[Federal Register Volume 59, Number 204 (Monday, October 24, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-26081]


[[Page Unknown]]

[Federal Register: October 24, 1994]


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DEPARTMENT OF DEFENSE
Office of the Secretary

 

Medical Services Reimbursement Rates for Fiscal Year 1995

    Notice is hereby given that the Deputy Comptroller (Financial 
Systems) in a memorandum dated September 2, 1994, established the 
following reimbursement rates for inpatient and outpatient medical care 
to be provided in FY 1995.

Inpatient, Outpatient, and Other Rates and Charges

                                            I. Inpatient Rates\1\,\2\                                           
----------------------------------------------------------------------------------------------------------------
                                                                                          Interagency           
                                                                           International     other              
                                                                              Military      federal             
                            Per inpatient day                              Education and     agency      Other  
                                                                              Training     sponsored            
                                                                              (IMET)       patients             
----------------------------------------------------------------------------------------------------------------
A. Burn Center...........................................................       $2,053        $3,532      $3,781
B. Surgical Care Services (Cosmetic Surgery).............................          473         1,057       1,122
C. All Other Inpatient Services (Based on Diagnosis Related Groups (DRG)                                        
 Charges\3\..............................................................  .............  ...........  .........
----------------------------------------------------------------------------------------------------------------
Explanations at end of docket.                                                                                  


                              1. FY 1995 Direct Care Inpatient Reimbursement Rates                              
----------------------------------------------------------------------------------------------------------------
                                                                               Interagency  Full cost    Third  
                     Adjusted Standard Amount                         IMET                               party  
----------------------------------------------------------------------------------------------------------------
Large urban.......................................................     $1,670      $3,679      $3,908     $3,908
Other urban.......................................................      1,954       3,997       4,267      4,267
Rural.............................................................      2,085       4,744       5,066      5,066
Overseas..........................................................      2,146       4,794       5,089      5,089
----------------------------------------------------------------------------------------------------------------

2. Overview

    The FY 1995 inpatient rates are based on the cost per DRG which is 
the inpatient full reimbursement rate per hospital discharge, weighted 
to reflect the intensity of the principal diagnosis involved. The 
average costs per Relative Weighted Product (RWP) for large urban, 
other urban, rural, and overseas facilities will be published annually 
as an inpatient standardized amount. (See item 1 above). A relative 
weight for each DRG using the standardized amount will be the same as 
the DRG weights published annually for hospital reimbursement rates 
under the Civilian Health and Medical Program of the Uniformed Services 
(CHAMPUS) pursuant to 32 CFR 199.14(a)(1) which includes adjustments 
for outliers, area wages, and indirect medical education. An example of 
how to apply DoD costs to a DRG standardized weight to arrive at DoD 
costs is contained in part 3 of Section I.C., below.

3. Example of Adjusted Standardized Amounts for Procedures Performed

Large Urban Area--Example
    a. The cost to be recovered is DoD's cost for medical services 
provided in a large urban area. Billings will be at the third party 
rate.
    b. DRG: Nervous System infection except viral meningitis Relative 
Weight of Procedure 1.8427
    c. The DoD adjusted standardized amount to be recovered is $3,908 
(i.e., the third party rate as shown in the table).
    d. DoD cost to be recovered is the RWP factor (1.8427) in item 3b, 
above, times the amount ($3,908) in 3c, above.
    Cost to be recovered is $7,201.

                                           II. Outpatient Rates\1\\2\                                           
----------------------------------------------------------------------------------------------------------------
                                                                        International   Interagency &           
                                                                          Military      other Federal           
     MEPRS code*                 Per Visit Clinical Service             Education And      agency-       Other  
                                                                          Training        sponsored             
                                                                           (IMET)         patients              
----------------------------------------------------------------------------------------------------------------
                                                A. Medical Care                                                 
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BAA.................  Internal medicine..............................             $72            $144       $153
BAC.................  Cardiology.....................................              57             114        121
BAF.................  Endocrinology..................................              64             129        138
BAG.................  Gastroenterology...............................              68             137        145
BAH.................  Hematology.....................................              99             199        210
BAJ.................  Nephrology.....................................              67             135        143
BAK.................  Neurology......................................              59             118        126
BAM.................  Oncology.......................................              54             108        116
BAN.................  Pulmonary disease..............................              59             118        125
BAO.................  Rheumatology...................................              61             123        130
BAP.................  Dermatology....................................              42              85         91
BAQ.................  Infectious disease.............................              46              92         98
BAR.................  Physical medicine..............................              56             113        120
BAB.................  Allergy........................................              22              44         49
BAE.................  Diabetes.......................................              25              50         54
BAI.................  Hypertension...................................              26              52         56
BAL.................  Nutrition......................................              16              33         35
                                                                                                                
----------------------------------------------------------------------------------------------------------------
                                                B. Surgical Care                                                
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BBA.................  General surgery................................              67             135        141
BBB.................  Cardiovascular/Thoracic surgery................              81             162        169
BBC.................  Neurosurgery...................................              93             187        195
BBD.................  Ophthalmology..................................              53             107        112
BBE.................  Organ transplant...............................             128             257        268
BBF.................  Otolaryngoloy..................................              60             121        126
BBG.................  Plastic surgery................................              77             154        160
BBH.................  Proctology.....................................              54             108        114
BBI.................  Urology........................................              75             150        158
BBJ.................  Pediatric surgery..............................              30              60         64
----------------------------------------------------------------------------------------------------------------
                                                                                                                
                                   C. Obstetrical and Gynecological (OB-GYN)                                    
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BCA.................  Family planning................................              49              99        105
BCB.................  Gynecology.....................................              50             100        106
BCC.................  Obstetrics.....................................              46              93         99
----------------------------------------------------------------------------------------------------------------
                                                                                                                
                                                D. Pediatric Care                                               
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BDA.................  Pediatric......................................              40              80         86
BDB.................  Adolescent.....................................              39              78         83
BDC.................  Well baby......................................              25              50         55
----------------------------------------------------------------------------------------------------------------
                                                                                                                
                                               E. Orthopaedic Care                                              
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BEA.................  Orthopaedic....................................              67             134        140
BEC.................  Hand surgery...................................              37              74         78
BED/BLC.............  Neuromuscularskeletal..........................              26              52         55
BEE.................  Orthopaedic appliance..........................              44              88         93
BEF.................  Podiatry.......................................              36              72         77
----------------------------------------------------------------------------------------------------------------
                                                                                                                
                                    F. Psychiatric and/or Mental Health Care                                    
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BFB.................  Psychology.....................................              49              99        104
BFC.................  Child guidance.................................              39              79         84
BFA/BFD.............  Mental health..................................              54             108        114
BFE.................  Social work....................................              40              81         86
BFF.................  Substance abuse rehabilitation.................              41              82         87
----------------------------------------------------------------------------------------------------------------
                                                                                                                
                                             G. Primary Medical Care                                            
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BGA/BHA.............  Family practice/primary........................              45              90         96
BHB.................  Medical examination............................              43              86         91
BHC.................  Optometry......................................              30              60         64
BHD.................  Audiology clinic...............................              25              50         54
BHE.................  Speech pathology...............................              39              78         82
BHF.................  Community health...............................              35              70         75
BHG.................  Occupational health............................              36              72         76
BHI.................  Immediate care clinic..........................              59             119        125
----------------------------------------------------------------------------------------------------------------
                                                                                                                
                                            H. Emergency Medical Care                                           
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BIA.................  Emergency care clinic..........................              72             144        151
----------------------------------------------------------------------------------------------------------------
                                                                                                                
                                            I. Flight Medicine Clinic                                           
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BJA.................  Flight medicine................................              63             126        132
----------------------------------------------------------------------------------------------------------------
                                                                                                                
                                           J. Underseas Medicine Care                                           
                                                                                                                
----------------------------------------------------------------------------------------------------------------
BKA.................  Underseas medicine clinic......................              42              85         90
----------------------------------------------------------------------------------------------------------------
                                                                                                                
                                           K. Rehabilitative Services                                           
                                                                                                                
----------------------------------------------------------------------------------------------------------------
DHB.................  Occupational therapy...........................              24              48         51
DHD.................  Physical therapy...............................              17              35         38
----------------------------------------------------------------------------------------------------------------
                                                                                                                
                                               L. Same Day Surgery                                              
                                                                                                                
----------------------------------------------------------------------------------------------------------------
                      Same day surgery...............................             169             340        361
----------------------------------------------------------------------------------------------------------------
*The Medical Expense and Performance Reporting System (MEPRS) code is a three digit code which defines the      
  summary account and the subaccount within a functional category in the DoD medical system. An example of this 
  hierarchal arrangement is as follows:                                                                         


                                                                        
        Outpatient Care (Functional Category)               MEPRScode   
                                                                        
Medical Care (Summary Account)........................  BA              
Internal Medicine (Subaccount)........................  BAA             
                                                                        
MEPRS codes are used to ensure that consistent financial and operating  
  performance data is reported in the DoD military medical system.      
Explanations at end of docket.                                          


                                          III. Other Rates and Charges                                          
----------------------------------------------------------------------------------------------------------------
                                                                   International   Interagency,                 
                                                                     Military      other federal                
                                                                   Education and      agency           Other    
                                                                     Training        sponsored                  
                                                                      (IMET)         patients                   
----------------------------------------------------------------------------------------------------------------
A. Immunizations................................................              $9             $18             $19
B. Hyperbaric services:                                                                                         
    1-60 minutes................................................              81             163             169
    61-120 minutes..............................................             162             325             338
    121-180 minutes.............................................             243             488             506
    181-240 minutes.............................................             324             650             675
C. Family member rate (Formerly military dependents rate).......  ..............            9.50  ..............
----------------------------------------------------------------------------------------------------------------
(Note: Charges may be prorated based on usage)                                                                  

D. Third Party Drug Reimbursement Rates\4\

    Upon request, a complete list of the FY 1995 third party drug 
reimbursement rates may be obtained in electronic format. All requests 
for this information should be addressed to: Third Party Collection 
Program Officer, OASD(HA)/HSO&R/OMS, The Pentagon, Rm 3E343, 
Washington, DC 20301-1200.
    The following is a listing of the dosage form description used in 
connection with pharmaceuticals being dispensed. See note 4 to 
reimbursable rates for cost of dispensing drugs.

----------------------------------------------------------------------------------------------------------------
     Dosage form                  Description                                  Interpretation                   
----------------------------------------------------------------------------------------------------------------
AA..................  Aerosol............................  Aerosol (ML).                                        
AB..................  Aerosol............................  Aerosol (GM).                                        
AC..................  Aerosol............................  Aerosol (EA).                                        
AD..................  Aer Refill.........................  Aerosol Refill (ML).                                 
AE..................  Aer Refill.........................  Aerosol Refill (EA).                                 
AF..................  Foam...............................  Aerosol Foam.                                        
AG..................  Aer Refill.........................  Aerosol Refill (GM).                                 
AH..................  Aer Adap...........................  Aerosol w/Adapter (ML).                              
AI..................  Aer W/Adap.........................  Aerosol w/Adapter (EA).                              
AJ..................  Aer Adap...........................  Aerosol wo/Adapter (GM).                             
AK..................  AR Powder..........................  Aerosol Powder (EA).                                 
AL..................  Ampul-Neb..........................  Ampul for Nebulization (ML).                         
AM..................  Mist...............................  Aerosol, Mist.                                       
AN..................  Vial-Neb...........................  Vial Nebulizer.                                      
AP..................  Aero Powd..........................  Aerosol Powder (GM).                                 
AQ..................  Spray..............................  Spray (GM).                                          
AR..................  Spray Rfi..........................  Spray Refill (ML).                                   
AS..................  Spray..............................  Aerosol, Spray (ML).                                 
AT..................  Spray/Pump.........................  Aerosol, Spray w/Pump (ML).                          
AW..................  Foam/appl..........................  Aerosol, Foam with applicator.                       
CA..................  Capsule............................  Capsule (hard, soft, etc.)                           
CE..................  Capsule EC.........................  Capsule, Enteric Coated.                             
CK..................  Sprinkle...........................  Sprinkle Capsule.                                    
CP..................  Cap Pellet.........................  Pellets in Capsule.                                  
CS..................  Capsule SA.........................  Capsule, Sustained Action.                           
CT..................  Capsule SA.........................  Capsule, Degradable Controlled-Release.              
EA..................  Each...............................  Each.                                                
EB..................  Bar................................  Bar.                                                 
EC..................  Cake...............................  Cake.                                                
ED..................  Med. Soap..........................  Soap, Medicated (EA).                                
EE..................  Liq Soap...........................  Soap, Liquid.                                        
EF..................  Dental Cone........................  Dental Cone.                                         
EG..................  Med. Dress.........................  Dressing, Medicated (EA).                            
EH..................  Stick..............................  Stick.                                               
EJ..................  Plaster............................  Plaster.                                             
EK..................  Poultice...........................  Poultice.                                            
EL..................  Med. Swab..........................  Swab, Medicated.                                     
EM..................  Med. Gauze.........................  Guaze, Medicated.                                    
EN..................  Med. Tape..........................  Tape, Medicated.                                     
EP..................  Med. Soap..........................  Soap, Medicated (ML).                                
ER..................  Med. Soap..........................  Soap, Medicated (GM).                                
ES..................  Med. Dress.........................  Dressing, Medicated (GM).                            
ET..................  Med. Pad...........................  Pads, Medicated (EA).                                
GA..................  Gas................................  Gas.                                                 
GH..................  Inhaler............................  Inhaler (ML).                                        
GI..................  Inhaler............................  Inhaler (EA).                                        
GJ..................  Inhaler kit........................  Inhaler Kit (EA).                                    
GZ..................  Inhaler............................  Inhaler (GM).                                        
HA..................  Infus. Btl.........................  Infusion Bottle (EA).                                
HB..................  Infus. Btl.........................  Infusion Bottle (ML).                                
HC..................  Pipette............................  Pipette (EA).                                        
HD..................  Pipette............................  Pipette (ML).                                        
HE..................  Allergen...........................  Allergen.                                            
HH..................  Ampul..............................  Ampul (ML).                                          
HI..................  Cartridge..........................  Cartridge (EA).                                      
HJ..................  Cartridge..........................  Cartridge (ML).                                      
HM..................  IV Soln............................  Intravenous Solution                                 
HN..................  Piggyback..........................  Intravenous Solution, Piggyback (EA).                
HP..................  Piggyback..........................  Intravenous Solution, Piggyback (ML).                
HQ..................  Disp Syrin.........................  Disposable Syringe (ML).                             
HR..................  Ampul..............................  Ampul (EA).                                          
HS..................  Vial...............................  Vial (SDV, MDV or Additive) (EA).                    
HT..................  Skin Test..........................  Skin Test.                                           
HU..................  Plast. Bag.........................  Plastic Bag, Injection (EA).                         
HV..................  Vial...............................  Vial (SDV, MDV or Additive) (ML).                    
HW..................  Add. Syrin.........................  Additive Syringe.                                    
HX..................  Disp Syrin.........................  Disposable Syringe (EA).                             
HY..................  IP Soln............................  Intraperitoneal Solution.                            
HZ..................  Plast. Bag.........................  Plastic Bag, Injection (ML).                         
JA..................  Jelly..............................  Jelly.                                               
JB..................  Jel................................  Jel (ML).                                            
JC..................  Gel................................  Gel (ML).                                            
JD..................  Jel................................  Jel (GM).                                            
JE..................  Beads..............................  Beads.                                               
JG..................  Gel................................  Gel (ML).                                            
JH..................  Pudding............................  Pudding (EA).                                        
JJ..................  Pudding............................  Pudding (GM).                                        
JV..................  Gel/Appl...........................  Gel with Applicator.                                 
JW..................  Jelly/Appl.........................  Jelly with Applicator.                               
KA..................  Cream..............................  Cream.                                               
KL..................  Lubricant..........................  Lubricant.                                           
KP..................  Paste..............................  Paste.                                               
KT..................  Toothpaste.........................  Toothpaste.                                          
KW..................  Cream/Appl.........................  Cream with Applicator.                               
OA..................  Ointment...........................  Ointment.                                            
OW..................  Oint/Appl..........................  Ointment with Applicator.                            
PA..................  Powder.............................  Powder (GM).                                         
PB..................  Leaves.............................  Leaves (GM).                                         
PC..................  Crystals...........................  Crystals.                                            
PE..................  Powder Effer.......................  Powder Effervescent.                                 
PF..................  Flakes.............................  Flakes.                                              
PG..................  Granules...........................  Granules, Powder-like, Non-effervescent.             
PL..................  Cleanser...........................  Cleanser.                                            
PM..................  Lump...............................  Lump.                                                
PP..................  Packet.............................  Packet.                                              
PS..................  Adh. Patch.........................  Adhesive Patch, Medicated.                           
PT..................  Tooth Powd.........................  Tooth Powder.                                        
PU..................  Powder.............................  Powder (EA).                                         
QA..................  Suppos.............................  Suppository.                                         
QB..................  Insert.............................  Insert.                                              
SA..................  Solution...........................  Solution, Topical EENT                               
SB..................  FI Extract.........................  Fluid Extract                                        
SC..................  Oral Susp..........................  Suspension, Oral (final dose form) (ML).             
SD..................  Douche.............................  Douche.                                              
SE..................  Elixir.............................  Elixir                                               
SF..................  Enema..............................  Enema (ML).                                          
SG..................  Enema..............................  Enema (EA).                                          
SH..................  Expect.............................  Expectorant.                                         
SI..................  Liniment...........................  Liniment.                                            
SJ..................  Solution...........................  Solution, Oral.                                      
SK..................  Lotion.............................  Lotion (ML).                                         
SL..................  Liquid.............................  Liquid.                                              
SM..................  Mouthwash..........................  Mouthwash.                                           
SN..................  Powder.............................  Powder (ML).                                         
SO..................  Drops..............................  Drops.                                               
SP..................  Spirit.............................  Spirit.                                              
SQ..................  Oil................................  Oil.                                                 
SR..................  Suspension.........................  Suspension, Topical.                                 
SS..................  Shampoo............................  Shampoo.                                             
ST..................  Syrup..............................   Syrup.                                              
SU..................  Emulsion...........................  Emulsion.                                            
SV..................  Gran Eff...........................  Grnules, Effervescent.                               
SW..................  Irrig Soln.........................  Solution, Irrigating.                                
SX..................  Tincture...........................  Tincture.                                            
SY..................  Oral Conc..........................  Concentrate, Oral.                                   
SZ..................  Lotion.............................  Lotion (GM).                                         
TA..................  Tablet.............................  Tablet (compressed, sugar coated caplets)            
TB..................  Tablet Sol.........................  Tablet, Soluble                                      
TC..................  Tab Chew...........................  Tablet, Chewable.                                    
TD..................  Disk...............................  Disk.                                                
TE..................  Tablet EC..........................  Tablet, Enteric Coated.                              
TF..................  Tablet, Eff........................  Tablet, Effervescent.                                
TG..................  Gum................................  Gum.                                                 
TH..................  Tablet Hyp.........................  Tablet, Hypodermic.                                  
TL..................  Lozenge............................  Lozenge.                                             
TN..................  Granules...........................  Granules, Oral Tablet-like or Packets.               
TP..................  Pellet.............................  Pellet.                                              
TR..................  Tab Part...........................  Particles in tablet, pH dependent.                   
TS..................  Tablet SA..........................  Tablet, Sustained Action.                            
TT..................  Troche.............................  Troche.                                              
TU..................  Tab Subl...........................  Tablet, Sublingual.                                  
TV..................  Tab Buccal.........................  Tablet, Buccal.                                      
TW..................  Wafer..............................  Wafer.                                               
TX..................  Pill...............................  Pill.                                                
TY..................  Tab Buc SA.........................  Tablet, Buccal Sustained Action.                     
UN..................  Unit...............................  Unit.                                                
WH..................  Whip...............................  Whip.                                                
YA..................  Needle.............................  Needle, Reusable.                                    
YB..................  Bulk...............................  Bulk.                                                
YC..................  Syringe............................  Syringe, Reusable.                                   
YD..................  Diaphragm..........................  Diaphragm.                                           
YE..................  Dressing...........................  Dressing.                                            
YF..................  Lense..............................  Lense.                                               
YG..................  Gauze..............................  Gauze, Non-Medicated.                                
YH..................  Dis Needle.........................  Needle, Disposable.                                  
YI..................  IUD................................  Intrauterine Device.                                 
YJ..................  Crwl Syrin.........................  Syringe, Cornwall.                                   
YK..................  Kit................................  Kit.                                                 
YL..................  Disp Syrin.........................  Syring, Empty Disposable.                            
YM..................  Pad................................  Pad.                                                 
YN..................  Tampon.............................  Tampon.                                              
YP..................  IP Set.............................  Intraperitoneal Admin. Sets--Paraphernalia.          
YQ..................  IV Set.............................  Intravenous Admin. Sets--Paraphernalia.              
YR..................  Strip..............................  Strip.                                               
YS..................  Suture.............................  Suture.                                              
YT..................  Tape...............................  Tape.                                                
YU..................  Irrig Set..........................  Irrigation Set.                                      
YV..................  Sponge.............................  Sponge.                                              
YW..................  Swab...............................  Swab, non-Medicated.                                 
YX..................  IV Access..........................  Intravenous Admixture Accessories.                   
YZ..................  Blood Set..........................  Blood Administration Set.                            
ZA..................  Miscell............................  Miscellaneous.                                       
ZB..................  Box................................  Box.                                                 
ZC..................  Bottle.............................  Bottle.                                              
ZD..................  Combo. Pkg.........................  Combination Package.                                 
ZE..................  Carton.............................  Carton.                                              
ZP..................  Package............................  Package.                                             
ZT..................  Tray...............................  Tray.                                                
----------------------------------------------------------------------------------------------------------------
Explanations at end of docket.                                                                                  

E. High Cost Services Requested By External Providers\5\

                                                                                                                
----------------------------------------------------------------------------------------------------------------
                                                              International      Interagency                    
   Resource based                                               military        other Federal                   
relative value scale            Service provided              education and   agency sponsored        Other     
                                                             training (IMET)      patients                      
----------------------------------------------------------------------------------------------------------------
0040................  Chest, PA/Lat/Bilat Decub...........               $34               $68               $72
0063................  Chest, Portable.....................                35                70                74
0783................  Bilat Ankles & Stress Views.........                41                82                87
1090................  Bilat Hips & Dan Miller.............                43                85                90
1250................  Skeletal Survey.....................               120               240               254
1251................  Skeletal Survey (Exam)..............                73               146               155
1252................  Skeletal Survey (Read)..............                47                94               100
1253................  Arthritic Survey....................                87               173               184
1254................  Arthritic Survey (Exam).............                55               110               117
1255................  Arthritic Survey (Read).............                32                64                67
1256................  Metastatic Bone Survey..............               120               240               254
1257................  Metastatic Bone Survey (Exam).......                73               146               155
1258................  Metastatic Bone Survey (Read).......                47                94               100
3000................  Upper GI Series.....................                34                68                72
3003................  UGI, Air Contrast...................                36                72                77
3046................  UGI, Other..........................                34                68                72
3050................  Barium Enema........................                37                74                78
3053................  BE, Air Contrast....................                50               100               106
3056................  BE, Thru Colostomy..................                50               100               106
3096................  BE, Other...........................                37                74                78
3109................  Enteroclysis........................                53               106               113
3110................  Enteroclysis (Exam).................                32                64                67
3133................  Cholangiogram, Operative............                51               102               108
3134................  Cholangiogram, Operative (Exam).....                38                76                80
3136................  Cholangiogram, Transhepatic.........               100               200               213
3137................  Cholangiogram, Transhepatic (E).....                38                76                80
3138................  Cholangiogram, Transhepatic (R).....                63               125               132
3140................  Cholangiogram, Percutaneous.........               100               200               213
3141................  Cholangiogram, Percutaneous (E).....                38                76                80
3142................  Cholangiogram, Percutaneous (R).....                63               125               132
3143................  Percutaneous Biliary Drain..........               128               255               271
3144................  Percutaneous Biliary Drain (E)......                32                64                67
3145................  Percutaneous Biliary Drain (R)......                96               192               204
3160................  ERCP................................               128               255               270
3161................  ERCP (Exam).........................                32                64                67
3162................  ERCP (Read).........................                96               191               203
3173................  Bronchoscopy, Unilateral............                55               109               116
3175................  Bronchoscopy, Unilateral, (Read)....                37                74                79
3176................  Bronchoscopy, Bilateral.............                67               134               142
3178................  Bronchoscopy, Bilateral, (Read).....                40                80                86
3180................  Hysterosalpingogram.................                40                80                85
3183................  Fallopian Tube Dilatation...........               208               416               442
3184................  Fallopian Tube Dilatation (E).......               104               208               221
3185................  Fallopian Tube Dilatation (R).......               104               208               221
3200................  Lymphangio, Bilat Extrem............               236               471               501
3201................  Lymphangio, Bilat Extrem (Exam).....               125               250               265
3202................  Lymphangio, Bilat Extrem (Read).....               111               222               236
3203................  Lymphangio, Extremity...............               132               263               279
3204................  Lymphangio, Extremity (Exam)........                63               125               132
3205................  Lymphangio, Extremity (Read)........                69               138               147
3210................  Lymphangio, Pelvic, Unilat..........               132               263               279
3211................  Lymphangio, Pelvic, Unilat (Exam)...                63               125               132
3212................  Lymphangio, Pelvic, Unilat (Read)...                69               138               147
3213................  Lymphangio, Pelvic, Bilat...........               236               471               500
3214................  Lymphangio, Pelvic, Bilat (Exam)....               125               250               265
3215................  Lymphangio, Pelvic, Bilat (Read)....               111               221               235
3216................  Lymphangio, Abd, Unilat.............               132               263               279
3217................  Lymphangio, Abd, Unilat (Exam)......                63               125               132
3218................  Lymphangio, Abd, Unilat (Read)......                69               138               147
3220................  Lymphangio, Abd, Bilat..............               236               471               500
3221................  Lymphangio, Abd, Bilat (Exam).......               125               250               265
3222................  Lymphangio, Abd, Bilat (Read).......               111               221               235
3230................  Venogram, Bilat Extremity...........               133               265               281
3231................  Venogram, Bilat Extremity (Exam)....                92               183               194
3232................  Venogram, Bilat Extremity (Read)....                41                82                87
3233................  Venogram, Lt Extremity..............                74               148               157
3234................  Venogram, Lt Extremity (Exam).......                46                92                97
3240................  Venogram, Inf Cav W/Serial..........               116               231               246
3241................  Venogram, Inf Cav W/Serial (E)......                46                92                97
3242................  Venogram, Inf Cav W/Serial (R)......                70               140               148
3243................  Venogram, Sup Cav W/Serial..........               116               231               246
3244................  Venogram, Sup Cav W/Serial (E)......                46                92                97
3245................  Venogram, Sup Cav W/Serial (R)......                70               140               148
3246................  Venogram, Bilat Renal...............               191               381               405
3247................  Venogram, Bilat Renal (Exam)........                92               183               194
3248................  Venogram, Bilat Renal (Read)........                99               198               210
3250................  Venogram, Lt Renal..................               126               252               268
3251................  Venogram, Lt Renal ((Exam)..........                46                92                97
3252................  Venogram, Lt Renal (Read)...........                80               160               170
3253................  Venogram, Rt Renal..................               126               252               268
3254................  Venogram, Rt Renal (Exam)...........                46                92                97
3255................  Venogram, Rt Renal (Read)...........                80               160               170
3256................  Venogram, Bilat Adrenal.............               191               381               405
3257................  Venogram, Bilat Adrenal (Exam)......                92               183               194
3258................  Venogram, Bilat Adrenal (Read)......                99               198               210
3260................  Venogram, Lt Adrenal................               126               252               268
3261................  Venogram, Lt Adrenal (Exam).........                46                92                97
3262................  Venogram, Lt Adrenal (Read).........                80               160               170
3263................  Venogram, Rt Adrenal................               126               252               268
3264................  Venogram, Rt Adrenal (Exam).........                46                92                97
3265................  Venogram, Rt Adrenal (Read).........                80               160               170
3266................  Venogram, Azygos (Select)...........               126               252               268
3267................  Venogram, Azygos (Select) (Exam)....                46                92                97
3268................  Venogram, Azygos (Select) (Read)....                80               160               170
3270................  Venogram, Azygos (Nonselect)........               116               231               245
3271................  Venogram, Azygos (Nonselect) (E)....                46                92                97
3272................  Venogram, Azygos (Nonselect) (R)....                70               139               148
3273................  Venogram, Intraosseous..............                91               182               193
3274................  Venogram, Intraosseous (Exam).......                46                92                97
3275................  Venogram, Intraosseous (Read).......                45                90                95
3276................  Venogram, Sinus.....................               126               252               268
3277................  Venogram, Sinus (Exam)..............                46                92                97
3278................  Venogram, Sinus (Read)..............                80               160               170
3280................  Venogram, Jugular...................               126               252               268
3281................  Venogram, Jugular (Exam)............                46                92                97
3282................  Venogram, Jugular (Read)............                80               160               170
3283................  Venogram, Sup Sag Sinus.............               101               202               215
3284................  Venogram, Sup Sag Sinus (Exam)......                46                92                97
3285................  Venogram, Sup Sag Sinus (Read)......                55               110               117
3286................  Venogram, Epidural..................               126               252               268
3287................  Venogram, Epidural (Exam)...........                46                92                97
3288................  Venogram, Epidural (Read)...........                80               160               170
3290................  Venogram, Orbital...................                74               148               157
3291................  Venogram, Orbital (Exam)............                46                92                97
3300................  Perc Transhep Porto W/Hemo..........               219               437               464
3301................  Perc Transhep Porto W/Hemo (E)......               104               208               221
3302................  Perc Transhep Porto W/Hemo (R)......               115               229               243
3303................  Perc Transhep Porto W/O Hemo........               220               439               465
3304................  Perc Transhep Porto W/O Hemo (E)....               104               208               221
3305................  Perc Transhep Porto W/O Hemo (R)....               115               229               243
3310................  Hepat Veno, Wed/Free W/Hemo.........               185               369               391
3311................  Hepat Veno, Wed/Free W/Hemo (E).....               104               208               221
3312................  Hepat Veno, Wed/Free W/Hemo (R).....                80               160               170
3313................  Hepat Veno, Wed/Free W/O Hemo.......               185               369               391
3314................  Hepat Veno, Wed/Free W/O Hemo (E)...               104               208               221
3315................  Hepat Veno, Wed/Free W/O Hemo (R)...                80               160               170
3320................  Venous Sampling Thru Cath...........                59               118               125
3321................  Venous Sampling Thru Cath (E).......                46                92                97
3330................  Transcath TX, Embol W/Angio.........               273               545               579
3331................  Transcath TX, Embol W/Angio (E).....               104               208               221
3332................  Transcath TX, Embol W/Angio (R).....               169               337               358
3333................  Transcath TX, Infus W/Angio.........               273               545               579
3334................  Transcath TX, Infus W/Angio (E).....               104               208               221
3335................  Transcath TX, Infus W/Angio (R).....               169               337               358
3340................  Percu Place IVC Filter..............               268               535               567
3341................  Percu Place IVC Filter (Exam).......                83               166               177
3342................  Percu Place IVC Filter (Read).......               184               368               390
3350................  Transcath Intrav Occ, Temp..........               273               545               579
3351................  Transcath Intrav Occ, Temp (E)......               104               208               221
3352................  Transcath Intrav Occ, Temp (R)......               169               337               358
3353................  Transcath Intrav Occ, Perm..........               273               545               579
3354................  Transcath Intrav Occ, Perm (E)......               104               208               221
3355................  Transcath Intrav Occ, Perm (R)......               169               337               358
3356................  Transcath Retriev, Perc, FX V/A.....               203               406               431
3357................  Transcath Retriev, Perc, FX V/AE....               104               208               221
3358................  Transcath Retriev, Perc, FX V/AR....                99               198               210
3360................  Percu Transl Angio, Perip, Art......               273               545               579
3361................  Percu Transl Angio, Perip, Art (E)..               104               208               221
3362................  Percu Transl Angio, Perip, Art (R)..               169               337               358
3363................  Percu Transl Angio, q Ad Per........               220               439               465
3364................  Percu Transl Angio, q Ad Per (E)....               104               208               221
3365................  Percu Transl Angio, q Ad Per (R)....               116               231               245
3366................  Percu Transl Angio, Vicer A.........               308               614               652
3367................  Percu Transl Angio, Vicer A (E).....               104               208               221
3368................  Percu Transl Angio, Vicer A (R).....               203               406               431
3370................  Transcath BX........................               173               345               367
3371................  Transcath BX (Exam).................               104               208               221
3372................  Transcath BX (Read).................                69               138               146
3380................  Perc Transhep Bil Drain W/Con.......               219               437               464
3381................  Perc Transhep Bil Drain W/Cone......               104               208               221
3382................  Perc Transhep Bil Drain W/Conr......               115               229               243
3383................  Per Pl Cath For Inop Bil Obs........               247               493               524
3384................  Per Pl Cath For Inop Bil Obse.......               104               208               221
3385................  Per Pl Cath For Inop Bil Obsr.......               143               285               303
3400................  Aortogram, Thoracic (Wo/Ser)........               183               365               388
3401................  Aortogram, Thoracic (Wo/Ser) (E)....               104               208               221
3402................  Aortogram, Thoracic (Wo/Ser) (R)....                79               157               167
3403................  Aortogram, Thoracic (W/Ser).........               198               396               420
3404................  Aortogram, Thoracic (W/Ser) (E).....               104               208               221
3405................  Aortogram, Thoracic (W/Ser) (R).....                94               188               200
3406................  Aortogram, Translum (W/Ser).........               183               365               388
3407................  Aortogram, Translum (Wo/Ser) (E)....               104               208               221
3408................  Aortogram, Translum (Wo/Ser) (R)....                79               157               167
3410................  Aortogram, Translum (W/Ser).........               198               396               420
3411................  Aortogram, Translum (W/Ser) (E).....               104               208               221
3412................  Aortogram, Translum (W/Ser) (R).....                94               188               200
3413................  Aortogram, Abd Cath (Wo/Ser)........               183               365               388
3414................  Aortogram, Abd Cath (Wo/Ser) (E)....               104               208               221
3415................  Aortogram, Abd Cath (Wo/Ser) (R)....                79               157               167
3416................  Aortogram, Abd Cath (W/Ser).........               198               396               420
3417................  Aortogram, Abd Cath (W/Ser) (E).....               109               216               231
3418................  Aortogram, Abd Cath (W/Ser) (R).....                99               196               210
3420................  Aortogr, Abd & Bil Ilfem, Cath......               207               411               435
3421................  Aortogr, Abd & Bil Ilfem, Cath (E)..               109               216               231
3422................  Aortogr, Abd & Bil Ilfem, Cath (R)..               103               204               218
3430................  Angiogram...........................               213               423               448
3431................  Angiogram (Exam)....................               109               216               231
3432................  Angiogram (Read)....................               109               216               231
3433................  Angiogram, Cerebral.................               228               452               478
3434................  Angiogram, Cerebral (Exam)..........               109               216               231
3435................  Angiogram, Cerebral (Read)..........               124               246               261
3436................  Angiogram, Angioplasty (Art)........               213               423               448
3437................  Angiogram, Angioplasty (Art)(Ex)....               109               216               231
3438................  Angiogram, Angioplasty (Art)(Re)....               109               216               231
3440................  Angiogram, Angioplasty (Ven)........               213               423               448
3441................  Angiogram, Angioplasty (Ven)(Ex)....               109               216               231
3442................  Angiogram, Angioplasty (Ven)(Re)....               109               216               231
3443................  Angiogram, Pulmonary................               232               460               487
3444................  Angiogram, Pulmonary (Exam).........               109               216               231
3445................  Angiogram, Pulmonary (Read).........               128               254               270
3446................  Angiogram, Venous Phase.............               155               309               328
3447................  Angiogram, Venous Phase (Exam)......               104               208               221
3448................  Angiogram, Venous Phase (Read)......                50               100               107
3450................  Angiogram, Vena Cava................               219               437               464
3451................  Angiogram, Vena Cava (Exam).........               104               208               221
3452................  Angiogram, Vena Cava (Read).........               115               229               243
3453................  Angiogram, Portal Vein..............               240               479               508
3454................  Angiogram, Portal Vein (Exam).......               104               208               221
3455................  Angiogram, Portal Vein (Read).......               136               271               287
3456................  Angiogram, Renal Vein...............               240               479               508
3457................  Angiogram, Renal Vein (Exam)........               104               208               221
3458................  Angiogram, Renal Vein (Read)........               136               271               287
3460................  Angiogram, Renal Vein Renins........               208               416               442
3461................  Angiogram, Renal Vein Renins (E)....               104               208               221
3462................  Angiogram, Renal Vein Renins (R)....               104               208               221
3463................  Angiogram, Subclavian Vein..........               208               416               442
3464................  Angiogram, Subclavian Vein (Ex).....               104               208               221
3465................  Angiogram, Subclavian Vein (Re).....               104               208               221
3466................  Angiogram, Testicular...............               208               416               442
3467................  Angiogram, Testicular (Exam)........               104               208               221
3468................  Angiogram, Testicular (Read)........               104               208               221
3470................  Angiogram, Embolization.............               208               416               442
3471................  Angiogram, Embolization (Exam)......               104               208               221
3472................  Angiogram, Embolization (Read)......               104               208               221
3473................  Angiogram, Cerebral.................               223               445               473
3474................  Angiogram, Cerebral (Exam)..........               104               208               221
3475................  Angiogram, Cerebral (Read)..........               119               237               252
3490................  Angiogram, Ea Add Run...............                42                84                88
3500................  Arteriogram, Lt Carotid.............               208               416               442
3501................  Arteriogram, Lt Carotid (Exam)......               104               208               221
3502................  Arteriogram, Lt Carotid (Read)......               104               208               221
3503................  Arteriogram, Lt Vertebral...........               208               416               442
3504................  Arteriogram, Lt Vertebral (Exam)....               104               208               221
3505................  Arteriogram, Lt Vertebral (Read)....               104               208               221
3506................  Arteriogram, Lt Carot & Vert........               313               624               662
3507................  Arteriogram, Lt Carot & Vert (E)....               208               416               442
3508................  Arteriogram, Lt Carot & Vert (R)....               104               208               221
3510................  Arteriogram, Rt Carotid.............               208               416               442
3511................  Arteriogram, Rt Carotid (Exam)......               104               208               221
3512................  Arteriogram, Rt Carotid (Read)......               104               208               221
3513................  Arteriogram, Rt Vertebral...........               208               416               442
3514................  Arteriogram, Rt Vertebral (Exam)....               104               208               221
3515................  Arteriogram, Rt Vertebral (Read)....               104               208               221
3516................  Arteriogram, Rt Carot & Vert........               313               624               662
3517................  Arteriogram, Rt Carot & Vert (E)....               208               416               442
3518................  Arteriogram, Rt Carot & Vert (R)....               104               208               221
3520................  Arteriogram, Bilat Carotid..........               313               624               662
3521................  Arteriogram, Bilat Carotid (Exam)...               208               416               442
3522................  Arteriogram, Bilat Carotid (Read)...               104               208               221
3523................  Arteriogram, Bilat Vertebral........               313               624               662
3524................  Arteriogram, Bilat Vertebral (E)....               208               416               442
3525................  Arteriogram, Bilat Vertebral (R)....               104               208               221
3526................  Arteriogram, Bilat Carot & Ver......               417               832               883
3527................  Arteriogram, Bilat Carot & Ver (Ex).               313               624               662
3528................  Arteriogram, Bilat Carot & Ver (Re).               104               208               221
3530................  Arteriogram, Brachial...............               208               416               442
3531................  Arteriogram, Brachial (Exam)........               104               208               221
3532................  Arteriogram, Brachial (Read)........               104               208               221
3533................  Arteriogram, Subclavian.............               208               416               442
3534................  Arteriogram, Subclavian (Exam)......               104               208               221
3535................  Arteriogram, Subclavian (Read)......               104               208               221
3536................  Arteriogram, Gastroduodenal.........               208               416               442
3537................  Arteriogram, Gastroduodenal (E).....               104               208               221
3538................  Arteriogram, Gastroduodenal (R).....               104               208               221
3540................  Arteriogram, Lt Gastric.............               208               416               442
3541................  Arteriogram, Lt Gastric (Exam)......               104               208               221
3542................  Arteriogram, Lt Gastric (Read)......               104               208               221
3543................  Arteriogram, Hepatic................               208               416               442
3544................  Arteriogram, Hepatic (Exam).........               104               208               221
3545................  Arteriogram, Hepatic (Read).........               104               208               221
3546................  Arteriogram, Celiac Axis............               208               416               442
3547................  Arteriogram, Celiac Axis (Exam).....               104               208               221
3548................  Arteriogram, Celiac Axis (Read).....               104               208               221
3550................  Arteriogram, Iliac..................               208               416               442
3551................  Arteriogram, Iliac (Exam)...........               104               208               221
3552................  Arteriogram, Iliac (Read)...........               104               208               221
3553................  Arteriogram, IMA....................               208               416               442
3554................  Arteriogram, IMA (Exam).............               104               208               221
3555................  Arteriogram, IMA (Read).............               104               208               221
3556................  Arteriogram, SMA....................               208               416               442
3557................  Arteriogram, SMA (Exam).............               104               208               221
3558................  Arteriogram, SMA (Read).............               104               208               221
3560................  Arteriogram, IMA & SMA..............               313               624               662
3561................  Arteriogram, IMA & SMA (Exam).......               208               416               442
3562................  Arteriogram, IMA & SMA (Read).......               104               208               221
3563................  Arteriogram, Renal..................               208               416               442
3564................  Arteriogram, Renal (Exam)...........               104               208               221
3565................  Arteriogram, Renal (Read)...........               104               208               221
3566................  Arteriogram, Femoral Runoff.........               208               416               442
3567................  Arteriogram, Femoral Runoff (E).....               104               208               221
3568................  Arteriogram, Femoral Runoff (R).....               104               208               221
3576................  Arteriogram/Intervent, Other........               208               416               442
3577................  Arteriogram/Intervent, Oth (E)......               104               208               221
3578................  Arteriogram/Intervent, Oth (R)......               104               208               221
3600................  IVP.................................                32                64                67
3603................  IVP, Hypertensive...................                35                69                73
3610................  IVP, Infusion.......................                35                70                74
3613................  IVP, Retrograde.....................                40                79                84
3614................  IVP, Retrograde (Exam)..............                32                64                67
3616................  IVP W/Tomograms.....................                37                74                79
3620................  Renal Cyst Puncture.................               146               291               308
3621................  Renal Cyst Puncture (Exam)..........                83               166               177
3622................  Renal Cyst Puncture (Read)..........                62               124               132
3623................  Nephrostomy.........................               225               449               477
3624................  Nephrostomy (Exam)..................               104               208               221
3625................  Nephrostomy (Read)..................               121               241               256
3626................  Nephrotomograms, No Contrast........                54               108               115
3627................  Nephrotomograms, No Contrast (E)....                42                84                88
3630................  Nephrostogram.......................               225               449               477
3631................  Nephrostogram (Exam)................               104               208               221
3632................  Nephrostogram (Read)................               121               241               256
3636................  Cystogram, Retrograde...............                32                64                68
3640................  Cystogram, Vcug.....................                35                70                74
3643................  Cystogram, Chain....................                32                64                68
3646................  Urethrogram, Retrograde.............                32                64                68
3650................  Peri-Urethrogram....................                32                64                68
3653................  Basket Extraction...................               208               416               442
3654................  Basket Extraction (Exam)............               104               208               221
3655................  Basket Extraction (Read)............               104               208               221
3656................  Stent Replacement/Removal...........               104               208               221
3673................  Mammogram, (Localization)...........                55               109               116
3674................  Mammogram, (Localization) (Exam)....                32                64                67
3676................  Mammillary Stereotaxic Biopsy.......                53               105               111
3677................  Mammillary Stereotaxic Biop (E).....                32                64                67
3693................  Mammogram, Bilat (Localize).........                80               160               170
3694................  Mammogram, Bilat (Localize) (Ex)....                45                89                95
3695................  Mammogram, Bilat (Localize) (Re)....                36                72                76
3696................  Mammillary Ductogram, Bilat.........                70               140               149
3697................  Mammillary Ductogram, Bilat (Exam)..                44                88                94
3700................  Myelogram, Cervical.................               128               256               272
3701................  Myelogram, Cervical (Exam)..........                49                98               104
3702................  Myelogram, Cervical (Read)..........                79               158               168
3703................  Myelgram, Thoracic..................               128               256               272
3704................  Myelogram, Thoracic (Exam)..........                49                98               104
3705................  Myelogram, Thoracic (Read)..........                79               158               168
3706................  Myelogram, Lumbar...................               126               252               268
3707................  Myelogram, Lumbar (Exam)............                47                94               100
3708................  Myelogram, Lumbar (Read)............                79               158               168
3713................  Myelogram, Other....................               128               256               272
3714................  Myelogram, Other (Exam).............                49                98               104
3715................  Myelogram, Other (Read).............                79               158               168
3716................  Arthrogram, Wrist...................                48                96               102
3720................  Arthrogram, Elbow...................                55               109               116
3723................  Arthrogram, Shoulder................                55               109               116
3726................  Arthrogram, Ankle...................                55               109               116
3730................  Arthrogram, Knee....................                64               128               135
3731................  Arthrogram, Knee (Exam).............                32                64                67
3732................  Arthrogram, Knee (Read).............                32                64                68
3733................  Arthrogram, Hip.....................                55               109               116
3736................  Arthrogram, TMJ.....................                60               120               128
3738................  Arthrogram, TMJ (Read)..............                35                70                74
3770................  Sialogram...........................                45                89                95
3773................  Sialogram, Parotidm.................                45                89                95
3776................  Sialogram, Submandibular............                45                89                95
3780................  Laryngogram.........................                48                95               101
3790................  Sinogram............................                58               116               124
3792................  Sinogram (Read).....................                42                84                88
3800................  Fistulagram.........................                58               116               124
3802................  Fistulagram, (Read).................                42                84                88
3810................  Dacrocystogram, (Bilat).............                65               130               138
3812................  Dacrocystogram, (Bilat) (Read)......                43                85                90
3813................  Dacrocystogram, Unilat..............                33                65                69
3896................  Specials, Other.....................                58               116               124
3897................  Specials, Other (Exam)..............                42                84                88
3898................  Special, Other (Read)...............                58               116               124
3980................  Tomogram, Single Plane..............                54               108               115
3981................  Tomogram, Single Plane (Exam).......                42                84                88
3983................  Tomogram, Cmplx Motion (Unil).......               108               216               230
3984................  Tomogram, Cmplx Motion (Unil) (E)...                83               166               177
3986................  Tomogram, Cmplx Motion (Bilat)......               125               250               265
3987................  Tomogram, Cmplx Motion (Bilat) (E)..               100               200               212
4000................  US, Head............................                37                74                79
4100................  US, Pelvis..........................                35                69                73
4120................  US, Kidney (Unilat).................                41                82                87
4126................  US, Bilat Kidney....................                58               115               122
4127................  US, Bilat Kidney (Exam).............                32                64                68
4140................  US, Pancreas........................                43                85                90
4160................  US, Spleen..........................                43                85                90
4180................  US, Liver...........................                43                85                90
4200................  US, Breast (Bilat)..................                51               192               108
4210................  US, Superficial Lesions.............                37                74                79
4300................  US, Knee (Bilat)....................                62               123               131
4301................  US, Knee (Bilat) (Exam).............                33                66                71
4400................  US. Abdominal Aorta.................                43                85                90
4440................  US, Iliacs..........................                37                74                79
4480................  US, Renals..........................                41                82                87
4520................  US, Abdomen (Complete)..............                93               185               196
4521................  US, Abdomen (Complete) (Exam).......                50               100               106
4522................  US, Abdomen (Complete) (Read).......                43                85                90
4540................  US, Testicular......................                33                66                71
4560................  US, Gall Bladder....................                43                85                90
4563................  US, Biliary Ducts...................                43                85                90
4580................  US, Pelvis..........................                35                69                73
4600................  US, OB..............................                48                96               102
4620................  US, Gestational Age.................                38                75                79
4640................  US, Fetal Evaluation................                42                84                88
4660................  US, Amniocentesis...................                61               122               129
4662................  US, Amniocentesis (Read)............                43                85                90
4700................  US, Dynamic Mass Study..............               124               247               262
4702................  US, Dynamic Mass Study (Read).......               105               210               223
4720................  US, Cyst Aspiration.................                84               167               177
4722................  US, Cyst Aspiration (Read)..........                65               130               137
4726................  US, Thoracenthesis..................                56               112               119
4728................  US, Thoracenthesis (Read)...........                38                75                79
4729................  US, Biopsy..........................                83               166               176
4731................  US, Biopsy (Read)...................                65               130               139
4996................  US, Other...........................                35                69                73
5000................  CT, Head/Brain (W/O Contrast).......                83               166               176
5001................  CT, Head/Brain (W/O Contrast) (E)...                63               126               135
5003................  CT, Head/Brain (W/Contrast).........               102               204               217
5004................  CT, Head/Brain (W/Contrast) (Ex)....                76               152               161
5006................  CT, Head/Brain (W W/O Contrast).....               166               332               352
5007................  CT, Head/Brain (W W/O Contrast) (E).                95               190               202
5020................  CT, Post Fossa (W/O Contrast).......                93               186               197
5021................  CT, Post Fossa (W/O Contrast) (E)...                63               126               134
5023................  CT, Post Fossa (W/Contrast).........               108               216               230
5024................  CT, Post Fossa (W/Contrast) (Ex)....                76               152               161
5025................  CT, Post Fossa (W/Contrast) (Re)....                32                64                68
5026................  CT, Post Fossa (W/Wo Contrast)......               129               257               273
5027................  CT, Post Fossa (W/Wo Contrast) E....                95               190               202
5028................  CT, Post Fossa (W/Wo Contrast) R....                34                68                72
5040................  CT, Sella Wo/Contrast...............                93               186               196
5041................  CT, Sella Wo/Contrast (Exam)........                63               126               134
5043................  CT, Sella W/Contrast................               108               216               228
5044................  CT, Sella W/Contrast (Exam).........                76               152               161
5045................  CT, Sella W/Contrast (Read).........                32                64                69
5046................  CT, Sella Wo/W Contrast.............               129               257               273
5047................  CT, Sella Wo/W Contrast (Exam)......                95               190               202
5048................  CT, Sella Wo/W Contrast (Read)......                34                68                73
5080................  CT, Orbits Wo/Contrast..............                93               186               197
5081................  CT, Orbits Wo/Contrast (Exam).......                63               126               134
5083................  CT, Orbits W/Contrast...............                93               186               197
5084................  CT, Orbits W/Contrast (Exam)........                63               126               134
5086................  CT, Orbits Wo/W Contrast............               129               257               273
5087................  CT, Orbits Wo/W Contrast (Exam).....                95               190               202
5088................  CT, Orbits Wo/W Contrast (Read).....                34                68                73
5100................  CT, Sinus Wo/ Contrast..............                90               179               190
5101................  CT, Sinus Wo/Contrast (Exam)........                63               126               134
5103................  CT, Sinus W/Contrast................               106               212               225
5104................  CT, Sinus W/Contrast (Exam).........                76               152               161
5106................  CT, Sinus Wo/W Contrast.............               128               256               272
5107................  CT, Sinus Wo/W Contrast (Exam)......                95               190               201
5108................  CT, Sinus Wo/W Contrast (Read)......                33                66                70
5120................  CT, IAMS/IACS Wo/Contrast...........                93               186               196
5121................  CT, IAMS/IACS Wo/Contrast (Exam)....                63               126               134
5123................  CT, IAMS/IACS W/Contrast............               108               216               230
5124................  CT, IAMS/IACS W/Contrast (Exam).....                76               152               161
5125................  CT, IAMS/IACS W/Contrast (Read).....                32                64                68
5126................  CT, IAMS/IACS Wo/W Contrast.........               129               257               274
5127................  CT, IAMS/IACS Wo/W Contrast (E).....                95               190               202
5128................  CT, IAMS/IACS Wo/W Contrast (R).....                34                68                72
5140................  CT, Facial Wo/Contrast..............                90               179               190
5141................  CT, Facial Wo/Contrast (Exam).......                63               126               134
5143................  CT, Facial W/Contrast...............               106               212               225
5144................  CT, Facial W/Contrast (Exam)........                76               152               161
5146................  CT, Facial W/Wo Contrast............               128               256               273
5147................  CT, Facial W/Wo Contrast (Exam).....                95               190               202
5148................  CT, Facial W/Wo Contrast (Read).....                33                66                70
5160................  CT, Coronals Wo/Contrast............                83               166               176
5161................  CT, Coronals Wo/Contrast (Exam).....                63               126               134
5163................  CT, Coronals W/Contrast.............               102               204               217
5164................  CT, Coronals W/Contrast (Exam)......                76               152               160
5166................  CT, Coronals Wo/W Contrast..........               125               249               264
5167................  CT, Coronals Wo/W Contrast (Ex).....                95               190               201
5170................  CT, Temporals Wo/Contrast...........                93               186               197
5171................  CT, Temporals Wo/Contrast (Exam)....                63               126               135
5173................  CT, Temporals W/Contrast............               106               212               225
5174................  CT, Temporals W/Contrast (Exam).....                76               152               161
5175................  CT, Temporals W/Contrast (Read).....                32                64                69
5176................  CT, Temporals Wo/W Contrast.........               129               257               273
5177................  CT, Temporals Wo/W Contrast (E).....                95               190               202
5178................  CT, Temporals Wo/W Contrast (R).....                34                68                72
5200................  CT, Brain Biopsy....................               129               257               273
5201................  CT, Brain Biopsy (Exam).............                95               190               202
5202................  CT, Brain Biopsy (Read).............                34                68                72
5300................  CT, Chest...........................               151               301               321
5301................  CT, Chest (Exam)....................               119               237               252
5302................  CT, Chest (Read)....................                32                64                68
5303................  CT, Chest Biopsy....................               151               301               320
5304................  CT, Chest Biopsy (Exam).............               119               237               252
5305................  CT, Chest Biopsy (Read).............                32                64                68
5400................  CT, C-Spine Wo/Contrast.............               106               212               224
5401................  CT, C-Spine Wo/Contrast (Exam)......                79               158               168
5403................  CT, C-Spine W/Contrast..............               165               329               348
5404................  CT, C-Spine W/Contrast (Exam).......                95               190               202
5406................  CT, C-Spine Wo/W Contrast...........               148               296               315
5407................  CT, C-Spine Wo/W Contrast (Exam)....               119               237               252
5420................  CT, T-Spine Wo/Contrast.............               106               212               225
5421................  CT, T-Spine Wo/Contrast (Exam)......                79               158               169
5423................  CT, T-Spine W/Contrast..............               123               246               261
5424................  CT, T-Spine W/Contrast (Exam).......                95               190               202
5426................  CT, T-Spine Wo/W Contrast...........               148               296               314
5427................  CT, T-Spine Wo/W Contrast (Exam)....               119               237               252
5440................  CT, L-Spine Wo/Contrast.............               106               212               225
5441................  CT, L-Spine Wo/Contrast (Exam)......                79               158               168
5443................  CT, L-Spine W/Contrast..............               123               246               262
5444................  CT, L-Spine W/Contrast (Exam).......                95               190               202
5446................  CT, L-Spine Wo/W Contrast...........               148               296               314
5447................  CT, L-Spine Wo/W Cntrst (E).........               119               237               252
5463................  CT, Spinal Stenosis.................               123               246               261
5464................  CT, Spinal Stenosis (Exam)..........                95               190               202
5500................  CT, Routine ABD Wo/Contrast.........               103               206               218
5501................  CT, Routine ABD Wo/Cntrst (E).......                76               152               161
5503................  CT, Routine ABD W/Contrast..........               121               242               256
5504................  CT, Routine ABD W/Cntrst (E)........                92               183               194
5506................  CT, Routine ABD Wo/W Contrast.......               147               293               312
5507................  CT, Routine ABD Wo/W Cntrst (E).....               114               227               241
5508................  CT, Routine ABD Wo/W Cntrst (R).....                33                66                70
5523................  CT, Invasive Procedure..............               187               373               397
5524................  CT, Invasive Procedure (Exam).......               111               221               235
5525................  CT, Invasive Procedure (Read).......                77               153               162
5540................  CT, Liver W/O Contrast..............               103               206               219
5541................  CT, Liver W/O Contrast (Exam).......                76               152               161
5543................  CT, Liver W Contrast................               121               242               257
5544................  CT, Liver W Contrast (Exam).........                92               183               194
5546................  CT, Liver Wo/W Contrast.............               147               293               312
5547................  CT, Liver Wo/W Contrast (Exam)......               114               227               241
5548................  CT, Liver Wo/W Contrast (Read)......                33                66                70
5560................  CT, Pancreas Wo/Contrast............               103               206               219
5561................  CT, Pancreas Wo/Contrast (Exam).....                76               152               161
5563................  CT, Pancreas Wo/Contrast............               121               242               257
5564................  CT, Pancreas Wo/Contrast (Exam).....                92               183               193
5566................  CT, Pancreas Wo/Contrast............               147               293               311
5567................  CT, Pancreas Wo/Contrast (Ex).......               114               227               240
5568................  CT, Pancreas Wo/Contrast (RE).......                33                66                70
5580................  CT, Kidney Wo/Contrast..............               103               206               220
5581................  CT, Kidney Wo/Contrast (Exam).......                76               152               161
5583................  CT, Kidney W/Contrast...............               121               242               257
5584................  CT, Kidney W/Contrast (Exam)........                92               183               195
5586................  CT, Kidney Wo/W Contrast............               147               293               311
5587................  CT, Kidney Wo/W Contrast (Exam).....               114               227               241
5588................  CT, Kidney Wo/W Contrast (Read).....                33                66                70
5600................  CT, Pelvis Wo/Contrast..............               103               206               219
5601................  CT, Pelvis Wo/Contrast (Exam).......                76               152               161
5603................  CT, Pelvis W/Contrast...............               121               242               257
5604................  CT, Pelvis W/Contrast (Exam)........                92               183               195
5606................  CT, Pelvis Wo/W Contrast............               147               293               311
5607................  CT, Pelvis Wo/W Contrast (Exam).....               114               227               241
5608................  CT, Pelvis Wo/W Contrast (Read).....                33                66                70
5700................  CT, Extremity Wo/Contrast...........                92               183               194
5701................  CT, Extremity Wo/Contrast (Exam)....                66               132               140
5703................  CT, Extremity W/Contrast............               106               212               224
5704................  CT, Extremity W/Contrast (Exam).....                79               158               168
5706................  CT, Extremity Wo/W Contrast.........               128               255               270
5707................  CT, Extremity Wo/W Contrast (E).....               100               199               211
5720................  CT, Ortho Bone Study................                45                90                97
5721................  CT, Ortho Bone Study (Exam).........                40                79                84
5800................  CT, Reconstruction..................               142               283               300
5820................  CT, Review..........................                71               142               152
5840................  CT, Therapy Planning................               142               283               300
5996................  CT, Other...........................               154               308               327
5997................  CT, Other (Exam)....................                83               166               176
5998................  CT, Other (Read)....................                71               142               151
6009................  Thyroid Scn/Upt, Single Det.........                40                80                85
6012................  Thy Scn/Upt, Mult Det...............                43                86                91
6018................  Thyroid Image W/Flow................                40                80                86
6021................  Thy Metascan: Ltd Area..............                47                93                99
6024................  Parathyroid.........................                43                86                91
6027................  Thy Metascan: Mult Areas............                65               130               138
6028................  Thy Metascan: Mult Areas (E)........                45                90                96
6030................  Thy Metascan: Whole Body............                88               175               186
6031................  Thy Metascan: Whole Body (E)........                65               130               137
6033................  Adrenal Image: Cortical.............                83               166               176
6034................  Adrenal Image: Cortical (E).........                65               130               137
6036................  Bone Marrow Image: Ltd Area.........                38                75                80
6039................  Bone Marrow Image: Multi Area.......                56               112               120
6040................  Bone Marrow Image: Multi Area (E)...                38                76                81
6042................  Bone Marrow Image: Whole Body.......                68               135               143
6043................  Bone Marrow Image: Whole Body (E)...                49                98               105
6048................  Plasma Volume Mult Sample...........                36                72                76
6054................  Red Cell Vol Mult Sample............                43                85                90
6055................  Red Cell Vol Mult Sample (E)........                35                70                74
6057................  WB Vol: W/Plasma & RBC Vol..........                66               132               140
6058................  WB Vol: W/Plasma & RBC Vol (E)......                56               112               119
6060................  Red Cell Survival Study.............                49                98               104
6061................  Red Cell Survival Study (E).........                35                69                74
6063................  RBC Surv: W/Spleen & Hep Sequest....                74               147               156
6064................  RBC Surv: W/Spleen & Hep Seq (E)....                59               118               125
6066................  RBC Spleen & Hepatic Sequest........                62               123               131
6067................  RBC Spleen & Pepatic Seq (E)........                48                95               101
6069................  Plasma Iron Disappearance...........                52               103               109
6070................  Plasma Iron Disapp (E)..............                44                88                92
6072................  Iron Oral Absorption................                49                98               104
6073................  Iron Oral Absorption (E)............                39                78                82
6075................  Iron Red Cell Utilization...........                74               147               156
6076................  Iron Red Cell Util (E)..............                64               128               137
6078................  Spleen Imaging Only.................                38                75                80
6081................  Spleen Imaging Only: W/Flow.........                46                92                98
6082................  Spleen Imaging Only: W/Flow (E).....                35                70                75
6084................  Platelet Survival...................               103               206               219
6085................  Platelet Survival (E)...............                89               177               188
6087................  WBC Localization: LTD...............                60               119               126
6088................  WBC Localization: LTD (E)...........                41                82                87
6090................  WBC Localization: Whole Body........               138               276               293
6091................  WBC Localization: Whole Body (E)....               118               235               249
6093................  Rad Nuclide Lymphangiogram..........                65               130               139
6094................  Rad Nuclide Lymphangiogram (E)......                49                98               104
6096................  Liver Imaging: Static...............                39                78                83
6099................  Liver Imaging: W/Flow...............                47                94               100
6100................  Liver Imaging: W/Flow (E)...........                35                70                74
6102................  Liver Imaging: Spect................                88               176               186
6103................  Liver Imaging: Spect (E)............                71               142               151
6105................  Liver/Spleen Imaging: Static........                47                94               100
6106................  Liver/Spleen Imag: Static (E).......                35                70                75
6108................  Liver/Spleen Imaging: Flow..........                55               110               117
6109................  Liver/Spleen Imaging: Flow (E)......                42                84                89
6111................  Liver FXN: W/Hepbil Agent/Dyn.......                57               113               120
6112................  Liver FXN: W/Hepbil Agnt/Dyn (E)....                45                90                95
6114................  Hepatobiliary: Duct & GB............                64               128               135
6115................  Hepatobiliary: Duct & GB (E)........                44                88                94
6117................  Liver-Lung Imaging..................                60               120               128
6118................  Liver-Lung Imaging (E)..............                48                96               102
6120................  Salivary Gland: Static Only.........                37                74                79
6123................  Salivary Gland: Dynamic.............                50               100               107
6124................  Salivary Gland: Dynamic (E).........                38                76                81
6126................  Salivary Gland: Function............                54               108               114
6127................  Salivary Gland: Function (E)........                43                85                90
6129................  Esophageal Motility.................                52               104               110
6130................  Esophageal Motility (E).............                35                70                74
6132................  Gastric Mucosa Imaging..............                65               130               139
6133................  Gastric Mucosa Imaging (E)..........                49                98               104
6135................  Gastroesophageal Study..............                67               134               142
6136................  Gastroesophageal Study (E)..........                51               102               109
6138................  Gastric Emptying Study..............                68               136               144
6139................  Gastric Emptying Study (E)..........                50                99               105
6147................  Schillings Stage 1 & 2 (Dicopac)....                34                68                72
6150................  GI ASP Blood Loss Loc...............                55               110               117
6151................  GI ASP Blood Loss Loc (E)...........                39                78                82
6153................  Acute GI Blood Loss Imaging.........                82               163               173
6154................  Acute GI Blood Loss Imaging (E).....                59               118               125
6156................  GI Blood Loss: Stool Count..........                48                96               102
6157................  GI Blood Loss: Stool Count (E)......                39                78                83
6159................  Bowel Imag (ECT Meckels)............                53               106               112
6160................  Bowel Imag (ECT Meckels) (E)........                37                74                78
6162................  Perit-Venous Shunt (Leveen).........                58               115               122
6163................  Perit-Venous Shunt (Leveen) (E).....                33                66                71
6165................  Bone Imaging: LTD Area..............                45                89                95
6168................  Bone Imaging: Multi Area............                63               126               134
6169................  Bone Imaging: Multi Area (E)........                44                88                94
6171................  Bone Imaging: Whole Body............                70               140               149
6172................  Bone Imaging: Whole Body (E)........                52               103               110
6177................  Bone, 3 Phase.......................                78               156               166
6178................  Bone, 3 Phase (E)...................                58               115               122
6180................  Bone Spect..........................                95               190               202
6181................  Bone Spect (E)......................                71               142               151
6189................  Joint Imaging, Ltd Area.............                46                92                98
6190................  Joint Imaging, Ltd Area (E).........                34                68                72
6192................  Joint Imaging, Multi Area...........                61               122               129
6193................  Joint Imaging, Multi Area (E).......                43                86                92
6195................  Card Blood Pool, FXN Imag...........                43                86                92
6196................  Card Blood Pool, FXN Imag (E).......                33                65                69
6201................  Cardiac Shunt Detection.............                45                90                96
6204................  Cardiac Flow (Angiocard)............                55               110               117
6205................  Cardiac Flow (Angiocard) (E)........                44                88                93
6207................  Vascular Flow (Venography)..........                34                68                72
6210................  VEN Thrombosis (Fibrinogen).........                65               130               138
6211................  VEN Thrombosis (Fibrinogen) (E).....                48                96               102
6213................  Rad Nuc Venogram: Unilat............                50               100               106
6214................  Rad Nuc Venogram: Unilat (E)........                32                64                68
6216................  Rad Nuc Venogram: Bilat.............                69               138               147
6217................  Rad Nuc Venogram: Bilat (E).........                48                96               102
6219................  Myocard Perf/Qual Rest..............                49                98               103
6222................  Myoc Perf/Qual, RE&EX/Pharm.........                86               172               182
6223................  Myoc Perf/Qual, RE&EX/Pharm (E).....                57               114               121
6225................  Myocard Perf/Quant Rest.............                62               123               131
6226................  Myocard Perf/Quant Rest (E).........                40                80                86
6228................  Yoc Perf/Quant RE&EX/Pharm..........               101               202               215
6229................  Myoc Perf/Quant RE&EX/Pharm (E).....                71               142               151
6231................  Myocard Perf/Spect Rest.............               111               221               235
6232................  Myocard Perf/Spect Rest (E).........                85               170               181
6234................  Myoc Perf/Spect RE&EX/Pharm.........               176               352               374
6235................  Myoc Perf/Spect RE&EX/Pharm (E).....               143               285               302
6236................  Myoc Perf/Spect RE&EX/Pharm (R).....                34                68                72
6237................  Myocard Imfarct IMG: Qual...........                48                96               102
6238................  Myocard Imfarct IMG: Qual (E).......                32                64                67
6240................  Myocard Imfarct IMG: Quant..........                55               110               117
6241................  Myocard Imfarct IMG: Quant (E)......                38                76                80
6243................  Myoc Infarct IMG: W/1St Pass........                63               126               133
6244................  Myoc Infarct IMG: W/1St Pass (E)....                44                88                94
6246................  Myoc Infarct Img: Spect.............                85               169               179
6247................  Myco Infarct Img: Spect (E).........                63               126               134
6249................  Cardiac Output......................                55               110               117
6250................  Cardiac Output (E)..................                45                89                95
6252................  Gated Rest: Wall MTN&EF.............                85               170               180
6253................  Gated Rest: Wall MTN&EF (E).........                63               126               134
6255................  Gated Rest: Wall MTN® EF.........                89               178               189
6256................  Gated Rest: Wall MTN® EF (E).....                66               132               140
6258................  Gtd Rest: Wall MTN, REG EF, VV......                97               193               205
6259................  Gtd Rest: Wall MTN, REG EF, VV (E)..                73               146               155
6261................  Gated Ex/Phrm: Quan, Wall MTN.......               142               283               300
6262................  Gated Ex/Phrm: Quan, Wall MTN (E)...               114               227               241
6264................  Gtd Rst, Ex/Phrm: Wall MTN, EF......               147               294               312
6265................  Gtd Rst, Ex/Phrm: Wall MTN EF (E)...               120               239               254
6267................  Gtd Rst, Ex/Phrm: Wm, EF, VV........               160               319               338
6268................  Gtd Rst, Ex/Phrm: Wm, EF, VV (E)....               131               261               277
6273................  1st Pass, Wall MTN&EF...............                86               172               183
6274................  1st Pass, Wall MTN&EF (E)...........                63               126               134
6276................  1st Pass, Wall MTN, EF, VVD.........                97               193               205
6277................  1st Pass, Wall MTN, EF, VVD (E).....                73               146               155
6279................  1st Pass, Ex/Pharm, Wl MTN..........               142               283               300
6280................  1st Pass, Ex/Pharm, Wl MTN (E)......               114               227               241
6282................  1st Pass, Ex/Ph, Wl MTN, VV.........               147               294               312
6283................  1st Pass, Ex/Ph, Wl MTN, VV (E).....               120               239               254
6285................  1st Pass, Ex/Ph, Wl MTN, EF, VV.....               160               319               338
6286................  1st Pass, Ex/Ph, Wl MTN, EF, VV (E).               131               261               277
6288................  1st Pass, Rest, Ser, Any Comb.......                63               125               132
6289................  1st Pass, Rest Ser, Any Comb (E)....                42                84                88
6291................  Lung Perf, Particulate..............                59               118               125
6292................  Lung Perf, Particulate (E)..........                41                82                87
6294................  Lung Perf, Gaseous..................                45                90                95
6297................  Lung Perf: Gas W/VNT, EQ, W/O.......                67               133               141
6298................  Lung Perf: Gas W/VNT, EQ, W/O (E)...                45                90                96
6300................  Lung Perf: Part, VNT, 1br...........                62               123               131
6301................  Lung Perf: Part, VNT, 1br (E).......                39                78                82
6303................  V/Q Part, Full Study................                93               186               198
6304................  V/Q Part, Full Study (E)............                68               136               144
6306................  Pulm Aerosol, 1view.................                40                80                86
6309................  Pulm Aerosol, Mult View.............                45                90                96
6310................  Pulm Aerosol, Mult View (E).........                34                68                72
6312................  Pulm Vent, 1br, 1view...............                44                88                93
6313................  Pulm Vent, 1br, 1view (E)...........                35                69                73
6315................  Pulm Vent, W/1br, EQ, W/O, 1view....                53               106               113
6316................  Pulm Vent, W/1br, EQ, W/O, 1v (E)...                42                84                88
6318................  Pul Ven, W/1br, EQ, W/O, Mult V.....                71               142               150
6319................  Pul Ven, W/1br, Eq, W/O, Mult V (E).                60               120               127
6321................  Brain, Ltd, Static Only.............                45                90                95
6322................  Brain, Ltd, Static Only (E).........                35                70                74
6324................  Brain, Flow & Scan, Ltd.............                53               106               113
6325................  Brain Flow & Scan, Ltd (E)..........                41                82                87
6327................  Brain Complete, Static Only.........                54               108               114
6328................  Brain Complete, Static Only (E).....                41                82                87
6330................  Brain Flow & Scan, Complete.........                62               123               131
6331................  Brain Flow & Scan, Complete (E).....                47                93                99
6333................  Brain Spect Complete................               108               216               229
6334................  Brain Spect Complete (E)............                79               158               168
6339................  Cerebral Blood Flow.................                56               112               119
6340................  Cerebral Blood Flow (E).............                47                93                99
6342................  CSF Flow, W/O Intro, Cisterno.......                77               153               163
6343................  CST Flow, W/O Intro, Cisterno (E)...                61               122               129
6345................  CSF Flow Ventriculography...........                45                90                95
6348................  CSF Flow Shunt Eval.................                55               110               117
6349................  CSF Flow Shunt Eval (E).............                41                82                87
6351................  CSF leak Detection & Localize.......                70               140               149
6352................  CSF Leak Detection & Localize (E)...                56               112               118
6354................  CSF Flow Spect......................                92               184               195
6355................  CSF Flow Spect (E)..................                71               142               151
6357................  Radionucl ID of Eye Tumor...........                73               146               155
6358................  Radionucl ID of Eye Tumor (E).......                60               120               127
6360................  Dacrocystography....................                38                76                81
6363................  Renal Static Only...................                47                94               100
6364................  Renal Static Only (E)...............                37                74                78
6366................  Renal W/Flow........................                55               109               116
6367................  Renal W/Flow (E)....................                43                86                91
6369................  Renal W/Funct (EG IM Reno)..........                65               130               138
6370................  Renal W/Funct (EG IM Reno) (E)......                48                96               102
6372................  Renal W/Flow & Funct................                76               152               161
6373................  Renal W/Flow & Funct (E)............                54               108               115
6375................  Renal Spect.........................                87               173               184
6376................  Renal Spect (E).....................                71               142               151
6384................  Renal Funct W/Pharm Interv..........                56               112               119
6385................  Renal Funct W/Pharm Interv (E)......                36                72                76
6387................  Renal Transplant Eval...............                71               142               151
6388................  Renal Transplant Eval (E)...........                48                96               102
6396................  Testicular Imaging..................                48                95               101
6397................  Testicular Imaging (E)..............                32                64                68
6400................  Testicular Imaging W/Flow (E).......                39                78                82
6402................  Tumor Localization, Ltd.............                56               112               119
6403................  Tumor Localization, Ltd (E).........                41                82                87
6405................  Tumor Locatization Mult Area........                69               138               147
6406................  Tumor Locatization Mult Area (E)....                51               102               108
6408................  Tumor Local Whole Body..............                87               174               185
6409................  Tumor Local Whole Body (E)..........                68               136               145
6411................  Tumor Localization Spect............                84               167               178
6412................  Tumor Localization Spect (E)........                83               165               175
6414................  Gallium Study, Ltd..................                57               114               121
6415................  Gallium Study, Ltd (Exam)...........                41                82                87
6417................  Gallium Study Whole Body............                87               173               184
6418................  Gallium Study Whole Body (E)........                67               133               141
6423................  Auto Data Interdisc>30Min...........                34                68                72
6424................  Auto Data Interdisc>30Min (E).......                32                64                67
6226................  TX Hyperthy, Init W/Eval............                73               146               155
6427................  TX Hyperthy, Init W/Eval (E)........                32                64                67
6428................  TX Hyperthy, Init W/Eval (R)........                42                84                88
6429................  TX Hyperthy, Subseq, Ea Visit.......                40                80                85
6432................  Thy Suppress, Euthy (Card D)........                74               147               156
6433................  Thy Suppress, Euthy (Card D) (E)....                32                64                67
6434................  Thy Suppress, Euthy (Card D) (R)....                42                84                89
6435................  Thyroid CA Ablation.................                80               160               170
6436................  Thyroid CA Ablation (Exam)..........                32                64                67
6437................  Thyroid CA Ablation (Read)..........                48                96               102
6438................  RN Metastases of Thy CA.............                90               180               191
6439................  RN Metastases of Thy CA (E).........                32                64                67
6440................  RN Metastases of Thy CA (R).........                59               118               125
6441................  TX For Polycy Vera, Q/TX............                63               125               132
6442................  TX For Polycy Vera, Q/TX (E)........                32                64                67
6444................  TX Intracavitary Colloid............                78               156               165
6445................  TX Intracavitary Colloid (E)........                32                64                67
6446................  TX Intracavitary Colloid (R)........                46                92                98
6447................  Non Thy, Non Hemat (Bone Met).......                78               155               164
6448................  Non Thy, Non Hemat (Bone Met) (E)...                32                64                67
6449................  Non Thy, Non Hemat (Bone Met) (R)...                46                92                97
7000................  Th Rad TX Planning; Simple..........                33                65                69
7003................  Th Rad TX Planning; Intermed........                49                98               104
7006................  Th Rad TX Planning; Complex.........                73               146               155
7020................  Th Rad Simul-Aid Fld Set Smpl.......                53               106               112
7021................  Th Rad Simul-Aid Fld Set Smple......                37                74                78
7023................  Th Rad Simul-Aid Fld Set Med........                83               166               177
7024................  Th Rad Simul-Aid Fld Set Med (E)....                59               118               125
7026................  Th Rad Simul-Aid Fld Set Complx.....               105               210               223
7027................  Th Rad Simul-Aid Fld Set Cplxe......                69               138               146
7028................  Th Rad Simul-Aid Fld Set Cplxr......                36                72                76
7043................  Teletx, Isodose Plan; Simple........                36                72                76
7046................  Teletx, Isodose Plan; Intermed......                49                98               103
7060................  Teletx, Isodose Plan; Complx........                65               129               137
7062................  Teletx, Isodose Plan; Complx (Rea)..                37                74                78
7063................  Spec Teletx Port PL, Hemi/Tot.......                65               129               137
7064................  Spec Teletx Port PL, Hemi/Tot (E)...                43                85                90
7080................  Brachyth Isodose Calcul, Smple......                47                93                99
7083................  Brachyth Isodose Calcul, Interm.....                69               138               147
7084................  Brachyth Isodose Calcul, Intere.....                37                74                78
7085................  Brachyth Isodose Calcul, Interr.....                33                65                69
7086................  Brachyth Isodose Calcul, Comple.....               101               202               215
7087................  Brachyth Isodose Calcul, Cmplxe.....                53               105               111
7088................  Brachyth Isodose Calcul, Complxr....                49                98               103
7103................  TX Devices, Design & Constr, Inter..                40                79                84
7106................  TX Devices, Design & Constr, Coml...                63               126               134
7107................  TX Devices, Design & Constr, Cmpex..                34                68                72
7120................  Cont Rad Phys Cons Sup W/OA.........                32                64                67
7123................  Special Med Rad Physic Consul.......                37                74                79
7130................  Weekly Megavolt TX Manage Simp......               131               261               277
7131................  Wkly Megavolt TX Manage Smpl (E)....                93               186               198
7132................  Wkly Megavolt TX Manage Smpl (R)....                38                75                79
7133................  Weekly Megavolt TX Manage Inte......               168               335               355
7134................  Wkly Megavolt TX Manage Inte (E)....               111               221               234
7135................  Wkly Megavolt TX Manage Inte (R)....                57               114               121
7136................  Wkeely Megavolt TX Manage Comp......               207               413               438
7137................  Wkly Megavolt TX Manage Cplx (E)....               123               245               260
7138................  Wkly Megavolt TX Manage Cplx (R)....                84               168               178
7146................  Spec TC Proc (Tot/Hemibod/P-OS).....               166               332               352
7147................  Spec TC Proc (Tot/Hemibod/P-OS) (E).                49                98               103
7148................  Spec TC Proc (Tot/Hemibod/P-OS) (R).               249               235               118
7160................  Hyperthermia, Ext Gen, Superf.......               155               146                73
7161................  Hyperthermia, Ext Gen, Superf (E)...                78                74                37
7162................  Hyperthermia, Ext Gen, Superf (R)...                77                74                37
7163................  Hyperthermia, Ext Gen, Deep.........               207               195                98
7164................  Hyperthermia, Ext Gen, Deep (Ex)....               105                98                49
7165................  Hyperthermia, Ext Gen, Deep (Re)....               103                98                49
7166................  Hyperthermia, Interstit Probe.......               156               146                73
7167................  Hyperthermia, Interstit Probe (Ex)..                79                74                37
7168................  Hyperthermia, Interstit Probe (Re)..                79                74                37
7170................  Hyperthermia, Interstit Pro>5.......               207               195                98
7171................  Hyperthermia, Interstit Pro>5E......               207               195                98
7172................  Hyperthermia, Interstit Pro>5R......               104                98                49
7173................  Hypertherm Gen By Intracav Pro......               156               146                73
7174................  Hypertherm Gen By Intracav Pre......                78                74                37
7175................  Hypertherm Gen By Intracav Prr......                77                74                37
7176................  Infusion/Instill Radioelem Sol......               261               245               123
7178................  Infusion/Instill Radioele Solr......               226               214               107
7200................  Intracav Radioele Appl Simple.......               232               219               110
7202................  Intracav Radioele Appl Simp (R).....               175               166                83
7203................  Intracav Radioelem Appl Interm......               163               326               346
7204................  Intracav Radioele Appl Inte (Ex)....                38                76                81
7205................  Intracav Radioele Appl Inte (Re)....               125               250               265
7206................  Intracav Radioelem Applic Comp......               235               469               497
7207................  Intracav Radioele Appl Cmpl (Ex)....                48                95               101
7208................  Intracav Radioele Appl Cmpl (Re)....               187               373               397
7220................  Interstit Radioelem Appl Simpl......               135               270               286
7222................  Interstit Radioel Appl Smple (R)....               109               217               231
7223................  Interstit Radioelem Applic Int......               214               427               454
7224................  Interstit Radioele Appl; Inte (E)...                51               102               109
7225................  Interstit Radioele Appl; Inte (R)...               163               325               345
7226................  Interstit Radioelem Appl Compl......               306               611               649
7227................  Interstit Radioele Appl Cmp (Ex)....                62               123               131
7228................  Interstit Radioele Appl Cmp (Re)....               244               487               518
8000................  MrI, Brain (W/O Contrast)...........               125               250               265
8001................  MRI, Brain (W/O Contrast) (Exam)....                95               190               201
8003................  MRI, Brain (W/Contrast).............               221               441               469
8004................  MRI, Brain (W/Contrast) (Exam)......               181               361               382
8005................  MRI, Brain (W/Contrast) (Read)......                41                82                87
8006................  MRI, Brain (W W/O Contrast).........               356               710               753
8007................  MRI, Brain (W W/O Contrast) (Ex)....               301               600               637
8008................  MRI, Brain (W W/O Contrast) (Re)....                55               110               117
8010................  MRI, Angiogram......................               356               710               753
8011................  MRI, Angiogram (Exam)...............               301               600               637
8012................  MRI, Angiogram (Read)...............                55               110               117
8020................  MRI, Orbit Wo/Contrast..............                93               186               198
8021................  MRI, Orbit Wo/Contrast (Exam).......                63               126               134
8023................  MRI, Orbit W/Contrast...............                93               186               198
8024................  MRI, Orbit W/Contrast (Exam)........                63               126               134
8026................  MRI, Orbit Wo/W Contrast............               129               257               273
8027................  MRI, Orbit Wo/W Contrast (Exam).....                95               190               201
8028................  MRI, Orbit Wo/W Contrast (Read).....                34                68                72
8040................  MRI, Sinus Wo/Contrast..............                90               179               190
8041................  MRI, Sinus Wo/Contrast (Exam).......                63               126               134
8043................  MRI, Sinus W/Contrast...............               106               212               225
8044................  MRI, Sinus W/Contrast (Exam)........                76               152               161
8046................  MRI, Sinus W/Wo Contrast............               128               256               272
8047................  MRI, Sinus W/Wo Contr (Exam)........                95               190               201
8048................  MRI, Sinus W/Wo Contr (Read)........                33                66                71
8060................  MRI, Neck (W/O Contrast)............                83               166               177
8061................  MRI, Neck (W/O Contrast) (Exam).....                63               126               134
8063................  MRI, Neck (W/Contrast)..............               102               204               216
8064................  MRI, Neck (W/Contrast) (Exam).......                76               152               161
8066................  MRI, Neck (W W/O Contrast)..........               166               332               352
8067................  MRI, Neck (W W/O Contrst) (Exam)....                95               190               201
8080................  MRI, Chest Wo/Contrast..............                93               186               198
8081................  MRI, Chest Wo/Contrast (Exam).......                63               126               134
8083................  MRI, Chest W/Contrast...............                93               186               198
8084................  MRI, Chest W/Contrast (Exam)........                63               126               134
8086................  MRI, Chest Wo/W Contrast............               129               257               273
8087................  MRI, Chest Wo/W Contrast (Exam).....                95               190               201
8088................  MRI, Chest Wo/W Contrast (Read).....                34                68                72
8100................  MRI, C-Spine Wo/Contrast............               106               212               225
8101................  MRI, C-Spine Wo/Contrast (Exam).....                79               158               168
8103................  MRI, C-Spine W/Contrast.............               225               449               477
8104................  MRI, C-Spine W/Contrast (Exam)......               180               359               382
8105................  MRI, C-Spine W/Contrast (Read)......                45                90                95
8106................  MRI, C-Spine Wo/W Contrast..........               361               720               764
8107................  MRI, C-Spine Wo/W Contrast (Exam)...               301               600               637
8108................  MRI, C-Spine Wo/W Contrast (Read)...                60               120               127
8120................  MRI, T-Spine Wo/Contrast............               106               212               225
8121................  MRI, T-Spine Wo/Contrast (Exam).....                79               158               168
8123................  MRI, T-Spine W/Contrast.............               225               449               477
8124................  MRI, T-Spine W/Contrast (Exam)......               180               359               382
8125................  MRI, T-Spine W/Contrast (Read)......                45                90                95
8126................  MRI, T-Spine Wo/W Contrast..........               361               720               764
8127................  MRI, T-Spine Wo/W Contrast (Exam)...               301               600               637
8128................  MRI, T-Spine Wo/W Contrast (Read)...                60               120               127
8140................  MRI, L-Spine Wo/Contrast............               106               212               225
8141................  MRI, L-Spine Wo/Contrast (Exam).....                79               158               168
8143................  MRI, L-Spine W/Contrast.............               222               443               470
8144................  MRI, L-Spine W/Contrast (Exam)......               181               361               382
8145................  MRI, L-Spine W/Contrast (Read)......                41                82                87
8146................  MRI, L-Spine Wo/Contrast............               148               296               314
8147................  MRI, L-Spine Wo/Contrast (Exam).....               356               710               753
8148................  MRI, L-Spine Wo/W Contrast (Read)...               301               600               637
8160................  MRI, Pelvis Wo/Contrast.............               103               206               219
8161................  MRI, Pelvis Wo/Contrast (Exam)......                76               152               161
8163................  MRI, Pelvis W/Contrast..............               121               242               257
8164................  MRI, Pelvis W/Contrast (Exam).......                92               183               194
8166................  MRI, Pelvis Wo/Contrast.............               147               293               311
8167................  MRI, Pelvis Wo/Contrast (Exam)......               114               227               241
8168................  MRI, Pelvis Wo/Contrast (Read)......                33                66                70
8180................  MRI, Upper Ext Wo/Contrast..........               173               345               366
8181................  MRI, Upper Ext Wo/Contrast (Exam)...               150               299               318
8183................  MRI, Upper Ext W/Contrast...........               106               212               225
8184................  MRI, Upper Ext W/Contrast (Exam)....                79               158               168
8186................  MRI, Upper Ext Wo/W Contrast........               128               255               271
8187................  MRI, Upper Ext Wo/W Contrast (E)....               100               199               211
8200................  MRI, Lower Ext Wo/Contrast..........               173               345               366
8201................  MRI, Lower Ext Wo/Contrast (Exam)...               150               299               318
8203................  MRI, Lower Ext W/Contrast...........               106               212               225
8204................  MRI, Lower Ext W/Contrast (Exam)....                79               158               168
8206................  MRI, Lower Ext Wo/W Contrast........               128               255               271
8207................  MRI, Lower Ext Wo/W Contrast (E)....               100               199               211
8220................  MRI, Abdomen Wo/Contrast............               106               212               225
8221................  MRI, Abdomen Wo/Contrast (Exam).....                79               158               168
8223................  MRI, Abdomen W/Contrast.............               123               246               261
8224................  MRI, Abdomen W/Contrast (Exam)......                95               190               201
8226................  MRI, Abdomen Wo/W Contrast..........               148               296               314
8227................  MRI, Abdomen Wo/W Contrast (Exam)...               119               237               252
8240................  MRI, Heart Wo/Contrast..............               106               212               225
8241................  MRI, Heart Wo/Contrast (Exam).......                79               158               168
8243................  MRI, Heart W/Contrast...............               123               246               261
8244................  MRI, Heart W/Contrast (Exam)........                95               190               201
8246................  MRI, Heart Wo/W Contrast............               148               296               314
8247................  MRI, Heart Wo/W Contrast (Exam).....               119               237               252
8260................  MRI, TMJ Wo/Contrast................               172               343               365
8261................  MRI, TMJ Wo/Contrast (Exam).........               150               299               318
8263................  MRI, TMJ W/Contrast.................               106               212               225
8264................  MRI, TMJ W/Contrast (Exam)..........                79               158               168
8996................  MRI, Other..........................               125               250               265
8997................  MRI, Other (Exam)...................                95               190               201
8266................  MRI, TMJ Wo/W Contrast..............               128               255               271
8267................  MRI, TMJ Wo/W Contrast (Exam).......               100               199               211
----------------------------------------------------------------------------------------------------------------
Explanations at end of docket.                                                                                  

F. Elective Cosmetic Surgery Procedures and Rates

----------------------------------------------------------------------------------------------------------------
                                      International     Common                                                  
                                     classification   procedure                                        Amount of
    Cosmetic surgery procedure       diseases (ICD-  terminology           FY 95 charge\7\              charge  
                                           9)         (CPT)\6\                                                  
----------------------------------------------------------------------------------------------------------------
Mammaplasty........................           85.50       19325   Surgical care services or same day  (a)       
                                              85.32       19324    surgery.                           (b)       
                                              85.31       19318                                                 
Mastopexy..........................           85.60       19316   Surgical care services or same day  (a)       
                                                                   surgery.                           (b)       
Facial Rhytidectomy................           86.82       15824   Surgical care services or same day  (a)       
                                              86.22                surgery.                           (b)       
Blepharoplasty.....................           08.70       15820   Surgical care services or same day  (a)       
                                              08.44       15821    surgery.                           (b)       
                                                          15822                                                 
                                                          15823                                                 
Mentoplasty (Augmentation                     76.68       21208   Surgical care services or same day  (a)       
 Reduction).                                  76.67       21209    surgery.                           (b)       
Abdominoplasty.....................           86.83       15831   Surgical care services or same day  (a)       
                                                                   surgery.                           (b)       
Lipectomy, suction per region\8\...           86.83       15876   Surgical care services or same day  (a)       
                                                          15877    surgery.                           (b)       
                                                          15878                                                 
                                                          15879                                                 
Rhinoplasty........................           21.87       30400   Surgical care services or same day  (a)       
                                              21.86       30410    surgery.                           (b)       
Scar revisions beyond CHAMPUS......           86.84      1578__   Surgical care services or same day  (a)       
                                                                   surgery.                           (b)       
Mandibular or maxillary                       76.41       21194   Surgical care services or same day  (a)       
 repositioning.                                                    surgery.                           (b)       
Minor skin lesions\9\..............           86.30      1578__   Surgical care services or same day  (a)       
                                                                   surgery.                           (b)       
Dermabrasion.......................           86.25       15780   Surgical care services or same day  (a)       
                                                                   surgery.                           (b)       
Hair Restoration...................           86.64       15775   Surgical care services or same day  (a)       
                                                                   surgery.                           (b)       
Removing Tatoos....................           86.25       15780   Surgical care services or same day  (a)       
                                                                   surgery.                           (b)       
Chemical Peel......................           86.24       15790   Surgical care services or same day  (a)       
                                                                   surgery.                           (b)       
Arm/Thigh Dermolipectomy...........           86.83      1583__   Surgical care services or same day  (a)       
                                                                   surgery.                           (b)       
Brow Lift..........................            86.3       15839   Surgical care services or same day  (a)       
                                                                   surgery.                           (b)       
----------------------------------------------------------------------------------------------------------------

Notes on Cosmetic Surgery Charges

    aCharges for surgical care are contained in Section I.B. (See 
notes 7 through 9 on reimbursable rates for further details.)
    bCharges for same day surgery are contained in Section II.L. 
(See notes 7 through 9 on reimbursable rates for further details.)

Notes on Reimbursable Rates

    \1\Percentages are applied to both inpatient and outpatient 
services provided when billing third party payers (e.g., insurance 
companies). Pursuant to the provisions of 10 U.S.C. 1095, the inpatient 
Diagnosis Related Groups are 95 percent hospital and 5 percent 
professional fee. The outpatient per visit percentages are 57 percent 
hospital, 33 percent ancillary and 10 percent professional.
    \2\DoD civilian employees located in overseas areas shall be 
rendered a bill when services are performed. Payment is due 60 days 
from the date of the bill.
    \3\The cost of DRG (Diagnosis Related Groups) is based on the 
inpatient full reimbursement rate per hospital discharge, weighted to 
reflect the intensity of the principal diagnosis involved. The adjusted 
standardized amounts (ASA) per Relative Weighted Product (RWP) for use 
in the Direct Care System will be comparable to procedures utilized by 
Health Care Financing Administration (HFCA) and the Civilian Health and 
Medical Program for the Uniformed Services (CHAMPUS). These expenses 
include all direct care expenses associated with direct patient care. 
The average cost per relative weight product for large urban, other 
urban, rural and overseas will be published annually as an inpatient 
standardized amount and will include the cost of inpatient professional 
services. The DRG rates will apply to reimbursement from all sources, 
not just third party payers.
    \4\A third party payer may be billed if the total prescription 
costs exceed $60. The prescription cost is calculated by multiplying 
the number of units (tablets, capsules, etc.) times the unit cost and 
adding a $3.95 dispensing fee per prescription.
    \5\Charges for high cost medications/services requested by external 
providers (Physicians, Dentists, etc.) are only relevant to the Third 
Party Collection Program. Third party payers (such as insurance 
companies) shall be billed for high cost services in those instances in 
which dependents who have medical insurance, seen by providers external 
to a Military Medical Treatment Facility (MTF), obtain the prescribed 
service or medication from an MTF. Eligible beneficiaries (family 
members or retirees with medical insurance) are not personally liable 
for this cost and shall not be billed by the MTF. The standard cost of 
high cost medications includes the cost of the drugs plus a dispensing 
fee, per prescription.
    \6\The attending physician is to complete the common procedure 
terminology code to indicate the appropriate procedure followed during 
cosmetic surgery. The appropriate rate will be applied depending on the 
admission type of the patient, e.g., outpatient surgical, same day/
ambulatory surgery, or surgical care services.
    \7\Family members of active duty personnel, retirees and their 
family members, and survivors will be charged cosmetic surgery rates. 
The patient shall be charged the rate as specified in the FY 1995 
reimbursable rates for an episode of care. The charges for elective 
cosmetic surgery are at the full reimbursement rate (designated as the 
Other rate) in Section I.B., general surgery (designated as the Other 
rate) in Section II.B., or same day surgery as contained in Section 
II.L. of this attachment. The patient will be responsible for both the 
cost of the implant(s) in addition to the prescribed cosmetic surgery 
rates.

    Note: The implants and procedures used for the augmentation 
mammaplasty are in compliance with Federal Drug Administration 
guidelines.

    \8\Each regional lipectomy will carry a separate charge. Regions 
include head and neck, abdomen, flanks, and hips.
    \9\These procedures are inclusive in the minor skin lesions. 
However, CHAMPUS separates them as noted here. All charges are for the 
entire treatment regardless of the number of visits required.

    Dated: October 17, 1994.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 94-26081 Filed 10-21-94; 8:45 am]
BILLING CODE 5000-04-M