05-14448. Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 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 and to implement certain related provisions of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. In addition, the proposed rule describes proposed changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. This proposed rule would also change the requirement for physician oversight of mid-level practitioners in critical access hospitals (CAHs). These changes would be applicable to services furnished on or after January 1, 2006.

    DATES:

    To be ensured consideration, comments must be received at one of the addresses provided in the ADDRESSES section, no later than 5 p.m. on September 16, 2005.

    ADDRESSES:

    In commenting, please refer to file code CMS-1501-P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission.

    You may submit comments in one of three ways (no duplicates, please):

    1. Electronically. You may submit electronic comments on specific issues in this proposed rule to http://www.cms.hhs.gov/​regulations/​ecomments. (Attachments should be in Microsoft Word, WordPerfect, or Excel; however, we prefer Microsoft Word).

    2. By regular mail. You may 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-1501-P, P.O. Box 8016, Baltimore, MD 21244-8018.

    3. By express or overnight mail. You may send 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-1501-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.

    4. By hand or courier. If you prefer, you may deliver (by hand or courier) your written comments (one original and two copies) before the close of the comment period to one of the following addresses. If you intend to deliver your comments to the Baltimore address, please call telephone number (410) 786-7195 in advance to schedule your arrival with one of our staff members. Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201, or 7500 Security Boulevard, Baltimore, MD 21244-1850.

    (Because access to the interior of the Hubert H. Humphrey 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 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 received after the comment period.

    Submission of Comments on Paperwork Requirements: For comments that relate to information collection requirements, mail a copy of comments to the following addresses: Centers for Medicare & Medicaid Services, Office of Strategic Operations and Regulatory Affairs, Security and Standards Group, Office of Issuances, Room C4-24-02, 7500 Security Boulevard, Baltimore, MD 21244-1850, Attn: James Wickliffe, CMS-1501-P; and, Office of Information and Regulatory Affairs, Office of Management and Budget, Room 3001, New Executive Office Building, Washington, DC 20503, Christopher Martin, CMS Desk Officer, CMS-1501-P.

    Comments submitted to OMB may also be e-mailed to the following address: Christopher_Martin@omb.eop.gov, or faxed to OMB at (202) 395-6974.

    Submitting Comments: We welcome comments from the public on all issues set forth in this rule to assist us in fully considering issues and developing policies. You can assist us by referencing the file code CMS-1501-P and the specific “issue identifier” that precedes the section on which you choose to comment.

    Inspection of Public Comments: All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. CMS posts all electronic comments received before the close of the comment period on its public Web site as soon as possible after they have been received. Hard copy 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, MD 21244-1850, Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view public comments, phone 1-800-743-3951.

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    FOR FURTHER INFORMATION, CONTACT:

    Rebecca Kane, (410) 786-0378, Outpatient prospective payment issues, and Suzanne Asplen, (410) 786-4558, Partial hospitalization and community mental health center issues.

    End Further Info End Preamble Start Supplemental Information

    SUPPLEMENTARY INFORMATION:

    Electronic Access

    This Federal Register document is 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.gpoaccess.gov/​fr/​index.html.

    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

    AMP Average manufacturer price

    ASP Average sales price

    ASC Ambulatory surgical center

    AWP Average wholesale price

    BBA Balanced Budget Act of 1997, Pub. L. 105-33

    BIPA Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, Pub. L. 106-554

    BBRA Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999, Pub. L. 106-113

    CAH Critical access hospital

    CBSA Core-Based Statistical Areas

    CCR (Cost center specific) cost-to-charge ratio

    CMHC Community mental health center Start Printed Page 42675

    CMS Centers for Medicare & Medicaid Services (formerly known as the Health Care Financing Administration)

    CORF Comprehensive outpatient rehabilitation facility

    CPT [Physicians'] Current Procedural Terminology, Fourth Edition, 2005, copyrighted by the American Medical Association

    CRNA Certified registered nurse anesthetist

    CY Calendar year

    DMEPOS Durable medical equipment, prosthetics, orthotics, and supplies

    DMERC Durable medical equipment regional carrier

    DRG Diagnosis-related group

    DSH Disproportionate share hospital

    EACH Essential Access Community Hospital

    E/M Evaluation and management

    EPO Erythropoietin

    ESRD End-stage renal disease

    FACA Federal Advisory Committee Act, Pub. L. 92-463

    FDA Food and Drug Administration

    FI Fiscal intermediary

    FSS Federal Supply Schedule

    FY Federal fiscal year

    GAO Government Accountability Office

    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, Pub. L. 104-191

    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

    MMA Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Pub. L. 108-173

    MSA Metropolitan Statistical Area

    NCCI National Correct Coding Initiative

    NCD National Coverage Determination

    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

    PPI Producer Price Index

    PPS Prospective payment system

    PPV Pneumococcal pneumonia (virus)

    PRA Paperwork Reduction Act

    QIO Quality Improvement Organization

    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 of 1982, Pub. L. 97-248

    TOPS Transitional outpatient payments

    USPDI United States Pharmacopoeia Drug Information

    To assist readers in referencing sections contained in this document, we are providing the following outline of contents:

    Outline of Contents

    I. Background

    A. Legislative and Regulatory Authority for the Hospital Outpatient Prospective Payment System

    B. Excluded OPPS Services and Hospitals

    C. Prior Rulemaking

    D. APC Advisory Panel

    1. Authority for the APC Panel

    2. Establishment of the APC Panel

    3. APC Panel Meetings and Organizational Structure

    E. Provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 To Be Implemented Beginning in CY 2006

    1. Hold Harmless Provisions

    2. Study and Authorization of Adjustment for Rural Hospitals

    3. Payment for “Specified Covered Outpatient Drugs”

    4. Adjustment in Payment Rates for “Specified Covered Outpatient Drugs” for Overhead Costs

    5. Budget Neutrality Adjustment

    F. CMS' Commitment to New Technologies

    G. Summary of the Major Content of This Proposed Rule

    II. Proposed Updates Affecting Payments for CY 2006

    A. Recalibration of APC Relative Weights for CY 2006

    1. Database Construction

    a. Database Source and Methodology

    b. Proposed Use of Single and Multiple Procedure Claims

    2. Proposed Calculation of Median Costs for CY 2006

    3. Proposed Calculation of Scaled OPPS Payment Weights

    4. Proposed Changes to Packaged Services

    B. Proposed Payment for Partial Hospitalization

    1. Background

    2. Proposed PHP APC Update for CY 2006

    3. Proposed Separate Threshold for Outlier Payments to CMHCs

    C. Proposed Conversion Factor Update for CY 2006

    D. Proposed Wage Index Changes for CY 2006

    E. Proposed Statewide Average Default Cost-to-Charge Ratios

    F. Expiring Hold Harmless Provision for Transitional Corridor Payments for certain Rural Hospitals

    G. Proposed Adjustment for Rural Hospitals

    1. Factors Contributing to Unit Cost Differences Between Rural Hospitals and Urban Hospitals

    2. Explanatory Variables

    3. Results

    H. Proposed Hospital Outpatient Outlier Payments

    I. Calculation of Proposed National Unadjusted Medicare Payment

    J. Proposed Beneficiary Copayments for CY 2006

    1. Background

    2. Proposed Copayment for CY 2006

    3. Calculation of the Proposed Unadjusted Copayment Amount for CY 2006

    III. Proposed Ambulatory Payment Classification (APC) Group Policies

    A. Background

    B. Proposed Changes—Variations Within APCs

    1. Application of the 2 Times Rule

    a. APC 0146: Level I Sigmoidoscopy

    b. APC 0342: Level I Pathology

    2. Proposed Exceptions to the 2 Times Rule

    C. New Technology APCs

    1. Background

    2. Proposed Refinement of New Technology Cost Bands

    3. Proposed Requirements for Assigning Services to New Technology APCs

    4. Proposed Movement of Procedures from New Technology APCs to Clinically Appropriate APCs

    a. Proton Beam Therapy

    b. Stereotactic Radiosurgery

    c. Other Services in New Technology APCs

    D. Proposed APC-Specific Policies

    1. Hyperbaric Oxygen Therapy

    2. Allergy Testing

    3. Stretta Procedure

    4. Vascular Access Procedures

    E. Proposed Addition of New Procedure Codes

    IV. Proposed Payment Changes for Devices

    A. Device-Dependent APCs

    B. APC Panel Recommendations Pertaining to APC 0107 and APC 0108

    C. Pass-Through Payments for Devices

    1. Expiration of Transitional Pass-Through Payments for Certain Devices

    2. Proposed Policy for CY 2006

    D. Other Policy Issues Relating to Pass-Through Device Categories

    1. Provisions for Reducing Transitional Pass-Through Payments to Offset Costs Packaged into APC Groups

    a. Background

    b. Proposed Policy for CY 2006

    2. Criteria for Establishing New Pass-Through Device Categories

    a. Surgical Insertion and Implantation Criterion

    b. Public Comments Received and Our Responses

    c. Existing Device Category Criterion

    V. Proposed Payment Changes for Drugs, Biologicals, and Radiopharmaceutical Agents

    A. Transitional Pass-Through Payment for Additional Costs of Drugs and Biologicals Start Printed Page 42676

    1. Background

    2. Expiration in CY 2005 of Pass-Through Status for Drugs and Biologicals

    3. Drugs and Biologicals with Proposed Pass-Through Status in CY 2006

    B. Proposed Payment for Drugs, Biologicals, and Radiopharmaceuticals Without Pass-Through Status

    1. Background

    2. Proposed Criteria for Packaging Payment for Drugs, Biologicals, and Radiopharmaceuticals

    3. Proposed Payment for Drugs, Biologicals, and Radiopharmaceuticals Without Pass-Through Status That Are Not Packaged

    a. Proposed Payment for Specified Covered Outpatient Drugs

    (1) Background

    (2) Proposed Changes for CY 2006 Related to Pub. L. 108-173

    (3) Data Sources Available for Setting CY 2006 Payment Rates

    (4) CY 2006 Proposed Payment Policy for Radiopharmaceutical Agents

    (5) MedPAC Report on APC Payment Rate Adjustment of Specified Covered Outpatient Drugs

    b. Proposed CY 2006 Payment for Nonpass-Through Drugs, Biologicals, and Radiopharmaceuticals with HCPCS Codes But Without OPPS Hospital Claims Data

    C. Proposed Coding and Billing Changes for Specified Covered Outpatient Drugs

    1. Background

    2. Proposed Policy for CY 2006

    D. Proposed Payment for New Drugs, Biologicals, and Radiopharmaceuticals Before HCPCS Codes Are Assigned

    1. Background

    2. Proposed Policy for CY 2006

    E. Proposed Payment for Vaccines

    F. Proposed Changes in Payments for Single Indication Orphan Drugs

    VI. Estimate of Transitional Pass-Through Spending in CY 2006 for Drugs, Biologicals, and Devices

    A. Total Allowed Pass-Through Spending

    B. Estimate of Pass-Through Spending for CY 2006

    VII. Proposed Brachytherapy Payment Changes

    A. Background

    B. Proposed Changes Related to Pub. L. 108-173

    VIII. Proposed Coding and Payment for Drug Administration

    A. Background

    B. Proposed Changes for CY 2006

    C. Proposed Changes to Vaccine Administration

    IX. Hospital Coding for Evaluation and Management (E/M) Services

    X. Proposed Payment for Blood and Blood Products

    A. Background

    B. Proposed Changes for CY 2006

    XI. Proposed Payment for Observation Services

    A. Background

    B. Proposed CY 2006 Coding Changes for Observation Services

    C. Proposed Criteria for Separately Payable Observation Services

    1. Diagnosis Requirements

    2. Observation Time

    3. Additional Hospital Services

    4. Physician Evaluation

    D. Separate Payment for Direct Admission to Observation Care (APC 0600)

    XII. Procedures That Will Be Paid Only as Inpatient Procedures

    A. Background

    B. Proposed Changes to the Inpatient List

    C. Ancillary Outpatient Services When Patient Expires

    XIII. Proposed Indicator Assignments

    A. Proposed Status Indicator Assignments

    B. Proposed Comment Indicators for the CY 2006 OPPS Final Rule

    XIV. Proposed Nonrecurring Policy Changes

    A. Proposed Payment for Multiple Diagnostic Imaging Procedures

    B. Interrupted Procedure Payment Policies (Modifiers -52, -73, and -74)

    XV. OPPS Policy and Payment Recommendations

    A. MedPAC Recommendations

    B. APC Panel Recommendations

    C. GAO Recommendations

    XVI. Physician Oversight of Mid-Level Practitioners in Critical Access Hospitals

    A. Background

    B. Proposed Policy Change

    XVII. Files Available to the Public via the Internet

    XVIII. Collection of Information Requirements

    XIX. Response to Public Comments

    XX. Regulatory Impact Analysis

    A. OPPS: General

    1. Executive Order 12866

    2. Regulatory Flexibility Act (RFA)

    3. Small Rural Hospitals

    4. Unfunded Mandates

    5. Federalism

    B. Impact of Proposed Changes in this Proposed Rule

    C. Alternatives Considered

    1. Option Considered for Proposed Payment Policy for Separately Payable Drugs and Biologicals

    2. Payment Adjustment for Rural Sole Community Hospitals

    3. Change in the Percentage of Total OPPS Payments Dedicated to Outlier Payments

    D. Limitations of Our Analysis

    E. Estimated Impacts of this Proposed Rule on Hospitals

    F. Estimated Impacts of this Proposed Rule on Beneficiaries

    Regulation Text

    Addenda

    Addendum A—List of Ambulatory Payment Classification (APCs) with Status Indicators, Relative Weights, Payment Rates, and Copayment Amounts for CY 2006

    Addendum B—Payment Status by HCPCS Code and Related Information—CY 2006

    Addendum C—Healthcare Common Procedure Coding System (HCPCS) Codes by Ambulatory Payment Classification (APC) (Available only on CMS Web site via Internet. Refer to section XVII. of the preamble of this proposed rule.)

    Addendum D1—Payment Status Indicators for the Hospital Outpatient Prospective Payment System

    Addendum D2—Comment Indicators

    Addendum E—CPT Codes That Are 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 K—Puerto Rico Wage Index by CBSA

    Addendum L—Out-Migration Wage Adjustment—CY 2006

    Addendum M—Hospital Reclassifications and Redesignations by Individual Hospitals and CBSA

    Addendum N—Hospital Reclassifications and Redesignations by Individual Hospitals under Section 508 of Pub. L. 108-173

    Addendum O—Hospitals Redesignated as Rural Under Section 1886(d)(8)(E) of the Act

    I. Background

    A. Legislative and Regulatory Authority for the Hospital 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 reasonable 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 Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA) (Pub. L. 106-113), enacted on November 29, 1999, made major changes that affected the hospital outpatient PPS (OPPS). The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) (Pub. L. 106-554), enacted on December 21, 2000, made further changes in the OPPS. Section 1833(t) of the Act was also amended by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Pub. L. 108-173, enacted on December 8, 2003. (Discussion of provisions related specifically to the CY 2006 OPPS is included in sections V. and VII. of this proposed rule.) The OPPS was first implemented for services furnished on or after August 1, 2000. Implementing regulations for the OPPS are located at 42 CFR part 419.

    Under the OPPS, we pay for hospital outpatient services on a rate-per-service basis that varies according to the ambulatory payment classification (APC) group to which the service is Start Printed Page 42677assigned. We use Healthcare Common Procedure Coding System (HCPCS) codes (which include certain Current Procedural Terminology (CPT) codes) and descriptors to identify and group the services within each APC group. The OPPS includes payment for most hospital outpatient services, except those identified in section I.B. of this proposed rule. Section 1833(t)(1)(B)(ii) of the Act provides for Medicare payment under the OPPS for certain services designated by the Secretary that are furnished to inpatients who have exhausted their Part A benefits or who are otherwise not in a covered Part A stay. Section 611 of Pub. L. 108-173 provided for Medicare coverage of an initial preventive physical examination, subject to the applicable deductible and coinsurance, as an outpatient department service, payable under the OPPS. In addition, the OPPS includes payment for partial hospitalization services furnished by community mental health centers (CMHCs).

    The OPPS rate is an unadjusted national payment amount that includes the Medicare payment and the beneficiary copayment. This rate is divided into a labor-related amount and a nonlabor-related amount. The labor-related amount is adjusted for area wage differences using the inpatient hospital wage index value for the locality in which the hospital or CMHC is located.

    All services and items within an APC group are comparable clinically and with respect to resource use (section 1833(t)(2)(B) of the Act). In accordance with section 1833(t)(2) of the Act, subject to certain exceptions, services and items 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 APC group is more than 2 times greater than the lowest median cost for an item or service within the same APC group (referred to as the “2 times rule”). In implementing this provision, we use the median cost of the item or service assigned to an APC group.

    Special payments under the OPPS may be made for new technology items and services in one of two ways. Section 1833(t)(6) of the Act provides for temporary additional payments or “transitional pass-through payments” for certain drugs, biological agents, brachytherapy devices used for the treatment of cancer, and categories of medical devices for at least 2 but not more than 3 years. For new technology services that are not eligible for pass-through payments and for which we lack sufficient data to appropriately assign them to a clinical APC group, we have established special APC groups based on costs, which we refer to as “APC cost bands.” These cost bands allow us to price these new procedures more appropriately and consistently. Similar to pass-through payments, these special payments for new technology services are also temporary; that is, we retain a service within a new technology APC group until we acquire adequate data to assign it to a clinically appropriate APC group.

    B. Excluded OPPS Services and Hospitals

    Section 1833(t)(1)(B)(i) of the Act authorizes the Secretary to designate the hospital outpatient services that are paid under the OPPS. While most hospital outpatient services are payable under the OPPS, section 1833(t)(1)(B)(iv) of the Act excluded payment for ambulance, physical and occupational therapy, and speech-language pathology services, for which payment is made under a fee schedule. Section 614 of Pub. L. 108-173 amended section 1833(t)(1)(B)(iv) of the Act to exclude OPPS payment for screening and diagnostic mammography services. The Secretary exercised the broad authority granted under the statute to exclude from the OPPS those services that are paid under fee schedules or other payment systems. Such excluded services include, for example, the professional services of physicians and nonphysician practitioners paid under the Medicare Physician Fee Schedule (MPFS); laboratory services paid under the clinical diagnostic laboratory fee schedule; services for beneficiaries with end-stage renal disease (ESRD) that are paid under the ESRD composite rate; and services and procedures that require an inpatient stay that are paid under the hospital inpatient prospective payment system (IPPS). We set forth the services that are excluded from payment under the OPPS in § 419.22 of the regulations.

    Under § 419.20 of the regulations, we specify the types of hospitals and entities that are excluded from payment under the OPPS. These excluded entities include Maryland hospitals, but only for services that are paid under a cost containment waiver in accordance with section 1814(b)(3) of the Act; critical access hospitals (CAHs); hospitals located outside of the 50 States, the District of Columbia, and Puerto Rico; and Indian Health Service hospitals.

    C. Prior Rulemaking

    On April 7, 2000, we published in the Federal Register a final rule with comment period (65 FR 18434) to implement a prospective payment system for hospital outpatient services. The hospital OPPS was first implemented for services furnished on or after August 1, 2000. Section 1833(t)(9) of the Act requires the Secretary to review certain 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. Since implementing the OPPS, we have published final rules in the Federal Register annually to implement statutory requirements and changes arising from our experience with this system. For a full discussion of the changes to the OPPS, we refer readers to these Federal Register final rules.[1]

    On November 15, 2004, we published in the Federal Register a final rule with comment period (69 FR 65681) that revised the OPPS to update the payment weights and conversion factor for services payable under the calendar year (CY) 2005 OPPS on the basis of claims data from January 1, 2003 through December 31, 2003, and to implement certain provisions of Pub. L. 108-173. In addition, we responded to public comments received on the January 6, 2004 interim final rule with comment period relating to Pub. L. 108-173 provisions that were effective January 1, 2004, and finalized those policies. Further, we responded to public comments received on the November 7, 2003 final rule with comment period pertaining to the APC assignment of HCPCS codes identified in Addendum B of that rule with the new interim (NI) comment indicators; and public comments received on the August 16, 2004 OPPS proposed rule (69 FR 50448).

    Subsequent to publishing the November 15, 2004 final rule with comment period, we published a correction of final rule with comment period on December 30, 2004 (69 FR 78315). This document corrected technical errors that appeared in the November 15, 2004 final rule with Start Printed Page 42678comment period. It also provided additional information about the CY 2005 wage indices for the OPPS that was not published in the November 15, 2004 final rule with comment period.

    D. APC Advisory Panel

    1. Authority of the APC Panel

    Section 1833(t)(9)(A) of the Act, as amended by section 201(h) of the BBRA of 1999, requires that we consult with an outside panel of experts to review the clinical integrity of the payment groups and weights under the OPPS. The Advisory Panel on Ambulatory Payment Classification (APC) Groups (the APC Panel), discussed under section I.D.2. of this preamble, fulfills this requirement. The Act further specifies that the APC Panel will act in an advisory capacity. This expert panel, which is to be composed of 15 representatives of providers subject to the OPPS (currently employed full-time, not consultants, in their respective areas of expertise), reviews and advises us about the clinical integrity of the APC groups and their weights. The APC Panel is not restricted to using our data and may use data collected or developed by organizations outside the Department in conducting its review.

    2. Establishment of the APC Panel

    On November 21, 2000, the Secretary originally signed the charter establishing the APC Panel. The APC Panel is technical in nature and is governed by the provisions of the Federal Advisory Committee Act (FACA), as amended (Pub. L. 92-463). Since its initial chartering, the Secretary has twice renewed the APC Panel's charter: On November 1, 2002, and on November 8, 2004. The renewed charter indicates that the APC Panel continues to be technical in nature; is governed by the provisions of the FACA with a Designated Federal Official (DEO) to oversee the day-to-day administration of the FACA requirements and to provide to the Committee Management Officer all committee reports for forwarding to the Library of Congress; may convene up to three meetings per year; and is chaired by a Federal official who also serves as a CMS medical officer.

    Originally, in establishing the APC 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 who nominated either colleagues or themselves. After carefully reviewing the applications, we chose 15 highly qualified individuals to serve on the APC Panel. Because of the loss of four APC Panel members due to the expiration of terms of office on March 31, 2004, we published a Federal Register notice on January 23, 2004 (69 FR 3370) that solicited nominations for APC Panel membership. From the 24 nominations that we received, we chose four new members. Six members' terms expired on March 31, 2005; therefore, a Federal Register notice was published on February 25, 2005, requesting nominations to the APC Panel. We received only 13 nominations before the nomination period closed on March 15, 2005. Therefore, we extended the deadline for nominations to May 9, 2005, and announced the extension in the Federal Register on April 8, 2005 (70 FR 18028). The entire APC Panel membership and information pertaining to it, including Federal Register notices, meeting dates, agenda topics, and meeting reports are identified on the CMS Web site: http://www.cms.hhs.gov/​faca/​apc/​apcmem.asp.

    3. APC Panel Meetings and Organizational Structure

    The APC Panel first met on February 27, February 28, and March 1, 2001. Since that initial meeting, the APC Panel has held six subsequent meetings, with the last meeting taking place on February 23 and 24, 2005. (The APC Panel did not meet on February 25, 2004, as announced in the meeting notice published on December 30, 2004, (69 FR 78464).) Prior to each of these biennial meetings, we published a notice in the Federal Register to announce each meeting and, when necessary, to solicit and announce nominations for APC Panel membership. For a more detailed discussion about these announcements, refer to the following Federal Register notices: December 5, 2000 (65 FR 75943), December 14, 2001 (66 FR 64838), December 27, 2002 (67 FR 79107), July 25, 2003 (68 FR 44089), December 24, 2003 (68 FR 74621), August 5, 2004 (69 FR 47446), and December 30, 2004 (69 FR 78464).

    During these meetings, the APC Panel established its operational structure that, in part, includes the use of three subcommittees to facilitate its required APC review process. Currently, the three subcommittees are the Data Subcommittee, the Observation Subcommittee, and the Packaging Subcommittee. The Data Subcommittee is responsible for studying the data issues confronting the APC Panel and for recommending viable options for resolving them. This subcommittee was initially established on April 23, 2001, as the Research Subcommittee and reestablished as the Data Subcommittee on April 13, 2004, and February 11, 2005. The Observation Subcommittee, which was established on June 24, 2003, and reestablished with new members on March 8, 2004, and February 11, 2005, reviews and makes recommendations to the APC Panel on all issues pertaining to observation services paid under the OPPS, such as coding and operational issues. The Packaging Subcommittee, which was established on March 8, 2004 and reestablished with new members on February 11, 2005, studies and makes recommendations on issues pertaining to services that are not separately payable under the OPPS but are bundled or packaged APC payments. Each of these subcommittees was established by a majority vote of the APC Panel during a scheduled APC Panel meeting. All subcommittee recommendations are discussed and voted upon by the full APC Panel.

    For a detailed discussion of the APC Panel meetings, refer to the hospital OPPS final rules cited in section I.C. of this preamble. Full discussion of the recommendations resulting from the APC Panel's February 2005 meeting are included in the sections of this preamble that are specific to each recommendation.

    E. Provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 To Be Implemented Beginning in CY 2006

    On December 8, 2003, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Pub. L. 108-173, was enacted. Pub. L. 108-173 made changes to the Act relating to the Medicare OPPS. In the January 6, 2004 interim final rule with comment period and the November 15, 2004 final rule with comment period, we implemented provisions of Pub. L. 108-173 relating to the OPPS that were effective for CY 2004 and CY 2005, respectively. Provisions of Pub. L. 108-173 that were implemented in CY 2004 or CY 2005, and that are continuing in CY 2006, are discussed throughout this proposed rule. Moreover, in this proposed rule, we are proposing to implement the following provisions of Pub. L. 108-173 that affect the OPPS beginning in CY 2006:

    1. Hold Harmless Provisions

    Section 411 of Pub. L. 108-173 amended section 1833(t)(7)(D)(i) of the Act and extended the hold harmless provision for small rural hospitals having 100 or fewer beds through December 31, 2005. Section 411 of Pub. L. 108-173 further amended section 1833(t)(7) of the Act to provide that hold-harmless transitional corridor payments shall apply through December Start Printed Page 4267931, 2005 to sole community hospitals (SCHs) (as defined in section 1886(d)(5)(D)(iii) of the Act) located in a rural area. In accordance with these provisions, effective January 1, 2006, we are proposing to discontinue transitional corridor payments for small rural hospitals having 100 or fewer beds and for SCHs located in a rural area.

    2. Study and Authorization of Adjustment for Rural Hospitals

    Section 411(b) of Pub. L. 108-173 added a new paragraph (13) to section 1833(t) of the Act to authorize an “Adjustment for Rural Hospitals”. This provision requires us to conduct a study to determine if costs incurred by hospitals located in rural areas by APCs exceed those costs incurred by hospitals located in urban areas. This provision further requires us to provide for an appropriate adjustment by January 1, 2006, if we find that the costs incurred by hospitals located in rural areas exceed those costs incurred by hospitals located in urban areas.

    3. Payment for “Specified Covered Outpatient Drugs”

    Section 621(a)(1) of Pub. L. 108-173 added section 1833(t)(14) to the Act that specifies payments for certain “specified covered outpatient drugs” beginning in 2006. Specifically, section 1833(t)(14)(A)(iii)(I) of the Act states that such payment shall be equal to what we determine to be the average acquisition cost for the drug, taking into account hospital acquisition cost survey data furnished by the Government Accountability Office (GAO). Section 1833(t)(14)(A)(iii)(II) of the Act further notes that if hospital acquisition cost data are not available, payment for specified covered outpatient drugs shall equal the average price for the drug established under section 1842(o), section 1847(A), or section 1847(B) of the Act as calculated and adjusted by the Secretary as necessary. Both payment approaches are subject to adjustments under section 1833(t)(14)(E) of the Act as discussed below.

    4. Adjustment in Payment Rates for “Specified Covered Outpatient Drugs” for Overhead Costs

    Section 621(a)(1) of Pub. L. 108-173 added section 1833(t)(14)(E) to the Act. Section 1833(t)(14)(E)(ii) of the Act authorizes us to make an adjustment to payments for “specified covered outpatient drugs” to take into account overhead and related expenses such as pharmacy services and handling costs, based on recommendations contained in a report prepared by the Medicare Payment Advisory Commission (MedPAC).

    5. Budget Neutrality Adjustment

    Section 621(a)(1) of Pub. L. 108-173 amended the Act by adding section 1833(t)(14)(H), which requires that additional expenditures resulting from adjustments in APC payment rates for specified covered outpatient drugs be taken into account beginning in CY 2006 and continuing in subsequent years, in establishing the OPPS conversion, weighting, and other adjustment factors.

    F. CMS' Commitment to New Technologies

    (If you choose to comment on issues in this section, please include the caption “Commitment to New Technologies” at the beginning of your comment.)

    CMS is committed to ensuring that Medicare beneficiaries will have timely access to new medical treatments and technologies that are well-evaluated and demonstrated to be effective. We launched the Council on Technology and Innovation (CTI) to provide the Agency with improved methods for developing practical information about the clinical benefits of new medical technologies to result in faster and more efficient coverage and payment of these medical technologies. The CTI supports CMS efforts to develop better evidence on the safety, effectiveness, and cost of new and approved technologies to help promote their more effective use.

    We want to provide doctors and patients with better information about the benefits of new medical treatments and/or technologies, especially compared to other treatment options. We also want beneficiaries to have access to valuable new medical innovations as quickly and efficiently as possible. We note there are a number of payment mechanisms in the OPPS and the IPPS designed to achieve appropriate payment of promising new technologies. In the OPPS, qualifying new medical devices may be paid on a cost basis by means of transitional pass-through payments, in addition to the APC payments for the procedures which utilize the devices. In addition, qualifying new services may be assigned for payment to New Technology APCs or, if appropriate, to regular clinical APCs. In the IPPS, qualifying new technologies may receive add-on payments to the standard diagnosis-related group (DRG) payments. We also note that collaborative efforts are underway to facilitate coordination between the Food and Drug Administration (FDA) and CMS with regard to streamlining the CMS coverage process by which new technologies come to the marketplace.

    To promote timely access to new medical treatments and technologies, in this proposed rule we are proposing enhancements to both the OPPS pass-through payment criteria for devices as discussed in section IV.D.2. of this preamble and the qualifying process for assignment of new services to New Technology APCs or regular clinical APCs discussed in section III.C.3. of this preamble. We are proposing to make device pass-through eligibility available to a broader range of qualifying devices. We are also proposing to change the application and review process for assignment of new services to New Technology APCs to promote thoughtful review of the coding, clinical use and efficacy of new services by the wider medical community, encouraging appropriate dissemination of new technologies. These enhancements are explained in this proposed rule.

    G. Summary of the Major Content of This Proposed Rule

    In this proposed rule, we are setting forth proposed changes to the Medicare hospital OPPS for CY 2006. These changes would be effective for services furnished on or after January 1, 2006. The following is a summary of the major changes that we are proposing to make:

    1. Proposed Updates to Payments for CY 2006

    In section II. of this preamble, we set forth—

    • The methodology used to recalibrate the proposed APC relative payment weights and the proposed recalibration of the relative payment weights for CY 2006.
    • The proposed payment for partial hospitalization, including the proposed separate threshold for outlier payments for CMCHs.
    • The proposed update to the conversion factor used to determine payment rates under the OPPS for CY 2006.
    • The proposed retention of our current policy to apply the IPPS wage indices to wage adjust the APC median costs in determining the OPPS payment rate and the copayment standardized amount for CY 2006.
    • The proposed update of statewide average default cost-to-charge ratios.
    • Proposed changes relating to the expiring hold harmless payment provision.
    • Proposed changes to payment for rural sole community hospitals for CY 2006. Start Printed Page 42680
    • Proposed changes in the way we calculate hospital outpatient outlier payments for CY 2006.
    • Calculation of the proposed national unadjusted Medicare OPPS payment.
    • The proposed beneficiary copayment for OPPS services for CY 2006.

    2. Proposed Ambulatory Payment Classification (APC) Group Policies

    In section III. of this preamble, we discuss our proposal to establish a number of new APCs and to make changes to the assignment of HCPCS codes under a number of existing APCs based on our analyses of Medicare claims data and recommendations of the APC Panel. We also discuss in section III. of this preamble, the application of the 2 times rule and proposed exceptions to it; proposed changes for specific APCs; the proposed refinement of the New Technology cost bands; the proposed movement of procedures from the New Technology APCs; and the proposed additions of new procedure codes to the APC groups.

    3. Proposed Payment Changes for Devices

    In section IV. of this preamble, we discuss proposed changes to the device-dependent APCs and to the pass-through payment for three categories of devices.

    4. Proposed Payment Changes for Drugs, Biologicals, and Radiopharmaceutical Agents

    In section V. of this preamble, we discuss proposed changes for drugs, biologicals, radiopharmaceutical agents, and vaccines.

    5. Estimate of Transitional Pass-Through Spending in CY 2006 for Drugs, Biologicals, and Devices

    In section VI. of this preamble, we discuss the proposed methodology for estimating total pass-through spending and whether there should be a pro rata reduction for transitional pass-through drugs, biologicals, radiopharmacials, and categories of devices for CY 2006.

    6. Proposed Brachytherapy Payment Changes

    In section VII. of this preamble, we include a discussion of our proposal concerning coding and payment for the sources of brachytherapy.

    7. Proposed Coding and Payment for Drug Administration

    In section VIII. of this preamble, we discuss our proposed coding and payment changes for drug administration services.

    8. Hospital Coding for Evaluation and Management (E/M) Services

    In section IX. of this preamble, we include a discussion of our proposal for developing the coding guidelines for evaluation and management services.

    9. Proposed Payment for Blood and Blood Products

    In section X. of this preamble, we discuss our proposed payment changes for blood and blood products.

    10. Proposed Payment for Observation Services

    In section XI. of this preamble, we discuss our proposed criteria and coding changes for separately payable observation services.

    11. Procedures That Will Be Paid Only as Inpatient Services

    In section XII. of this preamble, we discuss the procedures that we are proposing to remove from the inpatient list and assign to APCs.

    12. Proposed Indicator Assignments

    In section XIII. of this preamble, we discuss the proposed changes to the list of status indicators assigned to APCs and present our proposed comment indicators for the CY 2006 OPPS final rule.

    13. Proposed Nonrecurring Policy Changes

    In section XIV. of this preamble, we discuss proposed changes in payments for multiple diagnostic imaging procedures and in the interrupted procedures payment policies.

    14. OPPS Policy and Payment Recommendations

    In section XV. of this preamble, we address recommendations made by MedPAC, the APC Panel, and the GAO regarding the OPPS for CY 2006.

    15. Physician Oversight in Critical Access Hospitals

    In section XVI. of this preamble, we address physician oversight for services provided by nonphysician practitioners such as physician assistants, nurse practitioners, and clinical nurse specialists in critical access hospitals (CAHs).

    II. Proposed Updates Affecting Payments for CY 2006

    A. Recalibration of APC Relative Weights for CY 2006

    (If you choose to comment on the issues in this section, please include the caption “APC Relative Weights” at the beginning of your comment.)

    1. Database Construction

    a. Database Source and Methodology

    Section 1833(t)(9)(A) of the Act requires that the Secretary review and revise the relative payment weights for APCs at least annually. In the April 7, 2000 OPPS 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 a small number of APC changes, these relative payment weights continued to be in effect for CY 2001. This policy is discussed in the November 13, 2000 interim final rule (65 FR 67824 through 67827).

    We are proposing to use the same basic methodology that we described in the April 7, 2000 final rule to recalibrate the APC relative payment weights for services furnished on or after January 1, 2006, and before January 1, 2007. That is, we would recalibrate the relative payment weights for each APC based on claims and cost report data for outpatient services. We are proposing to use the most recent available data to construct the database for calculating APC group weights. For the purpose of recalibrating APC relative payment weights for CY 2006, we used approximately 127 million final action claims for hospital OPD services furnished on or after January 1, 2004, and before January 1, 2005. Of the 127 million final action claims for services provided in hospital outpatient settings, 102 million claims were of the type of bill potentially appropriate for use in setting rates for OPPS services (but did not necessarily contain services payable under the OPPS). Of the 102 million claims, we were able to use 49 million whole claims to set the proposed OPPS APC relative weights for CY 2006 OPPS. From the 49 million whole claims, we created 81 million single records, of which 50 million were “pseudo” single claims (created from multiple procedure claims using the process we discuss in this section).

    The proposed APC relative weights and payments in Addenda A and B to this proposed rule were calculated using claims from this period that had been processed before January 1, 2005. We selected claims for services paid under the OPPS and matched these claims to the most recent cost report filed by the individual hospitals represented in our claims data. We are proposing that the APC relative payment weights for CY 2006 under the OPPS would continue to be based on the median hospital costs for services in the APC groups. For the CY 2006 OPPS final rule, we are proposing to base APC median costs on Start Printed Page 42681claims for services furnished in CY 2004 and processed before June 30, 2005.

    b. Proposed Use of Single and Multiple Procedure Claims

    For CY 2006, we are proposing to continue to use single procedure claims to set the medians on which the APC relative payment weights would be based. As noted in the November 15, 2004 final rule with comment period, 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 relative payment weights (69 FR 65730 through 65731). Requesters believe that relying solely on single procedure claims to recalibrate APC relative payment weights fails to take into account data for many frequently performed procedures, particularly those commonly performed in combination with other procedures. They believe that, by depending upon single procedure claims, we base relative payment weights on the least-costly services, thereby introducing downward bias to the medians on which the weights are based.

    We agree that, optimally, it is desirable to use the data from as many claims as possible to recalibrate the APC relative payment weights, including those with multiple procedures. We generally use single procedure claims to set the median costs for APCs because we are, so far, unable to ensure that packaged costs can be appropriately allocated across multiple procedures performed on the same date of service. However, by bypassing specified codes that we believe do not have significant packaged costs, we are able to use more data from multiple procedure claims. In many cases this enables us to create multiple “pseudo” single claims from claims that, as submitted, contained multiple separately paid procedures on the same claim. We have used the date of service on the claims and a list of codes to be bypassed to create “pseudo” single claims from multiple procedure claims the same as we did in recalibrating the CY 2005 APC relative payment weights. We refer to these newly created single procedure claims as “pseudo” singles because they were submitted by providers as multiple procedure claims.

    For CY 2003, we created “pseudo” single claims by bypassing HCPCS codes 93005 (Electrocardiogram, tracing), 71010 (Chest x-ray), and 71020 (Chest x-ray) on a submitted claim. However, we did not use claims data for the bypassed codes in the creation of the median costs for the APCs to which these three codes were assigned because the level of packaging that would have remained on the claim after we selected the bypass code was not apparent and, therefore, it was difficult to determine if the medians for these codes would be correct.

    For CY 2004, we created “pseudo” single claims by bypassing these three codes and also by bypassing an additional 269 HCPCS codes in APCs. We selected these codes based on a clinical review of the services and because it was presumed that these codes had only very limited packaging and could appropriately be bypassed for the purpose of creating “pseudo” single claims. The APCs to which these codes were assigned were varied and included mammography, cardiac rehabilitation, and Level I plain film x-rays. To derive more “pseudo” single claims, we also split the claims where there were dates of service for revenue code charges on that claim that could be matched to a single procedure code on the claim on the same date.

    As in CY 2003, we did not include the claims data for the bypassed codes in the creation of the APCs to which the 269 codes were assigned because, again, we had not established that such an approach was appropriate and would aid in accurately estimating the median cost for that APC. For CY 2004, from about 16.3 million otherwise unusable claims, we used about 9.5 million multiple procedure claims to create about 27 million “pseudo” single claims. For CY 2005, we created 383 bypass codes and from approximately 24 million otherwise unusable claims, we used about 18 million multiple procedure claims to create about 52 million “pseudo” single claims.

    For CY 2006, we are proposing to continue using date of service matching as a tool for creation of “pseudo” single claims and to continue the use of a bypass list to create “pseudo” single claims. The process we are proposing for CY 2006 OPPS results in our being able to use some part of 90 percent of the total claims that are eligible for use in OPPS ratesetting and modeling in developing this proposed rule. This process enabled us to use, for CY 2006, 81 million single bills for ratesetting: 50 million “pseudo” singles and 31 million “natural” single bills (bills that were submitted containing only one separately payable major HCPCS code).

    We are proposing to bypass the 404 codes identified in Table 1 to create new single claims and to use the line-item costs associated with the bypass codes on these claims in the creation of the median costs for the APCs into which they are assigned. Of the codes on this list, 345 were used for bypass in CY 2005. We are proposing to continue the use of the codes on the CY 2005 OPPS bypass list and expand it by adding 46 codes that, using data presented to the APC Panel at its February 2005 meeting, meet the same empirical criteria as those used in CY 2005 to create the bypass list. Our examination of the data against the criteria for inclusion on the bypass list, as discussed below for the addition of new codes, shows that the empirically selected codes used for bypass for the CY 2005 OPPS generally continue to meet the criteria or come very close to meeting the criteria, and we have received no comments against bypassing them.

    To facilitate comment, Table 1 indicates the list of codes we are proposing to bypass for creation of “pseudo” singles for CY 2006 OPPS and indicates those used in the CY 2005 OPPS for bypass and those proposed to be added for the CY 2006 OPPS. Bypass codes shown in Table 1 with an asterisk indicate the HCPCs codes we are proposing to add to the list for the CY 2006 OPPS. The criteria we are proposing to use to determine the additional codes to add to the CY 2005 OPPS bypass list in order to create the bypass list for CY 2006 OPPS are discussed below.

    The following empirical criteria were developed by reviewing the frequency and magnitude of packaging in the single claims for payable codes other than drugs and biologicals. We assumed that the representation of packaging on the single claims for any given code is comparable to packaging for that code in the multiple claims:

    • There were 100 or more single claims for the code. This number of single claims ensured that observed outcomes were sufficiently representative of packaging that might occur in the multiple claims.
    • Five percent or fewer of the single claims for the code had packaged costs on that single claim for the code. This criterion results in limiting the amount of packaging being redistributed to the payable procedure remaining on the claim after the bypass code is removed and ensures that the costs associated with the bypass code represent the cost of the bypassed service.
    • The median cost of packaging observed in the single claim was equal to or less than $50. This limits the amount of error in redistributed costs.
    • The code is not a code for an unlisted service.

    We also added to the bypass list three codes (CPT codes 51701, 51702, and 51703 for bladder catheterization) which do not meet these criteria. These Start Printed Page 42682codes have been packaged and have never been paid separately. For that reason, when these were the only services provided to the beneficiary, no payment was made to the hospital. The APC Panel's packaging subcommittee recommends that we make separate payment when they are the only service on the claim. See section II.A.4. of this preamble for further discussion of our proposal to pay them separately. We are proposing to add them to the bypass list because changing them from packaged to separately paid would result in the reduction of the number of single bills on which we could base median costs for other major separately paid procedures which are billed on the same claim with these procedure codes. Single bills which contain other procedures would become multiple procedure claims when these bladder catheterization codes were converted from packaged to separately paid status.

    We examined the packaging on the single procedure claims in the CY 2004 data used for this proposed rule for these codes. We found that none of these codes met the empirical standards for the bypass list. However, we believe that when these services are performed on the same date as another separately paid procedure, any packaging that appears on the claim would appropriately be associated with the other procedures and not with these codes. Therefore, we believe that bypassing them does not adversely affect the medians for other procedures. Moreover, future separate payment for these codes does not harm the hospitals that furnish these services, in view of the historical absence of separate payment for them under the OPPS in the past. Hence, we propose to pay separately for these codes and to add them to the bypass list for the CY 2006 OPPS.

    We specifically invite public comment on the “pseudo” single process, including the bypass list and the criteria.

    Table 1.—Proposed CY 2006 HCPCS Bypass Codes for Creating “Pseudo” Single Claims for Calculating Median Costs

    HCPCS code 1Short descriptionStatus indicator
    11056*Trim skin lesions, 2 to 4T
    11057*Trim skin lesions, over 4T
    11719Trim nail(s)T
    11720Debride nail, 1-5T
    11721Debride nail, 6 or moreT
    17003*Destroy lesions, 2-14T
    31231*Nasal endoscopy, dxT
    31579Diagnostic laryngoscopyT
    51701*Insert bladder catheterX
    51702*Insert temp bladder catheterX
    51703*Insert bladder catheter, complexX
    51798*Us urine capacity measureX
    54240Penis studyT
    67820*Revise eyelashesS
    70030*X-ray eye for foreign bodyX
    70100X-ray exam of jawX
    70110X-ray exam of jawX
    70130X-ray exam of mastoidsX
    70140X-ray exam of facial bonesX
    70150X-ray exam of facial bonesX
    70160X-ray exam of nasal bonesX
    70200X-ray exam of eye socketsX
    70210X-ray exam of sinusesX
    70220X-ray exam of sinusesX
    70250X-ray exam of skullX
    70260X-ray exam of skullX
    70328X-ray exam of jaw jointX
    70330X-ray exam of jaw jointsX
    70336*Magnetic image, jaw jointS
    70355Panoramic x-ray of jawsX
    70360X-ray exam of neckX
    70370*Throat x-ray & fluoroscopyX
    70371Speech evaluation, complexX
    70450Ct head/brain w/o dyeS
    70480Ct orbit/ear/fossa w/o dyeS
    70486Ct maxillofacial w/o dyeS
    70544Mr angiography head w/o dyeS
    70551*Mri brain w/o dyeS
    71010Chest x-rayX
    71015Chest x-rayX
    71020Chest x-rayX
    71021Chest x-rayX
    71022Chest x-rayX
    71023*Chest x-ray and fluoroscopyX
    71030Chest x-rayX
    71034Chest x-ray and fluoroscopyX
    71090X-ray & pacemaker insertionX
    71100X-ray exam of ribsX
    71101X-ray exam of ribs/chestX
    Start Printed Page 42683
    71110X-ray exam of ribsX
    71111X-ray exam of ribs/chestX
    71120X-ray exam of breastboneX
    71130X-ray exam of breastboneX
    71250Ct thorax w/o dyeS
    72040X-ray exam of neck spineX
    72050X-ray exam of neck spineX
    72052X-ray exam of neck spineX
    72069*X-ray exam of trunk spineX
    72070X-ray exam of thoracic spineX
    72072X-ray exam of thoracic spineX
    72074X-ray exam of thoracic spineX
    72080X-ray exam of trunk spineX
    72090X-ray exam of trunk spineX
    72100X-ray exam of lower spineX
    72110X-ray exam of lower spineX
    72114X-ray exam of lower spineX
    72120X-ray exam of lower spineX
    72125Ct neck spine w/o dyeS
    72128*Ct chest spine w/o dyeS
    72141Mri neck spine w/o dyeS
    72146Mri chest spine w/o dyeS
    72148Mri lumbar spine w/o dyeS
    72170X-ray exam of pelvisX
    72190X-ray exam of pelvisX
    72192Ct pelvis w/o dyeS
    72220X-ray exam of tailboneX
    73000X-ray exam of collar boneX
    73010X-ray exam of shoulder bladeX
    73020X-ray exam of shoulderX
    73030X-ray exam of shoulderX
    73050X-ray exam of shouldersX
    73060X-ray exam of humerusX
    73070X-ray exam of elbowX
    73080X-ray exam of elbowX
    73090X-ray exam of forearmX
    73100X-ray exam of wristX
    73110X-ray exam of wristX
    73120X-ray exam of handX
    73130X-ray exam of handX
    73140X-ray exam of finger(s)X
    73218Mri upper extremity w/o dyeS
    73221Mri joint upr extrem w/o dyeS
    73510X-ray exam of hipX
    73520X-ray exam of hipsX
    73540X-ray exam of pelvis & hipsX
    73550X-ray exam of thighX
    73560X-ray exam of knee, 1 or 2X
    73562X-ray exam of knee, 3X
    73564X-ray exam, knee, 4 or moreX
    73565X-ray exam of kneesX
    73590X-ray exam of lower legX
    73600X-ray exam of ankleX
    73610X-ray exam of ankleX
    73620X-ray exam of footX
    73630X-ray exam of footX
    73650X-ray exam of heelX
    73660X-ray exam of toe(s)X
    73700Ct lower extremity w/o dyeS
    73718*Mri lower extremity w/o dyeS
    73721Mri jnt of lwr extre w/o dyeS
    74000X-ray exam of abdomenX
    74010*X-ray exam of abdomenX
    74210Contrst x-ray exam of throatS
    74220Contrast x-ray, esophagusS
    74230Cine/vid x-ray, throat/esophS
    74235Remove esophagus obstructionS
    74240X-ray exam, upper gi tractS
    74245X-ray exam, upper gi tractS
    74246Contrst x-ray uppr gi tractS
    Start Printed Page 42684
    74247Contrst x-ray uppr gi tractS
    74249Contrst x-ray uppr gi tractS
    74250X-ray exam of small bowelS
    74300X-ray bile ducts/pancreasX
    74301X-rays at surgery add-onX
    74305X-ray bile ducts/pancreasX
    74327X-ray bile stone removalS
    74340X-ray guide for GI tubeX
    74350X-ray guide, stomach tubeX
    74355X-ray guide, intestinal tubeX
    74360X-ray guide, GI dilationS
    74363X-ray, bile duct dilationS
    74475X-ray control, cath insertS
    74480X-ray control, cath insertS
    74485X-ray guide, GU dilationS
    74742X-ray, fallopian tubeX
    75894X-rays, transcath therapyS
    75898Follow-up angiographyX
    75901Remove cva device obstructX
    75902Remove cva lumen obstructX
    75945Intravascular usS
    75946Intravascular us add-onS
    75960Transcatheter intro, stentS
    75961Retrieval, broken catheterS
    75962Repair arterial blockageS
    75964Repair artery blockage, eachS
    75966Repair arterial blockageS
    75968Repair artery blockage, eachS
    75970Vascular biopsyS
    75978Repair venous blockageS
    75980Contrast xray exam bile ductS
    75982Contrast xray exam bile ductS
    75984Xray control catheter changeX
    75992Atherectomy, x-ray examS
    75993Atherectomy, x-ray examS
    75994Atherectomy, x-ray examS
    75995Atherectomy, x-ray examS
    75996Atherectomy, x-ray examS
    76012Percut vertebroplasty fluorS
    76013Percut vertebroplasty, ctS
    76040X-rays, bone evaluationX
    76061X-rays, bone surveyX
    76062X-rays, bone surveyX
    76066Joint survey, single viewX
    76070*CT scan, bone density studyS
    76075Dexa, axial skeleton studyS
    76076Dexa, peripheral studyS
    76078Radiographic absorptiometryX
    76095Stereotactic breast biopsyT
    76096X-ray of needle wire, breastX
    76100X-ray exam of body sectionX
    76101Complex body section x-rayX
    76360Ct scan for needle biopsyS
    76380CAT scan follow-up studyS
    76393Mr guidance for needle placeS
    76511Echo exam of eyeS
    76512Echo exam of eyeS
    76516Echo exam of eyeS
    76519Echo exam of eyeS
    76536Us exam of head and neckS
    76645Us exam, breast(s)S
    76700Us exam, abdom, completeS
    76705Echo exam of abdomenS
    76770Us exam abdo back wall, compS
    76775Us exam abdo back wall, limS
    76778*Us exam kidney transplantS
    76801*Ob us < 14 wks, single fetusS
    76811*Ob us, detailed, sngl fetusS
    76817*Transvaginal us, obstetricS
    76830Transvaginal us, non-obS
    Start Printed Page 42685
    76856Us exam, pelvic, completeS
    76857Us exam, pelvic, limitedS
    76870Us exam, scrotumS
    76880Us exam, extremityS
    76941Echo guide for transfusionS
    76945Echo guide, villus samplingS
    76946Echo guide for amniocentesisS
    76948Echo guide, ova aspirationS
    76950*Echo guidance radiotherapyS
    76970*Ultrasound exam follow-upS
    76977Us bone density measureX
    77280Set radiation therapy fieldX
    77285Set radiation therapy fieldX
    77295*Set radiation therapy fieldX
    77300Radiation therapy dose planX
    77301Radiotherapy dose plan, imrtX
    77315Teletx isodose plan complexX
    77326Radiation therapy dose planX
    77327Brachytx isodose calc intermX
    77328Brachytx isodose plan complX
    77331Special radiation dosimetryX
    77332Radiation treatment aid(s)X
    77333Radiation treatment aid(s)X
    77334Radiation treatment aid(s)X
    77336Radiation physics consultX
    77370Radiation physics consultX
    77402*Radiation treatment deliveryS
    77403Radiation treatment deliveryS
    77404*Radiation treatment deliveryS
    77408*Radiation treatment deliveryS
    77409Radiation treatment deliveryS
    77411Radiation treatment deliveryS
    77412Radiation treatment deliveryS
    77413Radiation treatment deliveryS
    77414Radiation treatment deliveryS
    77416Radiation treatment deliveryS
    77417Radiology port film(s)X
    77418Radiation tx delivery, imrtS
    77470Special radiation treatmentS
    78350Bone mineral, single photonX
    80502Lab pathology consultationX
    85060Blood smear interpretationX
    86585TB tine testX
    86850RBC antibody screenX
    86870RBC antibody identificationX
    86880Coombs test, directX
    86885Coombs test, indirect, qualX
    86886Coombs test, indirect, titerX
    86890Autologous blood processX
    86900Blood typing, ABOX
    86901Blood typing, Rh (D)X
    86905Blood typing, RBC antigensX
    86906Blood typing, Rh phenotypeX
    86930Frozen blood prepX
    86970RBC pretreatmentX
    88104Cytopathology, fluidsX
    88106Cytopathology, fluidsX
    88107Cytopathology, fluidsX
    88108Cytopath, concentrate techX
    88160Cytopath smear, other sourceX
    88161Cytopath smear, other sourceX
    88172Cytopathology eval of fnaX
    88182Cell marker studyX
    88300Surgical path, grossX
    88304Tissue exam by pathologistX
    88305Tissue exam by pathologistX
    88311Decalcify tissueX
    88312Special stainsX
    88313Special stainsX
    88321Microslide consultationX
    Start Printed Page 42686
    88323Microslide consultationX
    88325Comprehensive review of dataX
    88331Path consult intraop, 1 blocX
    88342ImmunohistochemistryX
    88346Immunofluorescent studyX
    88347Immunofluorescent studyX
    90801Psy dx interviewS
    90804*Psytx, office, 20-30 minS
    90805Psytx, off, 20-30 min w/e&mS
    90806Psytx, off, 45-50 minS
    90807Psytx, off, 45-50 min w/e&mS
    90808Psytx, office, 75-80 minS
    90809Psytx, off, 75-80, w/e&mS
    90810Intac psytx, off, 20-30 minS
    90818Psytx, hosp, 45-50 minS
    90826Intac psytx, hosp, 45-50 minS
    90845PsychoanalysisS
    90846Family psytx w/o patientS
    90847Family psytx w/patientS
    90853Group psychotherapyS
    90857Intac group psytxS
    90862Medication managementX
    92002Eye exam, new patientV
    92004Eye exam, new patientV
    92012Eye exam established patV
    92014Eye exam & treatmentV
    92020*Special eye evaluationS
    92081*Visual field examination(s)S
    92082Visual field examination(s)S
    92083Visual field examination(s)S
    92135Opthalmic dx imagingS
    92136Ophthalmic biometryS
    92225Special eye exam, initialS
    92226Special eye exam, subsequentS
    92230Eye exam with photosT
    92250Eye exam with photosS
    92275ElectroretinographyS
    92285Eye photographyS
    92286Internal eye photographyS
    92520Laryngeal function studiesX
    92541*Spontaneous nystagmus testX
    92546Sinusoidal rotational testX
    92548PosturographyX
    92552Pure tone audiometry, airX
    92553Audiometry, air & boneX
    92555Speech threshold audiometryX
    92556Speech audiometry, completeX
    92557*Comprehensive hearing testX
    92567TympanometryX
    92582Conditioning play audiometryX
    92585Auditor evoke potent, compreS
    92604*Reprogram cochlear implt 7 >X
    93005Electrocardiogram, tracingS
    93225ECG monitor/record, 24 hrsX
    93226ECG monitor/report, 24 hrsX
    93231Ecg monitor/record, 24 hrsX
    93232ECG monitor/report, 24 hrsX
    93236ECG monitor/report, 24 hrsX
    93270ECG recordingX
    93278ECG/signal-averagedS
    93303Echo transthoracicS
    93307Echo exam of heartS
    93320Doppler echo exam, heartS
    93731Analyze pacemaker systemS
    93732*Analyze pacemaker systemS
    93733Telephone analy, pacemakerS
    93734Analyze pacemaker systemS
    93735*Analyze pacemaker systemS
    93736Telephonic analy, pacemakerS
    93741*Analyze ht pace device snglS
    Start Printed Page 42687
    93743Analyze ht pace device dualS
    93797Cardiac rehabS
    93798Cardiac rehab/monitorS
    93875Extracranial studyS
    93880Extracranial studyS
    93882Extracranial studyS
    93886Intracranial studyS
    93888Intracranial studyS
    93922Extremity studyS
    93923Extremity studyS
    93924Extremity studyS
    93925Lower extremity studyS
    93926Lower extremity studyS
    93930*Upper extremity studyS
    93931Upper extremity studyS
    93965Extremity studyS
    93970Extremity studyS
    93971Extremity studyS
    93975Vascular studyS
    93976Vascular studyS
    93978Vascular studyS
    93979Vascular studyS
    93990Doppler flow testingS
    94015Patient recorded spirometryX
    95115Immunotherapy, one injectionX
    95117*Immunotherapy injectionsX
    95165Antigen therapy servicesX
    95805Multiple sleep latency testS
    95806*Sleep study, unattendedS
    95807Sleep study, attendedS
    95812Electroencephalogram (EEG)S
    95813Eeg, over 1 hourS
    95816Electroencephalogram (EEG)S
    95819Electroencephalogram (EEG)S
    95822Sleep electroencephalogramS
    95864Muscle test, 4 limbsS
    95867*Muscle test, head or neckS
    95872Muscle test, one fiberS
    95900Motor nerve conduction testS
    95921Autonomic nerv function testS
    95925*Somatosensory testingS
    95926Somatosensory testingS
    95930Visual evoked potential testS
    95937Neuromuscular junction testS
    95950Ambulatory eeg monitoringS
    95953EEG monitoring/computerS
    95970*Analyze neurostim, no progS
    95972*Analyze neurostim, complexS
    95974*Cranial neurostim, complexS
    96000Motion analysis, video/3dS
    96100Psychological testingX
    96115Neurobehavior status examX
    96117*Neuropsych test batteryX
    96900Ultraviolet light therapyS
    96910Photochemotherapy with UV-BS
    96912Photochemotherapy with UV-AS
    96913Photochemotherapy, UV-A or BS
    98925*Osteopathic manipulationS
    98940Chiropractic manipulationS
    99213Office/outpatient visit, estV
    99214Office/outpatient visit, estV
    99241Office consultationV
    99242*Office consultationV
    99243Office consultationV
    99244Office consultationV
    99245Office consultationV
    99273Confirmatory consultationV
    99274Confirmatory consultationV
    99275Confirmatory consultationV
    D0473Micro exam, prep & reportS
    Start Printed Page 42688
    G0101CA screen; pelvic/breast examV
    G0127Trim nail(s)T
    G0166Extrnl counterpulse, per txT
    G0175OPPS Service, sched team confV
    HCPCSDescriptorSI
    Q0091Obtaining screen pap smearT
    1 HCPCS codes shown with an asterisk are bypass codes we are proposing to add to the list for CY 2006.

    2. Proposed Calculation of Median Costs for CY 2006

    In this section of the preamble, we discuss the use of claims to calculate the proposed OPPS payment rates for CY 2006. The hospital outpatient prospective payment page on the CMS Web site on which this proposed rule is posted provides an accounting of claims used in the development of the proposed rates: http://www.cms.hhs.gov/​providers/​hopps. The accounting of claims used in the development of the proposed rule is included on the Web site under supplemental materials for the CY 2006 proposed rule. That accounting provides additional detail regarding the number of claims derived at each stage of the process. In addition, below we discuss the files of claims that comprise the data sets that are available for purchase under a CMS data user contract. Our CMS Web site, http://www.cms.hhs.gov/​providers/​hopps, includes information about purchasing the following two OPPS data files: “OPPS Limited Data Set” and “OPPS Identifiable Data Set.”

    We are proposing to use the following methodology to establish the relative weights to be used in calculating the proposed OPPS payment rates for CY 2006 shown in Addenda A and B to this proposed rule. This methodology is as follows:

    We used outpatient claims for full CY 2004 to set the proposed relative weights for CY 2006. To begin the calculation of the relative weights for CY 2006, we pulled all claims for outpatient services furnished in CY 2004 from the national claims history file. This is not the population of claims paid under the OPPS, but all outpatient claims (including, for example, CAH claims, and hospital claims for clinical laboratory services for persons who are neither inpatients nor outpatients of the hospital).

    We then excluded claims with condition codes 04, 20, 21, and 77. These are claims that providers submitted to Medicare knowing that no payment will be made. For example, providers submit claims with a condition code 21 to elicit an official denial notice from Medicare and document that a service is not covered. We then excluded claims for services furnished in Maryland, Guam, and the U.S. Virgin Islands because hospitals in those geographic areas are not paid under the OPPS.

    We divided the remaining claims into the three groups shown below. Groups 2 and 3 comprise the 102 million claims that contain hospital bill types paid under the OPPS.

    1. Claims that were not bill types 12X, 13X, 14X (hospital bill types), or 76X (CMHC bill types). Other bill types, such as ambulatory surgical centers (ASCs), bill type 83, are not paid under the OPPS and, therefore, these claims were not used to set OPPS payment.

    2. Claims that were bill types 12X, 13X, or 14X (hospital bill types). These claims are hospital outpatient claims.

    3. Claims that were bill type 76X (CMHC). (These claims are later combined with any claims in item 2 above with a condition code 41 to set the per diem partial hospitalization rate determined through a separate process.)

    For the cost-to-charge ratio (CCR) calculation process, we used the same approach as that used in developing the final APC rates for CY 2005 (69 FR 65744). That is, we first limited the population of cost reports to only those for hospitals that filed outpatient claims in CY 2004 before determining whether the CCRs for such hospitals were valid. This initial limitation changed the distribution of CCRs used during the trimming process discussed below.

    We then calculated the CCRs at a departmental level and overall for each hospital for which we had claims data. We did this using hospital-specific data from the Hospital Cost Report Information System (HCRIS). We used the most recent available cost report data, in most cases, cost reports for CY 2002 or CY 2003. We used the most recent cost report available whether submitted or settled. If the most recent available cost report was submitted but not settled, we looked at the last settled cost report to determine the ratio of submitted to settled cost, and we then adjusted the most recent available submitted but not settled cost report using that ratio. We propose to use the most recently submitted cost reports to calculate the CCRs to be used to calculate median costs for the OPPS CY 2006 final rule.

    We then flagged CAHs, which are not paid under the OPPS, and hospitals with invalid CCRs. These included claims from hospitals without a CCR; those from hospitals paid an all-inclusive rate; those from hospitals with obviously erroneous CCRs (greater than 90 or less than .0001); and those from hospitals with CCRs that were identified as outliers (3 standard deviations from the geometric mean after removing error CCRs). In addition, we trimmed the CCRs at the departmental level by removing the CCRs for each cost center as outliers if they exceeded +/−3 standard deviations of the geometric mean. This is the same methodology that we used in developing the final CY 2005 CCRs. For CY 2006, we are proposing to trim at the departmental CCR level to eliminate aberrant CCRs that, if found in high volume hospitals, could skew the medians. We used a four-tiered hierarchy of cost center CCRs to match a cost center to a revenue code with the top tier being the most common cost center and the last tier being the default CCR. If a hospital's departmental CCR was deleted by trimming, we set the departmental CCR for that cost center to “missing,” so that another departmental CCR in the revenue center hierarchy could apply. If no other departmental CCR could apply to the revenue code on the claim, we used the hospital's overall CCR for the revenue code in question. The hierarchy of CCRs is available for inspection and comment at the CMS Web site: http://www.cms.hhs.gov/​providers/​hopps/​default.asp.

    We then converted the charges on the claim by applying the CCR that we believed was best suited to the revenue Start Printed Page 42689code indicated on the line with the charge. Table 2 below in this preamble contains a list of the allowed revenue codes. Revenue codes not included in Table 2 are those not allowed under the OPPS because their services cannot be paid under the OPPS (for example, inpatient room and board charges) and, thus charges with those revenue codes were not packaged for creation of the OPPS median costs. If a hospital did not have a CCR that was appropriate to the revenue code reported for a line-item charge (for example, a visit reported under the clinic revenue code, but the hospital did not have a clinic cost center), we applied the hospital-specific overall CCR, except as discussed in section X. of this preamble, for calculation of costs for blood.

    Thus, we applied CCRs as described above to claims with bill types 12X, 13X, or 14X, excluding all claims from CAHs and hospitals in Maryland, Guam, and the U.S. Virgin Islands, and flagged hospitals with invalid CCRs. We excluded claims from all hospitals for which CCRs were flagged as invalid.

    We identified claims with condition code 41 as partial hospitalization services of CMHCs and moved them to another file. These claims were combined with the 76X claims identified previously to calculate the proposed partial hospitalization per diem rate.

    We then excluded claims without a HCPCS code. We also moved claims for observation services to another file. We moved to another file claims that contained nothing but flu and pneumococcal pneumonia (“PPV”) vaccine. Influenza and PPV vaccines are paid at reasonable cost and, therefore, these claims are not used to set OPPS rates. We note that the two above mentioned separate files containing partial hospitalization claims and the observation services claims are included in the files that are available for purchase as discussed above.

    We next copied line-item costs for drugs, blood, and devices (the lines stay on the claim, but are copied off onto another file) to a separate file. No claims were deleted when we copied these lines onto another file. These line-items are used to calculate the per unit median for drugs, radiopharmaceuticals, and blood and blood products. The line-item costs were also used to calculate the per administration cost of drugs, radiopharmaceuticals, and biologicals (other than blood and blood products).

    We then divided the remaining claims into five groups.

    1. Single Major Claims: Claims with a single separately payable procedure, all of which would be used in median setting.

    2. Multiple Major Claims: Claims with more than one separately payable procedure or multiple units for one payable procedure. As discussed below, some of these can be used in median setting.

    3. Single Minor Claims: Claims with a single HCPCS code that is not separately payable. These claims may have a single packaged procedure or a drug code.

    4. Multiple Minor Claims: Claims with multiple HCPCS codes that are not separately payable without examining dates of service. For example, pathology codes are not used unless the pathology service is the single code on the bill or unless the pathology code is on a separate date of service from the other procedure on the claim. The multiple minor file has claims with multiple occurrences of pathology codes, with packaged costs that cannot be appropriately allocated across the multiple pathology codes. However, by matching dates of service for the code and the reported costs through the “pseudo” single creation process discussed earlier, a claim with multiple pathology codes may become several “pseudo” single claims with a unique pathology code and its associated costs on each day. These “pseudo” singles for the pathology codes would then be considered a separately payable code and would be used the same as claims in the single major claim file.

    5. Non-OPPS Claims: Claims that contain no services payable under the OPPS. These claims are excluded from the files used for the OPPS. Non-OPPS claims have codes paid under other fee schedules, for example, durable medical equipment or clinical laboratory.

    We note that the claims listed in numbers 1, 2, and 4 above are included in the data files that can be purchased as described above.

    We set aside the single minor claims and the non-OPPS claims (numbers 3 and 5 above) because we did not use either in calculating median cost. We then examined the multiple major and multiple minor claims (numbers 2 and 4 above) to determine if we could convert any of them to single major claims using the process described previously. We first grouped items on the claims by date of service. If each major procedure on the claim had a different date of service and if the line-items for packaged HCPCS and packaged revenue codes had dates of service, we split the claim into multiple “pseudo” single claims based on the date of service.

    After those single claims were created, we used the list of “bypass codes” in Table 1 of this preamble to remove separately payable procedures that we determined contain limited costs or no packaged costs from a multiple procedure bill. A discussion of the creation of the list of bypass codes used for the creation of “pseudo” single claims is contained in section II.A.1.b. of this preamble.

    When one of the two separately payable procedures on a multiple procedure claim was on the bypass code list, we split the claim into two single procedure claims records. The single procedure claim record that contained the bypass code did not retain packaged services. The single procedure claim record that contained the other separately payable procedure (but no bypass code) retained the packaged revenue code charges and the packaged HCPCS charges. This enables us to use a claim that would otherwise be a multiple procedure claim and could not be used.

    We excluded those claims that we were not able to convert to singles even after applying both of the techniques for creation of “pseudo” singles. We then packaged the costs of packaged HCPCS codes (codes with status indicator “N” listed in Addendum B to this proposed rule) and packaged revenue codes into the cost of the single major procedure remaining on the claim. The list of packaged revenue codes is shown in Table 2 below.

    After removing claims for hospitals with error CCRs, claims without HCPCS codes, claims for immunizations not covered under the OPPS, and claims for services not paid under the OPPS, 55 million claims were left. Of these 55 million claims, we were able to use some portion of 49 million whole claims (90 percent of the potentially usable claims) to create the 81 million single and “pseudo” single claims for use in the CY 2006 median payment ratesetting.

    We also excluded (1) claims that had zero costs after summing all costs on the claim; (2) claims for which CMS lacked an appropriate provider wage index; and (3) claims containing token charges (charges of less than $1.01) or for which intermediary systems had allocated charges as if the charges were submitted on the claim. We are proposing to delete claims containing token charges. We do not believe that a charge of less than $1.01 would yield a cost that would be valid to set weights for a significant separately paid service. Moreover, effective for services furnished on or after July 1, 2004, the OCE assigns payment flag number 3 to claims on which hospitals submitted token charges for a service with status Start Printed Page 42690indicator “S” or “T” (a major separately paid service under OPPS) for which the intermediary is required to allocate the sum of charges for services with a status indicator equaling “S” or “T” based on the weight for the APC to which each code is assigned. We do not believe that these charges, which were token charges as submitted by the hospital, are valid reflections of hospital resource and that they should not be used to set median costs. Therefore, we are proposing to delete these claims.

    For the remaining claims, we then wage adjusted 60 percent of the cost of the claim (which we have previously determined to be the labor-related portion), as has been our policy since the initial implementation of the OPPS, to adjust for geographic variation in labor-related costs. We made this adjustment by determining the wage index that applied to the hospital that furnished the service and dividing the cost for the separately paid HCPCS code furnished by the hospital by that wage index. As has been our policy since the inception of the OPPS, we are proposing to use the pre-reclassified wage indices for standardization because we believe that they better reflect the true costs of items and services in the area in which the hospital is located than the post-reclassification wage indices, and would result in the most accurate adjusted median costs.

    We then excluded claims that were outside 3 standard deviations from the geometric mean cost for each HCPCS code. We used the remaining claims to calculate median costs for each separately payable HCPCS code; first, to determine the applicability of the “2 times” rule, and second, to determine APC medians based on the claims containing the HCPCS codes assigned to each APC. As stated previously, 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 (“the 2 times rule”). Finally, we reviewed the medians and reassigned HCPCS codes to different APCs as deemed appropriate. Section III.B. of this preamble includes a discussion of the HCPCS code assignment changes that resulted from examination of the medians and for other reasons. The APC medians were recalculated after we reassigned the affected HCPCS codes.

    A detailed discussion of the medians for blood and blood products is included in section X. of this preamble. A discussion of the medians for APCs that require one or more devices when the service is performed is included in section IV.A. of this preamble. A discussion of the median for observation services is included in section XI. of this preamble and a discussion of the median for partial hospitalization is included below in section II.B. of this preamble.

    Table 2.—CY 2006 Proposed Packaged Services by Revenue Code

    Revenue codeDescription
    250PHARMACY.
    251GENERIC.
    252NONGENERIC.
    254PHARMACY INCIDENT TO OTHER DIAGNOSTIC.
    255PHARMACY INCIDENT TO RADIOLOGY.
    257NONPRESCRIPTION DRUGS.
    258IV SOLUTIONS.
    259OTHER PHARMACY.
    260IV THERAPY, GENERAL CLASS.
    262IV THERAPY/PHARMACY SERVICES.
    263SUPPLY/DELIVERY.
    264IV THERAPY/SUPPLIES.
    269OTHER IV THERAPY.
    270M&S SUPPLIES.
    271NONSTERILE SUPPLIES.
    272STERILE SUPPLIES.
    274PROSTHETIC/ORTHOTIC DEVICES.
    275PACEMAKER DRUG.
    276INTRAOCULAR LENS SOURCE DRUG.
    278OTHER IMPLANTS.
    279OTHER M&S SUPPLIES.
    280ONCOLOGY.
    289OTHER ONCOLOGY.
    290DURABLE MEDICAL EQUIPMENT.
    343DIAGNOSTIC RADIOPHARMS.
    344THERAPEUTIC RADIOPHARMS.
    370ANESTHESIA.
    371ANESTHESIA INCIDENT TO RADIOLOGY.
    372ANESTHESIA INCIDENT TO OTHER DIAGNOSTIC.
    379OTHER ANESTHESIA.
    390BLOOD STORAGE AND PROCESSING.
    399OTHER BLOOD STORAGE AND PROCESSING.
    560MEDICAL SOCIAL SERVICES.
    569OTHER MEDICAL SOCIAL SERVICES.
    621SUPPLIES INCIDENT TO RADIOLOGY.
    622SUPPLIES INCIDENT TO OTHER DIAGNOSTIC.
    624INVESTIGATIONAL DEVICE (IDE).
    630DRUGS REQUIRING SPECIFIC IDENTIFICATION, GENERAL CLASS.
    631SINGLE SOURCE.
    632MULTIPLE.
    633RESTRICTIVE PRESCRIPTION.
    681TRAUMA RESPONSE, LEVEL I.
    682TRAUMA RESPONSE, LEVEL II.
    683TRAUMA RESPONSE, LEVEL III.
    684TRAUMA RESPONSE, LEVEL IV.
    689TRAUMA RESPONSE, OTHER.
    700CAST ROOM.
    709OTHER CAST ROOM.
    710RECOVERY ROOM.
    719OTHER RECOVERY ROOM.
    720LABOR ROOM.
    721LABOR.
    762OBSERVATION ROOM.
    810ORGAN ACQUISITION.
    819OTHER ORGAN ACQUISITION.
    942EDUCATION/TRAINING.

    3. Proposed Calculation of Scaled OPPS Payment Weights

    Using the median APC costs discussed previously, we calculated the proposed relative payment weights for each APC for CY 2006 shown in Addenda A and B to this proposed rule. 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 CY 2004 data, the median cost for APC 0601 is $60.57 for CY 2006.

    Section 1833(t)(9)(B) of the Act requires that APC reclassification and recalibration changes, wage index changes, and other adjustments be made in a manner that assures that aggregate payments under the OPPS for CY 2006 are neither greater than nor less than the aggregate payments that would have been made without the changes. To comply with this requirement concerning the APC changes, we compared aggregate payments using the CY 2005 relative weights to aggregate payments using the CY 2006 proposed relative weights. Based on this comparison, we are proposing to make an adjustment to the relative weights for purposes of budget neutrality. The unscaled relative payment weights were adjusted by .999207669 for budget neutrality. The proposed relative payment weights are listed in Addenda A and B to this proposed rule. The proposed relative payment weights incorporate the recalibration adjustments discussed in sections II.A.1. and 2. Start Printed Page 42691

    Section 1833(t)(14)(H) of the Act, as added by section 621(a)(1) of Pub. L. 108-173, states that “Additional expenditures resulting from this paragraph shall not be taken into account in establishing the conversion factor, weighting and other adjustment factors for 2004 and 2005 under paragraph (9) but shall be taken into account for subsequent years.” Section 1833(t)(14) of the Act provides the payment rates for certain “specified covered outpatient drugs.” Therefore, the incremental cost of those specified covered outpatient drugs (as discussed in section V. of this preamble) is included in the budget neutrality calculations.

    Under section 1833(t)(16)(C) of the Act, as added by section 621(b)(1) of Pub. L. 108-173, payment for devices of brachytherapy consisting of a seed or seeds (or radioactive source) is to be made at charges adjusted to cost for services furnished on or after January 1, 2004, and before January 1, 2006. As we stated in our January 6, 2004 interim final rule, charges for the brachytherapy sources will not be used in determining outlier payments and payments for these items will be excluded from budget neutrality calculations. (We provide a discussion of brachytherapy payment issues at section VII. of this proposed rule.)

    4. Proposed Changes to Packaged Services

    Payments for packaged services under the OPPS are bundled into the payments providers receive for separately payable services provided on the same day. Packaged services are identified by the status indicator “N.” Hospitals include charges for packaged services on their claims, and the costs associated with these packaged services are then bundled into the costs for separately payable procedures on the claims for purposes of median cost calculations. Hospitals may use CPT codes to report any packaged services that were performed, consistent with CPT coding guidelines.

    As a result of requests from the public, a Packaging Subcommittee to the APC Panel was established to review all the procedural CPT codes with a status indicator of “N.”

    Providers have often suggested that many packaged services could be provided alone, without any other separately payable services on the claim, and requested that these codes not be assigned status indicator “N.” The Packaging Subcommittee reviewed every code that was packaged in the CY 2004 OPPS. Based on comments we have received and their own expert judgment, the subcommittee identified a set of packaged codes that are often provided separately and subsequently reviewed utilization and median cost data for these codes. One of the main criteria utilized by the Packaging Subcommittee to determine whether a code should become unpackaged was how likely it was for the code to be billed without any other separately payable services on the claim. The Packaging Subcommittee also examined median costs from hospital claims for packaged services that were billed alone.

    The Packaging Subcommittee identified areas for change for some packaged CPT codes that they believe could frequently be provided to patients as the sole service on a given date and that require significant hospital resources as determined from hospital claims data. During the February 2005 meeting, the APC Panel accepted the report of the Packaging Subcommittee and made the following recommendations:

    (1) That packaged codes be reviewed by the Panel individually.

    (2) That the Packaging Subcommittee continue to meet throughout the year to discuss problematic packaged codes.

    (3) That CMS assign a modifier to CPT codes 36540 (Collect blood, venous device); 36600 (Withdrawal of arterial blood); and 51701 (Insertion of non-indwelling bladder catheter), for use when there are no other separately payable codes on the claim. The modifier would flag the outpatient code editor (OCE) to assign payment to the claim.

    (4) That CMS maintain the current packaged status indicator for CPT code 76937 (Ultrasound guidance for vascular access).

    (5) That CMS change the status indicators for CPT immunization administration codes 90471 and 90472 to allow separate payment and ensure consistency with other injection codes.

    (6) That CMS gather more data on CPT code 94762 (Overnight pulse oximetry) to determine how often this code is billed without any other separately payable codes and whether it is performed more frequently alone in rural settings than other settings.

    (7) No changes to the packaged status of CPT codes 77790 (radiation source handling) and 94760 and 94761 (both codes measure blood oxygen levels).

    (8) That CMS provide education and consistent guidelines to providers and fiscal intermediaries on correct billing procedures for packaged codes in general and in particular for CPT codes 36540, 36600, and 51701 and the recommended modifier, if approved.

    (9) That the Packaging Subcommittee review CPT codes 42550 (Injection for salivary x-ray) and 38792 (Sentinel node imaging).

    (10) That CPT code 97602 (Nonselective wound care) be referred to the Physician Payment Group within CMS for evaluation of its bundled status as it relates to services provided under the OPPS and that the Physician Payment Group report its conclusions back to the APC Panel.

    For CY 2006, we are proposing to maintain CPT codes 36540 (Collect blood venous device) and 36600 (Withdrawal of arterial blood) as packaged services and not adopt the APC Panel's recommendation to add a modifier. We note CPT code 36540 is also bundled under the Medicare Physician Fee Schedule (MPFS), and our data demonstrate that the service is generally billed with other separately payable services. We also have relatively few single claims for CPT code 36600, compared to the procedure's overall frequency. Both of these codes have relatively low resource utilization. As these procedures are almost always provided with other separately payable services, hospitals' payments for those other services include the costs of CPT codes 36540 and 36600.

    For CY 2006, we are proposing to pay separately for CPT code 51701 (Insertion of non-indwelling bladder catheter), and to map it to APC 0340 (Minor Ancillary Procedures), with status indicator “X”, and a median cost of $38.52. The APC Panel recommended that we pay separately for this code only when there are no other separately payable services on the claim. However, we are proposing to pay separately for this code every time it is billed. We believe that it is more appropriate to make payment for each procedure rather than increase hospitals' administrative burden by requiring specific coding changes to indicate that there are no other separately payable procedures on the claim. Based on our review of the data, the cost for this procedure is not insignificant, and the volume of single and multiple claims is modest. When we reviewed related codes, including CPT code 51702 (Insertion of temporary indwelling bladder catheter, simple) and CPT code 51703 (Insertion of temporary indwelling bladder catheter, complicate), we noted that these codes also had substantial median costs and a moderate volume of single claims. Therefore, for CY 2006, we are also proposing to pay separately for CPT codes 51702 and 51703, mapping them to APC 0340 with a median cost of $38.52 and APC 0164 (Level I Urinary Start Printed Page 42692and Anal Procedures) with a median cost of $71.54, respectively. CPT codes 51701, 51702, and 51703 will be placed on the bypass list, as discussed in section II.A.1.b. of this proposed rule.

    For CY 2006, we are proposing to accept the APC Panel recommendation that CPT code 76937 (Ultrasound guidance for vascular access) remain packaged. We are concerned that there may be unnecessary overuse of this procedure if it is separately payable. In addition, we believe that the service would always be provided with another separately payable procedure, so its costs would be appropriately bundled with the definitive vascular access service. As stated in the CY 2005 final rule with comment period (69 FR 65697), CMS and the Packaging Subcommittee reviewed CY 2004 claims data for CPT code 76937 and determined that this code should remain packaged.

    For CY 2006, see section VIII. of this preamble on drug administration regarding CPT codes 90471 and 90472.

    For CY 2006, we are proposing to accept the APC Panel recommendations that CPT codes 77790 (Radiation handling), 94760 (Pulse oximetry for oxygen saturation, single determination), and 94761 (Pulse oximetry for oxygen saturation, multiple determinations) remain packaged. We believe that CPT code 77790 is integral to the provision of brachytherapy and should always be billed on the same day with brachytherapy sources and their loading, ensuring that the provider would receive appropriate payment for the radiation source handling and loading bundled with the payment for the brachytherapy service. The small number of single claims for this code in our data verifies that this code is rarely billed alone without other payable services on the claim, and those few single claims may be miscoded claims. Our data review of CPT codes 94760 and 94761 revealed that these codes have low resource utilization, and are most frequently provided with other services. Similar to CPT code 77790, there are many fewer single claims for CPT codes 94760 and 94761 than multiple procedure claims that include CPT codes 94760 and 94761. CPT codes 94760 and 94761 describe services that are very commonly performed in the hospital outpatient setting, and unpackaging these codes would likely significantly decrease the number of single claims available for use in calculating median costs for other services.

    For CY 2006, we are proposing to accept the APC Panel recommendation to gather data and review CPT codes 94762, 42550, and 38792 with the Packaging Subcommittee. We will analyze single and multiple procedure claims' volumes and resource utilization data, and review these studies with the Packaging Subcommittee.

    We referred CPT code 97602 (non-selective wound care) for MPFS evaluation of its bundled status as CPT code 97602 relates to services provided under the OPPS. CPT code 97602 is assigned status indicator “A” in this OPPS proposed rule, meaning that while it is no longer payable under the OPPS, it is payable under a fee schedule other than OPPS. Under the MPFS, the nonselective wound care services described by CPT code 97602 are “bundled” into the selective wound care debridement codes (CPT codes 97597 and 97598). Under the MPFS, a separate payment is never made for “bundled” services and, because of this designation, the provider does not receive separate payment for non-selective wound care described by CPT code 97602. While this code now falls under the MPFS rules, payment policy for this “bundled” service has not changed and separate payment is not made.

    The APC Panel Packaging Subcommittee remains active, and additional issues and new data concerning the packaging status of codes will be shared for its consideration as information becomes available. We continue to encourage submission of common clinical scenarios involving currently packaged HCPCS codes to the Packaging Subcommittee for its ongoing review. Additional detailed suggestions for the Packaging Subcommittee should be submitted to APCPanel@cms.hhs.gov, with “Packaging Subcommittee” in the subject line.

    B. Proposed Payment for Partial Hospitalization

    (If you choose to comment on issues in this section, please include the caption “Partial Hospitalization” at the beginning of your comment.)

    1. Background

    Partial hospitalization is an intensive outpatient program of psychiatric services provided to patients as an alternative to inpatient psychiatric care for beneficiaries who have an acute mental illness. A partial hospitalization program (PHP) may be provided by a hospital to its outpatients or by a Medicare-certified CMHC. Section 1833(t)(1)(B)(i) of the Act provides the Secretary with the authority to designate the hospital outpatient services to be covered under the OPPS. Section 419.21(c) of the Medicare regulations that implement this provision specifies that payments under the OPPS will be made for partial hospitalization services furnished by CMHCs. Section 1883(t)(2)(C) of the Act requires that we establish relative payment weights based on median (or mean, at the election of the Secretary) hospital costs determined by 1996 claims data and data from the most recent available cost reports. 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. For a detailed discussion, refer to the April 7, 2000 OPPS final rule (65 FR 18452).

    2. Proposed PHP APC Update for CY 2006

    To calculate the proposed CY 2006 PHP per diem payment, we used the same methodology that was used to compute the CY 2005 PHP per diem payment. For CY 2005, the per diem amount was based on 12 months of hospital and CMHC PHP claims data (for services furnished from January 1, 2003 through December 31, 2003). We used data from all hospital bills reporting condition code 41, which identifies the claim as partial hospitalization, and all bills from CMHCs because CMHCs are Medicare providers only for the purpose of providing partial hospitalization services. We used CCRs 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 services. Per diem costs were then computed by summing the line-item costs on each bill and dividing by the number of days on the bill.

    In a Program Memorandum issued on January 17, 2003 (Transmittal A-03-004), we directed fiscal intermediaries to recalculate hospital and CMHC CCRs using the most recently settled cost reports by April 30, 2003. Following the initial update of CCRs, fiscal intermediaries were further instructed to continue to update a provider's CCR and enter revised CCRs into the outpatient provider specific file. Therefore, for CMHCs, we use CCRs from the outpatient provider specific file.

    Historically, the median per diem cost for CMHCs has greatly exceeded the median per diem cost for hospital-based PHPs and has fluctuated significantly Start Printed Page 42693from year to year while the median per diem cost for hospital-based PHPs has remained relatively constant ($200-$225). Medicare providers are required to maintain uniform charges for all payers. We believe that hospitals have multiple payers and are far less likely to significantly change their charges for PHP from year to year. However, many CMHCs have indicated that Medicare is their only payer. As a result, we believe that these providers may have increased and decreased their charges in response to Medicare payment policies. As discussed in more detail in the next section and in the final rule establishing the CY 2004 OPPS (68 FR 63470), we believe that some CMHCs manipulated their charges in order to inappropriately receive outlier payments.

    In the CY 2003 update, the difference in median per diem cost for CMHCs and hospital-based PHPs was so great, $685 for CMHCs and $225 for hospital-based PHPs, that we applied an adjustment factor of .583 to CMHC costs to account for the difference between “as submitted” and “final settled” cost reports. By doing so, the CMHC median per diem cost was reduced to $384, resulting in a combined hospital-based and CMHC PHP median per diem cost of $273. As with all APCs in the OPPS, the median cost for each APC was scaled to be relative to the cost of a mid-level office visit and the conversion factor was applied. The resulting per diem rate for PHP for CY 2003 was $240.03.

    In the CY 2004 OPPS update, the median per diem cost for CMHCs grew to $1038, while the median per diem cost for hospital-based PHPs was again $225. After applying the .583 adjustment factor to the median CMHC per diem cost, the median CMHC per diem cost was $605. As the CMHC median per diem cost exceeded the average per diem cost of inpatient psychiatric care, we proposed a per diem rate for CY 2004 based solely on hospital-based PHP data. The proposed PHP per diem for CY 2004, after scaling, was $208.95. However, by the time we published the OPPS final rule for CY 2004, we had received updated CCRs for CMHCs. Using the updated CCRs significantly lowered the CMHC median per diem cost to $440. As a result, we determined that the higher per diem cost for CMHCs was not due to the difference between “as submitted” and “final settled” cost reports, but were the result of excessive increases in charges which may have been done in order to receive higher outlier payments. Therefore, in calculating the PHP median per diem cost for CY 2004, we did not apply the .583 adjustment factor to CMHC costs to compute the PHP APC. Using the updated CCRs for CMHCs, the combined hospital-based and CMHC median per diem cost for PHP was $303. After scaling, we established the CY 2004 PHP APC of $286.82.

    Then, in the CY 2005 OPPS update, the CMHC median per diem cost was $310 and the hospital-based PHP median per diem cost was $215. No adjustments were determined to be necessary and, after scaling, the combined median per diem cost of $289 was reduced to $281.33. We believed that the reduction in the CMHC median per diem cost indicated that the use of updated CCRs had accounted for the previous increase in CMHC charges, and represented a more accurate estimate of CMHC per diem costs for PHP.

    For CY 2006, we analyzed 12 months of data for hospital and CMHC PHP claims for services furnished between January 1, 2004, and December 31, 2004. The data indicated that the median per diem cost for CMHCs had dropped to $143, while the median per diem cost for hospital-based PHPs was $209. It appears that CMHCs significantly reduced their charges in CY 2004. The average charge per day for CMHCs in CY 2003 was $1,184 and the average cost per day was $335. In CY 2004, the CMHC average charge per day dropped to $765 and the average cost per day was $167. We have determined that a combination of lower charges and slightly lower CCRs for CMHCs resulted in a significant decline in the CMHC median per diem cost.

    Following the methodology used for the CY 2005 OPPS update, the combined hospital-based and CMHC median per diem cost would be $149, a decrease of 48 percent compared to the CY 2005 combined median per diem amount. We believe that after scaling this amount to the cost of a mid-level office visit, the resulting APC rate would be too low to cover the per diem cost for all PHPs.

    We are considering an alternative update methodology for the PHP APC for CY 2006 that would mitigate this drastic reduction in payment for PHP. One alternative would be to base the PHP APC on hospital-based PHP data alone. The median per diem cost of hospital-based PHPs has remained in the $200-225 range over the last 5 years, while the median per diem cost for CMHC PHPs has fluctuated significantly from a high of $1,037 to a low of $143. Under this alternative, we would use $209, the median per diem cost for hospital-based PHPs during CY 2004 to establish the PHP APC for CY 2006. However, we believe using this amount would also result in an unacceptable drop in Medicare payments for all PHPs in CY 2006 compared to payments in CY 2005.

    Another alternative we are considering is to apply a different trimming methodology to CMHC costs in an effort to eliminate the effect of data for those CMHCs that appeared to have excessively increased their charges in order to receive outlier payments. We compared CMHC per diem costs in CY 2003 to CMHC per diem costs in CY 2004 and determined the percentage change. Initially, we trimmed CMHCs claims where the CMHC's per diem costs changed by 50 percent or more from CY 2003 to CY 2004. After combining the remaining CMHC claims with the hospital-based PHP claims, we calculated a median per diem cost of $160.75. However, this approach did not eliminate the data for all of the CMHCs with unreasonable per diem costs. We then analyzed the resulting median per diem cost if we trimmed CMHC claims where the difference in CMHC per diem costs from 2003 to 2004 was 25 percent. This trimming approach resulted in a combined CMHC and hospital-based PHP median per diem cost of $176. We also trimmed the CMHC claims from the CY 2003 data to see how trimming aberrant data would affect the combined hospital/CMHC median per diem cost. We found that trimming the claims from the CMHCs with a 25 percent difference in per diem cost from CY 2003 to CY 2004 reduced the $289 median per diem cost to $218.

    We believe it is important to eliminate aberrant data and we believe trimming certain CMHC data would provide an incentive for CMHCs to stabilize their charges so that we could use their data in future updates of the PHP APC. However, we believe that the trimming methods described above would also result in an unacceptably large decrease in payment. In addition, the trimming method we used was based on percentage change in cost per day, and may not have identified all the CMHCs that may have manipulated their charges in order to receive more outlier payments, for example, CMHCs with high charges and no reduction in charges compared to CY 2003.

    Although we prefer to use both CMHC and hospital data to establish the PHP APC, we continue to be concerned about the volatility of the CMHC data. The analyses we have conducted seem to indicate that eliminating aberrant CMHC data results in a median per diem cost more in line with hospital data. We will continue to analyze the CMHC data in developing payment rates, however, if the data continues to Start Printed Page 42694be unstable, we may use only hospital data in the future.

    We are considering an approach that would lessen the PHP payment reduction for CY 2006, yet, ensure an adequate payment amount and continue to ensure access to the partial hospitalization benefit for Medicare beneficiaries. For CY 2006, we are proposing to apply a 15-percent reduction in the combined hospital-based and CMHC median per diem cost that was used to establish the CY 2005 PHP APC. That amount would then be scaled to be relative to the cost of a mid-level office visit to establish the PHP APC for CY 2006. We believe a reduction in the CY 2005 median per diem cost would strike an appropriate balance between using the best available data and providing adequate payment for a program that often spans 5-6 hours a day. We believe 15 percent is an appropriate reduction because it recognizes decreases in median per diem costs in both the hospital data and the CMHC data, and also reduces the risk of any adverse impact on access to these services that might result from a large single-year rate reduction. However, we would propose that the reduction in payments for PHP be a transitional measure, and will continue to monitor CMHC costs and charges for these services and work with CMHCs to improve their reporting so that payments can be calculated based on better empirical data, consistent with the approach we have used to calculate payments in other areas of the OPPS.

    To apply the methodology, we would reduce $289 (the CY 2005 combined hospital-based and CMHC median per diem cost) by 15 percent, resulting in a combined median per diem cost of $245.65. After scaling, we are proposing the resulting APC amount for PHP of $240.51 for CY 2006, of which $48.10 is the beneficiary's coinsurance. We will continue to analyze the data to determine whether there is a more targeted approach that would allow use of the CMHC and hospital PHP claims data to establish the final PHP rate for CY 2006.

    3. Proposed Separate Threshold for Outlier Payments to CMHCs

    In the November 7, 2003 final rule with comment period (68 FR 63469), we indicated that, given the difference in PHP charges between hospitals and CMHCs, we did not believe it was appropriate to make outlier payments to CMHCs using the outlier percentage target amount and threshold established for hospitals. There was a significant difference in the amount of outlier payments made to hospitals and CMHCs for PHP. Further analysis indicated the use of OPPS outlier payments for CMHCs was contrary to the intent of the general OPPS outlier policy. Therefore, for CYs 2004 and 2005, we established a separate outlier threshold for CMHCs. We designated 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 each of those years, excluding outlier payments.

    As stated in the November 15, 2004 final rule with comment period, CMHCs were projected to receive 0.6 percent of the estimated total OPPS payments in CY 2005 (69 FR 65848). The CY 2005 CMHC outlier threshold is met when the cost of furnishing services by a CMHC exceeds 3.5 times the PHP APC payment amount. The current outlier payment percentage is 50 percent of the amount of costs in excess of the threshold.

    CMS and the Office of the Inspector General are continuing to monitor the excessive outlier payments to CMHCs. As previously stated in section II.B.2. above, we used CY 2004 claims data to calculate the proposed CY 2006 per diem payment. These data show the effect of the separate outlier threshold for CMHCs that was effective January 1, 2004. During CY 2004, the separate outlier threshold for CMHCs resulted in $1.8 million in outlier payments to CMHCs, within the 2.0 percent of total OPPS payments identified for CMHCs. In CY 2003, more than $30 million was paid to CMHCs in outlier payments. We believe this difference in outlier payments indicates that the separate outlier threshold for CMHCs has been successful in keeping outlier payments to CMHCs in line with the percentage of OPPS payments made to CMHCs.

    As noted in section II.H. of this preamble, for CY 2006, we are proposing to set the target for hospital outpatient outlier payments at 1.0 percent of total OPPS payments. We are also proposing to allocate a portion of that 1.0 percent, 0.006 percent (or 0.006 percent of total OPPS payments), to CMHCs for PHP services. As discussed in section II.G. below, we are proposing a dollar threshold in addition to an APC multiplier threshold for hospital OPPS outlier payments. However, because PHP is the only APC for which CMHCs may receive payment under the OPPS, we would not expect to redirect outlier payments by imposing a dollar threshold. Therefore, we are not proposing a dollar threshold for CMHC outliers. We are proposing to set the outlier threshold for CMHCs for CY 2006 at 3.45 percent times the APC payment amount and the CY 2006 outlier payment percentage applicable to costs in excess of the threshold at 50 percent. As we did with the hospital outlier threshold, we used hospital charge inflation factor to inflate charges to CY 2006.

    C. Proposed Conversion Factor Update for CY 2006

    (If you choose to comment on issues in this section, please include the caption “Conversion Factor” at the beginning of your comment.)

    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 CY 2006, 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 2006 published in the IPPS proposed rule on May 4, 2005 is 3.2 percent (70 FR 23384). To set the OPPS proposed conversion factor for CY 2006, we increased the CY 2005 conversion factor of $56.983, as specified in the November 15, 2004 final rule with comment period (69 FR 65842), by 3.2 percent.

    In accordance with section 1833(t)(9)(B) of the Act, we further adjusted the conversion factor for CY 2005 to ensure that the revisions we are making to our updates by means of the wage index are made on a budget-neutral basis. We calculated a proposed budget neutrality factor of 1.002015212 for wage index changes by comparing total payments from our simulation model using the FY 2006 IPPS proposed wage index values to those payments using the current (FY 2005) IPPS wage index values. In addition, to accommodate the proposed rural adjustment discussed in section II.G. of this preamble, we calculated a proposed budget neutrality factor of 0.99652023 by comparing payments with the rural adjustment to those without. For CY 2006, allowed pass-through payments are estimated to decrease to 0.05 percent of total OPPS payments, down from 0.1 percent in CY 2005. The proposed conversion factor is also adjusted by the difference in estimated pass-through payments of 0.05 percent. Finally, decreasing proposed payments for outliers to 1.0 percent of total payments returned 1.0 percent to the conversion factor.

    The proposed market basket increase update factor of 3.2 percent for CY 2006, the required wage index budget neutrality adjustment of approximately 1.002015212, the return of 1.0 percent Start Printed Page 42695in total payments from a reduced outlier target, the 0.05 percent adjustment to the pass-through estimate, and the adjustment for the proposed rural payment adjustment of 0.99652023 result in a proposed conversion factor for CY 2006 of $59.350.

    D. Proposed Wage Index Changes for CY 2006

    (If you choose to comment on issues in this section, please include the caption “Wage Index” at the beginning of your comment.)

    Section 1833(t)(2)(D) of the Act requires the Secretary to determine a wage adjustment factor to adjust, for geographic wage differences, the portion of the OPPS payment rate and the copayment standardized amount attributable to labor and labor-related cost. This adjustment must be made in a budget neutral manner. As we have done in prior years, we are proposing to adopt the IPPS wage indices and extend these wage indices to TEFRA hospitals that participate in the OPPS but not the IPPS.

    As discussed in section II.A. of this preamble, we standardize 60 percent of estimated costs (labor-related costs) for geographic area wage variation using the IPPS wage indices that are calculated prior to adjustments for reclassification to remove the effects of differences in area wage levels in determining the OPPS payment rate and the copayment standardized amount.

    As published in the original OPPS April 7, 2000 final rule (65 FR 18545), OPPS has consistently adopted the final IPPS wage indices as the wage indices for adjusting the OPPS standard payment amounts for labor market differences. As initially explained in the September 8, 1998 OPPS proposed rule, we believed and continue to believe that using the IPPS wage index as the source of an adjustment factor for OPPS is reasonable and logical, given the inseparable, subordinate status of the hospital outpatient within the hospital overall. In accordance with section 1886(d)(3)(E) of the Act, the IPPS wage index is updated annually. In this proposed rule, we are proposing to use the proposed FY 2006 hospital IPPS wage index published in the Federal Register on May 4, 2005 (70 FR 23550 through 23581), and as corrected and posted on the CMS Web site, to determine the wage adjustments for the OPPS payment rate and the copayment standardized amount for CY 2006. In accordance with our established policy, we are proposing to use the FY 2006 final version of these wage indices to determine the wage adjustments and copayment standardized amount that we will publish in our final rule for CY 2006.

    We note that the FY 2006 IPPS wage indices continue to reflect a number of changes implemented in FY 2005 as a result of the new OMB standards for defining geographic statistical areas, the implementation of an occupational mix adjustment as part of the wage index, and new wage adjustments provided for under Pub. L. 108-173. The following is a brief summary of the proposed changes in the FY 2005 IPPS wage indices, continued for FY 2006, and any adjustments that we are proposing applying to the OPPS for CY 2006. We refer the reader to the FY 2006 IPPS proposed rule (70 FR 23367 through 23384, May 4, 2005) for a detailed discussion of the changes to the wage indices.)

    1. The proposed continued use of the new Core Based Statistical Areas (CBSAs) issued by the Office of Management and Budget (OMB) as revised standards for designating geographical statistical areas based on the 2000 Census data, to define labor market areas for hospitals for purposes of the IPPS wage index. The OMB revised standards were published in the Federal Register on December 27, 2000 (65 FR 82235), and OMB announced the new CBSAs on June 6, 2003, through an OMB bulletin. In the FY 2005 hospital IPPS final rule, CMS adopted the new OMB definitions for wage index purposes. In the FY 2006 IPPS proposed rule, we again stated that hospitals located in MSAs would be urban and hospitals that are located in Micropolitan Areas or Outside CBSAs would be rural. To help alleviate the decreased payments for previously urban hospitals that became rural under the new MSA definitions, we allowed these hospitals to maintain their assignment to the MSA where they previously had been located for the 3-year period from FY 2005 through FY 2007. To be consistent with IPPS, we will continue the policy we began in CY 2005 of applying the same criterion to TEFRA hospitals paid under the OPPS but not under the IPPS and to maintain that MSA designation for determining a wage index for the specified period. Beginning in FY 2008, these hospitals will receive their statewide rural wage index, although those hospitals paid under the IPPS will be eligible to apply for reclassification. In addition to this “hold harmless” provision, the FY 2005 IPPS final rule implemented a one-year transition for hospitals that experienced a decrease in their FY 2005 wage index compared to their FY 2004 wage index due solely to the changes in labor market definitions. These hospitals received 50 percent of their wage indices based on the new MSA configurations and 50 percent based on the FY 2004 labor market areas. In the FY 2006 IPPS proposed rule, we discussed the cessation of the one-year transition and proposed that hospitals receive 100 percent of their wage index based upon the new CBSA configurations beginning in FY 2006. Again, for the sake of consistency with IPPS, we also are proposing that TEFRA hospitals would receive 100 percent of their wage index based upon the new CBSA configurations beginning in FY 2006.

    2. We again proposed to apply the proposed occupational mix adjustment for FY 2006 IPPS to 10-percent of the average hourly wage and leave 90 percent of the average hourly wage unadjusted for occupational mix. As noted in the FY 2006 IPPS proposed rule, we are, essentially, using the same CMS Wage Index Occupational Mix Survey and Bureau of Labor Statistics data to calculate the adjustment. Because there are no significant differences between the FY 2005 and the FY 2006 occupational mix survey data and results, we believe it is appropriate to adopt the IPPS rule and apply the same occupational mix adjustment to 10 percent of the proposed FY 2006 wage index.

    3. The reclassifications of hospitals to geographic areas for purposes of the wage index. For purposes of the OPPS wage index, we are proposing to adopt all of the IPPS reclassifications proposed for FY 2006, including reclassifications that the Medicare Geographic Classification Review Board (MGCRB) approved under the one-time appeal process for hospitals under section 508 of Pub. L. 108-173. We note that section 508 reclassifications will terminate March 31, 2007.

    4. The proposed continuation of an adjustment to the wage index to reflect the “out-migration” of hospital employees who reside in one county but commute to work in a different county with a higher wage index, in accordance with section 505 of Pub. L. 108-173 (FY 2006 IPPS proposed rule (70 FR 23381 and 23382, May 4, 2005)). Hospitals paid under the IPPS located in the qualifying section 505 “out-migration” counties receive a wage index increase unless they have already been reclassified under section 1886(d)(10) of the Act, redesignated under section 1886(d)(8)(B) of the Act, or reclassified under section 508. As discussed in the FY 2006 IPPS proposed rule, we proposed that reclassified hospitals not receive the out-migration adjustment unless they waive their reclassified Start Printed Page 42696status. For OPPS purposes, we are continuing our policy from CY 2005 to apply the same 505 criterion to TEFRA hospitals paid under the OPPS but not paid under the IPPS. Because TEFRA hospitals cannot reclassify under sections 1886(d)(8) and 1886(d)(10) of the Act or section 508, they are eligible for the out-migration adjustment. Therefore, TEFRA hospitals located in a qualifying section 505 county will also receive an increase to their wage index under OPPS. Addendum L shows the hospitals, including TEFRA hospitals, that we currently believe will receive the out-migration adjustment. However, because we are proposing to adopt the final FY 2006 IPPS wage index, we will adopt any changes in a hospital's classification status that would make them either eligible or ineligible for the out-migration adjustment.

    The following proposed FY 2006 IPPS wage indices that were published in the May 4, 2005 Federal Register (70 FR 23550 through 2323581) are reprinted as Addenda in this OPPS proposed rule: Addendum H—Wage Index for Urban Areas; Addendum I—Wage Index for Rural Areas; Addendum J—Wage Index for Hospitals That Are Reclassified; Addendum K—Puerto Rico Wage Index by CBSA; Addendum L—Out-Migration Wage Adjustment; Addendum M—Hospital Reclassifications and Redesignations by Individual Hospital and CBSA; Addendum N—Hospital Reclassifications and Redesignations by Individual Hospital under Section 508 of Pub. L. 108-173; and Addendum O—Hospitals Redesignated as Rural Under Section 1886(d)(8)(E) of the Act. We are proposing to use these FY 2006 IPPS indices, as they are finalized, to adjust the payment rates and coinsurance amounts that we will publish in the OPPS final rule for CY 2006.

    With the exception of reclassifications resulting from the implementation of the one-time appeal process under section 508 of Pub. L. 108-173, all changes to the wage index resulting from geographic labor market area reclassifications or other adjustments must be incorporated in a budget neutral manner. Accordingly, in calculating the OPPS budget neutrality estimates for CY 2006, we have included the wage index changes that result from MGCRB reclassifications, implementation of section 505 of Pub. L. 108-173, and other refinements made in the FY 2006 IPPS proposed rule, such as the hold harmless provision for hospitals changing status from urban to rural under the new CBSA geographic statistical area definitions. However, section 508 set aside $900 million to implement the section 508 reclassifications. We considered the increased Medicare payments that the section 508 reclassifications would create in both the IPPS and OPPS when we determined the impact of the one-time appeal process. Because the increased OPPS payments already counted against the $900 million limit, we did not consider these reclassifications when we calculated the OPPS budget neutrality adjustment.

    E. Proposed Statewide Average Default Cost-to-Charge Ratios

    (If you choose to comment on issues in this section, please include the caption “Cost-to-Charge Ratios” at the beginning of your comment.)

    CMS uses CCRs to determine outlier payments, payments for pass-through devices, and monthly interim transitional corridor payments under the OPPS. Some hospitals do not have a valid CCR. These hospitals include, but are not limited to, hospitals that are new and have not yet submitted a cost report, hospitals that have a CCR that falls outside predetermined floor and ceiling thresholds for a valid CCR, or hospitals that have recently given up their all-inclusive rate status. Last year we updated the default urban and rural CCRs for CY 2005 in our final rule published on November 15, 2004 (69 FR 65821 through 65825). We are proposing to update the default ratios using the most recent cost report data for CY 2006.

    We calculated the proposed statewide default CCRs using the same CCRs that we use to adjust charges to costs on claims data. Table 3 lists the proposed CY 2006 default urban and rural CCRs by State. These CCRs are the ratio of total costs to total charges from each provider's most recently submitted cost report, for those cost centers relevant to outpatient services. We also adjusted these ratios to reflect final settled status by applying the differential between settled to submitted costs and charges from the most recent pair of settled to submitted cost reports.

    The majority of submitted cost reports, 80.79 percent, were for CY 2003. We only used valid CCRs to calculate these default ratios. That is, we removed the CCRs for all-inclusive hospitals, CAHs, and hospitals in Guam and the U.S. Virgin Islands because these entities are not paid under the OPPS, or in the case of all-inclusive hospitals, because their CCRs are suspect. We further identified and removed any obvious error CCRs and trimmed any outliers. We limited the hospitals used in the calculation of the default CCRs to those hospitals that billed for services under the OPPS during CY 2003.

    Finally, we calculated an overall average CCR, weighted by a measure of volume, for each State except Maryland. This measure of volume is the total lines on claims and is the same one that we use in our impact tables. For Maryland, we used an overall weighted average CCR for all hospitals in the nation as a substitute for Maryland CCRs, which appear in Table 3. Very few providers in Maryland are eligible to receive payment under the OPPS, which limits the data available to calculate an accurate and representative CCR. The overall decrease in default statewide CCRs can be attributed to the general decline in the ratio between costs and charges widely observed in the cost report data.

    Table 3.—Statewide Average Cost-to-Charge Ratios

    StateUrban/ruralPrevious default CCRDefault CCR
    ALABAMARURAL0.315520.26710
    ALABAMAURBAN0.298600.24570
    ALASKARURAL0.593880.61850
    ALASKAURBAN0.385550.42710
    ARIZONARURAL0.397480.32760
    ARIZONAURBAN0.309220.26980
    ARKANSASRURAL0.359360.31750
    ARKANSASURBAN0.382780.30470
    CALIFORNIARURAL0.403350.29310
    CALIFORNIAURBAN0.324270.24210
    COLORADORURAL0.510410.43060
    Start Printed Page 42697
    COLORADOURBAN0.418630.32170
    CONNECTICUTRURAL0.427020.47250
    CONNECTICUTURBAN0.465920.44620
    DELAWARERURAL0.362890.36300
    DELAWAREURBAN0.450610.45940
    DISTRICT OF COLUMBIAURBAN0.386900.37510
    FLORIDARURAL0.317820.24300
    FLORIDAURBAN0.283630.22400
    GEORGIARURAL0.398290.33820
    GEORGIAURBAN0.402620.32100
    HAWAIIRURAL0.444200.41020
    HAWAIIURBAN0.348150.34470
    IDAHORURAL0.496820.46450
    IDAHOURBAN0.519420.49170
    ILLINOISRURAL0.418250.34060
    ILLINOISURBAN0.368250.29960
    INDIANARURAL0.445960.36860
    INDIANAURBAN0.442050.37230
    IOWARURAL0.501660.41990
    IOWAURBAN0.469630.38780
    KANSASRURAL0.480650.38970
    KANSASURBAN0.346980.29270
    KENTUCKYRURAL0.369870.31080
    KENTUCKYURBAN0.373810.32470
    LOUISIANARURAL0.343170.29910
    LOUISIANAURBAN0.343570.27730
    MAINERURAL0.478570.38800
    MAINEURBAN0.540840.44890
    MARYLANDRURAL0.703800.36521
    MARYLANDURBAN0.681040.32997
    MASSACHUSETTSURBAN0.444390.38810
    MICHIGANRURAL0.448900.39410
    MICHIGANURBAN0.411430.37420
    MINNESOTARURAL0.485140.47130
    MINNESOTAURBAN0.452590.37410
    MISSISSIPPIRURAL0.342640.30290
    MISSISSIPPIURBAN0.370970.29320
    MISSOURIRURAL0.421870.34160
    MISSOURIURBAN0.381280.31080
    MONTANARURAL0.511730.47890
    MONTANAURBAN0.493960.44810
    NEBRASKARURAL0.493860.42370
    NEBRASKAURBAN0.420430.33870
    NEVADARURAL0.428780.50620
    NEVADAURBAN0.228540.22330
    NEW HAMPSHIRERURAL0.500830.43580
    NEW HAMPSHIREURBAN0.399540.33220
    NEW JERSEYURBAN0.490240.34030
    NEW MEXICORURAL0.449320.33890
    NEW MEXICOURBAN0.508570.43310
    NEW YORKRURAL0.520620.43940
    NEW YORKURBAN0.546250.42550
    NORTH CAROLINARURAL0.377760.35410
    NORTH CAROLINAURBAN0.427260.38110
    NORTH DAKOTARURAL0.528290.41170
    NORTH DAKOTAURBAN0.473410.36740
    OHIORURAL0.425620.41160
    OHIOURBAN0.427180.32810
    OKLAHOMARURAL0.406280.32900
    OKLAHOMAURBAN0.362640.29190
    OREGONRURAL0.479150.42460
    OREGONURBAN0.499580.43760
    PENNSYLVANIARURAL0.405820.36010
    PENNSYLVANIAURBAN0.338070.28010
    PUERTO RICOURBAN0.422080.41370
    RHODE ISLANDURBAN0.439300.35100
    SOUTH CAROLINARURAL0.359960.29370
    SOUTH CAROLINAURBAN0.369610.29160
    SOUTH DAKOTARURAL0.495990.39210
    SOUTH DAKOTAURBAN0.442590.33940
    TENNESSEERURAL0.366630.30290
    Start Printed Page 42698
    TENNESSEEURBAN0.364640.28310
    TEXASRURAL0.417630.33640
    TEXASURBAN0.336110.30300
    UTAHRURAL0.497480.47090
    UTAHURBAN0.467330.45230
    VERMONTRURAL0.472780.46750
    VERMONTURBAN0.545330.44250
    VIRGINIARURAL0.394080.33500
    VIRGINIAURBAN0.386040.32550
    WASHINGTONRURAL0.542460.43420
    WASHINGTONURBAN0.546580.41360
    WEST VIRGINIARURAL0.426710.35070
    WEST VIRGINIAURBAN0.456160.40700
    WISCONSINRURAL0.501260.42300
    WISCONSINURBAN0.462680.38480
    WYOMINGRURAL0.545960.51580
    WYOMINGURBAN0.412650.41080

    F. Expiring Hold Harmless Provision for Transitional Corridor Payments for Certain Rural Hospitals

    When the OPPS was implemented, every provider was eligible to receive an additional payment adjustment (transitional corridor payment) if the payments it received for covered OPD services under the OPPS were less than the payments it would have received for the same services under the prior reasonable cost-based system (section 1833(t)(7) of the Act). Section 1833(t)(7) of the Act provides that the transitional corridor payments are temporary payments for most providers, with two exceptions, to ease their transition from the prior reasonable cost-based payment system to the OPPS system. Cancer hospitals and children's hospitals receive the transitional corridor payments on a permanent basis. Section 1833(t)(7)(D)(i) of the Act originally provided for transitional corridor payments to rural hospitals with 100 or fewer beds for covered OPD services furnished before January 1, 2004. However, section 411 of Pub. L. 108-173 amended section 1833(t)(7)(D)(i) of the Act to extend these payments through December 31, 2005, for rural hospitals with 100 or fewer beds. Section 411 also extended the transitional corridor payments to sole community hospitals located in rural areas for services furnished during the period that begins with the provider's first cost reporting period beginning on or after January 1, 2004, and ends on December 31, 2005. Accordingly, the authority for making transitional corridor payments under section 1833(t)(7)(D)(i) of the Act, as amended by section 411 of Pub . L. 108-173, will expire for rural hospitals having 100 or fewer beds and sole community hospitals located in rural areas on December 31, 2005. For CY 2006, transitional corridor payments will continue to be available to cancer and children's hospitals. (We note that the succeeding section II.G. of this preamble discusses an additional provision of section 411 of Pub. L. 108-173 that related to a study to determine appropriate adjustment to payments for rural hospitals under the OPPS beginning January 2006.)

    G. Proposed Adjustment for Rural Hospitals

    (If you choose to comment on issues in this section, please include the caption “Rural Hospital Adjustment” at the beginning of your comment.)

    Section 411 of Pub. L. 108-173 added a new paragraph (13) to section 1833(t) of the Act. New section 1833(t)(13)(A) specifically instructs the Secretary to conduct a study to determine if rural hospital outpatient costs exceed urban hospital outpatient costs. Moreover, under new section 1833(t)(13)(B) of the Act, the Secretary is given authorization to provide an appropriate adjustment to rural hospitals by January 1, 2006, if rural hospital costs are determined to be greater than urban hospital costs.

    To conduct the study required under section 1833(t)(13)(A), as added by section 411 of Pub. L. 108-173, we believe that a simple comparison of unit costs is insufficient because the costs faced by hospitals, whether urban or rural, will be a function of many factors. These include the local labor supply, and the complexity and volume of services provided. Therefore, we used regression analysis to study differences in the outpatient cost per unit between rural and urban hospitals in order to compare costs after accounting for the influence of these other factors.

    Our regression analysis included all 4,077 hospitals billing under OPPS for which we could model accurate cost per unit estimates. For each hospital, total outpatient costs and descriptive information were derived from CY 2004 Medicare claims and the hospital's most recently submitted cost report. The description of claims used, our methodology for creating costs from charges, and a description of the specific hospitals included in our modeling are discussed in section II.A. of this preamble. We excluded separately payable drugs and biologicals, and clinical laboratory services paid on a fee schedule from our analysis. We excluded the 49 hospitals in Puerto Rico because their wage indices and unit costs are so different that they would have skewed results. Finally, we excluded facilities whose unit outpatient costs were outside of 3 standard deviations from the geometric mean unit outpatient cost.

    Total unit outpatient cost for each hospital was calculated by dividing total outpatient cost by the total number of APC units discounted for the joint performance of multiple procedures. (See section II.G.2. below for a definition of discounted units.) We modeled both explanatory and payment regression models. In an “explanatory model” approach, all variables that are hypothesized to be important determinants of cost are included in the cost regression, whether or not they are going to be used as payment adjustments. In a “payment model” approach, the only independent variables included in the cost regression are those variables that are used as payment adjustments. The regression Start Printed Page 42699equations for both models were specified in double logarithmetic form. The dependent variable in the explanatory regression equation was unit outpatient cost. The dependent variable in the payment regressions was standardized unit outpatient costs, that is, unit outpatient costs adjusted to reflect payment by dividing through by the provider's service-mix index which was adjusted by the provider's wage index. The service-mix index is a measure of the resource intensity of services provided by each hospital. Both regression equation models included quantitative independent variables transformed into natural logarithms and categorical independent variables. Categorical independent (dummy) variables included hospital characteristics such as rural location or type of hospital (short stay or specialty hospital).

    1. Factors Contributing to Unit Cost Differences Between Rural Hospitals and Urban Hospitals

    In considering potential independent variables that might explain differences in unit outpatient costs between urban and rural hospitals, we determined that several factors would be important:

    • First, unit outpatient costs are expected to vary directly with the prices of inputs used to produce outpatient services, especially labor. Wage rates tend to be lower in rural areas than in urban areas.
    • Second, there may be economies of scale in producing outpatient services, which imply that unit costs will vary inversely with the volume of outpatient services provided.
    • Third, independent of the volume of outpatient services, hospitals that provide more complex outpatient services are expected to have higher unit costs than hospitals with less complex service-mixes. Typically, greater complexity involves a combination of higher equipment and labor costs. Rural hospitals usually have less volume and perform less complex services than urban hospitals.
    • Fourth, the size of a hospital may influence the volume and service-mix of outpatient services. Large hospitals generally provide a wider range of more complex services than do small hospitals. Large hospitals may also have larger volumes in ancillary departments that are shared between outpatient and inpatient services, and as a result, benefit from greater economies of scale than do small hospitals. Rural hospitals tend to be smaller than urban hospitals. Our primary measure of outpatient volume is units of APCs, which only reflects the volume of Medicare services paid under the outpatient PPS. This measure does not include the inpatient utilization of shared ancillary departments or non-Medicare outpatient services. For all these reasons, it seems appropriate to include a broader measure of facility size in the explanatory regression model. Therefore, as explained below, we used the total number of facility beds to measure facility size. Unit outpatient costs may be positively or negatively related to facility size depending on whether complexity effects or scale economies are more important.

    2. Explanatory Variables

    We used the hospital wage index as our measure of labor input prices. To reflect the complexity of outpatient services, we used a service-mix index defined as the ratio of the number of discounted units weighted by APC relative weights divided by the number of unweighted discounted units. Discounted units are the total number of units after we adjust for the multiple procedure reduction of 50 percent that applies to payment for surgical services when two surgical procedures are performed during the same operative session and for selected radiology procedures, as proposed (see section XIV. of the preamble). For example, if a procedure is paid at 100 percent of payment 1,000 times and the same procedure is paid at 50 percent of payment 100 times, the discounted units for that procedure equal 1,050 units (the sum of 1,000 units at full payment plus 100 units at 50 percent payment). We then calculate the total weight for that procedure by multiplying the discounted units by the full weight for the procedure. The service-mix index reflects the average APC weight of each facility's outpatient services. Outpatient service volume was measured as the total number of unweighted discounted units. We used the total number of facility beds as the broader measure of facility size. We also included categorical variables to indicate the types of specialty hospitals that participate in OPPS, specifically cancer, children's, long-term care, rehabilitation, and psychiatric hospitals. Finally, we included a categorical variable for rural/urban location to capture variation unexplained by the other independent variables in the model. For all of the rural dummy variables discussed below, urban hospitals are the reference group. Table 4 provides descriptive statistics for the dependent variable and key independent variables by urban and rural status. Without controlling for the other influences on per unit cost, rural hospitals have lower cost per unit than urban hospitals. However, when standardized for the service-mix wage indices, average unit costs are nearly identical between urban and rural hospitals

    Table 4.—Means and Standard Deviations (In Parenthesis) for Key Variables by Urban-Rural Location

    RuralUrban
    Unit Outpatient Cost$163.78$195.54
    ($65.69)($93.59)
    Standardized Unit Outpatient Cost$75.04$75.15
    ($26.97)($45.00)
    Wage Index0.87981.0214
    (0.0771)(0.1487)
    Service-Mix Index2.41212.7741
    (0.8915)(1.4579)
    Outpatient Volume18,64535,744
    (19,578)(42,626)
    Beds76.70198
    (55.82)(169)
    Number of Hospitals1,2572,820
    Start Printed Page 42700

    3. Results

    Overall, all rural hospitals give some indication of having higher cost per unit, after controlling for labor input prices, service-mix complexity, volume, facility size, and type of hospital. In an explanatory model regressing unit costs on all independent variables discussed above, the coefficient for the rural categorical variable was 0.024 (p=0.058), which suggests that rural hospitals are approximately 2.4 percent more costly than urban hospitals after accounting for the impact of other explanatory variables. The results of this regression appear in Table 5. This regression demonstrated reasonably good explanatory power with an adjusted R2 of 0.53 (rounded). Adjusted R2 is the percentage of variation in the dependent variable explained by the independent variables and is a standard measure of how well the regression model fits the data. The regression coefficients of the key explanatory variables all move in the expected direction: positive for the wage index, indicating that rural hospitals can be expected to have lower unit outpatient costs because they tend to be located in areas with lower wage rates; positive for the outpatient service-mix index, consistent with the hypothesis that rural hospitals' less complex outpatient service-mixes result in lower unit costs than those of the typical urban hospital; negative for outpatient service volume, implying that, on average, rural hospitals' lower service volumes are a source of higher unit cost compared to urban hospitals; and positive for the facility size variable (beds), suggesting that facility size is more reflective of complexity than any economies of scale. The rural dummy variable has a coefficient of 0.02414. If the unit costs of rural hospitals are the same as the unit costs of urban hospitals, the probability of observing a value as extreme as or more extreme than 2.4 percent would be approximately 6 percent or less. This explanatory regression model provides some evidence that outpatient services provided by rural hospitals are more costly than outpatient services provided by urban hospitals, but the evidence is weak. The payment regression that accompanies this explanatory model indicates an adjustment for all rural hospitals of 3.7 percent.

    Table 5.—Regression Results for Unit Outpatient Cost: Rural Versus Urban

    VariableExplanatoryPayment
    Regression coefficientt Value 1p Value 2Regression coefficientt Value 1p Value 2
    Intercept4.89665124.65<.00014.240920.00624<0.0001
    Wage Index0.6443517.96<.0001
    Service-Mix Index0.7581358.51<.0001
    Outpatient Volume−0.06532−14.40<.0001
    Beds0.044756.17<.0001
    Rural0.024141.890.05820.036563.250.0012
    Children's Hospital0.064971.330.1824
    Psychiatric Hospital−0.44446−15.13<.0001
    Long-Term Care Hospital−0.08759−2.77.0.0057
    Rehabilitation Hospital−0.25295−7.85<.0001
    Cancer Hospital0.308973.450.0006
    R20.5285
    Note: Coefficients of all quantitative variables are elasticities since both the dependent variable, unit outpatient cost, and all quantitative independent variables were in natural logarithms. To calculate percentage differences for categorical variables, their coefficients must be raised to the power, e, the base of natural logarithms.
    1 A t value is an indicator of our degree of confidence that the regression coefficient is different from zero, taking into account the statistical variability of the estimated coefficient.
    2 A p value is the probability of observing the specific t value when the estimated coefficient is zero. The t values greater than 2 and less than −2 indicate a probability less than 5 percent, p-value<0.05, that the estimated coefficient is zero.

    In order to assess whether the small difference in costs was uniform across rural hospitals or whether all of the variation was attributable to a specific class of rural hospitals, we included more specific categories of rural hospitals in our explanatory regression analysis. We divided rural hospitals into rural SCHs, rural hospitals with less than 100 beds that are not rural sole community hospitals, and other rural hospitals. The first two categories of rural hospitals are currently eligible for payments under the expiring hold-harmless provision. Because it appears that rural SCHs are responsible for the variation in rural hospital costs, we then collapsed the last remaining categories in an “all other” rural hospital category.

    We found that rural SCHs demonstrated significantly higher cost per unit than urban hospitals after controlling for labor input prices, service-mix complexity, volume, facility size, and type of hospital. The results of this regression appear in Table 6. With the exception of the new rural variables, the independent variables have the same sign and significance as in Table 5. Rural SCHs have a positive and significant coefficient; all other rural hospitals do not. The rural SCH “dummy” variable has an explanatory regression coefficient of 0.05668 and an observed probability that the coefficient is zero of less than 0.001. If the unit costs of rural SCHs are the same as those of urban hospitals, the probability of observing a value as extreme or more extreme than 5.8 percent would be less than 0.1 percent. Accordingly, we have determined that rural SCHs are more costly than urban hospitals, holding all other variables constant. Notably, we observed no significant difference between all other rural hospitals and urban hospitals.Start Printed Page 42701

    Table 6.—Regression Results for Unit Outpatient Cost: Rural Sole Community Hospitals

    VariableExplanatoryPayment
    Regression coefficientt Value 1pValue 2Regression coefficientt Value 1pValue 2
    Intercept4.89444124.70<.00014.24474768.57<.0001
    Wage Index0.6402217.85<.0001
    Service-Mix Index0.7579858.56<.0001
    Outpatient Volume−0.06538−14.43<.0001
    Beds0.045336.26<.0001
    Rural SCH0.056683.420.00060.063543.94<.0001
    All Other Rural0.004150.290.7715
    Children's Hospital0.064751.330.1835
    Psychiatric Hospital−0.44345−15.11<.0001
    Long-Term Care Hospital−0.08644−2.730.0063
    Rehabilitation Hospital−0.25234−7.83<.0001
    Cancer Hospital0.309573.460.0005
    R20.5295
    Note: Coefficients of all quantitative variables are elasticities since both the dependent variables, unit outpatient cost, and all quantitative independent variables were in natural logarithms. To calculate percentage differences for categorical variables, their coefficients must be raised to the power, e, the base of natural logarithms.
    1 A t value is an indicator of our degree of confidence that the regression coefficient is different from zero, taking into account the statistical variability of the estimated coefficient.
    2 A p value is the probability of observing the specific t value when the estimated coefficient is zero. The t values greater than 2 and less than −2 indicate a probability less than 5 percent, p-value <0.05, that the estimated coefficient is zero.

    Based on the above analysis and as noted in the explanatory regression in Table 6, we believe that a payment adjustment for rural SCHs is warranted. The accompanying payment regression, also appearing in Table 6, indicates a cost impact of 6.6 percent. Thus, in accordance with the authority provided in section 1833(t)(13)(B) of the Act, as added by section 411 of Pub. L. 108-173, we are proposing a 6.6 percent payment increase for rural SCHs for CY 2006. This adjustment would apply to all services and procedures paid under the OPPS, excluding drugs and biologicals. We note that this adjustment would be budget neutral, and would be applied before calculating outliers and coinsurance. We may revisit this adjustment in the future.

    Additional descriptive statistics are available on the CMS Web site.

    H. Proposed Hospital Outpatient Outlier Payments

    (If you choose to comment on issues in this section, please include the caption “Outlier Payments” at the beginning of your comment.)

    Currently, the OPPS pays outlier payments on a service-by-service basis. For CY 2005, the outlier threshold is met when the cost of furnishing a service or procedure by a hospital exceeds 1.75 times the APC payment amount and exceeds the APC payment rate plus a $1,175 fixed dollar threshold. We introduced a fixed dollar threshold in CY 2005 in addition to the traditional multiple threshold to better target outliers to those high cost and complex procedures where a very costly case could present a hospital with significant financial loss. If a provider meets both of these conditions, the multiple threshold and the fixed dollar threshold, the outlier payment is calculated as 50 percent of the amount by which the cost of furnishing the service exceeds 1.75 times the APC payment rate. For CMHCs, the outlier threshold is met when the cost of furnishing a service or procedure by a CMHC exceeds 3.5 times the APC payment rate. If a CMHC provider meets this condition, the outlier payment is calculated as 50 percent of the amount by which the cost exceeds 3.5 times the APC payment rate.

    As explained in our CY 2005 final rule (69 FR 65844), we set our projected target for aggregate outlier payments at 2.0 percent of aggregate total payments under OPPS. Our outlier thresholds were set so that estimated CY 2005 aggregate outlier payments would equal 2.0 percent of aggregate total payments under OPPS.

    For CY 2006, we are proposing to set our projected target for aggregate outlier payments at 1.0 percent of aggregate total payments under OPPS. A portion of that 1.0 percent, an amount equal to .006 percent of aggregate total payments under OPPS, would be allocated to CMHCs for partial hospitalization program service outliers. In its March 2004 Report, MedPAC recommended that Congress should eliminate the outlier policy under the outpatient prospective payment system. While this would require a statutory change, many of the reasons cited by MedPAC for the elimination of the outlier policy are equally applicable to any reduction in the size of the percentage of total payments dedicated to outlier payments, including the following: the narrow definition of many of the services provided in hospital outpatient departments suggests that variability in costs should not be great; the distribution of outlier payments benefits some hospital groups more than others; the outlier policy is susceptible to “gaming” through charge inflation; and, the OPPS is the only ambulatory payment system with an outlier policy.

    In order to ensure that estimated CY 2006 aggregate outlier payments would equal 1.0 percent of estimated aggregate total payments under OPPS, we are proposing that the outlier threshold be modified so that outlier payments are triggered when the cost of furnishing a service or procedure by a hospital exceeds 1.75 times the APC payment amount and exceeds the APC payment rate plus a $1,575 fixed dollar threshold. We choose to modify the fixed dollar threshold to target 1.0 percent of estimated aggregate total payment under OPPS and not modify the current 1.75 multiple to further our policy of targeting outlier payments to complex and expensive procedures with sufficient variability to pose a financial risk for hospitals. Modifying the multiple would do less to target outlier payments to complex and expensive procedures. For example, if we were to establish a multiple of 2.00 rather than 1.75, then an APC with a payment rate of $20,000 would see the outlier threshold associated with the multiple increase from $35,000 to $40,000. Raising the fixed dollar threshold to Start Printed Page 42702$1,575 only increases the threshold for expensive procedures by $400. For this reason, we believe it is more appropriate to focus the modification necessary to target 1.0 percent of aggregate OPPS payments on the fixed dollar threshold and increase it from $1,175 in CY 2005 to our proposed $1,575 in CY 2006 and have the multiple threshold remain at 1.75.

    For CY 2006, the outlier threshold for CMHCs is met when the cost of furnishing a service or procedure by a CMHC exceeds 3.45 times the APC payment rate. If a CMHC provider meets this condition, the outlier payment is calculated as 50 percent of the amount by which the cost exceeds 3.45 times the APC payment rate.

    The following is an example of an outlier calculation for CY 2006 under our proposed policy. A hospital charges $26,000 for a procedure. The APC payment for the procedure is $3,000, including a rural adjustment, if applicable. Using the provider's cost-to-charge ratio of 0.30, the estimated cost to the hospital is $7,800. To determine whether this provider is eligible for outlier payments for this procedure, the provider must determine whether the cost for the service exceeds both the APC outlier cost threshold (1.75 × APC payment) and the fixed dollar threshold ($1,575 + APC payment). In this example, the provider meets both criteria:

    (1) $7,800 exceeds $5,250 (1.75 × $3,000)

    (2) $7,800 exceeds $4,575 ($1,575 + $3,000)

    To calculate the outlier payment, which is 50 percent of the amount by which the cost of furnishing the service exceeds 1.75 times the APC rate, subtract $5,250 (1.75 × $3,000) from $7,800 (resulting in $2,550). The provider is eligible for 50 percent of the difference, in this case $1,275 ($2,550/2). The formula is (cost −(1.75 × APC payment rate))/2.

    I. Calculation of the Proposed National Unadjusted Medicare Payment

    (If you choose to comment on issues in this section, please include the caption “Payment Rate for APCs” at the beginning of your comment.)

    The basic methodology for determining prospective payment rates for OPD services under the OPPS is set forth in existing regulations at § 419.31 and § 419.32. The payment rate for services and procedures for which payment is made under the OPPS is the product of the conversion factor calculated in accordance with section II.C. of this proposed rule, and the relative weight determined under section II.A. of this proposed rule. Therefore, the national unadjusted payment rate for APCs contained in Addendum A to this proposed rule and for payable HCPCS codes in Addendum B to this proposed rule (Addendum B is provided as a convenience for readers) was calculated by multiplying the proposed CY 2006 scaled weight for the APC by the proposed CY 2006 conversion factor.

    However, to determine the payment that would be made in a calendar year under the OPPS to a specific hospital for an APC for a service other than a drug, in a circumstance in which the multiple procedure discount does not apply, we take the following steps:

    Step 1. Calculate 60 percent (the labor-related portion) of the national unadjusted payment rate. Since initial implementation of the OPPS, we have used 60 percent to represent our estimate of that portion of costs attributable, on average, to labor. (Refer to the April 7, 2000 final rule with comment period (65 FR 18496 through 18497), for a detailed discussion of how we derived this percentage.)

    Step 2. Determine the wage index area in which the hospital is located and identify the wage index level that applies to the specific hospital. The wage index values assigned to each area reflect the new geographic statistical areas as a result of revised OMB standards (urban and rural) to which hospitals would be assigned for FY 2006 under the IPPS, reclassifications through the Medicare Classification Geographic Review Board, section 1866(d)(8)(B) “Lugar” hospitals, and section 401 of Pub. L. 108-173, and the reclassifications of hospitals under the one-time appeals process under section 508 of Pub. L. 108-173. Assess whether the previous MSA-based wage index is higher than the CBSA-based wage index, and, if higher, apply a 50/50 blend. The wage index values include the occupational mix adjustment described in section II.D. of this proposed rule that was developed for the IPPS.

    Step 3. Adjust the wage index of hospitals located in certain qualifying counties that have a relatively high percentage of hospital employees who reside in the county, but who work in a different county with a higher wage index, in accordance with section 505 of Pub. L. 108-173. Addendum K contains the qualifying counties and the proposed wage index increase developed for the IPPS. This step is to be followed only if the hospital has chosen not to accept reclassification under Step 2 above.

    Step 4. Multiply the applicable wage index determined under Steps 2 and 3 by the amount determined under Step 1 that represents the labor-related portion of the national unadjusted payment rate.

    Step 5. Calculate 40 percent (the nonlabor-related portion) of the national unadjusted payment rate and add that amount to the resulting product of Step 4. The result is the wage index adjusted payment rate for the relevant wage index area.

    Step 6. If a provider is a sole community hospital, as defined in § 419.92, and located in a rural area, as defined in § 412.63(b) or is treated as being located in a rural area under section 1886(d)(8)(E) of the Act, multiply the wage index adjusted payment rate by 1.066 to calculate the total payment.

    J. Proposed Beneficiary Copayments for CY 2006

    (If you choose to comment on issues in this section, please include the caption “Beneficiary Copayment” at the beginning of your comment.)

    1. Background

    Section 1833(t)(3)(B) of the Act requires the Secretary to set rules for determining copayment amounts to be paid by beneficiaries for covered OPD services. Section 1833(t)(8)(C)(ii) of the Act specifies that the Secretary must reduce the national unadjusted copayment amount for a covered OPD service (or group of such services) furnished in a year in a manner so that the effective copayment rate (determined on a national unadjusted basis) for that service in the year does not exceed specified percentages. For all services paid under the OPPS in CY 2006, and in calendar years thereafter, the specified percentage is 40 percent of the APC payment rate. Section 1833(t)(3)(B)(ii) of the Act provides that, for a covered OPD service (or group of such services) furnished in a year, the national unadjusted coinsurance amount cannot be less than 20 percent of the OPD fee schedule amount.

    2. Proposed Copayment for CY 2006

    For CY 2006, we are proposing to determine copayment amounts for new and revised APCs using the same methodology that we implemented for CY 2004 (see the November 7, 2003 OPPS final rule with comment period, 68 FR 63458). The proposed unadjusted copayment amounts for services payable under the OPPS that would be effective January 1, 2006, are shown in Addendum A and Addendum B of this proposed rule.Start Printed Page 42703

    3. Calculation of the Proposed Unadjusted Copayment Amount for CY 2006

    To calculate the unadjusted copayment amount for an APC group, take the following steps:

    Step 1. Calculate the beneficiary payment percentage for the APC by dividing the APC's national unadjusted copayment by its payment rate. For example, using APC 0001, $9.95 is 40 percent of $24.89.

    Step 2. Calculate the wage adjusted payment rate for the APC, for the provider in question, as indicated in section II.I. above.

    Step 3. Multiply the percentage calculated in Step 1 by the payment rate calculated in Step 2. The result is the wage adjusted copayment amount for the APC.

    III. Proposed Ambulatory Payment Classification (APC) Group Policies

    A. Background

    Section 1833(t)(2)(A) of the Act requires the Secretary to develop a classification system for covered hospital outpatient services. Section 1833(t)(2)(B) provides that this classification system may be composed of groups of services, so that services within each group are comparable clinically and with respect to the use of resources. In accordance with these provisions, we developed a grouping classification system, referred to as the Ambulatory Payment Classification Groups (or APCs), as set forth in § 419.31 of the regulations. We use Level I and Level II HCPCS codes and descriptors to identify and group the services within each APC. The APCs are organized such that each group is homogeneous both clinically and in terms of resource use. Using this classification system, we have established distinct groups of surgical, diagnostic, and partial hospitalization services, and medical visits. We also have developed separate APC groups for certain medical devices, drugs, biologicals, radiopharmaceuticals, and devices of brachytherapy.

    We have packaged into each procedure or service within an APC group the cost associated with those items or services that are directly related and integral to performing a procedure or furnishing a service. Therefore, we do not make separate payment for packaged items or services. For example, packaged items and services include: use of an operating, treatment, or procedure room; use of a recovery room; use of an observation bed; anesthesia; medical/surgical supplies; pharmaceuticals (other than those for which separate payment may be allowed under the provisions discussed in section V. of this preamble); and incidental services such as venipuncture. Our packaging methodology is discussed in section II.A. of this proposed rule.

    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 0601 (Mid-Level Clinic Visits). The APC weights are scaled to APC 0601 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 than annually and to revise the groups and relative payment weights and make 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, as amended by section 201(h) of the BBRA of 1999, also requires the Secretary, beginning in CY 2001, to consult with an outside panel of experts to review the APC groups and the relative payment weights (the APC Panel recommendations for CY 2006 OPPS and our responses to them are discussed in sections III.B. and III.C.4. of this preamble).

    Finally, as discussed earlier, 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 unusual cases, such as low-volume items and services.

    B. Proposed Changes—Variations Within APCs

    (If you choose to comment on issues in this section, please include the caption “2 Times Rule” at the beginning of your comment.)

    1. Application of the 2 Times Rule

    In accordance with section 1833(t)(2) of the Act and § 419.31 of the regulations, we annually review the items and services within an APC group to determine with respect to comparability of the use of resources if the median of the highest cost item or service within an APC group is more than 2 times greater than the median of the lowest cost item or service within that same group (“2 times rule”). We make exceptions to this limit on the variation of costs within each APC group in unusual cases such as low-volume items and services. The statute provides no exception in the case of a drug or biological that has been designated as an orphan drug under section 526 of the Federal Food, Drug, and Cosmetic Act because these drugs are assigned to individual APC's.

    During the APC Panel's February 2005 meeting, we presented median cost and utilization data for the period of January 1, 2004, through September 30, 2004, concerning a number of APCs that violate the 2 times rule and asked the APC Panel for its recommendation. After carefully considering the information and data we presented, the APC Panel recommended moving a total of 65 HCPCS codes from their currently assigned APC to a different APC to resolve the 2 times rule violations. Of the 65 HCPCS code reassignments recommended by the APC Panel, we concur with 58 of the recommended reassignments. Therefore, we are proposing to reassign these HCPCS codes as shown in Table 7.

    Table 7.—Proposed Movement of HCPCS Codes Among APCs Based on the APC Panel's Recommendations for CY 2006

    HCPCS codeDescriptionCY 2005 APCProposed CY 2006 APC
    45307Proctosigmoidoscopy fb01460428
    45320Proctosigmoidoscopy ablate01470428
    45321Proctosigmoidoscopy volvul01470428
    Start Printed Page 42704
    45335Sigmoidoscopy w/submuc inj01470146
    45337Sigmoidoscopy & decompress01470146
    46606Anoscopy and biopsy01470146
    46610Anoscopy, remove lesion01470428
    46612Anoscopy, remove lesions01470428
    46614Anoscopy, control bleeding01470146
    46615Anoscopy01470428
    56405I & D of vulva/perineum01920189
    57155Insert uteri tandems/ovoids01930192
    65265Remove foreign body from eye02360237
    65285Repair of eye wound02360672
    66220Repair eye lesion02360672
    67025Replace eye fluid02360237
    67027Implant eye drug system02370672
    67036Removal of inner eye fluid02370672
    67038Strip retinal membrane02370672
    67039Laser treatment of retina02370672
    67121Remove eye implant material02360237
    75790Visualize A-V shunt02810279
    75820Vein x-ray, arm/leg02810668
    75822Vein x-ray, arms/legs02810668
    75831Vein x-ray, kidney02870279
    75840Vein x-ray, adrenal gland02870280
    75842Vein x-ray, adrenal glands02870280
    75860Vein x-ray, neck02870668
    75870Vein x-ray, skull02870668
    75872Vein x-ray, skull02870279
    75880Vein x-ray, eye socket02870668
    86077Physician blood bank service03430433
    86079Physician blood bank service03430433
    88104Cytopathology, fluids03430433
    88107Cytopathology, fluids03430433
    88160Cytopath smear, other source03420433
    88161Cytopath smear, other source03430433
    88162Cytopath smear, other source03420433
    88184Flowcytometry/tc, 1 marker03420344
    88185Flowcytometry/tc, add-on03420343
    88187Flowcytometry/read, 2-803420433
    88188Flowcytometry/read, 9-1503420433
    88189Flowcytometry/read, 16 & >03440343
    88312Special stains03420433
    88313Special stains03420433
    88318Chemical histochemistry03420433
    88323Microslide consultation03440343
    88329Path consult introp03420433
    88332Path consult intraop, add'l03420433
    88342Immunohistochemistry03440343
    88346Immunofluorescent study03440343
    88347Immunofluorescent study03440343
    88355Analysis, skeletal muscle03440343
    89230Collect sweat for test03430433
    92004Eye exam, new patient06020601
    92014Eye exam & treatment06020601

    The seven HCPCS code movements that the APC Panel recommended, but upon further review we are proposing not to accept, are discussed below. We include in our discussion our proposal specific to each of them to resolve the 2 times rule violations.

    a. APC 0146: Level I Sigmoidoscopy, APC 0147: Level II Sigmoidoscopy, APC 0428: Level III Sigmoidoscopy.

    APCs 0146 and 0147 were exceptions to the 2 times rule in CY 2005. Our analysis of these two APCs based on the most current CY 2004 data revealed greater violations of the 2 times rule and changing relative frequencies of simple and complex procedures in these two APCs. Thus, for CY 2006, the APC Panel assisted us in reconfiguring these two APCs into three related APCs to resolve the two times violations and improve their clinical and resource homogeneity based on the most current hospital claims data and to remove these APCs from the list of exceptions. The APC Panel recommended moving CPT codes 45303 (Proctosigmoidoscopy dilate) and 45305 (Proctosigmoidoscopy w/bx) from APC 0147 to APC 0146 because the median cost for these codes appeared too high, and was likely based primarily on aberrant CY 2004 claims. In addition, the APC Panel recommended that CMS move CPT code 45309 (Proctosigmoidoscopy removal) from APC 0147 to a new proposed APC 0428. Start Printed Page 42705Based on the results of our review of several years of claims data and our study of hospital resource homogeneity, we disagree that these claims data are aberrant. We are proposing to move CPT codes 45303 and 45305 to APC 0147 and to keep CPT 45309 in APC 0147, to resolve the 2 times rule violation.

    b. APC 0342: Level I Pathology, APC 0433: Level II Pathology, APC 0343: Level III Pathology.

    To resolve a 2 times rule violation, the APC Panel recommended moving CPT codes 88108 (Cytopath, concentrate tech) and 88112 (Cytopath, cell enhance tech) from APC 0343 to a proposed new APC 0433. The APC Panel also recommended moving CPT codes 88319 (Enzyme histochemistry) and 88321 (Microslide consultation) from APC 0342 to a proposed new APC 0433. Based on the results of our review of several years of claims data and the study of hospital resource homogeneity, we are proposing a different way to resolve the 2 times rule violation: We are proposing to place CPT codes 88319 and 88112 in APC 0343 and to place CPT codes 88108 and 88321 in APC 0433.

    2. Proposed Exceptions to the 2 Times Rule

    As discussed earlier, we may make exceptions to the 2 times limit on the variation of costs within each APC group in unusual cases such as low-volume items and services. Taking into account the APC changes that we are proposing for CY 2006 based on the APC Panel recommendations discussed in section III.B.1. of this preamble and the use of CY 2004 claims data to calculate the median cost of procedures classified in the APCs, we reviewed all the APCs to determine which APCs would not meet the 2 times limit. We used the following criteria to decide whether to propose exceptions to the 2 times rule for affected APCs:

    • Resource homogeneity
    • Clinical homogeneity
    • Hospital concentration
    • Frequency of service (volume)
    • Opportunity for upcoding and code fragments.

    For a detailed discussion of these criteria, refer to the April 7, 2000 OPPS final rule with comment period (65 FR 18457).

    Table 8 below contains the APCs that we are proposing 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 APC Panel's recommendation because these recommendations were based on explicit consideration of resource use, clinical homogeneity, hospital specialization, and the quality of the data used to determine the APC payment rates that we are proposing for CY 2006. The median cost for hospital outpatient services for these and all other APCs can be found on the CMS Web site: http//www.cms.hhs.gov.

    Table 8.—Proposed APC Exceptions to the 2 Times Rule For CY 2006

    APCAPC description
    0004Level I Needle Biopsy/ Aspiration Except Bone Marrow
    0005Level II Needle Biopsy/Aspiration Except Bone Marrow
    0019Level I Excision/ Biopsy
    0024Level I Skin Repair
    0040Level I Implantation of Neurostimulator Electrodes
    0043Closed Treatment Fracture Finger/Toe/Trunk
    0046Open/Percutaneous Treatment Fracture or Dislocation
    0060Manipulation Therapy
    0080Diagnostic Cardiac Catheterization
    0081Non-Coronary Angioplasty or Atherectomy
    0093Vascular Reconstruction/Fistula Repair without Device
    0099Electrocardiograms
    0105Revision/Removal of Pacemakers, AICD, or Vascular
    0120Infusion Therapy Except Chemotherapy
    0140Esophageal Dilation without Endoscopy
    0141Level I Upper GI Procedures
    0148Level I Anal/Rectal Procedures
    0164Level I Urinary and Anal Procedures
    0191Level I Female Reproductive Proc
    0204Level I Nerve Injections
    0209Extended EEG Studies and Sleep Studies, Level II
    0235Level I Posterior Segment Eye Procedures
    0251Level I ENT Procedures
    0252Level II ENT Procedures
    0262Plain Film of Teeth
    0274Myelography
    0297Level II Therapeutic Radiologic Procedures
    0303Treatment Device Construction
    0312Radioelement Applications
    0325Group Psychotherapy
    0330Dental Procedures
    0341Skin Tests
    0353Level II Injections
    0373Neuropsychological Testing
    0397Vascular Imaging
    0409Red Blood Cell Tests
    0432Health and Behavior Services
    0600Low Level Clinic Visits
    0688Revision/Removal of Neurostimulator Pulse Generator Receiver
    0004Level I Needle Biopsy/ Aspiration Except Bone Marrow
    0005Level II Needle Biopsy/Aspiration Except Bone Marrow
    Start Printed Page 42706
    0019Level I Excision/ Biopsy

    C. New Technology APCs

    (If you choose to comment on issues in this section, please include the caption “New Technology APCs” at the beginning of your comment.)

    1. Background

    In the November 30, 2001 final rule (66 FR 59903), we finalized changes to the time period a service was eligible for payment under a New Technology APC. Beginning in CY 2002, we retain services within New Technology APC groups until we gather sufficient claims data to enable 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. 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.

    2. Proposed Refinement of New Technology Cost Bands

    In the November 7, 2003 final rule with comment period, we last restructured the New Technology APC groups to make the cost intervals more consistent across payment levels (68 FR 63416). We established payment levels in $50, $100, and $500 intervals and expanded the number of New Technology APCs. We also retained two parallel sets of New Technology APCs, one set with a status indicator of “S” (Significant Procedure, Not Discounted When Multiple) and the other set with a status indicator of “T” (Significant Procedures, Multiple Reduction Applies). We did this restructuring because the number of procedures assigned to New Technology APCs had increased, and narrower cost bands were necessary to avoid significant payment inaccuracies for New Technology services. Therefore, we dedicated two new series of APCs to the restructured New Technology APCs, which allowed us to narrow the cost bands and afforded us the flexibility to create additional bands as future needs dictated.

    As the number of procedures that qualify for placement in the New Technology APCs has continued to increase over the past 2 years, the $0 to $50 cost band represented by “S” status APC 1501 (New Technology, Level I, $0-$50) and “T” status APC 1538 (New Technology, Level I, $0-$50) spans too broad of a cost interval to accurately represent the lower costs of an ever-increasing number of procedures that qualify for New Technology payment. Therefore, we are proposing to refine this cost band to five $10 increments, resulting in the creation of an additional 10 New Technology APCs to accommodate the two parallel sets of New Technology APCs, one set with a status indicator of “S” and the other set with a status indicator of “T.” We are also proposing to eliminate the two $0 to $50 cost band New Technology APCs 1501 and 1538, so that the cost bands of all New Technology APCs would continue to be mutually exclusive. Table 9 contains a listing of the 10 additional New Technology APCs that we are proposing for CY 2006.

    Table 9.—Proposed New Technology APCs for CY 2006

    APCDescriptorStatus indicatorProposed CY 2006 payment rate
    1491New Technology—Level IA ($0-$10)S$5
    1492New Technology—Level IB ($10-$20)S15
    1493New Technology—Level IC ($20-$30)S25
    1494New Technology—Level ID ($30-$40)S35
    1495New Technology—Level IE ($40-$50)S45
    1496New Technology—Level IA ($0-$10)T5
    1497New Technology—Level B ($10-$20)T15
    1498New Technology—Level IC ($20-$30)T25
    1499New Technology—Level D ($30-$40)T35
    1500New Technology—Level E ($40-$50)T45

    As we explained in the November 30, 2001 final rule (66 FR 59897), 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, or where the New Technology APCs are restructured, we may, based on more recent resource utilization information (including claims data) or the availability of refined New Technology APC bands, reassign the procedure or service to a different New Technology APC that most appropriately reflects its cost. Therefore, we are proposing to discontinue New Technology APCs 1501 and 1538, and reassign the procedures currently assigned to them to proposed New Technology APCs 1491 through 1500. Table 10 summarizes these proposed New Technology APC reassignments. Start Printed Page 42707

    Table 10.—Proposed Movement of HCPCS Codes From New Technology APCS 1501 and 1538 to New Technology APCs 1491 Through 1500 for CY 2006

    HCPCS/CPT codeDescriptorCY 2005 new technology APC assignmentCY 2006 proposed new technology APC reassignment
    0003TCervicography15011492
    90473Immunization Admin, one vaccine by intranasal or oralN/A1491
    90474Immunization Admin, each additional vaccine by intranasal or oralN/A1491
    G0375Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes15011491
    G0376Smoking and tobacco-use cessation counseling visit; intensive, greater than 10 minutes15011492

    3. Proposed Requirements for Assigning Services to New Technology APCs

    In the April 7, 2000 final rule (65 FR 18477), we created a set of New Technology APCs to pay for certain new technology services under the OPPS. We described a group of criteria for use in determining whether a service is eligible for assignment to a New Technology APC. We subsequently modified this set of criteria in our November 30, 2001 final rule (66 FR 59897 to 59901), effective January 1, 2002. These modifications were based on changes in the data (we were no longer required to use 1996 data to set payment rates) and on our continuing experience with the assignment of services to New Technology APCs.

    Based on our history of reviewing applications for New Technology APC assignments under the OPPS, we have encountered situations where there is extremely limited clinical experience with new technology services regarding their use and efficacy in the typical Medicare population. In some cases, there may be ambiguity regarding how the new technology services fit within the standard coding framework for established procedures, and there may be no specific coding available for the new technology services in other settings or for use by other payers. Nevertheless, applicants requesting assignment of services to New Technology APCs request that we provide billing and payment mechanisms under the OPPS for the new technology services through the establishment of codes, descriptors, and payment rates. As stated in section I.F. of this preamble, we remain committed to the overarching goal of ensuring that Medicare beneficiaries have timely access to the most effective new medical treatments and technologies in clinically appropriate settings. We believe that our current New Technology APC assignment process helps to assure such access, and that an enhancement to the New Technology service application process may further encourage appropriate dissemination of and Medicare beneficiary access to new technology services.

    We are interested in promoting review of the coding, clinical use, and efficacy of new technology services by the greater medical community through our New Technology service application and review process for the OPPS. Therefore, in addition to our current information requirements at the time of application, we are proposing to require that an application for a code for a new technology service be submitted to the American Medical Association's (AMA's) CPT Editorial Panel before we accept a New Technology APC application for review. This will not change our current criteria for assignment of a service to a New Technology APC. This requirement will encourage timely review by the wider medical community as CMS is reviewing the service for possible new coding and assignment to a New Technology APC under the OPPS. There is only one CPT code application that is used by applicants requesting consideration for either Category I or III codes. We would accept either a Category I or Category III code application to the CPT Editorial Panel. The application requests relevant clinical information regarding new services, including their appropriate use and the patient populations expected to benefit from the services which will provide us with useful additional information. CPT code applications are reviewed by the CPT Editorial Panel, whose members bring diverse clinical expertise to that review. We believe that consideration by the CPT Editorial Panel may facilitate appropriate dissemination of the new technology services across delivery settings and may bring to light other needed coding changes or clarifications. We are further proposing that a copy of the submitted CPT application be filed with us as part of the application for a New Technology APC assignment under the OPPS, along with CPT's letter acknowledging or accepting the coding application. We remind the public that we do not consider an application complete until all informational requirements are provided. In addition, we remind the public that when we assign a new service a HCPCS code and provide for payment under the OPPS, these actions do not imply coverage by the Medicare program, but indicate only how the procedure or service may be paid if covered by the program. Fiscal intermediaries must determine whether a service meets all program requirements for coverage, for example, that it is reasonable and necessary to treat the beneficiary's condition and whether it is excluded from payment. CMS may also make National Coverage Determinations (NCDs) on new technology procedures.

    4. Proposed Movement of Procedures From New Technology APCs to Clinical APCs

    The procedures discussed below represent New Technology services for which we believe we have sufficient data to reassign to a clinically appropriate APC.

    a. Proton Beam Therapy

    (If you choose to comment on issues in this section, please include the caption “Proton Beam Therapy” at the beginning of your comment.)

    In the August 16, 2004 proposed rule (69 FR 50467), we proposed to reassign CPT codes 77523 (Proton treatment delivery, intermediate) and 77525 (Proton treatment delivery, complex) from New Technology APC 1511 (New Technology, Level XI, $900-$1,000) to clinical APC 0419 (Proton Beam Therapy, Level II). In response to this proposal, we received numerous comments urging that we maintain CPT codes 77523 and 77525 in New Technology APC 1511 at a payment rate of $950 for CY 2005, arguing that the proposed payment rate of $678.31 for Start Printed Page 42708CY 2005 would halt diffusion of this technology and negatively impact patient access to this cancer treatment. Commenters explained that the low volume of claims submitted by only two facilities provided volatile and insufficient data for movement into the proposed clinical APC 0419. They further explained that the extraordinary capital expense of between $70 and $125 million and high operating costs of a proton beam facility necessitate adequate payment for this service to protect the financial viability of this emerging technology.

    In the November 15, 2004 final rule with comment period (69 FR 65719 through 65720), we considered the concerns expressed by numerous commenters that patient access to proton beam therapy might be impeded by a significant reduction in OPPS payment. Therefore, we set the CY 2005 payment rate for CPT codes 77523 and 77525 by calculating a 50/50 blend of the median cost for intermediate and complex proton beam therapies of $690.45 derived from CY 2003 claims and the CY 2004 New Technology payment rate of $950. We used the result of this calculation ($820) to assign intermediate and complex proton beam therapies (CPT codes 77523 and 77525) to New Technology APC 1510 (New Technology—Level X ($800-$900) for a blended payment rate of $850 for CY 2005.

    Our examination of the CY 2004 claims data has revealed a second year of a stable, albeit modest, number of claims on which to set the CY 2006 payment rates for CPT codes 77523 and 77525. However, unlike the median of $690.45 for the CY 2005 Level II proton beam radiation therapy clinical APC containing CPT codes 77523 and 77525 derived from the CY 2003 claims data, the median for a comparable Level II proton beam radiation therapy clinical APC is $934.46 derived from CY 2004 claims data. This more recent median appears to more accurately reflect the significant capital expense and high operating costs of a proton beam therapy facility, and supports patient access to proton beam therapy. Therefore, we are proposing to move CPT codes 77523 and 77525 from New Technology APC 1510 to clinical APC 0667 (Level II Proton Beam Radiation Therapy) based on a median cost of $934.46 for CY 2006.

    b. Stereotactic Radiosurgery

    (If you choose to comment on issues in this section, please include the caption “Stereotactic Radiosurgery” at the beginning of your comment.)

    In a correction to the November 7, 2003 final rule with comment period, issued on December 31, 2003 (68 FR 75442), we considered a commenter's request to combine HCPCS codes G0242 (Cobalt 60-based stereotactic radiosurgery planning) and G0243 (Cobalt 60-based stereotactic radiosurgery delivery) into a single procedure code in order to capture the costs of this treatment in single procedure claims because the majority of patients receive the planning and delivery of this treatment on the same day. We responded to the commenter's request by explaining that several other commenters stated that HCPCS code G0242 was being misused to code for the planning phase of linear accelerator-based stereotactic radiosurgery planning. Because the claims data for HCPCS code G0242 represented costs for linear accelerator-based stereotactic radiosurgery planning (due to misuse of the code), in addition to Cobalt 60-based stereotactic radiosurgery planning, we were uncertain of how to combine these data with HCPCS code G0243 to determine an accurate payment rate for a combined code for planning and delivery of Cobalt 60-based stereotactic radiosurgery.

    In consideration of the misuse of HCPCS code G0242 and the potential for causing greater confusion by combining HCPCS codes G0242 and G0243 into a single procedure code, for CY 2004 we created a planning code for linear accelerator-based stereotactic radiosurgery (HCPCS code G0338) to distinguish this service from Cobalt 60-based stereotactic radiosurgery planning. We maintained both HCPCS codes G0242 and G0243 for the planning and delivery of Cobalt 60-based stereotactic radiosurgery, consistent with the use of the two G-codes for planning (HCPCS code G0338) and delivery (HCPCS codes G0173, G0251, G0339, G0340, as applicable) of each type of linear accelerator-based stereotactic radiosurgery (SRS). We indicated that we intended to maintain these new codes in their current New Technology APCs until we had sufficient hospital claims data reflecting the costs of the services to consider moving them to clinical APCs.

    During the February 2005 APC Panel meeting, the APC Panel discussed the clinical and resource cost similarities between planning for Cobalt 60-based and linear accelerator-based SRS. The APC Panel also discussed the use of CPT codes instead of specific G-codes to describe the services involved in SRS planning, noting the clinical similarities in radiation treatment planning regardless of the mode of treatment delivery. Acknowledging the possible need for CMS to separately track planning for SRS, the APC Panel eventually recommended that we create a single HCPCS code to encompass both Cobalt 60-based and linear accelerator-based SRS planning. However, a hospital association and other presenters at the APC Panel meeting urged that we discontinue the use of G-codes for SRS planning, and instead, recognize the current CPT codes that describe the specific component services involved in SRS planning to reduce the burden on hospitals of maintaining duplicative codes for the same services to accommodate different payers. Lastly, one presenter urged that we combine HCPCS codes G0242 (Cobalt 60-based stereotactic radiosurgery planning) and G0243 (Cobalt 60-based stereotactic radiosurgery delivery) into a single procedure code to reflect that the majority of patients receive the planning and delivery of this treatment on the same day as a single fully integrated service.

    The APC Panel recommended that we make no changes to the coding or APC placement of SRS delivery codes G0173, G0243, G0251, G0339, and G0340 for CY 2006. We first established the above full group of delivery codes in 2004, so we have only one year of hospital claims data reflecting costs of the services. In addition, presenters to the APC Panel described current ongoing deliberations amongst interested professional societies around the descriptions and coding for SRS. The APC Panel and presenters suggested that we wait for the outcome of these deliberations prior to making any significant changes to SRS delivery coding or payment rates.

    In an effort to balance the recommendations of the APC Panel with the recommendations of presenters at the APC Panel meeting, in accordance with the APC Panel recommendations, we are proposing to make no changes to the APC placement of the following SRS treatment delivery codes for CY 2006: HCPCS codes G0173, G0243, G0251, G0339, and G0340.

    We recognize concerns expressed by some presenters urging that we discontinue the use of the G-codes for SRS planning, and instead, recognize the current CPT codes that describe the specific component services involved in SRS planning to reduce the burden on hospitals of maintaining duplicative codes for the same services to accommodate different payers. In addition, we have no need to separately track SRS planning services, which share clinical and resource homogeneity with other radiation treatment planning Start Printed Page 42709services described by current CPT codes.

    When HCPCS code G0242 was established for SRS planning, several radiology planning services were considered in determining its APC placement. In the November 30, 2001 final rule, in which we described our determination of the total cost for SRS planning based on our claims experience, we added the median costs of the following CPT codes that we found to be regularly billed with SRS delivery (CPT code 61793 in the available hospital data): 77295, 77300, 77370, and 77315. Our examination of the costs from the CY 2004 claims data for the above-mentioned CPT codes closely approximates the CY 2004 median costs reported for HCPCS codes G0242 and G0338. The APC median costs for the above-mentioned CPT codes based on the CY 2004 claims data total $1,297, while the median cost for HCPCS code G0242 is $1,366 and the median cost for HCPCS code G0338 is $1,100 based on the CY 2004 claims data. In addition, three of the above-mentioned CPT codes are included on the proposed bypass list for CY 2006, so we would not anticipate that the billing of these codes on the same day as an SRS treatment service would cause significant problems with multiple bills for SRS services. Therefore, we are proposing to discontinue HCPCS codes G0242 and G0338 for the reporting of charges for SRS planning under the OPPS, and to instruct hospitals to bill charges for SRS planning using all of the available CPT codes that most accurately reflect the services provided.

    We acknowledge one APC Panel presenter's concern that the coding structure of Cobalt 60-based SRS, using either the current SRS planning G code or the appropriate CPT codes for planning services as we are proposing for CY 2006, may not necessarily reflect the same day, integrated Cobalt 60-based SRS service furnished to the majority of patients receiving Cobalt 60-based SRS. Thus, we are seeking public comment on the clinical, administrative, or other concerns that could arise if we were to bundle Cobalt 60-based SRS planning services, currently reported using HCPCS code G0242 and proposed for CY 2006 to be billed using the appropriate CPT codes for planning services, into the Cobalt 60-based SRS treatment service, currently reported under the OPPS using HCPCS code G0243. Under such a scenario, the SRS treatment service described by HCPCS code G0243 would be placed in a higher paying New Technology APC to reflect payment for the costs of the SRS planning and delivery as an integrated service. Hospitals would be prohibited from billing other radiation planning services along with the Cobalt 60-based SRS treatment delivery code. In contrast to Cobalt 60-based SRS coding, we would not consider bundling the planning for linear accelerator-based SRS with the treatment delivery services, given the various timeframes for planning that may occur with linear accelerator-based SRS.

    c. Other Services in New Technology APCs

    (If you choose to comment on issues in this section, please include the caption “Other New Technology Services” at the beginning of your comment.)

    Other than proton beam and stereotactic radiosurgery services, there are 10 procedures currently assigned to New Technology APCs for which we have data adequate to support their assignment to clinical APCs. We are proposing to reassign these procedures to clinically appropriate APCs, using CY 2004 claims data to establish median costs on which payments would be based. These procedures and their proposed APC assignments are displayed below in Table 11.

    Table 11.—Proposed APC Reassignment of New Technology Procedures Into Clinical APCs for CY 2006

    HCPCSDescriptorCY 2005 APCCY 2005 status indicatorProposed CY 2006 APCProposed CY 2006 status indicatorCY 2005 payment amountProposed CY 2006 payment amount
    0027TEndoscopic epidural lysis1547T0220T$850$1,025.57
    33225L ventric pacing lead add-on1525S0418T3,7506,457.83
    61623Endovasc tempory vessel occl1555T0081T1,6502,035.19
    92974Cath place, cardio brachytx1559T0103T2,250869.34
    93580Transcath closure of asd1559T0434T2,2505,363.85
    93581Transcath closure of vsd1559T0434T2,2505,363.85
    95965Meg, spontaneous1528S0430T5,250673.76
    95966Meg, evoked, single1516S0430T1,450673.76
    95967Meg, evoked, each add'l1511S0430T950673.76
    C9713Non-contact laser vap prosta1525S0429T3,7502,500.01

    We are proposing to move these 10 procedures to new or established clinical APCs that contain services that exhibit clinical and resource homogeneity. HCPCS code C9713 (Noncontact laser vaporization of prostate, including coagulation control of intraoperative and post-operative bleeding) is similar to CPT code 52647 (Noncontact laser coagulation of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included)) and CPT code 52648 (Contact laser vaporization with or without transurethral resection of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included)) with respect to their clinical characteristics and hospital resource utilization. However, instead of mapping HCPCS code C9713 to APC 163 (Level IV Cystourethroscopy and other Genitourinary Procedures), where CPT codes 52647 and 52648 are currently mapped for CY 2005, we are proposing to create a Level V APC for Cystourethroscopy and Other Genitourinary Procedures. These codes are more clinically sound in this new Level V APC. We are also proposing to map CPT codes 52647 and 52648 to this new Level V APC. In addition, we are proposing to move CPT codes 50080 and 50081 from APC 0163 to this new Level V APC, since they are similar clinically and use similar hospital resources. We believe that this configuration would improve homogeneity as well as result in a Start Printed Page 42710clinically coherent Level V APC, where the procedures utilize similar hospital resources.

    D. Proposed APC-Specific Policies

    1. Hyperbaric Oxygen Therapy (APC 0659)

    (If you choose to comment on issues in this section, please include the caption “Hyperbaric Oxygen” at the beginning of your comment.)

    When hyperbaric oxygen therapy (HBOT) is prescribed for promoting the healing of chronic wounds, it typically is prescribed on average for 90 minutes, which would be billed using multiple units of HBOT to achieve full body hyperbaric oxygen therapy. In addition to the therapeutic time spent at full hyperbaric oxygen pressure, treatment involves additional time for achieving full pressure (descent), providing air breaks to prevent neurological and other complications from occurring during the course of treatment, and returning the patient to atmospheric pressure (ascent). The OPPS recognizes HCPCS code C1300 (Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval) for HBOT provided in the hospital outpatient setting.

    We explained in the August 16, 2004 proposed rule (69 FR 50495) that our CY 2003 claims data revealed that many providers were improperly reporting charges for 90 to 120 minutes under only one unit rather than three or four units of HBOT. This inaccurate coding resulted in an inflated median cost of $177.96 for HBOT, derived using single service claims and “pseudo” single service claims. Because of these single claims coding anomalies, we proposed to calculate a “per unit” median cost for APC 0659, using only multiple units or multiple occurrences of HBOT, excluding claims with only one unit of HBOT and excluding packaged costs. To convert HBOT charges to costs, we used the CCR from the respiratory therapy cost center when available; otherwise, we used the hospital's overall CCR. Using this “per unit” methodology, we proposed a median cost for APC 0659 of $82.91 for CY 2005.

    In the November 15, 2004 final rule with comment period (69 FR 65758), we agreed with commenters that there was sufficient evidence that the CCR for HBOT was not reflected solely in the respiratory therapy cost center; rather, the CCR for HBOT was reflected in a variety of cost centers. Therefore, we calculated a “per unit” median of $93.26 for HBOT, using only multiple units or multiple occurrences of HBOT and each hospital's overall CCR.

    Our examination of the CY 2004 single procedure claims filed for HCPCS code C1300 revealed similar coding anomalies to those encountered in the CY 2003 single procedure claims data. Therefore, for CY 2006 ratesetting, we recalculated a “per unit” median cost for HCPCS code C1300 using only multiple units or multiple occurrences of HBOT and each hospital's overall CCR, which is the same methodology we used for setting the CY 2005 payment rate for HBOT. Excluding claims with only one unit of HBOT, we used a total of 26,556 claims to calculate the median for APC 0659 for CY 2006. Applying the methodology described above, we are proposing a median cost for APC 0659 of $93.71 for CY 2006.

    2. Allergy Testing (APC 0370)

    (If you choose to comment on issues in this section, please include the caption “Allergy Testing” at the beginning of your comment.)

    A number of providers have expressed confusion related to the reporting of units for allergy testing described by CPT codes 95004 through 95078. Most of the CPT codes in the code range are assigned to APC 0370 (Allergy Tests) for the CY 2005 OPPS. Nine of these CPT codes assigned to APC 0370 instruct providers to specify the number of tests or use the singular word “test” in their descriptors, while five of these CPT codes assigned to APC 0370 do not contain such an instruction or do not contain “tests” or “testing” in their descriptors. Some providers have stated that the lack of clarity related to the reporting of units has resulted in erroneous reporting of charges for multiple allergy tests under one unit (that is, “per visit”) for the CPT codes that instruct providers to specify the number of tests.

    In light of the variable hospital billing that may be inconsistent with the CPT code descriptors, we have examined carefully the CY 2004 single and multiple procedure claims data for the allergy test codes that reside in APC 0370 to set the CY 2006 payment rates. Our examination of the CY 2004 claims data revealed that many of the services for which providers billed multiple units of an allergy test reported a consistent charge for each unit. Conversely, some providers that billed only a single unit of an allergy test reported a charge many times greater than the “per test” charge reported by providers billing multiple units of an allergy test.

    Our analysis of the claims data appears to validate reports made by a number of providers that the charges reported on many of the single procedure claims represent a “per visit” charge, rather than a “per test” charge, including claims for the allergy test codes that instruct providers to specify the number of tests. Because the OPPS relies only on these single procedure claims in establishing payment rates, we believe this inaccurate coding would have resulted in an inflated CY 2006 median cost of $66.44 for services that are in the CY 2005 configuration of APC 0370.

    Therefore, we are proposing to move the allergy test CPT codes that instruct providers to specify the number of tests or use the singular word “test” in their descriptors from APC 0370 (Allergy Tests) to proposed APC 0381 (Single Allergy Tests) for CY 2006. We are proposing to calculate a “per unit” median cost for proposed APC 0381 using a total of 306 claims containing multiple units or multiple occurrences of a single CPT code. Packaging on the claims was allocated equally to each unit of the CPT code. Using this “per unit” methodology, we are proposing a median cost for APC 0381 of $11.37 for CY 2006. Because we believe the single procedure claims for the codes remaining in APC 0370 reflect accurate coding of these services, we are proposing to use the standard OPPS methodology to calculate the median for APC 0370. Table 12 below lists the proposed assignment of CPT codes to APC 0370 and proposed APC 0381 for CY 2006.

    Table 12.—Proposed Assignment of CPT Codes to APC 0370 and Proposed APC 0381 for CY 2006

    APC 0370Proposed APC 0381
    95056, Photosensitivity tests95004, Percut allergy skin tests.
    95060, Eye allergy tests95010, Percut allergy titrate test.
    95078, Provoactive testing95015, ld allergy titrate-drug/bug.
    95180, Rapid desensitization95024, ld allergy test, drug/bug.
    95199U, Unlisted allergy/clinical immunologic service or procedure95027, ld allergy titrate-airborne.
    95028, ld allergy test-delayed type.
    Start Printed Page 42711
    95044, Allergy patch tests.
    95052, Photo patch test.
    95065, Nose allergy test.

    3. Stretta Procedure (APC 0322)

    (If you choose to comment on issues in this section, please include the caption “Stretta” at the beginning of your comment.)

    CPT code 43257, effective January 1, 2005, is used for esophagoscopy with delivery of thermal energy to the muscle of the lower esophageal sphincter and/or gastric cardia for the treatment of gastresophageal reflux disease. This code describes the Stretta procedure, including use of the Stretta System and all endoscopies associated with the Stretta procedure. Prior to CY 2005, the Stretta procedure was recognized under HCPCS code C9701 in the OPPS. For the CY 2005 OPPS, C9701 was deleted and CPT code 43257 was utilized for the Stretta procedure. In CY 2005, the Stretta procedure was transitioned from a New Technology APC to clinical APC 0422 (Level II Upper GI Procedures) based on several years of hospital cost data. Procedures within APC 0422 were similar to the Stretta procedure in terms of clinical characteristics and resource use.

    For CY 2006, we are proposing to use both CY 2004 single claims for C9701 and multiple procedure claims containing one unit of HCPCS code C9701 and one unit of either CPT code 43234 or CPT code 43235 to calculate the Stretta procedure's contribution to the median for APC 0422. Claims reporting one endoscopy code (43234 or 43235) along with HCPCS code C9701 are included in the proposed median calculation because, in CY 2002, CMS authorized the separate and additional billing of a single endoscopy code with HCPCS code C9701, while CPT code 43257 now includes all endoscopies performed during the procedure.

    Using this proposed methodology, we calculated a median for CPT code 43257 (HCPCS code C9701 in the CY 2004 claims data) of $1669.43. Using these claims in the calculation of the median cost for APC 0422, we calculated a median cost of $1385.77. We are proposing to use this methodology, applied to the more complete final rule claims set, to calculate the final CY 2006 OPPS median cost for APC 0422.

    4. Vascular Access Procedures (APCs 0032, 0109, 0115, 0119, 0124, and 0187)

    (If you choose to comment on issues in this section, please include the caption “Vascular Access Procedures” at the beginning of your comment.)

    Many of the codes that currently describe vascular access procedures were new in the 2004 version of CPT and were assigned into APC groups by crosswalking the newly created CPT codes to the deleted codes' APC assignments. Although the new codes were implemented in January 2004, because of the delay between a bill being submitted to Medicare and when the bill data are viable for analysis, we did not have cost and utilization data for the new codes available for analysis until this year in preparation for the CY 2006 OPPS.

    Since those original APC assignments were made, we have received requests from the public for specific APC assignment changes. We were reluctant to make changes without data to support reassignments and, therefore, made few changes to those original APC assignments.

    As an outcome of an analysis of procedure-specific median costs and 2 times rule violations in preparation for the CY 2006 update of the OPPS, we developed a new APC configuration for vascular access procedure codes and several other related codes. The proposed new assignments are supported by CY 2004 hospital claims data and are based on median cost and clinical considerations.

    Thus, for CY 2006, we are proposing to reassign many of the CPT codes that are currently in the following APCs:

    • APC 0032 (Insertion of Central Venous/Arterial Catheter).
    • APC 0109 (Removal of Implanted Devices).
    • APC 0115 (Cannula/Access Device Procedures).
    • APC 0119 (Implantation of Infusion Pump).
    • APC 0124 (Revision of Implanted Infusion Pump).
    • APC 0187 (Miscellaneous Placement/Repositioning).

    The configuration that we are proposing places all of the procedures currently assigned to APC 0187 into more clinically appropriate APCs. We are also proposing to reassign all of the vascular access procedure codes currently assigned to any of the identified APCs to existing or newly reconfigured clinical APCs to create more clinical and median cost homogeneity. As a result of the proposed reassignments, those APCs are comprised of a different mix of codes than is currently the case for the CY 2005 OPPS. There are no codes assigned to APC 0187 because the only procedures that remained in APC 0187 after reassigning the vascular access procedures as we are proposing were CPT code 75940 (X-ray placement of vein filter) and CPT code 76095 (Stereotactic breast biopsy), which we reassigned to more clinically appropriate APCs. We are proposing to reassign CPT code 75940 to APC 0297 (Level II Therapeutic Radiologic Procedures) and CPT code 76095 to APC 0264 (Level II Miscellaneous Radiology Procedures).

    We are proposing to create three new APCs, APC 0621 (Level I Vascular Access Codes), APC 0622 (Level II Vascular Access Codes), and APC 0623 (Level III Vascular Access Codes) and assign procedures to each of these based on median cost and clinical homogeneity. We are also proposing to rename APCs 0109 and 0115 as follows: APC 0109 (Removal of Implanted Devices); and APC 0115 (Cannula/Access Device Procedures). Table 13 displays the procedures and their current and the CY 2006 proposed APC assignments. Start Printed Page 42712

    Table 13.—Current and Proposed APC Assignments for Vascular Access Procedures and Related Procedures for CY 2006

    CPT codeDescriptorCY 2005 APCProposed CY 2006 APC
    APC 0621—Level I Vascular Access Procedure
    36555Insertion non-tunneled cv cath01870621
    36556Insertion non-tunneled cv cath01870621
    36568Insert tunneled cv cath01870621
    36569Insert tunneled cv cath01870621
    36575Repair tunneled cv cath01870621
    36576Repair tunneled cv cath01870621
    36580Replace tunneled cv cath01870621
    36584Replace tunneled cv cath01870621
    36589Remove tunneled cv cath01090621
    36590Remove tunneled cv cath01870621
    36596Mech removal tunneled cv cath01870621
    36597Reposition venous catheter01870621
    APC 0622—Level II Vascular Access Procedures
    36557Insert tunneled cv cath00320622
    36558Insert tunneled cv cath00320622
    36578Replace tunneled cv cath01870622
    36581Replace tunneled cv cath00320622
    36585Replace tunneled cv cath00320622
    36570Insert tunneled cv cath00320622
    36571Insert tunneled cv cath00320622
    36595Mech removal tunneled cv cath01870622
    36262Removal intra-arterial inf. Pump01240622
    APC 0623—Level III Vascular Access Procedures
    36560Insert tunneled cv cath01150623
    36561Insert tunneled cv cath01150623
    36563Insert tunneled cv cath01190623
    36565Insert tunneled cv cath01150623
    36582Replace tunneled cv cath01150623
    36583Insertion of access device01190623
    36640Insertion catheter, artery00320623
    36260Insertion of infusion pump01190623
    36261Revision of infusion pump01240623
    APC 0115—Cannula/Access Device Procedures
    36835Artery to vein shunt01150115
    35903Excision, graft, extremity01150115
    36815Insertion of cannula01150115
    36861Cannula declotting01150115
    35761Exploration of artery/vein01150115
    49419Insert abdominal cath for chemo01150115
    36800Insertion of cannula01150115
    37204Transcatheter occlusion01150115
    36810Insertion of cannula01150115
    APC 0109—Removal of Implanted Devices
    33284Remove pt-activated heart recorder01090109
    63746Removal of spinal shunt01090109

    We presented this proposal to the APC Panel at its February, 2005 meeting. The APC Panel was supportive of the proposed reassignments and recommended that we make these changes. Therefore, for the stated reasons, we are proposing the APC modifications for CY 2006 OPPS as summarized in Table 13 above.

    E. Proposed Addition of New Procedure Codes

    (If you choose to comment on issues in this section, please include the caption “New Procedure Codes” at the beginning of your comment.)

    During the second quarter of CY 2005, we created 11 HCPCS codes that were not addressed in the November 15, 2004 final rule with comment period that updated the CY 2005 OPPS. We have designated the payment status of those codes and added them to the April update of the CY 2005 OPPS (Transmittal 514). The codes are shown in Table 14 below. In this proposed rule, we are soliciting comment on the APC assignment of these services.

    Further, consistent with our annual APC updating policy, we are proposing to assign the new HCPCS codes for CY 2006 to the appropriate APC's and Start Printed Page 42713would incorporate them into our final rule for CY 2006.

    Table 14.—New HCPCS Codes Implemented in April 2005

    HCPCS codeDescription
    C9127Injection, paclitaxel protein-bound particles, per 1 mg.
    C9128Injection, pegaptamib sodium, per 0.3 mg.
    C9223Injection, adenosine for therapeutic or diagnostic use, 6 mg (not to be used to report any adenosine phosphate compounds, instead use A9270).
    C9440Vinorelbine tartrate, brand name, per 10 mg.
    C9723Dynamic infrared blood perfusion imaging (DIRI).
    C9724Endoscopic full-thickness plication in the gastric cardia using endoscopic plication system (EPS); includes endoscopy.
    Q4079Injection, natalizumab, 1 mg.
    Q9941Injection, Immune Globulin, Intravenous, Lyophilized, 1g.
    Q9942Injection, Immune Globulin, Intravenous, Lyophilized, 10 mg.
    Q9943Injection, Immune Globulin, Intravenous, Non-Lyophilized, 1g.
    Q9944Injection, Immune Globulin, Intravenous, Non-Lyophilized, 10 mg.

    IV. Proposed Payment Changes for Devices

    A. Device-Dependent APCs

    (If you choose to comment on issues in this section, please include the caption “Device-Dependent APCs” at the beginning of your comment.)

    Device-dependent APCs are populated by HCPCS codes that usually, but not always, require that a device be implanted or used to perform the procedure. For the CY 2002 OPPS, we used external data, in part, to establish the device-dependent APC medians used for weight setting. At that time, many devices were eligible for pass-through payment. For the CY 2002 OPPS, we estimated that the total amount of pass-through payments would far exceed the limit imposed by statute. To reduce the amount of a pro rata adjustment to all pass-through items, we packaged 75 percent of the cost of the devices, using external data furnished by commenters on the August 24, 2001 proposed rule and information furnished on applications for pass-through payment, into the median cost for the device-dependent APCs associated with these pass-through devices. The remaining 25 percent of the cost was considered to be pass-through payment.

    In the CY 2003 OPPS, we determined APC medians for device-dependent APCs using a three pronged approach. First, we used only claims with device codes on the claim to set the medians for these APCs. Second, we used external data, in part, to set the medians for selected device-dependent APCs by blending that external data with claims data to establish the APC medians. Finally, we also adjusted the median for any APC (whether device-dependent or not) that declined more than 15 percent. In addition, in the CY 2003 OPPS, we deleted the device codes (“C” codes) from the HCPCS file in the belief that hospitals would include the charges for the devices on their claims, notwithstanding the absence of specific codes for devices used.

    In the CY 2004 OPPS, we used only claims containing device codes to set the medians for device-dependent APCs and again used external data in a 50-percent blend with claims data to adjust medians for a few device-dependent codes when it appeared that the adjustments were important to ensure access to care. However, hospital device code reporting was optional.

    In the CY 2005 OPPS, which was based on CY 2003 claims data, there were no device codes on the claims and, therefore, we could not use device-coded claims in median calculations as a proxy for completeness of the coding and charges on the claims. For the CY 2005 OPPS, we adjusted device-dependent APC medians for those device-dependent APCs for which the CY 2005 OPPS payment median was less than 95 percent of the CY 2004 OPPS payment median. In these cases, the CY 2005 OPPS payment median was adjusted to 95 percent of the CY 2004 OPPS payment median. We also reinstated the device codes and made the use of the device codes mandatory where an appropriate code exists to describe a device utilized in a procedure and also implemented HCPCS code edits to facilitate complete reporting of the charges for the devices used in the procedures assigned to the device-dependent APCs.

    We are proposing to base the CY 2006 OPPS device-dependent APC medians on CY 2004 claims, the most current data available. In CY 2004, the use of device codes was optional. Thus, for the CY 2006 OPPS, we calculated median costs for these APCs using all single bills without regard to whether there was a device code on the claim. We calculated median costs for this set of APCs using the standard median calculation methodology. This methodology uses single procedure claims to set the median costs for the APC. We then compared these unadjusted median costs to the adjusted median costs that we used to set the payment rates for the CY 2005 OPPS. We found that 21 APCs experienced increases in median cost compared to the CY 2005 OPPS adjusted median costs, 1 APC median was unchanged, 16 APCs experienced decreases in median costs, and 8 APCs are proposed to be reconfigured in such a way that no valid comparison was possible. Table 15 shows the comparison of these median costs.

    As we stated previously, in CY 2004, CMS reissued HCPCS codes for devices and asked that hospitals voluntarily code devices utilized to provide services. As part of our development of the proposed medians for this proposed rule, we examined CY 2004 claims that contained device codes that met our device edits, as posted on the OPPS Web site at http://www.cms.hhs.gov/​providers/​hopps/​default.asp. We found that, in many cases, the number of claims that passed the device edits was quite small. To use these claims to set medians for the CY 2006 OPPS would mean that the medians for some of these APCs would be set based on very small numbers of claims, reflecting the fact that in CY 2004 when device coding was optional under the OPPS relatively few hospitals chose to code for devices. For example, if we used only claims that passed the device code edits, the median for APC 0089 (Insertion/Replacement of Permanent Pacemaker and Electrodes), would be based on 34 claims that passed the device edits (0.78 percent of all claims), rather than on 1,934 single bills out of 4,424 total bills (43.72 percent of all claims). Median Start Printed Page 42714costs for insertion/replacement of a permanent pacemaker and electrodes developed based upon these 34 claims from a small subset of hospitals are unlikely to be representative of the resource costs of most hospitals that provided the service. Moreover, there are a few procedures for which no device codes are required although the procedures require a device to be used. For this set of services, subsetting the claims to those that pass the device edits does not change the group of single bills available for median calculation. For these reasons, we decided not to use only claims that passed the device edits to set the median costs for device-dependent APCs for the CY 2006 OPPS.

    When we considered whether to base the weights for these APCs on the unadjusted median costs, we found that for 10 of the 38 APCs for which the APC composition is stable, basing the payment weight on the unadjusted median cost would result in a reduction of more than 15 percent in the median cost for the CY 2006 OPPS compared to the CY 2005 OPPS.

    We fully expect to use the unadjusted median costs for device-dependent APCs as the basis of their payment weights for the CY 2007 OPPS because device coding is required for CY 2005 and device editing is being implemented in CY 2005, so that all CY 2005 claims should reflect the costs of devices used to provide services. Nevertheless we recognize that a payment reduction of more than 15 percent from the CY 2005 OPPS to the CY 2006 OPPS may be problematic for hospitals that provide the services contained in these APCs. Therefore, for the CY 2006 OPPS, as we have consistently done for device-dependent APCs, we are proposing to adjust the median costs for the device-dependent APCs listed in Table 15 for which comparisons with prior years are valid to the higher of the CY 2006 unadjusted APC median or 85 percent of the adjusted median on which payment was based for the CY 2005 OPPS. This would result in the use of adjusted medians for 10 device-dependent APCs. We view this as a transitional step from the adjusted medians of past years to the use of unadjusted medians based solely on hospital claims data with device codes in future years.

    We expect that this would be the last year in which we would make an across the board adjustment to the median costs for these device-dependent APCs based on comparisons to the prior year's payment medians. We believe that mandatory reporting of device codes for services furnished in CY 2005, combined with the editing of claims for the presence of device codes, where such codes are appropriate, would result in claims data that more fully reflect the relative costs of these services and that across the board adjustments to median costs for these APCs would no longer be appropriate.

    We recognize that the APC Panel recommended that CMS set a corridor of median costs for device-dependent APCs at no less than 90 percent of the CY 2005 payment median nor more than 110 percent of the CY 2005 payment median for purposes of setting the payment rate for the CY 2006 OPPS for these APCs. We do not believe that setting a corridor to control both increases and decreases in median costs is consistent with the use of adjusted medians as a means of transitioning hospitals to the use of the unadjusted claims data. The purpose of the transition is to moderate the rate of decline in payments so that hospitals can determine how to best adjust to payments based on unadjusted claims data. Limiting the rate of increase in payments based on such claims data would be inconsistent with that purpose. Therefore, we are proposing to adjust median costs to the greater of the median from claims data or 85 percent of the CY 2005 median used to set the payment rate in CY 2005 and not to impose a limit on the extent to which a median cost can increase.

    Table 15.—Proposed Median Cost Adjustments for Device-Dependent APCs for CY 2006

    APCDescriptionStatus indicatorAdjusted final CY 2005 OPPS median cost (percent)Proposed unadjusted CY 2006 APC median costChange from CY 2005 adjusted to CY 2006 unadjusted median cost (percent)Proposed CY 2006 OPPS adjusted median costCY 2006 single frequency (CY 2004 claims)CY 2006 total frequency (CY 2004 claims)
    0039Implantation of NeurostimulatorS$12,878.01$9,905.38−23$10,946.318091,809
    0040Level II Implantation of Neurostimulator ElectrodesS2,885.373,338.79163,338.792,61511,986
    0080Diagnostic Cardiac CatheterizationT2,123.652,240.9262,240.92267,077393,166
    0081Non-Coronary Angioplasty or AtherectomyT1,918.042,078.6782,078.672,046130,737
    0082Coronary AtherectomyT6,035.254,819.40−205,129.9627359
    0083Coronary Angioplasty and Percutaneous ValvuloplastyT3,241.853,071.03−53,071.035395,492
    0085Level II Electrophysiologic EvaluationT2,034.822,123.4642,123.463,08820,401
    0086Ablate Heart Dysrhythm FocusT2,637.962,670.7812,670.789199,160
    0087Cardiac Electrophysiologic Recording/MappingT2,180.19853.76−611,853.1633012,969
    0089Insertion/Replacement of Permanent Pacemaker and ElectrodesT6,416.906,373.13−16,373.131,9344,424
    0090Insertion/Replacement of Pacemaker Pulse GeneratorT5,301.995,380.0715,380.077406,412
    Start Printed Page 42715
    0104Transcatheter Placement of Intracoronary StentsT4,750.064,767.7004,767.701,1038,137
    0106Insertion/Replacement/Repair of Pacemaker and/or ElectrodesT3,229.101,908.38−412,744.734893,938
    0107Insertion of Cardioverter-DefibrillatorT18,460.1015,166.64−1815,691.084458,073
    0108Insertion/Replacement/Repair of Cardioverter-Defibrillator LeadsT24,788.2618,165.78−2721,070.025206,003
    0115Cannula/device access proceduresT1,502.711,899.17261,899.173,02210,115
    0202Level X Female Reproductive ProcT2,322.832,437.0752,437.077,95115,303
    0222Implantation of Neurological DeviceT12,714.609,742.78−2310,807.411,6785,629
    0225Level I Implementation of Neurostimulator ElectrodesS12,327.5214,162.161514,162.16185939
    0227Implantation of Drug Infusion DeviceT8,806.848,236.41−68,236.414422,776
    0229Transcatherter Placement of Intravascular ShuntsT3,638.523,889.4173,889.4177846,625
    0259Level VI ENT ProceduresT26,006.7421,424.48−1822,105.73554964
    0315Level II Implantation of NeurostimulatorT20,633.7012,170.26−4117,538.65229327
    0384GI Procedures with StentsT1,585.921,287.07−191,348.036,26820,711
    0385Level I Prosthetic Urological ProceduresS4,080.564,564.66124,564.66553783
    0386Level II Prosthetic Urological ProceduresS6,674.537,251.4497,251.443,2134,549
    0418Left ventricular leadT4,363.376,595.80516,595.802024,712
    0425Level II Arthroplasty with prosthesisT5,715.976,046.7766,046.77375882
    0648Breast Reconstruction with ProsthesisT2,957.763,044.0833,044.083981,320
    0652Insertion of Intraperitoneal CathetersT1,626.291,743.6171,743.613,0674,986
    0653Vascular Reconstruction/Fistula Repair with DeviceT1,644.531,842.52121,842.5280028,788
    0654Insertion/Replacement of a permanent dual chamber pacemakerT6,170.836,090.43−16,090.431,80720,809
    0655Insertion/Replacement/Conversion of a permanent dual chamber pacemakerT7,913.858,072.5628,072.567,35313,991
    0656Transcatheter Placement of Intracoronary Drug Eluting StentsT6,156.146,633.1886,633.182,39419,898
    0670Intravenous and Intracardiac UltrasoundS1,779.081,533.52−141,533.521117,041
    0674Prostate CryoablationT6,569.335,780.04−125,780.041,2482,080
    0680Insertion of Patient Activated Event RecordersS3,744.693,796.1013,796.101,4002,226
    0681Knee ArthroplastyT5,374.988,276.89548,276.89492683
    No adjustment; major HCPCS migration:
    0122Level II Tube changes and RepositioningT485.26420.72420.725,13814,701
    0427Level III Tube changes and Repositioning (new for 2006)T615.37615.372,4855,376
    Start Printed Page 42716
    0166Level I Urethral procedures (contains part of deleted DD APC 167)T1,040.531,066.531,066.537782,282
    0167Urethral procedures (deleted APC; codes moved to 167 and 168 for '06)T1,664.80NANANANA
    0168Level II Urethral procedures (contains part of deleted DD APC 167)T1,801.961,705.821,705.827,68410,018
    0621Level I VADTnew in 06500.77500.7760,115113,720
    0622Level II VADTnew in 061,283.331,283.3321,79254,816
    0623Level III VADTnew in 061,635.941,635.9423,96362,538

    B. APC Panel Recommendations Pertaining to APC 0107 and APC 0108

    The median costs for APC 0107 (Implantation of Cardioverter-Defibrillator) and APC 0108 (Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads and Insertion of Cardioverter-Defibrillator) have been adjusted each year since CY 2003 when pass-through payment expired for cardioverter-defibrillators, because the unadjusted medians have differed significantly from the prior year's payment medians. Moreover, because we use single procedure claims to set the median costs, the median costs for these APCs have always been set on a relatively small number of claims as compared to the total frequency of claims for the services under the OPPS. For example, for this CY 2006 OPPS proposed rule, the unadjusted median cost for APC 0107 was set based on 445 single procedure claims, which is 5.5 percent of the 8,073 claims on which a procedure code in the APC was billed. Similarly, the unadjusted median cost for APC 0108 was set based on 520 single procedure claims, which is 8.7 percent of the 6,003 claims on which a procedure code in the APC was billed. Commenters have frequently told us that using the single procedure median costs for these APCs does not accurately reflect the costs of the procedures because claims from typical clinical circumstances involving multiple procedures are not used to establish the medians.

    At the February 2005 APC Panel meeting, the APC Panel recommended that CMS package CPT codes 93640 and 93641 (electrophysiologic evaluation at time of initial implantation or replacement of cardioverter-defibrillator leads). The APC Panel recommended that we always package the costs for these codes because the definitions of the codes state that these evaluations are done at the time of lead implantation. Therefore, CPT codes 93640 and 93641 would never be correctly reported without a code in APC 0107 or APC 0108 also being reported. In addition, when a service assigned to APC 0107 or APC 0108 is provided, we would expect that CPT codes 93640 or 93641 for electrophysiologic evaluation and testing would also be performed frequently, and CY 2004 claims data for services in APC 0107 and APC 0108 confirm this. The APC Panel believed that packaging the costs of CPT codes 93640 and 93641 would result in more single bills available for setting the median costs for APC 0107 and APC 0108, and thus would likely yield more appropriate median costs for those APCs. Those medians would then include the costs of the electrophysiologic testing commonly performed at the time of the implantable cardioverter-defibrillator (ICD) insertion.

    The APC Panel further recommended that CMS treat CPT code 33241 (Subcutaneous removal of cardioverter-defibrillator) as a bypass code when the code appeared on the same claims with services assigned to APC 0107 or APC 0108. The APC Panel recommended bypassing charges for this code only when it appeared on the same claim with codes in APC 0107 or APC 0108, because when a cardioverter defibrillator (ICD) is removed and replaced in the same operative session, it is appropriate to attribute all of the packaged costs on the claim to the implantation of the device rather than to the removal of the device. The line costs for CPT code 33241 that are removed from the claims in this case would be discarded and would not be used to set the median for APC 0105 (the APC in which the code is located).

    We modeled the median costs that would be calculated for APCs 0107 and 0108, if we were to make the changes recommended by the APC Panel for these APCs, under four possible scenarios: (1) The cardioverter-defibrillator device is inserted without removal or testing; (2) the device is inserted and tested with no removal; (3) the device is removed and inserted but not tested; and (4) the device is removed, inserted, and tested. We then compared the sum of the unadjusted median costs, the sum of the proposed adjusted median costs and the sum of the costs that we modeled using the APC Panel recommendations. These results are shown in Table 16 below. Start Printed Page 42717

    Table 16.—Total Median Costs for APCs 0107 and 0108

    APC 0107 Using unadjusted median costAPC 0107 Using adjusted median costAPC 0107 With panel changesAPC 0108 Using unadjusted median costAPC 0108 Using adjusted median costAPC 0108 With panel changes
    (1)(2)(3)(4)(5)(6)
    Median for codes in APC$15,166.64$15,691.08$15,961.14$18,165.78$21,070.02$21,517.00
    50% of median for APC 0105 (CPT code 33241; removal); multiple procedure discount674.90674.90674.90674.90674.90674.90
    Proposed median for APC 0084 (CPT code 93640/93641; testing)604.67604.67(1)604.67604.67(1)
    (A) Median total if device is inserted only (neither removal nor testing)15,166.6415,691.0815,961.1418,165.7821,070.0221,517.00
    (B) Median total if device is inserted and tested (no removal)15,771.3116,295.7515,961.1418,770.4521,674.6921,517.00
    (C) Median total if device is removed and inserted (no testing)15,841.5416,365.9816,636.0418,840.6821,744.9222,191.90
    (D) Median total if device is removed, inserted and tested16,446.2116,970.6516,636.0419,445.3522,349.5922,191.90
    1 NA (testing is packaged).

    We also found that if we were to adopt the APC Panel recommendations for APCs 0107 and 0108 for the CY 2006 OPPS, the number of single bills that would be available for use in median setting would increase significantly, as shown in Table 17.

    Table 17.—Single Bills for APC 0107 and APC 0108

    Single bills without recommended changesSingle bills with recommended changesTotal frequency
    APC 010744545008073
    APC 010852014476003

    In general, we believe that the recommendations of the APC Panel show great potential for providing a far more robust set of single bills for use in setting medians for APCs 0107 and 0108 and, therefore, for improving the accuracy of the median costs acquired from the claims data. However, for the CY 2006 OPPS, adopting the APC Panel recommendations would result in higher total payments for services related to cardioverter-defibrillator insertion for some possible clinical scenarios than under the proposed adjustment methodology but would result in lower total payments in other cases. Moreover, the effects are not identical for both APCs. Both APCs require the insertion of an ICD, but the codes in APC 0108 also require the repair, revision or insertion of leads. Because the APCs are so closely related clinically and both APCs include payments for expensive implanted cardioverter-defibrillators, we are proposing to apply the same payment policy to both APC 0107 and APC 0108. We would like to receive input from the APC Panel and from the affected parties regarding the results of modeling the methodology before we decide whether to implement this multiple procedure claim strategy for both of these APCs.

    Specifically, we are proposing to set the medians for these APCs at 85 percent of their CY 2005 payment medians and have based our modeling of the scaler and the impact analysis on that proposal, although we believe that the APC Panel recommendations have significant merit, particularly when we move to complete reliance on claims data in updating the OPPS for CY 2007. Although we are proposing to adjust the median costs for these APCs in the same manner as other device-dependent APCs, we will consider, based on the public comments, whether it would be appropriate to apply the multiple procedure claims methodology to these APCs for the CY 2006 OPPS. We look forward to specifically receiving public comments on the APC Panel recommendations regarding packaging and bypassing services frequently performed with procedures assigned to APC 0107 and APC 0108, with the goal of increasing single bills available for ratesetting in order to improve the accuracy of median costs based upon hospital claims.

    C. Pass-Through Payments for Devices

    (If you choose to comment on issues in this section, please include the caption “Transitional Pass-Through Payments for Devices” at the beginning of your comment.)

    1. Expiration of Transitional Pass-Through Payments for Certain Devices

    Section 1833(t)(6)(B)(iii) of the Act requires that, under the OPPS, 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. In our November 15, 2004 final rule with comment period (69 FR 65773), we specified three device categories currently in effect that would cease to be eligible for pass-through payment effective January 1, 2006.

    The device category codes became effective April 1, 2001, under the provisions of the BIPA. Prior to pass-through device categories, we paid for pass-through devices under the OPPS on a brand-specific basis. All of the initial 97 category codes that were established as of April 1, 2001, have Start Printed Page 42718expired; 95 categories expired after CY 2002 and 2 categories expired after CY 2003. All of the categories listed in Table 18, along with their expected expiration dates, were created since we published the criteria and process for creating additional device categories for pass-through payment on November 2, 2001 (66 FR 55850 through 55857). We based the expiration dates for the category codes listed in Table 18 on the date on which a category was first eligible for pass-through payment.

    There are three categories for devices that would have been eligible for pass-through payments for at least 2 years as of December 31, 2005. In the November 15, 2004 final rule with comment period, we finalized the December 31, 2005 expiration dates for these three categories—C1814 (Retinal tamponade device, silicone oil), C1818 (Integrated keratoprosthesis), and C1819 (Tissue localization excision device). Each category includes devices for which pass-through payment was first made under the OPPS in CY 2003 or 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). For CY 2003, we packaged the costs of the devices no longer eligible for pass-through payments into the costs of the procedures with which the devices were billed in CY 2001. There were few exceptions to this established policy (brachytherapy sources for other than prostate brachytherapy, which is now also separately paid in accordance with section 621(b)(2) of Pub. L. 108-173). For CY 2005, we continued to apply this policy, the same as we did in CY 2003 and 2004, to categories of devices that expired on December 31, 2004.

    2. Proposed Policy for CY 2006

    For CY 2006, we are proposing to implement the final decision we made in the November 15, 2004 final rule with comment period that finalizes the expiration date for pass-through status for device categories C1814, C1818, and C1819. Therefore, as of January 1, 2006, we will discontinue pass-through payment for C1814, C1818, and C1819. In accordance with our established policy, we are proposing to package the costs of the devices assigned to these three categories into the costs of the procedures with which the devices were billed in CY 2004, the year of hospital claims data used for this proposed OPPS update.

    Table 18.—List of Current Pass-Through Device Categories By Expiration Date

    HCPCS codesCategory long descriptorDate(s) populatedExpiration date
    C1814Retinal tamponade device, silicone oil4/1/0312/31/05
    C1818Integrated keratoprosthesis7/1/0312/31/05
    C1819Tissue localization excision device1/1/0412/31/05

    D. Other Policy Issues Relating To Pass-Through Device Categories

    (If you choose to comment on issues in this section, please include the caption “Pass-Through Device Categories” at the beginning of your comment.)

    1. Provisions for Reducing Transitional Pass-Through Payments to Offset Costs Packaged Into APC Groups

    a. Background

    In the November 30, 2001 final rule, we explained the methodology we used to estimate the portion of each APC payment rate that could reasonably be attributed to the cost of the associated devices that are eligible for pass-through payments (66 FR 59904). Beginning with the implementation of the CY 2002 OPPS quarterly update (April 1, 2002), we deducted from the pass-through payments for the identified devices an amount that reflected the portion of the APC payment amount that we determined was associated with the cost of the device, as required by section 1833(t)(6)(D)(ii) of the Act. In the November 1, 2002 interim final rule with comment period, we published the applicable offset amounts for CY 2003 (67 FR 66801).

    For the CY 2002 and CY 2003 OPPS updates, to estimate the portion of each APC payment rate that could reasonably be attributed to the cost of an associated device eligible for pass-through payment, we used claims data from the period used for recalibration of the APC rates. That is, for CY 2002 OPPS updating, we used CY 2000 claims data and for CY 2003 OPPS updating, we used CY 2001 claims data. For CY 2002, we used median cost claims data based on specific revenue centers used for device related costs because C-code cost data were not available until CY 2003. For CY 2003, 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 the associated device category C-codes that were billed with the APC packaged into the median. Comparing the median APC cost without device packaging to the median APC cost including device packaging enabled us to determine the percentage of the median APC cost that is attributable to the associated pass-through devices. By applying those percentages to the APC payment rates, we determined the applicable amount to be deducted from the pass-through payment, the ”offset” amount. We created an offset list comprised of any APC for which the device cost was at least 1 percent of the APC's cost.

    The offset list that we have published each year is a list of offset amounts associated with those APCs with identified offset amounts developed using the methodology described above. As a rule, we do not know in advance which procedures residing in certain APCs may be billed with new device categories. Therefore, an offset amount is applied only when a new device category is billed with a HCPCS procedure code that is assigned to an APC appearing on the offset list. The list of potential offsets for CY 2005 is currently published on the CMS Web site: http://www.cms.hhs.gov, as “Device-Related Portions of Ambulatory Payment Classification Costs for 2005.”

    For CY 2004, we modified our policy for applying offsets to device pass-through payments. Specifically, we indicated that we would apply an offset to a new device category only when we could determine that an APC contains costs associated with the device. We continued our existing methodology for determining the offset amount, described earlier. We were able to use this methodology to establish the device offset amounts for CY 2004 because providers reported device codes (C-codes) on the CY 2002 claims used for the CY 2004 OPPS update. For the CY 2005 update to the OPPS, our data consisted of CY 2003 claims that did not contain device codes and, therefore, for CY 2005 we utilized the device percentages as developed for CY 2004. In the CY 2004 OPPS update, we reviewed the device categories eligible Start Printed Page 42719for continuing pass-through payment in CY 2004 to determine whether the costs associated with the device categories are packaged into the existing APCs. Based on our review of the data for the device categories existing in CY 2004, we determined that there were no close or identifiable costs associated with the devices relating to the respective APCs that are normally billed with them. Therefore, for those device categories, we set the offset to $0 for CY 2004. We continued this policy of setting offsets to $0 for the device categories that continued to receive pass-through payment in CY 2005.

    For the CY 2006 OPPS update, CY 2004 hospital claims are available for analysis. Hospitals billed device C-codes in CY 2004 on a voluntary basis. We have reviewed our CY 2004 data, examining hospital claims for services that included device C-codes and utilizing the methodology for calculating device offsets noted above. The numbers of claims for services in many of the APCs for which we calculated device percentages using CY 2004 data were quite small. Many of these APCs already had relatively few single claims available for median calculations compared with the total bill frequencies because of our inability to use many multiple bills in establishing median costs for all APCs, and subsetting the single claims to only those including C-codes often reduced those single bills by 80 percent or more. Our claims demonstrate that relatively few hospitals specifically coded for devices utilized in CY 2004. Thus, we do not feel confident that CY 2004 claims reporting C-codes represent the typical costs of all hospitals providing the services. Therefore, we do not propose to use CY 2004 claims with device coding to propose CY 2006 device offset amounts at this time. In addition, we do not propose to use CY 2005's methodology, for which we utilized the device percentages as developed for CY 2004. Two years have passed since we developed the device offsets for CY 2004, and the device offsets originally calculated from CY 2002 hospitals' claims data may not appropriately reflect the contributions of device costs to procedural costs in the current outpatient hospital environment. In addition, a number of the APCs on the CY 2004 and CY 2005 device offset percentage lists are either no longer in existence or have been so significantly reconfigured that the past device offsets likely do not apply.

    b. Proposed Policy for CY 2006

    For CY 2006, we are proposing to continue to review each new device category on a case-by-case basis as we have done in CY 2004 and CY 2005, to determine whether device costs associated with the new category are packaged into the existing APC structure. If we do not determine that for any new device category that device costs associated with the new category are packaged into existing APCs, we are proposing to continue our current policy of setting the offset for the new category to $0 for CY 2006. There are currently no established categories that would continue for pass-through payment in CY 2006. However, we may establish new categories in any quarter. If we create a new device category and determine that our data contain a sufficient number of claims with identifiable costs associated with the devices in any APC, we would adjust the APC payment if the offset is greater than $0. If we determine that a device offset greater than $0 is appropriate for any new category that we create, we are proposing to announce the offset amounts in the program transmittal that announces the new category.

    For CY 2006, we are proposing to use available partial year or full year CY 2005 hospital claims data to calculate device percentages and potential offsets for CY 2006 applications for new device categories. Effective January 1, 2005, we require hospitals to report device C-codes and their costs when hospitals bill for services which utilize devices described by the existing C-codes. In addition, during CY 2005 we are implementing device edits for many services which require devices and for which appropriate device C-codes exist. Therefore, we expect that the number of claims including device codes and their respective costs will be much more robust and representative for CY 2005 than for CY 2004. We also note that offsets would not be used for any existing categories at this time. If a new device category is created for payment, for CY 2006 we are proposing to examine the available CY 2005 claims data, including device costs, to determine whether device costs associated with the new category are already packaged into the existing APC structure, as indicated earlier. If we conclude that some related device costs are packaged into existing APCs, we are proposing to utilize the methodology described earlier and first used for the CY 2003 OPPS to determine an appropriate device offset percentage for those APCs with which the new category would be reported.

    Our proposal not to publish a list of APCs with device percentages at this time would be a transitional policy for CY 2006 because of the previously discussed limitations of the CY 2004 OPPS data with respect to device costs associated with procedures. We expect that we will reexamine our previous methodology for calculating the device percentages and offset amounts for the CY 2007 OPPS update, which will be based on CY 2005 hospitals claims data where device C-code reporting is required.

    2. Criteria for Establishing New Pass-Through Device Categories

    a. Surgical Insertion and Implantation Criterion

    One of our criteria, as set forth in § 419.66(b)(3) of the regulations, for establishing a new category of devices for pass-through payment is that the item be surgically inserted or implanted. The criterion that a device be surgically inserted or implanted is one of our original criteria adopted when we implemented the BBRA requirement that we establish pass-through payment for devices. This criterion helps us define whether an item is a device, as distinguished from other items, such as materials and supplies. We further clarified our definition of the surgical insertion and implantation criterion in the November 13, 2000 final rule (65 FR 67805). In that rule we stated that we consider a device to be surgically inserted or implanted if it is introduced into the human body through a surgically created incision. We also stated that we do not consider an item used to cut or otherwise create a surgical opening to be a device that is surgically inserted or implanted.

    In our November 15, 2004 final rule with comment period, we responded to comments received on our August 16, 2004 proposed rule, which requested that we revisit our surgical insertion and implantation criterion for establishing a new device category. The commenters specifically requested that CMS eliminate the current requirement that items that are included in new pass-through device categories must be surgically inserted or implanted through a surgically created incision. The commenters expressed concern that the current requirement may prevent access to innovative and less invasive technologies, particularly in the areas of gynecologic, urologic, colorectal and gastrointestinal procedures. These commenters asked that CMS change the surgical insertion or implantation criterion to allow pass-through payment for potential new device categories that include items introduced into the human body through a natural orifice, as well as through a surgically created incision. Several of the commenters Start Printed Page 42720recommended that CMS allow the creation of a new pass-through category for items implanted or inserted through a natural orifice, as long as the other existing criteria are met.

    In responding to the commenters, we stated in the November 15, 2004 final rule with comment period (69 FR 65774) that we were also interested in hearing the views of other parties and receiving additional information on these issues. While we appreciate and welcome additional comments on these issues from the medical device makers, we were also interested in hearing the views of Medicare beneficiaries, of the hospitals that are paid under the OPPS, and of physicians and other practitioners who attend to patients in the hospital outpatient setting. For that reason, we solicited additional comments on this topic within the 60-day comment period for the November 15, 2004 final rule with comment period (69 FR 65774 through 65775). In framing their comments, we asked that commenters consider the following questions specific to devices introduced into the body through natural orifices:

    1. Whether orifices include those that are either naturally or surgically created, as in the case of ostomies. If you believe this includes only natural orifices, why do you distinguish between natural and surgically created orifices?

    2. How would you define “new,” with respect to time and to predecessor technology? What additional criteria or characteristics do you believe distinguish “new” devices that are surgically introduced through an existing orifice from older technology that also is inserted through an orifice?

    3. What characteristics do you consider to distinguish a device that might be eligible for a pass-through category even if inserted through an existing orifice from materials and supplies such as sutures, clips or customized surgical kits that are used incident to a service or procedure?

    4. Are there differences with respect to instruments that are seen as supplies or equipment for open procedures when those same instruments are passed through an orifice using a scope?

    b. Public Comments Received and Our Responses

    Below is a summary of the public comments we received on the four stated surgical insertion and implantation device criterion questions and our response to them.

    Comment: Most commenters generally framed their responses to the four questions listed above. Commenters were generally in favor of modifying our surgical insertion and implantation criterion so that devices that are placed into patients without the need for a surgical incision would not be ineligible for pass-through payment, claiming that devices that are inserted through a natural orifice offer important benefits to Medicare beneficiaries, such as avoidance of more costly and more invasive surgery. One commenter stated that procedures that could be performed with minimal morbidity and on an outpatient basis are the trend for surgery and should be encouraged. Another commenter believed that our criterion of surgical insertion or implantation through a surgically created incision was ineffective as a clear and comprehensive description of surgical procedures, including endoscopic and laparoscopic procedures.

    Regarding the first specific question we posed, whether devices introduced into the body through natural orifices includes orifices that are either naturally or surgically created, commenters generally stated we should include devices as potentially eligible for pass-through categories whether they are introduced through orifices that are either naturally or surgically created, as in the case of ostomies, if the devices meet other cost and clinical criteria, in order to encourage the development of new technologies.

    Regarding the second question restated above, which asked how the public would define “new” with respect to time and to predecessor technology, some commenters stated that they believed the current clinical and cost criteria are sufficient and that no additional criteria or characteristics are needed. Several commenters indicated that the timeframe for what we consider “new” could be clarified if the device in question was not FDA approved or in use in the OPD during the year that hospital claims are used for that calendar year's OPPS update, that is, it should be considered “new.” Some commenters elaborated by example. They stated that if we change the surgical insertion or implantation requirement to include devices inserted through natural orifices in 2005, devices approved by the FDA and in use in the OPD in 2003 or previously would not be eligible, while devices approved by FDA in 2004 or later and used in the OPD settings would be eligible for pass-through consideration. Another commenter stated that the definition of “new” device should include those devices that require only an FDA investigational device exemption (IDE) clearance. The commenter further stated that these devices should be granted “new” status at the time of FDA release as an IDE. The commenter stated that if FDA required a premarket approval (PMA) for the device, a determination of newness should be made on a case by case basis.

    Regarding the question of what characteristics distinguish a device that might be eligible for a pass-through category even if inserted through an existing orifice from materials and supplies that are used incident to a service or procedure, some commenters generally stated their belief that the current clinical and cost criteria are sufficient to distinguish devices that might be eligible from materials and supplies. Other commenters stated that the device must be an integral part of the procedure or that it should include the characteristic of having a diagnostic or therapeutic purpose, without which the procedure could not be performed. Thus, according to these commenters, the device must function for a specific procedure, while supplies may be used for many procedures. One commenter pointed out that many devices are now implanted through the use of naturally occurring orifices or without significant incisions. This commenter indicated that the requirement of a “traditional incision” no longer serves the purpose of distinguishing between devices that are and are not implanted, or between devices and supplies and instruments. The commenter stated that retaining the requirement of a traditional incision could create incentives to use more invasive technology, if that is the technology that is eligible for pass-through payments and less invasive technology is not. This commenter suggested excluding tools and disposable supplies by excluding any item that is used primarily for the purpose of cutting or delivering an implantable device. However, the commenter recommended not reducing payment when delivery systems are packaged with the device. The commenter further recommended that the term incision be clearly defined to include all procedures involving the cutting, breaking or puncturing of tissue or skin, regardless of how small that cut is, provided that the device is attached to or inserted into the body via this cut or puncture or break. Another commenter stated that there are items included in a surgical kit that have significant cost and are single use, for example, guide wires, implying that it is sometimes difficult to determine what a supply is.

    Regarding our question about whether there are differences with respect to instruments that are seen as supplies or equipment for open procedures when those same instruments are passed through an orifice using a scope, Start Printed Page 42721commenters believed that the definitions of supplies and eligible devices are independent of the use of a scope during a procedure, and stated there were no distinguishing features of supplies or equipment. A commenter reiterated that the current clinical and cost criteria are sufficient to distinguish eligible devices (that is, those with “a specific therapeutic use”) from materials and supplies. Commenters believed that the use of a scope should not be a factor in the distinction between devices and supplies.

    One commenter urged us to consider the points that the surgical incision requirement is not mandated by statute and that CMS's criterion to limit devices to only those that are surgically inserted or implanted may have been based upon concern that less restrictive criteria would cause spending on pass-though items to exceed the pool of money set to fund the pass-though payments. This commenter indicated that this concern would no longer be valid, given the relatively few items currently paid on a pass-through basis.

    Response: As we stated in the November 15, 2004 final rule, we share the view that it is important to ensure access for Medicare beneficiaries to new technologies that offer substantial clinical improvement in the treatment of their medical conditions. We also recognize that since the beginning of the OPPS, there have been beneficial advances in technologies and services for many conditions, which have both markedly altered the courses of medical care and ultimately improved the health outcomes of many beneficiaries.

    We carefully considered the comments and are proposing to maintain our current criterion that a device must be surgically inserted or implanted, but are also proposing to modify the way we currently interpret this criterion under § 419.66(b)(3) of the regulations. We are proposing to consider eligible those items that are surgically inserted or implanted either through a natural orifice or a surgically created orifice (such as through an ostomy), as well as those that are inserted or implanted through a surgically created incision. We will maintain all of our other criteria in § 419.66 of the regulations, as elaborated in our various rules, such as the November 1, 2002 final rule (67 FR 66781 through 66787). Specifically, the clarification made at the time we clarified the surgically inserted or implanted criterion in our August 3, 2000 interim final rule with comment period, namely, that we do not consider an item used to cut or otherwise create a surgical opening to be a device that is surgically implanted or inserted (65 FR 67805).

    With this revision of our definition of devices that are surgically inserted or implanted, we remind the public that device category eligibility for transitional pass-through payment continues to depend on meeting our substantial clinical improvement criterion, where we compare the clinical outcomes of treatment options using the device to currently available treatments, including treatments using devices in existing or previously established pass-through device categories. We expect that requested new pass-through device categories that successfully demonstrate substantial clinical improvement for Medicare beneficiaries would describe new devices, where the additional device costs would not be reflected in the hospital claims data providing the costs of treatments available during the time period used for the most recent OPPS update.

    c. Existing Device Category Criterion

    One of our criteria, as set forth in § 419.66(c)(1) of the regulations, to establish a new device category for pass-through payment, is that the devices that would populate the category not be described by any existing or previously existing category. Commenters to our various proposed rules, as well as applicants for new device categories, have expressed concern that some of our existing and previously existing device category descriptors are overly broad, and that the category descriptors as they are currently written may preclude some new technologies from qualifying for establishment of a new device category for pass-through payment. Such parties have recommended that we consider modifying the descriptors for existing device categories, especially when a device would otherwise meet all the other criteria for establishing a new device category to qualify for pass-through payment.

    We agree that implementation of the requirement that a new device category not be described by an existing or previously existing category merits review. Beginning with CY 2006, 3 years will have elapsed since 95 of the 97 initial device categories we established on April 1, 2001 will have expired: 95 categories expired after December 31, 2002, and 2 categories expired after December 31, 2003. Several additional years will have passed since those categories were first populated in CY 2000 or CY 2001. Thus, while some of the initial device category descriptors sufficed at the time they were first created, further clarification as to the types of devices that they are meant to describe is indicated. Therefore, we are proposing to create an additional category for devices that meet all of the criteria required to establish a new category for pass-through payment in instances where we believe that an existing or previously existing category descriptor does not appropriately describe the new type of device. This may entail the need to clarify or refine the short or long descriptors of the previous category. We would evaluate each situation on a case by case basis. We are proposing that any such clarification would be made prospectively from the date the new category would be made effective.

    We are also proposing to revise § 419.66(c)(1) of the regulations, accordingly, to reflect as one of the criteria for establishing a device category our determination that a device is not appropriately described by any of the existing categories or by any category previously in effect. In order to determine if a “new” device is appropriately described by an existing or previously existing category of devices, we are proposing to apply two tests based upon our evaluation of information provided to us in the device category application. First, we will expect an applicant for a new device category to show that their device is not similar to devices (including related predicate devices) whose costs are reflected in our OPPS claims data in the most recent OPPS update. Second, we will require an applicant for a new device category to demonstrate that utilization of their device provides a substantial clinical improvement for Medicare beneficiaries compared with currently available treatments, including procedures utilizing devices in existing or previously existing device categories. We would consider a new device that meets both of these tests not to be appropriately described by one of the existing or previously existing pass-through device categories.

    V. Proposed Payment Changes for Drugs, Biologicals, and Radiopharmaceutical Agents

    A. Transitional Pass-Through Payment for Additional Costs of Drugs and Biologicals

    (If you choose to comment on issues in this section, please include the caption “Pass-Through” at the beginning of your comment.)

    1. Background

    Section 1833(t)(6) of the Act provides for temporary additional payments or “transitional pass-through payments” for certain drugs and biological agents. As originally enacted by the BBRA, this Start Printed Page 42722provision required the Secretary to make additional payments to hospitals for current orphan drugs, as designated under section 526 of the Federal Food, Drug, and Cosmetic Act (Pub. L. 107-186); current drugs and biological agents and brachytherapy used for the treatment of cancer; and current radiopharmaceutical drugs and biological products. For those drugs and biological agents referred to as “current,” the transitional pass-through payment began on the first date the hospital OPPS was implemented (before enactment of BIPA (Pub. L. 106-554), on December 21, 2000).

    Transitional pass-through payments are also required for certain “new” drugs, devices, and biological agents that were not being paid for as a hospital OPD 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 drug, device, or biological. Under the statute, transitional pass-through payments can be made for at least 2 years but not more than 3 years. In Addenda A and B to this proposed rule, pass-through drugs and biological agents are identified by status indicator “G.”

    The process to apply for transitional pass-through payment for eligible drugs and biological agents can be found on our CMS Web site: http://www.cms.hhs.gov. If we revise the application instructions in any way, we will post the revisions on our Web site and submit the changes to the Office of Management and Budget (OMB) for approval, as required under the Paperwork Reduction Act (PRA). Notification of new drugs and biologicals application processes is generally posted on the OPPS Web site at: http://www.cms.hhs.gov/​providers/​hopps.

    2. Expiration in CY 2005 of Pass-Through Status for Drugs and Biologicals

    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 and no longer than 3 years. The drugs whose pass-through status will expire on December 31, 2005, meet that criterion. Table 19 below lists the 10 drugs and biologicals for which we are proposing that pass-through status would expire on December 31, 2005.

    Table 19.—Proposed List of Drugs and Biologicals for Which Pass-Through Status Expires December 31, 2005

    HCPCSAPCShort descriptor
    C91239123Transcyte, per 247 sq cm.
    C92059205Oxaliplatin.
    C92119211Inj, alefacept, IV.
    C92129212Inj, alefacept, IM.
    J01809208Agalsidase beta injection.
    J19319209Laronidase injection.
    J24699210Palonosetron HCl.
    J34869204Ziprasidone mesylate.
    J90419207Bortezomib injection.
    Q99559203Inj perflexane lip micros, ml.

    3. Drugs and Biologicals With Proposed Pass-Through Status in CY 2006

    We are proposing to continue pass-through status in CY 2006 for 14 drugs and biologicals. These items, which are listed in Table 20 below, were given pass-through status as of April 1, 2005. The APCs and HCPCS codes for drugs and biologicals that we are proposing to continue with pass-through status in CY 2006 are assigned status indicator “G” in Addendum A and Addendum B of this proposed rule.

    Section 1833(t)(6)(D)(i) of the Act sets the payment rate for pass-through eligible drugs (assuming that no pro rata reduction in pass-through payment is necessary) as the amount determined under section 1842(o) of the Act. We note that this section of the Act also states that if a drug or biological is covered under a competitive acquisition contract under section 1847(B), then the payment rate be equal to the average price for the drug or biological for all competitive acquisition areas and year established as calculated and adjusted by the Secretary. The competitive acquisition program has not yet been implemented as of the development of this proposed rule; therefore, we do not have payment rates for certain drugs and biologicals that would be covered under this program at this time. Section 1847(A) of the Act, as added by section 303(c) of Pub. L. 108-173, establishes the use of the average sales price (ASP) methodology as the basis for payment of drugs and biologicals described in section 1842(o)(1)(C) of the Act and furnished on or after January 1, 2005. This payment methodology is set forth in § 419.64 of the regulations. Similar to the payment policy established for pass-through drugs and biologicals in CY 2005, we are proposing to pay under the OPPS for drugs and biologicals with pass-through status in CY 2006 consistent with the provisions of section 1842(o) of the Act, as amended by section 621 of Pub. L. 108-173, at a rate that is equivalent to the payment these drugs and biologicals would receive in the physician office setting.

    Section 1833(t)(6)(D)(i) of the Act also sets the amount of additional payment for pass-through eligible drugs and biologicals (the pass-through payment amount). The pass-through payment amount is the difference between the amount authorized under section 1842(o) of the Act, and the portion of the otherwise applicable fee schedule amount (that is, the APC payment rate) that the Secretary determines is associated with the drug or biological.

    As we explain in section V.B. of this proposed rule, we are proposing to continue to make separate payment in CY 2006 for new drugs and biologicals with a HCPCS code consistent with the provisions of section 1842(o) of the Act, as amended by section 621 of Pub. L. 108-173, at a rate that is equivalent to the payment they would receive in a physician office setting, whether or not we have received a pass-through application for the item. Accordingly, in CY 2006, the pass-through payment amount would equal zero for those new drugs and biologicals that we determine have pass-through status. That is, when we subtract the amount to be paid for pass-through drugs and biologicals under section 1842(o) of the Act, as amended by section 621 of Pub. L. 108-173, from the portion of the otherwise applicable fee schedule amount, or the APC payment rate associated with the drug or biological that would be the amount paid for drugs and biologicals under section 1842(o) of the Act as amended by section 621 of Pub. L. 108-173, the resulting difference is equal to zero.

    We are proposing to use payment rates based on the ASP data from the fourth quarter of 2004 for budget neutrality estimates, impact analyses, and to complete Addenda A and B of this proposed rule because these are the most recent numbers available to us during the development of this proposed rule. These payment rates were also the basis for drug payments in the physician office setting effective April 1, 2005. To be consistent with the ASP-based payments that would be made when these drugs and biologicals are furnished in physician offices, we plan to make any appropriate adjustments to the amounts shown in Addenda A and B of this proposed rule when we publish our final rule and also on a quarterly basis on our Web site during CY 2006 if later quarter ASP submissions indicate that adjustments to the payment rates for these pass-Start Printed Page 42723through drugs and biologicals are necessary.

    Table 20 lists the drugs and biologicals for which we are proposing that pass-through status continue in CY 2006. We assigned pass-through status to these drugs and biologicals as of April 1, 2005. We also have included in Addenda A and B to this proposed rule the proposed CY 2006 APC payment rates for these pass-through drugs and biologicals.

    Table 20.—Proposed List of Drugs and Biologicals With Pass-Through Status in CY 2006

    HCPCS codeAPCShort descriptor
    C92209220Sodium hyaluronate.
    C92219221Graftjacket Reg Matrix.
    C92229222Graftjacket SftTis.
    J01289216Abarelix injection.
    J08789124Daptomycin injection.
    J23579300Omalizumab injection.
    J27830738Rasburicase.
    J27949125Risperidone, long acting.
    J75189219Mycophenolic acid.
    J85010868Oral aprepitant.
    J90359214Bevacizumab injection.
    J90559215Cetuximab injection.
    J93059213Pemetrexed injection.
    Q40799126Injection, Natalizumab, 1 MG.

    B. Proposed Payment for Drugs, Biologicals, and Radiopharmaceuticals Without Pass-Through Status

    (If you choose to comment on issues in this section, please include the caption “NonPass-Throughs” at the beginning of your comment.)

    1. Background

    Under the OPPS, we currently pay for drugs, biologicals including blood and blood products, and radiopharmaceuticals that do not have pass-through status in one of two ways: packaged payment and separate payment (individual APCs). We explained in the April 7, 2000 final rule (65 FR 18450) that 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 packaged items and supplies whose costs are recognized and paid for within the national OPPS payment rate for the associated procedure or service. (Program Memorandum Transmittal A-01-133, issued on November 20, 2001, explains in greater detail the rules regarding separate payment for packaged services.)

    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, biologicals, 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.

    Section 1833(t)(16)(B) of the Act, as added by section 621(a)(1) of Pub. L. 108-173, requires that the threshold for establishing separate APCs for drugs and biologicals be set at $50 per administration for CYs 2005 and 2006. For CY 2005, we finalized our policy to continue paying separately for drugs, biologicals, and radiopharmaceuticals whose median cost per day exceeds $50 and packaging the cost of drugs, biologicals, and radiopharmaceuticals whose median cost per day is less than $50 into the procedures with which they are billed. For CY 2005, we also adopted an exception policy to our packaging rule for one particular class of drugs, the oral and injectible 5HT3 forms of anti-emetic treatments (69 FR 65779 through 65780).

    2. Proposed Criteria for Packaging Payment for Drugs, Biologicals, and Radiopharmaceuticals

    For CY 2006, the threshold for establishing separate APCs for drugs and biologicals is required to be set at $50 per administration according to section 1833(t)(16)(B) of the Act. Therefore, we are proposing to continue our existing policy of paying separately for drugs, biologicals, and radiopharmaceuticals whose per day cost exceeds $50 and packaging the cost of drugs, biologicals, and radiopharmaceuticals whose per day cost is less than $50 into the procedures with which they are billed. We are also proposing to continue our policy of exempting the oral and injectible 5HT3 anti-emetic products from our packaging rule (Table 21), thereby making separate payment for all of the 5HT3 anti-emetic products. As stated in our CY 2005 final rule with comment period (69 FR 65779 through 65780), chemotherapy is very difficult for many patients to tolerate as the side effects are often debilitating. In order for beneficiaries to achieve the maximum therapeutic benefit from chemotherapy and other therapies with side effects of nausea and vomiting, anti-emetic use is often an integral part of the treatment regimen. We want to continue to ensure that our payment rules do not impede a beneficiary's access to the particular anti-emetic that is most effective for him or her as determined by the beneficiary and his or her physician.

    Table 21.—Proposed Anti-Emetics To Exempt From $50 Packaging Requirement

    HCPCS codeShort description
    J2405Ondansetron HCl injection.
    Q0179Ondansetron HCl 8 mg oral.
    Q0180Dolasetron mesylate oral.
    J1260Dolasetron mesylate.
    J1626Granisetron HCl injection.
    Q0166Granisetron HCl 1 mg oral.
    J2469Palonosetron HCl.

    For the CY 2006 proposed payment rates, we calculated the per day cost of all drugs, biologicals, and radiopharmaceuticals that had a HCPCS code in CY 2004 and were paid (via packaged or separate payment) under the OPPS using claims data from January 1, 2004, to December 31, 2004. In CY 2004, multisource drugs and radiopharmaceuticals had two HCPCS codes that distinguished the innovator multisource (brand) drug or radiopharmaceutical from the noninnovator multisource (generic) drug or radiopharmaceutical. We aggregated claims for both the brand and generic HCPCS codes in our packaging analysis of these multisource products. Items such as single indication orphan drugs, certain vaccines, and blood and blood products were excluded from these calculations and our treatment of these items is discussed separately in sections V.F., E., and I., respectively, of this preamble.

    In order to calculate the per day cost for drugs, biologicals, and radiopharmaceuticals to determine their packaging status in CY 2006, we are proposing several changes in the methodology that was described in detail in the CY 2004 OPPS proposed rule (68 FR 47996 through 47997) and finalized in the CY 2004 final rule with comment period (68 FR 63444 through 63447). For CY 2006, to calculate the per day cost of the drugs, biologicals, and radiopharmaceuticals, we took the following steps:Start Printed Page 42724

    Step 1. 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 product. This resulted in creation of 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.

    Step 2. We then created a separate record for each drug or radiopharmaceutical by date of service, regardless of the number of lines on which the drug or radiopharmaceutical was billed on 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 two line-items with a cost of $10 and 5 units for each line-item. In this case, the computer program would create two records for this drug, and each record would have a total cost of $20 and 10 units of the product.

    Step 3. We trimmed records with unit counts per day greater or less than 3 standard deviations from the geometric mean (This is a new step in the methodology we are proposing for CY 2006).

    Step 4. For each remaining record for a drug or radiopharmaceutical, we calculated the cost per unit of the drug. If the HCPCS descriptor for “drug X” 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. We then weighted this unit cost by the total number of units in the record. We did this by generating a number of line-items equivalent to the number of units in that particular claim. Thus, a claim with 100 units of “drug X” and a total cost of $200 would be given 100 line-items, each with a cost of $2, while a claim of 50 units with a cost of $50 would be given 50 line items, each with a cost of $1.

    Step 5. We then trimmed the unit records with cost per unit greater or less than 3 standard deviations from the geometric mean.

    Step 6. We aggregated the remaining unit records to determine the mean cost per unit of the drug or radiopharmaceutical.

    Step 7. Using only the records that remained after records with unit counts per day greater or less than 3 standard deviations from the geometric mean were trimmed (step 3), the total number of units billed for each item and the total number of unique per-day records for each item were determined. We divided the count of the total number of units by the total number of unique per-day records for each item to calculate an average number of units per day.

    Step 8. Instead of using median cost as done in previous years, we used the payment rate for each drug and biological effective April 1, 2005 furnished in the physician office setting, which was calculated using the ASP methodology, and multiplied the payment rate by the average number of units per day for each drug or biological to arrive at its per day cost. For items that did not have an ASP-based payment rate, we used their mean unit cost derived from the CY 2004 hospital claims data to determine their per day cost. Our reasoning for using these cost data is discussed in section V.B.3.a. of this preamble.

    Step 9. We then packaged the items with per day cost based on the ASP methodology or mean cost less than $50 and made items with per day cost greater than $50 separately payable.

    In the past, many commenters have alleged that hospitals do not accurately bill the number of units for drugs and radiopharmaceuticals. We have consistently decided not to identify which hospital claims contain correctly coded units because we do not believe we should be identifying when a dosage is clinically appropriate from hospital claims information. Variations among patients with respect to appropriate doses, the variety of indications with different dosing regimens for some agents, and the possibility of off-label uses make it difficult to know when units are incorrect. However, we do believe that trimming the units would improve the accuracy of estimates by removing those records with the most extreme units, without requiring us to speculate about clinically appropriate dosing. Therefore, we believe that trimming the records with unit counts greater or less than 3 standard deviations from the geometric mean will eliminate claims from our analysis that may not appropriately represent the actual number of units of a drug or radiopharmaceutical furnished by a hospital to a patient during a specific clinical encounter. Because it reduces extreme variation, trimming on greater or less than 3 standard deviations from the geometric mean makes this trim more conservative and removes fewer records. This change in methodology gives us even greater confidence in the cost estimates we use for our packaging decisions. We are seeking comments on the changes that we are proposing in our methodology for packaging drugs and radiopharmaceuticals.

    Section 1833(t)(16)(B) of the Act that requires the threshold for establishing separate APCs for drugs and biologicals to be set at $50 per administration will expire at the end of CY 2006. Therefore, we will be evaluating other packaging thresholds for these products for the CY 2007 OPPS update. We are specifically requesting comments on the use of alternative thresholds for packaging drugs and radiopharmaceuticals in CY 2007.

    3. Proposed Payment for Drugs, Biologicals, and Radiopharmaceuticals Without Pass-Through Status That Are Not Packaged

    a. Proposed Payment for Specified Covered Outpatient Drugs

    (1) Background

    Section 1833(t)(14) of the Act, as added by section 621(a)(1) of Pub. L. 108-173, requires special classification of certain separately paid radiopharmaceutical agents, drugs, and biologicals and mandates specific payments for these items. Under section 1833(t)(14)(B)(i) of the Act, a “specified covered outpatient drug” is a covered outpatient drug, as defined in section 1927(k)(2) of the Act, for which a separate APC exists and that either is a radiopharmaceutical agent or is a drug or biological for which payment was made on a pass-through basis on or before December 31, 2002.

    Under section 1833(t)(14)(B)(ii) of the Act, certain drugs and biologicals are designated as exceptions and are not included in the definition of “specified covered outpatient drugs.” These exceptions are—

    • A drug or biological for which payment is first made on or after January 1, 2003, under the transitional pass-through payment provision in section 1833(t)(6) of the Act.
    • A drug or biological for which a temporary HCPCS code has not been assigned.
    • During CYs 2004 and 2005, an orphan drug (as designated by the Secretary).

    Section 1833(t)(14)(F) of the Act defines the categories of drugs based on section 1861(t)(1) and sections 1927(k)(7)(A)(ii), (k)(7)(A)(iii), and (k)(7)(A)(iv) of the Act. The categories of drugs are “sole source drugs (includes a biological product or a single source drug),” “innovator multiple source drugs,” and “noninnovator multiple source drugs.” The definitions of these specified categories for drugs, biologicals, and radiopharmaceutical agents were discussed in the January 6, 2004 OPPS interim final rule with comment period (69 FR 822), along with our use of the Medicaid average manufacturer price database to determine the appropriate classification Start Printed Page 42725of these products. Because of the many comments received on the January 6, 2004 interim final rule with comment period, the classification of many of the drugs, biologicals, and radiopharmaceuticals changed from that initially published. We announced these changes to the public on February 27, 2004, Transmittal 112, Change Request 3144. We also implemented additional classification changes through Transmittals 132 (Change Request 3154, released March 30, 2004) and Transmittal 194 (Change Request 3322, released June 4, 2004).

    Section 1833(t)(14)(A) of the Act, as added by section 621(a)(1) of Pub. L. 108-173, also provides that payment for these specified covered outpatient drugs for CYs 2004 and 2005 is to be based on its “reference average wholesale price.” Section 1833(t)(14)(G) of the Act) defines reference AWP as the AWP determined under section 1842(o) of the Act as of May 1, 2003. Section 1833(t)(14)(A)(ii) of the Act, as added by section 621(a) of Pub. L. 108-173 requires that in CY 2005—

    • A sole source drug must be paid no less than 83 percent and no more than 95 percent of the reference AWP.
    • An innovator multiple source drug must be paid no more than 68 percent of the reference AWP.
    • A noninnovator multiple source drug must be paid no more than 46 percent of the reference AWP.

    Section 1833(t)(14)(G) of the Act defines “reference AWP” as the AWP determined under section 1842(o) the Act as of May 1, 2003. We interpreted this to mean the AWP set under the CMS single drug pricer (SDP) based on prices published in the Red Book on May 1, 2003.

    For CY 2005, we finalized our policy to determine the payment rates for specified covered outpatient drugs under the provisions of Pub. L. 108-173 by comparing the payment amount calculated under the median cost methodology as done for procedural APCs to the AWP percentages specified in section 1833(t)(14)(A)(ii) of the Act.

    (2) Proposed Changes for CY 2006 Related to Pub. L. 108-173

    Section 1833(t)(14)(A)(iii) of the Act, as added by section 621(a)(1) of Pub. L. 108-173, requires that payment for specified covered outpatient drugs in CY 2006 be equal to the average acquisition cost for the drug for that year as determined by the Secretary but subject to any adjustment for overhead costs and taking into account the hospital acquisition cost survey data collected by the GAO in 2004 and 2005. If hospital acquisition cost data are not available, then the law requires that payment be equal to payment rates established under the methodology described in section 1842(o), section 1847(A), or section 1847(B) of the Act as calculated and adjusted by the Secretary as necessary.

    (3) Data Sources Available for Setting CY 2006 Payment Rates

    Section 1833(t)(14)(D) of the Act, as added by section 621(a)(1) of Pub. L. 108-173, outlines the provisions of the hospital outpatient drug acquisition cost survey mandated for the GAO. This provision directs the GAO to collect data on hospital acquisition costs of specified covered outpatient drugs and to provide information based on these data that can be taken into consideration for setting CY 2006 payment rates for these products under the OPPS. Accordingly, the GAO conducted a survey of 1,400 acute care, Medicare-certified hospitals requesting hospitals to provide purchase prices for specified covered outpatient drugs purchased from July 1, 2003 to June 30, 2004. The survey yielded a response rate of 83 percent where 1,157 hospitals provided usable information. To ensure that its methodology for data collection and analysis were sound, the GAO consulted an advisory panel of experts in pharmaceutical economics, pharmacy, medicine, survey sampling and Medicare payment.

    The GAO reported the average and median purchase prices for 55 specified covered outpatient drug categories for the period July 1, 2003 to June 30, 2004. These items represented 86 percent of the Medicare spending for specified covered outpatient drugs during the first 9 months of 2004. The initial GAO data did not include any radiopharmaceuticals. The report noted that the purchase price information accounted for volume and other discounts provided at the time of purchase, but excluded subsequent rebates from manufacturers and payments from group purchasing organizations.

    Another source of drug pricing information that we have is the ASP data from the fourth quarter of 2004, which were used to set payment rates for drugs and biologicals in the physician office setting effective April 1, 2005. We have ASP-based prices for approximately 475 drugs and biologicals (including contrast agents) payable under the OPPS; however, we currently do not have any ASP data on radiopharmaceuticals. Payments for most of the drugs and biologicals paid in the physician office setting are based on the ASP+6 percent. Payments for items with no reported ASP are based on wholesale acquisition cost (WAC).

    Lastly, the third source of cost data we have for drugs, biologicals, and radiopharmaceuticals are the mean and median costs derived from the CY 2004 hospital claims data. In our data analysis, we compared the payment rates for drugs and biologicals using data from all three sources described above. As section 1833(t)(14)(A)(iii) of the Act clearly specifies that payment for specified covered outpatient drugs in CY 2006 be equal to the “average” acquisition cost for the drug, we limited our analysis to the mean costs of drugs determined using the GAO acquisition cost survey and the hospital claims data, instead of using median costs.

    We estimated aggregate expenditures for all drugs and biologicals (excluding radiopharmaceuticals) that would be separately payable in CY 2006 and for the 55 drugs and biologicals reported by the GAO using mean cost from the claims data, the GAO mean purchase price, and the ASP-based payment amount (ASP+6 percent in most cases), and then calculated the equivalent average ASP-based payment rate under each of the three payment methodologies. The results are presented in Table 22 below.

    Table 22.—Comparison of Relative Pricing for OPPS Drugs and Biologicals Under Various Payment Methodologies

    Type of pricing dataTime period of pricing dataASP equivalent (55 GAO drugs only) (percent)ASP equivalent (all separately billable drugs)
    GAO mean purchase price12 months ending June 2004ASP+3N/A
    ASP+6%4th quarter of 2004ASP+6ASP+6%
    Start Printed Page 42726
    Mean cost from claims data1st 9 months of 2004ASP+8ASP+8%

    Prior to any adjustments for the differing time periods of the pricing data, the results indicated that using the GAO mean purchase prices as the basis for paying the 55 drugs and biologicals would be equivalent to paying for those drugs and biologicals, on average, at ASP+3 percent. Additionally, using mean unit cost to set the payment rates for the drugs and biologicals that would be separately payable in CY 2006 would be equivalent to basing their payment rates, on average, at ASP+8 percent.

    In determining the payment rates for drugs and biologicals in CY 2006, we are not proposing to use the GAO mean purchase prices for the 55 drugs and biologicals because the GAO data reflect hospital acquisition costs from a less recent period of time. The survey was conducted from July 1, 2003 to June 30, 2004; thus, the purchase prices are generally reflective of the time that is the midpoint of this period, which is January 1, 2004. The hospital purchase price data also does not fully account for rebates from manufacturers or payments from group purchasing organizations made to hospitals. We also note that it would be difficult to update the GAO mean purchase prices during CY 2006 and in future years.

    We are also not proposing, in general, to use mean costs from CY 2004 hospital claims data to set payment rates for drugs and biologicals in CY 2006. In previous OPPS rules, we stated that pharmacy overhead costs are captured in the pharmacy revenue cost centers and reflected in the median cost of drug administration APCs, and the payment rate we established for a drug, biological, or radiopharmaceutical APC was intended to pay only for the cost of acquiring the item (66 FR 59896 and 67 FR 66769). However, findings from a MedPAC survey of hospital charging practices indicated that hospitals set charges for drugs, biologicals, and radiopharmaceuticals high enough to reflect their handling costs as well as their acquisition costs; therefore, the mean costs calculated using charges from hospital claims data converted to costs are representative of hospital acquisition costs for these products, as well as their overhead costs. For CY 2006, the statute specifies that payments for specified covered outpatient drugs are required to be equal to the “average” acquisition cost for the drug. Payments based on mean costs would represent the products' acquisition costs plus overhead costs, instead of acquisition costs only. Therefore, we believe that it is appropriate for us to use a source of cost information other than the CY 2004 hospital claims data to set the payment rates for most drugs and biologicals in CY 2006.

    We are proposing to pay ASP+6 percent for separately payable drugs and biologicals in CY 2006. Given the data as described above, we believe this is our best estimate of average acquisition costs for CY 2006. We note that the comparison between the GAO purchase price data and the ASP data indicated that the GAO data on average were equivalent to ASP+3 percent. However, as noted earlier, this comparison is problematic for two reasons. First, there are differences in the time periods for two sources of data. The GAO data are from the 12 months ending June 2004 and the ASP data are from the fourth quarter of 2004. It could be argued that prices increased in the intervening time period. However, we do not have a source of reliable information on specific price changes for this time period for the drugs studied by the GAO. In the future, we will have better information on price trends for Medicare Part B drugs as more quarters of pricing information are reported under the ASP system.

    We also note the comparison between the GAO data and the ASP data is problematic as the ASP data include rebates and other price concessions and the GAO data do not. Inclusion of these rebates and price concession in the GAO data would decrease the GAO prices relative to the ASP prices, suggesting that ASP+6 percent may be an overestimate of hospitals' average acquisition costs. Unfornately, we do not have a source of information on the magnitude of the rebates and price concessions for the specific drugs in the GAO data at this time.

    At the present time, therefore, it is difficult to adjust the GAO prices for inflation, rebates, and price concessions to make the comparison with ASP more precise. We will continue to examine new data to improve our future estimates of acquisition costs. In future years, our proposed pricing will be modified as appropriate to reflect the most recent data and analyses available. We also note that, in addition to the importance of making accurate estimates of acquisition costs for drug pricing, there are important implications for prices of other services due to the required budget neutrality of the OPPS. For example, drugs and biological prices set at ASP+3 percent instead of ASP+6 percent would have made available approximately an additional $60 million for other items and services under the OPPS.

    We note that ASP data are unavailable for some drugs and biologicals. For the few drugs and biologicals, other than radiopharmaceuticals as discussed later, where ASP data are unavailable, we are proposing to use the mean costs from the CY 2004 hospital claims data to determine their packaging status for ratesetting. Until we receive ASP data for these items, payment will be based on their mean cost.

    Our proposal uses payment rates based on ASP data from the fourth quarter of 2004 because these are the most recent numbers available to us during the development of this proposed rule. To be consistent with the ASP-based payments that would be made when these drugs and biologicals are furnished in physician offices, we plan to make any appropriate adjustments to the amounts shown in Addenda A and B to this proposed rule for these items based on more recent ASP data from the second quarter of 2005, which will be the basis for setting payment rates for drugs and biologicals in the physician office setting effective October 1, 2005, prior to our publication of the CY 2006 OPPS final rule and also on a quarterly basis on our Web site during CY 2006. We note that we would determine the packaging status of each drug or biological only once during the year during the update process; however, for the separately payable drugs and biologicals, we would update their ASP-based payment rates on a quarterly basis. Start Printed Page 42727

    We intend for the quarterly updates of the ASP-based payment rates for separately payable drugs and biologicals to function as future surveys of hospital acquisition cost data, as section 1833(t)(14)(D)(ii) of the Act instructs us to conduct periodic subsequent surveys to determine hospital acquisition cost for each specified covered outpatient drug.

    We are specifically requesting comments on our proposal to pay for drugs and biologicals (including contrast agents) under the OPPS using the ASP-based methodology that is also used to set the payment rates for drugs and biologicals furnished in physician offices and the adequacy of the payment rates to account for acquisition costs of the drugs and biologicals.

    In CY 2005, we applied an equitable adjustment to determine the payment rate for darbepoetin alfa (Q0137) pursuant to section 1833(t)(2)(E) of the Act. However, for CY 2006, we are proposing to establish the payment rate for this biological using the ASP methodology. The ASP data represents market prices for this biological; therefore, we believe it is appropriate to use the ASP methodology to establish payment rates for darbepoetin alfa because this method will permit market forces to determine the appropriate payment for this biological. We are seeking comments on the proposed payment policy for this biological.

    Effective April 1, 2005, several HCPCS codes were created to describe various concentrations of low osmolar contrast material (LOCM). These new codes are Q9945 through Q9951. However, in Transmittal 514 (April 2005 Update of the OPPS), we instructed hospitals to continue reporting LOCM in CY 2005 using the existing HCPCS codes A4644, A4645, and A4646 and made Q9945 through Q9951 not payable under the OPPS. For CY 2006, we are proposing to activate the new Q-codes for hospitals and discontinue the use of HCPCS codes A4644 through A4646 for billing LOCM products. We have CY 2004 hospital claims data for HCPCS codes A4644 through A4646, which show that the mean costs per day for these products are greater than $50. Because we do not have CY 2004 hospital claims data for HCPCS codes Q9945 through Q9951, we crosswalked the cost data for the HCPCS A-codes to the new Q-codes. There is no predecessor code which crosswalks to HCPCS code Q9951 for LOCM with a concentration of 400 or greater mg/ml of iodine. Therefore, our general payment policy of paying separately for new codes while hospital data are being collected applies to HCPCS code Q9951. As our historical hospital mean per day costs for the three A codes exceed the packaging threshold and our payment policy for new codes without predecessors applies to one of the new codes, we are proposing to pay for the HCPCS codes Q9945 through Q9951 separately in CY 2006 at payment rates calculated using the ASP methodology. We note that because the new Q-codes describing LOCM are more descriptively discriminating and have different units than the previous A-codes for LOCM as well as widely varying ASPs, we expect that the packaging status of these Q-codes may change in future years when we have specific OPPS claims data for these new codes. We are seeking comments specifically on our proposed policy to pay separately for LOCM described by HCPCS codes Q9945 through Q9951 in CY 2006.

    (4) CY 2006 Proposed Payment Policy for Radiopharmaceutical Agents

    We do not have ASP data for radiopharmaceuticals. Therefore, for CY 2006, we are proposing to calculate per day costs of radiopharmaceuticals using mean unit cost from the CY 2004 hospital claims data to determine the items' packaging status similar to the drugs and biologicals with no ASP data. In a separate report, the GAO provided CMS with hospital purchase price information for nine radiopharmaceutical agents. As part of the GAO survey described earlier, the GAO surveyed 1,400 acute-care, Medicare-certified hospitals requesting hospitals to provide purchase prices for radiopharmaceuticals from July 1, 2003 to June 30, 2004. The radiopharmaceutical part of the survey yielded a response rate of 61 percent, where 808 hospitals provided usable information. The GAO reported the average and median purchase prices for nine radiopharmaceuticals for the period July 1, 2003 to June 30, 2004. These items represented 9 percent of the Medicare spending for specified covered outpatient drugs during the first 9 months of 2004. The report noted that the purchase price information accounted for volume and other discounts provided at the time of purchase, but excluded subsequent rebates from manufacturers and payments from group purchasing organizations.

    When we examined differences between the CY 2005 payment rates for these nine radiopharmaceutical agents and their GAO mean purchase prices, we saw that the GAO purchase prices were substantially lower for several of these agents. We also saw similar patterns when we compared the CY 2005 payment rates for radiopharmaceutical agents with their CY 2004 median and mean costs from hospital claims data. Our intent is to maintain consistency, whenever possible between the payment rates for these agents from CY 2005 to CY 2006, because such rapid reductions could adversely affect beneficiary access to services utilizing radiopharmaceuticals.

    As we do not have ASPs for radiopharmaceuticals that best represent market prices, we are proposing as a temporary 1-year policy for CY 2006 to pay for radiopharmaceutical agents that are separately payable in CY 2006 based on the hospital's charge for each radiopharmaceutical agent adjusted to cost. As MedPAC has indicated that hospitals currently include the charge for pharmacy overhead costs in their charge for the radiopharmaceutical, if we pay for these items using charges converted to cost, we believe that payment at cost would be the best available proxy for the average acquisition cost of the radiopharmaceutical along with its handling cost until we receive ASP information and overhead information on these agents. We expect that hospitals' different purchasing and preparation and handling practices for radiopharmaceuticals would be reflected in their charges, which would be converted to costs using hospital-specific cost-to-charge ratios. To better identify the separately payable radiopharmaceutical agents to which this policy would apply, we propose to assign them to status indicator “H” in Addendum B of this rule. Should ASP data be unavailable for radiopharmaceuticals for CY 2007, it is not apparent to us what methodology we could use to establish payment rates for these items in CY 2007 other than the hospital CY 2006 claims-based methodology. We are seeking comments specifically on the proposed payment policy for separately payable radiopharmaceutical agents in CY 2006.

    Section 303(h) of Pub. L. 108-173 exempted radiopharmaceuticals from ASP pricing in the physician office setting where the fewer numbers (relative to the hospital outpatient setting) of radiopharmaceuticals are priced locally by Medicare contractors. However, radiopharmaceuticals are subject to ASP reporting. We currently do not require reporting for radiopharmaceuticals because we do not pay for any of the radiopharmaceuticals using the ASP methodology. However, for CY 2006, we are proposing to begin collecting ASP data on all radiopharmaceutical agents for purposes of ASP-based payment of Start Printed Page 42728radiopharmaceuticals beginning in CY 2007.

    We recognize that there are significant complex issues surrounding the reporting of ASPs for radiopharmaceutical agents. Most radiopharmaceuticals must be compounded from a “cold kit” containing necessary nonradioactive materials for the final product to which a radioisotope is added. There are critical timing issues, given the short half-lives of many radioisotopes used for diagnostic or therapeutic purposes. Significant variations in practices exist with respect to what entity purchases the constituents and who then compounds the radiopharmaceutical to develop a final product for administration to a patient. For example, manufacturers may sell the components of a radiopharmaceutical to independent radiopharmacies. These radiopharmacies may then sell unit or multi-doses to many hospitals; however, some hospitals also may purchase the components of the radiopharmaceutical and prepare the radiopharmaceutical themselves. In some cases, hospitals may generate the radioisotope on-site, rather than purchasing it. The costs associated with acquiring the radiopharmaceutical in these instances may significantly vary. Also, there may only be manufacturer pricing for the components; however, the price set by the manufacturer for one component of a radiopharmaceutical may not directly translate into the acquisition cost of the ”complete” radiopharmaceutical, which may result from the combination of several components. In general, for drugs other than radiopharmaceuticals, the products sold by manufacturers with National Drug Codes (NDCs) correspond directly with the HCPCS codes for the products administered to patients so ASPs may be directly calculated for the HCPCS codes. In the case of radiopharmaceuticals this 1:1 relationship may not hold, potentially making the calculation of ASPs for radiopharmaceuticals more complex. In addition, some hospitals may generate their own radioisotopes, which they then use for radiopharmaceutical compounding, and they may sell these complete products to other sites. The costs associated with this practice could be difficult to capture through ASP reporting. We seek very specific comments on these and all other relevant issues surrounding implementation of ASP reporting for radiopharmaceuticals. We discuss in section V.B.3.a.(5) of this preamble under the MedPAC report on APC payment rate adjustments, our CY 2006 proposed payment policies for overhead costs of drugs, biologicals, and radiopharmaceuticals.

    In section V.D. of the preamble we discuss the methodology that we are proposing to use to determine the CY 2006 payment rates for new drugs, biologicals, and radiopharmaceuticals.

    While payments for drugs, biologicals and radiopharmaceuticals are taken into account when calculating budget neutrality, we note that we are proposing to pay for drugs, biologicals and radiopharmaceuticals without scaling these payment amounts. We believe that these payment amounts are the best proxies we have for the average acquisition costs of drugs, biologicals, and radiopharmaceuticals for CY 2006; therefore, Congress would not have intended for us to scale these payment rates. In section V.B.3.a.(5) of this preamble, we also discuss that we propose to add 2 percent of the ASP to the payment rates for drugs and biologicals with rates based on the ASP methodology to provide payment to hospitals for pharmacy overhead costs associated with furnishing these products. We are proposing to scale these additional payment amounts for pharmacy overhead costs. We are seeking comments on whether it is appropriate to exempt payment rates for drugs, biologicals, and radiopharmaceuticals from scaling and scale the additional payment amount for pharmacy overhead costs.

    We note that further discussion of the budget neutrality implications of the various drug payment proposals that we considered is included in section XIV.C. of this preamble.

    (5) MedPAC Report on APC Payment Rate Adjustment of Specified Covered Outpatient Drugs

    Section 1833(t)(14)(E) of the Act, as added by section 621(a)(1) of Pub. L. 108-173, requires MedPAC to submit a report to the Secretary, not later than July 1, 2005, on adjusting the APC rates for specified covered outpatient drugs to take into account overhead and related expenses, such as pharmacy services and handling costs. This provision also requires that the MedPAC report include the following: A description and analysis of the data available for adjusting such overhead expenses; recommendation as to whether a payment adjustment should be made; and the methodology for adjusting payment, if an adjustment is recommended. Section 1833(t)(14)(E)(ii) of the Act, as added by section 621(a)(1) of Pub. L. 108-173, authorizes the Secretary to adjust the APC weights for specified covered outpatient drugs to reflect the MedPAC recommendation.

    The statute mandates MedPAC to report on whether drug APC payments under the OPPS should be adjusted to account for pharmacy overhead and nuclear medicine handling costs associated with providing specified covered outpatient drugs. In creating its framework for analysis, MedPAC interviewed stakeholders, analyzed cost report data, conducted four individual hospital case studies, and received technical advice on grouping items with similar handling costs from a team of experts in hospital pharmacy, hospital finance, cost accounting, and nuclear medicine.

    MedPAC concluded that the handling costs for drugs, biologicals, and radiopharmaceuticals delivered in the hospital outpatient department are not insignificant, as medications typically administered in outpatient departments generally require greater pharmacy preparation time than do those provided to inpatients. MedPAC found that little information is currently available about the magnitude of these costs. According to the MedPAC analysis, hospitals historically set charges for drugs, biologicals, and radiopharmaceuticals at levels that reflected their respective handling costs, and payments covered both drug acquisition and handling. Moreover, hospitals vary considerably in their likelihood of providing services which utilize drugs, biologicals, or radiopharmaceuticals with different handling costs.

    MedPAC developed seven drug categories for pharmacy and nuclear medicine handling costs, according to the level of resources used to prepare the products (Table 23). Characteristics associated with the level of handling resources required included radioactivity, toxicity, mode of administration, and the need for special handling. Groupings ranged from dispensing an oral medication on the low end of relative cost to providing radiopharmaceuticals on the high end. MedPAC collected cost data from four hospitals that were then used to develop relative median costs for all categories but radiopharmaceuticals (Category 7+). The case study facilities were not able to provide sufficient cost information regarding the handling of outpatient radiopharmaceuticals to develop a cost relative for Category 7+. The MedPAC study classified about 230 different drugs, biologicals, and radiopharmaceuticals into the seven categories based on input from their expert panel and each case study facility. Start Printed Page 42729

    Table 23.—MedPAC Recommended Drug Categories and Median Cost Relatives

    Drug categoryDescriptionMedian cost relative
    Category 1Orals (oral tablets, capsules, solutions)0.36
    Category 2Injection/Sterile Preparation (draw up a drug for administration)1.00
    Category 3Single IV Solution/Sterile Preparation (adding a drug or drugs to a sterile IV solution) or Controlled Substances1.28
    Category 4Compounded/Reconstituted IV Preparations (requiring calculations performed correctly and then compounded correctly)1.61
    Category 5Specialty IV or Agents requiring special handling in order to preserve their therapeutic value or Cytotoxic Agents, oral (chemotherapeutic, teratogenic, or toxic) requiring PPE2.70
    Category 6Cytotoxic Agents (chemotherapeutic, teratogenic, or toxic) in all formulations except oral requiring personal protective equipment (PPE)5.33
    Category 7+Radiopharmaceuticals: Basic and Complex Diagnostic Agents, PET Agents, Therapeutic Agents, and Radioimmunoconjugates(1)
    1 Not available.

    In its report, MedPAC recommended the following:

    (1) Establish separate, budget neutral payments to cover the costs hospitals incur for handling separately payable drugs, biologicals, and radiopharmaceuticals; and

    (2) Define a set of handling fee APCs that group drugs, biologicals, and radiopharmaceuticals based on attributes of the products that affect handling costs; instruct hospitals to submit charges for these APCs; and base payment rates for the handling fee APCs on submitted charges reduced to costs.

    MedPAC found some differences in the categorizations of drug and radiopharmaceutical products by different experts and across the case study sites. In the majority of cases where groupings disagreed, hospitals used different forms of the products which were coded with the same HCPCS code. For example, a drug may be purchased as a prepackaged liquid or as a powder requiring reconstitution. Such a drug would vary in the handling resources required for its preparation and would fall into a different drug category depending on its form. In addition, the handling cost groupings may vary depending on the intended method of drug delivery, such as via intravenous push or intravenous infusion. For a number of commonly used drugs, MedPAC provided two categories in their final consensus categorizations, with the categories 2 and 3 reported as the most frequent combination. For example, MedPAC placed HCPCS codes J1260 (Injection, dolasetron mesylate, 10 mg) and J2020 (Injection, linezolid, 200 mg) in consensus categories 2 and 3, acknowledging that the appropriate categorization could vary depending on the clinical preparation and use of the drug. We note that we have no information regarding hospitals' frequencies of use of various forms of drugs provided in the outpatient department under the OPPS, as the case studies only included four facilities and the technical advisory committee was similarly small. Thus, in many cases it is impossible to exclusively and appropriately assign a drug to a certain overhead category that would apply to all hospital outpatient uses of the drug because of the different handling resources required to prepare different forms of the drugs.

    There are over 100 separately payable drugs, biologicals, and radiopharmaceuticals that are separately payable under the OPPS but for which MedPAC provided no consensus categorizations in its seven drug groups. We independently examined these products and considered the handling cost categories that could be appropriately assigned to each product as described by an individual HCPCS code. As discussed above, many of the drugs had several forms which would place them in different handling cost groupings depending on the specific form of the drug prepared by the hospital pharmacy for a patient's treatment. Additionally, we believe that hospitals may have difficulty discriminating among the seven categories for some drugs, because the applicability of a given category description to a specific clinical situation may be ambiguous. Indeed, in the MedPAC study, initially only about 80 percent of the case study pharmacists agreed with the expert panel category assignments; however, concurrence increased that percentage to almost 90 percent after discussion and review. Nevertheless, there remained a number of drugs for which differences in categorization by the case study facilities and the expert panel persisted.

    In light of our concerns over our ability to appropriately assign drugs to the seven MedPAC drug categories so that the categories accurately describe the drugs' attributes in all of the OPPS hospitals and the MedPAC recommendations, for CY 2006 we are proposing to establish three distinct HCPCS C-codes and three corresponding APCs for drug handling categories to differentiate overhead costs for drugs and biologicals, by combining several of the categories identified in the MedPAC report. We collapsed the MedPAC categories 2, 3, and 4 into a single category described by HCPCS code CXXXX, and MedPAC categories 5 and 6 into another category described by HCPCS code CYYYY, while maintaining MedPAC category 1 as described by HCPCS code CWWWW. Our rationale for not creating an overhead payment category for radiopharmaceuticals is discussed below. We believe that merging categories in this way generally resolves the categorization dilemmas resulting from the most common scenarios where drugs may fall into more than one grouping and minimizes the administrative burden on hospitals to determine which category applies to the handling of a drug in a specific clinical situation. In addition, these broader handling cost groupings minimize any undesirable payment policy incentives to utilize particular forms of drugs or specific preparation methods. We have only collapsed those categories whose MedPAC relative weights differ by less than a factor of two, consistent with the principle outlined in section 1833(t)(2) of the Act that provides that items and services within an APC group cannot be considered comparable with respect to the use of resources if the median of the highest cost item or service within an APC group is more than 2 times greater than the median of the lowest cost item or service within that same group.

    As noted previously, we believe that pharmacy overhead costs are captured in the pharmacy revenue cost centers and reflected in the median cost of drug Start Printed Page 42730administration APCs, and the payment rate we established for a drug, biological, or radiopharmaceutical APC was intended to pay only for the cost of acquiring the item (66 FR 59896 and 67 FR 66769). As a MedPAC survey of hospital charging practices indicated that hospitals' charges for drugs, biologicals, and radiopharmaceuticals reflect their handling costs as well as their acquisition costs, we believe pharmacy overhead costs would be incorporated into the OPPS payment rates for drugs, biologicals, and radiopharmaceuticals if the rates are based on hospital claims data. However, in light of our proposal to establish three distinct C-codes for drug handling categories, we are proposing to instruct hospitals to charge the appropriate pharmacy overhead C-code for overhead costs associated with each administration of each separately payable drug and biological based on the code description which best reflects the service the hospital provides to prepare the product for administration to a patient. We would then collect hospital charges for these C-codes for 2 years, and consider basing payment for the corresponding drug handling APCs on the charges reduced to costs in CY 2008, similar to the payment methodology for other procedural APCs. Median hospital costs for the drug handling APCs should reflect the CY 2006 practice patterns across all OPPS hospitals of handling drugs whose preparation is described by each of the C-codes, reflecting the differential utilization of various forms of drugs and alternative methods of preparation and delivery through hospitals' billing and charges for the C-codes. Table 24 contains the drug handling categories, C-codes, and APCs we are proposing for CY 2006.

    Table 24.—Proposed CY 2006 Drug Handling Categories, C-Codes, and APCs

    Drug handling categoryC codeDrug candling APCDescription
    Category 1CWWWWWWWW• Orals (oral tablets, capsules, solutions).
    Category 2CXXXXXXXX• Injection/Sterile Preparation (draw up a drug for administration).
    • Single IV Solution/Sterile Preparation (adding a drug or drugs to a sterile IV solution) or Controlled Substances.
    • Compounded/Reconstituted IV Preparations (requiring calculations performed correctly and then compounded correctly).
    Category 3CYYYYYYYY• Specialty IV or Agents requiring special handling in order to preserve their therapeutic value or Cytotoxic Agents, oral (chemotherapeutic, teratogenic, or toxic) requiring PPE.
    • Cytotoxic Agents (chemotherapeutic, teratogenic, or toxic) in all formulations except oral requiring personal protective equipment (PPE).

    We believe that these three categories are sufficiently distinct and reflective of the resources necessary for drug handling to permit appropriate hospital billing and to capture the varying overhead costs of the drugs and biologicals separately payable under the OPPS. We are not proposing to adopt the median cost relatives reported for MedPAC's six categories (excluding radiopharmaceuticals). It is very difficult to accurately crosswalk the cost relatives for the six categories to the three categories we are proposing. In addition, we are not confident that the cost relatives that were based on cost data from four hospitals appropriately reflect the median relative resource costs of all hospitals that would bill these drug handling services under the OPPS. Instead, we believe it is most appropriate to collect hospital charges for the drug handling services based on attributes of the products that affect the hospital resources required for their handling, and consider making future payments under the OPPS using the proposed C-codes based on the medians of charges converted to costs for the drug handling APC associated with each administration of a separately payable drug or biological.

    For CY 2006, pursuant to section 1833(t)(14)(E)(ii) of the Act, we propose an adjustment to cover the costs hospitals incur for handling separately payable drugs and biologicals. As we do not currently have separate hospital charge data on pharmacy overhead, we are proposing for CY 2006 to pay for drug and biological overhead costs based on 2 percent of the ASP. As described earlier, we estimated aggregate expenditure for all separately payable OPPS drugs and biologicals (excluding radiopharmaceuticals) using mean costs from the claims data and then determined the equivalent average ASP-based rates. Our calculations indicated that using mean unit costs to set the payment rates for all separately payable drugs and biologicals would be equivalent to basing their payment rates on the ASP+8 percent. As noted previously, because pharmacy overhead costs are already built into the charges for drugs, biologicals, and radiopharmaceuticals as indicated by the MedPAC study described above, we believe that payment for drugs and biologicals and overhead at a combined ASP+8 percent would serve as a proxy for representing both the acquisition cost and overhead cost of each of these products. Moreover, as we are proposing to pay for all separately payable drugs and biologicals using the ASP methodology, where payment rates for most of these items are set at the ASP+6 percent, we believe that an additional 2 percent of the ASP would provide adequate additional payment for the overhead cost of these products and be consistent with historical hospital costs for drug acquisition and handling. Even though we are not proposing to scale the payment rates for drugs and biologicals based on the ASP methodology, we are proposing to scale the additional payment amount of 2 percent of the ASP for pharmacy overhead costs. Therefore, for CY 2006, we are proposing to pay an additional 2 percent of the ASP scaled for budget neutrality for overhead costs associated with separately payable drugs and biologicals, along with paying ASP+6 percent for the acquisition costs of the drugs and biologicals. The payment rate for a separately payable drug or biological shown in Addenda A and B to this proposed rule represents the payment rate for the drug or biological in addition to payment for its overhead costs. We are specifically seeking comments on this proposed policy for paying for pharmacy overhead costs in CY 2006 and on the proposed policy regarding hospital billing of drug handling charges associated with each administration of each separately payable drug or biological using the proposed C-codes.

    As discussed earlier, we are proposing to pay for separately payable radiopharmaceutical agents based on their charges in the claims submitted by hospitals converted to costs. MedPAC found that the handling resource costs Start Printed Page 42731associated with radiopharmaceuticals were especially difficult to study because of the varying resource requirements for handling them in a variety of hospital outpatient settings for different clinical uses. These various methods of preparation of radiopharmaceuticals, and the individual radiopharmaceuticals themselves, differ significantly in the costs of their handling, with substantial variation in such factors as site of preparation, personnel time, shielding, transportation, equipment, waste disposal, and regulatory compliance requirements. However, as MedPAC also found that handling costs for drugs, biologicals, and radiopharmaceuticals were built into hospitals' charges for the products themselves, we believe that the charges from hospital claims converted to costs are representative of hospital acquisition costs for these agents, as well as their overhead costs. These costs would appropriately reflect each hospital's potentially diverse patterns of acquisition or production of radiopharmaceuticals for use in the outpatient hospital setting and their related handling costs that vary across radiopharmaceutical products and the circumstances of their production and use. Therefore, we are not proposing to create separate handling categories for radiopharmaceutical agents for CY 2006.

    However, because we are proposing to collect ASP information for radiopharmaceuticals in CY 2006, we are seeking specific comments on appropriate categories for potentially capturing radiopharmaceutical handling costs. We believe that these handling costs may vary depending on many factors. The handling cost categories should exclude any resources covered by specific diagnostic procedures or administration codes for patient services that utilize the radiopharmaceuticals. However, the handling cost categories should include all aspects of radiopharmaceutical handling and preparation, including transportation, storage, compounding, required shielding, inventory management, revision of dosages based on patient conditions, documentation, disposal, and regulatory compliance. The MedPAC study contractor suggested a variety of discriminating factors which may be related to the magnitude of radiopharmaceutical handling costs, including the complexity of the calculations and manipulations involved with compounding, the intended use of the product for diagnostic or therapeutic purposes, the item's status as a radioimmunoconjugate or non-radioimmunoconjugate, short-lived agents produced in-house, and preparation of the radiopharmaceutical in-house versus production in a commercial radiopharmacy. We are seeking comments on the construction of radiopharmaceutical handling cost categories that would meaningfully reflect differences in the levels of necessary hospital resources and that could easily be understood and applied by hospitals characterizing their preparation of radiopharmaceuticals.

    b. Proposed CY 2006 Payment for Nonpass-Through Drugs, Biologicals, and Radiopharmaceuticals With HCPCS Codes, But Without OPPS Hospital Claims Data

    Pub. L. 108-173 does not address the OPPS payment in CY 2005 and after for new drugs, biologicals, and radiopharmaceuticals that have assigned HCPCS codes, but that do not have a reference AWP or approval for payment as pass-through drugs or biologicals. Because there is no statutory provision that dictated payment for such drugs and biologicals in CY 2005, and because we had no hospital claims data to use in establishing a payment rate for them, we investigated several payment options for CY 2005 and discussed them in detail in the CY 2005 OPPS final rule with comment period (69 FR 65797 through 65799).

    For CY 2006, we are proposing to use the same methodology that we used in CY 2005. That is, we are proposing to pay for these new drugs and biologicals with HCPCS codes but which do not have pass-through status at a rate that is equivalent to the payment they would receive in the physician office setting, which would be established in accordance with the ASP methodology described in the CY 2005 Medicare Physician Fee Schedule final rule (69 FR 66299). As discussed in the OPPS CY 2005 final rule (69 FR 65797), new drugs, biologicals, and radiopharmaceuticals may be expensive and we are concerned that packaging these new items may jeopardize beneficiary access to them. In addition, we do not want to delay separate payment for these items solely because a pass-through application was not submitted. We note that this payment methodology is the same as the methodology that would be used to calculate the OPPS payment amount that pass-through drugs and biologicals would be paid in CY 2006 in accordance with section 1842(o) of the Act, as amended by section 303(b) of Pub. L. 108-173, and section 1847A of the Act. Thus, we are proposing to continue to treat new drugs, biologicals, and radiopharmaceuticals with established HCPCS codes the same, irrespective of whether pass-through status has been determined. We are also proposing to assign status indicator “K” to HCPCS codes for new drugs and biologicals for which we have not received a pass-through application.

    There are several drugs, biologicals, and radiopharmaceuticals that were payable during CY 2004 or their HCPCS codes were created effective January 1, 2005 for which we do not have any CY 2004 hospital claims data. In order to determine the packaging status of these items for CY 2006, we calculated an estimate of per day cost of each of these items by multiplying the payment rate for each product as determined using the ASP methodology by an estimated average number of units of each product that would be furnished to a patient during one administration. We are proposing to package items for which we estimated the per administration cost to be less than $50 and pay separately for items with estimated per administration cost greater than $50. Payment for the separately payable items would be based on rates determined using the ASP methodology established in the physician office setting. There are two codes 90393 (Vaccina ig, im) and Q9953 (Inj Fe-based MR contrast, ml) for which we were not able to determine payment rates based on the ASP methodology. Because we are unable to estimate the per administration cost of these items, we are proposing to package them in CY 2006. We are specifically seeking comments on our proposed policy for determining per administration cost of these drugs, biologicals, and radiopharmaceuticals that are payable under the OPPS, but do not have any CY 2004 claims data.Start Printed Page 42732

    Table 25.—Proposed CY ASP Payment Rate for Drugs, Biologicals, and Radiopharmaceuticals Without CY 2004 Claims Data

    HCPCS codeDescriptionAPCASP-based payment rateEst. average number of units per administrationProposed 2006 status indicator
    C1093TC99M fanolesomab1093$1,197.001H
    C9206Integra, per cm292069.0619K
    J0135Adalimumab injection1083294.632K
    J0288Ampho b cholesteryl sulfate073512.0035K
    J0395Arbutamine HCl injection9031160.001K
    J1180Dyphylline injection91667.598.4K
    J1457Gallium nitrate injection10851.28340K
    J3315Triptorelin pamoate9122363.241K
    J7350Injectable human tissue90553.4733K
    J9357Valrubicin, 200 mg9167369.604K
    Q2012Pegademase bovine, 25 iu9168158.0556K
    Q2018Urofollitropin, 75 iu703743.872K
    90581Anthrax vaccine, sc9169126.461K
    J0200Alatrofloxacin mesylate14.752.5N
    J7674Methacholine chloride, neb0.408.875N
    J0190Inj biperiden lactate/5 mg3.161N
    J3530Nasal vaccine inhalation15.001N

    C. Proposed Coding and Billing Changes for Specified Covered Outpatient Drugs

    (If you choose to comment on issues in this section, please include the caption “Drug Coding and Billing” at the beginning of your comment.)

    1. Background

    As discussed in the January 6, 2004 interim final rule with comment period (69 FR 826), we instructed hospitals to bill for sole source drugs using the existing HCPCS codes, which were priced in accordance with the provisions of section 1833(t)(14)(A)(i) of the Act, as added by Pub. L. 108-173. However, at that time, the existing HCPCS codes did not allow us to differentiate payment amounts for innovator multiple source and noninnovator multiple source forms of the drug. Therefore, effective April 1, 2004, we implemented new HCPCS codes via Program Transmittal 112 (Change Request 3144, February 27, 2004) and Program Transmittal 132 (Change Request 3154, March 30, 2004) that providers were instructed to use to bill for innovator multiple source drugs in order to receive appropriate payment in accordance with section 1833(t)(14)(A)(i)(II) of the Act. We also instructed providers to continue to use the existing HCPCS codes to bill for noninnovator multiple source drugs to receive payment in accordance with section 1833(t)(14)(A)(i)(III) of the Act. These coding policies allowed hospitals to appropriately code for drugs, biologicals, and radiopharmaceuticals based on their classification and to be paid accordingly. We continued this coding practice in CY 2005 with payment made in accordance with section 1833(t)(14)(A)(ii) of the Act.

    2. Proposed Policy for CY 2006

    For CY 2006, we are proposing to base the payment rates for drugs and biologicals and their pharmacy overhead costs on the ASP methodology that is used to set payment rates for these items in the physician office setting. Under this methodology, a single payment rate for the drug is calculated by considering the prices for both the innovator multiple source (brand) and noninnovator multiple source (generic) forms of the drug. Therefore, under the OPPS, we believe that there is no longer a need to differentiate between the brand and generic forms of a drug. Thus, we are proposing to discontinue use of the C-codes that were created to represent the innovator multiple source drugs. In CY 2006, hospitals would use the HCPCS codes for noninnovator multiple source (generic) drugs to bill for both the brand and generic forms of a drug as they did prior to implementation of section 1833(t)(14)(A) in Pub. L. 108-173. We are specifically requesting comments on this proposed policy.

    D. Proposed Payment for New Drugs, Biologicals, and Radiopharmaceuticals Before HCPCS Codes Are Assigned

    (If you choose to comment on issues in this section, please include the caption “HCPCS Codes” at the beginning of your comment.)

    1. Background

    Historically, hospitals have used a HCPCS code for an unlisted or unclassified drug, biological, or radiopharmaceutical or used an appropriate revenue code to bill for drugs, biologicals, and radiopharmaceuticals furnished in the outpatient department that do not have an assigned HCPCS code. The codes for not otherwise classified drugs, biologicals, and radiopharmaceuticals are assigned packaged status under the OPPS. That is, separate payment is not made for the code, but charges for the code would be eligible for an outlier payment and, in future OPPS updates, the charges for the code are packaged with the separately payable service with which the code is reported for the same date of service.

    Drugs and biologicals that are newly approved by the FDA and for which a HCPCS code has not yet been assigned by the National HCPCS Alpha-Numeric Workgroup could qualify for pass-through payment under the OPPS. An application must be submitted to CMS in order for a drug or biological to be assigned pass-through status, a temporary C-code assigned for billing purposes, and an APC payment amount to be determined. Pass-through applications are reviewed on a flow basis, and payment for drugs and biologicals approved for pass-through status is implemented throughout the year as part of the quarterly updates of the OPPS.

    2. Proposed Policy for CY 2006

    Section 1833(t)(15) of the Act, as added by section 621(a)(1) of Pub. L. 108-173, provides for payment for new drugs and biologicals until HCPCS codes are assigned under the OPPS. Under this provision, we are required to make payment for an outpatient drug or Start Printed Page 42733biological that is furnished as part of the covered OPD services for which a HCPCS code has not been assigned in an amount equal to 95 percent of AWP. This provision applies only to payments made under the OPPS on or after January 1, 2004.

    We initially adopted the methodology for determining payment under section 1833(t)(15) of the Act on an interim basis on May 28, 2004, via Transmittal 188, Change Request 3287, and finalized the methodology for CY 2005 in our CY 2005 OPPS final rule with comment period. In that final rule with comment period, we also expanded the methodology to include payment for new radiopharmaceuticals to which a HCPCS code is not assigned (69 FR 65804 through 65807). We instructed hospitals to bill for a drug or biological that is newly approved by the FDA by reporting the NDC for the product along with a new HCPCS code, C9399 (Unclassified drug or biological). When HCPCS code C9399 appears on a claim, the OCE suspends the claim for manual pricing by the fiscal intermediary. The fiscal intermediary prices the claim at 95 percent of its AWP using the Red Book or an equivalent recognized compendium, and processes the claim for payment. This approach enables hospitals to bill and receive payment for a new drug, biological, or radiopharmaceutical concurrent with its approval by the FDA. The hospital does not have to wait for the next OPPS quarterly release or for approval of a product-specific HCPCS code to receive payment for a newly approved drug, biological, or radiopharmaceutical. In addition, the hospital does not have to resubmit claims for adjustment. Hospitals would discontinue billing HCPCS code C9399 and the NDC upon implementation of a HCPCS code, status indicator, and appropriate payment amount with the next OPPS quarterly update.

    For CY 2006, we are proposing to continue the same methodology for paying for new drugs, biologicals, and radiopharmaceuticals without HCPCS codes.

    E. Proposed Payment for Vaccines

    (If you choose to comment on issues in this section, please include the caption “Vaccines” at the beginning of your comment.)

    Outpatient hospital departments administer large numbers of immunizations 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 the 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 the OPPS rates as a major concern. They indicated 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 costs 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, which were paid for these vaccines under the OPPS in CY 2002, have been receiving payment at reasonable cost for these vaccines since CY 2003.

    Influenza, pneumococcal, and hepatitis B vaccines and their administration are specifically covered by Medicare under section 1861(s)(10) of the Act. We are proposing to continue to pay influenza and pneumococcal vaccines at reasonable cost in CY 2006. However, hepatitis B vaccines so far have been paid under clinical APCs that also include other vaccines. For CY 2006, we are proposing to pay for all hepatitis B vaccines at reasonable cost, consistent with the payment methodology for influenza and pneumococcal vaccines. Influenza and pneumococcal vaccines are exempt from coinsurance and deductible payments under sections 1833(a)(3) and 1833(b) of the Act and have been assigned to status indicator “L”. However, hepatitis B vaccines have no similar coinsurance or deductible exemption. Therefore, we are proposing to assign these items to status indicator “F”.

    Previously, under the OPPS, separately payable vaccines other than influenza and pneumococcal were grouped into clinical APCs 355 and 356 for payment purposes. Payment rates for these APCs were based on the APCs' median costs, calculated from the costs of all of the vaccines grouped within the APCs. For CY 2006, we are proposing to pay for each separately payable vaccine under its own APC, consistent with our policy for separately payable drugs other than vaccines, instead of aggregating them into clinical APCs with other vaccines. We believe this policy would allow us to more appropriately establish a payment rate for each separately payable vaccine based on the ASP methodology. We are specifically requesting comments on our proposed vaccine policies for CY 2006. Proposed policy changes to coding and payments for the administration of these vaccines are discussed in section VIII. of this preamble.

    F. Proposed Changes in Payment for Single Indication Orphan Drugs

    (If you choose to comment on issues in this section, please include the caption “Orphan Drugs” at the beginning of your comment.)

    Section 1833 (t)(1)((B)(i) of the Act gives the Secretary the authority to designate the hospital outpatient services to be covered. The Secretary has specified coverage for certain drugs as orphan drugs (section 1833(t)(14)(B)(ii)(III) of the Act, as added by section 621(a)(1) of Pub. L. 108-173). Section 1833 (t)(14)(C) of the Act, as added by section 621(a)(1) of Pub. L. 108-173, gives the Secretary the authority in CYs 2004 and 2005 to specify the amount of payment for an orphan drug that has been designated as such by the Secretary.

    We recognize that orphan drugs that are used solely for an orphan condition or conditions are generally expensive and, by definition, are rarely used. We believe that if the costs of these drugs were packaged into the payment for an associated procedure or visit, the payment for the procedure might be insufficient to compensate a hospital for the typically high costs of this special type of drug. Therefore, we are proposing to continue paying for them separately.

    In the November 1, 2002 final rule (67 FR 66772), we identified 11 single indication 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).

    Eleven single indication orphan drugs were identified as having met these criteria and payments for these drugs were made outside of the OPPS on a reasonable cost basis.

    In the November 7, 2003 final rule with comment period (68 FR 63452), we discontinued payment for orphan drugs on a reasonable cost basis and made separate payments for each single indication orphan drug under its own APC. Payments for the orphan drugs were made at 88 percent of the AWP listed for these drugs in the April 1, 2003 single drug pricer, unless we were presented with verifiable information Start Printed Page 42734that showed that our payment rate did not reflect the price that was widely available to the hospital market. For CY 2004, Ceredase (alglucerase) and Cerezyme (imiglucerase) were paid at 94 percent of the AWP because external data submitted by commenters on the August 12, 2003 proposed rule caused us to believe that payment at 88 percent of the AWP would be insufficient to ensure beneficiaries' access to these drugs.

    In the December 31, 2003 correction of the November 7, 2003 final rule with comment period (68 FR 75442), we added HCPCS code J9017 (Arsenic trioxide, 1 mg) to our list of single indication orphan drugs. In the November 15, 2004 final rule with comment period (69 FR 65807), we retained the same criteria for identifying single indication orphan drugs and added two HCPCS codes to our list—C9218 (Injection, Azactidine, per 1 mg) and J9010 (Alemtuzumab, 10 mg) (69 FR 65808). As of CY 2005, the following are the 14 orphan drugs that we have identified as meeting our criteria: C9218 (Injection, Azactidine, per 1 mg); J0205 (Injection, Alglucerase, per 10 units); J0256 (Injection, Alpha 1-proteinase inhibitor, 10 mg); J9300 (Gemtuzumab ozogamicin, 5mg); J1785 (Injection, Imiglucerase, per unit); J2355 (Injection, Oprelvekin, 5 mg); J3240 (Injection, Thyrotropin alpha, 0.9 mg); J7513 (Daclizumab, parenteral, 25 mg); J9010 (Alemtuzumab, 10 mg); J9015 (Aldesleukin, per single use vial); J9017 (Arsenic trioxide, 1 mg); J9160 (Denileukin diftitox, 300 mcg); J9216 (Interferon, gamma 1-b, 3 million units); and Q2019 (Injection, Basiliximab, 20 mg).

    In the November 15, 2004 final rule with comment period (69 FR 65808), we stated that had we not classified these drugs as single indication orphan drugs for payment under the OPPS, they would have met the definition of single source specified covered outpatient drugs and received lower payments, which could have impeded beneficiary access to these unique drugs dedicated to the treatment of rare diseases. Instead, for CY 2005, under our authority at section 1833(t)(14)(C) of the Act, we set payment for all 14 single indication orphan drugs at the higher of 88 percent of the AWP or the ASP+6 percent. For CY 2005, we also updated on a quarterly basis the payment rates through comparison of the most current ASP and AWP information available to us. Given that CY 2005 was the first year of mandatory ASP reporting by manufacturers, we did not want potential significant fluctuations in the ASPs to affect payments to hospitals furnishing these drugs, which in turn might cause access problems for beneficiaries. Therefore, in the November 15, 2004 final rule, we did not implement the proposed 95 percent AWP cap on payments for single indication orphan drugs which was described in the August 16, 2004 proposed rule (69 FR 50518), as we intended to monitor the impact of our payment policy and consider the need for a cap in future OPPS updates if appropriate (69 FR 65809).

    As a part of the GAO study on hospital acquisition costs of specified covered outpatient drugs, the GAO provided the average hospital purchase prices for four orphan drugs: J0256 (Injection, Alpha 1-proteinase inhibitor, 10 mg), J1785 (Injection, Imiglucerase, per unit), J9160 (Denileukin difitox, 300 mcg), and J9010 (Alemtuzumab, 10 mg).

    For alpha 1-proteinase inhibitor (J0256), the hospitals in the study sample represented only about 14 percent of the estimated total number of hospitals purchasing the drug. The mean hospital purchase price was about 73 percent of the payment rate based on ASP+6 percent rate and about 63 percent of the CY 2005 payment rate updated in April 2005. We believe the GAO acquisition data for alpha 1-proteinase inhibitor are likely not representative of hospital acquisition costs for the drug because the number of hospitals providing data was so small compared to the total number of hospitals expected to utilize the drug. Furthermore, we recognize that the GAO data on hospital drug acquisition costs do not reflect the current acquisition costs experienced by hospitals but instead, rely on past cost data from late CY 2003 through early CY 2004. On the other hand, the ASP data are more current and thus are likely more reflective of present hospital acquisition costs for alpha 1-proteinase inhibitor.

    In contrast to the GAO data for alpha 1-proteinase inhibitor, the GAO data for imiglucerase (J1785) reflect hospital purchase prices from about 69 percent of the hospitals expected to utilize the drug. For this drug, the mean hospital purchase price was about 93 percent of the CY 2005 payment rate for imiglucerase updated in April 2005, which was based on ASP+6 percent rate. Thus, the ASP-based payment rate also would appear to be appropriately reflective of hospital acquisition costs for imiglucerase, and to be consistent with the GAO mean purchase price.

    For denileukin difitox (J9160) and alemtuzumab (J9010), the GAO data for these drugs reflect hospital purchase prices from about 77 percent and 66 percent of the hospitals expected to acquire these drugs, respectively. The mean hospital purchase price for denileukin difitox was about 94 percent of the payment rate based on the ASP+6 percent rate and about 79 percent of the CY 2005 payment rate. As for alemtuzumab, the mean hospital purchase price was about 95 percent of the payment rate based on the ASP+6 percent rate and about 89 percent of the CY 2005 payment rate. For both of these drugs, the ASP-based payment rates also appear to be appropriately reflective of their hospital acquisition costs, based on confirmation by the GAO average purchase price data from over two-thirds of the hospitals expected to acquire the drugs.

    During the quarterly updates to payment rates for single indication orphan drugs for CY 2005, we observed significant improvement in the accuracy and consistency of manufacturers' reporting of the ASPs for these orphan drugs. Overall, we found that the ASPs as compared to the AWPs were less likely to experience dramatic fluctuations in prices from quarter to quarter. We expect that as the ASP system continues to mature, manufacturers will further refine their quarterly reporting, leading to even greater stability and accuracy in their reporting of sales prices. As the ASPs reflect the average sales prices to all purchasers, the ASP data also include drug sales to hospitals. Past commenters have indicated to us that some orphan drugs are administered principally in hospitals, and to the extent that this is true their ASPs should predominantly be based upon the sales of drugs used by hospitals. For three of the orphan drugs for which the GAO provided average purchase prices from a large percentage of hospitals expected to acquire the drugs, the GAO data were very consistent with the ASP+6 percent. For the fourth drug, the GAO mean was significantly lower than the ASP+6 percent and the confidence interval around that mean was quite tight, although only a small proportion of hospitals expected to acquire the drug reported their purchase prices. Thus, we believe that proposing to pay for orphan drugs based on an ASP methodology is appropriate for the CY 2006 OPPS and should assure patients' continued access to these orphan drugs in the hospital outpatient department. Therefore, for CY 2006, we are proposing to pay for single indication orphan drugs at the ASP+6 percent. We believe that paying for orphan drugs using the ASP methodology is consistent with our proposed general drug payment policy for other separately payable drugs and Start Printed Page 42735biologicals in the CY 2006 and reflects our general view that ASP-based payment rates serve as the best proxy for the average acquisition cost for these items as described in this section V. of the preamble. In addition, we are proposing to pay an additional 2 percent of the ASP scaled for budget neutrality to cover the handling costs of these drugs, also consistent with our proposed general pharmacy overhead payment policy for handling costs associated with separately payable drugs and biologicals. We believe that the ASPs plus 6 percent for orphan drugs will provide appropriate payment for hospital acquisition costs for these drugs that are administered by a relatively small number of providers, so that patients will continue to have access to orphan drugs in the hospital outpatient setting. Hospitals will also receive additional payments for costs associated with their storage, handling, and preparation of orphan drugs. Payment rates will be updated on a quarterly basis to reflect the most current ASPs available to us. Appropriate adjustments to the payment amounts shown in Addendum A and B would be made if the ASP submissions in a later quarter indicate that adjustments to the payment rates are necessary. These changes to the Addenda would be announced in our program instructions released on a quarterly basis and posted on our Web site at http://www.cms.hhs.gov. We are specifically requesting comments on our proposed payment policy for orphan drugs in CY 2006.

    VI. Estimate of Transitional Pass-Through Spending in CY 2006 for Drugs, Biologicals, and Devices

    (If you choose to comment on issues in this section, please include the caption “Estimated Transitional Pass-Through Spending” at the beginning of your comment.)

    A. Total Allowed Pass-Through Spending

    Section 1833(t)(6)(E) of the Act limits the total projected amount of transitional pass-through payments for drugs, biologicals, radiopharmaceuticals, and categories of devices for a given year to an “applicable percentage” of projected total Medicare and beneficiary payments under the hospital OPPS. For a year before CY 2004, the applicable percentage was 2.5 percent; for CY 2005 and subsequent years, we specify the applicable percentage up to 2.0 percent.

    If we estimate before the beginning of the calendar year that the total amount of pass-through payments in that year would exceed the applicable percentage, section 1833(t)(6)(E)(iii) of the Act requires a 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 payments exceed the applicable percentage, but also to determine the appropriate reduction to the conversion factor for the projected level of pass-through spending in the following year.

    For devices, making an estimate of pass-through spending in CY 2006 entails estimating spending for two groups of items. The first group consists of those items for which we have claims data for procedures that we believe used devices that were eligible for pass-through status in CY 2004 and CY 2005 and that would continue to be eligible for pass-through payment in CY 2006. The second group consists of those items for which we have no direct claims data, that is, items that became, or would become, eligible in CY 2005 and would retain pass-through status in CY 2006, as well as items that would be newly eligible for pass-through payment beginning in CY 2006.

    B. Estimate of Pass-Through Spending for CY 2006

    We are proposing to set the applicable percentage cap at 2.0 percent of the total OPPS projected payments for CY 2006. As we discuss in section IV.C. of this preamble, the three remaining device categories receiving pass-through payment in CY 2005 will expire on December 31, 2005. Therefore, we estimate pass-through spending attributable to the first group of items described above to equal zero.

    To estimate CY 2006 pass-through spending for device categories in the second group, that is, items for which we have no direct claims data, we are proposing to use the following approach: For additional device categories that are approved for pass-through status after July 1, 2005, but before January 1, 2006, we are proposing to use price information from manufacturers and volume estimates based on claims for procedures that would most likely use the devices in question because we would have no CY 2004 claims data upon which to base a spending estimate. We are proposing to project these data forward to CY 2006 using inflation and utilization factors based on total growth in OPPS services as projected by CMS' Office of the Actuary (OACT) to estimate CY 2006 pass-through spending for this group of device categories. For device categories that become eligible for pass-through status in CY 2006, we are proposing to use the same methodology. We anticipate that any new categories for January 1, 2006, would be announced after the publication of this proposed rule, but before publication of the final rule. Therefore, the estimate of pass-through spending in the CY 2006 OPPS final rule would incorporate any pass-through spending for device categories made effective January 1, 2006, and during subsequent quarters of CY 2006.

    With respect to CY 2006 pass-through spending for drugs and biologicals, as we explain in section V.A.3. of this proposed rule, the pass-through payment amount for new drugs and biologicals that we determine have pass-through status would equal zero. Therefore, our estimate of pass-through spending for drugs and biologicals with pass-through status in CY 2006 equals zero.

    In accordance with the methodology described above and the methodology for estimating pass-through spending discussed in the August 16, 2004 proposed rule (69 FR 50526), we estimate that total pass-through spending for device categories that first become eligible for pass-through status after publication of this proposed rule for which pass-through payment continues in CY 2006 or become eligible during CY 2006 would equal approximately $12.5 million, which represents 0.05 percent of total OPPS projected payments for CY 2006. This figure includes estimates for the current device categories continuing into CY 2006, which equals zero, in addition to projections for categories that first become eligible during the second half of CY 2005 or in CY 2006.

    This estimate of total pass-through spending for CY 2006 is significantly lower than previous years' estimates both because of the method we are proposing in section V.A.3. of this preamble for determining the amount of pass-through payment for drugs and biologicals with pass-through status, and the fact that there are no CY 2005 pass-through device categories that are being carried over to CY 2006.

    Because we estimate pass-through spending in CY 2006 would not amount to 2.0 percent of total projected OPPS CY 2006 spending, we are proposing to return 1.95 percent of the pass-through pool to adjust the conversion factor, as we discuss in section II.C. of this preamble. Start Printed Page 42736

    VII. Proposed Brachytherapy Payment Changes

    (If you choose to comment on issues in this section, please include the caption “Brachytherapy” at the beginning of your comment.)

    A. Background

    Section 1833(t)(16)(C) and section 1833(t)(2)(H) of the Act, as added by sections 621(b)(1) and (b)(2) of Pub. L. 108-173, respectively, establish separate payment for devices of brachytherapy consisting of a seed or seeds (or radioactive source) based on a hospital's charges for the service, adjusted to cost. Charges for the brachytherapy devices may not be used in determining any outlier payments under the OPPS. In addition, consistent with our practice under the OPPS to exclude items paid at cost from budget neutrality consideration, these items must be excluded from budget neutrality as well. The period of payment under this provision is for brachytherapy sources furnished from January 1, 2004, through December 31, 2006.

    Section 621(b)(3) of Pub. L. 108-173 requires the Government Accountability Office (GAO) to conduct a study to determine appropriate payment amounts for devices of brachytherapy, and to submit a report on its study to the Congress and the Secretary, including recommendations. We are awaiting the report and any recommendations on the payment of brachytherapy, which would pertain to brachytherapy payments after December 31, 2006.

    In the OPPS interim final rule with comment period published on January 6, 2004 (69 FR 827), we implemented sections 621(b)(1) and (b)(2)(C) of Pub. L. 108-173. In that rule, we stated that we will pay for the brachytherapy sources listed in Table 4 of the interim final rule with comment period (69 FR 828) on a cost basis, as required by the statute. The status indicator for brachytherapy sources was changed to “H.” The definition of status indicator “H” was for pass-through payment only for devices, but the brachytherapy sources affected by sections 1833(t)(16)(C) and 1833(t)(2)(H) of the Act are not pass-through device categories. Therefore, we also changed, for CY 2004, the definition of payment status indicator “H” to include nonpass-through brachytherapy sources paid on a cost basis. This use of status indicator “H” was a pragmatic decision that allowed us to pay for brachytherapy sources in accordance with section 1833(t)(16)(C) of the Act, effective January 1, 2004, without having to modify our claims processing systems. We stated in the January 6, 2004 interim final rule with comment period that we would revisit the use and definition of status indicator “H” for this purpose in the OPPS update for CY 2005. In the November 15, 2004 final rule with comment period, we finalized this policy for CY 2005 (69 FR 65838).

    As we indicated in the January 6, 2004 interim final rule with comment period, we began payment for the brachytherapy source in HCPCS code C1717 (Brachytx source, HCR lr-192) based on the hospital's charge adjusted to cost beginning January 1, 2004. Prior to enactment of Pub. L. 108-173, these sources were paid as packaged services in APC 0313. As a result of the requirement under Pub. L. 108-173 to pay for HCPCS code C1717 separately, we adjusted the payment rate for APC 0313, Brachytherapy, to reflect the unpackaging of the brachytherapy source. We finalized this payment methodology in our November 15, 2004 final rule with comment period (69 FR 65839).

    Section 1833(t)(2)(H) of the Act, as added by section 621(b)(2)(C) of Pub. L. 108-173, mandated the creation of separate groups of covered OPD services that classify brachytherapy devices separately from other services or groups of services. The additional groups must be created in a manner that reflects the number, isotope, and radioactive intensity of the devices of brachytherapy furnished, including separate groups for Palladium-103 and Iodine-125 devices. At its meetings in February 2004, the APC Panel heard from parties that recommended the addition of two new codes to describe brachtherapy sources in a manner that reflects the number, radioisostope, and radioactive intensity of the sources. The presenters recommended two new brachytherapy HCPCS codes and APCs for high activity Iodine-125 and high activity Palladium-103. The APC Panel, in turn, recommended that CMS establish new HCPCS codes and new APCs, on a per source basis, for these two brachytherapy sources.

    We considered this recommendation and agreed with the APC Panel. Therefore, in the November 15, 2004 final rule with comment period, we established the following two new brachytherapy source codes for CY 2005:

    C2634 Brachytherapy source, High Activity Iodine-125, greater than 1.01 mCi (NIST), per source

    C2635 Brachytherapy source, High Activity Palladium-103, greater than 2.2 mCi (NIST), per source

    In addition, we believed the APC Panel's recommendation to establish new HCPCS codes that would distinguish high activity Iodine-125 from high activity Palladium-103 on a per source basis should have been implemented for other brachytherapy code descriptors, as well. Therefore, beginning January 1, 2005, we included “per source” in the HCPCS code descriptors for all those brachytherapy source descriptors for which units of payment were not already delineated. Table 40 published in the November 15, 2004 final rule with comment period included a complete listing of the HCPCS codes, long descriptors, APC assignments, and status indicators that we used for brachytherapy sources paid under the OPPS in CY 2005 (69 FR 65840 through 65841).

    Further, for CY 2005, we added the following code of linear source Palladium-103 to be paid at cost: C2636 Brachytherapy linear source, Palladium-103, per 1 mm. We had indicated in our August 16, 2004 proposed rule that we were aware of a new linear source Palladium-103, which came to our attention in CY 2003 through an application for a new device category for pass-through payment. We stated that, while we decided not to create a new category for pass-through payment, we believed that the new linear source fell under the provisions of Pub. L. 108-173. Therefore, we made final our proposal to add HCPCS code C2636 as a new brachytherapy source to be paid at cost in CY 2005.

    B. Proposed Changes Related to Pub. L. 108-173

    We have consistently invited the public to submit recommendations for new codes to describe brachytherapy sources in a manner reflecting the number, radioisotope, and radioactivity intensity of the sources. We requested that commenters provide a detailed rationale to support recommended new codes and to send recommendations to us. We stated that we would endeavor to add new brachytherapy source codes and descriptors to our systems for payment on a quarterly basis. We have only very recently received one such request for coding and payment of a new brachytherapy source since we added separate APC payment beginning in CY 2005 for the three brachytherapy sources discussed above. We will evaluate this source prior to our final rule for CY 2006. Therefore, we are not proposing any coding changes to the sources of brachytherapy for CY 2006 at this time. Table 26 below includes a list of the separately payable brachytherapy Start Printed Page 42737sources that we are proposing to continue for CY 2006.

    Table 26.—Proposed Separately Payable Brachytherapy Sources for CY 2006

    HCPCSLong descriptorAPCAPC titleNew status indicator
    C1716Brachytherapy source, Gold 198, per source1716Brachytx source, Gold 198H
    C1717Brachytherapy source, High Dose Rate Iridium 192, per source1717Brachytx source, HDR Ir-192H
    C1718Brachytherapy source, Iodine 125, per source1718Brachytx source, Iodine 125H
    C1719Brachytherapy source, Non-High Dose Rate Iridium 192, per source1719Brachytx source, Non-HDR Ir-192H
    C1720Brachytherapy source, Palladium 103, per source1720Brachytx source, Palladium 103H
    C2616Brachytherapy source, Yttrium-90, per source2616Brachytx source, Yttrium-90H
    C2632Brachytherapy solution, Iodine 125, per mCi2632Brachytx sol, I-125, per mCiH
    C2633Brachytherapy source, Cesium-131, per source2633Brachytx source, Cesium-131H
    C2634Brachytherapy source, High Activity, Iodine-125, greater than 1.01 mCi (NIST), per source2634Brachytx source, HA, I-125H
    C2635Brachytherapy source, High Activity, Palladium-103, greater than 2.2 mCi (NIST), per source2635Brachytx source, HA, P-103H

    VIII. Proposed Coding and Payment for Drug Administration

    (If you choose to comment on issues in this section, please include the caption “Drug Administration” at the beginning of your comment.)

    A. Background

    From the start of the OPPS until the end of CY 2004, three HCPCS codes were used to bill drug administration services provided in the hospital outpatient department:

    • Q0081 (Infusion therapy, using other than chemotherapeutic drugs, per visit)
    • Q0083 (Chemotherapy administration by other than infusion technique only, per visit)
    • Q0084 (Chemotherapy administration by infusion technique only, per visit) A fourth OPPS drug administration HCPCS code, Q0085 (Administration of chemotherapy by both infusion and another route, per visit) was active from the beginning of the OPPS through the end of CY 2003.

    Each of these four HCPCS codes mapped to an APC (that is, Q0081 mapped to APC 0120, Q0083 mapped to APC 0116, Q0084 mapped to APC 0117, and Q0085 mapped to APC 0118), and APC payment rates for these codes were made on a per-visit basis. The per-visit payment included payment for all hospital resources (except separately payable drugs) associated with the drug administration procedures. For CY 2004, we discontinued using HCPCS code Q0085 to identify drug administration services, moving to a combination of HCPCS codes Q0083 and Q0084 that allowed more accurate calculations when determining OPPS payment rates.

    In response to comments we received concerning the available opportunities to gather additional drug administration data (and subsequently facilitate development of more accurate payment rates for drug administration services in future years) and to reduce hospital administrative burden, we proposed for the CY 2005 OPPS to change our coding and payment methodologies related to drug administration services.

    After examining comments and suggestions, including recommendations of the APC Panel, we adopted a crosswalk for the CY 2005 OPPS that identified all active CPT drug administration codes and the corresponding Q-codes, which hospitals had previously used to report their charges for the procedures. Hospitals were instructed to begin billing CPT codes for drug administration services in the hospital outpatient department effective January 1, 2005.

    Payment rates for CY 2005 drug administration services were set using CY 2003 claims data. These data reflected per-visit costs associated with the four Q-codes listed above. To allow for the time necessary to collect data at the more specific CPT code level and to continue accurate payments based on available claims data, we used the Q-code crosswalk to map CPT drug administration codes to existing drug administration APCs. While hospitals were instructed to bill all relevant CPT codes that describe the services provided, the Outpatient Code Editor (OCE) collapsed payments for drug administration services attributed to the same APC and paid a single APC amount for those services for each visit, unless a modifier was used to identify drug administration services provided more than once in a separate encounter on the same day.

    B. Proposed Changes for CY 2006

    In 2004, the CPT Editorial Panel approved several new drug administration codes and revised several existing codes for use beginning in 2006. For use in the physician office setting in CY 2005, we established HCPCS G-codes that correspond with the expected new CPT codes that will become active in 2006.

    For CY 2006 OPPS billing purposes, we are proposing to continue our policy of using CPT codes to bill for drug administration services provided in the hospital outpatient department. We anticipate that the current CPT codes will no longer be effective in CY 2006, and, therefore, we are proposing a CY 2006 crosswalk that maps current CPT codes to the CPT drug administration codes approved by the CPT Editorial Panel in 2004, which correspond to the G-codes used in the physician office setting for CY 2005 and which we expect to become active CPT codes for 2006.

    The OPPS drug administration payment rates that we are proposing for CY 2006 are dependent on CY 2004 data Start Printed Page 42738containing per-visit charges for HCPCS codes Q0081, Q0083, and Q0084. While HCPCS code Q0085 was used to inform payment rates for drug administration APCs for CY 2005, there are no data from this code to develop payment rates for drug administration APCs for CY 2006 because this code was not used in CY 2004. We are proposing to map the new CPT codes to existing drug administration APC groups (APC 0116, APC 0117, and APC 0120) as we did in CY 2005. Again, hospitals would be expected to bill all relevant CPT codes for services provided, but payment for services within the same APC group would be collapsed by the OCE into a single per-visit APC payment, unless a modifier is used to identify drug administration services provided more than once in a separate encounter on the same day.

    Table 27 shows the crosswalk from the CY 2005 CPT codes to the expected CY 2006 CPT codes (indicated by definition and 2005 HCPCS G-code) and includes the proposed CY 2006 status indicators and APC payment groups for these services. At its February 2005 meeting, the APC Panel recommended that this crosswalk be used to establish drug administration payments for the CY 2006 OPPS. Therefore, we are proposing to use the crosswalk as illustrated in Table 27 to assign drug administration services to APC payment groups for CY 2006 OPPS.

    Table 27.—Proposed Crosswalk From Expected CY 2006 Drug Administration CPT Codes to Drug Administration APCs

    [Note: G-codes are only for use in the physician office setting in CY 2005]

    2005 CPT code2005 HCPCS codeDescriptionCY 2006 Proposed status indicatorAPCOCE maximum APC units without modifier 59OCE maximum APC units with modifier 59
    90780G0345Intravenous Infusion, Hydration; Initial, up to one hourS012014
    90781G0346Intravenous Infusion, Hydration; each additional hour, up to eight (8) hoursN00
    90780G0347Intravenous Infusion, for Therapeutic/Diagnostic; Initial, up to one hourS012014
    90781G0348Intravenous Infusion, for Therapeutic/Diagnostic; each additional hour, up to eight (8) hoursN00
    G0349Intravenous Infusion, for Therapeutic/Diagnostic; additional sequential infusion, up to one hourN00
    G0350Intravenous Infusion, for Therapeutic/Diagnostic; concurrent infusionN00
    90782G0351Therapeutic or Diagnostic Injection; subcutaneous or intramuscularX0353N/AN/A
    90784G0353Intravenous Push; single or initial substance/drugX0359N/AN/A
    90784G0354Intravenous Push; each additional sequential intravenous pushX0359N/AN/A
    9078390783Injection, iaX0359N/AN/A
    9078890788Injection of antibioticX0359N/AN/A
    9654996549Chemotherapy, unspecifiedS011612
    96400G0355Chemotherapy Administration, subcutaneous or intramuscular non-hormonal antineoplasticS011612
    96400G0356Chemotherapy Administration, subcutaneous or intramuscular hormonal antineoplasticS011612
    9654296542Chemotherapy injectionS011612
    9640596405Intralesional chemo adminS011612
    9640696406Intralesional chemo adminS011612
    96408G0357Intravenous, push technique, single or initial substance/drugS011612
    96408G0358Intravenous, push technique, each additional substance/drugS011612
    9642096420Chemotherapy, push techniqueS011612
    9644096440Chemotherapy, intracavitaryS011612
    9644596445Chemotherapy, intracavitaryS011612
    9645096450Chemotherapy, into CNSS011612
    96410G0359Chemotherapy Administration, Intravenous Infusion Technique; up to one hour, single or initial substance/drugS011712
    96412G0360Chemotherapy Administration, Intravenous Infusion Technique; Each additional hour, one to eight (8) hoursN00
    G0362Chemotherapy Administration, Intravenous Infusion Technique; Each additional sequential infusion (different substance/drug), up to one hourN00
    96414G0361Initiation of prolonged chemotherapy infusion (more than eight hours), requiring use of a portable or implantable pumpS011712
    9642296422Chemotherapy, infusion methodS011712
    Start Printed Page 42739
    9642396423Chemo, infuse method add-onN00
    9642596425Chemotherapy, infusion methodS011712
    G0363Irrigation of Implanted Venous Access Device for Drug Delivery SystemsN00
    9652096520Port pump refill & mainT0125N/AN/A
    9653096530Syst pump refill & mainT0125N/AN/A

    C. Proposed Changes to Vaccine Administration

    Hospitals currently use three HCPCS G-codes to indicate the administration of the following vaccines that have specific statutory coverage:

    • G0008—Administration of Influenza Virus Vaccine
    • G0009—Administration of Pneumococcal Vaccine
    • G0010—Administration of Hepatitis B Vaccine

    HCPCS codes G0008 and G0009 are exempt from beneficiary coinsurance and deductible applications and, as such, payment has been made outside of the OPPS since CY 2003 based on reasonable cost. We have made payment for HCPCS code G0010 through a clinical APC (that is, APC 0355) that included vaccines along with this vaccine administration code. Additional vaccine administration codes have been packaged or not paid under the OPPS.

    We believe that HCPCS codes G0008, G0009 and G0010 are clinically similar and comparable in resource use to one another and to the administration of other immunizations and other therapeutic, prophylactic, or diagnostic injections. The appropriate APC assignment for these vaccine administration services is newly reconfigured APC 0353 (“Injection, Level II”). However, because of their statutory exemption regarding beneficiary deductible and coinsurance, for operational reasons we are unable to include HCPCS codes G0008 and G0009 in an APC with codes that do not share this exemption.

    Therefore, for CY 2006, we are proposing to map HCPCS codes G0008 and G0009 to new APC 0350 (Administration of flu and PPV vaccines). As dictated by statute, HCPCS codes G0008 and G0009 will continue to be exempt from beneficiary coinsurance and deductible.

    We are also proposing to change the status indicator for HCPCS code G0010 from “K” (Separate APC Payment) to “B” (Not paid under OPPS; Alternate code may be available), and to change the status indicators for vaccine administration codes 90471 and 90472 from “N” (Packaged) to “X” (Separate APC Payment), in agreement with the recommendation of the APC Panel to unpackage these services. Hospitals would code for hepatitis B vaccine administration using codes 96471 or 96472 (as appropriate), and payment would be mapped to reconfigured APC 0353 (“Injection, Level II”) that will include other injection services that are clinically similar and comparable in resource use.

    Additionally, in order to pay appropriately for services that we believe are clinically similar and comparable in resource use and, barring technical restrictions, would otherwise be assigned to the same APC, we are proposing to calculate a combined median cost for all services assigned to APC 0350 and APC 0353 that would then serve as the median cost for both APCs. This combined median would be calculated using charges converted to costs from claims for services in both APCs and would have the effect of making the OPPS payment rates for APC 0350 and APC 0353 identical, although beneficiary copayment and deductible would not be applied to services in APC 0350.

    In addition, we are proposing to change the status indicators for vaccine administration codes 90473 and 90474 from “E” (Not paid under OPPS) to “S” (Paid under OPPS) and make payments for these services when they are covered through proposed APC 1491 (New Technology—Level IA ($0-$10)). Finally, we are proposing to change the status indicators for the four remaining vaccine administration codes involving physician counseling (90465, 90466, 90467 and 90468) from “N” (Packaged) to “B” (Not paid under OPPS; Alternate code may be available). Hospitals providing immunization services with physician counseling would use the vaccine administration codes 90471, 90472, 90473, and 90473 to report such services, as we do not believe the provision of physician counseling significantly affects the hospital resources required for administration of immunizations. Table 28 displays the changes that we are proposing for CY 2006.

    Table 28.—Proposed CY 2006 Vaccine Administration Codes and APC Median Cost

    HCPCSDescriptionCY 2005CY 2006
    SIAPCSIAPCMedian
    G0008Influenza Vaccine AdministrationLReasonable CostX0350$24.00
    G0009Pneumococcal Vaccine AdministrationLReasonable CostX035024.00
    G0010Hepatitis B Vaccine AdministrationK0355B
    90465Immunization Admin, under 8 yrs old, with counseling; first injectionNB
    90466Immunization Admin, under 8 yrs old, with counseling; each additional injectionNB
    Start Printed Page 42740
    90467Immunization Admin, under 8 yrs old, with counseling; first intranasal or oralNB
    90468Immunization Admin, under 8 yrs old, with counseling; each additional intranasal or oralNB
    90471Immunization Admin, one vaccine injectionNX035324.00
    90472Immunization Admin, each additional vaccine injectionNX035324.00
    90473Immunization Admin, one vaccine by intranasal or oralES14915.00
    90474Immunization Admin, each additional vaccine by intranasal or oralES14915.00

    IX. Hospital Coding for Evaluation and Management (E/M) Services

    (If you choose to comment on issues in this section, please include the caption “E/M Services” at the beginning of your comment.)

    In the November 15, 2004 final rule with comment period (69 FR 65838), we noted our primary concerns and direction for developing the proposed coding guidelines for emergency department and clinic visits. We intend to make available for public comment the proposed coding guidelines that we are considering through the CMS OPPS Web site as soon as we have completed them. We will notify the public through our listserve when these proposed guidelines become available. To subscribe to this listserve, please go to the following CMS Web site: http://www.cms.hhs.gov/​medlearn/​listserv.asp and follow the directions to the OPPS listserve. We will provide ample opportunity for the public to comment on the proposal.

    We will continue to be considerate of the time necessary to educate clinicians and coders on the use of the new codes and guidelines and for hospitals to modify their systems. We anticipate providing a minimum notice of between 6 and 12 months prior to implementation of the new evaluation and management codes and guidelines. We will continue developing and testing the new codes even though we have not yet made plans for their implementation.

    X. Proposed Payment for Blood and Blood Products

    (If you choose to comment on issues in this section, please include the caption “Blood and Blood Products” at the beginning of your comment.)

    A. Background

    Since the implementation of the OPPS in August 2000, separate payments have been made for blood and blood products through APCs rather than packaging them into payments for the procedures with which they were administered. Hospital payments for the costs of blood and blood products, as well as the costs of collecting, processing, and storing blood and blood products, are made through the OPPS payments for specific blood product APCs. On April 12, 2001, CMS issued the original billing guidance for blood products to hospitals (Program Transmittal A-01-50). In response to requests for clarification of these instructions, CMS issued Transmittal 496 on March 4, 2005. The comprehensive billing guidelines in the Transmittal also addressed specific concerns and issues related to billing for blood-related services, which the public had brought to our attention.

    In CY 2000, payments for blood and blood products were established based on external data provided by commenters due to limited Medicare claims data. From CY 2000 to CY 2002, payment rates for blood and blood products were updated for inflation. For CY 2003, as described in the November 1, 2002 final rule with comment period (67 FR 66773), we applied a special dampening methodology to blood and blood products that had significant reductions in payment rates from CY 2002 to CY 2003, when median costs were first calculated from hospital claims. Using the dampening methodology, we limited the decrease in payment rates for blood and blood products to approximately 15 percent. For CY 2004, as recommended by the APC Panel, we froze payment rates for blood and blood products at CY 2003 levels as we studied concerns raised by commenters and presenters at the August 2003 and February 2004 APC Panel meetings.

    For CY 2005, we established new APCs that allowed each blood product to be assigned to its own separate APC, as several of the previous blood product APCs contained multiple blood products with no clinical homogeneity or whose product-specific median costs may not have been similar. Some of the blood product HCPCS codes were reassigned to the new APCs (Table 34 of the November 15, 2004 final rule with comment period (69 FR 65819)).

    We also noted in the November 15, 2004 final rule with comment period that public comments to previous OPPS rules had stated that the CCRs that were used to adjust charges to costs for blood products in past years were too low. Past commenters indicated that this approach resulted in an underestimation of the true hospital costs for blood and blood products. In response to these comments and APC Panel recommendations from their February 2004 and September 2004 meetings, we conducted a thorough analysis of the OPPS CY 2003 claims (used to calculate the CY 2005 APC payment rates) to compare CCRs between those hospitals reporting a blood-specific cost center and those hospitals defaulting to the overall hospital CCR in the conversion of their blood product charges to costs. As a result of this analysis, we observed a significant difference in CCRs utilized for conversion of blood product charges to costs for those hospitals with and without blood-specific cost centers. The median hospital blood-specific CCRs were almost two times the median overall hospital CCR. As discussed in the November 15, 2004 final rule with comment period, we applied a methodology for hospitals not reporting a blood-specific cost center, which simulated a blood-specific CCR for each hospital that we then used to convert charges to costs for blood products. Thus, we developed simulated medians for all blood and blood products based on CY 2003 hospital claims data (69 FR 65816).Start Printed Page 42741

    For CY 2005, we also identified a subset of blood products that had less than 1,000 units billed in CY 2003. For these low-volume blood products, we based the CY 2005 payment rate on a 50/50 blend of CY 2004 product-specific OPPS median costs and the CY 2005 simulated medians based on the application of blood-specific CCRs to all claims. We were concerned that, given the low frequency in which these products were billed, a few occurrences of coding or billing errors may have led to significant variability in the median calculation. The claims data may not have captured the complete costs of these products to hospitals as fully as possible. This low-volume adjustment methodology also allowed us to further study the issues raised by commenters and by presenters at the September 2004 APC Panel meeting, without putting beneficiary access to these low-volume blood products at risk.

    B. Proposed Changes for CY 2006

    For CY 2006, we are proposing to continue to make separate payments for blood and blood products under the OPPS through individual APCs for each product. We are also proposing to establish payment rates for these blood and blood products by using the same simulation methodology described in the November 15, 2004 final rule with comment period (69 FR 65816), which utilized hospital-specific actual or simulated CCRs for blood cost centers to convert hospital charges to costs, with an adjustment applied to some products. We continue to believe that using blood-specific CCRs applied to hospital claims data will result in reasonably accurate payments that more fully reflect hospitals' true costs of providing blood and blood products than our general methodology of defaulting to the overall hospital CCR when more specific CCRs are unavailable.

    For blood and blood products whose CY 2006 simulated medians experienced a decrease of more than 10 percent in comparison to their CY 2005 payment medians, we are proposing to limit the decrease in medians to 10 percent. Therefore, overall we are proposing to base median costs for blood and blood products in CY 2006 on the greater of: (1) Simulated medians calculated using CY 2004 claims data; or (2) 90 percent of the APC payment median for CY 2005 for such products. We recognize that possible errors in hospital billing or coding for blood products in CY 2004 may have contributed to these decreases in medians. In particular, hospitals may have been uncertain about which of their many different costs for providing blood and blood products should be captured in their charges for the products, based on variations in the specific circumstances of the services they provided. In addition, the six products affected by the proposed CY 2006 adjustment policy all were relatively low volume with fewer than 7,000 units billed in CY 2004. Three of these products were affected by the low-volume payment adjustment for CY 2005 because there were less than 1,000 units billed, and their CY 2005 payment medians would have decreased without the adjustment. In the interim, as hospitals become more familiar with the comprehensive billing guidelines for blood and blood products that are described in Program Transmittal 496, (Change Request 3681 dated March 4, 2005), we acknowledge the need to protect beneficiaries' access to a safe blood supply and are proposing to do so by limiting significant decreases in payment rates for blood and blood products from CY 2005 to CY 2006. We expect that our billing guidance will assist hospitals in more fully including all appropriate costs for providing blood and blood products in their charges for those products, so that our data for CY 2005, which will be used to set median costs for blood and blood products in the CY 2007 OPPS, should more accurately capture the hospital costs associated with each different blood product.

    Displayed in Table 29 is the list of blood product HCPCS codes with their proposed CY 2006 payment medians. Overall, medians from CY 2005 and CY 2006 were relatively stable, and we expect that as hospitals improve their billing and coding practices, medians based on historical hospital claims data should continue to become more consistent and reflective of all hospital costs. For blood and blood products whose CY 2006 simulated median would have experienced a decrease from CY 2005 to CY 2006 of greater than 10 percent, the adjusted median is shown.

    Therefore, for CY 2006, we are proposing to establish payment rates for blood and blood products under the OPPS by using the same simulation methodology described in the November 15, 2004 final rule with comment period (69 FR 65816). For blood and blood products whose 2006 medians would have otherwise experienced a decrease of more than 10 percent in comparison with their CY 2005 payment rates, we are proposing to adjust the simulated medians by limiting their decrease to 10 percent.

    Table 29.—Proposed CY 2006 Payment Medians for Blood and Blood Products by HCPCS/APC Codes

    HCPCSAPCCY 2004 unitsDescriptionCY 2005 payment medianProposed CY 2006 median, (limited if applicable)
    P90160954609026RBC leukocytes reduced$170.28$165.16
    P90210959158964Red blood cells unit116.42122.50
    P9040096946732RBC leukoreduced irradiated211.28219.96
    P9035950137199Platelet pheres leukoreduced486.18491.77
    P9019095737079Platelets, each unit49.5050.19
    P9017950836807Plasma 1 donor frz w/in 8 hr65.1072.64
    P9031101321899Platelets leukocytes reduced88.7896.69
    P9037101913873Plate pheres leukoredu irrad603.62574.05
    P9034950710419Platelets, pheresis449.86416.30
    P903309686031Platelets leukoreduced irrad158.50*142.65
    P904410095635Cryoprecipitate reduced plasma63.2078.82
    P901209525264Cryoprecipitate each unit49.58*44.62
    P905510174546Plt, aph/pher, l/r, cmv-neg489.46518.94
    P905610183759Blood, l/r, irradiated187.76*168.98
    P903895053149RBC irradiated122.09144.08
    P901009503012Whole blood for transfusion115.97121.43
    Start Printed Page 42742
    P905110102854Blood, l/r, cmv-neg172.35179.17
    P902209602086Washed red blood cells unit199.18*179.26
    P905909551863Plasma, frz between 8-24 hour76.2878.05
    P905210111603Platelets, hla-m, l/r, unit583.87661.91
    P903695021166Platelet pheresis irradiated343.02313.15
    P905810221081RBC, l/r, cmv-neg, irrad280.94258.88
    P903295001080Platelets, irradiated91.11*82.00
    P90200958944Plaelet rich plasma unit155.53312.67
    P90399504862RBC deglycerolized305.13388.09
    P90509506793Granulocytes, pheresis unit1,046.99*942.29
    P90230949776Frozen plasma, pooled, sd80.16*72.14
    P90541016681Blood, l/r, froz/degly/wash275.72317.59
    P90531020549Plt, pher, l/r cmv-neg, irr573.06612.79
    P90480966524Plasmaprotein fract, 5%, 250 ml332.32*299.09
    P90609503488Fr frz plasma donor retested76.8698.00
    P9043095643Plasma protein fract, 5%, 50 ml68.6267.74
    P9057102127RBC, frz/deg/wsh, l/r, irrad327.11*294.40
    * Indicates adjusted median.

    In addition, we are proposing to change the status indicator for CPT code 85060 (Blood smear, peripheral, interpretation by physician with written report) from “X” (separately paid under the OPPS) to “B” (not paid under the OPPS). When a hospital provides a physician interpretation of an abnormal peripheral blood smear interpretation for a hospital outpatient, the charge for the facility resources associated with the interpretation should be bundled into the charge reported for the ordered hematology lab service, such as, CPT code 85007 (Blood count; blood smear, microscopic examination with manual differential WBC count) or CPT code 85008 (Blood count; blood smear, microscopic examination without manual differential WBC count), which are paid under the Clinical Laboratory Fee Schedule (CLFS). A physician interpretation of an abnormal peripheral blood smear is considered a routine part of the ordered hematology lab service, such as CPT codes 85007 and 85008 paid under the CLFS, so hospitals would receive duplicate payment for the facility resources associated with a physician's blood smear interpretation if we were to continue to pay separately for CPT code 85060 under the OPPS for hospital outpatients. Therefore, for CY 2006, we are proposing to discontinue payment under the OPPS for CPT code 85060 by changing its status indicator from “X” to “B.”

    XI. Proposed Payment for Observation Services

    (If you choose to comment on issues in this section, please include the caption “Observation Services” at the beginning of your comment.)

    A. Background

    Observation care is a well-defined set of specific, clinically appropriate services, which include ongoing short-term treatment, assessment, and reassessment, before a decision can be made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged from the hospital. Observation status is commonly assigned to patients with unexpectedly prolonged recovery after surgery and to patients who present to the emergency department and who then require a significant period of treatment or monitoring before a decision is made concerning their next placement. For a detailed discussion of the clinical and payment history of observation services, refer to the November 1, 2002 final rule with comment period (67 FR 66794).

    Before the implementation of the OPPS in CY 2000, payment for observation care was made on a reasonable cost basis. With the initiation of the OPPS, costs for observation services were packaged into payments for the services with which the observation care was associated but no separate payment for observation services was implemented.

    For CY 2002, we implemented separate payment for observation services (APC 0339) under the OPPS for three medical conditions (chest pain, congestive heart failure, and asthma). Additional criteria, such as the billing of select diagnosis codes, an evaluation and management service, a minimum and maximum number of observation hours, and provision of certain condition-specific diagnostic tests, along with documentation of the physician's determination that the patient would benefit from observation care, were also required in order for hospitals to receive the separate APC payment (APC 0339) for observation services.

    Taking into account numerous comments from providers about the increased administrative burden caused by reporting requirements associated with payment for APC 0339 and after reviewing comments and recommendations by the APC Panel, we removed the mandated diagnostic testing requirements beginning in CY 2005 (Transmittal 514, Change Request 3756, released March 30, 2005). Hospitals were instructed to rely on clinical judgment in combination with internal and external quality review processes to ensure that appropriate diagnostic testing is provided for patients receiving high quality, medically necessary observation care. In an effort to further reduce administrative burden related to accurate billing and in response to suggestions from hospitals and the APC Panel, effective January 1, 2005, we clarified our instructions for counting time in observation care to end at the time the outpatient is actually discharged from the hospital or admitted as an inpatient. Our expectation was that specific, medically necessary observation services were being provided to the patient up until Start Printed Page 42743the time of discharge. However, we did not expect reported observation time to include the time patients remain in the observation area after treatment is finished for reasons such as waiting for transportation home.

    In updating the CY 2005 OPPS, we also looked at CY 2003 claims data for all packaged visit-related observation care for all medical conditions in order to determine whether or not there were other diagnoses that would be candidates for separately payable observation services. This year, we again reviewed the most recent claims data (CY 2004) for packaged and unpackaged observation services to assess the current appropriateness of the three medical conditions for separately payable observation services and to determine if the list of diagnosis codes was complete for those conditions. The APC Panel recommended at the February 2005 APC Panel meeting that CMS expand the list of diagnoses eligible for separate observation payments.

    The diagnoses currently associated with the three medical conditions continue to be frequently reported on OPPS visit-related claims with packaged observation services, and there are a large number of claims for separately payable observation care for the three medical conditions. At this time, our data show almost 80,000 claims from CY 2004 for separately payable observation services, compared with 67,182 for CY 2003 hospital claims. We have also explored other diagnoses that appeared in hospital claims data with packaged observation services. However, the data on packaged observation services continue to be incomplete and unreliable, reported using a number of different CPT codes with “per day” in their code descriptors. Some hospitals appear to be reporting observation services per day, while others appear to be reporting each hour of observation care as one unit, as we instructed them to do when reporting HCPCS code G0244 for separately payable observation. As described in section XI.B. of this preamble, we are proposing to make changes to hospital coding for all observation services for CY 2006, both separately payable and packaged. We are currently not convinced that there are other conditions for which there is a well-defined set of hospital services that are distinct from the services provided during a clinic or emergency visit. Moreover, hospital data from CY 2004 do not reflect our CY 2005 changes in separately payable observation policy. We also seek to gain additional experience with more consistent hospital billing for observation services, both packaged and separately payable, to guide our future analyses of observation care. Thus, we believe it is premature to expand the conditions for which we would separately pay for visit-related observation services.

    B. Proposed CY 2006 Coding Changes for Observation Services

    In response to comments received regarding the continuing administrative burden on hospitals when attempting to differentiate between packaged and separately payable observation services for purposes of billing correctly, and recommendations put forward by the APC Panel and participants at the February 2005 APC Panel meeting, we are proposing two changes in payment policy for observation services in CY 2006. First, we are proposing to discontinue HCPCS codes G0244 (Observation care by facility to patient), G0263 (Direct admission with CHF, CP, asthma), and G0264 (Assessment other than CHF, CP, asthma) and to create two new HCPCS codes to be used by hospitals to report all observation services whether separately payable or packaged, and direct admission for observation care:

    • GXXXX—Hospital observation services, per hour
    • GYYYY—Direct admission of patient for hospital observation care

    Second, we are proposing to shift determination of whether or not observation services are separately payable under APC 0339 from the hospital billing department to the OPPS claims processing logic. That is, hospitals would bill GXXXX when observation services are provided to any patient admitted to “observation status,” regardless of the patient's status as an inpatient or outpatient. Hospitals would additionally bill GYYYY when observation services are the result of a direct admission to “observation status” without an associated emergency room visit, hospital outpatient clinic visit, or critical care service on the day of or day before the observation services. Both of these new HCPCS codes would be assigned a new status indicator that would trigger OCE logic during the processing of the claim to determine if the observation service is packaged with the other separately payable hospital services provided or if a separate APC payment for observation services is appropriate in accordance with the criteria discussed below in section XI.C. of this preamble. In addition, we are proposing to change the status indicator for CPT codes 99217 through 99220 and 99234 through 99236 from “N” (packaged) to “B” (code not recognized by OPPS). We will expect hospitals to utilize GXXXX to accurately report all observation services provided to beneficiaries, whether the observation would be packaged or separately payable, to assist us in developing consistent and complete hospital claims data regarding the utilization and costs of observation services. The units of service reported with GXXXX would equal the number of hours the patient is in observation status.

    C. Proposed Criteria for Separately Payable Observation Services (APC 0339)

    For CY 2006, we are proposing to continue applying the existing CY 2005 criteria (69 FR 65830), which determine if hospitals may receive separate payment for medically necessary observation care provided to a patient with congestive heart failure, chest pain, or asthma. In addition, we are proposing to continue our policy of packaging payment for all other observation services into the payments for the separately payable services with which the observation service is reported. As explained previously in section XI.B. of this section, the only changes we are proposing are related to the codes hospitals would use to report observation services, and the point at which a payment determination is made. Rather than requiring the hospital to determine prior to claims submission whether patient condition and the services furnished meet the criteria for payment of APC 0339, that determination would shift to the claims processing modules installed by the fiscal intermediaries to process all OPPS bills, thereby reducing the administrative burden on hospitals.

    Criteria for separate observation service payments include documentation of specific ICD-9-CM diagnostic codes (International Classification of Diseases, Ninth Edition, Clinical Modification); the length of time a patient is in observation status; hospital services provided before, during, and after the patient receives observation care; and ongoing physician evaluation of the patient's status.

    As we stated in Transmittal A-02-129, released in January 2003, we will continue to update any changes in the list of ICD-9-CM codes required for payment of HCPCS code GXXXX resulting from the October 1 annual update of ICD-9-CM in the October quarterly update of the OPPS. In addition, changes to the ICD-9-CM codes, which are listed in Table 30 below, would be included in the OPPS CY 2006 final rule. Start Printed Page 42744

    Below are the criteria that we are proposing to continue using in CY 2006 to determine if hospitals may receive separate OPPS payment for medically necessary observation care provided to a patient with congestive heart failure, chest pain, or asthma.

    1. Diagnosis Requirements

    a. The beneficiary must have one of three medical conditions: Congestive heart failure, chest pain, or asthma.

    b. The hospital bill must report as the reason for visit or principal diagnosis an appropriate ICD-9-CM code (as shown in Table 30 below) to reflect the condition.

    c. The qualifying ICD-9-CM diagnosis code must be reported in Form Locator (FL) 76, Patient Reason for Visit, or FL 67, principal diagnosis, or both, in order for the hospital to receive separate payment for APC 0339. If a qualifying ICD-9-CM diagnosis code(s) is reported in the secondary diagnosis field but is not reported in either the Patient Reason for Visit field (FL 76) or in the principal diagnosis field (FL 67), separate payment for APC 0339 will not be allowed.

    Table 30.—CY 2006 Eligible Diagnosis Codes for Billing Observation Services

    Required diagnosis forEligible ICD-9-CM codeCode descriptor
    Chest pain411.0Postmyocardial infarction syndrome.
    411.1Intermediate coronary syndrome.
    411.81Coronary occlusion without myocardial infarction.
    411.89Other acute ischemic heart disease.
    413.0Angina decubitus.
    413.1Prinzmetal angina.
    413.9Other and unspecified angina pectoris.
    786.05Shortness of breath.
    786.50Chest pain, unspecified.
    786.51Precordial pain.
    786.52Painful respiration.
    786.59Other chest pain.
    Asthma493.01Extrinsic asthma with status asthmaticus.
    493.02Extrinsic asthma with acute exacerbation.
    493.11Intrinsic asthma with status asthmaticus.
    493.12Intrinsic asthma with acute exacerbation.
    493.21Chronic obstructive asthma with status asthmaticus.
    493.22Chronic obstructive asthma with acute exacerbation.
    493.91Asthma, unspecified with status asthmaticus.
    493.92Asthma, unspecified with acute exacerbation.
    Heart Failure391.8Other acute rheumatic heart disease.
    398.91Rheumatic heart failure (congestive).
    402.01Malignant hypertensive heart disease with congestive heart failure.
    402.11Benign hypertensive heart disease with congestive heart failure.
    402.91Unspecified hypertensive heart disease with congestive heart failure.
    404.01Malignant hypertensive heart and renal disease with congestive heart failure.
    404.03Malignant hypertensive heart and renal disease with congestive heart and renal failure.
    404.11Benign hypertensive heart and renal disease with congestive heart failure.
    404.13Benign hypertensive heart and renal disease with congestive heart and renal failure.
    404.91Unspecified hypertensive heart and renal disease with congestive heart failure.
    404.93Unspecified hypertensive heart and renal disease with heart and renal failure.
    428.0Congestive heart failure.
    428.1Left heart failure.
    428.20Unspecified systolic heart failure.
    428.21Acute systolic heart failure.
    428.22Chronic systolic heart failure.
    428.23Acute on chronic systolic heart failure.
    428.30Unspecified diastolic heart failure.
    428.31Acute diastolic heart failure.
    428.32Chronic diastolic heart failure.
    428.33Acute on chronic diastolic heart failure.
    428.40Unspecified combined systolic and diastolic heart failure.
    428.41Acute combined systolic and diastolic heart failure.
    428.42Chronic combined systolic and diastolic heart failure.
    428.43Acute on chronic combined systolic and diastolic heart failure.
    428.9Heart failure, unspecified.

    2. Observation Time

    a. Observation time must be documented in the medical record.

    b. A beneficiary's time in observation (and hospital billing) begins with the beneficiary's admission to an observation bed.

    c. A beneficiary's time in observation (and hospital billing) ends when all clinical or medical interventions have been completed, including followup care furnished by hospital staff and physicians that may take place after a physician has ordered the patient be released or admitted as an inpatient.

    d. The number of units reported with HCPCS code GXXXX must equal or exceed 8 hours.

    3. Additional Hospital Services

    a. The hospital must provide on the same day or the day before and report on the bill: Start Printed Page 42745

    • An emergency department visit (APC 0610, 0611, or 0612),
    • A clinic visit (APC 0600, 0601, or 0602), or
    • Critical care (APC 0620).

    b. No procedure with a “T” status indicator can be reported on the same day or day before observation care is provided.

    4. Physician Evaluation

    a. The beneficiary must be in the care of a physician during the period of observation, as documented in the medical record by admission, discharge, and other appropriate progress notes that are timed, written, and signed by the physician.

    b. The medical record must include documentation that the physician explicitly assessed patient risk to determine that the beneficiary would benefit from observation care.

    D. Separate Payment for Direct Admission to Observation Care (APC 0600)

    For CY 2006, we are proposing to continue paying for direct admission to observation at a rate equal to that of a Level I Clinic Visit when a Medicare beneficiary is directly admitted into a hospital outpatient department for observation care that does not qualify for separate payment under APC 0339. In order to receive separate payment for a direct admission into observation (APC 0600), the claim must show:

    1. Both HCPCS codes GXXXX (Hourly Observation) and GYYYY (Direct Admit to Observation) with the same date of service.

    2. That no services with a status indicator “T” or “V” were provided on the same day of service as HCPCS code GYYYY.

    XII. Procedures That Will Be Paid Only as Inpatient Procedures

    (If you choose to comment on issues in this section, please include the caption “Inpatient Procedures” at the beginning of your comment.)

    A. Background

    Section 1833(t)(B)(i) of the Act gives the Secretary broad authority to determine the services to be covered and paid for under the OPPS. Before implementation of the OPPS in August 2000, Medicare paid reasonable costs for services provided in the outpatient department. The claims submitted were subject to medical review by the fiscal intermediaries to determine the appropriateness of providing certain services in the outpatient setting. We did not specify in regulations those services that were appropriate to provide only in the inpatient setting and that, therefore, should be payable only when provided in that setting.

    In the April 7, 2000 final rule with comment period, 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 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 final rule with comment period (65 FR 18455) and the November 30, 2001 final rule (66 FR 59856), 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 with comment period (67 FR 66792), we removed 43 procedures from the inpatient list for payment under OPPS. We also 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 ambulatory surgical center (ASC) and is on the list of approved ASC procedures or proposed by us for addition to the ASC list.

    We believe that these additional criteria help us to identify procedures that are appropriate for removal from the inpatient list.

    In the November 7, 2003 final rule with comment period (68 FR 63465), no significant changes were made to the inpatient list. In the November 15, 2004 final rule 5with comment period (69 FR 65834), we removed 22 procedures from the inpatient list, effective for services furnished on or after January 1, 2005.

    B. Proposed Changes to the Inpatient List

    We used the same methodology as described in the November 15, 2004 final rule with comment period (69 FR 65837) to identify a subset of procedures currently on the inpatient list that were being widely performed on an outpatient basis. These procedures were then clinically reviewed for possible removal from the inpatient list. We solicited input from the APC Panel on the appropriateness of the removal of 26 procedures from the inpatient list at the February 2005 APC Panel meeting. The APC Panel recommended that these 26 procedures be removed from the list and further recommended that CMS consider CPT code 37183 (Remove hepatic shunt (TIPS)) for removal. We agree with the APC Panel's recommendation that CPT code 37183 be removed from the inpatient list for CY 2006 and we are proposing to remove it from the inpatient list.

    However, subsequent to the APC Panel's February 2005 meeting, we conducted further clinical evaluations of three procedures (CPT codes 33420, 65273, and 59856) included among the 26 procedures that the APC Panel recommended for removal from the inpatient list. Upon further clinical evaluation of CPT code 33420 (Valvotomy, mitral valve; closed heart), we believe that the utilization data suggesting that this procedure is an office-based procedure were errant. Additional sources of utilization data suggest that this procedure is predominately performed on an inpatient basis. Concomitant with not meeting our criteria of being performed on an outpatient basis in multiple hospitals and not appearing on the ASC list of approved procedures, we are not compelled to support the removal of this procedure from the inpatient list. For this reason, we are proposing to retain CPT code 33420 on the inpatient list for CY 2006.

    CPT codes 65273 and 59856 were similarly reevaluated because of our concern with the HCPCS long descriptors for these two codes. The long descriptors for these codes are as follows: CPT code 65273 (Repair of laceration; conjunctiva, by mobilization and rearrangement, with hospitalization) and CPT code 59856 (Induced abortion, by one or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines; with dilation and Start Printed Page 42746curettage and/or evacuation). The long descriptors indicate that hospital admission or hospitalization is included in the codes for these two procedures, which leads us to believe that these two procedures do not meet the established criteria for removal from the inpatient list. The same code descriptor for CPT code 65273, but without hospitalization, is assigned to CPT code 65272, which is already separately payable under the OPPS. Therefore, we are proposing to retain CPT codes 65273 and 59856 on the inpatient list for CY 2006.

    In addition, we are proposing to remove CPT code 62160 (Neuroendoscopy) from the inpatient list. Questions about this service have been raised to us by the hospital community because CPT code 62160 is an add-on CPT code (that is, a code that is commonly performed as an “additional or supplemental” procedure to the primary procedure). Two of the separately coded services that CPT indicates are to be used with the add-on code are currently payable under the OPPS. Further clinical evaluation of this add-on procedure and its use in various sites of service leads us to believe it is appropriate for removal from the inpatient list.

    Therefore, for CY 2006, we are proposing to remove 25 procedures from the inpatient list and to assign 23 of these procedures to clinically appropriate APCs, as shown below in Table 31. We are not proposing to assign two of these procedures to APC groups, that is, CPT codes 00634 (Anesthesia for procedures in lumbar region; chemonucleoysis) and 01190 (Anesthesia for obturator neurectomy; intrapelvic) because they are anesthesia procedures for which a separate payment is not made under the OPPS. Payment for these two procedures would be packaged into the procedures with which they are billed. The proposed changes to the inpatient list would be effective for services furnished on or after January 1, 2006.

    Table 31.—Proposed Procedure Codes to Remove From Inpatient List and Proposed APC Assignment, Effective January 1, 2006

    HCPCSLong descriptorNew APC assignmentOld status indicatorNew status indicator
    00634ANESTHESIA FOR PROCEDURES IN LUMBAR REGION; CHEMONUCLEOLYSISn/aCN
    01190ANESTHESIA FOR OBTURATOR NEURECTOMY; INTRAPELVICn/aCN
    20662APPLICATION OF HALO, INCLUDING REMOVAL; PELVIC0049CT
    20663APPLICATION OF HALO, INCLUDING REMOVAL; FEMORAL0049CT
    20822REPLANTATION, DIGIT, EXCLUDING THUMB (INCLUDES DISTAL TIP TO SUBLIMIS TENDON INSERTION), COMPLETE AMPUTATION0054CT
    20972FREE OSTEOCUTANEOUS FLAP WITH MICROVASCULAR ANASTOMOSIS; METATARSAL0056CT
    20973FREE OSTEOCUTANEOUS FLAP WITH MICROVASCULAR ANASTOMOSIS; GREAT TOE WITH WEB SPACE0056CT
    21150RECONSTRUCTION MIDFACE, LEFORT II; ANTERIOR INTRUSION (EG, TREACHER-COLLINS SYNDROME)0256CT
    21175RECONSTRUCTION, BIFRONTAL, SUPERIOR-LATERAL ORBITAL RIMS AND LOWER FOREHEAD, ADVANCEMENT OR ALTERATION (EG, PLAGIOCEPHALY, TRIGONOCEPHALY, BRACHYCEPHALY), WITH OR WITHOUT GRAFTS (INCLUDES OBTAINING AUTOGRAFTS)0256CT
    21195RECONSTRUCTION OF MANDIBULAR RAMI AND/OR BODY, SAGITTAL SPLIT; WITHOUT INTERNAL RIGID FIXATION0256CT
    21408OPEN TREATMENT OF FRACTURE OF ORBIT, EXCEPT BLOWOUT; WITH BONE GRAFTING (INCLUDES OBTAINING GRAFT)0256CT
    21495OPEN TREATMENT OF HYOID FRACTURE0253CT
    27475ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYSIODESIS); DISTAL FEMUR0050CT
    31293NASAL/SINUS ENDOSCOPY, SURGICAL; WITH MEDIAL ORBITAL WALL AND INFERIOR ORBITAL WALL DECOMPRESSION0075CT
    31294NASAL/SINUS ENDOSCOPY, SURGICAL; WITH OPTIC NERVE DECOMPRESSION0075CT
    36510CATHETERIZATION OF UMBILICAL VEIN FOR DIAGNOSIS OR THERAPY, NEWBORNn/aCT
    37183REMOVE HEPATIC SHUNT (TIPS)0229CT
    37195THROMBOLYSIS, CEREBRAL, BY INTRAVENOUS INFUSION0676CT
    54560EXPLORATION FOR UNDESCENDED TESTIS WITH ABDOMINAL EXPLORATION0183CT
    55600VESICULOTOMY0183CT
    59100HYSTEROTOMY, ABDOMINAL (EG, FOR HYDATIDIFORM MOLE, ABORTION)0195CT
    61334EXPLORATION OF ORBIT (TRANSCRANIAL APPROACH); WITH REMOVAL OF FOREIGN BODY0256CT
    62160NEUROENDOSCOPY0122CT
    64763TRANSECTION OR AVULSION OF OBTURATOR NERVE, EXTRAPELVIC, WITH OR WITHOUT ADDUCTOR TENOTOMY0220CT
    64766TRANSECTION OR AVULSION OF OBTURATOR NERVE, INTRAPELVIC, WITH OR WITHOUT ADDUCTOR TENOTOMY0221CT
    Start Printed Page 42747

    C. Ancillary Outpatient Services When Patient Expires (-CA Modifier)

    (If you choose to comment on issues in this section, please include the caption “Ancillary Outpatient Services” at the beginning of your comment.)

    In the November 1, 2002 final rule with comment period (67 FR 66798), we discussed the creation of a new HCPCS modifier -CA to address situations where a procedure on the OPPS inpatient list must be performed to resuscitate or stabilize a patient (whose status is that of an outpatient) with an emergent, life-threatening condition, and the patient dies before being admitted as an inpatient. In Transmittal A-02-129, issued on January 3, 2003, we instructed hospitals on the use of this modifier when submitting a claim on bill type 13x for a procedure that is on the inpatient list and assigned the payment status indicator (SI) “C.” Conditions to be met for hospital payment for a claim reporting a service billed with modifier -CA include a patient with an emergent, life-threatening condition on whom a procedure on the inpatient list is performed on an emergency basis to resuscitate or stabilize the patient. For CY 2003, a single payment for otherwise payable outpatient services billed on a claim with a procedure appended with this new -CA modifier was made under APC 0977 (New Technology Level VIII, $1,000-$1,250), due to the lack of available claims data to establish a payment rate based on historical hospital costs.

    As discussed in the November 7, 2003 final rule with comment period, we created APC 0375 to pay for services furnished on the same date as a procedure with SI “C” and billed with the modifier -CA (68 FR 63467) because we were concerned that payment under a New Technology APC would not result in an appropriate payment. Payment under a New Technology APC is a fixed amount that does not have a relative payment weight and, therefore, is not subject to recalibration based on hospital costs. In the absence of hospital claims data to determine costs, the clinical APC 0375 payment rate for CY 2004 was set at of $1,150, which was the payment amount for the newly structured New Technology APC that replaced APC 0977.

    For CY 2005, payment for otherwise payable outpatient services furnished on the same date of service that a procedure with SI “C” was performed on an emergent basis on an outpatient who died before inpatient admission and where modifier -CA was appended to the inpatient procedure continued to be made under APC 0375 (Ancillary Outpatient Services When Patient Expires) at a payment rate of $3,217.47. As discussed in the November 15, 2004 final rule with comment period (69 FR 65841), the payment median was set in accordance with the same methodology we followed to set payment rates for the other procedural APCs in CY 2005, based on the relative payment weight calculated for APC 0375. A review of the 18 hospital claims utilized for ratesetting revealed a reasonable mix of outpatient services that a hospital could be expected to furnish during an encounter with a patient with an emergency condition requiring immediate medical intervention, as well as a wide range of costs.

    For CY 2006, we are not proposing any changes to our payment policy for services billed on the same date as a “C” status procedure appended with modifier -CA. We are proposing to continue to make one payment under APC 0375 for the services that meet the specific conditions discussed in previous rules for using modifier -CA, based on calculation of the relative payment weight for APC 0375, using charge data from CY 2004 claims for line items with a HCPCS code and status indicator “V,” “S,” “T,” “X,” “N,” “K,” “G,” and “H,” in addition to charges for revenue codes without a HCPCS code.

    In accordance with this methodology, for CY 2006, we calculated a median cost of $2,528.61 for APC 0375 for the aggregated otherwise payable outpatient hospital services based on 300 CY 2004 hospital claims reporting modifier -CA with an inpatient procedure. These 300 claims were billed by 218 different hospital providers, each submitting between 1 and 10 claims with modifier -CA appended to a “C” status procedure. This median cost for APC 0375 is relatively consistent with the median calculated for the CY 2005 OPPS update, and, as expected, the hospital claims once again show a wide range of costs. Nevertheless, we are concerned with the very large increase in the volume of hospital claims billed with the -CA modifier from CY 2003 to CY 2004, growing from 18 to 300 claims over that 1-year time period. We acknowledge that modifier -CA was first introduced quite recently in CY 2003, and in CY 2003 and CY 2004 hospitals may have been experiencing a learning curve with respect to its appropriate use on claims for services payable under the OPPS.

    However, our clinical review of the 300 claims reporting modifier -CA lends some support to our early concerns regarding the increased CY 2004 modifier volume and hospitals' possible incorrect use of the modifier for services that do not meet the payment conditions we established. Hospitals should be using this modifier only under circumstances described in section VI. of Transmittal A-02-129, which provided specific billing guidance for the use of modifier -CA. In addition to expected use of the -CA modifier for exploratory laparotomies and insertions of intra-aortic balloon assist devices, other unanticipated examples of “C” status procedures reported with the -CA modifier by hospitals in CY 2004 include knee arthroplasty, thyroidectomy, repair of nonunion or malunion of the femur, and thromboendarterectomy of the carotid, vertebral, or subclavian arteries. Moreover, few of the claims also include a clinic or emergency room visit on the same date of service as the procedure appended with modifier -CA, as might be expected for some patients presenting to a hospital with serious medical conditions which require urgent interventions with inpatient procedures. We are concerned that some procedures reported by hospitals with the -CA modifier in CY 2004 may not have been provided to patients with emergent, life-threatening conditions, where the inpatient procedure was performed on an emergency basis to resuscitate or stabilize the patient. Instead, those procedures may have been provided to hospital outpatients as scheduled inpatient procedures that were not emergency interventions for patients in critical or unstable condition and such circumstances would have been inconsistent with our billing and payment rules regarding correct use of the -CA modifier to receive payment for APC 0375. In light of these claims findings and our current analysis, we will continue to closely monitor hospital use of modifier -CA, following changes in the claims volume, noting inpatient procedures to which the -CA modifier is appended, examining other services billed on the same date as the inpatient procedure, and analyzing specific hospital patterns of billing for services with modifier -CA appended, to assess whether a proposal to change our policies regarding payment for APC 0375 would be warranted in the future or whether hospitals require further education regarding correct use of the modifier -CA.

    XIII. Proposed Indicator Assignments

    A. Proposed Status Indicator Assignments

    (If you choose to comment on issues in the section, please include the caption “Status Start Printed Page 42748Indicator” at the beginning of your comment.)

    The payment status indicators (SIs) that we assign to HCPCS codes and APCs under the OPPS play an important role in determining 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. For CY 2006, we are providing our proposed status indicator assignments for APCs in Addendum A, for the HCPCS codes in Addendum B, and the definitions of the status indicators in Addendum D1 to this proposed rule.

    Payment under 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 through the OCE software as to HCPCS codes that 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 D1 contains the proposed definitions of each status indicator for purposes of the OPPS for CY 2006.

    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, for CY 2006, we are proposing to use the following status indicators in the specified manner:

    • “A” to indicate services that are billable to fiscal intermediaries but are paid under some payment method other than OPPS, such as under the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) fee schedule or the Medicare Physician Fee Schedule. Some, but not all, of these other payment systems are identified in Addendum D1 to this proposed rule.
    • “B” to indicate the services that are billable to fiscal intermediaries but are not payable under the OPPS when submitted on an outpatient hospital Part B bill type, but that may be payable by fiscal intermediaries to other provider types when submitted on an appropriate bill type.
    • “C” to indicate inpatient services that are not payable under the OPPS.
    • “D” to indicate a code that is discontinued, effective January 1, 2006.
    • “E” to indicate items or services that are not covered by Medicare or codes that are not recognized by Medicare.
    • “F” to indicate acquisition of corneal tissue which is paid on a reasonable cost basis, certain CRNA services, and hepatitis B vaccines that are paid on a reasonable cost basis.
    • “G” to indicate drugs and biologicals that are paid under the OPPS transitional pass-through rules.
    • “H” to indicate pass-through devices, brachytherapy sources, and separately payable radiopharmaceuticals that are paid on a cost basis.
    • “K” to indicate drugs and biologicals (including blood and blood products) and radiopharmaceutical agents that are paid in separate APCs under the OPPS, but that are not paid under the OPPS transitional pass-through rules.
    • “L” to indicate flu and pneumococcal immunizations that are paid at reasonable cost but to which no coinsurance or copayment apply.
    • “M” to indicate services that are only billable to carriers and not to fiscal intermediaries and that are not payable under the OPPS.
    • “N” to indicate services that are paid under the OPPS, but for which payment is packaged into another service or APC group.
    • “P” to indicate services that are paid under the OPPS, but only in partial hospitalization programs.
    • “Q” to indicate packaged services subject to separate payment under OPPS payment criteria.
    • “S” to indicate significant services subject to separate payment under the OPPS.
    • “T” to indicate significant services that are paid under the OPPS and to which the multiple procedure payment discount under the OPPS applies.
    • “V” to indicate medical visits (including emergency department or clinic visits) that are paid under the OPPS.
    • “X” to indicate ancillary services that are paid under the OPPS.
    • “Y” to indicate nonimplantable durable medical equipment that must be billed directly to the durable medical equipment regional carrier rather than to the fiscal intermediary.

    We are proposing the payment status indicators identified above, of which indicators “M” and “Q” are new for CY 2006, for each HCPCS code and each APC listed in Addenda A and B and are requesting comments on the appropriateness of the indicators we have assigned.

    B. Proposed Comment Indicators for the CY 2006 OPPS Final Rule

    (If you choose to comment on issues in the section, please include the caption “Comment Indicator” at the beginning of your comment.)

    We are proposing to continue our use of the two comment indicators finalized in the November 15, 2004 final rule with comment period (69 FR 65827 and 65828) to identify in the CY 2006 OPPS final rule the assignment status of a specific HCPCS code to an APC and the timeframe when comments on the HCPCS APC assignment will be accepted. The two comment indicators are listed below, and in Addendum D2 of this proposed rule:

    • “NF”—New code, final APC assignment; Comments were accepted on a proposed APC assignment in the Proposed Rule; APC assignment is no longer open to comment.
    • “NI”—New code, interim APC assignment; Comments will be accepted on the interim APC assignment for the new code.

    XIV. Proposed Nonrecurring Policy Changes

    A. Proposed Payments for Multiple Diagnostic Imaging Procedures

    (If you choose to comment on issues in this section, please include the caption “Multiple Diagnostic Imaging Procedures” at the beginning of your comment.)

    Currently, under the OPPS, hospitals billing for diagnostic imaging procedures receive full APC payments for each service on a claim, regardless of how many procedures are performed using a single imaging modality and whether or not contiguous areas of the body are studied in the same session. In its March 2005 Report to Congress, MedPAC recommended that the Secretary should improve Medicare coding edits that detect unbundled diagnostic imaging services and reduce the technical component payment for multiple imaging services when they are performed on contiguous areas of the body (Recommendation 3-B). MedPAC pointed out that Medicare's payment rates are based on each service being provided independently and that the rates do not account for efficiencies that may be gained when multiple studies using the same imaging modality are performed in the same session. Those efficiencies are especially likely when contiguous body areas are the focus of the imaging because the patient and Start Printed Page 42749equipment have already been prepared for the second and subsequent procedures, potentially yielding resource savings in areas such as clerical time, technical preparation, and supplies, elements of hospital costs for imaging procedures that are reflected in APC payment rates under the OPPS.

    Under the OPPS, we have a longstanding policy of reducing payment for multiple surgical procedures performed on the same patient in the same operative session (§ 419.44(a) of the regulations). In such cases, full payment is made for the procedure with the highest APC payment rate, and each subsequent procedure is paid at 50 percent of its respective APC payment rate. We believe that a similar policy for payment of diagnostic imaging services would be more appropriate than our current policy because it would lead to more appropriate payment for multiple imaging procedures of contiguous body areas that are performed during the same session.

    In our efforts to determine whether or not such a policy would improve the accuracy of OPPS payments, we identified 11 “families” of imaging procedures by imaging modality (ultrasound, computerized tomography (CT) and computerized tomography angiography (CTA), magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA)) and contiguous body area (for example, CT and CTA of Chest/Thorax/Abdomen/Pelvis), as displayed in Table 32. Using those Families of procedures, we examined OPPS bills for CY 2004 and found that there were numerous claims reporting more than one imaging procedure within the same Family provided to a beneficiary by a hospital on the same day. For instance, of the approximately 2.7 million OPPS claims billed for services within Family 2 (CT and CTA of the Chest/Thorax/Abdomen/Pelvis), approximately 1.1 million were claims for multiple procedures within Family 2. In particular, there were 288,200 claims for the combination of CPT codes 72192 (CT of the pelvis without dye) and 74150 (CT of the abdomen without dye).

    Table 32.—Multiple Imaging Procedures Families by Imaging Modality and Contiguous Body Area

    FamilyImaging modality/contiguous body area
    Family 1—Ultrasound (Chest/Abdomen/Pelvis—Non-Obstetrical):
    76604Us exam, chest, b-scan.
    76645Us exam, breast(s).
    76700Us exam, abdom, complete.
    76705Echo exam of abdomen.
    76770Us exam abdo back wall, comp.
    76775Us exam abdo back wall, lim.
    76778Us exam kidney transplant.
    76830Transvaginal us, non-ob.
    76831Echo exam, uterus.
    76856Us exam, pelvic, complete.
    76857Us exam, pelvic, limited.
    Family 2—CT and CTA (Chest/Thorax/Abd/Pelvis):
    71250Ct thorax w/o dye.
    71260Ct thorax w/ dye.
    71270Ct thorax w/o & w/ dye.
    72192Ct pelvis w/o dye.
    72193Ct pelvis w/ dye.
    72194Ct pelvis w/o & w/ dye.
    74150Ct abdomen w/o dye.
    74160Ct abdomen w/ dye.
    74170Ct abdomen w/o & w/ dye.
    71275Ct angiography, chest.
    72191Ct angiography, pelv w/o & w/ dye.
    74175Ct angiography, abdom w/o & w/ dye.
    75635Ct angio abdominal arteries.
    0067TCt colonography; dx.
    Family 3—CT and CTA (Head/Brain/Orbit/Maxillofacial/Neck):
    70450Ct head/brain w/o dye.
    70460Ct head/brain w/ dye.
    70470Ct head/brain w/o & w/ dye.
    70480Ct orbit/ear/fossa w/o dye.
    70481Ct orbit/ear/fossa w/ dye.
    70482Ct orbit/ear/fossa w/o & w/ dye.
    70486Ct maxillofacial w/o dye.
    70487Ct maxillofacial w/ dye.
    70488Ct maxillofacial w/o & w/ dye.
    70490Ct soft tissue neck w/o dye.
    70491Ct soft tissue neck w/ dye.
    70492Ct soft tissue neck w/o & w/ dye.
    70496Ct angiography, head.
    70498Ct angiography, neck.
    Family 4—MRI and MRA (Chest/Abd/Pelvis):
    71550Mri chest w/o dye.
    71551Mri chest w/ dye.
    71552Mri chest w/o & w/ dye.
    72195Mri pelvis w/o dye.
    72196Mri pelvis w/ dye.
    72197Mri pelvis w/o &w/ dye.
    74181Mri abdomen w/o dye.
    Start Printed Page 42750
    74182Mri abdomen w/ dye.
    74183Mri abdomen w/o and w/ dye.
    C8900MRA w/contrast, abdomen.
    C8901MRA w/o contrast, abdomen.
    C8902MRA w/o fol w/contrast, abd.
    C8903MRI w/contrast, breast, unilateral.
    C8904MRI w/o contrast, breast, unilateral.
    C8905MRI w/o fol w/contrast, breast, uni.
    C8906MRI w/contrast, breast, bilateral.
    C8907MRI w/o contrast, breast, bilateral.
    C8908MRI w/o fol w/contrast, breast, bilat.
    C8909MRA w/contrast, chest.
    C8910MRA w/o contrast, chest.
    C8911MRA w/o fol w/contrast, chest.
    C8918MRA w/contrast, pelvis.
    C8919MRA w/o contrast, pelvis.
    C8920MRA w/o fol w/contrast, pelvis.
    Family 5—MRI and MRA (Head/Brain/Neck):
    70540Mri orbit/face/neck w/o dye.
    70542Mri orbit/face/neck w/ dye.
    70543Mri orbit/face/neck w/o & w/dye.
    70551Mri brain w/o dye.
    70552Mri brain w/dye.
    70553Mri brain w/o & w/dye.
    70544Mr angiography head w/o dye.
    70545Mr angiography head w/dye.
    70546Mr angiography head w/o & w/dye.
    70547Mr angiography neck w/o dye.
    70548Mr angiography neck w/dye.
    70549Mr angiography neck w/o & w/dye.
    Family 6—MRI and MRA (Spine):
    72141Mri neck spine w/o dye.
    72142Mri neck spine w/dye.
    72146Mri chest spine w/o dye.
    72147Mri chest spine w/dye.
    72148Mri lumbar spine w/o dye.
    72149Mri lumbar spine w/dye.
    72156Mri neck spine w/o & w/dye.
    72157Mri chest spine w/o & w/dye.
    72158Mri lumbar spine w/o & w/dye.
    Family 7—CT (Spine):
    72125CT neck spine w/o dye.
    72126Ct neck spine w/dye.
    72127Ct neck spine w/o & w/dye.
    72128Ct chest spine w/o dye.
    72129Ct chest spine w/dye.
    72130Ct chest spine w/o & w/dye.
    72131Ct lumbar spine w/o dye.
    72132Ct lumbar spine w/dye.
    72133Ct lumbar spine w/o & w/dye.
    Family 8—MRI and MRA (Lower Extremities):
    73718Mri lower extremity w/o dye.
    73719Mri lower extremity w/dye.
    73720Mri lower ext w/ & w/o dye.
    73721Mri joint of lwr extre w/o dye.
    73722Mri joint of lwr extr w/dye.
    73723Mri joint of lwr extr w/o & w/dye.
    C8912MRA w/contrast, lwr extremity.
    C8913MRA w/o contrast, lwr extremity.
    C8914MRA w/o fol w/contrast, lwr extremity.
    Family 9—CT and CTA (Lower Extremities):
    73700Ct lower extremity w/o dye.
    73701Ct lower extremity w/dye.
    73702Ct lower extremity w/o & w/dye.
    73706Ct angio lower ext w/o & w/dye.
    Family 10—Mr and MRI (Upper Extremities and Joints):
    73218Mri upper extr w/o dye.
    73219Mri upper extr w/dye.
    73220Mri upper extremity w/o & w/dye.
    73221Mri joint upper extr w/o dye.
    73222Mri joint upper extr w/dye.
    Start Printed Page 42751
    73223Mri joint upper extr w/o & w/dye.
    Family 11—CT and CTA (Upper Extremities):
    73200Ct upper extremity w/o dye.
    73201Ct upper extremity w/dye.
    73202Ct upper extremity w/o & w/dye.
    73206Ct angio upper extr w/o & w/dye.

    The imaging procedures described by CPT codes 72192 and 74150 study two adjacent body regions. Appropriate diagnostic evaluation of many constellations of patients' signs and symptoms and potentially affected organ systems may involve assessment of pathology in both the abdomen and pelvis, body areas that are anatomically and functionally closely related. Therefore, both studies are frequently performed in the same session to provide the necessary clinical information to diagnose and treat a patient. Although each procedure, by itself, entails the use of hospital resources, including certain staff, equipment, and supplies, some of those resource costs are not incurred twice when the procedures are performed in the same session and thus, should not be paid as if they were. Beginning with the beneficiary's arrival in the outpatient department, costs are incurred only once for registering the patient, taking the patient to the procedure room, positioning the patient on the table for the CT scan, among others. We believe it is clear that reducing the payment for the second and subsequent procedures within the identified families would result in more accurate payments with respect to the hospital resources utilized for multiple imaging procedures performed in the same session.

    OPPS bills do not contain detailed information on the hospitals' costs that are incurred in furnishing imaging procedures. Much of the costs are packaged and included in the overall charges for the procedures. Even if bundled costs are reported with charges on separate lines either with HCPCS codes or with revenue codes, when there are multiple procedures on the claims, it is impossible for us to accurately attribute bundled costs to each procedure. However, our analysis of CY 2004 hospital claims convinced us that some discounting of multiple imaging procedures is warranted. In order to determine the level of adjustment that would be appropriate for the second and subsequent procedures performed within a family in the same session, we used the MPFS methodology and data.

    Under the resource-based practice expense methodology used for Medicare payments to physicians, specific practice expense inputs of clinical labor, supplies and equipment are used to calculate “relative value units” on which physician payments are based. When multiple images are acquired in a single session, most of the clinical labor activities are not performed twice and many of the supplies are not furnished twice. Specifically, we consider that the following clinical labor activities included in the “technical component” (TC) of the MPFS are not duplicated for subsequent procedures: Greeting, positioning and escorting the patient; providing education and obtaining consent; retrieving prior exams; setting up the IV; and preparing and cleaning the room. In addition, we consider that supplies, with the exception of film, are not duplicated for subsequent procedures. Equipment time and indirect costs are allocated based on clinical labor time in the physician payment methodology and, therefore, these inputs should be reduced accordingly.

    We performed analyses and found that excluding those practice expense inputs, along with the corresponding portion of equipment time and indirect costs, supports a 50-percent reduction in the payment for the TC portion of subsequent procedures. The items and services that make up hospitals' facility costs are generally very similar to those that are counted in the TC portion of the MPFS for diagnostic imaging procedures. We believe that the analytic justification for a 50-percent reduction of the TC for the second and subsequent imaging procedures using the MPFS input data also provides a basis for a similar relative reduction to payments for multiple imaging procedures performed in the hospital outpatient department. Therefore, we are proposing to make a 50-percent reduction in the OPPS payments for some second and subsequent imaging procedures performed in the same session, similar to our policy of reducing payments for some second and subsequent surgical procedures.

    We are proposing to apply the multiple imaging procedure reduction only to individual services described by codes within one Family, not across Families. Reductions would apply when more than one procedure within the Family is performed in the same session. For example, no reduction would apply to an MRI of the brain (CPT code 70552) in code Family 5, when performed in the same session as an MRI of the spinal canal and contents (CPT code 72142) in code Family 6. We are proposing to make full payment for the procedure with the highest APC payment rate, and payment at 50 percent of the applicable APC payment rate for every additional procedure, when performed in the same session.

    B. Interrupted Procedure Payment Policies (Modifiers -52, -73, and -74)

    (If you choose to comment on issues in this section, please include the caption “Interrupted Procedures” at the beginning of your comment.)

    Since implementation of the OPPS in 2000, we have required hospitals to report modifiers -52, -73, and -74 to indicate procedures that were terminated before their completion. Modifier -52 indicates partial reduction or discontinuation of services that do not require anesthesia, while modifiers -73 and -74 are used for procedures requiring anesthesia, where the patient was taken to the treatment room and the procedure was discontinued before anesthesia administration or after anesthesia administration/procedure initiation respectively. The elective cancellation of procedures is not reported. Hospitals are paid 50 percent of the APC payment for services with -73 appended and 100 percent for procedures with modifier -52 or -74 reported, in accordance with § 419.44(b) of the regulations. In January 2005, we clarified in Program Transmittal 442 the definition of anesthesia for purposes of billing for services furnished in the hospital outpatient department in the context of reporting modifiers -73 and -74. The APC Panel considered the Start Printed Page 42752current OPPS payment policies for interrupted procedures at its February 2005 meeting and made a number of recommendations that are addressed in the following discussion.

    Current OPPS policy requires providers to use modifier -52 to indicate that a service that did not require anesthesia was partially reduced or discontinued at the physician's discretion. The physician may discontinue or cancel a procedure that is not completed in its entirety due to a number of circumstances, such as adverse patient reaction or medical judgment that completion of the full study is unnecessary. Based on an analysis of CY 2004 hospital claims data, in the outpatient hospital setting modifier -52 is used infrequently. The modifier is reported most often to identify interrupted or reduced radiological and imaging procedures, and our current policy is to make full payment for procedures with a -52 modifier.

    We are now reconsidering our payment policy for interrupted or reduced services not requiring anesthesia and reported with a -52 modifier. At its February 2005 meeting, the APC Panel recommended continuing current OPPS payment policy at 100 percent of the APC payment for reduced services reported with modifier -52, although the Panel members acknowledged their limited familiarity with the specific outpatient hospital services and their clinical circumstances that would warrant the reporting of modifier -52. We have examined our data to determine the appropriateness of our current policy regarding payment for services that are reduced, and although some hospital resources are used to provide even an incomplete service, such as a radiology service, we are skeptical that it is accurate to pay the full rate for a discontinued or reduced radiological service. Compared to surgical procedures that require anesthesia, a number of general and procedure-specific supplies, and reserved procedure rooms that must be cleaned and prepared prior to performance of each specific procedure, the costs to the hospital outpatient department for the rooms and supplies typically associated with procedures not requiring anesthesia are much more limited. For example, the scheduling maintained for radiological services not requiring anesthesia generally exhibits greater flexibility than that for surgical procedures, and the procedure rooms are used for many unscheduled services that are fit in, when possible, between those that are scheduled. Consequently, we believe that the loss of revenue that may result from a surgical procedure being discontinued prior to its initiation in the procedure room is usually more substantial than that lost as the result of a discontinued service not requiring anesthesia, such as a radiology procedure. Nonetheless, under our current policy, Medicare makes the full APC payment for discontinued or reduced radiological procedures and only 50 percent of the APC payment for surgical procedures that are discontinued prior to initiation of the procedure or the administration of anesthesia.

    Therefore, we are proposing to pay 50 percent of the APC payment amount for a discontinued procedure that does not require anesthesia where modifier -52 is reported. We believe that this proposed payment would appropriately recognize the hospital's costs involved with the delivery of a typical reduced service, similar to our payment policies for interrupted procedures that require anesthesia.

    When a procedure requiring anesthesia is discontinued after the beneficiary was prepared for the procedure and taken to the room where it was to be performed but before the administration of anesthesia, hospitals currently report modifier -73 and receive 50 percent of the APC payment for the planned service. The APC Panel recommended that we make full APC payment for services with modifier -73 reported, because significant hospital resources were expended to prepare the patient and the treatment room or operating room for the procedure. Although the circumstances that require use of modifier -73 occur infrequently, we continue to believe that hospitals realize significant savings when procedures are discontinued prior to initiation but after the beneficiary is taken to the procedure room. We believe savings are recognized for treatment/operating room time, single use devices, drugs, equipment, supplies, and recovery room time. Thus, we believe our policy of paying 50 percent of the procedure's APC payment when modifier -73 is reported remains appropriate.

    Further, we are exploring the possibility of applying a payment reduction for interrupted procedures in which anesthesia was to be used (and may have been administered) and the procedure was initiated. Currently, those cases are reported using modifier -74, and we make the full APC payment for the planned service. We are now reviewing that policy and are soliciting comments that include information regarding what costs are incurred by providers in these cases.

    The payment policy for interrupted procedures reported with modifier -74 was originally adopted because we believed that the facility costs incurred for discontinued procedures that were initiated to some degree were as significant to the hospital provider as for a completed procedure, including resources for patient preparation, operating room use, and recovery room care. However, we have come to question that underlying assumption, especially as many surgical procedures have come to require specialized and costly devices and equipment, and our APC payments include the costs for those devices and equipment. We now believe that there are costs that are not incurred in the event of a procedure's discontinuation, if a hospital is managing its use of devices, supplies, and equipment efficiently and conservatively. For example, the patient's recovery time may be less than the recovery time would have been for the planned procedure, because less extensive surgery was performed or costly devices planned for the procedure may not be used.

    The APC Panel recommended that we continue to pay 100 percent of the procedural APC payment when modifier -74 is appended to the surgical service because, in its opinion, procedures may frequently be terminated prior to completion because the patient is experiencing adverse effects from the surgical service or the anesthesia. The Panel speculated that, in fact, significant additional resources could be expended in such a situation to stabilize and treat the patient if a procedure were discontinued because of patient complications. However, we believe that many of such additional services, including critical care, drugs, blood and blood products, and x-rays that may be necessary to manage and treat such patients, are separately payable under the OPPS and thus the hospital's costs need not be paid through the APC payment for the planned procedure. Because the OPPS is paying for the time in the operating room, recovery room, outpatient department staff, and supplies related to the typical procedure, it would seem that those costs may be lower in those infrequent cases when the procedure is initiated but not completed. We acknowledge that the costs on claims reporting a service with modifier -74 may be particularly diverse, depending upon the point in the procedure the service is interrupted. Thus, we are seeking comment on the clinical circumstances in which modifier -74 is used in the Start Printed Page 42753hospital outpatient department, and the degree to which hospitals may experience cost savings in such situations where procedures are not completed. We are specifically interested in comments regarding the disposition of devices and specialized equipment that are not used because a procedure is discontinued after its initiation. In particular, we are interested in obtaining information about when during the procedure the decision to discontinue is made.

    XV. OPPS Policy and Payment Recommendations

    A. MedPAC Recommendations

    1. Report to the Congress: Medicare Payment Policy (March 2005)

    The Medicare Payment Advisory Commission (MedPAC) submits reports to Congress in March and June that summarize payment policy recommendations. The March 2005 MedPAC report included the following two recommendations relating specifically to the hospital OPPS:

    a. Recommendation 1: The Congress should increase payment rates for the outpatient prospective payment system by the projected increase in the hospital market basket index less 0.4 percent for calendar year 2006. A discussion regarding hospital update payments, and the effect of the market basket update in relation to other factors influencing OPPS proposed payment rates, is included in section II.C. (“Proposed Conversion Factor Update for CY 2006”) of this preamble.

    b. Recommendation 2: The Congress should extend hold-harmless payments under the outpatient prospective payment system for rural sole community hospitals and other rural hospitals with 100 or fewer beds through calendar year 2006. A discussion of the expiration of the hold-harmless provision is included in section II.F. of this preamble. See also section II.G. (“Proposed Adjustment for Rural Hospitals”) of this preamble for a discussion of section 411 of Pub. L. 108-173.

    2. Report to the Congress: Issues in a Modernized Medicare Program—Payment for Pharmacy Handling Costs in Hospital Outpatient Departments (June 2005)

    A discussion of the MedPAC recommendations relating to pharmacy overhead payments in the hospital outpatient department can be found in section V. of the preamble of this proposed rule.

    B. APC Panel Recommendations

    Recommendations made by the APC Panel are discussed in sections of this preamble that correspond to topics addressed by the APC Panel. Minutes of the APC Panel's February 2005 meeting are available online at http://www.cms.hhs.gov/​faca/​apc/​default.asp.

    C. GAO Hospital Outpatient Drug Acquisition Cost Survey

    A discussion of the June 30, 2005 GAO report entitled “Medicare: Drug Purchase Prices for CMS Consideration in Hospital Outpatient Rate-Setting” and section 621(a)(1) of the MMA is included in section V. of the preamble of this proposed rule.

    XVI. Physician Oversight of Mid-Level Practitioners in Critical Access Hospitals

    (If you choose to comment on issues in this section, please include the caption “Physician Oversight of Nonphysician Practitioners” at the beginning of your comment.)

    A. Background

    Section 1820 of the Act, as amended by section 4201 of the Balanced Budget Act of 1997, Pub. L. 105-33, provides for the establishment of Medicare Rural Hospital Flexibility Programs (MRHFPs), under which individual States may designate certain facilities as critical access hospitals (CAHs). Facilities that are so designated and meet the CAH conditions of participations (COPs) under 42 CFR Part 485, Subpart F, will be certified as CAHs by CMS. The MRHFP replaced the Essential Access Community Hospital (EACH)/ Rural Primary Care Hospital (RPCH) program.

    B. Proposed Policy Change

    Under the former EACH/RPCH program, physician oversight was required for services provided by nonphysician practitioners such as physician assistants (PAs), nurse practitioners (NPs), and clinical nurse specialists (CNSs) in a CAH. Under the MRHFP, the statute likewise required a physician oversight provision for nonphysician practitioners.

    We note that under the EACH/RPCH program, we allowed for situations when the RPCH had an unusually high volume of outpatients (100 or more during a 2-week period) that were treated by nonphysician practitioners. We stated that it would be sufficient for a physician to review and sign a 25-percent sample of medical records for patients cared for by a mid-level practitioner unless State practice and laws require higher standards for physician oversight for mid-level practitioners.

    However, the current regulation does not distinguish between inpatient and outpatient physician oversight. Although the CAH CoPs at § 485.631(b)(iv) provide that a doctor of medicine or osteopathy periodically reviews and signs the records of patients cared for by NPs, CNSs, or PAs, section 1820(c)(2)(B)(iv)(III) of the Act states that CAH inpatient care provided by a PA or NP is subject to the oversight of a physician. The review of outpatient records is not addressed in the statute. Presently, for patients cared for by nonphysician practitioners, the interpretative guidelines set forth in Appendix W of the State Operations Manual (CMS Publication 107) set parameters for inpatient and outpatient physician reviews. To maintain consistency from the EACH/RPCH program to the CAH program, we indicated that CAHs with a high volume of outpatients need to have a physician review and sign a random sample of 25 percent outpatient medical records. Therefore, the interpretative guidelines allow a physician to review and sign a 25-percent sample of outpatient records for patients under the care of a nonphysician practitioner.

    Nonphysician practitioners recently brought to our attention their concerns regarding their ability to practice under their State laws governing scope of practice. Particularly, the nonphysician practitioners believe the current regulations and guidelines impede their ability to practice in CAHs. Certified nurse midwives, NPs, and CNSs disagree with the need for a physician to review records of patients that have been in their care when State law permits them to practice independently.

    MedPAC, in its June 2002 Report to the Congress, stated that certified nurse midwives, NPs, CNSs, and PAs are health care practitioners who furnish many of the same health care services traditionally provided by physicians, such as diagnosing illnesses, performing physical examinations, ordering and interpreting laboratory tests, and providing preventive health services. In many States, advance practice nurses are permitted to practice independently or in collaboration with a physician. MedPAC reported that NPs have independent practice authority in 21 States, and CNSs have independent practice authority in 20 States. PAs, by law, must work under the supervision of a physician. Based on the American Medical Association's guidelines for PAs, the definition of supervision varies by State. Generally, the physician assistant is a representative of the Start Printed Page 42754physician, treating the patient in the style and manner developed and directed by the supervising physician.

    MedPAC further reported that several studies have shown comparable patient outcomes for the services provided by physician and nonphysician practitioners. MedPAC reported that research conducted by Mundinger et al.[2] in 2000, Brown and Grimes [3] in 1993, Ryan in 1993,[4] and the Office of Technology Assessment [5] in 1986 has shown that nonphysician practitioners can perform about 80 percent of the services provided by primary care physicians with comparable quality. A randomized trial of physicians and nurse practitioners providing care in ambulatory care settings who had the same authority, responsibilities, productivity, and administrative requirements were shown to have comparable patient outcomes (see pages 5 and 11 of the June 2002 MedPAC report). Nonphysician practitioners are trained with the expectation that they will exercise a certain degree of autonomy when providing patient care. About 90 percent of nurse practitioners and 50 percent of physician assistants provide primary care.

    We believe sufficient control and oversight of these nonphysician practitioners is generated by State laws which allow independent practice authority. Moreover, it further appears that quality is not impaired by such nonphysician practitioners. We remain concerned, however, that in those States without independent practice laws we have a responsibility to continue to ensure the safety and quality of services provided to Medicare beneficiaries.

    Therefore, we are proposing to revise the regulation at § 485.631(b)(iv) to defer to State law regarding the review of records for outpatients cared for by nonphysician practitioners. We are proposing that if State law allows these practitioners to practice independently, we would not require physicians to review and sign medical records of outpatients cared for by nonphysician practitioners. However, for those States that do not allow independent practice of nonphysician practitioners, we would continue to maintain that periodic review is performed by the physician on outpatient records under the care of a nonphysician practitioner. We believe a review of at least every 2 weeks provides a sufficient time period without unduly imposing an administrative burden on the physician or the CAH. In addition, we would allow the CAH to determine the sample size of the reviewed records in accordance with current standards of practice to allow the CAH flexibility in adapting the review to its particular circumstances. Specifically, we are proposing that the physician periodically (that is, at least once every 2 weeks) reviews and signs a sample of the outpatient records of nonphysician practitioners according to the facility policy and current standards of practice. We would still require periodic review and oversight of all inpatient records by physicians.

    XVII. Files Available to the Public Via the Internet

    The data referenced for Addendum C and Addendum P to this proposed rule are available on the following CMS Web site via Internet only: http://www.cms.hhs.gov/​providers/​hopps/​. We are not republishing the data represented in these Addenda to this proposed rule because of their volume. For additional assistance, contact Rebecca Kane, at (410) 786-0378.

    Addendum C—Healthcare Common Procedure Coding System (HCPCS) Codes by Ambulatory Payment Classification (APC)

    This file contains the HCPCS codes sorted by the APCs into which they are assigned for payment under the OPPS. The file also includes the APC status indicators, relative weights, and OPPS payment amounts.

    XVIII. Collection of Information Requirements

    Under the Paperwork Reduction Act of 1995 (PRA), 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 evaluate fairly whether an information collection should be approved by OMB, section 35006(c)(2)(A) of the PRA requires that we solicit comment on the following issues:

    • The need for the information collection and its usefulness in carrying out the proper functions of the agency.
    • The accuracy of our estimates of the information collection burden,
    • The quality, utility, and clarity of the information to be collected.
    • Recommendations to minimize the information collection burden on the affected public, including automated collection techniques.

    We are soliciting public comments on each of these issues for the information requirement discussed below.

    The following information collection requirements in this proposed rule and the associated burdens are subject to the PRA:

    Proposed § 485.631(b)(1)(iv), (b)(1)(v), and (b)(1)(vi)—Condition of Participation: Staffing and Staff Responsibilities

    Existing § 485.631(b)(1)(iv) requires, as a condition of participation for a CAH, that a doctor of medicine or osteopathy to periodically review and sign the records of patients cared for by nurse practitioners, clinical specialists, or physician assistants. This proposed rule would amend those requirements to require that a doctor of medicine or osteopathy (1) periodically review and sign the records of all inpatients cared for by nurse practitioners, clinical nurse specialists, certified nurse midwives, or physician assistants; and (2) periodically, but not less than every 2 weeks, review and sign a sample of outpatient records of patients cared for by nurse practitioners, clinical nurse specialists, certified nurse midwives, or physician assistants according to the policy and standard practice of the CAH when State law does not allow these nonphysician practitioners to practice independently. In addition, the proposed rule would provide that a doctor of medicine or osteopathy is not required to review and sign outpatient records of patients cared for by nurse practitioners, clinical nurse specialists, certified nurse midwives, or physician assistants when State law allows these nonphysician practitioners to practice independently.

    The information collection requirements associated with these provisions are subject to the PRA. However, the collection requirement is currently approved under OMB control number 0938-0328 with an expiration date of January 31, 2008.

    We have submitted a copy of this proposed rule to OMB for its review of the information collection requirements described above. These requirements are Start Printed Page 42755not effective until they have been approved by OMB.

    If you comment on any of these information collection and record keeping requirements, please mail copies directly to the following:

    Centers for Medicare & Medicaid Services, Office of Strategic Operations and Regulatory Affairs, Regulations Development and Issuances Group, Attn: James Wickliffe, CMS-1501-P, 7500 Security Boulevard, Baltimore, MD 21244-1850; and

    Office of Information and Regulatory Affairs, Office of Management and Budget, Room 10235, New Executive Office Building, Washington, DC 20503, Attn: Christopher Martin, CMS Desk Officer.

    Comments submitted to OMB may also be e-mailed to the following address: Christopher_Martin@omb.eop.gov, or faxed at (202) 395-6974.

    XIX. Response to 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 when we proceed with a subsequent document, we will respond to the comments in the preamble to that document.

    XX. Regulatory Impact Analysis

    (If you choose to comment on issues in this section, please include the caption “Impact” at the beginning of your comment.)

    A. OPPS: General

    We have examined the impacts of this proposed rule as required by Executive Order 12866 (September 1993, Regulatory Planning and Review), the Regulatory Flexibility Act (RFA) (September 19, 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.

    1. Executive Order 12866

    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 this proposed rule as well as enrollment, utilization, and case-mix changes) in expenditures under the OPPS for CY 2006 compared to CY 2005 to be approximately $1.4 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).

    2. Regulatory Flexibility Act (RFA)

    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 (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.

    3. Small Rural Hospitals

    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 previously defined a small rural hospital as a hospital with fewer than 100 beds that is located outside of a Metropolitan Statistical Area (MSA) (or New England County Metropolitan Area (NECMA)). However, under the new labor market definitions that we are adopted in the November 15, 2004 final rule with comment period, for CY 2005, (consistent with the FY 2005 IPPS final rule), we no longer employ NECMAs to define urban areas in New England. Therefore, we now define a small rural hospital as a hospital with fewer than 100 beds that is located outside of an MSA. 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.

    4. 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 does not mandate any requirements for State, local, or tribal governments. This proposed rule also does not impose unfunded mandates on the private sector of more than $110 million dollars.

    5. Federalism

    Executive Order 13132 establishes certain requirements that an agency must meet when it publishes any rule (proposed or 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 Start Printed Page 42756governments. The impact analysis (refer to Table 33) shows that payments to governmental hospitals (including State, local, and tribal governmental hospitals) would increase by 1.8 percent under this proposed rule.

    B. Impact of Proposed 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, 2006, as we discuss in sections II.C. and II.D., respectively, of this proposed rule. We also are proposing to revise the relative APC payment weights using claims data from January 1, 2004, through December 31, 2004. In response to a provision in Pub. L. 108-173 that we analyze the cost of outpatient services in rural hospitals relative to urban hospitals, we are proposing to increase payments to rural sole community hospitals. Refer to section II.G. of the preamble to this proposed rule for greater detail on this adjustment. Finally, we are proposing to remove 3 device categories from pass-through payment status. In particular, refer to section IV.C.1 of the preamble of this proposed rule with regard to the expiration of pass-through status for devices.

    Under this proposed rule, the update change to the conversion factor as provided by statute would increase total OPPS payments by 3.2 percent in CY 2006. The inclusion in CY 2006 of payment for specific covered outpatient drugs within budget neutrality, and the expiration of additional drug payment outside budget neutrality, which were authorized by Pub. L. 108-173 result in a net increase of 1.9 percent. The changes to the APC weights, the introduction of a multiple procedure discount for diagnostic imaging, changes to the wage index, and the introduction of a payment adjustment for rural sole community hospitals would not increase OPPS payments because these changes to the OPPS are budget neutral. However, these updates do change the distribution of payments within the budget neutral system as shown in Table 33 and described in more detail in this section.

    C. Alternatives Considered

    Alternatives to the changes we are making and the reasons that we have chosen the options we have are discussed throughout this proposed rule. Some of the major issues discussed in this proposed rule and the options considered are discussed below.

    1. Option Considered for Proposed Payment Policy for Separately Payable Drugs and Biologicals

    As discussed in detail in section V.B.3 of the preamble of this proposed rule, section 1833(t)(14)(A)(iii) of the Act requires that payment for specified covered outpatient drugs in CY 2006, as adjusted for pharmacy overhead costs, be equal to the average acquisition cost for the drug for that year as determined by the Secretary and taking into account the hospital acquisition cost survey data collected by the GAO in 2004 and 2005. If hospital acquisition cost data are not available, then the law requires that payment be equal to payment rates established under the methodology described in section 1842(o), section 1847(A), or section 1847(B) of the Act as calculated and adjusted by the Secretary as necessary.

    The payment policy that we are proposing for CY 2006 is to pay for all separately payable drugs and biologicals at the payment rates effective in the physician office setting as determined using the manufacturer's average sales price (ASP) methodology. Our proposal uses payment rates based on ASP data from the fourth quarter of 2004, which were used to set payment rates for drugs and biologicals in the physician office setting effective April 1, 2005, as these are the most recent numbers available to us during the development of this proposed rule. For the few drugs and biologicals, other than radiopharmaceuticals as discussed earlier, where ASP data are unavailable, we are proposing to use the mean costs from the CY 2004 hospital claims data to determine their packaging status and for ratesetting. We believe that the ASP-based payment rates serve as the best proxy for the average acquisition cost for the drug or biological because the rates calculated using the ASP methodology are based on the manufacturers' sales prices from the fourth quarter of 2004 and take into consideration information on sales prices to hospitals. Furthermore, payments for drugs and biologicals using the ASP methodology would allow for consistency of drug pricing between the physician offices and hospital outpatient departments.

    An alternative payment option for separately payable drugs and biologicals (before payment for pharmacy overhead) we considered was using ASP+3 percent based on the average relationship between the GAO mean purchase prices and ASP. A second payment option we considered using was ASP+8 percent (again before payment for pharmacy overhead) based on the average relationship between the mean costs from hospital claims data and ASP.

    We are not proposing to set payment rates for separately payable drugs and biologcals at ASP+3 percent because the GAO data reflect hospital acquisition costs from a less recent period of time as the midpoint of the time period when the survey was conducted is January 1, 2004, and it would be difficult to update the GAO mean purchase prices during CY 2006 and in future years. Because the changes in drug payments are required to be budget neutral by law, we note that paying for separately payable drugs and biologicals at ASP+3 percent relative to ASP+6 percent would have made available approximately an additional $60 million for other items and services paid under the OPPS.

    We are also not proposing to use ASP+8 percent to set payment rates for drugs and biologicals in CY 2006. The statute specifies that CY 2006 payments for specified covered outpatient drugs are required to be equal to the “average” acquisition cost for the drug. Payment at ASP+8 percent for drugs or biologicals, which represents the average relationship between the mean cost from hospital claims data and ASP, would reflect the product's acquisition cost plus overhead cost, instead of acquisition cost only. Therefore, we believe that it would not be appropriate for us to use ASP+8 percent to set the payment rates for drugs and biologicals in CY 2006. Using ASP+8 percent to set payments for separately payable drugs and biologicals relative to ASP+6 percent would have reduced payments for other items and services paid under the OPPS by approximately $40 million as the law requires that changes in drug payments be made in a budget neutral manner.

    2. Payment Adjustment for Rural Sole Community Hospitals

    In section II.G. of the preamble of this proposed rule, we propose a 6.6 percent payment adjustment increase to rural sole community hospitals. Section 1833(t)(13)(A) of the Act instructs the Secretary to conduct a study to determine if rural hospital outpatient costs exceed urban hospital outpatient Start Printed Page 42757costs. In addition, under new section 1833(t)(13)(B) of the Act, the Secretary is given authorization to provide an appropriate adjustment to rural hospitals, by January 1, 2006, if rural hospital costs are determined to be greater than urban hospital costs.

    To conduct the study, we believe that a simple comparison of unit costs is insufficient because the costs faced by hospitals, whether urban or rural, will be a function of many factors. These include the local labor supply, and the complexity and volume of services provided. (We note that without controlling for the other influences on per unit cost, rural hospitals have lower cost per unit than urban hospitals.) Therefore, we rejected the option of using a simple comparison of unit costs and instead used regression analysis to analyze the differences in the outpatient cost per unit between rural and urban hospitals in order to compare costs after accounting for the influence of these other factors.

    Our initial regression analysis found that all rural hospitals give some indication of having higher cost per unit, after controlling for labor input prices, service-mix complexity, volume, facility size, and type of hospital. Initially, we planned a small adjustment to all rural hospitals. However, in order to assess whether the small difference in costs was uniform across rural hospitals or whether all of the variation was attributable to a specific class of rural hospitals, we included more specific categories of rural hospitals in our explanatory regression analysis. Further analysis revealed that only rural sole community hospitals are more costly than urban hospitals holding all other variables constant. Notably, we observed no significant difference between all other rural hospitals and urban hospitals. Therefore, we propose not to pay a small adjustment increase to all rural hospitals, but to instead pay a 6.6 percent payment increase to rural sole community hospitals.

    3. Change in the Percentage of Total OPPS Payments Dedicated to Outlier Payments

    In section II.H. of the preamble of this proposed rule, we are proposing to change the percentage of total OPPS payments dedicated to outlier payments to 1.0 percent in CY 2006 from the current policy of 2.0 percent. We also are proposing to continue using a fixed-dollar threshold in addition to the threshold based on a multiple of the APC amount that we have applied since the beginning of the OPPS. In response to findings reported by the MedPAC in their March 2004 Report to Congress that the OPPS outlier policy did not provide sufficient insurance against large financial loses for certain complex procedures that ultimately could impact beneficiary access to services, we implemented the fixed-dollar threshold in the CY 2005 OPPS. Our decision to reduce the percentage of total payments dedicated to outlier payments continues to refine our outlier policy to improve its appropriateness for OPPS. Because OPPS pays by service, rather than by case, hospitals are already paid for every increased service associated with a costly case. A reduction in the size of the outlier pool combined with the fixed dollar threshold continues to target outlier payments to those services where one costly occurrence could pose a financial risk for hospitals, but limits these payments to the most complex and costly services. At the same time, reducing the outlier pool increases overall payments for all services by 1.0 percent.

    Alternatives to this policy are either to remain at 2.0 percent or to increase the percentage of payments dedicated to outliers to the statutory limit of 3.0 percent. Increasing the percentage of payments dedicated to outliers could target more payment to outliers, but is at odds with OPPS payment by service rather than case. It is not possible to eliminate outlier payments entirely without a statutory change.

    D. Limitations of Our Analysis

    The distributional impacts presented here are the projected effects of the policy changes, as well as the statutory changes that would be effective for CY 2006, 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. As we have done in previous proposed rules, we are soliciting comments and information about the anticipated effects of these proposed changes on hospitals and our methodology for estimating them.

    E. Estimated Impacts of This Proposed Rule on Hospitals

    The estimated increase in the total payments made under OPPS is limited by the increase to the conversion factor set under the methodology in the statute. The distributional impacts presented do not include assumptions about changes in volume and service-mix. However, total payments actually made under the system also may be influenced by changes in volume and service-mix, which CMS cannot forecast. The enactment of Pub. L. 108-173 on December 8, 2003, provided for the payment of additional dollars in CY 2004 and CY 2005 to providers of OPPS services outside of the budget neutrality requirements for specified covered outpatient drugs. These provisions expire CY 2006, as noted in this proposed rule. Pub. L. 108-173 also provided for additional payment for wage indexes for specific hospitals reclassified under section 508 through 2007. Table 33 shows the estimated redistribution of hospital payments among providers as a result of a new APC structure, multiple procedure discount for diagnostic imaging, wage indices, and rural adjustment, which are budget neutral; the estimated distribution of increased payments in CY 2006 resulting from the combined impact of proposed APC recalibration, proposed wage effects, the proposed rural sole community hospital adjustment, and the proposed market basket update to the conversion factor; and, finally, estimated payments considering all proposed payments for CY 2006 relative to all payments for CY 2005 including the expiration of the provision in Pub. L. 108-173 that required payment for specified covered outpatient drugs outside budget neutrality and the proposed change in the percentage of total payments dedicated to outlier payments. The expiration of the requirement that payment for specified covered outpatient drugs need not be budget neutral, leaves most classes of hospitals with a positive update that is lower than the proposed market basket. We also estimate that a few classes of hospitals may receive less payment in CY 2006. Because updates to the conversion factor, including the market basket, any reintroduction of transitional pass-through dollars, and change in the percentage of total payments dedicated to outlier payments are applied uniformly, observed redistributions of payments in the impact table largely depends on 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. However, the extent to which this proposed rule redistributes money during implementation would also depend on changes in volume, practice patterns, and case-mix of services billed between CY 2005 and CY 2006. Overall, the Start Printed Page 42758proposed OPPS rates for CY 2006 would have a positive effect for all hospitals paid under OPPS. Proposed changes would result in a 1.9 percent increase in Medicare payments to all hospitals, exclusive of transitional pass-through payments.

    To illustrate the impact of the proposed CY 2006 changes, our analysis begins with a baseline simulation model that uses the final CY 2005 weights, the FY 2005 final post-reclassification IPPS wage indices, as subsequently corrected, without changes in wage indices resulting from section 508 reclassifications, and the final CY 2005 conversion factor. Columns 2, 3, and 4 in Table 33 reflect the independent effects of the proposed changes in the APC reclassification and recalibration changes, the proposed multiple procedure discount for diagnostic imaging, the proposed wage indices, and the proposed adjustment for rural sole community hospitals respectively. These effects are budget neutral, which is apparent in the overall zero impact in payment for all hospitals in the top row. Column 2 shows the independent effect of changes resulting from the proposed reclassification of HCPCS codes among APC groups and the proposed recalibration of APC weights based on a complete year of CY 2004 hospital OPPS claims data. This column also shows the impact of incorporating drug payment at 106 percent of ASP plus overhead and, for radiopharmaceuticals, at cost, within budget neutrality. This column also includes the impact of a multiple procedure discount for diagnostic imaging services. We modeled the independent effect of APC recalibration by varying only the weights, the final CY 2005 weights versus the proposed CY 2006 weights, in our baseline model, and calculating the percent difference in payments. Column 3 shows the impact of updating the wage indices used to calculate payment by applying the proposed FY 2006 IPPS wage indices. The OPPS wage indices used in Column 3 do not include changes to the wage indices for hospitals reclassified under section 508 of Pub. L. 108-173. We modeled the independent effect of introducing the new wage indices by varying only the wage index, using the proposed CY 2006 scaled weights, and a CY 2005 conversion factor that included a budget neutrality adjustment for changes in wage effects between CY 2005 and CY 2006. Column 4 shows the budget neutral impact of adding a proposed 6.6 percent adjustment to payment for services other than drugs and biologicals to rural sole community hospitals. We modeled the independent effect of the proposed payment adjustment for rural sole community hospitals by varying only the presence of the rural adjustment, using CY 2006 scaled weights, FY 2006 wage index, and a CY 2005 conversion factor with the wage and rural budget neutrality adjustments.

    Column 5 demonstrates the combined “budget neutral” impact of proposed APC recalibration and wage index updates on various classes of hospitals, as well as the impact of updating the conversion factor with the market basket. We modeled the independent effect of proposed budget neutrality adjustments and the market basket update by using the weights and wage indices for each year to model CY 2006 requirements, and using a CY 2005 conversion factor that included a budget neutrality adjustment for differences in wages, the proposed adjustment for rural sole community hospitals, and the market basket increase.

    Finally, Column 6 depicts the full impact of the proposed CY 2006 policy on each hospital group by including the effect of all the changes for CY 2006 and comparing them to the full effect of all payments in CY 2005, including those required by Pub. L. 108-173. Column 6 shows the combined budget neutral effects of Columns 2 through 5, as well as the impact of changing the percentage of total payments dedicated to outlier payments to 1.0 percent, changing the percentage of total payments dedicated to transitional pass-through payments to 0.05 percent, the effects of expiring monies added to OPPS in CY 2005 as a result of Pub. L. 108-173, and the continued presence of payment for wage indices reclassified under section 508 of Pub. L. 108-173.

    We modeled the independent effect of all changes in column 6 using the final weights for CY 2005 with additional money for drugs required by section 621 of Pub. L. 108-173 and the proposed weights for CY 2006. The wage indices in each year include wage index increases for hospitals eligible for reclassification under section 508 of Pub. L. 108-173. We used the final conversion factor for CY 2005 and the proposed CY 2006 conversion factor of $59.35. Column 6 also contains simulated outlier payments for each year. We used the charge inflation factor used in the proposed FY 2006 IPPS rule of 8.65 percent to increase individual costs on the CY 2004 claims to reflect CY 2005 and CY 2006 dollars respectively. Using the CY 2004 claims and an 8.65 percent charge inflation factor, we currently estimate that actual outlier payments for CY 2005, using a multiple threshold of 1.75 and a fixed dollar threshold of $1,175 will be 1.0 percent of total payments, which is 1.0 percent lower than the 2.0 percent that we projected in setting outlier policies for CY 2005. Outlier payments of only 1.0 percent appear in the CY 2005 comparison in Column 6. We used the same set of claims and a charge inflation factor of 18.04 percent to model the proposed CY 2006 outliers at 1.0 percent of total payments using a multiple threshold of 1.75 and a fixed dollar threshold of $1,575.

    Column 1: Total Number of Hospitals

    Column 1 in Table 33 shows the total number of hospital providers (4,212) for which we were able to use CY 2004 hospital outpatient claims to model CY 2005 and CY 2006 payments by classes of hospitals. We excluded all hospitals for which we could not accurately estimate CY 2005 or CY 2006 payment and entities that are not paid under the OPPS. The latter include critical access hospitals, all-inclusive hospitals, and hospitals located in Guam, the U.S. Virgin Islands, and the State of Maryland. This process is discussed in greater detail in section II.A. of this proposed rule. At this time we are unable to calculate a disproportionate share (DSH) variable for hospitals not participating in the IPPS. Hospitals for whom we do not have a DSH variable are grouped separately. Finally, because section 1833(t)(7)(D) of the Act permanently holds harmless cancer hospitals and children's hospitals, that is, these hospitals cannot receive less payment in CY 2006 than they did in the CY 2005, we removed these hospitals from our impact analyses.

    Column 2: APC Recalibration

    The combined effect of proposed APC reclassification and recalibration, including the proposal to pay for drugs and biologicals as 106 percent of ASP plus 2 percent of ASP for overhead, and the introduction of a proposed multiple procedure discount for diagnostic imaging resulted in larger changes in Column 2 than are typically observed for APC recalibration. In general, these changes have a greater negative impact on some classes of urban hospitals than on rural hospitals. APC changes effect the distribution of hospital payments by increasing payments to specific subsets of urban hospitals while decreasing payments made to large urban hospitals and rural hospitals.

    Overall, these changes have no impact on all urban hospitals, which show no projected change in payments, although some classes of urban hospitals experience large decreases in payments. However, changes to the APC structure Start Printed Page 42759for CY 2006 tend to favor, slightly, urban hospitals that are not located in large urban areas. Large urban hospitals experience a decline of 0.8 percent, while “other” urban hospitals experience an increase of 1.0 percent. Urban hospitals with between 100 and 199 beds and between 300 and 499 beds experienced decreases, while the largest urban hospitals, those with beds greater than 500, and moderately sized urban hospitals, those with beds between 200 and 299 beds report increases of at least 0.2 percent. The smallest urban hospitals do not appear to be impacted by changes to the APC structure. With regard to volume, all urban hospitals except those with the highest volume, experience a decrease in payments. The lowest volume hospitals experience the largest decrease of 5.8 percent. Urban hospitals providing the highest volume of services demonstrate a projected increase of 0.2 percent as a result of APC recalibration. Decreases for urban hospitals are also concentrated in some regions, specifically, New England, Pacific, South Atlantic, West South Central, and Mountain, with the first two experiencing the largest decreases of 1.2 and 1.8 percent respectively. On the other hand, a few regions experience moderate increases. Hospitals in the East South Central and West North Central regions experience increases of 1.5 and 2.6 percent respectively.

    Overall, rural hospitals show a modest 0.1 percent decrease as a result of changes to the APC structure, and this 0.1 percent decrease appears to be concentrated in rural hospitals that are not rural sole community hospitals. Notwithstanding a modest overall decline, there is substantial variation among classes of rural hospitals. Specifically, rural hospitals with less than 100 beds and between 150 and 199 beds experience decreases, with hospitals having less than 50 beds experiencing the largest decrease of 0.9 percent. Rural hospitals with greater than 100 and less than 150 beds experience the largest increase of 1.4 percent. With regard to volume, all rural hospitals except those with the highest volume, experience a decrease in payments. The lowest volume hospitals experience the largest decrease of 2.9 percent. Rural hospitals providing the highest volume of services demonstrate a projected increase of 0.7 percent as a result of APC recalibration. Decreases for rural hospitals occur in every region except West North Central and the Middle Atlantic. The largest decreases are observed in West South Central and Mountain regions. On the other hand, hospitals in the Middle Atlantic and West North Central experience increases of 1.9 and 1.8 percent respectively.

    Among other classes of hospitals, the largest observed impacts resulting from APC recalibration include declines of 0.4 percent for non-teaching hospitals and increases of 0.5 percent for major teaching hospitals. Hospitals without a valid DSH variable, most of which are TEFRA hospitals, experience decreases of 0.9 percent, and of these, those in urban areas experience a decline of 1.4 percent. Hospitals treating the most low-income patients (high DSH percentage) demonstrate declines of 0.3 percent, where as all other hospitals treating DSH patients appear to experience slight increases of 0.1 percent. Hospitals that are treating DSH patients and are also teaching hospitals experience increases of 0.4 percent. Classifying hospitals by type of ownership suggests that proprietary hospitals will lose 1.3 percent and voluntary and government hospitals will gain at least 0.1 percent.

    Column 3: New Wage Index

    Changes introduced by the proposed FY 2006 IPPS wage indices would have a modest impact in CY 2006, increasing payments to rural hospitals slightly and reducing payments to specific classes of urban hospitals. We estimate that rural hospitals, and specifically rural hospitals that are not sole community hospitals, will experience an increase in payments of 0.1 percent. With respect to facility size, only rural hospitals with between 150 and 199 beds experience a decrease in payments of 0.2 percent. Similarly, moderate rural volume hospitals experience a decrease of 0.1 percent. For both facility size and volume, no category of rural hospitals experiences an increase greater than 0.2 percent. Examining hospitals by region reveals slightly greater variability. We estimate that rural hospitals in several regions will experience decreases in payment up to 0.4 percent due to wage changes, including the Middle Atlantic, South Atlantic, West North Central, West South Central. However, rural hospitals in the remaining regions experience increases. We estimate that the Pacific region will see the largest increase of 1.8 percent.

    Overall, urban hospitals experience no change in payments as a result of the new wage indices. With respect to facility size, we estimate that urban hospitals with between 300 and 499 beds will experience a decrease in payments of 0.1 percent. Urban hospitals with less than 99 beds experience the largest increase of 0.2 percent. When categorized by volume, no class of urban hospitals experience a decrease in payment as a result of changes to the wage index. We estimate that urban hospitals in all but the Pacific and East South Central region will experience modest decreases due to wage changes of no more than 0.4 percent. Urban hospitals in the Pacific region will experience an increase of 1.1 percent, and urban hospitals in the East South Central region will experience no change in payments.

    Looking across other categories of hospitals, we estimate that updating the wage index will lead major teaching hospitals to lose 0.2 percent and hospitals without graduate medical education programs are estimated to gain 0.1 percent. Hospitals serving between 0.0 and 0.10 percent of low-income patients and between 0.23 and 0.35 percent of low-income patients lose up to 0.2 percent and 0.1 percent respectively, whereas hospitals serving other percentages of low-income patients gain by up to 0.1 percent or experience no change. Government hospitals will experience an increase of 0.1 percent.

    Column 4: New Adjustment for Rural Sole Community Hospitals

    As discussed in section II.G. of the preamble of this proposed rule, we have proposed to increase payments for all services except drugs and biologicals to rural sole community hospitals by 6.6 percent. This resulted in an adjustment to the conversion factor of 0.997. Targeting payments to these rural hospitals uniformly reduces payments to all other hospitals by 0.3 percent. The uniform reduction for all urban and other rural hospitals is evident in Column 4. The observed increase of 5.2 percent for rural sole community hospitals is lower than 6.6 percent because drugs and biologicals do not receive the proposed payment adjustment. The remaining classes of rural hospitals show variable increases that reflect the distribution of rural sole community hospitals. The largest increases are observed among rural hospitals with small numbers of beds, with moderate volume, and regions in the western half of the country.

    Column 5: All Budget Neutrality Changes and Market Basket Update

    With the exception of urban hospitals with the lowest volume of services, the addition of the market basket update alleviates any negative impacts on payments for CY 2006 created by the budget neutrality adjustments made in Columns 2, 3, and 4. In many instances, and especially among rural hospitals, the redistribution of payments created by proposed APC recalibration offset those introduced by updating the wage Start Printed Page 42760indices. In some instances, especially for urban hospitals, APC recalibration changes compound the impact of updating the wage index. In addition, all urban and other rural hospitals experience a decrease in payment of 0.3 percent as a result of the proposed payment adjustment for rural sole community hospitals.

    We estimate that the cumulative impact of proposed budget neutrality adjustments and the addition of the market basket would result in an increase in payments for urban hospitals of 2.8 percent, which is less than the market basket update of 3.2 percent. Large urban hospitals would experience an increase of 2.0 percent and other urban hospitals would experience an increase of 3.8 percent. This trend of updates lower than the market basket holds for most other classes of urban hospitals. For example, of all classes of urban hospitals, urban hospitals with the lowest volume are the only group to experience a negative market basket update, which is largely a function of the 5.8 percent decrease in payments attributable to proposed changes to the APC structure. Urban hospitals with moderate volume would also lose the bulk of the market basket update as a result of a −2.8 percent change resulting from proposed APC recalibration and the addition of the proposed payment adjustment for rural sole community hospitals. The same compounding effect holds true for urban hospitals in New England as well. Urban hospitals in New England would experience a 1.2 percent loss due to changes in APC structure, a 0.1 percent loss for changes to the wage index and a 0.3 percent loss for the new rural adjustment, reducing their increase to 1.5 percent. Urban hospitals in a few regions experience increases in payment for CY 2006 above the market basket, including the East South Central, Middle Atlantic, and West North Central regions.

    We estimate that the cumulative impact of budget neutrality adjustments and the market basket update will result in an overall increase for rural hospitals of 5.0 percent, with rural sole community hospitals experiencing an update of 8.6 percent and other rural hospitals experiencing an update of 2.8 percent. In general, rural hospitals with more than 100 beds and high volume rural hospitals experience increases of more than 5.0 percent, which generally results from the combined impact of increases in payment from APC recalibration, wage changes, and the new adjustment for rural sole community hospitals. Rural hospitals also demonstrate large increases by region, with Middle Atlantic, West North Central, Mountain, and Pacific regions experiencing large increases. For these regions, in aggregate, the payment adjustment for rural sole community hospitals compensates for observed loses in the APC recalibration column.

    The changes across columns for other classes of hospitals are fairly moderate and most show updates relatively close to the market basket. TEFRA hospitals that are not paid under OPPS show payment updates much lower than the market basket as a result of negative payment changes for proposed APC recalibration and the proposed adjustment for rural sole community hospitals. Proprietary hospitals also show an increase much less than the market basket as a result of negative payments under APC recalibration.

    Column 6: All Proposed Changes for CY 2006

    Column 6 compares all proposed changes for CY 2006 to final payment for CY 2005 and includes any additional dollars resulting from provisions in Pub. L. 108-173 in both years, changes in outlier payment percentages and proposed thresholds, and the difference in pass-through estimates. Overall, we estimate that hospitals would gain 1.9 percent under this proposed rule in CY 2006 relative to total spending in CY 2005, which included Pub. L. 108-173 dollars for drugs and wage indices. While hospitals receive the 3.2 percent increase due to the market basket appearing in Column 5 and the additional 1.0 percent in outlier payments that we estimate as not being paid in CY 2005, we estimate that hospitals also experience an overall 2.3 percent loss due to the expiration of additional payment for drugs in CY 2005. That is, without the additional 1.0 percent increase in outlier payments due to lower than expected payment for outliers in CY 2005, hospitals would receive a positive increase in payments of 0.9 percent. Paying the additional 1.0 percent in outlier payments in CY 2006 increases overall gains to 1.9 percent, which is lower than the market basket. Overall, the change in the outlier thresholds has a minimal redistributive impact by class of hospital and the vast majority of redistributive impacts observed between Columns 5 and 6 can be attributed to the loss of additional payment for drugs outside budget neutrality required by Pub. L. 108-173.

    In general, urban hospitals appear to experience the largest negative impacts from the loss of additional payments for drugs because of the combined effects of decreases in payment from the proposed payment adjustment for rural sole community hospitals and, frequently, negative changes in payments due to APC recalibration. We estimate that hospitals in large urban areas will gain 0.8 percent in CY 2006 and hospitals in other urban areas will gain 2.6 percent. We estimate that some urban hospitals will experience a decrease in total payments between CY 2005 and CY 2006. Specifically, low volume urban hospitals will experience a decrease in payments of 2.1 percent, which includes the cumulative effect of negative payments from APC recalibration, a negative impact of the payment adjustment for rural sole community hospitals, and a loss of payments outside budget neutrality for drugs. We estimate that urban hospitals in New England would experience a loss of 0.2 percent in CY 2006. The reason for this is the same as that for low volume urban hospitals, except that the urban hospitals in New England also experience a decrease in payments from updating the wage index. Other classes of urban hospitals generally show increases between 1.0 and 3.0 percent. Urban hospitals in the East South Central and West North Central experience the largest increases for urban hospitals of 3.4 and 3.7 percent, respectively.

    Overall, rural hospitals experience larger increases than those observed for urban hospitals because the proposed payment adjustment for rural sole community hospitals tends to buffer the loss of payments for drugs from Pub. L. 108-173. However, this adjustment is only for rural sole community hospitals. Overall, we estimate that rural hospitals will experience an increase in payments of 3.4 percent. But, we also estimate that rural sole community hospitals will experience an increase of 6.4 percent and that other rural hospitals will only experience an increase of 1.6 percent. No rural hospital experiences a decrease in payments between CY 2005 and CY 2006 and some classes of rural hospitals show increases comparable to the market basket. For example rural hospitals with more than 100 beds experience increases of at least 3.1 percent. Rural hospitals with moderate to high volume experience increases comparable to the market basket. Across the regions, rural hospitals in the Middle Atlantic, South Atlantic, West North Central, West South Central, Mountain, and Pacific all experience increases in payments greater than 3 percent. Low volume rural hospitals and rural hospitals in New England experience the lowest updates of only 1.0 percent.

    Among other classes of hospitals, we estimate that TEFRA hospitals not paid Start Printed Page 42761under IPPS would experience decreases in payments between CY 2005 and CY 2006 of 1.9 percent and that TEFRA hospitals in urban areas will experience a decrease in payments between CY 2005 and CY 2006 of 2.6 percent. Factoring in expiring payments for drugs through Pub. L. 108-173, we estimate that major teaching hospitals would only experience an increase of 0.8 percent.

    G. Estimated Impacts of This Proposed Rule on Beneficiaries

    For services for which the beneficiary pays a copayment of 20 percent of the payment rate, the beneficiary share of payment will increase for services for which OPPS payments will rise and will decrease for services for which OPPS payments will fall. For example, for a mid-level office visit (APC 0601), the minimum unadjusted copayment in CY 2005 was $11.22. In this proposed rule, the minimum unadjusted copayment for APC 601 is $11.86 because the OPPS payment for the service will increase under this proposed rule. In another example, for a Level IV Needle Biopsy (APC 0037), the minimum unadjusted copayment in CY 2005 was $234.20. In this proposed rule, the minimum unadjusted copayment for APC 0037 is $223.91 because the minimum unadjusted copayment is limited to 40 percent of the APC payment rate for CY 2006, as discussed in section II. of the preamble to this proposed rule. However, in all cases, the statute limits beneficiary liability for copayment for a service to the inpatient hospital deductible for the applicable year.

    In order to better understand the impact of changes in copayment on beneficiaries we modeled the percent change in total copayment liability using CY 2004 claims. We estimate that total beneficiary liability for copayments will decline as an overall percentage of total payments from 32 percent in CY 2005 to 30 percent in CY 2006.

    Conclusion

    The changes in this proposed rule would affect all classes of hospitals. Some hospitals experience significant gains and others less significant gains, but all hospitals would experience positive updates in OPPS payments in CY 2006. Table 33 demonstrates the estimated distributional impact of the OPPS budget neutrality requirements and an additional 1.9 percent increase in payments for CY 2006, after considering the expiring provision for additional drug payment under Pub. L. 108-173 and a change in the percentage of total payments dedicated to outliers and transitional pass-through payments, exclusive of transitional pass-through payments, across various classes of hospitals. The accompanying discussion, in combination with the rest of this proposed rule constitutes a regulatory impact analysis.

    Table 33.—Impact of Proposed Changes for CY 2006 Hospital Outpatient Prospective Payment System

    Hospital category(1) Number of hospitals(2) APC changes(3) New wage index(4) New adj for rural sole community hospitals(5) Cumulative (cols 2,3,4) with market basket update(6) All changes
    ALL HOSPITALS42120.00.00.03.21.9
    URBAN HOSPITALS29490.00.0−0.32.81.6
    LARGE URBAN1624−0.80.0−0.32.00.8
    OTHER URBAN13251.00.0−0.33.82.6
    RURAL HOSPITALS1263−0.10.11.85.03.4
    SOLE COMMUNITY4780.00.05.28.66.4
    OTHER RURAL785−0.10.1−0.32.81.6
    BEDS (URBAN):
    0-99 BEDS9170.00.2−0.33.02.1
    100-199 BEDS964−0.40.0−0.32.41.4
    200-299 BEDS5030.20.1−0.33.12.3
    300-499 BEDS402−0.1−0.1−0.32.61.5
    500 + BEDS1630.50.0−0.33.31.2
    BEDS (RURAL):
    0—49 BEDS551−0.90.22.04.53.0
    50-100 BEDS419−0.80.22.24.82.9
    101-149 BEDS1801.40.01.15.84.7
    150-199 BEDS62−0.3−0.21.74.53.5
    200 + BEDS510.20.01.75.13.1
    VOLUME (URBAN):
    LT 5,000 claim lines600−5.80.5−0.3−2.7−2.1
    5,000-10,999180−2.80.2−0.30.20.2
    11,000-20,999299−0.80.2−0.32.22.3
    21,000-42,999575−0.80.1−0.32.21.8
    GT 42,99912950.20.0−0.33.01.6
    VOLUME (RURAL):
    LT 5,000 claim lines119−2.90.01.31.61.3
    5,000—10,999195−2.10.02.13.22.2
    11,000—20,999325−1.0−0.12.04.13.3
    21,000—42,999364−0.90.21.94.42.9
    GT 42,9992600.70.01.65.73.8
    REGION (URBAN):
    NEW ENGLAND166−1.2−0.1−0.31.5−0.2
    MIDDLE ATLANTIC3930.7−0.1−0.33.52.2
    SOUTH ATLANTIC453−0.4−0.4−0.32.01.0
    EAST NORTH CENT4660.5−0.1−0.33.21.7
    EAST SOUTH CENT1971.50.0−0.34.43.4
    WEST NORTH CENT1842.6−0.3−0.35.23.7
    WEST SOUTH CENT445−0.3−0.1−0.32.41.3
    Start Printed Page 42762
    MOUNTAIN163−0.1−0.2−0.32.51.3
    PACIFIC431−1.81.1−0.32.11.3
    PUERTO RICO510.1−0.3−0.32.71.9
    REGION (RURAL):
    NEW ENGLAND37−0.90.81.24.41.0
    MIDDLE ATLANTIC781.9−0.41.46.14.2
    SOUTH ATLANTIC189−0.4−0.21.74.33.2
    EAST NORTH CENT171−0.50.11.34.12.2
    EAST SOUTH CENT202−0.90.50.53.32.9
    WEST NORTH CENT1881.8−0.32.57.34.8
    WEST SOUTH CENT242−1.1−0.22.24.13.5
    MOUNTAIN95−1.00.14.46.85.0
    PACIFIC61−0.61.82.67.15.2
    TEACHING STATUS:
    NON-TEACHING3115−0.40.10.23.12.2
    MINOR7690.20.0−0.23.32.2
    MAJOR3280.5−0.2−0.33.20.8
    DSH PATIENT PERCENT:
    0160.00.0−0.32.82.8
    GT 0-0.103860.1−0.2−0.32.71.7
    0.10-0.165550.00.10.23.52.4
    0.16-0.238020.10.00.13.52.3
    0.23-0.359770.1−0.10.03.21.9
    GE 0.35792−0.30.1−0.13.01.8
    TEFRA: DSH NOT AVAIL 1684−0.90.0−0.31.9−1.9
    URBAN TEACHING/DSH:
    TEACHING & DSH9440.4−0.1−0.33.21.7
    NO TEACHING/DSH1401−0.40.0−0.32.51.7
    NO TEACHING/NO DSH160.00.0−0.32.82.8
    TEFRA: DSH NOT AVAIL 1588−1.40.1−0.31.5−2.6
    TYPE OF OWNERSHIP:
    VOLUNTARY23970.20.00.03.32.0
    PROPRIETARY1091−1.30.00.01.91.4
    GOVERNMENT7240.10.10.23.71.8
    Col (1) Total hospitals in CY 2006.
    Col (2) This column shows the impact of changes resulting from the reclassification of HCPCS codes among APC groups and from the addition of multiple procedure discounting for radiology procedures (budget neutral overall).
    Col (3) This column shows the adjustment for updating the wage index (budget neutral overall).
    Col (4) This column shows the adjustment for rural sole community hospitals (budget neutral overall).
    Col (5) This column shows the cumulative impact of cols 2 through 4 and the addition of the market basket update.
    Col (6) The column shows the impact of the change in MMA dollars in CY 2006 (drugs and 508) and outlier changes.
    1 Complete DSH numbers are not available for hospitals that are not paid under IPPS.

    In accordance with the provisions of Executive Order 12866, this proposed rule was reviewed by the Office of Management and Budget.

    Start List of Subjects

    List of Subjects

    42 CFR Part 419

    • Hospitals
    • Medicare
    • Reporting and recordkeeping requirements

    42 CFR Part 485

    • Grant program-health
    • Health facilities
    • Medicaid
    • Medicare
    • Reporting and recordkeeping requirements
    End List of Subjects

    For the reasons stated in the preamble of this proposed rule, the Centers for Medicare & Medicaid Services is proposing to amend 42 CFR Chapter IV as set forth below:

    Start Part

    PART 419—PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES

    A. Part 419 is amended as follows:

    1. The authority citation for Part 419 continues to read as follows:

    Start Authority

    Authority: Secs. 1102, 1833(t), and 1871 of the Social Security Act (42 U.S.C. 1302, 1395l(t), and 1395hh).

    End Authority

    2. Section 419.43 is amended by adding a new paragraph (g) to read as follows:

    Adjustments to national program payment and beneficiary copayment amounts.
    * * * * *

    (g) Payment adjustment for certain rural hospitals. (1) General rule. CMS provides for additional payment for covered hospital outpatient service not excluded under paragraph (g)(4) of this section, furnished on or after January 1, 2006, if the hospital—

    (i) Is a sole community hospital under § 412.92 of this chapter; and

    (ii) Is located in a rural area as defined in § 412.64(b) of this chapter or is treated as being located in a rural area under section 1886(d)(8)(E) of the Act.

    (2) Amount of adjustment. The amount of the additional payment under paragraph (g)(1) of this section is determined by CMS and is based on the difference between costs incurred by hospitals that meet the criteria in paragraphs (g)(1)(i) and (g)(1)(ii) of this section and costs incurred by hospitals located in urban areas.

    (3) Budget neutrality. CMS establishes the payment adjustment under Start Printed Page 42763paragraph (g)(2) of this section in a budget neutral manner, excluding services and groups specified in paragraph (g)(4) of this section.

    (4) Excluded services and groups. Drugs and biologicals that are paid under a separate APC and devices of brachytheraphy consisting of a seed or seeds (including a radioactive source) are excluded from qualification for the payment adjustment in paragraph (g)(2) of this section.

    (5) Copayment The payment adjustment in paragraph (g)((2) of this section is applied before calculating copayment amounts.

    (6) Outliers: The payment adjustment in paragraph (g) (2) of this section is applied before calculating outlier payments.

    * * * * *

    3. Section 419.66 is amended by revising paragraph (c)(1) to read as follows:

    Transitional pass-through payments: Medical devices.
    * * * * *

    (c) Criteria for establishing device categories. * * *

    (1) CMS determines that a device to be included in the category is not appropriately described by any of the existing categories or by any category previously in effect, and was not being paid for as an outpatient service as of December 31, 1996.

    * * * * *
    End Part Start Part

    PART 485—CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS

    B. Part 485 is amended as follows:

    1. The authority citation for Part 485 continues to read as follows:

    Start Authority

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh).

    End Authority

    2. Section 485.631 is amended by—

    a. Republishing paragraph (b)(1).

    b. Revising paragraph (b)(1)(iv).

    c. Adding new paragraphs (b)(1)(v) and (b)(1)(vi).

    The revision and additions read as follows:

    Condition of participation: Staffing and staff responsibilities.
    * * * * *

    (b) Standard: Responsibilities of the doctor of medicine or osteopathy. (1) The doctor of medicine or osteopathy—

    * * * * *

    (iv) Periodically reviews and signs the records of all inpatients cared for by nurse practitioners, clinical nurse specialists, certified nurse midwives, or physician assistants.

    (v) Periodically, but not less than every 2 weeks, reviews and signs a sample of outpatient records of patients cared for by nurse practitioners, clinical nurse specialists, certified nurse midwives, or physician assistants according to the policies of the CAH and according to current standards of practice where State law does not allow these nonphysician practitioners to practice independently.

    (vi) Is not required to review and sign outpatient records of patients cared for by nurse practitioners, clinical nurse specialists, certified nurse midwives, or physician assistants where State law allows these nonphysician practitioners to practice independently.

    * * * * *

    (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program)

    Start Signature

    Dated: July 8, 2005.

    Mark B. McClellan,

    Administrator, Centers for Medicare & Medicaid Services.

    Dated: July 13, 2005.

    Michael O. Leavitt,

    Secretary.

    End Signature Start Printed Page 42764

    Addendum A.—List of Ambulatory Payment Classifications (APCs) with Status Indicators, Relative Weights, Payment Rates, and Copayment Amounts Calendar Year 2006

    APCGroup titleStatus indicatorRelative weightPayment rateNational unadjusted copaymentMinimum unadjusted copayment
    0001Level I PhotochemotherapyS0.4194$24.89$7.00$4.98
    0002Level I Fine Needle Biopsy/AspirationT0.9515$56.47$11.29
    0003Bone Marrow Biopsy/AspirationT2.6410$156.74$31.35
    0004Level I Needle Biopsy/Aspiration Except Bone MarrowT1.7566$104.25$22.36$20.85
    0005Level II Needle Biopsy/Aspiration Except Bone MarrowT3.5831$212.66$71.45$42.53
    0006Level I Incision & DrainageT1.5430$91.58$22.18$18.32
    0007Level II Incision & DrainageT11.3983$676.49$135.30
    0008Level III Incision and DrainageT16.4242$974.78$194.96
    0009Nail ProceduresT0.6650$39.47$8.34$7.89
    0010Level I Destruction of LesionT0.5693$33.79$9.63$6.76
    0011Level II Destruction of LesionT2.0745$123.12$25.06$24.62
    0012Level I Debridement & DestructionT0.8458$50.20$11.18$10.04
    0013Level II Debridement & DestructionT1.1028$65.45$14.20$13.09
    0015Level III Debridement & DestructionT1.6439$97.57$20.20$19.51
    0016Level IV Debridement & DestructionT2.5717$152.63$33.42$30.53
    0017Level VI Debridement & DestructionT18.3377$1,088.34$227.84$217.67
    0018Biopsy of Skin/Puncture of LesionT1.1673$69.28$16.04$13.86
    0019Level I Excision/BiopsyT4.0363$239.55$71.87$47.91
    0020Level II Excision/BiopsyT6.9118$410.22$106.93$82.04
    0021Level III Excision/BiopsyT14.9098$884.90$219.48$176.98
    0022Level IV Excision/BiopsyT19.5582$1,160.78$354.45$232.16
    0023Exploration Penetrating WoundT4.7558$282.26$56.45
    0024Level I Skin RepairT1.6011$95.03$31.11$19.01
    0025Level II Skin RepairT5.4690$324.59$101.85$64.92
    0027Level IV Skin RepairT18.3348$1,088.17$329.72$217.63
    0028Level I Breast SurgeryT19.4914$1,156.81$303.74$231.36
    0029Level II Breast SurgeryT31.9024$1,893.41$632.64$378.68
    0030Level III Breast SurgeryT39.9010$2,368.12$763.55$473.62
    0033Partial HospitalizationP4.0524$240.51$48.10
    0035Venous CutdownT0.7125$42.29$8.46
    0036Level II Fine Needle Biopsy/AspirationT2.1675$128.64$25.73
    0037Level IV Needle Biopsy/Aspiration Except Bone MarrowT9.4322$559.80$223.91$111.96
    0039Level I Implantation of NeurostimulatorS180.5784$10,717.33$2,143.47
    0040Level I Implantation of Neurostimulator ElectrodesS55.0791$3,268.94$653.79
    0041Level I ArthroscopyT28.0044$1,662.06$332.41
    0042Level II ArthroscopyT43.7761$2,598.11$804.74$519.62
    0043Closed Treatment Fracture Finger/Toe/TrunkT1.7614$104.54$20.91
    0045Bone/Joint Manipulation Under AnesthesiaT14.4289$856.36$268.47$171.27
    0046Open/Percutaneous Treatment Fracture or DislocationT37.5315$2,227.49$535.76$445.50
    0047Arthroplasty without ProsthesisT31.4675$1,867.60$537.03$373.52
    0048Level I Arthroplasty with ProsthesisT42.9335$2,548.10$570.30$509.62
    0049Level I Musculoskeletal Procedures Except Hand and FootT20.2784$1,203.52$240.70
    0050Level II Musculoskeletal Procedures Except Hand and FootT23.7998$1,412.52$282.50
    0051Level III Musculoskeletal Procedures Except Hand and FootT36.3617$2,158.07$431.61
    0052Level IV Musculoskeletal Procedures Except Hand and FootT43.7388$2,595.90$519.18
    0053Level I Hand Musculoskeletal ProceduresT15.6085$926.36$253.49$185.27
    0054Level II Hand Musculoskeletal ProceduresT25.2562$1,498.96$299.79
    0055Level I Foot Musculoskeletal ProceduresT19.9783$1,185.71$355.34$237.14
    0056Level II Foot Musculoskeletal ProceduresT40.1132$2,380.72$476.14
    0057Bunion ProceduresT27.4246$1,627.65$475.91$325.53
    0058Level I Strapping and Cast ApplicationS1.0884$64.60$12.92
    0060Manipulation TherapyS0.4913$29.16$5.83
    0068CPAP InitiationS1.2237$72.63$29.05$14.53
    0069ThoracoscopyT30.5386$1,812.47$591.64$362.49
    0070Thoracentesis/Lavage ProceduresT3.1956$189.66$37.93
    0071Level I Endoscopy Upper AirwayT0.7879$46.76$11.31$9.35
    0072Level II Endoscopy Upper AirwayT1.4296$84.85$21.27$16.97
    0073Level III Endoscopy Upper AirwayT4.1420$245.83$73.38$49.17
    0074Level IV Endoscopy Upper AirwayT15.7042$932.04$295.70$186.41
    0075Level V Endoscopy Upper AirwayT21.2460$1,260.95$445.92$252.19
    0076Level I Endoscopy Lower AirwayT9.4163$558.86$189.82$111.77
    0077Level I Pulmonary TreatmentS0.3428$20.35$7.74$4.07
    0078Level II Pulmonary TreatmentS1.0190$60.48$14.55$12.10
    0079Ventilation Initiation and ManagementS2.3375$138.73$27.75
    0080Diagnostic Cardiac CatheterizationT36.9679$2,194.04$838.92$438.81
    0081Non-Coronary Angioplasty or AtherectomyT34.2913$2,035.19$407.04
    0082Coronary AtherectomyT84.6276$5,022.65$1,080.41$1,004.53
    0083Coronary Angioplasty and Percutaneous ValvuloplastyT50.6620$3,006.79$601.36
    0084Level I Electrophysiologic EvaluationS9.9751$592.02$118.40
    Start Printed Page 42765
    0085Level II Electrophysiologic EvaluationT35.0288$2,078.96$426.25$415.79
    0086Ablate Heart Dysrhythm FocusT44.0592$2,614.91$833.33$522.98
    0087Cardiac Electrophysiologic Recording/MappingT30.5711$1,814.39$362.88
    0088ThrombectomyT36.3961$2,160.11$655.22$432.02
    0089Insertion/Replacement of Permanent Pacemaker and ElectrodesT105.1359$6,239.82$1,681.06$1,247.96
    0090Insertion/Replacement of Pacemaker Pulse GeneratorT88.7536$5,267.53$1,612.80$1,053.51
    0091Level II Vascular LigationT28.8685$1,713.35$348.23$342.67
    0092Level I Vascular LigationT26.3621$1,564.59$505.37$312.92
    0093Vascular Reconstruction/Fistula Repair without DeviceT23.3454$1,385.55$277.34$277.11
    0094Level I Resuscitation and CardioversionS2.5248$149.85$47.41$29.97
    0095Cardiac RehabilitationS0.5858$34.77$13.90$6.95
    0096Non-Invasive Vascular StudiesS1.6233$96.34$38.53$19.27
    0097Cardiac and Ambulatory Blood Pressure MonitoringX1.0177$60.40$23.79$12.08
    0098Injection of Sclerosing SolutionT1.1295$67.04$13.41
    0099ElectrocardiogramsS0.3804$22.58$4.52
    0100Cardiac Stress TestsX2.4855$147.51$41.44$29.50
    0101Tilt Table EvaluationS4.2593$252.79$101.11$50.56
    0103Miscellaneous Vascular ProceduresT14.6476$869.34$223.63$173.87
    0104Transcatheter Placement of Intracoronary StentsT78.6515$4,667.97$933.59
    0105Revision/Removal of Pacemakers, AICD, or VascularT22.2671$1,321.55$370.40$264.31
    0106Insertion/Replacement/Repair of Pacemaker and/or ElectrodesT45.2791$2,687.31$537.46
    0107Insertion of Cardioverter-DefibrillatorT258.8517$15,362.85$3,089.53$3,072.57
    0108Insertion/Replacement/Repair of Cardioverter-Defibrillator LeadsT347.5867$20,629.27$4,125.85
    0109Removal of Implanted DevicesT10.9933$652.45$131.49$130.49
    0110TransfusionS3.6428$216.20$43.24
    0111Blood Product ExchangeS12.3394$732.34$200.18$146.47
    0112Apheresis, Photopheresis, and PlasmapheresisS26.6734$1,583.07$437.01$316.61
    0113Excision Lymphatic SystemT21.3681$1,268.20$253.64
    0114Thyroid/Lymphadenectomy ProceduresT40.5805$2,408.45$485.91$481.69
    0115Cannula/Access Device ProceduresT31.3302$1,859.45$459.35$371.89
    0116Chemotherapy Administration by Other Technique Except InfusionS1.1401$67.66$13.53
    0117Chemotherapy Administration by Infusion OnlyS3.2231$191.29$42.54$38.26
    0120Infusion Therapy Except ChemotherapyS2.0101$119.30$28.21$23.86
    0121Level I Tube changes and RepositioningT2.2663$134.50$43.80$26.90
    0122Level II Tube changes and RepositioningT6.9405$411.92$84.48$82.38
    0123Bone Marrow Harvesting and Bone Marrow/Stem Cell TransplantS22.8861$1,358.29$271.66
    0125Refilling of Infusion PumpT1.9244$114.21$22.84
    0130Level I LaparoscopyT31.7825$1,886.29$659.53$377.26
    0131Level II LaparoscopyT43.1426$2,560.51$1,001.89$512.10
    0132Level III LaparoscopyT62.7061$3,721.61$1,239.22$744.32
    0140Esophageal Dilation without EndoscopyT5.4489$323.39$93.77$64.68
    0141Level I Upper GI ProceduresT8.1464$483.49$143.38$96.70
    0142Small Intestine EndoscopyT9.3063$552.33$152.78$110.47
    0143Lower GI EndoscopyT8.6475$513.23$186.06$102.65
    0146Level I Sigmoidoscopy and AnoscopyT4.6164$273.98$64.40$54.80
    0147Level II Sigmoidoscopy and AnoscopyT7.9318$470.75$94.15
    0148Level I Anal/Rectal ProceduresT3.7213$220.86$56.96$44.17
    0149Level III Anal/Rectal ProceduresT17.9907$1,067.75$293.06$213.55
    0150Level IV Anal/Rectal ProceduresT23.7573$1,410.00$437.12$282.00
    0151Endoscopic Retrograde Cholangio-Pancreatography (ERCP)T18.6489$1,106.81$245.46$221.36
    0152Level I Percutaneous Abdominal and Biliary ProceduresT12.2277$725.71$145.14
    0153Peritoneal and Abdominal ProceduresT21.5979$1,281.84$381.07$256.37
    0154Hernia/Hydrocele ProceduresT28.6544$1,700.64$464.85$340.13
    0155Level II Anal/Rectal ProceduresT16.1810$960.34$192.07
    0156Level II Urinary and Anal ProceduresT2.5635$152.14$40.52$30.43
    0157Colorectal Cancer Screening: Barium EnemaS2.2800$135.32$27.06
    0158Colorectal Cancer Screening: ColonoscopyT7.6242$452.50$113.13
    0159Colorectal Cancer Screening: Flexible SigmoidoscopyS3.1312$185.84$46.46
    0160Level I Cystourethroscopy and other Genitourinary ProceduresT6.6450$394.38$105.06$78.88
    0161Level II Cystourethroscopy and other Genitourinary ProceduresT18.4736$1,096.41$249.36$219.28
    0162Level III Cystourethroscopy and other Genitourinary ProceduresT23.2858$1,382.01$276.40
    0163Level IV Cystourethroscopy and other Genitourinary ProceduresT33.5826$1,993.13$398.63
    Start Printed Page 42766
    0164Level I Urinary and Anal ProceduresT1.1802$70.04$17.21$14.01
    0165Level III Urinary and Anal ProceduresT16.5934$984.82$196.96
    0166Level I Urethral ProceduresT17.5942$1,044.22$218.73$208.84
    0168Level II Urethral ProceduresT28.1405$1,670.14$386.32$334.03
    0169LithotripsyT42.8184$2,541.27$1,016.50$508.25
    0170DialysisS5.8726$348.54$69.71
    0180CircumcisionT19.7926$1,174.69$304.87$234.94
    0181Penile ProceduresT30.7265$1,823.62$621.82$364.72
    0183Testes/Epididymis ProceduresT23.5344$1,396.77$279.35
    0184Prostate BiopsyT4.3369$257.40$96.27$51.48
    0188Level II Female Reproductive ProcT1.1348$67.35$13.47
    0189Level III Female Reproductive ProcT2.3602$140.08$28.02
    0190Level I HysteroscopyT20.9699$1,244.56$424.28$248.91
    0191Level I Female Reproductive ProcT0.1663$9.87$2.77$1.97
    0192Level IV Female Reproductive ProcT4.2887$254.53$50.91
    0193Level V Female Reproductive ProcT14.5183$861.66$172.33
    0194Level VIII Female Reproductive ProcT20.6585$1,226.08$397.84$245.22
    0195Level IX Female Reproductive ProcT26.5582$1,576.23$483.80$315.25
    0196Dilation and CurettageT17.0200$1,010.14$338.23$202.03
    0197Infertility ProceduresT2.3465$139.26$27.85
    0198Pregnancy and Neonatal Care ProceduresT1.3621$80.84$32.19$16.17
    0200Level VII Female Reproductive ProcT17.7919$1,055.95$263.69$211.19
    0201Level VI Female Reproductive ProcT17.5250$1,040.11$329.65$208.02
    0202Level X Female Reproductive ProcT40.2037$2,386.09$954.43$477.22
    0203Level IV Nerve InjectionsT10.3544$614.53$245.81$122.91
    0204Level I Nerve InjectionsT2.1811$129.45$40.13$25.89
    0206Level II Nerve InjectionsT5.4672$324.48$75.55$64.90
    0207Level III Nerve InjectionsT5.9837$355.13$86.92$71.03
    0208Laminotomies and LaminectomiesT42.1492$2,501.56$500.31
    0209Extended EEG Studies and Sleep Studies, Level IIS11.5189$683.65$273.46$136.73
    0212Nervous System InjectionsT2.9606$175.71$70.28$35.14
    0213Extended EEG Studies and Sleep Studies, Level IS2.2828$135.48$54.19$27.10
    0214ElectroencephalogramS1.1302$67.08$26.83$13.42
    0215Level I Nerve and Muscle TestsS0.6087$36.13$14.45$7.23
    0216Level III Nerve and Muscle TestsS2.6599$157.87$31.57
    0218Level II Nerve and Muscle TestsS1.1356$67.40$13.48
    0220Level I Nerve ProceduresT17.2800$1,025.57$205.11
    0221Level II Nerve ProceduresT29.7854$1,767.76$463.62$353.55
    0222Implantation of Neurological DeviceT178.2870$10,581.33$2,116.27
    0223Implantation or Revision of Pain Management CatheterT27.9956$1,661.54$332.31
    0224Implantation of Reservoir/Pump/ShuntT40.4614$2,401.38$480.28
    0225Level II Implantation of Neurostimulator ElectrodesS233.6295$13,865.91$2,773.18
    0226Implantation of Drug Infusion ReservoirT138.2406$8,204.58$1,640.92
    0227Implantation of Drug Infusion DeviceT135.8740$8,064.12$1,612.82
    0228Creation of Lumbar Subarachnoid ShuntT51.4916$3,056.03$611.21
    0229Transcatherter Placement of Intravascular ShuntsT64.1626$3,808.05$771.23$761.61
    0230Level I Eye Tests & TreatmentsS0.7823$46.43$14.97$9.29
    0231Level III Eye Tests & TreatmentsS1.9191$113.90$22.78
    0232Level I Anterior Segment Eye ProceduresT6.6429$394.26$103.17$78.85
    0233Level II Anterior Segment Eye ProceduresT14.8995$884.29$266.33$176.86
    0234Level III Anterior Segment Eye ProceduresT21.8746$1,298.26$511.31$259.65
    0235Level I Posterior Segment Eye ProceduresT4.6382$275.28$67.10$55.06
    0236Level II Posterior Segment Eye ProceduresT16.9458$1,005.73$201.15
    0237Level III Posterior Segment Eye ProceduresT28.8091$1,709.82$341.96
    0238Level I Repair and Plastic Eye ProceduresT2.5816$153.22$30.64
    0239Level II Repair and Plastic Eye ProceduresT6.8784$408.23$81.65
    0240Level III Repair and Plastic Eye ProceduresT18.0686$1,072.37$315.31$214.47
    0241Level IV Repair and Plastic Eye ProceduresT23.1980$1,376.80$384.47$275.36
    0242Level V Repair and Plastic Eye ProceduresT30.4081$1,804.72$597.36$360.94
    0243Strabismus/Muscle ProceduresT22.0667$1,309.66$431.39$261.93
    0244Corneal TransplantT38.1985$2,267.08$803.26$453.42
    0245Level I Cataract Procedures without IOL InsertT13.3020$789.47$220.91$157.89
    0246Cataract Procedures with IOL InsertT23.3535$1,386.03$495.96$277.21
    0247Laser Eye Procedures Except RetinalT5.0102$297.36$104.31$59.47
    0248Laser Retinal ProceduresT4.6557$276.32$93.57$55.26
    0249Level II Cataract Procedures without IOL InsertT27.8103$1,650.54$524.67$330.11
    0250Nasal Cauterization/PackingT1.2838$76.19$26.67$15.24
    0251Level I ENT ProceduresT2.0010$118.76$23.75
    0252Level II ENT ProceduresT7.8317$464.81$113.41$92.96
    Start Printed Page 42767
    0253Level III ENT ProceduresT16.0627$953.32$282.29$190.66
    0254Level IV ENT ProceduresT23.2980$1,382.74$321.35$276.55
    0256Level V ENT ProceduresT37.1513$2,204.93$440.99
    0258Tonsil and Adenoid ProceduresT22.1458$1,314.35$437.25$262.87
    0259Level VI ENT ProceduresT364.6725$21,643.31$8,034.61$4,328.66
    0260Level I Plain Film Except TeethX0.7521$44.64$17.85$8.93
    0261Level II Plain Film Except Teeth Including Bone Density MeasurementX1.2843$76.22$15.24
    0262Plain Film of TeethX0.9186$54.52$10.90
    0263Level I Miscellaneous Radiology ProceduresX1.7397$103.25$24.29$20.65
    0264Level II Miscellaneous Radiology ProceduresX3.5080$208.20$79.41$41.64
    0265Level I Diagnostic UltrasoundS1.0167$60.34$24.13$12.07
    0266Level II Diagnostic UltrasoundS1.6319$96.85$38.74$19.37
    0267Level III Diagnostic UltrasoundS2.6208$155.54$62.18$31.11
    0268Ultrasound Guidance ProceduresS1.0562$62.69$12.54
    0269Level III Echocardiogram Except TransesophagealS3.2290$191.64$76.65$38.33
    0270Transesophageal EchocardiogramS5.9919$355.62$142.24$71.12
    0272Level I FluoroscopyX1.3738$81.54$32.61$16.31
    0274MyelographyS3.0275$179.68$71.87$35.94
    0275ArthrographyS3.5617$211.39$69.09$42.28
    0276Level I Digestive RadiologyS1.5250$90.51$36.20$18.10
    0277Level II Digestive RadiologyS2.3744$140.92$56.36$28.18
    0278Diagnostic UrographyS2.6314$156.17$62.46$31.23
    0279Level II Angiography and Venography except ExtremityS8.8914$527.70$150.03$105.54
    0280Level III Angiography and Venography except ExtremityS20.6960$1,228.31$353.85$245.66
    0282Miscellaneous Computerized Axial TomographyS1.6467$97.73$39.09$19.55
    0283Computerized Axial Tomography with Contrast MaterialS4.4053$261.45$104.58$52.29
    0284Magnetic Resonance Imaging and Magnetic Resonance Angiography with ContrasS6.3910$379.31$151.72$75.86
    0285Myocardial Positron Emission Tomography (PET)S17.1020$1,015.00$318.72$203.00
    0288Bone Density:Axial SkeletonS1.2511$74.25$14.85
    0296Level I Therapeutic Radiologic ProceduresS2.2350$132.65$53.06$26.53
    0297Level II Therapeutic Radiologic ProceduresS5.2293$310.36$122.13$62.07
    0299Miscellaneous Radiation TreatmentS5.8217$345.52$69.10
    0300Level I Radiation TherapyS1.5129$89.79$17.96
    0301Level II Radiation TherapyS2.2094$131.13$26.23
    0302Level III Radiation TherapyS4.5936$272.63$103.28$54.53
    0303Treatment Device ConstructionX2.8228$167.53$66.95$33.51
    0304Level I Therapeutic Radiation Treatment PreparationX1.7658$104.80$41.52$20.96
    0305Level II Therapeutic Radiation Treatment PreparationX3.9854$236.53$91.38$47.31
    0310Level III Therapeutic Radiation Treatment PreparationX13.8858$824.12$325.27$164.82
    0312Radioelement ApplicationsS4.9806$295.60$59.12
    0313BrachytherapyS12.8072$760.11$152.02
    0314Hyperthermic TherapiesS5.9674$354.17$98.36$70.83
    0315Level II Implantation of NeurostimulatorT289.3306$17,171.77$3,434.35
    0320Electroconvulsive TherapyS5.3522$317.65$80.06$63.53
    0321Biofeedback and Other TrainingS1.3517$80.22$21.61$16.04
    0322Brief Individual PsychotherapyS1.2263$72.78$14.56
    0323Extended Individual PsychotherapyS1.6153$95.87$19.99$19.17
    0324Family PsychotherapyS2.0901$124.05$24.81
    0325Group PsychotherapyS1.3130$77.93$17.03$15.59
    0330Dental ProceduresS7.1431$423.94$84.79
    0332Computerized Axial Tomography and Computerized Angiography without ContrasS3.2546$193.16$77.26$38.63
    0333Computerized Axial Tomography and Computerized Angio w/o Contrast MaterialS5.2596$312.16$124.86$62.43
    0335Magnetic Resonance Imaging, MiscellaneousS5.1347$304.74$121.89$60.95
    0336Magnetic Resonance Imaging and Magnetic Resonance Angiography without ContS6.0467$358.87$143.54$71.77
    0337MRI and Magnetic Resonance Angiography without Contrast Material followedS8.7547$519.59$207.83$103.92
    0339ObservationS7.1080$421.86$84.37
    0340Minor Ancillary ProceduresX0.6355$37.72$7.54
    0341Skin TestsX0.1107$6.57$2.62$1.31
    0342Level I PathologyX0.1553$9.22$3.68$1.84
    0343Level III PathologyX0.4764$28.27$11.10$5.65
    0344Level IV PathologyX0.7960$47.24$15.66$9.45
    0345Level I Transfusion Laboratory ProceduresX0.2266$13.45$2.99$2.69
    0346Level II Transfusion Laboratory ProceduresX0.3418$20.29$4.52$4.06
    Start Printed Page 42768
    0347Level III Transfusion Laboratory ProceduresX0.8395$49.82$12.30$9.96
    0348Fertility Laboratory ProceduresX0.7891$46.83$9.37
    0350Administration of flu and PPV vaccinesX0.3936$23.36$0.00$0.00
    0352Level I InjectionsX0.1407$8.35$1.67
    0353Level II InjectionsX0.3936$23.36$4.67
    0359Level III InjectionsX0.8274$49.11$9.82
    0360Level I Alimentary TestsX1.4672$87.08$34.83$17.42
    0361Level II Alimentary TestsX3.6052$213.97$83.23$42.79
    0362Contact Lens and Spectacle ServicesX2.6486$157.19$31.44
    0363Level I Otorhinolaryngologic Function TestsX0.9087$53.93$17.44$10.79
    0364Level I AudiometryX0.4686$27.81$9.06$5.56
    0365Level II AudiometryX1.2300$73.00$18.95$14.60
    0366Level III AudiometryX1.7663$104.83$27.36$20.97
    0367Level I Pulmonary TestX0.6629$39.34$14.80$7.87
    0368Level II Pulmonary TestsX0.9716$57.66$23.06$11.53
    0369Level III Pulmonary TestsX2.7394$162.58$44.18$32.52
    0370Allergy TestsX1.1181$66.36$13.27
    0372Therapeutic PhlebotomyX0.5675$33.68$10.09$6.74
    0373Neuropsychological TestingX2.1827$129.54$25.91
    0374Monitoring Psychiatric DrugsX1.0367$61.53$12.31
    0375Ancillary Outpatient Services When Patient ExpiresT42.3971$2,516.27$503.25
    0376Level II Cardiac ImagingS5.1740$307.08$121.42$61.42
    0377Level III Cardiac ImagingS6.8034$403.78$161.51$80.76
    0378Level II Pulmonary ImagingS5.4748$324.93$129.97$64.99
    0379Injection adenosineK$33.44$6.69
    0381Single Allergy TestsX0.1876$11.13$2.34$2.23
    0384GI Procedures with StentsT22.2381$1,319.83$286.66$263.97
    0385Level I Prosthetic Urological ProceduresS75.3020$4,469.17$893.83
    0386Level II Prosthetic Urological ProceduresS119.6251$7,099.75$1,419.95
    0387Level II HysteroscopyT32.3971$1,922.77$655.55$384.55
    0388DiscographyS12.2736$728.44$291.37$145.69
    0389Non-imaging Nuclear MedicineS1.4908$88.48$35.39$17.70
    0390Level I Endocrine ImagingS2.5446$151.02$60.40$30.20
    0391Level II Endocrine ImagingS2.8643$170.00$68.00$34.00
    0393Red Cell/Plasma StudiesS3.4282$203.46$81.38$40.69
    0394Hepatobiliary ImagingS4.4428$263.68$105.47$52.74
    0395GI Tract ImagingS3.8523$228.63$91.45$45.73
    0396Bone ImagingS4.1238$244.75$97.90$48.95
    0397Vascular ImagingS2.2543$133.79$53.51$26.76
    0398Level I Cardiac ImagingS4.2898$254.60$101.84$50.92
    0399Nuclear Medicine Add-on ImagingS1.5123$89.76$35.90$17.95
    0400Hematopoietic ImagingS4.1147$244.21$97.68$48.84
    0401Level I Pulmonary ImagingS3.3995$201.76$80.70$40.35
    0402Brain ImagingS5.1612$306.32$122.52$61.26
    0403CSF ImagingS3.5974$213.51$85.40$42.70
    0404Renal and Genitourinary Studies Level IS3.8385$227.81$91.12$45.56
    0405Renal and Genitourinary Studies Level IIS4.2480$252.12$100.84$50.42
    0406Tumor/Infection ImagingS4.2840$254.26$101.70$50.85
    0407Radionuclide TherapyS3.9659$235.38$94.15$47.08
    0409Red Blood Cell TestsX0.1252$7.43$2.22$1.49
    0411Respiratory ProceduresS0.3852$22.86$4.57
    0412IMRT Treatment DeliveryS5.3400$316.93$63.39
    0415Level II Endoscopy Lower AirwayT21.9955$1,305.43$459.92$261.09
    0416Level I Intravascular and Intracardiac Ultrasound and Flow ReserveS19.4657$1,155.29$231.06
    0417Computerized ReconstructionS4.0566$240.76$48.15
    0418Insertion of Left Ventricular Pacing Elect.T108.8092$6,457.83$1,291.57
    0421Prolonged Physiologic MonitoringX1.6525$98.08$19.62
    0422Level II Upper GI ProceduresT22.8607$1,356.78$448.81$271.36
    0423Level II Percutaneous Abdominal and Biliary ProceduresT40.1041$2,380.18$476.04
    0425Level II Arthroplasty with ProsthesisT99.7520$5,920.28$1,378.01$1,184.06
    0426Level II Strapping and Cast ApplicationS2.1147$125.51$25.10
    0427Level III Tube Changes and RepositioningT10.1516$602.50$123.56$120.50
    0428Level III Sigmoidoscopy and AnoscopyT19.8121$1,175.85$235.17
    0429Level V Cystourethroscopy and other Genitourinary ProceduresT42.1231$2,500.01$500.00
    0430Level IV Nerve and Muscle TestsT11.3524$673.76$134.75
    0432Health and Behavior ServicesS0.6918$41.06$8.21
    0433Level II PathologyX0.2569$15.25$6.10$3.05
    Start Printed Page 42769
    0434Cardiac Defect RepairT90.3765$5,363.85$1,072.77
    0600Low Level Clinic VisitsV0.8649$51.33$10.27
    0601Mid Level Clinic VisitsV0.9992$59.30$11.86
    0602High Level Clinic VisitsV1.4220$84.40$16.88
    0610Low Level Emergency VisitsV1.2889$76.50$19.40$15.30
    0611Mid Level Emergency VisitsV2.2615$134.22$35.60$26.84
    0612High Level Emergency VisitsV3.9673$235.46$54.12$47.09
    0620Critical CareS8.2620$490.35$135.08$98.07
    0621Level I Vascular Access ProceduresT8.2610$490.29$98.06
    0622Level II Vascular Access ProceduresT21.1708$1,256.49$251.30
    0623Level III Vascular Access ProceduresT26.9877$1,601.72$320.34
    0648Breast Reconstruction with ProsthesisT50.2174$2,980.40$596.08
    0651Complex Interstitial Radiation Source ApplicationS12.0898$717.53$143.51
    0652Insertion of Intraperitoneal CathetersT28.7639$1,707.14$341.43
    0653Vascular Reconstruction/Fistula Repair with DeviceT30.3956$1,803.98$360.80
    0654Insertion/Replacement of a permanent dual chamber pacemakerT100.4722$5,963.03$1,192.61
    0655Insertion/Replacement/Conversion of a permanent dual chamber pacemakerT133.1709$7,903.69$1,580.74
    0656Transcatheter Placement of Intracoronary Drug-Eluting StentsT109.4258$6,494.42$1,298.88
    0657Placement of Tissue ClipsS1.7015$100.98$20.20
    0658Percutaneous Breast BiopsiesT6.0773$360.69$72.14
    0659Hyperbaric OxygenS1.5403$91.42$18.28
    0660Level II Otorhinolaryngologic Function TestsX1.6345$97.01$30.60$19.40
    0661Level V PathologyX3.3622$199.55$79.82$39.91
    0662CT AngiographyS5.1387$304.98$121.99$61.00
    0664Level I Proton Beam Radiation TherapyS12.8853$764.74$152.95
    0665Bone Density:AppendicularSkeletonS0.6435$38.19$7.64
    0667Level II Proton Beam Radiation TherapyS15.4156$914.92$182.98
    0668Level I Angiography and Venography except ExtremityS6.4730$384.17$114.67$76.83
    0670Level II Intravascular and Intracardiac Ultrasound and Flow ReserveS25.2980$1,501.44$470.38$300.29
    0671Level II Echocardiogram Except TransesophagealS1.6951$100.60$40.24$20.12
    0672Level IV Posterior Segment Eye ProceduresT36.7611$2,181.77$436.35
    0673Level IV Anterior Segment Eye ProceduresT29.1257$1,728.61$649.56$345.72
    0674Prostate CryoablationT95.3518$5,659.13$1,131.83
    0675Prostatic ThermotherapyT43.5348$2,583.79$516.76
    0676Thrombolysis and ThrombectomyT2.3996$142.42$28.48
    0678External CounterpulsationT1.7197$102.06$20.41
    0679Level II Resuscitation and CardioversionS5.5521$329.52$95.30$65.90
    0680Insertion of Patient Activated Event RecordersS62.6232$3,716.69$743.34
    0681Knee ArthroplastyT136.5417$8,103.75$2,081.48$1,620.75
    0682Level V Debridement & DestructionT6.8794$408.29$161.70$81.66
    0683Level II PhotochemotherapyS1.8920$112.29$25.23$22.46
    0685Level III Needle Biopsy/Aspiration Except Bone MarrowT5.9902$355.52$115.47$71.10
    0686Level III Skin RepairT13.7661$817.02$163.40
    0687Revision/Removal of Neurostimulator ElectrodesT19.1476$1,136.41$454.56$227.28
    0688Revision/Removal of Neurostimulator Pulse Generator ReceiverT42.8494$2,543.11$1,017.24$508.62
    0689Electronic Analysis of Cardioverter-defibrillatorsS0.5709$33.88$6.78
    0690Electronic Analysis of Pacemakers and other Cardiac DevicesS0.3738$22.19$8.87$4.44
    0691Electronic Analysis of Programmable Shunts/PumpsS2.5138$149.19$59.67$29.84
    0692Electronic Analysis of Neurostimulator Pulse GeneratorsS2.0020$118.82$30.16$23.76
    0693Level II Breast ReconstructionT42.0342$2,494.73$798.17$498.95
    0694Mohs SurgeryT3.8278$227.18$61.59$45.44
    0695Level VII Debridement & DestructionT20.2244$1,200.32$266.59$240.06
    0697Level I Echocardiogram Except TransesophagealS1.5288$90.73$36.29$18.15
    0698Level II Eye Tests & TreatmentsS1.2381$73.48$16.48$14.70
    0699Level IV Eye Tests & TreatmentsT9.9723$591.86$118.37
    0700Antepartum ManipulationT5.3371$316.76$63.35
    0701SR 89 chloride, per mCiH
    0702SM 153 lexidronamH
    0704IN 111 Satumomab pendetide per doseH
    0705Technetium TC99M tetrofosminH
    0726Dexrazoxane hcl injectionK$216.38$43.28
    0728Filgrastim injectionK$178.38$35.68
    0730Pamidronate disodiumK$58.41$11.68
    0731Sargramostim injectionK$21.11$4.22
    0732Mesna injectionK$13.68$2.74
    Start Printed Page 42770
    0733Non esrd epoetin alpha injK$9.99$2.00
    0734Injection, darbepoetin alfa (for non-ESRD)K$3.28$.66
    0735Ampho b cholesteryl sulfateK$12.24$2.45
    0736Amphotericin b liposome injK$21.91$4.38
    0737Ammonia N-13, per doseH
    0738RasburicaseG$109.17$21.83
    0750Dolasetron mesylateK$6.55$1.31
    0763Dolasetron mesylate oralK$48.54$9.71
    0764Granisetron HCl injectionK$7.24$1.45
    0765Granisetron HCl oralK$33.50$6.70
    0768Ondansetron hcl injectionK$3.80$.76
    0769Ondansetron hcl oralK$32.02$6.40
    0800Leuprolide acetateK$441.74$88.35
    0802Etoposide oralK$41.12$8.22
    0807Aldesleukin/single use vialK$701.71$140.34
    0809Bcg live intravesical vacK$121.74$24.35
    0810Goserelin acetate implantK$196.24$39.25
    0811Carboplatin injectionK$77.15$15.43
    0812Carmus bischl nitro injK$141.27$28.25
    0814Asparaginase injectionK$55.41$11.08
    0819Dacarbazine injK$6.20$1.24
    0820DaunorubicinK$35.28$7.06
    0821Daunorubicin citrate liposomK$57.55$11.51
    0823DocetaxelK$301.15$60.23
    0827Floxuridine injectionK$60.16$12.03
    0828Gemcitabine HCLK$117.44$23.49
    0830Irinotecan injectionK$129.07$25.81
    0831Ifosfomide injectionK$53.53$10.71
    0832Idarubicin hcl injectionK$313.97$62.79
    0834Interferon alfa-2a injK$31.75$6.35
    0835Inj cosyntropinK$69.27$13.85
    0836Interferon alfa-2b inj recombinant, 1 millionK$13.22$2.64
    0838Interferon gamma 1-b injK$277.77$55.55
    0840Melphalan hydrochlK$523.18$104.64
    0842Fludarabine phosphate injK$262.39$52.48
    0843PegaspargaseK$1,528.67$305.73
    0844Pentostatin injectionK$1,868.76$373.75
    0849RituximabK$447.93$89.59
    0850Streptozocin injectionK$153.31$30.66
    0851Thiotepa injectionK$44.55$8.91
    0852TopotecanK$755.44$151.09
    0855Vinorelbine tartrateK$62.84$12.57
    0856Porfimer sodiumK$2,457.78$491.56
    0857Bleomycin sulfate injectionK$54.17$10.83
    0858CladribineK$39.37$7.87
    0860Plicamycin (mithramycin) injK$80.54$16.11
    0861Leuprolide acetate injectionK$10.96$2.19
    0862MitomycinK$26.36$5.27
    0863Paclitaxel injectionK$19.11$3.82
    0864Mitoxantrone hclK$329.66$65.93
    0865Interferon alfa-n3 inj, human leukocyte derived, 2K$8.77$1.75
    0868Oral aprepitantG$4.75$.95
    0869IVIG lyophil 1gK$39.46$7.89
    0870IVIG lyophil 10 mgK$.40$.08
    0871IVIG non-lyophil 1gK$57.26$11.45
    0872IVIG non-lyophil 10 mgK$.57$.11
    0876Caffeine citrate injectionK$3.34$.67
    0880Penicillin g benzathine injK$72.25$14.45
    0884Rho d immune globulin injK$113.90$22.78
    0887Azathioprine parenteralK$47.39$9.48
    0888Cyclosporine oralK$3.94$.79
    0890Lymphocyte immune globulinK$290.28$58.06
    0891Tacrolimus oralK$3.37$.67
    0892Edetate calcium disodium injK$40.34$8.07
    0893Calcitonin salmon injectionK$35.68$7.14
    0895Deferoxamine mesylate injK$14.91$2.98
    0900Alglucerase injectionK$39.94$7.99
    0901Alpha 1 proteinase inhibitorK$3.30$.66
    0902Botulinum toxin a, per unitK$4.80$.96
    Start Printed Page 42771
    0903Cytomegalovirus imm IV/vialK$683.02$136.60
    0906RSV-ivigK$15.56$3.11
    0910Interferon beta-1bK$81.94$16.39
    0911StreptokinaseK$83.35$16.67
    0912Interferon alfacon-1K$3.91$.78
    0913Ganciclovir long act implantK$4,318.33$863.67
    0916Injection imiglucerase /unitK$3.98$.80
    0917Adenosine injectionK$71.52$14.30
    0925Factor viiiK$.51$.10
    0926Factor VIII (porcine)K$1.75$.35
    0927Factor viii recombinantK$.94$.19
    0928Factor ix complexK$.52$.10
    0929Anti-inhibitor per iuK$1.12$.22
    0931Factor IX non-recombinantK$.75$.15
    0932Factor IX recombinantK$.86$.17
    0935Clonidine hydrochlorideK$57.46$11.49
    0949Plasma, Pooled Multiple Donor, Solvent/Detergent TK1.1902$70.64$14.13
    0950Blood (Whole) For TransfusionK2.0032$118.89$23.78
    0952CryoprecipitateK0.7361$43.69$8.74
    0954RBC leukocytes reducedK2.7246$161.71$32.34
    0955Plasma, Fresh FrozenK1.2876$76.42$15.28
    0956Plasma Protein FractionK1.1175$66.32$13.26
    0957Platelet ConcentrateK0.8279$49.14$9.83
    0958Platelet Rich PlasmaK5.1580$306.13$61.23
    0959Red Blood CellsK2.0209$119.94$23.99
    0960Washed Red Blood CellsK2.9573$175.52$35.10
    0961Infusion, Albumin (Human) 5%, 50 mlK0.5119$30.38$6.08
    0963Albumin (human), 5%K1.3867$82.30$16.46
    0964Albumin (human), 25%K0.4878$28.95$5.79
    0965Albumin (human), 25%K1.1115$65.97$13.19
    0966Plasmaprotein fract,5%K4.9340$292.83$58.57
    0967Split unit of bloodK1.2641$75.02$15.00
    0968Platelets leukocyte reduced irradiatedK2.3532$139.66$27.93
    0969Red blood cell leukocyte reduced irradiatedK3.6286$215.36$43.07
    1009Cryoprecip reduced plasmaK1.3003$77.17$15.43
    1010Blood, L/R, CMV-negK2.9558$175.43$35.09
    1011Platelets, HLA-m, L/R, unitK10.9193$648.06$129.61
    1013Platelet concentrate, L/R, unitK1.5950$94.66$18.93
    1016Blood, L/R, froz/deglycerol/washedK5.2392$310.95$62.19
    1017Platelets, aph/pher, L/R, CMV-neg, unitK8.5608$508.08$101.62
    1018Blood, L/R, irradiatedK2.7877$165.45$33.09
    1019Platelets, aph/pher, L/R, irradiated, unitK9.4700$562.04$112.41
    1020Pit, pher,L/R,CMV,irradK10.1091$599.98$120.00
    1021RBC, frz/deg/wsh, L/R, irradK4.8566$288.24$57.65
    1022RBC, L/R, CMV neg, irradK4.2707$253.47$50.69
    1045Iobenguane sulfate I-131H
    1052Injection, VoriconazoleK$4.63$.93
    1064I-131 sodium iodide capsuleH
    1065I-131 sodium iodide solutionH
    1080I-131 tositumomab, dxH
    1081I-131 tositumomab, txH
    1082TreprostinilK$55.02$11.00
    1083Injection, AdalimumabK$300.07$60.01
    1084Denileukin diftitoxK$1,235.23$247.05
    1085Injection, Gallium NitrateK$1.30$.26
    1086Temozolomide,oralK$7.28$1.46
    1088Dx I131 so iodide cap millicH
    1091IN 111 OxyquinolineH
    1092IN 111 PentetateH
    1093TC99M fanolesomabH
    1096TC 99M Exametazime, per doseH
    1150Th I131 so iodide sol millicH
    1166Cytarabine liposomeK$366.40$73.28
    1167Epirubicin hclK$25.15$5.03
    1178Busulfan IVK0.2851$16.92$3.38
    1201TC 99M SUCCIMER, PER VialH
    1203Verteporfin for injectionK$9.16$1.83
    1207Octreotide injection, depotK$87.39$17.48
    1210Inj dihydroergotamine mesyltK$27.82$5.56
    Start Printed Page 42772
    1280Corticotropin injectionK$95.43$19.09
    1305ApligrafK12.9206$766.84$153.37
    1330Ergonovine maleate injectionK0.5262$31.23$6.25
    1409Factor viia recombinantK$1,080.03$216.01
    1436Etidronate disodium injK$68.69$13.74
    1491New Technology - Level I ($0-$10)S$5.00$1.00
    1492New Technology - Level I ($10-$20)S$15.00$3.00
    1493New Technology - Level I ($20-$30)S$25.00$5.00
    1494New Technology - Level I ($30-$40)S$35.00$7.00
    1495New Technology - Level I ($40-$50)S$45.00$9.00
    1496New Technology - Level I ($0-$10)T$5.00$1.00
    1497New Technology - Level I ($10-$20)T$15.00$3.00
    1498New Technology - Level I ($20-$30)T$25.00$5.00
    1499New Technology - Level I ($30-$40)T$35.00$7.00
    1500New Technology - Level I ($40-$50)T$45.00$9.00
    1502New Technology - Level II ($50 - $100)S$75.00$15.00
    1503New Technology - Level III ($100 - $200)S$150.00$30.00
    1504New Technology - Level IV ($200 - $300)S$250.00$50.00
    1505New Technology - Level V ($300 - $400)S$350.00$70.00
    1506New Technology - Level VI ($400 - $500)S$450.00$90.00
    1507New Technology - Level VII ($500 - $600)S$550.00$110.00
    1508New Technology - Level VIII ($600 - $700)S$650.00$130.00
    1509New Technology - Level IX ($700 - $800)S$750.00$150.00
    1510New Technology - Level X ($800 - $900)S$850.00$170.00
    1511New Technology - Level XI ($900 - $1000)S$950.00$190.00
    1512New Technology - Level XII ($1000 - $1100)S$1,050.00$210.00
    1513New Technology - Level XIII ($1100 - $1200)S$1,150.00$230.00
    1514New Technology-Level XIV ($1200- $1300)S$1,250.00$250.00
    1515New Technology - Level XV ($1300 - $1400)S$1,350.00$270.00
    1516New Technology - Level XVI ($1400 - $1500)S$1,450.00$290.00
    1517New Technology - Level XVII ($1500-$1600)S$1,550.00$310.00
    1518New Technology - Level XVIII ($1600-$1700)S$1,650.00$330.00
    1519New Technology - Level IXX ($1700-$1800)S$1,750.00$350.00
    1520New Technology - Level XX ($1800-$1900)S$1,850.00$370.00
    1521New Technology - Level XXI ($1900-$2000)S$1,950.00$390.00
    1522New Technology - Level XXII ($2000-$2500)S$2,250.00$450.00
    1523New Technology - Level XXIII ($2500-$3000)S$2,750.00$550.00
    1524New Technology - Level XIV ($3000-$3500)S$3,250.00$650.00
    1525New Technology - Level XXV ($3500-$4000)S$3,750.00$750.00
    1526New Technology - Level XXVI ($4000-$4500)S$4,250.00$850.00
    1527New Technology - Level XXVII ($4500-$5000)S$4,750.00$950.00
    1528New Technology - Level XXVIII ($5000-$5500)S$5,250.00$1,050.00
    1529New Technology - Level XXIX ($5500-$6000)S$5,750.00$1,150.00
    1530New Technology - Level XXX ($6000-$6500)S$6,250.00$1,250.00
    1531New Technology - Level XXXI ($6500-$7000)S$6,750.00$1,350.00
    1532New Technology - Level XXXII ($7000-$7500)S$7,250.00$1,450.00
    1533New Technology - Level XXXIII ($7500-$8000)S$7,750.00$1,550.00
    1534New Technology - Level XXXIV ($8000-$8500)S$8,250.00$1,650.00
    1535New Technology - Level XXXV ($8500-$9000)S$8,750.00$1,750.00
    1536New Technology - Level XXXVI ($9000-$9500)S$9,250.00$1,850.00
    1537New Technology - Level XXXVII ($9500-$10000)S$9,750.00$1,950.00
    1539New Technology - Level II ($50 - $100)T$75.00$15.00
    1540New Technology - Level III ($100 - $200)T$150.00$30.00
    1541New Technology - Level IV ($200 - $300)T$250.00$50.00
    1542New Technology - Level V ($300 - $400)T$350.00$70.00
    1543New Technology - Level VI ($400 - $500)T$450.00$90.00
    1544New Technology - Level VII ($500 - $600)T$550.00$110.00
    1545New Technology - Level VIII ($600 - $700)T$650.00$130.00
    1546New Technology - Level IX ($700 - $800)T$750.00$150.00
    1547New Technology - Level X ($800 - $900)T$850.00$170.00
    1548New Technology - Level XI ($900 - $1000)T$950.00$190.00
    1549New Technology - Level XII ($1000 - $1100)T$1,050.00$210.00
    1550New Technology - Level XIII ($1100 - $1200)T$1,150.00$230.00
    1551New Technology-Level XIV ($1200- $1300)T$1,250.00$250.00
    1552New Technology - Level XV ($1300 - $1400)T$1,350.00$270.00
    1553New Technology - Level XVI ($1400 - $1500)T$1,450.00$290.00
    1554New Technology - Level XVII ($1500-$1600)T$1,550.00$310.00
    1555New Technology - Level XVIII ($1600-$1700)T$1,650.00$330.00
    1556New Technology - Level XIX ($1700-$1800)T$1,750.00$350.00
    Start Printed Page 42773
    1557New Technology - Level XX ($1800-$1900)T$1,850.00$370.00
    1558New Technology - Level XXI ($1900-$2000)T$1,950.00$390.00
    1559New Technology - Level XXII ($2000-$2500)T$2,250.00$450.00
    1560New Technology - Level XXIII ($2500-$3000)T$2,750.00$550.00
    1561New Technology - Level XXIV ($3000-$3500)T$3,250.00$650.00
    1562New Technology - Level XXV ($3500-$4000)T$3,750.00$750.00
    1563New Technology - Level XXVI ($4000-$4500)T$4,250.00$850.00
    1564New Technology - Level XXVII ($4500-$5000)T$4,750.00$950.00
    1565New Technology - Level XXVIII ($5000-$5500)T$5,250.00$1,050.00
    1566New Technology - Level XXIX ($5500-$6000)T$5,750.00$1,150.00
    1567New Technology - Level XXX ($6000-$6500)T$6,250.00$1,250.00
    1568New Technology - Level XXXI ($6500-$7000)T$6,750.00$1,350.00
    1569New Technology - Level XXXII ($7000-$7500)T$7,250.00$1,450.00
    1570New Technology - Level XXXIII ($7500-$8000)T$7,750.00$1,550.00
    1571New Technology - Level XXXIV ($8000-$8500)T$8,250.00$1,650.00
    1572New Technology - Level XXXV ($8500-$9000)T$8,750.00$1,750.00
    1573New Technology - Level XXXVI ($9000-$9500)T$9,250.00$1,850.00
    1574New Technology - Level XXXVII ($9500-$10000)T$9,750.00$1,950.00
    1600Technetium TC 99m sestamibiH
    1603Thallous chloride TL 201H
    1604IN 111 capromab pendetide, per doseH
    1605Abciximab injectionK$450.56$90.11
    1607Eptifibatide injectionK$12.73$2.55
    1608Etanercept injectionK$152.10$30.42
    1609Rho(D) immune globulin h, sdK$12.04$2.41
    1611Hylan G-F 20 injectionK$203.13$40.63
    1612Daclizumab, parenteralK$381.45$76.29
    1613TrastuzumabK$53.97$10.79
    1615BasiliximabK$1,473.45$294.69
    1618Vonwillebrandfactrcmplx, per iuK$.74$.15
    1619Gallium ga 67H
    1620Technetium tc99m bicisateH
    1622Technetium tc99m mertiatideH
    1624Sodium phosphate p32H
    1625Indium 111-in pentetreotideH
    1628Chromic phosphate p32H
    1655Tinzaparin sodium injectionK$2.53$.51
    1670Tetanus immune globulin injK$76.89$15.38
    1716Brachytx source, Gold 198H
    1717Brachytx source, HDR Ir-192H
    1718Brachytx source, Iodine 125H
    1719Brachytx sour,Non-HDR Ir-192H
    1720Brachytx sour, Palladium 103H
    1740Diazoxide injectionK$113.85$22.77
    1775FDG, per dose (4-40 mCi/ml)H
    2210Methyldopate hcl injectionK$9.58$1.92
    2616Brachytx source, Yttrium-90H
    2632Brachytx sol, I-125, per mCiH
    2633Brachytx source, Cesium-131H
    2634Brachytx source, HA, I-125H
    2635Brachytx source, HA, P-103H
    2636Brachytx linear source, P-103H
    2730Pralidoxime chloride injK$76.67$15.33
    2770Quinupristin/dalfopristinK$105.48$21.10
    2940Somatrem injectionK$43.13$8.63
    3030Sumatriptan succinateK$51.03$10.21
    7000AmifostineK$435.98$87.20
    7005Gonadorelin hydrochK$173.42$34.68
    7011Oprelvekin injectionK$249.04$49.81
    7015Busulfan, oralK$1.98$.40
    7019AprotininK$2.20$.44
    7024Corticorelin ovine triflutatK$386.49$77.30
    7025Digoxin immune FAB (ovine)K$552.14$110.43
    7026Ethanolamine oleateK$64.53$12.91
    7027FomepizoleK$12.31$2.46
    7028FosphenytoinK$5.19$1.04
    7030HeminK$6.51$1.30
    7034Somatropin injectionK$42.93$8.59
    7035TeniposideK$266.21$53.24
    Start Printed Page 42774
    7036Urokinase injK$415.66$83.13
    7037UrofollitropinK$44.73$8.95
    7038Monoclonal antibodiesK$885.29$177.06
    7040Pentastarch 10% solutionK$12.45$2.49
    7041Tirofiban hclK$7.89$1.58
    7042Capecitabine, oralK$3.30$.66
    7043Infliximab injectionK$54.19$10.84
    7045Trimetrexate glucoronateK$139.84$27.97
    7046Doxorubicin hcl liposome injK$365.61$73.12
    7048Alteplase recombinantK$30.65$6.13
    7049Filgrastim injectionK$282.27$56.45
    7051Leuprolide acetate implantK$2,262.01$452.40
    7308Aminolevulinic acid hcl topK$96.79$19.36
    7316Sodium hyaluronate injectionK$110.64$22.13
    7515Cyclosporine oralK$1.00$.20
    9001Linezolid injectionK$24.15$4.83
    9002TenecteplaseK$2,052.60$410.52
    9003PalivizumabK4.1486$246.22$49.24
    9004Gemtuzumab ozogamicinK$2,244.86$448.97
    9005Reteplase injectionK$898.74$179.75
    9006Tacrolimus injectionK$126.61$25.32
    9008Baclofen Refill Kit-500mcgK0.2447$14.52$2.90
    9009Baclofen refill kit - per 2000 mcgK0.7208$42.78$8.56
    9012Arsenic TrioxideK$33.76$6.75
    9015Mycophenolate mofetil oralK$2.50$.50
    9018Botulinum toxin BK$7.89$1.58
    9019Caspofungin acetateK$32.35$6.47
    9020Sirolimus tabletK$6.85$1.37
    9022IM inj interferon beta 1-aK$89.09$17.82
    9023Rho d immune globulinK$25.08$5.02
    9024Amphotericin b lipid complexK$11.95$2.39
    9025Rubidium-Rb-82H
    9030Amphotericin BK$30.70$6.14
    9031Arbutamine HCl injectionK$163.13$32.63
    9032Baclofen 10 MG injectionK$188.00$37.60
    9033Cidofovir injectionK$782.91$156.58
    9038Inj estrogen conjugateK$57.76$11.55
    9040Intraocular Fomivirsen naK$203.91$40.78
    9042Glucagon hydrochlorideK$62.16$12.43
    9044Ibutilide fumarate injectionK$243.32$48.66
    9045Iron dextranK$11.43$2.29
    9046Iron sucrose injectionK$.38$.08
    9047Itraconazole injectionK$36.93$7.39
    9051Urea injectionK1.0453$62.04$12.41
    9054Metabolically active tissueK$15.69$3.14
    9055Injectable human tissueK$3.54$.71
    9057LepirudinK$128.16$25.63
    9100Iodinated I-131 serumalbumin, per 5uciH
    9104Anti-thymocycte globulin rabbitK$299.45$59.89
    9105Hep B imm globK1.8810$111.64$22.33
    9108Thyrotropin alfaK$712.52$142.50
    9110Alemtuzumab injectionK$516.83$103.37
    9112Inj Perflutren lipid micros, mlK$63.50$12.70
    9114NesiritideK$75.18$15.04
    9115Inj, zoledronic acidK$202.39$40.48
    9117Yttrium 90 ibritumomab tiuxetanH
    9118In-111 ibritumomab tiuxetanH
    9119PegfilgrastimK$2,178.11$435.62
    9120Inj, FulvestrantK$82.90$16.58
    9121Inj, ArgatrobanK0.1897$11.26$2.25
    9122Triptorelin pamoateK$369.95$73.99
    9123TranscyteK$719.36$143.87
    9124Injection, daptomycinG$.30$.06
    9125Risperidone, long actingG$4.71$.94
    9126Injection, natalizumabG$6.51$1.30
    9127Paclitaxel protein prK$8.59$1.72
    9128Inj pegaptanib sodiumK$1,074.18$214.84
    9130Na chromateCr51, per 0.25mCiH
    913251 Na Chromate, 50mCiHStart Printed Page 42775
    9133Rabies ig, im/scK$64.56$12.91
    9134Rabies ig, heat treatedK$69.78$13.96
    9135Varicella-zoster ig, imK$96.57$19.31
    9136Adenovirus vaccine, type 4K0.9498$56.37$11.27
    9137Bcg vaccine, percutK$124.53$24.91
    9138Hep a/hep b vacc, adult imK0.9673$57.41$11.48
    9139Rabies vaccine, imK$128.03$25.61
    9140Rabies vaccine, idK1.4957$88.77$17.75
    9141Measles-rubella vaccine, scK0.9466$56.18$11.24
    9142Chicken pox vaccine, scK$64.29$12.86
    9143Meningococcal vaccine, scK$56.74$11.35
    9144Encephalitis vaccine, scK$67.72$13.54
    9145Meningococcal vaccine, imK0.8947$53.10$10.62
    9146Technetium TC99m DisofeninH
    9147Technetium TC 99M DepreotideH
    9148I-123 sodium iodide capsuleH
    9149Dx I131 so iodide microcurieH
    9150I-125 serum albumin microH
    9151Tc 99M ARCITUMOMAB PER VIALH
    9152Baclofen Intrathecal kit-1amK0.8561$50.81$10.16
    9153Na Iothalamate I-125, 10 uCiH
    9154Technetium tc99m glucepatateH
    9155Technetium tc99mlabeledrbcsH
    9156Nonmetabolic active tissueK$53.75$10.75
    9157LOCM <=149 mg/ml iodineK$.51$.10
    9158LOCM 150-199mg/ml iodineK$2.00$.40
    9159LOCM 200-249mg/ml iodineK$.78$.16
    9160LOCM 250-299mg/ml iodineK$.66$.13
    9161LOCM 300-349mg/ml iodineK$.41$.08
    9162LOCM 350-399mg/ml iodineK$.27$.05
    9163LOCM >= 400 mg/ml iodineK$.20$.04
    9164Inj Gad-base MR contrastK$3.01$.60
    9165Oral MR contrastK$9.01$1.80
    9166Dyphylline injectionK$7.74$1.55
    9167ValrubicinK$376.83$75.37
    9168Pegademase bovineK$161.15$32.23
    9169Anthrax vaccine, scK$128.94$25.79
    9200OrcelK2.6890$159.59$31.92
    9201DermagraftK6.2059$368.32$73.66
    9202Inj Octafluoropropane mic,mlK$41.42$8.28
    9203Inj Perflexane lipid micros, mlK$13.49$2.70
    9205OxaliplatinK$84.05$16.81
    9206IntegraK$9.23$1.85
    9207Injection, bortezomibK$28.90$5.78
    9208Injection, agalsidase betaK$123.35$24.67
    9209Injection, laronidaseK$23.16$4.63
    9210Injection, palonosetron HCLK$18.42$3.68
    9211Inj, alefacept, IVK$570.97$114.19
    9212Inj, alefacept, IMK$401.97$80.39
    9213Injection, PemetrexedG$41.29$8.26
    9214Injection, BevacizumabG$58.17$11.63
    9215Injection, CetuximabG$50.58$10.12
    9216Abarelix InjectionG$66.96$13.39
    9217Leuprolide acetate suspnsionK$230.85$46.17
    9218Injection, AzacitidineK$4.03$.81
    9219Mycophenolic AcidG$2.47$.49
    9220Sodium hyaluronateG$203.82$40.76
    9221Graftjacket Reg MatrixG$1,234.26$246.85
    9222Graftjacket SftTisG$890.67$178.13
    9300Injection, OmalizumabG$15.98$3.20
    9500Platelets, irradiatedK1.3527$80.28$16.06
    9501Platelets, pheresis, leukocytes reducedK8.1126$481.48$96.30
    9502Platelet pheresis irradiatedK5.1660$306.60$61.32
    9503Fresh frozen plasma, ea unitK1.6167$95.95$19.19
    9504RBC deglycerolizedK6.4022$379.97$75.99
    9505RBC irradiatedK2.3768$141.06$28.21
    9506Granulocytes, pheresisK15.5448$922.58$184.52
    9507Platelets, pheresisK6.8676$407.59$81.52
    9508Plasma, frozen w/in 8 hoursK1.1983$71.12$14.22

    End Part —————————— *Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All rights reserved. Start Printed Page 42776

    Addendum B.—Payment Status by HCPCS Code and Related Information Calendar Year 2006

    CPT/HCPCSSICIDescriptionAPCRelative weightPayment rateNational unadjusted copaymentMinimum unadjusted copayment
    0003TSCervicography1492$15.00$3.00
    0008TTUpper gi endoscopy w/suture042222.8607$1,356.78$448.81$271.36
    00100NAnesth, salivary gland
    00102NAnesth, repair of cleft lip
    00103NAnesth, blepharoplasty
    00104NAnesth, electroshock
    0010TATb test, gamma interferon
    00120NAnesth, ear surgery
    00124NAnesth, ear exam
    00126NAnesth, tympanotomy
    00140NAnesth, procedures on eye
    00142NAnesth, lens surgery
    00144NAnesth, corneal transplant
    00145NAnesth, vitreoretinal surg
    00147NAnesth, iridectomy
    00148NAnesth, eye exam
    00160NAnesth, nose/sinus surgery
    00162NAnesth, nose/sinus surgery
    00164NAnesth, biopsy of nose
    0016TTThermotx choroid vasc lesion02354.6382$275.28$67.10$55.06
    00170NAnesth, procedure on mouth
    00172NAnesth, cleft palate repair
    00174NAnesth, pharyngeal surgery
    00176CAnesth, pharyngeal surgery
    0017TEPhotocoagulat macular drusen
    0018TSTranscranial magnetic stimul02150.6087$36.13$14.45$7.23
    00190NAnesth, face/skull bone surg
    00192CAnesth, facial bone surgery
    0019TEExtracorp shock wave tx, ms
    0020TBExtracorp shock wave tx, ft
    00210NAnesth, open head surgery
    00212NAnesth, skull drainage
    00214CAnesth, skull drainage
    00215CAnesth, skull repair/fract
    00216NAnesth, head vessel surgery
    00218NAnesth, special head surgery
    0021TCFetal oximetry, trnsvag/cerv
    00220NAnesth, intrcrn nerve
    00222NAnesth, head nerve surgery
    0023TAPhenotype drug test, hiv 1
    0024TCTranscath cardiac reduction
    0026TAMeasure remnant lipoproteins
    0027TTEndoscopic epidural lysis022017.2800$1,025.57$205.11
    0028TNDexa body composition study
    0029TAMagnetic tx for incontinence
    00300NAnesth, head/neck/ptrunk
    0030TAAntiprothrombin antibody
    0031TNSpeculoscopy
    00320NAnesth, neck organ, 1 & over
    00322NAnesth, biopsy of thyroid
    00326NAnesth, larynx/trach, < 1 yr
    0032TNSpeculoscopy w/direct sample
    0033TCEndovasc taa repr incl subcl
    0034TCEndovasc taa repr w/o subcl
    00350NAnesth, neck vessel surgery
    00352NAnesth, neck vessel surgery
    0035TCInsert endovasc prosth, taa
    0036TCEndovasc prosth, taa, add-on
    0037TCArtery transpose/endovas taa
    0038TCRad endovasc taa rpr w/cover
    0039TCRad s/i, endovasc taa repair
    00400NAnesth, skin, ext/per/atrunk
    00402NAnesth, surgery of breast
    00404CAnesth, surgery of breast
    00406CAnesth, surgery of breast
    0040TCRad s/i, endovasc taa prosthStart Printed Page 42777
    00410NAnesth, correct heart rhythm
    0041TADetect ur infect agnt w/cpas
    0042TNCt perfusion w/contrast, cbf
    0043TACo expired gas analysis
    0044TNWhole body photography
    00450NAnesth, surgery of shoulder
    00452CAnesth, surgery of shoulder
    00454NAnesth, collar bone biopsy
    0045TNWhole body photography
    0046TTCath lavage, mammary duct(s)002114.9098$884.90$219.48$176.98
    00470NAnesth, removal of rib
    00472NAnesth, chest wall repair
    00474CAnesth, surgery of rib(s)
    0047TTCath lavage, mammary duct(s)002114.9098$884.90$219.48$176.98
    0048TCImplant ventricular device
    0049TCExternal circulation assist
    00500NAnesth, esophageal surgery
    0050TCRemoval circulation assist
    0051TCImplant total heart system
    00520NAnesth, chest procedure
    00522NAnesth, chest lining biopsy
    00524CAnesth, chest drainage
    00528NAnesth, chest partition view
    00529NAnesth, chest partition view
    0052TCReplace component heart syst
    00530NAnesth, pacemaker insertion
    00532NAnesth, vascular access
    00534NAnesth, cardioverter/defib
    00537NAnesth, cardiac electrophys
    00539NAnesth, trach-bronch reconst
    0053TCReplace component heart syst
    00540CAnesth, chest surgery
    00541NAnesth, one lung ventilation
    00542CAnesth, release of lung
    00546CAnesth, lung,chest wall surg
    00548NAnesth, trachea,bronchi surg
    0054TBBone surgery using computer
    00550NAnesth, sternal debridement
    0055TBBone surgery using computer
    00560CAnesth, open heart surgery
    00561CAnesth, heart surg < age 1
    00562CAnesth, open heart surgery
    00563NAnesth, heart proc w/pump
    00566NAnesth, cabg w/o pump
    0056TBBone surgery using computer
    00580CAnesth, heart/lung transplnt
    0058TXCryopreservation, ovary tiss03480.7891$46.83$9.37
    0059TXCryopreservation, oocyte03480.7891$46.83$9.37
    00600NAnesth, spine, cord surgery
    00604CAnesth, sitting procedure
    0060TBElectrical impedance scan
    0061TBDestruction of tumor, breast
    00620NAnesth, spine, cord surgery
    00622CAnesth, removal of nerves
    0062TTRep intradisc annulus1 lev020310.3544$614.53$245.81$122.91
    00630NAnesth, spine, cord surgery
    00632CAnesth, removal of nerves
    00634NAnesth for chemonucleolysis
    00635NAnesth, lumbar puncture
    0063TTRep intradisc annulus>1lev020310.3544$614.53$245.81$122.91
    00640NAnesth, spine manipulation
    0064TASpectroscop eval expired gas
    0065TAOcular photoscreen bilat
    0066TECt colonography screen
    00670CAnesth, spine, cord surgery
    0067T*SCt colonography dx03335.2596$312.16$124.86$62.43
    Start Printed Page 42778
    0068TBInterp/rept heart sound
    0069TNAnalysis only heart sound
    00700NAnesth, abdominal wall surg
    00702NAnesth, for liver biopsy
    0070TNInterp only heart sound
    0071TTU/s leiomyomata ablate <200019314.5183$861.66$172.33
    0072TTU/s leiomyomata ablate >200019314.5183$861.66$172.33
    00730NAnesth, abdominal wall surg
    0073TSDelivery, comp imrt04125.3400$316.93$63.39
    00740NAnesth, upper gi visualize
    0074TEOnline physician e/m
    00750NAnesth, repair of hernia
    00752NAnesth, repair of hernia
    00754NAnesth, repair of hernia
    00756NAnesth, repair of hernia
    0075TCPerq stent/chest vert art
    0076TCS&i stent/chest vert art
    00770NAnesth, blood vessel repair
    0077TCCereb therm perfusion probe
    0078TCEndovasc aort repr w/device
    00790NAnesth, surg upper abdomen
    00792CAnesth, hemorr/excise liver
    00794CAnesth, pancreas removal
    00796CAnesth, for liver transplant
    00797NAnesth, surgery for obesity
    0079TCEndovasc visc extnsn repr
    00800NAnesth, abdominal wall surg
    00802CAnesth, fat layer removal
    0080TCEndovasc aort repr rad s&i
    00810NAnesth, low intestine scope
    0081TCEndovasc visc extnsn s&i
    00820NAnesth, abdominal wall surg
    0082TBStereotactic rad delivery
    00830NAnesth, repair of hernia
    00832NAnesth, repair of hernia
    00834NAnesth, hernia repair < 1 yr
    00836NAnesth hernia repair preemie
    0083TNStereotactic rad tx mngmt
    00840NAnesth, surg lower abdomen
    00842NAnesth, amniocentesis
    00844CAnesth, pelvis surgery
    00846CAnesth, hysterectomy
    00848CAnesth, pelvic organ surg
    0084TTTemp prostate urethral stent01641.1802$70.04$17.21$14.01
    00851NAnesth, tubal ligation
    0085TXBreath test heart reject03400.6355$37.72$7.54
    00860NAnesth, surgery of abdomen
    00862NAnesth, kidney/ureter surg
    00864CAnesth, removal of bladder
    00865CAnesth, removal of prostate
    00866CAnesth, removal of adrenal
    00868CAnesth, kidney transplant
    0086TNL ventricle fill pressure
    00870NAnesth, bladder stone surg
    00872NAnesth kidney stone destruct
    00873NAnesth kidney stone destruct
    0087TXSperm eval hyaluronan03480.7891$46.83$9.37
    00880NAnesth, abdomen vessel surg
    00882CAnesth, major vein ligation
    0088TTRf tongue base vol reduxn025316.0627$953.32$282.29$190.66
    00902NAnesth, anorectal surgery
    00904CAnesth, perineal surgery
    00906NAnesth, removal of vulva
    00908CAnesth, removal of prostate
    00910NAnesth, bladder surgery
    00912NAnesth, bladder tumor surg
    Start Printed Page 42779
    00914NAnesth, removal of prostate
    00916NAnesth, bleeding control
    00918NAnesth, stone removal
    00920NAnesth, genitalia surgery
    00921NAnesth, vasectomy
    00922NAnesth, sperm duct surgery
    00924NAnesth, testis exploration
    00926NAnesth, removal of testis
    00928NAnesth, removal of testis
    00930NAnesth, testis suspension
    00932CAnesth, amputation of penis
    00934CAnesth, penis, nodes removal
    00936CAnesth, penis, nodes removal
    00938NAnesth, insert penis device
    00940NAnesth, vaginal procedures
    00942NAnesth, surg on vag/urethral
    00944CAnesth, vaginal hysterectomy
    00948NAnesth, repair of cervix
    00950NAnesth, vaginal endoscopy
    00952NAnesth, hysteroscope/graph
    01112NAnesth, bone aspirate/bx
    01120NAnesth, pelvis surgery
    01130NAnesth, body cast procedure
    01140CAnesth, amputation at pelvis
    01150CAnesth, pelvic tumor surgery
    01160NAnesth, pelvis procedure
    01170NAnesth, pelvis surgery
    01173NAnesth, fx repair, pelvis
    01180NAnesth, pelvis nerve removal
    01190NAnesth, pelvis nerve removal
    01200NAnesth, hip joint procedure
    01202NAnesth, arthroscopy of hip
    01210NAnesth, hip joint surgery
    01212CAnesth, hip disarticulation
    01214CAnesth, hip arthroplasty
    01215NAnesth, revise hip repair
    01220NAnesth, procedure on femur
    01230NAnesth, surgery of femur
    01232CAnesth, amputation of femur
    01234CAnesth, radical femur surg
    01250NAnesth, upper leg surgery
    01260NAnesth, upper leg veins surg
    01270NAnesth, thigh arteries surg
    01272CAnesth, femoral artery surg
    01274CAnesth, femoral embolectomy
    01320NAnesth, knee area surgery
    01340NAnesth, knee area procedure
    01360NAnesth, knee area surgery
    01380NAnesth, knee joint procedure
    01382NAnesth, dx knee arthroscopy
    01390NAnesth, knee area procedure
    01392NAnesth, knee area surgery
    01400NAnesth, knee joint surgery
    01402CAnesth, knee arthroplasty
    01404CAnesth, amputation at knee
    01420NAnesth, knee joint casting
    01430NAnesth, knee veins surgery
    01432NAnesth, knee vessel surg
    01440NAnesth, knee arteries surg
    01442CAnesth, knee artery surg
    01444CAnesth, knee artery repair
    01462NAnesth, lower leg procedure
    01464NAnesth, ankle/ft arthroscopy
    01470NAnesth, lower leg surgery
    01472NAnesth, achilles tendon surg
    01474NAnesth, lower leg surgery
    Start Printed Page 42780
    01480NAnesth, lower leg bone surg
    01482NAnesth, radical leg surgery
    01484NAnesth, lower leg revision
    01486CAnesth, ankle replacement
    01490NAnesth, lower leg casting
    01500NAnesth, leg arteries surg
    01502CAnesth, lwr leg embolectomy
    01520NAnesth, lower leg vein surg
    01522NAnesth, lower leg vein surg
    01610NAnesth, surgery of shoulder
    01620NAnesth, shoulder procedure
    01622NAnes dx shoulder arthroscopy
    01630NAnesth, surgery of shoulder
    01632CAnesth, surgery of shoulder
    01634CAnesth, shoulder joint amput
    01636CAnesth, forequarter amput
    01638CAnesth, shoulder replacement
    01650NAnesth, shoulder artery surg
    01652CAnesth, shoulder vessel surg
    01654CAnesth, shoulder vessel surg
    01656CAnesth, arm-leg vessel surg
    01670NAnesth, shoulder vein surg
    01680NAnesth, shoulder casting
    01682NAnesth, airplane cast
    01710NAnesth, elbow area surgery
    01712NAnesth, uppr arm tendon surg
    01714NAnesth, uppr arm tendon surg
    01716NAnesth, biceps tendon repair
    01730NAnesth, uppr arm procedure
    01732NAnesth, dx elbow arthroscopy
    01740NAnesth, upper arm surgery
    01742NAnesth, humerus surgery
    01744NAnesth, humerus repair
    01756CAnesth, radical humerus surg
    01758NAnesth, humeral lesion surg
    01760NAnesth, elbow replacement
    01770NAnesth, uppr arm artery surg
    01772NAnesth, uppr arm embolectomy
    01780NAnesth, upper arm vein surg
    01782NAnesth, uppr arm vein repair
    01810NAnesth, lower arm surgery
    01820NAnesth, lower arm procedure
    01829NAnesth, dx wrist arthroscopy
    01830NAnesth, lower arm surgery
    01832NAnesth, wrist replacement
    01840NAnesth, lwr arm artery surg
    01842NAnesth, lwr arm embolectomy
    01844NAnesth, vascular shunt surg
    01850NAnesth, lower arm vein surg
    01852NAnesth, lwr arm vein repair
    01860NAnesth, lower arm casting
    01905NAnes, spine inject, x-ray/re
    01916NAnesth, dx arteriography
    01920NAnesth, catheterize heart
    01922NAnesth, cat or MRI scan
    01924NAnes, ther interven rad, art
    01925NAnes, ther interven rad, car
    01926NAnes, tx interv rad hrt/cran
    01930NAnes, ther interven rad, vei
    01931NAnes, ther interven rad, tip
    01932NAnes, tx interv rad, th vein
    01933NAnes, tx interv rad, cran v
    01951NAnesth, burn, less 4 percent
    01952NAnesth, burn, 4-9 percent
    01953NAnesth, burn, each 9 percent
    01958NAnesth, antepartum manipul
    Start Printed Page 42781
    01960NAnesth, vaginal delivery
    01961NAnesth, cs delivery
    01962NAnesth, emer hysterectomy
    01963NAnesth, cs hysterectomy
    01964NAnesth, abortion procedures
    01967NAnesth/analg, vag delivery
    01968NAnes/analg cs deliver add-on
    01969NAnesth/analg cs hyst add-on
    01990CSupport for organ donor
    01991NAnesth, nerve block/inj
    01992NAnesth, n block/inj, prone
    01995NRegional anesthesia limb
    01996NHosp manage cont drug admin
    01999NUnlisted anesth procedure
    0500FEInitial prenatal care visit
    0501FEPrenatal flow sheet
    0502FESubsequent prenatal care
    0503FEPostpartum care visit
    1000FETobacco use, smoking, assess
    1001FETobacco use, non-smoking
    10021TFna w/o image00020.9515$56.47$11.29
    10022TFna w/image00362.1675$128.64$25.73
    1002FEAssess anginal symptom/level
    10040TAcne surgery00100.5693$33.79$9.63$6.76
    10060TDrainage of skin abscess00061.5430$91.58$22.18$18.32
    10061TDrainage of skin abscess00061.5430$91.58$22.18$18.32
    10080TDrainage of pilonidal cyst00061.5430$91.58$22.18$18.32
    10081TDrainage of pilonidal cyst000711.3983$676.49$135.30
    10120TRemove foreign body00061.5430$91.58$22.18$18.32
    10121TRemove foreign body002114.9098$884.90$219.48$176.98
    10140TDrainage of hematoma/fluid000711.3983$676.49$135.30
    10160TPuncture drainage of lesion00181.1673$69.28$16.04$13.86
    10180TComplex drainage, wound000816.4242$974.78$194.96
    11000TDebride infected skin00151.6439$97.57$20.20$19.51
    11001TDebride infected skin add-on00120.8458$50.20$11.18$10.04
    11004CDebride genitalia & perineum
    11005CDebride abdom wall
    11006CDebride genit/per/abdom wall
    11008CRemove mesh from abd wall
    11010TDebride skin, fx00194.0363$239.55$71.87$47.91
    11011TDebride skin/muscle, fx00194.0363$239.55$71.87$47.91
    11012TDebride skin/muscle/bone, fx00194.0363$239.55$71.87$47.91
    11040TDebride skin, partial00151.6439$97.57$20.20$19.51
    11041TDebride skin, full00151.6439$97.57$20.20$19.51
    11042TDebride skin/tissue00162.5717$152.63$33.42$30.53
    11043TDebride tissue/muscle00162.5717$152.63$33.42$30.53
    11044TDebride tissue/muscle/bone06826.8794$408.29$161.70$81.66
    11055TTrim skin lesion00120.8458$50.20$11.18$10.04
    11056TTrim skin lesions, 2 to 400120.8458$50.20$11.18$10.04
    11057TTrim skin lesions, over 400131.1028$65.45$14.20$13.09
    11100TBiopsy, skin lesion00181.1673$69.28$16.04$13.86
    11101TBiopsy, skin add-on00181.1673$69.28$16.04$13.86
    11200TRemoval of skin tags00131.1028$65.45$14.20$13.09
    11201TRemove skin tags add-on00151.6439$97.57$20.20$19.51
    11300TShave skin lesion00120.8458$50.20$11.18$10.04
    11301TShave skin lesion00120.8458$50.20$11.18$10.04
    11302TShave skin lesion00131.1028$65.45$14.20$13.09
    11303TShave skin lesion00151.6439$97.57$20.20$19.51
    11305TShave skin lesion00131.1028$65.45$14.20$13.09
    11306TShave skin lesion00131.1028$65.45$14.20$13.09
    11307TShave skin lesion00131.1028$65.45$14.20$13.09
    11308TShave skin lesion00131.1028$65.45$14.20$13.09
    11310TShave skin lesion00131.1028$65.45$14.20$13.09
    11311TShave skin lesion00131.1028$65.45$14.20$13.09
    11312TShave skin lesion00131.1028$65.45$14.20$13.09
    11313TShave skin lesion00162.5717$152.63$33.42$30.53
    Start Printed Page 42782
    11400TRemoval of skin lesion00194.0363$239.55$71.87$47.91
    11401TRemoval of skin lesion00194.0363$239.55$71.87$47.91
    11402TRemoval of skin lesion00194.0363$239.55$71.87$47.91
    11403TRemoval of skin lesion00206.9118$410.22$106.93$82.04
    11404TRemoval of skin lesion002114.9098$884.90$219.48$176.98
    11406TRemoval of skin lesion002114.9098$884.90$219.48$176.98
    11420TRemoval of skin lesion00206.9118$410.22$106.93$82.04
    11421TRemoval of skin lesion00206.9118$410.22$106.93$82.04
    11422TRemoval of skin lesion00206.9118$410.22$106.93$82.04
    11423TRemoval of skin lesion002114.9098$884.90$219.48$176.98
    11424TRemoval of skin lesion002114.9098$884.90$219.48$176.98
    11426TRemoval of skin lesion002219.5582$1,160.78$354.45$232.16
    11440TRemoval of skin lesion00194.0363$239.55$71.87$47.91
    11441TRemoval of skin lesion00194.0363$239.55$71.87$47.91
    11442TRemoval of skin lesion00206.9118$410.22$106.93$82.04
    11443TRemoval of skin lesion00206.9118$410.22$106.93$82.04
    11444TRemoval of skin lesion00206.9118$410.22$106.93$82.04
    11446TRemoval of skin lesion002219.5582$1,160.78$354.45$232.16
    11450TRemoval, sweat gland lesion002219.5582$1,160.78$354.45$232.16
    11451TRemoval, sweat gland lesion002219.5582$1,160.78$354.45$232.16
    11462TRemoval, sweat gland lesion002219.5582$1,160.78$354.45$232.16
    11463TRemoval, sweat gland lesion002219.5582$1,160.78$354.45$232.16
    11470TRemoval, sweat gland lesion002219.5582$1,160.78$354.45$232.16
    11471TRemoval, sweat gland lesion002219.5582$1,160.78$354.45$232.16
    11600TRemoval of skin lesion00194.0363$239.55$71.87$47.91
    11601TRemoval of skin lesion00194.0363$239.55$71.87$47.91
    11602TRemoval of skin lesion00194.0363$239.55$71.87$47.91
    11603TRemoval of skin lesion00206.9118$410.22$106.93$82.04
    11604TRemoval of skin lesion00206.9118$410.22$106.93$82.04
    11606TRemoval of skin lesion002114.9098$884.90$219.48$176.98
    11620TRemoval of skin lesion00206.9118$410.22$106.93$82.04
    11621TRemoval of skin lesion00194.0363$239.55$71.87$47.91
    11622TRemoval of skin lesion00206.9118$410.22$106.93$82.04
    11623TRemoval of skin lesion002114.9098$884.90$219.48$176.98
    11624TRemoval of skin lesion002114.9098$884.90$219.48$176.98
    11626TRemoval of skin lesion002219.5582$1,160.78$354.45$232.16
    11640TRemoval of skin lesion00206.9118$410.22$106.93$82.04
    11641TRemoval of skin lesion00206.9118$410.22$106.93$82.04
    11642TRemoval of skin lesion00206.9118$410.22$106.93$82.04
    11643TRemoval of skin lesion00206.9118$410.22$106.93$82.04
    11644TRemoval of skin lesion002114.9098$884.90$219.48$176.98
    11646TRemoval of skin lesion002219.5582$1,160.78$354.45$232.16
    11719TTrim nail(s)00090.6650$39.47$8.34$7.89
    11720TDebride nail, 1-500090.6650$39.47$8.34$7.89
    11721TDebride nail, 6 or more00090.6650$39.47$8.34$7.89
    11730TRemoval of nail plate00131.1028$65.45$14.20$13.09
    11732TRemove nail plate, add-on00120.8458$50.20$11.18$10.04
    11740TDrain blood from under nail00090.6650$39.47$8.34$7.89
    11750TRemoval of nail bed00194.0363$239.55$71.87$47.91
    11752TRemove nail bed/finger tip002219.5582$1,160.78$354.45$232.16
    11755TBiopsy, nail unit00194.0363$239.55$71.87$47.91
    11760TRepair of nail bed00241.6011$95.03$31.11$19.01
    11762TReconstruction of nail bed00241.6011$95.03$31.11$19.01
    11765TExcision of nail fold, toe00151.6439$97.57$20.20$19.51
    11770TRemoval of pilonidal lesion002219.5582$1,160.78$354.45$232.16
    11771TRemoval of pilonidal lesion002219.5582$1,160.78$354.45$232.16
    11772TRemoval of pilonidal lesion002219.5582$1,160.78$354.45$232.16
    11900TInjection into skin lesions00120.8458$50.20$11.18$10.04
    11901TAdded skin lesions injection00120.8458$50.20$11.18$10.04
    11920TCorrect skin color defects00241.6011$95.03$31.11$19.01
    11921TCorrect skin color defects00241.6011$95.03$31.11$19.01
    11922TCorrect skin color defects00241.6011$95.03$31.11$19.01
    11950TTherapy for contour defects00241.6011$95.03$31.11$19.01
    11951TTherapy for contour defects00241.6011$95.03$31.11$19.01
    11952TTherapy for contour defects00241.6011$95.03$31.11$19.01
    11954TTherapy for contour defects00241.6011$95.03$31.11$19.01
    Start Printed Page 42783
    11960TInsert tissue expander(s)002718.3348$1,088.17$329.72$217.63
    11970TReplace tissue expander002718.3348$1,088.17$329.72$217.63
    11971TRemove tissue expander(s)002219.5582$1,160.78$354.45$232.16
    11975EInsert contraceptive cap
    11976TRemoval of contraceptive cap00194.0363$239.55$71.87$47.91
    11977ERemoval/reinsert contra cap
    11980XImplant hormone pellet(s)03400.6355$37.72$7.54
    11981XInsert drug implant device03400.6355$37.72$7.54
    11982XRemove drug implant device03400.6355$37.72$7.54
    11983XRemove/insert drug implant03400.6355$37.72$7.54
    12001TRepair superficial wound(s)00241.6011$95.03$31.11$19.01
    12002TRepair superficial wound(s)00241.6011$95.03$31.11$19.01
    12004TRepair superficial wound(s)00241.6011$95.03$31.11$19.01
    12005TRepair superficial wound(s)00241.6011$95.03$31.11$19.01
    12006TRepair superficial wound(s)00241.6011$95.03$31.11$19.01
    12007TRepair superficial wound(s)00241.6011$95.03$31.11$19.01
    12011TRepair superficial wound(s)00241.6011$95.03$31.11$19.01
    12013TRepair superficial wound(s)00241.6011$95.03$31.11$19.01
    12014TRepair superficial wound(s)00241.6011$95.03$31.11$19.01
    12015TRepair superficial wound(s)00241.6011$95.03$31.11$19.01
    12016TRepair superficial wound(s)00241.6011$95.03$31.11$19.01
    12017TRepair superficial wound(s)00241.6011$95.03$31.11$19.01
    12018TRepair superficial wound(s)00241.6011$95.03$31.11$19.01
    12020TClosure of split wound00241.6011$95.03$31.11$19.01
    12021TClosure of split wound00241.6011$95.03$31.11$19.01
    12031TLayer closure of wound(s)00241.6011$95.03$31.11$19.01
    12032TLayer closure of wound(s)00241.6011$95.03$31.11$19.01
    12034TLayer closure of wound(s)00241.6011$95.03$31.11$19.01
    12035TLayer closure of wound(s)00241.6011$95.03$31.11$19.01
    12036TLayer closure of wound(s)00241.6011$95.03$31.11$19.01
    12037TLayer closure of wound(s)00255.4690$324.59$101.85$64.92
    12041TLayer closure of wound(s)00241.6011$95.03$31.11$19.01
    12042TLayer closure of wound(s)00241.6011$95.03$31.11$19.01
    12044TLayer closure of wound(s)00241.6011$95.03$31.11$19.01
    12045TLayer closure of wound(s)00241.6011$95.03$31.11$19.01
    12046TLayer closure of wound(s)00241.6011$95.03$31.11$19.01
    12047TLayer closure of wound(s)00255.4690$324.59$101.85$64.92
    12051TLayer closure of wound(s)00241.6011$95.03$31.11$19.01
    12052TLayer closure of wound(s)00241.6011$95.03$31.11$19.01
    12053TLayer closure of wound(s)00241.6011$95.03$31.11$19.01
    12054TLayer closure of wound(s)00241.6011$95.03$31.11$19.01
    12055TLayer closure of wound(s)00241.6011$95.03$31.11$19.01
    12056TLayer closure of wound(s)00241.6011$95.03$31.11$19.01
    12057TLayer closure of wound(s)00255.4690$324.59$101.85$64.92
    13100TRepair of wound or lesion00255.4690$324.59$101.85$64.92
    13101TRepair of wound or lesion00255.4690$324.59$101.85$64.92
    13102TRepair wound/lesion add-on00241.6011$95.03$31.11$19.01
    13120TRepair of wound or lesion00241.6011$95.03$31.11$19.01
    13121TRepair of wound or lesion00241.6011$95.03$31.11$19.01
    13122TRepair wound/lesion add-on00241.6011$95.03$31.11$19.01
    13131TRepair of wound or lesion00241.6011$95.03$31.11$19.01
    13132TRepair of wound or lesion00241.6011$95.03$31.11$19.01
    13133TRepair wound/lesion add-on00241.6011$95.03$31.11$19.01
    13150TRepair of wound or lesion00255.4690$324.59$101.85$64.92
    13151TRepair of wound or lesion00241.6011$95.03$31.11$19.01
    13152TRepair of wound or lesion00255.4690$324.59$101.85$64.92
    13153TRepair wound/lesion add-on00241.6011$95.03$31.11$19.01
    13160TLate closure of wound002718.3348$1,088.17$329.72$217.63
    14000TSkin tissue rearrangement068613.7661$817.02$163.40
    14001TSkin tissue rearrangement002718.3348$1,088.17$329.72$217.63
    14020TSkin tissue rearrangement068613.7661$817.02$163.40
    14021TSkin tissue rearrangement002718.3348$1,088.17$329.72$217.63
    14040TSkin tissue rearrangement068613.7661$817.02$163.40
    14041TSkin tissue rearrangement002718.3348$1,088.17$329.72$217.63
    14060TSkin tissue rearrangement002718.3348$1,088.17$329.72$217.63
    14061TSkin tissue rearrangement068613.7661$817.02$163.40
    Start Printed Page 42784
    14300TSkin tissue rearrangement002718.3348$1,088.17$329.72$217.63
    14350TSkin tissue rearrangement002718.3348$1,088.17$329.72$217.63
    15000TSkin graft00255.4690$324.59$101.85$64.92
    15001TSkin graft add-on00255.4690$324.59$101.85$64.92
    15050TSkin pinch graft00255.4690$324.59$101.85$64.92
    15100TSkin split graft002718.3348$1,088.17$329.72$217.63
    15101TSkin split graft add-on002718.3348$1,088.17$329.72$217.63
    15120TSkin split graft002718.3348$1,088.17$329.72$217.63
    15121TSkin split graft add-on002718.3348$1,088.17$329.72$217.63
    15200TSkin full graft002718.3348$1,088.17$329.72$217.63
    15201TSkin full graft add-on00255.4690$324.59$101.85$64.92
    15220TSkin full graft002718.3348$1,088.17$329.72$217.63
    15221TSkin full graft add-on00255.4690$324.59$101.85$64.92
    15240TSkin full graft068613.7661$817.02$163.40
    15241TSkin full graft add-on00255.4690$324.59$101.85$64.92
    15260TSkin full graft068613.7661$817.02$163.40
    15261TSkin full graft add-on00255.4690$324.59$101.85$64.92
    15342TCultured skin graft, 25 cm00241.6011$95.03$31.11$19.01
    15343TCulture skn graft add'l 25 cm00241.6011$95.03$31.11$19.01
    15350TSkin homograft068613.7661$817.02$163.40
    15351TSkin homograft add-on068613.7661$817.02$163.40
    15400TSkin heterograft00255.4690$324.59$101.85$64.92
    15401TSkin heterograft add-on00255.4690$324.59$101.85$64.92
    15570TForm skin pedicle flap002718.3348$1,088.17$329.72$217.63
    15572TForm skin pedicle flap002718.3348$1,088.17$329.72$217.63
    15574TForm skin pedicle flap002718.3348$1,088.17$329.72$217.63
    15576TForm skin pedicle flap068613.7661$817.02$163.40
    15600TSkin graft002718.3348$1,088.17$329.72$217.63
    15610TSkin graft002718.3348$1,088.17$329.72$217.63
    15620TSkin graft002718.3348$1,088.17$329.72$217.63
    15630TSkin graft002718.3348$1,088.17$329.72$217.63
    15650TTransfer skin pedicle flap002718.3348$1,088.17$329.72$217.63
    15732TMuscle-skin graft, head/neck002718.3348$1,088.17$329.72$217.63
    15734TMuscle-skin graft, trunk002718.3348$1,088.17$329.72$217.63
    15736TMuscle-skin graft, arm002718.3348$1,088.17$329.72$217.63
    15738TMuscle-skin graft, leg002718.3348$1,088.17$329.72$217.63
    15740TIsland pedicle flap graft068613.7661$817.02$163.40
    15750TNeurovascular pedicle graft002718.3348$1,088.17$329.72$217.63
    15756CFree muscle flap, microvasc
    15757CFree skin flap, microvasc
    15758CFree fascial flap, microvasc
    15760TComposite skin graft002718.3348$1,088.17$329.72$217.63
    15770TDerma-fat-fascia graft002718.3348$1,088.17$329.72$217.63
    15775THair transplant punch grafts00255.4690$324.59$101.85$64.92
    15776THair transplant punch grafts00255.4690$324.59$101.85$64.92
    15780TAbrasion treatment of skin002219.5582$1,160.78$354.45$232.16
    15781TAbrasion treatment of skin00194.0363$239.55$71.87$47.91
    15782TDressing change not for burn00194.0363$239.55$71.87$47.91
    15783TAbrasion treatment of skin00162.5717$152.63$33.42$30.53
    15786TAbrasion, lesion, single00131.1028$65.45$14.20$13.09
    15787TAbrasion, lesions, add-on00131.1028$65.45$14.20$13.09
    15788TChemical peel, face, epiderm00120.8458$50.20$11.18$10.04
    15789TChemical peel, face, dermal00151.6439$97.57$20.20$19.51
    15792TChemical peel, nonfacial00131.1028$65.45$14.20$13.09
    15793TChemical peel, nonfacial00120.8458$50.20$11.18$10.04
    15810TSalabrasion00162.5717$152.63$33.42$30.53
    15811TSalabrasion00162.5717$152.63$33.42$30.53
    15819TPlastic surgery, neck00255.4690$324.59$101.85$64.92
    15820TRevision of lower eyelid002718.3348$1,088.17$329.72$217.63
    15821TRevision of lower eyelid002718.3348$1,088.17$329.72$217.63
    15822TRevision of upper eyelid002718.3348$1,088.17$329.72$217.63
    15823TRevision of upper eyelid002718.3348$1,088.17$329.72$217.63
    15824TRemoval of forehead wrinkles002718.3348$1,088.17$329.72$217.63
    15825TRemoval of neck wrinkles002718.3348$1,088.17$329.72$217.63
    15826TRemoval of brow wrinkles002718.3348$1,088.17$329.72$217.63
    15828TRemoval of face wrinkles002718.3348$1,088.17$329.72$217.63
    Start Printed Page 42785
    15829TRemoval of skin wrinkles002718.3348$1,088.17$329.72$217.63
    15831TExcise excessive skin tissue002219.5582$1,160.78$354.45$232.16
    15832TExcise excessive skin tissue002219.5582$1,160.78$354.45$232.16
    15833TExcise excessive skin tissue002219.5582$1,160.78$354.45$232.16
    15834TExcise excessive skin tissue002219.5582$1,160.78$354.45$232.16
    15835TExcise excessive skin tissue00255.4690$324.59$101.85$64.92
    15836TExcise excessive skin tissue002114.9098$884.90$219.48$176.98
    15837TExcise excessive skin tissue002114.9098$884.90$219.48$176.98
    15838TExcise excessive skin tissue002114.9098$884.90$219.48$176.98
    15839TExcise excessive skin tissue002114.9098$884.90$219.48$176.98
    15840TGraft for face nerve palsy002718.3348$1,088.17$329.72$217.63
    15841TGraft for face nerve palsy002718.3348$1,088.17$329.72$217.63
    15842TFlap for face nerve palsy002718.3348$1,088.17$329.72$217.63
    15845TSkin and muscle repair, face002718.3348$1,088.17$329.72$217.63
    15850TRemoval of sutures00162.5717$152.63$33.42$30.53
    15851TRemoval of sutures00162.5717$152.63$33.42$30.53
    15852XDressing change not for burn03400.6355$37.72$7.54
    15860XTest for blood flow in graft03590.8274$49.11$9.82
    15876TSuction assisted lipectomy002718.3348$1,088.17$329.72$217.63
    15877TSuction assisted lipectomy002718.3348$1,088.17$329.72$217.63
    15878TSuction assisted lipectomy068613.7661$817.02$163.40
    15879TSuction assisted lipectomy002718.3348$1,088.17$329.72$217.63
    15920TRemoval of tail bone ulcer00194.0363$239.55$71.87$47.91
    15922TRemoval of tail bone ulcer002718.3348$1,088.17$329.72$217.63
    15931TRemove sacrum pressure sore002219.5582$1,160.78$354.45$232.16
    15933TRemove sacrum pressure sore002219.5582$1,160.78$354.45$232.16
    15934TRemove sacrum pressure sore002718.3348$1,088.17$329.72$217.63
    15935TRemove sacrum pressure sore002718.3348$1,088.17$329.72$217.63
    15936TRemove sacrum pressure sore002718.3348$1,088.17$329.72$217.63
    15937TRemove sacrum pressure sore002718.3348$1,088.17$329.72$217.63
    15940TRemove hip pressure sore002219.5582$1,160.78$354.45$232.16
    15941TRemove hip pressure sore002219.5582$1,160.78$354.45$232.16
    15944TRemove hip pressure sore002718.3348$1,088.17$329.72$217.63
    15945TRemove hip pressure sore002718.3348$1,088.17$329.72$217.63
    15946TRemove hip pressure sore002718.3348$1,088.17$329.72$217.63
    15950TRemove thigh pressure sore002219.5582$1,160.78$354.45$232.16
    15951TRemove thigh pressure sore002219.5582$1,160.78$354.45$232.16
    15952TRemove thigh pressure sore002718.3348$1,088.17$329.72$217.63
    15953TRemove thigh pressure sore002718.3348$1,088.17$329.72$217.63
    15956TRemove thigh pressure sore002718.3348$1,088.17$329.72$217.63
    15958TRemove thigh pressure sore002718.3348$1,088.17$329.72$217.63
    15999TRemoval of pressure sore00194.0363$239.55$71.87$47.91
    16000TInitial treatment of burn(s)00120.8458$50.20$11.18$10.04
    16010TTreatment of burn(s)00162.5717$152.63$33.42$30.53
    16015TTreatment of burn(s)001718.3377$1,088.34$227.84$217.67
    16020TTreatment of burn(s)00131.1028$65.45$14.20$13.09
    16025TTreatment of burn(s)00131.1028$65.45$14.20$13.09
    16030TTreatment of burn(s)00151.6439$97.57$20.20$19.51
    16035CIncision of burn scab, initi
    16036CEscharotomy addl incision
    17000TDestroy benign/premlg lesion00100.5693$33.79$9.63$6.76
    17003TDestroy lesions, 2-1400100.5693$33.79$9.63$6.76
    17004TDestroy lesions, 15 or more00112.0745$123.12$25.06$24.62
    17106TDestruction of skin lesions00112.0745$123.12$25.06$24.62
    17107TDestruction of skin lesions00112.0745$123.12$25.06$24.62
    17108TDestruction of skin lesions00112.0745$123.12$25.06$24.62
    17110TDestruct lesion, 1-1400100.5693$33.79$9.63$6.76
    17111TDestruct lesion, 15 or more00100.5693$33.79$9.63$6.76
    17250TChemical cautery, tissue00131.1028$65.45$14.20$13.09
    17260TDestruction of skin lesions00151.6439$97.57$20.20$19.51
    17261TDestruction of skin lesions00151.6439$97.57$20.20$19.51
    17262TDestruction of skin lesions00151.6439$97.57$20.20$19.51
    17263TDestruction of skin lesions00151.6439$97.57$20.20$19.51
    17264TDestruction of skin lesions00151.6439$97.57$20.20$19.51
    17266TDestruction of skin lesions00162.5717$152.63$33.42$30.53
    17270TDestruction of skin lesions00151.6439$97.57$20.20$19.51
    Start Printed Page 42786
    17271TDestruction of skin lesions00131.1028$65.45$14.20$13.09
    17272TDestruction of skin lesions00151.6439$97.57$20.20$19.51
    17273TDestruction of skin lesions00151.6439$97.57$20.20$19.51
    17274TDestruction of skin lesions00162.5717$152.63$33.42$30.53
    17276TDestruction of skin lesions00162.5717$152.63$33.42$30.53
    17280TDestruction of skin lesions00151.6439$97.57$20.20$19.51
    17281TDestruction of skin lesions00151.6439$97.57$20.20$19.51
    17282TDestruction of skin lesions00151.6439$97.57$20.20$19.51
    17283TDestruction of skin lesions00151.6439$97.57$20.20$19.51
    17284TDestruction of skin lesions00162.5717$152.63$33.42$30.53
    17286TDestruction of skin lesions00151.6439$97.57$20.20$19.51
    17304TChemosurgery of skin lesion06943.8278$227.18$61.59$45.44
    17305T2 stage mohs, up to 5 spec06943.8278$227.18$61.59$45.44
    17306T3 stage mohs, up to 5 spec06943.8278$227.18$61.59$45.44
    17307TMohs addl stage up to 5 spec06943.8278$227.18$61.59$45.44
    17310TExtensive skin chemosurgery06943.8278$227.18$61.59$45.44
    17340TCryotherapy of skin00120.8458$50.20$11.18$10.04
    17360TSkin peel therapy00131.1028$65.45$14.20$13.09
    17380THair removal by electrolysis00131.1028$65.45$14.20$13.09
    17999TSkin tissue procedure00061.5430$91.58$22.18$18.32
    19000TDrainage of breast lesion00041.7566$104.25$22.36$20.85
    19001TDrain breast lesion add-on00041.7566$104.25$22.36$20.85
    19020TIncision of breast lesion000816.4242$974.78$194.96
    19030NInjection for breast x-ray
    19100TBx breast percut w/o image00053.5831$212.66$71.45$42.53
    19101TBiopsy of breast, open002819.4914$1,156.81$303.74$231.36
    19102TBx breast percut w/image00053.5831$212.66$71.45$42.53
    19103TBx breast percut w/device06586.0773$360.69$72.14
    19110Tnipple exploration002819.4914$1,156.81$303.74$231.36
    19112TExcise breast duct fistula002819.4914$1,156.81$303.74$231.36
    19120TRemoval of breast lesion002819.4914$1,156.81$303.74$231.36
    19125TExcision, breast lesion002819.4914$1,156.81$303.74$231.36
    19126TExcision, addl breast lesion002819.4914$1,156.81$303.74$231.36
    19140TRemoval of breast tissue002819.4914$1,156.81$303.74$231.36
    19160TRemoval of breast tissue002819.4914$1,156.81$303.74$231.36
    19162TRemove breast tissue, nodes069342.0342$2,494.73$798.17$498.95
    19180TRemoval of breast002931.9024$1,893.41$632.64$378.68
    19182TRemoval of breast002931.9024$1,893.41$632.64$378.68
    19200CRemoval of breast
    19220CRemoval of breast
    19240TRemoval of breast003039.9010$2,368.12$763.55$473.62
    19260TRemoval of chest wall lesion002114.9098$884.90$219.48$176.98
    19271CRevision of chest wall
    19272CExtensive chest wall surgery
    19290NPlace needle wire, breast
    19291NPlace needle wire, breast
    19295SPlace breast clip, percut06571.7015$100.98$20.20
    19296SPlace po breast cath for rad1524$3,250.00$650.00
    19297SPlace breast cath for rad1523$2,750.00$550.00
    19298SPlace breast rad tube/caths1524$3,250.00$650.00
    19316TSuspension of breast002931.9024$1,893.41$632.64$378.68
    19318TReduction of large breast069342.0342$2,494.73$798.17$498.95
    19324TEnlarge breast069342.0342$2,494.73$798.17$498.95
    19325TEnlarge breast with implant064850.2174$2,980.40$596.08
    19328TRemoval of breast implant002931.9024$1,893.41$632.64$378.68
    19330TRemoval of implant material002931.9024$1,893.41$632.64$378.68
    19340TImmediate breast prosthesis003039.9010$2,368.12$763.55$473.62
    19342TDelayed breast prosthesis064850.2174$2,980.40$596.08
    19350TBreast reconstruction002819.4914$1,156.81$303.74$231.36
    19355TCorrect inverted nipple(s)002931.9024$1,893.41$632.64$378.68
    19357TBreast reconstruction064850.2174$2,980.40$596.08
    19361CBreast reconstruction
    19364CBreast reconstruction
    19366TBreast reconstruction002931.9024$1,893.41$632.64$378.68
    19367CBreast reconstruction
    19368CBreast reconstruction
    Start Printed Page 42787
    19369CBreast reconstruction
    19370TSurgery of breast capsule002931.9024$1,893.41$632.64$378.68
    19371TRemoval of breast capsule002931.9024$1,893.41$632.64$378.68
    19380TRevise breast reconstruction003039.9010$2,368.12$763.55$473.62
    19396TDesign custom breast implant002931.9024$1,893.41$632.64$378.68
    19499TBreast surgery procedure002819.4914$1,156.81$303.74$231.36
    20000TIncision of abscess00061.5430$91.58$22.18$18.32
    20005TIncision of deep abscess004920.2784$1,203.52$240.70
    2000FEBlood pressure, measured
    20100TExplore wound, neck00234.7558$282.26$56.45
    20101TExplore wound, chest002718.3348$1,088.17$329.72$217.63
    20102TExplore wound, abdomen002718.3348$1,088.17$329.72$217.63
    20103TExplore wound, extremity00234.7558$282.26$56.45
    20150TExcise epiphyseal bar005136.3617$2,158.07$431.61
    20200TMuscle biopsy002114.9098$884.90$219.48$176.98
    20205TDeep muscle biopsy002114.9098$884.90$219.48$176.98
    20206TNeedle biopsy, muscle00053.5831$212.66$71.45$42.53
    20220TBone biopsy, trocar/needle00194.0363$239.55$71.87$47.91
    20225TBone biopsy, trocar/needle00206.9118$410.22$106.93$82.04
    20240TBone biopsy, excisional002219.5582$1,160.78$354.45$232.16
    20245TBone biopsy, excisional002219.5582$1,160.78$354.45$232.16
    20250TOpen bone biopsy004920.2784$1,203.52$240.70
    20251TOpen bone biopsy004920.2784$1,203.52$240.70
    20500TInjection of sinus tract02512.0010$118.76$23.75
    20501NInject sinus tract for x-ray
    20520TRemoval of foreign body00194.0363$239.55$71.87$47.91
    20525TRemoval of foreign body002219.5582$1,160.78$354.45$232.16
    20526TTher injection, carp tunnel02042.1811$129.45$40.13$25.89
    20550TInject tendon/ligament/cyst02042.1811$129.45$40.13$25.89
    20551TInj tendon origin/insertion02042.1811$129.45$40.13$25.89
    20552TInj trigger point, 1/2 muscl02042.1811$129.45$40.13$25.89
    20553TInject trigger points, > 302042.1811$129.45$40.13$25.89
    20600TDrain/inject, joint/bursa02042.1811$129.45$40.13$25.89
    20605TDrain/inject, joint/bursa02042.1811$129.45$40.13$25.89
    20610TDrain/inject, joint/bursa02042.1811$129.45$40.13$25.89
    20612TAspirate/inj ganglion cyst02042.1811$129.45$40.13$25.89
    20615TTreatment of bone cyst00041.7566$104.25$22.36$20.85
    20650TInsert and remove bone pin004920.2784$1,203.52$240.70
    20660CApply, rem fixation device
    20661CApplication of head brace
    20662TApplication of pelvis brace004920.2784$1,203.52$240.70
    20663TApplication of thigh brace004920.2784$1,203.52$240.70
    20664CHalo brace application
    20665XRemoval of fixation device03400.6355$37.72$7.54
    20670TRemoval of support implant002114.9098$884.90$219.48$176.98
    20680TRemoval of support implant002219.5582$1,160.78$354.45$232.16
    20690TApply bone fixation device005023.7998$1,412.52$282.50
    20692TApply bone fixation device005023.7998$1,412.52$282.50
    20693TAdjust bone fixation device004920.2784$1,203.52$240.70
    20694TRemove bone fixation device004920.2784$1,203.52$240.70
    20802CReplantation, arm, complete
    20805CReplant forearm, complete
    20808CReplantation hand, complete
    20816CReplantation digit, complete
    20822TReplantation digit, complete005425.2562$1,498.96$299.79
    20824CReplantation thumb, complete
    20827CReplantation thumb, complete
    20838CReplantation foot, complete
    20900TRemoval of bone for graft005023.7998$1,412.52$282.50
    20902TRemoval of bone for graft005023.7998$1,412.52$282.50
    20910TRemove cartilage for graft002718.3348$1,088.17$329.72$217.63
    20912TRemove cartilage for graft002718.3348$1,088.17$329.72$217.63
    20920TRemoval of fascia for graft068613.7661$817.02$163.40
    20922TRemoval of fascia for graft002718.3348$1,088.17$329.72$217.63
    20924TRemoval of tendon for graft005023.7998$1,412.52$282.50
    20926TRemoval of tissue for graft068613.7661$817.02$163.40
    Start Printed Page 42788
    20930CSpinal bone allograft
    20931CSpinal bone allograft
    20936CSpinal bone autograft
    20937CSpinal bone autograft
    20938CSpinal bone autograft
    20950TFluid pressure, muscle00061.5430$91.58$22.18$18.32
    20955CFibula bone graft, microvasc
    20956CIliac bone graft, microvasc
    20957CMt bone graft, microvasc
    20962COther bone graft, microvasc
    20969CBone/skin graft, microvasc
    20970CBone/skin graft, iliac crest
    20972TBone/skin graft, metatarsal005640.1132$2,380.72$476.14
    20973TBone/skin graft, great toe005640.1132$2,380.72$476.14
    20974AElectrical bone stimulation
    20975XElectrical bone stimulation03400.6355$37.72$7.54
    20979AUs bone stimulation
    20982TAblate, bone tumor(s) perq1557$1,850.00$370.00
    20999TMusculoskeletal surgery004920.2784$1,203.52$240.70
    21010TIncision of jaw joint025423.2980$1,382.74$321.35$276.55
    21015TResection of facial tumor025316.0627$953.32$282.29$190.66
    21025TExcision of bone, lower jaw025637.1513$2,204.93$440.99
    21026TExcision of facial bone(s)025637.1513$2,204.93$440.99
    21029TContour of face bone lesion025637.1513$2,204.93$440.99
    21030TRemoval of face bone lesion025423.2980$1,382.74$321.35$276.55
    21031TRemove exostosis, mandible025423.2980$1,382.74$321.35$276.55
    21032TRemove exostosis, maxilla025423.2980$1,382.74$321.35$276.55
    21034TRemoval of face bone lesion025637.1513$2,204.93$440.99
    21040TRemoval of jaw bone lesion025423.2980$1,382.74$321.35$276.55
    21044TRemoval of jaw bone lesion025637.1513$2,204.93$440.99
    21045CExtensive jaw surgery
    21046TRemove mandible cyst complex025637.1513$2,204.93$440.99
    21047TExcise lwr jaw cyst w/repair025637.1513$2,204.93$440.99
    21048TRemove maxilla cyst complex025637.1513$2,204.93$440.99
    21049TExcis uppr jaw cyst w/repair025637.1513$2,204.93$440.99
    21050TRemoval of jaw joint025637.1513$2,204.93$440.99
    21060TRemove jaw joint cartilage025637.1513$2,204.93$440.99
    21070TRemove coronoid process025637.1513$2,204.93$440.99
    21076TPrepare face/oral prosthesis025423.2980$1,382.74$321.35$276.55
    21077TPrepare face/oral prosthesis025637.1513$2,204.93$440.99
    21079TPrepare face/oral prosthesis025637.1513$2,204.93$440.99
    21080TPrepare face/oral prosthesis025637.1513$2,204.93$440.99
    21081TPrepare face/oral prosthesis025637.1513$2,204.93$440.99
    21082TPrepare face/oral prosthesis025637.1513$2,204.93$440.99
    21083TPrepare face/oral prosthesis025637.1513$2,204.93$440.99
    21084TPrepare face/oral prosthesis025637.1513$2,204.93$440.99
    21085TPrepare face/oral prosthesis025316.0627$953.32$282.29$190.66
    21086TPrepare face/oral prosthesis025637.1513$2,204.93$440.99
    21087TPrepare face/oral prosthesis025637.1513$2,204.93$440.99
    21088TPrepare face/oral prosthesis025637.1513$2,204.93$440.99
    21089TPrepare face/oral prosthesis02512.0010$118.76$23.75
    21100TMaxillofacial fixation025637.1513$2,204.93$440.99
    21110TInterdental fixation02527.8317$464.81$113.41$92.96
    21116NInjection, jaw joint x-ray
    21120TReconstruction of chin025423.2980$1,382.74$321.35$276.55
    21121TReconstruction of chin025423.2980$1,382.74$321.35$276.55
    21122TReconstruction of chin025423.2980$1,382.74$321.35$276.55
    21123TReconstruction of chin025423.2980$1,382.74$321.35$276.55
    21125TAugmentation, lower jaw bone025423.2980$1,382.74$321.35$276.55
    21127TAugmentation, lower jaw bone025637.1513$2,204.93$440.99
    21137TReduction of forehead025423.2980$1,382.74$321.35$276.55
    21138TReduction of forehead025637.1513$2,204.93$440.99
    21139TReduction of forehead025637.1513$2,204.93$440.99
    21141CReconstruct midface, lefort
    21142CReconstruct midface, lefort
    21143CReconstruct midface, lefort
    Start Printed Page 42789
    21145CReconstruct midface, lefort
    21146CReconstruct midface, lefort
    21147CReconstruct midface, lefort
    21150TReconstruct midface, lefort025637.1513$2,204.93$440.99
    21151CReconstruct midface, lefort
    21154CReconstruct midface, lefort
    21155CReconstruct midface, lefort
    21159CReconstruct midface, lefort
    21160CReconstruct midface, lefort
    21172CReconstruct orbit/forehead
    21175TReconstruct orbit/forehead025637.1513$2,204.93$440.99
    21179CReconstruct entire forehead
    21180CReconstruct entire forehead
    21181TContour cranial bone lesion025423.2980$1,382.74$321.35$276.55
    21182CReconstruct cranial bone
    21183CReconstruct cranial bone
    21184CReconstruct cranial bone
    21188CReconstruction of midface
    21193CReconst lwr jaw w/o graft
    21194CReconst lwr jaw w/graft
    21195TReconst lwr jaw w/o fixation025637.1513$2,204.93$440.99
    21196CReconst lwr jaw w/fixation
    21198TReconstr lwr jaw segment025637.1513$2,204.93$440.99
    21199TReconstr lwr jaw w/advance025637.1513$2,204.93$440.99
    21206TReconstruct upper jaw bone025637.1513$2,204.93$440.99
    21208TAugmentation of facial bones025637.1513$2,204.93$440.99
    21209TReduction of facial bones025637.1513$2,204.93$440.99
    21210TFace bone graft025637.1513$2,204.93$440.99
    21215TLower jaw bone graft025637.1513$2,204.93$440.99
    21230TRib cartilage graft025637.1513$2,204.93$440.99
    21235TEar cartilage graft025423.2980$1,382.74$321.35$276.55
    21240TReconstruction of jaw joint025637.1513$2,204.93$440.99
    21242TReconstruction of jaw joint025637.1513$2,204.93$440.99
    21243TReconstruction of jaw joint025637.1513$2,204.93$440.99
    21244TReconstruction of lower jaw025637.1513$2,204.93$440.99
    21245TReconstruction of jaw025637.1513$2,204.93$440.99
    21246TReconstruction of jaw025637.1513$2,204.93$440.99
    21247CReconstruct lower jaw bone
    21248TReconstruction of jaw025637.1513$2,204.93$440.99
    21249TReconstruction of jaw025637.1513$2,204.93$440.99
    21255CReconstruct lower jaw bone
    21256CReconstruction of orbit
    21260TRevise eye sockets025637.1513$2,204.93$440.99
    21261TRevise eye sockets025637.1513$2,204.93$440.99
    21263TRevise eye sockets025637.1513$2,204.93$440.99
    21267TRevise eye sockets025637.1513$2,204.93$440.99
    21268CRevise eye sockets
    21270TAugmentation, cheek bone025637.1513$2,204.93$440.99
    21275TRevision, orbitofacial bones025637.1513$2,204.93$440.99
    21280TRevision of eyelid025637.1513$2,204.93$440.99
    21282TRevision of eyelid025316.0627$953.32$282.29$190.66
    21295TRevision of jaw muscle/bone02527.8317$464.81$113.41$92.96
    21296TRevision of jaw muscle/bone025423.2980$1,382.74$321.35$276.55
    21299TCranio/maxillofacial surgery02512.0010$118.76$23.75
    21300TTreatment of skull fracture025316.0627$953.32$282.29$190.66
    21310TTreatment of nose fracture02512.0010$118.76$23.75
    21315TTreatment of nose fracture02512.0010$118.76$23.75
    21320TTreatment of nose fracture02527.8317$464.81$113.41$92.96
    21325TTreatment of nose fracture025423.2980$1,382.74$321.35$276.55
    21330TTreatment of nose fracture025423.2980$1,382.74$321.35$276.55
    21335TTreatment of nose fracture025423.2980$1,382.74$321.35$276.55
    21336TTreat nasal septal fracture004637.5315$2,227.49$535.76$445.50
    21337TTreat nasal septal fracture025316.0627$953.32$282.29$190.66
    21338TTreat nasoethmoid fracture025423.2980$1,382.74$321.35$276.55
    21339TTreat nasoethmoid fracture025423.2980$1,382.74$321.35$276.55
    21340TTreatment of nose fracture025637.1513$2,204.93$440.99
    Start Printed Page 42790
    21343CTreatment of sinus fracture
    21344CTreatment of sinus fracture
    21345TTreat nose/jaw fracture025423.2980$1,382.74$321.35$276.55
    21346CTreat nose/jaw fracture
    21347CTreat nose/jaw fracture
    21348CTreat nose/jaw fracture
    21355TTreat cheek bone fracture025637.1513$2,204.93$440.99
    21356TTreat cheek bone fracture025423.2980$1,382.74$321.35$276.55
    21360CTreat cheek bone fracture
    21365CTreat cheek bone fracture
    21366CTreat cheek bone fracture
    21385CTreat eye socket fracture
    21386CTreat eye socket fracture
    21387CTreat eye socket fracture
    21390TTreat eye socket fracture025637.1513$2,204.93$440.99
    21395CTreat eye socket fracture
    21400TTreat eye socket fracture02527.8317$464.81$113.41$92.96
    21401TTreat eye socket fracture025316.0627$953.32$282.29$190.66
    21406TTreat eye socket fracture025637.1513$2,204.93$440.99
    21407TTreat eye socket fracture025637.1513$2,204.93$440.99
    21408TTreat eye socket fracture025637.1513$2,204.93$440.99
    21421TTreat mouth roof fracture025423.2980$1,382.74$321.35$276.55
    21422CTreat mouth roof fracture
    21423CTreat mouth roof fracture
    21431CTreat craniofacial fracture
    21432CTreat craniofacial fracture
    21433CTreat craniofacial fracture
    21435CTreat craniofacial fracture
    21436CTreat craniofacial fracture
    21440TTreat dental ridge fracture025423.2980$1,382.74$321.35$276.55
    21445TTreat dental ridge fracture025423.2980$1,382.74$321.35$276.55
    21450TTreat lower jaw fracture02512.0010$118.76$23.75
    21451TTreat lower jaw fracture02527.8317$464.81$113.41$92.96
    21452TTreat lower jaw fracture025316.0627$953.32$282.29$190.66
    21453TTreat lower jaw fracture025637.1513$2,204.93$440.99
    21454TTreat lower jaw fracture025423.2980$1,382.74$321.35$276.55
    21461TTreat lower jaw fracture025637.1513$2,204.93$440.99
    21462TTreat lower jaw fracture025637.1513$2,204.93$440.99
    21465TTreat lower jaw fracture025637.1513$2,204.93$440.99
    21470TTreat lower jaw fracture025637.1513$2,204.93$440.99
    21480TReset dislocated jaw02512.0010$118.76$23.75
    21485TReset dislocated jaw025316.0627$953.32$282.29$190.66
    21490TRepair dislocated jaw025637.1513$2,204.93$440.99
    21493TTreat hyoid bone fracture02527.8317$464.81$113.41$92.96
    21494TTreat hyoid bone fracture02527.8317$464.81$113.41$92.96
    21495TTreat hyoid bone fracture025316.0627$953.32$282.29$190.66
    21497TInterdental wiring025316.0627$953.32$282.29$190.66
    21499THead surgery procedure02512.0010$118.76$23.75
    21501TDrain neck/chest lesion000816.4242$974.78$194.96
    21502TDrain chest lesion004920.2784$1,203.52$240.70
    21510CDrainage of bone lesion
    21550TBiopsy of neck/chest002114.9098$884.90$219.48$176.98
    21555TRemove lesion, neck/chest002219.5582$1,160.78$354.45$232.16
    21556TRemove lesion, neck/chest002219.5582$1,160.78$354.45$232.16
    21557TRemove tumor, neck/chest002219.5582$1,160.78$354.45$232.16
    21600TPartial removal of rib005023.7998$1,412.52$282.50
    21610TPartial removal of rib005023.7998$1,412.52$282.50
    21615CRemoval of rib
    21616CRemoval of rib and nerves
    21620CPartial removal of sternum
    21627CSternal debridement
    21630CExtensive sternum surgery
    21632CExtensive sternum surgery
    21685THyoid myotomy & suspension02527.8317$464.81$113.41$92.96
    21700TRevision of neck muscle004920.2784$1,203.52$240.70
    21705CRevision of neck muscle/rib
    Start Printed Page 42791
    21720TRevision of neck muscle004920.2784$1,203.52$240.70
    21725TRevision of neck muscle00061.5430$91.58$22.18$18.32
    21740CReconstruction of sternum
    21742TRepair stern/nuss w/o scope005136.3617$2,158.07$431.61
    21743TRepair sternum/nuss w/scope005136.3617$2,158.07$431.61
    21750CRepair of sternum separation
    21800TTreatment of rib fracture00431.7614$104.54$20.91
    21805TTreatment of rib fracture004637.5315$2,227.49$535.76$445.50
    21810CTreatment of rib fracture(s)
    21820TTreat sternum fracture00431.7614$104.54$20.91
    21825CTreat sternum fracture
    21899TNeck/chest surgery procedure02512.0010$118.76$23.75
    21920TBiopsy soft tissue of back00206.9118$410.22$106.93$82.04
    21925TBiopsy soft tissue of back002219.5582$1,160.78$354.45$232.16
    21930TRemove lesion, back or flank002219.5582$1,160.78$354.45$232.16
    21935TRemove tumor, back002219.5582$1,160.78$354.45$232.16
    22100TRemove part of neck vertebra020842.1492$2,501.56$500.31
    22101TRemove part, thorax vertebra020842.1492$2,501.56$500.31
    22102TRemove part, lumbar vertebra020842.1492$2,501.56$500.31
    22103TRemove extra spine segment020842.1492$2,501.56$500.31
    22110CRemove part of neck vertebra
    22112CRemove part, thorax vertebra
    22114CRemove part, lumbar vertebra
    22116CRemove extra spine segment
    22210CRevision of neck spine
    22212CRevision of thorax spine
    22214CRevision of lumbar spine
    22216CRevise, extra spine segment
    22220CRevision of neck spine
    22222TRevision of thorax spine020842.1492$2,501.56$500.31
    22224CRevision of lumbar spine
    22226CRevise, extra spine segment
    22305TTreat spine process fracture00431.7614$104.54$20.91
    22310TTreat spine fracture00431.7614$104.54$20.91
    22315TTreat spine fracture00431.7614$104.54$20.91
    22318CTreat odontoid fx w/o graft
    22319CTreat odontoid fx w/graft
    22325CTreat spine fracture
    22326CTreat neck spine fracture
    22327CTreat thorax spine fracture
    22328CTreat each add spine fx
    22505TManipulation of spine004514.4289$856.36$268.47$171.27
    22520TPercut vertebroplasty thor005023.7998$1,412.52$282.50
    22521TPercut vertebroplasty lumb005023.7998$1,412.52$282.50
    22522TPercut vertebroplasty add'l005023.7998$1,412.52$282.50
    22532CLat thorax spine fusion
    22533CLat lumbar spine fusion
    22534CLat thor/lumb, add'l seg
    22548CNeck spine fusion
    22554CNeck spine fusion
    22556CThorax spine fusion
    22558CLumbar spine fusion
    22585CAdditional spinal fusion
    22590CSpine & skull spinal fusion
    22595CNeck spinal fusion
    22600CNeck spine fusion
    22610CThorax spine fusion
    22612TLumbar spine fusion020842.1492$2,501.56$500.31
    22614TSpine fusion, extra segment020842.1492$2,501.56$500.31
    22630CLumbar spine fusion
    22632CSpine fusion, extra segment
    22800CFusion of spine
    22802CFusion of spine
    22804CFusion of spine
    22808CFusion of spine
    22810CFusion of spine
    Start Printed Page 42792
    22812CFusion of spine
    22818CKyphectomy, 1-2 segments
    22819CKyphectomy, 3 or more
    22830CExploration of spinal fusion
    22840CInsert spine fixation device
    22841CInsert spine fixation device
    22842CInsert spine fixation device
    22843CInsert spine fixation device
    22844CInsert spine fixation device
    22845CInsert spine fixation device
    22846CInsert spine fixation device
    22847CInsert spine fixation device
    22848CInsert pelv fixation device
    22849CReinsert spinal fixation
    22850CRemove spine fixation device
    22851CApply spine prosth device
    22852CRemove spine fixation device
    22855CRemove spine fixation device
    22899TSpine surgery procedure00431.7614$104.54$20.91
    22900TRemove abdominal wall lesion002219.5582$1,160.78$354.45$232.16
    22999TAbdomen surgery procedure00194.0363$239.55$71.87$47.91
    23000TRemoval of calcium deposits002114.9098$884.90$219.48$176.98
    23020TRelease shoulder joint005136.3617$2,158.07$431.61
    23030TDrain shoulder lesion000816.4242$974.78$194.96
    23031TDrain shoulder bursa000816.4242$974.78$194.96
    23035TDrain shoulder bone lesion004920.2784$1,203.52$240.70
    23040TExploratory shoulder surgery005023.7998$1,412.52$282.50
    23044TExploratory shoulder surgery005023.7998$1,412.52$282.50
    23065TBiopsy shoulder tissues002114.9098$884.90$219.48$176.98
    23066TBiopsy shoulder tissues002219.5582$1,160.78$354.45$232.16
    23075TRemoval of shoulder lesion002114.9098$884.90$219.48$176.98
    23076TRemoval of shoulder lesion002219.5582$1,160.78$354.45$232.16
    23077TRemove tumor of shoulder002219.5582$1,160.78$354.45$232.16
    23100TBiopsy of shoulder joint004920.2784$1,203.52$240.70
    23101TShoulder joint surgery005023.7998$1,412.52$282.50
    23105TRemove shoulder joint lining005023.7998$1,412.52$282.50
    23106TIncision of collarbone joint005023.7998$1,412.52$282.50
    23107TExplore treat shoulder joint005023.7998$1,412.52$282.50
    23120TPartial removal, collar bone005136.3617$2,158.07$431.61
    23125TRemoval of collar bone005136.3617$2,158.07$431.61
    23130TRemove shoulder bone, part005136.3617$2,158.07$431.61
    23140TRemoval of bone lesion004920.2784$1,203.52$240.70
    23145TRemoval of bone lesion005023.7998$1,412.52$282.50
    23146TRemoval of bone lesion005023.7998$1,412.52$282.50
    23150TRemoval of humerus lesion005023.7998$1,412.52$282.50
    23155TRemoval of humerus lesion005023.7998$1,412.52$282.50
    23156TRemoval of humerus lesion005023.7998$1,412.52$282.50
    23170TRemove collar bone lesion005023.7998$1,412.52$282.50
    23172TRemove shoulder blade lesion005023.7998$1,412.52$282.50
    23174TRemove humerus lesion005023.7998$1,412.52$282.50
    23180TRemove collar bone lesion005023.7998$1,412.52$282.50
    23182TRemove shoulder blade lesion005023.7998$1,412.52$282.50
    23184TRemove humerus lesion005023.7998$1,412.52$282.50
    23190TPartial removal of scapula005023.7998$1,412.52$282.50
    23195TRemoval of head of humerus005023.7998$1,412.52$282.50
    23200CRemoval of collar bone
    23210CRemoval of shoulder blade
    23220CPartial removal of humerus
    23221CPartial removal of humerus
    23222CPartial removal of humerus
    23330TRemove shoulder foreign body00206.9118$410.22$106.93$82.04
    23331TRemove shoulder foreign body002219.5582$1,160.78$354.45$232.16
    23332CRemove shoulder foreign body
    23350NInjection for shoulder x-ray
    23395TMuscle transfer,shoulder/arm005136.3617$2,158.07$431.61
    23397TMuscle transfers005243.7388$2,595.90$519.18
    Start Printed Page 42793
    23400TFixation of shoulder blade005023.7998$1,412.52$282.50
    23405TIncision of tendon & muscle005023.7998$1,412.52$282.50
    23406TIncise tendon(s) & muscle(s)005023.7998$1,412.52$282.50
    23410TRepair of tendon(s)005243.7388$2,595.90$519.18
    23412TRepair rotator cuff, chronic005243.7388$2,595.90$519.18
    23415TRelease of shoulder ligament005136.3617$2,158.07$431.61
    23420TRepair of shoulder005243.7388$2,595.90$519.18
    23430TRepair biceps tendon005243.7388$2,595.90$519.18
    23440TRemove/transplant tendon005243.7388$2,595.90$519.18
    23450TRepair shoulder capsule005243.7388$2,595.90$519.18
    23455TRepair shoulder capsule005243.7388$2,595.90$519.18
    23460TRepair shoulder capsule005243.7388$2,595.90$519.18
    23462TRepair shoulder capsule005243.7388$2,595.90$519.18
    23465TRepair shoulder capsule005243.7388$2,595.90$519.18
    23466TRepair shoulder capsule005243.7388$2,595.90$519.18
    23470TReconstruct shoulder joint042599.7520$5,920.28$1,378.01$1,184.06
    23472CReconstruct shoulder joint
    23480TRevision of collar bone005136.3617$2,158.07$431.61
    23485TRevision of collar bone005136.3617$2,158.07$431.61
    23490TReinforce clavicle005136.3617$2,158.07$431.61
    23491TReinforce shoulder bones005136.3617$2,158.07$431.61
    23500TTreat clavicle fracture00431.7614$104.54$20.91
    23505TTreat clavicle fracture00431.7614$104.54$20.91
    23515TTreat clavicle fracture004637.5315$2,227.49$535.76$445.50
    23520TTreat clavicle dislocation00431.7614$104.54$20.91
    23525TTreat clavicle dislocation00431.7614$104.54$20.91
    23530TTreat clavicle dislocation004637.5315$2,227.49$535.76$445.50
    23532TTreat clavicle dislocation004637.5315$2,227.49$535.76$445.50
    23540TTreat clavicle dislocation00431.7614$104.54$20.91
    23545TTreat clavicle dislocation00431.7614$104.54$20.91
    23550TTreat clavicle dislocation004637.5315$2,227.49$535.76$445.50
    23552TTreat clavicle dislocation004637.5315$2,227.49$535.76$445.50
    23570TTreat shoulder blade fx00431.7614$104.54$20.91
    23575TTreat shoulder blade fx00431.7614$104.54$20.91
    23585TTreat scapula fracture004637.5315$2,227.49$535.76$445.50
    23600TTreat humerus fracture00431.7614$104.54$20.91
    23605TTreat humerus fracture00431.7614$104.54$20.91
    23615TTreat humerus fracture004637.5315$2,227.49$535.76$445.50
    23616TTreat humerus fracture004637.5315$2,227.49$535.76$445.50
    23620TTreat humerus fracture00431.7614$104.54$20.91
    23625TTreat humerus fracture00431.7614$104.54$20.91
    23630TTreat humerus fracture004637.5315$2,227.49$535.76$445.50
    23650TTreat shoulder dislocation00431.7614$104.54$20.91
    23655TTreat shoulder dislocation004514.4289$856.36$268.47$171.27
    23660TTreat shoulder dislocation004637.5315$2,227.49$535.76$445.50
    23665TTreat dislocation/fracture00431.7614$104.54$20.91
    23670TTreat dislocation/fracture004637.5315$2,227.49$535.76$445.50
    23675TTreat dislocation/fracture00431.7614$104.54$20.91
    23680TTreat dislocation/fracture004637.5315$2,227.49$535.76$445.50
    23700TFixation of shoulder004514.4289$856.36$268.47$171.27
    23800TFusion of shoulder joint005136.3617$2,158.07$431.61
    23802TFusion of shoulder joint005136.3617$2,158.07$431.61
    23900CAmputation of arm & girdle
    23920CAmputation at shoulder joint
    23921TAmputation follow-up surgery00255.4690$324.59$101.85$64.92
    23929TShoulder surgery procedure00431.7614$104.54$20.91
    23930TDrainage of arm lesion000816.4242$974.78$194.96
    23931TDrainage of arm bursa000816.4242$974.78$194.96
    23935TDrain arm/elbow bone lesion004920.2784$1,203.52$240.70
    24000TExploratory elbow surgery005023.7998$1,412.52$282.50
    24006TRelease elbow joint005023.7998$1,412.52$282.50
    24065TBiopsy arm/elbow soft tissue002114.9098$884.90$219.48$176.98
    24066TBiopsy arm/elbow soft tissue002114.9098$884.90$219.48$176.98
    24075TRemove arm/elbow lesion002114.9098$884.90$219.48$176.98
    24076TRemove arm/elbow lesion002219.5582$1,160.78$354.45$232.16
    24077TRemove tumor of arm/elbow002219.5582$1,160.78$354.45$232.16
    Start Printed Page 42794
    24100TBiopsy elbow joint lining004920.2784$1,203.52$240.70
    24101TExplore/treat elbow joint005023.7998$1,412.52$282.50
    24102TRemove elbow joint lining005023.7998$1,412.52$282.50
    24105TRemoval of elbow bursa004920.2784$1,203.52$240.70
    24110TRemove humerus lesion004920.2784$1,203.52$240.70
    24115TRemove/graft bone lesion005023.7998$1,412.52$282.50
    24116TRemove/graft bone lesion005023.7998$1,412.52$282.50
    24120TRemove elbow lesion004920.2784$1,203.52$240.70
    24125TRemove/graft bone lesion005023.7998$1,412.52$282.50
    24126TRemove/graft bone lesion005023.7998$1,412.52$282.50
    24130TRemoval of head of radius005023.7998$1,412.52$282.50
    24134TRemoval of arm bone lesion005023.7998$1,412.52$282.50
    24136TRemove radius bone lesion005023.7998$1,412.52$282.50
    24138TRemove elbow bone lesion005023.7998$1,412.52$282.50
    24140TPartial removal of arm bone005023.7998$1,412.52$282.50
    24145TPartial removal of radius005023.7998$1,412.52$282.50
    24147TPartial removal of elbow005023.7998$1,412.52$282.50
    24149TRadical resection of elbow005023.7998$1,412.52$282.50
    24150TExtensive humerus surgery005243.7388$2,595.90$519.18
    24151TExtensive humerus surgery005243.7388$2,595.90$519.18
    24152TExtensive radius surgery005243.7388$2,595.90$519.18
    24153TExtensive radius surgery005243.7388$2,595.90$519.18
    24155TRemoval of elbow joint005136.3617$2,158.07$431.61
    24160TRemove elbow joint implant005023.7998$1,412.52$282.50
    24164TRemove radius head implant005023.7998$1,412.52$282.50
    24200TRemoval of arm foreign body00194.0363$239.55$71.87$47.91
    24201TRemoval of arm foreign body002114.9098$884.90$219.48$176.98
    24220NInjection for elbow x-ray
    24300TManipulate elbow w/anesth004514.4289$856.36$268.47$171.27
    24301TMuscle/tendon transfer005023.7998$1,412.52$282.50
    24305TArm tendon lengthening005023.7998$1,412.52$282.50
    24310TRevision of arm tendon004920.2784$1,203.52$240.70
    24320TRepair of arm tendon005136.3617$2,158.07$431.61
    24330TRevision of arm muscles005136.3617$2,158.07$431.61
    24331TRevision of arm muscles005136.3617$2,158.07$431.61
    24332TTenolysis, triceps004920.2784$1,203.52$240.70
    24340TRepair of biceps tendon005136.3617$2,158.07$431.61
    24341TRepair arm tendon/muscle005136.3617$2,158.07$431.61
    24342TRepair of ruptured tendon005136.3617$2,158.07$431.61
    24343TRepr elbow lat ligmnt w/tiss005023.7998$1,412.52$282.50
    24344TReconstruct elbow lat ligmnt005136.3617$2,158.07$431.61
    24345TRepr elbw med ligmnt w/tissu005023.7998$1,412.52$282.50
    24346TReconstruct elbow med ligmnt005136.3617$2,158.07$431.61
    24350TRepair of tennis elbow005023.7998$1,412.52$282.50
    24351TRepair of tennis elbow005023.7998$1,412.52$282.50
    24352TRepair of tennis elbow005023.7998$1,412.52$282.50
    24354TRepair of tennis elbow005023.7998$1,412.52$282.50
    24356TRevision of tennis elbow005023.7998$1,412.52$282.50
    24360TReconstruct elbow joint004731.4675$1,867.60$537.03$373.52
    24361TReconstruct elbow joint042599.7520$5,920.28$1,378.01$1,184.06
    24362TReconstruct elbow joint004842.9335$2,548.10$570.30$509.62
    24363TReplace elbow joint042599.7520$5,920.28$1,378.01$1,184.06
    24365TReconstruct head of radius004731.4675$1,867.60$537.03$373.52
    24366TReconstruct head of radius042599.7520$5,920.28$1,378.01$1,184.06
    24400TRevision of humerus005023.7998$1,412.52$282.50
    24410TRevision of humerus005023.7998$1,412.52$282.50
    24420TRevision of humerus005136.3617$2,158.07$431.61
    24430TRepair of humerus005136.3617$2,158.07$431.61
    24435TRepair humerus with graft005136.3617$2,158.07$431.61
    24470TRevision of elbow joint005136.3617$2,158.07$431.61
    24495TDecompression of forearm005023.7998$1,412.52$282.50
    24498TReinforce humerus005136.3617$2,158.07$431.61
    24500TTreat humerus fracture00431.7614$104.54$20.91
    24505TTreat humerus fracture00431.7614$104.54$20.91
    24515TTreat humerus fracture004637.5315$2,227.49$535.76$445.50
    24516TTreat humerus fracture004637.5315$2,227.49$535.76$445.50
    Start Printed Page 42795
    24530TTreat humerus fracture00431.7614$104.54$20.91
    24535TTreat humerus fracture00431.7614$104.54$20.91
    24538TTreat humerus fracture004637.5315$2,227.49$535.76$445.50
    24545TTreat humerus fracture004637.5315$2,227.49$535.76$445.50
    24546TTreat humerus fracture004637.5315$2,227.49$535.76$445.50
    24560TTreat humerus fracture00431.7614$104.54$20.91
    24565TTreat humerus fracture00431.7614$104.54$20.91
    24566TTreat humerus fracture004637.5315$2,227.49$535.76$445.50
    24575TTreat humerus fracture004637.5315$2,227.49$535.76$445.50
    24576TTreat humerus fracture00431.7614$104.54$20.91
    24577TTreat humerus fracture00431.7614$104.54$20.91
    24579TTreat humerus fracture004637.5315$2,227.49$535.76$445.50
    24582TTreat humerus fracture004637.5315$2,227.49$535.76$445.50
    24586TTreat elbow fracture004637.5315$2,227.49$535.76$445.50
    24587TTreat elbow fracture004637.5315$2,227.49$535.76$445.50
    24600TTreat elbow dislocation00431.7614$104.54$20.91
    24605TTreat elbow dislocation004514.4289$856.36$268.47$171.27
    24615TTreat elbow dislocation004637.5315$2,227.49$535.76$445.50
    24620TTreat elbow fracture00431.7614$104.54$20.91
    24635TTreat elbow fracture004637.5315$2,227.49$535.76$445.50
    24640TTreat elbow dislocation00431.7614$104.54$20.91
    24650TTreat radius fracture00431.7614$104.54$20.91
    24655TTreat radius fracture00431.7614$104.54$20.91
    24665TTreat radius fracture004637.5315$2,227.49$535.76$445.50
    24666TTreat radius fracture004637.5315$2,227.49$535.76$445.50
    24670TTreat ulnar fracture00431.7614$104.54$20.91
    24675TTreat ulnar fracture00431.7614$104.54$20.91
    24685TTreat ulnar fracture004637.5315$2,227.49$535.76$445.50
    24800TFusion of elbow joint005136.3617$2,158.07$431.61
    24802TFusion/graft of elbow joint005136.3617$2,158.07$431.61
    24900CAmputation of upper arm
    24920CAmputation of upper arm
    24925TAmputation follow-up surgery004920.2784$1,203.52$240.70
    24930CAmputation follow-up surgery
    24931CAmputate upper arm & implant
    24935TRevision of amputation005243.7388$2,595.90$519.18
    24940CRevision of upper arm
    24999TUpper arm/elbow surgery00431.7614$104.54$20.91
    25000TIncision of tendon sheath004920.2784$1,203.52$240.70
    25001TIncise flexor carpi radialis004920.2784$1,203.52$240.70
    25020TDecompress forearm 1 space004920.2784$1,203.52$240.70
    25023TDecompress forearm 1 space005023.7998$1,412.52$282.50
    25024TDecompress forearm 2 spaces005023.7998$1,412.52$282.50
    25025TDecompress forearm 2 spaces005023.7998$1,412.52$282.50
    25028TDrainage of forearm lesion004920.2784$1,203.52$240.70
    25031TDrainage of forearm bursa004920.2784$1,203.52$240.70
    25035TTreat forearm bone lesion004920.2784$1,203.52$240.70
    25040TExplore/treat wrist joint005023.7998$1,412.52$282.50
    25065TBiopsy forearm soft tissues002114.9098$884.90$219.48$176.98
    25066TBiopsy forearm soft tissues002219.5582$1,160.78$354.45$232.16
    25075TRemovel forearm lesion subcu002114.9098$884.90$219.48$176.98
    25076TRemovel forearm lesion deep002219.5582$1,160.78$354.45$232.16
    25077TRemove tumor, forearm/wrist002219.5582$1,160.78$354.45$232.16
    25085TIncision of wrist capsule004920.2784$1,203.52$240.70
    25100TBiopsy of wrist joint004920.2784$1,203.52$240.70
    25101TExplore/treat wrist joint005023.7998$1,412.52$282.50
    25105TRemove wrist joint lining005023.7998$1,412.52$282.50
    25107TRemove wrist joint cartilage005023.7998$1,412.52$282.50
    25110TRemove wrist tendon lesion004920.2784$1,203.52$240.70
    25111TRemove wrist tendon lesion005315.6085$926.36$253.49$185.27
    25112TReremove wrist tendon lesion005315.6085$926.36$253.49$185.27
    25115TRemove wrist/forearm lesion004920.2784$1,203.52$240.70
    25116TRemove wrist/forearm lesion004920.2784$1,203.52$240.70
    25118TExcise wrist tendon sheath005023.7998$1,412.52$282.50
    25119TPartial removal of ulna005023.7998$1,412.52$282.50
    25120TRemoval of forearm lesion005023.7998$1,412.52$282.50
    Start Printed Page 42796
    25125TRemove/graft forearm lesion005023.7998$1,412.52$282.50
    25126TRemove/graft forearm lesion005023.7998$1,412.52$282.50
    25130TRemoval of wrist lesion005023.7998$1,412.52$282.50
    25135TRemove & graft wrist lesion005023.7998$1,412.52$282.50
    25136TRemove & graft wrist lesion005023.7998$1,412.52$282.50
    25145TRemove forearm bone lesion005023.7998$1,412.52$282.50
    25150TPartial removal of ulna005023.7998$1,412.52$282.50
    25151TPartial removal of radius005023.7998$1,412.52$282.50
    25170TExtensive forearm surgery005243.7388$2,595.90$519.18
    25210TRemoval of wrist bone005425.2562$1,498.96$299.79
    25215TRemoval of wrist bones005425.2562$1,498.96$299.79
    25230TPartial removal of radius005023.7998$1,412.52$282.50
    25240TPartial removal of ulna005023.7998$1,412.52$282.50
    25246NInjection for wrist x-ray
    25248TRemove forearm foreign body004920.2784$1,203.52$240.70
    25250TRemoval of wrist prosthesis005023.7998$1,412.52$282.50
    25251TRemoval of wrist prosthesis005023.7998$1,412.52$282.50
    25259TManipulate wrist w/anesthes00431.7614$104.54$20.91
    25260TRepair forearm tendon/muscle005023.7998$1,412.52$282.50
    25263TRepair forearm tendon/muscle005023.7998$1,412.52$282.50
    25265TRepair forearm tendon/muscle005023.7998$1,412.52$282.50
    25270TRepair forearm tendon/muscle005023.7998$1,412.52$282.50
    25272TRepair forearm tendon/muscle005023.7998$1,412.52$282.50
    25274TRepair forearm tendon/muscle005023.7998$1,412.52$282.50
    25275TRepair forearm tendon sheath005023.7998$1,412.52$282.50
    25280TRevise wrist/forearm tendon005023.7998$1,412.52$282.50
    25290TIncise wrist/forearm tendon005023.7998$1,412.52$282.50
    25295TRelease wrist/forearm tendon004920.2784$1,203.52$240.70
    25300TFusion of tendons at wrist005023.7998$1,412.52$282.50
    25301TFusion of tendons at wrist005023.7998$1,412.52$282.50
    25310TTransplant forearm tendon005136.3617$2,158.07$431.61
    25312TTransplant forearm tendon005136.3617$2,158.07$431.61
    25315TRevise palsy hand tendon(s)005136.3617$2,158.07$431.61
    25316TRevise palsy hand tendon(s)005136.3617$2,158.07$431.61
    25320TRepair/revise wrist joint005136.3617$2,158.07$431.61
    25332TRevise wrist joint004731.4675$1,867.60$537.03$373.52
    25335TRealignment of hand005136.3617$2,158.07$431.61
    25337TReconstruct ulna/radioulnar005136.3617$2,158.07$431.61
    25350TRevision of radius005136.3617$2,158.07$431.61
    25355TRevision of radius005136.3617$2,158.07$431.61
    25360TRevision of ulna005023.7998$1,412.52$282.50
    25365TRevise radius & ulna005023.7998$1,412.52$282.50
    25370TRevise radius or ulna005136.3617$2,158.07$431.61
    25375TRevise radius & ulna005136.3617$2,158.07$431.61
    25390TShorten radius or ulna005023.7998$1,412.52$282.50
    25391TLengthen radius or ulna005136.3617$2,158.07$431.61
    25392TShorten radius & ulna005023.7998$1,412.52$282.50
    25393TLengthen radius & ulna005136.3617$2,158.07$431.61
    25394TRepair carpal bone, shorten005315.6085$926.36$253.49$185.27
    25400TRepair radius or ulna005023.7998$1,412.52$282.50
    25405TRepair/graft radius or ulna005023.7998$1,412.52$282.50
    25415TRepair radius & ulna005023.7998$1,412.52$282.50
    25420TRepair/graft radius & ulna005136.3617$2,158.07$431.61
    25425TRepair/graft radius or ulna005136.3617$2,158.07$431.61
    25426TRepair/graft radius & ulna005136.3617$2,158.07$431.61
    25430TVasc graft into carpal bone005425.2562$1,498.96$299.79
    25431TRepair nonunion carpal bone005425.2562$1,498.96$299.79
    25440TRepair/graft wrist bone005136.3617$2,158.07$431.61
    25441TReconstruct wrist joint042599.7520$5,920.28$1,378.01$1,184.06
    25442TReconstruct wrist joint042599.7520$5,920.28$1,378.01$1,184.06
    25443TReconstruct wrist joint004842.9335$2,548.10$570.30$509.62
    25444TReconstruct wrist joint004842.9335$2,548.10$570.30$509.62
    25445TReconstruct wrist joint004842.9335$2,548.10$570.30$509.62
    25446TWrist replacement042599.7520$5,920.28$1,378.01$1,184.06
    25447TRepair wrist joint(s)004731.4675$1,867.60$537.03$373.52
    25449TRemove wrist joint implant004731.4675$1,867.60$537.03$373.52
    Start Printed Page 42797
    25450TRevision of wrist joint005136.3617$2,158.07$431.61
    25455TRevision of wrist joint005136.3617$2,158.07$431.61
    25490TReinforce radius005136.3617$2,158.07$431.61
    25491TReinforce ulna005136.3617$2,158.07$431.61
    25492TReinforce radius and ulna005136.3617$2,158.07$431.61
    25500TTreat fracture of radius00431.7614$104.54$20.91
    25505TTreat fracture of radius00431.7614$104.54$20.91
    25515TTreat fracture of radius004637.5315$2,227.49$535.76$445.50
    25520TTreat fracture of radius00431.7614$104.54$20.91
    25525TTreat fracture of radius004637.5315$2,227.49$535.76$445.50
    25526TTreat fracture of radius004637.5315$2,227.49$535.76$445.50
    25530TTreat fracture of ulna00431.7614$104.54$20.91
    25535TTreat fracture of ulna00431.7614$104.54$20.91
    25545TTreat fracture of ulna004637.5315$2,227.49$535.76$445.50
    25560TTreat fracture radius & ulna00431.7614$104.54$20.91
    25565TTreat fracture radius & ulna00431.7614$104.54$20.91
    25574TTreat fracture radius & ulna004637.5315$2,227.49$535.76$445.50
    25575TTreat fracture radius/ulna004637.5315$2,227.49$535.76$445.50
    25600TTreat fracture radius/ulna00431.7614$104.54$20.91
    25605TTreat fracture radius/ulna00431.7614$104.54$20.91
    25611TTreat fracture radius/ulna004637.5315$2,227.49$535.76$445.50
    25620TTreat fracture radius/ulna004637.5315$2,227.49$535.76$445.50
    25622TTreat wrist bone fracture00431.7614$104.54$20.91
    25624TTreat wrist bone fracture00431.7614$104.54$20.91
    25628TTreat wrist bone fracture004637.5315$2,227.49$535.76$445.50
    25630TTreat wrist bone fracture00431.7614$104.54$20.91
    25635TTreat wrist bone fracture00431.7614$104.54$20.91
    25645TTreat wrist bone fracture004637.5315$2,227.49$535.76$445.50
    25650TTreat wrist bone fracture00431.7614$104.54$20.91
    25651TPin ulnar styloid fracture004637.5315$2,227.49$535.76$445.50
    25652TTreat fracture ulnar styloid004637.5315$2,227.49$535.76$445.50
    25660TTreat wrist dislocation00431.7614$104.54$20.91
    25670TTreat wrist dislocation004637.5315$2,227.49$535.76$445.50
    25671TPin radioulnar dislocation004637.5315$2,227.49$535.76$445.50
    25675TTreat wrist dislocation00431.7614$104.54$20.91
    25676TTreat wrist dislocation004637.5315$2,227.49$535.76$445.50
    25680TTreat wrist fracture00431.7614$104.54$20.91
    25685TTreat wrist fracture004637.5315$2,227.49$535.76$445.50
    25690TTreat wrist dislocation00431.7614$104.54$20.91
    25695TTreat wrist dislocation004637.5315$2,227.49$535.76$445.50
    25800TFusion of wrist joint005136.3617$2,158.07$431.61
    25805TFusion/graft of wrist joint005136.3617$2,158.07$431.61
    25810TFusion/graft of wrist joint005136.3617$2,158.07$431.61
    25820TFusion of hand bones005315.6085$926.36$253.49$185.27
    25825TFuse hand bones with graft005425.2562$1,498.96$299.79
    25830TFusion, radioulnar jnt/ulna005136.3617$2,158.07$431.61
    25900CAmputation of forearm
    25905CAmputation of forearm
    25907TAmputation follow-up surgery004920.2784$1,203.52$240.70
    25909CAmputation follow-up surgery
    25915CAmputation of forearm
    25920CAmputate hand at wrist
    25922TAmputate hand at wrist004920.2784$1,203.52$240.70
    25924CAmputation follow-up surgery
    25927CAmputation of hand
    25929TAmputation follow-up surgery068613.7661$817.02$163.40
    25931CAmputation follow-up surgery
    25999TForearm or wrist surgery00431.7614$104.54$20.91
    26010TDrainage of finger abscess00061.5430$91.58$22.18$18.32
    26011TDrainage of finger abscess000711.3983$676.49$135.30
    26020TDrain hand tendon sheath005315.6085$926.36$253.49$185.27
    26025TDrainage of palm bursa005315.6085$926.36$253.49$185.27
    26030TDrainage of palm bursa(s)005315.6085$926.36$253.49$185.27
    26034TTreat hand bone lesion005315.6085$926.36$253.49$185.27
    26035TDecompress fingers/hand005315.6085$926.36$253.49$185.27
    26037TDecompress fingers/hand005315.6085$926.36$253.49$185.27
    Start Printed Page 42798
    26040TRelease palm contracture005425.2562$1,498.96$299.79
    26045TRelease palm contracture005425.2562$1,498.96$299.79
    26055TIncise finger tendon sheath005315.6085$926.36$253.49$185.27
    26060TIncision of finger tendon005315.6085$926.36$253.49$185.27
    26070TExplore/treat hand joint005315.6085$926.36$253.49$185.27
    26075TExplore/treat finger joint005315.6085$926.36$253.49$185.27
    26080TExplore/treat finger joint005315.6085$926.36$253.49$185.27
    26100TBiopsy hand joint lining005315.6085$926.36$253.49$185.27
    26105TBiopsy finger joint lining005315.6085$926.36$253.49$185.27
    26110TBiopsy finger joint lining005315.6085$926.36$253.49$185.27
    26115TRemovel hand lesion subcut002219.5582$1,160.78$354.45$232.16
    26116TRemovel hand lesion, deep002219.5582$1,160.78$354.45$232.16
    26117TRemove tumor, hand/finger002219.5582$1,160.78$354.45$232.16
    26121TRelease palm contracture005425.2562$1,498.96$299.79
    26123TRelease palm contracture005425.2562$1,498.96$299.79
    26125TRelease palm contracture005315.6085$926.36$253.49$185.27
    26130TRemove wrist joint lining005315.6085$926.36$253.49$185.27
    26135TRevise finger joint, each005425.2562$1,498.96$299.79
    26140TRevise finger joint, each005315.6085$926.36$253.49$185.27
    26145TTendon excision, palm/finger005315.6085$926.36$253.49$185.27
    26160TRemove tendon sheath lesion005315.6085$926.36$253.49$185.27
    26170TRemoval of palm tendon, each005315.6085$926.36$253.49$185.27
    26180TRemoval of finger tendon005315.6085$926.36$253.49$185.27
    26185TRemove finger bone005315.6085$926.36$253.49$185.27
    26200TRemove hand bone lesion005315.6085$926.36$253.49$185.27
    26205TRemove/graft bone lesion005425.2562$1,498.96$299.79
    26210TRemoval of finger lesion005315.6085$926.36$253.49$185.27
    26215TRemove/graft finger lesion005315.6085$926.36$253.49$185.27
    26230TPartial removal of hand bone005315.6085$926.36$253.49$185.27
    26235TPartial removal, finger bone005315.6085$926.36$253.49$185.27
    26236TPartial removal, finger bone005315.6085$926.36$253.49$185.27
    26250TExtensive hand surgery005315.6085$926.36$253.49$185.27
    26255TExtensive hand surgery005425.2562$1,498.96$299.79
    26260TExtensive finger surgery005315.6085$926.36$253.49$185.27
    26261TExtensive finger surgery005315.6085$926.36$253.49$185.27
    26262TPartial removal of finger005315.6085$926.36$253.49$185.27
    26320TRemoval of implant from hand002114.9098$884.90$219.48$176.98
    26340TManipulate finger w/anesth00431.7614$104.54$20.91
    26350TRepair finger/hand tendon005425.2562$1,498.96$299.79
    26352TRepair/graft hand tendon005425.2562$1,498.96$299.79
    26356TRepair finger/hand tendon005425.2562$1,498.96$299.79
    26357TRepair finger/hand tendon005425.2562$1,498.96$299.79
    26358TRepair/graft hand tendon005425.2562$1,498.96$299.79
    26370TRepair finger/hand tendon005425.2562$1,498.96$299.79
    26372TRepair/graft hand tendon005425.2562$1,498.96$299.79
    26373TRepair finger/hand tendon005425.2562$1,498.96$299.79
    26390TRevise hand/finger tendon005425.2562$1,498.96$299.79
    26392TRepair/graft hand tendon005425.2562$1,498.96$299.79
    26410TRepair hand tendon005315.6085$926.36$253.49$185.27
    26412TRepair/graft hand tendon005425.2562$1,498.96$299.79
    26415TExcision, hand/finger tendon005425.2562$1,498.96$299.79
    26416TGraft hand or finger tendon005425.2562$1,498.96$299.79
    26418TRepair finger tendon005315.6085$926.36$253.49$185.27
    26420TRepair/graft finger tendon005425.2562$1,498.96$299.79
    26426TRepair finger/hand tendon005425.2562$1,498.96$299.79
    26428TRepair/graft finger tendon005425.2562$1,498.96$299.79
    26432TRepair finger tendon005315.6085$926.36$253.49$185.27
    26433TRepair finger tendon005315.6085$926.36$253.49$185.27
    26434TRepair/graft finger tendon005425.2562$1,498.96$299.79
    26437TRealignment of tendons005315.6085$926.36$253.49$185.27
    26440TRelease palm/finger tendon005315.6085$926.36$253.49$185.27
    26442TRelease palm & finger tendon005425.2562$1,498.96$299.79
    26445TRelease hand/finger tendon005315.6085$926.36$253.49$185.27
    26449TRelease forearm/hand tendon005425.2562$1,498.96$299.79
    26450TIncision of palm tendon005315.6085$926.36$253.49$185.27
    26455TIncision of finger tendon005315.6085$926.36$253.49$185.27
    Start Printed Page 42799
    26460TIncise hand/finger tendon005315.6085$926.36$253.49$185.27
    26471TFusion of finger tendons005315.6085$926.36$253.49$185.27
    26474TFusion of finger tendons005315.6085$926.36$253.49$185.27
    26476TTendon lengthening005315.6085$926.36$253.49$185.27
    26477TTendon shortening005315.6085$926.36$253.49$185.27
    26478TLengthening of hand tendon005315.6085$926.36$253.49$185.27
    26479TShortening of hand tendon005315.6085$926.36$253.49$185.27
    26480TTransplant hand tendon005425.2562$1,498.96$299.79
    26483TTransplant/graft hand tendon005425.2562$1,498.96$299.79
    26485TTransplant palm tendon005425.2562$1,498.96$299.79
    26489TTransplant/graft palm tendon005425.2562$1,498.96$299.79
    26490TRevise thumb tendon005425.2562$1,498.96$299.79
    26492TTendon transfer with graft005425.2562$1,498.96$299.79
    26494THand tendon/muscle transfer005425.2562$1,498.96$299.79
    26496TRevise thumb tendon005425.2562$1,498.96$299.79
    26497TFinger tendon transfer005425.2562$1,498.96$299.79
    26498TFinger tendon transfer005425.2562$1,498.96$299.79
    26499TRevision of finger005425.2562$1,498.96$299.79
    26500THand tendon reconstruction005315.6085$926.36$253.49$185.27
    26502THand tendon reconstruction005425.2562$1,498.96$299.79
    26504THand tendon reconstruction005425.2562$1,498.96$299.79
    26508TRelease thumb contracture005315.6085$926.36$253.49$185.27
    26510TThumb tendon transfer005425.2562$1,498.96$299.79
    26516TFusion of knuckle joint005425.2562$1,498.96$299.79
    26517TFusion of knuckle joints005425.2562$1,498.96$299.79
    26518TFusion of knuckle joints005425.2562$1,498.96$299.79
    26520TRelease knuckle contracture005315.6085$926.36$253.49$185.27
    26525TRelease finger contracture005315.6085$926.36$253.49$185.27
    26530TRevise knuckle joint004731.4675$1,867.60$537.03$373.52
    26531TRevise knuckle with implant004842.9335$2,548.10$570.30$509.62
    26535TRevise finger joint004731.4675$1,867.60$537.03$373.52
    26536TRevise/implant finger joint004842.9335$2,548.10$570.30$509.62
    26540TRepair hand joint005315.6085$926.36$253.49$185.27
    26541TRepair hand joint with graft005425.2562$1,498.96$299.79
    26542TRepair hand joint with graft005315.6085$926.36$253.49$185.27
    26545TReconstruct finger joint005425.2562$1,498.96$299.79
    26546TRepair nonunion hand005425.2562$1,498.96$299.79
    26548TReconstruct finger joint005425.2562$1,498.96$299.79
    26550TConstruct thumb replacement005425.2562$1,498.96$299.79
    26551CGreat toe-hand transfer
    26553CSingle transfer, toe-hand
    26554CDouble transfer, toe-hand
    26555TPositional change of finger005425.2562$1,498.96$299.79
    26556CToe joint transfer
    26560TRepair of web finger005315.6085$926.36$253.49$185.27
    26561TRepair of web finger005425.2562$1,498.96$299.79
    26562TRepair of web finger005425.2562$1,498.96$299.79
    26565TCorrect metacarpal flaw005425.2562$1,498.96$299.79
    26567TCorrect finger deformity005425.2562$1,498.96$299.79
    26568TLengthen metacarpal/finger005425.2562$1,498.96$299.79
    26580TRepair hand deformity005315.6085$926.36$253.49$185.27
    26587TReconstruct extra finger005315.6085$926.36$253.49$185.27
    26590TRepair finger deformity005315.6085$926.36$253.49$185.27
    26591TRepair muscles of hand005425.2562$1,498.96$299.79
    26593TRelease muscles of hand005315.6085$926.36$253.49$185.27
    26596TExcision constricting tissue005315.6085$926.36$253.49$185.27
    26600TTreat metacarpal fracture00431.7614$104.54$20.91
    26605TTreat metacarpal fracture00431.7614$104.54$20.91
    26607TTreat metacarpal fracture00431.7614$104.54$20.91
    26608TTreat metacarpal fracture004637.5315$2,227.49$535.76$445.50
    26615TTreat metacarpal fracture004637.5315$2,227.49$535.76$445.50
    26641TTreat thumb dislocation00431.7614$104.54$20.91
    26645TTreat thumb fracture00431.7614$104.54$20.91
    26650TTreat thumb fracture004637.5315$2,227.49$535.76$445.50
    26665TTreat thumb fracture004637.5315$2,227.49$535.76$445.50
    26670TTreat hand dislocation00431.7614$104.54$20.91
    Start Printed Page 42800
    26675TTreat hand dislocation00431.7614$104.54$20.91
    26676TPin hand dislocation004637.5315$2,227.49$535.76$445.50
    26685TTreat hand dislocation004637.5315$2,227.49$535.76$445.50
    26686TTreat hand dislocation004637.5315$2,227.49$535.76$445.50
    26700TTreat knuckle dislocation00431.7614$104.54$20.91
    26705TTreat knuckle dislocation00431.7614$104.54$20.91
    26706TPin knuckle dislocation00431.7614$104.54$20.91
    26715TTreat knuckle dislocation004637.5315$2,227.49$535.76$445.50
    26720TTreat finger fracture, each00431.7614$104.54$20.91
    26725TTreat finger fracture, each00431.7614$104.54$20.91
    26727TTreat finger fracture, each004637.5315$2,227.49$535.76$445.50
    26735TTreat finger fracture, each004637.5315$2,227.49$535.76$445.50
    26740TTreat finger fracture, each00431.7614$104.54$20.91
    26742TTreat finger fracture, each00431.7614$104.54$20.91
    26746TTreat finger fracture, each004637.5315$2,227.49$535.76$445.50
    26750TTreat finger fracture, each00431.7614$104.54$20.91
    26755TTreat finger fracture, each00431.7614$104.54$20.91
    26756TPin finger fracture, each004637.5315$2,227.49$535.76$445.50
    26765TTreat finger fracture, each004637.5315$2,227.49$535.76$445.50
    26770TTreat finger dislocation00431.7614$104.54$20.91
    26775TTreat finger dislocation004514.4289$856.36$268.47$171.27
    26776TPin finger dislocation004637.5315$2,227.49$535.76$445.50
    26785TTreat finger dislocation004637.5315$2,227.49$535.76$445.50
    26820TThumb fusion with graft005425.2562$1,498.96$299.79
    26841TFusion of thumb005425.2562$1,498.96$299.79
    26842TThumb fusion with graft005425.2562$1,498.96$299.79
    26843TFusion of hand joint005425.2562$1,498.96$299.79
    26844TFusion/graft of hand joint005425.2562$1,498.96$299.79
    26850TFusion of knuckle005425.2562$1,498.96$299.79
    26852TFusion of knuckle with graft005425.2562$1,498.96$299.79
    26860TFusion of finger joint005425.2562$1,498.96$299.79
    26861TFusion of finger jnt, add-on005425.2562$1,498.96$299.79
    26862TFusion/graft of finger joint005425.2562$1,498.96$299.79
    26863TFuse/graft added joint005425.2562$1,498.96$299.79
    26910TAmputate metacarpal bone005425.2562$1,498.96$299.79
    26951TAmputation of finger/thumb005315.6085$926.36$253.49$185.27
    26952TAmputation of finger/thumb005315.6085$926.36$253.49$185.27
    26989THand/finger surgery00431.7614$104.54$20.91
    26990TDrainage of pelvis lesion004920.2784$1,203.52$240.70
    26991TDrainage of pelvis bursa004920.2784$1,203.52$240.70
    26992CDrainage of bone lesion
    27000TIncision of hip tendon004920.2784$1,203.52$240.70
    27001TIncision of hip tendon005023.7998$1,412.52$282.50
    27003TIncision of hip tendon005023.7998$1,412.52$282.50
    27005CIncision of hip tendon
    27006CIncision of hip tendons
    27025CIncision of hip/thigh fascia
    27030CDrainage of hip joint
    27033TExploration of hip joint005136.3617$2,158.07$431.61
    27035TDenervation of hip joint005243.7388$2,595.90$519.18
    27036CExcision of hip joint/muscle
    27040TBiopsy of soft tissues00206.9118$410.22$106.93$82.04
    27041TBiopsy of soft tissues00206.9118$410.22$106.93$82.04
    27047TRemove hip/pelvis lesion002219.5582$1,160.78$354.45$232.16
    27048TRemove hip/pelvis lesion002219.5582$1,160.78$354.45$232.16
    27049TRemove tumor, hip/pelvis002219.5582$1,160.78$354.45$232.16
    27050TBiopsy of sacroiliac joint004920.2784$1,203.52$240.70
    27052TBiopsy of hip joint004920.2784$1,203.52$240.70
    27054CRemoval of hip joint lining
    27060TRemoval of ischial bursa004920.2784$1,203.52$240.70
    27062TRemove femur lesion/bursa004920.2784$1,203.52$240.70
    27065TRemoval of hip bone lesion004920.2784$1,203.52$240.70
    27066TRemoval of hip bone lesion005023.7998$1,412.52$282.50
    27067TRemove/graft hip bone lesion005023.7998$1,412.52$282.50
    27070CPartial removal of hip bone
    27071CPartial removal of hip bone
    Start Printed Page 42801
    27075CExtensive hip surgery
    27076CExtensive hip surgery
    27077CExtensive hip surgery
    27078CExtensive hip surgery
    27079CExtensive hip surgery
    27080TRemoval of tail bone005023.7998$1,412.52$282.50
    27086TRemove hip foreign body00206.9118$410.22$106.93$82.04
    27087TRemove hip foreign body004920.2784$1,203.52$240.70
    27090CRemoval of hip prosthesis
    27091CRemoval of hip prosthesis
    27093NInjection for hip x-ray
    27095NInjection for hip x-ray
    27096BInject sacroiliac joint
    27097TRevision of hip tendon005023.7998$1,412.52$282.50
    27098TTransfer tendon to pelvis005023.7998$1,412.52$282.50
    27100TTransfer of abdominal muscle005136.3617$2,158.07$431.61
    27105TTransfer of spinal muscle005136.3617$2,158.07$431.61
    27110TTransfer of iliopsoas muscle005136.3617$2,158.07$431.61
    27111TTransfer of iliopsoas muscle005136.3617$2,158.07$431.61
    27120CReconstruction of hip socket
    27122CReconstruction of hip socket
    27125CPartial hip replacement
    27130CTotal hip arthroplasty
    27132CTotal hip arthroplasty
    27134CRevise hip joint replacement
    27137CRevise hip joint replacement
    27138CRevise hip joint replacement
    27140CTransplant femur ridge
    27146CIncision of hip bone
    27147CRevision of hip bone
    27151CIncision of hip bones
    27156CRevision of hip bones
    27158CRevision of pelvis
    27161CIncision of neck of femur
    27165CIncision/fixation of femur
    27170CRepair/graft femur head/neck
    27175CTreat slipped epiphysis
    27176CTreat slipped epiphysis
    27177CTreat slipped epiphysis
    27178CTreat slipped epiphysis
    27179CRevise head/neck of femur
    27181CTreat slipped epiphysis
    27185CRevision of femur epiphysis
    27187CReinforce hip bones
    27193TTreat pelvic ring fracture00431.7614$104.54$20.91
    27194TTreat pelvic ring fracture004514.4289$856.36$268.47$171.27
    27200TTreat tail bone fracture00431.7614$104.54$20.91
    27202TTreat tail bone fracture004637.5315$2,227.49$535.76$445.50
    27215CTreat pelvic fracture(s)
    27216TTreat pelvic ring fracture005023.7998$1,412.52$282.50
    27217CTreat pelvic ring fracture
    27218CTreat pelvic ring fracture
    27220TTreat hip socket fracture00431.7614$104.54$20.91
    27222CTreat hip socket fracture
    27226CTreat hip wall fracture
    27227CTreat hip fracture(s)
    27228CTreat hip fracture(s)
    27230TTreat thigh fracture00431.7614$104.54$20.91
    27232CTreat thigh fracture
    27235TTreat thigh fracture005023.7998$1,412.52$282.50
    27236CTreat thigh fracture
    27238TTreat thigh fracture00431.7614$104.54$20.91
    27240CTreat thigh fracture
    27244CTreat thigh fracture
    27245CTreat thigh fracture
    27246TTreat thigh fracture00431.7614$104.54$20.91
    Start Printed Page 42802
    27248CTreat thigh fracture
    27250TTreat hip dislocation00431.7614$104.54$20.91
    27252TTreat hip dislocation004514.4289$856.36$268.47$171.27
    27253CTreat hip dislocation
    27254CTreat hip dislocation
    27256TTreat hip dislocation00431.7614$104.54$20.91
    27257TTreat hip dislocation004514.4289$856.36$268.47$171.27
    27258CTreat hip dislocation
    27259CTreat hip dislocation
    27265TTreat hip dislocation00431.7614$104.54$20.91
    27266TTreat hip dislocation004514.4289$856.36$268.47$171.27
    27275TManipulation of hip joint004514.4289$856.36$268.47$171.27
    27280CFusion of sacroiliac joint
    27282CFusion of pubic bones
    27284CFusion of hip joint
    27286CFusion of hip joint
    27290CAmputation of leg at hip
    27295CAmputation of leg at hip
    27299TPelvis/hip joint surgery00431.7614$104.54$20.91
    27301TDrain thigh/knee lesion000816.4242$974.78$194.96
    27303CDrainage of bone lesion
    27305TIncise thigh tendon & fascia004920.2784$1,203.52$240.70
    27306TIncision of thigh tendon004920.2784$1,203.52$240.70
    27307TIncision of thigh tendons004920.2784$1,203.52$240.70
    27310TExploration of knee joint005023.7998$1,412.52$282.50
    27315TPartial removal, thigh nerve022017.2800$1,025.57$205.11
    27320TPartial removal, thigh nerve022017.2800$1,025.57$205.11
    27323TBiopsy, thigh soft tissues002114.9098$884.90$219.48$176.98
    27324TBiopsy, thigh soft tissues002219.5582$1,160.78$354.45$232.16
    27327TRemoval of thigh lesion002219.5582$1,160.78$354.45$232.16
    27328TRemoval of thigh lesion002219.5582$1,160.78$354.45$232.16
    27329TRemove tumor, thigh/knee002219.5582$1,160.78$354.45$232.16
    27330TBiopsy, knee joint lining005023.7998$1,412.52$282.50
    27331TExplore/treat knee joint005023.7998$1,412.52$282.50
    27332TRemoval of knee cartilage005023.7998$1,412.52$282.50
    27333TRemoval of knee cartilage005023.7998$1,412.52$282.50
    27334TRemove knee joint lining005023.7998$1,412.52$282.50
    27335TRemove knee joint lining005023.7998$1,412.52$282.50
    27340TRemoval of kneecap bursa004920.2784$1,203.52$240.70
    27345TRemoval of knee cyst004920.2784$1,203.52$240.70
    27347TRemove knee cyst004920.2784$1,203.52$240.70
    27350TRemoval of kneecap005023.7998$1,412.52$282.50
    27355TRemove femur lesion005023.7998$1,412.52$282.50
    27356TRemove femur lesion/graft005023.7998$1,412.52$282.50
    27357TRemove femur lesion/graft005023.7998$1,412.52$282.50
    27358TRemove femur lesion/fixation005023.7998$1,412.52$282.50
    27360TPartial removal, leg bone(s)005023.7998$1,412.52$282.50
    27365CExtensive leg surgery
    27370NInjection for knee x-ray
    27372TRemoval of foreign body002219.5582$1,160.78$354.45$232.16
    27380TRepair of kneecap tendon004920.2784$1,203.52$240.70
    27381TRepair/graft kneecap tendon004920.2784$1,203.52$240.70
    27385TRepair of thigh muscle004920.2784$1,203.52$240.70
    27386TRepair/graft of thigh muscle004920.2784$1,203.52$240.70
    27390TIncision of thigh tendon004920.2784$1,203.52$240.70
    27391TIncision of thigh tendons004920.2784$1,203.52$240.70
    27392TIncision of thigh tendons004920.2784$1,203.52$240.70
    27393TLengthening of thigh tendon005023.7998$1,412.52$282.50
    27394TLengthening of thigh tendons005023.7998$1,412.52$282.50
    27395TLengthening of thigh tendons005136.3617$2,158.07$431.61
    27396TTransplant of thigh tendon005023.7998$1,412.52$282.50
    27397TTransplants of thigh tendons005136.3617$2,158.07$431.61
    27400TRevise thigh muscles/tendons005136.3617$2,158.07$431.61
    27403TRepair of knee cartilage005023.7998$1,412.52$282.50
    27405TRepair of knee ligament005136.3617$2,158.07$431.61
    27407TRepair of knee ligament005136.3617$2,158.07$431.61
    Start Printed Page 42803
    27409TRepair of knee ligaments005136.3617$2,158.07$431.61
    27412TAutochondrocyte implant knee004243.7761$2,598.11$804.74$519.62
    27415TOsteochondral knee allograft004243.7761$2,598.11$804.74$519.62
    27418TRepair degenerated kneecap005136.3617$2,158.07$431.61
    27420TRevision of unstable kneecap005136.3617$2,158.07$431.61
    27422TRevision of unstable kneecap005136.3617$2,158.07$431.61
    27424TRevision/removal of kneecap005136.3617$2,158.07$431.61
    27425TLateral retinacular release005023.7998$1,412.52$282.50
    27427TReconstruction, knee005243.7388$2,595.90$519.18
    27428TReconstruction, knee005243.7388$2,595.90$519.18
    27429TReconstruction, knee005243.7388$2,595.90$519.18
    27430TRevision of thigh muscles005136.3617$2,158.07$431.61
    27435TIncision of knee joint005136.3617$2,158.07$431.61
    27437TRevise kneecap004731.4675$1,867.60$537.03$373.52
    27438TRevise kneecap with implant004842.9335$2,548.10$570.30$509.62
    27440TRevision of knee joint004731.4675$1,867.60$537.03$373.52
    27441TRevision of knee joint004731.4675$1,867.60$537.03$373.52
    27442TRevision of knee joint004731.4675$1,867.60$537.03$373.52
    27443TRevision of knee joint004731.4675$1,867.60$537.03$373.52
    27445CRevision of knee joint
    27446TRevision of knee joint0681136.5417$8,103.75$2,081.48$1,620.75
    27447CTotal knee arthroplasty
    27448CIncision of thigh
    27450CIncision of thigh
    27454CRealignment of thigh bone
    27455CRealignment of knee
    27457CRealignment of knee
    27465CShortening of thigh bone
    27466CLengthening of thigh bone
    27468CShorten/lengthen thighs
    27470CRepair of thigh
    27472CRepair/graft of thigh
    27475TSurgery to stop leg growth005023.7998$1,412.52$282.50
    27477CSurgery to stop leg growth
    27479CSurgery to stop leg growth
    27485CSurgery to stop leg growth
    27486CRevise/replace knee joint
    27487CRevise/replace knee joint
    27488CRemoval of knee prosthesis
    27495CReinforce thigh
    27496TDecompression of thigh/knee004920.2784$1,203.52$240.70
    27497TDecompression of thigh/knee004920.2784$1,203.52$240.70
    27498TDecompression of thigh/knee004920.2784$1,203.52$240.70
    27499TDecompression of thigh/knee004920.2784$1,203.52$240.70
    27500TTreatment of thigh fracture00431.7614$104.54$20.91
    27501TTreatment of thigh fracture00431.7614$104.54$20.91
    27502TTreatment of thigh fracture00431.7614$104.54$20.91
    27503TTreatment of thigh fracture00431.7614$104.54$20.91
    27506CTreatment of thigh fracture
    27507CTreatment of thigh fracture
    27508TTreatment of thigh fracture00431.7614$104.54$20.91
    27509TTreatment of thigh fracture004637.5315$2,227.49$535.76$445.50
    27510TTreatment of thigh fracture00431.7614$104.54$20.91
    27511CTreatment of thigh fracture
    27513CTreatment of thigh fracture
    27514CTreatment of thigh fracture
    27516TTreat thigh fx growth plate00431.7614$104.54$20.91
    27517TTreat thigh fx growth plate00431.7614$104.54$20.91
    27519CTreat thigh fx growth plate
    27520TTreat kneecap fracture00431.7614$104.54$20.91
    27524TTreat kneecap fracture004637.5315$2,227.49$535.76$445.50
    27530TTreat knee fracture00431.7614$104.54$20.91
    27532TTreat knee fracture00431.7614$104.54$20.91
    27535CTreat knee fracture
    27536CTreat knee fracture
    27538TTreat knee fracture(s)00431.7614$104.54$20.91
    Start Printed Page 42804
    27540CTreat knee fracture
    27550TTreat knee dislocation00431.7614$104.54$20.91
    27552TTreat knee dislocation004514.4289$856.36$268.47$171.27
    27556CTreat knee dislocation
    27557CTreat knee dislocation
    27558CTreat knee dislocation
    27560TTreat kneecap dislocation00431.7614$104.54$20.91
    27562TTreat kneecap dislocation004514.4289$856.36$268.47$171.27
    27566TTreat kneecap dislocation004637.5315$2,227.49$535.76$445.50
    27570TFixation of knee joint004514.4289$856.36$268.47$171.27
    27580CFusion of knee
    27590CAmputate leg at thigh
    27591CAmputate leg at thigh
    27592CAmputate leg at thigh
    27594TAmputation follow-up surgery004920.2784$1,203.52$240.70
    27596CAmputation follow-up surgery
    27598CAmputate lower leg at knee
    27599TLeg surgery procedure00431.7614$104.54$20.91
    27600TDecompression of lower leg004920.2784$1,203.52$240.70
    27601TDecompression of lower leg004920.2784$1,203.52$240.70
    27602TDecompression of lower leg004920.2784$1,203.52$240.70
    27603TDrain lower leg lesion000816.4242$974.78$194.96
    27604TDrain lower leg bursa004920.2784$1,203.52$240.70
    27605TIncision of achilles tendon005519.9783$1,185.71$355.34$237.14
    27606TIncision of achilles tendon004920.2784$1,203.52$240.70
    27607TTreat lower leg bone lesion004920.2784$1,203.52$240.70
    27610TExplore/treat ankle joint005023.7998$1,412.52$282.50
    27612TExploration of ankle joint005023.7998$1,412.52$282.50
    27613TBiopsy lower leg soft tissue00206.9118$410.22$106.93$82.04
    27614TBiopsy lower leg soft tissue002219.5582$1,160.78$354.45$232.16
    27615TRemove tumor, lower leg004637.5315$2,227.49$535.76$445.50
    27618TRemove lower leg lesion002114.9098$884.90$219.48$176.98
    27619TRemove lower leg lesion002219.5582$1,160.78$354.45$232.16
    27620TExplore/treat ankle joint005023.7998$1,412.52$282.50
    27625TRemove ankle joint lining005023.7998$1,412.52$282.50
    27626TRemove ankle joint lining005023.7998$1,412.52$282.50
    27630TRemoval of tendon lesion004920.2784$1,203.52$240.70
    27635TRemove lower leg bone lesion005023.7998$1,412.52$282.50
    27637TRemove/graft leg bone lesion005023.7998$1,412.52$282.50
    27638TRemove/graft leg bone lesion005023.7998$1,412.52$282.50
    27640TPartial removal of tibia005136.3617$2,158.07$431.61
    27641TPartial removal of fibula005023.7998$1,412.52$282.50
    27645CExtensive lower leg surgery
    27646CExtensive lower leg surgery
    27647TExtensive ankle/heel surgery005136.3617$2,158.07$431.61
    27648NInjection for ankle x-ray
    27650TRepair achilles tendon005136.3617$2,158.07$431.61
    27652TRepair/graft achilles tendon005136.3617$2,158.07$431.61
    27654TRepair of achilles tendon005136.3617$2,158.07$431.61
    27656TRepair leg fascia defect004920.2784$1,203.52$240.70
    27658TRepair of leg tendon, each004920.2784$1,203.52$240.70
    27659TRepair of leg tendon, each004920.2784$1,203.52$240.70
    27664TRepair of leg tendon, each004920.2784$1,203.52$240.70
    27665TRepair of leg tendon, each005023.7998$1,412.52$282.50
    27675TRepair lower leg tendons004920.2784$1,203.52$240.70
    27676TRepair lower leg tendons005023.7998$1,412.52$282.50
    27680TRelease of lower leg tendon005023.7998$1,412.52$282.50
    27681TRelease of lower leg tendons005023.7998$1,412.52$282.50
    27685TRevision of lower leg tendon005023.7998$1,412.52$282.50
    27686TRevise lower leg tendons005023.7998$1,412.52$282.50
    27687TRevision of calf tendon005023.7998$1,412.52$282.50
    27690TRevise lower leg tendon005136.3617$2,158.07$431.61
    27691TRevise lower leg tendon005136.3617$2,158.07$431.61
    27692TRevise additional leg tendon005136.3617$2,158.07$431.61
    27695TRepair of ankle ligament005023.7998$1,412.52$282.50
    27696TRepair of ankle ligaments005023.7998$1,412.52$282.50
    Start Printed Page 42805
    27698TRepair of ankle ligament005023.7998$1,412.52$282.50
    27700TRevision of ankle joint004731.4675$1,867.60$537.03$373.52
    27702CReconstruct ankle joint
    27703CReconstruction, ankle joint
    27704TRemoval of ankle implant004920.2784$1,203.52$240.70
    27705TIncision of tibia005136.3617$2,158.07$431.61
    27707TIncision of fibula004920.2784$1,203.52$240.70
    27709TIncision of tibia & fibula005023.7998$1,412.52$282.50
    27712CRealignment of lower leg
    27715CRevision of lower leg
    27720CRepair of tibia
    27722CRepair/graft of tibia
    27724CRepair/graft of tibia
    27725CRepair of lower leg
    27727CRepair of lower leg
    27730TRepair of tibia epiphysis005023.7998$1,412.52$282.50
    27732TRepair of fibula epiphysis005023.7998$1,412.52$282.50
    27734TRepair lower leg epiphyses005023.7998$1,412.52$282.50
    27740TRepair of leg epiphyses005023.7998$1,412.52$282.50
    27742TRepair of leg epiphyses005136.3617$2,158.07$431.61
    27745TReinforce tibia005136.3617$2,158.07$431.61
    27750TTreatment of tibia fracture00431.7614$104.54$20.91
    27752TTreatment of tibia fracture00431.7614$104.54$20.91
    27756TTreatment of tibia fracture004637.5315$2,227.49$535.76$445.50
    27758TTreatment of tibia fracture004637.5315$2,227.49$535.76$445.50
    27759TTreatment of tibia fracture004637.5315$2,227.49$535.76$445.50
    27760TTreatment of ankle fracture00431.7614$104.54$20.91
    27762TTreatment of ankle fracture00431.7614$104.54$20.91
    27766TTreatment of ankle fracture004637.5315$2,227.49$535.76$445.50
    27780TTreatment of fibula fracture00431.7614$104.54$20.91
    27781TTreatment of fibula fracture00431.7614$104.54$20.91
    27784TTreatment of fibula fracture004637.5315$2,227.49$535.76$445.50
    27786TTreatment of ankle fracture00431.7614$104.54$20.91
    27788TTreatment of ankle fracture00431.7614$104.54$20.91
    27792TTreatment of ankle fracture004637.5315$2,227.49$535.76$445.50
    27808TTreatment of ankle fracture00431.7614$104.54$20.91
    27810TTreatment of ankle fracture00431.7614$104.54$20.91
    27814TTreatment of ankle fracture004637.5315$2,227.49$535.76$445.50
    27816TTreatment of ankle fracture00431.7614$104.54$20.91
    27818TTreatment of ankle fracture00431.7614$104.54$20.91
    27822TTreatment of ankle fracture004637.5315$2,227.49$535.76$445.50
    27823TTreatment of ankle fracture004637.5315$2,227.49$535.76$445.50
    27824TTreat lower leg fracture00431.7614$104.54$20.91
    27825TTreat lower leg fracture00431.7614$104.54$20.91
    27826TTreat lower leg fracture004637.5315$2,227.49$535.76$445.50
    27827TTreat lower leg fracture004637.5315$2,227.49$535.76$445.50
    27828TTreat lower leg fracture004637.5315$2,227.49$535.76$445.50
    27829TTreat lower leg joint004637.5315$2,227.49$535.76$445.50
    27830TTreat lower leg dislocation00431.7614$104.54$20.91
    27831TTreat lower leg dislocation00431.7614$104.54$20.91
    27832TTreat lower leg dislocation004637.5315$2,227.49$535.76$445.50
    27840TTreat ankle dislocation00431.7614$104.54$20.91
    27842TTreat ankle dislocation004514.4289$856.36$268.47$171.27
    27846TTreat ankle dislocation004637.5315$2,227.49$535.76$445.50
    27848TTreat ankle dislocation004637.5315$2,227.49$535.76$445.50
    27860TFixation of ankle joint004514.4289$856.36$268.47$171.27
    27870TFusion of ankle joint005136.3617$2,158.07$431.61
    27871TFusion of tibiofibular joint005136.3617$2,158.07$431.61
    27880CAmputation of lower leg
    27881CAmputation of lower leg
    27882CAmputation of lower leg
    27884TAmputation follow-up surgery004920.2784$1,203.52$240.70
    27886CAmputation follow-up surgery
    27888CAmputation of foot at ankle
    27889TAmputation of foot at ankle005023.7998$1,412.52$282.50
    27892TDecompression of leg004920.2784$1,203.52$240.70
    Start Printed Page 42806
    27893TDecompression of leg004920.2784$1,203.52$240.70
    27894TDecompression of leg004920.2784$1,203.52$240.70
    27899TLeg/ankle surgery procedure00431.7614$104.54$20.91
    28001TDrainage of bursa of foot000711.3983$676.49$135.30
    28002TTreatment of foot infection004920.2784$1,203.52$240.70
    28003TTreatment of foot infection004920.2784$1,203.52$240.70
    28005TTreat foot bone lesion005519.9783$1,185.71$355.34$237.14
    28008TIncision of foot fascia005519.9783$1,185.71$355.34$237.14
    28010TIncision of toe tendon005519.9783$1,185.71$355.34$237.14
    28011TIncision of toe tendons005519.9783$1,185.71$355.34$237.14
    28020TExploration of foot joint005519.9783$1,185.71$355.34$237.14
    28022TExploration of foot joint005519.9783$1,185.71$355.34$237.14
    28024TExploration of toe joint005519.9783$1,185.71$355.34$237.14
    28030TRemoval of foot nerve022017.2800$1,025.57$205.11
    28035TDecompression of tibia nerve022017.2800$1,025.57$205.11
    28043TExcision of foot lesion002114.9098$884.90$219.48$176.98
    28045TExcision of foot lesion005519.9783$1,185.71$355.34$237.14
    28046TResection of tumor, foot005519.9783$1,185.71$355.34$237.14
    28050TBiopsy of foot joint lining005519.9783$1,185.71$355.34$237.14
    28052TBiopsy of foot joint lining005519.9783$1,185.71$355.34$237.14
    28054TBiopsy of toe joint lining005519.9783$1,185.71$355.34$237.14
    28060TPartial removal, foot fascia005519.9783$1,185.71$355.34$237.14
    28062TRemoval of foot fascia005519.9783$1,185.71$355.34$237.14
    28070TRemoval of foot joint lining005519.9783$1,185.71$355.34$237.14
    28072TRemoval of foot joint lining005519.9783$1,185.71$355.34$237.14
    28080TRemoval of foot lesion005519.9783$1,185.71$355.34$237.14
    28086TExcise foot tendon sheath005519.9783$1,185.71$355.34$237.14
    28088TExcise foot tendon sheath005519.9783$1,185.71$355.34$237.14
    28090TRemoval of foot lesion005519.9783$1,185.71$355.34$237.14
    28092TRemoval of toe lesions005519.9783$1,185.71$355.34$237.14
    28100TRemoval of ankle/heel lesion005519.9783$1,185.71$355.34$237.14
    28102TRemove/graft foot lesion005640.1132$2,380.72$476.14
    28103TRemove/graft foot lesion005640.1132$2,380.72$476.14
    28104TRemoval of foot lesion005519.9783$1,185.71$355.34$237.14
    28106TRemove/graft foot lesion005640.1132$2,380.72$476.14
    28107TRemove/graft foot lesion005640.1132$2,380.72$476.14
    28108TRemoval of toe lesions005519.9783$1,185.71$355.34$237.14
    28110TPart removal of metatarsal005519.9783$1,185.71$355.34$237.14
    28111TPart removal of metatarsal005519.9783$1,185.71$355.34$237.14
    28112TPart removal of metatarsal005519.9783$1,185.71$355.34$237.14
    28113TPart removal of metatarsal005519.9783$1,185.71$355.34$237.14
    28114TRemoval of metatarsal heads005519.9783$1,185.71$355.34$237.14
    28116TRevision of foot005519.9783$1,185.71$355.34$237.14
    28118TRemoval of heel bone005519.9783$1,185.71$355.34$237.14
    28119TRemoval of heel spur005519.9783$1,185.71$355.34$237.14
    28120TPart removal of ankle/heel005519.9783$1,185.71$355.34$237.14
    28122TPartial removal of foot bone005519.9783$1,185.71$355.34$237.14
    28124TPartial removal of toe005519.9783$1,185.71$355.34$237.14
    28126TPartial removal of toe005519.9783$1,185.71$355.34$237.14
    28130TRemoval of ankle bone005519.9783$1,185.71$355.34$237.14
    28140TRemoval of metatarsal005519.9783$1,185.71$355.34$237.14
    28150TRemoval of toe005519.9783$1,185.71$355.34$237.14
    28153TPartial removal of toe005519.9783$1,185.71$355.34$237.14
    28160TPartial removal of toe005519.9783$1,185.71$355.34$237.14
    28171TExtensive foot surgery005519.9783$1,185.71$355.34$237.14
    28173TExtensive foot surgery005519.9783$1,185.71$355.34$237.14
    28175TExtensive foot surgery005519.9783$1,185.71$355.34$237.14
    28190TRemoval of foot foreign body00194.0363$239.55$71.87$47.91
    28192TRemoval of foot foreign body002114.9098$884.90$219.48$176.98
    28193TRemoval of foot foreign body00206.9118$410.22$106.93$82.04
    28200TRepair of foot tendon005519.9783$1,185.71$355.34$237.14
    28202TRepair/graft of foot tendon005519.9783$1,185.71$355.34$237.14
    28208TRepair of foot tendon005519.9783$1,185.71$355.34$237.14
    28210TRepair/graft of foot tendon005640.1132$2,380.72$476.14
    28220TRelease of foot tendon005519.9783$1,185.71$355.34$237.14
    28222TRelease of foot tendons005519.9783$1,185.71$355.34$237.14
    Start Printed Page 42807
    28225TRelease of foot tendon005519.9783$1,185.71$355.34$237.14
    28226TRelease of foot tendons005519.9783$1,185.71$355.34$237.14
    28230TIncision of foot tendon(s)005519.9783$1,185.71$355.34$237.14
    28232TIncision of toe tendon005519.9783$1,185.71$355.34$237.14
    28234TIncision of foot tendon005519.9783$1,185.71$355.34$237.14
    28238TRevision of foot tendon005640.1132$2,380.72$476.14
    28240TRelease of big toe005519.9783$1,185.71$355.34$237.14
    28250TRevision of foot fascia005519.9783$1,185.71$355.34$237.14
    28260TRelease of midfoot joint005519.9783$1,185.71$355.34$237.14
    28261TRevision of foot tendon005519.9783$1,185.71$355.34$237.14
    28262TRevision of foot and ankle005519.9783$1,185.71$355.34$237.14
    28264TRelease of midfoot joint005640.1132$2,380.72$476.14
    28270TRelease of foot contracture005519.9783$1,185.71$355.34$237.14
    28272TRelease of toe joint, each005519.9783$1,185.71$355.34$237.14
    28280TFusion of toes005519.9783$1,185.71$355.34$237.14
    28285TRepair of hammertoe005519.9783$1,185.71$355.34$237.14
    28286TRepair of hammertoe005519.9783$1,185.71$355.34$237.14
    28288TPartial removal of foot bone005519.9783$1,185.71$355.34$237.14
    28289TRepair hallux rigidus005519.9783$1,185.71$355.34$237.14
    28290TCorrection of bunion005727.4246$1,627.65$475.91$325.53
    28292TCorrection of bunion005727.4246$1,627.65$475.91$325.53
    28293TCorrection of bunion005727.4246$1,627.65$475.91$325.53
    28294TCorrection of bunion005727.4246$1,627.65$475.91$325.53
    28296TCorrection of bunion005727.4246$1,627.65$475.91$325.53
    28297TCorrection of bunion005727.4246$1,627.65$475.91$325.53
    28298TCorrection of bunion005727.4246$1,627.65$475.91$325.53
    28299TCorrection of bunion005727.4246$1,627.65$475.91$325.53
    28300TIncision of heel bone005640.1132$2,380.72$476.14
    28302TIncision of ankle bone005519.9783$1,185.71$355.34$237.14
    28304TIncision of midfoot bones005640.1132$2,380.72$476.14
    28305TIncise/graft midfoot bones005640.1132$2,380.72$476.14
    28306TIncision of metatarsal005519.9783$1,185.71$355.34$237.14
    28307TIncision of metatarsal005519.9783$1,185.71$355.34$237.14
    28308TIncision of metatarsal005519.9783$1,185.71$355.34$237.14
    28309TIncision of metatarsals005640.1132$2,380.72$476.14
    28310TRevision of big toe005519.9783$1,185.71$355.34$237.14
    28312TRevision of toe005519.9783$1,185.71$355.34$237.14
    28313TRepair deformity of toe005519.9783$1,185.71$355.34$237.14
    28315TRemoval of sesamoid bone005519.9783$1,185.71$355.34$237.14
    28320TRepair of foot bones005640.1132$2,380.72$476.14
    28322TRepair of metatarsals005640.1132$2,380.72$476.14
    28340TResect enlarged toe tissue005519.9783$1,185.71$355.34$237.14
    28341TResect enlarged toe005519.9783$1,185.71$355.34$237.14
    28344TRepair extra toe(s)005519.9783$1,185.71$355.34$237.14
    28345TRepair webbed toe(s)005519.9783$1,185.71$355.34$237.14
    28360TReconstruct cleft foot005640.1132$2,380.72$476.14
    28400TTreatment of heel fracture00431.7614$104.54$20.91
    28405TTreatment of heel fracture00431.7614$104.54$20.91
    28406TTreatment of heel fracture004637.5315$2,227.49$535.76$445.50
    28415TTreat heel fracture004637.5315$2,227.49$535.76$445.50
    28420TTreat/graft heel fracture004637.5315$2,227.49$535.76$445.50
    28430TTreatment of ankle fracture00431.7614$104.54$20.91
    28435TTreatment of ankle fracture00431.7614$104.54$20.91
    28436TTreatment of ankle fracture004637.5315$2,227.49$535.76$445.50
    28445TTreat ankle fracture004637.5315$2,227.49$535.76$445.50
    28450TTreat midfoot fracture, each00431.7614$104.54$20.91
    28455TTreat midfoot fracture, each00431.7614$104.54$20.91
    28456TTreat midfoot fracture004637.5315$2,227.49$535.76$445.50
    28465TTreat midfoot fracture, each004637.5315$2,227.49$535.76$445.50
    28470TTreat metatarsal fracture00431.7614$104.54$20.91
    28475TTreat metatarsal fracture00431.7614$104.54$20.91
    28476TTreat metatarsal fracture004637.5315$2,227.49$535.76$445.50
    28485TTreat metatarsal fracture004637.5315$2,227.49$535.76$445.50
    28490TTreat big toe fracture00431.7614$104.54$20.91
    28495TTreat big toe fracture00431.7614$104.54$20.91
    28496TTreat big toe fracture004637.5315$2,227.49$535.76$445.50
    Start Printed Page 42808
    28505TTreat big toe fracture004637.5315$2,227.49$535.76$445.50
    28510TTreatment of toe fracture00431.7614$104.54$20.91
    28515TTreatment of toe fracture00431.7614$104.54$20.91
    28525TTreat toe fracture004637.5315$2,227.49$535.76$445.50
    28530TTreat sesamoid bone fracture00431.7614$104.54$20.91
    28531TTreat sesamoid bone fracture004637.5315$2,227.49$535.76$445.50
    28540TTreat foot dislocation00431.7614$104.54$20.91
    28545TTreat foot dislocation004514.4289$856.36$268.47$171.27
    28546TTreat foot dislocation004637.5315$2,227.49$535.76$445.50
    28555TRepair foot dislocation004637.5315$2,227.49$535.76$445.50
    28570TTreat foot dislocation00431.7614$104.54$20.91
    28575TTreat foot dislocation00431.7614$104.54$20.91
    28576TTreat foot dislocation004637.5315$2,227.49$535.76$445.50
    28585TRepair foot dislocation004637.5315$2,227.49$535.76$445.50
    28600TTreat foot dislocation00431.7614$104.54$20.91
    28605TTreat foot dislocation00431.7614$104.54$20.91
    28606TTreat foot dislocation004637.5315$2,227.49$535.76$445.50
    28615TRepair foot dislocation004637.5315$2,227.49$535.76$445.50
    28630TTreat toe dislocation00431.7614$104.54$20.91
    28635TTreat toe dislocation004514.4289$856.36$268.47$171.27
    28636TTreat toe dislocation004637.5315$2,227.49$535.76$445.50
    28645TRepair toe dislocation004637.5315$2,227.49$535.76$445.50
    28660TTreat toe dislocation00431.7614$104.54$20.91
    28665TTreat toe dislocation004514.4289$856.36$268.47$171.27
    28666TTreat toe dislocation004637.5315$2,227.49$535.76$445.50
    28675TRepair of toe dislocation004637.5315$2,227.49$535.76$445.50
    28705TFusion of foot bones005640.1132$2,380.72$476.14
    28715TFusion of foot bones005640.1132$2,380.72$476.14
    28725TFusion of foot bones005640.1132$2,380.72$476.14
    28730TFusion of foot bones005640.1132$2,380.72$476.14
    28735TFusion of foot bones005640.1132$2,380.72$476.14
    28737TRevision of foot bones005640.1132$2,380.72$476.14
    28740TFusion of foot bones005640.1132$2,380.72$476.14
    28750TFusion of big toe joint005640.1132$2,380.72$476.14
    28755TFusion of big toe joint005519.9783$1,185.71$355.34$237.14
    28760TFusion of big toe joint005640.1132$2,380.72$476.14
    28800CAmputation of midfoot
    28805CAmputation thru metatarsal
    28810TAmputation toe & metatarsal005519.9783$1,185.71$355.34$237.14
    28820TAmputation of toe005519.9783$1,185.71$355.34$237.14
    28825TPartial amputation of toe005519.9783$1,185.71$355.34$237.14
    28899TFoot/toes surgery procedure00431.7614$104.54$20.91
    29000SApplication of body cast00581.0884$64.60$12.92
    29010SApplication of body cast04262.1147$125.51$25.10
    29015SApplication of body cast04262.1147$125.51$25.10
    29020SApplication of body cast00581.0884$64.60$12.92
    29025SApplication of body cast00581.0884$64.60$12.92
    29035SApplication of body cast04262.1147$125.51$25.10
    29040SApplication of body cast00581.0884$64.60$12.92
    29044SApplication of body cast04262.1147$125.51$25.10
    29046SApplication of body cast04262.1147$125.51$25.10
    29049SApplication of figure eight00581.0884$64.60$12.92
    29055SApplication of shoulder cast04262.1147$125.51$25.10
    29058SApplication of shoulder cast00581.0884$64.60$12.92
    29065SApplication of long arm cast04262.1147$125.51$25.10
    29075SApplication of forearm cast04262.1147$125.51$25.10
    29085SApply hand/wrist cast00581.0884$64.60$12.92
    29086SApply finger cast00581.0884$64.60$12.92
    29105SApply long arm splint00581.0884$64.60$12.92
    29125SApply forearm splint00581.0884$64.60$12.92
    29126SApply forearm splint00581.0884$64.60$12.92
    29130SApplication of finger splint00581.0884$64.60$12.92
    29131SApplication of finger splint00581.0884$64.60$12.92
    29200SStrapping of chest00581.0884$64.60$12.92
    29220SStrapping of low back00581.0884$64.60$12.92
    29240SStrapping of shoulder00581.0884$64.60$12.92
    Start Printed Page 42809
    29260SStrapping of elbow or wrist00581.0884$64.60$12.92
    29280SStrapping of hand or finger00581.0884$64.60$12.92
    29305SApplication of hip cast04262.1147$125.51$25.10
    29325SApplication of hip casts04262.1147$125.51$25.10
    29345SApplication of long leg cast04262.1147$125.51$25.10
    29355SApplication of long leg cast04262.1147$125.51$25.10
    29358SApply long leg cast brace04262.1147$125.51$25.10
    29365SApplication of long leg cast04262.1147$125.51$25.10
    29405SApply short leg cast04262.1147$125.51$25.10
    29425SApply short leg cast04262.1147$125.51$25.10
    29435SApply short leg cast04262.1147$125.51$25.10
    29440SAddition of walker to cast00581.0884$64.60$12.92
    29445SApply rigid leg cast04262.1147$125.51$25.10
    29450SApplication of leg cast00581.0884$64.60$12.92
    29505SApplication, long leg splint00581.0884$64.60$12.92
    29515SApplication lower leg splint00581.0884$64.60$12.92
    29520SStrapping of hip00581.0884$64.60$12.92
    29530SStrapping of knee00581.0884$64.60$12.92
    29540SStrapping of ankle00581.0884$64.60$12.92
    29550SStrapping of toes00581.0884$64.60$12.92
    29580SApplication of paste boot00581.0884$64.60$12.92
    29590SApplication of foot splint00581.0884$64.60$12.92
    29700SRemoval/revision of cast00581.0884$64.60$12.92
    29705SRemoval/revision of cast00581.0884$64.60$12.92
    29710SRemoval/revision of cast04262.1147$125.51$25.10
    29715SRemoval/revision of cast00581.0884$64.60$12.92
    29720SRepair of body cast00581.0884$64.60$12.92
    29730SWindowing of cast00581.0884$64.60$12.92
    29740SWedging of cast00581.0884$64.60$12.92
    29750SWedging of clubfoot cast00581.0884$64.60$12.92
    29799SCasting/strapping procedure00581.0884$64.60$12.92
    29800TJaw arthroscopy/surgery004128.0044$1,662.06$332.41
    29804TJaw arthroscopy/surgery004128.0044$1,662.06$332.41
    29805TShoulder arthroscopy, dx004128.0044$1,662.06$332.41
    29806TShoulder arthroscopy/surgery004243.7761$2,598.11$804.74$519.62
    29807TShoulder arthroscopy/surgery004243.7761$2,598.11$804.74$519.62
    29819TShoulder arthroscopy/surgery004128.0044$1,662.06$332.41
    29820TShoulder arthroscopy/surgery004128.0044$1,662.06$332.41
    29821TShoulder arthroscopy/surgery004128.0044$1,662.06$332.41
    29822TShoulder arthroscopy/surgery004128.0044$1,662.06$332.41
    29823TShoulder arthroscopy/surgery004128.0044$1,662.06$332.41
    29824TShoulder arthroscopy/surgery004128.0044$1,662.06$332.41
    29825TShoulder arthroscopy/surgery004128.0044$1,662.06$332.41
    29826TShoulder arthroscopy/surgery004243.7761$2,598.11$804.74$519.62
    29827TArthroscop rotator cuff repr004243.7761$2,598.11$804.74$519.62
    29830TElbow arthroscopy004128.0044$1,662.06$332.41
    29834TElbow arthroscopy/surgery004128.0044$1,662.06$332.41
    29835TElbow arthroscopy/surgery004128.0044$1,662.06$332.41
    29836TElbow arthroscopy/surgery004128.0044$1,662.06$332.41
    29837TElbow arthroscopy/surgery004128.0044$1,662.06$332.41
    29838TElbow arthroscopy/surgery004128.0044$1,662.06$332.41
    29840TWrist arthroscopy004128.0044$1,662.06$332.41
    29843TWrist arthroscopy/surgery004128.0044$1,662.06$332.41
    29844TWrist arthroscopy/surgery004128.0044$1,662.06$332.41
    29845TWrist arthroscopy/surgery004128.0044$1,662.06$332.41
    29846TWrist arthroscopy/surgery004128.0044$1,662.06$332.41
    29847TWrist arthroscopy/surgery004128.0044$1,662.06$332.41
    29848TWrist endoscopy/surgery004128.0044$1,662.06$332.41
    29850TKnee arthroscopy/surgery004128.0044$1,662.06$332.41
    29851TKnee arthroscopy/surgery004243.7761$2,598.11$804.74$519.62
    29855TTibial arthroscopy/surgery004243.7761$2,598.11$804.74$519.62
    29856TTibial arthroscopy/surgery004128.0044$1,662.06$332.41
    29860THip arthroscopy, dx004128.0044$1,662.06$332.41
    29861THip arthroscopy/surgery004128.0044$1,662.06$332.41
    29862THip arthroscopy/surgery004243.7761$2,598.11$804.74$519.62
    29863THip arthroscopy/surgery004243.7761$2,598.11$804.74$519.62
    Start Printed Page 42810
    29866TAutgrft implnt, knee w/scope004243.7761$2,598.11$804.74$519.62
    29867TAllgrft implnt, knee w/scope004243.7761$2,598.11$804.74$519.62
    29868TMeniscal trnspl, knee w/scpe004243.7761$2,598.11$804.74$519.62
    29870TKnee arthroscopy, dx004128.0044$1,662.06$332.41
    29871TKnee arthroscopy/drainage004128.0044$1,662.06$332.41
    29873TKnee arthroscopy/surgery004128.0044$1,662.06$332.41
    29874TKnee arthroscopy/surgery004128.0044$1,662.06$332.41
    29875TKnee arthroscopy/surgery004128.0044$1,662.06$332.41
    29876TKnee arthroscopy/surgery004128.0044$1,662.06$332.41
    29877TKnee arthroscopy/surgery004128.0044$1,662.06$332.41
    29879TKnee arthroscopy/surgery004128.0044$1,662.06$332.41
    29880TKnee arthroscopy/surgery004128.0044$1,662.06$332.41
    29881TKnee arthroscopy/surgery004128.0044$1,662.06$332.41
    29882TKnee arthroscopy/surgery004128.0044$1,662.06$332.41
    29883TKnee arthroscopy/surgery004128.0044$1,662.06$332.41
    29884TKnee arthroscopy/surgery004128.0044$1,662.06$332.41
    29885TKnee arthroscopy/surgery004243.7761$2,598.11$804.74$519.62
    29886TKnee arthroscopy/surgery004128.0044$1,662.06$332.41
    29887TKnee arthroscopy/surgery004128.0044$1,662.06$332.41
    29888TKnee arthroscopy/surgery004243.7761$2,598.11$804.74$519.62
    29889TKnee arthroscopy/surgery004243.7761$2,598.11$804.74$519.62
    29891TAnkle arthroscopy/surgery004128.0044$1,662.06$332.41
    29892TAnkle arthroscopy/surgery004128.0044$1,662.06$332.41
    29893TScope, plantar fasciotomy005519.9783$1,185.71$355.34$237.14
    29894TAnkle arthroscopy/surgery004128.0044$1,662.06$332.41
    29895TAnkle arthroscopy/surgery004128.0044$1,662.06$332.41
    29897TAnkle arthroscopy/surgery004128.0044$1,662.06$332.41
    29898TAnkle arthroscopy/surgery004128.0044$1,662.06$332.41
    29899TAnkle arthroscopy/surgery004243.7761$2,598.11$804.74$519.62
    29900TMcp joint arthroscopy, dx005315.6085$926.36$253.49$185.27
    29901TMcp joint arthroscopy, surg005315.6085$926.36$253.49$185.27
    29902TMcp joint arthroscopy, surg005315.6085$926.36$253.49$185.27
    29999TArthroscopy of joint004128.0044$1,662.06$332.41
    30000TDrainage of nose lesion02512.0010$118.76$23.75
    30020TDrainage of nose lesion02512.0010$118.76$23.75
    30100TIntranasal biopsy02527.8317$464.81$113.41$92.96
    30110TRemoval of nose polyp(s)025316.0627$953.32$282.29$190.66
    30115TRemoval of nose polyp(s)025316.0627$953.32$282.29$190.66
    30117TRemoval of intranasal lesion025316.0627$953.32$282.29$190.66
    30118TRemoval of intranasal lesion025423.2980$1,382.74$321.35$276.55
    30120TRevision of nose025316.0627$953.32$282.29$190.66
    30124TRemoval of nose lesion02527.8317$464.81$113.41$92.96
    30125TRemoval of nose lesion025637.1513$2,204.93$440.99
    30130TRemoval of turbinate bones025316.0627$953.32$282.29$190.66
    30140TRemoval of turbinate bones025423.2980$1,382.74$321.35$276.55
    30150TPartial removal of nose025637.1513$2,204.93$440.99
    30160TRemoval of nose025637.1513$2,204.93$440.99
    30200TInjection treatment of nose02527.8317$464.81$113.41$92.96
    30210TNasal sinus therapy02527.8317$464.81$113.41$92.96
    30220TInsert nasal septal button02527.8317$464.81$113.41$92.96
    30300XRemove nasal foreign body03400.6355$37.72$7.54
    30310TRemove nasal foreign body025316.0627$953.32$282.29$190.66
    30320TRemove nasal foreign body025316.0627$953.32$282.29$190.66
    30400TReconstruction of nose025637.1513$2,204.93$440.99
    30410TReconstruction of nose025637.1513$2,204.93$440.99
    30420TReconstruction of nose025637.1513$2,204.93$440.99
    30430TRevision of nose025423.2980$1,382.74$321.35$276.55
    30435TRevision of nose025637.1513$2,204.93$440.99
    30450TRevision of nose025637.1513$2,204.93$440.99
    30460TRevision of nose025637.1513$2,204.93$440.99
    30462TRevision of nose025637.1513$2,204.93$440.99
    30465TRepair nasal stenosis025637.1513$2,204.93$440.99
    30520TRepair of nasal septum025423.2980$1,382.74$321.35$276.55
    30540TRepair nasal defect025637.1513$2,204.93$440.99
    30545TRepair nasal defect025637.1513$2,204.93$440.99
    30560TRelease of nasal adhesions02512.0010$118.76$23.75
    Start Printed Page 42811
    30580TRepair upper jaw fistula025637.1513$2,204.93$440.99
    30600TRepair mouth/nose fistula025637.1513$2,204.93$440.99
    30620TIntranasal reconstruction025637.1513$2,204.93$440.99
    30630TRepair nasal septum defect025423.2980$1,382.74$321.35$276.55
    30801TCauterization, inner nose02527.8317$464.81$113.41$92.96
    30802TCauterization, inner nose02527.8317$464.81$113.41$92.96
    30901TControl of nosebleed02501.2838$76.19$26.67$15.24
    30903TControl of nosebleed02501.2838$76.19$26.67$15.24
    30905TControl of nosebleed02501.2838$76.19$26.67$15.24
    30906TRepeat control of nosebleed02501.2838$76.19$26.67$15.24
    30915TLigation, nasal sinus artery009128.8685$1,713.35$348.23$342.67
    30920TLigation, upper jaw artery009226.3621$1,564.59$505.37$312.92
    30930TTherapy, fracture of nose025316.0627$953.32$282.29$190.66
    30999TNasal surgery procedure02512.0010$118.76$23.75
    31000TIrrigation, maxillary sinus02512.0010$118.76$23.75
    31002TIrrigation, sphenoid sinus02527.8317$464.81$113.41$92.96
    31020TExploration, maxillary sinus025423.2980$1,382.74$321.35$276.55
    31030TExploration, maxillary sinus025637.1513$2,204.93$440.99
    31032TExplore sinus, remove polyps025637.1513$2,204.93$440.99
    31040TExploration behind upper jaw025423.2980$1,382.74$321.35$276.55
    31050TExploration, sphenoid sinus025637.1513$2,204.93$440.99
    31051TSphenoid sinus surgery025637.1513$2,204.93$440.99
    31070TExploration of frontal sinus025423.2980$1,382.74$321.35$276.55
    31075TExploration of frontal sinus025637.1513$2,204.93$440.99
    31080TRemoval of frontal sinus025637.1513$2,204.93$440.99
    31081TRemoval of frontal sinus025637.1513$2,204.93$440.99
    31084TRemoval of frontal sinus025637.1513$2,204.93$440.99
    31085TRemoval of frontal sinus025637.1513$2,204.93$440.99
    31086TRemoval of frontal sinus025637.1513$2,204.93$440.99
    31087TRemoval of frontal sinus025637.1513$2,204.93$440.99
    31090TExploration of sinuses025637.1513$2,204.93$440.99
    31200TRemoval of ethmoid sinus025637.1513$2,204.93$440.99
    31201TRemoval of ethmoid sinus025637.1513$2,204.93$440.99
    31205TRemoval of ethmoid sinus025637.1513$2,204.93$440.99
    31225CRemoval of upper jaw
    31230CRemoval of upper jaw
    31231TNasal endoscopy, dx00721.4296$84.85$21.27$16.97
    31233TNasal/sinus endoscopy, dx00721.4296$84.85$21.27$16.97
    31235TNasal/sinus endoscopy, dx007415.7042$932.04$295.70$186.41
    31237TNasal/sinus endoscopy, surg007521.2460$1,260.95$445.92$252.19
    31238TNasal/sinus endoscopy, surg007415.7042$932.04$295.70$186.41
    31239TNasal/sinus endoscopy, surg007521.2460$1,260.95$445.92$252.19
    31240TNasal/sinus endoscopy, surg007415.7042$932.04$295.70$186.41
    31254TRevision of ethmoid sinus007521.2460$1,260.95$445.92$252.19
    31255TRemoval of ethmoid sinus007521.2460$1,260.95$445.92$252.19
    31256TExploration maxillary sinus007521.2460$1,260.95$445.92$252.19
    31267TEndoscopy, maxillary sinus007521.2460$1,260.95$445.92$252.19
    31276TSinus endoscopy, surgical007521.2460$1,260.95$445.92$252.19
    31287TNasal/sinus endoscopy, surg007521.2460$1,260.95$445.92$252.19
    31288TNasal/sinus endoscopy, surg007521.2460$1,260.95$445.92$252.19
    31290CNasal/sinus endoscopy, surg
    31291CNasal/sinus endoscopy, surg
    31292TNasal/sinus endoscopy, surg007521.2460$1,260.95$445.92$252.19
    31293TNasal/sinus endoscopy, surg007521.2460$1,260.95$445.92$252.19
    31294TNasal/sinus endoscopy, surg007521.2460$1,260.95$445.92$252.19
    31299TSinus surgery procedure02512.0010$118.76$23.75
    31300TRemoval of larynx lesion025423.2980$1,382.74$321.35$276.55
    31320TDiagnostic incision, larynx025637.1513$2,204.93$440.99
    31360CRemoval of larynx
    31365CRemoval of larynx
    31367CPartial removal of larynx
    31368CPartial removal of larynx
    31370CPartial removal of larynx
    31375CPartial removal of larynx
    31380CPartial removal of larynx
    31382CPartial removal of larynx
    Start Printed Page 42812
    31390CRemoval of larynx & pharynx
    31395CReconstruct larynx & pharynx
    31400TRevision of larynx025637.1513$2,204.93$440.99
    31420TRemoval of epiglottis025637.1513$2,204.93$440.99
    31500SInsert emergency airway00942.5248$149.85$47.41$29.97
    31502TChange of windpipe airway01212.2663$134.50$43.80$26.90
    31505TDiagnostic laryngoscopy00710.7879$46.76$11.31$9.35
    31510TLaryngoscopy with biopsy007415.7042$932.04$295.70$186.41
    31511TRemove foreign body, larynx00721.4296$84.85$21.27$16.97
    31512TRemoval of larynx lesion007415.7042$932.04$295.70$186.41
    31513TInjection into vocal cord00721.4296$84.85$21.27$16.97
    31515TLaryngoscopy for aspiration007415.7042$932.04$295.70$186.41
    31520TDiagnostic laryngoscopy00721.4296$84.85$21.27$16.97
    31525TDiagnostic laryngoscopy007415.7042$932.04$295.70$186.41
    31526TDiagnostic laryngoscopy007521.2460$1,260.95$445.92$252.19
    31527TLaryngoscopy for treatment007521.2460$1,260.95$445.92$252.19
    31528TLaryngoscopy and dilation007415.7042$932.04$295.70$186.41
    31529TLaryngoscopy and dilation007415.7042$932.04$295.70$186.41
    31530TOperative laryngoscopy007521.2460$1,260.95$445.92$252.19
    31531TOperative laryngoscopy007521.2460$1,260.95$445.92$252.19
    31535TOperative laryngoscopy007521.2460$1,260.95$445.92$252.19
    31536TOperative laryngoscopy007521.2460$1,260.95$445.92$252.19
    31540TOperative laryngoscopy007521.2460$1,260.95$445.92$252.19
    31541TOperative laryngoscopy007521.2460$1,260.95$445.92$252.19
    31545TRemove vc lesion w/scope007521.2460$1,260.95$445.92$252.19
    31546TRemove vc lesion scope/graft007521.2460$1,260.95$445.92$252.19
    31560TOperative laryngoscopy007521.2460$1,260.95$445.92$252.19
    31561TOperative laryngoscopy007521.2460$1,260.95$445.92$252.19
    31570TLaryngoscopy with injection007415.7042$932.04$295.70$186.41
    31571TLaryngoscopy with injection007521.2460$1,260.95$445.92$252.19
    31575TDiagnostic laryngoscopy00721.4296$84.85$21.27$16.97
    31576TLaryngoscopy with biopsy007521.2460$1,260.95$445.92$252.19
    31577TRemove foreign body, larynx00734.1420$245.83$73.38$49.17
    31578TRemoval of larynx lesion007521.2460$1,260.95$445.92$252.19
    31579TDiagnostic laryngoscopy00734.1420$245.83$73.38$49.17
    31580TRevision of larynx025637.1513$2,204.93$440.99
    31582TRevision of larynx025637.1513$2,204.93$440.99
    31584CTreat larynx fracture
    31585TTreat larynx fracture025316.0627$953.32$282.29$190.66
    31586TTreat larynx fracture025637.1513$2,204.93$440.99
    31587CRevision of larynx
    31588TRevision of larynx025637.1513$2,204.93$440.99
    31590TReinnervate larynx025637.1513$2,204.93$440.99
    31595TLarynx nerve surgery025637.1513$2,204.93$440.99
    31599TLarynx surgery procedure02512.0010$118.76$23.75
    31600TIncision of windpipe025423.2980$1,382.74$321.35$276.55
    31601TIncision of windpipe025423.2980$1,382.74$321.35$276.55
    31603TIncision of windpipe02527.8317$464.81$113.41$92.96
    31605TIncision of windpipe02527.8317$464.81$113.41$92.96
    31610TIncision of windpipe025423.2980$1,382.74$321.35$276.55
    31611TSurgery/speech prosthesis025423.2980$1,382.74$321.35$276.55
    31612TPuncture/clear windpipe025423.2980$1,382.74$321.35$276.55
    31613TRepair windpipe opening025423.2980$1,382.74$321.35$276.55
    31614TRepair windpipe opening025637.1513$2,204.93$440.99
    31615TVisualization of windpipe00769.4163$558.86$189.82$111.77
    31620SEndobronchial us add-on067025.2980$1,501.44$470.38$300.29
    31622TDx bronchoscope/wash00769.4163$558.86$189.82$111.77
    31623TDx bronchoscope/brush00769.4163$558.86$189.82$111.77
    31624TDx bronchoscope/lavage00769.4163$558.86$189.82$111.77
    31625TBronchoscopy w/biopsy(s)00769.4163$558.86$189.82$111.77
    31628TBronchoscopy/lung bx, each00769.4163$558.86$189.82$111.77
    31629TBronchoscopy/needle bx, each00769.4163$558.86$189.82$111.77
    31630TBronchoscopy dilate/fx repr041521.9955$1,305.43$459.92$261.09
    31631TBronchoscopy, dilate w/stent041521.9955$1,305.43$459.92$261.09
    31632TBronchoscopy/lung bx, add'l00769.4163$558.86$189.82$111.77
    31633TBronchoscopy/needle bx add'l00769.4163$558.86$189.82$111.77
    Start Printed Page 42813
    31635TBronchoscopy w/fb removal00769.4163$558.86$189.82$111.77
    31636TBronchoscopy, bronch stents041521.9955$1,305.43$459.92$261.09
    31637TBronchoscopy, stent add-on00769.4163$558.86$189.82$111.77
    31638TBronchoscopy, revise stent041521.9955$1,305.43$459.92$261.09
    31640TBronchoscopy w/tumor excise041521.9955$1,305.43$459.92$261.09
    31641TBronchoscopy, treat blockage041521.9955$1,305.43$459.92$261.09
    31643TDiag bronchoscope/catheter00769.4163$558.86$189.82$111.77
    31645TBronchoscopy, clear airways00769.4163$558.86$189.82$111.77
    31646TBronchoscopy, reclear airway00769.4163$558.86$189.82$111.77
    31656TBronchoscopy, inj for x-ray00769.4163$558.86$189.82$111.77
    31700TInsertion of airway catheter00721.4296$84.85$21.27$16.97
    31708NInstill airway contrast dye
    31710NInsertion of airway catheter
    31715NInjection for bronchus x-ray
    31717TBronchial brush biopsy00734.1420$245.83$73.38$49.17
    31720TClearance of airways00710.7879$46.76$11.31$9.35
    31725CClearance of airways
    31730TIntro, windpipe wire/tube00734.1420$245.83$73.38$49.17
    31750TRepair of windpipe025637.1513$2,204.93$440.99
    31755TRepair of windpipe025637.1513$2,204.93$440.99
    31760CRepair of windpipe
    31766CReconstruction of windpipe
    31770CRepair/graft of bronchus
    31775CReconstruct bronchus
    31780CReconstruct windpipe
    31781CReconstruct windpipe
    31785TRemove windpipe lesion025423.2980$1,382.74$321.35$276.55
    31786CRemove windpipe lesion
    31800CRepair of windpipe injury
    31805CRepair of windpipe injury
    31820TClosure of windpipe lesion025316.0627$953.32$282.29$190.66
    31825TRepair of windpipe defect025423.2980$1,382.74$321.35$276.55
    31830TRevise windpipe scar025423.2980$1,382.74$321.35$276.55
    31899TAirways surgical procedure00769.4163$558.86$189.82$111.77
    32000TDrainage of chest00703.1956$189.66$37.93
    32002TTreatment of collapsed lung00703.1956$189.66$37.93
    32005TTreat lung lining chemically00703.1956$189.66$37.93
    32019TInsert pleural catheter00703.1956$189.66$37.93
    32020TInsertion of chest tube00703.1956$189.66$37.93
    32035CExploration of chest
    32036CExploration of chest
    32095CBiopsy through chest wall
    32100CExploration/biopsy of chest
    32110CExplore/repair chest
    32120CRe-exploration of chest
    32124CExplore chest free adhesions
    32140CRemoval of lung lesion(s)
    32141CRemove/treat lung lesions
    32150CRemoval of lung lesion(s)
    32151CRemove lung foreign body
    32160COpen chest heart massage
    32200CDrain, open, lung lesion
    32201TDrain, percut, lung lesion00703.1956$189.66$37.93
    32215CTreat chest lining
    32220CRelease of lung
    32225CPartial release of lung
    32310CRemoval of chest lining
    32320CFree/remove chest lining
    32400TNeedle biopsy chest lining06855.9902$355.52$115.47$71.10
    32402COpen biopsy chest lining
    32405TBiopsy, lung or mediastinum06855.9902$355.52$115.47$71.10
    32420TPuncture/clear lung00703.1956$189.66$37.93
    32440CRemoval of lung
    32442CSleeve pneumonectomy
    32445CRemoval of lung
    32480CPartial removal of lung
    Start Printed Page 42814
    32482CBilobectomy
    32484CSegmentectomy
    32486CSleeve lobectomy
    32488CCompletion pneumonectomy
    32491CLung volume reduction
    32500CPartial removal of lung
    32501CRepair bronchus add-on
    32520CRemove lung & revise chest
    32522CRemove lung & revise chest
    32525CRemove lung & revise chest
    32540CRemoval of lung lesion
    32601TThoracoscopy, diagnostic006930.5386$1,812.47$591.64$362.49
    32602TThoracoscopy, diagnostic006930.5386$1,812.47$591.64$362.49
    32603TThoracoscopy, diagnostic006930.5386$1,812.47$591.64$362.49
    32604TThoracoscopy, diagnostic006930.5386$1,812.47$591.64$362.49
    32605TThoracoscopy, diagnostic006930.5386$1,812.47$591.64$362.49
    32606TThoracoscopy, diagnostic006930.5386$1,812.47$591.64$362.49
    32650CThoracoscopy, surgical
    32651CThoracoscopy, surgical
    32652CThoracoscopy, surgical
    32653CThoracoscopy, surgical
    32654CThoracoscopy, surgical
    32655CThoracoscopy, surgical
    32656CThoracoscopy, surgical
    32657CThoracoscopy, surgical
    32658CThoracoscopy, surgical
    32659CThoracoscopy, surgical
    32660CThoracoscopy, surgical
    32661CThoracoscopy, surgical
    32662CThoracoscopy, surgical
    32663CThoracoscopy, surgical
    32664CThoracoscopy, surgical
    32665CThoracoscopy, surgical
    32800CRepair lung hernia
    32810CClose chest after drainage
    32815CClose bronchial fistula
    32820CReconstruct injured chest
    32850CDonor pneumonectomy
    32851CLung transplant, single
    32852CLung transplant with bypass
    32853CLung transplant, double
    32854CLung transplant with bypass
    32855CPrepare donor lung, single
    32856CPrepare donor lung, double
    32900CRemoval of rib(s)
    32905CRevise & repair chest wall
    32906CRevise & repair chest wall
    32940CRevision of lung
    32960TTherapeutic pneumothorax00703.1956$189.66$37.93
    32997CTotal lung lavage
    32999TChest surgery procedure00703.1956$189.66$37.93
    33010TDrainage of heart sac00703.1956$189.66$37.93
    33011TRepeat drainage of heart sac00703.1956$189.66$37.93
    33015CIncision of heart sac
    33020CIncision of heart sac
    33025CIncision of heart sac
    33030CPartial removal of heart sac
    33031CPartial removal of heart sac
    33050CRemoval of heart sac lesion
    33120CRemoval of heart lesion
    33130CRemoval of heart lesion
    33140CHeart revascularize (tmr)
    33141CHeart tmr w/other procedure
    33200CInsertion of heart pacemaker
    33201CInsertion of heart pacemaker
    33206TInsertion of heart pacemaker0089105.1359$6,239.82$1,681.06$1,247.96
    Start Printed Page 42815
    33207TInsertion of heart pacemaker0089105.1359$6,239.82$1,681.06$1,247.96
    33208TInsertion of heart pacemaker0655133.1709$7,903.69$1,580.74
    33210TInsertion of heart electrode010645.2791$2,687.31$537.46
    33211TInsertion of heart electrode010645.2791$2,687.31$537.46
    33212TInsertion of pulse generator009088.7536$5,267.53$1,612.80$1,053.51
    33213TInsertion of pulse generator0654100.4722$5,963.03$1,192.61
    33214TUpgrade of pacemaker system0655133.1709$7,903.69$1,580.74
    33215TReposition pacing-defib lead010522.2671$1,321.55$370.40$264.31
    33216TRevise eltrd pacing-defib010645.2791$2,687.31$537.46
    33217TInsert lead pace-defib, dual010645.2791$2,687.31$537.46
    33218TRepair lead pace-defib, one010645.2791$2,687.31$537.46
    33220TRepair lead pace-defib, dual010645.2791$2,687.31$537.46
    33222TRevise pocket, pacemaker002718.3348$1,088.17$329.72$217.63
    33223TRevise pocket, pacing-defib002718.3348$1,088.17$329.72$217.63
    33224TInsert pacing lead & connect0418108.8092$6,457.83$1,291.57
    33225TL ventric pacing lead add-on0418108.8092$6,457.83$1,291.57
    33226TReposition l ventric lead010522.2671$1,321.55$370.40$264.31
    33233TRemoval of pacemaker system010522.2671$1,321.55$370.40$264.31
    33234TRemoval of pacemaker system010522.2671$1,321.55$370.40$264.31
    33235TRemoval pacemaker electrode010522.2671$1,321.55$370.40$264.31
    33236CRemove electrode/thoracotomy
    33237CRemove electrode/thoracotomy
    33238CRemove electrode/thoracotomy
    33240BInsert pulse generator
    33241TRemove pulse generator010522.2671$1,321.55$370.40$264.31
    33243CRemove eltrd/thoracotomy
    33244TRemove eltrd, transven010522.2671$1,321.55$370.40$264.31
    33245CInsert epic eltrd pace-defib
    33246CInsert epic eltrd/generator
    33249BEltrd/insert pace-defib
    33250CAblate heart dysrhythm focus
    33251CAblate heart dysrhythm focus
    33253CReconstruct atria
    33261CAblate heart dysrhythm focus
    33282SImplant pat-active ht record068062.6232$3,716.69$743.34
    33284TRemove pat-active ht record010910.9933$652.45$131.49$130.49
    33300CRepair of heart wound
    33305CRepair of heart wound
    33310CExploratory heart surgery
    33315CExploratory heart surgery
    33320CRepair major blood vessel(s)
    33321CRepair major vessel
    33322CRepair major blood vessel(s)
    33330CInsert major vessel graft
    33332CInsert major vessel graft
    33335CInsert major vessel graft
    33400CRepair of aortic valve
    33401CValvuloplasty, open
    33403CValvuloplasty, w/cp bypass
    33404CPrepare heart-aorta conduit
    33405CReplacement of aortic valve
    33406CReplacement of aortic valve
    33410CReplacement of aortic valve
    33411CReplacement of aortic valve
    33412CReplacement of aortic valve
    33413CReplacement of aortic valve
    33414CRepair of aortic valve
    33415CRevision, subvalvular tissue
    33416CRevise ventricle muscle
    33417CRepair of aortic valve
    33420CRevision of mitral valve
    33422CRevision of mitral valve
    33425CRepair of mitral valve
    33426CRepair of mitral valve
    33427CRepair of mitral valve
    33430CReplacement of mitral valve
    Start Printed Page 42816
    33460CRevision of tricuspid valve
    33463CValvuloplasty, tricuspid
    33464CValvuloplasty, tricuspid
    33465CReplace tricuspid valve
    33468CRevision of tricuspid valve
    33470CRevision of pulmonary valve
    33471CValvotomy, pulmonary valve
    33472CRevision of pulmonary valve
    33474CRevision of pulmonary valve
    33475CReplacement, pulmonary valve
    33476CRevision of heart chamber
    33478CRevision of heart chamber
    33496CRepair, prosth valve clot
    33500CRepair heart vessel fistula
    33501CRepair heart vessel fistula
    33502CCoronary artery correction
    33503CCoronary artery graft
    33504CCoronary artery graft
    33505CRepair artery w/tunnel
    33506CRepair artery, translocation
    33508NEndoscopic vein harvest
    33510CCABG, vein, single
    33511CCABG, vein, two
    33512CCABG, vein, three
    33513CCABG, vein, four
    33514CCABG, vein, five
    33516CCabg, vein, six or more
    33517CCABG, artery-vein, single
    33518CCABG, artery-vein, two
    33519CCABG, artery-vein, three
    33521CCABG, artery-vein, four
    33522CCABG, artery-vein, five
    33523CCabg, art-vein, six or more
    33530CCoronary artery, bypass/reop
    33533CCABG, arterial, single
    33534CCABG, arterial, two
    33535CCABG, arterial, three
    33536CCabg, arterial, four or more
    33542CRemoval of heart lesion
    33545CRepair of heart damage
    33572COpen coronary endarterectomy
    33600CClosure of valve
    33602CClosure of valve
    33606CAnastomosis/artery-aorta
    33608CRepair anomaly w/conduit
    33610CRepair by enlargement
    33611CRepair double ventricle
    33612CRepair double ventricle
    33615CRepair, modified fontan
    33617CRepair single ventricle
    33619CRepair single ventricle
    33641CRepair heart septum defect
    33645CRevision of heart veins
    33647CRepair heart septum defects
    33660CRepair of heart defects
    33665CRepair of heart defects
    33670CRepair of heart chambers
    33681CRepair heart septum defect
    33684CRepair heart septum defect
    33688CRepair heart septum defect
    33690CReinforce pulmonary artery
    33692CRepair of heart defects
    33694CRepair of heart defects
    33697CRepair of heart defects
    33702CRepair of heart defects
    33710CRepair of heart defects
    Start Printed Page 42817
    33720CRepair of heart defect
    33722CRepair of heart defect
    33730CRepair heart-vein defect(s)
    33732CRepair heart-vein defect
    33735CRevision of heart chamber
    33736CRevision of heart chamber
    33737CRevision of heart chamber
    33750CMajor vessel shunt
    33755CMajor vessel shunt
    33762CMajor vessel shunt
    33764CMajor vessel shunt & graft
    33766CMajor vessel shunt
    33767CMajor vessel shunt
    33770CRepair great vessels defect
    33771CRepair great vessels defect
    33774CRepair great vessels defect
    33775CRepair great vessels defect
    33776CRepair great vessels defect
    33777CRepair great vessels defect
    33778CRepair great vessels defect
    33779CRepair great vessels defect
    33780CRepair great vessels defect
    33781CRepair great vessels defect
    33786CRepair arterial trunk
    33788CRevision of pulmonary artery
    33800CAortic suspension
    33802CRepair vessel defect
    33803CRepair vessel defect
    33813CRepair septal defect
    33814CRepair septal defect
    33820CRevise major vessel
    33822CRevise major vessel
    33824CRevise major vessel
    33840CRemove aorta constriction
    33845CRemove aorta constriction
    33851CRemove aorta constriction
    33852CRepair septal defect
    33853CRepair septal defect
    33860CAscending aortic graft
    33861CAscending aortic graft
    33863CAscending aortic graft
    33870CTransverse aortic arch graft
    33875CThoracic aortic graft
    33877CThoracoabdominal graft
    33910CRemove lung artery emboli
    33915CRemove lung artery emboli
    33916CSurgery of great vessel
    33917CRepair pulmonary artery
    33918CRepair pulmonary atresia
    33919CRepair pulmonary atresia
    33920CRepair pulmonary atresia
    33922CTransect pulmonary artery
    33924CRemove pulmonary shunt
    33930CRemoval of donor heart/lung
    33933CPrepare donor heart/lung
    33935CTransplantation, heart/lung
    33940CRemoval of donor heart
    33944CPrepare donor heart
    33945CTransplantation of heart
    33960CExternal circulation assist
    33961CExternal circulation assist
    33967CInsert ia percut device
    33968CRemove aortic assist device
    33970CAortic circulation assist
    33971CAortic circulation assist
    33973CInsert balloon device
    Start Printed Page 42818
    33974CRemove intra-aortic balloon
    33975CImplant ventricular device
    33976CImplant ventricular device
    33977CRemove ventricular device
    33978CRemove ventricular device
    33979CInsert intracorporeal device
    33980CRemove intracorporeal device
    33999TCardiac surgery procedure00703.1956$189.66$37.93
    34001CRemoval of artery clot
    34051CRemoval of artery clot
    34101TRemoval of artery clot008836.3961$2,160.11$655.22$432.02
    34111TRemoval of arm artery clot008836.3961$2,160.11$655.22$432.02
    34151CRemoval of artery clot
    34201TRemoval of artery clot008836.3961$2,160.11$655.22$432.02
    34203TRemoval of leg artery clot008836.3961$2,160.11$655.22$432.02
    34401CRemoval of vein clot
    34421TRemoval of vein clot008836.3961$2,160.11$655.22$432.02
    34451CRemoval of vein clot
    34471TRemoval of vein clot008836.3961$2,160.11$655.22$432.02
    34490TRemoval of vein clot008836.3961$2,160.11$655.22$432.02
    34501TRepair valve, femoral vein008836.3961$2,160.11$655.22$432.02
    34502CReconstruct vena cava
    34510TTransposition of vein valve008836.3961$2,160.11$655.22$432.02
    34520TCross-over vein graft008836.3961$2,160.11$655.22$432.02
    34530TLeg vein fusion008836.3961$2,160.11$655.22$432.02
    34800CEndovasc abdo repair w/tube
    34802CEndovasc abdo repr w/device
    34803CEndovas aaa repr w/3-p part
    34804CEndovasc abdo repr w/device
    34805CEndovasc abdo repair w/pros
    34808CEndovasc abdo occlud device
    34812CXpose for endoprosth, aortic
    34813CFemoral endovas graft add-on
    34820CXpose for endoprosth, iliac
    34825CEndovasc extend prosth, init
    34826CEndovasc exten prosth, add'l
    34830COpen aortic tube prosth repr
    34831COpen aortoiliac prosth repr
    34832COpen aortofemor prosth repr
    34833CXpose for endoprosth, iliac
    34834CXpose, endoprosth, brachial
    34900CEndovasc iliac repr w/graft
    35001CRepair defect of artery
    35002CRepair artery rupture, neck
    35005CRepair defect of artery
    35011TRepair defect of artery065330.3956$1,803.98$360.80
    35013CRepair artery rupture, arm
    35021CRepair defect of artery
    35022CRepair artery rupture, chest
    35045CRepair defect of arm artery
    35081CRepair defect of artery
    35082CRepair artery rupture, aorta
    35091CRepair defect of artery
    35092CRepair artery rupture, aorta
    35102CRepair defect of artery
    35103CRepair artery rupture, groin
    35111CRepair defect of artery
    35112CRepair artery rupture,spleen
    35121CRepair defect of artery
    35122CRepair artery rupture, belly
    35131CRepair defect of artery
    35132CRepair artery rupture, groin
    35141CRepair defect of artery
    35142CRepair artery rupture, thigh
    35151CRepair defect of artery
    35152CRepair artery rupture, knee
    Start Printed Page 42819
    35180TRepair blood vessel lesion009323.3454$1,385.55$277.34$277.11
    35182CRepair blood vessel lesion
    35184TRepair blood vessel lesion009323.3454$1,385.55$277.34$277.11
    35188TRepair blood vessel lesion008836.3961$2,160.11$655.22$432.02
    35189CRepair blood vessel lesion
    35190TRepair blood vessel lesion009323.3454$1,385.55$277.34$277.11
    35201TRepair blood vessel lesion009323.3454$1,385.55$277.34$277.11
    35206TRepair blood vessel lesion009323.3454$1,385.55$277.34$277.11
    35207TRepair blood vessel lesion008836.3961$2,160.11$655.22$432.02
    35211CRepair blood vessel lesion
    35216CRepair blood vessel lesion
    35221CRepair blood vessel lesion
    35226TRepair blood vessel lesion009323.3454$1,385.55$277.34$277.11
    35231TRepair blood vessel lesion009323.3454$1,385.55$277.34$277.11
    35236TRepair blood vessel lesion009323.3454$1,385.55$277.34$277.11
    35241CRepair blood vessel lesion
    35246CRepair blood vessel lesion
    35251CRepair blood vessel lesion
    35256TRepair blood vessel lesion009323.3454$1,385.55$277.34$277.11
    35261TRepair blood vessel lesion065330.3956$1,803.98$360.80
    35266TRepair blood vessel lesion065330.3956$1,803.98$360.80
    35271CRepair blood vessel lesion
    35276CRepair blood vessel lesion
    35281CRepair blood vessel lesion
    35286TRepair blood vessel lesion065330.3956$1,803.98$360.80
    35301CRechanneling of artery
    35311CRechanneling of artery
    35321TRechanneling of artery009323.3454$1,385.55$277.34$277.11
    35331CRechanneling of artery
    35341CRechanneling of artery
    35351CRechanneling of artery
    35355CRechanneling of artery
    35361CRechanneling of artery
    35363CRechanneling of artery
    35371CRechanneling of artery
    35372CRechanneling of artery
    35381CRechanneling of artery
    35390CReoperation, carotid add-on
    35400CAngioscopy
    35450CRepair arterial blockage
    35452CRepair arterial blockage
    35454CRepair arterial blockage
    35456CRepair arterial blockage
    35458TRepair arterial blockage008134.2913$2,035.19$407.04
    35459TRepair arterial blockage008134.2913$2,035.19$407.04
    35460TRepair venous blockage008134.2913$2,035.19$407.04
    35470TRepair arterial blockage008134.2913$2,035.19$407.04
    35471TRepair arterial blockage008134.2913$2,035.19$407.04
    35472TRepair arterial blockage008134.2913$2,035.19$407.04
    35473TRepair arterial blockage008134.2913$2,035.19$407.04
    35474TRepair arterial blockage008134.2913$2,035.19$407.04
    35475TRepair arterial blockage008134.2913$2,035.19$407.04
    35476TRepair venous blockage008134.2913$2,035.19$407.04
    35480CAtherectomy, open
    35481CAtherectomy, open
    35482CAtherectomy, open
    35483CAtherectomy, open
    35484TAtherectomy, open008134.2913$2,035.19$407.04
    35485TAtherectomy, open008134.2913$2,035.19$407.04
    35490TAtherectomy, percutaneous008134.2913$2,035.19$407.04
    35491TAtherectomy, percutaneous008134.2913$2,035.19$407.04
    35492TAtherectomy, percutaneous008134.2913$2,035.19$407.04
    35493TAtherectomy, percutaneous008134.2913$2,035.19$407.04
    35494TAtherectomy, percutaneous008134.2913$2,035.19$407.04
    35495TAtherectomy, percutaneous008134.2913$2,035.19$407.04
    35500THarvest vein for bypass008134.2913$2,035.19$407.04
    Start Printed Page 42820
    35501CArtery bypass graft
    35506CArtery bypass graft
    35507CArtery bypass graft
    35508CArtery bypass graft
    35509CArtery bypass graft
    35510CArtery bypass graft
    35511CArtery bypass graft
    35512CArtery bypass graft
    35515CArtery bypass graft
    35516CArtery bypass graft
    35518CArtery bypass graft
    35521CArtery bypass graft
    35522CArtery bypass graft
    35525CArtery bypass graft
    35526CArtery bypass graft
    35531CArtery bypass graft
    35533CArtery bypass graft
    35536CArtery bypass graft
    35541CArtery bypass graft
    35546CArtery bypass graft
    35548CArtery bypass graft
    35549CArtery bypass graft
    35551CArtery bypass graft
    35556CArtery bypass graft
    35558CArtery bypass graft
    35560CArtery bypass graft
    35563CArtery bypass graft
    35565CArtery bypass graft
    35566CArtery bypass graft
    35571CArtery bypass graft
    35572NHarvest femoropopliteal vein
    35583CVein bypass graft
    35585CVein bypass graft
    35587CVein bypass graft
    35600CHarvest artery for cabg
    35601CArtery bypass graft
    35606CArtery bypass graft
    35612CArtery bypass graft
    35616CArtery bypass graft
    35621CArtery bypass graft
    35623CBypass graft, not vein
    35626CArtery bypass graft
    35631CArtery bypass graft
    35636CArtery bypass graft
    35641CArtery bypass graft
    35642CArtery bypass graft
    35645CArtery bypass graft
    35646CArtery bypass graft
    35647CArtery bypass graft
    35650CArtery bypass graft
    35651CArtery bypass graft
    35654CArtery bypass graft
    35656CArtery bypass graft
    35661CArtery bypass graft
    35663CArtery bypass graft
    35665CArtery bypass graft
    35666CArtery bypass graft
    35671CArtery bypass graft
    35681CComposite bypass graft
    35682CComposite bypass graft
    35683CComposite bypass graft
    35685TBypass graft patency/patch009323.3454$1,385.55$277.34$277.11
    35686TBypass graft/av fist patency009323.3454$1,385.55$277.34$277.11
    35691CArterial transposition
    35693CArterial transposition
    35694CArterial transposition
    Start Printed Page 42821
    35695CArterial transposition
    35697CReimplant artery each
    35700CReoperation, bypass graft
    35701CExploration, carotid artery
    35721CExploration, femoral artery
    35741CExploration popliteal artery
    35761TExploration of artery/vein011531.3302$1,859.45$459.35$371.89
    35800CExplore neck vessels
    35820CExplore chest vessels
    35840CExplore abdominal vessels
    35860TExplore limb vessels009323.3454$1,385.55$277.34$277.11
    35870CRepair vessel graft defect
    35875TRemoval of clot in graft008836.3961$2,160.11$655.22$432.02
    35876TRemoval of clot in graft008836.3961$2,160.11$655.22$432.02
    35879TRevise graft w/vein008836.3961$2,160.11$655.22$432.02
    35881TRevise graft w/vein008836.3961$2,160.11$655.22$432.02
    35901CExcision, graft, neck
    35903TExcision, graft, extremity011531.3302$1,859.45$459.35$371.89
    35905CExcision, graft, thorax
    35907CExcision, graft, abdomen
    36000NPlace needle in vein
    36002SPseudoaneurysm injection trt02672.6208$155.54$62.18$31.11
    36005NInjection ext venography
    36010NPlace catheter in vein
    36011NPlace catheter in vein
    36012NPlace catheter in vein
    36013NPlace catheter in artery
    36014NPlace catheter in artery
    36015NPlace catheter in artery
    36100NEstablish access to artery
    36120NEstablish access to artery
    36140NEstablish access to artery
    36145NArtery to vein shunt
    36160NEstablish access to aorta
    36200NPlace catheter in aorta
    36215NPlace catheter in artery
    36216NPlace catheter in artery
    36217NPlace catheter in artery
    36218NPlace catheter in artery
    36245NPlace catheter in artery
    36246NPlace catheter in artery
    36247NPlace catheter in artery
    36248NPlace catheter in artery
    36260TInsertion of infusion pump062326.9877$1,601.72$320.34
    36261TRevision of infusion pump062326.9877$1,601.72$320.34
    36262TRemoval of infusion pump062221.1708$1,256.49$251.30
    36299NVessel injection procedure
    36400NBl draw < 3 yrs fem/jugular
    36405NBl draw < 3 yrs scalp vein
    36406NBl draw < 3 yrs other vein
    36410NNon-routine bl draw > 3 yrs
    36415ADrawing blood
    36416NCapillary blood draw
    36420TVein access cutdown < 1 yr00350.7125$42.29$8.46
    36425TVein access cutdown > 1 yr00350.7125$42.29$8.46
    36430SBlood transfusion service01103.6428$216.20$43.24
    36440SBl push transfuse, 2 yr or <01103.6428$216.20$43.24
    36450SBl exchange/transfuse, nb01103.6428$216.20$43.24
    36455SBl exchange/transfuse non-nb01103.6428$216.20$43.24
    36460STransfusion service, fetal01103.6428$216.20$43.24
    36468TInjection(s), spider veins00981.1295$67.04$13.41
    36469TInjection(s), spider veins00981.1295$67.04$13.41
    36470TInjection therapy of vein00981.1295$67.04$13.41
    36471TInjection therapy of veins00981.1295$67.04$13.41
    36475TEndovenous rf, 1st vein009226.3621$1,564.59$505.37$312.92
    36476TEndovenous rf, vein add-on009226.3621$1,564.59$505.37$312.92
    Start Printed Page 42822
    36478TEndovenous laser, 1st vein009226.3621$1,564.59$505.37$312.92
    36479TEndovenous laser vein addon009226.3621$1,564.59$505.37$312.92
    36481NInsertion of catheter, vein
    36500NInsertion of catheter, vein
    36510NInsertion of catheter, vein
    36511SApheresis wbc011112.3394$732.34$200.18$146.47
    36512SApheresis rbc011112.3394$732.34$200.18$146.47
    36513SApheresis platelets011112.3394$732.34$200.18$146.47
    36514SApheresis plasma011112.3394$732.34$200.18$146.47
    36515SApheresis, adsorp/reinfuse011226.6734$1,583.07$437.01$316.61
    36516SApheresis, selective011226.6734$1,583.07$437.01$316.61
    36522SPhotopheresis011226.6734$1,583.07$437.01$316.61
    36540NCollect blood venous device
    36550TDeclot vascular device06762.3996$142.42$28.48
    36555TInsert non-tunnel cv cath06218.2610$490.29$98.06
    36556TInsert non-tunnel cv cath06218.2610$490.29$98.06
    36557TInsert tunneled cv cath062221.1708$1,256.49$251.30
    36558TInsert tunneled cv cath062221.1708$1,256.49$251.30
    36560TInsert tunneled cv cath062326.9877$1,601.72$320.34
    36561TInsert tunneled cv cath062326.9877$1,601.72$320.34
    36563TInsert tunneled cv cath062326.9877$1,601.72$320.34
    36565TInsert tunneled cv cath062326.9877$1,601.72$320.34
    36566TInsert tunneled cv cath1564$4,750.00$950.00
    36568TInsert tunneled cv cath06218.2610$490.29$98.06
    36569TInsert tunneled cv cath06218.2610$490.29$98.06
    36570TInsert tunneled cv cath062221.1708$1,256.49$251.30
    36571TInsert tunneled cv cath062221.1708$1,256.49$251.30
    36575TRepair tunneled cv cath06218.2610$490.29$98.06
    36576TRepair tunneled cv cath06218.2610$490.29$98.06
    36578TReplace tunneled cv cath062221.1708$1,256.49$251.30
    36580TReplace tunneled cv cath06218.2610$490.29$98.06
    36581TReplace tunneled cv cath062221.1708$1,256.49$251.30
    36582TReplace tunneled cv cath062326.9877$1,601.72$320.34
    36583TReplace tunneled cv cath062326.9877$1,601.72$320.34
    36584TReplace tunneled cv cath06218.2610$490.29$98.06
    36585TReplace tunneled cv cath062221.1708$1,256.49$251.30
    36589TRemoval tunneled cv cath06218.2610$490.29$98.06
    36590TRemoval tunneled cv cath06218.2610$490.29$98.06
    36595TMech remov tunneled cv cath062221.1708$1,256.49$251.30
    36596TMech remov tunneled cv cath06218.2610$490.29$98.06
    36597TReposition venous catheter06218.2610$490.29$98.06
    36600NWithdrawal of arterial blood
    36620NInsertion catheter, artery
    36625NInsertion catheter, artery
    36640TInsertion catheter, artery062326.9877$1,601.72$320.34
    36660CInsertion catheter, artery
    36680TInsert needle, bone cavity00020.9515$56.47$11.29
    36800TInsertion of cannula011531.3302$1,859.45$459.35$371.89
    36810TInsertion of cannula011531.3302$1,859.45$459.35$371.89
    36815TInsertion of cannula011531.3302$1,859.45$459.35$371.89
    36818TAv fuse, uppr arm, cephalic008836.3961$2,160.11$655.22$432.02
    36819TAv fusion/uppr arm vein008836.3961$2,160.11$655.22$432.02
    36820TAv fusion/forearm vein008836.3961$2,160.11$655.22$432.02
    36821TAv fusion direct any site008836.3961$2,160.11$655.22$432.02
    36822CInsertion of cannula(s)
    36823CInsertion of cannula(s)
    36825TArtery-vein autograft008836.3961$2,160.11$655.22$432.02
    36830TArtery-vein graft008836.3961$2,160.11$655.22$432.02
    36831TOpen thrombect av fistula008836.3961$2,160.11$655.22$432.02
    36832TAv fistula revision, open008836.3961$2,160.11$655.22$432.02
    36833TAv fistula revision008836.3961$2,160.11$655.22$432.02
    36834TRepair A-V aneurysm008836.3961$2,160.11$655.22$432.02
    36835TArtery to vein shunt011531.3302$1,859.45$459.35$371.89
    36838TDist revas ligation, hemo008836.3961$2,160.11$655.22$432.02
    36860TExternal cannula declotting06762.3996$142.42$28.48
    36861TCannula declotting011531.3302$1,859.45$459.35$371.89
    Start Printed Page 42823
    36870TPercut thrombect av fistula065330.3956$1,803.98$360.80
    37140CRevision of circulation
    37145CRevision of circulation
    37160CRevision of circulation
    37180CRevision of circulation
    37181CSplice spleen/kidney veins
    37182CInsert hepatic shunt (tips)
    37183TRemove hepatic shunt (tips)022964.1626$3,808.05$771.23$761.61
    37195TThrombolytic therapy, stroke06762.3996$142.42$28.48
    37200TTranscatheter biopsy06855.9902$355.52$115.47$71.10
    37201TTranscatheter therapy infuse06762.3996$142.42$28.48
    37202TTranscatheter therapy infuse06762.3996$142.42$28.48
    37203TTranscatheter retrieval010314.6476$869.34$223.63$173.87
    37204TTranscatheter occlusion011531.3302$1,859.45$459.35$371.89
    37205TTranscatheter stent022964.1626$3,808.05$771.23$761.61
    37206TTranscatheter stent add-on022964.1626$3,808.05$771.23$761.61
    37207TTranscatheter stent022964.1626$3,808.05$771.23$761.61
    37208TTranscatheter stent add-on022964.1626$3,808.05$771.23$761.61
    37209TExchange arterial catheter010314.6476$869.34$223.63$173.87
    37215CTranscath stent, cca w/eps
    37216CTranscath stent, cca w/o eps
    37250SIv us first vessel add-on041619.4657$1,155.29$231.06
    37251SIv us each add vessel add-on041619.4657$1,155.29$231.06
    37500TEndoscopy ligate perf veins009226.3621$1,564.59$505.37$312.92
    37501TVascular endoscopy procedure009226.3621$1,564.59$505.37$312.92
    37565TLigation of neck vein009323.3454$1,385.55$277.34$277.11
    37600TLigation of neck artery009323.3454$1,385.55$277.34$277.11
    37605TLigation of neck artery009128.8685$1,713.35$348.23$342.67
    37606TLigation of neck artery009128.8685$1,713.35$348.23$342.67
    37607TLigation of a-v fistula009226.3621$1,564.59$505.37$312.92
    37609TTemporal artery procedure002114.9098$884.90$219.48$176.98
    37615TLigation of neck artery009128.8685$1,713.35$348.23$342.67
    37616CLigation of chest artery
    37617CLigation of abdomen artery
    37618CLigation of extremity artery
    37620TRevision of major vein009128.8685$1,713.35$348.23$342.67
    37650TRevision of major vein009128.8685$1,713.35$348.23$342.67
    37660CRevision of major vein
    37700TRevise leg vein009128.8685$1,713.35$348.23$342.67
    37720TRemoval of leg vein009226.3621$1,564.59$505.37$312.92
    37730TRemoval of leg veins009226.3621$1,564.59$505.37$312.92
    37735TRemoval of leg veins/lesion009226.3621$1,564.59$505.37$312.92
    37760TRevision of leg veins009128.8685$1,713.35$348.23$342.67
    37765TPhleb veins - extrem - to 20009128.8685$1,713.35$348.23$342.67
    37766TPhleb veins - extrem 20+009128.8685$1,713.35$348.23$342.67
    37780TRevision of leg vein009128.8685$1,713.35$348.23$342.67
    37785TLigate/divide/excise vein009128.8685$1,713.35$348.23$342.67
    37788CRevascularization, penis
    37790TPenile venous occlusion018130.7265$1,823.62$621.82$364.72
    37799TVascular surgery procedure010314.6476$869.34$223.63$173.87
    38100CRemoval of spleen, total
    38101CRemoval of spleen, partial
    38102CRemoval of spleen, total
    38115CRepair of ruptured spleen
    38120TLaparoscopy, splenectomy013143.1426$2,560.51$1,001.89$512.10
    38129TLaparoscope proc, spleen013031.7825$1,886.29$659.53$377.26
    38200NInjection for spleen x-ray
    38204EBl donor search management
    38205SHarvest allogenic stem cells011112.3394$732.34$200.18$146.47
    38206SHarvest auto stem cells011112.3394$732.34$200.18$146.47
    38207ECryopreserve stem cells
    38208EThaw preserved stem cells
    38209EWash harvest stem cells
    38210ET-cell depletion of harvest
    38211ETumor cell deplete of harvst
    38212ERbc depletion of harvest
    Start Printed Page 42824
    38213EPlatelet deplete of harvest
    38214EVolume deplete of harvest
    38215EHarvest stem cell concentrte
    38220TBone marrow aspiration00032.6410$156.74$31.35
    38221TBone marrow biopsy00032.6410$156.74$31.35
    38230SBone marrow collection011112.3394$732.34$200.18$146.47
    38240SBone marrow/stem transplant012322.8861$1,358.29$271.66
    38241SBone marrow/stem transplant012322.8861$1,358.29$271.66
    38242SLymphocyte infuse transplant011112.3394$732.34$200.18$146.47
    38300TDrainage, lymph node lesion000711.3983$676.49$135.30
    38305TDrainage, lymph node lesion000816.4242$974.78$194.96
    38308TIncision of lymph channels011321.3681$1,268.20$253.64
    38380CThoracic duct procedure
    38381CThoracic duct procedure
    38382CThoracic duct procedure
    38500TBiopsy/removal, lymph nodes011321.3681$1,268.20$253.64
    38505TNeedle biopsy, lymph nodes00053.5831$212.66$71.45$42.53
    38510TBiopsy/removal, lymph nodes011321.3681$1,268.20$253.64
    38520TBiopsy/removal, lymph nodes011321.3681$1,268.20$253.64
    38525TBiopsy/removal, lymph nodes011321.3681$1,268.20$253.64
    38530TBiopsy/removal, lymph nodes011321.3681$1,268.20$253.64
    38542TExplore deep node(s), neck011440.5805$2,408.45$485.91$481.69
    38550TRemoval, neck/armpit lesion011321.3681$1,268.20$253.64
    38555TRemoval, neck/armpit lesion011321.3681$1,268.20$253.64
    38562CRemoval, pelvic lymph nodes
    38564CRemoval, abdomen lymph nodes
    38570TLaparoscopy, lymph node biop013143.1426$2,560.51$1,001.89$512.10
    38571TLaparoscopy, lymphadenectomy013262.7061$3,721.61$1,239.22$744.32
    38572TLaparoscopy, lymphadenectomy013143.1426$2,560.51$1,001.89$512.10
    38589TLaparoscope proc, lymphatic013031.7825$1,886.29$659.53$377.26
    38700TRemoval of lymph nodes, neck011321.3681$1,268.20$253.64
    38720TRemoval of lymph nodes, neck011321.3681$1,268.20$253.64
    38724CRemoval of lymph nodes, neck
    38740TRemove armpit lymph nodes011440.5805$2,408.45$485.91$481.69
    38745TRemove armpit lymph nodes011440.5805$2,408.45$485.91$481.69
    38746CRemove thoracic lymph nodes
    38747CRemove abdominal lymph nodes
    38760TRemove groin lymph nodes011321.3681$1,268.20$253.64
    38765CRemove groin lymph nodes
    38770CRemove pelvis lymph nodes
    38780CRemove abdomen lymph nodes
    38790NInject for lymphatic x-ray
    38792NIdentify sentinel node
    38794NAccess thoracic lymph duct
    38999SBlood/lymph system procedure01103.6428$216.20$43.24
    39000CExploration of chest
    39010CExploration of chest
    39200CRemoval chest lesion
    39220CRemoval chest lesion
    39400TVisualization of chest006930.5386$1,812.47$591.64$362.49
    39499CChest procedure
    39501CRepair diaphragm laceration
    39502CRepair paraesophageal hernia
    39503CRepair of diaphragm hernia
    39520CRepair of diaphragm hernia
    39530CRepair of diaphragm hernia
    39531CRepair of diaphragm hernia
    39540CRepair of diaphragm hernia
    39541CRepair of diaphragm hernia
    39545CRevision of diaphragm
    39560CResect diaphragm, simple
    39561CResect diaphragm, complex
    39599CDiaphragm surgery procedure
    4000FETobacco use txmnt counseling
    4001FETobacco use txmnt, pharmacol
    4002FEStatin therapy, rx
    Start Printed Page 42825
    4006FEBeta-blocker therapy, rx
    4009FEAce inhibitor therapy, rx
    4011FEOral antiplatelet tx, rx
    40490TBiopsy of lip02512.0010$118.76$23.75
    40500TPartial excision of lip025316.0627$953.32$282.29$190.66
    40510TPartial excision of lip025423.2980$1,382.74$321.35$276.55
    40520TPartial excision of lip025316.0627$953.32$282.29$190.66
    40525TReconstruct lip with flap025423.2980$1,382.74$321.35$276.55
    40527TReconstruct lip with flap025423.2980$1,382.74$321.35$276.55
    40530TPartial removal of lip025423.2980$1,382.74$321.35$276.55
    40650TRepair lip02527.8317$464.81$113.41$92.96
    40652TRepair lip02527.8317$464.81$113.41$92.96
    40654TRepair lip02527.8317$464.81$113.41$92.96
    40700TRepair cleft lip/nasal025637.1513$2,204.93$440.99
    40701TRepair cleft lip/nasal025637.1513$2,204.93$440.99
    40702TRepair cleft lip/nasal025637.1513$2,204.93$440.99
    40720TRepair cleft lip/nasal025637.1513$2,204.93$440.99
    40761TRepair cleft lip/nasal025637.1513$2,204.93$440.99
    40799TLip surgery procedure02512.0010$118.76$23.75
    40800TDrainage of mouth lesion02512.0010$118.76$23.75
    40801TDrainage of mouth lesion02527.8317$464.81$113.41$92.96
    40804XRemoval, foreign body, mouth03400.6355$37.72$7.54
    40805TRemoval, foreign body, mouth02527.8317$464.81$113.41$92.96
    40806TIncision of lip fold02512.0010$118.76$23.75
    40808TBiopsy of mouth lesion02512.0010$118.76$23.75
    40810TExcision of mouth lesion025316.0627$953.32$282.29$190.66
    40812TExcise/repair mouth lesion025316.0627$953.32$282.29$190.66
    40814TExcise/repair mouth lesion025316.0627$953.32$282.29$190.66
    40816TExcision of mouth lesion025423.2980$1,382.74$321.35$276.55
    40818TExcise oral mucosa for graft02512.0010$118.76$23.75
    40819TExcise lip or cheek fold02527.8317$464.81$113.41$92.96
    40820TTreatment of mouth lesion025316.0627$953.32$282.29$190.66
    40830TRepair mouth laceration02512.0010$118.76$23.75
    40831TRepair mouth laceration02527.8317$464.81$113.41$92.96
    40840TReconstruction of mouth025423.2980$1,382.74$321.35$276.55
    40842TReconstruction of mouth025423.2980$1,382.74$321.35$276.55
    40843TReconstruction of mouth025423.2980$1,382.74$321.35$276.55
    40844TReconstruction of mouth025637.1513$2,204.93$440.99
    40845TReconstruction of mouth025637.1513$2,204.93$440.99
    40899TMouth surgery procedure02512.0010$118.76$23.75
    41000TDrainage of mouth lesion025316.0627$953.32$282.29$190.66
    41005TDrainage of mouth lesion02512.0010$118.76$23.75
    41006TDrainage of mouth lesion025423.2980$1,382.74$321.35$276.55
    41007TDrainage of mouth lesion025316.0627$953.32$282.29$190.66
    41008TDrainage of mouth lesion025316.0627$953.32$282.29$190.66
    41009TDrainage of mouth lesion02512.0010$118.76$23.75
    41010TIncision of tongue fold02527.8317$464.81$113.41$92.96
    41015TDrainage of mouth lesion02512.0010$118.76$23.75
    41016TDrainage of mouth lesion02527.8317$464.81$113.41$92.96
    41017TDrainage of mouth lesion02527.8317$464.81$113.41$92.96
    41018TDrainage of mouth lesion02527.8317$464.81$113.41$92.96
    41100TBiopsy of tongue02527.8317$464.81$113.41$92.96
    41105TBiopsy of tongue025316.0627$953.32$282.29$190.66
    41108TBiopsy of floor of mouth02527.8317$464.81$113.41$92.96
    41110TExcision of tongue lesion025316.0627$953.32$282.29$190.66
    41112TExcision of tongue lesion025316.0627$953.32$282.29$190.66
    41113TExcision of tongue lesion025316.0627$953.32$282.29$190.66
    41114TExcision of tongue lesion025423.2980$1,382.74$321.35$276.55
    41115TExcision of tongue fold02527.8317$464.81$113.41$92.96
    41116TExcision of mouth lesion025316.0627$953.32$282.29$190.66
    41120TPartial removal of tongue025423.2980$1,382.74$321.35$276.55
    41130CPartial removal of tongue
    41135CTongue and neck surgery
    41140CRemoval of tongue
    41145CTongue removal, neck surgery
    41150CTongue, mouth, jaw surgery
    Start Printed Page 42826
    41153CTongue, mouth, neck surgery
    41155CTongue, jaw, & neck surgery
    41250TRepair tongue laceration02512.0010$118.76$23.75
    41251TRepair tongue laceration02512.0010$118.76$23.75
    41252TRepair tongue laceration02527.8317$464.81$113.41$92.96
    41500TFixation of tongue025423.2980$1,382.74$321.35$276.55
    41510TTongue to lip surgery025316.0627$953.32$282.29$190.66
    41520TReconstruction, tongue fold02527.8317$464.81$113.41$92.96
    41599TTongue and mouth surgery02512.0010$118.76$23.75
    41800TDrainage of gum lesion02512.0010$118.76$23.75
    41805TRemoval foreign body, gum025423.2980$1,382.74$321.35$276.55
    41806TRemoval foreign body,jawbone025316.0627$953.32$282.29$190.66
    41820TExcision, gum, each quadrant02527.8317$464.81$113.41$92.96
    41821TExcision of gum flap02527.8317$464.81$113.41$92.96
    41822TExcision of gum lesion025316.0627$953.32$282.29$190.66
    41823TExcision of gum lesion025423.2980$1,382.74$321.35$276.55
    41825TExcision of gum lesion025316.0627$953.32$282.29$190.66
    41826TExcision of gum lesion025316.0627$953.32$282.29$190.66
    41827TExcision of gum lesion025423.2980$1,382.74$321.35$276.55
    41828TExcision of gum lesion025316.0627$953.32$282.29$190.66
    41830TRemoval of gum tissue025316.0627$953.32$282.29$190.66
    41850TTreatment of gum lesion025316.0627$953.32$282.29$190.66
    41870TGum graft025423.2980$1,382.74$321.35$276.55
    41872TRepair gum025316.0627$953.32$282.29$190.66
    41874TRepair tooth socket025423.2980$1,382.74$321.35$276.55
    41899TDental surgery procedure02512.0010$118.76$23.75
    42000TDrainage mouth roof lesion02512.0010$118.76$23.75
    42100TBiopsy roof of mouth02527.8317$464.81$113.41$92.96
    42104TExcision lesion, mouth roof025316.0627$953.32$282.29$190.66
    42106TExcision lesion, mouth roof025316.0627$953.32$282.29$190.66
    42107TExcision lesion, mouth roof025423.2980$1,382.74$321.35$276.55
    42120TRemove palate/lesion025637.1513$2,204.93$440.99
    42140TExcision of uvula02527.8317$464.81$113.41$92.96
    42145TRepair palate, pharynx/uvula025423.2980$1,382.74$321.35$276.55
    42160TTreatment mouth roof lesion025316.0627$953.32$282.29$190.66
    42180TRepair palate02512.0010$118.76$23.75
    42182TRepair palate025637.1513$2,204.93$440.99
    42200TReconstruct cleft palate025637.1513$2,204.93$440.99
    42205TReconstruct cleft palate025637.1513$2,204.93$440.99
    42210TReconstruct cleft palate025637.1513$2,204.93$440.99
    42215TReconstruct cleft palate025637.1513$2,204.93$440.99
    42220TReconstruct cleft palate025637.1513$2,204.93$440.99
    42225TReconstruct cleft palate025637.1513$2,204.93$440.99
    42226TLengthening of palate025637.1513$2,204.93$440.99
    42227TLengthening of palate025637.1513$2,204.93$440.99
    42235TRepair palate025316.0627$953.32$282.29$190.66
    42260TRepair nose to lip fistula025423.2980$1,382.74$321.35$276.55
    42280TPreparation, palate mold02512.0010$118.76$23.75
    42281TInsertion, palate prosthesis025316.0627$953.32$282.29$190.66
    42299TPalate/uvula surgery02512.0010$118.76$23.75
    42300TDrainage of salivary gland025316.0627$953.32$282.29$190.66
    42305TDrainage of salivary gland025316.0627$953.32$282.29$190.66
    42310TDrainage of salivary gland02512.0010$118.76$23.75
    42320TDrainage of salivary gland02512.0010$118.76$23.75
    42325TCreate salivary cyst drain02512.0010$118.76$23.75
    42326TCreate salivary cyst drain02527.8317$464.81$113.41$92.96
    42330TRemoval of salivary stone025316.0627$953.32$282.29$190.66
    42335TRemoval of salivary stone025316.0627$953.32$282.29$190.66
    42340TRemoval of salivary stone025316.0627$953.32$282.29$190.66
    42400TBiopsy of salivary gland00053.5831$212.66$71.45$42.53
    42405TBiopsy of salivary gland025316.0627$953.32$282.29$190.66
    42408TExcision of salivary cyst025316.0627$953.32$282.29$190.66
    42409TDrainage of salivary cyst025316.0627$953.32$282.29$190.66
    42410TExcise parotid gland/lesion025637.1513$2,204.93$440.99
    42415TExcise parotid gland/lesion025637.1513$2,204.93$440.99
    42420TExcise parotid gland/lesion025637.1513$2,204.93$440.99
    Start Printed Page 42827
    42425TExcise parotid gland/lesion025637.1513$2,204.93$440.99
    42426CExcise parotid gland/lesion
    42440TExcise submaxillary gland025637.1513$2,204.93$440.99
    42450TExcise sublingual gland025423.2980$1,382.74$321.35$276.55
    42500TRepair salivary duct025423.2980$1,382.74$321.35$276.55
    42505TRepair salivary duct025637.1513$2,204.93$440.99
    42507TParotid duct diversion025637.1513$2,204.93$440.99
    42508TParotid duct diversion025637.1513$2,204.93$440.99
    42509TParotid duct diversion025637.1513$2,204.93$440.99
    42510TParotid duct diversion025637.1513$2,204.93$440.99
    42550NInjection for salivary x-ray
    42600TClosure of salivary fistula025316.0627$953.32$282.29$190.66
    42650TDilation of salivary duct02527.8317$464.81$113.41$92.96
    42660TDilation of salivary duct02512.0010$118.76$23.75
    42665TLigation of salivary duct025423.2980$1,382.74$321.35$276.55
    42699TSalivary surgery procedure02512.0010$118.76$23.75
    42700TDrainage of tonsil abscess02512.0010$118.76$23.75
    42720TDrainage of throat abscess025316.0627$953.32$282.29$190.66
    42725TDrainage of throat abscess025637.1513$2,204.93$440.99
    42800TBiopsy of throat025316.0627$953.32$282.29$190.66
    42802TBiopsy of throat025316.0627$953.32$282.29$190.66
    42804TBiopsy of upper nose/throat025316.0627$953.32$282.29$190.66
    42806TBiopsy of upper nose/throat025423.2980$1,382.74$321.35$276.55
    42808TExcise pharynx lesion025316.0627$953.32$282.29$190.66
    42809XRemove pharynx foreign body03400.6355$37.72$7.54
    42810TExcision of neck cyst025423.2980$1,382.74$321.35$276.55
    42815TExcision of neck cyst025637.1513$2,204.93$440.99
    42820TRemove tonsils and adenoids025822.1458$1,314.35$437.25$262.87
    42821TRemove tonsils and adenoids025822.1458$1,314.35$437.25$262.87
    42825TRemoval of tonsils025822.1458$1,314.35$437.25$262.87
    42826TRemoval of tonsils025822.1458$1,314.35$437.25$262.87
    42830TRemoval of adenoids025822.1458$1,314.35$437.25$262.87
    42831TRemoval of adenoids025822.1458$1,314.35$437.25$262.87
    42835TRemoval of adenoids025822.1458$1,314.35$437.25$262.87
    42836TRemoval of adenoids025822.1458$1,314.35$437.25$262.87
    42842TExtensive surgery of throat025423.2980$1,382.74$321.35$276.55
    42844TExtensive surgery of throat025637.1513$2,204.93$440.99
    42845CExtensive surgery of throat
    42860TExcision of tonsil tags025822.1458$1,314.35$437.25$262.87
    42870TExcision of lingual tonsil025822.1458$1,314.35$437.25$262.87
    42890TPartial removal of pharynx025637.1513$2,204.93$440.99
    42892TRevision of pharyngeal walls025637.1513$2,204.93$440.99
    42894CRevision of pharyngeal walls
    42900TRepair throat wound02527.8317$464.81$113.41$92.96
    42950TReconstruction of throat025423.2980$1,382.74$321.35$276.55
    42953CRepair throat, esophagus
    42955TSurgical opening of throat025423.2980$1,382.74$321.35$276.55
    42960TControl throat bleeding02501.2838$76.19$26.67$15.24
    42961CControl throat bleeding
    42962TControl throat bleeding025637.1513$2,204.93$440.99
    42970TControl nose/throat bleeding02501.2838$76.19$26.67$15.24
    42971CControl nose/throat bleeding
    42972TControl nose/throat bleeding025316.0627$953.32$282.29$190.66
    42999TThroat surgery procedure02512.0010$118.76$23.75
    43020TIncision of esophagus02527.8317$464.81$113.41$92.96
    43030TThroat muscle surgery025316.0627$953.32$282.29$190.66
    43045CIncision of esophagus
    43100CExcision of esophagus lesion
    43101CExcision of esophagus lesion
    43107CRemoval of esophagus
    43108CRemoval of esophagus
    43112CRemoval of esophagus
    43113CRemoval of esophagus
    43116CPartial removal of esophagus
    43117CPartial removal of esophagus
    43118CPartial removal of esophagus
    Start Printed Page 42828
    43121CPartial removal of esophagus
    43122CPartial removal of esophagus
    43123CPartial removal of esophagus
    43124CRemoval of esophagus
    43130TRemoval of esophagus pouch025423.2980$1,382.74$321.35$276.55
    43135CRemoval of esophagus pouch
    43200TEsophagus endoscopy01418.1464$483.49$143.38$96.70
    43201TEsoph scope w/submucous inj01418.1464$483.49$143.38$96.70
    43202TEsophagus endoscopy, biopsy01418.1464$483.49$143.38$96.70
    43204TEsoph scope w/sclerosis inj01418.1464$483.49$143.38$96.70
    43205TEsophagus endoscopy/ligation01418.1464$483.49$143.38$96.70
    43215TEsophagus endoscopy01418.1464$483.49$143.38$96.70
    43216TEsophagus endoscopy/lesion01418.1464$483.49$143.38$96.70
    43217TEsophagus endoscopy01418.1464$483.49$143.38$96.70
    43219TEsophagus endoscopy038422.2381$1,319.83$286.66$263.97
    43220TEsoph endoscopy, dilation01418.1464$483.49$143.38$96.70
    43226TEsoph endoscopy, dilation01418.1464$483.49$143.38$96.70
    43227TEsoph endoscopy, repair01418.1464$483.49$143.38$96.70
    43228TEsoph endoscopy, ablation042222.8607$1,356.78$448.81$271.36
    43231TEsoph endoscopy w/us exam01418.1464$483.49$143.38$96.70
    43232TEsoph endoscopy w/us fn bx01418.1464$483.49$143.38$96.70
    43234TUpper GI endoscopy, exam01418.1464$483.49$143.38$96.70
    43235TUppr gi endoscopy, diagnosis01418.1464$483.49$143.38$96.70
    43236TUppr gi scope w/submuc inj01418.1464$483.49$143.38$96.70
    43237TEndoscopic us exam, esoph01418.1464$483.49$143.38$96.70
    43238TUppr gi endoscopy w/us fn bx01418.1464$483.49$143.38$96.70
    43239TUpper GI endoscopy, biopsy01418.1464$483.49$143.38$96.70
    43240TEsoph endoscope w/drain cyst01418.1464$483.49$143.38$96.70
    43241TUpper GI endoscopy with tube01418.1464$483.49$143.38$96.70
    43242TUppr gi endoscopy w/us fn bx01418.1464$483.49$143.38$96.70
    43243TUpper gi endoscopy & inject01418.1464$483.49$143.38$96.70
    43244TUpper GI endoscopy/ligation01418.1464$483.49$143.38$96.70
    43245TUppr gi scope dilate strictr01418.1464$483.49$143.38$96.70
    43246TPlace gastrostomy tube01418.1464$483.49$143.38$96.70
    43247TOperative upper GI endoscopy01418.1464$483.49$143.38$96.70
    43248TUppr gi endoscopy/guide wire01418.1464$483.49$143.38$96.70
    43249TEsoph endoscopy, dilation01418.1464$483.49$143.38$96.70
    43250TUpper GI endoscopy/tumor01418.1464$483.49$143.38$96.70
    43251TOperative upper GI endoscopy01418.1464$483.49$143.38$96.70
    43255TOperative upper GI endoscopy01418.1464$483.49$143.38$96.70
    43256TUppr gi endoscopy w stent038422.2381$1,319.83$286.66$263.97
    43257TUppr gi scope w/thrml txmnt042222.8607$1,356.78$448.81$271.36
    43258TOperative upper GI endoscopy01418.1464$483.49$143.38$96.70
    43259TEndoscopic ultrasound exam01418.1464$483.49$143.38$96.70
    43260TEndo cholangiopancreatograph015118.6489$1,106.81$245.46$221.36
    43261TEndo cholangiopancreatograph015118.6489$1,106.81$245.46$221.36
    43262TEndo cholangiopancreatograph015118.6489$1,106.81$245.46$221.36
    43263TEndo cholangiopancreatograph015118.6489$1,106.81$245.46$221.36
    43264TEndo cholangiopancreatograph015118.6489$1,106.81$245.46$221.36
    43265TEndo cholangiopancreatograph015118.6489$1,106.81$245.46$221.36
    43267TEndo cholangiopancreatograph015118.6489$1,106.81$245.46$221.36
    43268TEndo cholangiopancreatograph038422.2381$1,319.83$286.66$263.97
    43269TEndo cholangiopancreatograph038422.2381$1,319.83$286.66$263.97
    43271TEndo cholangiopancreatograph015118.6489$1,106.81$245.46$221.36
    43272TEndo cholangiopancreatograph015118.6489$1,106.81$245.46$221.36
    43280TLaparoscopy, fundoplasty013262.7061$3,721.61$1,239.22$744.32
    43289TLaparoscope proc, esoph013031.7825$1,886.29$659.53$377.26
    43300CRepair of esophagus
    43305CRepair esophagus and fistula
    43310CRepair of esophagus
    43312CRepair esophagus and fistula
    43313CEsophagoplasty congenital
    43314CTracheo-esophagoplasty cong
    43320CFuse esophagus & stomach
    43324CRevise esophagus & stomach
    43325CRevise esophagus & stomach
    Start Printed Page 42829
    43326CRevise esophagus & stomach
    43330CRepair of esophagus
    43331CRepair of esophagus
    43340CFuse esophagus & intestine
    43341CFuse esophagus & intestine
    43350CSurgical opening, esophagus
    43351CSurgical opening, esophagus
    43352CSurgical opening, esophagus
    43360CGastrointestinal repair
    43361CGastrointestinal repair
    43400CLigate esophagus veins
    43401CEsophagus surgery for veins
    43405CLigate/staple esophagus
    43410CRepair esophagus wound
    43415CRepair esophagus wound
    43420CRepair esophagus opening
    43425CRepair esophagus opening
    43450TDilate esophagus01405.4489$323.39$93.77$64.68
    43453TDilate esophagus01405.4489$323.39$93.77$64.68
    43456TDilate esophagus01405.4489$323.39$93.77$64.68
    43458TDilate esophagus01405.4489$323.39$93.77$64.68
    43460CPressure treatment esophagus
    43496CFree jejunum flap, microvasc
    43499TEsophagus surgery procedure01418.1464$483.49$143.38$96.70
    43500CSurgical opening of stomach
    43501CSurgical repair of stomach
    43502CSurgical repair of stomach
    43510TSurgical opening of stomach01418.1464$483.49$143.38$96.70
    43520CIncision of pyloric muscle
    43600TBiopsy of stomach01418.1464$483.49$143.38$96.70
    43605CBiopsy of stomach
    43610CExcision of stomach lesion
    43611CExcision of stomach lesion
    43620CRemoval of stomach
    43621CRemoval of stomach
    43622CRemoval of stomach
    43631CRemoval of stomach, partial
    43632CRemoval of stomach, partial
    43633CRemoval of stomach, partial
    43634CRemoval of stomach, partial
    43635CRemoval of stomach, partial
    43638CRemoval of stomach, partial
    43639CRemoval of stomach, partial
    43640CVagotomy & pylorus repair
    43641CVagotomy & pylorus repair
    43644CLap gastric bypass/roux-en-y
    43645CLap gastr bypass incl smll i
    43651TLaparoscopy, vagus nerve013262.7061$3,721.61$1,239.22$744.32
    43652TLaparoscopy, vagus nerve013262.7061$3,721.61$1,239.22$744.32
    43653TLaparoscopy, gastrostomy013143.1426$2,560.51$1,001.89$512.10
    43659TLaparoscope proc, stom013031.7825$1,886.29$659.53$377.26
    43750TPlace gastrostomy tube01418.1464$483.49$143.38$96.70
    43752XNasal/orogastric w/stent02721.3738$81.54$32.61$16.31
    43760TChange gastrostomy tube01212.2663$134.50$43.80$26.90
    43761TReposition gastrostomy tube01226.9405$411.92$84.48$82.38
    43800CReconstruction of pylorus
    43810CFusion of stomach and bowel
    43820CFusion of stomach and bowel
    43825CFusion of stomach and bowel
    43830TPlace gastrostomy tube042222.8607$1,356.78$448.81$271.36
    43831TPlace gastrostomy tube01418.1464$483.49$143.38$96.70
    43832CPlace gastrostomy tube
    43840CRepair of stomach lesion
    43842CGastroplasty for obesity
    43843CGastroplasty for obesity
    43845CGastroplasty duodenal switch
    Start Printed Page 42830
    43846CGastric bypass for obesity
    43847CGastric bypass for obesity
    43848CRevision gastroplasty
    43850CRevise stomach-bowel fusion
    43855CRevise stomach-bowel fusion
    43860CRevise stomach-bowel fusion
    43865CRevise stomach-bowel fusion
    43870TRepair stomach opening01418.1464$483.49$143.38$96.70
    43880CRepair stomach-bowel fistula
    43999TStomach surgery procedure01418.1464$483.49$143.38$96.70
    44005CFreeing of bowel adhesion
    44010CIncision of small bowel
    44015CInsert needle cath bowel
    44020CExplore small intestine
    44021CDecompress small bowel
    44025CIncision of large bowel
    44050CReduce bowel obstruction
    44055CCorrect malrotation of bowel
    44100TBiopsy of bowel01418.1464$483.49$143.38$96.70
    44110CExcise intestine lesion(s)
    44111CExcision of bowel lesion(s)
    44120CRemoval of small intestine
    44121CRemoval of small intestine
    44125CRemoval of small intestine
    44126CEnterectomy w/o taper, cong
    44127CEnterectomy w/taper, cong
    44128CEnterectomy cong, add-on
    44130CBowel to bowel fusion
    44132CEnterectomy, cadaver donor
    44133CEnterectomy, live donor
    44135CIntestine transplnt, cadaver
    44136CIntestine transplant, live
    44137CRemove intestinal allograft
    44139CMobilization of colon
    44140CPartial removal of colon
    44141CPartial removal of colon
    44143CPartial removal of colon
    44144CPartial removal of colon
    44145CPartial removal of colon
    44146CPartial removal of colon
    44147CPartial removal of colon
    44150CRemoval of colon
    44151CRemoval of colon/ileostomy
    44152CRemoval of colon/ileostomy
    44153CRemoval of colon/ileostomy
    44155CRemoval of colon/ileostomy
    44156CRemoval of colon/ileostomy
    44160CRemoval of colon
    44200TLaparoscopy, enterolysis013143.1426$2,560.51$1,001.89$512.10
    44201TLaparoscopy, jejunostomy013143.1426$2,560.51$1,001.89$512.10
    44202CLap resect s/intestine singl
    44203CLap resect s/intestine, addl
    44204CLaparo partial colectomy
    44205CLap colectomy part w/ileum
    44206TLap part colectomy w/stoma013262.7061$3,721.61$1,239.22$744.32
    44207TL colectomy/coloproctostomy013262.7061$3,721.61$1,239.22$744.32
    44208TL colectomy/coloproctostomy013262.7061$3,721.61$1,239.22$744.32
    44210CLaparo total proctocolectomy
    44211CLaparo total proctocolectomy
    44212CLaparo total proctocolectomy
    44238TLaparoscope proc, intestine013031.7825$1,886.29$659.53$377.26
    44239TLaparoscope proc, rectum013031.7825$1,886.29$659.53$377.26
    44300COpen bowel to skin
    44310CIleostomy/jejunostomy
    44312TRevision of ileostomy002718.3348$1,088.17$329.72$217.63
    44314CRevision of ileostomy
    Start Printed Page 42831
    44316CDevise bowel pouch
    44320CColostomy
    44322CColostomy with biopsies
    44340TRevision of colostomy002718.3348$1,088.17$329.72$217.63
    44345CRevision of colostomy
    44346CRevision of colostomy
    44360TSmall bowel endoscopy01429.3063$552.33$152.78$110.47
    44361TSmall bowel endoscopy/biopsy01429.3063$552.33$152.78$110.47
    44363TSmall bowel endoscopy01429.3063$552.33$152.78$110.47
    44364TSmall bowel endoscopy01429.3063$552.33$152.78$110.47
    44365TSmall bowel endoscopy01429.3063$552.33$152.78$110.47
    44366TSmall bowel endoscopy01429.3063$552.33$152.78$110.47
    44369TSmall bowel endoscopy01429.3063$552.33$152.78$110.47
    44370TSmall bowel endoscopy/stent038422.2381$1,319.83$286.66$263.97
    44372TSmall bowel endoscopy01429.3063$552.33$152.78$110.47
    44373TSmall bowel endoscopy01429.3063$552.33$152.78$110.47
    44376TSmall bowel endoscopy01429.3063$552.33$152.78$110.47
    44377TSmall bowel endoscopy/biopsy01429.3063$552.33$152.78$110.47
    44378TSmall bowel endoscopy01429.3063$552.33$152.78$110.47
    44379TS bowel endoscope w/stent038422.2381$1,319.83$286.66$263.97
    44380TSmall bowel endoscopy01429.3063$552.33$152.78$110.47
    44382TSmall bowel endoscopy01429.3063$552.33$152.78$110.47
    44383TIleoscopy w/stent038422.2381$1,319.83$286.66$263.97
    44385TEndoscopy of bowel pouch01438.6475$513.23$186.06$102.65
    44386TEndoscopy, bowel pouch/biop01438.6475$513.23$186.06$102.65
    44388TColonoscopy01438.6475$513.23$186.06$102.65
    44389TColonoscopy with biopsy01438.6475$513.23$186.06$102.65
    44390TColonoscopy for foreign body01438.6475$513.23$186.06$102.65
    44391TColonoscopy for bleeding01438.6475$513.23$186.06$102.65
    44392TColonoscopy & polypectomy01438.6475$513.23$186.06$102.65
    44393TColonoscopy, lesion removal01438.6475$513.23$186.06$102.65
    44394TColonoscopy w/snare01438.6475$513.23$186.06$102.65
    44397TColonoscopy w/stent038422.2381$1,319.83$286.66$263.97
    44500TIntro, gastrointestinal tube01212.2663$134.50$43.80$26.90
    44602CSuture, small intestine
    44603CSuture, small intestine
    44604CSuture, large intestine
    44605CRepair of bowel lesion
    44615CIntestinal stricturoplasty
    44620CRepair bowel opening
    44625CRepair bowel opening
    44626CRepair bowel opening
    44640CRepair bowel-skin fistula
    44650CRepair bowel fistula
    44660CRepair bowel-bladder fistula
    44661CRepair bowel-bladder fistula
    44680CSurgical revision, intestine
    44700CSuspend bowel w/prosthesis
    44701NIntraop colon lavage add-on
    44715CPrepare donor intestine
    44720CPrep donor intestine/venous
    44721CPrep donor intestine/artery
    44799TUnlisted procedure intestine01429.3063$552.33$152.78$110.47
    44800CExcision of bowel pouch
    44820CExcision of mesentery lesion
    44850CRepair of mesentery
    44899CBowel surgery procedure
    44900CDrain app abscess, open
    44901TDrain app abscess, percut00379.4322$559.80$223.91$111.96
    44950CAppendectomy
    44955CAppendectomy add-on
    44960CAppendectomy
    44970TLaparoscopy, appendectomy013143.1426$2,560.51$1,001.89$512.10
    44979TLaparoscope proc, app013031.7825$1,886.29$659.53$377.26
    45000TDrainage of pelvic abscess01483.7213$220.86$56.96$44.17
    45005TDrainage of rectal abscess015516.1810$960.34$192.07
    Start Printed Page 42832
    45020TDrainage of rectal abscess015516.1810$960.34$192.07
    45100TBiopsy of rectum014917.9907$1,067.75$293.06$213.55
    45108TRemoval of anorectal lesion015023.7573$1,410.00$437.12$282.00
    45110CRemoval of rectum
    45111CPartial removal of rectum
    45112CRemoval of rectum
    45113CPartial proctectomy
    45114CPartial removal of rectum
    45116CPartial removal of rectum
    45119CRemove rectum w/reservoir
    45120CRemoval of rectum
    45121CRemoval of rectum and colon
    45123CPartial proctectomy
    45126CPelvic exenteration
    45130CExcision of rectal prolapse
    45135CExcision of rectal prolapse
    45136CExcise ileoanal reservior
    45150TExcision of rectal stricture014917.9907$1,067.75$293.06$213.55
    45160TExcision of rectal lesion015023.7573$1,410.00$437.12$282.00
    45170TExcision of rectal lesion015023.7573$1,410.00$437.12$282.00
    45190TDestruction, rectal tumor015023.7573$1,410.00$437.12$282.00
    45300TProctosigmoidoscopy dx01464.6164$273.98$64.40$54.80
    45303TProctosigmoidoscopy dilate01477.9318$470.75$94.15
    45305TProctosigmoidoscopy w/bx01477.9318$470.75$94.15
    45307TProctosigmoidoscopy fb042819.8121$1,175.85$235.17
    45308TProctosigmoidoscopy removal01477.9318$470.75$94.15
    45309TProctosigmoidoscopy removal01477.9318$470.75$94.15
    45315TProctosigmoidoscopy removal01477.9318$470.75$94.15
    45317TProctosigmoidoscopy bleed01477.9318$470.75$94.15
    45320TProctosigmoidoscopy ablate042819.8121$1,175.85$235.17
    45321TProctosigmoidoscopy volvul042819.8121$1,175.85$235.17
    45327TProctosigmoidoscopy w/stent038422.2381$1,319.83$286.66$263.97
    45330TDiagnostic sigmoidoscopy01464.6164$273.98$64.40$54.80
    45331TSigmoidoscopy and biopsy01464.6164$273.98$64.40$54.80
    45332TSigmoidoscopy w/fb removal01464.6164$273.98$64.40$54.80
    45333TSigmoidoscopy & polypectomy01477.9318$470.75$94.15
    45334TSigmoidoscopy for bleeding01477.9318$470.75$94.15
    45335TSigmoidoscopy w/submuc inj01464.6164$273.98$64.40$54.80
    45337TSigmoidoscopy & decompress01464.6164$273.98$64.40$54.80
    45338TSigmoidoscopy w/tumr remove01477.9318$470.75$94.15
    45339TSigmoidoscopy w/ablate tumr01477.9318$470.75$94.15
    45340TSig w/balloon dilation01477.9318$470.75$94.15
    45341TSigmoidoscopy w/ultrasound01477.9318$470.75$94.15
    45342TSigmoidoscopy w/us guide bx01477.9318$470.75$94.15
    45345TSigmoidoscopy w/stent038422.2381$1,319.83$286.66$263.97
    45355TSurgical colonoscopy01438.6475$513.23$186.06$102.65
    45378TDiagnostic colonoscopy01438.6475$513.23$186.06$102.65
    45379TColonoscopy w/fb removal01438.6475$513.23$186.06$102.65
    45380TColonoscopy and biopsy01438.6475$513.23$186.06$102.65
    45381TColonoscopy, submucous inj01438.6475$513.23$186.06$102.65
    45382TColonoscopy/control bleeding01438.6475$513.23$186.06$102.65
    45383TLesion removal colonoscopy01438.6475$513.23$186.06$102.65
    45384TLesion remove colonoscopy01438.6475$513.23$186.06$102.65
    45385TLesion removal colonoscopy01438.6475$513.23$186.06$102.65
    45386TColonoscopy dilate stricture01438.6475$513.23$186.06$102.65
    45387TColonoscopy w/stent038422.2381$1,319.83$286.66$263.97
    45391TColonoscopy w/endoscope us01438.6475$513.23$186.06$102.65
    45392TColonoscopy w/endoscopic fnb01438.6475$513.23$186.06$102.65
    45500TRepair of rectum014917.9907$1,067.75$293.06$213.55
    45505TRepair of rectum015023.7573$1,410.00$437.12$282.00
    45520TTreatment of rectal prolapse00981.1295$67.04$13.41
    45540CCorrect rectal prolapse
    45541TCorrect rectal prolapse015023.7573$1,410.00$437.12$282.00
    45550CRepair rectum/remove sigmoid
    45560TRepair of rectocele015023.7573$1,410.00$437.12$282.00
    45562CExploration/repair of rectum
    Start Printed Page 42833
    45563CExploration/repair of rectum
    45800CRepair rect/bladder fistula
    45805CRepair fistula w/colostomy
    45820CRepair rectourethral fistula
    45825CRepair fistula w/colostomy
    45900TReduction of rectal prolapse01483.7213$220.86$56.96$44.17
    45905TDilation of anal sphincter014917.9907$1,067.75$293.06$213.55
    45910TDilation of rectal narrowing014917.9907$1,067.75$293.06$213.55
    45915TRemove rectal obstruction01483.7213$220.86$56.96$44.17
    45999TRectum surgery procedure01483.7213$220.86$56.96$44.17
    46020TPlacement of seton015023.7573$1,410.00$437.12$282.00
    46030TRemoval of rectal marker01483.7213$220.86$56.96$44.17
    46040TIncision of rectal abscess014917.9907$1,067.75$293.06$213.55
    46045TIncision of rectal abscess015023.7573$1,410.00$437.12$282.00
    46050TIncision of anal abscess01483.7213$220.86$56.96$44.17
    46060TIncision of rectal abscess015023.7573$1,410.00$437.12$282.00
    46070TIncision of anal septum015516.1810$960.34$192.07
    46080TIncision of anal sphincter014917.9907$1,067.75$293.06$213.55
    46083TIncise external hemorrhoid01483.7213$220.86$56.96$44.17
    46200TRemoval of anal fissure015023.7573$1,410.00$437.12$282.00
    46210TRemoval of anal crypt014917.9907$1,067.75$293.06$213.55
    46211TRemoval of anal crypts015023.7573$1,410.00$437.12$282.00
    46220TRemoval of anal tag014917.9907$1,067.75$293.06$213.55
    46221TLigation of hemorrhoid(s)01483.7213$220.86$56.96$44.17
    46230TRemoval of anal tags014917.9907$1,067.75$293.06$213.55
    46250THemorrhoidectomy015023.7573$1,410.00$437.12$282.00
    46255THemorrhoidectomy015023.7573$1,410.00$437.12$282.00
    46257TRemove hemorrhoids & fissure015023.7573$1,410.00$437.12$282.00
    46258TRemove hemorrhoids & fistula015023.7573$1,410.00$437.12$282.00
    46260THemorrhoidectomy015023.7573$1,410.00$437.12$282.00
    46261TRemove hemorrhoids & fissure015023.7573$1,410.00$437.12$282.00
    46262TRemove hemorrhoids & fistula015023.7573$1,410.00$437.12$282.00
    46270TRemoval of anal fistula015023.7573$1,410.00$437.12$282.00
    46275TRemoval of anal fistula015023.7573$1,410.00$437.12$282.00
    46280TRemoval of anal fistula015023.7573$1,410.00$437.12$282.00
    46285TRemoval of anal fistula015023.7573$1,410.00$437.12$282.00
    46288TRepair anal fistula015023.7573$1,410.00$437.12$282.00
    46320TRemoval of hemorrhoid clot01483.7213$220.86$56.96$44.17
    46500TInjection into hemorrhoid(s)015516.1810$960.34$192.07
    46600XDiagnostic anoscopy03400.6355$37.72$7.54
    46604TAnoscopy and dilation01477.9318$470.75$94.15
    46606TAnoscopy and biopsy01464.6164$273.98$64.40$54.80
    46608TAnoscopy, remove for body01477.9318$470.75$94.15
    46610TAnoscopy, remove lesion042819.8121$1,175.85$235.17
    46611TAnoscopy01477.9318$470.75$94.15
    46612TAnoscopy, remove lesions042819.8121$1,175.85$235.17
    46614TAnoscopy, control bleeding01464.6164$273.98$64.40$54.80
    46615TAnoscopy042819.8121$1,175.85$235.17
    46700TRepair of anal stricture015023.7573$1,410.00$437.12$282.00
    46705CRepair of anal stricture
    46706TRepr of anal fistula w/glue015023.7573$1,410.00$437.12$282.00
    46715CRepair of anovaginal fistula
    46716CRepair of anovaginal fistula
    46730CConstruction of absent anus
    46735CConstruction of absent anus
    46740CConstruction of absent anus
    46742CRepair of imperforated anus
    46744CRepair of cloacal anomaly
    46746CRepair of cloacal anomaly
    46748CRepair of cloacal anomaly
    46750TRepair of anal sphincter015023.7573$1,410.00$437.12$282.00
    46751CRepair of anal sphincter
    46753TReconstruction of anus015023.7573$1,410.00$437.12$282.00
    46754TRemoval of suture from anus014917.9907$1,067.75$293.06$213.55
    46760TRepair of anal sphincter015023.7573$1,410.00$437.12$282.00
    46761TRepair of anal sphincter015023.7573$1,410.00$437.12$282.00
    Start Printed Page 42834
    46762TImplant artificial sphincter015023.7573$1,410.00$437.12$282.00
    46900TDestruction, anal lesion(s)00162.5717$152.63$33.42$30.53
    46910TDestruction, anal lesion(s)001718.3377$1,088.34$227.84$217.67
    46916TCryosurgery, anal lesion(s)00131.1028$65.45$14.20$13.09
    46917TLaser surgery, anal lesions069520.2244$1,200.32$266.59$240.06
    46922TExcision of anal lesion(s)069520.2244$1,200.32$266.59$240.06
    46924TDestruction, anal lesion(s)069520.2244$1,200.32$266.59$240.06
    46934TDestruction of hemorrhoids015516.1810$960.34$192.07
    46935TDestruction of hemorrhoids015516.1810$960.34$192.07
    46936TDestruction of hemorrhoids014917.9907$1,067.75$293.06$213.55
    46937TCryotherapy of rectal lesion014917.9907$1,067.75$293.06$213.55
    46938TCryotherapy of rectal lesion015023.7573$1,410.00$437.12$282.00
    46940TTreatment of anal fissure014917.9907$1,067.75$293.06$213.55
    46942TTreatment of anal fissure01483.7213$220.86$56.96$44.17
    46945TLigation of hemorrhoids015516.1810$960.34$192.07
    46946TLigation of hemorrhoids015516.1810$960.34$192.07
    46947THemorrhoidopexy by stapling015023.7573$1,410.00$437.12$282.00
    46999TAnus surgery procedure01483.7213$220.86$56.96$44.17
    47000TNeedle biopsy of liver06855.9902$355.52$115.47$71.10
    47001NNeedle biopsy, liver add-on
    47010COpen drainage, liver lesion
    47011TPercut drain, liver lesion00379.4322$559.80$223.91$111.96
    47015CInject/aspirate liver cyst
    47100CWedge biopsy of liver
    47120CPartial removal of liver
    47122CExtensive removal of liver
    47125CPartial removal of liver
    47130CPartial removal of liver
    47133CRemoval of donor liver
    47135CTransplantation of liver
    47136CTransplantation of liver
    47140CPartial removal, donor liver
    47141CPartial removal, donor liver
    47142CPartial removal, donor liver
    47143CPrep donor liver, whole
    47144CPrep donor liver, 3-segment
    47145CPrep donor liver, lobe split
    47146CPrep donor liver/venous
    47147CPrep donor liver/arterial
    47300CSurgery for liver lesion
    47350CRepair liver wound
    47360CRepair liver wound
    47361CRepair liver wound
    47362CRepair liver wound
    47370TLaparo ablate liver tumor rf013143.1426$2,560.51$1,001.89$512.10
    47371TLaparo ablate liver cryosurg013143.1426$2,560.51$1,001.89$512.10
    47379TLaparoscope procedure, liver013031.7825$1,886.29$659.53$377.26
    47380COpen ablate liver tumor rf
    47381COpen ablate liver tumor cryo
    47382TPercut ablate liver rf042340.1041$2,380.18$476.04
    47399TLiver surgery procedure00020.9515$56.47$11.29
    47400CIncision of liver duct
    47420CIncision of bile duct
    47425CIncision of bile duct
    47460CIncise bile duct sphincter
    47480CIncision of gallbladder
    47490TIncision of gallbladder015212.2277$725.71$145.14
    47500NInjection for liver x-rays
    47505NInjection for liver x-rays
    47510TInsert catheter, bile duct015212.2277$725.71$145.14
    47511TInsert bile duct drain015212.2277$725.71$145.14
    47525TChange bile duct catheter042710.1516$602.50$123.56$120.50
    47530TRevise/reinsert bile tube042710.1516$602.50$123.56$120.50
    47550CBile duct endoscopy add-on
    47552TBiliary endoscopy thru skin015212.2277$725.71$145.14
    47553TBiliary endoscopy thru skin015212.2277$725.71$145.14
    Start Printed Page 42835
    47554TBiliary endoscopy thru skin015212.2277$725.71$145.14
    47555TBiliary endoscopy thru skin015212.2277$725.71$145.14
    47556TBiliary endoscopy thru skin015212.2277$725.71$145.14
    47560TLaparoscopy w/cholangio013031.7825$1,886.29$659.53$377.26
    47561TLaparo w/cholangio/biopsy013031.7825$1,886.29$659.53$377.26
    47562TLaparoscopic cholecystectomy013143.1426$2,560.51$1,001.89$512.10
    47563TLaparo cholecystectomy/graph013143.1426$2,560.51$1,001.89$512.10
    47564TLaparo cholecystectomy/explr013143.1426$2,560.51$1,001.89$512.10
    47570CLaparo cholecystoenterostomy
    47579TLaparoscope proc, biliary013031.7825$1,886.29$659.53$377.26
    47600CRemoval of gallbladder
    47605CRemoval of gallbladder
    47610CRemoval of gallbladder
    47612CRemoval of gallbladder
    47620CRemoval of gallbladder
    47630TRemove bile duct stone015212.2277$725.71$145.14
    47700CExploration of bile ducts
    47701CBile duct revision
    47711CExcision of bile duct tumor
    47712CExcision of bile duct tumor
    47715CExcision of bile duct cyst
    47716CFusion of bile duct cyst
    47720CFuse gallbladder & bowel
    47721CFuse upper gi structures
    47740CFuse gallbladder & bowel
    47741CFuse gallbladder & bowel
    47760CFuse bile ducts and bowel
    47765CFuse liver ducts & bowel
    47780CFuse bile ducts and bowel
    47785CFuse bile ducts and bowel
    47800CReconstruction of bile ducts
    47801CPlacement, bile duct support
    47802CFuse liver duct & intestine
    47900CSuture bile duct injury
    47999TBile tract surgery procedure015212.2277$725.71$145.14
    48000CDrainage of abdomen
    48001CPlacement of drain, pancreas
    48005CResect/debride pancreas
    48020CRemoval of pancreatic stone
    48100CBiopsy of pancreas, open
    48102TNeedle biopsy, pancreas06855.9902$355.52$115.47$71.10
    48120CRemoval of pancreas lesion
    48140CPartial removal of pancreas
    48145CPartial removal of pancreas
    48146CPancreatectomy
    48148CRemoval of pancreatic duct
    48150CPartial removal of pancreas
    48152CPancreatectomy
    48153CPancreatectomy
    48154CPancreatectomy
    48155CRemoval of pancreas
    48160EPancreas removal/transplant
    48180CFuse pancreas and bowel
    48400CInjection, intraop add-on
    48500CSurgery of pancreatic cyst
    48510CDrain pancreatic pseudocyst
    48511TDrain pancreatic pseudocyst00379.4322$559.80$223.91$111.96
    48520CFuse pancreas cyst and bowel
    48540CFuse pancreas cyst and bowel
    48545CPancreatorrhaphy
    48547CDuodenal exclusion
    48550EDonor pancreatectomy
    48551CPrep donor pancreas
    48552CPrep donor pancreas/venous
    48554ETranspl allograft pancreas
    48556CRemoval, allograft pancreas
    Start Printed Page 42836
    48999TPancreas surgery procedure00041.7566$104.25$22.36$20.85
    49000CExploration of abdomen
    49002CReopening of abdomen
    49010CExploration behind abdomen
    49020CDrain abdominal abscess
    49021TDrain abdominal abscess00379.4322$559.80$223.91$111.96
    49040CDrain, open, abdom abscess
    49041TDrain, percut, abdom abscess00379.4322$559.80$223.91$111.96
    49060CDrain, open, retrop abscess
    49061TDrain, percut, retroper absc00379.4322$559.80$223.91$111.96
    49062CDrain to peritoneal cavity
    49080TPuncture, peritoneal cavity00703.1956$189.66$37.93
    49081TRemoval of abdominal fluid00703.1956$189.66$37.93
    49085TRemove abdomen foreign body015321.5979$1,281.84$381.07$256.37
    49180TBiopsy, abdominal mass06855.9902$355.52$115.47$71.10
    49200TRemoval of abdominal lesion013031.7825$1,886.29$659.53$377.26
    49201CRemove abdom lesion, complex
    49215CExcise sacral spine tumor
    49220CMultiple surgery, abdomen
    49250TExcision of umbilicus015321.5979$1,281.84$381.07$256.37
    49255CRemoval of omentum
    49320TDiag laparo separate proc013031.7825$1,886.29$659.53$377.26
    49321TLaparoscopy, biopsy013031.7825$1,886.29$659.53$377.26
    49322TLaparoscopy, aspiration013031.7825$1,886.29$659.53$377.26
    49323TLaparo drain lymphocele013031.7825$1,886.29$659.53$377.26
    49329TLaparo proc, abdm/per/oment013031.7825$1,886.29$659.53$377.26
    49400NAir injection into abdomen
    49419TInsrt abdom cath for chemotx011531.3302$1,859.45$459.35$371.89
    49420TInsert abdom drain, temp065228.7639$1,707.14$341.43
    49421TInsert abdom drain, perm065228.7639$1,707.14$341.43
    49422TRemove perm cannula/catheter010522.2671$1,321.55$370.40$264.31
    49423TExchange drainage catheter015212.2277$725.71$145.14
    49424NAssess cyst, contrast inject
    49425CInsert abdomen-venous drain
    49426TRevise abdomen-venous shunt015321.5979$1,281.84$381.07$256.37
    49427NInjection, abdominal shunt
    49428CLigation of shunt
    49429TRemoval of shunt010522.2671$1,321.55$370.40$264.31
    49491TRpr hern preemie reduc015428.6544$1,700.64$464.85$340.13
    49492TRpr ing hern premie, blocked015428.6544$1,700.64$464.85$340.13
    49495TRpr ing hernia baby, reduc015428.6544$1,700.64$464.85$340.13
    49496TRpr ing hernia baby, blocked015428.6544$1,700.64$464.85$340.13
    49500TRpr ing hernia, init, reduce015428.6544$1,700.64$464.85$340.13
    49501TRpr ing hernia, init blocked015428.6544$1,700.64$464.85$340.13
    49505TPrp i/hern init reduc>5 yr015428.6544$1,700.64$464.85$340.13
    49507TPrp i/hern init block>5 yr015428.6544$1,700.64$464.85$340.13
    49520TRerepair ing hernia, reduce015428.6544$1,700.64$464.85$340.13
    49521TRerepair ing hernia, blocked015428.6544$1,700.64$464.85$340.13
    49525TRepair ing hernia, sliding015428.6544$1,700.64$464.85$340.13
    49540TRepair lumbar hernia015428.6544$1,700.64$464.85$340.13
    49550TRpr rem hernia, init, reduce015428.6544$1,700.64$464.85$340.13
    49553TRpr fem hernia, init blocked015428.6544$1,700.64$464.85$340.13
    49555TRerepair fem hernia, reduce015428.6544$1,700.64$464.85$340.13
    49557TRerepair fem hernia, blocked015428.6544$1,700.64$464.85$340.13
    49560TRpr ventral hern init, reduc015428.6544$1,700.64$464.85$340.13
    49561TRpr ventral hern init, block015428.6544$1,700.64$464.85$340.13
    49565TRerepair ventrl hern, reduce015428.6544$1,700.64$464.85$340.13
    49566TRerepair ventrl hern, block015428.6544$1,700.64$464.85$340.13
    49568THernia repair w/mesh015428.6544$1,700.64$464.85$340.13
    49570TRpr epigastric hern, reduce015428.6544$1,700.64$464.85$340.13
    49572TRpr epigastric hern, blocked015428.6544$1,700.64$464.85$340.13
    49580TRpr umbil hern, reduc < 5 yr015428.6544$1,700.64$464.85$340.13
    49582TRpr umbil hern, block < 5 yr015428.6544$1,700.64$464.85$340.13
    49585TRpr umbil hern, reduc > 5 yr015428.6544$1,700.64$464.85$340.13
    49587TRpr umbil hern, block > 5 yr015428.6544$1,700.64$464.85$340.13
    49590TRepair spigilian hernia015428.6544$1,700.64$464.85$340.13
    Start Printed Page 42837
    49600TRepair umbilical lesion015428.6544$1,700.64$464.85$340.13
    49605CRepair umbilical lesion
    49606CRepair umbilical lesion
    49610CRepair umbilical lesion
    49611CRepair umbilical lesion
    49650TLaparo hernia repair initial013143.1426$2,560.51$1,001.89$512.10
    49651TLaparo hernia repair recur013143.1426$2,560.51$1,001.89$512.10
    49659TLaparo proc, hernia repair013031.7825$1,886.29$659.53$377.26
    49900CRepair of abdominal wall
    49904COmental flap, extra-abdom
    49905COmental flap
    49906CFree omental flap, microvasc
    49999TAbdomen surgery procedure015321.5979$1,281.84$381.07$256.37
    50010CExploration of kidney
    50020TRenal abscess, open drain016223.2858$1,382.01$276.40
    50021TRenal abscess, percut drain00379.4322$559.80$223.91$111.96
    50040CDrainage of kidney
    50045CExploration of kidney
    50060CRemoval of kidney stone
    50065CIncision of kidney
    50070CIncision of kidney
    50075CRemoval of kidney stone
    50080TRemoval of kidney stone042942.1231$2,500.01$500.00
    50081TRemoval of kidney stone042942.1231$2,500.01$500.00
    50100CRevise kidney blood vessels
    50120CExploration of kidney
    50125CExplore and drain kidney
    50130CRemoval of kidney stone
    50135CExploration of kidney
    50200TBiopsy of kidney06855.9902$355.52$115.47$71.10
    50205CBiopsy of kidney
    50220CRemove kidney, open
    50225CRemoval kidney open, complex
    50230CRemoval kidney open, radical
    50234CRemoval of kidney & ureter
    50236CRemoval of kidney & ureter
    50240CPartial removal of kidney
    50280CRemoval of kidney lesion
    50290CRemoval of kidney lesion
    50300CRemoval of donor kidney
    50320CRemoval of donor kidney
    50323CPrep cadaver renal allograft
    50325CPrep donor renal graft
    50327CPrep renal graft/venous
    50328CPrep renal graft/arterial
    50329CPrep renal graft/ureteral
    50340CRemoval of kidney
    50360CTransplantation of kidney
    50365CTransplantation of kidney
    50370CRemove transplanted kidney
    50380CReimplantation of kidney
    50390TDrainage of kidney lesion06855.9902$355.52$115.47$71.10
    50391TInstll rx agnt into rnal tub01562.5635$152.14$40.52$30.43
    50392TInsert kidney drain016118.4736$1,096.41$249.36$219.28
    50393TInsert ureteral tube016118.4736$1,096.41$249.36$219.28
    50394NInjection for kidney x-ray
    50395TCreate passage to kidney016118.4736$1,096.41$249.36$219.28
    50396TMeasure kidney pressure01641.1802$70.04$17.21$14.01
    50398TChange kidney tube01226.9405$411.92$84.48$82.38
    50400CRevision of kidney/ureter
    50405CRevision of kidney/ureter
    50500CRepair of kidney wound
    50520CClose kidney-skin fistula
    50525CRepair renal-abdomen fistula
    50526CRepair renal-abdomen fistula
    50540CRevision of horseshoe kidney
    Start Printed Page 42838
    50541TLaparo ablate renal cyst013031.7825$1,886.29$659.53$377.26
    50542TLaparo ablate renal mass013143.1426$2,560.51$1,001.89$512.10
    50543TLaparo partial nephrectomy013143.1426$2,560.51$1,001.89$512.10
    50544TLaparoscopy, pyeloplasty013031.7825$1,886.29$659.53$377.26
    50545CLaparo radical nephrectomy
    50546CLaparoscopic nephrectomy
    50547CLaparo removal donor kidney
    50548CLaparo remove w/ ureter
    50549TLaparoscope proc, renal013031.7825$1,886.29$659.53$377.26
    50551TKidney endoscopy01606.6450$394.38$105.06$78.88
    50553TKidney endoscopy016118.4736$1,096.41$249.36$219.28
    50555TKidney endoscopy & biopsy01606.6450$394.38$105.06$78.88
    50557TKidney endoscopy & treatment016223.2858$1,382.01$276.40
    50561TKidney endoscopy & treatment016118.4736$1,096.41$249.36$219.28
    50562TRenal scope w/tumor resect01606.6450$394.38$105.06$78.88
    50570TKidney endoscopy01606.6450$394.38$105.06$78.88
    50572TKidney endoscopy01606.6450$394.38$105.06$78.88
    50574TKidney endoscopy & biopsy01606.6450$394.38$105.06$78.88
    50575TKidney endoscopy016333.5826$1,993.13$398.63
    50576TKidney endoscopy & treatment016118.4736$1,096.41$249.36$219.28
    50580CKidney endoscopy & treatment
    50590TFragmenting of kidney stone016942.8184$2,541.27$1,016.50$508.25
    50600CExploration of ureter
    50605CInsert ureteral support
    50610CRemoval of ureter stone
    50620CRemoval of ureter stone
    50630CRemoval of ureter stone
    50650CRemoval of ureter
    50660CRemoval of ureter
    50684NInjection for ureter x-ray
    50686TMeasure ureter pressure01641.1802$70.04$17.21$14.01
    50688TChange of ureter tube01226.9405$411.92$84.48$82.38
    50690NInjection for ureter x-ray
    50700CRevision of ureter
    50715CRelease of ureter
    50722CRelease of ureter
    50725CRelease/revise ureter
    50727CRevise ureter
    50728CRevise ureter
    50740CFusion of ureter & kidney
    50750CFusion of ureter & kidney
    50760CFusion of ureters
    50770CSplicing of ureters
    50780CReimplant ureter in bladder
    50782CReimplant ureter in bladder
    50783CReimplant ureter in bladder
    50785CReimplant ureter in bladder
    50800CImplant ureter in bowel
    50810CFusion of ureter & bowel
    50815CUrine shunt to intestine
    50820CConstruct bowel bladder
    50825CConstruct bowel bladder
    50830CRevise urine flow
    50840CReplace ureter by bowel
    50845CAppendico-vesicostomy
    50860CTransplant ureter to skin
    50900CRepair of ureter
    50920CClosure ureter/skin fistula
    50930CClosure ureter/bowel fistula
    50940CRelease of ureter
    50945TLaparoscopy ureterolithotomy013143.1426$2,560.51$1,001.89$512.10
    50947TLaparo new ureter/bladder013143.1426$2,560.51$1,001.89$512.10
    50948TLaparo new ureter/bladder013143.1426$2,560.51$1,001.89$512.10
    50949TLaparoscope proc, ureter013031.7825$1,886.29$659.53$377.26
    50951TEndoscopy of ureter01606.6450$394.38$105.06$78.88
    50953TEndoscopy of ureter01606.6450$394.38$105.06$78.88
    Start Printed Page 42839
    50955TUreter endoscopy & biopsy016118.4736$1,096.41$249.36$219.28
    50957TUreter endoscopy & treatment016118.4736$1,096.41$249.36$219.28
    50961TUreter endoscopy & treatment016118.4736$1,096.41$249.36$219.28
    50970TUreter endoscopy01606.6450$394.38$105.06$78.88
    50972TUreter endoscopy & catheter01606.6450$394.38$105.06$78.88
    50974TUreter endoscopy & biopsy016118.4736$1,096.41$249.36$219.28
    50976TUreter endoscopy & treatment016118.4736$1,096.41$249.36$219.28
    50980TUreter endoscopy & treatment016118.4736$1,096.41$249.36$219.28
    51000TDrainage of bladder01641.1802$70.04$17.21$14.01
    51005TDrainage of bladder01641.1802$70.04$17.21$14.01
    51010TDrainage of bladder016516.5934$984.82$196.96
    51020TIncise & treat bladder016223.2858$1,382.01$276.40
    51030TIncise & treat bladder016223.2858$1,382.01$276.40
    51040TIncise & drain bladder016223.2858$1,382.01$276.40
    51045TIncise bladder/drain ureter01606.6450$394.38$105.06$78.88
    51050TRemoval of bladder stone016223.2858$1,382.01$276.40
    51060CRemoval of ureter stone
    51065TRemove ureter calculus016223.2858$1,382.01$276.40
    51080TDrainage of bladder abscess000816.4242$974.78$194.96
    51500TRemoval of bladder cyst015428.6544$1,700.64$464.85$340.13
    51520TRemoval of bladder lesion016223.2858$1,382.01$276.40
    51525CRemoval of bladder lesion
    51530CRemoval of bladder lesion
    51535CRepair of ureter lesion
    51550CPartial removal of bladder
    51555CPartial removal of bladder
    51565CRevise bladder & ureter(s)
    51570CRemoval of bladder
    51575CRemoval of bladder & nodes
    51580CRemove bladder/revise tract
    51585CRemoval of bladder & nodes
    51590CRemove bladder/revise tract
    51595CRemove bladder/revise tract
    51596CRemove bladder/create pouch
    51597CRemoval of pelvic structures
    51600NInjection for bladder x-ray
    51605NPreparation for bladder xray
    51610NInjection for bladder x-ray
    51700TIrrigation of bladder01641.1802$70.04$17.21$14.01
    51701XInsert bladder catheter03400.6355$37.72$7.54
    51702XInsert temp bladder cath03400.6355$37.72$7.54
    51703TInsert bladder cath, complex01641.1802$70.04$17.21$14.01
    51705TChange of bladder tube01212.2663$134.50$43.80$26.90
    51710TChange of bladder tube01226.9405$411.92$84.48$82.38
    51715TEndoscopic injection/implant016828.1405$1,670.14$386.32$334.03
    51720TTreatment of bladder lesion01562.5635$152.14$40.52$30.43
    51725TSimple cystometrogram01562.5635$152.14$40.52$30.43
    51726TComplex cystometrogram01562.5635$152.14$40.52$30.43
    51736TUrine flow measurement01641.1802$70.04$17.21$14.01
    51741TElectro-uroflowmetry, first01641.1802$70.04$17.21$14.01
    51772TUrethra pressure profile01562.5635$152.14$40.52$30.43
    51784TAnal/urinary muscle study01641.1802$70.04$17.21$14.01
    51785TAnal/urinary muscle study01641.1802$70.04$17.21$14.01
    51792TUrinary reflex study01641.1802$70.04$17.21$14.01
    51795TUrine voiding pressure study01641.1802$70.04$17.21$14.01
    51797TIntraabdominal pressure test01641.1802$70.04$17.21$14.01
    51798XUs urine capacity measure03400.6355$37.72$7.54
    51800CRevision of bladder/urethra
    51820CRevision of urinary tract
    51840CAttach bladder/urethra
    51841CAttach bladder/urethra
    51845CRepair bladder neck
    51860CRepair of bladder wound
    51865CRepair of bladder wound
    51880TRepair of bladder opening016223.2858$1,382.01$276.40
    51900CRepair bladder/vagina lesion
    Start Printed Page 42840
    51920CClose bladder-uterus fistula
    51925CHysterectomy/bladder repair
    51940CCorrection of bladder defect
    51960CRevision of bladder & bowel
    51980CConstruct bladder opening
    51990TLaparo urethral suspension013143.1426$2,560.51$1,001.89$512.10
    51992TLaparo sling operation013262.7061$3,721.61$1,239.22$744.32
    52000TCystoscopy01606.6450$394.38$105.06$78.88
    52001TCystoscopy, removal of clots01606.6450$394.38$105.06$78.88
    52005TCystoscopy & ureter catheter016118.4736$1,096.41$249.36$219.28
    52007TCystoscopy and biopsy016118.4736$1,096.41$249.36$219.28
    52010TCystoscopy & duct catheter01606.6450$394.38$105.06$78.88
    52204TCystoscopy016118.4736$1,096.41$249.36$219.28
    52214TCystoscopy and treatment016223.2858$1,382.01$276.40
    52224TCystoscopy and treatment016223.2858$1,382.01$276.40
    52234TCystoscopy and treatment016223.2858$1,382.01$276.40
    52235TCystoscopy and treatment016223.2858$1,382.01$276.40
    52240TCystoscopy and treatment016223.2858$1,382.01$276.40
    52250TCystoscopy and radiotracer016223.2858$1,382.01$276.40
    52260TCystoscopy and treatment016118.4736$1,096.41$249.36$219.28
    52265TCystoscopy and treatment01606.6450$394.38$105.06$78.88
    52270TCystoscopy & revise urethra016118.4736$1,096.41$249.36$219.28
    52275TCystoscopy & revise urethra016118.4736$1,096.41$249.36$219.28
    52276TCystoscopy and treatment016118.4736$1,096.41$249.36$219.28
    52277TCystoscopy and treatment016223.2858$1,382.01$276.40
    52281TCystoscopy and treatment016118.4736$1,096.41$249.36$219.28
    52282TCystoscopy, implant stent016333.5826$1,993.13$398.63
    52283TCystoscopy and treatment016118.4736$1,096.41$249.36$219.28
    52285TCystoscopy and treatment016118.4736$1,096.41$249.36$219.28
    52290TCystoscopy and treatment016118.4736$1,096.41$249.36$219.28
    52300TCystoscopy and treatment016118.4736$1,096.41$249.36$219.28
    52301TCystoscopy and treatment016118.4736$1,096.41$249.36$219.28
    52305TCystoscopy and treatment016118.4736$1,096.41$249.36$219.28
    52310TCystoscopy and treatment01606.6450$394.38$105.06$78.88
    52315TCystoscopy and treatment016118.4736$1,096.41$249.36$219.28
    52317TRemove bladder stone016223.2858$1,382.01$276.40
    52318TRemove bladder stone016223.2858$1,382.01$276.40
    52320TCystoscopy and treatment016223.2858$1,382.01$276.40
    52325TCystoscopy, stone removal016223.2858$1,382.01$276.40
    52327TCystoscopy, inject material016223.2858$1,382.01$276.40
    52330TCystoscopy and treatment016223.2858$1,382.01$276.40
    52332TCystoscopy and treatment016223.2858$1,382.01$276.40
    52334TCreate passage to kidney016223.2858$1,382.01$276.40
    52341TCysto w/ureter stricture tx016223.2858$1,382.01$276.40
    52342TCysto w/up stricture tx016223.2858$1,382.01$276.40
    52343TCysto w/renal stricture tx016223.2858$1,382.01$276.40
    52344TCysto/uretero, stone remove016223.2858$1,382.01$276.40
    52345TCysto/uretero w/up stricture016223.2858$1,382.01$276.40
    52346TCystouretero w/renal strict016223.2858$1,382.01$276.40
    52351TCystouretero & or pyeloscope016118.4736$1,096.41$249.36$219.28
    52352TCystouretero w/stone remove016223.2858$1,382.01$276.40
    52353TCystouretero w/lithotripsy016333.5826$1,993.13$398.63
    52354TCystouretero w/biopsy016223.2858$1,382.01$276.40
    52355TCystouretero w/excise tumor016223.2858$1,382.01$276.40
    52400TCystouretero w/congen repr016223.2858$1,382.01$276.40
    52402TCystourethro cut ejacul duct016223.2858$1,382.01$276.40
    52450TIncision of prostate016223.2858$1,382.01$276.40
    52500TRevision of bladder neck016223.2858$1,382.01$276.40
    52510TDilation prostatic urethra016118.4736$1,096.41$249.36$219.28
    52601TProstatectomy (TURP)016333.5826$1,993.13$398.63
    52606TControl postop bleeding016223.2858$1,382.01$276.40
    52612TProstatectomy, first stage016333.5826$1,993.13$398.63
    52614TProstatectomy, second stage016333.5826$1,993.13$398.63
    52620TRemove residual prostate016333.5826$1,993.13$398.63
    52630TRemove prostate regrowth016333.5826$1,993.13$398.63
    52640TRelieve bladder contracture016223.2858$1,382.01$276.40
    Start Printed Page 42841
    52647TLaser surgery of prostate042942.1231$2,500.01$500.00
    52648TLaser surgery of prostate042942.1231$2,500.01$500.00
    52700TDrainage of prostate abscess016223.2858$1,382.01$276.40
    53000TIncision of urethra016617.5942$1,044.22$218.73$208.84
    53010TIncision of urethra016617.5942$1,044.22$218.73$208.84
    53020TIncision of urethra016617.5942$1,044.22$218.73$208.84
    53025TIncision of urethra016617.5942$1,044.22$218.73$208.84
    53040TDrainage of urethra abscess016617.5942$1,044.22$218.73$208.84
    53060TDrainage of urethra abscess016617.5942$1,044.22$218.73$208.84
    53080TDrainage of urinary leakage016617.5942$1,044.22$218.73$208.84
    53085TDrainage of urinary leakage016617.5942$1,044.22$218.73$208.84
    53200TBiopsy of urethra016617.5942$1,044.22$218.73$208.84
    53210TRemoval of urethra016828.1405$1,670.14$386.32$334.03
    53215TRemoval of urethra016617.5942$1,044.22$218.73$208.84
    53220TTreatment of urethra lesion016828.1405$1,670.14$386.32$334.03
    53230TRemoval of urethra lesion016828.1405$1,670.14$386.32$334.03
    53235TRemoval of urethra lesion016617.5942$1,044.22$218.73$208.84
    53240TSurgery for urethra pouch016828.1405$1,670.14$386.32$334.03
    53250TRemoval of urethra gland016617.5942$1,044.22$218.73$208.84
    53260TTreatment of urethra lesion016617.5942$1,044.22$218.73$208.84
    53265TTreatment of urethra lesion016617.5942$1,044.22$218.73$208.84
    53270TRemoval of urethra gland016617.5942$1,044.22$218.73$208.84
    53275TRepair of urethra defect016617.5942$1,044.22$218.73$208.84
    53400TRevise urethra, stage 1016828.1405$1,670.14$386.32$334.03
    53405TRevise urethra, stage 2016828.1405$1,670.14$386.32$334.03
    53410TReconstruction of urethra016828.1405$1,670.14$386.32$334.03
    53415CReconstruction of urethra
    53420TReconstruct urethra, stage 1016828.1405$1,670.14$386.32$334.03
    53425TReconstruct urethra, stage 2016828.1405$1,670.14$386.32$334.03
    53430TReconstruction of urethra016828.1405$1,670.14$386.32$334.03
    53431TReconstruct urethra/bladder016828.1405$1,670.14$386.32$334.03
    53440SCorrect bladder function038575.3020$4,469.17$893.83
    53442TRemove perineal prosthesis016828.1405$1,670.14$386.32$334.03
    53444SInsert tandem cuff038575.3020$4,469.17$893.83
    53445SInsert uro/ves nck sphincter0386119.6251$7,099.75$1,419.95
    53446TRemove uro sphincter016828.1405$1,670.14$386.32$334.03
    53447SRemove/replace ur sphincter0386119.6251$7,099.75$1,419.95
    53448CRemov/replc ur sphinctr comp
    53449TRepair uro sphincter016828.1405$1,670.14$386.32$334.03
    53450TRevision of urethra016828.1405$1,670.14$386.32$334.03
    53460TRevision of urethra016617.5942$1,044.22$218.73$208.84
    53500TUrethrlys, transvag w/ scope016828.1405$1,670.14$386.32$334.03
    53502TRepair of urethra injury016617.5942$1,044.22$218.73$208.84
    53505TRepair of urethra injury016828.1405$1,670.14$386.32$334.03
    53510TRepair of urethra injury016617.5942$1,044.22$218.73$208.84
    53515TRepair of urethra injury016828.1405$1,670.14$386.32$334.03
    53520TRepair of urethra defect016828.1405$1,670.14$386.32$334.03
    53600TDilate urethra stricture01562.5635$152.14$40.52$30.43
    53601TDilate urethra stricture01641.1802$70.04$17.21$14.01
    53605TDilate urethra stricture016118.4736$1,096.41$249.36$219.28
    53620TDilate urethra stricture016516.5934$984.82$196.96
    53621TDilate urethra stricture01641.1802$70.04$17.21$14.01
    53660TDilation of urethra01641.1802$70.04$17.21$14.01
    53661TDilation of urethra01641.1802$70.04$17.21$14.01
    53665TDilation of urethra016617.5942$1,044.22$218.73$208.84
    53850TProstatic microwave thermotx067543.5348$2,583.79$516.76
    53852TProstatic rf thermotx067543.5348$2,583.79$516.76
    53853TProstatic water thermother016223.2858$1,382.01$276.40
    53899TUrology surgery procedure01641.1802$70.04$17.21$14.01
    54000TSlitting of prepuce016617.5942$1,044.22$218.73$208.84
    54001TSlitting of prepuce016617.5942$1,044.22$218.73$208.84
    54015TDrain penis lesion000816.4242$974.78$194.96
    54050TDestruction, penis lesion(s)00131.1028$65.45$14.20$13.09
    54055TDestruction, penis lesion(s)001718.3377$1,088.34$227.84$217.67
    54056TCryosurgery, penis lesion(s)00120.8458$50.20$11.18$10.04
    54057TLaser surg, penis lesion(s)001718.3377$1,088.34$227.84$217.67
    Start Printed Page 42842
    54060TExcision of penis lesion(s)001718.3377$1,088.34$227.84$217.67
    54065TDestruction, penis lesion(s)069520.2244$1,200.32$266.59$240.06
    54100TBiopsy of penis002114.9098$884.90$219.48$176.98
    54105TBiopsy of penis002219.5582$1,160.78$354.45$232.16
    54110TTreatment of penis lesion018130.7265$1,823.62$621.82$364.72
    54111TTreat penis lesion, graft018130.7265$1,823.62$621.82$364.72
    54112TTreat penis lesion, graft018130.7265$1,823.62$621.82$364.72
    54115TTreatment of penis lesion000816.4242$974.78$194.96
    54120TPartial removal of penis018130.7265$1,823.62$621.82$364.72
    54125CRemoval of penis
    54130CRemove penis & nodes
    54135CRemove penis & nodes
    54150TCircumcision018019.7926$1,174.69$304.87$234.94
    54152TCircumcision018019.7926$1,174.69$304.87$234.94
    54160TCircumcision018019.7926$1,174.69$304.87$234.94
    54161TCircumcision018019.7926$1,174.69$304.87$234.94
    54162TLysis penil circumic lesion018019.7926$1,174.69$304.87$234.94
    54163TRepair of circumcision018019.7926$1,174.69$304.87$234.94
    54164TFrenulotomy of penis018019.7926$1,174.69$304.87$234.94
    54200TTreatment of penis lesion01562.5635$152.14$40.52$30.43
    54205TTreatment of penis lesion018130.7265$1,823.62$621.82$364.72
    54220TTreatment of penis lesion01562.5635$152.14$40.52$30.43
    54230NPrepare penis study
    54231TDynamic cavernosometry016516.5934$984.82$196.96
    54235TPenile injection01641.1802$70.04$17.21$14.01
    54240TPenis study01641.1802$70.04$17.21$14.01
    54250TPenis study01641.1802$70.04$17.21$14.01
    54300TRevision of penis018130.7265$1,823.62$621.82$364.72
    54304TRevision of penis018130.7265$1,823.62$621.82$364.72
    54308TReconstruction of urethra018130.7265$1,823.62$621.82$364.72
    54312TReconstruction of urethra018130.7265$1,823.62$621.82$364.72
    54316TReconstruction of urethra018130.7265$1,823.62$621.82$364.72
    54318TReconstruction of urethra018130.7265$1,823.62$621.82$364.72
    54322TReconstruction of urethra018130.7265$1,823.62$621.82$364.72
    54324TReconstruction of urethra018130.7265$1,823.62$621.82$364.72
    54326TReconstruction of urethra018130.7265$1,823.62$621.82$364.72
    54328TRevise penis/urethra018130.7265$1,823.62$621.82$364.72
    54332CRevise penis/urethra
    54336CRevise penis/urethra
    54340TSecondary urethral surgery018130.7265$1,823.62$621.82$364.72
    54344TSecondary urethral surgery018130.7265$1,823.62$621.82$364.72
    54348TSecondary urethral surgery018130.7265$1,823.62$621.82$364.72
    54352TReconstruct urethra/penis018130.7265$1,823.62$621.82$364.72
    54360TPenis plastic surgery018130.7265$1,823.62$621.82$364.72
    54380TRepair penis018130.7265$1,823.62$621.82$364.72
    54385TRepair penis018130.7265$1,823.62$621.82$364.72
    54390CRepair penis and bladder
    54400SInsert semi-rigid prosthesis038575.3020$4,469.17$893.83
    54401SInsert self-contd prosthesis0386119.6251$7,099.75$1,419.95
    54405SInsert multi-comp penis pros0386119.6251$7,099.75$1,419.95
    54406TRemove muti-comp penis pros018130.7265$1,823.62$621.82$364.72
    54408TRepair multi-comp penis pros018130.7265$1,823.62$621.82$364.72
    54410SRemove/replace penis prosth0386119.6251$7,099.75$1,419.95
    54411CRemov/replc penis pros, comp
    54415TRemove self-contd penis pros018130.7265$1,823.62$621.82$364.72
    54416SRemv/repl penis contain pros0386119.6251$7,099.75$1,419.95
    54417CRemv/replc penis pros, compl
    54420TRevision of penis018130.7265$1,823.62$621.82$364.72
    54430CRevision of penis
    54435TRevision of penis018130.7265$1,823.62$621.82$364.72
    54440TRepair of penis018130.7265$1,823.62$621.82$364.72
    54450TPreputial stretching01562.5635$152.14$40.52$30.43
    54500TBiopsy of testis00379.4322$559.80$223.91$111.96
    54505TBiopsy of testis018323.5344$1,396.77$279.35
    54512TExcise lesion testis018323.5344$1,396.77$279.35
    54520TRemoval of testis018323.5344$1,396.77$279.35
    Start Printed Page 42843
    54522TOrchiectomy, partial018323.5344$1,396.77$279.35
    54530TRemoval of testis015428.6544$1,700.64$464.85$340.13
    54535CExtensive testis surgery
    54550TExploration for testis015428.6544$1,700.64$464.85$340.13
    54560TExploration for testis018323.5344$1,396.77$279.35
    54600TReduce testis torsion018323.5344$1,396.77$279.35
    54620TSuspension of testis018323.5344$1,396.77$279.35
    54640TSuspension of testis015428.6544$1,700.64$464.85$340.13
    54650COrchiopexy (Fowler-Stephens)
    54660TRevision of testis018323.5344$1,396.77$279.35
    54670TRepair testis injury018323.5344$1,396.77$279.35
    54680TRelocation of testis(es)018323.5344$1,396.77$279.35
    54690TLaparoscopy, orchiectomy013143.1426$2,560.51$1,001.89$512.10
    54692TLaparoscopy, orchiopexy013262.7061$3,721.61$1,239.22$744.32
    54699TLaparoscope proc, testis013031.7825$1,886.29$659.53$377.26
    54700TDrainage of scrotum018323.5344$1,396.77$279.35
    54800TBiopsy of epididymis00041.7566$104.25$22.36$20.85
    54820TExploration of epididymis018323.5344$1,396.77$279.35
    54830TRemove epididymis lesion018323.5344$1,396.77$279.35
    54840TRemove epididymis lesion018323.5344$1,396.77$279.35
    54860TRemoval of epididymis018323.5344$1,396.77$279.35
    54861TRemoval of epididymis018323.5344$1,396.77$279.35
    54900TFusion of spermatic ducts018323.5344$1,396.77$279.35
    54901TFusion of spermatic ducts018323.5344$1,396.77$279.35
    55000TDrainage of hydrocele00041.7566$104.25$22.36$20.85
    55040TRemoval of hydrocele015428.6544$1,700.64$464.85$340.13
    55041TRemoval of hydroceles015428.6544$1,700.64$464.85$340.13
    55060TRepair of hydrocele018323.5344$1,396.77$279.35
    55100TDrainage of scrotum abscess000816.4242$974.78$194.96
    55110TExplore scrotum018323.5344$1,396.77$279.35
    55120TRemoval of scrotum lesion018323.5344$1,396.77$279.35
    55150TRemoval of scrotum018323.5344$1,396.77$279.35
    55175TRevision of scrotum018323.5344$1,396.77$279.35
    55180TRevision of scrotum018323.5344$1,396.77$279.35
    55200TIncision of sperm duct018323.5344$1,396.77$279.35
    55250TRemoval of sperm duct(s)018323.5344$1,396.77$279.35
    55300NPrepare, sperm duct x-ray
    55400TRepair of sperm duct018323.5344$1,396.77$279.35
    55450TLigation of sperm duct018323.5344$1,396.77$279.35
    55500TRemoval of hydrocele018323.5344$1,396.77$279.35
    55520TRemoval of sperm cord lesion018323.5344$1,396.77$279.35
    55530TRevise spermatic cord veins018323.5344$1,396.77$279.35
    55535TRevise spermatic cord veins015428.6544$1,700.64$464.85$340.13
    55540TRevise hernia & sperm veins015428.6544$1,700.64$464.85$340.13
    55550TLaparo ligate spermatic vein013143.1426$2,560.51$1,001.89$512.10
    55559TLaparo proc, spermatic cord013031.7825$1,886.29$659.53$377.26
    55600TIncise sperm duct pouch018323.5344$1,396.77$279.35
    55605CIncise sperm duct pouch
    55650CRemove sperm duct pouch
    55680TRemove sperm pouch lesion018323.5344$1,396.77$279.35
    55700TBiopsy of prostate01844.3369$257.40$96.27$51.48
    55705TBiopsy of prostate01844.3369$257.40$96.27$51.48
    55720TDrainage of prostate abscess016223.2858$1,382.01$276.40
    55725TDrainage of prostate abscess016223.2858$1,382.01$276.40
    55801CRemoval of prostate
    55810CExtensive prostate surgery
    55812CExtensive prostate surgery
    55815CExtensive prostate surgery
    55821CRemoval of prostate
    55831CRemoval of prostate
    55840CExtensive prostate surgery
    55842CExtensive prostate surgery
    55845CExtensive prostate surgery
    55859TPercut/needle insert, pros016333.5826$1,993.13$398.63
    55860TSurgical exposure, prostate016516.5934$984.82$196.96
    55862CExtensive prostate surgery
    Start Printed Page 42844
    55865CExtensive prostate surgery
    55866CLaparo radical prostatectomy
    55870TElectroejaculation01972.3465$139.26$27.85
    55873TCryoablate prostate067495.3518$5,659.13$1,131.83
    55899TGenital surgery procedure01641.1802$70.04$17.21$14.01
    55970ESex transformation, M to F
    55980ESex transformation, F to M
    56405TI & D of vulva/perineum01892.3602$140.08$28.02
    56420TDrainage of gland abscess01892.3602$140.08$28.02
    56440TSurgery for vulva lesion019420.6585$1,226.08$397.84$245.22
    56441TLysis of labial lesion(s)019314.5183$861.66$172.33
    56501TDestroy, vulva lesions, sim001718.3377$1,088.34$227.84$217.67
    56515TDestroy vulva lesion/s compl069520.2244$1,200.32$266.59$240.06
    56605TBiopsy of vulva/perineum00194.0363$239.55$71.87$47.91
    56606TBiopsy of vulva/perineum00194.0363$239.55$71.87$47.91
    56620TPartial removal of vulva019526.5582$1,576.23$483.80$315.25
    56625TComplete removal of vulva019526.5582$1,576.23$483.80$315.25
    56630CExtensive vulva surgery
    56631CExtensive vulva surgery
    56632CExtensive vulva surgery
    56633CExtensive vulva surgery
    56634CExtensive vulva surgery
    56637CExtensive vulva surgery
    56640CExtensive vulva surgery
    56700TPartial removal of hymen019420.6585$1,226.08$397.84$245.22
    56720TIncision of hymen019314.5183$861.66$172.33
    56740TRemove vagina gland lesion019420.6585$1,226.08$397.84$245.22
    56800TRepair of vagina019420.6585$1,226.08$397.84$245.22
    56805TRepair clitoris019314.5183$861.66$172.33
    56810TRepair of perineum019420.6585$1,226.08$397.84$245.22
    56820TExam of vulva w/scope01881.1348$67.35$13.47
    56821TExam/biopsy of vulva w/scope01892.3602$140.08$28.02
    57000TExploration of vagina019314.5183$861.66$172.33
    57010TDrainage of pelvic abscess019314.5183$861.66$172.33
    57020TDrainage of pelvic fluid01924.2887$254.53$50.91
    57022TI & d vaginal hematoma, pp000711.3983$676.49$135.30
    57023TI & d vag hematoma, non-ob000816.4242$974.78$194.96
    57061TDestroy vag lesions, simple019420.6585$1,226.08$397.84$245.22
    57065TDestroy vag lesions, complex019420.6585$1,226.08$397.84$245.22
    57100TBiopsy of vagina01924.2887$254.53$50.91
    57105TBiopsy of vagina019420.6585$1,226.08$397.84$245.22
    57106TRemove vagina wall, partial019420.6585$1,226.08$397.84$245.22
    57107TRemove vagina tissue, part019526.5582$1,576.23$483.80$315.25
    57109TVaginectomy partial w/nodes019526.5582$1,576.23$483.80$315.25
    57110CRemove vagina wall, complete
    57111CRemove vagina tissue, compl
    57112CVaginectomy w/nodes, compl
    57120TClosure of vagina019526.5582$1,576.23$483.80$315.25
    57130TRemove vagina lesion019420.6585$1,226.08$397.84$245.22
    57135TRemove vagina lesion019420.6585$1,226.08$397.84$245.22
    57150TTreat vagina infection01910.1663$9.87$2.77$1.97
    57155TInsert uteri tandems/ovoids01924.2887$254.53$50.91
    57160TInsert pessary/other device01881.1348$67.35$13.47
    57170TFitting of diaphragm/cap01910.1663$9.87$2.77$1.97
    57180TTreat vaginal bleeding01892.3602$140.08$28.02
    57200TRepair of vagina019420.6585$1,226.08$397.84$245.22
    57210TRepair vagina/perineum019420.6585$1,226.08$397.84$245.22
    57220TRevision of urethra020240.2037$2,386.09$954.43$477.22
    57230TRepair of urethral lesion019526.5582$1,576.23$483.80$315.25
    57240TRepair bladder & vagina019526.5582$1,576.23$483.80$315.25
    57250TRepair rectum & vagina019526.5582$1,576.23$483.80$315.25
    57260TRepair of vagina019526.5582$1,576.23$483.80$315.25
    57265TExtensive repair of vagina020240.2037$2,386.09$954.43$477.22
    57267TInsert mesh/pelvic flr addon015428.6544$1,700.64$464.85$340.13
    57268TRepair of bowel bulge019526.5582$1,576.23$483.80$315.25
    57270CRepair of bowel pouch
    Start Printed Page 42845
    57280CSuspension of vagina
    57282CRepair of vaginal prolapse
    57283CColpopexy, intraperitoneal
    57284TRepair paravaginal defect020240.2037$2,386.09$954.43$477.22
    57287TRevise/remove sling repair020240.2037$2,386.09$954.43$477.22
    57288TRepair bladder defect020240.2037$2,386.09$954.43$477.22
    57289TRepair bladder & vagina019526.5582$1,576.23$483.80$315.25
    57291TConstruction of vagina019526.5582$1,576.23$483.80$315.25
    57292CConstruct vagina with graft
    57300TRepair rectum-vagina fistula019526.5582$1,576.23$483.80$315.25
    57305CRepair rectum-vagina fistula
    57307CFistula repair & colostomy
    57308CFistula repair, transperine
    57310TRepair urethrovaginal lesion020240.2037$2,386.09$954.43$477.22
    57311CRepair urethrovaginal lesion
    57320TRepair bladder-vagina lesion019526.5582$1,576.23$483.80$315.25
    57330TRepair bladder-vagina lesion019526.5582$1,576.23$483.80$315.25
    57335CRepair vagina
    57400TDilation of vagina019420.6585$1,226.08$397.84$245.22
    57410TPelvic examination019314.5183$861.66$172.33
    57415TRemove vaginal foreign body019420.6585$1,226.08$397.84$245.22
    57420TExam of vagina w/scope01892.3602$140.08$28.02
    57421TExam/biopsy of vag w/scope01892.3602$140.08$28.02
    57425TLaparoscopy, surg, colpopexy013031.7825$1,886.29$659.53$377.26
    57452TExamination of vagina01892.3602$140.08$28.02
    57454TVagina examination & biopsy01892.3602$140.08$28.02
    57455TBiopsy of cervix w/scope01892.3602$140.08$28.02
    57456TEndocerv curettage w/scope01892.3602$140.08$28.02
    57460TCervix excision019314.5183$861.66$172.33
    57461TConz of cervix w/scope, leep019420.6585$1,226.08$397.84$245.22
    57500TBiopsy of cervix01924.2887$254.53$50.91
    57505TEndocervical curettage01892.3602$140.08$28.02
    57510TCauterization of cervix019314.5183$861.66$172.33
    57511TCryocautery of cervix01892.3602$140.08$28.02
    57513TLaser surgery of cervix019314.5183$861.66$172.33
    57520TConization of cervix019420.6585$1,226.08$397.84$245.22
    57522TConization of cervix019526.5582$1,576.23$483.80$315.25
    57530TRemoval of cervix019526.5582$1,576.23$483.80$315.25
    57531CRemoval of cervix, radical
    57540CRemoval of residual cervix
    57545CRemove cervix/repair pelvis
    57550TRemoval of residual cervix019526.5582$1,576.23$483.80$315.25
    57555TRemove cervix/repair vagina019526.5582$1,576.23$483.80$315.25
    57556TRemove cervix, repair bowel020240.2037$2,386.09$954.43$477.22
    57700TRevision of cervix019420.6585$1,226.08$397.84$245.22
    57720TRevision of cervix019420.6585$1,226.08$397.84$245.22
    57800TDilation of cervical canal019314.5183$861.66$172.33
    57820TD & c of residual cervix019617.0200$1,010.14$338.23$202.03
    58100TBiopsy of uterus lining01881.1348$67.35$13.47
    58120TDilation and curettage019617.0200$1,010.14$338.23$202.03
    58140CRemoval of uterus lesion
    58145TMyomectomy vag method019526.5582$1,576.23$483.80$315.25
    58146CMyomectomy abdom complex
    58150CTotal hysterectomy
    58152CTotal hysterectomy
    58180CPartial hysterectomy
    58200CExtensive hysterectomy
    58210CExtensive hysterectomy
    58240CRemoval of pelvis contents
    58260CVaginal hysterectomy
    58262CVag hyst including t/o
    58263CVag hyst w/t/o & vag repair
    58267CVag hyst w/urinary repair
    58270CVag hyst w/enterocele repair
    58275CHysterectomy/revise vagina
    58280CHysterectomy/revise vagina
    Start Printed Page 42846
    58285CExtensive hysterectomy
    58290CVag hyst complex
    58291CVag hyst incl t/o, complex
    58292CVag hyst t/o & repair, compl
    58293CVag hyst w/uro repair, compl
    58294CVag hyst w/enterocele, compl
    58300EInsert intrauterine device
    58301TRemove intrauterine device01892.3602$140.08$28.02
    58321TArtificial insemination01972.3465$139.26$27.85
    58322TArtificial insemination01972.3465$139.26$27.85
    58323TSperm washing01972.3465$139.26$27.85
    58340NCatheter for hysterography
    58345TReopen fallopian tube019314.5183$861.66$172.33
    58346TInsert heyman uteri capsule019314.5183$861.66$172.33
    58350TReopen fallopian tube019526.5582$1,576.23$483.80$315.25
    58353TEndometr ablate, thermal019526.5582$1,576.23$483.80$315.25
    58356TEndometrial cryoablation020240.2037$2,386.09$954.43$477.22
    58400CSuspension of uterus
    58410CSuspension of uterus
    58520CRepair of ruptured uterus
    58540CRevision of uterus
    58545TLaparoscopic myomectomy013031.7825$1,886.29$659.53$377.26
    58546TLaparo-myomectomy, complex013143.1426$2,560.51$1,001.89$512.10
    58550TLaparo-asst vag hysterectomy013262.7061$3,721.61$1,239.22$744.32
    58552TLaparo-vag hyst incl t/o013143.1426$2,560.51$1,001.89$512.10
    58553TLaparo-vag hyst, complex013143.1426$2,560.51$1,001.89$512.10
    58554TLaparo-vag hyst w/t/o, compl013143.1426$2,560.51$1,001.89$512.10
    58555THysteroscopy, dx, sep proc019020.9699$1,244.56$424.28$248.91
    58558THysteroscopy, biopsy019020.9699$1,244.56$424.28$248.91
    58559THysteroscopy, lysis019020.9699$1,244.56$424.28$248.91
    58560THysteroscopy, resect septum038732.3971$1,922.77$655.55$384.55
    58561THysteroscopy, remove myoma038732.3971$1,922.77$655.55$384.55
    58562THysteroscopy, remove fb019020.9699$1,244.56$424.28$248.91
    58563THysteroscopy, ablation038732.3971$1,922.77$655.55$384.55
    58565THysteroscopy, sterilization020240.2037$2,386.09$954.43$477.22
    58578TLaparo proc, uterus013031.7825$1,886.29$659.53$377.26
    58579THysteroscope procedure019020.9699$1,244.56$424.28$248.91
    58600TDivision of fallopian tube019526.5582$1,576.23$483.80$315.25
    58605CDivision of fallopian tube
    58611CLigate oviduct(s) add-on
    58615TOcclude fallopian tube(s)019420.6585$1,226.08$397.84$245.22
    58660TLaparoscopy, lysis013143.1426$2,560.51$1,001.89$512.10
    58661TLaparoscopy, remove adnexa013143.1426$2,560.51$1,001.89$512.10
    58662TLaparoscopy, excise lesions013143.1426$2,560.51$1,001.89$512.10
    58670TLaparoscopy, tubal cautery013143.1426$2,560.51$1,001.89$512.10
    58671TLaparoscopy, tubal block013143.1426$2,560.51$1,001.89$512.10
    58672TLaparoscopy, fimbrioplasty013143.1426$2,560.51$1,001.89$512.10
    58673TLaparoscopy, salpingostomy013143.1426$2,560.51$1,001.89$512.10
    58679TLaparo proc, oviduct-ovary013031.7825$1,886.29$659.53$377.26
    58700CRemoval of fallopian tube
    58720CRemoval of ovary/tube(s)
    58740CRevise fallopian tube(s)
    58750CRepair oviduct
    58752CRevise ovarian tube(s)
    58760CRemove tubal obstruction
    58770TCreate new tubal opening019526.5582$1,576.23$483.80$315.25
    58800TDrainage of ovarian cyst(s)019314.5183$861.66$172.33
    58805CDrainage of ovarian cyst(s)
    58820TDrain ovary abscess, open019526.5582$1,576.23$483.80$315.25
    58822CDrain ovary abscess, percut
    58823TDrain pelvic abscess, percut019314.5183$861.66$172.33
    58825CTransposition, ovary(s)
    58900TBiopsy of ovary(s)019314.5183$861.66$172.33
    58920TPartial removal of ovary(s)019526.5582$1,576.23$483.80$315.25
    58925TRemoval of ovarian cyst(s)019526.5582$1,576.23$483.80$315.25
    58940CRemoval of ovary(s)
    Start Printed Page 42847
    58943CRemoval of ovary(s)
    58950CResect ovarian malignancy
    58951CResect ovarian malignancy
    58952CResect ovarian malignancy
    58953CTah, rad dissect for debulk
    58954CTah rad debulk/lymph remove
    58956CBso, omentectomy w/tah
    58960CExploration of abdomen
    58970TRetrieval of oocyte01972.3465$139.26$27.85
    58974TTransfer of embryo01972.3465$139.26$27.85
    58976TTransfer of embryo01972.3465$139.26$27.85
    58999TGenital surgery procedure01910.1663$9.87$2.77$1.97
    59000TAmniocentesis, diagnostic01981.3621$80.84$32.19$16.17
    59001TAmniocentesis, therapeutic01924.2887$254.53$50.91
    59012TFetal cord puncture,prenatal01981.3621$80.84$32.19$16.17
    59015TChorion biopsy01981.3621$80.84$32.19$16.17
    59020TFetal contract stress test01924.2887$254.53$50.91
    59025TFetal non-stress test01981.3621$80.84$32.19$16.17
    59030TFetal scalp blood sample01981.3621$80.84$32.19$16.17
    59050EFetal monitor w/report
    59051BFetal monitor/interpret only
    59070TTransabdom amnioinfus w/ us01981.3621$80.84$32.19$16.17
    59072TUmbilical cord occlud w/ us01981.3621$80.84$32.19$16.17
    59074TFetal fluid drainage w/ us01981.3621$80.84$32.19$16.17
    59076TFetal shunt placement, w/ us01981.3621$80.84$32.19$16.17
    59100TRemove uterus lesion019526.5582$1,576.23$483.80$315.25
    59120CTreat ectopic pregnancy
    59121CTreat ectopic pregnancy
    59130CTreat ectopic pregnancy
    59135CTreat ectopic pregnancy
    59136CTreat ectopic pregnancy
    59140CTreat ectopic pregnancy
    59150TTreat ectopic pregnancy013143.1426$2,560.51$1,001.89$512.10
    59151TTreat ectopic pregnancy013143.1426$2,560.51$1,001.89$512.10
    59160TD & c after delivery019617.0200$1,010.14$338.23$202.03
    59200TInsert cervical dilator01892.3602$140.08$28.02
    59300TEpisiotomy or vaginal repair019314.5183$861.66$172.33
    59320TRevision of cervix019420.6585$1,226.08$397.84$245.22
    59325CRevision of cervix
    59350CRepair of uterus
    59400BObstetrical care
    59409TObstetrical care019420.6585$1,226.08$397.84$245.22
    59410BObstetrical care
    59412TAntepartum manipulation07005.3371$316.76$63.35
    59414TDeliver placenta019314.5183$861.66$172.33
    59425BAntepartum care only
    59426BAntepartum care only
    59430BCare after delivery
    59510ECesarean delivery
    59514CCesarean delivery only
    59515ECesarean delivery
    59525CRemove uterus after cesarean
    59610EVbac delivery
    59612TVbac delivery only019420.6585$1,226.08$397.84$245.22
    59614EVbac care after delivery
    59618EAttempted vbac delivery
    59620CAttempted vbac delivery only
    59622EAttempted vbac after care
    59812TTreatment of miscarriage020117.5250$1,040.11$329.65$208.02
    59820TCare of miscarriage020117.5250$1,040.11$329.65$208.02
    59821TTreatment of miscarriage020117.5250$1,040.11$329.65$208.02
    59830CTreat uterus infection
    59840TAbortion020017.7919$1,055.95$263.69$211.19
    59841TAbortion020017.7919$1,055.95$263.69$211.19
    59850CAbortion
    59851CAbortion
    Start Printed Page 42848
    59852CAbortion
    59855CAbortion
    59856CAbortion
    59857CAbortion
    59866TAbortion (mpr)01981.3621$80.84$32.19$16.17
    59870TEvacuate mole of uterus020117.5250$1,040.11$329.65$208.02
    59871TRemove cerclage suture019420.6585$1,226.08$397.84$245.22
    59897TFetal invas px w/ us01981.3621$80.84$32.19$16.17
    59898TLaparo proc, ob care/deliver013031.7825$1,886.29$659.53$377.26
    59899TMaternity care procedure01981.3621$80.84$32.19$16.17
    60000TDrain thyroid/tongue cyst02527.8317$464.81$113.41$92.96
    60001TAspirate/inject thyriod cyst00041.7566$104.25$22.36$20.85
    60100TBiopsy of thyroid00041.7566$104.25$22.36$20.85
    60200TRemove thyroid lesion011440.5805$2,408.45$485.91$481.69
    60210TPartial thyroid excision011440.5805$2,408.45$485.91$481.69
    60212TPartial thyroid excision011440.5805$2,408.45$485.91$481.69
    60220TPartial removal of thyroid011440.5805$2,408.45$485.91$481.69
    60225TPartial removal of thyroid011440.5805$2,408.45$485.91$481.69
    60240TRemoval of thyroid011440.5805$2,408.45$485.91$481.69
    60252TRemoval of thyroid025637.1513$2,204.93$440.99
    60254CExtensive thyroid surgery
    60260TRepeat thyroid surgery025637.1513$2,204.93$440.99
    60270CRemoval of thyroid
    60271CRemoval of thyroid
    60280TRemove thyroid duct lesion011440.5805$2,408.45$485.91$481.69
    60281TRemove thyroid duct lesion011440.5805$2,408.45$485.91$481.69
    60500TExplore parathyroid glands025637.1513$2,204.93$440.99
    60502CRe-explore parathyroids
    60505CExplore parathyroid glands
    60512TAutotransplant parathyroid002219.5582$1,160.78$354.45$232.16
    60520CRemoval of thymus gland
    60521CRemoval of thymus gland
    60522CRemoval of thymus gland
    60540CExplore adrenal gland
    60545CExplore adrenal gland
    60600CRemove carotid body lesion
    60605CRemove carotid body lesion
    60650CLaparoscopy adrenalectomy
    60659TLaparo proc, endocrine013031.7825$1,886.29$659.53$377.26
    60699TEndocrine surgery procedure011440.5805$2,408.45$485.91$481.69
    61000TRemove cranial cavity fluid02122.9606$175.71$70.28$35.14
    61001TRemove cranial cavity fluid02122.9606$175.71$70.28$35.14
    61020TRemove brain cavity fluid02122.9606$175.71$70.28$35.14
    61026TInjection into brain canal02122.9606$175.71$70.28$35.14
    61050TRemove brain canal fluid02122.9606$175.71$70.28$35.14
    61055TInjection into brain canal02122.9606$175.71$70.28$35.14
    61070TBrain canal shunt procedure02122.9606$175.71$70.28$35.14
    61105CTwist drill hole
    61107CDrill skull for implantation
    61108CDrill skull for drainage
    61120CBurr hole for puncture
    61140CPierce skull for biopsy
    61150CPierce skull for drainage
    61151CPierce skull for drainage
    61154CPierce skull & remove clot
    61156CPierce skull for drainage
    61210CPierce skull, implant device
    61215TInsert brain-fluid device022440.4614$2,401.38$480.28
    61250CPierce skull & explore
    61253CPierce skull & explore
    61304COpen skull for exploration
    61305COpen skull for exploration
    61312COpen skull for drainage
    61313COpen skull for drainage
    61314COpen skull for drainage
    61315COpen skull for drainage
    Start Printed Page 42849
    61316CImplt cran bone flap to abdo
    61320COpen skull for drainage
    61321COpen skull for drainage
    61322CDecompressive craniotomy
    61323CDecompressive lobectomy
    61330TDecompress eye socket025637.1513$2,204.93$440.99
    61332CExplore/biopsy eye socket
    61333CExplore orbit/remove lesion
    61334TExplore orbit/remove object025637.1513$2,204.93$440.99
    61340CRelieve cranial pressure
    61343CIncise skull (press relief)
    61345CRelieve cranial pressure
    61440CIncise skull for surgery
    61450CIncise skull for surgery
    61458CIncise skull for brain wound
    61460CIncise skull for surgery
    61470CIncise skull for surgery
    61480CIncise skull for surgery
    61490CIncise skull for surgery
    61500CRemoval of skull lesion
    61501CRemove infected skull bone
    61510CRemoval of brain lesion
    61512CRemove brain lining lesion
    61514CRemoval of brain abscess
    61516CRemoval of brain lesion
    61517CImplt brain chemotx add-on
    61518CRemoval of brain lesion
    61519CRemove brain lining lesion
    61520CRemoval of brain lesion
    61521CRemoval of brain lesion
    61522CRemoval of brain abscess
    61524CRemoval of brain lesion
    61526CRemoval of brain lesion
    61530CRemoval of brain lesion
    61531CImplant brain electrodes
    61533CImplant brain electrodes
    61534CRemoval of brain lesion
    61535CRemove brain electrodes
    61536CRemoval of brain lesion
    61537CRemoval of brain tissue
    61538CRemoval of brain tissue
    61539CRemoval of brain tissue
    61540CRemoval of brain tissue
    61541CIncision of brain tissue
    61542CRemoval of brain tissue
    61543CRemoval of brain tissue
    61544CRemove & treat brain lesion
    61545CExcision of brain tumor
    61546CRemoval of pituitary gland
    61548CRemoval of pituitary gland
    61550CRelease of skull seams
    61552CRelease of skull seams
    61556CIncise skull/sutures
    61557CIncise skull/sutures
    61558CExcision of skull/sutures
    61559CExcision of skull/sutures
    61563CExcision of skull tumor
    61564CExcision of skull tumor
    61566CRemoval of brain tissue
    61567CIncision of brain tissue
    61570CRemove foreign body, brain
    61571CIncise skull for brain wound
    61575CSkull base/brainstem surgery
    61576CSkull base/brainstem surgery
    61580CCraniofacial approach, skull
    61581CCraniofacial approach, skull
    Start Printed Page 42850
    61582CCraniofacial approach, skull
    61583CCraniofacial approach, skull
    61584COrbitocranial approach/skull
    61585COrbitocranial approach/skull
    61586CResect nasopharynx, skull
    61590CInfratemporal approach/skull
    61591CInfratemporal approach/skull
    61592COrbitocranial approach/skull
    61595CTranstemporal approach/skull
    61596CTranscochlear approach/skull
    61597CTranscondylar approach/skull
    61598CTranspetrosal approach/skull
    61600CResect/excise cranial lesion
    61601CResect/excise cranial lesion
    61605CResect/excise cranial lesion
    61606CResect/excise cranial lesion
    61607CResect/excise cranial lesion
    61608CResect/excise cranial lesion
    61609CTransect artery, sinus
    61610CTransect artery, sinus
    61611CTransect artery, sinus
    61612CTransect artery, sinus
    61613CRemove aneurysm, sinus
    61615CResect/excise lesion, skull
    61616CResect/excise lesion, skull
    61618CRepair dura
    61619CRepair dura
    61623TEndovasc tempory vessel occl008134.2913$2,035.19$407.04
    61624COcclusion/embolization cath
    61626TTranscath occlusion, non-cns008134.2913$2,035.19$407.04
    61680CIntracranial vessel surgery
    61682CIntracranial vessel surgery
    61684CIntracranial vessel surgery
    61686CIntracranial vessel surgery
    61690CIntracranial vessel surgery
    61692CIntracranial vessel surgery
    61697CBrain aneurysm repr, complx
    61698CBrain aneurysm repr, complx
    61700CBrain aneurysm repr, simple
    61702CInner skull vessel surgery
    61703CClamp neck artery
    61705CRevise circulation to head
    61708CRevise circulation to head
    61710CRevise circulation to head
    61711CFusion of skull arteries
    61720CIncise skull/brain surgery
    61735CIncise skull/brain surgery
    61750CIncise skull/brain biopsy
    61751CBrain biopsy w/ ct/mr guide
    61760CImplant brain electrodes
    61770CIncise skull for treatment
    61790TTreat trigeminal nerve022017.2800$1,025.57$205.11
    61791TTreat trigeminal tract02065.4672$324.48$75.55$64.90
    61793EFocus radiation beam
    61795SBrain surgery using computer03024.5936$272.63$103.28$54.53
    61850CImplant neuroelectrodes
    61860CImplant neuroelectrodes
    61863CImplant neuroelectrode
    61864CImplant neuroelectrde, add'l
    61867CImplant neuroelectrode
    61868CImplant neuroelectrde, add'l
    61870CImplant neuroelectrodes
    61875CImplant neuroelectrodes
    61880TRevise/remove neuroelectrode068719.1476$1,136.41$454.56$227.28
    61885SImplant neurostim one array0039180.5784$10,717.33$2,143.47
    61886TImplant neurostim arrays0315289.3306$17,171.77$3,434.35
    Start Printed Page 42851
    61888TRevise/remove neuroreceiver068842.8494$2,543.11$1,017.24$508.62
    62000CTreat skull fracture
    62005CTreat skull fracture
    62010CTreatment of head injury
    62100CRepair brain fluid leakage
    62115CReduction of skull defect
    62116CReduction of skull defect
    62117CReduction of skull defect
    62120CRepair skull cavity lesion
    62121CIncise skull repair
    62140CRepair of skull defect
    62141CRepair of skull defect
    62142CRemove skull plate/flap
    62143CReplace skull plate/flap
    62145CRepair of skull & brain
    62146CRepair of skull with graft
    62147CRepair of skull with graft
    62148CRetr bone flap to fix skull
    62160TNeuroendoscopy add-on01226.9405$411.92$84.48$82.38
    62161CDissect brain w/scope
    62162CRemove colloid cyst w/scope
    62163CNeuroendoscopy w/fb removal
    62164CRemove brain tumor w/scope
    62165CRemove pituit tumor w/scope
    62180CEstablish brain cavity shunt
    62190CEstablish brain cavity shunt
    62192CEstablish brain cavity shunt
    62194TReplace/irrigate catheter042710.1516$602.50$123.56$120.50
    62200CEstablish brain cavity shunt
    62201CEstablish brain cavity shunt
    62220CEstablish brain cavity shunt
    62223CEstablish brain cavity shunt
    62225TReplace/irrigate catheter042710.1516$602.50$123.56$120.50
    62230TReplace/revise brain shunt022440.4614$2,401.38$480.28
    62252SCsf shunt reprogram06912.5138$149.19$59.67$29.84
    62256CRemove brain cavity shunt
    62258CReplace brain cavity shunt
    62263TLysis epidural adhesions020310.3544$614.53$245.81$122.91
    62264TEpidural lysis on single day020310.3544$614.53$245.81$122.91
    62268TDrain spinal cord cyst02122.9606$175.71$70.28$35.14
    62269TNeedle biopsy, spinal cord06855.9902$355.52$115.47$71.10
    62270TSpinal fluid tap, diagnostic02042.1811$129.45$40.13$25.89
    62272TDrain cerebro spinal fluid02042.1811$129.45$40.13$25.89
    62273TTreat epidural spine lesion02065.4672$324.48$75.55$64.90
    62280TTreat spinal cord lesion02075.9837$355.13$86.92$71.03
    62281TTreat spinal cord lesion02075.9837$355.13$86.92$71.03
    62282TTreat spinal canal lesion02075.9837$355.13$86.92$71.03
    62284NInjection for myelogram
    62287TPercutaneous diskectomy022129.7854$1,767.76$463.62$353.55
    62290NInject for spine disk x-ray
    62291NInject for spine disk x-ray
    62292TInjection into disk lesion02122.9606$175.71$70.28$35.14
    62294TInjection into spinal artery02122.9606$175.71$70.28$35.14
    62310TInject spine c/t02075.9837$355.13$86.92$71.03
    62311TInject spine l/s (cd)02075.9837$355.13$86.92$71.03
    62318TInject spine w/cath, c/t02075.9837$355.13$86.92$71.03
    62319TInject spine w/cath l/s (cd)02075.9837$355.13$86.92$71.03
    62350TImplant spinal canal cath022327.9956$1,661.54$332.31
    62351TImplant spinal canal cath020842.1492$2,501.56$500.31
    62355TRemove spinal canal catheter020310.3544$614.53$245.81$122.91
    62360TInsert spine infusion device0226138.2406$8,204.58$1,640.92
    62361TImplant spine infusion pump0227135.8740$8,064.12$1,612.82
    62362TImplant spine infusion pump0227135.8740$8,064.12$1,612.82
    62365TRemove spine infusion device022129.7854$1,767.76$463.62$353.55
    62367SAnalyze spine infusion pump06912.5138$149.19$59.67$29.84
    62368SAnalyze spine infusion pump06912.5138$149.19$59.67$29.84
    Start Printed Page 42852
    63001TRemoval of spinal lamina020842.1492$2,501.56$500.31
    63003TRemoval of spinal lamina020842.1492$2,501.56$500.31
    63005TRemoval of spinal lamina020842.1492$2,501.56$500.31
    63011TRemoval of spinal lamina020842.1492$2,501.56$500.31
    63012TRemoval of spinal lamina020842.1492$2,501.56$500.31
    63015TRemoval of spinal lamina020842.1492$2,501.56$500.31
    63016TRemoval of spinal lamina020842.1492$2,501.56$500.31
    63017TRemoval of spinal lamina020842.1492$2,501.56$500.31
    63020TNeck spine disk surgery020842.1492$2,501.56$500.31
    63030TLow back disk surgery020842.1492$2,501.56$500.31
    63035TSpinal disk surgery add-on020842.1492$2,501.56$500.31
    63040TLaminotomy, single cervical020842.1492$2,501.56$500.31
    63042TLaminotomy, single lumbar020842.1492$2,501.56$500.31
    63043CLaminotomy, add'l cervical
    63044CLaminotomy, add'l lumbar
    63045TRemoval of spinal lamina020842.1492$2,501.56$500.31
    63046TRemoval of spinal lamina020842.1492$2,501.56$500.31
    63047TRemoval of spinal lamina020842.1492$2,501.56$500.31
    63048TRemove spinal lamina add-on020842.1492$2,501.56$500.31
    63050CCervical laminoplasty
    63051CC-laminoplasty w/graft/plate
    63055TDecompress spinal cord020842.1492$2,501.56$500.31
    63056TDecompress spinal cord020842.1492$2,501.56$500.31
    63057TDecompress spine cord add-on020842.1492$2,501.56$500.31
    63064TDecompress spinal cord020842.1492$2,501.56$500.31
    63066TDecompress spine cord add-on020842.1492$2,501.56$500.31
    63075CNeck spine disk surgery
    63076CNeck spine disk surgery
    63077CSpine disk surgery, thorax
    63078CSpine disk surgery, thorax
    63081CRemoval of vertebral body
    63082CRemove vertebral body add-on
    63085CRemoval of vertebral body
    63086CRemove vertebral body add-on
    63087CRemoval of vertebral body
    63088CRemove vertebral body add-on
    63090CRemoval of vertebral body
    63091CRemove vertebral body add-on
    63101CRemoval of vertebral body
    63102CRemoval of vertebral body
    63103CRemove vertebral body add-on
    63170CIncise spinal cord tract(s)
    63172CDrainage of spinal cyst
    63173CDrainage of spinal cyst
    63180CRevise spinal cord ligaments
    63182CRevise spinal cord ligaments
    63185CIncise spinal column/nerves
    63190CIncise spinal column/nerves
    63191CIncise spinal column/nerves
    63194CIncise spinal column & cord
    63195CIncise spinal column & cord
    63196CIncise spinal column & cord
    63197CIncise spinal column & cord
    63198CIncise spinal column & cord
    63199CIncise spinal column & cord
    63200CRelease of spinal cord
    63250CRevise spinal cord vessels
    63251CRevise spinal cord vessels
    63252CRevise spinal cord vessels
    63265CExcise intraspinal lesion
    63266CExcise intraspinal lesion
    63267CExcise intraspinal lesion
    63268CExcise intraspinal lesion
    63270CExcise intraspinal lesion
    63271CExcise intraspinal lesion
    63272CExcise intraspinal lesion
    Start Printed Page 42853
    63273CExcise intraspinal lesion
    63275CBiopsy/excise spinal tumor
    63276CBiopsy/excise spinal tumor
    63277CBiopsy/excise spinal tumor
    63278CBiopsy/excise spinal tumor
    63280CBiopsy/excise spinal tumor
    63281CBiopsy/excise spinal tumor
    63282CBiopsy/excise spinal tumor
    63283CBiopsy/excise spinal tumor
    63285CBiopsy/excise spinal tumor
    63286CBiopsy/excise spinal tumor
    63287CBiopsy/excise spinal tumor
    63290CBiopsy/excise spinal tumor
    63295CRepair of laminectomy defect
    63300CRemoval of vertebral body
    63301CRemoval of vertebral body
    63302CRemoval of vertebral body
    63303CRemoval of vertebral body
    63304CRemoval of vertebral body
    63305CRemoval of vertebral body
    63306CRemoval of vertebral body
    63307CRemoval of vertebral body
    63308CRemove vertebral body add-on
    63600TRemove spinal cord lesion022017.2800$1,025.57$205.11
    63610TStimulation of spinal cord022017.2800$1,025.57$205.11
    63615TRemove lesion of spinal cord022017.2800$1,025.57$205.11
    63650SImplant neuroelectrodes004055.0791$3,268.94$653.79
    63655SImplant neuroelectrodes004055.0791$3,268.94$653.79
    63660TRevise/remove neuroelectrode068719.1476$1,136.41$454.56$227.28
    63685TImplant neuroreceiver0222178.2870$10,581.33$2,116.27
    63688TRevise/remove neuroreceiver068842.8494$2,543.11$1,017.24$508.62
    63700CRepair of spinal herniation
    63702CRepair of spinal herniation
    63704CRepair of spinal herniation
    63706CRepair of spinal herniation
    63707CRepair spinal fluid leakage
    63709CRepair spinal fluid leakage
    63710CGraft repair of spine defect
    63740CInstall spinal shunt
    63741TInstall spinal shunt022851.4916$3,056.03$611.21
    63744TRevision of spinal shunt022851.4916$3,056.03$611.21
    63746TRemoval of spinal shunt010910.9933$652.45$131.49$130.49
    64400TN block inj, trigeminal02042.1811$129.45$40.13$25.89
    64402TN block inj, facial02042.1811$129.45$40.13$25.89
    64405TN block inj, occipital02042.1811$129.45$40.13$25.89
    64408TN block inj, vagus02042.1811$129.45$40.13$25.89
    64410TN block inj, phrenic02065.4672$324.48$75.55$64.90
    64412TN block inj, spinal accessor02065.4672$324.48$75.55$64.90
    64413TN block inj, cervical plexus02042.1811$129.45$40.13$25.89
    64415TInjection for nerve block02042.1811$129.45$40.13$25.89
    64416TN block cont infuse, b plex02042.1811$129.45$40.13$25.89
    64417TN block inj, axillary02042.1811$129.45$40.13$25.89
    64418TN block inj, suprascapular02042.1811$129.45$40.13$25.89
    64420TN block inj, intercost, sng02042.1811$129.45$40.13$25.89
    64421TN block inj, intercost, mlt02065.4672$324.48$75.55$64.90
    64425TN block inj ilio-ing/hypogi02042.1811$129.45$40.13$25.89
    64430TN block inj, pudendal02042.1811$129.45$40.13$25.89
    64435TN block inj, paracervical02042.1811$129.45$40.13$25.89
    64445TInjection for nerve block02042.1811$129.45$40.13$25.89
    64446TN blk inj, sciatic, cont inf02065.4672$324.48$75.55$64.90
    64447TN block inj fem, single02042.1811$129.45$40.13$25.89
    64448TN block inj fem, cont inf02042.1811$129.45$40.13$25.89
    64449TN block inj, lumbar plexus02042.1811$129.45$40.13$25.89
    64450TN block, other peripheral02042.1811$129.45$40.13$25.89
    64470TInj paravertebral c/t02075.9837$355.13$86.92$71.03
    64472TInj paravertebral c/t add-on02065.4672$324.48$75.55$64.90
    Start Printed Page 42854
    64475TInj paravertebral l/s02075.9837$355.13$86.92$71.03
    64476TInj paravertebral l/s add-on02065.4672$324.48$75.55$64.90
    64479TInj foramen epidural c/t02075.9837$355.13$86.92$71.03
    64480TInj foramen epidural add-on02075.9837$355.13$86.92$71.03
    64483TInj foramen epidural l/s02075.9837$355.13$86.92$71.03
    64484TInj foramen epidural add-on02075.9837$355.13$86.92$71.03
    64505TN block, spenopalatine gangl02042.1811$129.45$40.13$25.89
    64508TN block, carotid sinus s/p02042.1811$129.45$40.13$25.89
    64510TN block, stellate ganglion02075.9837$355.13$86.92$71.03
    64517TN block inj, hypogas plxs02042.1811$129.45$40.13$25.89
    64520TN block, lumbar/thoracic02075.9837$355.13$86.92$71.03
    64530TN block inj, celiac pelus02075.9837$355.13$86.92$71.03
    64550AApply neurostimulator
    64553SImplant neuroelectrodes0225233.6295$13,865.91$2,773.18
    64555SImplant neuroelectrodes004055.0791$3,268.94$653.79
    64560SImplant neuroelectrodes004055.0791$3,268.94$653.79
    64561SImplant neuroelectrodes004055.0791$3,268.94$653.79
    64565SImplant neuroelectrodes004055.0791$3,268.94$653.79
    64573SImplant neuroelectrodes0225233.6295$13,865.91$2,773.18
    64575SImplant neuroelectrodes004055.0791$3,268.94$653.79
    64577SImplant neuroelectrodes0225233.6295$13,865.91$2,773.18
    64580SImplant neuroelectrodes004055.0791$3,268.94$653.79
    64581SImplant neuroelectrodes004055.0791$3,268.94$653.79
    64585TRevise/remove neuroelectrode068719.1476$1,136.41$454.56$227.28
    64590TImplant neuroreceiver0222178.2870$10,581.33$2,116.27
    64595TRevise/remove neuroreceiver068842.8494$2,543.11$1,017.24$508.62
    64600TInjection treatment of nerve020310.3544$614.53$245.81$122.91
    64605TInjection treatment of nerve020310.3544$614.53$245.81$122.91
    64610TInjection treatment of nerve020310.3544$614.53$245.81$122.91
    64612TDestroy nerve, face muscle02042.1811$129.45$40.13$25.89
    64613TDestroy nerve, spine muscle02042.1811$129.45$40.13$25.89
    64614TDestroy nerve, extrem musc02042.1811$129.45$40.13$25.89
    64620TInjection treatment of nerve020310.3544$614.53$245.81$122.91
    64622TDestr paravertebrl nerve l/s020310.3544$614.53$245.81$122.91
    64623TDestr paravertebral n add-on02075.9837$355.13$86.92$71.03
    64626TDestr paravertebrl nerve c/t020310.3544$614.53$245.81$122.91
    64627TDestr paravertebral n add-on02075.9837$355.13$86.92$71.03
    64630TInjection treatment of nerve02065.4672$324.48$75.55$64.90
    64640TInjection treatment of nerve02065.4672$324.48$75.55$64.90
    64680TInjection treatment of nerve02075.9837$355.13$86.92$71.03
    64681TInjection treatment of nerve020310.3544$614.53$245.81$122.91
    64702TRevise finger/toe nerve022017.2800$1,025.57$205.11
    64704TRevise hand/foot nerve022017.2800$1,025.57$205.11
    64708TRevise arm/leg nerve022017.2800$1,025.57$205.11
    64712TRevision of sciatic nerve022017.2800$1,025.57$205.11
    64713TRevision of arm nerve(s)022017.2800$1,025.57$205.11
    64714TRevise low back nerve(s)022017.2800$1,025.57$205.11
    64716TRevision of cranial nerve022017.2800$1,025.57$205.11
    64718TRevise ulnar nerve at elbow022017.2800$1,025.57$205.11
    64719TRevise ulnar nerve at wrist022017.2800$1,025.57$205.11
    64721TCarpal tunnel surgery022017.2800$1,025.57$205.11
    64722TRelieve pressure on nerve(s)022017.2800$1,025.57$205.11
    64726TRelease foot/toe nerve022017.2800$1,025.57$205.11
    64727TInternal nerve revision022017.2800$1,025.57$205.11
    64732TIncision of brow nerve022017.2800$1,025.57$205.11
    64734TIncision of cheek nerve022017.2800$1,025.57$205.11
    64736TIncision of chin nerve022017.2800$1,025.57$205.11
    64738TIncision of jaw nerve022017.2800$1,025.57$205.11
    64740TIncision of tongue nerve022017.2800$1,025.57$205.11
    64742TIncision of facial nerve022017.2800$1,025.57$205.11
    64744TIncise nerve, back of head022017.2800$1,025.57$205.11
    64746TIncise diaphragm nerve022017.2800$1,025.57$205.11
    64752CIncision of vagus nerve
    64755CIncision of stomach nerves
    64760CIncision of vagus nerve
    64761TIncision of pelvis nerve022017.2800$1,025.57$205.11
    Start Printed Page 42855
    64763TIncise hip/thigh nerve022017.2800$1,025.57$205.11
    64766TIncise hip/thigh nerve022129.7854$1,767.76$463.62$353.55
    64771TSever cranial nerve022017.2800$1,025.57$205.11
    64772TIncision of spinal nerve022017.2800$1,025.57$205.11
    64774TRemove skin nerve lesion022017.2800$1,025.57$205.11
    64776TRemove digit nerve lesion022017.2800$1,025.57$205.11
    64778TDigit nerve surgery add-on022017.2800$1,025.57$205.11
    64782TRemove limb nerve lesion022017.2800$1,025.57$205.11
    64783TLimb nerve surgery add-on022017.2800$1,025.57$205.11
    64784TRemove nerve lesion022017.2800$1,025.57$205.11
    64786TRemove sciatic nerve lesion022129.7854$1,767.76$463.62$353.55
    64787TImplant nerve end022017.2800$1,025.57$205.11
    64788TRemove skin nerve lesion022017.2800$1,025.57$205.11
    64790TRemoval of nerve lesion022017.2800$1,025.57$205.11
    64792TRemoval of nerve lesion022129.7854$1,767.76$463.62$353.55
    64795TBiopsy of nerve022017.2800$1,025.57$205.11
    64802TRemove sympathetic nerves022017.2800$1,025.57$205.11
    64804CRemove sympathetic nerves
    64809CRemove sympathetic nerves
    64818CRemove sympathetic nerves
    64820TRemove sympathetic nerves022017.2800$1,025.57$205.11
    64821TRemove sympathetic nerves005425.2562$1,498.96$299.79
    64822TRemove sympathetic nerves005425.2562$1,498.96$299.79
    64823TRemove sympathetic nerves005425.2562$1,498.96$299.79
    64831TRepair of digit nerve022129.7854$1,767.76$463.62$353.55
    64832TRepair nerve add-on022129.7854$1,767.76$463.62$353.55
    64834TRepair of hand or foot nerve022129.7854$1,767.76$463.62$353.55
    64835TRepair of hand or foot nerve022129.7854$1,767.76$463.62$353.55
    64836TRepair of hand or foot nerve022129.7854$1,767.76$463.62$353.55
    64837TRepair nerve add-on022129.7854$1,767.76$463.62$353.55
    64840TRepair of leg nerve022129.7854$1,767.76$463.62$353.55
    64856TRepair/transpose nerve022129.7854$1,767.76$463.62$353.55
    64857TRepair arm/leg nerve022129.7854$1,767.76$463.62$353.55
    64858TRepair sciatic nerve022129.7854$1,767.76$463.62$353.55
    64859TNerve surgery022129.7854$1,767.76$463.62$353.55
    64861TRepair of arm nerves022129.7854$1,767.76$463.62$353.55
    64862TRepair of low back nerves022129.7854$1,767.76$463.62$353.55
    64864TRepair of facial nerve022129.7854$1,767.76$463.62$353.55
    64865TRepair of facial nerve022129.7854$1,767.76$463.62$353.55
    64866CFusion of facial/other nerve
    64868CFusion of facial/other nerve
    64870TFusion of facial/other nerve022129.7854$1,767.76$463.62$353.55
    64872TSubsequent repair of nerve022129.7854$1,767.76$463.62$353.55
    64874TRepair & revise nerve add-on022129.7854$1,767.76$463.62$353.55
    64876TRepair nerve/shorten bone022129.7854$1,767.76$463.62$353.55
    64885TNerve graft, head or neck022129.7854$1,767.76$463.62$353.55
    64886TNerve graft, head or neck022129.7854$1,767.76$463.62$353.55
    64890TNerve graft, hand or foot022129.7854$1,767.76$463.62$353.55
    64891TNerve graft, hand or foot022129.7854$1,767.76$463.62$353.55
    64892TNerve graft, arm or leg022129.7854$1,767.76$463.62$353.55
    64893TNerve graft, arm or leg022129.7854$1,767.76$463.62$353.55
    64895TNerve graft, hand or foot022129.7854$1,767.76$463.62$353.55
    64896TNerve graft, hand or foot022129.7854$1,767.76$463.62$353.55
    64897TNerve graft, arm or leg022129.7854$1,767.76$463.62$353.55
    64898TNerve graft, arm or leg022129.7854$1,767.76$463.62$353.55
    64901TNerve graft add-on022129.7854$1,767.76$463.62$353.55
    64902TNerve graft add-on022129.7854$1,767.76$463.62$353.55
    64905TNerve pedicle transfer022129.7854$1,767.76$463.62$353.55
    64907TNerve pedicle transfer022129.7854$1,767.76$463.62$353.55
    64999TNervous system surgery02042.1811$129.45$40.13$25.89
    65091TRevise eye024230.4081$1,804.72$597.36$360.94
    65093TRevise eye with implant024123.1980$1,376.80$384.47$275.36
    65101TRemoval of eye024230.4081$1,804.72$597.36$360.94
    65103TRemove eye/insert implant024230.4081$1,804.72$597.36$360.94
    65105TRemove eye/attach implant024230.4081$1,804.72$597.36$360.94
    65110TRemoval of eye024230.4081$1,804.72$597.36$360.94
    Start Printed Page 42856
    65112TRemove eye/revise socket024230.4081$1,804.72$597.36$360.94
    65114TRemove eye/revise socket024230.4081$1,804.72$597.36$360.94
    65125TRevise ocular implant024018.0686$1,072.37$315.31$214.47
    65130TInsert ocular implant024123.1980$1,376.80$384.47$275.36
    65135TInsert ocular implant024123.1980$1,376.80$384.47$275.36
    65140TAttach ocular implant024230.4081$1,804.72$597.36$360.94
    65150TRevise ocular implant024123.1980$1,376.80$384.47$275.36
    65155TReinsert ocular implant024230.4081$1,804.72$597.36$360.94
    65175TRemoval of ocular implant024018.0686$1,072.37$315.31$214.47
    65205SRemove foreign body from eye06981.2381$73.48$16.48$14.70
    65210SRemove foreign body from eye06981.2381$73.48$16.48$14.70
    65220SRemove foreign body from eye06981.2381$73.48$16.48$14.70
    65222SRemove foreign body from eye06981.2381$73.48$16.48$14.70
    65235TRemove foreign body from eye023314.8995$884.29$266.33$176.86
    65260TRemove foreign body from eye023616.9458$1,005.73$201.15
    65265TRemove foreign body from eye023728.8091$1,709.82$341.96
    65270TRepair of eye wound024018.0686$1,072.37$315.31$214.47
    65272TRepair of eye wound023421.8746$1,298.26$511.31$259.65
    65273CRepair of eye wound
    65275TRepair of eye wound023421.8746$1,298.26$511.31$259.65
    65280TRepair of eye wound023616.9458$1,005.73$201.15
    65285TRepair of eye wound067236.7611$2,181.77$436.35
    65286TRepair of eye wound02326.6429$394.26$103.17$78.85
    65290TRepair of eye socket wound024322.0667$1,309.66$431.39$261.93
    65400TRemoval of eye lesion023314.8995$884.29$266.33$176.86
    65410TBiopsy of cornea023314.8995$884.29$266.33$176.86
    65420TRemoval of eye lesion023314.8995$884.29$266.33$176.86
    65426TRemoval of eye lesion023421.8746$1,298.26$511.31$259.65
    65430SCorneal smear06981.2381$73.48$16.48$14.70
    65435TCurette/treat cornea02396.8784$408.23$81.65
    65436TCurette/treat cornea023314.8995$884.29$266.33$176.86
    65450STreatment of corneal lesion02311.9191$113.90$22.78
    65600TRevision of cornea024018.0686$1,072.37$315.31$214.47
    65710TCorneal transplant024438.1985$2,267.08$803.26$453.42
    65730TCorneal transplant024438.1985$2,267.08$803.26$453.42
    65750TCorneal transplant024438.1985$2,267.08$803.26$453.42
    65755TCorneal transplant024438.1985$2,267.08$803.26$453.42
    65760ERevision of cornea
    65765ERevision of cornea
    65767ECorneal tissue transplant
    65770TRevise cornea with implant024438.1985$2,267.08$803.26$453.42
    65771ERadial keratotomy
    65772TCorrection of astigmatism023314.8995$884.29$266.33$176.86
    65775TCorrection of astigmatism023314.8995$884.29$266.33$176.86
    65780TOcular reconst, transplant024438.1985$2,267.08$803.26$453.42
    65781TOcular reconst, transplant024438.1985$2,267.08$803.26$453.42
    65782TOcular reconst, transplant024438.1985$2,267.08$803.26$453.42
    65800TDrainage of eye023314.8995$884.29$266.33$176.86
    65805TDrainage of eye023314.8995$884.29$266.33$176.86
    65810TDrainage of eye023421.8746$1,298.26$511.31$259.65
    65815TDrainage of eye023421.8746$1,298.26$511.31$259.65
    65820TRelieve inner eye pressure02326.6429$394.26$103.17$78.85
    65850TIncision of eye023421.8746$1,298.26$511.31$259.65
    65855TLaser surgery of eye02475.0102$297.36$104.31$59.47
    65860TIncise inner eye adhesions02475.0102$297.36$104.31$59.47
    65865TIncise inner eye adhesions023314.8995$884.29$266.33$176.86
    65870TIncise inner eye adhesions023421.8746$1,298.26$511.31$259.65
    65875TIncise inner eye adhesions023421.8746$1,298.26$511.31$259.65
    65880TIncise inner eye adhesions023314.8995$884.29$266.33$176.86
    65900TRemove eye lesion023314.8995$884.29$266.33$176.86
    65920TRemove implant of eye023421.8746$1,298.26$511.31$259.65
    65930TRemove blood clot from eye023421.8746$1,298.26$511.31$259.65
    66020TInjection treatment of eye023314.8995$884.29$266.33$176.86
    66030TInjection treatment of eye02326.6429$394.26$103.17$78.85
    66130TRemove eye lesion023421.8746$1,298.26$511.31$259.65
    66150TGlaucoma surgery023421.8746$1,298.26$511.31$259.65
    Start Printed Page 42857
    66155TGlaucoma surgery023421.8746$1,298.26$511.31$259.65
    66160TGlaucoma surgery023421.8746$1,298.26$511.31$259.65
    66165TGlaucoma surgery023421.8746$1,298.26$511.31$259.65
    66170TGlaucoma surgery023421.8746$1,298.26$511.31$259.65
    66172TIncision of eye067329.1257$1,728.61$649.56$345.72
    66180TImplant eye shunt067329.1257$1,728.61$649.56$345.72
    66185TRevise eye shunt067329.1257$1,728.61$649.56$345.72
    66220TRepair eye lesion067236.7611$2,181.77$436.35
    66225TRepair/graft eye lesion067329.1257$1,728.61$649.56$345.72
    66250TFollow-up surgery of eye023314.8995$884.29$266.33$176.86
    66500TIncision of iris02326.6429$394.26$103.17$78.85
    66505TIncision of iris02326.6429$394.26$103.17$78.85
    66600TRemove iris and lesion023421.8746$1,298.26$511.31$259.65
    66605TRemoval of iris023421.8746$1,298.26$511.31$259.65
    66625TRemoval of iris02326.6429$394.26$103.17$78.85
    66630TRemoval of iris023421.8746$1,298.26$511.31$259.65
    66635TRemoval of iris023421.8746$1,298.26$511.31$259.65
    66680TRepair iris & ciliary body023421.8746$1,298.26$511.31$259.65
    66682TRepair iris & ciliary body023421.8746$1,298.26$511.31$259.65
    66700TDestruction, ciliary body023314.8995$884.29$266.33$176.86
    66710TDestruction, ciliary body023314.8995$884.29$266.33$176.86
    66711TCiliary endoscopic ablation023314.8995$884.29$266.33$176.86
    66720TDestruction, ciliary body023314.8995$884.29$266.33$176.86
    66740TDestruction, ciliary body023421.8746$1,298.26$511.31$259.65
    66761TRevision of iris02475.0102$297.36$104.31$59.47
    66762TRevision of iris02475.0102$297.36$104.31$59.47
    66770TRemoval of inner eye lesion02475.0102$297.36$104.31$59.47
    66820TIncision, secondary cataract02326.6429$394.26$103.17$78.85
    66821TAfter cataract laser surgery02475.0102$297.36$104.31$59.47
    66825TReposition intraocular lens023421.8746$1,298.26$511.31$259.65
    66830TRemoval of lens lesion02326.6429$394.26$103.17$78.85
    66840TRemoval of lens material024513.3020$789.47$220.91$157.89
    66850TRemoval of lens material024927.8103$1,650.54$524.67$330.11
    66852TRemoval of lens material024927.8103$1,650.54$524.67$330.11
    66920TExtraction of lens024927.8103$1,650.54$524.67$330.11
    66930TExtraction of lens024927.8103$1,650.54$524.67$330.11
    66940TExtraction of lens024513.3020$789.47$220.91$157.89
    66982TCataract surgery, complex024623.3535$1,386.03$495.96$277.21
    66983TCataract surg w/iol, 1 stage024623.3535$1,386.03$495.96$277.21
    66984TCataract surg w/iol, 1 stage024623.3535$1,386.03$495.96$277.21
    66985TInsert lens prosthesis024623.3535$1,386.03$495.96$277.21
    66986TExchange lens prosthesis024623.3535$1,386.03$495.96$277.21
    66990NOphthalmic endoscope add-on
    66999TEye surgery procedure02326.6429$394.26$103.17$78.85
    67005TPartial removal of eye fluid023728.8091$1,709.82$341.96
    67010TPartial removal of eye fluid023728.8091$1,709.82$341.96
    67015TRelease of eye fluid023728.8091$1,709.82$341.96
    67025TReplace eye fluid023728.8091$1,709.82$341.96
    67027TImplant eye drug system067236.7611$2,181.77$436.35
    67028TInjection eye drug02354.6382$275.28$67.10$55.06
    67030TIncise inner eye strands023616.9458$1,005.73$201.15
    67031TLaser surgery, eye strands02475.0102$297.36$104.31$59.47
    67036TRemoval of inner eye fluid067236.7611$2,181.77$436.35
    67038TStrip retinal membrane067236.7611$2,181.77$436.35
    67039TLaser treatment of retina067236.7611$2,181.77$436.35
    67040TLaser treatment of retina067236.7611$2,181.77$436.35
    67101TRepair detached retina023616.9458$1,005.73$201.15
    67105TRepair detached retina02484.6557$276.32$93.57$55.26
    67107TRepair detached retina067236.7611$2,181.77$436.35
    67108TRepair detached retina067236.7611$2,181.77$436.35
    67110TRepair detached retina023616.9458$1,005.73$201.15
    67112TRerepair detached retina067236.7611$2,181.77$436.35
    67115TRelease encircling material023616.9458$1,005.73$201.15
    67120TRemove eye implant material023616.9458$1,005.73$201.15
    67121TRemove eye implant material023728.8091$1,709.82$341.96
    67141TTreatment of retina02354.6382$275.28$67.10$55.06
    Start Printed Page 42858
    67145TTreatment of retina02484.6557$276.32$93.57$55.26
    67208TTreatment of retinal lesion023616.9458$1,005.73$201.15
    67210TTreatment of retinal lesion02484.6557$276.32$93.57$55.26
    67218TTreatment of retinal lesion023616.9458$1,005.73$201.15
    67220TTreatment of choroid lesion02354.6382$275.28$67.10$55.06
    67221TOcular photodynamic ther02354.6382$275.28$67.10$55.06
    67225TEye photodynamic ther add-on02354.6382$275.28$67.10$55.06
    67227TTreatment of retinal lesion023616.9458$1,005.73$201.15
    67228TTreatment of retinal lesion02484.6557$276.32$93.57$55.26
    67250TReinforce eye wall024018.0686$1,072.37$315.31$214.47
    67255TReinforce/graft eye wall023728.8091$1,709.82$341.96
    67299TEye surgery procedure02354.6382$275.28$67.10$55.06
    67311TRevise eye muscle024322.0667$1,309.66$431.39$261.93
    67312TRevise two eye muscles024322.0667$1,309.66$431.39$261.93
    67314TRevise eye muscle024322.0667$1,309.66$431.39$261.93
    67316TRevise two eye muscles024322.0667$1,309.66$431.39$261.93
    67318TRevise eye muscle(s)024322.0667$1,309.66$431.39$261.93
    67320TRevise eye muscle(s) add-on024322.0667$1,309.66$431.39$261.93
    67331TEye surgery follow-up add-on024322.0667$1,309.66$431.39$261.93
    67332TRerevise eye muscles add-on024322.0667$1,309.66$431.39$261.93
    67334TRevise eye muscle w/suture024322.0667$1,309.66$431.39$261.93
    67335TEye suture during surgery024322.0667$1,309.66$431.39$261.93
    67340TRevise eye muscle add-on024322.0667$1,309.66$431.39$261.93
    67343TRelease eye tissue024322.0667$1,309.66$431.39$261.93
    67345TDestroy nerve of eye muscle02382.5816$153.22$30.64
    67350TBiopsy eye muscle06999.9723$591.86$118.37
    67399TEye muscle surgery procedure024322.0667$1,309.66$431.39$261.93
    67400TExplore/biopsy eye socket024123.1980$1,376.80$384.47$275.36
    67405TExplore/drain eye socket024123.1980$1,376.80$384.47$275.36
    67412TExplore/treat eye socket024123.1980$1,376.80$384.47$275.36
    67413TExplore/treat eye socket024123.1980$1,376.80$384.47$275.36
    67414TExplr/decompress eye socket024230.4081$1,804.72$597.36$360.94
    67415TAspiration, orbital contents024018.0686$1,072.37$315.31$214.47
    67420TExplore/treat eye socket024230.4081$1,804.72$597.36$360.94
    67430TExplore/treat eye socket024230.4081$1,804.72$597.36$360.94
    67440TExplore/drain eye socket024230.4081$1,804.72$597.36$360.94
    67445TExplr/decompress eye socket024230.4081$1,804.72$597.36$360.94
    67450TExplore/biopsy eye socket024230.4081$1,804.72$597.36$360.94
    67500SInject/treat eye socket02311.9191$113.90$22.78
    67505TInject/treat eye socket02382.5816$153.22$30.64
    67515TInject/treat eye socket02382.5816$153.22$30.64
    67550TInsert eye socket implant024230.4081$1,804.72$597.36$360.94
    67560TRevise eye socket implant024123.1980$1,376.80$384.47$275.36
    67570TDecompress optic nerve024230.4081$1,804.72$597.36$360.94
    67599TOrbit surgery procedure02382.5816$153.22$30.64
    67700TDrainage of eyelid abscess02382.5816$153.22$30.64
    67710TIncision of eyelid02396.8784$408.23$81.65
    67715TIncision of eyelid fold024018.0686$1,072.37$315.31$214.47
    67800TRemove eyelid lesion02382.5816$153.22$30.64
    67801TRemove eyelid lesions02396.8784$408.23$81.65
    67805TRemove eyelid lesions02382.5816$153.22$30.64
    67808TRemove eyelid lesion(s)024018.0686$1,072.37$315.31$214.47
    67810TBiopsy of eyelid02382.5816$153.22$30.64
    67820SRevise eyelashes06981.2381$73.48$16.48$14.70
    67825TRevise eyelashes02382.5816$153.22$30.64
    67830TRevise eyelashes02396.8784$408.23$81.65
    67835TRevise eyelashes024018.0686$1,072.37$315.31$214.47
    67840TRemove eyelid lesion02396.8784$408.23$81.65
    67850TTreat eyelid lesion02396.8784$408.23$81.65
    67875TClosure of eyelid by suture02396.8784$408.23$81.65
    67880TRevision of eyelid023314.8995$884.29$266.33$176.86
    67882TRevision of eyelid024018.0686$1,072.37$315.31$214.47
    67900TRepair brow defect024018.0686$1,072.37$315.31$214.47
    67901TRepair eyelid defect024018.0686$1,072.37$315.31$214.47
    67902TRepair eyelid defect024018.0686$1,072.37$315.31$214.47
    67903TRepair eyelid defect024018.0686$1,072.37$315.31$214.47
    Start Printed Page 42859
    67904TRepair eyelid defect024018.0686$1,072.37$315.31$214.47
    67906TRepair eyelid defect024018.0686$1,072.37$315.31$214.47
    67908TRepair eyelid defect024018.0686$1,072.37$315.31$214.47
    67909TRevise eyelid defect024018.0686$1,072.37$315.31$214.47
    67911TRevise eyelid defect024018.0686$1,072.37$315.31$214.47
    67912TCorrection eyelid w/ implant024018.0686$1,072.37$315.31$214.47
    67914TRepair eyelid defect024018.0686$1,072.37$315.31$214.47
    67915TRepair eyelid defect024018.0686$1,072.37$315.31$214.47
    67916TRepair eyelid defect024018.0686$1,072.37$315.31$214.47
    67917TRepair eyelid defect024018.0686$1,072.37$315.31$214.47
    67921TRepair eyelid defect024018.0686$1,072.37$315.31$214.47
    67922TRepair eyelid defect024018.0686$1,072.37$315.31$214.47
    67923TRepair eyelid defect024018.0686$1,072.37$315.31$214.47
    67924TRepair eyelid defect024018.0686$1,072.37$315.31$214.47
    67930TRepair eyelid wound024018.0686$1,072.37$315.31$214.47
    67935TRepair eyelid wound024018.0686$1,072.37$315.31$214.47
    67938SRemove eyelid foreign body06981.2381$73.48$16.48$14.70
    67950TRevision of eyelid024018.0686$1,072.37$315.31$214.47
    67961TRevision of eyelid024018.0686$1,072.37$315.31$214.47
    67966TRevision of eyelid024018.0686$1,072.37$315.31$214.47
    67971TReconstruction of eyelid024123.1980$1,376.80$384.47$275.36
    67973TReconstruction of eyelid024123.1980$1,376.80$384.47$275.36
    67974TReconstruction of eyelid024123.1980$1,376.80$384.47$275.36
    67975TReconstruction of eyelid024018.0686$1,072.37$315.31$214.47
    67999TRevision of eyelid02382.5816$153.22$30.64
    68020TIncise/drain eyelid lining024018.0686$1,072.37$315.31$214.47
    68040STreatment of eyelid lesions06981.2381$73.48$16.48$14.70
    68100TBiopsy of eyelid lining02326.6429$394.26$103.17$78.85
    68110TRemove eyelid lining lesion06999.9723$591.86$118.37
    68115TRemove eyelid lining lesion024018.0686$1,072.37$315.31$214.47
    68130TRemove eyelid lining lesion023314.8995$884.29$266.33$176.86
    68135TRemove eyelid lining lesion02396.8784$408.23$81.65
    68200STreat eyelid by injection02300.7823$46.43$14.97$9.29
    68320TRevise/graft eyelid lining024018.0686$1,072.37$315.31$214.47
    68325TRevise/graft eyelid lining024230.4081$1,804.72$597.36$360.94
    68326TRevise/graft eyelid lining024123.1980$1,376.80$384.47$275.36
    68328TRevise/graft eyelid lining024123.1980$1,376.80$384.47$275.36
    68330TRevise eyelid lining023421.8746$1,298.26$511.31$259.65
    68335TRevise/graft eyelid lining024123.1980$1,376.80$384.47$275.36
    68340TSeparate eyelid adhesions024018.0686$1,072.37$315.31$214.47
    68360TRevise eyelid lining023421.8746$1,298.26$511.31$259.65
    68362TRevise eyelid lining023421.8746$1,298.26$511.31$259.65
    68371THarvest eye tissue, alograft023314.8995$884.29$266.33$176.86
    68399TEyelid lining surgery02382.5816$153.22$30.64
    68400TIncise/drain tear gland02382.5816$153.22$30.64
    68420TIncise/drain tear sac024018.0686$1,072.37$315.31$214.47
    68440TIncise tear duct opening02382.5816$153.22$30.64
    68500TRemoval of tear gland024123.1980$1,376.80$384.47$275.36
    68505TPartial removal, tear gland024123.1980$1,376.80$384.47$275.36
    68510TBiopsy of tear gland024018.0686$1,072.37$315.31$214.47
    68520TRemoval of tear sac024123.1980$1,376.80$384.47$275.36
    68525TBiopsy of tear sac024018.0686$1,072.37$315.31$214.47
    68530TClearance of tear duct024018.0686$1,072.37$315.31$214.47
    68540TRemove tear gland lesion024123.1980$1,376.80$384.47$275.36
    68550TRemove tear gland lesion024230.4081$1,804.72$597.36$360.94
    68700TRepair tear ducts024123.1980$1,376.80$384.47$275.36
    68705TRevise tear duct opening02382.5816$153.22$30.64
    68720TCreate tear sac drain024230.4081$1,804.72$597.36$360.94
    68745TCreate tear duct drain024123.1980$1,376.80$384.47$275.36
    68750TCreate tear duct drain024230.4081$1,804.72$597.36$360.94
    68760SClose tear duct opening06981.2381$73.48$16.48$14.70
    68761SClose tear duct opening02311.9191$113.90$22.78
    68770TClose tear system fistula024018.0686$1,072.37$315.31$214.47
    68801SDilate tear duct opening06981.2381$73.48$16.48$14.70
    68810SProbe nasolacrimal duct02311.9191$113.90$22.78
    68811TProbe nasolacrimal duct024018.0686$1,072.37$315.31$214.47
    Start Printed Page 42860
    68815TProbe nasolacrimal duct024018.0686$1,072.37$315.31$214.47
    68840SExplore/irrigate tear ducts02311.9191$113.90$22.78
    68850NInjection for tear sac x-ray
    68899STear duct system surgery02300.7823$46.43$14.97$9.29
    69000TDrain external ear lesion00061.5430$91.58$22.18$18.32
    69005TDrain external ear lesion000816.4242$974.78$194.96
    69020TDrain outer ear canal lesion00061.5430$91.58$22.18$18.32
    69090EPierce earlobes
    69100TBiopsy of external ear00194.0363$239.55$71.87$47.91
    69105TBiopsy of external ear canal025316.0627$953.32$282.29$190.66
    69110TRemove external ear, partial002114.9098$884.90$219.48$176.98
    69120TRemoval of external ear025423.2980$1,382.74$321.35$276.55
    69140TRemove ear canal lesion(s)025423.2980$1,382.74$321.35$276.55
    69145TRemove ear canal lesion(s)002114.9098$884.90$219.48$176.98
    69150TExtensive ear canal surgery02527.8317$464.81$113.41$92.96
    69155CExtensive ear/neck surgery
    69200XClear outer ear canal03400.6355$37.72$7.54
    69205TClear outer ear canal002219.5582$1,160.78$354.45$232.16
    69210XRemove impacted ear wax03400.6355$37.72$7.54
    69220TClean out mastoid cavity00120.8458$50.20$11.18$10.04
    69222TClean out mastoid cavity025316.0627$953.32$282.29$190.66
    69300TRevise external ear025423.2980$1,382.74$321.35$276.55
    69310TRebuild outer ear canal025637.1513$2,204.93$440.99
    69320TRebuild outer ear canal025637.1513$2,204.93$440.99
    69399TOuter ear surgery procedure02512.0010$118.76$23.75
    69400TInflate middle ear canal02512.0010$118.76$23.75
    69401TInflate middle ear canal02512.0010$118.76$23.75
    69405TCatheterize middle ear canal02527.8317$464.81$113.41$92.96
    69410TInset middle ear (baffle)02512.0010$118.76$23.75
    69420TIncision of eardrum02512.0010$118.76$23.75
    69421TIncision of eardrum025316.0627$953.32$282.29$190.66
    69424TRemove ventilating tube02527.8317$464.81$113.41$92.96
    69433TCreate eardrum opening02527.8317$464.81$113.41$92.96
    69436TCreate eardrum opening025316.0627$953.32$282.29$190.66
    69440TExploration of middle ear025423.2980$1,382.74$321.35$276.55
    69450TEardrum revision025637.1513$2,204.93$440.99
    69501TMastoidectomy025637.1513$2,204.93$440.99
    69502TMastoidectomy025423.2980$1,382.74$321.35$276.55
    69505TRemove mastoid structures025637.1513$2,204.93$440.99
    69511TExtensive mastoid surgery025637.1513$2,204.93$440.99
    69530TExtensive mastoid surgery025637.1513$2,204.93$440.99
    69535CRemove part of temporal bone
    69540TRemove ear lesion025316.0627$953.32$282.29$190.66
    69550TRemove ear lesion025637.1513$2,204.93$440.99
    69552TRemove ear lesion025637.1513$2,204.93$440.99
    69554CRemove ear lesion
    69601TMastoid surgery revision025637.1513$2,204.93$440.99
    69602TMastoid surgery revision025637.1513$2,204.93$440.99
    69603TMastoid surgery revision025637.1513$2,204.93$440.99
    69604TMastoid surgery revision025637.1513$2,204.93$440.99
    69605TMastoid surgery revision025637.1513$2,204.93$440.99
    69610TRepair of eardrum025423.2980$1,382.74$321.35$276.55
    69620TRepair of eardrum025423.2980$1,382.74$321.35$276.55
    69631TRepair eardrum structures025637.1513$2,204.93$440.99
    69632TRebuild eardrum structures025637.1513$2,204.93$440.99
    69633TRebuild eardrum structures025637.1513$2,204.93$440.99
    69635TRepair eardrum structures025637.1513$2,204.93$440.99
    69636TRebuild eardrum structures025637.1513$2,204.93$440.99
    69637TRebuild eardrum structures025637.1513$2,204.93$440.99
    69641TRevise middle ear & mastoid025637.1513$2,204.93$440.99
    69642TRevise middle ear & mastoid025637.1513$2,204.93$440.99
    69643TRevise middle ear & mastoid025637.1513$2,204.93$440.99
    69644TRevise middle ear & mastoid025637.1513$2,204.93$440.99
    69645TRevise middle ear & mastoid025637.1513$2,204.93$440.99
    69646TRevise middle ear & mastoid025637.1513$2,204.93$440.99
    69650TRelease middle ear bone025423.2980$1,382.74$321.35$276.55
    Start Printed Page 42861
    69660TRevise middle ear bone025637.1513$2,204.93$440.99
    69661TRevise middle ear bone025637.1513$2,204.93$440.99
    69662TRevise middle ear bone025637.1513$2,204.93$440.99
    69666TRepair middle ear structures025637.1513$2,204.93$440.99
    69667TRepair middle ear structures025637.1513$2,204.93$440.99
    69670TRemove mastoid air cells025637.1513$2,204.93$440.99
    69676TRemove middle ear nerve025637.1513$2,204.93$440.99
    69700TClose mastoid fistula025637.1513$2,204.93$440.99
    69710EImplant/replace hearing aid
    69711TRemove/repair hearing aid025637.1513$2,204.93$440.99
    69714TImplant temple bone w/stimul025637.1513$2,204.93$440.99
    69715TTemple bne implnt w/stimulat025637.1513$2,204.93$440.99
    69717TTemple bone implant revision025637.1513$2,204.93$440.99
    69718TRevise temple bone implant025637.1513$2,204.93$440.99
    69720TRelease facial nerve025637.1513$2,204.93$440.99
    69725TRelease facial nerve025637.1513$2,204.93$440.99
    69740TRepair facial nerve025637.1513$2,204.93$440.99
    69745TRepair facial nerve025637.1513$2,204.93$440.99
    69799TMiddle ear surgery procedure02512.0010$118.76$23.75
    69801TIncise inner ear025637.1513$2,204.93$440.99
    69802TIncise inner ear025637.1513$2,204.93$440.99
    69805TExplore inner ear025637.1513$2,204.93$440.99
    69806TExplore inner ear025637.1513$2,204.93$440.99
    69820TEstablish inner ear window025637.1513$2,204.93$440.99
    69840TRevise inner ear window025637.1513$2,204.93$440.99
    69905TRemove inner ear025637.1513$2,204.93$440.99
    69910TRemove inner ear & mastoid025637.1513$2,204.93$440.99
    69915TIncise inner ear nerve025637.1513$2,204.93$440.99
    69930TImplant cochlear device0259364.6725$21,643.31$8,034.61$4,328.66
    69949TInner ear surgery procedure02512.0010$118.76$23.75
    69950CIncise inner ear nerve
    69955TRelease facial nerve025637.1513$2,204.93$440.99
    69960TRelease inner ear canal025637.1513$2,204.93$440.99
    69970CRemove inner ear lesion
    69979TTemporal bone surgery02512.0010$118.76$23.75
    69990NMicrosurgery add-on
    70010SContrast x-ray of brain02743.0275$179.68$71.87$35.94
    70015SContrast x-ray of brain02743.0275$179.68$71.87$35.94
    70030XX-ray eye for foreign body02600.7521$44.64$17.85$8.93
    70100XX-ray exam of jaw02600.7521$44.64$17.85$8.93
    70110XX-ray exam of jaw02600.7521$44.64$17.85$8.93
    70120XX-ray exam of mastoids02600.7521$44.64$17.85$8.93
    70130XX-ray exam of mastoids02600.7521$44.64$17.85$8.93
    70134XX-ray exam of middle ear02611.2843$76.22$15.24
    70140XX-ray exam of facial bones02600.7521$44.64$17.85$8.93
    70150XX-ray exam of facial bones02600.7521$44.64$17.85$8.93
    70160XX-ray exam of nasal bones02600.7521$44.64$17.85$8.93
    70170XX-ray exam of tear duct02643.5080$208.20$79.41$41.64
    70190XX-ray exam of eye sockets02600.7521$44.64$17.85$8.93
    70200XX-ray exam of eye sockets02600.7521$44.64$17.85$8.93
    70210XX-ray exam of sinuses02600.7521$44.64$17.85$8.93
    70220XX-ray exam of sinuses02600.7521$44.64$17.85$8.93
    70240XX-ray exam, pituitary saddle02600.7521$44.64$17.85$8.93
    70250XX-ray exam of skull02600.7521$44.64$17.85$8.93
    70260XX-ray exam of skull02611.2843$76.22$15.24
    70300XX-ray exam of teeth02620.9186$54.52$10.90
    70310XX-ray exam of teeth02620.9186$54.52$10.90
    70320XFull mouth x-ray of teeth02620.9186$54.52$10.90
    70328XX-ray exam of jaw joint02600.7521$44.64$17.85$8.93
    70330XX-ray exam of jaw joints02600.7521$44.64$17.85$8.93
    70332SX-ray exam of jaw joint02753.5617$211.39$69.09$42.28
    70336SMagnetic image, jaw joint03355.1347$304.74$121.89$60.95
    70350XX-ray head for orthodontia02600.7521$44.64$17.85$8.93
    70355XPanoramic x-ray of jaws02600.7521$44.64$17.85$8.93
    70360XX-ray exam of neck02600.7521$44.64$17.85$8.93
    70370XThroat x-ray & fluoroscopy02721.3738$81.54$32.61$16.31
    Start Printed Page 42862
    70371XSpeech evaluation, complex02721.3738$81.54$32.61$16.31
    70373XContrast x-ray of larynx02631.7397$103.25$24.29$20.65
    70380XX-ray exam of salivary gland02600.7521$44.64$17.85$8.93
    70390XX-ray exam of salivary duct02631.7397$103.25$24.29$20.65
    70450*SCt head/brain w/o dye03323.2546$193.16$77.26$38.63
    70460*SCt head/brain w/dye02834.4053$261.45$104.58$52.29
    70470*SCt head/brain w/o & w/ dye03335.2596$312.16$124.86$62.43
    70480*SCt orbit/ear/fossa w/o dye03323.2546$193.16$77.26$38.63
    70481*SCt orbit/ear/fossa w/dye02834.4053$261.45$104.58$52.29
    70482*SCt orbit/ear/fossa w/o&w dye03335.2596$312.16$124.86$62.43
    70486*SCt maxillofacial w/o dye03323.2546$193.16$77.26$38.63
    70487*SCt maxillofacial w/dye02834.4053$261.45$104.58$52.29
    70488*SCt maxillofacial w/o & w dye03335.2596$312.16$124.86$62.43
    70490*SCt soft tissue neck w/o dye03323.2546$193.16$77.26$38.63
    70491*SCt soft tissue neck w/dye02834.4053$261.45$104.58$52.29
    70492*SCt sft tsue nck w/o & w/dye03335.2596$312.16$124.86$62.43
    70496*SCt angiography, head06625.1387$304.98$121.99$61.00
    70498*SCt angiography, neck06625.1387$304.98$121.99$61.00
    70540*SMri orbit/face/neck w/o dye03366.0467$358.87$143.54$71.77
    70542*SMri orbit/face/neck w/dye02846.3910$379.31$151.72$75.86
    70543*SMri orbt/fac/nck w/o & w dye03378.7547$519.59$207.83$103.92
    70544*SMr angiography head w/o dye03366.0467$358.87$143.54$71.77
    70545*SMr angiography head w/dye02846.3910$379.31$151.72$75.86
    70546*SMr angiograph head w/o&w dye03378.7547$519.59$207.83$103.92
    70547*SMr angiography neck w/o dye03366.0467$358.87$143.54$71.77
    70548*SMr angiography neck w/dye02846.3910$379.31$151.72$75.86
    70549*SMr angiograph neck w/o&w dye03378.7547$519.59$207.83$103.92
    70551*SMri brain w/o dye03366.0467$358.87$143.54$71.77
    70552*SMri brain w/ dye02846.3910$379.31$151.72$75.86
    70553*SMri brain w/o & w/ dye03378.7547$519.59$207.83$103.92
    70557SMri brain w/o dye03366.0467$358.87$143.54$71.77
    70558SMri brain w/ dye02846.3910$379.31$151.72$75.86
    70559SMri brain w/o & w/ dye03378.7547$519.59$207.83$103.92
    71010XChest x-ray02600.7521$44.64$17.85$8.93
    71015XChest x-ray02600.7521$44.64$17.85$8.93
    71020XChest x-ray02600.7521$44.64$17.85$8.93
    71021XChest x-ray02600.7521$44.64$17.85$8.93
    71022XChest x-ray02600.7521$44.64$17.85$8.93
    71023XChest x-ray and fluoroscopy02721.3738$81.54$32.61$16.31
    71030XChest x-ray02600.7521$44.64$17.85$8.93
    71034XChest x-ray and fluoroscopy02721.3738$81.54$32.61$16.31
    71035XChest x-ray02600.7521$44.64$17.85$8.93
    71040XContrast x-ray of bronchi02631.7397$103.25$24.29$20.65
    71060XContrast x-ray of bronchi02631.7397$103.25$24.29$20.65
    71090XX-ray & pacemaker insertion02721.3738$81.54$32.61$16.31
    71100XX-ray exam of ribs02600.7521$44.64$17.85$8.93
    71101XX-ray exam of ribs/chest02600.7521$44.64$17.85$8.93
    71110XX-ray exam of ribs02600.7521$44.64$17.85$8.93
    71111XX-ray exam of ribs/ chest02611.2843$76.22$15.24
    71120XX-ray exam of breastbone02600.7521$44.64$17.85$8.93
    71130XX-ray exam of breastbone02600.7521$44.64$17.85$8.93
    71250*SCt thorax w/o dye03323.2546$193.16$77.26$38.63
    71260*SCt thorax w/dye02834.4053$261.45$104.58$52.29
    71270*SCt thorax w/o & w/ dye03335.2596$312.16$124.86$62.43
    71275*SCt angiography, chest06625.1387$304.98$121.99$61.00
    71550*SMri chest w/o dye03366.0467$358.87$143.54$71.77
    71551*SMri chest w/dye02846.3910$379.31$151.72$75.86
    71552*SMri chest w/o & w/dye03378.7547$519.59$207.83$103.92
    71555BMri angio chest w or w/o dye
    72010XX-ray exam of spine02600.7521$44.64$17.85$8.93
    72020XX-ray exam of spine02600.7521$44.64$17.85$8.93
    72040XX-ray exam of neck spine02600.7521$44.64$17.85$8.93
    72050XX-ray exam of neck spine02611.2843$76.22$15.24
    72052XX-ray exam of neck spine02611.2843$76.22$15.24
    72069XX-ray exam of trunk spine02600.7521$44.64$17.85$8.93
    72070XX-ray exam of thoracic spine02600.7521$44.64$17.85$8.93
    Start Printed Page 42863
    72072XX-ray exam of thoracic spine02600.7521$44.64$17.85$8.93
    72074XX-ray exam of thoracic spine02600.7521$44.64$17.85$8.93
    72080XX-ray exam of trunk spine02600.7521$44.64$17.85$8.93
    72090XX-ray exam of trunk spine02611.2843$76.22$15.24
    72100XX-ray exam of lower spine02600.7521$44.64$17.85$8.93
    72110XX-ray exam of lower spine02611.2843$76.22$15.24
    72114XX-ray exam of lower spine02611.2843$76.22$15.24
    72120XX-ray exam of lower spine02611.2843$76.22$15.24
    72125*SCt neck spine w/o dye03323.2546$193.16$77.26$38.63
    72126*SCt neck spine w/dye02834.4053$261.45$104.58$52.29
    72127*SCt neck spine w/o & w/dye03335.2596$312.16$124.86$62.43
    72128*SCt chest spine w/o dye03323.2546$193.16$77.26$38.63
    72129*SCt chest spine w/dye02834.4053$261.45$104.58$52.29
    72130*SCt chest spine w/o & w/dye03335.2596$312.16$124.86$62.43
    72131*SCt lumbar spine w/o dye03323.2546$193.16$77.26$38.63
    72132*SCt lumbar spine w/dye02834.4053$261.45$104.58$52.29
    72133*SCt lumbar spine w/o & w/dye03335.2596$312.16$124.86$62.43
    72141*SMri neck spine w/o dye03366.0467$358.87$143.54$71.77
    72142*SMri neck spine w/dye02846.3910$379.31$151.72$75.86
    72146*SMri chest spine w/o dye03366.0467$358.87$143.54$71.77
    72147*SMri chest spine w/dye02846.3910$379.31$151.72$75.86
    72148*SMri lumbar spine w/o dye03366.0467$358.87$143.54$71.77
    72149*SMri lumbar spine w/dye02846.3910$379.31$151.72$75.86
    72156*SMri neck spine w/o & w/dye03378.7547$519.59$207.83$103.92
    72157*SMri chest spine w/o & w/dye03378.7547$519.59$207.83$103.92
    72158*SMri lumbar spine w/o & w/dye03378.7547$519.59$207.83$103.92
    72159EMr angio spine w/o&w/dye
    72170XX-ray exam of pelvis02600.7521$44.64$17.85$8.93
    72190XX-ray exam of pelvis02600.7521$44.64$17.85$8.93
    72191*SCt angiograph pelv w/o&w/dye06625.1387$304.98$121.99$61.00
    72192*SCt pelvis w/o dye03323.2546$193.16$77.26$38.63
    72193*SCt pelvis w/dye02834.4053$261.45$104.58$52.29
    72194*SCt pelvis w/o & w/dye03335.2596$312.16$124.86$62.43
    72195*SMri pelvis w/o dye03366.0467$358.87$143.54$71.77
    72196*SMri pelvis w/dye02846.3910$379.31$151.72$75.86
    72197*SMri pelvis w/o & w/dye03378.7547$519.59$207.83$103.92
    72198BMr angio pelvis w/o & w/dye
    72200XX-ray exam sacroiliac joints02600.7521$44.64$17.85$8.93
    72202XX-ray exam sacroiliac joints02600.7521$44.64$17.85$8.93
    72220XX-ray exam of tailbone02600.7521$44.64$17.85$8.93
    72240SContrast x-ray of neck spine02743.0275$179.68$71.87$35.94
    72255SContrast x-ray, thorax spine02743.0275$179.68$71.87$35.94
    72265SContrast x-ray, lower spine02743.0275$179.68$71.87$35.94
    72270SContrast x-ray, spine02743.0275$179.68$71.87$35.94
    72275SEpidurography02743.0275$179.68$71.87$35.94
    72285SX-ray c/t spine disk038812.2736$728.44$291.37$145.69
    72295SX-ray of lower spine disk038812.2736$728.44$291.37$145.69
    73000XX-ray exam of collar bone02600.7521$44.64$17.85$8.93
    73010XX-ray exam of shoulder blade02600.7521$44.64$17.85$8.93
    73020XX-ray exam of shoulder02600.7521$44.64$17.85$8.93
    73030XX-ray exam of shoulder02600.7521$44.64$17.85$8.93
    73040SContrast x-ray of shoulder02753.5617$211.39$69.09$42.28
    73050XX-ray exam of shoulders02600.7521$44.64$17.85$8.93
    73060XX-ray exam of humerus02600.7521$44.64$17.85$8.93
    73070XX-ray exam of elbow02600.7521$44.64$17.85$8.93
    73080XX-ray exam of elbow02600.7521$44.64$17.85$8.93
    73085SContrast x-ray of elbow02753.5617$211.39$69.09$42.28
    73090XX-ray exam of forearm02600.7521$44.64$17.85$8.93
    73092XX-ray exam of arm, infant02600.7521$44.64$17.85$8.93
    73100XX-ray exam of wrist02600.7521$44.64$17.85$8.93
    73110XX-ray exam of wrist02600.7521$44.64$17.85$8.93
    73115SContrast x-ray of wrist02753.5617$211.39$69.09$42.28
    73120XX-ray exam of hand02600.7521$44.64$17.85$8.93
    73130XX-ray exam of hand02600.7521$44.64$17.85$8.93
    73140XX-ray exam of finger(s)02600.7521$44.64$17.85$8.93
    73200*SCt upper extremity w/o dye03323.2546$193.16$77.26$38.63
    Start Printed Page 42864
    73201*SCt upper extremity w/dye02834.4053$261.45$104.58$52.29
    73202*SCt uppr extremity w/o&w/dye03335.2596$312.16$124.86$62.43
    73206*SCt angio upr extrm w/o&w/dye06625.1387$304.98$121.99$61.00
    73218*SMri upper extremity w/o dye03366.0467$358.87$143.54$71.77
    73219*SMri upper extremity w/dye02846.3910$379.31$151.72$75.86
    73220*SMri uppr extremity w/o&w/dye03378.7547$519.59$207.83$103.92
    73221*SMri joint upr extrem w/o dye03366.0467$358.87$143.54$71.77
    73222*SMri joint upr extrem w/dye02846.3910$379.31$151.72$75.86
    73223*SMri joint upr extr w/o&w/dye03378.7547$519.59$207.83$103.92
    73225EMr angio upr extr w/o&w/dye
    73500XX-ray exam of hip02600.7521$44.64$17.85$8.93
    73510XX-ray exam of hip02600.7521$44.64$17.85$8.93
    73520XX-ray exam of hips02611.2843$76.22$15.24
    73525SContrast x-ray of hip02753.5617$211.39$69.09$42.28
    73530XX-ray exam of hip02611.2843$76.22$15.24
    73540XX-ray exam of pelvis & hips02600.7521$44.64$17.85$8.93
    73542SX-ray exam, sacroiliac joint02753.5617$211.39$69.09$42.28
    73550XX-ray exam of thigh02600.7521$44.64$17.85$8.93
    73560XX-ray exam of knee, 1 or 202600.7521$44.64$17.85$8.93
    73562XX-ray exam of knee, 302600.7521$44.64$17.85$8.93
    73564XX-ray exam, knee, 4 or more02600.7521$44.64$17.85$8.93
    73565XX-ray exam of knees02600.7521$44.64$17.85$8.93
    73580SContrast x-ray of knee joint02753.5617$211.39$69.09$42.28
    73590XX-ray exam of lower leg02600.7521$44.64$17.85$8.93
    73592XX-ray exam of leg, infant02600.7521$44.64$17.85$8.93
    73600XX-ray exam of ankle02600.7521$44.64$17.85$8.93
    73610XX-ray exam of ankle02600.7521$44.64$17.85$8.93
    73615SContrast x-ray of ankle02753.5617$211.39$69.09$42.28
    73620XX-ray exam of foot02600.7521$44.64$17.85$8.93
    73630XX-ray exam of foot02600.7521$44.64$17.85$8.93
    73650XX-ray exam of heel02600.7521$44.64$17.85$8.93
    73660XX-ray exam of toe(s)02600.7521$44.64$17.85$8.93
    73700*SCt lower extremity w/o dye03323.2546$193.16$77.26$38.63
    73701*SCt lower extremity w/dye02834.4053$261.45$104.58$52.29
    73702*SCt lwr extremity w/o&w/dye03335.2596$312.16$124.86$62.43
    73706*SCt angio lwr extr w/o&w/dye06625.1387$304.98$121.99$61.00
    73718*SMri lower extremity w/o dye03366.0467$358.87$143.54$71.77
    73719*SMri lower extremity w/dye02846.3910$379.31$151.72$75.86
    73720*SMri lwr extremity w/o&w/dye03378.7547$519.59$207.83$103.92
    73721*SMri jnt of lwr extre w/o dye03366.0467$358.87$143.54$71.77
    73722*SMri joint of lwr extr w/dye02846.3910$379.31$151.72$75.86
    73723*SMri joint lwr extr w/o&w/dye03378.7547$519.59$207.83$103.92
    73725BMr ang lwr ext w or w/o dye
    74000XX-ray exam of abdomen02600.7521$44.64$17.85$8.93
    74010XX-ray exam of abdomen02600.7521$44.64$17.85$8.93
    74020XX-ray exam of abdomen02600.7521$44.64$17.85$8.93
    74022XX-ray exam series, abdomen02611.2843$76.22$15.24
    74150*SCt abdomen w/o dye03323.2546$193.16$77.26$38.63
    74160*SCt abdomen w/dye02834.4053$261.45$104.58$52.29
    74170*SCt abdomen w/o &w /dye03335.2596$312.16$124.86$62.43
    74175*SCt angio abdom w/o & w/dye06625.1387$304.98$121.99$61.00
    74181*SMri abdomen w/o dye03366.0467$358.87$143.54$71.77
    74182*SMri abdomen w/dye02846.3910$379.31$151.72$75.86
    74183*SMri abdomen w/o & w/dye03378.7547$519.59$207.83$103.92
    74185BMri angio, abdom w orw/o dye
    74190XX-ray exam of peritoneum02643.5080$208.20$79.41$41.64
    74210SContrst x-ray exam of throat02761.5250$90.51$36.20$18.10
    74220SContrast x-ray, esophagus02761.5250$90.51$36.20$18.10
    74230SCine/vid x-ray, throat/esoph02761.5250$90.51$36.20$18.10
    74235SRemove esophagus obstruction02962.2350$132.65$53.06$26.53
    74240SX-ray exam, upper gi tract02761.5250$90.51$36.20$18.10
    74241SX-ray exam, upper gi tract02761.5250$90.51$36.20$18.10
    74245SX-ray exam, upper gi tract02772.3744$140.92$56.36$28.18
    74246SContrst x-ray uppr gi tract02761.5250$90.51$36.20$18.10
    74247SContrst x-ray uppr gi tract02761.5250$90.51$36.20$18.10
    74249SContrst x-ray uppr gi tract02772.3744$140.92$56.36$28.18
    Start Printed Page 42865
    74250SX-ray exam of small bowel02761.5250$90.51$36.20$18.10
    74251SX-ray exam of small bowel02772.3744$140.92$56.36$28.18
    74260SX-ray exam of small bowel02772.3744$140.92$56.36$28.18
    74270SContrast x-ray exam of colon02761.5250$90.51$36.20$18.10
    74280SContrast x-ray exam of colon02772.3744$140.92$56.36$28.18
    74283SContrast x-ray exam of colon02761.5250$90.51$36.20$18.10
    74290SContrast x-ray, gallbladder02761.5250$90.51$36.20$18.10
    74291SContrast x-rays, gallbladder02761.5250$90.51$36.20$18.10
    74300XX-ray bile ducts/pancreas02631.7397$103.25$24.29$20.65
    74301XX-rays at surgery add-on02631.7397$103.25$24.29$20.65
    74305XX-ray bile ducts/pancreas02631.7397$103.25$24.29$20.65
    74320XContrast x-ray of bile ducts02643.5080$208.20$79.41$41.64
    74327SX-ray bile stone removal02962.2350$132.65$53.06$26.53
    74328NX-ray bile duct endoscopy
    74329NX-ray for pancreas endoscopy
    74330NX-ray bile/panc endoscopy
    74340XX-ray guide for GI tube02721.3738$81.54$32.61$16.31
    74350XX-ray guide, stomach tube02631.7397$103.25$24.29$20.65
    74355XX-ray guide, intestinal tube02631.7397$103.25$24.29$20.65
    74360SX-ray guide, GI dilation02962.2350$132.65$53.06$26.53
    74363SX-ray, bile duct dilation02975.2293$310.36$122.13$62.07
    74400SContrst x-ray, urinary tract02782.6314$156.17$62.46$31.23
    74410SContrst x-ray, urinary tract02782.6314$156.17$62.46$31.23
    74415SContrst x-ray, urinary tract02782.6314$156.17$62.46$31.23
    74420SContrst x-ray, urinary tract02782.6314$156.17$62.46$31.23
    74425SContrst x-ray, urinary tract02782.6314$156.17$62.46$31.23
    74430SContrast x-ray, bladder02782.6314$156.17$62.46$31.23
    74440SX-ray, male genital tract02782.6314$156.17$62.46$31.23
    74445SX-ray exam of penis02782.6314$156.17$62.46$31.23
    74450SX-ray, urethra/bladder02782.6314$156.17$62.46$31.23
    74455SX-ray, urethra/bladder02782.6314$156.17$62.46$31.23
    74470XX-ray exam of kidney lesion02631.7397$103.25$24.29$20.65
    74475SX-ray control, cath insert02975.2293$310.36$122.13$62.07
    74480SX-ray control, cath insert02962.2350$132.65$53.06$26.53
    74485SX-ray guide, GU dilation02962.2350$132.65$53.06$26.53
    74710XX-ray measurement of pelvis02611.2843$76.22$15.24
    74740XX-ray, female genital tract02643.5080$208.20$79.41$41.64
    74742XX-ray, fallopian tube02643.5080$208.20$79.41$41.64
    74775SX-ray exam of perineum02782.6314$156.17$62.46$31.23
    75552SHeart mri for morph w/o dye03366.0467$358.87$143.54$71.77
    75553SHeart mri for morph w/dye02846.3910$379.31$151.72$75.86
    75554SCardiac MRI/function03366.0467$358.87$143.54$71.77
    75555SCardiac MRI/limited study03366.0467$358.87$143.54$71.77
    75556ECardiac MRI/flow mapping
    75600SContrast x-ray exam of aorta028020.6960$1,228.31$353.85$245.66
    75605SContrast x-ray exam of aorta028020.6960$1,228.31$353.85$245.66
    75625SContrast x-ray exam of aorta028020.6960$1,228.31$353.85$245.66
    75630SX-ray aorta, leg arteries028020.6960$1,228.31$353.85$245.66
    75635*SCt angio abdominal arteries06625.1387$304.98$121.99$61.00
    75650SArtery x-rays, head & neck028020.6960$1,228.31$353.85$245.66
    75658SArtery x-rays, arm02798.8914$527.70$150.03$105.54
    75660SArtery x-rays, head & neck06686.4730$384.17$114.67$76.83
    75662SArtery x-rays, head & neck028020.6960$1,228.31$353.85$245.66
    75665SArtery x-rays, head & neck028020.6960$1,228.31$353.85$245.66
    75671SArtery x-rays, head & neck028020.6960$1,228.31$353.85$245.66
    75676SArtery x-rays, neck028020.6960$1,228.31$353.85$245.66
    75680SArtery x-rays, neck028020.6960$1,228.31$353.85$245.66
    75685SArtery x-rays, spine028020.6960$1,228.31$353.85$245.66
    75705SArtery x-rays, spine06686.4730$384.17$114.67$76.83
    75710SArtery x-rays, arm/leg028020.6960$1,228.31$353.85$245.66
    75716SArtery x-rays, arms/legs028020.6960$1,228.31$353.85$245.66
    75722SArtery x-rays, kidney028020.6960$1,228.31$353.85$245.66
    75724SArtery x-rays, kidneys028020.6960$1,228.31$353.85$245.66
    75726SArtery x-rays, abdomen028020.6960$1,228.31$353.85$245.66
    75731SArtery x-rays, adrenal gland028020.6960$1,228.31$353.85$245.66
    75733SArtery x-rays, adrenals06686.4730$384.17$114.67$76.83
    Start Printed Page 42866
    75736SArtery x-rays, pelvis028020.6960$1,228.31$353.85$245.66
    75741SArtery x-rays, lung02798.8914$527.70$150.03$105.54
    75743SArtery x-rays, lungs028020.6960$1,228.31$353.85$245.66
    75746SArtery x-rays, lung02798.8914$527.70$150.03$105.54
    75756SArtery x-rays, chest02798.8914$527.70$150.03$105.54
    75774SArtery x-ray, each vessel02798.8914$527.70$150.03$105.54
    75790SVisualize A-V shunt02798.8914$527.70$150.03$105.54
    75801XLymph vessel x-ray, arm/leg02643.5080$208.20$79.41$41.64
    75803XLymph vessel x-ray,arms/legs02643.5080$208.20$79.41$41.64
    75805XLymph vessel x-ray, trunk02643.5080$208.20$79.41$41.64
    75807XLymph vessel x-ray, trunk02643.5080$208.20$79.41$41.64
    75809XNonvascular shunt, x-ray02631.7397$103.25$24.29$20.65
    75810SVein x-ray, spleen/liver02798.8914$527.70$150.03$105.54
    75820SVein x-ray, arm/leg06686.4730$384.17$114.67$76.83
    75822SVein x-ray, arms/legs06686.4730$384.17$114.67$76.83
    75825SVein x-ray, trunk02798.8914$527.70$150.03$105.54
    75827SVein x-ray, chest02798.8914$527.70$150.03$105.54
    75831SVein x-ray, kidney02798.8914$527.70$150.03$105.54
    75833SVein x-ray, kidneys02798.8914$527.70$150.03$105.54
    75840SVein x-ray, adrenal gland028020.6960$1,228.31$353.85$245.66
    75842SVein x-ray, adrenal glands028020.6960$1,228.31$353.85$245.66
    75860SVein x-ray, neck06686.4730$384.17$114.67$76.83
    75870SVein x-ray, skull06686.4730$384.17$114.67$76.83
    75872SVein x-ray, skull02798.8914$527.70$150.03$105.54
    75880SVein x-ray, eye socket06686.4730$384.17$114.67$76.83
    75885SVein x-ray, liver028020.6960$1,228.31$353.85$245.66
    75887SVein x-ray, liver02798.8914$527.70$150.03$105.54
    75889SVein x-ray, liver028020.6960$1,228.31$353.85$245.66
    75891SVein x-ray, liver02798.8914$527.70$150.03$105.54
    75893NVenous sampling by catheter
    75894SX-rays, transcath therapy02975.2293$310.36$122.13$62.07
    75896SX-rays, transcath therapy02975.2293$310.36$122.13$62.07
    75898XFollow-up angiography02631.7397$103.25$24.29$20.65
    75900CArterial catheter exchange
    75901XRemove cva device obstruct02631.7397$103.25$24.29$20.65
    75902XRemove cva lumen obstruct02631.7397$103.25$24.29$20.65
    75940SX-ray placement, vein filter02975.2293$310.36$122.13$62.07
    75945SIntravascular us02672.6208$155.54$62.18$31.11
    75946SIntravascular us add-on02661.6319$96.85$38.74$19.37
    75952CEndovasc repair abdom aorta
    75953CAbdom aneurysm endovas rpr
    75954CIliac aneurysm endovas rpr
    75960STranscatheter intro, stent06686.4730$384.17$114.67$76.83
    75961SRetrieval, broken catheter06686.4730$384.17$114.67$76.83
    75962SRepair arterial blockage06686.4730$384.17$114.67$76.83
    75964SRepair artery blockage, each06686.4730$384.17$114.67$76.83
    75966SRepair arterial blockage06686.4730$384.17$114.67$76.83
    75968SRepair artery blockage, each06686.4730$384.17$114.67$76.83
    75970SVascular biopsy06686.4730$384.17$114.67$76.83
    75978SRepair venous blockage06686.4730$384.17$114.67$76.83
    75980SContrast xray exam bile duct02975.2293$310.36$122.13$62.07
    75982SContrast xray exam bile duct02975.2293$310.36$122.13$62.07
    75984XXray control catheter change02631.7397$103.25$24.29$20.65
    75989NAbscess drainage under x-ray
    75992SAtherectomy, x-ray exam02798.8914$527.70$150.03$105.54
    75993SAtherectomy, x-ray exam02798.8914$527.70$150.03$105.54
    75994SAtherectomy, x-ray exam02798.8914$527.70$150.03$105.54
    75995SAtherectomy, x-ray exam02798.8914$527.70$150.03$105.54
    75996SAtherectomy, x-ray exam02798.8914$527.70$150.03$105.54
    75998NFluoroguide for vein device
    76000XFluoroscope examination02721.3738$81.54$32.61$16.31
    76001NFluoroscope exam, extensive
    76003NNeedle localization by x-ray
    76005NFluoroguide for spine inject
    76006XX-ray stress view02600.7521$44.64$17.85$8.93
    76010XX-ray, nose to rectum02600.7521$44.64$17.85$8.93
    Start Printed Page 42867
    76012SPercut vertebroplasty fluor02743.0275$179.68$71.87$35.94
    76013SPercut vertebroplasty, ct02743.0275$179.68$71.87$35.94
    76020XX-rays for bone age02600.7521$44.64$17.85$8.93
    76040XX-rays, bone evaluation02611.2843$76.22$15.24
    76061XX-rays, bone survey02611.2843$76.22$15.24
    76062XX-rays, bone survey02611.2843$76.22$15.24
    76065XX-rays, bone evaluation02611.2843$76.22$15.24
    76066XJoint survey, single view02600.7521$44.64$17.85$8.93
    76070SCT scan, bone density study02881.2511$74.25$14.85
    76071SCt bone density, peripheral02821.6467$97.73$39.09$19.55
    76075SDexa, axial skeleton study02881.2511$74.25$14.85
    76076SDexa, peripheral study06650.6435$38.19$7.64
    76077XDxa bone density/v-fracture02600.7521$44.64$17.85$8.93
    76078XRadiographic absorptiometry02600.7521$44.64$17.85$8.93
    76080XX-ray exam of fistula02631.7397$103.25$24.29$20.65
    76082AComputer mammogram add-on
    76083AComputer mammogram add-on
    76086XX-ray of mammary duct02631.7397$103.25$24.29$20.65
    76088XX-ray of mammary ducts02631.7397$103.25$24.29$20.65
    76090AMammogram, one breast
    76091AMammogram, both breasts
    76092AMammogram, screening
    76093EMagnetic image, breast
    76094EMagnetic image, both breasts
    76095XStereotactic breast biopsy02643.5080$208.20$79.41$41.64
    76096XX-ray of needle wire, breast02631.7397$103.25$24.29$20.65
    76098XX-ray exam, breast specimen02600.7521$44.64$17.85$8.93
    76100XX-ray exam of body section02611.2843$76.22$15.24
    76101XComplex body section x-ray02631.7397$103.25$24.29$20.65
    76102XComplex body section x-rays02643.5080$208.20$79.41$41.64
    76120XCine/video x-rays02721.3738$81.54$32.61$16.31
    76125XCine/video x-rays add-on02600.7521$44.64$17.85$8.93
    76140EX-ray consultation
    76150XX-ray exam, dry process02600.7521$44.64$17.85$8.93
    76350NSpecial x-ray contrast study
    76355SCt scan for localization02834.4053$261.45$104.58$52.29
    76360SCt scan for needle biopsy02834.4053$261.45$104.58$52.29
    76362SCt guide for tissue ablation03323.2546$193.16$77.26$38.63
    76370SCt scan for therapy guide02821.6467$97.73$39.09$19.55
    76375S3d/holograph reconstr add-on02821.6467$97.73$39.09$19.55
    76380SCAT scan follow-up study02821.6467$97.73$39.09$19.55
    76390EMr spectroscopy
    76393SMr guidance for needle place03355.1347$304.74$121.89$60.95
    76394SMri for tissue ablation03355.1347$304.74$121.89$60.95
    76400SMagnetic image, bone marrow03355.1347$304.74$121.89$60.95
    76496XFluoroscopic procedure02721.3738$81.54$32.61$16.31
    76497SCt procedure02821.6467$97.73$39.09$19.55
    76498SMri procedure03355.1347$304.74$121.89$60.95
    76499XRadiographic procedure02600.7521$44.64$17.85$8.93
    76506SEcho exam of head02651.0167$60.34$24.13$12.07
    76510SOphth us, b & quant a02661.6319$96.85$38.74$19.37
    76511SEcho exam of eye02661.6319$96.85$38.74$19.37
    76512SEcho exam of eye02661.6319$96.85$38.74$19.37
    76513SEcho exam of eye, water bath02661.6319$96.85$38.74$19.37
    76514XEcho exam of eye, thickness03400.6355$37.72$7.54
    76516SEcho exam of eye02651.0167$60.34$24.13$12.07
    76519SEcho exam of eye02661.6319$96.85$38.74$19.37
    76529SEcho exam of eye02651.0167$60.34$24.13$12.07
    76536SUs exam of head and neck02661.6319$96.85$38.74$19.37
    76604*SUs exam, chest, b-scan02661.6319$96.85$38.74$19.37
    76645*SUs exam, breast(s)02651.0167$60.34$24.13$12.07
    76700*SUs exam, abdom, complete02661.6319$96.85$38.74$19.37
    76705*SEcho exam of abdomen02661.6319$96.85$38.74$19.37
    76770*SUs exam abdo back wall, comp02661.6319$96.85$38.74$19.37
    76775*SUs exam abdo back wall, lim02661.6319$96.85$38.74$19.37
    76778*SUs exam kidney transplant02661.6319$96.85$38.74$19.37
    Start Printed Page 42868
    76800SUs exam, spinal canal02661.6319$96.85$38.74$19.37
    76801SOb us < 14 wks, single fetus02661.6319$96.85$38.74$19.37
    76802SOb us < 14 wks, add'l fetus02651.0167$60.34$24.13$12.07
    76805SUs exam, pg uterus, compl02661.6319$96.85$38.74$19.37
    76810SUs exam, pg uterus, mult02661.6319$96.85$38.74$19.37
    76811SOb us, detailed, sngl fetus02672.6208$155.54$62.18$31.11
    76812SOb us, detailed, addl fetus02661.6319$96.85$38.74$19.37
    76815SUs exam, pg uterus limit02651.0167$60.34$24.13$12.07
    76816SUs exam pg uterus repeat02651.0167$60.34$24.13$12.07
    76817STransvaginal us, obstetric02661.6319$96.85$38.74$19.37
    76818SFetal biophys profile w/nst02661.6319$96.85$38.74$19.37
    76819SFetal biophys profil w/o nst02661.6319$96.85$38.74$19.37
    76820SUmbilical artery echo00961.6233$96.34$38.53$19.27
    76821SMiddle cerebral artery echo00961.6233$96.34$38.53$19.27
    76825SEcho exam of fetal heart06711.6951$100.60$40.24$20.12
    76826SEcho exam of fetal heart06971.5288$90.73$36.29$18.15
    76827SEcho exam of fetal heart06711.6951$100.60$40.24$20.12
    76828SEcho exam of fetal heart06971.5288$90.73$36.29$18.15
    76830*STransvaginal us, non-ob02661.6319$96.85$38.74$19.37
    76831*SEcho exam, uterus02672.6208$155.54$62.18$31.11
    76856*SUs exam, pelvic, complete02661.6319$96.85$38.74$19.37
    76857*SUs exam, pelvic, limited02651.0167$60.34$24.13$12.07
    76870SUs exam, scrotum02661.6319$96.85$38.74$19.37
    76872SUs, transrectal02661.6319$96.85$38.74$19.37
    76873SEchograp trans r, pros study02661.6319$96.85$38.74$19.37
    76880SUs exam, extremity02661.6319$96.85$38.74$19.37
    76885SUs exam infant hips, dynamic02651.0167$60.34$24.13$12.07
    76886SUs exam infant hips, static02661.6319$96.85$38.74$19.37
    76930SEcho guide, cardiocentesis02681.0562$62.69$12.54
    76932SEcho guide for heart biopsy02681.0562$62.69$12.54
    76936SEcho guide for artery repair02681.0562$62.69$12.54
    76937NUs guide, vascular access
    76940SUs guide, tissue ablation02681.0562$62.69$12.54
    76941SEcho guide for transfusion02681.0562$62.69$12.54
    76942SEcho guide for biopsy02681.0562$62.69$12.54
    76945SEcho guide, villus sampling02681.0562$62.69$12.54
    76946SEcho guide for amniocentesis02681.0562$62.69$12.54
    76948SEcho guide, ova aspiration02681.0562$62.69$12.54
    76950SEcho guidance radiotherapy02681.0562$62.69$12.54
    76965SEcho guidance radiotherapy02681.0562$62.69$12.54
    76970SUltrasound exam follow-up02651.0167$60.34$24.13$12.07
    76975SGI endoscopic ultrasound02661.6319$96.85$38.74$19.37
    76977XUs bone density measure03400.6355$37.72$7.54
    76986SUltrasound guide intraoper02661.6319$96.85$38.74$19.37
    76999SEcho examination procedure02651.0167$60.34$24.13$12.07
    77261ERadiation therapy planning
    77262ERadiation therapy planning
    77263ERadiation therapy planning
    77280XSet radiation therapy field03041.7658$104.80$41.52$20.96
    77285XSet radiation therapy field03053.9854$236.53$91.38$47.31
    77290XSet radiation therapy field03053.9854$236.53$91.38$47.31
    77295XSet radiation therapy field031013.8858$824.12$325.27$164.82
    77299ERadiation therapy planning
    77300XRadiation therapy dose plan03041.7658$104.80$41.52$20.96
    77301XRadiotherapy dose plan, imrt031013.8858$824.12$325.27$164.82
    77305XTeletx isodose plan simple03041.7658$104.80$41.52$20.96
    77310XTeletx isodose plan intermed03053.9854$236.53$91.38$47.31
    77315XTeletx isodose plan complex03053.9854$236.53$91.38$47.31
    77321XSpecial teletx port plan03053.9854$236.53$91.38$47.31
    77326XRadiation therapy dose plan03041.7658$104.80$41.52$20.96
    77327XBrachytx isodose calc interm03053.9854$236.53$91.38$47.31
    77328XBrachytx isodose plan compl03053.9854$236.53$91.38$47.31
    77331XSpecial radiation dosimetry03041.7658$104.80$41.52$20.96
    77332XRadiation treatment aid(s)03032.8228$167.53$66.95$33.51
    77333XRadiation treatment aid(s)03032.8228$167.53$66.95$33.51
    77334XRadiation treatment aid(s)03032.8228$167.53$66.95$33.51
    Start Printed Page 42869
    77336XRadiation physics consult03041.7658$104.80$41.52$20.96
    77370XRadiation physics consult03041.7658$104.80$41.52$20.96
    77399XExternal radiation dosimetry03041.7658$104.80$41.52$20.96
    77401SRadiation treatment delivery03001.5129$89.79$17.96
    77402SRadiation treatment delivery03001.5129$89.79$17.96
    77403SRadiation treatment delivery03001.5129$89.79$17.96
    77404SRadiation treatment delivery03001.5129$89.79$17.96
    77406SRadiation treatment delivery03001.5129$89.79$17.96
    77407SRadiation treatment delivery03001.5129$89.79$17.96
    77408SRadiation treatment delivery03001.5129$89.79$17.96
    77409SRadiation treatment delivery03001.5129$89.79$17.96
    77411SRadiation treatment delivery03012.2094$131.13$26.23
    77412SRadiation treatment delivery03012.2094$131.13$26.23
    77413SRadiation treatment delivery03012.2094$131.13$26.23
    77414SRadiation treatment delivery03012.2094$131.13$26.23
    77416SRadiation treatment delivery03012.2094$131.13$26.23
    77417XRadiology port film(s)02600.7521$44.64$17.85$8.93
    77418SRadiation tx delivery, imrt04125.3400$316.93$63.39
    77427ERadiation tx management, x5
    77431ERadiation therapy management
    77432EStereotactic radiation trmt
    77470SSpecial radiation treatment02995.8217$345.52$69.10
    77499ERadiation therapy management
    77520SProton trmt, simple w/o comp066412.8853$764.74$152.95
    77522SProton trmt, simple w/comp066412.8853$764.74$152.95
    77523SProton trmt, intermediate066715.4156$914.92$182.98
    77525SProton treatment, complex066715.4156$914.92$182.98
    77600SHyperthermia treatment03145.9674$354.17$98.36$70.83
    77605SHyperthermia treatment03145.9674$354.17$98.36$70.83
    77610SHyperthermia treatment03145.9674$354.17$98.36$70.83
    77615SHyperthermia treatment03145.9674$354.17$98.36$70.83
    77620SHyperthermia treatment03145.9674$354.17$98.36$70.83
    77750SInfuse radioactive materials03012.2094$131.13$26.23
    77761SApply intrcav radiat simple03124.9806$295.60$59.12
    77762SApply intrcav radiat interm03124.9806$295.60$59.12
    77763SApply intrcav radiat compl03124.9806$295.60$59.12
    77776SApply interstit radiat simpl03124.9806$295.60$59.12
    77777SApply interstit radiat inter03124.9806$295.60$59.12
    77778SApply interstit radiat compl065112.0898$717.53$143.51
    77781SHigh intensity brachytherapy031312.8072$760.11$152.02
    77782SHigh intensity brachytherapy031312.8072$760.11$152.02
    77783SHigh intensity brachytherapy031312.8072$760.11$152.02
    77784SHigh intensity brachytherapy031312.8072$760.11$152.02
    77789SApply surface radiation03001.5129$89.79$17.96
    77790NRadiation handling
    77799SRadium/radioisotope therapy031312.8072$760.11$152.02
    78000SThyroid, single uptake03891.4908$88.48$35.39$17.70
    78001SThyroid, multiple uptakes03891.4908$88.48$35.39$17.70
    78003SThyroid suppress/stimul03891.4908$88.48$35.39$17.70
    78006SThyroid imaging with uptake03902.5446$151.02$60.40$30.20
    78007SThyroid image, mult uptakes03912.8643$170.00$68.00$34.00
    78010SThyroid imaging03902.5446$151.02$60.40$30.20
    78011SThyroid imaging with flow03902.5446$151.02$60.40$30.20
    78015SThyroid met imaging04064.2840$254.26$101.70$50.85
    78016SThyroid met imaging/studies04064.2840$254.26$101.70$50.85
    78018SThyroid met imaging, body04064.2840$254.26$101.70$50.85
    78020SThyroid met uptake03991.5123$89.76$35.90$17.95
    78070SParathyroid nuclear imaging03912.8643$170.00$68.00$34.00
    78075SAdrenal nuclear imaging03912.8643$170.00$68.00$34.00
    78099SEndocrine nuclear procedure03902.5446$151.02$60.40$30.20
    78102SBone marrow imaging, ltd04004.1147$244.21$97.68$48.84
    78103SBone marrow imaging, mult04004.1147$244.21$97.68$48.84
    78104SBone marrow imaging, body04004.1147$244.21$97.68$48.84
    78110SPlasma volume, single03933.4282$203.46$81.38$40.69
    78111SPlasma volume, multiple03933.4282$203.46$81.38$40.69
    78120SRed cell mass, single03933.4282$203.46$81.38$40.69
    Start Printed Page 42870
    78121SRed cell mass, multiple03933.4282$203.46$81.38$40.69
    78122SBlood volume03933.4282$203.46$81.38$40.69
    78130SRed cell survival study03933.4282$203.46$81.38$40.69
    78135SRed cell survival kinetics03933.4282$203.46$81.38$40.69
    78140SRed cell sequestration03933.4282$203.46$81.38$40.69
    78160SPlasma iron turnover03933.4282$203.46$81.38$40.69
    78162SRadioiron absorption exam03933.4282$203.46$81.38$40.69
    78170SRed cell iron utilization03933.4282$203.46$81.38$40.69
    78172STotal body iron estimation03933.4282$203.46$81.38$40.69
    78185SSpleen imaging04004.1147$244.21$97.68$48.84
    78190SPlatelet survival, kinetics03891.4908$88.48$35.39$17.70
    78191SPlatelet survival03891.4908$88.48$35.39$17.70
    78195SLymph system imaging04004.1147$244.21$97.68$48.84
    78199SBlood/lymph nuclear exam04004.1147$244.21$97.68$48.84
    78201SLiver imaging03944.4428$263.68$105.47$52.74
    78202SLiver imaging with flow03944.4428$263.68$105.47$52.74
    78205SLiver imaging (3D)03944.4428$263.68$105.47$52.74
    78206SLiver image (3d) with flow03944.4428$263.68$105.47$52.74
    78215SLiver and spleen imaging03944.4428$263.68$105.47$52.74
    78216SLiver & spleen image/flow03944.4428$263.68$105.47$52.74
    78220SLiver function study03944.4428$263.68$105.47$52.74
    78223SHepatobiliary imaging03944.4428$263.68$105.47$52.74
    78230SSalivary gland imaging03953.8523$228.63$91.45$45.73
    78231SSerial salivary imaging03953.8523$228.63$91.45$45.73
    78232SSalivary gland function exam03953.8523$228.63$91.45$45.73
    78258SEsophageal motility study03953.8523$228.63$91.45$45.73
    78261SGastric mucosa imaging03953.8523$228.63$91.45$45.73
    78262SGastroesophageal reflux exam03953.8523$228.63$91.45$45.73
    78264SGastric emptying study03953.8523$228.63$91.45$45.73
    78267ABreath tst attain/anal c-14
    78268ABreath test analysis, c-14
    78270SVit B-12 absorption exam03891.4908$88.48$35.39$17.70
    78271SVit b-12 absrp exam, int fac03891.4908$88.48$35.39$17.70
    78272SVit B-12 absorp, combined03891.4908$88.48$35.39$17.70
    78278SAcute GI blood loss imaging03953.8523$228.63$91.45$45.73
    78282SGI protein loss exam03953.8523$228.63$91.45$45.73
    78290SMeckel?s divert exam03953.8523$228.63$91.45$45.73
    78291SLeveen/shunt patency exam03953.8523$228.63$91.45$45.73
    78299SGI nuclear procedure03953.8523$228.63$91.45$45.73
    78300SBone imaging, limited area03964.1238$244.75$97.90$48.95
    78305SBone imaging, multiple areas03964.1238$244.75$97.90$48.95
    78306SBone imaging, whole body03964.1238$244.75$97.90$48.95
    78315SBone imaging, 3 phase03964.1238$244.75$97.90$48.95
    78320SBone imaging (3D)03964.1238$244.75$97.90$48.95
    78350XBone mineral, single photon02600.7521$44.64$17.85$8.93
    78351EBone mineral, dual photon
    78399SMusculoskeletal nuclear exam03964.1238$244.75$97.90$48.95
    78414SNon-imaging heart function03984.2898$254.60$101.84$50.92
    78428SCardiac shunt imaging03984.2898$254.60$101.84$50.92
    78445SVascular flow imaging03972.2543$133.79$53.51$26.76
    78455SVenous thrombosis study03972.2543$133.79$53.51$26.76
    78456SAcute venous thrombus image03972.2543$133.79$53.51$26.76
    78457SVenous thrombosis imaging03972.2543$133.79$53.51$26.76
    78458SVen thrombosis images, bilat03972.2543$133.79$53.51$26.76
    78459SHeart muscle imaging (PET)028517.1020$1,015.00$318.72$203.00
    78460SHeart muscle blood, single03984.2898$254.60$101.84$50.92
    78461SHeart muscle blood, multiple03776.8034$403.78$161.51$80.76
    78464SHeart image (3d), single03984.2898$254.60$101.84$50.92
    78465SHeart image (3d), multiple03776.8034$403.78$161.51$80.76
    78466SHeart infarct image03984.2898$254.60$101.84$50.92
    78468SHeart infarct image (ef)03984.2898$254.60$101.84$50.92
    78469SHeart infarct image (3D)03984.2898$254.60$101.84$50.92
    78472SGated heart, planar, single03984.2898$254.60$101.84$50.92
    78473SGated heart, multiple03765.1740$307.08$121.42$61.42
    78478SHeart wall motion add-on03991.5123$89.76$35.90$17.95
    78480SHeart function add-on03991.5123$89.76$35.90$17.95
    Start Printed Page 42871
    78481SHeart first pass, single03984.2898$254.60$101.84$50.92
    78483SHeart first pass, multiple03765.1740$307.08$121.42$61.42
    78491SHeart image (pet), single028517.1020$1,015.00$318.72$203.00
    78492SHeart image (pet), multiple028517.1020$1,015.00$318.72$203.00
    78494SHeart image, spect03984.2898$254.60$101.84$50.92
    78496SHeart first pass add-on03991.5123$89.76$35.90$17.95
    78499SCardiovascular nuclear exam03984.2898$254.60$101.84$50.92
    78580SLung perfusion imaging04013.3995$201.76$80.70$40.35
    78584SLung V/Q image single breath03785.4748$324.93$129.97$64.99
    78585SLung V/Q imaging03785.4748$324.93$129.97$64.99
    78586SAerosol lung image, single04013.3995$201.76$80.70$40.35
    78587SAerosol lung image, multiple04013.3995$201.76$80.70$40.35
    78588SPerfusion lung image03785.4748$324.93$129.97$64.99
    78591SVent image, 1 breath, 1 proj04013.3995$201.76$80.70$40.35
    78593SVent image, 1 proj, gas04013.3995$201.76$80.70$40.35
    78594SVent image, mult proj, gas04013.3995$201.76$80.70$40.35
    78596SLung differential function03785.4748$324.93$129.97$64.99
    78599SRespiratory nuclear exam04013.3995$201.76$80.70$40.35
    78600SBrain imaging, ltd static04025.1612$306.32$122.52$61.26
    78601SBrain imaging, ltd w/flow04025.1612$306.32$122.52$61.26
    78605SBrain imaging, complete04025.1612$306.32$122.52$61.26
    78606SBrain imaging, compl w/flow04025.1612$306.32$122.52$61.26
    78607SBrain imaging (3D)04025.1612$306.32$122.52$61.26
    78608SBrain imaging (PET)1513$1,150.00$230.00
    78609SBrain imaging (PET)1513$1,150.00$230.00
    78610SBrain flow imaging only04025.1612$306.32$122.52$61.26
    78615SCerebral vascular flow image04025.1612$306.32$122.52$61.26
    78630SCerebrospinal fluid scan04033.5974$213.51$85.40$42.70
    78635SCSF ventriculography04033.5974$213.51$85.40$42.70
    78645SCSF shunt evaluation04033.5974$213.51$85.40$42.70
    78647SCerebrospinal fluid scan04033.5974$213.51$85.40$42.70
    78650SCSF leakage imaging04033.5974$213.51$85.40$42.70
    78660SNuclear exam of tear flow04033.5974$213.51$85.40$42.70
    78699SNervous system nuclear exam04025.1612$306.32$122.52$61.26
    78700SKidney imaging, static02672.6208$155.54$62.18$31.11
    78701SKidney imaging with flow04043.8385$227.81$91.12$45.56
    78704SImaging renogram04043.8385$227.81$91.12$45.56
    78707SKidney flow/function image04043.8385$227.81$91.12$45.56
    78708SKidney flow/function image04054.2480$252.12$100.84$50.42
    78709SKidney flow/function image04054.2480$252.12$100.84$50.42
    78710SKidney imaging (3D)04043.8385$227.81$91.12$45.56
    78715SRenal vascular flow exam04043.8385$227.81$91.12$45.56
    78725SKidney function study03891.4908$88.48$35.39$17.70
    78730XUrinary bladder retention03400.6355$37.72$7.54
    78740SUreteral reflux study04043.8385$227.81$91.12$45.56
    78760STesticular imaging04043.8385$227.81$91.12$45.56
    78761STesticular imaging/flow04043.8385$227.81$91.12$45.56
    78799SGenitourinary nuclear exam04043.8385$227.81$91.12$45.56
    78800STumor imaging, limited area04064.2840$254.26$101.70$50.85
    78801STumor imaging, mult areas04064.2840$254.26$101.70$50.85
    78802STumor imaging, whole body04064.2840$254.26$101.70$50.85
    78803STumor imaging (3D)04064.2840$254.26$101.70$50.85
    78804STumor imaging, whole body1508$650.00$130.00
    78805SAbscess imaging, ltd area04064.2840$254.26$101.70$50.85
    78806SAbscess imaging, whole body04064.2840$254.26$101.70$50.85
    78807SNuclear localization/abscess04064.2840$254.26$101.70$50.85
    78811STumor imaging (pet), limited1513$1,150.00$230.00
    78812STumor image (pet)/skul-thigh1513$1,150.00$230.00
    78813STumor image (pet) full body1513$1,150.00$230.00
    78814STumor image pet/ct, limited1513$1,150.00$230.00
    78815STumorimage pet/ct skul-thigh1513$1,150.00$230.00
    78816STumor image pet/ct full body1513$1,150.00$230.00
    78890NNuclear medicine data proc
    78891NNuclear med data proc
    78999SNuclear diagnostic exam03891.4908$88.48$35.39$17.70
    79005SNuclear rx, oral admin04073.9659$235.38$94.15$47.08
    Start Printed Page 42872
    79101SNuclear rx, iv admin04073.9659$235.38$94.15$47.08
    79200SIntracavitary nuclear trmt04073.9659$235.38$94.15$47.08
    79300SInterstitial nuclear therapy04073.9659$235.38$94.15$47.08
    79403SHematopoetic nuclear therapy1507$550.00$110.00
    79440SNuclear joint therapy04073.9659$235.38$94.15$47.08
    79445SNuclear rx, intra-arterial04073.9659$235.38$94.15$47.08
    79999SNuclear medicine therapy04073.9659$235.38$94.15$47.08
    80048ABasic metabolic panel
    80050EGeneral health panel
    80051AElectrolyte panel
    80053AComprehen metabolic panel
    80055EObstetric panel
    80061ALipid panel
    80069ARenal function panel
    80074AAcute hepatitis panel
    80076AHepatic function panel
    80100ADrug screen, qualitate/multi
    80101ADrug screen, single
    80102ADrug confirmation
    80103NDrug analysis, tissue prep
    80150AAssay of amikacin
    80152AAssay of amitriptyline
    80154AAssay of benzodiazepines
    80156AAssay, carbamazepine, total
    80157AAssay, carbamazepine, free
    80158AAssay of cyclosporine
    80160AAssay of desipramine
    80162AAssay of digoxin
    80164AAssay, dipropylacetic acid
    80166AAssay of doxepin
    80168AAssay of ethosuximide
    80170AAssay of gentamicin
    80172AAssay of gold
    80173AAssay of haloperidol
    80174AAssay of imipramine
    80176AAssay of lidocaine
    80178AAssay of lithium
    80182AAssay of nortriptyline
    80184AAssay of phenobarbital
    80185AAssay of phenytoin, total
    80186AAssay of phenytoin, free
    80188AAssay of primidone
    80190AAssay of procainamide
    80192AAssay of procainamide
    80194AAssay of quinidine
    80196AAssay of salicylate
    80197AAssay of tacrolimus
    80198AAssay of theophylline
    80200AAssay of tobramycin
    80201AAssay of topiramate
    80202AAssay of vancomycin
    80299AQuantitative assay, drug
    80400AActh stimulation panel
    80402AActh stimulation panel
    80406AActh stimulation panel
    80408AAldosterone suppression eval
    80410ACalcitonin stimul panel
    80412ACRH stimulation panel
    80414ATestosterone response
    80415AEstradiol response panel
    80416ARenin stimulation panel
    80417ARenin stimulation panel
    80418APituitary evaluation panel
    80420ADexamethasone panel
    80422AGlucagon tolerance panel
    80424AGlucagon tolerance panel
    Start Printed Page 42873
    80426AGonadotropin hormone panel
    80428AGrowth hormone panel
    80430AGrowth hormone panel
    80432AInsulin suppression panel
    80434AInsulin tolerance panel
    80435AInsulin tolerance panel
    80436AMetyrapone panel
    80438ATRH stimulation panel
    80439ATRH stimulation panel
    80440ATRH stimulation panel
    80500XLab pathology consultation04330.2569$15.25$6.10$3.05
    80502XLab pathology consultation03420.1553$9.22$3.68$1.84
    81000AUrinalysis, nonauto w/scope
    81001AUrinalysis, auto w/scope
    81002AUrinalysis nonauto w/o scope
    81003AUrinalysis, auto, w/o scope
    81005AUrinalysis
    81007AUrine screen for bacteria
    81015AMicroscopic exam of urine
    81020AUrinalysis, glass test
    81025AUrine pregnancy test
    81050AUrinalysis, volume measure
    81099AUrinalysis test procedure
    82000AAssay of blood acetaldehyde
    82003AAssay of acetaminophen
    82009ATest for acetone/ketones
    82010AAcetone assay
    82013AAcetylcholinesterase assay
    82016AAcylcarnitines, qual
    82017AAcylcarnitines, quant
    82024AAssay of acth
    82030AAssay of adp & amp
    82040AAssay of serum albumin
    82042AAssay of urine albumin
    82043AMicroalbumin, quantitative
    82044AMicroalbumin, semiquant
    82045AAlbumin, ischemia modified
    82055AAssay of ethanol
    82075AAssay of breath ethanol
    82085AAssay of aldolase
    82088AAssay of aldosterone
    82101AAssay of urine alkaloids
    82103AAlpha-1-antitrypsin, total
    82104AAlpha-1-antitrypsin, pheno
    82105AAlpha-fetoprotein, serum
    82106AAlpha-fetoprotein, amniotic
    82108AAssay of aluminum
    82120AAmines, vaginal fluid qual
    82127AAmino acid, single qual
    82128AAmino acids, mult qual
    82131AAmino acids, single quant
    82135AAssay, aminolevulinic acid
    82136AAmino acids, quant, 2-5
    82139AAmino acids, quan, 6 or more
    82140AAssay of ammonia
    82143AAmniotic fluid scan
    82145AAssay of amphetamines
    82150AAssay of amylase
    82154AAndrostanediol glucuronide
    82157AAssay of androstenedione
    82160AAssay of androsterone
    82163AAssay of angiotensin II
    82164AAngiotensin I enzyme test
    82172AAssay of apolipoprotein
    82175AAssay of arsenic
    82180AAssay of ascorbic acid
    Start Printed Page 42874
    82190AAtomic absorption
    82205AAssay of barbiturates
    82232AAssay of beta-2 protein
    82239ABile acids, total
    82240ABile acids, cholylglycine
    82247ABilirubin, total
    82248ABilirubin, direct
    82252AFecal bilirubin test
    82261AAssay of biotinidase
    82270ATest for blood, feces
    82273ATest for blood, other source
    82274AAssay test for blood, fecal
    82286AAssay of bradykinin
    82300AAssay of cadmium
    82306AAssay of vitamin D
    82307AAssay of vitamin D
    82308AAssay of calcitonin
    82310AAssay of calcium
    82330AAssay of calcium
    82331ACalcium infusion test
    82340AAssay of calcium in urine
    82355ACalculus analysis, qual
    82360ACalculus assay, quant
    82365ACalculus spectroscopy
    82370AX-ray assay, calculus
    82373AAssay, c-d transfer measure
    82374AAssay, blood carbon dioxide
    82375AAssay, blood carbon monoxide
    82376ATest for carbon monoxide
    82378ACarcinoembryonic antigen
    82379AAssay of carnitine
    82380AAssay of carotene
    82382AAssay, urine catecholamines
    82383AAssay, blood catecholamines
    82384AAssay, three catecholamines
    82387AAssay of cathepsin-d
    82390AAssay of ceruloplasmin
    82397AChemiluminescent assay
    82415AAssay of chloramphenicol
    82435AAssay of blood chloride
    82436AAssay of urine chloride
    82438AAssay, other fluid chlorides
    82441ATest for chlorohydrocarbons
    82465AAssay, bld/serum cholesterol
    82480AAssay, serum cholinesterase
    82482AAssay, rbc cholinesterase
    82485AAssay, chondroitin sulfate
    82486AGas/liquid chromatography
    82487APaper chromatography
    82488APaper chromatography
    82489AThin layer chromatography
    82491AChromotography, quant, sing
    82492AChromotography, quant, mult
    82495AAssay of chromium
    82507AAssay of citrate
    82520AAssay of cocaine
    82523ACollagen crosslinks
    82525AAssay of copper
    82528AAssay of corticosterone
    82530ACortisol, free
    82533ATotal cortisol
    82540AAssay of creatine
    82541AColumn chromotography, qual
    82542AColumn chromotography, quant
    82543AColumn chromotograph/isotope
    82544AColumn chromotograph/isotope
    Start Printed Page 42875
    82550AAssay of ck (cpk)
    82552AAssay of cpk in blood
    82553ACreatine, MB fraction
    82554ACreatine, isoforms
    82565AAssay of creatinine
    82570AAssay of urine creatinine
    82575ACreatinine clearance test
    82585AAssay of cryofibrinogen
    82595AAssay of cryoglobulin
    82600AAssay of cyanide
    82607AVitamin B-12
    82608AB-12 binding capacity
    82615ATest for urine cystines
    82626ADehydroepiandrosterone
    82627ADehydroepiandrosterone
    82633ADesoxycorticosterone
    82634ADeoxycortisol
    82638AAssay of dibucaine number
    82646AAssay of dihydrocodeinone
    82649AAssay of dihydromorphinone
    82651AAssay of dihydrotestosterone
    82652AAssay of dihydroxyvitamin d
    82654AAssay of dimethadione
    82656APancreatic elastase, fecal
    82657AEnzyme cell activity
    82658AEnzyme cell activity, ra
    82664AElectrophoretic test
    82666AAssay of epiandrosterone
    82668AAssay of erythropoietin
    82670AAssay of estradiol
    82671AAssay of estrogens
    82672AAssay of estrogen
    82677AAssay of estriol
    82679AAssay of estrone
    82690AAssay of ethchlorvynol
    82693AAssay of ethylene glycol
    82696AAssay of etiocholanolone
    82705AFats/lipids, feces, qual
    82710AFats/lipids, feces, quant
    82715AAssay of fecal fat
    82725AAssay of blood fatty acids
    82726ALong chain fatty acids
    82728AAssay of ferritin
    82731AAssay of fetal fibronectin
    82735AAssay of fluoride
    82742AAssay of flurazepam
    82746ABlood folic acid serum
    82747AAssay of folic acid, rbc
    82757AAssay of semen fructose
    82759AAssay of rbc galactokinase
    82760AAssay of galactose
    82775AAssay galactose transferase
    82776AGalactose transferase test
    82784AAssay of gammaglobulin igm
    82785AAssay of gammaglobulin ige
    82787AIgg 1, 2, 3 or 4, each
    82800ABlood pH
    82803ABlood gases pH, pO2 & pCO2
    82805ABlood gases W/02 saturation
    82810ABlood gases, O2 sat only
    82820AHemoglobin-oxygen affinity
    82926AAssay of gastric acid
    82928AAssay of gastric acid
    82938AGastrin test
    82941AAssay of gastrin
    82943AAssay of glucagon
    Start Printed Page 42876
    82945AGlucose other fluid
    82946AGlucagon tolerance test
    82947AAssay, glucose, blood quant
    82948AReagent strip/blood glucose
    82950AGlucose test
    82951AGlucose tolerance test (GTT)
    82952AGTT-added samples
    82953AGlucose-tolbutamide test
    82955AAssay of g6pd enzyme
    82960ATest for G6PD enzyme
    82962AGlucose blood test
    82963AAssay of glucosidase
    82965AAssay of gdh enzyme
    82975AAssay of glutamine
    82977AAssay of GGT
    82978AAssay of glutathione
    82979AAssay, rbc glutathione
    82980AAssay of glutethimide
    82985AGlycated protein
    83001AGonadotropin (FSH)
    83002AGonadotropin (LH)
    83003AAssay, growth hormone (hgh)
    83008AAssay of guanosine
    83009AH pylori (c-13), blood
    83010AAssay of haptoglobin, quant
    83012AAssay of haptoglobins
    83013AH pylori analysis
    83014AH pylori drug admin/collect
    83015AHeavy metal screen
    83018AQuantitative screen, metals
    83020AHemoglobin electrophoresis
    83021AHemoglobin chromotography
    83026AHemoglobin, copper sulfate
    83030AFetal hemoglobin, chemical
    83033AFetal hemoglobin assay, qual
    83036AGlycated hemoglobin test
    83045ABlood methemoglobin test
    83050ABlood methemoglobin assay
    83051AAssay of plasma hemoglobin
    83055ABlood sulfhemoglobin test
    83060ABlood sulfhemoglobin assay
    83065AAssay of hemoglobin heat
    83068AHemoglobin stability screen
    83069AAssay of urine hemoglobin
    83070AAssay of hemosiderin, qual
    83071AAssay of hemosiderin, quant
    83080AAssay of b hexosaminidase
    83088AAssay of histamine
    83090AAssay of homocystine
    83150AAssay of for hva
    83491AAssay of corticosteroids
    83497AAssay of 5-hiaa
    83498AAssay of progesterone
    83499AAssay of progesterone
    83500AAssay, free hydroxyproline
    83505AAssay, total hydroxyproline
    83516AImmunoassay, nonantibody
    83518AImmunoassay, dipstick
    83519AImmunoassay, nonantibody
    83520AImmunoassay, RIA
    83525AAssay of insulin
    83527AAssay of insulin
    83528AAssay of intrinsic factor
    83540AAssay of iron
    83550AIron binding test
    83570AAssay of idh enzyme
    Start Printed Page 42877
    83582AAssay of ketogenic steroids
    83586AAssay 17- ketosteroids
    83593AFractionation, ketosteroids
    83605AAssay of lactic acid
    83615ALactate (LD) (LDH) enzyme
    83625AAssay of ldh enzymes
    83630ALactoferrin, fecal (qual)
    83632APlacental lactogen
    83633ATest urine for lactose
    83634AAssay of urine for lactose
    83655AAssay of lead
    83661AL/s ratio, fetal lung
    83662AFoam stability, fetal lung
    83663AFluoro polarize, fetal lung
    83664ALamellar bdy, fetal lung
    83670AAssay of lap enzyme
    83690AAssay of lipase
    83715AAssay of blood lipoproteins
    83716AAssay of blood lipoproteins
    83718AAssay of lipoprotein
    83719AAssay of blood lipoprotein
    83721AAssay of blood lipoprotein
    83727AAssay of lrh hormone
    83735AAssay of magnesium
    83775AAssay of md enzyme
    83785AAssay of manganese
    83788AMass spectrometry qual
    83789AMass spectrometry quant
    83805AAssay of meprobamate
    83825AAssay of mercury
    83835AAssay of metanephrines
    83840AAssay of methadone
    83857AAssay of methemalbumin
    83858AAssay of methsuximide
    83864AMucopolysaccharides
    83866AMucopolysaccharides screen
    83872AAssay synovial fluid mucin
    83873AAssay of csf protein
    83874AAssay of myoglobin
    83880ANatriuretic peptide
    83883AAssay, nephelometry not spec
    83885AAssay of nickel
    83887AAssay of nicotine
    83890AMolecule isolate
    83891AMolecule isolate nucleic
    83892AMolecular diagnostics
    83893AMolecule dot/slot/blot
    83894AMolecule gel electrophor
    83896AMolecular diagnostics
    83897AMolecule nucleic transfer
    83898AMolecule nucleic ampli
    83901AMolecule nucleic ampli
    83902AMolecular diagnostics
    83903AMolecule mutation scan
    83904AMolecule mutation identify
    83905AMolecule mutation identify
    83906AMolecule mutation identify
    83912AGenetic examination
    83915AAssay of nucleotidase
    83916AOligoclonal bands
    83918AOrganic acids, total, quant
    83919AOrganic acids, qual, each
    83921AOrganic acid, single, quant
    83925AAssay of opiates
    83930AAssay of blood osmolality
    83935AAssay of urine osmolality
    Start Printed Page 42878
    83937AAssay of osteocalcin
    83945AAssay of oxalate
    83950AOncoprotein, her-2/neu
    83970AAssay of parathormone
    83986AAssay of body fluid acidity
    83992AAssay for phencyclidine
    84022AAssay of phenothiazine
    84030AAssay of blood pku
    84035AAssay of phenylketones
    84060AAssay acid phosphatase
    84061APhosphatase, forensic exam
    84066AAssay prostate phosphatase
    84075AAssay alkaline phosphatase
    84078AAssay alkaline phosphatase
    84080AAssay alkaline phosphatases
    84081AAmniotic fluid enzyme test
    84085AAssay of rbc pg6d enzyme
    84087AAssay phosphohexose enzymes
    84100AAssay of phosphorus
    84105AAssay of urine phosphorus
    84106ATest for porphobilinogen
    84110AAssay of porphobilinogen
    84119ATest urine for porphyrins
    84120AAssay of urine porphyrins
    84126AAssay of feces porphyrins
    84127AAssay of feces porphyrins
    84132AAssay of serum potassium
    84133AAssay of urine potassium
    84134AAssay of prealbumin
    84135AAssay of pregnanediol
    84138AAssay of pregnanetriol
    84140AAssay of pregnenolone
    84143AAssay of 17-hydroxypregneno
    84144AAssay of progesterone
    84146AAssay of prolactin
    84150AAssay of prostaglandin
    84152AAssay of psa, complexed
    84153AAssay of psa, total
    84154AAssay of psa, free
    84155AAssay of protein, serum
    84156AAssay of protein, urine
    84157AAssay of protein, other
    84160AAssay of protein, any source
    84163APappa, serum
    84165AElectrophoreisis of proteins
    84166AProtein e-phoresis/urine/csf
    84181AWestern blot test
    84182AProtein, western blot test
    84202AAssay RBC protoporphyrin
    84203ATest RBC protoporphyrin
    84206AAssay of proinsulin
    84207AAssay of vitamin b-6
    84210AAssay of pyruvate
    84220AAssay of pyruvate kinase
    84228AAssay of quinine
    84233AAssay of estrogen
    84234AAssay of progesterone
    84235AAssay of endocrine hormone
    84238AAssay, nonendocrine receptor
    84244AAssay of renin
    84252AAssay of vitamin b-2
    84255AAssay of selenium
    84260AAssay of serotonin
    84270AAssay of sex hormone globul
    84275AAssay of sialic acid
    84285AAssay of silica
    Start Printed Page 42879
    84295AAssay of serum sodium
    84300AAssay of urine sodium
    84302AAssay of sweat sodium
    84305AAssay of somatomedin
    84307AAssay of somatostatin
    84311ASpectrophotometry
    84315ABody fluid specific gravity
    84375AChromatogram assay, sugars
    84376ASugars, single, qual
    84377ASugars, multiple, qual
    84378ASugars, single, quant
    84379ASugars multiple quant
    84392AAssay of urine sulfate
    84402AAssay of testosterone
    84403AAssay of total testosterone
    84425AAssay of vitamin b-1
    84430AAssay of thiocyanate
    84432AAssay of thyroglobulin
    84436AAssay of total thyroxine
    84437AAssay of neonatal thyroxine
    84439AAssay of free thyroxine
    84442AAssay of thyroid activity
    84443AAssay thyroid stim hormone
    84445AAssay of tsi
    84446AAssay of vitamin e
    84449AAssay of transcortin
    84450ATransferase (AST) (SGOT)
    84460AAlanine amino (ALT) (SGPT)
    84466AAssay of transferrin
    84478AAssay of triglycerides
    84479AAssay of thyroid (t3 or t4)
    84480AAssay, triiodothyronine (t3)
    84481AFree assay (FT-3)
    84482AT3 reverse
    84484AAssay of troponin, quant
    84485AAssay duodenal fluid trypsin
    84488ATest feces for trypsin
    84490AAssay of feces for trypsin
    84510AAssay of tyrosine
    84512AAssay of troponin, qual
    84520AAssay of urea nitrogen
    84525AUrea nitrogen semi-quant
    84540AAssay of urine/urea-n
    84545AUrea-N clearance test
    84550AAssay of blood/uric acid
    84560AAssay of urine/uric acid
    84577AAssay of feces/urobilinogen
    84578ATest urine urobilinogen
    84580AAssay of urine urobilinogen
    84583AAssay of urine urobilinogen
    84585AAssay of urine vma
    84586AAssay of vip
    84588AAssay of vasopressin
    84590AAssay of vitamin a
    84591AAssay of nos vitamin
    84597AAssay of vitamin k
    84600AAssay of volatiles
    84620AXylose tolerance test
    84630AAssay of zinc
    84681AAssay of c-peptide
    84702AChorionic gonadotropin test
    84703AChorionic gonadotropin assay
    84830AOvulation tests
    84999AClinical chemistry test
    85002ABleeding time test
    85004AAutomated diff wbc count
    Start Printed Page 42880
    85007ADifferential WBC count
    85008ANondifferential WBC count
    85009ADifferential WBC count
    85013ASpun microhematocrit
    85014AHematocrit
    85018AHemoglobin
    85025AAutomated hemogram
    85027AAutomated hemogram
    85032AManual cell count, each
    85041ARed blood cell (RBC) count
    85044AReticulocyte count
    85045AReticulocyte count
    85046AReticyte/hgb concentrate
    85048AWhite blood cell (WBC) count
    85049AAutomated platelet count
    85055AReticulated platelet assay
    85060BBlood smear interpretation
    85097XBone marrow interpretation03430.4764$28.27$11.10$5.65
    85130AChromogenic substrate assay
    85170ABlood clot retraction
    85175ABlood clot lysis time
    85210ABlood clot factor II test
    85220ABlood clot factor V test
    85230ABlood clot factor VII test
    85240ABlood clot factor VIII test
    85244ABlood clot factor VIII test
    85245ABlood clot factor VIII test
    85246ABlood clot factor VIII test
    85247ABlood clot factor VIII test
    85250ABlood clot factor IX test
    85260ABlood clot factor X test
    85270ABlood clot factor XI test
    85280ABlood clot factor XII test
    85290ABlood clot factor XIII test
    85291ABlood clot factor XIII test
    85292ABlood clot factor assay
    85293ABlood clot factor assay
    85300AAntithrombin III test
    85301AAntithrombin III test
    85302ABlood clot inhibitor antigen
    85303ABlood clot inhibitor test
    85305ABlood clot inhibitor assay
    85306ABlood clot inhibitor test
    85307AAssay activated protein c
    85335AFactor inhibitor test
    85337AThrombomodulin
    85345ACoagulation time
    85347ACoagulation time
    85348ACoagulation time
    85360AEuglobulin lysis
    85362AFibrin degradation products
    85366AFibrinogen test
    85370AFibrinogen test
    85378AFibrin degradation
    85379AFibrin degradation, quant
    85380AFibrin degradation, vte
    85384AFibrinogen
    85385AFibrinogen
    85390AFibrinolysins screen
    85396NClotting assay, whole blood
    85400AFibrinolytic plasmin
    85410AFibrinolytic antiplasmin
    85415AFibrinolytic plasminogen
    85420AFibrinolytic plasminogen
    85421AFibrinolytic plasminogen
    85441AHeinz bodies, direct
    Start Printed Page 42881
    85445AHeinz bodies, induced
    85460AHemoglobin, fetal
    85461AHemoglobin, fetal
    85475AHemolysin
    85520AHeparin assay
    85525AHeparin neutralization
    85530AHeparin-protamine tolerance
    85536AIron stain peripheral blood
    85540AWbc alkaline phosphatase
    85547ARBC mechanical fragility
    85549AMuramidase
    85555ARBC osmotic fragility
    85557ARBC osmotic fragility
    85576ABlood platelet aggregation
    85597APlatelet neutralization
    85610AProthrombin time
    85611AProthrombin test
    85612AViper venom prothrombin time
    85613ARussell viper venom, diluted
    85635AReptilase test
    85651ARbc sed rate, nonautomated
    85652ARbc sed rate, automated
    85660ARBC sickle cell test
    85670AThrombin time, plasma
    85675AThrombin time, titer
    85705AThromboplastin inhibition
    85730AThromboplastin time, partial
    85732AThromboplastin time, partial
    85810ABlood viscosity examination
    85999AHematology procedure
    86000AAgglutinins, febrile
    86001AAllergen specific igg
    86003AAllergen specific IgE
    86005AAllergen specific IgE
    86021AWBC antibody identification
    86022APlatelet antibodies
    86023AImmunoglobulin assay
    86038AAntinuclear antibodies
    86039AAntinuclear antibodies (ANA)
    86060AAntistreptolysin o, titer
    86063AAntistreptolysin o, screen
    86064AB cells, total count
    86077XPhysician blood bank service04330.2569$15.25$6.10$3.05
    86078XPhysician blood bank service03430.4764$28.27$11.10$5.65
    86079XPhysician blood bank service04330.2569$15.25$6.10$3.05
    86140AC-reactive protein
    86141AC-reactive protein, hs
    86146AGlycoprotein antibody
    86147ACardiolipin antibody
    86148APhospholipid antibody
    86155AChemotaxis assay
    86156ACold agglutinin, screen
    86157ACold agglutinin, titer
    86160AComplement, antigen
    86161AComplement/function activity
    86162AComplement, total (CH50)
    86171AComplement fixation, each
    86185ACounterimmunoelectrophoresis
    86215ADeoxyribonuclease, antibody
    86225ADNA antibody
    86226ADNA antibody, single strand
    86235ANuclear antigen antibody
    86243AFc receptor
    86255AFluorescent antibody, screen
    86256AFluorescent antibody, titer
    86277AGrowth hormone antibody
    Start Printed Page 42882
    86280AHemagglutination inhibition
    86294AImmunoassay, tumor, qual
    86300AImmunoassay, tumor, ca 15-3
    86301AImmunoassay, tumor, ca 19-9
    86304AImmunoassay, tumor, ca 125
    86308AHeterophile antibodies
    86309AHeterophile antibodies
    86310AHeterophile antibodies
    86316AImmunoassay, tumor other
    86317AImmunoassay,infectious agent
    86318AImmunoassay,infectious agent
    86320ASerum immunoelectrophoresis
    86325AOther immunoelectrophoresis
    86327AImmunoelectrophoresis assay
    86329AImmunodiffusion
    86331AImmunodiffusion ouchterlony
    86332AImmune complex assay
    86334AImmunofixation procedure
    86335AImmunfix e-phorsis/urine/csf
    86336AInhibin A
    86337AInsulin antibodies
    86340AIntrinsic factor antibody
    86341AIslet cell antibody
    86343ALeukocyte histamine release
    86344ALeukocyte phagocytosis
    86353ALymphocyte transformation
    86359AT cells, total count
    86360AT cell, absolute count/ratio
    86361AT cell, absolute count
    86376AMicrosomal antibody
    86378AMigration inhibitory factor
    86379ANk cells, total count
    86382ANeutralization test, viral
    86384Anitroblue tetrazolium dye
    86403AParticle agglutination test
    86406AParticle agglutination test
    86430ARheumatoid factor test
    86431ARheumatoid factor, quant
    86485XSkin test, candida03410.1107$6.57$2.62$1.31
    86490XCoccidioidomycosis skin test03410.1107$6.57$2.62$1.31
    86510XHistoplasmosis skin test03410.1107$6.57$2.62$1.31
    86580XTB intradermal test03410.1107$6.57$2.62$1.31
    86585XTB tine test03410.1107$6.57$2.62$1.31
    86586XSkin test, unlisted03410.1107$6.57$2.62$1.31
    86587AStem cells, total count
    86590AStreptokinase, antibody
    86592ABlood serology, qualitative
    86593ABlood serology, quantitative
    86602AAntinomyces antibody
    86603AAdenovirus antibody
    86606AAspergillus antibody
    86609ABacterium antibody
    86611ABartonella antibody
    86612ABlastomyces antibody
    86615ABordetella antibody
    86617ALyme disease antibody
    86618ALyme disease antibody
    86619ABorrelia antibody
    86622ABrucella antibody
    86625ACampylobacter antibody
    86628ACandida antibody
    86631AChlamydia antibody
    86632AChlamydia igm antibody
    86635ACoccidioides antibody
    86638AQ fever antibody
    86641ACryptococcus antibody
    Start Printed Page 42883
    86644ACMV antibody
    86645ACMV antibody, IgM
    86648ADiphtheria antibody
    86651AEncephalitis antibody
    86652AEncephalitis antibody
    86653AEncephalitis antibody
    86654AEncephalitis antibody
    86658AEnterovirus antibody
    86663AEpstein-barr antibody
    86664AEpstein-barr antibody
    86665AEpstein-barr antibody
    86666AEhrlichia antibody
    86668AFrancisella tularensis
    86671AFungus antibody
    86674AGiardia lamblia antibody
    86677AHelicobacter pylori
    86682AHelminth antibody
    86684AHemophilus influenza
    86687AHtlv-i antibody
    86688AHtlv-ii antibody
    86689AHTLV/HIV confirmatory test
    86692AHepatitis, delta agent
    86694AHerpes simplex test
    86695AHerpes simplex test
    86696AHerpes simplex type 2
    86698AHistoplasma
    86701AHIV-1
    86702AHIV-2
    86703AHIV-1/HIV-2, single assay
    86704AHep b core antibody, total
    86705AHep b core antibody, igm
    86706AHep b surface antibody
    86707AHep be antibody
    86708AHep a antibody, total
    86709AHep a antibody, igm
    86710AInfluenza virus antibody
    86713ALegionella antibody
    86717ALeishmania antibody
    86720ALeptospira antibody
    86723AListeria monocytogenes ab
    86727ALymph choriomeningitis ab
    86729ALympho venereum antibody
    86732AMucormycosis antibody
    86735AMumps antibody
    86738AMycoplasma antibody
    86741ANeisseria meningitidis
    86744ANocardia antibody
    86747AParvovirus antibody
    86750AMalaria antibody
    86753AProtozoa antibody nos
    86756ARespiratory virus antibody
    86757ARickettsia antibody
    86759ARotavirus antibody
    86762ARubella antibody
    86765ARubeola antibody
    86768ASalmonella antibody
    86771AShigella antibody
    86774ATetanus antibody
    86777AToxoplasma antibody
    86778AToxoplasma antibody, igm
    86781ATreponema pallidum, confirm
    86784ATrichinella antibody
    86787AVaricella-zoster antibody
    86790AVirus antibody nos
    86793AYersinia antibody
    86800AThyroglobulin antibody
    Start Printed Page 42884
    86803AHepatitis c ab test
    86804AHep c ab test, confirm
    86805ALymphocytotoxicity assay
    86806ALymphocytotoxicity assay
    86807ACytotoxic antibody screening
    86808ACytotoxic antibody screening
    86812AHLA typing, A, B, or C
    86813AHLA typing, A, B, or C
    86816AHLA typing, DR/DQ
    86817AHLA typing, DR/DQ
    86821ALymphocyte culture, mixed
    86822ALymphocyte culture, primed
    86849AImmunology procedure
    86850XRBC antibody screen03450.2266$13.45$2.99$2.69
    86860XRBC antibody elution03460.3418$20.29$4.52$4.06
    86870XRBC antibody identification03460.3418$20.29$4.52$4.06
    86880XCoombs test, direct04090.1252$7.43$2.22$1.49
    86885XCoombs test, indirect, qual04090.1252$7.43$2.22$1.49
    86886XCoombs test, indirect, titer04090.1252$7.43$2.22$1.49
    86890XAutologous blood process03470.8395$49.82$12.30$9.96
    86891XAutologous blood, op salvage03460.3418$20.29$4.52$4.06
    86900XBlood typing, ABO04090.1252$7.43$2.22$1.49
    86901XBlood typing, Rh (D)04090.1252$7.43$2.22$1.49
    86903XBlood typing, antigen screen03450.2266$13.45$2.99$2.69
    86904XBlood typing, patient serum03460.3418$20.29$4.52$4.06
    86905XBlood typing, RBC antigens03450.2266$13.45$2.99$2.69
    86906XBlood typing, Rh phenotype03450.2266$13.45$2.99$2.69
    86910EBlood typing, paternity test
    86911EBlood typing, antigen system
    86920XCompatibility test03460.3418$20.29$4.52$4.06
    86921XCompatibility test03450.2266$13.45$2.99$2.69
    86922XCompatibility test03460.3418$20.29$4.52$4.06
    86927XPlasma, fresh frozen03450.2266$13.45$2.99$2.69
    86930XFrozen blood prep03470.8395$49.82$12.30$9.96
    86931XFrozen blood thaw03470.8395$49.82$12.30$9.96
    86932XFrozen blood freeze/thaw03470.8395$49.82$12.30$9.96
    86940AHemolysins/agglutinins, auto
    86941AHemolysins/agglutinins
    86945XBlood product/irradiation03450.2266$13.45$2.99$2.69
    86950XLeukacyte transfusion03450.2266$13.45$2.99$2.69
    86965XPooling blood platelets03450.2266$13.45$2.99$2.69
    86970XRBC pretreatment03450.2266$13.45$2.99$2.69
    86971XRBC pretreatment03450.2266$13.45$2.99$2.69
    86972XRBC pretreatment03460.3418$20.29$4.52$4.06
    86975XRBC pretreatment, serum03450.2266$13.45$2.99$2.69
    86976XRBC pretreatment, serum03450.2266$13.45$2.99$2.69
    86977XRBC pretreatment, serum03450.2266$13.45$2.99$2.69
    86978XRBC pretreatment, serum03450.2266$13.45$2.99$2.69
    86985XSplit blood or products03450.2266$13.45$2.99$2.69
    86999XTransfusion procedure03450.2266$13.45$2.99$2.69
    87001ASmall animal inoculation
    87003ASmall animal inoculation
    87015ASpecimen concentration
    87040ABlood culture for bacteria
    87045AFeces culture, bacteria
    87046AStool cultr, bacteria, each
    87070ACulture, bacteria, other
    87071ACulture bacteri aerobic othr
    87073ACulture bacteria anaerobic
    87075ACultr bacteria, except blood
    87076ACulture anaerobe ident, each
    87077ACulture aerobic identify
    87081ACulture screen only
    87084ACulture of specimen by kit
    87086AUrine culture/colony count
    87088AUrine bacteria culture
    Start Printed Page 42885
    87101ASkin fungi culture
    87102AFungus isolation culture
    87103ABlood fungus culture
    87106AFungi identification, yeast
    87107AFungi identification, mold
    87109AMycoplasma
    87110AChlamydia culture
    87116AMycobacteria culture
    87118AMycobacteric identification
    87140ACulture type immunofluoresc
    87143ACulture typing, glc/hplc
    87147ACulture type, immunologic
    87149ACulture type, nucleic acid
    87152ACulture type pulse field gel
    87158ACulture typing, added method
    87164ADark field examination
    87166ADark field examination
    87168AMacroscopic exam arthropod
    87169AMacroscopic exam parasite
    87172APinworm exam
    87176ATissue homogenization, cultr
    87177AOva and parasites smears
    87181AMicrobe susceptible, diffuse
    87184AMicrobe susceptible, disk
    87185AMicrobe susceptible, enzyme
    87186AMicrobe susceptible, mic
    87187AMicrobe susceptible, mlc
    87188AMicrobe suscept, macrobroth
    87190AMicrobe suscept, mycobacteri
    87197ABactericidal level, serum
    87205ASmear, gram stain
    87206ASmear, fluorescent/acid stai
    87207ASmear, special stain
    87210ASmear, wet mount, saline/ink
    87220ATissue exam for fungi
    87230AAssay, toxin or antitoxin
    87250AVirus inoculate, eggs/animal
    87252AVirus inoculation, tissue
    87253AVirus inoculate tissue, addl
    87254AVirus inoculation, shell via
    87255AGenet virus isolate, hsv
    87260AAdenovirus ag, if
    87265APertussis ag, if
    87267AEnterovirus antibody, dfa
    87269AGiardia ag, if
    87270AChlamydia trachomatis ag, if
    87271ACryptosporidum/gardia ag, if
    87272ACryptosporidium ag, if
    87273AHerpes simplex 2, ag, if
    87274AHerpes simplex 1, ag, if
    87275AInfluenza b, ag, if
    87276AInfluenza a, ag, if
    87277ALegionella micdadei, ag, if
    87278ALegion pneumophilia ag, if
    87279AParainfluenza, ag, if
    87280ARespiratory syncytial ag, if
    87281APneumocystis carinii, ag, if
    87283ARubeola, ag, if
    87285ATreponema pallidum, ag, if
    87290AVaricella zoster, ag, if
    87299AAntibody detection, nos, if
    87300AAg detection, polyval, if
    87301AAdenovirus ag, eia
    87320AChylmd trach ag, eia
    87324AClostridium ag, eia
    87327ACryptococcus neoform ag, eia
    Start Printed Page 42886
    87328ACryptosporidium ag, eia
    87329AGiardia ag, eia
    87332ACytomegalovirus ag, eia
    87335AE coli 0157 ag, eia
    87336AEntamoeb hist dispr, ag, eia
    87337AEntamoeb hist group, ag, eia
    87338AHpylori, stool, eia
    87339AH pylori ag, eia
    87340AHepatitis b surface ag, eia
    87341AHepatitis b surface, ag, eia
    87350AHepatitis be ag, eia
    87380AHepatitis delta ag, eia
    87385AHistoplasma capsul ag, eia
    87390AHiv-1 ag, eia
    87391AHiv-2 ag, eia
    87400AInfluenza a/b, ag, eia
    87420AResp syncytial ag, eia
    87425ARotavirus ag, eia
    87427AShiga-like toxin ag, eia
    87430AStrep a ag, eia
    87449AAg detect nos, eia, mult
    87450AAg detect nos, eia, single
    87451AAg detect polyval, eia, mult
    87470ABartonella, dna, dir probe
    87471ABartonella, dna, amp probe
    87472ABartonella, dna, quant
    87475ALyme dis, dna, dir probe
    87476ALyme dis, dna, amp probe
    87477ALyme dis, dna, quant
    87480ACandida, dna, dir probe
    87481ACandida, dna, amp probe
    87482ACandida, dna, quant
    87485AChylmd pneum, dna, dir probe
    87486AChylmd pneum, dna, amp probe
    87487AChylmd pneum, dna, quant
    87490AChylmd trach, dna, dir probe
    87491AChylmd trach, dna, amp probe
    87492AChylmd trach, dna, quant
    87495ACytomeg, dna, dir probe
    87496ACytomeg, dna, amp probe
    87497ACytomeg, dna, quant
    87510AGardner vag, dna, dir probe
    87511AGardner vag, dna, amp probe
    87512AGardner vag, dna, quant
    87515AHepatitis b, dna, dir probe
    87516AHepatitis b, dna, amp probe
    87517AHepatitis b, dna, quant
    87520AHepatitis c, rna, dir probe
    87521AHepatitis c, rna, amp probe
    87522AHepatitis c, rna, quant
    87525AHepatitis g, dna, dir probe
    87526AHepatitis g, dna, amp probe
    87527AHepatitis g, dna, quant
    87528AHsv, dna, dir probe
    87529AHsv, dna, amp probe
    87530AHsv, dna, quant
    87531AHhv-6, dna, dir probe
    87532AHhv-6, dna, amp probe
    87533AHhv-6, dna, quant
    87534AHiv-1, dna, dir probe
    87535AHiv-1, dna, amp probe
    87536AHiv-1, dna, quant
    87537AHiv-2, dna, dir probe
    87538AHiv-2, dna, amp probe
    87539AHiv-2, dna, quant
    87540ALegion pneumo, dna, dir prob
    Start Printed Page 42887
    87541ALegion pneumo, dna, amp prob
    87542ALegion pneumo, dna, quant
    87550AMycobacteria, dna, dir probe
    87551AMycobacteria, dna, amp probe
    87552AMycobacteria, dna, quant
    87555AM.tuberculo, dna, dir probe
    87556AM.tuberculo, dna, amp probe
    87557AM.tuberculo, dna, quant
    87560AM.avium-intra, dna, dir prob
    87561AM.avium-intra, dna, amp prob
    87562AM.avium-intra, dna, quant
    87580AM.pneumon, dna, dir probe
    87581AM.pneumon, dna, amp probe
    87582AM.pneumon, dna, quant
    87590AN.gonorrhoeae, dna, dir prob
    87591AN.gonorrhoeae, dna, amp prob
    87592AN.gonorrhoeae, dna, quant
    87620AHpv, dna, dir probe
    87621AHpv, dna, amp probe
    87622AHpv, dna, quant
    87650AStrep a, dna, dir probe
    87651AStrep a, dna, amp probe
    87652AStrep a, dna, quant
    87660ATrichomonas vagin, dir probe
    87797ADetect agent nos, dna, dir
    87798ADetect agent nos, dna, amp
    87799ADetect agent nos, dna, quant
    87800ADetect agnt mult, dna, direc
    87801ADetect agnt mult, dna, ampli
    87802AStrep b assay w/optic
    87803AClostridium toxin a w/optic
    87804AInfluenza assay w/optic
    87807ARsv assay w/optic
    87810AChylmd trach assay w/optic
    87850AN. gonorrhoeae assay w/optic
    87880AStrep a assay w/optic
    87899AAgent nos assay w/optic
    87901AGenotype, dna, hiv reverse t
    87902AGenotype, dna, hepatitis C
    87903APhenotype, dna hiv w/culture
    87904APhenotype, dna hiv w/clt add
    87999AMicrobiology procedure
    88000EAutopsy (necropsy), gross
    88005EAutopsy (necropsy), gross
    88007EAutopsy (necropsy), gross
    88012EAutopsy (necropsy), gross
    88014EAutopsy (necropsy), gross
    88016EAutopsy (necropsy), gross
    88020EAutopsy (necropsy), complete
    88025EAutopsy (necropsy), complete
    88027EAutopsy (necropsy), complete
    88028EAutopsy (necropsy), complete
    88029EAutopsy (necropsy), complete
    88036ELimited autopsy
    88037ELimited autopsy
    88040EForensic autopsy (necropsy)
    88045ECoroner's autopsy (necropsy)
    88099ENecropsy (autopsy) procedure
    88104XCytopathology, fluids04330.2569$15.25$6.10$3.05
    88106XCytopathology, fluids04330.2569$15.25$6.10$3.05
    88107XCytopathology, fluids04330.2569$15.25$6.10$3.05
    88108XCytopath, concentrate tech04330.2569$15.25$6.10$3.05
    88112XCytopath, cell enhance tech03430.4764$28.27$11.10$5.65
    88125XForensic cytopathology03420.1553$9.22$3.68$1.84
    88130ASex chromatin identification
    88140ASex chromatin identification
    Start Printed Page 42888
    88141NCytopath, c/v, interpret
    88142ACytopath, c/v, thin layer
    88143ACytopath c/v thin layer redo
    88147ACytopath, c/v, automated
    88148ACytopath, c/v, auto rescreen
    88150ACytopath, c/v, manual
    88152ACytopath, c/v, auto redo
    88153ACytopath, c/v, redo
    88154ACytopath, c/v, select
    88155ACytopath, c/v, index add-on
    88160XCytopath smear, other source04330.2569$15.25$6.10$3.05
    88161XCytopath smear, other source04330.2569$15.25$6.10$3.05
    88162XCytopath smear, other source04330.2569$15.25$6.10$3.05
    88164ACytopath tbs, c/v, manual
    88165ACytopath tbs, c/v, redo
    88166ACytopath tbs, c/v, auto redo
    88167ACytopath tbs, c/v, select
    88172XCytopathology eval of fna03430.4764$28.27$11.10$5.65
    88173XCytopath eval, fna, report03430.4764$28.27$11.10$5.65
    88174ACytopath, c/v auto, in fluid
    88175ACytopath c/v auto fluid redo
    88182XCell marker study03440.7960$47.24$15.66$9.45
    88184XFlowcytometry/ tc, 1 marker03440.7960$47.24$15.66$9.45
    88185XFlowcytometry/tc, add-on03430.4764$28.27$11.10$5.65
    88187XFlowcytometry/read, 2-804330.2569$15.25$6.10$3.05
    88188XFlowcytometry/read, 9-1504330.2569$15.25$6.10$3.05
    88189XFlowcytometry/read, 16 & >03430.4764$28.27$11.10$5.65
    88199ACytopathology procedure
    88230ATissue culture, lymphocyte
    88233ATissue culture, skin/biopsy
    88235ATissue culture, placenta
    88237ATissue culture, bone marrow
    88239ATissue culture, tumor
    88240ACell cryopreserve/storage
    88241AFrozen cell preparation
    88245AChromosome analysis, 20-25
    88248AChromosome analysis, 50-100
    88249AChromosome analysis, 100
    88261AChromosome analysis, 5
    88262AChromosome analysis, 15-20
    88263AChromosome analysis, 45
    88264AChromosome analysis, 20-25
    88267AChromosome analys, placenta
    88269AChromosome analys, amniotic
    88271ACytogenetics, dna probe
    88272ACytogenetics, 3-5
    88273ACytogenetics, 10-30
    88274ACytogenetics, 25-99
    88275ACytogenetics, 100-300
    88280AChromosome karyotype study
    88283AChromosome banding study
    88285AChromosome count, additional
    88289AChromosome study, additional
    88291ACyto/molecular report
    88299XCytogenetic study03420.1553$9.22$3.68$1.84
    88300XSurgical path, gross04330.2569$15.25$6.10$3.05
    88302XTissue exam by pathologist04330.2569$15.25$6.10$3.05
    88304XTissue exam by pathologist03430.4764$28.27$11.10$5.65
    88305XTissue exam by pathologist03430.4764$28.27$11.10$5.65
    88307XTissue exam by pathologist03440.7960$47.24$15.66$9.45
    88309XTissue exam by pathologist03440.7960$47.24$15.66$9.45
    88311XDecalcify tissue03420.1553$9.22$3.68$1.84
    88312XSpecial stains04330.2569$15.25$6.10$3.05
    88313XSpecial stains04330.2569$15.25$6.10$3.05
    88314XHistochemical stain03420.1553$9.22$3.68$1.84
    88318XChemical histochemistry04330.2569$15.25$6.10$3.05
    Start Printed Page 42889
    88319XEnzyme histochemistry03430.4764$28.27$11.10$5.65
    88321XMicroslide consultation04330.2569$15.25$6.10$3.05
    88323XMicroslide consultation03430.4764$28.27$11.10$5.65
    88325XComprehensive review of data03440.7960$47.24$15.66$9.45
    88329XPath consult introp04330.2569$15.25$6.10$3.05
    88331XPath consult intraop, 1 bloc03430.4764$28.27$11.10$5.65
    88332XPath consult intraop, add'l04330.2569$15.25$6.10$3.05
    88342XImmunohistochemistry03430.4764$28.27$11.10$5.65
    88346XImmunofluorescent study03430.4764$28.27$11.10$5.65
    88347XImmunofluorescent study03430.4764$28.27$11.10$5.65
    88348XElectron microscopy06613.3622$199.55$79.82$39.91
    88349XScanning electron microscopy06613.3622$199.55$79.82$39.91
    88355XAnalysis, skeletal muscle03430.4764$28.27$11.10$5.65
    88356XAnalysis, nerve03440.7960$47.24$15.66$9.45
    88358XAnalysis, tumor03440.7960$47.24$15.66$9.45
    88360XTumor immunohistochem/manual03440.7960$47.24$15.66$9.45
    88361XImmunohistochemistry, tumor03440.7960$47.24$15.66$9.45
    88362XNerve teasing preparations03440.7960$47.24$15.66$9.45
    88365XTissue hybridization03440.7960$47.24$15.66$9.45
    88367XInsitu hybridization, auto03440.7960$47.24$15.66$9.45
    88368XInsitu hybridization, manual03440.7960$47.24$15.66$9.45
    88371AProtein, western blot tissue
    88372AProtein analysis w/probe
    88380AMicrodissection
    88399ASurgical pathology procedure
    88400ABilirubin total transcut
    89050ABody fluid cell count
    89051ABody fluid cell count
    89055ALeukocyte assessment, fecal
    89060AExam,synovial fluid crystals
    89100XSample intestinal contents03601.4672$87.08$34.83$17.42
    89105XSample intestinal contents03601.4672$87.08$34.83$17.42
    89125ASpecimen fat stain
    89130XSample stomach contents03601.4672$87.08$34.83$17.42
    89132XSample stomach contents03601.4672$87.08$34.83$17.42
    89135XSample stomach contents03601.4672$87.08$34.83$17.42
    89136XSample stomach contents03601.4672$87.08$34.83$17.42
    89140XSample stomach contents03601.4672$87.08$34.83$17.42
    89141XSample stomach contents03601.4672$87.08$34.83$17.42
    89160AExam feces for meat fibers
    89190ANasal smear for eosinophils
    89220XSputum specimen collection03430.4764$28.27$11.10$5.65
    89225AStarch granules, feces
    89230XCollect sweat for test04330.2569$15.25$6.10$3.05
    89235AWater load test
    89240APathology lab procedure
    89250XCultr oocyte/embryo <4 days03480.7891$46.83$9.37
    89251XCultr oocyte/embryo <4 days03480.7891$46.83$9.37
    89253XEmbryo hatching03480.7891$46.83$9.37
    89254XOocyte identification03480.7891$46.83$9.37
    89255XPrepare embryo for transfer03480.7891$46.83$9.37
    89257XSperm identification03480.7891$46.83$9.37
    89258XCryopreservation embryo(s)03480.7891$46.83$9.37
    89259XCryopreservation, sperm03480.7891$46.83$9.37
    89260XSperm isolation, simple03480.7891$46.83$9.37
    89261XSperm isolation, complex03480.7891$46.83$9.37
    89264XIdentify sperm tissue03480.7891$46.83$9.37
    89268XInsemination of oocytes03480.7891$46.83$9.37
    89272XExtended culture of oocytes03480.7891$46.83$9.37
    89280XAssist oocyte fertilization03480.7891$46.83$9.37
    89281XAssist oocyte fertilization03480.7891$46.83$9.37
    89290XBiopsy, oocyte polar body03480.7891$46.83$9.37
    89291XBiopsy, oocyte polar body03480.7891$46.83$9.37
    89300ASemen analysis w/huhner
    89310ASemen analysis
    89320ASemen analysis, complete
    Start Printed Page 42890
    89321ASemen analysis & motility
    89325ASperm antibody test
    89329ASperm evaluation test
    89330AEvaluation, cervical mucus
    89335XCryopreserve testicular tiss03480.7891$46.83$9.37
    89342XStorage/year embryo(s)03480.7891$46.83$9.37
    89343XStorage/year sperm/semen03480.7891$46.83$9.37
    89344XStorage/year reprod tissue03480.7891$46.83$9.37
    89346XStorage/year oocyte03480.7891$46.83$9.37
    89352XThawing cryopresrved embryo03480.7891$46.83$9.37
    89353XThawing cryopresrved sperm03480.7891$46.83$9.37
    89354XThaw cryoprsvrd reprod tiss03480.7891$46.83$9.37
    89356XThawing cryopresrved oocyte03480.7891$46.83$9.37
    90281EHuman ig, im
    90283EHuman ig, iv
    90287EBotulinum antitoxin
    90288EBotulism ig, iv
    90291ECmv ig, iv
    90296NDiphtheria antitoxin
    90371EHep b ig, im
    90375KRabies ig, im/sc9133$64.56$12.91
    90376KRabies ig, heat treated9134$69.78$13.96
    90378ERsv ig, im, 50mg
    90379ERsv ig, iv
    90384ERh ig, full-dose, im
    90385NRh ig, minidose, im
    90386ERh ig, iv
    90389ETetanus ig, im
    90393NVaccina ig, im
    90396KVaricella-zoster ig, im9135$96.57$19.31
    90399EImmune globulin
    90465BImmune admin 1 inj, < 8 yrs
    90466BImmune admin addl inj, < 8 y
    90467BImmune admin o or n, < 8 yrs
    90468BImmune admin o/n, addl < 8 y
    90471XImmunization admin03530.3936$23.36$4.67
    90472XImmunization admin, each add03530.3936$23.36$4.67
    90473SImmune admin oral/nasal1491$5.00$1.00
    90474SImmune admin oral/nasal addl1491$5.00$1.00
    90476KAdenovirus vaccine, type 491360.9498$56.37$11.27
    90477NAdenovirus vaccine, type 7
    90581KAnthrax vaccine, sc9169$128.94$25.79
    90585KBcg vaccine, percut9137$124.53$24.91
    90586BBcg vaccine, intravesical
    90632NHep a vaccine, adult im
    90633NHep a vacc, ped/adol, 2 dose
    90634NHep a vacc, ped/adol, 3 dose
    90636KHep a/hep b vacc, adult im91380.9673$57.41$11.48
    90645NHib vaccine, hboc, im
    90646NHib vaccine, prp-d, im
    90647NHib vaccine, prp-omp, im
    90648NHib vaccine, prp-t, im
    90655LFlu vaccine, 6-35 mo, im
    90656LFlu vaccine no preserv 3 & >
    90657LFlu vaccine, 6-35 mo, im
    90658LFlu vaccine, 3 yrs, im
    90660EFlu vaccine, nasal
    90665NLyme disease vaccine, im
    90669EPneumococcal vacc, ped <5
    90675KRabies vaccine, im9139$128.03$25.61
    90676KRabies vaccine, id91401.4957$88.77$17.75
    90680NRotovirus vaccine, oral
    90690NTyphoid vaccine, oral
    90691NTyphoid vaccine, im
    90692NTyphoid vaccine, h-p, sc/id
    90693NTyphoid vaccine, akd, sc
    Start Printed Page 42891
    90698NDtap-hib-ip vaccine, im
    90700NDtap vaccine, im
    90701NDtp vaccine, im
    90702NDt vaccine < 7, im
    90703NTetanus vaccine, im
    90704NMumps vaccine, sc
    90705NMeasles vaccine, sc
    90706NRubella vaccine, sc
    90707NMmr vaccine, sc
    90708KMeasles-rubella vaccine, sc91410.9466$56.18$11.24
    90710NMmrv vaccine, sc
    90712NOral poliovirus vaccine
    90713NPoliovirus, ipv, sc
    90715NTdap vaccine >7 im
    90716KChicken pox vaccine, sc9142$64.29$12.86
    90717NYellow fever vaccine, sc
    90718NTd vaccine > 7, im
    90719NDiphtheria vaccine, im
    90720NDtp/hib vaccine, im
    90721NDtap/hib vaccine, im
    90723EDtap-hep b-ipv vaccine, im
    90725NCholera vaccine, injectable
    90727NPlague vaccine, im
    90732LPneumococcal vaccine
    90733KMeningococcal vaccine, sc9143$56.74$11.35
    90734KMeningococcal vaccine, im91450.8947$53.10$10.62
    90735KEncephalitis vaccine, sc9144$67.72$13.54
    90740FHepb vacc, ill pat 3 dose im
    90743FHep b vacc, adol, 2 dose, im
    90744FHepb vacc ped/adol 3 dose im
    90746FHep b vaccine, adult, im
    90747FHepb vacc, ill pat 4 dose im
    90748EHep b/hib vaccine, im
    90749NVaccine toxoid
    90780SIV infusion therapy, 1 hour01202.0101$119.30$28.21$23.86
    90781NIV infusion, additional hour
    90782XInjection, sc/im03530.3936$23.36$4.67
    90783XInjection, ia03590.8274$49.11$9.82
    90784XInjection, iv03590.8274$49.11$9.82
    90788XInjection of antibiotic03590.8274$49.11$9.82
    90799XTher/prophylactic/dx inject03520.1407$8.35$1.67
    90801SPsy dx interview03231.6153$95.87$19.99$19.17
    90802SIntac psy dx interview03231.6153$95.87$19.99$19.17
    90804SPsytx, office, 20-30 min03221.2263$72.78$14.56
    90805SPsytx, off, 20-30 min w/e&m03221.2263$72.78$14.56
    90806SPsytx, off, 45-50 min03231.6153$95.87$19.99$19.17
    90807SPsytx, off, 45-50 min w/e&m03231.6153$95.87$19.99$19.17
    90808SPsytx, office, 75-80 min03231.6153$95.87$19.99$19.17
    90809SPsytx, off, 75-80, w/e&m03231.6153$95.87$19.99$19.17
    90810SIntac psytx, off, 20-30 min03221.2263$72.78$14.56
    90811SIntac psytx, 20-30, w/e&m03221.2263$72.78$14.56
    90812SIntac psytx, off, 45-50 min03231.6153$95.87$19.99$19.17
    90813SIntac psytx, 45-50 min w/e&m03231.6153$95.87$19.99$19.17
    90814SIntac psytx, off, 75-80 min03231.6153$95.87$19.99$19.17
    90815SIntac psytx, 75-80 w/e&m03231.6153$95.87$19.99$19.17
    90816SPsytx, hosp, 20-30 min03221.2263$72.78$14.56
    90817SPsytx, hosp, 20-30 min w/e&m03221.2263$72.78$14.56
    90818SPsytx, hosp, 45-50 min03231.6153$95.87$19.99$19.17
    90819SPsytx, hosp, 45-50 min w/e&m03231.6153$95.87$19.99$19.17
    90821SPsytx, hosp, 75-80 min03231.6153$95.87$19.99$19.17
    90822SPsytx, hosp, 75-80 min w/e&m03231.6153$95.87$19.99$19.17
    90823SIntac psytx, hosp, 20-30 min03221.2263$72.78$14.56
    90824SIntac psytx, hsp 20-30 w/e&m03221.2263$72.78$14.56
    90826SIntac psytx, hosp, 45-50 min03231.6153$95.87$19.99$19.17
    90827SIntac psytx, hsp 45-50 w/e&m03231.6153$95.87$19.99$19.17
    90828SIntac psytx, hosp, 75-80 min03231.6153$95.87$19.99$19.17
    Start Printed Page 42892
    90829SIntac psytx, hsp 75-80 w/e&m03231.6153$95.87$19.99$19.17
    90845SPsychoanalysis03231.6153$95.87$19.99$19.17
    90846SFamily psytx w/o patient03242.0901$124.05$24.81
    90847SFamily psytx w/patient03242.0901$124.05$24.81
    90849SMultiple family group psytx03251.3130$77.93$17.03$15.59
    90853SGroup psychotherapy03251.3130$77.93$17.03$15.59
    90857SIntac group psytx03251.3130$77.93$17.03$15.59
    90862XMedication management03741.0367$61.53$12.31
    90865SNarcosynthesis03231.6153$95.87$19.99$19.17
    90870SElectroconvulsive therapy03205.3522$317.65$80.06$63.53
    90871EElectroconvulsive therapy
    90875EPsychophysiological therapy
    90876EPsychophysiological therapy
    90880SHypnotherapy03231.6153$95.87$19.99$19.17
    90882EEnvironmental manipulation
    90885NPsy evaluation of records
    90887NConsultation with family
    90889NPreparation of report
    90899SPsychiatric service/therapy03221.2263$72.78$14.56
    90901ABiofeedback train, any meth
    90911SBiofeedback peri/uro/rectal03211.3517$80.22$21.61$16.04
    90918EESRD related services, month
    90919EESRD related services, month
    90920EESRD related services, month
    90921EESRD related services, month
    90922EESRD related services, day
    90923EEsrd related services, day
    90924EEsrd related services, day
    90925EEsrd related services, day
    90935SHemodialysis, one evaluation01705.8726$348.54$69.71
    90937EHemodialysis, repeated eval
    90939NHemodialysis study, transcut
    90940NHemodialysis access study
    90945SDialysis, one evaluation01705.8726$348.54$69.71
    90947EDialysis, repeated eval
    90989BDialysis training, complete
    90993BDialysis training, incompl
    90997EHemoperfusion
    90999BDialysis procedure
    91000XEsophageal intubation03613.6052$213.97$83.23$42.79
    91010XEsophagus motility study03613.6052$213.97$83.23$42.79
    91011XEsophagus motility study03613.6052$213.97$83.23$42.79
    91012XEsophagus motility study03613.6052$213.97$83.23$42.79
    91020XGastric motility03613.6052$213.97$83.23$42.79
    91030XAcid perfusion of esophagus03613.6052$213.97$83.23$42.79
    91034XGastroesophageal reflux test03613.6052$213.97$83.23$42.79
    91035XG-esoph reflx tst w/electrod03613.6052$213.97$83.23$42.79
    91037XEsoph imped function test03613.6052$213.97$83.23$42.79
    91038XEsoph imped funct test > 1h03613.6052$213.97$83.23$42.79
    91040XEsoph balloon distension tst03601.4672$87.08$34.83$17.42
    91052XGastric analysis test03613.6052$213.97$83.23$42.79
    91055XGastric intubation for smear03601.4672$87.08$34.83$17.42
    91060XGastric saline load test03601.4672$87.08$34.83$17.42
    91065XBreath hydrogen test03601.4672$87.08$34.83$17.42
    91100XPass intestine bleeding tube03601.4672$87.08$34.83$17.42
    91105XGastric intubation treatment03601.4672$87.08$34.83$17.42
    91110TGi tract capsule endoscopy01429.3063$552.33$152.78$110.47
    91120TRectal sensation test01562.5635$152.14$40.52$30.43
    91122TAnal pressure record01562.5635$152.14$40.52$30.43
    91123NIrrigate fecal impaction
    91132XElectrogastrography03601.4672$87.08$34.83$17.42
    91133XElectrogastrography w/test03601.4672$87.08$34.83$17.42
    91299XGastroenterology procedure03601.4672$87.08$34.83$17.42
    92002VEye exam, new patient06010.9992$59.30$11.86
    92004VEye exam, new patient06010.9992$59.30$11.86
    92012VEye exam established pat06000.8649$51.33$10.27
    Start Printed Page 42893
    92014VEye exam & treatment06010.9992$59.30$11.86
    92015ERefraction
    92018TNew eye exam & treatment06999.9723$591.86$118.37
    92019TEye exam & treatment06999.9723$591.86$118.37
    92020SSpecial eye evaluation02300.7823$46.43$14.97$9.29
    92060SSpecial eye evaluation02300.7823$46.43$14.97$9.29
    92065SOrthoptic/pleoptic training06981.2381$73.48$16.48$14.70
    92070NFitting of contact lens
    92081SVisual field examination(s)02300.7823$46.43$14.97$9.29
    92082SVisual field examination(s)02300.7823$46.43$14.97$9.29
    92083SVisual field examination(s)02300.7823$46.43$14.97$9.29
    92100NSerial tonometry exam(s)
    92120STonography & eye evaluation02300.7823$46.43$14.97$9.29
    92130SWater provocation tonography02300.7823$46.43$14.97$9.29
    92135SOpthalmic dx imaging02300.7823$46.43$14.97$9.29
    92136SOphthalmic biometry06981.2381$73.48$16.48$14.70
    92140SGlaucoma provocative tests06981.2381$73.48$16.48$14.70
    92225SSpecial eye exam, initial02300.7823$46.43$14.97$9.29
    92226SSpecial eye exam, subsequent02300.7823$46.43$14.97$9.29
    92230TEye exam with photos06999.9723$591.86$118.37
    92235SEye exam with photos02311.9191$113.90$22.78
    92240SIcg angiography02311.9191$113.90$22.78
    92250SEye exam with photos02300.7823$46.43$14.97$9.29
    92260SOphthalmoscopy/dynamometry06981.2381$73.48$16.48$14.70
    92265SEye muscle evaluation02300.7823$46.43$14.97$9.29
    92270SElectro-oculography02300.7823$46.43$14.97$9.29
    92275SElectroretinography02311.9191$113.90$22.78
    92283SColor vision examination02300.7823$46.43$14.97$9.29
    92284SDark adaptation eye exam06981.2381$73.48$16.48$14.70
    92285SEye photography02300.7823$46.43$14.97$9.29
    92286SInternal eye photography06981.2381$73.48$16.48$14.70
    92287SInternal eye photography06981.2381$73.48$16.48$14.70
    92310EContact lens fitting
    92311XContact lens fitting03622.6486$157.19$31.44
    92312XContact lens fitting03622.6486$157.19$31.44
    92313XContact lens fitting03622.6486$157.19$31.44
    92314EPrescription of contact lens
    92315XPrescription of contact lens03622.6486$157.19$31.44
    92316XPrescription of contact lens03622.6486$157.19$31.44
    92317XPrescription of contact lens03622.6486$157.19$31.44
    92325XModification of contact lens03622.6486$157.19$31.44
    92326XReplacement of contact lens03622.6486$157.19$31.44
    92330SFitting of artificial eye02300.7823$46.43$14.97$9.29
    92335NFitting of artificial eye
    92340EFitting of spectacles
    92341EFitting of spectacles
    92342EFitting of spectacles
    92352XSpecial spectacles fitting03622.6486$157.19$31.44
    92353XSpecial spectacles fitting03622.6486$157.19$31.44
    92354XSpecial spectacles fitting03622.6486$157.19$31.44
    92355XSpecial spectacles fitting03622.6486$157.19$31.44
    92358XEye prosthesis service03622.6486$157.19$31.44
    92370ERepair & adjust spectacles
    92371XRepair & adjust spectacles03622.6486$157.19$31.44
    92390ESupply of spectacles
    92391ESupply of contact lenses
    92392ESupply of low vision aids
    92393ESupply of artificial eye
    92395ESupply of spectacles
    92396ESupply of contact lenses
    92499SEye service or procedure02300.7823$46.43$14.97$9.29
    92502TEar and throat examination02512.0010$118.76$23.75
    92504NEar microscopy examination
    92506ASpeech/hearing evaluation
    92507ASpeech/hearing therapy
    92508ASpeech/hearing therapy
    Start Printed Page 42894
    92510ERehab for ear implant
    92511TNasopharyngoscopy00710.7879$46.76$11.31$9.35
    92512XNasal function studies03630.9087$53.93$17.44$10.79
    92516XFacial nerve function test06601.6345$97.01$30.60$19.40
    92520XLaryngeal function studies06601.6345$97.01$30.60$19.40
    92526AOral function therapy
    92531NSpontaneous nystagmus study
    92532NPositional nystagmus test
    92533NCaloric vestibular test
    92534NOptokinetic nystagmus test
    92541XSpontaneous nystagmus test03630.9087$53.93$17.44$10.79
    92542XPositional nystagmus test03630.9087$53.93$17.44$10.79
    92543XCaloric vestibular test06601.6345$97.01$30.60$19.40
    92544XOptokinetic nystagmus test03630.9087$53.93$17.44$10.79
    92545XOscillating tracking test03630.9087$53.93$17.44$10.79
    92546XSinusoidal rotational test06601.6345$97.01$30.60$19.40
    92547XSupplemental electrical test03630.9087$53.93$17.44$10.79
    92548XPosturography06601.6345$97.01$30.60$19.40
    92551EPure tone hearing test, air
    92552XPure tone audiometry, air03640.4686$27.81$9.06$5.56
    92553XAudiometry, air & bone03651.2300$73.00$18.95$14.60
    92555XSpeech threshold audiometry03640.4686$27.81$9.06$5.56
    92556XSpeech audiometry, complete03640.4686$27.81$9.06$5.56
    92557XComprehensive hearing test03651.2300$73.00$18.95$14.60
    92559EGroup audiometric testing
    92560EBekesy audiometry, screen
    92561XBekesy audiometry, diagnosis03640.4686$27.81$9.06$5.56
    92562XLoudness balance test03640.4686$27.81$9.06$5.56
    92563XTone decay hearing test03640.4686$27.81$9.06$5.56
    92564XSisi hearing test03640.4686$27.81$9.06$5.56
    92565XStenger test, pure tone03640.4686$27.81$9.06$5.56
    92567XTympanometry03640.4686$27.81$9.06$5.56
    92568XAcoustic reflex testing03640.4686$27.81$9.06$5.56
    92569XAcoustic reflex decay test03640.4686$27.81$9.06$5.56
    92571XFiltered speech hearing test03640.4686$27.81$9.06$5.56
    92572XStaggered spondaic word test03651.2300$73.00$18.95$14.60
    92573XLombard test03640.4686$27.81$9.06$5.56
    92575XSensorineural acuity test03640.4686$27.81$9.06$5.56
    92576XSynthetic sentence test03640.4686$27.81$9.06$5.56
    92577XStenger test, speech03661.7663$104.83$27.36$20.97
    92579XVisual audiometry (vra)03651.2300$73.00$18.95$14.60
    92582XConditioning play audiometry03651.2300$73.00$18.95$14.60
    92583XSelect picture audiometry03640.4686$27.81$9.06$5.56
    92584XElectrocochleography06601.6345$97.01$30.60$19.40
    92585SAuditor evoke potent, compre02162.6599$157.87$31.57
    92586SAuditor evoke potent, limit02181.1356$67.40$13.48
    92587XEvoked auditory test03630.9087$53.93$17.44$10.79
    92588XEvoked auditory test03630.9087$53.93$17.44$10.79
    92590EHearing aid exam, one ear
    92591EHearing aid exam, both ears
    92592EHearing aid check, one ear
    92593EHearing aid check, both ears
    92594EElectro hearng aid test, one
    92595EElectro hearng aid tst, both
    92596XEar protector evaluation03640.4686$27.81$9.06$5.56
    92597AVoice Prosthetic Evaluation
    92601XCochlear implt f/up exam < 703661.7663$104.83$27.36$20.97
    92602XReprogram cochlear implt < 703661.7663$104.83$27.36$20.97
    92603XCochlear implt f/up exam 7 >03661.7663$104.83$27.36$20.97
    92604XReprogram cochlear implt 7 >03661.7663$104.83$27.36$20.97
    92605AEval for nonspeech device rx
    92606ANon-speech device service
    92607AEx for speech device rx, 1hr
    92608AEx for speech device rx addl
    92609AUse of speech device service
    92610AEvaluate swallowing function
    Start Printed Page 42895
    92611AMotion fluoroscopy/swallow
    92612AEndoscopy swallow tst (fees)
    92613EEndoscopy swallow tst (fees)
    92614ALaryngoscopic sensory test
    92615EEval laryngoscopy sense tst
    92616AFees w/laryngeal sense test
    92617EInterprt fees/laryngeal test
    92620XAuditory function, 60 min03640.4686$27.81$9.06$5.56
    92621NAuditory function, + 15 min
    92625XTinnitus assessment03640.4686$27.81$9.06$5.56
    92700XEnt procedure/service03640.4686$27.81$9.06$5.56
    92950SHeart/lung resuscitation cpr00942.5248$149.85$47.41$29.97
    92953STemporary external pacing00942.5248$149.85$47.41$29.97
    92960SCardioversion electric, ext06795.5521$329.52$95.30$65.90
    92961SCardioversion, electric, int06795.5521$329.52$95.30$65.90
    92970CCardioassist, internal
    92971CCardioassist, external
    92973TPercut coronary thrombectomy06762.3996$142.42$28.48
    92974TCath place, cardio brachytx010314.6476$869.34$223.63$173.87
    92975CDissolve clot, heart vessel
    92977TDissolve clot, heart vessel06762.3996$142.42$28.48
    92978SIntravasc us, heart add-on067025.2980$1,501.44$470.38$300.29
    92979SIntravasc us, heart add-on041619.4657$1,155.29$231.06
    92980TInsert intracoronary stent010478.6515$4,667.97$933.59
    92981TInsert intracoronary stent010478.6515$4,667.97$933.59
    92982TCoronary artery dilation008350.6620$3,006.79$601.36
    92984TCoronary artery dilation008350.6620$3,006.79$601.36
    92986TRevision of aortic valve008350.6620$3,006.79$601.36
    92987TRevision of mitral valve008350.6620$3,006.79$601.36
    92990TRevision of pulmonary valve008350.6620$3,006.79$601.36
    92992CRevision of heart chamber
    92993CRevision of heart chamber
    92995TCoronary atherectomy008284.6276$5,022.65$1,080.41$1,004.53
    92996TCoronary atherectomy add-on008284.6276$5,022.65$1,080.41$1,004.53
    92997TPul art balloon repr, percut008134.2913$2,035.19$407.04
    92998TPul art balloon repr, percut008134.2913$2,035.19$407.04
    93000BElectrocardiogram, complete
    93005SElectrocardiogram, tracing00990.3804$22.58$4.52
    93010AElectrocardiogram report
    93012NTransmission of ecg
    93014BReport on transmitted ecg
    93015BCardiovascular stress test
    93016BCardiovascular stress test
    93017XCardiovascular stress test01002.4855$147.51$41.44$29.50
    93018BCardiovascular stress test
    93024XCardiac drug stress test01002.4855$147.51$41.44$29.50
    93025XMicrovolt t-wave assess01002.4855$147.51$41.44$29.50
    93040BRhythm ECG with report
    93041SRhythm ECG, tracing00990.3804$22.58$4.52
    93042BRhythm ECG, report
    93224BECG monitor/report, 24 hrs
    93225XECG monitor/record, 24 hrs00971.0177$60.40$23.79$12.08
    93226XECG monitor/report, 24 hrs00971.0177$60.40$23.79$12.08
    93227BECG monitor/review, 24 hrs
    93230BECG monitor/report, 24 hrs
    93231XEcg monitor/record, 24 hrs00971.0177$60.40$23.79$12.08
    93232XECG monitor/report, 24 hrs00971.0177$60.40$23.79$12.08
    93233BECG monitor/review, 24 hrs
    93235BECG monitor/report, 24 hrs
    93236XECG monitor/report, 24 hrs00971.0177$60.40$23.79$12.08
    93237BECG monitor/review, 24 hrs
    93268BECG record/review
    93270XECG recording00971.0177$60.40$23.79$12.08
    93271XEcg/monitoring and analysis00971.0177$60.40$23.79$12.08
    93272BEcg/review, interpret only
    93278SECG/signal-averaged00990.3804$22.58$4.52
    Start Printed Page 42896
    93303SEcho transthoracic02693.2290$191.64$76.65$38.33
    93304SEcho transthoracic06971.5288$90.73$36.29$18.15
    93307SEcho exam of heart02693.2290$191.64$76.65$38.33
    93308SEcho exam of heart06971.5288$90.73$36.29$18.15
    93312SEcho transesophageal02705.9919$355.62$142.24$71.12
    93313SEcho transesophageal02705.9919$355.62$142.24$71.12
    93314NEcho transesophageal
    93315SEcho transesophageal02705.9919$355.62$142.24$71.12
    93316SEcho transesophageal02705.9919$355.62$142.24$71.12
    93317NEcho transesophageal
    93318SEcho transesophageal intraop02705.9919$355.62$142.24$71.12
    93320SDoppler echo exam, heart06711.6951$100.60$40.24$20.12
    93321SDoppler echo exam, heart06971.5288$90.73$36.29$18.15
    93325SDoppler color flow add-on06971.5288$90.73$36.29$18.15
    93350SEcho transthoracic02693.2290$191.64$76.65$38.33
    93501TRight heart catheterization008036.9679$2,194.04$838.92$438.81
    93503TInsert/place heart catheter010314.6476$869.34$223.63$173.87
    93505TBiopsy of heart lining010314.6476$869.34$223.63$173.87
    93508TCath placement, angiography008036.9679$2,194.04$838.92$438.81
    93510TLeft heart catheterization008036.9679$2,194.04$838.92$438.81
    93511TLeft heart catheterization008036.9679$2,194.04$838.92$438.81
    93514TLeft heart catheterization008036.9679$2,194.04$838.92$438.81
    93524TLeft heart catheterization008036.9679$2,194.04$838.92$438.81
    93526TRt & Lt heart catheters008036.9679$2,194.04$838.92$438.81
    93527TRt & Lt heart catheters008036.9679$2,194.04$838.92$438.81
    93528TRt & Lt heart catheters008036.9679$2,194.04$838.92$438.81
    93529TRt, lt heart catheterization008036.9679$2,194.04$838.92$438.81
    93530TRt heart cath, congenital008036.9679$2,194.04$838.92$438.81
    93531TR & l heart cath, congenital008036.9679$2,194.04$838.92$438.81
    93532TR & l heart cath, congenital008036.9679$2,194.04$838.92$438.81
    93533TR & l heart cath, congenital008036.9679$2,194.04$838.92$438.81
    93539NInjection, cardiac cath
    93540NInjection, cardiac cath
    93541NInjection for lung angiogram
    93542NInjection for heart x-rays
    93543NInjection for heart x-rays
    93544NInjection for aortography
    93545NInject for coronary x-rays
    93555NImaging, cardiac cath
    93556NImaging, cardiac cath
    93561NCardiac output measurement
    93562NCardiac output measurement
    93571SHeart flow reserve measure067025.2980$1,501.44$470.38$300.29
    93572SHeart flow reserve measure041619.4657$1,155.29$231.06
    93580TTranscath closure of asd043490.3765$5,363.85$1,072.77
    93581TTranscath closure of vsd043490.3765$5,363.85$1,072.77
    93600TBundle of His recording008730.5711$1,814.39$362.88
    93602TIntra-atrial recording008730.5711$1,814.39$362.88
    93603TRight ventricular recording008730.5711$1,814.39$362.88
    93609TMap tachycardia, add-on008730.5711$1,814.39$362.88
    93610TIntra-atrial pacing008730.5711$1,814.39$362.88
    93612TIntraventricular pacing008730.5711$1,814.39$362.88
    93613TElectrophys map 3d, add-on008730.5711$1,814.39$362.88
    93615TEsophageal recording008730.5711$1,814.39$362.88
    93616TEsophageal recording008730.5711$1,814.39$362.88
    93618THeart rhythm pacing008730.5711$1,814.39$362.88
    93619TElectrophysiology evaluation008535.0288$2,078.96$426.25$415.79
    93620TElectrophysiology evaluation008535.0288$2,078.96$426.25$415.79
    93621TElectrophysiology evaluation008535.0288$2,078.96$426.25$415.79
    93622TElectrophysiology evaluation008535.0288$2,078.96$426.25$415.79
    93623TStimulation, pacing heart008730.5711$1,814.39$362.88
    93624TElectrophysiologic study008535.0288$2,078.96$426.25$415.79
    93631THeart pacing, mapping008730.5711$1,814.39$362.88
    93640SEvaluation heart device00849.9751$592.02$118.40
    93641SElectrophysiology evaluation00849.9751$592.02$118.40
    93642SElectrophysiology evaluation00849.9751$592.02$118.40
    Start Printed Page 42897
    93650TAblate heart dysrhythm focus008644.0592$2,614.91$833.33$522.98
    93651TAblate heart dysrhythm focus008644.0592$2,614.91$833.33$522.98
    93652TAblate heart dysrhythm focus008644.0592$2,614.91$833.33$522.98
    93660STilt table evaluation01014.2593$252.79$101.11$50.56
    93662SIntracardiac ecg (ice)067025.2980$1,501.44$470.38$300.29
    93668EPeripheral vascular rehab
    93701SBioimpedance, thoracic00990.3804$22.58$4.52
    93720BTotal body plethysmography
    93721XPlethysmography tracing03680.9716$57.66$23.06$11.53
    93722BPlethysmography report
    93724SAnalyze pacemaker system06900.3738$22.19$8.87$4.44
    93727SAnalyze ilr system06900.3738$22.19$8.87$4.44
    93731SAnalyze pacemaker system06900.3738$22.19$8.87$4.44
    93732SAnalyze pacemaker system06900.3738$22.19$8.87$4.44
    93733STelephone analy, pacemaker06900.3738$22.19$8.87$4.44
    93734SAnalyze pacemaker system06900.3738$22.19$8.87$4.44
    93735SAnalyze pacemaker system06900.3738$22.19$8.87$4.44
    93736STelephonic analy, pacemaker06900.3738$22.19$8.87$4.44
    93740XTemperature gradient studies03680.9716$57.66$23.06$11.53
    93741SAnalyze ht pace device sngl06890.5709$33.88$6.78
    93742SAnalyze ht pace device sngl06890.5709$33.88$6.78
    93743SAnalyze ht pace device dual06890.5709$33.88$6.78
    93744SAnalyze ht pace device dual06890.5709$33.88$6.78
    93745SSet-up cardiovert-defibrill06890.5709$33.88$6.78
    93760ECephalic thermogram
    93762EPeripheral thermogram
    93770NMeasure venous pressure
    93784EAmbulatory BP monitoring
    93786XAmbulatory BP recording00971.0177$60.40$23.79$12.08
    93788XAmbulatory BP analysis00971.0177$60.40$23.79$12.08
    93790BReview/report BP recording
    93797SCardiac rehab00950.5858$34.77$13.90$6.95
    93798SCardiac rehab/monitor00950.5858$34.77$13.90$6.95
    93799SCardiovascular procedure00961.6233$96.34$38.53$19.27
    93875SExtracranial study00961.6233$96.34$38.53$19.27
    93880SExtracranial study02672.6208$155.54$62.18$31.11
    93882SExtracranial study02672.6208$155.54$62.18$31.11
    93886SIntracranial study02672.6208$155.54$62.18$31.11
    93888SIntracranial study02661.6319$96.85$38.74$19.37
    93890STcd, vasoreactivity study02661.6319$96.85$38.74$19.37
    93892STcd, emboli detect w/o inj02661.6319$96.85$38.74$19.37
    93893STcd, emboli detect w/inj02661.6319$96.85$38.74$19.37
    93922SExtremity study00961.6233$96.34$38.53$19.27
    93923SExtremity study00961.6233$96.34$38.53$19.27
    93924SExtremity study00961.6233$96.34$38.53$19.27
    93925SLower extremity study02672.6208$155.54$62.18$31.11
    93926SLower extremity study02661.6319$96.85$38.74$19.37
    93930SUpper extremity study02672.6208$155.54$62.18$31.11
    93931SUpper extremity study02661.6319$96.85$38.74$19.37
    93965SExtremity study00961.6233$96.34$38.53$19.27
    93970SExtremity study02672.6208$155.54$62.18$31.11
    93971SExtremity study02661.6319$96.85$38.74$19.37
    93975SVascular study02672.6208$155.54$62.18$31.11
    93976SVascular study02672.6208$155.54$62.18$31.11
    93978SVascular study02661.6319$96.85$38.74$19.37
    93979SVascular study02661.6319$96.85$38.74$19.37
    93980SPenile vascular study02672.6208$155.54$62.18$31.11
    93981SPenile vascular study02661.6319$96.85$38.74$19.37
    93990SDoppler flow testing02661.6319$96.85$38.74$19.37
    94010XBreathing capacity test03680.9716$57.66$23.06$11.53
    94014XPatient recorded spirometry03670.6629$39.34$14.80$7.87
    94015XPatient recorded spirometry03670.6629$39.34$14.80$7.87
    94016AReview patient spirometry
    94060XEvaluation of wheezing03680.9716$57.66$23.06$11.53
    94070XEvaluation of wheezing03692.7394$162.58$44.18$32.52
    94150XVital capacity test03670.6629$39.34$14.80$7.87
    Start Printed Page 42898
    94200XLung function test (MBC/MVV)03670.6629$39.34$14.80$7.87
    94240XResidual lung capacity03680.9716$57.66$23.06$11.53
    94250XExpired gas collection03670.6629$39.34$14.80$7.87
    94260XThoracic gas volume03670.6629$39.34$14.80$7.87
    94350XLung nitrogen washout curve03670.6629$39.34$14.80$7.87
    94360XMeasure airflow resistance03670.6629$39.34$14.80$7.87
    94370XBreath airway closing volume03670.6629$39.34$14.80$7.87
    94375XRespiratory flow volume loop03670.6629$39.34$14.80$7.87
    94400XCO2 breathing response curve03670.6629$39.34$14.80$7.87
    94450XHypoxia response curve03680.9716$57.66$23.06$11.53
    94452XHast w/report03680.9716$57.66$23.06$11.53
    94453XHast w/oxygen titrate03680.9716$57.66$23.06$11.53
    94620XPulmonary stress test/simple03680.9716$57.66$23.06$11.53
    94621XPulm stress test/complex03692.7394$162.58$44.18$32.52
    94640SAirway inhalation treatment00770.3428$20.35$7.74$4.07
    94642SAerosol inhalation treatment00781.0190$60.48$14.55$12.10
    94656SInitial ventilator mgmt00792.3375$138.73$27.75
    94657SContinued ventilator mgmt00792.3375$138.73$27.75
    94660SPos airway pressure, CPAP00681.2237$72.63$29.05$14.53
    94662SNeg press ventilation, cnp00792.3375$138.73$27.75
    94664SAerosol or vapor inhalations00770.3428$20.35$7.74$4.07
    94667SChest wall manipulation00770.3428$20.35$7.74$4.07
    94668SChest wall manipulation00770.3428$20.35$7.74$4.07
    94680XExhaled air analysis, o203670.6629$39.34$14.80$7.87
    94681XExhaled air analysis, o2/co203680.9716$57.66$23.06$11.53
    94690XExhaled air analysis03680.9716$57.66$23.06$11.53
    94720XMonoxide diffusing capacity03680.9716$57.66$23.06$11.53
    94725XMembrane diffusion capacity03680.9716$57.66$23.06$11.53
    94750XPulmonary compliance study03680.9716$57.66$23.06$11.53
    94760NMeasure blood oxygen level
    94761NMeasure blood oxygen level
    94762NMeasure blood oxygen level
    94770XExhaled carbon dioxide test03670.6629$39.34$14.80$7.87
    94772XBreath recording, infant03692.7394$162.58$44.18$32.52
    94799XPulmonary service/procedure03670.6629$39.34$14.80$7.87
    95004XPercut allergy skin tests03810.1876$11.13$2.34$2.23
    95010XPercut allergy titrate test03810.1876$11.13$2.34$2.23
    95015XId allergy titrate-drug/bug03810.1876$11.13$2.34$2.23
    95024XId allergy test, drug/bug03810.1876$11.13$2.34$2.23
    95027XSkin end point titration03810.1876$11.13$2.34$2.23
    95028XId allergy test-delayed type03810.1876$11.13$2.34$2.23
    95044XAllergy patch tests03810.1876$11.13$2.34$2.23
    95052XPhoto patch test03810.1876$11.13$2.34$2.23
    95056XPhotosensitivity tests03701.1181$66.36$13.27
    95060XEye allergy tests03701.1181$66.36$13.27
    95065XNose allergy test03810.1876$11.13$2.34$2.23
    95070XBronchial allergy tests03692.7394$162.58$44.18$32.52
    95071XBronchial allergy tests03692.7394$162.58$44.18$32.52
    95075XIngestion challenge test03613.6052$213.97$83.23$42.79
    95078XProvocative testing03701.1181$66.36$13.27
    95115XImmunotherapy, one injection03520.1407$8.35$1.67
    95117XImmunotherapy injections03530.3936$23.36$4.67
    95120BImmunotherapy, one injection
    95125BImmunotherapy, many antigens
    95130BImmunotherapy, insect venom
    95131BImmunotherapy, insect venoms
    95132BImmunotherapy, insect venoms
    95133BImmunotherapy, insect venoms
    95134BImmunotherapy, insect venoms
    95144XAntigen therapy services03530.3936$23.36$4.67
    95145XAntigen therapy services03530.3936$23.36$4.67
    95146XAntigen therapy services03590.8274$49.11$9.82
    95147XAntigen therapy services03590.8274$49.11$9.82
    95148XAntigen therapy services03530.3936$23.36$4.67
    95149XAntigen therapy services03520.1407$8.35$1.67
    95165XAntigen therapy services03530.3936$23.36$4.67
    Start Printed Page 42899
    95170XAntigen therapy services03520.1407$8.35$1.67
    95180XRapid desensitization03701.1181$66.36$13.27
    95199XAllergy immunology services03701.1181$66.36$13.27
    95250XGlucose monitoring, cont04211.6525$98.08$19.62
    95805SMultiple sleep latency test020911.5189$683.65$273.46$136.73
    95806SSleep study, unattended02132.2828$135.48$54.19$27.10
    95807SSleep study, attended020911.5189$683.65$273.46$136.73
    95808SPolysomnography, 1-3020911.5189$683.65$273.46$136.73
    95810SPolysomnography, 4 or more020911.5189$683.65$273.46$136.73
    95811SPolysomnography w/cpap020911.5189$683.65$273.46$136.73
    95812SElectroencephalogram (EEG)02132.2828$135.48$54.19$27.10
    95813SEeg, over 1 hour02132.2828$135.48$54.19$27.10
    95816SElectroencephalogram (EEG)02132.2828$135.48$54.19$27.10
    95819SElectroencephalogram (EEG)02132.2828$135.48$54.19$27.10
    95822SSleep electroencephalogram02132.2828$135.48$54.19$27.10
    95824SEeg, cerebral death only02141.1302$67.08$26.83$13.42
    95827Snight electroencephalogram02132.2828$135.48$54.19$27.10
    95829SSurgery electrocorticogram02141.1302$67.08$26.83$13.42
    95830BInsert electrodes for EEG
    95831ALimb muscle testing, manual
    95832AHand muscle testing, manual
    95833ABody muscle testing, manual
    95834ABody muscle testing, manual
    95851ARange of motion measurements
    95852ARange of motion measurements
    95857STensilon test02181.1356$67.40$13.48
    95858STensilon test & myogram02150.6087$36.13$14.45$7.23
    95860SMuscle test, one limb02181.1356$67.40$13.48
    95861SMuscle test, 2 limbs02181.1356$67.40$13.48
    95863SMuscle test, 3 limbs02181.1356$67.40$13.48
    95864SMuscle test, 4 limbs02181.1356$67.40$13.48
    95867SMuscle test, head or neck02181.1356$67.40$13.48
    95868SMuscle test cran nerve bilat02181.1356$67.40$13.48
    95869SMuscle test, thor paraspinal02150.6087$36.13$14.45$7.23
    95870SMuscle test, nonparaspinal02150.6087$36.13$14.45$7.23
    95872SMuscle test, one fiber02181.1356$67.40$13.48
    95875SLimb exercise test02150.6087$36.13$14.45$7.23
    95900SMotor nerve conduction test02150.6087$36.13$14.45$7.23
    95903SMotor nerve conduction test02150.6087$36.13$14.45$7.23
    95904SSense nerve conduction test02150.6087$36.13$14.45$7.23
    95920SIntraop nerve test add-on02162.6599$157.87$31.57
    95921SAutonomic nerv function test02181.1356$67.40$13.48
    95922SAutonomic nerv function test02181.1356$67.40$13.48
    95923SAutonomic nerv function test02181.1356$67.40$13.48
    95925SSomatosensory testing02162.6599$157.87$31.57
    95926SSomatosensory testing02162.6599$157.87$31.57
    95927SSomatosensory testing02162.6599$157.87$31.57
    95928SC motor evoked, uppr limbs02181.1356$67.40$13.48
    95929SC motor evoked, lwr limbs02181.1356$67.40$13.48
    95930SVisual evoked potential test02162.6599$157.87$31.57
    95933SBlink reflex test02150.6087$36.13$14.45$7.23
    95934SH-reflex test02150.6087$36.13$14.45$7.23
    95936SH-reflex test02150.6087$36.13$14.45$7.23
    95937SNeuromuscular junction test02181.1356$67.40$13.48
    95950SAmbulatory eeg monitoring02132.2828$135.48$54.19$27.10
    95951SEEG monitoring/videorecord020911.5189$683.65$273.46$136.73
    95953SEEG monitoring/computer020911.5189$683.65$273.46$136.73
    95954SEEG monitoring/giving drugs02141.1302$67.08$26.83$13.42
    95955SEEG during surgery02132.2828$135.48$54.19$27.10
    95956SEeg monitoring, cable/radio020911.5189$683.65$273.46$136.73
    95957SEEG digital analysis02141.1302$67.08$26.83$13.42
    95958SEEG monitoring/function test02132.2828$135.48$54.19$27.10
    95961SElectrode stimulation, brain02162.6599$157.87$31.57
    95962SElectrode stim, brain add-on02162.6599$157.87$31.57
    95965TMeg, spontaneous043011.3524$673.76$134.75
    95966TMeg, evoked, single043011.3524$673.76$134.75
    Start Printed Page 42900
    95967TMeg, evoked, each add'l043011.3524$673.76$134.75
    95970SAnalyze neurostim, no prog02181.1356$67.40$13.48
    95971SAnalyze neurostim, simple06922.0020$118.82$30.16$23.76
    95972SAnalyze neurostim, complex06922.0020$118.82$30.16$23.76
    95973SAnalyze neurostim, complex06922.0020$118.82$30.16$23.76
    95974SCranial neurostim, complex06922.0020$118.82$30.16$23.76
    95975SCranial neurostim, complex06922.0020$118.82$30.16$23.76
    95978SAnalyze neurostim brain/1h06922.0020$118.82$30.16$23.76
    95979SAnalyz neurostim brain addon06922.0020$118.82$30.16$23.76
    95990TSpin/brain pump refil & main01251.9244$114.21$22.84
    95991TSpin/brain pump refil & main01251.9244$114.21$22.84
    95999SNeurological procedure02150.6087$36.13$14.45$7.23
    96000SMotion analysis, video/3d02162.6599$157.87$31.57
    96001SMotion test w/ft press meas02162.6599$157.87$31.57
    96002SDynamic surface emg02181.1356$67.40$13.48
    96003SDynamic fine wire emg02150.6087$36.13$14.45$7.23
    96004EPhys review of motion tests
    96100XPsychological testing03732.1827$129.54$25.91
    96105AAssessment of aphasia
    96110XDevelopmental test, lim03732.1827$129.54$25.91
    96111XDevelopmental test, extend03732.1827$129.54$25.91
    96115XNeurobehavior status exam03732.1827$129.54$25.91
    96117XNeuropsych test battery03732.1827$129.54$25.91
    96150SAssess lth/behave, init04320.6918$41.06$8.21
    96151SAssess hlth/behave, subseq04320.6918$41.06$8.21
    96152SIntervene hlth/behave, indiv04320.6918$41.06$8.21
    96153SIntervene hlth/behave, group04320.6918$41.06$8.21
    96154SInterv hlth/behav, fam w/pt04320.6918$41.06$8.21
    96155EInterv hlth/behav fam no pt
    96400SChemotherapy, sc/im01161.1401$67.66$13.53
    96405SIntralesional chemo admin01161.1401$67.66$13.53
    96406SIntralesional chemo admin01161.1401$67.66$13.53
    96408SChemotherapy, push technique01161.1401$67.66$13.53
    96410SChemotherapy,infusion method01173.2231$191.29$42.54$38.26
    96412NChemo, infuse method add-on
    96414SChemo, infuse method add-on01173.2231$191.29$42.54$38.26
    96420SChemotherapy, push technique01161.1401$67.66$13.53
    96422SChemotherapy,infusion method01173.2231$191.29$42.54$38.26
    96423NChemo, infuse method add-on
    96425SChemotherapy,infusion method01173.2231$191.29$42.54$38.26
    96440SChemotherapy, intracavitary01161.1401$67.66$13.53
    96445SChemotherapy, intracavitary01161.1401$67.66$13.53
    96450SChemotherapy, into CNS01161.1401$67.66$13.53
    96520TPort pump refill & main01251.9244$114.21$22.84
    96530TPump refilling, maintenance01251.9244$114.21$22.84
    96542SChemotherapy injection01161.1401$67.66$13.53
    96545NProvide chemotherapy agent
    96549SChemotherapy, unspecified01161.1401$67.66$13.53
    96567TPhotodynamic tx, skin00162.5717$152.63$33.42$30.53
    96570TPhotodynamic tx, 30 min00151.6439$97.57$20.20$19.51
    96571TPhotodynamic tx, addl 15 min00151.6439$97.57$20.20$19.51
    96900SUltraviolet light therapy00010.4194$24.89$7.00$4.98
    96902NTrichogram
    96910SPhotochemotherapy with UV-B00010.4194$24.89$7.00$4.98
    96912SPhotochemotherapy with UV-A00010.4194$24.89$7.00$4.98
    96913SPhotochemotherapy, UV-A or B06831.8920$112.29$25.23$22.46
    96920TLaser tx, skin < 250 sq cm00131.1028$65.45$14.20$13.09
    96921TLaser tx, skin 250-500 sq cm00131.1028$65.45$14.20$13.09
    96922TLaser tx, skin > 500 sq cm00131.1028$65.45$14.20$13.09
    96999TDermatological procedure00100.5693$33.79$9.63$6.76
    97001APt evaluation
    97002APt re-evaluation
    97003AOt evaluation
    97004AOt re-evaluation
    97005EAthletic train eval
    97006EAthletic train reeval
    Start Printed Page 42901
    97010AHot or cold packs therapy
    97012AMechanical traction therapy
    97014EElectric stimulation therapy
    97016AVasopneumatic device therapy
    97018AParaffin bath therapy
    97020AMicrowave therapy
    97022AWhirlpool therapy
    97024ADiathermy treatment
    97026AInfrared therapy
    97028AUltraviolet therapy
    97032AElectrical stimulation
    97033AElectric current therapy
    97034AContrast bath therapy
    97035AUltrasound therapy
    97036AHydrotherapy
    97039APhysical therapy treatment
    97110ATherapeutic exercises
    97112ANeuromuscular reeducation
    97113AAquatic therapy/exercises
    97116AGait training therapy
    97124AMassage therapy
    97139APhysical medicine procedure
    97140AManual therapy
    97150AGroup therapeutic procedures
    97504AOrthotic training
    97520AProsthetic training
    97530ATherapeutic activities
    97532ACognitive skills development
    97533ASensory integration
    97535ASelf care mngment training
    97537ACommunity/work reintegration
    97542AWheelchair mngment training
    97545AWork hardening
    97546AWork hardening add-on
    97597AActive wound care/20 cm or <
    97598AActive wound care > 20 cm
    97602AWound(s) care non-selective
    97605ANeg press wound tx, < 50 cm
    97606ANeg press wound tx, > 50 cm
    97703AProsthetic checkout
    97750APhysical performance test
    97755AAssistive technology assess
    97799APhysical medicine procedure
    97802AMedical nutrition, indiv, in
    97803AMed nutrition, indiv, subseq
    97804AMedical nutrition, group
    97810EAcupunct w/o stimul 15 min
    97811EAcupunct w/o stimul addl 15m
    97813EAcupunct w/stimul 15 min
    97814EAcupunct w/stimul addl 15m
    98925SOsteopathic manipulation00600.4913$29.16$5.83
    98926SOsteopathic manipulation00600.4913$29.16$5.83
    98927SOsteopathic manipulation00600.4913$29.16$5.83
    98928SOsteopathic manipulation00600.4913$29.16$5.83
    98929SOsteopathic manipulation00600.4913$29.16$5.83
    98940SChiropractic manipulation00600.4913$29.16$5.83
    98941SChiropractic manipulation00600.4913$29.16$5.83
    98942SChiropractic manipulation00600.4913$29.16$5.83
    98943EChiropractic manipulation
    99000BSpecimen handling
    99001BSpecimen handling
    99002BDevice handling
    99024BPostop follow-up visit
    99026EIn-hospital on call service
    99027EOut-of-hosp on call service
    99050BMedical services after hrs
    Start Printed Page 42902
    99052BMedical services at night
    99054BMedical servcs, unusual hrs
    99056BNon-office medical services
    99058BOffice emergency care
    99070BSpecial supplies
    99071BPatient education materials
    99075EMedical testimony
    99078NGroup health education
    99080BSpecial reports or forms
    99082BUnusual physician travel
    99090BComputer data analysis
    99091ECollect/review data from pt
    99100BSpecial anesthesia service
    99116BAnesthesia with hypothermia
    99135BSpecial anesthesia procedure
    99140BEmergency anesthesia
    99141NSedation, iv/im or inhalant
    99142NSedation, oral/rectal/nasal
    99170TAnogenital exam, child01910.1663$9.87$2.77$1.97
    99172EOcular function screen
    99173EVisual acuity screen
    99175NInduction of vomiting
    99183BHyperbaric oxygen therapy
    99185NRegional hypothermia
    99186NTotal body hypothermia
    99190CSpecial pump services
    99191CSpecial pump services
    99192CSpecial pump services
    99195XPhlebotomy03720.5675$33.68$10.09$6.74
    99199BSpecial service/proc/report
    99201VOffice/outpatient visit, new06000.8649$51.33$10.27
    99202VOffice/outpatient visit, new06000.8649$51.33$10.27
    99203VOffice/outpatient visit, new06010.9992$59.30$11.86
    99204VOffice/outpatient visit, new06021.4220$84.40$16.88
    99205VOffice/outpatient visit, new06021.4220$84.40$16.88
    99211VOffice/outpatient visit, est06000.8649$51.33$10.27
    99212VOffice/outpatient visit, est06000.8649$51.33$10.27
    99213VOffice/outpatient visit, est06010.9992$59.30$11.86
    99214VOffice/outpatient visit, est06021.4220$84.40$16.88
    99215VOffice/outpatient visit, est06021.4220$84.40$16.88
    99217BObservation care discharge
    99218BObservation care
    99219BObservation care
    99220BObservation care
    99221EInitial hospital care
    99222EInitial hospital care
    99223EInitial hospital care
    99231ESubsequent hospital care
    99232ESubsequent hospital care
    99233ESubsequent hospital care
    99234BObserv/hosp same date
    99235BObserv/hosp same date
    99236BObserv/hosp same date
    99238EHospital discharge day
    99239EHospital discharge day
    99241VOffice consultation06000.8649$51.33$10.27
    99242VOffice consultation06000.8649$51.33$10.27
    99243VOffice consultation06010.9992$59.30$11.86
    99244VOffice consultation06021.4220$84.40$16.88
    99245VOffice consultation06021.4220$84.40$16.88
    99251CInitial inpatient consult
    99252CInitial inpatient consult
    99253CInitial inpatient consult
    99254CInitial inpatient consult
    99255CInitial inpatient consult
    99261CFollow-up inpatient consult
    Start Printed Page 42903
    99262CFollow-up inpatient consult
    99263CFollow-up inpatient consult
    99271VConfirmatory consultation06000.8649$51.33$10.27
    99272VConfirmatory consultation06000.8649$51.33$10.27
    99273VConfirmatory consultation06010.9992$59.30$11.86
    99274VConfirmatory consultation06021.4220$84.40$16.88
    99275VConfirmatory consultation06021.4220$84.40$16.88
    99281VEmergency dept visit06101.2889$76.50$19.40$15.30
    99282VEmergency dept visit06101.2889$76.50$19.40$15.30
    99283VEmergency dept visit06112.2615$134.22$35.60$26.84
    99284VEmergency dept visit06123.9673$235.46$54.12$47.09
    99285VEmergency dept visit06123.9673$235.46$54.12$47.09
    99288BDirect advanced life support
    99289NPt transport, 30-74 min
    99290NPt transport, addl 30 min
    99291SCritical care, first hour06208.2620$490.35$135.08$98.07
    99292NCritical care, add'l 30 min
    99293CPed critical care, initial
    99294CPed critical care, subseq
    99295CNeonatal critical care
    99296CNeonatal critical care
    99298CNeonatal critical care
    99299CIc, lbw infant 1500-2500 gm
    99301BNursing facility care
    99302BNursing facility care
    99303BNursing facility care
    99311BNursing fac care, subseq
    99312BNursing fac care, subseq
    99313BNursing fac care, subseq
    99315BNursing fac discharge day
    99316BNursing fac discharge day
    99321BRest home visit, new patient
    99322BRest home visit, new patient
    99323BRest home visit, new patient
    99331BRest home visit, est pat
    99332BRest home visit, est pat
    99333BRest home visit, est pat
    99341BHome visit, new patient
    99342BHome visit, new patient
    99343BHome visit, new patient
    99344BHome visit, new patient
    99345BHome visit, new patient
    99347BHome visit, est patient
    99348BHome visit, est patient
    99349BHome visit, est patient
    99350BHome visit, est patient
    99354NProlonged service, office
    99355NProlonged service, office
    99356CProlonged service, inpatient
    99357CProlonged service, inpatient
    99358NProlonged serv, w/o contact
    99359NProlonged serv, w/o contact
    99360BPhysician standby services
    99361EPhysician/team conference
    99362EPhysician/team conference
    99371BPhysician phone consultation
    99372BPhysician phone consultation
    99373BPhysician phone consultation
    99374BHome health care supervision
    99375EHome health care supervision
    99377BHospice care supervision
    99378EHospice care supervision
    99379BNursing fac care supervision
    99380BNursing fac care supervision
    99381EPrev visit, new, infant
    99382EPrev visit, new, age 1-4
    Start Printed Page 42904
    99383EPrev visit, new, age 5-11
    99384EPrev visit, new, age 12-17
    99385EPrev visit, new, age 18-39
    99386EPrev visit, new, age 40-64
    99387EPrev visit, new, 65 & over
    99391EPrev visit, est, infant
    99392EPrev visit, est, age 1-4
    99393EPrev visit, est, age 5-11
    99394EPrev visit, est, age 12-17
    99395EPrev visit, est, age 18-39
    99396EPrev visit, est, age 40-64
    99397EPrev visit, est, 65 & over
    99401EPreventive counseling, indiv
    99402EPreventive counseling, indiv
    99403EPreventive counseling, indiv
    99404EPreventive counseling, indiv
    99411EPreventive counseling, group
    99412EPreventive counseling, group
    99420EHealth risk assessment test
    99429EUnlisted preventive service
    99431VInitial care, normal newborn06000.8649$51.33$10.27
    99432NNewborn care, not in hosp
    99433CNormal newborn care/hospital
    99435ENewborn discharge day hosp
    99436NAttendance, birth
    99440SNewborn resuscitation00942.5248$149.85$47.41$29.97
    99450ELife/disability evaluation
    99455BDisability examination
    99456BDisability examination
    99499BUnlisted e&m service
    99500EHome visit, prenatal
    99501EHome visit, postnatal
    99502EHome visit, nb care
    99503EHome visit, resp therapy
    99504EHome visit mech ventilator
    99505EHome visit, stoma care
    99506EHome visit, im injection
    99507EHome visit, cath maintain
    99509EHome visit day life activity
    99510EHome visit, sing/m/fam couns
    99511EHome visit, fecal/enema mgmt
    99512EHome visit for hemodialysis
    99600EHome visit nos
    99601EHome infusion/visit, 2 hrs
    99602EHome infusion, each addtl hr
    A0021EOutside state ambulance serv
    A0080ENoninterest escort in non er
    A0090EInterest escort in non er
    A0100ENonemergency transport taxi
    A0110ENonemergency transport bus
    A0120ENoner transport mini-bus
    A0130ENoner transport wheelch van
    A0140ENonemergency transport air
    A0160ENoner transport case worker
    A0170ENoner transport parking fees
    A0180ENoner transport lodgng recip
    A0190ENoner transport meals recip
    A0200ENoner transport lodgng escrt
    A0210ENoner transport meals escort
    A0225ANeonatal emergency transport
    A0380ABasic life support mileage
    A0382ABasic support routine suppls
    A0384ABls defibrillation supplies
    A0390AAdvanced life support mileag
    A0392AAls defibrillation supplies
    A0394AAls IV drug therapy supplies
    Start Printed Page 42905
    A0396AAls esophageal intub suppls
    A0398AAls routine disposble suppls
    A0420AAmbulance waiting 1/2 hr
    A0422AAmbulance 02 life sustaining
    A0424AExtra ambulance attendant
    A0425AGround mileage
    A0426AAls 1
    A0427AALS1-emergency
    A0428Abls
    A0429ABLS-emergency
    A0430AFixed wing air transport
    A0431ARotary wing air transport
    A0432API volunteer ambulance co
    A0433Aals 2
    A0434ASpecialty care transport
    A0435AFixed wing air mileage
    A0436ARotary wing air mileage
    A0800BAmb trans 7pm-7am
    A0888ENoncovered ambulance mileage
    A0999AUnlisted ambulance service
    A4206E1 CC sterile syringe&needle
    A4207E2 CC sterile syringe&needle
    A4208E3 CC sterile syringe&needle
    A4209E5+ CC sterile syringe&needle
    A4210ENonneedle injection device
    A4211BSupp for self-adm injections
    A4212BNon coring needle or stylet
    A4213E20+ CC syringe only
    A4215ESterile needle
    A4216ASterile water/saline, 10 ml
    A4217ASterile water/saline, 500 ml
    A4220NInfusion pump refill kit
    A4221YMaint drug infus cath per wk
    A4222YDrug infusion pump supplies
    A4223EInfusion supplies w/o pump
    A4230YInfus insulin pump non needl
    A4231YInfusion insulin pump needle
    A4232YSyringe w/needle insulin 3cc
    A4244EAlcohol or peroxide per pint
    A4245EAlcohol wipes per box
    A4246EBetadine/phisohex solution
    A4247EBetadine/iodine swabs/wipes
    A4248NChlorhexidine antisept
    A4250EUrine reagent strips/tablets
    A4253YBlood glucose/reagent strips
    A4254YBattery for glucose monitor
    A4255YGlucose monitor platforms
    A4256YCalibrator solution/chips
    A4257YReplace Lensshield Cartridge
    A4258YLancet device each
    A4259YLancets per box
    A4260ELevonorgestrel implant
    A4261ECervical cap contraceptive
    A4262NTemporary tear duct plug
    A4263NPermanent tear duct plug
    A4265YParaffin
    A4266EDiaphragm
    A4267EMale condom
    A4268EFemale condom
    A4269ESpermicide
    A4270ADisposable endoscope sheath
    A4280ABrst prsths adhsv attchmnt
    A4281EReplacement breastpump tube
    A4282EReplacement breastpump adpt
    A4283EReplacement breastpump cap
    A4284EReplcmnt breast pump shield
    Start Printed Page 42906
    A4285EReplcmnt breast pump bottle
    A4286EReplcmnt breastpump lok ring
    A4290BSacral nerve stim test lead
    A4300NCath impl vasc access portal
    A4301NImplantable access syst perc
    A4305ADrug delivery system >=50 ML
    A4306ADrug delivery system <=5 ML
    A4310AInsert tray w/o bag/cath
    A4311ACatheter w/o bag 2-way latex
    A4312ACath w/o bag 2-way silicone
    A4313ACatheter w/bag 3-way
    A4314ACath w/drainage 2-way latex
    A4315ACath w/drainage 2-way silcne
    A4316ACath w/drainage 3-way
    A4320AIrrigation tray
    A4321ACath therapeutic irrig agent
    A4322AIrrigation syringe
    A4326AMale external catheter
    A4327AFem urinary collect dev cup
    A4328AFem urinary collect pouch
    A4330AStool collection pouch
    A4331AExtension drainage tubing
    A4332ALubricant for cath insertion
    A4333AUrinary cath anchor device
    A4334AUrinary cath leg strap
    A4335AIncontinence supply
    A4338AIndwelling catheter latex
    A4340AIndwelling catheter special
    A4344ACath indw foley 2 way silicn
    A4346ACath indw foley 3 way
    A4348AMale ext cath extended wear
    A4349ADisposable male external cat
    A4351AStraight tip urine catheter
    A4352ACoude tip urinary catheter
    A4353AIntermittent urinary cath
    A4354ACath insertion tray w/bag
    A4355ABladder irrigation tubing
    A4356AExt ureth clmp or compr dvc
    A4357ABedside drainage bag
    A4358AUrinary leg or abdomen bag
    A4359AUrinary suspensory w/o leg b
    A4361AOstomy face plate
    A4362ASolid skin barrier
    A4364AAdhesive, liquid or equal
    A4365AAdhesive remover wipes
    A4366AOstomy vent
    A4367AOstomy belt
    A4368AOstomy filter
    A4369ASkin barrier liquid per oz
    A4371ASkin barrier powder per oz
    A4372ASkin barrier solid 4x4 equiv
    A4373ASkin barrier with flange
    A4375ADrainable plastic pch w fcpl
    A4376ADrainable rubber pch w fcplt
    A4377ADrainable plstic pch w/o fp
    A4378ADrainable rubber pch w/o fp
    A4379AUrinary plastic pouch w fcpl
    A4380AUrinary rubber pouch w fcplt
    A4381AUrinary plastic pouch w/o fp
    A4382AUrinary hvy plstc pch w/o fp
    A4383AUrinary rubber pouch w/o fp
    A4384AOstomy faceplt/silicone ring
    A4385AOst skn barrier sld ext wear
    A4387AOst clsd pouch w att st barr
    A4388ADrainable pch w ex wear barr
    A4389ADrainable pch w st wear barr
    Start Printed Page 42907
    A4390ADrainable pch ex wear convex
    A4391AUrinary pouch w ex wear barr
    A4392AUrinary pouch w st wear barr
    A4393AUrine pch w ex wear bar conv
    A4394AOstomy pouch liq deodorant
    A4395AOstomy pouch solid deodorant
    A4396APeristomal hernia supprt blt
    A4397AIrrigation supply sleeve
    A4398AOstomy irrigation bag
    A4399AOstomy irrig cone/cath w brs
    A4400AOstomy irrigation set
    A4402ALubricant per ounce
    A4404AOstomy ring each
    A4405ANonpectin based ostomy paste
    A4406APectin based ostomy paste
    A4407AExt wear ost skn barr <=4sq″
    A4408AExt wear ost skn barr >4sq″
    A4409AOst skn barr w flng <=4 sq″
    A4410AOst skn barr w flng >4sq″
    A4413A2 pc drainable ost pouch
    A4414AOstomy sknbarr w flng <=4sq″
    A4415AOstomy skn barr w flng >4sq″
    A4416AOst pch clsd w barrier/filtr
    A4417AOst pch w bar/bltinconv/fltr
    A4418AOst pch clsd w/o bar w filtr
    A4419AOst pch for bar w flange/flt
    A4420AOst pch clsd for bar w lk fl
    A4421EOstomy supply misc
    A4422AOst pouch absorbent material
    A4423AOst pch for bar w lk fl/fltr
    A4424AOst pch drain w bar & filter
    A4425AOst pch drain for barrier fl
    A4426AOst pch drain 2 piece system
    A4427AOst pch drain/barr lk flng/f
    A4428AUrine ost pouch w faucet/tap
    A4429AUrine ost pch bar w lock fln
    A4430AOst pch urine w lock flng/ft
    A4431AUrine ost pch bar w lock fln
    A4432AOst pch urine w lock flng/ft
    A4433AUrine ost pch bar w lock fln
    A4434AOst pch urine w lock flng/ft
    A4450ANon-waterproof tape
    A4452AWaterproof tape
    A4455AAdhesive remover per ounce
    A4458EReusable enema bag
    A4462AAbdmnl drssng holder/binder
    A4465ANon-elastic extremity binder
    A4470AGravlee jet washer
    A4480AVabra aspirator
    A4481ATracheostoma filter
    A4483AMoisture exchanger
    A4490EAbove knee surgical stocking
    A4495EThigh length surg stocking
    A4500EBelow knee surgical stocking
    A4510EFull length surg stocking
    A4520EIncontinence garment anytype
    A4550BSurgical trays
    A4554EDisposable underpads
    A4555EDisposable underpad small
    A4556YElectrodes, pair
    A4557YLead wires, pair
    A4558YConductive paste or gel
    A4561NPessary rubber, any type
    A4562NPessary, non rubber,any type
    A4565ASlings
    A4570ESplint
    Start Printed Page 42908
    A4575EHyperbaric o2 chamber disps
    A4580ECast supplies (plaster)
    A4590ESpecial casting material
    A4595YTENS suppl 2 lead per month
    A4605YTrach suction cath close sys
    A4606AOxygen probe used w oximeter
    A4608YTranstracheal oxygen cath
    A4611YHeavy duty battery
    A4612YBattery cables
    A4613YBattery charger
    A4614AHand-held PEFR meter
    A4615YCannula nasal
    A4616YTubing (oxygen) per foot
    A4617YMouth piece
    A4618YBreathing circuits
    A4619YFace tent
    A4620YVariable concentration mask
    A4623ATracheostomy inner cannula
    A4624YTracheal suction tube
    A4625ATrach care kit for new trach
    A4626ATracheostomy cleaning brush
    A4627ESpacer bag/reservoir
    A4628YOropharyngeal suction cath
    A4629ATracheostomy care kit
    A4630YRepl bat t.e.n.s. own by pt
    A4632YInfus pump rplcemnt battery
    A4633YUvl replacement bulb
    A4634AReplacement bulb th lightbox
    A4635YUnderarm crutch pad
    A4636YHandgrip for cane etc
    A4637YRepl tip cane/crutch/walker
    A4638YRepl batt pulse gen sys
    A4639YInfrared ht sys replcmnt pad
    A4640YAlternating pressure pad
    A4641NDiagnostic imaging agent
    A4642HSatumomab pendetide per dose0704
    A4643BHigh dose contrast MRI
    A4644BContrast 100-199 MGs iodine
    A4645BContrast 200-299 MGs iodine
    A4646BContrast 300-399 MGs iodine
    A4647BSupp- paramagnetic contr mat
    A4649ASurgical supplies
    A4651ACalibrated microcap tube
    A4652AMicrocapillary tube sealant
    A4653APD catheter anchor belt
    A4656ADialysis needle
    A4657ADialysis syringe w/wo needle
    A4660ASphyg/bp app w cuff and stet
    A4663ADialysis blood pressure cuff
    A4670EAutomatic bp monitor, dial
    A4671BDisposable cycler set
    A4672BDrainage ext line, dialysis
    A4673BExt line w easy lock connect
    A4674BChem/antisept solution, 8oz
    A4680AActivated carbon filter, ea
    A4690ADialyzer, each
    A4706ABicarbonate conc sol per gal
    A4707ABicarbonate conc pow per pac
    A4708AAcetate conc sol per gallon
    A4709AAcid conc sol per gallon
    A4714ATreated water per gallon
    A4719A“Y set” tubing
    A4720ADialysat sol fld vol > 249cc
    A4721ADialysat sol fld vol > 999cc
    A4722ADialys sol fld vol > 1999cc
    A4723ADialys sol fld vol > 2999cc
    Start Printed Page 42909
    A4724ADialys sol fld vol > 3999cc
    A4725ADialys sol fld vol > 4999cc
    A4726ADialys sol fld vol > 5999cc
    A4728BDialysate solution, non-dex
    A4730AFistula cannulation set, ea
    A4736ATopical anesthetic, per gram
    A4737AInj anesthetic per 10 ml
    A4740AShunt accessory
    A4750AArt or venous blood tubing
    A4755AComb art/venous blood tubing
    A4760ADialysate sol test kit, each
    A4765ADialysate conc pow per pack
    A4766ADialysate conc sol add 10 ml
    A4770ABlood collection tube/vacuum
    A4771ASerum clotting time tube
    A4772ABlood glucose test strips
    A4773AOccult blood test strips
    A4774AAmmonia test strips
    A4802AProtamine sulfate per 50 mg
    A4860ADisposable catheter tips
    A4870APlumb/elec wk hm hemo equip
    A4890ARepair/maint cont hemo equip
    A4911ADrain bag/bottle
    A4913AMisc dialysis supplies noc
    A4918AVenous pressure clamp
    A4927ANon-sterile gloves
    A4928ASurgical mask
    A4929ATourniquet for dialysis, ea
    A4930ASterile, gloves per pair
    A4931AReusable oral thermometer
    A4932EReusable rectal thermometer
    A5051APouch clsd w barr attached
    A5052AClsd ostomy pouch w/o barr
    A5053AClsd ostomy pouch faceplate
    A5054AClsd ostomy pouch w/flange
    A5055AStoma cap
    A5061APouch drainable w barrier at
    A5062ADrnble ostomy pouch w/o barr
    A5063ADrain ostomy pouch w/flange
    A5071AUrinary pouch w/barrier
    A5072AUrinary pouch w/o barrier
    A5073AUrinary pouch on barr w/flng
    A5081AContinent stoma plug
    A5082AContinent stoma catheter
    A5093AOstomy accessory convex inse
    A5102ABedside drain btl w/wo tube
    A5105AUrinary suspensory
    A5112AUrinary leg bag
    A5113ALatex leg strap
    A5114AFoam/fabric leg strap
    A5119ASkin barrier wipes box pr 50
    A5121ASolid skin barrier 6x6
    A5122ASolid skin barrier 8x8
    A5126ADisk/foam pad +or- adhesive
    A5131AAppliance cleaner
    A5200APercutaneous catheter anchor
    A5500YDiab shoe for density insert
    A5501YDiabetic custom molded shoe
    A5503YDiabetic shoe w/roller/rockr
    A5504YDiabetic shoe with wedge
    A5505YDiab shoe w/metatarsal bar
    A5506YDiabetic shoe w/off set heel
    A5507YModification diabetic shoe
    A5508YDiabetic deluxe shoe
    A5509EDirect heat form shoe insert
    A5510ECompression form shoe insert
    Start Printed Page 42910
    A5511ECustom fab molded shoe inser
    A6000EWound warming wound cover
    A6010ACollagen based wound filler
    A6011ACollagen gel/paste wound fil
    A6021ACollagen dressing <=16 sq in
    A6022ACollagen drsg>6<=48 sq in
    A6023ACollagen dressing >48 sq in
    A6024ACollagen dsg wound filler
    A6025ESilicone gel sheet, each
    A6154AWound pouch each
    A6196AAlginate dressing <=16 sq in
    A6197AAlginate drsg >16 <=48 sq in
    A6198Aalginate dressing > 48 sq in
    A6199AAlginate drsg wound filler
    A6200ACompos drsg <=16 no border
    A6201ACompos drsg >16<=48 no bdr
    A6202ACompos drsg >48 no border
    A6203AComposite drsg <= 16 sq in
    A6204AComposite drsg >16<=48 sq in
    A6205AComposite drsg > 48 sq in
    A6206AContact layer <= 16 sq in
    A6207AContact layer >16<= 48 sq in
    A6208AContact layer > 48 sq in
    A6209AFoam drsg <=16 sq in w/o bdr
    A6210AFoam drg >16<=48 sq in w/o b
    A6211AFoam drg > 48 sq in w/o brdr
    A6212AFoam drg <=16 sq in w/border
    A6213AFoam drg >16<=48 sq in w/bdr
    A6214AFoam drg > 48 sq in w/border
    A6215AFoam dressing wound filler
    A6216ANon-sterile gauze<=16 sq in
    A6217ANon-sterile gauze>16<=48 sq
    A6218ANon-sterile gauze > 48 sq in
    A6219AGauze <= 16 sq in w/border
    A6220AGauze >16 <=48 sq in w/bordr
    A6221AGauze > 48 sq in w/border
    A6222AGauze <=16 in no w/sal w/o b
    A6223AGauze >16<=48 no w/sal w/o b
    A6224AGauze > 48 in no w/sal w/o b
    A6228AGauze <= 16 sq in water/sal
    A6229AGauze >16<=48 sq in watr/sal
    A6230AGauze > 48 sq in water/salne
    A6231AHydrogel dsg<=16 sq in
    A6232AHydrogel dsg>16<=48 sq in
    A6233AHydrogel dressing >48 sq in
    A6234AHydrocolld drg <=16 w/o bdr
    A6235AHydrocolld drg >16<=48 w/o b
    A6236AHydrocolld drg > 48 in w/o b
    A6237AHydrocolld drg <=16 in w/bdr
    A6238AHydrocolld drg >16<=48 w/bdr
    A6239AHydrocolld drg > 48 in w/bdr
    A6240AHydrocolld drg filler paste
    A6241AHydrocolloid drg filler dry
    A6242AHydrogel drg <=16 in w/o bdr
    A6243AHydrogel drg >16<=48 w/o bdr
    A6244AHydrogel drg >48 in w/o bdr
    A6245AHydrogel drg <= 16 in w/bdr
    A6246AHydrogel drg >16<=48 in w/b
    A6247AHydrogel drg > 48 sq in w/b
    A6248AHydrogel drsg gel filler
    A6250ASkin seal protect moisturizr
    A6251AAbsorpt drg <=16 sq in w/o b
    A6252AAbsorpt drg >16 <=48 w/o bdr
    A6253AAbsorpt drg > 48 sq in w/o b
    A6254AAbsorpt drg <=16 sq in w/bdr
    A6255AAbsorpt drg >16<=48 in w/bdr
    Start Printed Page 42911
    A6256AAbsorpt drg > 48 sq in w/bdr
    A6257ATransparent film <= 16 sq in
    A6258ATransparent film >16<=48 in
    A6259ATransparent film > 48 sq in
    A6260AWound cleanser any type/size
    A6261AWound filler gel/paste /oz
    A6262AWound filler dry form / gram
    A6266AImpreg gauze no h20/sal/yard
    A6402ASterile gauze <= 16 sq in
    A6403ASterile gauze>16 <= 48 sq in
    A6404ASterile gauze > 48 sq in
    A6407APacking strips, non-impreg
    A6410ASterile eye pad
    A6411ANon-sterile eye pad
    A6412EOcclusive eye patch
    A6441APad band w>=3″ <5″/yd
    A6442AConform band n/s w<3″/yd
    A6443AConform band n/s w>=3″<5″/yd
    A6444AConform band n/s w>=5″/yd
    A6445AConform band s w <3″/yd
    A6446AConform band s w>=3″ <5″/yd
    A6447AConform band s w >=5″/yd
    A6448ALt compres band <3″/yd
    A6449ALt compres band >=3″ <5″/yd
    A6450ALt compres band >=5″/yd
    A6451AMod compres band w>=3″<5″/yd
    A6452AHigh compres band w>=3″<5″yd
    A6453ASelf-adher band w <3″/yd
    A6454ASelf-adher band w>=3″ <5″/yd
    A6455ASelf-adher band >=5″/yd
    A6456AZinc paste band w >=3″<5″/yd
    A6501ACompres burngarment bodysuit
    A6502ACompres burngarment chinstrp
    A6503ACompres burngarment facehood
    A6504ACmprsburngarment glove-wrist
    A6505ACmprsburngarment glove-elbow
    A6506ACmprsburngrmnt glove-axilla
    A6507ACmprs burngarment foot-knee
    A6508ACmprs burngarment foot-thigh
    A6509ACompres burn garment jacket
    A6510ACompres burn garment leotard
    A6511ACompres burn garment panty
    A6512ACompres burn garment, noc
    A6550YNeg pres wound ther drsg set
    A6551YNeg press wound ther canistr
    A7000YDisposable canister for pump
    A7001YNondisposable pump canister
    A7002YTubing used w suction pump
    A7003YNebulizer administration set
    A7004YDisposable nebulizer sml vol
    A7005YNondisposable nebulizer set
    A7006YFiltered nebulizer admin set
    A7007YLg vol nebulizer disposable
    A7008YDisposable nebulizer prefill
    A7009YNebulizer reservoir bottle
    A7010YDisposable corrugated tubing
    A7011YNondispos corrugated tubing
    A7012YNebulizer water collec devic
    A7013YDisposable compressor filter
    A7014YCompressor nondispos filter
    A7015YAerosol mask used w nebulize
    A7016YNebulizer dome & mouthpiece
    A7017YNebulizer not used w oxygen
    A7018YWater distilled w/nebulizer
    A7025YReplace chest compress vest
    A7026YReplace chst cmprss sys hose
    Start Printed Page 42912
    A7030YCPAP full face mask
    A7031YReplacement facemask interfa
    A7032YReplacement nasal cushion
    A7033YReplacement nasal pillows
    A7034YNasal application device
    A7035YPos airway press headgear
    A7036YPos airway press chinstrap
    A7037YPos airway pressure tubing
    A7038YPos airway pressure filter
    A7039YFilter, non disposable w pap
    A7040AOne way chest drain valve
    A7041AWater seal drain container
    A7042AImplanted pleural catheter
    A7043AVacuum drainagebottle/tubing
    A7044YPAP oral interface
    A7045YRepl exhalation port for PAP
    A7046YRepl water chamber, PAP dev
    A7501ATracheostoma valve w diaphra
    A7502AReplacement diaphragm/fplate
    A7503AHMES filter holder or cap
    A7504ATracheostoma HMES filter
    A7505AHMES or trach valve housing
    A7506AHMES/trachvalve adhesivedisk
    A7507AIntegrated filter & holder
    A7508AHousing & Integrated Adhesiv
    A7509AHeat & moisture exchange sys
    A7520ATrach/laryn tube non-cuffed
    A7521ATrach/laryn tube cuffed
    A7522ATrach/laryn tube stainless
    A7523ATracheostomy shower protect
    A7524ATracheostoma stent/stud/bttn
    A7525ATracheostomy mask
    A7526ATracheostomy tube collar
    A7527ATrach/laryn tube plug/stop
    A9150BMisc/exper non-prescript dru
    A9152ESingle vitamin nos
    A9153EMulti-vitamin nos
    A9180ELice treatment, topical
    A9270ENon-covered item or service
    A9280EAlert device, noc
    A9300EExercise equipment
    A9500HTechnetium TC 99m sestamibi1600
    A9502HTechnetium TC99M tetrofosmin0705
    A9503NTechnetium TC 99m medronate
    A9504NTechnetium tc 99m apcitide
    A9505HThallous chloride TL 201/mci1603
    A9507HIndium/111 capromab pendetid1604
    A9508HIobenguane sulfate I-131, pe1045
    A9510HTechnetium TC99m Disofenin9146
    A9511HTechnetium TC 99m depreotide9147
    A9512NTechnetiumtc99mpertechnetate
    A9513NTechnetium tc-99m mebrofenin
    A9514NTechnetiumtc99mpyrophosphate
    A9515NTechnetium tc-99m pentetate
    A9516HI-123 sodium iodide capsule9148
    A9517HTh I131 so iodide cap millic1064
    A9519NTechnetiumtc-99mmacroag albu
    A9520NTechnetiumtc-99m sulfur clld
    A9521HTechnetiumtc-99m exametazine1096
    A9522BIndium111ibritumomabtiuxetan
    A9523BYttrium90ibritumomabtiuxetan
    A9524HIodinated I-131 serumalbumin9100
    A9525ELow/iso-osmolar contrast mat
    A9526HAmmonia N-13, per dose0737
    A9528HDx I131 so iodide cap millic1088
    A9529HDx I131 so iodide sol millic1065
    Start Printed Page 42913
    A9530HTh I131 so iodide sol millic1150
    A9531HDx I131 so iodide microcurie9149
    A9532HI-125 serum albumin micro9150
    A9533BI-131 tositumomab diagnostic
    A9534BI-131 tositumomab therapeut
    A9600HStrontium-89 chloride0701
    A9605HSamarium sm153 lexidronamm0702
    A9699NNoc therapeutic radiopharm
    A9700BEchocardiography Contrast
    A9900ASupply/accessory/service
    A9901ADelivery/set up/dispensing
    A9999YDME supply or accessory, nos
    B4034AEnter feed supkit syr by day
    B4035AEnteral feed supp pump per d
    B4036AEnteral feed sup kit grav by
    B4081AEnteral ng tubing w/ stylet
    B4082AEnteral ng tubing w/o stylet
    B4083AEnteral stomach tube levine
    B4086AGastrostomy/jejunostomy tube
    B4100EFood thickener oral
    B4102YEF adult fluids and electro
    B4103YEF ped fluid and electrolyte
    B4104EAdditive for enteral formula
    B4149YEF blenderized foods
    B4150AEnteral formulae category i
    B4152AEnteral formulae category ii
    B4153AEnteral formulae categoryIII
    B4154AEnteral formulae category IV
    B4155AEnteral formulae category v
    B4157YEF special metabolic inherit
    B4158YEF ped complete intact nut
    B4159YEF ped complete soy based
    B4160YEF ped calorie dense>/=0.7kc
    B4161YEF ped hydrolyzed/amino acid
    B4162YEF ped specmetabolic inherit
    B4164AParenteral 50% dextrose solu
    B4168AParenteral sol amino acid 3.
    B4172AParenteral sol amino acid 5.
    B4176AParenteral sol amino acid 7-
    B4178AParenteral sol amino acid >
    B4180AParenteral sol carb > 50%
    B4184AParenteral sol lipids 10%
    B4186AParenteral sol lipids 20%
    B4189AParenteral sol amino acid &
    B4193AParenteral sol 52-73 gm prot
    B4197AParenteral sol 74-100 gm pro
    B4199AParenteral sol > 100gm prote
    B4216AParenteral nutrition additiv
    B4220AParenteral supply kit premix
    B4222AParenteral supply kit homemi
    B4224AParenteral administration ki
    B5000AParenteral sol renal-amirosy
    B5100AParenteral sol hepatic-fream
    B5200AParenteral sol stres-brnch c
    B9000AEnter infusion pump w/o alrm
    B9002AEnteral infusion pump w/ ala
    B9004AParenteral infus pump portab
    B9006AParenteral infus pump statio
    B9998AEnteral supp not otherwise c
    B9999AParenteral supp not othrws c
    C1079NCO 57/58 per 0.5 uCi
    C1080HI-131 tositumomab, dx1080
    C1081HI-131 tositumomab, tx1081
    C1082HIn-111 ibritumomab tiuxetan9118
    C1083HYttrium 90 ibritumomab tiuxe9117
    C1091HIN111 oxyquinoline,per0.5mCi1091
    Start Printed Page 42914
    C1092HIN 111 pentetate per 0.5 mCi1092
    C1093HTC99M fanolesomab1093
    C1122HTc 99M ARCITUMOMAB PER VIAL9151
    C1178KBUSULFAN IV, 6 Mg11780.2851$16.92$3.38
    C1200NTC 99M Sodium Glucoheptonat
    C1201HTC 99M SUCCIMER, PER Vial1201
    C1300SHYPERBARIC Oxygen06591.5403$91.42$18.28
    C1305KApligraf, 44cm2130512.9206$766.84$153.37
    C1713NAnchor/screw bn/bn,tis/bn
    C1714NCath, trans atherectomy, dir
    C1715NBrachytherapy needle
    C1716HBrachytx source, Gold 1981716
    C1717HBrachytx source, HDR Ir-1921717
    C1718HBrachytx source, Iodine 1251718
    C1719HBrachytx sour,Non-HDR Ir-1921719
    C1720HBrachytx sour, Palladium 1031720
    C1721NAICD, dual chamber
    C1722NAICD, single chamber
    C1724NCath, trans atherec,rotation
    C1725NCath, translumin non-laser
    C1726NCath, bal dil, non-vascular
    C1727NCath, bal tis dis, non-vas
    C1728NCath, brachytx seed adm
    C1729NCath, drainage
    C1730NCath, EP, 19 or few elect
    C1731NCath, EP, 20 or more elec
    C1732NCath, EP, diag/abl, 3D/vect
    C1733NCath, EP, othr than cool-tip
    C1750NCath, hemodialysis,long-term
    C1751NCath, inf, per/cent/midline
    C1752NCath,hemodialysis,short-term
    C1753NCath, intravas ultrasound
    C1754NCatheter, intradiscal
    C1755NCatheter, intraspinal
    C1756NCath, pacing, transesoph
    C1757NCath, thrombectomy/embolect
    C1758NCatheter, ureteral
    C1759NCath, intra echocardiography
    C1760NClosure dev, vasc
    C1762NConn tiss, human(inc fascia)
    C1763NConn tiss, non-human
    C1764NEvent recorder, cardiac
    C1765NAdhesion barrier
    C1766NIntro/sheath,strble,non-peel
    C1767NGenerator, neurostim, imp
    C1768NGraft, vascular
    C1769NGuide wire
    C1770NImaging coil, MR, insertable
    C1771NRep dev, urinary, w/sling
    C1772NInfusion pump, programmable
    C1773NRet dev, insertable
    C1775HFDG, per dose (4-40 mCi/ml)1775
    C1776NJoint device (implantable)
    C1777NLead, AICD, endo single coil
    C1778NLead, neurostimulator
    C1779NLead, pmkr, transvenous VDD
    C1780NLens, intraocular (new tech)
    C1781NMesh (implantable)
    C1782NMorcellator
    C1783NOcular imp, aqueous drain de
    C1784NOcular dev, intraop, det ret
    C1785NPmkr, dual, rate-resp
    C1786NPmkr, single, rate-resp
    C1787NPatient progr, neurostim
    C1788NPort, indwelling, imp
    C1789NProsthesis, breast, imp
    Start Printed Page 42915
    C1813NProsthesis, penile, inflatab
    C1814NRetinal tamp, silicone oil
    C1815NPros, urinary sph, imp
    C1816NReceiver/transmitter, neuro
    C1817NSeptal defect imp sys
    C1818NIntegrated keratoprosthesis
    C1819NTissue local excision
    C1874NStent, coated/cov w/del sys
    C1875NStent, coated/cov w/o del sy
    C1876NStent, non-coa/non-cov w/del
    C1877NStent, non-coat/cov w/o del
    C1878NMatrl for vocal cord
    C1879NTissue marker, implantable
    C1880NVena cava filter
    C1881NDialysis access system
    C1882NAICD, other than sing/dual
    C1883NAdapt/ext, pacing/neuro lead
    C1884NEmbolization Protect syst
    C1885NCath, translumin angio laser
    C1887NCatheter, guiding
    C1888NEndovas non-cardiac abl cath
    C1891NInfusion pump,non-prog, perm
    C1892NIntro/sheath,fixed,peel-away
    C1893NIntro/sheath, fixed,non-peel
    C1894NIntro/sheath, non-laser
    C1895NLead, AICD, endo dual coil
    C1896NLead, AICD, non sing/dual
    C1897NLead, neurostim test kit
    C1898NLead, pmkr, other than trans
    C1899NLead, pmkr/AICD combination
    C1900NLead coronary venous
    C2614NProbe, perc lumb disc
    C2615NSealant, pulmonary, liquid
    C2616HBrachytx source, Yttrium-902616
    C2617NStent, non-cor, tem w/o del
    C2618NProbe, cryoablation
    C2619NPmkr, dual, non rate-resp
    C2620NPmkr, single, non rate-resp
    C2621NPmkr, other than sing/dual
    C2622NProsthesis, penile, non-inf
    C2625NStent, non-cor, tem w/del sy
    C2626NInfusion pump, non-prog,temp
    C2627NCath, suprapubic/cystoscopic
    C2628NCatheter, occlusion
    C2629NIntro/sheath, laser
    C2630NCath, EP, cool-tip
    C2631NRep dev, urinary, w/o sling
    C2632HBrachytx sol, I-125, per mCi2632
    C2633HBrachytx source, Cesium-1312633
    C2634HBrachytx source, HA, I-1252634
    C2635HBrachytx source, HA, P-1032635
    C2636HBrachytx linear source, P-102636
    C8900*SMRA w/cont, abd02846.3910$379.31$151.72$75.86
    C8901*SMRA w/o cont, abd03366.0467$358.87$143.54$71.77
    C8902*SMRA w/o fol w/cont, abd03378.7547$519.59$207.83$103.92
    C8903*SMRI w/cont, breast, uni02846.3910$379.31$151.72$75.86
    C8904*SMRI w/o cont, breast, uni03366.0467$358.87$143.54$71.77
    C8905*SMRI w/o fol w/cont, brst, un03378.7547$519.59$207.83$103.92
    C8906*SMRI w/cont, breast, bi02846.3910$379.31$151.72$75.86
    C8907*SMRI w/o cont, breast, bi03366.0467$358.87$143.54$71.77
    C8908*SMRI w/o fol w/cont, breast,03378.7547$519.59$207.83$103.92
    C8909*SMRA w/cont, chest02846.3910$379.31$151.72$75.86
    C8910*SMRA w/o cont, chest03366.0467$358.87$143.54$71.77
    C8911*SMRA w/o fol w/cont, chest03378.7547$519.59$207.83$103.92
    C8912*SMRA w/cont, lwr ext02846.3910$379.31$151.72$75.86
    C8913*SMRA w/o cont, lwr ext03366.0467$358.87$143.54$71.77
    Start Printed Page 42916
    C8914*SMRA w/o fol w/cont, lwr ext03378.7547$519.59$207.83$103.92
    C8918*SMRA w/cont, pelvis02846.3910$379.31$151.72$75.86
    C8919*SMRA w/o cont, pelvis03366.0467$358.87$143.54$71.77
    C8920*SMRA w/o fol w/cont, pelvis03378.7547$519.59$207.83$103.92
    C9000HNa chromateCr51, per 0.25mCi9130
    C9003KPalivizumab, per 50 mg90034.1486$246.22$49.24
    C9007KBaclofen Intrathecal kit-1am91520.8561$50.81$10.16
    C9008KBaclofen Refill Kit-500mcg90080.2447$14.52$2.90
    C9009KBaclofen Refill Kit-2000mcg90090.7208$42.78$8.56
    C9013NCo 57 cobaltous chloride
    C9102H51 Na Chromate, 50mCi9132
    C9103HNa Iothalamate I-125, 10 uCi9153
    C9105KHep B imm glob, per 1 ml91051.8810$111.64$22.33
    C9112DPerflutren lipid micro, 2ml
    C9113NInj pantoprazole sodium, via
    C9121KInjection, argatroban91210.1897$11.26$2.25
    C9123KTranscyte, 247cm29123$719.36$143.87
    C9127KPaclitaxel protein pr9127$8.59$1.72
    C9128KInj pegaptanib sodium9128$1,074.18$214.84
    C9200KOrcel, 36 cm292002.6890$159.59$31.92
    C9201KDermagraft, 37.5cm292016.2059$368.32$73.66
    C9202DOctafluoropropane
    C9203DPerflexane lipid micro
    C9205KOxaliplatin9205$84.05$16.81
    C9206KIntegra, per cm29206$9.23$1.85
    C9211KInj, alefacept, IV9211$570.97$114.19
    C9212KInj, alefacept, IM9212$401.97$80.39
    C9218KInjection, Azacitidine9218$4.03$.81
    C9220GSodium hyaluronate9220$203.82$40.76
    C9221GGraftjacket Reg Matrix9221$1,234.26$246.85
    C9222GGraftjacket SftTis9222$890.67$178.13
    C9223DInj adenosine, tx dx
    C9399AUnclass drugs/biologicals
    C9400DThallous chloride, brand
    C9401DStrontium-89 chloride, brand
    C9402DTh I131 so iodide cap, brand
    C9403DDx I131 so iodide cap, brand
    C9404DDx I131 so iodide sol, brand
    C9405DTh I131 so iodide sol, brand
    C9410DDexrazoxane HCl inj, brand
    C9411DPamidronate disodium, brand
    C9413DNa hyaluronate bran
    C9414DEtoposide oral, brand
    C9415DDoxorubic hcl chemo, brand
    C9417DBleomycin sulfate inj, brand
    C9418DCisplatin inj, brand
    C9419DInj cladribine, brand
    C9420DCyclophosphamide inj, brand
    C9421DCyclophosphamide lyo, brand
    C9422DCytarabine hcl inj, brand
    C9423DDacarbazine inj, brand
    C9424DDaunorubicin, brand
    C9425DEtoposide inj, brand
    C9426DFloxuridine inj, brand
    C9427DIfosfomide inj, brand
    C9428DMesna injection, brand
    C9429DIdarubicin hcl inj, brand
    C9430DLeuprolide acetate bran
    C9431DPaclitaxel inj, brand
    C9432DMitomycin inj, brand
    C9433DThiotepa inj, brand
    C9435DGonadorelin hydroch, brand
    C9436DAzathioprine parenteral,brnd
    C9437DCarmus bischl nitro inj
    C9438DCyclosporine oral, brand
    C9439DDiethylstilbestrol injection
    Start Printed Page 42917
    C9440DVinorelbine tar,brand
    C9704TInj inert subs upper GI1556$1,750.00$350.00
    C9713TNon-contact laser vap prosta042942.1231$2,500.01$500.00
    C9716SRF Energy to Anus1519$1,750.00$350.00
    C9718TKyphoplasty, first vertebra005136.3617$2,158.07$431.61
    C9719TKyphoplasty, each addl005136.3617$2,158.07$431.61
    C9720THE ESW tx, tennis elbow1547$850.00$170.00
    C9721THE ESW tx, plantar fasciitis1547$850.00$170.00
    C9722SKV imaging w/IR tracking1502$75.00$15.00
    C9723SDyn IR Perf Img1502$75.00$15.00
    C9724TEPS gast cardia plic042222.8607$1,356.78$448.81$271.36
    D0120EPeriodic oral evaluation
    D0140ELimit oral eval problm focus
    D0150SComprehensve oral evaluation03307.1431$423.94$84.79
    D0160EExtensv oral eval prob focus
    D0170ERe-eval,est pt,problem focus
    D0180EComp periodontal evaluation
    D0210EIntraor complete film series
    D0220EIntraoral periapical first f
    D0230EIntraoral periapical ea add
    D0240SIntraoral occlusal film03307.1431$423.94$84.79
    D0250SExtraoral first film03307.1431$423.94$84.79
    D0260SExtraoral ea additional film03307.1431$423.94$84.79
    D0270SDental bitewing single film03307.1431$423.94$84.79
    D0272SDental bitewings two films03307.1431$423.94$84.79
    D0274SDental bitewings four films03307.1431$423.94$84.79
    D0277SVert bitewings-sev to eight03307.1431$423.94$84.79
    D0290EDental film skull/facial bon
    D0310EDental saliography
    D0320EDental tmj arthrogram incl i
    D0321EDental other tmj films
    D0322EDental tomographic survey
    D0330EDental panoramic film
    D0340EDental cephalometric film
    D0350EOral/facial images
    D0415EBacteriologic study
    D0416BViral culture
    D0421BGen tst suscept oral disease
    D0425ECaries susceptibility test
    D0431BDiag tst detect mucos abnorm
    D0460SPulp vitality test03307.1431$423.94$84.79
    D0470EDiagnostic casts
    D0472BGross exam, prep & report
    D0473BMicro exam, prep & report
    D0474BMicro w exam of surg margins
    D0475BDecalcification procedure
    D0476BSpec stains for microorganis
    D0477BSpec stains not for microorg
    D0478BImmunohistochemical stains
    D0479BTissue in-situ hybridization
    D0480BCytopath smear prep & report
    D0481BElectron microscopy diagnost
    D0482BDirect immunofluorescence
    D0483BIndirect immunofluorescence
    D0484BConsult slides prep elsewher
    D0485BConsult inc prep of slides
    D0502BOther oral pathology procedu
    D0999BUnspecified diagnostic proce
    D1110EDental prophylaxis adult
    D1120EDental prophylaxis child
    D1201ETopical fluor w prophy child
    D1203ETopical fluor w/o prophy chi
    D1204ETopical fluor w/o prophy adu
    D1205ETopical fluoride w/ prophy a
    D1310ENutri counsel-control caries
    D1320ETobacco counseling
    Start Printed Page 42918
    D1330EOral hygiene instruction
    D1351EDental sealant per tooth
    D1510SSpace maintainer fxd unilat03307.1431$423.94$84.79
    D1515SFixed bilat space maintainer03307.1431$423.94$84.79
    D1520SRemove unilat space maintain03307.1431$423.94$84.79
    D1525SRemove bilat space maintain03307.1431$423.94$84.79
    D1550SRecement space maintainer03307.1431$423.94$84.79
    D2140EAmalgam one surface permanen
    D2150EAmalgam two surfaces permane
    D2160EAmalgam three surfaces perma
    D2161EAmalgam 4 or > surfaces perm
    D2330EResin one surface-anterior
    D2331EResin two surfaces-anterior
    D2332EResin three surfaces-anterio
    D2335EResin 4/> surf or w incis an
    D2390EAnt resin-based cmpst crown
    D2391EPost 1 srfc resinbased cmpst
    D2392EPost 2 srfc resinbased cmpst
    D2393EPost 3 srfc resinbased cmpst
    D2394EPost >=4srfc resinbase cmpst
    D2410EDental gold foil one surface
    D2420EDental gold foil two surface
    D2430EDental gold foil three surfa
    D2510EDental inlay metalic 1 surf
    D2520EDental inlay metallic 2 surf
    D2530EDental inlay metl 3/more sur
    D2542EDental onlay metallic 2 surf
    D2543EDental onlay metallic 3 surf
    D2544EDental onlay metl 4/more sur
    D2610EInlay porcelain/ceramic 1 su
    D2620EInlay porcelain/ceramic 2 su
    D2630EDental onlay porc 3/more sur
    D2642EDental onlay porcelin 2 surf
    D2643EDental onlay porcelin 3 surf
    D2644EDental onlay porc 4/more sur
    D2650EInlay composite/resin one su
    D2651EInlay composite/resin two su
    D2652EDental inlay resin 3/mre sur
    D2662EDental onlay resin 2 surface
    D2663EDental onlay resin 3 surface
    D2664EDental onlay resin 4/mre sur
    D2710ECrown resin laboratory
    D2712ECrown 3/4 resin-based compos
    D2720ECrown resin w/ high noble me
    D2721ECrown resin w/ base metal
    D2722ECrown resin w/ noble metal
    D2740ECrown porcelain/ceramic subs
    D2750ECrown porcelain w/ h noble m
    D2751ECrown porcelain fused base m
    D2752ECrown porcelain w/ noble met
    D2780ECrown 3/4 cast hi noble met
    D2781ECrown 3/4 cast base metal
    D2782ECrown 3/4 cast noble metal
    D2783ECrown 3/4 porcelain/ceramic
    D2790ECrown full cast high noble m
    D2791ECrown full cast base metal
    D2792ECrown full cast noble metal
    D2794ECrown-titanium
    D2799EProvisional crown
    D2910EDental recement inlay
    D2915ERecement cast or prefab post
    D2920EDental recement crown
    D2930EPrefab stnlss steel crwn pri
    D2931EPrefab stnlss steel crown pe
    D2932EPrefabricated resin crown
    D2933EPrefab stainless steel crown
    Start Printed Page 42919
    D2934EPrefab steel crown primary
    D2940EDental sedative filling
    D2950ECore build-up incl any pins
    D2951ETooth pin retention
    D2952EPost and core cast + crown
    D2953EEach addtnl cast post
    D2954EPrefab post/core + crown
    D2955EPost removal
    D2957EEach addtnl prefab post
    D2960ELaminate labial veneer
    D2961ELab labial veneer resin
    D2962ELab labial veneer porcelain
    D2971EAdd proc construct new crown
    D2975ECoping
    D2980ECrown repair
    D2999SDental unspec restorative pr03307.1431$423.94$84.79
    D3110EPulp cap direct
    D3120EPulp cap indirect
    D3220ETherapeutic pulpotomy
    D3221EGross pulpal debridement
    D3230EPulpal therapy anterior prim
    D3240EPulpal therapy posterior pri
    D3310EAnterior
    D3320ERoot canal therapy 2 canals
    D3330ERoot canal therapy 3 canals
    D3331ENon-surg tx root canal obs
    D3332EIncomplete endodontic tx
    D3333EInternal root repair
    D3346ERetreat root canal anterior
    D3347ERetreat root canal bicuspid
    D3348ERetreat root canal molar
    D3351EApexification/recalc initial
    D3352EApexification/recalc interim
    D3353EApexification/recalc final
    D3410EApicoect/perirad surg anter
    D3421ERoot surgery bicuspid
    D3425ERoot surgery molar
    D3426ERoot surgery ea add root
    D3430ERetrograde filling
    D3450ERoot amputation
    D3460SEndodontic endosseous implan03307.1431$423.94$84.79
    D3470EIntentional replantation
    D3910EIsolation- tooth w rubb dam
    D3920ETooth splitting
    D3950ECanal prep/fitting of dowel
    D3999SEndodontic procedure03307.1431$423.94$84.79
    D4210EGingivectomy/plasty per quad
    D4211EGingivectomy/plasty per toot
    D4240EGingival flap proc w/ planin
    D4241EGngvl flap w rootplan 1-3 th
    D4245EApically positioned flap
    D4249ECrown lengthen hard tissue
    D4260SOsseous surgery per quadrant03307.1431$423.94$84.79
    D4261EOsseous surgl-3teethperquad
    D4263SBone replce graft first site03307.1431$423.94$84.79
    D4264SBone replce graft each add03307.1431$423.94$84.79
    D4265EBio mtrls to aid soft/os reg
    D4266EGuided tiss regen resorble
    D4267EGuided tiss regen nonresorb
    D4268SSurgical revision procedure03307.1431$423.94$84.79
    D4270SPedicle soft tissue graft pr03307.1431$423.94$84.79
    D4271SFree soft tissue graft proc03307.1431$423.94$84.79
    D4273SSubepithelial tissue graft03307.1431$423.94$84.79
    D4274EDistal/proximal wedge proc
    D4275ESoft tissue allograft
    D4276ECon tissue w dble ped graft
    Start Printed Page 42920
    D4320EProvision splnt intracoronal
    D4321EProvisional splint extracoro
    D4341EPeriodontal scaling & root
    D4342EPeriodontal scaling 1-3teeth
    D4355SFull mouth debridement03307.1431$423.94$84.79
    D4381SLocalized chemo delivery03307.1431$423.94$84.79
    D4910EPeriodontal maint procedures
    D4920EUnscheduled dressing change
    D4999EUnspecified periodontal proc
    D5110EDentures complete maxillary
    D5120EDentures complete mandible
    D5130EDentures immediat maxillary
    D5140EDentures immediat mandible
    D5211EDentures maxill part resin
    D5212EDentures mand part resin
    D5213EDentures maxill part metal
    D5214EDentures mandibl part metal
    D5225EMaxillary part denture flex
    D5226EMandibular part denture flex
    D5281ERemovable partial denture
    D5410EDentures adjust cmplt maxil
    D5411EDentures adjust cmplt mand
    D5421EDentures adjust part maxill
    D5422EDentures adjust part mandbl
    D5510EDentur repr broken compl bas
    D5520EReplace denture teeth complt
    D5610EDentures repair resin base
    D5620ERep part denture cast frame
    D5630ERep partial denture clasp
    D5640EReplace part denture teeth
    D5650EAdd tooth to partial denture
    D5660EAdd clasp to partial denture
    D5670EReplc tth&acrlc on mtl frmwk
    D5671EReplc tth&acrlc mandibular
    D5710EDentures rebase cmplt maxil
    D5711EDentures rebase cmplt mand
    D5720EDentures rebase part maxill
    D5721EDentures rebase part mandbl
    D5730EDenture reln cmplt maxil ch
    D5731EDenture reln cmplt mand chr
    D5740EDenture reln part maxil chr
    D5741EDenture reln part mand chr
    D5750EDenture reln cmplt max lab
    D5751EDenture reln cmplt mand lab
    D5760EDenture reln part maxil lab
    D5761EDenture reln part mand lab
    D5810EDenture interm cmplt maxill
    D5811EDenture interm cmplt mandbl
    D5820EDenture interm part maxill
    D5821EDenture interm part mandbl
    D5850EDenture tiss conditn maxill
    D5851EDenture tiss condtin mandbl
    D5860EOverdenture complete
    D5861EOverdenture partial
    D5862EPrecision attachment
    D5867EReplacement of precision att
    D5875EProsthesis modification
    D5899ERemovable prosthodontic proc
    D5911SFacial moulage sectional03307.1431$423.94$84.79
    D5912SFacial moulage complete03307.1431$423.94$84.79
    D5913ENasal prosthesis
    D5914EAuricular prosthesis
    D5915EOrbital prosthesis
    D5916EOcular prosthesis
    D5919EFacial prosthesis
    D5922ENasal septal prosthesis
    Start Printed Page 42921
    D5923EOcular prosthesis interim
    D5924ECranial prosthesis
    D5925EFacial augmentation implant
    D5926EReplacement nasal prosthesis
    D5927EAuricular replacement
    D5928EOrbital replacement
    D5929EFacial replacement
    D5931ESurgical obturator
    D5932EPostsurgical obturator
    D5933ERefitting of obturator
    D5934EMandibular flange prosthesis
    D5935EMandibular denture prosth
    D5936ETemp obturator prosthesis
    D5937ETrismus appliance
    D5951EFeeding aid
    D5952EPediatric speech aid
    D5953EAdult speech aid
    D5954ESuperimposed prosthesis
    D5955EPalatal lift prosthesis
    D5958EIntraoral con def inter plt
    D5959EIntraoral con def mod palat
    D5960EModify speech aid prosthesis
    D5982ESurgical stent
    D5983SRadiation applicator03307.1431$423.94$84.79
    D5984SRadiation shield03307.1431$423.94$84.79
    D5985SRadiation cone locator03307.1431$423.94$84.79
    D5986EFluoride applicator
    D5987SCommissure splint03307.1431$423.94$84.79
    D5988ESurgical splint
    D5999EMaxillofacial prosthesis
    D6010EOdontics endosteal implant
    D6040EOdontics eposteal implant
    D6050EOdontics transosteal implnt
    D6053EImplnt/abtmnt spprt remv dnt
    D6054EImplnt/abtmnt spprt remvprtl
    D6055EImplant connecting bar
    D6056EPrefabricated abutment
    D6057ECustom abutment
    D6058EAbutment supported crown
    D6059EAbutment supported mtl crown
    D6060EAbutment supported mtl crown
    D6061EAbutment supported mtl crown
    D6062EAbutment supported mtl crown
    D6063EAbutment supported mtl crown
    D6064EAbutment supported mtl crown
    D6065EImplant supported crown
    D6066EImplant supported mtl crown
    D6067EImplant supported mtl crown
    D6068EAbutment supported retainer
    D6069EAbutment supported retainer
    D6070EAbutment supported retainer
    D6071EAbutment supported retainer
    D6072EAbutment supported retainer
    D6073EAbutment supported retainer
    D6074EAbutment supported retainer
    D6075EImplant supported retainer
    D6076EImplant supported retainer
    D6077EImplant supported retainer
    D6078EImplnt/abut suprtd fixd dent
    D6079EImplnt/abut suprtd fixd dent
    D6080EImplant maintenance
    D6090ERepair implant
    D6094EAbut support crown titanium
    D6095EOdontics repr abutment
    D6100ERemoval of implant
    D6190ERadio/surgical implant index
    Start Printed Page 42922
    D6194EAbut support retainer titani
    D6199EImplant procedure
    D6205EPontic-indirect resin based
    D6210EProsthodont high noble metal
    D6211EBridge base metal cast
    D6212EBridge noble metal cast
    D6214EPontic titanium
    D6240EBridge porcelain high noble
    D6241EBridge porcelain base metal
    D6242EBridge porcelain nobel metal
    D6245EBridge porcelain/ceramic
    D6250EBridge resin w/high noble
    D6251EBridge resin base metal
    D6252EBridge resin w/noble metal
    D6253EProvisional pontic
    D6545EDental retainr cast metl
    D6548EPorcelain/ceramic retainer
    D6600EPorcelain/ceramic inlay 2srf
    D6601EPorc/ceram inlay >= 3 surfac
    D6602ECst hgh nble mtl inlay 2 srf
    D6603ECst hgh nble mtl inlay >=3sr
    D6604ECst bse mtl inlay 2 surfaces
    D6605ECst bse mtl inlay >= 3 surfa
    D6606ECast noble metal inlay 2 sur
    D6607ECst noble mtl inlay >=3 surf
    D6608EOnlay porc/crmc 2 surfaces
    D6609EOnlay porc/crmc >=3 surfaces
    D6610EOnlay cst hgh nbl mtl 2 srfc
    D6611EOnlay cst hgh nbl mtl >=3srf
    D6612EOnlay cst base mtl 2 surface
    D6613EOnlay cst base mtl >=3 surfa
    D6614EOnlay cst nbl mtl 2 surfaces
    D6615EOnlay cst nbl mtl >=3 surfac
    D6624EInlay titanium
    D6634EOnlay titanium
    D6710ECrown-indirect resin based
    D6720ERetain crown resin w hi nble
    D6721ECrown resin w/base metal
    D6722ECrown resin w/noble metal
    D6740ECrown porcelain/ceramic
    D6750ECrown porcelain high noble
    D6751ECrown porcelain base metal
    D6752ECrown porcelain noble metal
    D6780ECrown 3/4 high noble metal
    D6781ECrown 3/4 cast based metal
    D6782ECrown 3/4 cast noble metal
    D6783ECrown 3/4 porcelain/ceramic
    D6790ECrown full high noble metal
    D6791ECrown full base metal cast
    D6792ECrown full noble metal cast
    D6793EProvisional retainer crown
    D6794ECrown titanium
    D6920SDental connector bar03307.1431$423.94$84.79
    D6930EDental recement bridge
    D6940EStress breaker
    D6950EPrecision attachment
    D6970EPost & core plus retainer
    D6971ECast post bridge retainer
    D6972EPrefab post & core plus reta
    D6973ECore build up for retainer
    D6975ECoping metal
    D6976EEach addtnl cast post
    D6977EEach addtl prefab post
    D6980EBridge repair
    D6985EPediatric partial denture fx
    D6999EFixed prosthodontic proc
    Start Printed Page 42923
    D7111SCoronal remnants deciduous t03307.1431$423.94$84.79
    D7140SExtraction erupted tooth/exr03307.1431$423.94$84.79
    D7210SRem imp tooth w mucoper flp03307.1431$423.94$84.79
    D7220SImpact tooth remov soft tiss03307.1431$423.94$84.79
    D7230SImpact tooth remov part bony03307.1431$423.94$84.79
    D7240SImpact tooth remov comp bony03307.1431$423.94$84.79
    D7241SImpact tooth rem bony w/comp03307.1431$423.94$84.79
    D7250STooth root removal03307.1431$423.94$84.79
    D7260SOral antral fistula closure03307.1431$423.94$84.79
    D7261SPrimary closure sinus perf03307.1431$423.94$84.79
    D7270ETooth reimplantation
    D7272ETooth transplantation
    D7280EExposure impact tooth orthod
    D7282EMobilize erupted/malpos toot
    D7283BPlace device impacted tooth
    D7285EBiopsy of oral tissue hard
    D7286EBiopsy of oral tissue soft
    D7287ECytology sample collection
    D7288BBrush biopsy
    D7290ERepositioning of teeth
    D7291STransseptal fiberotomy03307.1431$423.94$84.79
    D7310EAlveoplasty w/ extraction
    D7311EAlveoloplasty w/extract 1-3
    D7320EAlveoplasty w/o extraction
    D7321BAlveoloplasty not w/extracts
    D7340EVestibuloplasty ridge extens
    D7350EVestibuloplasty exten graft
    D7410ERad exc lesion up to 1.25 cm
    D7411EExcision benign lesion>1.25c
    D7412EExcision benign lesion compl
    D7413EExcision malig lesion<=1.25c
    D7414EExcision malig lesion>1.25cm
    D7415EExcision malig les complicat
    D7440EMalig tumor exc to 1.25 cm
    D7441EMalig tumor > 1.25 cm
    D7450ERem odontogen cyst to 1.25cm
    D7451ERem odontogen cyst > 1.25 cm
    D7460ERem nonodonto cyst to 1.25cm
    D7461ERem nonodonto cyst > 1.25 cm
    D7465ELesion destruction
    D7471ERem exostosis any site
    D7472ERemoval of torus palatinus
    D7473ERemove torus mandibularis
    D7485ESurg reduct osseoustuberosit
    D7490EMandible resection
    D7510EI&d absc intraoral soft tiss
    D7511BIncision/drain abscess intra
    D7520EI&d abscess extraoral
    D7521BIncision/drain abscess extra
    D7530ERemoval fb skin/areolar tiss
    D7540ERemoval of fb reaction
    D7550ERemoval of sloughed off bone
    D7560EMaxillary sinusotomy
    D7610EMaxilla open reduct simple
    D7620EClsd reduct simpl maxilla fx
    D7630EOpen red simpl mandible fx
    D7640EClsd red simpl mandible fx
    D7650EOpen red simp malar/zygom fx
    D7660EClsd red simp malar/zygom fx
    D7670EClosd rductn splint alveolus
    D7671EAlveolus open reduction
    D7680EReduct simple facial bone fx
    D7710EMaxilla open reduct compound
    D7720EClsd reduct compd maxilla fx
    D7730EOpen reduct compd mandble fx
    D7740EClsd reduct compd mandble fx
    Start Printed Page 42924
    D7750EOpen red comp malar/zygma fx
    D7760EClsd red comp malar/zygma fx
    D7770EOpen reduc compd alveolus fx
    D7771EAlveolus clsd reduc stblz te
    D7780EReduct compnd facial bone fx
    D7810ETmj open reduct-dislocation
    D7820EClosed tmp manipulation
    D7830ETmj manipulation under anest
    D7840ERemoval of tmj condyle
    D7850ETmj meniscectomy
    D7852ETmj repair of joint disc
    D7854ETmj excisn of joint membrane
    D7856ETmj cutting of a muscle
    D7858ETmj reconstruction
    D7860ETmj cutting into joint
    D7865ETmj reshaping components
    D7870ETmj aspiration joint fluid
    D7871ELysis + lavage w catheters
    D7872ETmj diagnostic arthroscopy
    D7873ETmj arthroscopy lysis adhesn
    D7874ETmj arthroscopy disc reposit
    D7875ETmj arthroscopy synovectomy
    D7876ETmj arthroscopy discectomy
    D7877ETmj arthroscopy debridement
    D7880EOcclusal orthotic appliance
    D7899ETmj unspecified therapy
    D7910EDent sutur recent wnd to 5cm
    D7911EDental suture wound to 5 cm
    D7912ESuture complicate wnd > 5 cm
    D7920EDental skin graft
    D7940SReshaping bone orthognathic03307.1431$423.94$84.79
    D7941EBone cutting ramus closed
    D7943ECutting ramus open w/graft
    D7944EBone cutting segmented
    D7945EBone cutting body mandible
    D7946EReconstruction maxilla total
    D7947EReconstruct maxilla segment
    D7948EReconstruct midface no graft
    D7949EReconstruct midface w/graft
    D7950EMandible graft
    D7953EBone replacement graft
    D7955ERepair maxillofacial defects
    D7960EFrenulectomy/frenulotomy
    D7963EFrenuloplasty
    D7970EExcision hyperplastic tissue
    D7971EExcision pericoronal gingiva
    D7972ESurg redct fibrous tuberosit
    D7980ESialolithotomy
    D7981EExcision of salivary gland
    D7982ESialodochoplasty
    D7983EClosure of salivary fistula
    D7990EEmergency tracheotomy
    D7991EDental coronoidectomy
    D7995ESynthetic graft facial bones
    D7996EImplant mandible for augment
    D7997EAppliance removal
    D7999EOral surgery procedure
    D8010ELimited dental tx primary
    D8020ELimited dental tx transition
    D8030ELimited dental tx adolescent
    D8040ELimited dental tx adult
    D8050EIntercep dental tx primary
    D8060EIntercep dental tx transitn
    D8070ECompre dental tx transition
    D8080ECompre dental tx adolescent
    D8090ECompre dental tx adult
    Start Printed Page 42925
    D8210EOrthodontic rem appliance tx
    D8220EFixed appliance therapy habt
    D8660EPreorthodontic tx visit
    D8670EPeriodic orthodontc tx visit
    D8680EOrthodontic retention
    D8690EOrthodontic treatment
    D8691ERepair ortho appliance
    D8692EReplacement retainer
    D8999EOrthodontic procedure
    D9110NTx dental pain minor proc
    D9210EDent anesthesia w/o surgery
    D9211ERegional block anesthesia
    D9212ETrigeminal block anesthesia
    D9215ELocal anesthesia
    D9220EGeneral anesthesia
    D9221EGeneral anesthesia ea ad 15m
    D9230NAnalgesia
    D9241EIntravenous sedation
    D9242EIV sedation ea ad 30 m
    D9248NSedation (non-iv)
    D9310EDental consultation
    D9410EDental house call
    D9420EHospital call
    D9430EOffice visit during hours
    D9440EOffice visit after hours
    D9450ECase presentation tx plan
    D9610EDent therapeutic drug inject
    D9630SOther drugs/medicaments03307.1431$423.94$84.79
    D9910EDent appl desensitizing med
    D9911EAppl desensitizing resin
    D9920EBehavior management
    D9930STreatment of complications03307.1431$423.94$84.79
    D9940SDental occlusal guard03307.1431$423.94$84.79
    D9941EFabrication athletic guard
    D9942ERepair/reline occlusal guard
    D9950SOcclusion analysis03307.1431$423.94$84.79
    D9951SLimited occlusal adjustment03307.1431$423.94$84.79
    D9952SComplete occlusal adjustment03307.1431$423.94$84.79
    D9970EEnamel microabrasion
    D9971EOdontoplasty 1-2 teeth
    D9972EExtrnl bleaching per arch
    D9973EExtrnl bleaching per tooth
    D9974EIntrnl bleaching per tooth
    D9999EAdjunctive procedure
    E0100YCane adjust/fixed with tip
    E0105YCane adjust/fixed quad/3 pro
    E0110YCrutch forearm pair
    E0111YCrutch forearm each
    E0112YCrutch underarm pair wood
    E0113YCrutch underarm each wood
    E0114YCrutch underarm pair no wood
    E0116YCrutch underarm each no wood
    E0117YUnderarm springassist crutch
    E0118ECrutch substitute
    E0130YWalker rigid adjust/fixed ht
    E0135YWalker folding adjust/fixed
    E0140YWalker w trunk support
    E0141YRigid wheeled walker adj/fix
    E0143YWalker folding wheeled w/o s
    E0144YEnclosed walker w rear seat
    E0147YWalker variable wheel resist
    E0148YHeavyduty walker no wheels
    E0149YHeavy duty wheeled walker
    E0153YForearm crutch platform atta
    E0154YWalker platform attachment
    E0155YWalker wheel attachment,pair
    Start Printed Page 42926
    E0156YWalker seat attachment
    E0157YWalker crutch attachment
    E0158YWalker leg extenders set of4
    E0159YBrake for wheeled walker
    E0160YSitz type bath or equipment
    E0161YSitz bath/equipment w/faucet
    E0162YSitz bath chair
    E0163YCommode chair stationry fxd
    E0164YCommode chair mobile fixed a
    E0166YCommode chair mobile detach
    E0167YCommode chair pail or pan
    E0168YHeavyduty/wide commode chair
    E0169YSeatlift incorp commodechair
    E0175YCommode chair foot rest
    E0180YPress pad alternating w pump
    E0181YPress pad alternating w/ pum
    E0182YPressure pad alternating pum
    E0184YDry pressure mattress
    E0185YGel pressure mattress pad
    E0186YAir pressure mattress
    E0187YWater pressure mattress
    E0188YSynthetic sheepskin pad
    E0189YLambswool sheepskin pad
    E0190EPositioning cushion
    E0191YProtector heel or elbow
    E0193YPowered air flotation bed
    E0194YAir fluidized bed
    E0196YGel pressure mattress
    E0197YAir pressure pad for mattres
    E0198YWater pressure pad for mattr
    E0199YDry pressure pad for mattres
    E0200YHeat lamp without stand
    E0202YPhototherapy light w/ photom
    E0203ETherapeutic lightbox tabletp
    E0205YHeat lamp with stand
    E0210YElectric heat pad standard
    E0215YElectric heat pad moist
    E0217YWater circ heat pad w pump
    E0218YWater circ cold pad w pump
    E0220YHot water bottle
    E0221EInfrared heating pad system
    E0225YHydrocollator unit
    E0230YIce cap or collar
    E0231EWound warming device
    E0232EWarming card for NWT
    E0235YParaffin bath unit portable
    E0236YPump for water circulating p
    E0238YHeat pad non-electric moist
    E0239YHydrocollator unit portable
    E0240EBath/shower chair
    E0241EBath tub wall rail
    E0242EBath tub rail floor
    E0243EToilet rail
    E0244EToilet seat raised
    E0245ETub stool or bench
    E0246ETransfer tub rail attachment
    E0247ETrans bench w/wo comm open
    E0248EHDtrans bench w/wo comm open
    E0249YPad water circulating heat u
    E0250YHosp bed fixed ht w/ mattres
    E0251YHosp bed fixd ht w/o mattres
    E0255YHospital bed var ht w/ mattr
    E0256YHospital bed var ht w/o matt
    E0260YHosp bed semi-electr w/ matt
    E0261YHosp bed semi-electr w/o mat
    E0265YHosp bed total electr w/ mat
    Start Printed Page 42927
    E0266YHosp bed total elec w/o matt
    E0270EHospital bed institutional t
    E0271YMattress innerspring
    E0272YMattress foam rubber
    E0273EBed board
    E0274EOver-bed table
    E0275YBed pan standard
    E0276YBed pan fracture
    E0277YPowered pres-redu air mattrs
    E0280YBed cradle
    E0290YHosp bed fx ht w/o rails w/m
    E0291YHosp bed fx ht w/o rail w/o
    E0292YHosp bed var ht w/o rail w/o
    E0293YHosp bed var ht w/o rail w/
    E0294YHosp bed semi-elect w/ mattr
    E0295YHosp bed semi-elect w/o matt
    E0296YHosp bed total elect w/ matt
    E0297YHosp bed total elect w/o mat
    E0300YEnclosed ped crib hosp grade
    E0301YHD hosp bed, 350-600 lbs
    E0302YEx hd hosp bed > 600 lbs
    E0303YHosp bed hvy dty xtra wide
    E0304YHosp bed xtra hvy dty x wide
    E0305YRails bed side half length
    E0310YRails bed side full length
    E0315EBed accessory brd/tbl/supprt
    E0316YBed safety enclosure
    E0325YUrinal male jug-type
    E0326YUrinal female jug-type
    E0350EControl unit bowel system
    E0352EDisposable pack w/bowel syst
    E0370EAir elevator for heel
    E0371YNonpower mattress overlay
    E0372YPowered air mattress overlay
    E0373YNonpowered pressure mattress
    E0424YStationary compressed gas 02
    E0425EGas system stationary compre
    E0430EOxygen system gas portable
    E0431YPortable gaseous 02
    E0434YPortable liquid 02
    E0435EOxygen system liquid portabl
    E0439YStationary liquid 02
    E0440EOxygen system liquid station
    E0441YOxygen contents, gaseous
    E0442YOxygen contents, liquid
    E0443YPortable 02 contents, gas
    E0444YPortable 02 contents, liquid
    E0445AOximeter non-invasive
    E0450YVolume vent stationary/porta
    E0455YOxygen tent excl croup/ped t
    E0457YChest shell
    E0459YChest wrap
    E0460YNeg press vent portabl/statn
    E0461YVol vent noninvasive interfa
    E0462YRocking bed w/ or w/o side r
    E0463YPress supp vent invasive int
    E0464YPress supp vent noninv int
    E0470YRAD w/o backup non-inv intfc
    E0471YRAD w/backup non inv intrfc
    E0472YRAD w backup invasive intrfc
    E0480YPercussor elect/pneum home m
    E0481EIntrpulmnry percuss vent sys
    E0482YCough stimulating device
    E0483YChest compression gen system
    E0484YNon-elec oscillatory pep dvc
    E0500YIppb all types
    Start Printed Page 42928
    E0550YHumidif extens supple w ippb
    E0555YHumidifier for use w/ regula
    E0560YHumidifier supplemental w/ i
    E0561YHumidifier nonheated w PAP
    E0562YHumidifier heated used w PAP
    E0565YCompressor air power source
    E0570YNebulizer with compression
    E0571YAerosol compressor for svneb
    E0572YAerosol compressor adjust pr
    E0574YUltrasonic generator w svneb
    E0575YNebulizer ultrasonic
    E0580YNebulizer for use w/ regulat
    E0585YNebulizer w/ compressor & he
    E0590YDispensing fee dme neb drug
    E0600YSuction pump portab hom modl
    E0601YCont airway pressure device
    E0602YManual breast pump
    E0603AElectric breast pump
    E0604AHosp grade elec breast pump
    E0605YVaporizer room type
    E0606YDrainage board postural
    E0607YBlood glucose monitor home
    E0610YPacemaker monitr audible/vis
    E0615YPacemaker monitr digital/vis
    E0616NCardiac event recorder
    E0617YAutomatic ext defibrillator
    E0618AApnea monitor
    E0619AApnea monitor w recorder
    E0620YCap bld skin piercing laser
    E0621YPatient lift sling or seat
    E0625EPatient lift bathroom or toi
    E0627YSeat lift incorp lift-chair
    E0628YSeat lift for pt furn-electr
    E0629YSeat lift for pt furn-non-el
    E0630YPatient lift hydraulic
    E0635YPatient lift electric
    E0636YPT support & positioning sys
    E0637ESit-stand w seatlift wheeled
    E0638EStanding frame sys wheeled
    E0639EMoveable patient lift system
    E0640EFixed patient lift system
    E0650YPneuma compresor non-segment
    E0651YPneum compressor segmental
    E0652YPneum compres w/cal pressure
    E0655YPneumatic appliance half arm
    E0660YPneumatic appliance full leg
    E0665YPneumatic appliance full arm
    E0666YPneumatic appliance half leg
    E0667YSeg pneumatic appl full leg
    E0668YSeg pneumatic appl full arm
    E0669YSeg pneumatic appli half leg
    E0671YPressure pneum appl full leg
    E0672YPressure pneum appl full arm
    E0673YPressure pneum appl half leg
    E0675YPneumatic compression device
    E0691YUvl pnl 2 sq ft or less
    E0692YUvl sys panel 4 ft
    E0693YUvl sys panel 6 ft
    E0694YUvl md cabinet sys 6 ft
    E0700ESafety equipment
    E0701YHelmet w face guard prefab
    E0710ERestraints any type
    E0720YTens two lead
    E0730YTens four lead
    E0731YConductive garment for tens/
    E0740YIncontinence treatment systm
    Start Printed Page 42929
    E0744YNeuromuscular stim for scoli
    E0745YNeuromuscular stim for shock
    E0746EElectromyograph biofeedback
    E0747YElec osteogen stim not spine
    E0748YElec osteogen stim spinal
    E0749NElec osteogen stim implanted
    E0752BNeurostimulator electrode
    E0754APulsegenerator pt programmer
    E0755EElectronic salivary reflex s
    E0756BImplantable pulse generator
    E0757NImplantable RF receiver
    E0758AExternal RF transmitter
    E0759AReplace rdfrquncy transmittr
    E0760YOsteogen ultrasound stimltor
    E0761ENontherm electromgntc device
    E0765YNerve stimulator for tx n&v
    E0769BElectric wound treatment dev
    E0776YIv pole
    E0779YAmb infusion pump mechanical
    E0780YMech amb infusion pump <8hrs
    E0781YExternal ambulatory infus pu
    E0782NNon-programble infusion pump
    E0783NProgrammable infusion pump
    E0784YExt amb infusn pump insulin
    E0785NReplacement impl pump cathet
    E0786NImplantable pump replacement
    E0791YParenteral infusion pump sta
    E0830NAmbulatory traction device
    E0840YTract frame attach headboard
    E0849YCervical pneum trac equip
    E0850YTraction stand free standing
    E0855YCervical traction equipment
    E0860YTract equip cervical tract
    E0870YTract frame attach footboard
    E0880YTrac stand free stand extrem
    E0890YTraction frame attach pelvic
    E0900YTrac stand free stand pelvic
    E0910YTrapeze bar attached to bed
    E0920YFracture frame attached to b
    E0930YFracture frame free standing
    E0935YExercise device passive moti
    E0940YTrapeze bar free standing
    E0941YGravity assisted traction de
    E0942YCervical head harness/halter
    E0944YPelvic belt/harness/boot
    E0945YBelt/harness extremity
    E0946YFracture frame dual w cross
    E0947YFracture frame attachmnts pe
    E0948YFracture frame attachmnts ce
    E0950ETray
    E0951ELoop heel
    E0952EToe loop/holder, each
    E0953EPneumatic tire
    E0954EWheelchair semi-pneumatic ca
    E0955YCushioned headrest
    E0956YW/c lateral trunk/hip suppor
    E0957YW/c medial thigh support
    E0958AWhlchr att- conv 1 arm drive
    E0959BAmputee adapter
    E0960YW/c shoulder harness/straps
    E0961BWheelchair brake extension
    E0966BWheelchair head rest extensi
    E0967YWheelchair hand rims
    E0968YWheelchair commode seat
    E0969YWheelchair narrowing device
    E0970BWheelchair no. 2 footplates
    Start Printed Page 42930
    E0971BWheelchair anti-tipping devi
    E0972ATransfer board or device
    E0973BW/Ch access det adj armrest
    E0974BW/Ch access anti-rollback
    E0977YWheelchair wedge cushion
    E0978BW/C acc,saf belt pelv strap
    E0980YWheelchair safety vest
    E0981YSeat upholstery, replacement
    E0982YBack upholstery, replacement
    E0983YAdd pwr joystick
    E0984YAdd pwr tiller
    E0985YW/c seat lift mechanism
    E0986YMan w/c push-rim pow assist
    E0990BWhellchair elevating leg res
    E0992BWheelchair solid seat insert
    E0994YWheelchair arm rest
    E0995BWheelchair calf rest
    E0996BWheelchair tire solid
    E0997YWheelchair caster w/ a fork
    E0998YWheelchair caster w/o a fork
    E0999YWheelchr pneumatic tire w/wh
    E1000BWheelchair tire pneumatic ca
    E1001YWheelchair wheel
    E1002YPwr seat tilt
    E1003YPwr seat recline
    E1004YPwr seat recline mech
    E1005YPwr seat recline pwr
    E1006YPwr seat combo w/o shear
    E1007YPwr seat combo w/shear
    E1008YPwr seat combo pwr shear
    E1009YAdd mech leg elevation
    E1010YAdd pwr leg elevation
    E1011YPed wc modify width adjustm
    E1014YReclining back add ped w/c
    E1015YShock absorber for man w/c
    E1016YShock absorber for power w/c
    E1017YHD shck absrbr for hd man wc
    E1018YHD shck absrber for hd powwc
    E1019EHD feature power seat
    E1020YResidual limb support system
    E1021EEx hd feature power seat
    E1025EPedwc lat/thor sup nocontour
    E1026EPedwc contoured lat/thor sup
    E1027EPed wc lat/ant support
    E1028YW/c manual swingaway
    E1029YW/c vent tray fixed
    E1030YW/c vent tray gimbaled
    E1031YRollabout chair with casters
    E1035YPatient transfer system
    E1037YTransport chair, ped size
    E1038YTransport chair, adult size
    E1039YTransport chair pt wt>=250lb
    E1050AWhelchr fxd full length arms
    E1060AWheelchair detachable arms
    E1070AWheelchair detachable foot r
    E1083AHemi-wheelchair fixed arms
    E1084AHemi-wheelchair detachable a
    E1085AHemi-wheelchair fixed arms
    E1086AHemi-wheelchair detachable a
    E1087AWheelchair lightwt fixed arm
    E1088AWheelchair lightweight det a
    E1089AWheelchair lightwt fixed arm
    E1090AWheelchair lightweight det a
    E1092AWheelchair wide w/ leg rests
    E1093AWheelchair wide w/ foot rest
    E1100AWhchr s-recl fxd arm leg res
    Start Printed Page 42931
    E1110AWheelchair semi-recl detach
    E1130AWhlchr stand fxd arm ft rest
    E1140AWheelchair standard detach a
    E1150YWheelchair standard w/ leg r
    E1160AWheelchair fixed arms
    E1161AManual adult wc w tiltinspac
    E1170AWhlchr ampu fxd arm leg rest
    E1171AWheelchair amputee w/o leg r
    E1172AWheelchair amputee detach ar
    E1180AWheelchair amputee w/ foot r
    E1190AWheelchair amputee w/ leg re
    E1195AWheelchair amputee heavy dut
    E1200AWheelchair amputee fixed arm
    E1210YWhlchr moto ful arm leg rest
    E1211YWheelchair motorized w/ det
    E1212AWheelchair motorized w full
    E1213AWheelchair motorized w/ det
    E1220AWhlchr special size/constrc
    E1221AWheelchair spec size w foot
    E1222AWheelchair spec size w/ leg
    E1223AWheelchair spec size w foot
    E1224AWheelchair spec size w/ leg
    E1225YWheelchair spec sz semi-recl
    E1226BW/C access fully reclineback
    E1227YWheelchair spec sz spec ht a
    E1228YWheelchair spec sz spec ht b
    E1229YPediatric wheelchair NOS
    E1230YPower operated vehicle
    E1231YRigid ped w/c tilt-in-space
    E1232YFolding ped wc tilt-in-space
    E1233YRig ped wc tltnspc w/o seat
    E1234YFld ped wc tltnspc w/o seat
    E1235YRigid ped wc adjustable
    E1236YFolding ped wc adjustable
    E1237YRgd ped wc adjstabl w/o seat
    E1238YFld ped wc adjstabl w/o seat
    E1239YPed power wheelchair NOS
    E1240AWhchr litwt det arm leg rest
    E1250AWheelchair lightwt fixed arm
    E1260AWheelchair lightwt foot rest
    E1270AWheelchair lightweight leg r
    E1280AWhchr h-duty det arm leg res
    E1285AWheelchair heavy duty fixed
    E1290AWheelchair hvy duty detach a
    E1295AWheelchair heavy duty fixed
    E1296YWheelchair special seat heig
    E1297YWheelchair special seat dept
    E1298YWheelchair spec seat depth/w
    E1300EWhirlpool portable
    E1310YWhirlpool non-portable
    E1340YRepair for DME, per 15 min
    E1353YOxygen supplies regulator
    E1355YOxygen supplies stand/rack
    E1372YOxy suppl heater for nebuliz
    E1390YOxygen concentrator
    E1391YOxygen concentrator, dual
    E1399NDurable medical equipment mi
    E1405YO2/water vapor enrich w/heat
    E1406YO2/water vapor enrich w/o he
    E1500ACentrifuge
    E1510AKidney dialysate delivry sys
    E1520AHeparin infusion pump
    E1530AReplacement air bubble detec
    E1540AReplacement pressure alarm
    E1550ABath conductivity meter
    E1560AReplace blood leak detector
    Start Printed Page 42932
    E1570AAdjustable chair for esrd pt
    E1575ATransducer protect/fld bar
    E1580AUnipuncture control system
    E1590AHemodialysis machine
    E1592AAuto interm peritoneal dialy
    E1594ACycler dialysis machine
    E1600ADeli/install chrg hemo equip
    E1610AReverse osmosis h2o puri sys
    E1615ADeionizer H2O puri system
    E1620AReplacement blood pump
    E1625AWater softening system
    E1630AReciprocating peritoneal dia
    E1632AWearable artificial kidney
    E1634BPeritoneal dialysis clamp
    E1635ACompact travel hemodialyzer
    E1636ASorbent cartridges per 10
    E1637AHemostats for dialysis, each
    E1639ADialysis scale
    E1699ADialysis equipment noc
    E1700YJaw motion rehab system
    E1701YRepl cushions for jaw motion
    E1702YRepl measr scales jaw motion
    E1800YAdjust elbow ext/flex device
    E1801YSPS elbow device
    E1802YAdjst forearm pro/sup device
    E1805YAdjust wrist ext/flex device
    E1806YSPS wrist device
    E1810YAdjust knee ext/flex device
    E1811YSPS knee device
    E1815YAdjust ankle ext/flex device
    E1816YSPS ankle device
    E1818YSPS forearm device
    E1820YSoft interface material
    E1821YReplacement interface SPSD
    E1825YAdjust finger ext/flex devc
    E1830YAdjust toe ext/flex device
    E1840YAdj shoulder ext/flex device
    E1841YStatic str shldr dev rom adj
    E1902AAAC non-electronic board
    E2000YGastric suction pump hme mdl
    E2100YBld glucose monitor w voice
    E2101YBld glucose monitor w lance
    E2120YPulse gen sys tx endolymp fl
    E2201YMan w/ch acc seat w>=20″<24″
    E2202YSeat width 24-27 in
    E2203YFrame depth less than 22 in
    E2204YFrame depth 22 to 25 in
    E2205YManual wc accessory, handrim
    E2206YComplete wheel lock assembly
    E2291EPlanar back for ped size wc
    E2292EPlanar seat for ped size wc
    E2293EContour back for ped size wc
    E2294EContour seat for ped size wc
    E2300YPwr seat elevation sys
    E2301YPwr standing
    E2310YElectro connect btw control
    E2311YElectro connect btw 2 sys
    E2320YHand chin control
    E2321YHand interface joystick
    E2322YMult mech switches
    E2323YSpecial joystick handle
    E2324YChin cup interface
    E2325YSip and puff interface
    E2326YBreath tube kit
    E2327YHead control interface mech
    E2328YHead/extremity control inter
    Start Printed Page 42933
    E2329YHead control nonproportional
    E2330YHead control proximity switc
    E2331YAttendant control
    E2340YW/c wdth 20-23 in seat frame
    E2341YW/c wdth 24-27 in seat frame
    E2342YW/c dpth 20-21 in seat frame
    E2343YW/c dpth 22-25 in seat frame
    E2351YElectronic SGD interface
    E2360Y22nf nonsealed leadacid
    E2361Y22nf sealed leadacid battery
    E2362YGr24 nonsealed leadacid
    E2363YGr24 sealed leadacid battery
    E2364YU1nonsealed leadacid battery
    E2365YU1 sealed leadacid battery
    E2366YBattery charger, single mode
    E2367YBattery charger, dual mode
    E2368YPower wc motor replacement
    E2369YPwr wc gear box replacement
    E2370YPwr wc motor/gear box combo
    E2399YNoc interface
    E2402YNeg press wound therapy pump
    E2500YSGD digitized pre-rec <=8min
    E2502YSGD prerec msg >8min <=20min
    E2504YSGD prerec msg>20min <=40min
    E2506YSGD prerec msg > 40 min
    E2508YSGD spelling phys contact
    E2510YSGD w multi methods msg/accs
    E2511YSGD sftwre prgrm for PC/PDA
    E2512YSGD accessory, mounting sys
    E2599YSGD accessory noc
    E2601YGen w/c cushion wdth < 22 in
    E2602YGen w/c cushion wdth >=22 in
    E2603YSkin protect wc cus wd <22in
    E2604YSkin protect wc cus wd>=22in
    E2605YPosition wc cush wdth <22 in
    E2606YPosition wc cush wdth>=22 in
    E2607YSkin pro/pos wc cus wd <22in
    E2608YSkin pro/pos wc cus wd>=22in
    E2609YCustom fabricate w/c cushion
    E2610BPowered w/c cushion
    E2611YGen use back cush wdth <22in
    E2612YGen use back cush wdth>=22in
    E2613YPosition back cush wd <22in
    E2614YPosition back cush wd>=22in
    E2615YPos back post/lat wdth <22in
    E2616YPos back post/lat wdth>=22in
    E2617YCustom fab w/c back cushion
    E2618YWc acc solid seat supp base
    E2619YReplace cover w/c seat cush
    E2620YWC planar back cush wd <22in
    E2621YWC planar back cush wd>=22in
    E8000EPosterior gait trainer
    E8001EUpright gait trainer
    E8002EAnterior gait trainer
    G0008XAdmin influenza virus vac03500.3936$23.36$.00$.00
    G0009XAdmin pneumococcal vaccine03500.3936$23.36$.00$.00
    G0010BAdmin hepatitis b vaccine
    G0027ASemen analysis
    G0101VCA screen pelvic/breast exam06000.8649$51.33$10.27
    G0102NProstate ca screening dre
    G0103APsa, total screening
    G0104SCA screen flexi sigmoidscope01593.1312$185.84$46.46
    G0105TColorectal scrn hi risk ind01587.6242$452.50$113.13
    G0106SColon CA screen barium enema01572.2800$135.32$27.06
    G0107ACA screen fecal blood test
    G0108ADiab manage trn per indiv
    Start Printed Page 42934
    G0109ADiab manage trn ind/group
    G0110ANett pulm-rehab educ ind
    G0111ANett pulm-rehab educ group
    G0112ANett nutrition guid, initial
    G0113ANett nutrition guid,subseqnt
    G0114ANett psychosocial consult
    G0115ANett psychological testing
    G0116ANett psychosocial counsel
    G0117SGlaucoma scrn hgh risk direc02300.7823$46.43$14.97$9.29
    G0118SGlaucoma scrn hgh risk direc02300.7823$46.43$14.97$9.29
    G0120SColon ca scrn barium enema01572.2800$135.32$27.06
    G0121TColon ca scrn not hi rsk ind01587.6242$452.50$113.13
    G0122EColon ca scrn barium enema
    G0123AScreen cerv/vag thin layer
    G0124AScreen c/v thin layer by MD
    G0127TTrim nail(s)00090.6650$39.47$8.34$7.89
    G0128BCORF skilled nursing service
    G0129PPartial hosp prog service00334.0524$240.51$48.10
    G0130XSingle energy x-ray study02600.7521$44.64$17.85$8.93
    G0141EScr c/v cyto,autosys and md
    G0143AScr c/v cyto,thinlayer,rescr
    G0144AScr c/v cyto,thinlayer,rescr
    G0145AScr c/v cyto,thinlayer,rescr
    G0147AScr c/v cyto, automated sys
    G0148AScr c/v cyto, autosys, rescr
    G0151BHHCP-serv of pt,ea 15 min
    G0152BHHCP-serv of ot,ea 15 min
    G0153BHHCP-svs of s/l path,ea 15mn
    G0154BHHCP-svs of rn,ea 15 min
    G0155BHHCP-svs of csw,ea 15 min
    G0156BHHCP-svs of aide,ea 15 min
    G0166TExtrnl counterpulse, per tx06781.7197$102.06$20.41
    G0168NWound closure by adhesive
    G0173SLinear acc stereo radsur com1528$5,250.00$1,050.00
    G0175VOPPS Service,sched team conf06021.4220$84.40$16.88
    G0176POPPS/PHP activity therapy00334.0524$240.51$48.10
    G0177POPPS/PHP train & educ serv00334.0524$240.51$48.10
    G0179EMD recertification HHA PT
    G0180EMD certification HHA patient
    G0181EHome health care supervision
    G0182EHospice care supervision
    G0186TDstry eye lesn,fdr vssl tech02354.6382$275.28$67.10$55.06
    G0202AScreeningmammographydigital
    G0204ADiagnosticmammographydigital
    G0206ADiagnosticmammographydigital
    G0219EPET img whbd ring noncov ind
    G0235EPET not otherwise specified
    G0237STherapeutic procd strg endur04110.3852$22.86$4.57
    G0238SOth resp proc, indiv04110.3852$22.86$4.57
    G0239SOth resp proc, group04110.3852$22.86$4.57
    G0243SMultisour photon stero treat1528$5,250.00$1,050.00
    G0244BObserv care by facility topt
    G0245VInitial Foot Exam PTLOPS06000.8649$51.33$10.27
    G0246VFollowup eval of foot pt lop06000.8649$51.33$10.27
    G0247TRoutine footcare pt w lops00090.6650$39.47$8.34$7.89
    G0248SDemonstrate use home inr mon1503$150.00$30.00
    G0249SProvide test material,equipm1503$150.00$30.00
    G0250EMD review interpret of test
    G0251SLinear acc based stero radio1513$1,150.00$230.00
    G0252EPET imaging initial dx
    G0255ECurrent percep threshold tst
    G0257SUnsched dialysis ESRD pt hos01705.8726$348.54$69.71
    G0258XIV infusion during obs stay03400.6355$37.72$7.54
    G0259NInject for sacroiliac joint
    G0260TInj for sacroiliac jt anesth02065.4672$324.48$75.55$64.90
    G0263BAdm with CHF, CP, asthma
    Start Printed Page 42935
    G0264BAssmt otr CHF, CP, asthma
    G0265ACryopresevation Freeze+stora
    G0266AThawing + expansion froz cel
    G0267SBone marrow or psc harvest01103.6428$216.20$43.24
    G0268XRemoval of impacted wax md03400.6355$37.72$7.54
    G0269NOcclusive device in vein art
    G0270AMNT subs tx for change dx
    G0271AGroup MNT 2 or more 30 mins
    G0275NRenal angio, cardiac cath
    G0278NIliac art angio,cardiac cath
    G0279AExcorp shock tx, elbow epi
    G0280AExcorp shock tx other than
    G0281AElec stim unattend for press
    G0282EElect stim wound care not pd
    G0283AElec stim other than wound
    G0288SRecon, CTA for pre & post su04174.0566$240.76$48.15
    G0289NArthro, loose body + chondro
    G0290TDrug-eluting stents, single0656109.4258$6,494.42$1,298.88
    G0291TDrug-eluting stents,each add0656109.4258$6,494.42$1,298.88
    G0293SNon-cov surg proc,clin trial1505$350.00$70.00
    G0294SNon-cov proc, clinical trial1502$75.00$15.00
    G0295EElectromagnetic therapy onc
    G0297TInsert single chamber/cd0107258.8517$15,362.85$3,089.53$3,072.57
    G0298TInsert dual chamber/cd0107258.8517$15,362.85$3,089.53$3,072.57
    G0299TInser/repos single icd+leads0108347.5867$20,629.27$4,125.85
    G0300TInsert reposit lead dual+gen0108347.5867$20,629.27$4,125.85
    G0302SPre-op service LVRS complete1509$750.00$150.00
    G0303SPre-op service LVRS 10-15dos1507$550.00$110.00
    G0304SPre-op service LVRS 1-9 dos1504$250.00$50.00
    G0305SPost op service LVRS min 61504$250.00$50.00
    G0306ACBC/diffwbc w/o platelet
    G0307ACBC without platelet
    G0308AESRD related svc 4+mo<2yrs
    G0309AESRD related svc 2-3mo<2yrs
    G0310AESRD related svc 1vst<2yr
    G0311AESRD related svs 4+mo 2-11yr
    G0312AESRD relate svs 2-3 mo 2-11y
    G0313AESRD related svs 1 mon 2-11y
    G0314AESRD relate svs 4+mo 12-19
    G0315AESRD related svs 2-3 mo 12-1
    G0316AESRD related svs 1 vis/12-19
    G0317AESRD related svs 4+mo 20+yrs
    G0318AESRD related svs 2-3 mo 20+y
    G0319AESRD related svs 1visit 20+y
    G0320AESRD related svs home under
    G0321AESRDrelatedsvs home mo 2-11y
    G0322AESRD related svs home mo12-1
    G0323AESRD related svs home mo 20+
    G0324AESRD related svs home/dy/2y
    G0325AESRD relate home/dy 2-11yr
    G0326AESRD relate home/dy 12-19y
    G0327AESRD relate home/dy 20+yrs
    G0328AFecal blood scrn immunoassay
    G0329AElectromagntic tx for ulcers
    G0337AHospice evaluation preelecti
    G0339SRobot lin-radsurg com, first1528$5,250.00$1,050.00
    G0340SRobt lin-radsurg fractx 2-51525$3,750.00$750.00
    G0341CPercutaneous islet celltrans
    G0342CLaparoscopy Islet cell Trans
    G0343CLaparotomy Islet cell tranp
    G0344VInitial preventive exam06010.9992$59.30$11.86
    G0345MIV infuse hydration initial
    G0346MEach additional infuse hours
    G0347MIV infusion therapy/diagnost
    G0348Meach additional hr up to 8hr
    G0349Madditional sequential infuse
    Start Printed Page 42936
    G0350Mconcurrent infusion
    G0351Mtherapeutic/diagnostic injec
    G0353MIV push,single orinitial dru
    G0354Meach addition sequential IV
    G0355Mchemo administrate subcut/IM
    G0356Mhormonal anti-neoplastic
    G0357MIV push single/initial subst
    G0358MIV push each additional drug
    G0359Mchemotherapy IV one hr initi
    G0360Meach additional hr 1-8 hrs
    G0361Mprolong chemo Infuse>8hrs pu
    G0362Meach add sequential infusion
    G0363Mirrigate implanted venous de
    G0364XBone marrow aspirate & biops03420.1553$9.22$3.68$1.84
    G0365SVessel mapping hemo access02672.6208$155.54$62.18$31.11
    G0366BEKG for initial prevent exam
    G0367SEKG tracing for initial prev00990.3804$22.58$4.52
    G0368MEKG interpret & report preve
    G0369MPharm fee 1st month transpla
    G0370MPharmacy fee oral cancer etc
    G0371MPharm dispense inhalation 30
    G0374MPharm dispense inhalation 90
    G0375SSmoke/Tobacco counseling 3-11491$5.00$1.00
    G0376SSmoke/Tobacco counseling >101491$5.00$1.00
    G3001SAdmin + supply, tositumomab1522$2,250.00$450.00
    G9001BMCCD, initial rate
    G9002BMCCD,maintenance rate
    G9003BMCCD, risk adj hi, initial
    G9004BMCCD, risk adj lo, initial
    G9005BMCCD, risk adj, maintenance
    G9006BMCCD, Home monitoring
    G9007BMCCD, sch team conf
    G9008BMccd,phys coor-care ovrsght
    G9009EMCCD, risk adj, level 3
    G9010EMCCD, risk adj, level 4
    G9011EMCCD, risk adj, level 5
    G9012EOther Specified Case Mgmt
    G9013EESRD demo bundle level I
    G9014EESRD demo bundle-level II
    G9016EDemo-smoking cessation coun
    G9017AAmantadine HCL,oral
    G9018AZanamivir, inh pwdr
    G9019AOseltamivir phosp
    G9020ARimantadine HCL
    G9021MChemo assess nausea vomit L1
    G9022MChemo assess nausea vomit L2
    G9023MChemo assess nausea vomit L3
    G9024MChemo assess nausea vomit L4
    G9025MChemo assessment pain level1
    G9026MChemo assessment pain level2
    G9027MChemo assessment pain level3
    G9028MChemo assessment pain level4
    G9029MChemo assess for fatigue L1
    G9030MChemo assess for fatigue L2
    G9031MChemo assess for fatigue L3
    G9032MChemo assess for fatigue L4
    G9033AAmantadine HCL, oral, brand
    G9034AZanamivir, inh pwdr, brand
    G9035AOseltamivir phosp, brand
    G9036ARimantadine HCL, brand
    G9041ALow vision serv occupational
    G9042ALow vision orient/mobility
    G9043ALow vision rehab therapist
    G9044ALow vision rehab teacher
    J0120NTetracyclin injection
    J0128GAbarelix injection9216$66.96$13.39
    Start Printed Page 42937
    J0130KAbciximab injection1605$450.56$90.11
    J0135KAdalimumab injection1083$300.07$60.01
    J0150KInjection adenosine 6 MG0379$33.44$6.69
    J0152KAdenosine injection0917$71.52$14.30
    J0170NAdrenalin epinephrin inject
    J0180KAgalsidase beta injection9208$123.35$24.67
    J0190NInj biperiden lactate/5 mg
    J0200NAlatrofloxacin mesylate
    J0205KAlglucerase injection0900$39.94$7.99
    J0207KAmifostine7000$435.98$87.20
    J0210KMethyldopate hcl injection2210$9.58$1.92
    J0215BAlefacept
    J0256KAlpha 1 proteinase inhibitor0901$3.30$.66
    J0270BAlprostadil for injection
    J0275BAlprostadil urethral suppos
    J0280NAminophyllin 250 MG inj
    J0282NAmiodarone HCl
    J0285KAmphotericin B9030$30.70$6.14
    J0287KAmphotericin b lipid complex9024$11.95$2.39
    J0288KAmpho b cholesteryl sulfate0735$12.24$2.45
    J0289KAmphotericin b liposome inj0736$21.91$4.38
    J0290NAmpicillin 500 MG inj
    J0295NAmpicillin sodium per 1.5 gm
    J0300NAmobarbital 125 MG inj
    J0330NSuccinycholine chloride inj
    J0350NInjection anistreplase 30 u
    J0360NHydralazine hcl injection
    J0380NInj metaraminol bitartrate
    J0390NChloroquine injection
    J0395KArbutamine HCl injection9031$163.13$32.63
    J0456NAzithromycin
    J0460NAtropine sulfate injection
    J0470NDimecaprol injection
    J0475KBaclofen 10 MG injection9032$188.00$37.60
    J0476BBaclofen intrathecal trial
    J0500NDicyclomine injection
    J0515NInj benztropine mesylate
    J0520NBethanechol chloride inject
    J0530NPenicillin g benzathine inj
    J0540NPenicillin g benzathine inj
    J0550NPenicillin g benzathine inj
    J0560NPenicillin g benzathine inj
    J0570NPenicillin g benzathine inj
    J0580KPenicillin g benzathine inj0880$72.25$14.45
    J0583NBivalirudin
    J0585KBotulinum toxin a per unit0902$4.80$.96
    J0587KBotulinum toxin type B9018$7.89$1.58
    J0592NBuprenorphine hydrochloride
    J0595NButorphanol tartrate 1 mg
    J0600KEdetate calcium disodium inj0892$40.34$8.07
    J0610NCalcium gluconate injection
    J0620NCalcium glycer & lact/10 ML
    J0630KCalcitonin salmon injection0893$35.68$7.14
    J0636NInj calcitriol per 0.1 mcg
    J0637KCaspofungin acetate9019$32.35$6.47
    J0640NLeucovorin calcium injection
    J0670NInj mepivacaine HCL/10 ml
    J0690NCefazolin sodium injection
    J0692NCefepime HCl for injection
    J0694NCefoxitin sodium injection
    J0696NCeftriaxone sodium injection
    J0697NSterile cefuroxime injection
    J0698NCefotaxime sodium injection
    J0702NBetamethasone acet&sod phosp
    J0704NBetamethasone sod phosp/4 MG
    J0706KCaffeine citrate injection0876$3.34$.67
    Start Printed Page 42938
    J0710NCephapirin sodium injection
    J0713NInj ceftazidime per 500 mg
    J0715NCeftizoxime sodium / 500 MG
    J0720NChloramphenicol sodium injec
    J0725NChorionic gonadotropin/1000u
    J0735KClonidine hydrochloride0935$57.46$11.49
    J0740KCidofovir injection9033$782.91$156.58
    J0743NCilastatin sodium injection
    J0744NCiprofloxacin iv
    J0745NInj codeine phosphate /30 MG
    J0760NColchicine injection
    J0770NColistimethate sodium inj
    J0780NProchlorperazine injection
    J0800KCorticotropin injection1280$95.43$19.09
    J0835KInj cosyntropin per 0.25 MG0835$69.27$13.85
    J0850KCytomegalovirus imm IV /vial0903$683.02$136.60
    J0878GDaptomycin injection9124$.30$.06
    J0880EDarbepoetin alfa injection
    J0895KDeferoxamine mesylate inj0895$14.91$2.98
    J0900NTestosterone enanthate inj
    J0945NBrompheniramine maleate inj
    J0970NEstradiol valerate injection
    J1000NDepo-estradiol cypionate inj
    J1020NMethylprednisolone 20 MG inj
    J1030NMethylprednisolone 40 MG inj
    J1040NMethylprednisolone 80 MG inj
    J1051NMedroxyprogesterone inj
    J1055EMedrxyprogester acetate inj
    J1056EMA/EC contraceptiveinjection
    J1060NTestosterone cypionate 1 ML
    J1070NTestosterone cypionat 100 MG
    J1080NTestosterone cypionat 200 MG
    J1094NInj dexamethasone acetate
    J1100NDexamethasone sodium phos
    J1110KInj dihydroergotamine mesylt1210$27.82$5.56
    J1120NAcetazolamid sodium injectio
    J1160NDigoxin injection
    J1165NPhenytoin sodium injection
    J1170NHydromorphone injection
    J1180KDyphylline injection9166$7.74$1.55
    J1190KDexrazoxane HCl injection0726$216.38$43.28
    J1200NDiphenhydramine hcl injectio
    J1205NChlorothiazide sodium inj
    J1212NDimethyl sulfoxide 50% 50 ML
    J1230NMethadone injection
    J1240NDimenhydrinate injection
    J1245NDipyridamole injection
    J1250NInj dobutamine HCL/250 mg
    J1260KDolasetron mesylate0750$6.55$1.31
    J1270NInjection, doxercalciferol
    J1320NAmitriptyline injection
    J1325NEpoprostenol injection
    J1327KEptifibatide injection1607$12.73$2.55
    J1330KErgonovine maleate injection13300.5262$31.23$6.25
    J1335NErtapenem injection
    J1364NErythro lactobionate /500 MG
    J1380NEstradiol valerate 10 MG inj
    J1390NEstradiol valerate 20 MG inj
    J1410KInj estrogen conjugate 25 MG9038$57.76$11.55
    J1435NInjection estrone per 1 MG
    J1436KEtidronate disodium inj1436$68.69$13.74
    J1438KEtanercept injection1608$152.10$30.42
    J1440KFilgrastim 300 mcg injection0728$178.38$35.68
    J1441KFilgrastim 480 mcg injection7049$282.27$56.45
    J1450NFluconazole
    J1452KIntraocular Fomivirsen na9040$203.91$40.78
    Start Printed Page 42939
    J1455NFoscarnet sodium injection
    J1457KGallium nitrate injection1085$1.30$.26
    J1460NGamma globulin 1 CC inj
    J1470BGamma globulin 2 CC inj
    J1480BGamma globulin 3 CC inj
    J1490BGamma globulin 4 CC inj
    J1500BGamma globulin 5 CC inj
    J1510BGamma globulin 6 CC inj
    J1520BGamma globulin 7 CC inj
    J1530BGamma globulin 8 CC inj
    J1540BGamma globulin 9 CC inj
    J1550BGamma globulin 10 CC inj
    J1560BGamma globulin > 10 CC inj
    J1563EIV immune globulin
    J1564EImmune globulin 10 mg
    J1565KRSV-ivig0906$15.56$3.11
    J1570NGanciclovir sodium injection
    J1580NGaramycin gentamicin inj
    J1590NGatifloxacin injection
    J1595NInjection glatiramer acetate
    J1600NGold sodium thiomaleate inj
    J1610KGlucagon hydrochloride/1 MG9042$62.16$12.43
    J1620KGonadorelin hydroch/ 100 mcg7005$173.42$34.68
    J1626KGranisetron HCl injection0764$7.24$1.45
    J1630NHaloperidol injection
    J1631NHaloperidol decanoate inj
    J1642NInj heparin sodium per 10 u
    J1644NInj heparin sodium per 1000u
    J1645NDalteparin sodium
    J1650NInj enoxaparin sodium
    J1652NFondaparinux sodium
    J1655KTinzaparin sodium injection1655$2.53$.51
    J1670KTetanus immune globulin inj1670$76.89$15.38
    J1700NHydrocortisone acetate inj
    J1710NHydrocortisone sodium ph inj
    J1720NHydrocortisone sodium succ i
    J1730KDiazoxide injection1740$113.85$22.77
    J1742KIbutilide fumarate injection9044$243.32$48.66
    J1745KInfliximab injection7043$54.19$10.84
    J1750KIron dextran9045$11.43$2.29
    J1756KIron sucrose injection9046$.38$.08
    J1785KInjection imiglucerase /unit0916$3.98$.80
    J1790NDroperidol injection
    J1800NPropranolol injection
    J1810EDroperidol/fentanyl inj
    J1815NInsulin injection
    J1817NInsulin for insulin pump use
    J1825EInterferon beta-1a
    J1830KInterferon beta-1b / .25 MG0910$81.94$16.39
    J1835KItraconazole injection9047$36.93$7.39
    J1840NKanamycin sulfate 500 MG inj
    J1850NKanamycin sulfate 75 MG inj
    J1885NKetorolac tromethamine inj
    J1890NCephalothin sodium injection
    J1931KLaronidase injection9209$23.16$4.63
    J1940NFurosemide injection
    J1950KLeuprolide acetate /3.75 MG0800$441.74$88.35
    J1955BInj levocarnitine per 1 gm
    J1956NLevofloxacin injection
    J1960NLevorphanol tartrate inj
    J1980NHyoscyamine sulfate inj
    J1990NChlordiazepoxide injection
    J2001NLidocaine injection
    J2010NLincomycin injection
    J2020KLinezolid injection9001$24.15$4.83
    J2060NLorazepam injection
    Start Printed Page 42940
    J2150NMannitol injection
    J2175NMeperidine hydrochl /100 MG
    J2180NMeperidine/promethazine inj
    J2185NMeropenem
    J2210NMethylergonovin maleate inj
    J2250NInj midazolam hydrochloride
    J2260NInj milrinone lactate / 5 MG
    J2270NMorphine sulfate injection
    J2271NMorphine so4 injection 100mg
    J2275NMorphine sulfate injection
    J2280NInj, moxifloxacin 100 mg
    J2300NInj nalbuphine hydrochloride
    J2310NInj naloxone hydrochloride
    J2320NNandrolone decanoate 50 MG
    J2321NNandrolone decanoate 100 MG
    J2322NNandrolone decanoate 200 MG
    J2324KNesiritide9114$75.18$15.04
    J2353KOctreotide injection, depot1207$87.39$17.48
    J2354NOctreotide inj, non-depot
    J2355KOprelvekin injection7011$249.04$49.81
    J2357GOmalizumab injection9300$15.98$3.20
    J2360NOrphenadrine injection
    J2370NPhenylephrine hcl injection
    J2400NChloroprocaine hcl injection
    J2405KOndansetron hcl injection0768$3.80$.76
    J2410NOxymorphone hcl injection
    J2430KPamidronate disodium /30 MG0730$58.41$11.68
    J2440NPapaverin hcl injection
    J2460NOxytetracycline injection
    J2469KPalonosetron HCl9210$18.42$3.68
    J2501NParicalcitol
    J2505KInjection, pegfilgrastim 6mg9119$2,178.11$435.62
    J2510NPenicillin g procaine inj
    J2515NPentobarbital sodium inj
    J2540NPenicillin g potassium inj
    J2543NPiperacillin/tazobactam
    J2545YPentamidine isethionte/300mg
    J2550NPromethazine hcl injection
    J2560NPhenobarbital sodium inj
    J2590NOxytocin injection
    J2597NInj desmopressin acetate
    J2650NPrednisolone acetate inj
    J2670NTotazoline hcl injection
    J2675NInj progesterone per 50 MG
    J2680NFluphenazine decanoate 25 MG
    J2690NProcainamide hcl injection
    J2700NOxacillin sodium injeciton
    J2710NNeostigmine methylslfte inj
    J2720NInj protamine sulfate/10 MG
    J2725NInj protirelin per 250 mcg
    J2730KPralidoxime chloride inj2730$76.67$15.33
    J2760NPhentolaine mesylate inj
    J2765NMetoclopramide hcl injection
    J2770KQuinupristin/dalfopristin2770$105.48$21.10
    J2780NRanitidine hydrochloride inj
    J2783GRasburicase0738$109.17$21.83
    J2788KRho d immune globulin 50 mcg9023$25.08$5.02
    J2790KRho d immune globulin inj0884$113.90$22.78
    J2792KRho(D) immune globulin h, sd1609$12.04$2.41
    J2794GRisperidone, long acting9125$4.71$.94
    J2795NRopivacaine HCl injection
    J2800NMethocarbamol injection
    J2810NInj theophylline per 40 MG
    J2820KSargramostim injection0731$21.11$4.22
    J2910NAurothioglucose injeciton
    J2912NSodium chloride injection
    Start Printed Page 42941
    J2916NNa ferric gluconate complex
    J2920NMethylprednisolone injection
    J2930NMethylprednisolone injection
    J2940KSomatrem injection2940$43.13$8.63
    J2941KSomatropin injection7034$42.93$8.59
    J2950NPromazine hcl injection
    J2993KReteplase injection9005$898.74$179.75
    J2995KInj streptokinase /250000 IU0911$83.35$16.67
    J2997KAlteplase recombinant7048$30.65$6.13
    J3000NStreptomycin injection
    J3010NFentanyl citrate injeciton
    J3030KSumatriptan succinate / 6 MG3030$51.03$10.21
    J3070NPentazocine hcl injection
    J3100KTenecteplase injection9002$2,052.60$410.52
    J3105NTerbutaline sulfate inj
    J3110BTeriparatide injection
    J3120NTestosterone enanthate inj
    J3130NTestosterone enanthate inj
    J3140NTestosterone suspension inj
    J3150NTestosteron propionate inj
    J3230NChlorpromazine hcl injection
    J3240KThyrotropin injection9108$712.52$142.50
    J3246KTirofiban HCl7041$7.89$1.58
    J3250NTrimethobenzamide hcl inj
    J3260NTobramycin sulfate injection
    J3265NInjection torsemide 10 mg/ml
    J3280NThiethylperazine maleate inj
    J3301NTriamcinolone acetonide inj
    J3302NTriamcinolone diacetate inj
    J3303NTriamcinolone hexacetonl inj
    J3305KInj trimetrexate glucoronate7045$139.84$27.97
    J3310NPerphenazine injeciton
    J3315KTriptorelin pamoate9122$369.95$73.99
    J3320NSpectinomycn di-hcl inj
    J3350KUrea injection90511.0453$62.04$12.41
    J3360NDiazepam injection
    J3364NUrokinase 5000 IU injection
    J3365KUrokinase 250,000 IU inj7036$415.66$83.13
    J3370NVancomycin hcl injection
    J3396KVerteporfin injection1203$9.16$1.83
    J3400NTriflupromazine hcl inj
    J3410NHydroxyzine hcl injection
    J3411NThiamine hcl 100 mg
    J3415NPyridoxine hcl 100 mg
    J3420NVitamin b12 injection
    J3430NVitamin k phytonadione inj
    J3465KInjection, voriconazole1052$4.63$.93
    J3470NHyaluronidase injection
    J3475NInj magnesium sulfate
    J3480NInj potassium chloride
    J3485NZidovudine
    J3486NZiprasidone mesylate
    J3487KZoledronic acid9115$202.39$40.48
    J3490NDrugs unclassified injection
    J3520EEdetate disodium per 150 mg
    J3530NNasal vaccine inhalation
    J3535EMetered dose inhaler drug
    J3570ELaetrile amygdalin vit B17
    J3590NUnclassified biologics
    J7030NNormal saline solution infus
    J7040NNormal saline solution infus
    J7042N5% dextrose/normal saline
    J7050NNormal saline solution infus
    J7051NSterile saline/water
    J7060N5% dextrose/water
    J7070ND5w infusion
    Start Printed Page 42942
    J7100NDextran 40 infusion
    J7110NDextran 75 infusion
    J7120NRingers lactate infusion
    J7130NHypertonic saline solution
    J7190KFactor viii0925$.51$.10
    J7191KFactor VIII (porcine)0926$1.75$.35
    J7192KFactor viii recombinant0927$.94$.19
    J7193KFactor IX non-recombinant0931$.75$.15
    J7194KFactor ix complex0928$.52$.10
    J7195KFactor IX recombinant0932$.86$.17
    J7197NAntithrombin iii injection
    J7198KAnti-inhibitor0929$1.12$.22
    J7199BHemophilia clot factor noc
    J7300EIntraut copper contraceptive
    J7302ELevonorgestrel iu contracept
    J7303EContraceptive vaginal ring
    J7304EContraceptive hormone patch
    J7308KAminolevulinic acid hcl top7308$96.79$19.36
    J7310KGanciclovir long act implant0913$4,318.33$863.67
    J7317KSodium hyaluronate injection7316$110.64$22.13
    J7320KHylan G-F 20 injection1611$203.13$40.63
    J7330BCultured chondrocytes implnt
    J7340EMetabolic active D/E tissue
    J7342KMetabolically active tissue9054$15.69$3.14
    J7343BNonmetabolic act d/e tissue
    J7344KNonmetabolic active tissue9156$53.75$10.75
    J7350KInjectable human tissue9055$3.54$.71
    J7500NAzathioprine oral 50mg
    J7501KAzathioprine parenteral0887$47.39$9.48
    J7502KCyclosporine oral 100 mg0888$3.94$.79
    J7504KLymphocyte immune globulin0890$290.28$58.06
    J7505KMonoclonal antibodies7038$885.29$177.06
    J7506NPrednisone oral
    J7507KTacrolimus oral per 1 MG0891$3.37$.67
    J7509NMethylprednisolone oral
    J7510NPrednisolone oral per 5 mg
    J7511KAntithymocyte globuln rabbit9104$299.45$59.89
    J7513KDaclizumab, parenteral1612$381.45$76.29
    J7515KCyclosporine oral 25 mg7515$1.00$.20
    J7516NCyclosporin parenteral 250mg
    J7517KMycophenolate mofetil oral9015$2.50$.50
    J7518GMycophenolic acid9219$2.47$.49
    J7520KSirolimus, oral9020$6.85$1.37
    J7525KTacrolimus injection9006$126.61$25.32
    J7599NImmunosuppressive drug noc
    J7608YAcetylcysteine inh sol u d
    J7611YAlbuterol concentrated form
    J7612YLevalbuterol concentrated
    J7613YAlbuterol unit dose
    J7614YLevalbuterol unit dose
    J7616YAlbuterol compound solution
    J7617YLevalbuterol compounded sol
    J7622ABeclomethasone inhalatn sol
    J7624ABetamethasone inhalation sol
    J7626ABudesonide inhalation sol
    J7628YBitolterol mes inhal sol con
    J7629YBitolterol mes inh sol u d
    J7631YCromolyn sodium inh sol u d
    J7633NBudesonide concentrated sol
    J7635YAtropine inhal sol con
    J7636YAtropine inhal sol unit dose
    J7637YDexamethasone inhal sol con
    J7638YDexamethasone inhal sol u d
    J7639YDornase alpha inhal sol u d
    J7641AFlunisolide, inhalation sol
    J7642YGlycopyrrolate inhal sol con
    Start Printed Page 42943
    J7643YGlycopyrrolate inhal sol u d
    J7644YIpratropium brom inh sol u d
    J7648YIsoetharine hcl inh sol con
    J7649YIsoetharine hcl inh sol u d
    J7658YIsoproterenolhcl inh sol con
    J7659YIsoproterenol hcl inh sol ud
    J7668YMetaproterenol inh sol con
    J7669YMetaproterenol inh sol u d
    J7674NMethacholine chloride, neb
    J7680YTerbutaline so4 inh sol con
    J7681YTerbutaline so4 inh sol u d
    J7682YTobramycin inhalation sol
    J7683YTriamcinolone inh sol con
    J7684YTriamcinolone inh sol u d
    J7699YInhalation solution for DME
    J7799YNon-inhalation drug for DME
    J8499EOral prescrip drug non chemo
    J8501GOral aprepitant0868$4.75$.95
    J8510KOral busulfan7015$1.98$.40
    J8520KCapecitabine, oral, 150 mg7042$3.30$.66
    J8521ECapecitabine, oral, 500 mg
    J8530NCyclophosphamide oral 25 MG
    J8560KEtoposide oral 50 MG0802$41.12$8.22
    J8565EGefitinib oral
    J8600NMelphalan oral 2 MG
    J8610NMethotrexate oral 2.5 MG
    J8700KTemozolomide1086$7.28$1.46
    J8999BOral prescription drug chemo
    J9000NDoxorubic hcl 10 MG vl chemo
    J9001KDoxorubicin hcl liposome inj7046$365.61$73.12
    J9010KAlemtuzumab injection9110$516.83$103.37
    J9015KAldesleukin/single use vial0807$701.71$140.34
    J9017KArsenic trioxide9012$33.76$6.75
    J9020KAsparaginase injection0814$55.41$11.08
    J9031KBcg live intravesical vac0809$121.74$24.35
    J9035GBevacizumab injection9214$58.17$11.63
    J9040KBleomycin sulfate injection0857$54.17$10.83
    J9041KBortezomib injection9207$28.90$5.78
    J9045KCarboplatin injection0811$77.15$15.43
    J9050KCarmus bischl nitro inj0812$141.27$28.25
    J9055GCetuximab injection9215$50.58$10.12
    J9060NCisplatin 10 MG injection
    J9062BCisplatin 50 MG injection
    J9065KInj cladribine per 1 MG0858$39.37$7.87
    J9070NCyclophosphamide 100 MG inj
    J9080BCyclophosphamide 200 MG inj
    J9090BCyclophosphamide 500 MG inj
    J9091BCyclophosphamide 1.0 grm inj
    J9092BCyclophosphamide 2.0 grm inj
    J9093NCyclophosphamide lyophilized
    J9094BCyclophosphamide lyophilized
    J9095BCyclophosphamide lyophilized
    J9096BCyclophosphamide lyophilized
    J9097BCyclophosphamide lyophilized
    J9098KCytarabine liposome1166$366.40$73.28
    J9100NCytarabine hcl 100 MG inj
    J9110BCytarabine hcl 500 MG inj
    J9120NDactinomycin actinomycin d
    J9130KDacarbazine 100 mg inj0819$6.20$1.24
    J9140BDacarbazine 200 MG inj
    J9150KDaunorubicin0820$35.28$7.06
    J9151KDaunorubicin citrate liposom0821$57.55$11.51
    J9160KDenileukin diftitox, 300 mcg1084$1,235.23$247.05
    J9165NDiethylstilbestrol injection
    J9170KDocetaxel0823$301.15$60.23
    J9178KInj, epirubicin hcl, 2 mg1167$25.15$5.03
    Start Printed Page 42944
    J9181NEtoposide 10 MG inj
    J9182BEtoposide 100 MG inj
    J9185KFludarabine phosphate inj0842$262.39$52.48
    J9190NFluorouracil injection
    J9200KFloxuridine injection0827$60.16$12.03
    J9201KGemcitabine HCl0828$117.44$23.49
    J9202KGoserelin acetate implant0810$196.24$39.25
    J9206KIrinotecan injection0830$129.07$25.81
    J9208KIfosfomide injection0831$53.53$10.71
    J9209KMesna injection0732$13.68$2.74
    J9211KIdarubicin hcl injection0832$313.97$62.79
    J9212KInterferon alfacon-10912$3.91$.78
    J9213KInterferon alfa-2a inj0834$31.75$6.35
    J9214KInterferon alfa-2b inj0836$13.22$2.64
    J9215KInterferon alfa-n3 inj0865$8.77$1.75
    J9216KInterferon gamma 1-b inj0838$277.77$55.55
    J9217KLeuprolide acetate suspnsion9217$230.85$46.17
    J9218KLeuprolide acetate injeciton0861$10.96$2.19
    J9219KLeuprolide acetate implant7051$2,262.01$452.40
    J9230NMechlorethamine hcl inj
    J9245KInj melphalan hydrochl 50 MG0840$523.18$104.64
    J9250NMethotrexate sodium inj
    J9260BMethotrexate sodium inj
    J9263BOxaliplatin
    J9265KPaclitaxel injection0863$19.11$3.82
    J9266KPegaspargase/singl dose vial0843$1,528.67$305.73
    J9268KPentostatin injection0844$1,868.76$373.75
    J9270KPlicamycin (mithramycin) inj0860$80.54$16.11
    J9280KMitomycin 5 MG inj0862$26.36$5.27
    J9290BMitomycin 20 MG inj
    J9291BMitomycin 40 MG inj
    J9293KMitoxantrone hydrochl / 5 MG0864$329.66$65.93
    J9300KGemtuzumab ozogamicin9004$2,244.86$448.97
    J9305GPemetrexed injection9213$41.29$8.26
    J9310KRituximab cancer treatment0849$447.93$89.59
    J9320KStreptozocin injection0850$153.31$30.66
    J9340KThiotepa injection0851$44.55$8.91
    J9350KTopotecan0852$755.44$151.09
    J9355KTrastuzumab1613$53.97$10.79
    J9357KValrubicin, 200 mg9167$376.83$75.37
    J9360NVinblastine sulfate inj
    J9370NVincristine sulfate 1 MG inj
    J9375BVincristine sulfate 2 MG inj
    J9380BVincristine sulfate 5 MG inj
    J9390KVinorelbine tartrate/10 mg0855$62.84$12.57
    J9395KInjection, Fulvestrant9120$82.90$16.58
    J9600KPorfimer sodium0856$2,457.78$491.56
    J9999NChemotherapy drug
    K0001YStandard wheelchair
    K0002YStnd hemi (low seat) whlchr
    K0003YLightweight wheelchair
    K0004YHigh strength ltwt whlchr
    K0005YUltralightweight wheelchair
    K0006YHeavy duty wheelchair
    K0007YExtra heavy duty wheelchair
    K0009YOther manual wheelchair/base
    K0010YStnd wt frame power whlchr
    K0011YStnd wt pwr whlchr w control
    K0012YLtwt portbl power whlchr
    K0014YOther power whlchr base
    K0015YDetach non-adjus hght armrst
    K0017YDetach adjust armrest base
    K0018YDetach adjust armrst upper
    K0019YArm pad each
    K0020YFixed adjust armrest pair
    K0037YHigh mount flip-up footrest
    Start Printed Page 42945
    K0038YLeg strap each
    K0039YLeg strap h style each
    K0040YAdjustable angle footplate
    K0041YLarge size footplate each
    K0042YStandard size footplate each
    K0043YFtrst lower extension tube
    K0044YFtrst upper hanger bracket
    K0045YFootrest complete assembly
    K0046YElevat legrst low extension
    K0047YElevat legrst up hangr brack
    K0050YRatchet assembly
    K0051YCam relese assem ftrst/lgrst
    K0052YSwingaway detach footrest
    K0053YElevate footrest articulate
    K0056YSeat ht >17 or <=21 ltwt wc
    K0064YZero pressure tube flat free
    K0065YSpoke protectors
    K0066YSolid tire any size each
    K0067YPneumatic tire any size each
    K0068YPneumatic tire tube each
    K0069YRear whl complete solid tire
    K0070YRear whl compl pneum tire
    K0071YFront castr compl pneum tire
    K0072YFrnt cstr cmpl sem-pneum tir
    K0073YCaster pin lock each
    K0074YPneumatic caster tire each
    K0075YSemi-pneumatic caster tire
    K0076YSolid caster tire each
    K0077YFront caster assem complete
    K0078YPneumatic caster tire tube
    K0090YRear tire power wheelchair
    K0091YRear tire tube power whlchr
    K0092YRear assem cmplt powr whlchr
    K0093YRear zero pressure tire tube
    K0094YWheel tire for power base
    K0095YWheel tire tube each base
    K0096YWheel assem powr base complt
    K0097YWheel zero presure tire tube
    K0098YDrive belt power wheelchair
    K0099YPwr wheelchair front caster
    K0102YCrutch and cane holder
    K0104YCylinder tank carrier
    K0105YIv hanger
    K0106YArm trough each
    K0108YW/c component-accessory NOS
    K0195YElevating whlchair leg rests
    K0415BRX antiemetic drg, oral NOS
    K0416BRx antiemetic drg,rectal NOS
    K0452YWheelchair bearings
    K0455YPump uninterrupted infusion
    K0462YTemporary replacement eqpmnt
    K0552YSupply/Ext inf pump syr type
    K0600YFunctional neuromuscularstim
    K0601YRepl batt silver oxide 1.5 v
    K0602YRepl batt silver oxide 3 v
    K0603YRepl batt alkaline 1.5 v
    K0604YRepl batt lithium 3.6 v
    K0605YRepl batt lithium 4.5 v
    K0606YAED garment w/elec analysis
    K0607YRepl batt for AED
    K0608YRepl garment for AED
    K0609YRepl electrode for AED
    K0618ATLSO 2 piece rigid shell
    K0619ATLSO 3 piece rigid shell
    K0620ATubular elastic dressing
    K0628YMult dens insert direct form
    Start Printed Page 42946
    K0629YMult dens insert custom mold
    K0630YSIO flex pelvisacral prefab
    K0631YSIO flex pelvisacral custom
    K0632YSIO panel prefab
    K0633YSIO panel custom
    K0634YLO flexibl L1 - below L5 pre
    K0635YLO sag stays/panels pre-fab
    K0636YLO sagitt rigid panel prefab
    K0637YLO flex w/o rigid stays pre
    K0638YLSO flex w/rigid stays cust
    K0639YLSO post rigid panel pre
    K0640YLSO sag-coro rigid frame pre
    K0641YLSO sag-cor rigid frame cust
    K0642YLSO flexion control prefab
    K0643YLSO flexion control custom
    K0644YLSO sagit rigid panel prefab
    K0645YLSO sagittal rigid panel cus
    K0646YLSO sag-coronal panel prefab
    K0647YLSO sag-coronal panel custom
    K0648YLSO s/c shell/panel prefab
    K0649YLSO s/c shell/panel custom
    K0669YW/c seat/back no CVR SADMERC
    K0670AStance phase only
    K0671YPortable oxygen concentrator
    L0100ACranial orthosis/helmet mold
    L0110ACranial orthosis/helmet nonm
    L0112ACranial cervical orthosis
    L0120ACerv flexible non-adjustable
    L0130AFlex thermoplastic collar mo
    L0140ACervical semi-rigid adjustab
    L0150ACerv semi-rig adj molded chn
    L0160ACerv semi-rig wire occ/mand
    L0170ACervical collar molded to pt
    L0172ACerv col thermplas foam 2 pi
    L0174ACerv col foam 2 piece w thor
    L0180ACer post col occ/man sup adj
    L0190ACerv collar supp adj cerv ba
    L0200ACerv col supp adj bar & thor
    L0210AThoracic rib belt
    L0220AThor rib belt custom fabrica
    L0430ADewall posture protector
    L0450ATLSO flex prefab thoracic
    L0452Atlso flex custom fab thoraci
    L0454ATLSO flex prefab sacrococ-T9
    L0456ATLSO flex prefab
    L0458ATLSO 2Mod symphis-xipho pre
    L0460ATLSO2Mod symphysis-stern pre
    L0462ATLSO 3Mod sacro-scap pre
    L0464ATLSO 4Mod sacro-scap pre
    L0466ATLSO rigid frame pre soft ap
    L0468ATLSO rigid frame prefab pelv
    L0470ATLSO rigid frame pre subclav
    L0472ATLSO rigid frame hyperex pre
    L0480ATLSO rigid plastic custom fa
    L0482ATLSO rigid lined custom fab
    L0484ATLSO rigid plastic cust fab
    L0486ATLSO rigidlined cust fab two
    L0488ATLSO rigid lined pre one pie
    L0490ATLSO rigid plastic pre one
    L0700ACtlso a-p-l control molded
    L0710ACtlso a-p-l control w/ inter
    L0810AHalo cervical into jckt vest
    L0820AHalo cervical into body jack
    L0830AHalo cerv into milwaukee typ
    L0860AMagnetic resonanc image comp
    L0861AHalo repl liner/interface
    Start Printed Page 42947
    L0960EPost surgical support pads
    L0970ATlso corset front
    L0972ALso corset front
    L0974ATlso full corset
    L0976ALso full corset
    L0978AAxillary crutch extension
    L0980APeroneal straps pair
    L0982AStocking supp grips set of f
    L0984AProtective body sock each
    L0999AAdd to spinal orthosis NOS
    L1000ACtlso milwauke initial model
    L1005ATension based scoliosis orth
    L1010ACtlso axilla sling
    L1020AKyphosis pad
    L1025AKyphosis pad floating
    L1030ALumbar bolster pad
    L1040ALumbar or lumbar rib pad
    L1050ASternal pad
    L1060AThoracic pad
    L1070ATrapezius sling
    L1080AOutrigger
    L1085AOutrigger bil w/ vert extens
    L1090ALumbar sling
    L1100ARing flange plastic/leather
    L1110ARing flange plas/leather mol
    L1120ACovers for upright each
    L1200AFurnsh initial orthosis only
    L1210ALateral thoracic extension
    L1220AAnterior thoracic extension
    L1230AMilwaukee type superstructur
    L1240ALumbar derotation pad
    L1250AAnterior asis pad
    L1260AAnterior thoracic derotation
    L1270AAbdominal pad
    L1280ARib gusset (elastic) each
    L1290ALateral trochanteric pad
    L1300ABody jacket mold to patient
    L1310APost-operative body jacket
    L1499ASpinal orthosis NOS
    L1500AThkao mobility frame
    L1510AThkao standing frame
    L1520AThkao swivel walker
    L1600AAbduct hip flex frejka w cvr
    L1610AAbduct hip flex frejka covr
    L1620AAbduct hip flex pavlik harne
    L1630AAbduct control hip semi-flex
    L1640APelv band/spread bar thigh c
    L1650AHO abduction hip adjustable
    L1652AHO bi thighcuffs w sprdr bar
    L1660AHO abduction static plastic
    L1680APelvic & hip control thigh c
    L1685APost-op hip abduct custom fa
    L1686AHO post-op hip abduction
    L1690ACombination bilateral HO
    L1700ALeg perthes orth toronto typ
    L1710ALegg perthes orth newington
    L1720ALegg perthes orthosis trilat
    L1730ALegg perthes orth scottish r
    L1750ALegg perthes sling
    L1755ALegg perthes patten bottom t
    L1800AKnee orthoses elas w stays
    L1810AKo elastic with joints
    L1815AElastic with condylar pads
    L1820AKo elas w/ condyle pads & jo
    L1825AKo elastic knee cap
    L1830AKo immobilizer canvas longit
    Start Printed Page 42948
    L1831AKnee orth pos locking joint
    L1832AKO adj jnt pos rigid support
    L1834AKo w/0 joint rigid molded to
    L1836ARigid KO wo joints
    L1840AKo derot ant cruciate custom
    L1843AKO single upright custom fit
    L1844AKo w/adj jt rot cntrl molded
    L1845AKo w/ adj flex/ext rotat cus
    L1846AKo w adj flex/ext rotat mold
    L1847AKO adjustable w air chambers
    L1850AKo swedish type
    L1855AKo plas doub upright jnt mol
    L1858AKo polycentric pneumatic pad
    L1860AKo supracondylar socket mold
    L1870AKo doub upright lacers molde
    L1880AKo doub upright cuffs/lacers
    L1900AAfo sprng wir drsflx calf bd
    L1901APrefab ankle orthosis
    L1902AAfo ankle gauntlet
    L1904AAfo molded ankle gauntlet
    L1906AAfo multiligamentus ankle su
    L1907AAFO supramalleolar custom
    L1910AAfo sing bar clasp attach sh
    L1920AAfo sing upright w/ adjust s
    L1930AAfo plastic
    L1932AAfo rig ant tib prefab TCF/=
    L1940AAfo molded to patient plasti
    L1945AAfo molded plas rig ant tib
    L1950AAfo spiral molded to pt plas
    L1951AAFO spiral prefabricated
    L1960AAfo pos solid ank plastic mo
    L1970AAfo plastic molded w/ankle j
    L1971AAFO w/ankle joint, prefab
    L1980AAfo sing solid stirrup calf
    L1990AAfo doub solid stirrup calf
    L2000AKafo sing fre stirr thi/calf
    L2005AKAFO sng/dbl mechanical act
    L2010AKafo sng solid stirrup w/o j
    L2020AKafo dbl solid stirrup band/
    L2030AKafo dbl solid stirrup w/o j
    L2035AKAFO plastic pediatric size
    L2036AKafo plas doub free knee mol
    L2037AKafo plas sing free knee mol
    L2038AKafo w/o joint multi-axis an
    L2039AKAFO,plstic,medlat rotat con
    L2040AHkafo torsion bil rot straps
    L2050AHkafo torsion cable hip pelv
    L2060AHkafo torsion ball bearing j
    L2070AHkafo torsion unilat rot str
    L2080AHkafo unilat torsion cable
    L2090AHkafo unilat torsion ball br
    L2106AAfo tib fx cast plaster mold
    L2108AAfo tib fx cast molded to pt
    L2112AAfo tibial fracture soft
    L2114AAfo tib fx semi-rigid
    L2116AAfo tibial fracture rigid
    L2126AKafo fem fx cast thermoplas
    L2128AKafo fem fx cast molded to p
    L2132AKafo femoral fx cast soft
    L2134AKafo fem fx cast semi-rigid
    L2136AKafo femoral fx cast rigid
    L2180APlas shoe insert w ank joint
    L2182ADrop lock knee
    L2184ALimited motion knee joint
    L2186AAdj motion knee jnt lerman t
    L2188AQuadrilateral brim
    Start Printed Page 42949
    L2190AWaist belt
    L2192APelvic band & belt thigh fla
    L2200ALimited ankle motion ea jnt
    L2210ADorsiflexion assist each joi
    L2220ADorsi & plantar flex ass/res
    L2230ASplit flat caliper stirr & p
    L2232ARocker bottom, contact AFO
    L2240ARound caliper and plate atta
    L2250AFoot plate molded stirrup at
    L2260AReinforced solid stirrup
    L2265ALong tongue stirrup
    L2270AVarus/valgus strap padded/li
    L2275APlastic mod low ext pad/line
    L2280AMolded inner boot
    L2300AAbduction bar jointed adjust
    L2310AAbduction bar-straight
    L2320ANon-molded lacer
    L2330ALacer molded to patient mode
    L2335AAnterior swing band
    L2340APre-tibial shell molded to p
    L2350AProsthetic type socket molde
    L2360AExtended steel shank
    L2370APatten bottom
    L2375ATorsion ank & half solid sti
    L2380ATorsion straight knee joint
    L2385AStraight knee joint heavy du
    L2390AOffset knee joint each
    L2395AOffset knee joint heavy duty
    L2397ASuspension sleeve lower ext
    L2405AKnee joint drop lock ea jnt
    L2415AKnee joint cam lock each joi
    L2425AKnee disc/dial lock/adj flex
    L2430AKnee jnt ratchet lock ea jnt
    L2492AKnee lift loop drop lock rin
    L2500AThi/glut/ischia wgt bearing
    L2510ATh/wght bear quad-lat brim m
    L2520ATh/wght bear quad-lat brim c
    L2525ATh/wght bear nar m-l brim mo
    L2526ATh/wght bear nar m-l brim cu
    L2530AThigh/wght bear lacer non-mo
    L2540AThigh/wght bear lacer molded
    L2550AThigh/wght bear high roll cu
    L2570AHip clevis type 2 posit jnt
    L2580APelvic control pelvic sling
    L2600AHip clevis/thrust bearing fr
    L2610AHip clevis/thrust bearing lo
    L2620APelvic control hip heavy dut
    L2622AHip joint adjustable flexion
    L2624AHip adj flex ext abduct cont
    L2627APlastic mold recipro hip & c
    L2628AMetal frame recipro hip & ca
    L2630APelvic control band & belt u
    L2640APelvic control band & belt b
    L2650APelv & thor control gluteal
    L2660AThoracic control thoracic ba
    L2670AThorac cont paraspinal uprig
    L2680AThorac cont lat support upri
    L2750APlating chrome/nickel pr bar
    L2755ACarbon graphite lamination
    L2760AExtension per extension per
    L2768AOrtho sidebar disconnect
    L2770ALow ext orthosis per bar/jnt
    L2780ANon-corrosive finish
    L2785ADrop lock retainer each
    L2795AKnee control full kneecap
    L2800AKnee cap medial or lateral p
    Start Printed Page 42950
    L2810AKnee control condylar pad
    L2820ASoft interface below knee se
    L2830ASoft interface above knee se
    L2840ATibial length sock fx or equ
    L2850AFemoral lgth sock fx or equa
    L2860ATorsion mechanism knee/ankle
    L2999ALower extremity orthosis NOS
    L3000BFt insert ucb berkeley shell
    L3001BFoot insert remov molded spe
    L3002BFoot insert plastazote or eq
    L3003BFoot insert silicone gel eac
    L3010BFoot longitudinal arch suppo
    L3020BFoot longitud/metatarsal sup
    L3030BFoot arch support remov prem
    L3031EFoot lamin/prepreg composite
    L3040BFt arch suprt premold longit
    L3050BFoot arch supp premold metat
    L3060BFoot arch supp longitud/meta
    L3070BArch suprt att to sho longit
    L3080BArch supp att to shoe metata
    L3090BArch supp att to shoe long/m
    L3100BHallus-valgus nght dynamic s
    L3140BAbduction rotation bar shoe
    L3150BAbduct rotation bar w/o shoe
    L3160BShoe styled positioning dev
    L3170BFoot plastic heel stabilizer
    L3201BOxford w supinat/pronat inf
    L3202BOxford w/ supinat/pronator c
    L3203BOxford w/ supinator/pronator
    L3204BHightop w/ supp/pronator inf
    L3206BHightop w/ supp/pronator chi
    L3207BHightop w/ supp/pronator jun
    L3208BSurgical boot each infant
    L3209BSurgical boot each child
    L3211BSurgical boot each junior
    L3212BBenesch boot pair infant
    L3213BBenesch boot pair child
    L3214BBenesch boot pair junior
    L3215BOrthopedic ftwear ladies oxf
    L3216BOrthoped ladies shoes dpth i
    L3217BLadies shoes hightop depth i
    L3219BOrthopedic mens shoes oxford
    L3221BOrthopedic mens shoes dpth i
    L3222BMens shoes hightop depth inl
    L3224AWomans shoe oxford brace
    L3225AMans shoe oxford brace
    L3230BCustom shoes depth inlay
    L3250BCustom mold shoe remov prost
    L3251BShoe molded to pt silicone s
    L3252BShoe molded plastazote cust
    L3253BShoe molded plastazote cust
    L3254BOrth foot non-stndard size/w
    L3255BOrth foot non-standard size/
    L3257BOrth foot add charge split s
    L3260BAmbulatory surgical boot eac
    L3265BPlastazote sandal each
    L3300BSho lift taper to metatarsal
    L3310BShoe lift elev heel/sole neo
    L3320BShoe lift elev heel/sole cor
    L3330BLifts elevation metal extens
    L3332BShoe lifts tapered to one-ha
    L3334BShoe lifts elevation heel /i
    L3340BShoe wedge sach
    L3350BShoe heel wedge
    L3360BShoe sole wedge outside sole
    L3370BShoe sole wedge between sole
    Start Printed Page 42951
    L3380BShoe clubfoot wedge
    L3390BShoe outflare wedge
    L3400BShoe metatarsal bar wedge ro
    L3410BShoe metatarsal bar between
    L3420BFull sole/heel wedge btween
    L3430BSho heel count plast reinfor
    L3440BHeel leather reinforced
    L3450BShoe heel sach cushion type
    L3455BShoe heel new leather standa
    L3460BShoe heel new rubber standar
    L3465BShoe heel thomas with wedge
    L3470BShoe heel thomas extend to b
    L3480BShoe heel pad & depress for
    L3485BShoe heel pad removable for
    L3500BOrtho shoe add leather insol
    L3510BOrthopedic shoe add rub insl
    L3520BO shoe add felt w leath insl
    L3530BOrtho shoe add half sole
    L3540BOrtho shoe add full sole
    L3550BO shoe add standard toe tap
    L3560BO shoe add horseshoe toe tap
    L3570BO shoe add instep extension
    L3580BO shoe add instep velcro clo
    L3590BO shoe convert to sof counte
    L3595BOrtho shoe add march bar
    L3600BTrans shoe calip plate exist
    L3610BTrans shoe caliper plate new
    L3620BTrans shoe solid stirrup exi
    L3630BTrans shoe solid stirrup new
    L3640BShoe dennis browne splint bo
    L3649BOrthopedic shoe modifica NOS
    L3650AShlder fig 8 abduct restrain
    L3651APrefab shoulder orthosis
    L3652APrefab dbl shoulder orthosis
    L3660AAbduct restrainer canvas&web
    L3670AAcromio/clavicular canvas&we
    L3675ACanvas vest SO
    L3677ESO hard plastic stabilizer
    L3700AElbow orthoses elas w stays
    L3701APrefab elbow orthosis
    L3710AElbow elastic with metal joi
    L3720AForearm/arm cuffs free motio
    L3730AForearm/arm cuffs ext/flex a
    L3740ACuffs adj lock w/ active con
    L3760AEO withjoint, Prefabricated
    L3762ARigid EO wo joints
    L3800AWhfo short opponen no attach
    L3805AWhfo long opponens no attach
    L3807AWHFO,no joint, prefabricated
    L3810AWhfo thumb abduction bar
    L3815AWhfo second m.p. abduction a
    L3820AWhfo ip ext asst w/ mp ext s
    L3825AWhfo m.p. extension stop
    L3830AWhfo m.p. extension assist
    L3835AWhfo m.p. spring extension a
    L3840AWhfo spring swivel thumb
    L3845AWhfo thumb ip ext ass w/ mp
    L3850AAction wrist w/ dorsiflex as
    L3855AWhfo adj m.p. flexion contro
    L3860AWhfo adj m.p. flex ctrl & i.
    L3890BTorsion mechanism wrist/elbo
    L3900AHinge extension/flex wrist/f
    L3901AHinge ext/flex wrist finger
    L3902EWhfo ext power compress gas
    L3904AWhfo electric custom fitted
    L3906AWrist gauntlet molded to pt
    Start Printed Page 42952
    L3907AWhfo wrst gauntlt thmb spica
    L3908AWrist cock-up non-molded
    L3909APrefab wrist orthosis
    L3910AWhfo swanson design
    L3911APrefab hand finger orthosis
    L3912AFlex glove w/elastic finger
    L3914AWHO wrist extension cock-up
    L3916AWhfo wrist extens w/ outrigg
    L3917APrefab metacarpl fx orthosis
    L3918AHFO knuckle bender
    L3920AKnuckle bender with outrigge
    L3922AKnuckle bend 2 seg to flex j
    L3923AHFO, no joint, prefabricated
    L3924AOppenheimer
    L3926AThomas suspension
    L3928AFinger extension w/ clock sp
    L3930AFinger extension with wrist
    L3932ASafety pin spring wire
    L3934ASafety pin modified
    L3936APalmer
    L3938ADorsal wrist
    L3940ADorsal wrist w/ outrigger at
    L3942AReverse knuckle bender
    L3944AReverse knuckle bend w/ outr
    L3946AHFO composite elastic
    L3948AFinger knuckle bender
    L3950AOppenheimer w/ knuckle bend
    L3952AOppenheimer w/ rev knuckle 2
    L3954ASpreading hand
    L3956AAdd joint upper ext orthosis
    L3960ASewho airplan desig abdu pos
    L3962ASewho erbs palsey design abd
    L3963AMolded w/ articulating elbow
    L3964YSeo mobile arm sup att to wc
    L3965YArm supp att to wc rancho ty
    L3966YMobile arm supports reclinin
    L3968YFriction dampening arm supp
    L3969YMonosuspension arm/hand supp
    L3970YElevat proximal arm support
    L3972YOffset/lat rocker arm w/ ela
    L3974YMobile arm support supinator
    L3980AUpp ext fx orthosis humeral
    L3982AUpper ext fx orthosis rad/ul
    L3984AUpper ext fx orthosis wrist
    L3985AForearm hand fx orth w/ wr h
    L3986AHumeral rad/ulna wrist fx or
    L3995ASock fracture or equal each
    L3999AUpper limb orthosis NOS
    L4000ARepl girdle milwaukee orth
    L4002AReplace strap, any orthosis
    L4010AReplace trilateral socket br
    L4020AReplace quadlat socket brim
    L4030AReplace socket brim cust fit
    L4040AReplace molded thigh lacer
    L4045AReplace non-molded thigh lac
    L4050AReplace molded calf lacer
    L4055AReplace non-molded calf lace
    L4060AReplace high roll cuff
    L4070AReplace prox & dist upright
    L4080ARepl met band kafo-afo prox
    L4090ARepl met band kafo-afo calf/
    L4100ARepl leath cuff kafo prox th
    L4110ARepl leath cuff kafo-afo cal
    L4130AReplace pretibial shell
    L4205AOrtho dvc repair per 15 min
    L4210AOrth dev repair/repl minor p
    Start Printed Page 42953
    L4350AAnkle control orthosi prefab
    L4360APneumati walking boot prefab
    L4370APneumatic full leg splint
    L4380APneumatic knee splint
    L4386ANon-pneum walk boot prefab
    L4392AReplace AFO soft interface
    L4394AReplace foot drop spint
    L4396AStatic AFO
    L4398AFoot drop splint recumbent
    L5000ASho insert w arch toe filler
    L5010AMold socket ank hgt w/ toe f
    L5020ATibial tubercle hgt w/ toe f
    L5050AAnk symes mold sckt sach ft
    L5060ASymes met fr leath socket ar
    L5100AMolded socket shin sach foot
    L5105APlast socket jts/thgh lacer
    L5150AMold sckt ext knee shin sach
    L5160AMold socket bent knee shin s
    L5200AKne sing axis fric shin sach
    L5210ANo knee/ankle joints w/ ft b
    L5220ANo knee joint with artic ali
    L5230AFem focal defic constant fri
    L5250AHip canad sing axi cons fric
    L5270ATilt table locking hip sing
    L5280AHemipelvect canad sing axis
    L5301ABK mold socket SACH ft endo
    L5311AKnee disart, SACH ft, endo
    L5321AAK open end SACH
    L5331AHip disart canadian SACH ft
    L5341AHemipelvectomy canadian SACH
    L5400APostop dress & 1 cast chg bk
    L5410APostop dsg bk ea add cast ch
    L5420APostop dsg & 1 cast chg ak/d
    L5430APostop dsg ak ea add cast ch
    L5450APostop app non-wgt bear dsg
    L5460APostop app non-wgt bear dsg
    L5500AInit bk ptb plaster direct
    L5505AInit ak ischal plstr direct
    L5510APrep BK ptb plaster molded
    L5520APerp BK ptb thermopls direct
    L5530APrep BK ptb thermopls molded
    L5535APrep BK ptb open end socket
    L5540APrep BK ptb laminated socket
    L5560APrep AK ischial plast molded
    L5570APrep AK ischial direct form
    L5580APrep AK ischial thermo mold
    L5585APrep AK ischial open end
    L5590APrep AK ischial laminated
    L5595AHip disartic sach thermopls
    L5600AHip disart sach laminat mold
    L5610AAbove knee hydracadence
    L5611AAk 4 bar link w/fric swing
    L5613AAk 4 bar ling w/hydraul swig
    L5614A4-bar link above knee w/swng
    L5616AAk univ multiplex sys frict
    L5617AAK/BK self-aligning unit ea
    L5618ATest socket symes
    L5620ATest socket below knee
    L5622ATest socket knee disarticula
    L5624ATest socket above knee
    L5626ATest socket hip disarticulat
    L5628ATest socket hemipelvectomy
    L5629ABelow knee acrylic socket
    L5630ASyme typ expandabl wall sckt
    L5631AAk/knee disartic acrylic soc
    L5632ASymes type ptb brim design s
    Start Printed Page 42954
    L5634ASymes type poster opening so
    L5636ASymes type medial opening so
    L5637ABelow knee total contact
    L5638ABelow knee leather socket
    L5639ABelow knee wood socket
    L5640AKnee disarticulat leather so
    L5642AAbove knee leather socket
    L5643AHip flex inner socket ext fr
    L5644AAbove knee wood socket
    L5645ABk flex inner socket ext fra
    L5646ABelow knee cushion socket
    L5647ABelow knee suction socket
    L5648AAbove knee cushion socket
    L5649AIsch containmt/narrow m-l so
    L5650ATot contact ak/knee disart s
    L5651AAk flex inner socket ext fra
    L5652ASuction susp ak/knee disart
    L5653AKnee disart expand wall sock
    L5654ASocket insert symes
    L5655ASocket insert below knee
    L5656ASocket insert knee articulat
    L5658ASocket insert above knee
    L5661AMulti-durometer symes
    L5665AMulti-durometer below knee
    L5666ABelow knee cuff suspension
    L5668ASocket insert w/o lock lower
    L5670ABk molded supracondylar susp
    L5671ABK/AK locking mechanism
    L5672ABk removable medial brim sus
    L5673ASocket insert w lock mech
    L5676ABk knee joints single axis p
    L5677ABk knee joints polycentric p
    L5678ABk joint covers pair
    L5679ASocket insert w/o lock mech
    L5680ABk thigh lacer non-molded
    L5681AIntl custm cong/latyp insert
    L5682ABk thigh lacer glut/ischia m
    L5683AInitial custom socket insert
    L5684ABk fork strap
    L5685ABelow knee sus/seal sleeve
    L5686ABk back check
    L5688ABk waist belt webbing
    L5690ABk waist belt padded and lin
    L5692AAk pelvic control belt light
    L5694AAk pelvic control belt pad/l
    L5695AAk sleeve susp neoprene/equa
    L5696AAk/knee disartic pelvic join
    L5697AAk/knee disartic pelvic band
    L5698AAk/knee disartic silesian ba
    L5699AShoulder harness
    L5700AReplace socket below knee
    L5701AReplace socket above knee
    L5702AReplace socket hip
    L5704ACustom shape cover BK
    L5705ACustom shape cover AK
    L5706ACustom shape cvr knee disart
    L5707ACustom shape cvr hip disart
    L5710AKne-shin exo sng axi mnl loc
    L5711AKnee-shin exo mnl lock ultra
    L5712AKnee-shin exo frict swg & st
    L5714AKnee-shin exo variable frict
    L5716AKnee-shin exo mech stance ph
    L5718AKnee-shin exo frct swg & sta
    L5722AKnee-shin pneum swg frct exo
    L5724AKnee-shin exo fluid swing ph
    L5726AKnee-shin ext jnts fld swg e
    Start Printed Page 42955
    L5728AKnee-shin fluid swg & stance
    L5780AKnee-shin pneum/hydra pneum
    L5781ALower limb pros vacuum pump
    L5782AHD low limb pros vacuum pump
    L5785AExoskeletal bk ultralt mater
    L5790AExoskeletal ak ultra-light m
    L5795AExoskel hip ultra-light mate
    L5810AEndoskel knee-shin mnl lock
    L5811AEndo knee-shin mnl lck ultra
    L5812AEndo knee-shin frct swg & st
    L5814AEndo knee-shin hydral swg ph
    L5816AEndo knee-shin polyc mch sta
    L5818AEndo knee-shin frct swg & st
    L5822AEndo knee-shin pneum swg frc
    L5824AEndo knee-shin fluid swing p
    L5826AMiniature knee joint
    L5828AEndo knee-shin fluid swg/sta
    L5830AEndo knee-shin pneum/swg pha
    L5840AMulti-axial knee/shin system
    L5845AKnee-shin sys stance flexion
    L5848AKnee-shin sys hydraul stance
    L5850AEndo ak/hip knee extens assi
    L5855AMech hip extension assist
    L5856AElec knee-shin swing/stance
    L5857AElec knee-shin swing only
    L5910AEndo below knee alignable sy
    L5920AEndo ak/hip alignable system
    L5925AAbove knee manual lock
    L5930AHigh activity knee frame
    L5940AEndo bk ultra-light material
    L5950AEndo ak ultra-light material
    L5960AEndo hip ultra-light materia
    L5962ABelow knee flex cover system
    L5964AAbove knee flex cover system
    L5966AHip flexible cover system
    L5968AMultiaxial ankle w dorsiflex
    L5970AFoot external keel sach foot
    L5972AFlexible keel foot
    L5974AFoot single axis ankle/foot
    L5975ACombo ankle/foot prosthesis
    L5976AEnergy storing foot
    L5978AFt prosth multiaxial ankl/ft
    L5979AMulti-axial ankle/ft prosth
    L5980AFlex foot system
    L5981AFlex-walk sys low ext prosth
    L5982AExoskeletal axial rotation u
    L5984AEndoskeletal axial rotation
    L5985ALwr ext dynamic prosth pylon
    L5986AMulti-axial rotation unit
    L5987AShank ft w vert load pylon
    L5988AVertical shock reducing pylo
    L5990AUser adjustable heel height
    L5995ALower ext pros heavyduty fea
    L5999ALowr extremity prosthes NOS
    L6000APar hand robin-aids thum rem
    L6010AHand robin-aids little/ring
    L6020APart hand robin-aids no fing
    L6025APart hand disart myoelectric
    L6050AWrst MLd sck flx hng tri pad
    L6055AWrst mold sock w/exp interfa
    L6100AElb mold sock flex hinge pad
    L6110AElbow mold sock suspension t
    L6120AElbow mold doub splt soc ste
    L6130AElbow stump activated lock h
    L6200AElbow mold outsid lock hinge
    L6205AElbow molded w/ expand inter
    Start Printed Page 42956
    L6250AElbow inter loc elbow forarm
    L6300AShlder disart int lock elbow
    L6310AShoulder passive restor comp
    L6320AShoulder passive restor cap
    L6350AThoracic intern lock elbow
    L6360AThoracic passive restor comp
    L6370AThoracic passive restor cap
    L6380APostop dsg cast chg wrst/elb
    L6382APostop dsg cast chg elb dis/
    L6384APostop dsg cast chg shlder/t
    L6386APostop ea cast chg & realign
    L6388APostop applicat rigid dsg on
    L6400ABelow elbow prosth tiss shap
    L6450AElb disart prosth tiss shap
    L6500AAbove elbow prosth tiss shap
    L6550AShldr disar prosth tiss shap
    L6570AScap thorac prosth tiss shap
    L6580AWrist/elbow bowden cable mol
    L6582AWrist/elbow bowden cbl dir f
    L6584AElbow fair lead cable molded
    L6586AElbow fair lead cable dir fo
    L6588AShdr fair lead cable molded
    L6590AShdr fair lead cable direct
    L6600APolycentric hinge pair
    L6605ASingle pivot hinge pair
    L6610AFlexible metal hinge pair
    L6615ADisconnect locking wrist uni
    L6616ADisconnect insert locking wr
    L6620AFlexion/extension wrist unit
    L6623ASpring-ass rot wrst w/ latch
    L6625ARotation wrst w/ cable lock
    L6628AQuick disconn hook adapter o
    L6629ALamination collar w/ couplin
    L6630AStainless steel any wrist
    L6632ALatex suspension sleeve each
    L6635ALift assist for elbow
    L6637ANudge control elbow lock
    L6638AElec lock on manual pw elbow
    L6640AShoulder abduction joint pai
    L6641AExcursion amplifier pulley t
    L6642AExcursion amplifier lever ty
    L6645AShoulder flexion-abduction j
    L6646AMultipo locking shoulder jnt
    L6647AShoulder lock actuator
    L6648AExt pwrd shlder lock/unlock
    L6650AShoulder universal joint
    L6655AStandard control cable extra
    L6660AHeavy duty control cable
    L6665ATeflon or equal cable lining
    L6670AHook to hand cable adapter
    L6672AHarness chest/shlder saddle
    L6675AHarness figure of 8 sing con
    L6676AHarness figure of 8 dual con
    L6680ATest sock wrist disart/bel e
    L6682ATest sock elbw disart/above
    L6684ATest socket shldr disart/tho
    L6686ASuction socket
    L6687AFrame typ socket bel elbow/w
    L6688AFrame typ sock above elb/dis
    L6689AFrame typ socket shoulder di
    L6690AFrame typ sock interscap-tho
    L6691ARemovable insert each
    L6692ASilicone gel insert or equal
    L6693ALockingelbow forearm cntrbal
    L6694AElbow socket ins use w/lock
    L6695AElbow socket ins use w/o lck
    Start Printed Page 42957
    L6696ACus elbo skt in for con/atyp
    L6697ACus elbo skt in not con/atyp
    L6698ABelow/above elbow lock mech
    L6700ATerminal device model #3
    L6705ATerminal device model #5
    L6710ATerminal device model #5x
    L6715ATerminal device model #5xa
    L6720ATerminal device model #6
    L6725ATerminal device model #7
    L6730ATerminal device model #7lo
    L6735ATerminal device model #8
    L6740ATerminal device model #8x
    L6745ATerminal device model #88x
    L6750ATerminal device model #10p
    L6755ATerminal device model #10x
    L6765ATerminal device model #12p
    L6770ATerminal device model #99x
    L6775ATerminal device model #555
    L6780ATerminal device model #ss555
    L6790AHooks-accu hook or equal
    L6795AHooks-2 load or equal
    L6800AHooks-aprl vc or equal
    L6805AModifier wrist flexion unit
    L6806ATrs grip vc or equal
    L6807ATerm device grip1/2 or equal
    L6808ATerm device infant or child
    L6809ATrs super sport passive
    L6810APincher tool otto bock or eq
    L6825AHands dorrance vo
    L6830AHand aprl vc
    L6835AHand sierra vo
    L6840AHand becker imperial
    L6845AHand becker lock grip
    L6850ATerm dvc-hand becker plylite
    L6855AHand robin-aids vo
    L6860AHand robin-aids vo soft
    L6865AHand passive hand
    L6867AHand detroit infant hand
    L6868APassive inf hand steeper/hos
    L6870AHand child mitt
    L6872AHand nyu child hand
    L6873AHand mech inf steeper or equ
    L6875AHand bock vc
    L6880AHand bock vo
    L6881AAutograsp feature ul term dv
    L6882AMicroprocessor control uplmb
    L6890AProduction glove
    L6895ACustom glove
    L6900AHand restorat thumb/1 finger
    L6905AHand restoration multiple fi
    L6910AHand restoration no fingers
    L6915AHand restoration replacmnt g
    L6920AWrist disarticul switch ctrl
    L6925AWrist disart myoelectronic c
    L6930ABelow elbow switch control
    L6935ABelow elbow myoelectronic ct
    L6940AElbow disarticulation switch
    L6945AElbow disart myoelectronic c
    L6950AAbove elbow switch control
    L6955AAbove elbow myoelectronic ct
    L6960AShldr disartic switch contro
    L6965AShldr disartic myoelectronic
    L6970AInterscapular-thor switch ct
    L6975AInterscap-thor myoelectronic
    L7010AHand otto back steeper/eq sw
    L7015AHand sys teknik village swit
    Start Printed Page 42958
    L7020AElectronic greifer switch ct
    L7025AElectron hand myoelectronic
    L7030AHand sys teknik vill myoelec
    L7035AElectron greifer myoelectro
    L7040APrehensile actuator hosmer s
    L7045AElectron hook child michigan
    L7170AElectronic elbow hosmer swit
    L7180AElectronic elbow utah myoele
    L7181AElectronic elbo simultaneous
    L7185AElectron elbow adolescent sw
    L7186AElectron elbow child switch
    L7190AElbow adolescent myoelectron
    L7191AElbow child myoelectronic ct
    L7260AElectron wrist rotator otto
    L7261AElectron wrist rotator utah
    L7266AServo control steeper or equ
    L7272AAnalogue control unb or equa
    L7274AProportional ctl 12 volt uta
    L7360ASix volt bat otto bock/eq ea
    L7362ABattery chrgr six volt otto
    L7364ATwelve volt battery utah/equ
    L7366ABattery chrgr 12 volt utah/e
    L7367AReplacemnt lithium ionbatter
    L7368ALithium ion battery charger
    L7499AUpper extremity prosthes NOS
    L7500AProsthetic dvc repair hourly
    L7510AProsthetic device repair rep
    L7520ARepair prosthesis per 15 min
    L7900AMale vacuum erection system
    L8000AMastectomy bra
    L8001ABreast prosthesis bra & form
    L8002ABrst prsth bra & bilat form
    L8010AMastectomy sleeve
    L8015AExt breastprosthesis garment
    L8020AMastectomy form
    L8030ABreast prosthesis silicone/e
    L8035ACustom breast prosthesis
    L8039ABreast prosthesis NOS
    L8040ANasal prosthesis
    L8041AMidfacial prosthesis
    L8042AOrbital prosthesis
    L8043AUpper facial prosthesis
    L8044AHemi-facial prosthesis
    L8045AAuricular prosthesis
    L8046APartial facial prosthesis
    L8047ANasal septal prosthesis
    L8048AUnspec maxillofacial prosth
    L8049ARepair maxillofacial prosth
    L8100ECompression stocking BK18-30
    L8110ACompression stocking BK30-40
    L8120ACompression stocking BK40-50
    L8130EGc stocking thighlngth 18-30
    L8140EGc stocking thighlngth 30-40
    L8150EGc stocking thighlngth 40-50
    L8160EGc stocking full lngth 18-30
    L8170EGc stocking full lngth 30-40
    L8180EGc stocking full lngth 40-50
    L8190EGc stocking waistlngth 18-30
    L8195EGc stocking waistlngth 30-40
    L8200EGc stocking waistlngth 40-50
    L8210EGc stocking custom made
    L8220EGc stocking lymphedema
    L8230EGc stocking garter belt
    L8239EG compression stocking NOS
    L8300ATruss single w/ standard pad
    L8310ATruss double w/ standard pad
    Start Printed Page 42959
    L8320ATruss addition to std pad wa
    L8330ATruss add to std pad scrotal
    L8400ASheath below knee
    L8410ASheath above knee
    L8415ASheath upper limb
    L8417APros sheath/sock w gel cushn
    L8420AProsthetic sock multi ply BK
    L8430AProsthetic sock multi ply AK
    L8435APros sock multi ply upper lm
    L8440AShrinker below knee
    L8460AShrinker above knee
    L8465AShrinker upper limb
    L8470APros sock single ply BK
    L8480APros sock single ply AK
    L8485APros sock single ply upper l
    L8499AUnlisted misc prosthetic ser
    L8500AArtificial larynx
    L8501ATracheostomy speaking valve
    L8505AArtificial larynx, accessory
    L8507ATrach-esoph voice pros pt in
    L8509ATrach-esoph voice pros md in
    L8510AVoice amplifier
    L8511AIndwelling trach insert
    L8512AGel cap for trach voice pros
    L8513ATrach pros cleaning device
    L8514ARepl trach puncture dilator
    L8515AGel cap app device for trach
    L8600NImplant breast silicone/eq
    L8603NCollagen imp urinary 2.5 ml
    L8606NSynthetic implnt urinary 1ml
    L8610NOcular implant
    L8612NAqueous shunt prosthesis
    L8613NOssicular implant
    L8614NCochlear device/system
    L8615ACoch implant headset replace
    L8616ACoch implant microphone repl
    L8617ACoch implant trans coil repl
    L8618ACoch implant tran cable repl
    L8619AReplace cochlear processor
    L8620ARepl lithium ion battery
    L8621ARepl zinc air battery
    L8622ARepl alkaline battery
    L8630NMetacarpophalangeal implant
    L8631NMCP joint repl 2 pc or more
    L8641NMetatarsal joint implant
    L8642NHallux implant
    L8658NInterphalangeal joint spacer
    L8659NInterphalangeal joint repl
    L8670NVascular graft, synthetic
    L8699NProsthetic implant NOS
    L9900AO&P supply/accessory/service
    M0064XVisit for drug monitoring03741.0367$61.53$12.31
    M0075ECellular therapy
    M0076EProlotherapy
    M0100EIntragastric hypothermia
    M0300EIV chelationtherapy
    M0301EFabric wrapping of aneurysm
    P2028ACephalin floculation test
    P2029ACongo red blood test
    P2031EHair analysis
    P2033ABlood thymol turbidity
    P2038ABlood mucoprotein
    P3000AScreen pap by tech w md supv
    P3001BScreening pap smear by phys
    P7001ECulture bacterial urine
    P9010KWhole blood for transfusion09502.0032$118.89$23.78
    Start Printed Page 42960
    P9011KBlood split unit09671.2641$75.02$15.00
    P9012KCryoprecipitate each unit09520.7361$43.69$8.74
    P9016KRBC leukocytes reduced09542.7246$161.71$32.34
    P9017KPlasma 1 donor frz w/in 8 hr95081.1983$71.12$14.22
    P9019KPlatelets, each unit09570.8279$49.14$9.83
    P9020KPlaelet rich plasma unit09585.1580$306.13$61.23
    P9021KRed blood cells unit09592.0209$119.94$23.99
    P9022KWashed red blood cells unit09602.9573$175.52$35.10
    P9023KFrozen plasma, pooled, sd09491.1902$70.64$14.13
    P9031KPlatelets leukocytes reduced10131.5950$94.66$18.93
    P9032KPlatelets, irradiated95001.3527$80.28$16.06
    P9033KPlatelets leukoreduced irrad09682.3532$139.66$27.93
    P9034KPlatelets, pheresis95076.8676$407.59$81.52
    P9035KPlatelet pheres leukoreduced95018.1126$481.48$96.30
    P9036KPlatelet pheresis irradiated95025.1660$306.60$61.32
    P9037KPlate pheres leukoredu irrad10199.4700$562.04$112.41
    P9038KRBC irradiated95052.3768$141.06$28.21
    P9039KRBC deglycerolized95046.4022$379.97$75.99
    P9040KRBC leukoreduced irradiated09693.6286$215.36$43.07
    P9041KAlbumin (human),5%, 50ml09610.5119$30.38$6.08
    P9043KPlasma protein fract,5%,50ml09561.1175$66.32$13.26
    P9044KCryoprecipitatereducedplasma10091.3003$77.17$15.43
    P9045KAlbumin (human), 5%, 250 ml09631.3867$82.30$16.46
    P9046KAlbumin (human), 25%, 20 ml09640.4878$28.95$5.79
    P9047KAlbumin (human), 25%, 50ml09651.1115$65.97$13.19
    P9048KPlasmaprotein fract,5%,250ml09664.9340$292.83$58.57
    P9050KGranulocytes, pheresis unit950615.5448$922.58$184.52
    P9051KBlood, l/r, cmv-neg10102.9558$175.43$35.09
    P9052KPlatelets, hla-m, l/r, unit101110.9193$648.06$129.61
    P9053KPlt, pher, l/r cmv-neg, irr102010.1091$599.98$120.00
    P9054KBlood, l/r, froz/degly/wash10165.2392$310.95$62.19
    P9055KPlt, aph/pher, l/r, cmv-neg10178.5608$508.08$101.62
    P9056KBlood, l/r, irradiated10182.7877$165.45$33.09
    P9057KRBC, frz/deg/wsh, l/r, irrad10214.8566$288.24$57.65
    P9058KRBC, l/r, cmv-neg, irrad10224.2707$253.47$50.69
    P9059KPlasma, frz between 8-24hour09551.2876$76.42$15.28
    P9060KFr frz plasma donor retested95031.6167$95.95$19.19
    P9603AOne-way allow prorated miles
    P9604AOne-way allow prorated trip
    P9612NCatheterize for urine spec
    P9615NUrine specimen collect mult
    Q0035XCardiokymography01002.4855$147.51$41.44$29.50
    Q0081BInfusion ther other than che
    Q0083BChemo by other than infusion
    Q0084BChemotherapy by infusion
    Q0085BChemo by both infusion and o
    Q0091TObtaining screen pap smear01910.1663$9.87$2.77$1.97
    Q0092NSet up port xray equipment
    Q0111AWet mounts/ w preparations
    Q0112APotassium hydroxide preps
    Q0113APinworm examinations
    Q0114AFern test
    Q0115APost-coital mucous exam
    Q0136KNon esrd epoetin alpha inj0733$9.99$2.00
    Q0137KDarbepoetin alfa, non esrd0734$3.28$.66
    Q0144EAzithromycin dihydrate, oral
    Q0163NDiphenhydramine HCl 50mg
    Q0164NProchlorperazine maleate 5mg
    Q0165BProchlorperazine maleate10mg
    Q0166KGranisetron HCl 1 mg oral0765$33.50$6.70
    Q0167NDronabinol 2.5mg oral
    Q0168BDronabinol 5mg oral
    Q0169NPromethazine HCl 12.5mg oral
    Q0170BPromethazine HCl 25 mg oral
    Q0171NChlorpromazine HCl 10mg oral
    Q0172BChlorpromazine HCl 25mg oral
    Start Printed Page 42961
    Q0173NTrimethobenzamide HCl 250mg
    Q0174NThiethylperazine maleate10mg
    Q0175NPerphenazine 4mg oral
    Q0176BPerphenazine 8mg oral
    Q0177NHydroxyzine pamoate 25mg
    Q0178BHydroxyzine pamoate 50mg
    Q0179KOndansetron HCl 8mg oral0769$32.02$6.40
    Q0180KDolasetron mesylate oral0763$48.54$9.71
    Q0181EUnspecified oral anti-emetic
    Q0187KFactor viia recombinant1409$1,080.03$216.01
    Q1001NNtiol category 1
    Q1002NNtiol category 2
    Q1003NNtiol category 3
    Q1004NNtiol category 4
    Q1005NNtiol category 5
    Q2001EOral cabergoline 0.5 mg
    Q2002NElliotts b solution per ml
    Q2003KAprotinin, 10,000 kiu7019$2.20$.44
    Q2004NBladder calculi irrig sol
    Q2005KCorticorelin ovine triflutat7024$386.49$77.30
    Q2006KDigoxin immune fab (ovine)7025$552.14$110.43
    Q2007KEthanolamine oleate 100 mg7026$64.53$12.91
    Q2008KFomepizole, 15 mg7027$12.31$2.46
    Q2009KFosphenytoin, 50 mg7028$5.19$1.04
    Q2011KHemin, per 1 mg7030$6.51$1.30
    Q2012KPegademase bovine, 25 iu9168$161.15$32.23
    Q2013KPentastarch 10% solution7040$12.45$2.49
    Q2014NSermorelin acetate, 0.5 mg
    Q2017KTeniposide, 50 mg7035$266.21$53.24
    Q2018KUrofollitropin, 75 iu7037$44.73$8.95
    Q2019KBasiliximab1615$1,473.45$294.69
    Q2020EHistrelin acetate
    Q2021KLepirudin9057$128.16$25.63
    Q2022KVonWillebrandFactrCmplxperIU1618$.74$.15
    Q3000HRubidium-Rb-829025
    Q3001BBrachytherapy Radioelements
    Q3002HGallium ga 671619
    Q3003HTechnetium tc99m bicisate1620
    Q3004NXenon xe 133
    Q3005HTechnetium tc99m ertiatide1622
    Q3006HTechnetium tc99m glucepatate9154
    Q3007HSodium phosphate p321624
    Q3008HIndium 111-in pentetreotide1625
    Q3009NTechnetium tc99m oxidronate
    Q3010HTechnetium tc99mlabeledrbcs9155
    Q3011HChromic phosphate p321628
    Q3012NCyanocobalamin cobalt co57
    Q3014ATelehealth facility fee
    Q3019AALS emer trans no ALS serv
    Q3020AALS nonemer trans no ALS se
    Q3025KIM inj interferon beta 1-a9022$89.09$17.82
    Q3026ESubc inj interferon beta-1a
    Q3031NCollagen skin test
    Q4001BCast sup body cast plaster
    Q4002BCast sup body cast fiberglas
    Q4003BCast sup shoulder cast plstr
    Q4004BCast sup shoulder cast fbrgl
    Q4005BCast sup long arm adult plst
    Q4006BCast sup long arm adult fbrg
    Q4007BCast sup long arm ped plster
    Q4008BCast sup long arm ped fbrgls
    Q4009BCast sup sht arm adult plstr
    Q4010BCast sup sht arm adult fbrgl
    Q4011BCast sup sht arm ped plaster
    Q4012BCast sup sht arm ped fbrglas
    Q4013BCast sup gauntlet plaster
    Start Printed Page 42962
    Q4014BCast sup gauntlet fiberglass
    Q4015BCast sup gauntlet ped plster
    Q4016BCast sup gauntlet ped fbrgls
    Q4017BCast sup lng arm splint plst
    Q4018BCast sup lng arm splint fbrg
    Q4019BCast sup lng arm splnt ped p
    Q4020BCast sup lng arm splnt ped f
    Q4021BCast sup sht arm splint plst
    Q4022BCast sup sht arm splint fbrg
    Q4023BCast sup sht arm splnt ped p
    Q4024BCast sup sht arm splnt ped f
    Q4025BCast sup hip spica plaster
    Q4026BCast sup hip spica fiberglas
    Q4027BCast sup hip spica ped plstr
    Q4028BCast sup hip spica ped fbrgl
    Q4029BCast sup long leg plaster
    Q4030BCast sup long leg fiberglass
    Q4031BCast sup lng leg ped plaster
    Q4032BCast sup lng leg ped fbrgls
    Q4033BCast sup lng leg cylinder pl
    Q4034BCast sup lng leg cylinder fb
    Q4035BCast sup lngleg cylndr ped p
    Q4036BCast sup lngleg cylndr ped f
    Q4037BCast sup shrt leg plaster
    Q4038BCast sup shrt leg fiberglass
    Q4039BCast sup shrt leg ped plster
    Q4040BCast sup shrt leg ped fbrgls
    Q4041BCast sup lng leg splnt plstr
    Q4042BCast sup lng leg splnt fbrgl
    Q4043BCast sup lng leg splnt ped p
    Q4044BCast sup lng leg splnt ped f
    Q4045BCast sup sht leg splnt plstr
    Q4046BCast sup sht leg splnt fbrgl
    Q4047BCast sup sht leg splnt ped p
    Q4048BCast sup sht leg splnt ped f
    Q4049BFinger splint, static
    Q4050BCast supplies unlisted
    Q4051BSplint supplies misc
    Q4054ADarbepoetin alfa, esrd use
    Q4055AEpoetin alfa, esrd use
    Q4075NAcyclovir, 5 mg
    Q4076NDopamine hcl, 40 mg
    Q4077KTreprostinil, 1 mg1082$55.02$11.00
    Q4079GInjection, natalizumab9126$6.51$1.30
    Q9941KIVIG lyophil 1g0869$39.46$7.89
    Q9942KIVIG lyophil 10 mg0870$.40$.08
    Q9943KIVIG non-lyophil 1g0871$57.26$11.45
    Q9944KIVIG non-lyophil 10 mg0872$.57$.11
    Q9945KLOCM <=149 mg/ml iodine, 1ml9157$.51$.10
    Q9946KLOCM 150-199mg/ml iodine,1ml9158$2.00$.40
    Q9947KLOCM 200-249mg/ml iodine,1ml9159$.78$.16
    Q9948KLOCM 250-299mg/ml iodine,1ml9160$.66$.13
    Q9949KLOCM 300-349mg/ml iodine,1ml9161$.41$.08
    Q9950KLOCM 350-399mg/ml iodine,1ml9162$.27$.05
    Q9951KLOCM >= 400 mg/ml iodine,1ml9163$.20$.04
    Q9952KInj Gad-base MR contrast, ml9164$3.01$.60
    Q9953NInj Fe-based MR contrast, ml
    Q9954KOral MR contrast, 100 ml9165$9.01$1.80
    Q9955KInj perflexane lip micros, m9203$13.49$2.70
    Q9956KInj octafluoropropane mic,ml9202$41.42$8.28
    Q9957KInj perflutren lip micros, m9112$63.50$12.70
    R0070NTransport portable x-ray
    R0075NTransport port x-ray multipl
    R0076NTransport portable EKG
    V2020AVision svcs frames purchases
    V2025EEyeglasses delux frames
    Start Printed Page 42963
    V2100ALens spher single plano 4.00
    V2101ASingle visn sphere 4.12-7.00
    V2102ASingl visn sphere 7.12-20.00
    V2103ASpherocylindr 4.00d/12-2.00d
    V2104ASpherocylindr 4.00d/2.12-4d
    V2105ASpherocylinder 4.00d/4.25-6d
    V2106ASpherocylinder 4.00d/>6.00d
    V2107ASpherocylinder 4.25d/12-2d
    V2108ASpherocylinder 4.25d/2.12-4d
    V2109ASpherocylinder 4.25d/4.25-6d
    V2110ASpherocylinder 4.25d/over 6d
    V2111ASpherocylindr 7.25d/.25-2.25
    V2112ASpherocylindr 7.25d/2.25-4d
    V2113ASpherocylindr 7.25d/4.25-6d
    V2114ASpherocylinder over 12.00d
    V2115ALens lenticular bifocal
    V2118ALens aniseikonic single
    V2121ALenticular lens, single
    V2199ALens single vision not oth c
    V2200ALens spher bifoc plano 4.00d
    V2201ALens sphere bifocal 4.12-7.0
    V2202ALens sphere bifocal 7.12-20.
    V2203ALens sphcyl bifocal 4.00d/.1
    V2204ALens sphcy bifocal 4.00d/2.1
    V2205ALens sphcy bifocal 4.00d/4.2
    V2206ALens sphcy bifocal 4.00d/ove
    V2207ALens sphcy bifocal 4.25-7d/.
    V2208ALens sphcy bifocal 4.25-7/2.
    V2209ALens sphcy bifocal 4.25-7/4.
    V2210ALens sphcy bifocal 4.25-7/ov
    V2211ALens sphcy bifo 7.25-12/.25-
    V2212ALens sphcyl bifo 7.25-12/2.2
    V2213ALens sphcyl bifo 7.25-12/4.2
    V2214ALens sphcyl bifocal over 12.
    V2215ALens lenticular bifocal
    V2218ALens aniseikonic bifocal
    V2219ALens bifocal seg width over
    V2220ALens bifocal add over 3.25d
    V2221ALenticular lens, bifocal
    V2299ALens bifocal speciality
    V2300ALens sphere trifocal 4.00d
    V2301ALens sphere trifocal 4.12-7.
    V2302ALens sphere trifocal 7.12-20
    V2303ALens sphcy trifocal 4.0/.12-
    V2304ALens sphcy trifocal 4.0/2.25
    V2305ALens sphcy trifocal 4.0/4.25
    V2306ALens sphcyl trifocal 4.00/>6
    V2307ALens sphcy trifocal 4.25-7/.
    V2308ALens sphc trifocal 4.25-7/2.
    V2309ALens sphc trifocal 4.25-7/4.
    V2310ALens sphc trifocal 4.25-7/>6
    V2311ALens sphc trifo 7.25-12/.25-
    V2312ALens sphc trifo 7.25-12/2.25
    V2313ALens sphc trifo 7.25-12/4.25
    V2314ALens sphcyl trifocal over 12
    V2315ALens lenticular trifocal
    V2318ALens aniseikonic trifocal
    V2319ALens trifocal seg width > 28
    V2320ALens trifocal add over 3.25d
    V2321ALenticular lens, trifocal
    V2399ALens trifocal speciality
    V2410ALens variab asphericity sing
    V2430ALens variable asphericity bi
    V2499AVariable asphericity lens
    V2500AContact lens pmma spherical
    V2501ACntct lens pmma-toric/prism
    Start Printed Page 42964
    V2502AContact lens pmma bifocal
    V2503ACntct lens pmma color vision
    V2510ACntct gas permeable sphericl
    V2511ACntct toric prism ballast
    V2512ACntct lens gas permbl bifocl
    V2513AContact lens extended wear
    V2520AContact lens hydrophilic
    V2521ACntct lens hydrophilic toric
    V2522ACntct lens hydrophil bifocl
    V2523ACntct lens hydrophil extend
    V2530AContact lens gas impermeable
    V2531AContact lens gas permeable
    V2599AContact lens/es other type
    V2600AHand held low vision aids
    V2610ASingle lens spectacle mount
    V2615ATelescop/othr compound lens
    V2623APlastic eye prosth custom
    V2624APolishing artifical eye
    V2625AEnlargemnt of eye prosthesis
    V2626AReduction of eye prosthesis
    V2627AScleral cover shell
    V2628AFabrication & fitting
    V2629AProsthetic eye other type
    V2630NAnter chamber intraocul lens
    V2631NIris support intraoclr lens
    V2632NPost chmbr intraocular lens
    V2700ABalance lens
    V2702EDeluxe lens feature
    V2710AGlass/plastic slab off prism
    V2715APrism lens/es
    V2718AFresnell prism press-on lens
    V2730ASpecial base curve
    V2744ATint photochromatic lens/es
    V2745ATint, any color/solid/grad
    V2750AAnti-reflective coating
    V2755AUV lens/es
    V2756EEye glass case
    V2760AScratch resistant coating
    V2761BMirror coating
    V2762APolarization, any lens
    V2770AOccluder lens/es
    V2780AOversize lens/es
    V2781BProgressive lens per lens
    V2782ALens, 1.54-1.65 p/1.60-1.79g
    V2783ALens, >= 1.66 p/>=1.80 g
    V2784ALens polycarb or equal
    V2785FCorneal tissue processing
    V2786AOccupational multifocal lens
    V2790NAmniotic membrane
    V2797AVis item/svc in other code
    V2799AMiscellaneous vision service
    V5008EHearing screening
    V5010EAssessment for hearing aid
    V5011EHearing aid fitting/checking
    V5014EHearing aid repair/modifying
    V5020EConformity evaluation
    V5030EBody-worn hearing aid air
    V5040EBody-worn hearing aid bone
    V5050EHearing aid monaural in ear
    V5060EBehind ear hearing aid
    V5070EGlasses air conduction
    V5080EGlasses bone conduction
    V5090EHearing aid dispensing fee
    V5095EImplant mid ear hearing pros
    V5100EBody-worn bilat hearing aid
    V5110EHearing aid dispensing fee
    Start Printed Page 42965
    V5120EBody-worn binaur hearing aid
    V5130EIn ear binaural hearing aid
    V5140EBehind ear binaur hearing ai
    V5150EGlasses binaural hearing aid
    V5160EDispensing fee binaural
    V5170EWithin ear cros hearing aid
    V5180EBehind ear cros hearing aid
    V5190EGlasses cros hearing aid
    V5200ECros hearing aid dispens fee
    V5210EIn ear bicros hearing aid
    V5220EBehind ear bicros hearing ai
    V5230EGlasses bicros hearing aid
    V5240EDispensing fee bicros
    V5241EDispensing fee, monaural
    V5242EHearing aid, monaural, cic
    V5243EHearing aid, monaural, itc
    V5244EHearing aid, prog, mon, cic
    V5245EHearing aid, prog, mon, itc
    V5246EHearing aid, prog, mon, ite
    V5247EHearing aid, prog, mon, bte
    V5248EHearing aid, binaural, cic
    V5249EHearing aid, binaural, itc
    V5250EHearing aid, prog, bin, cic
    V5251EHearing aid, prog, bin, itc
    V5252EHearing aid, prog, bin, ite
    V5253EHearing aid, prog, bin, bte
    V5254EHearing id, digit, mon, cic
    V5255EHearing aid, digit, mon, itc
    V5256EHearing aid, digit, mon, ite
    V5257EHearing aid, digit, mon, bte
    V5258EHearing aid, digit, bin, cic
    V5259EHearing aid, digit, bin, itc
    V5260EHearing aid, digit, bin, ite
    V5261EHearing aid, digit, bin, bte
    V5262EHearing aid, disp, monaural
    V5263EHearing aid, disp, binaural
    V5264EEar mold/insert
    V5265EEar mold/insert, disp
    V5266EBattery for hearing device
    V5267EHearing aid supply/accessory
    V5268EALD Telephone Amplifier
    V5269EAlerting device, any type
    V5270EALD, TV amplifier, any type
    V5271EALD, TV caption decoder
    V5272ETdd
    V5273EALD for cochlear implant
    V5274EALD unspecified
    V5275EEar impression
    V5298EHearing aid noc
    V5299BHearing service
    V5336ERepair communication device
    V5362ESpeech screening
    V5363ELanguage screening
    V5364EDysphagia screening
    *Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule.
    CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.
    Copyright American Dental Association. All rights reserved.
            Start Printed Page 42966

    Addendum D1.—Payment Status Indicators for the Hospital Outpatient Prospective Payment System

    IndicatorItem/code/serviceOPPS payment status
    AServices furnished to a hospital outpatient that are paid under a fee schedule or payment system other than OPPS, for example:Not paid under OPPS. Paid by fiscal intermediaries under a fee schedule or payment system other than OPPS.
    • Ambulance Services
    • Clinical Diagnostic Laboratory Services
    • Non-Implantable Prosthetic and Orthotic Devices
    • EPO for ESRD Patients
    • Physical, Occupational, and Speech Therapy
    • Routine Dialysis Services for ESRD Patients Provided in a Certified Dialysis Unit of a Hospital
    • Diagnostic Mammography
    • Screening Mammography
    BCodes that are not recognized by OPPS when submitted on an outpatient hospital Part B bill type (12x,13x, and 14x)Not paid under OPPS • May be paid by intermediaries when submitted on a different bill type, for example, 75x (CORF), but not paid under OPPS. • An alternate code that is recognized by OPPS when submitted on an outpatient hospital Part B bill type (12x, 13x, and 14x) may be available.
    CInpatient ProceduresNot paid under OPPS. Admit patient. Bill as inpatient.
    DDiscontinued CodesNot paid under OPPS.
    EItems, Codes, and Services:Not paid under OPPS.
    • That are not covered by Medicare based on statutory exclusion
    • That are not covered by Medicare for reasons other than statutory exclusion
    • That are not recognized by Medicare but for which an alternate code for the same item or service may be available
    • For which separate payment is not provided by Medicare
    FCorneal Tissue Acquisition; Certain CRNA Services and Hepatitis B VaccinesNot paid under OPPS. Paid at reasonable cost.
    GPass-Through Drugs and BiologicalsPaid under OPPS; Separate APC payment includes passπthrough amount.
    H(1) Pass-Through Device Categories (2) Brachytherapy Sources (3) Radiopharmaceutical AgentsPaid under OPPS; (1) Separate cost-based pass-through payment. (2) Separate cost-based non-pass-through payment. (3) Separate cost-based non-pass-through payment.
    KNon-Pass-Through Drugs, Biologicals, and Radiopharmaceuticals AgentsPaid under OPPS; Separate APC payment.
    LInfluenza Vaccine; Pneumococcal Pneumonia VaccineNot paid under OPPS. Paid at reasonable cost; Not subject to deductible or coinsurance.
    MItems and Services Not Billable to the Fiscal IntermediaryNot paid under OPPS.
    NItems and Services Packaged into APC RatesPaid under OPPS; Payment is packaged into payment for other services, including outliers. Therefore, there is no separate APC payment.
    PPartial HospitalizationPaid under OPPS; Per diem APC payment.
    QPackaged Services Subject to Separate Payment Based on CriteriaPaid under OPPS; (1) Separate APC payment based on criteria. (2) If criteria are not met, payment is packaged into payment for other services, including outliers. Therefore, there is no separate APC payment.
    SSignificant Service, Separately PayablePaid under OPPS; Separate APC payment.
    TSignificant Procedure, Multiple Reduction AppliesPaid under OPPS; Separate APC payment.
    VClinic or Emergency Department VisitPaid under OPPS; Separate APC payment.
    YNon-Implantable Durable Medical EquipmentNot paid under OPPS. All institutional providers other than home health agencies bill to DMERC.
    XAncillary ServicesPaid under OPPS; Separate APC payment.

    Addendum D2.—Comment Indicators

    Comment indicatorDescriptor
    NFNew code, final APC assignment; Comments were accepted on a proposed APC assignment in the proposed rule; APC assignment is no longer open to comment.
    NINew code, interim APC assignment; Comments will be accepted on the interim APC assignment for the new code.
    Start Printed Page 42967

    Addendum E.—CPT Codes That Are Paid Only as Inpatient Procedures

    CPT/ HCPCSProposed CY 2006 status indicatorDescription
    00176CAnesth, pharyngeal surgery
    00192CAnesth, facial bone surgery
    00214CAnesth, skull drainage
    00215CAnesth, skull repair/fract
    0021TCFetal oximetry, trnsvag/cerv
    0024TCTranscath cardiac reduction
    0033TCEndovasc taa repr incl subcl
    0034TCEndovasc taa repr w/o subcl
    0035TCInsert endovasc prosth, taa
    0036TCEndovasc prosth, taa, add-on
    0037TCArtery transpose/endovas taa
    0038TCRad endovasc taa rpr w/cover
    0039TCRad s/i, endovasc taa repair
    00404CAnesth, surgery of breast
    00406CAnesth, surgery of breast
    0040TCRad s/i, endovasc taa prosth
    00452CAnesth, surgery of shoulder
    00474CAnesth, surgery of rib(s)
    0048TCImplant ventricular device
    0049TCExternal circulation assist
    0050TCRemoval circulation assist
    0051TCImplant total heart system
    00524CAnesth, chest drainage
    0052TCReplace component heart syst
    0053TCReplace component heart syst
    00540CAnesth, chest surgery
    00542CAnesth, release of lung
    00546CAnesth, lung,chest wall surg
    00560CAnesth, open heart surgery
    00561CAnesth, heart surg < age 1
    00562CAnesth, open heart surgery
    00580CAnesth, heart/lung transplnt
    00604CAnesth, sitting procedure
    00622CAnesth, removal of nerves
    00632CAnesth, removal of nerves
    00670CAnesth, spine, cord surgery
    0075TCPerq stent/chest vert art
    0076TCS&i stent/chest vert art
    0077TCCereb therm perfusion probe
    0078TCEndovasc aort repr w/device
    0079TCEndovasc visc extnsn repr
    00792CAnesth, hemorr/excise liver
    00794CAnesth, pancreas removal
    00796CAnesth, for liver transplant
    0080TCEndovasc aort repr rad s&i
    00802CAnesth, fat layer removal
    0081TCEndovasc visc extnsn s&i
    00844CAnesth, pelvis surgery
    00846CAnesth, hysterectomy
    00848CAnesth, pelvic organ surg
    00864CAnesth, removal of bladder
    00865CAnesth, removal of prostate
    00866CAnesth, removal of adrenal
    00868CAnesth, kidney transplant
    00882CAnesth, major vein ligation
    00904CAnesth, perineal surgery
    00908CAnesth, removal of prostate
    00932CAnesth, amputation of penis
    00934CAnesth, penis, nodes removal
    00936CAnesth, penis, nodes removal
    00944CAnesth, vaginal hysterectomy
    01140CAnesth, amputation at pelvis
    01150CAnesth, pelvic tumor surgery
    01212CAnesth, hip disarticulation
    01214CAnesth, hip arthroplasty
    01232CAnesth, amputation of femur
    01234CAnesth, radical femur surg
    01272CAnesth, femoral artery surg
    01274CAnesth, femoral embolectomy
    01402CAnesth, knee arthroplasty
    01404CAnesth, amputation at knee
    01442CAnesth, knee artery surg
    01444CAnesth, knee artery repair
    01486CAnesth, ankle replacement
    01502CAnesth, lwr leg embolectomy
    01632CAnesth, surgery of shoulder
    01634CAnesth, shoulder joint amput
    01636CAnesth, forequarter amput
    01638CAnesth, shoulder replacement
    01652CAnesth, shoulder vessel surg
    01654CAnesth, shoulder vessel surg
    01656CAnesth, arm-leg vessel surg
    01756CAnesth, radical humerus surg
    01990CSupport for organ donor
    11004CDebride genitalia & perineum
    11005CDebride abdom wall
    11006CDebride genit/per/abdom wall
    11008CRemove mesh from abd wall
    15756CFree muscle flap, microvasc
    15757CFree skin flap, microvasc
    15758CFree fascial flap, microvasc
    16035CIncision of burn scab, initi
    16036CEscharotomy addl incision
    19200CRemoval of breast
    19220CRemoval of breast
    19271CRevision of chest wall
    19272CExtensive chest wall surgery
    19361CBreast reconstruction
    19364CBreast reconstruction
    19367CBreast reconstruction
    19368CBreast reconstruction
    19369CBreast reconstruction
    20660CApply, rem fixation device
    20661CApplication of head brace
    20664CHalo brace application
    20802CReplantation, arm, complete
    20805CReplant forearm, complete
    20808CReplantation hand, complete
    Start Printed Page 42968
    20816CReplantation digit, complete
    20824CReplantation thumb, complete
    20827CReplantation thumb, complete
    20838CReplantation foot, complete
    20930CSpinal bone allograft
    20931CSpinal bone allograft
    20936CSpinal bone autograft
    20937CSpinal bone autograft
    20938CSpinal bone autograft
    20955CFibula bone graft, microvasc
    20956CIliac bone graft, microvasc
    20957CMt bone graft, microvasc
    20962COther bone graft, microvasc
    20969CBone/skin graft, microvasc
    20970CBone/skin graft, iliac crest
    21045CExtensive jaw surgery
    21141CReconstruct midface, lefort
    21142CReconstruct midface, lefort
    21143CReconstruct midface, lefort
    21145CReconstruct midface, lefort
    21146CReconstruct midface, lefort
    21147CReconstruct midface, lefort
    21151CReconstruct midface, lefort
    21154CReconstruct midface, lefort
    21155CReconstruct midface, lefort
    21159CReconstruct midface, lefort
    21160CReconstruct midface, lefort
    21172CReconstruct orbit/forehead
    21179CReconstruct entire forehead
    21180CReconstruct entire forehead
    21182CReconstruct cranial bone
    21183CReconstruct cranial bone
    21184CReconstruct cranial bone
    21188CReconstruction of midface
    21193CReconst lwr jaw w/o graft
    21194CReconst lwr jaw w/graft
    21196CReconst lwr jaw w/fixation
    21247CReconstruct lower jaw bone
    21255CReconstruct lower jaw bone
    21256CReconstruction of orbit
    21268CRevise eye sockets
    21343CTreatment of sinus fracture
    21344CTreatment of sinus fracture
    21346CTreat nose/jaw fracture
    21347CTreat nose/jaw fracture
    21348CTreat nose/jaw fracture
    21360CTreat cheek bone fracture
    21365CTreat cheek bone fracture
    21366CTreat cheek bone fracture
    21385CTreat eye socket fracture
    21386CTreat eye socket fracture
    21387CTreat eye socket fracture
    21395CTreat eye socket fracture
    21422CTreat mouth roof fracture
    21423CTreat mouth roof fracture
    21431CTreat craniofacial fracture
    21432CTreat craniofacial fracture
    21433CTreat craniofacial fracture
    21435CTreat craniofacial fracture
    21436CTreat craniofacial fracture
    21510CDrainage of bone lesion
    21615CRemoval of rib
    21616CRemoval of rib and nerves
    21620CPartial removal of sternum
    21627CSternal debridement
    21630CExtensive sternum surgery
    21632CExtensive sternum surgery
    21705CRevision of neck muscle/rib
    21740CReconstruction of sternum
    21750CRepair of sternum separation
    21810CTreatment of rib fracture(s)
    21825CTreat sternum fracture
    22110CRemove part of neck vertebra
    22112CRemove part, thorax vertebra
    22114CRemove part, lumbar vertebra
    22116CRemove extra spine segment
    22210CRevision of neck spine
    22212CRevision of thorax spine
    22214CRevision of lumbar spine
    22216CRevise, extra spine segment
    22220CRevision of neck spine
    22224CRevision of lumbar spine
    22226CRevise, extra spine segment
    22318CTreat odontoid fx w/o graft
    22319CTreat odontoid fx w/graft
    22325CTreat spine fracture
    22326CTreat neck spine fracture
    22327CTreat thorax spine fracture
    22328CTreat each add spine fx
    22532CLat thorax spine fusion
    22533CLat lumbar spine fusion
    22534CLat thor/lumb, add'l seg
    22548CNeck spine fusion
    22554CNeck spine fusion
    22556CThorax spine fusion
    22558CLumbar spine fusion
    22585CAdditional spinal fusion
    22590CSpine & skull spinal fusion
    22595CNeck spinal fusion
    22600CNeck spine fusion
    22610CThorax spine fusion
    22630CLumbar spine fusion
    22632CSpine fusion, extra segment
    22800CFusion of spine
    22802CFusion of spine
    22804CFusion of spine
    22808CFusion of spine
    22810CFusion of spine
    22812CFusion of spine
    22818CKyphectomy, 1-2 segments
    22819CKyphectomy, 3 or more
    22830CExploration of spinal fusion
    22840CInsert spine fixation device
    22841CInsert spine fixation device
    22842CInsert spine fixation device
    22843CInsert spine fixation device
    Start Printed Page 42969
    22844CInsert spine fixation device
    22845CInsert spine fixation device
    22846CInsert spine fixation device
    22847CInsert spine fixation device
    22848CInsert pelv fixation device
    22849CReinsert spinal fixation
    22850CRemove spine fixation device
    22851CApply spine prosth device
    22852CRemove spine fixation device
    22855CRemove spine fixation device
    23200CRemoval of collar bone
    23210CRemoval of shoulder blade
    23220CPartial removal of humerus
    23221CPartial removal of humerus
    23222CPartial removal of humerus
    23332CRemove shoulder foreign body
    23472CReconstruct shoulder joint
    23900CAmputation of arm & girdle
    23920CAmputation at shoulder joint
    24900CAmputation of upper arm
    24920CAmputation of upper arm
    24930CAmputation follow-up surgery
    24931CAmputate upper arm & implant
    24940CRevision of upper arm
    25900CAmputation of forearm
    25905CAmputation of forearm
    25909CAmputation follow-up surgery
    25915CAmputation of forearm
    25920CAmputate hand at wrist
    25924CAmputation follow-up surgery
    25927CAmputation of hand
    25931CAmputation follow-up surgery
    26551CGreat toe-hand transfer
    26553CSingle transfer, toe-hand
    26554CDouble transfer, toe-hand
    26556CToe joint transfer
    26992CDrainage of bone lesion
    27005CIncision of hip tendon
    27006CIncision of hip tendons
    27025CIncision of hip/thigh fascia
    27030CDrainage of hip joint
    27036CExcision of hip joint/muscle
    27054CRemoval of hip joint lining
    27070CPartial removal of hip bone
    27071CPartial removal of hip bone
    27075CExtensive hip surgery
    27076CExtensive hip surgery
    27077CExtensive hip surgery
    27078CExtensive hip surgery
    27079CExtensive hip surgery
    27090CRemoval of hip prosthesis
    27091CRemoval of hip prosthesis
    27120CReconstruction of hip socket
    27122CReconstruction of hip socket
    27125CPartial hip replacement
    27130CTotal hip arthroplasty
    27132CTotal hip arthroplasty
    27134CRevise hip joint replacement
    27137CRevise hip joint replacement
    27138CRevise hip joint replacement
    27140CTransplant femur ridge
    27146CIncision of hip bone
    27147CRevision of hip bone
    27151CIncision of hip bones
    27156CRevision of hip bones
    27158CRevision of pelvis
    27161CIncision of neck of femur
    27165CIncision/fixation of femur
    27170CRepair/graft femur head/neck
    27175CTreat slipped epiphysis
    27176CTreat slipped epiphysis
    27177CTreat slipped epiphysis
    27178CTreat slipped epiphysis
    27179CRevise head/neck of femur
    27181CTreat slipped epiphysis
    27185CRevision of femur epiphysis
    27187CReinforce hip bones
    27215CTreat pelvic fracture(s)
    27217CTreat pelvic ring fracture
    27218CTreat pelvic ring fracture
    27222CTreat hip socket fracture
    27226CTreat hip wall fracture
    27227CTreat hip fracture(s)
    27228CTreat hip fracture(s)
    27232CTreat thigh fracture
    27236CTreat thigh fracture
    27240CTreat thigh fracture
    27244CTreat thigh fracture
    27245CTreat thigh fracture
    27248CTreat thigh fracture
    27253CTreat hip dislocation
    27254CTreat hip dislocation
    27258CTreat hip dislocation
    27259CTreat hip dislocation
    27280CFusion of sacroiliac joint
    27282CFusion of pubic bones
    27284CFusion of hip joint
    27286CFusion of hip joint
    27290CAmputation of leg at hip
    27295CAmputation of leg at hip
    27303CDrainage of bone lesion
    27365CExtensive leg surgery
    27445CRevision of knee joint
    27447CTotal knee arthroplasty
    27448CIncision of thigh
    27450CIncision of thigh
    27454CRealignment of thigh bone
    27455CRealignment of knee
    27457CRealignment of knee
    27465CShortening of thigh bone
    27466CLengthening of thigh bone
    27468CShorten/lengthen thighs
    27470CRepair of thigh
    27472CRepair/graft of thigh
    27477CSurgery to stop leg growth
    27479CSurgery to stop leg growth
    27485CSurgery to stop leg growth
    27486CRevise/replace knee joint
    27487CRevise/replace knee joint
    27488CRemoval of knee prosthesis
    27495CReinforce thigh
    27506CTreatment of thigh fracture
    27507CTreatment of thigh fracture
    27511CTreatment of thigh fracture
    27513CTreatment of thigh fracture
    27514CTreatment of thigh fracture
    27519CTreat thigh fx growth plate
    27535CTreat knee fracture
    27536CTreat knee fracture
    27540CTreat knee fracture
    27556CTreat knee dislocation
    27557CTreat knee dislocation
    27558CTreat knee dislocation
    Start Printed Page 42970
    27580CFusion of knee
    27590CAmputate leg at thigh
    27591CAmputate leg at thigh
    27592CAmputate leg at thigh
    27596CAmputation follow-up surgery
    27598CAmputate lower leg at knee
    27645CExtensive lower leg surgery
    27646CExtensive lower leg surgery
    27702CReconstruct ankle joint
    27703CReconstruction, ankle joint
    27712CRealignment of lower leg
    27715CRevision of lower leg
    27720CRepair of tibia
    27722CRepair/graft of tibia
    27724CRepair/graft of tibia
    27725CRepair of lower leg
    27727CRepair of lower leg
    27880CAmputation of lower leg
    27881CAmputation of lower leg
    27882CAmputation of lower leg
    27886CAmputation follow-up surgery
    27888CAmputation of foot at ankle
    28800CAmputation of midfoot
    28805CAmputation thru metatarsal
    31225CRemoval of upper jaw
    31230CRemoval of upper jaw
    31290CNasal/sinus endoscopy, surg
    31291CNasal/sinus endoscopy, surg
    31360CRemoval of larynx
    31365CRemoval of larynx
    31367CPartial removal of larynx
    31368CPartial removal of larynx
    31370CPartial removal of larynx
    31375CPartial removal of larynx
    31380CPartial removal of larynx
    31382CPartial removal of larynx
    31390CRemoval of larynx & pharynx
    31395CReconstruct larynx & pharynx
    31584CTreat larynx fracture
    31587CRevision of larynx
    31725CClearance of airways
    31760CRepair of windpipe
    31766CReconstruction of windpipe
    31770CRepair/graft of bronchus
    31775CReconstruct bronchus
    31780CReconstruct windpipe
    31781CReconstruct windpipe
    31786CRemove windpipe lesion
    31800CRepair of windpipe injury
    31805CRepair of windpipe injury
    32035CExploration of chest
    32036CExploration of chest
    32095CBiopsy through chest wall
    32100CExploration/biopsy of chest
    32110CExplore/repair chest
    32120CRe-exploration of chest
    32124CExplore chest free adhesions
    32140CRemoval of lung lesion(s)
    32141CRemove/treat lung lesions
    32150CRemoval of lung lesion(s)
    32151CRemove lung foreign body
    32160COpen chest heart massage
    32200CDrain, open, lung lesion
    32215CTreat chest lining
    32220CRelease of lung
    32225CPartial release of lung
    32310CRemoval of chest lining
    32320CFree/remove chest lining
    32402COpen biopsy chest lining
    32440CRemoval of lung
    32442CSleeve pneumonectomy
    32445CRemoval of lung
    32480CPartial removal of lung
    32482CBilobectomy
    32484CSegmentectomy
    32486CSleeve lobectomy
    32488CCompletion pneumonectomy
    32491CLung volume reduction
    32500CPartial removal of lung
    32501CRepair bronchus add-on
    32520CRemove lung & revise chest
    32522CRemove lung & revise chest
    32525CRemove lung & revise chest
    32540CRemoval of lung lesion
    32650CThoracoscopy, surgical
    32651CThoracoscopy, surgical
    32652CThoracoscopy, surgical
    32653CThoracoscopy, surgical
    32654CThoracoscopy, surgical
    32655CThoracoscopy, surgical
    32656CThoracoscopy, surgical
    32657CThoracoscopy, surgical
    32658CThoracoscopy, surgical
    32659CThoracoscopy, surgical
    32660CThoracoscopy, surgical
    32661CThoracoscopy, surgical
    32662CThoracoscopy, surgical
    32663CThoracoscopy, surgical
    32664CThoracoscopy, surgical
    32665CThoracoscopy, surgical
    32800CRepair lung hernia
    32810CClose chest after drainage
    32815CClose bronchial fistula
    32820CReconstruct injured chest
    32850CDonor pneumonectomy
    32851CLung transplant, single
    32852CLung transplant with bypass
    32853CLung transplant, double
    32854CLung transplant with bypass
    32855CPrepare donor lung, single
    32856CPrepare donor lung, double
    32900CRemoval of rib(s)
    32905CRevise & repair chest wall
    32906CRevise & repair chest wall
    32940CRevision of lung
    32997CTotal lung lavage
    33015CIncision of heart sac
    33020CIncision of heart sac
    33025CIncision of heart sac
    33030CPartial removal of heart sac
    33031CPartial removal of heart sac
    33050CRemoval of heart sac lesion
    33120CRemoval of heart lesion
    33130CRemoval of heart lesion
    33140CHeart revascularize (tmr)
    33141CHeart tmr w/other procedure
    33200CInsertion of heart pacemaker
    33201CInsertion of heart pacemaker
    33236CRemove electrode/thoracotomy
    33237CRemove electrode/thoracotomy
    33238CRemove electrode/thoracotomy
    33243CRemove eltrd/thoracotomy
    Start Printed Page 42971
    33245CInsert epic eltrd pace-defib
    33246CInsert epic eltrd/generator
    33250CAblate heart dysrhythm focus
    33251CAblate heart dysrhythm focus
    33253CReconstruct atria
    33261CAblate heart dysrhythm focus
    33300CRepair of heart wound
    33305CRepair of heart wound
    33310CExploratory heart surgery
    33315CExploratory heart surgery
    33320CRepair major blood vessel(s)
    33321CRepair major vessel
    33322CRepair major blood vessel(s)
    33330CInsert major vessel graft
    33332CInsert major vessel graft
    33335CInsert major vessel graft
    33400CRepair of aortic valve
    33401CValvuloplasty, open
    33403CValvuloplasty, w/cp bypass
    33404CPrepare heart-aorta conduit
    33405CReplacement of aortic valve
    33406CReplacement of aortic valve
    33410CReplacement of aortic valve
    33411CReplacement of aortic valve
    33412CReplacement of aortic valve
    33413CReplacement of aortic valve
    33414CRepair of aortic valve
    33415CRevision, subvalvular tissue
    33416CRevise ventricle muscle
    33417CRepair of aortic valve
    33420CRevision of mitral valve
    33422CRevision of mitral valve
    33425CRepair of mitral valve
    33426CRepair of mitral valve
    33427CRepair of mitral valve
    33430CReplacement of mitral valve
    33460CRevision of tricuspid valve
    33463CValvuloplasty, tricuspid
    33464CValvuloplasty, tricuspid
    33465CReplace tricuspid valve
    33468CRevision of tricuspid valve
    33470CRevision of pulmonary valve
    33471CValvotomy, pulmonary valve
    33472CRevision of pulmonary valve
    33474CRevision of pulmonary valve
    33475CReplacement, pulmonary valve
    33476CRevision of heart chamber
    33478CRevision of heart chamber
    33496CRepair, prosth valve clot
    33500CRepair heart vessel fistula
    33501CRepair heart vessel fistula
    33502CCoronary artery correction
    33503CCoronary artery graft
    33504CCoronary artery graft
    33505CRepair artery w/tunnel
    33506CRepair artery, translocation
    33510CCABG, vein, single
    33511CCABG, vein, two
    33512CCABG, vein, three
    33513CCABG, vein, four
    33514CCABG, vein, five
    33516CCabg, vein, six or more
    33517CCABG, artery-vein, single
    33518CCABG, artery-vein, two
    33519CCABG, artery-vein, three
    33521CCABG, artery-vein, four
    33522CCABG, artery-vein, five
    33523CCabg, art-vein, six or more
    33530CCoronary artery, bypass/reop
    33533CCABG, arterial, single
    33534CCABG, arterial, two
    33535CCABG, arterial, three
    33536CCabg, arterial, four or more
    33542CRemoval of heart lesion
    33545CRepair of heart damage
    33572COpen coronary endarterectomy
    33600CClosure of valve
    33602CClosure of valve
    33606CAnastomosis/artery-aorta
    33608CRepair anomaly w/conduit
    33610CRepair by enlargement
    33611CRepair double ventricle
    33612CRepair double ventricle
    33615CRepair, modified fontan
    33617CRepair single ventricle
    33619CRepair single ventricle
    33641CRepair heart septum defect
    33645CRevision of heart veins
    33647CRepair heart septum defects
    33660CRepair of heart defects
    33665CRepair of heart defects
    33670CRepair of heart chambers
    33681CRepair heart septum defect
    33684CRepair heart septum defect
    33688CRepair heart septum defect
    33690CReinforce pulmonary artery
    33692CRepair of heart defects
    33694CRepair of heart defects
    33697CRepair of heart defects
    33702CRepair of heart defects
    33710CRepair of heart defects
    33720CRepair of heart defect
    33722CRepair of heart defect
    33730CRepair heart-vein defect(s)
    33732CRepair heart-vein defect
    33735CRevision of heart chamber
    33736CRevision of heart chamber
    33737CRevision of heart chamber
    33750CMajor vessel shunt
    33755CMajor vessel shunt
    33762CMajor vessel shunt
    33764CMajor vessel shunt & graft
    33766CMajor vessel shunt
    33767CMajor vessel shunt
    33770CRepair great vessels defect
    33771CRepair great vessels defect
    33774CRepair great vessels defect
    33775CRepair great vessels defect
    33776CRepair great vessels defect
    33777CRepair great vessels defect
    33778CRepair great vessels defect
    33779CRepair great vessels defect
    33780CRepair great vessels defect
    33781CRepair great vessels defect
    33786CRepair arterial trunk
    Start Printed Page 42972
    33788CRevision of pulmonary artery
    33800CAortic suspension
    33802CRepair vessel defect
    33803CRepair vessel defect
    33813CRepair septal defect
    33814CRepair septal defect
    33820CRevise major vessel
    33822CRevise major vessel
    33824CRevise major vessel
    33840CRemove aorta constriction
    33845CRemove aorta constriction
    33851CRemove aorta constriction
    33852CRepair septal defect
    33853CRepair septal defect
    33860CAscending aortic graft
    33861CAscending aortic graft
    33863CAscending aortic graft
    33870CTransverse aortic arch graft
    33875CThoracic aortic graft
    33877CThoracoabdominal graft
    33910CRemove lung artery emboli
    33915CRemove lung artery emboli
    33916CSurgery of great vessel
    33917CRepair pulmonary artery
    33918CRepair pulmonary atresia
    33919CRepair pulmonary atresia
    33920CRepair pulmonary atresia
    33922CTransect pulmonary artery
    33924CRemove pulmonary shunt
    33930CRemoval of donor heart/lung
    33933CPrepare donor heart/lung
    33935CTransplantation, heart/lung
    33940CRemoval of donor heart
    33944CPrepare donor heart
    33945CTransplantation of heart
    33960CExternal circulation assist
    33961CExternal circulation assist
    33967CInsert ia percut device
    33968CRemove aortic assist device
    33970CAortic circulation assist
    33971CAortic circulation assist
    33973CInsert balloon device
    33974CRemove intra-aortic balloon
    33975CImplant ventricular device
    33976CImplant ventricular device
    33977CRemove ventricular device
    33978CRemove ventricular device
    33979CInsert intracorporeal device
    33980CRemove intracorporeal device
    34001CRemoval of artery clot
    34051CRemoval of artery clot
    34151CRemoval of artery clot
    34401CRemoval of vein clot
    34451CRemoval of vein clot
    34502CReconstruct vena cava
    34800CEndovasc abdo repair w/tube
    34802CEndovasc abdo repr w/device
    34803CEndovas aaa repr w/3-p part
    34804CEndovasc abdo repr w/device
    34805CEndovasc abdo repair w/pros
    34808CEndovasc abdo occlud device
    34812CXpose for endoprosth, aortic
    34813CFemoral endovas graft add-on
    34820CXpose for endoprosth, iliac
    34825CEndovasc extend prosth, init
    34826CEndovasc exten prosth, add'l
    34830COpen aortic tube prosth repr
    34831COpen aortoiliac prosth repr
    34832COpen aortofemor prosth repr
    34833CXpose for endoprosth, iliac
    34834CXpose, endoprosth, brachial
    34900CEndovasc iliac repr w/graft
    35001CRepair defect of artery
    35002CRepair artery rupture, neck
    35005CRepair defect of artery
    35013CRepair artery rupture, arm
    35021CRepair defect of artery
    35022CRepair artery rupture, chest
    35045CRepair defect of arm artery
    35081CRepair defect of artery
    35082CRepair artery rupture, aorta
    35091CRepair defect of artery
    35092CRepair artery rupture, aorta
    35102CRepair defect of artery
    35103CRepair artery rupture, groin
    35111CRepair defect of artery
    35112CRepair artery rupture,spleen
    35121CRepair defect of artery
    35122CRepair artery rupture, belly
    35131CRepair defect of artery
    35132CRepair artery rupture, groin
    35141CRepair defect of artery
    35142CRepair artery rupture, thigh
    35151CRepair defect of artery
    35152CRepair artery rupture, knee
    35182CRepair blood vessel lesion
    35189CRepair blood vessel lesion
    35211CRepair blood vessel lesion
    35216CRepair blood vessel lesion
    35221CRepair blood vessel lesion
    35241CRepair blood vessel lesion
    35246CRepair blood vessel lesion
    35251CRepair blood vessel lesion
    35271CRepair blood vessel lesion
    35276CRepair blood vessel lesion
    35281CRepair blood vessel lesion
    35301CRechanneling of artery
    35311CRechanneling of artery
    35331CRechanneling of artery
    35341CRechanneling of artery
    35351CRechanneling of artery
    35355CRechanneling of artery
    35361CRechanneling of artery
    35363CRechanneling of artery
    35371CRechanneling of artery
    35372CRechanneling of artery
    35381CRechanneling of artery
    35390CReoperation, carotid add-on
    35400CAngioscopy
    35450CRepair arterial blockage
    35452CRepair arterial blockage
    35454CRepair arterial blockage
    35456CRepair arterial blockage
    35480CAtherectomy, open
    35481CAtherectomy, open
    35482CAtherectomy, open
    Start Printed Page 42973
    35483CAtherectomy, open
    35501CArtery bypass graft
    35506CArtery bypass graft
    35507CArtery bypass graft
    35508CArtery bypass graft
    35509CArtery bypass graft
    35510CArtery bypass graft
    35511CArtery bypass graft
    35512CArtery bypass graft
    35515CArtery bypass graft
    35516CArtery bypass graft
    35518CArtery bypass graft
    35521CArtery bypass graft
    35522CArtery bypass graft
    35525CArtery bypass graft
    35526CArtery bypass graft
    35531CArtery bypass graft
    35533CArtery bypass graft
    35536CArtery bypass graft
    35541CArtery bypass graft
    35546CArtery bypass graft
    35548CArtery bypass graft
    35549CArtery bypass graft
    35551CArtery bypass graft
    35556CArtery bypass graft
    35558CArtery bypass graft
    35560CArtery bypass graft
    35563CArtery bypass graft
    35565CArtery bypass graft
    35566CArtery bypass graft
    35571CArtery bypass graft
    35583CVein bypass graft
    35585CVein bypass graft
    35587CVein bypass graft
    35600CHarvest artery for cabg
    35601CArtery bypass graft
    35606CArtery bypass graft
    35612CArtery bypass graft
    35616CArtery bypass graft
    35621CArtery bypass graft
    35623CBypass graft, not vein
    35626CArtery bypass graft
    35631CArtery bypass graft
    35636CArtery bypass graft
    35641CArtery bypass graft
    35642CArtery bypass graft
    35645CArtery bypass graft
    35646CArtery bypass graft
    35647CArtery bypass graft
    35650CArtery bypass graft
    35651CArtery bypass graft
    35654CArtery bypass graft
    35656CArtery bypass graft
    35661CArtery bypass graft
    35663CArtery bypass graft
    35665CArtery bypass graft
    35666CArtery bypass graft
    35671CArtery bypass graft
    35681CComposite bypass graft
    35682CComposite bypass graft
    35683CComposite bypass graft
    35691CArterial transposition
    35693CArterial transposition
    35694CArterial transposition
    35695CArterial transposition
    35697CReimplant artery each
    35700CReoperation, bypass graft
    35701CExploration, carotid artery
    35721CExploration, femoral artery
    35741CExploration popliteal artery
    35800CExplore neck vessels
    35820CExplore chest vessels
    35840CExplore abdominal vessels
    35870CRepair vessel graft defect
    35901CExcision, graft, neck
    35905CExcision, graft, thorax
    35907CExcision, graft, abdomen
    36660CInsertion catheter, artery
    36822CInsertion of cannula(s)
    36823CInsertion of cannula(s)
    37140CRevision of circulation
    37145CRevision of circulation
    37160CRevision of circulation
    37180CRevision of circulation
    37181CSplice spleen/kidney veins
    37182CInsert hepatic shunt (tips)
    37215CTranscath stent, cca w/eps
    37216CTranscath stent, cca w/o eps
    37616CLigation of chest artery
    37617CLigation of abdomen artery
    37618CLigation of extremity artery
    37660CRevision of major vein
    37788CRevascularization, penis
    38100CRemoval of spleen, total
    38101CRemoval of spleen, partial
    38102CRemoval of spleen, total
    38115CRepair of ruptured spleen
    38380CThoracic duct procedure
    38381CThoracic duct procedure
    38382CThoracic duct procedure
    38562CRemoval, pelvic lymph nodes
    38564CRemoval, abdomen lymph nodes
    38724CRemoval of lymph nodes, neck
    38746CRemove thoracic lymph nodes
    38747CRemove abdominal lymph nodes
    38765CRemove groin lymph nodes
    38770CRemove pelvis lymph nodes
    38780CRemove abdomen lymph nodes
    39000CExploration of chest
    39010CExploration of chest
    39200CRemoval chest lesion
    39220CRemoval chest lesion
    39499CChest procedure
    39501CRepair diaphragm laceration
    39502CRepair paraesophageal hernia
    39503CRepair of diaphragm hernia
    39520CRepair of diaphragm hernia
    39530CRepair of diaphragm hernia
    39531CRepair of diaphragm hernia
    39540CRepair of diaphragm hernia
    39541CRepair of diaphragm hernia
    39545CRevision of diaphragm
    39560CResect diaphragm, simple
    39561CResect diaphragm, complex
    39599CDiaphragm surgery procedure
    41130CPartial removal of tongue
    41135CTongue and neck surgery
    41140CRemoval of tongue
    41145CTongue removal, neck surgery
    41150CTongue, mouth, jaw surgery
    41153CTongue, mouth, neck surgery
    41155CTongue, jaw, & neck surgery
    42426CExcise parotid gland/lesion
    42845CExtensive surgery of throat
    42894CRevision of pharyngeal walls
    42953CRepair throat, esophagus
    42961CControl throat bleeding
    42971CControl nose/throat bleeding
    43045CIncision of esophagus
    43100CExcision of esophagus lesion
    43101CExcision of esophagus lesion
    43107CRemoval of esophagus
    Start Printed Page 42974
    43108CRemoval of esophagus
    43112CRemoval of esophagus
    43113CRemoval of esophagus
    43116CPartial removal of esophagus
    43117CPartial removal of esophagus
    43118CPartial removal of esophagus
    43121CPartial removal of esophagus
    43122CPartial removal of esophagus
    43123CPartial removal of esophagus
    43124CRemoval of esophagus
    43135CRemoval of esophagus pouch
    43300CRepair of esophagus
    43305CRepair esophagus and fistula
    43310CRepair of esophagus
    43312CRepair esophagus and fistula
    43313CEsophagoplasty congenital
    43314CTracheo-esophagoplasty cong
    43320CFuse esophagus & stomach
    43324CRevise esophagus & stomach
    43325CRevise esophagus & stomach
    43326CRevise esophagus & stomach
    43330CRepair of esophagus
    43331CRepair of esophagus
    43340CFuse esophagus & intestine
    43341CFuse esophagus & intestine
    43350CSurgical opening, esophagus
    43351CSurgical opening, esophagus
    43352CSurgical opening, esophagus
    43360CGastrointestinal repair
    43361CGastrointestinal repair
    43400CLigate esophagus veins
    43401CEsophagus surgery for veins
    43405CLigate/staple esophagus
    43410CRepair esophagus wound
    43415CRepair esophagus wound
    43420CRepair esophagus opening
    43425CRepair esophagus opening
    43460CPressure treatment esophagus
    43496CFree jejunum flap, microvasc
    43500CSurgical opening of stomach
    43501CSurgical repair of stomach
    43502CSurgical repair of stomach
    43520CIncision of pyloric muscle
    43605CBiopsy of stomach
    43610CExcision of stomach lesion
    43611CExcision of stomach lesion
    43620CRemoval of stomach
    43621CRemoval of stomach
    43622CRemoval of stomach
    43631CRemoval of stomach, partial
    43632CRemoval of stomach, partial
    43633CRemoval of stomach, partial
    43634CRemoval of stomach, partial
    43635CRemoval of stomach, partial
    43638CRemoval of stomach, partial
    43639CRemoval of stomach, partial
    43640CVagotomy & pylorus repair
    43641CVagotomy & pylorus repair
    43644CLap gastric bypass/roux-en-y
    43645CLap gastr bypass incl smll i
    43800CReconstruction of pylorus
    43810CFusion of stomach and bowel
    43820CFusion of stomach and bowel
    43825CFusion of stomach and bowel
    43832CPlace gastrostomy tube
    43840CRepair of stomach lesion
    43842CGastroplasty for obesity
    43843CGastroplasty for obesity
    43845CGastroplasty duodenal switch
    43846CGastric bypass for obesity
    43847CGastric bypass for obesity
    43848CRevision gastroplasty
    43850CRevise stomach-bowel fusion
    43855CRevise stomach-bowel fusion
    43860CRevise stomach-bowel fusion
    43865CRevise stomach-bowel fusion
    43880CRepair stomach-bowel fistula
    44005CFreeing of bowel adhesion
    44010CIncision of small bowel
    44015CInsert needle cath bowel
    44020CExplore small intestine
    44021CDecompress small bowel
    44025CIncision of large bowel
    44050CReduce bowel obstruction
    44055CCorrect malrotation of bowel
    44110CExcise intestine lesion(s)
    44111CExcision of bowel lesion(s)
    44120CRemoval of small intestine
    44121CRemoval of small intestine
    44125CRemoval of small intestine
    44126CEnterectomy w/o taper, cong
    44127CEnterectomy w/taper, cong
    44128CEnterectomy cong, add-on
    44130CBowel to bowel fusion
    44132CEnterectomy, cadaver donor
    44133CEnterectomy, live donor
    44135CIntestine transplnt, cadaver
    44136CIntestine transplant, live
    44137CRemove intestinal allograft
    44139CMobilization of colon
    44140CPartial removal of colon
    44141CPartial removal of colon
    44143CPartial removal of colon
    44144CPartial removal of colon
    44145CPartial removal of colon
    44146CPartial removal of colon
    44147CPartial removal of colon
    44150CRemoval of colon
    44151CRemoval of colon/ileostomy
    44152CRemoval of colon/ileostomy
    Start Printed Page 42975
    44153CRemoval of colon/ileostomy
    44155CRemoval of colon/ileostomy
    44156CRemoval of colon/ileostomy
    44160CRemoval of colon
    44202CLap resect s/intestine singl
    44203CLap resect s/intestine, addl
    44204CLaparo partial colectomy
    44205CLap colectomy part w/ileum
    44210CLaparo total proctocolectomy
    44211CLaparo total proctocolectomy
    44212CLaparo total proctocolectomy
    44300COpen bowel to skin
    44310CIleostomy/jejunostomy
    44314CRevision of ileostomy
    44316CDevise bowel pouch
    44320CColostomy
    44322CColostomy with biopsies
    44345CRevision of colostomy
    44346CRevision of colostomy
    44602CSuture, small intestine
    44603CSuture, small intestine
    44604CSuture, large intestine
    44605CRepair of bowel lesion
    44615CIntestinal stricturoplasty
    44620CRepair bowel opening
    44625CRepair bowel opening
    44626CRepair bowel opening
    44640CRepair bowel-skin fistula
    44650CRepair bowel fistula
    44660CRepair bowel-bladder fistula
    44661CRepair bowel-bladder fistula
    44680CSurgical revision, intestine
    44700CSuspend bowel w/prosthesis
    44715CPrepare donor intestine
    44720CPrep donor intestine/venous
    44721CPrep donor intestine/artery
    44800CExcision of bowel pouch
    44820CExcision of mesentery lesion
    44850CRepair of mesentery
    44899CBowel surgery procedure
    44900CDrain app abscess, open
    44950CAppendectomy
    44955CAppendectomy add-on
    44960CAppendectomy
    45110CRemoval of rectum
    45111CPartial removal of rectum
    45112CRemoval of rectum
    45113CPartial proctectomy
    45114CPartial removal of rectum
    45116CPartial removal of rectum
    45119CRemove rectum w/reservoir
    45120CRemoval of rectum
    45121CRemoval of rectum and colon
    45123CPartial proctectomy
    45126CPelvic exenteration
    45130CExcision of rectal prolapse
    45135CExcision of rectal prolapse
    45136CExcise ileoanal reservior
    45540CCorrect rectal prolapse
    45550CRepair rectum/remove sigmoid
    45562CExploration/repair of rectum
    45563CExploration/repair of rectum
    45800CRepair rect/bladder fistula
    45805CRepair fistula w/colostomy
    45820CRepair rectourethral fistula
    45825CRepair fistula w/colostomy
    46705CRepair of anal stricture
    46715CRepair of anovaginal fistula
    46716CRepair of anovaginal fistula
    46730CConstruction of absent anus
    46735CConstruction of absent anus
    46740CConstruction of absent anus
    46742CRepair of imperforated anus
    46744CRepair of cloacal anomaly
    46746CRepair of cloacal anomaly
    46748CRepair of cloacal anomaly
    46751CRepair of anal sphincter
    47010COpen drainage, liver lesion
    47015CInject/aspirate liver cyst
    47100CWedge biopsy of liver
    47120CPartial removal of liver
    47122CExtensive removal of liver
    47125CPartial removal of liver
    47130CPartial removal of liver
    47133CRemoval of donor liver
    47135CTransplantation of liver
    47136CTransplantation of liver
    47140CPartial removal, donor liver
    47141CPartial removal, donor liver
    47142CPartial removal, donor liver
    47143CPrep donor liver, whole
    47144CPrep donor liver, 3-segment
    47145CPrep donor liver, lobe split
    47146CPrep donor liver/venous
    47147CPrep donor liver/arterial
    47300CSurgery for liver lesion
    47350CRepair liver wound
    47360CRepair liver wound
    47361CRepair liver wound
    47362CRepair liver wound
    47380COpen ablate liver tumor rf
    47381COpen ablate liver tumor cryo
    47400CIncision of liver duct
    47420CIncision of bile duct
    47425CIncision of bile duct
    47460CIncise bile duct sphincter
    47480CIncision of gallbladder
    47550CBile duct endoscopy add-on
    47570CLaparo cholecystoenterostomy
    47600CRemoval of gallbladder
    47605CRemoval of gallbladder
    47610CRemoval of gallbladder
    47612CRemoval of gallbladder
    47620CRemoval of gallbladder
    47700CExploration of bile ducts
    47701CBile duct revision
    47711CExcision of bile duct tumor
    47712CExcision of bile duct tumor
    47715CExcision of bile duct cyst
    47716CFusion of bile duct cyst
    47720CFuse gallbladder & bowel
    47721CFuse upper gi structures
    47740CFuse gallbladder & bowel
    47741CFuse gallbladder & bowel
    47760CFuse bile ducts and bowel
    47765CFuse liver ducts & bowel
    Start Printed Page 42976
    47780CFuse bile ducts and bowel
    47785CFuse bile ducts and bowel
    47800CReconstruction of bile ducts
    47801CPlacement, bile duct support
    47802CFuse liver duct & intestine
    47900CSuture bile duct injury
    48000CDrainage of abdomen
    48001CPlacement of drain, pancreas
    48005CResect/debride pancreas
    48020CRemoval of pancreatic stone
    48100CBiopsy of pancreas, open
    48120CRemoval of pancreas lesion
    48140CPartial removal of pancreas
    48145CPartial removal of pancreas
    48146CPancreatectomy
    48148CRemoval of pancreatic duct
    48150CPartial removal of pancreas
    48152CPancreatectomy
    48153CPancreatectomy
    48154CPancreatectomy
    48155CRemoval of pancreas
    48180CFuse pancreas and bowel
    48400CInjection, intraop add-on
    48500CSurgery of pancreatic cyst
    48510CDrain pancreatic pseudocyst
    48520CFuse pancreas cyst and bowel
    48540CFuse pancreas cyst and bowel
    48545CPancreatorrhaphy
    48547CDuodenal exclusion
    48551CPrep donor pancreas
    48552CPrep donor pancreas/venous
    48556CRemoval, allograft pancreas
    49000CExploration of abdomen
    49002CReopening of abdomen
    49010CExploration behind abdomen
    49020CDrain abdominal abscess
    49040CDrain, open, abdom abscess
    49060CDrain, open, retrop abscess
    49062CDrain to peritoneal cavity
    49201CRemove abdom lesion, complex
    49215CExcise sacral spine tumor
    49220CMultiple surgery, abdomen
    49255CRemoval of omentum
    49425CInsert abdomen-venous drain
    49428CLigation of shunt
    49605CRepair umbilical lesion
    49606CRepair umbilical lesion
    49610CRepair umbilical lesion
    49611CRepair umbilical lesion
    49900CRepair of abdominal wall
    49904COmental flap, extra-abdom
    49905COmental flap
    49906CFree omental flap, microvasc
    50010CExploration of kidney
    50040CDrainage of kidney
    50045CExploration of kidney
    50060CRemoval of kidney stone
    50065CIncision of kidney
    50070CIncision of kidney
    50075CRemoval of kidney stone
    50100CRevise kidney blood vessels
    50120CExploration of kidney
    50125CExplore and drain kidney
    50130CRemoval of kidney stone
    50135CExploration of kidney
    50205CBiopsy of kidney
    50220CRemove kidney, open
    50225CRemoval kidney open, complex
    50230CRemoval kidney open, radical
    50234CRemoval of kidney & ureter
    50236CRemoval of kidney & ureter
    50240CPartial removal of kidney
    50280CRemoval of kidney lesion
    50290CRemoval of kidney lesion
    50300CRemoval of donor kidney
    50320CRemoval of donor kidney
    50323CPrep cadaver renal allograft
    50325CPrep donor renal graft
    50327CPrep renal graft/venous
    50328CPrep renal graft/arterial
    50329CPrep renal graft/ureteral
    50340CRemoval of kidney
    50360CTransplantation of kidney
    50365CTransplantation of kidney
    50370CRemove transplanted kidney
    50380CReimplantation of kidney
    50400CRevision of kidney/ureter
    50405CRevision of kidney/ureter
    50500CRepair of kidney wound
    50520CClose kidney-skin fistula
    50525CRepair renal-abdomen fistula
    50526CRepair renal-abdomen fistula
    50540CRevision of horseshoe kidney
    50545CLaparo radical nephrectomy
    50546CLaparoscopic nephrectomy
    50547CLaparo removal donor kidney
    50548CLaparo remove w/ ureter
    50580CKidney endoscopy & treatment
    50600CExploration of ureter
    50605CInsert ureteral support
    50610CRemoval of ureter stone
    50620CRemoval of ureter stone
    50630CRemoval of ureter stone
    50650CRemoval of ureter
    50660CRemoval of ureter
    50700CRevision of ureter
    50715CRelease of ureter
    50722CRelease of ureter
    50725CRelease/revise ureter
    50727CRevise ureter
    50728CRevise ureter
    50740CFusion of ureter & kidney
    50750CFusion of ureter & kidney
    50760CFusion of ureters
    50770CSplicing of ureters
    50780CReimplant ureter in bladder
    50782CReimplant ureter in bladder
    50783CReimplant ureter in bladder
    50785CReimplant ureter in bladder
    50800CImplant ureter in bowel
    Start Printed Page 42977
    50810CFusion of ureter & bowel
    50815CUrine shunt to intestine
    50820CConstruct bowel bladder
    50825CConstruct bowel bladder
    50830CRevise urine flow
    50840CReplace ureter by bowel
    50845CAppendico-vesicostomy
    50860CTransplant ureter to skin
    50900CRepair of ureter
    50920CClosure ureter/skin fistula
    50930CClosure ureter/bowel fistula
    50940CRelease of ureter
    51060CRemoval of ureter stone
    51525CRemoval of bladder lesion
    51530CRemoval of bladder lesion
    51535CRepair of ureter lesion
    51550CPartial removal of bladder
    51555CPartial removal of bladder
    51565CRevise bladder & ureter(s)
    51570CRemoval of bladder
    51575CRemoval of bladder & nodes
    51580CRemove bladder/revise tract
    51585CRemoval of bladder & nodes
    51590CRemove bladder/revise tract
    51595CRemove bladder/revise tract
    51596CRemove bladder/create pouch
    51597CRemoval of pelvic structures
    51800CRevision of bladder/urethra
    51820CRevision of urinary tract
    51840CAttach bladder/urethra
    51841CAttach bladder/urethra
    51845CRepair bladder neck
    51860CRepair of bladder wound
    51865CRepair of bladder wound
    51900CRepair bladder/vagina lesion
    51920CClose bladder-uterus fistula
    51925CHysterectomy/bladder repair
    51940CCorrection of bladder defect
    51960CRevision of bladder & bowel
    51980CConstruct bladder opening
    53415CReconstruction of urethra
    53448CRemov/replc ur sphinctr comp
    54125CRemoval of penis
    54130CRemove penis & nodes
    54135CRemove penis & nodes
    54332CRevise penis/urethra
    54336CRevise penis/urethra
    54390CRepair penis and bladder
    54411CRemov/replc penis pros, comp
    54417CRemv/replc penis pros, compl
    54430CRevision of penis
    54535CExtensive testis surgery
    54650COrchiopexy (Fowler-Stephens)
    55605CIncise sperm duct pouch
    55650CRemove sperm duct pouch
    55801CRemoval of prostate
    55810CExtensive prostate surgery
    55812CExtensive prostate surgery
    55815CExtensive prostate surgery
    55821CRemoval of prostate
    55831CRemoval of prostate
    55840CExtensive prostate surgery
    55842CExtensive prostate surgery
    55845CExtensive prostate surgery
    55862CExtensive prostate surgery
    55865CExtensive prostate surgery
    55866CLaparo radical prostatectomy
    56630CExtensive vulva surgery
    56631CExtensive vulva surgery
    56632CExtensive vulva surgery
    56633CExtensive vulva surgery
    56634CExtensive vulva surgery
    56637CExtensive vulva surgery
    56640CExtensive vulva surgery
    57110CRemove vagina wall, complete
    57111CRemove vagina tissue, compl
    57112CVaginectomy w/nodes, compl
    57270CRepair of bowel pouch
    57280CSuspension of vagina
    57282CRepair of vaginal prolapse
    57283CColpopexy, intraperitoneal
    57292CConstruct vagina with graft
    57305CRepair rectum-vagina fistula
    57307CFistula repair & colostomy
    57308CFistula repair, transperine
    57311CRepair urethrovaginal lesion
    57335CRepair vagina
    57531CRemoval of cervix, radical
    57540CRemoval of residual cervix
    57545CRemove cervix/repair pelvis
    58140CRemoval of uterus lesion
    58146CMyomectomy abdom complex
    58150CTotal hysterectomy
    58152CTotal hysterectomy
    58180CPartial hysterectomy
    58200CExtensive hysterectomy
    58210CExtensive hysterectomy
    58240CRemoval of pelvis contents
    58260CVaginal hysterectomy
    58262CVag hyst including t/o
    58263CVag hyst w/t/o & vag repair
    58267CVag hyst w/urinary repair
    58270CVag hyst w/enterocele repair
    58275CHysterectomy/revise vagina
    58280CHysterectomy/revise vagina
    58285CExtensive hysterectomy
    58290CVag hyst complex
    58291CVag hyst incl t/o, complex
    58292CVag hyst t/o & repair, compl
    58293CVag hyst w/uro repair, compl
    58294CVag hyst w/enterocele, compl
    58400CSuspension of uterus
    58410CSuspension of uterus
    58520CRepair of ruptured uterus
    Start Printed Page 42978
    58540CRevision of uterus
    58605CDivision of fallopian tube
    58611CLigate oviduct(s) add-on
    58700CRemoval of fallopian tube
    58720CRemoval of ovary/tube(s)
    58740CRevise fallopian tube(s)
    58750CRepair oviduct
    58752CRevise ovarian tube(s)
    58760CRemove tubal obstruction
    58805CDrainage of ovarian cyst(s)
    58822CDrain ovary abscess, percut
    58825CTransposition, ovary(s)
    58940CRemoval of ovary(s)
    58943CRemoval of ovary(s)
    58950CResect ovarian malignancy
    58951CResect ovarian malignancy
    58952CResect ovarian malignancy
    58953CTah, rad dissect for debulk
    58954CTah rad debulk/lymph remove
    58956CBso, omentectomy w/tah
    58960CExploration of abdomen
    59120CTreat ectopic pregnancy
    59121CTreat ectopic pregnancy
    59130CTreat ectopic pregnancy
    59135CTreat ectopic pregnancy
    59136CTreat ectopic pregnancy
    59140CTreat ectopic pregnancy
    59325CRevision of cervix
    59350CRepair of uterus
    59514CCesarean delivery only
    59525CRemove uterus after cesarean
    59620CAttempted vbac delivery only
    59830CTreat uterus infection
    59850CAbortion
    59851CAbortion
    59852CAbortion
    59855CAbortion
    59856CAbortion
    59857CAbortion
    60254CExtensive thyroid surgery
    60270CRemoval of thyroid
    60271CRemoval of thyroid
    60502CRe-explore parathyroids
    60505CExplore parathyroid glands
    60520CRemoval of thymus gland
    60521CRemoval of thymus gland
    60522CRemoval of thymus gland
    60540CExplore adrenal gland
    60545CExplore adrenal gland
    60600CRemove carotid body lesion
    60605CRemove carotid body lesion
    60650CLaparoscopy adrenalectomy
    61105CTwist drill hole
    61107CDrill skull for implantation
    61108CDrill skull for drainage
    61120CBurr hole for puncture
    61140CPierce skull for biopsy
    61150CPierce skull for drainage
    61151CPierce skull for drainage
    61154CPierce skull & remove clot
    61156CPierce skull for drainage
    61210CPierce skull, implant device
    61250CPierce skull & explore
    61253CPierce skull & explore
    61304COpen skull for exploration
    61305COpen skull for exploration
    61312COpen skull for drainage
    61313COpen skull for drainage
    61314COpen skull for drainage
    61315COpen skull for drainage
    61316CImplt cran bone flap to abdo
    61320COpen skull for drainage
    61321COpen skull for drainage
    61322CDecompressive craniotomy
    61323CDecompressive lobectomy
    61332CExplore/biopsy eye socket
    61333CExplore orbit/remove lesion
    61340CRelieve cranial pressure
    61343CIncise skull (press relief)
    61345CRelieve cranial pressure
    61440CIncise skull for surgery
    61450CIncise skull for surgery
    61458CIncise skull for brain wound
    61460CIncise skull for surgery
    61470CIncise skull for surgery
    61480CIncise skull for surgery
    61490CIncise skull for surgery
    61500CRemoval of skull lesion
    61501CRemove infected skull bone
    61510CRemoval of brain lesion
    61512CRemove brain lining lesion
    61514CRemoval of brain abscess
    61516CRemoval of brain lesion
    61517CImplt brain chemotx add-on
    61518CRemoval of brain lesion
    61519CRemove brain lining lesion
    61520CRemoval of brain lesion
    61521CRemoval of brain lesion
    61522CRemoval of brain abscess
    61524CRemoval of brain lesion
    61526CRemoval of brain lesion
    61530CRemoval of brain lesion
    61531CImplant brain electrodes
    61533CImplant brain electrodes
    61534CRemoval of brain lesion
    61535CRemove brain electrodes
    61536CRemoval of brain lesion
    61537CRemoval of brain tissue
    61538CRemoval of brain tissue
    61539CRemoval of brain tissue
    61540CRemoval of brain tissue
    61541CIncision of brain tissue
    61542CRemoval of brain tissue
    61543CRemoval of brain tissue
    61544CRemove & treat brain lesion
    61545CExcision of brain tumor
    61546CRemoval of pituitary gland
    Start Printed Page 42979
    61548CRemoval of pituitary gland
    61550CRelease of skull seams
    61552CRelease of skull seams
    61556CIncise skull/sutures
    61557CIncise skull/sutures
    61558CExcision of skull/sutures
    61559CExcision of skull/sutures
    61563CExcision of skull tumor
    61564CExcision of skull tumor
    61566CRemoval of brain tissue
    61567CIncision of brain tissue
    61570CRemove foreign body, brain
    61571CIncise skull for brain wound
    61575CSkull base/brainstem surgery
    61576CSkull base/brainstem surgery
    61580CCraniofacial approach, skull
    61581CCraniofacial approach, skull
    61582CCraniofacial approach, skull
    61583CCraniofacial approach, skull
    61584COrbitocranial approach/skull
    61585COrbitocranial approach/skull
    61586CResect nasopharynx, skull
    61590CInfratemporal approach/skull
    61591CInfratemporal approach/skull
    61592COrbitocranial approach/skull
    61595CTranstemporal approach/skull
    61596CTranscochlear approach/skull
    61597CTranscondylar approach/skull
    61598CTranspetrosal approach/skull
    61600CResect/excise cranial lesion
    61601CResect/excise cranial lesion
    61605CResect/excise cranial lesion
    61606CResect/excise cranial lesion
    61607CResect/excise cranial lesion
    61608CResect/excise cranial lesion
    61609CTransect artery, sinus
    61610CTransect artery, sinus
    61611CTransect artery, sinus
    61612CTransect artery, sinus
    61613CRemove aneurysm, sinus
    61615CResect/excise lesion, skull
    61616CResect/excise lesion, skull
    61618CRepair dura
    61619CRepair dura
    61624COcclusion/embolization cath
    61680CIntracranial vessel surgery
    61682CIntracranial vessel surgery
    61684CIntracranial vessel surgery
    61686CIntracranial vessel surgery
    61690CIntracranial vessel surgery
    61692CIntracranial vessel surgery
    61697CBrain aneurysm repr, complx
    61698CBrain aneurysm repr, complx
    61700CBrain aneurysm repr, simple
    61702CInner skull vessel surgery
    61703CClamp neck artery
    61705CRevise circulation to head
    61708CRevise circulation to head
    61710CRevise circulation to head
    61711CFusion of skull arteries
    61720CIncise skull/brain surgery
    61735CIncise skull/brain surgery
    61750CIncise skull/brain biopsy
    61751CBrain biopsy w/ ct/mr guide
    61760CImplant brain electrodes
    61770CIncise skull for treatment
    61850CImplant neuroelectrodes
    61860CImplant neuroelectrodes
    61863CImplant neuroelectrode
    61864CImplant neuroelectrde, add'l
    61867CImplant neuroelectrode
    61868CImplant neuroelectrde, add'l
    61870CImplant neuroelectrodes
    61875CImplant neuroelectrodes
    62000CTreat skull fracture
    62005CTreat skull fracture
    62010CTreatment of head injury
    62100CRepair brain fluid leakage
    62115CReduction of skull defect
    62116CReduction of skull defect
    62117CReduction of skull defect
    62120CRepair skull cavity lesion
    62121CIncise skull repair
    62140CRepair of skull defect
    62141CRepair of skull defect
    62142CRemove skull plate/flap
    62143CReplace skull plate/flap
    62145CRepair of skull & brain
    62146CRepair of skull with graft
    62147CRepair of skull with graft
    62148CRetr bone flap to fix skull
    62161CDissect brain w/scope
    62162CRemove colloid cyst w/scope
    62163CNeuroendoscopy w/fb removal
    62164CRemove brain tumor w/scope
    62165CRemove pituit tumor w/scope
    62180CEstablish brain cavity shunt
    62190CEstablish brain cavity shunt
    62192CEstablish brain cavity shunt
    62200CEstablish brain cavity shunt
    62201CEstablish brain cavity shunt
    62220CEstablish brain cavity shunt
    62223CEstablish brain cavity shunt
    62256CRemove brain cavity shunt
    62258CReplace brain cavity shunt
    63043CLaminotomy, add'l cervical
    63044CLaminotomy, add'l lumbar
    63050CCervical laminoplasty
    63051CC-laminoplasty w/graft/plate
    63075CNeck spine disk surgery
    63076CNeck spine disk surgery
    63077CSpine disk surgery, thorax
    Start Printed Page 42980
    63078CSpine disk surgery, thorax
    63081CRemoval of vertebral body
    63082CRemove vertebral body add-on
    63085CRemoval of vertebral body
    63086CRemove vertebral body add-on
    63087CRemoval of vertebral body
    63088CRemove vertebral body add-on
    63090CRemoval of vertebral body
    63091CRemove vertebral body add-on
    63101CRemoval of vertebral body
    63102CRemoval of vertebral body
    63103CRemove vertebral body add-on
    63170CIncise spinal cord tract(s)
    63172CDrainage of spinal cyst
    63173CDrainage of spinal cyst
    63180CRevise spinal cord ligaments
    63182CRevise spinal cord ligaments
    63185CIncise spinal column/nerves
    63190CIncise spinal column/nerves
    63191CIncise spinal column/nerves
    63194CIncise spinal column & cord
    63195CIncise spinal column & cord
    63196CIncise spinal column & cord
    63197CIncise spinal column & cord
    63198CIncise spinal column & cord
    63199CIncise spinal column & cord
    63200CRelease of spinal cord
    63250CRevise spinal cord vessels
    63251CRevise spinal cord vessels
    63252CRevise spinal cord vessels
    63265CExcise intraspinal lesion
    63266CExcise intraspinal lesion
    63267CExcise intraspinal lesion
    63268CExcise intraspinal lesion
    63270CExcise intraspinal lesion
    63271CExcise intraspinal lesion
    63272CExcise intraspinal lesion
    63273CExcise intraspinal lesion
    63275CBiopsy/excise spinal tumor
    63276CBiopsy/excise spinal tumor
    63277CBiopsy/excise spinal tumor
    63278CBiopsy/excise spinal tumor
    63280CBiopsy/excise spinal tumor
    63281CBiopsy/excise spinal tumor
    63282CBiopsy/excise spinal tumor
    63283CBiopsy/excise spinal tumor
    63285CBiopsy/excise spinal tumor
    63286CBiopsy/excise spinal tumor
    63287CBiopsy/excise spinal tumor
    63290CBiopsy/excise spinal tumor
    63295CRepair of laminectomy defect
    63300CRemoval of vertebral body
    63301CRemoval of vertebral body
    63302CRemoval of vertebral body
    63303CRemoval of vertebral body
    63304CRemoval of vertebral body
    63305CRemoval of vertebral body
    63306CRemoval of vertebral body
    63307CRemoval of vertebral body
    63308CRemove vertebral body add-on
    63700CRepair of spinal herniation
    63702CRepair of spinal herniation
    63704CRepair of spinal herniation
    63706CRepair of spinal herniation
    63707CRepair spinal fluid leakage
    63709CRepair spinal fluid leakage
    63710CGraft repair of spine defect
    63740CInstall spinal shunt
    64752CIncision of vagus nerve
    64755CIncision of stomach nerves
    64760CIncision of vagus nerve
    64804CRemove sympathetic nerves
    64809CRemove sympathetic nerves
    64818CRemove sympathetic nerves
    64866CFusion of facial/other nerve
    64868CFusion of facial/other nerve
    65273CRepair of eye wound
    69155CExtensive ear/neck surgery
    69535CRemove part of temporal bone
    69554CRemove ear lesion
    69950CIncise inner ear nerve
    69970CRemove inner ear lesion
    75900CArterial catheter exchange
    75952CEndovasc repair abdom aorta
    75953CAbdom aneurysm endovas rpr
    75954CIliac aneurysm endovas rpr
    92970CCardioassist, internal
    92971CCardioassist, external
    92975CDissolve clot, heart vessel
    92992CRevision of heart chamber
    92993CRevision of heart chamber
    99190CSpecial pump services
    99191CSpecial pump services
    99192CSpecial pump services
    99251CInitial inpatient consult
    99252CInitial inpatient consult
    99253CInitial inpatient consult
    99254CInitial inpatient consult
    99255CInitial inpatient consult
    99261CFollow-up inpatient consult
    99262CFollow-up inpatient consult
    99263CFollow-up inpatient consult
    99293CPed critical care, initial
    99294CPed critical care, subseq
    99295CNeonatal critical care
    99296CNeonatal critical care
    99298CNeonatal critical care
    99299CIc, lbw infant 1500-2500 gm
    99356CProlonged service, inpatient
    99357CProlonged service, inpatient
    99433CNormal newborn care/hospital
    Start Printed Page 42981
    G0341CPercutaneous islet cell trans
    G0342CLaparoscopy Islet cell Trans
    G0343CLaparotomy Islet cell tranp

    Addendum H.—Wage Index for Urban Areas by CBSA

    CBSA codeUrban area (constituent counties)Wage index
    101802 Abilene, TX0.8038
    Callahan County, TX
    Jones County, TX
    Taylor County, TX
    10380Aguadilla-Isabela-San Sebastian, PR0.4736
    Aguada Municipio, PR
    Aguadilla Municipio, PR
    Anasco Municipio, PR
    Isabela Municipio, PR
    Lares Municipio, PR
    Moca Municipio, PR
    Rincon Municipio, PR
    San Sebastian Municipio, PR
    10420Akron, OH0.8979
    Portage County, OH
    Summit County, OH
    10500Albany, GA0.8645
    Baker County, GA
    Dougherty County, GA
    Lee County, GA
    Terrell County, GA
    Worth County, GA
    10580Albany-Schenectady-Troy, NY0.8565
    Albany County, NY
    Rensselaer County, NY
    Saratoga County, NY
    Schenectady County, NY
    Schoharie County, NY
    10740Albuquerque, NM0.9696
    Bernalillo County, NM
    Sandoval County, NM
    Torrance County, NM
    Valencia County, NM
    10780Alexandria, LA0.8048
    Grant Parish, LA
    Rapides Parish, LA
    10900Allentown-Bethlehem-Easton, PA-NJ (PA Hospitals)0.9844
    Warren County, NJ
    Carbon County, PA
    Lehigh County, PA
    Northampton County, PA
    109002 Allentown-Bethlehem-Easton, PA-NJ (NJ Hospitals)1.1253
    Warren County, NJ
    Carbon County, PA
    Lehigh County, PA
    Northampton County, PA
    11020Altoona, PA0.8942
    Blair County, PA
    11100Amarillo, TX0.9165
    Armstrong County, TX
    Carson County, TX
    Potter County, TX
    Randall County, TX
    11180Ames, IA0.9546
    Story County, IA
    11260Anchorage, AK1.2110
    Anchorage Municipality, AK
    Matanuska-Susitna Borough, AK
    Start Printed Page 42982
    11300Anderson, IN0.8634
    Madison County, IN
    11340Anderson, SC0.8887
    Anderson County, SC
    11460Ann Arbor, MI1.0885
    Washtenaw County, MI
    11500Anniston-Oxford, AL0.7702
    Calhoun County, AL
    115402 Appleton, WI0.9478
    Calumet County, WI
    Outagamie County, WI
    11700Asheville, NC0.9312
    Buncombe County, NC
    Haywood County, NC
    Henderson County, NC
    Madison County, NC
    12020Athens-Clarke County, GA0.9813
    Clarke County, GA
    Madison County, GA
    Oconee County, GA
    Oglethorpe County, GA
    120601 Atlanta-Sandy Springs-Marietta, GA0.9637
    Barrow County, GA
    Bartow County, GA
    Butts County, GA
    Carroll County, GA
    Cherokee County, GA
    Clayton County, GA
    Cobb County, GA
    Coweta County, GA
    Dawson County, GA
    DeKalb County, GA
    Douglas County, GA
    Fayette County, GA
    Forsyth County, GA
    Fulton County, GA
    Gwinnett County, GA
    Haralson County, GA
    Heard County, GA
    Henry County, GA
    Jasper County, GA
    Lamar County, GA
    Meriwether County, GA
    Newton County, GA
    Paulding County, GA
    Pickens County, GA
    Pike County, GA
    Rockdale County, GA
    Spalding County, GA
    Walton County, GA
    12100Atlantic City, NJ1.1618
    Atlantic County, NJ
    12220Auburn-Opelika, AL0.8113
    Lee County, AL
    12260Augusta-Richmond County, GA-SC0.9567
    Burke County, GA
    Columbia County, GA
    McDuffie County, GA
    Richmond County, GA
    Aiken County, SC
    Edgefield County, SC
    124201 Austin-Round Rock, TX0.9451
    Bastrop County, TX
    Caldwell County, TX
    Hays County, TX
    Travis County, TX
    Williamson County, TX
    125401 Bakersfield, CA1.0848
    Kern County, CA
    125801 Baltimore-Towson, MD0.9892
    Anne Arundel County, MD
    Start Printed Page 42983
    Baltimore County, MD
    Carroll County, MD
    Harford County, MD
    Howard County, MD
    Queen Anne's County, MD
    Baltimore City, MD
    12620Bangor, ME0.9985
    Penobscot County, ME
    12700Barnstable Town, MA1.2518
    Barnstable County, MA
    12940Baton Rouge, LA0.8605
    Ascension Parish, LA
    East Baton Rouge Parish, LA
    East Feliciana Parish, LA
    Iberville Parish, LA
    Livingston Parish, LA
    Pointe Coupee Parish, LA
    St. Helena Parish, LA
    West Baton Rouge Parish, LA
    West Feliciana Parish, LA
    12980Battle Creek, MI0.9492
    Calhoun County, MI
    13020Bay City, MI0.9535
    Bay County, MI
    13140Beaumont-Port Arthur, TX0.8422
    Hardin County, TX
    Jefferson County, TX
    Orange County, TX
    13380Bellingham, WA1.1705
    Whatcom County, WA
    13460Bend, OR1.0783
    Deschutes County, OR
    136441 Bethesda-Gaithersburg-Frederick, MD1.1471
    Frederick County, MD
    Montgomery County, MD
    13740Billings, MT0.8855
    Carbon County, MT
    Yellowstone County, MT
    13780Binghamton, NY0.8588
    Broome County, NY
    Tioga County, NY
    138201 Birmingham-Hoover, AL0.8979
    Bibb County, AL
    Blount County, AL
    Chilton County, AL
    Jefferson County, AL
    St. Clair County, AL
    Shelby County, AL
    Walker County, AL
    13900Bismarck, ND0.7519
    Burleigh County, ND
    Morton County, ND
    139802 Blacksburg-Christiansburg-Radford, VA0.8024
    Giles County, VA
    Montgomery County, VA
    Pulaski County, VA
    Radford City, VA
    140202 Bloomington, IN0.8632
    Greene County, IN
    Monroe County, IN
    Owen County, IN
    14060Bloomington-Normal, IL0.9083
    McLean County, IL
    14260Boise City-Nampa, ID0.9048
    Ada County, ID
    Boise County, ID
    Canyon County, ID
    Gem County, ID
    Owyhee County, ID
    144841 Boston-Quincy, MA1.1537
    Norfolk County, MA
    Start Printed Page 42984
    Plymouth County, MA
    Suffolk County, MA
    14500Boulder, CO0.9743
    Boulder County, CO
    14540Bowling Green, KY0.8222
    Edmonson County, KY
    Warren County, KY
    14740Bremerton-Silverdale, WA1.0681
    Kitsap County, WA
    14860Bridgeport-Stamford-Norwalk, CT1.2607
    Fairfield County, CT
    15180Brownsville-Harlingen, TX0.9853
    Cameron County, TX
    15260Brunswick, GA0.9341
    Brantley County, GA
    Glynn County, GA
    McIntosh County, GA
    153801 Buffalo-Niagara Falls, NY0.8888
    Erie County, NY
    Niagara County, NY
    15500Burlington, NC0.8902
    Alamance County, NC
    155402 Burlington-South Burlington, VT1.0199
    Chittenden County, VT
    Franklin County, VT
    Grand Isle County, VT
    157641 Cambridge-Newton-Framingham, MA1.1078
    Middlesex County, MA
    158041, 2 Camden, NJ1.1253
    Burlington County, NJ
    Camden County, NJ
    Gloucester County, NJ
    15940Canton-Massillon, OH0.8957
    Carroll County, OH
    Stark County, OH
    15980Cape Coral-Fort Myers, FL0.9333
    Lee County, FL
    16180Carson City, NV1.0229
    Carson City, NV
    162202 Casper, WY0.9207
    Natrona County, WY
    16300Cedar Rapids, IA0.8605
    Benton County, IA
    Jones County, IA
    Linn County, IA
    16580Champaign-Urbana, IL0.9591
    Champaign County, IL
    Ford County, IL
    Piatt County, IL
    16620Charleston, WV0.8429
    Boone County, WV
    Clay County, WV
    Kanawha County, WV
    Lincoln County, WV
    Putnam County, WV
    16700Charleston-North Charleston, SC0.9433
    Berkeley County, SC
    Charleston County, SC
    Dorchester County, SC
    167401 Charlotte-Gastonia-Concord, NC-SC0.9717
    Anson County, NC
    Cabarrus County, NC
    Gaston County, NC
    Mecklenburg County, NC
    Union County, NC
    York County, SC
    16820Charlottesville, VA1.0230
    Albemarle County, VA
    Fluvanna County, VA
    Greene County, VA
    Nelson County, VA
    Start Printed Page 42985
    Charlottesville City, VA
    16860Chattanooga, TN-GA0.9099
    Catoosa County, GA
    Dade County, GA
    Walker County, GA
    Hamilton County, TN
    Marion County, TN
    Sequatchie County, TN
    169402 Cheyenne, WY0.9207
    Laramie County, WY
    169741 Chicago-Naperville-Joliet, IL1.0846
    Cook County, IL
    DeKalb County, IL
    DuPage County, IL
    Grundy County, IL
    Kane County, IL
    Kendall County, IL
    McHenry County, IL
    Will County, IL
    170202 Chico, CA1.0848
    Butte County, CA
    171401 Cincinnati-Middletown, OH-KY-IN0.9604
    Dearborn County, IN
    Franklin County, IN
    Ohio County, IN
    Boone County, KY
    Bracken County, KY
    Campbell County, KY
    Gallatin County, KY
    Grant County, KY
    Kenton County, KY
    Pendleton County, KY
    Brown County, OH
    Butler County, OH
    Clermont County, OH
    Hamilton County, OH
    Warren County, OH
    17300Clarksville, TN-KY0.8272
    Christian County, KY
    Trigg County, KY
    Montgomery County, TN
    Stewart County, TN
    17420Cleveland, TN0.8160
    Bradley County, TN
    Polk County, TN
    174601 Cleveland-Elyria-Mentor, OH0.9197
    Cuyahoga County, OH
    Geauga County, OH
    Lake County, OH
    Lorain County, OH
    Medina County, OH
    17660Coeur d'Alene, ID0.9642
    Kootenai County, ID
    17780College Station-Bryan, TX0.8911
    Brazos County, TX
    Burleson County, TX
    Robertson County, TX
    17820Colorado Springs, CO0.9457
    El Paso County, CO
    Teller County, CO
    17860Columbia, MO0.8346
    Boone County, MO
    Howard County, MO
    17900Columbia, SC0.9057
    Calhoun County, SC
    Fairfield County, SC
    Kershaw County, SC
    Lexington County, SC
    Richland County, SC
    Saluda County, SC
    17980Columbus, GA-AL0.8570
    Start Printed Page 42986
    Russell County, AL
    Chattahoochee County, GA
    Harris County, GA
    Marion County, GA
    Muscogee County, GA
    18020Columbus, IN0.9596
    Bartholomew County, IN
    181401 Columbus, OH0.9848
    Delaware County, OH
    Fairfield County, OH
    Franklin County, OH
    Licking County, OH
    Madison County, OH
    Morrow County, OH
    Pickaway County, OH
    Union County, OH
    18580Corpus Christi, TX0.8557
    Aransas County, TX
    Nueces County, TX
    San Patricio County, TX
    18700Corvallis, OR1.0711
    Benton County, OR
    19060Cumberland, MD-WV0.9310
    Allegany County, MD
    Mineral County, WV
    191241 Dallas-Plano-Irving, TX1.0226
    Collin County, TX
    Dallas County, TX
    Delta County, TX
    Denton County, TX
    Ellis County, TX
    Hunt County, TX
    Kaufman County, TX
    Rockwall County, TX
    19140Dalton, GA0.9033
    Murray County, GA
    Whitfield County, GA
    19180Danville, IL0.9048
    Vermilion County, IL
    19260Danville, VA0.8514
    Pittsylvania County, VA
    Danville City, VA
    19340Davenport-Moline-Rock Island, IA-IL0.8716
    Henry County, IL
    Mercer County, IL
    Rock Island County, IL
    Scott County, IA
    19380Dayton, OH0.9069
    Greene County, OH
    Miami County, OH
    Montgomery County, OH
    Preble County, OH
    19460Decatur, AL0.8517
    Lawrence County, AL
    Morgan County, AL
    195002 Decatur, IL0.8285
    Macon County, IL
    19660Deltona-Daytona Beach-Ormond Beach, FL0.9307
    Volusia County, FL
    197401 Denver-Aurora, CO1.0710
    Adams County, CO
    Arapahoe County, CO
    Broomfield County, CO
    Clear Creek County, CO
    Denver County, CO
    Douglas County, CO
    Elbert County, CO
    Gilpin County, CO
    Jefferson County, CO
    Park County, CO
    19780Des Moines, IA0.9650
    Start Printed Page 42987
    Dallas County, IA
    Guthrie County, IA
    Madison County, IA
    Polk County, IA
    Warren County, IA
    198041 Detroit-Livonia-Dearborn, MI1.0453
    Wayne County, MI
    20020Dothan, AL0.7743
    Geneva County, AL
    Henry County, AL
    Houston County, AL
    20100Dover, DE0.9821
    Kent County, DE
    20220Dubuque, IA0.9116
    Dubuque County, IA
    20260Duluth, MN-WI1.0224
    Carlton County, MN
    St. Louis County, MN
    Douglas County, WI
    20500Durham, NC1.0260
    Chatham County, NC
    Durham County, NC
    Orange County, NC
    Person County, NC
    207402 Eau Claire, WI0.9478
    Chippewa County, WI
    Eau Claire County, WI
    207641 Edison, NJ1.1301
    Middlesex County, NJ
    Monmouth County, NJ
    Ocean County, NJ
    Somerset County, NJ
    209402 El Centro, CA1.0848
    Imperial County, CA
    21060Elizabethtown, KY0.8816
    Hardin County, KY
    Larue County, KY
    21140Elkhart-Goshen, IN0.9616
    Elkhart County, IN
    21300Elmira, NY0.8276
    Chemung County, NY
    21340El Paso, TX0.8954
    El Paso County, TX
    21500Erie, PA0.8746
    Erie County, PA
    21604Essex County, MA1.0679
    Essex County, MA
    21660Eugene-Springfield, OR1.0810
    Lane County, OR
    21780Evansville, IN-KY0.8735
    Gibson County, IN
    Posey County, IN
    Vanderburgh County, IN
    Warrick County, IN
    Henderson County, KY
    Webster County, KY
    218202 Fairbanks, AK1.1977
    Fairbanks North Star Borough, AK
    21940Fajardo, PR0.4160
    Ceiba Municipio, PR
    Fajardo Municipio, PR
    Luquillo Municipio, PR
    22020Fargo, ND-MN (ND Hospitals)0.8778
    Clay County, MN
    Cass County, ND
    220202 Fargo, ND-MN (MN Hospitals)0.9183
    Clay County, MN
    Cass County, ND
    221402 Farmington, NM0.8649
    San Juan County, NM
    22180Fayetteville, NC0.9426
    Start Printed Page 42988
    Cumberland County, NC
    Hoke County, NC
    22220Fayetteville-Springdale-Rogers, AR-MO0.8615
    Benton County, AR
    Madison County, AR
    Washington County, AR
    McDonald County, MO
    22380Flagstaff, AZ1.2094
    Coconino County, AZ
    22420Flint, MI
    Genesee County, MI1.0654
    22500Florence, SC0.8988
    Darlington County, SC
    Florence County, SC
    22520Florence-Muscle Shoals, AL0.8305
    Colbert County, AL
    Lauderdale County, AL
    22540Fond du Lac, WI0.9649
    Fond du Lac County, WI
    22660Fort Collins-Loveland, CO1.0146
    Larimer County, CO
    227441 Fort Lauderdale-Pompano Beach-Deerfield Beach, FL1.0508
    Broward County, FL
    22900Fort Smith, AR-OK0.8231
    Crawford County, AR
    Franklin County, AR
    Sebastian County, AR
    Le Flore County, OK
    Sequoyah County, OK
    23020Fort Walton Beach-Crestview-Destin, FL0.8877
    Okaloosa County, FL
    23060Fort Wayne, IN0.9797
    Allen County, IN
    Wells County, IN
    Whitley County, IN
    231041 Fort Worth-Arlington, TX0.9514
    Johnson County, TX
    Parker County, TX
    Tarrant County, TX
    Wise County, TX
    234202 Fresno, CA1.0848
    Fresno County, CA
    23460Gadsden, AL0.7974
    Etowah County, AL
    23540Gainesville, FL0.9461
    Alachua County, FL
    Gilchrist County, FL
    23580Gainesville, GA0.8897
    Hall County, GA
    23844Gary, IN0.9366
    Jasper County, IN
    Lake County, IN
    Newton County, IN
    Porter County, IN
    24020Glens Falls, NY0.8587
    Warren County, NY
    Washington County, NY
    24140Goldsboro, NC0.8781
    Wayne County, NC
    24220Grand Forks, ND-MN1.1521
    Polk County, MN
    Grand Forks County, ND
    24300Grand Junction, CO0.9590
    Mesa County, CO
    24340Grand Rapids-Wyoming, MI0.9398
    Barry County, MI
    Ionia County, MI
    Kent County, MI
    Newaygo County, MI
    24500Great Falls, MT0.9074
    Cascade County, MT
    Start Printed Page 42989
    24540Greeley, CO0.9597
    Weld County, CO
    245802 Green Bay, WI0.9478
    Brown County, WI
    Kewaunee County, WI
    Oconto County, WI
    24660Greensboro-High Point, NC0.9133
    Guilford County, NC
    Randolph County, NC
    Rockingham County, NC
    24780Greenville, NC0.9414
    Greene County, NC
    Pitt County, NC
    24860Greenville, SC1.0138
    Greenville County, SC
    Laurens County, SC
    Pickens County, SC
    25020Guayama, PR0.3186
    Arroyo Municipio, PR
    Guayama Municipio, PR
    Patillas Municipio, PR
    25060Gulfport-Biloxi, MS0.8922
    Hancock County, MS
    Harrison County, MS
    Stone County, MS
    25180Hagerstown-Martinsburg, MD-WV0.9528
    Washington County, MD
    Berkeley County, WV
    Morgan County, WV
    252602 Hanford-Corcoran, CA1.0848
    Kings County, CA
    25420Harrisburg-Carlisle, PA0.9317
    Cumberland County, PA
    Dauphin County, PA
    Perry County, PA
    25500Harrisonburg, VA0.9101
    Rockingham County, VA
    Harrisonburg City, VA
    255401, 2 Hartford-West Hartford-East Hartford, CT1.1790
    Hartford County, CT
    Litchfield County, CT
    Middlesex County, CT
    Tolland County, CT
    256202 Hattiesburg, MS0.7685
    Forrest County, MS
    Lamar County, MS
    Perry County, MS
    25860Hickory-Lenoir-Morganton, NC0.8931
    Alexander County, NC
    Burke County, NC
    Caldwell County, NC
    Catawba County, NC
    25980Hinesville-Fort Stewart, GA0.7684
    Liberty County, GA
    Long County, GA
    26100Holland-Grand Haven, MI0.9133
    Ottawa County, MI
    26180Honolulu, HI1.1206
    Honolulu County, HI
    26300Hot Springs, AR0.9066
    Garland County, AR
    26380Houma-Bayou Cane-Thibodaux, LA0.7903
    Lafourche Parish, LA
    Terrebonne Parish, LA
    264201 Houston-Sugar Land-Baytown, TX1.0008
    Austin County, TX
    Brazoria County, TX
    Chambers County, TX
    Fort Bend County, TX
    Galveston County, TX
    Harris County, TX
    Start Printed Page 42990
    Liberty County, TX
    Montgomery County, TX
    San Jacinto County, TX
    Waller County, TX
    26580Huntington-Ashland, WV-KY-OH0.9482
    Boyd County, KY
    Greenup County, KY
    Lawrence County, OH
    Cabell County, WV
    Wayne County, WV
    26620Huntsville, AL0.9124
    Limestone County, AL
    Madison County, AL
    26820Idaho Falls, ID0.9409
    Bonneville County, ID
    Jefferson County, ID
    269001 Indianapolis, IN0.9922
    Boone County, IN
    Brown County, IN
    Hamilton County, IN
    Hancock County, IN
    Hendricks County, IN
    Johnson County, IN
    Marion County, IN
    Morgan County, IN
    Putnam County, IN
    Shelby County, IN
    26980Iowa City, IA0.9751
    Johnson County, IA
    Washington County, IA
    27060Ithaca, NY0.9855
    Tompkins County, NY
    27100Jackson, MI0.9300
    Jackson County, MI
    27140Jackson, MS0.8313
    Copiah County, MS
    Hinds County, MS
    Madison County, MS
    Rankin County, MS
    Simpson County, MS
    27180Jackson, TN0.8964
    Chester County, TN
    Madison County, TN
    272601 Jacksonville, FL0.9303
    Baker County, FL
    Clay County, FL
    Duval County, FL
    Nassau County, FL
    St. Johns County, FL
    273402 Jacksonville, NC0.8570
    Onslow County, NC
    27500Janesville, WI0.9561
    Rock County, WI
    27620Jefferson City, MO0.8389
    Callaway County, MO
    Cole County, MO
    Moniteau County, MO
    Osage County, MO
    27740Johnson City, TN0.7958
    Carter County, TN
    Unicoi County, TN
    Washington County, TN
    27780Johnstown, PA0.8348
    Cambria County, PA
    27860Jonesboro, AR0.7968
    Craighead County, AR
    Poinsett County, AR
    27900Joplin, MO0.8594
    Jasper County, MO
    Newton County, MO
    28020Kalamazoo-Portage, MI
    Start Printed Page 42991
    Kalamazoo County, MI
    Van Buren County, MI1.0403
    28100Kankakee-Bradley, IL1.0991
    Kankakee County, IL
    281401 Kansas City, MO-KS0.9454
    Franklin County, KS
    Johnson County, KS
    Leavenworth County, KS
    Linn County, KS
    Miami County, KS
    Wyandotte County, KS
    Bates County, MO
    Caldwell County, MO
    Cass County, MO
    Clay County, MO
    Clinton County, MO
    Jackson County, MO
    Lafayette County, MO
    Platte County, MO
    Ray County, MO
    28420Kennewick-Richland-Pasco, WA1.0619
    Benton County, WA
    Franklin County, WA
    28660Killeen-Temple-Fort Hood, TX0.8566
    Bell County, TX
    Coryell County, TX
    Lampasas County, TX
    28700Kingsport-Bristol-Bristol, TN-VA0.8095
    Hawkins County, TN
    Sullivan County, TN
    Bristol City, VA
    Scott County, VA
    Washington County, VA
    28740Kingston, NY0.9260
    Ulster County, NY
    28940Knoxville, TN0.8470
    Anderson County, TN
    Blount County, TN
    Knox County, TN
    Loudon County, TN
    Union County, TN
    29020Kokomo, IN0.9555
    Howard County, IN
    Tipton County, IN
    29100La Crosse, WI-MN0.9557
    Houston County, MN
    La Crosse County, WI
    29140Lafayette, IN0.8730
    Benton County, IN
    Carroll County, IN
    Tippecanoe County, IN
    29180Lafayette, LA0.8429
    Lafayette Parish, LA
    St. Martin Parish, LA
    29340Lake Charles, LA0.7847
    Calcasieu Parish, LA
    Cameron Parish, LA
    29404Lake County-Kenosha County, IL-WI1.0444
    Lake County, IL
    Kenosha County, WI
    29460Lakeland, FL0.8934
    Polk County, FL
    29540Lancaster, PA0.9716
    Lancaster County, PA
    29620Lansing-East Lansing, MI0.9786
    Clinton County, MI
    Eaton County, MI
    Ingham County, MI
    29700Laredo, TX0.8101
    Webb County, TX
    297402 Las Cruces, NM0.8649
    Start Printed Page 42992
    Dona Ana County, NM
    298201 Las Vegas-Paradise, NV1.1416
    Clark County, NV
    29940Lawrence, KS0.8538
    Douglas County, KS
    30020Lawton, OK0.7916
    Comanche County, OK
    30140Lebanon, PA0.8654
    Lebanon County, PA
    30300Lewiston, ID-WA (ID Hospitals)0.9878
    Nez Perce County, ID
    Asotin County, WA
    303002 Lewiston, ID-WA (WA Hospitals)1.0459
    Nez Perce County, ID
    Asotin County, WA
    30340Lewiston-Auburn, ME0.9332
    Androscoggin County, ME
    30460Lexington-Fayette, KY0.9060
    Bourbon County, KY
    Clark County, KY
    Fayette County, KY
    Jessamine County, KY
    Scott County, KY
    Woodford County, KY
    30620Lima, OH0.9263
    Allen County, OH
    30700Lincoln, NE1.0197
    Lancaster County, NE
    Seward County, NE
    30780Little Rock-North Little Rock, AR0.8768
    Faulkner County, AR
    Grant County, AR
    Lonoke County, AR
    Perry County, AR
    Pulaski County, AR
    Saline County, AR
    30860Logan, UT-ID0.9183
    Franklin County, ID
    Cache County, UT
    30980Longview, TX0.8741
    Gregg County, TX
    Rusk County, TX
    Upshur County, TX
    310202 Longview, WA1.0459
    Cowlitz County, WA
    310841 Los Angeles-Long Beach-Glendale, CA1.1762
    Los Angeles County, CA
    311401 Louisville, KY-IN0.9264
    Clark County, IN
    Floyd County, IN
    Harrison County, IN
    Washington County, IN
    Bullitt County, KY
    Henry County, KY
    Jefferson County, KY
    Meade County, KY
    Nelson County, KY
    Oldham County, KY
    Shelby County, KY
    Spencer County, KY
    Trimble County, KY
    31180Lubbock, TX0.8790
    Crosby County, TX
    Lubbock County, TX
    31340Lynchburg, VA0.8706
    Amherst County, VA
    Appomattox County, VA
    Bedford County, VA
    Campbell County, VA
    Bedford City, VA
    Lynchburg City, VA
    Start Printed Page 42993
    31420Macon, GA0.9485
    Bibb County, GA
    Crawford County, GA
    Jones County, GA
    Monroe County, GA
    Twiggs County, GA
    314602 Madera, CA1.0848
    Madera County, CA
    31540Madison, WI1.0629
    Columbia County, WI
    Dane County, WI
    Iowa County, WI
    317002 Manchester-Nashua, NH1.0668
    Hillsborough County, NH
    Merrimack County, NH
    31900Mansfield, OH0.8788
    Richland County, OH
    32420Mayaguez, PR0.4016
    Hormigueros Municipio, PR
    Mayagüez Municipio, PR
    32580McAllen-Edinburg-Mission, TX0.8945
    Hidalgo County, TX
    327802 Medford, OR1.0284
    Jackson County, OR
    328201 Memphis, TN-MS-AR0.9346
    Crittenden County, AR
    DeSoto County, MS
    Marshall County, MS
    Tate County, MS
    Tunica County, MS
    Fayette County, TN
    Shelby County, TN
    Tipton County, TN
    32900Merced, CA1.1123
    Merced County, CA
    331241 Miami-Miami Beach-Kendall, FL0.9757
    Miami-Dade County, FL
    33140Michigan City-La Porte, IN0.9409
    LaPorte County, IN
    33260Midland, TX0.9522
    Midland County, TX
    333401 Milwaukee-Waukesha-West Allis, WI1.0111
    Milwaukee County, WI
    Ozaukee County, WI
    Washington County, WI
    Waukesha County, WI
    334601 Minneapolis-St. Paul-Bloomington, MN-WI1.1055
    Anoka County, MN
    Carver County, MN
    Chisago County, MN
    Dakota County, MN
    Hennepin County, MN
    Isanti County, MN
    Ramsey County, MN
    Scott County, MN
    Sherburne County, MN
    Washington County, MN
    Wright County, MN
    Pierce County, WI
    St. Croix County, WI
    33540Missoula, MT0.9535
    Missoula County, MT
    33660Mobile, AL0.7902
    Mobile County, AL
    33700Modesto, CA1.1885
    Stanislaus County, CA
    33740Monroe, LA0.8044
    Ouachita Parish, LA
    Union Parish, LA
    33780Monroe, MI0.9468
    Monroe County, MI
    Start Printed Page 42994
    33860Montgomery, AL0.8600
    Autauga County, AL
    Elmore County, AL
    Lowndes County, AL
    Montgomery County, AL
    34060Morgantown, WV0.8439
    Monongalia County, WV
    Preston County, WV
    34100Morristown, TN0.8758
    Grainger County, TN
    Hamblen County, TN
    Jefferson County, TN
    345802 Mount Vernon-Anacortes, WA1.0459
    Skagit County, WA
    34620Muncie, IN0.8952
    Delaware County, IN
    34740Muskegon-Norton Shores, MI0.9677
    Muskegon County, MI
    34820Myrtle Beach-Conway-North Myrtle Beach, SC0.8869
    Horry County, SC
    34900Napa, CA1.2643
    Napa County, CA
    34940Naples-Marco Island, FL1.0115
    Collier County, FL
    349801 Nashville-Davidson--Murfreesboro, TN0.9757
    Cannon County, TN
    Cheatham County, TN
    Davidson County, TN
    Dickson County, TN
    Hickman County, TN
    Macon County, TN
    Robertson County, TN
    Rutherford County, TN
    Smith County, TN
    Sumner County, TN
    Trousdale County, TN
    Williamson County, TN
    Wilson County, TN
    350041 Nassau-Suffolk, NY1.2781
    Nassau County, NY
    Suffolk County, NY
    350841 Newark-Union, NJ-PA1.2192
    Essex County, NJ
    Hunterdon County, NJ
    Morris County, NJ
    Sussex County, NJ
    Union County, NJ
    Pike County, PA
    353002 New Haven-Milford, CT1.1790
    New Haven County, CT
    353801 New Orleans-Metairie-Kenner, LA0.9003
    Jefferson Parish, LA
    Orleans Parish, LA
    Plaquemines Parish, LA
    St. Bernard Parish, LA
    St. Charles Parish, LA
    St. John the Baptist Parish, LA
    St. Tammany Parish, LA
    356441 New York-White Plains-Wayne, NY-NJ1.3191
    Bergen County, NJ
    Hudson County, NJ
    Passaic County, NJ
    Bronx County, NY
    Kings County, NY
    New York County, NY
    Putnam County, NY
    Queens County, NY
    Richmond County, NY
    Rockland County, NY
    Westchester County, NY
    356602 Niles-Benton Harbor, MI0.8923
    Start Printed Page 42995
    Berrien County, MI
    359802 Norwich-New London, CT1.1790
    New London County, CT
    360841 Oakland-Fremont-Hayward, CA1.5474
    Alameda County, CA
    Contra Costa County, CA
    36100Ocala, FL0.8955
    Marion County, FL
    36140Ocean City, NJ1.1253
    Cape May County, NJ
    36220Odessa, TX0.9893
    Ector County, TX
    36260Ogden-Clearfield, UT0.9048
    Davis County, UT
    Morgan County, UT
    Weber County, UT
    364201 Oklahoma City, OK0.9043
    Canadian County, OK
    Cleveland County, OK
    Grady County, OK
    Lincoln County, OK
    Logan County, OK
    McClain County, OK
    Oklahoma County, OK
    36500Olympia, WA1.0970
    Thurston County, WA
    36540Omaha-Council Bluffs, NE-IA0.9555
    Harrison County, IA
    Mills County, IA
    Pottawattamie County, IA
    Cass County, NE
    Douglas County, NE
    Sarpy County, NE
    Saunders County, NE
    Washington County, NE
    367401 Orlando-Kissimmee, FL0.9446
    Lake County, FL
    Orange County, FL
    Osceola County, FL
    Seminole County, FL
    367802 Oshkosh-Neenah, WI0.9478
    Winnebago County, WI
    36980Owensboro, KY0.8806
    Daviess County, KY
    Hancock County, KY
    McLean County, KY
    37100Oxnard-Thousand Oaks-Ventura, CA1.1604
    Ventura County, CA
    37340Palm Bay-Melbourne-Titusville, FL0.9826
    Brevard County, FL
    374602 Panama City-Lynn Haven, FL0.8613
    Bay County, FL
    37620Parkersburg-Marietta-Vienna, WV-OH (WV Hospitals)0.8303
    Washington County, OH
    Pleasants County, WV
    Wirt County, WV
    Wood County, WV
    376202 Parkersburg-Marietta-Vienna, WV-OH (OH Hospitals)0.8788
    Washington County, OH
    Pleasants County, WV
    Wirt County, WV
    Wood County, WV
    37700Pascagoula, MS0.8164
    George County, MS
    Jackson County, MS
    378602 Pensacola-Ferry Pass-Brent, FL0.8613
    Escambia County, FL
    Santa Rosa County, FL
    37900Peoria, IL0.8844
    Marshall County, IL
    Peoria County, IL
    Start Printed Page 42996
    Stark County, IL
    Tazewell County, IL
    Woodford County, IL
    379641 Philadelphia, PA1.1030
    Bucks County, PA
    Chester County, PA
    Delaware County, PA
    Montgomery County, PA
    Philadelphia County, PA
    380601 Phoenix-Mesa-Scottsdale, AZ1.0139
    Maricopa County, AZ
    Pinal County, AZ
    38220Pine Bluff, AR0.8716
    Cleveland County, AR
    Jefferson County, AR
    Lincoln County, AR
    383001 Pittsburgh, PA0.8840
    Allegheny County, PA
    Armstrong County, PA
    Beaver County, PA
    Butler County, PA
    Fayette County, PA
    Washington County, PA
    Westmoreland County, PA
    38340Pittsfield, MA1.0679
    Berkshire County, MA
    38540Pocatello, ID0.9348
    Bannock County, ID
    Power County, ID
    38660Ponce, PR0.5178
    Juana Diaz Municipio, PR
    Ponce Municipio, PR
    Villalba Municipio, PR
    38860Portland-South Portland-Biddeford, ME1.0382
    Cumberland County, ME
    Sagadahoc County, ME
    York County, ME
    389001 Portland-Vancouver-Beaverton, OR-WA1.1229
    Clackamas County, OR
    Columbia County, OR
    Multnomah County, OR
    Washington County, OR
    Yamhill County, OR
    Clark County, WA
    Skamania County, WA
    38940Port St. Lucie-Fort Pierce, FL1.0162
    Martin County, FL
    St. Lucie County, FL
    39100Poughkeepsie-Newburgh-Middletown, NY1.0767
    Dutchess County, NY
    Orange County, NY
    39140Prescott, AZ0.9884
    Yavapai County, AZ
    393001 Providence-New Bedford-Fall River, RI-MA1.0952
    Bristol County, MA
    Bristol County, RI
    Kent County, RI
    Newport County, RI
    Providence County, RI
    Washington County, RI
    39340Provo-Orem, UT0.9578
    Juab County, UT
    Utah County, UT
    393802 Pueblo, CO0.9379
    Pueblo County, CO
    39460Punta Gorda, FL0.9274
    Charlotte County, FL
    395402 Racine, WI0.9478
    Racine County, WI
    39580Raleigh-Cary, NC0.9709
    Franklin County, NC
    Start Printed Page 42997
    Johnston County, NC
    Wake County, NC
    39660Rapid City, SD0.9027
    Meade County, SD
    Pennington County, SD
    39740Reading, PA0.9698
    Berks County, PA
    39820Redding, CA1.2207
    Shasta County, CA
    39900Reno-Sparks, NV1.0984
    Storey County, NV
    Washoe County, NV
    400601 Richmond, VA0.9319
    Amelia County, VA
    Caroline County, VA
    Charles City County, VA
    Chesterfield County, VA
    Cumberland County, VA
    Dinwiddie County, VA
    Goochland County, VA
    Hanover County, VA
    Henrico County, VA
    King and Queen County, VA
    King William County, VA
    Louisa County, VA
    New Kent County, VA
    Powhatan County, VA
    Prince George County, VA
    Sussex County, VA
    Colonial Heights City, VA
    Hopewell City, VA
    Petersburg City, VA
    Richmond City, VA
    401401 Riverside-San Bernardino-Ontario, CA1.1021
    Riverside County, CA
    San Bernardino County, CA
    40220Roanoke, VA0.8450
    Botetourt County, VA
    Craig County, VA
    Franklin County, VA
    Roanoke County, VA
    Roanoke City, VA
    Salem City, VA
    40340Rochester, MN1.1128
    Dodge County, MN
    Olmsted County, MN
    Wabasha County, MN
    403801 Rochester, NY0.9117
    Livingston County, NY
    Monroe County, NY
    Ontario County, NY
    Orleans County, NY
    Wayne County, NY
    40420Rockford, IL0.9975
    Boone County, IL
    Winnebago County, IL
    404842 Rockingham County-Strafford County, NH1.0668
    Rockingham County, NH
    Strafford County, NH
    40580Rocky Mount, NC0.8924
    Edgecombe County, NC
    Nash County, NC
    40660Rome, GA0.9414
    Floyd County, GA
    409001 Sacramento--Arden-Arcade--Roseville, CA1.2953
    El Dorado County, CA
    Placer County, CA
    Sacramento County, CA
    Yolo County, CA
    40980Saginaw-Saginaw Township North, MI0.9474
    Saginaw County, MI
    Start Printed Page 42998
    41060St. Cloud, MN1.0030
    Benton County, MN
    Stearns County, MN
    41100St. George, UT0.9416
    Washington County, UT
    41140St. Joseph, MO-KS0.9565
    Doniphan County, KS
    Andrew County, MO
    Buchanan County, MO
    DeKalb County, MO
    41180St. Louis, MO-IL0.8953
    Bond County, IL
    Calhoun County, IL
    Clinton County, IL
    Jersey County, IL
    Macoupin County, IL
    Madison County, IL
    Monroe County, IL
    St. Clair County, IL
    Crawford County, MO
    Franklin County, MO
    Jefferson County, MO
    Lincoln County, MO
    St. Charles County, MO
    St. Louis County, MO
    Warren County, MO
    Washington County, MO
    St. Louis City, MO
    41420Salem, OR1.0445
    Marion County, OR
    Polk County, OR
    41500Salinas, CA1.4140
    Monterey County, CA
    415402 Salisbury, MD0.9099
    Somerset County, MD
    Wicomico County, MD
    41620Salt Lake City, UT0.9436
    Salt Lake County, UT
    Summit County, UT
    Tooele County, UT
    41660San Angelo, TX0.8287
    Irion County, TX
    Tom Green County, TX
    417001 San Antonio, TX0.8987
    Atascosa County, TX
    Bandera County, TX
    Bexar County, TX
    Comal County, TX
    Guadalupe County, TX
    Kendall County, TX
    Medina County, TX
    Wilson County, TX
    417401 San Diego-Carlsbad-San Marcos, CA1.1417
    San Diego County, CA
    41780Sandusky, OH0.9033
    Erie County, OH
    418841 San Francisco-San Mateo-Redwood City, CA1.4970
    Marin County, CA
    San Francisco County, CA
    San Mateo County, CA
    41900San German-Cabo Rojo, PR0.4646
    Cabo Rojo Municipio, PR
    Lajas Municipio, PR
    Sabana Grande Municipio, PR
    San German Municipio, PR
    419401 San Jose-Sunnyvale-Santa Clara, CA1.5114
    San Benito County, CA
    Santa Clara County, CA
    419801 San Juan-Caguas-Guaynabo, PR0.4686
    Aguas Buenas Municipio, PR
    Aibonito Municipio, PR
    Start Printed Page 42999
    Arecibo Municipio, PR
    Barceloneta Municipio, PR
    Barranquitas Municipio, PR
    Bayamon Municipio, PR
    Caguas Municipio, PR
    Camuy Municipio, PR
    Canovanas Municipio, PR
    Carolina Municipio, PR
    Catano Municipio, PR
    Cayey Municipio, PR
    Ciales Municipio, PR
    Cidra Municipio, PR
    Comerio Municipio, PR
    Corozal Municipio, PR
    Dorado Municipio, PR
    Florida Municipio, PR
    Guaynabo Municipio, PR
    Gurabo Municipio, PR
    Hatillo Municipio, PR
    Humacao Municipio, PR
    Juncos Municipio, PR
    Las Piedras Municipio, PR
    Loiza Municipio, PR
    Manati Municipio, PR
    Maunabo Municipio, PR
    Morovis Municipio, PR
    Naguabo Municipio, PR
    Naranjito Municipio, PR
    Orocovis Municipio, PR
    Quebradillas Municipio, PR
    Rio Grande Municipio, PR
    San Juan Municipio, PR
    San Lorenzo Municipio, PR
    Toa Alta Municipio, PR
    Toa Baja Municipio, PR
    Trujillo Alto Municipio, PR
    Vega Alta Municipio, PR
    Vega Baja Municipio, PR
    Yabucoa Municipio, PR
    42020San Luis Obispo-Paso Robles, CA1.1357
    San Luis Obispo County, CA
    420441 Santa Ana-Anaheim-Irvine, CA1.1564
    Orange County, CA
    42060Santa Barbara-Santa Maria, CA1.1525
    Santa Barbara County, CA
    42100Santa Cruz-Watsonville, CA1.5159
    Santa Cruz County, CA
    42140Santa Fe, NM1.0908
    Santa Fe County, NM
    42220Santa Rosa-Petaluma, CA1.3480
    Sonoma County, CA
    42260Sarasota-Bradenton-Venice, FL0.9554
    Manatee County, FL
    Sarasota County, FL
    42340Savannah, GA0.9483
    Bryan County, GA
    Chatham County, GA
    Effingham County, GA
    42540Scranton--Wilkes-Barre, PA0.8530
    Lackawanna County, PA
    Luzerne County, PA
    Wyoming County, PA
    426441 Seattle-Bellevue-Everett, WA1.1573
    King County, WA
    Snohomish County, WA
    431002 Sheboygan, WI0.9478
    Sheboygan County, WI
    43300Sherman-Denison, TX0.9518
    Grayson County, TX
    43340Shreveport-Bossier City, LA0.8767
    Bossier Parish, LA
    Start Printed Page 43000
    Caddo Parish, LA
    De Soto Parish, LA
    43580Sioux City, IA-NE-SD0.9360
    Woodbury County, IA
    Dakota County, NE
    Dixon County, NE
    Union County, SD
    43620Sioux Falls, SD0.9616
    Lincoln County, SD
    McCook County, SD
    Minnehaha County, SD
    Turner County, SD
    43780South Bend-Mishawaka, IN-MI0.9785
    St. Joseph County, IN
    Cass County, MI
    43900Spartanburg, SC0.9183
    Spartanburg County, SC
    44060Spokane, WA1.0898
    Spokane County, WA
    44100Springfield, IL0.8879
    Menard County, IL
    Sangamon County, IL
    44140Springfield, MA1.0679
    Franklin County, MA
    Hampden County, MA
    Hampshire County, MA
    44180Springfield, MO0.8251
    Christian County, MO
    Dallas County, MO
    Greene County, MO
    Polk County, MO
    Webster County, MO
    442202 Springfield, OH0.8788
    Clark County, OH
    44300State College, PA0.8368
    Centre County, PA
    44700Stockton, CA1.1333
    San Joaquin County, CA
    449402 Sumter, SC0.8663
    Sumter County, SC
    45060Syracuse, NY0.9595
    Madison County, NY
    Onondaga County, NY
    Oswego County, NY
    45104Tacoma, WA1.0794
    Pierce County, WA
    45220Tallahassee, FL0.8712
    Gadsden County, FL
    Jefferson County, FL
    Leon County, FL
    Wakulla County, FL
    453001 Tampa-St. Petersburg-Clearwater, FL0.9292
    Hernando County, FL
    Hillsborough County, FL
    Pasco County, FL
    Pinellas County, FL
    454602 Terre Haute, IN0.8632
    Clay County, IN
    Sullivan County, IN
    Vermillion County, IN
    Vigo County, IN
    45500Texarkana, TX-Texarkana, AR0.8293
    Miller County, AR
    Bowie County, TX
    45780Toledo, OH0.9573
    Fulton County, OH
    Lucas County, OH
    Ottawa County, OH
    Wood County, OH
    45820Topeka, KS0.8921
    Jackson County, KS
    Start Printed Page 43001
    Jefferson County, KS
    Osage County, KS
    Shawnee County, KS
    Wabaunsee County, KS
    45940Trenton-Ewing, NJ1.1253
    Mercer County, NJ
    46060Tucson, AZ0.9007
    Pima County, AZ
    46140Tulsa, OK0.8313
    Creek County, OK
    Okmulgee County, OK
    Osage County, OK
    Pawnee County, OK
    Rogers County, OK
    Tulsa County, OK
    Wagoner County, OK
    46220Tuscaloosa, AL0.8724
    Greene County, AL
    Hale County, AL
    Tuscaloosa County, AL
    46340Tyler, TX0.9322
    Smith County, TX
    46540Utica-Rome, NY0.8313
    Herkimer County, NY
    Oneida County, NY
    46660Valdosta, GA0.8873
    Brooks County, GA
    Echols County, GA
    Lanier County, GA
    Lowndes County, GA
    46700Vallejo-Fairfield, CA1.4888
    Solano County, CA
    46940Vero Beach, FL0.9458
    Indian River County, FL
    47020Victoria, TX0.8148
    Calhoun County, TX
    Goliad County, TX
    Victoria County, TX
    472202 Vineland-Millville-Bridgeton, NJ1.1253
    Cumberland County, NJ
    472601 Virginia Beach-Norfolk-Newport News, VA-NC0.8841
    Currituck County, NC
    Gloucester County, VA
    Isle of Wight County, VA
    James City County, VA
    Mathews County, VA
    Surry County, VA
    York County, VA
    Chesapeake City, VA
    Hampton City, VA
    Newport News City, VA
    Norfolk City, VA
    Poquoson City, VA
    Portsmouth City, VA
    Suffolk City, VA
    Virginia Beach City, VA
    Williamsburg City, VA
    473002 Visalia-Porterville, CA1.0848
    Tulare County, CA
    47380Waco, TX0.8532
    McLennan County, TX
    47580Warner Robins, GA0.8662
    Houston County, GA
    476441 Warren-Farmington Hills-Troy, MI0.9858
    Lapeer County, MI
    Livingston County, MI
    Macomb County, MI
    Oakland County, MI
    St. Clair County, MI
    478941 Washington-Arlington-Alexandria, DC-VA-MD-WV1.0935
    District of Columbia, DC
    Start Printed Page 43002
    Calvert County, MD
    Charles County, MD
    Prince George's County, MD
    Arlington County, VA
    Clarke County, VA
    Fairfax County, VA
    Fauquier County, VA
    Loudoun County, VA
    Prince William County, VA
    Spotsylvania County, VA
    Stafford County, VA
    Warren County, VA
    Alexandria City, VA
    Fairfax City, VA
    Falls Church City, VA
    Fredericksburg City, VA
    Manassas City, VA
    Manassas Park City, VA
    Jefferson County, WV
    47940Waterloo-Cedar Falls, IA0.8564
    Black Hawk County, IA
    Bremer County, IA
    Grundy County, IA
    48140Wausau, WI0.9964
    Marathon County, WI
    48260Weirton-Steubenville, WV-OH (WV Hospitals)0.7821
    Jefferson County, OH
    Brooke County, WV
    Hancock County, WV
    482602 Weirton-Steubenville, WV-OH (OH Hospitals)0.8788
    Jefferson County, OH
    Brooke County, WV
    Hancock County, WV
    483002 Wenatchee, WA1.0459
    Chelan County, WA
    Douglas County, WA
    484241 West Palm Beach-Boca Raton-Boynton Beach, FL1.0061
    Palm Beach County, FL
    485402 Wheeling, WV-OH (WV Hospitals)0.7742
    Belmont County, OH
    Marshall County, WV
    Ohio County, WV
    485402 Wheeling, WV-OH (OH Hospitals)0.8788
    Belmont County, OH
    Marshall County, WV
    Ohio County, WV
    48620Wichita, KS0.9156
    Butler County, KS
    Harvey County, KS
    Sedgwick County, KS
    Sumner County, KS
    48660Wichita Falls, TX0.8327
    Archer County, TX
    Clay County, TX
    Wichita County, TX
    48700Williamsport, PA0.8368
    Lycoming County, PA
    48864Wilmington, DE-MD-NJ1.0652
    New Castle County, DE
    Cecil County, MD
    Salem County, NJ
    48864Wilmington, DE-MD-NJ (NJ Hospitals)1.1253
    48900Wilmington, NC0.9580
    Brunswick County, NC
    New Hanover County, NC
    Pender County, NC
    49020Winchester, VA-WV1.0214
    Frederick County, VA
    Winchester City, VA
    Hampshire County, WV
    49180Winston-Salem, NC0.9020
    Start Printed Page 43003
    Davie County, NC
    Forsyth County, NC
    Stokes County, NC
    Yadkin County, NC
    49340Worcester, MA1.1044
    Worcester County, MA
    494202 Yakima, WA1.0459
    Yakima County, WA
    49500Yauco, PR0.4413
    Guanica Municipio, PR
    Guayanilla Municipio, PR
    Penuelas Municipio, PR
    Yauco Municipio, PR
    49620York-Hanover, PA0.9422
    York County, PA
    496602 Youngstown-Warren-Boardman, OH-PA (OH Hospitals)0.8788
    Mahoning County, OH
    Trumbull County, OH
    Mercer County, PA
    49660Youngstown-Warren-Boardman, OH-PA (PA Hospitals)0.8609
    Mahoning County, OH
    Trumbull County, OH
    Mercer County, PA
    49700Yuba City, CA1.0951
    Sutter County, CA
    Yuba County, CA
    49740Yuma, AZ0.9188
    Yuma County, AZ
    1 Large urban area.
    2 Hospitals geographically located in the area are assigned the statewide rural wage index for FY 2006.

    Addendum I.—Wage Index for Rural Areas by CBSA

    CBSA codeRural areaWage index
    01Alabama0.7495
    02Alaska1.1977
    03Arizona0.8991
    04Arkansas0.7478
    05California1.0848
    06Colorado0.9379
    07Connecticut1.1790
    08Delaware0.9606
    10Florida0.8613
    11Georgia0.7684
    12Hawaii1.0598
    13Idaho0.8810
    14Illinois0.8285
    15Indiana0.8632
    16Iowa0.8563
    17Kansas0.8032
    18Kentucky0.7788
    19Louisiana0.7445
    20Maine0.8840
    21Maryland0.9099
    22Massachusetts11.0679
    23Michigan0.8923
    24Minnesota0.9183
    25Mississippi0.7685
    26Missouri0.7927
    27Montana0.8822
    28Nebraska0.8666
    29Nevada0.9079
    30New Hampshire1.0668
    31New Jersey11.1253
    32New Mexico0.8649
    33New York0.8220
    34North Carolina0.8570
    35North Dakota0.7278
    36Ohio0.8788
    37Oklahoma0.7615
    38Oregon1.0284
    39Pennsylvania0.8300
    40Puerto Rico1
    41Rhode Island11.0952
    42South Carolina0.8663
    43South Dakota0.8475
    44Tennessee0.7915
    45Texas0.8038
    46Utah0.8134
    47Vermont1.0199
    49Virginia0.8024
    50Washington1.0459
    51West Virginia0.7742
    52Wisconsin0.9478
    53Wyoming0.9207
    1 All counties within the State are classified as urban, with the exception of Massachusetts. Massachusetts has area(s) designated as rural. However, no short-term, acute care hospitals are located in the area(s) for FY 2006. Massachusetts, New Jersey, and Rhode Island rural floors are imputed.

    Addendum J.—Wage Index for Hospitals That Are Reclassified by CBSA

    CBSA codeAreaWage index
    10180Abilene, TX0.8038
    10420Akron, OH0.8979
    10580Albany-Schenectady-Troy, NY0.8565
    10740Albuquerque, NM0.9558
    10780Alexandria, LA0.8048
    10900Allentown-Bethlehem-Easton, PA-NJ0.9844
    11020Altoona, PA0.8942
    11100Amarillo, TX0.9165
    11180Ames, IA0.9231
    11460Ann Arbor, MI1.0628
    11500Anniston-Oxford, AL0.7702
    11700Asheville, NC0.9312
    12020Athens-Clarke County, GA0.9684
    12060Atlanta-Sandy Springs-Marietta, GA0.9637
    12420Austin-Round Rock, TX0.9451
    12620Bangor, ME0.9985
    12700Barnstable Town, MA1.2254
    12940Baton Rouge, LA0.8470
    13020Bay City, MI0.9535
    13780Binghamton, NY0.8471
    13820Birmingham-Hoover, AL0.8872
    14260Boise City-Nampa, ID0.9048
    14484Boston-Quincy, MA1.1233
    14540Bowling Green, KY0.8222
    15380Buffalo-Niagara Falls, NY0.8888
    15540Burlington-South Burlington, VT0.9306
    Start Printed Page 43004
    15764Cambridge-Newton-Framingham, MA1.0903
    16180Carson City, NV0.9786
    16220Casper, WY0.9207
    16580Champaign-Urbana, IL0.9335
    16620Charleston, WV (WV Hospitals)0.8274
    16620Charleston, WV(OH Hospitals)0.8788
    16700Charleston-North Charleston, SC0.9317
    16740Charlotte-Gastonia-Concord, NC-SC0.9585
    16820Charlottesville, VA0.9806
    16860Chattanooga, TN-GA0.9099
    16974Chicago-Naperville-Joliet, IL1.0698
    17140Cincinnati-Middletown, OH-KY-IN0.9604
    17300Clarksville, TN-KY0.8092
    17460Cleveland-Elyria-Mentor, OH0.9197
    17780College Station-Bryan, TX0.8911
    17860Columbia, MO0.8346
    17900Columbia, SC0.9057
    17980Columbus, GA-AL0.8402
    18140Columbus, OH0.9848
    18700Corvallis, OR1.0328
    19124Dallas-Plano-Irving, TX0.9955
    19380Dayton, OH0.9069
    19460Decatur, AL0.8517
    19740Denver-Aurora, CO1.0517
    19780Des Moines, IA0.9413
    19804Detroit-Livonia-Dearborn, MI1.0453
    20260Duluth, MN-WI1.0224
    20500Durham, NC0.9993
    20764Edison, NJ1.1301
    20940El Centro, CA0.9102
    21060Elizabethtown, KY0.8286
    21500Erie, PA0.8424
    21604Essex County, MA1.0668
    21660Eugene-Springfield, OR1.0492
    21780Evansville, IN-KY0.8508
    22020Fargo, ND-MN (ND, SD Hospitals)0.8778
    22020Fargo, ND-MN (MN Hospitals)0.9183
    22180Fayetteville, NC0.9193
    22220Fayetteville-Springdale-Rogers, AR-MO0.8615
    22380Flagstaff, AZ1.1713
    22420Flint, MI1.0654
    22540Fond du Lac, WI0.9478
    22660Fort Collins-Loveland, CO1.0146
    22744Ft Lauderdale-Pompano Beach-Deerfield Beach, FL1.0508
    22900Fort Smith, AR-OK0.7986
    23020Fort Walton Beach-Crestview-Destin, FL0.8672
    23060Fort Wayne, IN0.9797
    23104Fort Worth-Arlington, TX0.9514
    23540Gainesville, FL0.9461
    23844Gary, IN0.9366
    24340Grand Rapids-Wyoming, MI0.9398
    24500Great Falls, MT0.9074
    24540Greeley, CO0.9597
    24580Green Bay, WI (MI Hospitals)0.9439
    24580Green Bay, WI (WI Hospitals)0.9478
    24780Greenville, NC0.9414
    24860Greenville, SC0.9807
    25060Gulfport-Biloxi, MS0.8612
    25420Harrisburg-Carlisle, PA0.9145
    25500Harrisonburg, VA0.8998
    25540Hartford-West Hartford-East Hartford, CT (MA Hospitals)1.1085
    25540Hartford-West Hartford-East Hartford, CT (CT Hospitals)1.1790
    25860Hickory-Lenoir-Morganton, NC0.8931
    26100Holland-Grand Haven, MI0.9133
    26180Honolulu, HI1.1206
    26420Houston-Sugar Land-Baytown, TX1.0008
    26580Huntington-Ashland, WV-KY-OH0.9119
    26620Huntsville, AL0.9124
    26900Indianapolis, IN0.9776
    26980Iowa City, IA0.9574
    27060Ithaca, NY0.9204
    27140Jackson, MS0.8182
    27180Jackson, TN0.8799
    27260Jacksonville, FL0.9303
    27860Jonesboro, AR0.7793
    27900Joplin, MO0.8458
    28020Kalamazoo-Portage, MI1.0403
    28100Kankakee-Bradley, IL1.0991
    28140Kansas City, MO-KS0.9454
    28420Kennewick-Richland-Pasco, WA1.0459
    28700Kingsport-Bristol-Bristol, TN-VA0.8095
    28740Kingston, NY0.8904
    28940Knoxville, TN0.8470
    29180Lafayette, LA0.8429
    29404Lake County-Kenosha County, IL-WI1.0444
    29460Lakeland, FL0.8934
    29620Lansing-East Lansing, MI0.9786
    29740Las Cruces, NM0.8649
    29820Las Vegas-Paradise, NV1.1249
    30020Lawton, OK0.7673
    30460Lexington-Fayette, KY0.8830
    30620Lima, OH0.9263
    30700Lincoln, NE0.9666
    30780Little Rock-North Little Rock, AR0.8552
    30980Longview, TX0.8621
    31084Los Angeles-Long Beach-Santa Ana, CA1.1660
    31140Louisville, KY-IN0.9264
    31180Lubbock, TX0.8790
    31340Lynchburg, VA0.8596
    31420Macon, GA0.9087
    31540Madison, WI1.0416
    31700Manchester-Nashua, NH1.0668
    32780Medford, OR1.0284
    32820Memphis, TN-MS-AR0.9108
    33124Miami-Miami Beach-Kendall, FL0.9757
    33260Midland, TX0.9317
    33340Milwaukee-Waukesha-West Allis, WI0.9957
    33460Minneapolis-St. Paul-Bloomington, MN-WI1.0905
    33540Missoula, MT0.9535
    33660Mobile, AL0.7902
    33700Modesto, CA1.1885
    33860Montgomery, AL0.8276
    34060Morgantown, WV0.8332
    34980Nashville-Davidson--Murfreesboro, TN0.9492
    35084Newark-Union, NJ-PA1.2192
    35380New Orleans-Metairie-Kenner, LA0.9003
    35644New York-White Plains-Wayne, NY-NJ1.3191
    36084Oakland-Fremont-Hayward, CA1.5474
    36100Ocala, FL0.8955
    36140Ocean City, NJ1.0289
    36220Odessa, TX0.9593
    36260Ogden-Clearfield, UT0.9048
    36420Oklahoma City, OK0.9043
    36500Olympia, WA1.0970
    36540Omaha-Council Bluffs, NE-IA0.9555
    36740Orlando-Kissimmee, FL0.9446
    37860Pensacola-Ferry Pass-Brent, FL0.8089
    37900Peoria, IL0.8844
    37964Philadelphia, PA1.1030
    38220Pine Bluff, AR0.8099
    38300Pittsburgh, PA0.8840
    38340Pittsfield, MA1.0199
    38860Portland-South Portland-Biddeford, ME0.9884
    38900Portland-Vancouver-Beaverton, OR-WA1.1229
    38940Port St. Lucie-Fort Pierce, FL1.0162
    39100Poughkeepsie-Newburgh-Middletown, NY1.0576
    39340Provo-Orem, UT0.9578
    39580Raleigh-Cary, NC0.9476
    39740Reading, PA0.9500
    39820Redding, CA1.1909
    39900Reno-Sparks, NV (NV Hospitals)1.0805
    39900Reno-Sparks, NV (CA Hospitals)1.0848
    40060Richmond, VA0.9319
    40220Roanoke, VA0.8450
    40340Rochester, MN1.1128
    40380Rochester, NY0.9117
    40420Rockford, IL0.9667
    40484Rockingham County, NH1.0503
    40660Rome, GA0.9414
    40900Sacramento—Arden-Arcade—Roseville, CA1.2953
    40980Saginaw-Saginaw Township North, MI0.9090
    41060St. Cloud, MN0.9785
    41100St. George, UT0.9416
    41180St. Louis, MO-IL0.8953
    41620Salt Lake City, UT0.9436
    41700San Antonio, TX0.8987
    Start Printed Page 43005
    41884San Francisco-San Mateo-Redwood City,CA1.4739
    41980San Juan-Caguas-Guaynabo, PR0.4686
    42044Santa Ana-Anaheim-Irvine, CA1.1297
    42140Santa Fe, NM1.0163
    42220Santa Rosa-Petaluma, CA1.3480
    42260Sarasota-Bradenton-Venice, FL0.9554
    42340Savannah, GA0.9316
    42644Seattle-Bellevue-Everett, WA1.1573
    43300Sherman-Denison, TX0.8971
    43340Shreveport-Bossier City, LA0.8767
    43620Sioux Falls, SD0.9616
    43780South Bend-Mishawaka, IN-MI0.9785
    43900Spartanburg, SC0.9183
    44060Spokane, WA1.0722
    44180Springfield, MO0.8251
    44300State College, PA0.8300]
    44940Sumter, SC0.8663
    45060Syracuse, NY0.9315
    45104Tacoma, WA1.0794
    45220Tallahassee, FL0.8420
    45300Tampa-St. Petersburg-Clearwater, FL0.9292
    45500Texarkana, TX-Texarkana, AR0.8293
    45820Topeka, KS0.8785
    46140Tulsa, OK0.8313
    46220Tuscaloosa, AL0.8614
    46340Tyler, TX0.9164
    46660Valdosta, GA0.8710
    46700Vallejo-Fairfield, CA1.3955
    47260Virginia Beach-Norfolk-Newport News, VA0.8841
    47380Waco, TX0.8532
    47894Washington-Arlington-Alexandria DC-VA1.0813
    48140Wausau, WI0.9964
    48620Wichita, KS0.8946
    48700Williamsport, PA0.8300
    48864Wilmington, DE-MD-NJ1.0652
    48864Wilmington, DE-MD-NJ (NJ Hospitals)1.1253
    48900Wilmington, NC0.9394
    49020Winchester, VA-WV1.0214
    49180Winston-Salem, NC0.9020
    49660Youngstown-Warren-Boardman, OH-PA (PA Hospitals)0.8446
    49660Youngstown-Warren-Boardman, OH-PA (OH Hospitals)0.8788
    03Rural Arizona0.8991
    04Rural Arkansas0.7478
    05Rural California1.0848
    07Rural Connecticut1.0448
    10Rural Florida0.8613
    13Rural Idaho0.8810
    14Rural Illinois0.8285
    15Rural Indiana0.8632
    16Rural Iowa0.8563
    17Rural Kansas0.8032
    19Rural Louisiana0.7445
    23Rural Michigan0.8923
    24Rural Minnesota0.9183
    26Rural Missouri0.7927
    30Rural New Hampshire1.0668
    37Rural Oklahoma0.7615
    38Rural Oregon1.0284
    45Rural Texas0.8038
    50Rural Washington (ID Hospitals)1.0061
    50Rural Washington (WA Hospitals)1.0459
    53Rural Wyoming0.9207

    Addendum K.—Puerto Rico Wage Index by CBSA

    CBSA codeAreaWage indexWage index- reclassified hospitals
    10380Aguadilla-Isabela-San Sebastian, PR1.0196
    21940Fajardo, PR0.8956
    25020Guayama, PR0.6858
    32420Mayaguez, PR0.8647
    38660Ponce, PR1.1147
    41900San German-Cabo Rojo, PR1.0002
    41980San JuanCaguasGuaynabo, PR1.00871.0087
    49500Yauco, PR0.9500

    Addendum L.—Out-Migration Wage Adjustment—FY 2006 1

    Provider No.Out- migration adjustmentQualifying county name
    0100090.0092MORGAN
    0100100.0259MARSHALL
    0100380.0062CALHOUN
    0100470.0155BUTLER
    0100540.0092MORGAN
    0100610.0506JACKSON
    0100780.0062CALHOUN
    0100850.0092MORGAN
    0101090.0464PICKENS
    0101150.0093FRANKLIN
    0101290.0121BALDWIN
    0101460.0062CALHOUN
    0400660.0382CLARK
    0400700.0140MISSISSIPPI
    0401430.0026JEFFERSON
    0500080.0028SAN FRANCISCO
    0500160.0087SAN LUIS OBISPO
    0500470.0028SAN FRANCISCO
    0500550.0028SAN FRANCISCO
    0500840.0555SAN JOAQUIN
    0500880.0087SAN LUIS OBISPO
    0501010.0269SOLANO
    0501170.0463MERCED
    0501220.0555SAN JOAQUIN
    0501330.0170YUBA
    0501520.0028SAN FRANCISCO
    0501670.0555SAN JOAQUIN
    0502320.0087SAN LUIS OBISPO
    0502530.0029ORANGE
    0503130.0555SAN JOAQUIN
    0503250.0176TUOLUMNE
    0503350.0176TUOLUMNE
    0503360.0555SAN JOAQUIN
    0503670.0269SOLANO
    0504070.0028SAN FRANCISCO
    0504440.0463MERCED
    0504540.0028SAN FRANCISCO
    0504570.0028SAN FRANCISCO
    0504760.0257LAKE
    0504910.0029ORANGE
    Start Printed Page 43006
    0505060.0087SAN LUIS OBISPO
    0505390.0257LAKE
    0505680.0062MADERA
    0506330.0087SAN LUIS OBISPO
    0506800.0269SOLANO
    0506950.0555SAN JOAQUIN
    0700200.0073MIDDLESEX
    0800010.0062NEW CASTLE
    0800030.0062NEW CASTLE
    1000140.0118VOLUSIA
    1000170.0118VOLUSIA
    1000470.0021CHARLOTTE
    1000620.0060MARION
    1000680.0118VOLUSIA
    1000720.0118VOLUSIA
    1000770.0021CHARLOTTE
    1001020.0133COLUMBIA
    1001560.0133COLUMBIA
    1001750.0231DE SOTO
    1002120.0060MARION
    1002360.0021CHARLOTTE
    1002900.0558SUMTER
    1100270.0387FRANKLIN
    1100630.0290LIBERTY
    1101200.0873POLK
    1101240.0428WAYNE
    1101360.0261BALDWIN
    1101900.0182MACON
    1300110.0218LATAH
    1300240.0275BONNER
    1400260.0346LA SALLE
    1400330.0147LAKE
    1400840.0147LAKE
    1401000.0147LAKE
    1401290.0096WABASH
    1401300.0147LAKE
    1401730.0046WHITESIDE
    1402020.0147LAKE
    1402050.0163BOONE
    1500220.0249MONTGOMERY
    1500350.0083PORTER
    1500450.0416DE KALB
    1500600.0052VERMILLION
    1500620.0153DECATUR
    1500910.0573HUNTINGTON
    1501220.0199RIPLEY
    1600130.0218MUSCATINE
    1600300.0032STORY
    1600320.0272JASPER
    1601400.0364PLYMOUTH
    1801280.0282LAWRENCE
    1900100.0401TANGIPAHOA
    1900170.0235ST. LANDRY
    1900490.0645WASHINGTON
    1900540.0107IBERIA
    1900780.0235ST. LANDRY
    1900880.0705WEBSTER
    1901330.0238ALLEN
    1901440.0705WEBSTER
    1901470.0401TANGIPAHOA
    1901480.0390AVOYELLES
    1901840.0161CALDWELL
    1901900.0161CALDWELL
    1902460.0161CALDWELL
    2000130.0186WALDO
    2000320.0460OXFORD
    2100010.0129WASHINGTON
    2100040.0040MONTGOMERY
    2100160.0040MONTGOMERY
    2100180.0040MONTGOMERY
    2100220.0040MONTGOMERY
    2100230.0209ANNE ARUNDEL
    2100280.0512ST. MARYS
    2100430.0209ANNE ARUNDEL
    2100480.0287HOWARD
    2100570.0040MONTGOMERY
    2200060.0306ESSEX
    2200760.0249MIDDLESEX
    2300150.0359ST. JOSEPH
    2300210.0136BERRIEN
    2300410.0099BAY
    2300750.0145CALHOUN
    2301840.0389JACKSON
    2302220.0228MIDLAND
    2400110.0506MC LEOD
    2400140.0454RICE
    2400210.0897LE SUEUR
    2400440.0868WINONA
    2400890.1196GOODHUE
    2401330.0319MEEKER
    2401540.0138ITASCA
    2402050.0138ITASCA
    2500300.0318LEAKE
    2500450.0042HANCOCK
    2500880.0122WILKINSON
    2501540.0318LEAKE
    2600970.0425JOHNSON
    2601270.0158PIKE
    2800540.0137GAGE
    2801230.0137GAGE
    3100100.0097MERCER
    3100110.0113CAPE MAY
    3100390.0350MIDDLESEX
    3100440.0097MERCER
    3100920.0097MERCER
    3101080.0350MIDDLESEX
    3101100.0097MERCER
    3200030.0630SAN MIGUEL
    3200110.0442RIO ARRIBA
    3200180.0063DONA ANA
    3200850.0063DONA ANA
    3301670.0137NASSAU
    3301980.0137NASSAU
    3302090.0560ORANGE
    3302220.0003SARATOGA
    3302240.0959ULSTER
    3302250.0137NASSAU
    3302590.0137NASSAU
    3302760.0063FULTON
    3303310.0137NASSAU
    3303320.0137NASSAU
    3303330.0137NASSAU
    3303720.0137NASSAU
    3304020.0959ULSTER
    3400150.0267ROWAN
    3400200.0207LEE
    3400370.0216CLEVELAND
    3400700.0448ALAMANCE
    3400850.0377DAVIDSON
    3400880.0115TRANSYLVANIA
    3400960.0377DAVIDSON
    3401040.0216CLEVELAND
    3401260.0161WILSON
    3401330.0302MARTIN
    3600340.0263WAYNE
    3600700.0028STARK
    3600840.0028STARK
    3600930.0120DEFIANCE
    3600950.0087HANCOCK
    3600990.0087HANCOCK
    3601000.0028STARK
    3601310.0028STARK
    3601510.0028STARK
    3601560.0213SANDUSKY
    3700230.0084STEPHENS
    3700430.0294MARSHALL
    3700650.0121CRAIG
    3701490.0356POTTAWATOMIE
    3800020.0130JOSEPHINE
    3800290.0073MARION
    3800510.0073MARION
    3800560.0073MARION
    3900110.0012CAMBRIA
    3900440.0200BERKS
    3900460.0098YORK
    3900560.0042HUNTINGDON
    3900960.0200BERKS
    3901010.0098YORK
    3901300.0012CAMBRIA
    3901460.0053WARREN
    3901620.0207NORTHAMPTON
    3902330.0098YORK
    4200070.0001SPARTANBURG
    4200270.0210ANDERSON
    4200430.0177CHEROKEE
    4200830.0001SPARTANBURG
    4200930.0001SPARTANBURG
    4200980.0035GEORGETOWN
    4400240.0387BRADLEY
    4400470.0499GIBSON
    4400560.0321JEFFERSON
    4400630.0011WASHINGTON
    4401050.0011WASHINGTON
    4401140.0523LAUDERDALE
    4401150.0499GIBSON
    4401430.0448MARSHALL
    4401530.0145COCKE
    4401740.0372HAYWOOD
    4401810.0407HARDEMAN
    4401840.0011WASHINGTON
    4500500.0750WARD
    4501130.0195ANDERSON
    4501630.0134KLEBERG
    4503620.0486BURNET
    4503700.0258COLORADO
    4503950.0484POLK
    4504650.0435MATAGORDA
    4505960.0808HOOD
    4505970.0077DE WITT
    4506260.0294JACKSON
    4507630.0236HUTCHINSON
    4508130.0195ANDERSON
    4600170.0392BOX ELDER
    4700180.0287WINDSOR
    4700230.0118CALEDONIA
    4900190.1240CULPEPER
    4900380.0022SMYTH
    4900840.0167ESSEX
    4901100.0082MONTGOMERY
    5000070.0208SKAGIT
    5000190.0213LEWIS
    5000210.0055PIERCE
    5000790.0055PIERCE
    5001080.0055PIERCE
    5001180.0548MASON
    Start Printed Page 43007
    5001290.0055PIERCE
    5100390.0112OHIO
    5100500.0112OHIO
    5100880.0141FAYETTE
    5200350.0077SHEBOYGAN
    5200420.0118SAUK
    5200440.0077SHEBOYGAN
    5200570.0118SAUK
    5201320.0077SHEBOYGAN
    1 The above table lists all hospitals that we anticipate will have their wage index increased by the out-migration adjustment. This list includes hospitals designated in Table 4J of FY 2006 hospital IPPS proposed rule (May 5, 2005) as NOT reclassified under section 1886(d)(10) of the Act or redesignated under section 1886(d)(8)(B) of the Act, as well as TEFRA hospitals falling in a designated out-migration county. In the IPPS proposed rule we asked hospitals to notify us if they wish to withdraw their reclassification/redesignation request and receive the out-migration adjustment. Because we are proposing to adopt the final IPPS wage indices for OPPS, we will adopt any changes in eligibility for the out-migration adjustment resulting from requests to waive reclassification

    Addendum M.—Hospitals Reclassifications and Redesignations by Individual Hospitals and CBSA—CY 2006

    Provider No.Geographic CBSAReclassified CBSALugar
    0100050113820
    0100080133860
    0100120116860
    0100220140660LUGAR
    0100250117980
    0100291222017980
    0100350113820
    0100440113820
    0100450113820
    0100650133860
    0100720111500LUGAR
    0100830137860
    0101000137860
    0101010111500LUGAR
    0101180133860
    0101200133660
    0101260133860
    0101430113820
    0101580119460
    0300134974020940
    0300330322380
    0400140430780
    0400170444180
    0400190432820
    0400202786032820
    0400270444180
    0400390427860
    0400410430780
    0400470427860
    0400690432820
    0400713822030780
    0400720430780
    0400760430780
    0400782630030780
    0400800427860
    0400880443340
    0400910445500
    0401000430780
    0401190430780
    0500060539820
    0500093490046700
    0500133490046700
    0500140540900
    0500224014042044
    0500420539820
    0500463710031084
    0500544014042044
    0500654204431084
    0500694204431084
    0500714194036084
    0500734670036084
    0500764188436084
    0500823710031084
    0500894014031084
    0500904222041884
    0500994014031084
    0501024014042044
    0501184470033700
    0501294014031084
    0501364222041884
    0501404014031084
    0501500540900
    0501593710031084
    0501684204431084
    0501734204431084
    0501744222041884
    0501773710031084
    0501934204431084
    0502244204431084
    0502264204431084
    0502284188436084
    0502304204431084
    0502363710031084
    0502434014042044
    0502454014031084
    0502510539900
    0502724014031084
    0502794014031084
    0502914222041884
    0502924014042044
    0502984014031084
    0503004014031084
    0503274014031084
    0503294014042044
    0503314222041884
    0503484204431084
    0503854222041884
    0503904014042044
    0503943710031084
    0504190539820
    0504234014042044
    0504264204431084
    0504300539900
    0505104188436084
    0505174014031084
    0505264204431084
    0505344014042044
    0505354204431084
    0505414188436084
    0505434204431084
    0505474222041884
    0505484204431084
    0505504204431084
    0505514204431084
    0505674204431084
    0505690542220
    0505704204431084
    0505734014042044
    0505804204431084
    0505844014031084
    0505854204431084
    0505864014031084
    0505894204431084
    0505924204431084
    0505944204431084
    0506034204431084
    0506094204431084
    0506163710031084
    0506673490046700
    0506684188436084
    0506784204431084
    0506844014042044
    0506864014042044
    0506904222041884
    0506934204431084
    0506944014042044
    0507014014042044
    0507094014031084
    0507184014042044
    0507204204431084
    0507284222041884
    0600012454019740
    0600031450019740
    0600232430039340
    0600271450019740
    0600440619740
    0600490622660
    0600960619740
    0601031450019740
    0700030725540LUGAR
    0700210725540LUGAR
    0700331486035644
    0800042010048864
    0800070836140
    1000223312422744
    1000231036740
    1000241033124
    1000451966036740
    1000491029460
    1000811023020LUGAR
    1001091036740
    1001181027260
    1001391023540LUGAR
    1001501033124
    1001572946045300
    1001764842438940
    1002174694038940
    1002321027260
    1002394530042260
    1002491036100
    1002521038940
    1002921023020LUGAR
    1100011914012060
    1100021112060
    1100031127260
    1100231112060
    Start Printed Page 43008
    1100251526027260
    1100292358012060
    1100381145220
    1100401112060LUGAR
    1100411112020
    1100521116860LUGAR
    1100544066012060
    1100694758031420
    1100751142340
    1100881112060LUGAR
    1100951146660
    1101171112060LUGAR
    1101224666045220
    1101251131420
    1101281142340
    1101501131420
    1101534758031420
    1101684066012060
    1101871112060LUGAR
    1101891112060
    1102051112060
    1200281226180
    1300021314260
    1300033030050
    1300491766044060
    1400121416974
    1400151441180
    1400321441180
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    1400401437900
    1400431440420
    1400461441180
    1400581441180
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    1400641437900
    1401101416974
    1401431437900
    1401601440420
    1401611416974
    1401641441180
    1401891416580
    1402334042016974
    1402341437900
    1402361428100LUGAR
    1402912940416974
    1500022384416974
    1500042384416974
    1500063314043780
    1500082384416974
    1500111526900
    1500153314016974
    1500301526900LUGAR
    1500481517140
    1500651526900
    1500691517140
    1500761543780
    1500881130026900
    1500902384416974
    1501021523844LUGAR
    1501121802026900
    1501131130026900
    1501252384416974
    1501262384416974
    1501322384416974
    1501331523060
    1501461523060
    1501472384416974
    1600011611180
    1600161619780
    1600261611180LUGAR
    1600571626980
    1600801640420
    1600891619780
    1601471611180
    1700061727900
    1700101746140
    1700121748620
    1700131748620
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    1700221728140
    1700231748620
    1700331748620
    1700581728140
    1700681711100
    1701201727900
    1701421745820
    1701751748620
    1800051826580
    1800111830460
    1800122106031140
    1800131454034980
    1800171821060
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    1800191817140
    1800241831140
    1800271817300
    1800281826580
    1800291828700
    1800441826580
    1800481831140
    1800661834980
    1800691826580
    1800751814540LUGAR
    1800781826580
    1800801828940
    1800931821780
    1801021817300
    1801041817300
    1801161814
    1801241454034980
    1801271831140
    1801321830460
    1801391830460
    1900011935380
    1900031929180
    1900151935380
    1900861943340
    1900991912940
    1901061910780
    1901311294035380
    1901551912940LUGAR
    1901641910780
    1901911912940
    1902231912940LUGAR
    2000022038860
    2000203886040484
    2000243034038860
    2000343034038860
    2000392038860
    2000502012620
    2000632038860
    2200014934014484
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    2300222311460
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    2300422326100LUGAR
    2300474764419804
    2300542324580
    2300694764422420
    2300774098022420
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    2401052440340LUGAR
    Start Printed Page 43009
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    3000033031700
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    3300853345060
    3300943328740
    3301363345060
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    3301813500435644
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    3301912402010580
    3302292746021500
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    3302392746021500
    3302503315540
    3302773327060
    3303593339100LUGAR
    3303863339100LUGAR
    3400042466049180
    3400083416740
    3400102414039580
    3400133416740
    3400183443900LUGAR
    3400213416740
    3400231170024860
    3400273424780
    3400393416740
    3400503422180
    3400513425860
    3400683448900
    3400693958020500
    3400713439580LUGAR
    3400733958020500
    3400912466049180
    3401093447260
    3401143958020500
    3401153420500
    3401243439580LUGAR
    3401273420500LUGAR
    3401293416740
    3401313424780
    3401363420500LUGAR
    3401383958020500
    3401443416740
    3401453416740LUGAR
    3401474058039580
    3401733958020500
    3500093522020
    3600083626580
    3600103610420
    3600113618140
    3600133630620
    3600143618140
    3600191042017460
    3600201042017460
    3600254178017460
    3600271042017460
    3600363617460
    3600393618140
    3600543616620
    3600653617460
    3600781042017460
    3600791938017140
    3600864422019380
    3600963649660LUGAR
    3601073617460
    3601124578011460
    3601253617460LUGAR
    3601501042017460
    3601593618140
    3601753618140
    3601853649660LUGAR
    3601874422019380
    3601973618140
    3602114826038300
    3602383649660LUGAR
    3602411042017460
    3602453617460LUGAR
    3700043727900
    3700143743300
    3700153746140
    3700183746140
    3700223730020
    3700253746140
    3700343722900
    3700473743300
    3700493736420
    3700993746140
    3701033745
    3701133722220
    3701793746140
    3800013838900
    3800083818700LUGAR
    3800223818700LUGAR
    3800273821660
    3800471346021660
    3800503832780
    3800703838900
    3900063925420
    3900133925420
    3900163949660
    3900303910900
    3900313939740LUGAR
    3900483925420
    3900523911020
    3900653947894
    3900663014025420
    3900713948700LUGAR
    3900793913780
    Start Printed Page 43010
    3900813796448864
    3900863944300
    3900913949660
    3900933949660
    3901102778038300
    3901133949660
    3901331090037964
    3901383947894
    3901503938300LUGAR
    3901513947894
    3901563796448864
    3901803796448864
    3902223796448864
    3902243913780LUGAR
    3902443948700LUGAR
    3902463948700
    3902493913780LUGAR
    4000482502041980
    4100013930014484
    4100043930014484
    4100053930014484
    4100063930014484
    4100073930014484
    4100083930014484
    4100093930014484
    4100113930014484
    4100123930014484
    4100133930014484
    4200094224860LUGAR
    4200204216700
    4200284244940LUGAR
    4200304216700
    4200364216740
    4200394243900LUGAR
    4200674242340
    4200684216700
    4200694244940LUGAR
    4200704494017900
    4200714224860
    4200804242340
    4200853482048900
    4300124343620
    4300144322020
    4300944353
    4400084421780
    4400204426620
    4400351730034980
    4400504411700
    4400584416860
    4400594434980
    4400604427180
    4400673410028940
    4400684416860
    4400724432820
    4400734434980
    4401484434980
    4401514434980
    4401754434980
    4401804428940
    4401851742016860
    4401924434980
    4500074541700
    4500324543340
    4500392310419124
    4500594170012420
    4500642310419124
    4500734510180
    4500804530980
    4500872310419124
    4500984530980
    4500994511100
    4501212310419124
    4501352310419124
    4501372310419124
    4501444536220
    4501482310419124
    4501874526420
    4501924519124
    4501944519124
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    4502114526420
    4502144526420
    4502244546340
    4502834519124LUGAR
    4502864517780LUGAR
    4503474526420
    4503514523104
    4503894519124LUGAR
    4504004547380
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    4507792310419124
    4508304536220
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    4508722310419124
    4508802310419124
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    4600053626041620
    4600074641100
    4600114639340
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    4600364639340
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    4600423626041620
    4700014730
    4700114715764
    4700124738340
    4900042550016820
    4900054902047894
    4900064949020LUGAR
    4900134931340
    4900184916820
    4900474925500LUGAR
    4900794949180
    4900924940060
    4901054928700
    4901064916820
    4901094726040060
    5000025028420
    5000033458042644
    5000164830042644
    5000243650045104
    5000315036500
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    5000413102038900
    5000725042644
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    5100013406038300
    5100025140220
    5100065138300
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    5100285116620
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    5200765231540
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    5201075224580
    5201135224580
    5201165233340LUGAR
    5201525224580
    5201735220260
    5201892940416974
    5300025316220
    5300255322660

    Addendum N.—Hospital Reclassifications and Redesignations by Individual Hospital Under Section 508 of Pub. L. 108-173

    Provider No.Geographic CBSAWage index CBSA 508 reclassificationOwn wage index
    0101500117980
    020008021.2841
    0504940542220
    0505493710042220
    0600570619740
    060075061.1709
    Start Printed Page 43011
    0700013530035004
    0700053530035004
    0700101486035644
    0700163530035004
    0700173530035004
    0700193530035004
    0700223530035004
    0700281486035644
    0700313530035004
    070036255401.2926
    0700393530035004
    1200251226180
    1500342384416974
    1600404794016300
    160064161.0228
    1600674794016300
    1601104794016300
    1902181943340
    2200463834014484
    2300032610028020
    2300043474028020
    2300134764422420
    2300194764422420
    2300201980411460
    2300241980411460
    2300294764422420
    2300362322420
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    2300531980411460
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    2300663474028020
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    2300722610028020
    2300891980411460
    2300922710024340
    2300972328020
    2301041980411460
    2301062434028020
    2301191980411460
    2301304764422420
    2301351980411460
    2301461980411460
    2301514764422420
    2301651980411460
    2301742610028020
    2301761980411460
    2302074764422420
    2302234764422420
    2302362434028020
    2302544764422420
    2302694764422420
    2302701980411460
    2302731980411460
    2302774764422420
    2500022525060
    2501222525060
    2700212713740
    2700233354013740
    2700322713740
    2700502713740
    2700572713740
    3100214594035644
    3100283508435644
    3100503508435644
    3100513508435644
    3100601090035644
    3101151090035644
    3101203508435644
    3300493910035644
    3300673910035300
    330106350041.4734
    3301263910035644
    3301353910035644
    3302053910035644
    3302643910035004
    3400021170016740
    3500021390022020
    3500033522020
    3500063522020
    3500103522020
    3500143522020
    3500151390022020
    3500173522020
    3500303522020
    3500613522020
    380090381.2316
    3900014254010900
    3900033910900
    3900544254029540
    3900723910900
    3900954254010900
    3901094254010900
    3901194254010900
    3901374254010900
    3901694254010900
    3901854254029540
    3901924254010900
    3902374254010900
    3902704254029540
    410010393001.1746
    4300054339660
    4300154343620
    4300484343620
    4300604343620
    4300644343620
    4300773966043620
    4300913966043620
    4500104866032580
    4500722642026420
    4505912642026420
    4700031554014484
    4900014931340
    4900244022019260
    530015530.9897
    070006*1486035644
    070018*1486035644
    070034*1486035644
    140155*2810016974
    140186*2810016974
    250078*2562025060
    270002*2733540
    270012*2450033540
    270084*2733540
    330023*3910035644
    330067*3910035644
    350019*2422022020
    430008*4343620
    430013*4343620
    430031*4343620
    530008*5316220
    530010*5316220
    * These hospitals are assigned a wage index value under a special exceptions policy (FY 2005 IPPS final rule, 69 FR 49105).

    Addendum O.—Hospitals Redesignated as Rural Under Section 1886(d)(8)(E) of the Act

    Provider No.Geographic CBSARedesignated rural area
    0300073914003
    0400752222004
    0501922342005
    0504694014005
    0505283290005
    0506184014005
    0700042554007
    1000483786010
    1001342726010
    1300182682013
    1401671414
    1500511402015
    1500782384415
    1701372994017
    1900482638019
    2300783566023
    2400373346024
    2600064114026
    3000093170030
    3700543642037
    3800401346038
    3800844142038
    3901813939
    3901833939
    3902013939
    4500524545
    4500781018045
    4502431018045
    4502764866045
    4503484545
    5000232842050
    5000374942050
    5001225050
    5001474264450
    5001484830050
    End Supplemental Information

    Footnotes

    1.  Interim final rule with comment period, August 3, 2000 (65 FR 47670); interim final rule with comment period, November 13, 2000 (65 FR 67798); final rule and interim final rule with comment period, November 2, 2001 (66 FR 55850 and 55857); final rule, November 30, 2001 (66 FR 59856); final rule, December 31, 2001 (66 FR 67494); final rule, March 1, 2002 (67 FR 9556); final rule, November 1, 2002 (67 FR 66718); final rule with comment period, November 7, 2003 (68 FR 63398); correction of the November 7, 2003 final rule with comment period, December 31, 2003 (68 FR 75442); interim final rule with comment period, January 6, 2004 (69 FR 820); and final rule with comment period, November 15, 2004 (69 FR 65681).

    Back to Citation

    2.  Mundinger, M.O., Kane, R.I., Lenez, E.R., et al., Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians, A Randomized Trial, The Journal of the American Medical Association, January 5, 2000, Vol. 283, No. 1, pages 59-68.

    Back to Citation

    3.  Brown, S.A. and Grimes, D.E., Nurse Practitioners and Certified Nurse Midwives: A Meta Analysis of Studies on Nurses in Primary Care Roles, American Nurses Association, Washington, DC, March 1993.

    Back to Citation

    4.  Ryan, S.A., Nurse Practitioners: Educational Issues, Practice Styles, and Service Barriers. In Clawson, D.K., Osterweis, M., eds: The Role of Physician Assistants and Nurse Practitioners in Primary Health Care, Association of Academic Health Centers, Washington, DC, 1993.

    Back to Citation

    5.  Office of Technology Assessment, U.S. Congress: Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives: A Policy Analysis, Health Technology Case Study 37, Washington, DC, U.S Government Printing Office, 1986.

    Back to Citation

    [FR Doc. 05-14448 Filed 7-18-05; 4:10 pm]

    BILLING CODE 4120-01-P

Document Information

Published:
07/25/2005
Department:
Centers for Medicare & Medicaid Services
Entry Type:
Proposed Rule
Action:
Proposed rule.
Document Number:
05-14448
Dates:
To be ensured consideration, comments must be received at one of
Pages:
42673-43011 (339 pages)
Docket Numbers:
CMS-1501-P
RINs:
0938-AN46: Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates (CMS-1501-P)
RIN Links:
https://www.federalregister.gov/regulations/0938-AN46/changes-to-the-hospital-outpatient-prospective-payment-system-and-calendar-year-2006-payment-rates-c
Topics:
Grant programs-health, Health facilities, Hospitals, Medicaid, Medicare, Reporting and recordkeeping requirements
PDF File:
05-14448.pdf
CFR: (3)
42 CFR 419.43
42 CFR 419.66
42 CFR 485.631