lesion
    61608CResect/excise cranial lesion
    61609CTransect artery, sinus
    61610CTransect artery, sinus
    61611CTransect artery, sinus
    61612CTransect artery, sinus
    61613CRemove aneurysm, sinus
    61615CResect/excise lesion, skull
    61616CResect/excise lesion, skull
    61618CRepair dura
    61619CRepair dura
    61624COcclusion/embolization cath
    61626COcclusion/embolization cath
    61680CIntracranial vessel surgery
    61682CIntracranial vessel surgery
    61684CIntracranial vessel surgery
    61686CIntracranial vessel surgery
    61690CIntracranial vessel surgery
    61692CIntracranial vessel surgery
    61700CInner skull vessel surgery
    61702CInner skull vessel surgery
    61703CClamp neck artery
    61705CRevise circulation to head
    61708CRevise circulation to head
    61710CRevise circulation to head
    61711CFusion of skull arteries
    61720CIncise skull/brain surgery
    61735CIncise skull/brain surgery
    61750CIncise skull/brain biopsy
    61751CBrain biopsy w/ct/mr guide
    61760CImplant brain electrodes
    61770CIncise skull for treatment
    61791CTreat trigeminal tract
    61795CBrain surgery using computer
    61850CImplant neuroelectrodes
    61860CImplant neuroelectrodes
    61862CImplant neurostimul, subcort
    61870CImplant neuroelectrodes
    61875CImplant neuroelectrodes
    61880CRevise/remove neuroelectrode
    61886CImplant neurostim arrays
    61888CRevise/remove neuroreceiver
    62000CTreat skull fracture
    62005CTreat skull fracture
    62010CTreatment of head injury
    62100CRepair brain fluid leakage
    62115CReduction of skull defect
    62116CReduction of skull defect
    62117CReduction of skull defect
    62120CRepair skull cavity lesion
    62121CIncise skull repair
    62140CRepair of skull defect
    62141CRepair of skull defect
    62142CRemove skull plate/flap
    62143CReplace skull plate/flap
    62145CRepair of skull & brain
    62146CRepair of skull with graft
    62147CRepair of skull with graft
    62180CEstablish brain cavity shunt
    62190CEstablish brain cavity shunt
    62192CEstablish brain cavity shunt
    62200CEstablish brain cavity shunt
    62201CEstablish brain cavity shunt
    62220CEstablish brain cavity shunt
    62223CEstablish brain cavity shunt
    62256CRemove brain cavity shunt
    62258CReplace brain cavity shunt
    62351CImplant spinal canal cath
    63001CRemoval of spinal lamina
    63003CRemoval of spinal lamina
    63005CRemoval of spinal lamina
    63011CRemoval of spinal lamina
    63012CRemoval of spinal lamina
    63015CRemoval of spinal lamina
    63016CRemoval of spinal lamina
    63017CRemoval of spinal lamina
    63020CNeck spine disk surgery
    63030CLow back disk surgery
    63035CSpinal disk surgery add-on
    63040CNeck spine disk surgery
    63042CLow back disk surgery
    63045CRemoval of spinal lamina
    63046CRemoval of spinal lamina
    63047CRemoval of spinal lamina
    63048CRemove spinal lamina add-on
    63055CDecompress spinal cord
    63056CDecompress spinal cord
    63057CDecompress spine cord add-on
    63064CDecompress spinal cord
    63066CDecompress spine cord add-on
    63075CNeck spine disk surgery
    63076CNeck spine disk surgery
    63077CSpine disk surgery, thorax
    63078CSpine disk surgery, thorax
    Start Printed Page 18787
    63081CRemoval of vertebral body
    63082CRemove vertebral body add-on
    63085CRemoval of vertebral body
    63086CRemove vertebral body add-on
    63087CRemoval of vertebral body
    63088CRemove vertebral body add-on
    63090CRemoval of vertebral body
    63091CRemove vertebral body add-on
    63170CIncise spinal cord tract(s)
    63172CDrainage of spinal cyst
    63173CDrainage of spinal cyst
    63180CRevise spinal cord ligaments
    63182CRevise spinal cord ligaments
    63185CIncise spinal column/nerves
    63190CIncise spinal column/nerves
    63191CIncise spinal column/nerves
    63194CIncise spinal column & cord
    63195CIncise spinal column & cord
    63196CIncise spinal column & cord
    63197CIncise spinal column & cord
    63198CIncise spinal column & cord
    63199CIncise spinal column & cord
    63200CRelease of spinal cord
    63250CRevise spinal cord vessels
    63251CRevise spinal cord vessels
    63252CRevise spinal cord vessels
    63265CExcise intraspinal lesion
    63266CExcise intraspinal lesion
    63267CExcise intraspinal lesion
    63268CExcise intraspinal lesion
    63270CExcise intraspinal lesion
    63271CExcise intraspinal lesion
    63272CExcise intraspinal lesion
    63273CExcise intraspinal lesion
    63275CBiopsy/excise spinal tumor
    63276CBiopsy/excise spinal tumor
    63277CBiopsy/excise spinal tumor
    63278CBiopsy/excise spinal tumor
    63280CBiopsy/excise spinal tumor
    63281CBiopsy/excise spinal tumor
    63282CBiopsy/excise spinal tumor
    63283CBiopsy/excise spinal tumor
    63285CBiopsy/excise spinal tumor
    63286CBiopsy/excise spinal tumor
    63287CBiopsy/excise spinal tumor
    63290CBiopsy/excise spinal tumor
    63300CRemoval of vertebral body
    63301CRemoval of vertebral body
    63302CRemoval of vertebral body
    63303CRemoval of vertebral body
    63304CRemoval of vertebral body
    63305CRemoval of vertebral body
    63306CRemoval of vertebral body
    63307CRemoval of vertebral body
    63308CRemove vertebral body add-on
    63655CImplant neuroelectrodes
    63700CRepair of spinal herniation
    63702CRepair of spinal herniation
    63704CRepair of spinal herniation
    63706CRepair of spinal herniation
    63707CRepair spinal fluid leakage
    63709CRepair spinal fluid leakage
    63710CGraft repair of spine defect
    63740CInstall spinal shunt
    63741CInstall spinal shunt
    64752CIncision of vagus nerve
    64755CIncision of stomach nerves
    64760CIncision of vagus nerve
    64763CIncise hip/thigh nerve
    64766CIncise hip/thigh nerve
    64802CRemove sympathetic nerves
    64804CRemove sympathetic nerves
    64809CRemove sympathetic nerves
    64818CRemove sympathetic nerves
    64820CRemove sympathetic nerves
    64866CFusion of facial/other nerve
    64868CFusion of facial/other nerve
    65273CRepair of eye wound
    69150CExtensive ear canal surgery
    69155CExtensive ear/neck surgery
    69502CMastoidectomy
    69535CRemove part of temporal bone
    69554CRemove ear lesion
    69950CIncise inner ear nerve
    69970CRemove inner ear lesion
    74300CX-ray bile ducts/pancreas
    74301CX-rays at surgery add-on
    75900CArterial catheter exchange
    75940CX-ray placement, vein filter
    75945CIntravascular us
    75946CIntravascular us add-on
    75960CTranscatheter intro, stent
    75961CRetrieval, broken catheter
    75962CRepair arterial blockage
    75964CRepair artery blockage, each
    75966CRepair arterial blockage
    75968CRepair artery blockage, each
    75970CVascular biopsy
    75978CRepair venous blockage
    75992CAtherectomy, x-ray exam
    75993CAtherectomy, x-ray exam
    75994CAtherectomy, x-ray exam
    75995CAtherectomy, x-ray exam
    75996CAtherectomy, x-ray exam
    92970CCardioassist, internal
    92971CCardioassist, external
    92975CDissolve clot, heart vessel
    92977CDissolve clot, heart vessel
    92978CIntravasc us, heart add-on
    92979CIntravasc us, heart add-on
    92986CRevision of aortic valve
    92987CRevision of mitral valve
    92990CRevision of pulmonary valve
    92992CRevision of heart chamber
    92993CRevision of heart chamber
    92997CPul art balloon repr, percut
    92998CPul art balloon repr, percut
    94652CPressure breathing (IPPB)
    94762CMeasure blood oxygen level
    95920CIntraop nerve test add-on
    95961CElectrode stimulation, brain
    95962CElectrode stim, brain add-on
    99190CSpecial pump services
    99191CSpecial pump services
    99192CSpecial pump services
    99234CObserv/hosp same date
    99235CObserv/hosp same date
    99236CObserv/hosp same date
    99251CInitial inpatient consult
    99252CInitial inpatient consult
    99253CInitial inpatient consult
    99254CInitial inpatient consult
    99255CInitial inpatient consult
    99261CFollow-up inpatient consult
    99262CFollow-up inpatient consult
    99263CFollow-up inpatient consult
    99295CNeonatal critical care
    99296CNeonatal critical care
    99297CNeonatal critical care
    99298CNeonatal critical care
    99356CProlonged service, inpatient
    99357CProlonged service, inpatient
    99433CNormal newborn care/hospital
    G0160CCryo. ablation, prostate

    Addendum F.—Status Indicators: How Various Services Are Treated Under Outpatient PPS

    IndicatorServiceStatus
    APulmonary Rehabilitation Clinical TrialNot Paid Under PPS
    CInpatient ProceduresAdmit Patient; Bill as Inpatient
    ADurable Medical Equipment, Prosthetics andDMEPOS Fee Schedule
    ENon-Covered Items and ServicesNon-paid
    APhysical, Occupational and SpeechTherapyRehabilitation Fee Schedule
    AAmbulanceAmbulance Fee Schedule
    AEPO for ESRD PatientsNational Rate
    AClinical Diagnostic Laboratory ServicesLaboratory Fee Schedule
    APhysican Services for ESRD PatientsNot Paid Under PPS
    AScreening MammographyNational Rate
    NIncidental Services, packaged into APC RatPackaged
    PPartial HospitalizationPaid Per Diem APC
    SSignificant Procedure, Not Discounted WhenPaid
    TProcedure, Multiple When Discount AppliesPaid
    VVisit to Clinic or Emergency DepartmentPaid
    XAncillary ServicePaid
    Start Printed Page 18788

    Addendum G.—Service Mix Indices by Hospital

    HospitalSMI
    0100013.13
    0100041.77
    0100052.17
    0100063.08
    0100071.70
    0100081.86
    0100091.69
    0100102.44
    0100112.56
    0100122.21
    0100152.29
    0100162.55
    0100186.45
    0100192.41
    0100211.74
    0100222.02
    0100232.85
    0100242.88
    0100252.14
    0100271.10
    0100293.22
    0100312.04
    0100321.28
    0100331.53
    0100342.69
    0100353.05
    0100362.72
    0100384.48
    0100392.19
    0100402.62
    0100432.32
    0100442.21
    0100452.00
    0100462.09
    0100471.67
    0100493.06
    0100501.93
    0100511.60
    0100521.60
    0100532.00
    0100541.88
    0100552.86
    0100562.70
    0100581.25
    0100591.90
    0100612.62
    0100621.81
    0100643.43
    0100652.41
    0100661.42
    0100681.39
    0100692.34
    0100722.61
    0100732.61
    0100782.55
    0100792.52
    0100801.08
    0100832.25
    0100844.17
    0100872.71
    0100892.61
    0100902.43
    0100911.63
    0100922.55
    0100942.50
    0100951.50
    0100972.07
    0100981.75
    0100992.14
    0101002.79
    0101012.38
    0101021.32
    0101032.38
    0101042.66
    0101081.95
    0101092.24
    0101101.20
    0101121.87
    0101132.85
    0101142.48
    0101151.47
    0101182.56
    0101192.13
    0101202.04
    0101233.11
    0101243.42
    0101251.44
    0101262.11
    0101273.32
    0101281.40
    0101291.84
    0101301.67
    0101312.80
    0101341.56
    0101371.57
    0101381.32
    0101392.72
    0101432.02
    0101442.70
    0101451.61
    0101463.10
    0101481.94
    0101492.84
    0101502.15
    0101522.14
    0101551.63
    0130251.64
    0130271.11
    0130280.93
    0133001.48
    0140021.41
    0200012.78
    0200022.30
    0200041.92
    0200051.07
    0200062.04
    0200070.87
    0200082.33
    0200091.05
    0200100.58
    0200111.02
    0200123.41
    0200131.89
    0200141.78
    0200173.41
    0200241.84
    0200251.06
    0240011.65
    0300012.73
    0300022.64
    0300032.15
    0300040.86
    0300062.79
    0300072.55
    0300091.43
    0300102.87
    0300113.75
    0300121.90
    0300132.56
    0300143.09
    0300161.86
    0300172.92
    0300183.33
    0300192.49
    0300221.73
    0300232.74
    0300243.70
    0300251.79
    0300271.63
    0300303.06
    0300332.60
    0300341.39
    0300353.18
    0300362.49
    0300374.59
    0300383.33
    0300401.99
    0300411.30
    0300432.57
    0300442.07
    0300471.68
    0300490.78
    0300540.83
    0300552.47
    0300592.66
    0300602.25
    0300612.09
    0300622.47
    0300642.59
    0300653.18
    0300671.59
    0300682.56
    0300693.02
    0300802.74
    0300832.58
    0300852.55
    0300862.27
    0300873.66
    0300882.22
    0300892.78
    0300922.94
    0300931.63
    0300942.11
    0300953.28
    0300992.09
    0330251.82
    0330262.18
    0330281.64
    0340041.58
    0340083.05
    0340091.55
    0340101.55
    0340131.57
    0340191.52
    0400012.42
    0400022.24
    0400031.98
    0400043.62
    0400052.05
    0400074.24
    0400081.31
    0400103.21
    0400112.11
    0400142.81
    0400151.77
    0400162.02
    0400172.57
    0400182.87
    0400192.10
    0400203.01
    0400213.28
    0400222.43
    0400241.80
    Start Printed Page 18789
    0400251.76
    0400262.63
    0400273.19
    0400282.17
    0400293.57
    0400301.37
    0400320.92
    0400351.17
    0400363.29
    0400372.01
    0400392.51
    0400401.35
    0400413.36
    0400422.13
    0400441.40
    0400451.65
    0400471.77
    0400482.46
    0400502.88
    0400512.07
    0400531.60
    0400543.26
    0400552.81
    0400582.42
    0400601.45
    0400622.58
    0400641.41
    0400663.53
    0400671.19
    0400701.77
    0400722.31
    0400742.91
    0400751.74
    0400761.79
    0400771.77
    0400782.74
    0400801.87
    0400810.93
    0400821.77
    0400843.12
    0400851.90
    0400883.29
    0400901.43
    0400911.73
    0400931.37
    0401002.39
    0401051.29
    0401062.06
    0401071.59
    0401092.02
    0401145.13
    0401162.93
    0401182.82
    0401193.14
    0401242.53
    0401261.95
    0401320.96
    0430261.30
    0430270.85
    0430281.17
    0430291.86
    0430310.82
    0430323.76
    0433001.57
    0440041.54
    0440051.57
    0440061.64
    0440101.65
    0440121.59
    0500022.06
    0500062.44
    0500072.29
    0500092.97
    0500133.22
    0500142.86
    0500152.38
    0500162.13
    0500175.03
    0500182.55
    0500212.26
    0500222.85
    0500242.28
    0500252.34
    0500262.34
    0500282.52
    0500292.32
    0500301.88
    0500323.20
    0500332.24
    0500362.67
    0500381.49
    0500392.85
    0500423.26
    0500432.85
    0500453.17
    0500462.32
    0500473.05
    0500511.60
    0500541.75
    0500551.93
    0500563.46
    0500573.51
    0500582.74
    0500602.11
    0500615.22
    0500632.75
    0500652.53
    0500662.43
    0500671.93
    0500682.71
    0500692.78
    0500773.23
    0500782.67
    0500792.20
    0500802.13
    0500811.14
    0500822.90
    0500842.44
    0500881.44
    0500892.10
    0500902.52
    0500912.57
    0500921.87
    0500933.76
    0500953.98
    0500963.94
    0500973.79
    0500992.27
    0501002.75
    0501012.80
    0501022.14
    0501033.29
    0501042.27
    0501072.69
    0501082.76
    0501092.26
    0501103.28
    0501115.30
    0501122.67
    0501131.35
    0501142.76
    0501152.18
    0501162.99
    0501173.02
    0501182.63
    0501213.26
    0501222.54
    0501242.32
    0501253.20
    0501262.94
    0501272.04
    0501282.45
    0501292.73
    0501312.45
    0501322.98
    0501332.08
    0501351.59
    0501362.67
    0501442.46
    0501452.76
    0501461.41
    0501482.31
    0501492.40
    0501502.44
    0501522.31
    0501532.58
    0501552.14
    0501583.58
    0501591.48
    0501671.42
    0501683.40
    0501692.78
    0501702.83
    0501721.89
    0501732.82
    0501743.38
    0501753.37
    0501771.89
    0501792.63
    0501802.32
    0501831.30
    0501861.96
    0501883.77
    0501892.48
    0501912.69
    0501921.60
    0501931.89
    0501942.70
    0501952.38
    0501962.39
    0501972.76
    0502043.22
    0502052.35
    0502073.48
    0502082.09
    0502112.71
    0502131.28
    0502142.05
    0502153.07
    0502172.15
    0502191.98
    0502222.61
    0502242.71
    0502252.28
    0502262.85
    0502281.17
    0502302.91
    0502313.44
    0502322.92
    0502333.37
    0502341.67
    0502352.64
    0502362.17
    Start Printed Page 18790
    0502382.14
    0502392.64
    0502402.66
    0502412.55
    0502422.23
    0502432.05
    0502451.24
    0502481.49
    0502512.23
    0502532.29
    0502543.23
    0502561.39
    0502571.90
    0502601.38
    0502612.11
    0502622.22
    0502642.24
    0502672.80
    0502702.61
    0502722.14
    0502741.56
    0502761.32
    0502772.59
    0502782.70
    0502791.93
    0502802.70
    0502813.99
    0502822.17
    0502831.16
    0502861.02
    0502892.76
    0502902.40
    0502911.73
    0502921.41
    0502931.42
    0502952.63
    0502962.45
    0502982.08
    0502993.08
    0503002.95
    0503012.95
    0503022.87
    0503052.12
    0503073.67
    0503082.42
    0503093.00
    0503102.96
    0503122.71
    0503133.15
    0503151.20
    0503171.84
    0503201.26
    0503243.46
    0503251.73
    0503272.36
    0503282.69
    0503291.93
    0503312.12
    0503331.10
    0503343.36
    0503351.34
    0503362.48
    0503371.78
    0503422.84
    0503433.36
    0503481.87
    0503491.17
    0503502.25
    0503513.35
    0503522.05
    0503532.61
    0503550.98
    0503572.47
    0503593.58
    0503603.42
    0503662.09
    0503671.90
    0503692.41
    0503770.95
    0503782.89
    0503791.56
    0503803.91
    0503822.62
    0503881.03
    0503902.90
    0503912.02
    0503921.48
    0503932.93
    0503943.37
    0503964.28
    0503971.44
    0504012.30
    0504041.55
    0504061.36
    0504072.93
    0504101.05
    0504142.65
    0504173.03
    0504181.29
    0504192.69
    0504202.12
    0504212.38
    0504232.49
    0504242.95
    0504262.60
    0504270.76
    0504301.38
    0504313.90
    0504322.60
    0504331.55
    0504341.37
    0504352.38
    0504361.58
    0504382.65
    0504401.53
    0504412.19
    0504431.62
    0504442.31
    0504461.43
    0504471.60
    0504483.14
    0504541.78
    0504553.70
    0504565.49
    0504572.23
    0504592.44
    0504681.71
    0504691.68
    0504702.22
    0504713.14
    0504762.73
    0504774.61
    0504781.57
    0504812.80
    0504821.06
    0504833.44
    0504853.44
    0504862.39
    0504882.21
    0504912.52
    0504922.39
    0504943.25
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    0504971.04
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    0505023.66
    0505033.44
    0505062.44
    0505163.39
    0505172.78
    0505222.46
    0505232.22
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    0505282.12
    0505313.41
    0505342.45
    0505352.86
    0505372.76
    0505392.31
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    0505521.32
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    0505592.89
    0505602.10
    0505642.61
    0505652.02
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    0505672.31
    0505682.82
    0505692.55
    0505703.36
    0505713.32
    0505732.43
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    0505812.45
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    0505912.53
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    0506012.91
    0506071.80
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    0506152.77
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    0506181.32
    0506242.96
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    6500012.01
    —————————— 1 Large Urban Area 2 Hospitals geographically located in the area are assigned the statewide rural wage index for FY 2000.

    Addendum H.—Wage Index for Urban Areas

    Urban CodeUrban Area (Constituent Counties)Wage Index
    0040Abilene, TX Taylor, TX0.8179
    00602 Aguadilla, PR Aguada, PR Aguadilla, PR Moca, PR0.4249
    0080Akron, OH Portage, OH Summit, OH1.0163
    0120Albany, GA Dougherty, GA Lee, GA1.0372
    0160Albany-Schenectady-Troy, NY Albany, NY Montgomery, NY Rensselaer, NY Saratoga, NY Schenectady, NY Schoharie, NY0.8754
    0200Albuquerque, NM Bernalillo, NM Sandoval, NM Valencia, NM0.8499
    0220Alexandria, LA Rapides, LA0.7910
    0240Allentown-Bethlehem-Easton, PA Carbon, PA Lehigh, PA Northampton, PA0.9550
    0280Altoona, PA Blair, PA0.9342
    0320Amarillo, TX Potter, TX Randall, TX0.8435
    0380Anchorage, AK Anchorage, AK1.3009
    0440Ann Arbor, MI Lenawee, MI Livingston, MI Washtenaw, MI1.1483
    0450Anniston, AL Calhoun, AL0.8462
    0460Appleton-Oshkosh-Neenah, WI Calumet, WI Outagamie, WI Winnebago, WI0.8913
    0470Arecibo, PR Arecibo, PR Camuy, PR Hatillo, PR0.4815
    0480Asheville, NC Buncombe, NC Madison, NC0.8884
    0500Athens, GA Clarke, GA Madison, GA Oconee, GA0.9800
    05201 Atlanta, GA 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 Walton1.0050
    0560Atlantic-Cape May, NJ Atlantic, NJ Cape May, NJ1.1050
    0580Auburn-Opelika, AL Lee, AL0.7748
    0600Augusta-Aiken, GA-SC Columbia, GA McDuffie, GA Richmond, GA Aiken, SC Edgefield, SC0.9013
    06401 Austin-San Marcos, TX Bastrop, TX Caldwell, TX Hays, TX Travis, TX Williamson, TX0.9081
    06802 Bakersfield, CA Kern, CA0.9951
    07201 Baltimore, MD Anne Arundel, MD Baltimore, MD Baltimore City, MD Carroll, MD Harford, MD Howard, MD Queen Anne's, MD0.9891
    0733Bangor, ME Penobscot, ME0.9609
    0743Barnstable-Yarmouth, MA Barnstable, MA1.3302
    0760Baton Rouge, LA Ascension, LA East Baton Rouge, LA Livingston, LA West Baton Rouge, LA0.8707
    0840Beaumont-Port Arthur, TX Hardin, TX Jefferson, TX Orange, TX0.8624
    0860Bellingham, WA Whatcom, WA1.1394
    08702 Benton Harbor, MI Berrien, MI0.8831
    08751 Bergen-Passaic, NJ Bergen, NJ Passaic, NJ1.1833
    0880Billings, MT Yellowstone, MT1.0038
    0920Biloxi-Gulfport-Pascagoula, MS Hancock, MS Harrison, MS Jackson, MS0.7949
    0960Binghamton, NY Broome, NY Tioga, NY0.8750
    1000Birmingham, AL Blount, AL Jefferson, AL St. Clair, AL Shelby, AL0.8994
    1010Bismarck, ND Burleigh, ND Morton, ND0.7893
    1020Bloomington, IN Monroe, IN0.8593
    1040Bloomington-Normal, IL McLean, IL0.8993
    1080Boise City, ID Ada, ID Canyon, ID0.9086
    112312 Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH (MA Hospitals) Bristol, MA Essex, MA Middlesex, MA Norfolk, MA Plymouth, MA Suffolk, MA Worcester, MA Hillsborough, NH Merrimack, NH Rockingham, NH Strafford, NH1.1369
    11231 Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH (NH Hospitals) Bristol, MA Essex, MA Middlesex, MA Norfolk, MA Plymouth, MA Suffolk, MA Worcester, MA Hillsborough, NH Merrimack, NH Rockingham, NH Strafford, NH1.1358
    Start Printed Page 18814
    1125Boulder-Longmont, CO Boulder, CO0.9944
    1145Brazoria, TX Brazoria, TX0.8516
    1150Bremerton, WA Kitsap, WA1.1011
    1240Brownsville-Harlingen-San Benito, TX Cameron, TX0.9212
    1260Bryan-College Station, TX Brazos, TX0.8501
    12801 Buffalo-Niagara Falls, NY Erie, NY Niagara, NY0.9604
    1303Burlington, VT Chittenden, VT Franklin, VT Grand Isle, VT1.0558
    1310Caguas, PR Caguas, PR Cayey, PR Cidra, PR Gurabo, PR San Lorenzo, PR0.4561
    13202 Canton-Massillon, OH Carroll, OH Stark, OH0.8649
    1350Casper, WY Natrona, WY0.9199
    1360Cedar Rapids, IA Linn, IA0.9018
    1400Champaign-Urbana, IL Champaign, IL0.9163
    1440Charleston-North Charleston, SC Berkeley, SC Charleston, SC Dorchester, SC0.8988
    1480Charleston, WV Kanawha, WV Putnam, WV0.9095
    15201 Charlotte-Gastonia-Rock Hill, NC-SC Cabarrus, NC Gaston, NC Lincoln, NC Mecklenburg, NC Rowan, NC Stanly, NC Union, NC York, SC0.9433
    1540Charlottesville, VA Albemarle, VA Charlottesville City, VA Fluvanna, VA Greene, VA1.0573
    1560Chattanooga, TN-GA Catoosa, GA Dade, GA Walker, GA Hamilton, TN Marion, TN0.9731
    15802 Cheyenne, WY Laramie, WY0.8859
    16001 Chicago, IL Cook, IL DeKalb, IL DuPage, IL Grundy, IL Kane, IL Kendall, IL Lake, IL McHenry, IL Will, IL1.0872
    1620Chico-Paradise, CA Butte, CA1.0390
    16401 Cincinnati, OH-KY-IN Dearborn, IN Ohio, IN Boone, KY Campbell, KY Gallatin, KY Grant, KY Kenton, KY Pendleton, KY Brown, OH Clermont, OH Hamilton, OH Warren, OH0.9434
    1660Clarksville-Hopkinsville, TN-KY Christian, KY Montgomery, TN0.8283
    16801 Cleveland-Lorain-Elyria, OH Ashtabula, OH Cuyahoga, OH Geauga, OH Lake, OH Lorain, OH Medina, OH0.9688
    1720Colorado Springs, CO El Paso, CO0.9218
    1740Columbia, MO Boone, MO0.8904
    1760Columbia, SC Lexington, SC Richland, SC0.9357
    1800Columbus, GA-AL Russell, AL Chattahoochee, GA Harris, GA Muscogee, GA0.8510
    18401 Columbus, OH Delaware, OH Fairfield, OH Franklin, OH Licking, OH Madison, OH Pickaway, OH0.9907
    1880Corpus Christi, TX Nueces, TX San Patricio, TX0.8702
    1890Corvallis, OR Benton, OR1.1087
    1900Cumberland, MD-WV (Maryland Hospitals) Allegany, MD Mineral, WV0.8801
    19201 Dallas, TX Collin, TX Dallas, TX Denton, TX Ellis, TX Henderson, TX Hunt, TX Kaufman, TX Rockwall, TX0.9589
    1950Danville, VA Danville City, VA Pittsylvania, VA0.9061
    1960Davenport-Moline-Rock Island, IA-IL Scott, IA Henry, IL Rock Island, IL0.8706
    2000Dayton-Springfield, OH Clark, OH Greene, OH Miami, OH Montgomery, OH0.9336
    20202 Daytona Beach, FL Flagler, FL Volusia, FL0.8986
    2030Decatur, AL Lawrence, AL Morgan, AL0.8679
    2040Decatur, IL Macon, IL0.8321
    20801 Denver, CO Adams, CO Arapahoe, CO Denver, CO Douglas, CO Jefferson, CO1.0197
    2120Des Moines, IA Dallas, IA Polk, IA Warren, IA0.8754
    21601 Detroit, MI Lapeer, MI Macomb, MI Monroe, MI Oakland, MI St. Clair, MI Wayne, MI1.0421
    2180Dothan, AL Dale, AL Houston, AL0.7836
    2190Dover, DE Kent, DE0.9335
    2200Dubuque, IA Dubuque, IA0.8520
    2240Duluth-Superior, MN-WI St. Louis, MN Douglas, WI1.0165
    2281Dutchess County, NY Dutchess, NY0.9872
    2290Eau Claire, WI Chippewa, WI Eau Claire, WI0.8957
    2320El Paso, TX El Paso, TX0.8947
    2330Elkhart-Goshen, IN Elkhart, IN0.9379
    23352 Elmira, NY Chemung, NY0.8636
    2340Enid, OK Garfield, OK0.7953
    2360Erie, PA Erie, PA0.9023
    2400Eugene-Springfield, OR Lane, OR1.0765
    24402 Evansville-Henderson, IN-KY (IN Hospitals) Posey, IN Vanderburgh, IN Warrick, IN Henderson, KY0.8396
    2440Evansville-Henderson, IN-KY (KY Hospitals) Posey, IN Vanderburgh, IN Warrick, IN Henderson, KY0.8303
    2520Fargo-Moorhead, ND-MN Clay, MN Cass, ND0.8620
    2560Fayetteville, NC Cumberland, NC0.8494
    2580Fayetteville-Springdale-Rogers, AR Benton, AR Washington, AR0.7773
    2620Flagstaff, AZ-UT Coconino, AZ Kane, UT1.0348
    2640Flint, MI Genesee, MI1.1020
    2650Florence, AL Colbert, AL Lauderdale, AL0.7927
    2655Florence, SC Florence, SC0.8618
    2670Fort Collins-Loveland, CO Larimer, CO1.0302
    26801 Ft. Lauderdale, FL Broward, FL1.0172
    27002 Fort Myers-Cape Coral, FL Lee, FL0.8986
    Start Printed Page 18815
    2710Fort Pierce-Port St. Lucie, FL Martin, FL St. Lucie, FL1.0109
    2720Fort Smith, AR-OK Crawford, AR Sebastian, AR Sequoyah, OK0.7844
    27502 Fort Walton Beach, FL Okaloosa, FL0.8986
    2760Fort Wayne, IN Adams, IN Allen, IN De Kalb, IN Huntington, IN Wells, IN Whitley, IN0.9096
    28001 Forth Worth-Arlington, TX Hood, TX Johnson, TX Parker, TX Tarrant, TX0.9835
    2840Fresno, CA Fresno, CA Madera, CA1.0262
    2880Gadsden, AL Etowah, AL0.8754
    2900Gainesville, FL Alachua, FL1.0102
    2920Galveston-Texas City, TX Galveston, TX0.9732
    2960Gary, IN Lake, IN Porter, IN0.9369
    29752 Glens Falls, NY Warren, NY Washington, NY0.8636
    2980Goldsboro, NC Wayne, NC0.8333
    2985Grand Forks, ND-MN Polk, MN Grand Forks, ND0.9097
    2995Grand Junction, CO Mesa, CO0.9188
    30001 Grand Rapids-Muskegon-Holland, MI Allegan, MI Kent, MI Muskegon, MI Ottawa, MI1.0135
    3040Great Falls, MT Cascade, MT1.0459
    3060Greeley, CO Weld, CO0.9722
    3080Green Bay, WI Brown, WI0.9215
    31201 Greensboro-Winston-Salem-High Point, NC Alamance, NC Davidson, NC Davie, NC Forsyth, NC Guilford, NC Randolph, NC Stokes, NC Yadkin, NC0.9037
    3150Greenville, NC Pitt, NC0.9500
    3160Greenville-Spartanburg-Anderson, SC Anderson, SC Cherokee, SC Greenville, SC Pickens, SC Spartanburg, SC0.9188
    3180Hagerstown, MD Washington, MD0.8853
    3200Hamilton-Middletown, OH Butler, OH0.8989
    3240Harrisburg-Lebanon-Carlisle, PA Cumberland, PA Dauphin, PA Lebanon, PA Perry, PA0.9917
    328312 Hartford, CT Hartford, CT Litchfield, CT Middlesex, CT Tolland, CT1.2413
    32852 Hattiesburg, MS Forrest, MS Lamar, MS0.7306
    3290Hickory-Morganton-Lenoir, NC Alexander, NC Burke, NC Caldwell, NC Catawba, NC0.9148
    3320Honolulu, HI Honolulu, HI1.1479
    3350Houma, LA Lafourche, LA Terrebonne, LA0.7837
    33601 Houston, TX Chambers, TX Fort Bend, TX Harris, TX Liberty, TX Montgomery, TX Waller, TX0.9387
    3400Huntington-Ashland, WV-KY-OH Boyd, KY Carter, KY Greenup, KY Lawrence, OH Cabell, WV Wayne, WV0.9757
    3440Huntsville, AL Limestone, AL Madison, AL0.8822
    34801 Indianapolis, IN Boone, IN Hamilton, IN Hancock, IN Hendricks, IN Johnson, IN Madison, IN Marion, IN Morgan, IN Shelby, IN0.9792
    3500Iowa City, IA Johnson, IA0.9607
    3520Jackson, MI Jackson, MI0.8840
    3560Jackson, MS Hinds, MS Madison, MS Rankin, MS0.8387
    3580Jackson, TN Madison, TN Chester, TN0.8600
    360012 Jacksonville, FL Clay, FL Duval, FL Nassau, FL St. Johns, FL0.8986
    36052 Jacksonville, NC Onslow, NC0.8290
    36102 Jamestown, NY Chautauqua, NY0.8636
    3620Janesville-Beloit, WI Rock, WI0.9656
    3640Jersey City, NJ Hudson, NJ1.1674
    3660Johnson City-Kingsport-Bristol, TN-VA Carter, TN Hawkins, TN Sullivan, TN Unicoi, TN Washington, TN Bristol City, VA Scott, VA Washington, VA0.8894
    36802 Johnstown, PA Cambria, PA Somerset, PA0.8524
    3700Jonesboro, AR Craighead, AR0.7251
    37102 Joplin, MO Jasper, MO Newton, MO0.7723
    3720Kalamazoo-Battlecreek, MI Calhoun, MI Kalamazoo, MI Van Buren, MI0.9981
    3740Kankakee, IL Kankakee, IL0.8598
    37601 Kansas City, KS-MO Johnson, KS Leavenworth, KS Miami, KS Wyandotte, KS Cass, MO Clay, MO Clinton, MO Jackson, MO Lafayette, MO Platte, MO Ray, MO0.9322
    3800Kenosha, WI Kenosha, WI0.9033
    3810Killeen-Temple, TX Bell, TX Coryell, TX0.9932
    3840Knoxville, TN Anderson, TN Blount, TN Knox, TN Loudon, TN Sevier, TN Union, TN0.9199
    3850Kokomo, IN Howard, IN Tipton, IN0.8984
    3870La Crosse, WI-MN Houston, MN La Crosse, WI0.8933
    3880Lafayette, LA Acadia, LA Lafayette, LA St. Landry, LA St. Martin, LA0.8397
    3920Lafayette, IN Clinton, IN Tippecanoe, IN0.8809
    3960Lake Charles, LA Calcasieu, LA0.7966
    39802 Lakeland-Winter Haven, FL Polk, FL0.8986
    4000Lancaster, PA Lancaster, PA0.9255
    4040Lansing-East Lansing, MI Clinton, MI Eaton, MI Ingham, MI0.9977
    4080Laredo, TX Webb, TX0.8323
    4100Las Cruces, NM Dona Ana, NM0.8590
    41201 Las Vegas, NV-AZ Mohave, AZ Clark, NV Nye, NV1.1258
    Start Printed Page 18816
    4150Lawrence, KS Douglas, KS0.8222
    4200Lawton, OK Comanche, OK0.9532
    4243Lewiston-Auburn, ME Androscoggin, ME0.8899
    4280Lexington, KY Bourbon, KY Clark, KY Fayette, KY Jessamine, KY Madison, KY Scott, KY Woodford, KY0.8552
    4320Lima, OH Allen, OH Auglaize, OH0.9108
    4360Lincoln, NE Lancaster, NE0.9670
    4400Little Rock-North Little Rock, AR Faulkner, AR Lonoke, AR Pulaski, AR Saline, AR0.8614
    4420Longview-Marshall, TX Gregg, TX Harrison, TX Upshur, TX0.8738
    44801 Los Angeles-Long Beach, CA Los Angeles, CA1.2085
    4520Louisville, KY-IN Clark, IN Floyd, IN Harrison, IN Scott, IN Bullitt, KY Jefferson, KY Oldham, KY0.9381
    4600Lubbock, TX Lubbock, TX0.8411
    4640Lynchburg, VA Amherst, VA Bedford, VA Bedford City, VA Campbell, VA Lynchburg City, VA0.8814
    4680Macon, GA Bibb, GA Houston, GA Jones, GA Peach, GA Twiggs, GA0.8530
    4720Madison, WI Dane, WI0.9729
    48002 Mansfield, OH Crawford, OH Richland, OH0.8649
    4840Mayaguez, PR Anasco, PR Cabo Rojo, PR Hormigueros, PR Mayaguez, PR Sabana Grande, PR San German, PR0.4674
    4880McAllen-Edinburg-Mission, TX Hidalgo, TX0.8120
    4890Medford-Ashland, OR Jackson, OR1.0492
    4900Melbourne-Titusville-Palm Bay, FL Brevard, Fl0.9296
    49201 Memphis, TN-AR-MS Crittenden, AR DeSoto, MS Fayette, TN Shelby, TN Tipton, TN0.8244
    4940Merced, CA Merced, CA1.0509
    50001 Miami, FL Dade, FL1.0233
    50151 Middlesex-Somerset-Hunterdon, NJ Hunterdon, NJ Middlesex, NJ Somerset, NJ1.0876
    50801 Milwaukee-Waukesha, WI Milwaukee, WI Ozaukee, WI Washington, WI Waukesha, WI0.9845
    51201 Minneapolis-St. Paul, MN-WI 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, WI1.0929
    5140Missoula, MT Missoula, MT0.9085
    5160Mobile, AL Baldwin, AL Mobile, AL0.8267
    5170Modesto, CA Stanislaus, CA1.0111
    51901 Monmouth-Ocean, NJ Monmouth, NJ Ocean, NJ1.1258
    5200Monroe, LA Ouachita, LA0.8221
    5240Montgomery, AL Autauga, AL Elmore, AL Montgomery, AL0.7724
    5280Muncie, IN Delaware, IN1.0834
    5330Myrtle Beach, SC Horry, SC0.8529
    5345Naples, FL Collier, FL0.9839
    53601 Nashville, TN Cheatham, TN Davidson, TN Dickson, TN Robertson, TN Rutherford TN Sumner, TN Williamson, TN Wilson, TN0.9449
    53801 Nassau-Suffolk, NY Nassau, NY Suffolk, NY1.4074
    54831 New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT Fairfield, CT New Haven, CT1.2417
    5523New London-Norwich, CT New London, CT1.2428
    55601 New Orleans, LA Jefferson, LA Orleans, LA Plaquemines, LA St. Bernard, LA St. Charles, LA St. James, LA St. John The Baptist, LA St. Tammany, LA0.9089
    56001 New York, NY Bronx, NY Kings, NY New York, NY Putnam, NY Queens, NY Richmond, NY Rockland, NY Westchester, NY1.4517
    56401 Newark, NJ Essex, NJ Morris, NJ Sussex, NJ Union, NJ Warren, NJ1.0772
    5660Newburgh, NY-PA Orange, NY Pike, PA1.0908
    57201 Norfolk-Virginia Beach-Newport News, VA-NC 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 C0.8442
    57751 Oakland, CA Alameda, CA Contra Costa, CA1.5095
    5790Ocala, FL Marion, FL0.9615
    5800Odessa-Midland, TX Ector, TX Midland, TX0.8873
    58801 Oklahoma City, OK Canadian, OK Cleveland, OK Logan, OK McClain, OK Oklahoma, OK Pottawatomie, OK0.8589
    5910Olympia, WA Thurston, WA1.0932
    5920Omaha, NE-IA Pottawattamie, IA Cass, NE Douglas, NE Sarpy, NE Washington, NE1.0455
    59451 Orange County, CA Orange, CA1.1592
    59601 Orlando, FL Lake, FL Orange, FL Osceola, FL Seminole, FL0.9806
    5990Owensboro, KY Daviess, KY0.8104
    6015Panama City, FL Bay, FL0.9169
    6020Parkersburg-Marietta, WV-OH (WV Hospitals) Washington, OH Wood, WV0.8414
    60202 Parkersburg-Marietta, WV-OH (OH Hospitals) Washington, OH Wood, WV0.8649
    60802 Pensacola, FL Escambia, FL Santa Rosa, FL0.8986
    6120Peoria-Pekin, IL Peoria, IL Tazewell, IL Woodford, IL0.8399
    61601 Philadelphia, PA-NJ Burlington, NJ Camden, NJ Gloucester, NJ Salem, NJ Bucks, PA Chester, PA Delaware, PA Montgomery, PA Philadelphia, PA1.1186
    62001 Phoenix-Mesa, AZ Maricopa, AZ Pinal, AZ0.9464
    6240Pine Bluff, AR Jefferson, AR0.7697
    Start Printed Page 18817
    62801 Pittsburgh, PA Allegheny, PA Beaver, PA Butler, PA Fayette, PA Washington, PA Westmoreland, PA0.9634
    63232 Pittsfield, MA Berkshire, MA1.1369
    6340Pocatello, ID Bannock, ID0.8973
    6360Ponce, PR Guayanilla, PR Juana Diaz, PR Penuelas, PR Ponce, PR Villalba, PR Yauco, PR0.4971
    6403Portland, ME Cumberland, ME Sagadahoc, ME York, ME0.9487
    64401 Portland-Vancouver, OR-WA Clackamas, OR Columbia, OR Multnomah, OR Washington, OR Yamhill, OR Clark, WA1.0996
    64831 Providence-Warwick-Pawtucket, RI Bristol, RI Kent, RI Newport, RI Providence, RI Washington, RI1.0690
    6520Provo-Orem, UT Utah, UT0.9818
    6560Pueblo, CO Pueblo, CO0.8853
    6580Punta Gorda, FL Charlotte, FL0.9508
    6600Racine, WI Racine, WI0.9216
    66401 Raleigh-Durham-Chapel Hill, NC Chatham, NC Durham, NC Franklin, NC Johnston, NC Orange, NC Wake, NC0.9544
    6660Rapid City, SD Pennington, SD0.8363
    6680Reading, PA Berks, PA0.9436
    6690Redding, CA Shasta, CA1.1263
    6720Reno, NV Washoe, NV1.0655
    6740Richland-Kennewick-Pasco, WA Benton, WA Franklin, WA1.1224
    6760Richmond-Petersburg, VA Charles City County, VA Chesterfield, VA Colonial Heights City, VA Dinwiddie, VA Goochland, VA Hanover, VA Henrico, VA Hopewell City, VA New Kent, VA Petersburg City, VA Powhatan, VA Prince George, VA Richmond City, V0.9545
    67801 Riverside-San Bernardino, CA Riverside, CA San Bernardino, CA1.1061
    6800Roanoke, VA Botetourt, VA Roanoke, VA Roanoke City, VA Salem City, VA0.8142
    6820Rochester, MN Olmsted, MN1.1429
    68401 Rochester, NY Genesee, NY Livingston, NY Monroe, NY Ontario, NY Orleans, NY Wayne, NY0.9184
    6880Rockford, IL Boone, IL Ogle, IL Winnebago, IL0.8783
    6895Rocky Mount, NC Edgecombe, NC Nash, NC0.8735
    69201 Sacramento, CA El Dorado, CA Placer, CA Sacramento, CA1.2284
    6960Saginaw-Bay City-Midland, MI Bay, MI Midland, MI Saginaw, MI0.9294
    6980St. Cloud, MN Benton, MN Stearns, MN0.9608
    7000St. Joseph, MO Andrew, MO Buchanan, MO0.8943
    70401 St. Louis, MO-IL 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, MO0.9052
    7080Salem, OR Marion, OR Polk, OR0.9949
    7120Salinas, CA Monterey, CA1.4710
    71601 Salt Lake City-Ogden, UT Davis, UT Salt Lake, UT Weber, UT0.9854
    7200San Angelo, TX Tom Green, TX0.7845
    72401 San Antonio, TX Bexar, TX Comal, TX Guadalupe, TX Wilson, TX0.8318
    73201 San Diego, CA San Diego, CA1.1955
    73601 San Francisco, CA Marin, CA San Francisco, CA San Mateo, CA1.3784
    74001 San Jose, CA Santa Clara, CA1.3492
    74401 San Juan-Bayamon, PR 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 Lug0.4657
    7460San Luis Obispo-Atascadero-Paso Robles, CA San Luis Obispo, CA1.0470
    7480Santa Barbara-Santa Maria-Lompoc, CA Santa Barbara, CA1.0819
    7485Santa Cruz-Watsonville, CA Santa Cruz, CA1.3927
    7490Santa Fe, NM Los Alamos, NM Santa Fe, NM1.0437
    7500Santa Rosa, CA Sonoma, CA1.3000
    7510Sarasota-Bradenton, FL Manatee, FL Sarasota, FL0.9905
    7520Savannah, GA Bryan, GA Chatham, GA Effingham, GA0.9953
    75602 Scranton—Wilkes-Barre—Hazleton, PA Columbia, PA Lackawanna, PA Luzerne, PA Wyoming, PA0.8524
    76001 Seattle-Bellevue-Everett, WA Island, WA King, WA Snohomish, WA1.1289
    76102 Sharon, PA Mercer, PA0.8524
    76202 Sheboygan, WI Sheboygan, WI0.8759
    7640Sherman-Denison, TX Grayson, TX0.9329
    7680Shreveport-Bossier City, LA Bossier, LA Caddo, LA Webster, LA0.9049
    7720Sioux City, IA-NE Woodbury, IA Dakota, NE0.8549
    7760Sioux Falls, SD Lincoln, SD Minnehaha, SD0.8776
    7800South Bend, IN St. Joseph, IN0.9793
    7840Spokane, WA Spokane, WA1.0799
    7880Springfield, IL Menard, IL Sangamon, IL0.8684
    7920Springfield, MO Christian, MO Greene, MO Webster, MO0.7991
    80032 Springfield, MA Hampden, MA Hampshire, MA1.1369
    8050State College, PA Centre, PA0.9138
    80802 Steubenville-Weirton, OH-WV (OH Hospitals) Jefferson, OH Brooke, WV Hancock, WV0.8649
    8080Steubenville-Weirton, OH-WV (WV Hospitals) Jefferson, OH Brooke, WV Hancock, WV0.8614
    8120Stockton-Lodi, CA San Joaquin, CA1.0518 Start Printed Page 18818
    81402 Sumter, SC Sumter, SC0.8264
    8160Syracuse, NY Cayuga, NY Madison, NY Onondaga, NY Oswego, NY0.9441
    8200Tacoma, WA Pierce, WA1.1631
    82402 Tallahassee, FL Gadsden, FL Leon, FL0.8986
    82801 Tampa-St. Petersburg-Clearwater, FL Hernando, FL Hillsborough, FL Pasco, FL Pinellas, FL0.9119
    8320Terre Haute, IN Clay, IN Vermillion, IN Vigo, IN0.8570
    8360Texarkana, AR-Texarkana, TX Miller, AR Bowie, TX0.8174
    8400Toledo, OH Fulton, OH Lucas, OH Wood, OH0.9593
    8440Topeka, KS Shawnee, KS0.9326
    8480Trenton, NJ Mercer, NJ0.9955
    8520Tucson, AZ Pima, AZ0.8742
    8560Tulsa, OK Creek, OK Osage, OK Rogers, OK Tulsa, OK Wagoner, OK0.8086
    8600Tuscaloosa, AL Tuscaloosa, AL0.8064
    8640Tyler, TX Smith, TX0.9369
    86802 Utica-Rome, NY Herkimer, NY Oneida, NY0.8636
    8720Vallejo-Fairfield-Napa, CA Napa, CA Solano, CA1.2655
    8735Ventura, CA Ventura, CA1.0952
    8750Victoria, TX Victoria, TX0.8378
    8760Vineland-Millville-Bridgeton, NJ Cumberland, NJ1.0517
    8780Visalia-Tulare-Porterville, CA Tulare, CA1.0411
    8800Waco, TX McLennan, TX0.8075
    88401 Washington, DC-MD-VA-WV 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,
    8920Waterloo-Cedar Falls, IA Black Hawk, IA0.8841
    8940Wausau, WI Marathon, WI0.9445
    89601 West Palm Beach-Boca Raton, FL Palm Beach, FL0.9909
    90002 Wheeling, WV-OH (WV Hospitals) Belmont, OH Marshall, WV Ohio, WV0.8068
    90002 Wheeling, WV-OH (OH Hospitals) Belmont, OH Marshall, WV Ohio, WV0.8649
    9040Wichita, KS Butler, KS Harvey, KS Sedgwick, KS0.9421
    9080Wichita Falls, TX Archer, TX Wichita, TX0.7652
    91402 Williamsport, PA Lycoming, PA0.8524
    9160Wilmington-Newark, DE-MD New Castle, DE Cecil, MD1.1274
    9200Wilmington, NC New Hanover, NC Brunswick, NC0.9707
    92602 Yakima, WA Yakima, WA1.0446
    9270Yolo, CA Yolo, CA1.0485
    9280York, PA York, PA0.9309
    9320Youngstown-Warren, OH Columbiana, OH Mahoning, OH Trumbull, OH0.9996
    9340Yuba City, CA Sutter, CA Yuba, CA1.0662
    9360Yuma, AZ Yuma, AZ0.9924
    —————————— 1 All counties within state are classified as urban.

    Addendum I.—Wage Index for Rural Areas

    Nonurban AreaWage Index
    Alabama0.7390
    Alaska1.2057
    Arizona0.8544
    Arkansas0.7236
    California0.9951
    Colorado0.8813
    Connecticut1.2413
    Delaware0.9166
    Florida0.8986
    Georgia0.8094
    Hawaii1.0726
    Idaho0.8651
    Illinois0.8047
    Indiana0.8396
    Iowa0.7926
    Kansas0.7460
    Kentucky0.8043
    Louisiana0.7486
    Maine0.8639
    Maryland0.8631
    Massachusetts1.1369
    Michigan0.8831
    Minnesota0.8669
    Mississippi0.7306
    Missouri0.7723
    Montana0.8398
    Nebraska0.8007
    Nevada0.9097
    New Hampshire0.9905
    1 New Jersey
    New Mexico0.8378
    New York0.8636
    North Carolina0.8290
    North Dakota0.7647
    Ohio0.8649
    Oklahoma0.7255
    Oregon0.9873
    Pennsylvania0.8524
    Puerto Rico0.4249
    1 Rhode Island
    South Carolina0.8264
    South Dakota0.7576
    Tennessee0.7650
    Texas0.7471
    Utah0.8906
    Vermont0.9427
    Virginia0.7916
    Washington1.0446
    West Virginia0.8068
    Wisconsin0.8759
    Wyoming0.8859
    Start Printed Page 18819

    Addendum J.—Wage Index for Hospitals That Are Reclassified

    AreaWage Index
    Abilene, TX0.8179
    Akron, OH0.9981
    Albany, GA0.9544
    Alexandria, LA0.7910
    Amarillo, TX0.8435
    Anchorage, AK1.3009
    Ann Arbor, MI1.1343
    Atlanta, GA1.0050
    Austin-San Marcos, TX0.9081
    Baltimore, MD0.9891
    Baton Rouge, LA0.8707
    Beaumont-Port Arthur, TX0.8624
    Benton Harbor, MI0.8831
    Bergen-Passaic, NJ1.1833
    Billings, MT1.0038
    Biloxi-Gulfport-Pascagoula, MS0.7949
    Binghamton, NY0.8750
    Birmingham, AL0.8994
    Bismarck, ND0.7893
    Boise City, ID0.9086
    Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH1.1358
    Burlington, VT1.0122
    Caguas, PR0.4561
    Champaign-Urbana, IL0.9163
    Charleston-North Charleston, SC0.8988
    Charleston, WV0.8861
    Charlotte-Gastonia-Rock Hill, NC-SC0.9433
    Chattanooga, TN-GA0.9453
    Chicago, IL1.0872
    Cincinnati, OH-KY-IN0.9434
    Clarksville-Hopkinsville, TN-KY0.8283
    Cleveland-Lorain-Elyria, OH0.9688
    Columbia, MO0.8736
    Columbia, SC0.9215
    Columbus, GA-AL0.8318
    Columbus, OH0.9728
    Corpus Christi, TX0.8599
    Dallas, TX0.9589
    Danville, VA0.8706
    Davenport-Moline-Rock Island, IA-IL0.8606
    Dayton-Springfield, OH0.9231
    Denver, CO1.0197
    Des Moines, IA0.8754
    Dothan, AL0.7836
    Dover, DE1.0511
    Duluth-Superior, MN-WI1.0165
    Elkhart-Goshen, IN0.9379
    Eugene-Springfield, OR1.0765
    Evansville-Henderson, IN-KY0.8396
    Fargo-Moorhead, ND-MN (ND and SD Hospitals)0.8620
    Fargo-Moorhead, ND-MN (MN Hospital)0.8669
    Fayetteville, NC0.8494
    Flagstaff, AZ-UT0.9860
    Flint, MI1.0918
    Fort Collins-Loveland, CO1.0197
    Fort Pierce-Port St. Lucie, FL1.0109
    Fort Smith, AR-OK0.7696
    Fort Walton Beach, FL0.8713
    Forth Worth-Arlington, TX0.9835
    Fresno, CA1.0262
    Gadsden, AL0.8754
    Gainesville, FL0.9963
    Goldsboro, NC0.8333
    Grand Forks, ND-MN0.9097
    Grand Rapids-Muskegon-Holland, MI1.0017
    Great Falls, MT1.0459
    Greeley, CO0.9449
    Green Bay, WI0.9215
    Greensboro-Winston-Salem-High Point, NC0.9037
    Greenville, NC0.9237
    Greenville-Spartanburg-Anderson, SC0.9188
    Hagerstown, MD0.8853
    Harrisburg-Lebanon-Carlisle, PA0.9793
    Hartford, CT1.1715
    Hickory-Morganton-Lenoir, NC0.9148
    Honolulu, HI1.1479
    Houston, TX0.9387
    Huntington-Ashland, WV-KY-OH0.9436
    Huntsville, AL0.8608
    Indianapolis, IN0.9792
    Iowa City, IA0.9460
    Jackson, MS0.8268
    Jackson, TN0.8447
    Jacksonville, FL0.8957
    Johnson City-Kingsport-Bristol, TN-VA0.8894
    Jonesboro, AR0.7251
    Joplin, MO0.7678
    Kalamazoo-Battlecreek, MI0.9981
    Kansas City, KS-MO0.9322
    Knoxville, TN0.9199
    Kokomo, IN0.8984
    Lafayette, LA0.8397
    Lansing-East Lansing, MI0.9834
    Las Vegas, NV-AZ1.1258
    Lexington, KY0.8552
    Lima, OH0.9108
    Lincoln, NE0.9451
    Little Rock-North Little Rock, AR0.8432
    Longview-Marshall, TX0.8541
    Los Angeles-Long Beach, CA1.2085
    Louisville, KY-IN0.9381
    Macon, GA0.8530
    Madison, WI0.9729
    Mansfield, OH0.8649
    Memphis, TN-AR-MS0.8244
    Merced, CA1.0509
    Milwaukee-Waukesha, WI0.9845
    Minneapolis-St. Paul, MN-WI1.0929
    Missoula, MT0.9085
    Monmouth-Ocean, NJ1.1258
    Monroe, LA0.8062
    Montgomery, AL0.7724
    Myrtle Beach, SC0.8357
    Nashville, TN0.9254
    New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT1.2417
    New London-Norwich, CT1.2328
    New Orleans, LA0.9089
    New York, NY1.4399
    Newark, NJ1.0772
    Newburgh, NY-PA1.0837
    Norfolk-Virginia Beach-Newport News, VA-NC0.8442
    Oakland, CA1.5095
    Oklahoma City, OK0.8589
    Omaha, NE-IA1.0455
    Orange County, CA1.1592
    Orlando, FL0.9806
    Peoria-Pekin, IL0.8399
    Philadelphia, PA-NJ1.1186
    Phoenix-Mesa, AZ0.9464
    Pittsburgh, PA0.9496
    Pocatello, ID0.8651
    Portland, ME0.9487
    Portland-Vancouver, OR-WA1.0996
    Provo-Orem, UT0.9818
    Raleigh-Durham-Chapel Hill, NC0.9544
    Roanoke, VA0.8142
    Rockford, IL0.8783
    Sacramento, CA1.2284
    Saginaw-Bay City-Midland, MI0.9294
    St. Cloud, MN0.9608
    St. Louis, MO-IL0.9052
    Salt Lake City-Ogden, UT0.9854
    San Diego, CA1.1955
    Santa Fe, NM0.9911
    Santa Rosa, CA1.3000
    Seattle-Bellevue-Everett, WA1.1289
    Sharon, PA0.8524
    Sherman-Denison, TX0.8833
    Sioux City, IA-NE0.8549
    South Bend, IN0.9692
    Springfield, IL0.8684
    Springfield, MO0.7991
    Syracuse, NY0.9441
    Tallahassee, FL0.8274
    Tampa-St. Petersburg-Clearwater, FL0.9119
    Texarkana, AR-Texarkana, TX0.8174
    Toledo, OH0.9593
    Topeka, KS0.9326
    Tulsa, OK0.7931
    Tuscaloosa, AL0.8064
    Tyler, TX0.9199
    Vallejo-Fairfield-Napa, CA1.2167
    Victoria, TX0.8378
    Waco, TX0.8075
    Washington, DC-MD-VA-WV1.1053
    Waterloo-Cedar Falls, IA0.8841
    Wausau, WI0.9445
    Wichita, KS0.9082
    Rural Colorado0.8813
    Rural Florida0.8986
    Rural Illinois0.8047
    Rural Louisiana0.7486
    Rural Michigan0.8831
    Rural Minnesota0.8669
    Rural Missouri0.7723
    Rural Montana0.8398
    Rural Oregon0.9873
    Rural Tennessee0.7650
    Rural Texas0.7471
    Rural Virginia (KY Hospital)0.8043
    Rural Washington1.0333
    Rural Wyoming0.8859
    —————————— 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 18820

    Addendum K.—Codes Eligible for Pass-Through Payment

    CPT/ HCPCSDescription
    A4642Satumomab pendetide per dose
    A9502Technetium TC99M tetrofosmin
    A9600Strontium-89 chloride
    A9605Samarium sm153 lexidronamm
    J0205Alglucerase injection
    J0207Amifostine
    J0256Alpha 1 proteinase inhibitor
    J0286Amphotericin B lipid complex
    J0476Baclofen intrathecal trial
    J0585Botulinum toxin a per unit
    J0640Leucovorin calcium injection
    J0735Clonidine hydrochloride
    J0850Cytomegalovirus imm IV/vial
    J1190Dexrazoxane HCl injection
    J1260Dolasetron mesylate
    J1325Epoprostenol injection
    J1436Etidronate disodium inj
    J1440Filgrastim 300 mcg injeciton
    J1561Immune globulin 500 mg
    J1562Immune globulin 5 gms
    J1565RSV-ivig
    J1620Gonadorelin hydroch/100 mcg
    J1626Granisetron HCl injection
    J1745Infliximab injection
    J1785Injection imiglucerase/unit
    J1825Interferon beta-1a
    J1830Interferon beta-1b/.25 MG
    J1950Leuprolide acetate/3.75 MG
    J2275Morphine sulfate injection
    J2352Octreotide acetate injection
    J2355Oprelvekin injection
    J2405Ondansetron hcl injection
    J2430Pamidronate disodium/30 MG
    J2545Pentamidine isethionte/300mg
    J2765Metoclopramide hcl injection
    J2790Rho d immune globulin inj
    J2820Sargramostim injection
    J3010Fentanyl citrate injeciton
    J3280Thiethylperazine maleate inj
    J3305Inj trimetrexate glucoronate
    J7190Factor viii
    J7191Factor VIII (porcine)
    J7192Factor viii recombinant
    J7194Factor ix complex
    J7197Antithrombin iii injection
    J7198Anti-inhibitor
    J7310Ganciclovir long act implant
    J7505Monoclonal antibodies
    J7913Daclizumab, Parenteral, 25 m
    J8510Oral busulfan
    J8520Capecitabine, oral, 150 mg
    J8530Cyclophosphamide oral 25 MG
    J8560Etoposide oral 50 MG
    J8600Melphalan oral 2 MG
    J8610Methotrexate oral 2.5 MG
    J9000Doxorubic hcl 10 MG vl chemo
    J9001Doxorubicin hcl liposome inj
    J9015Aldesleukin/single use vial
    J9020Asparaginase injection
    J9031Bcg live intravesical vac
    J9040Bleomycin sulfate injection
    J9045Carboplatin injection
    J9050Carmus bischl nitro inj
    J9060Cisplatin 10 MG injeciton
    J9065Inj cladribine per 1 MG
    J9070Cyclophosphamide 100 MG inj
    J9093Cyclophosphamide lyophilized
    J9100Cytarabine hcl 100 MG inj
    J9120Dactinomycin actinomycin d
    J9130Dacarbazine 10 MG inj
    J9150Daunorubicin
    J9151Daunorubicin citrate liposom
    J9165Diethylstilbestrol injection
    J9170Docetaxel
    J9181Etoposide 10 MG inj
    J9185Fludarabine phosphate inj
    J9190Fluorouracil injection
    J9200Floxuridine injection
    J9201Gemcitabine HCl
    J9202Goserelin acetate implant
    J9206Irinotecan injection
    J9208Ifosfomide injection
    J9209Mesna injection
    J9211Idarubicin hcl injeciton
    J9212Interferon alfacon-1
    J9213Interferon alfa-2a inj
    J9214Interferon alfa-2b inj
    J9215Interferon alfa-n3 inj
    J9216Interferon gamma 1-b inj
    J9218Leuprolide acetate injeciton
    J9230Mechlorethamine hcl inj
    J9245Inj melphalan hydrochl 50 MG
    J9250Methotrexate sodium inj
    J9265Paclitaxel injection
    J9266Pegaspargase/singl dose vial
    J9268Pentostatin injection
    J9270Plicamycin (mithramycin) inj
    J9280Mitomycin 5 MG inj
    J9293Mitoxantrone hydrochl/5 MG
    J9310Rituximab cancer treatment
    J9320Streptozocin injection
    J9340Thiotepa injection
    J9350Topotecan
    J9360Vinblastine sulfate inj
    J9370Vincristine sulfate 1 MG inj
    J9390Vinorelbine tartrate/10 mg
    J9600Porfimer sodium
    Q0136Non esrd epoetin alpha inj
    Q0160Factor IX non-recombinant
    Q0161Factor IX recombinant
    Q0163Diphenhydramine HCl 50mg
    Q0164Prochlorperazine maleate 5mg
    Q0166Granisetron HCl 1 mg oral
    Q0167Dronabinol 2.5mg oral
    Q0169Promethazine HCl 12.5mg oral
    Q0171Chlorpromazine HCl 10mg oral
    Q0173Trimethobenzamide HCl 250mg
    Q0174Thiethylperazine maleate10mg
    Q0175Perphenazine 4mg oral
    Q0177Hydroxyzine pamoate 25mg
    Q0179Ondansetron HCl 8mg oral
    Q0180Dolasetron mesylate oral
    Q0187Factor viia recombinant
    Q2002Elliot's B solution
    Q2003Aprotinin, 10,000 kiu
    Q2004Treatment for bladder calcul
    Q2005Corticorelin ovine triflutat
    Q2006Digoxin immune FAB (Ovine),
    Q2007Ethanolamine oleate, 1000 ml
    Q2008Fomepizole, 1.5 G
    Q2009Fosphenytoin, 50 mg
    Q2010Glatiramer acetate, 25 mgeny
    Q2011Hemin, 1 mg
    Q2012Pegademase bovine inj 25 I.U
    Q2013Pentastarch 10% inj, 100 ml
    Q2014Sermorelin acetate, 0.5 mg
    Q2015Somatrem, 5 mg
    Q2016Somatropin, 1 mg
    Q2017Teniposide, 50 mg
    Q2018Urofollitropin, 75 I.U.
    Q3001Brachytherapy Seeds
    End Supplemental Information

    [FR Doc. 00-8215 Filed 3-31-00 11:00 am]

    BILLING CODE 4120-01-P

Document Information

Published:
04/07/2000
Department:
Health Care Finance Administration
Entry Type:
Rule
Action:
Final rule with comment period.
Document Number:
00-8215
Pages:
18433-18820 (388 pages)
Docket Numbers:
HCFA-1005-FC
RINs:
0938-AI56: Medicare Program; Prospective Payment System for Hospital Outpatient Services (HCFA-1005-F)
RIN Links:
https://www.federalregister.gov/regulations/0938-AI56/medicare-program-prospective-payment-system-for-hospital-outpatient-services-hcfa-1005-f-
Topics:
Administrative practice and procedure, Archives and records, Emergency medical services, Grant programs-social programs, Health facilities, Health professions, Hospitals, Kidney diseases, Laboratories, Maternal and child health, Medicaid, Medicare, Penalties, Puerto Rico, Reporting and recordkeeping requirements, Rural areas, X-rays
PDF File:
00-8215.pdf
CFR: (40)
42 CFR 409.10
42 CFR 410.2
42 CFR 410.27
42 CFR 410.28
42 CFR 410.42
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