03-20280. Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2004 Payment Rates
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AGENCY:
Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION:
Proposed rule.
SUMMARY:
This proposed rule would revise the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. In addition, it would describe proposed changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes would be applicable to services furnished on or after January 1, 2004.
DATES:
We will consider comments if we receive them at the appropriate address, as provided below, no later than 5 p.m. on October 6, 2003.
ADDRESSES:
In commenting, please refer to file code CMS-1471-P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission or e-mail.
Mail written comments (one original and two copies) to the following address ONLY:
Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1471-P, P.O. Box 8018, Baltimore, MD 21244-8018.
Please allow sufficient time for mailed comments to be timely received in the event of delivery delays.
If you prefer, you may deliver (by hand or courier) your written comments (one original and two copies) to one of the following addresses:
Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201, or Room C5-14-03, 7500 Security Boulevard, Baltimore, MD 21244-1850.
(Because access to the interior of the HHH Building is not readily available to persons without Federal Government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.)
Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and could be considered late.
We encourage commenters submitting as comments information that contains beneficiary specific information (for example, medical records, or invoices with beneficiary identification) to remove any individually identifiable information, such as information that identifies an individual, diagnoses, addresses, telephone numbers, attending physician, medical record number, or Medicare or other insurance number. Moreover, individually identifiable beneficiary medical records, including progress notes, medical orders, test results, consultation reports, and photocopies of checks from hospitals or other documents that contain bank routing numbers should not be submitted to us. Persons or organizations submitting proprietary information as public comments must designate in writing if part or all of the information contained in such comments should be considered as exempt from disclosure under Exemption 4 of the Freedom of Information Act (FOIA). Generally, Exemption 4 of the FOIA protects trade secrets and commercial or financial information that is privileged or confidential, and affords the same protections as the Trade Secrets Act, which is also applicable. We will attempt to keep confidential and protect from disclosure information that qualifies under Exemption 4. However, only data that can be available for public inspection would be used for the final rule. For information on viewing public comments, see the beginning of the SUPPLEMENTARY INFORMATION section.
Start Further InfoFOR FURTHER INFORMATION CONTACT:
Dana Burley, (410) 786-4532—outpatient prospective payment issues; Suzanne Asplen, (410) 786-4558 or Jana Petze, (410) 786-9374—partial hospitalization and community mental health centers issues.
End Further Info End Preamble Start Supplemental InformationSUPPLEMENTARY INFORMATION:
Inspection of Public Comments: Comments received timely will be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, at the headquarters of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view public comments, call (410) 786-7197.
Availability of Copies and Electronic Access
Copies: To order copies of the Federal Register containing this document, send your request to: New Orders, Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date of the issue requested and enclose a check or money order payable to the Superintendent of Documents, or enclose your Visa or Master Card number and expiration date. Credit card orders can also be placed by calling the order desk at (202) 512-1800 (or toll-free at 1-888-293-6498) or by faxing to (202) 512-2250. The cost for each copy is $10. As an alternative, you can view and photocopy the Federal Register document at most libraries designated as Federal Depository Libraries and at many other public and academic libraries throughout the country that receive the Federal Register.
This Federal Register document is also available from the Federal Register online database through GPO Access, a service of the U.S. Government Printing Office. The Web site address is: http://www.access.gpo.gov/nara/index.html.
To assist readers in referencing sections contained in this document, we are providing the following table of contents.
Outline of Contents
I. Background
A. Authority for the Outpatient Prospective Payment System
B. Summary of Rulemaking for the Outpatient Prospective Payment System
II. Proposed Changes to the Ambulatory Payment Classification (APC) Groups and Relative Weights
A. Recommendations of the Advisory Panel on APC Groups
1. Establishment of the Advisory Panel on APC Groups
2. The Panel's Meetings
3. Establishment of an Observation Subcommittee
4. Recommendations of the Advisory Panel and Our Responses
B. Other Changes Affecting the APCs
1. Limit on Variation of Costs of Services Classified Within an APC Group
2. Procedures Moved from New Technology APCs to Clinically Appropriate APCs
3. Revision of Cost Bands and Payment Amounts for New Technology APCs
4. APC Assignment for New Codes Created During Calendar Year (CY) 2003
5. Creation of APCs for Combinations of Device Procedures
6. New APC for Antepartum Care
III. Recalibration of APC Weights for CY 2004 Start Printed Page 47967
A. Data Issues
1. Period of Claims Data Used
2. Treatment of “Multiple Procedure” Claims
3. Adjustment of Median Costs for CY 2003 OPPS
B. Description of How We Propose To Calculate Weights for CY 2004
IV. Transitional Pass-Through and Related Payment Issues
A. Background
B. Discussion of Pro Rata Reduction
V. Payment for Devices
A. Pass-Through Devices
B. Expiration of Transitional Pass-Through Payments in CY 2004
C. Other Policy Issues Relating to Pass-Through Device Categories
VI. Payment for Drugs, Biologicals, Radiopharmaceutical Agents, Blood, and Blood Products
A. Pass-Through Drugs and Biologicals
B. Drugs, Biologicals, and Radiopharmaceuticals Without Pass-Through Status
1. Background
2. Proposed Criteria for Packaging Payment for Drugs, Biologicals, and Radiopharmaceuticals
3. Payment for Drugs, Biologicals, and Radiopharmaceuticals That Are Not Packaged
4. Proposed Payment Methodology for Drug Administration
5. Generic Drugs and Radiopharmaceuticals
6. Orphan Drugs
7. Vaccines
8. Blood and Blood Products
9. Intravenous Immune Globulin
10. Drug and Device Coding
11. Payment for Split Unit of Blood
12. Other Issues
VII. Wage Index Changes for CY 2004
VIII. Copayment for CY 2004
IX. Conversion Factor Update for CY 2004
X. Proposed Outlier Policy and Elimination of Transitional Corridor Payments for CY 2004
A. Proposed Outlier Policy for CY 2004
B. Elimination of Transitional Corridor Payments for CY 2004
XI. Other Policy Decisions and Proposed Changes
A. Hospital Coding for Evaluation and Management (E/M) Services
B. Status Indicators and Issues Related to OCE Editing
C. Observation Services
D. Procedures That Will Be Paid Only As Inpatient Procedures
E. Partial Hospitalization Payment Methodology
1. Background
2. PHP APC Update for CY 2004
3. Outlier Payments to CMHCs
XII. Summary of and Responses to MedPAC Recommendations
XIII. Summary of Proposed Changes for 2004
A. Changes Required by Statute
B. Additional Changes
XIV. Collection of Information Requirements
XV. Response to Public Comments
XVI. Regulatory Impact Analysis
A. General
B. Changes in This Proposed Rule
C. Limitations of Our Analysis
D. Estimated Impacts of This Proposed Rule on Hospitals
E. Projected Distribution of Outlier Payments
F. Estimated Impacts of This Proposed Rule on Beneficiaries
Addenda
Addendum A—List of Ambulatory Payment Classifications (APCs) with Status Indicators, Relative Weights, Payment Rates, and Copayment Amounts
Addendum B—Payment Status by HCPCS Code, and Related Information
Addendum C—Hospital Outpatient Payment for Procedures by APC: Displayed on Web Site Only
Addendum D—Payment Status Indicators for the Hospital Outpatient Prospective Payment System
Addendum E—CPT Codes That Would Be Paid Only as Inpatient Procedures
Addendum H—Wage Index for Urban Areas
Addendum I—Wage Index for Rural Areas
Addendum J—Wage Index for Hospitals That Are Reclassified
Addendum L—Packaged Nonchemotherapy Infusion Drugs
Addendum M—Separately Paid Nonchemotherapy Infusion Drugs
Addendum N—Packaged Chemotherapy Drugs Other Than Infusion
Addendum O—Separately Paid Chemotherapy Drugs Other Than Infusion
Addendum P—Packaged Chemotherapy Drugs Infusion Only
Addendum Q—Separately Paid Chemotherapy Drugs Infusion Only
Alphabetical List of Acronyms Appearing in the Proposed Rule
ACEP—American College of Emergency Physicians
AHA—American Hospital Association
AHIMA—American Health Information Management Association
AMA—American Medical Association
APC—Ambulatory payment classification
ASC—Ambulatory surgical center
AWP—Average wholesale price
BBA—Balanced Budget Act of 1997
BIPA—Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000
BBRA—Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999
CAH—Critical access hospital
CCR—Cost center specific cost-to-charge ratio
CMHC—Community mental health center
CMS—Centers for Medicare & Medicaid Services (Formerly known as the Health Care Financing Administration)
CPT—[Physicians'] Current Procedural Terminology, Fourth Edition, 2002, copyrighted by the American Medical Association
CY—Calendar year
DMEPOS—Durable medical equipment, prosthetics, orthotics, and supplies
DRG—Diagnosis-related group
DSH—Disproportionate Share Hospital
EACH—Essential Access Community Hospital
E/M—Evaluation and management
ESRD—End-stage renal disease
FACA—Federal Advisory Committee Act
FDA—Food and Drug Administration
FI—Fiscal intermediary
FSS—Federal Supply Schedule
FY—Federal fiscal year
HCPCS—Healthcare Common Procedure Coding System
HCRIS—Hospital Cost Report Information System
HHA—Home health agency
HIPAA—Health Insurance Portability and Accountability Act of 1996
ICD-9-CM—International Classification of Diseases, Ninth Edition, Clinical Modification
IME—Indirect Medical Education
IPPS—(Hospital) inpatient prospective payment system
IVIG—Intravenous Immune Globulin
LTC—Long Term Care
MedPAC—Medicare Payment Advisory Commission
MDH—Medicare Dependent Hospital
MSA—Metropolitan statistical area
NECMA—New England County Metropolitan Area
OCE—Outpatient code editor
OMB—Office of Management and Budget
OPD—(Hospital) outpatient department
OPPS—(Hospital) outpatient prospective payment system
PHP—Partial hospitalization program
PM—Program memorandum
PPS—Prospective payment system
PPV—Pneumococcal pneumonia (virus)
PRA—Paperwork Reduction Act
RFA—Regulatory Flexibility Act
RRC—Rural Referral Center
SBA—Small Business Administration
SCH—Sole Community Hospital
SDP—Single drug pricer
SI—Status Indicator
TEFRA—Tax Equity and Fiscal Responsibility Act
TOPS—Transitional outpatient payments
USPDI—United States Pharmacopoeia Drug Information
I. Background
A. Authority for the Outpatient Prospective Payment System
When the Medicare statute was originally enacted, Medicare payment for hospital outpatient services was based on hospital-specific costs. In an effort to ensure that Medicare and its beneficiaries pay appropriately for services and to encourage more efficient delivery of care, the Congress mandated replacement of the cost-based payment methodology with a prospective payment system (PPS). The Balanced Budget Act of 1997 (BBA) (Pub. L. 105-33), enacted on August 5, 1997, added section 1833(t) to the Social Security Act (the Act) authorizing implementation of a PPS for hospital outpatient services. The Balanced Budget Refinement Act of 1999 (BBRA) (Pub. L. 106-113), enacted on November 29, 1999, made major changes that affected the hospital outpatient PPS (OPPS). The Medicare, Medicaid, and Start Printed Page 47968SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) (Pub. L. 106-554), enacted on December 21, 2000, made further changes in the OPPS. The OPPS was first implemented for services furnished on or after August 1, 2000.
B. Summary of Rulemaking for the Outpatient Prospective Payment System
- On September 8, 1998, we published a proposed rule (63 FR 47552) to establish in regulations a PPS for hospital outpatient services, to eliminate the formula-driven overpayment for certain hospital outpatient services, and to extend reductions in payment for costs of hospital outpatient services. On June 30, 1999, we published a correction notice (64 FR 35258) to correct a number of technical and typographic errors in the September 1998 proposed rule including the proposed amounts and factors used to determine the payment rates.
- On April 7, 2000, we published a final rule with comment period (65 FR 18434) that addressed the provisions of the PPS for hospital outpatient services scheduled to be effective for services furnished on or after July 1, 2000. Under this system, Medicare payment for hospital outpatient services included in the PPS is made at a predetermined, specific rate. These outpatient services are classified according to a list of ambulatory payment classifications (APCs). The April 7, 2000 final rule with comment period also established requirements for provider departments and provider-based entities and prohibited Medicare payment for nonphysician services furnished to a hospital outpatient by a provider or supplier other than a hospital unless the services are furnished under arrangement. In addition, this rule extended reductions in payment for costs of hospital outpatient services as required by the BBA and amended by the BBRA. Medicare regulations governing the hospital OPPS are set forth at 42 CFR part 419.
- On June 30, 2000, we published a notice (65 FR 40535) announcing a delay in implementation of the OPPS from July 1, 2000 to August 1, 2000. We implemented the OPPS on August 1, 2000.
- On August 3, 2000, we published an interim final rule with comment period (65 FR 47670) that modified criteria that we use to determine which medical devices are eligible for transitional pass-through payments. The August 3, 2000 rule also corrected and clarified certain provider-based provisions included in the April 7, 2000 rule.
- On November 13, 2000, we published an interim final rule with comment period (65 FR 67798). This rule provided for the annual update to the amounts and factors for OPPS payment rates effective for services furnished on or after January 1, 2001. We implemented the 2001 OPPS on January 1, 2001. We also responded to public comments on those portions of the April 7, 2000 final rule that implemented related provisions of the BBRA and public comments on the August 3, 2000 rule.
- On November 2, 2001, we published a final rule (66 FR 55857) that announced the Medicare OPPS conversion factor for calendar year (CY) 2002. In addition, it described the Secretary's estimate of the total amount of the transitional pass-through payments for CY 2002 and the implementation of a uniform reduction in each of the pass-through payments for that year.
- On November 2, 2001, we also published an interim final rule with comment period (66 FR 55850) that set forth the criteria the Secretary will use to establish new categories of medical devices eligible for transitional pass-through payments under Medicare's OPPS.
- On November 30, 2001, we published a final rule (66 FR 59856) that revised the Medicare OPPS to implement applicable statutory requirements, including relevant provisions of BIPA, and changes resulting from continuing experience with this system. In addition, it described the CY 2002 payment rates for Medicare hospital outpatient services paid under the PPS. This final rule also announced a uniform reduction of 68.9 percent to be applied to each of the transitional pass-through payments for certain categories of medical devices and drugs and biologicals.
- On December 31, 2001, we published a final rule (66 FR 67494) that delayed, until no later than April 1, 2002, the effective date of CY 2002 payment rates and the uniform reduction of transitional pass-through payments that were announced in the November 30, 2001 final rule. In addition, this final rule indefinitely delayed certain related regulatory provisions.
- On March 1, 2002, we published a final rule (67 FR 9556) that corrected technical errors that affected the amounts and factors used to determine the payment rates for services paid under the Medicare OPPS and corrected the uniform reduction to be applied to transitional pass-through payments for CY 2002 as published in the November 30, 2001 final rule. These corrections and the regulatory provisions that had been delayed became effective on April 1, 2002.
- On November 1, 2002, we published a final rule (67 FR 66718) that revised the Medicare OPPS to update the payment weights and conversion factor for services payable under the 2003 OPPS on the basis of data from claims for services furnished from April 1, 2001 through March 31, 2002. The rule also removed from pass-through status most drugs and devices that had been paid under pass-through provisions in 2002 as required by the applicable provisions of law governing the duration of pass-through payment.
II. Proposed Changes to the Ambulatory Payment Classification (APC) Groups and Relative Weights
Under the OPPS, we pay for hospital outpatient services on a rate-per-service basis that varies according to the APC group to which the service is assigned. Each APC weight represents the median hospital cost of the services included in that APC relative to the median hospital cost of the services included in APC 601, Mid-Level Clinic Visits. The APC weights are scaled to APC 601 because a mid-level clinic visit is one of the most frequently performed services in the outpatient setting.
Section 1833(t)(9)(A) of the Act requires the Secretary to review the components of the OPPS not less often than annually and to revise the groups, relative payment weights, 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 1833(t)(9)(A) of the Act requires the Secretary, beginning in 2001, to consult with an outside panel of experts to review the APC groups and the relative payment weights.
Finally, section 1833(t)(2) of the Act provides that, subject to certain exceptions, the items and services within an APC group cannot be considered comparable with respect to the use of resources if the highest median (or mean cost, if elected by the Secretary) for an item or service in the group is more than 2 times greater than the lowest median cost for an item or service within the same group (referred to as the “2 times rule”).
We use the median cost of the item or service in implementing this provision. The statute authorizes the Secretary to make exceptions to the 2 times rule “in Start Printed Page 47969unusual cases, such as low volume items and services.”
For purposes of this proposed rule, we analyzed the APC groups within this statutory framework.
A. Recommendations of the Advisory Panel on APC Groups
1. Establishment of the Advisory Panel on APC Groups
Section 1833(t)(9)(A) of the Act requires that we consult with an outside panel of experts, the Advisory Panel on APC Groups (the Panel), to review the clinical integrity of the groups and weights. The Act specifies that the Panel will act in an advisory capacity. This expert panel, which is to be composed of representatives of providers subject to the OPPS (currently employed full-time, in their respective areas of expertise), reviews and advises us about the clinical integrity of the APC groups and their weights. The Panel is not restricted to using our data and may use data collected or developed by organizations outside the Department in conducting its review.
On November 21, 2000, the Secretary signed the charter establishing an “Advisory Panel on APC Groups.” The Panel is technical in nature and is governed by the provisions of the Federal Advisory Committee Act (FACA) as amended (Pub. L. 92-463).
On November 1, 2002, the Secretary renewed the charter. The new charter indicates that the Panel continues to be technical in nature, is governed by the provisions of the FACA, may convene “up to three meetings per year,” and is chaired by a Federal official.
To establish the Panel, we solicited members in a notice published in the Federal Register on December 5, 2000 (65 FR 75943). We received applications from more than 115 individuals nominating either a colleague or themselves. After carefully reviewing the applications, we chose 15 highly qualified individuals to serve on the Panel.
Because of the loss of 6 Panel members in March 2003 due to the expiration of terms of office, retirement, and a career change, a Federal Register notice was published on February 28, 2003 (68 FR 9671), requesting nominations of Panel members. From the 40 nominations we received, 6 new members have been chosen and will be identified on the CMS Web site.
2. The Panel's Meetings
The first Panel meeting was held on February 27, February 28, and March 1, 2001. During the 2001 meeting, the Panel members felt that requiring consistency for all presentations with regard to format, data submission, and general information would assist them in analyzing the submissions and presentations and making recommendations. Therefore, upon the Panel's recommendation, the Research Subcommittee was established during the 2001 meeting.
The Panel began its 2002 meeting on January 22, 2002, by considering the Research Subcommittee's recommendation to the Panel on requirements for written submissions and oral presentations. The Research Subcommittee recommended that all future oral presentations and written submissions contain the following:
- Name, address, and telephone number of the proposed presenter.
- Financial relationship(s), if any, with any company whose products, services, or procedures are under consideration.
- CPT ([Physicians'] Current Procedural Technology) codes involved.
- APC(s) affected.
- Description of the issue.
- Clinical description of the service under discussion, with comparison to other services within the APC.
- Description of the resource inputs associated with the service under discussion, with a comparison to resource inputs for other services within the APC.
- Recommendations and rationale for change.
- Expected outcome of change and potential consequences of no change.
The Panel adopted these Subcommittee recommendations.
The third Panel meeting was held on January 21 and 22, 2003, to discuss the APCs of the newly implemented 2003 OPPS. We published a notice in the Federal Register on December 27, 2002 (67 FR 79107), to announce the following: The location and time of the third Panel meeting; a list of agenda items; and that the meeting was open to the public. In that document, we solicited public comment specifically on the items included on the agenda for the January 2003 Panel meeting. In this section, “commenter” refers to entities that provided comments in response to that Federal Register notice. We also provided additional information about the Panel meeting through a press release and on the CMS Web site. Presentations for the 2003 meeting met, at a minimum, the adopted guidelines for presentations referred to above.
3. Establishment of an Observation Subcommittee
At the third annual meeting in January 2003, the Panel suggested numerous changes to the APCs (listed below) and that a subcommittee be established to review observation issues, such as allowable International Classification of Diseases, clinical modification codes, and operational issues. Therefore, before the close of the third annual meeting, the Observation Subcommittee was established. Other Panel members that are not currently participating in this subcommittee are welcome to take part in this subcommittee, which is tasked with reviewing International Classification of Disease Codes, clinical modification codes, and operational issues related to observation. This subcommittee will report its findings to the Panel in 1 year.
4. Recommendations of the Advisory Panel and Our Responses
In this section, we consider the Panel's recommendations affecting specific APCs. The Panel based its recommendations on claims data for the period April 1, 2002 through September 30, 2002. This data set comprises a portion of the data that will be used to set 2004 payment rates. APC titles in this discussion are those that existed when the APC Panel met in January 2003. In a few cases, APC titles have been changed for this proposed rule, and, therefore, some APCs do not have the same title in Addendum A as they have in this section.
The Panel's agenda included APCs that our staff believe violate the 2 times rule as well as APCs for which comments were submitted. As discussed below, the Panel sometimes declined to recommend a change in an APC even though the APC appeared to violate the 2 times rule. In section II.B of this preamble, we discuss our proposals regarding the 2 times rule based on the April 1, 2002 through December 31, 2002 data that we used to determine the proposed 2004 APC relative weights. Section II.B also details the criteria we used when deciding to propose exceptions to the 2 times rule.
a. Debridement and Destruction.
APC 0012: Level I Debridement & Destruction.
APC 0013: Level II Debridement & Destruction.
We expressed concern to the Panel that APCs 0012 and 0013 appear to violate the 2 times rule. In order to remedy these violations, we asked the Panel to consider the following changes:
(1) Move the following codes from APC 0013 to APC 0012:
HCPCS Description 11001 Debride infected skin add-on. 11302 Shave skin lesion. Start Printed Page 47970 15786 Abrasion, lesion, single. 15793 Chemical peel, nonfacial. 15851 Removal of sutures. 16000 Initial treatment of burn(s). 16025 Treatment of burn(s). (2) Move code 11057 (Trim skin lesions, over 4) from APC 0012 to APC 0013.
The Panel agreed with our staff and recommended that we make these changes. We propose to accept the Panel's recommendation.
b. Excision/Biopsy.
APC 0019: Level I Excision/Biopsy.
APC 0020: Level II Excision/Biopsy.
APC 0021: Level III Excision/Biopsy.
We expressed concern to the Panel that APCs 0019 and 0020 appear to violate the 2 times rule. In order to remedy these violations, we asked the Panel to consider the following changes:
(1) Move the following HCPCS codes from APC 0019 to a new APC:
HCPCS Description 11755 Biopsy, nail unit. 11976 Removal of contraceptive cap. 24200 Removal of arm foreign body. 28190 Removal of foot foreign body. 56605 Biopsy of vulva/perineum. 56606 Biopsy of vulva/perineum. 69100 Biopsy of external ear. (2) Move the following HCPCS codes from APC 0020 to APC 0021:
HCPCS Description 11404 Removal of skin lesion. 11423 Removal of skin lesion. 11604 Removal of skin lesion. 11623 Removal of skin lesion. The Panel recommended that we not change the structure of APCs 0019, 0020, and 0021 at this time in the interest of preserving clinical homogeneity. We propose to accept the Panel's recommendation that we make no changes to the structure of these APCs for 2004. We plan to place these APCs on the Panel's agenda for the 2005 update.
c. Thoracentesis/Lavage Procedures and Endoscopies.
APC 0071: Level I Endoscopy Upper Airway.
APC 0072: Level II Endoscopy Upper Airway.
APC 0073: Level III Endoscopy Upper Airway.
We expressed concern to the Panel that APCs 0071 and 0072 appear to violate the 2 times rule. In order to remedy these violations, we asked the Panel to consider the following changes:
Move the following HCPCS codes as described below:
Table 1.—HCPCS Codes Proposed To Be Redistributed From APCs 0071 and 0072 to APCs 0071, 0072, and 0073
HCPCS Description 2003 APC 2004 APC 31505 Diagnostic laryngoscopy 0072 0071 31575 Diagnostic laryngoscopy 0071 0072 31720 Clearance of airways 0072 0073 The Panel recommended that we make the above changes. We propose to accept the Panel's recommendation, with the exception of CPT code 31720. After reviewing an additional quarter of claims data that was not available at the time the Panel convened, placement of CPT code 31720 into APC 0072 better reflects its resource consumption. Therefore, we propose to keep CPT code 31720 in APC 0072.
d. Cardiac and Ambulatory Blood Pressure Monitoring.
APC 0097: Cardiac and Ambulatory Blood Pressure Monitoring.
We expressed concern to the Panel that APC 0097 appears to violate the 2 times rule. We asked the Panel to recommend options for resolving this violation, and suggested splitting APC 0097 into two APCs. The Panel recommended that the structure of APC 0097 should not be changed at this time based on clinical homogeneity considerations. We propose to accept the Panel's recommendation that we make no changes to APC 0097 for 2004. We plan to place this APC on the Panel's agenda for the 2005 update.
e. Electrocardiograms.
APC 0099: Electrocardiograms.
APC 0340: Minor Ancillary Procedures.
We expressed concern to the Panel that APC 0099 appears to violate the 2 times rule. We asked the Panel to recommend options for resolving this violation, and suggested moving CPT code 93701 (Bioimpedance, thoracic) from APC 0099 to APC 0340. The Panel felt, however, that the structure of APC 0099 should not be changed at this time based on clinical homogeneity considerations. We propose to accept the Panel's recommendation that we make no changes to APC 0099 for 2004. We plan to place this APC on the Panel's agenda for the 2005 update.
f. Cardiac Stress Tests.
APC 0100: Cardiac Stress Tests.
A presenter to the Panel, who represented a device manufacturer, requested that we move CPT code 93025 (Microvolt t-wave assessment) out of APC 0100. The presenter believes that the actual cost for this procedure is significantly higher than for other procedures in the same APC. Since this technology is often billed in conjunction with other procedures (for example, stress tests, CPT code 93017), few single-APC claims were available to evaluate the presenter's contention.
The Panel felt the data presented are insufficient to merit moving the code and recommends that CPT code 93025 remain in APC 0100 until more data are available for review. We propose to accept the Panel's recommendation that CPT code 93025 remain in APC 0100 until more claims data become available for review.
g. Revision/Removal of Pacemakers or Automatic Implantable Cardioverter Defibrillators.
APC 0105: Revision/Removal of Pacemakers, AICD, or Vascular.
We asked the Panel to review the codes within APC 0105 for an apparent violation of the 2 times rule, stating that we believe the apparent violation is a result of incorrectly coded claims. The Panel agreed and recommended no changes to APC 0105 at this time. We propose to accept the Panel's recommendation that we make no changes to APC 0105 until more accurate claims data become available and support the need for a change.
h. Sigmoidoscopy.
APC 0146: Level I Sigmoidoscopy.
APC 0147: Level II Sigmoidoscopy.
We expressed concern to the Panel that relatively simple procedures such as anoscopy and rigid sigmoidoscopy have higher median costs than more complex procedures such as flexible sigmoidoscopy. Panel members suggested the high costs may be due to the need to perform an otherwise minor office procedure in a hospital setting (for example, due to the clinical condition of the patient). Panel members also suggested that claims may be incorrectly coded because coding Start Printed Page 47971instructions do not clearly state how to code when the procedure performed is not as extensive as the procedure planned (for example, when a colonoscopy is planned but only a sigmoidoscopy is performed). In these cases, coding instructions are unclear as to whether the planned procedure should be reported with a modifier for reduced services or with the code for the actual procedure performed.
The Panel recommended that we make no changes to APCs 0146 and 0147 at this time. We propose to accept the Panel's recommendation that we make no changes to APCs 0146 and 0147. We plan to place this APC on the Panel's agenda for the 2005 update.
i. Anal/Rectal Procedures.
APC 0148: Level I Anal/Rectal Procedure.
APC 0149: Level III Anal/Rectal Procedure.
APC 0155: Level II Anal/Rectal Procedure.
We expressed concern to the Panel that APCs 0148 and 0149 appear to violate the 2 times rule. We asked the Panel to recommend options for resolving these violations, and suggested rearranging some of the CPT codes within APCs 0148, 0149, and 0155. The Panel recommended that we move CPT code 46040 (Incision of rectal abscess) from APC 0155 to APC 0149. We propose to accept the Panel's recommendation.
j. Insertion of Penile Prosthesis.
APC 0179: Urinary Incontinence Procedures.
APC 0182: Insertion of Penile Prosthesis.
A presenter to the Panel representing manufacturers and providers requested that APC 0182 be split into two APCs, based on whether the procedure used inflatable or non-inflatable penile prostheses. The presenter stated that the complexity of the procedure, the cost of the devices, and related resources were all significantly higher with inflatable prostheses.
The Panel recommended that we eliminate APCs 0179 and 0182 and create two new APCs, 0385 and 0386 that contain the following CPT codes:
HCPCS Description APC 0385: 52282 Cystoscopy, implant stent. 53440 Correct bladder function. 53444 Insert tandem cuff. 54400 Insert semi-rigid prosthesis. 54416 Remv/repl penis contain prosthesis. APC 0386: 53445 Insert uro/ves nck sphincter. 53447 Remove/replace ur sphincter. 54401 Insert self-contained prosthesis. 54405 Insert multi-comp penis prosthesis. 54410 Remove/replace penis prosthesis. We propose to accept the Panel's recommendation to eliminate APCs 0179 and 0182 and create two new APCs, 0644 and 0645, containing the above CPT code configurations.
k. Surgical Hysteroscopy.
APC 0190: Surgical Hysteroscopy.
A presenter to the Panel, who represented a device manufacturer, requested that we move CPT code 58563 (Hysteroscopy, ablation) from APC 0190 to a higher paying APC. The presenter noted that endometrial cryoablation is included in a new technology APC, while a thermal ablation system is included with older, less costly techniques. The presenter expressed concern that cryoablation may be reimbursed at a higher rate than the thermal ablation system, giving its manufacturers an unfair competitive advantage.
Panel members agreed that new, more expensive technologies that prove to be more effective merit review for a higher payment rate. Without substantial evidence of greater effectiveness, however, the Panel was reluctant to create APCs that provide an incentive to use a more expensive device. In its discussion of whether or not to recommend moving CPT code 58563 to a higher paying APC, the Panel recommended that we take into account different methods of endometrial ablation associated with hysteroscopy, adequately reflect the resources used for the various procedures, avoid creating a competitive advantage or disadvantage, and collect data needed to track costs on the type of technologies used for this procedure.
After consulting with experts in the field, we propose to split APC 0190 (Surgical Hysteroscopy) into 2 APCs that are more clinically homogeneous. We propose to change the description for APC 0190 from “Surgical Hysteroscopy” to “Level I Hysteroscopy” and keep the following HCPCS codes in APC 0190:
HCPCS Description 58558 Hysteroscopy, biopsy. 58559 Hysteroscopy, lysis. 58562 Hysteroscopy, remove fb. 58579 Hysteroscope procedure. We also propose to move the following HCPCS codes from APC 0190 to newly created APC 0387 titled “Level II Hysteroscopy”:
HCPCS Description 58560 Hysteroscopy, resect septum. 58561 Hysteroscopy, remove myoma. 58563 Hysteroscopy, ablation. In addition, we propose to move the following HCPCS codes as described below:
Table 2.—HCPCS Codes Proposed To Be Redistributed to APCs 0130, 0195, and 0190
HCPCS Description 2003 APC 2004 APC 58578 Laparoscopic procedure, uterus 0190 0130 58353 Endometrial ablate, thermal 0193 0195 58555 Hysteroscopy, diagnostic, sep. procedure 0194 0190 We believe these proposed changes take into account the different technologies used to perform these procedures while maintaining the clinical comparability of these APCs as well as improving their homogeneity in terms of resource consumption.
l. Female Reproductive Procedures.
APC 0195: Level VII Female Reproductive Proc. APC 0202: Level VIII Female Reproductive Proc.
A commenter requested that we place CPT code 57288 (Repair bladder defect) in its own APC because it requires the use of a device. Our staff suggested that CPT codes 57288 and 57287 remain in APC 0202, while the remaining codes in APC 0202 be moved to APC 0195:
HCPCS Description 57109 Vaginectomy partial w/nodes. 58920 Partial removal of ovary(s). 58925 Removal of ovarian cyst(s). The Panel agreed with our staff, and we propose to accept the Panel's recommendation to move CPT codes Start Printed Page 4797257109, 58920, and 58925 from APC 0202 to APC 0195.
m. Nerve Injections.
APC 0203: Level IV Nerve Injections.
APC 0204: Level I Nerve Injections.
APC 0206: Level II Nerve Injections.
APC 0207: Level III Nerve Injections.
Several commenters suggested changes in the configuration of APCs 0203, 0204, 0206, and 0207 because of concerns that the current classifications result in payment rates that are too low relative to the resource costs associated with certain procedures in these APCs. Several of these APCs include procedures associated with drugs or devices for which pass-through payments are scheduled to expire in 2003.
We requested the Panel's input regarding whether or not these APCs should be restructured. The Panel stated that the current configuration of APCs 0203, 0204, 0206, and 0207 is more clinically cohesive than the previous year's configuration and that more data should be collected before making any changes. We propose to accept the Panel's recommendation that we make no changes to the structure of these APCs until more data become available for review.
n. Laminotomies and Laminectomies; Implantation of Pain Management Device.
APC 0208: Laminotomies and Laminectomies.
APC 0223: Implantation of Pain Management Device.
A presenter to the Panel, who represented a device manufacturer, requested that we move CPT code 62351 (Implant spinal canal catheter) from APC 0208 to APC 0223 to better capture the device cost that may be involved with the procedure. The Panel felt the data were insufficient to merit moving the code and recommended that CPT code 62351 remain in APC 0208 until more data are available for review. We propose to accept the Panel's recommendation that CPT code 62351 remain in APC 0208 until more claims data become available for review.
o. Extended EEG Studies and Sleep Studies; Electroencephalogram.
APC 0209: Extended EEG Studies and Sleep Studies, Level II.
APC 0213: Extended EEG Studies and Sleep Studies, Level I.
APC 0214: Electroencephalogram.
We expressed concern to the Panel that APC 0213 appears to minimally violate the 2 times rule. In order to remedy this violation, we asked the Panel to consider a commenter's suggestion that we move CPT code 95955 (EEG during surgery) from APC 0214 to APC 0213. The Panel agreed with the commenter's suggestion. We propose to accept the Panel's recommendation to move CPT code 95955 from APC 0214 to APC 0213.
p. Nerve and Muscle Tests.
APC 0215: Level I Nerve and Muscle Tests.
APC 0216: Level III Nerve and Muscle Tests.
APC 0218: Level II Nerve and Muscle Tests.
We expressed concern to the Panel that APC 0218 appears to violate the 2 times rule. In order to remedy this violation, one commenter requested that we move CPT codes 95921 (Autonomic nerve function test) and 95922 (Autonomic nerve function test) from APC 0218 to APC 0216, while another commenter requested that we move CPT code 95904 (Sensory nerve conduction test) from APC 0215 to APC 0218. Alternatively, our staff suggested to the Panel that the following CPT codes be moved from APC 0218 to APC 0215.
HCPCS Description 95858 Tensilon test & myogram. 95870 Muscle test, nonparaspinal. 95900 Motor nerve conduction test. 95903 Motor nerve conduction test. After considering all of the above proposals, the Panel recommended that we move CPT codes 95858, 95870, 95900, and 95903 from APC 0218 to APC 0215. We propose to accept the Panel's recommendation.
q. Implantation of Drug Infusion Device.
APC 0227: Implantation of Drug Infusion Device.
APC 0227 contains only two CPT codes: one for implantation of programmable spine infusion pumps, 62362, and for implantation of non-programmable spine infusion pumps, 62361. A commenter requested that we split APC 0227 into two APCs to recognize the cost difference between CPT code 62361 and CPT code 62362. However, since our cost data do not show a significant cost difference between the two devices and APC 227 does not violate the 2 times rule, the Panel recommended that CPT codes 62361 and 62362 remain in APC 0227. We propose to accept the Panel's recommendation.
r. Ophthalmologic APCs.
APC 0230: Level I Eye Tests & Treatments.
APC 0235: Level I Posterior Segment Eye Procedures.
APC 0236: Level II Posterior Segment Eye Procedures.
APC 0698: Level II Eye Tests & Treatments.
We advised the Panel that APCs 0230 and 0235 violate the 2 times rule but that the current configuration of these APCs reflects the Panel's previous recommendations. A presenter to the Panel, who represented a device manufacturer, expressed concern that the pass-through device category “New Technology: Intraocular Lens” was discontinued and these devices are now packaged. The presenter asked the Panel to recommend that future new intraocular lens devices be considered for a new pass-through category.
To remedy the violations to the 2 times rule, we asked the Panel to consider moving CPT code 67820 (Revise eyelashes) from APC 0230 to APC 0698 and CPT code 67110 (Repair detached retina) from APC 0235 to APC 0236. The Panel recommended that we make these changes. We propose to accept the Panel's recommendation and monitor the data for APC 0235 for possible review next year. The Panel also acknowledged that making recommendations concerning pass-through categories is beyond their purview.
s. Skin Tests and Miscellaneous Red Blood Cell Tests; Transfusion Laboratory Procedures.
APC 0341: Skin Tests and Miscellaneous Red Blood Cell Tests.
APC 0345: Level I Transfusion Laboratory Procedures.
We advised the Panel that APCs 0341 and 0345 minimally violate the 2 times rule and suggested moving several CPT codes within these APCs into a new APC because a commenter expressed concern over the combination of skin tests and miscellaneous red blood cell tests in APC 0341, asserting that services within this APC cannot be considered comparable with respect to resource usage.
In order to remedy these violations to the 2 times rule, we suggested moving CPT code 86901 (Blood typing, Rh (D)) from APC 0345 to a new APC along with the following CPT codes from APC 0341:
HCPCS Description 86880 Coombs test, direct. 86885 Coombs test, indirect, qualitative. 86886 Coombs test, indirect, titer. 86900 Blood typing, ABO. The Panel recommended that we make the above changes. We propose to accept the Panel's recommendation to move HCPCS codes 86880, 86885, 86886, and 86900 from APC 0341 to new APC 0409 and to move CPT code 86901 (Blood typing, Rh (D)) from APC 0345 to new APC 0409. Start Printed Page 47973
t. Otorhinolaryngologic Function Tests.
APC 0363: Level I Otorhinolaryngologic Function Tests.
APC 0660: Level II Otorhinolaryngologic Function Tests.
We expressed concern to the Panel that APC 0660 appears to violate the 2 times rule and suggested moving CPT codes 92543 (Caloric vestibular test) and 92588 (Evoked auditory test) from APC 0660 to APC 0363. The Panel recommended that we make these CPT code changes. We propose to accept the Panel's recommendation to move CPT codes 92543 and 92588 from APC 0660 to APC 0363.
u. Tube Changes and Repositioning.
APC 0121: Level I Tube changes and Repositioning
APC 0122: Level II Tube changes and Repositioning
We expressed concern to the Panel that APC 0121 appears to violate the 2 times rule. In order to remedy this violation, we suggested moving the following CPT codes from APC 0121 to APC 0122:
HCPCS Description 47530 Revise/reinsert bile tube. 50688 Change of ureter tube. 51710 Change of bladder tube. 62225 Replace/irrigate catheter. The Panel recommended that we make these CPT code changes. We propose to accept the Panel's recommendation to move CPT codes 47530, 50688, 51710, and 62225 from APC 0121 to APC 0122.
v. Myelography.
APC 0274: Myelography.
We advised the Panel that APC 0274 minimally violates the 2 times rule and suggested moving CPT codes 72285 (X-ray c/t spine disk) and 72295 (X-ray
c/t spine disk) from APC 0274 to a new APC. A presenter, from an organization representing radiologists, agreed with our proposal. The Panel recommended that we make these CPT code changes. We propose to accept the Panel's recommendation to move CPT codes 72285 and 72295 from APC 0274 to new APC 0388.
w. Therapeutic Radiologic Procedures.
APC 0296: Level I Therapeutic Radiologic Procedures
APC 0297: Level II Therapeutic Radiologic Procedures
We advised the Panel that APCs 0296 and 0297 appear to minimally violate the 2 times rule as a result of changes recommended by the Panel and adopted by CMS last year. The Panel recommended that no changes be made to APCs 0296 and 0297 in the interest of preserving the clinical homogeneity of these APCs. We propose to accept the Panel's recommendation that we make no CPT code changes to APCs 0296 and 0297.
x. Vascular Procedures; Cannula/Access Device Procedures.
APC 0103: Miscellaneous Vascular Procedures
APC 0115: Cannula/Access Device Procedures
A commenter requested that we move CPT code 36860 (External cannula declotting) from APC 0103 to APC 0115, asserting that this procedure is more similar to other procedures in APC 0115 and does not fit well in its current miscellaneous APC. The Panel found that the claims data were insufficient to support moving CPT code 36860 from APC 0103 to the higher paying APC 0115 and recommends that CPT code 36860 remain in APC 0103 until more data are available for review. We propose to accept the Panel's recommendation that CPT code 36860 remain in APC 0103 until more claims data become available for review.
y. Angiography and Venography Except Extremity.
APC 0279: Level II Angiography and Venography except Extremity.
APC 0280: Level III Angiography and Venography except Extremity.
APC 0668: Level I Angiography and Venography except Extremity.
A commenter requested that we move CPT code 75978 (Repair venous blockage) from APC 0668 to APC 0280 and that we move CPT code 75774 (Artery x-ray, each vessel) from APC 0668 to APC 0279. A presenter to the Panel testified that CPT code 75978 is commonly used for dialysis patients and often requires multiple intraoperative attempts to succeed; thus, it should be paid under APC 280. The Panel felt that APCs 0279, 0280, and 0668 were clinically homogenous and recommended that we only make changes after consulting with experts in the field. We propose to accept the Panel's recommendation to make no changes to APCs 0279, 0280, and 0668 until consulting with experts in the field. We plan to place these APCs on the Panel's agenda for the 2005 update.
z. Computed Tomography (CT), Magnetic Resonance (MR), and Ultrasound Guidance Procedures Currently Packaged.
APC 0332: Computerized Axial Tomography and Computerized Angiography without Contrast Material.
APC 0335: Magnetic Resonance Imaging, Miscellaneous.
APC 0268: Ultrasound Guidance Procedures.
A presenter to the Panel expressed concern that the packaging of guidance procedures for tissue ablation does not recognize the significant difference in cost and time required to perform each procedure (for example, MRI vs. CT). This presenter felt that hospitals needed more education on the appropriate application of these codes. Another commenter requested that CPT codes 76362, 76394, and 76490 be changed from a status indicator of N to a status indicator of S and included in an appropriate clinical or new technology APC.
The Panel agreed with the above comments and stated that the packaging of these three procedures made it difficult for hospitals to track their use for the purpose of allocating funds. The Panel recommended changing the following CPT codes from a packaged status (N status indicator) to a separately payable status (S status indicator) within the indicated APCs:
Table 3.—HCPCS Codes Proposed To Be Designated as Separately Payable
HCPCS Description 2003 status 2004 APC 76362 CT scan for tissue ablation Packaged 0332 76394 MRI for tissue ablation Packaged 0335 76490 US for tissue ablation Packaged 0268 We propose to accept the Panel's recommendation to change HCPCS codes 76362, 76394, and 76490 from a packaged status to a separately payable status as indicated above.
aa. Magnetic Resonance Imaging and Magnetic Resonance Angiography Without Contrast. Start Printed Page 47974
APC 0336: Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast
A commenter requested that we change CPT code 76393 (MR guidance for needle placement) from a packaged status to a separately payable status within APC 0336. Based on clinical homogeneity considerations, the Panel agreed with the commenter and recommended that CPT code 76393 be changed from a status indicator of N to a status indicator of S and placed in APC 0335. We propose to accept the Panel's recommendation.
bb. Plain Film Except Teeth; Plain Film Except Teeth Including Bone Density Measurement.
APC 0260: Level I Plain Film Except Teeth.
APC 0261: Level II Plain Film Except Teeth Including Bone Density Measurement.
APC 0272: Level I Fluoroscopy.
A commenter requested that we move CPT codes 76120 (Cine/video x-rays) and 76125 (Cine/video x-rays add-on) from APC 0260 to APC 0261. However, a presenter to the Panel argued that these CPT codes are fluoroscopic procedures that should not be grouped with Level I radiography procedures. The Panel recommended that we move CPT code 76120 from APC 0260 to APC 0272 and that CPT code 76125 remain in APC 0260. This change makes the APCs more clinically coherent. We propose to accept the Panel's recommendation.
cc. Chemotherapy Administration by Other Technique Except Infusion.
APC 0116: Chemotherapy Administration by Other Technique Except Infusion.
A presenter to the Panel requested that we split APC 0116 into three APCs according to the method of administration: (a) Subcutaneous or intramuscular administration (CPT code 96400); (b) “push” administration (CPT code 96408); and (c) central nervous system administration (CPT code 96450). The presenter also requested that existing CPT codes should replace the more nonspecific Q codes for administration of chemotherapy because the CPT codes would provide more detailed data on methods of chemotherapy administration, which could be used for future payment policy decisions. Another presenter agreed with this request and stated that CPT codes are preferable to Q codes because other payers require CPT codes.
The Panel agreed with the above suggestions to split APC 0116 into 3 APCs according to the method of administration. The Panel recommended that we require hospitals to use the existing CPT codes (for example, 96400, 96408, and 96450) for administration of chemotherapy and map them to APCs 0116, 0117, and 0118, as appropriate. The Panel also recommended that payment rates be based on current Q code cost data until cost data for the CPT codes are available. These cost data would be used to determine whether to change the APC structure for chemotherapy administration.
We propose not to accept the Panel's recommendations to split APC 0116 into 3 APCs and to use CPT codes for administration of chemotherapy. We would consider such a split in the future but would like to first address the administration of drugs issue. We believe that making a change in APC 116 would be too complicated for hospitals given the changes for administration in general that we are considering in this proposed rule for implementation in CY 2004. We will consider such a split for APC 116 for CY 2005. We also believe the use of CPT codes would be burdensome to hospitals, would require extensive education, and would result in a significant amount of miscoding. The CPT codes for infusion therapy are based on the service furnished per hour. We do not believe that all hospitals routinely record the start and stop time for infusion therapy and that doing so in order to be able to bill the proper number of hours of infusion therapy could be very burdensome for them. Moreover, the historic cost data on which we base the payment for the service is reported on a per visit basis (much easier to cull from the record than the number of hours of service) and if we changed to CPT codes for these services, we would be unable to convert the charge/cost data now on a per visit basis to a per hour basis (as required by the CPT code) for budget neutrality purposes. Please see section VI of this proposed rule for further discussion on payments for drugs and drug administration.
dd. Capturing the Costs of Drugs and Biologicals Packaged Into APCs.
APC 0290: Level I Diagnostic Nuclear Medicine Excluding Myocardial Scans.
APC 0291: Level II Diagnostic Nuclear Medicine Excluding Myocardial Scans.
APC 0292: Level III Diagnostic Nuclear Medicine Excluding Myocardial Scans.
APC 0294: Level II Therapeutic Nuclear Medicine.
APC 0666: Myocardial Add-on Scans.
We told the Panel that APCs 0290 and 0291 appear to violate the 2 times rule. Several presenters to the Panel expressed concern that our cost data are inadequate because of confusion over coding due to changes in codes and coding instructions for these procedures, poor hospital reporting of radiopharmaceutical use, and the use of single (not multiple) claims in determining costs. One presenter claimed that the current cost data used for CPT code 78122 (Whole blood volume determination) underestimated real costs because of confusion about whether to code radiopharmaceuticals on a “per dose” basis or “per millicurie” basis. This presenter requested that we move CPT code 78122 from APC 0290 to the higher paying APC 0292.
Other presenters agreed with these concerns and said they were applicable to payments for all drugs, not just radiopharmaceuticals. These commenters were also concerned about the loss of drug-specific data due to packaging because hospitals would have no incentive to code, and thereby, identify, packaged drugs.
Pass-through payments for 236 drugs, biologicals, and radiopharmaceuticals expired as of 2003, and these items are now paid either separately or packaged with the procedures with which they are associated. Drugs and radiopharmaceuticals with median costs for administration of $150 or less were packaged. Beginning in 2003 claims data will not provide specific cost information for packaged items. We requested input from the Panel for methods to determine drug costs.
Panel members were concerned that packaging the costs of radiopharmaceuticals into procedures would result in underpayments for the service because we lack adequate data on the cost of radiopharmaceuticals. They were also concerned about creating incentives to use radiopharmaceuticals based on cost rather than clinical efficacy. The Panel recommended that we consider grouping drugs and radiopharmaceuticals into new APCs taking into account both their cost and clinical use. The Panel further recommended that, if new APCs for radionucliides are created, the descriptors should be as simple as possible and use of confusing units of measure should be limited.
Due to the packaging of radiopharmaceuticals into the APC payments for nuclear medicine procedures, we, along with commenters have expressed concern to the Panel regarding whether the current nuclear medicine APC structure is homogeneous in terms of resource consumption. We have reviewed information about the use and cost of various Start Printed Page 47975radiopharmaceuticals and believe that reorganizing the APCs for nuclear medicine would result in greater clinical and resource homogeneity. Therefore, we propose to eliminate APCs 0286, 0290, 0291, 0292, 0294, 0666 and create 20 new APCs for nuclear medicine that contain the following CPT codes:
HCPCS Description APC 0389: 78000 Thyroid, single uptake. 78001 Thyroid, multiple uptakes. 78003 Thyroid suppress/stimul. 78020 Thyroid met uptake. 78099 Endocrine nuclear procedure. 78190 Platelet survival, kinetics. 78191 Platelet survival. 78199 Blood/lymph nuclear exam. 78299 GI nuclear procedure. 78399 Musculoskeletal nuclear exam. 78499 Cardiovascular nuclear exam. 78599 Respiratory nuclear exam. 78699 Nervous system nuclear exam. 78725 Kidney function study. 78799 Genitourinary nuclear exam. 78999 Nuclear diagnostic exam. 79999 Nuclear medicine therapy. APC 0390: 78006 Thyroid imaging with uptake. 78010 Thyroid imaging. 78015 Thyroid met imaging. 78016 Thyroid met imaging/studies. APC 0391: 78007 Thyroid image, mult uptakes. 78011 Thyroid imaging with flow. 78018 Thyroid met imaging, body. 78070 Parathyroid nuclear imaging. APC 0392: 78075 Adrenal nuclear imaging. APC 0393: 78110 Plasma volume, single. 78111 Plasma volume, multiple. 78120 Red cell mass, single. 78121 Red cell mass, multiple. 78122 Blood volume. 78130 Red cell survival study. 78135 Red cell survival kinetics. 78140 Red cell sequestration. 78160 Plasma iron turnover. 78162 Radioiron absorption exam. 78170 Red cell iron utilization. 78172 Total body iron estimation. APC 0400: 78102 Bone marrow imaging, ltd. 78103 Bone marrow imaging, mult. 78104 Bone marrow imaging, body. 78185 Spleen imaging. 78195 Lymph system imaging. APC 0394: 78201 Liver imaging. 78202 Liver imaging with flow. 78205 Liver imaging (3D). 78206 Liver image (3d) with flow. 78215 Liver and spleen imaging. 78216 Liver & spleen image/flow. 78220 Liver function study. 78223 Hepatobiliary imaging. APC 0395: 78230 Salivary gland imaging. 78231 Serial salivary imaging. 78232 Salivary gland function exam. 78258 Esophageal motility study. 78261 Gastric mucosa imaging. 78262 Gastroesophageal reflux exam. 78264 Gastric emptying study. 78278 Acute GI blood loss imaging. 78290 Meckel's divert exam. 78291 Leveen/shunt patency exam. 78270 Vit B-12 absorption exam. 78271 Vit b-12 absrp exam, int fac. 78272 Vit B-12 absorp, combined. 78282 GI protein loss exam. APC 0396: 78300 Bone imaging, limited area. 78305 Bone imaging, multiple areas. 78306 Bone imaging, whole body. 78315 Bone imaging, 3 phase. 78320 Bone imaging (3D). APC 0397: 78414 Non-imaging heart function. 78445 Venous thrombosis study. 78455 Venous thrombosis study. 78456 Acute venous thrombus image. 78457 Venous thrombosis imaging. 78458 Ven thrombosis images, bilat. APC 0398: 78428 Cardiac shunt imaging. 78460 Heart muscle blood, single. 78461 Heart muscle blood, multiple. 78464 Heart image (3d), single. 78465 Heart image (3d), multiple. 78466 Heart infarct image. 78468 Heart infarct image (ef). 78469 Heart infarct image (3D). 78472 Gated heart, planar, single. 78473 Gated heart, multiple. 78481 Heart first pass, single. 78483 Heart first pass, multiple. 78494 Heart image, spect. APC 0399: 78478 Heart wall motion add-on. 78480 Heart function add-on. 78496 Heart first pass add-on. APC 0401: 78580 Lung perfusion imaging. 78584 Lung V/Q image single breath. 78585 Lung V/Q imaging. 78586 Aerosol lung image, single. 78587 Aerosol lung image, multiple. 78588 Perfusion lung image. 78591 Vent image, 1 breath, 1 proj. 78593 Vent image, 1 proj, gas. 78594 Vent image, mult proj, gas. 78596 Lung differential function. APC 0402: 78600 Brain imaging, ltd static. 78601 Brain imaging, ltd w/flow. 78605 Brain imaging, complete. 78606 Brain imaging, compl w/flow. 78607 Brain imaging (3D). 78610 Brain flow imaging only. 78615 Cerebral vascular flow image. APC 0403: 78630 Cerebrospinal fluid scan. 78635 CSF ventriculography. 78645 CSF shunt evaluation. 78647 Cerebrospinal fluid scan. 78650 CSF leakage imaging. 78660 Nuclear exam of tear flow. APC 0404: 78700 Kidney imaging, static. 78701 Kidney imaging with flow. 78704 Imaging renogram. 78707 Kidney flow/function image. 78708 Kidney flow/function image. 78709 Kidney flow/function image. 78710 Kidney imaging (3D). 78715 Renal vascular flow exam. APC 0405: 78730 Urinary bladder retention. 78740 Ureteral reflux study. 78760 Testicular imaging. 78761 Testicular imaging/flow. APC 0406: 78800 Tumor imaging, limited area. 78801 Tumor imaging, mult areas. 78802 Tumor imaging, whole body. 78803 Tumor imaging, whole body. 78805 Abscess imaging, ltd area. 78806 Abscess imaging, whole body. 78807 Nuclear localization/abscess. G0273 Pretx planning, non-Hodgkins. APC 0407: 79000 Init hyperthyroid therapy. 79001 Repeat hyperthyroid therapy. 79020 Thyroid ablation. 79030 Thyroid ablation, carcinoma. 79035 Thyroid metastatic therapy. APC 0408: 79100 Hematopoetic nuclear therapy. 79200 Intracavitary nuclear trmt. 79300 Interstitial nuclear therapy. 79400 Nonhemato nuclear therapy. 79420 Thyroid metastatic therapy. 79440 Nuclear joint therapy. G0274 Radiopharm tx, non-Hodgkins. We believe that the proposed APC structure, which takes into account the organ(s) being examined (or treated) as well as the type and complexity of the procedure, is more homogeneous both clinically and in terms of resource consumption than the current APC structure.
Currently, payment for the radiopharmaceutical “zevalin” (Ibritumomab Tiuxetan) is packaged into the payment for HCPCS codes G0273 (Pretx planning, non-Hodgkins) and G0274 (Radiopharm tx, non-Hodgkins). To ensure consistency with our payment policy for other radiopharmaceuticals (that is, making separate payment for radiopharmaceuticals whose costs are greater than $150 per episode of care), we are proposing to make payment for “zevalin” (Ibritumomab Tiuxetan) separately from payment for the procedures with which “zevalin” (Ibritumomab Tiuxetan) is used.
We propose to use HCPCS A9522 (Indium 111 ibritumomab tiuxetan) to report the use of In-111 Zevalin (In-111 Ibritumomab Tiuxetan) and HCPCS A9523 (Yttrium 90 ibritumomab tiuxetan) to report the use of Y90 Zevalin (Y90 Ibritumomab Tiuxetan). We would place HCPCS A9522 in APC 9118 with a payment amount of $2,084.55 and HCPCS A9523 in APC 9117 with a payment amount of $18,066.09. We note that payment rates for radiopharmaceuticals are not subject to wage index adjustments because no Start Printed Page 47976portion of the payment is attributed to labor-related costs.
Because we propose that payment for G0273 and G0274 no longer include payment for “zevalin,” we also propose to place G0273 into newly created APC 0406 and G0274 into newly created APC 0408. These APCs include procedures that are similar clinically and in terms of resource consumption to G0274 and G0273, respectively.
Please see section VI of this proposed rule for further discussion on payments for drugs, biologicals, and radiopharmaceuticals.
ee. Endoscopy Lower Airway.
APC 0076: Endoscopy Lower Airway.
A presenter to the Panel expressed concern that APC 0076 apparently violates the 2 times rule and requested that we move CPT code 31631 (bronchoscopy with tracheal stent placement) from APC 0076 and into a new APC.
The Panel suggested that a new APC comprised of the four most costly procedures in APC 0076 would result in a more homogenous grouping, and recommended that we move the following CPT codes from APC 0076 and into newly created APC 0415.
HCPCS Description 31630 Bronchoscopy dilate/fracture reduction. 31631 Bronchoscopy, dilate w/stent. 31640 Bronchoscopy w/tumor excise. 31641 Bronchoscopy, treat blockage. We propose to accept the Panel's recommendation that we move CPT codes 31630, 31631, 31640, and 31641 from APC 0076 to new APC 0415.
ff. Gastrointestinal Endoscopic Stenting Procedures.
APC 0141: Upper GI Procedures.
APC 0142: Small Intestine Endoscopy.
APC 0143: Lower GI Endoscopy.
APC 0147: Level II Sigmoidoscopy.
A commenter requested that we create a new APC that would be comprised of all the gastrointestinal endoscopic stent codes. The Panel agreed with the commenter's suggestion because the resource requirements for all gastrointestinal endoscopic stents appear to be similar.
The Panel recommended that we move the following CPT codes from their 2003 APCs to newly created APC 0384 for 2004:
Table 4.—HCPCS Codes To Be Moved Into New APC 0646
HCPCS Description 2003 APC 2004 APC 43219 Esophagus endoscopy 0141 0384 43256 Upper GI endoscopy w/stent 0141 0384 44370 Small bowel endoscopy w/stent 0142 0384 44379 Small bowel endoscopy w/stent 0142 0384 44383 Small bowel endoscopy 0142 0384 44397 Colonoscopy w/stent 0143 0384 45387 Colonoscopy w/stent 0143 0384 45327 Proctosigmoidoscopy w/stent 0147 0384 45345 Sigmoidoscopy w/stent 0147 0384 We propose to accept the Panel's recommendation to move the following gastrointestinal endoscopic stent CPT codes into newly created APC 0384: 43219, 43256 (from APC 0141); 44370, 44379, 44383 (from APC 0142); 44397, 45387 (from APC 0143); 45327, and 45345 (from APC 0147).
gg. Capturing the Costs of Devices That Are Packaged Into APCs.
APC 0081: Non-Coronary Angioplasty or Atherectomy.
APC 0083: Coronary Angioplasty and Percutaneous Valvuloplasty.
APC 0104: Transcatheter Placement of Intracoronary Stents.
APC 0222: Implantation of Neurological Device.
APC 0223: Implantation of Pain Management Device.
APC 0227: Implantation of Drug Infusion Device.
APC 0229: Transcatheter Placement of Intravascular Shunts.
Several commenters requested that the status indicators for the above APCs (all of which include high-cost devices) be changed from T (multiple-procedure discount applies) to S (multiple-procedure discount does not apply). Two presenters to the Panel stated that hospitals do not pay less for devices when they are used in the context of a multiple-procedure claim and suggested that we apply the multiple-procedure reduction to the non-device portion of the claim only. Alternatively, these presenters recommended that we apply the discount policy only when the device cost is below a predetermined proportion of the APC cost. Another presenter to the Panel requested that APCs 0222, 0223, and 0227 be exempt from the multiple procedure discount policy because the cost of the devices used in these procedures makes up more than 50 percent of the APC cost.
We sought the Panel's input as to whether there are situations in which we should not apply our multiple procedure discount policy. The Panel recommended no changes to the status indicators for any of the device-related APCs discussed because they were concerned that exemptions from the discount policy could result in incentives to use more devices than necessary. However, the Panel asked that we analyze our data to determine if we may be underpaying for devices when the multiple procedure discounting policy is applied and recommended that we develop some methodology to track device costs. In section V.C of this proposed rule, we discuss the issue of device costs and multiple procedure reductions and our progress to date in developing “combination APCs” to address the Panel's concern.
hh. Discussion of Ways To Increase the Use of Multiple Claims To Set APC Payment Rates.
A presenter to the Panel suggested that we use dates of service on multiple procedure claims to increase the number of claims we use to set payment rates. Another presenter suggested that we could further increase the number of multiple procedure claims that could be used to set payment rates by ignoring codes with status indicator K. Other suggestions were to exclude from consideration those APCs with small dollar values and to create a new code or APC specifically for the insertion and removal of devices.
The Panel recommended that our staff explore ways to increase the number of claims used to set payment rates, including the following methodologies: sort multiple claims by date of service; exclude codes with K status indicator from evaluation; exclude those APCs with nominal costs (the definition of “nominal” can be determined by Start Printed Page 47977modeling a variety of possible dollar amounts). In addition, the Panel recommended that we create no G codes as part of the effort to use multiple procedure claims for developing relative weights. If new codes are needed, the Panel suggested that our staff work with the American Medical Association's CPT Board to identify possible new codes. Please see section V.C of this proposed rule for our discussion of the use of multiple procedure claims for developing payment rates for procedures that use devices.
B. Other Changes Affecting the APCs
1. Limit on Variation of Costs of Services Classified Within an APC Group
Section 1833(t)(2) of the Act provides that the items and services within an APC group cannot be considered comparable with respect to the use of resources if the highest cost item or service within an APC group is more than 2 times greater than the lowest cost item or service within the same group. However, the statute authorizes the Secretary to make exceptions to this limit on the variation of costs within each APC group in unusual cases such as low volume items and services. No exception may be made in the case of a drug or biological that has been designated as an orphan drug under section 526 of the Federal Food, Drug, and Cosmetic Act.
Taking into account the proposed APC changes discussed in relation to the APC Panel recommendations in section II.A.4 of this proposed rule and the use of 2002 claims data to calculate the median cost of procedures classified to APCs, we reviewed all the APCs to determine which of them would not meet the 2 times limit. We use the following criteria when deciding whether to make exceptions to the 2 times rule for affected APCs:
- Resource homogeneity.
- Clinical homogeneity.
- Hospital concentration.
- Frequency of service (volume).
- Opportunity for upcoding and code fragmentation.
For a detailed discussion of these criteria, refer to the April 7, 2000 final rule (65 FR 18457).
The following table contains APCs that we propose to exempt from the 2 times rule based on the criteria cited above. In cases in which a recommendation of the APC Panel appeared to result in or allow a violation of the 2 times rule, we generally accepted the Panel recommendation because Panel recommendations were based on explicit consideration of resource use, clinical homogeneity, hospital specialization, and the quality of the data used to determine payment rates.
The median cost for hospital outpatient services for these and all other APCs can be found at Web site: http://www.cms.hhs.gov.
Table 5.—Table of APCs Exempted From 2 Times Rule
Proposed rule APC Description 0004 Level I Needle Biopsy/Aspiration Except Bone Marrow. 0018 Biopsy of Skin/Puncture of Lesion. 0019 Level I Excision/Biopsy. 0020 Level II Excision/Biopsy. 0032 Insertion of Central Venous/Arterial Catheter. 0043 Closed Treatment Fracture Finger/Toe/Trunk. 0046 Open/Percutaneous Treatment Fracture or Dislocation. 0048 Arthroplasty with Prosthesis. 0055 Level I Foot Musculoskeletal Procedures. 0058 Level I Strapping and Cast Application. 0060 Manipulation Therapy. 0072 Level II Endoscopy Upper Airway. 0073 Level III Endoscopy Upper Airway. 0080 Diagnostic Cardiac Catheterization. 0084 Level I Electrophysiologic Evaluation. 0097 Cardiac and Ambulatory Blood Pressure Monitoring. 0099 Electrocardiograms. 0105 Revision/Removal of Pacemakers, AICD, or Vascular. 0130 Level I Laparoscopy. 0147 Level II Sigmoidoscopy. 0148 Level I Anal/Rectal Procedure. 0155 Level II Anal/Rectal Procedure. 0164 Level I Urinary and Anal Procedures. 0165 Level III Urinary and Anal Procedures. 0192 Level IV Female Reproductive Proc. 0203 Level IV Nerve Injections 0204 Level I Nerve Injections. 0207 Level III Nerve Injections. 0213 Extended EEG Studies and Sleep Studies, Level I. 0214 Electroencephalogram. 0218 Level II Nerve and Muscle Tests. 0231 Level III Eye Tests & Treatments. 0233 Level II Anterior Segment Eye Procedures. 0235 Level I Posterior Segment Eye Procedures. 0239 Level II Repair and Plastic Eye Procedures. 0245 Level I Cataract Procedures without IOL Insert. 0252 Level II ENT Procedures. 0262 Plain Film of Teeth. 0266 Level II Diagnostic Ultrasound Except Vascular. 0274 Myelography. 0303 Treatment Device Construction. 0330 Dental Procedures. 0340 Minor Ancillary Procedures. Start Printed Page 47978 0341 Skin Tests. 0344 Level III Pathology. 0363 Level I Otorhinolaryngologic Function Tests. 0364 Level I Audiometry. 0367 Level I Pulmonary Test. 0368 Level II Pulmonary Tests. 0370 Allergy Tests. 0373 Neuropsychological Testing. 0385 Urinary Incontinence Procedures. 0397 Vascular Imaging. 0408 Non-thyroid Radionucliide Treatment. 0409 Red Blood Cell Tests. 0600 Low Level Clinic Visits. 0668 Level I Angiography and Venography except Extremity. 0692 Electronic Analysis of Neurostimulator Pulse Generators. 0698 Level II Eye Tests & Treatments. 2. Procedures Moved From New Technology APCs to Clinically Appropriate APCs
In the November 30, 2001 final rule (66 FR 59903), we made final our proposal to change the period of time during which a service may be paid under a new technology APC. The April 7, 2000 final rule initially established the time frame that new technology APCs would be in effect (65 FR 18457). Beginning in 2002, we retain a service within a new technology APC group until we have acquired adequate data that allow us to assign the service to a clinically appropriate APC. This policy allows us to move a service from a new technology APC in less than 2 years if sufficient data are available, and it also allows us to retain a service in a new technology APC for more than 3 years if sufficient data upon which to base a decision for reassignment have not been collected.
In the context of new technology procedures, we create HCPCS codes for services only. We do not create HCPCS codes for equipment that is used in the course of providing an item or service (except in the case of “C” codes for devices that meet the criteria for transitional pass-through payments). Equipment that is used to provide an item or service is not separately coded because it is a resource required to furnish the service. Like other resources that are required to furnish a service (for example, cost of a room, cost of staff, cost of supplies), the hospital should show charges either as part of its charge for the procedure or with a revenue code.
As described in more detail below, we propose to delete four HCPCS codes that are currently paid in new technology APCs. These four HCPCS codes do not conform to our current policy to not create HCPCS codes for equipment used to provide a service. In addition, there exist, or soon will exist, CPT codes to describe the services being furnished, including any equipment that is needed to perform them, so we believe it is appropriate at this time to delete the HCPCS codes. The HCPCS codes we propose to delete effective January 1, 2004 are:
C1088: Laser Optic Treatment system, Indigo Laseroptic Treatment System,
C9701: Stretta System,
C9703: Bard Endoscopic Suturing System, and
C9711: H.E.L.P. Apheresis System.
These codes were created and assigned to New Technology APCs when it was CMS policy to create a C code to describe an item of equipment for which there was no other means of making payment for the service in which the equipment was used. In the November 30, 2001 final rule, we announced that we would not use New Technology APCs to pay for drugs, devices, and equipment that are used in the performance of a procedure, but which are not in and of themselves a complete service. It is due to an oversight on our part that we did not delete these codes at that time. We stopped using C codes to describe specific devices in April 2001 and no longer create C codes to describe items of equipment. Moreover, we have found that there are existing CPT codes or, in the case of C9701, there will soon be a CPT tracking code, that will accurately report the services being furnished, and under which the hospital should report the charges for providing the services, including charges related to the equipment needed to furnish the service. Therefore, payment will be appropriate regardless of whether there are separate codes for these items of equipment.
HCPCS code C1088, the Laser Optic Treatment System, Indigo Laseroptic Treatment System, now paid under APC 0980 is no longer needed because our review of data shows that the equipment it describes is appropriately reported under CPT codes 52647 and 52648. The procedures described by these CPT codes may be performed by using several types of equipment, one of which is the type described by C1088. In fact, most of the claims containing line items for C1088 are accompanied by line items for 52647 or 52648. This means that hospitals are appropriately reporting these services under the applicable CPT codes and that any charges associated with C1088 are likely duplicate charges for the service provided. Therefore, we propose to delete C1088 and to have hospitals continue to report these services under CPT codes 52647 and 52648, which are in APC 0163.
HCPCS code C9701, the Stretta System, now paid under APC 0980, is used in a procedure that will soon be given a CPT Category Three Tracking Code by the American Medical Association's CPT Editorial Panel. We propose to use the CPT tracking code to report services using the Stretta System and to delete HCPCS code C9701. We propose to assign the new CPT tracking code in APC 1557.
HCPCS code C9703, the Bard Endoscopic Suturing System, now paid under APC 0979, is used in a procedure that has been granted a CPT Category Three Tracking Code, 0008T, which describes the procedure for which this equipment is used. We propose to delete C9703 and to require hospitals to use 0008T to report services using this equipment. We propose to assign CPT code 0008T to APC 1555 for 2004.
HCPCS code C9711, the H.E.L.P. Apheresis System, now paid under APC Start Printed Page 479790978, is used to provide apheresis, which is appropriately reported using CPT codes 36511 through 36516. Therefore, we propose to delete C9711 and to require hospitals to report the service in which this equipment is used by using CPT codes 36511 through 36516.
3. Revision of Cost Bands and Payment Amounts for New Technology APCs
In the April 7, 2000 final rule (68 FR 18477), we created 15 new technology APCs (APCs 0970 through 0984) to pay for certain new technology services under the OPPS. As discussed in both the April 7, 2000 and November 30, 2001 final rules, new technology APCs are intended to pay for new or rarely performed procedures for which we lack sufficient cost data to make an assignment to a clinical APC. New technology APCs are defined on the basis of costs, not the clinical characteristics of a service. The payment rate for each new technology APC is based on the midpoint of a range of costs.
In the November 30, 2001 final rule (66 FR 59856), we revised several of the cost bands, added a payment level to the original group of new technology APCs, and assigned status indicator “T” to APCs 0970 through 0985. We also created a parallel set of new technology APCs (APCs 0706 through 0721), each of which was assigned status indicator “S.” In addition, we changed the definition of what is appropriately paid for under a new technology APC; we refined the criteria for determining assignment of a procedure or service to a new technology APC; we clarified the information that must be supplied for a request for new technology status to be considered; and we removed the restrictions on how long a procedure can be assigned to a new technology APC. These changes, which are discussed in detail in the November 30, 2001 final rule, were implemented effective April 1, 2002.
In the November 1, 2002 final rule, we established two additional new technology APCs, APC 989, and APC 725; as these APCs were not discussed in the proposed rule, they were considered interim with comment.
In this proposed rule, we are proposing to implement a comprehensive restructuring of all the new technology APCs. First, the cost intervals in the current new technology APCs are inconsistent, ranging from $50 to $1,500. Secondly, as the number of procedures assigned to new technology APCs increases, we believe that narrower cost bands are required to avoid significant mispayment for new technology services. The increased number of new technology APCs that would result from narrowing the cost bands cannot be accommodated within the current sequence of available APC numbers. Therefore, we are proposing to dedicate two new series of APC numbers to the restructured new technology APCs, which would allow us to narrow the cost bands and also afford us flexibility in creating additional bands as future needs may dictate.
We propose to establish cost bands from $0 to $100 in increments of $50, from $100 through $2,000 in intervals of $100, and from $2,000 through $6,000 in intervals of $500. We believe that these intervals would allow us to price new technology services more appropriately and consistently. We also propose to retain two parallel sets of new technology APCs, one with status indicator “S” and the other with status indicator “T.” We invite comments on the hierarchy of cost levels of the restructured new technology APCs.
We would reassign current new technology procedures to the level in the restructured new technology APCs so that the payment amount for the procedure in 2004 closely approximates the current payment amount. As we explained in the November 30, 2001 final rule, we generally keep a procedure in the new technology APC to which it is initially assigned until we have collected data sufficient to enable us to move the procedure to a clinically appropriate APC. However, in cases where we find that our original new technology APC assignment was based on inaccurate or inadequate information, we may, based on more recent information (including claims data), reassign the procedure or service to a different new technology APC that more appropriately reflects its cost.
The proposed restructured new technology APCs are listed in Addendum A.
4. APC Assignment for New Codes Created During Calendar Year (CY) 2003
During CY 2003, we created several HCPCS codes to describe services payable under the hospital OPPS. These codes have already been assigned to APCs for CY 2003. In this proposed rule, we solicit comment on the APC assignment of these services. In addition, in this proposed rule, we propose to create a new HCPCS code with an effective date of July 1, 2003. Table 6 includes a new procedural HCPCS code created for implementation in July 2003.
Table 6 does not include new codes for drugs and devices for which we established or intend to establish pass-through payment eligibility effective July or October 2003. Furthermore, neither the new procedural HCPCS nor the new pass-through codes proposed for implementation beginning October 2003, or later, are included in Addendum B of this proposed rule.
Table 6—New G Code for 2003
HCPCS code Long descriptor SI Effective date APC G0296 PET imaging, full and partial ring PET scanner only, for restaging of previously treated thyroid cancer of follicular cell origin following negative I-131 whole body scan S 07/01/03 0714 5. Creation of APCs for Combinations of Device Procedures
In the course of developing the proposed rule for the 2004 OPPS, we wanted to ensure that the claims we use to set payment rates for APCs into which we package medical devices accurately reflect the costs of both the device and non-device portions of the service. As discussed in section III of this proposed rule, we have made a number of changes to our methodology for the creation of single procedure claims used to set relative weights. These changes enabled us to use charge data from more claims to set relative weights. However, we have noted that in spite of our new methodology, we were unable to significantly increase the number of single procedure claims used to set relative weights for several APCs that use high cost devices. One reason for this is that these APCs are often billed in combination with several other major procedures so that we are unable to generate single procedure claims for these APCs.
In the past, commenters have alleged that without using multiple procedure claims, we will be unable to capture the Start Printed Page 47980costs of the more complex cases in which multiple procedures are performed and multiple devices are used. These commenters further requested that we change the status indicator of certain APCs from “T” to “S” in order to appropriately capture the cost of high cost devices when multiple procedures, each using devices, were billed. In addition to attempting to find a way to use multiple procedure claims, we also decided to examine our claims data to investigate whether our current payments for multiple procedures performed on the same date, each using high cost devices accurately captured the costs of the device and non-device portion of each procedure.
In order to do this, we reviewed claims from APCs that required high cost devices and from which we were unable to use the majority of claims to set a relative weight for the APC (for example, APCs for insertion of pacemakers, defibrillators, and neurostimulators). We determined the frequency with which other APCs were billed with the high cost device APCs. We then selected those claims where two APCs using high cost devices, or one APC using high cost devices and one high cost, non-device-requiring APC, were billed together with a frequency of more than 100 for the time period April 1, 2002 through September 30, 2002. This number was chosen in order to ensure that we had enough claims to determine reliable median costs. We included the APC combination 0081/0104 unintentionally and performed the analysis without realizing until after the data were developed that it had fewer than 100 claims and therefore should not have been selected. We expected that the data being used to set the 2004 weights would have a similar number of each combination to the number we found in the April 2002 to September 2002 claims. Review of Table 7, Combination APCs Used in Analysis, shows that even starting with 100 claims, we frequently had to determine median costs with very few claims. Additionally, Table 7 reveals that only a few combinations of two high cost device-requiring APCs are billed together 100 or more times. Six of the twelve combinations we analyzed (for example, claims for insertion of pacemakers and defibrillators) contained APC 0105 (Removal of pacemaker defibrillator), which is not a high cost, device-requiring APC. As the data show, APC 0105 is frequently found on multiple procedure claims, but because it is not a high cost device-requiring APC, when it is billed with these APCs, the multiple procedure reductions are applied to APC 0105. Therefore, we have determined that the vast majority of claims for APCs, such as “insertion of Cardioverter Defibrillators,” were not usable multiple procedure claims for the purpose of determining relative weights under our single claim process because they were billed with APC 0105.
After selecting the combinations to review, we determined the hospital costs associated with providing these “combination” procedures using the following methodology:
1. We selected claims where the two APCs of interest both appeared on the claim with the same date of service, and subjected them to the same trimming methodology we use for single procedure claims.
2. We then required that each APC appear on the claim only once. (For example, if two HCPCS codes from APC 0081 appeared on a claim with one HCPCS code from APC 0229, we did not use the claim. Many claims were discarded because of this requirement.)
3. From the claims in step two, we selected only those claims that included the device category codes for the devices required to perform the service. This is similar to our methodology for using single procedure claims where the procedure requires the use of a device with a category code (for example, for claims involving APCs 0222/0225, we used only claims that contained C codes for both a neurostimulator pulse generator and neuroelectrodes).
4. We ignored any line items for separately payable services under OPPS or the lab fee schedule and any line items with revenue centers containing HCPCS other than those in the APCs of interest.
5. At this point, we were left with claims where the only separately payable services were the line items for the HCPCS in the APCs of interest.
6. We packaged into the payable HCPCS codes all device category codes, all packaged HCPCS codes, and all revenue center codes without HCPCS.
7. We then determined the median cost for each APC pair using the remaining claims.
We believe the median cost estimate determined by this methodology should, if anything, overestimate the costs of the procedure combinations studied since all packaged line items were attributed to the APCs of interest unless they were clearly identified as being associated with other procedures. For example, if line items for a clinic visit and a medical or surgical supply revenue center appeared on the claim, we packaged the charges associated with the revenue center entirely into the APCs of interest and not into the APC for clinic visits.
We also determined the median costs for these APCs using our usual single claims methodology (these medians are contained in Addendum A). We then determined a summed median cost of each APC pair using our current payment policy, which allows payment at 100 percent for the most expensive APC with “T” status indicator and 50 percent for each additional APC with “T” status indicator. That is, we added the median cost of the more expensive APC and 50 percent of the median cost of the less expensive APC as a proxy for the total median cost (and payment) using our current payment policy. We then compared this figure with the median cost for the “combination APC.” (See Table 7.) We believe this comparison is an indicator of whether our current payment policy accurately pays for the costs of these APCs when they are billed together on the same date of service.
Our comparison reveals that, of the 12 “combination APCs” created, 7 had higher median costs than the median costs obtained with the multiple procedure methodology (we note that because APC 222 has a status indicator of “S”, we did not apply the multiple procedure reduction for the APC 0222/0225 combination).
For three of these seven combinations, we consider the data unreliable because we were able to use very few claims to determine the “combination” median cost. Specifically, for APC combination 0085/0655, we were able to use only 37 claims; for APC combination 0105/0089, we were to use only 16 claims; and for APC combination 0105/0655, we were able to use only 12 claims. This is in distinction to the number of claims we used to determine the median costs for APCs 0655 and 0089 alone (1,170 and 303 respectively). Further, two of these combinations contain only one APC using high cost devices because APC 0105 does not require the use of high cost devices. This means that the multiple procedure reduction was applied to APC 0105. In such cases, we believe the reduction is appropriate because when a pacemaker or defibrillator is removed and replaced, the patient is only anesthetized once, the room only needs to be prepared once, and the time for replacement is usually less than the time for insertion due to the existence of a subcutaneous pocket.
Three other APC combinations, 0105/0090, 0105/0107, and 0105/0654, also contain only one APC requiring the use of high cost devices and therefore Start Printed Page 47981should not pose the problem of underpayment due to the multiple procedure reduction, which was applied to APC 0105. Furthermore, in these three cases, the difference in median costs between the combination median and the median determined by our multiple procedure reduction methodology was, in our view, insignificant (all much less than 5 percent).
For APC combination 0222/0225, the difference in median cost could be considered significant at slightly under 5 percent, but only 74 claims were used to determine the combination median. Because we used approximately 600 claims to determine the median costs for APCs 0222 and APC 0225 individually, we consider the combination median cost comparatively unreliable.
Lastly, we note that for the other five combinations, our current payment policy pays more than the “combination” payment methodology.
Based on this comparison we considered several options for payment of these APCs when billed together:
1. Maintain our current payment policy.
2. Change the status indicators of certain APCs requiring the use of high cost devices to “S.”
3. Create “combination APCs” with relative weights calculated using the methodology described above in order to make a single payment when the two APCs in the combination are billed together.
The third option need not result in creation of new HCPCS codes and APCs for hospitals to report. Instead, we could make changes in the logic of the outpatient code editor (OCE) so that when hospitals bill the two APCs in a combination, the OCE would “map” the payment to a single amount rather than paying the more expensive APC at 100 percent and the less expensive at 50 percent. The following is an example of how combination APCs might work: If a unit of a code in APC 0081 was billed with a unit of a code in APC 0104 on the same date, the multiple procedure discount would not be applied, so payment would no longer be made at 100 percent of the payment for APC 0104 (the highest paid APC in the pair) and 50 percent of the payment for APC 0081. Instead, if we were to implement combination APCs for this pair, the combination of codes would be mapped to a new “combination” APC, and we would make a single payment for both services. The payment rate for the new “combination” APC would be based upon a scaled weight calculated from the median cost for all claims containing one unit of a code from APC 0081 and one unit of a code from APC 0104 (using the methodology described above). If either of the APCs were billed without the partner APC for that established “combination” APC, then the APC would map to the current APC that contains the code.
Based on our analysis, we are proposing option one: Maintaining our current payment policy. We believe that our analysis shows that our current payments for these APCs adequately reflect the costs of the procedures, even when billed in combination.
We note that only a few APCs requiring the use of high cost devices are billed in combination. Thus, we do not believe there are compelling reasons to establish a new, or special, payment policy in situations where two APCs requiring high cost devices are billed together fewer than 100 times. Even when APCs are billed together, we have shown that frequently the data are unreliable due to the low number of claims we can actually use to determine the total median cost of the “combined” procedure. Furthermore, even where the number of usable claims is large enough to give us some assurance that the data are reliable, the median costs as determined by the two methodologies do not support any changes in our current payment policy. In some instances, adoption of the new payment policy would actually reduce payments for these services, and, in most other cases, any increase in payments would be negligible.
One commenter has brought to our attention the fact that, rarely, correct coding does not allow hospitals to bill for two APCs requiring high cost devices. One example is APC 0082 (Coronary Atherectomy) and APC 0104 (Transcoronary Stent Placement) because atherectomy is considered to be a component of stent placement when both are performed together. In those cases, we would expect hospitals to bill for all the devices used to accomplish the atherectomy and the stent placement. To the extent that both were performed, the median cost of stent placement should reflect the cost of performing an atherectomy. Therefore, we do not believe there is a compelling reason to create new payment policy for these rare situations. (See also the discussion below on “case rate” purchasing by hospitals.)
It could be reasoned that our analysis of the costs of “combined” procedures is faulty because hospital coding and billing inaccuracies may apply to these claims as well as single procedure claims (and may even be magnified). However, that reasoning would undercut, and be contrary to, the repeated comments that we need to use more multiple procedure claims to set relative weights because single procedure claims do not capture the true costs of complex procedures or episodes of care. Our investigation was performed precisely to address these concerns, determine how we might use multiple procedure claims, and what effect use of those claims would have on payment rates. Even with use of a methodology that overestimated the costs of combination procedures, we were unable to show that the median costs (and payments) using our current payment policy do not accurately reflect the costs for performing these procedures.
Other possible factors affecting our analysis include charge compression and/or inadequate charges for these procedures or the devices associated with them. However, it is not possible for us to know the magnitude of how charge compression or inadequate charges might affect costs or what methodologic or payment adjustment would be appropriate to address the problem. Furthermore, we point out that charge compression and inadequate charges should affect our cost data for these APCs when billed alone and when these APCs are billed in combination. It is unknown whether the effects would be similar in each instance but we have no reason to believe they would be different. Therefore, we do not believe that adjusting for charge compression or inadequate charges would change the “relative” median costs of the APCs when billed alone or in combination. Finally, we believe that the median costs of the APCs billed in combination support the concept that economies of scale are achieved in those cases. There are at least two reasons why this might occur: First, many hospitals purchase devices on a case rate or capitated basis, which means that the hospitals' device cost “per case” is fixed (with quarterly adjustments made based on volume and actual device use in the previous quarter(s)). For example, inserting a stent or cardioverter defibrillator requires the use of multiple devices in addition to the stent or defibrillator. A hospital may agree to pay $XXXX “per case” for all the devices used to insert a stent (for example, guidewires, introducers, catheters, rotablators etc.). This “per case” payment means that the hospital has the same cost irrespective of whether a rotablator, two catheters, or four catheters were used for a specific patient. Second, even if hospitals purchase devices on a “per device” basis, it is possible that no extra catheters, guidewires, and/or Start Printed Page 47982introducers, for example, are used when a second related procedure is performed (for example, an electrophysiology study and a defibrillator lead placement, or an angioplasty and a stent placement).
In summary, we have concluded that there is no compelling reason to change our current payment policy for APCs requiring the use of high cost devices.
We solicit public comments on our methodology, analysis, and payment options for these APCs. We particularly solicit comments on how our analysis should affect any use of external data sources in the final rule. Specifically, we ask commenters to explain why submitted external data should be used in preference to our single or multiple claim data for APCs requiring the use of high cost devices.
We also note that creation of “combination APCs” would allow us to set relative weights using a number of claims that we otherwise would not be able to use. Therefore we solicit comments on this approach to using more claims to set relative weights and specifically request comments on how to use those claims even if we do not create “combination APCs.”
Table 7.—Combination APCs Used in Analysis
Combination of APCs Descriptions of both APCs in the combination Sum of single APC medians adjusted for multiple procedure policy Frequency of combination APC billed on the same date Frequency of claims used for median cost of services in both APCs Median cost of services in both APCs Percent difference median for both APCs to sum of adjusted single medians 0081/0104 Noncoronary Angioplasty/Athectomy & Transcatheter Placement of Intracoronary Stent $5,760.50 55 2 $5,589.14 −2.97 0081/0229 Noncoronary Angioplasty/Athectomy & Transcatheter Placement of Iintravascular Stent 4,507.09 6177 135 4,116.50 −8.67 0085/0108 Level II Electrophysiologic Evaluation & Insertion/Replacement/Convert of Cardioverter Defibrillator 29,749.68 502 63 20,438.99 −31.30 0085/0655 Level II Electrophysiologic Evaluation & Insertion/Replacement/Conversion of Permanent Dual Chamber Pacemaker 9,398.45 268 37 10,832.16 15.25 0105/0089 Revision/Removal of Pacemakers, AICD, or Vascular & Insertion/replacement of Permanent Pacemaker and Electrodes 7,360.80 221 16 12,268.96 66.68 0105/0090 Revision/Removal of Pacemakers, AICD, or Vascular & Insertion/replacement of Permanent Pacemaker Pulse Generator 5,668.72 1426 516 5,751.30 1.46 0105/0107 Revision/Removal of Pacemakers, AICD, or Vascular & Insertion of Cardioverter-Defibrillator 17,579.21 1106 235 18,294.85 4.07 0105/0108 Revision/Removal of Pacemakers, AICD, or Vascular & Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads 29,239.29 294 8 26,843.72 −8.19 0105/0654 Revision/Removal of Pacemakers, AICD, or Vascular & Insertion/Replacement of a permanent dual chamber pacemaker 6,639.65 3653 1475 7,014.00 5.64 0105/0655 Revision/Removal of Pacemakers, AICD, or Vascular & Insertion/Replacement/Conversion of a Permanent Dual Chamber Pacemaker 8,888.06 237 12 10,290.88 15.78 0222/0225 Implantation of Neurological Device & Implantation of Neurostimulator Electrodes 14,345.41 368 74 15,002.40 4.58 0223/0227 Implantation of Pain Management Device & Implantation of Drug Infusion Device 10,350.16 222 65 9,815.08 −5.17 Table 7 lists the combinations that we investigated, abbreviated titles for the single APCs in the pair, the number of times the APCs were billed together, the number of claims used to set the combination APC median, a combined median cost for claims in which both the APCs appeared (derived from the methodology discussed above), the median cost for the two APCs using the multiple procedure reduction policy, and the difference in median costs (expressed in percent). 6. New APC for Antepartum Care
We propose to split APC 0199, Obstetrical Care Service into two APCs. New APC 0700, Antepartum Care Service, would be created and 59412 (external cephalic version) would be assigned there. The two remaining HCPCS code 59409 (vaginal delivery only) and 59612 (vaginal delivery only, after previous cesarean delivery) would remain in APC 0199, Obstetrical Care Service. We propose to make this change because of the great difference in cost between vaginal delivery and the external cephalic version procedures. We believe that inclusion of the lower cost procedure in the APC with vaginal deliveries may have an affect on the median cost for the APC that results in less accurate payment.
III. Recalibration of APC Weights for CY 2004
Section 1833(t)(9)(A) of the Act requires that the Secretary review and revise the relative payment weights for APCs at least annually, beginning in 2001. In the April 7, 2000 final rule (65 FR 18482), we explained in detail how we calculated the relative payment weights that were implemented on August 1, 2000 for each APC group. Except for some reweighting due to APC changes, these relative weights continued to be in effect for CY 2001. (See the November 13, 2000 interim final rule (65 FR 67824 to 67827).)
To recalibrate the relative APC weights for services furnished on or after January 1, 2004 and before January 1, 2005, we are proposing to use the same basic methodology that we Start Printed Page 47983described in the April 7, 2000 final rule. That is, we would recalibrate the weights based on claims and cost report data for outpatient services. We propose to use the most recent available data to construct the database for calculating APC group weights. For the purpose of recalibrating APC relative weights for CY 2004, the most recent available claims data are the approximately 115 million final action claims for hospital outpatient department services furnished on or after January 1, 2002 and before January 1, 2003. We then eliminated the following 45.7 million claims because many of these claims were for services that are not paid under OPPS: Claims in the first quarter of calendar year 2002; claims for bill types other than OPPS bill types; claims for services furnished in Maryland, Guam, and the Virgin Islands. We matched the 69.3 million claims that were paid under the OPPS to the most recent cost report filed by the individual hospitals represented in our claims data. The APC relative weights would continue to be based on the median hospital costs for services in the APC groups.
A. Data Issues
1. Period of Claims Data Used
We propose to use claims for the period beginning April 1, 2002 through and including December 31, 2002 as the base for the CY 2004 OPPS. The statute requires that we take into account new cost data and other relevant information and factors in reviewing and revising the weights, and we believe that this period will give us the most recent costs. We chose not to include the claims for the period beginning on January 1, 2002 through March 31, 2002 because they were used to set the payment rates for the 2003 OPPS and we believe that the most recent 9 months of claims data will result in payment rates that are most representative of the current relative costs of hospital outpatient services.
The claims base used to calculate the proposed payment weights and payment rates in this proposed rule is not the totality of claims on which the final weights and rates will be based. The use of this claims base is due to (1) a lag in claims submission by providers; (2) a statutory limit on the date before which no claim can be paid; and (3) the additional processing time it takes for the claims data to be included in the national claims history, which is the source of our claims data. For these reasons, the claims data used for this proposed rule are for the period of services furnished between April 1, 2002 and November 1, 2002. However, when the final weights and rates are calculated, we will have access to approximately 95 percent of the claims data for services furnished from April 1, 2002 through December 1, 2002.
2. Treatment of “Multiple Procedure” Claims
We have received many requests asking that we ensure that the data from claims that contain charges for multiple procedures are included in the data from which we calculate the CY 2004 relative payment weights. Those making the requests believe that relying solely on single-procedure claims to recalibrate APC weights fails to take into account data for many frequently performed procedures, particularly those commonly performed in combination with other procedures.
We agree that optimally, it is desirable to use the data from as many claims as possible to recalibrate the relative payment weights, including those with multiple procedures. We identified certain multiple-procedure claims that could be treated as single-procedure claims, enabling us to greatly increase the number of services used to develop the APC payment weights for CY 2003. However, several inherent features of multiple procedure claims prevented us from using all of them to recalibrate the payment weights. We discussed these obstacles in detail in the August 9, 2002 proposed rule (67 FR 52092, 52108 through 52111), and the November 1, 2002 final rule (67 FR 66718, 66743 through 66746).
For the CY 2004 OPPS, we propose several changes to how we handle and use claims data to enable us to use more claims in the creation of median costs on which our payment weights and rates are based. Specifically, we propose to expand the number of HCPCS codes that we ignore for purposes of creating a pseudo single claim from claims that contain other separately payable HCPCS codes. We also looked at dates of service on packaged HCPCS codes and packaged revenue centers, and propose, where possible, to attribute the charges to major, separately payable HCPCS codes based on the codes' dates of service. Our complete discussion of the use of data to set the weights for CY 2004 OPPS follows in section III.B of this proposed rule.
Expansion of the list of codes to be ignored in creation of single claims. For CY 2003 OPPS, we ignored the presence of HCPCS codes 93005, 71010, and 71020 to create pseudo single claims where there was one remaining separately paid, major HCPCS code on the claim. This enabled us to attribute the costs of packaged HCPCS codes and packaged revenue centers to the remaining separately paid HCPCS codes and, therefore, to use the charge data on the claim. We did this based on our belief that these three separately payable HCPCS codes would not have charges related to them that would be placed in packaged HCPCS codes or packaged revenue centers. Instead, we believe that the charges found in the packaged HCPCS or packaged revenue centers would be appropriately associated with the only other separately payable HCPCS that remained on the claim when these codes are ignored.
For CY 2004 OPPS, we propose to expand the list of HCPCS codes that we would ignore for purposes of creating pseudo single claims. On claims that contain other separately payable HCPCS, we propose to ignore the HCPCS codes in the APCs identified in Table 9. As with HCPCS codes 93005, 71010, and 71020, we believe that these codes are highly unlikely to have charges that are found in packaged HCPCS or in packaged revenue centers. Therefore, we believe that they can be ignored for the purpose of creating a pseudo single claim from the remaining charges on the claim. We solicit comments on the proposed methodology to create pseudo single claims, on the list of codes in Table 9 that we propose to ignore, and whether there are other low cost services that we could ignore in using this methodology. We also request comments on whether we should use the charges for the codes in the APCs in Table 9 to create pseudo single claims to be used in setting the median costs for these APCs.
Use of dates of service to create single claims. For CY 2003, we did not use dates of service to attribute charges on packaged HCPCS and packaged revenue centers to major separately payable HCPCS codes. For CY 2004, we propose to use dates of service on HCPCS codes and on packaged revenue centers to attribute charges to a major payable HCPCS code where the dates of service match. We can only use this approach where there are different dates of service for the separately payable major HCPCS codes. Where there are multiple major payable HCPCS codes on a claim with the same date, we cannot use this approach because there is no way to tell to which major payable HCPCS code the charges from the packaged HCPCS or packaged revenue center belong. Moreover, where the hospital does not provide dates for all packaged revenue centers, we cannot attribute charges based on the date of service.
We believe that this methodology yields more single claims than if we did not use dates of service. However, Start Printed Page 47984because hospitals are not required to put dates of service for line items with only a revenue center but no HCPCS code, we will not be able to perform this analysis routinely for each claim. Therefore, the claims from hospitals that do provide those dates are more likely to be used for weight-setting than claims of hospitals that do not provide those dates on the claim. We are unable to determine what impact, if any, this methodology has on the weights for the services and we solicit comments on the approach.
We invite comments on whether we should require hospitals to enter a line item date of service for every OPPS charge. We are interested in receiving comments regarding the implications the policy would have for hospitals, including potential obstacles and estimates on the amount of time that would be required to implement this change.
3. Adjustment of Median Costs for CY 2003 OPPS
The relative weights of several APCs, especially APCs requiring the use of high cost devices, that were developed for the 2003 OPPS fee schedule, using claims data from April 1, 2001 to March 31, 2002, showed a significant decrease from the relative weights that were established for the 2002 OPPS fee schedule. The 2002 OPPS relative weights were based on both claims data and packaging of 75 percent of the manufacturer submitted costs for devices into the APC cost. Using our April 1, 2001, through March 31, 2002 claims data resulted in significant decreases in payment for many blood products and separately payable drugs. In order to minimize any beneficiary access problems related to the reduction in payment for blood products, separately payable drugs, and certain device-related APCs, we created a limit for any payment reductions as follows:
Device and Procedural APCs
For APCs requiring the use of one or more devices receiving pass-through payments, we determined the median cost of the APC using only claims that contained device category “C” codes. For selected APCs, we used only claims containing the device “C” code specific to the service furnished (for example, we used only claims containing the “C” codes for cardioverter defibrillators to determine the median cost for the APC for inserting cardioverter defibrillators).
We then compared the median costs established for the 2002 OPPS fee schedule and the median costs based on our April 1, 2001, through March 31, 2002 claims data and limited decreases in median costs (from the 2002 fee schedule) by 15 percent plus half the amount of any reduction beyond 15 percent (for example, if the claims data showed the median cost of an APC decreased 45 percent, the amount of allowed reduction would have been 15 percent + 1/2 × (45 percent−15 percent) = 30 percent). For a few APCs where device costs accounted for more than 80 percent of the total cost of the APC, we also incorporated external data into our calculation of the median cost.
Blood and Blood Products
We limited reductions in median costs to 11 percent as compared to the 2002 median costs so that the reduction in payments, after other adjustments, for these items would generally not exceed 15 percent.
Separately Payable Drugs
We noted in the November 1, 2002 final rule that the reason our April 1, 2001, through March 31, 2002 claims data resulted in lower median costs for many drugs was that the payment rates for 2002 were based on 95 percent of average wholesale price (AWP) as required by law for pass-through drugs. We believed, and continue to believe, that the acquisition cost for many drugs is considerably less than 95 percent of AWP. However, we limited reductions in median costs for separately payable drugs and for administration of packaged drugs using the same methodology as described above for device and procedural APCs.
Procedural and Device Intense APCs for 2004 OPPS
Comparison of procedural APC medians for 2004 OPPS to adjusted medians for 2003 OPPS. Our analysis of the April 1, 2002, through December 31, 2002 claims data, which is the basis for the proposed median costs for the 2004 OPPS, reveals a distribution of changes in median costs that are not unusual. Compared to the adjusted median costs used for the 2003 OPPS, most of the median cost increases and decreases were for nondevice-related APCs. Very few device-related APCs saw their median costs decrease significantly. We also note that, with a few exceptions, the median cost increases and decreases were not unusually distributed; we believe that the fluctuations should not be unexpected in a new payment system. For example, the cost of providing items and services changes yearly and, in a new payment system, the accuracy of coding services will improve year to year. We also compared the actual median costs from the April 1, 2001 through March 31, 2002 claims data with the actual median costs from the April 1, 2002 through December 31, 2002 claims data. Given the level of consistency we see in our claims data, we believe that adjustment of median costs last year may have resulted in payment amounts for some APCs that were too high.
The medians we propose to use to set weights for the 2004 OPPS for APCs in Table 8 have decreased more than 10 percent in median cost when compared to the adjusted median costs for 2003 OPPS. For reference, we also provide the actual median cost from the claims data we used to set 2003 OPPS payment rates. Some changes appear to be the result of normal fluctuation in the costs of services. In other cases the actual median cost in the April through December 2002 data (the 2004 OPPS medians) is consistent with the actual median cost in the April 1, 2001 through March 31, 2002 data (used for the 2003 OPPS medians), but decreased significantly only in comparison to the adjusted 2001 medians used for 2003 OPPS. In general, where there is consistency between the 2001 (2003 OPPS) and 2002 (2004 OPPS) unadjusted medians or where a change appears to represent normal fluctuations in costs, and we know of no special circumstances that would cause us to believe that there are problems in the claims data, we conclude that the claims data accurately represent the cost of the service. After reviewing the data, we believe that there is no sound basis for making an across-the-board adjustment to our April through December 2002 median costs, notwithstanding that using the unadjusted 2004 median may result in a reduced payment compared to the payment that was based on adjusted medians under 2003 OPPS. Start Printed Page 47985
Table 8.—APCs With Median Cost Decreases of 10 Percent or More
Final APC Description SI Final 2003 dampened median cost 2004 proposed rule APC median cost % diff APC median cost (2003 dampened vs. 2004 proposed rule) 0312 Radioelement Applications S $3,141.77 $216.18 −93.12 0330 Dental Procedures S 284.02 32.87 −88.43 0692 Electronic Analysis of Neurostimulator Pulse Generators S 371.55 56.40 −84.82 0651 Complex Interstitial Radiation Source Application S 3,250.63 588.67 −81.89 0225 Implantation of Neurostimulator Electrodes S 8,277.07 3,283.68 −60.33 0352 Level I Injections X 13.10 6.31 −51.83 0068 CPAP Initiation S 123.29 65.83 −46.61 0124 Revision of Implanted Infusion Pump T 2,975.12 1,608.78 −45.93 0688 Revision/Removal of Neurostimulator Pulse Generator Receiver T 4,429.71 2,495.57 −43.66 1719 Brachytx seed, Non-HDR Ir-192 K 31.04 17.89 −42.36 0699 Level IV Eye Tests & Treatments T 223.07 130.15 −41.65 0199 Obstetrical Care Service T 232.46 142.74 −38.59 0313 Brachytherapy S 1,249.57 769.14 −38.45 0236 Level II Posterior Segment Eye Procedures T 1,873.66 1,153.59 −38.43 0123 Bone Marrow Harvesting and Bone Marrow/Stem Cell Transplant S 380.54 234.84 −38.29 0223 Implantation or Revision of Pain Management Catheter T 2,437.21 1,525.61 −37.40 0385 Level I Prosthetic Urological Procedures T 6,199.09 3,895.76 −37.16 0681 Knee Arthroplasty T 8,780.47 5,669.25 −35.43 0302 Level III Radiation Therapy S 548.35 363.26 −33.75 0301 Level II Radiation Therapy S 187.53 125.03 −33.33 0094 Level I Resuscitation and Cardioversion S 228.18 154.77 −32.17 0671 Level II Echocardiogram Except Transesophageal S 140.57 96.05 −31.67 0098 Injection of Sclerosing Solution T 99.06 68.15 −31.20 0346 Level II Transfusion Laboratory Procedures X 30.59 22.72 −25.73 0043 Closed Treatment Fracture Finger/Toe/Trunk T 148.63 112.70 −24.17 0687 Revision/Removal of Neurostimulator Electrodes T 1,535.37 1,171.45 −23.70 0359 Level II Injections X 67.50 51.53 −23.66 0122 Level II Tube changes and Repositioning T 638.40 494.56 −22.53 0363 Level I Otorhinolaryngologic Function Tests X 64.56 50.02 −22.52 0081 Non-Coronary Angioplasty or Atherectomy T 2,584.47 2,041.29 −21.02 0191 Level I Female Reproductive Proc T 12.27 9.84 −19.80 0685 Level III Needle Biopsy/Aspiration Except Bone Marrow T 355.90 286.61 −19.47 0371 Level I Allergy Injections X 29.69 23.93 −19.39 0152 Percutaneous Abdominal and Biliary Procedures T 595.64 486.01 −18.41 0222 Implantation of Neurological Device T 13,528.13 11,061.74 −18.23 0118 Chemotherapy Administration by Both Infusion and Other Technique S 325.75 267.63 −17.84 0086 Ablate Heart Dysrhythm Focus T 3,138.30 2,611.43 −16.79 0202 Level VIII Female Reproductive Proc T 2,706.38 2,273.91 −15.98 0228 Creation of Lumbar Subarachnoid Shunt T 3,541.71 2,996.28 −15.40 0347 Level III Transfusion Laboratory Procedures X 66.49 56.52 −14.99 0245 Level I Cataract Procedures without IOL Insert T 863.71 736.87 −14.69 0189 Level III Female Reproductive Proc T 90.69 77.39 −14.67 0085 Level II Electrophysiologic Evaluation T 2,478.31 2,128.77 −14.10 0665 Bone Density: AppendicularSkeleton S 49.02 42.34 −13.63 0670 Intravenous and Intracardiac Ultrasound S 1,796.55 1,555.61 −13.41 0368 Level II Pulmonary Tests X 62.61 54.62 −12.76 0107 Insertion of Cardioverter-Defibrillator T 19,378.60 17,025.21 −12.14 0362 Level III Otorhinolaryngologic Function Tests X 168.41 148.74 −11.68 0287 Complex Venography S 415.06 368.16 −11.30 0120 Infusion Therapy Except Chemotherapy T 129.56 115.11 −11.15 0212 Nervous System Injections T 196.63 175.73 −10.63 0004 Level I Needle Biopsy/ Aspiration Except Bone Marrow T 103.36 92.43 −10.57 0676 Level II Transcatheter Thrombolysis T 245.24 219.77 −10.39 0268 Ultrasound Guidance Procedures S 82.47 74.07 −10.19 0106 Insertion/Replacement/Repair of Pacemaker and/or Electrodes T 3,256.61 2,927.17 −10.12 We solicit comments on the proposed weights for all APCs and for the APC placement of all HCPCS codes. However, because we believe the public may be interested in commenting on APCs where the payment rate decreases, we discuss several APCs whose payment rates decrease by more than 10 percent. We are particularly interested in comments, including the submission of external data (as discussed below) regarding these APCs.
Discussion of Selected APCs
APC 312 Radioelement Applications—The proposed median for this APC falls 93.12 percent in comparison with the 2003 adjusted median (from $3,141.77 to $216.18). The 2003 OPPS median was adjusted against Start Printed Page 47986the 2002 OPPS median ($7,080.00) into which we packaged the cost of brachytherapy seeds. However, for 2003 and 2004, we are making separate payment for bracytherapy seeds (with the exception of prostate brachytherapy) and, therefore, the costs of those seeds is not packaged into the APC payment (except for prostate brachytherapy). The 2003 OPPS unadjusted median was $265.53, which is comparable to the proposed 2004 OPPS median. Hence, we think the 2003 OPPS median reflects the costs of brachytherapy, with seeds paid separately.
APC 692 Electronic Analysis of Neurostimulator Pulse Generators—The proposed median for this APC falls 84.82 percent in comparison with the 2003 OPPS adjusted median (from $371.55 to $56.40). The 2003 OPPS median was adjusted against the 2002 OPPS median ($819.00), which contained costs for devices that should not have been packaged. Moreover, the 2003 OPPS unadjusted median for the service was $46.95, and this is comparable to the 2004 OPPS median of $56.40. Hence, we believe that the proposed 2004 OPPS median reflects the cost of the service.
APC 651 Complex Interstitial Radiation Source Application—The proposed median for this APC falls 81.89 percent in comparison with the 2003 OPPS adjusted median (from $3,250.63 to $588.67). The 2003 OPPS median was adjusted against the 2002 OPPS median ($7,080.00), which contained costs for brachytherapy seeds that are currently paid separately. Moreover, the 2003 OPPS unadjusted median for the service was $483.25, and this is comparable to the proposed 2004 OPPS median of $588.67. Hence, we believe that the proposed 2004 OPPS median reflects the cost of the service because brachytherapy seeds are paid separately.
APC 225 Implantation of Neurostimulator Electrodes—The proposed median for this APC fell 60.33 percent (from $8,277.07 to $3,283.68) as compared to the adjusted median used for the 2003 OPPS. The 2003 OPPS median was adjusted against the 2002 OPPS median ($15,286.00), which reflected the manufacturer(s) price(s) for the devices packaged into the APC. However, the proposed 2004 OPPS median ($3,283.68) is very close to the unadjusted 2003 OPPS median ($3,561.03), causing us to believe that the 2004 proposed median accurately reflects the costs of the procedure. Because this APC is commonly performed with implantation of a neurostimulator pulse generator (APC 222), we changed the status indicator of APC 225 to “S” so that it would not be subjected to the multiple procedure reduction when it is performed with implantation of a neurological device. We do not propose to change the status indicator this year, and the multiple procedure reductions would not be applied in CY 2004 to APC 0225.
We determined the proposed 2004 OPPS median for APC 225, using only claims that contained the C codes for the neurostimulator leads (either C1778 Lead, neurostimulator, or C1897 Lead, neurostimulator test kit) in order to ensure that we captured the costs for the leads in the data used to calculate the median. We solicit comments concerning the accuracy of our data and whether they appropriately reflect the cost of neurostimulator electrodes, as well as submission of data on the acquisition cost of neurostimulator electrodes (both permanent and test electrodes).
APC 352 Level 1 Injections—The proposed 2004 OPPS median for this APC fell 51.83 percent (from $13.10 to $6.31) as compared to the adjusted 2003 OPPS median. The 2003 OPPS median was adjusted against the 2002 OPPS median ($23.00). However, the 2003 OPPS median ($6.65) is very close to the proposed 2004 OPPS median ($6.31), and this leads us to believe that the proposed 2004 median reflects the cost of the service.
APC 313 Brachytherapy.—The proposed median for this APC falls 38.45 percent in comparison with the 2003 OPPS adjusted median (from $1,249.57 to $769.14) because the 2003 OPPS median was adjusted against the 2002 OPPS median ($2,030.00), which contained costs for brachytherapy seeds that should not have been included because the radioelement sources used in this APC are not single use seeds. Moreover, the 2003 OPPS unadjusted median for the service was $773.63, and this is comparable to the proposed 2004 OPPS median of $769.14. Hence, we believe that the proposed 2004 OPPS median reflects the cost of the service.
APC 223 Implantation or Revision of Pain Management Catheter.—The proposed median for this APC falls 37.40 percent in comparison with the 2003 OPPS adjusted median (from $2,437.21 to $1,525.61). The single CPT code in this APC describes three procedures: revision, repositioning, and insertion of a pain management catheter. Therefore, the median cost of this APC should reflect the relative frequencies with which these three procedures are performed. Furthermore, the descriptor makes it inappropriate to use only claims containing “C” codes to determine the median cost for this APC because a device is not always used when this procedure is performed. To require that a “C” code be on claims for this procedure would result in inaccurate median costs. We believe the decrease in median cost is due to the packaging of 75 percent of the cost of the catheter into the APC amount for the 2002 OPPS fee schedule.
APC 385 Level 1 Prosthetic Urological Procedures.—The proposed median for this APC fell 37.16 percent compared to the adjusted median for this APC in 2003 OPPS ($3895.76 compared to $6,199.09). This occurred because we removed the more expensive inflatable penile prosthesis and prosthetic urinary sphincters from APC 179 and placed them in a new APC (APC 386 with proposed 2004 OPPS median of $6,298.89). Hence, we believe that the proposed medians for both APCs reflect the costs of the services that they now contain.
APC 687 Revision/Removal of Neurostimulator Electrodes—The proposed median costs of this APC decreased 23.7 percent as compared to the adjusted median used for the 2003 OPPS fee schedule ($1,171.45 compared to $1,535.37). (See Table 8.) However, none of the procedures in this APC require the use of high cost devices, and we believe the change in median cost reflects fluctuation in the costs of providing these services.
APC 359 Level II Injections—See section VI.B.4 of this proposed rule for the discussion of administration of drugs.
APC 81 Non Coronary Angioplasty or Atherectomy—The median for this APC fell 21.02 percent in comparison with the actual median cost used in the 2003 OPPS fee schedule (from $2,584.47 to $2,041.29). The median cost used for OPPS 2003 was significantly higher than the median cost used for the 2002 OPPS, which included packaging of 75 percent of the devices used in this APC. We believe the decrease this year, which is still substantially higher than the median used for 2002, reflects the fluctuating costs of providing this service.
APC 222 Implantation of Neurological Device—The proposed median for this APC fell 18.23 percent in comparison with the 2003 OPPS adjusted median (from $13,528.13 to $11.528.13). The 2003 OPPS adjusted median was adjusted against the 2002 OPPS median, which packaged 75 percent of the cost (based on manufacturer submitted data) of the devices ($17,284.00) into the APC. However, the proposed 2004 OPPS median of $11,061.74 compares favorably with the unadjusted 2003 OPPS median of $9,146.22. Because we Start Printed Page 47987developed the proposed 2004 median for APC 222 using only claims that contained charges for device code C1767, we believe our current cost data better reflect the cost of these devices. We solicit comments on the accuracy of our data as well as the submission of data on the acquisition cost of these devices.
APC 118 Chemotherapy Administration by Both Infusion and Other Technique—See section VI.B.4 of this proposed rule for the discussion of administration of drugs.
APC 86 Ablate Heart Dysrhythm Focus—The proposed median for this APC fell 16.79 percent for 2004 OPPS when compared to the adjusted median for 2003 (from $3,138.30 to $2,611.43). The proposed 2004 OPPS median is comparable to the unadjusted median for 2003 OPPS of $2,745.69. Because this APC requires the use of a device, we required that the claims used to set the median for this APC contain a device code to qualify. We believe that our cost data accurately reflect the cost of providing this service. We note that the high payment rate for 2003 was adjusted against the 2002 median, which reflected packaging 75 percent of the device cost (based on manufacturer submitted costs) into the APC.
APC 202 Level VIII Female Reproductive Procedure—We made several changes to the structure of this APC and the proposed median for this APC fell 15.98 percent for 2004 OPPS when compared to the adjusted median for the 2003 (from $2,706.38 to $2,273.91). The proposed 2004 OPPS median is comparable to the unadjusted median for 2003 OPPS of $2,327.25. This APC requires the use of a device and, therefore, we required that the claims used to set the median for this APC must contain one or more specified device codes to qualify (C1771 Repair device, urinary incontinence, with sling graft, C2631 Repair device, urinary incontinence, without sling graft). We believe our cost data accurately reflect the costs of providing this service.
APC 670 Intravenous and Intracardiac Ultrasound—The proposed median for this APC fell 13.41 percent for the 2004 OPPS when compared to the median for 2003 OPPS (from $1,796.55 to $1,555.61). This APC requires the use of a device and therefore we required that the claims used to set the median for this APC must contain a device code to qualify. We believe that our cost data accurately reflect the cost of providing this service and that any change in median cost is due to fluctuations in hospital costs.
APC 107 Insertion of Cardioverter-Defibrillator—The proposed 2004 OPPS median for this APC fell 12.14 percent (from $19,378.60 to $17,025.21) as compared to the adjusted median cost for the 2003 OPPS fee schedule. The 2003 OPPS median was adjusted against the 2002 OPPS median ($21,679.00) which reflected packaging 75 percent of the manufacturer submitted prices for the devices used in this APC. The proposed 2004 OPPS median is much closer to the adjusted median than it is to the unadjusted 2003 OPPS median ($13,572.62).
We acquired the proposed 2004 OPPS median for APC 107 by using only claims that contained the C codes for cardioverter-defibrillators (either C1721 Cardioverter-defibrillator dual chamber, C1722 Cardioverter-defibrillator, single chamber, or C1882 Cardioverter-defibrillator, other than single or dual chamber) in order to ensure that we captured the costs for the device in the data used to calculate the median. Although the proposed median cost of this APC is lower than the adjusted median used last year, it is considerably higher than the actual median from last year, and we have confidence that it reflects the cost of the devices used in the procedure. We would also note that the proposed median cost for APC 108 also rose dramatically and is higher than the adjusted median used for the 2003 OPPS fee schedule. Assuming that the proposed median cost for APC 108 accurately reflects the cost of inserting a cardioverter-defibrillator with leads, we would expect that the proposed median cost of APC 107, which also rose significantly as compared to the actual median cost used for OPPS 2003, accurately reflects the cost of inserting a cardioverter-defibrillator without leads.
APC 120 Infusion Therapy Except Chemotherapy—See section VI.B.4 of this proposed rule for a discussion of infusion therapy other than chemotherapy.
APC 106 Insertion/Replacement/Repair of Pacemaker and/or Electrodes—The proposed 2004 OPPS median for this APC fell 10.12 percent compared to the 2003 OPPS median (from a final 2003 OPPS median of $3,256.61 to a proposed 2004 Median of $2,927.17). This APC contains both CPT codes for insertion of temporary pacemaker leads (CPT codes 33210 and 33211) and repair and revision of pacemaker leads (33216, 33217, 33218, and 33220). This APC contains a mixture of services and, therefore, its median cost should reflect the mixture of services provided. We solicit comments on whether the proposed median cost for this APC reflects the cost of providing these services as well as the submission of data on the acquisition costs of the leads used for each service in this APC.
Preferred Characteristics of External Data Submitted in Comments. We will consider external data on devices that are provided to the extent that they enable us to verify or adjust claims data where we are convinced that an adjustment is appropriate. All data we use to create payment amounts for the final rule will be available for public inspection.
External data must meet the following criterion:
- Be available for public inspection.
External data that are likely to be of optimal use should meet the following criteria:
- Represent a diverse group of hospitals both by location (for example, rural, urban) and by type (for example, community, teaching). We would prefer that commenters identify each hospital including location with city and State, nonprofit vs. for profit status, teaching vs. nonteaching status, and the percent of Medicare vs. non-Medicare patients receiving the service; a pseudo identifier could be used for the hospital identification. Data should be submitted both “per hospital” and in the aggregate.
- Identify the number of devices billed to Medicare by each hospital as well as any rebates or reductions for bulk purchase or similar discounts and identify the characteristics of providers to which any such price rebates or reductions apply.
- Identify all HCPCS codes with which each item would be used.
- Identify the source of the data.
- Include both the charges and costs for each hospital, by quarter for the last 3 quarters of 2002. Cost data for 2003 are not compatible with 2002 claims data.
This information would enable us to compare our claims data to the external data and help us determine whether the submitted data are representative of hospitals that submit claims under OPPS.
Please note that information that contains beneficiary-specific information (for example, medical records, invoices with beneficiary identification on it) should be altered, if necessary, to remove any individually identifiable information, such as information that identifies an individual, diagnoses, addresses, telephone numbers, attending physician, medical record number, Medicare or other insurance number, etc. Moreover, individually identifiable beneficiary medical records, including progress notes, medical orders, test results, consultation reports, etc. should Start Printed Page 47988not be submitted to us. Similarly, photocopies of checks from hospitals or other documents that contain bank routing numbers should not be submitted to us.
Blood and Blood Products
See section VI.B.8 of this proposed rule for our discussion of the analysis of data for blood and blood products and our proposal.
Separately Paid Drugs
See section VI.B.3 of this proposed rule for our discussion of the analysis of data for separately paid drugs and our proposal.
B. Description of How We Propose To Calculate Weights for CY 2004
The methodology we followed to calculate the APC relative payment weights proposed for CY 2004 is as follows:
- We excluded from the data claims for those bill and claim types that would not be paid under the OPPS (for example, bill type 72X for dialysis services for patients with end-stage renal disease (ESRD)).
- We eliminated claims from hospitals located in Maryland, Guam, and the U.S. Virgin Islands.
- Using the most recent available cost report from each hospital, we converted billed charges to costs and aggregated them to the procedure or visit level first by identifying the cost-to-charge ratio specific to each hospital's cost centers (“cost center specific cost-to-charge ratios” or CCRs) and then by matching the CCRs to revenue centers used on the hospital's CY 2001 outpatient bills. The CCRs include operating and capital costs but exclude items paid on a reasonable cost basis.
- We eliminated from the hospital CCR data 325 hospitals that we identified as having reported charges on their cost reports that were not actual charges (for example, a uniform charge applied to all services). Of these, only 166 hospitals had claims data.
- We eliminated from our data claims for critical access hospitals that are not paid under OPPS and whose claims are therefore not suitable for use in setting weights for services paid under OPPS.
- We calculated the geometric mean of the total operating CCRs of hospitals remaining in the CCR data. We removed from the CCR data 29 hospitals whose total operating CCR deviated from the geometric mean by more than three standard deviations.
- We excluded from our data approximately 2.1 million claims submitted by the hospitals that we removed or trimmed from the hospital CCR data.
- We matched revenue centers from the remaining universe of claims to hospital CCRs.
- We separated the 66.345 million claims that we had matched with a cost report into the following three distinct groups: (1) Single-procedure claims; (2) multiple-procedure claims; and (3) claims on which we could not identify at least one OPPS covered service. Single-procedure claims are those that include only one HCPCS code (other than laboratory and incidentals such as packaged drugs and venipuncture) that could be grouped to an APC. Multiple-procedure claims include more than one HCPCS code that could be mapped to an APC. Thus, dividing the claims yielded approximately 21.92 million single-procedure claims and 14.8 million multiple-procedure claims. Approximately 19.57 million claims without at least one covered OPPS service were set aside.
We converted 8.47 million multiple-procedure claims to single-procedure claims using the following criteria: (1) If a multiple-procedure claim contained lines with a HCPCS code in the pathology series (that is, CPT 80000 series of codes), we treated each of those lines as a single claim. (2) For multiple-procedure claims with a packaged HCPCS code (status indicator “N”) on the claim, we ignored line items for preoperative procedures and for those services in the APCs identified in Table 9. These are services with payment amounts below $50 (under CY 2003 OPPS) for which we believe the charge represents the totality of the charges associated with the service (that is, that there are no packaged HCPCS or packaged revenue centers attributable to the service). If only one procedure (other than HCPCS codes in Table 9) existed on the claim, we treated it as a single-procedure claim. (3) If the claim had no packaged HCPCS codes and if there were no packaged revenue centers on the claim, we treated each line with a procedure as a single-procedure claim if billed with single units. (4) If the claim had no packaged HCPCS codes but had packaged revenue centers for the procedure, we ignored the line item for codes in the APCs identified in Table 9. If only one HCPCS code remained, we treated the claim as a single-procedure claim.
Start Printed Page 47989Table 9.—APCS That Were Ignored To Create Pseudo Single Procedure Claims
0001 Level I Photochemotherapy S 0060 Manipulation Therapy S 0077 Level I Pulmonary Treatment S 0099 Electrocardiograms S 0215 Level I Nerve and Muscle Tests S 0215 Level I Nerve and Muscle Tests S 0230 Level I Eye Tests & Treatments S 0260 Level I Plain Film Except Teeth X 0262 Plain Film of Teeth X 0271 Mammography S 0341 Skin Tests and Miscellaneous Red Blood Cell Tests X 0342 Level I Pathology X 0343 Level II Pathology X 0344 Level III Pathology X 0345 Level I Transfusion Laboratory Procedures X 0364 Level I Audiometry X 0367 Level I Pulmonary Test X 0669 Digital Mammography S 0690 Electronic Analysis of Pacemakers and other Cardiac Devices S 0706 New Technology—Level I ($0-$50) S In addition, we assessed the dates of service for HCPCS codes and packaged revenue centers on each claim that contained more than one major code. Where it was possible to attribute charges for packaged HCPCS and packaged revenue centers to HCPCS codes for major procedures by matching unique dates of service, we did this and created single claims by packaging charges into the charge for the major service on the same date. We were only able to do this if the multiple major procedures had different dates of service and if there were dates of service on all of the packaged revenue centers. Dates of service on revenue centers are not required and, therefore, only claims from hospitals that submitted dates of service on revenue centers in CY 2002 could be used in this process for maximizing the number of single-procedure claims to be used for weight setting. We created an additional 23.58 million single-procedure bills through this process, which enabled us to use these data from multiple-procedure claims in calculation of the APC relative payment weights.
- To calculate median costs for services within an APC, we used only single-procedure bills and those multiple-procedure bills that we converted into single claims except as described otherwise. If a claim had a single code with a zero charge (that would have been considered a single-procedure claim), we did not use it. As we discussed in section III.A.2 of this proposed rule, we did not use multiple-procedure claims that billed more than one separately payable HCPCS code with charges for packaged items and services such as anesthesia, recovery room, or supplies that could not be reliably allocated or apportioned among the primary HCPCS codes on the claim. We have not yet developed what we regard as an acceptable method of using multiple procedure bills to recalibrate APC weights that minimizes the risk of improperly assigning charges to the wrong procedure or visit.
For APCs in Table 10, we required that there be a C code on the claim for the claim to be used. These APCs require the use of a device in the provision of the service. Moreover, in 2002, hospitals were required to bill the C code in order for the device to receive pass-through payment for the device. Therefore, if no C code was billed on the claim, we presumed that the claim was incorrectly coded, and we did not use it. For some of these APCs, we further required that specific devices be on the claim.
Start Printed Page 47990Table 10.—APCS for Which a HCPCS for a Device Was Required To Be on a Claim Used for Weight Setting
APC APC description Status 0032 Insertion of Central Venous/Arterial Catheter T 0048 Arthroplasty with Prosthesis T 0080 Diagnostic Cardiac Catheterization T 0081 Non-Coronary Angioplasty or Atherectomy T 0082 Coronary Atherectomy T 0083 Coronary Angioplasty and Percutaneous Valvuloplasty T 0085 Level II Electrophysiologic Evaluation T 0086 Ablate Heart Dysrhythm Focus T 0087 Cardiac Electrophysiologic Recording/Mapping T 0089 Insertion/Replacement of Permanent Pacemaker and Electrodes T 0090 Insertion/Replacement of Pacemaker Pulse Generator T 0104 Transcatheter Placement of Intracoronary Stents T 0106 Insertion/Replacement/Repair of Pacemaker and/or Electrodes T 0107 Insertion of Cardioverter-Defibrillator T 0108 Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads T 0115 Cannula/Access Device Procedures T 0119 Implantation of Devices T 0122 Level II Tube Changes and Repositioning T 0167 Level III Urethral Procedures T 0182 Insertion of Penile Prosthesis T 0202 Level VIII Female Reproductive Proc T 0222 Implantation of Neurological Device T 0225 Implantation of Neurostimulator Electrodes S 0226 Implantation of Drug Infusion Reservoir T 0227 Implantation of Drug Infusion Device T 0229 Transcatheter Placement of Intravascular Shunts T 0259 Level VI ENT Procedures T 0313 Brachytherapy S 0384 GI Procedures with Stents T 0385 Level I Prosthetic Urological Procedures T 0386 Level II Prosthetic Urological Procedures T 0648 Breast Reconstruction with Prosthesis T 0652 Insertion of Intraperitoneal Catheters T 0653 Vascular Reconstruction/Fistula Repair with Device T 0654 Insertion/Replacement of a permanent dual chamber pacemaker T 0655 Insertion/Replacement/Conversion of a permanent dual chamber pacemaker T 0670 Intravenous and Intracardiac Ultrasound S 0674 Prostate Cryoablation T 0680 Insertion of Patient Activated Event Recorders S 0681 Knee Arthroplasty T - 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. We used the most recent settled or submitted cost reports. Using the most recent “submitted to settled ratio,” we adjusted CCRs for the submitted cost reports but not the settled ones. If an appropriate cost center did not exist for a given hospital, we crosswalked the revenue center to a secondary cost center when possible, or used the hospital's overall CCR for outpatient department services. We excluded from this calculation all charges associated with HCPCS codes previously defined as not paid under the OPPS (for example, laboratory, ambulance, and therapy services). We included all charges associated with HCPCS codes that are designated as packaged services (that is, HCPCS codes with the status indicator of “N”).
- To calculate per-service costs, we used the charges shown in revenue centers that contained items integral to performing services. Table 11 contains a list of the revenue centers that we packaged into major HCPCS codes when they appeared on the same claim. This is a change to the packaging of revenue centers by category of service that had been done since the inception of the OPPS in the April 7, 2000 final rule (65 FR 18457). In all prior years of OPPS, we had specific subsets of revenue centers that we packaged into major HCPCS codes based on the type of service we assigned to the HCPCS code for this purpose. For example, we had a set of revenue centers that could be packaged into visit codes and a different, but overlapping, set of revenue centers that could be packaged into surgery codes. We propose to convert these categories to a single set of revenue codes (see Table 11) that would be packaged into the major HCPCS code with which it appears on a claim. We believe that this will increase the likelihood that the total charge for the major HCPCS code will capture all of the costs attributed to the services furnished.
Table 11 lists packaged services by revenue center that we are proposing to use to calculate per-service costs for outpatient services furnished in CY 2004.
Table 11.—Packaged Services by Revenue Code
Revenue Code Description 250 PHARMACY 251 GENERIC 252 NONGENERIC 254 PHARMACY INCIDENT TO OTHER DIAGNOSTIC 255 PHARMACY INCIDENT TO RADIOLOGY 257 NONPRESCRIPTION DRUGS 258 IV SOLUTIONS 259 OTHER PHARMACY 260 IV THERAPY, GENERAL CLASS 262 IV THERAPY/PHARMACY SERVICES 263 SUPPLY/DELIVERY 264 IV THERAPY/SUPPLIES 269 OTHER IV THERAPY 270 M&S SUPPLIES 271 NONSTERILE SUPPLIES 272 STERILE SUPPLIES 274 PROSTHETIC/ORTHOTIC DEVICES 275 PACEMAKER DRUG 276 INTRAOCULAR LENS SOURCE DRUG 278 OTHER IMPLANTS 279 OTHER M&S SUPPLIES 280 ONCOLOGY 289 OTHER ONCOLOGY 290 DURABLE MEDICAL EQUIPMENT 370 ANESTHESIA 371 ANESTHESIA INCIDENT TO RADIOLOGY 372 ANESTHESIA INCIDENT TO OTHER DIAGNOSTIC 379 OTHER ANESTHESIA 390 BLOOD STORAGE AND PROCESSING 399 OTHER BLOOD STORAGE AND PROCESSING 560 MEDICAL SOCIAL SERVICES 569 OTHER MEDICAL SOCIAL SERVICES 621 SUPPLIES INCIDENT TO RADIOLOGY 622 SUPPLIES INCIDENT TO OTHER DIAGNOSTIC 624 INVESTIGATIONAL DEVICE (IDE) 630 DRUGS REQUIRING SPECIFIC IDENTIFICATION, GENERAL CLASS 631 SINGLE SOURCE 632 MULTIPLE 633 RESTRICTIVE PRESCRIPTION 637 SELF-ADMINISTERED DRUG (INSULIN ADMIN. IN EMERGENCY DIABETIC COMA) 700 CAST ROOM 709 OTHER CAST ROOM 710 RECOVERY ROOM 719 OTHER RECOVERY ROOM 720 LABOR ROOM 721 LABOR 762 OBSERVATION ROOM 810 ORGAN ACQUISITION 819 OTHER ORGAN ACQUISITION 942 EDUCATION/TRAINING - We standardized costs for geographic wage variation by dividing the labor-related portion of the operating and capital costs for each billed item by the proposed FY 2004 hospital inpatient prospective payment system (IPPS) wage index published in the Federal Register on May 9, 2002 (67 FR 31602). We used 60 percent to represent our estimate of that portion of costs attributable, on average, to labor. We have used this estimate since the inception of the OPPS and continue to believe that it is appropriate. (See the April 7, 2000 final rule (65 FR 18496) for a complete description of how we derived this percentage).
- We summed the standardized labor-related cost and the nonlabor-related cost component for each billed item to derive the total standardized cost for each procedure or medical visit.
- We removed extremely unusual costs that appeared to be errors in the data using a trimming methodology analogous to what we use in calculating the diagnosis-related group (DRG) weights for the hospital IPPS. That is, we eliminated any bills with costs outside of three standard deviations from the geometric mean.
- After trimming the procedure and visit level costs, we mapped each procedure or visit cost to its assigned APC, including, to the extent possible, the proposed APC changes.
- We calculated the median cost for each APC.
To develop the median cost for observation (APC 339, HCPCS code G0244), we selected claims containing HCPCS code G0244 (Observation care Start Printed Page 47991provided by a facility to a patient with CHF, chest pain, or asthma, minimum eight hours, maximum forty-eight hours) that also showed one or more of the ICD-9 (International Classification of Diseases, Ninth Edition) diagnosis codes required for payment of APC 339. We ignored other separately payable codes so that the claims with G0244 would not be excluded for having multiple major procedures on a single claim. We packaged the costs of allowable revenue centers and HCPCS codes with status indicator “N” into the cost of G0244, and trimmed as was done for the calculation of the median costs for other APCs.
To calculate the weights for APCs 649 (Prostate Brachytherapy with Palladium seeds) and 684 (Prostate Brachytherapy with Iodine seeds) into which the cost of brachytherapy seeds are packaged, we selected claims that contained HCPCS codes 77778 and 55859 where the lines containing codes 77778 and 55859 have the same date of service and the claim contained either HCPCS code C1720 (Palladium seeds) or C1718 (Iodine seeds) (which need not be the same date of service as 77778 and 55859). We ignored line items for services paid on the laboratory fee schedule and lines with separately payable HCPCS (even if multiple majors). We packaged all remaining costs from allowable revenue centers and packaged HCPCS into the claim (regardless of date of service). We separated the claims with Palladium seeds from claims with Iodine seeds. We then created a median cost for prostate brachytherapy with Palladium seeds (APC 0649; G0256) from the claims containing 77778, 55859, and C1720 (Palladium seeds), and we created a median cost for prostate brachytherapy with Iodine seeds (APC 0684; G0261) from claims containing 77778, 55859, and C1718 (Iodine seeds).
- Using the median APC costs, we calculated the relative payment weights for each APC. As in prior years, we scaled all the relative payment weights to APC 0601, Mid-level clinic visit, because it is one of the most frequently performed services in the hospital outpatient setting. We assigned APC 0601 a relative payment weight of 1.00 and divided the median cost for each APC by the median cost for APC 0601 to derive the relative payment weight for each APC. Using 2002 data, the median cost for APC 0601 is $58.78.
Section 1833(t)(9)(B) of the Act requires that APC revisions, relative payment weight revisions, and wage index and other adjustments be made in a manner that ensures that estimated aggregate payments under the OPPS for 2004 are neither greater than nor less than the estimated aggregate payments that would have been made without the changes. To comply with this requirement concerning the APC changes, we compared aggregate payments using the CY 2003 relative weights to aggregate payments using the CY 2004 proposed weights. Based on this comparison, we are proposing to make an adjustment of 1.003107132 to the weights. The weights that we are proposing for CY 2004, which incorporate the recalibration adjustments explained in this section, are listed in Addendum A and Addendum B.
IV. Transitional Pass-Through and Related Payment Issues
A. Background
Section 1833(t)(6) of the Act provides for temporary additional payments or “transitional pass-through payments” for certain medical devices, drugs, and biological agents. As originally enacted by the BBRA, this provision required the Secretary to make additional payments to hospitals for current orphan drugs, as designated under section 526 of the Federal Food, Drug, and Cosmetic Act, Public Law 107-186; current drugs, biological agents, and brachytherapy devices used for the treatment of cancer; and current drugs and biological products.
For those drugs, biological agents, and devices referred to as “current,” the transitional pass-through payment began on the first date the hospital OPPS was implemented (before enactment of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA), Public Law 106-554, enacted December 21, 2000).
Transitional pass-through payments are also required for certain “new” medical devices, drugs, and biological agents that were not being paid for as a hospital outpatient service as of December 31, 1996 and whose cost is “not insignificant” in relation to the OPPS payment for the procedures or services associated with the new device, drug, or biological. Under the statute, transitional pass-through payments can be made for at least 2 years but not more than 3 years.
Section 1833(t)(6)(B)(i) of the Act required that we establish by April 1, 2001, initial categories to be used for purposes of determining which medical devices are eligible for transitional pass-through payments. Section 1833(t)(6)(B)(i)(II) of the Act explicitly authorized us to establish initial categories by program memorandum (PM). On March 22, 2001, we issued two PMs, Transmittals A-01-40 and A-01-41 that established the initial categories. We posted them on our Web site at: http://www.hcfa.gov/pubforms/transmit/A0140.pdf and http://www.hcfa.gov/pubforms/transmit/A0141.pdf,, respectively.
Transmittal A-01-41 includes a list of the initial device categories, a crosswalk of all the item-specific codes for individual devices that were approved for transitional pass-through payments, and the initial category code by which the cross-walked individual device was to be billed beginning April 1, 2001. Items eligible for transitional pass-through payments are generally coded using a Level II HCPCS code with an alpha prefix of “C.” Pass-through device categories are identified by status indicator “H” and pass-through drugs and biological agents are identified by status indicator “G.” Subsequently, we added a number of additional categories, retired 95 categories effective January 1, 2003, and made clarifications to some of the categories' long descriptors found in various program transmittals. A list of device category codes in effect as of July 1, 2003, can be found in Transmittal A-03-051, which was issued on June 13, 2003. This PM can be accessed on our Web site at http://www.cms.gov.
Section 1833(t)(6)(B)(ii) of the Act also requires us to establish, through rulemaking, criteria that will be used to create additional device categories. The criteria for new categories were the subject of a separate interim final rule with comment period published in the Federal Register on November 2, 2001 (66 FR 55850) and made final in the November 1, 2002 Federal Register (67 FR 66781) announcing the 2003 update to the OPPS.
Transitional pass-through categories are for devices only; they do not apply to drugs or biological agents. The regulations at § 419.64 governing transitional pass-through payments for eligible drugs and biological agents are unaffected by the creation of categories.
The process to apply for transitional pass-through payment for eligible drugs and biological agents or for additional device categories can be found on respective pages on our Web site at http://www.cms.gov. If we revise the application instructions in any way, we will post the revisions on our Web site and submit the changes for approval by the Office of Management and Budget (OMB) as required under the Paperwork Reduction Act (PRA). Notification of new drug, biological, or device category application processes is generally posted on the OPPS Web site at http://www.cms.gov. Start Printed Page 47992
B. Discussion of Pro Rata Reduction
Section 1833(t)(6)(E) of the Act limits the total projected amount of transitional pass-through payments for a given year to an “applicable percentage” of projected total Medicare and beneficiary payments under the hospital OPPS. For a year before 2004, the applicable percentage is 2.5 percent; for 2004 and subsequent years, we specify the applicable percentage up to 2.0 percent. We propose to set the percentage at 2.0 percent for the 2004 OPPS.
If we estimate before the beginning of the calendar year that the total amount of pass-through payments in that year would exceed the applicable percentage, section 1833(t)(6)(E)(iii) of the Act requires a prospective uniform reduction in the amount of each of the transitional pass-through payments made in that year to ensure that the limit is not exceeded. We make an estimate of pass-through spending to determine not only whether payment exceeds the applicable percentage but also to determine the appropriate reduction to the conversion factor.
For devices, making an estimate of pass-through spending in 2004 entails estimating spending for two groups of items. The first group consists of those items for which we have claims data (that is, items that were eligible in 2002 and that will continue to be eligible in 2004). The second group consists of those items for which we have no direct claims data (that is, items that became, or will become, eligible in 2003 and will retain pass-through status and items that will be newly eligible beginning in 2004).
To estimate 2004 pass-through spending for device categories in the first group, we would use volume and hospital cost (derived from charges on claims using cost-to-charge ratios) information from 2002 claims data. This information would be projected forward to 2004 levels using appropriate inflation and utilization factors. For existing categories with no claims data in 2002 that are, or will be, active in 2004, we would follow the method described in the November 2, 2001 final rule (66 FR 55857). We would use price information from manufacturers and volume estimates from claims related to procedures that use the devices in question. This information would be projected forward to 2004 using appropriate inflation and utilization factors to estimate 2004 pass-through spending for this group of categories. For categories that become eligible in 2004, we would use the same method as described for categories that were newly active in 2002. We anticipate that any new categories for January 1, 2004 will be announced after the publication of this proposed rule but before the publication of the final rule. Therefore, the estimate of pass-through spending would incorporate pass-through spending for categories made effective January 1, 2004.
To estimate 2004 pass-through spending for drugs and biological agents, we would make estimates of utilization, collect data on average wholesale price (AWP) and combine these with ratios used to represent hospital acquisition costs for these drugs. We would collect drug-specific information on Medicare use from the pharmaceutical manufacturer where possible and rely on other sources (such as peer-reviewed clinical studies) as needed. In the past, we relied upon the AWP published in the Redbook to establish the AWP of pass-through drugs payable under the OPPS. As described elsewhere in this preamble, we plan to adopt and apply the provisions outlined in the Payment Reform for Part B drugs. For the purpose of calculating payments for transitional pass-through items, we would determine 95 percent of the drug's average wholesale price based on the newly established AWP. We would use published ratios on hospital acquisition costs reported in our proposed rule of August 9, 2002 (67 FR 52129). For sole source drugs the ratio of acquisition cost to AWP equals 0.71; for multi-source drugs, the ratio is 0.68; and for multi-source drugs with generic competitors, the ratio equals 0.46.
For drugs and biological agents that may receive pass-through status effective January 1, 2004, we propose to use the same methodology as described for drugs and biological agents that received pass-through status in 2003. Any new pass-through drugs and biological agents effective beginning in 2004 would be announced after the publication of this proposed rule but before the publication of the final rule. Therefore, the estimate of pass-through spending would incorporate pass-through spending for these drugs and biological agents made effective January 1, 2004.
After using the methodologies described above to determine projected 2004 pass-through spending for the groups of devices, drugs, and biological agents, we would calculate total projected 2004 pass-through spending as a percentage of the total projected payments (Medicare and beneficiary payments) under OPPS to determine if the pro rata reduction will be required.
Table 12 shows our current estimate of 2004 pass-through spending for known pass-through drugs, biologicals, and devices based on information available at the time this table was developed. We are uncertain whether estimated pass-through spending in 2004 will exceed $456 million (2.0 percent of total estimated OPPS spending). We have not yet completed the estimate of pass-through spending for a number of drugs and devices. In particular, we do not have estimates for those drugs still under agency review for additional pass-through payments beginning October 2003 or the changes in pass-through spending that could result from quarterly rather than annual updates of AWP for pass-through drugs. Finally, we would incorporate an estimate of pass-through spending for items for which pass-through payment becomes effective later in 2004 (that is, April 1, 2004; July 1, 2004; and October 1, 2004) based on estimates of items that become eligible for pass-through payment on October 1, 2003 and January 1, 2004. Specifically, we would assume a proportionate amount of spending for items that become eligible later in the year while making an adjustment to account for the fact that items made eligible later in the year will not receive pass-through payments for the entire year. We invite comments on the methodology as described above and the estimates for utilization that appear in the table below.
Table 12.—Estimates for 2004 Transitional Pass-Through Spending
New HCPC APC Drug biological 2004 pass-through payment portion 2004 estimated utilization 2004 anticipated pass-through payments Existing Pass-through Drugs/Biologicals C9111 9111 Injection Bivalrudin, 250 mg per vial $100.50 21,007 2,111,200 C9112 9112 Perflutren lipid microsphere, per 2 ml $37.44 67,000 2,508,480 Start Printed Page 47993 C9113 9113 Inj Pantoprazole sodium, per vial $5.76 20,000 115,200 C9116 9116 Ertapenum sodium, per 1 gm vial $11.45 7,200 82,440 Q4053 9119 Pegfilgrastim, per 1 mg single dose vial $118.00 662,062 78,123,329 C9120 9120 Faslodex, per 50 mg injection $44.25 137,078 6,065,702 C9121 9121 Argatroban, per 5 mg $3.60 50,000 180,000 C9200 9200 Orcel, per 36 cm2 $286.80 1,000 286,800 C9203 9203 Perflexane lipid microspheres, per single use vial $36.00 82,400 2,966,400 J2324 9114 Nesiritide, per 0.5 mg vial $36.48 60,000 2,188,800 J3315 9122 Triptorelin pamoate, per 3.75 mg $104.90 219,600 23,036,040 J3487 9115 Zoledronic acid, 1 mg $51.38 539,000 27,693,820 C9204 9204 Ziprasidone mesylate, per 20 mg $10.50 117,143 1,230,000 C9205 9205 Oxaliplatin, per 5 mg $23.86 280,756 6,698,845 HCPCS APC Description 2004 estimated utilization 2004 anticipated payment Existing Pass-through Devices C1783 1783 Ocular implant, aqueous drainage assist device 323 159,756 C1814 1814 Retinal tamponade device, silicone oil 35106 13,649,018 C1884 1884 Embolization Protective System 25000 38,601,544 C1888 1888 Catheter, ablation, non-cardiac, endovascular (implantable) 214 129,128 C1900 1900 Lead, left ventricular coronary venous system 2091 2,814,528 C2614 2614 Probe, percutaneous lumbar discectomy 899 1,748,555 C2632 2632 Brachytherapy solution, iodine-125, per mCi 225 1,890,000 C1818 1818 Integrated keratoprosthesis 4 27,800 V. Payment for Devices
A. Pass-Through Devices
Section 1833(t)(6)(B)(iii) of the Act requires that a category of devices be eligible for transitional pass-through payments for at least 2, but not more than 3, years. This period begins with the first date on which a transitional pass-through payment is made for any medical device that is described by the category. We propose that two device categories currently in effect would expire effective January 1, 2004. Our proposed payment methodology for devices that have been paid by means of pass-through categories, and for which pass-through status would expire effective January 1, 2004, is discussed in the section below.
Although the device category codes became effective April 1, 2001, most of the item-specific “C” codes for pass-through devices that were crosswalked to the new category codes were approved for pass-through payment in CY 2000 and as of January 1, 2001. (The crosswalk for item-specific “C” codes to category codes was issued in Transmittals A-01-41 and A-01-97). We based the expiration dates for the category codes listed in Table 13, on when a category was first created, or when the item-specific devices that are described by, and included in, the initial categories were first paid as pass-through devices, before the implementation of device categories. These proposed device category expiration dates are listed in Table 13. We propose to base the expiration date for a device category on the earliest effective date of pass-through payment status of the devices that populate that category. There are two categories for devices that will have been eligible for pass-through payments for over 2 1/2 years as of December 31, 2003, and we propose that they would not be eligible for pass-through payments effective January 1, 2004. The two categories we propose for expiration are C1765 and C2618, as indicated in Table 13. Each category includes devices for which pass-through payment was first made under OPPS in 2000 or 2001.
A comprehensive list of all pass-through device categories effective on or before July 2003 is displayed in Table 13. Also displayed are the dates the devices described by the category were populated and their respective proposed expiration dates.
The methodology used to base expiration of a device category is the same as that used to determine the 95 initial categories that expired as of January 1, 2003. A list including those 95 categories that expired as of January 1, 2003 (as well as 5 categories that continue to be paid in 2003) is found in the November 1, 2002 final rule (67 FR 66761 through 66763).
Table 13.—List of Current Pass-Through Device Categories With Proposed Expiration Dates
HCPCS codes Category long descriptor Date(s) populated Expiration date C1765 Adhesion Barrier 10/1/00-3/31/01; 7/1/01 12/31/03 C2618 Probe, cryoblation 4/1/01 12/31/03 C1888 Catheter, ablation, non-cardiac, endovascular (implantable) 7/1/02 12/31/04 C1900 Lead, left ventricular coronary venous system 7/1/02 12/31/04 C1783 Ocular implant, aqueous drainage assist device 7/1/02 12/31/04 Start Printed Page 47994 C1884 Embolization protective system 1/1/03 12/31/04 C2614 Probe, percutaneous lumbar discectomy 1/1/03 12/31/04 C2632 Brachytherapy solution, iodine-125, per mCi 1/1/03 12/31/04 C1814 Retinal tamponade device, silicone oil 4/1/03 12/31/05 C1818 Integrated keratoprosthesis 7/1/03 12/31/05 The methodology that we propose to use to package pass-through device costs is consistent with the packaging methodology that we describe in section II.B.5. For the codes in APCs displayed in Table 10, we propose to use only those claims on which the hospital included the “C” code and to discard the claims on which no “C” code is billed.
We propose to limit our analysis to the claims with “C” codes because we are not confident that the claims for the relevant APCs include the charges for the devices unless the “C” codes are specifically billed.
To calculate the total cost for a service on a per-service basis, we included all charges billed with the service in a revenue center in addition to packaged HCPCS codes with status indicator “N.” We also packaged the costs of devices that we propose would no longer be eligible for pass-through payment in 2004 into the HCPCS codes with which the devices were billed.
B. Expiration of Transitional Pass-Through Payments in CY 2004
In the November 1, 2002 final rule, we established a policy for payment of devices included in pass-through categories that are due to expire (67 FR 66763). We stated that we would package the costs of the devices no longer eligible for pass-through payments in 2003 into the costs of the procedures with which the devices were billed in 2001. There were very few exceptions to the policy (for example, brachytherapy seed for other than prostate brachytherapy), and we propose to continue this policy. Therefore, we propose that the payment for the devices that populate C1765 and C2618, which we propose will cease to be eligible for pass-through payment on January 1, 2004, would be made as part of the payment for the APCs with which they are billed.
C. Other Policy Issues Relating to Pass-Through Device Categories
Reducing Transitional Pass-Through Payments To Offset Costs Packaged Into APC Groups
In the November 30, 2001 final rule, we explained the methodology we used to estimate the portion of each APC rate that could reasonably be attributed to the cost of associated devices that are eligible for pass-through payments (66 FR 59904). Beginning with the implementation of the 2002 OPPS update (April 1, 2002), we deduct from the pass-through payments for the identified devices an amount that offsets the portion of the APC payment amount that we determine is associated with the device, as required by section 1833(t)(6)(D)(ii) of the Act. In the November 1, 2002 final rule, we published the applicable offset amounts for 2003 (67 FR 66801).
For the 2002 and 2003 OPPS updates, we estimated the portion of each APC rate that could reasonably be attributed to the cost of an associated pass-through device that is eligible for pass-through payment using claims data from the period used for recalibration of the APC rates. Using these claims, we calculated a median cost for every APC without packaging the costs of associated “C” codes for device categories that were billed with the APC. We then calculated a median cost for every APC with the costs of associated device category “C” codes that were billed with the APC packaged into the median. Comparing the median APC cost minus device packaging to the median APC cost including device packaging enables us to determine the percentage of the median APC cost that is attributable to associated pass-through devices. By applying these percentages to the median APC costs, we determined the applicable offset amount. We included any APC on the offset list for which the device cost was at least 1 percent of the APC's cost.
As we discussed in our November 1, 2002 final rule (67 FR 66801), the listed offsets are those that may potentially be used because we do not know which procedures would be billed with newly created categories.
After publication of the November 1, 2002 final rule, we received a comment indicating that in some cases it may be inappropriate to apply an offset to a new device category because the device category is not replacing any device whose costs have been packaged into the APC. We agree with this comment. Therefore, we propose to modify our policy for applying offsets. Specifically, we would apply an offset to a new device category only when we can determine that an APC contains costs associated with the device. At this time, we propose to continue our existing methodology for determining the offset amount, described above. However, we solicit comments for alternative methodologies for determining the offset amounts that potentially could be applied to the payment amounts for new device categories.
We can use this methodology to establish the device offset amounts for the 2004 OPPS because we are using 2002 claims on which device codes are reported. However, for the 2005 update to OPPS, we would use 2003 claims that would not include device coding. Thus, for 2005, we are considering whether or not to use the charges from lines on the claim having no HCPCS code but have charges under revenue codes 272, 275, 276, 278, 279, 280, 289, and 624 as proxies for the device charges that would have been billed with HCPCS codes for these devices in previous years. We are also considering the reinstitution of the “C” codes for expired device categories and requiring hospitals to use one or more newly created “C” codes for identification of devices and costs on claims. See section VI.B of this proposed rule for further discussion.
We propose to review each new device category on a case-by-case basis to determine whether device costs associated with the new category are packaged into the existing APC structure.
We reviewed the device categories eligible for continuing pass-through payment in 2004 to determine whether the costs associated with the device Start Printed Page 47995categories are packaged into the existing APCs. For the categories existing as of publication of this proposed rule, we have determined that there are no close or identifiable costs associated with the devices in our data related to the respective APCs that are normally billed with those devices. Therefore, for these categories we are proposing to set the offset to $0 for 2004.
If we create a new device category and determine that our data contain identifiable costs associated with the devices in any APC, we would apply an offset. We propose, if any offsets apply, for new categories, to announce the offsets in the program memorandum that announces the information regarding the new category.
VI. Payment for Drugs, Biologicals, Radiopharmaceutical Agents, Blood, and Blood Products
A. Pass-Through Drugs and Biologicals
Section 1833(t)(6)(D)(i) of the Act requires us to make transitional pass-through payment for new drugs equal to the amount by which 95 percent of the average wholesale price (AWP) of the drug exceeds the proposed payment rate. In the past, we have used the AWP published in the Red Book to determine payment amounts for pass-through drugs as we explain in the correction notice issued on February 10, 2003 (68 FR 6637). However, we are concerned about the extent to which Medicare pays more for drugs than other payers and more than the market-based price of drugs. To address this problem of how to pay appropriately for drugs that are priced using the AWP, we are developing regulations that would revise the current payment methodology for part B covered drugs paid under section 1842(o) of the Act. When the AWP regulations are made final, we propose to adopt and apply the provisions of the final AWP rule to establish the AWP of pass-through drugs payable under the OPPS. If implementation of the AWP final rule necessitates mid-year changes in the 2004 OPPS payment rates for pass-through drugs, we propose to make those changes on a prospective payment basis through our regular OPPS PM and PRICER quarterly updates. We further propose to issue instructions by program memorandum regarding implementation of the provisions of the AWP final rule to set payment rates for pass-through drugs under the OPPS.
An AWP final rule could be published before 2004. However, if the AWP final rule is not issued in time to permit us to apply its provisions to price pass-through drugs furnished on or after January 1, 2004, we propose to use 95 percent of the AWP listed in the most recent quarterly update of the Single Drug Pricer (SDP). In the past, we have relied solely on the Red Book to determine the AWP for a pass-through drug, as we explain in the correction notice issued on February 10, 2003 (68 FR 6637). However, on January 1, 2003, we introduced for the first time a single pricing source for approximately 400 drugs and biologicals for which the Medicare payment allowance is based on 95 percent of their AWP. We established the SDP to address apparent discrepancies in drug pricing that were the unintended result of delegating calculation of AWP to multiple contractors, whose application of the pricing methodology established under 42 CFR 405.517 sometimes varied. The SDP continues to rely on published compilations such as the Red Book and First Data Bank to identify wholesale drug prices. However, using the SDP enables us to establish a uniform Medicare payment allowance for drugs whose payment is based on 95 percent of their AWP, which results in greater consistency in Medicare drug pricing nationally. If a drug with pass-through status is not included in the SDP, we propose to forward to the SDP contractor the AWP information submitted as part of the pass-through application.
Because the January SDP would not be available in time, we propose to announce the January 1, 2004 prices for pass-through drugs in our January 2004 OPPS implementing instructions to fiscal intermediaries and in the January 2004 OPPS PRICER rather than in the 2004 final rule, which is to be published in the Federal Register by November 1, 2003. We further propose to update the AWP for pass-through drugs paid under the OPPS on a quarterly basis in accordance with the quarterly updates of the SDP. The updated rates for pass-through drugs and biologicals would also be issued through our quarterly OPPS program memoranda and PRICER updates.
Additional information regarding the SDP can be found on the CMS Web site in Program Memorandum AB-02-174, issued December 3, 2002.
B. Drugs, Biologicals, and Radiopharmaceuticals Without Pass-Through Status
1. Background
Under the OPPS, we currently pay for radiopharmaceuticals, drugs, and biologicals including blood, and blood products, which do not have pass-through status, in one of three ways: packaged payment, separate payment (individual APCs), and reasonable cost. As we explained in the April 7, 2000 final rule (65 FR 18450), we generally package the cost of drugs and radiopharmaceuticals into the APC payment rate for the procedure or treatment with which the products are usually furnished. Hospitals do not receive separate payment from Medicare for packaged items and supplies, and hospitals may not bill beneficiaries separately for any such packaged items and supplies whose costs are recognized and paid for within the national OPPS payment rate for the associated procedure or service. (Transmittal A-01-133, a Program Memorandum issued to Intermediaries on November 20, 2001, explains in greater detail the rules regarding separate payment for packaged services). As we explained in the November 1, 2002 final rule (67 FR 66757), we do not classify diagnostic and therapeutic radiopharmaceutical agents as drugs or biologicals as described in section 1861(t) of the Act.
Packaging costs into a single aggregate payment for a service, procedure, or episode of care is a fundamental principle that distinguishes a prospective payment system from a fee schedule. In general, packaging the costs of items and services into the payment for the primary procedure or service with which they are associated encourages hospital efficiencies and also enables hospitals to manage their resources with maximum flexibility. Notwithstanding our commitment to package as many costs as possible, we are aware that packaging payments for certain drugs and radiopharmaceuticals, especially those that are particularly expensive or rarely used, might result in insufficient payments to hospitals, which could adversely affect beneficiary access to medically necessary services.
As discussed in the November 1, 2002 final rule (67 FR 66774), we packaged payment for drugs and radiopharmaceuticals into the APCs with which they were billed if the median cost per line for the drug or radiopharmaceutical was less than $150, and we established a separate APC payment for drugs and radiopharmaceuticals for which the median cost per line exceeded than $150. This supported our general view that payment for drugs and radiopharmaceuticals should be made as part of the payment for the services in which they are used in order to encourage efficient purchase and use of drugs and radiopharmaceuticals provided in the hospital outpatient department. Start Printed Page 47996
Payment Rates for 2003
To limit the dramatic reduction in payment rates for many of the separately payable drugs and radiopharmaceuticals from 2002 to 2003, we limited the decrease in their median costs from 2002 median costs to 15 percent plus half of the difference between the total proposed reduction and 15 percent reduction. (For example, for a drug whose cost decreased by 35 percent from the applicable 2002 median cost, the allowed reduction from 2002 to 2003 was 15 percent plus (1/2 times 35-15) percent = 25 percent.) For each blood and blood product, we provide separate payment in an individual APC and limited any decrease in payment rate from 2002 to 2003 to 15 percent. In 2003, we also excluded from OPPS certain vaccines and orphan drugs (that met our orphan criteria) and paid for these items at reasonable cost. Our intent in implementing these policies was to avoid adversely affecting beneficiary access to needed treatment.
Drugs for Which We Propose Pass-Through Status Will Expire in 2004
Section 1833(t)(6)(C)(i) of the Act specifies that the duration of transitional pass-through payments for drugs and biologicals must be no less than 2 years nor any longer than 3 years. The drugs that are due to expire December 31, 2003 meet that criterion. Table 14 lists the drugs and biologicals for which we propose pass-through status will expire on December 31, 2003.
Table 14.—Proposed List of Drugs and Biologicals for Which Pass-Through Status Expires CY 2004
HCPCS APC Long descriptor Trade name Proposed pass-through Expiration date A9700 9016 Injection, Octafluoropropane, per 3 ml Optison (single source) 12-31-03 J0587 9018 Injection, Botulinum toxin, type B, per 100 units Myobloc (single source) 12-31-03 J0637 9019 Injection, Caspofungin acetate, 5 mg Cancidas (single source) 12-31-03 J7517 9015 Mycophenolate mofetil, oral per 250 mg CellCept (single source) 12-31-03 J9010 9110 Injection, Alemtuzumab, per 10 mg Campath (single source) 12-31-03 J9017 9012 Injection, Arsenic trioxide, per 1 mg Trisenox (single source) 12-31-03 J9219 7051 Implant, Leuprolide acetate, per 65 mg implant Viadur (single source) 12-31-03 C9201 9201 Dermagraft, per 37.5 sq. centimeters Dermagraft (single source) 12-31-03 2. Proposed Criteria for Packaging Payment for Drugs, Biologicals, and Radiopharmaceuticals
To the maximum extent possible, our intention is to package into the APC payment the costs of any items and supplies that are furnished with an outpatient procedure. We considered several options for packaging in 2004 and propose the following policy:
For 2004, we propose to continue with our policy of paying separately for drugs and radiopharmaceuticals whose median cost per day exceeds $150 and packaging the cost of drugs and radiopharmaceuticals with median cost per day of less than $150 into the procedures with which they are billed.
As discussed in the November 1, 2002 final rule, we received several comments on our methodology of analyzing single line items on drug claims for the 2003 OPPS (67 FR 66772). Commenters stated that our methodology was not consistent with how hospitals bill for certain drugs, biologicals, and radiopharmaceuticals. They believe that this inconsistency affected whether or not a drug, biological, or radiopharmaceutical fell below the $150 median cost per line threshold. Commenters claimed that we incorrectly assumed “that a single administration of a drug was billed as a single line item on a claim.” These commenters alleged that hospitals often bill for certain drugs administered during a single patient encounter using multiple lines on a claim. For example, if 10 units of a drug were administered at a cost of $100 but the hospital billed 2 line items of 5 units at a cost of $50 each, then a methodology that determines median costs on a per line basis would incorporate 2 line items at $50 when the real cost was one line item at $100. If a significant percentage of administrations for this drug was billed in this manner, it would result in median costs that underestimate the true cost of the drug. We agree with this comment. Therefore, we propose to change our packaging methodology to account for such hospital billing practices.
We calculated the median cost per day using claims data from April 1, 2002 to December 31, 2002 for all drugs and radiopharmaceuticals paid under the OPPS that had a HCPCS code during this time period including drugs for which transitional pass-through payment ended on January 1, 2003. Although we included orphan drugs in this methodology, we discuss them separately below. We excluded from these calculations vaccines and blood and blood products that are discussed below. In order to calculate the median cost per day for the drugs, biologicals, and radiopharmaceuticals, we took the following steps:
- After application of the cost-to-charge ratios, we aggregated all line items for a single date of service on a single claim for each drug or radiopharmaceutical. This resulted in creating a single line item with the total number of units and the total cost of a drug or radiopharmaceutical given to a patient in a single day.
- A separate record was then created for each drug or radiopharmaceutical by date of service, regardless of the number of lines the drug or radiopharmaceutical was billed in each claim. For example, drug X is billed on a claim with two different dates of service, and for each date of service, the drug is billed on 2 line items with costs of $10 and 5 units in each line item. In this case, the computer program would have created two records for this drug, and each record would have a total cost of $20 and 10 units.
- For each record created for a drug or radiopharmaceutical, the cost per unit of the drug was calculated. If drug X's descriptor is “per 1 mg” and one record was created for a total of 10 mg (as indicated by the total number of units for the drug on the claim for each unique date of service), then the computer program divided the total cost for the record by 10 to give a per unit cost. This unit cost was then weighted by the total number of units in the record. This was done by generating a number of line items equivalent to the number of units in that particular claim. Thus, a claim with 100 units and a total cost of $200 would be given 100 line items each with a cost of $2 while a Start Printed Page 47997claim of 50 units with a cost of $50 would be given 50 line items each with a cost of $1.
- The unit records with cost per unit greater or less than 3 standard deviations from the geometric mean were then trimmed.
- The remaining unit observations were arrayed and the median cost per unit of the drug or radiopharmaceutical was established.
- Next, the total number of units billed on all claims for the drug or radiopharmaceutical was divided by the total number of unique per-day records for the drug or radiopharmaceutical to arrive at an average number of units per day.
- The average number of units per day for each drug or radiopharmaceutical was then multiplied by the median cost per unit to arrive at its “median cost” per day.
- We then arrayed the median cost per day for all drugs and radiopharmaceuticals in ascending order and examined the distribution.
Many commenters have alleged that hospitals do not accurately bill the number of units for drugs and radiopharmaceuticals. Because this methodology assumes that hospitals bill the number of units accurately, we compared the median cost per day obtained by the above methodology with the median cost per day derived as follows: We aggregated line items as above and created records for each drug and radiopharmaceutical based on date of service. However, instead of calculating costs on a per-unit basis, we simply reduced total charges to total costs for each record and determined the median. This methodology assumes that hospitals record charges more accurately than units. We believed that calculating median costs using the second methodology would address the concerns of commenters and would help us determine whether our median cost per unit calculation accurately reflected the costs of drugs and radiopharmaceuticals.
In most cases, the median costs determined by the two methodologies were similar. Based on this comparison, we believe that calculating median costs per unit accurately reflects the actual cost of the drug or radiopharmaceutical. Furthermore, given the wide variability of doses used for many drugs, we believe that it is important to pay on a “per unit” basis for separately payable drugs and radiopharmaceuticals. For example, many chemotherapy agents are dosed based on both body area and frequency of administration. Thus, a patient with a body area of 2 m squared could receive 600 mg of a drug every 3 weeks, 400 mg every 2 weeks, or 200 mg every week depending on the chemotherapy regimen.
Based on our analyses, we believe that it is reasonable to continue our current policy of packaging drugs and radiopharmaceuticals with a median cost of less than $150 per day. This means that approximately 52 percent of the drugs and radiopharmaceuticals will be packaged and 48 percent of the drugs and radiopharmaceuticals will be paid separately.
We noticed that several drugs and radiopharmaceuticals with median cost per line that were under $150 for the 2003 OPPS have median costs per day that are equal to or greater than $150 based on the data used for the 2004 OPPS. For some other drugs and radiopharmaceuticals, we saw that their median costs per line were equal to or greater than $150 for 2003 OPPS; however, using the 2002 data, their median costs per day fell below $150. These shifts from 2003 to 2004 would affect packaging decisions for a number of drugs.
Given that these variations exist, we propose to provide an exception in 2004 to the packaging rule for drugs and radiopharmaceuticals whose payment status would change as a result of using newer data and a different methodology. As we explain elsewhere in this proposed rule, we expect to use additional 2002 claims data for the establishment of our final policies for CY 2004. Based on this additional data and comments from the public, we intend to re-evaluate whether to package or pay separately for drugs for which the per-day median cost would cross the threshold from 2003 to 2004. For 2004, we propose that:
- Currently packaged drugs and radiopharmaceuticals with median costs per day that are at or above $150 would receive separate payment in 2004.
- Currently separately payable drugs and radiopharmaceuticals with median costs per day that are under $150 would continue to receive separate payment in CY 2004.
- Drugs whose pass-through status would expire on December 31, 2003, and whose median costs per day are under $150 would receive separate payment in 2004.
- Currently packaged drugs and radiopharmaceuticals with median costs per day below $150 would remain packaged in 2004.
We request comments on the methodology we used to determine the median cost per day, on the threshold we propose to use for packaging drugs and radiopharmaceuticals, and on the proposal to pay separately for drugs and radiopharmaceuticals whose payment status would change based on use of recent claims data and our proposed methodology.
Although in the future we expect to expand packaging the costs of drugs and radiopharmaceuticals into the APCs for the services with which they are billed, we request comments on alternatives to packaging.
3. Payment for Drugs, Biologicals, and Radiopharmaceuticals That Are Not Packaged
For the 2003 OPPS, the APC payment rate for separately payable drugs and radiopharmaceuticals with status indicator “K” is based on a relative weight calculated in the same way that the relative weights for procedural APCs are calculated. As with procedural APCs, we observed a decrease in the proposed payment rates for many separately payable drugs and radiopharmaceuticals; therefore, we dampened the payment reduction for APCs whose median costs decreased by more than 15 percent from 2002 to 2003.
In order to establish payment rates for separately payable drugs and radiopharmaceuticals for the 2004 OPPS, we first determined each drug's and radiopharmaceutical's median cost as described above. When we compared the median cost per unit used for determining the 2003 payment rate (for example, the true or dampened median cost) for separately payable drugs and radiopharmaceuticals with their 2004 median cost per unit, we found fluctuations in costs from 2003 to 2004.
CY 2004 median costs decreased more than 15 percent from the corresponding 2003 median cost for many of the separately payable drugs and radiopharmaceuticals. Many of these decreases affected low-volume drugs and radiopharmaceuticals and may be the result of inaccurate coding. Similarly, the 2004 median costs increased by more than 15 percent from the corresponding 2003 median cost for approximately 12 (mostly low volume) drugs and radiopharmaceuticals. For many of the high-volume, separately payable drugs and radiopharmaceuticals, the 2004 median costs increased or decreased by less than 15 percent as compared to the corresponding 2003 median cost. We solicit comments concerning the reasons for the fluctuations in median costs from 2003 to 2004. We are interested in determining whether these fluctuations reflect changes in the market prices of these drugs and radiopharmaceuticals or problems in the hospital claims data (for example, inaccurate coding, improper Start Printed Page 47998charges) that we use for setting payment rates.
We considered several options to address the fluctuations in median costs for separately payable drugs and radiopharmaceuticals. One option was to base payment on our 2002 claims data without modification. A second option was to adopt for 2004 the same methodology that we used to moderate payment decreases in 2003.
A third option was to create drug and radiopharmaceutical cost bands for separately payable drugs and radiopharmaceuticals (for example, all drugs with median costs per unit of $60.01 to $70 would be assigned a proxy median of $70), which would be based on their median costs calculated using 2002 claims data. We considered adopting two sets of cost bands: one for separately payable drugs and biologicals other than radiopharmaceutical agents and one for separately payable radiopharmaceutical agents. The cost bands for drugs and radiopharmaceuticals would be assigned based solely on cost, with no consideration given to the therapeutic use or chemical composition of the drug.
When we applied the dampening methodology used for the 2003 OPPS to drugs and radiopharmaceuticals that will be separately payable in 2004, we observed that this methodology did not sufficiently limit payment reductions for many of the drugs and radiopharmaceuticals with large decreases in median cost from 2003 to 2004. Therefore, a fourth option that we considered and are proposing for 2004 is a variation of the methodology used for the 2003 OPPS. For separately payable drugs and radiopharmaceuticals whose 2004 median costs decreased by more than 15 percent from the applicable 2003 median cost, we propose to limit the reduction in median costs to one fourth of the difference between the value derived from claims data and a 15 percent reduction (for example, for a drug whose cost decreased by 35 percent from the applicable 2003 median cost, the allowed reduction from 2003 to 2004 would be 15 percent + (1/4 times 35−15) percent = 20 percent). For separately payable drugs and radiopharmaceuticals whose median costs decreased by less than 15 percent from 2003 to 2004, we propose to establish their payment rates using the median costs derived from the 2002 claims data. We believe that it is appropriate to determine payment rates based on our claims data where those data show the cost of drugs and radiopharmaceuticals to be stable over 2 years. In cases where costs show significant fluctuation, we believe it is appropriate to mitigate the potential for underpayment. We believe our proposal bases payment rates on our claims data as required by statute and addresses the potential for making underpayments. However, based on more complete claims data we expect to have for the final rule and on the comments from the public, we will re-evaluate the appropriateness of adjusting median costs for drugs for which median costs would decline in 2004.
We also propose a separate payment policy, which is described below, for drugs, biologicals, and radiopharmaceuticals that have generic alternatives approved by the Food and Drug Administration (FDA) between October 2001 and December 2002.
We solicit comment on both our proposed methodology and payment rates for separately payable drugs and radiopharmaceuticals for 2004. Commenters who disagree with the proposed rate for a drug or radiopharmaceutical should submit verifiable information that shows our payment rate does not reflect the price that is widely available to the hospital market. Thus, information should demonstrate actual, market-based pricing of drugs and radiopharmaceuticals and should be prices at which a broadly based, national sample of hospitals are routinely able to procure the drug or radiopharmaceutical. We do not consider the published average wholesale price (AWP) for a drug to be an indication of its market-based price.
4. Proposed Payment Methodology for Drug Administration
Currently, payment for drug administration is made separately using HCPCS codes Q0081, Q0083, Q0084, Q0085, 90782, 90783, 90784, and 90788 with certain drugs packaged into the median cost for administration. The amount packaged should reflect the costs of the packaged drugs in relation to the frequency with which they are administered. Each of these codes is to be reported once per visit no matter how many drugs are administered. When a hospital administers only packaged drug(s), the appropriate HCPCS code is reported once and no separate payment is made for the drugs. When a hospital administers only separately payable drug(s) the appropriate HCPCS code is reported once; in addition, separate payment is made for the drugs. Because the payment for administration includes payment for packaged drugs, a hospital receives inappropriate reimbursement every time it administers a separately payable drug.
In order to facilitate accurate payments for drugs and drug administration, we are considering whether to make several changes in our current payment policy with regard to payment for Q0081, Q0083, Q0084, and Q0085. We are not considering changes to payment policy for HCPCS codes 90782, 90783, 90784, and 90788 at this time, although we are interested in receiving comments regarding payment for these codes.
We are proposing to continue our current policy of packaging drugs and radiopharmaceuticals that cost less than $150 per episode of care into the APC with which they are associated (for example, nuclear medicine scans, drug administration).
We are considering whether and how to make different payments to hospitals for administration of packaged drugs and administration of unpackaged drugs. We would like to ensure that when a hospital administers a separately paid drug, it would receive payment for the drug and the drug administration, but not for any drugs packaged into the administration. We also would like to ensure that the payments that are made for administration of packaged drugs are appropriate for the costs of the drugs as well as the cost of the administration.
In order to achieve the above objectives, we considered several coding and payment options and analyzed our claims data for the period April 1, 2002 through December 31, 2002.
Summary of Findings and Alternatives
As explained in greater detail below, we carefully examined data for administration of packaged and separately paid drugs billed under Q0081, Q0083, Q0084 and Q0085. We found that the data showed that paying based on a median cost for the APC for each of the current four codes generally results in underpayment when packaged drugs are billed on the claim and overpayment when separately paid drugs are billed on the claim. In the sections that follow, we discuss our data analysis in detail. We also discuss four alternatives to the current codes and APC payments in detail. In summary, those alternatives are:
1. Maintain the current codes and APCs with payments based on the median costs of all claims in the APC.
2. Eliminate the four current codes and create eight new codes to enable hospitals to report that they administered a packaged drug or a separately paid drug. We would pay a different APC amount for each of the Start Printed Page 47999eight new codes. The new code descriptors would parallel those of the current codes. This would retain the concept of using one code rather than two when both “infusion” and administration of chemotherapy by “other than infusion” occurred (as exists under the current codes). Coders would have to look up the drugs administered to know which code to bill.
3. Eliminate the four current codes and create six new codes to enable hospitals to report that they administered a packaged drug or separately paid drug and pay a different APC amount for each of the six new codes. In this option, no code equivalent to Q0085 would exist. Therefore, when administering chemotherapy by “infusion” or “other than infusion,” hospitals would report two codes, one for administration by “infusion” and one for administration by “other than infusion.” This would eliminate the need to use one code when both infusion and another method of administration of chemotherapy occurred. Coders would have to look up the drugs administered to know which code to bill.
4. Retain three of the current codes (Q0081, Q0083, and Q0084) but delete Q0085 (infusion and other administration of chemotherapy) and modify the OCE to use the drugs billed on the claim to assign an APC for packaged drugs or an APC for separately paid drugs. No drug administration code could be paid without a drug also being reported on the claim.
Claims Data Analysis
Using our methodology for creating single procedure claims, we looked at all single claims for HCPCS codes Q0081, Q0083, Q0084, and Q0085. We created separate files for each HCPCS code and further subdivided those into four subgroups for each code. The subgroups were for the HCPCS code billed (1) without any HCPCS for drugs; (2) with HCPCS only for packaged drugs; (3) with HCPCS only for separately payable drugs; and (4) with HCPCS for both packaged and separately packaged drugs.
We then reviewed the median costs for each of these subgroups and determined that we could use these subgroups to create two median costs for each existing administration HCPCS code (Q0081, Q0083, Q0084, and Q0085). See Table 15 for median cost data for HCPCS subgroups. We used claims where packaged drugs appeared (subgroups W and X) to create a median cost for administration of packaged drugs. We used claims without HCPCS codes for drugs and claims with HCPCS for only separately payable drugs (subgroups Y and Z) to create a median cost for the administration of separately payable drugs.
We believe that the resultant median costs accurately reflect the costs of packaged drugs and the costs of administration of separately payable drugs. It is obvious that there are significant differences in median costs of services within the same drug administration code, depending on whether a packaged or separately paid drug was administered, the type of drug administered (chemotherapy versus non-chemotherapy) and the route of administration (infusion versus other route or both).
Table 15.—Median Costs by Types of Drugs on the Claim
HCPCS Description Neither packaged nor separate drug (W) With packaged drug but no separate drug (X) No packaged drug but with separate drug (Y) Both packaged drug and separate drug (Z) Q0081 Infusion therapy other than chemo $104.97 $276.98 $117.89 $231.56 Q0083 Chemotherapy other than infusion 35.16 119.88 42.26 188.98 Q0084 Chemotherapy by infusion 127.34 250.97 159.01 265.46 Q0085 Chemotherapy by both infusion and other 97.11 154.01 203.43 318.05 We then calculated medians for circumstances in which there were neither packaged nor separately paid drugs on the claim, and there were no packaged drugs, but there were separately paid drugs on the claim (both W and Y). We also calculated medians for circumstances in which there were packaged drugs on the claim (both X and Z). The resultant medians and the number of claims used to set the medians appear in Table 16 below with the HCPCS medians for all claims (packaged and separately paid drugs together).
Table 16.—Numbers of Claims and Medians by Code
HCPCS code Number of claims with packaged drugs Median of claims with packaged drugs Number of claims with no drug or separately paid drug Median for claims with no drug or separately paid drug HCPCS Median for all claims for 2004 Q0081 19,116 $274.47 280,939 $107.93 $115.11 Q0083 8,681 125.86 24,710 39.10 48.25 Q0084 34,085 257.57 23,933 142.38 205.70 Q0085 17,749 303.87 3,242 126.55 267.63 Review of the data reveals that the median costs for all claims for Q0081 and Q0083 more closely reflect the median cost of claims where no drug or only separately payable drugs were on the claim because that subset of claims represents the vast majority of claims for Q0081 and Q0083. Therefore, if we do not differentiate payment for Q0081 and Q0083 based on whether or not a packaged drug was administered, we would underpay the cases in which a packaged drug was administered. The opposite is true of Q0084 and Q0085 in which more claims reflect packaged drugs than separately paid drugs, and, therefore, the claims with packaged drugs will determine the median cost for the code, thus overpaying cases in which the drug is separately paid. Start Printed Page 48000
We also examined the mean and median number of drugs billed with each of the Q codes when only packaged drugs were billed, only separately paid drugs were billed, and both packaged and separately payable drugs were billed (see Table 17). With the exception of Q0085, we believe the data on the number of drugs billed per claim is consistent with the cost data in Table 15. Again, with the exception of Q0085, we are confident that the cost of packaged drugs is accurately reflected in the median cost of the codes for administration of packaged drugs. We are also confident that the median cost for administration of separately payable drugs is appropriate.
Table 17.—Numbers of Drugs Billed per Specified Codes
HCPCS Mean number of drugs packaged Median number of drugs packaged Mean number of drugs separately paid Median number of drugs separately paid Q0081 1.05 1 1.01 1 Q0083 1.77 2 1.02 1 Q0084 1.68 1 1.10 1 Q0085 2.33 2 1.19 1 We have some concerns about the cost data for Q0085. The cost for administration of only separately payable drugs is less than the comparable cost for Q0084 ($126 vs. $142). This is counterintuitive as Q0085 describes administration of, at minimum, two drugs, while Q0084 describes administration of one or more drugs. These cost data for Q0085 also raise the concern that proper usage of the code is not understood by hospitals and, therefore, the data are not being used properly.
We believe our analysis supports the need for creating different payment amounts for the administration of packaged drugs and for the administration of separately payable drugs (and, in the case of Q0081, the administration of no drug).
While reviewing options for coding and payment for drug administration we kept five major considerations in mind:
1. Ensuring beneficiary access to drugs.
2. Making accurate payment for both packaged and separately payable drugs.
3. Collecting sufficient data on drugs and drug administration to ensure that future policy development in this area will be properly informed.
4. Facilitating proper coding by hospitals.
5. Avoiding complicated billing rules and hospital burden to the extent possible.
We thought that three basic coding and payment options were available:
1. Continuing the current coding structure and payment policy (for example, a single payment for drug administration per day no matter how many drugs were administered). (Option 1 below).
2. Creation of new codes and new payment policy to describe drug administration (for example, different sets of codes for administration of packaged and separately payable drugs along with allowance for more than one payment for drug administration per day). (Options 2 and 3 below).
3. Continuation of the current drug administration codes but creating new payment policy (for example, allowance for more than one payment for drug administration per day).
After reviewing these three basic options, we developed more fully four specific options. Under all of these options, hospitals would be required to bill all drugs using the HCPCS code for the drug.
Moreover, although we have included an expanded option for Q0085 (Chemotherapy by both infusion and other technique) in option 2, and have retained Q0085 in option 1, we have serious concerns about the extent to which Q0085 is used correctly and about the extent to which the data for this code validly reflect the costs of an identifiable service. Hence, we are particularly interested in comments regarding whether we should eliminate Q0085. (Option 4 below).
Option 1—Retain the current codes and continue to pay on a per-visit basis, based on median costs for each code regardless of whether or not packaged or separately paid drugs are administered.
We would retain the current codes, use all claims for these services to set a relative weight, and make a single payment based on the median costs for the code regardless of whether or not packaged or separately paid drugs are administered. This would result in significant underpayment for administration of packaged drugs because the largest volume of claims with this code are either for administration of no drug (Q0081) or for drugs that are separately paid (and have no packaged drug costs). See Table 16 for the median costs determined on the basis of all claims for the existing codes. We would require hospitals to report HCPCS codes for both packaged and separately payable drugs in order to inform future policy decisions in this area.
We do not propose payment amounts for this option because the budget neutrality scalar would be different under this proposal than under option 2 (which was used in the scalar and impact analysis).
Option 2—Create eight new drug administration codes to enable hospitals to report administration of both packaged and separately payable drugs.
We would create two new sets of HCPCS codes to describe administration of packaged and separately payable drugs. Each of the eight codes would have its own APC payment. The descriptions and median costs for these proposed codes would be as follows:
Table 18.—Median Costs of Proposed G Codes Under Option 2
HCPCS 2004 APC 2004 SI Description Median costs GXXX1 0382 S Infusion of packaged non-cancer chemotherapy drug(s), per day $274.47 GXXX3 0376 S Administration of packaged cancer chemotherapy drug(s) by other than infusion, per day 125.86 Start Printed Page 48001 GXXX4 0378 S Administration of packaged cancer chemotherapy drug(s) by infusion, per day 257.57 GXXX5 0380 S Administration of packaged cancer chemotherapy drugs by both infusion and other than infusion, per day 303.87 GYYY1 0383 S Infusion of separately payable non-cancer chemotherapy drug(s) or non-drug infusion therapy, per day 107.93 GYYY3 0377 S Administration of separately payable cancer chemotherapy drug(s) by other than infusion, per day 39.10 GYYY4 0379 S Administration of separately payable cancer chemotherapy drug(s) by infusion, per day 142.38 GYYY5 0381 S Administration of separately payable cancer chemotherapy drugs by both infusion and other than infusion, per day 126.55 The median costs for administration of packaged drugs would be determined from claims that contain at least one packaged drug and the median costs for administration of separately payable drugs (or no drugs in the case of Q0081) would be determined from claims that contained only separately payable (or no) drugs.
Although payment would not depend on accurate reporting of HCPCS codes for drugs, we would require hospitals to use HCPCS codes for both packaged and separately payable drugs in order to ensure that we had reliable data upon which to base future relative weights for these services. As described under option 4, we would create six lists of drugs in order to facilitate proper payment in the future.
Hospitals would report the appropriate code for the type of drug administered and the route(s) of administration. In this option, hospitals could bill for administration of both chemotherapy agents and administration of non-chemotherapy agents (or non-drug infusions). We would permit a maximum of one chemotherapy and one non-chemotherapy administration per day.
We are concerned that creation of these codes could require complicated billing rules and cause burden to hospitals. We would need to specify how to bill different combinations of route and category of drug (for example, two infused drugs, one pushed drug, antiemetics, and hydration). Because hospital billers would have to review both the type of administration and the type of drug administered to determine the correct code to bill, we are concerned about the potential for miscoding (with resultant mispayment) under this option, and we solicit comments on both of these issues. In some cases, this additional coding burden might result in less payment for administration (particularly Q0081).
Under this option, all codes would have a status indicator of S, and no multiple procedure reductions would apply.
This option is modeled for purposes of the budget neutrality scalar and the impact analysis (see Table 18).
Option 3—Create six new drug administration codes to enable hospitals to report administration of both packaged and separately payable drugs.
This option is similar to option 2 except that we would eliminate the codes used to describe administration of chemotherapy by both infusion and other techniques. Where a code is billed with a packaged drug suitable for the code, we would pay the APC for the packaged drug. Where both a packaged drug and a separately paid drug were administered via the same route of administration (and therefore only one code was billed), we would pay the APC only for the administration of the packaged drug and would pay separately for the separately paid drug and would not pay the APC for administration of the separately paid drug. Under this option, we would allow up to three payments for administration of drugs or infusions. We would allow one payment for non-chemotherapy drugs/infusions (for example, antiemetics, fluids), one payment for chemotherapy administered by infusion, and one payment for chemotherapy administered by “other than infusion.” As stated above, we would not allow payment for administration of packaged chemotherapy drugs by infusion and payment for administration of separately payable chemotherapy by infusion. This coding scheme would allow us to more accurately recognize the true costs of administering multiple drugs. For example, there are some economies of scale when infusing two or more drugs (for example, only one I. V. line needed), but each drug requires its own mixing and nursing care. This option would allow up to three payments for administration of drugs or non-drug infusion, thereby recognizing the unique costs of administering each drug while not making duplicate payment. In order to ensure that we do not make duplicate payment for patients receiving chemotherapy drugs and non-chemotherapy drugs (and/or hydration), we would pay GXXX1 and GYYY1 at 50 percent of their payment when one of these codes is paid in addition to chemotherapy administration (GXXX3, GXXX4, GYYY3, and GYYY4). This is because we believe there are economies of scale achieved for multiple drug administrations and that the additional resources used to provide non-chemotherapy treatment are minimal.
Following are examples of how payment would be made:
- When both packaged and separately payable chemotherapy drugs are infused, we would make payment for GXXX4—Administration of packaged chemotherapy drugs by infusion and for each separately payable chemotherapy drug, but we would not make payment for GYYY4—Infusion of separately payable chemotherapy drugs.
- When packaged chemotherapy drugs are pushed and infused, and separately payable chemotherapy drugs are infused, we would make payment for GXXX3 and GXXX4 and for each separately payable chemotherapy drug, but we would not make payment for GYYY4.
- When packaged chemotherapy drugs are infused and pushed; separately payable chemotherapy drugs are infused and packaged; and separately payable non-chemotherapy drugs are infused (for example, antiemetics), and hydration is given; we would make payment for GXXX3, GXXX4, each separately infused chemotherapy drug, GXXX1, and each separately payable non-chemotherapy drug. We would not make payment for GYYY1 or GYYY3. Note that payment for GXXX1 in this case would be made at 50 percent because it was billed with chemotherapy (if it was billed without Start Printed Page 48002chemotherapy, then payment would be made at 100 percent).
Medians for these codes would be as follows:
Table 19.—Median Costs Under Option 3
HCPCS 2004 APC 2004 SI Description Median costs GXXX1 XXX1 T Infusion of packaged non-cancer chemotherapy drug(s), per day $274.47 GXXX3 XXX3 S Administration of packaged cancer chemotherapy drug(s) by other than infusion, per day 125.86 GXXX4 XXX4 S Administration of packaged cancer chemotherapy drug(s) by infusion, per day 257.57 GYYY1 YYY1 T Infusion of separately payable non-cancer chemotherapy drug(s) or non-drug infusion therapy, per day 107.93 GYYY3 YYY3 S Administration of separately payable cancer chemotherapy drug(s) by other than infusion, per day 39.10 GYYY4 YYY4 S Administration of separately payable cancer chemotherapy drug(s) by infusion, per day 142.38 As modeled, these codes would have status indicator S (except as described above for GXXX1 and GYYY1).
Similar to option 2, we would require hospitals to report HCPCS codes for packaged and separately payable drugs to ensure that we have reliable data upon which to base future relative weights for these services. As described under option 4, we would create six lists of drugs in order to facilitate proper coding and payment in the future.
We do not propose payment amounts for this option because the budget neutrality scalar would be different under this proposal than under option 2 (which was used in the scalar and impact analysis).
Option 4—Use of codes Q0081, Q0083, and Q0084 and deletion of Q0085 with creation of logic in the outpatient code editor (OCE) to enable differential payment for administration of packaged and separately payable drugs.
This option is similar to option 3 in terms of payment policy. However, instead of creating six new codes, hospitals would continue to report codes Q0081, Q0083, Q0084, and the HCPCS codes for all packaged and separately payable drugs. We would delete Q0085 in order to simplify hospital reporting and to facilitate creation of payment logic in the OCE.
We would create six lists of drugs (see Addenda L, M, N, O, P, Q): packaged chemotherapy agents administered by other than infusion, separately payable chemotherapy agents administered by other than infusion, packaged chemotherapy agents administered by infusion, separately payable chemotherapy agents administered by infusion, packaged non-chemotherapy agents administered by infusion, and separately payable non-chemotherapy agents administered by infusion. These lists would be coded into the OCE, and would be updated quarterly by program memoranda. We realize that a few drugs may be administered by both infusion and other techniques. In these lists, we would assign each drug to its predominant form of administration in a hospital outpatient setting. If we could not determine whether a drug was infused or administered by a technique other than infusion (for example, we receive a claim with Q0083 and Q0084 and two drugs that may be administered by either infusion or another technique), we would associate each drug with its predominant administration code.
We would create logic in the OCE that would base payment on the combination of administration and drug codes on the claim but would only allow one unit of each administration type as described in option 3. The medians for the APCs to which OCE would assign the codes are described in Table 20.
Table 20.—Medians for APCS Under Option 4
Drug administration codes on the claim Nonchemo drug, packaged list (subgroup X) Chemo drug, packaged list (subgroup W) Nonchemo drug, separately paid list or no drug billed (subgroup Z) Chemo drug, separately paid list (subgroup Y) Admin APC APC median Applicable addenda Q0081 X A $274.47 L Q0081 X B 107.93 M Q0083 X C 125.86 N Q0083 X D 39.10 O Q0084 X E 257.57 P Q0084 X F 149.38 Q The payment policy is identical to the policy described in option 3 including the discount for Q0081 when billed with Q0083 and/or Q0084. Although this option would not require hospitals to change coding of drug administration it would, unlike options 2 and 3, require accurate coding of HCPCS codes for drugs in order to ensure proper payment. Additionally, we would revise the definitions of the administration codes to “per day” instead of “per visit.”
Similar to option 3, we would make payment for up to three drug administrations per day, if appropriate. Where a code is billed with a packaged drug suitable for the code, we would pay the APC for the packaged drug. Where both a packaged drug and a Start Printed Page 48003separately paid drug were administered via the same route of administration (and therefore only one code was billed), we would pay the APC only for the administration of the packaged drug and would pay separately for the separately paid drug and would not pay the APC for administration of the separately paid drug. In no case would we pay for more than one unit of an administration code.
Under options 2, 3, and 4, we would return a claim to the provider when a chemotherapy administration code was reported without a HCPCS code for a chemotherapy drug. Therefore, it is very important that commenters advise us as to whether there are any cancer chemotherapy drugs that are not included in Addenda L, M, N, O, P, or Q. Specifically, we solicit comments as to whether there are any cancer chemotherapy drugs that do not have HCPCS codes.
We do not propose payment amounts for this option because the budget neutrality scalar would be different under this proposal than under option 2 (which was used in the scalar and impact analysis). We solicit comment on each option described above.
General Billing Instructions
Any previous regulatory or sub-regulatory guidance notwithstanding, we propose to implement the following billing rules under any of the above payment options:
(1) Q0081 may not be used to bill separately for the hanging of a bag of solution for which the sole purpose is to administer chemotherapy drugs; that charge should be billed as part of the charge for Q0084 or Q0085.
(2) Q0081 may not be billed when it is an integral part of another procedure. In those cases, the charge for the procedure should reflect the costs of the infusion therapy, either as part of the charge for the HCPCS code or as a revenue code charge (for example, hydration or drug administration during a surgical procedure performed under general anesthesia).
(3) Q0081, Q0083, and Q0084 should not be used to bill for the administration of radiopharmaceuticals that are administered as part of diagnostic or therapeutic nuclear medicine procedures. In those cases, the radionucliide should be billed with the appropriate nuclear medicine HCPCS code.
(4) Q0081, Q0083, and Q0084 may not be used to report the transfusion of blood, platelets, or any other blood products. Those transfusions should be reported by use of the appropriate HCPCS code(s) in APC 0110.
5. Generic Drugs, and Radiopharmaceuticals
In general, hospital acquisition costs for drugs, biologicals, and radiopharmaceutical agents with generic competitors are lower than the acquisition costs for sole source or multi-source drugs. In order to ensure that Medicare recognizes these lower costs in a timely manner, we are proposing a new method of calculating payment amounts for drugs, biologicals, and radiopharmaceuticals that are separately paid under the OPPS and for which the Food and Drug Administration (FDA) has recently approved generic alternatives when we determine our claims data do not reflect the costs of the generic alternatives.
Because many hospitals have long term purchasing arrangements for drugs and radiopharmaceuticals, we believe that there is generally a 12-month lag between the time that generic items are made available and when our claims data will accurately reflect the costs associated with the availability of the generic alternative. Therefore, during the interval between FDA approval of a generic item and the time when we would reasonably expect claims data to reflect the cost of generic alternatives, we propose to adopt the following methodology to price the affected drugs, biologicals, and radiopharmaceuticals under the OPPS.
We would first identify items approved for generic availability by the FDA during the 6 months before the first day of the claims period we would use as the basis for an annual OPPS update. Where we determine that our claims data do not reflect the costs of generic alternatives for a separately payable drug, biological, or radiopharmaceutical, we propose to base our payment rate on 43 percent of the AWP for the drug, biological, or radiopharmaceutical. As described in the 2003 OPPS rule (67 FR 66768), the ratio of hospital acquisition cost, on average, to AWP for multisource drugs with generic competitors equals 0.43. We believe that using this ratio would allow us to appropriately calculate the costs that hospitals incur when purchasing generic drugs or radiopharmaceuticals. When we determine that our claims data accurately reflect the cost of the generic alternative(s), we would use the claims data to set payment rates in preference to 43 percent of AWP for the drug or radiopharmaceutical.
We considered another payment option where we would base our payment rate on the lower of: (1) The median cost (with dampening if applicable) based on claims data; or (2) the Federal Supply Schedule price. We are not proposing this policy because we believe we would not be able to calculate payment rates that are close to the actual hospital acquisition costs of generic alternatives since the Federal Supply Schedule represents prices that are lower than the prices paid by most hospitals. Also, median costs from the claims data would not reflect the actual cost of generics because of the time lag described above.
To apply this payment methodology to the 2004 OPPS update, we reviewed FDA approvals for generic drugs, biologicals, and radiopharmaceuticals issued between October 2001 and December 2002. We found six drugs, which we propose to be separately paid under the 2004 OPPS that had generic alternatives approved during that time. These drugs are: Daunorubicin, Bleomycin, Pamidronate, Paclitaxel, Ifosfomide, and Idarubicin. Table 21 shows the dates when the FDA approved generic alternatives for these drugs.
We understand that there is a wide range of utilization for these drugs in the OPPS and that price reductions for generic drugs will depend on their utilization and the types of illnesses for which they are used. However, we would not expect claims data from April 1, 2002 through December 31, 2002 to reflect fully the availability of the generic alternatives.
Table 21 shows the median cost for these six drugs as determined by claims data (with any adjustments for APCs that decreased in median cost by more than 15 percent from 2003 to 2004) and their costs at 43 percent of AWP as determined under the July 2003 update of the Medicare Single Drug Pricer.
We solicit comments on this proposed method of calculating payment for drugs, biologicals, and radiopharmaceuticals for which generic alternatives have recently been approved. Specifically, we are interested in comments concerning our proposed methodology for identifying these items, whether we properly identified all the items, and whether our proposed payment policy for these generic alternatives is appropriate.Start Printed Page 48004
Table 21.—Proposed List of Separately Payable OPPS Drugs With Generic Alternatives Approved Between October 2001 and December 2002
APC Description Date of Generic Approval by the FDA 43% of AWP 2004 Median cost (with dampening if applicable) 0832 Idarubicin hcl injection May 2002 $190.08 $188.25 0831 Ifosfomide injection May 2002 68.07 115.46 0863 Paclitaxel injection May 2002 74.27 116.61 0730 Pamidronate disodium May 2002 120.34 184.40 0857 Bleomycin sulfate injection October 2001 130.98 169.28 0820 Daunorubicin hcl injection November 2001 35.46 89.65 6. Orphan Drugs
In response to last year's proposed rule, many commenters explained that many orphan drugs were life-saving therapies used solely for the treatment of rare disorders where no other treatment was available. They further stated that many of these drugs would be received by very few Medicare beneficiaries and that if we packaged these drugs into other procedures, our payment rates would be insufficient to recognize their high cost, thus impairing the access of beneficiaries who needed the drugs. These commenters also stated that the claims data we used to set payment rates for 2003 did not accurately reflect the cost of these drugs. We shared these concerns, and in the November 1, 2002 final rule (67 FR 66772), we set forth the following payment policy:
We identified orphan drugs that are used solely for orphan conditions by applying the following criteria:
- The drug is designated as an orphan drug by the FDA and approved by the FDA for treatment of only one or more orphan condition(s).
- The current United States Pharmacopoeia Drug Information (USPDI) shows that the drug has neither an approved use nor an off-label use for other than the orphan condition(s). Payment for drugs that met these criteria was made outside of OPPS under reasonable cost.
In that same rule, we identified four orphan drugs (J0205 Injection, alglucerase, per 10 units; J0256 Injection, alpha 1-proteinase inhibitor, 10 mg; J9300 Gemtuzumab ozogamicin, 5 mg; and J1785 Injection, imiglucerase, per unit) as meeting these criteria. Therefore, we excluded them from payment under OPPS and paid for them at reasonable cost in 2003.
We received several comments in response to the final rule, stating that we had not identified all drugs that qualified for special payment as orphans under our criteria. After reviewing these comments, we have identified 7 additional drugs that meet our criteria. These drugs are: J2355 Injection, oprelvekin, 5 mg; J3240 Injection, thyrotropin alpha, 0.9 mg; J7513 Daclizumab parenteral, 25 mg; J9015 Aldesleukin, per vial; J9160 Denileukin diftitox, 300 mcg; J9216 Interferon, gamma 1-b, 3 million units; and Q2019 Injection, basiliximab, 20 mg.
We have now identified a total of 11 drugs that meet our orphan drug criteria, and we expect to identify more such drugs in the future. Last year's policy was intended to narrowly target a very small number of drugs received by very few Medicare beneficiaries in order to ensure beneficiary access to life saving therapies. The aggregate number of Medicare beneficiaries who will receive the 11 drugs that meet our criteria for orphans is significantly higher than the number who receive the 4 we identified last year. Furthermore, as we identify more drugs that meet our criteria, we expect the number of beneficiaries who receive these drugs to grow. As the number of beneficiaries who receive these drugs increases, so do total payments for the drugs. Therefore, we no longer believe that paying for these drugs at reasonable cost, outside of OPPS, is appropriate. Our goal is to pay for as many hospital outpatient department (OPD) services as possible under the OPPS system. We believe that any payments made outside of OPPS should remain relatively small and, as in the case of vaccines, be made because it is unlikely our claims data will reflect the cost of the item or service (see discussion of vaccines below).
In the case of orphan drugs, we believe that our claims data for April 1, 2002 through December 31, 2002 do reflect the cost of orphan drugs, and we are concerned about the potential of making ever increasing payments for these drugs outside of the OPPS. Furthermore, we believe that many of the concerns expressed by commenters would be addressed if we continue to make separate payment for these drugs.
Therefore, we propose the following payment policy for orphan drugs:
- We propose to continue using the same criteria to identify orphan drugs used solely for an orphan condition under the OPPS.
- We propose to discontinue retrospective cost payments and to make prospective payments under the OPPS for those identified orphan drugs.
- We propose to base payments on the same methodology we use to pay for other drugs including any limitation on payment reductions (as described above).
- We propose to make separate payment for orphan drugs and place them in APCs.
We solicit comment on each of these proposals and request that commenters submit information meeting the same criteria as comments for other drugs (as discussed above).
7. Vaccines
Outpatient hospital departments administer large amounts of the vaccines for influenza (flu) and pneumococcal pneumonia (PPV), typically by participating in immunization programs. In recent years, the availability and cost of some vaccines (particularly the flu vaccine) have fluctuated considerably. As discussed in the November 1, 2002 final rule (67 FR 66718), we were advised by providers that OPPS payment was insufficient to cover the costs of the flu vaccine and that access of Medicare beneficiaries to flu vaccines might be limited. They cited the timing of updates to OPPS rates as a major concern. They said that our update methodology, which uses 2-year-old claims data to recalibrate payment rates would never be able to take into account yearly fluctuations in the cost of the flu vaccine. We agreed with this concern and decided to pay hospitals for influenza and pneumococcal pneumonia vaccines based on a reasonable cost methodology. As a result of this change, hospitals, home health agencies (HHAs), and hospices, Start Printed Page 48005which were paid for these vaccines under OPPS in 2002 are being paid at reasonable cost for these vaccines in 2003. We are aware that access concerns continue to exist for these vaccines; therefore, we propose to continue paying for influenza and pneumococcal pneumonia vaccines under reasonable cost methodology.
8. Blood and Blood Products
From the onset of the OPPS, we have made separate payment for blood and blood products in APCs rather than packaging them into payment for the procedures with which they were administered. As we explained in the April 7, 2000 final rule (65 FR 18449), wide variations in patient requirements convinced us that we should pay for these items separately rather than packaging their costs into the procedural APCs. Moreover, the Secretary's Advisory Council on Blood Safety and Access recommended that blood and blood products be paid separately to ensure that we did not create any incentives that were inconsistent with the promotion of blood safety and access. Therefore, we propose to continue to pay separately for blood and blood products.
As described in the November 1, 2002 final rule (67 FR 66773), we applied a special dampening option to blood and blood products that had significant reductions in payment rates from 2002 to 2003. For 2003, we limited the decrease in payment rates for blood and blood products to approximately 15 percent.
After careful comparison of the 2003 dampened medians with the 2004 medians from our claims data, we believe that establishing payment rates based on the 2004 median costs would, for many blood and blood products, result in payments that are significantly lower than hospital acquisition costs. In order to mitigate any significant payment reductions and to minimize any compromise in access of beneficiaries to these products, we propose to limit the decrease in payment rates for blood and blood products from 2003 to 2004 by approximately 10 percent.
This is different than the amount by which we limited payment decreases last year because when we applied the dampening methodology used for the 2003 OPPS to blood and blood products, we observed that it did not sufficiently limit payment reductions for the blood and blood products with large decreases in median cost from 2003 to 2004. Therefore, we are proposing for 2004 a variation of the methodology used for the 2003 OPPS because we believe that a 10 percent limit in the decrease in payment rates for blood and blood products would better reflect hospital acquisition costs, ensure appropriate reimbursement to hospitals, and enable continued beneficiary access to blood and blood products.
The list of APCs containing blood and blood products can be found in the November 1, 2002 final rule (67 FR 66750). We note that the APCs for these products are intended to make payment for the costs of the products. Costs for storage and other administrative expenses are packaged into the APCs for the procedures with which the products are used.
We solicit comment on this proposal especially from hospitals. We are especially interested in comments that include verifiable information about the widely available acquisition cost of commonly used blood and blood products.
9. Intravenous Immune Globulin
Following publication of the proposed rule on August 9, 2002, we received comments urging us to reclassify intravenous immune globulin (IVIG) as a blood product. After carefully reviewing these comments with our medical advisors, we decided to make final our proposal to classify immune globulin as a biological, subject to the same payment policy we implemented for other drugs and biologicals. Our reasons were set forth in the November 1, 2002 final rule (67 FR 66774). Since implementation of the 2003 OPPS update, we have received further comments on this decision. These commenters continue to assert that we should make special payment provisions for IVIG and reclassify IVIG as a blood and blood product. They have expressed particular concern about the potentially negative impact of our payment policy for IVIG on patient access, especially for those individuals who have primary immune deficiency diseases.
We appreciate the concerns regarding our decision to pay for IVIG in accordance with the payment methodology we applied to other drugs and biologicals in the 2003 update of the OPPS. We have reviewed the claims data that are the basis for the payment rates in this proposed rule, and our analysis reveals that IVIG would be separately payable in 2004. The claims data for IVIG are robust, and the most recent claims data, when compared with claims data used in earlier updates of the OPPS suggest that hospital costs are consistent and that hospitals are billing accurately for these products. Therefore, we believe that payment for these products is appropriate using the methodology we propose to implement for other drugs and biologicals. Therefore, we propose to continue to classify IVIG as a biologic. We solicit comments on this proposal.
10. Drug and Device Coding
We propose to require hospitals to report individual codes for all drugs and devices used during the episode, including those that are packaged.
Last year (CY 2003), the pass-through status of many drugs and devices expired. These drugs and devices were packaged, consistent with the fundamental principles of a prospective payment system. By packaging the costs of items and services into the payment for the primary procedure or service with which they are associated, we encourage hospital efficiency and provide hospitals with the ability to manage their resources with maximum flexibility. We believed that an additional advantage of increased packaging would be that hospitals would no longer need to report codes for the individual items and services included in the package. While we continue to support packaging to the greatest extent possible, the loss of coding information on claims creates some obstacles to accurate rate-setting.
The data for 2002 that we are using for CY 2004 rate-setting still have considerable drug and device coding information. However, for the CY 2005 OPPS update, for which 2003 data would be used, there will be much less information regarding specific drug and device costs. We do not expect to have as much Medicare claims information on which to base certain decisions such as which drugs to remove from packaged status and pay separately.
This concerns us and has led us to consider the need for drug and device coding. Even though payment is not directly related to that information, we believe that reporting the codes may be in hospitals' best interest because it may result in the most accurate payments. For example, in setting the weights of certain device-related APCs, we discovered that the median costs of those APCs were higher when we used only claims on which the device codes appeared. Similarly, certain drug administration APCs have higher median costs when separate HCPCS for drugs are reported on the claims.
If we are to continue to price drugs and devices using up-to-date median costs from claims data, we need information on the costs of the items, even when packaged. We propose to require the separate coding of individual drugs and device categories, Start Printed Page 48006even where their costs are packaged, to address this need. We would like comments on whether or not to require coding of devices. We also solicit comments regarding our proposal to report drug codes on claims and alternative methods for rate-setting if codes for drugs and/or devices are no longer present on the claims. We are particularly interested in receiving comments from hospitals on this proposal.
11. Payment for Split Unit of Blood
Since implementation of the OPPS, we have assigned status indicator “E” to HCPCS code P9011, blood (split unit). Status indicator “E” designates services for which payment is not allowed under the OPPS or services that are not covered by Medicare. P9011 was created to identify situations where one unit of red blood cells or whole blood, for example, is split and half of the unit is transfused to one patient and the other half to another patient. Because use of split units is not uncommon, we propose to change the status indicator for P9011 from “E” to “K” and assign it to a blood and blood product APC that pays approximately 50 percent of the payment for the whole unit of blood. We propose to assign P9010 to APC 0957 (Platelet concentrate) with a payment rate of $37.30. We invite comments on this proposed change in the status indicator and payment amount for P9010.
12. Other Issues
We propose to continue our payment policy for Procrit and Aranesp for calendar year 2004. As explained in detail in the November 1, 2002 final rule (67 FR 66758), Aranesp and Procrit are in separate APCs, and are paid at equivalent rates with the application of a ratio to convert the dosage units of Aranesp into units of Procrit. The current conversion ratio is based on the best information available at the time we developed the final rule for calendar year 2003. In the final rule, we explained that we based our conclusion regarding the appropriate conversion ratio on the FDA labeling for each product and the body of available clinical evidence contained in published and unpublished articles and abstracts and in materials provided by the products' manufacturers. We indicated that we might refine the conversion ratio as soon as feasible based on information not available at the time we established the current conversion ratio.
Consistent with our statements in the final rule, we have continued to gather information regarding an appropriate conversion ratio by reviewing recent published studies and data from alternative sources. We have met with the manufacturers of the products and consulted with clinicians. We are continuing to evaluate this additional data and information. However, we have not yet determined whether the data would support a change to the current policy. We remain open to establishing a different conversion ratio in the final rule if we conclude that a change is warranted based on public comments and information submitted during the public comment period and/or any other information we consider in developing the final rule.
Therefore, we propose to continue with the current policy regarding payment for Procrit and Aranesp, including the current conversion ratio. We solicit comments on this issue and are especially interested in submission of articles in peer-reviewed publications and other clinical data concerning the frequency of administration and the dosage amounts of these agents. Submission of prospective, randomized, controlled trials comparing the dosage amounts, frequency of administration, and clinical outcomes of these agents are preferred. All data submitted would be available to the public. We would base any changes to our current payment policy for these two drugs only on data that we could make available to the public.
VII. Wage Index Changes for CY 2004
Section 1833(t)(2)(D) of the Act requires that we determine a wage adjustment factor to adjust for geographic wage differences, in a budget neutral manner, that portion of the OPPS payment rate and copayment amount that is attributable to labor and labor-related costs.
We used the proposed Federal fiscal year (FY) 2004 hospital inpatient PPS wage index to make wage adjustments in determining the proposed payment rates set forth in this proposed rule. The proposed FY 2004 hospital inpatient wage index published in the May 19, 2003 Federal Register (68 FR 27154) is reprinted in this proposed rule as Addendum H—Wage Index for Urban Areas; Addendum I—Wage Index for Rural Areas; and Addendum J—Wage Index for Hospitals That Are Reclassified. We propose to use the final FY 2004 hospital inpatient wage index to calculate the payment rates and coinsurance amounts that we will publish in the final rule implementing the OPPS for CY 2004.
VIII. Copayment for CY 2004
In the November 30, 2001 final rule (66 FR 59887), we adopted a methodology that applied five rules for calculating APC copayment amounts when payments for APC groups change because the APCs' relative weights are recalibrated or when individual services are reclassified from one APC group to another. In calculating the unadjusted copayment amounts for 2004, we encountered circumstances that the methodology in the November 30, 2001 final rule either did not address or whose applicability was ambiguous. For example, rules 2 and 3 refer to payment rate changes resulting from the recalibration of relative payment weights but do not clearly apply to payment rate changes resulting from the reclassification of HCPCS codes from one APC group to another APC group. Therefore, we propose to revise and clarify the methodology we would follow to calculate unadjusted copayment amounts, including situations in which recalibration of the relative payment weight of an existing APC results in a change in the APC payment; to situations in which reclassification of HCPCS codes from an existing APC to another APC results in a change in the APC payment; and to payment rates for newly created APCs that are comprised of HCPCS codes from existing APCs.
As a general rule, we would seek to lower the coinsurance rate for the services in an APC from the prior year. This principle is consistent with section 1833(t)(8)(C)(ii) of the Act, which accelerates the reduction in the national unadjusted coinsurance rate so that beneficiary liability will eventually equal 20 percent of the OPPS payment rate for all OPPS services and with section 1833(t)(3)(B), which indicates the congressional goal of achieving 20 percent coinsurance when fully phased in and gives the Secretary the authority to set rules for determining copayment amounts to new services. However, in no event is the proposed 2004 coinsurance rate for an APC group lower than 20 percent or greater than 50 percent of the payment rate.
We propose to determine copayment amounts in 2004 and subsequent years in accordance with the following rules.
1. When an APC group consists solely of HCPCS codes that were not paid under the OPPS the prior year because they were packaged or excluded or are new codes, the unadjusted copayment amount would be 20 percent of the APC payment rate.
2. If a new APC that did not exist during the prior year is created and Start Printed Page 48007consists of HCPCS codes previously assigned to other APCs, the copayment amount is calculated as the product of the APC payment rate and the lowest coinsurance percentage of the codes comprising the new APC.
3. If no codes are added to or removed from an APC and, after recalibration of its relative payment weight, the new payment rate is equal to or greater than the prior year's rate, the copayment amount remains constant (unless the resulting coinsurance rate is less than 20 percent).
4. If no codes are added to or removed from an APC and, after recalibration of its relative payment weight, the new payment rate is less than the prior year's rate, the copayment amount is calculated as the product of the new payment rate and the prior year's coinsurance percentage.
5. If HCPCS codes are added to or deleted from an APC, and, after recalibrating its relative payment weight, holding its unadjusted copayment amount constant results in a decrease in the coinsurance percentage for the reconfigured APC, the copayment amount would not change (unless retaining the copayment amount would result in a coinsurance rate less than 20 percent).
6. If HCPCS codes are added to an APC, and, after recalibrating its relative payment weight, holding its unadjusted copayment amount constant results in an increase in the coinsurance percentage for the reconfigured APC, the copayment amount would be calculated as the product of the payment rate of the reconfigured APC and the lowest coinsurance rate of the codes being added to the reconfigured APC.
This methodology would, in general, reduce the beneficiary coinsurance rate and copayment amount for APCs for which the payment rate changes as the result of the reconfiguration of APCs and/or the recalibration of relative payment weights.
IX. Conversion Factor Update for CY 2004
Section 1833(t)(3)(C)(ii) of the Act requires us to update the conversion factor used to determine payment rates under the OPPS on an annual basis. Section 1833(t)(3)(C)(iv) of the Act provides that for 2004, the update is equal to the hospital inpatient market basket percentage increase applicable to hospital discharges under section 1886(b)(3)(B)(iii) of the Act.
The forecast of the hospital market basket increase for FY 2004 published in the inpatient PPS proposed rule on May 19, 2003 is 3.5 percent. To set the proposed OPPS conversion factor for 2004, we increased the 2003 conversion factor of $52.151 (the figure from the November 1, 2002 final rule (67 FR 66788) by 3.5 percent.
In accordance with section 1833(t)(9)(B) of the Act, we further adjusted the proposed conversion factor for 2004 to ensure that the revisions we are proposing to update by means of the wage index are made on a budget-neutral basis. We calculated a budget neutrality factor of 1.003 for wage index changes by comparing total payments from our simulation model using the proposed FY 2004 hospital inpatient PPS wage index values to those payments using the current (FY 2003) wage index values. In addition, for CY 2004, allowed pass-through payments have decreased to 2 percent of total OPPS payments, down from 2.3 percent in CY 2003. The 0.3 percent was also used to adjust the conversion factor.
The increase factor of 3.5 percent for 2004, the required wage index budget neutrality adjustment of approximately 1.003, and the 0.3 percent adjustment to the pass-through estimate, result in a proposed conversion factor for 2004 of 54.289.
X. Proposed Outlier Policy and Elimination of Transitional Corridor Payments for CY 2004
A. Proposed Outlier Policy for CY 2004
For OPPS services furnished between August 1, 2000 and April 1, 2002, we calculated outlier payments in the aggregate for all OPPS services that appear on a bill in accordance with section 1833(t)(5)(D) of the Act. In the November 30, 2001 final rule (66 FR 59856, 59888), we specified that beginning with 2002, we will calculate outlier payments based on each individual OPPS service. We revised the aggregate method that we had used to calculate outlier payments and began to determine outliers on a service-by-service basis.
As explained in the April 7, 2000 final rule (65 FR 18498), we set a target for outlier payments at 2.0 percent of total payments. For purposes of simulating payments to calculate outlier thresholds, we propose to continue to set the target for outlier payments at 2.0 percent, as we did for CYs 2001, 2002, and 2003. For 2003, the outlier threshold is met when costs of furnishing a service or procedure exceed 2.75 times the APC payment amount, and the current outlier payment percentage is 45 percent of the amount of costs in excess of the threshold. For the reasons discussed in detail in section XI.E of this preamble, we are proposing to establish two separate outlier thresholds, one for community mental health centers (CMHCs) and one for hospitals. For CY 2004, we propose to continue to set the target for outlier payments at 2.0 percent of total OPPS payments (a portion of that 2.0 percent, 0.36 percent, would be allocated to CMHCs for PHP services). Based on our simulations for 2004, we propose to set the hospital threshold for 2004 at 2.75 times the APC payment amount, and the proposed 2004 payment percentage applicable to costs over the threshold at 50 percent. We propose to set the threshold for CMHCs for 2004 at 11.75 times the APC payment amount and the 2004 outlier payment percentage applicable to costs over the threshold at 50 percent.
B. Elimination of Transitional Corridor Payments for CY 2004
Since the inception of the OPPS, providers have been eligible to receive additional transitional payments if the payments they received under the OPPS were less than the payments they would have received for the same services under the payment system in effect before the OPPS. Under 1833(t)(7) of the Act, most hospitals that realize lower payments under the OPPS received transitional corridor payments based on a percent of the decrease in payments. However, rural hospitals having 100 or fewer beds, as well as cancer hospitals and children's hospitals described in section 1886(d)(1)(B)(iii) and (v) of the Act, were held harmless under this provision and paid the full amount of the decrease in payments under the OPPS. Transitional corridor payments were intended to be temporary payments to ease providers' transition from the prior cost-based payment system to the prospective payment system. Beginning January 1, 2004, in accordance with section 1833(t)(7) of the Act, transitional corridor payments will no longer be paid to providers other than cancer hospitals and children's hospitals. Cancer hospitals and children's hospitals are held harmless permanently under the transitional corridor provisions of the statute.
We are concerned that small rural hospitals are not able to achieve the same level of operating efficiencies as larger rural hospitals and urban hospitals, and we are concerned that the decrease in payments these hospitals may experience once they stop receiving transitional corridor payments will result in these hospitals having to decrease or altogether cease to provide certain outpatient services. A reduction of services could have consequences for Medicare beneficiaries and their continued access to care in rural areas. Start Printed Page 48008In light of these concerns, one thing we could do is to provide increased APC payments for clinic and emergency room visits furnished by rural hospitals having 100 or fewer beds. Any adjustment to payments for these hospitals would be made under the authority granted to the Secretary under section 1833(t)(2)(E) of the Act, to establish in a budget neutral manner adjustments as determined to be necessary to ensure equitable payments, such as adjustments for certain classes of hospitals. We invite comments on whether we should provide an adjustment, such as the one described above, for small rural hospitals.
XI. Other Policy Decisions and Proposed Changes
A. Hospital Coding for Evaluation and Management (E/M) Services
Facilities code clinic and emergency department visits using the same [Physicians'] Current Procedural Terminology (CPT) codes as physicians. For both clinic and emergency department visits, there are currently five levels of care. Because these codes were defined to reflect only the activities of physicians, they are inadequate to describe the range and mix of services provided to patients in the clinic and emergency department settings (for example, ongoing nursing care, preparation for diagnostic tests, and patient education). An example to illustrate the services that are billed using E/M codes in the hospital outpatient department follows:
An adult male patient presents to a clinic after a fall while working in his yard. As a result, he has scraped off the top layer of skin covering his entire back. The physician examines the patient, finds a dirty and possibly infected wound, which is the only injury. The physician orders the nurse to clean the wound, apply antiseptic medication, and dress the wound. In addition, the physician orders an intramuscular antibiotic and a tetanus injection.
The nurse will spend a considerable amount of time cleaning and dressing the wound with large amounts of sterile supplies (because of the large body surface area) as well as administering medications. The nurse also will give the patient discharge instructions regarding the care of the wound.
Although the physician services are captured using existing E/M codes, the additional staff and supplies integral to the outpatient department services are not. The low level E/M code that describes the physician services in the example is not reflective of the services provided by the nurse (and any other staff that may have become involved) or of the quantity of supplies used in the treatment.
In the April 7, 2000 final rule (65 FR 18434), we stated that in order to ensure proper payment to hospitals, it was important that emergency and clinic visits be coded properly. To facilitate proper coding, we required each hospital to create an internal set of guidelines to determine what level of visit to report for each patient. In the August 24, 2001 proposed rule (66 FR 44672), we asked for public comments regarding national guidelines for hospital coding of emergency and clinic visits. Commenters recommended that we should keep the current E/M coding system until facility specific E/M codes for emergency department and clinic visits, along with national coding guidelines, were established. Commenters also recommended that we convene a panel of experts to develop codes and guidelines that are simple to understand, implement, and that are compliant with the Health Insurance Portability and Accountability Act (HIPAA) requirements.
APC Panel Recommendations
During its January 2002 meeting, the APC Panel made the following recommendations regarding coding for evaluation and management services:
1. Propose, and make final, facility coding guidelines for E/M services for CY 2004.
2. Create a series of G codes with appropriate descriptors for facility E/M services.
3. Maintain a single set of codes, with five levels of service, for emergency department visits.
4. Develop a single set of codes, with five levels of service, for clinic visits. The Panel specifically recommended that we not differentiate among visit types (for example, new, established, and consultation visits) for the purposes of facility coding of clinic visits.
5. Adopt the American College of Emergency Physicians (ACEP) facility coding guidelines as the national guidelines for facility coding of emergency department visits.
6. Develop guidelines for clinic visits that are modeled on the ACEP guidelines but are appropriate for clinic visits.
7. Implement these guidelines as interim and continue to work with appropriate organizations and stakeholders to develop final guidelines.
After careful review and consideration of written comments, oral testimony, and the APC Panel's recommendations, we proposed the following in the August 9, 2002 proposed rule (for implementation no earlier than January 2004):
1. To develop five G codes to describe emergency department services:
GXXX1—Level 1 Facility Emergency Services;
GXXX2—Level 2 Facility Emergency Services;
GXXX3—Level 3 Facility Emergency Services;
GXXX4—Level 4 Facility Emergency Services; and
GXXX5—Level 5 Facility Emergency Services.
2. To develop five G codes to describe clinic services:
GXXX6—Level 1 Facility Clinic Services;
GXXX7—Level 2 Facility Clinic Services;
GXXX8—Level 3 Facility Clinic Services;
GXXX9—Level 4 Facility Clinic Services; and
GXXX10—Level 5 Facility Clinic Services.
3. To replace CPT Visit Codes with the 10 new G codes for OPPS payment purposes.
4. To establish separate documentation guidelines for emergency visits and clinic visits.
In our November 1, 2002 final rule (67 FR 66792), we stated that the most appropriate forum for development of new code definitions and guidelines would be an independent expert panel that would make recommendations to us. We wanted to ensure that definitions and guidelines were developed using an open process involving a variety of experts in the field. We stated that it is critically important to the development, acceptance, and implementation of facility visit code definitions and guidelines that the organizations that develop the guidelines also maintain and update the guidelines and provide ongoing education to providers on use of the codes. In light of the expertise of organizations such as the American Hospital Association (AHA) and the American Health Information Management Association (AHIMA), we felt that these organizations were particularly well equipped to make recommendations to us and to provide ongoing education to providers. Furthermore, we stated that the process should provide adequate time for the education of clinicians and coders and for hospitals to make the necessary changes in their systems to accommodate the new codes and guidelines.
On their own initiative, the AHA and the AHIMA convened an independent expert panel of individuals from various Start Printed Page 48009organizations to develop code descriptions and guidelines for hospital emergency department and clinic visits and make recommendations to us.
The panel recommended the following to us.
1. We should make payment for emergency and clinic visits based on four levels of care.
2. We should create HCPCS codes to describe these levels of care as follows:
GXXX1—Level 1 Emergency Visit.
GXXX2—Level 2 Emergency Visit.
GXXX3—Level 3 Emergency Visit.
GXXX4—Critical Care provided in the emergency department.
GXXX5—Level 1 Clinic Visit.
GXXX6—Level 2 Clinic Visit.
GXXX7—Level 3 Clinic Visit.
GXXX8—Critical Care provided in the clinic.
3. We should replace all the HCPCS currently in APCs 600, 601, 602, 610, 611, 612, and 620 with GXXX1 through GXXX8.
4. Based on the above recommendations, we would crosswalk payments as follows: GXXX1 to APC 610, GXXX2 to APC 611, GXXX3 to APC 612, GXXX4 to APC 620, GXXX5 to APC 600, GXXX6 to APC 601, GXXX7 to APC 602, and GXXX8 to APC 620. These crosswalks and code descriptions are listed in Table 22 below.
Table 22.—Crosswalks of 2003 HCPCS Codes to the Proposed G Codes
2003 HCPCS description 2004 G code description 2003 HCPCS 2004 Proposed G codes APC Payment amount Emergency department visit Level 1 Emergency Visit 99281 99282 GXXX1 0610 $76.80 Emergency department visit Level 2 Emergency Visit 99283 GXXX2 0611 $135.08 Emergency department visit Level 3 Emergency Visit 99284 99285 GXXX3 0612 $234.72 Critical care Level 4 Critical Care provided in the emergency department 99291 99292 GXXX4 0620 $503.03 Office/outpatient visit, new Level 1 Clinic Visit 99201 99202 GXXX5 0600 $50.90 Office/outpatient visit, new Level 2 Clinic Visit 99203 GXXX6 0601 $54.46 Office/outpatient visit, new Level 3 Clinic Visit 99204 99205 GXXX7 0602 $84.71 Office/outpatient visit, established Level 1 Clinic Visit 99211 99212 GXXX5 0600 $50.90 Office/outpatient visit, established Level 2 Clinic Visit 99213 GXXX6 0601 $54.46 Office/outpatient visit, established Level 3 Clinic Visit 99214 99215 GXXX7 0602 $84.71 Office consultation Level 1 Clinic Visit 99241 99242 GXXX5 0600 $50.90 Office consultation Level 2 Clinic Visit 99243 GXXX6 0601 $54.46 Office consultation Level 3 Clinic Visit 99244 99245 GXXX7 0602 $84.71 Critical care Level 4 Critical Care provided in the clinic 99291 99292 GXXX8 0620 $503.03 The independent panel convened by the AHA and AHIMA recommended these levels in anticipation of the development of national coding guidelines for emergency and clinic visits that meet the following criteria we announced in the August 9, 2002 proposed rule (67 FR 52131):
1. Coding guidelines for emergency and clinic visits should be based on emergency department or clinic facility resource use, rather than physician resource use.
2. Coding guidelines should be clear, facilitate accurate payment, be usable for compliance purposes and audits, and comply with HIPAA.
3. Coding guidelines should only require documentation that is clinically necessary for patient care. Preferably, coding guidelines should be based on current hospital documentation requirements.
4. Coding guidelines should not create incentives for inappropriate coding (for example, up-coding).
We have received recommendations for a set of coding guidelines from the independent E/M panel comprised of members of the AHA and AHIMA. We propose to implement new evaluation and management codes only when we are also ready to implement guidelines for their use, after allowing ample opportunity for public comment, systems change, and provider education. We also propose to use cost data from the current HCPCS codes in these APCs to determine the relative weights of these APCs until cost data from GXXX1 through GXXX8 are available to set relative weights. We note that this proposal requires discontinuing the use of all HCPCS codes in these APCs and would not allow us to collect cost data for the five levels of emergency and clinic visits that are currently described by CPT codes. We further note that we would no longer be able to distinguish among the costs for visits by new patients, established patients, consultation patients, or patients being seen for more specialized care (for example, pelvic screening exams and glaucoma screening exams).
We would be using claims data from current HCPCS codes and crosswalking those data to the new codes in the same APCs; therefore, there would be no change in payment for any of these services as a result of these coding changes. Once cost data become available from the new HCPCS codes, we would use those data to set the relative weights, and, therefore, there should be no budgetary impact.
We are currently considering the set of proposed national coding guidelines for emergency and clinic visits recommended by the independent panel. We plan to make any proposed guidelines available to the public for comment on the OPPS Web site as soon as they are complete. We will notify the public through our listserve when these proposed guidelines become available. To subscribe to this listserve, please go to the following Web site: http://www.cms.hhs.gov/medlearn/listserv.asp and follow the directions to the OPPS Start Printed Page 48010listserve. With regard to the development of these guidelines, our primary concerns are—
1. To make appropriate payment for medically necessary care;
2. To minimize the information collection and reporting burden on facilities;
3. To minimize any incentives to provide unnecessary or low quality care;
4. To minimize the extent to which separately billable services are counted as E/M services;
5. To develop coding guidelines that are consistent with facility resource use; and
6. To develop coding guidelines that are clear, facilitate accurate payment, are useful for compliance purposes and audits, and comply with HIPAA. Before implementation of the codes and coding guidelines, adequate time will be provided for the education of clinicians and coders and for hospitals to make the necessary changes in their systems to accommodate the codes and guidelines. We are requesting comments on the amount of time hospitals believe would be adequate to implement these new codes and guidelines. We remain committed to working with appropriate organizations and stakeholders in our continuing development of a standard set of codes and national guidelines for facility coding of emergency and clinic visits.
B. Status Indicators and Issues Related to OCE Editing
The status indicators we assign to HCPCS codes and APCs under the OPPS have an important role in payment for services under the OPPS because they indicate whether a service represented by a HCPCS code is payable under the OPPS or another payment system and also whether particular OPPS policies apply to the code. We are providing our proposed status indicator (SI) assignments for APCs in Addendum A, HCPCS codes in Addendum B, and definitions of the status indicators in Addendum D.
The OPPS is based on HCPCS codes for medical and other health services. These codes are used for a wide variety of payment systems under Medicare, including, but not limited to, the Medicare fee schedule for physician services, the Medicare fee schedule for durable medical equipment and prosthetic devices, and the Medicare clinical laboratory fee schedule. For purposes of making payment under the OPPS, we must be able to signal the claims processing system which HCPCS codes are paid under the OPPS and those codes to which particular OPPS payment policies apply. We accomplish this identification in the OPPS through the establishment of a system of status indicators with specific meanings. Addendum D defines the meaning of each status indicator for purposes of the OPPS.
We assign one and only one status indicator to each APC and to each HCPCS code. Each HCPCS code that is assigned to an APC has the same status indicator as the APC to which it is assigned.
Specifically, in 2004 we propose to use the status indicators in the following manner:
- We use “A” to indicate services that are paid under some payment method other than OPPS, such as the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) fee schedule or the physician fee schedule. Some but not all of these other payment systems are identified in Addendum D.
- We use “C” to indicate inpatient services that are not payable under the OPPS.
- We use “D” to indicate a code that was deleted effective with the beginning of the calendar year.
- We use “E” to indicate services for which payment is not allowed under the OPPS or that are not covered by Medicare.
- We use “F” to indicate acquisition of corneal tissue, which is paid at reasonable cost. (In 2003, we also use “F” to indicate those orphan drugs that are paid at reasonable cost.) In 2004, we propose to revise the definition of “F” solely to indicate acquisition of corneal tissue paid at reasonable cost.
- We use “G” to indicate drugs and biologicals that are paid under OPPS transitional pass-through rules.
- We use “H” to indicate devices that are paid under OPPS transitional pass-through rules.
- We use “K” to indicate drugs, biologicals (including blood and blood products), radiopharmaceutical agents, and certain brachytherapy seeds that are paid in separate APCs under the OPPS but that are not paid under OPPS transitional pass-through rules.
- We use “L” to indicate flu and pneumococcal immunizations which are paid at reasonable cost but to which no coinsurance or copayment apply.
- We use “N” to indicate services that are paid under the OPPS but for which payment is packaged into another service or APC group.
- We use “P” to indicate services that are paid under the OPPS but only in partial hospitalization programs.
- We use “S” to indicate significant procedures that are paid under OPPS but to which the multiple procedure reduction does not apply.
- We use “T” to indicate significant services that are paid under the OPPS and to which the multiple procedure payment discount under OPPS applies.
- We use “V” to indicate medical visits (including clinic or emergency department visits) that are paid under the OPPS.
- We use “X” to indicate ancillary services that are paid under the OPPS.
The software that controls Medicare payment looks to the status indicators attached to the HCPCS codes and APCs for direction in the processing of the claim. Therefore, the assignment of the status indicators has significance for the payment of services.
We are proposing the status indicators identified for each HCPCS code and each APC in Addenda A and B and are requesting comments on the appropriateness of the indicators we have assigned.
C. Observation Services
In the November 1, 2002 update to the OPPS (67 FR 66794), we summarized and clarified previously published guidance (Transmittal A-02-026) regarding payment requirements for HCPCS code G0244, Observation care provided by a facility to a patient with congestive heart failure, chest pain or asthma, minimum of 8 hours, maximum 48 hours. We also implemented HCPCS codes G0263 and G0264 to identify patients directly admitted to observation. In January 2003, we published Transmittal A-02-129, which provides further instructions regarding billing for observation services. In this proposed rule, we are neither proposing anything new with regard to observation services, nor are we seeking public comment on observation issues at this time. As we have in the past, we will update by Program Memorandum any changes in the list of ICD-9-CM codes required for payment of HCPCS code G0244 resulting from October 1 annual update of ICD-9-CM. Any such changes will be included in the 2004 final OPPS rule with comment period and the public will have an opportunity to comment at that time.
D. Procedures That Will Be Paid Only as Inpatient Procedures
Before implementation of the OPPS, Medicare paid reasonable costs for services provided in the outpatient department. The claims submitted were subject to medical review by the fiscal intermediaries to determine the appropriateness of providing certain services in the outpatient setting. We did not specify in regulations those services that were appropriate to provide only in the inpatient setting and Start Printed Page 48011that, therefore, should be payable only when provided in that setting.
Section 1833(t)(1)(B)(i) of the Act gives the Secretary broad authority to determine the services to be covered and paid for under the OPPS. In the April 7, 2000 final rule, we identified procedures that are typically provided only in an inpatient setting and, therefore, would not be paid by Medicare under the OPPS (65 FR 18455). These procedures comprise what is referred to as the “inpatient list.” The inpatient list specifies those services that are only paid when provided in an inpatient setting. These are services that require inpatient care because of the nature of the procedure, the need for at least 24 hours of postoperative recovery time or monitoring before the patient can be safely discharged, or the underlying physical condition of the patient. As we discussed in the April 7, 2000 and the November 30, 2001 final rules, we use the following criteria when reviewing procedures to determine whether or not they should be moved from the inpatient list and assigned to an APC group for payment under the OPPS:
- Most outpatient departments are equipped to provide the services to the Medicare population.
- The simplest procedure described by the code may be performed in most outpatient departments.
- The procedure is related to codes that we have already removed from the inpatient list.
In the November 1, 2002 final rule, we added the following criteria for use in reviewing procedures to determine whether they should be removed from the inpatient list and assigned to an APC group for payment under the OPPS:
- We have determined that the procedure is being performed in multiple hospitals on an outpatient basis; or
- We have determined that the procedure can be appropriately and safely performed in an ASC and is on the list of approved ambulatory surgical center (ASC) procedures or proposed by us for addition to the ASC list.
At its January 2003 meeting, the APC Panel did not make recommendations regarding procedures on the inpatient list, and we are not proposing to make any of the procedures that are currently on the inpatient list in Addendum E payable under the OPPS in 2004. We solicit comments on whether any procedures in Addendum E should be paid under the OPPS. We ask commenters recommending reclassification of a procedure to an APC to include evidence (preferably from peer-reviewed medical literature) that the procedure is being performed on an outpatient basis in a safe and effective manner. We also solicit comments on the appropriate APC assignment for the procedure in the event that we determine in the final rule, based on comments, that the procedure would be payable under the OPPS in 2004.
Following our review of any comments that we receive about the procedures in Addendum E, we propose either to assign a CPT code to an APC for payment under the OPPS or, if the comments do not provide sufficient information and data to enable us to make a decision, to present the comments to the APC Panel at its 2004 meeting.
Proposed New APC To Pay for Services Furnished on Same Date as Service with Modifier -CA:
In the 2003 update of the OPPS, we implemented a new modifier -CA, Procedure payable only in the inpatient setting when performed emergently on an outpatient who dies before admission. In section VI of Transmittal A-02-129, issued on January 3, 2003, we instructed hospitals on the use of modifier -CA when submitting a claim on bill type 13x for a procedure that is on the inpatient list and that is assigned payment status indicator “C.” (Transmittal A-02-129 can be found on our Web site at cms.hhs.gov.) We also implemented in the November 1, 2002 final rule (67 FR 66799) a new payment policy to allow payment, under certain conditions, for outpatient services on a claim that have the same date of service as the HCPCS code billed with modifier -CA. A single payment for outpatient services on the claim, other than those coded with status indicator “C” and modifier -CA, is currently made under APC 977.
We reviewed this policy and determined that assigning payment for these services to APC 977, which is a New Technology APC, is problematic because payment under New Technology APCs is a fixed amount that does not have a relative payment weight and is, therefore, not subject to recalibration based on hospital costs. We propose to establish a new APC for which payment would be made under certain conditions for otherwise payable outpatient services furnished on the same date of service that a procedure with status indicator “C” is performed emergently on an outpatient who dies before admission to the hospital as an inpatient. Beginning in 2004, hospitals would be paid under APC 375 instead of APC 977 for services furnished on the same date of service that a procedure with status indicator “C” and modifier -CA is billed. We propose at the outset to set the payment rate for APC 375 in the amount of $1,150, which is the payment amount for the newly structured New Technology APC that would replace APC 977. When the APC weights are recalibrated in 2005, we would use charge data from CY 2003 claims for line items that have the same date of service as the line with modifier -CA and that show a HCPCS code with status indicator “V,” “S,” “T,” “X,” “N,” or “K” to calculate a median cost and relative payment weight for APC 375. Once we have claims data, we would be able to determine whether it is appropriate to calculate a relative payment weight based on median costs from our claims data or to continue a fixed payment rate for these special cases. We invite comments on these proposed changes.
E. Partial Hospitalization Payment Methodology
1. Background
As we discussed in the April 7, 2000 OPPS final rule (65 FR 18452), partial hospitalization is an intensive outpatient program of psychiatric services provided to patients in place of inpatient psychiatric care. A partial hospitalization program (PHP) may be provided by a hospital to its outpatients or by a Medicare-certified community mental health center (CMHC). Payment to providers under the OPPS for PHPs represents the provider's overhead costs associated with the program. Because a day of care is the unit that defines the structure and scheduling of partial hospitalization services, we established a per diem payment methodology for the PHP APC, effective for services furnished on or after August 1, 2000.
The PHP per diem amount was based solely on hospital data. Section 1833(t)(2)(C) of the Act required that we initially establish relative payment weights based on median (or mean, at the discretion of the Secretary) hospital costs determined by 1996 claims and cost report data. 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. The analysis of hospital partial hospitalization claims resulted in a per diem payment of $202.19, effective August 1, 2000. This amount was updated effective January 1, 2001 and April 1, 2002 to $206.82 and $212.27, respectively.
Although we did not use CMHC data in establishing the initial APC amount Start Printed Page 48012for partial hospitalization, in the April 7, 2000 final rule, we committed to analyzing future data from hospitals and CMHCs to determine whether refinements to the per diem were warranted. As a result, for payment rates presented in the proposed and final rules in 2002, we used data from both hospitals and CMHCs to compute the CY 2003 per diem rate. A description of the methodology we followed in developing the CY 2003 PHP payment rate is presented below.
We based the CY 2003 per diem amount on hospital and CMHC claims data for services furnished from April 1, 2001 through March 31, 2002. We used data from all the hospital bills reporting condition code 41, which identifies the claim as partial hospitalization, and all bills from CMHCs, since CMHCs are Medicare providers only for the purpose of providing partial hospitalization services. We used cost-to-charge ratios from the most recently available hospital and CMHC cost reports to convert each provider's line item charges as reported on bills, to estimate the provider's cost for a day of PHP. Unlike hospitals, CMHCs do not file cost reports electronically and the cost report information is not included in the Hospital Cost Report Information System (HCRIS). The CMHC cost reports are held by the Medicare fiscal intermediaries (FIs). As a result, we requested that the FIs forward to us the most recently available CMHC cost-to-charge ratios so that we could apply the ratio to the CMHC's billed charges and approximate the CMHC's per diem cost for PHP.
Per diem costs are computed by summing the line item costs on each bill and dividing by the number of days on the bill. Using this method of computing costs, preliminary per diem cost estimates for CMHCs were much higher than expected, in many cases more than twice the average per diem for inpatient psychiatric care. Closer examination of the CMHC cost report data summaries showed that costs from CMHC settled cost reports were considerably lower than costs from “as submitted” CMHC cost reports. To account for the difference between settled and as submitted cost report data, we computed the ratio of total settled costs to total as submitted costs over a 3-year period (CMHC FYs 1998 through 2000) and calculated an average adjustment factor (0.583), which we applied to the costs on each claim. As stated in the 2002 proposed and final OPPS rules, we thought that an adjustment factor of 0.583 was adequate to account for the difference between settled and “as submitted” CMHC cost reports and was more reflective of CMHC costs for PHP. However, we did not have an opportunity to examine the data in depth before publishing the OPPS final rule on November 1, 2002.
The adjusted CMHC per diem costs on each claim were summed, then divided by the number of days on the claim. We then combined the CMHC and hospital PHP data files and determined the median per diem cost for PHP. Effective January 1, 2003, the PHP APC amount was $240.03, of which $48.17 is the beneficiary's coinsurance.
2. PHP APC Update for CY 2004
For CY 2004, we analyzed hospital and CMHC PHP claims for services furnished between April 1, 2002 and December 31, 2002. We intended to propose to use the same methodology for computing median costs per day for CY 2004, including the adjustment factor, as we used to compute the CY 2003 PHP median cost per day. However, when we applied the adjustment factor to the CMHC claims to compute the CY 2004 per diem, the CMHC median cost per day was determined to be $605. Without the adjustment, the median cost per day for CMHCs to provide partial hospitalization services is $1,038. The median cost per day for hospital outpatient departments to provide the same benefit is $225. We do not believe it is reasonable for CMHCs to incur costs that are more than double those incurred by hospital outpatient departments providing PHP services. In addition, the median CMHC cost for a day of outpatient PHP services exceeds the average per diem cost for inpatient psychiatric facilities, which provide a full 24 hours of care, medications, and other ancillary services. We do not believe it is appropriate for Medicare to pay more for a day of outpatient treatment than for a day of inpatient psychiatric care.
In addition to the vast difference in median costs between CMHCs and hospital outpatient departments, we are concerned that this difference has grown significantly larger since last year. The median per diem cost for hospitals is about the same for 2003 and 2004 ($224 for CY 2003 compared to $225 for the proposed CY 2004 update), while the median per diem cost for CMHCs (after adjustment) has increased by 58 percent ($384 for CY 2003 compared to $605 for the proposed CY 2004 update). We believe that the increase in the median CMHC per diem cost is primarily due to large increases in CMHC charges, coupled with the application of outdated cost-to-charge ratios to determine the per diem cost. In a Program Memorandum issued on January 17, 2003 (Transmittal A-03-004), we directed FIs to recalculate hospital and CMHC cost-to-charge ratios using the most recently settled or tentatively settled cost reports by April 30, 2003. However, we did not receive the updated CMHC cost-to-charge ratios in time to use in our data analysis for this proposed rule.
Therefore, we are proposing a per diem rate for PHP services furnished during CY 2004 based solely on hospital PHP data. The resulting PHP APC 0033 amount, after scaling, is $208.95, of which $41.69 is the beneficiary's coinsurance. We are not inclined to use the CMHC data in computing the per diem amount until the data discrepancies can be more fully resolved. We anticipate receipt of the revised CMHC cost-to-charge ratios this summer and will analyze the updated CMHC cost data. To the extent we believe the updated cost-to-charge ratios result in a more reasonable median per diem rate, we propose to use the CMHC data in developing the final rate for CY 2004.
3. Outlier Payments to CMHCs
In a related matter, the use of outdated cost-to-charge ratios applied to current charges has resulted in an excessive amount of outlier payments being made to CMHCs. As a result of more in-depth analysis of the 2001 data files that were used to compute the CY 2003 PHP per diem amount, we discovered a significant difference in the amount of outlier payments made to hospitals and CMHCs for PHP. Of the approximately 660 hospital programs with claims for PHP in CY 2001, 25 hospitals received approximately $9,000 in outlier payments. By contrast, almost half of the 155 CMHCs in our CY 2001 data file were paid outlier payments, totaling approximately $48 million.
Based on preliminary analysis of the 125 CMHCs with claims in the CY 2002 data files, that is, April 1, 2002 through December 31, 2002, we have determined that CMHCs received approximately $37 million in outlier payments, compared to approximately $13,000 for all hospitals in the PHP data file. The $37 million in outlier payments to CMHCs almost equals the total amount paid to CMHCs in regular APC payments.
CMHCs have indicated that they are unable to reduce their costs to the per diem payment amount and that outlier payments are needed to cover operating expenses. This use of outlier payments is contrary to the intent of an outlier policy. Establishing an outlier policy allows us to ensure beneficiary access to services by sharing in the loss Start Printed Page 48013associated with services for specific patients that are extraordinarily expensive. Through a comparison of the median per diem costs, we have determined that CMHCs dramatically increased their charges between CY 2001 and CY 2002. During this period, the median per diem cost for CMHCs increased by 58 percent. We believe that in most cases, these increases in charges were not related to a corresponding increase in costs. Since the CMHC cost-to-charge ratios used to calculate outlier payments remained constant during this period, we believe that the 58 percent increase in computed cost is attributable to artificial increases in charges designed to enhance outlier payments. Approximately two-thirds of outlier payments made to PHP providers were paid to 20 of the 125 CMHCs. The charges reported by these providers, on average, were over 10 times more than hospital per diem charges.
Given the difference in PHP charges between hospitals and CMHCs, we no longer believe it is appropriate to make outlier payments to CMHCs using the outlier percentage target amount and threshold established for hospitals. Therefore, we are proposing to designate a portion of the estimated 2.0 percent outlier target amount specifically for CMHCs, consistent with the percentage of projected payments to CMHCs under the OPPS in CY 2004, excluding outlier payments. CMHCs are projected to receive 0.36 percent of total OPPS payments in CY 2004, excluding outlier payments. Therefore, we are proposing to designate 0.36 percent of the estimated 2.0 percent outlier target amount for CMHCs and establish a threshold to achieve that level of outlier payments. Based on our simulations of CMHC payments in 2004, we are proposing to set the threshold for CY 2004 at 11.75 times the PHP APC payment amount. We believe that this approach would neutralize the impact of inflated CMHC charges on outlier payments. We are proposing to apply the same outlier payment percentage that applies to hospitals. Therefore, for CY 2004, we are proposing to pay 50 percent of CMHC per diem costs over the threshold. To the extent charges remain relatively constant, CMHCs would qualify for outlier payments in CY 2004 only for truly high cost patients.
As noted previously, we expect to receive updated cost-to-charge ratios from the FIs this summer. Many of the cost-to-charge ratios are expected to be considerably lower than those currently used to determine a provider's cost for the purpose of outlier and transitional pass-through or corridor payments. For example, we are aware of a number of situations where the updated cost-to-charge ratios have declined by more than 50 percent.
We specifically request public comments on this proposed outlier policy. We intend to monitor the extent to which the current pattern of escalating charges continues. CMS and the Office of the Inspector General will be further examining the excessive outlier payments to CMHCs.
XII. Summary of and Responses to MedPAC Recommendations
The Medicare Payment Advisory Commission (MedPAC) in its March 2002 Report to the Congress: “Medicare Payment Policy,” makes a number of recommendations relating to the OPPS. This section provides responses to those recommendations.
Recommendation: The Congress should increase payment rates for the OPPS by the rate of increase in the hospital market basket, less 0.9 percent, for CY 2004.
Response: Section 1833(t)(3)(C)(ii) of the Act requires the Secretary to update the conversion factor annually. Under section 1833(t)(3)(C)(iv) of the Act, the update must be equal to the hospital market basket percentage increase applicable under the hospital inpatient PPS. For years 2000 and 2002 only, the statute required the update to be determined by reducing the increase by one percentage point, but current law specifies such a reduction only for those 2 years. For 2004, we propose to increase the conversion factor by the rate of increase in the hospital market basket.
Recommendation: The Secretary should introduce clinical criteria for eligibility of drugs and biologicals to receive pass-through payments under the outpatient PPS.
Response: In accordance with section 402 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA), pass-through payments for medical devices is made on the basis of categories of devices. On November 2, 2001, we published in the Federal Register (66 FR 55850) a rule that specified the criteria for establishment of a new category of devices for purposes of pass-through payments. Among these is the requirement that the devices to be included in a possible category must demonstrate a substantial improvement in medical benefits for Medicare beneficiaries compared to benefits obtained by devices in previously established categories or other available treatments. We elaborated further about this criterion in the final rule updating the OPPS for CY 2003, published in the Federal Register on November 1, 2002. As we stated at that time, “We established this criterion because it is important for hospitals to receive pass-through payments for devices that offer substantial clinical improvement in the treatment of Medicare beneficiaries to facilitate access by beneficiaries to the advantages of the new technology. Conversely, the need for additional payments for devices that offer little or no clinical improvement over a previously existing device is less apparent.” (67 FR 66782)
At present, pass-through payment for drugs and biologicals is not made on the basis of categories, and no comparable criterion applies to them. Whether we should apply such a requirement to drugs and biologicals is an important question. On the one hand, as noted above, limiting extra payment to those items that have the potential to make a significant difference in treatment of Medicare beneficiaries appears useful. On the other hand, developing an appropriate mechanism for identifying which drugs or biologicals might qualify is difficult. Because the clinical characteristics of particular cases that are relevant for drug use may vary substantially, we believe that this challenge is more difficult than in the case of devices. Consequently, we have not developed a proposal in this area, and we are not prepared to advance one at this time.
XIII. Summary of Proposed Changes for 2004
A. Changes Required By Statute
We are proposing the following changes to implement statutory requirements:
- Add APCs, delete APCs, and modify the composition of some existing APCs.
- Recalibrate the relative payment weights of the APCs.
- Update the conversion factor and the wage index.
- Revise the APC payment amounts to reflect the APC reclassifications, the recalibration of payment weights, and the other required updates and adjustments.
- Cease transitional pass-through payments for drugs and biologicals and devices that will have been paid under the transitional pass-through methodology for at least 2 years by January 1, 2004.
- Cease transitional outpatient payments (TOPS payments) for all hospitals paid under OPPS except for cancer hospitals and children's hospitals. Start Printed Page 48014
B. Additional Changes
We are proposing the following additional changes to the OPPS:
- Adjust payment to moderate the effects of decreased median costs for non-pass-through drugs, biologicals, and radiopharmaceuticals.
- Implement a new method for paying for drug administration.
- Create new evaluation and management service codes for outpatient clinic and emergency department encounters.
- Change status indicators for HCPCS codes.
- List midyear and proposed HCPCS codes that are paid under OPPS.
- Allocate a portion of the outlier percentage target amount to CMHCs and create a separate threshold for outlier payments for partial hospitalization services.
- Create methodology and payment rates for separately payable drugs and radiopharmaceuticals for 2004.
- Make several changes in our current payment policy with regard to payment for Q0081, Q0083, Q0084, and Q0085 to facilitate accurate payments for drugs and drug administration.
- Change the status indicator and payment amount for P9010 by assigning it to APC 0957 (Platelet concentrate) with a payment rate of $37.30.
XIV. Collection of Information Requirements
Under the Paperwork Reduction Act of 1995, we are required to provide 60-day notice in the Federal Register and solicit public comment before a collection of information requirement is submitted to the Office of Management and Budget (OMB) for review and approval. In order to fairly evaluate whether an information collection should be approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 requires that we solicit comment on the following issues:
- 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.
The OPPS provisions set forth in this proposed rule do not impose information collection and recordkeeping requirements. Consequently, it need not be reviewed by the Office of Management and Budget under the authority of the Paperwork Reduction Act of 1995.
XV. Response to Public Comments
Because of the large number of items of correspondence we normally receive on a proposed rule, we are not able to acknowledge or respond to them individually. However, in preparing the final rule, we will consider all comments concerning the provisions of this proposed rule that we receive by the date and time specified in the DATES section of this preamble and respond to those comments in the preamble to that rule.
XVI. Regulatory Impact Analysis
A. General
We have examined the impacts of this rule as required by Executive Order 12866 (September 1993, Regulatory Planning and Review), the Regulatory Flexibility Act (RFA) (September 16, 1980, Pub. L. 96-354), section 1102(b) of the Social Security Act, the Unfunded Mandates Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.
Executive Order 12866 (as amended by Executive Order 13258, which merely reassigns responsibility of duties) directs agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year).
We estimate the effects of the provisions that would be implemented by this proposed rule would result in expenditures exceeding $100 million in any 1 year. We estimate the total increase (from changes in the proposed rule as well as enrollment, utilization, and case mix changes) in expenditures under the OPPS for CY 2004 compared to CY 2003 to be approximately $0.457 billion. Therefore, this proposed rule is an economically significant rule under Executive Order 12866, and a major rule under 5 U.S.C. 804(2).
The RFA requires agencies to determine whether a rule would have a significant economic impact on a substantial number of small entities. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and government agencies. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of $6 million to $29 million in any 1 year (see 65 FR 69432).
For purposes of the RFA, we have determined that approximately 37 percent of hospitals would be considered small entities according to the Small Business Administration (SBA) size standards. We do not have data available to calculate the percentages of entities in the pharmaceutical preparation manufacturing, biological products, or medical instrument industries that would be considered to be small entities according to the SBA size standards. For the pharmaceutical preparation manufacturing industry (NAICS 325412), the size standard is 750 or fewer employees and $67.6 billion in annual sales (1997 business census). For biological products (except diagnostic) (NAICS 325414), with $5.7 billion in annual sales, and medical instruments (NAICS 339112), with $18.5 billion in annual sales, the standard is 50 or fewer employees (see the standards Web site at http://www.sba.gov/regulations/siccodes/). Individuals and States are not included in the definition of a small entity.
In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 603 of the RFA. With the exception of hospitals located in certain New England counties, for purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside of a Metropolitan Statistical Area (MSA) and has fewer than 100 beds (or New England County Metropolitan Area (NECMA)). Section 601(g) of the Social Security Amendments of 1983 (Pub. L. 98-21) designated hospitals in certain New England counties as belonging to the adjacent NECMA. Thus, for purposes of the OPPS, we classify these hospitals as urban hospitals. We believe that the changes in this proposed rule would affect both a substantial number of rural hospitals as well as other classes of hospitals and that the effects on some may be significant. Therefore, we conclude that this proposed rule would have a significant impact on a substantial number of small entities.
Unfunded Mandates
Section 202 of the Unfunded Mandates Reform Act of 1995 (Pub. L. 104-4) also requires that agencies assess anticipated costs and benefits before issuing any rule that may result in an expenditure in any 1 year by State, local, or tribal governments, in the aggregate, or by the private sector, of $110 million. This proposed rule would not mandate any requirements for State, Start Printed Page 48015local, or tribal governments. This proposed rule would not impose unfunded mandates on the private sector of more than $110 million dollars.
Federalism
Executive Order 13132 establishes certain requirements that an agency must meet when it publishes a proposed rule (and subsequent final rule) that imposes substantial direct costs on State and local governments, preempts State law, or otherwise has Federalism implications.
We have examined this proposed rule in accordance with Executive Order 13132, Federalism, and have determined that it would not have an impact on the rights, roles, and responsibilities of State, local or tribal governments. The impact analysis (see Table 23) shows that payments to governmental hospitals (including State, local, and tribal governmental hospitals) would increase by 3.9 percent under the proposed rule.
B. Changes in This Proposed Rule
We are proposing several changes to the OPPS that are required by the statute. We are required under section 1833(t)(3)(C)(ii) of the Act to update annually the conversion factor used to determine the APC payment rates. We are also required under section 1833(t)(9)(A) of the Act to revise, not less often than annually, the wage index and other adjustments. In addition, we must review the clinical integrity of payment groups and weights at least annually. Accordingly, in this proposed rule, we are proposing to update the conversion factor and the wage index adjustment for hospital outpatient services furnished beginning January 1, 2004 as we discuss in sections IX and VII, respectively, of this proposed rule. We are also proposing to revise the relative APC payment weights based on claims data from April 1, 2002 through December 31, 2002. Finally, we are proposing to remove two devices and eight drugs and biologicals from pass-through payment status. Alternatives to the changes we are proposing and why we did not accept them are discussed throughout this proposed rule. In particular, see section V.B with regard to the expiration of pass-through payment for devices; see section VI.B with regard to the expiration of pass-through payment for drugs and biological agents.
Under this proposed rule, the change to the conversion factor as provided by statute would increase total OPPS payments by 3.8 percent in 2004. The changes to the wage index and to the APC weights (which incorporate the cessation of pass-through payments for many drugs and devices) would not increase OPPS payments because the OPPS is budget neutral. However, the wage index and APC weight changes would change the distribution of payments within the budget neutral system as shown in Table 23 and described in more detail in this section.
Alternatives Considered
Alternatives to the changes we are proposing and the reasons that we are proposing not to make them are discussed throughout this final rule. Below we discuss options we considered when analyzing methodologies to appropriately recognize the costs of former pass-through items. For a more detailed discussion, see section V.B of this proposed rule regarding the expiration of pass-through payment for devices and section VI.B of this proposed rule regarding the expiration of pass-through payment for drugs and biological agents.
Payment for the Administration of Drugs
As discussed in detail in section VI.B of this proposed rule, we considered the following alternatives with regard to payment for administration of packaged and separately paid drugs:
- Continue to pay under the current drug administration codes (Q0081, Q0083, Q0084, and Q0085). This alternative would pay the same amount for administration of packaged or separately paid drugs, although the data show that the costs are considerably more when packaged drugs are administered and considerably less if separately paid drugs are administered.
- Create eight new HCPCS codes (based on the existing Q codes listed above), with one set of codes for packaged drugs and one set for separately paid drugs. Establish an APC for each. This alternative permits more accurate payment for packaged and separately paid drugs than use of the current codes but imposes a significant burden on hospitals to bill correctly.
- Create six new HCPCS codes (based on the existing Q codes with deletion of Q0085). Establish an APC for each. This alternative permits more accurate payment for packaged and separately paid drugs than use of the current codes and imposes slightly less burden on hospital billing than the eight-code alternative.
- Delete Q0085 and revise the definitions of the other Q codes to once per day. Crosswalk each code billed to one of two APCs that would be paid dependent on the drugs billed on the same date of service. This alternative permits more accurate payment for packaged and separately paid drugs. It also simplifies hospital billing for drug administration. Under this option, however, hospitals would be required to bill for all drugs they administer, whether packaged or separately paid so that the outpatient code editor (OCE) could properly assign the APC that applies in the case. The systems changes required for this alternative are much more substantial than under any of the other alternatives, and we are considering whether we can implement this change before January 2005.
We modeled the second alternative for purposes of budget neutrality and impact analysis. We await comments before determining what alternative we will undertake for the 2004 OPPS.
Payment for Drugs That Are Not Packaged
As a result of marked and erratic fluctuations in median costs for drugs, biologicals, and radiopharmaceutical agents that are paid separately under the OPPS, we explored several options to determine how best to provide accurate payment for CY 2004. One option was to pay based on our 2002 claims data without any adjustment. We were certain that this would not result in accurate payments because of the magnitude of some of the fluctuations in median costs seen in the data.
Another option considered, to create cost bands similar to those used for New Technology APCs, was rejected because unless very narrow bands were created, this option also would result in inaccurate payments.
Finally, we looked at using the same methodology for moderating payment decreases that we used last year, to limit median cost decreases of 15 percent or more to 50 percent of the difference between the median cost and the amount of decrease greater than 15 percent. This option would enable us to moderate the decreased payment amount on an individual drug, biological, or radiopharmaceutical agent level, which is important in light of the great variations in the data; but the 50 percent adjustment level was not adequate for the level of moderation we believed was required for CY 2004.
The adjustment we put forth in this proposed rule is a 75 percent moderation of decreases of 15 percent or more. Thus, for separately payable drugs, biologicals, and radiopharmaceutical agents for which median costs decreased by 15 percent or more, we are proposing to limit the reduction in median costs to 15 percent plus 25 percent of the difference Start Printed Page 48016between the value derived from claims data and any decrease of 15 percent or more.
Our analyses indicate that application of this method of adjustment would result in payment levels that will be fair and accurate. However, based on more complete claims data we expect to have for the final rule and on the comments from the public, we will re-evaluate the appropriateness of adjusting median costs for drugs for which median costs would decline in 2004.
Conclusion
It is clear that the changes in this proposed rule would affect both a substantial number of rural hospitals as well as other classes of hospitals, and the effects on some may be significant. Therefore, the discussion below, in combination with the rest of this proposed rule, constitutes a regulatory impact analysis.
The OPPS rates for CY 2004 would have, overall, a positive effect for every category of hospital with the exception of cancer hospitals and children's hospitals, which are held harmless under the OPPS. These changes in the OPPS for 2004 would result in an overall 3.8 percent increase in Medicare payments to hospitals, exclusive of outlier and transitional pass-through payments and transitional corridor payments. As described in the preamble, budget neutrality adjustments are made to the conversion factor and the relative weights to ensure that the revisions in the wage index, APC groups, and relative weights do not affect aggregate payments. The impact of the wage and recalibration changes does vary somewhat by hospital group. Estimates of these impacts are displayed on Table 23.
The overall projected increase in payments for urban hospitals is slightly lower (3.7 percent) than the average increase for all hospitals (3.8 percent) while the increase for rural hospitals is slightly greater (4.0 percent) than the average increase. The introduction of a new wage index combined with changes to the APC structure would result in small distributional changes for all categories of hospitals. Rural hospitals would gain 0.1 percent from the wage index change but show no gains from APC changes. Large urban hospitals would lose 0.1 percent from the wage index change, whereas “other” urban hospitals show a decrease of −0.2 percent from the APC changes. A discussion of the distribution of outlier payments that we project under this proposed rule can be found under section XV.E below. Table 24 presents the outlier distribution that we expect to see under this proposed rule.
C. Limitations of Our Analysis
The distributional impacts represent the projected effects of the policy changes, as well as statutory changes effective for 2004, on various hospital groups. We estimate the effects of individual policy changes by estimating payments per service while holding all other payment policies constant. We use the best data available but do not attempt to predict behavioral responses to our policy changes. In addition, we are not proposing to make adjustments for future changes in variables such as service volume, service mix, or number of encounters.
D. Estimated Impacts of This Proposed Rule on Hospitals
The OPPS is a budget neutral payment system under which the increase to the total payments made under OPPS is limited by the increase to the conversion factor set under the methodology in the statute. The impact tables show the redistribution of hospital payments among providers as a result of a new wage index and APC structure. In some cases, under this proposed rule, hospitals would receive more total payment than in 2003 while in other cases they would receive less total payment than they received in 2003. The impact of this proposed rule would depend on a number of factors, most significant of which are the mix of services furnished by a hospital (for example, how the APCs for the hospital's most frequently furnished services would change) and the impact of the wage index changes on the hospital.
Column 4 in Table 23 represents the full impact on each hospital group of all the changes for 2004. Columns 2 and 3 in the table reflect the independent effects of the proposed change in the wage index and the APC reclassification and recalibration changes, respectively. We excluded critical access hospitals (CAHs) from the analysis of the impact of the proposed 2004 OPPS rates that is summarized in Table 23. For that reason, the total number of hospitals included in Table 23 (4,352) is lower than in previous years. CAHs are excluded from the OPPS.
To a very limited extent, wage index changes favor all hospital categories with the exception of large urban hospitals with 500 or more beds that show a −0.3 percentage change. Rural hospitals show modest increases of 0.1 percent for most bed sizes but show the largest gains for categories with 200 or more beds, a 0.3 percent increase. Rural hospitals located in Puerto Rico show the largest negative impact (−2.2 percent) due to changes in the wage index. Hospitals located in the Middle Atlantic, South Atlantic, and in the East North Central part of the country experience a negative impact due to wage index changes regardless of urban or rural designation. However, this effect is somewhat lessened by the distribution of outlier payments as discussed in more detail below.
The APC reclassification and recalibration changes also favor rural hospitals with the exception of rural hospitals with 200 or more beds that show a negative effect (−1.2 percent). Conversely, urban hospitals with 200 to 299 beds (−0.1 percent decrease), and urban hospitals with 300 to 499 beds (−0.5 percent) show a decrease attributed to APC recalibration. Urban hospitals in excess of 500 beds show a 0.1 percent increase as a result of APC recalibration. In general, APC changes are small and result in very few distributional changes among hospital categories.
In both urban and rural areas, hospitals that provide a lower volume of outpatient services are projected to receive a larger increase in payments than higher volume hospitals. In rural areas, hospitals with volumes of fewer than 5,000 services are projected to experience an increase in payments (4.4 percent). Urban hospitals that provide low-volume services experience an even larger increase (5.0 percent) in payments attributable to both wage index and APC changes. Conversely, urban and rural hospitals providing more than 21,000 services are projected to lose as a result of APC recalibration but gain from the introduction of the new wage index for a combined effect in the range of 3.4 to 3.9 percent.
Major teaching hospitals are projected to experience a smaller increase in payments (3.4 percent) than the aggregate for all hospitals (3.8 percent) due to negative impacts of the wage index (−0.4 percent). Hospitals with less intensive teaching programs are projected to experience an overall increase (3.7 percent) that is smaller than the average for all hospitals. There is little difference in impact among hospitals that serve low-income patients where increases in payments range from 3.4 to 4.2 percent higher than in 2003. Start Printed Page 48017
Table 23.—Impact of Changes for CY2004 Hospital Outpatient Prospective Payment System
(Percent change in total payments to hospitals (program and beneficiary); does not include hold harmless, corridor, outlier, or transitional pass-through payments)
Number of hospitals (1) New wage index (2) APC changes (3) All CY2003 changes (4) ALL HOSPITALS 4,352 0.0 0.0 3.8 NON-TEFRA HOSPITALS 3,849 0.0 0.0 3.8 URBAN HOSPS 2,390 0.0 0.0 3.7 LARGE URBAN (GT 1 MILL.) 1,377 −0.1 0.0 3.8 OTHER URBAN (LE 1 MILL.) 1,013 0.0 −0.2 3.7 RURAL HOSPS 1,459 0.1 0.0 4.0 BEDS (URBAN): 0-99 BEDS 546 0.2 0.4 4.4 100-199 BEDS 875 0.0 0.2 4.1 200-299 BEDS 456 0.0 −0.1 3.7 300-499 BEDS 364 0.1 −0.5 3.4 500 + BEDS 149 −0.3 0.1 3.6 BEDS (RURAL): 0-49 BEDS 694 0.1 1.0 4.9 50-99 BEDS 449 0.1 0.2 4.1 100-149 BEDS 190 0.1 0.0 3.9 150-199 BEDS 65 0.1 0.1 4.0 200 + BEDS 61 0.3 −1.2 2.9 VOLUME (URBAN): LT 5,000 225 0.0 1.1 5.0 5,000-10,999 396 0.0 1.0 4.9 11,000-20,999 529 −0.2 0.8 4.5 21,000-42,999 736 0.1 −0.1 3.9 GT 42,999 504 −0.1 −0.3 3.4 VOLUME (RURAL): LT 5,000 419 0.1 0.4 4.4 5,000-10,999 483 0.1 0.9 4.9 11,000-20,999 318 0.0 0.4 4.3 21,000-42,999 191 0.2 −0.6 3.5 GT 42,999 48 0.3 −0.7 3.4 REGION (URBAN): NEW ENGLAND 128 0.0 −0.7 3.1 MIDDLE ATLANTIC 367 −0.6 −0.5 2.7 SOUTH ATLANTIC 355 −0.1 −0.1 3.7 EAST NORTH CENT. 401 −0.1 0.4 4.1 EAST SOUTH CENT. 152 0.6 −0.2 4.3 WEST NORTH CENT. 166 0.3 0.1 4.2 WEST SOUTH CENT. 293 −0.1 0.1 3.9 MOUNTAIN 122 0.6 0.0 4.5 PACIFIC 366 0.1 0.0 3.9 PUERTO RICO 40 0.3 2.1 6.3 REGION (RURAL): NEW ENGLAND 36 0.8 −0.1 4.6 MIDDLE ATLANTIC 66 −0.2 0.2 3.8 SOUTH ATLANTIC 213 −0.2 −0.1 3.5 EAST NORTH CENT. 192 −0.1 −0.5 3.3 EAST SOUTH CENT. 225 0.4 0.2 4.4 WEST NORTH CENT. 244 0.6 0.0 4.4 WEST SOUTH CENT. 267 0.2 0.5 4.6 MOUNTAIN 123 0.1 0.0 3.9 PACIFIC 88 0.3 0.7 4.8 PUERTO RICO 5 −2.2 1.4 3.0 TEACHING STATUS: NON-TEACHING 2,803 0.1 0.1 4.0 MINOR 758 0.1 −0.2 3.7 MAJOR 288 −0.4 0.0 3.4 DSH PATIENT PERCENT: 0 11 2.7 3.0 9.8 GT 0-0.10 862 −0.1 −0.3 3.4 0.10-0.16 845 0.0 −0.2 3.6 0.16-0.23 778 0.1 0.4 4.2 0.23-0.35 757 0.0 0.0 3.8 GE 0.35 596 0.0 0.2 4.0 URBAN IME/DSH: IME & DSH 963 −0.1 −0.1 3.6 IME/NO DSH 1 0.0 −1.3 2.4 NO IME/DSH 1,417 0.0 0.1 3.9 NO IME/NO DSH 9 2.8 3.0 10.0 RURAL HOSP. TYPES: Start Printed Page 48018 NO SPECIAL STATUS 481 −0.2 0.3 4.0 RRC 159 0.3 −0.6 3.5 SCH/EACH 483 0.2 0.6 4.7 MDH 249 0.1 0.7 4.7 SCH AND RRC 78 0.3 −0.5 3.6 TYPE OF OWNERSHIP: VOLUNTARY 2,362 0.0 −0.1 3.6 PROPRIETARY 696 0.1 0.6 4.6 GOVERNMENT 791 0.1 0.0 3.9 SPECIALTY HOSPITALS: EYE AND EAR 13 −0.4 1.7 5.2 CANCER 11 −0.3 −4.7 −1.3 TEFRA HOSPITALS (NOT INCLUDED ON OTHER LINES): REHAB 159 0.5 0.3 4.6 PSYCH 167 0.8 7.2 12.2 LTC 135 1.8 4.3 10.3 CHILDREN 42 0.0 −1.1 2.7 1. Some data necessary to classify hospitals by category were missing; thus, the total number of hospitals in each category may not equal the national total. 2. This column shows the impact of updating the wage index used to calculate payment by applying the FY2004 hospital inpatient wage index after geographic reclassification by the Medicare Geographic Classification Review Board. The hospital inpatient proposed rule for FY2004 was published in the Federal Register on May 19, 2003. 3. This column shows the impact of changes resulting from the reclassification of HCPCS codes among APC groups and the recalibration of APC weights based on 2002 hospital claims data. 4. This column shows changes in total payment from CY2003 to CY2004, excluding outlier and pass-through payments. It incorporates all of the changes reflected in columns 2 and 3. In addition, it shows the impact of the FY 2004 payment update. The sum of the columns may be different from the percentage changes shown here due to rounding. E. Projected Distribution of Outlier Payments
As stated elsewhere in this preamble, we have allocated 2 percent of the estimated 2004 expenditures to outlier payments. In Table 24 below, we provide a table that illustrates the percentage of outlier payments relative to the total projected payments for the categories of hospitals that we show in the impact table.
We project, based on the mix of services for the hospitals that would be paid under the OPPS in 2004, that most hospitals would receive outlier payments—approximately 94 percent would receive outlier payments. The anticipated outlier payments for urban hospitals can be expected to ameliorate the impact of the wage index and APC changes on payments to urban hospitals.
Start Printed Page 48020Table 24.—Distribution of Outlier Payments for CY 2004 Hospital Outpatient Prospective Payment
Number of hospitals Percent of total hospitals Number of hospitals with outliers Outlier payments as a percent of total payments (percent) ALL HOSPITALS 4,352 96.4 4,097 2.0 NON-TEFRA HOSPITALS 3,849 85.2 3,831 2.0 URBAN HOSPS 2,390 52.8 2,376 2.1 LARGE URBAN (GT 1 MILL.) 1,377 30.4 1,368 2.3 OTHER URBAN (LE 1 MILL.) 1,013 22.4 1,008 1.9 RURAL HOSPS 1,459 32.2 1,455 1.7 BEDS (URBAN): 0-99 BEDS 546 12.0 534 2.6 100-199 BEDS 875 19.4 874 1.8 200-299 BEDS 456 10.0 455 2.0 300-499 BEDS 364 8.0 364 2.0 500 + BEDS 149 3.2 149 2.6 BEDS (RURAL): 0-49 BEDS 694 15.4 691 2.2 50-99 BEDS 449 10.0 448 1.8 100-149 BEDS 190 4.2 190 1.4 150-199 BEDS 65 1.4 65 1.7 200 + BEDS 61 1.4 61 1.4 VOLUME (URBAN): LT 5,000 225 5.0 212 3.0 5,000-10,999 396 8.8 395 3.4 11,000-20,999 529 11.8 529 2.1 21,000-42,999 736 16.2 736 1.9 GT 42,999 504 11.2 504 2.1 Start Printed Page 48019 VOLUME (RURAL): LT 5,000 419 9.2 416 2.7 5,000-10,999 483 10.6 482 2.1 11,000-20,999 318 7.0 318 1.7 21,000-42,999 191 4.2 191 1.4 GT 42,999 48 1.0 48 1.5 REGION (URBAN): NEW ENGLAND 128 2.8 127 1.9 MIDDLE ATLANTIC 367 8.2 367 3.2 SOUTH ATLANTIC 355 7.8 355 1.9 EAST NORTH CENT 401 8.8 398 1.7 EAST SOUTH CENT 152 3.4 150 1.4 WEST NORTH CENT 166 3.6 166 1.8 WEST SOUTH CENT 293 6.4 292 2.6 MOUNTAIN 122 2.6 120 1.8 PACIFIC 366 8.0 363 2.0 PUERTO RICO 40 0.8 38 0.6 REGION (RURAL): NEW ENGLAND 36 0.8 36 2.4 MIDDLE ATLANTIC 66 1.4 66 1.4 SOUTH ATLANTIC 213 4.8 212 1.6 EAST NORTH CENT 192 4.2 192 1.5 EAST SOUTH CENT 225 5.0 225 1.2 WEST NORTH CENT 244 5.4 243 1.8 WEST SOUTH CENT 267 6.0 266 1.7 MOUNTAIN 123 2.8 123 2.8 PACIFIC 88 2.0 87 2.2 PUERTO RICO 5 0.2 5 0.9 TEACHING STATUS: NON-TEACHING 2,803 62.0 2,786 1.8 MINOR 758 16.8 757 1.7 MAJOR 288 6.4 288 3.1 DSH PATIENT PERCENT: 0 11 0.2 10 6.7 GT 0-0.10 862 19.0 853 1.9 0.10-0.16 845 18.6 845 1.7 0.16-0.23 778 17.2 777 1.8 0.23-0.35 757 16.8 752 2.2 GE 0.35 596 13.2 594 3.1 URBAN IME/DSH: IME & DSH 963 21.4 963 2.3 IME/NO DSH 1 0.0 0 0.0 NO IME/DSH 1,417 31.4 1,404 1.9 NO IME/NO DSH 9 0.2 9 6.8 RURAL HOSP. TYPES: NO SPECIAL STATUS 481 10.6 478 1.8 RRC 159 3.6 159 1.4 SCH/EACH 483 10.6 483 2.1 MDH 249 5.6 249 1.8 SCH AND RRC 78 1.8 78 1.4 TYPE OF OWNERSHIP: VOLUNTARY 2,362 52.2 2,359 1.9 PROPRIETARY 696 15.4 685 2.4 GOVERNMENT 791 17.6 787 2.5 SPECIALTY HOSPITALS: EYE AND EAR 13 0.2 13 2.5 TRAUMA 151 3.4 151 2.6 CANCER 11 0.2 11 5.2 TEFRA HOSPITALS (NOT INCLUDED ON OTHER LINES): REHAB 159 3.6 94 5.8 PSYCH 167 3.6 46 0.6 LTC 135 3.0 88 2.7 CHILDREN 42 1.0 38 11.8 F. Estimated Impacts of This Proposed Rule on Beneficiaries
For services for which the beneficiary pays a coinsurance of 20 percent of the payment rate, the beneficiary share of payment would increase for services for which OPPS payments would rise and would decrease for services for which OPPS payments would fall. For example, for a mid level office visit (APC 0601), the minimum unadjusted copayment in 2003 was $10.11; under this proposed rule, the minimum unadjusted copayment for APC 601 would be $10.89 because the OPPS payment for the service would increase under this proposed rule. For some services (those services for which a national unadjusted copayment amount is shown in Addendum B), however, the beneficiary copayment is frozen based on historic data and would not change, therefore not presenting any potential impact on beneficiaries.
However, in all cases, the statute limits beneficiary liability for copayment for a service to the inpatient hospital deductible for the applicable year. This amount was $840 for 2003, but is not yet determined for 2004. In general, the impact of this proposed rule on beneficiaries would vary based on the service the beneficiary receives and whether the copayment for the service is one that is frozen under the OPPS.
In accordance with the provisions of Executive Order 12866, this regulation was reviewed by the Office of Management and Budget.
Start SignatureDated: July 16, 2003.
(Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program)
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
Approved: July 22, 2003.Tommy G. Thompson,
Secretary.
—————————— 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 48030Addendum A.—List of Ambulatory Payment Classifications (APCs) With Status Indicators, Relative Weights, Payment Rates, and Copayment Amounts Calendar Year 2004
APC Group title Status indicator Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment 0001 Level I Photochemotherapy S 0.3940 $21.39 $7.09 $4.28 0002 Fine needle Biopsy/Aspiration T 1.0937 $59.38 $11.88 0003 Bone Marrow Biopsy/Aspiration T 2.2627 $122.84 $24.57 0004 Level I Needle Biopsy/Aspiration Except Bone Marrow T 1.5774 $85.64 $22.10 $17.13 0005 Level II Needle Biopsy /Aspiration Except Bone Marrow T 3.3675 $182.82 $71.59 $36.56 0006 Level I Incision & Drainage T 1.7487 $94.94 $24.12 $18.99 0007 Level II Incision & Drainage T 11.4943 $624.01 $124.80 0008 Level III Incision and Drainage T 16.8303 $913.70 $182.74 0009 Nail Procedures T 0.6597 $35.81 $8.34 $7.16 0010 Level I Destruction of Lesion T 0.6806 $36.95 $10.08 $7.39 0011 Level II Destruction of Lesion T 2.1800 $118.35 $27.88 $23.67 0012 Level I Debridement & Destruction T 0.8203 $44.53 $11.18 $8.91 0013 Level II Debridement & Destruction T 1.1420 $62.00 $14.20 $12.40 0015 Level III Debridement & Destruction T 1.5832 $85.95 $20.35 $17.19 0016 Level IV Debridement & Destruction T 2.7343 $148.44 $57.31 $29.69 0017 Level VI Debridement & Destruction T 16.7332 $908.43 $227.84 $181.69 0018 Biopsy of Skin/Puncture of Lesion T 0.9567 $51.94 $16.04 $10.39 0019 Level I Excision/ Biopsy T 3.9807 $216.11 $71.87 $43.22 0020 Level II Excision/ Biopsy T 7.3105 $396.88 $113.25 $79.38 0021 Level III Excision/ Biopsy T 14.5749 $791.26 $219.48 $158.25 0022 Level IV Excision/ Biopsy T 18.6725 $1,013.71 $354.45 $202.74 0023 Exploration Penetrating Wound T 3.1587 $171.48 $40.37 $34.30 0024 Level I Skin Repair T 1.7847 $96.89 $34.75 $19.38 0025 Level II Skin Repair T 6.2703 $340.41 $115.49 $68.08 0027 Level IV Skin Repair T 15.8319 $859.50 $329.72 $171.90 0028 Level I Breast Surgery T 17.7459 $963.41 $303.74 $192.68 0029 Level II Breast Surgery T 29.2783 $1,589.49 $632.64 $317.90 0030 Level III Breast Surgery T 37.2809 $2,023.94 $763.55 $404.79 0032 Insertion of Central Venous/Arterial Catheter T 11.5584 $627.49 $125.50 0033 Partial Hospitalization P 3.8397 $208.45 $41.83 $41.69 0035 Placement of Arterial or Central Venous Catheter T 0.2236 $12.14 $3.51 $2.43 0041 Level I Arthroscopy T 27.2538 $1,479.58 $295.92 0042 Level II Arthroscopy T 42.8551 $2,326.56 $804.74 $465.31 0043 Closed Treatment Fracture Finger/Toe/Trunk T 1.9233 $104.41 $20.88 0045 Bone/Joint Manipulation Under Anesthesia T 13.5546 $735.87 $268.47 $147.17 0046 Open/Percutaneous Treatment Fracture or Dislocation T 31.9719 $1,735.72 $535.76 $347.14 0047 Arthroplasty without Prosthesis T 30.3786 $1,649.22 $537.03 $329.84 0048 Arthroplasty with Prosthesis T 47.4707 $2,577.14 $695.60 $515.43 0049 Level I Musculoskeletal Procedures Except Hand and Foot T 19.9376 $1,082.39 $216.48 0050 Level II Musculoskeletal Procedures Except Hand and Foot T 25.1166 $1,363.56 $272.71 0051 Level III Musculoskeletal Procedures Except Hand and Foot T 34.9381 $1,896.75 $379.35 0052 Level IV Musculoskeletal Procedures Except Hand and Foot T 42.6430 $2,315.05 $463.01 0053 Level I Hand Musculoskeletal Procedures T 14.8188 $804.50 $253.49 $160.90 0054 Level II Hand Musculoskeletal Procedures T 24.2685 $1,317.51 $263.50 0055 Level I Foot Musculoskeletal Procedures T 18.8851 $1,025.25 $355.34 $205.05 0056 Level II Foot Musculoskeletal Procedures T 25.1591 $1,365.86 $405.81 $273.17 0057 Bunion Procedures T 25.4248 $1,380.29 $475.91 $276.06 0058 Level I Strapping and Cast Application S 1.0785 $58.55 $11.71 Start Printed Page 48021 0060 Manipulation Therapy S 0.3151 $17.11 $3.43 $3.42 0068 CPAP Initiation S 1.1234 $60.99 $30.49 $12.20 0069 Thoracoscopy T 28.6334 $1,554.48 $591.64 $310.90 0070 Thoracentesis/Lavage Procedures T 3.1393 $170.43 $34.09 0071 Level I Endoscopy Upper Airway T 0.9012 $48.93 $12.89 $9.79 0072 Level II Endoscopy Upper Airway T 1.6987 $92.22 $26.68 $18.44 0073 Level III Endoscopy Upper Airway T 3.4396 $186.73 $73.38 $37.35 0074 Level IV Endoscopy Upper Airway T 14.4952 $786.93 $295.70 $157.39 0075 Level V Endoscopy Upper Airway T 20.4113 $1,108.11 $445.92 $221.62 0076 Level I Endoscopy Lower Airway T 9.3560 $507.93 $189.82 $101.59 0077 Level I Pulmonary Treatment S 0.2772 $15.05 $7.52 $3.01 0078 Level II Pulmonary Treatment S 0.7731 $41.97 $14.55 $8.39 0079 Ventilation Initiation and Management S 2.2837 $123.98 $24.80 0080 Diagnostic Cardiac Catheterization T 36.0982 $1,959.74 $838.92 $391.95 0081 Non-Coronary Angioplasty or Atherectomy T 34.8355 $1,891.18 $378.24 0082 Coronary Atherectomy T 100.3996 $5,450.59 $1,293.59 $1,090.12 0083 Coronary Angioplasty and Percutaneous Valvuloplasty T 59.3417 $3,221.60 $644.32 0084 Level I Electrophysiologic Evaluation S 10.3392 $561.30 $112.26 0085 Level II Electrophysiologic Evaluation T 36.3284 $1,972.23 $435.09 $394.45 0086 Ablate Heart Dysrhythm Focus T 44.5652 $2,419.40 $822.28 $483.88 0087 Cardiac Electrophysiologic Recording/Mapping T 40.4579 $2,196.42 $439.28 0088 Thrombectomy T 34.6065 $1,878.75 $655.22 $375.75 0089 Insertion/Replacement of Permanent Pacemaker and Electrodes T 116.1611 $6,306.27 $1,722.59 $1,261.25 0090 Insertion/Replacement of Pacemaker Pulse Generator T 87.2850 $4,738.62 $1,705.90 $947.72 0091 Level II Vascular Ligation T 28.5187 $1,548.25 $348.23 $309.65 0092 Level I Vascular Ligation T 25.1347 $1,364.54 $505.37 $272.91 0093 Vascular Reconstruction/Fistula Repair without Device T 20.6662 $1,121.95 $277.34 $224.39 0094 Level I Resuscitation and Cardioversion S 2.6412 $143.39 $48.46 $28.68 0095 Cardiac Rehabilitation S 0.5984 $32.49 $16.24 $6.50 0096 Non-Invasive Vascular Studies S 1.7332 $94.09 $47.05 $18.82 0097 Cardiac and Ambulatory Blood Pressure Monitoring X 1.0565 $57.36 $23.80 $11.47 0098 Injection of Sclerosing Solution T 1.1630 $63.14 $15.17 $12.63 0099 Electrocardiograms S 0.3708 $20.13 $4.03 0100 Cardiac Stress Tests X 1.6726 $90.80 $41.44 $18.16 0101 Tilt Table Evaluation S 4.3675 $237.11 $105.27 $47.42 0103 Miscellaneous Vascular Procedures T 12.1256 $658.29 $223.63 $131.66 0104 Transcatheter Placement of Intracoronary Stents T 80.8877 $4,391.31 $878.26 0105 Revision/Removal of Pacemakers, AICD, or Vascular T 18.9084 $1,026.52 $370.40 $205.30 0106 Insertion/Replacement/Repair of Pacemaker and/or Electrodes T 49.9534 $2,711.92 $542.39 $542.38 0107 Insertion of Cardioverter-Defibrillator T 290.5429 $15,773.28 $3,429.62 $3,154.66 0108 Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads T 489.5275 $26,575.96 $5,315.19 0109 Removal of Implanted Devices T 7.7075 $418.43 $131.49 $83.69 0110 Transfusion S 3.7128 $201.56 $40.31 0111 Blood Product Exchange S 14.0169 $760.96 $211.96 $152.19 0112 Apheresis, Photopheresis, and Plasmapheresis S 34.8318 $1,890.98 $609.71 $378.20 0113 Excision Lymphatic System T 19.9529 $1,083.22 $216.64 0114 Thyroid/Lymphadenectomy Procedures T 37.3583 $2,028.14 $485.91 $405.63 0115 Cannula/Access Device Procedures T 25.6233 $1,391.06 $459.35 $278.21 0119 Implantation of Infusion Pump T 129.8988 $7,052.08 $1,410.42 0121 Level I Tube changes and Repositioning T 2.2058 $119.75 $43.80 $23.95 0122 Level II Tube changes and Repositioning T 8.4398 $458.19 $93.97 $91.64 0123 Bone Marrow Harvesting and Bone Marrow/Stem Cell Transplant S 4.0076 $217.57 $43.51 0124 Revision of Implanted Infusion Pump T 27.4545 $1,490.48 $298.10 $298.10 0125 Refilling of Infusion Pump T 2.5105 $136.29 $27.26 0130 Level I Laparoscopy T 32.5959 $1,769.60 $659.53 $353.92 0131 Level II Laparoscopy T 40.8955 $2,220.18 $1,001.89 $444.04 0132 Level III Laparoscopy T 56.6318 $3,074.48 $1,239.22 $614.90 0140 Esophageal Dilation without Endoscopy T 6.3480 $344.63 $107.24 $68.93 0141 Upper GI Procedures T 7.8542 $426.40 $143.38 $85.28 0142 Small Intestine Endoscopy T 9.0138 $489.35 $152.78 $97.87 0143 Lower GI Endoscopy T 8.3227 $451.83 $186.06 $90.37 0146 Level I Sigmoidoscopy T 3.9986 $217.08 $64.40 $43.42 0147 Level II Sigmoidoscopy T 7.5876 $411.92 $82.38 0148 Level I Anal/Rectal Procedure T 4.1171 $223.51 $63.38 $44.70 0149 Level III Anal/Rectal Procedure T 16.8557 $915.08 $293.06 $183.02 Start Printed Page 48022 0150 Level IV Anal/Rectal Procedure T 22.2565 $1,208.28 $437.12 $241.66 0151 Endoscopic Retrograde Cholangio-Pancreatography (ERCP) T 18.8763 $1,024.78 $245.46 $204.96 0152 Percutaneous Abdominal and Biliary Procedures T 8.2940 $450.27 $113.02 $90.05 0153 Peritoneal and Abdominal Procedures T 21.2745 $1,154.97 $410.87 $230.99 0154 Hernia/Hydrocele Procedures T 26.8861 $1,459.62 $464.85 $291.92 0155 Level II Anal/Rectal Procedure T 9.9148 $538.26 $188.89 $107.65 0156 Level II Urinary and Anal Procedures T 3.1438 $170.67 $46.55 $34.13 0157 Colorectal Cancer Screening: Barium Enema S 2.4771 $134.48 $26.90 0158 Colorectal Cancer Screening: Colonoscopy T 7.4187 $402.75 $100.69 $80.55 0159 Colorectal Cancer Screening: Flexible Sigmoidoscopy S 2.7168 $147.49 $36.87 $29.50 0160 Level I Cystourethroscopy and other Genitourinary Procedures T 6.8152 $369.99 $105.06 $74.00 0161 Level II Cystourethroscopy and other Genitourinary Procedures T 16.5822 $900.23 $249.36 $180.05 0162 Level III Cystourethroscopy and other Genitourinary Procedures T 21.8578 $1,186.64 $237.33 0163 Level IV Cystourethroscopy and other Genitourinary Procedures T 33.6435 $1,826.47 $365.29 0164 Level I Urinary and Anal Procedures T 1.2115 $65.77 $17.59 $13.15 0165 Level III Urinary and Anal Procedures T 14.0780 $764.28 $152.86 0166 Level I Urethral Procedures T 16.8401 $914.23 $218.73 $182.85 0167 Level III Urethral Procedures T 30.1066 $1,634.46 $555.84 $326.89 0168 Level II Urethral Procedures T 30.3485 $1,647.59 $405.60 $329.52 0169 Lithotripsy T 44.5329 $2,417.65 $1,115.69 $483.53 0170 Dialysis S 5.9427 $322.62 $64.52 0180 Circumcision T 18.4967 $1,004.17 $304.87 $200.83 0181 Penile Procedures T 29.0094 $1,574.89 $621.82 $314.98 0183 Testes/Epididymis Procedures T 21.7612 $1,181.39 $236.28 0184 Prostate Biopsy T 3.8073 $206.69 $96.27 $41.34 0187 Miscellaneous Placement/Repositioning X 4.4274 $240.36 $90.71 $48.07 0188 Level II Female Reproductive Proc T 1.1079 $60.15 $12.03 0189 Level III Female Reproductive Proc T 1.3207 $71.70 $16.70 $14.34 0190 Level I Hysteroscopy T 19.8088 $1,075.40 $424.28 $215.08 0191 Level I Female Reproductive Proc T 0.1679 $9.12 $2.65 $1.82 0192 Level IV Female Reproductive Proc T 2.6966 $146.40 $39.11 $29.28 0193 Level V Female Reproductive Proc T 15.7365 $854.32 $171.13 $170.86 0194 Level VI Female Reproductive Proc T 18.8194 $1,021.69 $397.84 $204.34 0195 Level VII Female Reproductive Proc T 25.3207 $1,374.64 $483.80 $274.93 0196 Dilation and Curettage T 16.1823 $878.52 $338.23 $175.70 0197 Infertility Procedures T 5.1958 $282.07 $56.41 0198 Pregnancy and Neonatal Care Procedures T 1.3718 $74.47 $32.19 $14.89 0199 Obstetrical Care Service T 16.8630 $915.48 $183.10 0200 Therapeutic Abortion T 18.3633 $996.93 $307.83 $199.39 0201 Spontaneous Abortion T 17.2803 $938.13 $329.65 $187.63 0202 Level VIII Female Reproductive Proc T 38.8053 $2,106.70 $1,032.28 $421.34 0203 Level IV Nerve Injections T 11.8511 $643.38 $276.76 $128.68 0204 Level I Nerve Injections T 2.2209 $120.57 $40.13 $24.11 0206 Level II Nerve Injections T 5.2584 $285.47 $75.55 $57.09 0207 Level III Nerve Injections T 6.5998 $358.30 $123.69 $71.66 0208 Laminotomies and Laminectomies T 40.6521 $2,206.96 $441.39 0209 Extended EEG Studies and Sleep Studies, Level II S 11.5352 $626.23 $280.58 $125.25 0212 Nervous System Injections T 2.9989 $162.81 $74.92 $32.56 0213 Extended EEG Studies and Sleep Studies, Level I S 3.2422 $176.02 $70.41 $35.20 0214 Electroencephalogram S 2.2459 $121.93 $58.12 $24.39 0215 Level I Nerve and Muscle Tests S 0.6390 $34.69 $15.76 $6.94 0216 Level III Nerve and Muscle Tests S 2.8332 $153.81 $67.98 $30.76 0218 Level II Nerve and Muscle Tests S 1.1296 $61.32 $12.26 0220 Level I Nerve Procedures T 16.5293 $897.36 $179.47 0221 Level II Nerve Procedures T 25.8194 $1,401.71 $463.62 $280.34 0222 Implantation of Neurological Device T 188.7735 $10,248.32 $2,049.66 0223 Implantation or Revision of Pain Management Catheter T 26.0352 $1,413.42 $282.68 0224 Implantation of Reservoir/Pump/Shunt T 34.0161 $1,846.70 $453.41 $369.34 0225 Implantation of Neurostimulator Electrodes S 56.0375 $3,042.22 $608.44 0226 Implantation of Drug Infusion Reservoir T 159.6795 $8,668.84 $1,733.77 0227 Implantation of Drug Infusion Device T 163.6124 $8,882.35 $1,776.47 0228 Creation of Lumbar Subarachnoid Shunt T 51.1329 $2,775.95 $621.80 $555.19 0229 Transcatherter Placement of Intravascular Shunts T 59.4977 $3,230.07 $771.23 $646.01 0230 Level I Eye Tests & Treatments S 0.7379 $40.06 $14.97 $8.01 0231 Level III Eye Tests & Treatments S 2.0880 $113.36 $50.94 $22.67 Start Printed Page 48023 0232 Level I Anterior Segment Eye Procedures T 4.9739 $270.03 $103.17 $54.01 0233 Level II Anterior Segment Eye Procedures T 14.5435 $789.55 $266.33 $157.91 0234 Level III Anterior Segment Eye Procedures T 21.5482 $1,169.83 $511.31 $233.97 0235 Level I Posterior Segment Eye Procedures T 4.9900 $270.90 $72.04 $54.18 0236 Level II Posterior Segment Eye Procedures T 19.6866 $1,068.77 $213.75 0237 Level III Posterior Segment Eye Procedures T 34.0324 $1,847.58 $818.54 $369.52 0238 Level I Repair and Plastic Eye Procedures T 3.2016 $173.81 $58.96 $34.76 0239 Level II Repair and Plastic Eye Procedures T 6.2432 $338.94 $110.62 $67.79 0240 Level III Repair and Plastic Eye Procedures T 17.3397 $941.35 $315.31 $188.27 0241 Level IV Repair and Plastic Eye Procedures T 21.9830 $1,193.44 $384.47 $238.69 0242 Level V Repair and Plastic Eye Procedures T 29.2193 $1,586.29 $597.36 $317.26 0243 Strabismus/Muscle Procedures T 21.1035 $1,145.69 $431.39 $229.14 0244 Corneal Transplant T 37.4885 $2,035.21 $803.26 $407.04 0245 Level I Cataract Procedures without IOL Insert T 12.5751 $682.69 $226.11 $136.54 0246 Cataract Procedures with IOL Insert T 22.8428 $1,240.11 $495.96 $248.02 0247 Laser Eye Procedures Except Retinal T 5.0192 $272.49 $104.31 $54.50 0248 Laser Retinal Procedures T 4.7544 $258.11 $95.08 $51.62 0249 Level II Cataract Procedures without IOL Insert T 28.3307 $1,538.05 $524.67 $307.61 0250 Nasal Cauterization/Packing T 1.5381 $83.50 $29.23 $16.70 0251 Level I ENT Procedures T 1.8643 $101.21 $20.24 0252 Level II ENT Procedures T 6.5416 $355.14 $113.41 $71.03 0253 Level III ENT Procedures T 15.1698 $823.55 $282.29 $164.71 0254 Level IV ENT Procedures T 21.4368 $1,163.78 $321.35 $232.76 0256 Level V ENT Procedures T 35.0866 $1,904.82 $380.96 0258 Tonsil and Adenoid Procedures T 21.0273 $1,141.55 $437.25 $228.31 0259 Level VI ENT Procedures T 389.1764 $21,128.00 $9,394.83 $4,225.60 0260 Level I Plain Film Except Teeth X 0.7845 $42.59 $21.29 $8.52 0261 Level II Plain Film Except Teeth Including Bone Density Measurement X 1.3238 $71.87 $14.37 0262 Plain Film of Teeth X 0.7851 $42.62 $9.82 $8.52 0263 Level I Miscellaneous Radiology Procedures X 2.1875 $118.76 $43.58 $23.75 0264 Level II Miscellaneous Radiology Procedures X 3.0022 $162.99 $79.41 $32.60 0265 Level I Diagnostic Ultrasound Except Vascular S 1.0245 $55.62 $27.81 $11.12 0266 Level II Diagnostic Ultrasound Except Vascular S 1.6234 $88.13 $44.07 $17.63 0267 Level III Diagnostic Ultrasound Except Vascular S 2.4805 $134.66 $65.52 $26.93 0268 Ultrasound Guidance Procedures S 1.2640 $68.62 $13.72 0269 Level III Echocardiogram Except Transesophageal S 3.2517 $176.53 $87.24 $35.31 0270 Transesophageal Echocardiogram S 5.9057 $320.61 $146.79 $64.12 0271 Mammography S 0.6548 $35.55 $16.80 $7.11 0272 Level I Fluoroscopy X 1.4086 $76.47 $38.24 $15.29 0274 Myelography S 3.5837 $194.56 $92.92 $38.91 0275 Arthrography S 3.2967 $178.97 $69.09 $35.79 0276 Level I Digestive Radiology S 1.6025 $87.00 $41.72 $17.40 0277 Level II Digestive Radiology S 2.4462 $132.80 $60.47 $26.56 0278 Diagnostic Urography S 2.7365 $148.56 $66.07 $29.71 0279 Level II Angiography and Venography except Extremity S 11.0678 $600.86 $174.57 $120.17 0280 Level III Angiography and Venography except Extremity S 19.0237 $1,032.78 $353.85 $206.56 0281 Venography of Extremity S 6.6888 $363.13 $115.16 $72.63 0282 Miscellaneous Computerized Axial Tomography S 1.6813 $91.28 $44.51 $18.26 0283 Computerized Axial Tomography with Contrast Material S 4.6121 $250.39 $125.19 $50.08 0284 Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contras S 7.0207 $381.15 $190.57 $76.23 0285 Myocardial Positron Emission Tomography (PET) S 19.5044 $1,058.87 $409.56 $211.77 0287 Complex Venography S 6.2829 $341.09 $107.20 $68.22 0288 Bone Density:Axial Skeleton S 1.2854 $69.78 $13.96 0289 Needle Localization for Breast Biopsy X 3.6386 $197.54 $44.80 $39.51 0296 Level I Therapeutic Radiologic Procedures S 3.1381 $170.36 $69.20 $34.07 0297 Level II Therapeutic Radiologic Procedures S 8.1532 $442.63 $172.51 $88.53 0299 Miscellaneous Radiation Treatment S 5.7427 $311.77 $62.36 $62.35 0300 Level I Radiation Therapy S 1.5112 $82.04 $16.41 0301 Level II Radiation Therapy S 2.1337 $115.84 $23.17 $23.17 0302 Level III Radiation Therapy S 6.1992 $336.55 $127.49 $67.31 0303 Treatment Device Construction X 2.8636 $155.46 $66.95 $31.09 0304 Level I Therapeutic Radiation Treatment Preparation X 1.6599 $90.11 $41.52 $18.02 0305 Level II Therapeutic Radiation Treatment Preparation X 3.6649 $198.96 $91.38 $39.79 0310 Level III Therapeutic Radiation Treatment Preparation X 13.7085 $744.22 $325.27 $148.84 0312 Radioelement Applications S 3.6892 $200.28 $40.06 $40.06 0313 Brachytherapy S 13.1258 $712.59 $142.52 0314 Hyperthermic Therapies S 5.0930 $276.49 $101.77 $55.30 Start Printed Page 48024 0320 Electroconvulsive Therapy S 5.4480 $295.77 $80.06 $59.15 0321 Biofeedback and Other Training S 1.2462 $67.65 $21.78 $13.53 0322 Brief Individual Psychotherapy S 1.3091 $71.07 $14.21 0323 Extended Individual Psychotherapy S 1.7955 $97.48 $21.26 $19.50 0324 Family Psychotherapy S 2.8219 $153.20 $30.64 0325 Group Psychotherapy S 1.5820 $85.89 $18.27 $17.18 0330 Dental Procedures S 0.5609 $30.45 $6.09 $6.09 0332 Computerized Axial Tomography and Computerized Angiography without Contras S 3.3916 $184.13 $91.27 $36.83 0333 Computerized Axial Tomography and Computerized Angio w/o Contrast Material S 5.4299 $294.78 $146.98 $58.96 0335 Magnetic Resonance Imaging, Miscellaneous S 6.4453 $349.91 $151.46 $69.98 0336 Magnetic Resonance Imaging and Magnetic Resonance Angiography without Cont S 6.4817 $351.89 $175.94 $70.38 0337 MRI and Magnetic Resonance Angiography without Contrast Material followed S 9.3215 $506.05 $240.77 $101.21 0339 Observation S 7.2016 $390.97 $78.19 0340 Minor Ancillary Procedures X 0.6232 $33.83 $6.77 0341 Skin Tests X 0.1468 $7.97 $3.08 $1.59 0342 Level I Pathology X 0.2169 $11.78 $5.88 $2.36 0343 Level II Pathology X 0.4662 $25.31 $12.55 $5.06 0344 Level III Pathology X 0.6278 $34.08 $17.04 $6.82 0345 Level I Transfusion Laboratory Procedures X 0.2589 $14.06 $3.10 $2.81 0346 Level II Transfusion Laboratory Procedures X 0.3877 $21.05 $5.31 $4.21 0347 Level III Transfusion Laboratory Procedures X 0.9646 $52.37 $13.19 $10.47 0348 Fertility Laboratory Procedures X 1.2207 $66.27 $13.25 0352 Level I Injections X 0.1076 $5.84 $1.17 0353 Level II Allergy Injections X 0.4106 $22.29 $4.46 0355 Level III Immunizations K 0.2667 $14.48 $2.90 0356 Level IV Immunizations K 0.4353 $23.63 $4.73 0359 Level II Injections X 0.8794 $47.74 $9.55 0360 Level I Alimentary Tests X 1.7088 $92.77 $42.45 $18.55 0361 Level II Alimentary Tests X 3.5574 $193.13 $83.23 $38.63 0362 Level III Otorhinolaryngologic Function Tests X 2.5384 $137.81 $27.56 0363 Level I Otorhinolaryngologic Function Tests X 0.8536 $46.34 $17.15 $9.27 0364 Level I Audiometry X 0.4415 $23.97 $9.06 $4.79 0365 Level II Audiometry X 1.1915 $64.69 $18.95 $12.94 0367 Level I Pulmonary Test X 0.5828 $31.64 $15.16 $6.33 0368 Level II Pulmonary Tests X 0.9321 $50.60 $25.30 $10.12 0369 Level III Pulmonary Tests X 2.5282 $137.25 $44.18 $27.45 0370 Allergy Tests X 0.8858 $48.09 $11.58 $9.62 0371 Level I Allergy Injections X 0.4084 $22.17 $4.44 $4.43 0372 Therapeutic Phlebotomy X 0.5529 $30.02 $10.09 $6.00 0373 Neuropsychological Testing X 2.1165 $114.90 $22.98 $22.98 0374 Monitoring Psychiatric Drugs X 1.1062 $60.05 $12.01 0375 Ancillary Outpatient Services when Patient Expires T $1,150.00 $230.00 0376 Pkgd cancer chemo, other S 2.1479 $116.61 $23.32 0377 Sep cancer chemo, other S 0.6673 $36.23 $7.25 0378 Infusion of pkgd cancer S 4.3955 $238.63 $47.73 0379 Infusion, separate cancer S 2.4298 $131.91 $26.38 0380 Pkgd cancer chemo, both S 5.1857 $281.53 $56.31 0381 Sep cancer chemo, both S 2.1596 $117.24 $23.45 0382 Infusion, pkgd noncancer S 4.6839 $254.28 $50.86 0383 Infusion, separate noncancer S 1.8419 $99.99 $20.00 0384 GI Procedures with Stents T 36.0040 $1,954.62 $424.53 $390.92 0385 Level I Prosthetic Urological Procedures T 66.4829 $3,609.29 $721.86 0386 Level II Prosthetic Urological Procedures T 118.8122 $6,450.20 $1,290.04 0387 Level II Hysteroscopy T 28.5174 $1,548.18 $660.84 $309.64 0388 Discography S 11.7450 $637.62 $304.54 $127.52 0389 Non-imaging Nuclear Medicine S 1.6475 $89.44 $44.72 $17.89 0390 Level I Thyroid Imaging S 2.8434 $154.37 $77.18 $30.87 0391 Level II Thyroid Imaging S 3.7174 $201.81 $100.91 $40.36 0392 Adrenal Imaging S 6.7081 $364.18 $182.09 $72.84 0393 Red Cell/Plasma Studies S 4.0720 $221.06 $110.53 $44.21 0394 Hepatobiliary Imaging S 4.4370 $240.88 $120.44 $48.18 0395 GI Tract and B12 Studies S 3.9372 $213.75 $106.87 $42.75 0396 Bone Imaging S 4.2445 $230.43 $115.21 $46.09 0397 Vascular Imaging S 2.4737 $134.29 $67.15 $26.86 0398 Cardiac Imaging S 6.6521 $361.14 $180.57 $72.23 Start Printed Page 48025 0399 Cardiac Add-on Imaging S 1.6033 $87.04 $43.52 $17.41 0400 Hematopoietic Imaging S 3.8691 $210.05 $105.02 $42.01 0401 Pulmonary Imaging S 4.9130 $266.72 $133.36 $53.34 0402 Brain Imaging S 5.4818 $297.60 $148.80 $59.52 0403 CSF Imaging S 3.9265 $213.17 $106.58 $42.63 0404 Renal Imaging S 5.1538 $279.79 $139.90 $55.96 0405 Non-renal GU Studies S 0.7739 $42.01 $21.01 $8.40 0406 Tumor/Infection Imaging S 4.7542 $258.10 $51.62 0407 Thyroid Radionucliide treatment S 4.2797 $232.34 $116.17 $46.47 0408 Non-thyroid Radionucliide treatment S 4.0000 $217.16 $43.43 0409 Red Blood Cell Tests X 0.1385 $7.52 $2.31 $1.50 0410 Mammogram Add On S 0.1473 $8.00 $1.60 0411 Respiratory Procedures S 0.4207 $22.84 $4.57 0412 IMRT Treatment Delivery S 5.2832 $286.82 $57.36 0413 IMRT Treatment Plan S 6.0369 $327.74 $65.55 0414 Reconstruction CT Angiography of Aorta S 4.8012 $260.65 $52.13 0415 Level II Endoscopy Lower Airway T 20.9920 $1,139.63 $463.30 $227.93 0600 Low Level Clinic Visits V 0.9376 $50.90 $10.18 0601 Mid Level Clinic Visits V 1.0031 $54.46 $10.89 0602 High Level Clinic Visits V 1.5603 $84.71 $16.94 0610 Low Level Emergency Visits V 1.4146 $76.80 $19.57 $15.36 0611 Mid Level Emergency Visits V 2.4881 $135.08 $36.47 $27.02 0612 High Level Emergency Visits V 4.3235 $234.72 $54.14 $46.94 0620 Critical Care S 9.2657 $503.03 $145.78 $100.61 0648 Breast Reconstruction with Prosthesis T 55.5345 $3,014.91 $602.98 0649 Prostate Brachytherapy Palladium Seeds T 119.0281 $6,461.92 $1,292.38 0651 Complex Interstitial Radiation Source Application S 10.0459 $545.38 $109.08 $109.08 0652 Insertion of Intraperitoneal Catheters T 28.0692 $1,523.85 $304.77 0653 Vascular Reconstruction/Fistula Repair with Device T 32.4880 $1,763.74 $352.75 0654 Insertion/Replacement of a permanent dual chamber pacemaker T 103.8544 $5,638.15 $1,127.63 0655 Insertion/Replacement/Conversion of a permanent dual chamber pacemaker T 142.2244 $7,721.22 $1,544.24 0656 Transcatheter Placement of Intracoronary Drug-Eluting Stents T 101.3662 $5,503.07 $1,100.61 0657 Placement of Tissue Clips S 1.5630 $84.85 $16.97 0658 Percutaneous Breast Biopsies T 5.6035 $304.21 $60.84 0659 Hyperbaric Oxygen S 3.2220 $174.92 $34.98 0660 Level II Otorhinolaryngologic Function Tests X 1.7330 $94.08 $30.66 $18.82 0661 Level IV Pathology X 3.3215 $180.32 $90.16 $36.06 0662 CT Angiography S 5.8751 $318.95 $156.47 $63.79 0664 Proton Beam Radiation Therapy S 9.6828 $525.67 $105.13 0665 Bone Density:AppendicularSkeleton S 0.7225 $39.22 $7.84 0668 Level I Angiography and Venography except Extremity S 10.4896 $569.47 $237.76 $113.89 0669 Digital Mammography S 0.9111 $49.46 $9.89 0670 Intravenous and Intracardiac Ultrasound S 26.5472 $1,441.22 $521.95 $288.24 0671 Level II Echocardiogram Except Transesophageal S 1.6392 $88.99 $44.50 $17.80 0672 Level IV Posterior Segment Procedures T 39.1363 $2,124.67 $988.43 $424.93 0673 Level IV Anterior Segment Eye Procedures T 26.7626 $1,452.91 $649.56 $290.58 0674 Prostate Cryoablation T 101.1198 $5,489.69 $1,097.94 0675 Prostatic Thermotherapy T 49.3613 $2,679.78 $535.96 0676 Level II Transcatheter Thrombolysis T 3.7505 $203.61 $55.06 $40.72 0677 Level I Transcatheter Thrombolysis T 3.0769 $167.04 $33.41 0678 External Counterpulsation T 2.0622 $111.95 $22.39 0679 Level II Resuscitation and Cardioversion S 5.4862 $297.84 $95.30 $59.57 0680 Insertion of Patient Activated Event Recorders S 61.4222 $3,334.55 $666.91 0681 Knee Arthroplasty T 96.7483 $5,252.37 $2,090.21 $1,050.47 0682 Level V Debridement & Destruction T 7.6815 $417.02 $174.57 $83.40 0683 Level II Photochemotherapy S 1.7915 $97.26 $35.01 $19.45 0684 Prostate Brachytherapy Iodine Seeds T 104.7194 $5,685.11 $1,137.02 0685 Level III Needle Biopsy/Aspiration Except Bone Marrow T 4.8912 $265.54 $116.83 $53.11 0686 Level III Skin Repair T 17.0868 $927.63 $341.70 $185.53 0687 Revision/Removal of Neurostimulator Electrodes T 19.9913 $1,085.31 $499.24 $217.06 0688 Revision/Removal of Neurostimulator Pulse Generator Receiver T 42.5880 $2,312.06 $1,132.91 $462.41 0689 Electronic Analysis of Cardioverter-defibrillators S 0.5427 $29.46 $5.89 0690 Electronic Analysis of Pacemakers and other Cardiac Devices S 0.3986 $21.64 $10.35 $4.33 0691 Electronic Analysis of Programmable Shunts/Pumps S 2.9894 $162.29 $81.15 $32.46 0692 Electronic Analysis of Neurostimulator Pulse Generators S 0.9625 $52.25 $26.13 $10.45 0693 Level II Breast Reconstruction T 38.6469 $2,098.10 $798.17 $419.62 Start Printed Page 48026 0694 Mohs Surgery T 3.3272 $180.63 $72.25 $36.13 0695 Level VII Debridement & Destruction T 19.1377 $1,038.97 $266.59 $207.79 0697 Level I Echocardiogram Except Transesophageal S 1.4621 $79.38 $39.69 $15.88 0698 Level II Eye Tests & Treatments S 0.9355 $50.79 $18.72 $10.16 0699 Level IV Eye Tests & Treatments T 2.2211 $120.58 $54.26 $24.12 0700 Antepartum Manipulation T 2.4359 $132.24 $37.03 $26.45 0701 SR 89 chloride, per mCi K 7.4586 $404.92 $80.98 0702 SM 153 lexidronam, 50 mCi K 16.1415 $876.31 $175.26 0704 IN 111 Satumomab pendetide per dose K 2.9212 $158.59 $31.72 0726 Dexrazoxane hcl injection, 250 mg K 1.9860 $107.82 $21.56 0728 Filgrastim 300 mcg injection K 2.2544 $122.39 $24.48 0730 Pamidronate disodium , 30 mg K 1.5359 $83.38 $16.68 0732 Mesna injection 200 mg K 0.4908 $26.65 $5.33 0733 Non esrd epoetin alpha inj, 1000 u K 0.1782 $9.67 $1.93 0734 Injection, darbepoetin alfa (for non-ESRD use), pre 1 mcg K 0.0463 $2.51 $.50 0800 Leuprolide acetate, 3.75 mg K 3.3020 $179.26 $35.85 0802 Etoposide oral 50 mg K 0.4830 $26.22 $5.24 0807 Aldesleukin/single use vial K 7.0936 $385.10 $77.02 0810 Goserelin acetate implant 3.6 mg K 4.9549 $269.00 $53.80 0811 Carboplatin injection 50 mg K 1.5475 $84.01 $16.80 0812 Carmustine, 100 mg K 0.9972 $54.14 $10.83 0813 Cisplatin 10 mg injection K 0.3594 $19.51 $3.90 0820 Daunorubicin 10 mg K 0.60 $32.86 $6.57 0821 Daunorubicin citrate liposom 10 mg K 2.9697 $161.22 $32.24 0822 Diethylstilbestrol injection 250 mg K 1.3274 $72.06 $14.41 0823 Docetaxel, 20 mg K 4.0041 $217.38 $43.48 0827 Floxuridine injection 500 mg K 2.1836 $118.55 $23.71 0828 Gemcitabine HCL 200 mg K 1.4523 $78.84 $15.77 0830 Irinotecan injection 20 mg K 1.8626 $101.12 $20.22 0831 Ifosfomide injection 1 gm K 1.1616 $63.06 $12.61 0832 Idarubicin hcl injection 5 mg K 3.2438 $176.10 $35.22 0836 Interferon alfa-2b inj recombinant, 1 million K 0.2000 $10.86 $2.17 0838 Interferon gamma 1-b inj, 3 million u K 2.4742 $134.32 $26.86 0840 Melphalan hydrochl 50 mg K 4.4072 $239.26 $47.85 0842 Fludarabine phosphate inj 50 mg K 3.6854 $200.08 $40.02 0843 Pegaspargase, singl dose vial K 5.7621 $312.82 $62.56 0844 Pentostatin injection, 10 mg K 17.4201 $945.72 $189.14 0849 Rituximab, 100 mg K 5.5636 $302.04 $60.41 0850 Streptozocin injection, 1 gm K 1.3942 $75.69 $15.14 0852 Topotecan, 4 mg K 7.9075 $429.29 $85.86 0855 Vinorelbine tartrate, 10 mg K 1.1683 $63.43 $12.69 0856 Porfimer sodium, 75 mg K 25.3788 $1,377.79 $275.56 0857 Bleomycin sulfate injection 15 u K 2.2352 $121.35 $24.27 0858 Cladribine, 1mg K 0.7031 $38.17 $7.63 0861 Leuprolide acetate injection 1 mg K 0.8223 $44.64 $8.93 0862 Mitomycin 5 mg inj K 0.9557 $51.88 $10.38 0863 Paclitaxel injection, 30 mg K 1.2674 $68.81 $13.76 0864 Mitoxantrone hcl, 5 mg K 3.1513 $171.08 $34.22 0865 Interferon alfa-n3 inj, human leukocyte derived, 2 K 1.5823 $85.90 $17.18 0884 Rho d immune globulin inj, 1 dose pkg K 0.2312 $12.55 $2.51 0888 Cyclosporine oral 100 mg K 0.0482 $2.62 $.52 0890 Lymphocyte immune globulin 250 mg K 2.1958 $119.21 $23.84 0891 Tacrolimus oral per 1 mg K 0.0236 $1.28 $.26 0900 Alglucerase injection, per 10 u K 0.5473 $29.71 $5.94 0901 Alpha 1 proteinase inhibitor, 10 mg K 0.0214 $1.16 $.23 0902 Botulinum toxin a, per unit K 0.0460 $2.50 $.50 0903 Cytomegalovirus imm IV/vial K 5.0754 $275.54 $55.11 0905 Immune globulin, 1g K 0.8103 $43.99 $8.80 0906 RSV-ivig, 50 mg K 6.0142 $326.50 $65.30 0909 Interferon beta-1a, 33 mcg K 2.8010 $152.06 $30.41 0910 Interferon beta-1b /0.25 mg K 1.9843 $107.73 $21.55 0911 Streptokinase per 250,000 iu K 1.6055 $87.16 $17.43 0916 Imiglucerase injection/unit K 0.0531 $2.88 $.58 0917 Inj, Adenosine, 90 mg K 2.3474 $127.44 $25.49 0925 Factor viii per iu K 0.0085 $.46 $.09 0926 Factor VIII (porcine) per iu K 0.0253 $1.37 $.27 0927 Factor viii recombinant per iu K 0.0168 $.91 $.18 0928 Factor ix complex per iu K 0.0085 $.46 $.09 0929 Anti-inhibitor per iu K 0.0168 $.91 $.18 Start Printed Page 48027 0930 Antithrombin iii injection per iu K 0.0117 $.64 $.13 0931 Factor IX non-recombinant, per iu K 0.0104 $.56 $.11 0932 Factor IX recombinant, per iu K 0.0168 $.91 $.18 0949 Plasma, Pooled Multiple Donor, Solvent/Detergent T K 2.0608 $111.88 $22.38 0950 Blood (Whole) For Transfusion K 1.4575 $79.13 $15.83 0952 Cryoprecipitate K 0.4860 $26.38 $5.28 0954 RBC leukocytes reduced K 1.9770 $107.33 $21.47 0955 Plasma, Fresh Frozen K 1.5750 $85.51 $17.10 0956 Plasma Protein Fraction K 1.5414 $83.68 $16.74 0957 Platelet Concentrate K 0.6870 $37.30 $7.46 0958 Platelet Rich Plasma K 1.1296 $61.32 $12.26 0959 Red Blood Cells K 1.4326 $77.77 $15.55 0960 Washed Red Blood Cells K 2.6638 $144.62 $28.92 0961 Infusion, Albumin (Human) 5%, 50 ml K 0.7319 $39.73 $7.95 0963 Albumin (human), 5%, 250 ml K 3.4713 $188.45 $37.69 0964 Albumin (human), 25%, 20 ml K 0.7911 $42.95 $8.59 0965 Albumin (human), 25%, 50ml K 1.9432 $105.49 $21.10 0966 Plasmaprotein fract,5%,250ml K 7.7071 $418.41 $83.68 1009 Cryoprecip reduced plasma K 0.9447 $51.29 $10.26 1010 Blood, L/R, CMV-neg K 2.1361 $115.97 $23.19 1011 Platelets, HLA-m, L/R, unit K 8.2851 $449.79 $89.96 1013 Platelet concentrate, L/R, unit K 0.9101 $49.41 $9.88 1016 Blood, L/R, froz/deglycerol/washed K 5.0012 $271.51 $54.30 1017 Platelets, aph/pher, L/R, CMV-neg, unit K 6.5175 $353.83 $70.77 1018 Blood, L/R, irradiated K 2.1950 $119.16 $23.83 1019 Platelets, aph/pher, L/R, irradiated, unit K 6.7353 $365.65 $73.13 1020 Pit, pher,L/R,CMV,irrad K 9.6266 $522.62 $104.52 1021 RBC, frz/deg/wsh, L/R, irrad K 6.5287 $354.44 $70.89 1022 RBC, L/R, CMV neg, irrad K 3.9139 $212.48 $42.50 1045 Iobenguane sulfate I-131per 0.5 mCi K 2.9293 $159.03 $31.81 1064 I-131 sodium iodide capsule K 0.1007 $5.47 $1.09 1065 I-131 sodium iodide solution K 0.0002 $.01 $.00 1084 Denileukin diftitox, 300 MCG K 15.0913 $819.29 $163.86 1086 Temozolomide,oral 5 mg K 0.0643 $3.49 $.70 1091 IN 111 Oxyquinoline, per .5 mCi K 4.0535 $220.06 $44.01 1092 IN 111 Pentetate, per 0.5 mCi K 4.0824 $221.63 $44.33 1095 Technetium TC 99M Depreotide K 3.7042 $201.10 $40.22 1096 TC 99M Exametazime, per dose K 3.8103 $206.86 $41.37 1122 TC 99M arcitumomab, per vial K 9.6556 $524.19 $104.84 1167 Epirubicin hcl, 2 mg K 0.3597 $19.53 $3.91 1178 Busulfan IV, 6 mg K 6.0245 $327.06 $65.41 1203 Verteporfin for injection K 16.1946 $879.19 $175.84 1207 Octreotide injection, depot K 1.1849 $64.33 $12.87 1305 Apligraf K 11.2075 $608.44 $121.69 1409 Factor viia recombinant, per 1.2 mg K 17.9693 $975.54 $195.11 1501 New Technology - Level I ($0 - $50) S $25.00 $5.00 1502 New Technology - Level II ($50 - $100) S $75.00 $15.00 1503 New Technology - Level III ($100 - $200) S $150.00 $30.00 1504 New Technology - Level IV ($200 - $300) S $250.00 $50.00 1505 New Technology - Level V ($300 - $400) S $350.00 $70.00 1506 New Technology - Level VI ($400 - $500) S $450.00 $90.00 1507 New Technology - Level VII ($500 - $600) S $550.00 $110.00 1508 New Technology - Level VIII ($600 - $700) S $650.00 $130.00 1509 New Technology - Level IX ($700 - $800) S $750.00 $150.00 1510 New Technology - Level X ($800 - $900) S $850.00 $170.00 1511 New Technology - Level XI ($900 - $1000) S $950.00 $190.00 1512 New Technology - Level XII ($1000 - $1100) S $1,050.00 $210.00 1513 New Technology - Level XIII ($1100 - $1200) S $1,150.00 $230.00 1514 New Technology - Level XIV ($1200 - $1300) S $1,250.00 $250.00 1515 New Technology - Level XV ($1300 - $1400) S $1,350.00 $270.00 1516 New Technology - Level XVI ($1400 - $1500) S $1,450.00 $290.00 1517 New Technology - Level XX ($1500-$1600) S $1,550.00 $310.00 1518 New Technology - Level XX ($1600-$1700) S $1,650.00 $330.00 1519 New Technology - Level XX ($1700-$1800) S $1,750.00 $350.00 1520 New Technology - Level XX ($1800-$1900) S $1,850.00 $370.00 1521 New Technology - Level XX ($1900-$2000) S $1,950.00 $390.00 1522 New Technology - Level XX ($2000-$2500) S $2,250.00 $450.00 1523 New Technology - Level XX ($2500-$3000) S $2,750.00 $550.00 1524 New Technology - Level XX ($3000-$3500) S $3,250.00 $650.00 Start Printed Page 48028 1525 New Technology - Level XX ($3500-$4000) S $3,750.00 $750.00 1526 New Technology - Level XX ($4000-$4500) S $4,250.00 $850.00 1527 New Technology - Level XX ($4500-$5000) S $4,750.00 $950.00 1528 New Technology - Level XX ($5000-$5500) S $5,250.00 $1,050.00 1529 New Technology - Level XX ($5500-$6000) S $5,750.00 $1,150.00 1530 New Technology - Level XX ($6000-$6500) S $6,250.00 $1,250.00 1531 New Technology - Level XX ($6500-$7000) S $6,750.00 $1,350.00 1532 New Technology - Level XX ($7000-$7500) S $7,250.00 $1,450.00 1533 New Technology - Level XX ($7500-$8000) S $7,750.00 $1,550.00 1534 New Technology - Level XX ($8000-$8500) S $8,250.00 $1,650.00 1535 New Technology - Level XX ($8500-$9000) S $8,750.00 $1,750.00 1536 New Technology - Level XX ($9000-$9500) S $9,250.00 $1,850.00 1537 New Technology - Level XX ($9500-$10000) S $9,750.00 $1,950.00 1538 New Technology - Level I ($0 - $50) T $25.00 $5.00 1539 New Technology - Level II ($50 - $100) T $75.00 $15.00 1540 New Technology - Level III ($100 - $200) T $150.00 $30.00 1541 New Technology - Level IV ($200 - $300) T $250.00 $50.00 1542 New Technology - Level V ($300 - $400) T $350.00 $70.00 1543 New Technology - Level VI ($400 - $500) T $450.00 $90.00 1544 New Technology - Level VII ($500 - $600) T $550.00 $110.00 1545 New Technology - Level VIII ($600 - $700) T $650.00 $130.00 1546 New Technology - Level IX ($700 - $800) T $750.00 $150.00 1547 New Technology - Level X ($800 - $900) T $850.00 $170.00 1548 New Technology - Level XI ($900 - $1000) T $950.00 $190.00 1549 New Technology - Level XII ($1000 - $1100) T $1,050.00 $210.00 1550 New Technology - Level XIII ($1100 - $1200) T $1,150.00 $230.00 1551 New Technology - Level XIV ($1200 - $1300) T $1,250.00 $250.00 1552 New Technology - Level XV ($1300 - $1400) T $1,350.00 $270.00 1553 New Technology - Level XVI ($1400 - $1500) T $1,450.00 $290.00 1554 New Technology - Level XX ($1500-$1600) T $1,550.00 $310.00 1555 New Technology - Level XX ($1600-$1700) T $1,650.00 $330.00 1556 New Technology - Level XX ($1700-$1800) T $1,750.00 $350.00 1557 New Technology - Level XX ($1800-$1900) T $1,850.00 $370.00 1558 New Technology - Level XX ($1900-$2000) T $1,950.00 $390.00 1559 New Technology - Level XX ($2000-$2500) T $2,250.00 $450.00 1560 New Technology - Level XX ($2500-$3000) T $2,750.00 $550.00 1561 New Technology - Level XX ($3000-$3500) T $3,250.00 $650.00 1562 New Technology - Level XX ($3500-$4000) T $3,750.00 $750.00 1563 New Technology - Level XX ($4000-$4500) T $4,250.00 $850.00 1564 New Technology - Level XX ($4500-$5000) T $4,750.00 $950.00 1565 New Technology - Level XX ($5000-$5500) T $5,250.00 $1,050.00 1566 New Technology - Level XX ($5500-$6000) T $5,750.00 $1,150.00 1567 New Technology - Level XX ($6000-$6500) T $6,250.00 $1,250.00 1568 New Technology - Level XX ($6500-$7000) T $6,750.00 $1,350.00 1569 New Technology - Level XX ($7000-$7500) T $7,250.00 $1,450.00 1570 New Technology - Level XX ($7500-$8000) T $7,750.00 $1,550.00 1571 New Technology - Level XX ($8000-$8500) T $8,250.00 $1,650.00 1572 New Technology - Level XX ($8500-$9000) T $8,750.00 $1,750.00 1573 New Technology - Level XX ($9000-$9500) T $9,250.00 $1,850.00 1574 New Technology - Level XX ($9500-$10000) T $9,750.00 $1,950.00 1604 IN 111 capromab pendetide, per dose K 12.4029 $673.34 $134.67 1605 Abciximab injection, 10 mg K 5.2806 $286.68 $57.34 1606 Anistreplase, 30 u K 25.3116 $1,374.14 $274.83 1607 Eptifibatide injection, 5mg K 0.1426 $7.74 $1.55 1609 Rho(D) immune globulin h, sd, 100 iu K 0.1863 $10.11 $2.02 1611 Hylan G-F 20 injection, 16 mg K 2.1566 $117.08 $23.42 1612 Daclizumab, parenteral, 25 mg K 3.7304 $202.52 $40.50 1613 Trastuzumab, 10 mg K 0.7384 $40.09 $8.02 1614 Valrubicin, 200 mg K 9.6183 $522.17 $104.43 1615 Basiliximab, 20 mg K 11.2007 $608.07 $121.61 1618 Vonwillebrandfactrcmplx, per iu K 0.0168 $.91 $.18 1620 Technetium tc99m bicisate K 3.3106 $179.73 $35.95 1625 Indium 111-in pentetreotide K 6.8170 $370.09 $74.02 1628 Chromic phosphate p32 K 2.0103 $109.14 $21.83 1716 Brachytx source, Gold 198 K 1.3399 $72.74 $14.55 1718 Brachytx source, Iodine 125 K 0.6695 $36.35 $7.27 1719 Brachytx source, Non-HDR Ir-192 K 0.3053 $16.57 $3.31 1720 Brachytx source, Palladium 103 K 0.8104 $44.00 $8.80 1775 FDG, per dose (4-40 mCi/ml) K 5.8606 $318.17 $63.63 Start Printed Page 48029 1783 Ocular implant, aqueous drain device H 1814 Retinal Tamp, silicone oil H 1818 Integrated keratoprosthesis H 1900 Lead coronary venous H 2614 Probe, percutaneous lumbar disc H 2616 Brachytx source, Yttrium-90 K 163.4011 $8,870.88 $1,774.18 2632 Brachytx sol, I-125, per mCi H 7000 Amifostine, 500 mg K 3.9932 $216.79 $43.36 7011 Oprelvekin injection, 5 mg K 2.7246 $147.92 $29.58 7015 Busulfan, oral, 2 mg K 0.0263 $1.43 $.29 7024 Corticorelin ovine triflutat K 3.4880 $189.36 $37.87 7025 Digoxin immune FAB (ovine) K 4.4789 $243.16 $48.63 7027 Fomepizole, 15mg K 0.2215 $12.03 $2.41 7030 Hemin, per 1 mg K 0.0119 $.65 $.13 7031 Octreotide acetate injection K 1.0339 $56.13 $11.23 7034 Somatropin injection K 0.9206 $49.98 $10.00 7035 Teniposide, 50 mg K 1.5530 $84.31 $16.86 7036 Urokinase 250,000 iu inj K 5.1032 $277.05 $55.41 7037 Urofollitropin, 75 iu K 1.1321 $61.46 $12.29 7038 Muromonab-CD3, 5 mg K 5.8452 $317.33 $63.47 7041 Tirofiban hydrochloride 12.5 mg K 4.2976 $233.31 $46.66 7042 Capecitabine, oral, 150 mg K 0.0290 $1.57 $.31 7043 Infliximab injection 10 mg K 0.6841 $37.14 $7.43 7045 Trimetrexate glucoronate K 1.2099 $65.68 $13.14 7046 Doxorubicin hcl liposome inj 10 mg K 4.6362 $251.69 $50.34 7049 Filgrastim 480 mcg injection K 3.1998 $173.71 $34.74 7051 Leuprolide acetate implant, 65 mg K 68.9392 $3,742.64 $748.53 9000 Na chromate Cr51, per 0.25mCi K 1.2631 $68.57 $13.71 9002 Tenecteplase, 50mg/vial K 23.2303 $1,261.15 $252.23 9003 Palivizumab, per 50mg K 6.3850 $346.64 $69.33 9004 Gemtuzumab ozogamicin inj,5mg K 17.5020 $950.17 $190.03 9005 Reteplase injection K 10.1332 $550.12 $110.02 9009 Baclofen refill kit - per 2000 mcg K 0.7478 $40.60 $8.12 9010 Baclofen refill kit - per 4000 mcg K 0.7340 $39.85 $7.97 9012 Arsenic Trioxide K 0.4837 $26.26 $5.25 9015 Mycophenolate mofetil oral 250 mg K 0.0373 $2.02 $.40 9018 Botulinum toxin B, per 100 u K 0.1272 $6.91 $1.38 9019 Caspofungin acetate, 5 mg K 0.5334 $28.96 $5.79 9020 Sirolimus tablet, oral 1 mg K 0.0520 $2.82 $.56 9021 Immune globulin 10 mg K 0.0080 $.43 $.09 9022 IM inj interferon beta 1-a K 0.9417 $51.12 $10.22 9023 Rho d immune globulin 50 mcg K 0.0523 $2.84 $.57 9024 Amphotericin b lipid complex K 0.4174 $22.66 $4.53 9025 Rubidium-Rb-82 K 2.5939 $140.82 $28.16 9100 Iodinated I-131albumin, per 5 uci K 0.0071 $.39 $.08 9104 Anti-thymocycte globulin rabbit K 2.9801 $161.79 $32.36 9105 Hep B imm glob, per 1 ml K 1.5621 $84.80 $16.96 9108 Thyrotropin alfa, per 1.1 mg K 6.6059 $358.63 $71.73 9109 Tirofiban hcl, per 6.25 mg K 2.2328 $121.22 $24.24 9110 Alemtuzumab, per 10 mg K 7.6422 $414.89 $82.98 9111 Inj, bivalirudin, per 250 mg vial G $397.81 $59.46 9112 Perflutren lipid micro, per 2ml G $148.20 $22.15 9113 Inj, pantoprazole sodium, vial G $22.80 $3.41 9114 Nesiritide, per 0.5 mg vial G $144.40 $21.58 9115 Inj, zoledronic acid, per 1 mg G $203.40 $30.40 9116 Inj, Ertapenem sodium, per 1 gm vial G $45.31 $6.77 9117 Y-90 ibritumomab tiuxetan K 332.7763 $18,066.09 $3,613.22 9118 IN-111 ibritumomab tiuxetan K 38.3972 $2,084.55 $416.91 9119 Pegfilgrastim, per 1 mg G $467.09 $69.82 9120 Inj, Fulvestrant, per 50 mg G $175.16 $26.18 9121 Inj, Argatroban, per 5 mg G $14.25 $2.13 9122 Inj, Triptorelin pamoate, per 3.75 mg G $415.24 $62.07 9200 Orcel, per 36 cm2 G $1,135.25 $169.69 9201 Dermagraft, per 37.5 sq cm K 7.9288 $430.45 $86.09 9202 Octafluoropropane K 2.1253 $115.38 $23.08 9203 Perflexane lipid micro G $142.50 $21.30 9204 Ziprasidone mesylate G $41.56 $6.21 9205 Oxaliplatin G $94.46 $14.12 9217 Leuprolide acetate suspnsion, 7.5 mg K 5.5128 $299.28 $59.86 Start Printed Page 48030 9500 Platelets, irradiated K 1.2398 $67.31 $13.46 9501 Platelets, pheresis K 6.7772 $367.93 $73.59 9502 Platelet pheresis irradiated K 7.3552 $399.31 $79.86 9503 Fresh frozen plasma, ea unit K 1.1560 $62.76 $12.55 9504 RBC deglycerolized K 3.9764 $215.87 $43.17 9505 RBC irradiated K 1.8011 $97.78 $19.56 9506 Granulocytes, pheresis K 20.7004 $1,123.80 $224.76 Start Printed Page 48212Addendum B.—Payment Status by HCPCS Code and Related Information Calendar Year 2004
CPT/HCPCS Status indicator Condition Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment 0001T C Endovas repr abdo ao aneurys 0002T C Endovas repr abdo ao aneurys 0003T S Cervicography 1501 $25.00 $5.00 0005T C Perc cath stent/brain cv art 0006T C Perc cath stent/brain cv art 0007T C Perc cath stent/brain cv art 0008T E Upper gi endoscopy w/suture 0009T T Endometrial cryoablation 1557 $1,850.00 $370.00 00100 N Anesth, salivary gland 00102 N Anesth, repair of cleft lip 00103 N Anesth, blepharoplasty 00104 N Anesth, electroshock 0010T A Tb test, gamma interferon 00120 N Anesth, ear surgery 00124 N Anesth, ear exam 00126 N Anesth, tympanotomy 0012T T Osteochondral knee autograft 0041 27.2538 $1,479.58 $295.92 0013T T Osteochondral knee allograft 0041 27.2538 $1,479.58 $295.92 00140 N Anesth, procedures on eye 00142 N Anesth, lens surgery 00144 N Anesth, corneal transplant 00145 N Anesth, vitreoretinal surg 00147 N Anesth, iridectomy 00148 N Anesth, eye exam 0014T T Meniscal transplant, knee 0041 27.2538 $1,479.58 $295.92 00160 N Anesth, nose/sinus surgery 00162 N Anesth, nose/sinus surgery 00164 N Anesth, biopsy of nose 0016T T Thermotx choroid vasc lesion 0235 4.9900 $270.90 $72.04 $54.18 00170 N Anesth, procedure on mouth 00172 N Anesth, cleft palate repair 00174 C Anesth, pharyngeal surgery 00176 C Anesth, pharyngeal surgery 0017T E Photocoagulat macular drusen 0018T S Transcranial magnetic stimul 0215 0.6390 $34.69 $15.76 $6.94 00190 N Anesth, face/skull bone surg 00192 C Anesth, facial bone surgery 0019T E Extracorp shock wave tx, ms 0020T A Extracorp shock wave tx, ft 00210 N Anesth, open head surgery 00212 N Anesth, skull drainage 00214 C Anesth, skull drainage 00215 C Anesth, skull repair/fract 00216 N Anesth, head vessel surgery 00218 N Anesth, special head surgery 0021T C Fetal oximetry, trnsvag/cerv 00220 N Anesth, intrcrn nerve 00222 N Anesth, head nerve surgery 0023T A Phenotype drug test, hiv 1 0024T C Transcath cardiac reduction Start Printed Page 48031 0025T S Ultrasonic pachymetry 0230 0.7379 $40.06 $14.97 $8.01 0026T A Measure remnant lipoproteins 0027T T Endoscopic epidural lysis 1547 $850.00 $170.00 0028T N Dexa body composition study 0029T N Magnetic tx for incontinence 00300 N Anesth, head/neck/ptrunk 0030T A Antiprothrombin antibody 0031T N Speculoscopy 00320 N Anesth, neck organ surgery 00322 N Anesth, biopsy of thyroid 00326 N Anesth, larynx/trach, < 1 yr 0032T N Speculoscopy w/direct sample 0033T C Endovasc taa repr incl subcl 0034T C Endovasc taa repr w/o subcl 00350 N Anesth, neck vessel surgery 00352 N Anesth, neck vessel surgery 0035T C Insert endovasc prosth, taa 0036T C Endovasc prosth, taa, add-on 0037T C Artery transpose/endovas taa 0038T C Rad endovasc taa rpr w/cover 0039T C Rad s/i, endovasc taa repair 00400 N Anesth, skin, ext/per/atrunk 00402 N Anesth, surgery of breast 00404 C Anesth, surgery of breast 00406 C Anesth, surgery of breast 0040T C Rad s/i, endovasc taa prosth 00410 N Anesth, correct heart rhythm 0041T A Detect ur infect agnt w/cpas 0042T N Ct perfusion w/contrast, cbf 0043T A Co expired gas analysis 0044T N Whole body photography 00450 N Anesth, surgery of shoulder 00452 C Anesth, surgery of shoulder 00454 N Anesth, collar bone biopsy 00470 N Anesth, removal of rib 00472 N Anesth, chest wall repair 00474 C Anesth, surgery of rib(s) 00500 N Anesth, esophageal surgery 00520 N Anesth, chest procedure 00522 N Anesth, chest lining biopsy 00524 C Anesth, chest drainage 00528 N Anesth, chest partition view 00530 N Anesth, pacemaker insertion 00532 N Anesth, vascular access 00534 N Anesth, cardioverter/defib 00537 N Anesth, cardiac electrophys 00539 N Anesth, trach-bronch reconst 00540 C Anesth, chest surgery 00541 N Anesth, one lung ventilation 00542 C Anesth, release of lung 00544 C Anesth, chest lining removal 00546 C Anesth, lung,chest wall surg 00548 N Anesth, trachea,bronchi surg 00550 N Anesth, sternal debridement 00560 C Anesth, open heart surgery 00562 C Anesth, open heart surgery 00563 N Anesth, heart proc w/pump 00566 N Anesth, cabg w/o pump 00580 C Anesth, heart/lung transplnt 00600 N Anesth, spine, cord surgery 00604 C Anesth, sitting procedure 00620 N Anesth, spine, cord surgery 00622 C Anesth, removal of nerves 00630 N Anesth, spine, cord surgery 00632 C Anesth, removal of nerves 00634 C Anesth for chemonucleolysis Start Printed Page 48032 00635 N Anesth, lumbar puncture 00640 N Anesth, spine manipulation 00670 C Anesth, spine, cord surgery 00700 N Anesth, abdominal wall surg 00702 N Anesth, for liver biopsy 00730 N Anesth, abdominal wall surg 00740 N Anesth, upper gi visualize 00750 N Anesth, repair of hernia 00752 N Anesth, repair of hernia 00754 N Anesth, repair of hernia 00756 N Anesth, repair of hernia 00770 N Anesth, blood vessel repair 00790 N Anesth, surg upper abdomen 00792 C Anesth, hemorr/excise liver 00794 C Anesth, pancreas removal 00796 C Anesth, for liver transplant 00797 N Anesth, surgery for obesity 00800 N Anesth, abdominal wall surg 00802 C Anesth, fat layer removal 00810 N Anesth, low intestine scope 00820 N Anesth, abdominal wall surg 00830 N Anesth, repair of hernia 00832 N Anesth, repair of hernia 00834 N Anesth, hernia repair< 1 yr 00836 N Anesth hernia repair preemie 00840 N Anesth, surg lower abdomen 00842 N Anesth, amniocentesis 00844 C Anesth, pelvis surgery 00846 C Anesth, hysterectomy 00848 C Anesth, pelvic organ surg 00851 N Anesth, tubal ligation 00860 N Anesth, surgery of abdomen 00862 N Anesth, kidney/ureter surg 00864 C Anesth, removal of bladder 00865 C Anesth, removal of prostate 00866 C Anesth, removal of adrenal 00868 C Anesth, kidney transplant 00870 N Anesth, bladder stone surg 00872 N Anesth kidney stone destruct 00873 N Anesth kidney stone destruct 00880 N Anesth, abdomen vessel surg 00882 C Anesth, major vein ligation 00902 N Anesth, anorectal surgery 00904 C Anesth, perineal surgery 00906 N Anesth, removal of vulva 00908 C Anesth, removal of prostate 00910 N Anesth, bladder surgery 00912 N Anesth, bladder tumor surg 00914 N Anesth, removal of prostate 00916 N Anesth, bleeding control 00918 N Anesth, stone removal 00920 N Anesth, genitalia surgery 00921 N Anesth, vasectomy 00922 N Anesth, sperm duct surgery 00924 N Anesth, testis exploration 00926 N Anesth, removal of testis 00928 C Anesth, removal of testis 00930 N Anesth, testis suspension 00932 C Anesth, amputation of penis 00934 C Anesth, penis, nodes removal 00936 C Anesth, penis, nodes removal 00938 N Anesth, insert penis device 00940 N Anesth, vaginal procedures 00942 N Anesth, surg on vag/urethral 00944 C Anesth, vaginal hysterectomy 00948 N Anesth, repair of cervix Start Printed Page 48033 00950 N Anesth, vaginal endoscopy 00952 N Anesth, hysteroscope/graph 01112 N Anesth, bone aspirate/bx 01120 N Anesth, pelvis surgery 01130 N Anesth, body cast procedure 01140 C Anesth, amputation at pelvis 01150 C Anesth, pelvic tumor surgery 01160 N Anesth, pelvis procedure 01170 N Anesth, pelvis surgery 01180 N Anesth, pelvis nerve removal 01190 C Anesth, pelvis nerve removal 01200 N Anesth, hip joint procedure 01202 N Anesth, arthroscopy of hip 01210 N Anesth, hip joint surgery 01212 C Anesth, hip disarticulation 01214 C Anesth, hip arthroplasty 01215 N Anesth, revise hip repair 01220 N Anesth, procedure on femur 01230 N Anesth, surgery of femur 01232 C Anesth, amputation of femur 01234 C Anesth, radical femur surg 01250 N Anesth, upper leg surgery 01260 N Anesth, upper leg veins surg 01270 N Anesth, thigh arteries surg 01272 C Anesth, femoral artery surg 01274 C Anesth, femoral embolectomy 01320 N Anesth, knee area surgery 01340 N Anesth, knee area procedure 01360 N Anesth, knee area surgery 01380 N Anesth, knee joint procedure 01382 N Anesth, knee arthroscopy 01390 N Anesth, knee area procedure 01392 N Anesth, knee area surgery 01400 N Anesth, knee joint surgery 01402 C Anesth, knee arthroplasty 01404 C Anesth, amputation at knee 01420 N Anesth, knee joint casting 01430 N Anesth, knee veins surgery 01432 N Anesth, knee vessel surg 01440 N Anesth, knee arteries surg 01442 C Anesth, knee artery surg 01444 C Anesth, knee artery repair 01462 N Anesth, lower leg procedure 01464 N Anesth, ankle arthroscopy 01470 N Anesth, lower leg surgery 01472 N Anesth, achilles tendon surg 01474 N Anesth, lower leg surgery 01480 N Anesth, lower leg bone surg 01482 N Anesth, radical leg surgery 01484 N Anesth, lower leg revision 01486 C Anesth, ankle replacement 01490 N Anesth, lower leg casting 01500 N Anesth, leg arteries surg 01502 C Anesth, lwr leg embolectomy 01520 N Anesth, lower leg vein surg 01522 N Anesth, lower leg vein surg 01610 N Anesth, surgery of shoulder 01620 N Anesth, shoulder procedure 01622 N Anesth, shoulder arthroscopy 01630 N Anesth, surgery of shoulder 01632 C Anesth, surgery of shoulder 01634 C Anesth, shoulder joint amput 01636 C Anesth, forequarter amput 01638 C Anesth, shoulder replacement 01650 N Anesth, shoulder artery surg 01652 C Anesth, shoulder vessel surg Start Printed Page 48034 01654 C Anesth, shoulder vessel surg 01656 C Anesth, arm-leg vessel surg 01670 N Anesth, shoulder vein surg 01680 N Anesth, shoulder casting 01682 N Anesth, airplane cast 01710 N Anesth, elbow area surgery 01712 N Anesth, uppr arm tendon surg 01714 N Anesth, uppr arm tendon surg 01716 N Anesth, biceps tendon repair 01730 N Anesth, uppr arm procedure 01732 N Anesth, elbow arthroscopy 01740 N Anesth, upper arm surgery 01742 N Anesth, humerus surgery 01744 N Anesth, humerus repair 01756 C Anesth, radical humerus surg 01758 N Anesth, humeral lesion surg 01760 N Anesth, elbow replacement 01770 N Anesth, uppr arm artery surg 01772 N Anesth, uppr arm embolectomy 01780 N Anesth, upper arm vein surg 01782 N Anesth, uppr arm vein repair 01810 N Anesth, lower arm surgery 01820 N Anesth, lower arm procedure 01829 N Anesth, dx wrist arthroscopy 01830 N Anesth, lower arm surgery 01832 N Anesth, wrist replacement 01840 N Anesth, lwr arm artery surg 01842 N Anesth, lwr arm embolectomy 01844 N Anesth, vascular shunt surg 01850 N Anesth, lower arm vein surg 01852 N Anesth, lwr arm vein repair 01860 N Anesth, lower arm casting 01905 N Anes, spine inject, x-ray/re 01916 N Anesth, dx arteriography 01920 N Anesth, catheterize heart 01922 N Anesth, cat or MRI scan 01924 N Anes, ther interven rad, art 01925 N Anes, ther interven rad, car 01926 N Anes, tx interv rad hrt/cran 01930 N Anes, ther interven rad, vei 01931 N Anes, ther interven rad, tip 01932 N Anes, tx interv rad, th vein 01933 N Anes, tx interv rad, cran v 01951 N Anesth, burn, less 4 percent 01952 N Anesth, burn, 4-9 percent 01953 N Anesth, burn, each 9 percent 01960 N Anesth, vaginal delivery 01961 N Anesth, cs delivery 01962 N Anesth, emer hysterectomy 01963 N Anesth, cs hysterectomy 01964 N Anesth, abortion procedures 01967 N Anesth/analg, vag delivery 01968 N Anes/analg cs deliver add-on 01969 N Anesth/analg cs hyst add-on 01990 C Support for organ donor 01991 N Anesth, nerve block/inj 01992 N Anesth, n block/inj, prone 01995 N Regional anesthesia limb 01996 N Manage daily drug therapy 01999 N Unlisted anesth procedure 10021 T Fna w/o image 0002 1.0937 $59.38 $11.88 10022 T Fna w/image 0002 1.0937 $59.38 $11.88 10040 T Acne surgery 0010 0.6806 $36.95 $10.08 $7.39 10060 T Drainage of skin abscess 0006 1.7487 $94.94 $24.12 $18.99 10061 T Drainage of skin abscess 0006 1.7487 $94.94 $24.12 $18.99 10080 T Drainage of pilonidal cyst 0006 1.7487 $94.94 $24.12 $18.99 Start Printed Page 48035 10081 T Drainage of pilonidal cyst 0007 11.4943 $624.01 $124.80 10120 T Remove foreign body 0006 1.7487 $94.94 $24.12 $18.99 10121 T Remove foreign body 0021 14.5749 $791.26 $219.48 $158.25 10140 T Drainage of hematoma/fluid 0007 11.4943 $624.01 $124.80 10160 T Puncture drainage of lesion 0018 0.9567 $51.94 $16.04 $10.39 10180 T Complex drainage, wound 0007 11.4943 $624.01 $124.80 11000 T Debride infected skin 0015 1.5832 $85.95 $20.35 $17.19 11001 T Debride infected skin add-on 0012 0.8203 $44.53 $11.18 $8.91 11010 T Debride skin, fx 0022 18.6725 $1,013.71 $354.45 $202.74 11011 T Debride skin/muscle, fx 0022 18.6725 $1,013.71 $354.45 $202.74 11012 T Debride skin/muscle/bone, fx 0022 18.6725 $1,013.71 $354.45 $202.74 11040 T Debride skin, partial 0015 1.5832 $85.95 $20.35 $17.19 11041 T Debride skin, full 0015 1.5832 $85.95 $20.35 $17.19 11042 T Debride skin/tissue 0016 2.7343 $148.44 $57.31 $29.69 11043 T Debride tissue/muscle 0016 2.7343 $148.44 $57.31 $29.69 11044 T Debride tissue/muscle/bone 0682 7.6815 $417.02 $174.57 $83.40 11055 T Trim skin lesion 0012 0.8203 $44.53 $11.18 $8.91 11056 T Trim skin lesions, 2 to 4 0012 0.8203 $44.53 $11.18 $8.91 11057 T Trim skin lesions, over 4 0012 0.8203 $44.53 $11.18 $8.91 11100 T Biopsy of skin lesion 0018 0.9567 $51.94 $16.04 $10.39 11101 T Biopsy, skin add-on 0018 0.9567 $51.94 $16.04 $10.39 11200 T Removal of skin tags 0013 1.1420 $62.00 $14.20 $12.40 11201 T Remove skin tags add-on 0015 1.5832 $85.95 $20.35 $17.19 11300 T Shave skin lesion 0012 0.8203 $44.53 $11.18 $8.91 11301 T Shave skin lesion 0012 0.8203 $44.53 $11.18 $8.91 11302 T Shave skin lesion 0012 0.8203 $44.53 $11.18 $8.91 11303 T Shave skin lesion 0015 1.5832 $85.95 $20.35 $17.19 11305 T Shave skin lesion 0013 1.1420 $62.00 $14.20 $12.40 11306 T Shave skin lesion 0013 1.1420 $62.00 $14.20 $12.40 11307 T Shave skin lesion 0013 1.1420 $62.00 $14.20 $12.40 11308 T Shave skin lesion 0013 1.1420 $62.00 $14.20 $12.40 11310 T Shave skin lesion 0013 1.1420 $62.00 $14.20 $12.40 11311 T Shave skin lesion 0013 1.1420 $62.00 $14.20 $12.40 11312 T Shave skin lesion 0013 1.1420 $62.00 $14.20 $12.40 11313 T Shave skin lesion 0016 2.7343 $148.44 $57.31 $29.69 11400 T Removal of skin lesion 0019 3.9807 $216.11 $71.87 $43.22 11401 T Removal of skin lesion 0019 3.9807 $216.11 $71.87 $43.22 11402 T Removal of skin lesion 0019 3.9807 $216.11 $71.87 $43.22 11403 T Removal of skin lesion 0020 7.3105 $396.88 $113.25 $79.38 11404 T Removal of skin lesion 0020 7.3105 $396.88 $113.25 $79.38 11406 T Removal of skin lesion 0021 14.5749 $791.26 $219.48 $158.25 11420 T Removal of skin lesion 0020 7.3105 $396.88 $113.25 $79.38 11421 T Removal of skin lesion 0020 7.3105 $396.88 $113.25 $79.38 11422 T Removal of skin lesion 0020 7.3105 $396.88 $113.25 $79.38 11423 T Removal of skin lesion 0020 7.3105 $396.88 $113.25 $79.38 11424 T Removal of skin lesion 0021 14.5749 $791.26 $219.48 $158.25 11426 T Removal of skin lesion 0022 18.6725 $1,013.71 $354.45 $202.74 11440 T Removal of skin lesion 0019 3.9807 $216.11 $71.87 $43.22 11441 T Removal of skin lesion 0019 3.9807 $216.11 $71.87 $43.22 11442 T Removal of skin lesion 0020 7.3105 $396.88 $113.25 $79.38 11443 T Removal of skin lesion 0020 7.3105 $396.88 $113.25 $79.38 11444 T Removal of skin lesion 0020 7.3105 $396.88 $113.25 $79.38 11446 T Removal of skin lesion 0022 18.6725 $1,013.71 $354.45 $202.74 11450 T Removal, sweat gland lesion 0022 18.6725 $1,013.71 $354.45 $202.74 11451 T Removal, sweat gland lesion 0022 18.6725 $1,013.71 $354.45 $202.74 11462 T Removal, sweat gland lesion 0022 18.6725 $1,013.71 $354.45 $202.74 11463 T Removal, sweat gland lesion 0022 18.6725 $1,013.71 $354.45 $202.74 11470 T Removal, sweat gland lesion 0022 18.6725 $1,013.71 $354.45 $202.74 11471 T Removal, sweat gland lesion 0022 18.6725 $1,013.71 $354.45 $202.74 11600 T Removal of skin lesion 0019 3.9807 $216.11 $71.87 $43.22 11601 T Removal of skin lesion 0019 3.9807 $216.11 $71.87 $43.22 11602 T Removal of skin lesion 0019 3.9807 $216.11 $71.87 $43.22 11603 T Removal of skin lesion 0020 7.3105 $396.88 $113.25 $79.38 11604 T Removal of skin lesion 0020 7.3105 $396.88 $113.25 $79.38 11606 T Removal of skin lesion 0021 14.5749 $791.26 $219.48 $158.25 11620 T Removal of skin lesion 0020 7.3105 $396.88 $113.25 $79.38 Start Printed Page 48036 11621 T Removal of skin lesion 0019 3.9807 $216.11 $71.87 $43.22 11622 T Removal of skin lesion 0020 7.3105 $396.88 $113.25 $79.38 11623 T Removal of skin lesion 0020 7.3105 $396.88 $113.25 $79.38 11624 T Removal of skin lesion 0021 14.5749 $791.26 $219.48 $158.25 11626 T Removal of skin lesion 0022 18.6725 $1,013.71 $354.45 $202.74 11640 T Removal of skin lesion 0020 7.3105 $396.88 $113.25 $79.38 11641 T Removal of skin lesion 0020 7.3105 $396.88 $113.25 $79.38 11642 T Removal of skin lesion 0020 7.3105 $396.88 $113.25 $79.38 11643 T Removal of skin lesion 0020 7.3105 $396.88 $113.25 $79.38 11644 T Removal of skin lesion 0021 14.5749 $791.26 $219.48 $158.25 11646 T Removal of skin lesion 0022 18.6725 $1,013.71 $354.45 $202.74 11719 T Trim nail(s) 0009 0.6597 $35.81 $8.34 $7.16 11720 T Debride nail, 1-5 0009 0.6597 $35.81 $8.34 $7.16 11721 T Debride nail, 6 or more 0009 0.6597 $35.81 $8.34 $7.16 11730 T Removal of nail plate 0013 1.1420 $62.00 $14.20 $12.40 11732 T Remove nail plate, add-on 0012 0.8203 $44.53 $11.18 $8.91 11740 T Drain blood from under nail 0009 0.6597 $35.81 $8.34 $7.16 11750 T Removal of nail bed 0019 3.9807 $216.11 $71.87 $43.22 11752 T Remove nail bed/finger tip 0022 18.6725 $1,013.71 $354.45 $202.74 11755 T Biopsy, nail unit 0019 3.9807 $216.11 $71.87 $43.22 11760 T Repair of nail bed 0024 1.7847 $96.89 $34.75 $19.38 11762 T Reconstruction of nail bed 0024 1.7847 $96.89 $34.75 $19.38 11765 T Excision of nail fold, toe 0015 1.5832 $85.95 $20.35 $17.19 11770 T Removal of pilonidal lesion 0022 18.6725 $1,013.71 $354.45 $202.74 11771 T Removal of pilonidal lesion 0022 18.6725 $1,013.71 $354.45 $202.74 11772 T Removal of pilonidal lesion 0022 18.6725 $1,013.71 $354.45 $202.74 11900 T Injection into skin lesions 0012 0.8203 $44.53 $11.18 $8.91 11901 T Added skin lesions injection 0012 0.8203 $44.53 $11.18 $8.91 11920 T Correct skin color defects 0024 1.7847 $96.89 $34.75 $19.38 11921 T Correct skin color defects 0024 1.7847 $96.89 $34.75 $19.38 11922 T Correct skin color defects 0024 1.7847 $96.89 $34.75 $19.38 11950 T Therapy for contour defects 0024 1.7847 $96.89 $34.75 $19.38 11951 T Therapy for contour defects 0024 1.7847 $96.89 $34.75 $19.38 11952 T Therapy for contour defects 0024 1.7847 $96.89 $34.75 $19.38 11954 T Therapy for contour defects 0024 1.7847 $96.89 $34.75 $19.38 11960 T Insert tissue expander(s) 0027 15.8319 $859.50 $329.72 $171.90 11970 T Replace tissue expander 0027 15.8319 $859.50 $329.72 $171.90 11971 T Remove tissue expander(s) 0022 18.6725 $1,013.71 $354.45 $202.74 11975 E Insert contraceptive cap 11976 T Removal of contraceptive cap 0019 3.9807 $216.11 $71.87 $43.22 11977 E Removal/reinsert contra cap 11980 X Implant hormone pellet(s) 0340 0.6232 $33.83 $6.77 11981 X Insert drug implant device 0340 0.6232 $33.83 $6.77 11982 X Remove drug implant device 0340 0.6232 $33.83 $6.77 11983 X Remove/insert drug implant 0340 0.6232 $33.83 $6.77 12001 T Repair superficial wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12002 T Repair superficial wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12004 T Repair superficial wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12005 T Repair superficial wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12006 T Repair superficial wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12007 T Repair superficial wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12011 T Repair superficial wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12013 T Repair superficial wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12014 T Repair superficial wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12015 T Repair superficial wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12016 T Repair superficial wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12017 T Repair superficial wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12018 T Repair superficial wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12020 T Closure of split wound 0024 1.7847 $96.89 $34.75 $19.38 12021 T Closure of split wound 0024 1.7847 $96.89 $34.75 $19.38 12031 T Layer closure of wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12032 T Layer closure of wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12034 T Layer closure of wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12035 T Layer closure of wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12036 T Layer closure of wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12037 T Layer closure of wound(s) 0025 6.2703 $340.41 $115.49 $68.08 Start Printed Page 48037 12041 T Layer closure of wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12042 T Layer closure of wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12044 T Layer closure of wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12045 T Layer closure of wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12046 T Layer closure of wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12047 T Layer closure of wound(s) 0025 6.2703 $340.41 $115.49 $68.08 12051 T Layer closure of wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12052 T Layer closure of wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12053 T Layer closure of wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12054 T Layer closure of wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12055 T Layer closure of wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12056 T Layer closure of wound(s) 0024 1.7847 $96.89 $34.75 $19.38 12057 T Layer closure of wound(s) 0025 6.2703 $340.41 $115.49 $68.08 13100 T Repair of wound or lesion 0025 6.2703 $340.41 $115.49 $68.08 13101 T Repair of wound or lesion 0025 6.2703 $340.41 $115.49 $68.08 13102 T Repair wound/lesion add-on 0024 1.7847 $96.89 $34.75 $19.38 13120 T Repair of wound or lesion 0024 1.7847 $96.89 $34.75 $19.38 13121 T Repair of wound or lesion 0024 1.7847 $96.89 $34.75 $19.38 13122 T Repair wound/lesion add-on 0024 1.7847 $96.89 $34.75 $19.38 13131 T Repair of wound or lesion 0024 1.7847 $96.89 $34.75 $19.38 13132 T Repair of wound or lesion 0024 1.7847 $96.89 $34.75 $19.38 13133 T Repair wound/lesion add-on 0024 1.7847 $96.89 $34.75 $19.38 13150 T Repair of wound or lesion 0025 6.2703 $340.41 $115.49 $68.08 13151 T Repair of wound or lesion 0024 1.7847 $96.89 $34.75 $19.38 13152 T Repair of wound or lesion 0025 6.2703 $340.41 $115.49 $68.08 13153 T Repair wound/lesion add-on 0024 1.7847 $96.89 $34.75 $19.38 13160 T Late closure of wound 0027 15.8319 $859.50 $329.72 $171.90 14000 T Skin tissue rearrangement 0027 15.8319 $859.50 $329.72 $171.90 14001 T Skin tissue rearrangement 0027 15.8319 $859.50 $329.72 $171.90 14020 T Skin tissue rearrangement 0027 15.8319 $859.50 $329.72 $171.90 14021 T Skin tissue rearrangement 0027 15.8319 $859.50 $329.72 $171.90 14040 T Skin tissue rearrangement 0027 15.8319 $859.50 $329.72 $171.90 14041 T Skin tissue rearrangement 0027 15.8319 $859.50 $329.72 $171.90 14060 T Skin tissue rearrangement 0027 15.8319 $859.50 $329.72 $171.90 14061 T Skin tissue rearrangement 0027 15.8319 $859.50 $329.72 $171.90 14300 T Skin tissue rearrangement 0027 15.8319 $859.50 $329.72 $171.90 14350 T Skin tissue rearrangement 0027 15.8319 $859.50 $329.72 $171.90 15000 T Skin graft 0025 6.2703 $340.41 $115.49 $68.08 15001 T Skin graft add-on 0025 6.2703 $340.41 $115.49 $68.08 15050 T Skin pinch graft 0025 6.2703 $340.41 $115.49 $68.08 15100 T Skin split graft 0027 15.8319 $859.50 $329.72 $171.90 15101 T Skin split graft add-on 0027 15.8319 $859.50 $329.72 $171.90 15120 T Skin split graft 0027 15.8319 $859.50 $329.72 $171.90 15121 T Skin split graft add-on 0027 15.8319 $859.50 $329.72 $171.90 15200 T Skin full graft 0027 15.8319 $859.50 $329.72 $171.90 15201 T Skin full graft add-on 0025 6.2703 $340.41 $115.49 $68.08 15220 T Skin full graft 0027 15.8319 $859.50 $329.72 $171.90 15221 T Skin full graft add-on 0025 6.2703 $340.41 $115.49 $68.08 15240 T Skin full graft 0027 15.8319 $859.50 $329.72 $171.90 15241 T Skin full graft add-on 0025 6.2703 $340.41 $115.49 $68.08 15260 T Skin full graft 0027 15.8319 $859.50 $329.72 $171.90 15261 T Skin full graft add-on 0025 6.2703 $340.41 $115.49 $68.08 15342 T Cultured skin graft, 25 cm 0024 1.7847 $96.89 $34.75 $19.38 15343 T Culture skn graft addl 25 cm 0024 1.7847 $96.89 $34.75 $19.38 15350 T Skin homograft 0686 17.0868 $927.63 $341.70 $185.53 15351 T Skin homograft add-on 0027 15.8319 $859.50 $329.72 $171.90 15400 T Skin heterograft 0025 6.2703 $340.41 $115.49 $68.08 15401 T Skin heterograft add-on 0025 6.2703 $340.41 $115.49 $68.08 15570 T Form skin pedicle flap 0027 15.8319 $859.50 $329.72 $171.90 15572 T Form skin pedicle flap 0027 15.8319 $859.50 $329.72 $171.90 15574 T Form skin pedicle flap 0027 15.8319 $859.50 $329.72 $171.90 15576 T Form skin pedicle flap 0027 15.8319 $859.50 $329.72 $171.90 15600 T Skin graft 0027 15.8319 $859.50 $329.72 $171.90 15610 T Skin graft 0027 15.8319 $859.50 $329.72 $171.90 15620 T Skin graft 0027 15.8319 $859.50 $329.72 $171.90 15630 T Skin graft 0027 15.8319 $859.50 $329.72 $171.90 Start Printed Page 48038 15650 T Transfer skin pedicle flap 0027 15.8319 $859.50 $329.72 $171.90 15732 T Muscle-skin graft, head/neck 0027 15.8319 $859.50 $329.72 $171.90 15734 T Muscle-skin graft, trunk 0027 15.8319 $859.50 $329.72 $171.90 15736 T Muscle-skin graft, arm 0027 15.8319 $859.50 $329.72 $171.90 15738 T Muscle-skin graft, leg 0027 15.8319 $859.50 $329.72 $171.90 15740 T Island pedicle flap graft 0027 15.8319 $859.50 $329.72 $171.90 15750 T Neurovascular pedicle graft 0027 15.8319 $859.50 $329.72 $171.90 15756 C Free muscle flap, microvasc 15757 C Free skin flap, microvasc 15758 C Free fascial flap, microvasc 15760 T Composite skin graft 0027 15.8319 $859.50 $329.72 $171.90 15770 T Derma-fat-fascia graft 0027 15.8319 $859.50 $329.72 $171.90 15775 T Hair transplant punch grafts 0025 6.2703 $340.41 $115.49 $68.08 15776 T Hair transplant punch grafts 0025 6.2703 $340.41 $115.49 $68.08 15780 T Abrasion treatment of skin 0022 18.6725 $1,013.71 $354.45 $202.74 15781 T Abrasion treatment of skin 0022 18.6725 $1,013.71 $354.45 $202.74 15782 T Abrasion treatment of skin 0022 18.6725 $1,013.71 $354.45 $202.74 15783 T Abrasion treatment of skin 0016 2.7343 $148.44 $57.31 $29.69 15786 T Abrasion, lesion, single 0012 0.8203 $44.53 $11.18 $8.91 15787 T Abrasion, lesions, add-on 0013 1.1420 $62.00 $14.20 $12.40 15788 T Chemical peel, face, epiderm 0012 0.8203 $44.53 $11.18 $8.91 15789 T Chemical peel, face, dermal 0015 1.5832 $85.95 $20.35 $17.19 15792 T Chemical peel, nonfacial 0012 0.8203 $44.53 $11.18 $8.91 15793 T Chemical peel, nonfacial 0012 0.8203 $44.53 $11.18 $8.91 15810 T Salabrasion 0016 2.7343 $148.44 $57.31 $29.69 15811 T Salabrasion 0016 2.7343 $148.44 $57.31 $29.69 15819 T Plastic surgery, neck 0025 6.2703 $340.41 $115.49 $68.08 15820 T Revision of lower eyelid 0027 15.8319 $859.50 $329.72 $171.90 15821 T Revision of lower eyelid 0027 15.8319 $859.50 $329.72 $171.90 15822 T Revision of upper eyelid 0027 15.8319 $859.50 $329.72 $171.90 15823 T Revision of upper eyelid 0027 15.8319 $859.50 $329.72 $171.90 15824 T Removal of forehead wrinkles 0027 15.8319 $859.50 $329.72 $171.90 15825 T Removal of neck wrinkles 0027 15.8319 $859.50 $329.72 $171.90 15826 T Removal of brow wrinkles 0027 15.8319 $859.50 $329.72 $171.90 15828 T Removal of face wrinkles 0027 15.8319 $859.50 $329.72 $171.90 15829 T Removal of skin wrinkles 0027 15.8319 $859.50 $329.72 $171.90 15831 T Excise excessive skin tissue 0022 18.6725 $1,013.71 $354.45 $202.74 15832 T Excise excessive skin tissue 0022 18.6725 $1,013.71 $354.45 $202.74 15833 T Excise excessive skin tissue 0022 18.6725 $1,013.71 $354.45 $202.74 15834 T Excise excessive skin tissue 0022 18.6725 $1,013.71 $354.45 $202.74 15835 T Excise excessive skin tissue 0025 6.2703 $340.41 $115.49 $68.08 15836 T Excise excessive skin tissue 0020 7.3105 $396.88 $113.25 $79.38 15837 T Excise excessive skin tissue 0020 7.3105 $396.88 $113.25 $79.38 15838 T Excise excessive skin tissue 0020 7.3105 $396.88 $113.25 $79.38 15839 T Excise excessive skin tissue 0020 7.3105 $396.88 $113.25 $79.38 15840 T Graft for face nerve palsy 0027 15.8319 $859.50 $329.72 $171.90 15841 T Graft for face nerve palsy 0027 15.8319 $859.50 $329.72 $171.90 15842 T Flap for face nerve palsy 0027 15.8319 $859.50 $329.72 $171.90 15845 T Skin and muscle repair, face 0027 15.8319 $859.50 $329.72 $171.90 15850 T Removal of sutures 0016 2.7343 $148.44 $57.31 $29.69 15851 T Removal of sutures 0012 0.8203 $44.53 $11.18 $8.91 15852 X Dressing change,not for burn 0340 0.6232 $33.83 $6.77 15860 S Test for blood flow in graft 1501 $25.00 $5.00 15876 T Suction assisted lipectomy 0027 15.8319 $859.50 $329.72 $171.90 15877 T Suction assisted lipectomy 0027 15.8319 $859.50 $329.72 $171.90 15878 T Suction assisted lipectomy 0027 15.8319 $859.50 $329.72 $171.90 15879 T Suction assisted lipectomy 0027 15.8319 $859.50 $329.72 $171.90 15920 T Removal of tail bone ulcer 0022 18.6725 $1,013.71 $354.45 $202.74 15922 T Removal of tail bone ulcer 0027 15.8319 $859.50 $329.72 $171.90 15931 T Remove sacrum pressure sore 0022 18.6725 $1,013.71 $354.45 $202.74 15933 T Remove sacrum pressure sore 0022 18.6725 $1,013.71 $354.45 $202.74 15934 T Remove sacrum pressure sore 0027 15.8319 $859.50 $329.72 $171.90 15935 T Remove sacrum pressure sore 0027 15.8319 $859.50 $329.72 $171.90 15936 T Remove sacrum pressure sore 0027 15.8319 $859.50 $329.72 $171.90 15937 T Remove sacrum pressure sore 0027 15.8319 $859.50 $329.72 $171.90 15940 T Remove hip pressure sore 0022 18.6725 $1,013.71 $354.45 $202.74 Start Printed Page 48039 15941 T Remove hip pressure sore 0022 18.6725 $1,013.71 $354.45 $202.74 15944 T Remove hip pressure sore 0027 15.8319 $859.50 $329.72 $171.90 15945 T Remove hip pressure sore 0027 15.8319 $859.50 $329.72 $171.90 15946 T Remove hip pressure sore 0027 15.8319 $859.50 $329.72 $171.90 15950 T Remove thigh pressure sore 0022 18.6725 $1,013.71 $354.45 $202.74 15951 T Remove thigh pressure sore 0022 18.6725 $1,013.71 $354.45 $202.74 15952 T Remove thigh pressure sore 0027 15.8319 $859.50 $329.72 $171.90 15953 T Remove thigh pressure sore 0027 15.8319 $859.50 $329.72 $171.90 15956 T Remove thigh pressure sore 0027 15.8319 $859.50 $329.72 $171.90 15958 T Remove thigh pressure sore 0027 15.8319 $859.50 $329.72 $171.90 15999 T Removal of pressure sore 0022 18.6725 $1,013.71 $354.45 $202.74 16000 T Initial treatment of burn(s) 0012 0.8203 $44.53 $11.18 $8.91 16010 T Treatment of burn(s) 0016 2.7343 $148.44 $57.31 $29.69 16015 T Treatment of burn(s) 0017 16.7332 $908.43 $227.84 $181.69 16020 T Treatment of burn(s) 0013 1.1420 $62.00 $14.20 $12.40 16025 T Treatment of burn(s) 0012 0.8203 $44.53 $11.18 $8.91 16030 T Treatment of burn(s) 0015 1.5832 $85.95 $20.35 $17.19 16035 C Incision of burn scab, initi 16036 C Incise burn scab, addl incis 17000 T Destroy benign/premlg lesion 0010 0.6806 $36.95 $10.08 $7.39 17003 T Destroy lesions, 2-14 0010 0.6806 $36.95 $10.08 $7.39 17004 T Destroy lesions, 15 or more 0011 2.1800 $118.35 $27.88 $23.67 17106 T Destruction of skin lesions 0011 2.1800 $118.35 $27.88 $23.67 17107 T Destruction of skin lesions 0011 2.1800 $118.35 $27.88 $23.67 17108 T Destruction of skin lesions 0011 2.1800 $118.35 $27.88 $23.67 17110 T Destruct lesion, 1-14 0010 0.6806 $36.95 $10.08 $7.39 17111 T Destruct lesion, 15 or more 0011 2.1800 $118.35 $27.88 $23.67 17250 T Chemical cautery, tissue 0013 1.1420 $62.00 $14.20 $12.40 17260 T Destruction of skin lesions 0015 1.5832 $85.95 $20.35 $17.19 17261 T Destruction of skin lesions 0015 1.5832 $85.95 $20.35 $17.19 17262 T Destruction of skin lesions 0015 1.5832 $85.95 $20.35 $17.19 17263 T Destruction of skin lesions 0015 1.5832 $85.95 $20.35 $17.19 17264 T Destruction of skin lesions 0015 1.5832 $85.95 $20.35 $17.19 17266 T Destruction of skin lesions 0016 2.7343 $148.44 $57.31 $29.69 17270 T Destruction of skin lesions 0015 1.5832 $85.95 $20.35 $17.19 17271 T Destruction of skin lesions 0013 1.1420 $62.00 $14.20 $12.40 17272 T Destruction of skin lesions 0015 1.5832 $85.95 $20.35 $17.19 17273 T Destruction of skin lesions 0015 1.5832 $85.95 $20.35 $17.19 17274 T Destruction of skin lesions 0016 2.7343 $148.44 $57.31 $29.69 17276 T Destruction of skin lesions 0016 2.7343 $148.44 $57.31 $29.69 17280 T Destruction of skin lesions 0015 1.5832 $85.95 $20.35 $17.19 17281 T Destruction of skin lesions 0015 1.5832 $85.95 $20.35 $17.19 17282 T Destruction of skin lesions 0015 1.5832 $85.95 $20.35 $17.19 17283 T Destruction of skin lesions 0015 1.5832 $85.95 $20.35 $17.19 17284 T Destruction of skin lesions 0016 2.7343 $148.44 $57.31 $29.69 17286 T Destruction of skin lesions 0015 1.5832 $85.95 $20.35 $17.19 17304 T Chemosurgery of skin lesion 0694 3.3272 $180.63 $72.25 $36.13 17305 T 2 stage mohs, up to 5 spec 0694 3.3272 $180.63 $72.25 $36.13 17306 T 3 stage mohs, up to 5 spec 0694 3.3272 $180.63 $72.25 $36.13 17307 T Mohs addl stage up to 5 spec 0694 3.3272 $180.63 $72.25 $36.13 17310 T Extensive skin chemosurgery 0694 3.3272 $180.63 $72.25 $36.13 17340 T Cryotherapy of skin 0012 0.8203 $44.53 $11.18 $8.91 17360 T Skin peel therapy 0012 0.8203 $44.53 $11.18 $8.91 17380 T Hair removal by electrolysis 0012 0.8203 $44.53 $11.18 $8.91 17999 T Skin tissue procedure 0006 1.7487 $94.94 $24.12 $18.99 19000 T Drainage of breast lesion 0004 1.5774 $85.64 $22.10 $17.13 19001 T Drain breast lesion add-on 0004 1.5774 $85.64 $22.10 $17.13 19020 T Incision of breast lesion 0008 16.8303 $913.70 $182.74 19030 N Injection for breast x-ray 19100 T Bx breast percut w/o image 0005 3.3675 $182.82 $71.59 $36.56 19101 T Biopsy of breast, open 0028 17.7459 $963.41 $303.74 $192.68 19102 T Bx breast percut w/image 0005 3.3675 $182.82 $71.59 $36.56 19103 T Bx breast percut w/device 0658 5.6035 $304.21 $60.84 19110 T Nipple exploration 0028 17.7459 $963.41 $303.74 $192.68 19112 T Excise breast duct fistula 0028 17.7459 $963.41 $303.74 $192.68 19120 T Removal of breast lesion 0028 17.7459 $963.41 $303.74 $192.68 Start Printed Page 48040 19125 T Excision, breast lesion 0028 17.7459 $963.41 $303.74 $192.68 19126 T Excision, addl breast lesion 0028 17.7459 $963.41 $303.74 $192.68 19140 T Removal of breast tissue 0028 17.7459 $963.41 $303.74 $192.68 19160 T Removal of breast tissue 0028 17.7459 $963.41 $303.74 $192.68 19162 T Remove breast tissue, nodes 0693 38.6469 $2,098.10 $798.17 $419.62 19180 T Removal of breast 0029 29.2783 $1,589.49 $632.64 $317.90 19182 T Removal of breast 0029 29.2783 $1,589.49 $632.64 $317.90 19200 C Removal of breast 19220 C Removal of breast 19240 T Removal of breast 0030 37.2809 $2,023.94 $763.55 $404.79 19260 T Removal of chest wall lesion 0021 14.5749 $791.26 $219.48 $158.25 19271 C Revision of chest wall 19272 C Extensive chest wall surgery 19290 N Place needle wire, breast 19291 N Place needle wire, breast 19295 S Place breast clip, percut 0657 1.5630 $84.85 $16.97 19316 T Suspension of breast 0029 29.2783 $1,589.49 $632.64 $317.90 19318 T Reduction of large breast 0693 38.6469 $2,098.10 $798.17 $419.62 19324 T Enlarge breast 0693 38.6469 $2,098.10 $798.17 $419.62 19325 T Enlarge breast with implant 0648 55.5345 $3,014.91 $602.98 19328 T Removal of breast implant 0029 29.2783 $1,589.49 $632.64 $317.90 19330 T Removal of implant material 0029 29.2783 $1,589.49 $632.64 $317.90 19340 T Immediate breast prosthesis 0030 37.2809 $2,023.94 $763.55 $404.79 19342 T Delayed breast prosthesis 0648 55.5345 $3,014.91 $602.98 19350 T Breast reconstruction 0029 29.2783 $1,589.49 $632.64 $317.90 19355 T Correct inverted nipple(s) 0029 29.2783 $1,589.49 $632.64 $317.90 19357 T Breast reconstruction 0648 55.5345 $3,014.91 $602.98 19361 C Breast reconstruction 19364 C Breast reconstruction 19366 T Breast reconstruction 0029 29.2783 $1,589.49 $632.64 $317.90 19367 C Breast reconstruction 19368 C Breast reconstruction 19369 C Breast reconstruction 19370 T Surgery of breast capsule 0029 29.2783 $1,589.49 $632.64 $317.90 19371 T Removal of breast capsule 0029 29.2783 $1,589.49 $632.64 $317.90 19380 T Revise breast reconstruction 0030 37.2809 $2,023.94 $763.55 $404.79 19396 T Design custom breast implant 0029 29.2783 $1,589.49 $632.64 $317.90 19499 T Breast surgery procedure 0028 17.7459 $963.41 $303.74 $192.68 20000 T Incision of abscess 0006 1.7487 $94.94 $24.12 $18.99 20005 T Incision of deep abscess 0049 19.9376 $1,082.39 $216.48 20100 T Explore wound, neck 0023 3.1587 $171.48 $40.37 $34.30 20101 T Explore wound, chest 0027 15.8319 $859.50 $329.72 $171.90 20102 T Explore wound, abdomen 0027 15.8319 $859.50 $329.72 $171.90 20103 T Explore wound, extremity 0023 3.1587 $171.48 $40.37 $34.30 20150 T Excise epiphyseal bar 0051 34.9381 $1,896.75 $379.35 20200 T Muscle biopsy 0021 14.5749 $791.26 $219.48 $158.25 20205 T Deep muscle biopsy 0021 14.5749 $791.26 $219.48 $158.25 20206 T Needle biopsy, muscle 0005 3.3675 $182.82 $71.59 $36.56 20220 T Bone biopsy, trocar/needle 0019 3.9807 $216.11 $71.87 $43.22 20225 T Bone biopsy, trocar/needle 0020 7.3105 $396.88 $113.25 $79.38 20240 T Bone biopsy, excisional 0022 18.6725 $1,013.71 $354.45 $202.74 20245 T Bone biopsy, excisional 0022 18.6725 $1,013.71 $354.45 $202.74 20250 T Open bone biopsy 0049 19.9376 $1,082.39 $216.48 20251 T Open bone biopsy 0049 19.9376 $1,082.39 $216.48 20500 T Injection of sinus tract 0251 1.8643 $101.21 $20.24 20501 N Inject sinus tract for x-ray 20520 T Removal of foreign body 0019 3.9807 $216.11 $71.87 $43.22 20525 T Removal of foreign body 0022 18.6725 $1,013.71 $354.45 $202.74 20526 T Ther injection, carp tunnel 0204 2.2209 $120.57 $40.13 $24.11 20550 T Inject tendon/ligament/cyst 0204 2.2209 $120.57 $40.13 $24.11 20551 T Inject tendon origin/insert 0204 2.2209 $120.57 $40.13 $24.11 20552 T Inject trigger point, 1 or 2 0204 2.2209 $120.57 $40.13 $24.11 20553 T Inject trigger points, > 3 0204 2.2209 $120.57 $40.13 $24.11 20600 T Drain/inject, joint/bursa 0204 2.2209 $120.57 $40.13 $24.11 20605 T Drain/inject, joint/bursa 0204 2.2209 $120.57 $40.13 $24.11 20610 T Drain/inject, joint/bursa 0204 2.2209 $120.57 $40.13 $24.11 Start Printed Page 48041 20612 T Aspirate/inj ganglion cyst 0204 2.2209 $120.57 $40.13 $24.11 20615 T Treatment of bone cyst 0004 1.5774 $85.64 $22.10 $17.13 20650 T Insert and remove bone pin 0049 19.9376 $1,082.39 $216.48 20660 C Apply, rem fixation device 20661 C Application of head brace 20662 C Application of pelvis brace 20663 C Application of thigh brace 20664 C Halo brace application 20665 X Removal of fixation device 0340 0.6232 $33.83 $6.77 20670 T Removal of support implant 0021 14.5749 $791.26 $219.48 $158.25 20680 T Removal of support implant 0022 18.6725 $1,013.71 $354.45 $202.74 20690 T Apply bone fixation device 0050 25.1166 $1,363.56 $272.71 20692 T Apply bone fixation device 0050 25.1166 $1,363.56 $272.71 20693 T Adjust bone fixation device 0049 19.9376 $1,082.39 $216.48 20694 T Remove bone fixation device 0049 19.9376 $1,082.39 $216.48 20802 C Replantation, arm, complete 20805 C Replant forearm, complete 20808 C Replantation hand, complete 20816 C Replantation digit, complete 20822 C Replantation digit, complete 20824 C Replantation thumb, complete 20827 C Replantation thumb, complete 20838 C Replantation foot, complete 20900 T Removal of bone for graft 0050 25.1166 $1,363.56 $272.71 20902 T Removal of bone for graft 0050 25.1166 $1,363.56 $272.71 20910 T Remove cartilage for graft 0027 15.8319 $859.50 $329.72 $171.90 20912 T Remove cartilage for graft 0027 15.8319 $859.50 $329.72 $171.90 20920 T Removal of fascia for graft 0027 15.8319 $859.50 $329.72 $171.90 20922 T Removal of fascia for graft 0027 15.8319 $859.50 $329.72 $171.90 20924 T Removal of tendon for graft 0050 25.1166 $1,363.56 $272.71 20926 T Removal of tissue for graft 0027 15.8319 $859.50 $329.72 $171.90 20930 C Spinal bone allograft 20931 C Spinal bone allograft 20936 C Spinal bone autograft 20937 C Spinal bone autograft 20938 C Spinal bone autograft 20950 T Fluid pressure, muscle 0006 1.7487 $94.94 $24.12 $18.99 20955 C Fibula bone graft, microvasc 20956 C Iliac bone graft, microvasc 20957 C Mt bone graft, microvasc 20962 C Other bone graft, microvasc 20969 C Bone/skin graft, microvasc 20970 C Bone/skin graft, iliac crest 20972 C Bone/skin graft, metatarsal 20973 C Bone/skin graft, great toe 20974 A Electrical bone stimulation 20975 T Electrical bone stimulation 0049 19.9376 $1,082.39 $216.48 20979 A Us bone stimulation 20999 T Musculoskeletal surgery 0049 19.9376 $1,082.39 $216.48 21010 T Incision of jaw joint 0254 21.4368 $1,163.78 $321.35 $232.76 21015 T Resection of facial tumor 0253 15.1698 $823.55 $282.29 $164.71 21025 T Excision of bone, lower jaw 0256 35.0866 $1,904.82 $380.96 21026 T Excision of facial bone(s) 0256 35.0866 $1,904.82 $380.96 21029 T Contour of face bone lesion 0256 35.0866 $1,904.82 $380.96 21030 T Removal of face bone lesion 0254 21.4368 $1,163.78 $321.35 $232.76 21031 T Remove exostosis, mandible 0254 21.4368 $1,163.78 $321.35 $232.76 21032 T Remove exostosis, maxilla 0254 21.4368 $1,163.78 $321.35 $232.76 21034 T Removal of face bone lesion 0256 35.0866 $1,904.82 $380.96 21040 T Removal of jaw bone lesion 0254 21.4368 $1,163.78 $321.35 $232.76 21044 T Removal of jaw bone lesion 0256 35.0866 $1,904.82 $380.96 21045 C Extensive jaw surgery 21046 T Remove mandible cyst complex 0256 35.0866 $1,904.82 $380.96 21047 T Excise lwr jaw cyst w/repair 0256 35.0866 $1,904.82 $380.96 21048 T Remove maxilla cyst complex 0256 35.0866 $1,904.82 $380.96 21049 T Excis uppr jaw cyst w/repair 0256 35.0866 $1,904.82 $380.96 21050 T Removal of jaw joint 0256 35.0866 $1,904.82 $380.96 Start Printed Page 48042 21060 T Remove jaw joint cartilage 0256 35.0866 $1,904.82 $380.96 21070 T Remove coronoid process 0256 35.0866 $1,904.82 $380.96 21076 T Prepare face/oral prosthesis 0254 21.4368 $1,163.78 $321.35 $232.76 21077 T Prepare face/oral prosthesis 0256 35.0866 $1,904.82 $380.96 21079 T Prepare face/oral prosthesis 0256 35.0866 $1,904.82 $380.96 21080 T Prepare face/oral prosthesis 0256 35.0866 $1,904.82 $380.96 21081 T Prepare face/oral prosthesis 0256 35.0866 $1,904.82 $380.96 21082 T Prepare face/oral prosthesis 0256 35.0866 $1,904.82 $380.96 21083 T Prepare face/oral prosthesis 0256 35.0866 $1,904.82 $380.96 21084 T Prepare face/oral prosthesis 0256 35.0866 $1,904.82 $380.96 21085 T Prepare face/oral prosthesis 0253 15.1698 $823.55 $282.29 $164.71 21086 T Prepare face/oral prosthesis 0256 35.0866 $1,904.82 $380.96 21087 T Prepare face/oral prosthesis 0256 35.0866 $1,904.82 $380.96 21088 T Prepare face/oral prosthesis 0256 35.0866 $1,904.82 $380.96 21089 T Prepare face/oral prosthesis 0253 15.1698 $823.55 $282.29 $164.71 21100 T Maxillofacial fixation 0256 35.0866 $1,904.82 $380.96 21110 T Interdental fixation 0252 6.5416 $355.14 $113.41 $71.03 21116 N Injection, jaw joint x-ray 21120 T Reconstruction of chin 0254 21.4368 $1,163.78 $321.35 $232.76 21121 T Reconstruction of chin 0254 21.4368 $1,163.78 $321.35 $232.76 21122 T Reconstruction of chin 0254 21.4368 $1,163.78 $321.35 $232.76 21123 T Reconstruction of chin 0254 21.4368 $1,163.78 $321.35 $232.76 21125 T Augmentation, lower jaw bone 0254 21.4368 $1,163.78 $321.35 $232.76 21127 T Augmentation, lower jaw bone 0256 35.0866 $1,904.82 $380.96 21137 T Reduction of forehead 0254 21.4368 $1,163.78 $321.35 $232.76 21138 T Reduction of forehead 0256 35.0866 $1,904.82 $380.96 21139 T Reduction of forehead 0256 35.0866 $1,904.82 $380.96 21141 C Reconstruct midface, lefort 21142 C Reconstruct midface, lefort 21143 C Reconstruct midface, lefort 21145 C Reconstruct midface, lefort 21146 C Reconstruct midface, lefort 21147 C Reconstruct midface, lefort 21150 C Reconstruct midface, lefort 21151 C Reconstruct midface, lefort 21154 C Reconstruct midface, lefort 21155 C Reconstruct midface, lefort 21159 C Reconstruct midface, lefort 21160 C Reconstruct midface, lefort 21172 C Reconstruct orbit/forehead 21175 C Reconstruct orbit/forehead 21179 C Reconstruct entire forehead 21180 C Reconstruct entire forehead 21181 T Contour cranial bone lesion 0254 21.4368 $1,163.78 $321.35 $232.76 21182 C Reconstruct cranial bone 21183 C Reconstruct cranial bone 21184 C Reconstruct cranial bone 21188 C Reconstruction of midface 21193 C Reconst lwr jaw w/o graft 21194 C Reconst lwr jaw w/graft 21195 C Reconst lwr jaw w/o fixation 21196 C Reconst lwr jaw w/fixation 21198 T Reconstr lwr jaw segment 0256 35.0866 $1,904.82 $380.96 21199 T Reconstr lwr jaw w/advance 0256 35.0866 $1,904.82 $380.96 21206 T Reconstruct upper jaw bone 0256 35.0866 $1,904.82 $380.96 21208 T Augmentation of facial bones 0256 35.0866 $1,904.82 $380.96 21209 T Reduction of facial bones 0256 35.0866 $1,904.82 $380.96 21210 T Face bone graft 0256 35.0866 $1,904.82 $380.96 21215 T Lower jaw bone graft 0256 35.0866 $1,904.82 $380.96 21230 T Rib cartilage graft 0256 35.0866 $1,904.82 $380.96 21235 T Ear cartilage graft 0254 21.4368 $1,163.78 $321.35 $232.76 21240 T Reconstruction of jaw joint 0256 35.0866 $1,904.82 $380.96 21242 T Reconstruction of jaw joint 0256 35.0866 $1,904.82 $380.96 21243 T Reconstruction of jaw joint 0256 35.0866 $1,904.82 $380.96 21244 T Reconstruction of lower jaw 0256 35.0866 $1,904.82 $380.96 21245 T Reconstruction of jaw 0256 35.0866 $1,904.82 $380.96 Start Printed Page 48043 21246 T Reconstruction of jaw 0256 35.0866 $1,904.82 $380.96 21247 C Reconstruct lower jaw bone 21248 T Reconstruction of jaw 0256 35.0866 $1,904.82 $380.96 21249 T Reconstruction of jaw 0256 35.0866 $1,904.82 $380.96 21255 C Reconstruct lower jaw bone 21256 C Reconstruction of orbit 21260 T Revise eye sockets 0256 35.0866 $1,904.82 $380.96 21261 T Revise eye sockets 0256 35.0866 $1,904.82 $380.96 21263 T Revise eye sockets 0256 35.0866 $1,904.82 $380.96 21267 T Revise eye sockets 0256 35.0866 $1,904.82 $380.96 21268 C Revise eye sockets 21270 T Augmentation, cheek bone 0256 35.0866 $1,904.82 $380.96 21275 T Revision, orbitofacial bones 0256 35.0866 $1,904.82 $380.96 21280 T Revision of eyelid 0256 35.0866 $1,904.82 $380.96 21282 T Revision of eyelid 0253 15.1698 $823.55 $282.29 $164.71 21295 T Revision of jaw muscle/bone 0252 6.5416 $355.14 $113.41 $71.03 21296 T Revision of jaw muscle/bone 0254 21.4368 $1,163.78 $321.35 $232.76 21299 T Cranio/maxillofacial surgery 0253 15.1698 $823.55 $282.29 $164.71 21300 T Treatment of skull fracture 0253 15.1698 $823.55 $282.29 $164.71 21310 X Treatment of nose fracture 0340 0.6232 $33.83 $6.77 21315 X Treatment of nose fracture 0340 0.6232 $33.83 $6.77 21320 X Treatment of nose fracture 0340 0.6232 $33.83 $6.77 21325 T Treatment of nose fracture 0254 21.4368 $1,163.78 $321.35 $232.76 21330 T Treatment of nose fracture 0254 21.4368 $1,163.78 $321.35 $232.76 21335 T Treatment of nose fracture 0254 21.4368 $1,163.78 $321.35 $232.76 21336 T Treat nasal septal fracture 0046 31.9719 $1,735.72 $535.76 $347.14 21337 T Treat nasal septal fracture 0253 15.1698 $823.55 $282.29 $164.71 21338 T Treat nasoethmoid fracture 0254 21.4368 $1,163.78 $321.35 $232.76 21339 T Treat nasoethmoid fracture 0254 21.4368 $1,163.78 $321.35 $232.76 21340 T Treatment of nose fracture 0256 35.0866 $1,904.82 $380.96 21343 C Treatment of sinus fracture 21344 C Treatment of sinus fracture 21345 T Treat nose/jaw fracture 0254 21.4368 $1,163.78 $321.35 $232.76 21346 C Treat nose/jaw fracture 21347 C Treat nose/jaw fracture 21348 C Treat nose/jaw fracture 21355 T Treat cheek bone fracture 0256 35.0866 $1,904.82 $380.96 21356 C Treat cheek bone fracture 21360 C Treat cheek bone fracture 21365 C Treat cheek bone fracture 21366 C Treat cheek bone fracture 21385 C Treat eye socket fracture 21386 C Treat eye socket fracture 21387 C Treat eye socket fracture 21390 T Treat eye socket fracture 0256 35.0866 $1,904.82 $380.96 21395 C Treat eye socket fracture 21400 T Treat eye socket fracture 0252 6.5416 $355.14 $113.41 $71.03 21401 T Treat eye socket fracture 0253 15.1698 $823.55 $282.29 $164.71 21406 T Treat eye socket fracture 0256 35.0866 $1,904.82 $380.96 21407 T Treat eye socket fracture 0256 35.0866 $1,904.82 $380.96 21408 C Treat eye socket fracture 21421 T Treat mouth roof fracture 0254 21.4368 $1,163.78 $321.35 $232.76 21422 C Treat mouth roof fracture 21423 C Treat mouth roof fracture 21431 C Treat craniofacial fracture 21432 C Treat craniofacial fracture 21433 C Treat craniofacial fracture 21435 C Treat craniofacial fracture 21436 C Treat craniofacial fracture 21440 T Treat dental ridge fracture 0254 21.4368 $1,163.78 $321.35 $232.76 21445 T Treat dental ridge fracture 0254 21.4368 $1,163.78 $321.35 $232.76 21450 T Treat lower jaw fracture 0251 1.8643 $101.21 $20.24 21451 T Treat lower jaw fracture 0252 6.5416 $355.14 $113.41 $71.03 21452 T Treat lower jaw fracture 0253 15.1698 $823.55 $282.29 $164.71 21453 T Treat lower jaw fracture 0256 35.0866 $1,904.82 $380.96 21454 T Treat lower jaw fracture 0254 21.4368 $1,163.78 $321.35 $232.76 Start Printed Page 48044 21461 T Treat lower jaw fracture 0256 35.0866 $1,904.82 $380.96 21462 T Treat lower jaw fracture 0256 35.0866 $1,904.82 $380.96 21465 T Treat lower jaw fracture 0256 35.0866 $1,904.82 $380.96 21470 T Treat lower jaw fracture 0256 35.0866 $1,904.82 $380.96 21480 T Reset dislocated jaw 0251 1.8643 $101.21 $20.24 21485 T Reset dislocated jaw 0253 15.1698 $823.55 $282.29 $164.71 21490 T Repair dislocated jaw 0256 35.0866 $1,904.82 $380.96 21493 T Treat hyoid bone fracture 0252 6.5416 $355.14 $113.41 $71.03 21494 T Treat hyoid bone fracture 0252 6.5416 $355.14 $113.41 $71.03 21495 C Treat hyoid bone fracture 21497 T Interdental wiring 0253 15.1698 $823.55 $282.29 $164.71 21499 T Head surgery procedure 0253 15.1698 $823.55 $282.29 $164.71 21501 T Drain neck/chest lesion 0008 16.8303 $913.70 $182.74 21502 T Drain chest lesion 0049 19.9376 $1,082.39 $216.48 21510 C Drainage of bone lesion 21550 T Biopsy of neck/chest 0021 14.5749 $791.26 $219.48 $158.25 21555 T Remove lesion, neck/chest 0022 18.6725 $1,013.71 $354.45 $202.74 21556 T Remove lesion, neck/chest 0022 18.6725 $1,013.71 $354.45 $202.74 21557 C Remove tumor, neck/chest 21600 T Partial removal of rib 0050 25.1166 $1,363.56 $272.71 21610 T Partial removal of rib 0050 25.1166 $1,363.56 $272.71 21615 C Removal of rib 21616 C Removal of rib and nerves 21620 C Partial removal of sternum 21627 C Sternal debridement 21630 C Extensive sternum surgery 21632 C Extensive sternum surgery 21700 T Revision of neck muscle 0049 19.9376 $1,082.39 $216.48 21705 C Revision of neck muscle/rib 21720 T Revision of neck muscle 0049 19.9376 $1,082.39 $216.48 21725 T Revision of neck muscle 0006 1.7487 $94.94 $24.12 $18.99 21740 C Reconstruction of sternum 21742 T Repair stern/nuss w/o scope 0051 34.9381 $1,896.75 $379.35 21743 T Repair sternum/nuss w/scope 0051 34.9381 $1,896.75 $379.35 21750 C Repair of sternum separation 21800 T Treatment of rib fracture 0043 1.9233 $104.41 $20.88 21805 T Treatment of rib fracture 0046 31.9719 $1,735.72 $535.76 $347.14 21810 C Treatment of rib fracture(s) 21820 T Treat sternum fracture 0043 1.9233 $104.41 $20.88 21825 C Treat sternum fracture 21899 T Neck/chest surgery procedure 0252 6.5416 $355.14 $113.41 $71.03 21920 T Biopsy soft tissue of back 0020 7.3105 $396.88 $113.25 $79.38 21925 T Biopsy soft tissue of back 0022 18.6725 $1,013.71 $354.45 $202.74 21930 T Remove lesion, back or flank 0022 18.6725 $1,013.71 $354.45 $202.74 21935 T Remove tumor, back 0022 18.6725 $1,013.71 $354.45 $202.74 22100 T Remove part of neck vertebra 0208 40.6521 $2,206.96 $441.39 22101 T Remove part, thorax vertebra 0208 40.6521 $2,206.96 $441.39 22102 T Remove part, lumbar vertebra 0208 40.6521 $2,206.96 $441.39 22103 T Remove extra spine segment 0208 40.6521 $2,206.96 $441.39 22110 C Remove part of neck vertebra 22112 C Remove part, thorax vertebra 22114 C Remove part, lumbar vertebra 22116 C Remove extra spine segment 22210 C Revision of neck spine 22212 C Revision of thorax spine 22214 C Revision of lumbar spine 22216 C Revise, extra spine segment 22220 C Revision of neck spine 22222 C Revision of thorax spine 22224 C Revision of lumbar spine 22226 C Revise, extra spine segment 22305 T Treat spine process fracture 0043 1.9233 $104.41 $20.88 22310 T Treat spine fracture 0043 1.9233 $104.41 $20.88 22315 T Treat spine fracture 0043 1.9233 $104.41 $20.88 22318 C Treat odontoid fx w/o graft 22319 C Treat odontoid fx w/graft Start Printed Page 48045 22325 C Treat spine fracture 22326 C Treat neck spine fracture 22327 C Treat thorax spine fracture 22328 C Treat each add spine fx 22505 T Manipulation of spine 0045 13.5546 $735.87 $268.47 $147.17 22520 T Percut vertebroplasty thor 0050 25.1166 $1,363.56 $272.71 22521 T Percut vertebroplasty lumb 0050 25.1166 $1,363.56 $272.71 22522 T Percut vertebroplasty addl 0050 25.1166 $1,363.56 $272.71 22548 C Neck spine fusion 22554 C Neck spine fusion 22556 C Thorax spine fusion 22558 C Lumbar spine fusion 22585 C Additional spinal fusion 22590 C Spine & skull spinal fusion 22595 C Neck spinal fusion 22600 C Neck spine fusion 22610 C Thorax spine fusion 22612 T Lumbar spine fusion 0208 40.6521 $2,206.96 $441.39 22614 T Spine fusion, extra segment 0208 40.6521 $2,206.96 $441.39 22630 C Lumbar spine fusion 22632 C Spine fusion, extra segment 22800 C Fusion of spine 22802 C Fusion of spine 22804 C Fusion of spine 22808 C Fusion of spine 22810 C Fusion of spine 22812 C Fusion of spine 22818 C Kyphectomy, 1-2 segments 22819 C Kyphectomy, 3 or more 22830 C Exploration of spinal fusion 22840 C Insert spine fixation device 22841 C Insert spine fixation device 22842 C Insert spine fixation device 22843 C Insert spine fixation device 22844 C Insert spine fixation device 22845 C Insert spine fixation device 22846 C Insert spine fixation device 22847 C Insert spine fixation device 22848 C Insert pelv fixation device 22849 C Reinsert spinal fixation 22850 C Remove spine fixation device 22851 C Apply spine prosth device 22852 C Remove spine fixation device 22855 C Remove spine fixation device 22899 T Spine surgery procedure 0043 1.9233 $104.41 $20.88 22900 T Remove abdominal wall lesion 0022 18.6725 $1,013.71 $354.45 $202.74 22999 T Abdomen surgery procedure 0022 18.6725 $1,013.71 $354.45 $202.74 23000 T Removal of calcium deposits 0021 14.5749 $791.26 $219.48 $158.25 23020 T Release shoulder joint 0051 34.9381 $1,896.75 $379.35 23030 T Drain shoulder lesion 0008 16.8303 $913.70 $182.74 23031 T Drain shoulder bursa 0008 16.8303 $913.70 $182.74 23035 T Drain shoulder bone lesion 0049 19.9376 $1,082.39 $216.48 23040 T Exploratory shoulder surgery 0050 25.1166 $1,363.56 $272.71 23044 T Exploratory shoulder surgery 0050 25.1166 $1,363.56 $272.71 23065 T Biopsy shoulder tissues 0021 14.5749 $791.26 $219.48 $158.25 23066 T Biopsy shoulder tissues 0022 18.6725 $1,013.71 $354.45 $202.74 23075 T Removal of shoulder lesion 0021 14.5749 $791.26 $219.48 $158.25 23076 T Removal of shoulder lesion 0022 18.6725 $1,013.71 $354.45 $202.74 23077 T Remove tumor of shoulder 0022 18.6725 $1,013.71 $354.45 $202.74 23100 T Biopsy of shoulder joint 0049 19.9376 $1,082.39 $216.48 23101 T Shoulder joint surgery 0050 25.1166 $1,363.56 $272.71 23105 T Remove shoulder joint lining 0050 25.1166 $1,363.56 $272.71 23106 T Incision of collarbone joint 0050 25.1166 $1,363.56 $272.71 23107 T Explore treat shoulder joint 0050 25.1166 $1,363.56 $272.71 23120 T Partial removal, collar bone 0051 34.9381 $1,896.75 $379.35 23125 T Removal of collar bone 0051 34.9381 $1,896.75 $379.35 Start Printed Page 48046 23130 T Remove shoulder bone, part 0051 34.9381 $1,896.75 $379.35 23140 T Removal of bone lesion 0049 19.9376 $1,082.39 $216.48 23145 T Removal of bone lesion 0050 25.1166 $1,363.56 $272.71 23146 T Removal of bone lesion 0050 25.1166 $1,363.56 $272.71 23150 T Removal of humerus lesion 0050 25.1166 $1,363.56 $272.71 23155 T Removal of humerus lesion 0050 25.1166 $1,363.56 $272.71 23156 T Removal of humerus lesion 0050 25.1166 $1,363.56 $272.71 23170 T Remove collar bone lesion 0050 25.1166 $1,363.56 $272.71 23172 T Remove shoulder blade lesion 0050 25.1166 $1,363.56 $272.71 23174 T Remove humerus lesion 0050 25.1166 $1,363.56 $272.71 23180 T Remove collar bone lesion 0050 25.1166 $1,363.56 $272.71 23182 T Remove shoulder blade lesion 0050 25.1166 $1,363.56 $272.71 23184 T Remove humerus lesion 0050 25.1166 $1,363.56 $272.71 23190 T Partial removal of scapula 0050 25.1166 $1,363.56 $272.71 23195 T Removal of head of humerus 0050 25.1166 $1,363.56 $272.71 23200 C Removal of collar bone 23210 C Removal of shoulder blade 23220 C Partial removal of humerus 23221 C Partial removal of humerus 23222 C Partial removal of humerus 23330 T Remove shoulder foreign body 0020 7.3105 $396.88 $113.25 $79.38 23331 T Remove shoulder foreign body 0022 18.6725 $1,013.71 $354.45 $202.74 23332 C Remove shoulder foreign body 23350 N Injection for shoulder x-ray 23395 T Muscle transfer,shoulder/arm 0051 34.9381 $1,896.75 $379.35 23397 T Muscle transfers 0052 42.6430 $2,315.05 $463.01 23400 T Fixation of shoulder blade 0050 25.1166 $1,363.56 $272.71 23405 T Incision of tendon & muscle 0050 25.1166 $1,363.56 $272.71 23406 T Incise tendon(s) & muscle(s) 0050 25.1166 $1,363.56 $272.71 23410 T Repair of tendon(s) 0052 42.6430 $2,315.05 $463.01 23412 T Repair rotator cuff, chronic 0052 42.6430 $2,315.05 $463.01 23415 T Release of shoulder ligament 0051 34.9381 $1,896.75 $379.35 23420 T Repair of shoulder 0052 42.6430 $2,315.05 $463.01 23430 T Repair biceps tendon 0052 42.6430 $2,315.05 $463.01 23440 T Remove/transplant tendon 0052 42.6430 $2,315.05 $463.01 23450 T Repair shoulder capsule 0052 42.6430 $2,315.05 $463.01 23455 T Repair shoulder capsule 0052 42.6430 $2,315.05 $463.01 23460 T Repair shoulder capsule 0052 42.6430 $2,315.05 $463.01 23462 T Repair shoulder capsule 0052 42.6430 $2,315.05 $463.01 23465 T Repair shoulder capsule 0052 42.6430 $2,315.05 $463.01 23466 T Repair shoulder capsule 0052 42.6430 $2,315.05 $463.01 23470 T Reconstruct shoulder joint 0048 47.4707 $2,577.14 $695.60 $515.43 23472 C Reconstruct shoulder joint 23480 T Revision of collar bone 0051 34.9381 $1,896.75 $379.35 23485 T Revision of collar bone 0051 34.9381 $1,896.75 $379.35 23490 T Reinforce clavicle 0051 34.9381 $1,896.75 $379.35 23491 T Reinforce shoulder bones 0051 34.9381 $1,896.75 $379.35 23500 T Treat clavicle fracture 0043 1.9233 $104.41 $20.88 23505 T Treat clavicle fracture 0043 1.9233 $104.41 $20.88 23515 T Treat clavicle fracture 0046 31.9719 $1,735.72 $535.76 $347.14 23520 T Treat clavicle dislocation 0043 1.9233 $104.41 $20.88 23525 T Treat clavicle dislocation 0043 1.9233 $104.41 $20.88 23530 T Treat clavicle dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 23532 T Treat clavicle dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 23540 T Treat clavicle dislocation 0043 1.9233 $104.41 $20.88 23545 T Treat clavicle dislocation 0043 1.9233 $104.41 $20.88 23550 T Treat clavicle dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 23552 T Treat clavicle dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 23570 T Treat shoulder blade fx 0043 1.9233 $104.41 $20.88 23575 T Treat shoulder blade fx 0043 1.9233 $104.41 $20.88 23585 T Treat scapula fracture 0046 31.9719 $1,735.72 $535.76 $347.14 23600 T Treat humerus fracture 0043 1.9233 $104.41 $20.88 23605 T Treat humerus fracture 0043 1.9233 $104.41 $20.88 23615 T Treat humerus fracture 0046 31.9719 $1,735.72 $535.76 $347.14 23616 T Treat humerus fracture 0046 31.9719 $1,735.72 $535.76 $347.14 23620 T Treat humerus fracture 0043 1.9233 $104.41 $20.88 Start Printed Page 48047 23625 T Treat humerus fracture 0043 1.9233 $104.41 $20.88 23630 T Treat humerus fracture 0046 31.9719 $1,735.72 $535.76 $347.14 23650 T Treat shoulder dislocation 0043 1.9233 $104.41 $20.88 23655 T Treat shoulder dislocation 0045 13.5546 $735.87 $268.47 $147.17 23660 T Treat shoulder dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 23665 T Treat dislocation/fracture 0043 1.9233 $104.41 $20.88 23670 T Treat dislocation/fracture 0046 31.9719 $1,735.72 $535.76 $347.14 23675 T Treat dislocation/fracture 0043 1.9233 $104.41 $20.88 23680 T Treat dislocation/fracture 0046 31.9719 $1,735.72 $535.76 $347.14 23700 T Fixation of shoulder 0045 13.5546 $735.87 $268.47 $147.17 23800 T Fusion of shoulder joint 0051 34.9381 $1,896.75 $379.35 23802 T Fusion of shoulder joint 0051 34.9381 $1,896.75 $379.35 23900 C Amputation of arm & girdle 23920 C Amputation at shoulder joint 23921 T Amputation follow-up surgery 0025 6.2703 $340.41 $115.49 $68.08 23929 T Shoulder surgery procedure 0043 1.9233 $104.41 $20.88 23930 T Drainage of arm lesion 0008 16.8303 $913.70 $182.74 23931 T Drainage of arm bursa 0006 1.7487 $94.94 $24.12 $18.99 23935 T Drain arm/elbow bone lesion 0049 19.9376 $1,082.39 $216.48 24000 T Exploratory elbow surgery 0050 25.1166 $1,363.56 $272.71 24006 T Release elbow joint 0050 25.1166 $1,363.56 $272.71 24065 T Biopsy arm/elbow soft tissue 0021 14.5749 $791.26 $219.48 $158.25 24066 T Biopsy arm/elbow soft tissue 0021 14.5749 $791.26 $219.48 $158.25 24075 T Remove arm/elbow lesion 0021 14.5749 $791.26 $219.48 $158.25 24076 T Remove arm/elbow lesion 0022 18.6725 $1,013.71 $354.45 $202.74 24077 T Remove tumor of arm/elbow 0022 18.6725 $1,013.71 $354.45 $202.74 24100 T Biopsy elbow joint lining 0049 19.9376 $1,082.39 $216.48 24101 T Explore/treat elbow joint 0050 25.1166 $1,363.56 $272.71 24102 T Remove elbow joint lining 0050 25.1166 $1,363.56 $272.71 24105 T Removal of elbow bursa 0049 19.9376 $1,082.39 $216.48 24110 T Remove humerus lesion 0049 19.9376 $1,082.39 $216.48 24115 T Remove/graft bone lesion 0050 25.1166 $1,363.56 $272.71 24116 T Remove/graft bone lesion 0050 25.1166 $1,363.56 $272.71 24120 T Remove elbow lesion 0049 19.9376 $1,082.39 $216.48 24125 T Remove/graft bone lesion 0050 25.1166 $1,363.56 $272.71 24126 T Remove/graft bone lesion 0050 25.1166 $1,363.56 $272.71 24130 T Removal of head of radius 0050 25.1166 $1,363.56 $272.71 24134 T Removal of arm bone lesion 0050 25.1166 $1,363.56 $272.71 24136 T Remove radius bone lesion 0050 25.1166 $1,363.56 $272.71 24138 T Remove elbow bone lesion 0050 25.1166 $1,363.56 $272.71 24140 T Partial removal of arm bone 0050 25.1166 $1,363.56 $272.71 24145 T Partial removal of radius 0050 25.1166 $1,363.56 $272.71 24147 T Partial removal of elbow 0050 25.1166 $1,363.56 $272.71 24149 C Radical resection of elbow 24150 T Extensive humerus surgery 0052 42.6430 $2,315.05 $463.01 24151 T Extensive humerus surgery 0052 42.6430 $2,315.05 $463.01 24152 T Extensive radius surgery 0052 42.6430 $2,315.05 $463.01 24153 T Extensive radius surgery 0052 42.6430 $2,315.05 $463.01 24155 T Removal of elbow joint 0051 34.9381 $1,896.75 $379.35 24160 T Remove elbow joint implant 0050 25.1166 $1,363.56 $272.71 24164 T Remove radius head implant 0050 25.1166 $1,363.56 $272.71 24200 T Removal of arm foreign body 0019 3.9807 $216.11 $71.87 $43.22 24201 T Removal of arm foreign body 0021 14.5749 $791.26 $219.48 $158.25 24220 N Injection for elbow x-ray 24300 T Manipulate elbow w/anesth 0045 13.5546 $735.87 $268.47 $147.17 24301 T Muscle/tendon transfer 0050 25.1166 $1,363.56 $272.71 24305 T Arm tendon lengthening 0050 25.1166 $1,363.56 $272.71 24310 T Revision of arm tendon 0049 19.9376 $1,082.39 $216.48 24320 T Repair of arm tendon 0051 34.9381 $1,896.75 $379.35 24330 T Revision of arm muscles 0051 34.9381 $1,896.75 $379.35 24331 T Revision of arm muscles 0051 34.9381 $1,896.75 $379.35 24332 T Tenolysis, triceps 0049 19.9376 $1,082.39 $216.48 24340 T Repair of biceps tendon 0051 34.9381 $1,896.75 $379.35 24341 T Repair arm tendon/muscle 0051 34.9381 $1,896.75 $379.35 24342 T Repair of ruptured tendon 0051 34.9381 $1,896.75 $379.35 24343 T Repr elbow lat ligmnt w/tiss 0050 25.1166 $1,363.56 $272.71 Start Printed Page 48048 24344 T Reconstruct elbow lat ligmnt 0051 34.9381 $1,896.75 $379.35 24345 T Repr elbw med ligmnt w/tissu 0050 25.1166 $1,363.56 $272.71 24346 T Reconstruct elbow med ligmnt 0051 34.9381 $1,896.75 $379.35 24350 T Repair of tennis elbow 0050 25.1166 $1,363.56 $272.71 24351 T Repair of tennis elbow 0050 25.1166 $1,363.56 $272.71 24352 T Repair of tennis elbow 0050 25.1166 $1,363.56 $272.71 24354 T Repair of tennis elbow 0050 25.1166 $1,363.56 $272.71 24356 T Revision of tennis elbow 0050 25.1166 $1,363.56 $272.71 24360 T Reconstruct elbow joint 0047 30.3786 $1,649.22 $537.03 $329.84 24361 T Reconstruct elbow joint 0048 47.4707 $2,577.14 $695.60 $515.43 24362 T Reconstruct elbow joint 0048 47.4707 $2,577.14 $695.60 $515.43 24363 T Replace elbow joint 0048 47.4707 $2,577.14 $695.60 $515.43 24365 T Reconstruct head of radius 0047 30.3786 $1,649.22 $537.03 $329.84 24366 T Reconstruct head of radius 0048 47.4707 $2,577.14 $695.60 $515.43 24400 T Revision of humerus 0050 25.1166 $1,363.56 $272.71 24410 T Revision of humerus 0050 25.1166 $1,363.56 $272.71 24420 T Revision of humerus 0051 34.9381 $1,896.75 $379.35 24430 T Repair of humerus 0051 34.9381 $1,896.75 $379.35 24435 T Repair humerus with graft 0051 34.9381 $1,896.75 $379.35 24470 T Revision of elbow joint 0051 34.9381 $1,896.75 $379.35 24495 T Decompression of forearm 0050 25.1166 $1,363.56 $272.71 24498 T Reinforce humerus 0051 34.9381 $1,896.75 $379.35 24500 T Treat humerus fracture 0043 1.9233 $104.41 $20.88 24505 T Treat humerus fracture 0043 1.9233 $104.41 $20.88 24515 T Treat humerus fracture 0046 31.9719 $1,735.72 $535.76 $347.14 24516 T Treat humerus fracture 0046 31.9719 $1,735.72 $535.76 $347.14 24530 T Treat humerus fracture 0043 1.9233 $104.41 $20.88 24535 T Treat humerus fracture 0043 1.9233 $104.41 $20.88 24538 T Treat humerus fracture 0046 31.9719 $1,735.72 $535.76 $347.14 24545 T Treat humerus fracture 0046 31.9719 $1,735.72 $535.76 $347.14 24546 T Treat humerus fracture 0046 31.9719 $1,735.72 $535.76 $347.14 24560 T Treat humerus fracture 0043 1.9233 $104.41 $20.88 24565 T Treat humerus fracture 0043 1.9233 $104.41 $20.88 24566 T Treat humerus fracture 0046 31.9719 $1,735.72 $535.76 $347.14 24575 T Treat humerus fracture 0046 31.9719 $1,735.72 $535.76 $347.14 24576 T Treat humerus fracture 0043 1.9233 $104.41 $20.88 24577 T Treat humerus fracture 0043 1.9233 $104.41 $20.88 24579 T Treat humerus fracture 0046 31.9719 $1,735.72 $535.76 $347.14 24582 T Treat humerus fracture 0046 31.9719 $1,735.72 $535.76 $347.14 24586 T Treat elbow fracture 0046 31.9719 $1,735.72 $535.76 $347.14 24587 T Treat elbow fracture 0046 31.9719 $1,735.72 $535.76 $347.14 24600 T Treat elbow dislocation 0043 1.9233 $104.41 $20.88 24605 T Treat elbow dislocation 0045 13.5546 $735.87 $268.47 $147.17 24615 T Treat elbow dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 24620 T Treat elbow fracture 0043 1.9233 $104.41 $20.88 24635 T Treat elbow fracture 0046 31.9719 $1,735.72 $535.76 $347.14 24640 T Treat elbow dislocation 0043 1.9233 $104.41 $20.88 24650 T Treat radius fracture 0043 1.9233 $104.41 $20.88 24655 T Treat radius fracture 0043 1.9233 $104.41 $20.88 24665 T Treat radius fracture 0046 31.9719 $1,735.72 $535.76 $347.14 24666 T Treat radius fracture 0046 31.9719 $1,735.72 $535.76 $347.14 24670 T Treat ulnar fracture 0043 1.9233 $104.41 $20.88 24675 T Treat ulnar fracture 0043 1.9233 $104.41 $20.88 24685 T Treat ulnar fracture 0046 31.9719 $1,735.72 $535.76 $347.14 24800 T Fusion of elbow joint 0051 34.9381 $1,896.75 $379.35 24802 T Fusion/graft of elbow joint 0051 34.9381 $1,896.75 $379.35 24900 C Amputation of upper arm 24920 C Amputation of upper arm 24925 T Amputation follow-up surgery 0049 19.9376 $1,082.39 $216.48 24930 C Amputation follow-up surgery 24931 C Amputate upper arm & implant 24935 T Revision of amputation 0052 42.6430 $2,315.05 $463.01 24940 C Revision of upper arm 24999 T Upper arm/elbow surgery 0043 1.9233 $104.41 $20.88 25000 T Incision of tendon sheath 0049 19.9376 $1,082.39 $216.48 25001 T Incise flexor carpi radialis 0049 19.9376 $1,082.39 $216.48 Start Printed Page 48049 25020 T Decompress forearm 1 space 0049 19.9376 $1,082.39 $216.48 25023 T Decompress forearm 1 space 0050 25.1166 $1,363.56 $272.71 25024 T Decompress forearm 2 spaces 0050 25.1166 $1,363.56 $272.71 25025 T Decompress forarm 2 spaces 0050 25.1166 $1,363.56 $272.71 25028 T Drainage of forearm lesion 0049 19.9376 $1,082.39 $216.48 25031 T Drainage of forearm bursa 0049 19.9376 $1,082.39 $216.48 25035 T Treat forearm bone lesion 0049 19.9376 $1,082.39 $216.48 25040 T Explore/treat wrist joint 0050 25.1166 $1,363.56 $272.71 25065 T Biopsy forearm soft tissues 0021 14.5749 $791.26 $219.48 $158.25 25066 T Biopsy forearm soft tissues 0022 18.6725 $1,013.71 $354.45 $202.74 25075 T Removel forearm lesion subcu 0021 14.5749 $791.26 $219.48 $158.25 25076 T Removel forearm lesion deep 0022 18.6725 $1,013.71 $354.45 $202.74 25077 T Remove tumor, forearm/wrist 0022 18.6725 $1,013.71 $354.45 $202.74 25085 T Incision of wrist capsule 0049 19.9376 $1,082.39 $216.48 25100 T Biopsy of wrist joint 0049 19.9376 $1,082.39 $216.48 25101 T Explore/treat wrist joint 0050 25.1166 $1,363.56 $272.71 25105 T Remove wrist joint lining 0050 25.1166 $1,363.56 $272.71 25107 T Remove wrist joint cartilage 0050 25.1166 $1,363.56 $272.71 25110 T Remove wrist tendon lesion 0049 19.9376 $1,082.39 $216.48 25111 T Remove wrist tendon lesion 0053 14.8188 $804.50 $253.49 $160.90 25112 T Reremove wrist tendon lesion 0053 14.8188 $804.50 $253.49 $160.90 25115 T Remove wrist/forearm lesion 0049 19.9376 $1,082.39 $216.48 25116 T Remove wrist/forearm lesion 0049 19.9376 $1,082.39 $216.48 25118 T Excise wrist tendon sheath 0050 25.1166 $1,363.56 $272.71 25119 T Partial removal of ulna 0050 25.1166 $1,363.56 $272.71 25120 T Removal of forearm lesion 0050 25.1166 $1,363.56 $272.71 25125 T Remove/graft forearm lesion 0050 25.1166 $1,363.56 $272.71 25126 T Remove/graft forearm lesion 0050 25.1166 $1,363.56 $272.71 25130 T Removal of wrist lesion 0050 25.1166 $1,363.56 $272.71 25135 T Remove & graft wrist lesion 0050 25.1166 $1,363.56 $272.71 25136 T Remove & graft wrist lesion 0050 25.1166 $1,363.56 $272.71 25145 T Remove forearm bone lesion 0050 25.1166 $1,363.56 $272.71 25150 T Partial removal of ulna 0050 25.1166 $1,363.56 $272.71 25151 T Partial removal of radius 0050 25.1166 $1,363.56 $272.71 25170 T Extensive forearm surgery 0052 42.6430 $2,315.05 $463.01 25210 T Removal of wrist bone 0054 24.2685 $1,317.51 $263.50 25215 T Removal of wrist bones 0054 24.2685 $1,317.51 $263.50 25230 T Partial removal of radius 0050 25.1166 $1,363.56 $272.71 25240 T Partial removal of ulna 0050 25.1166 $1,363.56 $272.71 25246 N Injection for wrist x-ray 25248 T Remove forearm foreign body 0049 19.9376 $1,082.39 $216.48 25250 T Removal of wrist prosthesis 0050 25.1166 $1,363.56 $272.71 25251 T Removal of wrist prosthesis 0050 25.1166 $1,363.56 $272.71 25259 T Manipulate wrist w/anesthes 0043 1.9233 $104.41 $20.88 25260 T Repair forearm tendon/muscle 0050 25.1166 $1,363.56 $272.71 25263 T Repair forearm tendon/muscle 0050 25.1166 $1,363.56 $272.71 25265 T Repair forearm tendon/muscle 0050 25.1166 $1,363.56 $272.71 25270 T Repair forearm tendon/muscle 0050 25.1166 $1,363.56 $272.71 25272 T Repair forearm tendon/muscle 0050 25.1166 $1,363.56 $272.71 25274 T Repair forearm tendon/muscle 0050 25.1166 $1,363.56 $272.71 25275 T Repair forearm tendon sheath 0050 25.1166 $1,363.56 $272.71 25280 T Revise wrist/forearm tendon 0050 25.1166 $1,363.56 $272.71 25290 T Incise wrist/forearm tendon 0050 25.1166 $1,363.56 $272.71 25295 T Release wrist/forearm tendon 0049 19.9376 $1,082.39 $216.48 25300 T Fusion of tendons at wrist 0050 25.1166 $1,363.56 $272.71 25301 T Fusion of tendons at wrist 0050 25.1166 $1,363.56 $272.71 25310 T Transplant forearm tendon 0051 34.9381 $1,896.75 $379.35 25312 T Transplant forearm tendon 0051 34.9381 $1,896.75 $379.35 25315 T Revise palsy hand tendon(s) 0051 34.9381 $1,896.75 $379.35 25316 T Revise palsy hand tendon(s) 0051 34.9381 $1,896.75 $379.35 25320 T Repair/revise wrist joint 0051 34.9381 $1,896.75 $379.35 25332 T Revise wrist joint 0047 30.3786 $1,649.22 $537.03 $329.84 25335 T Realignment of hand 0051 34.9381 $1,896.75 $379.35 25337 T Reconstruct ulna/radioulnar 0051 34.9381 $1,896.75 $379.35 25350 T Revision of radius 0051 34.9381 $1,896.75 $379.35 25355 T Revision of radius 0051 34.9381 $1,896.75 $379.35 Start Printed Page 48050 25360 T Revision of ulna 0050 25.1166 $1,363.56 $272.71 25365 T Revise radius & ulna 0050 25.1166 $1,363.56 $272.71 25370 T Revise radius or ulna 0051 34.9381 $1,896.75 $379.35 25375 T Revise radius & ulna 0051 34.9381 $1,896.75 $379.35 25390 T Shorten radius or ulna 0050 25.1166 $1,363.56 $272.71 25391 T Lengthen radius or ulna 0051 34.9381 $1,896.75 $379.35 25392 T Shorten radius & ulna 0050 25.1166 $1,363.56 $272.71 25393 T Lengthen radius & ulna 0051 34.9381 $1,896.75 $379.35 25394 T Repair carpal bone, shorten 0053 14.8188 $804.50 $253.49 $160.90 25400 T Repair radius or ulna 0050 25.1166 $1,363.56 $272.71 25405 T Repair/graft radius or ulna 0050 25.1166 $1,363.56 $272.71 25415 T Repair radius & ulna 0050 25.1166 $1,363.56 $272.71 25420 T Repair/graft radius & ulna 0051 34.9381 $1,896.75 $379.35 25425 T Repair/graft radius or ulna 0051 34.9381 $1,896.75 $379.35 25426 T Repair/graft radius & ulna 0051 34.9381 $1,896.75 $379.35 25430 T Vasc graft into carpal bone 0054 24.2685 $1,317.51 $263.50 25431 T Repair nonunion carpal bone 0054 24.2685 $1,317.51 $263.50 25440 T Repair/graft wrist bone 0051 34.9381 $1,896.75 $379.35 25441 T Reconstruct wrist joint 0048 47.4707 $2,577.14 $695.60 $515.43 25442 T Reconstruct wrist joint 0048 47.4707 $2,577.14 $695.60 $515.43 25443 T Reconstruct wrist joint 0048 47.4707 $2,577.14 $695.60 $515.43 25444 T Reconstruct wrist joint 0048 47.4707 $2,577.14 $695.60 $515.43 25445 T Reconstruct wrist joint 0048 47.4707 $2,577.14 $695.60 $515.43 25446 T Wrist replacement 0048 47.4707 $2,577.14 $695.60 $515.43 25447 T Repair wrist joint(s) 0047 30.3786 $1,649.22 $537.03 $329.84 25449 T Remove wrist joint implant 0047 30.3786 $1,649.22 $537.03 $329.84 25450 T Revision of wrist joint 0051 34.9381 $1,896.75 $379.35 25455 T Revision of wrist joint 0051 34.9381 $1,896.75 $379.35 25490 T Reinforce radius 0051 34.9381 $1,896.75 $379.35 25491 T Reinforce ulna 0051 34.9381 $1,896.75 $379.35 25492 T Reinforce radius and ulna 0051 34.9381 $1,896.75 $379.35 25500 T Treat fracture of radius 0043 1.9233 $104.41 $20.88 25505 T Treat fracture of radius 0043 1.9233 $104.41 $20.88 25515 T Treat fracture of radius 0046 31.9719 $1,735.72 $535.76 $347.14 25520 T Treat fracture of radius 0043 1.9233 $104.41 $20.88 25525 T Treat fracture of radius 0046 31.9719 $1,735.72 $535.76 $347.14 25526 T Treat fracture of radius 0046 31.9719 $1,735.72 $535.76 $347.14 25530 T Treat fracture of ulna 0043 1.9233 $104.41 $20.88 25535 T Treat fracture of ulna 0043 1.9233 $104.41 $20.88 25545 T Treat fracture of ulna 0046 31.9719 $1,735.72 $535.76 $347.14 25560 T Treat fracture radius & ulna 0043 1.9233 $104.41 $20.88 25565 T Treat fracture radius & ulna 0043 1.9233 $104.41 $20.88 25574 T Treat fracture radius & ulna 0046 31.9719 $1,735.72 $535.76 $347.14 25575 T Treat fracture radius/ulna 0046 31.9719 $1,735.72 $535.76 $347.14 25600 T Treat fracture radius/ulna 0043 1.9233 $104.41 $20.88 25605 T Treat fracture radius/ulna 0043 1.9233 $104.41 $20.88 25611 T Treat fracture radius/ulna 0046 31.9719 $1,735.72 $535.76 $347.14 25620 T Treat fracture radius/ulna 0046 31.9719 $1,735.72 $535.76 $347.14 25622 T Treat wrist bone fracture 0043 1.9233 $104.41 $20.88 25624 T Treat wrist bone fracture 0043 1.9233 $104.41 $20.88 25628 T Treat wrist bone fracture 0046 31.9719 $1,735.72 $535.76 $347.14 25630 T Treat wrist bone fracture 0043 1.9233 $104.41 $20.88 25635 T Treat wrist bone fracture 0043 1.9233 $104.41 $20.88 25645 T Treat wrist bone fracture 0046 31.9719 $1,735.72 $535.76 $347.14 25650 T Treat wrist bone fracture 0043 1.9233 $104.41 $20.88 25651 T Pin ulnar styloid fracture 0046 31.9719 $1,735.72 $535.76 $347.14 25652 T Treat fracture ulnar styloid 0046 31.9719 $1,735.72 $535.76 $347.14 25660 T Treat wrist dislocation 0043 1.9233 $104.41 $20.88 25670 T Treat wrist dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 25671 T Pin radioulnar dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 25675 T Treat wrist dislocation 0043 1.9233 $104.41 $20.88 25676 T Treat wrist dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 25680 T Treat wrist fracture 0043 1.9233 $104.41 $20.88 25685 T Treat wrist fracture 0046 31.9719 $1,735.72 $535.76 $347.14 25690 T Treat wrist dislocation 0043 1.9233 $104.41 $20.88 25695 T Treat wrist dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 Start Printed Page 48051 25800 T Fusion of wrist joint 0051 34.9381 $1,896.75 $379.35 25805 T Fusion/graft of wrist joint 0051 34.9381 $1,896.75 $379.35 25810 T Fusion/graft of wrist joint 0051 34.9381 $1,896.75 $379.35 25820 T Fusion of hand bones 0053 14.8188 $804.50 $253.49 $160.90 25825 T Fuse hand bones with graft 0054 24.2685 $1,317.51 $263.50 25830 T Fusion, radioulnar jnt/ulna 0051 34.9381 $1,896.75 $379.35 25900 C Amputation of forearm 25905 C Amputation of forearm 25907 T Amputation follow-up surgery 0049 19.9376 $1,082.39 $216.48 25909 C Amputation follow-up surgery 25915 C Amputation of forearm 25920 C Amputate hand at wrist 25922 T Amputate hand at wrist 0049 19.9376 $1,082.39 $216.48 25924 C Amputation follow-up surgery 25927 C Amputation of hand 25929 T Amputation follow-up surgery 0027 15.8319 $859.50 $329.72 $171.90 25931 C Amputation follow-up surgery 25999 T Forearm or wrist surgery 0043 1.9233 $104.41 $20.88 26010 T Drainage of finger abscess 0006 1.7487 $94.94 $24.12 $18.99 26011 T Drainage of finger abscess 0007 11.4943 $624.01 $124.80 26020 T Drain hand tendon sheath 0053 14.8188 $804.50 $253.49 $160.90 26025 T Drainage of palm bursa 0053 14.8188 $804.50 $253.49 $160.90 26030 T Drainage of palm bursa(s) 0053 14.8188 $804.50 $253.49 $160.90 26034 T Treat hand bone lesion 0053 14.8188 $804.50 $253.49 $160.90 26035 T Decompress fingers/hand 0053 14.8188 $804.50 $253.49 $160.90 26037 T Decompress fingers/hand 0053 14.8188 $804.50 $253.49 $160.90 26040 T Release palm contracture 0054 24.2685 $1,317.51 $263.50 26045 T Release palm contracture 0054 24.2685 $1,317.51 $263.50 26055 T Incise finger tendon sheath 0053 14.8188 $804.50 $253.49 $160.90 26060 T Incision of finger tendon 0053 14.8188 $804.50 $253.49 $160.90 26070 T Explore/treat hand joint 0053 14.8188 $804.50 $253.49 $160.90 26075 T Explore/treat finger joint 0053 14.8188 $804.50 $253.49 $160.90 26080 T Explore/treat finger joint 0053 14.8188 $804.50 $253.49 $160.90 26100 T Biopsy hand joint lining 0053 14.8188 $804.50 $253.49 $160.90 26105 T Biopsy finger joint lining 0053 14.8188 $804.50 $253.49 $160.90 26110 T Biopsy finger joint lining 0053 14.8188 $804.50 $253.49 $160.90 26115 T Removel hand lesion subcut 0022 18.6725 $1,013.71 $354.45 $202.74 26116 T Removel hand lesion, deep 0022 18.6725 $1,013.71 $354.45 $202.74 26117 T Remove tumor, hand/finger 0022 18.6725 $1,013.71 $354.45 $202.74 26121 T Release palm contracture 0054 24.2685 $1,317.51 $263.50 26123 T Release palm contracture 0054 24.2685 $1,317.51 $263.50 26125 T Release palm contracture 0054 24.2685 $1,317.51 $263.50 26130 T Remove wrist joint lining 0053 14.8188 $804.50 $253.49 $160.90 26135 T Revise finger joint, each 0054 24.2685 $1,317.51 $263.50 26140 T Revise finger joint, each 0053 14.8188 $804.50 $253.49 $160.90 26145 T Tendon excision, palm/finger 0053 14.8188 $804.50 $253.49 $160.90 26160 T Remove tendon sheath lesion 0053 14.8188 $804.50 $253.49 $160.90 26170 T Removal of palm tendon, each 0053 14.8188 $804.50 $253.49 $160.90 26180 T Removal of finger tendon 0053 14.8188 $804.50 $253.49 $160.90 26185 T Remove finger bone 0053 14.8188 $804.50 $253.49 $160.90 26200 T Remove hand bone lesion 0053 14.8188 $804.50 $253.49 $160.90 26205 T Remove/graft bone lesion 0054 24.2685 $1,317.51 $263.50 26210 T Removal of finger lesion 0053 14.8188 $804.50 $253.49 $160.90 26215 T Remove/graft finger lesion 0053 14.8188 $804.50 $253.49 $160.90 26230 T Partial removal of hand bone 0053 14.8188 $804.50 $253.49 $160.90 26235 T Partial removal, finger bone 0053 14.8188 $804.50 $253.49 $160.90 26236 T Partial removal, finger bone 0053 14.8188 $804.50 $253.49 $160.90 26250 T Extensive hand surgery 0053 14.8188 $804.50 $253.49 $160.90 26255 T Extensive hand surgery 0054 24.2685 $1,317.51 $263.50 26260 T Extensive finger surgery 0053 14.8188 $804.50 $253.49 $160.90 26261 T Extensive finger surgery 0053 14.8188 $804.50 $253.49 $160.90 26262 T Partial removal of finger 0053 14.8188 $804.50 $253.49 $160.90 26320 T Removal of implant from hand 0021 14.5749 $791.26 $219.48 $158.25 26340 T Manipulate finger w/anesth 0043 1.9233 $104.41 $20.88 26350 T Repair finger/hand tendon 0054 24.2685 $1,317.51 $263.50 26352 T Repair/graft hand tendon 0054 24.2685 $1,317.51 $263.50 Start Printed Page 48052 26356 T Repair finger/hand tendon 0054 24.2685 $1,317.51 $263.50 26357 T Repair finger/hand tendon 0054 24.2685 $1,317.51 $263.50 26358 T Repair/graft hand tendon 0054 24.2685 $1,317.51 $263.50 26370 T Repair finger/hand tendon 0054 24.2685 $1,317.51 $263.50 26372 T Repair/graft hand tendon 0054 24.2685 $1,317.51 $263.50 26373 T Repair finger/hand tendon 0054 24.2685 $1,317.51 $263.50 26390 T Revise hand/finger tendon 0054 24.2685 $1,317.51 $263.50 26392 T Repair/graft hand tendon 0054 24.2685 $1,317.51 $263.50 26410 T Repair hand tendon 0053 14.8188 $804.50 $253.49 $160.90 26412 T Repair/graft hand tendon 0054 24.2685 $1,317.51 $263.50 26415 T Excision, hand/finger tendon 0054 24.2685 $1,317.51 $263.50 26416 T Graft hand or finger tendon 0054 24.2685 $1,317.51 $263.50 26418 T Repair finger tendon 0053 14.8188 $804.50 $253.49 $160.90 26420 T Repair/graft finger tendon 0054 24.2685 $1,317.51 $263.50 26426 T Repair finger/hand tendon 0054 24.2685 $1,317.51 $263.50 26428 T Repair/graft finger tendon 0054 24.2685 $1,317.51 $263.50 26432 T Repair finger tendon 0053 14.8188 $804.50 $253.49 $160.90 26433 T Repair finger tendon 0053 14.8188 $804.50 $253.49 $160.90 26434 T Repair/graft finger tendon 0054 24.2685 $1,317.51 $263.50 26437 T Realignment of tendons 0053 14.8188 $804.50 $253.49 $160.90 26440 T Release palm/finger tendon 0053 14.8188 $804.50 $253.49 $160.90 26442 T Release palm & finger tendon 0054 24.2685 $1,317.51 $263.50 26445 T Release hand/finger tendon 0053 14.8188 $804.50 $253.49 $160.90 26449 T Release forearm/hand tendon 0054 24.2685 $1,317.51 $263.50 26450 T Incision of palm tendon 0053 14.8188 $804.50 $253.49 $160.90 26455 T Incision of finger tendon 0053 14.8188 $804.50 $253.49 $160.90 26460 T Incise hand/finger tendon 0053 14.8188 $804.50 $253.49 $160.90 26471 T Fusion of finger tendons 0053 14.8188 $804.50 $253.49 $160.90 26474 T Fusion of finger tendons 0053 14.8188 $804.50 $253.49 $160.90 26476 T Tendon lengthening 0053 14.8188 $804.50 $253.49 $160.90 26477 T Tendon shortening 0053 14.8188 $804.50 $253.49 $160.90 26478 T Lengthening of hand tendon 0053 14.8188 $804.50 $253.49 $160.90 26479 T Shortening of hand tendon 0053 14.8188 $804.50 $253.49 $160.90 26480 T Transplant hand tendon 0054 24.2685 $1,317.51 $263.50 26483 T Transplant/graft hand tendon 0054 24.2685 $1,317.51 $263.50 26485 T Transplant palm tendon 0054 24.2685 $1,317.51 $263.50 26489 T Transplant/graft palm tendon 0054 24.2685 $1,317.51 $263.50 26490 T Revise thumb tendon 0054 24.2685 $1,317.51 $263.50 26492 T Tendon transfer with graft 0054 24.2685 $1,317.51 $263.50 26494 T Hand tendon/muscle transfer 0054 24.2685 $1,317.51 $263.50 26496 T Revise thumb tendon 0054 24.2685 $1,317.51 $263.50 26497 T Finger tendon transfer 0054 24.2685 $1,317.51 $263.50 26498 T Finger tendon transfer 0054 24.2685 $1,317.51 $263.50 26499 T Revision of finger 0054 24.2685 $1,317.51 $263.50 26500 T Hand tendon reconstruction 0053 14.8188 $804.50 $253.49 $160.90 26502 T Hand tendon reconstruction 0054 24.2685 $1,317.51 $263.50 26504 T Hand tendon reconstruction 0054 24.2685 $1,317.51 $263.50 26508 T Release thumb contracture 0053 14.8188 $804.50 $253.49 $160.90 26510 T Thumb tendon transfer 0054 24.2685 $1,317.51 $263.50 26516 T Fusion of knuckle joint 0054 24.2685 $1,317.51 $263.50 26517 T Fusion of knuckle joints 0054 24.2685 $1,317.51 $263.50 26518 T Fusion of knuckle joints 0054 24.2685 $1,317.51 $263.50 26520 T Release knuckle contracture 0053 14.8188 $804.50 $253.49 $160.90 26525 T Release finger contracture 0053 14.8188 $804.50 $253.49 $160.90 26530 T Revise knuckle joint 0047 30.3786 $1,649.22 $537.03 $329.84 26531 T Revise knuckle with implant 0048 47.4707 $2,577.14 $695.60 $515.43 26535 T Revise finger joint 0047 30.3786 $1,649.22 $537.03 $329.84 26536 T Revise/implant finger joint 0048 47.4707 $2,577.14 $695.60 $515.43 26540 T Repair hand joint 0053 14.8188 $804.50 $253.49 $160.90 26541 T Repair hand joint with graft 0054 24.2685 $1,317.51 $263.50 26542 T Repair hand joint with graft 0053 14.8188 $804.50 $253.49 $160.90 26545 T Reconstruct finger joint 0054 24.2685 $1,317.51 $263.50 26546 T Repair nonunion hand 0054 24.2685 $1,317.51 $263.50 26548 T Reconstruct finger joint 0054 24.2685 $1,317.51 $263.50 26550 T Construct thumb replacement 0054 24.2685 $1,317.51 $263.50 26551 C Great toe-hand transfer Start Printed Page 48053 26553 C Single transfer, toe-hand 26554 C Double transfer, toe-hand 26555 T Positional change of finger 0054 24.2685 $1,317.51 $263.50 26556 C Toe joint transfer 26560 T Repair of web finger 0053 14.8188 $804.50 $253.49 $160.90 26561 T Repair of web finger 0054 24.2685 $1,317.51 $263.50 26562 T Repair of web finger 0054 24.2685 $1,317.51 $263.50 26565 T Correct metacarpal flaw 0054 24.2685 $1,317.51 $263.50 26567 T Correct finger deformity 0054 24.2685 $1,317.51 $263.50 26568 T Lengthen metacarpal/finger 0054 24.2685 $1,317.51 $263.50 26580 T Repair hand deformity 0054 24.2685 $1,317.51 $263.50 26587 T Reconstruct extra finger 0053 14.8188 $804.50 $253.49 $160.90 26590 T Repair finger deformity 0054 24.2685 $1,317.51 $263.50 26591 T Repair muscles of hand 0054 24.2685 $1,317.51 $263.50 26593 T Release muscles of hand 0053 14.8188 $804.50 $253.49 $160.90 26596 T Excision constricting tissue 0054 24.2685 $1,317.51 $263.50 26600 T Treat metacarpal fracture 0043 1.9233 $104.41 $20.88 26605 T Treat metacarpal fracture 0043 1.9233 $104.41 $20.88 26607 T Treat metacarpal fracture 0043 1.9233 $104.41 $20.88 26608 T Treat metacarpal fracture 0046 31.9719 $1,735.72 $535.76 $347.14 26615 T Treat metacarpal fracture 0046 31.9719 $1,735.72 $535.76 $347.14 26641 T Treat thumb dislocation 0043 1.9233 $104.41 $20.88 26645 T Treat thumb fracture 0043 1.9233 $104.41 $20.88 26650 T Treat thumb fracture 0046 31.9719 $1,735.72 $535.76 $347.14 26665 T Treat thumb fracture 0046 31.9719 $1,735.72 $535.76 $347.14 26670 T Treat hand dislocation 0043 1.9233 $104.41 $20.88 26675 T Treat hand dislocation 0043 1.9233 $104.41 $20.88 26676 T Pin hand dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 26685 T Treat hand dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 26686 T Treat hand dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 26700 T Treat knuckle dislocation 0043 1.9233 $104.41 $20.88 26705 T Treat knuckle dislocation 0043 1.9233 $104.41 $20.88 26706 T Pin knuckle dislocation 0043 1.9233 $104.41 $20.88 26715 T Treat knuckle dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 26720 T Treat finger fracture, each 0043 1.9233 $104.41 $20.88 26725 T Treat finger fracture, each 0043 1.9233 $104.41 $20.88 26727 T Treat finger fracture, each 0046 31.9719 $1,735.72 $535.76 $347.14 26735 T Treat finger fracture, each 0046 31.9719 $1,735.72 $535.76 $347.14 26740 T Treat finger fracture, each 0043 1.9233 $104.41 $20.88 26742 T Treat finger fracture, each 0043 1.9233 $104.41 $20.88 26746 T Treat finger fracture, each 0046 31.9719 $1,735.72 $535.76 $347.14 26750 T Treat finger fracture, each 0043 1.9233 $104.41 $20.88 26755 T Treat finger fracture, each 0043 1.9233 $104.41 $20.88 26756 T Pin finger fracture, each 0046 31.9719 $1,735.72 $535.76 $347.14 26765 T Treat finger fracture, each 0046 31.9719 $1,735.72 $535.76 $347.14 26770 T Treat finger dislocation 0043 1.9233 $104.41 $20.88 26775 T Treat finger dislocation 0045 13.5546 $735.87 $268.47 $147.17 26776 T Pin finger dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 26785 T Treat finger dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 26820 T Thumb fusion with graft 0054 24.2685 $1,317.51 $263.50 26841 T Fusion of thumb 0054 24.2685 $1,317.51 $263.50 26842 T Thumb fusion with graft 0054 24.2685 $1,317.51 $263.50 26843 T Fusion of hand joint 0054 24.2685 $1,317.51 $263.50 26844 T Fusion/graft of hand joint 0054 24.2685 $1,317.51 $263.50 26850 T Fusion of knuckle 0054 24.2685 $1,317.51 $263.50 26852 T Fusion of knuckle with graft 0054 24.2685 $1,317.51 $263.50 26860 T Fusion of finger joint 0054 24.2685 $1,317.51 $263.50 26861 T Fusion of finger jnt, add-on 0054 24.2685 $1,317.51 $263.50 26862 T Fusion/graft of finger joint 0054 24.2685 $1,317.51 $263.50 26863 T Fuse/graft added joint 0054 24.2685 $1,317.51 $263.50 26910 T Amputate metacarpal bone 0054 24.2685 $1,317.51 $263.50 26951 T Amputation of finger/thumb 0053 14.8188 $804.50 $253.49 $160.90 26952 T Amputation of finger/thumb 0053 14.8188 $804.50 $253.49 $160.90 26989 T Hand/finger surgery 0043 1.9233 $104.41 $20.88 26990 T Drainage of pelvis lesion 0049 19.9376 $1,082.39 $216.48 26991 T Drainage of pelvis bursa 0049 19.9376 $1,082.39 $216.48 Start Printed Page 48054 26992 C Drainage of bone lesion 27000 T Incision of hip tendon 0049 19.9376 $1,082.39 $216.48 27001 T Incision of hip tendon 0050 25.1166 $1,363.56 $272.71 27003 T Incision of hip tendon 0050 25.1166 $1,363.56 $272.71 27005 C Incision of hip tendon 27006 C Incision of hip tendons 27025 C Incision of hip/thigh fascia 27030 C Drainage of hip joint 27033 T Exploration of hip joint 0051 34.9381 $1,896.75 $379.35 27035 T Denervation of hip joint 0052 42.6430 $2,315.05 $463.01 27036 C Excision of hip joint/muscle 27040 T Biopsy of soft tissues 0021 14.5749 $791.26 $219.48 $158.25 27041 T Biopsy of soft tissues 0022 18.6725 $1,013.71 $354.45 $202.74 27047 T Remove hip/pelvis lesion 0022 18.6725 $1,013.71 $354.45 $202.74 27048 T Remove hip/pelvis lesion 0022 18.6725 $1,013.71 $354.45 $202.74 27049 T Remove tumor, hip/pelvis 0022 18.6725 $1,013.71 $354.45 $202.74 27050 T Biopsy of sacroiliac joint 0049 19.9376 $1,082.39 $216.48 27052 T Biopsy of hip joint 0049 19.9376 $1,082.39 $216.48 27054 C Removal of hip joint lining 27060 T Removal of ischial bursa 0049 19.9376 $1,082.39 $216.48 27062 T Remove femur lesion/bursa 0049 19.9376 $1,082.39 $216.48 27065 T Removal of hip bone lesion 0049 19.9376 $1,082.39 $216.48 27066 T Removal of hip bone lesion 0050 25.1166 $1,363.56 $272.71 27067 T Remove/graft hip bone lesion 0050 25.1166 $1,363.56 $272.71 27070 C Partial removal of hip bone 27071 C Partial removal of hip bone 27075 C Extensive hip surgery 27076 C Extensive hip surgery 27077 C Extensive hip surgery 27078 C Extensive hip surgery 27079 C Extensive hip surgery 27080 T Removal of tail bone 0050 25.1166 $1,363.56 $272.71 27086 T Remove hip foreign body 0020 7.3105 $396.88 $113.25 $79.38 27087 T Remove hip foreign body 0049 19.9376 $1,082.39 $216.48 27090 C Removal of hip prosthesis 27091 C Removal of hip prosthesis 27093 N Injection for hip x-ray 27095 N Injection for hip x-ray 27096 E Inject sacroiliac joint 27097 T Revision of hip tendon 0050 25.1166 $1,363.56 $272.71 27098 T Transfer tendon to pelvis 0050 25.1166 $1,363.56 $272.71 27100 T Transfer of abdominal muscle 0051 34.9381 $1,896.75 $379.35 27105 T Transfer of spinal muscle 0051 34.9381 $1,896.75 $379.35 27110 T Transfer of iliopsoas muscle 0051 34.9381 $1,896.75 $379.35 27111 T Transfer of iliopsoas muscle 0051 34.9381 $1,896.75 $379.35 27120 C Reconstruction of hip socket 27122 C Reconstruction of hip socket 27125 C Partial hip replacement 27130 C Total hip arthroplasty 27132 C Total hip arthroplasty 27134 C Revise hip joint replacement 27137 C Revise hip joint replacement 27138 C Revise hip joint replacement 27140 C Transplant femur ridge 27146 C Incision of hip bone 27147 C Revision of hip bone 27151 C Incision of hip bones 27156 C Revision of hip bones 27158 C Revision of pelvis 27161 C Incision of neck of femur 27165 C Incision/fixation of femur 27170 C Repair/graft femur head/neck 27175 C Treat slipped epiphysis 27176 C Treat slipped epiphysis 27177 C Treat slipped epiphysis 27178 C Treat slipped epiphysis Start Printed Page 48055 27179 C Revise head/neck of femur 27181 C Treat slipped epiphysis 27185 C Revision of femur epiphysis 27187 C Reinforce hip bones 27193 T Treat pelvic ring fracture 0043 1.9233 $104.41 $20.88 27194 T Treat pelvic ring fracture 0045 13.5546 $735.87 $268.47 $147.17 27200 T Treat tail bone fracture 0043 1.9233 $104.41 $20.88 27202 T Treat tail bone fracture 0046 31.9719 $1,735.72 $535.76 $347.14 27215 C Treat pelvic fracture(s) 27216 T Treat pelvic ring fracture 0050 25.1166 $1,363.56 $272.71 27217 C Treat pelvic ring fracture 27218 C Treat pelvic ring fracture 27220 T Treat hip socket fracture 0043 1.9233 $104.41 $20.88 27222 C Treat hip socket fracture 27226 C Treat hip wall fracture 27227 C Treat hip fracture(s) 27228 C Treat hip fracture(s) 27230 T Treat thigh fracture 0043 1.9233 $104.41 $20.88 27232 C Treat thigh fracture 27235 T Treat thigh fracture 0050 25.1166 $1,363.56 $272.71 27236 C Treat thigh fracture 27238 T Treat thigh fracture 0043 1.9233 $104.41 $20.88 27240 C Treat thigh fracture 27244 C Treat thigh fracture 27245 C Treat thigh fracture 27246 T Treat thigh fracture 0043 1.9233 $104.41 $20.88 27248 C Treat thigh fracture 27250 T Treat hip dislocation 0043 1.9233 $104.41 $20.88 27252 T Treat hip dislocation 0045 13.5546 $735.87 $268.47 $147.17 27253 C Treat hip dislocation 27254 C Treat hip dislocation 27256 T Treat hip dislocation 0043 1.9233 $104.41 $20.88 27257 T Treat hip dislocation 0045 13.5546 $735.87 $268.47 $147.17 27258 C Treat hip dislocation 27259 C Treat hip dislocation 27265 T Treat hip dislocation 0043 1.9233 $104.41 $20.88 27266 T Treat hip dislocation 0045 13.5546 $735.87 $268.47 $147.17 27275 T Manipulation of hip joint 0045 13.5546 $735.87 $268.47 $147.17 27280 C Fusion of sacroiliac joint 27282 C Fusion of pubic bones 27284 C Fusion of hip joint 27286 C Fusion of hip joint 27290 C Amputation of leg at hip 27295 C Amputation of leg at hip 27299 T Pelvis/hip joint surgery 0043 1.9233 $104.41 $20.88 27301 T Drain thigh/knee lesion 0008 16.8303 $913.70 $182.74 27303 C Drainage of bone lesion 27305 T Incise thigh tendon & fascia 0049 19.9376 $1,082.39 $216.48 27306 T Incision of thigh tendon 0049 19.9376 $1,082.39 $216.48 27307 T Incision of thigh tendons 0049 19.9376 $1,082.39 $216.48 27310 T Exploration of knee joint 0050 25.1166 $1,363.56 $272.71 27315 T Partial removal, thigh nerve 0220 16.5293 $897.36 $179.47 27320 T Partial removal, thigh nerve 0220 16.5293 $897.36 $179.47 27323 T Biopsy, thigh soft tissues 0021 14.5749 $791.26 $219.48 $158.25 27324 T Biopsy, thigh soft tissues 0022 18.6725 $1,013.71 $354.45 $202.74 27327 T Removal of thigh lesion 0022 18.6725 $1,013.71 $354.45 $202.74 27328 T Removal of thigh lesion 0022 18.6725 $1,013.71 $354.45 $202.74 27329 T Remove tumor, thigh/knee 0022 18.6725 $1,013.71 $354.45 $202.74 27330 T Biopsy, knee joint lining 0050 25.1166 $1,363.56 $272.71 27331 T Explore/treat knee joint 0050 25.1166 $1,363.56 $272.71 27332 T Removal of knee cartilage 0050 25.1166 $1,363.56 $272.71 27333 T Removal of knee cartilage 0050 25.1166 $1,363.56 $272.71 27334 T Remove knee joint lining 0050 25.1166 $1,363.56 $272.71 27335 T Remove knee joint lining 0050 25.1166 $1,363.56 $272.71 27340 T Removal of kneecap bursa 0049 19.9376 $1,082.39 $216.48 27345 T Removal of knee cyst 0049 19.9376 $1,082.39 $216.48 Start Printed Page 48056 27347 T Remove knee cyst 0049 19.9376 $1,082.39 $216.48 27350 T Removal of kneecap 0050 25.1166 $1,363.56 $272.71 27355 T Remove femur lesion 0050 25.1166 $1,363.56 $272.71 27356 T Remove femur lesion/graft 0050 25.1166 $1,363.56 $272.71 27357 T Remove femur lesion/graft 0050 25.1166 $1,363.56 $272.71 27358 T Remove femur lesion/fixation 0050 25.1166 $1,363.56 $272.71 27360 T Partial removal, leg bone(s) 0050 25.1166 $1,363.56 $272.71 27365 C Extensive leg surgery 27370 N Injection for knee x-ray 27372 T Removal of foreign body 0022 18.6725 $1,013.71 $354.45 $202.74 27380 T Repair of kneecap tendon 0049 19.9376 $1,082.39 $216.48 27381 T Repair/graft kneecap tendon 0049 19.9376 $1,082.39 $216.48 27385 T Repair of thigh muscle 0049 19.9376 $1,082.39 $216.48 27386 T Repair/graft of thigh muscle 0049 19.9376 $1,082.39 $216.48 27390 T Incision of thigh tendon 0049 19.9376 $1,082.39 $216.48 27391 T Incision of thigh tendons 0049 19.9376 $1,082.39 $216.48 27392 T Incision of thigh tendons 0049 19.9376 $1,082.39 $216.48 27393 T Lengthening of thigh tendon 0050 25.1166 $1,363.56 $272.71 27394 T Lengthening of thigh tendons 0050 25.1166 $1,363.56 $272.71 27395 T Lengthening of thigh tendons 0051 34.9381 $1,896.75 $379.35 27396 T Transplant of thigh tendon 0050 25.1166 $1,363.56 $272.71 27397 T Transplants of thigh tendons 0051 34.9381 $1,896.75 $379.35 27400 T Revise thigh muscles/tendons 0051 34.9381 $1,896.75 $379.35 27403 T Repair of knee cartilage 0050 25.1166 $1,363.56 $272.71 27405 T Repair of knee ligament 0051 34.9381 $1,896.75 $379.35 27407 T Repair of knee ligament 0051 34.9381 $1,896.75 $379.35 27409 T Repair of knee ligaments 0051 34.9381 $1,896.75 $379.35 27418 T Repair degenerated kneecap 0051 34.9381 $1,896.75 $379.35 27420 T Revision of unstable kneecap 0051 34.9381 $1,896.75 $379.35 27422 T Revision of unstable kneecap 0051 34.9381 $1,896.75 $379.35 27424 T Revision/removal of kneecap 0051 34.9381 $1,896.75 $379.35 27425 T Lateral retinacular release 0050 25.1166 $1,363.56 $272.71 27427 T Reconstruction, knee 0052 42.6430 $2,315.05 $463.01 27428 T Reconstruction, knee 0052 42.6430 $2,315.05 $463.01 27429 T Reconstruction, knee 0052 42.6430 $2,315.05 $463.01 27430 T Revision of thigh muscles 0051 34.9381 $1,896.75 $379.35 27435 T Incision of knee joint 0051 34.9381 $1,896.75 $379.35 27437 T Revise kneecap 0047 30.3786 $1,649.22 $537.03 $329.84 27438 T Revise kneecap with implant 0048 47.4707 $2,577.14 $695.60 $515.43 27440 T Revision of knee joint 0047 30.3786 $1,649.22 $537.03 $329.84 27441 T Revision of knee joint 0047 30.3786 $1,649.22 $537.03 $329.84 27442 T Revision of knee joint 0047 30.3786 $1,649.22 $537.03 $329.84 27443 T Revision of knee joint 0047 30.3786 $1,649.22 $537.03 $329.84 27445 C Revision of knee joint 27446 T Revision of knee joint 0681 96.7483 $5,252.37 $2,090.21 $1,050.47 27447 C Total knee arthroplasty 27448 C Incision of thigh 27450 C Incision of thigh 27454 C Realignment of thigh bone 27455 C Realignment of knee 27457 C Realignment of knee 27465 C Shortening of thigh bone 27466 C Lengthening of thigh bone 27468 C Shorten/lengthen thighs 27470 C Repair of thigh 27472 C Repair/graft of thigh 27475 C Surgery to stop leg growth 27477 C Surgery to stop leg growth 27479 C Surgery to stop leg growth 27485 C Surgery to stop leg growth 27486 C Revise/replace knee joint 27487 C Revise/replace knee joint 27488 C Removal of knee prosthesis 27495 C Reinforce thigh 27496 T Decompression of thigh/knee 0049 19.9376 $1,082.39 $216.48 27497 T Decompression of thigh/knee 0049 19.9376 $1,082.39 $216.48 Start Printed Page 48057 27498 T Decompression of thigh/knee 0049 19.9376 $1,082.39 $216.48 27499 T Decompression of thigh/knee 0049 19.9376 $1,082.39 $216.48 27500 T Treatment of thigh fracture 0043 1.9233 $104.41 $20.88 27501 T Treatment of thigh fracture 0043 1.9233 $104.41 $20.88 27502 T Treatment of thigh fracture 0043 1.9233 $104.41 $20.88 27503 T Treatment of thigh fracture 0043 1.9233 $104.41 $20.88 27506 C Treatment of thigh fracture 27507 C Treatment of thigh fracture 27508 T Treatment of thigh fracture 0043 1.9233 $104.41 $20.88 27509 T Treatment of thigh fracture 0046 31.9719 $1,735.72 $535.76 $347.14 27510 T Treatment of thigh fracture 0043 1.9233 $104.41 $20.88 27511 C Treatment of thigh fracture 27513 C Treatment of thigh fracture 27514 C Treatment of thigh fracture 27516 T Treat thigh fx growth plate 0043 1.9233 $104.41 $20.88 27517 T Treat thigh fx growth plate 0043 1.9233 $104.41 $20.88 27519 C Treat thigh fx growth plate 27520 T Treat kneecap fracture 0043 1.9233 $104.41 $20.88 27524 T Treat kneecap fracture 0046 31.9719 $1,735.72 $535.76 $347.14 27530 T Treat knee fracture 0043 1.9233 $104.41 $20.88 27532 T Treat knee fracture 0043 1.9233 $104.41 $20.88 27535 C Treat knee fracture 27536 C Treat knee fracture 27538 T Treat knee fracture(s) 0043 1.9233 $104.41 $20.88 27540 C Treat knee fracture 27550 T Treat knee dislocation 0043 1.9233 $104.41 $20.88 27552 T Treat knee dislocation 0045 13.5546 $735.87 $268.47 $147.17 27556 C Treat knee dislocation 27557 C Treat knee dislocation 27558 C Treat knee dislocation 27560 T Treat kneecap dislocation 0043 1.9233 $104.41 $20.88 27562 T Treat kneecap dislocation 0045 13.5546 $735.87 $268.47 $147.17 27566 T Treat kneecap dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 27570 T Fixation of knee joint 0045 13.5546 $735.87 $268.47 $147.17 27580 C Fusion of knee 27590 C Amputate leg at thigh 27591 C Amputate leg at thigh 27592 C Amputate leg at thigh 27594 T Amputation follow-up surgery 0049 19.9376 $1,082.39 $216.48 27596 C Amputation follow-up surgery 27598 C Amputate lower leg at knee 27599 T Leg surgery procedure 0043 1.9233 $104.41 $20.88 27600 T Decompression of lower leg 0049 19.9376 $1,082.39 $216.48 27601 T Decompression of lower leg 0049 19.9376 $1,082.39 $216.48 27602 T Decompression of lower leg 0049 19.9376 $1,082.39 $216.48 27603 T Drain lower leg lesion 0008 16.8303 $913.70 $182.74 27604 T Drain lower leg bursa 0049 19.9376 $1,082.39 $216.48 27605 T Incision of achilles tendon 0055 18.8851 $1,025.25 $355.34 $205.05 27606 T Incision of achilles tendon 0049 19.9376 $1,082.39 $216.48 27607 T Treat lower leg bone lesion 0049 19.9376 $1,082.39 $216.48 27610 T Explore/treat ankle joint 0050 25.1166 $1,363.56 $272.71 27612 T Exploration of ankle joint 0050 25.1166 $1,363.56 $272.71 27613 T Biopsy lower leg soft tissue 0020 7.3105 $396.88 $113.25 $79.38 27614 T Biopsy lower leg soft tissue 0022 18.6725 $1,013.71 $354.45 $202.74 27615 T Remove tumor, lower leg 0046 31.9719 $1,735.72 $535.76 $347.14 27618 T Remove lower leg lesion 0021 14.5749 $791.26 $219.48 $158.25 27619 T Remove lower leg lesion 0022 18.6725 $1,013.71 $354.45 $202.74 27620 T Explore/treat ankle joint 0050 25.1166 $1,363.56 $272.71 27625 T Remove ankle joint lining 0050 25.1166 $1,363.56 $272.71 27626 T Remove ankle joint lining 0050 25.1166 $1,363.56 $272.71 27630 T Removal of tendon lesion 0049 19.9376 $1,082.39 $216.48 27635 T Remove lower leg bone lesion 0050 25.1166 $1,363.56 $272.71 27637 T Remove/graft leg bone lesion 0050 25.1166 $1,363.56 $272.71 27638 T Remove/graft leg bone lesion 0050 25.1166 $1,363.56 $272.71 27640 T Partial removal of tibia 0051 34.9381 $1,896.75 $379.35 27641 T Partial removal of fibula 0050 25.1166 $1,363.56 $272.71 Start Printed Page 48058 27645 C Extensive lower leg surgery 27646 C Extensive lower leg surgery 27647 T Extensive ankle/heel surgery 0051 34.9381 $1,896.75 $379.35 27648 N Injection for ankle x-ray 27650 T Repair achilles tendon 0051 34.9381 $1,896.75 $379.35 27652 T Repair/graft achilles tendon 0051 34.9381 $1,896.75 $379.35 27654 T Repair of achilles tendon 0051 34.9381 $1,896.75 $379.35 27656 T Repair leg fascia defect 0049 19.9376 $1,082.39 $216.48 27658 T Repair of leg tendon, each 0049 19.9376 $1,082.39 $216.48 27659 T Repair of leg tendon, each 0049 19.9376 $1,082.39 $216.48 27664 T Repair of leg tendon, each 0049 19.9376 $1,082.39 $216.48 27665 T Repair of leg tendon, each 0050 25.1166 $1,363.56 $272.71 27675 T Repair lower leg tendons 0049 19.9376 $1,082.39 $216.48 27676 T Repair lower leg tendons 0050 25.1166 $1,363.56 $272.71 27680 T Release of lower leg tendon 0050 25.1166 $1,363.56 $272.71 27681 T Release of lower leg tendons 0050 25.1166 $1,363.56 $272.71 27685 T Revision of lower leg tendon 0050 25.1166 $1,363.56 $272.71 27686 T Revise lower leg tendons 0050 25.1166 $1,363.56 $272.71 27687 T Revision of calf tendon 0050 25.1166 $1,363.56 $272.71 27690 T Revise lower leg tendon 0051 34.9381 $1,896.75 $379.35 27691 T Revise lower leg tendon 0051 34.9381 $1,896.75 $379.35 27692 T Revise additional leg tendon 0051 34.9381 $1,896.75 $379.35 27695 T Repair of ankle ligament 0050 25.1166 $1,363.56 $272.71 27696 T Repair of ankle ligaments 0050 25.1166 $1,363.56 $272.71 27698 T Repair of ankle ligament 0050 25.1166 $1,363.56 $272.71 27700 T Revision of ankle joint 0047 30.3786 $1,649.22 $537.03 $329.84 27702 C Reconstruct ankle joint 27703 C Reconstruction, ankle joint 27704 T Removal of ankle implant 0049 19.9376 $1,082.39 $216.48 27705 T Incision of tibia 0051 34.9381 $1,896.75 $379.35 27707 T Incision of fibula 0049 19.9376 $1,082.39 $216.48 27709 T Incision of tibia & fibula 0050 25.1166 $1,363.56 $272.71 27712 C Realignment of lower leg 27715 C Revision of lower leg 27720 C Repair of tibia 27722 C Repair/graft of tibia 27724 C Repair/graft of tibia 27725 C Repair of lower leg 27727 C Repair of lower leg 27730 T Repair of tibia epiphysis 0050 25.1166 $1,363.56 $272.71 27732 T Repair of fibula epiphysis 0050 25.1166 $1,363.56 $272.71 27734 T Repair lower leg epiphyses 0050 25.1166 $1,363.56 $272.71 27740 T Repair of leg epiphyses 0050 25.1166 $1,363.56 $272.71 27742 T Repair of leg epiphyses 0051 34.9381 $1,896.75 $379.35 27745 T Reinforce tibia 0051 34.9381 $1,896.75 $379.35 27750 T Treatment of tibia fracture 0043 1.9233 $104.41 $20.88 27752 T Treatment of tibia fracture 0043 1.9233 $104.41 $20.88 27756 T Treatment of tibia fracture 0046 31.9719 $1,735.72 $535.76 $347.14 27758 T Treatment of tibia fracture 0046 31.9719 $1,735.72 $535.76 $347.14 27759 T Treatment of tibia fracture 0046 31.9719 $1,735.72 $535.76 $347.14 27760 T Treatment of ankle fracture 0043 1.9233 $104.41 $20.88 27762 T Treatment of ankle fracture 0043 1.9233 $104.41 $20.88 27766 T Treatment of ankle fracture 0046 31.9719 $1,735.72 $535.76 $347.14 27780 T Treatment of fibula fracture 0043 1.9233 $104.41 $20.88 27781 T Treatment of fibula fracture 0043 1.9233 $104.41 $20.88 27784 T Treatment of fibula fracture 0046 31.9719 $1,735.72 $535.76 $347.14 27786 T Treatment of ankle fracture 0043 1.9233 $104.41 $20.88 27788 T Treatment of ankle fracture 0043 1.9233 $104.41 $20.88 27792 T Treatment of ankle fracture 0046 31.9719 $1,735.72 $535.76 $347.14 27808 T Treatment of ankle fracture 0043 1.9233 $104.41 $20.88 27810 T Treatment of ankle fracture 0043 1.9233 $104.41 $20.88 27814 T Treatment of ankle fracture 0046 31.9719 $1,735.72 $535.76 $347.14 27816 T Treatment of ankle fracture 0043 1.9233 $104.41 $20.88 27818 T Treatment of ankle fracture 0043 1.9233 $104.41 $20.88 27822 T Treatment of ankle fracture 0046 31.9719 $1,735.72 $535.76 $347.14 27823 T Treatment of ankle fracture 0046 31.9719 $1,735.72 $535.76 $347.14 Start Printed Page 48059 27824 T Treat lower leg fracture 0043 1.9233 $104.41 $20.88 27825 T Treat lower leg fracture 0043 1.9233 $104.41 $20.88 27826 T Treat lower leg fracture 0046 31.9719 $1,735.72 $535.76 $347.14 27827 T Treat lower leg fracture 0046 31.9719 $1,735.72 $535.76 $347.14 27828 T Treat lower leg fracture 0046 31.9719 $1,735.72 $535.76 $347.14 27829 T Treat lower leg joint 0046 31.9719 $1,735.72 $535.76 $347.14 27830 T Treat lower leg dislocation 0043 1.9233 $104.41 $20.88 27831 T Treat lower leg dislocation 0043 1.9233 $104.41 $20.88 27832 T Treat lower leg dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 27840 T Treat ankle dislocation 0043 1.9233 $104.41 $20.88 27842 T Treat ankle dislocation 0045 13.5546 $735.87 $268.47 $147.17 27846 T Treat ankle dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 27848 T Treat ankle dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 27860 T Fixation of ankle joint 0045 13.5546 $735.87 $268.47 $147.17 27870 T Fusion of ankle joint 0051 34.9381 $1,896.75 $379.35 27871 T Fusion of tibiofibular joint 0051 34.9381 $1,896.75 $379.35 27880 C Amputation of lower leg 27881 C Amputation of lower leg 27882 C Amputation of lower leg 27884 T Amputation follow-up surgery 0049 19.9376 $1,082.39 $216.48 27886 C Amputation follow-up surgery 27888 C Amputation of foot at ankle 27889 T Amputation of foot at ankle 0050 25.1166 $1,363.56 $272.71 27892 T Decompression of leg 0049 19.9376 $1,082.39 $216.48 27893 T Decompression of leg 0049 19.9376 $1,082.39 $216.48 27894 T Decompression of leg 0049 19.9376 $1,082.39 $216.48 27899 T Leg/ankle surgery procedure 0043 1.9233 $104.41 $20.88 28001 T Drainage of bursa of foot 0008 16.8303 $913.70 $182.74 28002 T Treatment of foot infection 0049 19.9376 $1,082.39 $216.48 28003 T Treatment of foot infection 0049 19.9376 $1,082.39 $216.48 28005 T Treat foot bone lesion 0055 18.8851 $1,025.25 $355.34 $205.05 28008 T Incision of foot fascia 0055 18.8851 $1,025.25 $355.34 $205.05 28010 T Incision of toe tendon 0055 18.8851 $1,025.25 $355.34 $205.05 28011 T Incision of toe tendons 0055 18.8851 $1,025.25 $355.34 $205.05 28020 T Exploration of foot joint 0055 18.8851 $1,025.25 $355.34 $205.05 28022 T Exploration of foot joint 0055 18.8851 $1,025.25 $355.34 $205.05 28024 T Exploration of toe joint 0055 18.8851 $1,025.25 $355.34 $205.05 28030 T Removal of foot nerve 0220 16.5293 $897.36 $179.47 28035 T Decompression of tibia nerve 0220 16.5293 $897.36 $179.47 28043 T Excision of foot lesion 0021 14.5749 $791.26 $219.48 $158.25 28045 T Excision of foot lesion 0055 18.8851 $1,025.25 $355.34 $205.05 28046 T Resection of tumor, foot 0055 18.8851 $1,025.25 $355.34 $205.05 28050 T Biopsy of foot joint lining 0055 18.8851 $1,025.25 $355.34 $205.05 28052 T Biopsy of foot joint lining 0055 18.8851 $1,025.25 $355.34 $205.05 28054 T Biopsy of toe joint lining 0055 18.8851 $1,025.25 $355.34 $205.05 28060 T Partial removal, foot fascia 0056 25.1591 $1,365.86 $405.81 $273.17 28062 T Removal of foot fascia 0056 25.1591 $1,365.86 $405.81 $273.17 28070 T Removal of foot joint lining 0056 25.1591 $1,365.86 $405.81 $273.17 28072 T Removal of foot joint lining 0056 25.1591 $1,365.86 $405.81 $273.17 28080 T Removal of foot lesion 0055 18.8851 $1,025.25 $355.34 $205.05 28086 T Excise foot tendon sheath 0055 18.8851 $1,025.25 $355.34 $205.05 28088 T Excise foot tendon sheath 0055 18.8851 $1,025.25 $355.34 $205.05 28090 T Removal of foot lesion 0055 18.8851 $1,025.25 $355.34 $205.05 28092 T Removal of toe lesions 0055 18.8851 $1,025.25 $355.34 $205.05 28100 T Removal of ankle/heel lesion 0055 18.8851 $1,025.25 $355.34 $205.05 28102 T Remove/graft foot lesion 0056 25.1591 $1,365.86 $405.81 $273.17 28103 T Remove/graft foot lesion 0056 25.1591 $1,365.86 $405.81 $273.17 28104 T Removal of foot lesion 0055 18.8851 $1,025.25 $355.34 $205.05 28106 T Remove/graft foot lesion 0056 25.1591 $1,365.86 $405.81 $273.17 28107 T Remove/graft foot lesion 0056 25.1591 $1,365.86 $405.81 $273.17 28108 T Removal of toe lesions 0055 18.8851 $1,025.25 $355.34 $205.05 28110 T Part removal of metatarsal 0056 25.1591 $1,365.86 $405.81 $273.17 28111 T Part removal of metatarsal 0055 18.8851 $1,025.25 $355.34 $205.05 28112 T Part removal of metatarsal 0055 18.8851 $1,025.25 $355.34 $205.05 28113 T Part removal of metatarsal 0055 18.8851 $1,025.25 $355.34 $205.05 28114 T Removal of metatarsal heads 0055 18.8851 $1,025.25 $355.34 $205.05 Start Printed Page 48060 28116 T Revision of foot 0055 18.8851 $1,025.25 $355.34 $205.05 28118 T Removal of heel bone 0055 18.8851 $1,025.25 $355.34 $205.05 28119 T Removal of heel spur 0055 18.8851 $1,025.25 $355.34 $205.05 28120 T Part removal of ankle/heel 0055 18.8851 $1,025.25 $355.34 $205.05 28122 T Partial removal of foot bone 0055 18.8851 $1,025.25 $355.34 $205.05 28124 T Partial removal of toe 0055 18.8851 $1,025.25 $355.34 $205.05 28126 T Partial removal of toe 0055 18.8851 $1,025.25 $355.34 $205.05 28130 T Removal of ankle bone 0055 18.8851 $1,025.25 $355.34 $205.05 28140 T Removal of metatarsal 0055 18.8851 $1,025.25 $355.34 $205.05 28150 T Removal of toe 0055 18.8851 $1,025.25 $355.34 $205.05 28153 T Partial removal of toe 0055 18.8851 $1,025.25 $355.34 $205.05 28160 T Partial removal of toe 0055 18.8851 $1,025.25 $355.34 $205.05 28171 T Extensive foot surgery 0055 18.8851 $1,025.25 $355.34 $205.05 28173 T Extensive foot surgery 0055 18.8851 $1,025.25 $355.34 $205.05 28175 T Extensive foot surgery 0055 18.8851 $1,025.25 $355.34 $205.05 28190 T Removal of foot foreign body 0019 3.9807 $216.11 $71.87 $43.22 28192 T Removal of foot foreign body 0021 14.5749 $791.26 $219.48 $158.25 28193 T Removal of foot foreign body 0021 14.5749 $791.26 $219.48 $158.25 28200 T Repair of foot tendon 0055 18.8851 $1,025.25 $355.34 $205.05 28202 T Repair/graft of foot tendon 0056 25.1591 $1,365.86 $405.81 $273.17 28208 T Repair of foot tendon 0055 18.8851 $1,025.25 $355.34 $205.05 28210 T Repair/graft of foot tendon 0055 18.8851 $1,025.25 $355.34 $205.05 28220 T Release of foot tendon 0055 18.8851 $1,025.25 $355.34 $205.05 28222 T Release of foot tendons 0055 18.8851 $1,025.25 $355.34 $205.05 28225 T Release of foot tendon 0055 18.8851 $1,025.25 $355.34 $205.05 28226 T Release of foot tendons 0055 18.8851 $1,025.25 $355.34 $205.05 28230 T Incision of foot tendon(s) 0055 18.8851 $1,025.25 $355.34 $205.05 28232 T Incision of toe tendon 0055 18.8851 $1,025.25 $355.34 $205.05 28234 T Incision of foot tendon 0055 18.8851 $1,025.25 $355.34 $205.05 28238 T Revision of foot tendon 0056 25.1591 $1,365.86 $405.81 $273.17 28240 T Release of big toe 0055 18.8851 $1,025.25 $355.34 $205.05 28250 T Revision of foot fascia 0056 25.1591 $1,365.86 $405.81 $273.17 28260 T Release of midfoot joint 0056 25.1591 $1,365.86 $405.81 $273.17 28261 T Revision of foot tendon 0056 25.1591 $1,365.86 $405.81 $273.17 28262 T Revision of foot and ankle 0056 25.1591 $1,365.86 $405.81 $273.17 28264 T Release of midfoot joint 0056 25.1591 $1,365.86 $405.81 $273.17 28270 T Release of foot contracture 0055 18.8851 $1,025.25 $355.34 $205.05 28272 T Release of toe joint, each 0055 18.8851 $1,025.25 $355.34 $205.05 28280 T Fusion of toes 0055 18.8851 $1,025.25 $355.34 $205.05 28285 T Repair of hammertoe 0055 18.8851 $1,025.25 $355.34 $205.05 28286 T Repair of hammertoe 0055 18.8851 $1,025.25 $355.34 $205.05 28288 T Partial removal of foot bone 0056 25.1591 $1,365.86 $405.81 $273.17 28289 T Repair hallux rigidus 0056 25.1591 $1,365.86 $405.81 $273.17 28290 T Correction of bunion 0056 25.1591 $1,365.86 $405.81 $273.17 28292 T Correction of bunion 0057 25.4248 $1,380.29 $475.91 $276.06 28293 T Correction of bunion 0057 25.4248 $1,380.29 $475.91 $276.06 28294 T Correction of bunion 0056 25.1591 $1,365.86 $405.81 $273.17 28296 T Correction of bunion 0056 25.1591 $1,365.86 $405.81 $273.17 28297 T Correction of bunion 0057 25.4248 $1,380.29 $475.91 $276.06 28298 T Correction of bunion 0056 25.1591 $1,365.86 $405.81 $273.17 28299 T Correction of bunion 0057 25.4248 $1,380.29 $475.91 $276.06 28300 T Incision of heel bone 0056 25.1591 $1,365.86 $405.81 $273.17 28302 T Incision of ankle bone 0056 25.1591 $1,365.86 $405.81 $273.17 28304 T Incision of midfoot bones 0056 25.1591 $1,365.86 $405.81 $273.17 28305 T Incise/graft midfoot bones 0056 25.1591 $1,365.86 $405.81 $273.17 28306 T Incision of metatarsal 0056 25.1591 $1,365.86 $405.81 $273.17 28307 T Incision of metatarsal 0056 25.1591 $1,365.86 $405.81 $273.17 28308 T Incision of metatarsal 0056 25.1591 $1,365.86 $405.81 $273.17 28309 T Incision of metatarsals 0056 25.1591 $1,365.86 $405.81 $273.17 28310 T Revision of big toe 0055 18.8851 $1,025.25 $355.34 $205.05 28312 T Revision of toe 0055 18.8851 $1,025.25 $355.34 $205.05 28313 T Repair deformity of toe 0055 18.8851 $1,025.25 $355.34 $205.05 28315 T Removal of sesamoid bone 0055 18.8851 $1,025.25 $355.34 $205.05 28320 T Repair of foot bones 0056 25.1591 $1,365.86 $405.81 $273.17 28322 T Repair of metatarsals 0056 25.1591 $1,365.86 $405.81 $273.17 28340 T Resect enlarged toe tissue 0055 18.8851 $1,025.25 $355.34 $205.05 Start Printed Page 48061 28341 T Resect enlarged toe 0055 18.8851 $1,025.25 $355.34 $205.05 28344 T Repair extra toe(s) 0056 25.1591 $1,365.86 $405.81 $273.17 28345 T Repair webbed toe(s) 0056 25.1591 $1,365.86 $405.81 $273.17 28360 T Reconstruct cleft foot 0056 25.1591 $1,365.86 $405.81 $273.17 28400 T Treatment of heel fracture 0043 1.9233 $104.41 $20.88 28405 T Treatment of heel fracture 0043 1.9233 $104.41 $20.88 28406 T Treatment of heel fracture 0046 31.9719 $1,735.72 $535.76 $347.14 28415 T Treat heel fracture 0046 31.9719 $1,735.72 $535.76 $347.14 28420 T Treat/graft heel fracture 0046 31.9719 $1,735.72 $535.76 $347.14 28430 T Treatment of ankle fracture 0043 1.9233 $104.41 $20.88 28435 T Treatment of ankle fracture 0043 1.9233 $104.41 $20.88 28436 T Treatment of ankle fracture 0046 31.9719 $1,735.72 $535.76 $347.14 28445 T Treat ankle fracture 0046 31.9719 $1,735.72 $535.76 $347.14 28450 T Treat midfoot fracture, each 0043 1.9233 $104.41 $20.88 28455 T Treat midfoot fracture, each 0043 1.9233 $104.41 $20.88 28456 T Treat midfoot fracture 0046 31.9719 $1,735.72 $535.76 $347.14 28465 T Treat midfoot fracture, each 0046 31.9719 $1,735.72 $535.76 $347.14 28470 T Treat metatarsal fracture 0043 1.9233 $104.41 $20.88 28475 T Treat metatarsal fracture 0043 1.9233 $104.41 $20.88 28476 T Treat metatarsal fracture 0046 31.9719 $1,735.72 $535.76 $347.14 28485 T Treat metatarsal fracture 0046 31.9719 $1,735.72 $535.76 $347.14 28490 T Treat big toe fracture 0043 1.9233 $104.41 $20.88 28495 T Treat big toe fracture 0043 1.9233 $104.41 $20.88 28496 T Treat big toe fracture 0046 31.9719 $1,735.72 $535.76 $347.14 28505 T Treat big toe fracture 0046 31.9719 $1,735.72 $535.76 $347.14 28510 T Treatment of toe fracture 0043 1.9233 $104.41 $20.88 28515 T Treatment of toe fracture 0043 1.9233 $104.41 $20.88 28525 T Treat toe fracture 0046 31.9719 $1,735.72 $535.76 $347.14 28530 T Treat sesamoid bone fracture 0043 1.9233 $104.41 $20.88 28531 T Treat sesamoid bone fracture 0046 31.9719 $1,735.72 $535.76 $347.14 28540 T Treat foot dislocation 0043 1.9233 $104.41 $20.88 28545 T Treat foot dislocation 0045 13.5546 $735.87 $268.47 $147.17 28546 T Treat foot dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 28555 T Repair foot dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 28570 T Treat foot dislocation 0043 1.9233 $104.41 $20.88 28575 T Treat foot dislocation 0043 1.9233 $104.41 $20.88 28576 T Treat foot dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 28585 T Repair foot dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 28600 T Treat foot dislocation 0043 1.9233 $104.41 $20.88 28605 T Treat foot dislocation 0043 1.9233 $104.41 $20.88 28606 T Treat foot dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 28615 T Repair foot dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 28630 T Treat toe dislocation 0043 1.9233 $104.41 $20.88 28635 T Treat toe dislocation 0045 13.5546 $735.87 $268.47 $147.17 28636 T Treat toe dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 28645 T Repair toe dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 28660 T Treat toe dislocation 0043 1.9233 $104.41 $20.88 28665 T Treat toe dislocation 0045 13.5546 $735.87 $268.47 $147.17 28666 T Treat toe dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 28675 T Repair of toe dislocation 0046 31.9719 $1,735.72 $535.76 $347.14 28705 T Fusion of foot bones 0056 25.1591 $1,365.86 $405.81 $273.17 28715 T Fusion of foot bones 0056 25.1591 $1,365.86 $405.81 $273.17 28725 T Fusion of foot bones 0056 25.1591 $1,365.86 $405.81 $273.17 28730 T Fusion of foot bones 0056 25.1591 $1,365.86 $405.81 $273.17 28735 T Fusion of foot bones 0056 25.1591 $1,365.86 $405.81 $273.17 28737 T Revision of foot bones 0055 18.8851 $1,025.25 $355.34 $205.05 28740 T Fusion of foot bones 0056 25.1591 $1,365.86 $405.81 $273.17 28750 T Fusion of big toe joint 0055 18.8851 $1,025.25 $355.34 $205.05 28755 T Fusion of big toe joint 0055 18.8851 $1,025.25 $355.34 $205.05 28760 T Fusion of big toe joint 0056 25.1591 $1,365.86 $405.81 $273.17 28800 C Amputation of midfoot 28805 C Amputation thru metatarsal 28810 T Amputation toe & metatarsal 0055 18.8851 $1,025.25 $355.34 $205.05 28820 T Amputation of toe 0055 18.8851 $1,025.25 $355.34 $205.05 28825 T Partial amputation of toe 0055 18.8851 $1,025.25 $355.34 $205.05 28899 T Foot/toes surgery procedure 0043 1.9233 $104.41 $20.88 Start Printed Page 48062 29000 S Application of body cast 0058 1.0785 $58.55 $11.71 29010 S Application of body cast 0058 1.0785 $58.55 $11.71 29015 S Application of body cast 0058 1.0785 $58.55 $11.71 29020 S Application of body cast 0058 1.0785 $58.55 $11.71 29025 S Application of body cast 0058 1.0785 $58.55 $11.71 29035 S Application of body cast 0058 1.0785 $58.55 $11.71 29040 S Application of body cast 0058 1.0785 $58.55 $11.71 29044 S Application of body cast 0058 1.0785 $58.55 $11.71 29046 S Application of body cast 0058 1.0785 $58.55 $11.71 29049 S Application of figure eight 0058 1.0785 $58.55 $11.71 29055 S Application of shoulder cast 0058 1.0785 $58.55 $11.71 29058 S Application of shoulder cast 0058 1.0785 $58.55 $11.71 29065 S Application of long arm cast 0058 1.0785 $58.55 $11.71 29075 S Application of forearm cast 0058 1.0785 $58.55 $11.71 29085 S Apply hand/wrist cast 0058 1.0785 $58.55 $11.71 29086 S Apply finger cast 0058 1.0785 $58.55 $11.71 29105 S Apply long arm splint 0058 1.0785 $58.55 $11.71 29125 S Apply forearm splint 0058 1.0785 $58.55 $11.71 29126 S Apply forearm splint 0058 1.0785 $58.55 $11.71 29130 S Application of finger splint 0058 1.0785 $58.55 $11.71 29131 S Application of finger splint 0058 1.0785 $58.55 $11.71 29200 S Strapping of chest 0058 1.0785 $58.55 $11.71 29220 S Strapping of low back 0058 1.0785 $58.55 $11.71 29240 S Strapping of shoulder 0058 1.0785 $58.55 $11.71 29260 S Strapping of elbow or wrist 0058 1.0785 $58.55 $11.71 29280 S Strapping of hand or finger 0058 1.0785 $58.55 $11.71 29305 S Application of hip cast 0058 1.0785 $58.55 $11.71 29325 S Application of hip casts 0058 1.0785 $58.55 $11.71 29345 S Application of long leg cast 0058 1.0785 $58.55 $11.71 29355 S Application of long leg cast 0058 1.0785 $58.55 $11.71 29358 S Apply long leg cast brace 0058 1.0785 $58.55 $11.71 29365 S Application of long leg cast 0058 1.0785 $58.55 $11.71 29405 S Apply short leg cast 0058 1.0785 $58.55 $11.71 29425 S Apply short leg cast 0058 1.0785 $58.55 $11.71 29435 S Apply short leg cast 0058 1.0785 $58.55 $11.71 29440 S Addition of walker to cast 0058 1.0785 $58.55 $11.71 29445 S Apply rigid leg cast 0058 1.0785 $58.55 $11.71 29450 S Application of leg cast 0058 1.0785 $58.55 $11.71 29505 S Application, long leg splint 0058 1.0785 $58.55 $11.71 29515 S Application lower leg splint 0058 1.0785 $58.55 $11.71 29520 S Strapping of hip 0058 1.0785 $58.55 $11.71 29530 S Strapping of knee 0058 1.0785 $58.55 $11.71 29540 S Strapping of ankle 0058 1.0785 $58.55 $11.71 29550 S Strapping of toes 0058 1.0785 $58.55 $11.71 29580 S Application of paste boot 0058 1.0785 $58.55 $11.71 29590 S Application of foot splint 0058 1.0785 $58.55 $11.71 29700 S Removal/revision of cast 0058 1.0785 $58.55 $11.71 29705 S Removal/revision of cast 0058 1.0785 $58.55 $11.71 29710 S Removal/revision of cast 0058 1.0785 $58.55 $11.71 29715 S Removal/revision of cast 0058 1.0785 $58.55 $11.71 29720 S Repair of body cast 0058 1.0785 $58.55 $11.71 29730 S Windowing of cast 0058 1.0785 $58.55 $11.71 29740 S Wedging of cast 0058 1.0785 $58.55 $11.71 29750 S Wedging of clubfoot cast 0058 1.0785 $58.55 $11.71 29799 S Casting/strapping procedure 0058 1.0785 $58.55 $11.71 29800 T Jaw arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29804 T Jaw arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29805 T Shoulder arthroscopy, dx 0041 27.2538 $1,479.58 $295.92 29806 T Shoulder arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29807 T Shoulder arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29819 T Shoulder arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29820 T Shoulder arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29821 T Shoulder arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29822 T Shoulder arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29823 T Shoulder arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29824 T Shoulder arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 Start Printed Page 48063 29825 T Shoulder arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29826 T Shoulder arthroscopy/surgery 0042 42.8551 $2,326.56 $804.74 $465.31 29827 T Arthroscop rotator cuff repr 0041 27.2538 $1,479.58 $295.92 29830 T Elbow arthroscopy 0041 27.2538 $1,479.58 $295.92 29834 T Elbow arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29835 T Elbow arthroscopy/surgery 0042 42.8551 $2,326.56 $804.74 $465.31 29836 T Elbow arthroscopy/surgery 0042 42.8551 $2,326.56 $804.74 $465.31 29837 T Elbow arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29838 T Elbow arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29840 T Wrist arthroscopy 0041 27.2538 $1,479.58 $295.92 29843 T Wrist arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29844 T Wrist arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29845 T Wrist arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29846 T Wrist arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29847 T Wrist arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29848 T Wrist endoscopy/surgery 0041 27.2538 $1,479.58 $295.92 29850 T Knee arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29851 T Knee arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29855 T Tibial arthroscopy/surgery 0042 42.8551 $2,326.56 $804.74 $465.31 29856 T Tibial arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29860 T Hip arthroscopy, dx 0041 27.2538 $1,479.58 $295.92 29861 T Hip arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29862 T Hip arthroscopy/surgery 0042 42.8551 $2,326.56 $804.74 $465.31 29863 T Hip arthroscopy/surgery 0042 42.8551 $2,326.56 $804.74 $465.31 29870 T Knee arthroscopy, dx 0041 27.2538 $1,479.58 $295.92 29871 T Knee arthroscopy/drainage 0041 27.2538 $1,479.58 $295.92 29873 T Knee arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29874 T Knee arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29875 T Knee arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29876 T Knee arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29877 T Knee arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29879 T Knee arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29880 T Knee arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29881 T Knee arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29882 T Knee arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29883 T Knee arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29884 T Knee arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29885 T Knee arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29886 T Knee arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29887 T Knee arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29888 T Knee arthroscopy/surgery 0042 42.8551 $2,326.56 $804.74 $465.31 29889 T Knee arthroscopy/surgery 0042 42.8551 $2,326.56 $804.74 $465.31 29891 T Ankle arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29892 T Ankle arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29893 T Scope, plantar fasciotomy 0055 18.8851 $1,025.25 $355.34 $205.05 29894 T Ankle arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29895 T Ankle arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29897 T Ankle arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29898 T Ankle arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29899 T Ankle arthroscopy/surgery 0041 27.2538 $1,479.58 $295.92 29900 T Mcp joint arthroscopy, dx 0053 14.8188 $804.50 $253.49 $160.90 29901 T Mcp joint arthroscopy, surg 0053 14.8188 $804.50 $253.49 $160.90 29902 T Mcp joint arthroscopy, surg 0053 14.8188 $804.50 $253.49 $160.90 29999 T Arthroscopy of joint 0041 27.2538 $1,479.58 $295.92 30000 T Drainage of nose lesion 0251 1.8643 $101.21 $20.24 30020 T Drainage of nose lesion 0251 1.8643 $101.21 $20.24 30100 T Intranasal biopsy 0252 6.5416 $355.14 $113.41 $71.03 30110 T Removal of nose polyp(s) 0253 15.1698 $823.55 $282.29 $164.71 30115 T Removal of nose polyp(s) 0253 15.1698 $823.55 $282.29 $164.71 30117 T Removal of intranasal lesion 0253 15.1698 $823.55 $282.29 $164.71 30118 T Removal of intranasal lesion 0254 21.4368 $1,163.78 $321.35 $232.76 30120 T Revision of nose 0253 15.1698 $823.55 $282.29 $164.71 30124 T Removal of nose lesion 0252 6.5416 $355.14 $113.41 $71.03 30125 T Removal of nose lesion 0256 35.0866 $1,904.82 $380.96 30130 T Removal of turbinate bones 0253 15.1698 $823.55 $282.29 $164.71 30140 T Removal of turbinate bones 0254 21.4368 $1,163.78 $321.35 $232.76 Start Printed Page 48064 30150 T Partial removal of nose 0256 35.0866 $1,904.82 $380.96 30160 T Removal of nose 0256 35.0866 $1,904.82 $380.96 30200 T Injection treatment of nose 0253 15.1698 $823.55 $282.29 $164.71 30210 T Nasal sinus therapy 0252 6.5416 $355.14 $113.41 $71.03 30220 T Insert nasal septal button 0252 6.5416 $355.14 $113.41 $71.03 30300 X Remove nasal foreign body 0340 0.6232 $33.83 $6.77 30310 T Remove nasal foreign body 0253 15.1698 $823.55 $282.29 $164.71 30320 T Remove nasal foreign body 0253 15.1698 $823.55 $282.29 $164.71 30400 T Reconstruction of nose 0256 35.0866 $1,904.82 $380.96 30410 T Reconstruction of nose 0256 35.0866 $1,904.82 $380.96 30420 T Reconstruction of nose 0256 35.0866 $1,904.82 $380.96 30430 T Revision of nose 0254 21.4368 $1,163.78 $321.35 $232.76 30435 T Revision of nose 0256 35.0866 $1,904.82 $380.96 30450 T Revision of nose 0256 35.0866 $1,904.82 $380.96 30460 T Revision of nose 0256 35.0866 $1,904.82 $380.96 30462 T Revision of nose 0256 35.0866 $1,904.82 $380.96 30465 T Repair nasal stenosis 0256 35.0866 $1,904.82 $380.96 30520 T Repair of nasal septum 0254 21.4368 $1,163.78 $321.35 $232.76 30540 T Repair nasal defect 0256 35.0866 $1,904.82 $380.96 30545 T Repair nasal defect 0256 35.0866 $1,904.82 $380.96 30560 T Release of nasal adhesions 0251 1.8643 $101.21 $20.24 30580 T Repair upper jaw fistula 0256 35.0866 $1,904.82 $380.96 30600 T Repair mouth/nose fistula 0256 35.0866 $1,904.82 $380.96 30620 T Intranasal reconstruction 0256 35.0866 $1,904.82 $380.96 30630 T Repair nasal septum defect 0254 21.4368 $1,163.78 $321.35 $232.76 30801 T Cauterization, inner nose 0252 6.5416 $355.14 $113.41 $71.03 30802 T Cauterization, inner nose 0253 15.1698 $823.55 $282.29 $164.71 30901 T Control of nosebleed 0250 1.5381 $83.50 $29.23 $16.70 30903 T Control of nosebleed 0250 1.5381 $83.50 $29.23 $16.70 30905 T Control of nosebleed 0250 1.5381 $83.50 $29.23 $16.70 30906 T Repeat control of nosebleed 0250 1.5381 $83.50 $29.23 $16.70 30915 T Ligation, nasal sinus artery 0091 28.5187 $1,548.25 $348.23 $309.65 30920 T Ligation, upper jaw artery 0092 25.1347 $1,364.54 $505.37 $272.91 30930 T Therapy, fracture of nose 0253 15.1698 $823.55 $282.29 $164.71 30999 T Nasal surgery procedure 0251 1.8643 $101.21 $20.24 31000 T Irrigation, maxillary sinus 0251 1.8643 $101.21 $20.24 31002 T Irrigation, sphenoid sinus 0252 6.5416 $355.14 $113.41 $71.03 31020 T Exploration, maxillary sinus 0254 21.4368 $1,163.78 $321.35 $232.76 31030 T Exploration, maxillary sinus 0256 35.0866 $1,904.82 $380.96 31032 T Explore sinus, remove polyps 0256 35.0866 $1,904.82 $380.96 31040 T Exploration behind upper jaw 0254 21.4368 $1,163.78 $321.35 $232.76 31050 T Exploration, sphenoid sinus 0256 35.0866 $1,904.82 $380.96 31051 T Sphenoid sinus surgery 0256 35.0866 $1,904.82 $380.96 31070 T Exploration of frontal sinus 0254 21.4368 $1,163.78 $321.35 $232.76 31075 T Exploration of frontal sinus 0256 35.0866 $1,904.82 $380.96 31080 T Removal of frontal sinus 0256 35.0866 $1,904.82 $380.96 31081 T Removal of frontal sinus 0256 35.0866 $1,904.82 $380.96 31084 T Removal of frontal sinus 0256 35.0866 $1,904.82 $380.96 31085 T Removal of frontal sinus 0256 35.0866 $1,904.82 $380.96 31086 T Removal of frontal sinus 0256 35.0866 $1,904.82 $380.96 31087 T Removal of frontal sinus 0256 35.0866 $1,904.82 $380.96 31090 T Exploration of sinuses 0256 35.0866 $1,904.82 $380.96 31200 T Removal of ethmoid sinus 0256 35.0866 $1,904.82 $380.96 31201 T Removal of ethmoid sinus 0256 35.0866 $1,904.82 $380.96 31205 T Removal of ethmoid sinus 0256 35.0866 $1,904.82 $380.96 31225 C Removal of upper jaw 31230 C Removal of upper jaw 31231 T Nasal endoscopy, dx 0071 0.9012 $48.93 $12.89 $9.79 31233 T Nasal/sinus endoscopy, dx 0073 3.4396 $186.73 $73.38 $37.35 31235 T Nasal/sinus endoscopy, dx 0074 14.4952 $786.93 $295.70 $157.39 31237 T Nasal/sinus endoscopy, surg 0075 20.4113 $1,108.11 $445.92 $221.62 31238 T Nasal/sinus endoscopy, surg 0074 14.4952 $786.93 $295.70 $157.39 31239 T Nasal/sinus endoscopy, surg 0075 20.4113 $1,108.11 $445.92 $221.62 31240 T Nasal/sinus endoscopy, surg 0074 14.4952 $786.93 $295.70 $157.39 31254 T Revision of ethmoid sinus 0075 20.4113 $1,108.11 $445.92 $221.62 31255 T Removal of ethmoid sinus 0075 20.4113 $1,108.11 $445.92 $221.62 Start Printed Page 48065 31256 T Exploration maxillary sinus 0075 20.4113 $1,108.11 $445.92 $221.62 31267 T Endoscopy, maxillary sinus 0075 20.4113 $1,108.11 $445.92 $221.62 31276 T Sinus endoscopy, surgical 0075 20.4113 $1,108.11 $445.92 $221.62 31287 T Nasal/sinus endoscopy, surg 0075 20.4113 $1,108.11 $445.92 $221.62 31288 T Nasal/sinus endoscopy, surg 0075 20.4113 $1,108.11 $445.92 $221.62 31290 C Nasal/sinus endoscopy, surg 31291 C Nasal/sinus endoscopy, surg 31292 C Nasal/sinus endoscopy, surg 31293 C Nasal/sinus endoscopy, surg 31294 C Nasal/sinus endoscopy, surg 31299 T Sinus surgery procedure 0252 6.5416 $355.14 $113.41 $71.03 31300 T Removal of larynx lesion 0254 21.4368 $1,163.78 $321.35 $232.76 31320 T Diagnostic incision, larynx 0256 35.0866 $1,904.82 $380.96 31360 C Removal of larynx 31365 C Removal of larynx 31367 C Partial removal of larynx 31368 C Partial removal of larynx 31370 C Partial removal of larynx 31375 C Partial removal of larynx 31380 C Partial removal of larynx 31382 C Partial removal of larynx 31390 C Removal of larynx & pharynx 31395 C Reconstruct larynx & pharynx 31400 T Revision of larynx 0256 35.0866 $1,904.82 $380.96 31420 T Removal of epiglottis 0256 35.0866 $1,904.82 $380.96 31500 S Insert emergency airway 0094 2.6412 $143.39 $48.46 $28.68 31502 T Change of windpipe airway 0121 2.2058 $119.75 $43.80 $23.95 31505 T Diagnostic laryngoscopy 0071 0.9012 $48.93 $12.89 $9.79 31510 T Laryngoscopy with biopsy 0074 14.4952 $786.93 $295.70 $157.39 31511 T Remove foreign body, larynx 0072 1.6987 $92.22 $26.68 $18.44 31512 T Removal of larynx lesion 0074 14.4952 $786.93 $295.70 $157.39 31513 T Injection into vocal cord 0072 1.6987 $92.22 $26.68 $18.44 31515 T Laryngoscopy for aspiration 0074 14.4952 $786.93 $295.70 $157.39 31520 T Diagnostic laryngoscopy 0072 1.6987 $92.22 $26.68 $18.44 31525 T Diagnostic laryngoscopy 0074 14.4952 $786.93 $295.70 $157.39 31526 T Diagnostic laryngoscopy 0075 20.4113 $1,108.11 $445.92 $221.62 31527 T Laryngoscopy for treatment 0075 20.4113 $1,108.11 $445.92 $221.62 31528 T Laryngoscopy and dilation 0074 14.4952 $786.93 $295.70 $157.39 31529 T Laryngoscopy and dilation 0074 14.4952 $786.93 $295.70 $157.39 31530 T Operative laryngoscopy 0075 20.4113 $1,108.11 $445.92 $221.62 31531 T Operative laryngoscopy 0075 20.4113 $1,108.11 $445.92 $221.62 31535 T Operative laryngoscopy 0075 20.4113 $1,108.11 $445.92 $221.62 31536 T Operative laryngoscopy 0075 20.4113 $1,108.11 $445.92 $221.62 31540 T Operative laryngoscopy 0075 20.4113 $1,108.11 $445.92 $221.62 31541 T Operative laryngoscopy 0075 20.4113 $1,108.11 $445.92 $221.62 31560 T Operative laryngoscopy 0075 20.4113 $1,108.11 $445.92 $221.62 31561 T Operative laryngoscopy 0075 20.4113 $1,108.11 $445.92 $221.62 31570 T Laryngoscopy with injection 0074 14.4952 $786.93 $295.70 $157.39 31571 T Laryngoscopy with injection 0075 20.4113 $1,108.11 $445.92 $221.62 31575 T Diagnostic laryngoscopy 0072 1.6987 $92.22 $26.68 $18.44 31576 T Laryngoscopy with biopsy 0075 20.4113 $1,108.11 $445.92 $221.62 31577 T Remove foreign body, larynx 0073 3.4396 $186.73 $73.38 $37.35 31578 T Removal of larynx lesion 0075 20.4113 $1,108.11 $445.92 $221.62 31579 T Diagnostic laryngoscopy 0073 3.4396 $186.73 $73.38 $37.35 31580 T Revision of larynx 0256 35.0866 $1,904.82 $380.96 31582 T Revision of larynx 0256 35.0866 $1,904.82 $380.96 31584 C Treat larynx fracture 31585 T Treat larynx fracture 0253 15.1698 $823.55 $282.29 $164.71 31586 T Treat larynx fracture 0256 35.0866 $1,904.82 $380.96 31587 C Revision of larynx 31588 T Revision of larynx 0256 35.0866 $1,904.82 $380.96 31590 T Reinnervate larynx 0256 35.0866 $1,904.82 $380.96 31595 T Larynx nerve surgery 0256 35.0866 $1,904.82 $380.96 31599 T Larynx surgery procedure 0254 21.4368 $1,163.78 $321.35 $232.76 31600 T Incision of windpipe 0254 21.4368 $1,163.78 $321.35 $232.76 31601 T Incision of windpipe 0254 21.4368 $1,163.78 $321.35 $232.76 Start Printed Page 48066 31603 T Incision of windpipe 0252 6.5416 $355.14 $113.41 $71.03 31605 T Incision of windpipe 0253 15.1698 $823.55 $282.29 $164.71 31610 T Incision of windpipe 0254 21.4368 $1,163.78 $321.35 $232.76 31611 T Surgery/speech prosthesis 0254 21.4368 $1,163.78 $321.35 $232.76 31612 T Puncture/clear windpipe 0254 21.4368 $1,163.78 $321.35 $232.76 31613 T Repair windpipe opening 0254 21.4368 $1,163.78 $321.35 $232.76 31614 T Repair windpipe opening 0256 35.0866 $1,904.82 $380.96 31615 T Visualization of windpipe 0076 9.3560 $507.93 $189.82 $101.59 31622 T Dx bronchoscope/wash 0076 9.3560 $507.93 $189.82 $101.59 31623 T Dx bronchoscope/brush 0076 9.3560 $507.93 $189.82 $101.59 31624 T Dx bronchoscope/lavage 0076 9.3560 $507.93 $189.82 $101.59 31625 T Bronchoscopy w/biopsy(s) 0076 9.3560 $507.93 $189.82 $101.59 31628 T Bronchoscopy/lung bx, each 0076 9.3560 $507.93 $189.82 $101.59 31629 T Bronchoscopy/needle bx, each 0076 9.3560 $507.93 $189.82 $101.59 31630 T Bronchoscopy dilate/fx repr 0415 20.9920 $1,139.63 $463.30 $227.93 31631 T Bronchoscopy, dilate w/stent 0415 20.9920 $1,139.63 $463.30 $227.93 31635 T Bronchoscopy w/fb removal 0076 9.3560 $507.93 $189.82 $101.59 31640 T Bronchoscopy w/tumor excise 0415 20.9920 $1,139.63 $463.30 $227.93 31641 T Bronchoscopy, treat blockage 0415 20.9920 $1,139.63 $463.30 $227.93 31643 T Diag bronchoscope/catheter 0076 9.3560 $507.93 $189.82 $101.59 31645 T Bronchoscopy, clear airways 0076 9.3560 $507.93 $189.82 $101.59 31646 T Bronchoscopy, reclear airway 0076 9.3560 $507.93 $189.82 $101.59 31656 T Bronchoscopy, inj for x-ray 0076 9.3560 $507.93 $189.82 $101.59 31700 T Insertion of airway catheter 0072 1.6987 $92.22 $26.68 $18.44 31708 N Instill airway contrast dye 31710 N Insertion of airway catheter 31715 N Injection for bronchus x-ray 31717 T Bronchial brush biopsy 0073 3.4396 $186.73 $73.38 $37.35 31720 T Clearance of airways 0072 1.6987 $92.22 $26.68 $18.44 31725 C Clearance of airways 31730 T Intro, windpipe wire/tube 0073 3.4396 $186.73 $73.38 $37.35 31750 T Repair of windpipe 0256 35.0866 $1,904.82 $380.96 31755 T Repair of windpipe 0256 35.0866 $1,904.82 $380.96 31760 C Repair of windpipe 31766 C Reconstruction of windpipe 31770 C Repair/graft of bronchus 31775 C Reconstruct bronchus 31780 C Reconstruct windpipe 31781 C Reconstruct windpipe 31785 T Remove windpipe lesion 0254 21.4368 $1,163.78 $321.35 $232.76 31786 C Remove windpipe lesion 31800 C Repair of windpipe injury 31805 C Repair of windpipe injury 31820 T Closure of windpipe lesion 0253 15.1698 $823.55 $282.29 $164.71 31825 T Repair of windpipe defect 0254 21.4368 $1,163.78 $321.35 $232.76 31830 T Revise windpipe scar 0254 21.4368 $1,163.78 $321.35 $232.76 31899 T Airways surgical procedure 0076 9.3560 $507.93 $189.82 $101.59 32000 T Drainage of chest 0070 3.1393 $170.43 $34.09 32002 T Treatment of collapsed lung 0070 3.1393 $170.43 $34.09 32005 T Treat lung lining chemically 0070 3.1393 $170.43 $34.09 32020 T Insertion of chest tube 0070 3.1393 $170.43 $34.09 32035 C Exploration of chest 32036 C Exploration of chest 32095 C Biopsy through chest wall 32100 C Exploration/biopsy of chest 32110 C Explore/repair chest 32120 C Re-exploration of chest 32124 C Explore chest free adhesions 32140 C Removal of lung lesion(s) 32141 C Remove/treat lung lesions 32150 C Removal of lung lesion(s) 32151 C Remove lung foreign body 32160 C Open chest heart massage 32200 C Drain, open, lung lesion 32201 T Drain, percut, lung lesion 0070 3.1393 $170.43 $34.09 32215 C Treat chest lining Start Printed Page 48067 32220 C Release of lung 32225 C Partial release of lung 32310 C Removal of chest lining 32320 C Free/remove chest lining 32400 T Needle biopsy chest lining 0005 3.3675 $182.82 $71.59 $36.56 32402 C Open biopsy chest lining 32405 T Biopsy, lung or mediastinum 0685 4.8912 $265.54 $116.83 $53.11 32420 T Puncture/clear lung 0070 3.1393 $170.43 $34.09 32440 C Removal of lung 32442 C Sleeve pneumonectomy 32445 C Removal of lung 32480 C Partial removal of lung 32482 C Bilobectomy 32484 C Segmentectomy 32486 C Sleeve lobectomy 32488 C Completion pneumonectomy 32491 C Lung volume reduction 32500 C Partial removal of lung 32501 C Repair bronchus add-on 32520 C Remove lung & revise chest 32522 C Remove lung & revise chest 32525 C Remove lung & revise chest 32540 C Removal of lung lesion 32601 T Thoracoscopy, diagnostic 0069 28.6334 $1,554.48 $591.64 $310.90 32602 T Thoracoscopy, diagnostic 0069 28.6334 $1,554.48 $591.64 $310.90 32603 T Thoracoscopy, diagnostic 0069 28.6334 $1,554.48 $591.64 $310.90 32604 T Thoracoscopy, diagnostic 0069 28.6334 $1,554.48 $591.64 $310.90 32605 T Thoracoscopy, diagnostic 0069 28.6334 $1,554.48 $591.64 $310.90 32606 T Thoracoscopy, diagnostic 0069 28.6334 $1,554.48 $591.64 $310.90 32650 C Thoracoscopy, surgical 32651 C Thoracoscopy, surgical 32652 C Thoracoscopy, surgical 32653 C Thoracoscopy, surgical 32654 C Thoracoscopy, surgical 32655 C Thoracoscopy, surgical 32656 C Thoracoscopy, surgical 32657 C Thoracoscopy, surgical 32658 C Thoracoscopy, surgical 32659 C Thoracoscopy, surgical 32660 C Thoracoscopy, surgical 32661 C Thoracoscopy, surgical 32662 C Thoracoscopy, surgical 32663 C Thoracoscopy, surgical 32664 C Thoracoscopy, surgical 32665 C Thoracoscopy, surgical 32800 C Repair lung hernia 32810 C Close chest after drainage 32815 C Close bronchial fistula 32820 C Reconstruct injured chest 32850 C Donor pneumonectomy 32851 C Lung transplant, single 32852 C Lung transplant with bypass 32853 C Lung transplant, double 32854 C Lung transplant with bypass 32900 C Removal of rib(s) 32905 C Revise & repair chest wall 32906 C Revise & repair chest wall 32940 C Revision of lung 32960 T Therapeutic pneumothorax 0070 3.1393 $170.43 $34.09 32997 C Total lung lavage 32999 T Chest surgery procedure 0070 3.1393 $170.43 $34.09 33010 T Drainage of heart sac 0070 3.1393 $170.43 $34.09 33011 T Repeat drainage of heart sac 0070 3.1393 $170.43 $34.09 33015 C Incision of heart sac 33020 C Incision of heart sac 33025 C Incision of heart sac Start Printed Page 48068 33030 C Partial removal of heart sac 33031 C Partial removal of heart sac 33050 C Removal of heart sac lesion 33120 C Removal of heart lesion 33130 C Removal of heart lesion 33140 C Heart revascularize (tmr) 33141 C Heart tmr w/other procedure 33200 C Insertion of heart pacemaker 33201 C Insertion of heart pacemaker 33206 T Insertion of heart pacemaker 0089 116.1611 $6,306.27 $1,722.59 $1,261.25 33207 T Insertion of heart pacemaker 0089 116.1611 $6,306.27 $1,722.59 $1,261.25 33208 T Insertion of heart pacemaker 0655 142.2244 $7,721.22 $1,544.24 33210 T Insertion of heart electrode 0106 49.9534 $2,711.92 $542.39 $542.38 33211 T Insertion of heart electrode 0106 49.9534 $2,711.92 $542.39 $542.38 33212 T Insertion of pulse generator 0090 87.2850 $4,738.62 $1,705.90 $947.72 33213 T Insertion of pulse generator 0654 103.8544 $5,638.15 $1,127.63 33214 T Upgrade of pacemaker system 0655 142.2244 $7,721.22 $1,544.24 33215 T Reposition pacing-defib lead 0105 18.9084 $1,026.52 $370.40 $205.30 33216 T Revise eltrd pacing-defib 0106 49.9534 $2,711.92 $542.39 $542.38 33217 T Insert lead pace-defib, dual 0106 49.9534 $2,711.92 $542.39 $542.38 33218 T Repair lead pace-defib, one 0106 49.9534 $2,711.92 $542.39 $542.38 33220 T Repair lead pace-defib, dual 0106 49.9534 $2,711.92 $542.39 $542.38 33222 T Revise pocket, pacemaker 0027 15.8319 $859.50 $329.72 $171.90 33223 T Revise pocket, pacing-defib 0027 15.8319 $859.50 $329.72 $171.90 33224 T Insert pacing lead & connect 1547 $850.00 $170.00 33225 T L ventric pacing lead add-on 1550 $1,150.00 $230.00 33226 T Reposition l ventric lead 0105 18.9084 $1,026.52 $370.40 $205.30 33233 T Removal of pacemaker system 0105 18.9084 $1,026.52 $370.40 $205.30 33234 T Removal of pacemaker system 0105 18.9084 $1,026.52 $370.40 $205.30 33235 T Removal pacemaker electrode 0105 18.9084 $1,026.52 $370.40 $205.30 33236 C Remove electrode/thoracotomy 33237 C Remove electrode/thoracotomy 33238 C Remove electrode/thoracotomy 33240 T Insert pulse generator 0107 290.5429 $15,773.28 $3,429.62 $3,154.66 33241 T Remove pulse generator 0105 18.9084 $1,026.52 $370.40 $205.30 33243 C Remove eltrd/thoracotomy 33244 T Remove eltrd, transven 0105 18.9084 $1,026.52 $370.40 $205.30 33245 C Insert epic eltrd pace-defib 33246 C Insert epic eltrd/generator 33249 T Eltrd/insert pace-defib 0108 489.5275 $26,575.96 $5,315.19 33250 C Ablate heart dysrhythm focus 33251 C Ablate heart dysrhythm focus 33253 C Reconstruct atria 33261 C Ablate heart dysrhythm focus 33282 S Implant pat-active ht record 0680 61.4222 $3,334.55 $666.91 33284 T Remove pat-active ht record 0109 7.7075 $418.43 $131.49 $83.69 33300 C Repair of heart wound 33305 C Repair of heart wound 33310 C Exploratory heart surgery 33315 C Exploratory heart surgery 33320 C Repair major blood vessel(s) 33321 C Repair major vessel 33322 C Repair major blood vessel(s) 33330 C Insert major vessel graft 33332 C Insert major vessel graft 33335 C Insert major vessel graft 33400 C Repair of aortic valve 33401 C Valvuloplasty, open 33403 C Valvuloplasty, w/cp bypass 33404 C Prepare heart-aorta conduit 33405 C Replacement of aortic valve 33406 C Replacement of aortic valve 33410 C Replacement of aortic valve 33411 C Replacement of aortic valve 33412 C Replacement of aortic valve 33413 C Replacement of aortic valve Start Printed Page 48069 33414 C Repair of aortic valve 33415 C Revision, subvalvular tissue 33416 C Revise ventricle muscle 33417 C Repair of aortic valve 33420 C Revision of mitral valve 33422 C Revision of mitral valve 33425 C Repair of mitral valve 33426 C Repair of mitral valve 33427 C Repair of mitral valve 33430 C Replacement of mitral valve 33460 C Revision of tricuspid valve 33463 C Valvuloplasty, tricuspid 33464 C Valvuloplasty, tricuspid 33465 C Replace tricuspid valve 33468 C Revision of tricuspid valve 33470 C Revision of pulmonary valve 33471 C Valvotomy, pulmonary valve 33472 C Revision of pulmonary valve 33474 C Revision of pulmonary valve 33475 C Replacement, pulmonary valve 33476 C Revision of heart chamber 33478 C Revision of heart chamber 33496 C Repair, prosth valve clot 33500 C Repair heart vessel fistula 33501 C Repair heart vessel fistula 33502 C Coronary artery correction 33503 C Coronary artery graft 33504 C Coronary artery graft 33505 C Repair artery w/tunnel 33506 C Repair artery, translocation 33508 N Endoscopic vein harvest 33510 C CABG, vein, single 33511 C CABG, vein, two 33512 C CABG, vein, three 33513 C CABG, vein, four 33514 C CABG, vein, five 33516 C Cabg, vein, six or more 33517 C CABG, artery-vein, single 33518 C CABG, artery-vein, two 33519 C CABG, artery-vein, three 33521 C CABG, artery-vein, four 33522 C CABG, artery-vein, five 33523 C Cabg, art-vein, six or more 33530 C Coronary artery, bypass/reop 33533 C CABG, arterial, single 33534 C CABG, arterial, two 33535 C CABG, arterial, three 33536 C Cabg, arterial, four or more 33542 C Removal of heart lesion 33545 C Repair of heart damage 33572 C Open coronary endarterectomy 33600 C Closure of valve 33602 C Closure of valve 33606 C Anastomosis/artery-aorta 33608 C Repair anomaly w/conduit 33610 C Repair by enlargement 33611 C Repair double ventricle 33612 C Repair double ventricle 33615 C Repair, modified fontan 33617 C Repair single ventricle 33619 C Repair single ventricle 33641 C Repair heart septum defect 33645 C Revision of heart veins 33647 C Repair heart septum defects 33660 C Repair of heart defects 33665 C Repair of heart defects Start Printed Page 48070 33670 C Repair of heart chambers 33681 C Repair heart septum defect 33684 C Repair heart septum defect 33688 C Repair heart septum defect 33690 C Reinforce pulmonary artery 33692 C Repair of heart defects 33694 C Repair of heart defects 33697 C Repair of heart defects 33702 C Repair of heart defects 33710 C Repair of heart defects 33720 C Repair of heart defect 33722 C Repair of heart defect 33730 C Repair heart-vein defect(s) 33732 C Repair heart-vein defect 33735 C Revision of heart chamber 33736 C Revision of heart chamber 33737 C Revision of heart chamber 33750 C Major vessel shunt 33755 C Major vessel shunt 33762 C Major vessel shunt 33764 C Major vessel shunt & graft 33766 C Major vessel shunt 33767 C Major vessel shunt 33770 C Repair great vessels defect 33771 C Repair great vessels defect 33774 C Repair great vessels defect 33775 C Repair great vessels defect 33776 C Repair great vessels defect 33777 C Repair great vessels defect 33778 C Repair great vessels defect 33779 C Repair great vessels defect 33780 C Repair great vessels defect 33781 C Repair great vessels defect 33786 C Repair arterial trunk 33788 C Revision of pulmonary artery 33800 C Aortic suspension 33802 C Repair vessel defect 33803 C Repair vessel defect 33813 C Repair septal defect 33814 C Repair septal defect 33820 C Revise major vessel 33822 C Revise major vessel 33824 C Revise major vessel 33840 C Remove aorta constriction 33845 C Remove aorta constriction 33851 C Remove aorta constriction 33852 C Repair septal defect 33853 C Repair septal defect 33860 C Ascending aortic graft 33861 C Ascending aortic graft 33863 C Ascending aortic graft 33870 C Transverse aortic arch graft 33875 C Thoracic aortic graft 33877 C Thoracoabdominal graft 33910 C Remove lung artery emboli 33915 C Remove lung artery emboli 33916 C Surgery of great vessel 33917 C Repair pulmonary artery 33918 C Repair pulmonary atresia 33919 C Repair pulmonary atresia 33920 C Repair pulmonary atresia 33922 C Transect pulmonary artery 33924 C Remove pulmonary shunt 33930 C Removal of donor heart/lung 33935 C Transplantation, heart/lung 33940 C Removal of donor heart Start Printed Page 48071 33945 C Transplantation of heart 33960 C External circulation assist 33961 C External circulation assist 33967 C Insert ia percut device 33968 C Remove aortic assist device 33970 C Aortic circulation assist 33971 C Aortic circulation assist 33973 C Insert balloon device 33974 C Remove intra-aortic balloon 33975 C Implant ventricular device 33976 C Implant ventricular device 33977 C Remove ventricular device 33978 C Remove ventricular device 33979 C Insert intracorporeal device 33980 C Remove intracorporeal device 33999 T Cardiac surgery procedure 0070 3.1393 $170.43 $34.09 34001 C Removal of artery clot 34051 C Removal of artery clot 34101 T Removal of artery clot 0088 34.6065 $1,878.75 $655.22 $375.75 34111 T Removal of arm artery clot 0088 34.6065 $1,878.75 $655.22 $375.75 34151 C Removal of artery clot 34201 T Removal of artery clot 0088 34.6065 $1,878.75 $655.22 $375.75 34203 T Removal of leg artery clot 0088 34.6065 $1,878.75 $655.22 $375.75 34401 C Removal of vein clot 34421 T Removal of vein clot 0088 34.6065 $1,878.75 $655.22 $375.75 34451 C Removal of vein clot 34471 T Removal of vein clot 0088 34.6065 $1,878.75 $655.22 $375.75 34490 T Removal of vein clot 0088 34.6065 $1,878.75 $655.22 $375.75 34501 T Repair valve, femoral vein 0088 34.6065 $1,878.75 $655.22 $375.75 34502 C Reconstruct vena cava 34510 T Transposition of vein valve 0088 34.6065 $1,878.75 $655.22 $375.75 34520 T Cross-over vein graft 0088 34.6065 $1,878.75 $655.22 $375.75 34530 T Leg vein fusion 0088 34.6065 $1,878.75 $655.22 $375.75 34800 C Endovasc abdo repair w/tube 34802 C Endovasc abdo repr w/device 34804 C Endovasc abdo repr w/device 34808 C Endovasc abdo occlud device 34812 C Xpose for endoprosth, aortic 34813 C Femoral endovas graft add-on 34820 C Xpose for endoprosth, iliac 34825 C Endovasc extend prosth, init 34826 C Endovasc exten prosth, addl 34830 C Open aortic tube prosth repr 34831 C Open aortoiliac prosth repr 34832 C Open aortofemor prosth repr 34833 C Xpose for endoprosth, iliac 34834 C Xpose, endoprosth, brachial 34900 C Endovasc iliac repr w/graft 35001 C Repair defect of artery 35002 C Repair artery rupture, neck 35005 C Repair defect of artery 35011 T Repair defect of artery 0653 32.4880 $1,763.74 $352.75 35013 C Repair artery rupture, arm 35021 C Repair defect of artery 35022 C Repair artery rupture, chest 35045 C Repair defect of arm artery 35081 C Repair defect of artery 35082 C Repair artery rupture, aorta 35091 C Repair defect of artery 35092 C Repair artery rupture, aorta 35102 C Repair defect of artery 35103 C Repair artery rupture, groin 35111 C Repair defect of artery 35112 C Repair artery rupture,spleen 35121 C Repair defect of artery 35122 C Repair artery rupture, belly Start Printed Page 48072 35131 C Repair defect of artery 35132 C Repair artery rupture, groin 35141 C Repair defect of artery 35142 C Repair artery rupture, thigh 35151 C Repair defect of artery 35152 C Repair artery rupture, knee 35161 C Repair defect of artery 35162 C Repair artery rupture 35180 T Repair blood vessel lesion 0093 20.6662 $1,121.95 $277.34 $224.39 35182 C Repair blood vessel lesion 35184 T Repair blood vessel lesion 0093 20.6662 $1,121.95 $277.34 $224.39 35188 T Repair blood vessel lesion 0088 34.6065 $1,878.75 $655.22 $375.75 35189 C Repair blood vessel lesion 35190 T Repair blood vessel lesion 0093 20.6662 $1,121.95 $277.34 $224.39 35201 T Repair blood vessel lesion 0093 20.6662 $1,121.95 $277.34 $224.39 35206 T Repair blood vessel lesion 0093 20.6662 $1,121.95 $277.34 $224.39 35207 T Repair blood vessel lesion 0088 34.6065 $1,878.75 $655.22 $375.75 35211 C Repair blood vessel lesion 35216 C Repair blood vessel lesion 35221 C Repair blood vessel lesion 35226 T Repair blood vessel lesion 0093 20.6662 $1,121.95 $277.34 $224.39 35231 T Repair blood vessel lesion 0093 20.6662 $1,121.95 $277.34 $224.39 35236 T Repair blood vessel lesion 0093 20.6662 $1,121.95 $277.34 $224.39 35241 C Repair blood vessel lesion 35246 C Repair blood vessel lesion 35251 C Repair blood vessel lesion 35256 T Repair blood vessel lesion 0093 20.6662 $1,121.95 $277.34 $224.39 35261 T Repair blood vessel lesion 0653 32.4880 $1,763.74 $352.75 35266 T Repair blood vessel lesion 0653 32.4880 $1,763.74 $352.75 35271 C Repair blood vessel lesion 35276 C Repair blood vessel lesion 35281 C Repair blood vessel lesion 35286 T Repair blood vessel lesion 0653 32.4880 $1,763.74 $352.75 35301 C Rechanneling of artery 35311 C Rechanneling of artery 35321 T Rechanneling of artery 0093 20.6662 $1,121.95 $277.34 $224.39 35331 C Rechanneling of artery 35341 C Rechanneling of artery 35351 C Rechanneling of artery 35355 C Rechanneling of artery 35361 C Rechanneling of artery 35363 C Rechanneling of artery 35371 C Rechanneling of artery 35372 C Rechanneling of artery 35381 C Rechanneling of artery 35390 C Reoperation, carotid add-on 35400 C Angioscopy 35450 C Repair arterial blockage 35452 C Repair arterial blockage 35454 C Repair arterial blockage 35456 C Repair arterial blockage 35458 T Repair arterial blockage 0081 34.8355 $1,891.18 $378.24 35459 T Repair arterial blockage 0081 34.8355 $1,891.18 $378.24 35460 T Repair venous blockage 0081 34.8355 $1,891.18 $378.24 35470 T Repair arterial blockage 0081 34.8355 $1,891.18 $378.24 35471 T Repair arterial blockage 0081 34.8355 $1,891.18 $378.24 35472 T Repair arterial blockage 0081 34.8355 $1,891.18 $378.24 35473 T Repair arterial blockage 0081 34.8355 $1,891.18 $378.24 35474 T Repair arterial blockage 0081 34.8355 $1,891.18 $378.24 35475 T Repair arterial blockage 0081 34.8355 $1,891.18 $378.24 35476 T Repair venous blockage 0081 34.8355 $1,891.18 $378.24 35480 C Atherectomy, open 35481 C Atherectomy, open 35482 C Atherectomy, open 35483 C Atherectomy, open 35484 T Atherectomy, open 0081 34.8355 $1,891.18 $378.24 Start Printed Page 48073 35485 T Atherectomy, open 0081 34.8355 $1,891.18 $378.24 35490 T Atherectomy, percutaneous 0081 34.8355 $1,891.18 $378.24 35491 T Atherectomy, percutaneous 0081 34.8355 $1,891.18 $378.24 35492 T Atherectomy, percutaneous 0081 34.8355 $1,891.18 $378.24 35493 T Atherectomy, percutaneous 0081 34.8355 $1,891.18 $378.24 35494 T Atherectomy, percutaneous 0081 34.8355 $1,891.18 $378.24 35495 T Atherectomy, percutaneous 0081 34.8355 $1,891.18 $378.24 35500 T Harvest vein for bypass 0081 34.8355 $1,891.18 $378.24 35501 C Artery bypass graft 35506 C Artery bypass graft 35507 C Artery bypass graft 35508 C Artery bypass graft 35509 C Artery bypass graft 35511 C Artery bypass graft 35515 C Artery bypass graft 35516 C Artery bypass graft 35518 C Artery bypass graft 35521 C Artery bypass graft 35526 C Artery bypass graft 35531 C Artery bypass graft 35533 C Artery bypass graft 35536 C Artery bypass graft 35541 C Artery bypass graft 35546 C Artery bypass graft 35548 C Artery bypass graft 35549 C Artery bypass graft 35551 C Artery bypass graft 35556 C Artery bypass graft 35558 C Artery bypass graft 35560 C Artery bypass graft 35563 C Artery bypass graft 35565 C Artery bypass graft 35566 C Artery bypass graft 35571 C Artery bypass graft 35572 N Harvest femoropopliteal vein 35582 C Vein bypass graft 35583 C Vein bypass graft 35585 C Vein bypass graft 35587 C Vein bypass graft 35600 C Harvest artery for cabg 35601 C Artery bypass graft 35606 C Artery bypass graft 35612 C Artery bypass graft 35616 C Artery bypass graft 35621 C Artery bypass graft 35623 C Bypass graft, not vein 35626 C Artery bypass graft 35631 C Artery bypass graft 35636 C Artery bypass graft 35641 C Artery bypass graft 35642 C Artery bypass graft 35645 C Artery bypass graft 35646 C Artery bypass graft 35647 C Artery bypass graft 35650 C Artery bypass graft 35651 C Artery bypass graft 35654 C Artery bypass graft 35656 C Artery bypass graft 35661 C Artery bypass graft 35663 C Artery bypass graft 35665 C Artery bypass graft 35666 C Artery bypass graft 35671 C Artery bypass graft 35681 C Composite bypass graft 35682 C Composite bypass graft 35683 C Composite bypass graft Start Printed Page 48074 35685 T Bypass graft patency/patch 0093 20.6662 $1,121.95 $277.34 $224.39 35686 T Bypass graft/av fist patency 0093 20.6662 $1,121.95 $277.34 $224.39 35691 C Arterial transposition 35693 C Arterial transposition 35694 C Arterial transposition 35695 C Arterial transposition 35700 C Reoperation, bypass graft 35701 C Exploration, carotid artery 35721 C Exploration, femoral artery 35741 C Exploration popliteal artery 35761 T Exploration of artery/vein 0115 25.6233 $1,391.06 $459.35 $278.21 35800 C Explore neck vessels 35820 C Explore chest vessels 35840 C Explore abdominal vessels 35860 T Explore limb vessels 0093 20.6662 $1,121.95 $277.34 $224.39 35870 C Repair vessel graft defect 35875 T Removal of clot in graft 0088 34.6065 $1,878.75 $655.22 $375.75 35876 T Removal of clot in graft 0088 34.6065 $1,878.75 $655.22 $375.75 35879 T Revise graft w/vein 0088 34.6065 $1,878.75 $655.22 $375.75 35881 T Revise graft w/vein 0088 34.6065 $1,878.75 $655.22 $375.75 35901 C Excision, graft, neck 35903 T Excision, graft, extremity 0115 25.6233 $1,391.06 $459.35 $278.21 35905 C Excision, graft, thorax 35907 C Excision, graft, abdomen 36000 N Place needle in vein 36002 S Pseudoaneurysm injection trt 0267 2.4805 $134.66 $65.52 $26.93 36005 N Injection ext venography 36010 N Place catheter in vein 36011 N Place catheter in vein 36012 N Place catheter in vein 36013 N Place catheter in artery 36014 N Place catheter in artery 36015 N Place catheter in artery 36100 N Establish access to artery 36120 N Establish access to artery 36140 N Establish access to artery 36145 N Artery to vein shunt 36160 N Establish access to aorta 36200 N Place catheter in aorta 36215 N Place catheter in artery 36216 N Place catheter in artery 36217 N Place catheter in artery 36218 N Place catheter in artery 36245 N Place catheter in artery 36246 N Place catheter in artery 36247 N Place catheter in artery 36248 N Place catheter in artery 36260 T Insertion of infusion pump 0119 129.8988 $7,052.08 $1,410.42 36261 T Revision of infusion pump 0124 27.4545 $1,490.48 $298.10 $298.10 36262 T Removal of infusion pump 0109 7.7075 $418.43 $131.49 $83.69 36299 N Vessel injection procedure 36400 N Bl draw < 3 yrs fem/jugular 36405 N Bl draw < 3 yrs scalp vein 36406 N Bl draw < 3 yrs other vein 36410 N Non-routine bl draw > 3 yrs 36415 E Drawing blood 36416 E Capillary blood draw 36420 T Vein access cutdown < 1 yr 0035 0.2236 $12.14 $3.51 $2.43 36425 T Vein access cutdown > 1 yr 0035 0.2236 $12.14 $3.51 $2.43 36430 S Blood transfusion service 0110 3.7128 $201.56 $40.31 36440 S Bl push transfuse, 2 yr or < 0110 3.7128 $201.56 $40.31 36450 S Bl exchange/transfuse, nb 0110 3.7128 $201.56 $40.31 36455 S Bl exchange/transfuse non-nb 0110 3.7128 $201.56 $40.31 36460 S Transfusion service, fetal 0110 3.7128 $201.56 $40.31 36468 T Injection(s), spider veins 0098 1.1630 $63.14 $15.17 $12.63 36469 T Injection(s), spider veins 0098 1.1630 $63.14 $15.17 $12.63 Start Printed Page 48075 36470 T Injection therapy of vein 0098 1.1630 $63.14 $15.17 $12.63 36471 T Injection therapy of veins 0098 1.1630 $63.14 $15.17 $12.63 36481 N Insertion of catheter, vein 36488 T Insertion of catheter, vein 0032 11.5584 $627.49 $125.50 36489 T Insertion of catheter, vein 0032 11.5584 $627.49 $125.50 36490 T Insertion of catheter, vein 0032 11.5584 $627.49 $125.50 36491 T Insertion of catheter, vein 0032 11.5584 $627.49 $125.50 36493 X Repositioning of cvc 0187 4.4274 $240.36 $90.71 $48.07 36500 N Insertion of catheter, vein 36510 C Insertion of catheter, vein 36511 S Apheresis wbc 0111 14.0169 $760.96 $211.96 $152.19 36512 S Apheresis rbc 0111 14.0169 $760.96 $211.96 $152.19 36513 S Apheresis platelets 0111 14.0169 $760.96 $211.96 $152.19 36514 S Apheresis plasma 0111 14.0169 $760.96 $211.96 $152.19 36515 S Apheresis, adsorp/reinfuse 0112 34.8318 $1,890.98 $609.71 $378.20 36516 S Apheresis, selective 0112 34.8318 $1,890.98 $609.71 $378.20 36522 S Photopheresis 0112 34.8318 $1,890.98 $609.71 $378.20 36530 T Insertion of infusion pump 0119 129.8988 $7,052.08 $1,410.42 36531 T Revision of infusion pump 0124 27.4545 $1,490.48 $298.10 $298.10 36532 T Removal of infusion pump 0109 7.7075 $418.43 $131.49 $83.69 36533 T Insertion of access device 0115 25.6233 $1,391.06 $459.35 $278.21 36534 T Revision of access device 0109 7.7075 $418.43 $131.49 $83.69 36535 T Removal of access device 0109 7.7075 $418.43 $131.49 $83.69 36536 T Remove cva device obstruct 1541 $250.00 $50.00 36537 T Remove cva lumen obstruct 1541 $250.00 $50.00 36540 N Collect blood venous device 36550 T Declot vascular device 0677 3.0769 $167.04 $33.41 36600 N Withdrawal of arterial blood 36620 N Insertion catheter, artery 36625 N Insertion catheter, artery 36640 T Insertion catheter, artery 0032 11.5584 $627.49 $125.50 36660 C Insertion catheter, artery 36680 X Insert needle, bone cavity 0340 0.6232 $33.83 $6.77 36800 T Insertion of cannula 0115 25.6233 $1,391.06 $459.35 $278.21 36810 T Insertion of cannula 0115 25.6233 $1,391.06 $459.35 $278.21 36815 T Insertion of cannula 0115 25.6233 $1,391.06 $459.35 $278.21 36819 T Av fusion/uppr arm vein 0088 34.6065 $1,878.75 $655.22 $375.75 36820 T Av fusion/forearm vein 0088 34.6065 $1,878.75 $655.22 $375.75 36821 T Av fusion direct any site 0088 34.6065 $1,878.75 $655.22 $375.75 36822 C Insertion of cannula(s) 36823 C Insertion of cannula(s) 36825 T Artery-vein autograft 0088 34.6065 $1,878.75 $655.22 $375.75 36830 T Artery-vein graft 0088 34.6065 $1,878.75 $655.22 $375.75 36831 T Open thrombect av fistula 0088 34.6065 $1,878.75 $655.22 $375.75 36832 T Av fistula revision, open 0088 34.6065 $1,878.75 $655.22 $375.75 36833 T Av fistula revision 0088 34.6065 $1,878.75 $655.22 $375.75 36834 T Repair A-V aneurysm 0088 34.6065 $1,878.75 $655.22 $375.75 36835 T Artery to vein shunt 0115 25.6233 $1,391.06 $459.35 $278.21 36860 T External cannula declotting 0103 12.1256 $658.29 $223.63 $131.66 36861 T Cannula declotting 0115 25.6233 $1,391.06 $459.35 $278.21 36870 T Percut thrombect av fistula 0653 32.4880 $1,763.74 $352.75 37140 C Revision of circulation 37145 C Revision of circulation 37160 C Revision of circulation 37180 C Revision of circulation 37181 C Splice spleen/kidney veins 37182 C Insert hepatic shunt (tips) 37183 C Remove hepatic shunt (tips) 37195 C Thrombolytic therapy, stroke 37200 T Transcatheter biopsy 0685 4.8912 $265.54 $116.83 $53.11 37201 T Transcatheter therapy infuse 0676 3.7505 $203.61 $55.06 $40.72 37202 T Transcatheter therapy infuse 0677 3.0769 $167.04 $33.41 37203 T Transcatheter retrieval 0103 12.1256 $658.29 $223.63 $131.66 37204 T Transcatheter occlusion 0115 25.6233 $1,391.06 $459.35 $278.21 37205 T Transcatheter stent 0229 59.4977 $3,230.07 $771.23 $646.01 37206 T Transcatheter stent add-on 0229 59.4977 $3,230.07 $771.23 $646.01 Start Printed Page 48076 37207 T Transcatheter stent 0229 59.4977 $3,230.07 $771.23 $646.01 37208 T Transcatheter stent add-on 0229 59.4977 $3,230.07 $771.23 $646.01 37209 T Exchange arterial catheter 0103 12.1256 $658.29 $223.63 $131.66 37250 S Iv us first vessel add-on 0670 26.5472 $1,441.22 $521.95 $288.24 37251 S Iv us each add vessel add-on 0670 26.5472 $1,441.22 $521.95 $288.24 37500 T Endoscopy ligate perf veins 0092 25.1347 $1,364.54 $505.37 $272.91 37501 T Vascular endoscopy procedure 0092 25.1347 $1,364.54 $505.37 $272.91 37565 T Ligation of neck vein 0093 20.6662 $1,121.95 $277.34 $224.39 37600 T Ligation of neck artery 0093 20.6662 $1,121.95 $277.34 $224.39 37605 T Ligation of neck artery 0091 28.5187 $1,548.25 $348.23 $309.65 37606 T Ligation of neck artery 0091 28.5187 $1,548.25 $348.23 $309.65 37607 T Ligation of a-v fistula 0092 25.1347 $1,364.54 $505.37 $272.91 37609 T Temporal artery procedure 0021 14.5749 $791.26 $219.48 $158.25 37615 T Ligation of neck artery 0091 28.5187 $1,548.25 $348.23 $309.65 37616 C Ligation of chest artery 37617 C Ligation of abdomen artery 37618 C Ligation of extremity artery 37620 T Revision of major vein 0091 28.5187 $1,548.25 $348.23 $309.65 37650 T Revision of major vein 0091 28.5187 $1,548.25 $348.23 $309.65 37660 C Revision of major vein 37700 T Revise leg vein 0091 28.5187 $1,548.25 $348.23 $309.65 37720 T Removal of leg vein 0092 25.1347 $1,364.54 $505.37 $272.91 37730 T Removal of leg veins 0092 25.1347 $1,364.54 $505.37 $272.91 37735 T Removal of leg veins/lesion 0092 25.1347 $1,364.54 $505.37 $272.91 37760 T Revision of leg veins 0091 28.5187 $1,548.25 $348.23 $309.65 37780 T Revision of leg vein 0091 28.5187 $1,548.25 $348.23 $309.65 37785 T Revise secondary varicosity 0091 28.5187 $1,548.25 $348.23 $309.65 37788 C Revascularization, penis 37790 T Penile venous occlusion 0181 29.0094 $1,574.89 $621.82 $314.98 37799 T Vascular surgery procedure 0035 0.2236 $12.14 $3.51 $2.43 38100 C Removal of spleen, total 38101 C Removal of spleen, partial 38102 C Removal of spleen, total 38115 C Repair of ruptured spleen 38120 T Laparoscopy, splenectomy 0131 40.8955 $2,220.18 $1,001.89 $444.04 38129 T Laparoscope proc, spleen 0130 32.5959 $1,769.60 $659.53 $353.92 38200 N Injection for spleen x-ray 38204 E Bl donor search management 38205 S Harvest allogenic stem cells 0111 14.0169 $760.96 $211.96 $152.19 38206 S Harvest auto stem cells 0111 14.0169 $760.96 $211.96 $152.19 38207 E Cryopreserve stem cells 38208 E Thaw preserved stem cells 38209 E Wash harvest stem cells 38210 E T-cell depletion of harvest 38211 E Tumor cell deplete of harvst 38212 E Rbc depletion of harvest 38213 E Platelet deplete of harvest 38214 E Volume deplete of harvest 38215 E Harvest stem cell concentrte 38220 T Bone marrow aspiration 0003 2.2627 $122.84 $24.57 38221 T Bone marrow biopsy 0003 2.2627 $122.84 $24.57 38230 S Bone marrow collection 0123 4.0076 $217.57 $43.51 38240 S Bone marrow/stem transplant 0123 4.0076 $217.57 $43.51 38241 S Bone marrow/stem transplant 0123 4.0076 $217.57 $43.51 38242 S Lymphocyte infuse transplant 0111 14.0169 $760.96 $211.96 $152.19 38300 T Drainage, lymph node lesion 0008 16.8303 $913.70 $182.74 38305 T Drainage, lymph node lesion 0008 16.8303 $913.70 $182.74 38308 T Incision of lymph channels 0113 19.9529 $1,083.22 $216.64 38380 C Thoracic duct procedure 38381 C Thoracic duct procedure 38382 C Thoracic duct procedure 38500 T Biopsy/removal, lymph nodes 0113 19.9529 $1,083.22 $216.64 38505 T Needle biopsy, lymph nodes 0005 3.3675 $182.82 $71.59 $36.56 38510 T Biopsy/removal, lymph nodes 0113 19.9529 $1,083.22 $216.64 38520 T Biopsy/removal, lymph nodes 0113 19.9529 $1,083.22 $216.64 38525 T Biopsy/removal, lymph nodes 0113 19.9529 $1,083.22 $216.64 Start Printed Page 48077 38530 T Biopsy/removal, lymph nodes 0113 19.9529 $1,083.22 $216.64 38542 T Explore deep node(s), neck 0114 37.3583 $2,028.14 $485.91 $405.63 38550 T Removal, neck/armpit lesion 0113 19.9529 $1,083.22 $216.64 38555 T Removal, neck/armpit lesion 0113 19.9529 $1,083.22 $216.64 38562 C Removal, pelvic lymph nodes 38564 C Removal, abdomen lymph nodes 38570 T Laparoscopy, lymph node biop 0131 40.8955 $2,220.18 $1,001.89 $444.04 38571 T Laparoscopy, lymphadenectomy 0132 56.6318 $3,074.48 $1,239.22 $614.90 38572 T Laparoscopy, lymphadenectomy 0131 40.8955 $2,220.18 $1,001.89 $444.04 38589 T Laparoscope proc, lymphatic 0130 32.5959 $1,769.60 $659.53 $353.92 38700 T Removal of lymph nodes, neck 0113 19.9529 $1,083.22 $216.64 38720 T Removal of lymph nodes, neck 0113 19.9529 $1,083.22 $216.64 38724 C Removal of lymph nodes, neck 38740 T Remove armpit lymph nodes 0114 37.3583 $2,028.14 $485.91 $405.63 38745 T Remove armpit lymph nodes 0114 37.3583 $2,028.14 $485.91 $405.63 38746 C Remove thoracic lymph nodes 38747 C Remove abdominal lymph nodes 38760 T Remove groin lymph nodes 0113 19.9529 $1,083.22 $216.64 38765 C Remove groin lymph nodes 38770 C Remove pelvis lymph nodes 38780 C Remove abdomen lymph nodes 38790 N Inject for lymphatic x-ray 38792 N Identify sentinel node 38794 N Access thoracic lymph duct 38999 S Blood/lymph system procedure 0110 3.7128 $201.56 $40.31 39000 C Exploration of chest 39010 C Exploration of chest 39200 C Removal chest lesion 39220 C Removal chest lesion 39400 T Visualization of chest 0069 28.6334 $1,554.48 $591.64 $310.90 39499 C Chest procedure 39501 C Repair diaphragm laceration 39502 C Repair paraesophageal hernia 39503 C Repair of diaphragm hernia 39520 C Repair of diaphragm hernia 39530 C Repair of diaphragm hernia 39531 C Repair of diaphragm hernia 39540 C Repair of diaphragm hernia 39541 C Repair of diaphragm hernia 39545 C Revision of diaphragm 39560 C Resect diaphragm, simple 39561 C Resect diaphragm, complex 39599 C Diaphragm surgery procedure 40490 T Biopsy of lip 0251 1.8643 $101.21 $20.24 40500 T Partial excision of lip 0253 15.1698 $823.55 $282.29 $164.71 40510 T Partial excision of lip 0254 21.4368 $1,163.78 $321.35 $232.76 40520 T Partial excision of lip 0253 15.1698 $823.55 $282.29 $164.71 40525 T Reconstruct lip with flap 0254 21.4368 $1,163.78 $321.35 $232.76 40527 T Reconstruct lip with flap 0254 21.4368 $1,163.78 $321.35 $232.76 40530 T Partial removal of lip 0254 21.4368 $1,163.78 $321.35 $232.76 40650 T Repair lip 0252 6.5416 $355.14 $113.41 $71.03 40652 T Repair lip 0252 6.5416 $355.14 $113.41 $71.03 40654 T Repair lip 0252 6.5416 $355.14 $113.41 $71.03 40700 T Repair cleft lip/nasal 0256 35.0866 $1,904.82 $380.96 40701 T Repair cleft lip/nasal 0256 35.0866 $1,904.82 $380.96 40702 T Repair cleft lip/nasal 0256 35.0866 $1,904.82 $380.96 40720 T Repair cleft lip/nasal 0256 35.0866 $1,904.82 $380.96 40761 T Repair cleft lip/nasal 0256 35.0866 $1,904.82 $380.96 40799 T Lip surgery procedure 0253 15.1698 $823.55 $282.29 $164.71 40800 T Drainage of mouth lesion 0251 1.8643 $101.21 $20.24 40801 T Drainage of mouth lesion 0252 6.5416 $355.14 $113.41 $71.03 40804 X Removal, foreign body, mouth 0340 0.6232 $33.83 $6.77 40805 T Removal, foreign body, mouth 0252 6.5416 $355.14 $113.41 $71.03 40806 T Incision of lip fold 0251 1.8643 $101.21 $20.24 40808 T Biopsy of mouth lesion 0251 1.8643 $101.21 $20.24 40810 T Excision of mouth lesion 0253 15.1698 $823.55 $282.29 $164.71 Start Printed Page 48078 40812 T Excise/repair mouth lesion 0253 15.1698 $823.55 $282.29 $164.71 40814 T Excise/repair mouth lesion 0253 15.1698 $823.55 $282.29 $164.71 40816 T Excision of mouth lesion 0254 21.4368 $1,163.78 $321.35 $232.76 40818 T Excise oral mucosa for graft 0251 1.8643 $101.21 $20.24 40819 T Excise lip or cheek fold 0252 6.5416 $355.14 $113.41 $71.03 40820 T Treatment of mouth lesion 0253 15.1698 $823.55 $282.29 $164.71 40830 T Repair mouth laceration 0251 1.8643 $101.21 $20.24 40831 T Repair mouth laceration 0252 6.5416 $355.14 $113.41 $71.03 40840 T Reconstruction of mouth 0254 21.4368 $1,163.78 $321.35 $232.76 40842 T Reconstruction of mouth 0254 21.4368 $1,163.78 $321.35 $232.76 40843 T Reconstruction of mouth 0254 21.4368 $1,163.78 $321.35 $232.76 40844 T Reconstruction of mouth 0256 35.0866 $1,904.82 $380.96 40845 T Reconstruction of mouth 0256 35.0866 $1,904.82 $380.96 40899 T Mouth surgery procedure 0252 6.5416 $355.14 $113.41 $71.03 41000 T Drainage of mouth lesion 0253 15.1698 $823.55 $282.29 $164.71 41005 T Drainage of mouth lesion 0251 1.8643 $101.21 $20.24 41006 T Drainage of mouth lesion 0254 21.4368 $1,163.78 $321.35 $232.76 41007 T Drainage of mouth lesion 0253 15.1698 $823.55 $282.29 $164.71 41008 T Drainage of mouth lesion 0253 15.1698 $823.55 $282.29 $164.71 41009 T Drainage of mouth lesion 0251 1.8643 $101.21 $20.24 41010 T Incision of tongue fold 0253 15.1698 $823.55 $282.29 $164.71 41015 T Drainage of mouth lesion 0251 1.8643 $101.21 $20.24 41016 T Drainage of mouth lesion 0252 6.5416 $355.14 $113.41 $71.03 41017 T Drainage of mouth lesion 0252 6.5416 $355.14 $113.41 $71.03 41018 T Drainage of mouth lesion 0252 6.5416 $355.14 $113.41 $71.03 41100 T Biopsy of tongue 0252 6.5416 $355.14 $113.41 $71.03 41105 T Biopsy of tongue 0253 15.1698 $823.55 $282.29 $164.71 41108 T Biopsy of floor of mouth 0252 6.5416 $355.14 $113.41 $71.03 41110 T Excision of tongue lesion 0253 15.1698 $823.55 $282.29 $164.71 41112 T Excision of tongue lesion 0253 15.1698 $823.55 $282.29 $164.71 41113 T Excision of tongue lesion 0253 15.1698 $823.55 $282.29 $164.71 41114 T Excision of tongue lesion 0254 21.4368 $1,163.78 $321.35 $232.76 41115 T Excision of tongue fold 0252 6.5416 $355.14 $113.41 $71.03 41116 T Excision of mouth lesion 0253 15.1698 $823.55 $282.29 $164.71 41120 T Partial removal of tongue 0254 21.4368 $1,163.78 $321.35 $232.76 41130 C Partial removal of tongue 41135 C Tongue and neck surgery 41140 C Removal of tongue 41145 C Tongue removal, neck surgery 41150 C Tongue, mouth, jaw surgery 41153 C Tongue, mouth, neck surgery 41155 C Tongue, jaw, & neck surgery 41250 T Repair tongue laceration 0251 1.8643 $101.21 $20.24 41251 T Repair tongue laceration 0252 6.5416 $355.14 $113.41 $71.03 41252 T Repair tongue laceration 0252 6.5416 $355.14 $113.41 $71.03 41500 T Fixation of tongue 0254 21.4368 $1,163.78 $321.35 $232.76 41510 T Tongue to lip surgery 0253 15.1698 $823.55 $282.29 $164.71 41520 T Reconstruction, tongue fold 0252 6.5416 $355.14 $113.41 $71.03 41599 T Tongue and mouth surgery 0251 1.8643 $101.21 $20.24 41800 T Drainage of gum lesion 0251 1.8643 $101.21 $20.24 41805 T Removal foreign body, gum 0254 21.4368 $1,163.78 $321.35 $232.76 41806 T Removal foreign body,jawbone 0253 15.1698 $823.55 $282.29 $164.71 41820 T Excision, gum, each quadrant 0252 6.5416 $355.14 $113.41 $71.03 41821 T Excision of gum flap 0252 6.5416 $355.14 $113.41 $71.03 41822 T Excision of gum lesion 0253 15.1698 $823.55 $282.29 $164.71 41823 T Excision of gum lesion 0254 21.4368 $1,163.78 $321.35 $232.76 41825 T Excision of gum lesion 0253 15.1698 $823.55 $282.29 $164.71 41826 T Excision of gum lesion 0253 15.1698 $823.55 $282.29 $164.71 41827 T Excision of gum lesion 0254 21.4368 $1,163.78 $321.35 $232.76 41828 T Excision of gum lesion 0253 15.1698 $823.55 $282.29 $164.71 41830 T Removal of gum tissue 0253 15.1698 $823.55 $282.29 $164.71 41850 T Treatment of gum lesion 0253 15.1698 $823.55 $282.29 $164.71 41870 T Gum graft 0254 21.4368 $1,163.78 $321.35 $232.76 41872 T Repair gum 0253 15.1698 $823.55 $282.29 $164.71 41874 T Repair tooth socket 0254 21.4368 $1,163.78 $321.35 $232.76 41899 T Dental surgery procedure 0253 15.1698 $823.55 $282.29 $164.71 Start Printed Page 48079 42000 T Drainage mouth roof lesion 0251 1.8643 $101.21 $20.24 42100 T Biopsy roof of mouth 0252 6.5416 $355.14 $113.41 $71.03 42104 T Excision lesion, mouth roof 0253 15.1698 $823.55 $282.29 $164.71 42106 T Excision lesion, mouth roof 0253 15.1698 $823.55 $282.29 $164.71 42107 T Excision lesion, mouth roof 0254 21.4368 $1,163.78 $321.35 $232.76 42120 T Remove palate/lesion 0256 35.0866 $1,904.82 $380.96 42140 T Excision of uvula 0252 6.5416 $355.14 $113.41 $71.03 42145 T Repair palate, pharynx/uvula 0254 21.4368 $1,163.78 $321.35 $232.76 42160 T Treatment mouth roof lesion 0253 15.1698 $823.55 $282.29 $164.71 42180 T Repair palate 0251 1.8643 $101.21 $20.24 42182 T Repair palate 0256 35.0866 $1,904.82 $380.96 42200 T Reconstruct cleft palate 0256 35.0866 $1,904.82 $380.96 42205 T Reconstruct cleft palate 0256 35.0866 $1,904.82 $380.96 42210 T Reconstruct cleft palate 0256 35.0866 $1,904.82 $380.96 42215 T Reconstruct cleft palate 0256 35.0866 $1,904.82 $380.96 42220 T Reconstruct cleft palate 0256 35.0866 $1,904.82 $380.96 42225 T Reconstruct cleft palate 0256 35.0866 $1,904.82 $380.96 42226 T Lengthening of palate 0256 35.0866 $1,904.82 $380.96 42227 T Lengthening of palate 0256 35.0866 $1,904.82 $380.96 42235 T Repair palate 0253 15.1698 $823.55 $282.29 $164.71 42260 T Repair nose to lip fistula 0254 21.4368 $1,163.78 $321.35 $232.76 42280 T Preparation, palate mold 0251 1.8643 $101.21 $20.24 42281 T Insertion, palate prosthesis 0253 15.1698 $823.55 $282.29 $164.71 42299 T Palate/uvula surgery 0251 1.8643 $101.21 $20.24 42300 T Drainage of salivary gland 0253 15.1698 $823.55 $282.29 $164.71 42305 T Drainage of salivary gland 0253 15.1698 $823.55 $282.29 $164.71 42310 T Drainage of salivary gland 0251 1.8643 $101.21 $20.24 42320 T Drainage of salivary gland 0251 1.8643 $101.21 $20.24 42325 T Create salivary cyst drain 0251 1.8643 $101.21 $20.24 42326 T Create salivary cyst drain 0252 6.5416 $355.14 $113.41 $71.03 42330 T Removal of salivary stone 0253 15.1698 $823.55 $282.29 $164.71 42335 T Removal of salivary stone 0253 15.1698 $823.55 $282.29 $164.71 42340 T Removal of salivary stone 0253 15.1698 $823.55 $282.29 $164.71 42400 T Biopsy of salivary gland 0005 3.3675 $182.82 $71.59 $36.56 42405 T Biopsy of salivary gland 0253 15.1698 $823.55 $282.29 $164.71 42408 T Excision of salivary cyst 0253 15.1698 $823.55 $282.29 $164.71 42409 T Drainage of salivary cyst 0253 15.1698 $823.55 $282.29 $164.71 42410 T Excise parotid gland/lesion 0256 35.0866 $1,904.82 $380.96 42415 T Excise parotid gland/lesion 0256 35.0866 $1,904.82 $380.96 42420 T Excise parotid gland/lesion 0256 35.0866 $1,904.82 $380.96 42425 T Excise parotid gland/lesion 0256 35.0866 $1,904.82 $380.96 42426 C Excise parotid gland/lesion 42440 T Excise submaxillary gland 0256 35.0866 $1,904.82 $380.96 42450 T Excise sublingual gland 0254 21.4368 $1,163.78 $321.35 $232.76 42500 T Repair salivary duct 0254 21.4368 $1,163.78 $321.35 $232.76 42505 T Repair salivary duct 0256 35.0866 $1,904.82 $380.96 42507 T Parotid duct diversion 0256 35.0866 $1,904.82 $380.96 42508 T Parotid duct diversion 0256 35.0866 $1,904.82 $380.96 42509 T Parotid duct diversion 0256 35.0866 $1,904.82 $380.96 42510 T Parotid duct diversion 0256 35.0866 $1,904.82 $380.96 42550 N Injection for salivary x-ray 42600 T Closure of salivary fistula 0253 15.1698 $823.55 $282.29 $164.71 42650 T Dilation of salivary duct 0252 6.5416 $355.14 $113.41 $71.03 42660 T Dilation of salivary duct 0252 6.5416 $355.14 $113.41 $71.03 42665 T Ligation of salivary duct 0254 21.4368 $1,163.78 $321.35 $232.76 42699 T Salivary surgery procedure 0253 15.1698 $823.55 $282.29 $164.71 42700 T Drainage of tonsil abscess 0251 1.8643 $101.21 $20.24 42720 T Drainage of throat abscess 0253 15.1698 $823.55 $282.29 $164.71 42725 T Drainage of throat abscess 0256 35.0866 $1,904.82 $380.96 42800 T Biopsy of throat 0253 15.1698 $823.55 $282.29 $164.71 42802 T Biopsy of throat 0253 15.1698 $823.55 $282.29 $164.71 42804 T Biopsy of upper nose/throat 0253 15.1698 $823.55 $282.29 $164.71 42806 T Biopsy of upper nose/throat 0254 21.4368 $1,163.78 $321.35 $232.76 42808 T Excise pharynx lesion 0253 15.1698 $823.55 $282.29 $164.71 42809 X Remove pharynx foreign body 0340 0.6232 $33.83 $6.77 42810 T Excision of neck cyst 0254 21.4368 $1,163.78 $321.35 $232.76 Start Printed Page 48080 42815 T Excision of neck cyst 0256 35.0866 $1,904.82 $380.96 42820 T Remove tonsils and adenoids 0258 21.0273 $1,141.55 $437.25 $228.31 42821 T Remove tonsils and adenoids 0258 21.0273 $1,141.55 $437.25 $228.31 42825 T Removal of tonsils 0258 21.0273 $1,141.55 $437.25 $228.31 42826 T Removal of tonsils 0258 21.0273 $1,141.55 $437.25 $228.31 42830 T Removal of adenoids 0258 21.0273 $1,141.55 $437.25 $228.31 42831 T Removal of adenoids 0258 21.0273 $1,141.55 $437.25 $228.31 42835 T Removal of adenoids 0258 21.0273 $1,141.55 $437.25 $228.31 42836 T Removal of adenoids 0258 21.0273 $1,141.55 $437.25 $228.31 42842 T Extensive surgery of throat 0254 21.4368 $1,163.78 $321.35 $232.76 42844 T Extensive surgery of throat 0256 35.0866 $1,904.82 $380.96 42845 C Extensive surgery of throat 42860 T Excision of tonsil tags 0258 21.0273 $1,141.55 $437.25 $228.31 42870 T Excision of lingual tonsil 0258 21.0273 $1,141.55 $437.25 $228.31 42890 T Partial removal of pharynx 0256 35.0866 $1,904.82 $380.96 42892 T Revision of pharyngeal walls 0256 35.0866 $1,904.82 $380.96 42894 C Revision of pharyngeal walls 42900 T Repair throat wound 0252 6.5416 $355.14 $113.41 $71.03 42950 T Reconstruction of throat 0254 21.4368 $1,163.78 $321.35 $232.76 42953 C Repair throat, esophagus 42955 T Surgical opening of throat 0254 21.4368 $1,163.78 $321.35 $232.76 42960 T Control throat bleeding 0250 1.5381 $83.50 $29.23 $16.70 42961 C Control throat bleeding 42962 T Control throat bleeding 0256 35.0866 $1,904.82 $380.96 42970 T Control nose/throat bleeding 0250 1.5381 $83.50 $29.23 $16.70 42971 C Control nose/throat bleeding 42972 T Control nose/throat bleeding 0253 15.1698 $823.55 $282.29 $164.71 42999 T Throat surgery procedure 0252 6.5416 $355.14 $113.41 $71.03 43020 T Incision of esophagus 0252 6.5416 $355.14 $113.41 $71.03 43030 T Throat muscle surgery 0253 15.1698 $823.55 $282.29 $164.71 43045 C Incision of esophagus 43100 C Excision of esophagus lesion 43101 C Excision of esophagus lesion 43107 C Removal of esophagus 43108 C Removal of esophagus 43112 C Removal of esophagus 43113 C Removal of esophagus 43116 C Partial removal of esophagus 43117 C Partial removal of esophagus 43118 C Partial removal of esophagus 43121 C Partial removal of esophagus 43122 C Partial removal of esophagus 43123 C Partial removal of esophagus 43124 C Removal of esophagus 43130 T Removal of esophagus pouch 0254 21.4368 $1,163.78 $321.35 $232.76 43135 C Removal of esophagus pouch 43200 T Esophagus endoscopy 0141 7.8542 $426.40 $143.38 $85.28 43201 T Esoph scope w/submucous inj 0141 7.8542 $426.40 $143.38 $85.28 43202 T Esophagus endoscopy, biopsy 0141 7.8542 $426.40 $143.38 $85.28 43204 T Esoph scope w/sclerosis inj 0141 7.8542 $426.40 $143.38 $85.28 43205 T Esophagus endoscopy/ligation 0141 7.8542 $426.40 $143.38 $85.28 43215 T Esophagus endoscopy 0141 7.8542 $426.40 $143.38 $85.28 43216 T Esophagus endoscopy/lesion 0141 7.8542 $426.40 $143.38 $85.28 43217 T Esophagus endoscopy 0141 7.8542 $426.40 $143.38 $85.28 43219 T Esophagus endoscopy 0384 36.0040 $1,954.62 $424.53 $390.92 43220 T Esoph endoscopy, dilation 0141 7.8542 $426.40 $143.38 $85.28 43226 T Esoph endoscopy, dilation 0141 7.8542 $426.40 $143.38 $85.28 43227 T Esoph endoscopy, repair 0141 7.8542 $426.40 $143.38 $85.28 43228 T Esoph endoscopy, ablation 0141 7.8542 $426.40 $143.38 $85.28 43231 T Esoph endoscopy w/us exam 0141 7.8542 $426.40 $143.38 $85.28 43232 T Esoph endoscopy w/us fn bx 0141 7.8542 $426.40 $143.38 $85.28 43234 T Upper GI endoscopy, exam 0141 7.8542 $426.40 $143.38 $85.28 43235 T Uppr gi endoscopy, diagnosis 0141 7.8542 $426.40 $143.38 $85.28 43236 T Uppr gi scope w/submuc inj 0141 7.8542 $426.40 $143.38 $85.28 43239 T Upper GI endoscopy, biopsy 0141 7.8542 $426.40 $143.38 $85.28 43240 T Esoph endoscope w/drain cyst 0141 7.8542 $426.40 $143.38 $85.28 Start Printed Page 48081 43241 T Upper GI endoscopy with tube 0141 7.8542 $426.40 $143.38 $85.28 43242 T Uppr gi endoscopy w/us fn bx 0141 7.8542 $426.40 $143.38 $85.28 43243 T Upper gi endoscopy & inject 0141 7.8542 $426.40 $143.38 $85.28 43244 T Upper GI endoscopy/ligation 0141 7.8542 $426.40 $143.38 $85.28 43245 T Uppr gi scope dilate strictr 0141 7.8542 $426.40 $143.38 $85.28 43246 T Place gastrostomy tube 0141 7.8542 $426.40 $143.38 $85.28 43247 T Operative upper GI endoscopy 0141 7.8542 $426.40 $143.38 $85.28 43248 T Uppr gi endoscopy/guide wire 0141 7.8542 $426.40 $143.38 $85.28 43249 T Esoph endoscopy, dilation 0141 7.8542 $426.40 $143.38 $85.28 43250 T Upper GI endoscopy/tumor 0141 7.8542 $426.40 $143.38 $85.28 43251 T Operative upper GI endoscopy 0141 7.8542 $426.40 $143.38 $85.28 43255 T Operative upper GI endoscopy 0141 7.8542 $426.40 $143.38 $85.28 43256 T Uppr gi endoscopy w stent 0384 36.0040 $1,954.62 $424.53 $390.92 43258 T Operative upper GI endoscopy 0141 7.8542 $426.40 $143.38 $85.28 43259 T Endoscopic ultrasound exam 0141 7.8542 $426.40 $143.38 $85.28 43260 T Endo cholangiopancreatograph 0151 18.8763 $1,024.78 $245.46 $204.96 43261 T Endo cholangiopancreatograph 0151 18.8763 $1,024.78 $245.46 $204.96 43262 T Endo cholangiopancreatograph 0151 18.8763 $1,024.78 $245.46 $204.96 43263 T Endo cholangiopancreatograph 0151 18.8763 $1,024.78 $245.46 $204.96 43264 T Endo cholangiopancreatograph 0151 18.8763 $1,024.78 $245.46 $204.96 43265 T Endo cholangiopancreatograph 0151 18.8763 $1,024.78 $245.46 $204.96 43267 T Endo cholangiopancreatograph 0151 18.8763 $1,024.78 $245.46 $204.96 43268 T Endo cholangiopancreatograph 0151 18.8763 $1,024.78 $245.46 $204.96 43269 T Endo cholangiopancreatograph 0151 18.8763 $1,024.78 $245.46 $204.96 43271 T Endo cholangiopancreatograph 0151 18.8763 $1,024.78 $245.46 $204.96 43272 T Endo cholangiopancreatograph 0151 18.8763 $1,024.78 $245.46 $204.96 43280 T Laparoscopy, fundoplasty 0132 56.6318 $3,074.48 $1,239.22 $614.90 43289 T Laparoscope proc, esoph 0130 32.5959 $1,769.60 $659.53 $353.92 43300 C Repair of esophagus 43305 C Repair esophagus and fistula 43310 C Repair of esophagus 43312 C Repair esophagus and fistula 43313 C Esophagoplasty congenital 43314 C Tracheo-esophagoplasty cong 43320 C Fuse esophagus & stomach 43324 C Revise esophagus & stomach 43325 C Revise esophagus & stomach 43326 C Revise esophagus & stomach 43330 C Repair of esophagus 43331 C Repair of esophagus 43340 C Fuse esophagus & intestine 43341 C Fuse esophagus & intestine 43350 C Surgical opening, esophagus 43351 C Surgical opening, esophagus 43352 C Surgical opening, esophagus 43360 C Gastrointestinal repair 43361 C Gastrointestinal repair 43400 C Ligate esophagus veins 43401 C Esophagus surgery for veins 43405 C Ligate/staple esophagus 43410 C Repair esophagus wound 43415 C Repair esophagus wound 43420 C Repair esophagus opening 43425 C Repair esophagus opening 43450 T Dilate esophagus 0140 6.3480 $344.63 $107.24 $68.93 43453 T Dilate esophagus 0140 6.3480 $344.63 $107.24 $68.93 43456 T Dilate esophagus 0140 6.3480 $344.63 $107.24 $68.93 43458 T Dilate esophagus 0140 6.3480 $344.63 $107.24 $68.93 43460 C Pressure treatment esophagus 43496 C Free jejunum flap, microvasc 43499 T Esophagus surgery procedure 0141 7.8542 $426.40 $143.38 $85.28 43500 C Surgical opening of stomach 43501 C Surgical repair of stomach 43502 C Surgical repair of stomach 43510 C Surgical opening of stomach 43520 C Incision of pyloric muscle Start Printed Page 48082 43600 T Biopsy of stomach 0141 7.8542 $426.40 $143.38 $85.28 43605 C Biopsy of stomach 43610 C Excision of stomach lesion 43611 C Excision of stomach lesion 43620 C Removal of stomach 43621 C Removal of stomach 43622 C Removal of stomach 43631 C Removal of stomach, partial 43632 C Removal of stomach, partial 43633 C Removal of stomach, partial 43634 C Removal of stomach, partial 43635 C Removal of stomach, partial 43638 C Removal of stomach, partial 43639 C Removal of stomach, partial 43640 C Vagotomy & pylorus repair 43641 C Vagotomy & pylorus repair 43651 T Laparoscopy, vagus nerve 0132 56.6318 $3,074.48 $1,239.22 $614.90 43652 T Laparoscopy, vagus nerve 0132 56.6318 $3,074.48 $1,239.22 $614.90 43653 T Laparoscopy, gastrostomy 0131 40.8955 $2,220.18 $1,001.89 $444.04 43659 T Laparoscope proc, stom 0130 32.5959 $1,769.60 $659.53 $353.92 43750 T Place gastrostomy tube 0141 7.8542 $426.40 $143.38 $85.28 43752 E Nasal/orogastric w/stent 43760 T Change gastrostomy tube 0121 2.2058 $119.75 $43.80 $23.95 43761 T Reposition gastrostomy tube 0121 2.2058 $119.75 $43.80 $23.95 43800 C Reconstruction of pylorus 43810 C Fusion of stomach and bowel 43820 C Fusion of stomach and bowel 43825 C Fusion of stomach and bowel 43830 T Place gastrostomy tube 0141 7.8542 $426.40 $143.38 $85.28 43831 T Place gastrostomy tube 0141 7.8542 $426.40 $143.38 $85.28 43832 C Place gastrostomy tube 43840 C Repair of stomach lesion 43842 C Gastroplasty for obesity 43843 C Gastroplasty for obesity 43846 C Gastric bypass for obesity 43847 C Gastric bypass for obesity 43848 C Revision gastroplasty 43850 C Revise stomach-bowel fusion 43855 C Revise stomach-bowel fusion 43860 C Revise stomach-bowel fusion 43865 C Revise stomach-bowel fusion 43870 T Repair stomach opening 0141 7.8542 $426.40 $143.38 $85.28 43880 C Repair stomach-bowel fistula 43999 T Stomach surgery procedure 0141 7.8542 $426.40 $143.38 $85.28 44005 C Freeing of bowel adhesion 44010 C Incision of small bowel 44015 C Insert needle cath bowel 44020 C Explore small intestine 44021 C Decompress small bowel 44025 C Incision of large bowel 44050 C Reduce bowel obstruction 44055 C Correct malrotation of bowel 44100 T Biopsy of bowel 0141 7.8542 $426.40 $143.38 $85.28 44110 C Excise intestine lesion(s) 44111 C Excision of bowel lesion(s) 44120 C Removal of small intestine 44121 C Removal of small intestine 44125 C Removal of small intestine 44126 C Enterectomy w/o taper, cong 44127 C Enterectomy w/taper, cong 44128 C Enterectomy cong, add-on 44130 C Bowel to bowel fusion 44132 C Enterectomy, cadaver donor 44133 C Enterectomy, live donor 44135 C Intestine transplnt, cadaver 44136 C Intestine transplant, live Start Printed Page 48083 44139 C Mobilization of colon 44140 C Partial removal of colon 44141 C Partial removal of colon 44143 C Partial removal of colon 44144 C Partial removal of colon 44145 C Partial removal of colon 44146 C Partial removal of colon 44147 C Partial removal of colon 44150 C Removal of colon 44151 C Removal of colon/ileostomy 44152 C Removal of colon/ileostomy 44153 C Removal of colon/ileostomy 44155 C Removal of colon/ileostomy 44156 C Removal of colon/ileostomy 44160 C Removal of colon 44200 T Laparoscopy, enterolysis 0131 40.8955 $2,220.18 $1,001.89 $444.04 44201 T Laparoscopy, jejunostomy 0131 40.8955 $2,220.18 $1,001.89 $444.04 44202 C Lap resect s/intestine singl 44203 C Lap resect s/intestine, addl 44204 C Laparo partial colectomy 44205 C Lap colectomy part w/ileum 44206 T Lap part colectomy w/stoma 0132 56.6318 $3,074.48 $1,239.22 $614.90 44207 T L colectomy/coloproctostomy 0132 56.6318 $3,074.48 $1,239.22 $614.90 44208 T L colectomy/coloproctostomy 0132 56.6318 $3,074.48 $1,239.22 $614.90 44210 C Laparo total proctocolectomy 44211 C Laparo total proctocolectomy 44212 C Laparo total proctocolectomy 44238 T Laparoscope proc, intestine 0130 32.5959 $1,769.60 $659.53 $353.92 44239 T Laparoscope proc, rectum 0130 32.5959 $1,769.60 $659.53 $353.92 44300 C Open bowel to skin 44310 C Ileostomy/jejunostomy 44312 T Revision of ileostomy 0027 15.8319 $859.50 $329.72 $171.90 44314 C Revision of ileostomy 44316 C Devise bowel pouch 44320 C Colostomy 44322 C Colostomy with biopsies 44340 T Revision of colostomy 0027 15.8319 $859.50 $329.72 $171.90 44345 C Revision of colostomy 44346 C Revision of colostomy 44360 T Small bowel endoscopy 0142 9.0138 $489.35 $152.78 $97.87 44361 T Small bowel endoscopy/biopsy 0142 9.0138 $489.35 $152.78 $97.87 44363 T Small bowel endoscopy 0142 9.0138 $489.35 $152.78 $97.87 44364 T Small bowel endoscopy 0142 9.0138 $489.35 $152.78 $97.87 44365 T Small bowel endoscopy 0142 9.0138 $489.35 $152.78 $97.87 44366 T Small bowel endoscopy 0142 9.0138 $489.35 $152.78 $97.87 44369 T Small bowel endoscopy 0142 9.0138 $489.35 $152.78 $97.87 44370 T Small bowel endoscopy/stent 0384 36.0040 $1,954.62 $424.53 $390.92 44372 T Small bowel endoscopy 0142 9.0138 $489.35 $152.78 $97.87 44373 T Small bowel endoscopy 0142 9.0138 $489.35 $152.78 $97.87 44376 T Small bowel endoscopy 0142 9.0138 $489.35 $152.78 $97.87 44377 T Small bowel endoscopy/biopsy 0142 9.0138 $489.35 $152.78 $97.87 44378 T Small bowel endoscopy 0142 9.0138 $489.35 $152.78 $97.87 44379 T S bowel endoscope w/stent 0384 36.0040 $1,954.62 $424.53 $390.92 44380 T Small bowel endoscopy 0142 9.0138 $489.35 $152.78 $97.87 44382 T Small bowel endoscopy 0142 9.0138 $489.35 $152.78 $97.87 44383 T Ileoscopy w/stent 0384 36.0040 $1,954.62 $424.53 $390.92 44385 T Endoscopy of bowel pouch 0143 8.3227 $451.83 $186.06 $90.37 44386 T Endoscopy, bowel pouch/biop 0143 8.3227 $451.83 $186.06 $90.37 44388 T Colon endoscopy 0143 8.3227 $451.83 $186.06 $90.37 44389 T Colonoscopy with biopsy 0143 8.3227 $451.83 $186.06 $90.37 44390 T Colonoscopy for foreign body 0143 8.3227 $451.83 $186.06 $90.37 44391 T Colonoscopy for bleeding 0143 8.3227 $451.83 $186.06 $90.37 44392 T Colonoscopy & polypectomy 0143 8.3227 $451.83 $186.06 $90.37 44393 T Colonoscopy, lesion removal 0143 8.3227 $451.83 $186.06 $90.37 44394 T Colonoscopy w/snare 0143 8.3227 $451.83 $186.06 $90.37 44397 T Colonoscopy w/stent 0384 36.0040 $1,954.62 $424.53 $390.92 Start Printed Page 48084 44500 T Intro, gastrointestinal tube 0121 2.2058 $119.75 $43.80 $23.95 44602 C Suture, small intestine 44603 C Suture, small intestine 44604 C Suture, large intestine 44605 C Repair of bowel lesion 44615 C Intestinal stricturoplasty 44620 C Repair bowel opening 44625 C Repair bowel opening 44626 C Repair bowel opening 44640 C Repair bowel-skin fistula 44650 C Repair bowel fistula 44660 C Repair bowel-bladder fistula 44661 C Repair bowel-bladder fistula 44680 C Surgical revision, intestine 44700 C Suspend bowel w/prosthesis 44701 N Intraop colon lavage add-on 44799 T Intestine surgery procedure 0142 9.0138 $489.35 $152.78 $97.87 44800 C Excision of bowel pouch 44820 C Excision of mesentery lesion 44850 C Repair of mesentery 44899 C Bowel surgery procedure 44900 C Drain app abscess, open 44901 C Drain app abscess, percut 44950 C Appendectomy 44955 C Appendectomy add-on 44960 C Appendectomy 44970 T Laparoscopy, appendectomy 0130 32.5959 $1,769.60 $659.53 $353.92 44979 T Laparoscope proc, app 0130 32.5959 $1,769.60 $659.53 $353.92 45000 T Drainage of pelvic abscess 0149 16.8557 $915.08 $293.06 $183.02 45005 T Drainage of rectal abscess 0148 4.1171 $223.51 $63.38 $44.70 45020 T Drainage of rectal abscess 0149 16.8557 $915.08 $293.06 $183.02 45100 T Biopsy of rectum 0149 16.8557 $915.08 $293.06 $183.02 45108 T Removal of anorectal lesion 0150 22.2565 $1,208.28 $437.12 $241.66 45110 C Removal of rectum 45111 C Partial removal of rectum 45112 C Removal of rectum 45113 C Partial proctectomy 45114 C Partial removal of rectum 45116 C Partial removal of rectum 45119 C Remove rectum w/reservoir 45120 C Removal of rectum 45121 C Removal of rectum and colon 45123 C Partial proctectomy 45126 C Pelvic exenteration 45130 C Excision of rectal prolapse 45135 C Excision of rectal prolapse 45136 C Excise ileoanal reservior 45150 T Excision of rectal stricture 0150 22.2565 $1,208.28 $437.12 $241.66 45160 T Excision of rectal lesion 0150 22.2565 $1,208.28 $437.12 $241.66 45170 T Excision of rectal lesion 0150 22.2565 $1,208.28 $437.12 $241.66 45190 T Destruction, rectal tumor 0150 22.2565 $1,208.28 $437.12 $241.66 45300 T Proctosigmoidoscopy dx 0146 3.9986 $217.08 $64.40 $43.42 45303 T Proctosigmoidoscopy dilate 0146 3.9986 $217.08 $64.40 $43.42 45305 T Proctosigmoidoscopy w/bx 0146 3.9986 $217.08 $64.40 $43.42 45307 T Proctosigmoidoscopy fb 0146 3.9986 $217.08 $64.40 $43.42 45308 T Proctosigmoidoscopy removal 0147 7.5876 $411.92 $82.38 45309 T Proctosigmoidoscopy removal 0147 7.5876 $411.92 $82.38 45315 T Proctosigmoidoscopy removal 0147 7.5876 $411.92 $82.38 45317 T Proctosigmoidoscopy bleed 0146 3.9986 $217.08 $64.40 $43.42 45320 T Proctosigmoidoscopy ablate 0147 7.5876 $411.92 $82.38 45321 T Proctosigmoidoscopy volvul 0147 7.5876 $411.92 $82.38 45327 T Proctosigmoidoscopy w/stent 0384 36.0040 $1,954.62 $424.53 $390.92 45330 T Diagnostic sigmoidoscopy 0146 3.9986 $217.08 $64.40 $43.42 45331 T Sigmoidoscopy and biopsy 0146 3.9986 $217.08 $64.40 $43.42 45332 T Sigmoidoscopy w/fb removal 0146 3.9986 $217.08 $64.40 $43.42 45333 T Sigmoidoscopy & polypectomy 0147 7.5876 $411.92 $82.38 Start Printed Page 48085 45334 T Sigmoidoscopy for bleeding 0147 7.5876 $411.92 $82.38 45335 T Sigmoidoscope w/submuc inj 0147 7.5876 $411.92 $82.38 45337 T Sigmoidoscopy & decompress 0147 7.5876 $411.92 $82.38 45338 T Sigmoidoscpy w/tumr remove 0147 7.5876 $411.92 $82.38 45339 T Sigmoidoscopy w/ablate tumr 0147 7.5876 $411.92 $82.38 45340 T Sig w/balloon dilation 0147 7.5876 $411.92 $82.38 45341 T Sigmoidoscopy w/ultrasound 0147 7.5876 $411.92 $82.38 45342 T Sigmoidoscopy w/us guide bx 0147 7.5876 $411.92 $82.38 45345 T Sigmoidoscopy w/stent 0384 36.0040 $1,954.62 $424.53 $390.92 45355 T Surgical colonoscopy 0143 8.3227 $451.83 $186.06 $90.37 45378 T Diagnostic colonoscopy 0143 8.3227 $451.83 $186.06 $90.37 45379 T Colonoscopy w/fb removal 0143 8.3227 $451.83 $186.06 $90.37 45380 T Colonoscopy and biopsy 0143 8.3227 $451.83 $186.06 $90.37 45381 T Colonoscope, submucous inj 0143 8.3227 $451.83 $186.06 $90.37 45382 T Colonoscopy/control bleeding 0143 8.3227 $451.83 $186.06 $90.37 45383 T Lesion removal colonoscopy 0143 8.3227 $451.83 $186.06 $90.37 45384 T Lesion remove colonoscopy 0143 8.3227 $451.83 $186.06 $90.37 45385 T Lesion removal colonoscopy 0143 8.3227 $451.83 $186.06 $90.37 45386 T Colonoscope dilate stricture 0143 8.3227 $451.83 $186.06 $90.37 45387 T Colonoscopy w/stent 0384 36.0040 $1,954.62 $424.53 $390.92 45500 T Repair of rectum 0150 22.2565 $1,208.28 $437.12 $241.66 45505 T Repair of rectum 0150 22.2565 $1,208.28 $437.12 $241.66 45520 T Treatment of rectal prolapse 0098 1.1630 $63.14 $15.17 $12.63 45540 C Correct rectal prolapse 45541 C Correct rectal prolapse 45550 C Repair rectum/remove sigmoid 45560 T Repair of rectocele 0150 22.2565 $1,208.28 $437.12 $241.66 45562 C Exploration/repair of rectum 45563 C Exploration/repair of rectum 45800 C Repair rect/bladder fistula 45805 C Repair fistula w/colostomy 45820 C Repair rectourethral fistula 45825 C Repair fistula w/colostomy 45900 T Reduction of rectal prolapse 0148 4.1171 $223.51 $63.38 $44.70 45905 T Dilation of anal sphincter 0149 16.8557 $915.08 $293.06 $183.02 45910 T Dilation of rectal narrowing 0149 16.8557 $915.08 $293.06 $183.02 45915 T Remove rectal obstruction 0148 4.1171 $223.51 $63.38 $44.70 45999 T Rectum surgery procedure 0148 4.1171 $223.51 $63.38 $44.70 46020 T Placement of seton 0148 4.1171 $223.51 $63.38 $44.70 46030 T Removal of rectal marker 0148 4.1171 $223.51 $63.38 $44.70 46040 T Incision of rectal abscess 0149 16.8557 $915.08 $293.06 $183.02 46045 T Incision of rectal abscess 0150 22.2565 $1,208.28 $437.12 $241.66 46050 T Incision of anal abscess 0148 4.1171 $223.51 $63.38 $44.70 46060 T Incision of rectal abscess 0150 22.2565 $1,208.28 $437.12 $241.66 46070 T Incision of anal septum 0155 9.9148 $538.26 $188.89 $107.65 46080 T Incision of anal sphincter 0149 16.8557 $915.08 $293.06 $183.02 46083 T Incise external hemorrhoid 0148 4.1171 $223.51 $63.38 $44.70 46200 T Removal of anal fissure 0150 22.2565 $1,208.28 $437.12 $241.66 46210 T Removal of anal crypt 0149 16.8557 $915.08 $293.06 $183.02 46211 T Removal of anal crypts 0150 22.2565 $1,208.28 $437.12 $241.66 46220 T Removal of anal tag 0149 16.8557 $915.08 $293.06 $183.02 46221 T Ligation of hemorrhoid(s) 0148 4.1171 $223.51 $63.38 $44.70 46230 T Removal of anal tags 0149 16.8557 $915.08 $293.06 $183.02 46250 T Hemorrhoidectomy 0150 22.2565 $1,208.28 $437.12 $241.66 46255 T Hemorrhoidectomy 0150 22.2565 $1,208.28 $437.12 $241.66 46257 T Remove hemorrhoids & fissure 0150 22.2565 $1,208.28 $437.12 $241.66 46258 T Remove hemorrhoids & fistula 0150 22.2565 $1,208.28 $437.12 $241.66 46260 T Hemorrhoidectomy 0150 22.2565 $1,208.28 $437.12 $241.66 46261 T Remove hemorrhoids & fissure 0150 22.2565 $1,208.28 $437.12 $241.66 46262 T Remove hemorrhoids & fistula 0150 22.2565 $1,208.28 $437.12 $241.66 46270 T Removal of anal fistula 0150 22.2565 $1,208.28 $437.12 $241.66 46275 T Removal of anal fistula 0150 22.2565 $1,208.28 $437.12 $241.66 46280 T Removal of anal fistula 0150 22.2565 $1,208.28 $437.12 $241.66 46285 T Removal of anal fistula 0150 22.2565 $1,208.28 $437.12 $241.66 46288 T Repair anal fistula 0150 22.2565 $1,208.28 $437.12 $241.66 46320 T Removal of hemorrhoid clot 0148 4.1171 $223.51 $63.38 $44.70 Start Printed Page 48086 46500 T Injection into hemorrhoid(s) 0155 9.9148 $538.26 $188.89 $107.65 46600 X Diagnostic anoscopy 0340 0.6232 $33.83 $6.77 46604 T Anoscopy and dilation 0147 7.5876 $411.92 $82.38 46606 T Anoscopy and biopsy 0147 7.5876 $411.92 $82.38 46608 T Anoscopy, remove for body 0147 7.5876 $411.92 $82.38 46610 T Anoscopy, remove lesion 0147 7.5876 $411.92 $82.38 46611 T Anoscopy 0147 7.5876 $411.92 $82.38 46612 T Anoscopy, remove lesions 0147 7.5876 $411.92 $82.38 46614 T Anoscopy, control bleeding 0147 7.5876 $411.92 $82.38 46615 T Anoscopy 0147 7.5876 $411.92 $82.38 46700 T Repair of anal stricture 0150 22.2565 $1,208.28 $437.12 $241.66 46705 C Repair of anal stricture 46706 T Repr of anal fistula w/glue 0148 4.1171 $223.51 $63.38 $44.70 46715 C Repair of anovaginal fistula 46716 C Repair of anovaginal fistula 46730 C Construction of absent anus 46735 C Construction of absent anus 46740 C Construction of absent anus 46742 C Repair of imperforated anus 46744 C Repair of cloacal anomaly 46746 C Repair of cloacal anomaly 46748 C Repair of cloacal anomaly 46750 T Repair of anal sphincter 0150 22.2565 $1,208.28 $437.12 $241.66 46751 C Repair of anal sphincter 46753 T Reconstruction of anus 0150 22.2565 $1,208.28 $437.12 $241.66 46754 T Removal of suture from anus 0149 16.8557 $915.08 $293.06 $183.02 46760 T Repair of anal sphincter 0150 22.2565 $1,208.28 $437.12 $241.66 46761 T Repair of anal sphincter 0150 22.2565 $1,208.28 $437.12 $241.66 46762 T Implant artificial sphincter 0150 22.2565 $1,208.28 $437.12 $241.66 46900 T Destruction, anal lesion(s) 0016 2.7343 $148.44 $57.31 $29.69 46910 T Destruction, anal lesion(s) 0017 16.7332 $908.43 $227.84 $181.69 46916 T Cryosurgery, anal lesion(s) 0013 1.1420 $62.00 $14.20 $12.40 46917 T Laser surgery, anal lesions 0695 19.1377 $1,038.97 $266.59 $207.79 46922 T Excision of anal lesion(s) 0695 19.1377 $1,038.97 $266.59 $207.79 46924 T Destruction, anal lesion(s) 0695 19.1377 $1,038.97 $266.59 $207.79 46934 T Destruction of hemorrhoids 0155 9.9148 $538.26 $188.89 $107.65 46935 T Destruction of hemorrhoids 0155 9.9148 $538.26 $188.89 $107.65 46936 T Destruction of hemorrhoids 0149 16.8557 $915.08 $293.06 $183.02 46937 T Cryotherapy of rectal lesion 0149 16.8557 $915.08 $293.06 $183.02 46938 T Cryotherapy of rectal lesion 0150 22.2565 $1,208.28 $437.12 $241.66 46940 T Treatment of anal fissure 0149 16.8557 $915.08 $293.06 $183.02 46942 T Treatment of anal fissure 0148 4.1171 $223.51 $63.38 $44.70 46945 T Ligation of hemorrhoids 0155 9.9148 $538.26 $188.89 $107.65 46946 T Ligation of hemorrhoids 0155 9.9148 $538.26 $188.89 $107.65 46999 T Anus surgery procedure 0148 4.1171 $223.51 $63.38 $44.70 47000 T Needle biopsy of liver 0685 4.8912 $265.54 $116.83 $53.11 47001 N Needle biopsy, liver add-on 47010 C Open drainage, liver lesion 47011 T Percut drain, liver lesion 0005 3.3675 $182.82 $71.59 $36.56 47015 C Inject/aspirate liver cyst 47100 C Wedge biopsy of liver 47120 C Partial removal of liver 47122 C Extensive removal of liver 47125 C Partial removal of liver 47130 C Partial removal of liver 47133 C Removal of donor liver 47134 C Partial removal, donor liver 47135 C Transplantation of liver 47136 C Transplantation of liver 47300 C Surgery for liver lesion 47350 C Repair liver wound 47360 C Repair liver wound 47361 C Repair liver wound 47362 C Repair liver wound 47370 T Laparo ablate liver tumor rf 0130 32.5959 $1,769.60 $659.53 $353.92 47371 T Laparo ablate liver cryosurg 0130 32.5959 $1,769.60 $659.53 $353.92 Start Printed Page 48087 47379 T Laparoscope procedure, liver 0130 32.5959 $1,769.60 $659.53 $353.92 47380 C Open ablate liver tumor rf 47381 C Open ablate liver tumor cryo 47382 T Percut ablate liver rf 1557 $1,850.00 $370.00 47399 T Liver surgery procedure 0005 3.3675 $182.82 $71.59 $36.56 47400 C Incision of liver duct 47420 C Incision of bile duct 47425 C Incision of bile duct 47460 C Incise bile duct sphincter 47480 C Incision of gallbladder 47490 T Incision of gallbladder 0152 8.2940 $450.27 $113.02 $90.05 47500 N Injection for liver x-rays 47505 N Injection for liver x-rays 47510 T Insert catheter, bile duct 0152 8.2940 $450.27 $113.02 $90.05 47511 T Insert bile duct drain 0152 8.2940 $450.27 $113.02 $90.05 47525 T Change bile duct catheter 0122 8.4398 $458.19 $93.97 $91.64 47530 T Revise/reinsert bile tube 0122 8.4398 $458.19 $93.97 $91.64 47550 C Bile duct endoscopy add-on 47552 T Biliary endoscopy thru skin 0152 8.2940 $450.27 $113.02 $90.05 47553 T Biliary endoscopy thru skin 0152 8.2940 $450.27 $113.02 $90.05 47554 T Biliary endoscopy thru skin 0152 8.2940 $450.27 $113.02 $90.05 47555 T Biliary endoscopy thru skin 0152 8.2940 $450.27 $113.02 $90.05 47556 T Biliary endoscopy thru skin 0152 8.2940 $450.27 $113.02 $90.05 47560 T Laparoscopy w/cholangio 0130 32.5959 $1,769.60 $659.53 $353.92 47561 T Laparo w/cholangio/biopsy 0130 32.5959 $1,769.60 $659.53 $353.92 47562 T Laparoscopic cholecystectomy 0131 40.8955 $2,220.18 $1,001.89 $444.04 47563 T Laparo cholecystectomy/graph 0131 40.8955 $2,220.18 $1,001.89 $444.04 47564 T Laparo cholecystectomy/explr 0131 40.8955 $2,220.18 $1,001.89 $444.04 47570 C Laparo cholecystoenterostomy 47579 T Laparoscope proc, biliary 0130 32.5959 $1,769.60 $659.53 $353.92 47600 C Removal of gallbladder 47605 C Removal of gallbladder 47610 C Removal of gallbladder 47612 C Removal of gallbladder 47620 C Removal of gallbladder 47630 T Remove bile duct stone 0152 8.2940 $450.27 $113.02 $90.05 47700 C Exploration of bile ducts 47701 C Bile duct revision 47711 C Excision of bile duct tumor 47712 C Excision of bile duct tumor 47715 C Excision of bile duct cyst 47716 C Fusion of bile duct cyst 47720 C Fuse gallbladder & bowel 47721 C Fuse upper gi structures 47740 C Fuse gallbladder & bowel 47741 C Fuse gallbladder & bowel 47760 C Fuse bile ducts and bowel 47765 C Fuse liver ducts & bowel 47780 C Fuse bile ducts and bowel 47785 C Fuse bile ducts and bowel 47800 C Reconstruction of bile ducts 47801 C Placement, bile duct support 47802 C Fuse liver duct & intestine 47900 C Suture bile duct injury 47999 T Bile tract surgery procedure 0152 8.2940 $450.27 $113.02 $90.05 48000 C Drainage of abdomen 48001 C Placement of drain, pancreas 48005 C Resect/debride pancreas 48020 C Removal of pancreatic stone 48100 C Biopsy of pancreas, open 48102 T Needle biopsy, pancreas 0685 4.8912 $265.54 $116.83 $53.11 48120 C Removal of pancreas lesion 48140 C Partial removal of pancreas 48145 C Partial removal of pancreas 48146 C Pancreatectomy 48148 C Removal of pancreatic duct Start Printed Page 48088 48150 C Partial removal of pancreas 48152 C Pancreatectomy 48153 C Pancreatectomy 48154 C Pancreatectomy 48155 C Removal of pancreas 48160 E Pancreas removal/transplant 48180 C Fuse pancreas and bowel 48400 C Injection, intraop add-on 48500 C Surgery of pancreatic cyst 48510 C Drain pancreatic pseudocyst 48511 T Drain pancreatic pseudocyst 0005 3.3675 $182.82 $71.59 $36.56 48520 C Fuse pancreas cyst and bowel 48540 C Fuse pancreas cyst and bowel 48545 C Pancreatorrhaphy 48547 C Duodenal exclusion 48550 E Donor pancreatectomy 48554 E Transpl allograft pancreas 48556 C Removal, allograft pancreas 48999 T Pancreas surgery procedure 0005 3.3675 $182.82 $71.59 $36.56 49000 C Exploration of abdomen 49002 C Reopening of abdomen 49010 C Exploration behind abdomen 49020 C Drain abdominal abscess 49021 C Drain abdominal abscess 49040 C Drain, open, abdom abscess 49041 C Drain, percut, abdom abscess 49060 C Drain, open, retrop abscess 49061 C Drain, percut, retroper absc 49062 C Drain to peritoneal cavity 49080 T Puncture, peritoneal cavity 0070 3.1393 $170.43 $34.09 49081 T Removal of abdominal fluid 0070 3.1393 $170.43 $34.09 49085 T Remove abdomen foreign body 0153 21.2745 $1,154.97 $410.87 $230.99 49180 T Biopsy, abdominal mass 0685 4.8912 $265.54 $116.83 $53.11 49200 T Removal of abdominal lesion 0130 32.5959 $1,769.60 $659.53 $353.92 49201 C Remove abdom lesion, complex 49215 C Excise sacral spine tumor 49220 C Multiple surgery, abdomen 49250 T Excision of umbilicus 0153 21.2745 $1,154.97 $410.87 $230.99 49255 C Removal of omentum 49320 T Diag laparo separate proc 0130 32.5959 $1,769.60 $659.53 $353.92 49321 T Laparoscopy, biopsy 0130 32.5959 $1,769.60 $659.53 $353.92 49322 T Laparoscopy, aspiration 0130 32.5959 $1,769.60 $659.53 $353.92 49323 T Laparo drain lymphocele 0130 32.5959 $1,769.60 $659.53 $353.92 49329 T Laparo proc, abdm/per/oment 0130 32.5959 $1,769.60 $659.53 $353.92 49400 N Air injection into abdomen 49419 T Insrt abdom cath for chemotx 0119 129.8988 $7,052.08 $1,410.42 49420 T Insert abdom drain, temp 0652 28.0692 $1,523.85 $304.77 49421 T Insert abdom drain, perm 0652 28.0692 $1,523.85 $304.77 49422 T Remove perm cannula/catheter 0105 18.9084 $1,026.52 $370.40 $205.30 49423 T Exchange drainage catheter 0152 8.2940 $450.27 $113.02 $90.05 49424 N Assess cyst, contrast inject 49425 C Insert abdomen-venous drain 49426 T Revise abdomen-venous shunt 0153 21.2745 $1,154.97 $410.87 $230.99 49427 N Injection, abdominal shunt 49428 C Ligation of shunt 49429 T Removal of shunt 0105 18.9084 $1,026.52 $370.40 $205.30 49491 T Rpr hern preemie reduc 0154 26.8861 $1,459.62 $464.85 $291.92 49492 T Rpr ing hern premie, blocked 0154 26.8861 $1,459.62 $464.85 $291.92 49495 T Rpr ing hernia baby, reduc 0154 26.8861 $1,459.62 $464.85 $291.92 49496 T Rpr ing hernia baby, blocked 0154 26.8861 $1,459.62 $464.85 $291.92 49500 T Rpr ing hernia, init, reduce 0154 26.8861 $1,459.62 $464.85 $291.92 49501 T Rpr ing hernia, init blocked 0154 26.8861 $1,459.62 $464.85 $291.92 49505 T Prp i/hern init reduc>5 yr 0154 26.8861 $1,459.62 $464.85 $291.92 49507 T Prp i/hern init block>5 yr 0154 26.8861 $1,459.62 $464.85 $291.92 49520 T Rerepair ing hernia, reduce 0154 26.8861 $1,459.62 $464.85 $291.92 49521 T Rerepair ing hernia, blocked 0154 26.8861 $1,459.62 $464.85 $291.92 Start Printed Page 48089 49525 T Repair ing hernia, sliding 0154 26.8861 $1,459.62 $464.85 $291.92 49540 T Repair lumbar hernia 0154 26.8861 $1,459.62 $464.85 $291.92 49550 T Rpr rem hernia, init, reduce 0154 26.8861 $1,459.62 $464.85 $291.92 49553 T Rpr fem hernia, init blocked 0154 26.8861 $1,459.62 $464.85 $291.92 49555 T Rerepair fem hernia, reduce 0154 26.8861 $1,459.62 $464.85 $291.92 49557 T Rerepair fem hernia, blocked 0154 26.8861 $1,459.62 $464.85 $291.92 49560 T Rpr ventral hern init, reduc 0154 26.8861 $1,459.62 $464.85 $291.92 49561 T Rpr ventral hern init, block 0154 26.8861 $1,459.62 $464.85 $291.92 49565 T Rerepair ventrl hern, reduce 0154 26.8861 $1,459.62 $464.85 $291.92 49566 T Rerepair ventrl hern, block 0154 26.8861 $1,459.62 $464.85 $291.92 49568 T Hernia repair w/mesh 0154 26.8861 $1,459.62 $464.85 $291.92 49570 T Rpr epigastric hern, reduce 0154 26.8861 $1,459.62 $464.85 $291.92 49572 T Rpr epigastric hern, blocked 0154 26.8861 $1,459.62 $464.85 $291.92 49580 T Rpr umbil hern, reduc < 5 yr 0154 26.8861 $1,459.62 $464.85 $291.92 49582 T Rpr umbil hern, block < 5 yr 0154 26.8861 $1,459.62 $464.85 $291.92 49585 T Rpr umbil hern, reduc > 5 yr 0154 26.8861 $1,459.62 $464.85 $291.92 49587 T Rpr umbil hern, block > 5 yr 0154 26.8861 $1,459.62 $464.85 $291.92 49590 T Repair spigilian hernia 0154 26.8861 $1,459.62 $464.85 $291.92 49600 T Repair umbilical lesion 0154 26.8861 $1,459.62 $464.85 $291.92 49605 C Repair umbilical lesion 49606 C Repair umbilical lesion 49610 C Repair umbilical lesion 49611 C Repair umbilical lesion 49650 T Laparo hernia repair initial 0131 40.8955 $2,220.18 $1,001.89 $444.04 49651 T Laparo hernia repair recur 0131 40.8955 $2,220.18 $1,001.89 $444.04 49659 T Laparo proc, hernia repair 0131 40.8955 $2,220.18 $1,001.89 $444.04 49900 C Repair of abdominal wall 49904 C Omental flap, extra-abdom 49905 C Omental flap 49906 C Free omental flap, microvasc 49999 T Abdomen surgery procedure 0153 21.2745 $1,154.97 $410.87 $230.99 50010 C Exploration of kidney 50020 C Renal abscess, open drain 50021 T Renal abscess, percut drain 0005 3.3675 $182.82 $71.59 $36.56 50040 C Drainage of kidney 50045 C Exploration of kidney 50060 C Removal of kidney stone 50065 C Incision of kidney 50070 C Incision of kidney 50075 C Removal of kidney stone 50080 T Removal of kidney stone 0163 33.6435 $1,826.47 $365.29 50081 T Removal of kidney stone 0163 33.6435 $1,826.47 $365.29 50100 C Revise kidney blood vessels 50120 C Exploration of kidney 50125 C Explore and drain kidney 50130 C Removal of kidney stone 50135 C Exploration of kidney 50200 T Biopsy of kidney 0685 4.8912 $265.54 $116.83 $53.11 50205 C Biopsy of kidney 50220 C Remove kidney, open 50225 C Removal kidney open, complex 50230 C Removal kidney open, radical 50234 C Removal of kidney & ureter 50236 C Removal of kidney & ureter 50240 C Partial removal of kidney 50280 C Removal of kidney lesion 50290 C Removal of kidney lesion 50300 C Removal of donor kidney 50320 C Removal of donor kidney 50340 C Removal of kidney 50360 C Transplantation of kidney 50365 C Transplantation of kidney 50370 C Remove transplanted kidney 50380 C Reimplantation of kidney 50390 T Drainage of kidney lesion 0685 4.8912 $265.54 $116.83 $53.11 50392 T Insert kidney drain 0161 16.5822 $900.23 $249.36 $180.05 Start Printed Page 48090 50393 T Insert ureteral tube 0161 16.5822 $900.23 $249.36 $180.05 50394 N Injection for kidney x-ray 50395 T Create passage to kidney 0161 16.5822 $900.23 $249.36 $180.05 50396 T Measure kidney pressure 0164 1.2115 $65.77 $17.59 $13.15 50398 T Change kidney tube 0122 8.4398 $458.19 $93.97 $91.64 50400 C Revision of kidney/ureter 50405 C Revision of kidney/ureter 50500 C Repair of kidney wound 50520 C Close kidney-skin fistula 50525 C Repair renal-abdomen fistula 50526 C Repair renal-abdomen fistula 50540 C Revision of horseshoe kidney 50541 T Laparo ablate renal cyst 0130 32.5959 $1,769.60 $659.53 $353.92 50542 T Laparo ablate renal mass 0131 40.8955 $2,220.18 $1,001.89 $444.04 50543 T Laparo partial nephrectomy 0131 40.8955 $2,220.18 $1,001.89 $444.04 50544 T Laparoscopy, pyeloplasty 0130 32.5959 $1,769.60 $659.53 $353.92 50545 C Laparo radical nephrectomy 50546 C Laparoscopic nephrectomy 50547 C Laparo removal donor kidney 50548 C Laparo remove k/ureter 50549 T Laparoscope proc, renal 0130 32.5959 $1,769.60 $659.53 $353.92 50551 T Kidney endoscopy 0160 6.8152 $369.99 $105.06 $74.00 50553 T Kidney endoscopy 0161 16.5822 $900.23 $249.36 $180.05 50555 T Kidney endoscopy & biopsy 0160 6.8152 $369.99 $105.06 $74.00 50557 T Kidney endoscopy & treatment 0162 21.8578 $1,186.64 $237.33 50559 T Renal endoscopy/radiotracer 0160 6.8152 $369.99 $105.06 $74.00 50561 T Kidney endoscopy & treatment 0161 16.5822 $900.23 $249.36 $180.05 50562 T Renal scope w/tumor resect 0160 6.8152 $369.99 $105.06 $74.00 50570 C Kidney endoscopy 50572 C Kidney endoscopy 50574 C Kidney endoscopy & biopsy 50575 C Kidney endoscopy 50576 C Kidney endoscopy & treatment 50578 C Renal endoscopy/radiotracer 50580 C Kidney endoscopy & treatment 50590 T Fragmenting of kidney stone 0169 44.5329 $2,417.65 $1,115.69 $483.53 50600 C Exploration of ureter 50605 C Insert ureteral support 50610 C Removal of ureter stone 50620 C Removal of ureter stone 50630 C Removal of ureter stone 50650 C Removal of ureter 50660 C Removal of ureter 50684 N Injection for ureter x-ray 50686 T Measure ureter pressure 0164 1.2115 $65.77 $17.59 $13.15 50688 T Change of ureter tube 0122 8.4398 $458.19 $93.97 $91.64 50690 N Injection for ureter x-ray 50700 C Revision of ureter 50715 C Release of ureter 50722 C Release of ureter 50725 C Release/revise ureter 50727 C Revise ureter 50728 C Revise ureter 50740 C Fusion of ureter & kidney 50750 C Fusion of ureter & kidney 50760 C Fusion of ureters 50770 C Splicing of ureters 50780 C Reimplant ureter in bladder 50782 C Reimplant ureter in bladder 50783 C Reimplant ureter in bladder 50785 C Reimplant ureter in bladder 50800 C Implant ureter in bowel 50810 C Fusion of ureter & bowel 50815 C Urine shunt to intestine 50820 C Construct bowel bladder 50825 C Construct bowel bladder Start Printed Page 48091 50830 C Revise urine flow 50840 C Replace ureter by bowel 50845 C Appendico-vesicostomy 50860 C Transplant ureter to skin 50900 C Repair of ureter 50920 C Closure ureter/skin fistula 50930 C Closure ureter/bowel fistula 50940 C Release of ureter 50945 T Laparoscopy ureterolithotomy 0131 40.8955 $2,220.18 $1,001.89 $444.04 50947 T Laparo new ureter/bladder 0131 40.8955 $2,220.18 $1,001.89 $444.04 50948 T Laparo new ureter/bladder 0131 40.8955 $2,220.18 $1,001.89 $444.04 50949 T Laparoscope proc, ureter 0130 32.5959 $1,769.60 $659.53 $353.92 50951 T Endoscopy of ureter 0160 6.8152 $369.99 $105.06 $74.00 50953 T Endoscopy of ureter 0160 6.8152 $369.99 $105.06 $74.00 50955 T Ureter endoscopy & biopsy 0161 16.5822 $900.23 $249.36 $180.05 50957 T Ureter endoscopy & treatment 0161 16.5822 $900.23 $249.36 $180.05 50959 T Ureter endoscopy & tracer 0161 16.5822 $900.23 $249.36 $180.05 50961 T Ureter endoscopy & treatment 0161 16.5822 $900.23 $249.36 $180.05 50970 T Ureter endoscopy 0160 6.8152 $369.99 $105.06 $74.00 50972 T Ureter endoscopy & catheter 0160 6.8152 $369.99 $105.06 $74.00 50974 T Ureter endoscopy & biopsy 0161 16.5822 $900.23 $249.36 $180.05 50976 T Ureter endoscopy & treatment 0161 16.5822 $900.23 $249.36 $180.05 50978 T Ureter endoscopy & tracer 0161 16.5822 $900.23 $249.36 $180.05 50980 T Ureter endoscopy & treatment 0161 16.5822 $900.23 $249.36 $180.05 51000 T Drainage of bladder 0165 14.0780 $764.28 $152.86 51005 T Drainage of bladder 0164 1.2115 $65.77 $17.59 $13.15 51010 T Drainage of bladder 0165 14.0780 $764.28 $152.86 51020 T Incise & treat bladder 0162 21.8578 $1,186.64 $237.33 51030 T Incise & treat bladder 0162 21.8578 $1,186.64 $237.33 51040 T Incise & drain bladder 0162 21.8578 $1,186.64 $237.33 51045 T Incise bladder/drain ureter 0160 6.8152 $369.99 $105.06 $74.00 51050 T Removal of bladder stone 0162 21.8578 $1,186.64 $237.33 51060 C Removal of ureter stone 51065 T Remove ureter calculus 0162 21.8578 $1,186.64 $237.33 51080 T Drainage of bladder abscess 0007 11.4943 $624.01 $124.80 51500 T Removal of bladder cyst 0154 26.8861 $1,459.62 $464.85 $291.92 51520 T Removal of bladder lesion 0162 21.8578 $1,186.64 $237.33 51525 C Removal of bladder lesion 51530 C Removal of bladder lesion 51535 C Repair of ureter lesion 51550 C Partial removal of bladder 51555 C Partial removal of bladder 51565 C Revise bladder & ureter(s) 51570 C Removal of bladder 51575 C Removal of bladder & nodes 51580 C Remove bladder/revise tract 51585 C Removal of bladder & nodes 51590 C Remove bladder/revise tract 51595 C Remove bladder/revise tract 51596 C Remove bladder/create pouch 51597 C Removal of pelvic structures 51600 N Injection for bladder x-ray 51605 N Preparation for bladder xray 51610 N Injection for bladder x-ray 51700 T Irrigation of bladder 0164 1.2115 $65.77 $17.59 $13.15 51701 N Insert bladder catheter 51702 N Insert temp bladder cath 51703 N Insert bladder cath, complex 51705 T Change of bladder tube 0121 2.2058 $119.75 $43.80 $23.95 51710 T Change of bladder tube 0122 8.4398 $458.19 $93.97 $91.64 51715 T Endoscopic injection/implant 0167 30.1066 $1,634.46 $555.84 $326.89 51720 T Treatment of bladder lesion 0156 3.1438 $170.67 $46.55 $34.13 51725 T Simple cystometrogram 0156 3.1438 $170.67 $46.55 $34.13 51726 T Complex cystometrogram 0156 3.1438 $170.67 $46.55 $34.13 51736 T Urine flow measurement 0164 1.2115 $65.77 $17.59 $13.15 51741 T Electro-uroflowmetry, first 0164 1.2115 $65.77 $17.59 $13.15 Start Printed Page 48092 51772 T Urethra pressure profile 0164 1.2115 $65.77 $17.59 $13.15 51784 T Anal/urinary muscle study 0164 1.2115 $65.77 $17.59 $13.15 51785 T Anal/urinary muscle study 0164 1.2115 $65.77 $17.59 $13.15 51792 T Urinary reflex study 0164 1.2115 $65.77 $17.59 $13.15 51795 T Urine voiding pressure study 0164 1.2115 $65.77 $17.59 $13.15 51797 T Intraabdominal pressure test 0164 1.2115 $65.77 $17.59 $13.15 51798 X Us urine capacity measure 0340 0.6232 $33.83 $6.77 51800 C Revision of bladder/urethra 51820 C Revision of urinary tract 51840 C Attach bladder/urethra 51841 C Attach bladder/urethra 51845 C Repair bladder neck 51860 C Repair of bladder wound 51865 C Repair of bladder wound 51880 T Repair of bladder opening 0162 21.8578 $1,186.64 $237.33 51900 C Repair bladder/vagina lesion 51920 C Close bladder-uterus fistula 51925 C Hysterectomy/bladder repair 51940 C Correction of bladder defect 51960 C Revision of bladder & bowel 51980 C Construct bladder opening 51990 T Laparo urethral suspension 0131 40.8955 $2,220.18 $1,001.89 $444.04 51992 T Laparo sling operation 0132 56.6318 $3,074.48 $1,239.22 $614.90 52000 T Cystoscopy 0160 6.8152 $369.99 $105.06 $74.00 52001 T Cystoscopy, removal of clots 0160 6.8152 $369.99 $105.06 $74.00 52005 T Cystoscopy & ureter catheter 0161 16.5822 $900.23 $249.36 $180.05 52007 T Cystoscopy and biopsy 0161 16.5822 $900.23 $249.36 $180.05 52010 T Cystoscopy & duct catheter 0160 6.8152 $369.99 $105.06 $74.00 52204 T Cystoscopy 0161 16.5822 $900.23 $249.36 $180.05 52214 T Cystoscopy and treatment 0162 21.8578 $1,186.64 $237.33 52224 T Cystoscopy and treatment 0162 21.8578 $1,186.64 $237.33 52234 T Cystoscopy and treatment 0162 21.8578 $1,186.64 $237.33 52235 T Cystoscopy and treatment 0162 21.8578 $1,186.64 $237.33 52240 T Cystoscopy and treatment 0162 21.8578 $1,186.64 $237.33 52250 T Cystoscopy and radiotracer 0162 21.8578 $1,186.64 $237.33 52260 T Cystoscopy and treatment 0161 16.5822 $900.23 $249.36 $180.05 52265 T Cystoscopy and treatment 0160 6.8152 $369.99 $105.06 $74.00 52270 T Cystoscopy & revise urethra 0161 16.5822 $900.23 $249.36 $180.05 52275 T Cystoscopy & revise urethra 0161 16.5822 $900.23 $249.36 $180.05 52276 T Cystoscopy and treatment 0161 16.5822 $900.23 $249.36 $180.05 52277 T Cystoscopy and treatment 0162 21.8578 $1,186.64 $237.33 52281 T Cystoscopy and treatment 0161 16.5822 $900.23 $249.36 $180.05 52282 T Cystoscopy, implant stent 0385 66.4829 $3,609.29 $721.86 52283 T Cystoscopy and treatment 0161 16.5822 $900.23 $249.36 $180.05 52285 T Cystoscopy and treatment 0161 16.5822 $900.23 $249.36 $180.05 52290 T Cystoscopy and treatment 0161 16.5822 $900.23 $249.36 $180.05 52300 T Cystoscopy and treatment 0161 16.5822 $900.23 $249.36 $180.05 52301 T Cystoscopy and treatment 0161 16.5822 $900.23 $249.36 $180.05 52305 T Cystoscopy and treatment 0161 16.5822 $900.23 $249.36 $180.05 52310 T Cystoscopy and treatment 0160 6.8152 $369.99 $105.06 $74.00 52315 T Cystoscopy and treatment 0161 16.5822 $900.23 $249.36 $180.05 52317 T Remove bladder stone 0162 21.8578 $1,186.64 $237.33 52318 T Remove bladder stone 0162 21.8578 $1,186.64 $237.33 52320 T Cystoscopy and treatment 0162 21.8578 $1,186.64 $237.33 52325 T Cystoscopy, stone removal 0162 21.8578 $1,186.64 $237.33 52327 T Cystoscopy, inject material 0162 21.8578 $1,186.64 $237.33 52330 T Cystoscopy and treatment 0162 21.8578 $1,186.64 $237.33 52332 T Cystoscopy and treatment 0162 21.8578 $1,186.64 $237.33 52334 T Create passage to kidney 0162 21.8578 $1,186.64 $237.33 52341 T Cysto w/ureter stricture tx 0162 21.8578 $1,186.64 $237.33 52342 T Cysto w/up stricture tx 0162 21.8578 $1,186.64 $237.33 52343 T Cysto w/renal stricture tx 0162 21.8578 $1,186.64 $237.33 52344 T Cysto/uretero, stone remove 0162 21.8578 $1,186.64 $237.33 52345 T Cysto/uretero w/up stricture 0162 21.8578 $1,186.64 $237.33 52346 T Cystouretero w/renal strict 0162 21.8578 $1,186.64 $237.33 52347 T Cystoscopy, resect ducts 0160 6.8152 $369.99 $105.06 $74.00 Start Printed Page 48093 52351 T Cystouretero & or pyeloscope 0160 6.8152 $369.99 $105.06 $74.00 52352 T Cystouretero w/stone remove 0162 21.8578 $1,186.64 $237.33 52353 T Cystouretero w/lithotripsy 0163 33.6435 $1,826.47 $365.29 52354 T Cystouretero w/biopsy 0162 21.8578 $1,186.64 $237.33 52355 T Cystouretero w/excise tumor 0162 21.8578 $1,186.64 $237.33 52400 T Cystouretero w/congen repr 0162 21.8578 $1,186.64 $237.33 52450 T Incision of prostate 0162 21.8578 $1,186.64 $237.33 52500 T Revision of bladder neck 0162 21.8578 $1,186.64 $237.33 52510 T Dilation prostatic urethra 0161 16.5822 $900.23 $249.36 $180.05 52601 T Prostatectomy (TURP) 0163 33.6435 $1,826.47 $365.29 52606 T Control postop bleeding 0162 21.8578 $1,186.64 $237.33 52612 T Prostatectomy, first stage 0163 33.6435 $1,826.47 $365.29 52614 T Prostatectomy, second stage 0163 33.6435 $1,826.47 $365.29 52620 T Remove residual prostate 0163 33.6435 $1,826.47 $365.29 52630 T Remove prostate regrowth 0163 33.6435 $1,826.47 $365.29 52640 T Relieve bladder contracture 0162 21.8578 $1,186.64 $237.33 52647 T Laser surgery of prostate 0163 33.6435 $1,826.47 $365.29 52648 T Laser surgery of prostate 0163 33.6435 $1,826.47 $365.29 52700 T Drainage of prostate abscess 0162 21.8578 $1,186.64 $237.33 53000 T Incision of urethra 0166 16.8401 $914.23 $218.73 $182.85 53010 T Incision of urethra 0166 16.8401 $914.23 $218.73 $182.85 53020 T Incision of urethra 0166 16.8401 $914.23 $218.73 $182.85 53025 T Incision of urethra 0166 16.8401 $914.23 $218.73 $182.85 53040 T Drainage of urethra abscess 0166 16.8401 $914.23 $218.73 $182.85 53060 T Drainage of urethra abscess 0166 16.8401 $914.23 $218.73 $182.85 53080 T Drainage of urinary leakage 0166 16.8401 $914.23 $218.73 $182.85 53085 C Drainage of urinary leakage 53200 T Biopsy of urethra 0166 16.8401 $914.23 $218.73 $182.85 53210 T Removal of urethra 0168 30.3485 $1,647.59 $405.60 $329.52 53215 T Removal of urethra 0168 30.3485 $1,647.59 $405.60 $329.52 53220 T Treatment of urethra lesion 0168 30.3485 $1,647.59 $405.60 $329.52 53230 T Removal of urethra lesion 0168 30.3485 $1,647.59 $405.60 $329.52 53235 T Removal of urethra lesion 0168 30.3485 $1,647.59 $405.60 $329.52 53240 T Surgery for urethra pouch 0168 30.3485 $1,647.59 $405.60 $329.52 53250 T Removal of urethra gland 0166 16.8401 $914.23 $218.73 $182.85 53260 T Treatment of urethra lesion 0166 16.8401 $914.23 $218.73 $182.85 53265 T Treatment of urethra lesion 0166 16.8401 $914.23 $218.73 $182.85 53270 T Removal of urethra gland 0167 30.1066 $1,634.46 $555.84 $326.89 53275 T Repair of urethra defect 0166 16.8401 $914.23 $218.73 $182.85 53400 T Revise urethra, stage 1 0168 30.3485 $1,647.59 $405.60 $329.52 53405 T Revise urethra, stage 2 0168 30.3485 $1,647.59 $405.60 $329.52 53410 T Reconstruction of urethra 0168 30.3485 $1,647.59 $405.60 $329.52 53415 C Reconstruction of urethra 53420 T Reconstruct urethra, stage 1 0168 30.3485 $1,647.59 $405.60 $329.52 53425 T Reconstruct urethra, stage 2 0168 30.3485 $1,647.59 $405.60 $329.52 53430 T Reconstruction of urethra 0168 30.3485 $1,647.59 $405.60 $329.52 53431 T Reconstruct urethra/bladder 0168 30.3485 $1,647.59 $405.60 $329.52 53440 T Correct bladder function 0385 66.4829 $3,609.29 $721.86 53442 T Remove perineal prosthesis 0166 16.8401 $914.23 $218.73 $182.85 53444 T Insert tandem cuff 0385 66.4829 $3,609.29 $721.86 53445 T Insert uro/ves nck sphincter 0386 118.8122 $6,450.20 $1,290.04 53446 T Remove uro sphincter 0168 30.3485 $1,647.59 $405.60 $329.52 53447 T Remove/replace ur sphincter 0386 118.8122 $6,450.20 $1,290.014 53448 C Remov/replc ur sphinctr comp 53449 T Repair uro sphincter 0168 30.3485 $1,647.59 $405.60 $329.52 53450 T Revision of urethra 0168 30.3485 $1,647.59 $405.60 $329.52 53460 T Revision of urethra 0168 30.3485 $1,647.59 $405.60 $329.52 53502 T Repair of urethra injury 0166 16.8401 $914.23 $218.73 $182.85 53505 T Repair of urethra injury 0167 30.1066 $1,634.46 $555.84 $326.89 53510 T Repair of urethra injury 0166 16.8401 $914.23 $218.73 $182.85 53515 T Repair of urethra injury 0168 30.3485 $1,647.59 $405.60 $329.52 53520 T Repair of urethra defect 0168 30.3485 $1,647.59 $405.60 $329.52 53600 T Dilate urethra stricture 0156 3.1438 $170.67 $46.55 $34.13 53601 T Dilate urethra stricture 0164 1.2115 $65.77 $17.59 $13.15 53605 T Dilate urethra stricture 0161 16.5822 $900.23 $249.36 $180.05 53620 T Dilate urethra stricture 0165 14.0780 $764.28 $152.86 Start Printed Page 48094 53621 T Dilate urethra stricture 0164 1.2115 $65.77 $17.59 $13.15 53660 T Dilation of urethra 0164 1.2115 $65.77 $17.59 $13.15 53661 T Dilation of urethra 0164 1.2115 $65.77 $17.59 $13.15 53665 T Dilation of urethra 0166 16.8401 $914.23 $218.73 $182.85 53850 T Prostatic microwave thermotx 0675 49.3613 $2,679.78 $535.96 53852 T Prostatic rf thermotx 0675 49.3613 $2,679.78 $535.96 53853 T Prostatic water thermother 1550 $1,150.00 $230.00 53899 T Urology surgery procedure 0164 1.2115 $65.77 $17.59 $13.15 54000 T Slitting of prepuce 0166 16.8401 $914.23 $218.73 $182.85 54001 T Slitting of prepuce 0166 16.8401 $914.23 $218.73 $182.85 54015 T Drain penis lesion 0007 11.4943 $624.01 $124.80 54050 T Destruction, penis lesion(s) 0013 1.1420 $62.00 $14.20 $12.40 54055 T Destruction, penis lesion(s) 0017 16.7332 $908.43 $227.84 $181.69 54056 T Cryosurgery, penis lesion(s) 0012 0.8203 $44.53 $11.18 $8.91 54057 T Laser surg, penis lesion(s) 0017 16.7332 $908.43 $227.84 $181.69 54060 T Excision of penis lesion(s) 0017 16.7332 $908.43 $227.84 $181.69 54065 T Destruction, penis lesion(s) 0695 19.1377 $1,038.97 $266.59 $207.79 54100 T Biopsy of penis 0021 14.5749 $791.26 $219.48 $158.25 54105 T Biopsy of penis 0022 18.6725 $1,013.71 $354.45 $202.74 54110 T Treatment of penis lesion 0181 29.0094 $1,574.89 $621.82 $314.98 54111 T Treat penis lesion, graft 0181 29.0094 $1,574.89 $621.82 $314.98 54112 T Treat penis lesion, graft 0181 29.0094 $1,574.89 $621.82 $314.98 54115 T Treatment of penis lesion 0008 16.8303 $913.70 $182.74 54120 T Partial removal of penis 0181 29.0094 $1,574.89 $621.82 $314.98 54125 C Removal of penis 54130 C Remove penis & nodes 54135 C Remove penis & nodes 54150 T Circumcision 0180 18.4967 $1,004.17 $304.87 $200.83 54152 T Circumcision 0180 18.4967 $1,004.17 $304.87 $200.83 54160 T Circumcision 0180 18.4967 $1,004.17 $304.87 $200.83 54161 T Circumcision 0180 18.4967 $1,004.17 $304.87 $200.83 54162 T Lysis penil circumic lesion 0180 18.4967 $1,004.17 $304.87 $200.83 54163 T Repair of circumcision 0180 18.4967 $1,004.17 $304.87 $200.83 54164 T Frenulotomy of penis 0180 18.4967 $1,004.17 $304.87 $200.83 54200 T Treatment of penis lesion 0156 3.1438 $170.67 $46.55 $34.13 54205 T Treatment of penis lesion 0181 29.0094 $1,574.89 $621.82 $314.98 54220 T Treatment of penis lesion 0156 3.1438 $170.67 $46.55 $34.13 54230 N Prepare penis study 54231 T Dynamic cavernosometry 0165 14.0780 $764.28 $152.86 54235 T Penile injection 0164 1.2115 $65.77 $17.59 $13.15 54240 T Penis study 0164 1.2115 $65.77 $17.59 $13.15 54250 T Penis study 0165 14.0780 $764.28 $152.86 54300 T Revision of penis 0181 29.0094 $1,574.89 $621.82 $314.98 54304 T Revision of penis 0181 29.0094 $1,574.89 $621.82 $314.98 54308 T Reconstruction of urethra 0181 29.0094 $1,574.89 $621.82 $314.98 54312 T Reconstruction of urethra 0181 29.0094 $1,574.89 $621.82 $314.98 54316 T Reconstruction of urethra 0181 29.0094 $1,574.89 $621.82 $314.98 54318 T Reconstruction of urethra 0181 29.0094 $1,574.89 $621.82 $314.98 54322 T Reconstruction of urethra 0181 29.0094 $1,574.89 $621.82 $314.98 54324 T Reconstruction of urethra 0181 29.0094 $1,574.89 $621.82 $314.98 54326 T Reconstruction of urethra 0181 29.0094 $1,574.89 $621.82 $314.98 54328 T Revise penis/urethra 0181 29.0094 $1,574.89 $621.82 $314.98 54332 C Revise penis/urethra 54336 C Revise penis/urethra 54340 T Secondary urethral surgery 0181 29.0094 $1,574.89 $621.82 $314.98 54344 T Secondary urethral surgery 0181 29.0094 $1,574.89 $621.82 $314.98 54348 T Secondary urethral surgery 0181 29.0094 $1,574.89 $621.82 $314.98 54352 T Reconstruct urethra/penis 0181 29.0094 $1,574.89 $621.82 $314.98 54360 T Penis plastic surgery 0181 29.0094 $1,574.89 $621.82 $314.98 54380 T Repair penis 0181 29.0094 $1,574.89 $621.82 $314.98 54385 T Repair penis 0181 29.0094 $1,574.89 $621.82 $314.98 54390 C Repair penis and bladder 54400 T Insert semi-rigid prosthesis 0385 66.4829 $3,609.29 $721.86 54401 T Insert self-contd prosthesis 0386 118.8122 $6,450.20 $1,240.04 54405 T Insert multi-comp penis pros 0386 118.8122 $6,450.20 $1,240.04 54406 T Remove muti-comp penis pros 0181 29.0094 $1,574.89 $621.82 $314.98 Start Printed Page 48095 54408 T Repair multi-comp penis pros 0181 29.0094 $1,574.89 $621.82 $314.98 54410 T Remove/replace penis prosth 0386 118.8122 $6,450.20 $1,290.04 54411 C Remov/replc penis pros, comp 54415 T Remove self-contd penis pros 0181 29.0094 $1,574.89 $621.82 $314.98 54416 T Remv/repl penis contain pros 0385 66.4829 $3,609.29 $721.86 54417 C Remv/replc penis pros, compl 54420 T Revision of penis 0181 29.0094 $1,574.89 $621.82 $314.98 54430 C Revision of penis 54435 T Revision of penis 0181 29.0094 $1,574.89 $621.82 $314.98 54440 T Repair of penis 0181 29.0094 $1,574.89 $621.82 $314.98 54450 T Preputial stretching 0156 3.1438 $170.67 $46.55 $34.13 54500 T Biopsy of testis 0005 3.3675 $182.82 $71.59 $36.56 54505 T Biopsy of testis 0183 21.7612 $1,181.39 $236.28 54512 T Excise lesion testis 0183 21.7612 $1,181.39 $236.28 54520 T Removal of testis 0183 21.7612 $1,181.39 $236.28 54522 T Orchiectomy, partial 0183 21.7612 $1,181.39 $236.28 54530 T Removal of testis 0154 26.8861 $1,459.62 $464.85 $291.92 54535 C Extensive testis surgery 54550 T Exploration for testis 0154 26.8861 $1,459.62 $464.85 $291.92 54560 C Exploration for testis 54600 T Reduce testis torsion 0183 21.7612 $1,181.39 $236.28 54620 T Suspension of testis 0183 21.7612 $1,181.39 $236.28 54640 T Suspension of testis 0154 26.8861 $1,459.62 $464.85 $291.92 54650 C Orchiopexy (Fowler-Stephens) 54660 T Revision of testis 0183 21.7612 $1,181.39 $236.28 54670 T Repair testis injury 0183 21.7612 $1,181.39 $236.28 54680 T Relocation of testis(es) 0183 21.7612 $1,181.39 $236.28 54690 T Laparoscopy, orchiectomy 0131 40.8955 $2,220.18 $1,001.89 $444.04 54692 T Laparoscopy, orchiopexy 0132 56.6318 $3,074.48 $1,239.22 $614.90 54699 T Laparoscope proc, testis 0130 32.5959 $1,769.60 $659.53 $353.92 54700 T Drainage of scrotum 0183 21.7612 $1,181.39 $236.28 54800 T Biopsy of epididymis 0004 1.5774 $85.64 $22.10 $17.13 54820 T Exploration of epididymis 0183 21.7612 $1,181.39 $236.28 54830 T Remove epididymis lesion 0183 21.7612 $1,181.39 $236.28 54840 T Remove epididymis lesion 0183 21.7612 $1,181.39 $236.28 54860 T Removal of epididymis 0183 21.7612 $1,181.39 $236.28 54861 T Removal of epididymis 0183 21.7612 $1,181.39 $236.28 54900 T Fusion of spermatic ducts 0183 21.7612 $1,181.39 $236.28 54901 T Fusion of spermatic ducts 0183 21.7612 $1,181.39 $236.28 55000 T Drainage of hydrocele 0004 1.5774 $85.64 $22.10 $17.13 55040 T Removal of hydrocele 0154 26.8861 $1,459.62 $464.85 $291.92 55041 T Removal of hydroceles 0154 26.8861 $1,459.62 $464.85 $291.92 55060 T Repair of hydrocele 0183 21.7612 $1,181.39 $236.28 55100 T Drainage of scrotum abscess 0007 11.4943 $624.01 $124.80 55110 T Explore scrotum 0183 21.7612 $1,181.39 $236.28 55120 T Removal of scrotum lesion 0183 21.7612 $1,181.39 $236.28 55150 T Removal of scrotum 0183 21.7612 $1,181.39 $236.28 55175 T Revision of scrotum 0183 21.7612 $1,181.39 $236.28 55180 T Revision of scrotum 0183 21.7612 $1,181.39 $236.28 55200 T Incision of sperm duct 0183 21.7612 $1,181.39 $236.28 55250 T Removal of sperm duct(s) 0183 21.7612 $1,181.39 $236.28 55300 N Prepare, sperm duct x-ray 55400 T Repair of sperm duct 0183 21.7612 $1,181.39 $236.28 55450 T Ligation of sperm duct 0183 21.7612 $1,181.39 $236.28 55500 T Removal of hydrocele 0183 21.7612 $1,181.39 $236.28 55520 T Removal of sperm cord lesion 0183 21.7612 $1,181.39 $236.28 55530 T Revise spermatic cord veins 0183 21.7612 $1,181.39 $236.28 55535 T Revise spermatic cord veins 0154 26.8861 $1,459.62 $464.85 $291.92 55540 T Revise hernia & sperm veins 0154 26.8861 $1,459.62 $464.85 $291.92 55550 T Laparo ligate spermatic vein 0131 40.8955 $2,220.18 $1,001.89 $444.04 55559 T Laparo proc, spermatic cord 0130 32.5959 $1,769.60 $659.53 $353.92 55600 C Incise sperm duct pouch 55605 C Incise sperm duct pouch 55650 C Remove sperm duct pouch 55680 T Remove sperm pouch lesion 0183 21.7612 $1,181.39 $236.28 55700 T Biopsy of prostate 0184 3.8073 $206.69 $96.27 $41.34 Start Printed Page 48096 55705 T Biopsy of prostate 0184 3.8073 $206.69 $96.27 $41.34 55720 T Drainage of prostate abscess 0162 21.8578 $1,186.64 $237.33 55725 T Drainage of prostate abscess 0162 21.8578 $1,186.64 $237.33 55801 C Removal of prostate 55810 C Extensive prostate surgery 55812 C Extensive prostate surgery 55815 C Extensive prostate surgery 55821 C Removal of prostate 55831 C Removal of prostate 55840 C Extensive prostate surgery 55842 C Extensive prostate surgery 55845 C Extensive prostate surgery 55859 T Percut/needle insert, pros 0163 33.6435 $1,826.47 $365.29 55860 T Surgical exposure, prostate 0165 14.0780 $764.28 $152.86 55862 C Extensive prostate surgery 55865 C Extensive prostate surgery 55866 C Laparo radical prostatectomy 55870 T Vag hyst w/enterocele repair 0197 5.1958 $282.07 $56.41 55873 T Cryoablate prostate 0674 101.1198 $5,489.69 $1,097.94 55899 T Genital surgery procedure 0164 1.2115 $65.77 $17.59 $13.15 55970 E Sex transformation, M to F 55980 E Sex transformation, F to M 56405 T I & D of vulva/perineum 0192 2.6966 $146.40 $39.11 $29.28 56420 T Drainage of gland abscess 0192 2.6966 $146.40 $39.11 $29.28 56440 T Surgery for vulva lesion 0194 18.8194 $1,021.69 $397.84 $204.34 56441 T Lysis of labial lesion(s) 0193 15.7365 $854.32 $171.13 $170.86 56501 T Destroy, vulva lesions, sim 0017 16.7332 $908.43 $227.84 $181.69 56515 T Destroy vulva lesion/s compl 0695 19.1377 $1,038.97 $266.59 $207.79 56605 T Biopsy of vulva/perineum 0019 3.9807 $216.11 $71.87 $43.22 56606 T Biopsy of vulva/perineum 0019 3.9807 $216.11 $71.87 $43.22 56620 T Partial removal of vulva 0195 25.3207 $1,374.64 $483.80 $274.93 56625 T Complete removal of vulva 0195 25.3207 $1,374.64 $483.80 $274.93 56630 C Extensive vulva surgery 56631 C Extensive vulva surgery 56632 C Extensive vulva surgery 56633 C Extensive vulva surgery 56634 C Extensive vulva surgery 56637 C Extensive vulva surgery 56640 C Extensive vulva surgery 56700 T Partial removal of hymen 0194 18.8194 $1,021.69 $397.84 $204.34 56720 T Incision of hymen 0193 15.7365 $854.32 $171.13 $170.86 56740 T Remove vagina gland lesion 0194 18.8194 $1,021.69 $397.84 $204.34 56800 T Repair of vagina 0194 18.8194 $1,021.69 $397.84 $204.34 56805 T Repair clitoris 0194 18.8194 $1,021.69 $397.84 $204.34 56810 T Repair of perineum 0194 18.8194 $1,021.69 $397.84 $204.34 56820 T Exam of vulva w/scope 0188 1.1079 $60.15 $12.03 56821 T Exam/biopsy of vulva w/scope 0189 1.3207 $71.70 $16.70 $14.34 57000 T Exploration of vagina 0194 18.8194 $1,021.69 $397.84 $204.34 57010 T Drainage of pelvic abscess 0194 18.8194 $1,021.69 $397.84 $204.34 57020 T Drainage of pelvic fluid 0192 2.6966 $146.40 $39.11 $29.28 57022 T I & d vaginal hematoma, pp 0007 11.4943 $624.01 $124.80 57023 T I & d vag hematoma, non-ob 0007 11.4943 $624.01 $124.80 57061 T Destroy vag lesions, simple 0194 18.8194 $1,021.69 $397.84 $204.34 57065 T Destroy vag lesions, complex 0194 18.8194 $1,021.69 $397.84 $204.34 57100 T Biopsy of vagina 0192 2.6966 $146.40 $39.11 $29.28 57105 T Biopsy of vagina 0194 18.8194 $1,021.69 $397.84 $204.34 57106 T Remove vagina wall, partial 0194 18.8194 $1,021.69 $397.84 $204.34 57107 T Remove vagina tissue, part 0195 25.3207 $1,374.64 $483.80 $274.93 57109 T Vaginectomy partial w/nodes 0195 25.3207 $1,374.64 $483.80 $274.93 57110 C Remove vagina wall, complete 57111 C Remove vagina tissue, compl 57112 C Vaginectomy w/nodes, compl 57120 T Closure of vagina 0194 18.8194 $1,021.69 $397.84 $204.34 57130 T Remove vagina lesion 0194 18.8194 $1,021.69 $397.84 $204.34 57135 T Remove vagina lesion 0194 18.8194 $1,021.69 $397.84 $204.34 57150 T Treat vagina infection 0191 0.1679 $9.12 $2.65 $1.82 Start Printed Page 48097 57155 T Insert uteri tandems/ovoids 0193 15.7365 $854.32 $171.13 $170.86 57160 T Insert pessary/other device 0188 1.1079 $60.15 $12.03 57170 T Fitting of diaphragm/cap 0191 0.1679 $9.12 $2.65 $1.82 57180 T Treat vaginal bleeding 0192 2.6966 $146.40 $39.11 $29.28 57200 T Repair of vagina 0194 18.8194 $1,021.69 $397.84 $204.34 57210 T Repair vagina/perineum 0194 18.8194 $1,021.69 $397.84 $204.34 57220 T Revision of urethra 0195 25.3207 $1,374.64 $483.80 $274.93 57230 T Repair of urethral lesion 0194 18.8194 $1,021.69 $397.84 $204.34 57240 T Repair bladder & vagina 0195 25.3207 $1,374.64 $483.80 $274.93 57250 T Repair rectum & vagina 0195 25.3207 $1,374.64 $483.80 $274.93 57260 T Repair of vagina 0195 25.3207 $1,374.64 $483.80 $274.93 57265 T Extensive repair of vagina 0195 25.3207 $1,374.64 $483.80 $274.93 57268 T Repair of bowel bulge 0195 25.3207 $1,374.64 $483.80 $274.93 57270 C Repair of bowel pouch 57280 C Suspension of vagina 57282 C Repair of vaginal prolapse 57284 T Repair paravaginal defect 0195 25.3207 $1,374.64 $483.80 $274.93 57287 T Revise/remove sling repair 0202 38.8053 $2,106.70 $1,032.28 $421.34 57288 T Repair bladder defect 0202 38.8053 $2,106.70 $1,032.28 $421.34 57289 T Repair bladder & vagina 0195 25.3207 $1,374.64 $483.80 $274.93 57291 T Construction of vagina 0195 25.3207 $1,374.64 $483.80 $274.93 57292 C Construct vagina with graft 57300 T Repair rectum-vagina fistula 0195 25.3207 $1,374.64 $483.80 $274.93 57305 C Repair rectum-vagina fistula 57307 C Fistula repair & colostomy 57308 C Fistula repair, transperine 57310 T Repair urethrovaginal lesion 0195 25.3207 $1,374.64 $483.80 $274.93 57311 C Repair urethrovaginal lesion 57320 T Repair bladder-vagina lesion 0195 25.3207 $1,374.64 $483.80 $274.93 57330 T Repair bladder-vagina lesion 0195 25.3207 $1,374.64 $483.80 $274.93 57335 C Repair vagina 57400 T Dilation of vagina 0194 18.8194 $1,021.69 $397.84 $204.34 57410 T Pelvic examination 0194 18.8194 $1,021.69 $397.84 $204.34 57415 T Remove vaginal foreign body 0194 18.8194 $1,021.69 $397.84 $204.34 57420 T Exam of vagina w/scope 0192 2.6966 $146.40 $39.11 $29.28 57421 T Exam/biopsy of vag w/scope 0192 2.6966 $146.40 $39.11 $29.28 57452 T Examination of vagina 0189 1.3207 $71.70 $16.70 $14.34 57454 T Vagina examination & biopsy 0192 2.6966 $146.40 $39.11 $29.28 57455 T Biopsy of cervix w/scope 0192 2.6966 $146.40 $39.11 $29.28 57456 T Endocerv curettage w/scope 0192 2.6966 $146.40 $39.11 $29.28 57460 T Cervix excision 0193 15.7365 $854.32 $171.13 $170.86 57461 T Conz of cervix w/scope, leep 0194 18.8194 $1,021.69 $397.84 $204.34 57500 T Biopsy of cervix 0192 2.6966 $146.40 $39.11 $29.28 57505 T Endocervical curettage 0192 2.6966 $146.40 $39.11 $29.28 57510 T Cauterization of cervix 0193 15.7365 $854.32 $171.13 $170.86 57511 T Cryocautery of cervix 0189 1.3207 $71.70 $16.70 $14.34 57513 T Laser surgery of cervix 0193 15.7365 $854.32 $171.13 $170.86 57520 T Conization of cervix 0194 18.8194 $1,021.69 $397.84 $204.34 57522 T Conization of cervix 0195 25.3207 $1,374.64 $483.80 $274.93 57530 T Removal of cervix 0195 25.3207 $1,374.64 $483.80 $274.93 57531 C Removal of cervix, radical 57540 C Removal of residual cervix 57545 C Remove cervix/repair pelvis 57550 T Removal of residual cervix 0195 25.3207 $1,374.64 $483.80 $274.93 57555 T Remove cervix/repair vagina 0195 25.3207 $1,374.64 $483.80 $274.93 57556 T Remove cervix, repair bowel 0195 25.3207 $1,374.64 $483.80 $274.93 57700 T Revision of cervix 0194 18.8194 $1,021.69 $397.84 $204.34 57720 T Revision of cervix 0194 18.8194 $1,021.69 $397.84 $204.34 57800 T Dilation of cervical canal 0193 15.7365 $854.32 $171.13 $170.86 57820 T D & c of residual cervix 0196 16.1823 $878.52 $338.23 $175.70 58100 T Biopsy of uterus lining 0188 1.1079 $60.15 $12.03 58120 T Dilation and curettage 0196 16.1823 $878.52 $338.23 $175.70 58140 C Removal of uterus lesion 58145 T Myomectomy vag method 0195 25.3207 $1,374.64 $483.80 $274.93 58146 C Myomectomy abdom complex 58150 C Total hysterectomy Start Printed Page 48098 58152 C Total hysterectomy 58180 C Partial hysterectomy 58200 C Extensive hysterectomy 58210 C Extensive hysterectomy 58240 C Removal of pelvis contents 58260 C Vaginal hysterectomy 58262 C Vag hyst including t/o 58263 C Vag hyst w/t/o & vag repair 58267 C Vag hyst w/urinary repair 58270 C Vag hyst w/enterocele repair 58275 C Hysterectomy/revise vagina 58280 C Hysterectomy/revise vagina 58285 C Extensive hysterectomy 58290 C Vag hyst complex 58291 C Vag hyst incl t/o, complex 58292 C Vag hyst t/o & repair, compl 58293 C Vag hyst w/uro repair, compl 58294 C Vag hyst w/enterocele, compl 58300 E Insert intrauterine device 58301 T Remove intrauterine device 0189 1.3207 $71.70 $16.70 $14.34 58321 T Artificial insemination 0197 5.1958 $282.07 $56.41 58322 T Artificial insemination 0197 5.1958 $282.07 $56.41 58323 T Sperm washing 0197 5.1958 $282.07 $56.41 58340 N Catheter for hysterography 58345 T Reopen fallopian tube 0194 18.8194 $1,021.69 $397.84 $204.34 58346 T Insert heyman uteri capsule 0193 15.7365 $854.32 $171.13 $170.86 58350 T Reopen fallopian tube 0194 18.8194 $1,021.69 $397.84 $204.34 58353 T Endometr ablate, thermal 0195 25.3207 $1,374.64 $483.80 $274.93 58400 C Suspension of uterus 58410 C Suspension of uterus 58520 C Repair of ruptured uterus 58540 C Revision of uterus 58545 T Laparoscopic myomectomy 0130 32.5959 $1,769.60 $659.53 $353.92 58546 T Laparo-myomectomy, complex 0131 40.8955 $2,220.18 $1,001.89 $444.04 58550 T Laparo-asst vag hysterectomy 0132 56.6318 $3,074.48 $1,239.22 $614.90 58552 T Laparo-vag hyst incl t/o 0131 40.8955 $2,220.18 $1,001.89 $444.04 58553 T Laparo-vag hyst, complex 0131 40.8955 $2,220.18 $1,001.89 $444.04 58554 T Laparo-vag hyst w/t/o, compl 0131 40.8955 $2,220.18 $1,001.89 $444.04 58555 T Hysteroscopy, dx, sep proc 0190 19.8088 $1,075.40 $424.28 $215.08 58558 T Hysteroscopy, biopsy 0190 19.8088 $1,075.40 $424.28 $215.08 58559 T Hysteroscopy, lysis 0190 19.8088 $1,075.40 $424.28 $215.08 58560 T Hysteroscopy, resect septum 0387 28.5174 $1,548.18 $660.84 $309.64 58561 T Hysteroscopy, remove myoma 0387 28.5174 $1,548.18 $660.84 $309.64 58562 T Hysteroscopy, remove fb 0190 19.8088 $1,075.40 $424.28 $215.08 58563 T Hysteroscopy, ablation 0387 28.5174 $1,548.18 $660.84 $309.64 58578 T Laparo proc, uterus 0130 32.5959 $1,769.60 $659.53 $353.92 58579 T Hysteroscope procedure 0190 19.8088 $1,075.40 $424.28 $215.08 58600 T Division of fallopian tube 0194 18.8194 $1,021.69 $397.84 $204.34 58605 C Division of fallopian tube 58611 C Ligate oviduct(s) add-on 58615 T Occlude fallopian tube(s) 0194 18.8194 $1,021.69 $397.84 $204.34 58660 T Laparoscopy, lysis 0131 40.8955 $2,220.18 $1,001.89 $444.04 58661 T Laparoscopy, remove adnexa 0131 40.8955 $2,220.18 $1,001.89 $444.04 58662 T Laparoscopy, excise lesions 0131 40.8955 $2,220.18 $1,001.89 $444.04 58670 T Laparoscopy, tubal cautery 0131 40.8955 $2,220.18 $1,001.89 $444.04 58671 T Laparoscopy, tubal block 0131 40.8955 $2,220.18 $1,001.89 $444.04 58672 T Laparoscopy, fimbrioplasty 0131 40.8955 $2,220.18 $1,001.89 $444.04 58673 T Laparoscopy, salpingostomy 0131 40.8955 $2,220.18 $1,001.89 $444.04 58679 T Laparo proc, oviduct-ovary 0130 32.5959 $1,769.60 $659.53 $353.92 58700 C Removal of fallopian tube 58720 C Removal of ovary/tube(s) 58740 C Revise fallopian tube(s) 58750 C Repair oviduct 58752 C Revise ovarian tube(s) 58760 C Remove tubal obstruction 58770 C Create new tubal opening Start Printed Page 48099 58800 T Drainage of ovarian cyst(s) 0195 25.3207 $1,374.64 $483.80 $274.93 58805 C Drainage of ovarian cyst(s) 58820 T Drain ovary abscess, open 0195 25.3207 $1,374.64 $483.80 $274.93 58822 C Drain ovary abscess, percut 58823 T Drain pelvic abscess, percut 0193 15.7365 $854.32 $171.13 $170.86 58825 C Transposition, ovary(s) 58900 T Biopsy of ovary(s) 0195 25.3207 $1,374.64 $483.80 $274.93 58920 T Partial removal of ovary(s) 0195 25.3207 $1,374.64 $483.80 $274.93 58925 T Removal of ovarian cyst(s) 0195 25.3207 $1,374.64 $483.80 $274.93 58940 C Removal of ovary(s) 58943 C Removal of ovary(s) 58950 C Resect ovarian malignancy 58951 C Resect ovarian malignancy 58952 C Resect ovarian malignancy 58953 C Tah, rad dissect for debulk 58954 C Tah rad debulk/lymph remove 58960 C Exploration of abdomen 58970 T Retrieval of oocyte 0194 18.8194 $1,021.69 $397.84 $204.34 58974 T Transfer of embryo 0197 5.1958 $282.07 $56.41 58976 T Transfer of embryo 0197 5.1958 $282.07 $56.41 58999 T Genital surgery procedure 0191 0.1679 $9.12 $2.65 $1.82 59000 T Amniocentesis, diagnostic 0198 1.3718 $74.47 $32.19 $14.89 59001 T Amniocentesis, therapeutic 0198 1.3718 $74.47 $32.19 $14.89 59012 T Fetal cord puncture,prenatal 0198 1.3718 $74.47 $32.19 $14.89 59015 T Chorion biopsy 0198 1.3718 $74.47 $32.19 $14.89 59020 T Fetal contract stress test 0198 1.3718 $74.47 $32.19 $14.89 59025 T Fetal non-stress test 0198 1.3718 $74.47 $32.19 $14.89 59030 T Fetal scalp blood sample 0198 1.3718 $74.47 $32.19 $14.89 59050 E Fetal monitor w/report 59051 E Fetal monitor/interpret only 59100 C Remove uterus lesion 59120 C Treat ectopic pregnancy 59121 C Treat ectopic pregnancy 59130 C Treat ectopic pregnancy 59135 C Treat ectopic pregnancy 59136 C Treat ectopic pregnancy 59140 C Treat ectopic pregnancy 59150 T Treat ectopic pregnancy 0131 40.8955 $2,220.18 $1,001.89 $444.04 59151 T Treat ectopic pregnancy 0131 40.8955 $2,220.18 $1,001.89 $444.04 59160 T D & c after delivery 0196 16.1823 $878.52 $338.23 $175.70 59200 T Insert cervical dilator 0189 1.3207 $71.70 $16.70 $14.34 59300 T Episiotomy or vaginal repair 0193 15.7365 $854.32 $171.13 $170.86 59320 T Revision of cervix 0194 18.8194 $1,021.69 $397.84 $204.34 59325 C Revision of cervix 59350 C Repair of uterus 59400 E Obstetrical care 59409 T Obstetrical care 0199 16.8630 $915.48 $183.10 59410 E Obstetrical care 59412 T Antepartum manipulation 0700 2.4359 $132.24 $37.03 $26.45 59414 T Deliver placenta 0199 16.8630 $915.48 $183.10 59425 E Antepartum care only 59426 E Antepartum care only 59430 E Care after delivery 59510 E Cesarean delivery 59514 C Cesarean delivery only 59515 E Cesarean delivery 59525 C Remove uterus after cesarean 59610 E Vbac delivery 59612 T Vbac delivery only 0199 16.8630 $915.48 $183.10 59614 E Vbac care after delivery 59618 E Attempted vbac delivery 59620 C Attempted vbac delivery only 59622 E Attempted vbac after care 59812 T Treatment of miscarriage 0201 17.2803 $938.13 $329.65 $187.63 59820 T Care of miscarriage 0201 17.2803 $938.13 $329.65 $187.63 59821 T Treatment of miscarriage 0201 17.2803 $938.13 $329.65 $187.63 Start Printed Page 48100 59830 C Treat uterus infection 59840 T Abortion 0200 18.3633 $996.93 $307.83 $199.39 59841 T Abortion 0200 18.3633 $996.93 $307.83 $199.39 59850 C Abortion 59851 C Abortion 59852 C Abortion 59855 C Abortion 59856 C Abortion 59857 C Abortion 59866 T Abortion (mpr) 0198 1.3718 $74.47 $32.19 $14.89 59870 T Evacuate mole of uterus 0201 17.2803 $938.13 $329.65 $187.63 59871 T Remove cerclage suture 0194 18.8194 $1,021.69 $397.84 $204.34 59898 T Laparo proc, ob care/deliver 0130 32.5959 $1,769.60 $659.53 $353.92 59899 T Maternity care procedure 0198 1.3718 $74.47 $32.19 $14.89 60000 T Drain thyroid/tongue cyst 0252 6.5416 $355.14 $113.41 $71.03 60001 T Aspirate/inject thyriod cyst 0004 1.5774 $85.64 $22.10 $17.13 60100 T Biopsy of thyroid 0004 1.5774 $85.64 $22.10 $17.13 60200 T Remove thyroid lesion 0114 37.3583 $2,028.14 $485.91 $405.63 60210 T Partial thyroid excision 0114 37.3583 $2,028.14 $485.91 $405.63 60212 T Partial thyroid excision 0114 37.3583 $2,028.14 $485.91 $405.63 60220 T Partial removal of thyroid 0114 37.3583 $2,028.14 $485.91 $405.63 60225 T Partial removal of thyroid 0114 37.3583 $2,028.14 $485.91 $405.63 60240 T Removal of thyroid 0114 37.3583 $2,028.14 $485.91 $405.63 60252 T Removal of thyroid 0256 35.0866 $1,904.82 $380.96 60254 C Extensive thyroid surgery 60260 T Repeat thyroid surgery 0256 35.0866 $1,904.82 $380.96 60270 C Removal of thyroid 60271 C Removal of thyroid 60280 T Remove thyroid duct lesion 0114 37.3583 $2,028.14 $485.91 $405.63 60281 T Remove thyroid duct lesion 0114 37.3583 $2,028.14 $485.91 $405.63 60500 T Explore parathyroid glands 0256 35.0866 $1,904.82 $380.96 60502 C Re-explore parathyroids 60505 C Explore parathyroid glands 60512 T Autotransplant parathyroid 0022 18.6725 $1,013.71 $354.45 $202.74 60520 C Removal of thymus gland 60521 C Removal of thymus gland 60522 C Removal of thymus gland 60540 C Explore adrenal gland 60545 C Explore adrenal gland 60600 C Remove carotid body lesion 60605 C Remove carotid body lesion 60650 C Laparoscopy adrenalectomy 60659 T Laparo proc, endocrine 0130 32.5959 $1,769.60 $659.53 $353.92 60699 T Endocrine surgery procedure 0114 37.3583 $2,028.14 $485.91 $405.63 61000 T Remove cranial cavity fluid 0212 2.9989 $162.81 $74.92 $32.56 61001 T Remove cranial cavity fluid 0212 2.9989 $162.81 $74.92 $32.56 61020 T Remove brain cavity fluid 0212 2.9989 $162.81 $74.92 $32.56 61026 T Injection into brain canal 0212 2.9989 $162.81 $74.92 $32.56 61050 T Remove brain canal fluid 0212 2.9989 $162.81 $74.92 $32.56 61055 T Injection into brain canal 0212 2.9989 $162.81 $74.92 $32.56 61070 T Brain canal shunt procedure 0212 2.9989 $162.81 $74.92 $32.56 61105 C Twist drill hole 61107 C Drill skull for implantation 61108 C Drill skull for drainage 61120 C Burr hole for puncture 61140 C Pierce skull for biopsy 61150 C Pierce skull for drainage 61151 C Pierce skull for drainage 61154 C Pierce skull & remove clot 61156 C Pierce skull for drainage 61210 C Pierce skull, implant device 61215 T Insert brain-fluid device 0224 34.0161 $1,846.70 $453.41 $369.34 61250 C Pierce skull & explore 61253 C Pierce skull & explore 61304 C Open skull for exploration 61305 C Open skull for exploration Start Printed Page 48101 61312 C Open skull for drainage 61313 C Open skull for drainage 61314 C Open skull for drainage 61315 C Open skull for drainage 61316 N Implt cran bone flap to abdo 61320 C Open skull for drainage 61321 C Open skull for drainage 61322 C Decompressive craniotomy 61323 C Decompressive lobectomy 61330 T Decompress eye socket 0256 35.0866 $1,904.82 $380.96 61332 C Explore/biopsy eye socket 61333 C Explore orbit/remove lesion 61334 C Explore orbit/remove object 61340 C Relieve cranial pressure 61343 C Incise skull (press relief) 61345 C Relieve cranial pressure 61440 C Incise skull for surgery 61450 C Incise skull for surgery 61458 C Incise skull for brain wound 61460 C Incise skull for surgery 61470 C Incise skull for surgery 61480 C Incise skull for surgery 61490 C Incise skull for surgery 61500 C Removal of skull lesion 61501 C Remove infected skull bone 61510 C Removal of brain lesion 61512 C Remove brain lining lesion 61514 C Removal of brain abscess 61516 C Removal of brain lesion 61517 N Implt brain chemotx add-on 61518 C Removal of brain lesion 61519 C Remove brain lining lesion 61520 C Removal of brain lesion 61521 C Removal of brain lesion 61522 C Removal of brain abscess 61524 C Removal of brain lesion 61526 C Removal of brain lesion 61530 C Removal of brain lesion 61531 C Implant brain electrodes 61533 C Implant brain electrodes 61534 C Removal of brain lesion 61535 C Remove brain electrodes 61536 C Removal of brain lesion 61538 C Removal of brain tissue 61539 C Removal of brain tissue 61541 C Incision of brain tissue 61542 C Removal of brain tissue 61543 C Removal of brain tissue 61544 C Remove & treat brain lesion 61545 C Excision of brain tumor 61546 C Removal of pituitary gland 61548 C Removal of pituitary gland 61550 C Release of skull seams 61552 C Release of skull seams 61556 C Incise skull/sutures 61557 C Incise skull/sutures 61558 C Excision of skull/sutures 61559 C Excision of skull/sutures 61563 C Excision of skull tumor 61564 C Excision of skull tumor 61570 C Remove foreign body, brain 61571 C Incise skull for brain wound 61575 C Skull base/brainstem surgery 61576 C Skull base/brainstem surgery 61580 C Craniofacial approach, skull 61581 C Craniofacial approach, skull Start Printed Page 48102 61582 C Craniofacial approach, skull 61583 C Craniofacial approach, skull 61584 C Orbitocranial approach/skull 61585 C Orbitocranial approach/skull 61586 C Resect nasopharynx, skull 61590 C Infratemporal approach/skull 61591 C Infratemporal approach/skull 61592 C Orbitocranial approach/skull 61595 C Transtemporal approach/skull 61596 C Transcochlear approach/skull 61597 C Transcondylar approach/skull 61598 C Transpetrosal approach/skull 61600 C Resect/excise cranial lesion 61601 C Resect/excise cranial lesion 61605 C Resect/excise cranial lesion 61606 C Resect/excise cranial lesion 61607 C Resect/excise cranial lesion 61608 C Resect/excise cranial lesion 61609 C Transect artery, sinus 61610 C Transect artery, sinus 61611 C Transect artery, sinus 61612 C Transect artery, sinus 61613 C Remove aneurysm, sinus 61615 C Resect/excise lesion, skull 61616 C Resect/excise lesion, skull 61618 C Repair dura 61619 C Repair dura 61623 T Endovasc tempory vessel occl 1555 $1,650.00 $330.00 61624 C Occlusion/embolization cath 61626 T Transcath occlusion, non-cns 0081 34.8355 $1,891.18 $378.24 61680 C Intracranial vessel surgery 61682 C Intracranial vessel surgery 61684 C Intracranial vessel surgery 61686 C Intracranial vessel surgery 61690 C Intracranial vessel surgery 61692 C Intracranial vessel surgery 61697 C Brain aneurysm repr, complx 61698 C Brain aneurysm repr, complx 61700 C Brain aneurysm repr, simple 61702 C Inner skull vessel surgery 61703 C Clamp neck artery 61705 C Revise circulation to head 61708 C Revise circulation to head 61710 C Revise circulation to head 61711 C Fusion of skull arteries 61720 C Incise skull/brain surgery 61735 C Incise skull/brain surgery 61750 C Incise skull/brain biopsy 61751 C Brain biopsy w/ ct/mr guide 61760 C Implant brain electrodes 61770 C Incise skull for treatment 61790 T Treat trigeminal nerve 0220 16.5293 $897.36 $179.47 61791 T Treat trigeminal tract 0204 2.2209 $120.57 $40.13 $24.11 61793 E Focus radiation beam 61795 S Brain surgery using computer 0302 6.1992 $336.55 $127.49 $67.31 61850 C Implant neuroelectrodes 61860 C Implant neuroelectrodes 61862 C Implant neurostimul, subcort 61870 C Implant neuroelectrodes 61875 C Implant neuroelectrodes 61880 T Revise/remove neuroelectrode 0687 19.9913 $1,085.31 $499.24 $217.06 61885 T Implant neurostim one array 0222 188.7735 $10,248.32 $2,049.66 61886 T Implant neurostim arrays 0222 188.7735 $10,248.32 $2,049.66 61888 T Revise/remove neuroreceiver 0688 42.5880 $2,312.06 $1,132.91 $462.41 62000 C Treat skull fracture 62005 C Treat skull fracture Start Printed Page 48103 62010 C Treatment of head injury 62100 C Repair brain fluid leakage 62115 C Reduction of skull defect 62116 C Reduction of skull defect 62117 C Reduction of skull defect 62120 C Repair skull cavity lesion 62121 C Incise skull repair 62140 C Repair of skull defect 62141 C Repair of skull defect 62142 C Remove skull plate/flap 62143 C Replace skull plate/flap 62145 C Repair of skull & brain 62146 C Repair of skull with graft 62147 C Repair of skull with graft 62148 N Retr bone flap to fix skull 62160 N Neuroendoscopy add-on 62161 C Dissect brain w/scope 62162 C Remove colloid cyst w/scope 62163 C Neuroendoscopy w/fb removal 62164 C Remove brain tumor w/scope 62165 C Remove pituit tumor w/scope 62180 C Establish brain cavity shunt 62190 C Establish brain cavity shunt 62192 C Establish brain cavity shunt 62194 T Replace/irrigate catheter 0121 2.2058 $119.75 $43.80 $23.95 62200 C Establish brain cavity shunt 62201 C Establish brain cavity shunt 62220 C Establish brain cavity shunt 62223 C Establish brain cavity shunt 62225 T Replace/irrigate catheter 0122 8.4398 $458.19 $93.97 $91.64 62230 T Replace/revise brain shunt 0224 34.0161 $1,846.70 $453.41 $369.34 62252 S Csf shunt reprogram 0691 2.9894 $162.29 $81.14 $32.46 62256 C Remove brain cavity shunt 62258 C Replace brain cavity shunt 62263 T Lysis epidural adhesions 0203 11.8511 $643.38 $276.76 $128.68 62264 T Epidural lysis on single day 0203 11.8511 $643.38 $276.76 $128.68 62268 T Drain spinal cord cyst 0212 2.9989 $162.81 $74.92 $32.56 62269 T Needle biopsy, spinal cord 0005 3.3675 $182.82 $71.59 $36.56 62270 T Spinal fluid tap, diagnostic 0206 5.2584 $285.47 $75.55 $57.09 62272 T Drain cerebro spinal fluid 0206 5.2584 $285.47 $75.55 $57.09 62273 T Treat epidural spine lesion 0206 5.2584 $285.47 $75.55 $57.09 62280 T Treat spinal cord lesion 0207 6.5998 $358.30 $123.69 $71.66 62281 T Treat spinal cord lesion 0207 6.5998 $358.30 $123.69 $71.66 62282 T Treat spinal canal lesion 0207 6.5998 $358.30 $123.69 $71.66 62284 N Injection for myelogram 62287 T Percutaneous diskectomy 0220 16.5293 $897.36 $179.47 62290 N Inject for spine disk x-ray 62291 N Inject for spine disk x-ray 62292 T Injection into disk lesion 0212 2.9989 $162.81 $74.92 $32.56 62294 T Injection into spinal artery 0212 2.9989 $162.81 $74.92 $32.56 62310 T Inject spine c/t 0206 5.2584 $285.47 $75.55 $57.09 62311 T Inject spine l/s (cd) 0206 5.2584 $285.47 $75.55 $57.09 62318 T Inject spine w/cath, c/t 0206 5.2584 $285.47 $75.55 $57.09 62319 T Inject spine w/cath l/s (cd) 0206 5.2584 $285.47 $75.55 $57.09 62350 T Implant spinal canal cath 0223 26.0352 $1,413.42 $282.68 62351 T Implant spinal canal cath 0208 40.6521 $2,206.96 $441.39 62355 T Remove spinal canal catheter 0203 11.8511 $643.38 $276.76 $128.68 62360 T Insert spine infusion device 0226 159.6795 $8,668.84 $1,733.77 62361 T Implant spine infusion pump 0227 163.6124 $8,882.35 $1,776.47 62362 T Implant spine infusion pump 0227 163.6124 $8,882.35 $1,776.47 62365 T Remove spine infusion device 0203 11.8511 $643.38 $276.76 $128.68 62367 S Analyze spine infusion pump 0691 2.9894 $162.29 $81.14 $32.46 62368 S Analyze spine infusion pump 0691 2.9894 $162.29 $81.14 $32.46 63001 T Removal of spinal lamina 0208 40.6521 $2,206.96 $441.39 63003 T Removal of spinal lamina 0208 40.6521 $2,206.96 $441.39 63005 T Removal of spinal lamina 0208 40.6521 $2,206.96 $441.39 Start Printed Page 48104 63011 T Removal of spinal lamina 0208 40.6521 $2,206.96 $441.39 63012 T Removal of spinal lamina 0208 40.6521 $2,206.96 $441.39 63015 T Removal of spinal lamina 0208 40.6521 $2,206.96 $441.39 63016 T Removal of spinal lamina 0208 40.6521 $2,206.96 $441.39 63017 T Removal of spinal lamina 0208 40.6521 $2,206.96 $441.39 63020 T Neck spine disk surgery 0208 40.6521 $2,206.96 $441.39 63030 T Low back disk surgery 0208 40.6521 $2,206.96 $441.39 63035 T Spinal disk surgery add-on 0208 40.6521 $2,206.96 $441.39 63040 T Laminotomy, single cervical 0208 40.6521 $2,206.96 $441.39 63042 T Laminotomy, single lumbar 0208 40.6521 $2,206.96 $441.39 63043 C Laminotomy, addl cervical 63044 C Laminotomy, addl lumbar 63045 T Removal of spinal lamina 0208 40.6521 $2,206.96 $441.39 63046 T Removal of spinal lamina 0208 40.6521 $2,206.96 $441.39 63047 T Removal of spinal lamina 0208 40.6521 $2,206.96 $441.39 63048 T Remove spinal lamina add-on 0208 40.6521 $2,206.96 $441.39 63055 T Decompress spinal cord 0208 40.6521 $2,206.96 $441.39 63056 T Decompress spinal cord 0208 40.6521 $2,206.96 $441.39 63057 T Decompress spine cord add-on 0208 40.6521 $2,206.96 $441.39 63064 T Decompress spinal cord 0208 40.6521 $2,206.96 $441.39 63066 T Decompress spine cord add-on 0208 40.6521 $2,206.96 $441.39 63075 C Neck spine disk surgery 63076 C Neck spine disk surgery 63077 C Spine disk surgery, thorax 63078 C Spine disk surgery, thorax 63081 C Removal of vertebral body 63082 C Remove vertebral body add-on 63085 C Removal of vertebral body 63086 C Remove vertebral body add-on 63087 C Removal of vertebral body 63088 C Remove vertebral body add-on 63090 C Removal of vertebral body 63091 C Remove vertebral body add-on 63170 C Incise spinal cord tract(s) 63172 C Drainage of spinal cyst 63173 C Drainage of spinal cyst 63180 C Revise spinal cord ligaments 63182 C Revise spinal cord ligaments 63185 C Incise spinal column/nerves 63190 C Incise spinal column/nerves 63191 C Incise spinal column/nerves 63194 C Incise spinal column & cord 63195 C Incise spinal column & cord 63196 C Incise spinal column & cord 63197 C Incise spinal column & cord 63198 C Incise spinal column & cord 63199 C Incise spinal column & cord 63200 C Release of spinal cord 63250 C Revise spinal cord vessels 63251 C Revise spinal cord vessels 63252 C Revise spinal cord vessels 63265 C Excise intraspinal lesion 63266 C Excise intraspinal lesion 63267 C Excise intraspinal lesion 63268 C Excise intraspinal lesion 63270 C Excise intraspinal lesion 63271 C Excise intraspinal lesion 63272 C Excise intraspinal lesion 63273 C Excise intraspinal lesion 63275 C Biopsy/excise spinal tumor 63276 C Biopsy/excise spinal tumor 63277 C Biopsy/excise spinal tumor 63278 C Biopsy/excise spinal tumor 63280 C Biopsy/excise spinal tumor 63281 C Biopsy/excise spinal tumor 63282 C Biopsy/excise spinal tumor Start Printed Page 48105 63283 C Biopsy/excise spinal tumor 63285 C Biopsy/excise spinal tumor 63286 C Biopsy/excise spinal tumor 63287 C Biopsy/excise spinal tumor 63290 C Biopsy/excise spinal tumor 63300 C Removal of vertebral body 63301 C Removal of vertebral body 63302 C Removal of vertebral body 63303 C Removal of vertebral body 63304 C Removal of vertebral body 63305 C Removal of vertebral body 63306 C Removal of vertebral body 63307 C Removal of vertebral body 63308 C Remove vertebral body add-on 63600 T Remove spinal cord lesion 0220 16.5293 $897.36 $179.47 63610 T Stimulation of spinal cord 0220 16.5293 $897.36 $179.47 63615 T Remove lesion of spinal cord 0220 16.5293 $897.36 $179.47 63650 S Implant neuroelectrodes 0225 56.0375 $3,042.22 $608.44 63655 S Implant neuroelectrodes 0225 56.0375 $3,042.22 $608.44 63660 T Revise/remove neuroelectrode 0687 19.9913 $1,085.31 $499.24 $217.06 63685 T Implant neuroreceiver 0222 188.7735 $10,248.32 $2,049.66 63688 T Revise/remove neuroreceiver 0688 42.5880 $2,312.06 $1,132.91 $462.41 63700 C Repair of spinal herniation 63702 C Repair of spinal herniation 63704 C Repair of spinal herniation 63706 C Repair of spinal herniation 63707 C Repair spinal fluid leakage 63709 C Repair spinal fluid leakage 63710 C Graft repair of spine defect 63740 C Install spinal shunt 63741 T Install spinal shunt 0228 51.1329 $2,775.95 $621.80 $555.19 63744 T Revision of spinal shunt 0228 51.1329 $2,775.95 $621.80 $555.19 63746 T Removal of spinal shunt 0109 7.7075 $418.43 $131.49 $83.69 64400 T N block inj, trigeminal 0204 2.2209 $120.57 $40.13 $24.11 64402 T N block inj, facial 0204 2.2209 $120.57 $40.13 $24.11 64405 T N block inj, occipital 0204 2.2209 $120.57 $40.13 $24.11 64408 T N block inj, vagus 0204 2.2209 $120.57 $40.13 $24.11 64410 T N block inj, phrenic 0204 2.2209 $120.57 $40.13 $24.11 64412 T N block inj, spinal accessor 0204 2.2209 $120.57 $40.13 $24.11 64413 T N block inj, cervical plexus 0204 2.2209 $120.57 $40.13 $24.11 64415 T Injection for nerve block 0204 2.2209 $120.57 $40.13 $24.11 64416 T N block cont infuse, b plex 0204 2.2209 $120.57 $40.13 $24.11 64417 T N block inj, axillary 0204 2.2209 $120.57 $40.13 $24.11 64418 T N block inj, suprascapular 0204 2.2209 $120.57 $40.13 $24.11 64420 T N block inj, intercost, sng 0207 6.5998 $358.30 $123.69 $71.66 64421 T N block inj, intercost, mlt 0207 6.5998 $358.30 $123.69 $71.66 64425 T N block inj ilio-ing/hypogi 0204 2.2209 $120.57 $40.13 $24.11 64430 T N block inj, pudendal 0204 2.2209 $120.57 $40.13 $24.11 64435 T N block inj, paracervical 0204 2.2209 $120.57 $40.13 $24.11 64445 T Injection for nerve block 0204 2.2209 $120.57 $40.13 $24.11 64446 T N blk inj, sciatic, cont inf 0204 2.2209 $120.57 $40.13 $24.11 64447 T N block inj fem, single 0204 2.2209 $120.57 $40.13 $24.11 64448 T N block inj fem, cont inf 0204 2.2209 $120.57 $40.13 $24.11 64450 T N block, other peripheral 0204 2.2209 $120.57 $40.13 $24.11 64470 T Inj paravertebral c/t 0207 6.5998 $358.30 $123.69 $71.66 64472 T Inj paravertebral c/t add-on 0207 6.5998 $358.30 $123.69 $71.66 64475 T Inj paravertebral l/s 0207 6.5998 $358.30 $123.69 $71.66 64476 T Inj paravertebral l/s add-on 0207 6.5998 $358.30 $123.69 $71.66 64479 T Inj foramen epidural c/t 0207 6.5998 $358.30 $123.69 $71.66 64480 T Inj foramen epidural add-on 0207 6.5998 $358.30 $123.69 $71.66 64483 T Inj foramen epidural l/s 0207 6.5998 $358.30 $123.69 $71.66 64484 T Inj foramen epidural add-on 0207 6.5998 $358.30 $123.69 $71.66 64505 T N block, spenopalatine gangl 0204 2.2209 $120.57 $40.13 $24.11 64508 T N block, carotid sinus s/p 0204 2.2209 $120.57 $40.13 $24.11 64510 T N block, stellate ganglion 0207 6.5998 $358.30 $123.69 $71.66 64520 T N block, lumbar/thoracic 0207 6.5998 $358.30 $123.69 $71.66 Start Printed Page 48106 64530 T N block inj, celiac pelus 0207 6.5998 $358.30 $123.69 $71.66 64550 A Apply neurostimulator 64553 S Implant neuroelectrodes 0225 56.0375 $3,042.22 $608.44 64555 S Implant neuroelectrodes 0225 56.0375 $3,042.22 $608.44 64560 S Implant neuroelectrodes 0225 56.0375 $3,042.22 $608.44 64561 S Implant neuroelectrodes 0225 56.0375 $3,042.22 $608.44 64565 S Implant neuroelectrodes 0225 56.0375 $3,042.22 $608.44 64573 S Implant neuroelectrodes 0225 56.0375 $3,042.22 $608.44 64575 S Implant neuroelectrodes 0225 56.0375 $3,042.22 $608.44 64577 S Implant neuroelectrodes 0225 56.0375 $3,042.22 $608.44 64580 S Implant neuroelectrodes 0225 56.0375 $3,042.22 $608.44 64581 S Implant neuroelectrodes 0225 56.0375 $3,042.22 $608.44 64585 T Revise/remove neuroelectrode 0687 19.9913 $1,085.31 $499.24 $217.06 64590 T Implant neuroreceiver 0222 188.7735 $10,248.32 $2,049.66 64595 T Revise/remove neuroreceiver 0688 42.5880 $2,312.06 $1,132.91 $462.41 64600 T Injection treatment of nerve 0203 11.8511 $643.38 $276.76 $128.68 64605 T Injection treatment of nerve 0203 11.8511 $643.38 $276.76 $128.68 64610 T Injection treatment of nerve 0203 11.8511 $643.38 $276.76 $128.68 64612 T Destroy nerve, face muscle 0204 2.2209 $120.57 $40.13 $24.11 64613 T Destroy nerve, spine muscle 0204 2.2209 $120.57 $40.13 $24.11 64614 T Destroy nerve, extrem musc 0204 2.2209 $120.57 $40.13 $24.11 64620 T Injection treatment of nerve 0203 11.8511 $643.38 $276.76 $128.68 64622 T Destr paravertebrl nerve l/s 0203 11.8511 $643.38 $276.76 $128.68 64623 T Destr paravertebral n add-on 0203 11.8511 $643.38 $276.76 $128.68 64626 T Destr paravertebrl nerve c/t 0203 11.8511 $643.38 $276.76 $128.68 64627 T Destr paravertebral n add-on 0203 11.8511 $643.38 $276.76 $128.68 64630 T Injection treatment of nerve 0207 6.5998 $358.30 $123.69 $71.66 64640 T Injection treatment of nerve 0207 6.5998 $358.30 $123.69 $71.66 64680 T Injection treatment of nerve 0203 11.8511 $643.38 $276.76 $128.68 64702 T Revise finger/toe nerve 0220 16.5293 $897.36 $179.47 64704 T Revise hand/foot nerve 0220 16.5293 $897.36 $179.47 64708 T Revise arm/leg nerve 0220 16.5293 $897.36 $179.47 64712 T Revision of sciatic nerve 0220 16.5293 $897.36 $179.47 64713 T Revision of arm nerve(s) 0220 16.5293 $897.36 $179.47 64714 T Revise low back nerve(s) 0220 16.5293 $897.36 $179.47 64716 T Revision of cranial nerve 0220 16.5293 $897.36 $179.47 64718 T Revise ulnar nerve at elbow 0220 16.5293 $897.36 $179.47 64719 T Revise ulnar nerve at wrist 0220 16.5293 $897.36 $179.47 64721 T Carpal tunnel surgery 0220 16.5293 $897.36 $179.47 64722 T Relieve pressure on nerve(s) 0220 16.5293 $897.36 $179.47 64726 T Release foot/toe nerve 0220 16.5293 $897.36 $179.47 64727 T Internal nerve revision 0220 16.5293 $897.36 $179.47 64732 T Incision of brow nerve 0220 16.5293 $897.36 $179.47 64734 T Incision of cheek nerve 0220 16.5293 $897.36 $179.47 64736 T Incision of chin nerve 0220 16.5293 $897.36 $179.47 64738 T Incision of jaw nerve 0220 16.5293 $897.36 $179.47 64740 T Incision of tongue nerve 0220 16.5293 $897.36 $179.47 64742 T Incision of facial nerve 0220 16.5293 $897.36 $179.47 64744 T Incise nerve, back of head 0220 16.5293 $897.36 $179.47 64746 T Incise diaphragm nerve 0220 16.5293 $897.36 $179.47 64752 C Incision of vagus nerve 64755 C Incision of stomach nerves 64760 C Incision of vagus nerve 64761 T Incision of pelvis nerve 0220 16.5293 $897.36 $179.47 64763 C Incise hip/thigh nerve 64766 C Incise hip/thigh nerve 64771 T Sever cranial nerve 0220 16.5293 $897.36 $179.47 64772 T Incision of spinal nerve 0220 16.5293 $897.36 $179.47 64774 T Remove skin nerve lesion 0220 16.5293 $897.36 $179.47 64776 T Remove digit nerve lesion 0220 16.5293 $897.36 $179.47 64778 T Digit nerve surgery add-on 0220 16.5293 $897.36 $179.47 64782 T Remove limb nerve lesion 0220 16.5293 $897.36 $179.47 64783 T Limb nerve surgery add-on 0220 16.5293 $897.36 $179.47 64784 T Remove nerve lesion 0220 16.5293 $897.36 $179.47 64786 T Remove sciatic nerve lesion 0221 25.8194 $1,401.71 $463.62 $280.34 64787 T Implant nerve end 0220 16.5293 $897.36 $179.47 Start Printed Page 48107 64788 T Remove skin nerve lesion 0220 16.5293 $897.36 $179.47 64790 T Removal of nerve lesion 0220 16.5293 $897.36 $179.47 64792 T Removal of nerve lesion 0221 25.8194 $1,401.71 $463.62 $280.34 64795 T Biopsy of nerve 0220 16.5293 $897.36 $179.47 64802 T Remove sympathetic nerves 0220 16.5293 $897.36 $179.47 64804 C Remove sympathetic nerves 64809 C Remove sympathetic nerves 64818 C Remove sympathetic nerves 64820 T Remove sympathetic nerves 0220 16.5293 $897.36 $179.47 64821 T Remove sympathestic nerves 0054 24.2685 $1,317.51 $263.50 64822 T Remove sympathetic nerves 0054 24.2685 $1,317.51 $263.50 64823 T Remove sympathetic nerves 0054 24.2685 $1,317.51 $263.50 64831 T Repair of digit nerve 0221 25.8194 $1,401.71 $463.62 $280.34 64832 T Repair nerve add-on 0221 25.8194 $1,401.71 $463.62 $280.34 64834 T Repair of hand or foot nerve 0221 25.8194 $1,401.71 $463.62 $280.34 64835 T Repair of hand or foot nerve 0221 25.8194 $1,401.71 $463.62 $280.34 64836 T Repair of hand or foot nerve 0221 25.8194 $1,401.71 $463.62 $280.34 64837 T Repair nerve add-on 0221 25.8194 $1,401.71 $463.62 $280.34 64840 T Repair of leg nerve 0221 25.8194 $1,401.71 $463.62 $280.34 64856 T Repair/transpose nerve 0221 25.8194 $1,401.71 $463.62 $280.34 64857 T Repair arm/leg nerve 0221 25.8194 $1,401.71 $463.62 $280.34 64858 T Repair sciatic nerve 0221 25.8194 $1,401.71 $463.62 $280.34 64859 T Nerve surgery 0221 25.8194 $1,401.71 $463.62 $280.34 64861 T Repair of arm nerves 0221 25.8194 $1,401.71 $463.62 $280.34 64862 T Repair of low back nerves 0221 25.8194 $1,401.71 $463.62 $280.34 64864 T Repair of facial nerve 0221 25.8194 $1,401.71 $463.62 $280.34 64865 T Repair of facial nerve 0221 25.8194 $1,401.71 $463.62 $280.34 64866 C Fusion of facial/other nerve 64868 C Fusion of facial/other nerve 64870 T Fusion of facial/other nerve 0221 25.8194 $1,401.71 $463.62 $280.34 64872 T Subsequent repair of nerve 0221 25.8194 $1,401.71 $463.62 $280.34 64874 T Repair & revise nerve add-on 0221 25.8194 $1,401.71 $463.62 $280.34 64876 T Repair nerve/shorten bone 0221 25.8194 $1,401.71 $463.62 $280.34 64885 T Nerve graft, head or neck 0221 25.8194 $1,401.71 $463.62 $280.34 64886 T Nerve graft, head or neck 0221 25.8194 $1,401.71 $463.62 $280.34 64890 T Nerve graft, hand or foot 0221 25.8194 $1,401.71 $463.62 $280.34 64891 T Nerve graft, hand or foot 0221 25.8194 $1,401.71 $463.62 $280.34 64892 T Nerve graft, arm or leg 0221 25.8194 $1,401.71 $463.62 $280.34 64893 T Nerve graft, arm or leg 0221 25.8194 $1,401.71 $463.62 $280.34 64895 T Nerve graft, hand or foot 0221 25.8194 $1,401.71 $463.62 $280.34 64896 T Nerve graft, hand or foot 0221 25.8194 $1,401.71 $463.62 $280.34 64897 T Nerve graft, arm or leg 0221 25.8194 $1,401.71 $463.62 $280.34 64898 T Nerve graft, arm or leg 0221 25.8194 $1,401.71 $463.62 $280.34 64901 T Nerve graft add-on 0221 25.8194 $1,401.71 $463.62 $280.34 64902 T Nerve graft add-on 0221 25.8194 $1,401.71 $463.62 $280.34 64905 T Nerve pedicle transfer 0221 25.8194 $1,401.71 $463.62 $280.34 64907 T Nerve pedicle transfer 0221 25.8194 $1,401.71 $463.62 $280.34 64999 T Nervous system surgery 0204 2.2209 $120.57 $40.13 $24.11 65091 T Revise eye 0242 29.2193 $1,586.29 $597.36 $317.26 65093 T Revise eye with implant 0241 21.9830 $1,193.44 $384.47 $238.69 65101 T Removal of eye 0242 29.2193 $1,586.29 $597.36 $317.26 65103 T Remove eye/insert implant 0242 29.2193 $1,586.29 $597.36 $317.26 65105 T Remove eye/attach implant 0242 29.2193 $1,586.29 $597.36 $317.26 65110 T Removal of eye 0242 29.2193 $1,586.29 $597.36 $317.26 65112 T Remove eye/revise socket 0242 29.2193 $1,586.29 $597.36 $317.26 65114 T Remove eye/revise socket 0242 29.2193 $1,586.29 $597.36 $317.26 65125 T Revise ocular implant 0240 17.3397 $941.35 $315.31 $188.27 65130 T Insert ocular implant 0241 21.9830 $1,193.44 $384.47 $238.69 65135 T Insert ocular implant 0241 21.9830 $1,193.44 $384.47 $238.69 65140 T Attach ocular implant 0242 29.2193 $1,586.29 $597.36 $317.26 65150 T Revise ocular implant 0241 21.9830 $1,193.44 $384.47 $238.69 65155 T Reinsert ocular implant 0242 29.2193 $1,586.29 $597.36 $317.26 65175 T Removal of ocular implant 0240 17.3397 $941.35 $315.31 $188.27 65205 S Remove foreign body from eye 0698 0.9355 $50.79 $18.72 $10.16 65210 S Remove foreign body from eye 0231 2.0880 $113.36 $50.94 $22.67 65220 S Remove foreign body from eye 0231 2.0880 $113.36 $50.94 $22.67 Start Printed Page 48108 65222 S Remove foreign body from eye 0231 2.0880 $113.36 $50.94 $22.67 65235 T Remove foreign body from eye 0233 14.5435 $789.55 $266.33 $157.91 65260 T Remove foreign body from eye 0236 19.6866 $1,068.77 $213.75 65265 T Remove foreign body from eye 0236 19.6866 $1,068.77 $213.75 65270 T Repair of eye wound 0240 17.3397 $941.35 $315.31 $188.27 65272 T Repair of eye wound 0233 14.5435 $789.55 $266.33 $157.91 65273 C Repair of eye wound 65275 T Repair of eye wound 0233 14.5435 $789.55 $266.33 $157.91 65280 T Repair of eye wound 0234 21.5482 $1,169.83 $511.31 $233.97 65285 T Repair of eye wound 0234 21.5482 $1,169.83 $511.31 $233.97 65286 T Repair of eye wound 0233 14.5435 $789.55 $266.33 $157.91 65290 T Repair of eye socket wound 0243 21.1035 $1,145.69 $431.39 $229.14 65400 T Removal of eye lesion 0233 14.5435 $789.55 $266.33 $157.91 65410 T Biopsy of cornea 0233 14.5435 $789.55 $266.33 $157.91 65420 T Removal of eye lesion 0233 14.5435 $789.55 $266.33 $157.91 65426 T Removal of eye lesion 0234 21.5482 $1,169.83 $511.31 $233.97 65430 S Corneal smear 0230 0.7379 $40.06 $14.97 $8.01 65435 T Curette/treat cornea 0239 6.2432 $338.94 $110.62 $67.79 65436 T Curette/treat cornea 0233 14.5435 $789.55 $266.33 $157.91 65450 S Treatment of corneal lesion 0231 2.0880 $113.36 $50.94 $22.67 65600 T Revision of cornea 0240 17.3397 $941.35 $315.31 $188.27 65710 T Corneal transplant 0244 37.4885 $2,035.21 $803.26 $407.04 65730 T Corneal transplant 0244 37.4885 $2,035.21 $803.26 $407.04 65750 T Corneal transplant 0244 37.4885 $2,035.21 $803.26 $407.04 65755 T Corneal transplant 0244 37.4885 $2,035.21 $803.26 $407.04 65760 E Revision of cornea 65765 E Revision of cornea 65767 E Corneal tissue transplant 65770 T Revise cornea with implant 0244 37.4885 $2,035.21 $803.26 $407.04 65771 E Radial keratotomy 65772 T Correction of astigmatism 0233 14.5435 $789.55 $266.33 $157.91 65775 T Correction of astigmatism 0233 14.5435 $789.55 $266.33 $157.91 65800 T Drainage of eye 0233 14.5435 $789.55 $266.33 $157.91 65805 T Drainage of eye 0233 14.5435 $789.55 $266.33 $157.91 65810 T Drainage of eye 0234 21.5482 $1,169.83 $511.31 $233.97 65815 T Drainage of eye 0234 21.5482 $1,169.83 $511.31 $233.97 65820 T Relieve inner eye pressure 0232 4.9739 $270.03 $103.17 $54.01 65850 T Incision of eye 0234 21.5482 $1,169.83 $511.31 $233.97 65855 T Laser surgery of eye 0247 5.0192 $272.49 $104.31 $54.50 65860 T Incise inner eye adhesions 0247 5.0192 $272.49 $104.31 $54.50 65865 T Incise inner eye adhesions 0233 14.5435 $789.55 $266.33 $157.91 65870 T Incise inner eye adhesions 0234 21.5482 $1,169.83 $511.31 $233.97 65875 T Incise inner eye adhesions 0234 21.5482 $1,169.83 $511.31 $233.97 65880 T Incise inner eye adhesions 0233 14.5435 $789.55 $266.33 $157.91 65900 T Remove eye lesion 0233 14.5435 $789.55 $266.33 $157.91 65920 T Remove implant of eye 0233 14.5435 $789.55 $266.33 $157.91 65930 T Remove blood clot from eye 0234 21.5482 $1,169.83 $511.31 $233.97 66020 T Injection treatment of eye 0233 14.5435 $789.55 $266.33 $157.91 66030 T Injection treatment of eye 0233 14.5435 $789.55 $266.33 $157.91 66130 T Remove eye lesion 0234 21.5482 $1,169.83 $511.31 $233.97 66150 T Glaucoma surgery 0233 14.5435 $789.55 $266.33 $157.91 66155 T Glaucoma surgery 0234 21.5482 $1,169.83 $511.31 $233.97 66160 T Glaucoma surgery 0234 21.5482 $1,169.83 $511.31 $233.97 66165 T Glaucoma surgery 0234 21.5482 $1,169.83 $511.31 $233.97 66170 T Glaucoma surgery 0234 21.5482 $1,169.83 $511.31 $233.97 66172 T Incision of eye 0673 26.7626 $1,452.91 $649.56 $290.58 66180 T Implant eye shunt 0673 26.7626 $1,452.91 $649.56 $290.58 66185 T Revise eye shunt 0673 26.7626 $1,452.91 $649.56 $290.58 66220 T Repair eye lesion 0236 19.6866 $1,068.77 $213.75 66225 T Repair/graft eye lesion 0673 26.7626 $1,452.91 $649.56 $290.58 66250 T Follow-up surgery of eye 0233 14.5435 $789.55 $266.33 $157.91 66500 T Incision of iris 0232 4.9739 $270.03 $103.17 $54.01 66505 T Incision of iris 0232 4.9739 $270.03 $103.17 $54.01 66600 T Remove iris and lesion 0233 14.5435 $789.55 $266.33 $157.91 66605 T Removal of iris 0234 21.5482 $1,169.83 $511.31 $233.97 66625 T Removal of iris 0233 14.5435 $789.55 $266.33 $157.91 Start Printed Page 48109 66630 T Removal of iris 0233 14.5435 $789.55 $266.33 $157.91 66635 T Removal of iris 0234 21.5482 $1,169.83 $511.31 $233.97 66680 T Repair iris & ciliary body 0234 21.5482 $1,169.83 $511.31 $233.97 66682 T Repair iris & ciliary body 0234 21.5482 $1,169.83 $511.31 $233.97 66700 T Destruction, ciliary body 0233 14.5435 $789.55 $266.33 $157.91 66710 T Destruction, ciliary body 0233 14.5435 $789.55 $266.33 $157.91 66720 T Destruction, ciliary body 0233 14.5435 $789.55 $266.33 $157.91 66740 T Destruction, ciliary body 0233 14.5435 $789.55 $266.33 $157.91 66761 T Revision of iris 0247 5.0192 $272.49 $104.31 $54.50 66762 T Revision of iris 0247 5.0192 $272.49 $104.31 $54.50 66770 T Removal of inner eye lesion 0247 5.0192 $272.49 $104.31 $54.50 66820 T Incision, secondary cataract 0232 4.9739 $270.03 $103.17 $54.01 66821 T After cataract laser surgery 0247 5.0192 $272.49 $104.31 $54.50 66825 T Reposition intraocular lens 0234 21.5482 $1,169.83 $511.31 $233.97 66830 T Removal of lens lesion 0232 4.9739 $270.03 $103.17 $54.01 66840 T Removal of lens material 0245 12.5751 $682.69 $226.11 $136.54 66850 T Removal of lens material 0249 28.3307 $1,538.05 $524.67 $307.61 66852 T Removal of lens material 0249 28.3307 $1,538.05 $524.67 $307.61 66920 T Extraction of lens 0249 28.3307 $1,538.05 $524.67 $307.61 66930 T Extraction of lens 0249 28.3307 $1,538.05 $524.67 $307.61 66940 T Extraction of lens 0245 12.5751 $682.69 $226.11 $136.54 66982 T Cataract surgery, complex 0246 22.8428 $1,240.11 $495.96 $248.02 66983 T Cataract surg w/iol, 1 stage 0246 22.8428 $1,240.11 $495.96 $248.02 66984 T Cataract surg w/iol, 1 stage 0246 22.8428 $1,240.11 $495.96 $248.02 66985 T Insert lens prosthesis 0246 22.8428 $1,240.11 $495.96 $248.02 66986 T Exchange lens prosthesis 0246 22.8428 $1,240.11 $495.96 $248.02 66990 N Ophthalmic endoscope add-on 66999 T Eye surgery procedure 0232 4.9739 $270.03 $103.17 $54.01 67005 T Partial removal of eye fluid 0237 34.0324 $1,847.58 $818.54 $369.52 67010 T Partial removal of eye fluid 0237 34.0324 $1,847.58 $818.54 $369.52 67015 T Release of eye fluid 0237 34.0324 $1,847.58 $818.54 $369.52 67025 T Replace eye fluid 0236 19.6866 $1,068.77 $213.75 67027 T Implant eye drug system 0237 34.0324 $1,847.58 $818.54 $369.52 67028 T Injection eye drug 0235 4.9900 $270.90 $72.04 $54.18 67030 T Incise inner eye strands 0236 19.6866 $1,068.77 $213.75 67031 T Laser surgery, eye strands 0247 5.0192 $272.49 $104.31 $54.50 67036 T Removal of inner eye fluid 0237 34.0324 $1,847.58 $818.54 $369.52 67038 T Strip retinal membrane 0237 34.0324 $1,847.58 $818.54 $369.52 67039 T Laser treatment of retina 0237 34.0324 $1,847.58 $818.54 $369.52 67040 T Laser treatment of retina 0672 39.1363 $2,124.67 $988.43 $424.93 67101 T Repair detached retina 0235 4.9900 $270.90 $72.04 $54.18 67105 T Repair detached retina 0248 4.7544 $258.11 $95.08 $51.62 67107 T Repair detached retina 0672 39.1363 $2,124.67 $988.43 $424.93 67108 T Repair detached retina 0672 39.1363 $2,124.67 $988.43 $424.93 67110 T Repair detached retina 0236 19.6866 $1,068.77 $213.75 67112 T Rerepair detached retina 0672 39.1363 $2,124.67 $988.43 $424.93 67115 T Release encircling material 0236 19.6866 $1,068.77 $213.75 67120 T Remove eye implant material 0236 19.6866 $1,068.77 $213.75 67121 T Remove eye implant material 0237 34.0324 $1,847.58 $818.54 $369.52 67141 T Treatment of retina 0235 4.9900 $270.90 $72.04 $54.18 67145 T Treatment of retina 0248 4.7544 $258.11 $95.08 $51.62 67208 T Treatment of retinal lesion 0235 4.9900 $270.90 $72.04 $54.18 67210 T Treatment of retinal lesion 0248 4.7544 $258.11 $95.08 $51.62 67218 T Treatment of retinal lesion 0236 19.6866 $1,068.77 $213.75 67220 T Treatment of choroid lesion 0235 4.9900 $270.90 $72.04 $54.18 67221 T Ocular photodynamic ther 0235 4.9900 $270.90 $72.04 $54.18 67225 T Eye photodynamic ther add-on 0235 4.9900 $270.90 $72.04 $54.18 67227 T Treatment of retinal lesion 0235 4.9900 $270.90 $72.04 $54.18 67228 T Treatment of retinal lesion 0248 4.7544 $258.11 $95.08 $51.62 67250 T Reinforce eye wall 0240 17.3397 $941.35 $315.31 $188.27 67255 T Reinforce/graft eye wall 0237 34.0324 $1,847.58 $818.54 $369.52 67299 T Eye surgery procedure 0235 4.9900 $270.90 $72.04 $54.18 67311 T Revise eye muscle 0243 21.1035 $1,145.69 $431.39 $229.14 67312 T Revise two eye muscles 0243 21.1035 $1,145.69 $431.39 $229.14 67314 T Revise eye muscle 0243 21.1035 $1,145.69 $431.39 $229.14 67316 T Revise two eye muscles 0243 21.1035 $1,145.69 $431.39 $229.14 Start Printed Page 48110 67318 T Revise eye muscle(s) 0243 21.1035 $1,145.69 $431.39 $229.14 67320 T Revise eye muscle(s) add-on 0243 21.1035 $1,145.69 $431.39 $229.14 67331 T Eye surgery follow-up add-on 0243 21.1035 $1,145.69 $431.39 $229.14 67332 T Rerevise eye muscles add-on 0243 21.1035 $1,145.69 $431.39 $229.14 67334 T Revise eye muscle w/suture 0243 21.1035 $1,145.69 $431.39 $229.14 67335 T Eye suture during surgery 0243 21.1035 $1,145.69 $431.39 $229.14 67340 T Revise eye muscle add-on 0243 21.1035 $1,145.69 $431.39 $229.14 67343 T Release eye tissue 0243 21.1035 $1,145.69 $431.39 $229.14 67345 T Destroy nerve of eye muscle 0238 3.2016 $173.81 $58.96 $34.76 67350 T Biopsy eye muscle 0699 2.2211 $120.58 $54.26 $24.12 67399 T Eye muscle surgery procedure 0243 21.1035 $1,145.69 $431.39 $229.14 67400 T Explore/biopsy eye socket 0241 21.9830 $1,193.44 $384.47 $238.69 67405 T Explore/drain eye socket 0241 21.9830 $1,193.44 $384.47 $238.69 67412 T Explore/treat eye socket 0241 21.9830 $1,193.44 $384.47 $238.69 67413 T Explore/treat eye socket 0241 21.9830 $1,193.44 $384.47 $238.69 67414 T Explr/decompress eye socket 0242 29.2193 $1,586.29 $597.36 $317.26 67415 T Aspiration, orbital contents 0239 6.2432 $338.94 $110.62 $67.79 67420 T Explore/treat eye socket 0242 29.2193 $1,586.29 $597.36 $317.26 67430 T Explore/treat eye socket 0242 29.2193 $1,586.29 $597.36 $317.26 67440 T Explore/drain eye socket 0242 29.2193 $1,586.29 $597.36 $317.26 67445 T Explr/decompress eye socket 0242 29.2193 $1,586.29 $597.36 $317.26 67450 T Explore/biopsy eye socket 0242 29.2193 $1,586.29 $597.36 $317.26 67500 S Inject/treat eye socket 0231 2.0880 $113.36 $50.94 $22.67 67505 T Inject/treat eye socket 0238 3.2016 $173.81 $58.96 $34.76 67515 T Inject/treat eye socket 0239 6.2432 $338.94 $110.62 $67.79 67550 T Insert eye socket implant 0242 29.2193 $1,586.29 $597.36 $317.26 67560 T Revise eye socket implant 0241 21.9830 $1,193.44 $384.47 $238.69 67570 T Decompress optic nerve 0242 29.2193 $1,586.29 $597.36 $317.26 67599 T Orbit surgery procedure 0239 6.2432 $338.94 $110.62 $67.79 67700 T Drainage of eyelid abscess 0238 3.2016 $173.81 $58.96 $34.76 67710 T Incision of eyelid 0239 6.2432 $338.94 $110.62 $67.79 67715 T Incision of eyelid fold 0240 17.3397 $941.35 $315.31 $188.27 67800 T Remove eyelid lesion 0238 3.2016 $173.81 $58.96 $34.76 67801 T Remove eyelid lesions 0239 6.2432 $338.94 $110.62 $67.79 67805 T Remove eyelid lesions 0238 3.2016 $173.81 $58.96 $34.76 67808 T Remove eyelid lesion(s) 0240 17.3397 $941.35 $315.31 $188.27 67810 T Biopsy of eyelid 0238 3.2016 $173.81 $58.96 $34.76 67820 S Revise eyelashes 0698 0.9355 $50.79 $18.72 $10.16 67825 T Revise eyelashes 0238 3.2016 $173.81 $58.96 $34.76 67830 T Revise eyelashes 0239 6.2432 $338.94 $110.62 $67.79 67835 T Revise eyelashes 0240 17.3397 $941.35 $315.31 $188.27 67840 T Remove eyelid lesion 0239 6.2432 $338.94 $110.62 $67.79 67850 T Treat eyelid lesion 0239 6.2432 $338.94 $110.62 $67.79 67875 T Closure of eyelid by suture 0239 6.2432 $338.94 $110.62 $67.79 67880 T Revision of eyelid 0233 14.5435 $789.55 $266.33 $157.91 67882 T Revision of eyelid 0240 17.3397 $941.35 $315.31 $188.27 67900 T Repair brow defect 0240 17.3397 $941.35 $315.31 $188.27 67901 T Repair eyelid defect 0240 17.3397 $941.35 $315.31 $188.27 67902 T Repair eyelid defect 0240 17.3397 $941.35 $315.31 $188.27 67903 T Repair eyelid defect 0240 17.3397 $941.35 $315.31 $188.27 67904 T Repair eyelid defect 0240 17.3397 $941.35 $315.31 $188.27 67906 T Repair eyelid defect 0240 17.3397 $941.35 $315.31 $188.27 67908 T Repair eyelid defect 0240 17.3397 $941.35 $315.31 $188.27 67909 T Revise eyelid defect 0240 17.3397 $941.35 $315.31 $188.27 67911 T Revise eyelid defect 0240 17.3397 $941.35 $315.31 $188.27 67914 T Repair eyelid defect 0240 17.3397 $941.35 $315.31 $188.27 67915 T Repair eyelid defect 0239 6.2432 $338.94 $110.62 $67.79 67916 T Repair eyelid defect 0240 17.3397 $941.35 $315.31 $188.27 67917 T Repair eyelid defect 0240 17.3397 $941.35 $315.31 $188.27 67921 T Repair eyelid defect 0240 17.3397 $941.35 $315.31 $188.27 67922 T Repair eyelid defect 0239 6.2432 $338.94 $110.62 $67.79 67923 T Repair eyelid defect 0240 17.3397 $941.35 $315.31 $188.27 67924 T Repair eyelid defect 0240 17.3397 $941.35 $315.31 $188.27 67930 T Repair eyelid wound 0240 17.3397 $941.35 $315.31 $188.27 67935 T Repair eyelid wound 0240 17.3397 $941.35 $315.31 $188.27 67938 S Remove eyelid foreign body 0698 0.9355 $50.79 $18.72 $10.16 Start Printed Page 48111 67950 T Revision of eyelid 0240 17.3397 $941.35 $315.31 $188.27 67961 T Revision of eyelid 0240 17.3397 $941.35 $315.31 $188.27 67966 T Revision of eyelid 0240 17.3397 $941.35 $315.31 $188.27 67971 T Reconstruction of eyelid 0241 21.9830 $1,193.44 $384.47 $238.69 67973 T Reconstruction of eyelid 0241 21.9830 $1,193.44 $384.47 $238.69 67974 T Reconstruction of eyelid 0241 21.9830 $1,193.44 $384.47 $238.69 67975 T Reconstruction of eyelid 0240 17.3397 $941.35 $315.31 $188.27 67999 T Revision of eyelid 0240 17.3397 $941.35 $315.31 $188.27 68020 T Incise/drain eyelid lining 0240 17.3397 $941.35 $315.31 $188.27 68040 S Treatment of eyelid lesions 0698 0.9355 $50.79 $18.72 $10.16 68100 T Biopsy of eyelid lining 0232 4.9739 $270.03 $103.17 $54.01 68110 T Remove eyelid lining lesion 0699 2.2211 $120.58 $54.26 $24.12 68115 T Remove eyelid lining lesion 0239 6.2432 $338.94 $110.62 $67.79 68130 T Remove eyelid lining lesion 0233 14.5435 $789.55 $266.33 $157.91 68135 T Remove eyelid lining lesion 0239 6.2432 $338.94 $110.62 $67.79 68200 S Treat eyelid by injection 0698 0.9355 $50.79 $18.72 $10.16 68320 T Revise/graft eyelid lining 0240 17.3397 $941.35 $315.31 $188.27 68325 T Revise/graft eyelid lining 0242 29.2193 $1,586.29 $597.36 $317.26 68326 T Revise/graft eyelid lining 0241 21.9830 $1,193.44 $384.47 $238.69 68328 T Revise/graft eyelid lining 0241 21.9830 $1,193.44 $384.47 $238.69 68330 T Revise eyelid lining 0233 14.5435 $789.55 $266.33 $157.91 68335 T Revise/graft eyelid lining 0241 21.9830 $1,193.44 $384.47 $238.69 68340 T Separate eyelid adhesions 0240 17.3397 $941.35 $315.31 $188.27 68360 T Revise eyelid lining 0234 21.5482 $1,169.83 $511.31 $233.97 68362 T Revise eyelid lining 0234 21.5482 $1,169.83 $511.31 $233.97 68399 T Eyelid lining surgery 0239 6.2432 $338.94 $110.62 $67.79 68400 T Incise/drain tear gland 0238 3.2016 $173.81 $58.96 $34.76 68420 T Incise/drain tear sac 0240 17.3397 $941.35 $315.31 $188.27 68440 T Incise tear duct opening 0238 3.2016 $173.81 $58.96 $34.76 68500 T Removal of tear gland 0241 21.9830 $1,193.44 $384.47 $238.69 68505 T Partial removal, tear gland 0241 21.9830 $1,193.44 $384.47 $238.69 68510 T Biopsy of tear gland 0240 17.3397 $941.35 $315.31 $188.27 68520 T Removal of tear sac 0241 21.9830 $1,193.44 $384.47 $238.69 68525 T Biopsy of tear sac 0240 17.3397 $941.35 $315.31 $188.27 68530 T Clearance of tear duct 0240 17.3397 $941.35 $315.31 $188.27 68540 T Remove tear gland lesion 0241 21.9830 $1,193.44 $384.47 $238.69 68550 T Remove tear gland lesion 0242 29.2193 $1,586.29 $597.36 $317.26 68700 T Repair tear ducts 0241 21.9830 $1,193.44 $384.47 $238.69 68705 T Revise tear duct opening 0238 3.2016 $173.81 $58.96 $34.76 68720 T Create tear sac drain 0242 29.2193 $1,586.29 $597.36 $317.26 68745 T Create tear duct drain 0241 21.9830 $1,193.44 $384.47 $238.69 68750 T Create tear duct drain 0242 29.2193 $1,586.29 $597.36 $317.26 68760 S Close tear duct opening 0698 0.9355 $50.79 $18.72 $10.16 68761 S Close tear duct opening 0231 2.0880 $113.36 $50.94 $22.67 68770 T Close tear system fistula 0240 17.3397 $941.35 $315.31 $188.27 68801 S Dilate tear duct opening 0231 2.0880 $113.36 $50.94 $22.67 68810 T Probe nasolacrimal duct 0699 2.2211 $120.58 $54.26 $24.12 68811 T Probe nasolacrimal duct 0240 17.3397 $941.35 $315.31 $188.27 68815 T Probe nasolacrimal duct 0240 17.3397 $941.35 $315.31 $188.27 68840 T Explore/irrigate tear ducts 0699 2.2211 $120.58 $54.26 $24.12 68850 N Injection for tear sac x-ray 68899 T Tear duct system surgery 0699 2.2211 $120.58 $54.26 $24.12 69000 T Drain external ear lesion 0006 1.7487 $94.94 $24.12 $18.99 69005 T Drain external ear lesion 0007 11.4943 $624.01 $124.80 69020 T Drain outer ear canal lesion 0006 1.7487 $94.94 $24.12 $18.99 69090 E Pierce earlobes 69100 T Biopsy of external ear 0019 3.9807 $216.11 $71.87 $43.22 69105 T Biopsy of external ear canal 0253 15.1698 $823.55 $282.29 $164.71 69110 T Remove external ear, partial 0021 14.5749 $791.26 $219.48 $158.25 69120 T Removal of external ear 0254 21.4368 $1,163.78 $321.35 $232.76 69140 T Remove ear canal lesion(s) 0254 21.4368 $1,163.78 $321.35 $232.76 69145 T Remove ear canal lesion(s) 0021 14.5749 $791.26 $219.48 $158.25 69150 T Extensive ear canal surgery 0252 6.5416 $355.14 $113.41 $71.03 69155 C Extensive ear/neck surgery 69200 X Clear outer ear canal 0340 0.6232 $33.83 $6.77 69205 T Clear outer ear canal 0022 18.6725 $1,013.71 $354.45 $202.74 Start Printed Page 48112 69210 X Remove impacted ear wax 0340 0.6232 $33.83 $6.77 69220 T Clean out mastoid cavity 0012 0.8203 $44.53 $11.18 $8.91 69222 T Clean out mastoid cavity 0253 15.1698 $823.55 $282.29 $164.71 69300 T Revise external ear 0254 21.4368 $1,163.78 $321.35 $232.76 69310 T Rebuild outer ear canal 0256 35.0866 $1,904.82 $380.96 69320 T Rebuild outer ear canal 0256 35.0866 $1,904.82 $380.96 69399 T Outer ear surgery procedure 0251 1.8643 $101.21 $20.24 69400 T Inflate middle ear canal 0251 1.8643 $101.21 $20.24 69401 T Inflate middle ear canal 0251 1.8643 $101.21 $20.24 69405 T Catheterize middle ear canal 0252 6.5416 $355.14 $113.41 $71.03 69410 T Inset middle ear (baffle) 0252 6.5416 $355.14 $113.41 $71.03 69420 T Incision of eardrum 0252 6.5416 $355.14 $113.41 $71.03 69421 T Incision of eardrum 0253 15.1698 $823.55 $282.29 $164.71 69424 T Remove ventilating tube 0252 6.5416 $355.14 $113.41 $71.03 69433 T Create eardrum opening 0252 6.5416 $355.14 $113.41 $71.03 69436 T Create eardrum opening 0253 15.1698 $823.55 $282.29 $164.71 69440 T Exploration of middle ear 0254 21.4368 $1,163.78 $321.35 $232.76 69450 T Eardrum revision 0256 35.0866 $1,904.82 $380.96 69501 T Mastoidectomy 0256 35.0866 $1,904.82 $380.96 69502 T Mastoidectomy 0254 21.4368 $1,163.78 $321.35 $232.76 69505 T Remove mastoid structures 0256 35.0866 $1,904.82 $380.96 69511 T Extensive mastoid surgery 0256 35.0866 $1,904.82 $380.96 69530 T Extensive mastoid surgery 0256 35.0866 $1,904.82 $380.96 69535 C Remove part of temporal bone 69540 T Remove ear lesion 0253 15.1698 $823.55 $282.29 $164.71 69550 T Remove ear lesion 0256 35.0866 $1,904.82 $380.96 69552 T Remove ear lesion 0256 35.0866 $1,904.82 $380.96 69554 C Remove ear lesion 69601 T Mastoid surgery revision 0256 35.0866 $1,904.82 $380.96 69602 T Mastoid surgery revision 0256 35.0866 $1,904.82 $380.96 69603 T Mastoid surgery revision 0256 35.0866 $1,904.82 $380.96 69604 T Mastoid surgery revision 0256 35.0866 $1,904.82 $380.96 69605 T Mastoid surgery revision 0256 35.0866 $1,904.82 $380.96 69610 T Repair of eardrum 0254 21.4368 $1,163.78 $321.35 $232.76 69620 T Repair of eardrum 0254 21.4368 $1,163.78 $321.35 $232.76 69631 T Repair eardrum structures 0256 35.0866 $1,904.82 $380.96 69632 T Rebuild eardrum structures 0256 35.0866 $1,904.82 $380.96 69633 T Rebuild eardrum structures 0256 35.0866 $1,904.82 $380.96 69635 T Repair eardrum structures 0256 35.0866 $1,904.82 $380.96 69636 T Rebuild eardrum structures 0256 35.0866 $1,904.82 $380.96 69637 T Rebuild eardrum structures 0256 35.0866 $1,904.82 $380.96 69641 T Revise middle ear & mastoid 0256 35.0866 $1,904.82 $380.96 69642 T Revise middle ear & mastoid 0256 35.0866 $1,904.82 $380.96 69643 T Revise middle ear & mastoid 0256 35.0866 $1,904.82 $380.96 69644 T Revise middle ear & mastoid 0256 35.0866 $1,904.82 $380.96 69645 T Revise middle ear & mastoid 0256 35.0866 $1,904.82 $380.96 69646 T Revise middle ear & mastoid 0256 35.0866 $1,904.82 $380.96 69650 T Release middle ear bone 0254 21.4368 $1,163.78 $321.35 $232.76 69660 T Revise middle ear bone 0256 35.0866 $1,904.82 $380.96 69661 T Revise middle ear bone 0256 35.0866 $1,904.82 $380.96 69662 T Revise middle ear bone 0256 35.0866 $1,904.82 $380.96 69666 T Repair middle ear structures 0256 35.0866 $1,904.82 $380.96 69667 T Repair middle ear structures 0256 35.0866 $1,904.82 $380.96 69670 T Remove mastoid air cells 0256 35.0866 $1,904.82 $380.96 69676 T Remove middle ear nerve 0256 35.0866 $1,904.82 $380.96 69700 T Close mastoid fistula 0256 35.0866 $1,904.82 $380.96 69710 E Implant/replace hearing aid 69711 T Remove/repair hearing aid 0256 35.0866 $1,904.82 $380.96 69714 T Implant temple bone w/stimul 0256 35.0866 $1,904.82 $380.96 69715 T Temple bne implnt w/stimulat 0256 35.0866 $1,904.82 $380.96 69717 T Temple bone implant revision 0256 35.0866 $1,904.82 $380.96 69718 T Revise temple bone implant 0256 35.0866 $1,904.82 $380.96 69720 T Release facial nerve 0256 35.0866 $1,904.82 $380.96 69725 T Release facial nerve 0256 35.0866 $1,904.82 $380.96 69740 T Repair facial nerve 0256 35.0866 $1,904.82 $380.96 69745 T Repair facial nerve 0256 35.0866 $1,904.82 $380.96 Start Printed Page 48113 69799 T Middle ear surgery procedure 0253 15.1698 $823.55 $282.29 $164.71 69801 T Incise inner ear 0256 35.0866 $1,904.82 $380.96 69802 T Incise inner ear 0256 35.0866 $1,904.82 $380.96 69805 T Explore inner ear 0256 35.0866 $1,904.82 $380.96 69806 T Explore inner ear 0256 35.0866 $1,904.82 $380.96 69820 T Establish inner ear window 0256 35.0866 $1,904.82 $380.96 69840 T Revise inner ear window 0256 35.0866 $1,904.82 $380.96 69905 T Remove inner ear 0256 35.0866 $1,904.82 $380.96 69910 T Remove inner ear & mastoid 0256 35.0866 $1,904.82 $380.96 69915 T Incise inner ear nerve 0256 35.0866 $1,904.82 $380.96 69930 T Implant cochlear device 0259 389.1764 $21,128.00 $9,394.83 $4,225.60 69949 T Inner ear surgery procedure 0253 15.1698 $823.55 $282.29 $164.71 69950 C Incise inner ear nerve 69955 T Release facial nerve 0256 35.0866 $1,904.82 $380.96 69960 T Release inner ear canal 0256 35.0866 $1,904.82 $380.96 69970 C Remove inner ear lesion 69979 T Temporal bone surgery 0251 1.8643 $101.21 $20.24 69990 N Microsurgery add-on 70010 S Contrast x-ray of brain 0274 3.5837 $194.56 $92.92 $38.91 70015 S Contrast x-ray of brain 0274 3.5837 $194.56 $92.92 $38.91 70030 X X-ray eye for foreign body 0260 0.7845 $42.59 $21.29 $8.52 70100 X X-ray exam of jaw 0260 0.7845 $42.59 $21.29 $8.52 70110 X X-ray exam of jaw 0260 0.7845 $42.59 $21.29 $8.52 70120 X X-ray exam of mastoids 0260 0.7845 $42.59 $21.29 $8.52 70130 X X-ray exam of mastoids 0260 0.7845 $42.59 $21.29 $8.52 70134 X X-ray exam of middle ear 0261 1.3238 $71.87 $14.37 70140 X X-ray exam of facial bones 0260 0.7845 $42.59 $21.29 $8.52 70150 X X-ray exam of facial bones 0260 0.7845 $42.59 $21.29 $8.52 70160 X X-ray exam of nasal bones 0260 0.7845 $42.59 $21.29 $8.52 70170 X X-ray exam of tear duct 0263 2.1875 $118.76 $43.58 $23.75 70190 X X-ray exam of eye sockets 0260 0.7845 $42.59 $21.29 $8.52 70200 X X-ray exam of eye sockets 0260 0.7845 $42.59 $21.29 $8.52 70210 X X-ray exam of sinuses 0260 0.7845 $42.59 $21.29 $8.52 70220 X X-ray exam of sinuses 0260 0.7845 $42.59 $21.29 $8.52 70240 X X-ray exam, pituitary saddle 0260 0.7845 $42.59 $21.29 $8.52 70250 X X-ray exam of skull 0260 0.7845 $42.59 $21.29 $8.52 70260 X X-ray exam of skull 0261 1.3238 $71.87 $14.37 70300 X X-ray exam of teeth 0262 0.7851 $42.62 $9.82 $8.52 70310 X X-ray exam of teeth 0262 0.7851 $42.62 $9.82 $8.52 70320 X Full mouth x-ray of teeth 0262 0.7851 $42.62 $9.82 $8.52 70328 X X-ray exam of jaw joint 0260 0.7845 $42.59 $21.29 $8.52 70330 X X-ray exam of jaw joints 0260 0.7845 $42.59 $21.29 $8.52 70332 S X-ray exam of jaw joint 0275 3.2967 $178.97 $69.09 $35.79 70336 S Magnetic image, jaw joint 0335 6.4453 $349.91 $151.46 $69.98 70350 X X-ray head for orthodontia 0260 0.7845 $42.59 $21.29 $8.52 70355 X Panoramic x-ray of jaws 0260 0.7845 $42.59 $21.29 $8.52 70360 X X-ray exam of neck 0260 0.7845 $42.59 $21.29 $8.52 70370 X Throat x-ray & fluoroscopy 0272 1.4086 $76.47 $38.23 $15.29 70371 X Speech evaluation, complex 0272 1.4086 $76.47 $38.23 $15.29 70373 X Contrast x-ray of larynx 0263 2.1875 $118.76 $43.58 $23.75 70380 X X-ray exam of salivary gland 0260 0.7845 $42.59 $21.29 $8.52 70390 X X-ray exam of salivary duct 0264 3.0022 $162.99 $79.41 $32.60 70450 S Ct head/brain w/o dye 0332 3.3916 $184.13 $91.27 $36.83 70460 S Ct head/brain w/dye 0283 4.6121 $250.39 $125.19 $50.08 70470 S Ct head/brain w/o&w dye 0333 5.4299 $294.78 $146.98 $58.96 70480 S Ct orbit/ear/fossa w/o dye 0332 3.3916 $184.13 $91.27 $36.83 70481 S Ct orbit/ear/fossa w/dye 0283 4.6121 $250.39 $125.19 $50.08 70482 S Ct orbit/ear/fossa w/o&w dye 0333 5.4299 $294.78 $146.98 $58.96 70486 S Ct maxillofacial w/o dye 0332 3.3916 $184.13 $91.27 $36.83 70487 S Ct maxillofacial w/dye 0283 4.6121 $250.39 $125.19 $50.08 70488 S Ct maxillofacial w/o&w dye 0333 5.4299 $294.78 $146.98 $58.96 70490 S Ct soft tissue neck w/o dye 0332 3.3916 $184.13 $91.27 $36.83 70491 S Ct soft tissue neck w/dye 0283 4.6121 $250.39 $125.19 $50.08 70492 S Ct sft tsue nck w/o & w/dye 0333 5.4299 $294.78 $146.98 $58.96 70496 S Ct angiography, head 0662 5.8751 $318.95 $156.47 $63.79 70498 S Ct angiography, neck 0662 5.8751 $318.95 $156.47 $63.79 Start Printed Page 48114 70540 S Mri orbit/face/neck w/o dye 0336 6.4817 $351.89 $175.94 $70.38 70542 S Mri orbit/face/neck w/dye 0284 7.0207 $381.15 $190.57 $76.23 70543 S Mri orbt/fac/nck w/o&w dye 0337 9.3215 $506.05 $240.77 $101.21 70544 S Mr angiography head w/o dye 0336 6.4817 $351.89 $175.94 $70.38 70545 S Mr angiography head w/dye 0284 7.0207 $381.15 $190.57 $76.23 70546 S Mr angiograph head w/o&w dye 0337 9.3215 $506.05 $240.77 $101.21 70547 S Mr angiography neck w/o dye 0336 6.4817 $351.89 $175.94 $70.38 70548 S Mr angiography neck w/dye 0284 7.0207 $381.15 $190.57 $76.23 70549 S Mr angiograph neck w/o&w dye 0337 9.3215 $506.05 $240.77 $101.21 70551 S Mri brain w/o dye 0336 6.4817 $351.89 $175.94 $70.38 70552 S Mri brain w/dye 0284 7.0207 $381.15 $190.57 $76.23 70553 S Mri brain w/o&w dye 0337 9.3215 $506.05 $240.77 $101.21 71010 X Chest x-ray 0260 0.7845 $42.59 $21.29 $8.52 71015 X Chest x-ray 0260 0.7845 $42.59 $21.29 $8.52 71020 X Chest x-ray 0260 0.7845 $42.59 $21.29 $8.52 71021 X Chest x-ray 0260 0.7845 $42.59 $21.29 $8.52 71022 X Chest x-ray 0260 0.7845 $42.59 $21.29 $8.52 71023 X Chest x-ray and fluoroscopy 0272 1.4086 $76.47 $38.23 $15.29 71030 X Chest x-ray 0260 0.7845 $42.59 $21.29 $8.52 71034 X Chest x-ray and fluoroscopy 0272 1.4086 $76.47 $38.23 $15.29 71035 X Chest x-ray 0260 0.7845 $42.59 $21.29 $8.52 71040 X Contrast x-ray of bronchi 0263 2.1875 $118.76 $43.58 $23.75 71060 X Contrast x-ray of bronchi 0264 3.0022 $162.99 $79.41 $32.60 71090 X X-ray & pacemaker insertion 0272 1.4086 $76.47 $38.23 $15.29 71100 X X-ray exam of ribs 0260 0.7845 $42.59 $21.29 $8.52 71101 X X-ray exam of ribs/chest 0260 0.7845 $42.59 $21.29 $8.52 71110 X X-ray exam of ribs 0260 0.7845 $42.59 $21.29 $8.52 71111 X X-ray exam of ribs/ chest 0261 1.3238 $71.87 $14.37 71120 X X-ray exam of breastbone 0260 0.7845 $42.59 $21.29 $8.52 71130 X X-ray exam of breastbone 0260 0.7845 $42.59 $21.29 $8.52 71250 S Ct thorax w/o dye 0332 3.3916 $184.13 $91.27 $36.83 71260 S Ct thorax w/dye 0283 4.6121 $250.39 $125.19 $50.08 71270 S Ct thorax w/o&w dye 0333 5.4299 $294.78 $146.98 $58.96 71275 S Ct angiography, chest 0662 5.8751 $318.95 $156.47 $63.79 71550 S Mri chest w/o dye 0336 6.4817 $351.89 $175.94 $70.38 71551 S Mri chest w/dye 0284 7.0207 $381.15 $190.57 $76.23 71552 S Mri chest w/o&w/dye 0337 9.3215 $506.05 $240.77 $101.21 71555 E Mri angio chest w or w/o dye 72010 X X-ray exam of spine 0261 1.3238 $71.87 $14.37 72020 X X-ray exam of spine 0260 0.7845 $42.59 $21.29 $8.52 72040 X X-ray exam of neck spine 0260 0.7845 $42.59 $21.29 $8.52 72050 X X-ray exam of neck spine 0261 1.3238 $71.87 $14.37 72052 X X-ray exam of neck spine 0261 1.3238 $71.87 $14.37 72069 X X-ray exam of trunk spine 0260 0.7845 $42.59 $21.29 $8.52 72070 X X-ray exam of thoracic spine 0260 0.7845 $42.59 $21.29 $8.52 72072 X X-ray exam of thoracic spine 0260 0.7845 $42.59 $21.29 $8.52 72074 X X-ray exam of thoracic spine 0260 0.7845 $42.59 $21.29 $8.52 72080 X X-ray exam of trunk spine 0260 0.7845 $42.59 $21.29 $8.52 72090 X X-ray exam of trunk spine 0261 1.3238 $71.87 $14.37 72100 X X-ray exam of lower spine 0260 0.7845 $42.59 $21.29 $8.52 72110 X X-ray exam of lower spine 0261 1.3238 $71.87 $14.37 72114 X X-ray exam of lower spine 0261 1.3238 $71.87 $14.37 72120 X X-ray exam of lower spine 0260 0.7845 $42.59 $21.29 $8.52 72125 S Ct neck spine w/o dye 0332 3.3916 $184.13 $91.27 $36.83 72126 S Ct neck spine w/dye 0283 4.6121 $250.39 $125.19 $50.08 72127 S Ct neck spine w/o&w/dye 0333 5.4299 $294.78 $146.98 $58.96 72128 S Ct chest spine w/o dye 0332 3.3916 $184.13 $91.27 $36.83 72129 S Ct chest spine w/dye 0283 4.6121 $250.39 $125.19 $50.08 72130 S Ct chest spine w/o&w/dye 0333 5.4299 $294.78 $146.98 $58.96 72131 S Ct lumbar spine w/o dye 0332 3.3916 $184.13 $91.27 $36.83 72132 S Ct lumbar spine w/dye 0283 4.6121 $250.39 $125.19 $50.08 72133 S Ct lumbar spine w/o&w/dye 0333 5.4299 $294.78 $146.98 $58.96 72141 S Mri neck spine w/o dye 0336 6.4817 $351.89 $175.94 $70.38 72142 S Mri neck spine w/dye 0284 7.0207 $381.15 $190.57 $76.23 72146 S Mri chest spine w/o dye 0336 6.4817 $351.89 $175.94 $70.38 72147 S Mri chest spine w/dye 0284 7.0207 $381.15 $190.57 $76.23 Start Printed Page 48115 72148 S Mri lumbar spine w/o dye 0336 6.4817 $351.89 $175.94 $70.38 72149 S Mri lumbar spine w/dye 0284 7.0207 $381.15 $190.57 $76.23 72156 S Mri neck spine w/o&w/dye 0337 9.3215 $506.05 $240.77 $101.21 72157 S Mri chest spine w/o&w/dye 0337 9.3215 $506.05 $240.77 $101.21 72158 S Mri lumbar spine w/o&w/dye 0337 9.3215 $506.05 $240.77 $101.21 72159 E Mr angio spine w/o&w/dye 72170 X X-ray exam of pelvis 0260 0.7845 $42.59 $21.29 $8.52 72190 X X-ray exam of pelvis 0260 0.7845 $42.59 $21.29 $8.52 72191 S Ct angiograph pelv w/o&w/dye 0662 5.8751 $318.95 $156.47 $63.79 72192 S Ct pelvis w/o dye 0332 3.3916 $184.13 $91.27 $36.83 72193 S Ct pelvis w/dye 0283 4.6121 $250.39 $125.19 $50.08 72194 S Ct pelvis w/o&w/dye 0333 5.4299 $294.78 $146.98 $58.96 72195 S Mri pelvis w/o dye 0336 6.4817 $351.89 $175.94 $70.38 72196 S Mri pelvis w/dye 0284 7.0207 $381.15 $190.57 $76.23 72197 S Mri pelvis w/o & w/dye 0337 9.3215 $506.05 $240.77 $101.21 72198 E Mr angio pelvis w/o&w/dye 72200 X X-ray exam sacroiliac joints 0260 0.7845 $42.59 $21.29 $8.52 72202 X X-ray exam sacroiliac joints 0260 0.7845 $42.59 $21.29 $8.52 72220 X X-ray exam of tailbone 0260 0.7845 $42.59 $21.29 $8.52 72240 S Contrast x-ray of neck spine 0274 3.5837 $194.56 $92.92 $38.91 72255 S Contrast x-ray, thorax spine 0274 3.5837 $194.56 $92.92 $38.91 72265 S Contrast x-ray, lower spine 0274 3.5837 $194.56 $92.92 $38.91 72270 S Contrast x-ray of spine 0274 3.5837 $194.56 $92.92 $38.91 72275 S Epidurography 0274 3.5837 $194.56 $92.92 $38.91 72285 S X-ray c/t spine disk 0388 11.7450 $637.62 $304.54 $127.52 72295 S X-ray of lower spine disk 0388 11.7450 $637.62 $304.54 $127.52 73000 X X-ray exam of collar bone 0260 0.7845 $42.59 $21.29 $8.52 73010 X X-ray exam of shoulder blade 0260 0.7845 $42.59 $21.29 $8.52 73020 X X-ray exam of shoulder 0260 0.7845 $42.59 $21.29 $8.52 73030 X X-ray exam of shoulder 0260 0.7845 $42.59 $21.29 $8.52 73040 S Contrast x-ray of shoulder 0275 3.2967 $178.97 $69.09 $35.79 73050 X X-ray exam of shoulders 0260 0.7845 $42.59 $21.29 $8.52 73060 X X-ray exam of humerus 0260 0.7845 $42.59 $21.29 $8.52 73070 X X-ray exam of elbow 0260 0.7845 $42.59 $21.29 $8.52 73080 X X-ray exam of elbow 0260 0.7845 $42.59 $21.29 $8.52 73085 S Contrast x-ray of elbow 0275 3.2967 $178.97 $69.09 $35.79 73090 X X-ray exam of forearm 0260 0.7845 $42.59 $21.29 $8.52 73092 X X-ray exam of arm, infant 0260 0.7845 $42.59 $21.29 $8.52 73100 X X-ray exam of wrist 0260 0.7845 $42.59 $21.29 $8.52 73110 X X-ray exam of wrist 0260 0.7845 $42.59 $21.29 $8.52 73115 S Contrast x-ray of wrist 0275 3.2967 $178.97 $69.09 $35.79 73120 X X-ray exam of hand 0260 0.7845 $42.59 $21.29 $8.52 73130 X X-ray exam of hand 0260 0.7845 $42.59 $21.29 $8.52 73140 X X-ray exam of finger(s) 0260 0.7845 $42.59 $21.29 $8.52 73200 S Ct upper extremity w/o dye 0332 3.3916 $184.13 $91.27 $36.83 73201 S Ct upper extremity w/dye 0283 4.6121 $250.39 $125.19 $50.08 73202 S Ct uppr extremity w/o&w/dye 0333 5.4299 $294.78 $146.98 $58.96 73206 S Ct angio upr extrm w/o&w/dye 0662 5.8751 $318.95 $156.47 $63.79 73218 S Mri upper extremity w/o dye 0336 6.4817 $351.89 $175.94 $70.38 73219 S Mri upper extremity w/dye 0284 7.0207 $381.15 $190.57 $76.23 73220 S Mri uppr extremity w/o&w/dye 0337 9.3215 $506.05 $240.77 $101.21 73221 S Mri joint upr extrem w/o dye 0336 6.4817 $351.89 $175.94 $70.38 73222 S Mri joint upr extrem w/dye 0284 7.0207 $381.15 $190.57 $76.23 73223 S Mri joint upr extr w/o&w/dye 0337 9.3215 $506.05 $240.77 $101.21 73225 E Mr angio upr extr w/o&w/dye 73500 X X-ray exam of hip 0260 0.7845 $42.59 $21.29 $8.52 73510 X X-ray exam of hip 0260 0.7845 $42.59 $21.29 $8.52 73520 X X-ray exam of hips 0260 0.7845 $42.59 $21.29 $8.52 73525 S Contrast x-ray of hip 0275 3.2967 $178.97 $69.09 $35.79 73530 X X-ray exam of hip 0261 1.3238 $71.87 $14.37 73540 X X-ray exam of pelvis & hips 0260 0.7845 $42.59 $21.29 $8.52 73542 S X-ray exam, sacroiliac joint 0275 3.2967 $178.97 $69.09 $35.79 73550 X X-ray exam of thigh 0260 0.7845 $42.59 $21.29 $8.52 73560 X X-ray exam of knee, 1 or 2 0260 0.7845 $42.59 $21.29 $8.52 73562 X X-ray exam of knee, 3 0260 0.7845 $42.59 $21.29 $8.52 73564 X X-ray exam, knee, 4 or more 0260 0.7845 $42.59 $21.29 $8.52 Start Printed Page 48116 73565 X X-ray exam of knees 0260 0.7845 $42.59 $21.29 $8.52 73580 S Contrast x-ray of knee joint 0275 3.2967 $178.97 $69.09 $35.79 73590 X X-ray exam of lower leg 0260 0.7845 $42.59 $21.29 $8.52 73592 X X-ray exam of leg, infant 0260 0.7845 $42.59 $21.29 $8.52 73600 X X-ray exam of ankle 0260 0.7845 $42.59 $21.29 $8.52 73610 X X-ray exam of ankle 0260 0.7845 $42.59 $21.29 $8.52 73615 S Contrast x-ray of ankle 0275 3.2967 $178.97 $69.09 $35.79 73620 X X-ray exam of foot 0260 0.7845 $42.59 $21.29 $8.52 73630 X X-ray exam of foot 0260 0.7845 $42.59 $21.29 $8.52 73650 X X-ray exam of heel 0260 0.7845 $42.59 $21.29 $8.52 73660 X X-ray exam of toe(s) 0260 0.7845 $42.59 $21.29 $8.52 73700 S Ct lower extremity w/o dye 0332 3.3916 $184.13 $91.27 $36.83 73701 S Ct lower extremity w/dye 0283 4.6121 $250.39 $125.19 $50.08 73702 S Ct lwr extremity w/o&w/dye 0333 5.4299 $294.78 $146.98 $58.96 73706 S Ct angio lwr extr w/o&w/dye 0662 5.8751 $318.95 $156.47 $63.79 73718 S Mri lower extremity w/o dye 0336 6.4817 $351.89 $175.94 $70.38 73719 S Mri lower extremity w/dye 0284 7.0207 $381.15 $190.57 $76.23 73720 S Mri lwr extremity w/o&w/dye 0337 9.3215 $506.05 $240.77 $101.21 73721 S Mri jnt of lwr extre w/o dye 0336 6.4817 $351.89 $175.94 $70.38 73722 S Mri joint of lwr extr w/dye 0284 7.0207 $381.15 $190.57 $76.23 73723 S Mri joint lwr extr w/o&w/dye 0337 9.3215 $506.05 $240.77 $101.21 73725 E Mr ang lwr ext w or w/o dye 74000 X X-ray exam of abdomen 0260 0.7845 $42.59 $21.29 $8.52 74010 X X-ray exam of abdomen 0260 0.7845 $42.59 $21.29 $8.52 74020 X X-ray exam of abdomen 0260 0.7845 $42.59 $21.29 $8.52 74022 X X-ray exam series, abdomen 0261 1.3238 $71.87 $14.37 74150 S Ct abdomen w/o dye 0332 3.3916 $184.13 $91.27 $36.83 74160 S Ct abdomen w/dye 0283 4.6121 $250.39 $125.19 $50.08 74170 S Ct abdomen w/o&w/dye 0333 5.4299 $294.78 $146.98 $58.96 74175 S Ct angio abdom w/o&w/dye 0662 5.8751 $318.95 $156.47 $63.79 74181 S Mri abdomen w/o dye 0336 6.4817 $351.89 $175.94 $70.38 74182 S Mri abdomen w/dye 0284 7.0207 $381.15 $190.57 $76.23 74183 S Mri abdomen w/o&w/dye 0337 9.3215 $506.05 $240.77 $101.21 74185 E Mri angio, abdom w or w/o dy 74190 X X-ray exam of peritoneum 0263 2.1875 $118.76 $43.58 $23.75 74210 S Contrst x-ray exam of throat 0276 1.6025 $87.00 $41.72 $17.40 74220 S Contrast x-ray, esophagus 0276 1.6025 $87.00 $41.72 $17.40 74230 S Cine/vid x-ray, throat/esoph 0276 1.6025 $87.00 $41.72 $17.40 74235 S Remove esophagus obstruction 0296 3.1381 $170.36 $69.20 $34.07 74240 S X-ray exam, upper gi tract 0276 1.6025 $87.00 $41.72 $17.40 74241 S X-ray exam, upper gi tract 0276 1.6025 $87.00 $41.72 $17.40 74245 S X-ray exam, upper gi tract 0277 2.4462 $132.80 $60.47 $26.56 74246 S Contrst x-ray uppr gi tract 0276 1.6025 $87.00 $41.72 $17.40 74247 S Contrst x-ray uppr gi tract 0276 1.6025 $87.00 $41.72 $17.40 74249 S Contrst x-ray uppr gi tract 0277 2.4462 $132.80 $60.47 $26.56 74250 S X-ray exam of small bowel 0276 1.6025 $87.00 $41.72 $17.40 74251 S X-ray exam of small bowel 0277 2.4462 $132.80 $60.47 $26.56 74260 S X-ray exam of small bowel 0277 2.4462 $132.80 $60.47 $26.56 74270 S Contrast x-ray exam of colon 0276 1.6025 $87.00 $41.72 $17.40 74280 S Contrast x-ray exam of colon 0277 2.4462 $132.80 $60.47 $26.56 74283 S Contrast x-ray exam of colon 0276 1.6025 $87.00 $41.72 $17.40 74290 S Contrast x-ray, gallbladder 0276 1.6025 $87.00 $41.72 $17.40 74291 S Contrast x-rays, gallbladder 0276 1.6025 $87.00 $41.72 $17.40 74300 X X-ray bile ducts/pancreas 0263 2.1875 $118.76 $43.58 $23.75 74301 X X-rays at surgery add-on 0263 2.1875 $118.76 $43.58 $23.75 74305 X X-ray bile ducts/pancreas 0263 2.1875 $118.76 $43.58 $23.75 74320 X Contrast x-ray of bile ducts 0264 3.0022 $162.99 $79.41 $32.60 74327 S X-ray bile stone removal 0296 3.1381 $170.36 $69.20 $34.07 74328 N X-ray bile duct endoscopy 74329 N X-ray for pancreas endoscopy 74330 N X-ray bile/panc endoscopy 74340 X X-ray guide for GI tube 0272 1.4086 $76.47 $38.23 $15.29 74350 X X-ray guide, stomach tube 0263 2.1875 $118.76 $43.58 $23.75 74355 X X-ray guide, intestinal tube 0263 2.1875 $118.76 $43.58 $23.75 74360 S X-ray guide, GI dilation 0296 3.1381 $170.36 $69.20 $34.07 74363 S X-ray, bile duct dilation 0297 8.1532 $442.63 $172.51 $88.53 Start Printed Page 48117 74400 S Contrst x-ray, urinary tract 0278 2.7365 $148.56 $66.07 $29.71 74410 S Contrst x-ray, urinary tract 0278 2.7365 $148.56 $66.07 $29.71 74415 S Contrst x-ray, urinary tract 0278 2.7365 $148.56 $66.07 $29.71 74420 S Contrst x-ray, urinary tract 0278 2.7365 $148.56 $66.07 $29.71 74425 S Contrst x-ray, urinary tract 0278 2.7365 $148.56 $66.07 $29.71 74430 S Contrast x-ray, bladder 0278 2.7365 $148.56 $66.07 $29.71 74440 S X-ray, male genital tract 0278 2.7365 $148.56 $66.07 $29.71 74445 S X-ray exam of penis 0278 2.7365 $148.56 $66.07 $29.71 74450 S X-ray, urethra/bladder 0278 2.7365 $148.56 $66.07 $29.71 74455 S X-ray, urethra/bladder 0278 2.7365 $148.56 $66.07 $29.71 74470 X X-ray exam of kidney lesion 0264 3.0022 $162.99 $79.41 $32.60 74475 S X-ray control, cath insert 0297 8.1532 $442.63 $172.51 $88.53 74480 S X-ray control, cath insert 0296 3.1381 $170.36 $69.20 $34.07 74485 S X-ray guide, GU dilation 0296 3.1381 $170.36 $69.20 $34.07 74710 X X-ray measurement of pelvis 0260 0.7845 $42.59 $21.29 $8.52 74740 X X-ray, female genital tract 0264 3.0022 $162.99 $79.41 $32.60 74742 X X-ray, fallopian tube 0263 2.1875 $118.76 $43.58 $23.75 74775 S X-ray exam of perineum 0278 2.7365 $148.56 $66.07 $29.71 75552 S Heart mri for morph w/o dye 0336 6.4817 $351.89 $175.94 $70.38 75553 S Heart mri for morph w/dye 0284 7.0207 $381.15 $190.57 $76.23 75554 S Cardiac MRI/function 0335 6.4453 $349.91 $151.46 $69.98 75555 S Cardiac MRI/limited study 0335 6.4453 $349.91 $151.46 $69.98 75556 E Cardiac MRI/flow mapping 75600 S Contrast x-ray exam of aorta 0280 19.0237 $1,032.78 $353.85 $206.56 75605 S Contrast x-ray exam of aorta 0280 19.0237 $1,032.78 $353.85 $206.56 75625 S Contrast x-ray exam of aorta 0280 19.0237 $1,032.78 $353.85 $206.56 75630 S X-ray aorta, leg arteries 0280 19.0237 $1,032.78 $353.85 $206.56 75635 S Ct angio abdominal arteries 0662 5.8751 $318.95 $156.47 $63.79 75650 S Artery x-rays, head & neck 0280 19.0237 $1,032.78 $353.85 $206.56 75658 S Artery x-rays, arm 0280 19.0237 $1,032.78 $353.85 $206.56 75660 S Artery x-rays, head & neck 0279 11.0678 $600.86 $174.57 $120.17 75662 S Artery x-rays, head & neck 0279 11.0678 $600.86 $174.57 $120.17 75665 S Artery x-rays, head & neck 0280 19.0237 $1,032.78 $353.85 $206.56 75671 S Artery x-rays, head & neck 0280 19.0237 $1,032.78 $353.85 $206.56 75676 S Artery x-rays, neck 0280 19.0237 $1,032.78 $353.85 $206.56 75680 S Artery x-rays, neck 0280 19.0237 $1,032.78 $353.85 $206.56 75685 S Artery x-rays, spine 0279 11.0678 $600.86 $174.57 $120.17 75705 S Artery x-rays, spine 0279 11.0678 $600.86 $174.57 $120.17 75710 S Artery x-rays, arm/leg 0280 19.0237 $1,032.78 $353.85 $206.56 75716 S Artery x-rays, arms/legs 0280 19.0237 $1,032.78 $353.85 $206.56 75722 S Artery x-rays, kidney 0280 19.0237 $1,032.78 $353.85 $206.56 75724 S Artery x-rays, kidneys 0280 19.0237 $1,032.78 $353.85 $206.56 75726 S Artery x-rays, abdomen 0280 19.0237 $1,032.78 $353.85 $206.56 75731 S Artery x-rays, adrenal gland 0280 19.0237 $1,032.78 $353.85 $206.56 75733 S Artery x-rays, adrenals 0280 19.0237 $1,032.78 $353.85 $206.56 75736 S Artery x-rays, pelvis 0280 19.0237 $1,032.78 $353.85 $206.56 75741 S Artery x-rays, lung 0279 11.0678 $600.86 $174.57 $120.17 75743 S Artery x-rays, lungs 0280 19.0237 $1,032.78 $353.85 $206.56 75746 S Artery x-rays, lung 0279 11.0678 $600.86 $174.57 $120.17 75756 S Artery x-rays, chest 0279 11.0678 $600.86 $174.57 $120.17 75774 S Artery x-ray, each vessel 0668 10.4896 $569.47 $237.76 $113.89 75790 S Visualize A-V shunt 0281 6.6888 $363.13 $115.16 $72.63 75801 X Lymph vessel x-ray, arm/leg 0264 3.0022 $162.99 $79.41 $32.60 75803 X Lymph vessel x-ray,arms/legs 0264 3.0022 $162.99 $79.41 $32.60 75805 X Lymph vessel x-ray, trunk 0264 3.0022 $162.99 $79.41 $32.60 75807 X Lymph vessel x-ray, trunk 0264 3.0022 $162.99 $79.41 $32.60 75809 X Nonvascular shunt, x-ray 0263 2.1875 $118.76 $43.58 $23.75 75810 S Vein x-ray, spleen/liver 0279 11.0678 $600.86 $174.57 $120.17 75820 S Vein x-ray, arm/leg 0281 6.6888 $363.13 $115.16 $72.63 75822 S Vein x-ray, arms/legs 0281 6.6888 $363.13 $115.16 $72.63 75825 S Vein x-ray, trunk 0279 11.0678 $600.86 $174.57 $120.17 75827 S Vein x-ray, chest 0279 11.0678 $600.86 $174.57 $120.17 75831 S Vein x-ray, kidney 0287 6.2829 $341.09 $107.20 $68.22 75833 S Vein x-ray, kidneys 0279 11.0678 $600.86 $174.57 $120.17 75840 S Vein x-ray, adrenal gland 0287 6.2829 $341.09 $107.20 $68.22 75842 S Vein x-ray, adrenal glands 0287 6.2829 $341.09 $107.20 $68.22 Start Printed Page 48118 75860 S Vein x-ray, neck 0287 6.2829 $341.09 $107.20 $68.22 75870 S Vein x-ray, skull 0287 6.2829 $341.09 $107.20 $68.22 75872 S Vein x-ray, skull 0287 6.2829 $341.09 $107.20 $68.22 75880 S Vein x-ray, eye socket 0287 6.2829 $341.09 $107.20 $68.22 75885 S Vein x-ray, liver 0279 11.0678 $600.86 $174.57 $120.17 75887 S Vein x-ray, liver 0280 19.0237 $1,032.78 $353.85 $206.56 75889 S Vein x-ray, liver 0279 11.0678 $600.86 $174.57 $120.17 75891 S Vein x-ray, liver 0279 11.0678 $600.86 $174.57 $120.17 75893 N Venous sampling by catheter 75894 S X-rays, transcath therapy 0297 8.1532 $442.63 $172.51 $88.53 75896 S X-rays, transcath therapy 0297 8.1532 $442.63 $172.51 $88.53 75898 X Follow-up angiography 0264 3.0022 $162.99 $79.41 $32.60 75900 C Arterial catheter exchange 75901 X Remove cva device obstruct 0264 3.0022 $162.99 $79.41 $32.60 75902 X Remove cva lumen obstruct 0263 2.1875 $118.76 $43.58 $23.75 75940 X X-ray placement, vein filter 0187 4.4274 $240.36 $90.71 $48.07 75945 S Intravascular us 0267 2.4805 $134.66 $65.52 $26.93 75946 S Intravascular us add-on 0267 2.4805 $134.66 $65.52 $26.93 75952 C Endovasc repair abdom aorta 75953 C Abdom aneurysm endovas rpr 75954 C Iliac aneurysm endovas rpr 75960 S Transcatheter intro, stent 0280 19.0237 $1,032.78 $353.85 $206.56 75961 S Retrieval, broken catheter 0280 19.0237 $1,032.78 $353.85 $206.56 75962 S Repair arterial blockage 0280 19.0237 $1,032.78 $353.85 $206.56 75964 S Repair artery blockage, each 0280 19.0237 $1,032.78 $353.85 $206.56 75966 S Repair arterial blockage 0280 19.0237 $1,032.78 $353.85 $206.56 75968 S Repair artery blockage, each 0280 19.0237 $1,032.78 $353.85 $206.56 75970 S Vascular biopsy 0280 19.0237 $1,032.78 $353.85 $206.56 75978 S Repair venous blockage 0668 10.4896 $569.47 $237.76 $113.89 75980 S Contrast xray exam bile duct 0296 3.1381 $170.36 $69.20 $34.07 75982 S Contrast xray exam bile duct 0297 8.1532 $442.63 $172.51 $88.53 75984 X Xray control catheter change 0264 3.0022 $162.99 $79.41 $32.60 75989 N Abscess drainage under x-ray 75992 S Atherectomy, x-ray exam 0280 19.0237 $1,032.78 $353.85 $206.56 75993 S Atherectomy, x-ray exam 0280 19.0237 $1,032.78 $353.85 $206.56 75994 S Atherectomy, x-ray exam 0280 19.0237 $1,032.78 $353.85 $206.56 75995 S Atherectomy, x-ray exam 0280 19.0237 $1,032.78 $353.85 $206.56 75996 S Atherectomy, x-ray exam 0280 19.0237 $1,032.78 $353.85 $206.56 76000 X Fluoroscope examination 0272 1.4086 $76.47 $38.23 $15.29 76001 N Fluoroscope exam, extensive 76003 N Needle localization by x-ray 76005 N Fluoroguide for spine inject 76006 X X-ray stress view 0260 0.7845 $42.59 $21.29 $8.52 76010 X X-ray, nose to rectum 0260 0.7845 $42.59 $21.29 $8.52 76012 S Percut vertebroplasty fluor 0274 3.5837 $194.56 $92.92 $38.91 76013 S Percut vertebroplasty, ct 0274 3.5837 $194.56 $92.92 $38.91 76020 X X-rays for bone age 0260 0.7845 $42.59 $21.29 $8.52 76040 X X-rays, bone evaluation 0260 0.7845 $42.59 $21.29 $8.52 76061 X X-rays, bone survey 0261 1.3238 $71.87 $14.37 76062 X X-rays, bone survey 0261 1.3238 $71.87 $14.37 76065 X X-rays, bone evaluation 0261 1.3238 $71.87 $14.37 76066 X Joint survey, single view 0260 0.7845 $42.59 $21.29 $8.52 76070 S CT scan, bone density study 0288 1.2854 $69.78 $13.96 76071 S Ct bone density, peripheral 0282 1.6813 $91.28 $44.51 $18.26 76075 S Dexa, axial skeleton study 0288 1.2854 $69.78 $13.96 76076 S Dexa, peripheral study 0665 0.7225 $39.22 $7.84 76078 X Radiographic absorptiometry 0261 1.3238 $71.87 $14.37 76080 X X-ray exam of fistula 0263 2.1875 $118.76 $43.58 $23.75 76085 A Computer mammogram add-on 76086 X X-ray of mammary duct 0263 2.1875 $118.76 $43.58 $23.75 76088 X X-ray of mammary ducts 0263 2.1875 $118.76 $43.58 $23.75 76090 S Mammogram, one breast 0271 0.6548 $35.55 $16.80 $7.11 76091 S Mammogram, both breasts 0271 0.6548 $35.55 $16.80 $7.11 76092 A Mammogram, screening 76093 E Magnetic image, breast 76094 E Magnetic image, both breasts Start Printed Page 48119 76095 X Stereotactic breast biopsy 0187 4.4274 $240.36 $90.71 $48.07 76096 X X-ray of needle wire, breast 0289 3.6386 $197.54 $44.80 $39.51 76098 X X-ray exam, breast specimen 0260 0.7845 $42.59 $21.29 $8.52 76100 X X-ray exam of body section 0261 1.3238 $71.87 $14.37 76101 X Complex body section x-ray 0264 3.0022 $162.99 $79.41 $32.60 76102 X Complex body section x-rays 0264 3.0022 $162.99 $79.41 $32.60 76120 X Cine/video x-rays 0272 1.4086 $76.47 $38.23 $15.29 76125 X Cine/video x-rays add-on 0260 0.7845 $42.59 $21.29 $8.52 76140 E X-ray consultation 76150 X X-ray exam, dry process 0260 0.7845 $42.59 $21.29 $8.52 76350 N Special x-ray contrast study 76355 S CAT scan for localization 0283 4.6121 $250.39 $125.19 $50.08 76360 S CAT scan for needle biopsy 0283 4.6121 $250.39 $125.19 $50.08 76362 S Cat scan for tissue ablation 0332 3.3916 $184.13 $91.27 $36.83 76370 S CAT scan for therapy guide 0282 1.6813 $91.28 $44.51 $18.26 76375 S 3d/holograph reconstr add-on 0282 1.6813 $91.28 $44.51 $18.26 76380 S CAT scan follow-up study 0282 1.6813 $91.28 $44.51 $18.26 76390 E Mr spectroscopy 76393 S Mr guidance for needle place 0335 6.4453 $349.91 $151.46 $69.98 76394 S Mri for tissue ablation 0335 6.4453 $349.91 $151.46 $69.98 76400 S Magnetic image, bone marrow 0335 6.4453 $349.91 $151.46 $69.98 76490 S Us for tissue ablation 0268 1.2640 $68.62 $13.72 76496 X Fluoroscopic procedure 0272 1.4086 $76.47 $38.23 $15.29 76497 S Ct procedure 0282 1.6813 $91.28 $44.51 $18.26 76498 S Mri procedure 0335 6.4453 $349.91 $151.46 $69.98 76499 X Radiographic procedure 0260 0.7845 $42.59 $21.29 $8.52 76506 S Echo exam of head 0266 1.6234 $88.13 $44.06 $17.63 76511 S Echo exam of eye 0266 1.6234 $88.13 $44.06 $17.63 76512 S Echo exam of eye 0266 1.6234 $88.13 $44.06 $17.63 76513 S Echo exam of eye, water bath 0265 1.0245 $55.62 $27.81 $11.12 76516 S Echo exam of eye 0266 1.6234 $88.13 $44.06 $17.63 76519 S Echo exam of eye 0266 1.6234 $88.13 $44.06 $17.63 76529 S Echo exam of eye 0265 1.0245 $55.62 $27.81 $11.12 76536 S Us exam of head and neck 0266 1.6234 $88.13 $44.06 $17.63 76604 S Us exam, chest, b-scan 0266 1.6234 $88.13 $44.06 $17.63 76645 S Us exam, breast(s) 0265 1.0245 $55.62 $27.81 $11.12 76700 S Us exam, abdom, complete 0266 1.6234 $88.13 $44.06 $17.63 76705 S Echo exam of abdomen 0266 1.6234 $88.13 $44.06 $17.63 76770 S Us exam abdo back wall, comp 0266 1.6234 $88.13 $44.06 $17.63 76775 S Us eam abdo back wall, lim 0266 1.6234 $88.13 $44.06 $17.63 76778 S Us exam kidney transplant 0266 1.6234 $88.13 $44.06 $17.63 76800 S Us exam, spinal canal 0266 1.6234 $88.13 $44.06 $17.63 76801 S Ob us < 14 wks, single fetus 0265 1.0245 $55.62 $27.81 $11.12 76802 S Ob us < 14 wks, addl fetus 0265 1.0245 $55.62 $27.81 $11.12 76805 S Us exam, pg uterus, compl 0266 1.6234 $88.13 $44.06 $17.63 76810 S Us exam, pg uterus, mult 0265 1.0245 $55.62 $27.81 $11.12 76811 S Ob us, detailed, sngl fetus 0267 2.4805 $134.66 $65.52 $26.93 76812 S Ob us, detailed, addl fetus 0266 1.6234 $88.13 $44.06 $17.63 76815 S Us exam, pg uterus limit 0265 1.0245 $55.62 $27.81 $11.12 76816 S Us exam pg uterus repeat 0265 1.0245 $55.62 $27.81 $11.12 76817 S Transvaginal us, obstetric 0265 1.0245 $55.62 $27.81 $11.12 76818 S Fetal biophys profile w/nst 0266 1.6234 $88.13 $44.06 $17.63 76819 S Fetal biophys profil w/o nst 0266 1.6234 $88.13 $44.06 $17.63 76825 S Echo exam of fetal heart 0671 1.6392 $88.99 $44.49 $17.80 76826 S Echo exam of fetal heart 0697 1.4621 $79.38 $39.69 $15.88 76827 S Echo exam of fetal heart 0671 1.6392 $88.99 $44.49 $17.80 76828 S Echo exam of fetal heart 0697 1.4621 $79.38 $39.69 $15.88 76830 S Transvaginal us, non-ob 0266 1.6234 $88.13 $44.06 $17.63 76831 S Echo exam, uterus 0266 1.6234 $88.13 $44.06 $17.63 76856 S Us exam, pelvic, complete 0266 1.6234 $88.13 $44.06 $17.63 76857 S Us exam, pelvic, limited 0265 1.0245 $55.62 $27.81 $11.12 76870 S Us exam, scrotum 0266 1.6234 $88.13 $44.06 $17.63 76872 S Echo exam, transrectal 0266 1.6234 $88.13 $44.06 $17.63 76873 S Echograp trans r, pros study 0266 1.6234 $88.13 $44.06 $17.63 76880 S Us exam, extremity 0266 1.6234 $88.13 $44.06 $17.63 76885 S Us exam infant hips, dynamic 0266 1.6234 $88.13 $44.06 $17.63 Start Printed Page 48120 76886 S Us exam infant hips, static 0266 1.6234 $88.13 $44.06 $17.63 76930 S Echo guide, cardiocentesis 0268 1.2640 $68.62 $13.72 76932 S Echo guide for heart biopsy 0268 1.2640 $68.62 $13.72 76936 S Echo guide for artery repair 0268 1.2640 $68.62 $13.72 76941 S Echo guide for transfusion 0268 1.2640 $68.62 $13.72 76942 S Echo guide for biopsy 0268 1.2640 $68.62 $13.72 76945 S Echo guide, villus sampling 0268 1.2640 $68.62 $13.72 76946 S Echo guide for amniocentesis 0268 1.2640 $68.62 $13.72 76948 S Echo guide, ova aspiration 0268 1.2640 $68.62 $13.72 76950 S Echo guidance radiotherapy 0268 1.2640 $68.62 $13.72 76965 S Echo guidance radiotherapy 0268 1.2640 $68.62 $13.72 76970 S Ultrasound exam follow-up 0265 1.0245 $55.62 $27.81 $11.12 76975 S GI endoscopic ultrasound 0266 1.6234 $88.13 $44.06 $17.63 76977 X Us bone density measure 0340 0.6232 $33.83 $6.77 76986 S Ultrasound guide intraoper 0266 1.6234 $88.13 $44.06 $17.63 76999 S Echo examination procedure 0265 1.0245 $55.62 $27.81 $11.12 77261 E Radiation therapy planning 77262 E Radiation therapy planning 77263 E Radiation therapy planning 77280 X Set radiation therapy field 0304 1.6599 $90.11 $41.52 $18.02 77285 X Set radiation therapy field 0305 3.6649 $198.96 $91.38 $39.79 77290 X Set radiation therapy field 0305 3.6649 $198.96 $91.38 $39.79 77295 X Set radiation therapy field 0310 13.7085 $744.22 $325.27 $148.84 77299 E Radiation therapy planning 77300 X Radiation therapy dose plan 0304 1.6599 $90.11 $41.52 $18.02 77301 S Radiotherapy dose plan, imrt 0413 6.0369 $327.74 $65.55 77305 X Teletx isodose plan simple 0304 1.6599 $90.11 $41.52 $18.02 77310 X Teletx isodose plan intermed 0304 1.6599 $90.11 $41.52 $18.02 77315 X Teletx isodose plan complex 0305 3.6649 $198.96 $91.38 $39.79 77321 X Special teletx port plan 0305 3.6649 $198.96 $91.38 $39.79 77326 X Radiation therapy dose plan 0305 3.6649 $198.96 $91.38 $39.79 77327 X Brachytx isodose calc interm 0305 3.6649 $198.96 $91.38 $39.79 77328 X Brachytx isodose plan compl 0305 3.6649 $198.96 $91.38 $39.79 77331 X Special radiation dosimetry 0304 1.6599 $90.11 $41.52 $18.02 77332 X Radiation treatment aid(s) 0303 2.8636 $155.46 $66.95 $31.09 77333 X Radiation treatment aid(s) 0303 2.8636 $155.46 $66.95 $31.09 77334 X Radiation treatment aid(s) 0303 2.8636 $155.46 $66.95 $31.09 77336 X Radiation physics consult 0304 1.6599 $90.11 $41.52 $18.02 77370 X Radiation physics consult 0305 3.6649 $198.96 $91.38 $39.79 77399 X External radiation dosimetry 0304 1.6599 $90.11 $41.52 $18.02 77401 S Radiation treatment delivery 0300 1.5112 $82.04 $16.41 77402 S Radiation treatment delivery 0300 1.5112 $82.04 $16.41 77403 S Radiation treatment delivery 0300 1.5112 $82.04 $16.41 77404 S Radiation treatment delivery 0300 1.5112 $82.04 $16.41 77406 S Radiation treatment delivery 0300 1.5112 $82.04 $16.41 77407 S Radiation treatment delivery 0300 1.5112 $82.04 $16.41 77408 S Radiation treatment delivery 0300 1.5112 $82.04 $16.41 77409 S Radiation treatment delivery 0300 1.5112 $82.04 $16.41 77411 S Radiation treatment delivery 0300 1.5112 $82.04 $16.41 77412 S Radiation treatment delivery 0301 2.1337 $115.84 $23.17 $23.17 77413 S Radiation treatment delivery 0301 2.1337 $115.84 $23.17 $23.17 77414 S Radiation treatment delivery 0301 2.1337 $115.84 $23.17 $23.17 77416 S Radiation treatment delivery 0301 2.1337 $115.84 $23.17 $23.17 77417 X Radiology port film(s) 0260 0.7845 $42.59 $21.29 $8.52 77418 S Radiation tx delivery, imrt 0412 5.2832 $286.82 $57.36 77427 E Radiation tx management, x5 77431 E Radiation therapy management 77432 E Stereotactic radiation trmt 77470 S Special radiation treatment 0299 5.7427 $311.77 $62.36 $62.35 77499 E Radiation therapy management 77520 S Proton trmt, simple w/o comp 0664 9.6828 $525.67 $105.13 77522 S Proton trmt, simple w/comp 0664 9.6828 $525.67 $105.13 77523 S Proton trmt, intermediate 1511 $950.00 $190.00 77525 S Proton treatment, complex 1511 $950.00 $190.00 77600 S Hyperthermia treatment 0314 5.0930 $276.49 $101.77 $55.30 77605 S Hyperthermia treatment 0314 5.0930 $276.49 $101.77 $55.30 Start Printed Page 48121 77610 S Hyperthermia treatment 0314 5.0930 $276.49 $101.77 $55.30 77615 S Hyperthermia treatment 0314 5.0930 $276.49 $101.77 $55.30 77620 S Hyperthermia treatment 0314 5.0930 $276.49 $101.77 $55.30 77750 S Infuse radioactive materials 0300 1.5112 $82.04 $16.41 77761 S Apply intrcav radiat simple 0312 3.6892 $200.28 $40.06 $40.06 77762 S Apply intrcav radiat interm 0312 3.6892 $200.28 $40.06 $40.06 77763 S Apply intrcav radiat compl 0312 3.6892 $200.28 $40.06 $40.06 77776 S Apply interstit radiat simpl 0312 3.6892 $200.28 $40.06 $40.06 77777 S Apply interstit radiat inter 0312 3.6892 $200.28 $40.06 $40.06 77778 S Apply interstit radiat compl 0651 10.0459 $545.38 $109.08 $109.08 77781 S High intensity brachytherapy 0313 13.1258 $712.59 $142.52 77782 S High intensity brachytherapy 0313 13.1258 $712.59 $142.52 77783 S High intensity brachytherapy 0313 13.1258 $712.59 $142.52 77784 S High intensity brachytherapy 0313 13.1258 $712.59 $142.52 77789 S Apply surface radiation 0300 1.5112 $82.04 $16.41 77790 N Radiation handling 77799 S Radium/radioisotope therapy 0313 13.1258 $712.59 $142.52 78000 S Thyroid, single uptake 0389 1.6475 $89.44 $44.72 $17.89 78001 S Thyroid, multiple uptakes 0389 1.6475 $89.44 $44.72 $17.89 78003 S Thyroid suppress/stimul 0389 1.6475 $89.44 $44.72 $17.89 78006 S Thyroid imaging with uptake 0390 2.8434 $154.37 $77.18 $30.87 78007 S Thyroid image, mult uptakes 0391 3.7174 $201.81 $100.90 $40.36 78010 S Thyroid imaging 0390 2.8434 $154.37 $77.18 $30.87 78011 S Thyroid imaging with flow 0391 3.7174 $201.81 $100.90 $40.36 78015 S Thyroid met imaging 0390 2.8434 $154.37 $77.18 $30.87 78016 S Thyroid met imaging/studies 0390 2.8434 $154.37 $77.18 $30.87 78018 S Thyroid met imaging, body 0391 3.7174 $201.81 $100.90 $40.36 78020 S Thyroid met uptake 0389 1.6475 $89.44 $44.72 $17.89 78070 S Parathyroid nuclear imaging 0391 3.7174 $201.81 $100.90 $40.36 78075 S Adrenal nuclear imaging 0392 6.7081 $364.18 $182.08 $72.84 78099 S Endocrine nuclear procedure 0389 1.6475 $89.44 $44.72 $17.89 78102 S Bone marrow imaging, ltd 0400 3.8691 $210.05 $105.02 $42.01 78103 S Bone marrow imaging, mult 0400 3.8691 $210.05 $105.02 $42.01 78104 S Bone marrow imaging, body 0400 3.8691 $210.05 $105.02 $42.01 78110 S Plasma volume, single 0393 4.0720 $221.06 $110.53 $44.21 78111 S Plasma volume, multiple 0393 4.0720 $221.06 $110.53 $44.21 78120 S Red cell mass, single 0393 4.0720 $221.06 $110.53 $44.21 78121 S Red cell mass, multiple 0393 4.0720 $221.06 $110.53 $44.21 78122 S Blood volume 0393 4.0720 $221.06 $110.53 $44.21 78130 S Red cell survival study 0393 4.0720 $221.06 $110.53 $44.21 78135 S Red cell survival kinetics 0393 4.0720 $221.06 $110.53 $44.21 78140 S Red cell sequestration 0393 4.0720 $221.06 $110.53 $44.21 78160 S Plasma iron turnover 0393 4.0720 $221.06 $110.53 $44.21 78162 S Radioiron absorption exam 0393 4.0720 $221.06 $110.53 $44.21 78170 S Red cell iron utilization 0393 4.0720 $221.06 $110.53 $44.21 78172 S Total body iron estimation 0393 4.0720 $221.06 $110.53 $44.21 78185 S Spleen imaging 0400 3.8691 $210.05 $105.02 $42.01 78190 S Platelet survival, kinetics 0389 1.6475 $89.44 $44.72 $17.89 78191 S Platelet survival 0389 1.6475 $89.44 $44.72 $17.89 78195 S Lymph system imaging 0400 3.8691 $210.05 $105.02 $42.01 78199 S Blood/lymph nuclear exam 0389 1.6475 $89.44 $44.72 $17.89 78201 S Liver imaging 0394 4.4370 $240.88 $120.44 $48.18 78202 S Liver imaging with flow 0394 4.4370 $240.88 $120.44 $48.18 78205 S Liver imaging (3D) 0394 4.4370 $240.88 $120.44 $48.18 78206 S Liver image (3d) with flow 0394 4.4370 $240.88 $120.44 $48.18 78215 S Liver and spleen imaging 0394 4.4370 $240.88 $120.44 $48.18 78216 S Liver & spleen image/flow 0394 4.4370 $240.88 $120.44 $48.18 78220 S Liver function study 0394 4.4370 $240.88 $120.44 $48.18 78223 S Hepatobiliary imaging 0394 4.4370 $240.88 $120.44 $48.18 78230 S Salivary gland imaging 0395 3.9372 $213.75 $106.87 $42.75 78231 S Serial salivary imaging 0395 3.9372 $213.75 $106.87 $42.75 78232 S Salivary gland function exam 0395 3.9372 $213.75 $106.87 $42.75 78258 S Esophageal motility study 0395 3.9372 $213.75 $106.87 $42.75 78261 S Gastric mucosa imaging 0395 3.9372 $213.75 $106.87 $42.75 78262 S Gastroesophageal reflux exam 0395 3.9372 $213.75 $106.87 $42.75 78264 S Gastric emptying study 0395 3.9372 $213.75 $106.87 $42.75 Start Printed Page 48122 78267 A Breath tst attain/anal c-14 78268 A Breath test analysis, c-14 78270 S Vit B-12 absorption exam 0395 3.9372 $213.75 $106.87 $42.75 78271 S Vit b-12 absrp exam, int fac 0395 3.9372 $213.75 $106.87 $42.75 78272 S Vit B-12 absorp, combined 0395 3.9372 $213.75 $106.87 $42.75 78278 S Acute GI blood loss imaging 0395 3.9372 $213.75 $106.87 $42.75 78282 S GI protein loss exam 0395 3.9372 $213.75 $106.87 $42.75 78290 S Meckel's divert exam 0395 3.9372 $213.75 $106.87 $42.75 78291 S Leveen/shunt patency exam 0395 3.9372 $213.75 $106.87 $42.75 78299 S GI nuclear procedure 0389 1.6475 $89.44 $44.72 $17.89 78300 S Bone imaging, limited area 0396 4.2445 $230.43 $115.21 $46.09 78305 S Bone imaging, multiple areas 0396 4.2445 $230.43 $115.21 $46.09 78306 S Bone imaging, whole body 0396 4.2445 $230.43 $115.21 $46.09 78315 S Bone imaging, 3 phase 0396 4.2445 $230.43 $115.21 $46.09 78320 S Bone imaging (3D) 0396 4.2445 $230.43 $115.21 $46.09 78350 X Bone mineral, single photon 0261 1.3238 $71.87 $14.37 78351 E Bone mineral, dual photon 78399 S Musculoskeletal nuclear exam 0389 1.6475 $89.44 $44.72 $17.89 78414 S Non-imaging heart function 0397 2.4737 $134.29 $67.14 $26.86 78428 S Cardiac shunt imaging 0398 6.6521 $361.14 $180.57 $72.23 78445 S Vascular flow imaging 0397 2.4737 $134.29 $67.14 $26.86 78455 S Venous thrombosis study 0397 2.4737 $134.29 $67.14 $26.86 78456 S Acute venous thrombus image 0397 2.4737 $134.29 $67.14 $26.86 78457 S Venous thrombosis imaging 0397 2.4737 $134.29 $67.14 $26.86 78458 S Ven thrombosis images, bilat 0397 2.4737 $134.29 $67.14 $26.86 78459 S Heart muscle imaging (PET) 0285 19.5044 $1,058.87 $409.56 $211.77 78460 S Heart muscle blood, single 0398 6.6521 $361.14 $180.57 $72.23 78461 S Heart muscle blood, multiple 0398 6.6521 $361.14 $180.57 $72.23 78464 S Heart image (3d), single 0398 6.6521 $361.14 $180.57 $72.23 78465 S Heart image (3d), multiple 0398 6.6521 $361.14 $180.57 $72.23 78466 S Heart infarct image 0398 6.6521 $361.14 $180.57 $72.23 78468 S Heart infarct image (ef) 0398 6.6521 $361.14 $180.57 $72.23 78469 S Heart infarct image (3D) 0398 6.6521 $361.14 $180.57 $72.23 78472 S Gated heart, planar, single 0398 6.6521 $361.14 $180.57 $72.23 78473 S Gated heart, multiple 0398 6.6521 $361.14 $180.57 $72.23 78478 S Heart wall motion add-on 0399 1.6033 $87.04 $43.52 $17.41 78480 S Heart function add-on 0399 1.6033 $87.04 $43.52 $17.41 78481 S Heart first pass, single 0398 6.6521 $361.14 $180.57 $72.23 78483 S Heart first pass, multiple 0398 6.6521 $361.14 $180.57 $72.23 78491 E Heart image (pet), single 78492 E Heart image (pet), multiple 78494 S Heart image, spect 0398 6.6521 $361.14 $180.57 $72.23 78496 S Heart first pass add-on 0399 1.6033 $87.04 $43.52 $17.41 78499 S Cardiovascular nuclear exam 0389 1.6475 $89.44 $44.72 $17.89 78580 S Lung perfusion imaging 0401 4.9130 $266.72 $133.35 $53.34 78584 S Lung V/Q image single breath 0401 4.9130 $266.72 $133.35 $53.34 78585 S Lung V/Q imaging 0401 4.9130 $266.72 $133.35 $53.34 78586 S Aerosol lung image, single 0401 4.9130 $266.72 $133.35 $53.34 78587 S Aerosol lung image, multiple 0401 4.9130 $266.72 $133.35 $53.34 78588 S Perfusion lung image 0401 4.9130 $266.72 $133.35 $53.34 78591 S Vent image, 1 breath, 1 proj 0401 4.9130 $266.72 $133.35 $53.34 78593 S Vent image, 1 proj, gas 0401 4.9130 $266.72 $133.35 $53.34 78594 S Vent image, mult proj, gas 0401 4.9130 $266.72 $133.35 $53.34 78596 S Lung differential function 0401 4.9130 $266.72 $133.35 $53.34 78599 S Respiratory nuclear exam 0389 1.6475 $89.44 $44.72 $17.89 78600 S Brain imaging, ltd static 0402 5.4818 $297.60 $148.79 $59.52 78601 S Brain imaging, ltd w/ flow 0402 5.4818 $297.60 $148.79 $59.52 78605 S Brain imaging, complete 0402 5.4818 $297.60 $148.79 $59.52 78606 S Brain imaging, compl w/flow 0402 5.4818 $297.60 $148.79 $59.52 78607 S Brain imaging (3D) 0402 5.4818 $297.60 $148.79 $59.52 78608 E Brain imaging (PET) 78609 E Brain imaging (PET) 78610 S Brain flow imaging only 0402 5.4818 $297.60 $148.79 $59.52 78615 S Cerebral vascular flow image 0402 5.4818 $297.60 $148.79 $59.52 78630 S Cerebrospinal fluid scan 0403 3.9265 $213.17 $106.58 $42.63 78635 S CSF ventriculography 0403 3.9265 $213.17 $106.58 $42.63 Start Printed Page 48123 78645 S CSF shunt evaluation 0403 3.9265 $213.17 $106.58 $42.63 78647 S Cerebrospinal fluid scan 0403 3.9265 $213.17 $106.58 $42.63 78650 S CSF leakage imaging 0403 3.9265 $213.17 $106.58 $42.63 78660 S Nuclear exam of tear flow 0403 3.9265 $213.17 $106.58 $42.63 78699 S Nervous system nuclear exam 0389 1.6475 $89.44 $44.72 $17.89 78700 S Kidney imaging, static 0404 5.1538 $279.79 $139.89 $55.96 78701 S Kidney imaging with flow 0404 5.1538 $279.79 $139.89 $55.96 78704 S Imaging renogram 0404 5.1538 $279.79 $139.89 $55.96 78707 S Kidney flow/function image 0404 5.1538 $279.79 $139.89 $55.96 78708 S Kidney flow/function image 0404 5.1538 $279.79 $139.89 $55.96 78709 S Kidney flow/function image 0404 5.1538 $279.79 $139.89 $55.96 78710 S Kidney imaging (3D) 0404 5.1538 $279.79 $139.89 $55.96 78715 S Renal vascular flow exam 0404 5.1538 $279.79 $139.89 $55.96 78725 S Kidney function study 0389 1.6475 $89.44 $44.72 $17.89 78730 S Urinary bladder retention 0405 0.7739 $42.01 $21.00 $8.40 78740 S Ureteral reflux study 0405 0.7739 $42.01 $21.00 $8.40 78760 S Testicular imaging 0405 0.7739 $42.01 $21.00 $8.40 78761 S Testicular imaging/flow 0405 0.7739 $42.01 $21.00 $8.40 78799 S Genitourinary nuclear exam 0389 1.6475 $89.44 $44.72 $17.89 78800 S Tumor imaging, limited area 0406 4.7542 $258.10 $51.62 78801 S Tumor imaging, mult areas 0406 4.7542 $258.10 $51.62 78802 S Tumor imaging, whole body 0406 4.7542 $258.10 $51.62 78803 S Tumor imaging (3D) 0406 4.7542 $258.10 $51.62 78805 S Abscess imaging, ltd area 0406 4.7542 $258.10 $51.62 78806 S Abscess imaging, whole body 0406 4.7542 $258.10 $51.62 78807 S Nuclear localization/abscess 0406 4.7542 $258.10 $51.62 78810 E Tumor imaging (PET) 78890 N Nuclear medicine data proc 78891 N Nuclear med data proc 78990 E Provide diag radionuclide(s) 78999 S Nuclear diagnostic exam 0389 1.6475 $89.44 $44.72 $17.89 79000 S Init hyperthyroid therapy 0407 4.2797 $232.34 $116.17 $46.47 79001 S Repeat hyperthyroid therapy 0407 4.2797 $232.34 $116.17 $46.47 79020 S Thyroid ablation 0407 4.2797 $232.34 $116.17 $46.47 79030 S Thyroid ablation, carcinoma 0407 4.2797 $232.34 $116.17 $46.47 79035 S Thyroid metastatic therapy 0407 4.2797 $232.34 $116.17 $46.47 79100 S Hematopoetic nuclear therapy 0408 4.0000 $217.16 $43.43 79200 S Intracavitary nuclear trmt 0408 4.0000 $217.16 $43.43 79300 S Interstitial nuclear therapy 0408 4.0000 $217.16 $43.43 79400 S Nonhemato nuclear therapy 0408 4.0000 $217.16 $43.43 79420 S Intravascular nuclear ther 0408 4.0000 $217.16 $43.43 79440 S Nuclear joint therapy 0408 4.0000 $217.16 $43.43 79900 N Provide ther radiopharm(s) 79999 S Nuclear medicine therapy 0389 1.6475 $89.44 $44.72 $17.89 80048 A Basic metabolic panel 80050 A General health panel 80051 A Electrolyte panel 80053 A Comprehen metabolic panel 80055 A Obstetric panel 80061 A Lipid panel 80069 A Renal function panel 80074 A Acute hepatitis panel 80076 A Hepatic function panel 80100 A Drug screen, qualitate/multi 80101 A Drug screen, single 80102 A Drug confirmation 80103 N Drug analysis, tissue prep 80150 A Assay of amikacin 80152 A Assay of amitriptyline 80154 A Assay of benzodiazepines 80156 A Assay, carbamazepine, total 80157 A Assay, carbamazepine, free 80158 A Assay of cyclosporine 80160 A Assay of desipramine 80162 A Assay of digoxin 80164 A Assay, dipropylacetic acid Start Printed Page 48124 80166 A Assay of doxepin 80168 A Assay of ethosuximide 80170 A Assay of gentamicin 80172 A Assay of gold 80173 A Assay of haloperidol 80174 A Assay of imipramine 80176 A Assay of lidocaine 80178 A Assay of lithium 80182 A Assay of nortriptyline 80184 A Assay of phenobarbital 80185 A Assay of phenytoin, total 80186 A Assay of phenytoin, free 80188 A Assay of primidone 80190 A Assay of procainamide 80192 A Assay of procainamide 80194 A Assay of quinidine 80196 A Assay of salicylate 80197 A Assay of tacrolimus 80198 A Assay of theophylline 80200 A Assay of tobramycin 80201 A Assay of topiramate 80202 A Assay of vancomycin 80299 A Quantitative assay, drug 80400 A Acth stimulation panel 80402 A Acth stimulation panel 80406 A Acth stimulation panel 80408 A Aldosterone suppression eval 80410 A Calcitonin stimul panel 80412 A CRH stimulation panel 80414 A Testosterone response 80415 A Estradiol response panel 80416 A Renin stimulation panel 80417 A Renin stimulation panel 80418 A Pituitary evaluation panel 80420 A Dexamethasone panel 80422 A Glucagon tolerance panel 80424 A Glucagon tolerance panel 80426 A Gonadotropin hormone panel 80428 A Growth hormone panel 80430 A Growth hormone panel 80432 A Insulin suppression panel 80434 A Insulin tolerance panel 80435 A Insulin tolerance panel 80436 A Metyrapone panel 80438 A TRH stimulation panel 80439 A TRH stimulation panel 80440 A TRH stimulation panel 80500 X Lab pathology consultation 0343 0.4662 $25.31 $12.55 $5.06 80502 X Lab pathology consultation 0342 0.2169 $11.78 $5.88 $2.36 81000 A Urinalysis, nonauto w/scope 81001 A Urinalysis, auto w/scope 81002 A Urinalysis nonauto w/o scope 81003 A Urinalysis, auto, w/o scope 81005 A Urinalysis 81007 A Urine screen for bacteria 81015 A Microscopic exam of urine 81020 A Urinalysis, glass test 81025 A Urine pregnancy test 81050 A Urinalysis, volume measure 81099 A Urinalysis test procedure 82000 A Assay of blood acetaldehyde 82003 A Assay of acetaminophen 82009 A Test for acetone/ketones 82010 A Acetone assay 82013 A Acetylcholinesterase assay 82016 A Acylcarnitines, qual Start Printed Page 48125 82017 A Acylcarnitines, quant 82024 A Assay of acth 82030 A Assay of adp & amp 82040 A Assay of serum albumin 82042 A Assay of urine albumin 82043 A Microalbumin, quantitative 82044 A Microalbumin, semiquant 82055 A Assay of ethanol 82075 A Assay of breath ethanol 82085 A Assay of aldolase 82088 A Assay of aldosterone 82101 A Assay of urine alkaloids 82103 A Alpha-1-antitrypsin, total 82104 A Alpha-1-antitrypsin, pheno 82105 A Alpha-fetoprotein, serum 82106 A Alpha-fetoprotein, amniotic 82108 A Assay of aluminum 82120 A Amines, vaginal fluid qual 82127 A Amino acid, single qual 82128 A Amino acids, mult qual 82131 A Amino acids, single quant 82135 A Assay, aminolevulinic acid 82136 A Amino acids, quant, 2-5 82139 A Amino acids, quan, 6 or more 82140 A Assay of ammonia 82143 A Amniotic fluid scan 82145 A Assay of amphetamines 82150 A Assay of amylase 82154 A Androstanediol glucuronide 82157 A Assay of androstenedione 82160 A Assay of androsterone 82163 A Assay of angiotensin II 82164 A Angiotensin I enzyme test 82172 A Assay of apolipoprotein 82175 A Assay of arsenic 82180 A Assay of ascorbic acid 82190 A Atomic absorption 82205 A Assay of barbiturates 82232 A Assay of beta-2 protein 82239 A Bile acids, total 82240 A Bile acids, cholylglycine 82247 A Bilirubin, total 82248 A Bilirubin, direct 82252 A Fecal bilirubin test 82261 A Assay of biotinidase 82270 A Test for blood, feces 82273 A Test for blood, other source 82274 A Assay test for blood, fecal 82286 A Assay of bradykinin 82300 A Assay of cadmium 82306 A Assay of vitamin D 82307 A Assay of vitamin D 82308 A Assay of calcitonin 82310 A Assay of calcium 82330 A Assay of calcium 82331 A Calcium infusion test 82340 A Assay of calcium in urine 82355 A Calculus analysis, qual 82360 A Calculus assay, quant 82365 A Calculus spectroscopy 82370 A X-ray assay, calculus 82373 A Assay, c-d transfer measure 82374 A Assay, blood carbon dioxide 82375 A Assay, blood carbon monoxide 82376 A Test for carbon monoxide 82378 A Carcinoembryonic antigen Start Printed Page 48126 82379 A Assay of carnitine 82380 A Assay of carotene 82382 A Assay, urine catecholamines 82383 A Assay, blood catecholamines 82384 A Assay, three catecholamines 82387 A Assay of cathepsin-d 82390 A Assay of ceruloplasmin 82397 A Chemiluminescent assay 82415 A Assay of chloramphenicol 82435 A Assay of blood chloride 82436 A Assay of urine chloride 82438 A Assay, other fluid chlorides 82441 A Test for chlorohydrocarbons 82465 A Assay, bld/serum cholesterol 82480 A Assay, serum cholinesterase 82482 A Assay, rbc cholinesterase 82485 A Assay, chondroitin sulfate 82486 A Gas/liquid chromatography 82487 A Paper chromatography 82488 A Paper chromatography 82489 A Thin layer chromatography 82491 A Chromotography, quant, sing 82492 A Chromotography, quant, mult 82495 A Assay of chromium 82507 A Assay of citrate 82520 A Assay of cocaine 82523 A Collagen crosslinks 82525 A Assay of copper 82528 A Assay of corticosterone 82530 A Cortisol, free 82533 A Total cortisol 82540 A Assay of creatine 82541 A Column chromotography, qual 82542 A Column chromotography, quant 82543 A Column chromotograph/isotope 82544 A Column chromotograph/isotope 82550 A Assay of ck (cpk) 82552 A Assay of cpk in blood 82553 A Creatine, MB fraction 82554 A Creatine, isoforms 82565 A Assay of creatinine 82570 A Assay of urine creatinine 82575 A Creatinine clearance test 82585 A Assay of cryofibrinogen 82595 A Assay of cryoglobulin 82600 A Assay of cyanide 82607 A Vitamin B-12 82608 A B-12 binding capacity 82615 A Test for urine cystines 82626 A Dehydroepiandrosterone 82627 A Dehydroepiandrosterone 82633 A Desoxycorticosterone 82634 A Deoxycortisol 82638 A Assay of dibucaine number 82646 A Assay of dihydrocodeinone 82649 A Assay of dihydromorphinone 82651 A Assay of dihydrotestosterone 82652 A Assay of dihydroxyvitamin d 82654 A Assay of dimethadione 82657 A Enzyme cell activity 82658 A Enzyme cell activity, ra 82664 A Electrophoretic test 82666 A Assay of epiandrosterone 82668 A Assay of erythropoietin 82670 A Assay of estradiol 82671 A Assay of estrogens Start Printed Page 48127 82672 A Assay of estrogen 82677 A Assay of estriol 82679 A Assay of estrone 82690 A Assay of ethchlorvynol 82693 A Assay of ethylene glycol 82696 A Assay of etiocholanolone 82705 A Fats/lipids, feces, qual 82710 A Fats/lipids, feces, quant 82715 A Assay of fecal fat 82725 A Assay of blood fatty acids 82726 A Long chain fatty acids 82728 A Assay of ferritin 82731 A Assay of fetal fibronectin 82735 A Assay of fluoride 82742 A Assay of flurazepam 82746 A Blood folic acid serum 82747 A Assay of folic acid, rbc 82757 A Assay of semen fructose 82759 A Assay of rbc galactokinase 82760 A Assay of galactose 82775 A Assay galactose transferase 82776 A Galactose transferase test 82784 A Assay of gammaglobulin igm 82785 A Assay of gammaglobulin ige 82787 A Igg 1, 2, 3 or 4, each 82800 A Blood pH 82803 A Blood gases: pH, pO2 & pCO2 82805 A Blood gases W/02 saturation 82810 A Blood gases, O2 sat only 82820 A Hemoglobin-oxygen affinity 82926 A Assay of gastric acid 82928 A Assay of gastric acid 82938 A Gastrin test 82941 A Assay of gastrin 82943 A Assay of glucagon 82945 A Glucose other fluid 82946 A Glucagon tolerance test 82947 A Assay, glucose, blood quant 82948 A Reagent strip/blood glucose 82950 A Glucose test 82951 A Glucose tolerance test (GTT) 82952 A GTT-added samples 82953 A Glucose-tolbutamide test 82955 A Assay of g6pd enzyme 82960 A Test for G6PD enzyme 82962 A Glucose blood test 82963 A Assay of glucosidase 82965 A Assay of gdh enzyme 82975 A Assay of glutamine 82977 A Assay of GGT 82978 A Assay of glutathione 82979 A Assay, rbc glutathione 82980 A Assay of glutethimide 82985 A Glycated protein 83001 A Gonadotropin (FSH) 83002 A Gonadotropin (LH) 83003 A Assay, growth hormone (hgh) 83008 A Assay of guanosine 83010 A Assay of haptoglobin, quant 83012 A Assay of haptoglobins 83013 A H pylori analysis 83014 A H pylori drug admin/collect 83015 A Heavy metal screen 83018 A Quantitative screen, metals 83020 A Hemoglobin electrophoresis 83021 A Hemoglobin chromotography Start Printed Page 48128 83026 A Hemoglobin, copper sulfate 83030 A Fetal hemoglobin, chemical 83033 A Fetal hemoglobin assay, qual 83036 A Glycated hemoglobin test 83045 A Blood methemoglobin test 83050 A Blood methemoglobin assay 83051 A Assay of plasma hemoglobin 83055 A Blood sulfhemoglobin test 83060 A Blood sulfhemoglobin assay 83065 A Assay of hemoglobin heat 83068 A Hemoglobin stability screen 83069 A Assay of urine hemoglobin 83070 A Assay of hemosiderin, qual 83071 A Assay of hemosiderin, quant 83080 A Assay of b hexosaminidase 83088 A Assay of histamine 83090 A Assay of homocystine 83150 A Assay of for hva 83491 A Assay of corticosteroids 83497 A Assay of 5-hiaa 83498 A Assay of progesterone 83499 A Assay of progesterone 83500 A Assay, free hydroxyproline 83505 A Assay, total hydroxyproline 83516 A Immunoassay, nonantibody 83518 A Immunoassay, dipstick 83519 A Immunoassay, nonantibody 83520 A Immunoassay, RIA 83525 A Assay of insulin 83527 A Assay of insulin 83528 A Assay of intrinsic factor 83540 A Assay of iron 83550 A Iron binding test 83570 A Assay of idh enzyme 83582 A Assay of ketogenic steroids 83586 A Assay 17- ketosteroids 83593 A Fractionation, ketosteroids 83605 A Assay of lactic acid 83615 A Lactate (LD) (LDH) enzyme 83625 A Assay of ldh enzymes 83632 A Placental lactogen 83633 A Test urine for lactose 83634 A Assay of urine for lactose 83655 A Assay of lead 83661 A L/s ratio, fetal lung 83662 A Foam stability, fetal lung 83663 A Fluoro polarize, fetal lung 83664 A Lamellar bdy, fetal lung 83670 A Assay of lap enzyme 83690 A Assay of lipase 83715 A Assay of blood lipoproteins 83716 A Assay of blood lipoproteins 83718 A Assay of lipoprotein 83719 A Assay of blood lipoprotein 83721 A Assay of blood lipoprotein 83727 A Assay of lrh hormone 83735 A Assay of magnesium 83775 A Assay of md enzyme 83785 A Assay of manganese 83788 A Mass spectrometry qual 83789 A Mass spectrometry quant 83805 A Assay of meprobamate 83825 A Assay of mercury 83835 A Assay of metanephrines 83840 A Assay of methadone 83857 A Assay of methemalbumin Start Printed Page 48129 83858 A Assay of methsuximide 83864 A Mucopolysaccharides 83866 A Mucopolysaccharides screen 83872 A Assay synovial fluid mucin 83873 A Assay of csf protein 83874 A Assay of myoglobin 83880 A Natriuretic peptide 83883 A Assay, nephelometry not spec 83885 A Assay of nickel 83887 A Assay of nicotine 83890 A Molecule isolate 83891 A Molecule isolate nucleic 83892 A Molecular diagnostics 83893 A Molecule dot/slot/blot 83894 A Molecule gel electrophor 83896 A Molecular diagnostics 83897 A Molecule nucleic transfer 83898 A Molecule nucleic ampli 83901 A Molecule nucleic ampli 83902 A Molecular diagnostics 83903 A Molecule mutation scan 83904 A Molecule mutation identify 83905 A Molecule mutation identify 83906 A Molecule mutation identify 83912 A Genetic examination 83915 A Assay of nucleotidase 83916 A Oligoclonal bands 83918 A Organic acids, total, quant 83919 A Organic acids, qual, each 83921 A Organic acid, single, quant 83925 A Assay of opiates 83930 A Assay of blood osmolality 83935 A Assay of urine osmolality 83937 A Assay of osteocalcin 83945 A Assay of oxalate 83950 A Oncoprotein, her-2/neu 83970 A Assay of parathormone 83986 A Assay of body fluid acidity 83992 A Assay for phencyclidine 84022 A Assay of phenothiazine 84030 A Assay of blood pku 84035 A Assay of phenylketones 84060 A Assay acid phosphatase 84061 A Phosphatase, forensic exam 84066 A Assay prostate phosphatase 84075 A Assay alkaline phosphatase 84078 A Assay alkaline phosphatase 84080 A Assay alkaline phosphatases 84081 A Amniotic fluid enzyme test 84085 A Assay of rbc pg6d enzyme 84087 A Assay phosphohexose enzymes 84100 A Assay of phosphorus 84105 A Assay of urine phosphorus 84106 A Test for porphobilinogen 84110 A Assay of porphobilinogen 84119 A Test urine for porphyrins 84120 A Assay of urine porphyrins 84126 A Assay of feces porphyrins 84127 A Assay of feces porphyrins 84132 A Assay of serum potassium 84133 A Assay of urine potassium 84134 A Assay of prealbumin 84135 A Assay of pregnanediol 84138 A Assay of pregnanetriol 84140 A Assay of pregnenolone 84143 A Assay of 17-hydroxypregneno Start Printed Page 48130 84144 A Assay of progesterone 84146 A Assay of prolactin 84150 A Assay of prostaglandin 84152 A Assay of psa, complexed 84153 A Assay of psa, total 84154 A Assay of psa, free 84155 A Assay of protein 84160 A Assay of serum protein 84165 A Assay of serum proteins 84181 A Western blot test 84182 A Protein, western blot test 84202 A Assay RBC protoporphyrin 84203 A Test RBC protoporphyrin 84206 A Assay of proinsulin 84207 A Assay of vitamin b-6 84210 A Assay of pyruvate 84220 A Assay of pyruvate kinase 84228 A Assay of quinine 84233 A Assay of estrogen 84234 A Assay of progesterone 84235 A Assay of endocrine hormone 84238 A Assay, nonendocrine receptor 84244 A Assay of renin 84252 A Assay of vitamin b-2 84255 A Assay of selenium 84260 A Assay of serotonin 84270 A Assay of sex hormone globul 84275 A Assay of sialic acid 84285 A Assay of silica 84295 A Assay of serum sodium 84300 A Assay of urine sodium 84302 A Assay of sweat sodium 84305 A Assay of somatomedin 84307 A Assay of somatostatin 84311 A Spectrophotometry 84315 A Body fluid specific gravity 84375 A Chromatogram assay, sugars 84376 A Sugars, single, qual 84377 A Sugars, multiple, qual 84378 A Sugars single quant 84379 A Sugars multiple quant 84392 A Assay of urine sulfate 84402 A Assay of testosterone 84403 A Assay of total testosterone 84425 A Assay of vitamin b-1 84430 A Assay of thiocyanate 84432 A Assay of thyroglobulin 84436 A Assay of total thyroxine 84437 A Assay of neonatal thyroxine 84439 A Assay of free thyroxine 84442 A Assay of thyroid activity 84443 A Assay thyroid stim hormone 84445 A Assay of tsi 84446 A Assay of vitamin e 84449 A Assay of transcortin 84450 A Transferase (AST) (SGOT) 84460 A Alanine amino (ALT) (SGPT) 84466 A Assay of transferrin 84478 A Assay of triglycerides 84479 A Assay of thyroid (t3 or t4) 84480 A Assay, triiodothyronine (t3) 84481 A Free assay (FT-3) 84482 A T3 reverse 84484 A Assay of troponin, quant 84485 A Assay duodenal fluid trypsin 84488 A Test feces for trypsin Start Printed Page 48131 84490 A Assay of feces for trypsin 84510 A Assay of tyrosine 84512 A Assay of troponin, qual 84520 A Assay of urea nitrogen 84525 A Urea nitrogen semi-quant 84540 A Assay of urine/urea-n 84545 A Urea-N clearance test 84550 A Assay of blood/uric acid 84560 A Assay of urine/uric acid 84577 A Assay of feces/urobilinogen 84578 A Test urine urobilinogen 84580 A Assay of urine urobilinogen 84583 A Assay of urine urobilinogen 84585 A Assay of urine vma 84586 A Assay of vip 84588 A Assay of vasopressin 84590 A Assay of vitamin a 84591 A Assay of nos vitamin 84597 A Assay of vitamin k 84600 A Assay of volatiles 84620 A Xylose tolerance test 84630 A Assay of zinc 84681 A Assay of c-peptide 84702 A Chorionic gonadotropin test 84703 A Chorionic gonadotropin assay 84830 A Ovulation tests 84999 A Clinical chemistry test 85002 A Bleeding time test 85004 A Automated diff wbc count 85007 A Differential WBC count 85008 A Nondifferential WBC count 85009 A Differential WBC count 85013 A Spun microhematocrit 85014 A Hematocrit 85018 A Hemoglobin 85025 A Automated hemogram 85027 A Automated hemogram 85032 A Manual cell count, each 85041 A Red blood cell (RBC) count 85044 A Reticulocyte count 85045 A Reticulocyte count 85046 A Reticyte/hgb concentrate 85048 A White blood cell (WBC) count 85049 A Automated platelet count 85060 X Blood smear interpretation 0342 0.2169 $11.78 $5.88 $2.36 85097 X Bone marrow interpretation 0343 0.4662 $25.31 $12.55 $5.06 85130 A Chromogenic substrate assay 85170 A Blood clot retraction 85175 A Blood clot lysis time 85210 A Blood clot factor II test 85220 A Blood clot factor V test 85230 A Blood clot factor VII test 85240 A Blood clot factor VIII test 85244 A Blood clot factor VIII test 85245 A Blood clot factor VIII test 85246 A Blood clot factor VIII test 85247 A Blood clot factor VIII test 85250 A Blood clot factor IX test 85260 A Blood clot factor X test 85270 A Blood clot factor XI test 85280 A Blood clot factor XII test 85290 A Blood clot factor XIII test 85291 A Blood clot factor XIII test 85292 A Blood clot factor assay 85293 A Blood clot factor assay 85300 A Antithrombin III test Start Printed Page 48132 85301 A Antithrombin III test 85302 A Blood clot inhibitor antigen 85303 A Blood clot inhibitor test 85305 A Blood clot inhibitor assay 85306 A Blood clot inhibitor test 85307 A Assay activated protein c 85335 A Factor inhibitor test 85337 A Thrombomodulin 85345 A Coagulation time 85347 A Coagulation time 85348 A Coagulation time 85360 A Euglobulin lysis 85362 A Fibrin degradation products 85366 A Fibrinogen test 85370 A Fibrinogen test 85378 A Fibrin degradation 85379 A Fibrin degradation, quant 85380 A Fibrin degradation, vte 85384 A Fibrinogen 85385 A Fibrinogen 85390 A Fibrinolysins screen 85400 A Fibrinolytic plasmin 85410 A Fibrinolytic antiplasmin 85415 A Fibrinolytic plasminogen 85420 A Fibrinolytic plasminogen 85421 A Fibrinolytic plasminogen 85441 A Heinz bodies, direct 85445 A Heinz bodies, induced 85460 A Hemoglobin, fetal 85461 A Hemoglobin, fetal 85475 A Hemolysin 85520 A Heparin assay 85525 A Heparin neutralization 85530 A Heparin-protamine tolerance 85536 A Iron stain peripheral blood 85540 A Wbc alkaline phosphatase 85547 A RBC mechanical fragility 85549 A Muramidase 85555 A RBC osmotic fragility 85557 A RBC osmotic fragility 85576 A Blood platelet aggregation 85597 A Platelet neutralization 85610 A Prothrombin time 85611 A Prothrombin test 85612 A Viper venom prothrombin time 85613 A Russell viper venom, diluted 85635 A Reptilase test 85651 A Rbc sed rate, nonautomated 85652 A Rbc sed rate, automated 85660 A RBC sickle cell test 85670 A Thrombin time, plasma 85675 A Thrombin time, titer 85705 A Thromboplastin inhibition 85730 A Thromboplastin time, partial 85732 A Thromboplastin time, partial 85810 A Blood viscosity examination 85999 A Hematology procedure 86000 A Agglutinins, febrile 86001 A Allergen specific igg 86003 A Allergen specific IgE 86005 A Allergen specific IgE 86021 A WBC antibody identification 86022 A Platelet antibodies 86023 A Immunoglobulin assay 86038 A Antinuclear antibodies 86039 A Antinuclear antibodies (ANA) Start Printed Page 48133 86060 A Antistreptolysin o, titer 86063 A Antistreptolysin o, screen 86077 A Physician blood bank service 86078 A Physician blood bank service 86079 A Physician blood bank service 86140 A C-reactive protein 86141 A C-reactive protein, hs 86146 A Glycoprotein antibody 86147 A Cardiolipin antibody 86148 A Phospholipid antibody 86155 A Chemotaxis assay 86156 A Cold agglutinin, screen 86157 A Cold agglutinin, titer 86160 A Complement, antigen 86161 A Complement/function activity 86162 A Complement, total (CH50) 86171 A Complement fixation, each 86185 A Counterimmunoelectrophoresis 86215 A Deoxyribonuclease, antibody 86225 A DNA antibody 86226 A DNA antibody, single strand 86235 A Nuclear antigen antibody 86243 A Fc receptor 86255 A Fluorescent antibody, screen 86256 A Fluorescent antibody, titer 86277 A Growth hormone antibody 86280 A Hemagglutination inhibition 86294 A Immunoassay, tumor qual 86300 A Immunoassay, tumor ca 15-3 86301 A Immunoassay, tumor ca 19-9 86304 A Immunoassay, tumor, ca 125 86308 A Heterophile antibodies 86309 A Heterophile antibodies 86310 A Heterophile antibodies 86316 A Immunoassay, tumor other 86317 A Immunoassay,infectious agent 86318 A Immunoassay,infectious agent 86320 A Serum immunoelectrophoresis 86325 A Other immunoelectrophoresis 86327 A Immunoelectrophoresis assay 86329 A Immunodiffusion 86331 A Immunodiffusion ouchterlony 86332 A Immune complex assay 86334 A Immunofixation procedure 86336 A Inhibin A 86337 A Insulin antibodies 86340 A Intrinsic factor antibody 86341 A Islet cell antibody 86343 A Leukocyte histamine release 86344 A Leukocyte phagocytosis 86353 A Lymphocyte transformation 86359 A T cells, total count 86360 A T cell, absolute count/ratio 86361 A T cell, absolute count 86376 A Microsomal antibody 86378 A Migration inhibitory factor 86382 A Neutralization test, viral 86384 A Nitroblue tetrazolium dye 86403 A Particle agglutination test 86406 A Particle agglutination test 86430 A Rheumatoid factor test 86431 A Rheumatoid factor, quant 86485 X Skin test, candida 0341 0.1468 $7.97 $3.08 $1.59 86490 X Coccidioidomycosis skin test 0341 0.1468 $7.97 $3.08 $1.59 86510 X Histoplasmosis skin test 0341 0.1468 $7.97 $3.08 $1.59 86580 X TB intradermal test 0341 0.1468 $7.97 $3.08 $1.59 Start Printed Page 48134 86585 X TB tine test 0341 0.1468 $7.97 $3.08 $1.59 86586 X Skin test, unlisted 0341 0.1468 $7.97 $3.08 $1.59 86590 A Streptokinase, antibody 86592 A Blood serology, qualitative 86593 A Blood serology, quantitative 86602 A Antinomyces antibody 86603 A Adenovirus antibody 86606 A Aspergillus antibody 86609 A Bacterium antibody 86611 A Bartonella antibody 86612 A Blastomyces antibody 86615 A Bordetella antibody 86617 A Lyme disease antibody 86618 A Lyme disease antibody 86619 A Borrelia antibody 86622 A Brucella antibody 86625 A Campylobacter antibody 86628 A Candida antibody 86631 A Chlamydia antibody 86632 A Chlamydia igm antibody 86635 A Coccidioides antibody 86638 A Q fever antibody 86641 A Cryptococcus antibody 86644 A CMV antibody 86645 A CMV antibody, IgM 86648 A Diphtheria antibody 86651 A Encephalitis antibody 86652 A Encephalitis antibody 86653 A Encephalitis antibody 86654 A Encephalitis antibody 86658 A Enterovirus antibody 86663 A Epstein-barr antibody 86664 A Epstein-barr antibody 86665 A Epstein-barr antibody 86666 A Ehrlichia antibody 86668 A Francisella tularensis 86671 A Fungus antibody 86674 A Giardia lamblia antibody 86677 A Helicobacter pylori 86682 A Helminth antibody 86684 A Hemophilus influenza 86687 A Htlv-i antibody 86688 A Htlv-ii antibody 86689 A HTLV/HIV confirmatory test 86692 A Hepatitis, delta agent 86694 A Herpes simplex test 86695 A Herpes simplex test 86696 A Herpes simplex type 2 86698 A Histoplasma 86701 A HIV-1 86702 A HIV-2 86703 A HIV-1/HIV-2, single assay 86704 A Hep b core antibody, total 86705 A Hep b core antibody, igm 86706 A Hep b surface antibody 86707 A Hep be antibody 86708 A Hep a antibody, total 86709 A Hep a antibody, igm 86710 A Influenza virus antibody 86713 A Legionella antibody 86717 A Leishmania antibody 86720 A Leptospira antibody 86723 A Listeria monocytogenes ab 86727 A Lymph choriomeningitis ab 86729 A Lympho venereum antibody 86732 A Mucormycosis antibody Start Printed Page 48135 86735 A Mumps antibody 86738 A Mycoplasma antibody 86741 A Neisseria meningitidis 86744 A Nocardia antibody 86747 A Parvovirus antibody 86750 A Malaria antibody 86753 A Protozoa antibody nos 86756 A Respiratory virus antibody 86757 A Rickettsia antibody 86759 A Rotavirus antibody 86762 A Rubella antibody 86765 A Rubeola antibody 86768 A Salmonella antibody 86771 A Shigella antibody 86774 A Tetanus antibody 86777 A Toxoplasma antibody 86778 A Toxoplasma antibody, igm 86781 A Treponema pallidum, confirm 86784 A Trichinella antibody 86787 A Varicella-zoster antibody 86790 A Virus antibody nos 86793 A Yersinia antibody 86800 A Thyroglobulin antibody 86803 A Hepatitis c ab test 86804 A Hep c ab test, confirm 86805 A Lymphocytotoxicity assay 86806 A Lymphocytotoxicity assay 86807 A Cytotoxic antibody screening 86808 A Cytotoxic antibody screening 86812 A HLA typing, A, B, or C 86813 A HLA typing, A, B, or C 86816 A HLA typing, DR/DQ 86817 A HLA typing, DR/DQ 86821 A Lymphocyte culture, mixed 86822 A Lymphocyte culture, primed 86849 A Immunology procedure 86850 X RBC antibody screen 0345 0.2589 $14.06 $3.10 $2.81 86860 X RBC antibody elution 0346 0.3877 $21.05 $5.31 $4.21 86870 X RBC antibody identification 0346 0.3877 $21.05 $5.31 $4.21 86880 X Coombs test, direct 0409 0.1385 $7.52 $2.31 $1.50 86885 X Coombs test, indirect, qual 0409 0.1385 $7.52 $2.31 $1.50 86886 X Coombs test, indirect, titer 0409 0.1385 $7.52 $2.31 $1.50 86890 X Autologous blood process 0347 0.9646 $52.37 $13.19 $10.47 86891 X Autologous blood, op salvage 0345 0.2589 $14.06 $3.10 $2.81 86900 X Blood typing, ABO 0409 0.1385 $7.52 $2.31 $1.50 86901 X Blood typing, Rh (D) 0409 0.1385 $7.52 $2.31 $1.50 86903 X Blood typing, antigen screen 0345 0.2589 $14.06 $3.10 $2.81 86904 X Blood typing, patient serum 0345 0.2589 $14.06 $3.10 $2.81 86905 X Blood typing, RBC antigens 0345 0.2589 $14.06 $3.10 $2.81 86906 X Blood typing, Rh phenotype 0345 0.2589 $14.06 $3.10 $2.81 86910 E Blood typing, paternity test 86911 E Blood typing, antigen system 86920 X Compatibility test 0346 0.3877 $21.05 $5.31 $4.21 86921 X Compatibility test 0345 0.2589 $14.06 $3.10 $2.81 86922 X Compatibility test 0346 0.3877 $21.05 $5.31 $4.21 86927 X Plasma, fresh frozen 0346 0.3877 $21.05 $5.31 $4.21 86930 X Frozen blood prep 0347 0.9646 $52.37 $13.19 $10.47 86931 X Frozen blood thaw 0347 0.9646 $52.37 $13.19 $10.47 86932 X Frozen blood freeze/thaw 0347 0.9646 $52.37 $13.19 $10.47 86940 A Hemolysins/agglutinins, auto 86941 A Hemolysins/agglutinins 86945 X Blood product/irradiation 0346 0.3877 $21.05 $5.31 $4.21 86950 X Leukacyte transfusion 0347 0.9646 $52.37 $13.19 $10.47 86965 X Pooling blood platelets 0346 0.3877 $21.05 $5.31 $4.21 86970 X RBC pretreatment 0345 0.2589 $14.06 $3.10 $2.81 86971 X RBC pretreatment 0345 0.2589 $14.06 $3.10 $2.81 Start Printed Page 48136 86972 X RBC pretreatment 0345 0.2589 $14.06 $3.10 $2.81 86975 X RBC pretreatment, serum 0345 0.2589 $14.06 $3.10 $2.81 86976 X RBC pretreatment, serum 0345 0.2589 $14.06 $3.10 $2.81 86977 X RBC pretreatment, serum 0345 0.2589 $14.06 $3.10 $2.81 86978 X RBC pretreatment, serum 0345 0.2589 $14.06 $3.10 $2.81 86985 X Split blood or products 0347 0.9646 $52.37 $13.19 $10.47 86999 X Transfusion procedure 0345 0.2589 $14.06 $3.10 $2.81 87001 A Small animal inoculation 87003 A Small animal inoculation 87015 A Specimen concentration 87040 A Blood culture for bacteria 87045 A Feces culture, bacteria 87046 A Stool cultr, bacteria, each 87070 A Culture, bacteria, other 87071 A Culture bacteri aerobic othr 87073 A Culture bacteria anaerobic 87075 A Culture bacteria anaerobic 87076 A Culture anaerobe ident, each 87077 A Culture aerobic identify 87081 A Culture screen only 87084 A Culture of specimen by kit 87086 A Urine culture/colony count 87088 A Urine bacteria culture 87101 A Skin fungi culture 87102 A Fungus isolation culture 87103 A Blood fungus culture 87106 A Fungi identification, yeast 87107 A Fungi identification, mold 87109 A Mycoplasma 87110 A Chlamydia culture 87116 A Mycobacteria culture 87118 A Mycobacteric identification 87140 A Culture type immunofluoresc 87143 A Culture typing, glc/hplc 87147 A Culture type, immunologic 87149 A Culture type, nucleic acid 87152 A Culture type pulse field gel 87158 A Culture typing, added method 87164 A Dark field examination 87166 A Dark field examination 87168 A Macroscopic exam arthropod 87169 A Macroscopic exam parasite 87172 A Pinworm exam 87176 A Tissue homogenization, cultr 87177 A Ova and parasites smears 87181 A Microbe susceptible, diffuse 87184 A Microbe susceptible, disk 87185 A Microbe susceptible, enzyme 87186 A Microbe susceptible, mic 87187 A Microbe susceptible, mlc 87188 A Microbe suscept, macrobroth 87190 A Microbe suscept, mycobacteri 87197 A Bactericidal level, serum 87205 A Smear, gram stain 87206 A Smear, fluorescent/acid stai 87207 A Smear, special stain 87210 A Smear, wet mount, saline/ink 87220 A Tissue exam for fungi 87230 A Assay, toxin or antitoxin 87250 A Virus inoculate, eggs/animal 87252 A Virus inoculation, tissue 87253 A Virus inoculate tissue, addl 87254 A Virus inoculation, shell via 87255 A Genet virus isolate, hsv 87260 A Adenovirus ag, if 87265 A Pertussis ag, if Start Printed Page 48137 87267 A Enterovirus antibody, dfa 87270 A Chlamydia trachomatis ag, if 87271 A Cryptosporidum/gardia ag, if 87272 A Cryptosporidum/gardia ag, if 87273 A Herpes simplex 2, ag, if 87274 A Herpes simplex 1, ag, if 87275 A Influenza b, ag, if 87276 A Influenza a, ag, if 87277 A Legionella micdadei, ag, if 87278 A Legion pneumophilia ag, if 87279 A Parainfluenza, ag, if 87280 A Respiratory syncytial ag, if 87281 A Pneumocystis carinii, ag, if 87283 A Rubeola, ag, if 87285 A Treponema pallidum, ag, if 87290 A Varicella zoster, ag, if 87299 A Antibody detection, nos, if 87300 A Ag detection, polyval, if 87301 A Adenovirus ag, eia 87320 A Chylmd trach ag, eia 87324 A Clostridium ag, eia 87327 A Cryptococcus neoform ag, eia 87328 A Cryptospor ag, eia 87332 A Cytomegalovirus ag, eia 87335 A E coli 0157 ag, eia 87336 A Entamoeb hist dispr, ag, eia 87337 A Entamoeb hist group, ag, eia 87338 A Hpylori, stool, eia 87339 A H pylori ag, eia 87340 A Hepatitis b surface ag, eia 87341 A Hepatitis b surface, ag, eia 87350 A Hepatitis be ag, eia 87380 A Hepatitis delta ag, eia 87385 A Histoplasma capsul ag, eia 87390 A Hiv-1 ag, eia 87391 A Hiv-2 ag, eia 87400 A Influenza a/b, ag, eia 87420 A Resp syncytial ag, eia 87425 A Rotavirus ag, eia 87427 A Shiga-like toxin ag, eia 87430 A Strep a ag, eia 87449 A Ag detect nos, eia, mult 87450 A Ag detect nos, eia, single 87451 A Ag detect polyval, eia, mult 87470 A Bartonella, dna, dir probe 87471 A Bartonella, dna, amp probe 87472 A Bartonella, dna, quant 87475 A Lyme dis, dna, dir probe 87476 A Lyme dis, dna, amp probe 87477 A Lyme dis, dna, quant 87480 A Candida, dna, dir probe 87481 A Candida, dna, amp probe 87482 A Candida, dna, quant 87485 A Chylmd pneum, dna, dir probe 87486 A Chylmd pneum, dna, amp probe 87487 A Chylmd pneum, dna, quant 87490 A Chylmd trach, dna, dir probe 87491 A Chylmd trach, dna, amp probe 87492 A Chylmd trach, dna, quant 87495 A Cytomeg, dna, dir probe 87496 A Cytomeg, dna, amp probe 87497 A Cytomeg, dna, quant 87510 A Gardner vag, dna, dir probe 87511 A Gardner vag, dna, amp probe 87512 A Gardner vag, dna, quant 87515 A Hepatitis b, dna, dir probe Start Printed Page 48138 87516 A Hepatitis b, dna, amp probe 87517 A Hepatitis b, dna, quant 87520 A Hepatitis c, rna, dir probe 87521 A Hepatitis c, rna, amp probe 87522 A Hepatitis c, rna, quant 87525 A Hepatitis g, dna, dir probe 87526 A Hepatitis g, dna, amp probe 87527 A Hepatitis g, dna, quant 87528 A Hsv, dna, dir probe 87529 A Hsv, dna, amp probe 87530 A Hsv, dna, quant 87531 A Hhv-6, dna, dir probe 87532 A Hhv-6, dna, amp probe 87533 A Hhv-6, dna, quant 87534 A Hiv-1, dna, dir probe 87535 A Hiv-1, dna, amp probe 87536 A Hiv-1, dna, quant 87537 A Hiv-2, dna, dir probe 87538 A Hiv-2, dna, amp probe 87539 A Hiv-2, dna, quant 87540 A Legion pneumo, dna, dir prob 87541 A Legion pneumo, dna, amp prob 87542 A Legion pneumo, dna, quant 87550 A Mycobacteria, dna, dir probe 87551 A Mycobacteria, dna, amp probe 87552 A Mycobacteria, dna, quant 87555 A M.tuberculo, dna, dir probe 87556 A M.tuberculo, dna, amp probe 87557 A M.tuberculo, dna, quant 87560 A M.avium-intra, dna, dir prob 87561 A M.avium-intra, dna, amp prob 87562 A M.avium-intra, dna, quant 87580 A M.pneumon, dna, dir probe 87581 A M.pneumon, dna, amp probe 87582 A M.pneumon, dna, quant 87590 A N.gonorrhoeae, dna, dir prob 87591 A N.gonorrhoeae, dna, amp prob 87592 A N.gonorrhoeae, dna, quant 87620 A Hpv, dna, dir probe 87621 A Hpv, dna, amp probe 87622 A Hpv, dna, quant 87650 A Strep a, dna, dir probe 87651 A Strep a, dna, amp probe 87652 A Strep a, dna, quant 87797 A Detect agent nos, dna, dir 87798 A Detect agent nos, dna, amp 87799 A Detect agent nos, dna, quant 87800 A Detect agnt mult, dna, direc 87801 A Detect agnt mult, dna, ampli 87802 A Strep b assay w/optic 87803 A Clostridium toxin a w/optic 87804 A Influenza assay w/optic 87810 A Chylmd trach assay w/optic 87850 A N. gonorrhoeae assay w/optic 87880 A Strep a assay w/optic 87899 A Agent nos assay w/optic 87901 A Genotype, dna, hiv reverse t 87902 A Genotype, dna, hepatitis C 87903 A Phenotype, dna hiv w/culture 87904 A Phenotype, dna hiv w/clt add 87999 A Microbiology procedure 88000 E Autopsy (necropsy), gross 88005 E Autopsy (necropsy), gross 88007 E Autopsy (necropsy), gross 88012 E Autopsy (necropsy), gross 88014 E Autopsy (necropsy), gross Start Printed Page 48139 88016 E Autopsy (necropsy), gross 88020 E Autopsy (necropsy), complete 88025 E Autopsy (necropsy), complete 88027 E Autopsy (necropsy), complete 88028 E Autopsy (necropsy), complete 88029 E Autopsy (necropsy), complete 88036 E Limited autopsy 88037 E Limited autopsy 88040 E Forensic autopsy (necropsy) 88045 E Coroner's autopsy (necropsy) 88099 E Necropsy (autopsy) procedure 88104 X Cytopathology, fluids 0343 0.4662 $25.31 $12.55 $5.06 88106 X Cytopathology, fluids 0343 0.4662 $25.31 $12.55 $5.06 88107 X Cytopathology, fluids 0343 0.4662 $25.31 $12.55 $5.06 88108 X Cytopath, concentrate tech 0343 0.4662 $25.31 $12.55 $5.06 88125 X Forensic cytopathology 0342 0.2169 $11.78 $5.88 $2.36 88130 A Sex chromatin identification 88140 A Sex chromatin identification 88141 N Cytopath, c/v, interpret 88142 A Cytopath, c/v, thin layer 88143 A Cytopath c/v thin layer redo 88147 A Cytopath, c/v, automated 88148 A Cytopath, c/v, auto rescreen 88150 A Cytopath, c/v, manual 88152 A Cytopath, c/v, auto redo 88153 A Cytopath, c/v, redo 88154 A Cytopath, c/v, select 88155 A Cytopath, c/v, index add-on 88160 X Cytopath smear, other source 0342 0.2169 $11.78 $5.88 $2.36 88161 X Cytopath smear, other source 0343 0.4662 $25.31 $12.55 $5.06 88162 X Cytopath smear, other source 0343 0.4662 $25.31 $12.55 $5.06 88164 A Cytopath tbs, c/v, manual 88165 A Cytopath tbs, c/v, redo 88166 A Cytopath tbs, c/v, auto redo 88167 A Cytopath tbs, c/v, select 88172 X Cytopathology eval of fna 0343 0.4662 $25.31 $12.55 $5.06 88173 X Cytopath eval, fna, report 0343 0.4662 $25.31 $12.55 $5.06 88174 A Cytopath, c/v auto, in fluid 88175 A Cytopath c/v auto fluid redo 88180 X Cell marker study 0343 0.4662 $25.31 $12.55 $5.06 88182 X Cell marker study 0344 0.6278 $34.08 $17.04 $6.82 88199 A Cytopathology procedure 88230 A Tissue culture, lymphocyte 88233 A Tissue culture, skin/biopsy 88235 A Tissue culture, placenta 88237 A Tissue culture, bone marrow 88239 A Tissue culture, tumor 88240 A Cell cryopreserve/storage 88241 A Frozen cell preparation 88245 A Chromosome analysis, 20-25 88248 A Chromosome analysis, 50-100 88249 A Chromosome analysis, 100 88261 A Chromosome analysis, 5 88262 A Chromosome analysis, 15-20 88263 A Chromosome analysis, 45 88264 A Chromosome analysis, 20-25 88267 A Chromosome analys, placenta 88269 A Chromosome analys, amniotic 88271 A Cytogenetics, dna probe 88272 A Cytogenetics, 3-5 88273 A Cytogenetics, 10-30 88274 A Cytogenetics, 25-99 88275 A Cytogenetics, 100-300 88280 A Chromosome karyotype study 88283 A Chromosome banding study 88285 A Chromosome count, additional Start Printed Page 48140 88289 A Chromosome study, additional 88291 A Cyto/molecular report 88299 X Cytogenetic study 0342 0.2169 $11.78 $5.88 $2.36 88300 X Surgical path, gross 0342 0.2169 $11.78 $5.88 $2.36 88302 X Tissue exam by pathologist 0342 0.2169 $11.78 $5.88 $2.36 88304 X Tissue exam by pathologist 0343 0.4662 $25.31 $12.55 $5.06 88305 X Tissue exam by pathologist 0343 0.4662 $25.31 $12.55 $5.06 88307 X Tissue exam by pathologist 0344 0.6278 $34.08 $17.04 $6.82 88309 X Tissue exam by pathologist 0344 0.6278 $34.08 $17.04 $6.82 88311 X Decalcify tissue 0342 0.2169 $11.78 $5.88 $2.36 88312 X Special stains 0342 0.2169 $11.78 $5.88 $2.36 88313 X Special stains 0342 0.2169 $11.78 $5.88 $2.36 88314 X Histochemical stain 0342 0.2169 $11.78 $5.88 $2.36 88318 X Chemical histochemistry 0342 0.2169 $11.78 $5.88 $2.36 88319 X Enzyme histochemistry 0342 0.2169 $11.78 $5.88 $2.36 88321 X Microslide consultation 0342 0.2169 $11.78 $5.88 $2.36 88323 X Microslide consultation 0343 0.4662 $25.31 $12.55 $5.06 88325 X Comprehensive review of data 0344 0.6278 $34.08 $17.04 $6.82 88329 X Path consult introp 0342 0.2169 $11.78 $5.88 $2.36 88331 X Path consult intraop, 1 bloc 0343 0.4662 $25.31 $12.55 $5.06 88332 X Path consult intraop, addl 0342 0.2169 $11.78 $5.88 $2.36 88342 X Immunocytochemistry 0344 0.6278 $34.08 $17.04 $6.82 88346 X Immunofluorescent study 0343 0.4662 $25.31 $12.55 $5.06 88347 X Immunofluorescent study 0344 0.6278 $34.08 $17.04 $6.82 88348 X Electron microscopy 0661 3.3215 $180.32 $90.16 $36.06 88349 X Scanning electron microscopy 0661 3.3215 $180.32 $90.16 $36.06 88355 X Analysis, skeletal muscle 0344 0.6278 $34.08 $17.04 $6.82 88356 X Analysis, nerve 0344 0.6278 $34.08 $17.04 $6.82 88358 X Analysis, tumor 0344 0.6278 $34.08 $17.04 $6.82 88362 X Nerve teasing preparations 0343 0.4662 $25.31 $12.55 $5.06 88365 X Tissue hybridization 0344 0.6278 $34.08 $17.04 $6.82 88371 A Protein, western blot tissue 88372 A Protein analysis w/probe 88380 A Microdissection 88399 A Surgical pathology procedure 88400 A Bilirubin total transcut 89050 A Body fluid cell count 89051 A Body fluid cell count 89055 A Leukocyte count, fecal 89060 A Exam,synovial fluid crystals 89100 X Sample intestinal contents 0360 1.7088 $92.77 $42.45 $18.55 89105 X Sample intestinal contents 0360 1.7088 $92.77 $42.45 $18.55 89125 A Specimen fat stain 89130 X Sample stomach contents 0360 1.7088 $92.77 $42.45 $18.55 89132 X Sample stomach contents 0360 1.7088 $92.77 $42.45 $18.55 89135 X Sample stomach contents 0360 1.7088 $92.77 $42.45 $18.55 89136 X Sample stomach contents 0360 1.7088 $92.77 $42.45 $18.55 89140 X Sample stomach contents 0360 1.7088 $92.77 $42.45 $18.55 89141 X Sample stomach contents 0360 1.7088 $92.77 $42.45 $18.55 89160 A Exam feces for meat fibers 89190 A Nasal smear for eosinophils 89250 X Fertilization of oocyte 0348 1.2207 $66.27 $13.25 89251 X Culture oocyte w/embryos 0348 1.2207 $66.27 $13.25 89252 X Assist oocyte fertilization 0348 1.2207 $66.27 $13.25 89253 X Embryo hatching 0348 1.2207 $66.27 $13.25 89254 X Oocyte identification 0348 1.2207 $66.27 $13.25 89255 X Prepare embryo for transfer 0348 1.2207 $66.27 $13.25 89256 X Prepare cryopreserved embryo 0348 1.2207 $66.27 $13.25 89257 X Sperm identification 0348 1.2207 $66.27 $13.25 89258 X Cryopreservation, embryo 0348 1.2207 $66.27 $13.25 89259 X Cryopreservation, sperm 0348 1.2207 $66.27 $13.25 89260 X Sperm isolation, simple 0348 1.2207 $66.27 $13.25 89261 X Sperm isolation, complex 0348 1.2207 $66.27 $13.25 89264 X Identify sperm tissue 0348 1.2207 $66.27 $13.25 89300 A Semen analysis w/huhner 89310 A Semen analysis Start Printed Page 48141 89320 A Semen analysis, complete 89321 A Semen analysis & motility 89325 A Sperm antibody test 89329 A Sperm evaluation test 89330 A Evaluation, cervical mucus 89350 X Sputum specimen collection 0344 0.6278 $34.08 $17.04 $6.82 89355 A Exam feces for starch 89360 X Collect sweat for test 0344 0.6278 $34.08 $17.04 $6.82 89365 A Water load test 89399 A Pathology lab procedure 90281 E Human ig, im 90283 E Human ig, iv 90287 E Botulinum antitoxin 90288 E Botulism ig, iv 90291 E Cmv ig, iv 90296 K Diphtheria antitoxin 0356 0.4353 $23.63 $4.73 90371 E Hep b ig, im 90375 K Rabies ig, im/sc 0356 0.4353 $23.63 $4.73 90376 K Rabies ig, heat treated 0356 0.4353 $23.63 $4.73 90378 E Rsv ig, im, 50mg 90379 K Rsv ig, iv 0356 0.4353 $23.63 $4.73 90384 E Rh ig, full-dose, im 90385 N Rh ig, minidose, im 90386 E Rh ig, iv 90389 N Tetanus ig, im 90393 N Vaccina ig, im 90396 N Varicella-zoster ig, im 90399 E Immune globulin 90471 N Immunization admin 90472 N Immunization admin, each add 90473 E Immune admin oral/nasal 90474 E Immune admin oral/nasal addl 90476 N Adenovirus vaccine, type 4 90477 N Adenovirus vaccine, type 7 90581 K Anthrax vaccine, sc 0356 0.4353 $23.63 $4.73 90585 N Bcg vaccine, percut 90586 N Bcg vaccine, intravesical 90632 N Hep a vaccine, adult im 90633 N Hep a vacc, ped/adol, 2 dose 90634 N Hep a vacc, ped/adol, 3 dose 90636 K Hep a/hep b vacc, adult im 0355 0.2667 $14.48 $2.90 90645 N Hib vaccine, hboc, im 90646 N Hib vaccine, prp-d, im 90647 N Hib vaccine, prp-omp, im 90648 N Hib vaccine, prp-t, im 90657 L Flu vaccine, 6-35 mo, im 90658 L Flu vaccine, 3 yrs, im 90659 L Flu vaccine, whole, im 90660 E Flu vaccine, nasal 90665 N Lyme disease vaccine, im 90669 E Pneumococcal vacc, ped <5 90675 N Rabies vaccine, im 90676 N Rabies vaccine, id 90680 N Rotovirus vaccine, oral 90690 N Typhoid vaccine, oral 90691 N Typhoid vaccine, im 90692 N Typhoid vaccine, h-p, sc/id 90693 K Typhoid vaccine, akd, sc 0356 0.4353 $23.63 $4.73 90700 N Dtap vaccine, im 90701 N Dtp vaccine, im 90702 N Dt vaccine < 7, im 90703 N Tetanus vaccine, im 90704 N Mumps vaccine, sc 90705 N Measles vaccine, sc 90706 N Rubella vaccine, sc 90707 N Mmr vaccine, sc Start Printed Page 48142 90708 N Measles-rubella vaccine, sc 90710 N Mmrv vaccine, sc 90712 N Oral poliovirus vaccine 90713 N Poliovirus, ipv, sc 90716 N Chicken pox vaccine, sc 90717 N Yellow fever vaccine, sc 90718 N Td vaccine > 7, im 90719 N Diphtheria vaccine, im 90720 N Dtp/hib vaccine, im 90721 N Dtap/hib vaccine, im 90723 K Dtap-hep b-ipv vaccine, im 0356 0.4353 $23.63 $4.73 90725 N Cholera vaccine, injectable 90727 N Plague vaccine, im 90732 L Pneumococcal vaccine 90733 N Meningococcal vaccine, sc 90735 N Encephalitis vaccine, sc 90740 K Hepb vacc, ill pat 3 dose im 0356 0.4353 $23.63 $4.73 90743 K Hep b vacc, adol, 2 dose, im 0356 0.4353 $23.63 $4.73 90744 K Hepb vacc ped/adol 3 dose im 0356 0.4353 $23.63 $4.73 90746 K Hep b vaccine, adult, im 0356 0.4353 $23.63 $4.73 90747 K Hepb vacc, ill pat 4 dose im 0356 0.4353 $23.63 $4.73 90748 K Hep b/hib vaccine, im 0356 0.4353 $23.63 $4.73 90749 N Vaccine toxoid 90780 E IV infusion therapy, 1 hour 90781 E IV infusion, additional hour 90782 X Injection, sc/im 0353 0.4106 $22.29 $4.46 90783 X Injection, ia 0359 0.8794 $47.74 $9.55 90784 X Injection, iv 0359 0.8794 $47.74 $9.55 90788 X Injection of antibiotic 0359 0.8794 $47.74 $9.55 90799 X Ther/prophylactic/dx inject 0352 0.1076 $5.84 $1.17 90801 S Psy dx interview 0323 1.7955 $97.48 $21.26 $19.50 90802 S Intac psy dx interview 0323 1.7955 $97.48 $21.26 $19.50 90804 S Psytx, office, 20-30 min 0322 1.3091 $71.07 $14.21 90805 S Psytx, off, 20-30 min w/e&m 0322 1.3091 $71.07 $14.21 90806 S Psytx, off, 45-50 min 0323 1.7955 $97.48 $21.26 $19.50 90807 S Psytx, off, 45-50 min w/e&m 0323 1.7955 $97.48 $21.26 $19.50 90808 S Psytx, office, 75-80 min 0323 1.7955 $97.48 $21.26 $19.50 90809 S Psytx, off, 75-80, w/e&m 0323 1.7955 $97.48 $21.26 $19.50 90810 S Intac psytx, off, 20-30 min 0322 1.3091 $71.07 $14.21 90811 S Intac psytx, 20-30, w/e&m 0322 1.3091 $71.07 $14.21 90812 S Intac psytx, off, 45-50 min 0323 1.7955 $97.48 $21.26 $19.50 90813 S Intac psytx, 45-50 min w/e&m 0323 1.7955 $97.48 $21.26 $19.50 90814 S Intac psytx, off, 75-80 min 0323 1.7955 $97.48 $21.26 $19.50 90815 S Intac psytx, 75-80 w/e&m 0323 1.7955 $97.48 $21.26 $19.50 90816 S Psytx, hosp, 20-30 min 0322 1.3091 $71.07 $14.21 90817 S Psytx, hosp, 20-30 min w/e&m 0322 1.3091 $71.07 $14.21 90818 S Psytx, hosp, 45-50 min 0323 1.7955 $97.48 $21.26 $19.50 90819 S Psytx, hosp, 45-50 min w/e&m 0323 1.7955 $97.48 $21.26 $19.50 90821 S Psytx, hosp, 75-80 min 0323 1.7955 $97.48 $21.26 $19.50 90822 S Psytx, hosp, 75-80 min w/e&m 0323 1.7955 $97.48 $21.26 $19.50 90823 S Intac psytx, hosp, 20-30 min 0322 1.3091 $71.07 $14.21 90824 S Intac psytx, hsp 20-30 w/e&m 0322 1.3091 $71.07 $14.21 90826 S Intac psytx, hosp, 45-50 min 0323 1.7955 $97.48 $21.26 $19.50 90827 S Intac psytx, hsp 45-50 w/e&m 0323 1.7955 $97.48 $21.26 $19.50 90828 S Intac psytx, hosp, 75-80 min 0323 1.7955 $97.48 $21.26 $19.50 90829 S Intac psytx, hsp 75-80 w/e&m 0323 1.7955 $97.48 $21.26 $19.50 90845 S Psychoanalysis 0323 1.7955 $97.48 $21.26 $19.50 90846 S Family psytx w/o patient 0324 2.8219 $153.20 $30.64 90847 S Family psytx w/patient 0324 2.8219 $153.20 $30.64 90849 S Multiple family group psytx 0325 1.5820 $85.89 $18.27 $17.18 90853 S Group psychotherapy 0325 1.5820 $85.89 $18.27 $17.18 90857 S Intac group psytx 0325 1.5820 $85.89 $18.27 $17.18 90862 X Medication management 0374 1.1062 $60.05 $12.01 90865 S Narcosynthesis 0323 1.7955 $97.48 $21.26 $19.50 90870 S Electroconvulsive therapy 0320 5.4480 $295.77 $80.06 $59.15 90871 E Electroconvulsive therapy Start Printed Page 48143 90875 E Psychophysiological therapy 90876 E Psychophysiological therapy 90880 S Hypnotherapy 0323 1.7955 $97.48 $21.26 $19.50 90882 E Environmental manipulation 90885 N Psy evaluation of records 90887 N Consultation with family 90889 N Preparation of report 90899 S Psychiatric service/therapy 0322 1.3091 $71.07 $14.21 90901 S Biofeedback train, any meth 0321 1.2462 $67.65 $21.78 $13.53 90911 S Biofeedback peri/uro/rectal 0321 1.2462 $67.65 $21.78 $13.53 90918 A ESRD related services, month 90919 A ESRD related services, month 90920 A ESRD related services, month 90921 A ESRD related services, month 90922 A ESRD related services, day 90923 A Esrd related services, day 90924 A Esrd related services, day 90925 A Esrd related services, day 90935 S Hemodialysis, one evaluation 0170 5.9427 $322.62 $64.52 90937 E Hemodialysis, repeated eval 90939 N Hemodialysis study, transcut 90940 N Hemodialysis access study 90945 S Dialysis, one evaluation 0170 5.9427 $322.62 $64.52 90947 E Dialysis, repeated eval 90989 E Dialysis training, complete 90993 E Dialysis training, incompl 90997 E Hemoperfusion 90999 E Dialysis procedure 91000 X Esophageal intubation 0361 3.5574 $193.13 $83.23 $38.63 91010 X Esophagus motility study 0361 3.5574 $193.13 $83.23 $38.63 91011 X Esophagus motility study 0361 3.5574 $193.13 $83.23 $38.63 91012 X Esophagus motility study 0361 3.5574 $193.13 $83.23 $38.63 91020 X Gastric motility 0361 3.5574 $193.13 $83.23 $38.63 91030 X Acid perfusion of esophagus 0361 3.5574 $193.13 $83.23 $38.63 91032 X Esophagus, acid reflux test 0361 3.5574 $193.13 $83.23 $38.63 91033 X Prolonged acid reflux test 0361 3.5574 $193.13 $83.23 $38.63 91052 X Gastric analysis test 0361 3.5574 $193.13 $83.23 $38.63 91055 X Gastric intubation for smear 0360 1.7088 $92.77 $42.45 $18.55 91060 X Gastric saline load test 0360 1.7088 $92.77 $42.45 $18.55 91065 X Breath hydrogen test 0360 1.7088 $92.77 $42.45 $18.55 91100 X Pass intestine bleeding tube 0360 1.7088 $92.77 $42.45 $18.55 91105 X Gastric intubation treatment 0360 1.7088 $92.77 $42.45 $18.55 91122 T Anal pressure record 0156 3.1438 $170.67 $46.55 $34.13 91123 N Irrigate fecal impaction 91132 X Electrogastrography 0360 1.7088 $92.77 $42.45 $18.55 91133 X Electrogastrography w/test 0360 1.7088 $92.77 $42.45 $18.55 91299 X Gastroenterology procedure 0360 1.7088 $92.77 $42.45 $18.55 92002 V Eye exam, new patient 0601 1.0031 $54.46 $10.89 92004 V Eye exam, new patient 0602 1.5603 $84.71 $16.94 92012 V Eye exam established pat 0600 0.9376 $50.90 $10.18 92014 V Eye exam & treatment 0602 1.5603 $84.71 $16.94 92015 E Refraction 92018 T New eye exam & treatment 0699 2.2211 $120.58 $54.26 $24.12 92019 S Eye exam & treatment 0698 0.9355 $50.79 $18.72 $10.16 92020 S Special eye evaluation 0230 0.7379 $40.06 $14.97 $8.01 92060 S Special eye evaluation 0230 0.7379 $40.06 $14.97 $8.01 92065 S Orthoptic/pleoptic training 0230 0.7379 $40.06 $14.97 $8.01 92070 N Fitting of contact lens 92081 S Visual field examination(s) 0230 0.7379 $40.06 $14.97 $8.01 92082 S Visual field examination(s) 0698 0.9355 $50.79 $18.72 $10.16 92083 S Visual field examination(s) 0698 0.9355 $50.79 $18.72 $10.16 92100 N Serial tonometry exam(s) 92120 S Tonography & eye evaluation 0230 0.7379 $40.06 $14.97 $8.01 92130 S Water provocation tonography 0698 0.9355 $50.79 $18.72 $10.16 92135 S Opthalmic dx imaging 0230 0.7379 $40.06 $14.97 $8.01 92136 S Ophthalmic biometry 0230 0.7379 $40.06 $14.97 $8.01 Start Printed Page 48144 92140 S Glaucoma provocative tests 0698 0.9355 $50.79 $18.72 $10.16 92225 S Special eye exam, initial 0698 0.9355 $50.79 $18.72 $10.16 92226 S Special eye exam, subsequent 0698 0.9355 $50.79 $18.72 $10.16 92230 T Eye exam with photos 0699 2.2211 $120.58 $54.26 $24.12 92235 T Eye exam with photos 0699 2.2211 $120.58 $54.26 $24.12 92240 S Icg angiography 0231 2.0880 $113.36 $50.94 $22.67 92250 S Eye exam with photos 0230 0.7379 $40.06 $14.97 $8.01 92260 S Ophthalmoscopy/dynamometry 0230 0.7379 $40.06 $14.97 $8.01 92265 S Eye muscle evaluation 0231 2.0880 $113.36 $50.94 $22.67 92270 S Electro-oculography 0698 0.9355 $50.79 $18.72 $10.16 92275 S Electroretinography 0231 2.0880 $113.36 $50.94 $22.67 92283 S Color vision examination 0230 0.7379 $40.06 $14.97 $8.01 92284 S Dark adaptation eye exam 0698 0.9355 $50.79 $18.72 $10.16 92285 S Eye photography 0230 0.7379 $40.06 $14.97 $8.01 92286 S Internal eye photography 0698 0.9355 $50.79 $18.72 $10.16 92287 S Internal eye photography 0231 2.0880 $113.36 $50.94 $22.67 92310 E Contact lens fitting 92311 X Contact lens fitting 0362 2.5384 $137.81 $27.56 92312 X Contact lens fitting 0362 2.5384 $137.81 $27.56 92313 X Contact lens fitting 0362 2.5384 $137.81 $27.56 92314 E Prescription of contact lens 92315 X Prescription of contact lens 0362 2.5384 $137.81 $27.56 92316 X Prescription of contact lens 0362 2.5384 $137.81 $27.56 92317 X Prescription of contact lens 0362 2.5384 $137.81 $27.56 92325 X Modification of contact lens 0362 2.5384 $137.81 $27.56 92326 X Replacement of contact lens 0362 2.5384 $137.81 $27.56 92330 S Fitting of artificial eye 0230 0.7379 $40.06 $14.97 $8.01 92335 N Fitting of artificial eye 92340 E Fitting of spectacles 92341 E Fitting of spectacles 92342 E Fitting of spectacles 92352 X Special spectacles fitting 0362 2.5384 $137.81 $27.56 92353 X Special spectacles fitting 0362 2.5384 $137.81 $27.56 92354 X Special spectacles fitting 0362 2.5384 $137.81 $27.56 92355 X Special spectacles fitting 0362 2.5384 $137.81 $27.56 92358 X Eye prosthesis service 0362 2.5384 $137.81 $27.56 92370 E Repair & adjust spectacles 92371 X Repair & adjust spectacles 0362 2.5384 $137.81 $27.56 92390 E Supply of spectacles 92391 E Supply of contact lenses 92392 E Supply of low vision aids 92393 E Supply of artificial eye 92395 E Supply of spectacles 92396 E Supply of contact lenses 92499 S Eye service or procedure 0230 0.7379 $40.06 $14.97 $8.01 92502 T Ear and throat examination 0251 1.8643 $101.21 $20.24 92504 N Ear microscopy examination 92506 A Speech/hearing evaluation 92507 A Speech/hearing therapy 92508 A Speech/hearing therapy 92510 A Rehab for ear implant 92511 T Nasopharyngoscopy 0071 0.9012 $48.93 $12.89 $9.79 92512 X Nasal function studies 0363 0.8536 $46.34 $17.15 $9.27 92516 X Facial nerve function test 0660 1.7330 $94.08 $30.66 $18.82 92520 X Laryngeal function studies 0660 1.7330 $94.08 $30.66 $18.82 92526 A Oral function therapy 92531 N Spontaneous nystagmus study 92532 N Positional nystagmus test 92533 N Caloric vestibular test 92534 N Optokinetic nystagmus test 92541 X Spontaneous nystagmus test 0363 0.8536 $46.34 $17.15 $9.27 92542 X Positional nystagmus test 0363 0.8536 $46.34 $17.15 $9.27 92543 X Caloric vestibular test 0363 0.8536 $46.34 $17.15 $9.27 92544 X Optokinetic nystagmus test 0363 0.8536 $46.34 $17.15 $9.27 92545 X Oscillating tracking test 0363 0.8536 $46.34 $17.15 $9.27 92546 X Sinusoidal rotational test 0660 1.7330 $94.08 $30.66 $18.82 Start Printed Page 48145 92547 X Supplemental electrical test 0363 0.8536 $46.34 $17.15 $9.27 92548 X Posturography 0660 1.7330 $94.08 $30.66 $18.82 92551 E Pure tone hearing test, air 92552 X Pure tone audiometry, air 0364 0.4415 $23.97 $9.06 $4.79 92553 X Audiometry, air & bone 0365 1.1915 $64.69 $18.95 $12.94 92555 X Speech threshold audiometry 0364 0.4415 $23.97 $9.06 $4.79 92556 X Speech audiometry, complete 0364 0.4415 $23.97 $9.06 $4.79 92557 X Comprehensive hearing test 0365 1.1915 $64.69 $18.95 $12.94 92559 E Group audiometric testing 92560 E Bekesy audiometry, screen 92561 X Bekesy audiometry, diagnosis 0365 1.1915 $64.69 $18.95 $12.94 92562 X Loudness balance test 0364 0.4415 $23.97 $9.06 $4.79 92563 X Tone decay hearing test 0364 0.4415 $23.97 $9.06 $4.79 92564 X Sisi hearing test 0364 0.4415 $23.97 $9.06 $4.79 92565 X Stenger test, pure tone 0364 0.4415 $23.97 $9.06 $4.79 92567 X Tympanometry 0364 0.4415 $23.97 $9.06 $4.79 92568 X Acoustic reflex testing 0364 0.4415 $23.97 $9.06 $4.79 92569 X Acoustic reflex decay test 0364 0.4415 $23.97 $9.06 $4.79 92571 X Filtered speech hearing test 0364 0.4415 $23.97 $9.06 $4.79 92572 X Staggered spondaic word test 0364 0.4415 $23.97 $9.06 $4.79 92573 X Lombard test 0364 0.4415 $23.97 $9.06 $4.79 92575 X Sensorineural acuity test 0365 1.1915 $64.69 $18.95 $12.94 92576 X Synthetic sentence test 0364 0.4415 $23.97 $9.06 $4.79 92577 X Stenger test, speech 0365 1.1915 $64.69 $18.95 $12.94 92579 X Visual audiometry (vra) 0365 1.1915 $64.69 $18.95 $12.94 92582 X Conditioning play audiometry 0365 1.1915 $64.69 $18.95 $12.94 92583 X Select picture audiometry 0364 0.4415 $23.97 $9.06 $4.79 92584 X Electrocochleography 0660 1.7330 $94.08 $30.66 $18.82 92585 S Auditor evoke potent, compre 0216 2.8332 $153.81 $67.98 $30.76 92586 S Auditor evoke potent, limit 0218 1.1296 $61.32 $12.26 92587 X Evoked auditory test 0363 0.8536 $46.34 $17.15 $9.27 92588 X Evoked auditory test 0363 0.8536 $46.34 $17.15 $9.27 92589 X Auditory function test(s) 0364 0.4415 $23.97 $9.06 $4.79 92590 E Hearing aid exam, one ear 92591 E Hearing aid exam, both ears 92592 E Hearing aid check, one ear 92593 E Hearing aid check, both ears 92594 E Electro hearng aid test, one 92595 E Electro hearng aid tst, both 92596 X Ear protector evaluation 0365 1.1915 $64.69 $18.95 $12.94 92597 E Voice Prosthetic Evaluation 92601 A Cochlear implt f/up exam < 7 92602 A Reprogram cochlear implt < 7 92603 A Cochlear implt f/up exam 7 > 92604 A Reprogram cochlear implt 7 > 92605 A Eval for nonspeech device rx 92606 A Non-speech device service 92607 A Ex for speech device rx, 1hr 92608 A Ex for speech device rx addl 92609 A Use of speech device service 92610 A Evaluate swallowing function 92611 A Motion fluoroscopy/swallow 92612 A Endoscopy swallow tst (fees) 92613 E Endoscopy swallow tst (fees) 92614 A Laryngoscopic sensory test 92615 E Eval laryngoscopy sense tst 92616 A Fees w/laryngeal sense test 92617 E Interprt fees/laryngeal test 92700 X Ent procedure/service 0364 0.4415 $23.97 $9.06 $4.79 92950 S Heart/lung resuscitation cpr 0094 2.6412 $143.39 $48.46 $28.68 92953 S Temporary external pacing 0094 2.6412 $143.39 $48.46 $28.68 92960 S Cardioversion electric, ext 0679 5.4862 $297.84 $95.30 $59.57 92961 S Cardioversion, electric, int 0679 5.4862 $297.84 $95.30 $59.57 92970 C Cardioassist, internal 92971 C Cardioassist, external 92973 T Percut coronary thrombectomy 1541 $250.00 $50.00 Start Printed Page 48146 92974 T Cath place, cardio brachytx 1559 $2,250.00 $450.00 92975 C Dissolve clot, heart vessel 92977 T Dissolve clot, heart vessel 0676 3.7505 $203.61 $55.06 $40.72 92978 S Intravasc us, heart add-on 0670 26.5472 $1,441.22 $521.95 $288.24 92979 S Intravasc us, heart add-on 0670 26.5472 $1,441.22 $521.95 $288.24 92980 T Insert intracoronary stent 0104 80.8877 $4,391.31 $878.26 92981 T Insert intracoronary stent 0104 80.8877 $4,391.31 $878.26 92982 T Coronary artery dilation 0083 59.3417 $3,221.60 $644.32 92984 T Coronary artery dilation 0083 59.3417 $3,221.60 $644.32 92986 T Revision of aortic valve 0083 59.3417 $3,221.60 $644.32 92987 T Revision of mitral valve 0083 59.3417 $3,221.60 $644.32 92990 T Revision of pulmonary valve 0083 59.3417 $3,221.60 $644.32 92992 C Revision of heart chamber 92993 C Revision of heart chamber 92995 T Coronary atherectomy 0082 100.3996 $5,450.59 $1,293.59 $1,090.12 92996 T Coronary atherectomy add-on 0082 100.3996 $5,450.59 $1,293.59 $1,090.12 92997 T Pul art balloon repr, percut 0081 34.8355 $1,891.18 $378.24 92998 T Pul art balloon repr, percut 0081 34.8355 $1,891.18 $378.24 93000 E Electrocardiogram, complete 93005 S Electrocardiogram, tracing 0099 0.3708 $20.13 $4.03 93010 A Electrocardiogram report 93012 N Transmission of ecg 93014 E Report on transmitted ecg 93015 E Cardiovascular stress test 93016 E Cardiovascular stress test 93017 X Cardiovascular stress test 0100 1.6726 $90.80 $41.44 $18.16 93018 E Cardiovascular stress test 93024 X Cardiac drug stress test 0100 1.6726 $90.80 $41.44 $18.16 93025 X Microvolt t-wave assess 0100 1.6726 $90.80 $41.44 $18.16 93040 E Rhythm ECG with report 93041 S Rhythm ECG, tracing 0099 0.3708 $20.13 $4.03 93042 E Rhythm ECG, report 93224 E ECG monitor/report, 24 hrs 93225 X ECG monitor/record, 24 hrs 0097 1.0565 $57.36 $23.80 $11.47 93226 X ECG monitor/report, 24 hrs 0097 1.0565 $57.36 $23.80 $11.47 93227 E ECG monitor/review, 24 hrs 93230 E ECG monitor/report, 24 hrs 93231 X Ecg monitor/record, 24 hrs 0097 1.0565 $57.36 $23.80 $11.47 93232 X ECG monitor/report, 24 hrs 0097 1.0565 $57.36 $23.80 $11.47 93233 E ECG monitor/review, 24 hrs 93235 E ECG monitor/report, 24 hrs 93236 X ECG monitor/report, 24 hrs 0097 1.0565 $57.36 $23.80 $11.47 93237 E ECG monitor/review, 24 hrs 93268 E ECG record/review 93270 X ECG recording 0097 1.0565 $57.36 $23.80 $11.47 93271 X Ecg/monitoring and analysis 0097 1.0565 $57.36 $23.80 $11.47 93272 E Ecg/review, interpret only 93278 S ECG/signal-averaged 0099 0.3708 $20.13 $4.03 93303 S Echo transthoracic 0269 3.2517 $176.53 $87.24 $35.31 93304 S Echo transthoracic 0697 1.4621 $79.38 $39.69 $15.88 93307 S Echo exam of heart 0269 3.2517 $176.53 $87.24 $35.31 93308 S Echo exam of heart 0697 1.4621 $79.38 $39.69 $15.88 93312 S Echo transesophageal 0270 5.9057 $320.61 $146.79 $64.12 93313 S Echo transesophageal 0270 5.9057 $320.61 $146.79 $64.12 93314 N Echo transesophageal 93315 S Echo transesophageal 0270 5.9057 $320.61 $146.79 $64.12 93316 S Echo transesophageal 0270 5.9057 $320.61 $146.79 $64.12 93317 N Echo transesophageal 93318 S Echo transesophageal intraop 0270 5.9057 $320.61 $146.79 $64.12 93320 S Doppler echo exam, heart 0671 1.6392 $88.99 $44.49 $17.80 93321 S Doppler echo exam, heart 0697 1.4621 $79.38 $39.69 $15.88 93325 S Doppler color flow add-on 0697 1.4621 $79.38 $39.69 $15.88 93350 S Echo transthoracic 0269 3.2517 $176.53 $87.24 $35.31 93501 T Right heart catheterization 0080 36.0982 $1,959.74 $838.92 $391.95 93503 T Insert/place heart catheter 0103 12.1256 $658.29 $223.63 $131.66 93505 T Biopsy of heart lining 0103 12.1256 $658.29 $223.63 $131.66 Start Printed Page 48147 93508 T Cath placement, angiography 0080 36.0982 $1,959.74 $838.92 $391.95 93510 T Left heart catheterization 0080 36.0982 $1,959.74 $838.92 $391.95 93511 T Left heart catheterization 0080 36.0982 $1,959.74 $838.92 $391.95 93514 T Left heart catheterization 0080 36.0982 $1,959.74 $838.92 $391.95 93524 T Left heart catheterization 0080 36.0982 $1,959.74 $838.92 $391.95 93526 T Rt & Lt heart catheters 0080 36.0982 $1,959.74 $838.92 $391.95 93527 T Rt & Lt heart catheters 0080 36.0982 $1,959.74 $838.92 $391.95 93528 T Rt & Lt heart catheters 0080 36.0982 $1,959.74 $838.92 $391.95 93529 T Rt, lt heart catheterization 0080 36.0982 $1,959.74 $838.92 $391.95 93530 T Rt heart cath, congenital 0080 36.0982 $1,959.74 $838.92 $391.95 93531 T R & l heart cath, congenital 0080 36.0982 $1,959.74 $838.92 $391.95 93532 T R & l heart cath, congenital 0080 36.0982 $1,959.74 $838.92 $391.95 93533 T R & l heart cath, congenital 0080 36.0982 $1,959.74 $838.92 $391.95 93539 N Injection, cardiac cath 93540 N Injection, cardiac cath 93541 N Injection for lung angiogram 93542 N Injection for heart x-rays 93543 N Injection for heart x-rays 93544 N Injection for aortography 93545 N Inject for coronary x-rays 93555 N Imaging, cardiac cath 93556 N Imaging, cardiac cath 93561 N Cardiac output measurement 93562 N Cardiac output measurement 93571 N Heart flow reserve measure 93572 N Heart flow reserve measure 93580 T Transcath closure of asd 1559 $2,250.00 $450.00 93581 T Transcath closure of vsd 1559 $2,250.00 $450.00 93600 T Bundle of His recording 0087 40.4579 $2,196.42 $439.28 93602 T Intra-atrial recording 0087 40.4579 $2,196.42 $439.28 93603 T Right ventricular recording 0087 40.4579 $2,196.42 $439.28 93609 T Map tachycardia, add-on 0087 40.4579 $2,196.42 $439.28 93610 T Intra-atrial pacing 0087 40.4579 $2,196.42 $439.28 93612 T Intraventricular pacing 0087 40.4579 $2,196.42 $439.28 93613 T Electrophys map 3d, add-on 0087 40.4579 $2,196.42 $439.28 93615 T Esophageal recording 0087 40.4579 $2,196.42 $439.28 93616 T Esophageal recording 0087 40.4579 $2,196.42 $439.28 93618 T Heart rhythm pacing 0087 40.4579 $2,196.42 $439.28 93619 T Electrophysiology evaluation 0085 36.3284 $1,972.23 $435.09 $394.45 93620 T Electrophysiology evaluation 0085 36.3284 $1,972.23 $435.09 $394.45 93621 T Electrophysiology evaluation 0085 36.3284 $1,972.23 $435.09 $394.45 93622 T Electrophysiology evaluation 0085 36.3284 $1,972.23 $435.09 $394.45 93623 T Stimulation, pacing heart 0087 40.4579 $2,196.42 $439.28 93624 S Electrophysiologic study 0084 10.3392 $561.30 $112.26 93631 T Heart pacing, mapping 0087 40.4579 $2,196.42 $439.28 93640 S Evaluation heart device 0084 10.3392 $561.30 $112.26 93641 S Electrophysiology evaluation 0084 10.3392 $561.30 $112.26 93642 S Electrophysiology evaluation 0084 10.3392 $561.30 $112.26 93650 T Ablate heart dysrhythm focus 0086 44.5652 $2,419.40 $822.28 $483.88 93651 T Ablate heart dysrhythm focus 0086 44.5652 $2,419.40 $822.28 $483.88 93652 T Ablate heart dysrhythm focus 0086 44.5652 $2,419.40 $822.28 $483.88 93660 S Tilt table evaluation 0101 4.3675 $237.11 $105.27 $47.42 93662 S Intracardiac ecg (ice) 0670 26.5472 $1,441.22 $521.95 $288.24 93668 E Peripheral vascular rehab 93701 S Bioimpedance, thoracic 0099 0.3708 $20.13 $4.03 93720 E Total body plethysmography 93721 X Plethysmography tracing 0368 0.9321 $50.60 $25.30 $10.12 93722 E Plethysmography report 93724 S Analyze pacemaker system 0690 0.3986 $21.64 $10.35 $4.33 93727 S Analyze ilr system 0690 0.3986 $21.64 $10.35 $4.33 93731 S Analyze pacemaker system 0690 0.3986 $21.64 $10.35 $4.33 93732 S Analyze pacemaker system 0690 0.3986 $21.64 $10.35 $4.33 93733 S Telephone analy, pacemaker 0690 0.3986 $21.64 $10.35 $4.33 93734 S Analyze pacemaker system 0690 0.3986 $21.64 $10.35 $4.33 93735 S Analyze pacemaker system 0690 0.3986 $21.64 $10.35 $4.33 93736 S Telephone analy, pacemaker 0690 0.3986 $21.64 $10.35 $4.33 Start Printed Page 48148 93740 X Temperature gradient studies 0367 0.5828 $31.64 $15.16 $6.33 93741 S Analyze ht pace device sngl 0689 0.5427 $29.46 $5.89 93742 S Analyze ht pace device sngl 0689 0.5427 $29.46 $5.89 93743 S Analyze ht pace device dual 0689 0.5427 $29.46 $5.89 93744 S Analyze ht pace device dual 0689 0.5427 $29.46 $5.89 93760 E Cephalic thermogram 93762 E Peripheral thermogram 93770 N Measure venous pressure 93784 E Ambulatory BP monitoring 93786 X Ambulatory BP recording 0097 1.0565 $57.36 $23.80 $11.47 93788 E Ambulatory BP analysis 93790 E Review/report BP recording 93797 S Cardiac rehab 0095 0.5984 $32.49 $16.24 $6.50 93798 S Cardiac rehab/monitor 0095 0.5984 $32.49 $16.24 $6.50 93799 S Cardiovascular procedure 0096 1.7332 $94.09 $47.04 $18.82 93875 S Extracranial study 0096 1.7332 $94.09 $47.04 $18.82 93880 S Extracranial study 0267 2.4805 $134.66 $65.52 $26.93 93882 S Extracranial study 0267 2.4805 $134.66 $65.52 $26.93 93886 S Intracranial study 0267 2.4805 $134.66 $65.52 $26.93 93888 S Intracranial study 0266 1.6234 $88.13 $44.06 $17.63 93922 S Extremity study 0096 1.7332 $94.09 $47.04 $18.82 93923 S Extremity study 0096 1.7332 $94.09 $47.04 $18.82 93924 S Extremity study 0096 1.7332 $94.09 $47.04 $18.82 93925 S Lower extremity study 0267 2.4805 $134.66 $65.52 $26.93 93926 S Lower extremity study 0267 2.4805 $134.66 $65.52 $26.93 93930 S Upper extremity study 0267 2.4805 $134.66 $65.52 $26.93 93931 S Upper extremity study 0266 1.6234 $88.13 $44.06 $17.63 93965 S Extremity study 0096 1.7332 $94.09 $47.04 $18.82 93970 S Extremity study 0267 2.4805 $134.66 $65.52 $26.93 93971 S Extremity study 0267 2.4805 $134.66 $65.52 $26.93 93975 S Vascular study 0267 2.4805 $134.66 $65.52 $26.93 93976 S Vascular study 0267 2.4805 $134.66 $65.52 $26.93 93978 S Vascular study 0267 2.4805 $134.66 $65.52 $26.93 93979 S Vascular study 0267 2.4805 $134.66 $65.52 $26.93 93980 S Penile vascular study 0267 2.4805 $134.66 $65.52 $26.93 93981 S Penile vascular study 0267 2.4805 $134.66 $65.52 $26.93 93990 S Doppler flow testing 0267 2.4805 $134.66 $65.52 $26.93 94010 X Breathing capacity test 0368 0.9321 $50.60 $25.30 $10.12 94014 X Patient recorded spirometry 0367 0.5828 $31.64 $15.16 $6.33 94015 X Patient recorded spirometry 0367 0.5828 $31.64 $15.16 $6.33 94016 A Review patient spirometry 94060 X Evaluation of wheezing 0368 0.9321 $50.60 $25.30 $10.12 94070 X Evaluation of wheezing 0369 2.5282 $137.25 $44.18 $27.45 94150 X Vital capacity test 0367 0.5828 $31.64 $15.16 $6.33 94200 X Lung function test (MBC/MVV) 0367 0.5828 $31.64 $15.16 $6.33 94240 X Residual lung capacity 0368 0.9321 $50.60 $25.30 $10.12 94250 X Expired gas collection 0367 0.5828 $31.64 $15.16 $6.33 94260 X Thoracic gas volume 0368 0.9321 $50.60 $25.30 $10.12 94350 X Lung nitrogen washout curve 0368 0.9321 $50.60 $25.30 $10.12 94360 X Measure airflow resistance 0367 0.5828 $31.64 $15.16 $6.33 94370 X Breath airway closing volume 0367 0.5828 $31.64 $15.16 $6.33 94375 X Respiratory flow volume loop 0367 0.5828 $31.64 $15.16 $6.33 94400 X CO2 breathing response curve 0367 0.5828 $31.64 $15.16 $6.33 94450 X Hypoxia response curve 0367 0.5828 $31.64 $15.16 $6.33 94620 X Pulmonary stress test/simple 0368 0.9321 $50.60 $25.30 $10.12 94621 X Pulm stress test/complex 0369 2.5282 $137.25 $44.18 $27.45 94640 S Airway inhalation treatment 0077 0.2772 $15.05 $7.52 $3.01 94642 S Aerosol inhalation treatment 0078 0.7731 $41.97 $14.55 $8.39 94656 S Initial ventilator mgmt 0079 2.2837 $123.98 $24.80 94657 S Continued ventilator mgmt 0079 2.2837 $123.98 $24.80 94660 S Pos airway pressure, CPAP 0068 1.1234 $60.99 $30.49 $12.20 94662 S Neg press ventilation, cnp 0079 2.2837 $123.98 $24.80 94664 S Aerosol or vapor inhalations 0077 0.2772 $15.05 $7.52 $3.01 94667 S Chest wall manipulation 0077 0.2772 $15.05 $7.52 $3.01 94668 S Chest wall manipulation 0077 0.2772 $15.05 $7.52 $3.01 94680 X Exhaled air analysis, o2 0367 0.5828 $31.64 $15.16 $6.33 Start Printed Page 48149 94681 X Exhaled air analysis, o2/co2 0368 0.9321 $50.60 $25.30 $10.12 94690 X Exhaled air analysis 0367 0.5828 $31.64 $15.16 $6.33 94720 X Monoxide diffusing capacity 0368 0.9321 $50.60 $25.30 $10.12 94725 X Membrane diffusion capacity 0368 0.9321 $50.60 $25.30 $10.12 94750 X Pulmonary compliance study 0367 0.5828 $31.64 $15.16 $6.33 94760 N Measure blood oxygen level 94761 N Measure blood oxygen level 94762 N Measure blood oxygen level 94770 X Exhaled carbon dioxide test 0367 0.5828 $31.64 $15.16 $6.33 94772 X Breath recording, infant 0369 2.5282 $137.25 $44.18 $27.45 94799 X Pulmonary service/procedure 0367 0.5828 $31.64 $15.16 $6.33 95004 X Percut allergy skin tests 0370 0.8858 $48.09 $11.58 $9.62 95010 X Percut allergy titrate test 0370 0.8858 $48.09 $11.58 $9.62 95015 X Id allergy titrate-drug/bug 0370 0.8858 $48.09 $11.58 $9.62 95024 X Id allergy test, drug/bug 0370 0.8858 $48.09 $11.58 $9.62 95027 X Skin end point titration 0370 0.8858 $48.09 $11.58 $9.62 95028 X Id allergy test-delayed type 0370 0.8858 $48.09 $11.58 $9.62 95044 X Allergy patch tests 0370 0.8858 $48.09 $11.58 $9.62 95052 X Photo patch test 0370 0.8858 $48.09 $11.58 $9.62 95056 X Photosensitivity tests 0370 0.8858 $48.09 $11.58 $9.62 95060 X Eye allergy tests 0370 0.8858 $48.09 $11.58 $9.62 95065 X Nose allergy test 0370 0.8858 $48.09 $11.58 $9.62 95070 X Bronchial allergy tests 0369 2.5282 $137.25 $44.18 $27.45 95071 X Bronchial allergy tests 0369 2.5282 $137.25 $44.18 $27.45 95075 X Ingestion challenge test 0361 3.5574 $193.13 $83.23 $38.63 95078 X Provocative testing 0370 0.8858 $48.09 $11.58 $9.62 95115 X Immunotherapy, one injection 0352 0.1076 $5.84 $1.17 95117 X Immunotherapy injections 0353 0.4106 $22.29 $4.46 95120 E Immunotherapy, one injection 95125 E Immunotherapy, many antigens 95130 E Immunotherapy, insect venom 95131 E Immunotherapy, insect venoms 95132 E Immunotherapy, insect venoms 95133 E Immunotherapy, insect venoms 95134 E Immunotherapy, insect venoms 95144 X Antigen therapy services 0371 0.4084 $22.17 $4.44 $4.43 95145 X Antigen therapy services 0371 0.4084 $22.17 $4.44 $4.43 95146 X Antigen therapy services 0371 0.4084 $22.17 $4.44 $4.43 95147 X Antigen therapy services 0371 0.4084 $22.17 $4.44 $4.43 95148 X Antigen therapy services 0371 0.4084 $22.17 $4.44 $4.43 95149 X Antigen therapy services 0371 0.4084 $22.17 $4.44 $4.43 95165 X Antigen therapy services 0371 0.4084 $22.17 $4.44 $4.43 95170 X Antigen therapy services 0371 0.4084 $22.17 $4.44 $4.43 95180 X Rapid desensitization 0370 0.8858 $48.09 $11.58 $9.62 95199 X Allergy immunology services 0370 0.8858 $48.09 $11.58 $9.62 95250 T Glucose monitoring, cont 1540 $150.00 $30.00 95805 S Multiple sleep latency test 0209 11.5352 $626.23 $280.58 $125.25 95806 S Sleep study, unattended 0213 3.2422 $176.02 $70.41 $35.20 95807 S Sleep study, attended 0209 11.5352 $626.23 $280.58 $125.25 95808 S Polysomnography, 1-3 0209 11.5352 $626.23 $280.58 $125.25 95810 S Polysomnography, 4 or more 0209 11.5352 $626.23 $280.58 $125.25 95811 S Polysomnography w/cpap 0209 11.5352 $626.23 $280.58 $125.25 95812 S Electroencephalogram (EEG) 0213 3.2422 $176.02 $70.41 $35.20 95813 S Eeg, over 1 hour 0213 3.2422 $176.02 $70.41 $35.20 95816 S Electroencephalogram (EEG) 0214 2.2459 $121.93 $58.12 $24.39 95819 S Electroencephalogram (EEG) 0214 2.2459 $121.93 $58.12 $24.39 95822 S Sleep electroencephalogram 0214 2.2459 $121.93 $58.12 $24.39 95824 S Eeg, cerebral death only 0214 2.2459 $121.93 $58.12 $24.39 95827 S Night electroencephalogram 0209 11.5352 $626.23 $280.58 $125.25 95829 S Surgery electrocorticogram 0214 2.2459 $121.93 $58.12 $24.39 95830 E Insert electrodes for EEG 95831 N Limb muscle testing, manual 95832 N Hand muscle testing, manual 95833 N Body muscle testing, manual 95834 N Body muscle testing, manual 95851 N Range of motion measurements Start Printed Page 48150 95852 N Range of motion measurements 95857 S Tensilon test 0218 1.1296 $61.32 $12.26 95858 S Tensilon test & myogram 0215 0.6390 $34.69 $15.76 $6.94 95860 S Muscle test, one limb 0218 1.1296 $61.32 $12.26 95861 S Muscle test, 2 limbs 0218 1.1296 $61.32 $12.26 95863 S Muscle test, 3 limbs 0218 1.1296 $61.32 $12.26 95864 S Muscle test, 4 limbs 0218 1.1296 $61.32 $12.26 95867 S Muscle test, head or neck 0218 1.1296 $61.32 $12.26 95868 S Muscle test cran nerve bilat 0218 1.1296 $61.32 $12.26 95869 S Muscle test, thor paraspinal 0215 0.6390 $34.69 $15.76 $6.94 95870 S Muscle test, nonparaspinal 0215 0.6390 $34.69 $15.76 $6.94 95872 S Muscle test, one fiber 0218 1.1296 $61.32 $12.26 95875 S Limb exercise test 0215 0.6390 $34.69 $15.76 $6.94 95900 S Motor nerve conduction test 0215 0.6390 $34.69 $15.76 $6.94 95903 S Motor nerve conduction test 0215 0.6390 $34.69 $15.76 $6.94 95904 S Sense nerve conduction test 0215 0.6390 $34.69 $15.76 $6.94 95920 S Intraop nerve test add-on 0216 2.8332 $153.81 $67.98 $30.76 95921 S Autonomic nerv function test 0218 1.1296 $61.32 $12.26 95922 S Autonomic nerv function test 0218 1.1296 $61.32 $12.26 95923 S Autonomic nerv function test 0215 0.6390 $34.69 $15.76 $6.94 95925 S Somatosensory testing 0216 2.8332 $153.81 $67.98 $30.76 95926 S Somatosensory testing 0216 2.8332 $153.81 $67.98 $30.76 95927 S Somatosensory testing 0216 2.8332 $153.81 $67.98 $30.76 95930 S Visual evoked potential test 0218 1.1296 $61.32 $12.26 95933 S Blink reflex test 0215 0.6390 $34.69 $15.76 $6.94 95934 S H-reflex test 0215 0.6390 $34.69 $15.76 $6.94 95936 S H-reflex test 0215 0.6390 $34.69 $15.76 $6.94 95937 S Neuromuscular junction test 0218 1.1296 $61.32 $12.26 95950 S Ambulatory eeg monitoring 0213 3.2422 $176.02 $70.41 $35.20 95951 S EEG monitoring/videorecord 0209 11.5352 $626.23 $280.58 $125.25 95953 S EEG monitoring/computer 0209 11.5352 $626.23 $280.58 $125.25 95954 S EEG monitoring/giving drugs 0214 2.2459 $121.93 $58.12 $24.39 95955 S EEG during surgery 0213 3.2422 $176.02 $70.41 $35.20 95956 S Eeg monitoring, cable/radio 0214 2.2459 $121.93 $58.12 $24.39 95957 S EEG digital analysis 0214 2.2459 $121.93 $58.12 $24.39 95958 S EEG monitoring/function test 0213 3.2422 $176.02 $70.41 $35.20 95961 S Electrode stimulation, brain 0216 2.8332 $153.81 $67.98 $30.76 95962 S Electrode stim, brain add-on 0216 2.8332 $153.81 $67.98 $30.76 95965 S Meg, spontaneous 1528 $5,250.00 $1,050.00 95966 S Meg, evoked, single 1516 $1,450.00 $290.00 95967 S Meg, evoked, each addl 1511 $950.00 $190.00 95970 S Analyze neurostim, no prog 0692 0.9625 $52.25 $26.12 $10.45 95971 S Analyze neurostim, simple 0692 0.9625 $52.25 $26.12 $10.45 95972 S Analyze neurostim, complex 0692 0.9625 $52.25 $26.12 $10.45 95973 S Analyze neurostim, complex 0692 0.9625 $52.25 $26.12 $10.45 95974 S Cranial neurostim, complex 0692 0.9625 $52.25 $26.12 $10.45 95975 S Cranial neurostim, complex 0692 0.9625 $52.25 $26.12 $10.45 95990 T Spin/brain pump refil & main 0125 2.5105 $136.29 $27.26 95999 S Neurological procedure 0215 0.6390 $34.69 $15.76 $6.94 96000 S Motion analysis, video/3d 1503 $150.00 $30.00 96001 S Motion test w/ft press meas 1503 $150.00 $30.00 96002 S Dynamic surface emg 1503 $150.00 $30.00 96003 S Dynamic fine wire emg 1503 $150.00 $30.00 96004 E Phys review of motion tests 96100 X Psychological testing 0373 2.1165 $114.90 $22.98 $22.98 96105 X Assessment of aphasia 0373 2.1165 $114.90 $22.98 $22.98 96110 X Developmental test, lim 0373 2.1165 $114.90 $22.98 $22.98 96111 X Developmental test, extend 0373 2.1165 $114.90 $22.98 $22.98 96115 X Neurobehavior status exam 0373 2.1165 $114.90 $22.98 $22.98 96117 X Neuropsych test battery 0373 2.1165 $114.90 $22.98 $22.98 96150 S Assess lth/behave, init 0322 1.3091 $71.07 $14.21 96151 S Assess hlth/behave, subseq 0322 1.3091 $71.07 $14.21 96152 S Intervene hlth/behave, indiv 0322 1.3091 $71.07 $14.21 96153 S Intervene hlth/behave, group 0322 1.3091 $71.07 $14.21 96154 S Interv hlth/behav, fam w/pt 0322 1.3091 $71.07 $14.21 96155 S Interv hlth/behav fam no pt 0322 1.3091 $71.07 $14.21 Start Printed Page 48151 96400 E Chemotherapy, sc/im 96405 E Intralesional chemo admin 96406 E Intralesional chemo admin 96408 E Chemotherapy, push technique 96410 E Chemotherapy, infusion method 96412 E Chemo, infuse method add-on 96414 E Chemo, infuse method add-on 96420 E Chemotherapy, push technique 96422 E Chemotherapy,infusion method 96423 E Chemo, infuse method add-on 96425 E Chemotherapy, infusion method 96440 E Chemotherapy, intracavitary 96445 E Chemotherapy, intracavitary 96450 E Chemotherapy, into CNS 96520 T Port pump refill & main 0125 2.5105 $136.29 $27.26 96530 T Pump refilling, maintenance 0125 2.5105 $136.29 $27.26 96542 E Chemotherapy injection 96545 E Provide chemotherapy agent 96549 E Chemotherapy, unspecified 96567 T Photodynamic tx, skin 1540 $150.00 $30.00 96570 T Photodynamic tx, 30 min 1541 $250.00 $50.00 96571 T Photodynamic tx, addl 15 min 1541 $250.00 $50.00 96900 S Ultraviolet light therapy 0001 0.3940 $21.39 $7.09 $4.28 96902 N Trichogram 96910 S Photochemotherapy with UV-B 0001 0.3940 $21.39 $7.09 $4.28 96912 S Photochemotherapy with UV-A 0001 0.3940 $21.39 $7.09 $4.28 96913 S Photochemotherapy, UV-A or B 0683 1.7915 $97.26 $35.01 $19.45 96920 T Laser tx, skin < 250 sq cm 0012 0.8203 $44.53 $11.18 $8.91 96921 T Laser tx, skin 250-500 sq cm 0012 0.8203 $44.53 $11.18 $8.91 96922 T Laser tx, skin > 500 sq cm 0013 1.1420 $62.00 $14.20 $12.40 96999 T Dermatological procedure 0010 0.6806 $36.95 $10.08 $7.39 97001 A Pt evaluation 97002 A Pt re-evaluation 97003 A Ot evaluation 97004 A Ot re-evaluation 97005 E Athletic train eval 97006 E Athletic train reeval 97010 A Hot or cold packs therapy 97012 A Mechanical traction therapy 97014 E Electric stimulation therapy 97016 A Vasopneumatic device therapy 97018 A Paraffin bath therapy 97020 A Microwave therapy 97022 A Whirlpool therapy 97024 A Diathermy treatment 97026 A Infrared therapy 97028 A Ultraviolet therapy 97032 A Electrical stimulation 97033 A Electric current therapy 97034 A Contrast bath therapy 97035 A Ultrasound therapy 97036 A Hydrotherapy 97039 A Physical therapy treatment 97110 A Therapeutic exercises 97112 A Neuromuscular reeducation 97113 A Aquatic therapy/exercises 97116 A Gait training therapy 97124 A Massage therapy 97139 A Physical medicine procedure 97140 A Manual therapy 97150 A Group therapeutic procedures 97504 A Orthotic training 97520 A Prosthetic training 97530 A Therapeutic activities 97532 A Cognitive skills development 97533 A Sensory integration Start Printed Page 48152 97535 A Self care mngment training 97537 A Community/work reintegration 97542 A Wheelchair mngment training 97545 A Work hardening 97546 A Work hardening add-on 97601 A Wound(s) care, selective 97602 N Wound(s) care non-selective 97703 A Prosthetic checkout 97750 A Physical performance test 97780 E Acupuncture w/o stimul 97781 E Acupuncture w/stimul 97799 A Physical medicine procedure 97802 A Medical nutrition, indiv, in 97803 A Med nutrition, indiv, subseq 97804 A Medical nutrition, group 98925 S Osteopathic manipulation 0060 0.3151 $17.11 $3.43 $3.42 98926 S Osteopathic manipulation 0060 0.3151 $17.11 $3.43 $3.42 98927 S Osteopathic manipulation 0060 0.3151 $17.11 $3.43 $3.42 98928 S Osteopathic manipulation 0060 0.3151 $17.11 $3.43 $3.42 98929 S Osteopathic manipulation 0060 0.3151 $17.11 $3.43 $3.42 98940 S Chiropractic manipulation 0060 0.3151 $17.11 $3.43 $3.42 98941 S Chiropractic manipulation 0060 0.3151 $17.11 $3.43 $3.42 98942 S Chiropractic manipulation 0060 0.3151 $17.11 $3.43 $3.42 98943 E Chiropractic manipulation 99000 E Specimen handling 99001 E Specimen handling 99002 E Device handling 99024 E Postop follow-up visit 99025 E Initial surgical evaluation 99026 E In-hospital on call service 99027 E Out-of-hosp on call service 99050 E Medical services after hrs 99052 E Medical services at night 99054 E Medical servcs, unusual hrs 99056 E Non-office medical services 99058 E Office emergency care 99070 E Special supplies 99071 E Patient education materials 99075 E Medical testimony 99078 N Group health education 99080 E Special reports or forms 99082 E Unusual physician travel 99090 E Computer data analysis 99091 E Collect/review data from pt 99100 E Special anesthesia service 99116 E Anesthesia with hypothermia 99135 E Special anesthesia procedure 99140 E Emergency anesthesia 99141 N Sedation, iv/im or inhalant 99142 N Sedation, oral/rectal/nasal 99170 T Anogenital exam, child 0191 0.1679 $9.12 $2.65 $1.82 99172 E Ocular function screen 99173 E Visual acuity screen 99175 N Induction of vomiting 99183 E Hyperbaric oxygen therapy 99185 N Regional hypothermia 99186 N Total body hypothermia 99190 C Special pump services 99191 C Special pump services 99192 C Special pump services 99195 X Phlebotomy 0372 0.5529 $30.02 $10.09 $6.00 99199 E Special service/proc/report 99201 V Office/outpatient visit, new 0600 0.9376 $50.90 $10.18 99202 V Office/outpatient visit, new 0600 0.9376 $50.90 $10.18 99203 V Office/outpatient visit, new 0601 1.0031 $54.46 $10.89 99204 V Office/outpatient visit, new 0602 1.5603 $84.71 $16.94 Start Printed Page 48153 99205 V Office/outpatient visit, new 0602 1.5603 $84.71 $16.94 99211 V Office/outpatient visit, est 0600 0.9376 $50.90 $10.18 99212 V Office/outpatient visit, est 0600 0.9376 $50.90 $10.18 99213 V Office/outpatient visit, est 0601 1.0031 $54.46 $10.89 99214 V Office/outpatient visit, est 0602 1.5603 $84.71 $16.94 99215 V Office/outpatient visit, est 0602 1.5603 $84.71 $16.94 99217 N Observation care discharge 99218 N Observation care 99219 N Observation care 99220 N Observation care 99221 E Initial hospital care 99222 E Initial hospital care 99223 E Initial hospital care 99231 E Subsequent hospital care 99232 E Subsequent hospital care 99233 E Subsequent hospital care 99234 N Observ/hosp same date 99235 N Observ/hosp same date 99236 N Observ/hosp same date 99238 E Hospital discharge day 99239 E Hospital discharge day 99241 V Office consultation 0600 0.9376 $50.90 $10.18 99242 V Office consultation 0600 0.9376 $50.90 $10.18 99243 V Office consultation 0601 1.0031 $54.46 $10.89 99244 V Office consultation 0602 1.5603 $84.71 $16.94 99245 V Office consultation 0602 1.5603 $84.71 $16.94 99251 C Initial inpatient consult 99252 C Initial inpatient consult 99253 C Initial inpatient consult 99254 C Initial inpatient consult 99255 C Initial inpatient consult 99261 C Follow-up inpatient consult 99262 C Follow-up inpatient consult 99263 C Follow-up inpatient consult 99271 V Confirmatory consultation 0600 0.9376 $50.90 $10.18 99272 V Confirmatory consultation 0600 0.9376 $50.90 $10.18 99273 V Confirmatory consultation 0601 1.0031 $54.46 $10.89 99274 V Confirmatory consultation 0602 1.5603 $84.71 $16.94 99275 V Confirmatory consultation 0602 1.5603 $84.71 $16.94 99281 V Emergency dept visit 0610 1.4146 $76.80 $19.57 $15.36 99282 V Emergency dept visit 0610 1.4146 $76.80 $19.57 $15.36 99283 V Emergency dept visit 0611 2.4881 $135.08 $36.47 $27.02 99284 V Emergency dept visit 0612 4.3235 $234.72 $54.14 $46.94 99285 V Emergency dept visit 0612 4.3235 $234.72 $54.14 $46.94 99288 E Direct advanced life support 99289 N Pt transport, 30-74 min 99290 N Pt transport, addl 30 min 99291 S Critical care, first hour 0620 9.2657 $503.03 $145.78 $100.61 99292 N Critical care, addl 30 min 99293 C Ped critical care, initial 99294 C Ped critical care, subseq 99295 C Neonatal critical care 99296 C Neonatal critical care 99298 C Neonatal critical care 99299 C Ic, lbw infant 1500-2500 gm 99301 E Nursing facility care 99302 E Nursing facility care 99303 E Nursing facility care 99311 E Nursing fac care, subseq 99312 E Nursing fac care, subseq 99313 E Nursing fac care, subseq 99315 E Nursing fac discharge day 99316 E Nursing fac discharge day 99321 E Rest home visit, new patient 99322 E Rest home visit, new patient 99323 E Rest home visit, new patient Start Printed Page 48154 99331 E Rest home visit, est pat 99332 E Rest home visit, est pat 99333 E Rest home visit, est pat 99341 E Home visit, new patient 99342 E Home visit, new patient 99343 E Home visit, new patient 99344 E Home visit, new patient 99345 E Home visit, new patient 99347 E Home visit, est patient 99348 E Home visit, est patient 99349 E Home visit, est patient 99350 E Home visit, est patient 99354 N Prolonged service, office 99355 N Prolonged service, office 99356 C Prolonged service, inpatient 99357 C Prolonged service, inpatient 99358 N Prolonged serv, w/o contact 99359 N Prolonged serv, w/o contact 99360 E Physician standby services 99361 E Physician/team conference 99362 E Physician/team conference 99371 E Physician phone consultation 99372 E Physician phone consultation 99373 E Physician phone consultation 99374 E Home health care supervision 99377 E Hospice care supervision 99379 E Nursing fac care supervision 99380 E Nursing fac care supervision 99381 E Prev visit, new, infant 99382 E Prev visit, new, age 1-4 99383 E Prev visit, new, age 5-11 99384 E Prev visit, new, age 12-17 99385 E Prev visit, new, age 18-39 99386 E Prev visit, new, age 40-64 99387 E Prev visit, new, 65 & over 99391 E Prev visit, est, infant 99392 E Prev visit, est, age 1-4 99393 E Prev visit, est, age 5-11 99394 E Prev visit, est, age 12-17 99395 E Prev visit, est, age 18-39 99396 E Prev visit, est, age 40-64 99397 E Prev visit, est, 65 & over 99401 E Preventive counseling, indiv 99402 E Preventive counseling, indiv 99403 E Preventive counseling, indiv 99404 E Preventive counseling, indiv 99411 E Preventive counseling, group 99412 E Preventive counseling, group 99420 E Health risk assessment test 99429 E Unlisted preventive service 99431 V Initial care, normal newborn 0600 0.9376 $50.90 $10.18 99432 N Newborn care, not in hosp 99433 C Normal newborn care/hospital 99435 E Newborn discharge day hosp 99436 N Attendance, birth 99440 S Newborn resuscitation 0094 2.6412 $143.39 $48.46 $28.68 99450 E Life/disability evaluation 99455 E Disability examination 99456 E Disability examination 99499 E Unlisted e&m service 99500 E Home visit, prenatal 99501 E Home visit, postnatal 99502 E Home visit, nb care 99503 E Home visit, resp therapy 99504 E Home visit mech ventilator 99505 E Home visit, stoma care Start Printed Page 48155 99506 E Home visit, im injection 99507 E Home visit, cath maintain 99509 E Home visit day life activity 99510 E Home visit, sing/m/fam couns 99511 E Home visit, fecal/enema mgmt 99512 E Home visit, hemodialysis 99551 E Home infus, pain mgmt, iv/sc 99552 E Hm infus pain mgmt, epid/ith 99553 E Home infuse, tocolytic tx 99554 E Home infus, hormone/platelet 99555 E Home infuse, chemotheraphy 99556 E Home infus, antibio/fung/vir 99557 E Home infuse, anticoagulant 99558 E Home infuse, immunotherapy 99559 E Home infus, periton dialysis 99560 E Home infus, entero nutrition 99561 E Home infuse, hydration tx 99562 E Home infus, parent nutrition 99563 E Home admin, pentamidine 99564 E Hme infus, antihemophil agnt 99565 E Home infus, proteinase inhib 99566 E Home infuse, iv therapy 99567 E Home infuse, sympath agent 99568 E Home infus, misc drug, daily 99569 E Home infuse, each addl tx 99600 E Home visit nos A0021 E Outside state ambulance serv A0080 E Noninterest escort in non er A0090 E Interest escort in non er A0100 E Nonemergency transport taxi A0110 E Nonemergency transport bus A0120 E Noner transport mini-bus A0130 E Noner transport wheelch van A0140 E Nonemergency transport air A0160 E Noner transport case worker A0170 E Noner transport parking fees A0180 E Noner transport lodgng recip A0190 E Noner transport meals recip A0200 E Noner transport lodgng escrt A0210 E Noner transport meals escort A0225 A Neonatal emergency transport A0380 A Basic life support mileage A0382 A Basic support routine suppls A0384 A Bls defibrillation supplies A0390 A Advanced life support mileag A0392 A Als defibrillation supplies A0394 A Als IV drug therapy supplies A0396 A Als esophageal intub suppls A0398 A Als routine disposble suppls A0420 A Ambulance waiting 1/2 hr A0422 A Ambulance 02 life sustaining A0424 A Extra ambulance attendant A0425 A Ground mileage A0426 A Als 1 A0427 A ALS1-emergency A0428 A bls A0429 A BLS-emergency A0430 A Fixed wing air transport A0431 A Rotary wing air transport A0432 A PI volunteer ambulance co A0433 A als 2 A0434 A Specialty care transport A0435 A Fixed wing air mileage A0436 A Rotary wing air mileage A0888 E Noncovered ambulance mileage A0999 A Unlisted ambulance service Start Printed Page 48156 A4206 A 1 CC sterile syringe&needle A4207 A 2 CC sterile syringe&needle A4208 A 3 CC sterile syringe&needle A4209 E 5+ CC sterile syringe&needle A4210 E Nonneedle injection device A4211 E Supp for self-adm injections A4212 E Non coring needle or stylet A4213 E 20+ CC syringe only A4214 A 30 CC sterile water/saline A4215 E Sterile needle A4220 A Infusion pump refill kit A4221 A Maint drug infus cath per wk A4222 A Drug infusion pump supplies A4230 A Infus insulin pump non needl A4231 A Infusion insulin pump needle A4232 E Syringe w/needle insulin 3cc A4244 E Alcohol or peroxide per pint A4245 E Alcohol wipes per box A4246 E Betadine/phisohex solution A4247 E Betadine/iodine swabs/wipes A4250 E Urine reagent strips/tablets A4253 A Blood glucose/reagent strips A4254 A Battery for glucose monitor A4255 A Glucose monitor platforms A4256 A Calibrator solution/chips A4257 A Replace Lensshield Cartridge A4258 A Lancet device each A4259 A Lancets per box A4260 E Levonorgestrel implant A4261 E Cervical cap contraceptive A4262 N Temporary tear duct plug A4263 N Permanent tear duct plug A4265 A Paraffin A4266 E Diaphragm A4267 E Male condom A4268 E Female condom A4269 E Spermicide A4270 A Disposable endoscope sheath A4280 A Brst prsths adhsv attchmnt A4281 E Replacement breastpump tube A4282 E Replacement breastpump adpt A4283 E Replacement breastpump cap A4284 E Replcmnt breast pump shield A4285 E Replcmnt breast pump bottle A4286 E Replcmnt breastpump lok ring A4290 E Sacral nerve stim test lead A4300 N Cath impl vasc access portal A4301 N Implantable access syst perc A4305 A Drug delivery system >=50 ML A4306 A Drug delivery system <=5 ML A4310 A Insert tray w/o bag/cath A4311 A Catheter w/o bag 2-way latex A4312 A Cath w/o bag 2-way silicone A4313 A Catheter w/bag 3-way A4314 A Cath w/drainage 2-way latex A4315 A Cath w/drainage 2-way silcne A4316 A Cath w/drainage 3-way A4319 A Sterile H2O irrigation solut A4320 A Irrigation tray A4321 A Cath therapeutic irrig agent A4322 A Irrigation syringe A4323 A Saline irrigation solution A4324 A Male ext cath w/adh coating A4325 A Male ext cath w/adh strip A4326 A Male external catheter A4327 A Fem urinary collect dev cup Start Printed Page 48157 A4328 A Fem urinary collect pouch A4330 A Stool collection pouch A4331 A Extension drainage tubing A4332 A Lubricant for cath insertion A4333 A Urinary cath anchor device A4334 A Urinary cath leg strap A4335 A Incontinence supply A4338 A Indwelling catheter latex A4340 A Indwelling catheter special A4344 A Cath indw foley 2 way silicn A4346 A Cath indw foley 3 way A4347 A Male external catheter A4348 A Male ext cath extended wear A4351 A Straight tip urine catheter A4352 A Coude tip urinary catheter A4353 A Intermittent urinary cath A4354 A Cath insertion tray w/bag A4355 A Bladder irrigation tubing A4356 A Ext ureth clmp or compr dvc A4357 A Bedside drainage bag A4358 A Urinary leg or abdomen bag A4359 A Urinary suspensory w/o leg b A4361 A Ostomy face plate A4362 A Solid skin barrier A4364 A Adhesive, liquid or equal A4365 A Adhesive remover wipes A4367 A Ostomy belt A4368 A Ostomy filter A4369 A Skin barrier liquid per oz A4371 A Skin barrier powder per oz A4372 A Skin barrier solid 4x4 equiv A4373 A Skin barrier with flange A4375 A Drainable plastic pch w fcpl A4376 A Drainable rubber pch w fcplt A4377 A Drainable plstic pch w/o fp A4378 A Drainable rubber pch w/o fp A4379 A Urinary plastic pouch w fcpl A4380 A Urinary rubber pouch w fcplt A4381 A Urinary plastic pouch w/o fp A4382 A Urinary hvy plstc pch w/o fp A4383 A Urinary rubber pouch w/o fp A4384 A Ostomy faceplt/silicone ring A4385 A Ost skn barrier sld ext wear A4387 A Ost clsd pouch w att st barr A4388 A Drainable pch w ex wear barr A4389 A Drainable pch w st wear barr A4390 A Drainable pch ex wear convex A4391 A Urinary pouch w ex wear barr A4392 A Urinary pouch w st wear barr A4393 A Urine pch w ex wear bar conv A4394 A Ostomy pouch liq deodorant A4395 A Ostomy pouch solid deodorant A4396 A Peristomal hernia supprt blt A4397 A Irrigation supply sleeve A4398 A Ostomy irrigation bag A4399 A Ostomy irrig cone/cath w brs A4400 A Ostomy irrigation set A4402 A Lubricant per ounce A4404 A Ostomy ring each A4405 A Nonpectin based ostomy paste A4406 A Pectin based ostomy paste A4407 A Ext wear ost skn barr <=4sq″ A4408 A Ext wear ost skn barr >4sq″ A4409 A Ost skn barr w flng <=4 ″ A4410 A Ost skn barr w flng >4sq″ A4413 A 2 pc drainable ost pouch Start Printed Page 48158 A4414 A Ostomy sknbarr w flng <=4sq″ A4415 A Ostomy skn barr w flng >4sq″ A4421 A Ostomy supply misc A4422 A Ost pouch absorbent material A4450 A Non-waterproof tape A4452 A Waterproof tape A4455 A Adhesive remover per ounce A4458 E Reusable enema bag A4462 A Abdmnl drssng holder/binder A4465 A Non-elastic extremity binder A4470 A Gravlee jet washer A4480 A Vabra aspirator A4481 A Tracheostoma filter A4483 A Moisture exchanger A4490 E Above knee surgical stocking A4495 E Thigh length surg stocking A4500 E Below knee surgical stocking A4510 E Full length surg stocking A4521 E Adult size diaper sm each A4522 E Adult size diaper med each A4523 E Adult size diaper lg each A4524 E Adult size diaper xl each A4525 E Adult size brief sm each A4526 E Adult size brief med each A4527 E Adult size brief lg each A4528 E Adult size brief xl each A4529 E Child size diaper sm/med ea A4530 E Child size diaper lg each A4531 E Child size brief sm/med each A4532 E Child size brief lg each A4533 E Youth size diaper each A4534 E Youth size brief each A4535 E Disp incont liner/shield ea A4536 E Prot underwr wshbl any sz ea A4537 E Under pad reusable any sz ea A4538 E Diaper sv ea reusable diaper A4550 E Surgical trays A4554 E Disposable underpads A4556 A Electrodes, pair A4557 A Lead wires, pair A4558 A Conductive paste or gel A4561 N Pessary rubber, any type A4562 N Pessary, non rubber,any type A4565 A Slings A4570 N Splint A4575 E Hyperbaric o2 chamber disps A4580 N Cast supplies (plaster) A4590 N Special casting material A4595 A TENS suppl 2 lead per month A4606 A Oxygen probe used w oximeter A4608 A Transtracheal oxygen cath A4609 A Trach suction cath clsed sys A4610 A Trach sctn cath 72h clsedsys A4611 A Heavy duty battery A4612 A Battery cables A4613 A Battery charger A4614 A Hand-held PEFR meter A4615 A Cannula nasal A4616 A Tubing (oxygen) per foot A4617 A Mouth piece A4618 A Breathing circuits A4619 A Face tent A4620 A Variable concentration mask A4621 A Tracheotomy mask or collar A4622 A Tracheostomy or larngectomy A4623 A Tracheostomy inner cannula Start Printed Page 48159 A4624 A Tracheal suction tube A4625 A Trach care kit for new trach A4626 A Tracheostomy cleaning brush A4627 E Spacer bag/reservoir A4628 A Oropharyngeal suction cath A4629 A Tracheostomy care kit A4630 A Repl bat t.e.n.s. own by pt A4631 A Wheelchair battery A4632 E Infus pump rplcemnt battery A4633 A Uvl replacement bulb A4634 A Replacement bulb th lightbox A4635 A Underarm crutch pad A4636 A Handgrip for cane etc A4637 A Repl tip cane/crutch/walker A4639 A Infrared ht sys replcmnt pad A4640 A Alternating pressure pad A4641 N Diagnostic imaging agent A4642 K Satumomab pendetide per dose 0704 2.9212 $158.59 $31.72 A4643 N High dose contrast MRI A4644 N Contrast 100-199 MGs iodine A4645 N Contrast 200-299 MGs iodine A4646 N Contrast 300-399 MGs iodine A4647 N Supp- paramagnetic contr mat A4649 A Surgical supplies A4651 A Calibrated microcap tube A4652 A Microcapillary tube sealant A4653 A PD catheter anchor belt A4656 A Dialysis needle A4657 A Dialysis syringe w/wo needle A4660 A Sphyg/bp app w cuff and stet A4663 A Dialysis blood pressure cuff A4670 E Automatic bp monitor, dial A4680 A Activated carbon filter, ea A4690 A Dialyzer, each A4706 A Bicarbonate conc sol per gal A4707 A Bicarbonate conc pow per pac A4708 A Acetate conc sol per gallon A4709 A Acid conc sol per gallon A4712 A Sterile water inj per 10 ml A4714 A Treated water per gallon A4719 A “Y set” tubing A4720 A Dialysat sol fld vol > 249cc A4721 A Dialysat sol fld vol > 999cc A4722 A Dialys sol fld vol > 1999cc A4723 A Dialys sol fld vol > 2999cc A4724 A Dialys sol fld vol > 3999cc A4725 A Dialys sol fld vol > 999cc A4726 A Dialys sol fld vol > 5999cc A4730 A Fistula cannulation set, ea A4736 A Topical anesthetic, per gram A4737 A Inj anesthetic per 10 ml A4740 A Shunt accessory A4750 A Art or venous blood tubing A4755 A Comb art/venous blood tubing A4760 A Dialysate sol test kit, each A4765 A Dialysate conc pow per pack A4766 A Dialysate conc sol add 10 ml A4770 A Blood collection tube/vacuum A4771 A Serum clotting time tube A4772 A Blood glucose test strips A4773 A Occult blood test strips A4774 A Ammonia test strips A4802 A Protamine sulfate per 50 mg A4860 A Disposable catheter tips A4870 A Plumb/elec wk hm hemo equip A4890 A Repair/maint cont hemo equip Start Printed Page 48160 A4911 A Drain bag/bottle A4913 A Misc dialysis supplies noc A4918 A Venous pressure clamp A4927 A Non-sterile gloves A4928 A Surgical mask A4929 A Tourniquet for dialysis, ea A4930 A Sterile, gloves per pair A4931 A Reusable oral thermometer A4932 E Reusable rectal thermometer A5051 A Pouch clsd w barr attached A5052 A Clsd ostomy pouch w/o barr A5053 A Clsd ostomy pouch faceplate A5054 A Clsd ostomy pouch w/flange A5055 A Stoma cap A5061 A Pouch drainable w barrier at A5062 A Drnble ostomy pouch w/o barr A5063 A Drain ostomy pouch w/flange A5071 A Urinary pouch w/barrier A5072 A Urinary pouch w/o barrier A5073 A Urinary pouch on barr w/flng A5081 A Continent stoma plug A5082 A Continent stoma catheter A5093 A Ostomy accessory convex inse A5102 A Bedside drain btl w/wo tube A5105 A Urinary suspensory A5112 A Urinary leg bag A5113 A Latex leg strap A5114 A Foam/fabric leg strap A5119 A Skin barrier wipes box pr 50 A5121 A Solid skin barrier 6x6 A5122 A Solid skin barrier 8x8 A5126 A Disk/foam pad +or- adhesive A5131 A Appliance cleaner A5200 A Percutaneous catheter anchor A5500 A Diab shoe for density insert A5501 A Diabetic custom molded shoe A5503 A Diabetic shoe w/roller/rockr A5504 A Diabetic shoe with wedge A5505 A Diab shoe w/metatarsal bar A5506 A Diabetic shoe w/off set heel A5507 A Modification diabetic shoe A5508 A Diabetic deluxe shoe A5509 A Direct heat form shoe insert A5510 A Compression form shoe insert A5511 A Custom fab molded shoe inser A6000 E Wound warming wound cover A6010 A Collagen based wound filler A6011 A Collagen gel/paste wound fil A6021 A Collagen dressing <=16 sq in A6022 A Collagen drsg>6<=48 sq in A6023 A Collagen dressing >48 sq in A6024 A Collagen dsg wound filler A6025 E Silicone gel sheet, each A6154 A Wound pouch each A6196 A Alginate dressing <=16 sq in A6197 A Alginate drsg >16 <=48 sq in A6198 A alginate dressing > 48 sq in A6199 A Alginate drsg wound filler A6200 A Compos drsg <=16 no border A6201 A Compos drsg >16<=48 no bdr A6202 A Compos drsg >48 no border A6203 A Composite drsg <= 16 sq in A6204 A Composite drsg >16<=48 sq in A6205 A Composite drsg > 48 sq in A6206 A Contact layer <= 16 sq in A6207 A Contact layer >16<= 48 sq in Start Printed Page 48161 A6208 A Contact layer > 48 sq in A6209 A Foam drsg <=16 sq in w/o bdr A6210 A Foam drg >16<=48 sq in w/o b A6211 A Foam drg > 48 sq in w/o brdr A6212 A Foam drg <=16 sq in w/border A6213 A Foam drg >16<=48 sq in w/bdr A6214 A Foam drg > 48 sq in w/border A6215 A Foam dressing wound filler A6216 A Non-sterile gauze<=16 sq in A6217 A Non-sterile gauze>16<=48 sq A6218 A Non-sterile gauze > 48 sq in A6219 A Gauze <= 16 sq in w/border A6220 A Gauze >16 <=48 sq in w/bordr A6221 A Gauze > 48 sq in w/border A6222 A Gauze <=16 in no w/sal w/o b A6223 A Gauze >16<=48 no w/sal w/o b A6224 A Gauze > 48 in no w/sal w/o b A6228 A Gauze <= 16 sq in water/sal A6229 A Gauze >16<=48 sq in watr/sal A6230 A Gauze > 48 sq in water/salne A6231 A Hydrogel dsg<=16 sq in A6232 A Hydrogel dsg>16<=48 sq in A6233 A Hydrogel dressing >48 sq in A6234 A Hydrocolld drg <=16 w/o bdr A6235 A Hydrocolld drg >16<=48 w/o b A6236 A Hydrocolld drg > 48 in w/o b A6237 A Hydrocolld drg <=16 in w/bdr A6238 A Hydrocolld drg >16<=48 w/bdr A6239 A Hydrocolld drg > 48 in w/bdr A6240 A Hydrocolld drg filler paste A6241 A Hydrocolloid drg filler dry A6242 A Hydrogel drg <=16 in w/o bdr A6243 A Hydrogel drg >16<=48 w/o bdr A6244 A Hydrogel drg >48 in w/o bdr A6245 A Hydrogel drg <= 16 in w/bdr A6246 A Hydrogel drg >16<=48 in w/b A6247 A Hydrogel drg > 48 sq in w/b A6248 A Hydrogel drsg gel filler A6250 A Skin seal protect moisturizr A6251 A Absorpt drg <=16 sq in w/o b A6252 A Absorpt drg >16 <=48 w/o bdr A6253 A Absorpt drg > 48 sq in w/o b A6254 A Absorpt drg <=16 sq in w/bdr A6255 A Absorpt drg >16<=48 in w/bdr A6256 A Absorpt drg > 48 sq in w/bdr A6257 A Transparent film <= 16 sq in A6258 A Transparent film >16<=48 in A6259 A Transparent film > 48 sq in A6260 A Wound cleanser any type/size A6261 A Wound filler gel/paste /oz A6262 A Wound filler dry form / gram A6266 A Impreg gauze no h20/sal/yard A6402 A Sterile gauze <= 16 sq in A6403 A Sterile gauze>16 <= 48 sq in A6404 A Sterile gauze > 48 sq in A6410 A Sterile eye pad A6411 A Non-sterile eye pad A6412 E Occlusive eye patch A6421 A Pad bandage >=3 <5in w /roll A6422 A Conf bandage ns >=3<5“w/roll A6424 A Conf bandage ns >=5“w /roll A6426 A Conf bandage s >=3<5“ w/roll A6428 A Conf bandage s >=5“ w /roll A6430 A Lt compres bdg >=3<5“w /roll A6432 A Lt compres bdg >=5“w /roll A6434 A Mo compres bdg >=3<5“w /roll Start Printed Page 48162 A6436 A Hi compres bdg >=3<5“w /roll A6438 A Self-adher bdg >=3<5“w /roll A6440 A Zinc paste bdg >=3<5“w /roll A6501 A Compres burngarment bodysuit A6502 A Compres burngarment chinstrp A6503 A Compres burngarment facehood A6504 A Cmprsburngarment glove-wrist A6505 A Cmprsburngarment glove-elbow A6506 A Cmprsburngrmnt glove-axilla A6507 A Cmprs burngarment foot-knee A6508 A Cmprs burngarment foot-thigh A6509 A Compres burn garment jacket A6510 A Compres burn garment leotard A6511 A Compres burn garment panty A6512 A Compres burn garment, noc A7000 A Disposable canister for pump A7001 A Nondisposable pump canister A7002 A Tubing used w suction pump A7003 A Nebulizer administration set A7004 A Disposable nebulizer sml vol A7005 A Nondisposable nebulizer set A7006 A Filtered nebulizer admin set A7007 A Lg vol nebulizer disposable A7008 A Disposable nebulizer prefill A7009 A Nebulizer reservoir bottle A7010 A Disposable corrugated tubing A7011 A Nondispos corrugated tubing A7012 A Nebulizer water collec devic A7013 A Disposable compressor filter A7014 A Compressor nondispos filter A7015 A Aerosol mask used w nebulize A7016 A Nebulizer dome & mouthpiece A7017 A Nebulizer not used w oxygen A7018 A Water distilled w/nebulizer A7019 A Saline solution dispenser A7020 A Sterile H2O or NSS w lgv neb A7025 A Replace chest compress vest A7026 A Replace chst cmprss sys hose A7030 A CPAP full face mask A7031 A Replacement facemask interfa A7032 A Replacement nasal cushion A7033 A Replacement nasal pillows A7034 A Nasal application device A7035 A Pos airway press headgear A7036 A Pos airway press chinstrap A7037 A Pos airway pressure tubing A7038 A Pos airway pressure filter A7039 A Filter, non disposable w pap A7042 A Implanted pleural catheter A7043 A Vacuum drainagebottle/tubing A7044 A PAP oral interface A7501 A Tracheostoma valve w diaphra A7502 A Replacement diaphragm/fplate A7503 A HMES filter holder or cap A7504 A Tracheostoma HMES filter A7505 A HMES or trach valve housing A7506 A HMES/trachvalve adhesivedisk A7507 A Integrated filter & holder A7508 A Housing & Integrated Adhesiv A7509 A Heat & moisture exchange sys A9150 E Misc/exper non-prescript dru A9270 E Non-covered item or service A9300 E Exercise equipment A9500 N Technetium TC 99m sestamibi A9502 N Technetium TC99M tetrofosmin A9503 N Technetium TC 99m medronate Start Printed Page 48163 A9504 N Technetium tc 99m apcitide A9505 N Thallous chloride TL 201/mci A9507 K Indium/111 capromab pendetid 1604 12.4029 $673.34 $134.67 A9508 K Iobenguane sulfate I-131, per 0.5 mCi 1045 2.9293 $159.03 $31.81 A9510 N Technetium TC99m Disofenin A9511 K Technetium TC 99m depreotide 1095 3.7042 $201.10 $40.22 A9512 N Technetiumtc99mpertechnetate A9513 N Technetium tc-99m mebrofenin A9514 N Technetiumtc99mpyrophosphate A9515 N Technetium tc-99m pentetate A9516 N I-123 sodium iodide capsule A9517 K I-131 sodium iodide capsule 1064 0.1007 $5.47 $1.09 A9518 K I-131 sodium iodide solution 1065 0.0002 $.01 A9519 N Technetiumtc-99mmacroag albu A9520 N Technetiumtc-99m sulfur clld A9521 K Technetiumtc-99m exametazine 1096 3.8103 $206.86 $41.37 A9522 K Indium111ibritumomabtiuxetan 9118 38.3972 $2,084.55 $416.91 A9523 K Yttrium90ibritumomabtiuxetan 9117 332.7763 $18,066.09 $3,613.22 A9524 K Iodinated I-131 serumalbumin, per 5uci 9100 0.0071 $.39 $.08 A9600 K Strontium-89 chloride 0701 7.4586 $404.92 $80.98 A9605 K Samarium sm153 lexidronamm 0702 16.1415 $876.31 $175.26 A9699 N Noc therapeutic radiopharm A9700 E Echocardiography Contrast A9900 A Supply/accessory/service A9901 A Delivery/set up/dispensing B4034 A Enter feed supkit syr by day B4035 A Enteral feed supp pump per d B4036 A Enteral feed sup kit grav by B4081 A Enteral ng tubing w/ stylet B4082 A Enteral ng tubing w/o stylet B4083 A Enteral stomach tube levine B4086 A Gastrostomy/jejunostomy tube B4100 E Food thickener oral B4150 A Enteral formulae category i B4151 A Enteral formulae cat1natural B4152 A Enteral formulae category ii B4153 A Enteral formulae categoryIII B4154 A Enteral formulae category IV B4155 A Enteral formulae category v B4156 A Enteral formulae category vi B4164 A Parenteral 50% dextrose solu B4168 A Parenteral sol amino acid 3. B4172 A Parenteral sol amino acid 5. B4176 A Parenteral sol amino acid 7- B4178 A Parenteral sol amino acid > B4180 A Parenteral sol carb > 50% B4184 A Parenteral sol lipids 10% B4186 A Parenteral sol lipids 20% B4189 A Parenteral sol amino acid & B4193 A Parenteral sol 52-73 gm prot B4197 A Parenteral sol 74-100 gm pro B4199 A Parenteral sol > 100gm prote B4216 A Parenteral nutrition additiv B4220 A Parenteral supply kit premix B4222 A Parenteral supply kit homemi B4224 A Parenteral administration ki B5000 A Parenteral sol renal-amirosy B5100 A Parenteral sol hepatic-fream B5200 A Parenteral sol stres-brnch c B9000 A Enter infusion pump w/o alrm B9002 A Enteral infusion pump w/ ala B9004 A Parenteral infus pump portab B9006 A Parenteral infus pump statio B9998 A Enteral supp not otherwise c Start Printed Page 48164 B9999 A Parenteral supp not othrws c C1010 K Blood, L/R, CMV-NEG 1010 2.1361 $115.97 $23.19 C1011 K Platelets, HLA-m, L/R, unit 1011 8.2851 $449.79 $89.96 C1015 K Plt, pher,L/R,CMV, irrad 1020 9.6266 $522.62 $104.52 C1016 K BLOOD,L/R,FROZ/DEGLY/Washed 1016 5.0012 $271.51 $54.30 C1017 K Plt, APH/PHER,L/R,CMV-NEG 1017 6.5175 $353.83 $70.77 C1018 K Blood, L/R, IRRADIATED 1018 2.1950 $119.16 $23.83 C1020 K RBC, frz/deg/wsh, L/R, irrad 1021 6.5287 $354.44 $70.89 C1021 K RBC, L/R, CMV neg, irrad 1022 3.9139 $212.48 $42.50 C1022 K Plasma, frz within 24 hour 0955 1.5750 $85.51 $17.10 C1079 N CO 57/58 per 0.5 uCi C1088 T LASER OPTIC TR Sys 1557 $1,850.00 $370.00 C1091 K IN111 oxyquinoline,per0.5mCi 1091 4.0535 $220.06 $44.01 C1092 K IN 111 pentetate per 0.5 mCi 1092 4.0824 $221.63 $44.33 C1122 K Tc 99M ARCITUMOMAB PER VIAL 1122 9.6556 $524.19 $104.84 C1166 N CYTARABINE LIPOSOMAL, 10 mg C1167 K EPIRUBICIN HCL, 2 mg 1167 0.3597 $19.53 $3.91 C1178 K BUSULFAN IV, 6 Mg 1178 6.0245 $327.06 $65.41 C1200 N TC 99M Sodium Glucoheptonat C1201 N TC 99M SUCCIMER, PER Vial C1300 S HYPERBARIC Oxygen 0659 3.2220 $174.92 $34.98 C1305 K Apligraf 1305 11.2075 $608.44 $121.69 C1716 K Brachytx source, Gold 198 1716 1.3399 $72.74 $14.55 C1718 K Brachytx source, Iodine 125 1718 0.6695 $36.35 $7.27 C1719 K Brachytx sour,Non-HDR Ir-192 1719 0.3053 $16.57 $3.31 C1720 K Brachytx sour, Palladium 103 1720 0.8104 $44.00 $8.80 C1765 N Adhesion barrier C1774 K Darbepoetin alfa, 1 mcg 0734 0.0463 $2.51 $.50 C1775 K FDG, per dose (4-40 mCi/ml) 1775 5.8606 $318.17 $63.63 C1783 H Ocular imp, aqueous drain dev 1783 C1814 H Retinal tamp, silicone oil 1814 C1818 H Integrated keratoprosthesis 1818 C1900 H Lead coronary venous 1900 C2614 H Probe, perc lumb disc 2614 C2616 K Brachytx source, Yttrium-90 2616 163.4011 $8,870.88 $1,774.18 C2618 N Probe, cryoablation C2632 H Brachytx sol, I-125, per mCi 2632 C8900 S MRA w/cont, abd 0284 7.0207 $381.15 $190.57 $76.23 C8901 S MRA w/o cont, abd 0336 6.4817 $351.89 $175.94 $70.38 C8902 S MRA w/o fol w/cont, abd 0337 9.3215 $506.05 $240.77 $101.21 C8903 S MRI w/cont, breast, uni 0284 7.0207 $381.15 $190.57 $76.23 C8904 S MRI w/o cont, breast, uni 0336 6.4817 $351.89 $175.94 $70.38 C8905 S MRI w/o fol w/cont, brst, un 0337 9.3215 $506.05 $240.77 $101.21 C8906 S MRI w/cont, breast, bi 0284 7.0207 $381.15 $190.57 $76.23 C8907 S MRI w/o cont, breast, bi 0336 6.4817 $351.89 $175.94 $70.38 C8908 S MRI w/o fol w/cont, breast, 0337 9.3215 $506.05 $240.77 $101.21 C8909 S MRA w/cont, chest 0284 7.0207 $381.15 $190.57 $76.23 C8910 S MRA w/o cont, chest 0336 6.4817 $351.89 $175.94 $70.38 C8911 S MRA w/o fol w/cont, chest 0337 9.3215 $506.05 $240.77 $101.21 C8912 S MRA w/cont, lwr ext 0284 7.0207 $381.15 $190.57 $76.23 C8913 S MRA w/o cont, lwr ext 0336 6.4817 $351.89 $175.94 $70.38 C8914 S MRA w/o fol w/cont, lwr ext 0337 9.3215 $506.05 $240.77 $101.21 C8918 S MRA w/cont, pelvis 0284 7.0207 $381.15 $190.57 $76.23 C8919 S MRA w/o cont, pelvis 0336 6.4817 $351.89 $175.94 $70.38 C8920 S MRA w/o fol w/cont, pelvis 0337 9.3215 $506.05 $240.77 $101.21 C9000 K Na chromateCr51, per 0.25mCi 9000 1.2631 $68.57 $13.71 C9003 K Palivizumab, per 50 mg 9003 6.3850 $346.64 $69.33 C9007 N Baclofen Intrathecal kit-1am C9008 N Baclofen Refill Kit-500mcg C9009 K Baclofen Refill Kit-2000mcg 9009 0.7478 $40.60 $8.12 C9010 K Baclofen Refill Kit--4000mcg 9010 0.7340 $39.85 $7.97 C9013 N Co 57 cobaltous chloride C9102 N 51 Na Chromate, 50mCi C9103 N Na Iothalamate I-125, 10 uCi C9105 K Hep B imm glob, per 1 ml 9105 1.5621 $84.80 $16.96 C9109 K Tirofiban hcl, 6.25 mg 9109 2.2328 $121.22 $24.24 Start Printed Page 48165 C9111 G Inj, bivalirudin, 250mg vial 9111 $397.81 $59.46 C9112 G Perflutren lipid micro, 2ml 9112 $148.20 $22.15 C9113 G Inj pantoprazole sodium, via 9113 $22.80 $3.41 C9116 G Ertapenem sodium, per 1 gm 9116 $45.31 $6.77 C9120 G Injection, fulvestrant 9120 $175.16 $26.18 C9121 G Injection, argatroban 9121 $14.25 $2.13 C9200 G Orcel, per 36 cm2 9200 $1,135.25 $169.69 C9201 K Dermagraft, per 37.5 sq cm 9201 7.9288 $430.45 $86.09 C9202 K Octafluoropropane 9202 2.1253 $115.38 $23.08 C9203 G Perflexane lipid micro 9203 $142.50 $21.30 C9204 G Ziprasidone mesylate 9204 $41.56 $6.21 C9205 G Oxaliplatin 9205 $94.46 $14.12 C9503 K Fresh frozen plasma, ea unit 9503 1.1560 $62.76 $12.55 C9701 T Stretta System 1557 $1,850.00 $370.00 C9703 T Bard Endoscopic Suturing Sys 1555 $1,650.00 $330.00 C9711 T H.E.L.P. Apheresis System 1552 $1,350.00 $270.00 D0120 E Periodic oral evaluation D0140 E Limit oral eval problm focus D0150 S Comprehensve oral evaluation 0330 0.5609 $30.45 $6.09 $6.09 D0160 E Extensv oral eval prob focus D0170 E Re-eval,est pt,problem focus D0180 E Comp periodontal evaluation D0210 E Intraor complete film series D0220 E Intraoral periapical first f D0230 E Intraoral periapical ea add D0240 S Intraoral occlusal film 0330 0.5609 $30.45 $6.09 $6.09 D0250 S Extraoral first film 0330 0.5609 $30.45 $6.09 $6.09 D0260 S Extraoral ea additional film 0330 0.5609 $30.45 $6.09 $6.09 D0270 S Dental bitewing single film 0330 0.5609 $30.45 $6.09 $6.09 D0272 S Dental bitewings two films 0330 0.5609 $30.45 $6.09 $6.09 D0274 S Dental bitewings four films 0330 0.5609 $30.45 $6.09 $6.09 D0277 S Vert bitewings-sev to eight 0330 0.5609 $30.45 $6.09 $6.09 D0290 E Dental film skull/facial bon D0310 E Dental saliography D0320 E Dental tmj arthrogram incl i D0321 E Dental other tmj films D0322 E Dental tomographic survey D0330 E Dental panoramic film D0340 E Dental cephalometric film D0350 E Oral/facial images D0415 E Bacteriologic study D0425 E Caries susceptibility test D0460 S Pulp vitality test 0330 0.5609 $30.45 $6.09 $6.09 D0470 E Diagnostic casts D0472 S Gross exam, prep & report 0330 0.5609 $30.45 $6.09 $6.09 D0473 S Micro exam, prep & report 0330 0.5609 $30.45 $6.09 $6.09 D0474 S Micro w exam of surg margins 0330 0.5609 $30.45 $6.09 $6.09 D0480 S Cytopath smear prep & report 0330 0.5609 $30.45 $6.09 $6.09 D0502 S Other oral pathology procedu 0330 0.5609 $30.45 $6.09 $6.09 D0999 S Unspecified diagnostic proce 0330 0.5609 $30.45 $6.09 $6.09 D1110 E Dental prophylaxis adult D1120 E Dental prophylaxis child D1201 E Topical fluor w prophy child D1203 E Topical fluor w/o prophy chi D1204 E Topical fluor w/o prophy adu D1205 E Topical fluoride w/ prophy a D1310 E Nutri counsel-control caries D1320 E Tobacco counseling D1330 E Oral hygiene instruction D1351 E Dental sealant per tooth D1510 S Space maintainer fxd unilat 0330 0.5609 $30.45 $6.09 $6.09 D1515 S Fixed bilat space maintainer 0330 0.5609 $30.45 $6.09 $6.09 D1520 S Remove unilat space maintain 0330 0.5609 $30.45 $6.09 $6.09 D1525 S Remove bilat space maintain 0330 0.5609 $30.45 $6.09 $6.09 D1550 S Recement space maintainer 0330 0.5609 $30.45 $6.09 $6.09 D2140 E Amalgam one surface permanen Start Printed Page 48166 D2150 E Amalgam two surfaces permane D2160 E Amalgam three surfaces perma D2161 E Amalgam 4 or > surfaces perm D2330 E Resin one surface-anterior D2331 E Resin two surfaces-anterior D2332 E Resin three surfaces-anterio D2335 E Resin 4/> surf or w incis an D2390 E Ant resin-based cmpst crown D2391 E Post 1 srfc resinbased cmpst D2392 E Post 2 srfc resinbased cmpst D2393 E Post 3 srfc resinbased cmpst D2394 E Post >=4srfc resinbase cmpst D2410 E Dental gold foil one surface D2420 E Dental gold foil two surface D2430 E Dental gold foil three surfa D2510 E Dental inlay metalic 1 surf D2520 E Dental inlay metallic 2 surf D2530 E Dental inlay metl 3/more sur D2542 E Dental onlay metallic 2 surf D2543 E Dental onlay metallic 3 surf D2544 E Dental onlay metl 4/more sur D2610 E Inlay porcelain/ceramic 1 su D2620 E Inlay porcelain/ceramic 2 su D2630 E Dental onlay porc 3/more sur D2642 E Dental onlay porcelin 2 surf D2643 E Dental onlay porcelin 3 surf D2644 E Dental onlay porc 4/more sur D2650 E Inlay composite/resin one su D2651 E Inlay composite/resin two su D2652 E Dental inlay resin 3/mre sur D2662 E Dental onlay resin 2 surface D2663 E Dental onlay resin 3 surface D2664 E Dental onlay resin 4/mre sur D2710 E Crown resin laboratory D2720 E Crown resin w/ high noble me D2721 E Crown resin w/ base metal D2722 E Crown resin w/ noble metal D2740 E Crown porcelain/ceramic subs D2750 E Crown porcelain w/ h noble m D2751 E Crown porcelain fused base m D2752 E Crown porcelain w/ noble met D2780 E Crown 3/4 cast hi noble met D2781 E Crown 3/4 cast base metal D2782 E Crown 3/4 cast noble metal D2783 E Crown 3/4 porcelain/ceramic D2790 E Crown full cast high noble m D2791 E Crown full cast base metal D2792 E Crown full cast noble metal D2799 E Provisional crown D2910 E Dental recement inlay D2920 E Dental recement crown D2930 E Prefab stnlss steel crwn pri D2931 E Prefab stnlss steel crown pe D2932 E Prefabricated resin crown D2933 E Prefab stainless steel crown D2940 E Dental sedative filling D2950 E Core build-up incl any pins D2951 E Tooth pin retention D2952 E Post and core cast + crown D2953 E Each addtnl cast post D2954 E Prefab post/core + crown D2955 E Post removal D2957 E Each addtnl prefab post D2960 E Laminate labial veneer D2961 E Lab labial veneer resin D2962 E Lab labial veneer porcelain Start Printed Page 48167 D2970 S Temporary- fractured tooth 0330 0.5609 $30.45 $6.09 $6.09 D2980 E Crown repair D2999 S Dental unspec restorative pr 0330 0.5609 $30.45 $6.09 $6.09 D3110 E Pulp cap direct D3120 E Pulp cap indirect D3220 E Therapeutic pulpotomy D3221 E Gross pulpal debridement D3230 E Pulpal therapy anterior prim D3240 E Pulpal therapy posterior pri D3310 E Anterior D3320 E Root canal therapy 2 canals D3330 E Root canal therapy 3 canals D3331 E Non-surg tx root canal obs D3332 E Incomplete endodontic tx D3333 E Internal root repair D3346 E Retreat root canal anterior D3347 E Retreat root canal bicuspid D3348 E Retreat root canal molar D3351 E Apexification/recalc initial D3352 E Apexification/recalc interim D3353 E Apexification/recalc final D3410 E Apicoect/perirad surg anter D3421 E Root surgery bicuspid D3425 E Root surgery molar D3426 E Root surgery ea add root D3430 E Retrograde filling D3450 E Root amputation D3460 S Endodontic endosseous implan 0330 0.5609 $30.45 $6.09 $6.09 D3470 E Intentional replantation D3910 E Isolation- tooth w rubb dam D3920 E Tooth splitting D3950 E Canal prep/fitting of dowel D3999 S Endodontic procedure 0330 0.5609 $30.45 $6.09 $6.09 D4210 E Gingivectomy/plasty per quad D4211 E Gingivectomy/plasty per toot D4240 E Gingival flap proc w/ planin D4241 E Gngvl flap w rootplan 1-3 th D4245 E Apically positioned flap D4249 E Crown lengthen hard tissue D4260 S Osseous surgery per quadrant 0330 0.5609 $30.45 $6.09 $6.09 D4261 E Osseous surgl-3teethperquad D4263 S Bone replce graft first site 0330 0.5609 $30.45 $6.09 $6.09 D4264 S Bone replce graft each add 0330 0.5609 $30.45 $6.09 $6.09 D4265 E Bio mtrls to aid soft/os reg D4266 E Guided tiss regen resorble D4267 E Guided tiss regen nonresorb D4268 S Surgical revision procedure 0330 0.5609 $30.45 $6.09 $6.09 D4270 S Pedicle soft tissue graft pr 0330 0.5609 $30.45 $6.09 $6.09 D4271 S Free soft tissue graft proc 0330 0.5609 $30.45 $6.09 $6.09 D4273 S Subepithelial tissue graft 0330 0.5609 $30.45 $6.09 $6.09 D4274 E Distal/proximal wedge proc D4275 E Soft tissue allograft D4276 E Con tissue w dble ped graft D4320 E Provision splnt intracoronal D4321 E Provisional splint extracoro D4341 E Periodontal scaling & root D4342 E Periodontal scaling 1-3teeth D4355 S Full mouth debridement 0330 0.5609 $30.45 $6.09 $6.09 D4381 S Localized chemo delivery 0330 0.5609 $30.45 $6.09 $6.09 D4910 E Periodontal maint procedures D4920 E Unscheduled dressing change D4999 E Unspecified periodontal proc D5110 E Dentures complete maxillary D5120 E Dentures complete mandible D5130 E Dentures immediat maxillary D5140 E Dentures immediat mandible Start Printed Page 48168 D5211 E Dentures maxill part resin D5212 E Dentures mand part resin D5213 E Dentures maxill part metal D5214 E Dentures mandibl part metal D5281 E Removable partial denture D5410 E Dentures adjust cmplt maxil D5411 E Dentures adjust cmplt mand D5421 E Dentures adjust part maxill D5422 E Dentures adjust part mandbl D5510 E Dentur repr broken compl bas D5520 E Replace denture teeth complt D5610 E Dentures repair resin base D5620 E Rep part denture cast frame D5630 E Rep partial denture clasp D5640 E Replace part denture teeth D5650 E Add tooth to partial denture D5660 E Add clasp to partial denture D5670 E Replc tth&acrlc on mtl frmwk D5671 E Replc tth&acrlc mandibular D5710 E Dentures rebase cmplt maxil D5711 E Dentures rebase cmplt mand D5720 E Dentures rebase part maxill D5721 E Dentures rebase part mandbl D5730 E Denture reln cmplt maxil ch D5731 E Denture reln cmplt mand chr D5740 E Denture reln part maxil chr D5741 E Denture reln part mand chr D5750 E Denture reln cmplt max lab D5751 E Denture reln cmplt mand lab D5760 E Denture reln part maxil lab D5761 E Denture reln part mand lab D5810 E Denture interm cmplt maxill D5811 E Denture interm cmplt mandbl D5820 E Denture interm part maxill D5821 E Denture interm part mandbl D5850 E Denture tiss conditn maxill D5851 E Denture tiss condtin mandbl D5860 E Overdenture complete D5861 E Overdenture partial D5862 E Precision attachment D5867 E Replacement of precision att D5875 E Prosthesis modification D5899 E Removable prosthodontic proc D5911 S Facial moulage sectional 0330 0.5609 $30.45 $6.09 $6.09 D5912 S Facial moulage complete 0330 0.5609 $30.45 $6.09 $6.09 D5913 E Nasal prosthesis D5914 E Auricular prosthesis D5915 E Orbital prosthesis D5916 E Ocular prosthesis D5919 E Facial prosthesis D5922 E Nasal septal prosthesis D5923 E Ocular prosthesis interim D5924 E Cranial prosthesis D5925 E Facial augmentation implant D5926 E Replacement nasal prosthesis D5927 E Auricular replacement D5928 E Orbital replacement D5929 E Facial replacement D5931 E Surgical obturator D5932 E Postsurgical obturator D5933 E Refitting of obturator D5934 E Mandibular flange prosthesis D5935 E Mandibular denture prosth D5936 E Temp obturator prosthesis D5937 E Trismus appliance D5951 E Feeding aid Start Printed Page 48169 D5952 E Pediatric speech aid D5953 E Adult speech aid D5954 E Superimposed prosthesis D5955 E Palatal lift prosthesis D5958 E Intraoral con def inter plt D5959 E Intraoral con def mod palat D5960 E Modify speech aid prosthesis D5982 E Surgical stent D5983 S Radiation applicator 0330 0.5609 $30.45 $6.09 $6.09 D5984 S Radiation shield 0330 0.5609 $30.45 $6.09 $6.09 D5985 S Radiation cone locator 0330 0.5609 $30.45 $6.09 $6.09 D5986 E Fluoride applicator D5987 S Commissure splint 0330 0.5609 $30.45 $6.09 $6.09 D5988 E Surgical splint D5999 E Maxillofacial prosthesis D6010 E Odontics endosteal implant D6020 E Odontics abutment placement D6040 E Odontics eposteal implant D6050 E Odontics transosteal implnt D6053 E Implnt/abtmnt spprt remv dnt D6054 E Implnt/abtmnt spprt remvprtl D6055 E Implant connecting bar D6056 E Prefabricated abutment D6057 E Custom abutment D6058 E Abutment supported crown D6059 E Abutment supported mtl crown D6060 E Abutment supported mtl crown D6061 E Abutment supported mtl crown D6062 E Abutment supported mtl crown D6063 E Abutment supported mtl crown D6064 E Abutment supported mtl crown D6065 E Implant supported crown D6066 E Implant supported mtl crown D6067 E Implant supported mtl crown D6068 E Abutment supported retainer D6069 E Abutment supported retainer D6070 E Abutment supported retainer D6071 E Abutment supported retainer D6072 E Abutment supported retainer D6073 E Abutment supported retainer D6074 E Abutment supported retainer D6075 E Implant supported retainer D6076 E Implant supported retainer D6077 E Implant supported retainer D6078 E Implnt/abut suprtd fixd dent D6079 E Implnt/abut suprtd fixd dent D6080 E Implant maintenance D6090 E Repair implant D6095 E Odontics repr abutment D6100 E Removal of implant D6199 E Implant procedure D6210 E Prosthodont high noble metal D6211 E Bridge base metal cast D6212 E Bridge noble metal cast D6240 E Bridge porcelain high noble D6241 E Bridge porcelain base metal D6242 E Bridge porcelain nobel metal D6245 E Bridge porcelain/ceramic D6250 E Bridge resin w/high noble D6251 E Bridge resin base metal D6252 E Bridge resin w/noble metal D6253 E Provisional pontic D6545 E Dental retainr cast metl D6548 E Porcelain/ceramic retainer D6600 E Porcelain/ceramic inlay 2srf D6601 E Porc/ceram inlay >= 3 surfac Start Printed Page 48170 D6602 E Cst hgh nble mtl inlay 2 srf D6603 E Cst hgh nble mtl inlay >=3sr D6604 E Cst bse mtl inlay 2 surfaces D6605 E Cst bse mtl inlay >= 3 surfa D6606 E Cast noble metal inlay 2 sur D6607 E Cst noble mtl inlay >=3 surf D6608 E Onlay porc/crmc 2 surfaces D6609 E Onlay porc/crmc >=3 surfaces D6610 E Onlay cst hgh nbl mtl 2 srfc D6611 E Onlay cst hgh nbl mtl >=3srf D6612 E Onlay cst base mtl 2 surface D6613 E Onlay cst base mtl >=3 surfa D6614 E Onlay cst nbl mtl 2 surfaces D6615 E Onlay cst nbl mtl >=3 surfac D6720 E Retain crown resin w hi nble D6721 E Crown resin w/base metal D6722 E Crown resin w/noble metal D6740 E Crown porcelain/ceramic D6750 E Crown porcelain high noble D6751 E Crown porcelain base metal D6752 E Crown porcelain noble metal D6780 E Crown 3/4 high noble metal D6781 E Crown 3/4 cast based metal D6782 E Crown 3/4 cast noble metal D6783 E Crown 3/4 porcelain/ceramic D6790 E Crown full high noble metal D6791 E Crown full base metal cast D6792 E Crown full noble metal cast D6793 E Provisional retainer crown D6920 S Dental connector bar 0330 0.5609 $30.45 $6.09 $6.09 D6930 E Dental recement bridge D6940 E Stress breaker D6950 E Precision attachment D6970 E Post & core plus retainer D6971 E Cast post bridge retainer D6972 E Prefab post & core plus reta D6973 E Core build up for retainer D6975 E Coping metal D6976 E Each addtnl cast post D6977 E Each addtl prefab post D6980 E Bridge repair D6985 E Pediatric partial denture fx D6999 E Fixed prosthodontic proc D7111 S Coronal remnants deciduous t 0330 0.5609 $30.45 $6.09 $6.09 D7140 S Extraction erupted tooth/exr 0330 0.5609 $30.45 $6.09 $6.09 D7210 S Rem imp tooth w mucoper flp 0330 0.5609 $30.45 $6.09 $6.09 D7220 S Impact tooth remov soft tiss 0330 0.5609 $30.45 $6.09 $6.09 D7230 S Impact tooth remov part bony 0330 0.5609 $30.45 $6.09 $6.09 D7240 S Impact tooth remov comp bony 0330 0.5609 $30.45 $6.09 $6.09 D7241 S Impact tooth rem bony w/comp 0330 0.5609 $30.45 $6.09 $6.09 D7250 S Tooth root removal 0330 0.5609 $30.45 $6.09 $6.09 D7260 S Oral antral fistula closure 0330 0.5609 $30.45 $6.09 $6.09 D7261 S Primary closure sinus perf 0330 0.5609 $30.45 $6.09 $6.09 D7270 E Tooth reimplantation D7272 E Tooth transplantation D7280 E Exposure impact tooth orthod D7281 E Exposure tooth aid eruption D7282 E Mobilize erupted/malpos toot D7285 E Biopsy of oral tissue hard D7286 E Biopsy of oral tissue soft D7287 E Cytology sample collection D7290 E Repositioning of teeth D7291 S Transseptal fiberotomy 0330 0.5609 $30.45 $6.09 $6.09 D7310 E Alveoplasty w/ extraction D7320 E Alveoplasty w/o extraction D7340 E Vestibuloplasty ridge extens Start Printed Page 48171 D7350 E Vestibuloplasty exten graft D7410 E Rad exc lesion up to 1.25 cm D7411 E Excision benign lesion>1.25c D7412 E Excision benign lesion compl D7413 E Excision malig lesion<=1.25c D7414 E Excision malig lesion>1.25cm D7415 E Excision malig les complicat D7440 E Malig tumor exc to 1.25 cm D7441 E Malig tumor > 1.25 cm D7450 E Rem odontogen cyst to 1.25cm D7451 E Rem odontogen cyst > 1.25 cm D7460 E Rem nonodonto cyst to 1.25cm D7461 E Rem nonodonto cyst > 1.25 cm D7465 E Lesion destruction D7471 E Rem exostosis any site D7472 E Removal of torus palatinus D7473 E Remove torus mandibularis D7485 E Surg reduct osseoustuberosit D7490 E Mandible resection D7510 E I&d absc intraoral soft tiss D7520 E I&d abscess extraoral D7530 E Removal fb skin/areolar tiss D7540 E Removal of fb reaction D7550 E Removal of sloughed off bone D7560 E Maxillary sinusotomy D7610 E Maxilla open reduct simple D7620 E Clsd reduct simpl maxilla fx D7630 E Open red simpl mandible fx D7640 E Clsd red simpl mandible fx D7650 E Open red simp malar/zygom fx D7660 E Clsd red simp malar/zygom fx D7670 E Closd rductn splint alveolus D7671 E Alveolus open reduction D7680 E Reduct simple facial bone fx D7710 E Maxilla open reduct compound D7720 E Clsd reduct compd maxilla fx D7730 E Open reduct compd mandble fx D7740 E Clsd reduct compd mandble fx D7750 E Open red comp malar/zygma fx D7760 E Clsd red comp malar/zygma fx D7770 E Open reduc compd alveolus fx D7771 E Alveolus clsd reduc stblz te D7780 E Reduct compnd facial bone fx D7810 E Tmj open reduct-dislocation D7820 E Closed tmp manipulation D7830 E Tmj manipulation under anest D7840 E Removal of tmj condyle D7850 E Tmj meniscectomy D7852 E Tmj repair of joint disc D7854 E Tmj excisn of joint membrane D7856 E Tmj cutting of a muscle D7858 E Tmj reconstruction D7860 E Tmj cutting into joint D7865 E Tmj reshaping components D7870 E Tmj aspiration joint fluid D7871 E Lysis + lavage w catheters D7872 E Tmj diagnostic arthroscopy D7873 E Tmj arthroscopy lysis adhesn D7874 E Tmj arthroscopy disc reposit D7875 E Tmj arthroscopy synovectomy D7876 E Tmj arthroscopy discectomy D7877 E Tmj arthroscopy debridement D7880 E Occlusal orthotic appliance D7899 E Tmj unspecified therapy D7910 E Dent sutur recent wnd to 5cm D7911 E Dental suture wound to 5 cm Start Printed Page 48172 D7912 E Suture complicate wnd > 5 cm D7920 E Dental skin graft D7940 S Reshaping bone orthognathic 0330 0.5609 $30.45 $6.09 $6.09 D7941 E Bone cutting ramus closed D7943 E Cutting ramus open w/graft D7944 E Bone cutting segmented D7945 E Bone cutting body mandible D7946 E Reconstruction maxilla total D7947 E Reconstruct maxilla segment D7948 E Reconstruct midface no graft D7949 E Reconstruct midface w/graft D7950 E Mandible graft D7955 E Repair maxillofacial defects D7960 E Frenulectomy/frenulotomy D7970 E Excision hyperplastic tissue D7971 E Excision pericoronal gingiva D7972 E Surg redct fibrous tuberosit D7980 E Sialolithotomy D7981 E Excision of salivary gland D7982 E Sialodochoplasty D7983 E Closure of salivary fistula D7990 E Emergency tracheotomy D7991 E Dental coronoidectomy D7995 E Synthetic graft facial bones D7996 E Implant mandible for augment D7997 E Appliance removal D7999 E Oral surgery procedure D8010 E Limited dental tx primary D8020 E Limited dental tx transition D8030 E Limited dental tx adolescent D8040 E Limited dental tx adult D8050 E Intercep dental tx primary D8060 E Intercep dental tx transitn D8070 E Compre dental tx transition D8080 E Compre dental tx adolescent D8090 E Compre dental tx adult D8210 E Orthodontic rem appliance tx D8220 E Fixed appliance therapy habt D8660 E Preorthodontic tx visit D8670 E Periodic orthodontc tx visit D8680 E Orthodontic retention D8690 E Orthodontic treatment D8691 E Repair ortho appliance D8692 E Replacement retainer D8999 E Orthodontic procedure D9110 N Tx dental pain minor proc D9210 E Dent anesthesia w/o surgery D9211 E Regional block anesthesia D9212 E Trigeminal block anesthesia D9215 E Local anesthesia D9220 E General anesthesia D9221 E General anesthesia ea ad 15m D9230 N Analgesia D9241 E Intravenous sedation D9242 E IV sedation ea ad 30 m D9248 N Sedation (non-iv) D9310 E Dental consultation D9410 E Dental house call D9420 E Hospital call D9430 E Office visit during hours D9440 E Office visit after hours D9450 E Case presentation tx plan D9610 E Dent therapeutic drug inject D9630 S Other drugs/medicaments 0330 0.5609 $30.45 $6.09 $6.09 D9910 E Dent appl desensitizing med D9911 E Appl desensitizing resin Start Printed Page 48173 D9920 E Behavior management D9930 S Treatment of complications 0330 0.5609 $30.45 $6.09 $6.09 D9940 S Dental occlusal guard 0330 0.5609 $30.45 $6.09 $6.09 D9941 E Fabrication athletic guard D9950 S Occlusion analysis 0330 0.5609 $30.45 $6.09 $6.09 D9951 S Limited occlusal adjustment 0330 0.5609 $30.45 $6.09 $6.09 D9952 S Complete occlusal adjustment 0330 0.5609 $30.45 $6.09 $6.09 D9970 E Enamel microabrasion D9971 E Odontoplasty 1-2 teeth D9972 E Extrnl bleaching per arch D9973 E Extrnl bleaching per tooth D9974 E Intrnl bleaching per tooth D9999 E Adjunctive procedure E0100 A Cane adjust/fixed with tip E0105 A Cane adjust/fixed quad/3 pro E0110 A Crutch forearm pair E0111 A Crutch forearm each E0112 A Crutch underarm pair wood E0113 A Crutch underarm each wood E0114 A Crutch underarm pair no wood E0116 A Crutch underarm each no wood E0117 A Underarm springassist crutch E0130 A Walker rigid adjust/fixed ht E0135 A Walker folding adjust/fixed E0141 A Rigid walker wheeled wo seat E0142 A Walker rigid wheeled with se E0143 A Walker folding wheeled w/o s E0144 A Enclosed walker w rear seat E0145 A Walker whled seat/crutch att E0146 A Folding walker wheels w seat E0147 A Walker variable wheel resist E0148 A Heavyduty walker no wheels E0149 A Heavy duty wheeled walker E0153 A Forearm crutch platform atta E0154 A Walker platform attachment E0155 A Walker wheel attachment,pair E0156 A Walker seat attachment E0157 A Walker crutch attachment E0158 A Walker leg extenders set of4 E0159 A Brake for wheeled walker E0160 A Sitz type bath or equipment E0161 A Sitz bath/equipment w/faucet E0162 A Sitz bath chair E0163 A Commode chair stationry fxd E0164 A Commode chair mobile fixed a E0165 A Commode chair stationry det E0166 A Commode chair mobile detach E0167 A Commode chair pail or pan E0168 A Heavyduty/wide commode chair E0169 A Seatlift incorp commodechair E0175 A Commode chair foot rest E0176 A Air pressre pad/cushion nonp E0177 A Water press pad/cushion nonp E0178 A Gel pressre pad/cushion nonp E0179 A Dry pressre pad/cushion nonp E0180 A Press pad alternating w pump E0181 A Press pad alternating w/ pum E0182 A Pressure pad alternating pum E0184 A Dry pressure mattress E0185 A Gel pressure mattress pad E0186 A Air pressure mattress E0187 A Water pressure mattress E0188 E Synthetic sheepskin pad E0189 E Lambswool sheepskin pad E0191 A Protector heel or elbow E0192 A Pad wheelchr low press/posit Start Printed Page 48174 E0193 A Powered air flotation bed E0194 A Air fluidized bed E0196 A Gel pressure mattress E0197 A Air pressure pad for mattres E0198 A Water pressure pad for mattr E0199 A Dry pressure pad for mattres E0200 A Heat lamp without stand E0202 A Phototherapy light w/ photom E0203 A Therapeutic lightbox tabletp E0205 A Heat lamp with stand E0210 A Electric heat pad standard E0215 A Electric heat pad moist E0217 A Water circ heat pad w pump E0218 E Water circ cold pad w pump E0220 A Hot water bottle E0221 A Infrared heating pad system E0225 A Hydrocollator unit E0230 A Ice cap or collar E0231 E Wound warming device E0232 E Warming card for NWT E0235 A Paraffin bath unit portable E0236 A Pump for water circulating p E0238 A Heat pad non-electric moist E0239 A Hydrocollator unit portable E0241 E Bath tub wall rail E0242 E Bath tub rail floor E0243 E Toilet rail E0244 E Toilet seat raised E0245 E Tub stool or bench E0246 E Transfer tub rail attachment E0249 A Pad water circulating heat u E0250 A Hosp bed fixed ht w/ mattres E0251 A Hosp bed fixd ht w/o mattres E0255 A Hospital bed var ht w/ mattr E0256 A Hospital bed var ht w/o matt E0260 A Hosp bed semi-electr w/ matt E0261 A Hosp bed semi-electr w/o mat E0265 A Hosp bed total electr w/ mat E0266 A Hosp bed total elec w/o matt E0270 E Hospital bed institutional t E0271 A Mattress innerspring E0272 A Mattress foam rubber E0273 E Bed board E0274 E Over-bed table E0275 A Bed pan standard E0276 A Bed pan fracture E0277 A Powered pres-redu air mattrs E0280 A Bed cradle E0290 A Hosp bed fx ht w/o rails w/m E0291 A Hosp bed fx ht w/o rail w/o E0292 A Hosp bed var ht w/o rail w/o E0293 A Hosp bed var ht w/o rail w/ E0294 A Hosp bed semi-elect w/ mattr E0295 A Hosp bed semi-elect w/o matt E0296 A Hosp bed total elect w/ matt E0297 A Hosp bed total elect w/o mat E0305 A Rails bed side half length E0310 A Rails bed side full length E0315 E Bed accessory brd/tbl/supprt E0316 A Bed safety enclosure E0325 A Urinal male jug-type E0326 A Urinal female jug-type E0350 E Control unit bowel system E0352 E Disposable pack w/bowel syst E0370 E Air elevator for heel E0371 A Nonpower mattress overlay Start Printed Page 48175 E0372 A Powered air mattress overlay E0373 A Nonpowered pressure mattress E0424 A Stationary compressed gas 02 E0425 E Gas system stationary compre E0430 E Oxygen system gas portable E0431 A Portable gaseous 02 E0434 A Portable liquid 02 E0435 E Oxygen system liquid portabl E0439 A Stationary liquid 02 E0440 E Oxygen system liquid station E0441 A Oxygen contents, gaseous E0442 A Oxygen contents, liquid E0443 A Portable 02 contents, gas E0444 A Portable 02 contents, liquid E0445 A Oximeter non-invasive E0450 A Volume vent stationary/porta E0454 A Pressure ventilator E0455 A Oxygen tent excl croup/ped t E0457 A Chest shell E0459 A Chest wrap E0460 A Neg press vent portabl/statn E0461 A Vol vent noninvasive interfa E0462 A Rocking bed w/ or w/o side r E0480 A Percussor elect/pneum home m E0481 E Intrpulmnry percuss vent sys E0482 A Cough stimulating device E0483 A Chest compression gen system E0484 A Non-elec oscillatory pep dvc E0500 A Ippb all types E0550 A Humidif extens supple w ippb E0555 A Humidifier for use w/ regula E0560 A Humidifier supplemental w/ i E0565 A Compressor air power source E0570 A Nebulizer with compression E0571 A Aerosol compressor for svneb E0572 A Aerosol compressor adjust pr E0574 A Ultrasonic generator w svneb E0575 A Nebulizer ultrasonic E0580 A Nebulizer for use w/ regulat E0585 A Nebulizer w/ compressor & he E0590 A Dispensing fee dme neb drug E0600 A Suction pump portab hom modl E0601 A Cont airway pressure device E0602 E Manual breast pump E0603 A Electric breast pump E0604 A Hosp grade elec breast pump E0605 A Vaporizer room type E0606 A Drainage board postural E0607 A Blood glucose monitor home E0610 A Pacemaker monitr audible/vis E0615 A Pacemaker monitr digital/vis E0616 N Cardiac event recorder E0617 A Automatic ext defibrillator E0618 A Apnea monitor E0619 A Apnea monitor w recorder E0620 A Cap bld skin piercing laser E0621 A Patient lift sling or seat E0625 E Patient lift bathroom or toi E0627 A Seat lift incorp lift-chair E0628 A Seat lift for pt furn-electr E0629 A Seat lift for pt furn-non-el E0630 A Patient lift hydraulic E0635 A Patient lift electric E0636 A PT support & positioning sys E0650 A Pneuma compresor non-segment E0651 A Pneum compressor segmental Start Printed Page 48176 E0652 A Pneum compres w/cal pressure E0655 A Pneumatic appliance half arm E0660 A Pneumatic appliance full leg E0665 A Pneumatic appliance full arm E0666 A Pneumatic appliance half leg E0667 A Seg pneumatic appl full leg E0668 A Seg pneumatic appl full arm E0669 A Seg pneumatic appli half leg E0671 A Pressure pneum appl full leg E0672 A Pressure pneum appl full arm E0673 A Pressure pneum appl half leg E0691 A Uvl pnl 2 sq ft or less E0692 A Uvl sys panel 4 ft E0693 A Uvl sys panel 6 ft E0694 A Uvl md cabinet sys 6 ft E0700 E Safety equipment E0701 A Helmet w face guard prefab E0710 E Restraints any type E0720 A Tens two lead E0730 A Tens four lead E0731 A Conductive garment for tens/ E0740 E Incontinence treatment systm E0744 A Neuromuscular stim for scoli E0745 A Neuromuscular stim for shock E0746 E Electromyograph biofeedback E0747 A Elec osteogen stim not spine E0748 A Elec osteogen stim spinal E0749 N Elec osteogen stim implanted E0752 N Neurostimulator electrode E0754 A Pulsegenerator pt programmer E0755 E Electronic salivary reflex s E0756 N Implantable pulse generator E0757 N Implantable RF receiver E0758 A External RF transmitter E0759 A Replace rdfrquncy transmittr E0760 E Osteogen ultrasound stimltor E0761 E Nontherm electromgntc device E0765 E Nerve stimulator for tx n&v E0776 A Iv pole E0779 A Amb infusion pump mechanical E0780 A Mech amb infusion pump <8hrs E0781 A External ambulatory infus pu E0782 N Non-programble infusion pump E0783 N Programmable infusion pump E0784 A Ext amb infusn pump insulin E0785 N Replacement impl pump cathet E0786 N Implantable pump replacement E0791 A Parenteral infusion pump sta E0830 N Ambulatory traction device E0840 A Tract frame attach headboard E0850 A Traction stand free standing E0855 A Cervical traction equipment E0860 A Tract equip cervical tract E0870 A Tract frame attach footboard E0880 A Trac stand free stand extrem E0890 A Traction frame attach pelvic E0900 A Trac stand free stand pelvic E0910 A Trapeze bar attached to bed E0920 A Fracture frame attached to b E0930 A Fracture frame free standing E0935 A Exercise device passive moti E0940 A Trapeze bar free standing E0941 A Gravity assisted traction de E0942 A Cervical head harness/halter E0943 A Cervical pillow E0944 A Pelvic belt/harness/boot Start Printed Page 48177 E0945 A Belt/harness extremity E0946 A Fracture frame dual w cross E0947 A Fracture frame attachmnts pe E0948 A Fracture frame attachmnts ce E0950 E Tray E0951 E Loop heel E0952 E Loop tie E0953 E Pneumatic tire E0954 E Wheelchair semi-pneumatic ca E0958 A Whlchr att- conv 1 arm drive E0959 E Amputee adapter E0961 E Wheelchair brake extension E0962 A Wheelchair 1 inch cushion E0963 A Wheelchair 2 inch cushion E0964 A Wheelchair 3 inch cushion E0965 A Wheelchair 4 inch cushion E0966 E Wheelchair head rest extensi E0967 E Wheelchair hand rims E0968 A Wheelchair commode seat E0969 E Wheelchair narrowing device E0970 E Wheelchair no. 2 footplates E0971 E Wheelchair anti-tipping devi E0972 A Transfer board or device E0973 E Wheelchair adjustabl height E0974 E Wheelchair grade-aid E0975 E Wheelchair reinforced seat u E0976 E Wheelchair reinforced back u E0977 E Wheelchair wedge cushion E0978 E Wheelchair belt w/airplane b E0979 E Wheelchair belt with velcro E0980 E Wheelchair safety vest E0990 E Whellchair elevating leg res E0991 E Wheelchair upholstry seat E0992 E Wheelchair solid seat insert E0993 E Wheelchair back upholstery E0994 E Wheelchair arm rest E0995 E Wheelchair calf rest E0996 E Wheelchair tire solid E0997 E Wheelchair caster w/ a fork E0998 E Wheelchair caster w/o a fork E0999 E Wheelchr pneumatic tire w/wh E1000 E Wheelchair tire pneumatic ca E1001 E Wheelchair wheel E1011 A Ped wc modify width adjustm E1012 A Int seat sys planar ped w/c E1013 A Int seat sys contour ped w/c E1014 A Reclining back add ped w/c E1015 A Shock absorber for man w/c E1016 A Shock absorber for power w/c E1017 A HD shck absrbr for hd man wc E1018 A HD shck absrber for hd powwc E1020 A Residual limb support system E1025 A Pedwc lat/thor sup nocontour E1026 A Pedwc contoured lat/thor sup E1027 A Ped wc lat/ant support E1031 A Rollabout chair with casters E1035 E Patient transfer system E1037 A Transport chair, ped size E1038 A Transport chair, adult size E1050 A Whelchr fxd full length arms E1060 A Wheelchair detachable arms E1065 E Wheelchair power attachment E1066 E Wheelchair battery charger E1069 E Wheelchair deep cycle batter E1070 A Wheelchair detachable foot r E1083 A Hemi-wheelchair fixed arms Start Printed Page 48178 E1084 A Hemi-wheelchair detachable a E1085 A Hemi-wheelchair fixed arms E1086 A Hemi-wheelchair detachable a E1087 A Wheelchair lightwt fixed arm E1088 A Wheelchair lightweight det a E1089 A Wheelchair lightwt fixed arm E1090 A Wheelchair lightweight det a E1091 A Wheelchair youth E1092 A Wheelchair wide w/ leg rests E1093 A Wheelchair wide w/ foot rest E1100 A Whchr s-recl fxd arm leg res E1110 A Wheelchair semi-recl detach E1130 A Whlchr stand fxd arm ft rest E1140 A Wheelchair standard detach a E1150 A Wheelchair standard w/ leg r E1160 A Wheelchair fixed arms E1161 A Manual adult wc w tiltinspac E1170 A Whlchr ampu fxd arm leg rest E1171 A Wheelchair amputee w/o leg r E1172 A Wheelchair amputee detach ar E1180 A Wheelchair amputee w/ foot r E1190 A Wheelchair amputee w/ leg re E1195 A Wheelchair amputee heavy dut E1200 A Wheelchair amputee fixed arm E1210 A Whlchr moto ful arm leg rest E1211 A Wheelchair motorized w/ det E1212 A Wheelchair motorized w full E1213 A Wheelchair motorized w/ det E1220 A Whlchr special size/constrc E1221 A Wheelchair spec size w foot E1222 A Wheelchair spec size w/ leg E1223 A Wheelchair spec size w foot E1224 A Wheelchair spec size w/ leg E1225 A Wheelchair spec sz semi-recl E1226 E Wheelchair spec sz full-recl E1227 E Wheelchair spec sz spec ht a E1228 A Wheelchair spec sz spec ht b E1230 A Power operated vehicle E1231 A Rigid ped w/c tilt-in-space E1232 A Folding ped wc tilt-in-space E1233 A Rig ped wc tltnspc w/o seat E1234 A Fld ped wc tltnspc w/o seat E1235 A Rigid ped wc adjustable E1236 A Folding ped wc adjustable E1237 A Rgd ped wc adjstabl w/o seat E1238 A Fld ped wc adjstabl w/o seat E1240 A Whchr litwt det arm leg rest E1250 A Wheelchair lightwt fixed arm E1260 A Wheelchair lightwt foot rest E1270 A Wheelchair lightweight leg r E1280 A Whchr h-duty det arm leg res E1285 A Wheelchair heavy duty fixed E1290 A Wheelchair hvy duty detach a E1295 A Wheelchair heavy duty fixed E1296 A Wheelchair special seat heig E1297 A Wheelchair special seat dept E1298 A Wheelchair spec seat depth/w E1300 E Whirlpool portable E1310 A Whirlpool non-portable E1340 A Repair for DME, per 15 min E1353 A Oxygen supplies regulator E1355 A Oxygen supplies stand/rack E1372 A Oxy suppl heater for nebuliz E1390 A Oxygen concentrator E1399 A Durable medical equipment mi E1405 A O2/water vapor enrich w/heat Start Printed Page 48179 E1406 A O2/water vapor enrich w/o he E1500 A Centrifuge E1510 A Kidney dialysate delivry sys E1520 A Heparin infusion pump E1530 A Replacement air bubble detec E1540 A Replacement pressure alarm E1550 A Bath conductivity meter E1560 A Replace blood leak detector E1570 A Adjustable chair for esrd pt E1575 A Transducer protect/fld bar E1580 A Unipuncture control system E1590 A Hemodialysis machine E1592 A Auto interm peritoneal dialy E1594 A Cycler dialysis machine E1600 A Deli/install chrg hemo equip E1610 A Reverse osmosis h2o puri sys E1615 A Deionizer H2O puri system E1620 A Replacement blood pump E1625 A Water softening system E1630 A Reciprocating peritoneal dia E1632 A Wearable artificial kidney E1635 A Compact travel hemodialyzer E1636 A Sorbent cartridges per 10 E1637 A Hemostats for dialysis, each E1639 A Dialysis scale E1699 A Dialysis equipment noc E1700 A Jaw motion rehab system E1701 A Repl cushions for jaw motion E1702 A Repl measr scales jaw motion E1800 A Adjust elbow ext/flex device E1801 A SPS elbow device E1802 A Adjst forearm pro/sup device E1805 A Adjust wrist ext/flex device E1806 A SPS wrist device E1810 A Adjust knee ext/flex device E1811 A SPS knee device E1815 A Adjust ankle ext/flex device E1816 A SPS ankle device E1818 A SPS forearm device E1820 A Soft interface material E1821 A Replacement interface SPSD E1825 A Adjust finger ext/flex devc E1830 A Adjust toe ext/flex device E1840 A Adj shoulder ext/flex device E1902 A AAC non-electronic board E2000 A Gastric suction pump hme mdl E2100 A Bld glucose monitor w voice E2101 A Bld glucose monitor w lance G0001 A Drawing blood for specimen G0008 L Admin influenza virus vac G0009 L Admin pneumococcal vaccine G0010 K Admin hepatitis b vaccine 0355 0.2667 $14.48 $2.90 G0025 N Collagen skin test kit G0030 S PET imaging prev PET single 0285 19.5044 $1,058.87 $409.56 $211.77 G0031 S PET imaging prev PET multple 0285 19.5044 $1,058.87 $409.56 $211.77 G0032 S PET follow SPECT 78464 singl 0285 19.5044 $1,058.87 $409.56 $211.77 G0033 S PET follow SPECT 78464 mult 0285 19.5044 $1,058.87 $409.56 $211.77 G0034 S PET follow SPECT 76865 singl 0285 19.5044 $1,058.87 $409.56 $211.77 G0035 S PET follow SPECT 78465 mult 0285 19.5044 $1,058.87 $409.56 $211.77 G0036 S PET follow cornry angio sing 0285 19.5044 $1,058.87 $409.56 $211.77 G0037 S PET follow cornry angio mult 0285 19.5044 $1,058.87 $409.56 $211.77 G0038 S PET follow myocard perf sing 0285 19.5044 $1,058.87 $409.56 $211.77 G0039 S PET follow myocard perf mult 0285 19.5044 $1,058.87 $409.56 $211.77 G0040 S PET follow stress echo singl 0285 19.5044 $1,058.87 $409.56 $211.77 G0041 S PET follow stress echo mult 0285 19.5044 $1,058.87 $409.56 $211.77 G0042 S PET follow ventriculogm sing 0285 19.5044 $1,058.87 $409.56 $211.77 Start Printed Page 48180 G0043 S PET follow ventriculogm mult 0285 19.5044 $1,058.87 $409.56 $211.77 G0044 S PET following rest ECG singl 0285 19.5044 $1,058.87 $409.56 $211.77 G0045 S PET following rest ECG mult 0285 19.5044 $1,058.87 $409.56 $211.77 G0046 S PET follow stress ECG singl 0285 19.5044 $1,058.87 $409.56 $211.77 G0047 S PET follow stress ECG mult 0285 19.5044 $1,058.87 $409.56 $211.77 G0101 V CA screen;pelvic/breast exam 0600 0.9376 $50.90 $10.18 G0102 N Prostate ca screening; dre G0103 A Psa, total screening G0104 S CA screen;flexi sigmoidscope 0159 2.7168 $147.49 $36.87 $29.50 G0105 T Colorectal scrn; hi risk ind 0158 7.4187 $402.75 $100.69 $80.55 G0106 S Colon CA screen;barium enema 0157 2.4771 $134.48 $26.90 G0107 A CA screen; fecal blood test G0108 A Diab manage trn per indiv G0109 A Diab manage trn ind/group G0110 A Nett pulm-rehab educ; ind G0111 A Nett pulm-rehab educ; group G0112 A Nett;nutrition guid, initial G0113 A Nett;nutrition guid,subseqnt G0114 A Nett; psychosocial consult G0115 A Nett; psychological testing G0116 A Nett; psychosocial counsel G0117 S Glaucoma scrn hgh risk direc 0230 0.7379 $40.06 $14.97 $8.01 G0118 S Glaucoma scrn hgh risk direc 0230 0.7379 $40.06 $14.97 $8.01 G0120 S Colon ca scrn; barium enema 0157 2.4771 $134.48 $26.90 G0121 T Colon ca scrn not hi rsk ind 0158 7.4187 $402.75 $100.69 $80.55 G0122 E Colon ca scrn; barium enema G0123 A Screen cerv/vag thin layer G0124 A Screen c/v thin layer by MD G0125 S PET img WhBD sgl pulm ring 1516 $1,450.00 $290.00 G0127 T Trim nail(s) 0009 0.6597 $35.81 $8.34 $7.16 G0128 E CORF skilled nursing service G0129 P Partial hosp prog service 0033 3.8397 $208.45 $41.83 $41.69 G0130 X Single energy x-ray study 0260 0.7845 $42.59 $21.29 $8.52 G0141 E Scr c/v cyto,autosys and md G0143 A Scr c/v cyto,thinlayer,rescr G0144 A Scr c/v cyto,thinlayer,rescr G0145 A Scr c/v cyto,thinlayer,rescr G0147 A Scr c/v cyto, automated sys G0148 A Scr c/v cyto, autosys, rescr G0151 E HHCP-serv of pt,ea 15 min G0152 E HHCP-serv of ot,ea 15 min G0153 E HHCP-svs of s/l path,ea 15mn G0154 E HHCP-svs of rn,ea 15 min G0155 E HHCP-svs of csw,ea 15 min G0156 E HHCP-svs of aide,ea 15 min G0166 T Extrnl counterpulse, per tx 0678 2.0622 $111.95 $22.39 G0167 E Hyperbaric oz tx;no md reqrd G0168 X Wound closure by adhesive 0340 0.6232 $33.83 $6.77 G0173 S Stereo radoisurgery,complete 1528 $5,250.00 $1,050.00 G0175 V OPPS Service,sched team conf 0602 1.5603 $84.71 $16.94 G0176 P OPPS/PHP;activity therapy 0033 3.8397 $208.45 $41.83 $41.69 G0177 P OPPS/PHP; train & educ serv 0033 3.8397 $208.45 $41.83 $41.69 G0179 E MD recertification HHA PT G0180 E MD certification HHA patient G0181 E Home health care supervision G0182 E Hospice care supervision G0186 T Dstry eye lesn,fdr vssl tech 0235 4.9900 $270.90 $72.04 $54.18 G0202 A Screeningmammographydigital G0204 S Diagnosticmammographydigital 0669 0.9111 $49.46 $9.89 G0206 S Diagnosticmammographydigital 0669 0.9111 $49.46 $9.89 G0210 S PET img whbd ring dxlung ca 1516 $1,450.00 $290.00 G0211 S PET img whbd ring init lung 1516 $1,450.00 $290.00 G0212 S PET img whbd ring restag lun 1516 $1,450.00 $290.00 G0213 S PET img whbd ring dx colorec 1516 $1,450.00 $290.00 G0214 S PET img whbd ring init colre 1516 $1,450.00 $290.00 G0215 S PET img whbd restag col 1516 $1,450.00 $290.00 Start Printed Page 48181 G0216 S PET img whbd ring dx melanom 1516 $1,450.00 $290.00 G0217 S PET img whbd ring init melan 1516 $1,450.00 $290.00 G0218 S PET img whbd ring restag mel 1516 $1,450.00 $290.00 G0219 E PET img whbd ring noncov ind G0220 S PET img whbd ring dx lymphom 1516 $1,450.00 $290.00 G0221 S PET img whbd ring init lymph 1516 $1,450.00 $290.00 G0222 S PET img whbd ring resta lymp 1516 $1,450.00 $290.00 G0223 S PET img whbd reg ring dx hea 1516 $1,450.00 $290.00 G0224 S PETimg whbd reg ring ini hea 1516 $1,450.00 $290.00 G0225 S PET img whbd ring restag hea 1516 $1,450.00 $290.00 G0226 S PET img whbd dx esophag 1516 $1,450.00 $290.00 G0227 S PET img whbd ring ini esopha 1516 $1,450.00 $290.00 G0228 S PET img whbd ring restg esop 1516 $1,450.00 $290.00 G0229 S PET img metabolic brain ring 1516 $1,450.00 $290.00 G0230 S PET myocard viability ring 1516 $1,450.00 $290.00 G0231 S PET WhBD colorec; gamma cam 1516 $1,450.00 $290.00 G0232 S PET whbd lymphoma; gamma cam 1516 $1,450.00 $290.00 G0233 S PET whbd melanoma; gamma cam 1516 $1,450.00 $290.00 G0234 S PET WhBD pulm nod; gamma cam 1516 $1,450.00 $290.00 G0236 S Digital film convert diag ma 0410 0.1473 $8.00 $1.60 G0237 S Therapeutic procd strg endur 0411 0.4207 $22.84 $4.57 G0238 S Oth resp proc, indiv 0411 0.4207 $22.84 $4.57 G0239 S Oth resp proc, group 0411 0.4207 $22.84 $4.57 G0242 S Multisource photon ster plan 1516 $1,450.00 $290.00 G0243 S Multisour photon stero treat 1528 $5,250.00 $1,050.00 G0244 S Observ care by facility topt 0339 7.2016 $390.97 $78.19 G0245 V Initial Foot Exam PTLOPS 0600 0.9376 $50.90 $10.18 G0246 V Follow-up Eval of Foot PTLOPS 0600 0.9376 $50.90 $10.18 G0247 T Routine footcare w LOPS 0009 0.6597 $35.81 $8.34 $7.16 G0248 S Demonstrate use home INR mon 1503 $150.00 $30.00 G0249 S Provide test material,equipm 1503 $150.00 $30.00 G0250 E MD review interpret of test G0251 S Linear acc based stero radio 1513 $1,150.00 $230.00 G0252 E PET imaging initial dx G0253 S PET image brst dection recur 1516 $1,450.00 $290.00 G0254 S PET image brst eval to tx 1516 $1,450.00 $290.00 G0255 E Current percep threshold tst G0256 T Prostate brachy w palladium 0649 119.0281 $6,461.92 $1,292.38 G0257 S Unsched dialysis ESRD pt hos 0170 5.9427 $322.62 $64.52 G0259 N Inject for sacroiliac joint G0260 T Inj for sacroiliac jt anesth 0204 2.2209 $120.57 $40.13 $24.11 G0261 T Prostate brachy w iodine see 0684 104.7194 $5,685.11 $1,137.02 G0262 S Sm intestinal image capsule 1508 $650.00 $130.00 G0263 N Adm with CHF, CP, asthma G0264 V Assmt otr CHF, CP, asthma 0600 0.9376 $50.90 $10.18 G0265 A Cryopresevation Freeze+stora G0266 A Thawing + expansion froz cel G0267 S Bone marrow or psc harvest 0110 3.7128 $201.56 $40.31 G0268 X Removal of impacted wax md 0340 0.6232 $33.83 $6.77 G0269 N Occlusive device in vein art G0270 A MNT subs tx for change dx G0271 A Group MNT 2 or more 30 mins G0272 X Naso/oro gastric tube pl MD 0272 1.4086 $76.47 $38.23 $15.29 G0273 S Pretx planning, non-Hodgkins 0406 4.7542 $258.10 $51.62 G0274 S Radiopharm tx, non-Hodgkins 0408 4.0000 $217.16 $43.43 G0275 N Renal angio, cardiac cath G0278 N Iliac art angio,cardiac cath G0279 A Excorp shock tx, elbow epi G0280 A Excorp shock tx other than G0281 A Elec stim unattend for press G0282 A Elect stim wound care not pd G0283 A Elec stim other than wound G0288 S Recon, CTA for surg plan 0414 4.8012 $260.65 $52.13 G0289 N Arthro, loose body + chondro G0290 T Drug-eluting stents, single 0656 101.3662 $5,503.07 $1,100.61 G0291 T Drug-eluting stents,each add 0656 101.3662 $5,503.07 $1,100.61 Start Printed Page 48182 G0292 S Adm exp drugs,clinical trial 1503 $150.00 $30.00 G0293 S Non-cov surg proc,clin trial 1505 $350.00 $70.00 G0294 S Non-cov proc, clinical trial 1502 $75.00 $15.00 G0295 E Electromagnetic therapy onc G9001 E MCCD, initial rate G9002 E MCCD,maintenance rate G9003 E MCCD, risk adj hi, initial G9004 E MCCD, risk adj lo, initial G9005 E MCCD, risk adj, maintenance G9006 E MCCD, Home monitoring G9007 E MCCD, sch team conf G9008 E Mccd,phys coor-care ovrsght G9009 E MCCD, risk adj, level 3 G9010 E MCCD, risk adj, level 4 G9011 E MCCD, risk adj, level 5 G9012 E Other Specified Case Mgmt G9016 A Demo-smoking cessation coun GXXX1 S Infusion, pkgd noncancer 0382 4.6839 $254.28 $50.86 GXXX3 S Pkgd cancer chemo, other 0376 2.1479 $116.61 $23.32 GXXX4 S Infusion of pkgd cancer 0378 4.3955 $238.63 $47.73 GXXX5 S Pkgd cancer chemo, both 0380 5.1857 $281.53 $56.31 GYYY1 S Infusion, separate noncancer 0383 1.8419 $99.99 $20.00 GYYY3 S Sep cancer chemo, other 0377 0.6673 $36.23 $7.25 GYYY4 S Infusion, separate cancer 0379 2.4298 $131.91 $26.38 GYYY5 S Sep cancer chemo, both 0381 2.1596 $117.24 $23.45 H0001 E Alcohol and/or drug assess H0002 E Alcohol and/or drug screenin H0003 E Alcohol and/or drug screenin H0004 E Alcohol and/or drug services H0005 E Alcohol and/or drug services H0006 E Alcohol and/or drug services H0007 E Alcohol and/or drug services H0008 E Alcohol and/or drug services H0009 E Alcohol and/or drug services H0010 E Alcohol and/or drug services H0011 E Alcohol and/or drug services H0012 E Alcohol and/or drug services H0013 E Alcohol and/or drug services H0014 E Alcohol and/or drug services H0015 E Alcohol and/or drug services H0016 E Alcohol and/or drug services H0017 E Alcohol and/or drug services H0018 E Alcohol and/or drug services H0019 E Alcohol and/or drug services H0020 E Alcohol and/or drug services H0021 E Alcohol and/or drug training H0022 E Alcohol and/or drug interven H0023 E Alcohol and/or drug outreach H0024 E Alcohol and/or drug preventi H0025 E Alcohol and/or drug preventi H0026 E Alcohol and/or drug preventi H0027 E Alcohol and/or drug preventi H0028 E Alcohol and/or drug preventi H0029 E Alcohol and/or drug preventi H0030 E Alcohol and/or drug hotline H0031 E MH health assess by non-md H0032 E MH svc plan dev by non-md H0033 E Oral med adm direct observe H0034 E Med trng & support per 15min H0035 E MH partial hosp tx under 24h H0036 E Comm psy face-face per 15min H0037 E Comm psy sup tx pgm per diem H0038 E Self-help/peer svc per 15min H0039 E Asser com tx face-face/15min H0040 E Assert comm tx pgm per diem H0041 E Fos c chld non-ther per diem Start Printed Page 48183 H0042 E Fos c chld non-ther per mon H0043 E Supported housing, per diem H0044 E Supported housing, per month H0045 E Respite not-in-home per diem H0046 E Mental health service, nos H0047 E Alcohol/drug abuse svc nos H0048 E Spec coll non-blood:a/d test H1000 A Prenatal care atrisk assessm H1001 A Antepartum management H1002 A Carecoordination prenatal H1003 A Prenatal at risk education H1004 A Follow up home visit/prental H1005 A Prenatalcare enhanced srv pk H1010 E Nonmed family planning ed H1011 E Family assessment H2000 E Comp multidisipln evaluation H2001 E Rehabilitation program 1/2 d J0120 N Tetracyclin injection J0130 K Abciximab injection 1605 5.2806 $286.68 $57.34 J0150 N Injection adenosine 6 MG J0151 K Adenosine injection 0917 2.3474 $127.44 $25.49 J0170 N Adrenalin epinephrin inject J0190 N Inj biperiden lactate/5 mg J0200 N Alatrofloxacin mesylate J0205 K Alglucerase injection 0900 0.5473 $29.71 $5.94 J0207 K Amifostine 7000 3.9932 $216.79 $43.36 J0210 N Methyldopate hcl injection J0256 K Alpha 1 proteinase inhibitor 0901 0.0214 $1.16 $.23 J0270 E Alprostadil for injection J0275 E Alprostadil urethral suppos J0280 N Aminophyllin 250 MG inj J0282 N Amiodarone HCl J0285 N Amphotericin B J0287 K Amphotericin b lipid complex 9024 0.4174 $22.66 $4.53 J0288 N Ampho b cholesteryl sulfate J0289 N Amphotericin b liposome inj J0290 N Ampicillin 500 MG inj J0295 N Ampicillin sodium per 1.5 gm J0300 N Amobarbital 125 MG inj J0330 N Succinycholine chloride inj J0350 K Injection anistreplase 30 u 1606 25.3116 $1,374.14 $274.83 J0360 N Hydralazine hcl injection J0380 N Inj metaraminol bitartrate J0390 N Chloroquine injection J0395 N Arbutamine HCl injection J0456 N Azithromycin J0460 N Atropine sulfate injection J0470 N Dimecaprol injection J0475 N Baclofen 10 MG injection J0476 E Baclofen intrathecal trial J0500 N Dicyclomine injection J0515 N Inj benztropine mesylate J0520 N Bethanechol chloride inject J0530 N Penicillin g benzathine inj J0540 N Penicillin g benzathine inj J0550 N Penicillin g benzathine inj J0560 N Penicillin g benzathine inj J0570 N Penicillin g benzathine inj J0580 N Penicillin g benzathine inj J0585 K Botulinum toxin a per unit 0902 0.0460 $2.50 $.50 J0587 K Botulinum toxin type B 9018 0.1272 $6.91 $1.38 J0592 N Buprenorphine hydrochloride J0600 N Edetate calcium disodium inj J0610 N Calcium gluconate injection J0620 N Calcium glycer & lact/10 ML J0630 N Calcitonin salmon injection Start Printed Page 48184 J0636 N Inj calcitriol per 0.1 mcg J0637 K Caspofungin acetate 9019 0.5334 $28.96 $5.79 J0640 N Leucovorin calcium injection J0670 N Inj mepivacaine HCL/10 ml J0690 N Cefazolin sodium injection J0692 N Cefepime HCl for injection J0694 N Cefoxitin sodium injection J0696 N Ceftriaxone sodium injection J0697 N Sterile cefuroxime injection J0698 N Cefotaxime sodium injection J0702 N Betamethasone acet&sod phosp J0704 N Betamethasone sod phosp/4 MG J0706 N Caffeine citrate injection J0710 N Cephapirin sodium injection J0713 N Inj ceftazidime per 500 mg J0715 N Ceftizoxime sodium / 500 MG J0720 N Chloramphenicol sodium injec J0725 N Chorionic gonadotropin/1000u J0735 N Clonidine hydrochloride J0740 N Cidofovir injection J0743 N Cilastatin sodium injection J0744 N Ciprofloxacin iv J0745 N Inj codeine phosphate /30 MG J0760 N Colchicine injection J0770 N Colistimethate sodium inj J0780 N Prochlorperazine injection J0800 N Corticotropin injection J0835 N Inj cosyntropin per 0.25 MG J0850 K Cytomegalovirus imm IV /vial 0903 5.0754 $275.54 $55.11 J0880 E Darbepoetin alfa injection J0895 N Deferoxamine mesylate inj J0900 N Testosterone enanthate inj J0945 N Brompheniramine maleate inj J0970 N Estradiol valerate injection J1000 N Depo-estradiol cypionate inj J1020 N Methylprednisolone 20 MG inj J1030 N Methylprednisolone 40 MG inj J1040 N Methylprednisolone 80 MG inj J1051 N Medroxyprogesterone inj J1055 E Medrxyprogester acetate inj J1056 E MA/EC contraceptiveinjection J1060 N Testosterone cypionate 1 ML J1070 N Testosterone cypionat 100 MG J1080 N Testosterone cypionat 200 MG J1094 N Inj dexamethasone acetate J1100 N Dexamethasone sodium phos J1110 N Inj dihydroergotamine mesylt J1120 N Acetazolamid sodium injectio J1160 N Digoxin injection J1165 N Phenytoin sodium injection J1170 N Hydromorphone injection J1180 N Dyphylline injection J1190 K Dexrazoxane HCl injection 0726 1.9860 $107.82 $21.56 J1200 N Diphenhydramine hcl injectio J1205 N Chlorothiazide sodium inj J1212 N Dimethyl sulfoxide 50% 50 ML J1230 N Methadone injection J1240 N Dimenhydrinate injection J1245 N Dipyridamole injection J1250 N Inj dobutamine HCL/250 mg J1260 N Dolasetron mesylate J1270 N Injection, doxercalciferol J1320 N Amitriptyline injection J1325 N Epoprostenol injection J1327 K Eptifibatide injection 1607 0.1426 $7.74 $1.55 J1330 N Ergonovine maleate injection Start Printed Page 48185 J1364 N Erythro lactobionate /500 MG J1380 N Estradiol valerate 10 MG inj J1390 N Estradiol valerate 20 MG inj J1410 N Inj estrogen conjugate 25 MG J1435 N Injection estrone per 1 MG J1436 N Etidronate disodium inj J1438 N Etanercept injection J1440 K Filgrastim 300 mcg injection 0728 2.2544 $122.39 $24.48 J1441 K Filgrastim 480 mcg injection 7049 3.1998 $173.71 $34.74 J1450 N Fluconazole J1452 N Intraocular Fomivirsen na J1455 N Foscarnet sodium injection J1460 N Gamma globulin 1 CC inj J1470 E Gamma globulin 2 CC inj J1480 E Gamma globulin 3 CC inj J1490 E Gamma globulin 4 CC inj J1500 E Gamma globulin 5 CC inj J1510 E Gamma globulin 6 CC inj J1520 E Gamma globulin 7 CC inj J1530 E Gamma globulin 8 CC inj J1540 E Gamma globulin 9 CC inj J1550 E Gamma globulin 10 CC inj J1560 E Gamma globulin > 10 CC inj J1563 K Immune globulin, 1 g 0905 0.8103 $43.99 $8.80 J1564 K Immune globulin 10 mg 9021 0.0080 $.43 $.09 J1565 K RSV-ivig 0906 6.0142 $326.50 $65.30 J1570 N Ganciclovir sodium injection J1580 N Garamycin gentamicin inj J1590 N Gatifloxacin injection J1600 N Gold sodium thiomaleate inj J1610 N Glucagon hydrochloride/1 MG J1620 N Gonadorelin hydroch/ 100 mcg J1626 N Granisetron HCl injection J1630 N Haloperidol injection J1631 N Haloperidol decanoate inj J1642 N Inj heparin sodium per 10 u J1644 N Inj heparin sodium per 1000u J1645 N Dalteparin sodium J1650 N Inj enoxaparin sodium J1652 N Fondaparinux sodium J1655 N Tinzaparin sodium injection J1670 N Tetanus immune globulin inj J1700 N Hydrocortisone acetate inj J1710 N Hydrocortisone sodium ph inj J1720 N Hydrocortisone sodium succ i J1730 N Diazoxide injection J1742 N Ibutilide fumarate injection J1745 K Infliximab injection 7043 0.6841 $37.14 $7.43 J1750 N Iron dextran J1756 N Iron sucrose injection J1785 K Injection imiglucerase /unit 0916 0.0531 $2.88 $.58 J1790 N Droperidol injection J1800 N Propranolol injection J1810 E Droperidol/fentanyl inj J1815 N Insulin injection J1817 N Insulin for insulin pump use J1825 K Interferon beta-1a 0909 2.8010 $152.06 $30.41 J1830 K Interferon beta-1b / .25 MG 0910 1.9843 $107.73 $21.55 J1835 N Itraconazole injection J1840 N Kanamycin sulfate 500 MG inj J1850 N Kanamycin sulfate 75 MG inj J1885 N Ketorolac tromethamine inj J1890 N Cephalothin sodium injection J1910 N Kutapressin injection J1940 N Furosemide injection J1950 K Leuprolide acetate /3.75 MG 0800 3.3020 $179.26 $35.85 Start Printed Page 48186 J1955 E Inj levocarnitine per 1 gm J1956 N Levofloxacin injection J1960 N Levorphanol tartrate inj J1980 N Hyoscyamine sulfate inj J1990 N Chlordiazepoxide injection J2000 N Lidocaine injection J2010 N Lincomycin injection J2020 N Linezolid injection J2060 N Lorazepam injection J2150 N Mannitol injection J2175 N Meperidine hydrochl /100 MG J2180 N Meperidine/promethazine inj J2210 N Methylergonovin maleate inj J2250 N Inj midazolam hydrochloride J2260 N Inj milrinone lactate, per 5 mg J2270 N Morphine sulfate injection J2271 N Morphine so4 injection 100mg J2275 N Morphine sulfate injection J2300 N Inj nalbuphine hydrochloride J2310 N Inj naloxone hydrochloride J2320 N Nandrolone decanoate 50 MG J2321 N Nandrolone decanoate 100 MG J2322 N Nandrolone decanoate 200 MG J2324 G Nesiritide, per 0.5 mg vial 9114 $144.40 $21.58 J2352 K Octreotide acetate injection 7031 1.0339 $56.13 $11.23 J2355 K Oprelvekin injection 7011 2.7246 $147.92 $29.58 J2360 N Orphenadrine injection J2370 N Phenylephrine hcl injection J2400 N Chloroprocaine hcl injection J2405 N Ondansetron hcl injection J2410 N Oxymorphone hcl injection J2430 K Pamidronate disodium /30 MG 0730 2.0537 $111.49 $22.30 J2440 N Papaverin hcl injection J2460 N Oxytetracycline injection J2501 N Paricalcitol J2510 N Penicillin g procaine inj J2515 N Pentobarbital sodium inj J2540 N Penicillin g potassium inj J2543 N Piperacillin/tazobactam J2545 A Pentamidine isethionte/300mg J2550 N Promethazine hcl injection J2560 N Phenobarbital sodium inj J2590 N Oxytocin injection J2597 N Inj desmopressin acetate J2650 N Prednisolone acetate inj J2670 N Totazoline hcl injection J2675 N Inj progesterone per 50 MG J2680 N Fluphenazine decanoate 25 MG J2690 N Procainamide hcl injection J2700 N Oxacillin sodium injeciton J2710 N Neostigmine methylslfte inj J2720 N Inj protamine sulfate/10 MG J2725 N Inj protirelin per 250 mcg J2730 N Pralidoxime chloride inj J2760 N Phentolaine mesylate inj J2765 N Metoclopramide hcl injection J2770 N Quinupristin/dalfopristin J2780 N Ranitidine hydrochloride inj J2788 K Rho d immune globulin 50 mcg 9023 0.0523 $2.84 $.57 J2790 K Rho d immune globulin inj 0884 0.2312 $12.55 $2.51 J2792 K Rho(D) immune globulin h, sd 1609 0.1863 $10.11 $2.02 J2795 N Ropivacaine HCl injection J2800 N Methocarbamol injection J2810 N Inj theophylline per 40 MG J2820 N Sargramostim injection J2910 N Aurothioglucose injeciton Start Printed Page 48187 J2912 N Sodium chloride injection J2916 N Na ferric gluconate complex J2920 N Methylprednisolone injection J2930 N Methylprednisolone injection J2940 N Somatrem injection J2941 K Somatropin injection 7034 0.9206 $49.98 $10.00 J2950 N Promazine hcl injection J2993 K Reteplase injection 9005 10.1332 $550.12 $110.02 J2995 K Inj streptokinase /250000 IU 0911 1.6055 $87.16 $17.43 J2997 N Alteplase recombinant J3000 N Streptomycin injection J3010 N Fentanyl citrate injeciton J3030 N Sumatriptan succinate / 6 MG J3070 N Pentazocine hcl injection J3100 K Tenecteplase injection 9002 23.2303 $1,261.15 $252.23 J3105 N Terbutaline sulfate inj J3120 N Testosterone enanthate inj J3130 N Testosterone enanthate inj J3140 N Testosterone suspension inj J3150 N Testosteron propionate inj J3230 N Chlorpromazine hcl injection J3240 K Thyrotropin injection 9108 6.6059 $358.63 $71.73 J3245 K Tirofiban hydrochloride 7041 4.2976 $233.31 $46.66 J3250 N Trimethobenzamide hcl inj J3260 N Tobramycin sulfate injection J3265 N Injection torsemide 10 mg/ml J3280 N Thiethylperazine maleate inj J3301 N Triamcinolone acetonide inj J3302 N Triamcinolone diacetate inj J3303 N Triamcinolone hexacetonl inj J3305 K Inj trimetrexate glucoronate 7045 1.2099 $65.68 $13.14 J3310 N Perphenazine injeciton J3315 G Triptorelin pamoate 9122 $415.24 $62.07 J3320 N Spectinomycn di-hcl inj J3350 N Urea injection J3360 N Diazepam injection J3364 N Urokinase 5000 IU injection J3365 K Urokinase 250,000 IU inj 7036 5.1032 $277.05 $55.41 J3370 N Vancomycin hcl injection J3395 K Verteporfin injection 1203 16.1946 $879.19 $175.84 J3400 N Triflupromazine hcl inj J3410 N Hydroxyzine hcl injection J3420 N Vitamin b12 injection J3430 N Vitamin k phytonadione inj J3470 N Hyaluronidase injection J3475 N Inj magnesium sulfate J3480 N Inj potassium chloride J3485 N Zidovudine J3487 G Zoledronic acid 9115 $203.40 $30.40 J3490 N Drugs unclassified injection J3520 E Edetate disodium per 150 mg J3530 N Nasal vaccine inhalation J3535 E Metered dose inhaler drug J3570 E Laetrile amygdalin vit B17 J3590 N Unclassified biologics J7030 N Normal saline solution infus J7040 N Normal saline solution infus J7042 N 5% dextrose/normal saline J7050 N Normal saline solution infus J7051 N Sterile saline/water J7060 N 5% dextrose/water J7070 N D5w infusion J7100 N Dextran 40 infusion J7110 N Dextran 75 infusion J7120 N Ringers lactate infusion J7130 N Hypertonic saline solution Start Printed Page 48188 J7190 K Factor viii 0925 0.0085 $.46 $.09 J7191 K Factor VIII (porcine) 0926 0.0253 $1.37 $.27 J7192 K Factor viii recombinant 0927 0.0168 $.91 $.18 J7193 K Factor IX non-recombinant 0931 0.0104 $.56 $.11 J7194 K Factor ix complex 0928 0.0085 $.46 $.09 J7195 K Factor IX recombinant 0932 0.0168 $.91 $.18 J7197 K Antithrombin iii injection 0930 0.0117 $.64 $.13 J7198 K Anti-inhibitor 0929 0.0168 $.91 $.18 J7199 E Hemophilia clot factor noc J7300 E Intraut copper contraceptive J7302 E Levonorgestrel iu contracept J7308 N Aminolevulinic acid hcl top J7310 N Ganciclovir long act implant J7317 N Sodium hyaluronate injection J7320 K Hylan G-F 20 injection 1611 2.1566 $117.08 $23.42 J7330 E Cultured chondrocytes implnt J7340 E Metabolic active D/E tissue J7342 N Metabolically active tissue J7350 N Injectable human tissue J7500 N Azathioprine oral 50mg J7501 N Azathioprine parenteral J7502 K Cyclosporine oral 100 mg 0888 0.0482 $2.62 $.52 J7504 K Lymphocyte immune globulin 0890 2.1958 $119.21 $23.84 J7505 K Monoclonal antibodies 7038 5.8452 $317.33 $63.47 J7506 N Prednisone oral J7507 K Tacrolimus oral per 1 MG 0891 0.0236 $1.28 $.26 J7508 E Tacrolimus oral per 5 MG J7509 N Methylprednisolone oral J7510 N Prednisolone oral per 5 mg J7511 K Antithymocyte globuln rabbit 9104 2.9801 $161.79 $32.36 J7513 K Daclizumab, parenteral 1612 3.7304 $202.52 $40.50 J7515 N Cyclosporine oral 25 mg J7516 N Cyclosporin parenteral 250mg J7517 K Mycophenolate mofetil oral 9015 0.0373 $2.02 $.40 J7520 K Sirolimus, oral 9020 0.0520 $2.82 $.56 J7525 N Tacrolimus injection J7599 E Immunosuppressive drug noc J7608 A Acetylcysteine inh sol u d J7618 A Albuterol inh sol con J7619 A Albuterol inh sol u d J7622 A Beclomethasone inhalatn sol J7624 A Betamethasone inhalation sol J7626 A Budesonide inhalation sol J7628 A Bitolterol mes inhal sol con J7629 A Bitolterol mes inh sol u d J7631 A Cromolyn sodium inh sol u d J7633 N Budesonide concentrated sol J7635 A Atropine inhal sol con J7636 A Atropine inhal sol unit dose J7637 A Dexamethasone inhal sol con J7638 A Dexamethasone inhal sol u d J7639 A Dornase alpha inhal sol u d J7641 A Flunisolide, inhalation sol J7642 A Glycopyrrolate inhal sol con J7643 A Glycopyrrolate inhal sol u d J7644 A Ipratropium brom inh sol u d J7648 A Isoetharine hcl inh sol con J7649 A Isoetharine hcl inh sol u d J7658 A Isoproterenolhcl inh sol con J7659 A Isoproterenol hcl inh sol ud J7668 A Metaproterenol inh sol con J7669 A Metaproterenol inh sol u d J7680 A Terbutaline so4 inh sol con J7681 A Terbutaline so4 inh sol u d J7682 A Tobramycin inhalation sol J7683 A Triamcinolone inh sol con Start Printed Page 48189 J7684 A Triamcinolone inh sol u d J7699 A Inhalation solution for DME J7799 A Non-inhalation drug for DME J8499 E Oral prescrip drug non chemo J8510 K Oral busulfan 7015 0.0263 $1.43 $.29 J8520 K Capecitabine, oral, 150 mg 7042 0.0290 $1.57 $.31 J8521 E Capecitabine, oral, 500 mg J8530 N Cyclophosphamide oral 25 MG J8560 K Etoposide oral 50 MG 0802 0.4830 $26.22 $5.24 J8600 N Melphalan oral 2 MG J8610 N Methotrexate oral 2.5 MG J8700 K Temozolmide 1086 0.0643 $3.49 $.70 J8999 E Oral prescription drug chemo J9000 N Doxorubic hcl 10 MG vl chemo J9001 K Doxorubicin hcl liposome inj 7046 4.6362 $251.69 $50.34 J9010 K Alemtuzumab injection 9110 7.6422 $414.89 $82.98 J9015 K Aldesleukin/single use vial 0807 7.0936 $385.10 $77.02 J9017 K Arsenic trioxide 9012 0.4837 $26.26 $5.25 J9020 N Asparaginase injection J9031 N Bcg live intravesical vac J9040 K Bleomycin sulfate injection 0857 2.2352 $121.35 $24.27 J9045 K Carboplatin injection 0811 1.5475 $84.01 $16.80 J9050 K Carmus bischl nitro inj 0812 0.9972 $54.14 $10.83 J9060 K Cisplatin 10 MG injection 0813 0.3594 $19.51 $3.90 J9062 E Cisplatin 50 MG injection J9065 K Inj cladribine per 1 MG 0858 0.7031 $38.17 $7.63 J9070 N Cyclophosphamide 100 MG inj J9080 E Cyclophosphamide 200 MG inj J9090 E Cyclophosphamide 500 MG inj J9091 E Cyclophosphamide 1.0 grm inj J9092 E Cyclophosphamide 2.0 grm inj J9093 N Cyclophosphamide lyophilized J9094 E Cyclophosphamide lyophilized J9095 E Cyclophosphamide lyophilized J9096 E Cyclophosphamide lyophilized J9097 E Cyclophosphamide lyophilized J9100 N Cytarabine hcl 100 MG inj J9110 E Cytarabine hcl 500 MG inj J9120 N Dactinomycin actinomycin d J9130 N Dacarbazine 10 MG inj J9140 E Dacarbazine 200 MG inj J9150 K Daunorubicin 0820 .6052 $32.86 $6.57 J9151 K Daunorubicin citrate liposom 0821 2.9697 $161.22 $32.24 J9160 K Denileukin diftitox, 300 mcg 1084 15.0913 $819.29 $163.86 J9165 K Diethylstilbestrol injection 0822 1.3274 $72.06 $14.41 J9170 K Docetaxel 0823 4.0041 $217.38 $43.48 J9180 E Epirubicin HCl injection J9181 N Etoposide 10 MG inj J9182 E Etoposide 100 MG inj J9185 K Fludarabine phosphate inj 0842 3.6854 $200.08 $40.02 J9190 N Fluorouracil injection J9200 K Floxuridine injection 0827 2.1836 $118.55 $23.71 J9201 K Gemcitabine HCl 0828 1.4523 $78.84 $15.77 J9202 K Goserelin acetate implant 0810 4.9549 $269.00 $53.80 J9206 K Irinotecan injection 0830 1.8626 $101.12 $20.22 J9208 K Ifosfomide injection 0831 1.1616 $63.06 $12.61 J9209 K Mesna injection 0732 0.4908 $26.65 $5.33 J9211 K Idarubicin hcl injection 0832 3.2438 $176.10 $35.22 J9212 N Interferon alfacon-1 J9213 N Interferon alfa-2a inj J9214 K Interferon alfa-2b inj 0836 0.2000 $10.86 $2.17 J9215 K Interferon alfa-n3 inj 0865 1.5823 $85.90 $17.18 J9216 K Interferon gamma 1-b inj 0838 2.4742 $134.32 $26.86 J9217 K Leuprolide acetate suspnsion 9217 5.5128 $299.28 $59.86 J9218 K Leuprolide acetate injeciton 0861 0.8223 $44.64 $8.93 J9219 K Leuprolide acetate implant 7051 68.9392 $3,742.64 $748.53 Start Printed Page 48190 J9230 N Mechlorethamine hcl inj J9245 K Inj melphalan hydrochl 50 MG 0840 4.4072 $239.26 $47.85 J9250 N Methotrexate sodium inj J9260 E Methotrexate sodium inj J9265 K Paclitaxel injection 0863 1.2674 $68.81 $13.76 J9266 K Pegaspargase/singl dose vial 0843 5.7621 $312.82 $62.56 J9268 K Pentostatin injection 0844 17.4201 $945.72 $189.14 J9270 N Plicamycin (mithramycin) inj J9280 K Mitomycin 5 MG inj 0862 0.9557 $51.88 $10.38 J9290 E Mitomycin 20 MG inj J9291 E Mitomycin 40 MG inj J9293 K Mitoxantrone hydrochl / 5 MG 0864 3.1513 $171.08 $34.22 J9300 K Gemtuzumab ozogamicin 9004 17.5020 $950.17 $190.03 J9310 K Rituximab cancer treatment 0849 5.5636 $302.04 $60.41 J9320 K Streptozocin injection 0850 1.3942 $75.69 $15.14 J9340 N Thiotepa injection J9350 K Topotecan 0852 7.9075 $429.29 $85.86 J9355 K Trastuzumab 1613 0.7384 $40.09 $8.02 J9357 K Valrubicin, 200 mg 1614 9.6183 $522.17 $104.43 J9360 N Vinblastine sulfate inj J9370 N Vincristine sulfate 1 MG inj J9375 E Vincristine sulfate 2 MG inj J9380 E Vincristine sulfate 5 MG inj J9390 K Vinorelbine tartrate/10 mg 0855 1.1683 $63.43 $12.69 J9600 K Porfimer sodium 0856 25.3788 $1,377.79 $275.56 J9999 N Chemotherapy drug K0001 A Standard wheelchair K0002 A Stnd hemi (low seat) whlchr K0003 A Lightweight wheelchair K0004 A High strength ltwt whlchr K0005 A Ultralightweight wheelchair K0006 A Heavy duty wheelchair K0007 A Extra heavy duty wheelchair K0009 A Other manual wheelchair/base K0010 A Stnd wt frame power whlchr K0011 A Stnd wt pwr whlchr w control K0012 A Ltwt portbl power whlchr K0014 A Other power whlchr base K0015 A Detach non-adjus hght armrst K0016 A Detach adjust armrst cmplete K0017 A Detach adjust armrest base K0018 A Detach adjust armrst upper K0019 A Arm pad each K0020 A Fixed adjust armrest pair K0022 A Reinforced back upholstery K0023 A Planr back insrt foam w/strp K0024 A Plnr back insrt foam w/hrdwr K0025 A Hook-on headrest extension K0026 A Back upholst lgtwt whlchr K0027 A Back upholst other whlchr K0028 A Manual fully reclining back K0029 A Reinforced seat upholstery K0030 A Solid plnr seat sngl dnsfoam K0031 A Safety belt/pelvic strap K0032 A Seat uphols lgtwt whlchr K0033 A Seat upholstery other whlchr K0035 A Heel loop with ankle strap K0036 A Toe loop each K0037 A High mount flip-up footrest K0038 A Leg strap each K0039 A Leg strap h style each K0040 A Adjustable angle footplate K0041 A Large size footplate each K0042 A Standard size footplate each K0043 A Ftrst lower extension tube K0044 A Ftrst upper hanger bracket Start Printed Page 48191 K0045 A Footrest complete assembly K0046 A Elevat legrst low extension K0047 A Elevat legrst up hangr brack K0048 A Elevate legrest complete K0049 A Calf pad each K0050 A Ratchet assembly K0051 A Cam relese assem ftrst/lgrst K0052 A Swingaway detach footrest K0053 A Elevate footrest articulate K0054 A Seat wdth 10-12/15/17/20 wc K0055 A Seat dpth 15/17/18 ltwt wc K0056 A Seat ht >17 or <=21 ltwt wc K0057 A Seat wdth 19/20 hvy dty wc K0058 A Seat dpth 17/18 power wc K0059 A Plastic coated handrim each K0060 A Steel handrim each K0061 A Aluminum handrim each K0062 A Handrim 8-10 vert/obliq proj K0063 A Hndrm 12-16 vert/obliq proj K0064 A Zero pressure tube flat free K0065 A Spoke protectors K0066 A Solid tire any size each K0067 A Pneumatic tire any size each K0068 A Pneumatic tire tube each K0069 A Rear whl complete solid tire K0070 A Rear whl compl pneum tire K0071 A Front castr compl pneum tire K0072 A Frnt cstr cmpl sem-pneum tir K0073 A Caster pin lock each K0074 A Pneumatic caster tire each K0075 A Semi-pneumatic caster tire K0076 A Solid caster tire each K0077 A Front caster assem complete K0078 A Pneumatic caster tire tube K0079 A Wheel lock extension pair K0080 A Anti-rollback device pair K0081 A Wheel lock assembly complete K0082 A 22 nf deep cycl acid battery K0083 A 22 nf gel cell battery each K0084 A Grp 24 deep cycl acid battry K0085 A Group 24 gel cell battery K0086 A U-1 lead acid battery each K0087 A U-1 gel cell battery each K0088 A Battry chrgr acid/gel cell K0089 A Battery charger dual mode K0090 A Rear tire power wheelchair K0091 A Rear tire tube power whlchr K0092 A Rear assem cmplt powr whlchr K0093 A Rear zero pressure tire tube K0094 A Wheel tire for power base K0095 A Wheel tire tube each base K0096 A Wheel assem powr base complt K0097 A Wheel zero presure tire tube K0098 A Drive belt power wheelchair K0099 A Pwr wheelchair front caster K0100 A Amputee adapter pair K0102 A Crutch and cane holder K0103 A Transfer board < 25≧ K0104 A Cylinder tank carrier K0105 A Iv hanger K0106 A Arm trough each K0107 A Wheelchair tray K0108 A W/c component-accessory NOS K0112 A Trunk vest supprt innr frame K0113 A Trunk vest suprt w/o inr frm K0114 A Whlchr back suprt inr frame Start Printed Page 48192 K0115 A Back module orthotic system K0116 A Back & seat modul orthot sys K0195 A Elevating whlchair leg rests K0268 A Humidifier nonheated w PAP K0415 E RX antiemetic drg, oral NOS K0416 E Rx antiemetic drg,rectal NOS K0452 A Wheelchair bearings K0455 A Pump uninterrupted infusion K0460 A WC power add-on joystick K0461 A WC power add-on tiller cntrl K0462 A Temporary replacement eqpmnt K0531 A Heated humidifier used w pap K0532 A Noninvasive assist wo backup K0533 A Noninvasive assist w backup K0534 A Invasive assist w backup K0538 A Neg pressure wnd thrpy pump K0539 A Neg pres wnd thrpy dsg set K0540 A Neg pres wnd thrp canister K0541 A SGD prerecorded msg <= 8 min K0542 A SGD prerecorded msg > 8 min K0543 A SGD msg formed by spelling K0544 A SGD w multi methods msg/accs K0545 A SGD sftwre prgrm for PC/PDA K0546 A SGD accessory,mounting systm K0547 A SGD accessory NOC K0548 A Insulin lispro K0549 A Hosp bed hvy dty xtra wide K0550 A Hosp bed xtra hvy dty x wide K0556 A Socket insert w lock mech K0557 A Socket insert w/o lock mech K0558 A Intl custm cong/atyp insert K0559 A Initial custom socket insert K0560 N Mcp joint 2-piece for implant K0581 A Ost pch clsd w barrier/filtr K0582 A Ost pch w bar/bltinconv/fltr K0583 A Ost pch clsd w/o bar w filtr K0584 A Ost pch for bar w flange/flt K0585 A Ost pch clsd for bar w lk fl K0586 A Ost pch for bar w lk fl/fltr K0587 A Ost pch drain w bar & filter K0588 A Ost pch drain for barrier fl K0589 A Ost pch drain 2 piece system K0590 A Ost pch drain/barr lk flng/f K0591 A Urine ost pouch w faucet/tap K0592 A Urine ost pouch w bltinconv K0593 A Ost urine pch w b/bltin conv K0594 A Ost pch urine w barrier/tapv K0595 A Os pch urine w bar/fange/tap K0596 A Urine ost pch bar w lock fln K0597 A Ost pch urine w lock flng/ft K0600 A Functional neuromuscular stim K0601 A Repl batt silver oxide 1.5 v K0602 A Repl batt silver oxide 3 v K0603 A Repl batt alkaline 1.5 v K0604 A Repl batt lithium 3.6 v K0605 A Repl batt lithium 4.5 v K0606 A AED garment w/elec analysis K0607 A Repl batt for AED device K0608 A Repl garment for AED K0609 A Repl electrode for AED K0610 A Peritoneal dialysis clamp K0611 A Disposable cycler set K0612 A Drainage ext line, dialysis K0613 A Ext line w/easy lock connect K0614 A Chem/antiseptic solution, 8oz K0615 A SGD prerec mes >8min <20min Start Printed Page 48193 K0616 A SGD prerec mes >20min <40min K0617 A SGD prerec mes >40min K0618 A TLSO 2 piece rigid shell K0619 A TLSO 3 piece rigid shell K0620 A Tubular elastic dressing K0621 A Gauze, non-impreg pack strip L0100 A Cranial orthosis/helmet mold L0110 A Cranial orthosis/helmet nonm L0120 A Cerv flexible non-adjustable L0130 A Flex thermoplastic collar mo L0140 A Cervical semi-rigid adjustab L0150 A Cerv semi-rig adj molded chn L0160 A Cerv semi-rig wire occ/mand L0170 A Cervical collar molded to pt L0172 A Cerv col thermplas foam 2 pi L0174 A Cerv col foam 2 piece w thor L0180 A Cer post col occ/man sup adj L0190 A Cerv collar supp adj cerv ba L0200 A Cerv col supp adj bar & thor L0210 A Thoracic rib belt L0220 A Thor rib belt custom fabrica L0450 A TLSO flex prefab thoracic L0452 A tlso flex custom fab thoraci L0454 A TLSO flex prefab sacrococ-T9 L0456 A TLSO flex prefab L0458 A TLSO 2Mod symphis-xipho pre L0460 A TLSO2Mod symphysis-stern pre L0462 A TLSO 3Mod sacro-scap pre L0464 A TLSO 4Mod sacro-scap pre L0466 A TLSO rigid frame pre soft ap L0468 A TLSO rigid frame prefab pelv L0470 A TLSO rigid frame pre subclav L0472 A TLSO rigid frame hyperex pre L0474 A TLSO rigid frame pre pelvic L0476 A TLSO flexion compres jac pre L0478 A TLSO flexion compres jac cus L0480 A TLSO rigid plastic custom fa L0482 A TLSO rigid lined custom fab L0484 A TLSO rigid plastic cust fab L0486 A TLSO rigidlined cust fab two L0488 A TLSO rigid lined pre one pie L0490 A TLSO rigid plastic pre one L0500 A Lso flex surgical support L0510 A Lso flexible custom fabricat L0515 A Lso flex elas w/ rig post pa L0520 A Lso a-p-l control with apron L0530 A Lso ant-pos control w apron L0540 A Lso lumbar flexion a-p-l L0550 A Lso a-p-l control molded L0560 A Lso a-p-l w interface L0561 A Prefab lso L0565 A Lso a-p-l control custom L0600 A Sacroiliac flex surg support L0610 A Sacroiliac flexible custm fa L0620 A Sacroiliac semi-rig w apron L0700 A Ctlso a-p-l control molded L0710 A Ctlso a-p-l control w/ inter L0810 A Halo cervical into jckt vest L0820 A Halo cervical into body jack L0830 A Halo cerv into milwaukee typ L0860 A Magnetic resonanc image comp L0960 A Post surgical support pads L0970 A Tlso corset front L0972 A Lso corset front L0974 A Tlso full corset L0976 A Lso full corset Start Printed Page 48194 L0978 A Axillary crutch extension L0980 A Peroneal straps pair L0982 A Stocking supp grips set of f L0984 A Protective body sock each L0999 A Add to spinal orthosis NOS L1000 A Ctlso milwauke initial model L1005 A Tension based scoliosis orth L1010 A Ctlso axilla sling L1020 A Kyphosis pad L1025 A Kyphosis pad floating L1030 A Lumbar bolster pad L1040 A Lumbar or lumbar rib pad L1050 A Sternal pad L1060 A Thoracic pad L1070 A Trapezius sling L1080 A Outrigger L1085 A Outrigger bil w/ vert extens L1090 A Lumbar sling L1100 A Ring flange plastic/leather L1110 A Ring flange plas/leather mol L1120 A Covers for upright each L1200 A Furnsh initial orthosis only L1210 A Lateral thoracic extension L1220 A Anterior thoracic extension L1230 A Milwaukee type superstructur L1240 A Lumbar derotation pad L1250 A Anterior asis pad L1260 A Anterior thoracic derotation L1270 A Abdominal pad L1280 A Rib gusset (elastic) each L1290 A Lateral trochanteric pad L1300 A Body jacket mold to patient L1310 A Post-operative body jacket L1499 A Spinal orthosis NOS L1500 A Thkao mobility frame L1510 A Thkao standing frame L1520 A Thkao swivel walker L1600 A Abduct hip flex frejka w cvr L1610 A Abduct hip flex frejka covr L1620 A Abduct hip flex pavlik harne L1630 A Abduct control hip semi-flex L1640 A Pelv band/spread bar thigh c L1650 A HO abduction hip adjustable L1652 A HO bi thighcuffs w sprdr bar L1660 A HO abduction static plastic L1680 A Pelvic & hip control thigh c L1685 A Post-op hip abduct custom fa L1686 A HO post-op hip abduction L1690 A Combination bilateral HO L1700 A Leg perthes orth toronto typ L1710 A Legg perthes orth newington L1720 A Legg perthes orthosis trilat L1730 A Legg perthes orth scottish r L1750 A Legg perthes sling L1755 A Legg perthes patten bottom t L1800 A Knee orthoses elas w stays L1810 A Ko elastic with joints L1815 A Elastic with condylar pads L1820 A Ko elas w/ condyle pads & jo L1825 A Ko elastic knee cap L1830 A Ko immobilizer canvas longit L1832 A KO adj jnt pos rigid support L1834 A Ko w/0 joint rigid molded to L1836 A Rigid KO wo joints L1840 A Ko derot ant cruciate custom L1843 A KO single upright custom fit Start Printed Page 48195 L1844 A Ko w/adj jt rot cntrl molded L1845 A Ko w/ adj flex/ext rotat cus L1846 A Ko w adj flex/ext rotat mold L1847 A KO adjustable w air chambers L1850 A Ko swedish type L1855 A Ko plas doub upright jnt mol L1858 A Ko polycentric pneumatic pad L1860 A Ko supracondylar socket mold L1870 A Ko doub upright lacers molde L1880 A Ko doub upright cuffs/lacers L1885 A Knee upright w/resistance L1900 A Afo sprng wir drsflx calf bd L1901 A Prefab ankle orthosis L1902 A Afo ankle gauntlet L1904 A Afo molded ankle gauntlet L1906 A Afo multiligamentus ankle su L1910 A Afo sing bar clasp attach sh L1920 A Afo sing upright w/ adjust s L1930 A Afo plastic L1940 A Afo molded to patient plasti L1945 A Afo molded plas rig ant tib L1950 A Afo spiral molded to pt plas L1960 A Afo pos solid ank plastic mo L1970 A Afo plastic molded w/ankle j L1980 A Afo sing solid stirrup calf L1990 A Afo doub solid stirrup calf L2000 A Kafo sing fre stirr thi/calf L2010 A Kafo sng solid stirrup w/o j L2020 A Kafo dbl solid stirrup band/ L2030 A Kafo dbl solid stirrup w/o j L2035 A KAFO plastic pediatric size L2036 A Kafo plas doub free knee mol L2037 A Kafo plas sing free knee mol L2038 A Kafo w/o joint multi-axis an L2039 A KAFO,plstic,medlat rotat con L2040 A Hkafo torsion bil rot straps L2050 A Hkafo torsion cable hip pelv L2060 A Hkafo torsion ball bearing j L2070 A Hkafo torsion unilat rot str L2080 A Hkafo unilat torsion cable L2090 A Hkafo unilat torsion ball br L2102 E Afo tibial fx cast plstr mol L2104 E Afo tib fx cast synthetic mo L2106 A Afo tib fx cast plaster mold L2108 A Afo tib fx cast molded to pt L2112 A Afo tibial fracture soft L2114 A Afo tib fx semi-rigid L2116 A Afo tibial fracture rigid L2122 E Kafo fem fx cast plaster mol L2124 E Kafo fem fx cast synthet mol L2126 A Kafo fem fx cast thermoplas L2128 A Kafo fem fx cast molded to p L2132 A Kafo femoral fx cast soft L2134 A Kafo fem fx cast semi-rigid L2136 A Kafo femoral fx cast rigid L2180 A Plas shoe insert w ank joint L2182 A Drop lock knee L2184 A Limited motion knee joint L2186 A Adj motion knee jnt lerman t L2188 A Quadrilateral brim L2190 A Waist belt L2192 A Pelvic band & belt thigh fla L2200 A Limited ankle motion ea jnt L2210 A Dorsiflexion assist each joi L2220 A Dorsi & plantar flex ass/res L2230 A Split flat caliper stirr & p Start Printed Page 48196 L2240 A Round caliper and plate atta L2250 A Foot plate molded stirrup at L2260 A Reinforced solid stirrup L2265 A Long tongue stirrup L2270 A Varus/valgus strap padded/li L2275 A Plastic mod low ext pad/line L2280 A Molded inner boot L2300 A Abduction bar jointed adjust L2310 A Abduction bar-straight L2320 A Non-molded lacer L2330 A Lacer molded to patient mode L2335 A Anterior swing band L2340 A Pre-tibial shell molded to p L2350 A Prosthetic type socket molde L2360 A Extended steel shank L2370 A Patten bottom L2375 A Torsion ank & half solid sti L2380 A Torsion straight knee joint L2385 A Straight knee joint heavy du L2390 A Offset knee joint each L2395 A Offset knee joint heavy duty L2397 A Suspension sleeve lower ext L2405 A Knee joint drop lock ea jnt L2415 A Knee joint cam lock each joi L2425 A Knee disc/dial lock/adj flex L2430 A Knee jnt ratchet lock ea jnt L2435 A Knee joint polycentric joint L2492 A Knee lift loop drop lock rin L2500 A Thi/glut/ischia wgt bearing L2510 A Th/wght bear quad-lat brim m L2520 A Th/wght bear quad-lat brim c L2525 A Th/wght bear nar m-l brim mo L2526 A Th/wght bear nar m-l brim cu L2530 A Thigh/wght bear lacer non-mo L2540 A Thigh/wght bear lacer molded L2550 A Thigh/wght bear high roll cu L2570 A Hip clevis type 2 posit jnt L2580 A Pelvic control pelvic sling L2600 A Hip clevis/thrust bearing fr L2610 A Hip clevis/thrust bearing lo L2620 A Pelvic control hip heavy dut L2622 A Hip joint adjustable flexion L2624 A Hip adj flex ext abduct cont L2627 A Plastic mold recipro hip & c L2628 A Metal frame recipro hip & ca L2630 A Pelvic control band & belt u L2640 A Pelvic control band & belt b L2650 A Pelv & thor control gluteal L2660 A Thoracic control thoracic ba L2670 A Thorac cont paraspinal uprig L2680 A Thorac cont lat support upri L2750 A Plating chrome/nickel pr bar L2755 A Carbon graphite lamination L2760 A Extension per extension per L2768 A Ortho sidebar disconnect L2770 A Low ext orthosis per bar/jnt L2780 A Non-corrosive finish L2785 A Drop lock retainer each L2795 A Knee control full kneecap L2800 A Knee cap medial or lateral p L2810 A Knee control condylar pad L2820 A Soft interface below knee se L2830 A Soft interface above knee se L2840 A Tibial length sock fx or equ L2850 A Femoral lgth sock fx or equa L2860 A Torsion mechanism knee/ankle Start Printed Page 48197 L2999 A Lower extremity orthosis NOS L3000 E Ft insert ucb berkeley shell L3001 E Foot insert remov molded spe L3002 E Foot insert plastazote or eq L3003 E Foot insert silicone gel eac L3010 E Foot longitudinal arch suppo L3020 E Foot longitud/metatarsal sup L3030 E Foot arch support remov prem L3040 E Ft arch suprt premold longit L3050 E Foot arch supp premold metat L3060 E Foot arch supp longitud/meta L3070 E Arch suprt att to sho longit L3080 E Arch supp att to shoe metata L3090 E Arch supp att to shoe long/m L3100 E Hallus-valgus nght dynamic s L3140 E Abduction rotation bar shoe L3150 E Abduct rotation bar w/o shoe L3160 E Shoe styled positioning dev L3170 E Foot plastic heel stabilizer L3201 E Oxford w supinat/pronat inf L3202 E Oxford w/ supinat/pronator c L3203 E Oxford w/ supinator/pronator L3204 E Hightop w/ supp/pronator inf L3206 E Hightop w/ supp/pronator chi L3207 E Hightop w/ supp/pronator jun L3208 E Surgical boot each infant L3209 E Surgical boot each child L3211 E Surgical boot each junior L3212 E Benesch boot pair infant L3213 E Benesch boot pair child L3214 E Benesch boot pair junior L3215 E Orthopedic ftwear ladies oxf L3216 E Orthoped ladies shoes dpth i L3217 E Ladies shoes hightop depth i L3219 E Orthopedic mens shoes oxford L3221 E Orthopedic mens shoes dpth i L3222 E Mens shoes hightop depth inl L3224 A Woman's shoe oxford brace L3225 A Man's shoe oxford brace L3230 E Custom shoes depth inlay L3250 E Custom mold shoe remov prost L3251 E Shoe molded to pt silicone s L3252 E Shoe molded plastazote cust L3253 E Shoe molded plastazote cust L3254 E Orth foot non-stndard size/w L3255 E Orth foot non-standard size/ L3257 E Orth foot add charge split s L3260 E Ambulatory surgical boot eac L3265 E Plastazote sandal each L3300 E Sho lift taper to metatarsal L3310 E Shoe lift elev heel/sole neo L3320 E Shoe lift elev heel/sole cor L3330 E Lifts elevation metal extens L3332 E Shoe lifts tapered to one-ha L3334 E Shoe lifts elevation heel /i L3340 E Shoe wedge sach L3350 E Shoe heel wedge L3360 E Shoe sole wedge outside sole L3370 E Shoe sole wedge between sole L3380 E Shoe clubfoot wedge L3390 E Shoe outflare wedge L3400 E Shoe metatarsal bar wedge ro L3410 E Shoe metatarsal bar between L3420 E Full sole/heel wedge btween L3430 E Sho heel count plast reinfor L3440 E Heel leather reinforced Start Printed Page 48198 L3450 E Shoe heel sach cushion type L3455 E Shoe heel new leather standa L3460 E Shoe heel new rubber standar L3465 E Shoe heel thomas with wedge L3470 E Shoe heel thomas extend to b L3480 E Shoe heel pad & depress for L3485 E Shoe heel pad removable for L3500 E Ortho shoe add leather insol L3510 E Orthopedic shoe add rub insl L3520 E O shoe add felt w leath insl L3530 E Ortho shoe add half sole L3540 E Ortho shoe add full sole L3550 E O shoe add standard toe tap L3560 E O shoe add horseshoe toe tap L3570 E O shoe add instep extension L3580 E O shoe add instep velcro clo L3590 E O shoe convert to sof counte L3595 E Ortho shoe add march bar L3600 E Trans shoe calip plate exist L3610 E Trans shoe caliper plate new L3620 E Trans shoe solid stirrup exi L3630 E Trans shoe solid stirrup new L3640 E Shoe dennis browne splint bo L3649 E Orthopedic shoe modifica NOS L3650 A Shlder fig 8 abduct restrain L3651 A Prefab shoulder orthosis L3652 A Prefab dbl shoulder orthosis L3660 A Abduct restrainer canvas&web L3670 A Acromio/clavicular canvas&we L3675 A Canvas vest SO L3677 E SO hard plastic stabilizer L3700 A Elbow orthoses elas w stays L3701 A Prefab elbow orthosis L3710 A Elbow elastic with metal joi L3720 A Forearm/arm cuffs free motio L3730 A Forearm/arm cuffs ext/flex a L3740 A Cuffs adj lock w/ active con L3760 A EO withjoint, Prefabricated L3762 A Rigid EO wo joints L3800 A Whfo short opponen no attach L3805 A Whfo long opponens no attach L3807 A WHFO,no joint, prefabricated L3810 A Whfo thumb abduction bar L3815 A Whfo second m.p. abduction a L3820 A Whfo ip ext asst w/ mp ext s L3825 A Whfo m.p. extension stop L3830 A Whfo m.p. extension assist L3835 A Whfo m.p. spring extension a L3840 A Whfo spring swivel thumb L3845 A Whfo thumb ip ext ass w/ mp L3850 A Action wrist w/ dorsiflex as L3855 A Whfo adj m.p. flexion contro L3860 A Whfo adj m.p. flex ctrl & i. L3890 E Torsion mechanism wrist/elbo L3900 A Hinge extension/flex wrist/f L3901 A Hinge ext/flex wrist finger L3902 A Whfo ext power compress gas L3904 A Whfo electric custom fitted L3906 A Wrist gauntlet molded to pt L3907 A Whfo wrst gauntlt thmb spica L3908 A Wrist cock-up non-molded L3909 A Prefab wrist orthosis L3910 A Whfo swanson design L3911 A Prefab hand finger orthosis L3912 A Flex glove w/elastic finger L3914 A WHO wrist extension cock-up Start Printed Page 48199 L3916 A Whfo wrist extens w/ outrigg L3918 A HFO knuckle bender L3920 A Knuckle bender with outrigge L3922 A Knuckle bend 2 seg to flex j L3923 A HFO, no joint, prefabricated L3924 A Oppenheimer L3926 A Thomas suspension L3928 A Finger extension w/ clock sp L3930 A Finger extension with wrist L3932 A Safety pin spring wire L3934 A Safety pin modified L3936 A Palmer L3938 A Dorsal wrist L3940 A Dorsal wrist w/ outrigger at L3942 A Reverse knuckle bender L3944 A Reverse knuckle bend w/ outr L3946 A HFO composite elastic L3948 A Finger knuckle bender L3950 A Oppenheimer w/ knuckle bend L3952 A Oppenheimer w/ rev knuckle 2 L3954 A Spreading hand L3956 A Add joint upper ext orthosis L3960 A Sewho airplan desig abdu pos L3962 A Sewho erbs palsey design abd L3963 A Molded w/ articulating elbow L3964 A Seo mobile arm sup att to wc L3965 A Arm supp att to wc rancho ty L3966 A Mobile arm supports reclinin L3968 A Friction dampening arm supp L3969 A Monosuspension arm/hand supp L3970 A Elevat proximal arm support L3972 A Offset/lat rocker arm w/ ela L3974 A Mobile arm support supinator L3980 A Upp ext fx orthosis humeral L3982 A Upper ext fx orthosis rad/ul L3984 A Upper ext fx orthosis wrist L3985 A Forearm hand fx orth w/ wr h L3986 A Humeral rad/ulna wrist fx or L3995 A Sock fracture or equal each L3999 A Upper limb orthosis NOS L4000 A Repl girdle milwaukee orth L4010 A Replace trilateral socket br L4020 A Replace quadlat socket brim L4030 A Replace socket brim cust fit L4040 A Replace molded thigh lacer L4045 A Replace non-molded thigh lac L4050 A Replace molded calf lacer L4055 A Replace non-molded calf lace L4060 A Replace high roll cuff L4070 A Replace prox & dist upright L4080 A Repl met band kafo-afo prox L4090 A Repl met band kafo-afo calf/ L4100 A Repl leath cuff kafo prox th L4110 A Repl leath cuff kafo-afo cal L4130 A Replace pretibial shell L4205 A Ortho dvc repair per 15 min L4210 A Orth dev repair/repl minor p L4350 A Pneumatic ankle cntrl splint L4360 A Pneumatic walking splint L4370 A Pneumatic full leg splint L4380 A Pneumatic knee splint L4386 A Non-pneumatic walking splint L4392 A Replace AFO soft interface L4394 A Replace foot drop spint L4396 A Static AFO L4398 A Foot drop splint recumbent Start Printed Page 48200 L5000 A Sho insert w arch toe filler L5010 A Mold socket ank hgt w/ toe f L5020 A Tibial tubercle hgt w/ toe f L5050 A Ank symes mold sckt sach ft L5060 A Symes met fr leath socket ar L5100 A Molded socket shin sach foot L5105 A Plast socket jts/thgh lacer L5150 A Mold sckt ext knee shin sach L5160 A Mold socket bent knee shin s L5200 A Kne sing axis fric shin sach L5210 A No knee/ankle joints w/ ft b L5220 A No knee joint with artic ali L5230 A Fem focal defic constant fri L5250 A Hip canad sing axi cons fric L5270 A Tilt table locking hip sing L5280 A Hemipelvect canad sing axis L5301 A BK mold socket SACH ft endo L5311 A Knee disart, SACH ft, endo L5321 A AK open end SACH L5331 A Hip disart canadian SACH ft L5341 A Hemipelvectomy canadian SACH L5400 A Postop dress & 1 cast chg bk L5410 A Postop dsg bk ea add cast ch L5420 A Postop dsg & 1 cast chg ak/d L5430 A Postop dsg ak ea add cast ch L5450 A Postop app non-wgt bear dsg L5460 A Postop app non-wgt bear dsg L5500 A Init bk ptb plaster direct L5505 A Init ak ischal plstr direct L5510 A Prep BK ptb plaster molded L5520 A Perp BK ptb thermopls direct L5530 A Prep BK ptb thermopls molded L5535 A Prep BK ptb open end socket L5540 A Prep BK ptb laminated socket L5560 A Prep AK ischial plast molded L5570 A Prep AK ischial direct form L5580 A Prep AK ischial thermo mold L5585 A Prep AK ischial open end L5590 A Prep AK ischial laminated L5595 A Hip disartic sach thermopls L5600 A Hip disart sach laminat mold L5610 A Above knee hydracadence L5611 A Ak 4 bar link w/fric swing L5613 A Ak 4 bar ling w/hydraul swig L5614 A 4-bar link above knee w/swng L5616 A Ak univ multiplex sys frict L5617 A AK/BK self-aligning unit ea L5618 A Test socket symes L5620 A Test socket below knee L5622 A Test socket knee disarticula L5624 A Test socket above knee L5626 A Test socket hip disarticulat L5628 A Test socket hemipelvectomy L5629 A Below knee acrylic socket L5630 A Syme typ expandabl wall sckt L5631 A Ak/knee disartic acrylic soc L5632 A Symes type ptb brim design s L5634 A Symes type poster opening so L5636 A Symes type medial opening so L5637 A Below knee total contact L5638 A Below knee leather socket L5639 A Below knee wood socket L5640 A Knee disarticulat leather so L5642 A Above knee leather socket L5643 A Hip flex inner socket ext fr L5644 A Above knee wood socket Start Printed Page 48201 L5645 A Bk flex inner socket ext fra L5646 A Below knee air cushion socke L5647 A Below knee suction socket L5648 A Above knee air cushion socke L5649 A Isch containmt/narrow m-l so L5650 A Tot contact ak/knee disart s L5651 A Ak flex inner socket ext fra L5652 A Suction susp ak/knee disart L5653 A Knee disart expand wall sock L5654 A Socket insert symes L5655 A Socket insert below knee L5656 A Socket insert knee articulat L5658 A Socket insert above knee L5661 A Multi-durometer symes L5665 A Multi-durometer below knee L5666 A Below knee cuff suspension L5668 A Socket insert w/o lock lower L5670 A Bk molded supracondylar susp L5671 A BK/AK locking mechanism L5672 A Bk removable medial brim sus L5674 A Bk suspension sleeve L5675 A Bk heavy duty susp sleeve L5676 A Bk knee joints single axis p L5677 A Bk knee joints polycentric p L5678 A Bk joint covers pair L5680 A Bk thigh lacer non-molded L5682 A Bk thigh lacer glut/ischia m L5684 A Bk fork strap L5686 A Bk back check L5688 A Bk waist belt webbing L5690 A Bk waist belt padded and lin L5692 A Ak pelvic control belt light L5694 A Ak pelvic control belt pad/l L5695 A Ak sleeve susp neoprene/equa L5696 A Ak/knee disartic pelvic join L5697 A Ak/knee disartic pelvic band L5698 A Ak/knee disartic silesian ba L5699 A Shoulder harness L5700 A Replace socket below knee L5701 A Replace socket above knee L5702 A Replace socket hip L5704 A Custom shape cover BK L5705 A Custom shape cover AK L5706 A Custom shape cvr knee disart L5707 A Custom shape cvr hip disart L5710 A Kne-shin exo sng axi mnl loc L5711 A Knee-shin exo mnl lock ultra L5712 A Knee-shin exo frict swg & st L5714 A Knee-shin exo variable frict L5716 A Knee-shin exo mech stance ph L5718 A Knee-shin exo frct swg & sta L5722 A Knee-shin pneum swg frct exo L5724 A Knee-shin exo fluid swing ph L5726 A Knee-shin ext jnts fld swg e L5728 A Knee-shin fluid swg & stance L5780 A Knee-shin pneum/hydra pneum L5781 A Lower limb pros vacuum pump L5782 A HD low limb pros vacuum pump L5785 A Exoskeletal bk ultralt mater L5790 A Exoskeletal ak ultra-light m L5795 A Exoskel hip ultra-light mate L5810 A Endoskel knee-shin mnl lock L5811 A Endo knee-shin mnl lck ultra L5812 A Endo knee-shin frct swg & st L5814 A Endo knee-shin hydral swg ph L5816 A Endo knee-shin polyc mch sta Start Printed Page 48202 L5818 A Endo knee-shin frct swg & st L5822 A Endo knee-shin pneum swg frc L5824 A Endo knee-shin fluid swing p L5826 A Miniature knee joint L5828 A Endo knee-shin fluid swg/sta L5830 A Endo knee-shin pneum/swg pha L5840 A Multi-axial knee/shin system L5845 A Knee-shin sys stance flexion L5846 A Knee-shin sys microprocessor L5847 A Microprocessor cntrl feature L5848 A Knee-shin sys hydraul stance L5850 A Endo ak/hip knee extens assi L5855 A Mech hip extension assist L5910 A Endo below knee alignable sy L5920 A Endo ak/hip alignable system L5925 A Above knee manual lock L5930 A High activity knee frame L5940 A Endo bk ultra-light material L5950 A Endo ak ultra-light material L5960 A Endo hip ultra-light materia L5962 A Below knee flex cover system L5964 A Above knee flex cover system L5966 A Hip flexible cover system L5968 A Multiaxial ankle w dorsiflex L5970 A Foot external keel sach foot L5972 A Flexible keel foot L5974 A Foot single axis ankle/foot L5975 A Combo ankle/foot prosthesis L5976 A Energy storing foot L5978 A Ft prosth multiaxial ankl/ft L5979 A Multi-axial ankle/ft prosth L5980 A Flex foot system L5981 A Flex-walk sys low ext prosth L5982 A Exoskeletal axial rotation u L5984 A Endoskeletal axial rotation L5985 A Lwr ext dynamic prosth pylon L5986 A Multi-axial rotation unit L5987 A Shank ft w vert load pylon L5988 A Vertical shock reducing pylo L5989 A Pylon w elctrnc force sensor L5990 A User adjustable heel height L5995 A Lower ext pros heavyduty fea L5999 A Lowr extremity prosthes NOS L6000 A Par hand robin-aids thum rem L6010 A Hand robin-aids little/ring L6020 A Part hand robin-aids no fing L6025 A Part hand disart myoelectric L6050 A Wrst MLd sck flx hng tri pad L6055 A Wrst mold sock w/exp interfa L6100 A Elb mold sock flex hinge pad L6110 A Elbow mold sock suspension t L6120 A Elbow mold doub splt soc ste L6130 A Elbow stump activated lock h L6200 A Elbow mold outsid lock hinge L6205 A Elbow molded w/ expand inter L6250 A Elbow inter loc elbow forarm L6300 A Shlder disart int lock elbow L6310 A Shoulder passive restor comp L6320 A Shoulder passive restor cap L6350 A Thoracic intern lock elbow L6360 A Thoracic passive restor comp L6370 A Thoracic passive restor cap L6380 A Postop dsg cast chg wrst/elb L6382 A Postop dsg cast chg elb dis/ L6384 A Postop dsg cast chg shlder/t L6386 A Postop ea cast chg & realign Start Printed Page 48203 L6388 A Postop applicat rigid dsg on L6400 A Below elbow prosth tiss shap L6450 A Elb disart prosth tiss shap L6500 A Above elbow prosth tiss shap L6550 A Shldr disar prosth tiss shap L6570 A Scap thorac prosth tiss shap L6580 A Wrist/elbow bowden cable mol L6582 A Wrist/elbow bowden cbl dir f L6584 A Elbow fair lead cable molded L6586 A Elbow fair lead cable dir fo L6588 A Shdr fair lead cable molded L6590 A Shdr fair lead cable direct L6600 A Polycentric hinge pair L6605 A Single pivot hinge pair L6610 A Flexible metal hinge pair L6615 A Disconnect locking wrist uni L6616 A Disconnect insert locking wr L6620 A Flexion-friction wrist unit L6623 A Spring-ass rot wrst w/ latch L6625 A Rotation wrst w/ cable lock L6628 A Quick disconn hook adapter o L6629 A Lamination collar w/ couplin L6630 A Stainless steel any wrist L6632 A Latex suspension sleeve each L6635 A Lift assist for elbow L6637 A Nudge control elbow lock L6638 A Elec lock on manual pw elbow L6640 A Shoulder abduction joint pai L6641 A Excursion amplifier pulley t L6642 A Excursion amplifier lever ty L6645 A Shoulder flexion-abduction j L6646 A Multipo locking shoulder jnt L6647 A Shoulder lock actuator L6648 A Ext pwrd shlder lock/unlock L6650 A Shoulder universal joint L6655 A Standard control cable extra L6660 A Heavy duty control cable L6665 A Teflon or equal cable lining L6670 A Hook to hand cable adapter L6672 A Harness chest/shlder saddle L6675 A Harness figure of 8 sing con L6676 A Harness figure of 8 dual con L6680 A Test sock wrist disart/bel e L6682 A Test sock elbw disart/above L6684 A Test socket shldr disart/tho L6686 A Suction socket L6687 A Frame typ socket bel elbow/w L6688 A Frame typ sock above elb/dis L6689 A Frame typ socket shoulder di L6690 A Frame typ sock interscap-tho L6691 A Removable insert each L6692 A Silicone gel insert or equal L6693 A Lockingelbow forearm cntrbal L6700 A Terminal device model #3 L6705 A Terminal device model #5 L6710 A Terminal device model #5x L6715 A Terminal device model #5xa L6720 A Terminal device model #6 L6725 A Terminal device model #7 L6730 A Terminal device model #7lo L6735 A Terminal device model #8 L6740 A Terminal device model #8x L6745 A Terminal device model #88x L6750 A Terminal device model #10p L6755 A Terminal device model #10x L6765 A Terminal device model #12p Start Printed Page 48204 L6770 A Terminal device model #99x L6775 A Terminal device model#555 L6780 A Terminal device model #ss555 L6790 A Hooks-accu hook or equal L6795 A Hooks-2 load or equal L6800 A Hooks-aprl vc or equal L6805 A Modifier wrist flexion unit L6806 A Trs grip vc or equal L6807 A Term device grip1/2 or equal L6808 A Term device infant or child L6809 A Trs super sport passive L6810 A Pincher tool otto bock or eq L6825 A Hands dorrance vo L6830 A Hand aprl vc L6835 A Hand sierra vo L6840 A Hand becker imperial L6845 A Hand becker lock grip L6850 A Term dvc-hand becker plylite L6855 A Hand robin-aids vo L6860 A Hand robin-aids vo soft L6865 A Hand passive hand L6867 A Hand detroit infant hand L6868 A Passive inf hand steeper/hos L6870 A Hand child mitt L6872 A Hand nyu child hand L6873 A Hand mech inf steeper or equ L6875 A Hand bock vc L6880 A Hand bock vo L6881 A Autograsp feature ul term dv L6882 A Microprocessor control uplmb L6890 A Production glove L6895 A Custom glove L6900 A Hand restorat thumb/1 finger L6905 A Hand restoration multiple fi L6910 A Hand restoration no fingers L6915 A Hand restoration replacmnt g L6920 A Wrist disarticul switch ctrl L6925 A Wrist disart myoelectronic c L6930 A Below elbow switch control L6935 A Below elbow myoelectronic ct L6940 A Elbow disarticulation switch L6945 A Elbow disart myoelectronic c L6950 A Above elbow switch control L6955 A Above elbow myoelectronic ct L6960 A Shldr disartic switch contro L6965 A Shldr disartic myoelectronic L6970 A Interscapular-thor switch ct L6975 A Interscap-thor myoelectronic L7010 A Hand otto back steeper/eq sw L7015 A Hand sys teknik village swit L7020 A Electronic greifer switch ct L7025 A Electron hand myoelectronic L7030 A Hand sys teknik vill myoelec L7035 A Electron greifer myoelectro L7040 A Prehensile actuator hosmer s L7045 A Electron hook child michigan L7170 A Electronic elbow hosmer swit L7180 A Electronic elbow utah myoele L7185 A Electron elbow adolescent sw L7186 A Electron elbow child switch L7190 A Elbow adolescent myoelectron L7191 A Elbow child myoelectronic ct L7260 A Electron wrist rotator otto L7261 A Electron wrist rotator utah L7266 A Servo control steeper or equ L7272 A Analogue control unb or equa Start Printed Page 48205 L7274 A Proportional ctl 12 volt uta L7360 A Six volt bat otto bock/eq ea L7362 A Battery chrgr six volt otto L7364 A Twelve volt battery utah/equ L7366 A Battery chrgr 12 volt utah/e L7367 A Replacemnt lithium ionbatter L7368 A Lithium ion battery charger L7499 A Upper extremity prosthes NOS L7500 A Prosthetic dvc repair hourly L7510 A Prosthetic device repair rep L7520 A Repair prosthesis per 15 min L7900 A Vacuum erection system L8000 A Mastectomy bra L8001 A Breast prosthesis bra & form L8002 A Brst prsth bra & bilat form L8010 A Mastectomy sleeve L8015 A Ext breastprosthesis garment L8020 A Mastectomy form L8030 A Breast prosthesis silicone/e L8035 A Custom breast prosthesis L8039 A Breast prosthesis NOS L8040 A Nasal prosthesis L8041 A Midfacial prosthesis L8042 A Orbital prosthesis L8043 A Upper facial prosthesis L8044 A Hemi-facial prosthesis L8045 A Auricular prosthesis L8046 A Partial facial prosthesis L8047 A Nasal septal prosthesis L8048 A Unspec maxillofacial prosth L8049 A Repair maxillofacial prosth L8100 E Compression stocking BK18-30 L8110 E Compression stocking BK30-40 L8120 E Compression stocking BK40-50 L8130 E Gc stocking thighlngth 18-30 L8140 E Gc stocking thighlngth 30-40 L8150 E Gc stocking thighlngth 40-50 L8160 E Gc stocking full lngth 18-30 L8170 E Gc stocking full lngth 30-40 L8180 E Gc stocking full lngth 40-50 L8190 E Gc stocking waistlngth 18-30 L8195 E Gc stocking waistlngth 30-40 L8200 E Gc stocking waistlngth 40-50 L8210 E Gc stocking custom made L8220 E Gc stocking lymphedema L8230 E Gc stocking garter belt L8239 E G compression stocking NOS L8300 A Truss single w/ standard pad L8310 A Truss double w/ standard pad L8320 A Truss addition to std pad wa L8330 A Truss add to std pad scrotal L8400 A Sheath below knee L8410 A Sheath above knee L8415 A Sheath upper limb L8417 A Pros sheath/sock w gel cushn L8420 A Prosthetic sock multi ply BK L8430 A Prosthetic sock multi ply AK L8435 A Pros sock multi ply upper lm L8440 A Shrinker below knee L8460 A Shrinker above knee L8465 A Shrinker upper limb L8470 A Pros sock single ply BK L8480 A Pros sock single ply AK L8485 A Pros sock single ply upper l L8490 A Air seal suction reten systm L8499 A Unlisted misc prosthetic ser Start Printed Page 48206 L8500 A Artificial larynx L8501 A Tracheostomy speaking valve L8505 A Artificial larynx, accessory L8507 A Trach-esoph voice pros pt in L8509 A Trach-esoph voice pros md in L8510 A Voice amplifier L8600 N Implant breast silicone/eq L8603 N Collagen imp urinary 2.5 ml L8606 N Synthetic implnt urinary 1ml L8610 N Ocular implant L8612 N Aqueous shunt prosthesis L8613 N Ossicular implant L8614 E Cochlear device/system L8619 A Replace cochlear processor L8630 N Metacarpophalangeal implant L8641 N Metatarsal joint implant L8642 N Hallux implant L8658 N Interphalangeal joint implnt L8670 N Vascular graft, synthetic L8699 N Prosthetic implant NOS L9900 A O&P supply/accessory/service M0064 X Visit for drug monitoring 0374 1.1062 $60.05 $12.01 M0075 E Cellular therapy M0076 E Prolotherapy M0100 E Intragastric hypothermia M0300 E IV chelationtherapy M0301 E Fabric wrapping of aneurysm P2028 A Cephalin floculation test P2029 A Congo red blood test P2031 E Hair analysis P2033 A Blood thymol turbidity P2038 A Blood mucoprotein P3000 A Screen pap by tech w md supv P3001 E Screening pap smear by phys P7001 E Culture bacterial urine P9010 K Whole blood for transfusion 0950 1.4575 $79.13 $15.83 P9011 K Blood split unit 0957 0.6870 $37.30 $7.46 P9012 K Cryoprecipitate each unit 0952 0.4860 $26.38 $5.28 P9016 K RBC leukocytes reduced 0954 1.9770 $107.33 $21.47 P9017 K One donor fresh frozn plasma 0955 1.5750 $85.51 $17.10 P9019 K Platelets, each unit 0957 0.6870 $37.30 $7.46 P9020 K Plaelet rich plasma unit 0958 1.1296 $61.32 $12.26 P9021 K Red blood cells unit 0959 1.4326 $77.77 $15.55 P9022 K Washed red blood cells unit 0960 2.6638 $144.62 $28.92 P9023 K Frozen plasma, pooled, sd 0949 2.0608 $111.88 $22.38 P9031 K Platelets leukocytes reduced 1013 0.9101 $49.41 $9.88 P9032 K Platelets, irradiated 9500 1.2398 $67.31 $13.46 P9033 K Platelets leukoreduced irrad 0954 1.9770 $107.33 $21.47 P9034 K Platelets, pheresis 9501 6.7772 $367.93 $73.59 P9035 K Platelet pheres leukoreduced 9501 6.7772 $367.93 $73.59 P9036 K Platelet pheresis irradiated 9502 7.3552 $399.31 $79.86 P9037 K Plate pheres leukoredu irrad 1019 6.7353 $365.65 $73.13 P9038 K RBC irradiated 9505 1.8011 $97.78 $19.56 P9039 K RBC deglycerolized 9504 3.9764 $215.87 $43.17 P9040 K RBC leukoreduced irradiated 9504 3.9764 $215.87 $43.17 P9041 K Albumin (human),5%, 50ml 0961 0.7319 $39.73 $7.95 P9043 K Plasma protein fract,5%,50ml 0956 1.5414 $83.68 $16.74 P9044 K Cryoprecipitatereducedplasma 1009 0.9447 $51.29 $10.26 P9045 K Albumin (human), 5%, 250 ml 0963 3.4713 $188.45 $37.69 P9046 K Albumin (human), 25%, 20 ml 0964 0.7911 $42.95 $8.59 P9047 K Albumin (human), 25%, 50ml 0965 1.9432 $105.49 $21.10 P9048 K Plasmaprotein fract,5%,250ml 0966 7.7071 $418.41 $83.68 P9050 K Granulocytes, pheresis unit 9506 20.7004 $1,123.80 $224.76 P9603 A One-way allow prorated miles P9604 A One-way allow prorated trip P9612 N Catheterize for urine spec Start Printed Page 48207 P9615 N Urine specimen collect mult Q0035 X Cardiokymography 0100 1.6726 $90.80 $41.44 $18.16 Q0081 E Infusion ther other than che Q0083 E Chemo by other than infusion Q0084 E Chemotherapy by infusion Q0085 E Chemo by both infusion and o Q0086 A Physical therapy evaluation/ Q0091 T Obtaining screen pap smear 0191 0.1679 $9.12 $2.65 $1.82 Q0092 N Set up port xray equipment Q0111 A Wet mounts/ w preparations Q0112 A Potassium hydroxide preps Q0113 A Pinworm examinations Q0114 A Fern test Q0115 A Post-coital mucous exam Q0136 K Non esrd epoetin alpha inj 0733 0.1782 $9.67 $1.93 Q0144 E Azithromycin dihydrate, oral Q0163 N Diphenhydramine HCl 50mg Q0164 N Prochlorperazine maleate 5mg Q0165 E Prochlorperazine maleate10mg Q0166 N Granisetron HCl 1 mg oral Q0167 N Dronabinol 2.5mg oral Q0168 E Dronabinol 5mg oral Q0169 N Promethazine HCl 12.5mg oral Q0170 E Promethazine HCl 25 mg oral Q0171 N Chlorpromazine HCl 10mg oral Q0172 E Chlorpromazine HCl 25mg oral Q0173 N Trimethobenzamide HCl 250mg Q0174 N Thiethylperazine maleate10mg Q0175 N Perphenazine 4mg oral Q0176 E Perphenazine 8mg oral Q0177 N Hydroxyzine pamoate 25mg Q0178 E Hydroxyzine pamoate 50mg Q0179 N Ondansetron HCl 8mg oral Q0180 N Dolasetron mesylate oral Q0181 E Unspecified oral anti-emetic Q0183 N Nonmetabolic active tissue Q0187 K Factor viia recombinant 1409 17.9693 $975.54 $195.11 Q1001 N Ntiol category 1 Q1002 N Ntiol category 2 Q1003 N Ntiol category 3 Q1004 N Ntiol category 4 Q1005 N Ntiol category 5 Q2001 N Oral cabergoline 0.5 mg Q2002 N Elliotts b solution per ml Q2003 N Aprotinin, 10,000 kiu Q2004 N Bladder calculi irrig sol Q2005 K Corticorelin ovine triflutat 7024 3.4880 $189.36 $37.87 Q2006 K Digoxin immune fab (ovine) 7025 4.4789 $243.16 $48.63 Q2007 N Ethanolamine oleate 100 mg Q2008 K Fomepizole, 15 mg 7027 0.2215 $12.03 $2.41 Q2009 N Fosphenytoin, 50 mg Q2010 N Glatiramer acetate, per dose Q2011 K Hemin, per 1 mg 7030 0.0119 $.65 $.13 Q2012 N Pegademase bovine, 25 iu Q2013 N Pentastarch 10% solution Q2014 N Sermorelin acetate, 0.5 mg Q2017 K Teniposide, 50 mg 7035 1.5530 $84.31 $16.86 Q2018 K Urofollitropin, 75 iu 7037 1.1321 $61.46 $12.29 Q2019 K Basiliximab 1615 11.2007 $608.07 $121.61 Q2020 E Histrelin acetate Q2021 N Lepirudin Q2022 K VonWillebrandFactrCmplxperIU 1618 0.0168 $.91 $.18 Q3000 K Rubidium-Rb-82 9025 2.5939 $140.82 $28.16 Q3001 N Brachytherapy Radioelements Q3002 N Gallium ga 67 Q3003 K Technetium tc99m bicisate 1620 3.3106 $179.73 $35.95 Start Printed Page 48208 Q3004 N Xenon xe 133 Q3005 N Technetium tc99m mertiatide Q3006 N Technetium tc99m glucepatate Q3007 N Sodium phosphate p32 Q3008 K Indium 111-in pentetreotide 1625 6.8170 $370.09 $74.02 Q3009 N Technetium tc99m oxidronate Q3010 N Technetium tc99mlabeledrbcs Q3011 K Chromic phosphate p32 1628 2.0103 $109.14 $21.83 Q3012 N Cyanocobalamin cobalt co57 Q3014 A Telehealth facility fee Q3019 A ALS emer trans no ALS serv Q3020 A ALS nonemer trans no ALS se Q3021 E Ped hepatitis b vaccine inj Q3022 E Hepatitis b vaccine adult ds Q3023 E Injection hepatitis Bvaccine Q3025 K IM inj interferon beta 1-a 9022 0.9417 $51.12 $10.22 Q3026 N Subc inj interferon beta-1a Q4001 A Cast sup body cast plaster Q4002 A Cast sup body cast fiberglas Q4003 A Cast sup shoulder cast plstr Q4004 A Cast sup shoulder cast fbrgl Q4005 A Cast sup long arm adult plst Q4006 A Cast sup long arm adult fbrg Q4007 A Cast sup long arm ped plster Q4008 A Cast sup long arm ped fbrgls Q4009 A Cast sup sht arm adult plstr Q4010 A Cast sup sht arm adult fbrgl Q4011 A Cast sup sht arm ped plaster Q4012 A Cast sup sht arm ped fbrglas Q4013 A Cast sup gauntlet plaster Q4014 A Cast sup gauntlet fiberglass Q4015 A Cast sup gauntlet ped plster Q4016 A Cast sup gauntlet ped fbrgls Q4017 A Cast sup lng arm splint plst Q4018 A Cast sup lng arm splint fbrg Q4019 A Cast sup lng arm splnt ped p Q4020 A Cast sup lng arm splnt ped f Q4021 A Cast sup sht arm splint plst Q4022 A Cast sup sht arm splint fbrg Q4023 A Cast sup sht arm splnt ped p Q4024 A Cast sup sht arm splnt ped f Q4025 A Cast sup hip spica plaster Q4026 A Cast sup hip spica fiberglas Q4027 A Cast sup hip spica ped plstr Q4028 A Cast sup hip spica ped fbrgl Q4029 A Cast sup long leg plaster Q4030 A Cast sup long leg fiberglass Q4031 A Cast sup lng leg ped plaster Q4032 A Cast sup lng leg ped fbrgls Q4033 A Cast sup lng leg cylinder pl Q4034 A Cast sup lng leg cylinder fb Q4035 A Cast sup lngleg cylndr ped p Q4036 A Cast sup lngleg cylndr ped f Q4037 A Cast sup shrt leg plaster Q4038 A Cast sup shrt leg fiberglass Q4039 A Cast sup shrt leg ped plster Q4040 A Cast sup shrt leg ped fbrgls Q4041 A Cast sup lng leg splnt plstr Q4042 A Cast sup lng leg splnt fbrgl Q4043 A Cast sup lng leg splnt ped p Q4044 A Cast sup lng leg splnt ped f Q4045 A Cast sup sht leg splnt plstr Q4046 A Cast sup sht leg splnt fbrgl Q4047 A Cast sup sht leg splnt ped p Q4048 A Cast sup sht leg splnt ped f Q4049 A Finger splint, static Start Printed Page 48209 Q4050 A Cast supplies unlisted Q4051 A Splint supplies misc Q4052 K Octreotide injection, depot 1207 1.1849 $64.33 $12.87 Q4053 G Pegfilgrastim, per 1 mg 9119 $467.09 $69.82 Q9920 A Epoetin with hct <= 20 Q9921 A Epoetin with hct = 21 Q9922 A Epoetin with hct = 22 Q9923 A Epoetin with hct = 23 Q9924 A Epoetin with hct = 24 Q9925 A Epoetin with hct = 25 Q9926 A Epoetin with hct = 26 Q9927 A Epoetin with hct = 27 Q9928 A Epoetin with hct = 28 Q9929 A Epoetin with hct = 29 Q9930 A Epoetin with hct = 30 Q9931 A Epoetin with hct = 31 Q9932 A Epoetin with hct = 32 Q9933 A Epoetin with hct = 33 Q9934 A Epoetin with hct = 34 Q9935 A Epoetin with hct = 35 Q9936 A Epoetin with hct = 36 Q9937 A Epoetin with hct = 37 Q9938 A Epoetin with hct = 38 Q9939 A Epoetin with hct = 39 Q9940 A Epoetin with hct >= 40 R0070 N Transport portable x-ray R0075 N Transport port x-ray multipl R0076 N Transport portable EKG T1015 E Clinic service T1016 E Case management T1017 E Targeted case management T1018 E School-based IEP ser bundled T1019 E Personal care ser per 15 min T1020 E Personal care ser per diem T1021 E HH Aide or cn aide per visit T1022 E Contracted services per day T1023 E Program intake assessment T1024 E Team evaluation & management T1025 E Ped compr care pkg, per diem T1026 E Ped compr care pkg, per hour T1027 E Family training & counseling T1028 E Home environment assessment T1029 E Dwelling lead investigation T1030 E RN home care per diem T1031 E LPN home care per diem T1500 E Reusable diaper/pant T1502 E Medication admin visit T1999 E NOC retail items andsupplies T2001 E N-et; patient attend/escort T2002 E N-et; per diem T2003 E N-et; encounter/trip T2004 E N-et; commerc carrier pass T2005 E N-et; stretcher van T2006 E Amb response & trt, no trans T2007 E Non-emer transport wait time V2020 A Vision svcs frames purchases V2025 E Eyeglasses delux frames V2100 A Lens spher single plano 4.00 V2101 A Single visn sphere 4.12-7.00 V2102 A Singl visn sphere 7.12-20.00 V2103 A Spherocylindr 4.00d/12-2.00d V2104 A Spherocylindr 4.00d/2.12-4d V2105 A Spherocylinder 4.00d/4.25-6d V2106 A Spherocylinder 4.00d/>6.00d V2107 A Spherocylinder 4.25d/12-2d V2108 A Spherocylinder 4.25d/2.12-4d Start Printed Page 48210 V2109 A Spherocylinder 4.25d/4.25-6d V2110 A Spherocylinder 4.25d/over 6d V2111 A Spherocylindr 7.25d/.25-2.25 V2112 A Spherocylindr 7.25d/2.25-4d V2113 A Spherocylindr 7.25d/4.25-6d V2114 A Spherocylinder over 12.00d V2115 A Lens lenticular bifocal V2116 A Nonaspheric lens bifocal V2117 A Aspheric lens bifocal V2118 A Lens aniseikonic single V2199 A Lens single vision not oth c V2200 A Lens spher bifoc plano 4.00d V2201 A Lens sphere bifocal 4.12-7.0 V2202 A Lens sphere bifocal 7.12-20. V2203 A Lens sphcyl bifocal 4.00d/.1 V2204 A Lens sphcy bifocal 4.00d/2.1 V2205 A Lens sphcy bifocal 4.00d/4.2 V2206 A Lens sphcy bifocal 4.00d/ove V2207 A Lens sphcy bifocal 4.25-7d/. V2208 A Lens sphcy bifocal 4.25-7/2. V2209 A Lens sphcy bifocal 4.25-7/4. V2210 A Lens sphcy bifocal 4.25-7/ov V2211 A Lens sphcy bifo 7.25-12/.25- V2212 A Lens sphcyl bifo 7.25-12/2.2 V2213 A Lens sphcyl bifo 7.25-12/4.2 V2214 A Lens sphcyl bifocal over 12. V2215 A Lens lenticular bifocal V2216 A Lens lenticular nonaspheric V2217 A Lens lenticular aspheric bif V2218 A Lens aniseikonic bifocal V2219 A Lens bifocal seg width over V2220 A Lens bifocal add over 3.25d V2299 A Lens bifocal speciality V2300 A Lens sphere trifocal 4.00d V2301 A Lens sphere trifocal 4.12-7. V2302 A Lens sphere trifocal 7.12-20 V2303 A Lens sphcy trifocal 4.0/.12- V2304 A Lens sphcy trifocal 4.0/2.25 V2305 A Lens sphcy trifocal 4.0/4.25 V2306 A Lens sphcyl trifocal 4.00/>6 V2307 A Lens sphcy trifocal 4.25-7/. V2308 A Lens sphc trifocal 4.25-7/2. V2309 A Lens sphc trifocal 4.25-7/4. V2310 A Lens sphc trifocal 4.25-7/>6 V2311 A Lens sphc trifo 7.25-12/.25- V2312 A Lens sphc trifo 7.25-12/2.25 V2313 A Lens sphc trifo 7.25-12/4.25 V2314 A Lens sphcyl trifocal over 12 V2315 A Lens lenticular trifocal V2316 A Lens lenticular nonaspheric V2317 A Lens lenticular aspheric tri V2318 A Lens aniseikonic trifocal V2319 A Lens trifocal seg width > 28 V2320 A Lens trifocal add over 3.25d V2399 A Lens trifocal speciality V2410 A Lens variab asphericity sing V2430 A Lens variable asphericity bi V2499 A Variable asphericity lens V2500 A Contact lens pmma spherical V2501 A Cntct lens pmma-toric/prism V2502 A Contact lens pmma bifocal V2503 A Cntct lens pmma color vision V2510 A Cntct gas permeable sphericl V2511 A Cntct toric prism ballast V2512 A Cntct lens gas permbl bifocl V2513 A Contact lens extended wear Start Printed Page 48211 V2520 A Contact lens hydrophilic V2521 A Cntct lens hydrophilic toric V2522 A Cntct lens hydrophil bifocl V2523 A Cntct lens hydrophil extend V2530 A Contact lens gas impermeable V2531 A Contact lens gas permeable V2599 A Contact lens/es other type V2600 A Hand held low vision aids V2610 A Single lens spectacle mount V2615 A Telescop/othr compound lens V2623 A Plastic eye prosth custom V2624 A Polishing artifical eye V2625 A Enlargemnt of eye prosthesis V2626 A Reduction of eye prosthesis V2627 A Scleral cover shell V2628 A Fabrication & fitting V2629 A Prosthetic eye other type V2630 N Anter chamber intraocul lens V2631 N Iris support intraoclr lens V2632 N Post chmbr intraocular lens V2700 A Balance lens V2710 A Glass/plastic slab off prism V2715 A Prism lens/es V2718 A Fresnell prism press-on lens V2730 A Special base curve V2740 A Rose tint plastic V2741 A Non-rose tint plastic V2742 A Rose tint glass V2743 A Non-rose tint glass V2744 A Tint photochromatic lens/es V2750 A Anti-reflective coating V2755 A UV lens/es V2760 A Scratch resistant coating V2770 A Occluder lens/es V2780 A Oversize lens/es V2781 E Progressive lens per lens V2785 F Corneal tissue processing V2790 N Amniotic membrane V2799 A Miscellaneous vision service V5008 E Hearing screening V5010 E Assessment for hearing aid V5011 E Hearing aid fitting/checking V5014 E Hearing aid repair/modifying V5020 E Conformity evaluation V5030 E Body-worn hearing aid air V5040 E Body-worn hearing aid bone V5050 E Hearing aid monaural in ear V5060 E Behind ear hearing aid V5070 E Glasses air conduction V5080 E Glasses bone conduction V5090 E Hearing aid dispensing fee V5095 E Implant mid ear hearing pros V5100 E Body-worn bilat hearing aid V5110 E Hearing aid dispensing fee V5120 E Body-worn binaur hearing aid V5130 E In ear binaural hearing aid V5140 E Behind ear binaur hearing ai V5150 E Glasses binaural hearing aid V5160 E Dispensing fee binaural V5170 E Within ear cros hearing aid V5180 E Behind ear cros hearing aid V5190 E Glasses cros hearing aid V5200 E Cros hearing aid dispens fee V5210 E In ear bicros hearing aid V5220 E Behind ear bicros hearing ai V5230 E Glasses bicros hearing aid Start Printed Page 48212 V5240 E Dispensing fee bicros V5241 E Dispensing fee, monaural V5242 E Hearing aid, monaural, cic V5243 E Hearing aid, monaural, itc V5244 E Hearing aid, prog, mon, cic V5245 E Hearing aid, prog, mon, itc V5246 E Hearing aid, prog, mon, ite V5247 E Hearing aid, prog, mon, bte V5248 E Hearing aid, binaural, cic V5249 E Hearing aid, binaural, itc V5250 E Hearing aid, prog, bin, cic V5251 E Hearing aid, prog, bin, itc V5252 E Hearing aid, prog, bin, ite V5253 E Hearing aid, prog, bin, bte V5254 E Hearing id, digit, mon, cic V5255 E Hearing aid, digit, mon, itc V5256 E Hearing aid, digit, mon, ite V5257 E Hearing aid, digit, mon, bte V5258 E Hearing aid, digit, bin, cic V5259 E Hearing aid, digit, bin, itc V5260 E Hearing aid, digit, bin, ite V5261 E Hearing aid, digit, bin, bte V5262 E Hearing aid, disp, monaural V5263 E Hearing aid, disp, binaural V5264 E Ear mold/insert V5265 E Ear mold/insert, disp V5266 E Battery for hearing device V5267 E Hearing aid supply/accessory V5268 E ALD Telephone Amplifier V5269 E Alerting device, any type V5270 E ALD, TV amplifier, any type V5271 E ALD, TV caption decoder V5272 E Tdd V5273 E ALD for cochlear implant V5274 E ALD unspecified V5275 E Ear impression V5298 E Hearing aid noc V5299 E Hearing service V5336 E Repair communication device V5362 A Speech screening V5363 A Language screening V5364 A Dysphagia screening CPT codes and escriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All right reserved. Addendum D.—Payment Status Indicators for the Hospital Outpatient Prospective Payment System
Indicator Service Status A Services Paid under a Fee Schedule Other than OPPS, e.g., Clinical Diagnostic Laboratory Services; Physical, Occupational and Speech Therapy; and Screening Mammography Paid under a Payment System other than OPPS. C Inpatient Procedures Not Paid under OPPS; Admit Patient; Bill as Inpatient. D Deleted Code Not Paid under Medicare. E Non-Covered Items and Services; Codes not Payable in Hospital Outpatient Setting; Codes Not Recognized by OPPS but for Which an Alternate Code may be Applicable. Not Covered under Medicare, or not an Allowed Code when Performed in a Hospital Outpatient Setting. F Corneal Tissue Acquisition Paid at Reasonable Cost. G Drug/Biological Pass-Through Paid under OPPS; Separate APC Payment Includes Pass-Through Amount. H Device Category Pass-Through Paid under OPPS; Separate Cost-Based Pass-Through Payment. K Non Pass-Through Drug/Biological, Radiopharmaceutical Agent, Certain Brachytherapy Sources Paid under OPPS; Separate APC. L Influenza Vaccine; Pneumococcal Pneumonia Vaccine Paid at Reasonable Cost; Not Subject to Deductible or Coinsurance. Start Printed Page 48213 N Items and Services Packaged into APC Rate Paid under OPPS; Payment is Packaged into Payment for Other Services. P Partial Hospitalization Paid under OPPS; Per Diem APC. S Significant Procedure, Not Discounted when Multiple Paid under OPPS; Separate APC. T Significant Procedure, Multiple Procedure Reduction Applies Paid under OPPS; Separate APC. V Clinic or Emergency Department Visit Paid under OPPS; Separate APC. X Ancillary Service Paid under OPPS; Separate APC. Start Printed Page 48239Addendum E.—CPT Codes Which Would Be Paid Only as Inpatient Procedures
[Calendar Year 2004]
CPT/HCPCS Status indicator Description 0001T C Endovas repr abdo ao aneurys 0002T C Endovas repr abdo ao aneurys 0005T C Perc cath stent/brain cv art 0006T C Perc cath stent/brain cv art 0007T C Perc cath stent/brain cv art 00174 C Anesth, pharyngeal surgery 00176 C Anesth, pharyngeal surgery 00192 C Anesth, facial bone surgery 00214 C Anesth, skull drainage 00215 C Anesth, skull repair/fract 0021T C Fetal oximetry, trnsvag/cerv 0024T C Transcath cardiac reduction 0033T C Endovasc taa repr incl subcl 0034T C Endovasc taa repr w/o subcl 0035T C Insert endovasc prosth, taa 0036T C Endovasc prosth, taa, add-on 0037T C Artery transpose/endovas taa 0038T C Rad endovasc taa rpr w/cover 0039T C Rad s/i, endovasc taa repair 00404 C Anesth, surgery of breast 00406 C Anesth, surgery of breast 0040T C Rad s/i, endovasc taa prosth 00452 C Anesth, surgery of shoulder 00474 C Anesth, surgery of rib(s) 00524 C Anesth, chest drainage 00540 C Anesth, chest surgery 00542 C Anesth, release of lung 00544 C Anesth, chest lining removal 00546 C Anesth, lung,chest wall surg 00560 C Anesth, open heart surgery 00562 C Anesth, open heart surgery 00580 C Anesth, heart/lung transplnt 00604 C Anesth, sitting procedure 00622 C Anesth, removal of nerves 00632 C Anesth, removal of nerves 00634 C Anesth for chemonucleolysis 00670 C Anesth, spine, cord surgery 00792 C Anesth, hemorr/excise liver 00794 C Anesth, pancreas removal 00796 C Anesth, for liver transplant 00802 C Anesth, fat layer removal 00844 C Anesth, pelvis surgery 00846 C Anesth, hysterectomy 00848 C Anesth, pelvic organ surg 00864 C Anesth, removal of bladder 00865 C Anesth, removal of prostate 00866 C Anesth, removal of adrenal 00868 C Anesth, kidney transplant 00882 C Anesth, major vein ligation 00904 C Anesth, perineal surgery 00908 C Anesth, removal of prostate 00928 C Anesth, removal of testis 00932 C Anesth, amputation of penis 00934 C Anesth, penis, nodes removal 00936 C Anesth, penis, nodes removal 00944 C Anesth, vaginal hysterectomy 01140 C Anesth, amputation at pelvis 01150 C Anesth, pelvic tumor surgery 01190 C Anesth, pelvis nerve removal 01212 C Anesth, hip disarticulation 01214 C Anesth, hip arthroplasty 01232 C Anesth, amputation of femur 01234 C Anesth, radical femur surg Start Printed Page 48215 01272 C Anesth, femoral artery surg 01274 C Anesth, femoral embolectomy 01402 C Anesth, knee arthroplasty 01404 C Anesth, amputation at knee 01442 C Anesth, knee artery surg 01444 C Anesth, knee artery repair 01486 C Anesth, ankle replacement 01502 C Anesth, lwr leg embolectomy 01632 C Anesth, surgery of shoulder 01634 C Anesth, shoulder joint amput 01636 C Anesth, forequarter amput 31225 C Removal of upper jaw 31230 C Removal of upper jaw 31290 C Nasal/sinus endoscopy, surg 31291 C Nasal/sinus endoscopy, surg 31292 C Nasal/sinus endoscopy, surg 31293 C Nasal/sinus endoscopy, surg 31294 C Nasal/sinus endoscopy, surg 31360 C Removal of larynx 31365 C Removal of larynx 31367 C Partial removal of larynx 31368 C Partial removal of larynx 31370 C Partial removal of larynx 31375 C Partial removal of larynx 31380 C Partial removal of larynx 31382 C Partial removal of larynx 31390 C Removal of larynx & pharynx 31395 C Reconstruct larynx & pharynx 31584 C Treat larynx fracture 31587 C Revision of larynx 31725 C Clearance of airways 31760 C Repair of windpipe 31766 C Reconstruction of windpipe 31770 C Repair/graft of bronchus 31775 C Reconstruct bronchus 31780 C Reconstruct windpipe 31781 C Reconstruct windpipe 31786 C Remove windpipe lesion 31800 C Repair of windpipe injury 31805 C Repair of windpipe injury 32035 C Exploration of chest 32036 C Exploration of chest 32095 C Biopsy through chest wall 32100 C Exploration/biopsy of chest 32110 C Explore/repair chest 32120 C Re-exploration of chest 32124 C Explore chest free adhesions 32140 C Removal of lung lesion(s) 32141 C Remove/treat lung lesions 32150 C Removal of lung lesion(s) 32151 C Remove lung foreign body 32160 C Open chest heart massage 32200 C Drain, open, lung lesion 32215 C Treat chest lining 32220 C Release of lung 32225 C Partial release of lung 32310 C Removal of chest lining 32320 C Free/remove chest lining 32402 C Open biopsy chest lining 32440 C Removal of lung 32442 C Sleeve pneumonectomy 32445 C Removal of lung 32480 C Partial removal of lung 32482 C Bilobectomy 32484 C Segmentectomy Start Printed Page 48216 32486 C Sleeve lobectomy 32488 C Completion pneumonectomy 32491 C Lung volume reduction 32500 C Partial removal of lung 32501 C Repair bronchus add-on 32520 C Remove lung & revise chest 32522 C Remove lung & revise chest 32525 C Remove lung & revise chest 32540 C Removal of lung lesion 32650 C Thoracoscopy, surgical 32651 C Thoracoscopy, surgical 32652 C Thoracoscopy, surgical 32653 C Thoracoscopy, surgical 32654 C Thoracoscopy, surgical 32655 C Thoracoscopy, surgical 32656 C Thoracoscopy, surgical 32657 C Thoracoscopy, surgical 32658 C Thoracoscopy, surgical 32659 C Thoracoscopy, surgical 32660 C Thoracoscopy, surgical 32661 C Thoracoscopy, surgical 32662 C Thoracoscopy, surgical 32663 C Thoracoscopy, surgical 32664 C Thoracoscopy, surgical 32665 C Thoracoscopy, surgical 32800 C Repair lung hernia 32810 C Close chest after drainage 01638 C Anesth, shoulder replacement 01652 C Anesth, shoulder vessel surg 01654 C Anesth, shoulder vessel surg 01656 C Anesth, arm-leg vessel surg 01756 C Anesth, radical humerus surg 01990 C Support for organ donor 15756 C Free muscle flap, microvasc 15757 C Free skin flap, microvasc 15758 C Free fascial flap, microvasc 16035 C Incision of burn scab, initi 16036 C Incise burn scab, addl incis 19200 C Removal of breast 19220 C Removal of breast 19271 C Revision of chest wall 19272 C Extensive chest wall surgery 19361 C Breast reconstruction 19364 C Breast reconstruction 19367 C Breast reconstruction 19368 C Breast reconstruction 19369 C Breast reconstruction 20660 C Apply, rem fixation device 20661 C Application of head brace 20662 C Application of pelvis brace 20663 C Application of thigh brace 20664 C Halo brace application 20802 C Replantation, arm, complete 20805 C Replant forearm, complete 20808 C Replantation hand, complete 20816 C Replantation digit, complete 20822 C Replantation digit, complete 20824 C Replantation thumb, complete 20827 C Replantation thumb, complete 20838 C Replantation foot, complete 20930 C Spinal bone allograft 20931 C Spinal bone allograft 20936 C Spinal bone autograft 20937 C Spinal bone autograft 20938 C Spinal bone autograft Start Printed Page 48217 20955 C Fibula bone graft, microvasc 20956 C Iliac bone graft, microvasc 20957 C Mt bone graft, microvasc 20962 C Other bone graft, microvasc 20969 C Bone/skin graft, microvasc 20970 C Bone/skin graft, iliac crest 20972 C Bone/skin graft, metatarsal 20973 C Bone/skin graft, great toe 21045 C Extensive jaw surgery 21141 C Reconstruct midface, lefort 21142 C Reconstruct midface, lefort 21143 C Reconstruct midface, lefort 21145 C Reconstruct midface, lefort 21146 C Reconstruct midface, lefort 21147 C Reconstruct midface, lefort 21150 C Reconstruct midface, lefort 21151 C Reconstruct midface, lefort 21154 C Reconstruct midface, lefort 21155 C Reconstruct midface, lefort 21159 C Reconstruct midface, lefort 21160 C Reconstruct midface, lefort 21172 C Reconstruct orbit/forehead 21175 C Reconstruct orbit/forehead 21179 C Reconstruct entire forehead 21180 C Reconstruct entire forehead 21182 C Reconstruct cranial bone 21183 C Reconstruct cranial bone 21184 C Reconstruct cranial bone 21188 C Reconstruction of midface 21193 C Reconst lwr jaw w/o graft 21194 C Reconst lwr jaw w/graft 21195 C Reconst lwr jaw w/o fixation 21196 C Reconst lwr jaw w/fixation 21247 C Reconstruct lower jaw bone 21255 C Reconstruct lower jaw bone 21256 C Reconstruction of orbit 21268 C Revise eye sockets 21343 C Treatment of sinus fracture 21344 C Treatment of sinus fracture 21346 C Treat nose/jaw fracture 21347 C Treat nose/jaw fracture 21348 C Treat nose/jaw fracture 21356 C Treat cheek bone fracture 21360 C Treat cheek bone fracture 21365 C Treat cheek bone fracture 21366 C Treat cheek bone fracture 21385 C Treat eye socket fracture 21386 C Treat eye socket fracture 21387 C Treat eye socket fracture 21395 C Treat eye socket fracture 21408 C Treat eye socket fracture 21422 C Treat mouth roof fracture 21423 C Treat mouth roof fracture 21431 C Treat craniofacial fracture 21432 C Treat craniofacial fracture 21433 C Treat craniofacial fracture 21435 C Treat craniofacial fracture 21436 C Treat craniofacial fracture 21495 C Treat hyoid bone fracture 21510 C Drainage of bone lesion 21557 C Remove tumor, neck/chest 21615 C Removal of rib 21616 C Removal of rib and nerves 21620 C Partial removal of sternum 21627 C Sternal debridement Start Printed Page 48218 21630 C Extensive sternum surgery 21632 C Extensive sternum surgery 21705 C Revision of neck muscle/rib 21740 C Reconstruction of sternum 21750 C Repair of sternum separation 21810 C Treatment of rib fracture(s) 21825 C Treat sternum fracture 22110 C Remove part of neck vertebra 22112 C Remove part, thorax vertebra 22114 C Remove part, lumbar vertebra 22116 C Remove extra spine segment 22210 C Revision of neck spine 22212 C Revision of thorax spine 22214 C Revision of lumbar spine 22216 C Revise, extra spine segment 22220 C Revision of neck spine 22222 C Revision of thorax spine 22224 C Revision of lumbar spine 22226 C Revise, extra spine segment 22318 C Treat odontoid fx w/o graft 22319 C Treat odontoid fx w/graft 22325 C Treat spine fracture 22326 C Treat neck spine fracture 22327 C Treat thorax spine fracture 22328 C Treat each add spine fx 22548 C Neck spine fusion 22554 C Neck spine fusion 22556 C Thorax spine fusion 22558 C Lumbar spine fusion 22585 C Additional spinal fusion 22590 C Spine & skull spinal fusion 22595 C Neck spinal fusion 22600 C Neck spine fusion 22610 C Thorax spine fusion 22630 C Lumbar spine fusion 22632 C Spine fusion, extra segment 22800 C Fusion of spine 22802 C Fusion of spine 22804 C Fusion of spine 22808 C Fusion of spine 22810 C Fusion of spine 22812 C Fusion of spine 22818 C Kyphectomy, 1-2 segments 22819 C Kyphectomy, 3 or more 22830 C Exploration of spinal fusion 22840 C Insert spine fixation device 22841 C Insert spine fixation device 22842 C Insert spine fixation device 22843 C Insert spine fixation device 22844 C Insert spine fixation device 22845 C Insert spine fixation device 22846 C Insert spine fixation device 22847 C Insert spine fixation device 22848 C Insert pelv fixation device 22849 C Reinsert spinal fixation 22850 C Remove spine fixation device 22851 C Apply spine prosth device 22852 C Remove spine fixation device 22855 C Remove spine fixation device 23200 C Removal of collar bone 23210 C Removal of shoulder blade 23220 C Partial removal of humerus 23221 C Partial removal of humerus 23222 C Partial removal of humerus 23332 C Remove shoulder foreign body Start Printed Page 48219 23472 C Reconstruct shoulder joint 23900 C Amputation of arm & girdle 23920 C Amputation at shoulder joint 24149 C Radical resection of elbow 24900 C Amputation of upper arm 24920 C Amputation of upper arm 24930 C Amputation follow-up surgery 24931 C Amputate upper arm & implant 24940 C Revision of upper arm 25900 C Amputation of forearm 25905 C Amputation of forearm 25909 C Amputation follow-up surgery 25915 C Amputation of forearm 25920 C Amputate hand at wrist 25924 C Amputation follow-up surgery 25927 C Amputation of hand 25931 C Amputation follow-up surgery 26551 C Great toe-hand transfer 26553 C Single transfer, toe-hand 26554 C Double transfer, toe-hand 26556 C Toe joint transfer 26992 C Drainage of bone lesion 27005 C Incision of hip tendon 27006 C Incision of hip tendons 27025 C Incision of hip/thigh fascia 27030 C Drainage of hip joint 27036 C Excision of hip joint/muscle 27054 C Removal of hip joint lining 27070 C Partial removal of hip bone 27071 C Partial removal of hip bone 27075 C Extensive hip surgery 27076 C Extensive hip surgery 27077 C Extensive hip surgery 27078 C Extensive hip surgery 27079 C Extensive hip surgery 27090 C Removal of hip prosthesis 27091 C Removal of hip prosthesis 27120 C Reconstruction of hip socket 27122 C Reconstruction of hip socket 27125 C Partial hip replacement 27130 C Total hip arthroplasty 27132 C Total hip arthroplasty 27134 C Revise hip joint replacement 27137 C Revise hip joint replacement 27138 C Revise hip joint replacement 27140 C Transplant femur ridge 27146 C Incision of hip bone 27147 C Revision of hip bone 27151 C Incision of hip bones 27156 C Revision of hip bones 27158 C Revision of pelvis 27161 C Incision of neck of femur 27165 C Incision/fixation of femur 27170 C Repair/graft femur head/neck 27175 C Treat slipped epiphysis 27176 C Treat slipped epiphysis 27177 C Treat slipped epiphysis 27178 C Treat slipped epiphysis 27179 C Revise head/neck of femur 27181 C Treat slipped epiphysis 27185 C Revision of femur epiphysis 27187 C Reinforce hip bones 27215 C Treat pelvic fracture(s) 27217 C Treat pelvic ring fracture 27218 C Treat pelvic ring fracture Start Printed Page 48220 27222 C Treat hip socket fracture 27226 C Treat hip wall fracture 27227 C Treat hip fracture(s) 27228 C Treat hip fracture(s) 27232 C Treat thigh fracture 27236 C Treat thigh fracture 27240 C Treat thigh fracture 27244 C Treat thigh fracture 27245 C Treat thigh fracture 27248 C Treat thigh fracture 27253 C Treat hip dislocation 27254 C Treat hip dislocation 27258 C Treat hip dislocation 27259 C Treat hip dislocation 27280 C Fusion of sacroiliac joint 27282 C Fusion of pubic bones 27284 C Fusion of hip joint 27286 C Fusion of hip joint 27290 C Amputation of leg at hip 27295 C Amputation of leg at hip 27303 C Drainage of bone lesion 27365 C Extensive leg surgery 27445 C Revision of knee joint 27447 C Total knee arthroplasty 27448 C Incision of thigh 27450 C Incision of thigh 27454 C Realignment of thigh bone 27455 C Realignment of knee 27457 C Realignment of knee 27465 C Shortening of thigh bone 27466 C Lengthening of thigh bone 27468 C Shorten/lengthen thighs 27470 C Repair of thigh 27472 C Repair/graft of thigh 27475 C Surgery to stop leg growth 27477 C Surgery to stop leg growth 27479 C Surgery to stop leg growth 27485 C Surgery to stop leg growth 27486 C Revise/replace knee joint 27487 C Revise/replace knee joint 27488 C Removal of knee prosthesis 27495 C Reinforce thigh 27506 C Treatment of thigh fracture 27507 C Treatment of thigh fracture 27511 C Treatment of thigh fracture 27513 C Treatment of thigh fracture 27514 C Treatment of thigh fracture 27519 C Treat thigh fx growth plate 27535 C Treat knee fracture 27536 C Treat knee fracture 27540 C Treat knee fracture 27556 C Treat knee dislocation 27557 C Treat knee dislocation 27558 C Treat knee dislocation 27580 C Fusion of knee 27590 C Amputate leg at thigh 27591 C Amputate leg at thigh 27592 C Amputate leg at thigh 27596 C Amputation follow-up surgery 27598 C Amputate lower leg at knee 27645 C Extensive lower leg surgery 27646 C Extensive lower leg surgery 27702 C Reconstruct ankle joint 27703 C Reconstruction, ankle joint 27712 C Realignment of lower leg Start Printed Page 48221 27715 C Revision of lower leg 27720 C Repair of tibia 27722 C Repair/graft of tibia 27724 C Repair/graft of tibia 27725 C Repair of lower leg 27727 C Repair of lower leg 27880 C Amputation of lower leg 27881 C Amputation of lower leg 27882 C Amputation of lower leg 27886 C Amputation follow-up surgery 27888 C Amputation of foot at ankle 28800 C Amputation of midfoot 28805 C Amputation thru metatarsal 32815 C Close bronchial fistula 32820 C Reconstruct injured chest 32850 C Donor pneumonectomy 32851 C Lung transplant, single 32852 C Lung transplant with bypass 32853 C Lung transplant, double 32854 C Lung transplant with bypass 32900 C Removal of rib(s) 32905 C Revise & repair chest wall 32906 C Revise & repair chest wall 32940 C Revision of lung 32997 C Total lung lavage 33015 C Incision of heart sac 33020 C Incision of heart sac 33025 C Incision of heart sac 33030 C Partial removal of heart sac 33031 C Partial removal of heart sac 33050 C Removal of heart sac lesion 33120 C Removal of heart lesion 33130 C Removal of heart lesion 33140 C Heart revascularize (tmr) 33141 C Heart tmr w/other procedure 33200 C Insertion of heart pacemaker 33201 C Insertion of heart pacemaker 33236 C Remove electrode/thoracotomy 33237 C Remove electrode/thoracotomy 33238 C Remove electrode/thoracotomy 33243 C Remove eltrd/thoracotomy 33245 C Insert epic eltrd pace-defib 33246 C Insert epic eltrd/generator 33250 C Ablate heart dysrhythm focus 33251 C Ablate heart dysrhythm focus 33253 C Reconstruct atria 33261 C Ablate heart dysrhythm focus 33300 C Repair of heart wound 33305 C Repair of heart wound 33310 C Exploratory heart surgery 33315 C Exploratory heart surgery 33320 C Repair major blood vessel(s) 33321 C Repair major vessel 33322 C Repair major blood vessel(s) 33330 C Insert major vessel graft 33332 C Insert major vessel graft 33335 C Insert major vessel graft 33400 C Repair of aortic valve 33401 C Valvuloplasty, open 33403 C Valvuloplasty, w/cp bypass 33404 C Prepare heart-aorta conduit 33405 C Replacement of aortic valve 33406 C Replacement of aortic valve 33410 C Replacement of aortic valve 33411 C Replacement of aortic valve Start Printed Page 48222 33412 C Replacement of aortic valve 33413 C Replacement of aortic valve 33414 C Repair of aortic valve 33415 C Revision, subvalvular tissue 33416 C Revise ventricle muscle 33417 C Repair of aortic valve 33420 C Revision of mitral valve 33422 C Revision of mitral valve 33425 C Repair of mitral valve 33426 C Repair of mitral valve 33427 C Repair of mitral valve 33430 C Replacement of mitral valve 33460 C Revision of tricuspid valve 33463 C Valvuloplasty, tricuspid 33464 C Valvuloplasty, tricuspid 33465 C Replace tricuspid valve 33468 C Revision of tricuspid valve 33470 C Revision of pulmonary valve 33471 C Valvotomy, pulmonary valve 33472 C Revision of pulmonary valve 33474 C Revision of pulmonary valve 33475 C Replacement, pulmonary valve 33476 C Revision of heart chamber 33478 C Revision of heart chamber 33496 C Repair, prosth valve clot 33500 C Repair heart vessel fistula 33501 C Repair heart vessel fistula 33502 C Coronary artery correction 33503 C Coronary artery graft 33504 C Coronary artery graft 33505 C Repair artery w/tunnel 33506 C Repair artery, translocation 33510 C CABG, vein, single 33511 C CABG, vein, two 33512 C CABG, vein, three 33513 C CABG, vein, four 33514 C CABG, vein, five 33516 C Cabg, vein, six or more 33517 C CABG, artery-vein, single 33518 C CABG, artery-vein, two 33519 C CABG, artery-vein, three 33521 C CABG, artery-vein, four 33522 C CABG, artery-vein, five 33523 C Cabg, art-vein, six or more 33530 C Coronary artery, bypass/reop 33533 C CABG, arterial, single 33534 C CABG, arterial, two 33535 C CABG, arterial, three 33536 C Cabg, arterial, four or more 33542 C Removal of heart lesion 33545 C Repair of heart damage 33572 C Open coronary endarterectomy 33600 C Closure of valve 33602 C Closure of valve 33606 C Anastomosis/artery-aorta 33608 C Repair anomaly w/conduit 33610 C Repair by enlargement 33611 C Repair double ventricle 33612 C Repair double ventricle 33615 C Repair, modified fontan 33617 C Repair single ventricle 33619 C Repair single ventricle 33641 C Repair heart septum defect 33645 C Revision of heart veins 33647 C Repair heart septum defects Start Printed Page 48223 33660 C Repair of heart defects 33665 C Repair of heart defects 33670 C Repair of heart chambers 33681 C Repair heart septum defect 33684 C Repair heart septum defect 33688 C Repair heart septum defect 33690 C Reinforce pulmonary artery 33692 C Repair of heart defects 33694 C Repair of heart defects 33697 C Repair of heart defects 33702 C Repair of heart defects 33710 C Repair of heart defects 33720 C Repair of heart defect 33722 C Repair of heart defect 33730 C Repair heart-vein defect(s) 33732 C Repair heart-vein defect 33735 C Revision of heart chamber 33736 C Revision of heart chamber 33737 C Revision of heart chamber 33750 C Major vessel shunt 33755 C Major vessel shunt 33762 C Major vessel shunt 33764 C Major vessel shunt & graft 33766 C Major vessel shunt 33767 C Major vessel shunt 33770 C Repair great vessels defect 33771 C Repair great vessels defect 33774 C Repair great vessels defect 33775 C Repair great vessels defect 33776 C Repair great vessels defect 33777 C Repair great vessels defect 33778 C Repair great vessels defect 33779 C Repair great vessels defect 33780 C Repair great vessels defect 33781 C Repair great vessels defect 33786 C Repair arterial trunk 33788 C Revision of pulmonary artery 33800 C Aortic suspension 33802 C Repair vessel defect 33803 C Repair vessel defect 33813 C Repair septal defect 33814 C Repair septal defect 33820 C Revise major vessel 33822 C Revise major vessel 33824 C Revise major vessel 33840 C Remove aorta constriction 33845 C Remove aorta constriction 33851 C Remove aorta constriction 33852 C Repair septal defect 33853 C Repair septal defect 33860 C Ascending aortic graft 33861 C Ascending aortic graft 33863 C Ascending aortic graft 33870 C Transverse aortic arch graft 33875 C Thoracic aortic graft 33877 C Thoracoabdominal graft 33910 C Remove lung artery emboli 33915 C Remove lung artery emboli 33916 C Surgery of great vessel 33917 C Repair pulmonary artery 33918 C Repair pulmonary atresia 33919 C Repair pulmonary atresia 33920 C Repair pulmonary atresia 33922 C Transect pulmonary artery 33924 C Remove pulmonary shunt Start Printed Page 48224 33930 C Removal of donor heart/lung 33935 C Transplantation, heart/lung 33940 C Removal of donor heart 33945 C Transplantation of heart 33960 C External circulation assist 33961 C External circulation assist 33967 C Insert ia percut device 33968 C Remove aortic assist device 33970 C Aortic circulation assist 33971 C Aortic circulation assist 33973 C Insert balloon device 33974 C Remove intra-aortic balloon 33975 C Implant ventricular device 33976 C Implant ventricular device 33977 C Remove ventricular device 33978 C Remove ventricular device 33979 C Insert intracorporeal device 33980 C Remove intracorporeal device 34001 C Removal of artery clot 34051 C Removal of artery clot 34151 C Removal of artery clot 34401 C Removal of vein clot 34451 C Removal of vein clot 34502 C Reconstruct vena cava 34800 C Endovasc abdo repair w/tube 34802 C Endovasc abdo repr w/device 34804 C Endovasc abdo repr w/device 34808 C Endovasc abdo occlud device 34812 C Xpose for endoprosth, aortic 34813 C Femoral endovas graft add-on 34820 C Xpose for endoprosth, iliac 34825 C Endovasc extend prosth, init 34826 C Endovasc exten prosth, addl 34830 C Open aortic tube prosth repr 34831 C Open aortoiliac prosth repr 34832 C Open aortofemor prosth repr 34833 C Xpose for endoprosth, iliac 34834 C Xpose, endoprosth, brachial 34900 C Endovasc iliac repr w/graft 35001 C Repair defect of artery 35002 C Repair artery rupture, neck 35005 C Repair defect of artery 35013 C Repair artery rupture, arm 35021 C Repair defect of artery 35022 C Repair artery rupture, chest 35045 C Repair defect of arm artery 35081 C Repair defect of artery 35082 C Repair artery rupture, aorta 35091 C Repair defect of artery 35092 C Repair artery rupture, aorta 35102 C Repair defect of artery 35103 C Repair artery rupture, groin 35111 C Repair defect of artery 35112 C Repair artery rupture,spleen 35121 C Repair defect of artery 35122 C Repair artery rupture, belly 35131 C Repair defect of artery 35132 C Repair artery rupture, groin 35141 C Repair defect of artery 35142 C Repair artery rupture, thigh 35151 C Repair defect of artery 35152 C Repair artery rupture, knee 35161 C Repair defect of artery 35162 C Repair artery rupture 35182 C Repair blood vessel lesion Start Printed Page 48225 35189 C Repair blood vessel lesion 35211 C Repair blood vessel lesion 35216 C Repair blood vessel lesion 35221 C Repair blood vessel lesion 35241 C Repair blood vessel lesion 35246 C Repair blood vessel lesion 35251 C Repair blood vessel lesion 35271 C Repair blood vessel lesion 35276 C Repair blood vessel lesion 35281 C Repair blood vessel lesion 35301 C Rechanneling of artery 35311 C Rechanneling of artery 35331 C Rechanneling of artery 35341 C Rechanneling of artery 35351 C Rechanneling of artery 35355 C Rechanneling of artery 35361 C Rechanneling of artery 35363 C Rechanneling of artery 35371 C Rechanneling of artery 35372 C Rechanneling of artery 35381 C Rechanneling of artery 35390 C Reoperation, carotid add-on 35400 C Angioscopy 35450 C Repair arterial blockage 35452 C Repair arterial blockage 35454 C Repair arterial blockage 35456 C Repair arterial blockage 35480 C Atherectomy, open 35481 C Atherectomy, open 35482 C Atherectomy, open 35483 C Atherectomy, open 35501 C Artery bypass graft 35506 C Artery bypass graft 35507 C Artery bypass graft 35508 C Artery bypass graft 35509 C Artery bypass graft 35511 C Artery bypass graft 35515 C Artery bypass graft 35516 C Artery bypass graft 35518 C Artery bypass graft 35521 C Artery bypass graft 35526 C Artery bypass graft 35531 C Artery bypass graft 35533 C Artery bypass graft 35536 C Artery bypass graft 35541 C Artery bypass graft 35546 C Artery bypass graft 35548 C Artery bypass graft 35549 C Artery bypass graft 35551 C Artery bypass graft 35556 C Artery bypass graft 35558 C Artery bypass graft 35560 C Artery bypass graft 35563 C Artery bypass graft 35565 C Artery bypass graft 35566 C Artery bypass graft 35571 C Artery bypass graft 35582 C Vein bypass graft 35583 C Vein bypass graft 35585 C Vein bypass graft 35587 C Vein bypass graft 35600 C Harvest artery for cabg 35601 C Artery bypass graft 35606 C Artery bypass graft 35612 C Artery bypass graft Start Printed Page 48226 35616 C Artery bypass graft 35621 C Artery bypass graft 35623 C Bypass graft, not vein 35626 C Artery bypass graft 35631 C Artery bypass graft 35636 C Artery bypass graft 35641 C Artery bypass graft 35642 C Artery bypass graft 35645 C Artery bypass graft 35646 C Artery bypass graft 35647 C Artery bypass graft 35650 C Artery bypass graft 35651 C Artery bypass graft 35654 C Artery bypass graft 35656 C Artery bypass graft 35661 C Artery bypass graft 35663 C Artery bypass graft 35665 C Artery bypass graft 35666 C Artery bypass graft 35671 C Artery bypass graft 35681 C Composite bypass graft 35682 C Composite bypass graft 35683 C Composite bypass graft 35691 C Arterial transposition 35693 C Arterial transposition 35694 C Arterial transposition 35695 C Arterial transposition 35700 C Reoperation, bypass graft 35701 C Exploration, carotid artery 35721 C Exploration, femoral artery 35741 C Exploration popliteal artery 35800 C Explore neck vessels 35820 C Explore chest vessels 35840 C Explore abdominal vessels 35870 C Repair vessel graft defect 35901 C Excision, graft, neck 35905 C Excision, graft, thorax 35907 C Excision, graft, abdomen 36510 C Insertion of catheter, vein 36660 C Insertion catheter, artery 36822 C Insertion of cannula(s) 36823 C Insertion of cannula(s) 37140 C Revision of circulation 37145 C Revision of circulation 37160 C Revision of circulation 37180 C Revision of circulation 37181 C Splice spleen/kidney veins 37182 C Insert hepatic shunt (tips) 37183 C Remove hepatic shunt (tips) 37195 C Thrombolytic therapy, stroke 37616 C Ligation of chest artery 37617 C Ligation of abdomen artery 37618 C Ligation of extremity artery 37660 C Revision of major vein 37788 C Revascularization, penis 38100 C Removal of spleen, total 38101 C Removal of spleen, partial 38102 C Removal of spleen, total 38115 C Repair of ruptured spleen 38380 C Thoracic duct procedure 38381 C Thoracic duct procedure 38382 C Thoracic duct procedure 38562 C Removal, pelvic lymph nodes 38564 C Removal, abdomen lymph nodes 38724 C Removal of lymph nodes, neck Start Printed Page 48227 38746 C Remove thoracic lymph nodes 38747 C Remove abdominal lymph nodes 38765 C Remove groin lymph nodes 38770 C Remove pelvis lymph nodes 38780 C Remove abdomen lymph nodes 39000 C Exploration of chest 39010 C Exploration of chest 39200 C Removal chest lesion 39220 C Removal chest lesion 39499 C Chest procedure 39501 C Repair diaphragm laceration 39502 C Repair paraesophageal hernia 39503 C Repair of diaphragm hernia 39520 C Repair of diaphragm hernia 39530 C Repair of diaphragm hernia 39531 C Repair of diaphragm hernia 39540 C Repair of diaphragm hernia 39541 C Repair of diaphragm hernia 39545 C Revision of diaphragm 39560 C Resect diaphragm, simple 39561 C Resect diaphragm, complex 39599 C Diaphragm surgery procedure 41130 C Partial removal of tongue 41135 C Tongue and neck surgery 41140 C Removal of tongue 41145 C Tongue removal, neck surgery 41150 C Tongue, mouth, jaw surgery 41153 C Tongue, mouth, neck surgery 41155 C Tongue, jaw, & neck surgery 42426 C Excise parotid gland/lesion 42845 C Extensive surgery of throat 42894 C Revision of pharyngeal walls 42953 C Repair throat, esophagus 42961 C Control throat bleeding 42971 C Control nose/throat bleeding 43045 C Incision of esophagus 43100 C Excision of esophagus lesion 43101 C Excision of esophagus lesion 43107 C Removal of esophagus 43108 C Removal of esophagus 43112 C Removal of esophagus 43113 C Removal of esophagus 43116 C Partial removal of esophagus 43117 C Partial removal of esophagus 43118 C Partial removal of esophagus 43121 C Partial removal of esophagus 43122 C Partial removal of esophagus 43123 C Partial removal of esophagus 43124 C Removal of esophagus 43135 C Removal of esophagus pouch 43300 C Repair of esophagus 43305 C Repair esophagus and fistula 43310 C Repair of esophagus 43312 C Repair esophagus and fistula 43313 C Esophagoplasty congenital 43314 C Tracheo-esophagoplasty cong 43320 C Fuse esophagus & stomach 43324 C Revise esophagus & stomach 43325 C Revise esophagus & stomach 43326 C Revise esophagus & stomach 43330 C Repair of esophagus 43331 C Repair of esophagus 43340 C Fuse esophagus & intestine 43341 C Fuse esophagus & intestine 43350 C Surgical opening, esophagus Start Printed Page 48228 43351 C Surgical opening, esophagus 43352 C Surgical opening, esophagus 43360 C Gastrointestinal repair 43361 C Gastrointestinal repair 43400 C Ligate esophagus veins 43401 C Esophagus surgery for veins 43405 C Ligate/staple esophagus 43410 C Repair esophagus wound 43415 C Repair esophagus wound 43420 C Repair esophagus opening 43425 C Repair esophagus opening 43460 C Pressure treatment esophagus 43496 C Free jejunum flap, microvasc 43500 C Surgical opening of stomach 43501 C Surgical repair of stomach 43502 C Surgical repair of stomach 43510 C Surgical opening of stomach 43520 C Incision of pyloric muscle 43605 C Biopsy of stomach 43610 C Excision of stomach lesion 43611 C Excision of stomach lesion 43620 C Removal of stomach 43621 C Removal of stomach 43622 C Removal of stomach 43631 C Removal of stomach, partial 43632 C Removal of stomach, partial 43633 C Removal of stomach, partial 43634 C Removal of stomach, partial 43635 C Removal of stomach, partial 43638 C Removal of stomach, partial 43639 C Removal of stomach, partial 43640 C Vagotomy & pylorus repair 43641 C Vagotomy & pylorus repair 43800 C Reconstruction of pylorus 43810 C Fusion of stomach and bowel 43820 C Fusion of stomach and bowel 43825 C Fusion of stomach and bowel 43832 C Place gastrostomy tube 43840 C Repair of stomach lesion 43842 C Gastroplasty for obesity 43843 C Gastroplasty for obesity 43846 C Gastric bypass for obesity 43847 C Gastric bypass for obesity 43848 C Revision gastroplasty 43850 C Revise stomach-bowel fusion 43855 C Revise stomach-bowel fusion 43860 C Revise stomach-bowel fusion 43865 C Revise stomach-bowel fusion 43880 C Repair stomach-bowel fistula 44005 C Freeing of bowel adhesion 44010 C Incision of small bowel 44015 C Insert needle cath bowel 44020 C Explore small intestine 44021 C Decompress small bowel 44025 C Incision of large bowel 44050 C Reduce bowel obstruction 44055 C Correct malrotation of bowel 44110 C Excise intestine lesion(s) 44111 C Excision of bowel lesion(s) 44120 C Removal of small intestine 44121 C Removal of small intestine 44125 C Removal of small intestine 44126 C Enterectomy w/o taper, cong 44127 C Enterectomy w/taper, cong 44128 C Enterectomy cong, add-on Start Printed Page 48229 44130 C Bowel to bowel fusion 44132 C Enterectomy, cadaver donor 44133 C Enterectomy, live donor 44135 C Intestine transplnt, cadaver 44136 C Intestine transplant, live 44139 C Mobilization of colon 44140 C Partial removal of colon 44141 C Partial removal of colon 44143 C Partial removal of colon 44144 C Partial removal of colon 44145 C Partial removal of colon 44146 C Partial removal of colon 44147 C Partial removal of colon 44150 C Removal of colon 44151 C Removal of colon/ileostomy 44152 C Removal of colon/ileostomy 44153 C Removal of colon/ileostomy 44155 C Removal of colon/ileostomy 44156 C Removal of colon/ileostomy 44160 C Removal of colon 44202 C Lap resect s/intestine singl 44203 C Lap resect s/intestine, addl 44204 C Laparo partial colectomy 44205 C Lap colectomy part w/ileum 44210 C Laparo total proctocolectomy 44211 C Laparo total proctocolectomy 44212 C Laparo total proctocolectomy 44300 C Open bowel to skin 44310 C Ileostomy/jejunostomy 44314 C Revision of ileostomy 44316 C Devise bowel pouch 44320 C Colostomy 44322 C Colostomy with biopsies 44345 C Revision of colostomy 44346 C Revision of colostomy 44602 C Suture, small intestine 44603 C Suture, small intestine 44604 C Suture, large intestine 44605 C Repair of bowel lesion 44615 C Intestinal stricturoplasty 44620 C Repair bowel opening 44625 C Repair bowel opening 44626 C Repair bowel opening 44640 C Repair bowel-skin fistula 44650 C Repair bowel fistula 44660 C Repair bowel-bladder fistula 44661 C Repair bowel-bladder fistula 44680 C Surgical revision, intestine 44700 C Suspend bowel w/prosthesis 44800 C Excision of bowel pouch 44820 C Excision of mesentery lesion 44850 C Repair of mesentery 44899 C Bowel surgery procedure 44900 C Drain app abscess, open 44901 C Drain app abscess, percut 44950 C Appendectomy 44955 C Appendectomy add-on 44960 C Appendectomy 45110 C Removal of rectum 45111 C Partial removal of rectum 45112 C Removal of rectum 45113 C Partial proctectomy 45114 C Partial removal of rectum 45116 C Partial removal of rectum 45119 C Remove rectum w/reservoir Start Printed Page 48230 45120 C Removal of rectum 45121 C Removal of rectum and colon 45123 C Partial proctectomy 45126 C Pelvic exenteration 45130 C Excision of rectal prolapse 45135 C Excision of rectal prolapse 45136 C Excise ileoanal reservior 45540 C Correct rectal prolapse 45541 C Correct rectal prolapse 45550 C Repair rectum/remove sigmoid 45562 C Exploration/repair of rectum 45563 C Exploration/repair of rectum 45800 C Repair rect/bladder fistula 45805 C Repair fistula w/colostomy 45820 C Repair rectourethral fistula 45825 C Repair fistula w/colostomy 46705 C Repair of anal stricture 46715 C Repair of anovaginal fistula 46716 C Repair of anovaginal fistula 46730 C Construction of absent anus 46735 C Construction of absent anus 46740 C Construction of absent anus 46742 C Repair of imperforated anus 46744 C Repair of cloacal anomaly 46746 C Repair of cloacal anomaly 46748 C Repair of cloacal anomaly 46751 C Repair of anal sphincter 47010 C Open drainage, liver lesion 47015 C Inject/aspirate liver cyst 47100 C Wedge biopsy of liver 47120 C Partial removal of liver 47122 C Extensive removal of liver 47125 C Partial removal of liver 47130 C Partial removal of liver 47133 C Removal of donor liver 47134 C Partial removal, donor liver 47135 C Transplantation of liver 47136 C Transplantation of liver 47300 C Surgery for liver lesion 47350 C Repair liver wound 47360 C Repair liver wound 47361 C Repair liver wound 47362 C Repair liver wound 47380 C Open ablate liver tumor rf 47381 C Open ablate liver tumor cryo 47400 C Incision of liver duct 47420 C Incision of bile duct 47425 C Incision of bile duct 47460 C Incise bile duct sphincter 47480 C Incision of gallbladder 47550 C Bile duct endoscopy add-on 47570 C Laparo cholecystoenterostomy 47600 C Removal of gallbladder 47605 C Removal of gallbladder 47610 C Removal of gallbladder 47612 C Removal of gallbladder 47620 C Removal of gallbladder 47700 C Exploration of bile ducts 47701 C Bile duct revision 47711 C Excision of bile duct tumor 47712 C Excision of bile duct tumor 47715 C Excision of bile duct cyst 47716 C Fusion of bile duct cyst 47720 C Fuse gallbladder & bowel 47721 C Fuse upper gi structures Start Printed Page 48231 47740 C Fuse gallbladder & bowel 47741 C Fuse gallbladder & bowel 47760 C Fuse bile ducts and bowel 47765 C Fuse liver ducts & bowel 47780 C Fuse bile ducts and bowel 47785 C Fuse bile ducts and bowel 47800 C Reconstruction of bile ducts 47801 C Placement, bile duct support 47802 C Fuse liver duct & intestine 47900 C Suture bile duct injury 48000 C Drainage of abdomen 48001 C Placement of drain, pancreas 48005 C Resect/debride pancreas 48020 C Removal of pancreatic stone 48100 C Biopsy of pancreas, open 48120 C Removal of pancreas lesion 48140 C Partial removal of pancreas 48145 C Partial removal of pancreas 48146 C Pancreatectomy 48148 C Removal of pancreatic duct 48150 C Partial removal of pancreas 48152 C Pancreatectomy 48153 C Pancreatectomy 48154 C Pancreatectomy 48155 C Removal of pancreas 48180 C Fuse pancreas and bowel 48400 C Injection, intraop add-on 48500 C Surgery of pancreatic cyst 48510 C Drain pancreatic pseudocyst 48520 C Fuse pancreas cyst and bowel 48540 C Fuse pancreas cyst and bowel 48545 C Pancreatorrhaphy 48547 C Duodenal exclusion 48556 C Removal, allograft pancreas 49000 C Exploration of abdomen 49002 C Reopening of abdomen 49010 C Exploration behind abdomen 49020 C Drain abdominal abscess 49021 C Drain abdominal abscess 49040 C Drain, open, abdom abscess 49041 C Drain, percut, abdom abscess 49060 C Drain, open, retrop abscess 49061 C Drain, percut, retroper absc 49062 C Drain to peritoneal cavity 49201 C Remove abdom lesion, complex 49215 C Excise sacral spine tumor 49220 C Multiple surgery, abdomen 49255 C Removal of omentum 49425 C Insert abdomen-venous drain 49428 C Ligation of shunt 49605 C Repair umbilical lesion 49606 C Repair umbilical lesion 49610 C Repair umbilical lesion 49611 C Repair umbilical lesion 49900 C Repair of abdominal wall 49904 C Omental flap, extra-abdom 49905 C Omental flap 49906 C Free omental flap, microvasc 50010 C Exploration of kidney 50020 C Renal abscess, open drain 50040 C Drainage of kidney 50045 C Exploration of kidney 50060 C Removal of kidney stone 50065 C Incision of kidney 50070 C Incision of kidney Start Printed Page 48232 50075 C Removal of kidney stone 50100 C Revise kidney blood vessels 50120 C Exploration of kidney 50125 C Explore and drain kidney 50130 C Removal of kidney stone 50135 C Exploration of kidney 50205 C Biopsy of kidney 50220 C Remove kidney, open 50225 C Removal kidney open, complex 50230 C Removal kidney open, radical 50234 C Removal of kidney & ureter 50236 C Removal of kidney & ureter 50240 C Partial removal of kidney 50280 C Removal of kidney lesion 50290 C Removal of kidney lesion 50300 C Removal of donor kidney 50320 C Removal of donor kidney 50340 C Removal of kidney 50360 C Transplantation of kidney 50365 C Transplantation of kidney 50370 C Remove transplanted kidney 50380 C Reimplantation of kidney 50400 C Revision of kidney/ureter 50405 C Revision of kidney/ureter 50500 C Repair of kidney wound 50520 C Close kidney-skin fistula 50525 C Repair renal-abdomen fistula 50526 C Repair renal-abdomen fistula 50540 C Revision of horseshoe kidney 50545 C Laparo radical nephrectomy 50546 C Laparoscopic nephrectomy 50547 C Laparo removal donor kidney 50548 C Laparo remove k/ureter 50570 C Kidney endoscopy 50572 C Kidney endoscopy 50574 C Kidney endoscopy & biopsy 50575 C Kidney endoscopy 50576 C Kidney endoscopy & treatment 50578 C Renal endoscopy/radiotracer 50580 C Kidney endoscopy & treatment 50600 C Exploration of ureter 50605 C Insert ureteral support 50610 C Removal of ureter stone 50620 C Removal of ureter stone 50630 C Removal of ureter stone 50650 C Removal of ureter 50660 C Removal of ureter 50700 C Revision of ureter 50715 C Release of ureter 50722 C Release of ureter 50725 C Release/revise ureter 50727 C Revise ureter 50728 C Revise ureter 50740 C Fusion of ureter & kidney 50750 C Fusion of ureter & kidney 50760 C Fusion of ureters 50770 C Splicing of ureters 50780 C Reimplant ureter in bladder 50782 C Reimplant ureter in bladder 50783 C Reimplant ureter in bladder 50785 C Reimplant ureter in bladder 50800 C Implant ureter in bowel 50810 C Fusion of ureter & bowel 50815 C Urine shunt to intestine 50820 C Construct bowel bladder Start Printed Page 48233 50825 C Construct bowel bladder 50830 C Revise urine flow 50840 C Replace ureter by bowel 50845 C Appendico-vesicostomy 50860 C Transplant ureter to skin 50900 C Repair of ureter 50920 C Closure ureter/skin fistula 50930 C Closure ureter/bowel fistula 50940 C Release of ureter 51060 C Removal of ureter stone 51525 C Removal of bladder lesion 51530 C Removal of bladder lesion 51535 C Repair of ureter lesion 51550 C Partial removal of bladder 51555 C Partial removal of bladder 51565 C Revise bladder & ureter(s) 51570 C Removal of bladder 51575 C Removal of bladder & nodes 51580 C Remove bladder/revise tract 51585 C Removal of bladder & nodes 51590 C Remove bladder/revise tract 51595 C Remove bladder/revise tract 51596 C Remove bladder/create pouch 51597 C Removal of pelvic structures 51800 C Revision of bladder/urethra 51820 C Revision of urinary tract 51840 C Attach bladder/urethra 51841 C Attach bladder/urethra 51845 C Repair bladder neck 51860 C Repair of bladder wound 51865 C Repair of bladder wound 51900 C Repair bladder/vagina lesion 51920 C Close bladder-uterus fistula 51925 C Hysterectomy/bladder repair 51940 C Correction of bladder defect 51960 C Revision of bladder & bowel 51980 C Construct bladder opening 53085 C Drainage of urinary leakage 53415 C Reconstruction of urethra 53448 C Remov/replc ur sphinctr comp 54125 C Removal of penis 54130 C Remove penis & nodes 54135 C Remove penis & nodes 54332 C Revise penis/urethra 54336 C Revise penis/urethra 54390 C Repair penis and bladder 54411 C Remov/replc penis pros, comp 54417 C Remv/replc penis pros, compl 54430 C Revision of penis 54535 C Extensive testis surgery 54560 C Exploration for testis 54650 C Orchiopexy (Fowler-Stephens) 55600 C Incise sperm duct pouch 55605 C Incise sperm duct pouch 55650 C Remove sperm duct pouch 55801 C Removal of prostate 55810 C Extensive prostate surgery 55812 C Extensive prostate surgery 55815 C Extensive prostate surgery 55821 C Removal of prostate 55831 C Removal of prostate 55840 C Extensive prostate surgery 55842 C Extensive prostate surgery 55845 C Extensive prostate surgery 55862 C Extensive prostate surgery Start Printed Page 48234 55865 C Extensive prostate surgery 55866 C Laparo radical prostatectomy 56630 C Extensive vulva surgery 56631 C Extensive vulva surgery 56632 C Extensive vulva surgery 56633 C Extensive vulva surgery 56634 C Extensive vulva surgery 56637 C Extensive vulva surgery 56640 C Extensive vulva surgery 57110 C Remove vagina wall, complete 57111 C Remove vagina tissue, compl 57112 C Vaginectomy w/nodes, compl 57270 C Repair of bowel pouch 57280 C Suspension of vagina 57282 C Repair of vaginal prolapse 57292 C Construct vagina with graft 57305 C Repair rectum-vagina fistula 57307 C Fistula repair & colostomy 57308 C Fistula repair, transperine 57311 C Repair urethrovaginal lesion 57335 C Repair vagina 57531 C Removal of cervix, radical 57540 C Removal of residual cervix 57545 C Remove cervix/repair pelvis 58140 C Removal of uterus lesion 58146 C Myomectomy abdom complex 58150 C Total hysterectomy 58152 C Total hysterectomy 58180 C Partial hysterectomy 58200 C Extensive hysterectomy 58210 C Extensive hysterectomy 58240 C Removal of pelvis contents 58260 C Vaginal hysterectomy 58262 C Vag hyst including t/o 58263 C Vag hyst w/t/o & vag repair 58267 C Vag hyst w/urinary repair 58270 C Vag hyst w/enterocele repair 58275 C Hysterectomy/revise vagina 58280 C Hysterectomy/revise vagina 58285 C Extensive hysterectomy 58290 C Vag hyst complex 58291 C Vag hyst incl t/o, complex 58292 C Vag hyst t/o & repair, compl 58293 C Vag hyst w/uro repair, compl 58294 C Vag hyst w/enterocele, compl 58400 C Suspension of uterus 58410 C Suspension of uterus 58520 C Repair of ruptured uterus 58540 C Revision of uterus 58605 C Division of fallopian tube 58611 C Ligate oviduct(s) add-on 58700 C Removal of fallopian tube 58720 C Removal of ovary/tube(s) 58740 C Revise fallopian tube(s) 58750 C Repair oviduct 58752 C Revise ovarian tube(s) 58760 C Remove tubal obstruction 58770 C Create new tubal opening 58805 C Drainage of ovarian cyst(s) 58822 C Drain ovary abscess, percut 58825 C Transposition, ovary(s) 58940 C Removal of ovary(s) 58943 C Removal of ovary(s) 58950 C Resect ovarian malignancy 58951 C Resect ovarian malignancy Start Printed Page 48235 58952 C Resect ovarian malignancy 58953 C Tah, rad dissect for debulk 58954 C Tah rad debulk/lymph remove 58960 C Exploration of abdomen 59100 C Remove uterus lesion 59120 C Treat ectopic pregnancy 59121 C Treat ectopic pregnancy 59130 C Treat ectopic pregnancy 59135 C Treat ectopic pregnancy 59136 C Treat ectopic pregnancy 59140 C Treat ectopic pregnancy 59325 C Revision of cervix 59350 C Repair of uterus 59514 C Cesarean delivery only 59525 C Remove uterus after cesarean 59620 C Attempted vbac delivery only 59830 C Treat uterus infection 59850 C Abortion 59851 C Abortion 59852 C Abortion 59855 C Abortion 59856 C Abortion 59857 C Abortion 60254 C Extensive thyroid surgery 60270 C Removal of thyroid 60271 C Removal of thyroid 60502 C Re-explore parathyroids 60505 C Explore parathyroid glands 60520 C Removal of thymus gland 60521 C Removal of thymus gland 60522 C Removal of thymus gland 60540 C Explore adrenal gland 60545 C Explore adrenal gland 60600 C Remove carotid body lesion 60605 C Remove carotid body lesion 60650 C Laparoscopy adrenalectomy 61105 C Twist drill hole 61107 C Drill skull for implantation 61108 C Drill skull for drainage 61120 C Burr hole for puncture 61140 C Pierce skull for biopsy 61150 C Pierce skull for drainage 61151 C Pierce skull for drainage 61154 C Pierce skull & remove clot 61156 C Pierce skull for drainage 61210 C Pierce skull, implant device 61250 C Pierce skull & explore 61253 C Pierce skull & explore 61304 C Open skull for exploration 61305 C Open skull for exploration 61312 C Open skull for drainage 61313 C Open skull for drainage 61314 C Open skull for drainage 61315 C Open skull for drainage 61320 C Open skull for drainage 61321 C Open skull for drainage 61322 C Decompressive craniotomy 61323 C Decompressive lobectomy 61332 C Explore/biopsy eye socket 61333 C Explore orbit/remove lesion 61334 C Explore orbit/remove object 61340 C Relieve cranial pressure 61343 C Incise skull (press relief) 61345 C Relieve cranial pressure 61440 C Incise skull for surgery Start Printed Page 48236 61450 C Incise skull for surgery 61458 C Incise skull for brain wound 61460 C Incise skull for surgery 61470 C Incise skull for surgery 61480 C Incise skull for surgery 61490 C Incise skull for surgery 61500 C Removal of skull lesion 61501 C Remove infected skull bone 61510 C Removal of brain lesion 61512 C Remove brain lining lesion 61514 C Removal of brain abscess 61516 C Removal of brain lesion 61518 C Removal of brain lesion 61519 C Remove brain lining lesion 61520 C Removal of brain lesion 61521 C Removal of brain lesion 61522 C Removal of brain abscess 61524 C Removal of brain lesion 61526 C Removal of brain lesion 61530 C Removal of brain lesion 61531 C Implant brain electrodes 61533 C Implant brain electrodes 61534 C Removal of brain lesion 61535 C Remove brain electrodes 61536 C Removal of brain lesion 61538 C Removal of brain tissue 61539 C Removal of brain tissue 61541 C Incision of brain tissue 61542 C Removal of brain tissue 61543 C Removal of brain tissue 61544 C Remove & treat brain lesion 61545 C Excision of brain tumor 61546 C Removal of pituitary gland 61548 C Removal of pituitary gland 61550 C Release of skull seams 61552 C Release of skull seams 61556 C Incise skull/sutures 61557 C Incise skull/sutures 61558 C Excision of skull/sutures 61559 C Excision of skull/sutures 61563 C Excision of skull tumor 61564 C Excision of skull tumor 61570 C Remove foreign body, brain 61571 C Incise skull for brain wound 61575 C Skull base/brainstem surgery 61576 C Skull base/brainstem surgery 61580 C Craniofacial approach, skull 61581 C Craniofacial approach, skull 61582 C Craniofacial approach, skull 61583 C Craniofacial approach, skull 61584 C Orbitocranial approach/skull 61585 C Orbitocranial approach/skull 61586 C Resect nasopharynx, skull 61590 C Infratemporal approach/skull 61591 C Infratemporal approach/skull 61592 C Orbitocranial approach/skull 61595 C Transtemporal approach/skull 61596 C Transcochlear approach/skull 61597 C Transcondylar approach/skull 61598 C Transpetrosal approach/skull 61600 C Resect/excise cranial lesion 61601 C Resect/excise cranial lesion 61605 C Resect/excise cranial lesion 61606 C Resect/excise cranial lesion 61607 C Resect/excise cranial lesion Start Printed Page 48237 61608 C Resect/excise cranial lesion 61609 C Transect artery, sinus 61610 C Transect artery, sinus 61611 C Transect artery, sinus 61612 C Transect artery, sinus 61613 C Remove aneurysm, sinus 61615 C Resect/excise lesion, skull 61616 C Resect/excise lesion, skull 61618 C Repair dura 61619 C Repair dura 61624 C Occlusion/embolization cath 61680 C Intracranial vessel surgery 61682 C Intracranial vessel surgery 61684 C Intracranial vessel surgery 61686 C Intracranial vessel surgery 61690 C Intracranial vessel surgery 61692 C Intracranial vessel surgery 61697 C Brain aneurysm repr, complx 61698 C Brain aneurysm repr, complx 61700 C Brain aneurysm repr, simple 61702 C Inner skull vessel surgery 61703 C Clamp neck artery 61705 C Revise circulation to head 61708 C Revise circulation to head 61710 C Revise circulation to head 61711 C Fusion of skull arteries 61720 C Incise skull/brain surgery 61735 C Incise skull/brain surgery 61750 C Incise skull/brain biopsy 61751 C Brain biopsy w/ ct/mr guide 61760 C Implant brain electrodes 61770 C Incise skull for treatment 61850 C Implant neuroelectrodes 61860 C Implant neuroelectrodes 61862 C Implant neurostimul, subcort 61870 C Implant neuroelectrodes 61875 C Implant neuroelectrodes 62000 C Treat skull fracture 62005 C Treat skull fracture 62010 C Treatment of head injury 62100 C Repair brain fluid leakage 62115 C Reduction of skull defect 62116 C Reduction of skull defect 62117 C Reduction of skull defect 62120 C Repair skull cavity lesion 62121 C Incise skull repair 62140 C Repair of skull defect 62141 C Repair of skull defect 62142 C Remove skull plate/flap 62143 C Replace skull plate/flap 62145 C Repair of skull & brain 62146 C Repair of skull with graft 62147 C Repair of skull with graft 62161 C Dissect brain w/scope 62162 C Remove colloid cyst w/scope 62163 C Neuroendoscopy w/fb removal 62164 C Remove brain tumor w/scope 62165 C Remove pituit tumor w/scope 62180 C Establish brain cavity shunt 62190 C Establish brain cavity shunt 62192 C Establish brain cavity shunt 62200 C Establish brain cavity shunt 62201 C Establish brain cavity shunt 62220 C Establish brain cavity shunt 62223 C Establish brain cavity shunt Start Printed Page 48238 62256 C Remove brain cavity shunt 62258 C Replace brain cavity shunt 63043 C Laminotomy, addl cervical 63044 C Laminotomy, addl lumbar 63075 C Neck spine disk surgery 63076 C Neck spine disk surgery 63077 C Spine disk surgery, thorax 63078 C Spine disk surgery, thorax 63081 C Removal of vertebral body 63082 C Remove vertebral body add-on 63085 C Removal of vertebral body 63086 C Remove vertebral body add-on 63087 C Removal of vertebral body 63088 C Remove vertebral body add-on 63090 C Removal of vertebral body 63091 C Remove vertebral body add-on 63170 C Incise spinal cord tract(s) 63172 C Drainage of spinal cyst 63173 C Drainage of spinal cyst 63180 C Revise spinal cord ligaments 63182 C Revise spinal cord ligaments 63185 C Incise spinal column/nerves 63190 C Incise spinal column/nerves 63191 C Incise spinal column/nerves 63194 C Incise spinal column & cord 63195 C Incise spinal column & cord 63196 C Incise spinal column & cord 63197 C Incise spinal column & cord 63198 C Incise spinal column & cord 63199 C Incise spinal column & cord 63200 C Release of spinal cord 63250 C Revise spinal cord vessels 63251 C Revise spinal cord vessels 63252 C Revise spinal cord vessels 63265 C Excise intraspinal lesion 63266 C Excise intraspinal lesion 63267 C Excise intraspinal lesion 63268 C Excise intraspinal lesion 63270 C Excise intraspinal lesion 63271 C Excise intraspinal lesion 63272 C Excise intraspinal lesion 63273 C Excise intraspinal lesion 63275 C Biopsy/excise spinal tumor 63276 C Biopsy/excise spinal tumor 63277 C Biopsy/excise spinal tumor 63278 C Biopsy/excise spinal tumor 63280 C Biopsy/excise spinal tumor 63281 C Biopsy/excise spinal tumor 63282 C Biopsy/excise spinal tumor 63283 C Biopsy/excise spinal tumor 63285 C Biopsy/excise spinal tumor 63286 C Biopsy/excise spinal tumor 63287 C Biopsy/excise spinal tumor 63290 C Biopsy/excise spinal tumor 63300 C Removal of vertebral body 63301 C Removal of vertebral body 63302 C Removal of vertebral body 63303 C Removal of vertebral body 63304 C Removal of vertebral body 63305 C Removal of vertebral body 63306 C Removal of vertebral body 63307 C Removal of vertebral body 63308 C Remove vertebral body add-on 63700 C Repair of spinal herniation 63702 C Repair of spinal herniation Start Printed Page 48239 63704 C Repair of spinal herniation 63706 C Repair of spinal herniation 63707 C Repair spinal fluid leakage 63709 C Repair spinal fluid leakage 63710 C Graft repair of spine defect 63740 C Install spinal shunt 64752 C Incision of vagus nerve 64755 C Incision of stomach nerves 64760 C Incision of vagus nerve 64763 C Incise hip/thigh nerve 64766 C Incise hip/thigh nerve 64804 C Remove sympathetic nerves 64809 C Remove sympathetic nerves 64818 C Remove sympathetic nerves 64866 C Fusion of facial/other nerve 64868 C Fusion of facial/other nerve 65273 C Repair of eye wound 69155 C Extensive ear/neck surgery 69535 C Remove part of temporal bone 69554 C Remove ear lesion 69950 C Incise inner ear nerve 69970 C Remove inner ear lesion 75900 C Arterial catheter exchange 75952 C Endovasc repair abdom aorta 75953 C Abdom aneurysm endovas rpr 75954 C Iliac aneurysm endovas rpr 92970 C Cardioassist, internal 92971 C Cardioassist, external 92975 C Dissolve clot, heart vessel 92992 C Revision of heart chamber 92993 C Revision of heart chamber 99190 C Special pump services 99191 C Special pump services 99192 C Special pump services 99251 C Initial inpatient consult 99252 C Initial inpatient consult 99253 C Initial inpatient consult 99254 C Initial inpatient consult 99255 C Initial inpatient consult 99261 C Follow-up inpatient consult 99262 C Follow-up inpatient consult 99263 C Follow-up inpatient consult 99293 C Ped critical care, initial 99294 C Ped critical care, subseq 99295 C Neonatal critical care 99296 C Neonatal critical care 99298 C Neonatal critical care 99299 C Ic, lbw infant 1500-2500 gm 99356 C Prolonged service, inpatient 99357 C Prolonged service, inpatient 99433 C Normal newborn care/hospital CPT codes and escriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All right reserved. Addendum H.—Wage Index for Urban Areas
Urban area (constituent counties) Wage index 0040 Abilene, TX 0.7678 Taylor, TX 0060 Aguadilla, PR 0.4335 Aguada, PR Aguadilla, PR Moca, PR 0080 Akron, OH 0.9445 Portage, OH Summit, OH 0120 Albany, GA 1.0838 Dougherty, GA Lee, GA 0160 Albany-Schenectady-Troy, NY 0.8693 Albany, NY Montgomery, NY Rensselaer, NY Saratoga, NY Schenectady, NY Schoharie, NY 0200 Albuquerque, NM 0.9431 Bernalillo, NM Sandoval, NM Valencia, NM Start Printed Page 48240 0220 Alexandria, LA 0.8087 Rapides, LA 0240 Allentown-Bethlehem-Easton, PA 0.9576 Carbon, PA Lehigh, PA Northampton, PA 0280 Altoona, PA 0.8886 Blair, PA 0320 Amarillo, TX 0.8968 Potter, TX Randall, TX 0380 Anchorage, AK 1.2433 Anchorage, AK 0440 Ann Arbor, MI 1.1069 Lenawee, MI Livingston, MI Washtenaw, MI 0450 Anniston, AL 0.8140 Calhoun, AL 0460 Appleton-Oshkosh-Neenah, WI 2 0.9130 Calumet, WI Outagamie, WI Winnebago, WI 0470 Arecibo, PR 0.4130 Arecibo, PR Camuy, PR Hatillo, PR 0480 Asheville, NC 0.9697 Buncombe, NC Madison, NC 0500 Athens, GA 0.9664 Clarke, GA Madison, GA Oconee, GA 0520 Atlanta, GA 1 1.0027 Barrow, GA Bartow, GA Carroll, GA Cherokee, GA Clayton, GA Cobb, GA Coweta, GA DeKalb, GA Douglas, GA Fayette, GA Forsyth, GA Fulton, GA Gwinnett, GA Henry, GA Newton, GA Paulding, GA Pickens, GA Rockdale, GA Spalding, GA Walton, GA 0560 Atlantic-Cape May, NJ 1.0862 Atlantic, NJ Cape May, NJ 0580 Auburn-Opelika, AL 0.8540 Lee, AL 0600 Augusta-Aiken, GA-SC 0.9725 Columbia, GA McDuffie, GA Richmond, GA Aiken, SC Edgefield, SC 0640 Austin-San Marcos, TX 1 0.9551 Bastrop, TX Caldwell, TX Hays, TX Travis, TX Williamson, TX 0680 Bakersfield, CA 2 0.9907 Kern, CA 0720 Baltimore, MD 1 0.9951 Anne Arundel, MD Baltimore, MD Baltimore City, MD Carroll, MD Harford, MD Howard, MD Queen Anne's, MD 0733 Bangor, ME 0.9750 Penobscot, ME 0743 Barnstable-Yarmouth, MA 1.2893 Barnstable, MA 0760 Baton Rouge, LA 0.8271 Ascension, LA East Baton Rouge, LA Livingston, LA West Baton Rouge, LA 0840 Beaumont-Port Arthur, TX 0.8503 Hardin, TX Jefferson, TX Orange, TX 0860 Bellingham, WA 1.1834 Whatcom, WA 0870 Benton Harbor, MI 0.8949 Berrien, MI 0875 Bergen-Passaic, NJ 1 1.1655 Bergen, NJ Passaic, NJ 0880 Billings, MT 0.8889 Yellowstone, MT 0920 Biloxi-Gulfport-Pascagoula, MS 0.9089 Hancock, MS Harrison, MS Jackson, MS 0960 Binghamton, NY 2 0.8530 Broome, NY Tioga, NY 1000 Birmingham, AL 0.9251 Blount, AL Jefferson, AL St. Clair, AL Shelby, AL 1010 Bismarck, ND 0.8101 Burleigh, ND Morton, ND 1020 Bloomington, IN 0.8968 Monroe, IN 1040 Bloomington-Normal, IL 0.8954 McLean, IL 1080 Boise City, ID 0.9295 Ada, ID Canyon, ID 1123 Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH 1 1.1269 Bristol, MA Essex, MA Middlesex, MA Norfolk, MA Plymouth, MA Suffolk, MA Worcester, MA Hillsborough, NH Merrimack, NH Rockingham, NH Strafford, NH 1125 Boulder-Longmont, CO 1.0119 Boulder, CO 1145 Brazoria, TX 0.8324 Brazoria, TX 1150 Bremerton, WA 1.0601 Kitsap, WA 1240 Brownsville-Harlingen-San Benito, TX 21.0231 Cameron, TX 1260 Bryan-College Station, TX Brazos, TX 0.9044 1280 Buffalo-Niagara Falls, NY 1 0.9600 Erie, NY Niagara, NY 1303 Burlington, VT 0.9768 Chittenden, VT Franklin, VT Grand Isle, VT 1310 Caguas, PR 0.4229 Caguas, PR Cayey, PR Cidra, PR Gurabo, PR San Lorenzo, PR 1320 Canton-Massillon, OH 0.9128 Carroll, OH Stark, OH 1350 Casper, WY 0.9239 Natrona, WY 1360 Cedar Rapids, IA 0.8933 Linn, IA 1400 Champaign-Urbana, IL 0.9907 Champaign, IL 1440 Charleston-North Charleston, SC 0.9307 Berkeley, SC Charleston, SC Dorchester, SC 1480 Charleston, WV 0.8753 Kanawha, WV Putnam, WV 1520 Charlotte-Gastonia-Rock Hill, NC-SC 1 0.9766 Cabarrus, NC Gaston, NC Lincoln, NC Mecklenburg, NC Rowan, NC Stanly, NC Union, NC York, SC 1540 Charlottesville, VA 1.0092 Albemarle, VA Charlottesville City, VA Fluvanna, VA Greene, VA 1560 Chattanooga, TN-GA 0.8985 Catoosa, GA Dade, GA Walker, GA Hamilton, TN Marion, TN 1580 Cheyenne, WY 2 0.9137 Laramie, WY 1600 Chicago, IL 1 1.1012 Cook, IL DeKalb, IL Start Printed Page 48241 DuPage, IL Grundy, IL Kane, IL Kendall, IL Lake, IL McHenry, IL Will, IL 1620 Chico-Paradise, CA 1.0147 Butte, CA 1640 Cincinnati, OH-KY-IN 1 0.9452 Dearborn, IN Ohio, IN Boone, KY Campbell, KY Gallatin, KY Grant, KY Kenton, KY Pendleton, KY Brown, OH Clermont, OH Hamilton, OH Warren, OH 1660 Clarksville-Hopkinsville, TN-KY 0.8410 Christian, KY Montgomery, TN 1680 Cleveland-Lorain-Elyria, OH 1 0.9686 Ashtabula, OH Cuyahoga, OH Geauga, OH Lake, OH Lorain, OH Medina, OH 1720 Colorado Springs, CO 2 0.8897 El Paso, CO 1740 Columbia, MO 0.8745 Boone, MO 1760 Columbia, SC 0.8958 Lexington, SC Richland, SC 1800 Columbus, GA-AL 0.8700 Russell, AL Chattahoochee, GA Harris, GA Muscogee, GA 1840 Columbus, OH 1 0.9649 Delaware, OH Fairfield, OH Franklin, OH Licking, OH Madison, OH Pickaway, OH 1880 Corpus Christi, TX 0.8565 Nueces, TX San Patricio, TX 1890 Corvallis, OR 1.1593 Benton, OR 1900 Cumberland, MD-WV 2 (MD Hospitals) 0.9175 Allegany, MD Mineral, WV 1900 Cumberland, MD-WV (WV Hospitals) 0.8224 Allegany, MD Mineral, WV 1920 Dallas, TX 1 0.9733 Collin, TX Dallas, TX Denton, TX Ellis, TX Henderson, TX Hunt, TX Kaufman, TX Rockwall, TX 1950 Danville, VA 0.9095 Danville City, VA Pittsylvania, VA 1960 Davenport-Moline-Rock Island, IA-IL 0.8727 Scott, IA Henry, IL Rock Island, IL 2000 Dayton-Springfield, OH 0.9432 Clark, OH Greene, OH Miami, OH Montgomery, OH 2020 Daytona Beach, FL 0.9208 Flagler, FL Volusia, FL 2030 Decatur, AL 0.8882 Lawrence, AL Morgan, AL 2040 Decatur, IL 2 0.8282 Macon, IL 2080 Denver, CO 1 1.0776 Adams, CO Arapahoe, CO Broomfield, CO Denver, CO Douglas, CO Jefferson, CO 2120 Des Moines, IA 0.9053 Dallas, IA Polk, IA Warren, IA 2160 Detroit, MI 1 1.0097 Lapeer, MI Macomb, MI Monroe, MI Oakland, MI St. Clair, MI Wayne, MI 2180 Dothan, AL 0.7931 Dale, AL Houston, AL 2190 Dover, DE 0.9870 Kent, DE 2200 Dubuque, IA 0.8946 Dubuque, IA 2240 Duluth-Superior, MN-WI 1.0133 St. Louis, MN Douglas, WI 2281 Dutchess County, NY 1.0966 Dutchess, NY 2290 Eau Claire, WI 0.9141 Chippewa, WI Eau Claire, WI 2320 El Paso, TX 0.9267 El Paso, TX 2330 Elkhart-Goshen, IN 0.9848 Elkhart, IN 2335 Elmira, NY 2 0.8530 Chemung, NY 2340 Enid, OK 0.8616 Garfield, OK 2360 Erie, PA 0.8636 Erie, PA 2400 Eugene-Springfield, OR 1.1212 Lane, OR 2440 Evansville-Henderson, IN-KY 2 (IN Hospitals) 0.8770 Posey, IN Vanderburgh, IN Warrick, IN Henderson, KY 2440 Evansville-Henderson, IN-KY (KY Hospitals) 0.8442 Posey, IN Vanderburgh, IN Warrick, IN Henderson, KY 2520 Fargo-Moorhead, ND-MN 0.9650 Clay, MN Cass, ND 2560 Fayetteville, NC 0.8957 Cumberland, NC 2580 Fayetteville-Springdale-Rogers, AR 0.8038 Benton, AR Washington, AR 2620 Flagstaff, AZ-UT 1.1283 Coconino, AZ Kane, UT 2640 Flint, MI 1.0929 Genesee, MI 2650 Florence, AL 0.7824 Colbert, AL Lauderdale, AL 2655 Florence, SC 0.8763 Florence, SC 2670 Fort Collins-Loveland, CO 1.0201 Larimer, CO 2680 Ft. Lauderdale, FL 1 1.0534 Broward, FL 2700 Fort Myers-Cape Coral, FL 0.9877 Lee, FL 2710 Fort Pierce-Port St. Lucie, FL 1.0227 Martin, FL St. Lucie, FL 2720 Fort Smith, AR-OK 2 (AR Hospitals) 0.7746 Crawford, AR Sebastian, AR Sequoyah, OK 2720 Fort Smith, AR-OK (OK Hospitals) 0.7740 Crawford, AR Sebastian, AR Sequoyah, OK 2750 Fort Walton Beach, FL 0.8929 Okaloosa, FL 2760 Fort Wayne, IN 0.9674 Adams, IN Allen, IN De Kalb, IN Huntington, IN Wells, IN Whitley, IN 2800 Forth Worth-Arlington, TX 1 0.9268 Hood, TX Johnson, TX Parker, TX Tarrant, TX 2840 Fresno, CA 1.0157 Fresno, CA Madera, CA 2880 Gadsden, AL 0.8295 Start Printed Page 48242 Etowah, AL 2900 Gainesville, FL 2 0.8782 Alachua, FL 2920 Galveston-Texas City, TX 0.9360 Galveston, TX 2960 Gary, IN 0.9462 Lake, IN Porter, IN 2975 Glens Falls, NY 2 0.8530 Warren, NY Washington, NY 2980 Goldsboro, NC 0.8679 Wayne, NC 2985 Grand Forks, ND-MN (ND Hospitals) 0.9031 Polk, MN Grand Forks, ND 2985 Grand Forks, ND-MN 2 (MN Hospitals) 0.9243 Polk, MN Grand Forks, ND 2995 Grand Junction, CO 0.9940 Mesa, CO 3000 Grand Rapids-Muskegon-Holland, MI 1 0.9406 Allegan, MI Kent, MI Muskegon, MI Ottawa, MI 3040 Great Falls, MT 0.8977 Cascade, MT 3060 Greeley, CO 0.9516 Weld, CO 3080 Green Bay, WI 0.9524 Brown, WI 3120 Greensboro-Winston-Salem-High Point, NC 1 0.8533 Alamance, NC Davidson, NC Davie, NC Forsyth, NC Guilford, NC Randolph, NC Stokes, NC Yadkin, NC 3150 Greenville, NC 0.9621 Pitt, NC 3160 Greenville-Spartanburg-Anderson, SC 0.9289 Anderson, SC Cherokee, SC Greenville, SC Pickens, SC Spartanburg, SC 3180 Hagerstown, MD 0.9233 Washington, MD 3200 Hamilton-Middletown, OH 0.9236 Butler, OH 3240 Harrisburg-Lebanon-Carlisle, PA 0.9178 Cumberland, PA Dauphin, PA Lebanon, PA Perry, PA 3283 Hartford, CT 1, 2 1.2199 Hartford, CT Litchfield, CT Middlesex, CT Tolland, CT 3285 Hattiesburg, MS 2 0.7810 Forrest, MS Lamar, MS 3290 Hickory-Morganton-Lenoir, NC 0.9090 Alexander, NC Burke, NC Caldwell, NC Catawba, NC 3320 Honolulu, HI 1.1176 Honolulu, HI 3350 Houma, LA 0.7763 Lafourche, LA Terrebonne, LA 3360 Houston, TX 1 0.9591 Chambers, TX Fort Bend, TX Harris, TX Liberty, TX Montgomery, TX Waller, TX 3400 Huntington-Ashland, WV-KY-OH 0.9620 Boyd, KY Carter, KY Greenup, KY Lawrence, OH Cabell, WV Wayne, WV 3440 Huntsville, AL 0.9238 Limestone, AL Madison, AL 3480 Indianapolis, IN 1 0.9934 Boone, IN Hamilton, IN Hancock, IN Hendricks, IN Johnson, IN Madison, IN Marion, IN Morgan, IN Shelby, IN 3500 Iowa City, IA 0.9605 Johnson, IA 3520 Jackson, MI 0.9043 Jackson, MI 3560 Jackson, MS 0.8459 Hinds, MS Madison, MS Rankin, MS 3580 Jackson, TN 0.8602 Madison, TN Chester, TN 3600 Jacksonville, FL 1 0.9426 Clay, FL Duval, FL Nassau, FL St. Johns, FL 3605 Jacksonville, NC 0.8589 Onslow, NC 3610 Jamestown, NY 2 0.8530 Chautauqua, NY 3620 Janesville-Beloit, WI 0.9344 Rock, WI 3640 Jersey City, NJ 1.1203 Hudson, NJ 3660 Johnson City-Kingsport-Bristol, TN-VA (TN Hospitals) 0.8371 Carter, TN Hawkins, TN Sullivan, TN Unicoi, TN Washington, TN Bristol City, VA Scott, VA Washington, VA 3660 Johnson City-Kingsport-Bristol, TN-VA 2 (VA Hospitals) 0.8542 Carter, TN Hawkins, TN Sullivan, TN Unicoi, TN Washington, TN Bristol City, VA Scott, VA Washington, VA 3680 Johnstown, PA 2 0.8429 Cambria, PA Somerset, PA 3700 Jonesboro, AR 2 0.7755 Craighead, AR 3710 Joplin, MO 0.8739 Jasper, MO Newton, MO 3720 Kalamazoo-Battlecreek, MI 1.0554 Calhoun, MI Kalamazoo, MI Van Buren, MI 3740 Kankakee, IL 1.1074 Kankakee, IL 3760 Kansas City, KS-MO 1 0.9551 Johnson, KS Leavenworth, KS Miami, KS Wyandotte, KS Cass, MO Clay, MO Clinton, MO Jackson, MO Lafayette, MO Platte, MO Ray, MO 3800 Kenosha, WI 0.9826 Kenosha, WI 3810 Killeen-Temple, TX 0.9221 Bell, TX Coryell, TX 3840 Knoxville, TN 0.8987 Anderson, TN Blount, TN Knox, TN Loudon, TN Sevier, TN Union, TN 3850 Kokomo, IN 0.8963 Howard, IN Tipton, IN 3870 La Crosse, WI-MN 0.9259 Houston, MN La Crosse, WI 3880 Lafayette, LA 0.8271 Acadia, LA Lafayette, LA St. Landry, LA St. Martin, LA 3920 Lafayette, IN 0.9052 Clinton, IN Tippecanoe, IN 3960 Lake Charles, LA 0.8460 Calcasieu, LA Start Printed Page 48243 3980 Lakeland-Winter Haven, FL 2 0.8782 Polk, FL 4000 Lancaster, PA 0.9325 Lancaster, PA 4040 Lansing-East Lansing, MI 0.9270 Clinton, MI Eaton, MI Ingham, MI 4080 Laredo, TX 0.8145 Webb, TX 4100 Las Cruces, NM 0.8532 Dona Ana, NM 4120 Las Vegas, NV-AZ 1 1.1457 Mohave, AZ Clark, NV Nye, NV 4150 Lawrence, KS 2 0.7860 Douglas, KS 4200 Lawton, OK 0.8322 Comanche, OK 4243 Lewiston-Auburn, ME 0.9389 Androscoggin, ME 4280 Lexington, KY 0.8622 Bourbon, KY Clark, KY Fayette, KY Jessamine, KY Madison, KY Scott, KY Woodford, KY 4320 Lima, OH 0.9457 Allen, OH Auglaize, OH 4360 Lincoln, NE 1.0101 Lancaster, NE 4400 Little Rock-North Little Rock, AR 0.8905 Faulkner, AR Lonoke, AR Pulaski, AR Saline, AR 4420 Longview-Marshall, TX 0.9141 Gregg, TX Harrison, TX Upshur, TX 4480 Los Angeles-Long Beach, CA 1 1.1656 Los Angeles, CA 4520 Louisville, KY-IN 1 0.9174 Clark, IN Floyd, IN Harrison, IN Scott, IN Bullitt, KY Jefferson, KY Oldham, KY 4600 Lubbock, TX 0.8330 Lubbock, TX 4640 Lynchburg, VA 0.9202 Amherst, VA Bedford, VA Bedford City, VA Campbell, VA Lynchburg City, VA 4680 Macon, GA 0.9011 Bibb, GA Houston, GA Jones, GA Peach, GA Twiggs, GA 4720 Madison, WI 1.0235 Dane, WI 4800 Mansfield, OH 0.9059 Crawford, OH Richland, OH 4840 Mayaguez, PR 0.4780 Anasco, PR Cabo Rojo, PR Hormigueros, PR Mayaguez, PR Sabana Grande, PR San German, PR 4880 McAllen-Edinburg-Mission, TX 0.9084 Hidalgo, TX 4890 Medford-Ashland, OR 1.0844 Jackson, OR 4900 Melbourne-Titusville-Palm Bay, FL 0.9837 Brevard, Fl 4920 Memphis, TN-AR-MS 1 0.9325 Crittenden, AR DeSoto, MS Fayette, TN Shelby, TN Tipton, TN 4940 Merced, CA 2 0.9907 Merced, CA 5000 Miami, FL 1 0.9888 Dade, FL 5015 Middlesex-Somerset-Hunterdon, NJ 1 1.1437 Hunterdon, NJ Middlesex, NJ Somerset, NJ 5080 Milwaukee-Waukesha, WI 1 0.9888 Milwaukee, WI Ozaukee, WI Washington, WI Waukesha, WI 5120 Minneapolis-St. Paul, MN-WI 1 1.1064 Anoka, MN Carver, MN Chisago, MN Dakota, MN Hennepin, MN Isanti, MN Ramsey, MN Scott, MN Sherburne, MN Washington, MN Wright, MN Pierce, WI St. Croix, WI 5140 Missoula, MT 0.8943 Missoula, MT 5160 Mobile, AL 0.7948 Baldwin, AL Mobile, AL 5170 Modesto, CA 1.1344 Stanislaus, CA 5190 Monmouth-Ocean, NJ 1 1.1094 Monmouth, NJ Ocean, NJ 5200 Monroe, LA 0.7978 Ouachita, LA 5240 Montgomery, AL 0.7856 Autauga, AL Elmore, AL Montgomery, AL 5280 Muncie, IN 2 0.8770 Delaware, IN 5330 Myrtle Beach, SC 0.8950 Horry, SC 5345 Naples, FL 0.9866 Collier, FL 5360 Nashville, TN 1 0.9836 Cheatham, TN Davidson, TN Dickson, TN Robertson, TN Rutherford TN Sumner, TN Williamson, TN Wilson, TN 5380 Nassau-Suffolk, NY 1 1.3011 Nassau, NY Suffolk, NY 5483 New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT 1 1.2525 Fairfield, CT New Haven, CT 5523 New London-Norwich, CT 2 1.2199 New London, CT 5560 New Orleans, LA 1 0.9167 Jefferson, LA Orleans, LA Plaquemines, LA St. Bernard, LA St. Charles, LA St. James, LA St. John The Baptist, LA St. Tammany, LA 5600 New York, NY 1 1.3867 Bronx, NY Kings, NY New York, NY Putnam, NY Queens, NY Richmond, NY Rockland, NY Westchester, NY 5640 Newark, NJ 1 1.1417 Essex, NJ Morris, NJ Sussex, NJ Union, NJ Warren, NJ 5660 Newburgh, NY-PA 1.1377 Orange, NY Pike, PA 5720 Norfolk-Virginia Beach-Newport News, VA-NC 1 0.8659 Currituck, NC Chesapeake City, VA Gloucester, VA Hampton City, VA Isle of Wight, VA James City, VA Mathews, VA Newport News City, VA Norfolk City, VA Poquoson City, VA Portsmouth City, VA Suffolk City, VA Virginia Beach City VA Williamsburg City, VA Start Printed Page 48244 York, VA 5775 Oakland, CA 1 1.5204 Alameda, CA Contra Costa, CA 5790 Ocala, FL 0.9788 Marion, FL 5800 Odessa-Midland, TX 0.9447 Ector, TX Midland, TX 5880 Oklahoma City, OK 1 0.9027 Canadian, OK Cleveland, OK Logan, OK McClain, OK Oklahoma, OK Pottawatomie, OK 5910 Olympia, WA 1.1030 Thurston, WA 5920 Omaha, NE-IA 0.9744 Pottawattamie, IA Cass, NE Douglas, NE Sarpy, NE Washington, NE 5945 Orange County, CA 1 1.1235 Orange, CA 5960 Orlando, FL 1 0.9612 Lake, FL Orange, FL Osceola, FL Seminole, FL 5990 Owensboro, KY 0.8429 Daviess, KY 6015 Panama City, FL 2 0.8782 Bay, FL 6020 Parkersburg-Marietta, WV-OH (WV Hospitals) 0.8093 Washington, OH Wood, WV 6020 Parkersburg-Marietta, WV-OH 2 (OH Hospitals) 0.8756 Washington, OH Wood, WV 6080 Pensacola, FL 2 0.8782 Escambia, FL Santa Rosa, FL 6120 Peoria-Pekin, IL 0.8811 Peoria, IL Tazewell, IL Woodford, IL 6160 Philadelphia, PA-NJ 1 1.0947 Burlington, NJ Camden, NJ Gloucester, NJ Salem, NJ Bucks, PA Chester, PA Delaware, PA Montgomery, PA Philadelphia, PA 6200 Phoenix-Mesa, AZ 1 1.0213 Maricopa, AZ Pinal, AZ 6240 Pine Bluff, AR 0.7753 Jefferson, AR 6280 Pittsburgh, PA 1 0.8788 Allegheny, PA Beaver, PA Butler, PA Fayette, PA Washington, PA Westmoreland, PA 6323 Pittsfield, MA 2 1.1234 Berkshire, MA 6340 Pocatello, ID 0.9103 Bannock, ID 6360 Ponce, PR 0.4762 Guayanilla, PR Juana Diaz, PR Penuelas, PR Ponce, PR Villalba, PR Yauco, PR 6403 Portland, ME 0.9985 Cumberland, ME Sagadahoc, ME York, ME 6440 Portland-Vancouver, OR-WA 1 1.1193 Clackamas, OR Columbia, OR Multnomah, OR Washington, OR Yamhill, OR Clark, WA 6483 Providence-Warwick-Pawtucket, RI 1 1.1025 Bristol, RI Kent, RI Newport, RI Providence, RI Washington, RI 6520 Provo-Orem, UT 1.0043 Utah, UT 6560 Pueblo, CO 2 0.8897 Pueblo, CO 6580 Punta Gorda, FL 0.9518 Charlotte, FL 6600 Racine, WI 2 0.9130 Racine, WI 6640 Raleigh-Durham-Chapel Hill, NC 1 1.0084 Chatham, NC Durham, NC Franklin, NC Johnston, NC Orange, NC Wake, NC 6660 Rapid City, SD 0.8865 Pennington, SD 6680 Reading, PA 0.9042 Berks, PA 6690 Redding, CA 1.1357 Shasta, CA 6720 Reno, NV 1.0758 Washoe, NV 6740 Richland-Kennewick-Pasco, WA 1.0639 Benton, WA Franklin, WA 6760 Richmond-Petersburg, VA 0.9402 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, VA 6780 Riverside-San Bernardino, CA 1 1.1318 Riverside, CA San Bernardino, CA 6800 Roanoke, VA 0.8759 Botetourt, VA Roanoke, VA Roanoke City, VA Salem City, VA 6820 Rochester, MN 1.1802 Olmsted, MN 6840 Rochester, NY 1 0.9556 Genesee, NY Livingston, NY Monroe, NY Ontario, NY Orleans, NY Wayne, NY 6880 Rockford, IL 0.9730 Boone, IL Ogle, IL Winnebago, IL 6895 Rocky Mount, NC 0.9058 Edgecombe, NC Nash, NC 6920 Sacramento, CA 1 1.1911 El Dorado, CA Placer, CA Sacramento, CA 6960 Saginaw-Bay City-Midland, MI 0.9620 Bay, MI Midland, MI Saginaw, MI 6980 St. Cloud, MN 0.9723 Benton, MN Stearns, MN 7000 St. Joseph, MO 2 0.7793 Andrew, MO Buchanan, MO 7040 St. Louis, MO-IL 1 0.9049 Clinton, IL Jersey, IL Madison, IL Monroe, IL St. Clair, IL Franklin, MO Jefferson, MO Lincoln, MO St. Charles, MO St. Louis, MO St. Louis City, MO Warren, MO 7080 Salem, OR 1.0594 Marion, OR Polk, OR 7120 Salinas, CA 1.4435 Monterey, CA 7160 Salt Lake City-Ogden, UT 1 0.9899 Davis, UT Salt Lake, UT Weber, UT 7200 San Angelo, TX 0.8288 Tom Green, TX 7240 San Antonio, TX 1 0.8876 Bexar, TX Start Printed Page 48245 Comal, TX Guadalupe, TX Wilson, TX 7320 San Diego, CA 1 1.1206 San Diego, CA 7360 San Francisco, CA 1 1.4349 Marin, CA San Francisco, CA San Mateo, CA 7400 San Jose, CA 1 1.4642 Santa Clara, CA 7440 San Juan-Bayamon, PR 1 0.4904 Aguas Buenas, PR Barceloneta, PR Bayamon, PR Canovanas, PR Carolina, PR Catano, PR Ceiba, PR Comerio, PR Corozal, PR Dorado, PR Fajardo, PR Florida, PR Guaynabo, PR Humacao, PR Juncos, PR Los Piedras, PR Loiza, PR Luguillo, PR Manati, PR Morovis, PR Naguabo, PR Naranjito, PR Rio Grande, PR San Juan, PR Toa Alta, PR Toa Baja, PR Trujillo Alto, PR Vega Alta, PR Vega Baja, PR Yabucoa, PR 7460 San Luis Obispo-Atascadero-Paso Robles, CA 1.1484 San Luis Obispo, CA 7480 Santa Barbara-Santa Maria-Lompoc, CA 1.0511 Santa Barbara, CA 7485 Santa Cruz-Watsonville, CA 1.3012 Santa Cruz, CA 7490 Santa Fe, NM 1.0639 Los Alamos, NM Santa Fe, NM 7500 Santa Rosa, CA 1.2836 Sonoma, CA 7510 Sarasota-Bradenton, FL 0.9834 Manatee, FL Sarasota, FL 7520 Savannah, GA 0.9556 Bryan, GA Chatham, GA Effingham, GA 7560 Scranton—Wilkes-Barre—Hazleton, PA 2 0.8429 Columbia, PA Lackawanna, PA Luzerne, PA Wyoming, PA 7600 Seattle-Bellevue-Everett, WA 1 1.1557 Island, WA King, WA Snohomish, WA 7610 Sharon, PA 2 0.8429 Mercer, PA 7620 Sheboygan, WI 2 0.9130 Sheboygan, WI 7640 Sherman-Denison, TX 0.9508 Grayson, TX 7680 Shreveport-Bossier City, LA 0.9127 Bossier, LA Caddo, LA Webster, LA 7720 Sioux City, IA-NE 0.9052 Woodbury, IA Dakota, NE 7760 Sioux Falls, SD 0.9371 Lincoln, SD Minnehaha, SD 7800 South Bend, IN 0.9887 St. Joseph, IN 7840 Spokane, WA 1.0954 Spokane, WA 7880 Springfield, IL 0.9004 Menard, IL Sangamon, IL 7920 Springfield, MO 0.8470 Christian, MO Greene, MO Webster, MO 8003 Springfield, MA 2 1.1234 Hampden, MA Hampshire, MA 8050 State College, PA 0.8798 Centre, PA 8080 Steubenville-Weirton, OH-WV 0.8454 Jefferson, OH Brooke, WV Hancock, WV 8120 Stockton-Lodi, CA 1.1168 San Joaquin, CA 8140 Sumter, SC 2 0.8489 Sumter, SC 8160 Syracuse, NY 0.9482 Cayuga, NY Madison, NY Onondaga, NY Oswego, NY 8200 Tacoma, WA 2 1.0242 Pierce, WA 8240 Tallahassee, FL 2 0.8782 Gadsden, FL Leon, FL 8280 Tampa-St. Petersburg-Clearwater, FL 1 0.9111 Hernando, FL Hillsborough, FL Pasco, FL Pinellas, FL 8320 Terre Haute, IN 2 0.8770 Clay, IN Vermillion, IN Vigo, IN 8360 Texarkana, AR-Texarkana, TX 0.8198 Miller, AR Bowie, TX 8400 Toledo, OH 0.9551 Fulton, OH Lucas, OH Wood, OH 8440 Topeka, KS 0.9021 Shawnee, KS 8480 Trenton, NJ 1.0556 Mercer, NJ 8520 Tucson, AZ 0.8958 Pima, AZ 8560 Tulsa, OK 0.9093 Creek, OK Osage, OK Rogers, OK Tulsa, OK Wagoner, OK 8600 Tuscaloosa, AL 0.8239 Tuscaloosa, AL 8640 Tyler, TX 0.8789 Smith, TX 8680 Utica-Rome, NY 2 0.8530 Herkimer, NY Oneida, NY 8720 Vallejo-Fairfield-Napa, CA 1.3500 Napa, CA Solano, CA 8735 Ventura, CA 1.0472 Ventura, CA 8750 Victoria, TX 0.8105 Victoria, TX 8760 Vineland-Millville-Bridgeton, NJ 1.0475 Cumberland, NJ 8780 Visalia-Tulare-Porterville, CA 2 0.9907 Tulare, CA 8800 Waco, TX 0.8449 McLennan, TX 8840 Washington, DC-MD-VA-WV 1 1.0707 District of Columbia, DC Calvert, MD Charles, MD Frederick, MD Montgomery, MD Prince Georges, MD Alexandria City, VA Arlington, VA Clarke, VA Culpepper, VA Fairfax, VA Fairfax City, VA Falls Church City, VA Fauquier, VA Fredericksburg City, VA King George, VA Loudoun, VA Manassas City, VA Manassas Park City, VA Prince William, VA Spotsylvania, VA Stafford, VA Warren, VA Berkeley, WV Jefferson, WV 8920 Waterloo-Cedar Falls, IA 0.8422 Black Hawk, IA 8940 Wausau, WI 0.9806 Marathon, WI 8960 West Palm Beach-Boca Raton, FL 1 0.9784 Palm Beach, FL Start Printed Page 48246 9000 Wheeling, WV-OH 2 (WV Hospitals) 0.8008 Belmont, OH Marshall, WV Ohio, WV 9000 Wheeling, WV-OH 2 (OH Hospitals) 0.8756 Belmont, OH Marshall, WV Ohio, WV 9040 Wichita, KS 0.9300 Butler, KS Harvey, KS Sedgwick, KS 9080 Wichita Falls, TX 0.8407 Archer, TX Wichita, TX 9140 Williamsport, PA 2 0.8429 Lycoming, PA 9160 Wilmington-Newark, DE-MD 1.0955 New Castle, DE Cecil, MD 9200 Wilmington, NC 0.9604 New Hanover, NC Brunswick, NC 9260 Yakima, WA 1.0320 Yakima, WA 9270Yolo, CA 2 0.9907 Yolo, CA 9280 York, PA 0.9154 York, PA 9320 Youngstown-Warren, OH 0.9273 Columbiana, OH Mahoning, OH Trumbull, OH 9340 Yuba City, CA 1.0264 Sutter, CA Yuba, CA 9360 Yuma, AZ 0.8954 Yuma, AZ 1 Large urban area. 2 Hospitals geographically located in the area are assigned the statewide rural wage index for FY 2004. Addendum I.—Wage Index for Rural Areas
Nonurban area Wage index Alaska 1.1958 Arizona 0.8906 Arkansas 0.7746 California 0.9907 Colorado 0.8897 Connecticut 1.2199 Delaware 0.9669 Florida 0.8782 Georgia 0.8365 Hawaii 0.9896 Idaho 0.8907 Illinois 0.8282 Indiana 0.8770 Iowa 0.8278 Kansas 0.7860 Kentucky 0.7924 Louisiana 0.7565 Maine 0.8995 Maryland 0.9175 Massachusetts 1.1234 Michigan 0.8807 Minnesota 0.9243 Mississippi 0.7810 Missouri 0.7793 Montana 0.8530 Nebraska 0.8326 Nevada 0.9758 New Hampshire 0.9944 New Jersey1 New Mexico 0.8314 New York 0.8530 North Carolina 0.8355 North Dakota 0.7536 Ohio 0.8756 Oklahoma 0.7577 Oregon 0.9939 Pennsylvania 0.8429 Puerto Rico 0.4037 Rhode Island1 South Carolina 0.8489 South Dakota 0.8093 Tennessee 0.7945 Texas 0.7673 Utah 0.9034 Vermont 0.9401 Virginia 0.8542 Washington 1.0242 West Virginia 0.8008 Wisconsin 0.9130 Wyoming 0.9137 1 All counties within the State are classified as urban. Addendum J.—Wage Index for Hospitals That are Reclassified
Area Wage index Akron, OH 0.9445 Albany, GA 1.0643 Albuquerque, NM 0.9431 Alexandria, LA 0.8087 Altoona, PA 0.8886 Amarillo, TX 0.8814 Anchorage, AK 1.2433 Ann Arbor, MI 1.0859 Anniston, AL 0.8025 Asheville, NC 0.9503 Athens, GA 0.9437 Atlanta, GA 0.9912 Atlantic-Cape May, NJ 1.0597 Augusta-Aiken, GA-SC 0.9491 Austin-San Marcos, TX 0.9551 Bangor, ME 0.9750 Barnstable-Yarmouth, MA 1.2703 Baton Rouge, LA 0.8271 Bellingham, WA 1.1834 Benton Harbor, MI 0.8949 Bergen-Passaic, NJ 1.1655 Billings, MT 0.8889 Biloxi-Gulfport-Pascagoula, MS 0.8449 Binghamton, NY 0.8433 Birmingham, AL 0.9251 Bismarck, ND 0.8101 Bloomington-Normal, IL 0.8954 Boise City, ID 0.9295 Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH 1.1269 Burlington, VT 0.9442 Caguas, PR 0.4229 Casper, WY 0.9239 Champaign-Urbana, IL 0.9385 Charleston-North Charleston, SC 0.9307 Charleston, WV (WV Hospitals) 0.8510 Charleston, WV (OH Hospitals) 0.8756 Charlotte-Gastonia-Rock Hill, NC-SC 0.9636 Charlottesville, VA 0.9946 Chattanooga, TN-GA 0.8985 Chicago, IL 1.0863 Cincinnati, OH-KY-IN 0.9452 Clarksville-Hopkinsville, TN-KY 0.8410 Cleveland-Lorain-Elyria, OH 0.9686 Columbia, MO 0.8607 Columbia, SC 0.8958 Columbus, GA-AL 0.8505 Columbus, OH 0.9649 Corpus Christi, TX 0.8565 Corvallis, OR 1.1316 Dallas, TX 0.9733 Davenport-Moline-Rock Island, IA-IL 0.8727 Dayton-Springfield, OH 0.9432 Decatur, AL 0.8633 Denver, CO 1.0581 Des Moines, IA 0.9053 Detroit, MI 1.0097 Dothan, AL 0.7931 Dover, DE 0.9669 Duluth-Superior, MN-WI 1.0133 Dutchess County, NY 1.0769 Eau Claire, WI 0.9141 Elkhart-Goshen, IN 0.9613 Erie, PA 0.8530 Eugene-Springfield, OR 1.0889 Fargo-Moorhead, ND-MN 0.9444 Fayetteville, NC 0.8957 Flagstaff, AZ-UT 1.1086 Flint, MI 1.0929 Florence, AL 0.7824 Florence, SC 0.8763 Fort Collins-Loveland, CO 1.0201 Ft. Lauderdale, FL 1.0534 Fort Pierce-Port St. Lucie, FL 1.0227 Fort Smith, AR-OK 0.7577 Fort Walton Beach, FL 0.8700 Forth Worth-Arlington, TX 0.9268 Gadsden, AL 0.8295 Grand Forks, ND-MN (ND Hospitals) 0.9031 Grand Forks, ND-MN (MN Hospitals) 0.9243 Grand Junction, CO 0.9940 Grand Rapids-Muskegon-Holland, MI 0.9406 Great Falls, MT 0.8977 Greeley, CO 0.9516 Green Bay, WI 0.9201 Greensboro-Winston-Salem-High Point, NC (NC Hospitals) 0.8533 Greensboro-Winston-Salem-High Point, NC (VA Hospitals) 0.8542 Greenville, NC 0.9621 Hamilton-Middletown, OH 0.9236 Harrisburg-Lebanon-Carlisle, PA 0.9178 Start Printed Page 48247 Hartford, CT (MA Hospitals) 1.1234 Hartford, CT (NY Hospitals) 1.1211 Hattiesburg, MS 0.7810 Hickory-Morganton-Lenoir, NC 0.8987 Honolulu, HI 1.1176 Houston, TX 0.9591 Huntington-Ashland, WV-KY-OH 0.9080 Huntsville, AL 0.8954 Indianapolis, IN 0.9934 Iowa City, IA 0.9460 Jackson, MS 0.8459 Jackson, TN 0.8602 Jacksonville, FL 0.9426 Johnson City-Kingsport-Bristol, TN-VA (VA Hospitals) 0.8542 Johnson City-Kingsport-Bristol, TN-VA (KY Hospitals) 0.8371 Jonesboro, AR (AR Hospitals) 0.7755 Jonesboro, AR (MO Hospitals) 0.7793 Joplin, MO 0.8621 Kalamazoo-Battlecreek, MI 1.0554 Kansas City, KS-MO 0.9551 Knoxville, TN 0.8987 Kokomo, IN 0.8963 Lafayette, LA 0.8271 Lakeland-Winter Haven, FL 0.8782 Las Vegas, NV-AZ 1.1341 Lawton, OK 0.8194 Lexington, KY 0.8424 Lima, OH 0.9457 Lincoln, NE 0.9613 Little Rock-North Little Rock, AR 0.8905 Longview-Marshall, TX 0.8969 Los Angeles-Long Beach, CA 1.1656 Louisville, KY-IN 0.9056 Lubbock, TX 0.8330 Lynchburg, VA 0.9004 Macon, GA 0.9011 Madison, WI 1.0108 Medford-Ashland, OR 1.0494 Melbourne-Titusville-Palm Bay, FL 0.9837 Memphis, TN-AR-MS 0.9010 Miami, FL 0.9888 Milwaukee-Waukesha, WI 0.9760 Minneapolis-St. Paul, MN-WI 1.1064 Missoula, MT 0.8943 Mobile, AL 0.7948 Modesto, CA 1.1183 Monmouth-Ocean, NJ 1.1094 Monroe, LA 0.7978 Montgomery, AL 0.7856 Nashville, TN 0.9582 New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT 1.2525 New Orleans, LA 0.9167 New York, NY 1.3867 Newark, NJ 1.1417 Newburgh, NY-PA 1.1377 Norfolk-Virginia Beach-Newport News, VA-NC 0.8659 Oakland, CA 1.5204 Ocala, FL 0.9646 Odessa-Midland, TX 0.9156 Oklahoma City, OK 0.9027 Olympia, WA 1.1030 Omaha, NE-IA 0.9744 Orange County, CA 1.1235 Orlando, FL 0.9612 Peoria-Pekin, IL 0.8811 Philadelphia, PA-NJ 1.0947 Phoenix-Mesa, AZ 1.0213 Pine Bluff, AR 0.7810 Pittsburgh, PA 0.8788 Pittsfield, MA 0.9861 Pocatello, ID (ID Hospitals) 0.9103 Pocatello, ID (WY Hospitals) 0.9137 Portland, ME 0.9784 Portland-Vancouver, OR-WA 1.1193 Provo-Orem, UT 0.9912 Raleigh-Durham-Chapel Hill, NC 0.9756 Rapid City, SD 0.8865 Reading, PA 0.8910 Redding, CA 1.1357 Reno, NV 1.0758 Richland-Kennewick-Pasco, WA 1.0639 Richmond-Petersburg, VA 0.9402 Roanoke, VA 0.8759 Rochester, MN 1.1802 Rockford, IL 0.9500 Sacramento, CA 1.1911 Saginaw-Bay City-Midland, MI 0.9470 St. Cloud, MN 0.9723 St. Joseph, MO 0.9694 St. Louis, MO-IL 0.9049 Salinas, CA 1.4435 Salt Lake City-Ogden, UT 0.9899 San Antonio, TX 0.8876 Santa Fe, NM 0.9543 Santa Rosa, CA 1.2836 Sarasota-Bradenton, FL 0.9834 Savannah, GA 0.9556 Seattle-Bellevue-Everett, WA 1.1557 Sherman-Denison, TX 0.9084 Shreveport-Bossier City, LA 0.9127 Sioux City, IA-NE 0.8806 Sioux Falls, SD 0.9246 South Bend, IN 0.9780 Spokane, WA 1.0770 Springfield, IL 0.9004 Springfield, MO 0.8269 Stockton-Lodi, CA 1.1168 Syracuse, NY 0.9381 Tampa-St. Petersburg-Clearwater, FL 0.9111 Texarkana, AR-Texarkana, TX 0.8018 Toledo, OH 0.9551 Topeka, KS 0.8791 Tucson, AZ 0.8958 Tulsa, OK 0.8876 Tuscaloosa, AL 0.8134 Tyler, TX 0.8789 Vallejo-Fairfield-Napa, CA 1.3500 Victoria, TX 0.8105 Waco, TX 0.8449 Washington, DC-MD-VA-WV 1.0707 Waterloo-Cedar Falls, IA 0.8422 Wausau, WI 0.9806 West Palm Beach-Boca Raton, FL 0.9784 Wichita, KS 0.9053 Wichita Falls, TX 0.8407 Wilmington-Newark, DE-MD 1.0782 Wilmington, NC 0.9402 York, PA 0.9154 Youngstown-Warren, OH 0.9273 Rural Alabama 0.7517 Rural Florida 0.8782 Rural Illinois 0.8282 Rural Kentucky 0.7924 Rural Louisiana 0.7565 Rural Michigan 0.8807 Rural Minnesota 0.9243 Rural Mississippi 0.7810 Rural Missouri 0.7793 Rural Nebraska 0.8326 Rural New Hampshire 0.9944 Rural Texas 0.7673 Rural Washington 1.0242 Rural Wyoming 0.9020 Addendum L.—Packaged Nonchemotherapy Infusion Drugs Calendar Year 2004
HCPCS Descriptor J0706 Caffeine citrate injection J1260 Dolasetron mesylate J1325 Epoprostenol injection J1436 Etidronate disodium inj J1570 Ganciclovir sodium injection J1626 Granisetron HCl injection J2020 Linezolid injection J2260 Inj milrinone lactate, per 5 J2275 Morphine sulfate injection J2405 Ondansetron hcl injection J2765 Metoclopramide hcl injection J2770 Quinupristin/dalfopristin J2820 Sargramostim injection J2997 Alteplase recombinant J3010 Fentanyl citrate injeciton J7501 Azathioprine parenteral J7516 Cyclosporin parenteral 250mg J7525 Tacrolimus injection Q2003 Aprotinin, 10,000 kiu Q2007 Ethanolamine oleate 100 mg Q2009 Fosphenytoin, 50 mg Q2013 Pentastarch 10% solution Q2021 Lepirudin Addendum M.—Separately Paid Nonchemotology Infusion Drugs Calendar Year 2004
HCPCS Descriptor C1178 BUSULFAN IV, 6 Mg C9019 Caspofungin acetate, 5 mg C9109 Tirofiban hcl, 6.25 mg J0130 Abciximab injection J0151 Adenosine injection J0286 Amphotericin B lipid complex J0350 Injection anistreplase 30 u J0850 Cytomegalovirus imm IV /vial J1327 Eptifibatide injection J1440 Filgrastim 300 mcg injection J1441 Filgrastim 480 mcg injection J1561 Immune globulin 500 mg J1563 Immune globulin, 1 g J1564 Immune globulin 10 mg J1565 RSV-ivig J1745 Infliximab injection J2792 Rho(D) immune globulin h, sd J2993 Reteplase injection J2995 Inj streptokinase /250000 IU Start Printed Page 48248 J3245 Tirofiban hydrochloride J3305 Inj trimetrexate glucoronate J3365 Urokinase 250,000 IU inj J3395 Verteporfin injection J7197 Antithrombin iii injection J7504 Lymphocyte immune globulin J7511 Antithymocyte globuln rabbit J9200 Floxuridine injection J9600 Porfimer sodium P9041 Albumin (human),5%, 50ml P9045 Albumin (human), 5%, 250 ml P9046 Albumin (human), 25%, 20 ml P9047 Albumin (human), 25%, 50ml Q2006 Digoxin immune fab (ovine) Q2008 Fomepizole, 15 mg Q2011 Hemin, per 1 mg Addendum N.—Packaged Chemotherapy Drug Other Than Infusion Calendar Year 2004
HCPCS Short descriptor J9000 Doxorubic hcl 10 MG vl chemo J9190 Fluorouracil injection J9212 Interferon alfacon-1 J9213 Interferon alfa-2a inj J9230 Mechlorethamine hcl inj J9250 Methotrexate sodium inj J9360 Vinblastine sulfate inj J9370 Vincristine sulfate 1 MG inj Addendum O.—Separately Paid Chemotherapy Drugs Other than Infusion Calendar Year 2004
HCPCS Short descriptor J2352 Octreotide acetate injection J9202 Goserelin acetate implant J9214 Interferon alfa-2b inj J9217 Leuprolide acetate suspnsion J9218 Leuprolide acetate inj J9219 Leuprolide acetate implant Addendum P.—Packaged Chemotherapy Drugs Infusion Only Calendar Year 2004
HCPCS Short descriptor C1166 CYTARABINE LIPOSOMAL, 10 mg J1620 Gonadorelin hydroch/100 mcg J9020 Asparaginase injection J9031 Bcg live intravesical vac J9070 Cyclophosphamide 100 MG inj J9093 Cyclophosphamide lyophilized J9100 Cytarabine hcl 100 MG inj J9120 Dactinomycin actinomycin d J9130 Dacarbazine 10 MG inj J9181 Etoposide 10 MG inj J9270 Plicamycin (mithramycin) inj J9340 Thiotepa injection End Supplemental InformationAddendum Q.—Separately Paid Chemotherapy Drugs Infusion Only Calendar Year 2004
HCPCS Short descriptor C1167 EPIRUBICIN HCL, 2 mg C1207 OCTREOTIDE ACETATE DEPOT 1mg C9110 Alemtuzumab, per 10mg/ml J0207 Amifostine J1190 Dexrazoxane HCl injection J1950 Leuprolide acetate /3.75 MG J2355 Oprelvekin injection J2430 Pamidronate disodium /30 MG J9001 Doxorubicin hcl liposome inj J9015 Aldesleukin/single use vial J9017 Arsenic trioxide J9040 Bleomycin sulfate injection J9045 Carboplatin injection J9050 Carmus bischl nitro inj J9060 Cisplatin 10 MG injection J9065 Inj cladribine per 1 MG J9150 Daunorubicin J9151 Daunorubicin citrate liposom J9160 Denileukin diftitox, 300 mcg J9165 Diethylstilbestrol injection J9170 Docetaxel J9185 Fludarabine phosphate inj J9201 Gemcitabine HCl J9206 Irinotecan injection J9208 Ifosfomide injection J9209 Mesna injection J9211 Idarubicin hcl injection J9245 Inj melphalan hydrochl 50 MG J9265 Paclitaxel injection J9266 Pegaspargase/singl dose vial J9268 Pentostatin injection J9280 Mitomycin 5 MG inj J9293 Mitoxantrone hydrochl/5 MG J9300 Gemtuzumab ozogamicin J9310 Rituximab cancer treatment J9320 Streptozocin injection J9350 Topotecan J9355 Trastuzumab J9357 Valrubicin, 200 mg J9390 Vinorelbine tartrate/10 mg Q2017 Teniposide, 50 mg [FR Doc. 03-20280 Filed 8-6-03; 8:45 am]
BILLING CODE 4120-01-P
Document Information
- Published:
- 08/12/2003
- Department:
- Centers for Medicare & Medicaid Services
- Entry Type:
- Proposed Rule
- Action:
- Proposed rule.
- Document Number:
- 03-20280
- Dates:
- We will consider comments if we receive them at the appropriate
- Pages:
- 47965-48248 (284 pages)
- Docket Numbers:
- CMS-1471-P
- RINs:
- 0938-AL19: Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2003 Payment Rates (CMS-1206-F)
- RIN Links:
- https://www.federalregister.gov/regulations/0938-AL19/changes-to-the-hospital-outpatient-prospective-payment-system-and-calendar-year-2003-payment-rates-c
- PDF File:
- 03-20280.pdf
- CFR: (2)
- 42 CFR 410
- 42 CFR 419