[Federal Register Volume 63, Number 108 (Friday, June 5, 1998)]
[Proposed Rules]
[Pages 30818-31012]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-14650]
[[Page 30817]]
_______________________________________________________________________
Part II
Department of Health and Human Services
_______________________________________________________________________
Health Care Financing Administration
_______________________________________________________________________
42 CFR Parts 405, et al.
Medicare Program; Revisions to Payment Policies Under the Physician Fee
Schedule for Calendar Year 1999; Proposed Rule
Federal Register / Vol. 63, No. 108 / Friday, June 5, 1998 / Proposed
Rules
[[Page 30818]]
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Parts 405, 410, 413, 414, 415, 424, and 485
[HCFA-1006-P]
RIN 0938-AI52
Medicare Program; Revisions to Payment Policies Under the
Physician Fee Schedule for Calendar Year 1999
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Proposed rule.
-----------------------------------------------------------------------
SUMMARY: This proposed rule would make several policy changes affecting
Medicare Part B payment. The changes that relate to physician services
include: resource-based practice expense relative value units, medical
direction rules for anesthesia services, and payment for abnormal Pap
smears. Also, we would rebase the Medicare Economic Index from a 1989
base year to a 1996 base year. Under the law, we are required to
develop a resource-based system for determining practice expense
relative value units. The Balanced Budget Act of 1997 (BBA 1997)
delayed, for 1 year, implementation of the resource-based practice
expense relative value units until January 1, 1999. Also, BBA 1997
revised our payment policy for nonphysician practitioners, for
outpatient rehabilitation services, and for drugs and biologicals not
paid on a cost or prospective payment basis. In addition, BBA 1997
permits certain physicians and practitioners to opt out of Medicare and
furnish covered services to Medicare beneficiaries through private
contracts. In addition, since we established the physician fee schedule
on January 1, 1992, our experience indicates that some of our Part B
payment policies need to be reconsidered. This proposed rule is
intended to correct inequities in physician payment and solicits public
comments on specific proposed policy changes.
DATES: Comments on the proposed resource-based practice expense policy
will be considered if we receive them at the appropriate address, as
provided below, no later than 5 p.m. on September 3, 1998. Comments on
all other issues will be considered if we receive them at the
appropriate address, as provided below, no later than 5 p.m. on August
4, 1998.
ADDRESSES: Mail written comments (1 original and 3 copies) to the
following address: Health Care Financing Administration, Department of
Health and Human Services, Attention: HCFA-1006-P, P.O. Box 26688,
Baltimore, MD 21207-0488.
If you prefer, you may deliver your written comments (1 original
and 3 copies) to one of the following addresses:
Room 309-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW.,
Washington, DC 20201, or
Room C5-09-26, 7500 Security Boulevard, Baltimore, MD 21244-1850
Because of staffing and resource limitations, we cannot accept
comments by facsimile (FAX) transmission. In commenting, please refer
to file code HCFA-1006-P. Comments received timely will be available
for public inspection as they are received, generally beginning
approximately 3 weeks after publication of a document, in Room 309-G of
the Department's offices at 200 Independence Avenue, SW., Washington,
DC, on Monday through Friday of each week from 8:30 a.m. to 5 p.m.
(phone: (202) 690-7890).
Copies: To order copies of the Federal Register containing this
document, send your request to: New Orders, Superintendent of
Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date
of the issue requested and enclose a check or money order payable to
the Superintendent of Documents, or enclose your Visa or Master Card
number and expiration date. Credit card orders can also be placed by
calling the order desk at (202) 512-1800 or by faxing to (202) 512-
2250. The cost for each copy is $8. As an alternative, you can view and
photocopy the Federal Register document at most libraries designated as
Federal Depository Libraries and at many other public and academic
libraries throughout the country that receive the Federal Register.
This Federal Register document is also available from the Federal
Register online database through GPO Access, a service of the U.S.
Government Printing Office. Free public access is available on a Wide
Area Information Server (WAIS) through the Internet and via
asynchronous dial-in. Internet users can access the database by using
the World Wide Web; the Superintendent of Documents home page address
is http://www.access.gpo.gov/su__docs/, by using local WAIS client
software, or by telnet to swais.access.gpo.gov, then login as guest (no
password required). Dial-in users should use communications software
and modem to call 202-512-1661; type swais, then login as guest (no
password required).
FOR FURTHER INFORMATION CONTACT: Roberta Epps, (410) 786-4503 (for
issues related to outpatient rehabilitation services, nurse
practitioners, clinical nurse specialists, and certified nurse-
midwives).
Stephen Heffler, (410) 786-1211 (for issues related to the Medicare
Economic Index).
Anita Heygster, (410) 786-4486 (for issues related to private
contracts).
Jim Menas, (410) 786-4507 (for issues related to Pap smears and
medical direction for anesthesia services).
Robert Niemann, (410) 786-4569 (for issues related to the drugs and
biologicals policy).
Regina Walker-Wren, (410) 786-9160 (for issues related to physician
assistants).
Stanley Weintraub, (410) 786-4498 (for issues related to practice
expense relative value units and all other issues).
SUPPLEMENTARY INFORMATION: To assist readers in referencing sections
contained in this preamble, we are providing the following table of
contents. Some of the issues discussed in this preamble affect the
payment policies but do not require changes to the regulations in the
Code of Federal Regulations. Information on the regulation's impact
appears throughout the preamble and not exclusively in part V.
Table of Contents
I. Background
A. Legislative History
B. Published Changes to the Fee Schedule
II. Specific Proposals for Calendar Year 1999
A. Resource-Based Practice Expense Relative Value Units
1. Current Practice Expense Relative Value Unit System
2. Criticism of Current Practice Expense Relative Value Unit
System
3. Resource-Based Practice Expense Legislation
4. Originally Proposed Methodology for Developing Resource-Based
Practice Expense Relative Value Units
5. Balanced Budget Act of 1997 Provisions Pertaining to
Resource-Based Practice Expense Relative Value Units
6. HCFA Response to BBA 1997 Requirements
7. Summary of General Input from the Medical Community and
Comments from the October 1997 Notice with Comment Period
8. Issues Considered in Developing New Practice Expense RVUs
9. Alternative Practice Expense Methodologies Considered
10. Description of the Proposed Methodology for Developing
Practice Expense Relative Value Units
a. Overview
b. Data Sources
c. Practice Expense Cost Pools
d. Cost Allocation Methodology
[[Page 30819]]
11. Comments of the American Medical Association Regarding the
Use of the Socioeconomic Monitoring System Survey Data to Construct
Practice Expense Relative Value Units
12. Other Methodological Issues
a. Professional and Technical Component Services
b. Practice Expenses per Hour Adjustments and Specialty
Crosswalks
c. Time Associated with the Work Relative Value Units
13. Other Practice Expense Policies
a. Site-of-Service Payment Differential
b. Additional Relative Value Units for Additional Office-Based
Expenses for Certain Procedure Codes
c. Anesthesia Services
14. Refinement
a. Issues Involved in Refinement
b. Example of the Process for Reviewing and Commenting on
Practice Expense Relative Value Units
c. Information on Accessing Data Files on HCFA's Homepage
15. Reductions in Practice Expense Relative Value Units for
Multiple Procedures
16. Transition
17. Proposed Regulation Revisions
18. Response to GAO Recommendations
B. Medical Direction for Anesthesia Services
C. Separate Payment for Physician Interpretation of an Abnormal
Papanicolaou Smear
D. Rebasing and Revising the Medicare Economic Index
1. Background
a. History
b. Use of Current Data
2. Rebasing and Revising Expense Categories
a. American Medical Association Socioeconomic Monitoring System
Survey
b. Employment Cost Index Survey
c. Asset and Expenditure Survey
d. Current Population Survey
e. Medical Economics Continuing Survey
3. Selection of Price Proxies
a. Background
b. Expense Categories
(1) Physician's Time
(2) Nonphysician Employee Compensation
(3) Office Expense
(4) Medical Materials and Supplies
(5) Professional Liability Insurance
(6) Medical Equipment
(7) Other Professional Expenses
4. Summary of Changes
III. Implementation of the Balanced Budget Act of 1997
A. Payment for Drugs and Biologicals
B. Private Contracting with Medicare Beneficiaries
C. Payment for Outpatient Rehabilitation Services
1. Overview of Policies Before BBA 1997
a. Coverage
b. Providers of Outpatient Rehabilitation Services
c. Payment for Services
(1) Reasonable Cost-Based Payments
(2) Fee Schedule Payments
d. Financial Limitation
2. BBA Provisions Affecting Payment for Outpatient
Rehabilitation Services
a. Reasonable Cost-Based Payments
b. Prospective Payment System for Outpatient Rehabilitation
Services
(1) Overview
(2) Services Furnished by Skilled Nursing Facilities
(3) Services Furnished by Home Health Agencies
(4) Services Furnished by Comprehensive Outpatient
Rehabilitation Facilities
(5) Site-of-Service Differential
(6) Mandatory Assignment
3. Uniform Procedure Codes for Outpatient Rehabilitation
Services
4. Financial Limitation
5. Qualified Therapists
6. Plan of Treatment
D. Payment for Services of Certain Nonphysician Practitioners
and Services Furnished Incident to their Professional Services
1. Coverage and Payment for Nurse Practitioner Services Before
BBA 1997
2. Coverage and Payment for Nurse Practitioner Services
Subsequent to BBA 1997
3. Coverage and Payment for Clinical Nurse Specialist Services
Before BBA 1997
4. Coverage and Payment for Clinical Nurse Specialist Services
Subsequent to BBA 1997
5. Coverage and Payment for Certified Nurse-Midwife Services
6. Coverage and Payment for Physician Assistant Services Before
BBA 1997
7. Coverage and Payment for Physician Assistant Services
Subsequent to BBA 1997
IV. Collection of Information Requirements
V. Response to Comments
VI. Regulatory Impact Analysis
A. Regulatory Flexibility Act
B. Resource-Based Practice Expense Relative Value Units
C. Medical Direction for Anesthesia Services
D. Separate Payment for Physician Interpretation of an Abnormal
Papanicolaou Smear
E. Rebasing and Revising the Medicare Economic Index
F. Payment for Nurse Midwives' Services
F. Payment for Drugs and Biologicals
G. BBA 1997 Provisions Included in This Proposed Rule
1. Payment for Services of Certain Nonphysician Practitioners
and Services Furnished Incident to Their Professional Services
2. Payment for Outpatient Rehabilitation Services
3. Payment for Drugs and Biologicals
4. Private Contracting with Medicare Beneficiaries
H. Impact on Beneficiaries
Addendum A--Description of Clinical Practice Expert Panel Data and
Methodology
Addendum B--Technical Description of the Proposed Methodology for
Developing Practice Expense Relative Value Units
Addendum C--Relative Value Units (RVUs) and Related Information
In addition, because of the many organizations and terms to
which we refer by acronym in this proposed rule, we are listing
these acronyms and their corresponding terms in alphabetical order
below:
AANA--American Association of Nurse Anesthetists
ABC--Activity based costing
ABN--Advance Beneficiary Notice
AHE--Average Hourly Earnings
AMA--American Medical Association
ASA--American Society of Anesthesiologists
AWP--Average Wholesale Price
BBA--Balanced Budget Act of 1997
BLS--Bureau of Labor Statistics
CF--Conversion factor
CFR--Code of Federal Regulations
CMSAs--Consolidated Metropolitan Statistical Areas
CORF--Comprehensive outpatient rehabilitation facility
CPEPs--Clinical Practice Expert Panels
CPI--Consumer Price Index
CPI-U--Consumer Price Index for All Urban Consumers
CPS--Current Population Survey
CPT--[Physicians'] Current Procedural Terminology [4th Edition,
1997, copyrighted by the American Medical Association]
CRNA--Certified Registered Nurse Anesthetist
DME--Durable medical equipment
DMEPOS--Durable medical equipment, prosthetics, orthotics, and
supplies
DRG--Diagnosis-related group
EAC--Estimated Acquisition Cost
ECI--Employment Cost Index
ES-202--Data--Bureau of Labor Statistics from State unemployment
insurance agencies
ESRD--End-stage renal disease
FDA--Food and Drug Administration
FMR--Fair market rental
GAAP--Generally accepted accounting principles
GAF--Geographic adjustment factor
GPCI--Geographic practice cost index
HCFA--Health Care Financing Administration
HCPCS--HCFA Common Procedure Coding System
HHS--[Department of] Health and Human Services
HMO--Health maintenance organization
HUD--[Department of] Housing and Urban Development
MEDPAC--Medicare Payment Advisory Commission
MEI--Medicare Economic Index
MGMA--Medical Group Management Association
MSA--Metropolitan Statistical Area
NAIC--National Association of Insurance Commissioners
NPI--National provider identifier
OBRA--Omnibus Budget Reconciliation Act
OTIP--Occupational therapist in independent practice
PC--Professional component
PMSA--Primary Metropolitan Statistical Area
PPI--Producer Price Index
PPS--Prospective payment system
PTIP--Physical therapist in independent practice
RUC--[AMA's Specialty Society] Relative [Value] Update Committee
[[Page 30820]]
RVU--Relative value unit
SMS--Socioeconomic Monitoring System
SNF--Skilled nursing facility
TC--Technical component
TEFRA--Tax Equity and Fiscal Responsibility Act
UPIN--Uniform provider identifier number
I. Background
A. Legislative History
Since January 1, 1992, Medicare has paid for physician services
under section 1848 of the Social Security Act (the Act), ``Payment for
Physicians' Services.'' This section contains three major elements: (1)
A fee schedule for the payment of physician services; (2) a sustainable
growth rate for the rates of increase in Medicare expenditures for
physician services; and (3) limits on the amounts that nonparticipating
physicians can charge beneficiaries. The Act requires that payments
under the fee schedule be based on national uniform relative value
units (RVUs) based on the resources used in furnishing a service.
Section 1848(c) of the Act requires that national RVUs be established
for physician work, practice expense, and malpractice expense.
Section 1848(c)(2)(B)(ii)(II) of the Act provides that adjustments
in RVUs because of changes resulting from a review of those RVUs may
not cause total physician fee schedule payments to differ by more than
$20 million from what they would have been had the adjustments not been
made. If this tolerance is exceeded, we must make adjustments to the
conversion factors (CFs) to preserve budget neutrality.
B. Published Changes to the Fee Schedule
We published a final rule on November 25, 1991 (56 FR 59502) to
implement section 1848 of the Act by establishing a fee schedule for
physician services furnished on or after January 1, 1992. In the
November 1991 final rule (56 FR 59511), we stated our intention to
update RVUs for new and revised codes in the American Medical
Association's (AMA's) Physicians' Current Procedural Terminology (CPT)
through an ``interim RVU'' process every year. The updates to the RVUs
and fee schedule policies follow:
November 25, 1992, as a final notice with comment period
on new and revised RVUs only (57 FR 55914).
December 2, 1993, as a final rule with comment period (58
FR 63626) to revise the refinement process used to establish physician
work RVUs and to revise payment policies for specific physician
services and supplies. (We solicited comments on new and revised RVUs
only.)
December 8, 1994, as a final rule with comment period (59
FR 63410) to revise the geographic adjustment factor (GAF) values, fee
schedule payment areas, and payment policies for specific physician
services. The final rule also discussed the process for periodic review
and adjustment of RVUs not less frequently than every 5 years as
required by section 1848(c)(2)(B)(i) of the Act.
December 8, 1995, as a final rule with comment period (60
FR 63124) to revise various policies affecting payment for physician
services including Medicare payment for physician services in teaching
settings, the RVUs for certain existing procedure codes, and to
establish interim RVUs for new and revised procedure codes. The rule
also included the final revised 1996 geographic practice cost indices
(GPCIs).
November 22, 1996, as a final rule with comment period (61
FR 59490) to revise the policy for payment for diagnostic services,
transportation in connection with furnishing diagnostic tests, changes
in geographic payment areas (localities), and changes in the procedure
status codes for a variety of services.
October 31, 1997, as a final rule with comment period (62
FR 59048) to revise the geographic practice cost index (GPCI),
physician supervision of diagnostic tests, establishment of independent
diagnostic testing facilities, the methodology used to develop
reasonable compensation equivalent limits, payment to participating and
nonparticipating suppliers, global surgical services, caloric
vestibular testing, and clinical consultations. The final rule also
implemented certain provisions of the Balanced Budget Act of 1997 (BBA
1997) (Public Law 105-33), enacted on August 5, 1997, and implemented
the RVUs for certain existing procedure codes and established interim
RVUs for new and revised procedure codes.
This proposed rule would affect the regulations set forth at 42 CFR
part 405, which consists of regulations on Federal health insurance for
the aged and disabled; part 410, which consists of regulations on
supplementary medical insurance benefits; part 414, which consists of
regulations on the payment for Part B medical and other health
services; part 415, which pertains to services furnished by physicians
in providers, supervising physicians in teaching settings, and
residents in certain settings; part 424, which pertains to the
conditions for Medicare payment; and part 485, which pertains to
conditions of participation: specialized providers.
II. Specific Proposals for Calendar Year 1999
A. Resource-Based Practice Expense Relative Value Units
1. Current Practice Expense Relative Value Unit System
The Act details the types of services that are paid under the
physician fee schedule. These include physician services, services and
supplies incident to a physician service, diagnostic x-ray tests,
diagnostic laboratory tests (excluding clinical laboratory tests), and
x-ray, radium, and radioactive isotope therapy. BBA 1997 added other
services such as certain preventive services. While some of these
services do not have work RVUs, all of the services have practice
expense and malpractice expense RVUs. (Physician anesthesia services
are included under the physician fee schedule but are paid under a
different payment methodology that uses a separate CF and allowable
base and time units. Physician anesthesia services do not have practice
expense and malpractice expense RVUs.) Payments for practice expense
RVUs account for approximately 41 percent of total physician fee
schedule payments.
In most cases, the current practice expense RVUs are calculated
based on a statutory formula. They are derived from the product of
``base allowed charges'' and service-specific practice expense
percentages. The base allowed charge is the national allowed charge for
the service furnished during 1991. The service-specific practice
expense percentage is a weighted average of the practice expense
percentages of the specialties performing the service.
For services furnished beginning with calendar year 1994 and whose
practice expense RVUs exceed 1994 work RVUs and are performed in the
office setting less than 75 percent of the time, practice expense RVUs
in each of 1994, 1995, and 1996 were reduced by 25 percent of the
amount they exceed the 1994 work RVUs. (Before 1998, practice expense
RVUs were not reduced to less than 128 percent of 1994 work RVUs.)
For services furnished beginning with calendar year 1998 whose
practice expense RVUs (determined for 1998) exceeded 110 percent of the
work RVUs and which were provided less than 75 percent of the time in
an office setting, the 1998 practice expense RVUs were reduced to a
number equal to 110 percent of the work RVUs. This limitation did not
apply to services that had a proposed resource-based practice expense
RVU in the June 18, 1997 proposed rule (62 FR 33158), which was
[[Page 30821]]
an increase from its 1997 practice expense RVU. For office visit
procedure codes performed beginning calendar year 1998, the practice
expense RVUs were increased by a uniform percentage to equal the
aggregate decrease in the practice expense RVUs for other services.
2. Criticism of Current Practice Expense Relative Value Unit System
A common criticism of the current practice expense RVU system is
that for many services the RVUs, which are based on charges under the
reasonable charge system, are not based directly on the resources
involved with furnishing the service. Rather, the charge-based nature
of the current fee schedule practice expense retains historical charge
patterns that existed before the implementation of the physician fee
schedule on January 1, 1992. Those charge patterns favor procedures and
tests performed in hospitals rather than evaluation and management
services and other office-based services.
For example, a primary care physician would have to bill CPT code
99213 (level 3 office visit, established patient) approximately 80
times to collect the same amount of practice expense payments as a
cardiac surgeon would for performing one coronary artery bypass graft
with three coronary venous grafts (CPT code 33512), although the
practice expenses the surgeon typically incurs for the cardiac surgery
are primarily related to the pre- and postoperative services furnished
in the office, administrative costs, and overhead. The costs for
clinical staff, medical supplies, and medical equipment furnished to
hospital patients are included in the diagnosis-related group (DRG)
payment made to the hospital as required by section 1862(a)(14).
In their 1993 annual report to the Congress, the Physician Payment
Review Commission recommended that the Congress revise the practice
expense component of the physician fee schedule so that it is resource-
based. They further recommended that we collect data regarding the
direct cost incurred in delivering each service and that a formula-
based approach be used to allocate indirect costs. This recommendation
was instrumental in the Congress' legislating the resource-based
practice expense component.
3. Resource-Based Practice Expense Legislation
Section 121 of the Social Security Act Amendments of 1994 (Public
Law 103-432), enacted on October 31, 1994, requires us to develop a
methodology for a resource-based system for determining practice
expense RVUs for each physician service. In developing the methodology,
we must consider the staff, equipment, and supplies used in providing
medical and surgical services in various settings. The legislation
required the new payment methodology to be effective for services
furnished in 1998.
The legislation specifically requires that, in implementing the new
system of practice expense RVUs, we must apply the same budget-
neutrality provisions that we apply to other adjustments under the
physician fee schedule.
Before publication of the final rule in October 1997, section 4505
of the BBA 1997 delayed initial implementation of resource-based
practice expense RVUs until 1999. It also required that we do the
following:
Use, to the maximum extent practicable, generally accepted
cost accounting principles that recognize all staff, equipment,
supplies, and expenses, not solely those that can be linked to specific
procedures.
Consult with organizations representing physicians
regarding methodology and data to be used.
Develop a refinement method to be used during the
transition.
Consider impact projections that compare new proposed
payment amounts to data on actual physician practice expenses.
4. Originally Proposed Methodology for Developing Resource-Based
Practice Expense Relative Value Units
To implement the October 1994 legislation, we published a proposed
rule on June 18, 1997 (62 FR 33158). In the proposed rule, we
established a framework in which practice expenses were divided into
direct and indirect costs. Direct costs are those costs that can be
directly attributed to providing a service, such as the cost of a
nurse's time (salary), medical supplies and equipment, administrative
costs of billing, record maintenance, and the scheduling of office
patients. Direct costs also include the physician's costs of office
staff time for scheduling appointments and billing and collection
activities associated with a medical procedure furnished in a hospital.
Indirect costs cannot be directly attributed to a specific service, and
include costs such as rent, utilities, office equipment and supplies,
and accounting and legal fees. The allocation of indirect costs to
specific products or services is a classic accounting problem. The
indirect costs are difficult to relate directly to a specific service
because they are incurred by the practice as a whole.
The June 1997 proposed rule (62 FR 33172) described the following
methodology for calculating the proposed direct practice expense RVUs.
We calculated the total pool of practice expense RVUs for
1995 and divided it into direct and indirect practice expense pools
using the American Medical Association's (AMA's) Socioeconomic
Monitoring System (SMS) survey data and our 1995 national claims
history data. The national distribution of direct and indirect practice
expense RVUs was 55 percent direct practice expense RVUs and 45 percent
indirect practice expense RVUs.
The underpinning for the proposed direct components of the
practice expense RVUs was the data reported by the Clinical Practice
Expert Panels (CPEPs) for clinical and administrative labor, medical
supplies, and medical equipment inputs. There were 15 CPEPs,
corresponding to the major medical specialties, which were made up of
nominees from all major specialty societies. (A description of the
CPEPs is contained in the June 1997 proposed rule (62 FR 33161).) (See
Addendum A for a detailed description of the CPEP process.)
These data were edited to apply Medicare payment policy
rules to ensure that the reported data were consistent with our
national hospital and physician payment policies. The primary
adjustment was the removal of direct inputs recorded for clinical labor
staff, medical equipment, and medical supplies furnished to hospital
patients. Other adjustments were made for the professional component of
a service, the technical component of a service, and the combined
service, for codes that have an indicator of ZZZ under the physician
fee schedule, and for certain allergy and immunotherapy codes performed
on a per-test, per-dose, or per-vial basis.
We believed that the relative relationships of the staff
time estimates within the individual CPEPs were generally correct but
that the absolute time estimates needed normalization. We placed the
codes from the different CPEPs on the same scale using a normalization
process that we call ``linking.'' Specifically, linking shifted an
entire CPEP's data relative to other CPEPs' data, based on the
relationship of the values assigned across panels for codes that had
been assigned to multiple CPEPs. We separately linked clinical and
administrative labor costs. Statistically, the linking was done using
regression methods.
[[Page 30822]]
After the data were edited and linked, our physicians and
clinical staff analyzed the direct practice expense RVUs to determine
if there were unexplainable variations in the underlying CPEP data.
This review resulted in the application of two general reasonableness
rules. First, a decision was made to cap the administrative time of
several categories of service (services without a global period and
procedures subject to global periods with zero follow-up days) at the
administrative time assigned to CPT code 99213 (midlevel office
visits). Second, we decided to cap the nonphysician clinical staff time
at 1.5 times the physician time, in minutes, for performing the
procedure. Additional more specific rules were applied to certain
supplies and supply costs and for certain codes, such as psychotherapy,
physical therapy, chemotherapy, and nerve block codes.
The aggregate percentage shares across all specialties of
labor and medical supplies and equipment from the CPEP data were scaled
to the percentage shares of these categories from the AMA's SMS survey
data. The CPEP expenses for labor, medical supplies, and medical
equipment were adjusted by scaling factors of 1.21, 1.06, and 0.39
respectively.
The direct practice expense dollar amounts were converted
into direct practice expense RVUs. An adjustment factor of 0.65 was
used to convert the aggregate direct practice expense dollars to the
available Medicare direct practice expense dollars.
Aggregate indirect practice expense RVUs were allocated to
individual codes based on the code-specific sum of the direct practice
expense, the malpractice expense, and the physician work RVU.
The direct and the indirect practice expense RVUs per code
were combined to produce a single practice expense RVU per code.
Other practice expense proposals in the June 1997 proposed rule (62
FR 33160) included:
Replacement of the current site-of-service differential
policy that systematically reduces the practice expense RVUs by 50
percent for certain procedures with a policy that would generally
identify two different levels (office or nonoffice) of practice expense
RVUs for each procedure code depending on the site of service.
Elimination of the current policy that allows additional
practice expense RVUs for supplies that are used incident to a
physician service but were not the type of routine supplies included in
the current practice expense RVUs for specific services. These supplies
were included in the CPEP data for the specific procedure code.
Reduction of the practice expenses for multiple
nonsurgical services performed at the same time as an evaluation and
management service.
The June 1997 proposed rule provided for a 60-day comment period
ending on August 18, 1997.
5. Balanced Budget Act of 1997 Provisions Pertaining to Resource-Based
Practice Expense Relative Value Units
On August 5, 1997, the President signed into law the Balanced
Budget Act of 1997 (BBA 1997). Section 4505(a) of BBA 1997 delayed the
effective date of the resource-based practice expense RVU system until
January 1, 1999. In addition, BBA 1997 provided for the following
revisions in the requirements to change from a charge-based practice
expense RVU system to a resource-based method.
Instead of paying for all services entirely under a resource-based
system in 1999, section 4505(b) of BBA 1997 provided for a 4-year
transition period. The practice expense RVUs for the year 1999 will be
the product of 75 percent of the previous year's RVUs (1998) and 25
percent of the resource-based RVUs. For the year 2000, the percentages
will be 50 percent charge-based and 50 percent resource-based. For the
year 2001, the percentages will be 25 percent charge-based and 75
percent resource-based. For subsequent years, the RVUs will be totally
resource-based.
Section 4505(c) of BBA 1997 required the Comptroller General to
review and evaluate our proposed rule and report to the Congress by
February 1998. The review was required to include an analysis of (1)
the adequacy of the data used in preparing the rule, (2) categories of
allowable costs, (3) methods for allocating direct and indirect
expenses, (4) the potential impact of the rule on beneficiary access to
services, and (5) any other matters related to the appropriateness of
resource-based methodology for practice expenses. The Comptroller
General was also to consult with representatives of physician
organizations with respect to matters of both data and methodology.
Section 4505(e) of BBA 1997 provided that, for 1998, the practice
expense RVUs be adjusted for certain services in anticipation of the
implementation of resource-based practice expenses beginning in 1999.
Practice expense RVUs for office visits were increased. For other
services whose practice expense RVUs (determined for 1998) exceeded 110
percent of the work RVUs and which were provided less than 75 percent
of the time in an office setting, the 1998 practice expense RVUs were
reduced to a number equal to 110 percent of the work RVUs. This
limitation did not apply to services that had a proposed resource-based
practice expense RVU in the June 1997 proposed rule that was an
increase from its 1997 practice expense RVU. The total of the
reductions was less than the statutory maximum of $390 million. The
procedure codes affected and the final RVUs for 1998 were published in
the October 31, 1997 final rule (62 FR 59103).
Section 4505(d)(2) of BBA 1997 required that the Secretary transmit
a report to the Congress by March 1, 1998, including a presentation of
data to be used in developing the practice expense RVUs and an
explanation of the methodology. A report was submitted to the Congress
in early March 1998. Section 4505(d)(3) requires that a proposed rule
be published by May 1, 1998, with a 90-day comment period. For the
transition to begin on January 1, 1999, a final rule must be published
by October 31, 1998.
BBA 1997 also required that we develop new resource-based practice
expense RVUs. In developing these new practice expense RVUs, section
4505(d)(1) required us to: (1) Utilize, to the maximum extent
practicable, generally accepted accounting principles that recognize
all staff, equipment, supplies, and expenses, not just those that can
be tied to specific procedures, and use actual data on equipment
utilization and other key assumptions; (2) consult with organizations
representing physicians regarding the methodology and data to be used;
and (3) develop a refinement process to be used during each of the 4
years of the transition period.
6. HCFA Response to BBA 1997 Requirements
BBA 1997 required us to develop new resource-based RVUs and to
consult with physician organizations regarding methodology and data. To
meet the BBA 1997 requirements and to promote input as we developed new
RVUs, we have sought and will continue to encourage maximum input from
those affected by this initiative. The following is a summary of
activities we have undertaken.
Validation Panel Meetings.
We hosted 17 medical specialty panels that were charged with
validating the CPEP direct cost data for the high-volume CPT codes for
each specialty. All the major medical specialty societies were
represented, including nonphysician organizations.
[[Page 30823]]
Each panel, consisting of about 12 to 15 members, was made up of the
appropriate specialists, two general surgeons, two primary care
physicians, and two Medicare carrier medical directors. The panel
members reviewed and, if they believed necessary, revised the clinical
and administrative times and the supplies and equipment involved for
each code. Consensus within panels was reached on about 200 codes.
Cross Specialty Panel.
Although the October validation panels were able to reach consensus
on many high-volume procedures within specific specialties, we were
concerned that there was not a uniform or consistent scale applied to
labor inputs across specialties. Therefore, in December, we convened a
multiple specialty panel of 37 panelists, including physicians,
nonphysicians, and administrators nominated by the specialty societies.
We expected the panel to help us achieve consistency across panels
on resource inputs, such as insurance billing and transcription times,
and to standardize the clinical staff types for similar classes of
services, whether they be registered nurses, medical assistants,
licensed practical nurses, or a mix of these staff types. The results
of the cross specialty panel were generally unsuccessful. While the
panel did provide the arena for panelists to furnish explanations of
times for activities that we believed to be excessive, the panelists
were generally reluctant to make any major modifications in the times
or staff they had assigned to their own services. The panelists could
not agree to any rules that would aid us in standardizing the data.
The panelists did recommend that we explore an option that treats
billing and insurance activities as indirect costs. Many panelists also
suggested that we proceed cautiously and try to minimize the magnitude
of redistribution.
Indirect Cost Symposium.
We convened a meeting on November 21, 1997 on indirect practice
expenses to provide a forum for participants to discuss their preferred
methodology for allocating indirect costs. We asked those organizations
that commented on our proposed indirect cost methodology to make a
formal presentation of their views. All major medical specialty groups
were invited to attend and join in the discussion.
Some groups endorsed the methodology we proposed in the June 1997
proposed rule (62 FR 33172) with some modifications. One modification
recommended was to eliminate malpractice RVUs as a factor in allocating
indirect costs. It was noted, even by some advocates for other
allocation methods, that our proposed methodology embodied traditional
accounting methods for allocating indirect costs.
Only two major alternatives to our proposed methodology were
presented. The first, the Activity Based Costing (ABC) method, was
described as a cutting edge approach to determining the cost of
individual products (CPT codes). Under the ABC method, the total costs
of a practice are collected and assigned to discrete processes or
activities. These costs are then assigned to products to which they are
related.
The ABC method was developed for industries in which direct labor
(the traditional cost accounting method for allocating indirect costs)
is not the dominant factor in the production of the good or service.
This method is in the early developmental stages in medical practice
use.
The second alternative methodology presented was the physician work
RVU method of allocating indirect practice expenses. This method would
allocate indirect costs using only the physician work RVUs. However,
there did not appear to be much support for this methodology at the
meeting. It would, for example, penalize physician practices that have
proportionately higher equipment costs.
October 31, 1997 Notice with Comment Period
To inform all interested parties of our plans to issue a
new proposed rule and to request additional data from the medical
community to assist us in meeting BBA 1997 requirements, on October 31,
1997, we published a notice (62 FR 59267).
In that notice, we requested that physicians, physician
organizations, or others provide us with the following information:
Generally accepted cost accounting principles--We
specifically requested information on the following: (1) Aspects of the
cost accounting methodology used in the June 1997 proposed rule that
were not consistent with the statutory guidance; and (2) complete
copies of studies of resource-based practice expense RVUs, including
any underlying surveys supporting these studies, performed by
physicians or physician groups or their contractors or consultants,
including pertinent details about the survey.
Equipment utilization--We specifically requested complete
copies of any studies or other data showing the actual utilization of
equipment by physician practices, including pertinent details about the
survey, such as response rates, sampling design, methodology,
directions, and definitions.
Other assumptions--We specifically requested information
regarding the useful life of equipment, the amount and percentage of
direct practice costs versus the amount and percentage of indirect
costs by specialty, and practice expense values for sites for which
values were not proposed in the June 1997 proposed rule (62 FR 33158).
Use of physician-employed staff in hospitals and other
facility settings--We specifically requested comments and information
about the extent to which a physician employee, such as a registered
nurse, accompanies the physician to the hospital, ambulatory surgical
center, or other facilities to provide services, such as acting as an
assistant at surgery or serving as a scrub nurse. We asked for names of
specific facilities so that we might contact them in order to more
fully understand the nature of the relationships.
Refinement process--We requested comments on how this
refinement process would operate including assigning practice expense
RVUs to new codes, who would be involved in the refinement process, and
how all of the users of the physician fee schedule would have access to
the process.
Review of New Methodology by KPMG Peat Marwick LLP--Under
contract #500-97-0402, we requested that KPMG Peat Marwick LLP review
the practice expense per hour methodology. They concluded that the
methodology follows reasonable cost accounting principles. They made
this determination based on an examination of the available data
sources and a consideration of the cost and feasibility of acquiring
additional nationally representative data. As a future consideration,
they recommended sample validation of our cost allocation bases.
7. Summary of General Input From the Medical Community and Comments
From the October 1997 Notice With Comment Period
Some physicians, such as primary care physicians, expressed
satisfaction that the proposed methodology was generally sound. In
addition, the AMA was supportive of our panel process for direct
expenses and offered many helpful comments. However, many surgeons and
medical specialties argued that we should discard our current practice
expense data, and develop payments that reflect their ``actual costs.''
[[Page 30824]]
Both in written comments and in our meetings with the medical
community, we received much feedback on our methodology for indirect
practice expense. However, there was no consensus regarding methods for
allocating indirect costs to individual procedure codes.
In addition, we received 56 specific comments from individuals,
major organizations, and physician specialty groups on our October 1997
notice. The comments are summarized by the following categories:
Generally Accepted Accounting Principles.
Some of the groups expected to experience an increase in payment
under the June 1997 proposed rule thought our approach satisfied the
current statutory mandate that we utilize generally accepted accounting
principles (GAAP). Those physician groups that expected to experience a
decrease in payments based on the methodology described in the June
1997 proposed rule said the approach in the proposed rule was
inconsistent with GAAP. They argued that GAAP requires us to use actual
practice expense data and said the data from the CPEPs and validation
panels were based on erroneous assumptions, or were unverified
approximations. At least five commenters supported using the activity-
based accounting approach.
Equipment utilization.
Some groups furnished equipment-specific utilization levels for a
few services. Generally, the equipment and utilization levels were not
based on representative surveys of physicians performing the service.
Some suggestions were as follows:
------------------------------------------------------------------------
Percent
------------------------------------------------------------------------
Electroencephalography equipment........... 26
Electromyography........................... 36.5
Nerve Conduction Velocity.................. 36.5
Cystoscope................................. 5
Loop electrode excision procedure.......... 1
Colposcope................................. 1.6
YAG laser.................................. 12
ARGON laser................................ 5 to 6.4
Fundus camera.............................. 31.3
Spirometry and Ancillary Equipment......... 10 to 17
Bronchoscopy............................... 5 to 10
------------------------------------------------------------------------
Useful Life.
We did not receive specific comments on suggested useful lives for
specific medical equipment, which is an important factor in estimating
equipment costs.
Direct and Indirect Costs.
Some commenters pointed out that not all clinical labor can be
classified as direct costs. Tasks such as ordering supplies and
attending meetings or continuing education classes should be captured
as indirect costs. Some groups, including one primary care group, said
that billing costs should be an indirect expense, while others
supported maintaining them as direct costs. Many groups supported an
allocation process in which indirect costs are assigned based on a
specialty's specific indirect cost percentage. Only one group
specifically objected to this approach. Some physician groups provided
specific direct and indirect cost ratios based on limited surveys of
their membership.
Employed Staff.
According to an American Hospital Association survey, 63 percent of
respondents (from 573 hospitals) believed that a physician brought
staff to the hospital during the last 6 months of 1996. Of these
respondents, 82 percent said this was not a regular practice.
Therefore, the American Hospital Association commented it is not a
typical practice in the United States for physicians to bring their own
staff to a hospital.
Five surgical specialties and subspecialties--neurosurgery,
ophthalmology, general thoracic surgery, congenital thoracic surgery,
and adult cardiac surgery--indicated that at least 50 percent of
practices use employed clinical staff in nonoffice settings. General
surgery indicated that 31 percent of general surgery practices pay for
clinical staff working in nonoffice settings. The Society of Thoracic
Surgeons stated that they do not have data on the number of clinical
nurses who work with thoracic surgeons in hospitals. However, they
stated that a survey of physician assistants shows that 72 percent of
physician assistants employed in cardiovascular surgery were employed
by solo or group physician practices.
According to the American Academy of Ophthalmology, 51 percent of
ophthalmologists bring equipment, such as keratomes, diamond knives,
cataract trays, and muscle trays to furnish services to hospital
patients.
Refinement.
Most commenters support using the AMA's Specialty Society Relative
Value Update Committee's (RUC's) process to refine the practice expense
RVUs. (Currently the RUC recommends refinement of the physician work
RVUs.) Of these commenters, many recommended that the process include
nurses and practice managers, that there be established rules and
procedures for data collection, survey design, and response rates, and
that the process allows participation by subspecialties, such as
transplant surgeons and pediatric surgeons. One commenter suggested a
process using the AMA, Medical Group Management Association (MGMA), and
HCFA. Some commenters suggested using a RUC process only for new codes.
Transition.
Several commenters stated that the base year for the transition
should be the 1997 practice expense RVUs and not the 1998 practice
expense RVUs. They suggested that the 1998 adjustment required by BBA
1997 is not intended to be included in the base for purposes of the
practice expense transition. Some commenters recommended that we
explore using ceilings and floors during the transition period or use
caution so as to limit the amount of the redistribution.
Site-of-Service Differential.
Commenters from the American Academy of Orthopaedic Surgeons stated
that we need office practice expense RVUs for musculoskeletal system
surgery codes 25000, 25031, 26040, 26060, 26608, 29815 through 29848,
and 29870 through 29898. Some commenters believe we should develop
practice expense RVUs for all procedures at all sites and permit office
endoscopy only under very limited and clearly defined standards.
Data Quality.
The American College of Surgeons stated that the CPEP data are
based on erroneous assumptions, educated guesses, and unverified
approximations. They stated that the data from panels are unreliable
for the administrative times for chiropractic manipulation, level 3
office visits, inpatient consultations, balloon angioplasty, and
clinical times for allergy skin testing.
Validation.
The AMA stated that we should use AMA and MGMA data on full time
equivalent staff for each physician to assess how well various
methodological options account for total labor costs. The American
College of Physicians suggested we complete an impact analysis that
compares proposed practice expense payments to actual practice expenses
on a specialty by specialty basis, as well as sponsoring a study
requiring on-site visits to practices.
8. Issues Considered in Developing New Practice Expense RVUs
We faced the following major issues as we decided whether and how
to modify our original proposal for physician practice expense RVUs.
These issues arose from many sources: from concerns about the CPEP data
and our
[[Page 30825]]
original proposed methodology, from the requirements of BBA 1997, from
the findings and recommendations in the General Accounting Office's
Report to the Congress on physician practice expense, and from input we
received from the medical community.
Purpose.
Our original practice expense proposal was based on the 1994
legislation, which stated that the new practice expense methodology
must consider the staff, equipment, and supplies used in the provision
of various medical and surgical services in various settings. We
interpreted this to mean that Medicare payments for each service should
be based on the relative resources typically and reasonably involved
with performing the service. We believed we could best calculate these
resources by achieving clinical consensus on the actual inputs it would
typically take to perform a given service. However, surgeons and some
other specialties contended that the purpose of a resource-based
practice expense system should be to reimburse them based on their
total current expenditures for practice costs. Because the higher paid
specialties have more to spend on their practices as a result of
historic charging practices and insurance coverage, there is a concern
that adopting such a methodology would not achieve the desired equity.
The argument made by some outside groups is that physicians have been
increasingly forced to be more efficient and, as a result, differences
in practice expenses among specialties reflect ``real'' costs that
should then be reflected in the new practice expense RVUs.
With the passage of BBA in August 1997, the statute now requires us
to ``utilize, to the maximum extent practicable, generally accepted
cost accounting principles which recognize all staff, equipment,
supplies, and expenses, not just those which can be tied to specific
procedures. * * *'' Therefore, in developing and analyzing any new
alternative methods for computing practice expense RVUs, we have
evaluated how well each option recognizes all practice expense costs.
``Bottom-up'' versus ``Top-down'' Methodology.
In line with our original stated purpose and the 1994 legislation,
our practice expense methodology published in the June 1997 proposed
rule (62 FR 33172) used a ``bottom-up'' approach, which obtained expert
panel estimates of actual inputs--staff times, supplies, and
equipment--for each procedure and then used these estimates to build up
to the direct practice expense RVUs. Some groups complained that some
of the published relative values were too low and favored using studies
that actually measured the inputs onsite. Unfortunately, if any
reliable data exist at all, they are only for a few scattered
specialties, and it certainly is not practical for us to undertake such
a task (Medicare pays physicians for over 7,000 services). We
understand that even the few specialties that have attempted surveys
have had limited success obtaining complete practice expense data from
even limited selected practices.
Many of the specialty societies favored a ``top-down'' methodology,
which would start our calculations with their total current
expenditures and then allocate these costs down to the procedure level
by some method. Several groups supported using an Activity Based
Costing (ABC) methodology for calculating practice expenses. The
proponents of ABC maintain that it produces more accurate costs because
it measures the costs of processes (for example, servicing patients,
scheduling, and billing) as opposed to traditional costing systems,
which measure resources (for example, salaries and rent). However, ABC
is only in the experimental stages in medical practice use, and many
difficult questions about its utility in medical practices have not
been resolved, for example, its assumption that all medical practices
operate in the same manner. ABC still requires subjective estimations,
or some other algorithm, to allocate costs from ``processes'' to
individual CPT codes.
Available Data Sources.
Much of the debate about what would constitute the most accurate
practice expense methodology cannot be resolved in the short run. There
is no consensus about the best way to determine the most accurate
practice expense methodology. Furthermore, there are only limited data
sources available. CPEP data, along with the modifications made by our
subsequent panels, are the only source of estimates at the CPT code
level of resource inputs needed to provide each service. AMA's SMS
survey data are from a national survey of randomly selected self-
employed physicians that collects information on practice expense on an
aggregate level, and can be used to determine overall differences in
expenditures among specialties.
The only other relevant data sources of which we are presently
aware are a few other surveys of practice expense, such as those
performed by the MGMA, Medical Economics, and the American College of
Surgeons. Because of selective sampling and low response rates of these
three surveys, these data are not representative of the population of
physicians and cannot be used to derive code-specific RVUs, though the
data might prove useful in validating general impacts.
Specialty-Specific Differences.
Our June 1997 proposed rule did not explicitly recognize specialty-
specific differences. Differences across specialties were only
reflected implicitly to the extent that more indirect RVUs would be
allocated to those procedures with the greatest physician work and
direct costs. Under our June 1997 proposed approach, we allocated
indirect relative values based on the typical use of resources, that
is, the direct practice expense RVUs, the physician work RVUs, and the
malpractice RVUs per code.
The specialty groups, along with the AMA and even some primary care
groups, were almost unanimous in their view that we should use an
approach that explicitly recognizes specialty-specific differences in
the indirect cost of practice. It was pointed out, as an example, that
some specialties such as radiology or ophthalmology would have much
higher indirect equipment costs than other specialties. The specialty
groups believed that not recognizing such specialty differences would
be inherently unfair to some specialties. The AMA staff suggested that
we use their survey data to calculate the specialty-specific indirect
costs.
In developing our options for a new practice expense methodology,
we, therefore, needed to decide whether we would maintain specialty-
neutral methods, use specialty differentials to help allocate only
indirect RVUs, or use specialty-specific data to establish the total
redistributive pools for each specialty.
Administrative Costs.
Another decision we had to make as we developed new practice
expense RVUs was how a new proposal would treat administrative costs.
The June 1997 proposed rule (62 FR 33167) methodology treated
administrative labor cost as a direct expense, and the administrative
cost RVUs were derived from the CPEP data. On first reviewing the raw
CPEP inputs for administrative staff times, it appeared that there were
some problems with the data. First, some of the suggested
administrative staff times appeared excessively high, particularly for
the billing staff. Second, there was variation in staff times for the
same CPT code between the different panels. In the June 1997 proposed
rule (62 FR 33166), we dealt with these problems through our linking
[[Page 30826]]
methodology and by capping administrative times. Both of these methods
were strongly opposed by many specialty groups, largely because our
adjustments had dramatic effects on the raw data. For example, the
linking coefficient for thoracic surgery reduced their administrative
inputs by 76 percent. There were also comments claiming that many
administrative duties are of a general nature that cannot be fully
captured on a code-specific basis.
As a result of these concerns, many outside groups have suggested
that we treat administrative cost as an indirect practice expense. The
advantages of adopting this suggestion would be that we could get
around the mentioned data discrepancies, avoid the controversial use of
linking for administrative labor, and be more certain that we had
captured all administrative costs. The main disadvantage would be that
it would greatly increase the percentage of RVUs that would have to be
allocated by a formula.
Clinical Costs.
Although the problems were on a lesser scale, we observed many of
the same difficulties with the raw CPEP inputs for clinical costs as
there were for the administrative costs discussed above. There was some
lack of standardization of clinical staff types between the CPEP
panels, and some staff times appeared excessive. In the June 1997
proposed rule, these problems were addressed by linking and by capping
the clinical times; both of these methods caused considerable
controversy in the medical community. We had hoped that the validation
and cross-specialty panels would have resolved the inconsistencies
across specialties, but they were unable to accomplish this task. It
was clear, therefore, that any new proposal would still have to address
a method of standardizing the data between the various specialty
panels.
The General Accounting Office (GAO) Report to Congress on
Physician Practice Expense.
As already mentioned, BBA 1997 required the GAO to review and
evaluate our June 1997 proposed rule on a resource-based methodology
for practice expenses. This report was issued in February 1998 and
concluded that both our use of expert panels to develop direct cost
estimates and our original allocation methodology for indirect costs
were acceptable options. However, the GAO raised questions about the
validity of some specifics of the linking regression model and about
the appropriateness of capping administrative and clinical labor time
estimates. In addition, the report suggested that using specialty-
specific indirect expense ratios, based on the SMS survey data, would
be more clearly consistent with BBA 1997. Also, the report recommended
that we consider classifying administrative labor costs as indirect
expenses. (See section 18 for a more detailed discussion of the
report's recommendations.)
9. Alternative Practice Expense Methodologies Considered
We carefully considered two alternative approaches to developing
new practice expense RVUs: the first maintained the ``bottom-up''
methodology of our original proposal, while the second adopted a ``top-
down'' methodology.
``Bottom-up'' Option.
We regard our original ``bottom-up'' proposal as a viable method of
developing practice expense RVUs. It clearly fulfilled the requirement
of the Social Security Amendments of 1994, which states that practice
expense relative values should be based on the relative practice
expense resources involved in furnishing the service. Both the GAO and
the Physician Payment Review Commission, as well as many researchers in
the field, supported our use of expert panels to estimate direct
practice expenses. Therefore, we developed a method that was similar to
our original proposal.
Like our proposal in the June 1997 proposed rule, this option based
its calculation for all direct inputs on the data reported by the
CPEPs. As before, both clinical and administrative labor were linked,
and all direct cost estimates were scaled as in the original proposed
rule. However, in a significant departure from our original proposal,
the caps on clinical and administrative staff times were eliminated.
For indirect costs, this option continued not to recognize a specialty-
specific method of cost allocation to specific procedures. It did,
however, have a different indirect allocation formula from our original
proposal; under this option, 50 percent would be allocated on the basis
of direct costs and 50 percent on the basis of physician time. Of the
latter 50 percent, physician time in the office would get a weight 50
percent higher than physician time out of the office. If there was no
physician involvement, as is the case with technical component
services, the maximum clinical staff time would be used.
The ``Top-Down'' Option.
This option is a departure from our original proposal and is an
effort to balance the requirements of the 1994 Social Security
Amendments with the 1997 BBA requirements. It uses the two significant
sources of actual practice expense data we have available: the CPEP
data and the AMA's SMS survey data. It allocates current aggregate
specialty practice costs to specific procedures and, thus, can be seen
as a ``top-down'' approach.
This option is based on an assumption that current aggregate
specialty practice costs are a reasonable way to establish initial
estimates of relative resource costs of physician services across
specialties. The specialty practice cost data are derived from the
AMA's SMS survey data on actual practice expenses. The survey data are
used to calculate the practice expenses generated for every hour worked
by a physician. The average practice expense per hour for the
physicians in a given specialty is then multiplied by the total number
of physician hours worked by that specialty as reflected in the
Medicare claims data. This determines the total pool of practice
expense payments for that specialty. We then allocated this pool to the
procedures performed by that specialty using the CPEP data (excluding
the administrative staff time associated with specific procedures) and
the physician work RVUs. We calculated a weighted average of the
practice expense payments for procedures performed by more than one
specialty.
After much analysis and discussion, we have decided to propose the
``top-down'' methodology. We believe the ``top-down'' methodology is
more responsive than the ``bottom-up'' approach to both BBA 1997
requirements and to many of the concerns of the medical community. By
using aggregate specialty practice costs as the basis for establishing
the practice expense pools, we are recognizing all of a specialty's
costs, not just those linked with a specific procedure. By basing the
redistributions of the practice expense system on physician-reported
actual practice expense data, by using a specialty-specific allocation
method, and by treating administrative costs as an indirect expense, we
avoid many of the criticisms leveled at our original proposal.
We also believe this option is responsive to the short-term
recommendations in the GAO Report to Congress on physician practice
expense payments relating to the June 1997 proposed rule's limits on
clinical and administrative staff time and possible changes in the
linking algorithm. Our recommended methodology would make these
recommendations moot by eliminating the limits and linking algorithm
that were part of our previous
[[Page 30827]]
proposal. Finally, based on our experiences with the validation panels
we held in October and December 1997, we believe the ``top-down''
approach will be less difficult to refine.
10. Description of the Proposed Methodology for Developing Practice
Expense Relative Value Units
(See Addendum B for a detailed technical description of the proposed
methodology.)
a. Overview. We used actual practice expense data by specialty to
create six cost pools (administrative labor, clinical labor, medical
supplies, medical equipment, office supplies, and all other). We then
allocated these cost pools to individual procedure codes. An overview
of this approach is presented in Exhibit 1.
Exhibit 1. Overall Allocation Approach
[GRAPHIC] [TIFF OMITTED] TP05JN98.019
b. Data Sources. We used the 1995 through 1997 AMA's SMS survey
data to develop the cost pools and the CPEP data to allocate these cost
pools to procedure codes.
The AMA originally developed the SMS in 1981. It covers a broad
range of economic and practice characteristics. The annual SMS survey
is designed to provide representative information on the population of
all non-federal physicians who spend the greatest proportion of their
time in patient care activities. The survey is sent to both office and
hospital-based physicians, but excludes residents. The recipients of
the survey are randomly selected from the AMA's physician master file,
which contains current and historical information on every physician in
the United States, including nonmembers of the AMA.
The SMS survey consists of three distinct sections:
Screening questions to verify the physician's self-
designated practice specialty and eligibility for the survey.
A main questionnaire to collect information on practice
characteristics, hours worked, volume of services, fees for selected
procedures, income, and expenses.
Special topic questions to provide information on key
socioeconomic issues.
The SMS survey is a computer-assisted telephone survey that checks
the consistency of responses during the survey and automatically skips
questions that are not relevant to the physician. To prepare the
physician, the AMA mails a practice expense summary in advance. The
physician may designate a proxy such as a practice manager or an
accountant to answer the practice expense questions. The AMA makes
vigorous efforts to achieve a high response rate despite the short
field period of surveys. Each interviewer's work is monitored by
supervisory staff for both production and quality. AMA staff also
monitors interviews to ensure that a high level of quality is
maintained throughout the survey.
The CPEP data were collected from panels of physicians, practice
administrators, and nonphysicians (for example, registered nurses) who
were nominated by physician specialty societies and other groups. There
were 15 CPEPs consisting of 180 members from more than 61 specialties
and subspecialties. Approximately 50 percent of the panelists were
physicians. The CPEPs identified the direct inputs involved in each
physician service for procedure codes in an office setting and out-of-
office setting. (See Addendum A for a detailed description of the CPEP
process.)
c. Practice Expense Cost Pools. We created practice expense cost
pools by physician specialty for clinical labor, administrative labor,
medical supplies, medical equipment, office supplies, and all other
expenses. There are three steps in the creation of the cost pools.
Step 1: Use the AMA's SMS survey data of actual cost data, by
physician specialty, for 1995 through 1997 to determine practice
expenses per hour by cost category.
Step 2: Determine the total number of physician hours, by
specialty, spent treating Medicare patients as reflected in the
Medicare claims data.
Step 3: Calculate the practice expense pools by specialty and by
cost category using the results from step 1 and step 2.
A short description of each step follows.
Step 1: Determine practice expenses per hour by cost category.
Based on the AMA's SMS survey data for each physician respondent,
we calculated practice expenses per hour spent in patient care
activities by cost pool. We made the following assumptions in this
calculation:
The physician respondent shares practice expense equally
with all other physician owners in the practice.
The physician respondent works the same number of hours as
all other physician owners in the practice.
For any employee physician in the practice, the hours
spent in patient care activities are the average hours spent in patient
care activities for employee physicians in the specialty of the
physician respondent.
Using the above assumptions, the practice expenses per hour for
each physician respondent's practice was calculated as the practice
expenses for the practice divided by the total number
[[Page 30828]]
of hours spent in patient care activities by the physicians in the
practice. The practice expenses per hour for the specialty are an
average of the practice expenses per hour for the respondent physicians
in that specialty.
Step 2: Determine the number of physician hours spent treating
Medicare patients.
For each specialty, the total number of physician hours spent
treating Medicare patients was calculated from physician time data for
each procedure code and the Medicare claims data. The primary sources
for the physician time data are surveys submitted to the AMA's RUC and
surveys done by Harvard for the initial establishment of the work RVUs.
Step 3: Determine the practice expense pools by specialty and by
cost category.
The practice expense cost pools for clinical labor, administrative
labor, medical supplies, medical equipment, office expenses, and all
other expenses are determined by multiplying the practice expenses per
hour for these categories (calculated in step 1) by the total physician
hours (calculated in step 2).
d. Cost Allocation Methodology
We allocated by specialty each practice expense cost pool to
individual procedure codes either using the CPEP data for clinical
labor, medical supplies, and medical equipment, or using a combination
of the CPEP data for clinical labor, medical supplies, and medical
equipment and the physician fee schedule work RVUs.
Exhibit 2 depicts our cost allocation methodology. For each
specialty, the six cost pools and their respective cost allocation
bases are used to determine costs for each procedure code.
Exhibit 2. Cost Allocation Methodology
[GRAPHIC] [TIFF OMITTED] TP05JN98.020
Step 4: Allocate the practice expense pools by specialty to
individual procedures.
For each specialty, we separated the six practice expense pools
(clinical labor, administrative labor, medical supplies, medical
equipment, office expenses, and all other expenses) created in Step 3
into two groups and used a different allocation basis for each group.
Group one includes clinical labor, medical supplies, and medical
equipment, and group two includes administrative labor, office
expenses, and all other expenses.
Group one: clinical labor, medical supplies, and medical equipment.
We used the CPEP data as the allocation basis for the group one
pools (clinical labor, medical supplies, and medical equipment). The
CPEP data for clinical labor were used to allocate the clinical labor
cost pool, the CPEP data for medical supplies were used to allocate the
medical supplies cost pool, and the CPEP data for medical equipment
were used to allocate the medical equipment cost pool.
Group two: administrative, labor, office expenses, and other
expenses.
For the allocation of administrative labor, office expenses, and
other expenses, a combination of the group one cost allocations and the
physician fee schedule work RVUs was used to allocate the cost pools.
Step 5: Weight average allocations for procedures performed by more
than one specialty.
For procedures performed by more than one specialty, the final
procedure code allocation was a weighted average of allocations for the
specialties that perform the procedure, with the weights being the
frequency with which each specialty performs the procedure on Medicare
patients.
11. Comments of the American Medical Association Regarding the Use of
the Socioeconomic Monitoring System Survey Data to Construct Practice
Expense Relative Value Units
At our request, the AMA sent two tables summarizing practice
expense information by physician specialty. Additionally, the AMA
supplied us with SMS background information and comments regarding its
use to construct resource-based practice expense RVUs.
The following are the AMA's comments as well as two tables derived
from the SMS data:
The SMS survey is an annual nationally representative survey of
physicians drawn randomly from the AMA's Physician Masterfile (a
listing of all member and nonmember physicians in the United
States). The survey was conducted by an external contractor--the
Rand Corporation was the survey contractor for the 1995 through 1997
SMS surveys. Unit response rates to SMS have been roughly 60 percent
in recent years, which is as high or higher than comparable
physician surveys. It is a computer-assisted telephone survey which
allows checks to be made for the consistency of responses during the
survey and to automatically skip questions that are not relevant to
particular physicians. On the practice expense questions, special
effort is made to obtain accurate information. A practice expense
summary is mailed to all physicians that are to be surveyed to allow
them to obtain the information before being contacted. The physician
may designate a proxy such as a
[[Page 30829]]
practice manager or accountant to answer the practice expense
questions if they do not have the information.
However, it is important to stress that the SMS data were never
collected for the purpose of developing relative values. We feel
that there are several potential problems with using SMS data to
construct practice expense RVUs. These concerns were first raised in
a letter from the AMA to HCFA in November 1996. In particular, we
are concerned that:
--Sample sizes for some specialties will be too small to permit
separate calculation of expense data from SMS. Even among the larger
specialties, the inherent variability of the expense data will mean
that the average expense figures provided will be subject to
significant sampling error.
--Response rates for the expense items tend to be low relative to
other questions on the survey leading to potential non-response
bias.
--SMS is a physician-level survey, and physicians in groups are
asked for their share of expenses rather than the practice's
expenses. Practice-level data may provide a better basis for
constructing practice expense RVUs.
Despite these problems, we recognize your need to use the best
available information. The tables that you requested show the means
and standard errors of practice expenses per direct patient care
hour from the 1995 through 1997 SMS surveys. Since SMS collects
practice expense data for the prior year, these tables summarize SMS
respondents' hourly expenses for the years 1994 through 1996. Only
non-federal, non-resident, patient care physicians are surveyed on
SMS. In addition, only physicians who are full or part-owners of
their practices are asked the practice expense questions. The
following records were excluded prior to tabulating the data as you
requested:
--Physicians practicing fewer than 26 weeks the prior year
(including cases where weeks worked the previous year were missing);
--Cases with a missing response to the question on typical hours in
direct patient care per week (3 cases where the response to this
question was 168 hours were also excluded);
--Cases where any of the individual expense items (total non-
physician personnel expense; clerical non-physician personnel
expense; office expenses; medical supplies expenses; medical
equipment expenses; and other or miscellaneous practice expenses)
were missing; and
--Cases where total expenses (excluding professional liability
insurance premiums and employee physician payroll expense) were
zero.
Expenses per hour were calculated as you requested (and as
described in the notes to the tables). All results were weighted for
unit non-response. It will not be possible to replicate these
figures exactly from the AMA's Physician Marketplace Statistics or
Socioeconomic Characteristics of Medical Practice publications due,
in part, to the exclusions mentioned above.
[[Page 30830]]
Table 1.--Mean Practice Expenses Per Hour Spent in Patient Care Activities, Hours and Expenses Adjusted for Practice Size
[In dollars]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Non-phys Clerical Office Supplies Equipment Other Total
Specialty Number of payroll per payroll per expense per expense per expense per expense per expense per
cases hour hour* hour hour hour hour hour**
--------------------------------------------------------------------------------------------------------------------------------------------------------
ALL PHYSICIANS.................................. 3910 27.0 15.0 19.1 7.2 3.2 11.0 67.5
GENERAL/FAMILY PRACTICE......................... 409 30.2 15.1 18.2 8.1 3.6 8.6 68.6
GENERAL INTERNAL MEDICINE....................... 430 22.4 13.3 17.0 6.4 2.1 6.2 54.2
CARDIOVASCULAR DISEASE.......................... 94 30.2 14.9 19.9 5.8 6.4 20.7 82.9
GASTROENTEROLOGY................................ 84 23.2 15.4 17.9 2.7 1.8 11.0 56.6
ALLERGY/IMMUNOLOGY.............................. 31 66.2 27.0 33.3 17.5 3.3 16.4 136.6
PULMONARY DISEASE............................... 49 20.0 12.2 15.0 2.8 1.6 6.4 45.8
ONCOLOGY........................................ 27 44.7 22.7 25.7 87.2 5.5 10.3 173.4
GENERAL SURGERY................................. 257 22.5 15.7 17.2 3.1 2.0 9.4 54.1
OTOLARYNGOLOGY.................................. 103 44.8 27.3 33.4 7.7 5.8 18.3 110.1
ORTHOPEDIC SURGERY.............................. 203 42.9 26.0 30.8 10.3 3.6 18.1 105.6
OPHTHALMOLOGY................................... 210 52.9 27.8 35.9 11.3 9.0 22.7 131.8
UROLOGICAL SURGERY.............................. 118 29.6 18.6 22.8 24.5 6.0 11.6 94.6
PLASTIC SURGERY................................. 85 28.6 18.3 30.2 16.3 4.6 23.3 103.0
NEUROLOGICAL SURGERY............................ 42 33.5 24.3 31.7 1.8 1.1 15.7 83.9
CARD/THOR/VASC SURGERY.......................... 44 30.1 16.2 18.3 1.4 3.1 11.0 63.8
PEDIATRICS...................................... 249 26.1 13.3 20.0 10.8 1.6 8.4 66.9
OBSTETRICS/GYNECOLOGY........................... 266 32.3 16.9 21.2 7.3 3.4 11.7 75.9
RADIOLOGY....................................... 214 19.0 9.6 12.5 4.8 8.3 13.6 58.2
PSYCHIATRY...................................... 351 7.3 5.3 10.1 0.4 0.3 7.5 25.6
ANESTHESIOLOGY.................................. 232 14.4 3.7 5.9 0.3 0.4 5.7 26.7
PATHOLOGY....................................... 82 16.7 8.4 6.7 4.0 1.6 17.7 46.7
DERMATOLOGY..................................... 96 49.5 26.7 33.1 12.5 4.8 15.2 115.0
EMERGENCY MEDICINE.............................. 61 5.3 1.9 1.6 0.5 0.1 5.5 13.0
NEUROLOGY....................................... 61 26.2 21.6 15.8 5.0 4.2 7.7 58.8
PHYS MED/RHEUMATOLOGY........................... 75 38.6 23.2 28.5 4.9 3.9 12.0 88.0
OTHER SPECIALTY................................. 37 21.1 12.4 19.7 3.6 1.3 9.7 55.4
--------------------------------------------------------------------------------------------------------------------------------------------------------
Source: American Medical Association, 1995-1997 Socioeconomic Monitoring System (SMS) surveys.
* Clerical payroll is included in total non-physician payroll.
** Total expenses exclude professional liability insurance premiums and employee physician payroll.
Notes:
(1) Only self-employed non-federal non-resident patient care physicians who responded to all relevant expense questions are included.
Self-employed physician respondents with no practice expenses for the year are excluded.
(2) Physicians whose typical number of hours worked in patient care activities per week is missing, less than 20, or equal to 168 (3 cases) are
excluded. Physicians whose number of weeks worked the previous year is missing or less than 26 are excluded.
(3) For each respondent, total practice expense and expense components per hour are calculated as (4)/(5) below.
(4) Expenses adjusted for practice size = self-employed respondent expenses* # physician owners.
(5) Hours adjusted for practice size = (respondent hours* # physician owners) + (employee physician hours (see (6) below)* # employee physicians).
6) The typical number of hours worked in patient care activities for the employee physician(s) of a self-employed physician's practice is not known.
Mean hours worked in patient care activities for employee physicians of each specialty are used as an estimate of employee physician hours.
[[Page 30831]]
Table 2.--Standard Errors of Mean Practice Expenses per Hour Spent in Patient Care Activities, Hours and Expenses Adjusted for Practice Size
[In dollars]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Non-phys Clerical Office Supplies Equipment Other Total
Specialty Number of payroll per payroll per expense per expense per expense per expense per expenses
cases hour hour hour hour hour hour per hour **
--------------------------------------------------------------------------------------------------------------------------------------------------------
ALL PHYSICIANS.................................. 3910 0.5 0.3 0.4 0.3 0.2 0.3 1.1
GENERAL/FAMILY PRACTICE......................... 409 1.3 0.6 1.2 0.5 0.7 0.6 3.0
GENERAL INTERNAL MEDICINE....................... 430 1.2 0.6 1.0 0.6 0.3 0.6 2.6
CARDIOVASCULAR DISEASE.......................... 94 2.9 1.4 1.9 0.8 1.3 5.2 8.0
GASTROENTEROLOGY................................ 84 1.6 1.1 1.9 0.3 0.3 2.2 4.1
ALLERGY/IMMUNOLOGY.............................. 31 7.9 3.8 3.8 4.2 1.5 2.9 11.2
PULMONARY DISEASE............................... 49 1.6 1.4 2.2 0.6 0.5 0.9 3.5
ONCOLOGY........................................ 27 7.5 3.8 5.7 16.4 1.4 3.8 23.2
GENERAL SURGERY................................. 257 1.4 0.9 0.9 0.3 0.3 0.8 2.5
OTOLARYNGOLOGY.................................. 103 3.0 2.3 3.5 0.9 1.1 2.1 6.8
ORTHOPEDIC SURGERY.............................. 203 1.7 1.2 2.1 0.8 0.4 2.0 4.7
OPHTHALMOLOGY................................... 210 2.9 1.4 2.6 1.3 1.1 2.1 6.3
UROLOGICAL SURGERY.............................. 118 1.4 1.0 2.1 1.8 1.0 1.4 4.4
PLASTIC SURGERY................................. 85 2.3 1.4 3.5 2.8 1.0 3.4 8.1
NEUROLOGICAL SURGERY............................ 42 4.0 2.5 5.7 0.7 0.4 2.1 9.4
CARD/THOR/VASC SURGERY.......................... 44 4.2 2.0 2.9 0.3 1.7 2.2 8.0
PEDIATRICS...................................... 249 1.6 0.7 1.7 1.0 0.3 1.2 3.8
OBSTETRICS/GYNECOLOGY........................... 266 1.7 0.9 1.3 0.7 0.3 1.0 3.3
RADIOLOGY....................................... 214 2.0 0.9 2.0 0.8 1.9 1.3 5.7
PSYCHIATRY...................................... 351 0.7 0.5 0.6 0.2 0.1 0.6 1.5
ANESTHESIOLOGY.................................. 232 1.8 0.6 0.8 0.1 0.1 0.7 2.4
PATHOLOGY....................................... 82 2.7 1.8 1.7 0.8 0.5 2.9 6.4
DERMATOLOGY..................................... 96 4.8 2.0 5.2 2.0 1.2 1.8 10.4
EMERGENCY MEDICINE.............................. 61 1.4 0.6 0.5 0.3 0.1 0.9 2.1
NEUROLOGY....................................... 61 3.1 3.1 1.4 1.5 1.1 2.2 6.4
PHYS MED/RHEUMATOLOGY........................... 75 5.1 2.5 6.1 0.7 1.4 2.9 12.1
OTHER SPECIALTY................................. 37 4.4 2.4 5.1 1.1 0.6 2.1 9.5
--------------------------------------------------------------------------------------------------------------------------------------------------------
Source: American Medical Association, 1995-1997 Socioeconomic Monitoring System (SMS) surveys.
* Clerical payroll is included in total non-physician payroll.
** Total expenses exclude professional liability insurance premiums and employee physician payroll.
Notes:
(1) Only self-employed non-federal non-resident patient care physicians who responded to all relevant expense questions are included. Self-employed
physician respondents with no practice expenses for the year are excluded.
(2) Physicians whose typical number of hours worked in patient care activities per week is missing, less than 20, or equal to 168 (3 cases) are
excluded. Physicians whose number of weeks worked the previous year is missing or less than 26 are excluded.
(3) For each respondent, total practice expense and expense components per hour are calculated as (4)/(5) below.
(4) Expenses adjusted for practice size = self-employed respondent expenses * # physician owners.
(5) Hours adjusted for practice size = (respondent hours * # physician owners) + (employee physician hours (see (6) below) * # employee physicians).
(6) The typical number of hours worked in patient care activities for the employee physician(s) of a self-employed physician's practice is not known.
Mean hours worked in patient care activities for employee physicians of each specialty are used as an estimate of employee physician hours.
12. Other Methodological Issues
a. Professional and Technical Component Services. Using the
methodology described above, the professional and technical components
of the resource-based practice expense relative value units do not
necessarily sum to the global resource-based practice expense relative
value units since specialties with different practice expenses per hour
provide the components of these services in different proportions. For
example, emergency medicine physicians have proportionately more
professional component chest x-ray billings than global billings
relative to radiologists. We used the following methodologies so that
the professional and technical component resource-based practice
expense relative value units for a service sum to the global resource-
based relative value units.
For codes with professional and technical components excluding
HCPCS codes 70010 through 79440, G0030 through G0047, G0050, G0062,
G0063, G0106, G0120, G0122, G0125, and G0126, we used the following
methodology:
After we determined the practice expense RVUs using the practice
expense per hour methodology, we budget neutrally distributed the total
(global, professional, and technical) practice expense payments for
each code between the global, professional, and technical components as
follows:
Step 1: Calculate a weighted average resource-based practice
expense RVU across the facility and nonfacility settings using the
allowed utilization from the Medicare claims data.
Step 2: Using the RVUs calculated in Step 1 for the global,
professional, and
[[Page 30832]]
technical components of each code and the Medicare utilization data,
calculate the total new resource-based practice expense payments for
each code.
Step 3: Set the global resource-based practice expense RVUs for
each code equal to the sum of the resource-based practice expense RVUs
for the professional and technical components calculated in Step 2.
Step 4: Using the global RVUs calculated in Step 3, the
professional and technical component RVUs calculated in Step 1, and the
Medicare utilization data, calculate practice expense payments for each
code.
Step 5: Multiply the global relative value units calculated in Step
3 and the professional and technical component RVUs calculated in Step
1 by the ratio of the practice expense payments for each code
calculated in Step 2 to the practice expense payments for each code
calculated in Step 4.
For HCPCS codes 70010 through 79440, G0030 through G0047, G0050,
G0062, G0063, G0106, G0120, G0122, G0125, and G0126, we used the
following methodology:
We used the current 1998 practice expense RVUs for this set of
codes, which are based primarily on the original radiology fee
schedule, to determine the relatives between the new resource-based
practice expense relative value units as follows:
Step 1: Using the current 1998 practice expense RVUs, calculate the
current aggregate practice expense payments for this set of codes.
Step 2: Using the resource-based practice expense RVUs determined
from the methodology described above, calculate the aggregate practice
expense payments for this set of codes.
Step 3: Uniformly multiply the current practice expense RVUs by the
ratio of the aggregate resource-based practice expense payments
calculated in Step 2 to the aggregate practice expense payments
calculated in Step 1.
For HCPCS codes Q0092, R0070, and R0075, we used the following
methodology:
The practice expense RVUs for HCPCS code Q0092 was determined by
applying the ratio described in Step 3 above to the existing practice
expense RVUs. The practice expense RVUs for HCPCS codes R0070 and R0075
were determined by applying the ratio described above to practice
expense RVUs for these codes calculated from the average allowed charge
in the Medicare claims data.
b. Practice Expenses per Hour Adjustments and Specialty Crosswalks.
We have one general comment on our use of the SMS practice expense per
hour data. Some practices employ midlevel providers such as nurse
practitioners and optometrists. The practice expenses per hour from the
SMS survey are calculated in terms of hours spent in patient care
activities by physicians in a practice. These practice expenses per
hour are greater than practice expenses per hour spent in patient care
activities by the physicians and midlevel providers in a practice. As a
result, the practice expense per hour methodology is potentially biased
in favor of specialties who use more, relative to other specialties,
midlevel providers as physician extenders to create billable services
under the Medicare fee schedule. Although we made no adjustment to the
practice expenses per hour for this due to a lack of data, we believe
the issue should be examined as part of the refinement of the resource-
based practice expense RVUs.
Below are the adjustments we made to the practice expense per hour
data and the crosswalks we used to assign the specialties reflected in
our claims data to those found in the practice expense tables from the
SMS survey data.
We set the medical materials and supplies practice
expenses per hour for the specialties of ``Oncology'' and ``Allergy and
Immunology'' equal to the medical materials and supplies practice
expenses per hour for ``All Physicians'' since we make separate payment
for the drugs furnished by these specialties.
With regard to oncology, while Medicare does not have an expansive
outpatient drug benefit, it does cover outpatient drugs that are
furnished by a physician, oral cancer drugs, and certain other specific
drugs. In addition to paying for the costs of these drugs (outside the
physician fee schedule), Medicare also makes a separate payment to
physicians for the ``administration'' of cancer drugs (under the
physician fee schedule). This separate payment for chemotherapy
administration recognizes the expenses involved with ordering, storing
and handling, and performing other tasks associated with administering
such drugs. These expenses are practice expenses and are treated as
part of resource-based practice expenses; they are not part of the
costs of the drug and are not included in Medicare payments for
chemotherapy drugs.
We believe that physicians' expenses for the administration of
cancer drugs, as well as the costs of the drugs themselves, are
included in their responses to the AMA survey. Therefore, to avoid a
duplicate payment (that is, paying for the drug separately and also
including the costs of the drug in practice expenses), we need to
separate the costs of the drug from the practice expenses for the
administration of the chemotherapy drugs.
We are proposing to use the ``All Physician'' practice expenses per
hour for medical materials and supplies to reflect, in a relative
sense, all the practice expenses for administration of chemotherapy.
The difference between the practice expense per hour for medical
material and supplies for oncologists and for all physicians would be
the costs of the drugs themselves. We invite comments about our
approach or alternative ways to separate the costs of the drugs from
the costs of their administration.
We based the administrative payroll, office, and other
practice expenses per hour for the specialties of ``Physical Therapy''
and ``Occupational Therapy'' on data used to develop the salary
equivalency guidelines for these specialties. (Since speech and
language pathologists are not identified as Medicare specialties in our
claims data, we could not explicitly use their salary equivalency
guideline data.) The data used to calculate the salary equivalency
practice expenses per hour for these categories of expenses includes an
allowance for 250 square feet of space per therapist, and the utilities
and other overhead to run the practice, including administrative costs.
We set the remaining practice expense per hour categories equal to the
``All Physicians'' practice expenses per hour from the SMS survey data.
We used the clinical payroll expenses for ``All Physicians'' instead of
the salary equivalency data for physical therapy assistants and aides
since we are concerned that there may be an overlap between the cost of
therapy assistants and aides reflected in the practice expenses and the
amount of work allocated to services provided by occupational and
physical therapists.
The following are the crosswalks we used to assign the
specialties reflected in our claims data to those found in the practice
expense tables from the SMS survey data. Note that we refer to the
difference between the nonphysician payroll expenses per hour and the
clerical payroll expenses per hour as the clinical payroll expenses per
hour.
[[Page 30833]]
Table 3.--Practice Expense per Hour Crosswalks
----------------------------------------------------------------------------------------------------------------
Medical Medical Cler.,
HCFA specialty code and AMA specialty Clinical supplies PE/ equipment office, and
description labor PE/Hr Hr PE/Hr other PE/Hr
----------------------------------------------------------------------------------------------------------------
01--General Practice............. General/Family Practice.. $15.10 $8.10 $3.60 $41.90
02--General Surgery.............. General Surgery.......... 6.80 3.10 2.00 42.30
03--Allergy/Immunology........... Allergy And Immunology*.. 39.20 7.20 3.30 76.70
04--Otology, Laryn., Rhino....... Otolaryngology........... 17.50 7.70 5.80 79.00
05--Anesthesiology............... Anesthesiology........... 10.70 0.30 0.40 15.30
06--Cardiology................... Cardiovascular Disease... 15.30 5.80 6.40 55.50
07--Dermatology.................. Dermatology.............. 22.80 12.50 4.80 75.00
08--Family Practice.............. General/Family Practice.. 15.10 8.10 3.60 41.90
10--Gastroenterology............. Gastroenterology......... 7.80 2.70 1.80 44.30
11--Internal Medicine............ General Internal Medicine 9.10 6.40 2.10 36.50
12--Manip. Therapy............... All Physicians........... 12.00 7.20 3.20 45.10
13--Neurology.................... Neurology................ 4.60 5.00 4.20 45.10
14--Neurosurgery................. Neurological Surgery..... 9.20 1.80 1.10 71.70
16--OB-GYN....................... Obstetrics/Gynecology.... 15.40 7.30 3.40 49.80
18--Ophthalmology................ Ophthalmology............ 25.10 11.30 9.00 86.40
19--Oral Surgery................. All Physicians........... 12.00 7.20 3.20 45.10
20--Orthopedic Surgery........... Orthopedic Surgery....... 16.90 10.30 3.60 74.90
22--Pathology.................... Pathology................ 8.30 4.00 1.60 32.80
24--Plastic Surgery.............. Plastic Surgery.......... 10.30 16.30 4.60 71.80
25--Physical Medicine............ Physical Medicine/ 15.40 4.90 3.90 63.70
Rheumatology.
26--Psychiatry................... Psychiatry............... 2.00 0.40 0.30 22.90
28--Colorectal Surgery........... General Surgery.......... 6.80 3.10 2.00 42.30
29--Pulmonary Disease............ Pulmonary Disease........ 7.80 2.80 1.60 33.60
30--Radiology.................... Radiology................ 9.40 4.80 8.30 35.70
33--Thoracic Surgery............. Cardiac/Thoracic/Vascular 13.90 1.40 3.10 45.50
Surgery.
34--Urology...................... Urological Surgery....... 11.00 24.50 6.00 53.00
35--Chiropractor, Licensed....... General Internal Medicine 9.10 6.40 2.10 36.50
36--Nuclear Medicine............. Radiology................ 9.40 4.80 8.30 35.70
37--Pediatrics................... Pediatrics............... 12.80 10.80 1.60 41.70
38--Geriatrics................... General Internal Medicine 9.10 6.40 2.10 36.50
39--Nephrology................... General Internal Medicine 9.10 6.40 2.10 36.50
40--Hand Surgery................. Orthopedic Surgery....... 16.90 10.30 3.60 74.90
41--Optometrist.................. All Physicians........... 12.00 7.20 3.20 45.10
43--CRNA/AA...................... Anesthesiology........... 10.70 0.30 0.40 15.30
44--Infectious Disease........... General Internal Medicine 9.10 6.40 2.10 36.50
46--Endocrinology................ General Internal Medicine 9.10 6.40 2.10 36.50
48--Podiatry..................... General Surgery.......... 6.80 3.10 2.00 42.30
50--Nurse Practitioners.......... General Internal Medicine 9.10 6.40 2.10 36.50
62--Psychologist (Billing Psychiatry............... 2.00 0.40 0.30 22.90
Independently).
65--Physical Therapist (Indep. All Physicians*.......... 12.00 7.20 3.20 10.90
Practice).
66--Rheumatology................. Physical Medicine/ 15.40 4.90 3.90 63.70
Rheumatology.
67--Occupational Therapist....... All Physicians*.......... 12.00 7.20 3.20 10.90
68--Clinical Psychologist........ Psychiatry............... 2.00 0.40 0.30 22.90
69--Independent Laboratory....... All Physicians........... 12.00 7.20 3.20 45.10
70--Clinic Or Other Group........ All Physicians........... 12.00 7.20 3.20 45.10
76--Periperal Vascular Disease... All Physicians........... 12.00 7.20 3.20 45.10
77--Vascular Surgery............. Cardiac/Thoracic/Vascular 13.90 1.40 3.10 45.50
Surgery.
78--Cardiac Surgery.............. Cardiac/Thoracic/Vascular 13.90 1.40 3.10 45.50
Surgery.
79--Addiction Medicine........... Psychiatry............... 2.00 0.40 0.30 22.90
80--Clinical Social Worker....... Psychiatry............... 2.00 0.40 0.30 22.90
81--Critical Care (Intensivists). All Physicians........... 12.00 7.20 3.20 45.10
82--Hematology................... General Internal Medicine 9.10 6.40 2.10 36.50
83--Hematology/Oncology.......... Oncology*................ 22.00 7.20 5.50 58.70
84--Preventive Medicine.......... General Internal Medicine 9.10 6.40 2.10 36.50
85--Maxillofacial Surgery........ All Physicians........... 12.00 7.20 3.20 45.10
86--Neuropsychiatry.............. Psychiatry............... 2.00 0.40 0.30 22.90
89--Clinical Nurse Practitioner.. General Internal Medicine 9.10 6.40 2.10 36.50
90--Medical Oncology............. Oncology................. 22.00 7.20 5.50 58.70
91--Surgical Oncology............ All Physicians........... 12.00 7.20 3.20 45.10
92--Radiation Oncology........... Radiology................ 9.40 4.80 8.30 35.70
93--Emergency Medicine........... Emergency Medicine....... 3.40 0.50 0.10 9.00
94--Interventional Radiology..... Radiology................ 9.40 4.80 8.30 35.70
95--Indep. Physiological Lab..... All Physicians........... 12.00 7.20 3.20 45.10
97--Physician Assistants......... General/Family Practice.. 15.10 8.10 3.60 41.90
98--Gynecology/Oncology.......... Obstetrics/Gynecology.... 15.40 7.30 3.40 49.80
----------------------------------------------------------------------------------------------------------------
* Practice expense per hour were adjusted as follows:
(1) Allergy & Immunology and Oncology use supplies for All Physicians.
(2) Physical Therapy and Occupational Therapy use salary equivalency data for clerical, office and other
practice expenses per hour.
[[Page 30834]]
Due to uncertainty concerning the appropriate crosswalk
and time data for the nonphysician specialty ``Audiologist'' and the
fact that the relatively few codes performed by audiologists are also
performed by other specialties, we did not crosswalk this specialty.
Until we can obtain more data, we derived the resource-based practice
expense RVUs for codes performed by audiologists from the practice
expenses per hour of the other specialties which perform these codes.
Because we have no reason to assume that the distribution
of radiologists by equipment ownership reflected in the SMS survey data
differs from the distribution found in our claims data, we did not
attempt to differentiate the practice expenses per hour for
radiologists by equipment ownership. The use of the average practice
expenses per hour should create the appropriate practice expense pool
for radiology. We invite comments on this issue. We realize that
practice expenses vary by equipment ownership; however, the appropriate
recognition of this is through the differential allocation of the
practice expense pool to the professional, technical, and global
services performed by radiologists.
c. Time Associated with the Work Relative Value Units. As a
general comment on the time data, we are concerned that any imprecision
in the time estimates for high volume services which have relatively
little time associated with them may potentially bias the practice
expense methodology in favor of the specialties which perform these
services. For example, if a high volume procedure which typically takes
four minutes to perform has a surveyed time of 5 minutes, this
procedure's contribution to the practice expense pool for that
specialty is inflated by 25 percent. In contrast, if a procedure which
typically takes 100 minutes to perform has a surveyed time of 101
minutes, its contribution is only inflated by 1 percent. We believe
this issue should be examined as part of the refinement of the
resource-based practice expense RVUs.
The time data from the Harvard study performed for the
initial establishment of the work relative value units were collected
over a number of years using primarily surveys of practicing
physicians. The time data submitted to the RUC for the refinement of
the work relative value units were also collected over a number of
years using primarily physician surveys. The time data resulting from
the refinement of the work relative value units have been
systematically greater than the time data obtained by the Harvard study
for the same services. On average, this difference is approximately 25
percent. We increased the Harvard time data in order to ensure
consistency between these data sources.
We calculated the total physician time for CPT codes 70010
through 79440 using the work RVUs and the work per unit time for CPT
99213, except for codes in the range of CPT codes 78000 through 78891
for which we had Harvard survey data and codes for which we had data
from surveys done for the AMA RUC.
Based on the judgment of our clinical staff, we calculated
the total physician time for CPT codes 90918 through 90921 using the
work RVUs and the work per unit time for CPT code 99213.
Based on the judgment of our clinical staff, we set the
total time associated with the work RVUs for CPT 97001 through 97770 as
follows:
------------------------------------------------------------------------
Time
HCPCS (min)
------------------------------------------------------------------------
97001.......................................................... 30
97002.......................................................... 20
97003.......................................................... 45
97004.......................................................... 30
97010.......................................................... 5
97012.......................................................... 15
97014.......................................................... 13
97016.......................................................... 18
97018.......................................................... 13
97020.......................................................... 14
97022.......................................................... 15
97024.......................................................... 15
97026.......................................................... 10
97028.......................................................... 9
97032.......................................................... 18
97033.......................................................... 14
97034.......................................................... 16
97035.......................................................... 12
97036.......................................................... 15
97039.......................................................... 10
97110.......................................................... 15
97112.......................................................... 15
97113.......................................................... 15
97116.......................................................... 15
97122.......................................................... 15
97124.......................................................... 15
97139.......................................................... 15
97150.......................................................... 15
97250.......................................................... 15
97260.......................................................... 15
97261.......................................................... 15
97265.......................................................... 15
97504.......................................................... 15
97520.......................................................... 15
97530.......................................................... 15
97535.......................................................... 15
97537.......................................................... 15
97542.......................................................... 15
97703.......................................................... 15
97750.......................................................... 15
97770.......................................................... 15
------------------------------------------------------------------------
A high percentage of codes performed by the nonphysician
specialties of Independent Physiological Lab, Clinical Psychologist,
and Psychologist (Independent Billing) do not have work RVUs and,
therefore, time data. Because the practice expenses per hour for these
specialties were crosswalked from SMS specialties, when calculating
their practice expense pools we used the maximum clinical staff time
from the CPEP data for the codes that lack work RVUs.
We calculated the time for CPT codes 00100 through 01996
using the base and time units from the anesthesia fee schedule and the
Medicare allowed claims data.
13. Other Practice Expense Policies
a. Site-of-Service Payment Differential. Under the physician fee
schedule, if a physician service of the type routinely furnished in
physician offices is furnished in facility settings, our current policy
is that the fee schedule amount for the service is determined by
reducing the practice expense RVUs for the service by 50 percent.
Certain services are excluded from the regulation including rural
health clinic services, surgical services not on the ambulatory
surgical center covered list that are furnished in an ambulatory
surgical center, anesthesia services, and diagnostic and therapeutic
radiology services (see Sec. 414.32 (Determining payments for certain
physician services furnished in facility settings)).
The site-of-service payment differential is a long established
policy to avoid duplicate payments for practice costs while, at the
same time, recognizing that some office practice cost is incurred when
physicians perform procedures outside the office setting. The site-of-
service policy applies to both inpatient and outpatient hospital
settings.
Since the implementation of the physician fee schedule, we have
compiled a list of services furnished outside physician offices that
are subject to the site-of-service payment differential. The current
list includes approximately 700 services.
As part of the resource-based practice expense initiative, we are
proposing to replace the current policy that systematically reduces the
practice expense RVU by 50 percent for certain procedures with a policy
that would generally identify two different levels (facility and
nonfacility) of practice expense RVUs for each procedure code depending
on the site-of-service. In general, we would furnish two levels of
practice expense RVUs per code; one when the procedure is performed in
the office or other site (or nonfacility) if no additional facility fee
is paid and
[[Page 30835]]
another when the procedure is performed out of the office (for example,
in a hospital or an ambulatory surgical center in which the costs of
resources, such as labor, medical supplies, and medical equipment are
paid outside the physician fee schedule and only to the hospital or
ambulatory surgical center).
Some services, by the nature of their codes, are performed only in
certain settings and would have only one level of practice expense RVU
per code. Many of these are evaluation and management codes with code
descriptions specific as to the site of service. Examples of these
codes are the following:
Inpatient hospital care for new or established patients
(CPT codes 99221 through 99223).
Subsequent hospital care (CPT codes 99231 through 99239).
Emergency department services for new or established
patients (CPT codes 99281 through 99285).
Critical care services (CPT codes 99291 through 99297).
Nursing facility services (CPT codes 99301 through 99303).
Subsequent nursing facility care (CPT codes 99311 through
99313).
Domiciliary, rest home (CPT codes 99321 through 99333).
Home services (CPT codes 99341 through 99350.
We note that office or outpatient evaluation and management
services (CPT codes 99201 through 99215) are used to report services
furnished in the physician office or in a hospital outpatient
department; therefore, these procedure codes will have different levels
of practice expense RVUs. Other services, such as most major surgical
services with a 90-day global period, are performed entirely or almost
entirely in the hospital, and we are generally providing a practice
expense RVU only for the out-of-office or facility setting.
In the majority of cases, however, we would provide both facility
and nonfacility practice expense RVUs. The higher nonfacility practice
expense RVUs are generally used to calculate payments for services
performed in a physician office and for services furnished to a patient
in the patient's home, or facility or institution other than a
hospital, skilled nursing facility, or ambulatory surgical center. For
these services, the physician typically bears the cost of resources,
such as labor, medical supplies, and medical equipment associated with
the physician service.
The lower facility practice expense RVUs generally are used to
calculate payments for services furnished to hospital, SNF, and
ambulatory surgical center patients. The costs for nonphysician
services and other items, including medical equipment and supplies, are
typically borne by the hospital, by the SNF, or the ambulatory surgical
center.
b. Additional Relative Value Units for Additional Office-Based
Expenses for Certain Procedure Codes. Usually office medical supplies
or surgical services in the physician office are included in the
practice expense portion of the payment for the medical or surgical
service to which they are incidental. The November 1991 final rule (56
FR 59522) included a policy that allowed a practice expense RVU of 1.0
to pay for the supplies that are used incident to a physician service
but generally are not the type of routine supplies included in the
practice expense RVUs for specific services. For example, if the
physician performed a cystourethroscopy with a biopsy (CPT code 52204)
in the office and billed for a surgical tray (HCFA Common Procedure
Coding System (HCPCS) code A4550) in addition to the procedure, the
physician would receive approximately $34.86 (an RVU of .95) for the
surgical tray in addition to the payment for the cystourethroscopy with
biopsy. The November 1991 final rule (56 FR 59811) listed 44 procedure
codes that qualified for additional RVUs if furnished in the physician
office. This list was expanded in the December 1993 final rule (58 FR
63854) to include several cystoscopy codes. Included in this list of
procedures for which an additional amount for supplies may be paid if
performed in a physician office are closing a tear duct (CPT code
68671) and billing for a permanent lacrimal duct implant (HCPCS A4263)
and inserting an access port (CPT code 36533) and billing for an
implantable vascular access portal/catheter (A4300). These supplies
were given the same RVU as HCPCS code A4550.
We are proposing to revise this policy under the resource-based
practice expense system. We believe the supply costs that this policy
is designed to cover were included in the supply inputs identified by
the CPEPs and the AMA's SMS survey. Thus, they were included in the
practice expense RVUs for each related procedure code. Therefore, we
are proposing to discontinue separate payment for supply codes A4263,
A4300 and A4550.
c. Anesthesia Services. Although physician anesthesia services are
paid under the physician fee schedule, these services do not have
practice expense RVUs. Rather, payment for physician anesthesia
services is determined based on the sum of allowable base and time
units multiplied by a locality-specific anesthesia CF.
Since the beginning of the physician fee schedule, overall budget
neutrality and work adjustments have been made to the anesthesia CF and
not to the base and time units. We are proposing to follow the same
process and make an adjustment to the anesthesia CF to move anesthesia
services under the resource-based practice expense system. The
adjustment to the anesthesia CF is 3.5 percent.
14. Refinement
Section 4505(d)(1)(C) of the BBA requires the Secretary to develop
a refinement process to be used during each of the 4 years of the
transition period. In this section, we will describe those aspects of
this proposed rule that we believe are subject to refinement as well as
our proposed process for refinement during the coming year. In light of
the complexity of the issues associated with establishing the initial
proposed practice expense RVUs, we believe it is premature to propose,
in this proposed rule, the refinement process for subsequent years of
the transition period. We also believe it would be premature to
finalize the practice expense RVUs before the fall of 1999. Therefore,
we will keep the practice expense RVUs as interim RVUs until at least
the fall of 1999. We also are open to extending the period during which
the practice expense RVUs are interim beyond 1999 if we believe that
more time is needed to identify and correct errors.
We are particularly interested in receiving comments on our
proposed refinement process for this year, and we are soliciting
recommendations for the process in subsequent years. Based on our
analysis of comments we receive, we hope to describe our plans for the
entire refinement process in the final rule.
a. Issues Involved in Refinement. We believe the refinement process
for practice expense RVUs will enable us to:
Review and refine practice expense/hour data.
Obtain and review practice expense/hour data for
specialties or practitioners not included in the SMS survey.
Address anomalies, if any, in the code-specific Harvard/
RUC physician time data.
Address anomalies, if any, in the code-specific CPEP data
on clinical staff types and times, quantity and cost of medical
supplies, and quantity and cost of medical equipment.
Refine, as needed, our process of developing practice
expense RVUs for codes that were not addressed by the
[[Page 30836]]
CPEP process, for example, codes that were new in 1996, 1997, and 1998.
Develop practice expense RVUs for codes that will be new
in 1999 and beyond.
Our plans for each of these six points are as follows:
Refinement of the practice expense/hour data. The practice
expense/hour data are based on the SMS survey. (These data can be found
in Table 1). Although the SMS survey was not designed to support the
development of practice expense RVUs, we believe it is the best
available source of data on actual practice costs that allows us to
recognize all staff, equipment, supplies, and expenses, not just those
that can be tied to specific procedures. In fact, we believe one
advantage of the SMS data is that they were collected before this
proposed rule.
The SMS survey data used in this proposed rule do not include the
practice expense information on all specialties recognized by Medicare.
However, for certain larger specialties, for example, family practice
and general surgery, the sample of physicians surveyed is of sufficient
size to serve as the basis of the practice expense/hour calculation in
the short term. For those larger specialties, we are unlikely to make
any changes in the practice expense/hour calculation in the final rule
to be published this fall. In the long term, specifically, 1999 and
beyond, we are prepared to refine the practice expense/hour data of the
larger specialties if we receive compelling evidence that the SMS data
are incorrect. Any arguments that the practice expense/hour for a given
specialty should be changed would be strengthened by the submission of
survey data comparable to the SMS that include data for a range of
specialties expected to gain and lose Medicare revenue.
We are concerned that the validity of future SMS surveys could be
affected if we decided to explicitly link the data collected to future
revisions of the Medicare fee schedule. Also, SMS is a physician level
survey, and physicians in groups are asked for their share of expenses
rather than the practices' expenses. Practice level data may provide a
better basis for constructing practice expense RVUs. We invite comments
on potential revisions to the SMS survey or alternative sources of data
that could be used for long term refinement. Finally, because the
calculation of the practice expense/hour is so critical to our
methodology, we also invite comment on the need to confirm, through
audit or other means, the survey data that would be used for long term
refinement.
Refinement of the crosswalk for the practice expense/hour
data. The SMS data we used for this proposed rule do not include data
for all specialties that are recognized by Medicare, and they do not
include data on nonphysician practitioners who are paid under the
physician fee schedule. To develop this proposal, it was necessary to
crosswalk certain specialties and nonphysician practitioners to the
practice expense/hour data we developed for the specialties included in
the SMS. We invite comments on the appropriateness of our crosswalks.
Any arguments that the practice expense/hour data should be changed
would be strengthened by the submission of survey data comparable to
the SMS data.
Refinement of the physician time data. The number of
practice expense RVUs assigned to the services performed by a given
specialty is determined by the practice expense/hour data from the SMS
and the physician time data for each of the codes. The physician time
data are based on the Harvard resource-based RVS study and RUC survey
data that were developed as part of the refinement of the work RVUs. We
are confident that these data are accurate although there may be some
codes for which the final work RVUs we have assigned may be
inconsistent with the time data. We will accept comments on the code-
specific physician time data but must point out that any proposed
revisions to the time data have implications for the work RVUs assigned
to those codes. We do not intend to revisit work RVU issues that have
been already addressed as part of the 5-year review. (Total physician
time data can be found in the ``Total Physician Time'' file located on
the HCFA Homepage. Specific instructions for accessing this and other
Internet files referred to in this proposed rule can be found at the
end of this refinement section.)
Refinement of the CPEP data. The identification and
correction of errors, if any, in the code-specific CPEP data on
clinical staff types and times, quantity and cost of medical supplies,
and quantity and cost of medical equipment has its principal effect on
the relative relationship of the practice expense RVUs assigned to
services performed by a given specialty.
It is important to understand that the allocation of practice
expense RVUs at the code level is based on CPEP data that have not been
revised or edited in any fashion. We have not made any revisions or
edits for two main reasons. First, we received many comments in
response to last year's proposed rule that objected to the data
reasonableness edits and caps that were part of our proposal. Second,
we received many comments in response to June 1997 proposed rule that
objected to our decision to exclude from the CPEP data the direct
inputs for medical equipment, medical supplies, and clinical staff
recorded for hospital patients. In addition, we found this decision to
be quite controversial in subsequent meetings with representatives of
various specialty societies. Under our proposed methodology that begins
with the total practice expense costs, the question as to the
appropriateness of including the direct inputs for medical equipment,
medical supplies, and clinical staff in the inputs for hospital
patients is much less important because the inclusion of the data
impacts the distribution of practice expense RVUs across the entire fee
schedule only to the extent codes are performed by more than one
specialty.
For example, if a given specialty performs cardiovascular
procedures, including time for nursing staff in the hospital for these
procedures allocates more of the fixed practice expense pool of dollars
for that specialty to these procedures, leaving fewer dollars for the
other codes performed by that specialty. We believe the most
appropriate method for determining the relative relationship of the
RVUs assigned to cardiovascular procedures in this proposed rule is to
rely on the CPEP that developed the inputs for those procedures.
Therefore, the direct inputs for medical equipment, medical supplies,
and clinical staff recorded for hospital patients have not been removed
from the CPEP data.
In deciding not to modify the CPEP data, we recognize the
possibility that the RVUs assigned to some codes will appear to be
incorrect or anomalous. Any apparent errors will be identified and
corrected in response to the comments we receive on this proposed rule
and through our refinement process. We received comments in response to
last year's proposed rule that pointed out apparent errors in the RVUs,
and many of the CPEP inputs were revised during the validation panels
we conducted in October 1997. We have not incorporated any of those
revisions to the data primarily because our methodology for developing
RVUs has been revised, and we were not convinced that all the revisions
that occurred during the validation panels were correct. To the extent
that commenters believe that previously submitted comments are still
valid or that data revisions that occurred during the validation panels
are still
[[Page 30837]]
appropriate, we request that they again be brought to our attention in
response to this proposed rule.
While we will accept comments on any code-specific data, we
recommend that commenters focus their attention during this comment
period on high-volume services with large aggregate expenditures under
Medicare. We will review the comments with the assistance of our
carrier medical directors. Time constraints preclude convening multiple
specialty panels to assist us in our review of the comments. However,
as noted above, the practice expense RVUs would be interim values for
at least 1999, including those we change as a result of our review of
the comments.
Because all of the practice expense RVUs will be interim during
1999, commenters will have another opportunity to identify errors in
the code-specific CPEP data during the comment period of the final rule
with comment period to be published in the fall of 1998. We believe
that the codes identified as possible errors during the comment periods
of the proposed rule and the final rule will constitute the universe of
codes whose code-specific CPEP data should be reviewed. In other words,
although we may keep all the practice expense RVUs interim beyond 1999
as we refine other aspects of the physician fee schedule, it is not our
intention to continually review the inputs for all the codes on the fee
schedule on an annual basis.
We do believe it is important to have the advice of practicing
physicians on the appropriateness of recommended changes to the CPEP
inputs. We have two principal options for obtaining that advice. The
first option would be for us to convene multiple specialty panels to
review the recommended changes. The second option would be to ask the
RUC, or a new organization like the RUC that includes broad
representation across all specialties and includes nonphysician
practitioners, to do this. We believe that under either option, the
panel or panels should include individuals other than physicians, for
example, practice managers or nurses, who could bring additional
experience and expertise to the discussion. The panels would need to
meet no later than the summer of 1999 to consider the comments we
received on both the proposed rule and the final rule. We invite
comments on these options and would welcome any other recommendations.
Refinement of the crosswalk for 1996, 1997, and 1998
codes. Because the CPEP process was based on 1995 CPT codes, it was
necessary for us to develop practice expense RVUs for new codes that
were developed for the 1996, 1997, and 1998 CPT books. The process we
used was based on comparing the new codes to other comparable codes for
which we had actual CPEP data. Files containing information about the
crosswalks used for codes that were new in 1996, 1997, and 1998 are
available on the HCFA homepage under the heading ``CPEP Data
Crosswalked to 1998 CPT Codes.'' Since this crosswalk was based on our
judgment rather than actual data, we invite comments on the
appropriateness of our crosswalks. Also, we will accept new code
specific-data on clinical staff types and times, quantity and cost of
medical supplies, and quantity and cost of medical equipment. Any
comments we receive on these codes will be reviewed as part of the
process of review described above.
Development of practice expense RVUs for codes that will
be new in 1999 and beyond. There will be new codes included in CPT 1999
for which we will not have practice expense data in time for
publication in the 1998 final rule. We plan to develop interim practice
expense RVUs for these codes by preparing a crosswalk of CPEP data from
existing codes. The crosswalk we use will be available with the final
rule, and the practice expense values for the codes will be subject to
comment. However, the interim values will serve as the basis of payment
during 1999.
We do not believe that preparing a crosswalk of new codes is the
most appropriate method of developing practice expense RVUs for new
codes. However, for 1999, time constraints do not permit any other
approach. Beyond 1999, we would like to develop a process whereby we
receive recommended practice expense RVUs or recommended inputs for
clinical staff types and times, quantity and cost of medical supplies,
and quantity and cost of medical equipment.
For the assignment of work RVUs to new and revised codes, we first
look to the RUC for recommended RVUs. Under that process, codes that
will be new or revised in the next year's CPT are referred from the CPT
editorial panel to the RUC. Specialty societies are informed of these
codes and furnished an opportunity to survey a sample of physicians in
their specialty for the development of recommended RVUs. The entire RUC
then reviews the survey results and forwards the recommended work RVUs
to us.
We then review the RUC's recommended work RVUs with the assistance
of our Medicare carrier medical directors and publish our decisions as
interim RVUs in the final rule for the upcoming year. For example, work
RVUs for codes that were new or revised in CPT 1998 were published as
interim RVUs in the October 1997 final rule.
Publishing RVUs as interim allows the public the opportunity to
furnish comments on the appropriateness of our interim work RVUs.
During the following year, we review any comments we have received with
the assistance of multiple-specialty panels we have convened. We
consider our analysis of any comments on the interim work RVUs and the
advice we receive from the multiple specialty panels in the assignment
of the final work RVUs that are announced in the final rule for the
next year's physician fee schedule.
For practice expense RVUs, we believe there are two principal
options. First, we could continue to crosswalk new codes to existing
codes, publish the results of that crosswalk as interim practice
expense RVUs in the final rule, and review comments we receive with the
assistance of our multiple specialty panels. Second, we could request
the RUC or a RUC-like organization to provide recommended practice
expense RVUs or recommended inputs before publication of the proposed
rule as we do with work RVUs. This approach would allow us to publish
interim RVUs based on the advice of practicing physicians. As with the
work RVUs, any comments we received on the interim RVUs could then be
reviewed with the assistance of HCFA multiple specialty panels. We
invite comments on these options and would welcome any other
recommendations.
b. Example of the Process for Reviewing and Commenting on Practice
Expense Relative Value Units. To facilitate the development of
responses to this proposed rule, to illustrate the issues involved in
refining the RVUs for practice expense, and to furnish further guidance
on the use of the data files that are available on the Internet, we are
furnishing the following analysis of an apparent anomaly in a family of
codes. This analysis is intended to serve as an example of the process
for reviewing and commenting on the practice expense RVUs. We have not
concluded that revisions to the RVUs proposed for this family of codes
are warranted. In the event that no comments are received on the RVUs
for these codes, it is unlikely that we will make any revisions.
In the ophthalmology section of the CPT, there are four codes for
the reporting of eye exams. The codes, brief descriptors, and the
proposed practice expense RVUs follow:
[[Page 30838]]
------------------------------------------------------------------------
Practice
Code Descriptor expense
RVUs
------------------------------------------------------------------------
92002........................... Eye exam, new patient, 0.96
intermediate.
92004........................... Eye exam, new patient, 1.58
comprehensive.
92012........................... Eye exam, established 1.26
patient, intermediate.
92014........................... Eye exam, established 1.25
patient, comprehensive.
------------------------------------------------------------------------
We believe there is a rank order anomaly in this family. We
expected that the practice expense RVUs for new patients would be
higher than the practice expense RVUs for established patients and that
the practice expense RVUs for comprehensive visits would be higher than
practice expense RVUs for intermediate visits. For example, we expected
that CPT code 92014 would have higher practice expenses than CPT code
92012, which is not the case.
To analyze this apparent anomaly, we first reviewed the data on
which specialties furnish the services. These data are located on the
HCFA Homepage under the file name ``Procedure Code Utilization by
Specialty.'' This analysis is important because one potential cause of
an anomaly is that codes in a given family of codes are performed by
physicians in different specialties whose practice expenses per hour
are different. In this case, the dominant specialty performing the
codes is ophthalmology. Optometrists also perform these services but
with less frequency than ophthalmologists. In Table 2, the sum of the
practice expenses per hour for ophthalmology is $131.80, and the sum of
the practice expenses per hour for optometry is $67.50. Although the
practice expense per hour differs for ophthalmology and optometry
because ophthalmology is by far the dominant specialty, this anomaly
cannot be attributed to differences in practice expense per hour.
We next reviewed the code-specific data for in-office services on
clinical labor, equipment, and supplies that are included in the file
``CPEP Data Converted Into 1998 Dollar Amounts,'' located on the HCFA
Homepage. This file is based on the raw CPEP data that have been
converted to monetary amounts. It is considerably easier to review than
the raw CPEP data because it includes fewer data points per code. (The
file containing raw CPEP data, ``Raw CPEP Data'', can also be found in
the HCFA Homepage. Both of these files also contain CPEP data for
supplies and equipment.)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total %
Code Descriptor Clin Eqp Sup services Ophthalmology % Optometry
--------------------------------------------------------------------------------------------------------------------------------------------------------
92002.................................... Eye exam, new patient, 15.44 11.76 3.41 354,000 48 50
intermediate.
92004.................................... Eye exam, new patient, 16.87 12.85 3.41 1,866,000 72 27
comprehensive.
92012.................................... Eye exam, est. patient, 11.15 8.49 27.60 6,022,000 85 13
intermediate.
92014.................................... Eye exam, est. patient, 14.01 10.67 3.41 6,980,000 79 20
comprehensive.
--------------------------------------------------------------------------------------------------------------------------------------------------------
These data show that the relative relationship within the family of
codes appears to be appropriate for clinical staff and equipment.
However, for supplies there is a large discrepancy in that the supply
costs for code 92012 are eight times greater than the supply costs for
the other three codes. To determine whether the supply costs for code
92012 are too high or the supply costs for the other three codes are
too low, it is necessary to review the actual supply inputs assigned to
the codes by the CPEP. These data may be found as a subdirectory of the
file, ``CPEP Data Converted to 1998 Dollars.'' We reviewed the inputs
but have made no judgments about them. We believe the inputs should be
reviewed by the specialties providing the service.
As can be seen in the table, 85 percent of the code 92012 services
are furnished by ophthalmologists, and 13 percent are furnished by
optometrists. The table also shows that this is a high volume family of
codes and that errors in the CPEP data could cause distortions in the
relative relationships of the RVUs assigned to services furnished by
ophthalmologists and optometrists. Under our proposed methodology for
developing RVUs, any revisions to the CPEP data will primarily impact
only those specialties that furnish the service. Thus, if we determine
that the supply inputs for code 92012 include items that are not
typically furnished and are recommended for removal, that will ``free
up'' RVUs that can be redistributed across the other services furnished
by the two specialties.
Conversely, if it is determined that the supply inputs for the
other three codes are missing items that are typically furnished and
are recommended for inclusion, that will require RVUs to be taken from
the other services furnished by the two specialties, not from other
services on the physician fee schedule. We view this as a significant
advantage of our proposed methodology in that the highly contentious
atmosphere of refinement under our earlier methodology is greatly
reduced because, except when multiple specialties perform the same
service, agreement or disagreement with the CPEP inputs of one
specialty does not directly impact the RVUs assigned to services
furnished by other specialties.
c. Information on Accessing Data Files on HCFA's Homepage. The
aforementioned files can be obtained on the HCFA Homepage at
``www.hcfa.gov.'' Following is the step by step process by which the
data files can be accessed.
Step 1: After accessing the HCFA Homepage go to Stats and Data.
Step 2: Go to 1999 Resource-Based Practice Expense.
Step 3: Under Resource-Based Practice Expense, you will have the
option of accessing one of six files related to resource-based practice
expense:
Raw CPEP Data
This file includes the original CPEP data. There are four subgroups
within this file:
Clinical Work
Medical Supplies
Procedure Specific Medical Equipment
[[Page 30839]]
Overhead Medical Equipment
1998 Code Crosswalks
Since the CPEP data were based upon 1995 data, we performed
crosswalks for codes which were new codes in 1996, 1997, and 1998. This
file shows the crosswalks that were used for all codes that were new
after 1995. In addition, this file also contains those codes gap-filled
based on analogous procedures due to an absence of data from the CPEP
process.
CPEP Data Crosswalked to 1998 Codes
This file crosswalks all CPEP data to 1998 codes.
CPEP Data Converted to 1998 Codes Converted Into Dollars
This file converts the CPEP data, crosswalked to 1998 codes, into
dollars.
Procedure Code Utilization by Specialty
This file shows the Medicare allowed services for each procedure
code performed by each specialty.
Time Associated With the Work Relative Value Units
This file contains the time associated with the work RVUs for each
procedure.
15. Reductions in Practice Expense Relative Value Units for Multiple
Procedures
In the June 1997 proposed rule (62 FR 33171), we had recommended
reducing the practice expense RVUs for multiple nonsurgical services
performed at the same time as an evaluation and management service. We
had proposed this as a way to reflect the lower practice costs that
would result when more than one service is performed during a single
patient encounter. Many commenters, as well as the Medicare Payment
Advisory Commission (MEDPAC), recommended that we not implement a
multiple procedure reduction, at least until this issue has been
further studied.
We have decided not to propose this reduction at this time but will
consider it in the future. We invite comments on this specific issue.
The current multiple surgical procedure reduction policy with regard to
physician work is not affected by the practice expense proposal.
16. Transition
Under the transition enacted under BBA 1997, practice expense RVUs
in 1999 are to be based 75 percent on the old method and 25 percent on
the resource-based method. In 2000, the shares are 50 percent old
method and 50 percent resource-based. In 2001, the shares are 25
percent old method and 75 percent resource-based. Beginning in 2002,
practice expense RVUs are entirely resource-based.
In our October 1997 final rule (62 FR 59052), we indicated that the
old method to be used in the formula constitutes the 1998 practice
expense RVUs actually used for payment. We received a comment that
suggested that we consider an alternative interpretation of the law for
purposes of the transition starting point that would eliminate the 1998
changes in practice expenses enacted by BBA 1997. This comment was
based on the theory that the 1998 changes were for 1 year only and not
intended to be included in the base practice expense used for the
transition. This alternative would result in higher payments for
certain specialty procedures and lower payments for medical visits
during 1999, 2000, and 2001. Beginning in 2002, the starting point for
the transition does not matter as practice expenses are entirely
resource-based.
We have considered this suggestion. We do not believe that we can,
as suggested by the commenter, utilize 1997 practice expense RVUs
actually used for payment because we do not believe that we could treat
the reductions enacted in BBA 1997 for 1998 differently from the
similar reductions enacted in OBRA 1993 on practice expenses for 1994,
1995, and 1996. That is, the effects of both amendments should be
included in the base or excluded. We believe that the appropriate
option, other than using 1998 practice expense RVUs, is to exclude the
effects of both the OBRA 1993 and BBA 1997 provisions and revert to
practice expense RVUs as they existed before any amendments. We do not
believe that this is the better alternative. In addition to creating
practical problems of requiring imputation of practice expense RVUs for
the many new codes that have been established between 1991 and 1998, it
would seem contrary to the statute's plain intent of moving toward a
resource-based payment system. This alternative could also potentially
result in a ``yo-yoing'' of practice expense RVUs between 1998 and
future years. Practice expense RVUs for certain procedures explicitly
increased by the Congress in 1998 could be reduced in 1999 only to be
increased again when the practice expense is fully resource-based. If
we were to use 1997 RVUs as the base for the transitions, payments for
office visit procedure codes, for example, would likely decrease
noticeably during 1999, reversing the clear policy the Congress enacted
in BBA 1997 by raising them. To adopt such a construction of the law
would not gradually ``transition'' payments to the new resource-based
system, but instead would represent an abrupt change in direction, a
result at odds with the purpose of having a transition period and with
transitions previously established for payment changes in Medicare. We
find nothing in the legislative history to suggest that the Congress
intended such an atypical transition. Therefore, we propose to use the
1998 practice expense RVUs for purposes of the blend during the
transition years of 1999, 2000, and 2001.
17. Proposed Regulation Revisions
We are proposing to revise Sec. 414.22 (Relative value units
(RVUs)), paragraph (b), (Practice expense RVUs), to state that for
services beginning January 1, 1999, the practice expense RVUs would be
based on a blend of 75 percent of the 1998 code-specific practice
expense RVUs and 25 percent of the relative practice expense resources
involved in furnishing the service. For services beginning January 1,
2000, the practice expense RVUs would be based on a blend of 50 percent
of the 1998 code-specific practice expense RVUs and 50 percent of the
relative practice expense resources involved in furnishing the service.
For services beginning January 1, 2001, the practice expense RVUs would
be based on a blend of 25 percent of the 1998 code-specific practice
expense RVUs and 75 percent of the relative practice expense resources
involved in furnishing the service. For services beginning January 1,
2002, the practice expense RVUs would be based on 100 percent of the
relative practice expense resources involved in furnishing the service.
There would be only one level of practice expense RVUs per code for
the following categories of services: those that have only the
technical component of the practice expense RVUs; only the professional
component practice expense RVUs; certain evaluation and management
services, such as hospital or nursing facility visits that are
furnished exclusively in one setting; and major surgical services. For
other services, there would be two different levels of practice expense
RVUs per code. The lower practice expense RVUs would apply to services
furnished to hospital or ambulatory surgical center patients. The
higher practice expense RVUs would apply to services furnished in a
physician office or services other than visits but performed in a
patient's home and services furnished to patients in a nursing
facility, skilled nursing
[[Page 30840]]
facility, or an institution other than a hospital or ambulatory
surgical center.
18. Response to GAO Recommendations
As previously discussed, the GAO report to Congress on practice
expense made five recommendations for further action; two of these are
short term recommendations that are addressed by this proposed rule and
three are longer term recommendations that will be addressed during the
refinement process. The GAO recommendations are as follows:
Short Term Recommendations.
+ Use sensitivity analyses to test the effects of the limits we
placed on the panels' estimates of clinical and administrative labor
and our assumptions about equipment utilization.
We believe that our proposed methodology answers the concerns that
prompted this recommendation. Our current proposal has eliminated the
limits previously placed on the CPEP panels' estimates of clinical and
administrative staff times. In addition, because the proposed
methodology is based on specialty-specific RVU pools, changes in
assumptions about equipment utilization rates would impact
redistributions between specialties only to the extent that codes are
performed by more than one specialty.
+ Evaluate the classification of the administrative labor
associated with billing and other administrative expenses as indirect
expenses, alternative methods for assigning indirect expenses, and
alternative specifications of the regression model used to link the
panels' estimates.
We again believe that our proposed methodology is responsive to
this recommendation. Under our proposal, administrative expenses are
treated as indirect costs, and we have developed a method of assigning
indirect expenses that we believe most closely reflects the various
specialties' actual costs. The third part of the recommendation is now
moot as the current proposed methodology no longer utilizes the linking
algorithm.
Longer Term Recommendations.
+ Determine whether changes in hospital staffing patterns and
physicians' use of their clinical staff in hospital settings warrant
adjustments between Medicare reimbursements to hospitals and
physicians. Similarly, we should determine whether physicians have
shifted tasks to nonphysician clinical staff in a way that warrants
reexamining the physician work RVUs.
+ Work with physician groups and the AMA to develop a process for
collecting data from physician practices as a cross-check on the
calculated practice expense RVUs and periodically refine and update the
RVUs.
+ Monitor indicators of beneficiary access to care, focusing on
those services with the greatest cumulative reductions in physician fee
schedule allowances, and consider any access problems when making
refinements to the practice expense RVUs.
We agree with all of these recommendations. One of the major tasks
of any proposed refinement process will be determining when any
additional data are need, whether it be on physician practice patterns
or actual practice expenses. We welcome comments and suggestions on how
best to carry out these recommendations to aid us in developing a
strategy for data gathering in our final rule. We plan to monitor
access to care.
B. Medical Direction for Anesthesia Services
The conditions for payment of medical direction were discussed in
the March 2, 1983 final rule (48 FR 8902) that implemented section 108
of the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982,
effective October 1, 1983.
TEFRA added section 1887 to the Act and required that we
distinguish between services furnished by physicians to patients that
are now payable under the physician fee schedule and services furnished
by physicians to hospitals that are reimbursed to the hospital on a
prospective payment basis for inpatients or on a reasonable cost basis
for outpatients.
Section 1887 of the Act did not, however, include a reference to
``medical direction.'' This is a term we adopted from the medical
profession that refers to the necessary level of direct involvement of
the anesthesiologist in each of two to four concurrent anesthesia
procedures so that the service meets the definition of physician
services as required by section 1887 of the Act.
Our definition of medical direction closely followed the standards
of anesthesia care team practice promulgated by the American Society of
Anesthesiologists (ASA).
The conditions for payment of medical direction are included in
Sec. 415.110 (Conditions for payment: Medically directed anesthesia
services). For each patient, the physician must furnish seven kinds of
services, and the physician may not perform any other services while he
or she is directing the concurrent procedures unless they meet the
exception as noted. The medical direction activities in Sec. 415.110(a)
(Services furnished directly or concurrently) are as follows:
Performs a pre-anesthesia examination and evaluation.
Prescribes the anesthesia plan.
Personally participates in the most demanding procedures
in the anesthesia plan, including induction and emergence.
Ensures that any procedures in the anesthesia plan that he
or she does not perform are performed by a qualified individual as
defined in program operating instructions.
Monitors the course of anesthesia at frequent intervals.
Remains physically present and available for immediate
diagnosis and treatment of emergencies.
Provides indicated post-anesthesia care.
The regulations currently refer to these conditions as applying to
services furnished directly or concurrently. The reference to services
furnished directly is not correct. It suggests that the physician
personally performing the anesthesia services only has to provide the
same kind of services as the physician medically directing the
anesthesia service. In fact, the physician personally performing the
anesthesia service must perform the entire anesthesia service alone.
This policy is included in Sec. 414.46(c)(1)(i) (Additional rules for
payment of anesthesia services, Physician personally performs the
anesthesia procedure). Therefore, we are proposing to delete the
reference in the regulations to services furnished directly.
The December 1995 final rule (60 FR 63152) included the policy to
allow the physician's medical direction of a certified registered nurse
anesthetist (CRNA) performing a single anesthesia service. However,
this provision did not take effect until January 1, 1998. This policy
was incorporated in Sec. 414.46(d)(iii) (Additional rules for payment
of anesthesia services, Anesthesia services medically directed by a
physician). A program memorandum explaining this policy was issued to
the Medicare carriers in January 1998.
We are revising Sec. 415.110 (Conditions for payment: Medically
directed anesthesia services) so that it is consistent with
Sec. 414.46(d)(iii) by stating that medical direction can apply to the
single anesthesia service furnished by a CRNA.
The Omnibus Budget Reconciliation Act of 1993 (OBRA 1993) added
section 1848(a)(4)(Special Rule For Medical Direction) to the Act. This
section of the
[[Page 30841]]
Act specified the calculation of the payment allowances for medical
direction services on or after January 1, 1994. Thus, the specific
payment policy is specified in the law. The law provides that the
medical direction of the performance of an anesthesia service furnished
on or after January 1, 1998, is 50 percent of the fee schedule amount
that would have been paid if the anesthesia service was furnished by
the physician alone.
Both the ASA and the American Association of Nurse Anesthetists
(AANA) have pointed out that the current requirements are outdated and
too restrictive. The current requirements are oriented to the
administration of a general anesthetic, which was the predominate mode
of practice when the regulations were originally implemented. There are
other types of anesthesia, such as regional, spinal or epidural
anesthesia, and monitored anesthesia care, which are becoming more
common and for which the current requirements are not completely
appropriate. For example, in monitored anesthesia care, there is no
definable emergence as there is for general anesthesia.
Also, the AANA has advised us that requiring the presence of the
anesthesiologist for induction for all cases may not be appropriate and
may delay the start of surgery and result in the inefficient use of
operating room time. In addition, the ASA has advised us that neither
the regulations nor the operating instructions explain the level of
documentation required by the anesthesiologist to support the payment
for the medical direction service. The ASA believes that the lack of
instructions for medical documentation and the concerns about payment
audits have reportedly prompted anesthesiologists to overly document
anesthesia records.
The ASA and the AANA have reached consensus on a revised
recommended set of medical direction requirements. We have reviewed
their recommendations and are proposing to revise our regulations in
Sec. 415.110 (Conditions for payment: Anesthesia services) to reflect
current anesthesia practice arrangements. Namely, we would:
Provide that the physician either perform the pre-
anesthesia examination and evaluation or review one performed by
another qualified individual.
No longer require the physician to be present during
induction and emergence.
Require that the physician monitor the course of
anesthesia at intervals medically indicated by the nature of the
procedure and the patient's condition.
C. Separate Payment for Physician Interpretation of an Abnormal
Papanicolaou Smear
With the exception of hospital inpatients, we currently do not
allow separate payment for the physician's interpretation of an
abnormal Papanicolaou (Pap) smear.
About 10 percent of Pap smears are abnormal and are interpreted by
a physician, usually a pathologist. If a physician interprets an
abnormal Pap smear for a patient, other than a hospital inpatient,
payment for the physician interpretation (and the underlying test) is
made under the clinical laboratory fee schedule payment for the Pap
smear test. The physician negotiates with the laboratory for payment
for the physician service.
The clinical laboratory fee schedule allowances were initially
derived from the 1984 prevailing charges made by independent
laboratories for the Pap smear test. Historically, independent
laboratories did not bill separately for the physician interpretation
of the abnormal Pap smear; thus, no separate allowance was established.
Therefore, the initial clinical laboratory fee schedule allowances
reflect payment for both the test and any associated interpretation.
The 1998 clinical fee schedule national allowance for the Pap smear
test is $7.15. The 1998 physician fee schedule national allowance for
the physician interpretation of the abnormal Pap smear for a hospital
inpatient is $28.62.
The College of American Pathologists requested we recognize
separate payment for the physician interpretation of the abnormal Pap
smear in all settings. We believe this proposal would establish an
understandable and uniform definition of physician services across
sites. Therefore, we are proposing to recognize, under the physician
fee schedule, separate payment for the physician interpretation of an
abnormal Pap smear in all settings.
The Pap smear test may be furnished by a hospital or an independent
laboratory. The independent laboratory could bill for the complete
service: the technical component (the performance of the test) and the
professional component (the interpretation of the test) furnished by
the independent laboratory's pathologist. For services to hospital
patients, the Pap smear interpretation usually is furnished by the
hospital pathologist who can bill for the professional component of the
service.
D. Rebasing and Revising the Medicare Economic Index
1. Background
a. History. In the 1972 Amendments to the Act (Public Law 92-603)
enacted on October 30, 1972, the Congress mandated the use of an
economic index in determining payment for physician services under
Medicare Part B. Although the 1972 Amendments did not specify the
particular type of index to be used, we established the Medicare
Economic Index (MEI). The MEI follows the recommendations outlined by
the Senate Finance Committee in its report accompanying the legislation
in that it attempts to present an equitable measure for changes in the
costs of physician time and operating expenses.
The current MEI represents a weighted sum of annual price changes
for various inputs needed to produce physician services. Since its
inception, the MEI has consisted of two principal components or expense
categories--physician net income and physician practice expenses.
Physician net income is further delineated into wages and salaries and
benefits. The physician practice expense portion is delineated into six
major categories: (1) Nonphysician employee compensation, which
includes the wages and salaries and benefits of nonphysician employees
in physician offices; (2) office expenses; (3) medical materials and
supplies; (4) professional liability insurance; (5) medical equipment;
and (6) other professional expenses. These broad expense categories are
still the major expense shares in the proposed MEI and are discussed in
greater detail in the following sections.
b. Use of Current Data. The MEI was last rebased and revised in the
November 25, 1992 final rule (57 FR 55896). The current base year for
the MEI is 1989. We believe that it is desirable to rebase and revise
the index periodically so that the expense shares and proxies will
reflect current conditions. For this reason, we are proposing to rebase
the MEI to reflect 1996 physician expenses and review the proxies we
currently use to ensure using the most appropriate proxy for each
expense category. We will continue to adjust the physician and
nonphysician employee compensation for economy-wide labor productivity
to avoid accounting for both physician productivity and economy-wide
productivity in the physician update framework.
The proposed MEI expense categories were derived primarily from the
1997 AMA SMS, which measured physician earnings and practice expenses
for 1996.
[[Page 30842]]
The AMA data were used to set expenditure weights for physician
earnings and the six major physician practice expense categories. To
further disaggregate into subcategories reflecting more specific
physician expenses, we used data from the 1992 Asset and Expenditure
Survey, the 1996 Bureau of the Census Current Population Survey, the
1997 Bureau of Labor Statistics Employment Cost Index, and the Medical
Economics Continuing Survey data for 1996.
2. Rebasing and Revising Expense Categories
Developing a rebased and revised MEI requires selecting a base year
and determining the number and composition of expense categories. As
mentioned earlier, we are proposing to rebase the MEI to 1996. We chose
1996 as the base year for two main reasons: (1) The 1996 data were the
most recent available data for most of the data sources we are
proposing to use; and (2) the 1996 data were representative of the
changing distribution of physician earnings and practice expenses over
time.
We determined the number and composition of expense categories
based on the criteria used to develop the current MEI expenditure
weights and our other input price index expenditure weights (for more
information on these criteria see the November 25, 1992, proposed rule
(57 FR 55900)). Using these criteria of mutually exclusiveness and
exhaustiveness, we developed the rebased and revised MEI presented in
Table 4.
Table 4.--Revised Medicare Economic Index Expenditure Categories, Weights, and Price Proxies
----------------------------------------------------------------------------------------------------------------
Weights Weights
Expense category -------------------------- Proposed price proxies
1989 (1) 1996 (1 2)
----------------------------------------------------------------------------------------------------------------
Total....................... 100.000 100.000
Physician Earnings (\4\) 54.155 54.460
Wages and Salaries...... 45.342 44.197 AHE--Private (\3\).
Benefits (\5\).......... 8.813 10.263 ECI--Ben: Private (\3\).
Physician Practice Expenses. 45.845 45.540
Non-Physician Employee 16.296 16.812
Compensation.
Employee Wages and 13.786 12.424
Salaries.
Prof/Tech Wages..... 3.790 5.662 ECI--W/S: Private P&T (\3\).
Managers Wages...... 2.620 2.410 ECI--W/S: Private Admin (\3\).
Clerical Wages...... 5.074 3.830 ECI--W/S: Private Clerical (\3\).
Services Wages...... 2.233 0.522 ECI--W/S: Private Service (\3\).
Craft Wages......... 0.069
Employee Benefits 2.510 4.388 ECI--Ben: Priv. White Collar (\3\).
(\5\).
Office Expenses......... 10.280 11.581 CPI(U)--Housing.
Medical Materials and 5.251 4.516 PPI Drugs/PPI Surg. Appl/CPI(U) Med Sup.
Supplies.
Professional Liability 4.780 3.152 HCFA--Prof. Liab. Phys. Prem. Survey.
Insurance.
Medical Equipment....... 2.348 1.878 PPI--Medical Instruments and Equip.
Other Professional 6.890 7.601
Expense.
Automobile.......... 1.400 1.300 CPI(U)--Private Transportation.
All Other........... 5.490 6.301 CPI(U)--All Items less Food and Energy.
----------------------------------------------------------------------------------------------------------------
Footnotes:
(\1\) Due to rounding, weights may not sum to 100.000%.
(\2\) Sources: Socioeconomic Monitoring System 1997 Survey of Physicians, Center for Health Policy Research,
American Medical Association; Anne L. Finger, ``What it costs to run a practice,'' Medical Economics, October
27, 1997; U.S. Department of Labor, Bureau of Labor Statistics; and U.S. Department of Commerce, Bureau of the
Census, 1992 Asset and Expenditure Survey, and 1997 Current Population Survey.
(\3\) Net of change in the 10-year moving average of output per man-hour for the non-farm business sector.
(\4\) Includes employee physician payroll.
(\5\) Includes paid leave.
To determine the expenditure weights, we used currently available
and statistically valid data sources on physician earnings and practice
expenses. While we consulted numerous data sources, we used five
sources to determine the rebased and revised MEI expenditure weights:
(1) The 1997 AMA SMS survey (1996 data); (2) the March 1997 Bureau of
Labor Statistics (BLS) Employment Cost Index; (3) the 1992 Bureau of
the Census Asset and Expenditure Survey (the latest available); (4) the
1996 Bureau of the Census Current Population Survey; and (5) the
Medical Economics continuing survey published October 1997 (1996 data).
No one data source provided all of the information needed to determine
expenditure weights according to our criteria. The use of each of these
data sources is described in detail below.
a. American Medical Association Socioeconomic Monitoring System
Survey. Like the current MEI, the proposed MEI will use AMA data on
mean physician net income (physician earnings) and professional
expenses for self-employed physicians for the major expenditure
categories. The seven major expenditure categories taken from the AMA
data, as shown in Table 1, are physician earnings, nonphysician
employee compensation, office expenses, medical materials and supplies,
professional liability insurance, medical equipment, and other
professional expenses. The weights represent each expenditure
category's proportion of total expenses in 1996. While many of the
category weights have changed since 1989, the effect on the percent
change in the MEI has been minimal, as explained later.
The physician earnings expenditure category in the rebased MEI is
defined differently from the one in the current MEI as it includes
employee physician compensation. Until recently, employee physician
compensation was not available through the AMA survey and was not
included in any AMA expenditure categories. AMA reported these data
separately in 1996. We believe it is appropriate, for our purposes, to
include employee physician compensation in the MEI category of
physician earnings. The physician income (earnings) and overhead
expenses generated by employee physicians are currently included in the
AMA expenditure
[[Page 30843]]
categories. We propose including employee physician payroll in
physician earnings to be consistent with the current methodologies used
in payment under the physician fee schedule. Under the physician fee
schedule, the work RVU is paid based on the service provided and not on
who provides the service. Since employee physicians do the same
services as self-employed physicians, employee physician time would be
included in the work RVU. By including employee physician compensation
in the physician earnings category for the MEI, we have achieved two
goals: (1) Appropriately categorizing these expenses to be consistent
with the physician fee schedule; and (2) adjusting these expenses by
the appropriate price proxies for a physician's own time. A detailed
discussion of the price proxies is presented below.
b. Employment Cost Index Survey. The Employment Cost Index (ECI)
survey has shares of total compensation for wages and salaries and
benefits by private industry health services occupational category that
can be used to allocate the wage and fringe benefit shares for
nonphysician employees. The data on these shares are produced for March
of every year. We determined that March 1997 would be most
representative of the shares in 1996 because the March 1996 data would
miss any changes that occurred during the last three quarters of that
year. The shares are determined from employer costs per hour worked.
Paid leave is defined as a benefit under this survey. Unfortunately,
this survey does not have data for offices of physicians. However, data
are available on wage and fringe benefit shares for total health
services that include hospitals, nursing homes, offices of physicians,
and offices of dentists. While not a direct measure of employee wage
and fringe benefit shares in offices of physicians, the shares for
health services from the ECI survey do provide a normative estimate of
the split between wages and fringes.
In the ECI survey for total health services, the wage and fringe
benefit split of compensation was 73.9 percent and 26.1 percent,
respectively. For comparison purposes, when we included paid leave as
part of wages, these shares were very similar to nonphysician employee
wage and fringe benefit share data from two physician group practice
studies. Based on this analysis, we are proposing to use the wage and
fringe benefit shares for total health services from the ECI survey,
with paid leave as a benefit, in the rebased and revised MEI for
nonphysician employee compensation. The wage and fringe benefit shares
for physicians and nonphysician compensation in the current MEI were
developed from a special study conducted by our Office of the Actuary.
These current and revised shares are presented in Table 1.
c. Asset and Expenditure Survey. We are proposing to use the 1992
Bureau of the Census Asset and Expenditure survey to derive an estimate
of the wage and fringe benefit share for physicians under the MEI. The
wage and fringe benefit share for all persons employed in physician
offices is available from the 1992 Asset and Expenditure survey. This
share includes both physicians and nonphysician employees in the
physician office. By aging this share to 1996 using the ECI for wages
and fringe benefits for total health services and moving paid leave
from wages to fringe benefits based on analysis of ECI data on health
services, we were able to develop a wage and fringe benefit share for
physician offices for 1996. The wage share for physician offices was
79.4 percent, and the fringe benefit share 20.6 percent. Using this
wage and fringe benefit share, the wage and fringe benefit share for
nonphysician employees developed from the ECI survey, and the share for
physician and nonphysician compensation developed from the AMA survey,
we were able to impute a wage and fringe benefit share for physicians.
The wage share was 81.2 percent, and the benefit share 18.8 percent for
physicians. We compared these shares to physician group data on
physician wage and fringe benefit shares and found them to be very
consistent. Therefore, we are proposing to use these wage and fringe
benefit shares for physicians in the rebased and revised MEI, as shown
in Table 1.
d. Current Population Survey. We are proposing to use the 1996
Current Population Survey (CPS) from the Bureau of the Census to
determine the distribution of nonphysician employee wages in the
rebased and revised MEI. The 1989 CPS was used to determine the
distribution for the current MEI. The new distribution is presented in
Table 5. Craft and kindred workers are no longer included in the
distribution because their share is not significant.
Table 5.--Percent Distribution of Non-Physician Payroll Expense by
Occupational Group: 1996
------------------------------------------------------------------------
Expenditure
BLS occupational group shares (1)
------------------------------------------------------------------------
Total...................................................... 100.000
Professional and Technical Workers..................... 45.570
Managers............................................... 19.399
Clerical Workers....................................... 30.831
Service Workers........................................ 4.199
------------------------------------------------------------------------
(1) These weights were derived from the 1996 Current Population Survey,
U.S. Bureau of the Census.
e. Medical Economics Continuing Survey. Consistent with the current
MEI, we are proposing to use the Medical Economics Continuing Survey to
determine the weight for automobile (professional car) expenses. We
used the 1996 Continuing Survey published in the October 27, 1997,
Medical Economics (Finger, 1997) to determine a weight of 1.3 percent
in the proposed MEI for automobile expenses, which is nearly identical
to the 1.4 percent share in the current MEI.
3. Selection of Price Proxies
a. Background. After the 1996 cost weights for the revised MEI were
developed, we reviewed the current set of price proxies to determine
whether they were still the most appropriate to monitor the rate of
price change for each expenditure category. As was the case in 1992 (57
FR 55901), most of the indicators we considered are based on BLS data
and are grouped into one of the following five categories:
Producer Price Indices (PPIs). PPIs measure price changes
for goods sold in other than retail markets. They are the preferred
proxies for physician purchases at the wholesale level. These fixed-
weight indexes are a measure of price change at the producer or at the
intermediate stage of production.
Consumer Price Indices (CPIs). CPIs measure change in the
prices of final goods and services bought by consumers. Similar to the
PPIs, they are fixed-weight. CPIs may not represent the price changes
faced by producers. For this reason, CPIs were used absent an
appropriate PPI or if the expenditure was similar to that of retail
consumers in general, rather than to a purchase at the wholesale level.
Average Hourly Earnings (AHEs). AHEs permit the
measurement of changes in hourly earnings for production and
nonsupervisory workers for specific industries as well as the nonfarm
business economy. AHEs are calculated by dividing gross payrolls for
wages and salaries by total hours. The
[[Page 30844]]
series reflects shifts in employment mix and, thus, is representative
of actual changes in hourly earnings for industries or for the nonfarm
business economy.
ECIs for wages and salaries. These ECIs measure the rate
of change in employee wage rates per hour worked. These fixed-weight
indices are not affected by shifts in industry or occupation employment
levels.
ECIs for employee benefits. These ECIs measure the rate of
change in employer costs of employee benefits such as the employer's
share of Social Security taxes, pension and other retirement plans,
insurance benefits (life, health, disability, and accident), and paid
leave. Like ECIs for wages and salaries, they are not affected by
changes in industry output or occupational shifts.
As with choosing the expenditure categories, choosing appropriate
wage and price proxies for each expense category necessarily involves
making tradeoffs and using judgment. The strengths and weaknesses of
each proxy variable need to be evaluated using several criteria that
can potentially conflict.
The first criterion is relevance. The price variable should
appropriately represent price changes for specific goods or services
within the expense category. Relevance may encompass judgments about
relative efficiency of the market generating the price and wage
increases and may include normative factors relating to fairness.
The second criterion is reliability or low sampling variability. If
the proxy wage-price variable has a high sampling variability or
inexplicable erratic patterns over time, its value is greatly
diminished since it is unlikely to reflect accurately price changes in
its associated expenditure category. Low sampling variability can
conflict with relevance since the more specifically a price variable is
defined in terms of service, commodity, or geographic area the higher
the sampling variability in some cases.
Timeliness of actual published data is the third criterion. For
this reason, monthly and quarterly data take priority over annual data.
The fourth criterion is the length of time the time-series data has
been in use. A well-established time series is needed to assess the
reasonableness of the series and to provide a solid base from which to
forecast future price changes in the series. Forecasting the MEI is
required to make Federal budget and Trustee's report estimates.
The BLS price proxy categories previously described meet the
criteria of relevance, reliability, timeliness, and time-series length.
The price-wage proxies for the rebased and revised MEI (shown in Table
1) are the same as those chosen for the current MEI.
b. Expense Categories. (1) Physician Time
Because the revenue associated with physician time is the single
largest cost component in the MEI (54.5 percent), the selection of the
price proxy for wages and salaries cost category is a major determinant
of the rate of change in the MEI. For that reason, we are furnishing an
extensive discussion of the selection of the price proxy for the wages
and salaries component as we did in the November 1992 final rule (57 FR
55903). We have found no compelling reason to change the wage proxy for
this expense category and offer the same rationale that we used in the
November 1992 final rule.
The legislative history of the MEI reveals Congressional concern
that increases in physician charges are a cause, rather than a result,
of inflation. The following language from the Senate Finance Committee
report accompanying the 1972 Social Security Amendments makes that
point clearly:
The committee * * * believes that it is necessary to move in the
direction of an approach to reasonable charge reimbursement that
ties recognition of fee increases to appropriate economic indexes so
that the program will not merely recognize whatever increases in
charges are established in a locality but would limit recognition of
charge increases to rates that economic data indicate would be fair
to all concerned (emphasis added) and follow rather than lead
inflationary trends. * * * Initially, the Secretary would be
expected to base the proposed economic indexes on presently
available information on changes in expenses of practice and general
earnings levels. * * * S. Rep. No. 1230, 92d Cong., 2d Sess. 190-191
(1972).
There is obvious circularity if increases in prevailing charges are
linked to increases in physician charges, which are then tied to
increases in physician income. The committee's expectation that the
rate of price inflation assigned to the physician time portion of the
MEI be permitted to increase by an amount consistent with increases in
general earnings levels seems to reflect the Congress' preference for
an equitable external price proxy; that is, a compensation proxy based
on compensation outside or external to the physician services industry.
We examined the following three principal alternatives for the wages
and salary component of the physician time cost category:
The use of AHEs for production and nonsupervisory workers
in the private nonfarm economy.
This option suggests a standard of payment that implies that price
increases for the physician labor component should be the same as for
workers in the overall economy, that is, general earnings. This option
presumes that the price increase for the physician time category
(excluding fringe benefits) should reflect the changing mix of industry
output and employment. This alternative appears to reflect most closely
the Senate Finance Committee's reference to general earnings levels.
Since earnings are per hour, a constant quantity of labor input per
unit of time is reflected. In addition, the use of the AHEs data is
consistent with the BLS labor productivity measures. The revised MEI as
well as the current MEI incorporates an adjustment for economy-wide
labor productivity to preclude a double-counting of productivity.
Economy-wide wage increases reflect economy-wide productivity
increases. In addition, physician practice productivity increases
associated with the fee-for-service Medicare payment system
automatically result in revenue increases for the individual physician
practices. Economy-wide productivity increases are adjusted out of the
compensation portion of the MEI so that individual physician practices
get all of their own productivity increases, but not economy-wide
productivity increases as well. The adjustment will continue to be for
the 10-year moving average change in productivity.
The use of ECIs for wages and salaries of the total
private nonfarm economy.
This option suggests a standard of payment that implies that price
increases for the physician labor component should be the same as that
for workers in a hypothetical, overall economy in which there are no
shifts in the employment patterns of workers. The overall ECI weighs
nine broad occupational categories and permits measurement of the
change in the hourly straight time wage rate for private industry
workers (Nathan, 1987 and Schwenk, 1985). ECIs are unaffected by
changes in occupational employment shifts or industry output shifts.
Therefore, this alternative would not recognize changes in the
composition of the work force over time as intended by the Senate
Finance Committee.
The use of an ECI for wages and salaries for private
professional and technical workers.
[[Page 30845]]
This proxy implies that price changes in the physician time
component, excluding fringe benefits, should correspond to those for
private sector professional and technical workers. The professional and
technical workers category is one of the nine categories that comprise
the overall ECI. Physicians are a tiny subset of this occupational
group. The supply, demand, and opportunity cost characteristics of this
broad category, however, may be different from the supply, demand, and
opportunity cost characteristics of an efficient market for physician
services. Most professional and technical workers are in labor markets
where firms compete for employees. Most office-based physicians are
self-employed. Some occupations within the professional and technical
group are in short supply leading to upward pressure on compensation
levels. Use of this price series would take the MEI away from the
general earnings specified in the enacting legislation.
Each of the above options implies a different standard of equity.
In Table 6, we compare the annual rates of change in the MEI using
three different price variables for physician earnings suggested as
options.
Table 6.--Comparison of Annual Percent Changes in the MEI With
Alternative Physician Wage Price Proxies
------------------------------------------------------------------------
Revised MEI with alternative
proxies for physicians' own
time
--------------------------------
ECI:
Year ending June 30 AHE: wages/ ECI: wages/
total salaries salaries for
private for professional
non- total and
farm private technical
------------------------------------------------------------------------
1992................................... 2.8 3.1 3.4
1993................................... 2.2 2.3 2.7
1994................................... 2.1 2.3 2.3
1995................................... 2.0 2.1 2.0
1996................................... 1.9 1.9 1.8
1997................................... 2.3 2.2 2.0
Average:
1992-1997............................ 2.2 2.3 2.4
------------------------------------------------------------------------
The proposed MEI uses AHEs for the private nonfarm economy as the
proxy of choice for the physician wages and salaries component of the
input price index and is the same price measure used in the 1989-based
MEI. In our judgment, this alternative remains the one that most
closely comports with Congressional intent as expressed in the Senate
Finance Committee's 1972 report referenced above. AHEs change in
accordance with market forces associated with changes in the type and
mix of workers. This is not the case with ECIs, since ECIs reflect a
fixed composition of the work force at a given time. Therefore, the
rate of change in an ECI may differ substantially from an actual AHE
measure.
The current MEI uses the ECI for fringe benefits for total private
industry as the price proxy for fringe benefits. We propose using the
same proxy for the 1996-based MEI. This means that both the wage and
fringe benefit proxies for physician time are derived from the nonfarm
private sector and are both computed on a per-hour basis.
(2) Nonphysician Employee Compensation. As in the 1989-based MEI,
we are proposing to use the 1996 Current Population Survey data on
earnings and employment by occupation to develop labor cost shares for
the nonphysician occupational groups shown in Table 5. BLS maintains an
ECI for each of these occupational groups and we are proposing to use
these as price proxies for nonphysician employee wages in the same
manner they are used in the current MEI. We multiplied each of the
occupational cost shares by the changes in the occupational ECI for
that category. These values were summed to yield an overall rate of
price change.
The skill mix shift in physician offices has been substantial in
the last few years as work formerly done in the hospital increasingly
is done in ambulatory settings. These skill mix shifts appropriately
are held constant in this Laspeyres index of nonphysician employees'
wages and salaries. Skill mix shifts that reflect rising intensity of
outputs in physician offices are automatically paid for by higher
charge structures for the more complex mix of service inputs.
Physicians performing more complex services may hire more skilled
employees, and, thus, may tend to charge more for their services.
The current MEI uses the ECI for fringe benefits for white collar
employees in the private sector. Most nonphysician employees in
physician offices are white collar employees. We are proposing to use
the ECI for benefits for white collar employees in the rebased and
revised MEI. Note that we will continue to adjust the nonphysician
employee compensation portion of the MEI by the 10-year moving average
change in economy-wide productivity since physician practice
productivity is being recognized.
(3) Office Expense. Office expenses include rent or mortgage for
office space, furnishings, insurance, utilities, and telephone. We are
proposing the continued use of the CPI-U for housing because it is a
comprehensive measure of the cost of housing including rent, owner's
equivalent rent, insurance, maintenance and repair services, fuels,
utilities, telephones, furnishings, and housekeeping services. This
proxy covers about 80 percent of the population.
(4) Medical Materials and Supplies. This cost category includes
drugs, outside laboratory work, x-ray films, and other related
services. There is no price proxy that includes this mix of materials
and supplies. In the absence of one index, in the 1989-based MEI we
equally weighted the following three price proxies associated with the
medical materials and supplies listed above:
The PPI for ethical drugs.
The PPI for surgical appliances and supplies.
The CPI-U for medical equipment and supplies.
We propose using the same blended proxy for the 1996-based MEI.
(5) Professional Liability Insurance. This cost category includes
costs for professional medical liability or malpractice insurance
premiums including costs associated with self-insurance. Changes in the
cost of medical liability insurance premiums currently are measured
based on our survey of the rate of change in average liability premiums
for $100,000/$300,000 coverage (that is, $100,000 for per-case
limitation and $300,000 for total coverage or the minimum furnished)
among major insurers. We measured change with historical data each
January 1 and interpolated quarterly changes for March, June, and
September.
We improved the professional medical liability index in two major
ways. First, we used actual rates for $1 million/$3 million premiums in
the index for the most current historical period and estimated them for
earlier years. Starting with 1996 levels and 1997 percentage changes,
rates for $1 million/$3 million premiums will be computed; in future
periods we will use premiums for $1 million/$3 million of coverage.
Second, the revised index uses data on a quarterly basis that is
calculated into a four-quarter moving average percent change like all
our other price proxies. We achieve this by tracking the premium
changes that occur during each quarter. We gathered historical premium
data back to 1992 and established average premium levels based on the
mix of physicians by specialty in 1996. We calculated four-
[[Page 30846]]
quarter moving averages and percent changes from 1992 through 1997 to
more accurately forecast changes in premium levels for future budget
and Trustees' report estimates. The previous method obtained the
premium change only for January 1 of each year.
We are proposing the changes described above because we believe
they will improve the quality of measuring change in physician
professional medical liability premiums. Far more physicians have $1
million/$3 million coverage rather than $100,000/$300,000 coverage.
Taking quarterly measurements and computing a four-quarter moving
average percent change is the same methodology used for all the other
price proxies. The resulting series better captures the changes through
the year.
(6) Medical Equipment. Medical equipment includes depreciation,
leases, and rent on medical equipment. We propose to use the PPI for
medical instruments and equipment as the price proxy for this category,
consistent with the price proxy used in the 1989-based MEI.
(7) Other Professional Expenses. This category has two
subcomponents: professional car and ``other.'' The professional car
category includes depreciation and upkeep for the practice-related use
of a professional car. We are proposing the continued use of the CPI-U
for private transportation for this cost category, consistent with the
price proxy used in the 1989-based MEI. This excludes airline fares,
inter-city bus and train transportation, and intra-city bus and train
transportation.
This category also includes the residual subcategory of other
expenses. This residual category includes professional expenses such as
accounting services, legal services, office management services,
continuing education, professional association memberships, journals,
and other professional expenses. In the absence of one price proxy or
even a group of price proxies that might reflect this heterogeneous mix
of goods and services, we use the CPI-U for all items less food and
energy, consistent with the price proxy used in the 1989-based MEI.
4. Summary of Changes
Updating the MEI to the 1996 base year resulted in small changes in
expense category weights. Physician earnings increased slightly from
54.2 percent of the index in 1989 to 54.5 percent in 1996. Physician
practice expenses dropped slightly due to declines in the expense
shares for medical materials and supplies, professional liability
insurance, and medical equipment. These declines were mostly offset by
increases in the expense shares for nonphysician employee compensation,
office expenses, and other professional expenses.
Table 7.--Annual Percent Change in the Current and Revised Medicare
Economic Index
------------------------------------------------------------------------
Current Revised
MEI 89- MEI 96-
Years ending June 30 base % base % Difference
change change
------------------------------------------------------------------------
1985...................................... 3.3 3.2 -0.1
1986...................................... 3.3 3.0 -0.3
1987...................................... 3.0 2.7 -0.3
1988...................................... 3.6 3.4 -0.2
1989...................................... 3.4 3.5 0.1
1990...................................... 3.0 3.4 0.4
1991...................................... 3.2 3.4 0.2
1992...................................... 2.8 2.8 0.0
1993...................................... 2.1 2.2 0.1
1994...................................... 2.1 2.1 0.0
1995...................................... 2.0 2.0 0.0
1996...................................... 2.1 1.9 -0.2
1997...................................... 2.2 2.3 0.1
Average 1985--1997........................ 2.8 2.8 0.0
------------------------------------------------------------------------
The rebased and revised MEI is very similar to the current MEI.
Using the new expense category weights and new proxy for professional
medical liability premiums, the difference in the annual percent change
in the index is within two-tenths of one percent in most years from
1985 through 1997. The average annual percent change from 1985 to 1997
was identical. Thus, this revision and rebasing, while making the
expense shares more timely, has little impact on the percent changes in
the MEI as a whole.
III. Implementation of the Balanced Budget Act of 1997 (BBA 1997)
In addition to the resource-based practice expense relative value
units, BBA 1997 provides for revisions to the payment policy for drugs
and biologicals, a provision allowing private contracting with Medicare
beneficiaries, payment for outpatient rehabilitation services based on
the physician fee schedule, and revisions to our policy for
nonphysician practitioners.
A. Payment for Drugs and Biologicals
Before January 1, 1998, drugs and biologicals not paid on a cost or
prospective payment basis were paid based on the lower of the estimated
acquisition cost (EAC) or the national average wholesale price (AWP) as
reflected in sources such as the Red Book, Blue Book, or Medispan. For
purposes of this discussion, we will use the term ``drugs'' to refer to
drugs and biologicals. Examples of drugs that are paid on this basis
are drugs furnished incident to a physician service, drugs furnished by
pharmacies under the durable medical equipment (DME) benefit, and drugs
furnished by independent dialysis facilities that are not included in
the end-stage renal disease (ESRD) composite rate payment.
Section 4556 of BBA 1997 established payment for drugs not paid on
a cost or prospective payment basis at the lower of the actual billed
amount or 95 percent of the AWP, effective January 1, 1998. In this
proposed rule, we are revising the current regulations at Sec. 405.517
to conform to this statutory change. This regulation would remove the
EAC and provide for payment at the lower of the actual charge on the
Medicare claim or 95 percent of the AWP.
Also, we are proposing to revise the method of calculating the AWP.
Our current regulations provide that, for multiple-source drugs, the
AWP equals the median AWP of the generic forms of the drug. The AWP of
the brand name products is ignored on the presumption the brand AWP is
always higher than the generic AWPs. While this may have been true when
the policy was first promulgated, it is not always true now. Therefore,
we are proposing that the AWP for multiple-source drugs would equal the
lower of the median price of the generic AWPs or the lowest brand name
AWP.
B. Private Contracting With Medicare Beneficiaries
Section 4507 of BBA 1997 amended section 1802 of the Act to permit
certain physicians and practitioners to opt-out of Medicare and to
provide through private contracts services that would otherwise be
covered by Medicare. Under such contracts the mandatory claims
submission and limiting charge rules of section 1848(g) of the Act
would not apply. This section, which was effective on January 1, 1998,
and was implemented through operating instructions, counters the effect
of certain provisions of Medicare law that, absent section 4507 of BBA
1997, preclude physicians and practitioners from contracting privately
with Medicare beneficiaries to pay without regard to Medicare limits.
Specifically, section 1848(g) of the Act restricts the amounts that
can be collected from beneficiaries by nonparticipating physicians who
do not take assignment on the Medicare claim (physicians who take
assignment
[[Page 30847]]
voluntarily agree to accept the Medicare payment amount as payment in
full and collect only deductible and coinsurance amounts from the
beneficiary). Moreover, section 1842(b)(18) requires certain
practitioners to take assignment when they furnish covered services to
Medicare beneficiaries and restricts what they can collect from
beneficiaries to deductible and coinsurance amounts. The statute not
only imposes these rules (without an exception before passage of
section 4507 of BBA 1997), but it also provides strong sanctions for
violation of them. Hence, Medicare law absent section 4507 effectively
precludes a physician or practitioner from privately contracting with a
Medicare beneficiary for the delivery of Medicare-covered items and
services, except in compliance with these rules (for example, to pay
more than the limits set by law). Section 4507 of BBA 1997 permits such
private contracting, provided the requirements of BBA 1997 are met.
The private contracting provision was effective for private
contracts entered into, on, or after January 1, 1998. We implemented it
through a series of operating instructions for Medicare carriers and
information that carriers were instructed to provide to physicians and
practitioners. Specifically, in November 1998, we issued Program
Memorandum No. B-97-9 (change request number 294) that transmitted the
Medicare fee schedule for physician services and contained the fact
sheet that carriers were instructed to send to physicians and
practitioners with the 1998 fee schedule information. This document,
which is commonly called the ``Dear Doctor letter,'' advised physicians
and practitioners of the fee schedule amounts for 1998, the changes to
regulations, and also the important changes that BBA 1997 made to
coverage and payment for physician services, including the private
contracting changes.
Due to the private contracting provisions, we extended the
participating enrollment period to February 2, 1998, to give physicians
sufficient time to consider the changes made by BBA 1997 before making
a participation decision. In January 1998, we issued Program Memorandum
No. B 97-17 (change request number 193), that was devoted in its
entirety to private contracting and not only laid out the processes
that would apply but also answered the most frequently asked questions
about private contracting. Carriers were instructed to share this
information with physicians and practitioners through carrier
bulletins.
Lastly, in April 1998, we issued Program Memorandum No. B 98-12
(change request number 468), which amended the process to be followed
when the carriers receive a claim from a physician or practitioner who
has opted-out of Medicare under the private contracting provision and
thus should not bill Medicare.
We are using this proposed rule to place in regulations the
requirements that section 4507 of BBA 1997 added to sections 1802(b)
and 1862(a)(19) of the Act. In addition to placing the statutory
requirements in regulations, this proposed rule also proposes ancillary
policies that we believe are necessary to clarify what it means when a
physician or practitioner exercises his or her ability to ``opt out''
of Medicare.
There has been a lot of confusion and misinformation about when
private contracts are needed. Before we discuss our proposed rules
governing private contracting, we want to address some of the most
common questions about Medicare claims submission rules and private
contracting.
Do the private contracting rules apply to Part A?
No. The Medicare claims submission and private contracting rules
apply only when a physician or practitioner furnishes Medicare-covered
services to a beneficiary who is enrolled in Medicare Part B. They do
not apply to individuals who have only Medicare Part A or to
individuals who are age 65 or over but who do not have Medicare.
Therefore, if the patient is not enrolled in Medicare Part B, a private
contract is not needed for the physician or practitioner to continue to
bill the patient and to charge without regard to the Medicare mandatory
claims submission and limiting charge rules.
The private contracting provision of the statute defines
``beneficiary'' (for purposes of that section only) as a person who is
eligible for Part A or who is enrolled in Part B. However, the private
contracting provisions of the law set aside the mandatory claims and
limiting charge rules that apply only to Part B. Therefore,
notwithstanding the statutory definition of the term ``beneficiary'' to
mean, in part, an individual who is eligible for Part A, as a practical
matter section 4507 applies only to services furnished to an individual
who is enrolled in Part B.
Must a physician or practitioner who provides services
that are not covered by Medicare sign a private contract with the
beneficiary and opt-out of Medicare to be paid for noncovered services?
No. Since Medicare rules do not apply to services that Medicare
does not cover, a section 4507 private contract is not needed to bill
for them, and neither the Medicare claims submission nor the Medicare
limiting charges rules apply to these services. A private contract is
needed only for Medicare-covered services and then only if the
physician or practitioner is opting-out or has opted-out.
A physician or practitioner may furnish a service that Medicare
covers under some or many circumstances but that would likely be deemed
as not reasonable and necessary by Medicare in a particular case (for
example, multiple nursing home visits, some concurrent care services).
In that particular case, the physician or practitioner should give the
beneficiary an advance beneficiary notice (ABN) that states the service
may not be covered by Medicare and that the beneficiary will be liable
to pay for the service if it is denied. If the claim is denied by
Medicare, a private contract is not necessary to permit the physician
or practitioner to bill the beneficiary for the service.
What are the rules governing claims submission to
Medicare?
There are situations where a physician or practitioner who has not
opted-out of Medicare is not authorized to submit a claim for a covered
item or service provided to a Medicare beneficiary. A beneficiary, for
reasons of his or her own, may decline to authorize the physician or
practitioner to submit a claim or to furnish confidential medical
information that is needed to submit a proper claim to Medicare. For
example, the beneficiary may not want information about the
beneficiary's mental illness or HIV/AIDS status to be disclosed to
anyone. If the beneficiary does not sign the claim or otherwise
authorize the claim submission, the physician or practitioner should
not submit the claim to Medicare. However, the limiting charge would
apply to the service. Moreover, if the beneficiary or his or her legal
representative later decides to authorize the submission of a claim for
the service and asks the physician or practitioner to submit the claim,
the physician or practitioner must do so.
Where the beneficiary authorizes the claim submission, physicians
and practitioners must submit claims for services furnished to an
individual enrolled in Medicare Part B unless they have opted-out of
Medicare under the private contracting provisions of the law.
Physicians and practitioners who furnish services to a Medicare
beneficiary need not submit claims to Medicare in the following cases:
[[Page 30848]]
The beneficiary is not enrolled in Medicare Part B;
Medicare limiting charge does not apply.
The beneficiary refuses to authorize the physician or
practitioner to submit a claim for a covered service to Medicare;
Medicare limiting charge does apply.
The service is categorically noncovered (for example,
hearing aids and meals on wheels for diabetics); Medicare limiting
charge does not apply.
The service is not covered because the beneficiary is
enrolled in a Medicare risk HMO and the HMO will not pay for the
service because the physician or practitioner is outside of the HMO's
network; Medicare limiting charge does not apply.
Provisions of the proposed rule relating to private contracting.
Definitions
In Sec. 405.400, we define certain terms. We are proposing to
define ``beneficiary'' to mean an individual who is enrolled in Part B
of Medicare. As we discussed above, the statute's definition of the
term has created considerable confusion about whether physicians must
opt-out of Medicare to charge individuals who are over age 65 and
eligible for Part A of Medicare but who are not enrolled in Part B of
Medicare. We believe it is necessary to define the term ``beneficiary''
as being limited to an individual who is enrolled in Part B of Medicare
in order to avoid continued confusion on this issue. We believe that
having a definition that differs from the statute's definition is
justified because the context in which the definition is used is that
of Part B claims submission rules, Part B limiting charges, and
coverage of Part B services. None of these policies is applicable to
individuals who are not enrolled in Part B of Medicare.
We propose to define ``emergency care services'' as being services
furnished to an individual who has an ``emergency medical condition''
as that term is defined in Sec. 489.24. Reliance on the longstanding
definition of emergency medical condition is, we believe, an
appropriate and useful way to define emergency care services.
We are proposing to define ``legal representative'' to mean an
individual who has been appointed as the Medicare beneficiary's legal
guardian under State law, or who has been granted a power of attorney
from the beneficiary, which power of attorney is sufficient to permit
the individual to enter into private contracts on the Medicare
beneficiary's behalf. This is necessary to clarify that, if a
beneficiary has a legal representative, that party can act on the
beneficiary's behalf when signing a private contract. We recognize that
this is a strict standard and we invite comments on it. However, our
concern is that we ensure that only parties who were authorized to make
legal and financial commitments on behalf of the beneficiary be
permitted to sign private contracts on a beneficiary's behalf since
signing such a contract may incur a significant debt for a beneficiary.
We are defining the term ``opt-out'' to mean the status of meeting
the conditions specified in Sec. 405.410. When the physician or
practitioner meets these conditions, he or she ceases to be bound by
Medicare's mandatory claims submission rule and, in the case of a
physician, the limiting charge rule or, in the case of a practitioner,
the mandatory assignment rule.
We are defining ``participating physician'' to mean a physician as
defined in this section who has signed an agreement to participate in
Part B.
We are defining ``physician'' to mean a doctor of medicine or a
doctor of osteopathy (who is legally authorized to practice as such in
the State in which he or she practices). This is the statutory
definition of the term for purposes of this section as specified in
section 1802(b)(5)(B) of the Act.
We are defining ``practitioner'' to mean any of the following to
the extent that the individual is legally authorized to practice as
such by the State where he or she furnishes services: a physician
assistant, nurse practitioner, clinical nurse specialist, certified
registered nurse anesthetist, certified nurse midwife, clinical
psychologist, and clinical social worker. These practitioners are those
included in the statutory definition of practitioner for this purpose
in section 1802(b)(5)(C) of the Act, that incorporates by reference
those practitioner types listed in section 1842(b)(18)(C) of the Act.
We are defining ``private contract'' to mean a document that meets
the criteria in Sec. 405.415.
We propose to define ``properly opt-out'' to mean to fully complete
the requirements in Sec. 405.410, each of which must be met for the
physician or practitioner to opt-out of Medicare and furnish items or
services under a private contract.
We propose to define ``properly terminate opt-out'' to mean to
fully complete the requirements in Sec. 405.445, each of which must be
met for the physician or practitioner who has opted-out of Medicare to
terminate his or her opt-out.
We are proposing to define ``urgent care services'' as services
that are provided to an individual who requires services to be
furnished within 12 hours in order to avoid the likely onset of an
emergency medical condition.
We also adopted the concept of ``emergency medical condition'' as
defined in Sec. 489.24 to help define urgent care services because the
former term has a longstanding history of use in Medicare with respect
to when a hospital must furnish emergency care to an individual who
appears at its door (specifically, the ``anti-dumping'' rules). We have
no standardized definition of ``urgent care services.'' We have been
unable to find a definition of an ``urgent care service'' in standard
usage. However, we think that an urgent care service would
appropriately be any service that needs to be furnished without
significant delay so as to avoid the onset of an emergency medical
condition. Therefore, we are proposing that an ``urgent care service''
is one that needs to be furnished within 12 hours of the determination
of need in order to avoid the individual's condition from becoming an
emergency medical condition. The chief distinction between urgent care
services and emergency care services is that urgent care services do
not have to be furnished ``immediately'' as do ``emergency care
services.''
General Rules
In Sec. 405.405, we specify the general rules that apply to private
contracting. Specifically, in Sec. 405.405(a), we state that a
physician or practitioner may enter into one or more private contracts
with Medicare beneficiaries for the purpose of furnishing items or
services that would otherwise be covered by Medicare when the
requirements of these rules are met. This is required by section
1802(b)(1)of the Act.
In Sec. 405.405(b), we specify that a physician or practitioner who
enters into at least one private contract with a Medicare beneficiary
under this provision, and who submits one or more affidavits in
accordance with these rules, opts out of Medicare for a 2-year period.
This is required by section 1802(b)(3)(B)(ii) of the Act. We also
specify that the physician's or practitioner's opt-out may be renewed
for subsequent 2-year periods. Since the statute specifies that the
physician or practitioner who meets the criteria for private
contracting cannot be paid by Medicare for a 2-year period and does not
address continuance of this period, we have chosen to make the opt-out
period 2 years but to permit subsequent opt-out periods. There is no
limit on the number of subsequent periods for which a physician or
practitioner may opt-out.
[[Page 30849]]
In Sec. 405.405(c), we specify that both the private contracts
described in paragraph (a) and the physician's or practitioner's opt-
out described in paragraph (b) are null and void if the physician or
practitioner fails to complete opt-out in accordance with these rules
or fails to remain in compliance with the conditions for opting-out. We
specify the results of failure to properly opt-out or to maintain the
conditions for opting-out in Sec. 405.430 and Sec. 405.435. Sections
1802(b)(2) and (b)(3)(A) of the Act, the criteria that governs the
private contract and the affidavit, must be met by physicians and
practitioners that want to opt-out and to privately contract with
Medicare beneficiaries.
In Sec. 405.405(d), we specify that services furnished under
private contracts meeting the requirements of this Subpart are not
covered services under Medicare and that no Medicare payment will be
made for such services either directly or indirectly. This implements
section 1862(a)(19) of the Act, which causes services furnished under
private contracts by physicians and practitioners who opt-out to be
excluded from coverage under Medicare.
Conditions for Opting-Out of Medicare
In Sec. 405.410, we specify the conditions that must be met for a
physician or practitioner to opt-out of Medicare and to furnish
services under private contracts with Medicare beneficiaries.
Specifically, in Sec. 405.410(a), we specify that each private contract
between a physician or a practitioner and a Medicare beneficiary must
meet the specifications of Sec. 405.415. In Sec. 405.410(b), we specify
that the physician or practitioner who wants to privately contract with
Medicare beneficiaries must submit to Medicare one or more affidavits
that meet the specifications of Sec. 405.420. The physician or
practitioner must submit an affidavit to each Medicare carrier to which
the physician or practitioner submits claims for Medicare payment.
In Sec. 405.410(c), we specify that a nonparticipating physician or
a practitioner may opt-out of Medicare at any time. We also specify
that the 2-year opt-out period begins the date the affidavit meeting
the requirements of Sec. 405.420 is signed, as long as the affidavit is
timely filed (that is, within 10 days after the first private contract
is entered into). In addition, we specify that if any required
affidavit is not timely filed, the 2-year opt-out period begins when
the last of the affidavits is filed. In this event, the private
contracts signed by the parties before the last required affidavit is
properly filed become effective upon the filing of the last required
affidavit, and the furnishing of any items or services to Medicare
beneficiaries under contracts before the last required affidavit is
properly filed are subject to standard Medicare rules. Section
1802(b)(3)(B)(ii) provides that the opt-out period begins when the
affidavit is signed, and section 1802(b)(3)(B)(iii) of the Act
specifies that the affidavit must be filed within 10 days of the date
the first private contract is signed.
In Sec. 405.410(d), we specify that a participating physician may
opt-out of Medicare at the beginning of any calendar quarter, provided
the affidavit described in Sec. 405.420 is submitted to Medicare at
least 30 days before the beginning of such quarter. Private contracts
signed by the parties before the beginning of the calendar quarter
become effective at the beginning of such calendar quarter, and the
furnishing of any items or services to Medicare beneficiaries under
these contracts before the beginning of that calendar quarter is
subject to standard Medicare rules.
It is necessary to treat participating physicians differently from
nonparticipating physicians because each participating physician has
entered into a contract with Medicare to be paid at the full fee
schedule for the services they furnish to Medicare beneficiaries
(rather than at 95 percent of the payment amount for nonparticipating
physicians). When a participating physician opts-out of Medicare, he or
she, in effect, terminates his or her participation agreement with
Medicare since he or she no longer agrees to accept assignment on all
services furnished to Medicare beneficiaries. When a participating
physician opts-out of Medicare, the carrier (that is, each applicable
carrier) must make systems changes to ensure the system pays the
physician at the higher participating-physician rate for the period
before the effective date of the opt-out, pays the physician as a
nonparticipating-physician for emergency and urgent care services
effective the date of the opt-out, and does not pay at all for all
other items and services effective the date of the opt-out. Therefore,
carriers need at least 30 days advance notice when a participating
physician opts-out to ensure that the systems changes are made
correctly. Moreover, carriers generally make systems changes no less
frequently than at the beginning of each calendar quarter. Therefore,
participating physicians must provide 30 days notice that they intend
to opt-out at the beginning of the next calendar quarter for the
changes to be made properly. We do not anticipate that this requirement
will cause significant hardship on participating physicians who choose
to opt-out or on beneficiaries who choose to privately contract with
them.
Requirements of Private Contracts
In Sec. 405.415, we are specifying criteria for a physician or
practitioner to opt-out of Medicare. To opt-out of Medicare, the
physician or practitioner must meet all of the criteria in this
section.
In Sec. 405.415, we specify the requirements for a private
contract. In Sec. 405.415(a) we specify that it must be in writing, in
accordance with section 1802(b)(2)(A)(i) of the Act. In addition, we
are proposing requiring that the contract be printed in sufficiently
large type to ensure that beneficiaries are able to read the contract.
In Sec. 405.415(b), we specify that, as required by 1802(b)(2)(B)
of the Act, it must state whether the physician or practitioner has
been excluded from Medicare under section 1128 of the Act.
In Sec. 405.415(c), we specify that, as required by
1802(b)(2)(B)(ii) of the Act, it must state that the beneficiary or
legal representative accepts full responsibility for payment of the
physician's or practitioner's charge for the services furnished.
In Sec. 405.415(d), as required by section 1802(b)(2)(B)(iii) of
the Act, it must state that the beneficiary or legal representative
understands that there are no limits on what the physician or
practitioner may charge for items or services furnished by the
physician or practitioner.
In Sec. 405.415(e), we specify that, as required by
1802(b)(2)(B)(i) of the Act, it must state that the beneficiary or
legal representative agrees not to submit a claim to Medicare nor to
ask the physician or practitioner to submit a claim to Medicare.
In Sec. 405.415(f), we specify that, as required by section
1802(b)(2)(B)(ii) of the Act, it must state that the beneficiary or
legal representative understands that no Medicare payment will be made
for any services furnished by the physician or practitioner, although
such Medicare-covered services would likely be covered and paid by
Medicare if they were provided by a physician or practitioner who had
not opted-out of Medicare.
In Sec. 405.415(g), we specify that, in accordance with section
1802(b)(2)(B)(v) of the Act, it must state that the beneficiary or
legal representative enters into this contract with the knowledge that
he or she has the right to obtain Medicare-covered items and services
[[Page 30850]]
from physicians and practitioners who have not opted-out of Medicare.
In Sec. 405.415(h), we propose that the private contract contain
the beginning effective date and expiration date of the opt-out period.
The private contract must expire on the expiration date of the opt-out
period since, after the expiration of the opt-out period, the physician
or practitioner is no longer authorized to privately contract unless he
or she enters into a new opt-out period.
In Sec. 405.415(i), we specify, in accord with section
1802(b)(2)(B)(iv) of the Act, that the private contract must state that
the beneficiary understands that Medigap plans do not, and that other
supplemental insurance plans may elect not to, make payments for such
items and services because payment is not made by Medicare.
In Sec. 405.415(j), we specify that the contract must be signed by
the beneficiary or by the beneficiary's legal representative and by the
physician or practitioner. Section 1802(b)(2)(A)(i) of the Act
expressly requires that the contract must be signed by the beneficiary.
Although there is no parallel express requirement for the physician or
practitioner, we believe that such a requirement is implicit in the
statute, and we are, therefore, proposing that the physician or
practitioner also sign the contract.
In Sec. 405.415(k), in accordance with 1802(b)(2)(A)(iii), we
specify that the contract must not have been entered into during a time
when the beneficiary requires emergency care services or urgent care
services.
405.415(l), we propose that the beneficiary or legal representative
must receive a copy of the contract before items or services are
furnished under the contract. This is standard practice when parties
sign binding contracts, and we believe it is important in this case so
that the beneficiary or family members have the contract available if
questions about charges for the services furnished arise.
In Sec. 405.415(m), we propose that the physician or practitioner
must retain a copy of each private contract for the duration of the
opt-out period to which the contract applies. Physicians and
practitioners may want to retain the private contracts for a longer
period of time in case a beneficiary disputes whether a valid contract
was signed.
In Sec. 405.415(n), we propose that the physician or practitioner
must permit us to inspect each such contract upon request. We propose
these requirements to ensure that the contracts will be available if
there are allegations that the physician or practitioner has failed
properly opt-out or maintain opt-out or if there is need to review them
to process an appeal under Sec. 405.450.
In Sec. 405.415(o), we propose that a private contract must be
entered into for each opt-out period.
We have been requested to create a standard form for the private
contract. We have decided that such a form is not necessary. While the
minimal content of the contract is controlled by Federal law and
regulation, the contracts are otherwise private agreements. Moreover,
such contracts will not generally be provided to nor inspected by the
Government.
Requirements for Opt-Out Affidavits
In Sec. 405.420, we specify the required elements of the affidavit
that the physician or practitioner must file with Medicare to opt-out.
In Sec. 405.420(a), as required by section 1802(b)(3)(B)(i) of the Act,
we specify that the affidavit must be in writing and be signed by the
physician or practitioner.
In Sec. 405.420(b), we specify that the affidavit must contain the
physician or practitioner's full name, address, telephone number,
national provider identifier (NPI) or billing number if one has been
assigned, uniform provider identification number (UPIN) if one has been
assigned, or, if neither a NPI, billing number nor a UPIN has been
assigned, the physician or practitioner's tax identification number
(TIN). This information is necessary to enable the Medicare carrier to
positively and uniquely identify the opt-out physician or practitioner,
as required by section 1802(b)(3)(B)(i), and to ensure that no Medicare
payment is made to the physician or practitioner or to any party for
the services of the physician or practitioner (except for emergency and
urgent care services), as required by section 1802(b)(1)(B)of the Act.
Medicare carriers will provide the identifying information to
Medicare+Choice (M+C) plans to ensure that they do not pay opt-out
physicians or practitioners or enable them to be paid by Medicare funds
for services they furnish to Medicare beneficiaries.
The TIN is necessary for physicians and practitioners that do not
have a NPI, billing number, or UPIN so that the carrier can establish a
means of tracking them without forcing them to complete the full
Medicare enrollment process in order to opt-out of Medicare.
Recent data indicate that approximately 4 percent of physicians in
the nation do not provide services to Medicare beneficiaries. We
believe that some of these physicians (and some practitioners who are
currently not enrolled in Medicare) are likely to choose to privately
contract with Medicare beneficiaries under section 1802(b) of the Act,
since doing so will open a market to them. It is also likely that many
of these physicians and practitioners do not have Medicare billing
numbers or UPINs because they have not been providing care to Medicare
beneficiaries. Now, however, if such physicians and practitioners wish
to privately contract with Medicare beneficiaries under section 1802 of
the Act, they will need to be enumerated, for purposes of monitoring
compliance with the law and particularly in case they furnish emergency
or urgent care services for which they must bill and be paid by
Medicare, notwithstanding that they have opted-out. Since we expect the
provision of emergency or urgent care services by opt-out physicians to
be very infrequent, and since we intend to monitor for potential abuse,
we believe that the burden associated with collecting this information
is very slight, is far outweighed by the benefit to beneficiaries of
having these physicians available to provide emergency or urgent care
services if they need such care, and is necessary to monitor
compliance.
In Sec. 405.420(c), we specify, pursuant to sections 1802(b)(3)(A),
1802(b)(3)(B), and 1802(b)(3)(C) of the Act, that the affidavit must
state that the physician or practitioner will provide items and
services to Medicare beneficiaries only through private contracts that
meet the criteria of Sec. 405.415.
In Sec. 405.420(d), we specify that, in accordance with section
1802(b)(3)(B)(ii) of the Act, the affidavit must state that the
physician or practitioner will not submit a claim to Medicare for any
item or service furnished to a Medicare beneficiary, nor will the
physician or practitioner permit any entity acting on his or her behalf
to submit a claim to Medicare for any item or service furnished to a
Medicare beneficiary. The extension of the requirement to include any
``entity'' reflects our belief that very few physicians and
practitioners themselves submit claims for services. Rather, we believe
that most physicians and practitioners use a billing service or
reassign benefits to organizations that bill and are paid for the
physician's or practitioner's services.
In Sec. 405.420(e), we specify that, in accordance with section
1802(b)(3)(B)(ii) of the Act, the affidavit must state that the
physician or practitioner understands that he or she may receive no
direct or indirect payment from Medicare for services to Medicare
beneficiaries who have signed
[[Page 30851]]
private contracts, whether as an employee of an organization, a partner
in a partnership, under a reassignment of benefits, or as payment for a
service furnished to a Medicare beneficiary under a M+C plan. As with
the prohibition on billing, this provision reflects the reality that
most physician and practitioner services are billed by and paid to
organizations to whom the physician or practitioner reassigns benefits.
When a physician or practitioner opts-out of Medicare, no payment
may be made for the services of the physician or practitioner,
regardless of whether another entity bills and is paid for those
services. In our experience, physicians and practitioners frequently
fail to understand that organizations to which they have reassigned
benefits are not, under Medicare law, considered to be the entity that
furnishes the service. Therefore, where a physician reassigns benefits
to an organization and subsequently decides to opt-out of Medicare, he
or she no longer has any Medicare benefits to reassign and that
organization can no longer bill and be paid by Medicare for the
services of the physician or practitioner. This has been a source of
confusion for physicians and practitioners since the implementation of
the private contracting provisions on January 1, 1998, and has resulted
in some physicians being terminated by organizations that can no longer
bill and be paid by Medicare for their services. Hence, we believe that
this important information should be placed in a document that the
physician or practitioner must sign before opting-out.
Moreover, we believe that it is important the physicians and
practitioners understand that opting-out of Medicare means that they
cannot be paid by a Medicare risk or cost contractor or, after June 1,
1998, a M+C organization (for example, an HMO, provider service
organizations, M+C fee for service plans, etc.), since payment by these
organizations for services to Medicare beneficiaries would constitute
payment by Medicare and would be a violation of the private contracting
rules.
In Sec. 405.420(f), as required by section 1802(b)(3)(B)(ii) of the
Act, the affidavit must state that the physician or practitioner
acknowledges that the services provided by the physician or
practitioner who opts-out of Medicare are not covered by Medicare and
that no Medicare payment may be made to any entity for those services,
directly or on a capitated basis. This is important to note since, when
Medicare does not cover a service, it neither pays for the item or
service as primary payer nor makes secondary payment when other
insurers are primary. (Also, many other insurers will not make any
payment because the service is not covered by Medicare.)
In Sec. 405.420(g), we specify that the affidavit must bind the
physician or practitioner to the terms of both the affidavit and the
private contracts for the 2-year opt-out period. Section
1802(b)(3)(B)(ii) of the Act requires that the physician or
practitioner may opt-out for a period of not less than 2 years.
Accordingly, we have defined the opt-out period to be 2 years and have
tied the duration of the private contract to the opt-out period.
In Sec. 405.420(h), we propose that the affidavit must acknowledge
that the physician or practitioner recognizes that the terms of the
affidavit apply to all Medicare-covered items and services furnished by
the physician or practitioner to Medicare beneficiaries, regardless of
any payment arrangement in which the physician or practitioner
participates. It is not unusual for physicians and practitioners to
have multiple sources of income and to reassign benefits to multiple
entities (for example, multiple HMOs, preferred provider organizations,
private practice, and part time employment by a facility). When a
physician or practitioner opts-out, we want to ensure that he or she
understands that he or she opts-out for all Medicare-covered items and
services, regardless of where or on whose behalf they are provided. For
example, a physician who is employed by a facility and who also has a
private practice cannot opt-out of Medicare with respect to only the
private practice and not opt-out for services he furnishes on behalf of
a facility or other organization for which such services are billed to
a carrier and paid under Part B. If the physician opts-out, no Medicare
payment can be made either to the private practice or to the facility
or other organization for the services of the physician. However, if
the physician is paid by the facility for administrative functions
which are not billable to individual beneficiaries as physician
services, such as direction of a department of a hospital or
administrative oversight of a teaching program, the payment by the
facility to the physician is not affected.
In Sec. 405.420(i), we propose that the affidavit must acknowledge
that the physician or practitioner who has previously signed a Part B
participation agreement understands that he or she terminates that
agreement as of the effective date of the affidavit. We believe that
this is necessary to ensure that the physician or practitioner
understands that he or she is no longer a Medicare-participating
physician or practitioner. This is important with regard to post opt-
out billing for emergency and urgent care services. The physician or
practitioner who provides such care (for which Medicare will pay) will
be paid as a nonparticipating physician if he or she submits those
claims for payment, notwithstanding that he or she had a Part B
participation agreement before he or she opted-out.
In Sec. 405.420(j), we specify that the affidavit must acknowledge
that the physician or practitioner understands that a beneficiary who
has not signed a private contract and who requires emergency or urgent
care services may not be asked to sign a private contract with respect
to receiving those services. If a physician or practitioner who opts
out of Medicare provides emergency or urgent care services to a
beneficiary who has not previously signed a private contract, the
physician or practitioner must submit a claim to Medicare for those
services and may not charge the beneficiary more than the limiting
charge for those services.
In Sec. 405.420(k), we propose that the affidavit must be filed
with each Medicare carrier to which the physician or practitioner has
submitted claims in the previous 2 years. This is necessary to ensure
that each Medicare claims payment system that needs to know of the opt-
out is advised promptly so that no Medicare payment is made for the
services of the opt-out physician or practitioner. This is based on
sections 1802(b)(1)(B) and 1802(b)(3)(B)(iii) of the Act.
In Sec. 405.420(l), we specify that in the case of a
nonparticipating physician or a practitioner, all required affidavits
must be filed within 10 days after the physician or practitioner signs
his or her first private contract with a Medicare beneficiary. In the
case of a participating physician, we specify that all required
affidavits must be filed in accordance with Sec. 405.410(d), which
requires that the affidavits be filed no later than 30 days before the
beginning of a calender quarter and must be effective on the first day
of the calender quarter. Section 1802(b)(3)(B)(iii) of the Act requires
that the physician or practitioner file the affidavit within 10 days
after the physician or practitioner signs his or her first private
contract with a Medicare beneficiary. As discussed previously in this
preamble, participating physicians are permitted to opt-out only on a
quarterly basis because of the systems changes that must be made to
reverse the effect of the participation agreements they previously
entered into.
[[Page 30852]]
Various members of the public have requested we create a standard
affidavit for submission to the Medicare carrier. We do not see a
reason to do this. The criteria of a legally sufficient affidavit will
be clearly specified in regulations, and we are confident that
physicians and practitioners and their counsel can produce an affidavit
without needing a Government form to sign.
Effect of Opting-Out of Medicare
In section Sec. 405.425, we specify the effects of opting-out of
Medicare. Specifically, we state that, a physician's or practitioner's
opt-out of Medicare, for the 2-year period for which the opt-out is
effective, has the following effects:
In Sec. 405.425(a), we state that (except as provided in
Sec. 405.440), in accordance with section 1802(b)(1)(B) of the Act, no
payment may be made directly by Medicare or by any M+C plan to the
physician or practitioner or to any entity to which the physician or
practitioner reassigns his or her right to receive payment for
services.
In Sec. 405.425(b), we state that, in accord with section
1802(b)(3)(B)(ii) of the Act, the physician or practitioner may not
furnish any item or service that would otherwise be covered by Medicare
(except for emergency or urgent care services) to any Medicare
beneficiary except through a private contract that meets the
requirements of these rules.
In Sec. 405.425(c), we state that the physician or
practitioner is not subject to the requirement to submit a claim for
items or services furnished to a Medicare beneficiary (as specified in
Sec. 424.5(a)(6)), except as provided in Sec. 405.440 with respect to
emergency and urgent care services.
In Sec. 405.425(d), in accordance with section
1802(b)(3)(B)(ii) of the Act, we state that the physician or
practitioner is prohibited from submitting a claim to Medicare for
items or services furnished to a Medicare beneficiary, except as
provided in Sec. 405.440 in the case of emergency or urgent care
services.
In Sec. 405.425(e), we state that, in accordance with
1802(b)(4) of the Act, the physician who has properly opted-out is not
subject to the limiting charge provisions of Sec. 414.48.
In Sec. 405.425(f), we state that a physician or
practitioner who has properly opted-out is not subject to the
prohibition-on-reassignment provisions of Sec. 414.80. These are the
rules that restrict when physicians and practitioners can reassign
Medicare benefits to organizations with which they have financial
arrangements.
In Sec. 405.425(g), we propose that in the case of a
practitioner, he or she is not prohibited from billing or collecting
amounts from beneficiaries in excess of those provided in section
1842(b)(18)(B) of the Act. This is not specifically provided for by
section 4507 of BBA 1997; however, we believe that this provision is
consistent with sections 1802(b)(1) and (2)(B) of the Act, that, when
read together, permit practitioners to collect more than the deductible
and coinsurance to which they are limited under section 1842(b)(18)(B)
of the Act when they provide covered services to Medicare beneficiaries
under standard Medicare rules. Section 1842(b)(18)(B) of the Act
specifies that practitioners must take assignment on all claims and may
not collect more than Medicare deductibles and coinsurance from
Medicare beneficiaries. We believe that the private contracting
provisions exempt practitioners from these restrictions.
In Sec. 405.425(h), we propose that the death of a
beneficiary who (or whose legal representative) has entered into a
private contract does not invoke Sec. 424.62 or Sec. 424.64 with
respect to the physician or practitioner with whom the beneficiary (or
legal representative) has privately contracted. These sections of the
regulations permit claims to be filed and payment to be made for
services furnished to a beneficiary who has died. We propose to include
this section to ensure that it is clear that the terms of a private
contract are not superseded by the provisions of Sec. 424.62 or
Sec. 424.64.
In Sec. 405.425(i), we specify that the opt-out physician
or practitioner may make referrals and may order or certify the need
for Medicare-covered items and services provided the physician or
practitioner is not paid directly or indirectly by Medicare for those
services. A physician or practitioner who has properly opted-out may
continue to act as a physician or practitioner for purposes of ordering
Medicare-covered services (for example, laboratory tests), making
necessary certifications (for example, home health plan of care),
attestations (for example, hospital inpatient), etc., as long as he or
she is not being paid directly or indirectly by Medicare for these
services.
Failure to Properly Opt-Out
In Sec. 405.430(a), we specify that a physician or practitioner
fails to properly opt-out if any private contract between the physician
or practitioner and a Medicare beneficiary does not meet the standards
of Sec. 405.415 or if the physician or practitioner fails to submit
affidavit(s) in accordance with Sec. 405.420. Sections 1802(b)(2) and
1802(b)(3) of the Act specify the criteria that private contracts and
affidavits must meet in order for the physician or practitioner to
successfully opt-out of Medicare.
In section Sec. 405.430(b), we specify that if a physician or
practitioner fails to properly opt-out as specified in Sec. 405.430(a),
the following result:
All of the private contracts between the physician or
practitioner and Medicare beneficiaries are deemed null and void.
The physician's or practitioner's attempt to opt-out of
Medicare is nullified.
The physician or practitioner must submit claims to
Medicare for all Medicare-covered items and services furnished to
Medicare beneficiaries. Section 1802(b)(4) of the Act, which would
excuse the physician and practitioner from the mandatory claims
submission requirements of section 1848(g)(4) of the Act, is not
effective when the opt-out rules are not met.
The physician is subject to the limiting charge provisions
of Sec. 414.48. Sections 1802(b)(1) and 1802(b)(2)(B)(iii), which
excuse the physician from the limiting charge rules, do not apply and
he or she continues to be subject to the limiting charge rules of
section 1848(g) of the Act.
The physician or practitioner may not reassign any claim
except as provided in Sec. 424.80. Medicare payment may be made only to
the beneficiary, to the physician or practitioner under an assignment
of benefits or to another party for the services of a physician or
practitioner only when the requirements of the reassignment of benefits
provision of Sec. 424.80 are met.
The practitioner may neither bill nor collect an amount
from the beneficiary except for applicable deductible and coinsurance
amounts. Section 1842(b)(18)(B) of the Act explicitly prohibits
practitioners from collecting more than the deductible or coinsurance
from the beneficiary. While this requirement would not apply if the
requirements to properly opt-out had been satisfied, it does apply when
the criteria to properly opt-out have not been met.
The physician or practitioner may attempt to properly opt-
out at any time. The statute does not preclude a physician or
practitioner who has not complied totally with the statute's criteria
for opting-out of Medicare from subsequently meeting the criteria and
thus at that time properly opting-out.
Failure to Maintain Opt-out
In Sec. 405.435(a), we specify four circumstances, under any one of
which
[[Page 30853]]
the physician or practitioner would be considered to have failed to
maintain opt-out, that is, failed to remain in compliance with the
requirements of these rules. Specifically, in Sec. 405.435(a)(1), we
state that a physician or practitioner would be considered to have
failed to maintain the opt-out if he or she knowingly and willfully
submits a claim for Medicare payment (except a claim for emergency care
services or urgent care services) or receives Medicare payment directly
or indirectly for services furnished to a Medicare beneficiary (except
when the services are emergency care services or urgent care services).
This implements section 1802(b)(3)(C) of the Act.
In Sec. 405.435(a)(2), we state that the physician or practitioner
would be considered to have violated the terms of the opt-out if he or
she enters into private contracts with Medicare beneficiaries for the
purpose of furnishing items and services that would otherwise be
covered by Medicare when the contracts fail to meet the requirements of
Sec. 405.415. This implements section 1802(b)(2) of the Act that
requires that the physician or practitioner must enter into private
contracts that meet certain criteria for the opt-out to be valid. This
provision is also consistent with the enforcement provisions of section
1802(b)(3)(C) of the Act.
In addition, in Sec. 405.435(a)(3), we specify that the physician
or practitioner would be considered to have failed to maintain the opt-
out if he or she fails to comply with the provisions of Sec. 405.440
regarding billing for emergency care services or urgent care services.
In part, this provision implements section 1802(b)(2)(A)(iii) of the
Act that prohibits a physician or practitioner from requesting that a
beneficiary enter into a private contract when he or she is in need of
emergency or urgent care services and is otherwise necessary to ensure
access by Medicare beneficiaries to emergency and urgent care services.
In Sec. 405.435(a)(4), we propose that the physician or
practitioner would be considered to have failed to maintain opt-out if
he or she fails to retain a copy of each private contract that he or
she entered into for the duration of the opt-out period for which such
contracts are applicable or fails to permit us to inspect such
contracts upon request. The issue of retaining copies of private
contracts is discussed in Sec. 405.415, requirements of the private
contract.
We intend to continue the administrative process currently in place
for dealing with the submission of claims by physicians and
practitioners who have opted-out of Medicare. Specifically, we have
instructed carriers to pend claims they receive from physicians and
practitioners who have filed an affidavit opting-out of Medicare and to
send the physician or practitioner a letter asking him or her if the
submission of the claim was intentional or accidental, and if the
latter by what date the physician or practitioner can remedy the
problem. We recognize that most physicians and practitioners may be
somewhat distant from the billing of their claims and that the use of
automation and billing services increases the chance that one or more
claims may be accidentally submitted to Medicare for an opt-out
physician or practitioner. We also recognize that if the problem is
systematic, it may take some time to correct. Hence, under the current
process, we give physicians and practitioners 45 days from the date of
the postmark on the carrier's letter to respond to the carrier and to
advise them of when they believe the problem can be fixed. Carrier
notices to beneficiaries will advise them that no payment can be made
for the services of the opt-out physician, and that there are no limits
on what the physician or practitioner can charge the beneficiary,
unless the physician or practitioner does not respond timely to the
carrier's letter, does not timely correct the billing problem, or
states that the submission of the claim was intentional. We do not
believe that any of these scenarios will happen often since physicians
and practitioner who opt-out of Medicare clearly have an incentive to
ensure that they abide by the terms of the opt-out and that neither
they nor any party on their behalf submit claims to Medicare.
In section Sec. 405.435(b), we specify that the effects of a
physician or practitioner failing to maintain opt-out as specified in
paragraph (a) are as follows:
All of the private contracts between the physician or
practitioner and Medicare beneficiaries are deemed null and void.
The physician's or practitioner's opt-out of Medicare is
nullified.
The physician or practitioner again becomes subject to the
mandatory claims submission rule. Therefore, the physician or
practitioner must submit claims to Medicare for all Medicare-covered
items and services furnished to Medicare beneficiaries.
The physician or practitioner will not receive Medicare
payment on such claims for the remainder of the opt-out period. This is
required by section 1802(b)(3)(C)(ii) of the Act.
The physician is subject to the limiting charge provisions
of Sec. 414.48. This is required by section 1848(g) of the Act pursuant
to section 1802(b)(3)(C)(i) of the Act.
The practitioner may neither bill nor collect an amount
from the beneficiary except for applicable deductible and coinsurance
amounts. This is required by section 1842(b)(18)(B) of the Act pursuant
to section 1802(b)(3)(C)(i) of the Act.
The physician or practitioner may not opt-out until the
now-nullified 2-year opt-out period expires. This is necessary to give
meaning to the enforcement provisions specified in section
1802(b)(3)(C) of the Act.
Emergency and Urgent Care Services
In Sec. 405.440, we specify the rules that apply to furnishing and
billing for emergency and urgent care services. Specifically, in
Sec. 405.440(a), we specify that a private contract is not necessary
for a physician or practitioner to furnish emergency care services or
urgent care services to a Medicare beneficiary. Accordingly, a
physician or practitioner will not be determined to have failed to
maintain opt-out if he or she furnishes emergency care services or
urgent care services to a Medicare beneficiary with whom the physician
or practitioner has not entered into a private contract, provided the
physician or practitioner complies with the Medicare billing
requirements with respect to emergency care services or urgent care
services.
In Sec. 405.440(b), we specify that when a physician or
practitioner furnishes emergency care services or urgent care services
to a Medicare beneficiary with whom the physician or practitioner has
not entered into a private contract, the physician or practitioner must
submit a claim to Medicare in accordance with 42 CFR Part 424 and
Medicare instructions issued pursuant to such regulations, including
instructions on coding emergency or urgent care services. Also, we
propose that the physician may collect no more than the Medicare
limiting charge and that the practitioner may collect no more than the
applicable deductible and coinsurance amounts. We specify these
requirements because the physician or practitioner cannot ask a
beneficiary to enter into a private contract when a beneficiary is in
need of emergency or urgent care services. Therefore, when the
beneficiary has not previously signed a private contract, the
beneficiary has not agreed to give up Medicare coverage for the
services of the physician or practitioner and the services are not
excluded from coverage under Medicare, nor is the physician or
[[Page 30854]]
practitioner excluded from the mandatory claims submission and charge
rules that would not apply had he or she been able to sign a private
contract with the beneficiary.
In Sec. 405.440(c), we specify that emergency care services or
urgent care services furnished to a Medicare beneficiary with whom the
physician or practitioner has previously entered into a private
contract (that is, entered into before the onset of the emergency
medical condition or urgent medical condition) are furnished under the
terms of the private contract. Although section 1802(b)(2)(A)(iii) of
the Act precludes the physician or practitioner from entering into a
private contract with a beneficiary when the beneficiary needs
emergency or urgent care services, the private contracting rules apply
to a beneficiary who has previously entered into a private contract (at
a time when the beneficiary was not in need of emergency or urgent care
services).
In Sec. 405.440(d), we specify that Medicare may make payment for
the emergency care services or urgent care services furnished by a
physician or practitioner who has properly opted-out, provided that no
private contract has been entered into by the beneficiary to whom
emergency care services or urgent care services were furnished.
Although the statute does not explicitly address whether payment may be
made in these cases, we believe that it is both permissible and
desirable to do so since this provision will facilitate access to
needed care in the circumstance when the beneficiary or their legal
representative has not signed a private contract and the physician or
practitioner who has opted-out cannot lawfully request that the
beneficiary or their legal representative now do so.
Renewal and Early Termination of Opt-out
In Sec. 405.445, we specify the terms of renewal and early
termination of the opt-out. In Sec. 405.445(a), we specify that a
physician or practitioner may renew his or her opt-out by filing an
affidavit with each carrier to which an affidavit was submitted for the
first opt-out period (as specified in Sec. 405.420) and to each carrier
to which a claim was submitted under Sec. 405.440 during the previous
opt-out period, provided such affidavits are filed within 30 days after
the current opt-out period expires. While section 1802(b)(3)(B)(ii) of
the Act provides that the physician or practitioner opts-out for a
period of 2 years, it does not address renewal of opt-out. Our proposal
is to establish reasonable standards and procedures for the physician
or practitioner to again opt-out of Medicare for subsequent opt-out
periods.
In Sec. 405.445(b), we propose that the physician or practitioner
may terminate the opt-out for any reason within the 90 days following
the effective date of the first affidavit filed with Medicare if he or
she agrees to do the following:
Notify all Medicare carriers with which he or she filed
an affidavit to properly opt-out of the termination of the opt-out, no
later than 90 days after the effective date of the opt-out period.
Refund to beneficiaries all payment collected in excess
of the Medicare limiting charge, in the case of physicians, or in
excess of the deductible and coinsurance, in the case of practitioners.
Notify all beneficiaries with whom the physician or
practitioner signed private contracts of the physician's or
practitioner's decision to terminate opt-out and of the beneficiaries'
right to have the physician or practitioner file claims on their
behalf, without charge, with Medicare for the services furnished during
the period between the effective date of the opt-out and the effective
date of the termination of the opt-out.
In Sec. 405.445(c), we propose that when the physician or
practitioner properly terminates opt-out in accordance with paragraph
(b), he or she will be reinstated in Medicare as if there had been no
opt-out and the provisions of ' 405.425 will not apply for the 2 years
following the signing of the affidavit unless the physician or
practitioner subsequently properly opts-out again.
We recognize that there may be cases when the physician or
practitioner may not have understood the opt-out rules and may want to
return to Medicare. We believe that it is advantageous to all parties
to permit a first-time opt-out physician or practitioner to properly
terminate opt-out. However, we are requiring that to properly terminate
opt-out, the termination must be accomplished within 90 days following
the effective date of the first opt-out, and we are permitting only one
termination of opt-out by the physician or practitioner. We believe
that it would be a mistake to permit repeated terminations of opt-out,
since it could be abused to manipulate payment, could create a
significant expense for Medicare systems, and would be confusing to
beneficiaries.
Appeals
In Sec. 405.450, we propose procedures for appeals by physicians or
practitioners and beneficiaries who believe that they have been
adversely affected by these rules.
In Sec. 405.450(a), we address appeals of determinations by
Medicare that a physician or practitioner has failed to properly opt-
out, failed to maintain opt-out, failed to timely renew opt-out, failed
to privately contract, or failed to properly terminate opt-out by
proposing that a determination with respect to any such matter is an
initial determination for purposes of Sec. 405.803. The effect of this
provision is that the appeals mechanism found in Part 405, Subpart H is
made available to physicians or practitioners for the purpose of
administrative review of Medicare determinations on matters addressed
in this subpart. Although we believe that these procedures will rarely
be needed for this purpose, we believe that it is important to provide
this mechanism because of the potential adverse impact on the physician
or practitioner of any such determination.
In Sec. 405.450(b), we propose that a determination by Medicare
that no payment can be made to the beneficiary as a result of the
application of any provision of this subpart is a initial determination
for the purposes of Sec. 405.803. We believe that the beneficiary must
have the right to appeal a denial of Medicare payment on a claim
submitted by or on behalf of the beneficiary when the basis for that
denial is the application of the provisions of this subpart. The effect
of this provision is that the appeals mechanism of Part 405, Subpart H
is made available to beneficiaries whose claims for Medicare payment
are denied on the basis of the opt-out provisions of this rule.
Under the BBA 1997 requirements, the physician who opts out under
these provisions must sign an affidavit agreeing for 2 years not to
furnish services to any Medicare beneficiary without signing a private
contract. We expect that the vast majority of opt-out physicians will
fully comply with these terms. Although we expect that physicians will
tell beneficiaries that they have opted-out, we are concerned that
there may be cases when an opt-out physician delivers non-emergency or
non-urgent services to a beneficiary without entering into a private
contract. The beneficiary may be unaware that the physician has opted
out. Nevertheless, the beneficiary would be billed for the physician's
full charges for the service. If the beneficiary seeks reimbursement
from Medicare, the claim would be denied and the beneficiary would be
informed that the reason for denial is that the physician has opted-out
of the Medicare program. We do not believe that the Congress intended
that beneficiaries who have
[[Page 30855]]
not chosen to sign a private contract would be financially harmed
because they unknowingly received services from an opt-out physician.
While the statute does not provide a specific remedy for this situation
and we expect the physician will tell beneficiaries that they have
opted-out, we believe that we have authority to develop some
beneficiary protections in this case in the limited cases when
physicians do not do so. One possibility would be to indemnify the
beneficiary for the amount that Medicare would have normally paid,
ensuring that the beneficiary is informed that the physician is an opt-
out physician. The program would then recoup this amount from the
physician and the physician would refund to the beneficiary any
balanced billing amounts above Medicare's limiting charge. The
beneficiary would remain liable for any coinsurance and deductible
amounts that would have been paid in the absence of a private contract.
A means of informing beneficiaries enrolled in M+C organizations may be
to require that such organizations disclose information on opt-out
physicians upon request by the beneficiary. We would welcome comments
on these and other approaches to providing protection for beneficiaries
in these circumstances.
Medicare+Choice
In Sec. 405.455, we propose to specify the requirements that are to
be imposed on an organization that has a contract with us to provide
one or more M+C plans to beneficiaries (Part 422 of this chapter). The
location of this section may change to part 422 with the final rule,
once the M+C interim rules are published. Part 422 will be the location
of the regulations that govern Part C of Medicare, commonly known as
M+C.
In Sec. 405.455(a), we propose that the M+C organization must
acquire and maintain information from Medicare carriers on physicians
and practitioners who have opted-out of Medicare.
In Sec. 405.455(b), we specify that the M+C organization must make
no payment directly or indirectly for Medicare-covered services
furnished to an enrolled Medicare beneficiary by a physician or
practitioner who has opted-out of Medicare. The services of physicians
and practitioners who properly opt-out are excluded from Medicare under
section 1862(a)(19) of the Act. Therefore, no payment may be made for
them as Medicare-covered services.
In Sec. 405.455(c), we specify that M+C organizations may make
payment to a physician or practitioner who has properly opted-out if he
or she furnishes emergency or urgent care services to a beneficiary who
has not previously entered into a private contract with the physician
or practitioner. This is consistent with our policy in Sec. 405.440
where Medicare payment is made by carriers rather than through M+C
contracts.
C. Payment for Outpatient Rehabilitation Services
The term outpatient rehabilitation therapy encompasses outpatient
physical therapy (including speech-language pathology) and outpatient
occupational therapy.
1. Overview of Policies Before BBA 1997
a. Coverage. Section 1861(p) of the Act defines outpatient physical
therapy services as physical therapy services furnished to a
beneficiary as an outpatient who meets the following criteria:
Is under the care of a physician.
Has a plan of treatment or care established by either a
physician or by a qualified physical therapist.
Has the plan of treatment or care periodically reviewed by
a physician.
The statute also incorporates speech language pathology services
within the definition of outpatient physical therapy services.
Section 1861(g) of the Act states that the term ``outpatient
occupational therapy services'' has the same meaning given the term
``outpatient physical therapy services'' in section 1861(p), except
that the word ``occupational'' is substituted for the word ``physical''
each time it is used in section 1861(p).
b. Providers of Outpatient Rehabilitation Services. Outpatient
physical therapy services (including speech-language pathology
services) and outpatient occupational therapy services are furnished by
providers of services, clinics, rehabilitation agencies, public health
agencies, or by others under an arrangement with, and under the
supervision of such entities. As defined in section 1861(w) of the Act,
the term ``arrangements'' is limited to arrangements under which
receipt of payment by the provider discharges the liability of the
beneficiary to pay for services.
Providers that furnish outpatient physical and occupational therapy
services include hospitals, skilled nursing facilities (SNFs),
rehabilitation agencies, home health agencies (HHAs), hospices, and
comprehensive outpatient rehabilitation facilities (CORFs) furnishing
services to patients other than those who receive SNF or inpatient
hospital benefits.
Hospital inpatients who have exhausted their hospital inpatient
benefits and who are entitled to Part B, and SNF patients who have
exhausted their SNF benefits and who are entitled to Part B may receive
outpatient physical therapy services (including speech-language
pathology services) and outpatient occupational therapy services even
though they are inpatients of the provider. Section 1861(p) of the Act
defines outpatient physical therapy services as those services that
meet the requirements of the first sentence of 1861(p), yet that are
furnished to a beneficiary as an inpatient of a hospital or extended
care facility. Section 1861(p) of the Act must be read in conjunction
with section 1833(d) of the Act. The latter section provides that
Medicare Part B payments, such as payment for outpatient physical and
occupational therapy services, may be made only when there is no
eligibility for Medicare Part A payments for the service, such as
payments for inpatient hospital or SNF care. Part B payment may be made
for inpatients only when there is no eligibility for Medicare Part A
payments; this means only a beneficiary who is not entitled to Medicare
Part A benefits or who has exhausted his or her Part A benefits. Also
see Sec. 410.60(b) (Outpatient physical therapy services: Conditions,
Outpatient physical therapy services to certain inpatients of a
hospital or a CAH or SNF).
Outpatient physical therapy (including speech-language pathology)
and occupational therapy services furnished by a home health agency may
be covered as ``medical and other health services'' under section
1861(s) of the Act when the beneficiary is not entitled to receive home
health benefits under section 1814(a)(2)(C) because he or she is not
homebound. To qualify for home health benefits, the beneficiary must be
homebound and need or have needed skilled nursing care on an
intermittent basis or physical or speech therapy, or in the case of an
individual who no longer has need for such care or therapy, continues
to need occupational therapy. Thus, most rehabilitative services
furnished by home health agencies under section 1861(s)(2)(D)
provisions are furnished to beneficiaries who are not homebound.
Section 1861(cc)(1) of the Act defines the services that can be
provided by a CORF. In addition to outpatient rehabilitation services,
CORF services include: physician services; respiratory therapy;
prosthetic and orthotic devices; social and psychological services;
nursing care; drugs and biologicals that cannot be self-administered;
supplies
[[Page 30856]]
and medical equipment; and, such other services as are medically
necessary and are ordinarily furnished by CORFs.
Services furnished by either a qualified physical therapist or a
qualified occupational therapist in his or her office or in the
beneficiary's home, for example, services of a physical therapist in
independent practice (PTIP) or occupational therapist in independent
practice (OTIP), are included as outpatient physical therapy services
and outpatient occupational therapy services. Medicare does not cover
the services of a speech-language pathologist in independent practice.
c. Payment for Services. (1) Reasonable Cost-Based Payments
Outpatient physical, occupational, and speech-language pathology
services furnished by a provider of services, a clinic, a
rehabilitation agency or public health agency are paid based on the
lesser of the charges imposed for the services or the reasonable costs
of providing the services.
The reasonable cost of services furnished under arrangements may
not exceed an amount equivalent to the prevailing salary and additional
costs that would reasonably have been incurred by such provider or
other organization had the services been performed by an employee. See
Sec. 413.106 (Reasonable cost of physical and other therapy services
furnished under arrangements).
The salary equivalency guideline amounts currently in effect were
published as a final rule on January 30, 1998, (63 FR 5106). In that
final rule, we updated the physical and respiratory therapy guideline
amounts and introduced new salary equivalency guidelines for
occupational therapy and speech-language pathology services furnished
under an arrangement. These guideline amounts are effective for
services furnished on or after April 10, 1998. The guidelines are used
by fiscal intermediaries to determine the maximum allowable cost of
those services. In general, the salary equivalency guideline amounts
are comprised of a prevailing hourly salary rate based on the 75th
percentile of the range of salaries paid to full-time employee
therapists by providers in the geographic area, by type of therapy, and
a fringe benefit and expense factor; a standard travel allowance and
additional allowances for costs incurred for services furnished by an
outside supplier.
(2) Fee Schedule Payments. Physical and occupational therapy
services furnished by physicians and certain other recognized
practitioners are payable by the carriers under the physician fee
schedule. This includes services of PTIPs and OTIPs. The fee schedule
also applies to nonphysician practitioners who furnish services that
would be physician services if furnished by a physician. Nonphysician
practitioners include physician assistants (section 1861(s)(2)(K)(i) of
the Act); and nurse practitioners and clinical nurse specialists
(sections 1861(s)(2)(K)(ii) and 1861(s)(2)(K)(iii) of the Act)
operating within the scope of their State licenses and within certain
settings. Physical and occupational therapy services provided incident
to the services of physicians or incident to the services of the
recognized nonphysician practitioners cited above are payable by the
carriers under the physician fee schedule.
d. Financial Limitation. Outpatient physical therapy services
provided by a PTIP and outpatient occupational therapy services
furnished by an OTIP are subject to an annual financial limitation.
This annual limitation or cap is $900 per beneficiary of incurred
expenses for physical therapy services and $900 per beneficiary of
incurred expenses for occupational therapy services. There is a
beneficiary liability that is comprised of the Part B deductible amount
and 20-percent coinsurance. If a beneficiary has already satisfied the
Part B deductible, the maximum amount payable by the Medicare program
under each of these benefits is $720, for example, 80 percent of $900.
The limit on expenses applies only to items and services covered under
the therapy benefit. When a beneficiary exceeds the annual limitation
or cap, the beneficiary is financially liable for any additional
therapy services that are furnished during the calendar year.
2. BBA 1997 Provisions Affecting Payment for Outpatient Rehabilitation
Services
a. Reasonable Cost-Based Payments. Section 4541(a) of BBA 1997
added new section 1834(k) of the Act. Section 1834(k)(2) established a
10 percent reduction in the reasonable cost of therapy services
furnished during 1998. The 10-percent reduction does not apply to
outpatient therapy services furnished by hospitals or critical access
hospitals. In accordance with this provision, we are proposing to make
payment for outpatient rehabilitation services furnished during 1998
based upon the lesser of the charges imposed or the reasonable cost
determined for such services, reduced by 10 percent. The 10-percent
reduction shall not apply to outpatient physical therapy or
occupational therapy services furnished by a hospital to an outpatient
or to a hospital inpatient entitled to benefits under Part A but who
has exhausted benefits or is otherwise not in a covered Part A stay.
The salary equivalency guidelines will continue to remain in effect
until all BBA 1997 provisions regarding a prospective payment system
for outpatient rehabilitation services are implemented. The prospective
payment system will negate the need for salary equivalency guidelines
because providers will no longer be paid on a reasonable cost basis for
their therapy services. The salary equivalency guidelines were a tool
used to determine the reasonable cost of therapy services provided by
practitioners other than physicians.
b. Prospective Payment System for Outpatient Rehabilitation
Services. (1) Overview. Section 4541 of BBA 1997 adds a new section
1834(k) to the Act that provides for a prospective payment system for
outpatient rehabilitation services and all services provided by CORFs.
The prospective payment system is effective for services furnished on
or after January 1, 1999. Section 1834(k)(1)(B) of the Act provides for
payment for those services to be made at 80 percent of the lesser of
(1) the actual charge for the services, or (2) the applicable fee
schedule. Section 1834(k)(3) defines the applicable fee schedule amount
as the amount determined under the physician fee schedule, or, if there
is no such fee schedule established for those services, the amount
determined under the fee schedule established for comparable services
as specified by the Secretary.
The physician fee schedule is currently applied to certain
outpatient rehabilitation therapy services. It is now the basis of
payment for outpatient rehabilitation services furnished by PTIPs and
OTIPs, physicians, and certain nonphysician practitioners or incident
to the services of such physicians or nonphysician practitioners. The
physician fee schedule has been the method of payment for outpatient
rehabilitation therapy services provided by such entities for several
years. Fee schedule payment will now apply when outpatient physical
therapy, occupational therapy, and speech language pathology services
are furnished by rehabilitation agencies, public health agencies,
clinics, SNFs, home health agencies for beneficiaries who are not
eligible for home health benefits because they are not homebound,
hospitals (when such services are provided to an outpatient or to a
hospital inpatient who is entitled to
[[Page 30857]]
benefits under Part A but who has exhausted benefits or is not
entitled), and CORFs. The fee schedule also applies to outpatient
rehabilitation services furnished under an arrangement with any of the
cited entities that are to be paid on the basis of the physician fee
schedule. The fee schedule will not apply to outpatient rehabilitation
services furnished by critical access hospitals. Under section 1833 of
the Act as amended by Section 4541 of BBA 1997, these services will be
paid on a reasonable cost basis.
(2) Services Furnished by Skilled Nursing Facilities. Section
4432(a) of BBA 1997 added a new subsection(e) to section 1888 of the
Act to establish a prospective payment systems for SNFs. Under the
statute, effective for cost reporting periods beginning on or after
July 1, 1998, Medicare pays for covered Part A SNF stays on the basis
of prospectively determined payment rates which encompass all costs of
``covered skilled nursing facility services'' furnished to a SNF
resident. The statute defines covered SNF services to include (1) post-
hospital extended care services paid for under Part A, as well as (2)
certain services that may be paid under Part B and which are furnished
to SNF residents receiving covered post-hospital extended care
services. Section 1888(e)(2) provides for exclusion of specific
services from the definition of covered SNF services, but the statute
explicitly states that the exclusions do not encompass ``any physical,
occupational or speech language therapy services regardless of whether
or not the services are furnished by, or under the supervision of, a
physician or other health care professional.'' Thus, if a SNF resident
is in a covered Part A stay, therapy services furnished to the SNF
resident are encompassed in the PPS payment and Medicare does not make
a separate Part B payment.
Under the new payment system for SNF inpatient services, and
consistent with current policy (which applied before enactment of BBA
1997, services furnished to SNF residents that are not covered under
Part A may nevertheless be covered under Part B. Section 4432(b) of BBA
1997 amended section 1842(b)(6) of the Act to require that payment for
most services furnished to an individual who is a resident of a SNF,
including outpatient rehabilitation services, be made to the facility
(without regard to whether the service was furnished by the facility,
by others under arrangement with the facility, or under any other
arrangement). When the services are not being furnished directly, the
facility then pays the provider of therapy services. The consolidated
billing provision is effective for services furnished on or after July
1, 1998.
Section 4432(b)(3) of BBA 1997 added a new paragraph (9) to section
1888(e) of the Act to provide that, with respect to a service covered
under Part B that is furnished to a SNF resident, the amount of payment
for the service shall be the amount provided under the fee schedule for
such item or service. This provision must be read in conjunction with
the provisions of section 4541 of BBA 1997. Section 4541 added a new
section 1833(a)(8) to specify that the amounts payable for outpatient
rehabilitation services furnished by a SNF will be the amounts
determined under section 1834(k) of the Act. Section 1834(k) of the Act
provides that payment in 1998 shall be based on adjusted reasonable
costs and in 1999 and thereafter, the physician fee schedule. Thus, we
are proposing that SNF Part B inpatient services remain payable on a
reasonable cost basis until January 1, 1999. Effective January 1, 1999,
the services will be paid under the physician fee schedule.
The physician fee schedule amount applicable to services furnished
in a non-facility setting will apply to the Part B services to
inpatients and other outpatient rehabilitation services furnished by
the SNF. The non-facility amount applies because the consolidated
billing provision requires that the SNF be directly paid for the entire
therapy service (including facility costs) based on the physician fee
schedule. This is in contrast to the amount applicable to physician
services, excluding outpatient rehabilitation services, billed for SNF
residents. In this case, the physician payment is not intended to cover
the facility costs associated with the service and the fee schedule
amount applicable to services furnished in a facility applies.
(3) Services Furnished by Home Health Agencies. Section
1833(a)(8)(A) requires that the physician fee schedule applies to
outpatient rehabilitation services furnished by a HHA to an individual
who is not homebound. The likelihood is great that most individuals who
are homebound and are receiving physical therapy, speech-language
pathology, or occupational therapy are entitled to home health
benefits. Therefore, most outpatient rehabilitation services furnished
by a HHA under section 1861(s)(2)(D) is to individuals who are not
homebound. There may be, however, some individuals who are not
homebound and have not required a qualifying service for home health
benefits but who need occupational therapy services. If provided by a
HHA, these services could be provided under section 1861(s)(2)(D) of
the Act. Since section 4541 of BBA 1997 did not expressly address these
services, they remain payable on a reasonable cost basis under section
1861(v)(1) of the Act. All other services furnished by the HHA will be
paid under a prospective payment system (effective October 1, 1999 with
respect to home health services). Section 1861(v)(1) provides that the
reasonable cost of any service shall be the cost actually incurred,
excluding any costs unnecessary to the efficient delivery of needed
health services. Since all other outpatient rehabilitation services are
to be paid under the physician fee schedule, we believe it would be
unreasonable for the costs of the services furnished to homebound
beneficiaries who are not entitled to home health benefits to exceed
the amount payable under the physician fee schedule. Therefore, we are
proposing to modify Sec. 413.125 to provide that effective for services
furnished on or after January 1, 1999, the reasonable cost of
outpatient rehabilitation services furnished by a HHA to homebound
patients who are not entitled to home health benefits may not exceed
the amounts payable under the physician fee schedule.
(4) Services Furnished by Comprehensive Outpatient Rehabilitation
Facilities. Section 4541(a)(1) adds a new section 1832(a)(2)(D)(9) of
the Act to provide that all services furnished by a CORF, and not just
outpatient rehabilitation services, will be paid the applicable fee
schedule amount. In cases where there is no physician fee schedule
amount for the services, section 1834(k) specifies that the applicable
fee schedule amount will be the amount established for comparable
services as specified by the Secretary. Therefore, we are proposing
that the existing fee schedules for prosthetic and orthotic devices,
durable medical equipment, and supplies, and drugs and biologicals
apply when these services are furnished by a CORF. We believe that
these fee schedules, together with the physician fee schedule, will
encompass all CORF services other than nursing services. The physician
fee schedule amount applicable to services furnished in a non-facility
setting will apply to the services furnished by the CORF since no
separate payment will be made for facility costs.
To establish a fee schedule amount for nursing services delivered
within a CORF, we created a new HCPCS code, G0128. We are defining this
code as
[[Page 30858]]
direct face-to-face skilled nursing services delivered to a CORF
patient as part of a rehabilitative plan of care. It is a timed code
and can be billed for 10-minute intervals (when the initial interval is
longer than 5 minutes). G0128 is to be used for services that are not
included in the work or practice expense of another therapy or
physician service. An example might be a nurse who spends 33 minutes
instructing a patient in the proper procedure of ``in and out''
urethral catheterization; in this situation, 3 units of G0128 would be
billed. We are proposing to set the RVUs for this code at 0.26, based
upon half the value of the lowest level physician follow-up visit,
HCPCS code 99211, in the non-facility setting. This results in a
payment for the time slightly more than the average wage reported by
the Bureau of Labor Statistics (BLS) for RNs, inflated to reflect
benefits and overhead (using the fringe benefit and expense factor used
to establish the salary equivalency guideline).
(5) Site-of-Service Differential. Providers of outpatient
rehabilitation services have suggested that we should consider making a
site-of-service differential, specifically, a payment amount greater
than that provided by the physician fee schedule for some of the types
of providers or sites at which outpatient rehabilitation services are
furnished. We are not proposing such a differential.
First, the law requires that these services be paid the amount
determined ``under the fee schedule established under section 1848.''
Furthermore, we believe higher payment amounts for certain facilities,
such as CORFs or rehabilitation agencies, would create payment
incentives that favor one site or setting over another. We believe the
statute establishes a ``level playing field'' for these services. We
find no direction in the statutory language or legislative history that
we recognize higher costs that some providers argue might be associated
with furnishing services in a provider setting. To the extent that
CORFs or rehabilitation facilities provide services to patients who
need additional care, CORFs or rehabilitation facilities may bill for
additional, medically necessary services. For these reasons, a site of
service adjustment or higher payment amount for specific settings is
not being proposed; however, we welcome any comments that you may
present regarding differences in services furnished in the various
settings that would justify a differential payment.
(6) Mandatory Assignment. Section 1834(k)(6) of the Act, as added
by BBA 1997, establishes a restraint on billing for outpatient
rehabilitation therapy services; that is, this provision requires that
services paid under section 1834(k) of the Act are subject to mandatory
assignment under the same terms applicable to practitioners under
section 1842(b)(18) of the Act. We propose, therefore, in accordance
with this provision to require mandatory assignment for services
provided under the outpatient rehabilitation prospective payment system
by hospitals, SNFs, HHAs, rehabilitation agencies, public health
agencies, clinics, and CORFs. The mandatory assignment provision does
not apply to therapy services furnished by a physician or ``incident
to'' a physician's service or to services furnished by a physical
therapist in private practice or an occupational therapist in private
practice. However, when these services are not furnished on an
assignment-related basis, the limiting charge applies.
3. Uniform Procedure Codes for Outpatient Rehabilitation Services
Section 4541(a)(2) of BBA 1997 added section 1834(k)(5) of the Act.
This new statutory provision requires that claims submitted on or after
April 1, 1998 for outpatient physical therapy services, including
speech language pathology services and outpatient occupational therapy
services, include a code under a uniform coding system that identifies
the services furnished.
The uniform coding requirement is needed to assure proper payment
under the physician fee schedule. Hospitals, SNFs, HHAs (for
individuals who are not eligible for home health services), CORFs, and
outpatient physical therapy providers must use HCPCS codes to report
outpatient rehabilitation services when furnished to their outpatients.
Hospitals and SNFs that provide outpatient rehabilitation services to
their inpatients who are entitled to benefits under Part A but who have
exhausted their benefits for inpatient services during a spell of
illness or to their inpatients who are not entitled to benefits under
Part A are also required to report HCPCS codes.
In March, 1998, we issued a program memorandum AB-98-8 which
described the coding for outpatient rehabilitation services. This
memorandum identifies the HCPCS codes that will be considered to be
outpatient rehabilitation services and specifies how these codes will
be reported on the UB-92. We assigned the various codes to revenue
centers, that is, physical therapy, occupational therapy, and speech-
language pathology, for purposes of applying the financial limitation
described below. Assigning codes to revenue centers was not intended to
limit the scope of practice or range of procedures that could be
furnished by therapists in a particular discipline. We are in the
process of revising AB-98-8 because we intend to implement the
financial limitation by using modifiers, as described below, rather
than assigning the HCPCS codes to revenue centers.
In the program memorandum, we also identify certain HCPCS codes
available for billing by CORFs that are not generally rehabilitation
services, including vaccinations and nursing services.
4. Financial Limitation
Outpatient rehabilitation therapy services are subject to annual
financial limitations or caps commencing January 1, 1999. (The amount
of the current cap is $900.) There will be a $1,500 per beneficiary
annual limitation or cap on incurred expenses for outpatient physical
therapy services including outpatient speech-language pathology
services. A separate $1,500 per beneficiary limitation will apply on
incurred expenses for outpatient occupational therapy services. The
annual limitation does not apply to services furnished directly or
under arrangements by a hospital or critical access hospital to an
outpatient or to an inpatient who is not in a covered Part A stay. The
limitation will apply to outpatient rehabilitation services furnished
by a separately certified hospital-based provider, such as a hospital-
based SNF. The limitation also applies to outpatient rehabilitation
services furnished by a physician or nonphysician practitioner, or
incident to a physician's professional services or to a nonphysician
practitioner's professional services.
As stated above, there is a single $1,500 limitation for outpatient
physical therapy services and outpatient speech-language pathology
services. As amended, section 1833(g) of the Act applies a single
$1,500 limitation to ``physical therapy services of the type described
in section 1861(p).'' Section 1861(p) defines outpatient physical
therapy services and includes speech-language pathology services within
that definition.
Outpatient rehabilitation services are subject to a 20 percent
coinsurance amount. Under the outpatient prospective payment system,
the beneficiary will be responsible for 20 percent of the applicable
fee schedule amounts. The $1,500 limitation is on incurred expenses. If
a beneficiary has already satisfied the Part B deductible, the maximum
amount payable by the
[[Page 30859]]
Medicare program is $1,200, that is, 80 percent of $1,500. Beginning
January 1, 2002, the $1,500 annual limitations or caps will be
increased by the percentage increase in the MEI.
In addition to outpatient physical therapy services and outpatient
occupational therapy services (other than those provided by a
hospital), the limitation applies to physical therapy services
(including speech-language pathology services) and occupational therapy
services ``of such type which are furnished by a physician or as
incident to a physician service.'' As discussed elsewhere in this
document, Medicare covers under certain conditions services performed
by nurse practitioners, clinical nurse specialists, and physician
assistants that would be physicians' services if furnished by a
physician. We are proposing to apply the financial limitation to
therapy services furnished by these nonphysician practitioners since
such therapy services are by definition the same type as are furnished
by physicians. Similarly, we propose to apply the financial limitation
to therapy services furnished incident to these nonphysician
practitioner's services. We have included in Addendum D a listing of
the specific services that we propose would be subject to the
limitation when furnished by a physician or practitioner directly or
incident to their services. Such outpatient rehabilitation services
included in Addendum D furnished either directly or incident to the
services of a physician or practitioner are always subject to the
financial limitation. Other services such as casting, splinting, and
strapping may be used in the treatment of conditions (for example,
fractures or sprains) or as part of the postsurgical treatment or
medical treatment when no other rehabilitation services are delivered.
If the services are delivered by a physical or occupational therapist,
speech-language pathologist, therapy assistant or therapy aide, are
part of a rehabilitation plan of care, or involve services included in
the aforementioned Addendum D, then the services are subject to the
cap. These outpatient rehabilitation services are delineated in
Addendum E and must be identified with a discipline-specific modifier.
Addendum E contains a listing of outpatient rehabilitation therapy
codes. Payment for certain HCPCS codes will be made on a basis other
than the physician fee schedule in hospital outpatient departments.
Other HCPCS codes are considered as CORF services. Further program
instructions will be provided in a forthcoming program memorandum
regarding the use of HCPCS codes for outpatient rehabilitation therapy
services.
With regard to ``incident to'' services, we note that section
4541(b) of BBA 1997 amended section 1862(a) of the Act to require that
outpatient physical therapy service (including speech-language
pathology services) and outpatient occupational therapy services
furnished ``incident to'' a physician's professional services meet the
standards and conditions (other than any licensing requirement
specified by the Secretary) that apply to therapy services furnished by
a therapist. This provision was effective January 1, 1998 and was
implemented through program instructions.
The financial limitations apply only to items and services
furnished by non-hospital providers and therapists under the outpatient
physical therapy (including speech-language pathology) and the
outpatient occupational therapy benefit (section 1861(s)(2)(D) of the
Act) and therapy services furnished by physicians and nonphysician
practitioners or incident to their services. The limitations do not
apply to diagnostic tests covered under section 1861(s)(3) of the Act.
To track the financial limitation or cap, we are proposing to use
modifiers that will be discipline-specific. Many of the services, for
example, physical modalities or therapeutic procedures as described by
HCPCS codes, are commonly delivered by both physical and occupational
therapists. Other services may be delivered by either occupational
therapists or speech-language pathologists. For these services, we
expect the claim to include a modifier which describes the type of
therapist who delivered the service; if the service was not delivered
by a therapist, then the type of therapy plan of care under which the
service is delivered would be specified. If the type of therapy is not
listed in the modifier field, the claim would be rejected and sent to
the provider for resubmission.
As required by section 1833(g) of the Act, as amended by section
4541 of BBA, we propose to establish two annual per beneficiary limits
of $1,500. There will be (1) an annual per beneficiary limit for all
outpatient physical therapy services excluding hospital outpatient
therapy services and (2) an annual per beneficiary limit for all
outpatient occupational therapy services excluding hospital outpatient
therapy services. As stated previously, outpatient physical therapy
services include speech-language pathology services. A provider of
outpatient rehabilitation services with a provider agreement under
section 1866 of the Act as will as physicians, PTIPs and OTIPs will be
allowed to collect payment from a beneficiary for therapy services
after the $1,500 limit is reached. This is consistent with current
policy allowing PTIPs and OTIPs to collect payment from a beneficiary
for therapy services in excess of the current $900 limit.
We note that a report to the Congress is due from the Secretary no
later than January 1, 2001. This report is to include recommendations
on the establishment of a revised coverage policy of outpatient
physical therapy services, including speech-language pathology services
and outpatient occupational therapy services. The revised policy is to
be based on a classification of individuals by diagnosis category and
prior use of services in both inpatient and outpatient settings. The
report should include recommendations on how such durational limits by
diagnostic category could be implemented in a budget-neutral manner.
5. Qualified Therapists
Section 1861(p) includes services furnished an individual by a
physical therapist who meets licensing and other standards prescribed
by the Secretary if the services meet such conditions relating to
health and safety as the Secretary may find necessary. The services
must be furnished in the therapist's office or the individual's home.
By regulation, we have defined therapists meeting the conditions for
coverage of services under this provision as physical therapists in
independent practice. The conditions for coverage are set forth in Part
486, Subpart D (Conditions for coverage: Outpatient Physical Therapy
Services Furnished by Physical Therapists in Independent Practice) and
require that the services be provided by a therapist in independent
practice under Sec. 410.60. Under Sec. 410.60, a therapist in
independent practice is one who:
Engages in the practice of therapy on a regular basis.
Furnishes services on his or her own responsibility
without the administrative and professional control of an employer.
Maintains at his or her own expense office space and
equipment.
Furnishes services only in the office or patient's home.
Treats individuals who are his or her own patients and
collects fees or other compensation for the services.
Under Sec. 486.151 (Conditions for coverage: Supervision), all
therapy services must be furnished under the direct supervision of a
qualified therapist in independent practice. In
[[Page 30860]]
other words, the therapist in independent practice must be on the
premises whenever services are provided to Medicare beneficiaries,
including services provided by a licensed physical therapist. This
long-standing requirement has been controversial with therapists in
independent practice. For example, a therapist in independent practice
cannot have more than one office open for services at the same time
since he or she could not be on both premises at once.
We are proposing to replace the existing ``Conditions for Coverage:
Outpatient Physical Therapy Services Furnished by Physical Therapists
in Independent Practice'' (Part 486, Subpart D), which requires survey
and certification, with a simplified criteria for physical therapists
in private practice that would use a carrier enrollment process. The
impetus for this change comes from congressional statements associated
with the fiscal year 1997 appropriations process. Statements in both
the House and Senate committee reports accompanying HCFA's fiscal year
1997 appropriations addressed the issue of requiring that the certified
physical or occupational therapist in independent practice directly
supervise all services performed by his or her employees, even if those
employees are fully licensed therapists. The House committee report
urged that we modify the regulations so that the certified therapist
need not be on premises to supervise other licensed therapists. The
Senate urged us to review this concern and recommend regulatory or
instructional changes.
We are proposing to redefine those therapists who are qualified
pursuant to section 1861(p) of the Act. That is, we would discontinue
the focus of the regulation on their ``independent'' status (which is
not statutory) and recognize therapists in private practice who are
employed by others and therefore, do not meet our current
``independent'' criteria. This would be consistent with health and
safety concerns and would conform to normal private sector practice
standards. The following new requirements would replace the current
ones for qualified therapists:
The term ``independent'' would be dropped and the benefit
would be for an individual physical therapist or occupational therapist
in private practice.
Private practice would include an ``individual'' whose practice is
in an unincorporated solo practice, unincorporated partnership, or
unincorporated group practice. Private practice also would include an
``individual'' who is practicing therapy as an employee of one of the
above or of a professional corporation or other incorporated therapy
practice. However, private practice would not include individuals when
they are working as employees of a provider. A provider as defined in
Sec. 400.202 includes a hospital, CAH, SNF, HHA, hospice, CORF, CMHC,
or an organization qualified under Part 485, Subpart H (Conditions of
Participation for Clinics, Rehabilitation Agencies, and Public Health
Agencies as Providers of Outpatient Physical Therapy and Speech-
Language Pathology Services), as a clinic, rehabilitation agency, or
public health agency.
In implementing the statutory requirement that services be
furnished to an individual in the therapist's office, or in the
individual's home, ``in his office'' would be defined as the
location(s) where the practice is operated, in the State(s) where the
therapist (and practice, if applicable) is legally authorized to
furnish services, during the hours that the therapist engages in
practice at that location.
A therapist in private practice would not be required to maintain a
private office, if services always are furnished in patients' homes.
However, when services are furnished in private practice office space,
that space would have to be owned, leased, or rented by the practice
and used for the exclusive purpose of operating the practice. For
example, because of the statutory restriction on the site of services,
a therapist in private practice cannot furnish covered services in a
SNF. Therefore, if a therapist wished to locate his or her own private
office on site at a nursing facility, special care would need to be
taken. The private office space could not be part of the Medicare-
participating SNF's space, and the therapist's services could be
furnished only within that private office space. Neither the therapist
nor any assistants or aides who help render services could be employed
by the SNF during the same hours that they are working in the private
practice. Another example where special attention would be needed is
space that generally serves other purposes and is only used by a
therapy practice during limited hours. For example, a therapist in
private practice may furnish aquatic therapy in a community center pool
on Wednesday mornings. The practice would have to rent or lease the
pool for those hours, and the use of the pool during that time would
have to be restricted to the therapist's patients, in order to
recognize the pool as part of the therapist's own private office during
those hours.
In describing other services that are specifically limited to the
patient's home, the statute uses qualifying language. For example, the
durable medical equipment definition in section 1861(n) refers to a
patient's home as ``including an institution used as his home other
than an institution that meets the requirements of subsection (e)(1) of
this section or section 1819(a)(1).'' This definition of home is
codified at Sec. 410.38(b). The same definition always has been used in
the Medicare Carriers Manual for purposes of covering therapists'
services in a patient's home. We propose to continue the current
practice and to adopt that definition formally in this regulation.
Assistants and aides would have to be personally
supervised by the therapist and employed directly by the therapist, by
the partnership or group to which the therapist belongs, or by the same
private practice that employs the therapist. Personal supervision
requires that the therapist be in the room during the performance of
the service. Levels of supervision are defined in Sec. 410.32.
The therapist must be licensed or otherwise legally
authorized to engage in private practice. We understand that all States
license or certify physical therapists, so no alternative personnel
qualifications need to be specified.
Each therapist would enroll ``as an individual'' with the
carrier.
There would be no survey and no certification by HCFA. The Medicare
carrier would verify that the qualifications proposed in
Sec. 410.59(c)(1) or Sec. 410.60(c)(1) are met. All applicants for new
enrollment would become subject to these new rules and procedures upon
the effective date of the final rule. For transition purposes, we
intend that independent therapists who are certified and enrolled at
that time would be ``grandfathered'' temporarily and would become
subject to the new enrollment rules and procedures at the time of their
next regular periodic reenrollment.
These changes would address the concern that current rules require
each independent therapist to personally supervise services performed
by any other licensed therapists that he or she employs. Under our
proposal, each individual therapist in a practice could qualify to
separately enroll, and enrolled therapists would not be required for
purposes of Medicare to be supervised by their employer. These changes
also address the concern that current rules prohibit an independent
therapist from being employed by any entity. Under our proposal, a
variety of
[[Page 30861]]
employment situations would be permitted. The following examples
illustrate how our proposals would apply:
Three PTs operate an unincorporated group practice, which
employs several physical therapy assistants and aides and maintains two
offices in two towns. Each therapist could enroll as a physical
therapist in private practice and could furnish services in either
office, while personally supervising any of the assistants or aides who
are helping to render therapy.
A corporation operates a physical therapy practice which
employs four physical therapists and several physical therapy
assistants and aides. Each therapist could enroll as a physical
therapist in private practice and could personally supervise any of the
assistants or aides who help to render therapy. If two additional PTs
are hired, each must enroll before their services could be covered
without supervision by one of the enrolled physical therapists.
A physical therapist works for a hospital's rehabilitation
department during the day. During evening hours, he operates his own
incorporated professional practice and goes to patient's homes to
furnish therapy. He could enroll as a physical therapist in private
practice for the evening hours and would not need to maintain an office
for furnishing therapy.
A physician's professional corporation employs three physical
therapists and six physical therapy assistants in a private therapy
practice associated with the physician's office. Each of the PTs could
enroll as a therapist in private practice. The physician is not
required to supervise any of the therapy. All physical therapy services
for which Medicare payment is sought are supervised by one of the
physical therapists.
These new requirements would be established in a revised
Sec. 410.60(c) for physical therapists. To date, the statutory
requirements for coverage of outpatient occupational therapy services
have not been codified. We are proposing to codify these requirements
by establishing a new Sec. 410.59 for outpatient occupational therapy
services. The proposed regulations section for outpatient occupational
therapy parallels the Sec. 410.60 requirements for outpatient physical
therapy, as revised in this proposed rule. We are also proposing to
make conforming changes in Sec. 410.61 to include occupational therapy.
Therapists in private practice do not participate in the Medicare
program in the same way that ``providers of services'' do. Though they
must be approved as meeting certain requirements, unlike ``providers of
services,'' they do not execute a formal provider agreement with the
Secretary as described in Part 489 (Provider Agreements and Supplier
Approval) of the CFR. Like physicians, they do have the option of
accepting a beneficiary's assignment of his or her claim for Medicare
Part B benefits and of becoming a Medicare participating supplier who
agrees to accept assignment in all cases.
6. Plan of Treatment
We are proposing to revise Secs. 410.61(e), 424.24(c)(4)(i), and
485.711(b), which concern the plan of treatment review requirements for
outpatient rehabilitation therapy services. Section 1861(p) of the Act
defines these therapy services, in part, as services furnished to an
individual who is under the care of a physician and for whom a plan,
prescribing the type, amount, and duration of therapy services that are
to be furnished, has been established by a physician or a qualified
therapist and is periodically reviewed by a physician.
Currently, providers that furnish outpatient rehabilitation therapy
services are required to have a physician review the plan of treatment
and recertify the need for care at least every 30 days. We are
proposing that the physician review and recertify the required plan of
treatment within the first 62 days and at least every 31 days after the
first review and recertification. The current requirement for the
review of a plan of treatment for patients of physical therapists in
independent practice is similar in that the physician must review the
plan at least every 30 days. We are proposing to change this review
requirement as well to require that the physician review and recertify
the plan of treatment within the first 62 days and at least every 31
days thereafter.
We are recommending these changes because it is our understanding
that an initial 2-month (62 day) review is consistent with usual
therapy course of treatment. It is also consistent with our current
therapy requirements in the home health setting. These changes would
reduce the burden on providers, patients, and physicians by eliminating
the current requirement for an initial review within the first 30 days.
After the first 62 days, we believe that patients receiving outpatient
rehabilitation services are likely to show significant progress that
warrants subsequent reviews every 31 days. Changes in the patients'
level of function and need for continued therapy can be expected to
occur more frequently after the first 2 months of therapy. We believe
this subsequent review schedule will help control potential over-
utilization that results in excessive therapy to some Medicare
patients.
Under our proposal, the therapists would be required to immediately
notify the physician of any changes in the patient's condition, and
physicians would retain the ability to review the care at closer
intervals if necessary.
D. Payment for Services of Certain Nonphysician Practitioners and
Services Furnished Incident to Their Professional Services
Nonphysician practitioner services have been covered by Medicare
since the inception of the program; originally the law did not provide
for separate payments for these services. Coverage and payment of
nonphysician services was primarily within the context of section
1861(s)(2)(A) of the Act as implemented by section 2050 of the Medicare
Carriers Manual, for the payment of services incident to a physician's
professional services. In recent years, the Congress has expanded
Medicare coverage of nonphysician practitioner services in certain
settings to improve beneficiary access to medical services. Separate
Part B coverage is specifically authorized for certain nonphysician
practitioner services and for services and supplies furnished as
incident to those services.
For purposes of this proposal as it applies to nonphysician
practitioners, we define nonphysician practitioners as nurse
practitioners, clinical nurse specialists, certified nurse-midwives,
and physician assistants. With respect to services and supplies
furnished as incident to a nonphysician practitioner's services, we are
proposing that to be covered by Medicare, the services must meet the
longstanding requirements in section 2050 of the Medicare Carriers
Manual applicable to services furnished as incident to the professional
services of a physician. Therefore, we would specify, in proposed new
Secs. 410.74(b), 410.75(d), 410.76(d), and 410.77(c) that Medicare Part
B covers services and supplies (including drugs and biologicals that
cannot be self-administered) furnished as incident to the
nonphysician's services only if these services and supplies would be
covered if furnished by a physician or furnished as incident to a
physician's professional services. In addition, Secs. 410.74(b),
410.75(d), 410.76(d), and 410.77(c) would specify
[[Page 30862]]
the various requirements for these incidental services and supplies.
1. Coverage and Payment for Nurse Practitioner Services Before BBA 1997
Effective for services furnished on or after April 1, 1990, section
6114 of the Omnibus Budget Reconciliation Act (OBRA) of 1989 (Pub. L.
101-239) authorized separate payment for the services of nurse
practitioners when furnished to patients in SNFs and nursing
facilities. The services of nurse practitioners are covered if they are
furnished in collaboration with a physician, they are within the scope
of services authorized by State law, and they are the type of services
that would be covered when furnished by a physician. The term,
collaboration is defined as a process in which a nurse practitioner
works with a physician to deliver health care services within the scope
of the practitioner's professional expertise, with medical direction
and appropriate supervision as provided for in jointly developed
guidelines, or other mechanisms as defined by State law, in the State
in which the services are performed.
Section 6114 of OBRA 1989 limited routine visits by nurse
practitioners who are serving as members of a team to 1.5 team visits
per month per resident of a SNF or nursing facility. The team must
include a physician and a physician assistant acting under the
supervision of the physician, or a nurse practitioner or a clinical
nurse specialist working in collaboration with a physician.
Section 6114 of OBRA 1989 requires that payment for nurse
practitioner services furnished to patients in SNFs and nursing
facilities be made on an assignment-related basis to the nurse
practitioner's employer only. This provision also limited the
prevailing charges for the services of nurse practitioners furnished
before January 1, 1992, to 85 percent of the prevailing charge rate
determined for these services when furnished by nonspecialist
physicians. For services furnished on or after January 1, 1992, OBRA
1989 limits the payment to 85 percent of the physician fee schedule
amount for those services furnished by physicians who are not
specialists.
The qualifications for nurse practitioners require individuals to:
Be a registered nurse who is currently licensed to
practice in the State where he or she practices, be authorized to
perform the services of a nurse practitioner in accordance with State
law, and have a master's degree in nursing;
Be certified as a nurse practitioner by a professional
association recognized by HCFA that has, at a minimum, eligibility
requirements that meet the standards in the paragraph above; or
Meet the requirements for a nurse practitioner set forth
in the first paragraph, except for the master's degree requirement, and
have received before 3 years prior to the effective date of a final
rule, a certificate of completion from a formal advanced practice
program that prepares registered nurses to perform an expanded role in
the delivery of primary care.
Section 4155 of OBRA 1990 (Pub. L. 101-508) extended coverage of
nurse practitioner services that was previously restricted to SNFs and
nursing facilities, to all settings in rural areas. Additionally, nurse
practitioners were authorized to either receive direct payment or
arrange for payment to be made directly to their employer for services
furnished in collaboration with a physician in all settings in a rural
area, with the exception of hospitals. This provision also allowed for
coverage of services and supplies furnished as an incident to a nurse
practitioner's services if the services would have been covered if
furnished as an incident to a physician's professional services.
The term, ``rural area'' as defined at section 1886(d)(2)(D) of the
Act means any area outside a Metropolitan Statistical Area or New
England County Metropolitan Area, as defined by the Executive Office of
Management and Budget, or outside any similar area the Secretary has
recognized by regulation as an urban area.
Sections 4155(b) and (c) of OBRA 1990 imposes a civil monetary
penalty not to exceed $2,000 on any person who knowingly and willfully
presents a bill or request for payment to a Medicare beneficiary
(except for coinsurance and deductible amounts) for nurse practitioner
services furnished in a rural area, or for services and supplies
furnished as an incident to those services, and for nurse practitioner
services furnished in a SNF or nursing facility.
Section 147(e)(4) of the Social Security Act Amendments of 1994
(SSAA'94) (Pub. L. 103-432) unbundled payment for nurse practitioner
services in SNFs and nursing facilities. It also added nurse
practitioner services to the list of services that are excluded from
the definition of inpatient hospital services. Accordingly, nurse
practitioners or their employer or contractor were authorized to bill
directly for services furnished to patients in SNFs or nursing
facilities and hospitals located in rural areas.
2. Coverage and Payment for Nurse Practitioner Services Subsequent to
BBA 1997
Effective for services furnished on or after January 1, 1998,
section 4511 of BBA 1997 authorizes nurse practitioners to bill the
program directly for services furnished in any setting, regardless of
whether the settings are located in rural or urban areas, but only if
the facility or other providers of services do not charge or are not
paid any amounts with respect to the furnishing of nurse practitioner
services. Accordingly, a new Sec. 410.75 of this proposed rule
specifies the qualifications for nurse practitioners, lists the
requirements for the professional services of a nurse practitioner and
the requirements for services furnished incident to the professional
services of a nurse practitioner. This new section also proposes a
definition for the collaboration process that is applicable to the
provision of nurse practitioner services.
A new Sec. 405.520(a), (b), and (c) of this proposed rule provides
the general rule, requirements, and penalties for nurse practitioners.
A new paragraph (15) is added to Sec. 410.150(b) to authorize payment
for nurse practitioner services when furnished in collaboration with a
physician in all settings located in both rural and urban areas. A new
paragraph (c) is added to Sec. 414.56 of this rule to set forth the
payment amount for nurse practitioner services.
3. Coverage and Payment for Clinical Nurse Specialist Services Before
BBA 1997
In addition to authorizing Medicare coverage of nurse practitioner
services furnished in rural areas, section 4155 of OBRA 1990 also
authorized the coverage of services furnished by clinical nurse
specialists in rural areas. The coverage provisions for clinical nurse
specialist services furnished in a rural area parallel those
established for nurse practitioner services furnished in rural areas.
That is, clinical nurse specialist services must be furnished in
collaboration with a physician and be the type of physician services
that would otherwise be covered if furnished by a physician.
Additionally, the services must be services that the clinical nurse
specialist is authorized by State law to furnish in the State in which
they are practicing. Furthermore, services furnished as an incident to
the professional services of a clinical nurse specialist are covered if
they are the type of services that would be covered if furnished
incident to a physician's
[[Page 30863]]
professional services and all the incident to requirements are met.
A clinical nurse specialist is defined as an individual who is
legally authorized to perform such services in accordance with State
law, and who meets training, education, and experience requirements as
the Secretary may prescribe in regulations.
Section 147(e)(4) of the SSAA'94 also unbundled payment for
clinical nurse specialist services furnished in SNFs, nursing
facilities, and hospitals. The services of clinical nurse specialists
are now paid under a separate benefit.
Payment for clinical nurse specialist services is made to the
clinical nurse specialist or to his or her employer. As is the case
with nurse practitioners, the services of clinical nurse specialists
furnished to patients in rural health clinics (RHCs), federally
qualified health centers (FQHCs), and health maintenance organizations
(HMOs) are not paid under the respective nurse practitioner or clinical
nurse specialist benefits. Instead, the services that nonphysician
practitioners furnish in RHCs, FQHCs, and HMOs education, and
experience requirements as the Secretary may prescribe in regulations.
Section 147 (e)(4) of the SSAA'94 also unbundled payment for
clinical nurse specialist services furnished in SNFs, nursing
facilities, and hospitals. The services of clinical nurse specialists
are now paid under a separate benefit.
Payment for clinical nurse specialist services is made to the
clinical nurse specialist or to his or her employer. As is the case
with nurse practitioners, the services of clinical nurse specialists
furnished to patients in rural health clinics (RHCs), federally
qualified health centers paid under the respective nurse practitioner
or clinical nurse specialist benefits. Instead, the services that
nonphysician practitioners furnish in RHCs, FQHCs, and HMOs are a part
of the facilities' services and cannot be billed or paid separately.
The payment provisions for clinical nurse specialist services
furnished in a rural area parallel those established for nurse
practitioner services furnished in rural areas. Accordingly, payment
for services is made on an assignment-related basis, the civil monetary
penalty provision for violation of the assignment agreement applies,
and the current Medicare-approved amount for covered clinical nurse
specialist services furnished in rural areas (other than in hospitals)
is limited to the lesser of the actual charge or 85 percent of the
physician fee schedule amount for nonspecialist physician services. For
covered services furnished in hospitals located in rural areas, the
Medicare-approved amount is limited to the lesser of the actual charge
or 75 percent of the physician fee schedule amount for nonspecialist
physician services.
4. Coverage and Payment for Clinical Nurse Specialist Services
Subsequent to BBA 1997
Effective for services furnished on or after January 1, 1998,
Section 4511 of BBA 1997 authorizes clinical nurse specialists to bill
the program directly for services furnished in any setting, regardless
of whether the settings are located in rural or urban areas, but only
if the facility or other providers of services does not charge or is
not paid any amounts with respect to the furnishing of nurse
practitioner services. A new Sec. 410.76(e) of this proposed rule sets
forth this provision.
The new Sec. 410.76(b) sets forth new qualifications for clinical
nurse specialists. Section 410.76(c) describes the conditions of
coverage for clinical nurse specialists services, defines the
collaboration process, and paragraph (d) lists the requirements for
services furnished incident to the professional services of a clinical
nurse specialist.
A new Sec. 405.520(a), (b), and (c) of this proposed rule provides
the general rule, requirements, and civil monetary penalties for
clinical nurse specialists. A new paragraph (15) is added to section
410.150(b) to authorize payment for clinical nurse specialist services
when furnished in collaboration with a physician in all settings
located in both rural and urban areas. A new paragraph (c) is added to
section 414.56 of this rule to set forth the payment amounts for
clinical nurse specialist services.
5. Coverage and Payment for Certified Nurse-Midwife Services
Certified nurse-midwife services were only covered under the
Medicare program when furnished incident to the professional services
of a physician or under the supervision of a physician in RHCs prior to
these individuals gaining statutory authorization to perform services
as independent nonphysician practitioners.
Certified nurse-midwives were defined initially section 1861(gg)(2)
of the Act and 42 CFR 405.2401 (b) as a registered professional nurse
who:
Is currently licensed to practice in the State as a
registered professional nurse;
Is legally authorized under State law or regulations to
practice as a certified nurse-midwife;
Has completed a program of study and clinical experience
for certified nurse-midwives, as specified by the State, or, if the
State does not specify a program--
+ Is currently certified as a nurse-midwife by the American College
of Nurse-Midwives;
+ Has satisfactorily completed a formal education program (of at
least 1 academic year) that, upon completion, qualifies the nurse to
take the certification examination offered by the American College of
Nurse-Midwives; or
+ Has successfully completed a formal educational program that
prepares registered nurses to furnish gynecological and obstetrical
care to women during pregnancy, delivery, and the postpartum period,
and care to newborns, and practiced as a nurse-midwife for a total of
12 months during any 18-month period from August 8, 1976, to July 16,
1982.
Certified nurse-midwife services are defined at section 1861(gg)(1)
of the Act as services furnished by a certified nurse-midwife, and
services and supplies furnished as an incident to those services, that
the certified nurse-midwife is legally authorized to furnished under
State law and that would be covered by Medicare if furnished by a
physician or as an incident to a physician's service.
Effective for services furnished on or after July 1, 1988, section
4073 of OBRA 1987 (Pub. L. 100-203) expanded Part B coverage of the
services of certified nurse-midwives to include services furnished
independently of the supervision of a physician. Subsequently, section
411(h)(4) of the Medicare Catastrophic Coverage Act (MCCA) of 1988
(Pub. L. 100-360) made several technical amendments to section 4073 of
OBRA 1987 to categorize and cover certified nurse-midwife services as
medical and other health services, specify that payment for the
services of a certified nurse-midwife is 80 percent of the lesser of
the actual charge or the amount determined by a fee schedule
established by the Secretary, and limit the fee schedule to 65 percent
of the prevailing charge that would be allowed for the same services
furnished by a physician. Additionally, section 4073 of OBRA 1987
requires that payment for certified nurse-midwife services be paid on
an assignment-related basis and that violators of the assignment
requirements be subject to civil monetary penalties.
Section 6102(f)(7) of OBRA 1989 (Pub. L. 101-239) provided that for
services furnished on or after January 1, 1992, payment is determined
based on the lesser or the actual charge or 65 percent of the Medicare
physician fee schedule.
In 1990, in section 4157 of OBRA 1990 (Pub. L. 101-508) the
Congress
[[Page 30864]]
recognized certified nurse-midwife services as separate and distinct
from hospital services. Accordingly, certified nurse-midwife services
are unbundled from hospital services and are paid separately under the
certified nurse-midwife benefit.
Ultimately, section 13554 of OBRA 1993 (Pub. L. 103-66) amended
section 1861(gg)(2) of the Act to revise the definition of certified
nurse-midwife. The revision eliminated the limitation on coverage to
include services furnished by certified nurse-midwives outside the
maternity cycle. This change was made effective for services furnished
on or after January 1, 1994.
A new Sec. 410.77 of this proposed rule lists the qualifications
for certified nurse-midwives and provides for the conditions for
coverage of certified nurse-midwife services. Paragraph (d) of
Sec. 410.77 lists the coverage requirements for the professional
services of certified nurse-midwives, while paragraph (c) lists the
requirements for services furnished incident to the professional
services of a certified nurse-midwife.
6. Coverage and Payment for Physician Assistant Services Before BBA
1997
For physician assistant services furnished on or after January 1,
1987, section 9338(a) of the Omnibus Budget Reconciliation Act (OBRA)
of 1986 (Pub. L. 99-509) authorized physician assistants to bill the
Medicare program for the type of services that would be considered as
physicians' services, provided that the physician assistant is legally
authorized by the State to furnish such services. Services furnished
incident to the physician assistant's professional services are also
covered if these same services would have been covered when furnished
incident to the professional services of a physician. Under this OBRA
provision, physician assistants furnished their services under the
general supervision of a physician in a hospital, SNF, nursing
facility, or as an assistant at surgery in both rural and urban areas.
In order to have furnished services under the physician assistant
benefit, individuals must have met the qualifications as follows:
1. Be certified currently by the National Commission on
Certification of Physician Assistants to assist primary care
physicians;
2. Have completed satisfactorily a program for preparing physician
assistants that--
Was at least 1 academic year in length;
Consisted of supervised clinical practice and at least 4
months (in the aggregate) of classroom instruction that prepared
students to deliver health care; and
Is accredited by the AMA's Committee on Allied Health
Education and Accreditation; or
3. Have completed satisfactorily a formal educational program for
preparing physician assistants (that does not meet the requirements
listed above) and assisted primary care physicians for a total of 12
months during the 18-month period immediately preceding January 1,
1987. Additionally, effective January 1, 1989, section 4076 of OBRA
1987 (Pub. L. 100-203) authorized physician assistants to furnish their
services under the supervision of a physician in all settings located
in rural areas that were designated under section 332(a)(1)(A) of the
Public Health Service Act as health professional shortage areas
(HPSAs).
Payment for physician assistant services prior to January 1, 1998
was made only on an assignment-related basis to the actual employer of
the physician assistant at 85 percent of the physician fee schedule for
professional services. Payment for the services of a physician
assistant performing as an assistant at surgery was made at 65 percent
of the physician fee schedule. The employer of a physician assistant
might have been a physician, medical group, professional corporation,
hospital, SNF, or nursing facility.
7. Coverage and Payment for Physician Assistant Services Subsequent to
BBA 1997
Effective for services furnished on or after January 1, 1998, the
majority of the conditions for coverage of physician assistant services
as indicated by new Secs. 410.74(a) and (b) remain unchanged with the
exception of the condition for coverage of physician assistant services
furnished in certain areas and settings. Section 4512 of BBA 1997
removes the restrictions on the site of services in which physician
assistants may furnish their professional services, regardless of
whether the settings are located in rural or urban areas. Physician
assistants are authorized to furnish their professional services as
independent nonphysician practitioners to practically all providers of
services and suppliers of services only if the facility or other
provider of services does not charge or is not paid any amounts with
respect to the furnishing of physician assistant professional services.
Accordingly, separate payment may be made for physician assistant
services in all settings with the exception of rural health clinics
(RHCs) and Federally qualified health centers (FQHCs) because Medicare
payment for their services is included in the all-inclusive payment
rate that the program makes to these facilities.
Under new Sec. 410.74(c), we are proposing to amend the
qualifications for physician assistants to recognize certification of
physician assistants by the National Board of Certification of
Orthopedic Physician Assistants. These qualifications will also
recognize academic programs for physician assistants that are
accredited by either the Commission on Accreditation of Allied Health
Education Programs or the American Society of Orthopedic Physician
Assistants.
Additionally, effective January 1, 1998, physician assistants have
the option of furnishing services under a different employment
arrangement with a physician. They can furnish services as an employee
of a physician under a W-2 form employment arrangement or they can
furnish services as an employee of a physician under a 1099 form,
independent contractor arrangement. Under either arrangement, the
employer of the physician assistant must bill the program for physician
assistant services as required under Sec. 410.150(b)(14). However, when
an individual furnishes services ``incident'' to the professional
services of a physician assistant, these ancillary services must meet
the requirements under Sec. 410.74(a)(2)(vi)(B).
The Medicare payment amount for physician assistant professional
services as of January 1, 1998, as stated under new paragraph (d) of
Sec. 414.52, remains at 80 percent of the lesser of either the actual
charge or 85 percent of the physician fee schedule amount for
professional services. However, payment for physician assistant at
surgery services, as also described at new paragraph (d) of
Sec. 414.52, increased to allow Medicare payment at 80 percent of the
lesser of either the actual charge or 85 percent of the physician fee
schedule amount paid to a physician assistant serving as an assistant
at surgery. Also, new Sec. 405.520 provides the general rule,
requirements, and civil monetary penalties for physician assistants who
furnish services under the Medicare program.
IV. Collection of Information Requirements
Under the Paperwork Reduction Act of 1995 (PRA), agencies are
required to provide a 60-day notice in the Federal Register and solicit
public comment before a collection of information requirement is
submitted to the Office of Management and Budget (OMB) for review and
approval. In order to fairly evaluate whether an information
[[Page 30865]]
collection should be approved by OMB, section 3506(c)(2)(A) of the PRA
requires that we solicit comment on the following issues:
Whether the information collection is necessary and useful
to carry out the proper functions of the agency.
The accuracy of the agency's estimate of the information
collection burden.
The quality, utility, and clarity of the information to be
collected.
Recommendations to minimize the information collection
burden on the affected public, including automated collection
techniques.
Therefore, we are soliciting public comment on each of these issues
for the information collection requirements (ICRs) discussed below.
New ICRs and Related Burden.
Sec. 405.410 (Conditions for opting-out of Medicare.)
Section 405.410(a) states that each private contract between a
physician or a practitioner and a Medicare beneficiary must meet the
specifications of Sec. 405.415.
The burden associated with these requirements is the time to draft,
and then read, sign, photocopy and retain the private contract. It is
estimated that it will take 300 physicians and/or practitioners 2 hours
each to create a contract for a total of 600 hours. It is estimated
that it will take 10 minutes for each to read, sign, photocopy and
retain the private contract for 25,000 beneficiaries for a total of
4,167 hours. The burden for these ICRs total 4,767 hours.
Section 405.410(b) states that the physician or practitioner must
submit to each Medicare carrier with which he or she files claims an
affidavit that meets the specifications of Sec. 405.420.
The burden associated with these requirements is the burden to
draft, sign and submit the affidavit to the Medicare carrier. It is
estimated that it will take 300 physicians and/or practitioners
approximately 2 hours each for a total of 600 burden hours.
Sec. 405.445 (Renewal and early termination of opt-out.)
Section 405.445(b)(2) states that a physician or practitioner must
notify all Medicare carriers with which he or she filed an affidavit of
the termination of the opt-out no later than 90 days after the
effective date of the opt-out period.
The burden associated with this requirement is the time for the
physician or practitioner to notify all Medicare carriers of the
affidavit. It is estimated that it will take 30 physicians and/or
practitioners 10 minutes each for a total of 5 hours.
Section 405.445(b)(4) states that a physician or practitioner must
notify all beneficiaries with whom the physician or practitioner
entered into private contracts of the physician's decision to terminate
opt-out and of the beneficiaries' right to have claims filed on their
behalf with Medicare for the services furnished during the period
between the effective date of the opt-out and the effective date of the
termination of the opt-out period.
The burden associated with this requirement is the time for the
physician and/or practitioner to notify all beneficiaries of his or her
decision to terminate opt-out and of the beneficiaries' right to have
claims filed on their behalf with Medicare. It is estimated that it
will take 30 physicians and/or practitioners each 2 hours to notify
their beneficiaries via bulk mailings for a total of 60 hours.
Sec. 405.455 (Medicare+Choice.)
Section 405.455(a) states that an organization that has a contract
with HCFA to provide one or more Medicare+Choice (M+C) plans to
beneficiaries must acquire and maintain information from Medicare
carriers on physicians and practitioners who have opted-out of
Medicare.
The burden associated with these requirements is the time
associated with acquiring and maintaining information provided by
Medicare carriers on physicians and practitioners who have opted-out of
Medicare. It is estimated that 500 organizations will spend 1 hour
annually to acquire and maintain this information for a total of 500
hours. The total burden for these ICRs is 500 hours.
Estimated Annual Burden
----------------------------------------------------------------------------------------------------------------
Annual
CFR section Responses Average burden per response burden
hours
----------------------------------------------------------------------------------------------------------------
405.410(a)
--Draft document.................... 300 2 hours..................................... 600
--Read, sign, photocopy, retain 25,000 10 minutes.................................. 4,167
document.
------------
Sub-total....................... ........... ............................................ 4,767
------------
405.410(b).............................. 300 2 hours..................................... 600
405.445(b)(2)........................... 30 10 minutes.................................. 5
405.445(b)(4)........................... 30 2 hours..................................... 60
405.455(a).............................. 500 1 hour...................................... 500
------------
Total........................... ........... ............................................ 5,932
----------------------------------------------------------------------------------------------------------------
New ICRs Without Burden.
The ICR below is subject to the Act. However, we believe the burden
associated with this ICR is exempt since the burden is imposed by
Sec. 405.410 and meets the specifications in Sec. 405.420.
Sec. 405.445 (Renewal and early termination of opt-out.)
Section 405.445(a) states that a physician or practitioner may
renew opt-out by filing an affidavit with each carrier to which an
affidavit was submitted for the first opt-out period (as specified in
Sec. 405.420), and to each carrier to which a claim was submitted under
Sec. 405.440 during the previous opt-out period, provided the
affidavits are filed within 30 days after the current opt-out period
expires.
The ICRs below are subject to the Act. However, we believe the
burden associated with these ICRs are exempt, as defined by 5 CFR
1320.3(b)(2), because the time, effort, and financial resources
necessary to comply with these requirements would be incurred by
persons in the normal course of their activities. Physicians and
practitioners routinely develop and update a plan of treatment so the
patient understands how often and when he or she will require care. In
addition, physicians and practitioners routinely maintain
[[Page 30866]]
documentation in the patient's medical record.
Sec. 410.61 (Plan of treatment requirements for outpatient physical
therapy and speech language pathology services.)
Section 410.61(e) states that the physician review the plan as
often as the individual's condition requires, but at least within the
first 62 days and at least 31 days after each previous review.
Sec. 415.110 (Conditions for payment: Medically directed
anesthesiology services.)
Section 415.110(b) states that the physician inclusively documents
in the patient's medical record that the conditions set forth in
paragraph (a)(1) of this section have been satisfied, specifically
documenting personal participation in the most demanding aspects of the
anesthesia plan.
The ICRs below are subject to the Act. However, we believe the
burden associated with these ICRs are exempt, as defined by 5 CFR
1320.3(b)(2), because the time, effort, and financial resources
necessary to comply with these requirements would be incurred by
persons in the normal course of their activities. We believe the record
keeping requirements described below are a reasonable and customary
part of the plan of treatment described in section 410.61.
Sec. 424.24 (Requirements for medical and other health services
furnished by providers under Medicare Part B.)
In summary Sec. 424.24(c)(1)(iii) and (3) requires that the
services that were furnished under a plan of treatment that meets the
requirements in Sec. 410.61. If the plan of treatment is established by
a physical therapist or speech-language pathologist, the certification
must be signed by a physician who has knowledge of the case.
Section 424.24(c)(4) states that the first recertification is
required by no later than the 62nd day and subsequent recertifications
are required at least every 31 days. The recertification statement must
indicate the continuing need for physical therapy or speech-language
pathology services and an estimate of how much longer the services will
be needed. Recertifications must be signed by the physician who reviews
the plan of treatment.
Currently Approved ICRs.
While the ICRs below are subject to the Act; the burden associated
with this requirement is captured in the HCFA-1500, OMB Number 0938-
0008, Medicare Common Claim Form, which expires on August 31, 1998.
Sec. 405.430 (Failure to perfect opt-out.)
Section 405.430(b)(3) states that the physician or practitioner
must submit claims to Medicare for all Medicare-covered items and
services furnished to Medicare beneficiaries.
Sec. 405.435 (Failure to maintain opt-out.)
Section 405.435(b)(3) states that the physician or practitioner
must submit claims to Medicare for all Medicare-covered items and
services furnished to Medicare beneficiaries.
Sec. 405.440 (Emergency and urgent care services.)
Section 405.440(b)(1) states that when a physician or practitioner
furnishes emergency or urgent care services to a Medicare beneficiary
with whom the physician or practitioner has not previously entered into
a private contract, the physician or practitioner must submit a claim
to Medicare in accordance with both 42 CFR Part 424 and Medicare
instruction (including but not limited to complying with proper coding
of emergency or urgent care services furnished by physicians and
practitioners who have opted-out of Medicare).
We have submitted a copy of this proposed rule to OMB for its
review of the ICRs described above. These requirements are not
effective until they have been approved by OMB.
If you comment on any of these information collection and record
keeping requirements, please mail copies directly to the following:
Health Care Financing Administration, office of Information Services,
Information Technology Investment Management Group, Division of HCFA
Enterprise Standards, Room C2-26-17, 7500 Security Boulevard,
Baltimore, MD 21244-1850, Attn.: Louis Blank, HCFA-1006,
Office of Information and Regulatory Affairs, Office of Management and
Budget, Room 10235, New Executive Office Building, Washington, D.C.
20503, Attn.: Allison Herron Eydt, HCFA Desk Officer
V. Response to Comments
Because of the large number of items of correspondence we normally
receive on Federal Register documents published for comment, we are not
able to acknowledge or respond to them individually. We will consider
all comments we receive by the date and time specified in the DATES
section of this preamble, and, if we proceed with a subsequent
document, we will respond to the comments in the preamble to that
document.
VI. Regulatory Impact Analysis
We have examined the impacts of this proposed rule as required by
Executive Order (EO) 12866, the Unfunded Mandates Act of 1995, and the
Regulatory Flexibility Act (RFA) (Public Law 96-354). Executive Order
12866 directs agencies to assess all costs and benefits of available
regulatory alternatives and, when regulation is necessary, to select
regulatory approaches that maximize net benefits (including potential
economic, environmental, public health and safety effects, distributive
impacts, and equity). A regulatory impact analysis (RIA) must be
prepared for major rules with economically significant effects ($100
million or more annually).
This proposed rule is expected to have varying effects on the
distribution of Medicare physician payments and services. With few
exceptions, we expect that the impact would be limited.
The Unfunded Mandates Reform Act of 1995 also requires (in section
202) that agencies prepare an assessment of anticipated costs and
benefits before proposing any rule that may result in an annual
expenditure by State, local, or tribal governments, in the aggregate,
or by the private sector, of $100 million. This proposed rule will have
no consequential effect on State, local, or tribal governments. We
believe the private sector cost of this rule falls below these
thresholds as well.
A. Regulatory Flexibility Act
Consistent with the provisions of the Regulatory Flexibility Act,
we analyze options for regulatory relief for small businesses and other
small entities. We prepare a Regulatory Flexibility Analysis (RFA)
unless we certify that a rule would not have a significant economic
impact on a substantial number of small entities. The RFA is to include
a justification of why action is being taken, the kinds and number of
small entities the proposed rule would affect, and an explanation of
any considered meaningful options that achieve the objectives and would
lessen any significant adverse economic impact on the small entities.
For purposes of the RFA, all physicians are considered to be small
entities. There are about 700,000 physicians and other practitioners
who receive Medicare payment under the physician fee schedule. Thus, we
have prepared the following analysis, which, together with the rest of
this preamble, meets all three assessment requirements. It explains the
rationale for and purposes of the rule, details the costs and benefits
of the rule, analyzes
[[Page 30867]]
alternatives, and presents the measures we propose to minimize the
burden on small entities.
B. Resource-Based Practice Expense Relative Value Units
Our proposal uses a methodology for implementing resource-based
practice expense RVUs for each physician service. The methodology
considers the staff, equipment, and supplies used in the provision of
various medical and surgical services in various settings, including
those that cannot be attributed to specific procedures. We are required
to begin the transition to the new practice expense relative value
units on January 1, 1999.
By law, the conversion to a resource-based determination for the
payment of physician practice expenses must be budget-neutral. In other
words, the total Medicare expenditures for calendar year 1999 must be
the same as the amount that would have been paid under the prior method
of paying practice expenses.
Each year since the fee schedule has been implemented, our
actuaries have determined any adjustments needed to meet this
requirement. A key component of the actuarial determination of budget
neutrality involves estimating the impact of changes in the volume-and-
intensity of physician services provided to Medicare beneficiaries as a
result of the proposed changes.
In estimating the impacts of proposed changes under the physician
fee schedule on the volume-and-intensity of services, the actuaries
have historically used a model that assumes that 50 percent of the
change in net revenue for a practice would be recouped. This does not
mean that payments are reduced by 50 percent. In fact, payments have
typically been reduced only a few percent or less. The actuaries also
assume that there is no offsetting reduction in volume-and-intensity
for physicians whose Medicare revenue increases.
Our actuaries have reviewed the literature and conducted data
analysis of the volume-and-intensity response. For the purpose of
establishing budget neutrality for the physician practice expense
determination, the actuaries plan to use a model that assumes a 30
percent volume-and-intensity response to price reductions but no
reduction in volume-and-intensity in response to a price increase. We
plan to make the actuary's analysis of the volume-and-intensity
response available soon. We expect it to be available on our homepage
(www.hcfa.gov).
Using the revised actuarial model, achieving budget neutrality for
the practice expense per hour method would require lowering physician
payments in calendar year 1999 by 0.33 percent (1.31 percent cumulative
from 1999-2002). The 0.33 percent volume-and-intensity adjustment
results in a reduction in the 1999 physician CF of $0.1223. (The
corresponding figures for the modified June 1997 proposed rule method
would be 0.61 percent in 1999, 2.43 percent cumulative, and a $0.2248
reduction in the 1999 CF. The adjustments are larger due to the greater
payment redistributions under this method.) We do not believe that we
can use the Sustainable Growth Rate (SGR) mechanism alone, without the
adjustment for volume-and-intensity for 1999, because any SGR
adjustment would be in the future and the actuaries would not determine
us to be in compliance with the statutory budget-neutrality requirement
for 1999. To the extent that the volume-and-intensity response does not
occur, the SGR system enacted as part of the BBA 1997 will return the
volume-and-intensity adjustment in the form of higher future updates to
the Medicare physician fee schedule conversion factor.
Table 8, ``Impact on Total Allowed Charges by Specialty of the
Resource-Based Practice Expense Relative Value Units under the Practice
Expense per Hour and Modified June 97 NPRM Methods'' shows the change
in Medicare physician fees resulting from the practice expense per hour
and the modified proposed rule methodologies discussed earlier in this
proposed rule. The impact of the changes on the total revenue (Medicare
and non-Medicare) for a given specialty is less than the impact
displayed in Table 8 since physicians furnish services to both Medicare
and non-Medicare patients.
The magnitude of the Medicare impact depends generally on the mix
of services the specialty provides and the sites in which the services
are performed. In general, those specialties that furnish more office-
based services are expected to experience larger increases in Medicare
payments than specialties that provide fewer office-based services.
Table 8 also includes the impact on the conversion factor of the volume
and intensity adjustments discussed above, but not the impact of the
volume response on revenues.
Table 8.--Impact on Total Allowed Charges by Specialty of the Resource-Based Practice Expense Relative Value
Units Under the Practice Expense per Hour (top-down) and Modified June 97 NPRM (Bottom-Up) Methods (Percent
Change)
----------------------------------------------------------------------------------------------------------------
Impact per year Cumulative four year
---------------------------------------------------
Specialty Modified Modified
PE/HR June 97 PE/HR June 97
NPRM NPRM
----------------------------------------------------------------------------------------------------------------
M.D./D.O. Physicians:
Anesthesiology.......................................... 0 2 2 9
Cardiac Surgery......................................... -4 -11 -14 -37
Cardiology.............................................. -3 -6 -13 -21
Clinics................................................. -1 -1 -3 -5
Dermatology............................................. 6 8 27 36
Emergency Medicine...................................... -3 -2 -13 -6
Family Practice......................................... 1 2 6 7
Gastroenterology........................................ -4 -7 -14 -24
General Practice........................................ 1 1 3 5
General Surgery......................................... -1 -4 -6 -16
Hematology/Oncology..................................... 1 4 2 15
Internal Medicine....................................... 0 0 1 -2
Nephrology.............................................. -1 -5 -5 -17
Neurology............................................... 0 -2 0 -7
Neurosurgery............................................ -3 -7 -10 -27
[[Page 30868]]
Obstetrics/Gynecology................................... 1 0 5 0
Ophthalmology........................................... 3 -1 11 -3
Orthopedic Surgery...................................... 0 -4 -1 -14
Other Physician *....................................... 0 0 0 2
Otolaryngology.......................................... 1 2 6 8
Pathology............................................... -3 1 -10 5
Plastic Surgery......................................... 1 -2 5 -9
Psychiatry.............................................. 1 4 4 19
Pulmonary............................................... -1 -3 -3 -10
Radiation Oncology...................................... -3 3 -13 15
Radiology............................................... -4 -3 -13 -13
Rheumatology............................................ 4 3 15 11
Thoracic Surgery........................................ -4 -10 -13 -33
Urology................................................. 2 0 7 2
Vascular Surgery........................................ -3 -6 -12 -23
Others:
Chiropractic............................................ 0 4 -2 19
Nonphysician Practitioner............................... 0 6 -1 26
Optometry............................................... 8 7 36 30
Podiatry................................................ 1 9 5 44
Suppliers............................................... -5 9 -18 39
----------------------------------------------------------------------------------------------------------------
* Other physician includes allergy/immunology, oral surgery, physical medicine and rehabilitation, pediatrics,
critical care, and hematology.
For several reasons, it is difficult to compare the impacts between
the impacts in last year's June 18, 1997, proposed rule and the impacts
in this proposed rule since BBA 1997 made several changes in physician
payment. Although BBA 1997 delayed the initial implementation of the
resource-based practice expense system until 1999, it created a down
payment for the new system by increasing the practice expense payments
for office visits in 1998 funded through decreases in the 1998 practice
expense payments for certain procedures. For comparison purposes, the
cumulative 4-year impacts displayed in Table 8 are shown below
alongside the impacts in last year's June 1997 proposed rule adjusted
for the down payment.
Table 9.--Comparison of Resource-Based Practice Expense Relative Value Units Impacts on Total Allowed Charges by
Specialty With the June 97 NPRM Net of the Down Payment (Percent Change)
----------------------------------------------------------------------------------------------------------------
Impact of
Specialty June 97 practice June 97 Modified PE/HR
NPRM expense NPRM June 97
----------------------------------------------------------------------------------------------------------------
M.D./D.O. Physicians:
Anesthesiology............................. 4.0 0.2 3.8 9 2
Cardiac Surgery............................ -32.0 -2.9 -30.0 -37 -14
Cardiology................................. -17.0 -1.1 -16.1 -21 -13
Clinics.................................... -3.0 0.1 -3.1 -5 -3
Dermatology................................ 18.0 0.6 17.2 36 27
Emergency Medicine......................... -2.0 -0.1 -1.9 -6 -13
Family Practice............................ 12.0 2.0 9.8 7 6
Gastroenterology........................... -20.0 -0.9 -19.3 -24 -14
General Practice........................... 9.0 1.5 7.4 5 3
General Surgery............................ -9.0 -0.2 -8.8 -16 -6
Hematology/Oncology........................ 11.0 1.2 9.7 15 2
Internal Medicine.......................... 3.0 1.2 1.8 -2 1
Nephrology................................. -13.0 -0.7 -12.4 -17 -5
Neurology.................................. -3.0 0.5 -3.4 -7 0
Neurosurgery............................... -21.0 -1.6 -19.7 -27 -10
Obstetrics/Gynecology...................... 4.0 1.5 2.5 0 5
Ophthalmology.............................. -11.0 -3.3 -8.0 -3 11
Orthopedic Surgery......................... -11.0 -0.9 -10.1 -14 -1
Other Physician *.......................... 4.0 0.2 3.8 2 0
Otolaryngology............................. 7.0 0.5 6.5 8 6
Pathology.................................. 1.0 -0.6 1.6 5 -10
Plastic Surgery............................ -3.0 -0.3 -2.7 -9 5
Psychiatry................................. 3.0 -0.1 3.1 19 4
Pulmonary.................................. -6.0 0.1 -6.1 -10 -3
[[Page 30869]]
Radiation Oncology......................... 10.0 -0.4 10.4 15 -13
Radiology.................................. -9.0 -0.3 -8.7 -13 -13
Rheumatology............................... 15.0 2.0 12.8 11 15
Thoracic Surgery........................... -28.0 -2.3 -26.3 -33 -13
Urology.................................... 1.0 0.1 0.9 2 7
Vascular Surgery........................... -17.0 0.3 -17.2 -23 -12
Others:
Chiropractic............................... 14.0 -0.3 14.3 -2 -2
Nonphysician Practitioner.................. 4.0 -0.7 4.8 -1 -1
Optometry.................................. 15.0 0.7 14.2 36 36
Podiatry................................... 24.0 0.6 23.3 5 5
Suppliers.................................. 14.0 -0.8 14.9 -18 -18
----------------------------------------------------------------------------------------------------------------
* Other physician includes allergy/immunology, oral surgery, physical medicine and rehabilitation, pediatrics,
critical care, and hematology.
Note: Columns do not add because figures are multiplicative. For example, the -30 June 97 NPRM net of the
downpayment for cardiac surgery is derived from (1-(32/100))/(1-(2.9/100)).
In addition to the downpayment, other 1998 changes that
significantly impacted Medicare physician fee schedule payments were
the BBA 1997 move to a single CF and changes to the work RVUs contained
in the October 31, 1997 final rule for the 1998 Medicare physician fee
schedule. To provide a context for the current proposal, we are again
publishing the impacts of these changes published in the October 1997
final notice (62 FR 59262). We are also expanding that table to
separate the total change due to relative value units into change due
to the downpayment and change due to work RVU revisions.
Table 10.--Impact on 1998 Allowed Charges by Specialty of the Single Conversion Factor, Practice Expense Down
Payment, and Work RVU Changes
[Percent change]
----------------------------------------------------------------------------------------------------------------
Combined impact
Impact of the Impact of the Impact of changes of the single CF,
Specialty move to a single practice expense in work relative down payment, and
CF down payment value units work RVU
----------------------------------------------------------------------------------------------------------------
M.D./D.O. Physicians:
Anesthesiology.................. 1.2 0.2 0.7 2.1
Cardiac Surgery................. -8.1 -2.9 2.3 -8.8
Cardiology...................... 7.9 -1.1 -0.3 6.4
Clinics......................... 4.5 0.1 -0.2 4.4
Dermatology..................... -4.8 0.6 -0.4 -4.6
Emergency Medicine.............. 3.8 -0.1 -0.5 3.2
Family Practice................. 5.0 2.0 -0.6 6.4
Gastroenterology................ 8.5 -0.9 -0.4 7.1
General Practice................ 4.7 1.5 -0.3 6.0
General Surgery................. -4.0 -0.2 2.0 -2.3
Hematology/Oncology............. 7.1 1.2 -0.3 8.0
Internal Medicine............... 6.4 1.2 -0.5 7.0
Nephrology...................... 6.0 -0.7 -0.5 4.7
Neurology....................... 7.9 0.5 -0.4 7.9
Neurosurgery.................... -5.7 -1.6 1.5 -5.9
Obstetrics/Gynecology........... -2.3 1.5 1.5 0.6
Ophthalmology................... -3.3 -3.3 0.7 -5.8
Orthopedic Surgery.............. -4.8 -0.9 1.8 -4.0
Other Physician*................ 6.4 0.2 -0.4 6.2
Otolaryngology.................. -0.1 0.5 0.1 0.5
Pathology....................... 9.3 -0.6 -0.5 8.1
Plastic Surgery................. -6.9 -0.3 2.0 -5.3
Psychiatry...................... 9.0 -0.1 -0.6 8.2
Pulmonary....................... 8.1 0.1 -0.5 7.7
Radiation Oncology.............. 9.2 -0.4 -0.3 8.4
Radiology....................... 9.0 -0.3 -0.4 8.2
Rheumatology.................... 5.7 2.0 -0.6 7.2
Thoracic Surgery................ -7.0 -2.3 2.2 -7.2
Urology......................... -3.3 0.1 0.3 -2.9
Vascular Surgery................ -4.0 0.3 1.3 -2.6
Others:
Chiropractic.................... 9.3 -0.3 -0.5 8.4
Nonphysician Practitioner....... 5.1 -0.7 0.2 4.5
Optometry....................... 5.7 0.7 -0.6 5.8
[[Page 30870]]
Podiatry........................ -5.2 0.6 0.2 -4.4
Suppliers....................... 9.3 -0.8 -0.1 8.2
----------------------------------------------------------------------------------------------------------------
* Other physician includes allergy/immunology, oral surgery, physical medicine and rehabilitation, pediatrics,
critical care, and hematology.
Finally, it is difficult to compare the impacts from last year's
proposed rule to this proposed rule because of technical modifications
to last year's methodology that are incorporated into this year's
modified proposed rule approach. Technical modifications include
elimination of last year's limits and caps on the CPEP estimates of
clinical and administrative labor. We had received many comments
(including from GAO) questioning this element of last year's
methodology. The elimination of the caps partially explains the
difference between the 9.8 percent increase for family practitioners
last year (after netting out the effects of the downpayment) and the 7
percent increase that would occur with the modified proposed rule
approach in this year's rule. It also partially explains the increase
in payments for dermatologists from last year's 17.2 percent (netting
out the effect of the downpayment) to the 36 percent increase which
would occur under the modified proposed rule approach in this year's
rule.
Table 11. ``Total Payment for Selected Procedures,'' shows the
percentage change in total payment allowances (in 1998 dollars) between
the current and the fully phased-in resource-based practice expense
system for certain high volume procedures.
Table 11.--Total Payment For Selected Procedures
--------------------------------------------------------------------------------------------------------------------------------------------------------
Non-
Current non- Resource facility Current Resource
Code Mod Description facility based non- percent facility based
facility change facility
--------------------------------------------------------------------------------------------------------------------------------------------------------
11721.................................. ................... Debride nail, 6 or more.. $39.81 $31.69 -20 $29.91 $30.90
17000.................................. ................... Destroy benign/premal 36.69 52.12 42 28.99 42.82
lesion.
27130.................................. ................... Total hip replacement.... NA NA NA 1,656.80 1,383.69
27236.................................. ................... Repair of thigh fracture. NA NA NA 1,244.62 1,065.87
27244.................................. ................... Repair of thigh fracture. NA NA NA 1,230.38 1,083.55
27447.................................. ................... Total knee replacement... NA NA NA 1,771.16 1,454.99
33533.................................. ................... CABG, arterial, single... NA NA NA 2,107.91 1,764.20
35301.................................. ................... Rechanneling of artery... NA NA NA 1,262.70 1,069.02
43239.................................. ................... Upper GI endoscopy, 228.81 241.66 6% 211.20 140.58
biopsy.
45378.................................. ................... Diagnostic colonoscopy... 290.30 292.34 1 288.10 208.17
45385.................................. ................... Colonoscopy, lesion 443.89 375.88 -15 414.17 277.71
removal.
66821.................................. ................... After cataract laser 187.65 192.66 3 187.65 184.24
surgery.
66984.................................. ................... Remove cataract, insert NA NA NA 795.26 677.97
lens.
67210.................................. ................... Treatment of retinal 686.27 639.55 -7 520.81 596.86
lesion.
71010.................................. 26................. Chest x-ray.............. 9.36 8.49 -9 9.36 8.49
71020.................................. ................... Chest x-ray.............. 34.55 27.71 -20 34.55 27.71
71020.................................. 26................. Chest x-ray.............. 11.44 10.36 -9 11.44 10.36
77430.................................. ................... Weekly radiation therapy. 188.62 171.24 -9 188.62 171.24
78465.................................. ................... Heart image (3D) multiple 514.68 397.85 -23 514.68 397.85
88305.................................. ................... Tissue exam by 65.95 66.01 0 65.95 66.01
pathologist.
88305.................................. 26................. Tissue exam by 46.14 37.58 -19 46.14 37.58
pathologist.
90801.................................. ................... Psy dx interview......... 122.08 135.64 11 122.08 134.08
90806.................................. ................... Psytx, office (45-50).... 80.95 86.09 6 80.95 82.49
90807.................................. ................... Psytx, office (45-50) w/ 90.03 98.66 10 90.03 94.67
e&m.
90862.................................. ................... Medication management.... 47.37 46.51 -2 47.37 45.88
90921.................................. ................... ESRD related services, 235.86 226.79 -4 235.86 226.79
month.
90935.................................. ................... Hemodialysis, one NA NA NA 93.87 64.99
evaluation.
92004.................................. ................... Eye exam, new patient.... 77.83 113.47 46 67.37 87.79
92012.................................. ................... Eye exam established pt.. 39.42 68.43 74 31.35 35.68
92014.................................. ................... Eye exam & treatment..... 57.55 82.39 43 47.65 58.21
92980.................................. ................... Insert intracoronary NA NA NA 1,142.75 899.31
stent.
92982.................................. ................... Coronary artery dilation. NA NA NA 857.33 680.44
93000.................................. ................... Electrocardiogram, 28.83 15.87 -45 28.83 15.87
complete.
93010.................................. ................... Electrocardiogram report. 11.96 8.45 -29 11.96 8.45
93015.................................. ................... Cardiovascular stress 116.95 98.79 -16 116.95 98.79
test.
93307.................................. ................... Echo exam of heart....... 215.85 103.39 -52 215.85 103.39
93307.................................. 26................. Echo exam of heart....... 70.94 50.80 -28 70.94 50.80
93510.................................. 26................. Left heart 266.37 222.31 -17 266.37 222.31
catheterization.
98941.................................. ................... Chiropractic manipulation 32.87 32.55 -1 27.55 28.26
99202.................................. ................... Office/outpatient visit, 50.15 71.19 42 39.69 49.05
new.
99203.................................. ................... Office/outpatient visit, 68.93 100.60 46 56.82 73.17
new.
[[Page 30871]]
99204.................................. ................... Office/outpatient visit, 102.50 141.83 38 84.53 105.52
new.
99205.................................. ................... Office/outpatient visit, 128.35 173.06 35 108.72 135.83
new.
99211.................................. ................... Office/outpatient visit, 14.16 17.96 27 9.94 12.22
est.
99212.................................. ................... Office/outpatient visit, 27.61 32.09 16 21.01 25.83
est.
99213.................................. ................... Office/outpatient visit, 39.42 43.39 10 30.61 35.86
est.
99214.................................. ................... Office/outpatient visit, 59.39 68.39 15 47.65 57.82
est.
99215.................................. ................... Office/outpatient visit, 93.67 101.73 9 76.06 90.38
est.
99221.................................. ................... Initial hospital care.... NA NA NA 69.84 67.71
99222.................................. ................... Initial hospital care.... NA NA NA 113.45 108.20
99223.................................. ................... Initial hospital care.... NA NA NA 144.98 147.84
99231.................................. ................... Subsequent hospital care. NA NA NA 36.57 32.35
99232.................................. ................... Subsequent hospital care. NA NA NA 53.64 52.07
99233.................................. ................... Subsequent hospital care. NA NA NA 74.65 73.72
99236.................................. ................... Observ/hosp same date.... NA NA NA 188.78 207.45
99238.................................. ................... Hospital discharge day... NA NA NA 63.24 64.40
99239.................................. ................... Hospital discharge day... NA NA NA 79.05 86.11
99241.................................. ................... Office consultation...... 47.95 50.20 5 36.21 38.46
99242.................................. ................... Office consultation...... 74.95 86.81 16 60.82 69.87
99243.................................. ................... Office consultation...... 97.12 111.83 15 79.33 92.28
99244.................................. ................... Office consultation...... 135.96 154.79 14 113.40 132.87
99245.................................. ................... Office consultation...... 183.26 196.49 7 152.26 174.83
99251.................................. ................... Initial inpatient consult NA NA NA 49.72 39.47
99252.................................. ................... Initial inpatient consult NA NA NA 75.59 72.93
99253.................................. ................... Initial inpatient consult NA NA NA 99.75 98.25
99254.................................. ................... Initial inpatient consult NA NA NA 136.88 137.30
99255.................................. ................... Initial inpatient consult NA NA NA 185.53 186.50
99261.................................. ................... Follow-up inpatient NA NA NA 27.34 25.99
consult.
99262.................................. ................... Follow-up inpatient NA NA NA 46.94 47.05
consult.
99263.................................. ................... Follow-up inpatient NA NA NA 68.77 67.16
consult.
99282.................................. ................... Emergency dept visit..... NA NA NA 33.55 24.76
99283.................................. ................... Emergency dept visit..... NA NA NA 61.16 52.53
99284.................................. ................... Emergency dept visit..... NA NA NA 93.48 81.10
99285.................................. ................... Emergency dept visit..... NA NA NA 147.34 125.14
99291.................................. ................... Critical care, first hour 191.07 189.23 -1 191.07 191.13
99292.................................. ................... Critical care, addl 30 91.86 96.23 5 91.86 96.62
min.
99301.................................. ................... Nursing facility care.... NA NA NA 57.98 65.81
99302.................................. ................... Nursing facility care.... NA NA NA 73.98 87.08
99303.................................. ................... Nursing facility care.... NA NA NA 105.04 107.40
99311.................................. ................... Nursing facility care, NA NA NA 33.76 34.61
subseq.
99312.................................. ................... Nursing facility care, NA NA NA 49.78 53.24
subseq.
99313.................................. ................... Nursing facility care, NA NA NA 66.12 73.34
subseq.
99348.................................. ................... Home visit, estab patient 63.30 65.30 3 63.30 74.41
99350.................................. ................... Home visit, estab patient 132.39 148.19 12 132.39 141.51
--------------------------------------------------------------------------------------------------------------------------------------------------------
BBA 1997 requires that we consider the geographic impacts of the
new payment system. The following table displays the impact of the
practice expense per hour methodology by Medicare payment locality,
including the volume-and-intensity increase and corresponding
conversion factor adjustment discussed earlier.
Table 12.--Impact of Practice Expense per Hour Methodology on Total Allowed Charges by Medicare Locality
[Percent change]
----------------------------------------------------------------------------------------------------------------
Cumulative
Locality State Impact per four year
year impact
----------------------------------------------------------------------------------------------------------------
All........................................... Alabama............................... -0.3 -1.0
All........................................... Alaska................................ 0.1 0.5
All........................................... Arizona............................... 0.1 0.3
All........................................... Arkansas.............................. -0.1 -0.3
Marin/Napa/Solano............................. California............................ 0.8 3.4
San Francisco................................. California............................ 0.9 3.5
San Mateo..................................... California............................ 0.6 2.5
Oakland/Berkeley.............................. California............................ 0.3 1.1
Santa Clara................................... California............................ 0.3 1.0
Rest of California............................ California............................ 0.2 0.8
[[Page 30872]]
Ventura....................................... California............................ 0.3 1.4
Los Angeles................................... California............................ 0.5 1.9
Anaheim/Santa Ana............................. California............................ 0.6 2.6
Rest of California............................ California............................ 0.7 3.0
All........................................... Colorado.............................. 0.3 1.1
All........................................... Connecticut........................... 0.1 0.3
All........................................... Delaware.............................. -0.2 -0.7
All........................................... District of Columbia.................. -0.1 -0.3
Ft Lauderdale................................. Florida............................... 0.5 2.1
Miami......................................... Florida............................... -0.3 -1.3
Rest of Florida............................... Florida............................... 0.0 0.0
Atlanta....................................... Georgia............................... -0.3 -1.2
Rest of Georgia............................... Georgia............................... -0.1 -0.4
All........................................... Hawaii................................ 0.9 3.7
All........................................... Idaho................................. 0.1 0.5
East St Louis................................. Illinois.............................. 0.1 0.3
Suburban Chicago.............................. Illinois.............................. 0.0 0.1
Chicago....................................... Illinois.............................. -0.3 -1.1
Rest of Illinois.............................. Illinois.............................. -0.2 -0.6
All........................................... Indiana............................... -0.2 -0.7
All........................................... Iowa.................................. 0.2 0.9
All........................................... Kansas................................ -0.1 -0.2
All........................................... Kentucky.............................. -0.2 -0.8
New Orleans................................... Louisiana............................. 0.0 0.1
Rest of Louisiana............................. Louisiana............................. -0.1 -0.5
Southern Maine................................ Maine................................. -0.1 -0.4
Rest of Maine................................. Maine................................. 0.2 0.7
Balto/Surr Ctys............................... Maryland.............................. -0.3 -1.2
Rest of Maryland.............................. Maryland.............................. -0.1 -0.6
Boston........................................ Massachusetts......................... 0.2 1.0
Rest of Massachusetts......................... Massachusetts......................... 0.2 1.0
Detroit....................................... Michigan.............................. -0.3 -1.2
Rest of Michigan.............................. Michigan.............................. -0.2 -1.0
All........................................... Minnesota............................. -0.2 -0.9
All........................................... Mississippi........................... -0.2 -0.9
Metro Kansas City............................. Missouri.............................. -0.6 -2.2
Rest of Missouri.............................. Missouri.............................. 0.1 0.3
St Louis...................................... Missouri.............................. -0.1 -0.5
Rest of Missouri.............................. Missouri.............................. 0.3 1.2
All........................................... Montana............................... 0.1 0.4
All........................................... Nebraska.............................. 0.1 0.4
All........................................... Nevada................................ -0.3 -1.2
All........................................... New Hampshire......................... 0.2 0.8
Northern New Jersey........................... New Jersey............................ -0.1 -0.4
Rest of New Jersey............................ New Jersey............................ -0.1 -0.5
All........................................... New Mexico............................ 0.3 1.3
Rest of New York.............................. New York.............................. -0.2 -0.6
Manhattan..................................... New York.............................. 0.3 1.1
NYC Suburbs/LI................................ New York.............................. -0.1 -0.5
Poughkpsie/N NYC.............................. New York.............................. 0.3 1.2
Queens........................................ New York.............................. 0.3 1.0
All........................................... North Carolina........................ 0.0 0.0
All........................................... North Dakota.......................... -0.3 -1.2
All........................................... Ohio.................................. -0.1 -0.2
All........................................... Oklahoma.............................. 0.1 0.3
Portland...................................... Oregon................................ 0.0 0.0
Rest of Oregon................................ Oregon................................ 0.5 2.1
Philadelphia.................................. Pennsylvania.......................... -0.2 -0.8
Rest of Pennsylvania.......................... Pennsylvania.......................... -0.1 -0.4
All........................................... Puerto Rico........................... 0.8 3.2
All........................................... Rhode Island.......................... 0.0 0.2
All........................................... South Carolina........................ 0.0 0.0
All........................................... South Dakota.......................... -0.3 -1.1
All........................................... Tennessee............................. -0.3 -1.0
Brazoria...................................... Texas................................. 0.8 3.4
Dallas........................................ Texas................................. -0.1 -0.4
Galveston..................................... Texas................................. 0.1 0.6
Houston....................................... Texas................................. -0.3 -1.2
[[Page 30873]]
Beaumont...................................... Texas................................. -0.4 -1.8
Fort Worth.................................... Texas................................. -0.2 -0.8
Austin........................................ Texas................................. -0.4 -1.5
Rest of Texas................................. Texas................................. 0.0 -0.2
All........................................... Utah.................................. 0.3 1.0
All........................................... Vermont............................... 0.5 2.1
All........................................... Virgin Islands........................ 0.6 2.6
All........................................... Virginia.............................. 0.1 0.5
Seattle (King Co)............................. Washington............................ 0.1 0.3
Rest of Washington............................ Washington............................ 0.2 0.8
All........................................... West Virginia......................... -0.1 -0.4
All........................................... Wisconsin............................. -0.1 -0.6
All........................................... Wyoming............................... 0.5 2.1
----------------------------------------------------------------------------------------------------------------
BBA 1997 requires that we consider the impacts of the new system on
urban and rural localities. The geographic payment areas we use for
payment under the physician fee schedule do not follow urban and rural
configurations. For example, in 34 States (plus the District of
Columbia, Puerto Rico, and the Virgin Islands) the payment areas are
statewide; that is, the Medicare payment is the same in both urban and
rural areas. In those States, there would be no differential impact of
this proposal on urban and rural areas. Since our payment areas do not
track urban and rural locations, our claims payment system does not
distinguish between urban and rural locations, and we do not have data
easily available to undertake an urban-rural impact analysis. We do not
believe that this proposal will have much urban-rural impact,
particularly since 34 States (plus the District of Columbia, Puerto
Rico, and the Virgin Islands) have statewide payment areas. Any urban-
rural impact should largely be explained by differences in the mix and
site of services among urban and rural localities.
BBA 1997 requires us to consider impact projections that compare
new proposed payment amounts to data on actual physician practice
expenses. We have satisfied this requirement by basing the new proposed
payments amounts on actual physician practice expense data.
C. Medical Direction for Anesthesia Services
We are proposing to revise the conditions for payment of medical
direction performed by a physician. Thus, we are proposing to revise
our regulations in Sec. 415.10 (Conditions for payment: Anesthesiology
services) to state that we will pay a physician for medical direction
of anesthesia services, for a single case or for two, three, or four
concurrent cases if the services meet the condition in Sec. 415.102(a)
(Conditions for fee schedule payment for physician services to
beneficiaries in providers). This proposal has no payment implications.
The payment rate for medical direction, which is included in the
statute, would not change.
D. Separate Payment for Physician Interpretation of an Abnormal
Papanicolaou Smear
Under our proposed policy, we would allow separate payment, under
the physician fee schedule, for the physician interpretation of Pap
smears in all sites. Currently, separate payment to physicians is
limited to services furnished for hospital inpatients. We estimate that
there would be a minimal cost impact in payments under the physician
fee schedule for this change in Pap smear interpretations. This cost
would be more than offset by the savings resulting from the change in
the calculation of the median for payment of drugs and biologicals.
E. Rebasing and Revising the Medicare Economic Index
There is negligible impact on Medicare expenditures as a result of
this change.
F. Payment for Nurse Midwives' Services
The provision for nurse midwives' services would place into
regulations text a provision of OBRA 1993 that eliminates the
limitation on coverage of services furnished outside the maternity
cycle by nurse midwives. This provision has been implemented previously
through program instructions; therefore, this change in the regulations
text would have no impact.
G. BBA 1997 Provisions Included in This Proposed Rule
The following four provisions of BBA 1997 are included in this
proposed rule. This proposed rule conforms the regulations text to the
BBA 1977 provisions. The following table provides the cost and savings
estimates (in millions of dollars) for these provisions for the fiscal
years shown:
--------------------------------------------------------------------------------------------------------------------------------------------------------
Provision Section Subject 1999 2000 2001 2002 2003
--------------------------------------------------------------------------------------------------------------------------------------------------------
4511.......................................... Nurse practitioners and Clinical Nurse 290 330 370 440 490
Specialists.
4512.......................................... Physician Assistants................... 60 60 70 90 100
4541.......................................... Outpatient Physical Therapy............ -130 -190 -200 -230 -250
4556.......................................... Drugs.................................. -60 -70 -70 -80 -80
--------------------------------------------------------------------------------------------------------------------------------------------------------
[[Page 30874]]
1. Payment for Services of Certain Nonphysician Practitioners and
Services Furnished Incident to Their Professional Services
Sections 4511 and 4512 of BBA 1997 provide for the expanded
coverage of nurse practitioner, clinical nurse specialist, and
physician assistant services. This provision is self-implementing. This
proposed rule changes the regulations text to conform to the BBA 1997
provisions. We are taking this opportunity to clarify the following two
existing issues unrelated to the BBA 1997 provisions for nonphysician
practitioners.
Proposing a revised definition of physician collaboration
for nurse practitioners and clinical nurse specialists.
Modifying the qualifications of physicians assistants to
recognize orthopedic physician assistants as physician assistants.
The impact of the BBA 1997 provision is shown in the table above (a
combination of sections 4511 and 4512 of BBA 1997). The proposals being
made in this proposed rule would have negligible budgetary impact.
2. Payment for Outpatient Rehabilitation Services
Sections 4541(a)(2)(B) and 4541(a)(3) of BBA 1997 change the
payment of outpatient rehabilitation services from cost-based to a
payment system based on the physician fee schedule. These provisions
are self-implementing. The impact of this proposal is shown in the
table above. The regulatory changes are to conform our regulations to
the provisions of BBA 1997.
The following proposals are being made in this proposed rule to
furnish information for identification of the outpatient rehabilitation
services and for administrative purposes:
Specifying HCPCS as the coding system for rehabilitation
services since it is used by the fee schedule in section 1848 of the
Act.
Providing for discipline-specific modifiers to be used in
coding services.
Providing for a code for nursing services performed in
CORFs.
These proposals will have a negligible impact.
We are providing some additional impact information regarding this
BBA 1997 provision. There are several different types of providers that
will be affected by this BBA 1997 provision. They are SNFs, outpatient
rehabilitation facilities, and hospital outpatient departments. There
about 15,000 SNFs, 2,500 outpatient rehabilitation facilities, and
about 5,600 outpatient hospital facilities. In estimating the impacts
of this provision on these entities, we determined that the services
that would be affected by these changes account for about 5 percent of
facility payments in these providers.
We realize there may be an impact on small rural hospitals;
however, we have been unable to assess this impact because we do not
have the data to make this analysis. Also, data that would identify the
extent to which these services are currently being furnished in small
rural hospitals to serve as the baseline for comparing impact of the
legislative changes are not available. In addition, we do not maintain
data that identify services furnished under the physician fee schedule
in areas where rural hospitals are located. Although there are
localities designated for payment purposes, there is very little
correlation between the payment localities (most of which are state-
wide) and areas where small rural hospitals are located.
3. Payment for Drugs and Biologicals
The impact of this BBA 1997 provision is shown in the table above.
This proposed rule modifies the current regulatory language regarding
drug reimbursement to conform to the BBA 1997 changes. The proposal in
this proposed rule to modify the method used to calculate the median to
include the brand name of the drug is not related to the BBA 1997 drug
provision but would have a slight program savings. This is offset by
the cost for the proposal to provide a separate payment for the
interpretation of an abnormal Pap smear, which was described above.
4. Private Contracting with Medicare Beneficiaries
We anticipate that there would be a negligible impact on Medicare
trust fund payments as a result of the regulation that implements the
law. The program impact of the provision when it was assessed in the
legislative process was negligible and vanished under our rounding
rules. The impact on beneficiaries, physicians, and practitioners is
impossible to assess in any quantitative way.
Specifically, beneficiaries who have had difficulty in finding
physicians or practitioners to furnish services because the physicians
or practitioners were dissatisfied with the Medicare payment rates may
find it easier to acquire care. On the other hand, beneficiaries who
cannot afford to privately contract with physicians or practitioners
who opt-out of Medicare may have more limited access to care as they
try to seek care from reduced numbers of physicians and practitioners
who will accept Medicare payment rules.
Physicians and practitioners who opt-out of Medicare may see
increased incomes as a result of their ability to charge without regard
to the Medicare limiting charge. However, to the extent that
beneficiaries cease to seek treatment from them because they have
opted-out of Medicare, their incomes may decline. Moreover,
organizations to which physicians and practitioners had reassigned
Medicare benefits may cease their contracts with them if they opt-out
since they could no longer be paid by Medicare for the physician or
practitioner service. Managed care plans that have a contract with
Medicare may cease their contractual arrangement with physicians and
practitioners who opt-out of Medicare since the plan cannot pay for any
of their services to Medicare beneficiaries and, hence, their services
no longer offer access to care under the plan. Similarly, insurance
plans other than Medicare can choose to not pay for the services
provided to any of their enrollees by physicians and practitioners who
opt-out of Medicare, causing the physicians and practitioners who opt-
out further loss of income.
H. Impact on Beneficiaries
Although changes in physician payments when the physician fee
schedule was implemented in 1992 were large, we detected no problems
with beneficiary access to care. Because there is a 4-year transition
to the proposed values, we anticipate a minimal impact on
beneficiaries.
In accordance with the provisions of Executive Order 12866, this
regulation was reviewed by the Office of Management and Budget.
List of Subjects
42 CFR Part 405
Administrative practice and procedure, Health facilities, Health
professions, Kidney diseases, Medicare, Reporting and recordkeeping
requirements, Rural areas, X-rays.
42 CFR Part 410
Health facilities, Health professions, Kidney diseases,
Laboratories, Medicare, Rural areas, X-rays.
42 CFR Part 413
Health facilities, Kidney diseases, Medicare, Reporting and
recordkeeping requirements.
42 CFR Part 414
Administrative practice and procedure, Health facilities, Health
professions, Kidney diseases, Medicare,
[[Page 30875]]
Reporting and recordkeeping requirements, Rural areas, X-rays.
42 CFR Part 415
Health facilities, Health professions, Medicare Reporting and
recordkeeping requirements.
42 CFR Part 424
Emergency medical services, Health facilities, Health professions,
Medicare.
42 CFR Part 485
Grant programs-health, Health facilities, Medicaid, Medicare,
Reporting and recordkeeping requirements.
For the reasons set forth in the preamble, 42 CFR chapter IV would
be amended as follows:
PART 405--FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED
A. Part 405 is amended as set forth below:
1. A new subpart D, consisting of Secs. 405.400, 405.405, 405.410,
405.415, 405.420, 405.425, 405.430, 405.435, 405.440, 405.445, 405.450,
and 405.455 is added to read as follows:
Subpart D--Private Contracts
Secs.
405.400 Definitions.
405.405 General rules.
405.410 Conditions for properly opting-out of Medicare.
405.415 Requirements of private contracts.
405.420 Requirements of opt-out affidavit.
405.425 Effects of opting-out of Medicare.
405.430 Failure to properly opt-out.
405.435 Failure to maintain opt-out.
405.440 Emergency and urgent care services.
405.445 Renewal and early termination of opt-out.
405.450 Appeals.
405.455 Medicare+Choice.
Subpart D--Private Contracts
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
Sec. 405.400 Definitions.
For purposes of this subpart, the following definitions apply:
Beneficiary means an individual who is enrolled in Part B of
Medicare.
Emergency care services means services furnished to an individual
for treatment of an ``emergency medical condition'' as that term is
defined in Sec. 489.24 of this chapter.
Legal representative means an individual who has been appointed as
the beneficiary's legal guardian under State law or who has been
granted a power of attorney from the beneficiary, which power of
attorney is sufficient to permit the individual to enter into private
contracts on the beneficiary's behalf.
Opt-out means the status of meeting the conditions specified in
Sec. 405.410.
Opt-out period means the 2-year period beginning on the effective
date of the affidavit as specified by Sec. 405.410(c)(1) or
Sec. 405.410(c)(2), as applicable.
Participating physician means a ``physician'' as defined in this
section who has signed an agreement to participate in Part B of
Medicare.
Physician means a doctor of medicine or a doctor of osteopathy who
is currently licensed as that type of doctor in each State in which he
or she furnishes services to patients.
Practitioner means a physician assistant, nurse practitioner,
clinical nurse specialist, certified registered nurse anesthetist,
certified nurse midwife, clinical psychologist, or clinical social
worker, who is currently legally authorized to practice in that
capacity by each State in which he or she furnishes services to
patients or clients.
Private contract means a document that meets the criteria specified
in Sec. 405.415.
Properly opt-out means to complete, without defect, the
requirements for opt-out as specified in Sec. 405.410.
Properly terminate opt-out means to complete, without defect, the
requirements for terminating opt-out as specified in Sec. 405.445.
Urgent care services means services furnished to an individual who
requires services to be furnished within 12 hours in order to avoid the
likely onset of an emergency medical condition.
Sec. 405.405 General rules.
(a) A physician or practitioner may enter into one or more private
contracts with Medicare beneficiaries for the purpose of furnishing
items or services that would otherwise be covered by Medicare, provided
the conditions of this subpart are met.
(b) A physician or practitioner who enters into at least one
private contract with a Medicare beneficiary under the conditions of
this subpart, and who submits one or more affidavits in accordance with
this subpart, opts-out of Medicare for a 2-year period. The physician's
or practitioner's opt-out may be renewed for subsequent 2-year periods.
(c) Both the private contracts described in paragraph (a) of this
section and the physician's or practitioner's opt-out described in
paragraph (b) of this section are null and void if the physician or
practitioner fails to properly opt-out in accordance with the
conditions of this subpart, or fails to remain in compliance with the
conditions of this subpart during the opt-out period.
(d) Services furnished under private contracts meeting the
requirements of this subpart are not covered services under Medicare,
and no Medicare payment would be made for such services either directly
or indirectly.
Sec. 405.410 Conditions for properly opting-out of Medicare.
The following conditions must be met for a physician or
practitioner to properly opt-out of Medicare:
(a) Each private contract between a physician or a practitioner and
a Medicare beneficiary must meet the specifications of Sec. 405.415.
(b) The physician or practitioner must submit to each Medicare
carrier with which he or she files claims an affidavit that meets the
specifications of Sec. 405.420.
(c) A nonparticipating physician or a practitioner may opt-out of
Medicare at any time in accordance with the following:
(1) The 2-year opt-out period begins the date the affidavit meeting
the requirements of Sec. 405.420 is signed, provided the affidavit is
timely filed (that is, within 10 days after the first private contract
is entered into).
(2) If the physician or practitioner does not timely file any
required affidavit, the 2-year opt-out period begins when the last such
affidavit is filed. Any private contract entered into before the last
required affidavit is filed becomes effective upon the filing of the
last required affidavit and the furnishing of any items or services to
a Medicare beneficiary under such contract before the last required
affidavit is filed is subject to standard Medicare rules.
(d) A participating physician may properly opt-out of Medicare at
the beginning of any calendar quarter, provided that the affidavit
described in Sec. 405.420 is submitted to the participating physician's
Medicare carriers at least 30 days before the beginning of the selected
calendar quarter. A private contract entered into before the beginning
of the selected calendar quarter becomes effective at the beginning of
the selected calendar quarter and the furnishing of any items or
services to a Medicare beneficiary under such contract before the
beginning of the selected calendar quarter is subject to standard
Medicare rules.
[[Page 30876]]
Sec. 405.415 Requirements of the private contract.
A private contract under this subpart must:
(a) Be in writing and in print sufficiently large to ensure that
beneficiaries are able to read the contract.
(b) State whether the physician or practitioner is excluded from
Medicare under section 1128 of the Social Security Act.
(c) State that the beneficiary or his or her legal representative
accepts full responsibility for payment of the physician's or
practitioner's charge for the services furnished.
(d) State that the beneficiary or his or her legal representative
understands that Medicare limits do not apply to what the physician or
practitioner may charge for items or services furnished by the
physician or practitioner.
(e) State that the beneficiary or his or her legal representative
agrees not to submit a claim to Medicare or to ask the physician or
practitioner to submit a claim to Medicare.
(f) State that the beneficiary or his or her legal representative
understands that Medicare payment will not be made for any items or
services furnished by the physician or practitioner that would have
otherwise been covered by Medicare if there was no private contract and
a proper Medicare claim had been submitted.
(g) State that the beneficiary or his or her legal representative
enters into this contract with the knowledge that he or she has the
right to obtain Medicare-covered items and services from physicians and
practitioners who have not opted-out of Medicare.
(h) State the expected effective date and expected expiration date
of the opt-out period.
(i) State that the beneficiary or his or her legal representative
understands that Medigap plans do not, and that other supplemental
plans may elect not to, make payments for items and services not paid
for by Medicare.
(j) Be signed by the beneficiary or his or her legal representative
and by the physician or practitioner.
(k) Not be entered into by the beneficiary or by the beneficiary's
legal representative during a time when the beneficiary requires
emergency care services or urgent care services. (However, a physician
or practitioner may furnish emergency or urgent care services to a
Medicare beneficiary in accordance with Sec. 405.440.)
(l) Be provided (a photocopy is permissible) to the beneficiary or
to his or her legal representative before items or services are
furnished to the beneficiary under the terms of the contract.
(m) Be retained (original signatures of both parties required) by
the physician or practitioner for the duration of the opt-out period.
(n) Be made available to HCFA upon request.
(o) Be entered into for each opt-out period.
Sec. 405.420 Requirements of the opt-out affidavit.
An affidavit under this subpart must:
(a) Be in writing and be signed by the physician or practitioner.
(b) Contain the physician's or practitioner's full name, address,
telephone number, national provider identifier (NPI) or billing number,
if one has been assigned, uniform provider identification number (UPIN)
if one has been assigned, or, if neither an NPI nor a UPIN has been
assigned, the physician's or practitioner's tax identification number
(TIN).
(c) State that, during the opt-out period, the physician or
practitioner will provide services to Medicare beneficiaries only
through private contracts that meet the criteria of paragraph
Sec. 405.415 for services that, except for their provision under a
private contract, would have been Medicare-covered services.
(d) State that the physician or practitioner will not submit a
claim to Medicare for any service furnished to a Medicare beneficiary
during the opt-out period, nor will the physician or practitioner
permit any entity acting on his or her behalf to submit a claim to
Medicare for services furnished to a Medicare beneficiary, except as
specified in Sec. 405.440.
(e) State that, during the opt-out period, the physician or
practitioner understands that he or she may receive no direct or
indirect Medicare payment for services that he or she furnishes to
Medicare beneficiaries with whom he or she has privately contracted,
whether as an individual, an employee of an organization, a partner in
a partnership, under a reassignment of benefits, or as payment for a
service furnished to a Medicare beneficiary under a Medicare+Choice
plan.
(f) State that a physician or practitioner who opts-out of Medicare
acknowledges that, during the opt-out period, his or her services are
not covered under Medicare and that no Medicare payment may be made to
any entity for his or her services, directly or on a capitated basis.
(g) State a promise by the physician or practitioner to the effect
that, during the opt-out period, the physician or practitioner agrees
to be bound by the terms of both the affidavit and the private
contracts that he or she has entered into.
(h) Acknowledge that the physician or practitioner recognizes that
the terms of the affidavit apply to all Medicare-covered items and
services furnished to Medicare beneficiaries by the physician or
practitioner during the opt-out period (except for emergency or urgent
care services furnished to the beneficiaries with whom he or she has
not previously privately contracted) without regard to any payment
arrangements the physician or practitioner may make.
(i) With respect to a physician who has signed a Part B
participation agreement, acknowledge that such agreement terminates on
the effective date of the affidavit.
(j) Acknowledge that the physician or practitioner understands that
a beneficiary who has not entered into a private contract and who
requires emergency or urgent care services may not be asked to enter
into a private contract with respect to receiving such services and
that the rules of Sec. 405.440 apply if the physician furnishes such
services.
(k) Be submitted to:
(1) Each Medicare carrier to which the physician or practitioner
has submitted claims within the past 2 years.
(2) To any additional carriers to which claims would be sent on the
date the first private contract is entered into, in accordance with
Medicare instructions on claim submission then in effect.
(l) With respect to nonparticipating physicians and with respect to
practitioners, be submitted within 10 days after the nonparticipating
physician or practitioner signs his or her first private contract with
a Medicare beneficiary.
(m) With respect to participating physicians, be submitted in
accordance with Sec. 405.410(d).
Sec. 405.425 Effects of opting-out of Medicare.
If a physician or practitioner opts-out of Medicare in accordance
with this subpart for the 2-year period for which the opt-out is
effective, the following results obtain:
(a) Except as provided in Sec. 405.440, no payment may be made
directly by Medicare or by any Medicare+Choice plan to the physician or
practitioner or to any entity to which the physician or practitioner
reassigns his right to receive payment for services.
(b) The physician or practitioner may not furnish any item or
service that would otherwise be covered by
[[Page 30877]]
Medicare (except for emergency or urgent care services) to any Medicare
beneficiary except through a private contract that meets the
requirements of this subpart.
(c) The physician or practitioner is not subject to the requirement
to submit a claim for items or services furnished to a Medicare
beneficiary, as specified in Sec. 424.5(a)(6) of this chapter, except
as provided in Sec. 405.440.
(d) The physician or practitioner is prohibited from submitting a
claim to Medicare for items or services furnished to a Medicare
beneficiary except as provided in Sec. 405.440.
(e) In the case of a physician, he or she is not subject to the
limiting charge provisions of Sec. 414.48 of this chapter.
(f) The physician or practitioner is not subject to the
prohibition-on-reassignment provisions of Sec. 414.80 of this chapter.
(g) In the case of a practitioner, he or she is not prohibited from
billing or collecting amounts from beneficiaries (as provided in 42
U.S.C. 1395u(b)(18)(B)).
(h) The death of a beneficiary who has entered into a private
contract (or whose legal representative has done so) does not invoke
Sec. 424.62 or Sec. 424.64 of this chapter with respect to the
physician or practitioner with whom the beneficiary (or legal
representative) has privately contracted.
(i) The physician or practitioner may order, certify the need for,
or refer a beneficiary for Medicare-covered items and services,
provided the physician or practitioner is not paid, directly or
indirectly, for such ordering, certifying, or referring services.
Sec. 405.430 Failure to properly opt-out.
(a) A physician or practitioner fails to properly opt-out if--
(1) Any private contract between the physician or practitioner and
a Medicare beneficiary, that was entered into before the affidavit
described in Sec. 405.420 was filed, does not meet the specifications
of Sec. 405.415; or
(2) He or she fails to submit the affidavit(s) in accordance with
Sec. 405.420.
(b) If a physician or practitioner fails to properly opt-out in
accordance with paragraph (a) of this section, the following results
obtain:
(1) All of the private contracts between the physician or
practitioner and Medicare beneficiaries are deemed null and void.
(2) The physician's or practitioner's attempt to opt-out of
Medicare is nullified.
(3) The physician or practitioner must submit claims to Medicare
for all Medicare-covered items and services furnished to Medicare
beneficiaries.
(4) The physician is subject to the limiting charge provisions of
Sec. 414.48 of this chapter.
(5) The practitioner may not reassign any claim except as provided
in Sec. 424.80 of this chapter.
(6) The practitioner may neither bill nor collect an amount from
the beneficiary except for applicable deductible and coinsurance
amounts.
(7) The physician or practitioner may make another attempt to
properly opt-out at any time.
Sec. 405.435 Failure to maintain opt-out.
(a) A physician or practitioner fails to maintain opt-out under
this subpart if, during the opt-out period--
(1) He or she knowingly and willfully--
(i) Submits a claim for Medicare payment (except as provided in
Sec. 405.440); or
(ii) Receives Medicare payment directly or indirectly for Medicare-
covered services furnished to a Medicare beneficiary (except as
provided in Sec. 405.440).
(2) He or she enters into private contracts with Medicare
beneficiaries for the purpose of furnishing items and services that
would otherwise be covered by Medicare, but such contracts fail to meet
the specifications of Sec. 405.415; or
(3) He or she fails to comply with the provisions of Sec. 405.440
regarding billing for emergency care services or urgent care services;
or
(4) He or she fails to retain a copy of each private contract that
he or she has entered into for the duration of the opt-out period for
which the contracts are applicable or fails to permit HCFA to inspect
them upon request.
(b) If a physician or practitioner fails to maintain opt-out in
accordance with paragraph (a) of this section, the following results
obtain:
(1) All of the private contracts between the physician or
practitioner and Medicare beneficiaries are deemed null and void.
(2) The physician's or practitioner's opt-out of Medicare is
nullified.
(3) The physician or practitioner must submit claims to Medicare
for all Medicare-covered items and services furnished to Medicare
beneficiaries.
(4) The physician or practitioner will not receive Medicare payment
on Medicare claims for the remainder of the opt-out period.
(5) The physician is subject to the limiting charge provisions of
Sec. 414.48 of this chapter.
(6) The practitioner may not reassign any claim except as provided
in Sec. 424.80 of this chapter.
(7) The practitioner may neither bill nor collect an amount from
the beneficiary except for applicable deductible and coinsurance
amounts.
(8) The physician or practitioner may not attempt to once more meet
the criteria for properly opting-out until the now-nullified 2-year
opt-out period expires.
Sec. 405.440 Emergency and urgent care services.
(a) A physician or practitioner who has opted-out of Medicare under
this subpart need not enter into a private contract to furnish
emergency care services or urgent care services to a Medicare
beneficiary. Accordingly, a physician or practitioner will not be
determined to have failed to maintain opt-out if he or she furnishes
emergency care services or urgent care services to a Medicare
beneficiary with whom the physician or practitioner has not previously
entered into a private contract, provided the physician or practitioner
complies with the billing requirements specified in paragraph (b) of
this section.
(b) When a physician or practitioner furnishes emergency care
services or urgent care services to a Medicare beneficiary with whom
the physician or practitioner has not previously entered into a private
contract, he or she:
(1) Must submit a claim to Medicare in accordance with both 42 CFR
part 424 and Medicare instructions (including but not limited to
complying with proper coding of emergency or urgent care services
furnished by physicians and practitioners who have opted-out of
Medicare).
(2) May collect no more than--
(i) The Medicare limiting charge, in the case of a physician; or
(ii) The deductible and coinsurance, in the case of a practitioner.
(c) Emergency care services or urgent care services furnished to a
Medicare beneficiary with whom the physician or practitioner has
previously entered into a private contract (that is, entered into
before the onset of the emergency medical condition or urgent medical
condition), are furnished under the terms of the private contract.
(d) Medicare may make payment for emergency care services or urgent
care services furnished by a physician or practitioner who has properly
opted-out when the services are furnished and the claim for services is
made in accordance with this section.
[[Page 30878]]
Sec. 405.445 Renewal and early termination of opt-out.
(a) A physician or practitioner may renew opt-out by filing an
affidavit with each carrier to which an affidavit was submitted for the
first opt-out period, (as specified in Sec. 405.420), and to each
carrier to which a claim was submitted under Sec. 405.440 during the
previous opt-out period, provided the affidavits are filed within 30
days after the current opt-out period expires.
(b) To properly terminate opt-out a physician or practitioner must:
(1) Not have previously opted out of Medicare.
(2) Notify all Medicare carriers with which he or she filed an
affidavit of the termination of the opt-out no later than 90 days after
the effective date of the opt-out period.
(3) Refund to each beneficiary with whom he or she has privately
contracted all payment collected in excess of:
(i) In the case of physicians: the Medicare limiting charge; or
(ii) In the case of practitioners: the deductible and coinsurance.
(4) Notify all beneficiaries with whom the physician or
practitioner entered into private contracts of the physician's or
practitioner's decision to terminate opt-out and of the beneficiaries'
right to have claims filed on their behalf with Medicare for the
services furnished during the period between the effective date of the
opt-out and the effective date of the termination of the opt-out
period.
(c) When the physician or practitioner properly terminates opt-out
in accordance with paragraph (b), he or she will be reinstated in
Medicare as if there had been no opt-out, and the provision of
Sec. 405.425 shall not apply unless the physician or practitioner
subsequently properly opts out.
Sec. 405.450 Appeals.
(a) A determination by HCFA that a physician or practitioner has
failed to properly opt-out, failed to maintain opt-out, failed to
timely renew opt-out, failed to privately contract, or failed to
properly terminate opt-out is an initial determination for purposes of
Sec. 405.803.
(b) A determination by HCFA that no payment can be made to a
beneficiary for the services of a physician who has opted-out is an
initial determination for purposes of Sec. 405.803.
Sec. 405.455 Medicare+Choice.
An organization that has a contract with HCFA to provide one or
more Medicare+Choice (M+C) plans to beneficiaries (part 422 of this
chapter):
(a) Must acquire and maintain information from Medicare carriers on
physicians and practitioners who have opted-out of Medicare.
(b) Must make no payment directly or indirectly for Medicare
covered services furnished to a Medicare beneficiary by a physician or
practitioner who has opted-out of Medicare.
(c) May make payment to a physician or practitioner who furnishes
emergency or urgent care services to a beneficiary who has not
previously entered into a private contract with the physician or
practitioner.
Subpart E--Criteria for Determining Reasonable Charges
2. The authority citation for part 405, subpart E, continues to
read as follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
3. Section 405.517 is revised to read as follows:
Sec. 405.517 Payment for drugs and biologicals that are not paid on a
cost or prospective payment basis.
(a) Applicability. Payment for a drug or biological that is not
paid on a cost or prospective payment basis is determined by the
standard methodology described in paragraph (b) of this section.
Examples of when this procedure applies include a drug or biological
furnished incident to a physician service, a drug or biological
furnished by an independent dialysis facility that is not included in
the ESRD composite rate set forth in Sec. 413.170(c) of this chapter,
and a drug or biological furnished as part of the durable medical
equipment benefit.
(b) Methodology. Payment for a drug or biological described in
paragraph (a) of this section is based on the lower of the actual
charge on the Medicare claim for benefits or 95 percent of the national
average wholesale price of the drug or biological.
(c) Multiple-source drugs. For multiple-source drugs and
biologicals, for purposes of this regulation, the average wholesale
price is defined as the lesser of the median average wholesale price
for all sources of the generic forms of the drug or biological or the
lowest average wholesale price of the brand name forms of the drug or
biological.
4. A new Sec. 405.520 is added to read as follows:
Sec. 405.520 Payment for physician assistant, nurse practitioner, and
clinical nurse specialist services and services furnished incident to
their professional services.
(a) General rule. Physician assistant, nurse practitioner, and
clinical nurse specialist services, and services and supplies furnished
incident to their professional services, are paid in accordance with
the physician fee schedule. The payment for physician assistant
services may not exceed the limits at Sec. 414.52 of this chapter. The
payment for nurse practitioner and clinical nurse specialist services
may not exceed the limits at Sec. 414.56 of this chapter.
(b) Requirements. Medicare payment is made only if all claims for
payment are made on an assignment-related basis in accordance with
Sec. 424.55 of this chapter, that sets forth, respectively, the
conditions for coverage of physician assistant services, nurse
practitioner services and clinical nurse specialist services, and
services and supplies furnished incident to their professional
services.
(c) Civil money penalties. Any person or entity who knowingly and
willingly bills a Medicare beneficiary amounts in excess of the
appropriate coinsurance and deductible is subject to a civil money
penalty not to exceed $2,000 for each bill or request for payment.
PART 410--SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS
B. Part 410 is amended as set forth below:
1. The authority citation for part 410 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
Sec. 410.32 [Amended]
2. In Sec. 410.32(a)(3), the last word, ``section,'' is removed and
the word ``paragraph'' is added in its place.
3. A new section 410.59 is added to read as follows:
Sec. 410.59 Outpatient occupational therapy services: Conditions.
(a) Basic rule. Medicare Part B pays for outpatient occupational
therapy services if they meet the following conditions:
(1) They are furnished to a beneficiary while he or she is under
the care of a physician who is a doctor of medicine, osteopathy, or
podiatric medicine.
(2) They are furnished under a written plan of treatment that meets
the requirements of Sec. 410.61.
(3) They are furnished--
(i) By a provider as defined in Sec. 489.2 of this chapter, or by
others under arrangements with, and under the supervision of, a
provider; or
(ii) By or under the personal supervision of an occupational
therapist in private practice as described in paragraph (c) of this
section.
(b) Outpatient occupational therapy services to certain inpatients
of a
[[Page 30879]]
hospital or a CAH or SNF. Medicare Part B pays for outpatient
occupational therapy services to an inpatient of a hospital, CAH, or
SNF who requires them but who has exhausted or is otherwise ineligible
for benefit days under Medicare Part A.
(c) Special provisions for services furnished by occupational
therapists in private practice. (1) Basic Qualifications. In order to
qualify under Medicare as a supplier of outpatient occupational therapy
services, each individual occupational therapist in private practice
must meet the following requirements:
(i) Is legally authorized (if applicable, licensed, certified, or
registered) to engage in the private practice of occupational therapy
by the State in which he or she practices, and practices only within
the scope of his or her license, certification, or registration.
(ii) Engages in the private practice of occupational therapy on a
regular basis, in one of the following practice types:
(A) An individual operating an unincorporated solo practice.
(B) An individual practicing as a member of a partnership or
unincorporated group practice.
(C) An individual practicing as an employee of an unincorporated
solo practice, partnership, or group practice, or an employee of a
professional corporation or other incorporated occupational therapy
practice. Private practice does not include any individual during the
time he or she is working as an employee of a provider.
(iii) Bills Medicare only for services furnished in his or her
private practice office space, or in the patient's home. A therapist's
private practice office space refers to the location(s) where the
practice is operated, in the State(s) where the therapist (and
practice, if applicable) is legally authorized to furnish services,
during the hours that the therapist engages in practice at that
location. When services are furnished in private practice office space,
that space must be owned, leased, or rented by the practice and used
for the exclusive purpose of operating the practice. A patient's home
does not include any institution that is a hospital, an CAH, or a SNF.
(iv) Treats individuals who are patients of the practice and for
whom the practice collects fees for the services furnished.
(2) Supervision of occupational therapy services. Occupational
therapy services are performed by, or under the personal supervision
of, the occupational therapist in private practice. All services not
performed personally by the therapist must be performed by employees of
the practice, personally supervised by the therapist, and included in
the fee for the therapist's services.
(d) Excluded expenses. No service is included as an outpatient
occupational therapy service if it would not be included as an
inpatient hospital service if furnished to a hospital or CAH inpatient.
(e) Annual limitation on incurred expenses. (1) Amount of
limitation. (i) In 1999, no more than $1500 of allowable charges
incurred in a calendar year for outpatient occupational therapy
services are recognized incurred expenses.
(ii) In 2002 and thereafter, the limitation shall be determined by
increasing the limitation in effect in the previous calendar year by
the increase in the Medicare Economic Index for the current year.
(2) For purposes of applying the limitation, outpatient physical
therapy includes:
(i) Except as provided in paragraph (e)(3) of this section,
outpatient occupational therapy services furnished under this section;
(ii) Outpatient occupational therapy services furnished by a
comprehensive outpatient rehabilitation facility;
(iii) Outpatient occupational therapy services furnished by a
physician or incident to a physician's service;
(iv) Outpatient occupational therapy services furnished by a nurse
practitioner, certified nurse specialist, or physician assistant or
incident to their services.
(3) For purposes of applying the limitation, outpatient
occupational therapy services excludes services furnished by a hospital
or CAH directly or under arrangements.
4. Section 410.60 is revised to read as follows:
Sec. 410.60 Outpatient physical therapy services: Conditions.
(a) Basic rule. Medicare Part B pays for outpatient physical
therapy services if they meet the following conditions:
(1) They are furnished to a beneficiary while he or she is under
the care of a physician who is a doctor of medicine, osteopathy, or
podiatric medicine.
(2) They are furnished under a written plan of treatment that meets
the requirements of Sec. 410.61.
(3) They are furnished--
(i) By a provider as defined in Sec. 489.2 of this chapter, or by
others under arrangements with, and under the supervision of, a
provider; or
(ii) By or under the personal supervision of a physical therapist
in private practice as described in paragraph (c) of this section.
(b) Outpatient physical therapy services to certain inpatients of a
hospital or a CAH or SNF. Medicare Part B pays for outpatient
occupational therapy services to an inpatient of a hospital, CAH, or
SNF who requires them but who has exhausted or is otherwise ineligible
for benefit days under Medicare Part A.
(c) Special provisions for services furnished by physical
therapists in private practice. (1) Basic Qualifications.
In order to qualify under Medicare as a supplier of outpatient
physical therapy services, each individual physical therapist in
private practice must meet the following requirements:
(i) Is legally authorized (if applicable, licensed, certified, or
registered) to engage in the private practice of physical therapy by
the State in which he or she practices, and practices only within the
scope of his or her license, certification, or registration.
(ii) Engages in the private practice of physical therapy on a
regular basis, in one of the following practice types:
(A) An individual operating an unincorporated solo practice.
(B) An individual practicing as a member of an unincorporated
partnership or unincorporated group practice.
(C) An individual practicing as an employee of an unincorporated
solo practice, partnership, or group practice, or an employee of a
professional corporation or other incorporated physical therapy
practice. Private practice does not include any individual during the
time he or she is working as an employee of a provider.
(iii) Bills Medicare only for services furnished in his or her
private practice office space, or in the patient's home. A therapist's
private practice office space refers to the location(s) where the
practice is operated, in the State(s) where the therapist (and
practice, if applicable) is legally authorized to furnish services,
during the hours that the therapist engages in practice at that
location. When services are furnished in private practice office space,
that space must be owned, leased, or rented by the practice and used
for the exclusive purpose of operating the practice. A patient's home
does not include any institution that is a hospital, a CAH, or a SNF.
(iv) Treats individuals who are patients of the practice and for
whom the practice collects fees for the services furnished.
(2) Supervision of physical therapy services. Physical therapy
services are performed by, or under the personal supervision of, the
physical therapist in
[[Page 30880]]
private practice. All services not performed personally by the
therapist must be performed by employees of the practice, personally
supervised by the therapist, and included in the fee for the
therapist's services.
(d) Excluded expenses. No service is included as an outpatient
physical therapy service if it would not be included as an inpatient
hospital service if furnished to a hospital or CAH inpatient.
(e) Annual limitation on incurred expenses. (1) Amount of
limitation. In 1999, no more than $1500 of allowable charges incurred
in a calendar year for outpatient physical therapy services are
recognized incurred expenses.
(ii) In 2002 and thereafter, the limitation shall be determined by
increasing the limitation in effect in the previous calendar year by
the increase in the Medicare Economic Index for the current year.
(2) For purposes of applying the limitation, outpatient
occupational therapy includes:
(i) Except as provided in paragraph (e)(3) of this section,
outpatient physical therapy services furnished under this section;
(ii) Except as provided in paragraph (e)(3) of this section,
outpatient speech-language pathology services furnished under
Sec. 410.62;
(iii) Outpatient physical therapy and speech-language pathology
services furnished by a comprehensive outpatient rehabilitation
facility;
(iv) Outpatient physical therapy and speech-language pathology
services furnished by a physician or incident to a physician's service;
(v) Outpatient physical therapy and speech-language pathology
services furnished by a nurse practitioner, certified nurse specialist,
or physician assistant or incident to their services.
(3) For purposes of applying the limitation, outpatient physical
therapy excludes services furnished by a hospital or CAH directly or
under arrangements.
5. In Sec. 410.61 pargraphs (a) through (d) and (e)(1) are revised
to read as follows:
Sec. 410.61 Plan of treatment requirements for outpatient
rehabilitation services.
(a) Basic requirement. Outpatient rehabilitation services
(including services furnished by a qualified physical or occupational
therapist in private practice), must be furnished under a written plan
of treatment that meets the requirements of paragraphs (b) through (e)
of this section.
(b) Establishment of the plan. The plan is established before
treatment is begun by one of the following:
(1) A physician.
(2) A physical therapist who will furnish the physical therapy
services.
(3) A speech-language pathologist who will furnish the speech-
language pathology services.
(4) An occupational therapist who will furnish the occupational
therapy services.
(c) Content of the plan. The plan prescribes the type, amount,
frequency, and duration of the physical therapy, occupational therapy,
or speech-language pathology services to be furnished to the
individual, and indicates the diagnosis and anticipated goals.
(d) Changes in the plan. Any changes in the plan--
(1) Are made in writing and signed by one of the following:
(i) The physician.
(ii) The physical therapist who furnished the physical therapy
services.
(iii) The occupational therapist who furnishes the physical therapy
services.
(iv) The speech-language pathologist who furnishes the speech-
language pathology services.
(v) A registered professional nurse or a staff physician, in
accordance with oral orders from the physician, physical therapist,
occupational therapist, or speech-language pathologist who furnishes
the services.
(2) The changes are incorporated in the plan immediately.
(e) Review of the plan. (1) The physician reviews the plan as often
as the individual's condition requires, but at least within the first
62 days and at least every 31 days after each previous review.
* * * * *
6. In Sec. 410.62, the section heading is revised, paragraph (a)(3)
is amended to add ``as defined in Sec. 489.2'' after the words, ``by a
provider'', and a new paragraph (d) is added to read as follows:
Sec. 410.62 Outpatient speech-language pathology services: Conditions
and exclusions.
* * * * *
(d) Limitation. After 1998, outpatient speech pathology services
are subject to the limitation in 410.60(e).
* * * * *
7. New Secs. 410.74, 410.75, 410.76, and 410.77 are added to
subpart B to read as follows:
Subpart B--Medical and Other Health Services
* * * * *
Sec. 410.74 Physician assistant services.
(a) Basic rule. Medicare Part B covers physician assistant services
only if the following conditions are met:
(1) The services would be covered as physician services if
furnished by a physician (as used in this section, the term
``physician'' means a doctor of medicine or osteopathy, as set forth in
section 1861(r)(1) of the Act).
(2) The physician assistant--
(i) Meets the qualification requirements set forth in paragraph (c)
of this section;
(ii) Is legally authorized to perform the services in the State
which they are performed;
(iii) Performs services that are not otherwise precluded from
coverage because of a statutory exclusion;
(iv) Performs the services under the general supervision of a
physician (that is, the supervising physician need not be physically
present when the physician assistant is performing the services unless
required by State law; however, the supervising physician must be
immediately available to the physician assistant for consultation); and
(v) Furnishes services that are billed by the employer of a
physician assistant; and
(vi) Performs the services--
(A) In all settings in either rural and urban areas; or
(B) As an assistant at surgery.
(b) Services and supplies furnished incident to physician assistant
services. Medicare covers services and supplies (including drugs and
biologicals that cannot be self-administered) that are furnished
incident to the physician assistant services described in paragraph (a)
of this section. These services and supplies are covered only if they--
(1) Would be covered if furnished by a physician or as incident to
the professional services of a physician;
(2) Are the type that are commonly furnished in a physician office
and are either furnished without charge or are included in the bill for
the physician assistant services;
(3) Are, although incidental, an integral part of the professional
service performed by the physician;
(4) Are performed under the direct supervision of the physician
assistant (that is, the physician assistant is physically present and
immediately available); and
(5) Are performed by the employee of a physician assistant or an
entity that employs both the physician assistant or ancillary
personnel.
(c) Qualifications. For Medicare Part B coverage of his or her
services, a
[[Page 30881]]
physician assistant must meet the applicable State requirements
governing the qualifications for physician assistants and at least one
of the following conditions:
(1) Be certified by either the National Commission on Certification
of Physician Assistants to assist primary care physicians or the
National Board for Certification of Orthopedic Physician assistants to
assist orthopedic surgeons; or
(2) Have satisfactorily completed a program for preparing physician
assistants that was at least 1 academic year in length, consisted of
supervised clinical practice and at least 4 months (in aggregate) of
classroom instruction directed toward preparing students to deliver
health care, and was accredited by either the Commission on
Accreditation of Allied Health Education Programs or the American
Society of Orthopedic Physician Assistants; or
(3) Have satisfactorily completed a formal education program for
preparing physician assistants that does not meet the requirements of
Sec. 410.74(c)(2) and have assisted physicians for a total of 12 months
during the 18-month period that ended on [Insert 18 months from the
effective date of final rule].
(d) Professional services. Physician assistants can be paid for
professional services only if the services have been professionally
performed by them and no facility or other provider charges for the
service or is paid any amount for the furnishing of those professional
services.
(1) Supervision of other nonphysician staff by physician does not
constitute personal performance of a professional service by physician
assistants.
(2) If a service is not payable by HCFA under this provision, the
beneficiary is not liable for payment for the service. Physician
assistants may not charge a beneficiary for a service not payable under
this provision. If a beneficiary has made payment for the services,
physician assistants must make the appropriate refund to the
beneficiary.
(3) Examples of the types of professional services that physician
assistants may furnish include services such as physical examinations,
minor surgery, setting casts for simple fractures, interpreting x-rays,
and other activities that involve an independent evaluation or
treatment of the patient's condition. These are services that have been
traditionally reserved for physicians and can be furnished by physician
assistants only if State law or regulation governing the physician
assistant scope of practice authorizes them to perform such services in
the State in which they are practicing.
Sec. 410.75 Nurse practitioner services.
(a) Definition. As used in this section, the term ``physician''
means a doctor of medicine or osteopathy, as set forth in section
1861(r)(1) of the Act.
(b) Qualifications. For Medicare Part B coverage of his or her
services, a nurse practitioner must--
(1) Be a registered nurse who is currently licensed to practice in
the State where he or she practices, be authorized to perform the
services of a nurse practitioner in accordance with State law, and have
a master's degree in nursing;
(2) Be certified as a nurse practitioner by a professional
association recognized by HCFA that has, at a minimum, eligibility
requirements that meet the standards in paragraph (b)(1) of this
section; or
(3) Meet the requirements for a nurse practitioner set forth in
paragraph (b)(1) of this section, except for the master's degree
requirement, and have received before [Insert 3 years from effective
date of final rule] a certificate of completion from a formal advanced
practice program that prepares registered nurses to perform an expanded
role in the delivery of primary care.
(c) Services. Medicare Part B covers nurse practitioner services in
all settings in both rural and urban areas, only if the services would
be covered if furnished by a physician and the nurse practitioner--
(1) Is legally authorized to perform them in the State in which
they are performed;
(2) Performs them while working in collaboration with a physician;
(i) Collaboration is a process in which a nurse practitioner works
with a physician to deliver health care services within the scope of
the practitioner's expertise, with medical direction and appropriate
supervision as provided for in guidelines jointly developed by the
practitioner and the physician, or as provided for by other mechanisms
defined by Federal regulations, or by the law of the State in which the
services are performed.
(ii) The absence of State law or guidelines does not negate the
requirement for collaboration.
(iii) The collaborating physician does not need to be present with
the nurse practitioner when the service is furnished or to make an
independent evaluation of each patient seen by the nurse practitioner.
(iv) Collaboration involves systematic formal planning, assessment,
and a practice arrangement that reflects and demonstrates evidence of
consultation, recognition of statutory limits, clinical authority and
accountability for patient care, according to a mutual agreement that
allows the physician and the nurse practitioner to function
independently as appropriate; and
(3) Is not performing services otherwise precluded from coverage
because of one of the statutory exclusions.
(d) Services and supplies incident to nurse practitioner services.
Medicare Part B covers services and supplies (including drugs and
biologicals that cannot be self-administered) incident to nurse
practitioner services that meet the requirements in paragraph (c) of
this section. These services and supplies are covered only if they--
(1) Would be covered if furnished by a physician or as incident to
the professional services of a physician;
(2) Are of the type that are commonly furnished in a physician
office and are either furnished without charge or are included in the
bill for the nurse practitioner services;
(3) Although incidental, are an integral part of the professional
service performed by the nurse practitioner; and
(4) Are performed under the direct supervision of the nurse
practitioner (that is, the nurse practitioner must be physically
present and immediately available).
(e) Professional services. Nurse practitioners can be paid for
professional services only when the services have been personally
performed by them and no facility or other provider charges or is paid
any amount for the furnishing of such professional services.
(1) Supervision of other nonphysician staff by nurse practitioners
does not constitute personal performance of a professional service by
nurse practitioners.
(2) If a service is not payable by HCFA under this provision, the
beneficiary is not liable for payment for the service. Nurse
practitioners may not charge a beneficiary for a service not payable
under this provision. If a beneficiary has made payment for the
services, the nurse practitioner must make the appropriate refund to
the beneficiary.
(3) Examples of the types of professional services that nurse
practitioners may provide include services such as physical
examinations, minor surgery, setting casts for simple fractures,
interpreting x-rays, and other activities that involve an independent
evaluation or treatment of the patient's condition. These are services
that have been traditionally reserved for physicians and can only be
furnished by
[[Page 30882]]
nurse practitioners if State law or regulation governing the nurse
practitioner scope of practice authorizes them to perform such services
in the State in which they are practicing.
Sec. 410.76 Clinical nurse specialist services.
(a) Definition. As used in this section, the term ``physician''
means a doctor of medicine or osteopathy, as set forth in section
1861(r)(1) of the Act.
(b) Qualifications. For Medicare Part B coverage of his or her
services, a clinical nurse specialist must--
(1) Be a registered nurse who is currently licensed to practice in
the State where he or she practices, be authorized to perform the
services of a clinical nurse specialist in accordance with State law,
and have a master's degree in a defined clinical area of nursing from
an accredited educational institution;
(2) Be certified as a clinical nurse specialist by a professional
association recognized by HCFA that has, at a minimum, eligibility
requirements that meet the standards in paragraph (b)(1) of this
section; or
(3) Meet the requirements for a clinical nurse specialist set forth
in paragraph (b)(1) of this section, except for the master's degree
requirement, and have received before [Insert 3 years from effective
date of final rule] a certificate of completion from a formal advanced
practice program that prepares registered nurses to perform an expanded
role in the delivery of primary care.
(c) Services. Medicare Part B covers clinical nurse specialist
services in all settings in both rural and urban areas only if the
services would be covered if furnished by a physician and the clinical
nurse specialist--
(1) Is legally authorized to perform them in the State in which
they are performed; and
(2) Performs them while working in collaboration with a physician.
(i) Collaboration is a process in which a clinical nurse specialist
works with a physician to deliver health care services within the scope
of the clinical nurse specialist's expertise, with medical direction
and appropriate supervision as provided for in guidelines jointly
developed by the clinical nurse specialist and the physician, or as
provided for by other mechanisms defined by Federal regulations, or by
the law of the State in which the services are performed.
(ii) The absence of State law or guidelines does not negate the
requirement for collaboration.
(iii) The collaborating physician does not need to be present with
the clinical nurse specialist when the service is furnished or to make
an independent evaluation of each patient seen by the clinical nurse
specialist.
(iv) Collaboration involves systematic formal planning, assessment,
and a practice arrangement that reflects and demonstrates evidence of
consultation, recognition of statutory limits, clinical authority and
accountability for patient care, according to a mutual agreement that
allows the physician and the clinical nurse specialist to function
independently as appropriate; and
(3) Is not performing services that are otherwise precluded from
coverage by one of the statutory exclusions.
(d) Services and supplies incident to clinical nurse specialist
services. Medicare Part B covers services and supplies (including drugs
and biologicals that cannot be self-administered) incident to a
clinical nurse specialist's services that meet the requirements in
paragraph (c) of this section. These services and supplies are covered
only if they--
(1) Would be covered if furnished by a physician or as incident to
the professional services of a physician;
(2) Are of the type that are commonly furnished in a physician
office and are either furnished without charge or are included in the
bill for the clinical nurse specialist services;
(3) Although incidental, are an integral part of the professional
service performed by the clinical nurse specialist; and
(4) Are performed under the direct supervision of the clinical
nurse specialist (that is, the clinical nurse specialist must be
physically present and immediately available).
(e) Professional services. Clinical nurse specialists can be paid
for professional services only when the services have been personally
performed by them and no facility or other provider charges or is paid
any amount for the furnishing of such professional services.
(1) Supervision of other nonphysician staff by clinical nurse
specialists does not constitute personal performance of a professional
service by clinical nurse specialists.
(2) If a service is not payable by HCFA under this provision, the
beneficiary is not liable for payment for the service. Clinical nurse
specialists may not charge a beneficiary for a service not payable
under this provision. If a beneficiary has made payment for the
services, the clinical nurse specialist must make the appropriate
refund to the beneficiary.
(3) Examples of the types of professional services that clinical
nurse specialists may provide include services such as physical
examinations, minor surgery, setting casts for simple fractures,
interpreting x-rays, and other activities that involve an independent
evaluation or treatment of the patient's condition. These are services
that have been traditionally reserved for physicians and can only be
furnished by clinical nurse specialists if State law or regulation
governing the clinical nurse specialist scope of practice authorizes
them to perform such services in the State in which they are
practicing.
Sec. 410.77 Certified nurse-midwife services: Qualifications and
conditions.
(a) Qualifications. For Medicare coverage of his or her services, a
certified nurse-midwife must--
(1) Be currently licensed to practice in the State as a registered
professional nurse;
(2) Be legally authorized under State law or regulations to
practice as a nurse-midwife in the State in which the services are
performed;
(3) Have successfully completed a program of study and clinical
experience for nurse-midwives, as specified by the State, or, if the
State does not specify a program of study and clinical experience that
nurse-midwives must complete to practice in that State, meet one of the
following criteria:
(i) Be currently certified as a nurse-midwife by the American
College of Nurse-Midwives, in accordance with its October 1994
requirements or subsequent amendments to those requirements recognized
by the Secretary, or by another certifying entity recognized by the
Secretary.
(ii) Have successfully completed a formal educational program (of
at least 1 academic year) that, upon completion, qualifies him or her
to take the certification examination offered by the American College
of Nurse-Midwives or by another certifying entity recognized by the
Secretary. (The individual is not required to take the examination,
however.)
(iii) Have successfully completed a formal educational program for
preparing registered nurses to furnish gynecological and obstetrical
care during pregnancy, delivery, and the postpartum period and care to
normal newborns, and practiced as a nurse-midwife for a total of 12
months during any 18-month period from August 8, 1976 to July 16, 1982.
(b) Services. Certified nurse-midwife services are services
furnished by a certified nurse-midwife and services and supplies
furnished as an incident to the certified nurse-midwife services that--
[[Page 30883]]
(1) Are within the scope of practice authorized by the law of the
State in which they are furnished and would otherwise be covered if
furnished by a physician or as an incident to a physician service; and
(2) Unless required by State law, are provided without regard to
whether the certified nurse-midwife is under the supervision of, or
associated with, a physician or other health care provider.
(c) Incident to services: Basic rule. Medicare covers services and
supplies furnished incident to the services of a certified nurse-
midwife, including drugs and biologicals that cannot be self-
administered, if the services and supplies meet the following
conditions:
(1) They would be covered if furnished by a physician or as
incident to the professional services of a physician.
(2) They are of the type that are commonly furnished in a physician
office and are either furnished without charge or are included in the
bill for the certified nurse-midwife services.
(3) Although incidental, they are an integral part of the
professional service performed by the certified nurse-midwife.
(4) They are furnished under the direct supervision of a certified
nurse-midwife (that is, the midwife is physically present and
immediately available).
(d) Professional services. A nurse-midwife can be paid for a
professional service only when the service has been personally
performed by the nurse-midwife.
(1) Supervision of other nonphysician staff by a nurse-midwife does
not constitute personal performance of a professional service by the
nurse-midwife.
(2) If a service is not payable by HCFA under this provision, the
beneficiary is not liable for payment for the service. A nurse-midwife
may not charge a beneficiary for a service not payable under this
provision. If the beneficiary has made payment for the service, the
nurse-midwife must make the appropriate refund to the beneficiary.
(3) A nurse-midwife may provide services related to the maternity
cycle that includes pregnancy, labor, and the immediate post partum
period and other services including obstetrical and gynecological
services.
(4) The services that the nurse-midwife performs are not services
otherwise precluded from coverage because of one of the statutory
exclusions.
7. In Sec. 410.150, the introductory text to paragraph (b) is
republished, and new paragraphs (b)(15) and (b)(16) are added to read
as follows:
Sec. 410.150 To whom payment is made.
* * * * *
(b) Specific rules. Subject to the conditions set forth in
paragraph (a) of this section, Medicare Part B pays as follows:
* * * * *
(15) To the qualified employer of a physician assistant for
professional services furnished by the physician assistant and for
services and supplies furnished incident to their services. Payment is
made to the employer of a physician assistant regardless of whether the
physician assistant is employed as a W-2 employee or whether the
physician assistant is a 1099 employee who is acting as an independent
contractor. A qualified employer is not a group of physician assistants
that incorporate to bill for their services. Payment is made only if no
facility or other provider charges or is paid any amount for services
furnished by a physician assistant.
(16) To a nurse practitioner or clinical nurse specialist for
professional services furnished by a nurse practitioner or clinical
nurse specialist in all settings in both rural and nonrural areas and
for services and supplies furnished incident to those services. Payment
is made only if no facility or other provider charges or is paid any
amount for the furnishing of the professional services of the nurse
practitioner or clinical nurse specialist.
8. In Sec. 410.152, the headings to paragraphs (a) and (a)(1) are
republished, and paragraph (a)(1)(v) is revised to read as follows:
Sec. 410.152 Amount of payment.
(a) General provisions--(1) Exclusion from incurred expenses. * * *
(v) In the case of expenses incurred for outpatient physical
therapy services including speech-language pathology services, the
expenses excluded are from the incurred expenses under Sec. 410.60(e).
In the case of expenses incurred for outpatient occupational therapy
including speech-language pathology services, the expenses excluded are
from the incurred expenses under Sec. 410.59(e).
* * * * *
PART 413--PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR
END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED
PAYMENT RATES FOR SKILLED NURSING FACILITIES
c. Part 413 is amended as set forth below.
1. The authority citation for part 413 continues to read as
follows:
Authority: Secs. 1102, 1861(v)(1)(A), and 1871 of the Social
Security Act (42 U.S.C. 1302, 1395x(v)(1)(A), and 1395hh).
2. Section 413.125 is revised to read as follows:
Sec. 413.125 Payment for home health agency services.
The reasonable cost of outpatient rehabilitation services furnished
by a home health agency to homebound patients who are not entitled to
home health benefits may not exceed the amounts payable under part 414
of this chapter for comparable services.
PART 414--PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES
C. Part 414 is amended as set forth below:
1. The authority citation for part 414 continues to read as
follows:
Authority: Secs. 1102, 1871, and 1881(b)(1) of the Social
Security Act (42 U.S.C. 1302, 1395hh, and 1395rr(b)(1)).
2. In Sec. 414.1, the introductory text is republished, and the
following statutory authority is added in numerical order to read as
follows:
Sec. 414.1 Basis and scope.
This part implements the indicated provisions of the following
sections of the Act:
1802--Rules for private contracts by Medicare beneficiaries.
* * * * *
3. Sections 414.20 through 414.62 are redesignated as subpart B,
and a new heading is added to read ``Physicians and Other
Practitioners''.
4. In Sec. 414.22, the introductory text to the section and the
heading to paragraph (b) are republished, and new paragraph (b)(5) is
added to read as follows:
Sec. 414.22 Relative value units (RVUs).
HCFA establishes RVUs for physician work, physician practice
expense, and malpractice insurance.
* * * * *
(b) Practice expense RVUs. * * *
[[Page 30884]]
(5) For services furnished in 1999, the practice expense RVUs are
based on 75 percent of the practice expense RVUs applicable to services
furnished in 1998 and 25 percent of the relative practice expense
resources involved in furnishing the service. For services furnished in
2000, the practice expense RVUs are based on 50 percent of the practice
expense RVUs applicable to services furnished in 1998 and 50 percent of
the relative practice expense resources involved in furnishing the
service. For services furnished in 2001, the practice expense RVUs are
based on 25 percent of the practice expense RVUs applicable to services
furnished in 1998 and 75 percent of the relative practice expense
resources involved in furnishing the service. For services furnished in
2002 and subsequent years, the practice expense RVUs are based entirely
on relative practice expense resources.
(i) Usually one of two levels of practice expense RVUs per code can
be applied to each service. The lower practice expense RVUs apply to
services furnished to hospital or ambulatory surgical center patients.
The higher practice expense RVUs apply to services performed in a
physician office; services, other than evaluation and management
services, furnished to patients in a nursing facility, in a facility or
institution other than a hospital or ambulatory surgical center, or in
the home; and other services furnished to facility patients for which
the facility payment does not include physician practice costs.
(ii) Only one practice expense RVU per code can be applied for each
of the following services: services that have only technical component
practice expense RVUs or only professional component practice expense
RVUs; evaluation and management services, such as hospital or nursing
facility visits, that are furnished exclusively in one setting; and
major surgical services.
* * * * *
6. In Sec. 414.32, paragraph (b) is revised to read as follows:
Sec. 414.32 Determining payments for certain physician services
furnished in facility settings.
* * * * *
(b) General rule. If physician services of the type routinely
furnished in physician offices are furnished in facility settings
before January 1, 1999, the physician fee schedule amount for those
services is determined by reducing the practice expense RVUs for the
services by 50 percent. For services furnished on or after January 1,
1999, the practice expense RVUs are determined in accordance with
Sec. 414.22(b)(5).
* * * * *
7. In Sec. 414.34, the section heading is revised, and a new
paragraph (a)(2)(iii) is added to read as follows:
Sec. 414.34 Payment for services and supplies incident to a physician
service.
* * * * *
(a) Medical supplies. * * *
(2) * * *
(iii) It is furnished before January 1, 1999.
* * * * *
8. In Sec. 414.52, the section heading and the introductory text
are revised, and a new paragraph (d) is added to read as follows:
Sec. 414.52 Payment for physician assistant services.
Allowed amounts for the services of a physician assistant furnished
beginning January 1, 1992 and ending December 31, 1997, may not exceed
the limits specified in paragraphs (a) through (c) of this section.
Allowed amounts for the services of a physician assistant furnished
beginning January 1, 1998, may not exceed the limits specified in
paragraph (d) of this section.
* * * * *
(d) For services (other than assistant-at-surgery services)
furnished beginning January 1, 1998, 85 percent of the physician fee
schedule amount for the service. For assistant-at-surgery services, 85
percent of the physician fee schedule amount that would be allowed
under the physician fee schedule if the assistant-at-surgery services
were furnished by a physician.
9. Section 414.56 is revised to read as follows:
Sec. 414.56 Payment for nurse practitioner and clinical nurse
specialist services.
(a) Rural areas. For services furnished beginning January 1, 1992
and ending December 31, 1997, allowed amounts for the services of a
nurse practitioner or a clinical nurse specialist in a rural area (as
described in section 1861(s)(2)(K)(iii) of the Act) may not exceed the
following limits.
(1) for services furnished in a hospital (including assistant-at-
surgery services), 75 percent of the physician fee schedule amount for
the service.
(2) For all other services, 85 percent of the physician fee
schedule amount for the service.
(b) Non-rural areas. For services furnished beginning January 1,
1992 and ending December 31, 1997, allowed amounts for the services of
a nurse practitioner or a clinical nurse specialist in a nursing
facility may not exceed 85 percent of the physician fee schedule amount
for the service.
(c) Beginning January 1, 1998. For services (other than assistant
at surgery services) furnished beginning January 1, 1998, allowed
amounts for the services of a nurse practitioner or clinical nurse
specialist may not exceed 85 percent of the physician fee schedule
amount for the service. For assistant at surgery services, allowed
amounts for the services of a nurse practitioner or clinical nurse
specialist may not exceed 85 percent of the physician fee schedule
amount that would be allowed under the physician fee schedule if the
assistant at surgery service were furnished by a physician.
PART 415--SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS,
SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN
CERTAIN SETTINGS
D. Part 415 is amended as set forth below:
1. The authority citation for part 415 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (41
U.S.C. 1302 and 1395hh).
2. In Sec. 415.110, the section heading is revised, paragraph (a)
is revised, paragraph (b) is redesignated as paragraph (c), and a new
paragraph (b) is added to read as follows:
Sec. 415.110 Conditions for payment: Medically directed anesthesia
services.
(a) General payment rule. The Medicare carrier pays for the
physician's medical direction of anesthesia services for one service or
two through four concurrent anesthesia services furnished after
December 31, 1998, only if each of the services meets the condition in
Sec. 415.102(a) and the following additional conditions:
(1) For each patient, the physician--
(i) Performs a pre-anesthetic examination and evaluation, or
reviews one performed by another qualified individual permitted by the
State to administer anesthetics;
(ii) Participates in the development of the anesthesia plan and
gives final approval of the proposed plan;
(iii) Personally participates in the most demanding aspects of the
anesthesia plan;
(iv) Ensures that any aspect of the anesthesia plan not performed
by the anesthesiologist is performed by a qualified individual as
specified in operating instructions;
(v) Monitors the course of anesthesia at intervals medically
indicated by the nature of the procedure and the patient's condition;
[[Page 30885]]
(vi) Remains physically present in the facility and immediately
available for diagnostic and therapeutic emergencies;
(vii) Provides indicated post-anesthesia care or ensures that it is
provided by a qualified individual as described in paragraph (a)(1)(iv)
of this section.
(2) The physician directs no more than four anesthesia services
concurrently and does not perform any other services while he or she is
directing the single or concurrent services so that one or more of the
conditions in paragraph (a)(1) of this section are not violated.
(3) If the physician personally performs the anesthesia service,
the payment rules in Sec. 414.46(c) of this chapter (Physician
personally performs the anesthesia procedure) apply.
(b) Medical documentation. The physician inclusively documents in
the patient's medical record that the conditions set forth in paragraph
(a)(1) of this section have been satisfied, specifically documenting
personal participation in the most demanding aspects of the anesthesia
plan.
* * * * *
PART 424--CONDITIONS FOR MEDICARE PAYMENT
E. Part 424 is amended as set forth below:
1. The authority citation for part 424 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (41
U.S.C. 1302 and 1395hh).
2. In Sec. 424.24, paragraphs (c)(1)(iii), (c)(3)(ii), and (c)(4)
are revised to read as follows:
Sec. 424.24 Requirements for medical and other health services
furnished by providers under Medicare Part B.
* * * * *
(c) Outpatient physical therapy and speech-language pathology
services--(1) Content of certification. * * *
(iii) The services were furnished under a plan of treatment that
meets the requirements of Sec. 410.61.
* * * * *
(3) Signature. * * *
(ii) If the plan of treatment is established by a physical
therapist or speech-language pathologist, the certification must be
signed by a physician who has knowledge of the case.
(4) Recertification--(i) Timing. The first recertification is
required by no later than the 62nd day and subsequent recertifications
are required at least every 31 days.
(ii) Content. The recertification statement must indicate the
continuing need for physical therapy or speech-language pathology
services and an estimate of how much longer the services will be
needed.
(iii) Signature. Recertifications must be signed by the physician
who reviews the plan of treatment.
* * * * *
PART 485--CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS
F. Part 485 is amended as set forth below:
1. The authority citation for part 485 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (41
U.S.C. 1302 and 1395hh).
2. Section 485.705 is revised to read as follows:
Sec. 485.705 Personnel qualifications.
(a) General qualification requirements. Except as specified in
paragraphs (b) and (c) of this section, all personnel who are involved
in the furnishing of outpatient physical therapy, occupational therapy,
and speech-language pathology services directly by or under
arrangements with an organization must be legally authorized (licensed
or, if applicable, certified or registered) to practice by the State in
which he or she performs the functions or actions, and must act only
within the scope of his or her state license or State certification or
registration.
(b) Exception for Federally defined qualifications. The following
Federally defined qualifications must be met:
(1) For a physician, the qualifications and conditions as defined
in section 1861(r) of the Act and the requirements in part 484 of this
chapter.
(2) For a speech-language pathologist, the qualifications specified
in section 1861(11)(1) of the Act and the requirements in part 484.
(c) Exceptions when no State Licensing laws or State certification
or registration requirements exist. If no State licensing laws or State
certification or registration requirements exist for the profession,
the following requirements must be met:
(1) An administrator is a person who has a bachelor's degree and:
(i) Has experience or specialized training in the administration of
health institutions or agencies; or
(ii) Is qualified and has experience in one of the professional
health disciplines.
(2) An occupational therapist must meet the requirements in part
484.
(3) An occupational therapy assistant must meet the requirements in
part 484.
(4) A physical therapist must meet the requirements in part 484.
(5) A physical therapist assistant must meet the requirements in
part 484.
(6) A social worker must meet the requirements in part 484.
(7) A vocational specialist is a person who has a baccalaureate
degree and:
(i) Two years experience in vocational counseling in a
rehabilitation setting such as a sheltered workshop, State employment
service agency, etc.; or
(ii) At least 18 semester hours in vocational rehabilitation,
educational or vocational guidance, psychology, social work, special
education or personnel administration, and 1 year of experience in
vocational counseling in a rehabilitation setting; or
(iii) A master's degree in vocational counseling.
3. In Sec. 485.711, paragraph (b)(3) is revised to read as follows:
Sec. 485.711 Conditions of participation: Plan of care and physician
involvement.
* * * * *
(b) * * *
(3) The plan of care and results of treatment are reviewed by the
physician or by the individual who established the plan at least as
often as the patient's condition requires, and the indicated action is
taken. (For Medicare patients, the plan must be reviewed by a physician
within the first 62 days and at least every 31 days thereafter, in
accordance with Sec. 410.61(e) of this chapter.)
* * * * *
(Catalog of Federal Domestic Assistance Program No. 93.774,
Medicare--Supplementary Medical Insurance Program)
Dated: May 15, 1998.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.
Dated: May 21, 1998.
Donna E. Shalala,
Secretary.
Note: The following addendums will not appear in the Code of
Federal Regulations.
Addendum A--Description of Clinical Practice Expert Panel Data and
Methodology
To aid us in collecting the data to implement our methodology for a
resource-based system for determining practice expense RVUs for each
physician service, we awarded a contract to Abt Associates in March
1995. Under the contract, Abt used Clinical Practice Expert Panels
(CPEPs)
[[Page 30886]]
to collect data that could be used to generate direct practice expense
RVUs for each service. Through the use of CPEPs, Abt furnished us with
the direct inputs of physician services. Direct inputs are the quantity
and type of nonphysician labor, medical supplies, and medical equipment
associated with a service, such as the minutes of a registered nurse's
time, a pair of sterile gloves, and a surgical mask. The CPEPs also
reported additional items as direct inputs, such as administrative
services, including the amount of time medical secretaries and billing
and insurance personnel spend in activities related to specific
services. Abt priced the direct inputs and determined the direct costs
for each service.
The direct inputs do not include the physician's time. Physician
time and effort are components of work RVUs and are paid under the work
component of the physician fee schedule.
The general approach for establishing a resource-based practice
expense system was to use CPEPs to identify as many direct inputs as
possible for a physician service furnished to a typical patient (across
all age groups) in various settings.
The CPEPs consisted of panels of physicians, practice
administrators, and nonphysicians (such as registered nurses,
psychologists, and physical therapists). Physician specialty societies
and other groups nominated individuals for these positions. Final
selections were made by Abt with our assistance.
In all, there were 15 CPEPs. The panels consisted of over 180
members from more than 61 specialties and subspecialties; approximately
50 percent of the panelists were physicians. Each CPEP consisted of 12
to 15 members.
The CPEPs identified the direct inputs involved in each physician
service in an office setting and an out-of-office setting (such as a
hospital and an ambulatory surgical center). Generally, if a service
was furnished both in an office setting and an out-of-office setting
but less than 10 percent of the time in either of these settings, it
was not profiled in that setting.
We assisted Abt in identifying approximately 6,300 procedure codes
for which resource-based practice expense RVUs were to be developed.
Approximately 850 of these procedure codes have both technical
components (TCs) and professional components (PCs), and we developed
practice expense RVUs for both the TC and PC for each of the 850
procedures.
Abt grouped procedure codes included under the physician fee
schedule into families of codes clinically related and with relatively
comparable direct costs. The classification system for families of
procedure codes is a hybrid of the Ambulatory Patient Groups System
developed by 3M and the Berenson-Eggers-Holahan (Urban Institute)
system. Abt assigned each family of codes to a CPEP based on the
physician specialty that predominantly furnished the services. For
example, the panels were categorized as integumentary, male genital and
urinary, orthopedics, obstetrics and gynecology, ophthalmology,
radiology, evaluation and management, general surgery, otolaryngology,
miscellaneous internal medicine, gastroenterology, cardiothoracic and
vascular, cardiology, anesthesia and pathology, and neurosurgery CPEPs.
Our medical staff, Abt's clinical consultants, and other advisors
reviewed this system. Some families of codes were assigned to more than
one CPEP to validate resource inputs across CPEPs. For example, the
evaluation and management family of codes was assigned to every CPEP
except the radiology CPEP and the anesthesia and pathology CPEP.
Abt selected a reference service for each family of codes. (Abt
compiled the initial list of reference services based on
recommendations from numerous specialty societies.) The following four
criteria were established to guide the selection process for the
reference service:
It had to be commonly performed.
It had to have a mid-range level of resource use relative
to other codes in the family.
It had to be a code whose definition or coding application
has not markedly changed in the last several years.
It had to be performed with minimal variation by all
physicians.
In August 1995, physician specialty groups were given an
opportunity to review and comment on a draft document containing the
procedure code family classification system, the reference code (to
serve as a benchmark for creating resource profiles for the remainder
of services within each family of procedure codes), and the CPEP to
which the family was assigned. The comments were considered by Abt and
HCFA in designing the final classification system including the number
of CPEPs.
The final classification system contained 229 unique families of
codes assigned to 15 CPEP panels. Twelve to 29 families of procedure
codes were assigned to each CPEP with most CPEPs reviewing 19 to 23
families of procedure codes.
The CPEPs met twice. During the first CPEP session in February
1996, the CPEPs identified the direct inputs for designated reference
services. The CPEPs met again in June 1996 to identify the inputs for
the remaining procedure codes covered under the physician fee schedule.
a. Collection of Information From the Clinical Practice Expert Panels
Abt designed the following four uniform worksheets that were used
to collect the inputs identified by the CPEPs:
Worksheet Package G: Services with a global period.
Worksheet Package P: Services without a global period.
Worksheet Package M: Evaluation and Management services.
Worksheet Package Pa: Pathology services.
For labor inputs, either clinical or administrative, the worksheets
identified the function or activity with the occupational category of
the individual furnishing the service. For clinical functions, examples
of occupational categories included a registered nurse, licensed
practical nurse, and certified medical assistant. For administrative
functions, examples of occupational categories included medical
secretaries, insurance or billing clerks, transcriptionists, and
scheduling secretaries. The clinical labor worksheets accumulated labor
inputs by preservice, service, and postservice periods for surgical
procedures with a global period. For surgical procedures without a
global period, evaluation and management services, and pathology
services, the worksheets accumulated labor inputs by the service
period. The administrative labor worksheets collected labor inputs by
preservice and postservice periods.
During the first round of the CPEPs, Abt collected detailed data by
each of the functions listed within the preservice, service, and
postsurgical visit periods of each service. These were activities
performed by nonphysician clinical and administrative personnel, not
physicians. For example, the evaluation and management services
worksheet listed the following clinical activities in the preservice
period:
Obtain medical history/review patient charts.
Greet patient/provide gowning.
Perform room preparation/prepare medical equipment.
Prepare patient.
Obtain vital signs.
Other.
[[Page 30887]]
Similarly, the following administrative activities were listed in
the preservice period:
Obtain referral from referring M.D.
Schedule patient/remind patient of appointment.
Obtain medical records, manage/recall patient database,
assemble/develop patient chart.
Precertify patient/conduct preservice billing.
Verify insurance/review coverage/register patient.
For the intraservice period, the following clinical activities were
listed:
Obtain medical history.
Record notes.
Other.
The following clinical activities were listed in the postservice
period:
Clean room/equipment/shut down equipment.
Provide postservice education.
Complete diagnostic medical forms, x-ray requisitions,
prescriptions.
Review results.
Checkout/provide discharge instructions/complete nursing
forms.
Conduct follow-up phone calls to patient/respond to
patient calls/call-in prescription refills.
Other.
Similarly the following administrative activities were listed in
the postservice period:
Transcribe results/file and manage patient records.
Schedule postoperative return evaluation and management
services/arrange for hospital readmission.
Notify and complete reports to referring MDs.
Conduct billing activities (coordinate bill collection/
rebilling, collect coinsurance payments or deductibles, postcertify
patient).
During the second round of the CPEPs, Abt collected the inputs by
the broader category of service. For example, for additional evaluation
and management services codes in the same family as the reference code,
Abt collected totals on clinical times for the preservice period, the
intraservice period, and the postservice period. Similarly, the same
process was followed for administrative inputs. This less detailed,
more aggregated, process was used because of the large volume of
procedure codes the CPEPs had to review during the second round and
because the CPEPs believed this level of detail was sufficient.
b. Pricing of Clinical Practice Expert Panels' Direct Inputs
Having identified the type and quantity of direct inputs from the
CPEP process, our methodology required the assignment of a national
price for each resource input. Abt priced each of the CPEP direct
inputs (nonphysician labor, medical supplies, and medical equipment)
using a specific methodology. The methodology for each of these items
is discussed below.
(1) Nonphysician Labor
Abt calculated the total compensation per minute for approximately
100 occupational categories that include clinical and administrative
staff. The data sources for these staff identified hourly wages,
including fringe benefits, per person for 1993 or 1994. These wages
were updated to 1995 using the Employment Cost Index for Wages and
Salaries in Private Health Industries (published by the Bureau of Labor
Statistics). They were converted to total compensation by adjusting the
wage rate by a fringe benefits multiplier. The fringe benefits
multiplier is 36.6 percent for all occupational categories. This is
estimated from the Bureau of Labor Statistics Employer Costs for
Employee Compensation for March 1995. Abt calculated the fringe benefit
multiplied from the Bureau of Labor Statistics data using the ratio of
the total cost of all benefits to the wage rate for all workers in
private health services industries.
Three specific data sources were used. They were: (1) The Bureau of
Labor Statistics' ``White Collar Pay Survey of Service-Producing
Industries'' dated 1989 and the ``Occupational Compensation Survey''
dated 1994; (2) ``The Survey of Hospital and Medical School Salaries''
dated 1994 performed by the University of Texas Medical Branch; and (3)
the Current Population Survey dated 1993. Although all three data
sources were used, in cases of similar categories across data sets, the
Bureau of Labor Statistics data were considered to be the primary data
set. The University of Texas Medical Branch and Current Population
Survey data were treated as supplements to be used when the Bureau of
Labor Statistics' data could not furnish sufficient detail.
Abt categorized all personnel into five broad categories: clinical
staff, administrative staff, clinical composite staff, administrative
composite staff, and clinical/administrative composite staff. The
administrative composite staff refers, for example, to a function
described by a CPEP that could be performed by different personnel. A
composite labor rate was calculated for this function for this CPEP.
We use the occupational category of the medical secretary to
illustrate the mapping of the price for an administrative staff
position. Every CPEP reported that a medical secretary performed
certain functions as part of the procedure codes reviewed by that CPEP.
From the Bureau of Labor Statistics' data, the updated 1995 total
compensation, including fringe benefits, for a level II medical
secretary is $16.43 per hour. (The Bureau of Labor Statistics furnishes
skilled level variations in wages and duties for registered nurses,
licensed practical nurses, secretaries, office clerks, and nursing
assistants. In general, as we advised, Abt used the Bureau of Labor
Statistics' wage for level II staff.) This converts to a total
compensation per minute of $0.274 for a medical secretary, and this
labor rate was made uniform across all CPEPs. If, for example, a CPEP
specified that a medical secretary was needed for 10 minutes to provide
administrative services for a specific CPT code, that labor input would
be costed at $2.74.
Similarly, we use the occupational category of a registered nurse
to illustrate the mapping of the price for a clinical staff position.
Every CPEP, except the gastroenterology CPEP, reported that a
registered nurse performed certain functions with respect to the
procedure codes reviewed by that CPEP. The hourly wage for a level II
registered nurse was $18.52 under the Bureau of Labor Statistics'
survey. The total compensation, including fringe benefits, for a
registered nurse is $25.30 per hour. This converts to a total
compensation per minute of $0.422. Thus, for each CPEP, the minutes of
a registered nurse's time are costed at $0.422. If, for example, a CPEP
specified that a registered nurse was needed for 10 minutes to provide
clinical services for a specific CPT code for a patient, that direct
input would be costed at $4.22.
(2) Medical Supplies
Overall, the CPEPs identified 665 supply items for which Abt
obtained prices from three types of sources:
Published catalogs--These were used for the most common
supplies and CPEP panelists often provided recommendations of catalogs
or other sources.
Contacts with suppliers--This source was used primarily
for specialized supplies.
CPEP members--This source was used if prices were
unavailable from catalogs or suppliers.
Examples of medical supplies include disposable gowns, examination
table paper, disposable pillow cases, nonsterile or sterile gloves,
disposable suture removal kit, Vicryl suture, 4-0 and 5-0, and sterile
gauze. Abt used the same prices for these supplies across all CPEPs.
For example, for all CPEPs, the
[[Page 30888]]
price of the disposable gown is $0.57 per item and is based on a
representative price from Baxter Healthcare Corporation, a major
medical supplier. Similarly, the price of the disposable suture removal
kit for all CPEPs is $5.45 per kit and is based on a representative
price from Darby Drug Company.
(3) Medical Equipment
Medical equipment was divided into two categories--procedure-
specific equipment and overhead equipment. Procedure-specific medical
equipment is used for a specific subset of services within a specialty,
such as a stress-test treadmill as part of a cardiology procedure.
Overhead medical equipment is either used for all services furnished or
is rarely used (for example, a crash cart containing emergency
supplies) but is routinely purchased and maintained in a practice and
is difficult to attribute to a specific service. Only equipment with
costs equal to or exceeding $500 was costed under the medical equipment
methodology. The cost per use for equipment costing less than $500 was
considered to be trivial.
Information about the type of equipment used to furnish each
service was obtained from the CPEPs. Abt applied price data to the
resource profiles generated by the CPEPs. In most cases, Abt collected
list prices from equipment suppliers. For example, the list price for a
flexible laryngoscope is $5,080 (this information is from Welch-Allyn,
a medical equipment supplier). Prices were obtained for almost 400
equipment items.
To cost procedure-specific and overhead equipment, Abt assumed 70-
percent and 100-percent utilization rates, respectively. Based on
comments from the physician specialty groups, we have changed the
utilization level for procedure-specific equipment from 70 percent to
50 percent.
Procedure-specific equipment was costed based on the number of
minutes the equipment was used for the procedure. The proxy for this is
usually technician time. Overhead equipment was costed based on the
estimated time for the staff with the most involvement in the
procedure. For example, if a procedure involving a piece of equipment
was performed in the office and involved 15 minutes of registered nurse
time and 30 minutes of physician assistant time, the time of the
procedure would be 30 minutes since this is the longest of the
nonphysician clinical staff times.
The objective in pricing medical equipment was to establish an
equipment cost per minute. The equipment pricing model uses the
following variables:
The purchase price of the equipment with primary sources
of information from national manufacturers.
The useful life of the equipment with primary sources of
information from ``Useful Life Guidelines'' from the American Hospital
Association.
The annual maintenance cost with primary sources of
information from the Medical Group Management Association.
The cost of capital.
The time per procedure with primary sources of information
from CPEP labor estimates.
The hours of practice (that is, 50 hours per week and 50
weeks per year) with primary sources of information from the Medical
Group Management Association and the AMA.
The machine capacity, based on a practice's hours, with
the assumption that the equipment operates at a fixed percentage (in
this case 50 percent) of capacity.
Ideally, a cost of capital would be established from a nationally
representative sample of data containing loan rates and length of loan
for physician practices. Such data do not exist. As a result, Abt
developed proxy data based on prevailing loan rates for small
businesses. In this model, interest rates varied by the loan period
(one rate for periods less than or equal to 7 years and another for
periods greater than 7 years) and based on the purchase price of the
equipment (one rate for equipment costing less than or equal to $25,000
and another for equipment costing more than $25,000).
------------------------------------------------------------------------
Interest rate (percent)
--------------------------
Amount Loan period
7 Loan period
years >7 Years
------------------------------------------------------------------------
>$25,000..................................... 9.5 10.
$25,000........................... 10.5 11
------------------------------------------------------------------------
For example, the cost of capital for an item of medical equipment
costing more than $25,000 and with a useful life less than 7 years was
assigned an interest rate of 9.5 percent.
The following example illustrates the application of the pricing
model for equipment that is used to perform only one type of procedure
code, assuming the following:
The equipment is operated at 50 percent of capacity.
The practice operates 50 hours per week or 105,000 minutes
per year (60 minutes/hour x 50 hours/week x 50 weeks/year x .50=75,000
minutes).
The cost of capital (that is, the interest cost of a loan
or opportunity cost of invested funds is 9.5 percent).
The purchase price of the equipment is $30,000.
The useful life of the equipment is 5 years.
The annual maintenance costs are 5 percent of the annual
purchase price (.05 x $30,000) or $1,500.
The procedure performed on the equipment takes 10 minutes.
Cost per procedure=10 x [$30,000/(75,000 x 3.8397)+1,500/75,000]
Cost per procedure=$1.24
Note: 3.38397 represents 1/(1+r)t where t=0
to 5. The cost of capital is discounted by the number of years of
useful life. The annualized capitalized cost for the equipment is
$9,313, which is the annual maintenance cost of $1,500, plus the
annualized purchase price ($7,813), taking into account the
opportunity cost of capital or $30,000 divided by 3.8397.
Addendum B. Resource Based Practice Expense Methodology and Example
Step 1: By specialty, use the American Medical Association's
Socioeconomic Monitoring Survey actual cost data for 1995-1997 (SMS
data) to determine practice expenses per hour by cost category.
Methodology
(1) Derive the expenses at the physician practice level using the
SMS data by cost category. The cost categories are:
(a) total non-physician payroll expenses, which are payroll
expenses (including fringe benefits) for non-physician personnel;
(b) administrative payroll expenses, which are payroll expenses
(including fringe benefits) for non-physician personnel involved in
administrative, secretarial, or clerical activities;
(c) office expenses, which include expenses for rent, mortgage
interest, depreciation on medical buildings, utilities, and telephone;
(d) medical material and supply expenses, which include expenses
for drugs, x-ray films, and disposable medical products;
(e) medical equipment expenses, which include expenses for
depreciation, leases, and rent of medical equipment used in the
diagnosis or treatment of patients;
(f) all other expenses, which include expenses for legal services,
accounting services, office management services, professional
association memberships, journals and continuing education,
professional car upkeep and depreciation, and any professional expenses
not mentioned above.
[[Page 30889]]
We refer to the difference between the total nonphysician payroll
expense category and the clerical payroll expense category as the
clinical payroll expense category.
(2) Derive the number of hours spent in patient care activities by
physicians in the practice.
(3) Divide the expenses at the practice level by the number of
hours spent in patient care activities by the physicians in the
practice.
Derivations
[GRAPHIC] [TIFF OMITTED] TP05JN98.000
i,j = respondent physician i of specialty j
pei,j,x = category x practice expenses for respondent i of
specialty j
oi,j = number of physician owners in the practice of
respondent i of specialty j
rhi,j = number of hours worked in patient care activities
during the year by respondent i of specialty j
ei,j = number of employee physicians in the practice of
respondent i of specialty j
ehj = average number of hours worked in patient care
activities for employee physician's in specialty j
wi,j= SMS weight for respondent i of specialty j to correct
for potential nonresponse bias
Step 2: By specialty, determine the number of physician hours spent
treating Medicare patients as reflected in the Medicare claims data.
Methodology
By specialty, determine the number of physician hours reflected in
the Medicare physician fee schedule claims data as a weighted sum of
the physician time associated with each procedure code on the fee
schedule.
[GRAPHIC] [TIFF OMITTED] TP05JN98.001
K = procedure code performed by specialty j
tk = the physician time associated with procedure k, taken
primarily from the AMA Relative Value Update committee surveys (where
available) or surveys done for the initial establishment of the work
relative value units
fk,j = the frequency with which procedure code k is
performed on Medicare patients by the physicians in specialty j as
reflected in the Medicare allowed claims data
Step 3: By specialty, multiply the SMS practice expenses per hour
for each cost category (as calculated in Step 1) by the number of
physician hours reflected in the Medicare physician fee schedule claims
data (as calculated in Step 2).
Methodology
[GRAPHIC] [TIFF OMITTED] TP05JN98.002
calculated for each x from 1 to 4, with 1 = clinical payroll expense,
2 = medical materials and supplies expense, 3 = medical equipment
expense, 4 = a combined category of clerical payroll expense, office
expense, and all other expenses.
Step 4: For each specialty and cost category, allocate the practice
expense pool calculated in Step 3 to the procedures performed by that
specialty.
Methodology
(1) Clinical payroll expense, medical materials and supplies, and
medical equipment SMS pools.
The CPEP cost categories of clinical labor, medical supplies, and
medical equipment in the facility and nonfacility place of service
settings are used to allocate, respectively, the SMS cost category
pools for clinical payroll expense, medical materials and supplies, and
medical equipment.
[GRAPHIC] [TIFF OMITTED] TP05JN98.003
p = place of service where the procedure is performed with p=1 the
facility setting (eg hospital) and p=2 the nonfacility setting (eg
physician's office)
cpepx,k,p = CPEP costs for category x for procedure code k
in setting p (procedure codes costed in a setting as nonzero by more
than one CPEP are averaged)
fk,j,p = the frequency with which procedure code k was
performed in place of service p on Medicare patients by the physicians
in
[[Page 30890]]
specialty j as reflected in the Medicare allowed claims data
calculate for each x from 1 to 3
(2) Administrative payroll expense, office expense, and other
expense SMS pools.
A combination of the clinical payroll, medical materials and
supplies, and medical equipment code allocations calculated in (1) and
the physician fee schedule work relative value units are used to
allocate the combined SMS cost category pool for administrative payroll
expense, office expense, and other expense (category 4).
[GRAPHIC] [TIFF OMITTED] TP05JN98.004
wk = the work relative value units for procedure code k
s = factor to convert work relative value units to SMS category pool
dollars
Step 5: Weight average the allocations calculated in Step 4 to
account for procedure codes performed by more than one specialty.
Methodology
For procedure codes performed by only one specialty, use that
specialty's allocation. For procedure codes performed by more than one
specialty, take a weighted average of the allocations for the
specialties which perform the procedure, where the weight is the
frequency with which the procedure is performed by that specialty.
Practice expense pool allocation for category x to procedure code k
in place of service p = costsx,k,p =
[GRAPHIC] [TIFF OMITTED] TP05JN98.005
Step 6: From the allocations calculated in Step 5, create the new
practice expense relative units by place of service for each procedure
code.
Methodology
For each procedure code, multiply the sum of the allocations from
Step 5 for the four cost categories by the ratio of the available pool
of practice expense relative value units to the weighted sum of all the
procedure code allocations. Although not illustrated below, procedure
codes with professional and technical components were adjusted as
described earlier in this Federal Register notice to ensure that the
technical and professional components sum to the global for the
service. New practice expense relative value unit for procedure code k
in place of service p = rvunewk,p =
[GRAPHIC] [TIFF OMITTED] TP05JN98.006
Example
The following example is designed to illustrate the resource based
practice expense methodology described above. For simplicity, the
entire Medicare physician fee schedule universe is assumed to consist
of two specialties and six procedure codes. This example does not yield
the actual resource based practice expense relative value units found
in Addendum C for the six codes.
BILLING CODE 4120-03-P
[[Page 30891]]
[GRAPHIC] [TIFF OMITTED] TP05JN98.007
[[Page 30892]]
[GRAPHIC] [TIFF OMITTED] TP05JN98.008
[[Page 30893]]
[GRAPHIC] [TIFF OMITTED] TP05JN98.009
[[Page 30894]]
[GRAPHIC] [TIFF OMITTED] TP05JN98.010
[[Page 30895]]
[GRAPHIC] [TIFF OMITTED] TP05JN98.011
[[Page 30896]]
[GRAPHIC] [TIFF OMITTED] TP05JN98.012
[[Page 30897]]
[GRAPHIC] [TIFF OMITTED] TP05JN98.013
[[Page 30898]]
[GRAPHIC] [TIFF OMITTED] TP05JN98.014
[[Page 30899]]
[GRAPHIC] [TIFF OMITTED] TP05JN98.015
[[Page 30900]]
[GRAPHIC] [TIFF OMITTED] TP05JN98.016
[[Page 30901]]
[GRAPHIC] [TIFF OMITTED] TP05JN98.017
[[Page 30902]]
[GRAPHIC] [TIFF OMITTED] TP05JN98.018
BILLING CODE 4120-03-C
[[Page 30902]]
Addendum C.--Relative Value Units (RVUs) and Related Information
--------------------------------------------------------------------------------------------------------------------------------------------------------
Non-
Physician facility Facility Mal- Non-
CPT \1\/ MOD Status Description work RVUs practice practice practice facility Facility Global
HCPCS \3\ expense expense RVUs total total
\2\ RVUs RVUs
--------------------------------------------------------------------------------------------------------------------------------------------------------
10040... .................. A Acne surgery of skin 1.18 1.47 4.46 0.03 2.68 15.78 010
abscess.
10060... .................. A Drainage of skin abscess. 1.17 0.86 0.52 0.04 2.07 1.73 010
10061... .................. A Drainage of skin abscess. 2.40 1.49 1.06 0.06 3.95 3.52 010
10080... .................. A Drainage of pilonidal 1.17 1.41 0.51 0.05 2.63 1.73 010
cyst.
10081... .................. A Drainage of pilonidal 2.45 1.95 1.25 0.16 4.56 3.86 010
cyst.
10120... .................. A Remove foreign body...... 1.22 1.23 0.48 0.05 2.50 1.75 010
10121... .................. A Remove foreign body...... 2.69 2.08 1.35 0.12 4.89 4.16 010
10140... .................. A Drainage of hematoma/ 1.53 0.94 0.79 0.05 2.52 2.37 010
fluid.
10160... .................. A Puncture drainage of 1.20 1.07 0.61 0.05 2.32 1.86 010
lesion.
[[Page 30903]]
10180... .................. A Complex drainage, wound.. 2.25 1.17 1.18 0.18 3.60 3.61 010
11000... .................. A Debride infected skin.... 0.60 0.37 0.24 0.04 1.01 0.88 000
11001... .................. A Debride infect skin add.. 0.30 0.20 0.13 0.02 0.52 0.45 ZZZ
11010... .................. A Debride skin, fx......... 4.20 2.01 1.78 0.65 6.86 6.63 010
11011... .................. A Debride skin/muscle, fx.. 4.95 2.88 2.44 0.77 8.60 8.16 000
11012... .................. A Debride skin/muscle/bone, 6.88 3.82 3.58 1.07 11.77 11.53 000
fx.
11040... .................. A Debride skin partial..... 0.50 0.32 0.20 0.04 0.86 0.74 000
11041... .................. A Debride skin full........ 0.82 0.47 0.35 0.06 1.35 1.23 000
11042... .................. A Debride skin/tissue...... 1.12 0.68 0.48 0.08 1.88 1.68 000
11043... .................. A Debride tissue/muscle.... 2.38 1.79 1.30 0.34 4.51 4.02 010
11044... .................. A Debride tissue/muscle/ 3.06 2.35 1.77 0.49 5.90 5.32 010
bone.
11055... .................. R Trim skin lesion......... 0.27 0.32 0.12 0.02 0.61 0.41 000
11056... .................. R Trim 2 to 4 skin lesions. 0.39 0.36 0.17 0.03 0.78 0.59 000
11057... .................. R Trim over 4 skin lesions. 0.50 0.41 0.22 0.03 0.94 0.75 000
11100... .................. A Biopsy of skin lesion.... 0.81 1.26 0.73 0.04 2.11 1.58 000
11101... .................. A Biopsy, each added lesion 0.41 0.72 0.53 0.02 1.15 0.96 ZZZ
11200... .................. A Removal of skin tags..... 0.77 1.72 0.56 0.04 2.53 1.37 010
11201... .................. A Removal of added skin 0.29 0.69 0.67 0.02 1.00 0.98 ZZZ
tags.
11300... .................. A Shave skin lesion........ 0.51 1.04 0.70 0.05 1.60 1.26 000
11301... .................. A Shave skin lesion........ 0.85 1.10 0.95 0.06 2.01 1.86 000
11302... .................. A Shave skin lesion........ 1.05 1.19 1.13 0.09 2.33 2.27 000
11303... .................. A Shave skin lesion........ 1.24 1.34 1.29 0.17 2.75 2.70 000
11305... .................. A Shave skin lesion........ 0.67 0.81 0.75 0.05 1.53 1.47 000
11306... .................. A Shave skin lesion........ 0.99 1.06 1.01 0.07 2.12 2.07 000
11307... .................. A Shave skin lesion........ 1.14 1.15 1.12 0.10 2.39 2.36 000
11308... .................. A Shave skin lesion........ 1.41 1.21 1.30 0.17 2.79 2.88 000
11310... .................. A Shave skin lesion........ 0.73 1.11 0.83 0.06 1.90 1.62 000
11311... .................. A Shave skin lesion........ 1.05 1.21 1.12 0.08 2.34 2.25 000
11312... .................. A Shave skin lesion........ 1.20 1.27 1.28 0.11 2.58 2.59 000
11313... .................. A Shave skin lesion........ 1.62 1.62 1.57 0.15 3.39 3.34 000
11400... .................. A Removal of skin lesion... 0.91 1.57 0.60 0.05 2.53 1.56 010
11401... .................. A Removal of skin lesion... 1.32 1.65 0.77 0.06 3.03 2.15 010
11402... .................. A Removal of skin lesion... 1.61 1.77 0.86 0.09 3.47 2.56 010
11403... .................. A Removal of skin lesion... 1.92 1.67 0.99 0.13 3.72 3.04 010
11404... .................. A Removal of skin lesion... 2.20 1.81 1.10 0.17 4.18 3.47 010
11406... .................. A Removal of skin lesion... 2.76 2.42 1.33 0.33 5.51 4.42 010
11420... .................. A Removal of skin lesion... 1.06 1.33 0.68 0.05 2.44 1.79 010
11421... .................. A Removal of skin lesion... 1.53 1.62 0.90 0.07 3.22 2.50 010
11422... .................. A Removal of skin lesion... 1.76 1.75 0.97 0.10 3.61 2.83 010
11423... .................. A Removal of skin lesion... 2.17 1.77 1.14 0.15 4.09 3.46 010
11424... .................. A Removal of skin lesion... 2.62 1.97 1.33 0.16 4.75 4.11 010
11426... .................. A Removal of skin lesion... 3.78 2.86 1.83 0.29 6.93 5.90 010
11440... .................. A Removal of skin lesion... 1.15 1.72 0.82 0.06 2.93 2.03 010
11441... .................. A Removal of skin lesion... 1.61 1.85 1.05 0.08 3.54 2.74 010
11442... .................. A Removal of skin lesion... 1.87 1.96 1.14 0.11 3.94 3.12 010
11443... .................. A Removal of skin lesion... 2.49 2.39 1.47 0.15 5.03 4.11 010
11444... .................. A Removal of skin lesion... 3.42 2.60 1.96 0.14 6.16 5.52 010
11446... .................. A Removal of skin lesion... 4.49 3.52 2.47 0.18 8.19 7.14 010
11450... .................. A Removal, sweat gland 2.73 5.45 1.79 0.44 8.62 4.96 090
lesion.
11451... .................. A Removal, sweat gland 3.95 7.23 2.48 0.46 11.64 6.89 090
lesion.
11462... .................. A Removal, sweat gland 2.51 5.50 1.83 0.36 8.37 4.70 090
lesion.
11463... .................. A Removal, sweat gland 3.95 6.91 2.02 0.34 11.20 6.31 090
lesion.
11470... .................. A Removal, sweat gland 3.25 6.63 1.90 0.45 10.33 5.60 090
lesion.
11471... .................. A Removal, sweat gland 4.41 7.55 2.63 0.48 12.44 7.52 090
lesion.
11600... .................. A Removal of skin lesion... 1.41 1.75 0.84 0.10 3.26 2.35 010
11601... .................. A Removal of skin lesion... 1.93 2.67 1.11 0.12 4.72 3.16 010
11602... .................. A Removal of skin lesion... 2.09 1.91 1.17 0.16 4.16 3.42 010
11603... .................. A Removal of skin lesion... 2.35 1.86 1.25 0.21 4.42 3.81 010
11604... .................. A Removal of skin lesion... 2.58 1.99 1.35 0.26 4.83 4.19 010
11606... .................. A Removal of skin lesion... 3.43 2.74 1.68 0.49 6.66 5.60 010
11620... .................. A Removal of skin lesion... 1.34 1.71 0.87 0.12 3.17 2.33 010
11621... .................. A Removal of skin lesion... 1.97 1.88 1.20 0.16 4.01 3.33 010
11622... .................. A Removal of skin lesion... 2.34 2.06 1.34 0.19 4.59 3.87 010
11623... .................. A Removal of skin lesion... 2.93 2.17 1.59 0.25 5.35 4.77 010
11624... .................. A Removal of skin lesion... 3.43 2.48 1.86 0.32 6.23 5.61 010
11626... .................. A Removal of skin lesion... 4.30 3.20 2.28 0.51 8.01 7.09 010
11640... .................. A Removal of skin lesion... 1.53 1.77 1.02 0.15 3.45 2.70 010
11641... .................. A Removal of skin lesion... 2.44 2.15 1.51 0.18 4.77 4.13 010
11642... .................. A Removal of skin lesion... 2.93 2.24 1.74 0.23 5.40 4.90 010
11643... .................. A Removal of skin lesion... 3.50 2.57 2.05 0.28 6.35 5.83 010
11644... .................. A Removal of skin lesion... 4.55 3.17 2.61 0.33 8.05 7.49 010
11646... .................. A Removal of skin lesion... 5.95 4.21 3.41 0.60 10.76 9.96 010
11719... .................. R Trim nail(s)............. 0.11 0.16 0.05 0.02 0.29 0.18 000
11720... .................. A Debride nail, 1-5........ 0.32 0.23 0.21 0.03 0.58 0.56 000
[[Page 30904]]
11721... .................. A Debride nail, 6 or more.. 0.54 0.33 0.31 0.05 0.92 0.90 000
11730... .................. A Removal of nail plate.... 1.13 0.59 0.55 0.04 1.76 1.72 000
11731... .................. A Removal of second nail 0.57 0.27 0.27 0.05 0.89 0.89 ZZZ
plate.
11732... .................. A Remove additional nail 0.57 0.27 0.30 0.02 0.86 0.89 ZZZ
plate.
11740... .................. A Drain blood from under 0.37 0.32 0.08 0.04 0.73 0.49 000
nail.
11750... .................. A Removal of nail bed...... 1.86 1.37 1.16 0.19 3.42 3.21 010
11752... .................. A Remove nail bed/finger 2.67 1.49 1.93 0.36 4.52 4.96 010
tip.
11755... .................. A Biopsy, nail unit........ 1.31 0.82 0.96 0.12 2.25 2.39 000
11760... .................. A Reconstruction of nail 1.58 1.10 1.24 0.09 2.77 2.91 010
bed.
11762... .................. A Reconstruction of nail 2.89 1.54 2.05 0.24 4.67 5.18 010
bed.
11765... .................. A Excision of nail fold, 0.69 0.53 0.55 0.05 1.27 1.29 010
toe.
11770... .................. A Removal of pilonidal 2.61 2.05 1.21 0.44 5.10 4.26 010
lesion.
11771... .................. A Removal of pilonidal 5.74 4.26 3.31 0.92 10.92 9.97 090
lesion.
11772... .................. A Removal of pilonidal 6.98 5.22 3.81 1.01 13.21 11.80 090
lesion.
11900... .................. A Injection into skin 0.52 0.84 0.24 0.02 1.38 0.78 000
lesions.
11901... .................. A Added skin lesions 0.80 0.97 0.38 0.03 1.80 1.21 000
injection.
11920... .................. R Correct skin color 1.61 2.43 0.94 0.23 4.27 2.78 000
defects.
11921... .................. R Correct skin color 1.93 1.87 1.13 0.28 4.08 3.34 000
defects.
11922... .................. R Correct skin color 0.49 2.10 0.52 0.07 2.66 1.08 ZZZ
defects.
11950... .................. R Therapy for contour 0.84 1.01 0.33 0.11 1.96 1.28 000
defects.
11951... .................. R Therapy for contour 1.19 1.65 0.77 0.11 2.95 2.07 000
defects.
11952... .................. R Therapy for contour 1.69 2.47 0.99 0.11 4.27 2.79 000
defects.
11954... .................. R Therapy for contour 1.85 2.20 0.82 0.11 4.16 2.78 000
defects.
11960... .................. A Insert tissue expander(s) 9.08 NA 8.08 1.48 NA 18.64 090
11970... .................. A Replace tissue expander.. 7.06 NA 4.67 1.61 NA 13.34 090
11971... .................. A Remove tissue expander(s) 2.13 4.01 2.53 0.82 6.96 5.48 090
11975... .................. N Insert contraceptive cap. +1.48 2.81 1.48 0.25 4.54 3.21 XXX
11976... .................. R Removal of contraceptive 1.78 1.34 0.71 0.30 3.42 2.79 XXX
cap.
11977... .................. N Removal/reinsert contra +3.30 4.63 3.30 0.55 8.48 7.15 XXX
cap.
12001... .................. A Repair superficial 1.70 1.69 0.53 0.05 3.44 2.28 010
wound(s).
12002... .................. A Repair superficial 1.86 1.78 0.56 0.07 3.71 2.49 010
wound(s).
12004... .................. A Repair superficial 2.24 1.95 0.66 0.10 4.29 3.00 010
wound(s).
12005... .................. A Repair superficial 2.86 2.32 0.87 0.14 5.32 3.87 010
wound(s).
12006... .................. A Repair superficial 3.67 3.11 1.27 0.19 6.97 5.13 010
wound(s).
12007... .................. A Repair superficial 4.12 3.52 1.64 0.19 7.83 5.95 010
wound(s).
12011... .................. A Repair superficial 1.76 1.77 0.52 0.06 3.59 2.34 010
wound(s).
12013... .................. A Repair superficial 1.99 1.88 0.57 0.08 3.95 2.64 010
wound(s).
12014... .................. A Repair superficial 2.46 2.15 0.71 0.10 4.71 3.27 010
wound(s).
12015... .................. A Repair superficial 3.19 2.56 0.83 0.14 5.89 4.16 010
wound(s).
12016... .................. A Repair superficial 3.93 2.85 1.06 0.19 6.97 5.18 010
wound(s).
12017... .................. A Repair superficial 4.71 3.97 1.78 0.31 8.99 6.80 010
wound(s).
12018... .................. A Repair superficial 5.53 3.98 2.22 0.48 9.99 8.23 010
wound(s).
12020... .................. A Closure of split wound... 2.62 2.06 1.36 0.18 4.86 4.16 010
12021... .................. A Closure of split wound... 1.84 1.67 1.03 0.11 3.62 2.98 010
12031... .................. A Layer closure of wound(s) 2.15 1.98 0.96 0.07 4.20 3.18 010
12032... .................. A Layer closure of wound(s) 2.47 2.05 0.98 0.10 4.62 3.55 010
12034... .................. A Layer closure of wound(s) 2.92 2.29 1.13 0.15 5.36 4.20 010
12035... .................. A Layer closure of wound(s) 3.43 2.44 1.38 0.23 6.10 5.04 010
12036... .................. A Layer closure of wound(s) 4.05 3.93 2.13 0.37 8.35 6.55 010
12037... .................. A Layer closure of wound(s) 4.67 3.69 2.57 0.48 8.84 7.72 010
12041... .................. A Layer closure of wound(s) 2.37 2.19 0.97 0.08 4.64 3.42 010
12042... .................. A Layer closure of wound(s) 2.74 2.24 1.10 0.12 5.10 3.96 010
12044... .................. A Layer closure of wound(s) 3.14 2.38 1.30 0.17 5.69 4.61 010
12045... .................. A Layer closure of wound(s) 3.64 2.67 1.63 0.23 6.54 5.50 010
12046... .................. A Layer closure of wound(s) 4.25 3.76 2.25 0.37 8.38 6.87 010
12047... .................. A Layer closure of wound(s) 4.65 4.47 2.50 0.56 9.68 7.71 010
12051... .................. A Layer closure of wound(s) 2.47 2.18 1.09 0.10 4.75 3.66 010
12052... .................. A Layer closure of wound(s) 2.77 2.19 0.99 0.14 5.10 3.90 010
12053... .................. A Layer closure of wound(s) 3.12 2.36 1.08 0.17 5.65 4.37 010
12054... .................. A Layer closure of wound(s) 3.46 2.64 1.25 0.25 6.35 4.96 010
12055... .................. A Layer closure of wound(s) 4.43 3.33 1.73 0.37 8.13 6.53 010
12056... .................. A Layer closure of wound(s) 5.24 4.75 2.72 0.52 10.51 8.48 010
12057... .................. A Layer closure of wound(s) 5.96 4.47 3.39 0.48 10.91 9.83 010
13100... .................. A Repair of wound or lesion 3.12 2.60 1.76 0.13 5.85 5.01 010
13101... .................. A Repair of wound or lesion 3.92 2.88 2.18 0.21 7.01 6.31 010
13120... .................. A Repair of wound or lesion 3.30 2.73 1.64 0.17 6.20 5.11 010
13121... .................. A Repair of wound or lesion 4.33 3.12 2.15 0.33 7.78 6.81 010
13131... .................. A Repair of wound or lesion 3.79 3.02 2.11 0.23 7.04 6.13 010
13132... .................. A Repair of wound or lesion 5.95 3.98 3.12 0.44 10.37 9.51 010
13150... .................. A Repair of wound or lesion 3.81 3.86 2.37 0.23 7.90 6.41 010
13151... .................. A Repair of wound or lesion 4.45 3.92 2.75 0.35 8.72 7.55 010
13152... .................. A Repair of wound or lesion 6.33 4.71 3.73 0.68 11.72 10.74 010
13160... .................. A Late closure of wound.... 10.48 NA 5.87 0.58 NA 16.93 090
13300... .................. A Repair of wound or lesion 5.27 3.69 2.87 0.86 9.82 9.00 010
[[Page 30905]]
14000... .................. A Skin tissue rearrangement 5.89 5.26 3.91 0.38 11.53 10.18 090
14001... .................. A Skin tissue rearrangement 8.47 6.60 5.33 0.76 15.83 14.56 090
14020... .................. A Skin tissue rearrangement 6.59 5.78 4.49 0.49 12.86 11.57 090
14021... .................. A Skin tissue rearrangement 10.06 7.47 6.47 0.94 18.47 17.47 090
14040... .................. A Skin tissue rearrangement 7.87 6.25 5.40 0.65 14.77 13.92 090
14041... .................. A Skin tissue rearrangement 11.49 8.13 7.41 1.02 20.64 19.92 090
14060... .................. A Skin tissue rearrangement 8.50 6.81 6.12 1.04 16.35 15.66 090
14061... .................. A Skin tissue rearrangement 12.29 8.96 8.34 1.27 22.52 21.90 090
14300... .................. A Skin tissue rearrangement 11.76 8.29 7.69 1.84 21.89 21.29 090
14350... .................. A Skin tissue rearrangement 9.61 NA 5.87 1.05 NA 16.53 090
15000... .................. A Skin graft procedure..... 1.95 1.26 1.04 0.53 3.74 3.52 ZZZ
15050... .................. A Skin pinch graft 4.30 3.65 3.16 0.30 8.25 7.76 090
procedure.
15100... .................. A Skin split graft 9.05 5.64 6.52 0.89 15.58 16.46 090
procedure.
15101... .................. A Skin split graft 1.72 1.16 0.83 0.33 3.21 2.88 ZZZ
procedure.
15120... .................. A Skin split graft 9.83 6.78 6.22 0.94 17.55 16.99 090
procedure.
15121... .................. A Skin split graft 2.67 1.58 1.40 0.53 4.78 4.60 ZZZ
procedure.
15200... .................. A Skin full graft procedure 8.03 7.04 5.00 0.69 15.76 13.72 090
15201... .................. A Skin full graft procedure 1.32 0.84 0.69 0.50 2.66 2.51 ZZZ
15220... .................. A Skin full graft procedure 7.87 6.91 5.28 0.85 15.63 14.00 090
15221... .................. A Skin full graft procedure 1.19 0.77 0.66 0.50 2.46 2.35 ZZZ
15240... .................. A Skin full graft procedure 9.04 7.11 6.10 1.03 17.18 16.17 090
15241... .................. A Skin full graft procedure 1.86 1.25 1.04 0.58 3.69 3.48 ZZZ
15260... .................. A Skin full graft procedure 10.06 7.34 6.92 0.99 18.39 17.97 090
15261... .................. A Skin full graft procedure 2.23 1.40 1.27 0.60 4.23 4.10 ZZZ
15350... .................. A Skin homograft procedure. 4.36 6.41 5.19 0.42 11.19 9.97 090
15400... .................. A Skin heterograft 5.78 3.84 4.86 0.17 9.79 10.81 090
procedure.
15570... .................. A Form skin pedicle flap... 9.21 5.97 6.57 2.08 17.26 17.86 090
15572... .................. A Form skin pedicle flap... 9.27 6.35 6.52 1.86 17.48 17.65 090
15574... .................. A Form skin pedicle flap... 9.88 6.89 6.44 1.66 18.43 17.98 090
15576... .................. A Form skin pedicle flap... 8.69 6.95 5.87 0.60 16.24 15.16 090
15580... .................. A Attach skin pedicle graft 9.46 NA 6.38 1.30 NA 17.14 090
15600... .................. A Skin graft procedure..... 1.91 3.27 1.71 0.88 6.06 4.50 090
15610... .................. A Skin graft procedure..... 2.42 3.45 1.90 0.80 6.67 5.12 090
15620... .................. A Skin graft procedure..... 2.94 3.88 2.55 0.86 7.68 6.35 090
15625... .................. A Skin graft procedure..... 1.91 NA 2.88 0.78 NA 5.57 090
15630... .................. A Skin graft procedure..... 3.27 4.16 2.83 0.90 8.33 7.00 090
15650... .................. A Transfer skin pedicle 3.97 4.02 2.95 0.93 8.92 7.85 090
flap.
15732... .................. A Muscle-skin graft, head/ 17.84 NA 11.45 3.46 NA 32.75 090
neck.
15734... .................. A Muscle-skin graft, trunk. 17.79 NA 10.90 3.24 NA 31.93 090
15736... .................. A Muscle-skin graft, arm... 16.27 NA 10.22 3.02 NA 29.51 090
15738... .................. A Muscle-skin graft, leg... 17.92 NA 10.91 3.29 NA 32.12 090
15740... .................. A Island pedicle flap graft 10.25 7.20 6.61 1.62 19.07 18.48 090
15750... .................. A Neurovascular pedicle 11.41 NA 7.69 2.03 NA 21.13 090
graft.
15756... .................. A Free muscle flap, 35.23 NA 21.75 5.33 NA 62.31 090
microvasc.
15757... .................. A Free skin flap, microvasc 35.23 NA 21.75 5.33 NA 62.31 090
15758... .................. A Free fascial flap, 35.10 NA 21.68 5.33 NA 62.11 090
microvasc.
15760... .................. A Composite skin graft..... 8.74 7.06 7.41 1.11 16.91 17.26 090
15770... .................. A Derma-fat-fascia graft... 7.52 NA 5.51 0.95 NA 13.98 090
15775... .................. R Hair transplant punch 3.96 6.08 3.99 0.56 10.60 8.51 000
grafts.
15776... .................. R Hair transplant punch 5.54 5.09 3.61 0.79 11.42 9.94 000
grafts.
15780... .................. A Abrasion treatment of 7.29 5.50 5.53 0.13 12.92 12.95 090
skin.
15781... .................. A Abrasion treatment of 4.85 3.91 4.03 0.39 9.15 9.27 090
skin.
15782... .................. A Abrasion treatment of 4.32 3.14 3.04 0.13 7.59 7.49 090
skin.
15783... .................. A Abrasion treatment of 4.29 3.36 3.58 0.19 7.84 8.06 090
skin.
15786... .................. A Abrasion treatment of 2.03 1.40 1.30 0.06 3.49 3.39 010
lesion.
15787... .................. A Abrasion, added skin 0.33 0.24 0.20 0.03 0.60 0.56 ZZZ
lesions.
15788... .................. R Chemical peel, face, 2.09 2.41 1.20 0.12 4.62 3.41 090
epiderm.
15789... .................. R Chemical peel, face, 4.92 4.08 3.54 0.12 9.12 8.58 090
dermal.
15792... .................. R Chemical peel, nonfacial. 1.86 1.84 1.37 0.05 3.75 3.28 090
15793... .................. A Chemical peel, nonfacial. 3.74 NA 2.90 0.05 NA 6.69 090
15810... .................. A Salabrasion.............. 4.74 3.54 3.60 0.29 8.57 8.63 090
15811... .................. A Salabrasion.............. 5.39 4.95 4.14 0.73 11.07 10.26 090
15819... .................. A Plastic surgery, neck.... 9.38 NA 5.81 0.87 NA 16.06 090
15820... .................. A Revision of lower eyelid. 5.15 7.71 6.23 0.64 13.50 12.02 090
15821... .................. A Revision of lower eyelid. 5.72 7.98 6.68 0.68 14.38 13.08 090
15822... .................. A Revision of upper eyelid. 4.45 7.04 5.85 0.56 12.05 10.86 090
15823... .................. A Revision of upper eyelid. 7.05 8.71 7.43 0.61 16.37 15.09 090
15831... .................. A Excise excessive skin 12.40 NA 8.16 2.01 NA 22.57 090
tissue.
15832... .................. A Excise excessive skin 11.59 NA 8.09 1.33 NA 21.01 090
tissue.
15833... .................. A Excise excessive skin 10.64 NA 7.38 1.12 NA 19.14 090
tissue.
15834... .................. A Excise excessive skin 10.85 NA 5.52 1.22 NA 17.59 090
tissue.
15835... .................. A Excise excessive skin 11.67 NA 6.43 1.22 NA 19.32 090
tissue.
15836... .................. A Excise excessive skin 9.34 NA 7.09 1.10 NA 17.53 090
tissue.
15837... .................. A Excise excessive skin 8.43 5.69 5.87 0.85 14.97 15.15 090
tissue.
[[Page 30906]]
15838... .................. A Excise excessive skin 7.13 NA 5.97 0.73 NA 13.83 090
tissue.
15839... .................. A Excise excessive skin 9.38 6.20 5.68 0.46 16.04 15.52 090
tissue.
15840... .................. A Graft for face nerve 13.26 NA 9.23 2.28 NA 24.77 090
palsy.
15841... .................. A Graft for face nerve 23.26 NA 13.57 2.76 NA 39.59 090
palsy.
15842... .................. A Graft for face nerve 37.96 NA 23.74 2.68 NA 64.38 090
palsy.
15845... .................. A Skin and muscle repair, 12.57 NA 8.35 2.54 NA 23.46 090
face.
15850... .................. B Removal of sutures....... +0.78 2.24 0.82 0.04 3.06 1.64 XXX
15851... .................. A Removal of sutures....... 0.86 1.17 0.37 0.03 2.06 1.26 000
15852... .................. A Dressing change,not for 0.86 1.14 0.41 0.07 2.07 1.34 000
burn.
15860... .................. A Test for blood flow in 1.95 1.26 0.99 0.25 3.46 3.19 000
graft.
15920... .................. A Removal of tail bone 7.95 NA 4.64 0.63 NA 13.22 090
ulcer.
15922... .................. A Removal of tail bone 9.90 NA 5.97 1.19 NA 17.06 090
ulcer.
15931... .................. A Remove sacrum pressure 9.24 NA 4.66 0.55 NA 14.45 090
sore.
15933... .................. A Remove sacrum pressure 10.85 NA 6.91 1.43 NA 19.19 090
sore.
15934... .................. A Remove sacrum pressure 12.69 NA 7.56 1.50 NA 21.75 090
sore.
15935... .................. A Remove sacrum pressure 14.57 NA 9.07 2.27 NA 25.91 090
sore.
15936... .................. A Remove sacrum pressure 12.38 NA 7.87 2.05 NA 22.30 090
sore.
15937... .................. A Remove sacrum pressure 14.21 NA 9.27 2.67 NA 26.15 090
sore.
15940... .................. A Removal of pressure sore. 9.34 NA 5.24 0.73 NA 15.31 090
15941... .................. A Removal of pressure sore. 11.43 NA 8.15 1.39 NA 20.97 090
15944... .................. A Removal of pressure sore. 11.46 NA 7.59 1.82 NA 20.87 090
15945... .................. A Removal of pressure sore. 12.69 NA 8.41 2.09 NA 23.19 090
15946... .................. A Removal of pressure sore. 21.57 NA 13.57 3.24 NA 38.38 090
15950... .................. A Remove thigh pressure 7.54 NA 4.19 0.58 NA 12.31 090
sore.
15951... .................. A Remove thigh pressure 10.72 NA 6.78 1.58 NA 19.08 090
sore.
15952... .................. A Remove thigh pressure 11.39 NA 6.66 1.37 NA 19.42 090
sore.
15953... .................. A Remove thigh pressure 12.63 NA 7.55 1.87 NA 22.05 090
sore.
15956... .................. A Remove thigh pressure 15.52 NA 9.76 3.39 NA 28.67 090
sore.
15958... .................. A Remove thigh pressure 15.48 NA 9.87 3.76 NA 29.11 090
sore.
16000... .................. A Initial treatment of 0.89 0.76 0.21 0.03 1.68 1.13 000
burn(s).
16010... .................. A Treatment of burn(s)..... 0.87 0.82 0.34 0.03 1.72 1.24 000
16015... .................. A Treatment of burn(s)..... 2.35 1.40 1.08 0.38 4.13 3.81 000
16020... .................. A Treatment of burn(s)..... 0.80 0.80 0.23 0.03 1.63 1.06 000
16025... .................. A Treatment of burn(s)..... 1.85 1.31 0.64 0.05 3.21 2.54 000
16030... .................. A Treatment of burn(s)..... 2.08 1.93 0.99 0.08 4.09 3.15 000
16035... .................. A Incision of burn scab.... 4.82 2.95 2.15 0.34 8.11 7.31 090
16040... .................. A Burn wound excision...... 1.02 1.63 0.49 0.53 3.18 2.04 000
16041... .................. A Burn wound excision...... 2.70 2.10 1.31 0.53 5.33 4.54 000
16042... .................. A Burn wound excision...... 2.35 NA 1.17 0.53 NA 4.05 000
17000... .................. A Destroy benign/premal 0.60 0.86 0.60 0.03 1.49 1.23 010
lesion.
17003... .................. A Destroy 2-14 lesions..... 0.15 0.54 0.38 0.01 0.70 0.54 ZZZ
17004... .................. A Destroy 15 & more lesions 2.79 2.05 1.74 0.20 5.04 4.73 010
17106... .................. A Destruction of skin 4.59 3.21 2.78 0.18 7.98 7.55 090
lesions.
17107... .................. A Destruction of skin 9.16 5.82 5.26 0.39 15.37 14.81 090
lesions.
17108... .................. A Destruction of skin 13.20 8.55 7.73 0.69 22.44 21.62 090
lesions.
17110... .................. A Destruct lesion, 1-14.... 0.65 1.18 0.71 0.03 1.86 1.39 010
17111... .................. A Destruct lesion, 15 or 0.92 1.30 0.83 0.05 2.27 1.80 010
more.
17250... .................. A Chemical cautery, tissue. 0.50 0.45 0.20 0.04 0.99 0.74 000
17260... .................. A Destruction of skin 0.91 1.21 0.56 0.10 2.22 1.57 010
lesions.
17261... .................. A Destruction of skin 1.17 1.30 0.70 0.12 2.59 1.99 010
lesions.
17262... .................. A Destruction of skin 1.58 1.52 0.91 0.16 3.26 2.65 010
lesions.
17263... .................. A Destruction of skin 1.79 1.64 1.00 0.21 3.64 3.00 010
lesions.
17264... .................. A Destruction of skin 1.94 1.73 1.11 0.26 3.93 3.31 010
lesions.
17266... .................. A Destruction of skin 2.34 1.98 1.21 0.49 4.81 4.04 010
lesions.
17270... .................. A Destruction of skin 1.32 1.43 0.77 0.12 2.87 2.21 010
lesions.
17271... .................. A Destruction of skin 1.49 1.47 0.87 0.16 3.12 2.52 010
lesions.
17272... .................. A Destruction of skin 1.77 1.62 1.01 0.19 3.58 2.97 010
lesions.
17273... .................. A Destruction of skin 2.05 1.79 1.14 0.25 4.09 3.44 010
lesions.
17274... .................. A Destruction of skin 2.59 2.08 1.30 0.32 4.99 4.21 010
lesions.
17276... .................. A Destruction of skin 3.20 2.09 1.76 0.51 5.80 5.47 010
lesions.
17280... .................. A Destruction of skin 1.17 1.33 0.70 0.15 2.65 2.02 010
lesions.
17281... .................. A Destruction of skin 1.72 1.60 1.01 0.18 3.50 2.91 010
lesions.
17282... .................. A Destruction of skin 2.04 1.77 1.19 0.23 4.04 3.46 010
lesions.
17283... .................. A Destruction of skin 2.64 2.11 1.51 0.28 5.03 4.43 010
lesions.
17284... .................. A Destruction of skin 3.21 2.42 1.86 0.33 5.96 5.40 010
lesions.
17286... .................. A Destruction of skin 4.44 2.80 2.58 0.60 7.84 7.62 010
lesions.
17304... .................. A Chemosurgery of skin 7.60 5.90 4.28 0.31 13.81 12.19 000
lesion.
17305... .................. A 2nd stage chemosurgery... 2.85 2.23 1.66 0.17 5.25 4.68 000
17306... .................. A 3rd stage chemosurgery... 2.85 2.23 1.67 0.11 5.19 4.63 000
17307... .................. A Followup skin lesion 2.85 2.23 1.69 0.12 5.20 4.66 000
therapy.
17310... .................. A Extensive skin 0.95 0.87 0.54 0.01 1.83 1.50 000
chemosurgery.
17340... .................. A Cryotherapy of skin...... 0.76 1.54 0.86 0.02 2.32 1.64 010
17360... .................. A Skin peel therapy........ 1.43 1.38 0.91 0.02 2.83 2.36 010
19000... .................. A Drainage of breast lesion 0.84 1.16 0.28 0.07 2.07 1.19 000
[[Page 30907]]
19001... .................. A Drain added breast lesion 0.42 0.86 0.14 0.05 1.33 0.61 ZZZ
19020... .................. A Incision of breast lesion 3.57 4.63 2.48 0.28 8.48 6.33 090
19030... .................. A Injection for breast x- 1.53 9.38 0.94 0.04 10.95 2.51 000
ray.
19100... .................. A Biopsy of breast......... 1.27 2.45 0.79 0.13 3.85 2.19 000
19101... .................. A Biopsy of breast......... 3.18 5.91 2.32 0.45 9.54 5.95 010
19110... .................. A Nipple exploration....... 4.30 5.66 3.12 0.51 10.47 7.93 090
19112... .................. A Excise breast duct 3.67 4.79 2.33 0.35 8.81 6.35 090
fistula.
19120... .................. A Removal of breast lesion. 5.56 3.29 4.14 0.60 9.45 10.30 090
19125... .................. A Excision, breast lesion.. 6.06 3.61 4.75 0.60 10.27 11.41 090
19126... .................. A Excision, add/-El breast 2.93 NA 1.28 0.31 NA 4.52 ZZZ
lesion.
19140... .................. A Removal of breast tissue. 5.14 6.25 2.91 0.91 12.30 8.96 090
19160... .................. A Removal of breast tissue. 5.99 NA 3.57 0.88 NA 10.44 090
19162... .................. A Remove breast tissue, 13.53 NA 7.01 1.96 NA 22.50 090
nodes.
19180... .................. A Removal of breast........ 8.80 NA 5.01 1.17 NA 14.98 090
19182... .................. A Removal of breast........ 7.73 NA 4.40 1.27 NA 13.40 090
19200... .................. A Removal of breast........ 15.49 NA 8.03 2.15 NA 25.67 090
19220... .................. A Removal of breast........ 15.72 NA 8.48 2.38 NA 26.58 090
19240... .................. A Removal of breast........ 16.00 NA 7.96 1.99 NA 25.95 090
19260... .................. A Removal of chest wall 15.44 NA 10.33 1.04 NA 26.81 090
lesion.
19271... .................. A Revision of chest wall... 18.90 NA 12.42 2.77 NA 34.09 090
19272... .................. A Extensive chest wall 21.55 NA 14.21 2.56 NA 38.32 090
surgery.
19290... .................. A Place needle wire, breast 1.27 5.74 0.85 0.07 7.08 2.19 000
19291... .................. A Place needle wire, breast 0.63 3.63 0.65 0.04 4.30 1.32 ZZZ
19316... .................. A Suspension of breast..... 10.69 NA 7.01 2.43 NA 20.13 090
19318... .................. A Reduction of large breast 15.62 NA 9.83 3.23 NA 28.68 090
19324... .................. A Enlarge breast........... 5.85 NA 3.44 0.67 NA 9.96 090
19325... .................. A Enlarge breast with 8.45 NA 5.87 1.13 NA 15.45 090
implant.
19328... .................. A Removal of breast implant 5.68 NA 3.94 0.73 NA 10.35 090
19330... .................. A Removal of implant 7.59 NA 4.90 0.75 NA 13.24 090
material.
19340... .................. A Immediate breast 6.33 NA 3.57 2.06 NA 11.96 ZZZ
prosthesis.
19342... .................. A Delayed breast prosthesis 11.20 NA 7.32 2.03 NA 20.55 090
19350... .................. A Breast reconstruction.... 8.92 9.60 6.05 1.38 19.90 16.35 090
19355... .................. A Correct inverted 7.57 10.44 5.12 1.00 19.01 13.69 090
nipple(s).
19357... .................. A Breast reconstruction.... 18.16 NA 12.25 2.37 NA 32.78 090
19361... .................. A Breast reconstruction.... 19.26 NA 11.82 3.88 NA 34.96 090
19364... .................. A Breast reconstruction.... 29.04 NA 17.48 3.58 NA 50.10 090
19366... .................. A Breast reconstruction.... 21.28 NA 11.46 3.18 NA 35.92 090
19367... .................. A Breast reconstruction.... 25.73 NA 15.21 3.88 NA 44.82 090
19368... .................. A Breast reconstruction.... 32.42 NA 19.61 3.88 NA 55.91 090
19369... .................. A Breast reconstruction.... 29.82 NA 17.91 3.88 NA 51.61 090
19370... .................. A Surgery of breast capsule 8.05 NA 5.49 1.19 NA 14.73 090
19371... .................. A Removal of breast capsule 9.35 NA 5.70 1.54 NA 16.59 090
19380... .................. A Revise breast 9.14 NA 6.24 1.57 NA 16.95 090
reconstruction.
19396... .................. A Design custom breast 2.17 2.97 1.26 0.31 5.45 3.74 000
implant.
20000... .................. A Incision of abscess...... 2.12 1.59 1.03 0.08 3.79 3.23 010
20005... .................. A Incision of deep abscess. 3.42 2.27 1.92 0.28 5.97 5.62 010
20100... .................. A Explore wound, neck...... 10.08 5.22 4.35 1.16 16.46 15.59 010
20101... .................. A Explore wound, chest..... 3.22 1.73 1.49 0.37 5.32 5.08 010
20102... .................. A Explore wound, abdomen... 3.94 2.50 1.78 0.45 6.89 6.17 010
20103... .................. A Explore wound, extremity. 5.30 3.52 2.68 0.60 9.42 8.58 010
20150... .................. A Excise epiphyseal bar.... 13.69 NA 19.46 2.03 NA 35.18 090
20200... .................. A Muscle biopsy............ 1.46 1.28 0.64 0.18 2.92 2.28 000
20205... .................. A Deep muscle biopsy....... 2.35 3.17 1.14 0.33 5.85 3.82 000
20206... .................. A Needle biopsy, muscle.... 0.99 2.14 0.92 0.14 3.27 2.05 000
20220... .................. A Bone biopsy, trocar/ 1.27 1.67 1.36 0.09 3.03 2.72 000
needle.
20225... .................. A Bone biopsy, trocar/ 1.87 0.73 1.76 0.28 2.88 3.91 000
needle.
20240... .................. A Bone biopsy, excisional.. 3.23 NA 2.69 0.18 NA 6.10 010
20245... .................. A Bone biopsy, excisional.. 3.95 NA 3.60 0.44 NA 7.99 010
20250... .................. A Open bone biopsy......... 5.03 NA 3.61 0.76 NA 9.40 010
20251... .................. A Open bone biopsy......... 5.56 NA 4.37 0.92 NA 10.85 010
20500... .................. A Injection of sinus tract. 1.23 2.80 2.12 0.04 4.07 3.39 010
20501... .................. A Inject sinus tract for x- 0.76 7.35 0.42 0.02 8.13 1.20 000
ray.
20520... .................. A Removal of foreign body.. 1.85 3.00 1.93 0.08 4.93 3.86 010
20525... .................. A Removal of foreign body.. 3.50 3.75 3.05 0.33 7.58 6.88 010
20550... .................. A Inj tendon/ligament/cyst. 0.86 2.07 0.29 0.04 2.97 1.19 000
20600... .................. A Drain/inject joint/bursa. 0.66 1.25 0.39 0.05 1.96 1.10 000
20605... .................. A Drain/inject joint/bursa. 0.68 1.76 0.38 0.05 2.49 1.11 000
20610... .................. A Drain/inject joint/bursa. 0.79 1.38 0.45 0.05 2.22 1.29 000
20615... .................. A Treatment of bone cyst... 2.28 2.75 1.84 0.06 5.09 4.18 010
20650... .................. A Insert and remove bone 2.23 2.45 2.05 0.14 4.82 4.42 010
pin.
20660... .................. A Apply,remove fixation 2.51 NA 1.40 0.21 NA 4.12 000
device.
20661... .................. A Application of head brace 4.89 NA 5.01 0.65 NA 10.55 090
20662... .................. A Application of pelvis 6.07 NA 4.67 1.03 NA 11.77 090
brace.
20663... .................. A Application of thigh 5.43 NA 4.52 0.76 NA 10.71 090
brace.
[[Page 30908]]
20664... .................. A Halo brace application... 8.06 NA 6.77 0.65 NA 15.48 090
20665... .................. A Removal of fixation 1.31 1.31 1.09 0.07 2.69 2.47 010
device.
20670... .................. A Removal of support 1.74 3.72 2.50 0.11 5.57 4.35 010
implant.
20680... .................. A Removal of support 3.35 3.33 6.39 0.51 7.19 10.25 090
implant.
20690... .................. A Apply bone fixation 3.52 NA 2.31 0.58 NA 6.41 ZZZ
device.
20692... .................. A Apply bone fixation 6.41 NA 3.92 0.89 NA 11.22 ZZZ
device.
20693... .................. A Adjust bone fixation 5.86 NA 8.69 0.42 NA 14.97 090
device.
20694... .................. A Remove bone fixation 4.16 6.02 4.74 0.41 10.59 9.31 090
device.
20802... .................. A Replantation, arm, 41.15 NA 29.93 6.17 NA 77.25 090
complete.
20805... .................. A Replant forearm, complete 50.00 NA 34.58 7.56 NA 92.14 090
20808... .................. A Replantation, hand, 61.65 NA 46.78 9.40 NA 117.83 090
complete.
20816... .................. A Replantation digit, 30.94 NA 34.06 4.63 NA 69.63 090
complete.
20822... .................. A Replantation digit, 25.59 NA 27.59 3.83 NA 57.01 090
complete.
20824... .................. A Replantation thumb, 30.94 NA 25.23 4.63 NA 60.80 090
complete.
20827... .................. A Replantation thumb, 26.41 NA 29.76 3.94 NA 60.11 090
complete.
20838... .................. A Replantation, foot, 41.41 NA 28.93 6.17 NA 76.51 090
complete.
20900... .................. A Removal of bone for graft 5.58 4.53 5.00 0.45 10.56 11.03 090
20902... .................. A Removal of bone for graft 7.55 NA 7.14 0.80 NA 15.49 090
20910... .................. A Remove cartilage for 5.34 5.32 4.76 0.09 10.75 10.19 090
graft.
20912... .................. A Remove cartilage for 6.35 NA 4.97 0.64 NA 11.96 090
graft.
20920... .................. A Removal of fascia for 5.31 NA 4.72 0.50 NA 10.53 090
graft.
20922... .................. A Removal of fascia for 6.61 5.86 5.18 0.71 13.18 12.50 090
graft.
20924... .................. A Removal of tendon for 6.48 NA 5.62 0.85 NA 12.95 090
graft.
20926... .................. A Removal of tissue for 5.53 NA 4.71 0.39 NA 10.63 090
graft.
20931... .................. A Spinal bone allograft.... 1.81 NA 1.24 0.28 NA 3.33 ZZZ
20937... .................. A Spinal bone autograft.... 2.79 NA 1.84 0.44 NA 5.07 ZZZ
20938... .................. A Spinal bone autograft.... 3.02 NA 1.93 0.47 NA 5.42 ZZZ
20950... .................. A Record fluid 1.26 NA 1.54 0.17 NA 2.97 000
pressure,muscle.
20955... .................. A Fibula bone graft, 39.21 NA 26.94 5.87 NA 72.02 090
microvasc.
20956... .................. A Iliac bone graft, 39.27 NA 49.63 5.26 NA 94.16 090
microvasc.
20957... .................. A Mt bone graft, microvasc. 40.65 NA 51.01 5.45 NA 97.11 090
20962... .................. A Other bone graft, 39.27 NA 25.47 5.26 NA 70.00 090
microvasc.
20969... .................. A Bone/skin graft, 43.92 NA 28.73 6.57 NA 79.22 090
microvasc.
20970... .................. A Bone/skin graft, iliac 43.06 NA 28.02 6.44 NA 77.52 090
crest.
20972... .................. A Bone-skin graft, 42.99 NA 19.72 6.49 NA 69.20 090
metatarsal.
20973... .................. A Bone-skin graft, great 45.76 NA 28.05 6.91 NA 80.72 090
toe.
20974... .................. A Electrical bone 0.62 0.32 0.35 0.53 1.47 1.50 000
stimulation.
20975... .................. A Electrical bone 2.60 NA 1.48 0.56 NA 4.64 ZZZ
stimulation.
21010... .................. A Incision of jaw joint.... 10.14 NA 7.03 0.93 NA 18.10 090
21015... .................. A Resection of facial tumor 5.29 NA 5.98 1.13 NA 12.40 090
21025... .................. A Excision of bone, lower 10.06 6.82 6.53 0.38 17.26 16.97 090
jaw.
21026... .................. A Excision of facial 4.85 4.64 4.23 0.28 9.77 9.36 090
bone(s).
21029... .................. A Contour of face bone 7.71 5.81 5.77 0.78 14.30 14.26 090
lesion.
21030... .................. A Removal of face bone 6.46 5.05 4.42 0.29 11.80 11.17 090
lesion.
21031... .................. A Remove exostosis, 3.24 3.24 2.14 0.32 6.80 5.70 090
mandible.
21032... .................. A Remove exostosis, maxilla 3.24 3.21 2.19 0.35 6.80 5.78 090
21034... .................. A Removal of face bone 16.17 9.87 10.61 0.89 26.93 27.67 090
lesion.
21040... .................. A Removal of jaw bone 2.11 2.89 1.77 0.24 5.24 4.12 090
lesion.
21041... .................. A Removal of jaw bone 6.71 5.24 4.24 0.50 12.45 11.45 090
lesion.
21044... .................. A Removal of jaw bone 11.86 NA 7.91 1.11 NA 20.88 090
lesion.
21045... .................. A Extensive jaw surgery.... 16.17 NA 10.49 1.58 NA 28.24 090
21050... .................. A Removal of jaw joint..... 10.77 NA 10.16 1.08 NA 22.01 090
21060... .................. A Remove jaw joint 10.23 NA 8.88 1.04 NA 20.15 090
cartilage.
21070... .................. A Remove coronoid process.. 8.20 NA 6.32 0.82 NA 15.34 090
21076... .................. A Prepare face/oral 13.42 6.70 5.60 1.35 21.47 20.37 010
prosthesis.
21077... .................. A Prepare face/oral 33.75 14.90 17.42 3.39 52.04 54.56 090
prosthesis.
21079... .................. A Prepare face/oral 22.34 10.55 9.52 2.25 35.14 34.11 090
prosthesis.
21080... .................. A Prepare face/oral 25.10 11.63 10.47 2.52 39.25 38.09 090
prosthesis.
21081... .................. A Prepare face/oral 22.88 10.89 9.62 2.30 36.07 34.80 090
prosthesis.
21082... .................. A Prepare face/oral 20.87 9.85 8.69 2.10 32.82 31.66 090
prosthesis.
21083... .................. A Prepare face/oral 19.30 9.20 8.08 1.94 30.44 29.32 090
prosthesis.
21084... .................. A Prepare face/oral 22.51 12.25 12.54 2.28 37.04 37.33 090
prosthesis.
21085... .................. A Prepare face/oral 9.00 5.01 3.87 0.90 14.91 13.77 010
prosthesis.
21086... .................. A Prepare face/oral 24.92 12.00 13.68 2.51 39.43 41.11 090
prosthesis.
21087... .................. A Prepare face/oral 24.92 11.66 11.30 2.51 39.09 38.73 090
prosthesis.
21100... .................. A Maxillofacial fixation... 4.22 4.14 3.69 0.11 8.47 8.02 090
21110... .................. A Interdental fixation..... 5.21 4.75 3.82 0.46 10.42 9.49 090
21116... .................. A Injection, jaw joint x- 0.81 5.51 0.27 0.06 6.38 1.14 000
ray.
21120... .................. A Reconstruction of chin... 4.93 5.71 5.13 0.42 11.06 10.48 090
21121... .................. A Reconstruction of chin... 7.64 6.30 6.30 0.66 14.60 14.60 090
21122... .................. A Reconstruction of chin... 8.52 NA 7.00 0.73 NA 16.25 090
21123... .................. A Reconstruction of chin... 11.16 NA 20.06 0.95 NA 32.17 090
21125... .................. A Augmentation lower jaw 10.62 7.69 7.67 0.54 18.85 18.83 090
bone.
21127... .................. A Augmentation lower jaw 11.12 8.30 7.47 0.92 20.34 19.51 090
bone.
[[Page 30909]]
21137... .................. A Reduction of forehead.... 9.82 NA 7.29 0.83 NA 17.94 090
21138... .................. A Reduction of forehead.... 12.19 NA 7.64 1.04 NA 20.87 090
21139... .................. A Reduction of forehead.... 14.61 NA 11.04 1.25 NA 26.90 090
21141... .................. A Reconstruct midface, 18.10 NA 10.89 1.68 NA 30.67 090
lefort.
21142... .................. A Reconstruct midface, 18.81 NA 13.27 1.74 NA 33.82 090
lefort.
21143... .................. A Reconstruct midface, 19.58 NA 11.67 1.81 NA 33.06 090
lefort.
21145... .................. A Reconstruct midface, 19.94 NA 11.71 1.68 NA 33.33 090
lefort.
21146... .................. A Reconstruct midface, 20.71 NA 12.56 1.74 NA 35.01 090
lefort.
21147... .................. A Reconstruct midface, 21.77 NA 13.16 1.81 NA 36.74 090
lefort.
21150... .................. A Reconstruct midface, 25.24 NA 15.59 2.17 NA 43.00 090
lefort.
21151... .................. A Reconstruct midface, 28.30 NA 15.30 2.42 NA 46.02 090
lefort.
21154... .................. A Reconstruct midface, 30.52 NA 22.04 2.59 NA 55.15 090
lefort.
21155... .................. A Reconstruct midface, 34.45 NA 51.03 2.94 NA 88.42 090
lefort.
21159... .................. A Reconstruct midface, 42.38 NA 60.58 3.63 NA 106.59 090
lefort.
21160... .................. A Reconstruct midface, 46.44 NA 64.64 3.98 NA 115.06 090
lefort.
21172... .................. A Reconstruct orbit/ 27.80 NA 21.24 2.37 NA 51.41 090
forehead.
21175... .................. A Reconstruct orbit/ 33.17 NA 24.31 2.85 NA 60.33 090
forehead.
21179... .................. A Reconstruct entire 22.25 NA 18.66 1.90 NA 42.81 090
forehead.
21180... .................. A Reconstruct entire 25.19 NA 24.32 2.17 NA 51.68 090
forehead.
21181... .................. A Contour cranial bone 9.90 NA 8.05 0.83 NA 18.78 090
lesion.
21182... .................. A Reconstruct cranial bone. 32.19 NA 24.10 2.77 NA 59.06 090
21183... .................. A Reconstruct cranial bone. 35.31 NA 25.88 3.03 NA 64.22 090
21184... .................. A Reconstruct cranial bone. 38.24 NA 29.40 3.28 NA 70.92 090
21188... .................. A Reconstruction of midface 22.46 NA 18.26 1.90 NA 42.62 090
21193... .................. A Reconstruct lower jaw 17.15 NA 10.91 1.44 NA 29.50 090
bone.
21194... .................. A Reconstruct lower jaw 19.84 NA 12.92 1.67 NA 34.43 090
bone.
21195... .................. A Reconstruct lower jaw 17.24 NA 11.08 1.44 NA 29.76 090
bone.
21196... .................. A Reconstruct lower jaw 18.91 NA 13.53 1.58 NA 34.02 090
bone.
21198... .................. A Reconstruct lower jaw 14.16 NA 10.93 1.74 NA 26.83 090
bone.
21206... .................. A Reconstruct upper jaw 14.10 NA 10.52 1.19 NA 25.81 090
bone.
21208... .................. A Augmentation of facial 10.23 7.88 8.26 1.07 19.18 19.56 090
bones.
21209... .................. A Reduction of facial bones 6.72 6.05 6.22 0.76 13.53 13.70 090
21210... .................. A Face bone graft.......... 10.23 7.72 7.87 1.29 19.24 19.39 090
21215... .................. A Lower jaw bone graft..... 10.77 7.83 7.13 1.42 20.02 19.32 090
21230... .................. A Rib cartilage graft...... 10.77 NA 9.34 1.69 NA 21.80 090
21235... .................. A Ear cartilage graft...... 6.72 8.15 7.42 1.09 15.96 15.23 090
21240... .................. A Reconstruction of jaw 14.05 NA 10.46 2.09 NA 26.60 090
joint.
21242... .................. A Reconstruction of jaw 12.95 NA 10.05 2.25 NA 25.25 090
joint.
21243... .................. A Reconstruction of jaw 20.79 NA 13.24 1.68 NA 35.71 090
joint.
21244... .................. A Reconstruction of lower 11.86 NA 9.33 1.93 NA 23.12 090
jaw.
21245... .................. A Reconstruction of jaw.... 11.86 8.63 9.93 1.31 21.80 23.10 090
21246... .................. A Reconstruction of jaw.... 12.47 8.83 9.24 1.04 22.34 22.75 090
21247... .................. A Reconstruct lower jaw 22.63 NA 14.51 2.27 NA 39.41 090
bone.
21248... .................. A Reconstruction of jaw.... 11.48 7.91 7.71 1.75 21.14 20.94 090
21249... .................. A Reconstruction of jaw.... 17.52 10.43 10.44 3.29 31.24 31.25 090
21255... .................. A Reconstruct lower jaw 16.72 NA 11.63 1.68 NA 30.03 090
bone.
21256... .................. A Reconstruction of orbit.. 16.19 NA 14.89 1.63 NA 32.71 090
21260... .................. A Revise eye sockets....... 16.52 NA 14.04 1.66 NA 32.22 090
21261... .................. A Revise eye sockets....... 31.49 NA 17.06 1.65 NA 50.20 090
21263... .................. A Revise eye sockets....... 28.42 NA 45.24 2.86 NA 76.52 090
21267... .................. A Revise eye sockets....... 18.90 NA 20.67 2.13 NA 41.70 090
21268... .................. A Revise eye sockets....... 24.48 NA 18.34 3.13 NA 45.95 090
21270... .................. A Augmentation cheek bone.. 10.23 5.40 9.69 1.41 17.04 21.33 090
21275... .................. A Revision orbitofacial 11.24 NA 13.42 1.26 NA 25.92 090
bones.
21280... .................. A Revision of eyelid....... 6.03 NA 8.21 0.61 NA 14.85 090
21282... .................. A Revision of eyelid....... 3.49 NA 6.72 0.79 NA 11.00 090
21295... .................. A Revision of jaw muscle/ 1.53 NA 3.72 0.13 NA 5.38 090
bone.
21296... .................. A Revision of jaw muscle/ 4.25 NA 5.02 0.22 NA 9.49 090
bone.
21300... .................. A Treatment of skull 0.72 3.32 0.21 0.11 4.15 1.04 000
fracture.
21310... .................. A Treatment of nose 0.58 2.47 0.11 0.09 3.14 0.78 000
fracture.
21315... .................. A Treatment of nose 1.51 2.93 0.89 0.21 4.65 2.61 010
fracture.
21320... .................. A Treatment of nose 1.85 3.06 1.65 0.34 5.25 3.84 010
fracture.
21325... .................. A Repair of nose fracture.. 3.77 NA 2.81 0.52 NA 7.10 090
21330... .................. A Repair of nose fracture.. 5.38 NA 5.97 0.86 NA 12.21 090
21335... .................. A Repair of nose fracture.. 8.61 NA 8.02 1.56 NA 18.19 090
21336... .................. A Repair nasal septal 5.72 NA 5.91 0.52 NA 12.15 090
fracture.
21337... .................. A Repair nasal septal 2.70 4.38 2.39 0.38 7.46 5.47 090
fracture.
21338... .................. A Repair nasoethmoid 6.46 NA 6.39 0.66 NA 13.51 090
fracture.
21339... .................. A Repair nasoethmoid 8.09 NA 7.31 0.70 NA 16.10 090
fracture.
21340... .................. A Repair of nose fracture.. 10.77 NA 9.73 1.04 NA 21.54 090
21343... .................. A Repair of sinus fracture. 12.95 NA 9.61 1.08 NA 23.64 090
21344... .................. A Repair of sinus fracture. 19.72 NA 14.46 1.08 NA 35.26 090
21345... .................. A Repair of nose/jaw 8.16 7.04 7.45 0.81 16.01 16.42 090
fracture.
21346... .................. A Repair of nose/jaw 10.61 NA 9.74 1.04 NA 21.39 090
fracture.
[[Page 30910]]
21347... .................. A Repair of nose/jaw 12.69 NA 9.53 1.36 NA 23.58 090
fracture.
21348... .................. A Repair of nose/jaw 16.69 NA 12.22 2.22 NA 31.13 090
fracture.
21355... .................. A Repair cheek bone 3.77 3.40 1.74 0.17 7.34 5.68 010
fracture.
21356... .................. A Repair cheek bone 4.15 NA 4.79 0.89 NA 9.83 010
fracture.
21360... .................. A Repair cheek bone 6.46 NA 6.84 0.89 NA 14.19 090
fracture.
21365... .................. A Repair cheek bone 14.95 NA 11.74 1.63 NA 28.32 090
fracture.
21366... .................. A Repair cheek bone 17.77 NA 9.32 2.36 NA 29.45 090
fracture.
21385... .................. A Repair eye socket 9.16 NA 7.61 1.13 NA 17.90 090
fracture.
21386... .................. A Repair eye socket 9.16 NA 8.63 1.25 NA 19.04 090
fracture.
21387... .................. A Repair eye socket 9.70 NA 9.10 0.96 NA 19.76 090
fracture.
21390... .................. A Repair eye socket 10.13 NA 10.45 1.37 NA 21.95 090
fracture.
21395... .................. A Repair eye socket 12.68 NA 10.66 1.37 NA 24.71 090
fracture.
21400... .................. A Treat eye socket fracture 1.40 3.31 0.65 0.17 4.88 2.22 090
21401... .................. A Repair eye socket 3.26 3.98 2.31 0.32 7.56 5.89 090
fracture.
21406... .................. A Repair eye socket 7.01 NA 7.24 0.74 NA 14.99 090
fracture.
21407... .................. A Repair eye socket 8.61 NA 8.85 0.78 NA 18.24 090
fracture.
21408... .................. A Repair eye socket 12.38 NA 9.57 0.99 NA 22.94 090
fracture.
21421... .................. A Treat mouth roof fracture 5.14 6.15 5.17 0.62 11.91 10.93 090
21422... .................. A Repair mouth roof 8.32 NA 7.33 1.19 NA 16.84 090
fracture.
21423... .................. A Repair mouth roof 10.40 NA 8.31 1.19 NA 19.90 090
fracture.
21431... .................. A Treat craniofacial 7.05 NA 5.95 0.71 NA 13.71 090
fracture.
21432... .................. A Repair craniofacial 8.61 NA 7.78 0.84 NA 17.23 090
fracture.
21433... .................. A Repair craniofacial 25.35 NA 17.90 2.10 NA 45.35 090
fracture.
21435... .................. A Repair craniofacial 17.25 NA 13.29 1.88 NA 32.42 090
fracture.
21436... .................. A Repair craniofacial 28.04 NA 17.06 2.08 NA 47.18 090
fracture.
21440... .................. A Repair dental ridge 2.70 4.56 3.56 0.28 7.54 6.54 090
fracture.
21445... .................. A Repair dental ridge 5.38 5.56 5.29 0.56 11.50 11.23 090
fracture.
21450... .................. A Treat lower jaw fracture. 2.97 4.24 3.45 0.26 7.47 6.68 090
21451... .................. A Treat lower jaw fracture. 4.87 5.43 4.60 0.74 11.04 10.21 090
21452... .................. A Treat lower jaw fracture. 1.98 6.58 3.89 0.17 8.73 6.04 090
21453... .................. A Treat lower jaw fracture. 5.54 5.95 5.49 0.55 12.04 11.58 090
21454... .................. A Treat lower jaw fracture. 6.46 NA 5.76 1.42 NA 13.64 090
21461... .................. A Repair lower jaw fracture 8.09 8.12 7.14 1.30 17.51 16.53 090
21462... .................. A Repair lower jaw fracture 9.79 8.46 7.77 1.34 19.59 18.90 090
21465... .................. A Repair lower jaw fracture 11.91 NA 8.02 0.99 NA 20.92 090
21470... .................. A Repair lower jaw fracture 15.34 NA 10.11 1.74 NA 27.19 090
21480... .................. A Reset dislocated jaw..... 0.61 1.75 0.16 0.09 2.45 0.86 000
21485... .................. A Reset dislocated jaw..... 3.99 3.72 2.48 0.20 7.91 6.67 090
21490... .................. A Repair dislocated jaw.... 11.86 NA 7.48 0.52 NA 19.86 090
21493... .................. A Treat hyoid bone fracture 1.27 0.59 3.15 0.13 1.99 4.55 090
21494... .................. A Repair hyoid bone 6.28 2.63 3.70 0.63 9.54 10.61 090
fracture.
21495... .................. A Repair hyoid bone 5.69 NA 5.95 0.51 NA 12.15 090
fracture.
21497... .................. A Interdental wiring....... 3.86 4.11 3.29 0.38 8.35 7.53 090
21501... .................. A Drain neck/chest lesion.. 3.81 3.16 2.67 0.26 7.23 6.74 090
21502... .................. A Drain chest lesion....... 7.12 NA 9.17 0.75 NA 17.04 090
21510... .................. A Drainage of bone lesion.. 5.74 NA 7.85 0.50 NA 14.09 090
21550... .................. A Biopsy of neck/chest..... 2.06 1.72 1.17 0.12 3.90 3.35 010
21555... .................. A Remove lesion neck/chest. 4.35 3.34 2.37 0.25 7.94 6.97 090
21556... .................. A Remove lesion neck/chest. 5.57 NA 3.17 0.64 NA 9.38 090
21557... .................. A Remove tumor, neck or 8.88 NA 8.79 1.41 NA 19.08 090
chest.
21600... .................. A Partial removal of rib... 6.89 NA 8.31 0.88 NA 16.08 090
21610... .................. A Partial removal of rib... 14.61 NA 9.89 0.76 NA 25.26 090
21615... .................. A Removal of rib........... 9.87 NA 8.38 1.96 NA 20.21 090
21616... .................. A Removal of rib and nerves 12.04 NA 9.33 1.50 NA 22.87 090
21620... .................. A Partial removal of 6.79 NA 7.60 1.23 NA 15.62 090
sternum.
21627... .................. A Sternal debridement...... 6.81 NA 12.71 0.90 NA 20.42 090
21630... .................. A Extensive sternum surgery 17.38 NA 15.34 2.40 NA 35.12 090
21632... .................. A Extensive sternum surgery 18.14 NA 13.05 2.22 NA 33.41 090
21700... .................. A Revision of neck muscle.. 6.19 5.11 4.88 0.50 11.80 11.57 090
21705... .................. A Revision of neck muscle/ 9.60 NA 10.23 0.96 NA 20.79 090
rib.
21720... .................. A Revision of neck muscle.. 5.68 6.36 4.90 0.52 12.56 11.10 090
21725... .................. A Revision of neck muscle.. 6.99 NA 6.16 0.74 NA 13.89 090
21740... .................. A Reconstruction of sternum 16.50 NA 13.90 1.64 NA 32.04 090
21750... .................. A Repair of sternum 10.77 NA 9.53 1.43 NA 21.73 090
separation.
21800... .................. A Treatment of rib fracture 0.96 1.33 0.63 0.07 2.36 1.66 090
21805... .................. A Treatment of rib fracture 2.75 NA 3.08 0.17 NA 6.00 090
21810... .................. A Treatment of rib 6.86 NA 8.65 0.61 NA 16.12 090
fracture(s).
21820... .................. A Treat sternum fracture... 1.28 1.74 0.99 0.17 3.19 2.44 090
21825... .................. A Repair sternum fracture.. 7.41 NA 7.42 1.12 NA 15.95 090
21920... .................. A Biopsy soft tissue of 2.06 1.75 0.85 0.11 3.92 3.02 010
back.
21925... .................. A Biopsy soft tissue of 4.49 7.49 3.55 0.32 12.30 8.36 090
back.
21930... .................. A Remove lesion, back or 5.00 3.64 2.52 0.49 9.13 8.01 090
flank.
21935... .................. A Remove tumor of back..... 17.96 NA 11.23 1.30 NA 30.49 090
22100... .................. A Remove part of neck 9.73 NA 7.68 1.09 NA 18.50 090
vertebra.
[[Page 30911]]
22101... .................. A Remove part, thorax 9.81 NA 7.77 1.38 NA 18.96 090
vertebra.
22102... .................. A Remove part, lumbar 9.81 NA 7.35 0.67 NA 17.83 090
vertebra.
22103... .................. A Remove extra spine 2.34 NA 1.45 0.37 NA 4.16 ZZZ
segment.
22110... .................. A Remove part of neck 12.74 NA 9.72 1.64 NA 24.10 090
vertebra.
22112... .................. A Remove part, thorax 12.81 NA 9.70 1.63 NA 24.14 090
vertebra.
22114... .................. A Remove part, lumbar 12.81 NA 9.69 1.17 NA 23.67 090
vertebra.
22116... .................. A Remove extra spine 2.32 NA 1.42 0.36 NA 4.10 ZZZ
segment.
22210... .................. A Revision of neck spine... 23.82 NA 16.43 2.43 NA 42.68 090
22212... .................. A Revision of thorax spine. 19.42 NA 14.76 2.83 NA 37.01 090
22214... .................. A Revision of lumbar spine. 19.45 NA 13.95 2.68 NA 36.08 090
22216... .................. A Revise, extra spine 6.04 NA 3.51 0.89 NA 10.44 ZZZ
segment.
22220... .................. A Revision of neck spine... 21.37 NA 14.66 2.63 NA 38.66 090
22222... .................. A Revision of thorax spine. 21.52 NA 13.03 1.58 NA 36.13 090
22224... .................. A Revision of lumbar spine. 21.52 NA 14.52 2.66 NA 38.70 090
22226... .................. A Revise, extra spine 6.04 NA 3.43 0.89 NA 10.36 ZZZ
segment.
22305... .................. A Treat spine process 2.05 2.22 1.58 0.37 4.64 4.00 090
fracture.
22310... .................. A Treat spine fracture..... 2.61 3.25 2.82 0.69 6.55 6.12 090
22315... .................. A Treat spine fracture..... 8.84 NA 7.92 0.86 NA 17.62 090
22325... .................. A Repair of spine fracture. 18.30 NA 11.68 1.34 NA 31.32 090
22326... .................. A Repair neck spine 19.59 NA 14.02 2.74 NA 36.35 090
fracture.
22327... .................. A Repair thorax spine 19.20 NA 13.47 2.35 NA 35.02 090
fracture.
22328... .................. A Repair each add spine fx. 4.61 NA 2.57 0.72 NA 7.90 ZZZ
22505... .................. A Manipulation of spine.... 1.87 2.43 1.66 0.17 4.47 3.70 010
22548... .................. A Neck spine fusion........ 25.82 NA 17.17 3.82 NA 46.81 090
22554... .................. A Neck spine fusion........ 18.62 NA 12.68 3.52 NA 34.82 090
22556... .................. A Thorax spine fusion...... 23.46 NA 16.24 3.58 NA 43.28 090
22558... .................. A Lumbar spine fusion...... 22.28 NA 15.16 3.38 NA 40.82 090
22585... .................. A Additional spinal fusion. 5.53 NA 3.18 0.93 NA 9.64 ZZZ
22590... .................. A Spine & skull spinal 20.51 NA 14.43 3.44 NA 38.38 090
fusion.
22595... .................. A Neck spinal fusion....... 19.39 NA 13.40 3.87 NA 36.66 090
22600... .................. A Neck spine fusion........ 16.14 NA 11.81 3.32 NA 31.27 090
22610... .................. A Thorax spine fusion...... 16.02 NA 12.11 2.75 NA 30.88 090
22612... .................. A Lumbar spine fusion...... 21.00 NA 14.94 3.33 NA 39.27 090
22614... .................. A Spine fusion, extra 6.44 NA 3.78 0.92 NA 11.14 ZZZ
segment.
22630... .................. A Lumbar spine fusion...... 20.84 NA 14.85 3.15 NA 38.84 090
22632... .................. A Spine fusion, extra 5.23 NA 3.01 0.82 NA 9.06 ZZZ
segment.
22800... .................. A Fusion of spine.......... 18.25 NA 13.50 3.58 NA 35.33 090
22802... .................. A Fusion of spine.......... 30.88 NA 21.23 4.61 NA 56.72 090
22804... .................. A Fusion of spine.......... 36.27 NA 24.20 4.61 NA 65.08 090
22808... .................. A Fusion of spine.......... 26.27 NA 18.13 3.15 NA 47.55 090
22810... .................. A Fusion of spine.......... 30.27 NA 19.97 3.15 NA 53.39 090
22812... .................. A Fusion of spine.......... 32.70 NA 21.49 4.24 NA 58.43 090
22818... .................. A Kyphectomy, 1-2 segments. 31.83 NA 19.42 4.85 NA 56.10 090
22819... .................. A Kyphectomy, 3 & more 36.44 NA 21.75 4.85 NA 63.04 090
segment.
22830... .................. A Exploration of spinal 10.85 NA 8.96 2.18 NA 21.99 090
fusion.
22840... .................. A Insert spine fixation 12.54 NA 7.94 0.98 NA 21.46 ZZZ
device.
22842... .................. A Insert spine fixation 12.58 NA 7.54 1.12 NA 21.24 ZZZ
device.
22843... .................. A Insert spine fixation 13.46 NA 8.67 1.40 NA 23.53 ZZZ
device.
22844... .................. A Insert spine fixation 16.44 NA 10.38 1.71 NA 28.53 ZZZ
device.
22845... .................. A Insert spine fixation 11.96 NA 7.56 0.93 NA 20.45 ZZZ
device.
22846... .................. A Insert spine fixation 12.42 NA 7.87 1.29 NA 21.58 ZZZ
device.
22847... .................. A Insert spine fixation 13.80 NA 8.62 1.44 NA 23.86 ZZZ
device.
22848... .................. A Insert pelvic fixation 6.00 NA 4.63 0.94 NA 11.57 ZZZ
device.
22849... .................. A Reinsert spinal fixation. 18.51 NA 13.16 1.97 NA 33.64 090
22850... .................. A Remove spine fixation 9.52 NA 7.79 1.50 NA 18.81 090
device.
22851... .................. A Apply spine prosth device 6.71 NA 4.70 1.05 NA 12.46 ZZZ
22852... .................. A Remove spine fixation 9.01 NA 7.52 1.57 NA 18.10 090
device.
22855... .................. A Remove spine fixation 15.13 NA 10.74 1.25 NA 27.12 090
device.
22900... .................. A Remove abdominal wall 5.80 NA 3.87 0.60 NA 10.27 090
lesion.
23000... .................. A Removal of calcium 4.36 5.42 5.20 0.47 10.25 10.03 090
deposits.
23020... .................. A Release shoulder joint... 8.93 NA 8.38 1.09 NA 18.40 090
23030... .................. A Drain shoulder lesion.... 3.43 3.56 3.34 0.35 7.34 7.12 010
23031... .................. A Drain shoulder bursa..... 2.74 3.26 3.12 0.05 6.05 5.91 010
23035... .................. A Drain shoulder bone 8.61 NA 11.29 1.04 NA 20.94 090
lesion.
23040... .................. A Exploratory shoulder 9.20 NA 9.44 1.47 NA 20.11 090
surgery.
23044... .................. A Exploratory shoulder 7.12 NA 7.98 1.18 NA 16.28 090
surgery.
23065... .................. A Biopsy shoulder tissues.. 2.27 2.22 1.28 0.09 4.58 3.64 010
23066... .................. A Biopsy shoulder tissues.. 4.16 4.62 4.33 0.10 8.88 8.59 090
23075... .................. A Removal of shoulder 2.39 2.93 2.25 0.29 5.61 4.93 010
lesion.
23076... .................. A Removal of shoulder 7.63 NA 6.07 0.65 NA 14.35 090
lesion.
23077... .................. A Remove tumor of shoulder. 16.09 NA 11.47 1.38 NA 28.94 090
23100... .................. A Biopsy of shoulder joint. 6.03 NA 6.40 1.24 NA 13.67 090
23101... .................. A Shoulder joint surgery... 5.58 NA 6.34 1.21 NA 13.13 090
23105... .................. A Remove shoulder joint 8.23 NA 7.89 1.73 NA 17.85 090
lining.
[[Page 30912]]
23106... .................. A Incision of collarbone 5.96 NA 6.22 0.80 NA 12.98 090
joint.
23107... .................. A Explore,treat shoulder 8.62 NA 8.13 1.60 NA 18.35 090
joint.
23120... .................. A Partial removal, collar 7.11 NA 7.35 0.74 NA 15.20 090
bone.
23125... .................. A Removal of collarbone.... 9.39 NA 8.49 1.27 NA 19.15 090
23130... .................. A Partial removal, 7.55 NA 7.61 1.14 NA 16.30 090
shoulderbone.
23140... .................. A Removal of bone lesion... 6.89 NA 5.98 0.73 NA 13.60 090
23145... .................. A Removal of bone lesion... 9.09 NA 8.41 1.33 NA 18.83 090
23146... .................. A Removal of bone lesion... 7.83 NA 17.31 1.01 NA 26.15 090
23150... .................. A Removal of humerus lesion 8.48 NA 7.89 1.01 NA 17.38 090
23155... .................. A Removal of humerus lesion 10.35 NA 9.85 1.37 NA 21.57 090
23156... .................. A Removal of humerus lesion 8.68 NA 8.40 1.25 NA 18.33 090
23170... .................. A Remove collarbone lesion. 6.86 NA 7.68 0.78 NA 15.32 090
23172... .................. A Remove shoulder blade 6.90 NA 7.76 0.73 NA 15.39 090
lesion.
23174... .................. A Remove humerus lesion.... 9.51 NA 9.23 1.21 NA 19.95 090
23180... .................. A Remove collar bone lesion 8.53 NA 11.46 0.67 NA 20.66 090
23182... .................. A Remove shoulder blade 8.15 NA 10.95 1.13 NA 20.23 090
lesion.
23184... .................. A Remove humerus lesion.... 9.38 NA 12.03 1.48 NA 22.89 090
23190... .................. A Partial removal of 7.24 NA 6.52 0.98 NA 14.74 090
scapula.
23195... .................. A Removal of head of 9.81 NA 8.88 1.45 NA 20.14 090
humerus.
23200... .................. A Removal of collar bone... 12.08 NA 9.81 1.26 NA 23.15 090
23210... .................. A Removal of shoulderblade. 12.49 NA 10.38 1.41 NA 24.28 090
23220... .................. A Partial removal of 14.56 NA 12.42 2.03 NA 29.01 090
humerus.
23221... .................. A Partial removal of 17.74 NA 13.26 1.19 NA 32.19 090
humerus.
23222... .................. A Partial removal of 23.92 NA 17.77 2.30 NA 43.99 090
humerus.
23330... .................. A Remove shoulder foreign 1.85 3.00 2.14 0.07 4.92 4.06 010
body.
23331... .................. A Remove shoulder foreign 7.38 NA 7.54 0.38 NA 15.30 090
body.
23332... .................. A Remove shoulder foreign 11.62 NA 10.00 1.57 NA 23.19 090
body.
23350... .................. A Injection for shoulder x- 1.00 7.27 0.32 0.05 8.32 1.37 000
ray.
23395... .................. A Muscle transfer, shoulder/ 16.85 NA 12.50 1.84 NA 31.19 090
arm.
23397... .................. A Muscle transfers......... 16.13 NA 12.69 2.34 NA 31.16 090
23400... .................. A Fixation of shoulder 13.54 NA 11.05 1.68 NA 26.27 090
blade.
23405... .................. A Incision of tendon & 8.37 NA 7.26 0.99 NA 16.62 090
muscle.
23406... .................. A Incise tendon(s) & 10.79 NA 9.63 1.58 NA 22.00 090
muscle(s).
23410... .................. A Repair of tendon(s)...... 12.45 NA 10.34 1.75 NA 24.54 090
23412... .................. A Repair of tendon(s)...... 13.31 NA 10.87 2.16 NA 26.34 090
23415... .................. A Release of shoulder 9.97 NA 8.38 0.83 NA 19.18 090
ligament.
23420... .................. A Repair of shoulder....... 13.30 NA 11.39 2.34 NA 27.03 090
23430... .................. A Repair biceps tendon..... 9.98 NA 8.91 1.19 NA 20.08 090
23440... .................. A Removal/transplant tendon 10.48 NA 9.31 1.17 NA 20.96 090
23450... .................. A Repair shoulder capsule.. 13.40 NA 10.73 2.04 NA 26.17 090
23455... .................. A Repair shoulder capsule.. 14.37 NA 11.51 2.50 NA 28.38 090
23460... .................. A Repair shoulder capsule.. 15.37 NA 6.49 2.24 NA 24.10 090
23462... .................. A Repair shoulder capsule.. 15.30 NA 12.08 2.48 NA 29.86 090
23465... .................. A Repair shoulder capsule.. 15.85 NA 12.50 2.27 NA 30.62 090
23466... .................. A Repair shoulder capsule.. 14.22 NA 11.54 2.67 NA 28.43 090
23470... .................. A Reconstruct shoulder 17.15 NA 13.00 2.65 NA 32.80 090
joint.
23472... .................. A Reconstruct shoulder 16.92 NA 13.09 4.89 NA 34.90 090
joint.
23480... .................. A Revision of collarbone... 11.18 NA 9.78 1.02 NA 21.98 090
23485... .................. A Revision of collar bone.. 13.43 NA 11.19 1.87 NA 26.49 090
23490... .................. A Reinforce clavicle....... 11.86 NA 9.43 0.80 NA 22.09 090
23491... .................. A Reinforce shoulder bones. 14.21 NA 11.56 2.11 NA 27.88 090
23500... .................. A Treat clavicle fracture.. 2.08 2.63 1.61 0.21 4.92 3.90 090
23505... .................. A Treat clavicle fracture.. 3.69 4.24 3.17 0.38 8.31 7.24 090
23515... .................. A Repair clavicle fracture. 7.41 NA 6.65 1.12 NA 15.18 090
23520... .................. A Treat clavicle 2.16 2.54 1.82 0.19 4.89 4.17 090
dislocation.
23525... .................. A Treat clavicle 3.60 4.07 3.00 0.27 7.94 6.87 090
dislocation.
23530... .................. A Repair clavicle 7.31 NA 5.55 0.91 NA 13.77 090
dislocation.
23532... .................. A Repair clavicle 8.01 NA 7.16 1.19 NA 16.36 090
dislocation.
23540... .................. A Treat clavicle 2.23 3.04 1.43 0.19 5.46 3.85 090
dislocation.
23545... .................. A Treat clavicle 3.25 3.55 2.57 0.29 7.09 6.11 090
dislocation.
23550... .................. A Repair clavicle 7.24 NA 6.40 1.46 NA 15.10 090
dislocation.
23552... .................. A Repair clavicle 8.45 NA 7.05 1.17 NA 16.67 090
dislocation.
23570... .................. A Treat shoulderblade 2.23 2.68 2.01 0.25 5.16 4.49 090
fracture.
23575... .................. A Treat shoulderblade 4.06 4.54 3.46 0.43 9.03 7.95 090
fracture.
23585... .................. A Repair scapula fracture.. 8.96 NA 7.78 1.29 NA 18.03 090
23600... .................. A Treat humerus fracture... 2.93 4.15 2.57 0.43 7.51 5.93 090
23605... .................. A Treat humerus fracture... 4.87 6.21 5.13 0.76 11.84 10.76 090
23615... .................. A Repair humerus fracture.. 9.35 NA 8.32 1.78 NA 19.45 090
23616... .................. A Repair humerus fracture.. 21.27 NA 14.86 3.54 NA 39.67 090
23620... .................. A Treat humerus fracture... 2.40 3.85 2.21 0.46 6.71 5.07 090
23625... .................. A Treat humerus fracture... 3.93 5.44 4.29 0.60 9.97 8.82 090
23630... .................. A Repair humerus fracture.. 7.35 NA 6.58 1.40 NA 15.33 090
23650... .................. A Treat shoulder 3.39 3.73 1.91 0.24 7.36 5.54 090
dislocation.
23655... .................. A Treat shoulder 4.57 NA 3.11 0.44 NA 8.12 090
dislocation.
[[Page 30913]]
23660... .................. A Repair shoulder 7.49 NA 6.16 1.40 NA 15.05 090
dislocation.
23665... .................. A Treat dislocation/ 4.47 5.60 4.59 0.51 10.58 9.57 090
fracture.
23670... .................. A Repair dislocation/ 7.90 NA 7.09 1.85 NA 16.84 090
fracture.
23675... .................. A Treat dislocation/ 6.05 6.66 5.56 0.61 13.32 12.22 090
fracture.
23680... .................. A Repair dislocation/ 10.06 NA 8.32 2.13 NA 20.51 090
fracture.
23700... .................. A Fixation of shoulder..... 2.52 NA 2.79 0.34 NA 5.65 010
23800... .................. A Fusion of shoulder joint. 14.16 NA 11.49 2.63 NA 28.28 090
23802... .................. A Fusion of shoulder joint. 16.60 NA 13.56 2.24 NA 32.40 090
23900... .................. A Amputation of arm & 19.72 NA 13.23 2.40 NA 35.35 090
girdle.
23920... .................. A Amputation at shoulder 14.61 NA 11.09 2.54 NA 28.24 090
joint.
23921... .................. A Amputation follow-up 5.49 6.05 4.83 0.74 12.28 11.06 090
surgery.
23930... .................. A Drainage of arm lesion... 2.94 3.45 2.68 0.24 6.63 5.86 010
23931... .................. A Drainage of arm bursa.... 1.79 3.20 2.61 0.11 5.10 4.51 010
23935... .................. A Drain arm/elbow bone 6.09 NA 8.88 0.78 NA 15.75 090
lesion.
24000... .................. A Exploratory elbow surgery 5.82 NA 5.29 1.44 NA 12.55 090
24006... .................. A Release elbow joint...... 9.31 NA 7.32 1.17 NA 17.80 090
24065... .................. A Biopsy arm/elbow soft 2.08 2.91 2.19 0.10 5.09 4.37 010
tissue.
24066... .................. A Biopsy arm/elbow soft 5.21 5.26 4.91 0.41 10.88 10.53 090
tissue.
24075... .................. A Remove arm/elbow lesion.. 3.92 4.47 3.94 0.35 8.74 8.21 090
24076... .................. A Remove arm/elbow lesion.. 6.30 NA 5.29 0.67 NA 12.26 090
24077... .................. A Remove tumor of arm/elbow 11.76 NA 9.56 1.87 NA 23.19 090
24100... .................. A Biopsy elbow joint lining 4.93 NA 4.41 0.69 NA 10.03 090
24101... .................. A Explore/treat elbow joint 6.13 NA 5.48 1.41 NA 13.02 090
24102... .................. A Remove elbow joint lining 8.03 NA 5.02 1.81 NA 14.86 090
24105... .................. A Removal of elbow bursa... 3.61 NA 3.83 0.63 NA 8.07 090
24110... .................. A Remove humerus lesion.... 7.39 NA 7.38 1.22 NA 15.99 090
24115... .................. A Remove/graft bone lesion. 9.63 NA 9.08 1.33 NA 20.04 090
24116... .................. A Remove/graft bone lesion. 11.81 NA 10.34 1.47 NA 23.62 090
24120... .................. A Remove elbow lesion...... 6.65 NA 5.69 0.98 NA 13.32 090
24125... .................. A Remove/graft bone lesion. 7.89 NA 6.71 0.61 NA 15.21 090
24126... .................. A Remove/graft bone lesion. 8.31 NA 5.16 1.21 NA 14.68 090
24130... .................. A Removal of head of radius 6.25 NA 5.61 1.08 NA 12.94 090
24134... .................. A Removal of arm bone 9.73 NA 11.90 1.24 NA 22.87 090
lesion.
24136... .................. A Remove radius bone lesion 7.99 NA 5.46 0.92 NA 14.37 090
24138... .................. A Remove elbow bone lesion. 8.05 NA 6.86 1.06 NA 15.97 090
24140... .................. A Partial removal of arm 9.18 NA 12.04 1.45 NA 22.67 090
bone.
24145... .................. A Partial removal of radius 7.58 NA 8.91 1.03 NA 17.52 090
24147... .................. A Partial removal of elbow. 7.54 NA 8.68 1.08 NA 17.30 090
24149... .................. A Radical resection of 14.20 NA 9.65 2.07 NA 25.92 090
elbow.
24150... .................. A Extensive humerus surgery 13.27 NA 11.56 2.24 NA 27.07 090
24151... .................. A Extensive humerus surgery 15.58 NA 12.80 2.11 NA 30.49 090
24152... .................. A Extensive radius surgery. 10.06 NA 8.54 1.16 NA 19.76 090
24153... .................. A Extensive radius surgery. 11.54 NA 6.20 1.71 NA 19.45 090
24155... .................. A Removal of elbow joint... 11.73 NA 8.35 1.72 NA 21.80 090
24160... .................. A Remove elbow joint 7.83 NA 6.62 0.80 NA 15.25 090
implant.
24164... .................. A Remove radius head 6.23 NA 5.52 0.90 NA 12.65 090
implant.
24200... .................. A Removal of arm foreign 1.76 2.87 1.96 0.06 4.69 3.78 010
body.
24201... .................. A Removal of arm foreign 4.56 5.46 4.53 0.49 10.51 9.58 090
body.
24220... .................. A Injection for elbow x-ray 1.31 8.29 0.43 0.05 9.65 1.79 000
24301... .................. A Muscle/tendon transfer... 10.20 NA 7.76 1.23 NA 19.19 090
24305... .................. A Arm tendon lengthening... 7.45 NA 6.23 0.29 NA 13.97 090
24310... .................. A Revision of arm tendon... 5.98 NA 6.20 0.48 NA 12.66 090
24320... .................. A Repair of arm tendon..... 10.56 NA 7.53 1.29 NA 19.38 090
24330... .................. A Revision of arm muscles.. 9.60 NA 7.25 1.43 NA 18.28 090
24331... .................. A Revision of arm muscles.. 10.65 NA 8.39 1.57 NA 20.61 090
24340... .................. A Repair of biceps tendon.. 7.89 NA 6.50 1.13 NA 15.52 090
24341... .................. A Repair tendon/muscle arm. 7.90 NA 6.57 1.14 NA 15.61 090
24342... .................. A Repair of ruptured tendon 10.62 NA 8.13 1.76 NA 20.51 090
24350... .................. A Repair of tennis elbow... 5.25 NA 4.97 0.69 NA 10.91 090
24351... .................. A Repair of tennis elbow... 5.91 NA 5.44 0.73 NA 12.08 090
24352... .................. A Repair of tennis elbow... 6.43 NA 5.76 0.93 NA 13.12 090
24354... .................. A Repair of tennis elbow... 6.48 NA 5.81 0.94 NA 13.23 090
24356... .................. A Revision of tennis elbow. 6.68 NA 5.85 1.18 NA 13.71 090
24360... .................. A Reconstruct elbow joint.. 12.34 NA 9.03 2.47 NA 23.84 090
24361... .................. A Reconstruct elbow joint.. 14.08 NA 10.28 2.00 NA 26.36 090
24362... .................. A Reconstruct elbow joint.. 14.99 NA 8.91 0.80 NA 24.70 090
24363... .................. A Replace elbow joint...... 18.49 NA 12.86 4.13 NA 35.48 090
24365... .................. A Reconstruct head of 8.39 NA 6.95 1.19 NA 16.53 090
radius.
24366... .................. A Reconstruct head of 9.13 NA 7.19 1.80 NA 18.12 090
radius.
24400... .................. A Revision of humerus...... 11.06 NA 10.14 1.37 NA 22.57 090
24410... .................. A Revision of humerus...... 14.82 NA 11.94 2.06 NA 28.82 090
24420... .................. A Revision of humerus...... 13.44 NA 13.08 2.01 NA 28.53 090
24430... .................. A Repair of humerus........ 12.81 NA 10.71 2.34 NA 25.86 090
24435... .................. A Repair humerus with graft 13.17 NA 11.46 2.84 NA 27.47 090
[[Page 30914]]
24470... .................. A Revision of elbow joint.. 8.74 NA 4.63 1.30 NA 14.67 090
24495... .................. A Decompression of forearm. 8.12 NA 7.31 1.10 NA 16.53 090
24498... .................. A Reinforce humerus........ 11.92 NA 10.21 1.62 NA 23.75 090
24500... .................. A Treat humerus fracture... 3.21 5.47 2.28 0.36 9.04 5.85 090
24505... .................. A Treat humerus fracture... 5.17 8.36 5.37 0.71 14.24 11.25 090
24515... .................. A Repair humerus fracture.. 11.65 NA 9.55 1.54 NA 22.74 090
24516... .................. A Repair humerus fracture.. 11.65 NA 9.97 1.54 NA 23.16 090
24530... .................. A Treat humerus fracture... 3.50 6.29 3.38 0.42 10.21 7.30 090
24535... .................. A Treat humerus fracture... 6.87 8.76 5.80 0.78 16.41 13.45 090
24538... .................. A Treat humerus fracture... 9.43 NA 8.63 1.26 NA 19.32 090
24545... .................. A Repair humerus fracture.. 10.46 NA 8.63 1.59 NA 20.68 090
24546... .................. A Repair humerus fracture.. 15.69 NA 11.88 1.59 NA 29.16 090
24560... .................. A Treat humerus fracture... 2.80 5.22 1.84 0.30 8.32 4.94 090
24565... .................. A Treat humerus fracture... 5.56 7.80 4.89 0.54 13.90 10.99 090
24566... .................. A Treat humerus fracture... 7.79 NA 7.72 0.96 NA 16.47 090
24575... .................. A Repair humerus fracture.. 10.66 NA 7.63 1.24 NA 19.53 090
24576... .................. A Treat humerus fracture... 2.86 5.19 2.32 0.33 8.38 5.51 090
24577... .................. A Treat humerus fracture... 5.79 8.10 5.13 0.61 14.50 11.53 090
24579... .................. A Repair humerus fracture.. 11.60 NA 9.50 1.35 NA 22.45 090
24582... .................. A Treat humerus fracture... 8.55 NA 7.95 1.06 NA 17.56 090
24586... .................. A Repair elbow fracture.... 15.21 NA 10.29 2.36 NA 27.86 090
24587... .................. A Repair elbow fracture.... 15.16 NA 10.16 2.17 NA 27.49 090
24600... .................. A Treat elbow dislocation.. 4.23 6.87 3.19 0.26 11.36 7.68 090
24605... .................. A Treat elbow dislocation.. 5.42 NA 4.19 0.37 NA 9.98 090
24615... .................. A Repair elbow dislocation. 9.42 NA 7.03 1.48 NA 17.93 090
24620... .................. A Treat elbow fracture..... 6.98 NA 5.53 0.57 NA 13.08 090
24635... .................. A Repair elbow fracture.... 13.19 NA 17.15 1.78 NA 32.12 090
24640... .................. A Treat elbow dislocation.. 1.20 3.49 0.77 0.08 4.77 2.05 010
24650... .................. A Treat radius fracture.... 2.16 4.93 1.72 0.33 7.42 4.21 090
24655... .................. A Treat radius fracture.... 4.40 7.15 4.13 0.45 12.00 8.98 090
24665... .................. A Repair radius fracture... 8.14 NA 7.41 1.14 NA 16.69 090
24666... .................. A Repair radius fracture... 9.49 NA 8.31 1.60 NA 19.40 090
24670... .................. A Treatment of ulna 2.54 4.99 2.09 0.27 7.80 4.90 090
fracture.
24675... .................. A Treatment of ulna 4.72 7.44 4.48 0.54 12.70 9.74 090
fracture.
24685... .................. A Repair ulna fracture..... 8.80 NA 7.82 1.34 NA 17.96 090
24800... .................. A Fusion of elbow joint.... 11.20 NA 8.22 1.55 NA 20.97 090
24802... .................. A Fusion/graft of elbow 13.69 NA 10.51 1.99 NA 26.19 090
joint.
24900... .................. A Amputation of upper arm.. 9.60 NA 8.14 1.39 NA 19.13 090
24920... .................. A Amputation of upper arm.. 9.54 NA 9.61 1.19 NA 20.34 090
24925... .................. A Amputation follow-up 7.07 NA 6.11 0.75 NA 13.93 090
surgery.
24930... .................. A Amputation follow-up 10.25 NA 9.60 1.17 NA 21.02 090
surgery.
24931... .................. A Amputate upper arm & 12.72 NA 11.49 1.84 NA 26.05 090
implant.
24935... .................. A Revision of amputation... 15.56 NA 10.07 2.24 NA 27.87 090
25000... .................. A Incision of tendon sheath 3.38 NA 5.29 0.62 NA 9.29 090
25020... .................. A Decompression of forearm. 5.92 NA 7.99 0.77 NA 14.68 090
25023... .................. A Decompression of forearm. 12.96 NA 13.16 0.94 NA 27.06 090
25028... .................. A Drainage of forearm 5.25 NA 6.95 0.36 NA 12.56 090
lesion.
25031... .................. A Drainage of forearm bursa 4.14 NA 6.81 0.09 NA 11.04 090
25035... .................. A Treat forearm bone lesion 7.36 NA 11.52 1.01 NA 19.89 090
25040... .................. A Explore/treat wrist joint 7.18 NA 7.45 0.90 NA 15.53 090
25065... .................. A Biopsy forearm soft 1.99 1.90 2.55 0.09 3.98 4.63 010
tissues.
25066... .................. A Biopsy forearm soft 4.13 NA 6.13 0.22 NA 10.48 090
tissues.
25075... .................. A Removal of forearm lesion 3.74 NA 5.14 0.37 NA 9.25 090
25076... .................. A Removal of forearm lesion 4.92 NA 8.53 0.67 NA 14.12 090
25077... .................. A Remove tumor, forearm/ 9.76 NA 10.69 1.67 NA 22.12 090
wrist.
25085... .................. A Incision of wrist capsule 5.50 NA 7.81 0.71 NA 14.02 090
25100... .................. A Biopsy of wrist joint.... 3.90 NA 5.49 0.79 NA 10.18 090
25101... .................. A Explore/treat wrist joint 4.69 NA 5.99 0.98 NA 11.66 090
25105... .................. A Remove wrist joint lining 5.85 NA 8.15 1.19 NA 15.19 090
25107... .................. A Remove wrist joint 6.43 NA 8.52 0.89 NA 15.84 090
cartilage.
25110... .................. A Remove wrist tendon 3.92 NA 5.83 0.46 NA 10.21 090
lesion.
25111... .................. A Remove wrist tendon 3.39 NA 4.52 0.55 NA 8.46 090
lesion.
25112... .................. A Reremove wrist tendon 4.53 NA 5.26 0.66 NA 10.45 090
lesion.
25115... .................. A Remove wrist/forearm 8.82 NA 11.76 1.23 NA 21.81 090
lesion.
25116... .................. A Remove wrist/forearm 7.11 NA 10.94 1.38 NA 19.43 090
lesion.
25118... .................. A Excise wrist tendon 4.37 NA 5.83 1.02 NA 11.22 090
sheath.
25119... .................. A Partial removal of ulna.. 6.04 NA 8.38 1.32 NA 15.74 090
25120... .................. A Removal of forearm lesion 6.10 NA 10.24 1.14 NA 17.48 090
25125... .................. A Remove/graft forearm 7.48 NA 10.82 1.04 NA 19.34 090
lesion.
25126... .................. A Remove/graft forearm 7.55 NA 11.84 1.12 NA 20.51 090
lesion.
25130... .................. A Removal of wrist lesion.. 5.26 NA 6.41 0.67 NA 12.34 090
25135... .................. A Remove & graft wrist 6.89 NA 7.29 0.97 NA 15.15 090
lesion.
25136... .................. A Remove & graft wrist 5.97 NA 6.61 0.85 NA 13.43 090
lesion.
25145... .................. A Remove forearm bone 6.37 NA 10.24 0.75 NA 17.36 090
lesion.
[[Page 30915]]
25150... .................. A Partial removal of ulna.. 7.09 NA 8.99 1.12 NA 17.20 090
25151... .................. A Partial removal of radius 7.39 NA 11.22 1.02 NA 19.63 090
25170... .................. A Extensive forearm surgery 11.09 NA 12.78 1.51 NA 25.38 090
25210... .................. A Removal of wrist bone.... 5.95 NA 6.68 0.80 NA 13.43 090
25215... .................. A Removal of wrist bones... 7.89 NA 9.32 1.42 NA 18.63 090
25230... .................. A Partial removal of radius 5.23 NA 6.38 0.85 NA 12.46 090
25240... .................. A Partial removal of ulna.. 5.17 NA 7.82 0.86 NA 13.85 090
25246... .................. A Injection for wrist x-ray 1.45 8.10 0.47 0.05 9.60 1.97 000
25248... .................. A Remove forearm foreign 5.14 NA 6.89 0.37 NA 12.40 090
body.
25250... .................. A Removal of wrist 6.60 NA 7.13 0.91 NA 14.64 090
prosthesis.
25251... .................. A Removal of wrist 9.57 NA 10.66 1.39 NA 21.62 090
prosthesis.
25260... .................. A Repair forearm tendon/ 7.80 NA 11.24 0.78 NA 19.82 090
muscle.
25263... .................. A Repair forearm tendon/ 7.82 NA 10.83 1.03 NA 19.68 090
muscle.
25265... .................. A Repair forearm tendon/ 9.88 NA 12.92 1.41 NA 24.21 090
muscle.
25270... .................. A Repair forearm tendon/ 6.00 NA 10.35 0.55 NA 16.90 090
muscle.
25272... .................. A Repair forearm tendon/ 7.04 NA 10.95 0.54 NA 18.53 090
muscle.
25274... .................. A Repair forearm tendon/ 8.75 NA 11.62 1.13 NA 21.50 090
muscle.
25280... .................. A Revise wrist/forearm 7.22 NA 11.21 0.69 NA 19.12 090
tendon.
25290... .................. A Incise wrist/forearm 5.29 NA 12.04 0.41 NA 17.74 090
tendon.
25295... .................. A Release wrist/forearm 6.55 NA 9.86 0.52 NA 16.93 090
tendon.
25300... .................. A Fusion of tendons at 8.80 NA 8.20 1.19 NA 18.19 090
wrist.
25301... .................. A Fusion of tendons at 8.40 NA 7.92 1.18 NA 17.50 090
wrist.
25310... .................. A Transplant forearm tendon 8.14 NA 11.53 1.17 NA 20.84 090
25312... .................. A Transplant forearm tendon 9.57 NA 12.17 1.31 NA 23.05 090
25315... .................. A Revise palsy hand 10.20 NA 13.02 1.34 NA 24.56 090
tendon(s).
25316... .................. A Revise palsy hand 12.33 NA 14.28 1.78 NA 28.39 090
tendon(s).
25320... .................. A Repair/revise wrist joint 10.77 NA 9.55 1.45 NA 21.77 090
25332... .................. A Revise wrist joint....... 11.41 NA 9.84 1.61 NA 22.86 090
25335... .................. A Realignment of hand...... 12.88 NA 12.17 1.56 NA 26.61 090
25337... .................. A Reconstruct ulna/ 10.17 NA 10.87 1.45 NA 22.49 090
radioulnar.
25350... .................. A Revision of radius....... 8.78 NA 11.95 1.26 NA 21.99 090
25355... .................. A Revision of radius....... 10.17 NA 12.54 1.49 NA 24.20 090
25360... .................. A Revision of ulna......... 8.43 NA 11.72 0.99 NA 21.14 090
25365... .................. A Revise radius & ulna..... 12.40 NA 13.58 1.57 NA 27.55 090
25370... .................. A Revise radius or ulna.... 13.36 NA 15.03 1.92 NA 30.31 090
25375... .................. A Revise radius & ulna..... 13.04 NA 14.84 0.87 NA 28.75 090
25390... .................. A Shorten radius/ulna...... 10.40 NA 13.14 1.50 NA 25.04 090
25391... .................. A Lengthen radius/ulna..... 13.65 NA 14.69 1.93 NA 30.27 090
25392... .................. A Shorten radius & ulna.... 13.95 NA 13.19 2.04 NA 29.18 090
25393... .................. A Lengthen radius & ulna... 15.87 NA 16.01 2.32 NA 34.20 090
25400... .................. A Repair radius or ulna.... 10.92 NA 13.41 1.75 NA 26.08 090
25405... .................. A Repair/graft radius or 14.38 NA 15.51 2.02 NA 31.91 090
ulna.
25415... .................. A Repair radius & ulna..... 13.35 NA 14.84 1.92 NA 30.11 090
25420... .................. A Repair/graft radius & 16.33 NA 16.41 2.28 NA 35.02 090
ulna.
25425... .................. A Repair/graft radius or 13.21 NA 19.06 1.87 NA 34.14 090
ulna.
25426... .................. A Repair/graft radius & 15.82 NA 15.54 2.13 NA 33.49 090
ulna.
25440... .................. A Repair/graft wrist bone.. 10.44 NA 9.35 1.50 NA 21.29 090
25441... .................. A Reconstruct wrist joint.. 12.90 NA 10.57 1.89 NA 25.36 090
25442... .................. A Reconstruct wrist joint.. 10.85 NA 9.78 1.22 NA 21.85 090
25443... .................. A Reconstruct wrist joint.. 10.39 NA 11.14 1.52 NA 23.05 090
25444... .................. A Reconstruct wrist joint.. 11.15 NA 11.18 1.66 NA 23.99 090
25445... .................. A Reconstruct wrist joint.. 9.69 NA 10.54 1.72 NA 21.95 090
25446... .................. A Wrist replacement........ 16.55 NA 12.82 3.49 NA 32.86 090
25447... .................. A Repair wrist joint(s).... 10.37 NA 9.41 1.56 NA 21.34 090
25449... .................. A Remove wrist joint 14.49 NA 13.45 1.16 NA 29.10 090
implant.
25450... .................. A Revision of wrist joint.. 7.87 NA 6.29 1.19 NA 15.35 090
25455... .................. A Revision of wrist joint.. 9.49 NA 12.73 1.42 NA 23.64 090
25490... .................. A Reinforce radius......... 9.54 NA 12.48 1.42 NA 23.44 090
25491... .................. A Reinforce ulna........... 9.96 NA 12.22 1.49 NA 23.67 090
25492... .................. A Reinforce radius and ulna 12.33 NA 14.20 1.84 NA 28.37 090
25500... .................. A Treat fracture of radius. 2.45 4.50 1.75 0.29 7.24 4.49 090
25505... .................. A Treat fracture of radius. 5.21 7.56 4.57 0.51 13.28 10.29 090
25515... .................. A Repair fracture of radius 9.18 NA 8.04 1.22 NA 18.44 090
25520... .................. A Repair fracture of radius 6.26 7.33 5.16 0.94 14.53 12.36 090
25525... .................. A Repair fracture of radius 12.24 NA 9.89 1.83 NA 23.96 090
25526... .................. A Repair fracture of radius 12.98 NA 14.96 1.94 NA 29.88 090
25530... .................. A Treat fracture of ulna... 2.09 4.66 1.88 0.35 7.10 4.32 090
25535... .................. A Treat fracture of ulna... 5.14 7.62 4.56 0.54 13.30 10.24 090
25545... .................. A Repair fracture of ulna.. 8.90 NA 7.87 1.20 NA 17.97 090
25560... .................. A Treat fracture radius & 2.44 4.72 1.52 0.27 7.43 4.23 090
ulna.
25565... .................. A Treat fracture radius & 5.63 7.84 4.83 0.70 14.17 11.16 090
ulna.
25574... .................. A Treat fracture radius & 7.01 NA 6.77 1.73 NA 15.51 090
ulna.
25575... .................. A Repair fracture radius/ 10.45 NA 8.74 1.73 NA 20.92 090
ulna.
25600... .................. A Treat fracture radius/ 2.63 5.04 1.96 0.42 8.09 5.01 090
ulna.
[[Page 30916]]
25605... .................. A Treat fracture radius/ 5.81 8.09 5.07 0.61 14.51 11.49 090
ulna.
25611... .................. A Repair fracture radius/ 7.77 NA 7.72 0.97 NA 16.46 090
ulna.
25620... .................. A Repair fracture radius/ 8.55 NA 7.68 1.14 NA 17.37 090
ulna.
25622... .................. A Treat wrist bone fracture 2.61 4.94 1.89 0.33 7.88 4.83 090
25624... .................. A Treat wrist bone fracture 4.53 7.20 4.03 0.57 12.30 9.13 090
25628... .................. A Repair wrist bone 8.43 NA 7.54 1.16 NA 17.13 090
fracture.
25630... .................. A Treat wrist bone fracture 2.88 5.15 1.89 0.30 8.33 5.07 090
25635... .................. A Treat wrist bone fracture 4.39 7.04 2.65 0.50 11.93 7.54 090
25645... .................. A Repair wrist bone 7.25 NA 6.63 0.95 NA 14.83 090
fracture.
25650... .................. A Repair wrist bone 3.05 5.07 1.85 0.36 8.48 5.26 090
fracture.
25660... .................. A Treat wrist dislocation.. 4.76 NA 3.77 0.26 NA 8.79 090
25670... .................. A Repair wrist dislocation. 7.92 NA 7.24 1.12 NA 16.28 090
25675... .................. A Treat wrist dislocation.. 4.67 6.88 3.73 0.34 11.89 8.74 090
25676... .................. A Repair wrist dislocation. 8.04 NA 7.31 1.11 NA 16.46 090
25680... .................. A Treat wrist fracture..... 5.99 NA 4.82 0.36 NA 11.17 090
25685... .................. A Repair wrist fracture.... 9.78 NA 8.08 1.44 NA 19.30 090
25690... .................. A Treat wrist dislocation.. 5.50 NA 5.30 0.73 NA 11.53 090
25695... .................. A Repair wrist dislocation. 8.34 NA 7.53 1.17 NA 17.04 090
25800... .................. A Fusion of wrist joint.... 9.76 NA 9.00 1.80 NA 20.56 090
25805... .................. A Fusion/graft of wrist 11.28 NA 9.89 2.09 NA 23.26 090
joint.
25810... .................. A Fusion/graft of wrist 10.57 NA 9.51 2.06 NA 22.14 090
joint.
25820... .................. A Fusion of hand bones..... 7.45 NA 7.22 1.48 NA 16.15 090
25825... .................. A Fusion hand bones with 9.27 NA 8.75 1.99 NA 20.01 090
graft.
25830... .................. A Fusion radioulnar jnt/ 10.06 NA 12.33 1.45 NA 23.84 090
ulna.
25900... .................. A Amputation of forearm.... 9.01 NA 10.20 1.31 NA 20.52 090
25905... .................. A Amputation of forearm.... 9.12 NA 10.56 1.15 NA 20.83 090
25907... .................. A Amputation follow-up 7.80 NA 9.44 1.00 NA 18.24 090
surgery.
25909... .................. A Amputation follow-up 8.96 NA 9.25 1.06 NA 19.27 090
surgery.
25915... .................. A Amputation of forearm.... 17.08 NA 27.86 2.59 NA 47.53 090
25920... .................. A Amputate hand at wrist... 8.68 NA 7.64 1.20 NA 17.52 090
25922... .................. A Amputate hand at wrist... 7.42 NA 8.39 1.02 NA 16.83 090
25924... .................. A Amputation follow-up 8.46 NA 6.74 1.22 NA 16.42 090
surgery.
25927... .................. A Amputation of hand....... 8.80 NA 9.39 1.22 NA 19.41 090
25929... .................. A Amputation follow-up 7.59 NA 5.42 0.96 NA 13.97 090
surgery.
25931... .................. A Amputation follow-up 7.81 NA 9.81 0.90 NA 18.52 090
surgery.
26010... .................. A Drainage of finger 1.54 3.16 2.25 0.05 4.75 3.84 010
abscess.
26011... .................. A Drainage of finger 2.19 4.46 4.45 0.24 6.89 6.88 010
abscess.
26020... .................. A Drain hand tendon sheath. 4.67 NA 8.66 0.63 NA 13.96 090
26025... .................. A Drainage of palm bursa... 4.82 NA 8.82 0.76 NA 14.40 090
26030... .................. A Drainage of palm bursa(s) 5.93 NA 9.38 0.98 NA 16.29 090
26034... .................. A Treat hand bone lesion... 6.23 NA 10.41 0.71 NA 17.35 090
26035... .................. A Decompress fingers/hand.. 9.51 NA 11.92 0.86 NA 22.29 090
26037... .................. A Decompress fingers/hand.. 7.25 NA 7.75 1.05 NA 16.05 090
26040... .................. A Release palm contracture. 3.33 NA 7.99 0.49 NA 11.81 090
26045... .................. A Release palm contracture. 5.56 NA 9.39 0.81 NA 15.76 090
26055... .................. A Incise finger tendon 2.69 5.15 8.67 0.56 8.40 11.92 090
sheath.
26060... .................. A Incision of finger tendon 2.81 NA 5.19 0.17 NA 8.17 090
26070... .................. A Explore/treat hand joint. 3.69 NA 7.33 0.42 NA 11.44 090
26075... .................. A Explore/treat finger 3.79 NA 7.85 0.62 NA 12.26 090
joint.
26080... .................. A Explore/treat finger 4.24 NA 8.63 0.51 NA 13.38 090
joint.
26100... .................. A Biopsy hand joint lining. 3.67 NA 5.43 0.45 NA 9.55 090
26105... .................. A Biopsy finger joint 3.71 NA 8.19 0.67 NA 12.57 090
lining.
26110... .................. A Biopsy finger joint 3.53 NA 7.67 0.50 NA 11.70 090
lining.
26115... .................. A Removal of hand lesion... 3.86 4.94 9.00 0.34 9.14 13.20 090
26116... .................. A Removal of hand lesion... 5.53 NA 9.13 0.62 NA 15.28 090
26117... .................. A Remove tumor, hand/finger 8.55 NA 10.50 0.91 NA 19.96 090
26121... .................. A Release palm contracture. 7.54 NA 10.65 1.61 NA 19.80 090
26123... .................. A Release palm contracture. 9.29 NA 11.74 1.53 NA 22.56 090
26125... .................. A Release palm contracture. 4.61 NA 2.91 0.45 NA 7.97 ZZZ
26130... .................. A Remove wrist joint lining 5.42 NA 10.50 0.86 NA 16.78 090
26135... .................. A Revise finger joint, each 6.96 NA 11.26 0.82 NA 19.04 090
26140... .................. A Revise finger joint, each 6.17 NA 10.68 0.75 NA 17.60 090
26145... .................. A Tendon excision, palm/ 6.32 NA 10.64 0.80 NA 17.76 090
finger.
26160... .................. A Remove tendon sheath 3.15 4.64 8.83 0.40 8.19 12.38 090
lesion.
26170... .................. A Removal of palm tendon, 4.77 NA 6.08 0.45 NA 11.30 090
each.
26180... .................. A Removal of finger tendon. 5.18 NA 6.32 0.71 NA 12.21 090
26185... .................. A Remove finger bone....... 5.25 NA 11.35 0.41 NA 17.01 090
26200... .................. A Remove hand bone lesion.. 5.51 NA 9.13 0.72 NA 15.36 090
26205... .................. A Remove/graft bone lesion. 7.70 NA 10.26 1.03 NA 18.99 090
26210... .................. A Removal of finger lesion. 5.15 NA 9.15 0.64 NA 14.94 090
26215... .................. A Remove/graft finger 7.10 NA 10.24 0.94 NA 18.28 090
lesion.
26230... .................. A Partial removal of hand 6.33 NA 9.17 0.69 NA 16.19 090
bone.
26235... .................. A Partial removal, finger 6.19 NA 8.93 0.71 NA 15.83 090
bone.
26236... .................. A Partial removal, finger 5.32 NA 8.66 0.66 NA 14.64 090
bone.
[[Page 30917]]
26250... .................. A Extensive hand surgery... 7.55 NA 11.60 1.07 NA 20.22 090
26255... .................. A Extensive hand surgery... 12.43 NA 13.32 1.54 NA 27.29 090
26260... .................. A Extensive finger surgery. 7.03 NA 10.85 0.97 NA 18.85 090
26261... .................. A Extensive finger surgery. 9.09 NA 12.59 1.31 NA 22.99 090
26262... .................. A Partial removal of finger 5.67 NA 9.35 0.76 NA 15.78 090
26320... .................. A Removal of implant from 3.98 NA 8.38 0.57 NA 12.93 090
hand.
26350... .................. A Repair finger/hand tendon 5.99 NA 11.30 0.99 NA 18.28 090
26352... .................. A Repair/graft hand tendon. 7.68 NA 13.41 1.10 NA 22.19 090
26356... .................. A Repair finger/hand tendon 8.07 NA 13.66 1.24 NA 22.97 090
26357... .................. A Repair finger/hand tendon 8.58 NA 14.49 1.19 NA 24.26 090
26358... .................. A Repair/graft hand tendon. 9.14 NA 14.42 1.27 NA 24.83 090
26370... .................. A Repair finger/hand tendon 7.11 NA 13.28 1.13 NA 21.52 090
26372... .................. A Repair/graft hand tendon. 8.76 NA 14.09 1.15 NA 24.00 090
26373... .................. A Repair finger/hand tendon 8.16 NA 12.55 1.11 NA 21.82 090
26390... .................. A Revise hand/finger tendon 9.19 NA 11.26 1.23 NA 21.68 090
26392... .................. A Repair/graft hand tendon. 10.26 NA 14.13 1.26 NA 25.65 090
26410... .................. A Repair hand tendon....... 4.63 NA 10.00 0.51 NA 15.14 090
26412... .................. A Repair/graft hand tendon. 6.31 NA 11.04 0.97 NA 18.32 090
26415... .................. A Excision, hand/finger 8.34 NA 11.11 0.90 NA 20.35 090
tendon.
26416... .................. A Graft hand or finger 9.37 NA 12.62 1.41 NA 23.40 090
tendon.
26418... .................. A Repair finger tendon..... 4.25 NA 9.77 0.59 NA 14.61 090
26420... .................. A Repair/graft finger 6.77 NA 11.47 0.96 NA 19.20 090
tendon.
26426... .................. A Repair finger/hand tendon 6.15 NA 11.03 1.07 NA 18.25 090
26428... .................. A Repair/graft finger 7.21 NA 11.25 1.00 NA 19.46 090
tendon.
26432... .................. A Repair finger tendon..... 4.02 NA 8.58 0.51 NA 13.11 090
26433... .................. A Repair finger tendon..... 4.56 NA 9.01 0.66 NA 14.23 090
26434... .................. A Repair/graft finger 6.09 NA 9.84 0.84 NA 16.77 090
tendon.
26437... .................. A Realignment of tendons... 5.82 NA 9.50 0.68 NA 16.00 090
26440... .................. A Release palm/finger 5.02 NA 11.65 0.59 NA 17.26 090
tendon.
26442... .................. A Release palm & finger 8.16 NA 13.05 0.59 NA 21.80 090
tendon.
26445... .................. A Release hand/finger 4.31 NA 10.94 0.54 NA 15.79 090
tendon.
26449... .................. A Release forearm/hand 7.00 NA 12.08 0.96 NA 20.04 090
tendon.
26450... .................. A Incision of palm tendon.. 3.67 NA 5.96 0.36 NA 9.99 090
26455... .................. A Incision of finger tendon 3.64 NA 5.84 0.33 NA 9.81 090
26460... .................. A Incise hand/finger tendon 3.46 NA 5.58 0.30 NA 9.34 090
26471... .................. A Fusion of finger tendons. 5.73 NA 9.06 0.67 NA 15.46 090
26474... .................. A Fusion of finger tendons. 5.32 NA 9.37 0.75 NA 15.44 090
26476... .................. A Tendon lengthening....... 5.18 NA 8.35 0.27 NA 13.80 090
26477... .................. A Tendon shortening........ 5.15 NA 9.42 0.73 NA 15.30 090
26478... .................. A Lengthening of hand 5.80 NA 9.83 0.72 NA 16.35 090
tendon.
26479... .................. A Shortening of hand tendon 5.74 NA 9.62 0.86 NA 16.22 090
26480... .................. A Transplant hand tendon... 6.69 NA 12.55 1.11 NA 20.35 090
26483... .................. A Transplant/graft hand 8.29 NA 13.35 1.40 NA 23.04 090
tendon.
26485... .................. A Transplant palm tendon... 7.70 NA 13.33 1.08 NA 22.11 090
26489... .................. A Transplant/graft palm 9.55 NA 11.16 0.51 NA 21.22 090
tendon.
26490... .................. A Revise thumb tendon...... 8.41 NA 11.00 1.28 NA 20.69 090
26492... .................. A Tendon transfer with 9.62 NA 11.46 1.21 NA 22.29 090
graft.
26494... .................. A Hand tendon/muscle 8.47 NA 9.62 1.23 NA 19.32 090
transfer.
26496... .................. A Revise thumb tendon...... 9.59 NA 11.45 1.53 NA 22.57 090
26497... .................. A Finger tendon transfer... 9.57 NA 11.79 1.38 NA 22.74 090
26498... .................. A Finger tendon transfer... 14.00 NA 14.34 2.04 NA 30.38 090
26499... .................. A Revision of finger....... 8.98 NA 9.91 1.25 NA 20.14 090
26500... .................. A Hand tendon 5.96 NA 9.52 0.60 NA 16.08 090
reconstruction.
26502... .................. A Hand tendon 7.14 NA 10.61 0.95 NA 18.70 090
reconstruction.
26504... .................. A Hand tendon 7.47 NA 11.04 1.11 NA 19.62 090
reconstruction.
26508... .................. A Release thumb contracture 6.01 NA 8.30 0.72 NA 15.03 090
26510... .................. A Thumb tendon transfer.... 5.43 NA 9.31 0.68 NA 15.42 090
26516... .................. A Fusion of knuckle joint.. 7.15 NA 10.32 0.67 NA 18.14 090
26517... .................. A Fusion of knuckle joints. 8.83 NA 10.98 1.23 NA 21.04 090
26518... .................. A Fusion of knuckle joints. 9.02 NA 11.97 1.22 NA 22.21 090
26520... .................. A Release knuckle 5.30 NA 11.54 0.71 NA 17.55 090
contracture.
26525... .................. A Release finger 5.33 NA 11.66 0.62 NA 17.61 090
contracture.
26530... .................. A Revise knuckle joint..... 6.69 NA 12.18 0.85 NA 19.72 090
26531... .................. A Revise knuckle with 7.91 NA 13.33 1.11 NA 22.35 090
implant.
26535... .................. A Revise finger joint...... 5.24 NA 5.91 0.58 NA 11.73 090
26536... .................. A Revise/implant finger 6.37 NA 11.33 1.19 NA 18.89 090
joint.
26540... .................. A Repair hand joint........ 6.43 NA 9.89 1.12 NA 17.44 090
26541... .................. A Repair hand joint with 8.62 NA 11.26 1.47 NA 21.35 090
graft.
26542... .................. A Repair hand joint with 6.78 NA 10.32 0.97 NA 18.07 090
graft.
26545... .................. A Reconstruct finger joint. 6.92 NA 10.33 0.94 NA 18.19 090
26546... .................. A Repair non-union hand.... 8.92 NA 18.85 1.33 NA 29.10 090
26548... .................. A Reconstruct finger joint. 8.03 NA 10.73 1.00 NA 19.76 090
26550... .................. A Construct thumb 21.24 NA 20.05 3.24 NA 44.53 090
replacement.
26551... .................. A Great toe-hand transfer.. 46.58 NA 60.48 6.92 NA 113.98 090
[[Page 30918]]
26553... .................. A Single toe-hand transfer. 46.27 NA 60.17 6.87 NA 113.31 090
26554... .................. A Double toe-hand transfer. 54.95 NA 68.86 8.20 NA 132.01 090
26555... .................. A Positional change of 16.63 NA 16.58 2.52 NA 35.73 090
finger.
26556... .................. A Toe joint transfer....... 47.26 NA 61.16 6.99 NA 115.41 090
26560... .................. A Repair of web finger..... 5.38 NA 8.35 0.66 NA 14.39 090
26561... .................. A Repair of web finger..... 10.92 NA 13.22 1.56 NA 25.70 090
26562... .................. A Repair of web finger..... 9.68 NA 12.46 0.82 NA 22.96 090
26565... .................. A Correct metacarpal flaw.. 6.74 NA 10.26 0.85 NA 17.85 090
26567... .................. A Correct finger deformity. 6.82 NA 9.90 0.67 NA 17.39 090
26568... .................. A Lengthen metacarpal/ 9.08 NA 11.61 1.06 NA 21.75 090
finger.
26580... .................. A Repair hand deformity.... 18.18 NA 12.16 2.76 NA 33.10 090
26585... .................. A Repair finger deformity.. 14.05 NA 12.14 2.12 NA 28.31 090
26590... .................. A Repair finger deformity.. 17.96 NA 13.66 2.72 NA 34.34 090
26591... .................. A Repair muscles of hand... 3.25 NA 7.72 0.39 NA 11.36 090
26593... .................. A Release muscles of hand.. 5.31 NA 9.00 0.70 NA 15.01 090
26596... .................. A Excision constricting 8.95 NA 7.08 1.35 NA 17.38 090
tissue.
26597... .................. A Release of scar 9.82 NA 11.96 1.37 NA 23.15 090
contracture.
26600... .................. A Treat metacarpal fracture 1.96 4.60 1.62 0.22 6.78 3.80 090
26605... .................. A Treat metacarpal fracture 2.85 5.96 3.11 0.36 9.17 6.32 090
26607... .................. A Treat metacarpal fracture 5.36 NA 6.40 0.57 NA 12.33 090
26608... .................. A Treat metacarpal fracture 5.36 NA 6.27 0.57 NA 12.20 090
26615... .................. A Repair metacarpal 5.33 NA 5.76 0.80 NA 11.89 090
fracture.
26641... .................. A Treat thumb dislocation.. 3.94 5.89 2.68 0.14 9.97 6.76 090
26645... .................. A Treat thumb fracture..... 4.41 6.82 3.68 0.33 11.56 8.42 090
26650... .................. A Repair thumb fracture.... 5.72 NA 6.42 0.64 NA 12.78 090
26665... .................. A Repair thumb fracture.... 7.60 NA 6.85 1.09 NA 15.54 090
26670... .................. A Treat hand dislocation... 3.69 6.06 2.34 0.10 9.85 6.13 090
26675... .................. A Treat hand dislocation... 4.64 5.89 3.88 0.60 11.13 9.12 090
26676... .................. A Pin hand dislocation..... 5.52 NA 6.35 0.67 NA 12.54 090
26685... .................. A Repair hand dislocation.. 6.98 NA 6.54 0.91 NA 14.43 090
26686... .................. A Repair hand dislocation.. 7.94 NA 7.17 1.04 NA 16.15 090
26700... .................. A Treat knuckle dislocation 3.69 3.41 1.51 0.10 7.20 5.30 090
26705... .................. A Treat knuckle dislocation 4.19 5.82 3.33 0.27 10.28 7.79 090
26706... .................. A Pin knuckle dislocation.. 5.12 NA 4.71 0.75 NA 10.58 090
26715... .................. A Repair knuckle 5.74 NA 6.05 0.66 NA 12.45 090
dislocation.
26720... .................. A Treat finger fracture, 1.66 2.06 1.08 0.15 3.87 2.89 090
each.
26725... .................. A Treat finger fracture, 3.33 3.74 2.59 0.23 7.30 6.15 090
each.
26727... .................. A Treat finger fracture, 5.23 NA 6.14 0.38 NA 11.75 090
each.
26735... .................. A Repair finger fracture, 5.98 NA 6.06 0.61 NA 12.65 090
each.
26740... .................. A Treat finger fracture, 1.94 2.52 1.77 0.16 4.62 3.87 090
each.
26742... .................. A Treat finger fracture, 3.85 6.77 3.77 0.32 10.94 7.94 090
each.
26746... .................. A Repair finger fracture, 5.81 NA 6.06 0.80 NA 12.67 090
each.
26750... .................. A Treat finger fracture, 1.70 2.33 1.28 0.10 4.13 3.08 090
each.
26755... .................. A Treat finger fracture, 3.10 3.50 2.15 0.15 6.75 5.40 090
each.
26756... .................. A Pin finger fracture, each 4.39 NA 5.69 0.33 NA 10.41 090
26765... .................. A Repair finger fracture, 4.17 NA 4.92 0.45 NA 9.54 090
each.
26770... .................. A Treat finger dislocation. 3.02 3.17 1.37 0.08 6.27 4.47 090
26775... .................. A Treat finger dislocation. 3.71 5.64 2.73 0.17 9.52 6.61 090
26776... .................. A Pin finger dislocation... 4.80 NA 5.88 0.35 NA 11.03 090
26785... .................. A Repair finger dislocation 4.21 NA 5.08 0.48 NA 9.77 090
26820... .................. A Thumb fusion with graft.. 8.26 NA 11.44 1.05 NA 20.75 090
26841... .................. A Fusion of thumb.......... 7.13 NA 10.68 1.00 NA 18.81 090
26842... .................. A Thumb fusion with graft.. 8.24 NA 11.52 1.37 NA 21.13 090
26843... .................. A Fusion of hand joint..... 7.61 NA 10.80 1.10 NA 19.51 090
26844... .................. A Fusion/graft of hand 8.73 NA 11.85 1.19 NA 21.77 090
joint.
26850... .................. A Fusion of knuckle........ 6.97 NA 10.39 0.76 NA 18.12 090
26852... .................. A Fusion of knuckle with 8.46 NA 11.32 1.00 NA 20.78 090
graft.
26860... .................. A Fusion of finger joint... 4.69 NA 8.73 0.68 NA 14.10 090
26861... .................. A Fusion of finger joint, 1.74 NA 1.24 0.43 NA 3.41 ZZZ
added.
26862... .................. A Fusion/graft of finger 7.37 NA 10.40 0.85 NA 18.62 090
joint.
26863... .................. A Fuse/graft added joint... 3.90 NA 2.53 0.57 NA 7.00 ZZZ
26910... .................. A Amputate metacarpal bone. 7.60 NA 9.46 0.93 NA 17.99 090
26951... .................. A Amputation of finger/ 4.59 NA 8.17 0.49 NA 13.25 090
thumb.
26952... .................. A Amputation of finger/ 6.31 NA 9.37 0.69 NA 16.37 090
thumb.
26990... .................. A Drainage of pelvis lesion 7.48 NA 11.61 0.51 NA 19.60 090
26991... .................. A Drainage of pelvis bursa. 6.68 6.46 7.02 0.29 13.43 13.99 090
26992... .................. A Drainage of bone lesion.. 13.02 NA 16.12 1.05 NA 30.19 090
27000... .................. A Incision of hip tendon... 5.62 NA 5.77 0.24 NA 11.63 090
27001... .................. A Incision of hip tendon... 6.94 NA 6.57 0.38 NA 13.89 090
27003... .................. A Incision of hip tendon... 7.34 NA 7.34 1.08 NA 15.76 090
27005... .................. A Incision of hip tendon... 9.66 NA 8.44 0.54 NA 18.64 090
27006... .................. A Incision of hip tendons.. 9.68 NA 8.57 0.77 NA 19.02 090
27025... .................. A Incision of hip/thigh 11.16 NA 8.69 1.02 NA 20.87 090
fascia.
27030... .................. A Drainage of hip joint.... 13.01 NA 10.67 1.86 NA 25.54 090
[[Page 30919]]
27033... .................. A Exploration of hip joint. 13.39 NA 10.76 1.85 NA 26.00 090
27035... .................. A Denervation of hip joint. 16.69 NA 13.32 2.21 NA 32.22 090
27036... .................. A Excision of hip joint/ 12.88 NA 22.96 1.87 NA 37.71 090
muscle.
27040... .................. A Biopsy of soft tissues... 2.87 3.49 2.69 0.11 6.47 5.67 010
27041... .................. A Biopsy of soft tissues... 9.89 NA 6.86 0.44 NA 17.19 090
27047... .................. A Remove hip/pelvis lesion. 7.45 6.09 5.33 0.32 13.86 13.10 090
27048... .................. A Remove hip/pelvis lesion. 6.25 NA 5.67 0.82 NA 12.74 090
27049... .................. A Remove tumor, hip/pelvis. 13.66 NA 9.93 1.87 NA 25.46 090
27050... .................. A Biopsy of sacroiliac 4.36 NA 5.40 0.90 NA 10.66 090
joint.
27052... .................. A Biopsy of hip joint...... 6.23 NA 6.46 1.59 NA 14.28 090
27054... .................. A Removal of hip joint 8.54 NA 8.31 2.26 NA 19.11 090
lining.
27060... .................. A Removal of ischial bursa. 5.43 NA 5.20 0.68 NA 11.31 090
27062... .................. A Remove femur lesion/bursa 5.37 NA 5.67 0.70 NA 11.74 090
27065... .................. A Removal of hip bone 5.90 NA 6.39 0.90 NA 13.19 090
lesion.
27066... .................. A Removal of hip bone 10.33 NA 9.79 1.30 NA 21.42 090
lesion.
27067... .................. A Remove/graft hip bone 13.83 NA 12.28 1.93 NA 28.04 090
lesion.
27070... .................. A Partial removal of hip 10.72 NA 14.61 1.21 NA 26.54 090
bone.
27071... .................. A Partial removal of hip 11.46 NA 14.77 1.45 NA 27.68 090
bone.
27075... .................. A Extensive hip surgery.... 17.23 NA 12.72 2.32 NA 32.27 090
27076... .................. A Extensive hip surgery.... 22.12 NA 16.75 2.61 NA 41.48 090
27077... .................. A Extensive hip surgery.... 23.13 NA 16.40 3.24 NA 42.77 090
27078... .................. A Extensive hip surgery.... 13.44 NA 12.41 1.67 NA 27.52 090
27079... .................. A Extensive hip surgery.... 13.75 NA 10.65 1.66 NA 26.06 090
27080... .................. A Removal of tail bone..... 6.39 NA 5.55 0.87 NA 12.81 090
27086... .................. A Remove hip foreign body.. 1.87 3.23 2.61 0.07 5.17 4.55 010
27087... .................. A Remove hip foreign body.. 8.54 NA 7.34 0.60 NA 16.48 090
27090... .................. A Removal of hip prosthesis 11.15 NA 9.72 1.46 NA 22.33 090
27091... .................. A Removal of hip prosthesis 22.14 NA 16.12 3.16 NA 41.42 090
27093... .................. A Injection for hip x-ray.. 1.30 7.97 0.49 0.11 9.38 1.90 000
27095... .................. A Injection for hip x-ray.. 1.50 8.30 0.50 0.13 9.93 2.13 000
27097... .................. A Revision of hip tendon... 8.80 NA 8.03 1.26 NA 18.09 090
27098... .................. A Transfer tendon to pelvis 8.83 NA 7.42 1.26 NA 17.51 090
27100... .................. A Transfer of abdominal 11.08 NA 9.91 1.42 NA 22.41 090
muscle.
27105... .................. A Transfer of spinal muscle 11.77 NA 6.42 1.36 NA 19.55 090
27110... .................. A Transfer of iliopsoas 13.26 NA 10.43 1.86 NA 25.55 090
muscle.
27111... .................. A Transfer of iliopsoas 12.15 NA 8.05 1.65 NA 21.85 090
muscle.
27120... .................. A Reconstruction of hip 18.01 NA 13.42 2.95 NA 34.38 090
socket.
27122... .................. A Reconstruction of hip 14.98 NA 12.41 2.94 NA 30.33 090
socket.
27125... .................. A Partial hip replacement.. 14.69 NA 11.92 3.01 NA 29.62 090
27130... .................. A Total hip replacement.... 20.12 NA 15.19 4.58 NA 39.89 090
27132... .................. A Total hip replacement.... 23.30 NA 17.05 5.09 NA 45.44 090
27134... .................. A Revise hip joint 28.52 NA 19.95 5.96 NA 54.43 090
replacement.
27137... .................. A Revise hip joint 21.17 NA 15.94 4.82 NA 41.93 090
replacement.
27138... .................. A Revise hip joint 22.17 NA 16.55 4.58 NA 43.30 090
replacement.
27140... .................. A Transplant of femur ridge 12.24 NA 10.20 1.71 NA 24.15 090
27146... .................. A Incision of hip bone..... 17.43 NA 13.63 1.35 NA 32.41 090
27147... .................. A Revision of hip bone..... 20.58 NA 15.63 2.76 NA 38.97 090
27151... .................. A Incision of hip bones.... 22.51 NA 15.69 2.90 NA 41.10 090
27156... .................. A Revision of hip bones.... 24.63 NA 18.51 3.08 NA 46.22 090
27158... .................. A Revision of pelvis....... 19.74 NA 14.29 2.64 NA 36.67 090
27161... .................. A Incision of neck of femur 16.71 NA 12.80 2.31 NA 31.82 090
27165... .................. A Incision/fixation of 17.91 NA 13.59 2.63 NA 34.13 090
femur.
27170... .................. A Repair/graft femur head/ 16.07 NA 12.55 2.65 NA 31.27 090
neck.
27175... .................. A Treat slipped epiphysis.. 8.46 NA 7.03 0.18 NA 15.67 090
27176... .................. A Treat slipped epiphysis.. 12.05 NA 9.33 1.70 NA 23.08 090
27177... .................. A Repair slipped epiphysis. 15.08 NA 10.93 2.05 NA 28.06 090
27178... .................. A Repair slipped epiphysis. 11.99 NA 8.19 1.55 NA 21.73 090
27179... .................. A Revise head/neck of femur 12.98 NA 18.75 1.83 NA 33.56 090
27181... .................. A Repair slipped epiphysis. 14.68 NA 11.12 2.16 NA 27.96 090
27185... .................. A Revision of femur 9.18 NA 8.55 0.87 NA 18.60 090
epiphysis.
27187... .................. A Reinforce hip bones...... 13.54 NA 11.36 2.76 NA 27.66 090
27193... .................. A Treat pelvic ring 5.56 5.61 4.69 0.39 11.56 10.64 090
fracture.
27194... .................. A Treat pelvic ring 9.65 8.18 7.22 0.50 18.33 17.37 090
fracture.
27200... .................. A Treat tail bone fracture. 1.84 2.14 1.29 0.17 4.15 3.30 090
27202... .................. A Repair tail bone fracture 7.04 NA 9.32 0.89 NA 17.25 090
27215... .................. A Pelvic fracture(s) 10.05 NA 7.12 2.33 NA 19.50 090
treatment.
27216... .................. A Treat pelvic ring 15.19 NA 12.70 0.66 NA 28.55 090
fracture.
27217... .................. A Treat pelvic ring 14.11 NA 11.11 2.33 NA 27.55 090
fracture.
27218... .................. A Treat pelvic ring 20.15 NA 14.75 2.33 NA 37.23 090
fracture.
27220... .................. A Treat hip socket fracture 6.18 5.95 5.07 0.64 12.77 11.89 090
27222... .................. A Treat hip socket fracture 12.70 NA 9.89 1.03 NA 23.62 090
27226... .................. A Treat hip wall fracture.. 14.91 NA 11.22 2.52 NA 28.65 090
27227... .................. A Treat hip fracture(s).... 23.45 NA 15.66 3.20 NA 42.31 090
27228... .................. A Treat hip fracture(s).... 27.16 NA 18.73 3.20 NA 49.09 090
[[Page 30920]]
27230... .................. A Treat fracture of thigh.. 5.50 5.79 4.53 0.41 11.70 10.44 090
27232... .................. A Treat fracture of thigh.. 10.68 NA 9.07 1.46 NA 21.21 090
27235... .................. A Repair of thigh fracture. 12.16 NA 10.54 2.60 NA 25.30 090
27236... .................. A Repair of thigh fracture. 15.60 NA 12.42 2.71 NA 30.73 090
27238... .................. A Treatment of thigh 5.52 NA 4.93 0.71 NA 11.16 090
fracture.
27240... .................. A Treatment of thigh 12.50 NA 10.45 1.53 NA 24.48 090
fracture.
27244... .................. A Repair of thigh fracture. 15.94 NA 12.69 2.62 NA 31.25 090
27245... .................. A Repair of thigh fracture. 20.31 NA 15.31 2.62 NA 38.24 090
27246... .................. A Treatment of thigh 4.71 5.45 4.88 0.60 10.76 10.19 090
fracture.
27248... .................. A Repair of thigh fracture. 10.45 NA 9.43 2.11 NA 21.99 090
27250... .................. A Treat hip dislocation.... 6.95 NA 4.07 0.45 NA 11.47 090
27252... .................. A Treat hip dislocation.... 10.39 NA 7.43 0.68 NA 18.50 090
27253... .................. A Repair of hip dislocation 12.92 NA 9.77 2.11 NA 24.80 090
27254... .................. A Repair of hip dislocation 18.26 NA 12.68 2.27 NA 33.21 090
27256... .................. A Treatment of hip 4.12 NA 3.03 0.31 NA 7.46 010
dislocation.
27257... .................. A Treatment of hip 5.22 NA 3.86 0.73 NA 9.81 010
dislocation.
27258... .................. A Repair of hip dislocation 15.43 NA 12.39 2.25 NA 30.07 090
27259... .................. A Repair of hip dislocation 21.55 NA 14.58 2.82 NA 38.95 090
27265... .................. A Treatment of hip 5.05 NA 4.66 0.54 NA 10.25 090
dislocation.
27266... .................. A Treatment of hip 7.49 NA 6.43 0.71 NA 14.63 090
dislocation.
27275... .................. A Manipulation of hip joint 2.27 NA 2.72 0.30 NA 5.29 010
27280... .................. A Fusion of sacroiliac 13.39 NA 11.68 1.77 NA 26.84 090
joint.
27282... .................. A Fusion of pubic bones.... 11.34 NA 9.76 1.69 NA 22.79 090
27284... .................. A Fusion of hip joint...... 16.76 NA 13.03 2.40 NA 32.19 090
27286... .................. A Fusion of hip joint...... 16.79 NA 13.64 2.26 NA 32.69 090
27290... .................. A Amputation of leg at hip. 23.28 NA 15.18 4.70 NA 43.16 090
27295... .................. A Amputation of leg at hip. 18.65 NA 12.45 2.95 NA 34.05 090
27301... .................. A Drain thigh/knee lesion.. 6.49 8.70 8.59 0.40 15.59 15.48 090
27303... .................. A Drainage of bone lesion.. 8.28 NA 10.78 0.96 NA 20.02 090
27305... .................. A Incise thigh tendon & 5.92 NA 6.41 0.68 NA 13.01 090
fascia.
27306... .................. A Incision of thigh tendon. 4.62 NA 5.49 0.32 NA 10.43 090
27307... .................. A Incision of thigh tendons 5.80 NA 6.03 0.48 NA 12.31 090
27310... .................. A Exploration of knee joint 9.27 NA 8.60 1.51 NA 19.38 090
27315... .................. A Partial removal, thigh 6.97 NA 4.64 0.96 NA 12.57 090
nerve.
27320... .................. A Partial removal, thigh 6.30 NA 4.45 0.73 NA 11.48 090
nerve.
27323... .................. A Biopsy thigh soft tissues 2.28 3.08 2.40 0.13 5.49 4.81 010
27324... .................. A Biopsy thigh soft tissues 4.90 NA 4.93 0.45 NA 10.28 090
27327... .................. A Removal of thigh lesion.. 4.47 4.69 4.36 0.40 9.56 9.23 090
27328... .................. A Removal of thigh lesion.. 5.57 NA 5.11 0.73 NA 11.41 090
27329... .................. A Remove tumor, thigh/knee. 14.14 NA 10.87 2.14 NA 27.15 090
27330... .................. A Biopsy knee joint lining. 4.97 NA 5.09 1.19 NA 11.25 090
27331... .................. A Explore/treat knee joint. 5.88 NA 6.01 1.49 NA 13.38 090
27332... .................. A Removal of knee cartilage 8.27 NA 7.21 1.73 NA 17.21 090
27333... .................. A Removal of knee cartilage 7.30 NA 6.73 2.52 NA 16.55 090
27334... .................. A Remove knee joint lining. 8.70 NA 7.78 1.77 NA 18.25 090
27335... .................. A Remove knee joint lining. 10.00 NA 8.93 2.05 NA 20.98 090
27340... .................. A Removal of kneecap bursa. 4.18 NA 4.60 0.62 NA 9.40 090
27345... .................. A Removal of knee cyst..... 5.92 NA 5.87 0.95 NA 12.74 090
27350... .................. A Removal of kneecap....... 8.17 NA 7.36 1.54 NA 17.07 090
27355... .................. A Remove femur lesion...... 7.65 NA 7.95 1.23 NA 16.83 090
27356... .................. A Remove femur lesion/graft 9.48 NA 9.14 1.34 NA 19.96 090
27357... .................. A Remove femur lesion/graft 10.53 NA 9.44 1.43 NA 21.40 090
27358... .................. A Remove femur lesion/ 4.74 NA 2.94 0.72 NA 8.40 ZZZ
fixation.
27360... .................. A Partial removal leg 10.50 NA 14.47 1.40 NA 26.37 090
bone(s).
27365... .................. A Extensive leg surgery.... 16.27 NA 12.69 2.43 NA 31.39 090
27370... .................. A Injection for knee x-ray. 0.96 7.73 0.31 0.05 8.74 1.32 000
27372... .................. A Removal of foreign body.. 5.07 5.07 4.89 0.54 10.68 10.50 090
27380... .................. A Repair of kneecap tendon. 7.16 NA 7.06 1.29 NA 15.51 090
27381... .................. A Repair/graft kneecap 10.34 NA 8.92 1.82 NA 21.08 090
tendon.
27385... .................. A Repair of thigh muscle... 7.76 NA 7.40 1.42 NA 16.58 090
27386... .................. A Repair/graft of thigh 10.56 NA 9.31 2.02 NA 21.89 090
muscle.
27390... .................. A Incision of thigh tendon. 5.33 NA 5.82 0.71 NA 11.86 090
27391... .................. A Incision of thigh tendons 7.20 NA 7.09 0.90 NA 15.19 090
27392... .................. A Incision of thigh tendons 9.20 NA 8.49 1.28 NA 18.97 090
27393... .................. A Lengthening of thigh 6.39 NA 6.44 0.93 NA 13.76 090
tendon.
27394... .................. A Lengthening of thigh 8.50 NA 8.42 0.94 NA 17.86 090
tendons.
27395... .................. A Lengthening of thigh 11.73 NA 10.86 1.65 NA 24.24 090
tendons.
27396... .................. A Transplant of thigh 7.86 NA 8.07 1.11 NA 17.04 090
tendon.
27397... .................. A Transplants of thigh 11.28 NA 9.88 1.45 NA 22.61 090
tendons.
27400... .................. A Revise thigh muscles/ 9.02 NA 8.62 1.24 NA 18.88 090
tendons.
27403... .................. A Repair of knee cartilage. 8.33 NA 7.30 1.44 NA 17.07 090
27405... .................. A Repair of knee ligament.. 8.65 NA 7.90 1.67 NA 18.22 090
27407... .................. A Repair of knee ligament.. 10.28 NA 8.42 1.42 NA 20.12 090
27409... .................. A Repair of knee ligaments. 12.90 NA 10.23 2.48 NA 25.61 090
[[Page 30921]]
27418... .................. A Repair degenerated 10.85 NA 9.39 1.85 NA 22.09 090
kneecap.
27420... .................. A Revision of unstable 9.83 NA 8.26 1.74 NA 19.83 090
kneecap.
27422... .................. A Revision of unstable 9.78 NA 8.37 1.83 NA 19.98 090
kneecap.
27424... .................. A Revision/removal of 9.81 NA 8.18 1.89 NA 19.88 090
kneecap.
27425... .................. A Lateral retinacular 5.22 NA 5.58 1.08 NA 11.88 090
release.
27427... .................. A Reconstruction, knee..... 9.36 NA 8.06 2.25 NA 19.67 090
27428... .................. A Reconstruction, knee..... 14.00 NA 10.92 2.71 NA 27.63 090
27429... .................. A Reconstruction, knee..... 15.52 NA 12.11 1.83 NA 29.46 090
27430... .................. A Revision of thigh muscles 9.67 NA 8.21 1.50 NA 19.38 090
27435... .................. A Incision of knee joint... 9.49 NA 8.02 1.13 NA 18.64 090
27437... .................. A Revise kneecap........... 8.46 NA 7.01 1.55 NA 17.02 090
27438... .................. A Revise kneecap with 11.23 NA 9.40 2.14 NA 22.77 090
implant.
27440... .................. A Revision of knee joint... 10.43 NA 8.60 2.10 NA 21.13 090
27441... .................. A Revision of knee joint... 10.82 NA 9.37 1.51 NA 21.70 090
27442... .................. A Revision of knee joint... 11.89 NA 9.63 3.05 NA 24.57 090
27443... .................. A Revision of knee joint... 10.93 NA 9.71 3.34 NA 23.98 090
27445... .................. A Revision of knee joint... 17.68 NA 13.38 4.21 NA 35.27 090
27446... .................. A Revision of knee joint... 15.84 NA 11.45 3.87 NA 31.16 090
27447... .................. A Total knee replacement... 21.48 NA 15.54 4.95 NA 41.97 090
27448... .................. A Incision of thigh........ 11.06 NA 9.86 2.09 NA 23.01 090
27450... .................. A Incision of thigh........ 13.98 NA 11.94 2.36 NA 28.28 090
27454... .................. A Realignment of thigh bone 17.56 NA 13.71 2.82 NA 34.09 090
27455... .................. A Realignment of knee...... 12.82 NA 10.77 1.95 NA 25.54 090
27457... .................. A Realignment of knee...... 13.45 NA 10.24 2.14 NA 25.83 090
27465... .................. A Shortening of thigh bone. 13.87 NA 11.42 2.00 NA 27.29 090
27466... .................. A Lengthening of thigh bone 16.33 NA 13.67 2.27 NA 32.27 090
27468... .................. A Shorten/lengthen thighs.. 18.97 NA 29.82 2.75 NA 51.54 090
27470... .................. A Repair of thigh.......... 16.07 NA 13.53 2.60 NA 32.20 090
27472... .................. A Repair/graft of thigh.... 17.72 NA 14.45 3.16 NA 35.33 090
27475... .................. A Surgery to stop leg 8.64 NA 7.93 1.27 NA 17.84 090
growth.
27477... .................. A Surgery to stop leg 9.85 NA 8.01 2.57 NA 20.43 090
growth.
27479... .................. A Surgery to stop leg 12.80 NA 10.49 1.89 NA 25.18 090
growth.
27485... .................. A Surgery to stop leg 8.84 NA 7.73 1.30 NA 17.87 090
growth.
27486... .................. A Revise knee joint replace 19.27 NA 14.36 4.26 NA 37.89 090
27487... .................. A Revise knee joint replace 25.27 NA 17.79 5.97 NA 49.03 090
27488... .................. A Removal of knee 15.74 NA 12.45 2.58 NA 30.77 090
prosthesis.
27495... .................. A Reinforce thigh.......... 15.55 NA 13.08 2.82 NA 31.45 090
27496... .................. A Decompression of thigh/ 6.11 NA 5.36 0.74 NA 12.21 090
knee.
27497... .................. A Decompression of thigh/ 7.17 NA 6.09 0.91 NA 14.17 090
knee.
27498... .................. A Decompression of thigh/ 7.99 NA 5.92 1.04 NA 14.95 090
knee.
27499... .................. A Decompression of thigh/ 9.00 NA 7.44 1.19 NA 17.63 090
knee.
27500... .................. A Treatment of thigh 5.92 11.07 5.44 0.82 17.81 12.18 090
fracture.
27501... .................. A Treatment of thigh 5.92 11.72 6.52 0.82 18.46 13.26 090
fracture.
27502... .................. A Treatment of thigh 10.58 NA 9.32 1.21 NA 21.11 090
fracture.
27503... .................. A Treatment of thigh 10.58 NA 9.44 1.21 NA 21.23 090
fracture.
27506... .................. A Repair of thigh fracture. 17.45 NA 12.72 2.56 NA 32.73 090
27507... .................. A Treatment of thigh 13.99 NA 11.03 2.56 NA 27.58 090
fracture.
27508... .................. A Treatment of thigh 5.83 7.50 4.61 0.65 13.98 11.09 090
fracture.
27509... .................. A Treatment of thigh 7.71 NA 7.80 0.65 NA 16.16 090
fracture.
27510... .................. A Treatment of thigh 9.13 NA 6.77 1.09 NA 16.99 090
fracture.
27511... .................. A Treatment of thigh 13.64 NA 11.72 2.56 NA 27.92 090
fracture.
27513... .................. A Treatment of thigh 17.92 NA 13.58 2.56 NA 34.06 090
fracture.
27514... .................. A Repair of thigh fracture. 17.30 NA 13.40 2.53 NA 33.23 090
27516... .................. A Repair of thigh growth 5.37 7.59 4.90 0.71 13.67 10.98 090
plate.
27517... .................. A Repair of thigh growth 8.78 9.97 6.87 1.28 20.03 16.93 090
plate.
27519... .................. A Repair of thigh growth 15.02 NA 12.54 2.05 NA 29.61 090
plate.
27520... .................. A Treat kneecap fracture... 2.86 5.74 2.53 0.45 9.05 5.84 090
27524... .................. A Repair of kneecap 10.00 NA 7.92 1.65 NA 19.57 090
fracture.
27530... .................. A Treatment of knee 3.78 6.31 3.37 0.51 10.60 7.66 090
fracture.
27532... .................. A Treatment of knee 7.30 6.38 5.78 0.91 14.59 13.99 090
fracture.
27535... .................. A Treatment of knee 11.50 NA 10.54 1.88 NA 23.92 090
fracture.
27536... .................. A Repair of knee fracture.. 15.65 NA 11.30 1.88 NA 28.83 090
27538... .................. A Treat knee fracture(s)... 4.87 7.56 4.48 0.51 12.94 9.86 090
27540... .................. A Repair of knee fracture.. 13.10 NA 9.57 1.74 NA 24.41 090
27550... .................. A Treat knee dislocation... 5.76 7.18 3.99 0.36 13.30 10.11 090
27552... .................. A Treat knee dislocation... 7.90 NA 6.78 0.53 NA 15.21 090
27556... .................. A Repair of knee 14.41 NA 12.43 1.95 NA 28.79 090
dislocation.
27557... .................. A Repair of knee 16.77 NA 14.14 2.43 NA 33.34 090
dislocation.
27558... .................. A Repair of knee 17.72 NA 14.48 2.43 NA 34.63 090
dislocation.
27560... .................. A Treat kneecap dislocation 3.82 6.18 2.00 0.16 10.16 5.98 090
27562... .................. A Treat kneecap dislocation 5.79 NA 4.57 0.76 NA 11.12 090
27566... .................. A Repair kneecap 12.23 NA 9.13 1.67 NA 23.03 090
dislocation.
27570... .................. A Fixation of knee joint... 1.74 NA 2.47 0.28 NA 4.49 010
27580... .................. A Fusion of knee........... 19.37 NA 14.92 2.56 NA 36.85 090
[[Page 30922]]
27590... .................. A Amputate leg at thigh.... 12.03 NA 8.47 1.80 NA 22.30 090
27591... .................. A Amputate leg at thigh.... 12.68 NA 10.89 2.11 NA 25.68 090
27592... .................. A Amputate leg at thigh.... 10.02 NA 8.01 1.61 NA 19.64 090
27594... .................. A Amputation follow-up 6.92 NA 5.82 0.68 NA 13.42 090
surgery.
27596... .................. A Amputation follow-up 10.60 NA 8.42 1.42 NA 20.44 090
surgery.
27598... .................. A Amputate lower leg at 10.53 NA 8.21 1.78 NA 20.52 090
knee.
27600... .................. A Decompression of lower 5.65 NA 4.80 0.64 NA 11.09 090
leg.
27601... .................. A Decompression of lower 5.64 NA 4.66 0.67 NA 10.97 090
leg.
27602... .................. A Decompression of lower 7.35 NA 5.39 0.77 NA 13.51 090
leg.
27603... .................. A Drain lower leg lesion... 4.94 8.33 6.14 0.41 13.68 11.49 090
27604... .................. A Drain lower leg bursa.... 4.47 5.29 4.08 0.14 9.90 8.69 090
27605... .................. A Incision of achilles 2.87 6.16 2.85 0.14 9.17 5.86 010
tendon.
27606... .................. A Incision of achilles 4.14 9.65 4.04 0.35 14.14 8.53 010
tendon.
27607... .................. A Treat lower leg bone 7.97 NA 10.46 0.98 NA 19.41 090
lesion.
27610... .................. A Explore/treat ankle joint 8.34 NA 7.48 1.13 NA 16.95 090
27612... .................. A Exploration of ankle 7.33 NA 6.22 1.30 NA 14.85 090
joint.
27613... .................. A Biopsy lower leg soft 2.17 3.22 1.92 0.10 5.49 4.19 010
tissue.
27614... .................. A Biopsy lower leg soft 5.66 6.67 5.06 0.38 12.71 11.10 090
tissue.
27615... .................. A Remove tumor, lower leg.. 12.56 NA 11.29 1.42 NA 25.27 090
27618... .................. A Remove lower leg lesion.. 5.09 6.78 4.63 0.32 12.19 10.04 090
27619... .................. A Remove lower leg lesion.. 8.40 8.20 6.66 0.67 17.27 15.73 090
27620... .................. A Explore, treat ankle 5.98 NA 6.09 0.96 NA 13.03 090
joint.
27625... .................. A Remove ankle joint lining 8.30 NA 7.31 1.27 NA 16.88 090
27626... .................. A Remove ankle joint lining 8.91 NA 8.21 1.25 NA 18.37 090
27630... .................. A Removal of tendon lesion. 4.80 6.25 4.87 0.46 11.51 10.13 090
27635... .................. A Remove lower leg bone 7.78 NA 8.23 1.27 NA 17.28 090
lesion.
27637... .................. A Remove/graft leg bone 9.85 NA 9.84 1.40 NA 21.09 090
lesion.
27638... .................. A Remove/graft leg bone 10.57 NA 10.21 1.52 NA 22.30 090
lesion.
27640... .................. A Partial removal of tibia. 11.37 NA 13.25 1.57 NA 26.19 090
27641... .................. A Partial removal of fibula 9.24 NA 11.40 1.18 NA 21.82 090
27645... .................. A Extensive lower leg 14.17 NA 13.99 1.98 NA 30.14 090
surgery.
27646... .................. A Extensive lower leg 12.66 NA 12.92 1.71 NA 27.29 090
surgery.
27647... .................. A Extensive ankle/heel 12.24 NA 8.33 1.35 NA 21.92 090
surgery.
27648... .................. A Injection for ankle x-ray 0.96 6.60 0.33 0.05 7.61 1.34 000
27650... .................. A Repair achilles tendon... 9.69 NA 7.90 1.41 NA 19.00 090
27652... .................. A Repair/graft achilles 10.33 NA 7.94 1.56 NA 19.83 090
tendon.
27654... .................. A Repair of achilles tendon 10.02 NA 8.49 1.65 NA 20.16 090
27656... .................. A Repair leg fascia defect. 4.57 7.73 4.37 0.54 12.84 9.48 090
27658... .................. A Repair of leg tendon, 4.98 6.07 6.15 0.60 11.65 11.73 090
each.
27659... .................. A Repair of leg tendon, 6.81 13.52 6.92 0.86 21.19 14.59 090
each.
27664... .................. A Repair of leg tendon, 4.59 11.75 5.94 0.52 16.86 11.05 090
each.
27665... .................. A Repair of leg tendon, 5.40 12.69 6.38 0.76 18.85 12.54 090
each.
27675... .................. A Repair lower leg tendons. 7.18 NA 6.29 0.94 NA 14.41 090
27676... .................. A Repair lower leg tendons. 8.42 NA 7.44 1.14 NA 17.00 090
27680... .................. A Release of lower leg 5.74 NA 5.60 0.61 NA 11.95 090
tendon.
27681... .................. A Release of lower leg 6.82 NA 6.59 0.86 NA 14.27 090
tendons.
27685... .................. A Revision of lower leg 6.50 4.66 6.08 0.41 11.57 12.99 090
tendon.
27686... .................. A Revise lower leg tendons. 7.46 5.57 7.66 0.90 13.93 16.02 090
27687... .................. A Revision of calf tendon.. 6.24 NA 5.40 0.76 NA 12.40 090
27690... .................. A Revise lower leg tendon.. 8.71 NA 7.22 0.88 NA 16.81 090
27691... .................. A Revise lower leg tendon.. 9.96 NA 8.91 1.23 NA 20.10 090
27692... .................. A Revise additional leg 1.87 NA 1.29 0.29 NA 3.45 ZZZ
tendon.
27695... .................. A Repair of ankle ligament. 6.51 NA 6.79 1.32 NA 14.62 090
27696... .................. A Repair of ankle ligaments 8.27 NA 7.80 1.16 NA 17.23 090
27698... .................. A Repair of ankle ligament. 9.36 NA 7.13 1.86 NA 18.35 090
27700... .................. A Revision of ankle joint.. 9.29 NA 6.00 1.51 NA 16.80 090
27702... .................. A Reconstruct ankle joint.. 13.67 NA 11.18 3.99 NA 28.84 090
27703... .................. A Reconstruction, ankle 15.87 NA 11.86 2.25 NA 29.98 090
joint.
27704... .................. A Removal of ankle implant. 7.62 NA 7.48 0.98 NA 16.08 090
27705... .................. A Incision of tibia........ 10.38 NA 9.24 1.76 NA 21.38 090
27707... .................. A Incision of fibula....... 4.37 NA 5.92 0.79 NA 11.08 090
27709... .................. A Incision of tibia & 9.95 NA 9.21 2.14 NA 21.30 090
fibula.
27712... .................. A Realignment of lower leg. 14.25 NA 11.78 1.63 NA 27.66 090
27715... .................. A Revision of lower leg.... 14.39 NA 12.54 1.88 NA 28.81 090
27720... .................. A Repair of tibia.......... 11.79 NA 10.92 2.25 NA 24.96 090
27722... .................. A Repair/graft of tibia.... 11.82 NA 11.09 1.64 NA 24.55 090
27724... .................. A Repair/graft of tibia.... 14.99 NA 12.75 2.87 NA 30.61 090
27725... .................. A Repair of lower leg...... 15.59 NA 13.20 1.53 NA 30.32 090
27727... .................. A Repair of lower leg...... 14.01 NA 12.46 1.84 NA 28.31 090
27730... .................. A Repair of tibia epiphysis 7.41 11.61 7.25 0.84 19.86 15.50 090
27732... .................. A Repair of fibula 5.32 6.26 3.86 0.79 12.37 9.97 090
epiphysis.
27734... .................. A Repair lower leg 8.48 NA 8.56 1.23 NA 18.27 090
epiphyses.
27740... .................. A Repair of leg epiphyses.. 9.30 3.15 6.39 1.36 13.81 17.05 090
27742... .................. A Repair of leg epiphyses.. 10.30 15.04 9.64 1.52 26.86 21.46 090
[[Page 30923]]
27745... .................. A Reinforce tibia.......... 10.07 NA 9.10 1.39 NA 20.56 090
27750... .................. A Treatment of tibia 3.19 5.92 2.96 0.50 9.61 6.65 090
fracture.
27752... .................. A Treatment of tibia 5.84 8.11 5.23 0.81 14.76 11.88 090
fracture.
27756... .................. A Repair of tibia fracture. 6.78 NA 7.87 1.70 NA 16.35 090
27758... .................. A Repair of tibia fracture. 11.67 NA 10.04 2.22 NA 23.93 090
27759... .................. A Repair of tibia fracture. 13.76 NA 11.36 2.22 NA 27.34 090
27760... .................. A Treatment of ankle 3.01 5.55 2.40 0.37 8.93 5.78 090
fracture.
27762... .................. A Treatment of ankle 5.25 7.28 4.63 0.50 13.03 10.38 090
fracture.
27766... .................. A Repair of ankle fracture. 8.36 NA 7.06 1.26 NA 16.68 090
27780... .................. A Treatment of fibula 2.65 3.74 2.30 0.26 6.65 5.21 090
fracture.
27781... .................. A Treatment of fibula 4.40 6.67 3.89 0.49 11.56 8.78 090
fracture.
27784... .................. A Repair of fibula fracture 7.11 NA 6.76 0.87 NA 14.74 090
27786... .................. A Treatment of ankle 2.84 5.55 2.43 0.38 8.77 5.65 090
fracture.
27788... .................. A Treatment of ankle 4.45 6.64 3.75 0.50 11.59 8.70 090
fracture.
27792... .................. A Repair of ankle fracture. 7.66 NA 6.66 1.17 NA 15.49 090
27808... .................. A Treatment of ankle 2.83 6.23 2.93 0.39 9.45 6.15 090
fracture.
27810... .................. A Treatment of ankle 5.13 7.60 4.66 0.80 13.53 10.59 090
fracture.
27814... .................. A Repair of ankle fracture. 10.68 NA 9.06 1.60 NA 21.34 090
27816... .................. A Treatment of ankle 2.89 5.90 2.93 0.55 9.34 6.37 090
fracture.
27818... .................. A Treatment of ankle 5.50 8.00 4.84 1.06 14.56 11.40 090
fracture.
27822... .................. A Repair of ankle fracture. 9.20 NA 26.99 1.88 NA 38.07 090
27823... .................. A Repair of ankle fracture. 11.80 NA 28.40 2.05 NA 42.25 090
27824... .................. A Treat lower leg fracture. 2.89 6.16 3.15 0.55 9.60 6.59 090
27825... .................. A Treat lower leg fracture. 6.19 7.96 5.44 1.06 15.21 12.69 090
27826... .................. A Treat lower leg fracture. 8.54 NA 26.59 1.88 NA 37.01 090
27827... .................. A Treat lower leg fracture. 14.06 NA 29.89 1.88 NA 45.83 090
27828... .................. A Treat lower leg fracture. 16.23 NA 31.03 2.05 NA 49.31 090
27829... .................. A Treat lower leg joint.... 5.49 NA 19.75 1.37 NA 26.61 090
27830... .................. A Treat lower leg 3.79 5.77 3.25 0.46 10.02 7.50 090
dislocation.
27831... .................. A Treat lower leg 4.56 NA 4.53 0.59 NA 9.68 090
dislocation.
27832... .................. A Repair lower leg 6.49 NA 7.05 0.89 NA 14.43 090
dislocation.
27840... .................. A Treat ankle dislocation.. 4.58 NA 3.17 0.21 NA 7.96 090
27842... .................. A Treat ankle dislocation.. 6.21 NA 4.00 0.34 NA 10.55 090
27846... .................. A Repair ankle dislocation. 9.79 NA 8.29 1.37 NA 19.45 090
27848... .................. A Repair ankle dislocation. 11.20 NA 22.13 1.32 NA 34.65 090
27860... .................. A Fixation of ankle joint.. 2.34 NA 2.68 0.23 NA 5.25 010
27870... .................. A Fusion of ankle joint.... 13.91 NA 11.49 2.22 NA 27.62 090
27871... .................. A Fusion of tibiofibular 9.17 NA 8.82 1.21 NA 19.20 090
joint.
27880... .................. A Amputation of lower leg.. 11.85 NA 8.36 1.60 NA 21.81 090
27881... .................. A Amputation of lower leg.. 12.34 NA 10.11 1.87 NA 24.32 090
27882... .................. A Amputation of lower leg.. 8.94 NA 8.19 1.42 NA 18.55 090
27884... .................. A Amputation follow-up 8.21 NA 7.12 0.61 NA 15.94 090
surgery.
27886... .................. A Amputation follow-up 9.32 NA 7.73 1.34 NA 18.39 090
surgery.
27888... .................. A Amputation of foot at 9.67 NA 8.39 1.65 NA 19.71 090
ankle.
27889... .................. A Amputation of foot at 9.98 NA 7.15 1.55 NA 18.68 090
ankle.
27892... .................. A Decompression of leg..... 7.39 NA 5.48 0.64 NA 13.51 090
27893... .................. A Decompression of leg..... 7.35 NA 5.87 0.67 NA 13.89 090
27894... .................. A Decompression of leg..... 10.49 NA 7.07 0.77 NA 18.33 090
28001... .................. A Drainage of bursa of foot 2.73 2.36 2.64 0.05 5.14 5.42 010
28002... .................. A Treatment of foot 4.62 3.28 3.68 0.33 8.23 8.63 010
infection.
28003... .................. A Treatment of foot 8.41 5.39 7.51 0.59 14.39 16.51 090
infection.
28005... .................. A Treat foot bone lesion... 8.68 NA 7.52 0.61 NA 16.81 090
28008... .................. A Incision of foot fascia.. 4.45 3.40 3.82 0.29 8.14 8.56 090
28010... .................. A Incision of toe tendon... 2.84 3.00 3.35 0.33 6.17 6.52 090
28011... .................. A Incision of toe tendons.. 4.14 4.82 4.92 0.19 9.15 9.25 090
28020... .................. A Exploration of a foot 5.01 4.78 4.46 0.56 10.35 10.03 090
joint.
28022... .................. A Exploration of a foot 4.67 3.52 4.02 0.31 8.50 9.00 090
joint.
28024... .................. A Exploration of a toe 4.38 3.91 3.97 0.24 8.53 8.59 090
joint.
28030... .................. A Removal of foot nerve.... 6.15 NA 3.17 0.42 NA 9.74 090
28035... .................. A Decompression of tibia 5.09 4.87 4.14 0.90 10.86 10.13 090
nerve.
28043... .................. A Excision of foot lesion.. 3.54 3.36 3.49 0.20 7.10 7.23 090
28045... .................. A Excision of foot lesion.. 4.72 3.80 3.88 0.46 8.98 9.06 090
28046... .................. A Resection of tumor, foot. 10.18 7.36 7.71 0.79 18.33 18.68 090
28050... .................. A Biopsy of foot joint 4.25 3.01 3.79 0.53 7.79 8.57 090
lining.
28052... .................. A Biopsy of foot joint 3.94 3.12 4.25 0.43 7.49 8.62 090
lining.
28054... .................. A Biopsy of toe joint 3.45 4.08 4.07 0.28 7.81 7.80 090
lining.
28060... .................. A Partial removal foot 5.23 4.14 4.05 0.53 9.90 9.81 090
fascia.
28062... .................. A Removal of foot fascia... 6.52 4.32 4.26 0.86 11.70 11.64 090
28070... .................. A Removal of foot joint 5.10 3.53 3.99 0.48 9.11 9.57 090
lining.
28072... .................. A Removal of foot joint 4.58 3.68 4.67 0.42 8.68 9.67 090
lining.
28080... .................. A Removal of foot lesion... 3.58 3.13 3.36 0.45 7.16 7.39 090
28086... .................. A Excise foot tendon sheath 4.78 5.90 5.34 0.46 11.14 10.58 090
28088... .................. A Excise foot tendon sheath 3.86 4.26 4.80 0.40 8.52 9.06 090
28090... .................. A Removal of foot lesion... 4.41 3.52 3.73 0.29 8.22 8.43 090
[[Page 30924]]
28092... .................. A Removal of toe lesions... 3.64 3.86 3.97 0.25 7.75 7.86 090
28100... .................. A Removal of ankle/heel 5.66 6.43 5.26 0.56 12.65 11.48 090
lesion.
28102... .................. A Remove/graft foot lesion. 7.73 NA 6.81 0.85 NA 15.39 090
28103... .................. A Remove/graft foot lesion. 6.50 4.89 5.49 0.69 12.08 12.68 090
28104... .................. A Removal of foot lesion... 5.12 3.88 4.63 0.49 9.49 10.24 090
28106... .................. A Remove/graft foot lesion. 7.16 NA 5.32 0.79 NA 13.27 090
28107... .................. A Remove/graft foot lesion. 5.56 3.69 5.13 0.48 9.73 11.17 090
28108... .................. A Removal of toe lesions... 4.16 3.08 3.44 0.38 7.62 7.98 090
28110... .................. A Part removal of 4.08 3.49 4.07 0.39 7.96 8.54 090
metatarsal.
28111... .................. A Part removal of 5.01 4.27 4.80 0.65 9.93 10.46 090
metatarsal.
28112... .................. A Part removal of 4.49 3.84 4.60 0.45 8.78 9.54 090
metatarsal.
28113... .................. A Part removal of 4.79 3.80 4.31 0.48 9.07 9.58 090
metatarsal.
28114... .................. A Removal of metatarsal 9.79 8.36 8.15 1.42 19.57 19.36 090
heads.
28116... .................. A Revision of foot......... 7.75 4.54 5.19 0.57 12.86 13.51 090
28118... .................. A Removal of heel bone..... 5.96 4.43 4.86 0.66 11.05 11.48 090
28119... .................. A Removal of heel spur..... 5.39 3.77 4.09 0.57 9.73 10.05 090
28120... .................. A Part removal of ankle/ 5.40 5.08 6.36 0.67 11.15 12.43 090
heel.
28122... .................. A Partial removal of foot 7.29 5.33 6.53 0.54 13.16 14.36 090
bone.
28124... .................. A Partial removal of toe... 4.81 3.80 4.88 0.37 8.98 10.06 090
28126... .................. A Partial removal of toe... 3.52 3.08 4.12 0.36 6.96 8.00 090
28130... .................. A Removal of ankle bone.... 8.11 NA 6.47 0.88 NA 15.46 090
28140... .................. A Removal of metatarsal.... 6.91 4.68 5.42 0.62 12.21 12.95 090
28150... .................. A Removal of toe........... 4.09 3.60 4.60 0.38 8.07 9.07 090
28153... .................. A Partial removal of toe... 3.66 3.05 2.86 0.36 7.07 6.88 090
28160... .................. A Partial removal of toe... 3.74 3.18 4.38 0.38 7.30 8.50 090
28171... .................. A Extensive foot surgery... 9.60 NA 5.64 0.88 NA 16.12 090
28173... .................. A Extensive foot surgery... 8.80 6.10 6.02 0.74 15.64 15.56 090
28175... .................. A Extensive foot surgery... 6.05 4.62 4.13 0.58 11.25 10.76 090
28190... .................. A Removal of foot foreign 1.96 2.82 1.70 0.05 4.83 3.71 010
body.
28192... .................. A Removal of foot foreign 4.64 4.21 3.75 0.24 9.09 8.63 090
body.
28193... .................. A Removal of foot foreign 5.73 4.89 4.33 0.30 10.92 10.36 090
body.
28200... .................. A Repair of foot tendon.... 4.60 3.65 4.03 0.50 8.75 9.13 090
28202... .................. A Repair/graft of foot 6.84 4.25 5.68 0.77 11.86 13.29 090
tendon.
28208... .................. A Repair of foot tendon.... 4.37 3.33 3.57 0.28 7.98 8.22 090
28210... .................. A Repair/graft of foot 6.35 4.43 4.37 0.60 11.38 11.32 090
tendon.
28220... .................. A Release of foot tendon... 4.53 3.27 3.85 0.43 8.23 8.81 090
28222... .................. A Release of foot tendons.. 5.62 3.78 4.41 0.63 10.03 10.66 090
28225... .................. A Release of foot tendon... 3.66 3.15 3.53 0.25 7.06 7.44 090
28226... .................. A Release of foot tendons.. 4.53 3.24 3.86 0.40 8.17 8.79 090
28230... .................. A Incision of foot 4.24 3.29 4.49 0.22 7.75 8.95 090
tendon(s).
28232... .................. A Incision of toe tendon... 3.39 3.12 4.14 0.15 6.66 7.68 090
28234... .................. A Incision of foot tendon.. 3.37 2.99 3.82 0.14 6.50 7.33 090
28238... .................. A Revision of foot tendon.. 7.73 5.32 5.38 0.85 13.90 13.96 090
28240... .................. A Release of big toe....... 4.36 3.22 3.97 0.23 7.81 8.56 090
28250... .................. A Revision of foot fascia.. 5.92 4.03 4.24 0.50 10.45 10.66 090
28260... .................. A Release of midfoot joint. 7.96 5.31 5.36 0.48 13.75 13.80 090
28261... .................. A Revision of foot tendon.. 11.73 6.39 7.41 0.58 18.70 19.72 090
28262... .................. A Revision of foot and 15.83 8.31 12.72 1.44 25.58 29.99 090
ankle.
28264... .................. A Release of midfoot joint. 10.35 5.92 6.61 1.17 17.44 18.13 090
28270... .................. A Release of foot 4.76 3.51 4.31 0.23 8.50 9.30 090
contracture.
28272... .................. A Release of toe joint, 3.80 2.94 3.54 0.18 6.92 7.52 090
each.
28280... .................. A Fusion of toes........... 5.19 4.73 5.19 0.30 10.22 10.68 090
28285... .................. A Repair of hammertoe...... 4.59 3.54 4.03 0.39 8.52 9.01 090
28286... .................. A Repair of hammertoe...... 4.56 3.52 4.01 0.38 8.46 8.95 090
28288... .................. A Partial removal of foot 4.74 3.93 5.42 0.43 9.10 10.59 090
bone.
28290... .................. A Correction of bunion..... 5.66 4.30 6.27 0.63 10.59 12.56 090
28292... .................. A Correction of bunion..... 7.04 4.62 5.09 0.74 12.40 12.87 090
28293... .................. A Correction of bunion..... 9.15 5.73 5.49 0.98 15.86 15.62 090
28294... .................. A Correction of bunion..... 8.56 5.35 5.12 0.86 14.77 14.54 090
28296... .................. A Correction of bunion..... 9.18 5.60 6.12 0.98 15.76 16.28 090
28297... .................. A Correction of bunion..... 9.18 9.18 7.35 1.05 19.41 17.58 090
28298... .................. A Correction of bunion..... 7.94 5.03 5.50 0.79 13.76 14.23 090
28299... .................. A Correction of bunion..... 8.88 5.32 5.58 1.08 15.28 15.54 090
28300... .................. A Incision of heel bone.... 9.54 6.28 7.24 0.79 16.61 17.57 090
28302... .................. A Incision of ankle bone... 9.55 5.33 6.63 1.12 16.00 17.30 090
28304... .................. A Incision of midfoot bones 9.16 5.85 6.00 0.70 15.71 15.86 090
28305... .................. A Incise/graft midfoot 10.50 7.76 7.22 1.03 19.29 18.75 090
bones.
28306... .................. A Incision of metatarsal... 5.86 4.29 4.37 0.47 10.62 10.70 090
28307... .................. A Incision of metatarsal... 6.33 5.57 6.27 0.76 12.66 13.36 090
28308... .................. A Incision of metatarsal... 5.29 3.50 3.50 0.50 9.29 9.29 090
28309... .................. A Incision of metatarsals.. 12.78 NA 9.00 1.00 NA 22.78 090
28310... .................. A Revision of big toe...... 5.43 3.82 3.97 0.42 9.67 9.82 090
28312... .................. A Revision of toe.......... 4.55 3.53 4.34 0.45 8.53 9.34 090
28313... .................. A Repair deformity of toe.. 5.01 3.89 6.32 0.31 9.21 11.64 090
[[Page 30925]]
28315... .................. A Removal of sesamoid bone. 4.86 3.47 3.57 0.41 8.74 8.84 090
28320... .................. A Repair of foot bones..... 9.18 NA 7.29 1.03 NA 17.50 090
28322... .................. A Repair of metatarsals.... 8.34 5.66 6.58 0.52 14.52 15.44 090
28340... .................. A Resect enlarged toe 6.98 4.31 4.45 0.91 12.20 12.34 090
tissue.
28341... .................. A Resect enlarged toe...... 8.41 4.94 5.65 0.96 14.31 15.02 090
28344... .................. A Repair extra toe(s)...... 4.26 3.01 4.00 0.60 7.87 8.86 090
28345... .................. A Repair webbed toe(s)..... 5.92 4.96 5.47 0.73 11.61 12.12 090
28360... .................. A Reconstruct cleft foot... 13.34 NA 12.53 1.95 NA 27.82 090
28400... .................. A Treatment of heel 2.16 5.37 3.00 0.40 7.93 5.56 090
fracture.
28405... .................. A Treatment of heel 4.57 6.46 4.76 0.58 11.61 9.91 090
fracture.
28406... .................. A Treatment of heel 6.31 NA 6.85 0.93 NA 14.09 090
fracture.
28415... .................. A Repair of heel fracture.. 15.97 NA 28.96 1.39 NA 46.32 090
28420... .................. A Repair/graft heel 16.64 NA 30.12 1.63 NA 48.39 090
fracture.
28430... .................. A Treatment of ankle 2.09 5.07 2.26 0.35 7.51 4.70 090
fracture.
28435... .................. A Treatment of ankle 3.40 5.14 3.72 0.50 9.04 7.62 090
fracture.
28436... .................. A Treatment of ankle 4.71 NA 5.92 0.68 NA 11.31 090
fracture.
28445... .................. A Repair of ankle fracture. 9.33 NA 8.25 1.40 NA 18.98 090
28450... .................. A Treat midfoot fracture, 1.90 4.76 2.28 0.25 6.91 4.43 090
each.
28455... .................. A Treat midfoot fracture, 3.09 4.07 3.81 0.34 7.50 7.24 090
each.
28456... .................. A Repair midfoot fracture.. 2.68 NA 4.36 0.38 NA 7.42 090
28465... .................. A Repair midfoot fracture, 7.01 NA 15.39 0.81 NA 23.21 090
each.
28470... .................. A Treat metatarsal fracture 1.99 4.39 1.94 0.23 6.61 4.16 090
28475... .................. A Treat metatarsal fracture 2.97 4.47 3.30 0.30 7.74 6.57 090
28476... .................. A Repair metatarsal 3.38 NA 4.92 0.45 NA 8.75 090
fracture.
28485... .................. A Repair metatarsal 5.71 NA 16.10 0.60 NA 22.41 090
fracture.
28490... .................. A Treat big toe fracture... 1.09 1.50 1.10 0.10 2.69 2.29 090
28495... .................. A Treat big toe fracture... 1.58 1.50 1.56 0.13 3.21 3.27 090
28496... .................. A Repair big toe fracture.. 2.33 3.13 3.93 0.31 5.77 6.57 090
28505... .................. A Repair big toe fracture.. 3.81 11.81 12.54 0.43 16.05 16.78 090
28510... .................. A Treatment of toe fracture 1.09 1.26 1.02 0.09 2.44 2.20 090
28515... .................. A Treatment of toe fracture 1.46 1.35 1.31 0.11 2.92 2.88 090
28525... .................. A Repair of toe fracture... 3.32 10.38 14.94 0.29 13.99 18.55 090
28530... .................. A Treat sesamoid bone 1.06 1.70 1.61 0.10 2.86 2.77 090
fracture.
28531... .................. A Treat sesamoid bone 2.35 2.86 12.41 0.32 5.53 15.08 090
fracture.
28540... .................. A Treat foot dislocation... 2.04 2.37 2.11 0.06 4.47 4.21 090
28545... .................. A Treat foot dislocation... 2.45 1.84 3.50 0.14 4.43 6.09 090
28546... .................. A Treat foot dislocation... 3.20 7.60 4.19 0.45 11.25 7.84 090
28555... .................. A Repair foot dislocation.. 6.30 21.63 17.07 0.73 28.66 24.10 090
28570... .................. A Treat foot dislocation... 1.66 3.36 2.59 0.17 5.19 4.42 090
28575... .................. A Treat foot dislocation... 3.31 4.96 4.00 0.42 8.69 7.73 090
28576... .................. A Treat foot dislocation... 4.17 6.82 5.28 0.42 11.41 9.87 090
28585... .................. A Repair foot dislocation.. 7.99 8.08 15.29 0.55 16.62 23.83 090
28600... .................. A Treat foot dislocation... 1.89 3.83 2.55 0.08 5.80 4.52 090
28605... .................. A Treat foot dislocation... 2.71 3.53 3.68 0.34 6.58 6.73 090
28606... .................. A Treat foot dislocation... 4.90 5.37 5.57 0.55 10.82 11.02 090
28615... .................. A Repair foot dislocation.. 7.77 NA 20.06 0.78 NA 28.61 090
28630... .................. A Treat toe dislocation.... 1.70 1.64 1.21 0.11 3.45 3.02 010
28635... .................. A Treat toe dislocation.... 1.91 1.94 2.13 0.18 4.03 4.22 010
28636... .................. A Treat toe dislocation.... 2.77 1.93 2.86 0.42 5.12 6.05 010
28645... .................. A Repair toe dislocation... 4.22 3.54 6.04 0.38 8.14 10.64 090
28660... .................. A Treat toe dislocation.... 1.23 2.55 1.12 0.06 3.84 2.41 010
28665... .................. A Treat toe dislocation.... 1.92 1.93 2.12 0.11 3.96 4.15 010
28666... .................. A Treat toe dislocation.... 2.66 8.44 2.68 0.40 11.50 5.74 010
28675... .................. A Repair of toe dislocation 2.92 4.34 9.17 0.41 7.67 12.50 090
28705... .................. A Fusion of foot bones..... 15.21 NA 11.62 2.35 NA 29.18 090
28715... .................. A Fusion of foot bones..... 13.10 NA 10.62 1.89 NA 25.61 090
28725... .................. A Fusion of foot bones..... 11.61 NA 9.76 1.44 NA 22.81 090
28730... .................. A Fusion of foot bones..... 10.76 NA 8.67 1.33 NA 20.76 090
28735... .................. A Fusion of foot bones..... 10.85 NA 8.94 1.37 NA 21.16 090
28737... .................. A Revision of foot bones... 9.64 NA 7.47 1.13 NA 18.24 090
28740... .................. A Fusion of foot bones..... 8.02 8.02 6.91 0.72 16.76 15.65 090
28750... .................. A Fusion of big toe joint.. 7.30 8.03 6.99 0.82 16.15 15.11 090
28755... .................. A Fusion of big toe joint.. 4.74 3.64 4.51 0.45 8.83 9.70 090
28760... .................. A Fusion of big toe joint.. 7.75 5.31 6.10 0.65 13.71 14.50 090
28800... .................. A Amputation of midfoot.... 8.21 NA 6.55 1.19 NA 15.95 090
28805... .................. A Amputation thru 8.39 NA 6.21 1.21 NA 15.81 090
metatarsal.
28810... .................. A Amputation toe & 6.21 NA 5.18 0.75 NA 12.14 090
metatarsal.
28820... .................. A Amputation of toe........ 4.41 5.54 4.59 0.46 10.41 9.46 090
28825... .................. A Partial amputation of toe 3.59 5.41 4.10 0.41 9.41 8.10 090
29000... .................. A Application of body cast. 2.25 7.59 1.34 0.21 10.05 3.80 000
29010... .................. A Application of body cast. 2.06 9.76 1.22 0.34 12.16 3.62 000
29015... .................. A Application of body cast. 2.41 6.34 1.07 0.33 9.08 3.81 000
29020... .................. A Application of body cast. 2.11 6.03 1.05 0.23 8.37 3.39 000
29025... .................. A Application of body cast. 2.40 8.76 1.43 0.14 11.30 3.97 000
[[Page 30926]]
29035... .................. A Application of body cast. 1.77 10.29 1.11 0.32 12.38 3.20 000
29040... .................. A Application of body cast. 2.22 7.79 0.91 0.30 10.31 3.43 000
29044... .................. A Application of body cast. 2.12 13.00 1.35 0.34 15.46 3.81 000
29046... .................. A Application of body cast. 2.41 11.41 1.46 0.36 14.18 4.23 000
29049... .................. A Application of figure 0.89 3.83 0.38 0.06 4.78 1.33 000
eight.
29055... .................. A Application of shoulder 1.78 8.03 0.98 0.17 9.98 2.93 000
cast.
29058... .................. A Application of shoulder 1.31 5.55 0.57 0.09 6.95 1.97 000
cast.
29065... .................. A Application of long arm 0.87 3.61 0.53 0.13 4.61 1.53 000
cast.
29075... .................. A Application of forearm 0.77 3.22 0.45 0.10 4.09 1.32 000
cast.
29085... .................. A Apply hand/wrist cast.... 0.87 3.14 0.48 0.08 4.09 1.43 000
29105... .................. A Apply long arm splint.... 0.87 2.50 0.31 0.08 3.45 1.26 000
29125... .................. A Apply forearm splint..... 0.59 1.99 0.18 0.05 2.63 0.82 000
29126... .................. A Apply forearm splint..... 0.77 2.55 0.41 0.06 3.38 1.24 000
29130... .................. A Application of finger 0.50 0.61 0.15 0.02 1.13 0.67 000
splint.
29131... .................. A Application of finger 0.55 0.82 0.25 0.06 1.43 0.86 000
splint.
29200... .................. A Strapping of chest....... 0.65 0.75 0.17 0.03 1.43 0.85 000
29220... .................. A Strapping of low back.... 0.64 0.79 0.25 0.05 1.48 0.94 000
29240... .................. A Strapping of shoulder.... 0.71 0.86 0.21 0.03 1.60 0.95 000
29260... .................. A Strapping of elbow or 0.55 0.71 0.15 0.03 1.29 0.73 000
wrist.
29280... .................. A Strapping of hand or 0.51 0.68 0.14 0.02 1.21 0.67 000
finger.
29305... .................. A Application of hip cast.. 2.03 10.18 1.27 0.31 12.52 3.61 000
29325... .................. A Application of hip casts. 2.32 9.99 1.42 0.28 12.59 4.02 000
29345... .................. A Application of long leg 1.40 4.54 0.83 0.16 6.10 2.39 000
cast.
29355... .................. A Application of long leg 1.53 4.43 0.91 0.17 6.13 2.61 000
cast.
29358... .................. A Apply long leg cast brace 1.43 5.28 0.91 0.33 7.04 2.67 000
29365... .................. A Application of long leg 1.18 3.96 0.72 0.14 5.28 2.04 000
cast.
29405... .................. A Apply short leg cast..... 0.86 3.26 0.50 0.12 4.24 1.48 000
29425... .................. A Apply short leg cast..... 1.01 3.09 0.56 0.14 4.24 1.71 000
29435... .................. A Apply short leg cast..... 1.18 5.52 0.74 0.18 6.88 2.10 000
29440... .................. A Addition of walker to 0.57 1.67 0.30 0.03 2.27 0.90 000
cast.
29445... .................. A Apply rigid leg cast..... 1.78 4.94 0.98 0.28 7.00 3.04 000
29450... .................. A Application of leg cast.. 1.02 2.89 0.46 0.04 3.95 1.52 000
29505... .................. A Application long leg 0.69 2.84 0.26 0.07 3.60 1.02 000
splint.
29515... .................. A Application lower leg 0.73 1.81 0.25 0.06 2.60 1.04 000
splint.
29520... .................. A Strapping of hip......... 0.54 0.68 0.32 0.03 1.25 0.89 000
29530... .................. A Strapping of knee........ 0.57 0.72 0.16 0.05 1.34 0.78 000
29540... .................. A Strapping of ankle....... 0.51 0.32 0.18 0.03 0.86 0.72 000
29550... .................. A Strapping of toes........ 0.47 0.30 0.18 0.03 0.80 0.68 000
29580... .................. A Application of paste boot 0.57 0.60 0.27 0.04 1.21 0.88 000
29590... .................. A Application of foot 0.76 0.47 0.34 0.03 1.26 1.13 000
splint.
29700... .................. A Removal/revision of cast. 0.57 0.54 0.26 0.05 1.16 0.88 000
29705... .................. A Removal/revision of cast. 0.76 0.77 0.35 0.05 1.58 1.16 000
29710... .................. A Removal/revision of cast. 1.34 1.22 0.89 0.07 2.63 2.30 000
29715... .................. A Removal/revision of cast. 0.94 2.86 0.65 0.12 3.92 1.71 000
29720... .................. A Repair of body cast...... 0.68 3.21 0.42 0.04 3.93 1.14 000
29730... .................. A Windowing of cast........ 0.75 0.73 0.35 0.04 1.52 1.14 000
29740... .................. A Wedging of cast.......... 1.12 2.35 0.64 0.06 3.53 1.82 000
29750... .................. A Wedging of clubfoot cast. 1.26 1.03 0.65 0.07 2.36 1.98 000
29800... .................. A Jaw arthroscopy/surgery.. 6.43 NA 7.16 0.46 NA 14.05 090
29804... .................. A Jaw arthroscopy/surgery.. 8.14 NA 7.84 1.46 NA 17.44 090
29815... .................. A Shoulder arthroscopy..... 5.89 NA 6.09 0.76 NA 12.74 090
29819... .................. A Shoulder arthroscopy/ 7.62 NA 7.41 1.73 NA 16.76 090
surgery.
29820... .................. A Shoulder arthroscopy/ 7.07 NA 7.33 1.73 NA 16.13 090
surgery.
29821... .................. A Shoulder arthroscopy/ 7.72 NA 7.75 2.13 NA 17.60 090
surgery.
29822... .................. A Shoulder arthroscopy/ 7.43 NA 7.54 1.74 NA 16.71 090
surgery.
29823... .................. A Shoulder arthroscopy/ 8.17 NA 7.97 2.32 NA 18.46 090
surgery.
29825... .................. A Shoulder arthroscopy/ 7.62 NA 7.65 2.05 NA 17.32 090
surgery.
29826... .................. A Shoulder arthroscopy/ 8.99 NA 8.42 2.31 NA 19.72 090
surgery.
29830... .................. A Elbow arthroscopy........ 5.76 NA 5.00 0.83 NA 11.59 090
29834... .................. A Elbow arthroscopy/surgery 6.28 NA 5.66 0.96 NA 12.90 090
29835... .................. A Elbow arthroscopy/surgery 6.48 NA 5.73 0.99 NA 13.20 090
29836... .................. A Elbow arthroscopy/surgery 7.55 NA 6.20 1.15 NA 14.90 090
29837... .................. A Elbow arthroscopy/surgery 6.87 NA 6.03 1.06 NA 13.96 090
29838... .................. A Elbow arthroscopy/surgery 7.71 NA 6.54 1.14 NA 15.39 090
29840... .................. A Wrist arthroscopy........ 5.54 NA 6.26 0.54 NA 12.34 090
29843... .................. A Wrist arthroscopy/surgery 6.01 NA 6.75 0.91 NA 13.67 090
29844... .................. A Wrist arthroscopy/surgery 6.37 NA 7.14 0.95 NA 14.46 090
29845... .................. A Wrist arthroscopy/surgery 7.52 NA 7.93 1.15 NA 16.60 090
29846... .................. A Wrist arthroscopy/surgery 6.75 NA 8.86 2.20 NA 17.81 090
29847... .................. A Wrist arthroscopy/surgery 7.08 NA 8.94 0.97 NA 16.99 090
29848... .................. A Wrist arthroscopy/surgery 5.44 NA 6.41 0.62 NA 12.47 090
29850... .................. A Knee arthroscopy/surgery. 8.19 NA 5.47 1.74 NA 15.40 090
29851... .................. A Knee arthroscopy/surgery. 13.10 NA 10.43 1.74 NA 25.27 090
29855... .................. A Tibial arthroscopy/ 10.62 NA 8.87 1.88 NA 21.37 090
surgery.
[[Page 30927]]
29856... .................. A Tibial arthroscopy/ 14.14 NA 11.01 1.88 NA 27.03 090
surgery.
29860... .................. A Hip arthroscopy, dx...... 8.05 NA 6.22 0.76 NA 15.03 090
29861... .................. A Hip arthroscopy/surgery.. 9.15 NA 7.11 1.73 NA 17.99 090
29862... .................. A Hip arthroscopy/surgery.. 9.90 NA 7.51 2.32 NA 19.73 090
29863... .................. A Hip arthroscopy/surgery.. 9.90 NA 7.80 1.73 NA 19.43 090
29870... .................. A Knee arthroscopy, 5.07 NA 4.90 0.64 NA 10.61 090
diagnostic.
29871... .................. A Knee arthroscopy/drainage 6.55 NA 6.54 0.96 NA 14.05 090
29874... .................. A Knee arthroscopy/surgery. 7.05 NA 6.37 1.52 NA 14.94 090
29875... .................. A Knee arthroscopy/surgery. 6.31 NA 6.16 1.61 NA 14.08 090
29876... .................. A Knee arthroscopy/surgery. 7.92 NA 7.42 1.95 NA 17.29 090
29877... .................. A Knee arthroscopy/surgery. 7.35 NA 6.80 1.81 NA 15.96 090
29879... .................. A Knee arthroscopy/surgery. 8.04 NA 7.21 2.19 NA 17.44 090
29880... .................. A Knee arthroscopy/surgery. 8.50 NA 7.47 2.22 NA 18.19 090
29881... .................. A Knee arthroscopy/surgery. 7.76 NA 7.04 1.82 NA 16.62 090
29882... .................. A Knee arthroscopy/surgery. 8.65 NA 7.05 1.90 NA 17.60 090
29883... .................. A Knee arthroscopy/surgery. 9.46 NA 8.10 2.80 NA 20.36 090
29884... .................. A Knee arthroscopy/surgery. 7.33 NA 7.08 1.56 NA 15.97 090
29885... .................. A Knee arthroscopy/surgery. 9.09 NA 8.18 1.35 NA 18.62 090
29886... .................. A Knee arthroscopy/surgery. 7.54 NA 7.14 1.12 NA 15.80 090
29887... .................. A Knee arthroscopy/surgery. 9.04 NA 7.82 1.71 NA 18.57 090
29888... .................. A Knee arthroscopy/surgery. 13.90 NA 10.66 3.18 NA 27.74 090
29889... .................. A Knee arthroscopy/surgery. 15.13 NA 11.08 1.68 NA 27.89 090
29891... .................. A Ankle arthroscopy/surgery 8.40 NA 6.99 1.77 NA 17.16 090
29892... .................. A Ankle arthroscopy/surgery 9.00 NA 7.27 1.77 NA 18.04 090
29893... .................. A Scope, plantar fasciotomy 5.22 NA 3.78 0.46 NA 9.46 090
29894... .................. A Ankle arthroscopy/surgery 7.21 NA 6.37 1.47 NA 15.05 090
29895... .................. A Ankle arthroscopy/surgery 6.99 NA 6.23 1.51 NA 14.73 090
29897... .................. A Ankle arthroscopy/surgery 7.18 NA 6.81 1.77 NA 15.76 090
29898... .................. A Ankle arthroscopy/surgery 8.32 NA 6.72 1.91 NA 16.95 090
30000... .................. A Drainage of nose lesion.. 1.43 1.59 1.40 0.05 3.07 2.88 010
30020... .................. A Drainage of nose lesion.. 1.43 1.57 1.44 0.06 3.06 2.93 010
30100... .................. A Intranasal biopsy........ 0.94 0.93 0.58 0.08 1.95 1.60 000
30110... .................. A Removal of nose polyp(s). 1.63 1.81 0.99 0.14 3.58 2.76 010
30115... .................. A Removal of nose polyp(s). 4.35 NA 4.11 0.30 NA 8.76 090
30117... .................. A Removal of intranasal 3.16 3.15 2.83 0.31 6.62 6.30 090
lesion.
30118... .................. A Removal of intranasal 9.69 NA 7.57 0.92 NA 18.18 090
lesion.
30120... .................. A Revision of nose......... 5.27 4.23 5.03 1.00 10.50 11.30 090
30124... .................. A Removal of nose lesion... 3.10 NA 2.96 0.16 NA 6.22 090
30125... .................. A Removal of nose lesion... 7.16 NA 6.04 0.73 NA 13.93 090
30130... .................. A Removal of turbinate 3.38 NA 3.60 0.17 NA 7.15 090
bones.
30140... .................. A Removal of turbinate 3.43 NA 3.81 0.34 NA 7.58 090
bones.
30150... .................. A Partial removal of nose.. 9.14 NA 7.40 1.07 NA 17.61 090
30160... .................. A Removal of nose.......... 9.58 NA 7.73 1.73 NA 19.04 090
30200... .................. A Injection treatment of 0.78 0.87 0.49 0.04 1.69 1.31 000
nose.
30210... .................. A Nasal sinus therapy...... 1.08 1.36 0.69 0.03 2.47 1.80 010
30220... .................. A Insert nasal septal 1.54 1.68 0.98 0.16 3.38 2.68 010
button.
30300... .................. A Remove nasal foreign body 1.04 1.56 0.39 0.05 2.65 1.48 010
30310... .................. A Remove nasal foreign body 1.96 NA 1.83 0.18 NA 3.97 010
30320... .................. A Remove nasal foreign body 4.52 NA 4.23 0.43 NA 9.18 090
30400... .................. R Reconstruction of nose... 9.83 NA 7.98 1.36 NA 19.17 090
30410... .................. R Reconstruction of nose... 12.98 NA 9.78 2.01 NA 24.77 090
30420... .................. R Reconstruction of nose... 15.88 NA 11.71 2.22 NA 29.81 090
30430... .................. R Revision of nose......... 7.21 NA 6.28 0.66 NA 14.15 090
30435... .................. R Revision of nose......... 11.71 NA 9.29 1.10 NA 22.10 090
30450... .................. R Revision of nose......... 18.65 NA 13.35 0.91 NA 32.91 090
30460... .................. A Revision of nose......... 9.96 NA 7.10 0.93 NA 17.99 090
30462... .................. A Revision of nose......... 19.57 NA 13.86 1.87 NA 35.30 090
30520... .................. A Repair of nasal septum... 5.70 NA 5.13 0.96 NA 11.79 090
30540... .................. A Repair nasal defect...... 7.75 NA 5.87 0.70 NA 14.32 090
30545... .................. A Repair nasal defect...... 11.38 NA 7.57 0.93 NA 19.88 090
30560... .................. A Release of nasal 1.26 1.52 1.38 0.06 2.84 2.70 010
adhesions.
30580... .................. A Repair upper jaw fistula. 6.69 4.15 4.89 0.57 11.41 12.15 090
30600... .................. A Repair mouth/nose fistula 6.02 3.84 4.84 0.36 10.22 11.22 090
30620... .................. A Intranasal reconstruction 5.97 NA 5.50 1.10 NA 12.57 090
30630... .................. A Repair nasal septum 7.12 NA 6.14 0.71 NA 13.97 090
defect.
30801... .................. A Cauterization inner nose. 1.09 1.55 1.84 0.05 2.69 2.98 010
30802... .................. A Cauterization inner nose. 2.03 2.15 2.48 0.11 4.29 4.62 010
30901... .................. A Control of nosebleed..... 1.21 1.48 0.46 0.06 2.75 1.73 000
30903... .................. A Control of nosebleed..... 1.54 1.76 0.74 0.08 3.38 2.36 000
30905... .................. A Control of nosebleed..... 1.97 2.94 1.18 0.17 5.08 3.32 000
30906... .................. A Repeat control of 2.45 3.23 1.76 0.11 5.79 4.32 000
nosebleed.
30915... .................. A Ligation nasal sinus 7.20 NA 6.23 0.52 NA 13.95 090
artery.
30920... .................. A Ligation upper jaw artery 9.83 NA 7.88 1.32 NA 19.03 090
30930... .................. A Therapy fracture of nose. 1.26 NA 1.93 0.08 NA 3.27 010
[[Page 30928]]
31000... .................. A Irrigation maxillary 1.15 1.46 0.72 0.05 2.66 1.92 010
sinus.
31002... .................. A Irrigation sphenoid sinus 1.91 NA 2.05 0.05 NA 4.01 010
31020... .................. A Exploration maxillary 2.94 2.99 3.01 0.29 6.22 6.24 090
sinus.
31030... .................. A Exploration maxillary 5.92 3.80 4.65 0.86 10.58 11.43 090
sinus.
31032... .................. A Explore sinus,remove 6.57 NA 5.59 0.99 NA 13.15 090
polyps.
31040... .................. A Exploration behind upper 9.42 NA 6.12 0.86 NA 16.40 090
jaw.
31050... .................. A Exploration sphenoid 5.28 NA 4.68 0.64 NA 10.60 090
sinus.
31051... .................. A Sphenoid sinus surgery... 7.11 NA 5.98 0.85 NA 13.94 090
31070... .................. A Exploration of frontal 4.28 NA 4.22 0.50 NA 9.00 090
sinus.
31075... .................. A Exploration of frontal 9.16 NA 7.54 1.10 NA 17.80 090
sinus.
31080... .................. A Removal of frontal sinus. 11.42 NA 8.20 1.12 NA 20.74 090
31081... .................. A Removal of frontal sinus. 12.75 NA 9.00 1.30 NA 23.05 090
31084... .................. A Removal of frontal sinus. 13.51 NA 10.25 1.62 NA 25.38 090
31085... .................. A Removal of frontal sinus. 14.20 NA 10.54 1.76 NA 26.50 090
31086... .................. A Removal of frontal sinus. 12.86 NA 9.98 1.15 NA 23.99 090
31087... .................. A Removal of frontal sinus. 13.10 NA 10.08 1.33 NA 24.51 090
31090... .................. A Exploration of sinuses... 9.53 NA 7.93 2.12 NA 19.58 090
31200... .................. A Removal of ethmoid sinus. 4.97 NA 5.42 0.48 NA 10.87 090
31201... .................. A Removal of ethmoid sinus. 8.37 NA 7.04 0.75 NA 16.16 090
31205... .................. A Removal of ethmoid sinus. 10.24 NA 8.74 0.81 NA 19.79 090
31225... .................. A Removal of upper jaw..... 19.23 NA 15.40 2.37 NA 37.00 090
31230... .................. A Removal of upper jaw..... 21.94 NA 17.90 2.48 NA 42.32 090
31231... .................. A Nasal endoscopy, dx...... 1.10 1.33 0.66 0.15 2.58 1.91 000
31233... .................. A Nasal/sinus endoscopy, dx 2.18 2.02 1.36 0.31 4.51 3.85 000
31235... .................. A Nasal/sinus endoscopy, dx 2.64 2.33 1.69 0.26 5.23 4.59 000
31237... .................. A Nasal/sinus endoscopy, 2.98 2.57 1.85 0.37 5.92 5.20 000
surg.
31238... .................. A Nasal/sinus endoscopy, 3.26 2.87 2.07 0.45 6.58 5.78 000
surg.
31239... .................. A Nasal/sinus endoscopy, 8.70 NA 6.90 1.18 NA 16.78 010
surg.
31240... .................. A Nasal/sinus endoscopy, 2.61 NA 1.94 0.37 NA 4.92 000
surg.
31254... .................. A Revision of ethmoid sinus 4.65 NA 3.27 0.69 NA 8.61 000
31255... .................. A Removal of ethmoid sinus. 6.96 NA 4.84 1.14 NA 12.94 000
31256... .................. A Exploration maxillary 3.29 NA 2.38 0.41 NA 6.08 000
sinus.
31267... .................. A Endoscopy, maxillary 5.46 NA 3.74 0.81 NA 10.01 000
sinus.
31276... .................. A Sinus surgical endoscopy. 8.85 NA 5.94 0.73 NA 15.52 000
31287... .................. A Nasal/sinus endoscopy, 3.92 NA 2.76 0.65 NA 7.33 000
surg.
31288... .................. A Nasal/sinus endoscopy, 4.58 NA 3.19 0.78 NA 8.55 000
surg.
31290... .................. A Nasal/sinus endoscopy, 17.24 NA 12.19 1.80 NA 31.23 010
surg.
31291... .................. A Nasal/sinus endoscopy, 18.19 NA 12.96 1.88 NA 33.03 010
surg.
31292... .................. A Nasal/sinus endoscopy, 14.76 NA 10.38 1.45 NA 26.59 010
surg.
31293... .................. A Nasal/sinus endoscopy, 16.21 NA 11.96 1.59 NA 29.76 010
surg.
31294... .................. A Nasal/sinus endoscopy, 19.06 NA 12.98 1.83 NA 33.87 010
surg.
31300... .................. A Removal of larynx lesion. 14.29 NA 14.31 1.28 NA 29.88 090
31320... .................. A Diagnostic incision 5.26 NA 9.19 0.48 NA 14.93 090
larynx.
31360... .................. A Removal of larynx........ 17.08 NA 17.11 2.19 NA 36.38 090
31365... .................. A Removal of larynx........ 24.16 NA 21.72 3.10 NA 48.98 090
31367... .................. A Partial removal of larynx 21.86 NA 21.02 1.88 NA 44.76 090
31368... .................. A Partial removal of larynx 27.09 NA 25.77 3.06 NA 55.92 090
31370... .................. A Partial removal of larynx 21.38 NA 20.44 1.88 NA 43.70 090
31375... .................. A Partial removal of larynx 20.21 NA 18.73 1.56 NA 40.50 090
31380... .................. A Partial removal of larynx 20.21 NA 18.65 1.88 NA 40.74 090
31382... .................. A Partial removal of larynx 20.52 NA 19.85 1.78 NA 42.15 090
31390... .................. A Removal of larynx & 27.53 NA 25.76 4.05 NA 57.34 090
pharynx.
31395... .................. A Reconstruct larynx & 31.09 NA 30.56 4.42 NA 66.07 090
pharynx.
31400... .................. A Revision of larynx....... 10.31 NA 11.89 0.91 NA 23.11 090
31420... .................. A Removal of epiglottis.... 10.22 NA 12.46 0.84 NA 23.52 090
31500... .................. A Insert emergency airway.. 2.33 NA 0.62 0.14 NA 3.09 000
31502... .................. A Change of windpipe airway 0.65 1.09 0.28 0.07 1.81 1.00 000
31505... .................. A Diagnostic laryngoscopy.. 0.61 1.05 0.35 0.05 1.71 1.01 000
31510... .................. A Laryngoscopy with biopsy. 1.92 1.90 1.01 0.07 3.89 3.00 000
31511... .................. A Remove foreign body, 2.16 2.12 0.70 0.10 4.38 2.96 000
larynx.
31512... .................. A Removal of larynx lesion. 2.07 2.07 1.23 0.20 4.34 3.50 000
31513... .................. A Injection into vocal cord 2.10 NA 1.55 0.38 NA 4.03 000
31515... .................. A Laryngoscopy for 1.80 1.03 1.13 0.14 2.97 3.07 000
aspiration.
31520... .................. A Diagnostic laryngoscopy.. 2.56 NA 1.66 0.18 NA 4.40 000
31525... .................. A Diagnostic laryngoscopy.. 2.63 2.29 1.84 0.23 5.15 4.70 000
31526... .................. A Diagnostic laryngoscopy.. 2.57 NA 1.85 0.38 NA 4.80 000
31527... .................. A Laryngoscopy for 3.27 NA 2.00 0.30 NA 5.57 000
treatment.
31528... .................. A Laryngoscopy and 2.37 NA 1.56 0.30 NA 4.23 000
dilatation.
31529... .................. A Laryngoscopy and 2.68 NA 1.89 0.25 NA 4.82 000
dilatation.
31530... .................. A Operative laryngoscopy... 3.39 NA 1.97 0.39 NA 5.75 000
31531... .................. A Operative laryngoscopy... 3.59 NA 2.54 0.60 NA 6.73 000
31535... .................. A Operative laryngoscopy... 3.16 NA 2.16 0.45 NA 5.77 000
31536... .................. A Operative laryngoscopy... 3.56 NA 2.53 0.59 NA 6.68 000
31540... .................. A Operative laryngoscopy... 4.13 NA 2.78 0.61 NA 7.52 000
[[Page 30929]]
31541... .................. A Operative laryngoscopy... 4.53 NA 3.15 0.75 NA 8.43 000
31560... .................. A Operative laryngoscopy... 5.46 NA 3.57 0.51 NA 9.54 000
31561... .................. A Operative laryngoscopy... 6.00 NA 4.13 1.08 NA 11.21 000
31570... .................. A Laryngoscopy with 3.87 2.38 2.77 0.60 6.85 7.24 000
injection.
31571... .................. A Laryngoscopy with 4.27 NA 2.98 0.69 NA 7.94 000
injection.
31575... .................. A Diagnostic laryngoscopy.. 1.10 1.37 0.65 0.17 2.64 1.92 000
31576... .................. A Laryngoscopy with biopsy. 1.97 1.64 1.12 0.33 3.94 3.42 000
31577... .................. A Remove foreign body, 2.47 1.97 1.22 0.37 4.81 4.06 000
larynx.
31578... .................. A Removal of larynx lesion. 2.84 2.17 1.35 0.48 5.49 4.67 000
31579... .................. A Diagnostic laryngoscopy.. 2.26 2.16 1.25 0.26 4.68 3.77 000
31580... .................. A Revision of larynx....... 12.38 NA 13.28 1.63 NA 27.29 090
31582... .................. A Revision of larynx....... 21.62 NA 19.49 1.94 NA 43.05 090
31584... .................. A Repair of larynx fracture 19.64 NA 17.42 1.34 NA 38.40 090
31585... .................. A Repair of larynx fracture 4.64 NA 6.56 0.40 NA 11.60 090
31586... .................. A Repair of larynx fracture 8.03 NA 9.67 0.71 NA 18.41 090
31587... .................. A Revision of larynx....... 11.99 NA 13.22 0.79 NA 26.00 090
31588... .................. A Revision of larynx....... 13.11 NA 14.51 1.16 NA 28.78 090
31590... .................. A Reinnervate larynx....... 6.97 NA 9.63 0.62 NA 17.22 090
31595... .................. A Larynx nerve surgery..... 8.34 NA 9.26 0.74 NA 18.34 090
31600... .................. A Incision of windpipe..... 3.62 NA 2.22 0.65 NA 6.49 000
31601... .................. A Incision of windpipe..... 4.45 NA 2.90 0.66 NA 8.01 000
31603... .................. A Incision of windpipe..... 4.15 NA 2.49 0.66 NA 7.30 000
31605... .................. A Incision of windpipe..... 3.58 NA 1.76 0.50 NA 5.84 000
31610... .................. A Incision of windpipe..... 8.76 NA 9.04 0.92 NA 18.72 090
31611... .................. A Surgery/speech prosthesis 5.64 NA 7.88 1.04 NA 14.56 090
31612... .................. A Puncture/clear windpipe.. 0.91 1.14 0.52 0.12 2.17 1.55 000
31613... .................. A Repair windpipe opening.. 4.59 NA 6.56 0.28 NA 11.43 090
31614... .................. A Repair windpipe opening.. 7.12 NA 9.23 0.73 NA 17.08 090
31615... .................. A Visualization of windpipe 2.09 4.04 1.44 0.22 6.35 3.75 000
31622... .................. A Diagnostic bronchoscopy.. 2.80 2.75 1.37 0.34 5.89 4.51 000
31625... .................. A Bronchoscopy with biopsy. 3.37 2.79 1.50 0.35 6.51 5.22 000
31628... .................. A Bronchoscopy with biopsy. 3.81 2.77 1.59 0.38 6.96 5.78 000
31629... .................. A Bronchoscopy with biopsy. 3.37 NA 1.28 0.34 NA 4.99 000
31630... .................. A Bronchoscopy with repair. 3.82 NA 2.03 0.50 NA 6.35 000
31631... .................. A Bronchoscopy with 4.37 NA 2.10 0.48 NA 6.95 000
dilation.
31635... .................. A Remove foreign body, 3.68 NA 1.72 0.53 NA 5.93 000
airway.
31640... .................. A Bronchoscopy & remove 4.94 NA 2.38 0.67 NA 7.99 000
lesion.
31641... .................. A Bronchoscopy, treat 5.03 NA 2.10 0.85 NA 7.98 000
blockage.
31645... .................. A Bronchoscopy, clear 3.16 NA 1.28 0.30 NA 4.74 000
airways.
31646... .................. A Bronchoscopy, reclear 2.72 NA 1.16 0.27 NA 4.15 000
airways.
31656... .................. A Bronchoscopy, inject for 2.17 NA 0.95 0.31 NA 3.43 000
xray.
31700... .................. A Insertion of airway 1.34 1.85 0.64 0.17 3.36 2.15 000
catheter.
31708... .................. A Instill airway contrast 1.41 NA 0.76 0.09 NA 2.26 000
dye.
31710... .................. A Insertion of airway 1.30 NA 0.70 0.12 NA 2.12 000
catheter.
31715... .................. A Injection for bronchus x- 1.11 NA 0.57 0.04 NA 1.72 000
ray.
31717... .................. A Bronchial brush biopsy... 2.12 2.11 0.87 0.06 4.29 3.05 000
31720... .................. A Clearance of airways..... 1.06 1.59 0.51 0.09 2.74 1.66 000
31725... .................. A Clearance of airways..... 1.96 NA 0.83 0.15 NA 2.94 000
31730... .................. A Intro windpipe wire/tube. 2.85 1.76 1.06 0.23 4.84 4.14 000
31750... .................. A Repair of windpipe....... 13.02 NA 13.74 1.09 NA 27.85 090
31755... .................. A Repair of windpipe....... 15.93 NA 16.59 1.44 NA 33.96 090
31760... .................. A Repair of windpipe....... 22.35 NA 14.37 2.55 NA 39.27 090
31766... .................. A Reconstruction of 30.43 NA 19.67 1.12 NA 51.22 090
windpipe.
31770... .................. A Repair/graft of bronchus. 22.51 NA 15.37 2.08 NA 39.96 090
31775... .................. A Reconstruct bronchus..... 23.54 NA 18.49 1.92 NA 43.95 090
31780... .................. A Reconstruct windpipe..... 17.72 NA 15.56 2.08 NA 35.36 090
31781... .................. A Reconstruct windpipe..... 23.53 NA 22.21 1.96 NA 47.70 090
31785... .................. A Remove windpipe lesion... 17.23 NA 16.74 1.17 NA 35.14 090
31786... .................. A Remove windpipe lesion... 23.98 NA 21.83 2.24 NA 48.05 090
31800... .................. A Repair of windpipe injury 7.43 NA 8.70 0.76 NA 16.89 090
31805... .................. A Repair of windpipe injury 13.13 NA 12.12 1.41 NA 26.66 090
31820... .................. A Closure of windpipe 4.49 5.74 6.36 0.46 10.69 11.31 090
lesion.
31825... .................. A Repair of windpipe defect 6.81 7.91 8.99 0.58 15.30 16.38 090
31830... .................. A Revise windpipe scar..... 4.50 5.74 6.40 0.42 10.66 11.32 090
32000... .................. A Drainage of chest........ 1.54 2.62 0.66 0.08 4.24 2.28 000
32002... .................. A Treatment of collapsed 2.19 NA 0.92 0.22 NA 3.33 000
lung.
32005... .................. A Treat lung lining 2.19 NA 0.96 0.15 NA 3.30 000
chemically.
32020... .................. A Insertion of chest tube.. 3.98 NA 1.61 0.43 NA 6.02 000
32035... .................. A Exploration of chest..... 8.67 NA 8.41 1.25 NA 18.33 090
32036... .................. A Exploration of chest..... 9.68 NA 8.84 1.32 NA 19.84 090
32095... .................. A Biopsy through chest wall 8.36 NA 8.11 1.45 NA 17.92 090
32100... .................. A Exploration/biopsy of 11.84 NA 9.52 2.10 NA 23.46 090
chest.
32110... .................. A Explore/repair chest..... 13.62 NA 11.93 2.01 NA 27.56 090
32120... .................. A Re-exploration of chest.. 11.54 NA 9.94 1.72 NA 23.20 090
[[Page 30930]]
32124... .................. A Explore chest, free 12.72 NA 10.22 2.21 NA 25.15 090
adhesions.
32140... .................. A Removal of lung lesion(s) 13.93 NA 10.82 2.42 NA 27.17 090
32141... .................. A Remove/treat lung lesions 14.00 NA 12.36 2.53 NA 28.89 090
32150... .................. A Removal of lung lesion(s) 14.15 NA 10.82 2.01 NA 26.98 090
32151... .................. A Remove lung foreign body. 14.21 NA 10.55 1.37 NA 26.13 090
32160... .................. A Open chest heart massage. 9.30 NA 8.36 1.52 NA 19.18 090
32200... .................. A Open drainage, lung 15.29 NA 13.85 0.93 NA 30.07 090
lesion.
32201... .................. A Percut drainage, lung 4.00 NA 9.66 0.35 NA 14.01 000
lesion.
32215... .................. A Treat chest lining....... 11.33 NA 8.92 1.28 NA 21.53 090
32220... .................. A Release of lung.......... 19.27 NA 14.67 3.01 NA 36.95 090
32225... .................. A Partial release of lung.. 13.96 NA 12.42 2.28 NA 28.66 090
32310... .................. A Removal of chest lining.. 13.44 NA 12.07 2.10 NA 27.61 090
32320... .................. A Free/remove chest lining. 20.54 NA 14.84 3.40 NA 38.78 090
32400... .................. A Needle biopsy chest 1.76 1.32 0.98 0.12 3.20 2.86 000
lining.
32402... .................. A Open biopsy chest lining. 7.56 NA 6.91 1.34 NA 15.81 090
32405... .................. A Biopsy, lung or 1.93 1.49 1.24 0.18 3.60 3.35 000
mediastinum.
32420... .................. A Puncture/clear lung...... 2.18 NA 0.92 0.13 NA 3.23 000
32440... .................. A Removal of lung.......... 21.02 NA 14.46 3.55 NA 39.03 090
32442... .................. A Sleeve pneumonectomy..... 26.24 NA 17.50 3.50 NA 47.24 090
32445... .................. A Removal of lung.......... 25.09 NA 17.24 3.88 NA 46.21 090
32480... .................. A Partial removal of lung.. 18.32 NA 11.23 3.23 NA 32.78 090
32482... .................. A Bilobectomy.............. 19.71 NA 12.90 3.23 NA 35.84 090
32484... .................. A Segmentectomy............ 20.69 NA 13.37 3.23 NA 37.29 090
32486... .................. A Sleeve lobectomy......... 23.92 NA 16.28 3.23 NA 43.43 090
32488... .................. A Completion pneumonectomy. 25.71 NA 16.85 3.46 NA 46.02 090
32491... .................. R Lung volume reduction.... 21.25 NA 45.14 3.02 NA 69.41 090
32500... .................. A Partial removal of lung.. 14.30 NA 10.60 2.56 NA 27.46 090
32501... .................. A Repair bronchus (add-on). 4.69 NA 1.92 0.70 NA 7.31 ZZZ
32520... .................. A Remove lung & revise 21.68 NA 14.48 3.93 NA 40.09 090
chest.
32522... .................. A Remove lung & revise 24.20 NA 16.71 4.19 NA 45.10 090
chest.
32525... .................. A Remove lung & revise 26.50 NA 17.36 4.61 NA 48.47 090
chest.
32540... .................. A Removal of lung lesion... 14.64 NA 12.62 2.05 NA 29.31 090
32601... .................. A Thoracoscopy, diagnostic. 5.46 NA 4.37 0.57 NA 10.40 000
32602... .................. A Thoracoscopy, diagnostic. 5.96 NA 4.59 0.64 NA 11.19 000
32603... .................. A Thoracoscopy, diagnostic. 7.81 NA 5.71 0.57 NA 14.09 000
32604... .................. A Thoracoscopy, diagnostic. 8.78 NA 5.85 0.64 NA 15.27 000
32605... .................. A Thoracoscopy, diagnostic. 6.93 NA 4.86 0.57 NA 12.36 000
32606... .................. A Thoracoscopy, diagnostic. 8.40 NA 5.59 0.64 NA 14.63 000
32650... .................. A Thoracoscopy, surgical... 10.75 NA 9.05 1.28 NA 21.08 090
32651... .................. A Thoracoscopy, surgical... 12.91 NA 10.09 2.28 NA 25.28 090
32652... .................. A Thoracoscopy, surgical... 18.66 NA 13.47 3.01 NA 35.14 090
32653... .................. A Thoracoscopy, surgical... 12.87 NA 11.02 2.01 NA 25.90 090
32654... .................. A Thoracoscopy, surgical... 12.44 NA 11.35 2.01 NA 25.80 090
32655... .................. A Thoracoscopy, surgical... 13.10 NA 11.32 2.53 NA 26.95 090
32656... .................. A Thoracoscopy, surgical... 12.91 NA 9.83 2.36 NA 25.10 090
32657... .................. A Thoracoscopy, surgical... 13.65 NA 10.22 2.56 NA 26.43 090
32658... .................. A Thoracoscopy, surgical... 11.63 NA 9.63 2.52 NA 23.78 090
32659... .................. A Thoracoscopy, surgical... 11.59 NA 9.64 2.61 NA 23.84 090
32660... .................. A Thoracoscopy, surgical... 17.43 NA 12.53 3.56 NA 33.52 090
32661... .................. A Thoracoscopy, surgical... 13.25 NA 9.98 1.47 NA 24.70 090
32662... .................. A Thoracoscopy, surgical... 16.44 NA 10.82 2.74 NA 30.00 090
32663... .................. A Thoracoscopy, surgical... 18.47 NA 12.95 3.23 NA 34.65 090
32664... .................. A Thoracoscopy, surgical... 14.20 NA 9.81 2.04 NA 26.05 090
32665... .................. A Thoracoscopy, surgical... 15.54 NA 10.92 2.64 NA 29.10 090
32800... .................. A Repair lung hernia....... 13.69 NA 9.95 1.58 NA 25.22 090
32810... .................. A Close chest after 13.05 NA 10.62 1.19 NA 24.86 090
drainage.
32815... .................. A Close bronchial fistula.. 23.15 NA 16.10 2.62 NA 41.87 090
32820... .................. A Reconstruct injured chest 21.48 NA 16.63 3.24 NA 41.35 090
32851... .................. A Lung transplant, single.. 38.63 NA 21.92 4.99 NA 65.54 090
32852... .................. A Lung transplant w/bypass. 41.80 NA 24.20 5.41 NA 71.41 090
32853... .................. A Lung transplant, double.. 47.81 NA 27.72 6.24 NA 81.77 090
32854... .................. A Lung transplant w/bypass. 50.98 NA 29.31 6.67 NA 86.96 090
32900... .................. A Removal of rib(s)........ 20.27 NA 13.27 1.63 NA 35.17 090
32905... .................. A Revise & repair chest 20.75 NA 13.80 2.60 NA 37.15 090
wall.
32906... .................. A Revise & repair chest 26.77 NA 18.37 2.92 NA 48.06 090
wall.
32940... .................. A Revision of lung......... 19.43 NA 12.97 1.75 NA 34.15 090
32960... .................. A Therapeutic pneumothorax. 1.84 1.70 0.53 0.13 3.67 2.50 000
33010... .................. A Drainage of heart sac.... 2.24 NA 0.95 0.14 NA 3.33 000
33011... .................. A Repeat drainage of heart 2.24 NA 1.18 0.12 NA 3.54 000
sac.
33015... .................. A Incision of heart sac.... 6.80 NA 4.01 0.62 NA 11.43 090
33020... .................. A Incision of heart sac.... 12.61 NA 7.40 2.52 NA 22.53 090
33025... .................. A Incision of heart sac.... 12.09 NA 6.97 2.61 NA 21.67 090
33030... .................. A Partial removal of heart 18.71 NA 14.40 3.92 NA 37.03 090
sac.
33031... .................. A Partial removal of heart 21.79 NA 18.63 2.50 NA 42.92 090
sac.
[[Page 30931]]
33050... .................. A Removal of heart sac 14.36 NA 10.51 1.47 NA 26.34 090
lesion.
33120... .................. A Removal of heart lesion.. 24.56 NA 21.61 5.17 NA 51.34 090
33130... .................. A Removal of heart lesion.. 21.39 NA 14.67 2.22 NA 38.28 090
33200... .................. A Insertion of heart 12.48 NA 9.41 1.90 NA 23.79 090
pacemaker.
33201... .................. A Insertion of heart 10.18 NA 7.50 1.67 NA 19.35 090
pacemaker.
33206... .................. A Insertion of heart 6.67 NA 5.04 1.34 NA 13.05 090
pacemaker.
33207... .................. A Insertion of heart 8.04 NA 5.67 1.33 NA 15.04 090
pacemaker.
33208... .................. A Insertion of heart 8.13 NA 5.92 1.54 NA 15.59 090
pacemaker.
33210... .................. A Insertion of heart 3.30 NA 1.64 0.27 NA 5.21 000
electrode.
33211... .................. A Insertion of heart 3.40 NA 1.80 0.27 NA 5.47 000
electrode.
33212... .................. A Insertion of pulse 5.52 NA 4.00 0.88 NA 10.40 090
generator.
33213... .................. A Insertion of pulse 6.37 NA 4.52 0.88 NA 11.77 090
generator.
33214... .................. A Upgrade of pacemaker 7.75 NA 5.62 1.06 NA 14.43 090
system.
33216... .................. A Revision implanted 5.39 NA 4.31 0.55 NA 10.25 090
electrode.
33217... .................. A Insert/revise electrode.. 5.75 NA 4.80 0.55 NA 11.10 090
33218... .................. A Repair pacemaker 5.44 NA 4.09 0.62 NA 10.15 090
electrodes.
33220... .................. A Repair pacemaker 5.52 NA 4.33 0.62 NA 10.47 090
electrode.
33222... .................. A Pacemaker aicd pocket.... 4.96 NA 3.78 1.01 NA 9.75 090
33223... .................. A Pacemaker aicd pocket.... 6.46 NA 5.03 1.01 NA 12.50 090
33233... .................. A Removal of pacemaker 3.29 NA 3.15 0.05 NA 6.49 090
system.
33234... .................. A Removal of pacemaker 7.82 NA 5.18 0.23 NA 13.23 090
system.
33235... .................. A Removal pacemaker 9.40 NA 5.96 0.33 NA 15.69 090
electrode.
33236... .................. A Remove electrode/ 12.60 NA 9.10 0.62 NA 22.32 090
thoracotomy.
33237... .................. A Remove electrode/ 13.71 NA 9.86 1.13 NA 24.70 090
thoracotomy.
33238... .................. A Remove electrode/ 15.22 NA 9.93 2.01 NA 27.16 090
thoracotomy.
33240... .................. A Insert/replace pulse 7.60 NA 5.48 0.88 NA 13.96 090
gener.
33241... .................. A Remove pulse generator 3.24 NA 3.27 0.43 NA 6.94 090
only.
33242... .................. A Repair pulse generator/ 6.17 NA 5.28 1.54 NA 12.99 090
leads.
33243... .................. A Remove generator/ 22.64 NA 12.43 1.54 NA 36.61 090
thoracotomy.
33244... .................. A Remove generator......... 8.97 NA 5.88 1.54 NA 16.39 090
33245... .................. A Implant heart 14.30 NA 10.81 2.36 NA 27.47 090
defibrillator.
33246... .................. A Implant heart 20.71 NA 13.35 3.19 NA 37.25 090
defibrillator.
33247... .................. A Insert/replace leads..... 10.21 NA 6.52 2.36 NA 19.09 090
33249... .................. A Insert/replace leads/ 13.28 NA 8.88 3.19 NA 25.35 090
gener.
33250... .................. A Ablate heart dysrhythm 21.85 NA 21.85 0.86 NA 44.56 090
focus.
33251... .................. A Ablate heart dysrhythm 24.88 NA 19.99 3.21 NA 48.08 090
focus.
33253... .................. A Reconstruct atria........ 31.06 NA 22.52 4.26 NA 57.84 090
33261... .................. A Ablate heart dysrhythm 24.88 NA 20.05 2.73 NA 47.66 090
focus.
33300... .................. A Repair of heart wound.... 17.92 NA 13.72 2.60 NA 34.24 090
33305... .................. A Repair of heart wound.... 21.44 NA 18.22 3.07 NA 42.73 090
33310... .................. A Exploratory heart surgery 18.51 NA 13.81 1.93 NA 34.25 090
33315... .................. A Exploratory heart surgery 22.37 NA 18.11 2.57 NA 43.05 090
33320... .................. A Repair major blood 16.79 NA 13.37 2.51 NA 32.67 090
vessel(s).
33321... .................. A Repair major vessel...... 20.20 NA 14.89 3.61 NA 38.70 090
33322... .................. A Repair major blood 20.62 NA 17.45 3.61 NA 41.68 090
vessel(s).
33330... .................. A Insert major vessel graft 21.43 NA 16.43 1.93 NA 39.79 090
33332... .................. A Insert major vessel graft 23.96 NA 16.43 2.39 NA 42.78 090
33335... .................. A Insert major vessel graft 30.01 NA 22.99 2.39 NA 55.39 090
33400... .................. A Repair of aortic valve... 25.34 NA 19.64 2.83 NA 47.81 090
33401... .................. A Valvuloplasty, open...... 23.91 NA 16.16 2.83 NA 42.90 090
33403... .................. A Valvuloplasty, w/cp 24.89 NA 19.19 2.83 NA 46.91 090
bypass.
33404... .................. A Prepare heart-aorta 28.54 NA 21.32 5.59 NA 55.45 090
conduit.
33405... .................. A Replacement of aortic 30.61 NA 22.26 5.33 NA 58.20 090
valve.
33406... .................. A Replacement, aortic valve 32.30 NA 23.15 7.45 NA 62.90 090
33411... .................. A Replacement of aortic 32.47 NA 23.68 7.45 NA 63.60 090
valve.
33412... .................. A Replacement of aortic 34.79 NA 26.42 7.45 NA 68.66 090
valve.
33413... .................. A Replacement, aortic valve 35.24 NA 26.89 7.23 NA 69.36 090
33414... .................. A Repair, aortic valve..... 30.35 NA 23.29 7.45 NA 61.09 090
33415... .................. A Revision, subvalvular 27.15 NA 19.43 5.33 NA 51.91 090
tissue.
33416... .................. A Revise ventricle muscle.. 30.35 NA 22.06 4.99 NA 57.40 090
33417... .................. A Repair of aortic valve... 28.53 NA 20.93 6.18 NA 55.64 090
33420... .................. A Revision of mitral valve. 22.70 NA 14.14 2.45 NA 39.29 090
33422... .................. A Revision of mitral valve. 25.94 NA 19.49 6.45 NA 51.88 090
33425... .................. A Repair of mitral valve... 27.00 NA 20.19 5.42 NA 52.61 090
33426... .................. A Repair of mitral valve... 31.03 NA 22.99 5.80 NA 59.82 090
33427... .................. A Repair of mitral valve... 33.72 NA 25.61 6.30 NA 65.63 090
33430... .................. A Replacement of mitral 31.43 NA 23.99 6.11 NA 61.53 090
valve.
33460... .................. A Revision of tricuspid 23.60 NA 18.79 4.73 NA 47.12 090
valve.
33463... .................. A Valvuloplasty, tricuspid. 25.62 NA 19.35 5.95 NA 50.92 090
33464... .................. A Valvuloplasty, tricuspid. 27.33 NA 20.43 5.95 NA 53.71 090
33465... .................. A Replace tricuspid valve.. 28.79 NA 21.25 5.95 NA 55.99 090
33468... .................. A Revision of tricuspid 30.12 NA 22.60 6.30 NA 59.02 090
valve.
33470... .................. A Revision of pulmonary 20.81 NA 21.86 2.45 NA 45.12 090
valve.
33471... .................. A Valvotomy, pulmonary 22.25 NA 16.00 2.83 NA 41.08 090
valve.
[[Page 30932]]
33472... .................. A Revision of pulmonary 22.25 NA 43.06 2.83 NA 68.14 090
valve.
33474... .................. A Revision of pulmonary 23.04 NA 17.82 2.83 NA 43.69 090
valve.
33475... .................. A Replacement, pulmonary 28.41 NA 21.61 6.11 NA 56.13 090
valve.
33476... .................. A Revision of heart chamber 25.77 NA 20.87 4.99 NA 51.63 090
33478... .................. A Revision of heart chamber 26.74 NA 19.25 5.42 NA 51.41 090
33496... .................. A Repair, prosth valve clot 27.25 NA 20.82 5.33 NA 53.40 090
33500... .................. A Repair heart vessel 25.55 NA 17.29 5.20 NA 48.04 090
fistula.
33501... .................. A Repair heart vessel 17.78 NA 12.14 2.51 NA 32.43 090
fistula.
33502... .................. A Coronary artery 21.04 NA 15.92 2.51 NA 39.47 090
correction.
33503... .................. A Coronary artery graft.... 21.78 NA 15.61 5.20 NA 42.59 090
33504... .................. A Coronary artery graft.... 24.66 NA 21.49 5.20 NA 51.35 090
33505... .................. A Repair artery w/tunnel... 26.84 NA 21.99 6.03 NA 54.86 090
33506... .................. A Repair artery, 26.71 NA 27.49 6.03 NA 60.23 090
translocation.
33510... .................. A CABG, vein, single....... 25.12 NA 19.13 5.20 NA 49.45 090
33511... .................. A CABG, vein, two.......... 27.40 NA 20.51 5.71 NA 53.62 090
33512... .................. A CABG, vein, three........ 29.67 NA 22.07 6.22 NA 57.96 090
33513... .................. A CABG, vein, four......... 31.95 NA 23.50 6.73 NA 62.18 090
33514... .................. A CABG, vein, five......... 35.00 NA 25.94 7.23 NA 68.17 090
33516... .................. A CABG, vein, six+......... 37.40 NA 27.00 7.74 NA 72.14 090
33517... .................. A CABG, artery-vein, single 2.57 NA 1.89 0.50 NA 4.96 090
33518... .................. A CABG, artery-vein, two... 4.85 NA 3.38 1.02 NA 9.25 090
33519... .................. A CABG, artery-vein, three. 7.12 NA 4.86 1.52 NA 13.50 090
33521... .................. A CABG, artery-vein, four.. 9.40 NA 6.34 2.03 NA 17.77 090
33522... .................. A CABG, artery-vein, five.. 11.67 NA 7.81 2.54 NA 22.02 090
33523... .................. A CABG, artery-vein, six+.. 13.95 NA 9.30 3.05 NA 26.30 090
33530... .................. A Coronary artery, bypass/ 5.86 NA 12.93 2.18 NA 20.97 ZZZ
reop.
33533... .................. A CABG, arterial, single... 25.83 NA 19.68 5.36 NA 50.87 090
33534... .................. A CABG, arterial, two...... 28.82 NA 21.60 6.03 NA 56.45 090
33535... .................. A CABG, arterial, three.... 31.81 NA 21.94 6.70 NA 60.45 090
33536... .................. A CABG, arterial, four+.... 34.79 NA 25.27 7.37 NA 67.43 090
33542... .................. A Removal of heart lesion.. 28.85 NA 23.04 5.53 NA 57.42 090
33545... .................. A Repair of heart damage... 36.78 NA 28.76 6.28 NA 71.82 090
33572... .................. A Open coronary 4.45 NA 2.18 0.63 NA 7.26 ZZZ
endarterectomy.
33600... .................. A Closure of valve......... 29.51 NA 23.71 6.11 NA 59.33 090
33602... .................. A Closure of valve......... 28.54 NA 20.46 5.33 NA 54.33 090
33606... .................. A Anastomosis/artery-aorta. 30.74 NA 26.86 7.45 NA 65.05 090
33608... .................. A Repair anomaly w/conduit. 31.09 NA 22.38 7.45 NA 60.92 090
33610... .................. A Repair by enlargement.... 30.61 NA 24.18 7.45 NA 62.24 090
33611... .................. A Repair double ventricle.. 32.30 NA 22.97 7.45 NA 62.72 090
33612... .................. A Repair double ventricle.. 33.26 NA 25.25 7.45 NA 65.96 090
33615... .................. A Repair (simple fontan)... 32.06 NA 23.68 7.45 NA 63.19 090
33617... .................. A Repair by modified fontan 34.03 NA 24.49 7.45 NA 65.97 090
33619... .................. A Repair single ventricle.. 37.57 NA 31.02 8.04 NA 76.63 090
33641... .................. A Repair heart septum 21.39 NA 16.49 4.87 NA 42.75 090
defect.
33645... .................. A Revision of heart veins.. 24.82 NA 17.60 4.87 NA 47.29 090
33647... .................. A Repair heart septum 28.73 NA 20.98 6.28 NA 55.99 090
defects.
33660... .................. A Repair of heart defects.. 25.54 NA 18.72 5.42 NA 49.68 090
33665... .................. A Repair of heart defects.. 28.60 NA 19.06 5.42 NA 53.08 090
33670... .................. A Repair of heart chambers. 32.73 NA 20.41 7.45 NA 60.59 090
33681... .................. A Repair heart septum 27.67 NA 20.17 6.28 NA 54.12 090
defect.
33684... .................. A Repair heart septum 29.65 NA 23.79 6.28 NA 59.72 090
defect.
33688... .................. A Repair heart septum 30.62 NA 63.16 6.28 NA 100.06 090
defect.
33690... .................. A Reinforce pulmonary 19.55 NA 16.44 4.29 NA 40.28 090
artery.
33692... .................. A Repair of heart defects.. 30.75 NA 21.13 7.45 NA 59.33 090
33694... .................. A Repair of heart defects.. 31.73 NA 21.61 7.45 NA 60.79 090
33697... .................. A Repair of heart defects.. 33.71 NA 22.46 7.45 NA 63.62 090
33702... .................. A Repair of heart defects.. 26.54 NA 20.22 5.33 NA 52.09 090
33710... .................. A Repair of heart defects.. 29.71 NA 21.83 6.28 NA 57.82 090
33720... .................. A Repair of heart defect... 26.56 NA 19.32 5.33 NA 51.21 090
33722... .................. A Repair of heart defect... 28.41 NA 21.06 5.33 NA 54.80 090
33730... .................. A Repair heart-vein 31.67 NA 22.08 7.45 NA 61.20 090
defect(s).
33732... .................. A Repair heart-vein defect. 28.16 NA 23.01 5.42 NA 56.59 090
33735... .................. A Revision of heart chamber 21.39 NA 12.93 4.87 NA 39.19 090
33736... .................. A Revision of heart chamber 23.52 NA 19.80 4.87 NA 48.19 090
33737... .................. A Revision of heart chamber 21.76 NA 42.57 4.87 NA 69.20 090
33750... .................. A Major vessel shunt....... 21.41 NA 14.24 4.29 NA 39.94 090
33755... .................. A Major vessel shunt....... 21.79 NA 13.68 4.29 NA 39.76 090
33762... .................. A Major vessel shunt....... 21.79 NA 41.95 4.29 NA 68.03 090
33764... .................. A Major vessel shunt & 21.79 NA 16.45 4.29 NA 42.53 090
graft.
33766... .................. A Major vessel shunt....... 22.76 NA 15.04 4.29 NA 42.09 090
33767... .................. A Atrial septectomy/ 24.50 NA 19.22 4.87 NA 48.59 090
septostomy.
33770... .................. A Repair great vessels 33.29 NA 24.12 7.45 NA 64.86 090
defect.
33771... .................. A Repair great vessels 34.65 NA 22.66 7.45 NA 64.76 090
defect.
33774... .................. A Repair great vessels 30.98 NA 22.61 5.42 NA 59.01 090
defect.
[[Page 30933]]
33775... .................. A Repair great vessels 32.20 NA 66.64 5.42 NA 104.26 090
defect.
33776... .................. A Repair great vessels 34.04 NA 69.46 6.28 NA 109.78 090
defect.
33777... .................. A Repair great vessels 33.46 NA 68.87 5.42 NA 107.75 090
defect.
33778... .................. A Repair great vessels 35.82 NA 26.25 7.37 NA 69.44 090
defect.
33779... .................. A Repair great vessels 36.21 NA 74.50 7.37 NA 118.08 090
defect.
33780... .................. A Repair great vessels 36.94 NA 21.44 7.37 NA 65.75 090
defect.
33781... .................. A Repair great vessels 36.45 NA 74.00 7.37 NA 117.82 090
defect.
33786... .................. A Repair arterial trunk.... 34.84 NA 25.43 7.45 NA 67.72 090
33788... .................. A Revision of pulmonary 26.62 NA 19.74 5.20 NA 51.56 090
artery.
33800... .................. A Aortic suspension........ 16.24 NA 12.22 2.51 NA 30.97 090
33802... .................. A Repair vessel defect..... 17.66 NA 12.54 4.29 NA 34.49 090
33803... .................. A Repair vessel defect..... 19.60 NA 13.73 4.29 NA 37.62 090
33813... .................. A Repair septal defect..... 20.65 NA 14.15 4.29 NA 39.09 090
33814... .................. A Repair septal defect..... 25.77 NA 20.07 5.33 NA 51.17 090
33820... .................. A Revise major vessel...... 16.29 NA 10.40 4.29 NA 30.98 090
33822... .................. A Revise major vessel...... 17.32 NA 11.47 4.29 NA 33.08 090
33824... .................. A Revise major vessel...... 19.52 NA 14.73 4.29 NA 38.54 090
33840... .................. A Remove aorta constriction 20.63 NA 14.20 5.59 NA 40.42 090
33845... .................. A Remove aorta constriction 22.12 NA 15.14 5.59 NA 42.85 090
33851... .................. A Remove aorta constriction 21.27 NA 38.59 5.59 NA 65.45 090
33852... .................. A Repair septal defect..... 23.71 NA 15.49 5.59 NA 44.79 090
33853... .................. A Repair septal defect..... 31.72 NA 22.13 7.45 NA 61.30 090
33860... .................. A Ascending aorta graft.... 33.96 NA 24.68 6.18 NA 64.82 090
33861... .................. A Ascending aorta graft.... 34.52 NA 25.56 6.18 NA 66.26 090
33863... .................. A Ascending aorta graft.... 36.47 NA 26.75 6.18 NA 69.40 090
33870... .................. A Transverse aortic arch 40.31 NA 28.86 8.04 NA 77.21 090
graft.
33875... .................. A Thoracic aorta graft..... 33.06 NA 24.29 5.59 NA 62.94 090
33877... .................. A Thoracoabdominal graft... 42.60 NA 33.86 8.38 NA 84.84 090
33910... .................. A Remove lung artery emboli 24.59 NA 19.32 2.77 NA 46.68 090
33915... .................. A Remove lung artery emboli 21.02 NA 14.95 2.22 NA 38.19 090
33916... .................. A Surgery of great vessel.. 25.83 NA 21.82 3.43 NA 51.08 090
33917... .................. A Repair pulmonary artery.. 24.50 NA 18.33 6.30 NA 49.13 090
33918... .................. A Repair pulmonary atresia. 26.45 NA 47.27 5.20 NA 78.92 090
33919... .................. A Repair pulmonary atresia. 32.67 NA 70.82 7.45 NA 110.94 090
33920... .................. A Repair pulmonary atresia. 31.95 NA 67.30 7.45 NA 106.70 090
33922... .................. A Transect pulmonary artery 23.52 NA 18.86 2.83 NA 45.21 090
33924... .................. A Remove pulmonary shunt... 5.50 NA 6.42 0.78 NA 12.70 ZZZ
33935... .................. R Transplantation, heart/ 60.96 NA 33.17 13.54 NA 107.67 090
lung.
33945... .................. R Transplantation of heart. 42.10 NA 23.73 11.05 NA 76.88 090
33960... .................. A External circulation 19.36 NA 10.19 0.94 NA 30.49 XXX
assist.
33961... .................. A External circulation 10.93 NA 9.18 0.94 NA 21.05 XXX
assist.
33970... .................. A Aortic circulation assist 6.75 NA 6.02 1.00 NA 13.77 000
33971... .................. A Aortic circulation assist 9.69 NA 9.35 0.91 NA 19.95 090
33973... .................. A Insert balloon device.... 9.76 NA 4.53 1.00 NA 15.29 000
33974... .................. A Remove intra-aortic 14.41 NA 12.17 0.91 NA 27.49 090
balloon.
33975... .................. A Implant ventricular 21.60 NA 27.04 2.77 NA 51.41 090
device.
33976... .................. A Implant ventricular 29.10 NA 30.12 3.78 NA 63.00 090
device.
33977... .................. A Remove ventricular device 19.29 NA 15.19 2.43 NA 36.91 090
33978... .................. A Remove ventricular device 21.73 NA 15.83 2.77 NA 40.33 090
34001... .................. A Removal of artery clot... 12.91 NA 6.63 1.87 NA 21.41 090
34051... .................. A Removal of artery clot... 15.21 NA 8.32 1.59 NA 25.12 090
34101... .................. A Removal of artery clot... 9.97 NA 5.11 1.71 NA 16.79 090
34111... .................. A Removal of arm artery 8.07 NA 4.24 1.59 NA 13.90 090
clot.
34151... .................. A Removal of artery clot... 16.86 NA 8.78 2.39 NA 28.03 090
34201... .................. A Removal of artery clot... 9.13 NA 5.06 1.78 NA 15.97 090
34203... .................. A Removal of leg artery 12.21 NA 6.50 1.72 NA 20.43 090
clot.
34401... .................. A Removal of vein clot..... 12.86 NA 6.97 1.39 NA 21.22 090
34421... .................. A Removal of vein clot..... 9.93 NA 5.53 1.51 NA 16.97 090
34451... .................. A Removal of vein clot..... 14.44 NA 7.56 2.14 NA 24.14 090
34471... .................. A Removal of vein clot..... 10.18 NA 5.99 0.55 NA 16.72 090
34490... .................. A Removal of vein clot..... 7.60 NA 4.44 1.54 NA 13.58 090
34501... .................. A Repair valve, femoral 10.93 NA 6.64 0.86 NA 18.43 090
vein.
34502... .................. A Reconstruct, vena cava... 26.95 NA 13.27 3.64 NA 43.86 090
34510... .................. A Transposition of vein 13.25 NA 7.27 1.04 NA 21.56 090
valve.
34520... .................. A Cross-over vein graft.... 13.74 NA 7.82 1.09 NA 22.65 090
34530... .................. A Leg vein fusion.......... 17.61 NA 8.53 1.44 NA 27.58 090
35001... .................. A Repair defect of artery.. 19.64 NA 9.74 3.18 NA 32.56 090
35002... .................. A Repair artery rupture, 21.00 NA 10.45 2.41 NA 33.86 090
neck.
35005... .................. A Repair defect of artery.. 18.12 NA 8.37 2.19 NA 28.68 090
35011... .................. A Repair defect of artery.. 11.65 NA 6.04 2.76 NA 20.45 090
35013... .................. A Repair artery rupture, 17.40 NA 8.36 3.03 NA 28.79 090
arm.
35021... .................. A Repair defect of artery.. 19.65 NA 10.62 3.06 NA 33.33 090
35022... .................. A Repair artery rupture, 23.18 NA 11.79 2.80 NA 37.77 090
chest.
35045... .................. A Repair defect of arm 11.26 NA 6.20 2.50 NA 19.96 090
artery.
[[Page 30934]]
35081... .................. A Repair defect of artery.. 28.01 NA 13.63 4.18 NA 45.82 090
35082... .................. A Repair artery rupture, 36.35 NA 16.98 4.59 NA 57.92 090
aorta.
35091... .................. A Repair defect of artery.. 35.40 NA 17.11 4.25 NA 56.76 090
35092... .................. A Repair artery rupture, 38.39 NA 18.51 5.21 NA 62.11 090
aorta.
35102... .................. A Repair defect of artery.. 30.76 NA 14.86 4.32 NA 49.94 090
35103... .................. A Repair artery rupture, 33.57 NA 16.03 5.21 NA 54.81 090
groin.
35111... .................. A Repair defect of artery.. 16.43 NA 8.76 3.70 NA 28.89 090
35112... .................. A Repair artery rupture, 18.69 NA 9.51 2.22 NA 30.42 090
spleen.
35121... .................. A Repair defect of artery.. 25.99 NA 13.06 3.66 NA 42.71 090
35122... .................. A Repair artery rupture, 33.45 NA 16.16 3.96 NA 53.57 090
belly.
35131... .................. A Repair defect of artery.. 18.55 NA 10.00 3.15 NA 31.70 090
35132... .................. A Repair artery rupture, 21.95 NA 11.46 3.58 NA 36.99 090
groin.
35141... .................. A Repair defect of artery.. 14.46 NA 7.74 2.88 NA 25.08 090
35142... .................. A Repair artery rupture, 15.86 NA 8.30 3.24 NA 27.40 090
thigh.
35151... .................. A Repair defect of artery.. 17.00 NA 9.27 2.94 NA 29.21 090
35152... .................. A Repair artery rupture, 16.70 NA 9.28 1.95 NA 27.93 090
knee.
35161... .................. A Repair defect of artery.. 18.76 NA 10.07 3.15 NA 31.98 090
35162... .................. A Repair artery rupture.... 19.78 NA 10.70 3.58 NA 34.06 090
35180... .................. A Repair blood vessel 13.62 NA 6.71 1.48 NA 21.81 090
lesion.
35182... .................. A Repair blood vessel 17.74 NA 8.29 1.61 NA 27.64 090
lesion.
35184... .................. A Repair blood vessel 12.25 NA 6.82 1.96 NA 21.03 090
lesion.
35188... .................. A Repair blood vessel 14.28 NA 7.97 1.59 NA 23.84 090
lesion.
35189... .................. A Repair blood vessel 18.43 NA 9.60 2.21 NA 30.24 090
lesion.
35190... .................. A Repair blood vessel 12.75 NA 6.87 2.14 NA 21.76 090
lesion.
35201... .................. A Repair blood vessel 9.99 NA 5.50 1.94 NA 17.43 090
lesion.
35206... .................. A Repair blood vessel 9.25 NA 5.52 2.03 NA 16.80 090
lesion.
35207... .................. A Repair blood vessel 10.15 NA 8.47 1.93 NA 20.55 090
lesion.
35211... .................. A Repair blood vessel 22.12 NA 18.02 2.59 NA 42.73 090
lesion.
35216... .................. A Repair blood vessel 18.75 NA 17.42 2.08 NA 38.25 090
lesion.
35221... .................. A Repair blood vessel 16.42 NA 8.49 2.20 NA 27.11 090
lesion.
35226... .................. A Repair blood vessel 9.06 NA 5.51 1.95 NA 16.52 090
lesion.
35231... .................. A Repair blood vessel 12.00 NA 6.96 2.91 NA 21.87 090
lesion.
35236... .................. A Repair blood vessel 10.54 NA 6.24 2.56 NA 19.34 090
lesion.
35241... .................. A Repair blood vessel 23.12 NA 20.47 2.60 NA 46.19 090
lesion.
35246... .................. A Repair blood vessel 19.84 NA 19.39 2.15 NA 41.38 090
lesion.
35251... .................. A Repair blood vessel 17.49 NA 9.04 1.88 NA 28.41 090
lesion.
35256... .................. A Repair blood vessel 11.38 NA 6.68 2.39 NA 20.45 090
lesion.
35261... .................. A Repair blood vessel 11.63 NA 6.10 2.66 NA 20.39 090
lesion.
35266... .................. A Repair blood vessel 10.30 NA 5.93 2.41 NA 18.64 090
lesion.
35271... .................. A Repair blood vessel 22.12 NA 20.24 2.56 NA 44.92 090
lesion.
35276... .................. A Repair blood vessel 18.75 NA 17.51 2.26 NA 38.52 090
lesion.
35281... .................. A Repair blood vessel 16.48 NA 8.93 3.37 NA 28.78 090
lesion.
35286... .................. A Repair blood vessel 11.87 NA 6.88 2.33 NA 21.08 090
lesion.
35301... .................. A Rechanneling of artery... 18.70 NA 9.57 2.81 NA 31.08 090
35311... .................. A Rechanneling of artery... 23.85 NA 12.29 4.61 NA 40.75 090
35321... .................. A Rechanneling of artery... 11.97 NA 5.89 2.69 NA 20.55 090
35331... .................. A Rechanneling of artery... 23.52 NA 11.84 2.66 NA 38.02 090
35341... .................. A Rechanneling of artery... 25.11 NA 12.97 3.53 NA 41.61 090
35351... .................. A Rechanneling of artery... 20.11 NA 10.51 2.97 NA 33.59 090
35355... .................. A Rechanneling of artery... 16.09 NA 8.95 2.99 NA 28.03 090
35361... .................. A Rechanneling of artery... 23.59 NA 11.90 3.88 NA 39.37 090
35363... .................. A Rechanneling of artery... 24.66 NA 12.69 4.40 NA 41.75 090
35371... .................. A Rechanneling of artery... 11.64 NA 6.48 2.50 NA 20.62 090
35372... .................. A Rechanneling of artery... 13.56 NA 7.08 2.28 NA 22.92 090
35381... .................. A Rechanneling of artery... 15.81 NA 8.02 2.71 NA 26.54 090
35390... .................. A Reoperation, carotid..... 3.19 NA 1.47 0.39 NA 5.05 ZZZ
35400... .................. A Angioscopy............... 3.00 NA 1.39 0.27 NA 4.66 ZZZ
35450... .................. A Repair arterial blockage. 10.07 NA 5.11 1.38 NA 16.56 000
35452... .................. A Repair arterial blockage. 6.91 NA 3.96 0.61 NA 11.48 000
35454... .................. A Repair arterial blockage. 6.04 NA 3.32 1.53 NA 10.89 000
35456... .................. A Repair arterial blockage. 7.35 NA 3.90 1.69 NA 12.94 000
35458... .................. A Repair arterial blockage. 9.49 NA 4.81 1.83 NA 16.13 000
35459... .................. A Repair arterial blockage. 8.63 NA 4.38 1.69 NA 14.70 000
35460... .................. A Repair venous blockage... 6.04 NA 3.09 0.74 NA 9.87 000
35470... .................. A Repair arterial blockage. 8.63 NA 4.92 1.69 NA 15.24 000
35471... .................. A Repair arterial blockage. 10.07 NA 5.54 1.38 NA 16.99 000
35472... .................. A Repair arterial blockage. 6.91 NA 4.11 0.85 NA 11.87 000
35473... .................. A Repair arterial blockage. 6.04 NA 3.76 1.53 NA 11.33 000
35474... .................. A Repair arterial blockage. 7.36 NA 4.17 1.69 NA 13.22 000
35475... .................. R Repair arterial blockage. 9.49 NA 4.98 1.83 NA 16.30 000
35476... .................. A Repair venous blockage... 6.04 NA 3.62 0.74 NA 10.40 000
35480... .................. A Atherectomy, open........ 11.08 NA 5.46 1.38 NA 17.92 000
35481... .................. A Atherectomy, open........ 7.61 NA 4.07 0.61 NA 12.29 000
35482... .................. A Atherectomy, open........ 6.65 NA 3.63 1.53 NA 11.81 000
[[Page 30935]]
35483... .................. A Atherectomy, open........ 8.10 NA 4.29 1.69 NA 14.08 000
35484... .................. A Atherectomy, open........ 10.44 NA 5.02 1.83 NA 17.29 000
35485... .................. A Atherectomy, open........ 9.49 NA 5.02 1.06 NA 15.57 000
35490... .................. A Atherectomy, percutaneous 11.08 NA 6.00 1.38 NA 18.46 000
35491... .................. A Atherectomy, percutaneous 7.61 NA 3.71 0.61 NA 11.93 000
35492... .................. A Atherectomy, percutaneous 6.65 NA 4.06 1.53 NA 12.24 000
35493... .................. A Atherectomy, percutaneous 8.10 NA 4.99 1.69 NA 14.78 000
35494... .................. A Atherectomy, percutaneous 10.44 NA 5.22 1.83 NA 17.49 000
35495... .................. A Atherectomy, percutaneous 9.49 NA 5.63 1.06 NA 16.18 000
35501... .................. A Artery bypass graft...... 19.19 NA 9.34 3.49 NA 32.02 090
35506... .................. A Artery bypass graft...... 19.67 NA 9.60 3.64 NA 32.91 090
35507... .................. A Artery bypass graft...... 19.67 NA 9.58 3.61 NA 32.86 090
35508... .................. A Artery bypass graft...... 18.65 NA 9.64 3.43 NA 31.72 090
35509... .................. A Artery bypass graft...... 18.07 NA 9.12 3.92 NA 31.11 090
35511... .................. A Artery bypass graft...... 16.83 NA 8.53 1.92 NA 27.28 090
35515... .................. A Artery bypass graft...... 18.65 NA 9.09 2.01 NA 29.75 090
35516... .................. A Artery bypass graft...... 16.32 NA 8.02 3.54 NA 27.88 090
35518... .................. A Artery bypass graft...... 15.42 NA 7.63 3.38 NA 26.43 090
35521... .................. A Artery bypass graft...... 16.17 NA 8.51 3.34 NA 28.02 090
35526... .................. A Artery bypass graft...... 20.00 NA 11.12 2.44 NA 33.56 090
35531... .................. A Artery bypass graft...... 25.61 NA 12.68 3.90 NA 42.19 090
35533... .................. A Artery bypass graft...... 20.52 NA 10.25 4.43 NA 35.20 090
35536... .................. A Artery bypass graft...... 23.11 NA 11.63 4.17 NA 38.91 090
35541... .................. A Artery bypass graft...... 25.80 NA 13.09 3.65 NA 42.54 090
35546... .................. A Artery bypass graft...... 25.54 NA 13.05 4.26 NA 42.85 090
35548... .................. A Artery bypass graft...... 21.57 NA 10.45 3.65 NA 35.67 090
35549... .................. A Artery bypass graft...... 23.35 NA 11.99 4.26 NA 39.60 090
35551... .................. A Artery bypass graft...... 26.67 NA 13.47 3.87 NA 44.01 090
35556... .................. A Artery bypass graft...... 21.76 NA 10.85 3.71 NA 36.32 090
35558... .................. A Artery bypass graft...... 14.04 NA 7.38 3.23 NA 24.65 090
35560... .................. A Artery bypass graft...... 23.56 NA 12.08 3.93 NA 39.57 090
35563... .................. A Artery bypass graft...... 15.14 NA 8.31 1.70 NA 25.15 090
35565... .................. A Artery bypass graft...... 15.14 NA 8.29 3.51 NA 26.94 090
35566... .................. A Artery bypass graft...... 26.92 NA 14.80 4.08 NA 45.80 090
35571... .................. A Artery bypass graft...... 18.58 NA 10.80 3.87 NA 33.25 090
35582... .................. A Vein bypass graft........ 27.13 NA 13.35 4.89 NA 45.37 090
35583... .................. A Vein bypass graft........ 22.37 NA 11.75 4.13 NA 38.25 090
35585... .................. A Vein bypass graft........ 28.39 NA 14.81 4.63 NA 47.83 090
35587... .................. A Vein bypass graft........ 19.05 NA 11.24 4.13 NA 34.42 090
35601... .................. A Artery bypass graft...... 17.50 NA 8.65 3.33 NA 29.48 090
35606... .................. A Artery bypass graft...... 18.71 NA 9.06 3.51 NA 31.28 090
35612... .................. A Artery bypass graft...... 15.76 NA 8.05 3.30 NA 27.11 090
35616... .................. A Artery bypass graft...... 15.70 NA 7.83 3.42 NA 26.95 090
35621... .................. A Artery bypass graft...... 14.54 NA 7.60 3.80 NA 25.94 090
35623... .................. A Bypass graft, not vein... 16.62 NA 8.71 1.88 NA 27.21 090
35626... .................. A Artery bypass graft...... 23.63 NA 12.27 4.08 NA 39.98 090
35631... .................. A Artery bypass graft...... 24.60 NA 12.40 3.57 NA 40.57 090
35636... .................. A Artery bypass graft...... 22.46 NA 11.18 2.45 NA 36.09 090
35641... .................. A Artery bypass graft...... 24.57 NA 12.51 4.08 NA 41.16 090
35642... .................. A Artery bypass graft...... 17.98 NA 8.88 2.20 NA 29.06 090
35645... .................. A Artery bypass graft...... 17.47 NA 8.37 2.05 NA 27.89 090
35646... .................. A Artery bypass graft...... 25.81 NA 13.02 4.73 NA 43.56 090
35650... .................. A Artery bypass graft...... 14.36 NA 7.08 3.56 NA 25.00 090
35651... .................. A Artery bypass graft...... 25.04 NA 12.98 4.69 NA 42.71 090
35654... .................. A Artery bypass graft...... 18.61 NA 9.57 4.42 NA 32.60 090
35656... .................. A Artery bypass graft...... 19.53 NA 9.51 3.60 NA 32.64 090
35661... .................. A Artery bypass graft...... 13.18 NA 6.84 3.30 NA 23.32 090
35663... .................. A Artery bypass graft...... 14.17 NA 7.96 3.80 NA 25.93 090
35665... .................. A Artery bypass graft...... 15.40 NA 8.43 3.57 NA 27.40 090
35666... .................. A Artery bypass graft...... 19.19 NA 11.24 4.00 NA 34.43 090
35671... .................. A Artery bypass graft...... 14.80 NA 9.14 4.08 NA 28.02 090
35681... .................. A Artery bypass graft...... 8.05 NA 4.35 3.52 NA 15.92 ZZZ
35691... .................. A Arterial transposition... 18.05 NA 8.66 3.81 NA 30.52 090
35693... .................. A Arterial transposition... 15.36 NA 7.72 1.91 NA 24.99 090
35694... .................. A Arterial transposition... 19.16 NA 9.16 2.17 NA 30.49 090
35695... .................. A Arterial transposition... 19.16 NA 9.16 2.17 NA 30.49 090
35700... .................. A Reoperation, bypass graft 3.08 NA 2.49 0.38 NA 5.95 ZZZ
35701... .................. A Exploration, carotid 5.55 NA 3.90 1.25 NA 10.70 090
artery.
35721... .................. A Exploration, femoral 5.28 NA 3.58 1.11 NA 9.97 090
artery.
35741... .................. A Exploration popliteal 5.37 NA 3.66 1.15 NA 10.18 090
artery.
35761... .................. A Exploration of artery/ 5.37 NA 3.77 1.14 NA 10.28 090
vein.
35800... .................. A Explore neck vessels..... 7.02 NA 4.07 0.97 NA 12.06 090
35820... .................. A Explore chest vessels.... 12.88 NA 8.88 1.43 NA 23.19 090
35840... .................. A Explore abdominal vessels 9.77 NA 5.99 1.44 NA 17.20 090
[[Page 30936]]
35860... .................. A Explore limb vessels..... 5.55 NA 3.64 1.15 NA 10.34 090
35870... .................. A Repair vessel graft 22.17 NA 12.13 2.47 NA 36.77 090
defect.
35875... .................. A Removal of clot in graft. 10.01 NA 5.62 1.65 NA 17.28 090
35876... .................. A Removal of clot in graft. 13.67 NA 7.42 1.65 NA 22.74 090
35901... .................. A Excision, graft, neck.... 8.19 NA 5.37 1.46 NA 15.02 090
35903... .................. A Excision, graft, 9.39 NA 7.09 1.46 NA 17.94 090
extremity.
35905... .................. A Excision, graft, thorax.. 18.19 NA 17.16 1.46 NA 36.81 090
35907... .................. A Excision, graft, abdomen. 19.24 NA 11.58 1.46 NA 32.28 090
36000... .................. A Place needle in vein..... 0.18 0.31 0.05 0.04 0.53 0.27 XXX
36005... .................. A Injection, venography.... 0.95 11.83 0.31 0.04 12.82 1.30 000
36010... .................. A Place catheter in vein... 2.43 NA 1.48 0.31 NA 4.22 XXX
36011... .................. A Place catheter in vein... 3.14 NA 1.82 0.22 NA 5.18 XXX
36012... .................. A Place catheter in vein... 3.52 NA 2.28 0.32 NA 6.12 XXX
36013... .................. A Place catheter in artery. 2.52 NA 1.38 0.31 NA 4.21 XXX
36014... .................. A Place catheter in artery. 3.02 NA 1.90 0.27 NA 5.19 XXX
36015... .................. A Place catheter in artery. 3.52 NA 2.03 0.32 NA 5.87 XXX
36100... .................. A Establish access to 3.02 NA 1.98 0.32 NA 5.32 XXX
artery.
36120... .................. A Establish access to 2.01 NA 1.45 0.30 NA 3.76 XXX
artery.
36140... .................. A Establish access to 2.01 NA 1.45 0.24 NA 3.70 XXX
artery.
36145... .................. A Artery to vein shunt..... 2.01 NA 1.55 0.49 NA 4.05 XXX
36160... .................. A Establish access to aorta 2.52 NA 1.68 0.35 NA 4.55 XXX
36200... .................. A Place catheter in aorta.. 3.02 NA 1.94 0.28 NA 5.24 XXX
36215... .................. A Place catheter in artery. 4.68 NA 2.50 0.23 NA 7.41 XXX
36216... .................. A Place catheter in artery. 5.28 NA 2.88 0.27 NA 8.43 XXX
36217... .................. A Place catheter in artery. 6.30 NA 3.27 0.32 NA 9.89 XXX
36218... .................. A Place catheter in artery. 1.01 NA 1.48 0.05 NA 2.54 XXX
36245... .................. A Place catheter in artery. 4.68 NA 2.57 0.26 NA 7.51 XXX
36246... .................. A Place catheter in artery. 5.28 NA 2.93 0.27 NA 8.48 XXX
36247... .................. A Place catheter in artery. 6.30 NA 3.23 0.32 NA 9.85 XXX
36248... .................. A Place catheter in artery. 1.01 NA 1.47 0.05 NA 2.53 XXX
36260... .................. A Insertion of infusion 9.71 NA 5.54 1.41 NA 16.66 090
pump.
36261... .................. A Revision of infusion pump 5.45 NA 3.31 0.42 NA 9.18 090
36262... .................. A Removal of infusion pump. 4.02 NA 2.77 0.40 NA 7.19 090
36400... .................. A Drawing blood............ 0.18 0.39 0.05 0.01 0.58 0.24 XXX
36405... .................. A Drawing blood............ 0.18 0.29 0.04 0.03 0.50 0.25 XXX
36406... .................. A Drawing blood............ 0.18 0.32 0.06 0.01 0.51 0.25 XXX
36410... .................. A Drawing blood............ 0.18 0.30 0.05 0.02 0.50 0.25 XXX
36420... .................. A Establish access to vein. 1.01 NA 0.41 0.05 NA 1.47 XXX
36425... .................. A Establish access to vein. 0.76 2.17 0.25 0.01 2.94 1.02 XXX
36430... .................. A Blood transfusion service 0.00 1.50 0.10 0.07 1.57 0.17 XXX
36440... .................. A Blood transfusion service 1.03 NA 0.37 0.07 NA 1.47 XXX
36450... .................. A Exchange transfusion 2.23 NA 1.15 0.18 NA 3.56 XXX
service.
36455... .................. A Exchange transfusion 2.43 NA 0.92 0.22 NA 3.57 XXX
service.
36460... .................. A Transfusion service, 6.59 NA 2.91 1.09 NA 10.59 XXX
fetal.
36470... .................. A Injection therapy of vein 1.09 1.89 0.44 0.04 3.02 1.57 010
36471... .................. A Injection therapy of 1.57 2.13 0.64 0.05 3.75 2.26 010
veins.
36481... .................. A Insertion of catheter, 6.99 NA 2.56 0.61 NA 10.16 000
vein.
36488... .................. A Insertion of catheter, 1.35 NA 0.54 0.14 NA 2.03 000
vein.
36489... .................. A Insertion of catheter, 1.22 2.72 0.45 0.17 4.11 1.84 000
vein.
36490... .................. A Insertion of catheter, 1.67 NA 0.65 0.20 NA 2.52 000
vein.
36491... .................. A Insertion of catheter, 1.43 NA 0.59 0.32 NA 2.34 000
vein.
36493... .................. A Repositioning of cvc..... 1.21 NA 0.59 0.16 NA 1.96 000
36500... .................. A Insertion of catheter, 3.52 NA 1.78 0.01 NA 5.31 000
vein.
36510... .................. A Insertion of catheter, 1.09 NA 0.72 0.02 NA 1.83 000
vein.
36520... .................. A Plasma and/or cell 1.74 NA 0.82 0.12 NA 2.68 000
exchange.
36522... .................. A Photopheresis............ 1.67 4.18 1.01 0.37 6.22 3.05 000
36530... .................. R Insertion of infusion 6.20 NA 3.34 1.02 NA 10.56 010
pump.
36531... .................. R Revision of infusion pump 4.87 NA 2.88 0.27 NA 8.02 010
36532... .................. R Removal of infusion pump. 3.30 NA 1.64 0.37 NA 5.31 010
36533... .................. A Insertion of access port. 5.32 3.02 3.92 0.85 9.19 10.09 010
36534... .................. A Revision of access port.. 2.80 NA 1.52 0.21 NA 4.53 010
36535... .................. A Removal of access port... 2.27 1.92 1.99 0.38 4.57 4.64 010
36600... .................. A Withdrawal of arterial 0.32 0.27 0.08 0.02 0.61 0.42 XXX
blood.
36620... .................. A Insertion catheter, 1.15 NA 0.38 0.14 NA 1.67 000
artery.
36625... .................. A Insertion catheter, 2.11 NA 0.59 0.18 NA 2.88 000
artery.
36640... .................. A Insertion catheter, 2.10 NA 1.06 0.40 NA 3.56 000
artery.
36660... .................. A Insertion catheter, 1.40 NA 0.72 0.04 NA 2.16 000
artery.
36680... .................. A Insert needle, bone 1.20 NA 0.42 0.10 NA 1.72 000
cavity.
36800... .................. A Insertion of cannula..... 2.43 NA 1.47 0.28 NA 4.18 000
36810... .................. A Insertion of cannula..... 3.97 NA 2.41 0.74 NA 7.12 000
36815... .................. A Insertion of cannula..... 2.62 NA 1.90 0.70 NA 5.22 000
36821... .................. A Artery-vein fusion....... 8.93 NA 4.71 1.46 NA 15.10 090
36822... .................. A Insertion of cannula(s).. 5.42 NA 6.99 0.77 NA 13.18 090
36825... .................. A Artery-vein graft........ 9.84 NA 5.38 2.21 NA 17.43 090
[[Page 30937]]
36830... .................. A Artery-vein graft........ 12.00 NA 6.05 2.36 NA 20.41 090
36832... .................. A Revise artery-vein 6.45 NA 3.82 2.38 NA 12.65 090
fistula.
36834... .................. A Repair A-V aneurysm...... 9.93 NA 5.01 1.66 NA 16.60 090
36835... .................. A Artery to vein shunt..... 7.15 NA 4.03 0.79 NA 11.97 090
36860... .................. A Cannula declotting....... 2.01 2.05 3.31 0.43 4.49 5.75 000
36861... .................. A Cannula declotting....... 2.52 NA 1.52 1.01 NA 5.05 000
37140... .................. A Revision of circulation.. 23.60 NA 11.09 3.34 NA 38.03 090
37145... .................. A Revision of circulation.. 24.61 NA 13.07 1.72 NA 39.40 090
37160... .................. A Revision of circulation.. 21.60 NA 10.56 3.79 NA 35.95 090
37180... .................. A Revision of circulation.. 24.61 NA 11.66 2.76 NA 39.03 090
37181... .................. A Splice spleen/kidney 26.68 NA 12.36 3.52 NA 42.56 090
veins.
37195... .................. A Thrombolytic therapy, 0.00 2.02 0.16 0.54 2.56 0.70 XXX
stroke.
37200... .................. A Transcatheter biopsy..... 4.56 NA 3.39 0.13 NA 8.08 000
37201... .................. A Transcatheter therapy 5.00 NA 2.97 0.64 NA 8.61 000
infuse.
37202... .................. A Transcatheter therapy 5.68 NA 3.78 0.50 NA 9.96 000
infuse.
37203... .................. A Transcatheter retrieval.. 5.03 NA 2.93 0.45 NA 8.41 000
37204... .................. A Transcatheter occlusion.. 18.14 NA 7.97 1.60 NA 27.71 000
37205... .................. A Transcatheter stent...... 8.28 NA 4.71 0.42 NA 13.41 000
37206... .................. A Transcatheter stent...... 4.13 NA 2.40 0.21 NA 6.74 ZZZ
37207... .................. A Transcatheter stent...... 8.28 NA 4.34 0.42 NA 13.04 000
37208... .................. A Transcatheter stent...... 4.13 NA 1.94 0.21 NA 6.28 ZZZ
37209... .................. A Exchange arterial 2.27 NA 1.64 0.11 NA 4.02 000
catheter.
37250... .................. A Intravascular us......... 2.10 NA 3.83 0.13 NA 6.06 ZZZ
37251... .................. A Intravascular us......... 1.60 NA 3.33 0.10 NA 5.03 ZZZ
37565... .................. A Ligation of neck vein.... 4.44 NA 2.84 0.74 NA 8.02 090
37600... .................. A Ligation of neck artery.. 4.57 NA 3.45 0.80 NA 8.82 090
37605... .................. A Ligation of neck artery.. 6.19 NA 4.06 1.04 NA 11.29 090
37606... .................. A Ligation of neck artery.. 6.28 NA 4.94 0.72 NA 11.94 090
37607... .................. A Ligation of fistula...... 6.16 NA 3.24 0.71 NA 10.11 090
37609... .................. A Temporal artery procedure 2.30 4.20 1.94 0.38 6.88 4.62 010
37615... .................. A Ligation of neck artery.. 5.73 NA 3.99 1.11 NA 10.83 090
37616... .................. A Ligation of chest artery. 16.49 NA 13.38 0.83 NA 30.70 090
37617... .................. A Ligation of abdomen 15.95 NA 8.73 1.54 NA 26.22 090
artery.
37618... .................. A Ligation of extremity 4.84 NA 3.33 1.06 NA 9.23 090
artery.
37620... .................. A Revision of major vein... 10.56 NA 5.78 1.48 NA 17.82 090
37650... .................. A Revision of major vein... 5.13 NA 3.12 0.52 NA 8.77 090
37660... .................. A Revision of major vein... 10.61 NA 6.09 1.07 NA 17.77 090
37700... .................. A Revise leg vein.......... 3.73 NA 2.49 0.73 NA 6.95 090
37720... .................. A Removal of leg vein...... 5.66 NA 3.17 1.04 NA 9.87 090
37730... .................. A Removal of leg veins..... 7.33 NA 4.19 1.40 NA 12.92 090
37735... .................. A Removal of leg veins/ 10.53 NA 6.07 1.68 NA 18.28 090
lesion.
37760... .................. A Revision of leg veins.... 10.47 NA 6.21 1.52 NA 18.20 090
37780... .................. A Revision of leg vein..... 3.84 NA 2.51 0.35 NA 6.70 090
37785... .................. A Revise secondary 3.88 4.63 3.11 0.18 8.69 7.17 090
varicosity.
37788... .................. A Revascularization, penis. 22.01 NA 11.57 1.48 NA 35.06 090
37790... .................. A Penile venous occlusion.. 8.34 NA 5.86 0.55 NA 14.75 090
38100... .................. A Removal of spleen, total. 13.01 NA 6.41 1.81 NA 21.23 090
38101... .................. A Removal of spleen, 13.74 NA 6.94 1.51 NA 22.19 090
partial.
38102... .................. A Removal of spleen, total. 4.80 NA 2.03 0.58 NA 7.41 ZZZ
38115... .................. A Repair of ruptured spleen 14.19 NA 6.91 1.49 NA 22.59 090
38200... .................. A Injection for spleen x- 2.64 NA 0.83 0.15 NA 3.62 000
ray.
38230... .................. R Bone marrow collection... 4.54 NA 2.23 0.21 NA 6.98 010
38231... .................. R Stem cell collection..... 1.50 NA 0.58 0.08 NA 2.16 000
38240... .................. R Bone marrow/stem 2.24 NA 1.20 0.14 NA 3.58 XXX
transplant.
38241... .................. R Bone marrow/stem 2.24 NA 1.28 0.13 NA 3.65 XXX
transplant.
38300... .................. A Drainage lymph node 1.53 2.60 1.54 0.10 4.23 3.17 010
lesion.
38305... .................. A Drainage lymph node 4.61 5.06 4.08 0.36 10.03 9.05 090
lesion.
38308... .................. A Incision of lymph 4.95 NA 3.75 0.45 NA 9.15 090
channels.
38380... .................. A Thoracic duct procedure.. 7.46 NA 5.68 0.76 NA 13.90 090
38381... .................. A Thoracic duct procedure.. 12.88 NA 10.21 1.50 NA 24.59 090
38382... .................. A Thoracic duct procedure.. 10.08 NA 9.37 1.13 NA 20.58 090
38500... .................. A Biopsy/removal, lymph 2.88 2.02 1.92 0.31 5.21 5.11 010
node(s).
38505... .................. A Needle biopsy, lymph 1.14 1.98 1.04 0.17 3.29 2.35 000
node(s).
38510... .................. A Biopsy/removal, lymph 4.14 NA 3.28 0.45 NA 7.87 090
node(s).
38520... .................. A Biopsy/removal, lymph 5.12 NA 3.57 0.56 NA 9.25 090
node(s).
38525... .................. A Biopsy/removal, lymph 4.66 NA 2.95 0.53 NA 8.14 090
node(s).
38530... .................. A Biopsy/removal, lymph 6.13 NA 4.08 0.65 NA 10.86 090
node(s).
38542... .................. A Explore deep node(s), 5.91 NA 4.90 0.59 NA 11.40 090
neck.
38550... .................. A Removal neck/armpit 6.73 NA 4.15 0.63 NA 11.51 090
lesion.
38555... .................. A Removal neck/armpit 14.27 NA 8.94 1.38 NA 24.59 090
lesion.
38562... .................. A Removal, pelvic lymph 10.49 NA 6.35 1.20 NA 18.04 090
nodes.
38564... .................. A Removal, abdomen lymph 10.83 NA 6.15 1.51 NA 18.49 090
nodes.
38700... .................. A Removal of lymph nodes, 8.24 NA 10.81 1.31 NA 20.36 090
neck.
38720... .................. A Removal of lymph nodes, 13.61 NA 13.91 2.04 NA 29.56 090
neck.
[[Page 30938]]
38724... .................. A Removal of lymph nodes, 14.54 NA 14.45 2.00 NA 30.99 090
neck.
38740... .................. A Remove armpit lymph nodes 6.77 NA 3.81 1.00 NA 11.58 090
38745... .................. A Remove armpits lymph 8.84 NA 5.36 1.76 NA 15.96 090
nodes.
38746... .................. A Remove thoracic lymph 4.39 NA 2.29 0.53 NA 7.21 ZZZ
nodes.
38747... .................. A Remove abdominal lymph 4.89 NA 2.24 0.59 NA 7.72 ZZZ
nodes.
38760... .................. A Remove groin lymph nodes. 8.74 NA 4.84 1.35 NA 14.93 090
38765... .................. A Remove groin lymph nodes. 16.06 NA 9.45 2.42 NA 27.93 090
38770... .................. A Remove pelvis lymph nodes 13.23 NA 7.39 1.73 NA 22.35 090
38780... .................. A Remove abdomen lymph 16.59 NA 9.80 3.13 NA 29.52 090
nodes.
38790... .................. A Injection for lymphatic 1.29 15.73 0.46 0.19 17.21 1.94 000
xray.
38794... .................. A Access thoracic lymph 4.45 NA 1.63 0.38 NA 6.46 090
duct.
39000... .................. A Exploration of chest..... 6.10 NA 7.52 1.08 NA 14.70 090
39010... .................. A Exploration of chest..... 11.79 NA 10.10 2.08 NA 23.97 090
39200... .................. A Removal chest lesion..... 13.62 NA 9.99 2.14 NA 25.75 090
39220... .................. A Removal chest lesion..... 17.42 NA 11.53 2.83 NA 31.78 090
39400... .................. A Visualization of chest... 5.61 NA 5.83 0.95 NA 12.39 010
39501... .................. A Repair diaphragm 13.19 NA 8.27 2.10 NA 23.56 090
laceration.
39502... .................. A Repair paraesophageal 16.33 NA 9.21 2.45 NA 27.99 090
hernia.
39503... .................. A Repair of diaphragm 34.85 NA 16.15 2.94 NA 53.94 090
hernia.
39520... .................. A Repair of diaphragm 16.10 NA 10.12 2.46 NA 28.68 090
hernia.
39530... .................. A Repair of diaphragm 15.41 NA 9.39 2.71 NA 27.51 090
hernia.
39531... .................. A Repair of diaphragm 16.42 NA 10.12 1.80 NA 28.34 090
hernia.
39540... .................. A Repair of diaphragm 13.32 NA 7.38 2.51 NA 23.21 090
hernia.
39541... .................. A Repair of diaphragm 14.41 NA 8.60 2.37 NA 25.38 090
hernia.
39545... .................. A Revision of diaphragm.... 13.37 NA 8.87 1.31 NA 23.55 090
40490... .................. A Biopsy of lip............ 1.22 1.11 0.68 0.07 2.40 1.97 000
40500... .................. A Partial excision of lip.. 4.28 3.71 4.46 0.94 8.93 9.68 090
40510... .................. A Partial excision of lip.. 4.70 4.37 4.92 0.83 9.90 10.45 090
40520... .................. A Partial excision of lip.. 4.67 4.80 5.06 0.68 10.15 10.41 090
40525... .................. A Reconstruct lip with flap 7.55 NA 6.94 1.43 NA 15.92 090
40527... .................. A Reconstruct lip with flap 9.13 NA 8.05 1.65 NA 18.83 090
40530... .................. A Partial removal of lip... 5.40 4.34 4.99 0.74 10.48 11.13 090
40650... .................. A Repair lip............... 3.64 3.35 3.03 0.65 7.64 7.32 090
40652... .................. A Repair lip............... 4.26 4.36 4.46 0.79 9.41 9.51 090
40654... .................. A Repair lip............... 5.31 4.81 5.43 1.00 11.12 11.74 090
40700... .................. A Repair cleft lip/nasal... 12.79 NA 9.03 1.28 NA 23.10 090
40701... .................. A Repair cleft lip/nasal... 15.85 NA 8.34 1.62 NA 25.81 090
40702... .................. A Repair cleft lip/nasal... 13.04 NA 8.30 1.10 NA 22.44 090
40720... .................. A Repair cleft lip/nasal... 13.55 NA 9.97 1.79 NA 25.31 090
40761... .................. A Repair cleft lip/nasal... 14.72 NA 11.73 1.74 NA 28.19 090
40800... .................. A Drainage of mouth lesion. 1.17 2.22 1.41 0.07 3.46 2.65 010
40801... .................. A Drainage of mouth lesion. 2.53 1.94 1.90 0.16 4.63 4.59 010
40804... .................. A Removal foreign body, 1.24 1.67 1.50 0.06 2.97 2.80 010
mouth.
40805... .................. A Removal foreign body, 2.69 2.40 2.50 0.30 5.39 5.49 010
mouth.
40806... .................. A Incision of lip fold..... 0.31 0.58 0.60 0.03 0.92 0.94 000
40808... .................. A Biopsy of mouth lesion... 0.96 1.32 1.60 0.08 2.36 2.64 010
40810... .................. A Excision of mouth lesion. 1.31 1.76 1.85 0.11 3.18 3.27 010
40812... .................. A Excise/repair mouth 2.31 2.16 2.45 0.14 4.61 4.90 010
lesion.
40814... .................. A Excise/repair mouth 3.42 3.08 3.61 0.32 6.82 7.35 090
lesion.
40816... .................. A Excision of mouth lesion. 3.67 3.32 3.85 0.33 7.32 7.85 090
40818... .................. A Excise oral mucosa for 2.41 2.76 4.56 0.20 5.37 7.17 090
graft.
40819... .................. A Excise lip or cheek fold. 2.41 2.57 2.64 0.14 5.12 5.19 090
40820... .................. A Treatment of mouth lesion 1.28 1.54 1.80 0.06 2.88 3.14 010
40830... .................. A Repair mouth laceration.. 1.76 1.71 1.52 0.07 3.54 3.35 010
40831... .................. A Repair mouth laceration.. 2.46 2.11 2.14 0.21 4.78 4.81 010
40840... .................. R Reconstruction of mouth.. 8.73 5.13 6.14 0.73 14.59 15.60 090
40842... .................. R Reconstruction of mouth.. 8.73 5.21 6.40 0.73 14.67 15.86 090
40843... .................. R Reconstruction of mouth.. 12.10 6.00 8.99 1.03 19.13 22.12 090
40844... .................. R Reconstruction of mouth.. 16.01 8.17 8.59 1.36 25.54 25.96 090
40845... .................. R Reconstruction of mouth.. 18.58 9.57 10.76 1.93 30.08 31.27 090
41000... .................. A Drainage of mouth lesion. 1.30 1.53 1.44 0.08 2.91 2.82 010
41005... .................. A Drainage of mouth lesion. 1.26 1.50 1.28 0.07 2.83 2.61 010
41006... .................. A Drainage of mouth lesion. 3.24 2.72 2.86 0.11 6.07 6.21 090
41007... .................. A Drainage of mouth lesion. 3.10 2.67 2.82 0.30 6.07 6.22 090
41008... .................. A Drainage of mouth lesion. 3.37 2.74 2.81 0.11 6.22 6.29 090
41009... .................. A Drainage of mouth lesion. 3.59 2.82 2.85 0.34 6.75 6.78 090
41010... .................. A Incision of tongue fold.. 1.06 1.93 2.83 0.04 3.03 3.93 010
41015... .................. A Drainage of mouth lesion. 3.96 3.03 3.07 0.10 7.09 7.13 090
41016... .................. A Drainage of mouth lesion. 4.07 3.07 3.13 0.38 7.52 7.58 090
41017... .................. A Drainage of mouth lesion. 4.07 3.10 3.12 0.14 7.31 7.33 090
41018... .................. A Drainage of mouth lesion. 5.10 3.61 3.52 0.38 9.09 9.00 090
41100... .................. A Biopsy of tongue......... 1.63 1.76 2.03 0.08 3.47 3.74 010
41105... .................. A Biopsy of tongue......... 1.42 1.61 1.92 0.12 3.15 3.46 010
41108... .................. A Biopsy of floor of mouth. 1.05 1.44 1.68 0.09 2.58 2.82 010
[[Page 30939]]
41110... .................. A Excision of tongue lesion 1.51 1.97 1.98 0.15 3.63 3.64 010
41112... .................. A Excision of tongue lesion 2.73 2.56 2.94 0.23 5.52 5.90 090
41113... .................. A Excision of tongue lesion 3.19 2.70 4.71 0.37 6.26 8.27 090
41114... .................. A Excision of tongue lesion 8.47 NA 6.15 0.73 NA 15.35 090
41115... .................. A Excision of tongue fold.. 1.74 1.85 2.00 0.17 3.76 3.91 010
41116... .................. A Excision of mouth lesion. 2.44 2.42 2.78 0.27 5.13 5.49 090
41120... .................. A Partial removal of tongue 9.77 NA 7.88 0.88 NA 18.53 090
41130... .................. A Partial removal of tongue 11.15 NA 8.73 1.14 NA 21.02 090
41135... .................. A Tongue and neck surgery.. 23.09 NA 16.39 2.64 NA 42.12 090
41140... .................. A Removal of tongue........ 25.50 NA 17.08 2.45 NA 45.03 090
41145... .................. A Tongue removal; neck 30.06 NA 20.79 2.95 NA 53.80 090
surgery.
41150... .................. A Tongue, mouth, jaw 23.04 NA 16.14 2.46 NA 41.64 090
surgery.
41153... .................. A Tongue, mouth, neck 23.77 NA 17.27 3.03 NA 44.07 090
surgery.
41155... .................. A Tongue, jaw, & neck 27.72 NA 19.93 3.75 NA 51.40 090
surgery.
41250... .................. A Repair tongue laceration. 1.91 1.89 1.50 0.11 3.91 3.52 010
41251... .................. A Repair tongue laceration. 2.27 1.94 1.88 0.21 4.42 4.36 010
41252... .................. A Repair tongue laceration. 2.97 2.48 2.21 0.26 5.71 5.44 010
41500... .................. A Fixation of tongue....... 3.71 NA 2.80 0.26 NA 6.77 090
41510... .................. A Tongue to lip surgery.... 3.42 NA 3.04 0.45 NA 6.91 090
41520... .................. A Reconstruction, tongue 2.73 2.31 2.90 0.28 5.32 5.91 090
fold.
41800... .................. A Drainage of gum lesion... 1.17 1.35 1.12 0.07 2.59 2.36 010
41805... .................. A Removal foreign body, gum 1.24 1.36 1.78 0.08 2.68 3.10 010
41806... .................. A Removal foreign body, 2.69 2.00 2.33 0.15 4.84 5.17 010
jawbone.
41822... .................. R Excision of gum lesion... 2.31 3.15 2.96 0.25 5.71 5.52 010
41823... .................. R Excision of gum lesion... 3.30 2.76 2.83 0.34 6.40 6.47 090
41825... .................. A Excision of gum lesion... 1.31 1.67 1.78 0.14 3.12 3.23 010
41826... .................. A Excision of gum lesion... 2.31 2.05 2.24 0.18 4.54 4.73 010
41827... .................. A Excision of gum lesion... 3.42 2.79 3.30 0.38 6.59 7.10 090
41828... .................. R Excision of gum lesion... 3.09 2.44 2.33 0.33 5.86 5.75 010
41830... .................. R Removal of gum tissue.... 3.35 2.49 2.74 0.36 6.20 6.45 010
41872... .................. R Repair gum............... 2.59 2.40 2.44 0.27 5.26 5.30 090
41874... .................. R Repair tooth socket...... 3.09 2.27 2.26 0.32 5.68 5.67 090
42000... .................. A Drainage mouth roof 1.23 1.65 1.41 0.06 2.94 2.70 010
lesion.
42100... .................. A Biopsy roof of mouth..... 1.31 1.57 1.84 0.08 2.96 3.23 010
42104... .................. A Excision lesion, mouth 1.64 1.72 2.08 0.17 3.53 3.89 010
roof.
42106... .................. A Excision lesion, mouth 2.10 1.99 2.29 0.21 4.30 4.60 010
roof.
42107... .................. A Excision lesion, mouth 4.44 3.32 3.94 0.50 8.26 8.88 090
roof.
42120... .................. A Remove palate/lesion..... 6.17 NA 5.28 1.01 NA 12.46 090
42140... .................. A Excision of uvula........ 1.62 2.22 2.38 0.15 3.99 4.15 090
42145... .................. A Repair, palate, pharynx/ 8.05 NA 6.73 1.45 NA 16.23 090
uvula.
42160... .................. A Treatment mouth roof 1.80 2.02 2.10 0.16 3.98 4.06 010
lesion.
42180... .................. A Repair palate............ 2.50 2.01 1.94 0.26 4.77 4.70 010
42182... .................. A Repair palate............ 3.83 2.77 3.02 0.38 6.98 7.23 010
42200... .................. A Reconstruct cleft palate. 12.00 NA 9.19 0.85 NA 22.04 090
42205... .................. A Reconstruct cleft palate. 9.59 NA 7.39 0.79 NA 17.77 090
42210... .................. A Reconstruct cleft palate. 14.50 NA 9.13 0.95 NA 24.58 090
42215... .................. A Reconstruct cleft palate. 8.82 NA 7.70 0.86 NA 17.38 090
42220... .................. A Reconstruct cleft palate. 7.02 NA 5.37 0.81 NA 13.20 090
42225... .................. A Reconstruct cleft palate. 9.54 NA 7.73 1.08 NA 18.35 090
42226... .................. A Lengthening of palate.... 10.01 NA 8.78 0.86 NA 19.65 090
42227... .................. A Lengthening of palate.... 9.52 NA 14.99 0.38 NA 24.89 090
42235... .................. A Repair palate............ 7.87 NA 5.57 0.49 NA 13.93 090
42260... .................. A Repair nose to lip 9.80 5.49 7.44 0.44 15.73 17.68 090
fistula.
42280... .................. A Preparation, palate mold. 1.54 1.14 0.82 0.17 2.85 2.53 010
42281... .................. A Insertion, palate 1.93 1.30 1.09 0.15 3.38 3.17 010
prosthesis.
42300... .................. A Drainage of salivary 1.93 1.87 2.26 0.12 3.92 4.31 010
gland.
42305... .................. A Drainage of salivary 6.07 NA 5.09 0.27 NA 11.43 090
gland.
42310... .................. A Drainage of salivary 1.56 1.60 1.95 0.12 3.28 3.63 010
gland.
42320... .................. A Drainage of salivary 2.35 2.10 2.40 0.22 4.67 4.97 010
gland.
42325... .................. A Create salivary cyst 2.75 2.35 1.15 0.20 5.30 4.10 090
drain.
42326... .................. A Create salivary cyst 3.78 3.65 1.44 0.33 7.76 5.55 090
drain.
42330... .................. A Removal of salivary stone 2.21 2.04 1.27 0.12 4.37 3.60 010
42335... .................. A Removal of salivary stone 3.31 2.78 3.56 0.27 6.36 7.14 090
42340... .................. A Removal of salivary stone 4.60 3.74 4.38 0.45 8.79 9.43 090
42400... .................. A Biopsy of salivary gland. 0.78 1.63 0.74 0.10 2.51 1.62 000
42405... .................. A Biopsy of salivary gland. 3.29 2.54 3.25 0.19 6.02 6.73 010
42408... .................. A Excision of salivary cyst 4.54 3.45 4.37 0.38 8.37 9.29 090
42409... .................. A Drainage of salivary cyst 2.81 2.44 3.35 0.30 5.55 6.46 090
42410... .................. A Excise parotid gland/ 9.34 NA 6.83 0.92 NA 17.09 090
lesion.
42415... .................. A Excise parotid gland/ 16.89 NA 12.33 1.68 NA 30.90 090
lesion.
42420... .................. A Excise parotid gland/ 19.59 NA 14.21 1.87 NA 35.67 090
lesion.
42425... .................. A Excise parotid gland/ 13.02 NA 10.06 1.43 NA 24.51 090
lesion.
42426... .................. A Excise parotid gland/ 21.26 NA 15.55 3.21 NA 40.02 090
lesion.
42440... .................. A Excision submaxillary 6.97 NA 5.73 0.99 NA 13.69 090
gland.
[[Page 30940]]
42450... .................. A Excision sublingual gland 4.62 3.71 4.47 0.35 8.68 9.44 090
42500... .................. A Repair salivary duct..... 4.30 3.70 4.34 0.50 8.50 9.14 090
42505... .................. A Repair salivary duct..... 6.18 4.43 5.38 0.86 11.47 12.42 090
42507... .................. A Parotid duct diversion... 6.11 NA 5.22 0.67 NA 12.00 090
42508... .................. A Parotid duct diversion... 9.10 NA 7.48 0.94 NA 17.52 090
42509... .................. A Parotid duct diversion... 11.54 NA 9.89 1.23 NA 22.66 090
42510... .................. A Parotid duct diversion... 8.15 NA 5.61 0.84 NA 14.60 090
42550... .................. A Injection for salivary x- 1.25 7.23 0.40 0.04 8.52 1.69 000
ray.
42600... .................. A Closure of salivary 4.82 4.52 4.79 0.46 9.80 10.07 090
fistula.
42650... .................. A Dilation of salivary duct 0.77 1.10 1.36 0.04 1.91 2.17 000
42660... .................. A Dilation of salivary duct 1.13 0.96 1.78 0.06 2.15 2.97 000
42665... .................. A Ligation of salivary duct 2.53 2.88 3.17 0.25 5.66 5.95 090
42700... .................. A Drainage of tonsil 1.62 1.96 1.78 0.10 3.68 3.50 010
abscess.
42720... .................. A Drainage of throat 5.42 4.08 4.43 0.22 9.72 10.07 010
abscess.
42725... .................. A Drainage of throat 10.72 NA 7.89 0.53 NA 19.14 090
abscess.
42800... .................. A Biopsy of throat......... 1.39 1.79 1.92 0.08 3.26 3.39 010
42802... .................. A Biopsy of throat......... 1.54 1.89 2.02 0.12 3.55 3.68 010
42804... .................. A Biopsy of upper nose/ 1.24 1.71 1.85 0.13 3.08 3.22 010
throat.
42806... .................. A Biopsy of upper nose/ 1.58 2.01 2.16 0.16 3.75 3.90 010
throat.
42808... .................. A Excise pharynx lesion.... 2.30 2.84 2.56 0.29 5.43 5.15 010
42809... .................. A Remove pharynx foreign 1.81 2.09 1.45 0.08 3.98 3.34 010
body.
42810... .................. A Excision of neck cyst.... 3.33 3.66 3.33 0.47 7.46 7.13 090
42815... .................. A Excision of neck cyst.... 7.23 NA 5.86 1.12 NA 14.21 090
42820... .................. A Remove tonsils and 3.91 NA 3.38 0.32 NA 7.61 090
adenoids.
42821... .................. A Remove tonsils and 4.29 NA 3.69 0.46 NA 8.44 090
adenoids.
42825... .................. A Removal of tonsils....... 3.42 NA 3.27 0.33 NA 7.02 090
42826... .................. A Removal of tonsils....... 3.38 NA 3.24 0.43 NA 7.05 090
42830... .................. A Removal of adenoids...... 2.57 NA 2.28 0.27 NA 5.12 090
42831... .................. A Removal of adenoids...... 2.71 NA 2.50 0.25 NA 5.46 090
42835... .................. A Removal of adenoids...... 2.30 NA 2.54 0.10 NA 4.94 090
42836... .................. A Removal of adenoids...... 3.18 NA 3.13 0.31 NA 6.62 090
42842... .................. A Extensive surgery of 8.76 NA 7.14 0.73 NA 16.63 090
throat.
42844... .................. A Extensive surgery of 14.31 NA 10.67 1.27 NA 26.25 090
throat.
42845... .................. A Extensive surgery of 24.29 NA 17.14 2.22 NA 43.65 090
throat.
42860... .................. A Excision of tonsil tags.. 2.22 NA 2.43 0.21 NA 4.86 090
42870... .................. A Excision of lingual 5.40 NA 5.08 0.26 NA 10.74 090
tonsil.
42890... .................. A Partial removal of 12.94 NA 10.10 1.03 NA 24.07 090
pharynx.
42892... .................. A Revision of pharyngeal 15.83 NA 12.11 1.27 NA 29.21 090
walls.
42894... .................. A Revision of pharyngeal 22.88 NA 16.72 1.83 NA 41.43 090
walls.
42900... .................. A Repair throat wound...... 5.25 NA 3.94 0.48 NA 9.67 010
42950... .................. A Reconstruction of throat. 8.10 NA 6.76 1.10 NA 15.96 090
42953... .................. A Repair throat, esophagus. 8.96 NA 7.93 0.93 NA 17.82 090
42955... .................. A Surgical opening of 7.39 NA 5.74 0.43 NA 13.56 090
throat.
42960... .................. A Control throat bleeding.. 2.33 NA 2.09 0.12 NA 4.54 010
42961... .................. A Control throat bleeding.. 5.59 NA 4.67 0.19 NA 10.45 090
42962... .................. A Control throat bleeding.. 7.14 NA 4.55 0.68 NA 12.37 090
42970... .................. A Control nose/throat 5.43 NA 3.46 0.10 NA 8.99 090
bleeding.
42971... .................. A Control nose/throat 6.21 NA 4.85 0.34 NA 11.40 090
bleeding.
42972... .................. A Control nose/throat 7.20 NA 5.58 0.73 NA 13.51 090
bleeding.
43020... .................. A Incision of esophagus.... 8.09 NA 5.75 0.71 NA 14.55 090
43030... .................. A Throat muscle surgery.... 7.69 NA 6.16 1.21 NA 15.06 090
43045... .................. A Incision of esophagus.... 20.12 NA 11.38 2.36 NA 33.86 090
43100... .................. A Excision of esophagus 9.19 NA 7.68 0.95 NA 17.82 090
lesion.
43101... .................. A Excision of esophagus 16.24 NA 9.49 1.88 NA 27.61 090
lesion.
43107... .................. A Removal of esophagus..... 28.79 NA 16.54 4.42 NA 49.75 090
43108... .................. A Removal of esophagus..... 34.19 NA 18.50 4.77 NA 57.46 090
43112... .................. A Removal of esophagus..... 31.22 NA 17.71 4.22 NA 53.15 090
43113... .................. A Removal of esophagus..... 35.27 NA 19.69 4.77 NA 59.73 090
43116... .................. A Partial removal of 31.22 NA 22.24 4.77 NA 58.23 090
esophagus.
43117... .................. A Partial removal of 30.02 NA 17.20 4.77 NA 51.99 090
esophagus.
43118... .................. A Partial removal of 33.20 NA 17.53 4.77 NA 55.50 090
esophagus.
43121... .................. A Partial removal of 29.19 NA 16.84 4.19 NA 50.22 090
esophagus.
43122... .................. A Parital removal of 29.11 NA 16.10 4.19 NA 49.40 090
esophagus.
43123... .................. A Partial removal of 33.20 NA 18.08 4.77 NA 56.05 090
esophagus.
43124... .................. A Removal of esophagus..... 27.32 NA 16.97 4.42 NA 48.71 090
43130... .................. A Removal of esophagus 11.75 NA 9.35 1.60 NA 22.70 090
pouch.
43135... .................. A Removal of esophagus 16.10 NA 10.05 2.17 NA 28.32 090
pouch.
43200... .................. A Esophagus endoscopy...... 1.59 3.93 1.00 0.26 5.78 2.85 000
43202... .................. A Esophagus endoscopy, 1.89 3.61 0.94 0.31 5.81 3.14 000
biopsy.
43204... .................. A Esophagus endoscopy & 3.77 NA 1.45 0.36 NA 5.58 000
inject.
43205... .................. A Esophagus endoscopy/ 3.79 NA 1.47 0.18 NA 5.44 000
ligation.
43215... .................. A Esophagus endoscopy...... 2.60 NA 1.16 0.46 NA 4.22 000
43216... .................. A Esophagus endoscopy/ 2.40 NA 1.06 0.37 NA 3.83 000
lesion.
43217... .................. A Esophagus endoscopy...... 2.90 NA 1.25 0.37 NA 4.52 000
[[Page 30941]]
43219... .................. A Esophagus endoscopy...... 2.80 NA 1.22 0.34 NA 4.36 000
43220... .................. A Esophagus endoscopy, 2.10 NA 0.91 0.27 NA 3.28 000
dilation.
43226... .................. A Esophagus endoscopy, 2.34 NA 0.96 0.26 NA 3.56 000
dilation.
43227... .................. A Esophagus endoscopy, 3.60 NA 1.41 0.34 NA 5.35 000
repair.
43228... .................. A Esophagus endoscopy, 3.77 NA 1.56 0.38 NA 5.71 000
ablation.
43234... .................. A Upper GI endoscopy, exam. 2.01 2.35 0.86 0.30 4.66 3.17 000
43235... .................. A Upper gi endoscopy, 2.39 3.80 0.98 0.29 6.48 3.66 000
diagnosis.
43239... .................. A Upper GI endoscopy, 2.69 3.88 1.09 0.33 6.90 4.11 000
biopsy.
43241... .................. A Upper GI endoscopy with 2.59 NA 1.04 0.38 NA 4.01 000
tube.
43243... .................. A Upper GI endoscopy & 4.57 NA 1.73 0.39 NA 6.69 000
inject..
43244... .................. A Upper GI endoscopy/ 4.59 NA 1.74 0.41 NA 6.74 000
ligation.
43245... .................. A Operative upper GI 3.39 NA 1.33 0.40 NA 5.12 000
endoscopy.
43246... .................. A Place gastrostomy tube... 4.33 NA 1.65 0.51 NA 6.49 000
43247... .................. A Operative upper GI 3.39 NA 1.33 0.38 NA 5.10 000
endoscopy.
43248... .................. A Upper GI endoscopy/ 3.15 NA 1.23 0.35 NA 4.73 000
guidewire.
43249... .................. A Esophagus endoscopy, 2.90 NA 1.15 0.30 NA 4.35 000
dilation.
43250... .................. A Upper GI endoscopy/tumor. 3.20 NA 1.26 0.43 NA 4.89 000
43251... .................. A Operative upper GI 3.70 NA 1.43 0.43 NA 5.56 000
endoscopy.
43255... .................. A Operative upper GI 4.40 NA 1.62 0.38 NA 6.40 000
endoscopy.
43258... .................. A Operative upper GI 4.55 NA 1.73 0.38 NA 6.66 000
endoscopy.
43259... .................. A Endoscopic ultrasound 4.89 NA 1.88 0.35 NA 7.12 000
exam.
43260... .................. A Endoscopy, bile duct/ 5.96 NA 2.21 0.39 NA 8.56 000
pancreas.
43261... .................. A Endoscopy, bile duct/ 6.27 NA 2.33 0.39 NA 8.99 000
pancreas.
43262... .................. A Endoscopy, bile duct/ 7.39 NA 2.72 0.58 NA 10.69 000
pancreas.
43263... .................. A Endoscopy, bile duct/ 6.19 NA 2.31 0.38 NA 8.88 000
pancreas.
43264... .................. A Endoscopy, bile duct/ 8.90 NA 3.26 0.61 NA 12.77 000
pancreas.
43265... .................. A Endoscopy, bile duct/ 8.90 NA 3.27 0.49 NA 12.66 000
pancreas.
43267... .................. A Endoscopy, bile duct/ 7.39 NA 2.72 0.48 NA 10.59 000
pancreas.
43268... .................. A Endoscopy, bile duct/ 7.39 NA 2.72 0.56 NA 10.67 000
pancreas.
43269... .................. A Endoscopy, bile duct/ 6.04 NA 2.25 0.51 NA 8.80 000
pancreas.
43271... .................. A Endoscopy, bile duct/ 7.39 NA 2.72 0.50 NA 10.61 000
pancreas.
43272... .................. A Endoscopy, bile duct/ 7.39 NA 2.74 0.42 NA 10.55 000
pancreas.
43300... .................. A Repair of esophagus...... 9.14 NA 6.70 1.70 NA 17.54 090
43305... .................. A Repair esophagus and 17.15 NA 15.03 1.78 NA 33.96 090
fistula.
43310... .................. A Repair of esophagus...... 25.39 NA 15.67 3.23 NA 44.29 090
43312... .................. A Repair esophagus and 28.42 NA 18.88 2.30 NA 49.60 090
fistula.
43320... .................. A Fuse esophagus & stomach. 16.07 NA 10.25 2.05 NA 28.37 090
43324... .................. A Revise esophagus & 16.58 NA 9.19 2.53 NA 28.30 090
stomach.
43325... .................. A Revise esophagus & 16.17 NA 9.81 2.29 NA 28.27 090
stomach.
43326... .................. A Revise esophagus & 15.91 NA 10.44 1.75 NA 28.10 090
stomach.
43330... .................. A Repair of esophagus...... 15.94 NA 9.56 2.39 NA 27.89 090
43331... .................. A Repair of esophagus...... 16.23 NA 10.50 2.64 NA 29.37 090
43340... .................. A Fuse esophagus & 15.81 NA 9.82 2.52 NA 28.15 090
intestine.
43341... .................. A Fuse esophagus & 16.81 NA 10.70 1.56 NA 29.07 090
intestine.
43350... .................. A Surgical opening, 12.72 NA 10.38 1.15 NA 24.25 090
esophagus.
43351... .................. A Surgical opening, 14.79 NA 9.21 1.53 NA 25.53 090
esophagus.
43352... .................. A Surgical opening, 12.30 NA 9.19 1.47 NA 22.96 090
esophagus.
43360... .................. A Gastrointestinal repair.. 28.78 NA 16.01 4.19 NA 48.98 090
43361... .................. A Gastrointestinal repair.. 32.65 NA 18.33 4.77 NA 55.75 090
43400... .................. A Ligate esophagus veins... 17.09 NA 9.76 1.63 NA 28.48 090
43401... .................. A Esophagus surgery for 17.81 NA 10.85 1.93 NA 30.59 090
veins.
43405... .................. A Ligate/staple esophagus.. 16.13 NA 10.21 2.64 NA 28.98 090
43410... .................. A Repair esophagus wound... 10.86 NA 8.25 1.54 NA 20.65 090
43415... .................. A Repair esophagus wound... 17.06 NA 10.46 2.52 NA 30.04 090
43420... .................. A Repair esophagus opening. 11.57 NA 8.52 0.78 NA 20.87 090
43425... .................. A Repair esophagus opening. 16.95 NA 10.15 1.71 NA 28.81 090
43450... .................. A Dilate esophagus......... 1.38 0.91 0.54 0.05 2.34 1.97 000
43453... .................. A Dilate esophagus......... 1.51 NA 0.58 0.11 NA 2.20 000
43456... .................. A Dilate esophagus......... 2.57 NA 0.97 0.24 NA 3.78 000
43458... .................. A Dilation of esophagus.... 3.06 NA 1.15 0.27 NA 4.48 000
43460... .................. A Pressure treatment 3.80 NA 1.74 0.15 NA 5.69 000
esophagus.
43500... .................. A Surgical opening of 8.44 NA 4.35 1.20 NA 13.99 090
stomach.
43501... .................. A Surgical repair of 15.31 NA 7.45 1.83 NA 24.59 090
stomach.
43502... .................. A Surgical repair of 17.67 NA 8.37 1.83 NA 27.87 090
stomach.
43510... .................. A Surgical opening of 9.99 NA 5.88 0.94 NA 16.81 090
stomach.
43520... .................. A Incision of pyloric 7.63 NA 4.44 0.87 NA 12.94 090
muscle.
43600... .................. A Biopsy of stomach........ 1.91 NA 0.80 0.05 NA 2.76 000
43605... .................. A Biopsy of stomach........ 9.15 NA 4.62 1.29 NA 15.06 090
43610... .................. A Excision of stomach 11.15 NA 5.84 1.71 NA 18.70 090
lesion.
43611... .................. A Excision of stomach 13.63 NA 6.85 1.71 NA 22.19 090
lesion.
43620... .................. A Removal of stomach....... 22.54 NA 11.01 3.19 NA 36.74 090
43621... .................. A Removal of stomach....... 23.06 NA 11.28 3.19 NA 37.53 090
43622... .................. A Removal of stomach....... 24.41 NA 11.86 3.19 NA 39.46 090
43631... .................. A Removal of stomach, 19.66 NA 9.48 2.66 NA 31.80 090
partial.
[[Page 30942]]
43632... .................. A Removal stomach, partial. 19.66 NA 9.48 2.66 NA 31.80 090
43633... .................. A Removal stomach, partial. 20.10 NA 9.74 2.66 NA 32.50 090
43634... .................. A Removal stomach, partial. 21.86 NA 10.69 4.57 NA 37.12 090
43635... .................. A Partial removal of 2.06 NA 0.89 0.26 NA 3.21 ZZZ
stomach.
43638... .................. A Partial removal of 21.76 NA 10.27 2.73 NA 34.76 090
stomach.
43639... .................. A Removal stomach, partial. 22.25 NA 10.59 2.73 NA 35.57 090
43640... .................. A Vagotomy & pylorus repair 14.81 NA 7.28 2.19 NA 24.28 090
43641... .................. A Vagotomy & pylorus repair 15.03 NA 7.36 2.18 NA 24.57 090
43750... .................. A Place gastrostomy tube... 4.49 NA 2.33 0.56 NA 7.38 010
43760... .................. A Change gastrostomy tube.. 1.10 0.88 0.50 0.09 2.07 1.69 000
43761... .................. A Reposition gastrostomy 2.01 NA 0.71 0.25 NA 2.97 000
tube.
43800... .................. A Reconstruction of pylorus 10.46 NA 5.53 1.47 NA 17.46 090
43810... .................. A Fusion of stomach and 11.19 NA 5.86 1.53 NA 18.58 090
bowel.
43820... .................. A Fusion of stomach and 11.74 NA 6.01 1.75 NA 19.50 090
bowel.
43825... .................. A Fusion of stomach and 14.68 NA 7.24 2.30 NA 24.22 090
bowel.
43830... .................. A Place gastrostomy tube... 7.28 NA 4.11 1.19 NA 12.58 090
43831... .................. A Place gastrostomy tube... 7.33 NA 4.08 0.93 NA 12.34 090
43832... .................. A Place gastrostomy tube... 11.92 NA 6.23 1.36 NA 19.51 090
43840... .................. A Repair of stomach lesion. 11.89 NA 6.02 1.66 NA 19.57 090
43842... .................. A Gastroplasty for obesity. 14.71 NA 8.34 2.93 NA 25.98 090
43843... .................. A Gastroplasty for obesity. 14.85 NA 8.41 2.93 NA 26.19 090
43846... .................. A Gastric bypass for 19.15 NA 10.32 3.30 NA 32.77 090
obesity.
43847... .................. A Gastric bypass for 21.44 NA 11.57 3.30 NA 36.31 090
obesity.
43848... .................. A Revision gastroplasty.... 23.41 NA 12.70 3.30 NA 39.41 090
43850... .................. A Revise stomach-bowel 19.69 NA 9.27 2.25 NA 31.21 090
fusion.
43855... .................. A Revise stomach-bowel 20.83 NA 9.71 2.28 NA 32.82 090
fusion.
43860... .................. A Revise stomach-bowel 19.91 NA 9.43 2.51 NA 31.85 090
fusion.
43865... .................. A Revise stomach-bowel 21.12 NA 9.97 2.98 NA 34.07 090
fusion.
43870... .................. A Repair stomach opening... 7.40 NA 4.13 1.14 NA 12.67 090
43880... .................. A Repair stomach-bowel 19.63 NA 9.75 1.76 NA 31.14 090
fistula.
44005... .................. A Freeing of bowel adhesion 13.84 NA 6.88 1.75 NA 22.47 090
44010... .................. A Incision of small bowel.. 10.68 NA 5.89 1.42 NA 17.99 090
44015... .................. A Insert needle 2.62 NA 1.10 0.45 NA 4.17 ZZZ
catheter,bowel.
44020... .................. A Exploration of small 11.93 NA 6.06 1.65 NA 19.64 090
bowel.
44021... .................. A Decompress small bowel... 12.01 NA 6.30 1.48 NA 19.79 090
44025... .................. A Incision of large bowel.. 12.18 NA 6.03 1.61 NA 19.82 090
44050... .................. A Reduce bowel obstruction. 11.40 NA 5.86 1.64 NA 18.90 090
44055... .................. A Correct malrotation of 13.14 NA 6.56 1.60 NA 21.30 090
bowel.
44100... .................. A Biopsy of bowel.......... 2.01 NA 0.86 0.13 NA 3.00 000
44110... .................. A Excision of bowel 10.07 NA 5.42 1.58 NA 17.07 090
lesion(s).
44111... .................. A Excision of bowel 12.19 NA 6.68 2.14 NA 21.01 090
lesion(s).
44120... .................. A Removal of small 14.50 NA 7.15 2.02 NA 23.67 090
intestine.
44121... .................. A Removal of small 4.45 NA 1.98 0.54 NA 6.97 ZZZ
intestine.
44125... .................. A Removal of small 14.96 NA 7.39 2.28 NA 24.63 090
intestine.
44130... .................. A Bowel to bowel fusion.... 12.36 NA 6.29 1.86 NA 20.51 090
44139... .................. A Mobilization of colon.... 2.23 NA 0.98 0.27 NA 3.48 ZZZ
44140... .................. A Partial removal of colon. 18.35 NA 8.86 2.40 NA 29.61 090
44141... .................. A Partial removal of colon. 19.51 NA 11.52 2.55 NA 33.58 090
44143... .................. A Partial removal of colon. 20.17 NA 11.83 2.62 NA 34.62 090
44144... .................. A Partial removal of colon. 18.89 NA 10.76 2.53 NA 32.18 090
44145... .................. A Partial removal of colon. 23.18 NA 11.32 2.78 NA 37.28 090
44146... .................. A Partial removal of colon. 24.16 NA 13.56 3.14 NA 40.86 090
44147... .................. A Partial removal of colon. 18.17 NA 9.40 3.30 NA 30.87 090
44150... .................. A Removal of colon......... 21.01 NA 12.18 3.17 NA 36.36 090
44151... .................. A Removal of colon/ 20.04 NA 12.76 2.22 NA 35.02 090
ileostomy.
44152... .................. A Removal of colon/ 24.41 NA 15.25 3.36 NA 43.02 090
ileostomy.
44153... .................. A Removal of colon/ 26.83 NA 15.26 3.63 NA 45.72 090
ileostomy.
44155... .................. A Removal of colon......... 24.44 NA 13.46 3.50 NA 41.40 090
44156... .................. A Removal of colon/ 23.01 NA 13.26 2.52 NA 38.79 090
ileostomy.
44160... .................. A Removal of colon......... 15.88 NA 7.85 2.68 NA 26.41 090
44300... .................. A Open bowel to skin....... 8.88 NA 5.32 1.29 NA 15.49 090
44310... .................. A Ileostomy/jejunostomy.... 11.70 NA 7.71 1.66 NA 21.07 090
44312... .................. A Revision of ileostomy.... 5.88 NA 4.12 0.45 NA 10.45 090
44314... .................. A Revision of ileostomy.... 11.04 NA 7.79 1.21 NA 20.04 090
44316... .................. A Devise bowel pouch....... 15.47 NA 11.49 1.43 NA 28.39 090
44320... .................. A Colostomy................ 12.94 NA 8.94 1.57 NA 23.45 090
44322... .................. A Colostomy with biopsies.. 11.98 NA 8.75 1.88 NA 22.61 090
44340... .................. A Revision of colostomy.... 5.66 NA 3.74 0.35 NA 9.75 090
44345... .................. A Revision of colostomy.... 11.32 NA 6.80 1.03 NA 19.15 090
44346... .................. A Revision of colostomy.... 12.46 NA 7.25 1.38 NA 21.09 090
44360... .................. A Small bowel endoscopy.... 2.92 NA 1.19 0.32 NA 4.43 000
44361... .................. A Small bowel 3.23 NA 1.29 0.34 NA 4.86 000
endoscopy,biopsy.
44363... .................. A Small bowel endoscopy.... 3.94 NA 1.52 0.36 NA 5.82 000
44364... .................. A Small bowel endoscopy.... 4.22 NA 1.67 0.72 NA 6.61 000
[[Page 30943]]
44365... .................. A Small bowel endoscopy.... 3.73 NA 1.50 0.72 NA 5.95 000
44366... .................. A Small bowel endoscopy.... 4.97 NA 1.90 0.45 NA 7.32 000
44369... .................. A Small bowel endoscopy.... 5.09 NA 1.96 0.50 NA 7.55 000
44372... .................. A Small bowel endoscopy.... 4.97 NA 1.96 0.67 NA 7.60 000
44373... .................. A Small bowel endoscopy.... 3.94 NA 1.57 0.50 NA 6.01 000
44376... .................. A Small bowel endoscopy.... 5.69 NA 2.19 0.26 NA 8.14 000
44377... .................. A Small bowel endoscopy.... 5.98 NA 2.27 0.28 NA 8.53 000
44378... .................. A Small bowel endoscopy.... 7.71 NA 2.90 0.35 NA 10.96 000
44380... .................. A Small bowel endoscopy.... 1.51 NA 0.70 0.22 NA 2.43 000
44382... .................. A Small bowel endoscopy.... 1.82 NA 0.81 0.29 NA 2.92 000
44385... .................. A Endoscopy of bowel pouch. 1.82 2.87 0.90 0.34 5.03 3.06 000
44386... .................. A Endoscopy, bowel pouch, 2.12 3.78 1.04 0.15 6.05 3.31 000
biopsy.
44388... .................. A Colon endoscopy.......... 2.82 3.48 1.30 0.50 6.80 4.62 000
44389... .................. A Colonoscopy with biopsy.. 3.13 4.09 1.41 0.45 7.67 4.99 000
44390... .................. A Colonoscopy for foreign 3.83 4.31 1.71 0.28 8.42 5.82 000
body.
44391... .................. A Colonoscopy for bleeding. 4.32 3.79 1.81 0.53 8.64 6.66 000
44392... .................. A Colonoscopy & polypectomy 3.82 4.34 1.66 0.70 8.86 6.18 000
44393... .................. A Colonoscopy, lesion 4.84 4.39 2.01 0.70 9.93 7.55 000
removal.
44394... .................. A Colonoscopy w/snare...... 4.43 4.53 1.90 0.70 9.66 7.03 000
44500... .................. A Intro, gastrointestinal 0.49 NA 0.25 0.02 NA 0.76 000
tube.
44602... .................. A Suture, small intestine.. 10.61 NA 5.66 1.62 NA 17.89 090
44603... .................. A Suture, small intestine.. 14.00 NA 7.23 1.96 NA 23.19 090
44604... .................. A Suture, large intestine.. 14.28 NA 7.08 1.67 NA 23.03 090
44605... .................. A Repair of bowel lesion... 15.37 NA 7.91 2.02 NA 25.30 090
44615... .................. A Intestinal 14.19 NA 7.34 1.57 NA 23.10 090
stricturoplasty.
44620... .................. A Repair bowel opening..... 10.87 NA 5.63 1.26 NA 17.76 090
44625... .................. A Repair bowel opening..... 13.41 NA 6.71 2.03 NA 22.15 090
44626... .................. A Repair bowel opening..... 22.59 NA 10.26 2.40 NA 35.25 090
44640... .................. A Repair bowel-skin fistula 14.83 NA 7.81 1.35 NA 23.99 090
44650... .................. A Repair bowel fistula..... 15.25 NA 7.97 1.46 NA 24.68 090
44660... .................. A Repair bowel-bladder 14.63 NA 7.85 1.21 NA 23.69 090
fistula.
44661... .................. A Repair bowel-bladder 16.99 NA 8.69 2.52 NA 28.20 090
fistula.
44680... .................. A Surgical revision, 13.72 NA 7.51 2.14 NA 23.37 090
intestine.
44700... .................. A Suspend bowel w/ 14.35 NA 7.86 2.40 NA 24.61 090
prosthesis.
44800... .................. A Excision of bowel pouch.. 11.23 NA 5.71 1.08 NA 18.02 090
44820... .................. A Excision of mesentery 10.31 NA 5.39 1.21 NA 16.91 090
lesion.
44850... .................. A Repair of mesentery...... 9.57 NA 5.09 1.18 NA 15.84 090
44900... .................. A Drain, app abscess, open. 8.82 NA 5.23 0.88 NA 14.93 090
44901... .................. A Drain, app abscess, perc. 3.38 NA 3.15 0.30 NA 6.83 000
44950... .................. A Appendectomy............. 8.70 NA 4.46 1.01 NA 14.17 090
44955... .................. A Appendectomy............. 1.53 NA 0.68 0.60 NA 2.81 ZZZ
44960... .................. A Appendectomy............. 10.74 NA 5.72 1.24 NA 17.70 090
45000... .................. A Drainage of pelvic 4.52 NA 3.28 0.24 NA 8.04 090
abscess.
45005... .................. A Drainage of rectal 1.99 2.91 1.24 0.21 5.11 3.44 010
abscess.
45020... .................. A Drainage of rectal 4.72 NA 3.18 0.51 NA 8.41 090
abscess.
45100... .................. A Biopsy of rectum......... 3.68 3.40 1.91 0.35 7.43 5.94 090
45108... .................. A Removal of anorectal 4.76 4.36 2.54 0.53 9.65 7.83 090
lesion.
45110... .................. A Removal of rectum........ 23.80 NA 11.87 3.43 NA 39.10 090
45111... .................. A Partial removal of rectum 16.48 NA 8.73 2.49 NA 27.70 090
45112... .................. A Removal of rectum........ 25.96 NA 12.03 3.36 NA 41.35 090
45113... .................. A Partial proctectomy...... 25.99 NA 12.33 3.36 NA 41.68 090
45114... .................. A Partial removal of rectum 23.22 NA 11.45 3.24 NA 37.91 090
45116... .................. A Partial removal of rectum 20.89 NA 10.07 2.34 NA 33.30 090
45119... .................. A Remove, rectum w/ 26.21 NA 12.12 3.36 NA 41.69 090
reservoir.
45120... .................. A Removal of rectum........ 24.60 NA 12.00 3.54 NA 40.14 090
45121... .................. A Removal of rectum and 27.04 NA 13.11 2.01 NA 42.16 090
colon.
45123... .................. A Partial proctectomy...... 14.20 NA 7.46 2.49 NA 24.15 090
45130... .................. A Excision of rectal 13.97 NA 6.51 1.79 NA 22.27 090
prolapse.
45135... .................. A Excision of rectal 16.39 NA 8.28 3.50 NA 28.17 090
prolapse.
45150... .................. A Excision of rectal 5.67 4.05 2.84 0.63 10.35 9.14 090
stricture.
45160... .................. A Excision of rectal lesion 13.02 NA 6.50 1.56 NA 21.08 090
45170... .................. A Excision of rectal lesion 9.77 NA 4.81 0.96 NA 15.54 090
45190... .................. A Destruction, rectal tumor 8.28 NA 4.15 1.06 NA 13.49 090
45300... .................. A Proctosigmoidoscopy...... 0.70 2.68 0.30 0.07 3.45 1.07 000
45303... .................. A Proctosigmoidoscopy...... 0.80 3.28 0.34 0.12 4.20 1.26 000
45305... .................. A Proctosigmoidoscopy; 1.01 2.65 0.42 0.14 3.80 1.57 000
biopsy.
45307... .................. A Proctosigmoidoscopy...... 1.71 3.54 0.60 0.18 5.43 2.49 000
45308... .................. A Proctosigmoidoscopy...... 1.51 2.24 0.62 0.20 3.95 2.33 000
45309... .................. A Proctosigmoidoscopy...... 2.01 3.03 0.81 0.20 5.24 3.02 000
45315... .................. A Proctosigmoidoscopy...... 2.54 3.79 1.00 0.18 6.51 3.72 000
45317... .................. A Proctosigmoidoscopy...... 2.73 2.62 1.06 0.19 5.54 3.98 000
45320... .................. A Proctosigmoidoscopy...... 2.88 2.85 1.13 0.34 6.07 4.35 000
45321... .................. A Proctosigmoidoscopy...... 2.12 NA 0.84 0.27 NA 3.23 000
45330... .................. A Sigmoidoscopy, diagnostic 0.96 3.42 0.38 0.12 4.50 1.46 000
[[Page 30944]]
45331... .................. A Sigmoidoscopy and biopsy. 1.26 3.44 0.49 0.15 4.85 1.90 000
45332... .................. A Sigmoidoscopy............ 1.96 4.71 0.75 0.16 6.83 2.87 000
45333... .................. A Sigmoidoscopy & 1.96 3.76 0.75 0.26 5.98 2.97 000
polypectomy.
45334... .................. A Sigmoidoscopy for 2.99 NA 1.11 0.23 NA 4.33 000
bleeding.
45337... .................. A Sigmoidoscopy, 2.36 NA 0.90 0.38 NA 3.64 000
decompression.
45338... .................. A Sigmoidoscopy............ 2.57 4.21 0.97 0.26 7.04 3.80 000
45339... .................. A Sigmoidoscopy............ 3.14 3.94 1.16 0.31 7.39 4.61 000
45355... .................. A Surgical colonoscopy..... 3.52 NA 1.71 0.10 NA 5.33 000
45378... .................. A Diagnostic colonoscopy... 3.70 4.29 1.97 0.39 8.38 6.06 000
45378... 53 A Diagnostic colonoscopy... 0.96 1.28 0.59 0.12 2.36 1.67 000
45379... .................. A Colonoscopy.............. 4.72 4.69 2.08 0.45 9.86 7.25 000
45380... .................. A Colonoscopy and biopsy... 4.01 4.37 1.74 0.40 8.78 6.15 000
45382... .................. A Colonoscopy,control 5.73 5.11 2.33 0.41 11.25 8.47 000
bleeding.
45383... .................. A Colonoscopy, lesion 5.87 5.21 2.42 0.50 11.58 8.79 000
removal.
45384... .................. A Colonoscopy.............. 4.70 4.73 2.01 0.58 10.01 7.29 000
45385... .................. A Colonoscopy, lesion 5.31 4.93 2.22 0.58 10.82 8.11 000
removal.
45500... .................. A Repair of rectum......... 7.29 NA 3.84 1.21 NA 12.34 090
45505... .................. A Repair of rectum......... 6.02 NA 3.05 1.23 NA 10.30 090
45520... .................. A Treatment of rectal 0.55 0.46 0.21 0.10 1.11 0.86 000
prolapse.
45540... .................. A Correct rectal prolapse.. 12.92 NA 6.63 2.10 NA 21.65 090
45541... .................. A Correct rectal prolapse.. 10.64 NA 5.55 2.04 NA 18.23 090
45550... .................. A Repair rectum; remove 18.26 NA 8.85 2.38 NA 29.49 090
sigmoid.
45560... .................. A Repair of rectocele...... 8.40 NA 4.94 0.98 NA 14.32 090
45562... .................. A Exploration/repair of 12.21 NA 6.07 1.58 NA 19.86 090
rectum.
45563... .................. A Exploration/repair of 18.63 NA 9.55 2.49 NA 30.67 090
rectum.
45800... .................. A Repair rectumbladder 14.11 NA 6.95 1.45 NA 22.51 090
fistula.
45805... .................. A Repair fistula; colostomy 16.50 NA 8.63 2.39 NA 27.52 090
45820... .................. A Repair rectourethral 14.67 NA 7.07 1.23 NA 22.97 090
fistula.
45825... .................. A Repair fistula; colostomy 16.87 NA 9.22 1.66 NA 27.75 090
45900... .................. A Reduction of rectal 1.83 NA 0.96 0.11 NA 2.90 010
prolapse.
45905... .................. A Dilation of anal 1.61 1.75 0.78 0.12 3.48 2.51 010
sphincter.
45910... .................. A Dilation of rectal 1.96 2.25 0.92 0.13 4.34 3.01 010
narrowing.
45915... .................. A Remove rectal obstruction 2.20 2.70 0.92 0.09 4.99 3.21 010
46030... .................. A Removal of rectal marker. 1.23 1.57 0.93 0.07 2.87 2.23 010
46040... .................. A Incision of rectal 4.96 3.80 2.63 0.34 9.10 7.93 090
abscess.
46045... .................. A Incision of rectal 4.32 NA 2.35 0.38 NA 7.05 090
abscess.
46050... .................. A Incision of anal abscess. 1.19 2.11 0.91 0.11 3.41 2.21 010
46060... .................. A Incision of rectal 5.69 NA 3.10 1.12 NA 9.91 090
abscess.
46070... .................. A Incision of anal septum.. 2.71 NA 5.74 0.33 NA 8.78 090
46080... .................. A Incision of anal 2.49 2.33 1.43 0.43 5.25 4.35 010
sphincter.
46083... .................. A Incise external 1.40 2.90 0.98 0.08 4.38 2.46 010
hemorrhoid.
46200... .................. A Removal of anal fissure.. 3.42 2.53 1.97 0.66 6.61 6.05 090
46210... .................. A Removal of anal crypt.... 2.67 3.28 1.65 0.14 6.09 4.46 090
46211... .................. A Removal of anal crypts... 4.25 3.26 2.29 0.38 7.89 6.92 090
46220... .................. A Removal of anal tab...... 1.56 0.99 0.60 0.12 2.67 2.28 010
46221... .................. A Ligation of hemorrhoid(s) 1.43 1.81 0.55 0.14 3.38 2.12 010
46230... .................. A Removal of anal tabs..... 2.57 2.78 1.48 0.12 5.47 4.17 010
46250... .................. A Hemorrhoidectomy......... 4.53 3.80 2.48 0.52 8.85 7.53 090
46255... .................. A Hemorrhoidectomy......... 5.36 4.10 2.83 0.85 10.31 9.04 090
46257... .................. A Remove hemorrhoids & 6.28 NA 3.16 1.08 NA 10.52 090
fissure.
46258... .................. A Remove hemorrhoids & 6.67 NA 3.35 1.22 NA 11.24 090
fistula.
46260... .................. A Hemorrhoidectomy......... 7.42 NA 3.78 1.25 NA 12.45 090
46261... .................. A Remove hemorrhoids & 8.24 NA 4.05 1.34 NA 13.63 090
fissure.
46262... .................. A Remove hemorrhoids & 8.73 NA 4.31 1.39 NA 14.43 090
fistula.
46270... .................. A Removal of anal fistula.. 3.72 3.41 2.13 0.37 7.50 6.22 090
46275... .................. A Removal of anal fistula.. 4.56 3.52 2.42 1.13 9.21 8.11 090
46280... .................. A Removal of anal fistula.. 5.98 NA 3.23 1.24 NA 10.45 090
46285... .................. A Removal of anal fistula.. 4.09 2.52 2.21 0.43 7.04 6.73 090
46288... .................. A Repair anal fistula...... 7.13 NA 3.27 0.83 NA 11.23 090
46320... .................. A Removal of hemorrhoid 1.61 2.39 0.98 0.11 4.11 2.70 010
clot.
46500... .................. A Injection into 1.61 1.56 0.60 0.06 3.23 2.27 010
hemorrhoids.
46600... .................. A Diagnostic anoscopy...... 0.50 0.56 0.14 0.03 1.09 0.67 000
46604... .................. A Anoscopy and dilation.... 1.31 0.77 0.49 0.06 2.14 1.86 000
46606... .................. A Anoscopy and biopsy...... 0.81 0.64 0.31 0.06 1.51 1.18 000
46608... .................. A Anoscopy; remove foreign 1.51 1.34 0.39 0.12 2.97 2.02 000
body.
46610... .................. A Anoscopy; remove lesion.. 1.32 1.12 0.51 0.15 2.59 1.98 000
46611... .................. A Anoscopy................. 1.81 1.45 0.70 0.15 3.41 2.66 000
46612... .................. A Anoscopy; remove lesions. 2.34 1.66 0.87 0.20 4.20 3.41 000
46614... .................. A Anoscopy; control 2.01 1.26 0.73 0.25 3.52 2.99 000
bleeding.
46615... .................. A Anoscopy................. 2.68 1.47 1.03 0.25 4.40 3.96 000
46700... .................. A Repair of anal stricture. 7.25 NA 3.64 1.24 NA 12.13 090
46705... .................. A Repair of anal stricture. 7.17 NA 3.84 0.77 NA 11.78 090
46715... .................. A Repair of anovaginal 7.46 NA 5.30 0.82 NA 13.58 090
fistula.
46716... .................. A Repair of anovaginal 12.15 NA 18.73 1.40 NA 32.28 090
fistula.
[[Page 30945]]
46730... .................. A Construction of absent 21.57 NA 10.64 2.50 NA 34.71 090
anus.
46735... .................. A Construction of absent 25.94 NA 12.05 3.04 NA 41.03 090
anus.
46740... .................. A Construction of absent 23.11 NA 10.68 2.68 NA 36.47 090
anus.
46742... .................. A Repair, imperforated anus 29.67 NA 40.97 1.93 NA 72.57 090
46744... .................. A Repair, cloacal anomaly.. 33.21 NA 15.40 2.17 NA 50.78 090
46746... .................. A Repair, cloacal anomaly.. 36.74 NA 16.73 2.37 NA 55.84 090
46748... .................. A Repair, cloacal anomaly.. 40.52 NA 53.98 2.64 NA 97.14 090
46750... .................. A Repair of anal sphincter. 8.14 NA 4.39 1.22 NA 13.75 090
46751... .................. A Repair of anal sphincter. 8.56 NA 13.65 0.95 NA 23.16 090
46753... .................. A Reconstruction of anus... 6.58 NA 3.24 1.02 NA 10.84 090
46754... .................. A Removal of suture from 1.54 2.74 1.09 0.30 4.58 2.93 010
anus.
46760... .................. A Repair of anal sphincter. 11.46 NA 6.44 1.41 NA 19.31 090
46761... .................. A Repair of anal sphincter. 10.99 NA 5.26 1.35 NA 17.60 090
46762... .................. A Implant artificial 10.09 NA 5.03 1.21 NA 16.33 090
sphincter.
46900... .................. A Destruction, anal 1.91 2.68 1.27 0.06 4.65 3.24 010
lesion(s).
46910... .................. A Destruction, anal 1.86 2.22 1.27 0.08 4.16 3.21 010
lesion(s).
46916... .................. A Cryosurgery, anal 1.86 2.01 1.33 0.06 3.93 3.25 010
lesion(s).
46917... .................. A Laser surgery,anal 1.86 2.27 1.37 0.31 4.44 3.54 010
lesion(s).
46922... .................. A Excision of anal 1.86 2.25 1.26 0.23 4.34 3.35 010
lesion(s).
46924... .................. A Destruction, anal 2.76 2.99 1.63 0.46 6.21 4.85 010
lesion(s).
46934... .................. A Destruction of 4.08 3.64 2.61 0.17 7.89 6.86 090
hemorrhoids.
46935... .................. A Destruction of 2.43 4.73 1.60 0.22 7.38 4.25 010
hemorrhoids.
46936... .................. A Destruction of 4.30 3.45 2.70 0.24 7.99 7.24 090
hemorrhoids.
46937... .................. A Cryotherapy of rectal 2.69 2.73 1.54 0.45 5.87 4.68 010
lesion.
46938... .................. A Cryotherapy of rectal 4.66 4.51 2.99 0.52 9.69 8.17 090
lesion.
46940... .................. A Treatment of anal fissure 2.32 2.58 1.20 0.09 4.99 3.61 010
46942... .................. A Treatment of anal fissure 2.04 2.01 1.19 0.08 4.13 3.31 010
46945... .................. A Ligation of hemorrhoids.. 2.14 2.53 1.51 0.12 4.79 3.77 090
46946... .................. A Ligation of hemorrhoids.. 3.00 2.59 1.88 0.17 5.76 5.05 090
47000... .................. A Needle biopsy of liver... 1.90 5.71 1.13 0.13 7.74 3.16 000
47001... .................. A Needle biopsy, liver..... 1.90 NA 0.83 0.13 NA 2.86 ZZZ
47010... .................. A Open drainage, liver 10.28 NA 7.53 1.13 NA 18.94 090
lesion.
47011... .................. A Percut drain, liver 3.70 NA 5.32 0.33 NA 9.35 000
lesion.
47015... .................. A Inject/aspirate liver 9.70 NA 5.97 1.13 NA 16.80 090
cyst.
47100... .................. A Wedge biopsy of liver.... 7.49 NA 4.54 0.67 NA 12.70 090
47120... .................. A Partial removal of liver. 22.79 NA 12.14 2.48 NA 37.41 090
47122... .................. A Extensive removal of 35.39 NA 18.09 3.59 NA 57.07 090
liver.
47125... .................. A Partial removal of liver. 31.58 NA 15.94 3.61 NA 51.13 090
47130... .................. A Partial removal of liver. 34.25 NA 17.15 3.89 NA 55.29 090
47134... .................. R Partial removal, donor 39.15 NA 16.42 4.77 NA 60.34 XXX
liver.
47135... .................. R Transplantation of liver. 81.52 NA 42.58 8.49 NA 132.59 090
47136... .................. R Transplantation of liver. 68.60 NA 114.97 7.79 NA 191.36 090
47300... .................. A Surgery for liver lesion. 9.68 NA 5.76 1.59 NA 17.03 090
47350... .................. A Repair liver wound....... 12.56 NA 6.72 1.49 NA 20.77 090
47360... .................. A Repair liver wound....... 17.28 NA 9.73 2.18 NA 29.19 090
47361... .................. A Repair liver wound....... 30.25 NA 14.34 3.41 NA 48.00 090
47362... .................. A Repair liver wound....... 11.88 NA 7.38 1.22 NA 20.48 090
47400... .................. A Incision of liver duct... 20.86 NA 10.76 1.36 NA 32.98 090
47420... .................. A Incision of bile duct.... 16.72 NA 8.61 1.99 NA 27.32 090
47425... .................. A Incision of bile duct.... 16.68 NA 8.96 2.45 NA 28.09 090
47460... .................. A Incise bile duct 15.17 NA 8.18 1.82 NA 25.17 090
sphincter.
47480... .................. A Incision of gallbladder.. 9.10 NA 5.82 1.59 NA 16.51 090
47490... .................. A Incision of gallbladder.. 7.23 NA 6.73 0.38 NA 14.34 090
47500... .................. A Injection for liver x- 1.96 NA 0.62 0.14 NA 2.72 000
rays.
47505... .................. A Injection for liver x- 0.76 7.82 0.24 0.14 8.72 1.14 000
rays.
47510... .................. A Insert catheter, bile 7.83 NA 22.22 0.25 NA 30.30 090
duct.
47511... .................. A Insert bile duct drain... 10.50 NA 23.45 0.25 NA 34.20 090
47525... .................. A Change bile duct catheter 5.55 NA 3.18 0.16 NA 8.89 010
47530... .................. A Revise, reinsert bile 5.85 NA 4.65 0.19 NA 10.69 090
tube.
47550... .................. A Bile duct endoscopy...... 3.02 NA 1.28 0.35 NA 4.65 000
47552... .................. A Biliary endoscopy, thru 6.04 NA 2.34 0.21 NA 8.59 000
skin.
47553... .................. A Biliary endoscopy, thru 6.35 NA 2.27 0.62 NA 9.24 000
skin.
47554... .................. A Biliary endoscopy, thru 9.06 NA 3.49 0.67 NA 13.22 000
skin.
47555... .................. A Biliary endoscopy, thru 7.56 NA 2.65 0.30 NA 10.51 000
skin.
47556... .................. A Biliary endoscopy, thru 8.56 NA 2.96 0.30 NA 11.82 000
skin.
47600... .................. A Removal of gallbladder... 11.42 NA 6.00 1.58 NA 19.00 090
47605... .................. A Removal of gallbladder... 12.36 NA 6.40 1.75 NA 20.51 090
47610... .................. A Removal of gallbladder... 15.83 NA 8.09 2.00 NA 25.92 090
47612... .................. A Removal of gallbladder... 15.80 NA 8.17 3.05 NA 27.02 090
47620... .................. A Removal of gallbladder... 17.36 NA 8.97 2.36 NA 28.69 090
47630... .................. A Remove bile duct stone... 9.11 NA 3.49 0.40 NA 13.00 090
47700... .................. A Exploration of bile ducts 14.93 NA 8.10 1.58 NA 24.61 090
47701... .................. A Bile duct revision....... 27.81 NA 13.96 1.90 NA 43.67 090
47711... .................. A Excision of bile duct 19.37 NA 10.08 2.46 NA 31.91 090
tumor.
[[Page 30946]]
47712... .................. A Excision of bile duct 25.44 NA 12.63 2.46 NA 40.53 090
tumor.
47715... .................. A Excision of bile duct 15.81 NA 8.45 1.71 NA 25.97 090
cyst.
47716... .................. A Fusion of bile duct cyst. 13.83 NA 7.61 1.53 NA 22.97 090
47720... .................. A Fuse gallbladder & bowel. 13.38 NA 7.30 1.93 NA 22.61 090
47721... .................. A Fuse upper gi structures. 16.08 NA 8.50 2.47 NA 27.05 090
47740... .................. A Fuse gallbladder & bowel. 15.54 NA 8.29 2.14 NA 25.97 090
47741... .................. A Fuse gallbladder & bowel. 17.95 NA 9.30 3.02 NA 30.27 090
47760... .................. A Fuse bile ducts and bowel 21.74 NA 10.76 2.53 NA 35.03 090
47765... .................. A Fuse liver ducts & bowel. 20.93 NA 11.52 2.97 NA 35.42 090
47780... .................. A Fuse bile ducts and bowel 22.29 NA 11.27 2.73 NA 36.29 090
47785... .................. A Fuse bile ducts and bowel 26.23 NA 13.50 2.73 NA 42.46 090
47800... .................. A Reconstruction of bile 19.60 NA 10.14 2.43 NA 32.17 090
ducts.
47801... .................. A Placement, bile duct 12.76 NA 8.03 0.81 NA 21.60 090
support.
47802... .................. A Fuse liver duct & 18.13 NA 9.88 1.75 NA 29.76 090
intestine.
47900... .................. A Suture bile duct injury.. 16.74 NA 8.87 2.43 NA 28.04 090
48000... .................. A Drainage of abdomen...... 14.91 NA 8.86 1.40 NA 25.17 090
48001... .................. A Placement of drain, 18.83 NA 10.21 1.89 NA 30.93 090
pancreas.
48005... .................. A Resect/debride pancreas.. 22.40 NA 11.28 2.14 NA 35.82 090
48020... .................. A Removal of pancreatic 14.22 NA 7.80 1.57 NA 23.59 090
stone.
48100... .................. A Biopsy of pancreas....... 11.08 NA 6.06 0.79 NA 17.93 090
48102... .................. A Needle biopsy, pancreas.. 4.68 5.97 2.73 0.25 10.90 7.66 010
48120... .................. A Removal of pancreas 14.36 NA 7.39 2.07 NA 23.82 090
lesion.
48140... .................. A Partial removal of 20.78 NA 10.31 2.83 NA 33.92 090
pancreas.
48145... .................. A Partial removal of 21.76 NA 11.16 3.16 NA 36.08 090
pancreas.
48146... .................. A Pancreatectomy........... 23.91 NA 12.87 1.92 NA 38.70 090
48148... .................. A Removal of pancreatic 15.71 NA 8.32 1.68 NA 25.71 090
duct.
48150... .................. A Partial removal of 43.48 NA 21.74 4.75 NA 69.97 090
pancreas.
48152... .................. A Pancreatectomy........... 39.63 NA 19.76 4.75 NA 64.14 090
48153... .................. A Pancreatectomy........... 43.38 NA 21.70 4.75 NA 69.83 090
48154... .................. A Pancreatectomy........... 39.95 NA 20.03 4.75 NA 64.73 090
48155... .................. A Removal of pancreas...... 22.32 NA 13.03 4.26 NA 39.61 090
48180... .................. A Fuse pancreas and bowel.. 22.39 NA 11.09 2.63 NA 36.11 090
48400... .................. A Injection, intraoperative 1.95 NA 0.77 0.24 NA 2.96 ZZZ
48500... .................. A Surgery of pancreas cyst. 13.84 NA 7.20 1.66 NA 22.70 090
48510... .................. A Drain pancreatic 12.96 NA 7.51 1.44 NA 21.91 090
pseudocyst.
48511... .................. A Drain pancreatic 4.00 NA 4.36 0.35 NA 8.71 000
pseudocyst.
48520... .................. A Fuse pancreas cyst and 14.12 NA 7.23 2.43 NA 23.78 090
bowel.
48540... .................. A Fuse pancreas cyst and 17.86 NA 8.85 2.65 NA 29.36 090
bowel.
48545... .................. A Pancreatorrhaphy......... 16.47 NA 8.38 1.79 NA 26.64 090
48547... .................. A Duodenal exclusion....... 23.40 NA 11.06 2.58 NA 37.04 090
48554... .................. N Transplantallograft +34.17 NA 57.19 4.16 NA 95.52 XXX
pancreas.
48556... .................. A Removal, allograft 15.71 NA 8.69 1.69 NA 26.09 090
pancreas.
49000... .................. A Exploration of abdomen... 11.68 NA 5.90 1.40 NA 18.98 090
49002... .................. A Reopening of abdomen..... 10.49 NA 5.84 1.21 NA 17.54 090
49010... .................. A Exploration behind 12.28 NA 6.40 1.31 NA 19.99 090
abdomen.
49020... .................. A Drain abdominal abscess.. 16.79 NA 9.55 0.91 NA 27.25 090
49021... .................. A Drain abdominal abscess.. 3.38 NA 4.88 0.91 NA 9.17 000
49040... .................. A Open drainage abdom 9.94 NA 6.91 1.27 NA 18.12 090
abscess.
49041... .................. A Percut drain abdom 4.00 NA 4.79 0.35 NA 9.14 000
abscess.
49060... .................. A Open drain retroper 11.66 NA 7.71 1.01 NA 20.38 090
abscess.
49061... .................. A Percutdrain retroper 3.70 NA 5.01 0.33 NA 9.04 000
abscess.
49062... .................. A Drain to peritoneal 11.36 NA 6.59 0.79 NA 18.74 090
cavity.
49080... .................. A Puncture, peritoneal 1.35 1.86 0.65 0.08 3.29 2.08 000
cavity.
49081... .................. A Removal of abdominal 1.26 2.12 0.61 0.07 3.45 1.94 000
fluid.
49085... .................. A Remove abdomen foreign 8.93 NA 5.02 0.67 NA 14.62 090
body.
49180... .................. A Biopsy, abdominal mass... 1.73 4.35 1.34 0.20 6.28 3.27 000
49200... .................. A Removal of abdominal 10.25 NA 5.98 1.70 NA 17.93 090
lesion.
49201... .................. A Removal of abdominal 14.84 NA 8.52 2.50 NA 25.86 090
lesion.
49215... .................. A Excise sacral spine tumor 22.36 NA 11.08 1.59 NA 35.03 090
49220... .................. A Multiple surgery, abdomen 14.88 NA 7.86 2.53 NA 25.27 090
49250... .................. A Excision of umbilicus.... 8.35 NA 4.41 0.96 NA 13.72 090
49255... .................. A Removal of omentum....... 11.14 NA 6.40 1.15 NA 18.69 090
49400... .................. A Air injection into 1.88 NA 0.87 0.17 NA 2.92 000
abdomen.
49420... .................. A Insert abdominal drain... 2.22 NA 1.20 0.20 NA 3.62 000
49421... .................. A Insert abdominal drain... 5.54 NA 3.52 0.81 NA 9.87 090
49422... .................. A Remove perm cannula/ 6.25 NA 3.03 0.81 NA 10.09 010
catheter.
49423... .................. A Exchange drainage cath... 1.46 NA 2.00 0.13 NA 3.59 000
49424... .................. A Assess cyst, contrast inj 0.76 NA 1.30 0.07 NA 2.13 000
49425... .................. A Insert abdomen-venous 11.37 NA 6.08 1.78 NA 19.23 090
drain.
49426... .................. A Revise abdomen-venous 9.63 NA 5.42 1.07 NA 16.12 090
shunt.
49427... .................. A Injection, abdominal 0.89 NA 0.56 0.03 NA 1.48 000
shunt.
49428... .................. A Ligation of shunt........ 2.38 NA 1.42 0.24 NA 4.04 010
49429... .................. A Removal of shunt......... 7.40 NA 4.02 0.77 NA 12.19 010
49495... .................. A Repair inguinal hernia, 5.89 NA 3.06 0.95 NA 9.90 090
init.
[[Page 30947]]
49496... .................. A Repair inguinal hernia, 8.79 NA 5.33 1.08 NA 15.20 090
init.
49500... .................. A Repair inguinal hernia... 4.68 NA 2.69 0.95 NA 8.32 090
49501... .................. A Repair inguinal hernia, 7.58 NA 3.84 1.08 NA 12.50 090
init.
49505... .................. A Repair inguinal hernia... 6.49 3.34 4.15 0.94 10.77 11.58 090
49507... .................. A Repair, inguinal hernia.. 8.17 NA 4.80 1.08 NA 14.05 090
49520... .................. A Rerepair inguinal hernia. 8.22 NA 4.39 1.11 NA 13.72 090
49521... .................. A Repair inguinal hernia, 10.22 NA 5.10 1.08 NA 16.40 090
rec.
49525... .................. A Repair inguinal hernia... 7.32 NA 3.91 1.16 NA 12.39 090
49540... .................. A Repair lumbar hernia..... 8.87 NA 4.66 1.12 NA 14.65 090
49550... .................. A Repair femoral hernia.... 7.37 NA 3.70 0.97 NA 12.04 090
49553... .................. A Repair femoral hernia, 8.06 NA 4.29 0.97 NA 13.32 090
init.
49555... .................. A Repair femoral hernia.... 7.71 NA 4.25 1.26 NA 13.22 090
49557... .................. A Repair femoral hernia, 9.52 NA 4.85 1.26 NA 15.63 090
recur.
49560... .................. A Repair abdominal hernia.. 9.88 NA 5.05 1.19 NA 16.12 090
49561... .................. A Repair incisional hernia. 12.17 NA 5.94 1.19 NA 19.30 090
49565... .................. A Rerepair abdominal hernia 9.88 NA 5.28 1.35 NA 16.51 090
49566... .................. A Repair incisional hernia. 12.30 NA 6.02 1.35 NA 19.67 090
49568... .................. A Hernia repair w/mesh..... 4.89 NA 2.07 0.59 NA 7.55 ZZZ
49570... .................. A Repair epigastric hernia. 4.86 NA 2.74 0.91 NA 8.51 090
49572... .................. A Repair, epigastric hernia 5.75 NA 3.43 1.18 NA 10.36 090
49580... .................. A Repair umbilical hernia.. 3.51 NA 2.17 0.94 NA 6.62 090
49582... .................. A Repair umbilical hernia.. 5.68 NA 3.63 0.94 NA 10.25 090
49585... .................. A Repair umbilical hernia.. 5.32 NA 3.10 0.91 NA 9.33 090
49587... .................. A Repair umbilical hernia.. 6.46 NA 3.65 0.91 NA 11.02 090
49590... .................. A Repair abdominal hernia.. 7.29 NA 3.84 1.22 NA 12.35 090
49600... .................. A Repair umbilical lesion.. 10.35 NA 5.21 0.77 NA 16.33 090
49605... .................. A Repair umbilical lesion.. 22.66 NA 11.17 1.77 NA 35.60 090
49606... .................. A Repair umbilical lesion.. 18.60 NA 9.65 0.96 NA 29.21 090
49610... .................. A Repair umbilical lesion.. 10.50 NA 6.60 1.27 NA 18.37 090
49611... .................. A Repair umbilical lesion.. 8.92 NA 16.34 0.58 NA 25.84 090
49900... .................. A Repair of abdominal wall. 12.28 NA 6.58 0.75 NA 19.61 090
49905... .................. A Omental flap............. 6.55 NA 3.08 0.80 NA 10.43 ZZZ
50010... .................. A Exploration of kidney.... 10.98 NA 6.07 1.13 NA 18.18 090
50020... .................. A Open drain renal abscess. 14.66 NA 9.96 0.85 NA 25.47 090
50021... .................. A Percut drain renal 3.38 NA 6.17 0.30 NA 9.85 000
abscess.
50040... .................. A Drainage of kidney....... 14.94 NA 9.11 0.62 NA 24.67 090
50045... .................. A Exploration of kidney.... 15.46 NA 7.78 0.89 NA 24.13 090
50060... .................. A Removal of kidney stone.. 19.30 NA 9.20 1.21 NA 29.71 090
50065... .................. A Incision of kidney....... 20.79 NA 9.81 1.35 NA 31.95 090
50070... .................. A Incision of kidney....... 20.32 NA 9.58 1.35 NA 31.25 090
50075... .................. A Removal of kidney stone.. 25.34 NA 11.74 1.62 NA 38.70 090
50080... .................. A Removal of kidney stone.. 14.71 NA 9.10 1.15 NA 24.96 090
50081... .................. A Removal of kidney stone.. 21.80 NA 11.69 1.44 NA 34.93 090
50100... .................. A Revise kidney blood 16.09 NA 8.58 1.35 NA 26.02 090
vessels.
50120... .................. A Exploration of kidney.... 15.91 NA 8.00 1.24 NA 25.15 090
50125... .................. A Explore and drain kidney. 16.52 NA 8.02 1.06 NA 25.60 090
50130... .................. A Removal of kidney stone.. 17.29 NA 8.46 1.26 NA 27.01 090
50135... .................. A Exploration of kidney.... 19.18 NA 9.18 1.63 NA 29.99 090
50200... .................. A Biopsy of kidney......... 2.63 NA 1.25 0.22 NA 4.10 000
50205... .................. A Biopsy of kidney......... 11.31 NA 5.98 0.69 NA 17.98 090
50220... .................. A Removal of kidney........ 17.15 NA 8.40 1.43 NA 26.98 090
50225... .................. A Removal of kidney........ 20.23 NA 9.58 1.70 NA 31.51 090
50230... .................. A Removal of kidney........ 22.07 NA 10.27 1.84 NA 34.18 090
50234... .................. A Removal of kidney & 22.40 NA 10.39 1.65 NA 34.44 090
ureter.
50236... .................. A Removal of kidney & 24.86 NA 12.78 1.74 NA 39.38 090
ureter.
50240... .................. A Partial removal of kidney 22.00 NA 11.71 1.70 NA 35.41 090
50280... .................. A Removal of kidney lesion. 15.67 NA 7.84 1.16 NA 24.67 090
50290... .................. A Removal of kidney lesion. 14.73 NA 7.26 1.19 NA 23.18 090
50320... .................. A Removal of donor kidney.. 22.21 NA 10.23 2.40 NA 34.84 090
50340... .................. A Removal of kidney........ 12.15 NA 5.67 2.24 NA 20.06 090
50360... .................. A Transplantation of kidney 31.53 NA 16.90 4.24 NA 52.67 090
50365... .................. A Transplantation of kidney 36.81 NA 19.94 3.89 NA 60.64 090
50370... .................. A Remove transplanted 13.72 NA 8.02 1.92 NA 23.66 090
kidney.
50380... .................. A Reimplantation of kidney. 20.76 NA 12.25 1.71 NA 34.72 090
50390... .................. A Drainage of kidney lesion 1.96 NA 1.18 0.15 NA 3.29 000
50392... .................. A Insert kidney drain...... 3.38 NA 1.63 0.20 NA 5.21 000
50393... .................. A Insert ureteral tube..... 4.16 NA 1.87 0.26 NA 6.29 000
50394... .................. A Injection for kidney x- 0.76 10.57 0.24 0.05 11.38 1.05 000
ray.
50395... .................. A Create passage to kidney. 3.38 NA 1.61 0.29 NA 5.28 000
50396... .................. A Measure kidney pressure.. 2.09 NA 0.76 0.05 NA 2.90 000
50398... .................. A Change kidney tube....... 1.46 0.79 1.66 0.05 2.30 3.17 000
50400... .................. A Revision of kidney/ureter 19.50 NA 9.32 1.36 NA 30.18 090
50405... .................. A Revision of kidney/ureter 23.93 NA 12.08 1.74 NA 37.75 090
50500... .................. A Repair of kidney wound... 19.57 NA 9.85 1.64 NA 31.06 090
[[Page 30948]]
50520... .................. A Close kidney-skin fistula 17.23 NA 9.54 1.50 NA 28.27 090
50525... .................. A Repair renal-abdomen 22.27 NA 11.53 1.99 NA 35.79 090
fistula.
50526... .................. A Repair renal-abdomen 24.02 NA 19.58 2.32 NA 45.92 090
fistula.
50540... .................. A Revision of horseshoe 19.93 NA 8.91 1.54 NA 30.38 090
kidney.
50551... .................. A Kidney endoscopy......... 5.60 3.89 2.30 0.21 9.70 8.11 000
50553... .................. A Kidney endoscopy......... 5.99 13.31 2.48 0.17 19.47 8.64 000
50555... .................. A Kidney endoscopy & biopsy 6.53 14.10 2.65 0.45 21.08 9.63 000
50557... .................. A Kidney endoscopy & 6.62 14.38 2.68 0.49 21.49 9.79 000
treatment.
50559... .................. A Renal endoscopy; 6.78 NA 2.74 0.14 NA 9.66 000
radiotracer.
50561... .................. A Kidney endoscopy & 7.59 12.38 3.03 0.49 20.46 11.11 000
treatment.
50570... .................. A Kidney endoscopy......... 9.54 NA 3.77 0.14 NA 13.45 000
50572... .................. A Kidney endoscopy......... 10.35 NA 4.03 0.75 NA 15.13 000
50574... .................. A Kidney endoscopy & biopsy 11.02 NA 4.36 0.64 NA 16.02 000
50575... .................. A Kidney endoscopy......... 13.98 NA 5.42 0.97 NA 20.37 000
50576... .................. A Kidney endoscopy & 10.99 NA 4.32 0.77 NA 16.08 000
treatment.
50578... .................. A Renal endoscopy; 11.35 NA 4.44 1.19 NA 16.98 000
radiotracer.
50580... .................. A Kidney endoscopy & 11.86 NA 4.62 0.35 NA 16.83 000
treatment.
50590... .................. A Fragmenting of kidney 9.09 4.97 6.03 0.97 15.03 16.09 090
stone.
50600... .................. A Exploration of ureter.... 15.84 NA 7.94 1.01 NA 24.79 090
50605... .................. A Insert ureteral support.. 15.46 NA 7.72 0.60 NA 23.78 090
50610... .................. A Removal of ureter stone.. 15.92 NA 8.07 1.17 NA 25.16 090
50620... .................. A Removal of ureter stone.. 15.16 NA 7.61 1.16 NA 23.93 090
50630... .................. A Removal of ureter stone.. 14.94 NA 7.56 1.25 NA 23.75 090
50650... .................. A Removal of ureter........ 17.41 NA 8.64 1.21 NA 27.26 090
50660... .................. A Removal of ureter........ 19.55 NA 9.48 1.53 NA 30.56 090
50684... .................. A Injection for ureter x- 0.76 10.95 0.27 0.05 11.76 1.08 000
ray.
50686... .................. A Measure ureter pressure.. 1.51 3.50 0.58 0.04 5.05 2.13 000
50688... .................. A Change of ureter tube.... 1.17 NA 1.59 0.04 NA 2.80 010
50690... .................. A Injection for ureter x- 1.16 12.38 0.38 0.03 13.57 1.57 000
ray.
50700... .................. A Revision of ureter....... 15.21 NA 7.72 1.29 NA 24.22 090
50715... .................. A Release of ureter........ 18.90 NA 10.01 1.49 NA 30.40 090
50722... .................. A Release of ureter........ 16.35 NA 8.95 1.97 NA 27.27 090
50725... .................. A Release/revise ureter.... 18.49 NA 9.15 1.75 NA 29.39 090
50727... .................. A Revise ureter............ 8.18 NA 5.20 0.51 NA 13.89 090
50728... .................. A Revise ureter............ 12.02 NA 6.78 0.77 NA 19.57 090
50740... .................. A Fusion of ureter & kidney 18.42 NA 8.77 1.88 NA 29.07 090
50750... .................. A Fusion of ureter & kidney 19.51 NA 9.57 1.26 NA 30.34 090
50760... .................. A Fusion of ureters........ 18.42 NA 9.00 1.48 NA 28.90 090
50770... .................. A Splicing of ureters...... 19.51 NA 9.41 1.53 NA 30.45 090
50780... .................. A Reimplant ureter in 18.36 NA 9.00 1.46 NA 28.82 090
bladder.
50782... .................. A Reimplant ureter in 19.54 NA 9.60 1.46 NA 30.60 090
bladder.
50783... .................. A Reimplant ureter in 20.55 NA 10.09 1.46 NA 32.10 090
bladder.
50785... .................. A Reimplant ureter in 20.52 NA 9.83 1.80 NA 32.15 090
bladder.
50800... .................. A Implant ureter in bowel.. 14.52 NA 8.21 1.51 NA 24.24 090
50810... .................. A Fusion of ureter & bowel. 20.05 NA 10.52 1.75 NA 32.32 090
50815... .................. A Urine shunt to bowel..... 19.93 NA 10.42 2.75 NA 33.10 090
50820... .................. A Construct bowel bladder.. 21.89 NA 10.95 2.50 NA 35.34 090
50825... .................. A Construct bowel bladder.. 28.18 NA 13.66 3.33 NA 45.17 090
50830... .................. A Revise urine flow........ 31.28 NA 14.49 2.27 NA 48.04 090
50840... .................. A Replace ureter by bowel.. 20.00 NA 10.26 1.35 NA 31.61 090
50845... .................. A Appendico-vesicostomy.... 20.89 NA 10.44 1.35 NA 32.68 090
50860... .................. A Transplant ureter to skin 15.36 NA 7.87 1.16 NA 24.39 090
50900... .................. A Repair of ureter......... 13.62 NA 6.95 1.15 NA 21.72 090
50920... .................. A Closure ureter/skin 14.33 NA 7.26 0.99 NA 22.58 090
fistula.
50930... .................. A Closure ureter/bowel 18.72 NA 8.90 1.22 NA 28.84 090
fistula.
50940... .................. A Release of ureter........ 14.51 NA 7.41 0.95 NA 22.87 090
50951... .................. A Endoscopy of ureter...... 5.84 4.15 2.39 0.17 10.16 8.40 000
50953... .................. A Endoscopy of ureter...... 6.24 13.47 2.55 0.16 19.87 8.95 000
50955... .................. A Ureter endoscopy & biopsy 6.75 14.05 2.72 0.25 21.05 9.72 000
50957... .................. A Ureter endoscopy & 6.79 10.33 2.92 0.25 17.37 9.96 000
treatment.
50959... .................. A Ureter endoscopy & tracer 4.40 NA 1.85 0.29 NA 6.54 000
50961... .................. A Ureter endoscopy & 6.05 16.81 2.43 0.26 23.12 8.74 000
treatment.
50970... .................. A Ureter endoscopy......... 7.14 NA 2.87 0.52 NA 10.53 000
50972... .................. A Ureter endoscopy & 6.89 NA 2.81 0.16 NA 9.86 000
catheter.
50974... .................. A Ureter endoscopy & biopsy 9.17 NA 3.62 0.65 NA 13.44 000
50976... .................. A Ureter endoscopy & 9.04 NA 3.60 0.62 NA 13.26 000
treatment.
50978... .................. A Ureter endoscopy & tracer 5.10 NA 2.26 0.48 NA 7.84 000
50980... .................. A Ureter endoscopy & 6.85 NA 2.77 0.30 NA 9.92 000
treatment.
51000... .................. A Drainage of bladder...... 0.78 1.24 0.53 0.05 2.07 1.36 000
51005... .................. A Drainage of bladder...... 1.02 2.05 0.58 0.04 3.11 1.64 000
51010... .................. A Drainage of bladder...... 3.53 5.13 1.95 0.11 8.77 5.59 010
51020... .................. A Incise & treat bladder... 6.71 NA 4.46 0.71 NA 11.88 090
51030... .................. A Incise & treat bladder... 6.77 NA 4.77 0.43 NA 11.97 090
51040... .................. A Incise & drain bladder... 4.40 NA 3.41 0.75 NA 8.56 090
[[Page 30949]]
51045... .................. A Incise bladder, drain 6.77 NA 4.53 0.50 NA 11.80 090
ureter.
51050... .................. A Removal of bladder stone. 6.92 NA 4.31 0.70 NA 11.93 090
51060... .................. A Removal of ureter stone.. 8.85 NA 5.28 1.19 NA 15.32 090
51065... .................. A Removal of ureter stone.. 8.85 NA 5.25 0.71 NA 14.81 090
51080... .................. A Drainage of bladder 5.96 NA 4.24 0.57 NA 10.77 090
abscess.
51500... .................. A Removal of bladder cyst.. 10.14 NA 4.05 1.21 NA 15.40 090
51520... .................. A Removal of bladder lesion 9.29 NA 5.41 0.87 NA 15.57 090
51525... .................. A Removal of bladder lesion 13.97 NA 7.17 1.06 NA 22.20 090
51530... .................. A Removal of bladder lesion 12.38 NA 6.59 1.02 NA 19.99 090
51535... .................. A Repair of ureter lesion.. 12.57 NA 6.99 1.14 NA 20.70 090
51550... .................. A Partial removal of 15.66 NA 7.75 1.17 NA 24.58 090
bladder.
51555... .................. A Partial removal of 21.23 NA 10.07 1.31 NA 32.61 090
bladder.
51565... .................. A Revise bladder & 21.62 NA 10.46 1.67 NA 33.75 090
ureter(s).
51570... .................. A Removal of bladder....... 24.24 NA 11.63 1.62 NA 37.49 090
51575... .................. A Removal of bladder & 30.45 NA 14.31 2.25 NA 47.01 090
nodes.
51580... .................. A Remove bladder; revise 31.08 NA 14.70 2.04 NA 47.82 090
tract.
51585... .................. A Removal of bladder & 35.23 NA 16.24 2.42 NA 53.89 090
nodes.
51590... .................. A Remove bladder; revise 32.66 NA 15.03 2.56 NA 50.25 090
tract.
51595... .................. A Remove bladder; revise 37.14 NA 16.73 3.34 NA 57.21 090
tract.
51596... .................. A Remove bladder, create 39.52 NA 17.86 3.45 NA 60.83 090
pouch.
51597... .................. A Removal of pelvic 38.35 NA 17.46 4.31 NA 60.12 090
structures.
51600... .................. A Injection for bladder x- 0.88 11.09 0.29 0.03 12.00 1.20 000
ray.
51605... .................. A Preparation for bladder 0.64 11.15 0.22 0.03 11.82 0.89 000
xray.
51610... .................. A Injection for bladder x- 1.05 11.29 0.36 0.02 12.36 1.43 000
ray.
51700... .................. A Irrigation of bladder.... 0.88 2.77 0.34 0.02 3.67 1.24 000
51705... .................. A Change of bladder tube... 1.02 1.84 1.16 0.04 2.90 2.22 010
51710... .................. A Change of bladder tube... 1.49 3.52 1.40 0.06 5.07 2.95 010
51715... .................. A Endoscopic injection/ 3.74 3.30 1.62 0.27 7.31 5.63 000
implant.
51720... .................. A Treatment of bladder 1.96 2.97 0.99 0.05 4.98 3.00 000
lesion.
51725... .................. A Simple cystometrogram.... 1.51 3.96 3.96 0.11 5.58 5.58 000
51725... 26 A Simple cystometrogram.... 1.51 0.59 0.59 0.07 2.17 2.17 000
51725... TC A Simple cystometrogram.... 0.00 3.37 3.37 0.04 3.41 3.41 000
51726... .................. A Complex cystometrogram... 1.71 3.15 3.15 0.13 4.99 4.99 000
51726... 26 A Complex cystometrogram... 1.71 0.64 0.64 0.08 2.43 2.43 000
51726... TC A Complex cystometrogram... 0.00 2.51 2.51 0.05 2.56 2.56 000
51736... .................. A Urine flow measurement... 0.61 0.63 0.63 0.04 1.28 1.28 000
51736... 26 A Urine flow measurement... 0.61 0.24 0.24 0.03 0.88 0.88 000
51736... TC A Urine flow measurement... 0.00 0.39 0.39 0.01 0.40 0.40 000
51741... .................. A Electro-uroflowmetry, 1.14 1.20 1.20 0.06 2.40 2.40 000
first.
51741... 26 A Electro-uroflowmetry, 1.14 0.43 0.43 0.04 1.61 1.61 000
first.
51741... TC A Electro-uroflowmetry, 0.00 0.77 0.77 0.02 0.79 0.79 000
first.
51772... .................. A Urethra pressure profile. 1.61 3.20 3.20 0.11 4.92 4.92 000
51772... 26 A Urethra pressure profile. 1.61 0.61 0.61 0.06 2.28 2.28 000
51772... TC A Urethra pressure profile. 0.00 2.59 2.59 0.05 2.64 2.64 000
51784... .................. A Anal/urinary muscle study 1.53 2.13 2.13 0.11 3.77 3.77 000
51784... 26 A Anal/urinary muscle study 1.53 0.78 0.78 0.07 2.38 2.38 000
51784... TC A Anal/urinary muscle study 0.00 1.35 1.35 0.04 1.39 1.39 000
51785... .................. A Anal/urinary muscle study 1.53 2.25 2.25 0.11 3.89 3.89 000
51785... 26 A Anal/urinary muscle study 1.53 0.58 0.58 0.07 2.18 2.18 000
51785... TC A Anal/urinary muscle study 0.00 1.67 1.67 0.04 1.71 1.71 000
51792... .................. A Urinary reflex study..... 1.10 2.34 2.34 0.20 3.64 3.64 000
51792... 26 A Urinary reflex study..... 1.10 0.25 0.25 0.06 1.41 1.41 000
51792... TC A Urinary reflex study..... 0.00 2.09 2.09 0.14 2.23 2.23 000
51795... .................. A Urine voiding pressure 1.53 3.21 3.21 0.16 4.90 4.90 000
study.
51795... 26 A Urine voiding pressure 1.53 0.57 0.57 0.06 2.16 2.16 000
study.
51795... TC A Urine voiding pressure 0.00 2.64 2.64 0.10 2.74 2.74 000
study.
51797... .................. A Intraabdominal pressure 1.60 3.27 3.27 0.10 4.97 4.97 000
test.
51797... 26 A Intraabdominal pressure 1.60 0.61 0.61 0.05 2.26 2.26 000
test.
51797... TC A Intraabdominal pressure 0.00 2.66 2.66 0.05 2.71 2.71 000
test.
51800... .................. A Revision of bladder/ 17.42 NA 8.68 1.47 NA 27.57 090
urethra.
51820... .................. A Revision of urinary tract 17.89 NA 9.48 1.32 NA 28.69 090
51840... .................. A Attach bladder/urethra... 10.71 NA 5.93 1.26 NA 17.90 090
51841... .................. A Attach bladder/urethra... 13.03 NA 7.26 1.48 NA 21.77 090
51845... .................. A Repair bladder neck...... 9.73 NA 5.72 1.09 NA 16.54 090
51860... .................. A Repair of bladder wound.. 12.02 NA 6.57 0.91 NA 19.50 090
51865... .................. A Repair of bladder wound.. 15.04 NA 7.78 1.27 NA 24.09 090
51880... .................. A Repair of bladder opening 7.66 NA 4.65 0.52 NA 12.83 090
51900... .................. A Repair bladder/vagina 12.97 NA 6.95 1.41 NA 21.33 090
lesion.
51920... .................. A Close bladder-uterus 11.81 NA 6.38 0.73 NA 18.92 090
fistula.
51925... .................. A Hysterectomy/bladder 15.58 NA 8.45 2.33 NA 26.36 090
repair.
51940... .................. A Correction of bladder 26.81 NA 13.08 2.22 NA 42.11 090
defect.
51960... .................. A Revision of bladder & 23.01 NA 11.75 2.27 NA 37.03 090
bowel.
51980... .................. A Construct bladder opening 11.36 NA 6.25 0.75 NA 18.36 090
52000... .................. A Cystoscopy............... 2.01 2.44 0.96 0.14 4.59 3.11 000
[[Page 30950]]
52005... .................. A Cystoscopy & ureter 2.37 3.76 1.09 0.22 6.35 3.68 000
catheter.
52007... .................. A Cystoscopy and biopsy.... 3.02 NA 1.33 0.28 NA 4.63 000
52010... .................. A Cystoscopy & duct 3.02 4.04 1.35 0.20 7.26 4.57 000
catheter.
52204... .................. A Cystoscopy............... 2.37 4.32 1.09 0.24 6.93 3.70 000
52214... .................. A Cystoscopy and treatment. 3.71 4.76 1.59 0.28 8.75 5.58 000
52224... .................. A Cystoscopy and treatment. 3.14 4.59 1.38 0.29 8.02 4.81 000
52234... .................. A Cystoscopy and treatment. 4.63 5.41 1.94 0.45 10.49 7.02 000
52235... .................. A Cystoscopy and treatment. 5.45 5.72 2.24 0.81 11.98 8.50 000
52240... .................. A Cystoscopy and treatment. 9.72 7.33 4.04 1.04 18.09 14.80 000
52250... .................. A Cystoscopy & radiotracer. 4.50 NA 1.88 0.29 NA 6.67 000
52260... .................. A Cystoscopy & treatment... 3.92 NA 1.72 0.22 NA 5.86 000
52265... .................. A Cystoscopy & treatment... 2.94 2.84 1.30 0.14 5.92 4.38 000
52270... .................. A Cystoscopy & revise 3.37 4.97 1.50 0.35 8.69 5.22 000
urethra.
52275... .................. A Cystoscopy & revise 4.70 5.52 2.00 0.34 10.56 7.04 000
urethra.
52276... .................. A Cystoscopy and treatment. 5.00 5.63 2.34 0.45 11.08 7.79 000
52277... .................. A Cystoscopy and treatment. 6.17 NA 2.54 0.47 NA 9.18 000
52281... .................. A Cystoscopy and treatment. 2.80 2.82 1.25 0.23 5.85 4.28 000
52282... .................. A Cystoscopy, implant stent 6.40 5.98 2.83 0.45 12.83 9.68 000
52283... .................. A Cystoscopy and treatment. 3.74 4.95 1.60 0.15 8.84 5.49 000
52285... .................. A Cystoscopy and treatment. 3.61 5.10 1.55 0.30 9.01 5.46 000
52290... .................. A Cystoscopy and treatment. 4.59 NA 1.92 0.24 NA 6.75 000
52300... .................. A Cystoscopy and treatment. 5.31 NA 2.19 0.36 NA 7.86 000
52301... .................. A Cystoscopy and treatment. 5.51 NA 2.26 0.36 NA 8.13 000
52305... .................. A Cystoscopy and treatment. 5.31 NA 2.19 0.35 NA 7.85 000
52310... .................. A Cystoscopy and treatment. 2.81 10.72 1.26 0.30 13.83 4.37 000
52315... .................. A Cystoscopy and treatment. 5.21 11.74 2.13 0.40 17.35 7.74 000
52317... .................. A Remove bladder stone..... 6.72 17.78 2.72 0.59 25.09 10.03 000
52318... .................. A Remove bladder stone..... 9.19 NA 3.64 0.77 NA 13.60 000
52320... .................. A Cystoscopy and treatment. 4.70 NA 1.96 0.47 NA 7.13 000
52325... .................. A Cystoscopy, stone removal 6.16 NA 2.50 0.68 NA 9.34 000
52327... .................. A Cystoscopy, inject 5.19 NA 2.15 0.36 NA 7.70 000
material.
52330... .................. A Cystoscopy and treatment. 5.04 14.55 2.09 0.35 19.94 7.48 000
52332... .................. A Cystoscopy and treatment. 2.83 20.61 1.26 0.32 23.76 4.41 000
52334... .................. A Create passage to kidney. 4.83 NA 2.00 0.34 NA 7.17 000
52335... .................. A Endoscopy of urinary 5.86 NA 2.40 0.45 NA 8.71 000
tract.
52336... .................. A Cystoscopy, stone removal 6.88 NA 2.78 0.99 NA 10.65 000
52337... .................. A Cystoscopy, stone removal 7.97 NA 3.18 1.08 NA 12.23 000
52338... .................. A Cystoscopy and treatment. 7.34 NA 2.94 0.57 NA 10.85 000
52339... .................. A Cystoscopy and treatment. 8.82 NA 3.39 0.57 NA 12.78 000
52340... .................. A Cystoscopy and treatment. 9.68 NA 5.05 0.50 NA 15.23 090
52450... .................. A Incision of prostate..... 7.64 NA 5.33 0.49 NA 13.46 090
52500... .................. A Revision of bladder neck. 8.47 NA 5.64 0.72 NA 14.83 090
52510... .................. A Dilation prostatic 6.72 NA 4.75 0.74 NA 12.21 090
urethra.
52601... .................. A Prostatectomy (TURP)..... 12.37 NA 7.09 1.16 NA 20.62 090
52606... .................. A Control postop bleeding.. 8.13 NA 5.25 0.33 NA 13.71 090
52612... .................. A Prostatectomy, first 7.98 NA 5.46 0.99 NA 14.43 090
stage.
52614... .................. A Prostatectomy, second 6.84 NA 5.02 0.68 NA 12.54 090
stage.
52620... .................. A Remove residual prostate. 6.61 NA 4.94 0.51 NA 12.06 090
52630... .................. A Remove prostate regrowth. 7.26 NA 5.19 1.13 NA 13.58 090
52640... .................. A Relieve bladder 6.62 NA 4.70 0.62 NA 11.94 090
contracture.
52647... .................. A Laser surgery of prostate 10.36 NA 6.35 1.16 NA 17.87 090
52648... .................. A Laser surgery of prostate 11.21 NA 6.62 1.16 NA 18.99 090
52700... .................. A Drainage of prostate 6.80 NA 5.00 0.34 NA 12.14 090
abscess.
53000... .................. A Incision of urethra...... 2.28 4.63 2.02 0.17 7.08 4.47 010
53010... .................. A Incision of urethra...... 3.64 NA 3.23 0.37 NA 7.24 090
53020... .................. A Incision of urethra...... 1.77 3.07 0.69 0.09 4.93 2.55 000
53025... .................. A Incision of urethra...... 1.13 3.25 0.45 0.08 4.46 1.66 000
53040... .................. A Drainage of urethra 6.40 7.08 8.13 0.19 13.67 14.72 090
abscess.
53060... .................. A Drainage of urethra 2.63 4.88 2.02 0.07 7.58 4.72 010
abscess.
53080... .................. A Drainage of urinary 6.29 NA 6.39 0.45 NA 13.13 090
leakage.
53085... .................. A Drainage of urinary 10.27 NA 7.98 0.70 NA 18.95 090
leakage.
53200... .................. A Biopsy of urethra........ 2.59 3.96 1.01 0.12 6.67 3.72 000
53210... .................. A Removal of urethra....... 12.57 NA 6.79 0.67 NA 20.03 090
53215... .................. A Removal of urethra....... 15.58 NA 7.84 0.96 NA 24.38 090
53220... .................. A Treatment of urethra 7.00 NA 4.47 0.49 NA 11.96 090
lesion.
53230... .................. A Removal of urethra lesion 9.58 NA 5.50 0.79 NA 15.87 090
53235... .................. A Removal of urethra lesion 10.14 NA 5.52 0.49 NA 16.15 090
53240... .................. A Surgery for urethra pouch 6.45 NA 4.14 0.45 NA 11.04 090
53250... .................. A Removal of urethra gland. 5.89 NA 3.63 0.40 NA 9.92 090
53260... .................. A Treatment of urethra 2.98 4.34 1.93 0.16 7.48 5.07 010
lesion.
53265... .................. A Treatment of urethra 3.12 4.79 1.93 0.22 8.13 5.27 010
lesion.
53270... .................. A Removal of urethra gland. 3.09 4.35 2.03 0.18 7.62 5.30 010
53275... .................. A Repair of urethra defect. 4.53 NA 2.98 0.25 NA 7.76 010
53400... .................. A Revise urethra, 1st stage 12.77 NA 6.89 0.76 NA 20.42 090
[[Page 30951]]
53405... .................. A Revise urethra, 2nd stage 14.48 NA 7.42 1.21 NA 23.11 090
53410... .................. A Reconstruction of urethra 16.44 NA 8.19 0.84 NA 25.47 090
53415... .................. A Reconstruction of urethra 19.41 NA 9.33 1.15 NA 29.89 090
53420... .................. A Reconstruct urethra, 14.08 NA 7.15 1.05 NA 22.28 090
stage 1.
53425... .................. A Reconstruct urethra, 15.98 NA 7.99 0.88 NA 24.85 090
stage 2.
53430... .................. A Reconstruction of urethra 16.34 NA 8.23 0.76 NA 25.33 090
53440... .................. A Correct bladder function. 12.34 NA 6.87 1.39 NA 20.60 090
53442... .................. A Remove perineal 8.27 NA 5.01 0.67 NA 13.95 090
prosthesis.
53443... .................. A Reconstruction of urethra 19.89 NA 9.15 1.07 NA 30.11 090
53445... .................. A Correct urine flow 14.06 NA 7.48 2.03 NA 23.57 090
control.
53447... .................. A Remove artificial 13.17 NA 6.93 0.89 NA 20.99 090
sphincter.
53449... .................. A Correct artificial 9.70 NA 5.63 0.82 NA 16.15 090
sphincter.
53450... .................. A Revision of urethra...... 6.14 NA 4.08 0.27 NA 10.49 090
53460... .................. A Revision of urethra...... 7.12 NA 4.45 0.25 NA 11.82 090
53502... .................. A Repair of urethra injury. 7.63 NA 4.76 0.56 NA 12.95 090
53505... .................. A Repair of urethra injury. 7.63 NA 4.63 0.51 NA 12.77 090
53510... .................. A Repair of urethra injury. 10.11 NA 5.90 0.66 NA 16.67 090
53515... .................. A Repair of urethra injury. 13.31 NA 6.76 0.88 NA 20.95 090
53520... .................. A Repair of urethra defect. 8.68 NA 4.96 0.56 NA 14.20 090
53600... .................. A Dilate urethra stricture. 1.21 2.94 0.50 0.03 4.18 1.74 000
53601... .................. A Dilate urethra stricture. 0.98 2.86 0.42 0.03 3.87 1.43 000
53605... .................. A Dilate urethra stricture. 1.28 NA 0.69 0.05 NA 2.02 000
53620... .................. A Dilate urethra stricture. 1.62 4.35 0.81 0.05 6.02 2.48 000
53621... .................. A Dilate urethra stricture. 1.35 4.31 0.71 0.04 5.70 2.10 000
53660... .................. A Dilation of urethra...... 0.71 2.68 0.32 0.03 3.42 1.06 000
53661... .................. A Dilation of urethra...... 0.72 2.74 0.27 0.03 3.49 1.02 000
53665... .................. A Dilation of urethra...... 0.76 NA 0.56 0.04 NA 1.36 000
53670... .................. A Insert urinary catheter.. 0.50 2.57 0.15 0.02 3.09 0.67 000
53675... .................. A Insert urinary catheter.. 1.47 3.45 0.71 0.05 4.97 2.23 000
53850... .................. A Prostatic microwave 9.45 NA 6.00 0.66 NA 16.11 090
thermotx.
53852... .................. A Prostatic rf thermotx.... 9.88 NA 6.16 0.69 NA 16.73 090
54000... .................. A Slitting of prepuce...... 1.54 3.93 1.19 0.07 5.54 2.80 010
54001... .................. A Slitting of prepuce...... 2.19 4.35 1.66 0.09 6.63 3.94 010
54015... .................. A Drain penis lesion....... 5.32 5.33 2.84 0.09 10.74 8.25 010
54050... .................. A Destruction, penis 1.24 4.80 1.12 0.03 6.07 2.39 010
lesion(s).
54055... .................. A Destruction, penis 1.22 4.14 1.08 0.06 5.42 2.36 010
lesion(s).
54056... .................. A Cryosurgery, penis 1.24 3.11 1.18 0.04 4.39 2.46 010
lesion(s).
54057... .................. A Laser surg, penis 1.24 1.62 1.10 0.21 3.07 2.55 010
lesion(s).
54060... .................. A Excision of penis 1.93 3.63 1.34 0.12 5.68 3.39 010
lesion(s).
54065... .................. A Destruction, penis 2.42 3.40 1.74 0.25 6.07 4.41 010
lesion(s).
54100... .................. A Biopsy of penis.......... 1.90 2.41 0.77 0.07 4.38 2.74 000
54105... .................. A Biopsy of penis.......... 3.50 4.58 1.94 0.11 8.19 5.55 010
54110... .................. A Treatment of penis lesion 10.13 NA 6.85 0.61 NA 17.59 090
54111... .................. A Treat penis lesion, graft 13.57 NA 8.25 0.97 NA 22.79 090
54112... .................. A Treat penis lesion, graft 15.86 NA 9.29 1.14 NA 26.29 090
54115... .................. A Treatment of penis lesion 6.15 7.66 5.34 0.44 14.25 11.93 090
54120... .................. A Partial removal of penis. 9.97 NA 6.87 0.62 NA 17.46 090
54125... .................. A Removal of penis......... 13.53 NA 8.24 1.17 NA 22.94 090
54130... .................. A Remove penis & nodes..... 20.14 NA 10.87 1.32 NA 32.33 090
54135... .................. A Remove penis & nodes..... 26.36 NA 13.23 1.74 NA 41.33 090
54150... .................. A Circumcision............. 1.81 3.25 1.48 0.05 5.11 3.34 010
54152... .................. A Circumcision............. 2.31 NA 1.47 0.20 NA 3.98 010
54160... .................. A Circumcision............. 2.48 3.66 1.54 0.21 6.35 4.23 010
54161... .................. A Circumcision............. 3.27 NA 1.85 0.23 NA 5.35 010
54200... .................. A Treatment of penis lesion 1.06 1.79 0.40 0.03 2.88 1.49 010
54205... .................. A Treatment of penis lesion 7.93 NA 6.08 0.50 NA 14.51 090
54220... .................. A Treatment of penis lesion 2.42 1.72 0.99 0.17 4.31 3.58 000
54230... .................. A Prepare penis study...... 1.34 NA 0.49 0.13 NA 1.96 000
54231... .................. A Dynamic cavernosometry... 2.04 1.56 0.81 0.14 3.74 2.99 000
54235... .................. A Penile injection......... 1.19 0.85 0.44 0.04 2.08 1.67 000
54240... .................. A Penis study.............. 1.31 1.16 1.16 0.12 2.59 2.59 000
54240... 26 A Penis study.............. 1.31 0.38 0.38 0.06 1.75 1.75 000
54240... TC A Penis study.............. 0.00 0.78 0.78 0.06 0.84 0.84 000
54250... .................. A Penis study.............. 2.22 2.00 2.00 0.08 4.30 4.30 000
54250... 26 A Penis study.............. 2.22 0.77 0.77 0.05 3.04 3.04 000
54250... TC A Penis study.............. 0.00 1.23 1.23 0.03 1.26 1.26 000
54300... .................. A Revision of penis........ 10.41 NA 7.30 0.87 NA 18.58 090
54304... .................. A Revision of penis........ 12.49 NA 8.54 0.90 NA 21.93 090
54308... .................. A Reconstruction of urethra 11.83 NA 8.36 0.74 NA 20.93 090
54312... .................. A Reconstruction of urethra 13.57 NA 9.92 0.91 NA 24.40 090
54316... .................. A Reconstruction of urethra 16.82 NA 6.95 1.12 NA 24.89 090
54318... .................. A Reconstruction of urethra 11.25 NA 19.72 1.11 NA 32.08 090
54322... .................. A Reconstruction of urethra 13.01 NA 7.94 0.74 NA 21.69 090
54324... .................. A Reconstruction of urethra 16.31 NA 9.76 1.08 NA 27.15 090
[[Page 30952]]
54326... .................. A Reconstruction of urethra 15.72 NA 9.17 1.03 NA 25.92 090
54328... .................. A Revise penis, urethra.... 15.65 NA 9.45 1.24 NA 26.34 090
54332... .................. A Revise penis, urethra.... 17.08 NA 10.05 1.13 NA 28.26 090
54336... .................. A Revise penis, urethra.... 20.04 NA 11.41 1.40 NA 32.85 090
54340... .................. A Secondary urethral 8.91 NA 6.44 0.59 NA 15.94 090
surgery.
54344... .................. A Secondary urethral 15.94 NA 11.37 1.10 NA 28.41 090
surgery.
54348... .................. A Secondary urethral 17.15 NA 14.36 1.14 NA 32.65 090
surgery.
54352... .................. A Reconstruct urethra, 24.74 NA 13.56 1.49 NA 39.79 090
penis.
54360... .................. A Penis plastic surgery.... 11.93 NA 7.60 0.73 NA 20.26 090
54380... .................. A Repair penis............. 13.18 NA 8.00 0.75 NA 21.93 090
54385... .................. A Repair penis............. 15.39 NA 9.03 0.89 NA 25.31 090
54390... .................. A Repair penis and bladder. 21.61 NA 30.09 1.58 NA 53.28 090
54400... .................. A Insert semi-rigid 8.99 NA 5.39 1.27 NA 15.65 090
prosthesis.
54401... .................. A Insert self-contd 10.28 NA 6.08 1.73 NA 18.09 090
prosthesis.
54402... .................. A Remove penis prosthesis.. 9.21 NA 5.44 0.58 NA 15.23 090
54405... .................. A Insert multi-comp 13.43 NA 7.25 2.10 NA 22.78 090
prosthesis.
54407... .................. A Remove multi-comp 13.34 NA 7.00 1.10 NA 21.44 090
prosthesis.
54409... .................. A Revise penis prosthesis.. 12.20 NA 6.59 0.87 NA 19.66 090
54420... .................. A Revision of penis........ 11.42 NA 7.23 0.87 NA 19.52 090
54430... .................. A Revision of penis........ 10.15 NA 6.87 0.69 NA 17.71 090
54435... .................. A Revision of penis........ 6.12 NA 5.12 0.39 NA 11.63 090
54450... .................. A Preputial stretching..... 1.12 0.85 0.46 0.07 2.04 1.65 000
54500... .................. A Biopsy of testis......... 1.31 4.14 0.74 0.05 5.50 2.10 000
54505... .................. A Biopsy of testis......... 3.46 NA 2.32 0.22 NA 6.00 010
54510... .................. A Removal of testis lesion. 5.45 NA 3.16 0.38 NA 8.99 090
54520... .................. A Removal of testis........ 5.23 NA 3.22 0.52 NA 8.97 090
54530... .................. A Removal of testis........ 8.58 NA 4.78 0.77 NA 14.13 090
54535... .................. A Extensive testis surgery. 12.16 NA 6.30 1.02 NA 19.48 090
54550... .................. A Exploration for testis... 7.78 NA 4.37 0.61 NA 12.76 090
54560... .................. A Exploration for testis... 11.13 NA 6.09 0.81 NA 18.03 090
54600... .................. A Reduce testis torsion.... 7.01 NA 3.90 0.48 NA 11.39 090
54620... .................. A Suspension of testis..... 4.90 NA 2.88 0.33 NA 8.11 010
54640... .................. A Suspension of testis..... 6.90 NA 3.90 0.91 NA 11.71 090
54650... .................. A Orchiopexy (Fowler- 11.45 NA 6.05 0.91 NA 18.41 090
Stephens).
54660... .................. A Revision of testis....... 5.11 NA 3.20 0.34 NA 8.65 090
54670... .................. A Repair testis injury..... 6.41 NA 3.71 0.43 NA 10.55 090
54680... .................. A Relocation of testis(es). 12.65 NA 6.61 0.80 NA 20.06 090
54700... .................. A Drainage of scrotum...... 3.43 6.31 2.81 0.11 9.85 6.35 010
54800... .................. A Biopsy of epididymis..... 2.33 3.92 1.15 0.19 6.44 3.67 000
54820... .................. A Exploration of epididymis 5.14 NA 3.21 0.29 NA 8.64 090
54830... .................. A Remove epididymis lesion. 5.38 NA 3.28 0.39 NA 9.05 090
54840... .................. A Remove epididymis lesion. 5.20 NA 3.25 0.48 NA 8.93 090
54860... .................. A Removal of epididymis.... 6.32 NA 3.81 0.50 NA 10.63 090
54861... .................. A Removal of epididymis.... 8.90 NA 4.83 0.72 NA 14.45 090
54900... .................. A Fusion of spermatic ducts 13.20 NA 6.55 0.87 NA 20.62 090
54901... .................. A Fusion of spermatic ducts 17.94 NA 8.55 1.20 NA 27.69 090
55000... .................. A Drainage of hydrocele.... 1.43 1.36 0.76 0.04 2.83 2.23 000
55040... .................. A Removal of hydrocele..... 5.36 NA 3.12 0.55 NA 9.03 090
55041... .................. A Removal of hydroceles.... 7.74 NA 4.21 0.81 NA 12.76 090
55060... .................. A Repair of hydrocele...... 5.52 NA 3.19 0.50 NA 9.21 090
55100... .................. A Drainage of scrotum 2.13 7.25 2.72 0.07 9.45 4.92 010
abscess.
55110... .................. A Explore scrotum.......... 5.70 NA 3.04 0.37 NA 9.11 090
55120... .................. A Removal of scrotum lesion 5.09 NA 3.07 0.21 NA 8.37 090
55150... .................. A Removal of scrotum....... 7.22 NA 4.20 0.57 NA 11.99 090
55175... .................. A Revision of scrotum...... 5.24 NA 3.32 0.48 NA 9.04 090
55180... .................. A Revision of scrotum...... 10.72 NA 5.79 0.82 NA 17.33 090
55200... .................. A Incision of sperm duct... 4.24 NA 2.77 0.20 NA 7.21 090
55250... .................. A Removal of sperm duct(s). 3.29 6.89 2.51 0.28 10.46 6.08 090
55300... .................. A Preparation, sperm duct x- 3.51 NA 1.50 0.27 NA 5.28 000
ray.
55400... .................. A Repair of sperm duct..... 8.49 NA 4.85 0.62 NA 13.96 090
55450... .................. A Ligation of sperm duct... 4.12 6.35 2.47 0.32 10.79 6.91 010
55500... .................. A Removal of hydrocele..... 5.59 NA 3.04 0.50 NA 9.13 090
55520... .................. A Removal of sperm cord 6.03 NA 3.27 0.51 NA 9.81 090
lesion.
55530... .................. A Revise spermatic cord 5.66 NA 3.39 0.60 NA 9.65 090
veins.
55535... .................. A Revise spermatic cord 6.56 NA 3.78 0.45 NA 10.79 090
veins.
55540... .................. A Revise hernia & sperm 7.67 NA 3.90 0.91 NA 12.48 090
veins.
55600... .................. A Incise sperm duct pouch.. 6.38 NA 3.93 0.55 NA 10.86 090
55605... .................. A Incise sperm duct pouch.. 7.96 NA 4.56 0.59 NA 13.11 090
55650... .................. A Remove sperm duct pouch.. 11.80 NA 6.04 0.76 NA 18.60 090
55680... .................. A Remove sperm pouch lesion 5.19 NA 3.35 0.38 NA 8.92 090
55700... .................. A Biopsy of prostate....... 1.57 2.69 0.82 0.15 4.41 2.54 000
55705... .................. A Biopsy of prostate....... 4.57 NA 3.16 0.34 NA 8.07 010
55720... .................. A Drainage of prostate 7.64 NA 4.80 0.37 NA 12.81 090
abscess.
55725... .................. A Drainage of prostate 8.68 NA 5.32 0.54 NA 14.54 090
abscess.
[[Page 30953]]
55801... .................. A Removal of prostate...... 17.80 NA 8.82 1.44 NA 28.06 090
55810... .................. A Extensive prostate 22.58 NA 10.82 1.77 NA 35.17 090
surgery.
55812... .................. A Extensive prostate 27.51 NA 12.82 1.94 NA 42.27 090
surgery.
55815... .................. A Extensive prostate 30.46 NA 13.64 2.42 NA 46.52 090
surgery.
55821... .................. A Removal of prostate...... 14.25 NA 7.29 1.35 NA 22.89 090
55831... .................. A Removal of prostate...... 15.62 NA 7.82 1.44 NA 24.88 090
55840... .................. A Extensive prostate 22.69 NA 11.10 1.61 NA 35.40 090
surgery.
55842... .................. A Extensive prostate 24.38 NA 11.72 1.88 NA 37.98 090
surgery.
55845... .................. A Extensive prostate 28.55 NA 13.27 2.44 NA 44.26 090
surgery.
55859... .................. A Percut/needle insert, 12.52 NA 6.62 0.58 NA 19.72 090
pros.
55860... .................. A Surgical exposure, 14.45 NA 7.42 0.70 NA 22.57 090
prostate.
55862... .................. A Extensive prostate 18.39 NA 8.86 1.20 NA 28.45 090
surgery.
55865... .................. A Extensive prostate 22.87 NA 10.69 2.39 NA 35.95 090
surgery.
55870... .................. A Electroejaculation....... 2.58 1.52 0.99 0.18 4.28 3.75 000
56300... .................. A Laparoscopy; diagnostic.. 5.10 NA 2.79 0.93 NA 8.82 010
56301... .................. A Laparoscopy; tubal 5.60 NA 3.48 1.28 NA 10.36 010
cautery.
56302... .................. A Laparoscopy; tubal block. 5.60 NA 3.49 1.32 NA 10.41 010
56303... .................. A Laparoscopy; excise 11.79 NA 5.25 1.16 NA 18.20 090
lesions.
56304... .................. A Laparoscopy; lysis....... 11.29 NA 5.20 1.20 NA 17.69 090
56305... .................. A Laparoscopy; biopsy...... 5.40 NA 2.87 0.79 NA 9.06 010
56306... .................. A Laparoscopy; aspiration.. 5.70 NA 3.28 1.18 NA 10.16 010
56307... .................. A Laparoscopy; remove 11.05 NA 5.11 1.60 NA 17.76 010
adnexa.
56308... .................. A Laparoscopy; hysterectomy 14.19 NA 6.56 2.07 NA 22.82 010
56309... .................. A Laparoscopy; remove myoma 14.21 NA 6.53 1.03 NA 21.77 010
56310... .................. A Laparoscopic enterolysis. 14.44 NA 7.11 1.75 NA 23.30 090
56311... .................. A Laparoscopic lymph node 9.25 NA 4.59 1.47 NA 15.31 010
biop.
56312... .................. A Laparoscopic 12.38 NA 5.86 0.84 NA 19.08 010
lymphadenectomy.
56313... .................. A Laparoscopic 14.32 NA 6.96 2.31 NA 23.59 010
lymphadenectomy.
56314... .................. A Lapar; drain lymphocele.. 9.48 NA 4.66 0.66 NA 14.80 090
56315... .................. A Laparoscopic appendectomy 8.70 NA 4.28 1.01 NA 13.99 090
56316... .................. A Laparoscopic hernia 6.27 NA 3.23 0.94 NA 10.44 090
repair.
56317... .................. A Laparoscopic hernia 8.24 NA 4.20 1.11 NA 13.55 090
repair.
56318... .................. A Laparoscopic orchiectomy. 10.96 NA 6.02 0.81 NA 17.79 090
56320... .................. A Laparoscopy, spermatic 6.57 NA 3.54 0.45 NA 10.56 090
veins.
56322... .................. A Laparoscopy, vagus nerves 10.15 NA 4.84 1.18 NA 16.17 090
56323... .................. A Laparoscopy, vagus nerves 12.15 NA 5.91 1.41 NA 19.47 090
56324... .................. A Laparoscopy, 12.58 NA 6.23 1.93 NA 20.74 090
cholecystoenter.
56340... .................. A Laparoscopic 11.09 NA 5.25 1.74 NA 18.08 090
cholecystectomy.
56341... .................. A Laparoscopic 11.94 NA 5.68 1.84 NA 19.46 090
cholecystectomy.
56342... .................. A Laparoscopic 14.23 NA 7.04 2.00 NA 23.27 090
cholecystectomy.
56343... .................. A Laparoscopic 13.74 NA 6.70 1.11 NA 21.55 090
salpingostomy.
56344... .................. A Laparoscopic 12.88 NA 5.77 1.19 NA 19.84 090
fimbrioplasty.
56346... .................. A Laparoscopic gastrostomy. 7.73 NA 4.29 1.19 NA 13.21 090
56348... .................. A Laparo; resect intestine. 22.04 NA 10.28 2.78 NA 35.10 090
56349... .................. A Laparoscopy; fundoplasty. 17.25 NA 9.46 2.53 NA 29.24 090
56350... .................. A Hysteroscopy; diagnostic. 3.33 2.58 1.44 0.44 6.35 5.21 000
56351... .................. A Hysteroscopy; biopsy..... 4.75 3.17 2.03 0.44 8.36 7.22 000
56352... .................. A Hysteroscopy; lysis...... 6.17 NA 2.59 0.85 NA 9.61 000
56353... .................. A Hysteroscopy; resect 7.00 NA 2.98 0.85 NA 10.83 000
septum.
56354... .................. A Hysteroscopy; remove 10.00 NA 4.19 1.30 NA 15.49 000
myoma.
56355... .................. A Hysteroscopy; remove 5.21 NA 2.19 0.44 NA 7.84 000
impact.
56356... .................. A Hysteroscopy; ablation... 6.17 NA 2.61 1.49 NA 10.27 000
56362... .................. A Laparoscopy w/cholangio.. 4.89 NA 2.29 0.19 NA 7.37 000
56363... .................. A Laparoscopy w/biopsy..... 5.18 NA 2.50 0.45 NA 8.13 000
56405... .................. A I & D of vulva/perineum.. 1.44 1.88 1.01 0.15 3.47 2.60 010
56420... .................. A Drainage of gland abscess 1.39 1.86 0.88 0.13 3.38 2.40 010
56440... .................. A Surgery for vulva lesion. 2.84 2.83 2.05 0.52 6.19 5.41 010
56441... .................. A Lysis of labial lesion(s) 1.97 2.15 1.80 0.30 4.42 4.07 010
56501... .................. A Destruction, vulva 1.53 1.85 1.18 0.11 3.49 2.82 010
lesion(s).
56515... .................. A Destruction, vulva 1.88 2.17 1.67 0.66 4.71 4.21 010
lesion(s).
56605... .................. A Biopsy of vulva/perineum. 1.10 1.44 0.47 0.15 2.69 1.72 000
56606... .................. A Biopsy of vulva/perineum. 0.55 1.21 0.25 0.08 1.84 0.88 000
56620... .................. A Partial removal of vulva. 7.47 NA 4.32 1.40 NA 13.19 090
56625... .................. A Complete removal of vulva 8.40 NA 4.96 2.13 NA 15.49 090
56630... .................. A Extensive vulva surgery.. 12.36 NA 6.83 3.28 NA 22.47 090
56631... .................. A Extensive vulva surgery.. 16.20 NA 8.96 4.51 NA 29.67 090
56632... .................. A Extensive vulva surgery.. 20.29 NA 10.64 4.51 NA 35.44 090
56633... .................. A Extensive vulva surgery.. 16.47 NA 8.54 3.28 NA 28.29 090
56634... .................. A Extensive vulva surgery.. 17.88 NA 9.67 4.51 NA 32.06 090
56637... .................. A Extensive vulva surgery.. 21.97 NA 11.32 4.51 NA 37.80 090
56640... .................. A Extensive vulva surgery.. 22.17 NA 11.23 4.36 NA 37.76 090
56700... .................. A Partial removal of hymen. 2.52 2.45 1.78 0.35 5.32 4.65 010
56720... .................. A Incision of hymen........ 0.68 1.32 0.61 0.11 2.11 1.40 000
56740... .................. A Remove vagina gland 3.76 2.82 2.37 0.55 7.13 6.68 010
lesion.
[[Page 30954]]
56800... .................. A Repair of vagina......... 3.89 NA 2.54 0.57 NA 7.00 010
56805... .................. A Repair clitoris.......... 18.86 NA 9.03 1.37 NA 29.26 090
56810... .................. A Repair of perineum....... 4.13 NA 2.57 0.51 NA 7.21 010
57000... .................. A Exploration of vagina.... 2.97 NA 2.08 0.35 NA 5.40 010
57010... .................. A Drainage of pelvic 6.03 NA 3.54 0.51 NA 10.08 090
abscess.
57020... .................. A Drainage of pelvic fluid. 1.50 1.24 0.60 0.14 2.88 2.24 000
57061... .................. A Destruction vagina 1.25 1.77 1.06 0.17 3.19 2.48 010
lesion(s).
57065... .................. A Destruction vagina 2.61 2.42 1.96 0.74 5.77 5.31 010
lesion(s).
57100... .................. A Biopsy of vagina......... 0.97 1.14 0.41 0.13 2.24 1.51 000
57105... .................. A Biopsy of vagina......... 1.69 1.99 1.57 0.33 4.01 3.59 010
57108... .................. A Partial removal of vagina 6.36 NA 3.73 1.10 NA 11.19 090
57110... .................. A Removal of vagina........ 14.29 NA 6.92 1.76 NA 22.97 090
57120... .................. A Closure of vagina........ 7.41 NA 4.33 1.51 NA 13.25 090
57130... .................. A Remove vagina lesion..... 2.43 NA 1.85 0.55 NA 4.83 010
57135... .................. A Remove vagina lesion..... 2.67 2.39 1.97 0.38 5.44 5.02 010
57150... .................. A Treat vagina infection... 0.55 0.81 0.22 0.04 1.40 0.81 000
57160... .................. A Insertion of pessary/ 0.89 1.07 0.36 0.05 2.01 1.30 000
device.
57170... .................. A Fitting of diaphragm/cap. 0.91 1.07 0.35 0.06 2.04 1.32 000
57180... .................. A Treat vaginal bleeding... 1.58 1.78 1.19 0.11 3.47 2.88 010
57200... .................. A Repair of vagina......... 3.94 NA 2.66 0.60 NA 7.20 090
57210... .................. A Repair vagina/perineum... 5.17 NA 3.20 0.65 NA 9.02 090
57220... .................. A Revision of urethra...... 4.31 NA 3.05 0.80 NA 8.16 090
57230... .................. A Repair of urethral lesion 5.64 NA 3.76 0.64 NA 10.04 090
57240... .................. A Repair bladder & vagina.. 6.07 NA 3.92 1.60 NA 11.59 090
57250... .................. A Repair rectum & vagina... 5.53 NA 3.53 1.69 NA 10.75 090
57260... .................. A Repair of vagina......... 8.27 NA 4.66 1.88 NA 14.81 090
57265... .................. A Extensive repair of 11.34 NA 6.28 2.11 NA 19.73 090
vagina.
57268... .................. A Repair of bowel bulge.... 6.76 NA 4.03 1.50 NA 12.29 090
57270... .................. A Repair of bowel pouch.... 12.11 NA 6.08 1.44 NA 19.63 090
57280... .................. A Suspension of vagina..... 15.04 NA 7.27 1.85 NA 24.16 090
57282... .................. A Repair of vaginal 8.86 NA 4.91 1.89 NA 15.66 090
prolapse.
57284... .................. A Repair paravaginal defect 12.70 NA 6.67 0.84 NA 20.21 090
57288... .................. A Repair bladder defect.... 13.02 NA 6.65 1.36 NA 21.03 090
57289... .................. A Repair bladder & vagina.. 11.58 NA 6.21 1.13 NA 18.92 090
57291... .................. A Construction of vagina... 7.95 NA 5.76 1.19 NA 14.90 090
57292... .................. A Construct vagina with 13.09 NA 6.89 1.38 NA 21.36 090
graft.
57300... .................. A Repair rectum-vagina 7.61 NA 4.30 1.66 NA 13.57 090
fistula.
57305... .................. A Repair rectum-vagina 13.77 NA 7.02 1.56 NA 22.35 090
fistula.
57307... .................. A Fistula repair & 15.93 NA 7.93 1.28 NA 25.14 090
colostomy.
57308... .................. A Fistula repair, 9.94 NA 4.76 1.41 NA 16.11 090
transperine.
57310... .................. A Repair urethrovaginal 6.78 NA 4.22 0.48 NA 11.48 090
lesion.
57311... .................. A Repair urethrovaginal 7.98 NA 4.74 0.41 NA 13.13 090
lesion.
57320... .................. A Repair bladder-vagina 8.01 NA 4.77 1.35 NA 14.13 090
lesion.
57330... .................. A Repair bladder-vagina 12.35 NA 6.21 0.81 NA 19.37 090
lesion.
57335... .................. A Repair vagina............ 18.73 NA 9.14 0.81 NA 28.68 090
57400... .................. A Dilation of vagina....... 2.27 NA 1.22 0.06 NA 3.55 000
57410... .................. A Pelvic examination....... 1.75 1.93 1.01 0.05 3.73 2.81 000
57415... .................. A Removal vaginal foreign 2.17 2.75 1.78 0.05 4.97 4.00 010
body.
57452... .................. A Examination of vagina.... 0.99 1.30 0.39 0.14 2.43 1.52 000
57454... .................. A Vagina examination & 1.27 1.42 0.51 0.26 2.95 2.04 000
biopsy.
57460... .................. A Cervix excision.......... 2.83 1.83 1.16 0.46 5.12 4.45 000
57500... .................. A Biopsy of cervix......... 0.97 1.17 0.42 0.12 2.26 1.51 000
57505... .................. A Endocervical curettage... 1.14 1.54 1.07 0.13 2.81 2.34 010
57510... .................. A Cauterization of cervix.. 1.90 2.45 1.38 0.09 4.44 3.37 010
57511... .................. A Cryocautery of cervix.... 1.90 1.99 0.75 0.17 4.06 2.82 010
57513... .................. A Laser surgery of cervix.. 1.90 2.06 1.35 0.67 4.63 3.92 010
57520... .................. A Conization of cervix..... 4.04 3.50 2.56 0.73 8.27 7.33 090
57522... .................. A Conization of cervix..... 3.36 3.16 2.30 0.73 7.25 6.39 090
57530... .................. A Removal of cervix........ 4.79 NA 3.23 0.78 NA 8.80 090
57531... .................. A Removal of cervix, 28.00 NA 12.75 3.87 NA 44.62 090
radical.
57540... .................. A Removal of residual 12.22 NA 5.99 1.51 NA 19.72 090
cervix.
57545... .................. A Remove cervix, repair 13.03 NA 6.53 1.03 NA 20.59 090
pelvis.
57550... .................. A Removal of residual 5.53 NA 3.52 1.54 NA 10.59 090
cervix.
57555... .................. A Remove cervix, repair 8.95 NA 5.09 2.17 NA 16.21 090
vagina.
57556... .................. A Remove cervix, repair 8.37 NA 4.64 1.92 NA 14.93 090
bowel.
57700... .................. A Revision of cervix....... 3.55 NA 2.27 0.34 NA 6.16 090
57720... .................. A Revision of cervix....... 4.13 NA 2.97 0.50 NA 7.60 090
57800... .................. A Dilation of cervical 0.77 0.94 0.33 0.10 1.81 1.20 000
canal.
57820... .................. A D&C of residual cervix... 1.67 2.07 1.86 0.46 4.20 3.99 010
58100... .................. A Biopsy of uterus lining.. 0.71 0.92 0.29 0.14 1.77 1.14 000
58120... .................. A Dilation and curettage 3.27 3.12 2.22 0.56 6.95 6.05 010
(D&C).
58140... .................. A Removal of uterus lesion. 14.60 NA 6.98 1.71 NA 23.29 090
58145... .................. A Removal of uterus lesion. 8.04 NA 4.57 1.54 NA 14.15 090
58150... .................. A Total hysterectomy....... 15.24 NA 7.32 2.08 NA 24.64 090
[[Page 30955]]
58152... .................. A Total hysterectomy....... 15.09 NA 7.28 2.59 NA 24.96 090
58180... .................. A Partial hysterectomy..... 15.29 NA 7.27 2.11 NA 24.67 090
58200... .................. A Extensive hysterectomy... 21.59 NA 10.57 2.80 NA 34.96 090
58210... .................. A Extensive hysterectomy... 28.85 NA 13.49 3.87 NA 46.21 090
58240... .................. A Removal of pelvis 38.39 NA 17.76 6.15 NA 62.30 090
contents.
58260... .................. A Vaginal hysterectomy..... 12.20 NA 5.84 2.07 NA 20.11 090
58262... .................. A Vaginal hysterectomy..... 13.99 NA 6.57 2.07 NA 22.63 090
58263... .................. A Vaginal hysterectomy..... 15.28 NA 6.88 2.22 NA 24.38 090
58267... .................. A Hysterectomy & vagina 15.00 NA 6.93 2.46 NA 24.39 090
repair.
58270... .................. A Hysterectomy & vagina 13.48 NA 6.37 2.22 NA 22.07 090
repair.
58275... .................. A Hysterectomy, revise 14.98 NA 6.95 2.32 NA 24.25 090
vagina.
58280... .................. A Hysterectomy, revise 15.41 NA 7.10 2.30 NA 24.81 090
vagina.
58285... .................. A Extensive hysterectomy... 18.57 NA 9.55 2.70 NA 30.82 090
58300... .................. N Insert intrauterine +1.01 2.37 1.01 0.13 3.51 2.15 XXX
device.
58301... .................. A Remove intrauterine 1.27 1.20 0.49 0.08 2.55 1.84 000
device.
58321... .................. A Artificial insemination.. 0.92 0.86 0.34 0.15 1.93 1.41 000
58322... .................. A Artificial insemination.. 1.10 0.90 0.42 0.15 2.15 1.67 000
58323... .................. A Sperm washing............ 0.23 0.37 0.10 0.04 0.64 0.37 000
58340... .................. A Catheter for 0.88 9.69 0.32 0.08 10.65 1.28 000
hysterography.
58345... .................. A Reopen fallopian tube.... 4.66 NA 1.74 0.41 NA 6.81 010
58350... .................. A Reopen fallopian tube.... 1.01 1.58 0.98 0.16 2.75 2.15 010
58400... .................. A Suspension of uterus..... 6.36 NA 3.70 1.16 NA 11.22 090
58410... .................. A Suspension of uterus..... 12.73 NA 6.19 0.84 NA 19.76 090
58520... .................. A Repair of ruptured uterus 11.92 NA 5.74 0.99 NA 18.65 090
58540... .................. A Revision of uterus....... 14.64 NA 6.89 1.42 NA 22.95 090
58600... .................. A Division of fallopian 3.84 NA 2.46 1.38 NA 7.68 090
tube.
58605... .................. A Division of fallopian 3.34 NA 2.26 1.01 NA 6.61 090
tube.
58611... .................. A Ligate oviduct(s)........ 0.63 NA 0.40 0.10 NA 1.13 ZZZ
58615... .................. A Occlude fallopian tube(s) 3.90 NA 5.53 0.35 NA 9.78 010
58700... .................. A Removal of fallopian tube 6.49 NA 3.56 1.31 NA 11.36 090
58720... .................. A Removal of ovary/tube(s). 11.36 NA 5.58 1.63 NA 18.57 090
58740... .................. A Revise fallopian tube(s). 5.83 NA 3.47 1.88 NA 11.18 090
58750... .................. A Repair oviduct........... 14.84 NA 7.09 1.46 NA 23.39 090
58752... .................. A Revise ovarian tube(s)... 14.84 NA 7.36 0.93 NA 23.13 090
58760... .................. A Remove tubal obstruction. 13.13 NA 6.43 1.19 NA 20.75 090
58770... .................. A Create new tubal opening. 13.97 NA 6.88 1.11 NA 21.96 090
58800... .................. A Drainage of ovarian 4.14 3.67 3.33 0.53 8.34 8.00 090
cyst(s).
58805... .................. A Drainage of ovarian 5.88 NA 3.27 1.36 NA 10.51 090
cyst(s).
58820... .................. A Open drain ovary abscess. 4.22 NA 2.85 0.49 NA 7.56 090
58822... .................. A Percut drain ovary 10.13 NA 4.89 0.81 NA 15.83 090
abscess.
58823... .................. A Percut drain pelvic 3.38 NA 2.46 0.30 NA 6.14 000
abscess.
58825... .................. A Transposition, ovary(s).. 6.13 NA 3.69 0.93 NA 10.75 090
58900... .................. A Biopsy of ovary(s)....... 5.99 NA 3.29 1.07 NA 10.35 090
58920... .................. A Partial removal of 6.78 NA 3.66 1.41 NA 11.85 090
ovary(s).
58925... .................. A Removal of ovarian 11.36 NA 5.46 1.38 NA 18.20 090
cyst(s).
58940... .................. A Removal of ovary(s)...... 7.29 NA 3.76 1.33 NA 12.38 090
58943... .................. A Removal of ovary(s)...... 18.43 NA 9.07 2.63 NA 30.13 090
58950... .................. A Resect ovarian malignancy 15.27 NA 7.83 2.38 NA 25.48 090
58951... .................. A Resect ovarian malignancy 21.81 NA 10.61 3.93 NA 36.35 090
58952... .................. A Resect ovarian malignancy 25.01 NA 11.86 3.92 NA 40.79 090
58960... .................. A Exploration of abdomen... 14.65 NA 7.59 2.95 NA 25.19 090
58970... .................. A Retrieval of oocyte...... 3.53 6.04 1.90 0.58 10.15 6.01 000
58976... .................. A Transfer of embryo....... 3.83 4.93 4.62 0.63 9.39 9.08 000
59000... .................. A Amniocentesis............ 1.30 1.36 0.53 0.18 2.84 2.01 000
59012... .................. A Fetal cord puncture, 3.45 NA 1.53 0.31 NA 5.29 000
prenatal.
59015... .................. A Chorion biopsy........... 2.20 1.25 0.91 0.10 3.55 3.21 000
59020... .................. A Fetal contract stress 0.66 1.15 1.15 0.29 2.10 2.10 000
test.
59020... 26 A Fetal contract stress 0.66 NA 0.21 0.19 NA 1.06 000
test.
59020... TC A Fetal contract stress 0.00 0.94 0.94 0.10 1.04 1.04 000
test.
59025... .................. A Fetal non-stress test.... 0.53 0.61 0.61 0.12 1.26 1.26 000
59025... 26 A Fetal non-stress test.... 0.53 NA 0.21 0.08 NA 0.82 000
59025... TC A Fetal non-stress test.... 0.00 0.40 0.40 0.04 0.44 0.44 000
59030... .................. A Fetal scalp blood sample. 1.99 NA 1.00 0.21 NA 3.20 000
59050... .................. A Fetal monitor w/report... 0.89 NA 0.37 0.15 NA 1.41 XXX
59051... .................. A Fetal monitor/interpret 0.74 NA 0.31 0.15 NA 1.20 XXX
only.
59100... .................. A Remove uterus lesion..... 12.35 NA 6.27 0.96 NA 19.58 090
59120... .................. A Treat ectopic pregnancy.. 11.49 NA 5.88 1.50 NA 18.87 090
59121... .................. A Treat ectopic pregnancy.. 11.67 NA 5.63 1.07 NA 18.37 090
59130... .................. A Treat ectopic pregnancy.. 14.22 NA 16.39 0.70 NA 31.31 090
59135... .................. A Treat ectopic pregnancy.. 13.88 NA 6.08 1.15 NA 21.11 090
59136... .................. A Treat ectopic pregnancy.. 13.18 NA 6.67 1.44 NA 21.29 090
59140... .................. A Treat ectopic pregnancy.. 5.46 NA 2.97 0.29 NA 8.72 090
59150... .................. A Treat ectopic pregnancy.. 6.89 NA 4.30 1.05 NA 12.24 090
59151... .................. A Treat ectopic pregnancy.. 7.86 NA 4.21 0.64 NA 12.71 090
[[Page 30956]]
59160... .................. A D&C after delivery....... 2.71 2.93 1.99 0.52 6.16 5.22 010
59200... .................. A Insert cervical dilator.. 0.79 1.03 0.31 0.11 1.93 1.21 000
59300... .................. A Episiotomy or vaginal 2.41 1.54 0.97 0.10 4.05 3.48 000
repair.
59320... .................. A Revision of cervix....... 2.48 NA 1.36 0.41 NA 4.25 000
59325... .................. A Revision of cervix....... 4.07 NA 2.35 0.29 NA 6.71 000
59350... .................. A Repair of uterus......... 4.95 NA 2.11 0.82 NA 7.88 000
59400... .................. A Obstetrical care......... 23.06 NA 12.94 3.47 NA 39.47 MMM
59409... .................. A Obstetrical care......... 13.50 NA 5.47 2.20 NA 21.17 MMM
59410... .................. A Obstetrical care......... 14.78 NA 6.52 2.39 NA 23.69 MMM
59412... .................. A Antepartum manipulation.. 1.71 1.29 0.70 0.29 3.29 2.70 MMM
59414... .................. A Deliver placenta......... 1.61 NA 1.07 0.27 NA 2.95 MMM
59425... .................. A Antepartum care only..... 4.81 4.02 4.05 0.66 9.49 9.52 MMM
59426... .................. A Antepartum care only..... 8.28 6.86 6.89 1.14 16.28 16.31 MMM
59430... .................. A Care after delivery...... 2.13 1.11 1.10 0.07 3.31 3.30 MMM
59510... .................. A Cesarean delivery........ 26.22 NA 14.88 3.92 NA 45.02 MMM
59514... .................. A Cesarean delivery only... 15.97 NA 6.48 2.55 NA 25.00 MMM
59515... .................. A Cesarean delivery........ 17.37 NA 7.92 2.73 NA 28.02 MMM
59525... .................. A Remove uterus after 8.54 NA 3.67 0.88 NA 13.09 MMM
cesarean.
59610... .................. A Vbac delivery............ 24.62 NA 10.06 3.47 NA 38.15 MMM
59612... .................. A Vbac delivery only....... 15.06 NA 6.06 2.20 NA 23.32 MMM
59614... .................. A Vbac care after delivery. 16.34 NA 6.41 2.39 NA 25.14 MMM
59618... .................. A Attempted vbac delivery.. 27.78 NA 11.13 3.92 NA 42.83 MMM
59620... .................. A Attempted vbac delivery 17.53 NA 17.55 2.55 NA 37.63 MMM
only.
59622... .................. A Attempted vbac after care 18.93 NA 7.86 2.73 NA 29.52 MMM
59812... .................. A Treatment of miscarriage. 3.25 3.59 2.21 0.77 7.61 6.23 090
59820... .................. A Care of miscarriage...... 4.01 3.93 2.50 0.77 8.71 7.28 090
59821... .................. A Treatment of miscarriage. 4.47 4.13 2.67 0.62 9.22 7.76 090
59830... .................. A Treat uterus infection... 6.11 NA 3.64 0.52 NA 10.27 090
59840... .................. A Abortion................. 3.01 3.85 2.08 0.69 7.55 5.78 010
59841... .................. A Abortion................. 5.24 5.30 3.28 0.76 11.30 9.28 010
59850... .................. A Abortion................. 5.91 NA 2.77 0.85 NA 9.53 090
59851... .................. A Abortion................. 5.93 NA 3.07 0.88 NA 9.88 090
59852... .................. A Abortion................. 8.24 NA 4.05 1.27 NA 13.56 090
59855... .................. A Abortion................. 6.12 NA 3.12 0.96 NA 10.20 090
59856... .................. A Abortion................. 7.48 NA 3.75 1.19 NA 12.42 090
59857... .................. A Abortion................. 9.29 NA 10.55 1.44 NA 21.28 090
59866... .................. A Abortion................. 4.00 NA 4.69 0.66 NA 9.35 000
59870... .................. A Evacuate mole of uterus.. 4.28 NA 2.99 0.67 NA 7.94 090
59871... .................. A Remove cerclage suture... 2.13 3.59 2.17 0.41 6.13 4.71 000
60000... .................. A Drain thyroid/tongue cyst 1.76 1.56 1.65 0.09 3.41 3.50 010
60001... .................. A Aspirate/inject thyriod 0.97 1.47 0.36 0.12 2.56 1.45 000
cyst.
60100... .................. A Biopsy of thyroid........ 0.97 1.88 0.72 0.12 2.97 1.81 000
60200... .................. A Remove thyroid lesion.... 9.55 NA 6.23 1.04 NA 16.82 090
60210... .................. A Partial excision thyroid. 10.88 NA 6.20 1.65 NA 18.73 090
60212... .................. A Parital thyroid excision. 16.03 NA 8.19 1.74 NA 25.96 090
60220... .................. A Partial removal of 10.53 NA 6.31 1.61 NA 18.45 090
thyroid.
60225... .................. A Partial removal of 14.19 NA 8.08 1.92 NA 24.19 090
thyroid.
60240... .................. A Removal of thyroid....... 16.06 NA 9.13 1.96 NA 27.15 090
60252... .................. A Removal of thyroid....... 18.20 NA 10.75 2.55 NA 31.50 090
60254... .................. A Extensive thyroid surgery 23.88 NA 14.70 3.08 NA 41.66 090
60260... .................. A Repeat thyroid surgery... 15.46 NA 9.42 0.34 NA 25.22 090
60270... .................. A Removal of thyroid....... 17.94 NA 10.61 2.54 NA 31.09 090
60271... .................. A Removal of thyroid....... 14.89 NA 8.98 2.25 NA 26.12 090
60280... .................. A Remove thyroid duct 6.08 NA 4.89 1.11 NA 12.08 090
lesion.
60281... .................. A Remove thyroid duct 8.53 NA 5.94 0.95 NA 15.42 090
lesion.
60500... .................. A Explore parathyroid 16.23 NA 8.14 2.31 NA 26.68 090
glands.
60502... .................. A Re-explore parathyroids.. 20.35 NA 10.27 2.33 NA 32.95 090
60505... .................. A Explore parathyroid 21.49 NA 11.63 2.56 NA 35.68 090
glands.
60512... .................. A Autotransplant, 4.45 NA 2.04 0.54 NA 7.03 ZZZ
parathyroid.
60520... .................. A Removal of thymus gland.. 16.81 NA 9.26 2.46 NA 28.53 090
60521... .................. A Removal thymus gland..... 18.87 NA 10.85 2.46 NA 32.18 090
60522... .................. A Removal of thymus gland.. 23.09 NA 12.72 2.46 NA 38.27 090
60540... .................. A Explore adrenal gland.... 17.03 NA 8.46 2.08 NA 27.57 090
60545... .................. A Explore adrenal gland.... 19.88 NA 9.89 2.34 NA 32.11 090
60600... .................. A Remove carotid body 17.93 NA 12.24 1.88 NA 32.05 090
lesion.
60605... .................. A Remove carotid body 20.24 NA 17.68 2.21 NA 40.13 090
lesion.
61000... .................. A Remove cranial cavity 1.58 1.26 1.30 0.17 3.01 3.05 000
fluid.
61001... .................. A Remove cranial cavity 1.49 1.24 1.27 0.17 2.90 2.93 000
fluid.
61020... .................. A Remove brain cavity fluid 1.51 1.30 1.23 0.20 3.01 2.94 000
61026... .................. A Injection into brain 1.69 1.33 1.28 0.22 3.24 3.19 000
canal.
61050... .................. A Remove brain canal fluid. 1.51 NA 1.34 0.15 NA 3.00 000
61055... .................. A Injection into brain 2.10 NA 1.45 0.19 NA 3.74 000
canal.
61070... .................. A Brain canal shunt 0.89 3.37 0.84 0.03 4.29 1.76 000
procedure.
61105... .................. A Drill skull for 5.14 NA 3.51 1.24 NA 9.89 090
examination.
[[Page 30957]]
61106... .................. A Drill skull for exam/ 4.62 NA 2.67 1.15 NA 8.44 ZZZ
surgery.
61107... .................. A Drill skull for 5.00 NA 3.13 1.26 NA 9.39 000
implantation.
61108... .................. A Drill skull for drainage. 10.19 NA 6.82 2.22 NA 19.23 090
61120... .................. A Pierce skull for 8.76 NA 5.73 1.08 NA 15.57 090
examination.
61130... .................. A Pierce skull, exam/ 6.37 NA 3.71 0.96 NA 11.04 ZZZ
surgery.
61140... .................. A Pierce skull for biopsy.. 15.90 NA 10.04 2.56 NA 28.50 090
61150... .................. A Pierce skull for drainage 17.57 NA 10.62 2.63 NA 30.82 090
61151... .................. A Pierce skull for drainage 12.42 NA 8.03 0.37 NA 20.82 090
61154... .................. A Pierce skull, remove clot 14.99 NA 9.45 3.27 NA 27.71 090
61156... .................. A Pierce skull for drainage 16.32 NA 10.26 3.05 NA 29.63 090
61210... .................. A Pierce skull; implant 5.84 NA 3.67 1.53 NA 11.04 000
device.
61215... .................. A Insert brain-fluid device 4.89 NA 3.87 1.63 NA 10.39 090
61250... .................. A Pierce skull & explore... 10.42 NA 6.74 1.44 NA 18.60 090
61253... .................. A Pierce skull & explore... 12.36 NA 7.87 1.69 NA 21.92 090
61304... .................. A Open skull for 21.96 NA 13.26 4.78 NA 40.00 090
exploration.
61305... .................. A Open skull for 26.61 NA 15.78 5.05 NA 47.44 090
exploration.
61312... .................. A Open skull for drainage.. 24.57 NA 14.75 4.46 NA 43.78 090
61313... .................. A Open skull for drainage.. 24.93 NA 15.30 4.38 NA 44.61 090
61314... .................. A Open skull for drainage.. 24.23 NA 14.74 4.68 NA 43.65 090
61315... .................. A Open skull for drainage.. 27.68 NA 17.03 4.47 NA 49.18 090
61320... .................. A Open skull for drainage.. 25.62 NA 15.91 3.41 NA 44.94 090
61321... .................. A Open skull for drainage.. 28.50 NA 17.28 3.54 NA 49.32 090
61330... .................. A Decompress eye socket.... 23.32 NA 18.40 1.22 NA 42.94 090
61332... .................. A Explore/biopsy eye socket 27.28 NA 20.32 2.76 NA 50.36 090
61333... .................. A Explore orbit; remove 27.95 NA 19.48 3.26 NA 50.69 090
lesion.
61334... .................. A Explore orbit; remove 18.27 NA 11.98 1.82 NA 32.07 090
object.
61340... .................. A Relieve cranial pressure. 18.66 NA 11.75 2.54 NA 32.95 090
61343... .................. A Incise skull, pressure 29.77 NA 18.69 5.28 NA 53.74 090
relief.
61345... .................. A Relieve cranial pressure. 27.20 NA 16.48 3.45 NA 47.13 090
61440... .................. A Incise skull for surgery. 26.63 NA 14.53 3.00 NA 44.16 090
61450... .................. A Incise skull for surgery. 25.95 NA 15.66 3.43 NA 45.04 090
61458... .................. A Incise skull for brain 27.29 NA 16.70 4.87 NA 48.86 090
wound.
61460... .................. A Incise skull for surgery. 28.39 NA 17.74 3.98 NA 50.11 090
61470... .................. A Incise skull for surgery. 26.06 NA 16.40 2.53 NA 44.99 090
61480... .................. A Incise skull for surgery. 26.49 NA 32.47 1.78 NA 60.74 090
61490... .................. A Incise skull for surgery. 25.66 NA 15.39 2.16 NA 43.21 090
61500... .................. A Removal of skull lesion.. 17.92 NA 11.45 3.58 NA 32.95 090
61501... .................. A Remove infected skull 14.84 NA 9.58 3.33 NA 27.75 090
bone.
61510... .................. A Removal of brain lesion.. 28.45 NA 17.40 4.90 NA 50.75 090
61512... .................. A Remove brain lining 35.09 NA 21.10 5.28 NA 61.47 090
lesion.
61514... .................. A Removal of brain abscess. 25.26 NA 15.37 4.74 NA 45.37 090
61516... .................. A Removal of brain lesion.. 24.61 NA 15.37 4.57 NA 44.55 090
61518... .................. A Removal of brain lesion.. 37.32 NA 23.03 5.46 NA 65.81 090
61519... .................. A Remove brain lining 41.39 NA 25.28 5.77 NA 72.44 090
lesion.
61520... .................. A Removal of brain lesion.. 54.84 NA 33.94 5.89 NA 94.67 090
61521... .................. A Removal of brain lesion.. 44.48 NA 27.27 5.85 NA 77.60 090
61522... .................. A Removal of brain abscess. 29.45 NA 19.01 3.79 NA 52.25 090
61524... .................. A Removal of brain lesion.. 27.86 NA 17.28 5.15 NA 50.29 090
61526... .................. A Removal of brain lesion.. 52.17 NA 33.40 4.79 NA 90.36 090
61530... .................. A Removal of brain lesion.. 43.86 NA 29.39 4.79 NA 78.04 090
61531... .................. A Implant brain electrodes. 14.63 NA 9.56 1.75 NA 25.94 090
61533... .................. A Implant brain electrodes. 19.71 NA 12.33 3.33 NA 35.37 090
61534... .................. A Removal of brain lesion.. 20.97 NA 13.26 2.01 NA 36.24 090
61535... .................. A Remove brain electrodes.. 11.63 NA 8.05 1.25 NA 20.93 090
61536... .................. A Removal of brain lesion.. 35.52 NA 21.77 3.99 NA 61.28 090
61538... .................. A Removal of brain tissue.. 26.81 NA 17.07 4.97 NA 48.85 090
61539... .................. A Removal of brain tissue.. 32.08 NA 18.98 4.07 NA 55.13 090
61541... .................. A Incision of brain tissue. 28.85 NA 18.26 3.78 NA 50.89 090
61542... .................. A Removal of brain tissue.. 31.02 NA 17.53 3.90 NA 52.45 090
61543... .................. A Removal of brain tissue.. 29.22 NA 18.17 2.49 NA 49.88 090
61544... .................. A Remove & treat brain 25.50 NA 16.41 2.11 NA 44.02 090
lesion.
61545... .................. A Excision of brain tumor.. 43.80 NA 26.55 4.80 NA 75.15 090
61546... .................. A Removal of pituitary 31.30 NA 19.32 4.78 NA 55.40 090
gland.
61548... .................. A Removal of pituitary 21.53 NA 14.40 4.03 NA 39.96 090
gland.
61550... .................. A Release of skull seams... 14.65 NA 6.61 1.11 NA 22.37 090
61552... .................. A Release of skull seams... 19.56 NA 10.26 2.70 NA 32.52 090
61556... .................. A Incise skull/sutures..... 22.26 NA 11.78 3.04 NA 37.08 090
61557... .................. A Incise skull/sutures..... 22.38 NA 11.40 3.05 NA 36.83 090
61558... .................. A Excision of skull/sutures 25.58 NA 16.83 3.47 NA 45.88 090
61559... .................. A Excision of skull/sutures 32.79 NA 21.49 4.50 NA 58.78 090
61563... .................. A Excision of skull tumor.. 26.83 NA 17.62 3.68 NA 48.13 090
61564... .................. A Excision of skull tumor.. 33.83 NA 22.16 4.64 NA 60.63 090
61570... .................. A Remove brain foreign body 24.60 NA 14.66 3.06 NA 42.32 090
61571... .................. A Incise skull for brain 26.39 NA 16.46 3.21 NA 46.06 090
wound.
[[Page 30958]]
61575... .................. A Skull base/brainstem 34.36 NA 23.04 5.05 NA 62.45 090
surgery.
61576... .................. A Skull base/brainstem 52.43 NA 36.28 3.91 NA 92.62 090
surgery.
61580... .................. A Craniofacial approach, 30.35 NA 20.42 4.10 NA 54.87 090
skull.
61581... .................. A Craniofacial approach, 34.60 NA 23.59 4.66 NA 62.85 090
skull.
61582... .................. A Craniofacial approach, 31.66 NA 19.47 4.22 NA 55.35 090
skull.
61583... .................. A Craniofacial approach, 36.21 NA 22.95 4.83 NA 63.99 090
skull.
61584... .................. A Orbitocranial approach/ 34.65 NA 21.45 4.68 NA 60.78 090
skull.
61585... .................. A Orbitocranial approach/ 38.61 NA 25.32 5.23 NA 69.16 090
skull.
61586... .................. A Resect nasopharynx, skull 25.10 NA 18.73 2.32 NA 46.15 090
61590... .................. A Infratemporal approach/ 41.78 NA 28.03 5.68 NA 75.49 090
skull.
61591... .................. A Infratemporal approach/ 43.68 NA 29.19 5.96 NA 78.83 090
skull.
61592... .................. A Orbitocranial approach/ 39.64 NA 24.66 5.41 NA 69.71 090
skull.
61595... .................. A Transtemporal approach/ 29.57 NA 20.52 4.00 NA 54.09 090
skull.
61596... .................. A Transcochlear approach/ 35.63 NA 24.72 4.86 NA 65.21 090
skull.
61597... .................. A Transcondylar approach/ 37.96 NA 22.85 5.13 NA 65.94 090
skull.
61598... .................. A Transpetrosal approach/ 33.41 NA 22.09 4.52 NA 60.02 090
skull.
61600... .................. A Resect/excise cranial 25.85 NA 18.10 3.46 NA 47.41 090
lesion.
61601... .................. A Resect/excise cranial 27.89 NA 17.64 3.72 NA 49.25 090
lesion.
61605... .................. A Resect/excise cranial 29.33 NA 19.91 3.93 NA 53.17 090
lesion.
61606... .................. A Resect/excise cranial 38.83 NA 23.98 5.25 NA 68.06 090
lesion.
61607... .................. A Resect/excise cranial 36.27 NA 22.45 4.91 NA 63.63 090
lesion.
61608... .................. A Resect/excise cranial 42.10 NA 25.98 5.71 NA 73.79 090
lesion.
61609... .................. A Transect, artery, sinus.. 9.89 NA 5.36 1.40 NA 16.65 ZZZ
61610... .................. A Transect, artery, sinus.. 29.67 NA 16.40 4.21 NA 50.28 ZZZ
61611... .................. A Transect, artery, sinus.. 7.42 NA 8.99 1.06 NA 17.47 ZZZ
61612... .................. A Transect, artery, sinus.. 27.88 NA 15.35 3.96 NA 47.19 ZZZ
61613... .................. A Remove aneurysm, sinus... 40.86 NA 24.84 5.61 NA 71.31 090
61615... .................. A Resect/excise lesion, 32.07 NA 21.56 4.31 NA 57.94 090
skull.
61616... .................. A Resect/excise lesion, 43.33 NA 27.06 5.86 NA 76.25 090
skull.
61618... .................. A Repair dura.............. 16.99 NA 11.54 2.22 NA 30.75 090
61619... .................. A Repair dura.............. 20.71 NA 14.37 2.77 NA 37.85 090
61624... .................. A Occlusion/embolization 20.15 NA 12.30 1.79 NA 34.24 000
cath.
61626... .................. A Occlusion/embolization 16.62 NA 9.57 1.47 NA 27.66 000
cath.
61680... .................. A Intracranial vessel 30.71 NA 18.58 5.79 NA 55.08 090
surgery.
61682... .................. A Intracranial vessel 61.57 NA 36.19 6.36 NA 104.12 090
surgery.
61684... .................. A Intracranial vessel 39.81 NA 24.39 3.47 NA 67.67 090
surgery.
61686... .................. A Intracranial vessel 64.49 NA 36.48 4.20 NA 105.17 090
surgery.
61690... .................. A Intracranial vessel 29.31 NA 18.15 4.09 NA 51.55 090
surgery.
61692... .................. A Intracranial vessel 51.87 NA 31.20 3.36 NA 86.43 090
surgery.
61700... .................. A Inner skull vessel 50.52 NA 29.37 5.67 NA 85.56 090
surgery.
61702... .................. A Inner skull vessel 48.41 NA 28.26 6.61 NA 83.28 090
surgery.
61703... .................. A Clamp neck artery........ 17.47 NA 11.29 2.24 NA 31.00 090
61705... .................. A Revise circulation to 36.20 NA 20.67 5.25 NA 62.12 090
head.
61708... .................. A Revise circulation to 35.30 NA 15.87 2.32 NA 53.49 090
head.
61710... .................. A Revise circulation to 29.67 NA 14.80 1.75 NA 46.22 090
head.
61711... .................. A Fusion of skull arteries. 36.33 NA 21.45 6.20 NA 63.98 090
61712... .................. A Skull or spine 3.49 NA 2.21 0.93 NA 6.63 ZZZ
microsurgery.
61720... .................. A Incise skull/brain 16.77 NA 10.55 4.05 NA 31.37 090
surgery.
61735... .................. A Incise skull/brain 20.43 NA 12.95 1.51 NA 34.89 090
surgery.
61750... .................. A Incise skull; brain 18.20 NA 11.26 4.31 NA 33.77 090
biopsy.
61751... .................. A Brain biopsy with cat 17.62 NA 10.82 4.44 NA 32.88 090
scan.
61760... .................. A Implant brain electrodes. 22.27 NA 13.31 1.75 NA 37.33 090
61770... .................. A Incise skull for 21.44 NA 13.67 3.43 NA 38.54 090
treatment.
61790... .................. A Treat trigeminal nerve... 10.86 NA 6.57 3.03 NA 20.46 090
61791... .................. A Treat trigeminal tract... 14.61 NA 9.51 3.16 NA 27.28 090
61793... .................. A Focus radiation beam..... 17.24 NA 11.21 1.96 NA 30.41 090
61795... .................. A Brain surgery using 4.04 NA 2.61 1.55 NA 8.20 000
computer.
61850... .................. A Implant neuroelectrodes.. 12.39 NA 8.25 2.26 NA 22.90 090
61855... .................. A Implant neuroelectrodes.. 13.39 NA 8.95 1.47 NA 23.81 090
61860... .................. A Implant neuroelectrodes.. 20.87 NA 13.11 1.59 NA 35.57 090
61865... .................. A Implant neuroelectrodes.. 22.97 NA 13.68 3.09 NA 39.74 090
61870... .................. A Implant neuroelectrodes.. 14.94 NA 10.21 0.82 NA 25.97 090
61875... .................. A Implant neuroelectrodes.. 15.06 NA 21.03 1.31 NA 37.40 090
61880... .................. A Revise/remove 6.29 NA 4.64 0.66 NA 11.59 090
neuroelectrode.
61885... .................. A Implant neuroreceiver.... 5.85 NA 4.42 0.29 NA 10.56 090
61888... .................. A Revise/remove 5.07 NA 3.60 0.44 NA 9.11 010
neuroreceiver.
62000... .................. A Repair of skull fracture. 12.53 NA 6.11 0.95 NA 19.59 090
62005... .................. A Repair of skull fracture. 16.17 NA 9.71 1.97 NA 27.85 090
62010... .................. A Treatment of head injury. 19.81 NA 12.24 3.39 NA 35.44 090
62100... .................. A Repair brain fluid 22.03 NA 14.47 3.72 NA 40.22 090
leakage.
62115... .................. A Reduction of skull defect 21.66 NA 13.85 1.82 NA 37.33 090
62116... .................. A Reduction of skull defect 23.59 NA 15.13 1.99 NA 40.71 090
62117... .................. A Reduction of skull defect 26.60 NA 16.82 2.25 NA 45.67 090
62120... .................. A Repair skull cavity 23.35 NA 16.32 1.98 NA 41.65 090
lesion.
[[Page 30959]]
62121... .................. A Incise skull repair...... 21.58 NA 14.65 3.41 NA 39.64 090
62140... .................. A Repair of skull defect... 13.51 NA 8.88 2.39 NA 24.78 090
62141... .................. A Repair of skull defect... 14.91 NA 9.90 3.28 NA 28.09 090
62142... .................. A Remove skull plate/flap.. 10.79 NA 7.19 2.64 NA 20.62 090
62143... .................. A Replace skull plate/flap. 13.05 NA 8.77 1.65 NA 23.47 090
62145... .................. A Repair of skull & brain.. 18.82 NA 12.41 2.29 NA 33.52 090
62146... .................. A Repair of skull with 16.12 NA 10.41 2.15 NA 28.68 090
graft.
62147... .................. A Repair of skull with 19.34 NA 12.51 2.57 NA 34.42 090
graft.
62180... .................. A Establish brain cavity 21.06 NA 13.51 2.70 NA 37.27 090
shunt.
62190... .................. A Establish brain cavity 11.07 NA 7.75 3.21 NA 22.03 090
shunt.
62192... .................. A Establish brain cavity 12.25 NA 8.28 2.74 NA 23.27 090
shunt.
62194... .................. A Replace/irrigate catheter 5.03 NA 2.49 0.29 NA 7.81 010
62200... .................. A Establish brain cavity 18.32 NA 11.85 3.09 NA 33.26 090
shunt.
62201... .................. A Establish brain cavity 14.86 NA 10.10 1.72 NA 26.68 090
shunt.
62220... .................. A Establish brain cavity 13.00 NA 8.29 3.12 NA 24.41 090
shunt.
62223... .................. A Establish brain cavity 12.87 NA 8.36 3.02 NA 24.25 090
shunt.
62225... .................. A Replace/irrigate catheter 5.41 NA 3.93 0.58 NA 9.92 090
62230... .................. A Replace/revise brain 10.54 NA 6.77 1.82 NA 19.13 090
shunt.
62256... .................. A Remove brain cavity shunt 6.60 NA 4.90 1.17 NA 12.67 090
62258... .................. A Replace brain cavity 14.54 NA 9.12 2.55 NA 26.21 090
shunt.
62268... .................. A Drain spinal cord cyst... 4.74 NA 2.47 0.36 NA 7.57 000
62269... .................. A Needle biopsy spinal cord 5.02 NA 2.43 0.28 NA 7.73 000
62270... .................. A Spinal fluid tap, 1.13 0.64 0.40 0.06 1.83 1.59 000
diagnostic.
62272... .................. A Drain spinal fluid....... 1.35 0.79 0.58 0.12 2.26 2.05 000
62273... .................. A Treat lumbar spine lesion 2.15 1.24 0.82 0.26 3.65 3.23 000
62274... .................. A Inject spinal anesthetic. 1.78 2.37 1.22 0.17 4.32 3.17 000
62275... .................. A Inject spinal anesthetic. 1.79 2.14 1.21 0.19 4.12 3.19 000
62276... .................. A Inject spinal anesthetic. 2.04 1.89 1.46 0.23 4.16 3.73 000
62277... .................. A Inject spinal anesthetic. 2.15 3.63 1.26 0.23 6.01 3.64 000
62278... .................. A Inject spinal anesthetic. 1.51 1.52 2.16 0.26 3.29 3.93 000
62279... .................. A Inject spinal anesthetic. 1.58 1.80 1.13 0.24 3.62 2.95 000
62280... .................. A Treat spinal cord lesion. 2.63 2.29 1.49 0.14 5.06 4.26 010
62281... .................. A Treat spinal cord lesion. 2.66 2.36 1.39 0.28 5.30 4.33 010
62282... .................. A Treat spinal canal lesion 2.33 3.74 1.41 0.40 6.47 4.14 010
62284... .................. A Injection for myelogram.. 1.54 2.27 0.78 0.34 4.15 2.66 000
62287... .................. A Percutaneous diskectomy.. 8.08 NA 4.98 2.65 NA 15.71 090
62288... .................. A Injection into spinal 1.74 2.48 1.36 0.24 4.46 3.34 000
canal.
62289... .................. A Injection into spinal 1.64 2.43 1.19 0.29 4.36 3.12 000
canal.
62290... .................. A Inject for spine disk x- 3.00 2.84 1.48 0.24 6.08 4.72 000
ray.
62291... .................. A Inject for spine disk x- 2.91 2.96 1.17 0.39 6.26 4.47 000
ray.
62292... .................. A Injection into disk 7.86 NA 4.91 2.13 NA 14.90 090
lesion.
62294... .................. A Injection into spinal 11.83 NA 6.64 0.68 NA 19.15 090
artery.
62298... .................. A Injection into spinal 2.20 2.45 1.25 0.13 4.78 3.58 000
canal.
62350... .................. A Implant spinal catheter.. 6.87 NA 3.29 1.02 NA 11.18 090
62351... .................. A Implant spinal catheter.. 10.00 NA 6.04 1.50 NA 17.54 090
62355... .................. A Remove spinal canal 5.45 NA 2.26 0.68 NA 8.39 090
catheter.
62360... .................. A Insert spine infusion 2.62 NA 2.18 0.33 NA 5.13 090
device.
62361... .................. A Implant spine infusion 5.42 NA 2.63 0.78 NA 8.83 090
pump.
62362... .................. A Implant spine infusion 7.04 NA 3.87 1.02 NA 11.93 090
pump.
62365... .................. A Remove spine infusion 5.42 NA 2.88 0.68 NA 8.98 090
device.
62367... 26 A Analyze spine infusion 0.48 0.10 0.10 0.07 0.65 0.65 XXX
pump.
62368... 26 A Analyze spine infusion 0.75 0.16 0.16 0.11 1.02 1.02 XXX
pump.
63001... .................. A Removal of spinal lamina. 15.82 NA 10.73 3.42 NA 29.97 090
63003... .................. A Removal of spinal lamina. 15.95 NA 10.73 3.23 NA 29.91 090
63005... .................. A Removal of spinal lamina. 14.92 NA 10.60 3.10 NA 28.62 090
63011... .................. A Removal of spinal lamina. 14.52 NA 10.02 1.87 NA 26.41 090
63012... .................. A Removal of spinal lamina. 15.40 NA 10.51 3.15 NA 29.06 090
63015... .................. A Removal of spinal lamina. 19.35 NA 12.63 4.18 NA 36.16 090
63016... .................. A Removal of spinal lamina. 19.20 NA 12.90 4.11 NA 36.21 090
63017... .................. A Removal of spinal lamina. 15.94 NA 11.18 4.00 NA 31.12 090
63020... .................. A Neck spine disk surgery.. 14.81 NA 10.25 3.38 NA 28.44 090
63030... .................. A Low back disk surgery.... 12.00 NA 8.73 2.81 NA 23.54 090
63035... .................. A Added spinal disk surgery 3.15 NA 2.10 0.76 NA 6.01 ZZZ
63040... .................. A Neck spine disk surgery.. 18.81 NA 12.81 4.30 NA 35.92 090
63042... .................. A Low back disk surgery.... 17.47 NA 11.99 4.38 NA 33.84 090
63045... .................. A Removal of spinal lamina. 16.50 NA 11.21 4.38 NA 32.09 090
63046... .................. A Removal of spinal lamina. 15.80 NA 10.99 4.58 NA 31.37 090
63047... .................. A Removal of spinal lamina. 14.61 NA 10.46 4.48 NA 29.55 090
63048... .................. A Removal of spinal lamina. 3.26 NA 2.23 1.03 NA 6.52 ZZZ
63055... .................. A Decompress spinal cord... 21.99 NA 14.35 4.18 NA 40.52 090
63056... .................. A Decompress spinal cord... 20.36 NA 13.92 3.76 NA 38.04 090
63057... .................. A Decompress spinal cord... 5.26 NA 3.19 0.85 NA 9.30 ZZZ
63064... .................. A Decompress spinal cord... 24.61 NA 16.30 4.09 NA 45.00 090
63066... .................. A Decompress spinal cord... 3.26 NA 2.18 0.45 NA 5.89 ZZZ
[[Page 30960]]
63075... .................. A Neck spine disk surgery.. 19.41 NA 12.78 3.21 NA 35.40 090
63076... .................. A Neck spine disk surgery.. 4.05 NA 2.73 0.97 NA 7.75 ZZZ
63077... .................. A Spine disk surgery, 21.44 NA 14.91 3.17 NA 39.52 090
thorax.
63078... .................. A Spine disk surgery, 3.28 NA 2.34 0.45 NA 6.07 ZZZ
thorax.
63081... .................. A Removal of vertebral body 23.73 NA 15.84 4.50 NA 44.07 090
63082... .................. A Removal of vertebral body 4.37 NA 2.96 1.22 NA 8.55 ZZZ
63085... .................. A Removal of vertebral body 26.92 NA 17.86 4.69 NA 49.47 090
63086... .................. A Removal of vertebral body 3.19 NA 1.35 1.07 NA 5.61 ZZZ
63087... .................. A Removal of vertebral body 35.57 NA 22.64 4.85 NA 63.06 090
63088... .................. A Removal of vertebral body 4.33 NA 2.98 1.18 NA 8.49 ZZZ
63090... .................. A Removal of vertebral body 28.16 NA 18.37 4.92 NA 51.45 090
63091... .................. A Removal of vertebral body 3.03 NA 2.10 0.46 NA 5.59 ZZZ
63170... .................. A Incise spinal cord 19.83 NA 13.17 3.28 NA 36.28 090
tract(s).
63172... .................. A Drainage of spinal cyst.. 17.66 NA 12.04 4.26 NA 33.96 090
63173... .................. A Drainage of spinal cyst.. 21.99 NA 14.50 1.81 NA 38.30 090
63180... .................. A Revise spinal cord 18.27 NA 11.80 2.05 NA 32.12 090
ligaments.
63182... .................. A Revise spinal cord 20.50 NA 13.00 2.21 NA 35.71 090
ligaments.
63185... .................. A Incise spinal column/ 15.04 NA 9.89 2.93 NA 27.86 090
nerves.
63190... .................. A Incise spinal column/ 17.45 NA 11.57 3.91 NA 32.93 090
nerves.
63191... .................. A Incise spinal column/ 17.54 NA 12.16 2.21 NA 31.91 090
nerves.
63194... .................. A Incise spinal column & 19.19 NA 13.04 2.33 NA 34.56 090
cord.
63195... .................. A Incise spinal column & 18.84 NA 12.24 2.11 NA 33.19 090
cord.
63196... .................. A Incise spinal column & 22.30 NA 12.39 1.83 NA 36.52 090
cord.
63197... .................. A Incise spinal column & 21.11 NA 13.78 2.62 NA 37.51 090
cord.
63198... .................. A Incise spinal column & 25.38 NA 33.47 3.19 NA 62.04 090
cord.
63199... .................. A Incise spinal column & 26.89 NA 12.16 2.61 NA 41.66 090
cord.
63200... .................. A Release of spinal cord... 19.18 NA 12.21 1.83 NA 33.22 090
63250... .................. A Revise spinal cord 40.76 NA 23.31 5.22 NA 69.29 090
vessels.
63251... .................. A Revise spinal cord 41.20 NA 24.91 4.32 NA 70.43 090
vessels.
63252... .................. A Revise spinal cord 41.19 NA 22.74 5.52 NA 69.45 090
vessels.
63265... .................. A Excise intraspinal lesion 21.56 NA 13.88 3.90 NA 39.34 090
63266... .................. A Excise intraspinal lesion 22.30 NA 14.16 4.43 NA 40.89 090
63267... .................. A Excise intraspinal lesion 17.95 NA 11.93 4.20 NA 34.08 090
63268... .................. A Excise intraspinal lesion 18.52 NA 11.63 2.46 NA 32.61 090
63270... .................. A Excise intraspinal lesion 26.80 NA 16.57 3.42 NA 46.79 090
63271... .................. A Excise intraspinal lesion 26.92 NA 16.80 4.79 NA 48.51 090
63272... .................. A Excise intraspinal lesion 25.32 NA 15.72 4.26 NA 45.30 090
63273... .................. A Excise intraspinal lesion 24.29 NA 15.41 3.12 NA 42.82 090
63275... .................. A Biopsy/excise spinal 23.68 NA 14.78 5.09 NA 43.55 090
tumor.
63276... .................. A Biopsy/excise spinal 23.45 NA 14.78 4.62 NA 42.85 090
tumor.
63277... .................. A Biopsy/excise spinal 20.83 NA 13.44 4.25 NA 38.52 090
tumor.
63278... .................. A Biopsy/excise spinal 20.56 NA 13.18 4.32 NA 38.06 090
tumor.
63280... .................. A Biopsy/excise spinal 28.35 NA 17.77 4.99 NA 51.11 090
tumor.
63281... .................. A Biopsy/excise spinal 28.05 NA 17.40 4.96 NA 50.41 090
tumor.
63282... .................. A Biopsy/excise spinal 26.39 NA 16.53 4.44 NA 47.36 090
tumor.
63283... .................. A Biopsy/excise spinal 25.00 NA 15.98 3.44 NA 44.42 090
tumor.
63285... .................. A Biopsy/excise spinal 36.00 NA 21.55 4.49 NA 62.04 090
tumor.
63286... .................. A Biopsy/excise spinal 35.63 NA 21.97 4.92 NA 62.52 090
tumor.
63287... .................. A Biopsy/excise spinal 36.70 NA 22.55 4.53 NA 63.78 090
tumor.
63290... .................. A Biopsy/excise spinal 37.38 NA 22.74 4.65 NA 64.77 090
tumor.
63300... .................. A Removal of vertebral body 24.43 NA 15.51 2.02 NA 41.96 090
63301... .................. A Removal of vertebral body 27.60 NA 17.36 3.58 NA 48.54 090
63302... .................. A Removal of vertebral body 27.81 NA 18.00 3.02 NA 48.83 090
63303... .................. A Removal of vertebral body 30.50 NA 18.91 3.39 NA 52.80 090
63304... .................. A Removal of vertebral body 30.33 NA 18.67 2.49 NA 51.49 090
63305... .................. A Removal of vertebral body 32.03 NA 19.28 3.75 NA 55.06 090
63306... .................. A Removal of vertebral body 32.22 NA 19.95 2.65 NA 54.82 090
63307... .................. A Removal of vertebral body 31.63 NA 17.92 2.98 NA 52.53 090
63308... .................. A Removal of vertebral body 5.25 NA 3.17 0.73 NA 9.15 ZZZ
63600... .................. A Remove spinal cord lesion 14.02 NA 5.15 2.63 NA 21.80 090
63610... .................. A Stimulation of spinal 8.73 NA 2.31 2.06 NA 13.10 000
cord.
63615... .................. A Remove lesion of spinal 16.28 NA 10.48 2.03 NA 28.79 090
cord.
63650... .................. A Implant neuroelectrodes.. 6.74 NA 2.48 2.13 NA 11.35 090
63655... .................. A Implant neuroelectrodes.. 10.29 NA 7.28 3.64 NA 21.21 090
63660... .................. A Revise/remove 6.16 NA 3.22 1.56 NA 10.94 090
neuroelectrode.
63685... .................. A Implant neuroreceiver.... 7.04 NA 3.67 1.46 NA 12.17 090
63688... .................. A Revise/remove 5.39 NA 3.27 1.26 NA 9.92 090
neuroreceiver.
63690... .................. A Analysis of neuroreceiver 0.45 0.31 0.24 0.12 0.88 0.81 XXX
63691... .................. A Analysis of neuroreceiver 0.65 0.41 0.35 0.11 1.17 1.11 XXX
63700... .................. A Repair of spinal 16.53 NA 10.92 2.22 NA 29.67 090
herniation.
63702... .................. A Repair of spinal 18.48 NA 11.93 2.49 NA 32.90 090
herniation.
63704... .................. A Repair of spinal 21.18 NA 14.82 2.77 NA 38.77 090
herniation.
63706... .................. A Repair of spinal 24.11 NA 15.25 3.18 NA 42.54 090
herniation.
63707... .................. A Repair spinal fluid 11.26 NA 8.05 2.56 NA 21.87 090
leakage.
[[Page 30961]]
63709... .................. A Repair spinal fluid 14.32 NA 10.23 3.30 NA 27.85 090
leakage.
63710... .................. A Graft repair of spine 14.07 NA 9.67 1.58 NA 25.32 090
defect.
63740... .................. A Install spinal shunt..... 11.36 NA 7.83 2.99 NA 22.18 090
63741... .................. A Install spinal shunt..... 8.25 NA 4.93 2.39 NA 15.57 090
63744... .................. A Revision of spinal shunt. 8.10 NA 4.95 1.68 NA 14.73 090
63746... .................. A Removal of spinal shunt.. 6.43 NA 3.39 1.08 NA 10.90 090
64400... .................. A Injection for nerve block 1.11 1.44 1.03 0.05 2.60 2.19 000
64402... .................. A Injection for nerve block 1.25 2.85 1.19 0.09 4.19 2.53 000
64405... .................. A Injection for nerve block 1.32 1.49 0.99 0.07 2.88 2.38 000
64408... .................. A Injection for nerve block 1.41 1.68 1.36 0.11 3.20 2.88 000
64410... .................. A Injection for nerve block 1.43 1.56 1.12 0.15 3.14 2.70 000
64412... .................. A Injection for nerve block 1.18 1.52 0.96 0.08 2.78 2.22 000
64413... .................. A Injection for nerve block 1.40 1.74 1.17 0.08 3.22 2.65 000
64415... .................. A Injection for nerve block 1.48 1.52 1.12 0.07 3.07 2.67 000
64417... .................. A Injection for nerve block 1.44 1.44 1.09 0.15 3.03 2.68 000
64418... .................. A Injection for nerve block 1.32 1.42 0.98 0.10 2.84 2.40 000
64420... .................. A Injection for nerve block 1.18 1.47 0.98 0.07 2.72 2.23 000
64421... .................. A Injection for nerve block 1.68 1.62 1.16 0.17 3.47 3.01 000
64425... .................. A Injection for nerve block 1.75 1.43 1.07 0.10 3.28 2.92 000
64430... .................. A Injection for nerve block 1.46 2.10 1.16 0.12 3.68 2.74 000
64435... .................. A Injection for nerve block 1.45 2.24 1.58 0.09 3.78 3.12 000
64440... .................. A Injection for nerve block 1.34 2.16 1.20 0.09 3.59 2.63 000
64441... .................. A Injection for nerve block 1.79 2.29 1.25 0.12 4.20 3.16 000
64442... .................. A Injection for nerve block 1.41 2.40 1.33 0.16 3.97 2.90 000
64443... .................. A Injection for nerve block 0.98 2.18 1.34 0.12 3.28 2.44 ZZZ
64445... .................. A Injection for nerve block 1.48 2.00 1.19 0.06 3.54 2.73 000
64450... .................. A Injection for nerve block 1.27 1.00 1.00 0.05 2.32 2.32 000
64505... .................. A Injection for nerve block 1.36 1.57 1.14 0.06 2.99 2.56 000
64508... .................. A Injection for nerve block 1.12 1.69 1.42 0.08 2.89 2.62 000
64510... .................. A Injection for nerve block 1.22 1.43 1.05 0.18 2.83 2.45 000
64520... .................. A Injection for nerve block 1.35 2.03 1.10 0.17 3.55 2.62 000
64530... .................. A Injection for nerve block 1.58 3.11 1.30 0.28 4.97 3.16 000
64550... .................. A Apply neurostimulator.... 0.18 0.25 0.04 0.04 0.47 0.26 000
64553... .................. A Implant neuroelectrodes.. 2.31 1.19 1.50 0.10 3.60 3.91 010
64555... .................. A Implant neuroelectrodes.. 2.27 1.75 0.91 0.10 4.12 3.28 010
64560... .................. A Implant neuroelectrodes.. 2.36 1.13 1.05 0.24 3.73 3.65 010
64565... .................. A Implant neuroelectrodes.. 1.76 1.77 0.73 0.08 3.61 2.57 010
64573... .................. A Implant neuroelectrodes.. 4.43 NA 2.77 0.61 NA 7.81 090
64575... .................. A Implant neuroelectrodes.. 4.35 NA 3.07 0.40 NA 7.82 090
64577... .................. A Implant neuroelectrodes.. 4.62 NA 3.02 0.45 NA 8.09 090
64580... .................. A Implant neuroelectrodes.. 4.12 NA 2.55 0.20 NA 6.87 090
64585... .................. A Revise/remove 2.06 1.66 1.54 0.09 3.81 3.69 010
neuroelectrode.
64590... .................. A Implant neuroreceiver.... 2.40 NA 2.18 0.35 NA 4.93 010
64595... .................. A Revise/remove 1.73 NA 1.55 0.21 NA 3.49 010
neuroreceiver.
64600... .................. A Injection treatment of 3.45 2.22 1.88 0.17 5.84 5.50 010
nerve.
64605... .................. A Injection treatment of 5.61 4.38 2.31 0.33 10.32 8.25 010
nerve.
64610... .................. A Injection treatment of 7.16 NA 4.22 1.35 NA 12.73 010
nerve.
64612... .................. A Destroy nerve, face 1.96 2.41 2.10 0.17 4.54 4.23 010
muscle.
64613... .................. A Destroy nerve, spine 1.96 1.23 1.18 0.17 3.36 3.31 010
muscle.
64620... .................. A Injection treatment of 2.84 1.87 1.47 0.19 4.90 4.50 010
nerve.
64622... .................. A Injection treatment of 3.00 3.33 1.56 0.35 6.68 4.91 010
nerve.
64623... .................. A Injection treatment of 0.99 2.08 1.13 0.17 3.24 2.29 ZZZ
nerve.
64630... .................. A Injection treatment of 3.00 2.29 1.43 0.38 5.67 4.81 010
nerve.
64640... .................. A Injection treatment of 2.76 2.52 1.94 0.09 5.37 4.79 010
nerve.
64680... .................. A Injection treatment of 2.62 1.56 1.55 0.41 4.59 4.58 010
nerve.
64702... .................. A Revise finger/toe nerve.. 4.23 NA 3.52 0.70 NA 8.45 090
64704... .................. A Revise hand/foot nerve... 4.57 NA 2.92 0.74 NA 8.23 090
64708... .................. A Revise arm/leg nerve..... 6.12 NA 4.82 1.26 NA 12.20 090
64712... .................. A Revision of sciatic nerve 7.75 NA 4.87 1.68 NA 14.30 090
64713... .................. A Revision of arm nerve(s). 11.00 NA 6.33 1.72 NA 19.05 090
64714... .................. A Revise low back nerve(s). 10.33 NA 4.61 1.41 NA 16.35 090
64716... .................. A Revision of cranial nerve 6.31 NA 4.82 0.67 NA 11.80 090
64718... .................. A Revise ulnar nerve at 5.99 NA 4.90 1.13 NA 12.02 090
elbow.
64719... .................. A Revise ulnar nerve at 4.85 NA 4.10 0.85 NA 9.80 090
wrist.
64721... .................. A Carpal tunnel surgery.... 4.29 4.68 6.98 0.83 9.80 12.10 090
64722... .................. A Relieve pressure on 4.70 NA 3.06 1.11 NA 8.87 090
nerve(s).
64726... .................. A Release foot/toe nerve... 4.18 NA 2.49 0.07 NA 6.74 090
64727... .................. A Internal nerve revision.. 3.10 NA 2.10 0.55 NA 5.75 ZZZ
64732... .................. A Incision of brow nerve... 4.41 NA 3.16 0.72 NA 8.29 090
64734... .................. A Incision of cheek nerve.. 4.92 NA 3.23 0.67 NA 8.82 090
64736... .................. A Incision of chin nerve... 4.60 NA 2.70 0.42 NA 7.72 090
64738... .................. A Incision of jaw nerve.... 5.73 NA 3.22 0.61 NA 9.56 090
64740... .................. A Incision of tongue nerve. 5.59 NA 3.55 0.62 NA 9.76 090
64742... .................. A Incision of facial nerve. 6.22 NA 4.72 0.44 NA 11.38 090
[[Page 30962]]
64744... .................. A Incise nerve, back of 5.24 NA 3.43 1.10 NA 9.77 090
head.
64746... .................. A Incise diaphragm nerve... 5.93 NA 3.88 0.77 NA 10.58 090
64752... .................. A Incision of vagus nerve.. 7.06 NA 4.07 0.85 NA 11.98 090
64755... .................. A Incision of stomach 13.52 NA 6.43 2.27 NA 22.22 090
nerves.
64760... .................. A Incision of vagus nerve.. 6.96 NA 3.72 1.50 NA 12.18 090
64761... .................. A Incision of pelvis nerve. 6.41 NA 3.66 0.50 NA 10.57 090
64763... .................. A Incise hip/thigh nerve... 6.93 NA 5.70 0.92 NA 13.55 090
64766... .................. A Incise hip/thigh nerve... 8.67 NA 4.91 1.20 NA 14.78 090
64771... .................. A Sever cranial nerve...... 7.35 NA 5.16 0.73 NA 13.24 090
64772... .................. A Incision of spinal nerve. 7.21 NA 4.03 1.30 NA 12.54 090
64774... .................. A Remove skin nerve lesion. 5.17 NA 3.43 0.45 NA 9.05 090
64776... .................. A Remove digit nerve lesion 5.12 NA 3.59 0.41 NA 9.12 090
64778... .................. A Added digit nerve surgery 3.11 NA 1.95 0.43 NA 5.49 ZZZ
64782... .................. A Remove limb nerve lesion. 6.23 NA 3.40 0.46 NA 10.09 090
64783... .................. A Added limb nerve surgery. 3.72 NA 2.42 0.47 NA 6.61 ZZZ
64784... .................. A Remove nerve lesion...... 9.82 NA 6.55 0.96 NA 17.33 090
64786... .................. A Remove sciatic nerve 15.46 NA 10.12 2.14 NA 27.72 090
lesion.
64787... .................. A Implant nerve end........ 4.30 NA 2.51 0.60 NA 7.41 ZZZ
64788... .................. A Remove skin nerve lesion. 4.61 NA 2.99 0.50 NA 8.10 090
64790... .................. A Removal of nerve lesion.. 11.31 NA 7.35 1.22 NA 19.88 090
64792... .................. A Removal of nerve lesion.. 14.92 NA 9.11 1.66 NA 25.69 090
64795... .................. A Biopsy of nerve.......... 3.01 NA 1.73 0.39 NA 5.13 000
64802... .................. A Remove sympathetic nerves 9.15 NA 5.06 1.10 NA 15.31 090
64804... .................. A Remove sympathetic nerves 14.64 NA 8.06 2.44 NA 25.14 090
64809... .................. A Remove sympathetic nerves 13.67 NA 6.18 2.04 NA 21.89 090
64818... .................. A Remove sympathetic nerves 10.30 NA 5.49 1.72 NA 17.51 090
64820... .................. A Remove sympathetic nerves 10.37 NA 7.87 1.42 NA 19.66 090
64830... .................. A Microrepair of nerve..... 3.10 NA 2.09 0.38 NA 5.57 ZZZ
64831... .................. A Repair of digit nerve.... 9.44 NA 6.91 0.56 NA 16.91 090
64832... .................. A Repair additional nerve.. 5.66 NA 3.63 0.24 NA 9.53 ZZZ
64834... .................. A Repair of hand or foot 10.19 NA 7.05 0.56 NA 17.80 090
nerve.
64835... .................. A Repair of hand or foot 10.94 NA 7.57 1.03 NA 19.54 090
nerve.
64836... .................. A Repair of hand or foot 10.94 NA 7.50 1.22 NA 19.66 090
nerve.
64837... .................. A Repair additional nerve.. 6.26 NA 3.93 0.85 NA 11.04 ZZZ
64840... .................. A Repair of leg nerve...... 13.02 NA 9.09 0.53 NA 22.64 090
64856... .................. A Repair/transpose nerve... 13.80 NA 9.82 1.46 NA 25.08 090
64857... .................. A Repair arm/leg nerve..... 14.49 NA 10.20 1.54 NA 26.23 090
64858... .................. A Repair sciatic nerve..... 16.49 NA 10.05 2.11 NA 28.65 090
64859... .................. A Additional nerve surgery. 4.26 NA 2.55 0.58 NA 7.39 ZZZ
64861... .................. A Repair of arm nerves..... 19.24 NA 14.22 1.38 NA 34.84 090
64862... .................. A Repair of low back nerves 19.44 NA 8.00 1.61 NA 29.05 090
64864... .................. A Repair of facial nerve... 12.55 NA 8.83 1.16 NA 22.54 090
64865... .................. A Repair of facial nerve... 15.24 NA 10.67 1.50 NA 27.41 090
64866... .................. A Fusion of facial/other 15.74 NA 10.75 1.84 NA 28.33 090
nerve.
64868... .................. A Fusion of facial/other 14.04 NA 9.67 1.47 NA 25.18 090
nerve.
64870... .................. A Fusion of facial/other 15.99 NA 20.77 1.70 NA 38.46 090
nerve.
64872... .................. A Subsequent repair of 1.99 NA 1.29 0.29 NA 3.57 ZZZ
nerve.
64874... .................. A Repair & revise nerve.... 2.98 NA 1.80 0.43 NA 5.21 ZZZ
64876... .................. A Repair nerve; shorten 3.38 NA 2.25 0.48 NA 6.11 ZZZ
bone.
64885... .................. A Nerve graft, head or neck 17.53 NA 11.64 1.48 NA 30.65 090
64886... .................. A Nerve graft, head or neck 20.75 NA 13.57 1.77 NA 36.09 090
64890... .................. A Nerve graft, hand or foot 15.15 NA 10.74 2.12 NA 28.01 090
64891... .................. A Nerve graft, hand or foot 16.14 NA 11.69 1.73 NA 29.56 090
64892... .................. A Nerve graft, arm or leg.. 14.65 NA 10.55 1.69 NA 26.89 090
64893... .................. A Nerve graft, arm or leg.. 15.60 NA 10.68 2.27 NA 28.55 090
64895... .................. A Nerve graft, hand or foot 19.25 NA 11.82 2.55 NA 33.62 090
64896... .................. A Nerve graft, hand or foot 20.49 NA 14.75 1.90 NA 37.14 090
64897... .................. A Nerve graft, arm or leg.. 18.24 NA 11.06 2.47 NA 31.77 090
64898... .................. A Nerve graft, arm or leg.. 19.50 NA 13.66 2.35 NA 35.51 090
64901... .................. A Additional nerve graft... 10.22 NA 6.60 0.87 NA 17.69 ZZZ
64902... .................. A Additional nerve graft... 11.83 NA 8.07 0.99 NA 20.89 ZZZ
64905... .................. A Nerve pedicle transfer... 14.02 NA 10.13 0.70 NA 24.85 090
64907... .................. A Nerve pedicle transfer... 18.83 NA 13.77 2.55 NA 35.15 090
65091... .................. A Revise eye............... 6.46 NA 8.43 0.45 NA 15.34 090
65093... .................. A Revise eye with implant.. 6.87 NA 9.14 0.52 NA 16.53 090
65101... .................. A Removal of eye........... 7.03 NA 9.28 0.47 NA 16.78 090
65103... .................. A Remove eye/insert implant 7.57 NA 9.63 0.50 NA 17.70 090
65105... .................. A Remove eye/attach implant 8.49 NA 10.38 0.55 NA 19.42 090
65110... .................. A Removal of eye........... 13.95 NA 13.66 1.14 NA 28.75 090
65112... .................. A Remove eye, revise socket 16.38 NA 15.14 1.09 NA 32.61 090
65114... .................. A Remove eye, revise socket 17.53 NA 16.81 1.65 NA 35.99 090
65125... .................. A Revise ocular implant.... 3.12 4.05 1.78 0.13 7.30 5.03 090
65130... .................. A Insert ocular implant.... 7.15 NA 8.87 0.50 NA 16.52 090
65135... .................. A Insert ocular implant.... 7.33 NA 9.07 0.35 NA 16.75 090
[[Page 30963]]
65140... .................. A Attach ocular implant.... 8.02 NA 9.49 0.33 NA 17.84 090
65150... .................. A Revise ocular implant.... 6.26 NA 8.41 0.56 NA 15.23 090
65155... .................. A Reinsert ocular implant.. 8.66 NA 10.02 0.90 NA 19.58 090
65175... .................. A Removal of ocular implant 6.28 NA 8.25 0.40 NA 14.93 090
65205... .................. A Remove foreign body from 0.71 3.17 0.23 0.02 3.90 0.96 000
eye.
65210... .................. A Remove foreign body from 0.84 3.18 0.26 0.03 4.05 1.13 000
eye.
65220... .................. A Remove foreign body from 0.71 4.56 0.22 0.04 5.31 0.97 000
eye.
65222... .................. A Remove foreign body from 0.93 3.17 0.23 0.03 4.13 1.19 000
eye.
65235... .................. A Remove foreign body from 7.57 NA 7.08 0.30 NA 14.95 090
eye.
65260... .................. A Remove foreign body from 10.96 NA 11.16 0.45 NA 22.57 090
eye.
65265... .................. A Remove foreign body from 12.59 NA 13.18 0.51 NA 26.28 090
eye.
65270... .................. A Repair of eye wound...... 1.90 2.72 2.29 0.07 4.69 4.26 010
65272... .................. A Repair of eye wound...... 3.82 4.32 4.04 0.10 8.24 7.96 090
65273... .................. A Repair of eye wound...... 4.36 NA 4.39 0.21 NA 8.96 090
65275... .................. A Repair of eye wound...... 5.34 4.47 4.28 0.04 9.85 9.66 090
65280... .................. A Repair of eye wound...... 7.66 NA 8.10 0.49 NA 16.25 090
65285... .................. A Repair of eye wound...... 12.90 NA 14.06 0.64 NA 27.60 090
65286... .................. A Repair of eye wound...... 5.51 6.60 6.30 0.25 12.36 12.06 090
65290... .................. A Repair of eye socket 5.41 NA 6.59 0.37 NA 12.37 090
wound.
65400... .................. A Removal of eye lesion.... 6.06 7.42 6.99 0.35 13.83 13.40 090
65410... .................. A Biopsy of cornea......... 1.47 1.50 1.16 0.11 3.08 2.74 000
65420... .................. A Removal of eye lesion.... 4.17 5.78 5.53 0.23 10.18 9.93 090
65426... .................. A Removal of eye lesion.... 5.25 6.83 6.54 0.38 12.46 12.17 090
65430... .................. A Corneal smear............ 1.47 3.62 1.03 0.03 5.12 2.53 000
65435... .................. A Curette/treat cornea..... 0.92 1.16 0.48 0.04 2.12 1.44 000
65436... .................. A Curette/treat cornea..... 4.19 4.51 4.25 0.08 8.78 8.52 090
65450... .................. A Treatment of corneal 3.27 5.32 5.02 0.17 8.76 8.46 090
lesion.
65600... .................. A Revision of cornea....... 3.40 4.03 1.45 0.14 7.57 4.99 090
65710... .................. A Corneal transplant....... 12.35 NA 13.50 1.13 NA 26.98 090
65730... .................. A Corneal transplant....... 14.25 NA 14.30 1.29 NA 29.84 090
65750... .................. A Corneal transplant....... 15.00 NA 14.90 1.33 NA 31.23 090
65755... .................. A Corneal transplant....... 14.89 NA 14.73 1.39 NA 31.01 090
65770... .................. A Revise cornea with 17.56 NA 16.78 0.71 NA 35.05 090
implant.
65772... .................. A Correction of astigmatism 4.29 5.25 4.98 0.31 9.85 9.58 090
65775... .................. A Correction of astigmatism 5.79 NA 7.85 0.50 NA 14.14 090
65800... .................. A Drainage of eye.......... 1.91 1.98 1.73 0.10 3.99 3.74 000
65805... .................. A Drainage of eye.......... 1.91 1.99 1.74 0.10 4.00 3.75 000
65810... .................. A Drainage of eye.......... 4.87 NA 6.59 0.30 NA 11.76 090
65815... .................. A Drainage of eye.......... 5.05 6.67 6.36 0.24 11.96 11.65 090
65820... .................. A Relieve inner eye 8.13 NA 8.81 0.51 NA 17.45 090
pressure.
65850... .................. A Incision of eye.......... 10.52 NA 9.81 0.69 NA 21.02 090
65855... .................. A Laser surgery of eye..... 4.30 4.61 3.88 0.52 9.43 8.70 090
65860... .................. A Incise inner eye 3.55 3.56 2.91 0.37 7.48 6.83 090
adhesions.
65865... .................. A Incise inner eye 5.60 NA 6.64 0.41 NA 12.65 090
adhesions.
65870... .................. A Incise inner eye 6.27 NA 7.02 0.31 NA 13.60 090
adhesions.
65875... .................. A Incise inner eye 6.54 NA 7.18 0.34 NA 14.06 090
adhesions.
65880... .................. A Incise inner eye 7.09 NA 7.56 0.37 NA 15.02 090
adhesions.
65900... .................. A Remove eye lesion........ 10.93 NA 11.93 0.92 NA 23.78 090
65920... .................. A Remove implant from eye.. 8.40 NA 8.40 0.44 NA 17.24 090
65930... .................. A Remove blood clot from 7.44 NA 8.40 0.41 NA 16.25 090
eye.
66020... .................. A Injection treatment of 1.59 1.98 1.72 0.14 3.71 3.45 010
eye.
66030... .................. A Injection treatment of 1.25 1.77 1.32 0.03 3.05 2.60 010
eye.
66130... .................. A Remove eye lesion........ 7.69 6.54 6.27 0.28 14.51 14.24 090
66150... .................. A Glaucoma surgery......... 8.30 NA 9.01 0.59 NA 17.90 090
66155... .................. A Glaucoma surgery......... 8.29 NA 9.00 0.50 NA 17.79 090
66160... .................. A Glaucoma surgery......... 10.17 NA 10.01 0.55 NA 20.73 090
66165... .................. A Glaucoma surgery......... 8.01 NA 8.86 0.57 NA 17.44 090
66170... .................. A Glaucoma surgery......... 12.16 10.57 15.51 0.63 23.36 28.30 090
66172... .................. A Incision of eye.......... 15.04 NA 12.81 0.63 NA 28.48 090
66180... .................. A Implant eye shunt........ 14.55 NA 13.02 1.03 NA 28.60 090
66185... .................. A Revise eye shunt......... 8.14 NA 9.00 0.58 NA 17.72 090
66220... .................. A Repair eye lesion........ 7.77 NA 9.21 0.34 NA 17.32 090
66225... .................. A Repair/graft eye lesion.. 11.05 NA 10.47 0.86 NA 22.38 090
66250... .................. A Follow-up surgery of eye. 5.98 7.38 6.96 0.38 13.74 13.32 090
66500... .................. A Incision of iris......... 3.71 NA 4.02 0.27 NA 8.00 090
66505... .................. A Incision of iris......... 4.08 NA 4.20 0.17 NA 8.45 090
66600... .................. A Remove iris and lesion... 8.68 NA 8.72 0.51 NA 17.91 090
66605... .................. A Removal of iris.......... 12.79 NA 13.29 0.67 NA 26.75 090
66625... .................. A Removal of iris.......... 5.13 6.70 6.41 0.48 12.31 12.02 090
66630... .................. A Removal of iris.......... 6.16 NA 7.33 0.45 NA 13.94 090
66635... .................. A Removal of iris.......... 6.25 NA 7.04 0.49 NA 13.78 090
66680... .................. A Repair iris & ciliary 5.44 NA 6.63 0.35 NA 12.42 090
body.
66682... .................. A Repair iris and ciliary 6.21 NA 7.35 0.38 NA 13.94 090
body.
66700... .................. A Destruction, ciliary body 4.78 6.17 5.89 0.35 11.30 11.02 090
[[Page 30964]]
66710... .................. A Destruction, ciliary body 4.78 6.36 5.87 0.41 11.55 11.06 090
66720... .................. A Destruction, ciliary body 4.78 6.07 5.85 0.38 11.23 11.01 090
66740... .................. A Destruction, ciliary body 4.78 NA 6.35 0.39 NA 11.52 090
66761... .................. A Revision of iris......... 4.07 3.83 3.19 0.47 8.37 7.73 090
66762... .................. A Revision of iris......... 4.58 4.11 3.47 0.55 9.24 8.60 090
66770... .................. A Removal of inner eye 5.18 4.46 3.81 0.45 10.09 9.44 090
lesion.
66820... .................. A Incision, secondary 3.89 NA 6.03 0.29 NA 10.21 090
cataract.
66821... .................. A After cataract laser 2.35 2.80 2.56 0.37 5.52 5.28 090
surgery.
66825... .................. A Reposition intraocular 8.23 NA 8.49 0.38 NA 17.10 090
lens.
66830... .................. A Removal of lens lesion... 8.20 8.47 13.09 0.40 17.07 21.69 090
66840... .................. A Removal of lens material. 7.91 NA 7.95 0.54 NA 16.40 090
66850... .................. A Removal of lens material. 9.11 NA 8.58 0.70 NA 18.39 090
66852... .................. A Removal of lens material. 9.97 NA 9.18 0.90 NA 20.05 090
66920... .................. A Extraction of lens....... 8.86 NA 8.48 0.60 NA 17.94 090
66930... .................. A Extraction of lens....... 10.18 NA 9.27 0.57 NA 20.02 090
66940... .................. A Extraction of lens....... 8.93 NA 8.54 0.62 NA 18.09 090
66983... .................. A Remove cataract, insert 8.99 NA 5.94 0.95 NA 15.88 090
lens.
66984... .................. A Remove cataract, insert 10.28 NA 8.36 0.94 NA 19.58 090
lens.
66985... .................. A Insert lens prosthesis... 8.39 NA 7.24 0.63 NA 16.26 090
66986... .................. A Exchange lens prosthesis. 12.28 NA 10.45 0.63 NA 23.36 090
67005... .................. A Partial removal of eye 5.70 NA 3.42 1.13 NA 10.25 090
fluid.
67010... .................. A Partial removal of eye 6.87 NA 4.34 1.04 NA 12.25 090
fluid.
67015... .................. A Release of eye fluid..... 6.92 NA 7.55 0.35 NA 14.82 090
67025... .................. A Replace eye fluid........ 6.84 10.75 7.07 0.36 17.95 14.27 090
67027... .................. A Implant eye drug system.. 10.85 24.75 15.60 0.47 36.07 26.92 090
67028... .................. A Injection eye drug....... 2.52 5.37 1.68 0.18 8.07 4.38 000
67030... .................. A Incise inner eye strands. 4.84 NA 5.99 0.50 NA 11.33 090
67031... .................. A Laser surgery, eye 3.67 3.63 2.98 0.75 8.05 7.40 090
strands.
67036... .................. A Removal of inner eye 11.89 NA 9.91 1.49 NA 23.29 090
fluid.
67038... .................. A Strip retinal membrane... 21.24 NA 17.55 1.80 NA 40.59 090
67039... .................. A Laser treatment of retina 14.52 NA 12.59 1.68 NA 28.79 090
67040... .................. A Laser treatment of retina 17.23 NA 14.64 1.75 NA 33.62 090
67101... .................. A Repair, detached retina.. 7.53 9.23 8.73 0.66 17.42 16.92 090
67105... .................. A Repair, detached retina.. 7.41 7.17 5.67 0.80 15.38 13.88 090
67107... .................. A Repair detached retina... 14.84 NA 13.64 1.10 NA 29.58 090
67108... .................. A Repair detached retina... 20.82 NA 18.57 1.76 NA 41.15 090
67110... .................. A Repair detached retina... 8.81 13.73 10.00 0.97 23.51 19.78 090
67112... .................. A Re-repair detached retina 16.86 NA 15.75 0.86 NA 33.47 090
67115... .................. A Release, encircling 4.99 NA 5.99 0.44 NA 11.42 090
material.
67120... .................. A Remove eye implant 5.98 10.12 6.53 0.38 16.48 12.89 090
material.
67121... .................. A Remove eye implant 10.67 NA 11.52 0.49 NA 22.68 090
material.
67141... .................. A Treatment of retina...... 5.20 6.47 6.18 0.48 12.15 11.86 090
67145... .................. A Treatment of retina...... 5.37 5.01 4.15 0.49 10.87 10.01 090
67208... .................. A Treatment of retinal 6.70 7.13 6.73 0.52 14.35 13.95 090
lesion.
67210... .................. A Treatment of retinal 10.05 7.98 6.80 0.47 18.50 17.32 090
lesion.
67218... .................. A Treatment of retinal 13.52 NA 13.52 0.70 NA 27.74 090
lesion.
67227... .................. A Treatment of retinal 6.58 7.23 6.94 0.51 14.32 14.03 090
lesion.
67228... .................. A Treatment of retinal 12.74 10.02 8.11 0.48 23.24 21.33 090
lesion.
67250... .................. A Reinforce eye wall....... 8.66 NA 9.58 0.40 NA 18.64 090
67255... .................. A Reinforce/graft eye wall. 8.90 NA 9.96 0.87 NA 19.73 090
67311... .................. A Revise eye muscle........ 6.65 NA 6.99 0.47 NA 14.11 090
67312... .................. A Revise two eye muscles... 8.54 NA 8.28 0.53 NA 17.35 090
67314... .................. A Revise eye muscle........ 7.52 NA 7.48 0.58 NA 15.58 090
67316... .................. A Revise two eye muscles... 9.66 NA 8.78 0.67 NA 19.11 090
67318... .................. A Revise eye muscle(s)..... 7.85 NA 7.92 0.33 NA 16.10 090
67320... .................. A Revise eye muscle(s)..... 8.66 NA 9.44 0.69 NA 18.79 090
67331... .................. A Eye surgery follow-up.... 8.12 NA 8.00 0.54 NA 16.66 090
67332... .................. A Rerevise eye muscles..... 8.99 NA 9.20 0.58 NA 18.77 090
67334... .................. A Revise eye muscle w/ 7.96 NA 7.99 0.33 NA 16.28 090
suture.
67335... .................. A Eye suture during surgery 2.49 NA 3.31 0.43 NA 6.23 ZZZ
67340... .................. A Revise eye muscle........ 9.85 NA 10.06 0.41 NA 20.32 090
67343... .................. A Release eye tissue....... 7.35 NA 7.65 0.31 NA 15.31 090
67345... .................. A Destroy nerve of eye 2.96 3.29 1.51 0.26 6.51 4.73 010
muscle.
67350... .................. A Biopsy eye muscle........ 2.87 NA 3.23 0.13 NA 6.23 000
67400... .................. A Explore/biopsy eye socket 9.76 NA 10.78 0.62 NA 21.16 090
67405... .................. A Explore/drain eye socket. 7.93 NA 9.75 0.67 NA 18.35 090
67412... .................. A Explore/treat eye socket. 9.50 NA 12.50 0.67 NA 22.67 090
67413... .................. A Explore/treat eye socket. 10.00 NA 11.17 0.57 NA 21.74 090
67414... .................. A Explore/decompress eye 11.13 NA 13.33 0.44 NA 24.90 090
socket.
67415... .................. A Aspiration orbital 1.76 NA 1.52 0.12 NA 3.40 000
contents.
67420... .................. A Explore/treat eye socket. 20.06 NA 18.62 1.11 NA 39.79 090
67430... .................. A Explore/treat eye socket. 13.39 NA 14.77 0.54 NA 28.70 090
67440... .................. A Explore/drain eye socket. 13.09 NA 14.66 0.97 NA 28.72 090
67445... .................. A Explore/decompress eye 14.42 NA 15.53 0.57 NA 30.52 090
socket.
[[Page 30965]]
67450... .................. A Explore/biopsy eye socket 13.51 NA 14.67 0.87 NA 29.05 090
67500... .................. A Inject/treat eye socket.. 0.79 4.27 0.82 0.06 5.12 1.67 000
67505... .................. A Inject/treat eye socket.. 0.82 3.21 0.32 0.06 4.09 1.20 000
67515... .................. A Inject/treat eye socket.. 0.61 3.07 0.56 0.03 3.71 1.20 000
67550... .................. A Insert eye socket implant 10.19 NA 10.57 0.70 NA 21.46 090
67560... .................. A Revise eye socket implant 10.60 NA 10.68 0.48 NA 21.76 090
67570... .................. A Decompress optic nerve... 13.58 NA 14.66 0.39 NA 28.63 090
67700... .................. A Drainage of eyelid 1.35 4.33 0.65 0.03 5.71 2.03 010
abscess.
67710... .................. A Incision of eyelid....... 1.02 4.42 1.59 0.06 5.50 2.67 010
67715... .................. A Incision of eyelid fold.. 1.22 NA 1.74 0.09 NA 3.05 010
67800... .................. A Remove eyelid lesion..... 1.38 4.52 0.78 0.05 5.95 2.21 010
67801... .................. A Remove eyelid lesions.... 1.88 2.96 2.30 0.08 4.92 4.26 010
67805... .................. A Remove eyelid lesions.... 2.22 6.30 2.60 0.08 8.60 4.90 010
67808... .................. A Remove eyelid lesion(s).. 3.80 NA 4.12 0.13 NA 8.05 090
67810... .................. A Biopsy of eyelid......... 1.48 3.62 0.84 0.05 5.15 2.37 000
67820... .................. A Revise eyelashes......... 0.89 3.26 0.49 0.02 4.17 1.40 000
67825... .................. A Revise eyelashes......... 1.38 4.39 1.78 0.05 5.82 3.21 010
67830... .................. A Revise eyelashes......... 1.70 5.26 2.16 0.17 7.13 4.03 010
67835... .................. A Revise eyelashes......... 5.56 NA 5.13 0.45 NA 11.14 090
67840... .................. A Remove eyelid lesion..... 2.04 5.86 2.80 0.07 7.97 4.91 010
67850... .................. A Treat eyelid lesion...... 1.69 4.51 2.12 0.05 6.25 3.86 010
67875... .................. A Closure of eyelid by 1.35 5.70 2.47 0.13 7.18 3.95 000
suture.
67880... .................. A Revision of eyelid....... 3.80 7.02 3.83 0.23 11.05 7.86 090
67882... .................. A Revision of eyelid....... 5.07 8.66 4.86 0.37 14.10 10.30 090
67900... .................. A Repair brow defect....... 6.14 8.06 6.72 0.20 14.40 13.06 090
67901... .................. A Repair eyelid defect..... 6.97 NA 7.07 0.64 NA 14.68 090
67902... .................. A Repair eyelid defect..... 7.03 NA 7.32 0.72 NA 15.07 090
67903... .................. A Repair eyelid defect..... 6.37 7.89 6.78 0.73 14.99 13.88 090
67904... .................. A Repair eyelid defect..... 6.26 10.24 7.81 0.71 17.21 14.78 090
67906... .................. A Repair eyelid defect..... 6.79 8.01 7.07 0.36 15.16 14.22 090
67908... .................. A Repair eyelid defect..... 5.13 7.35 6.24 0.54 13.02 11.91 090
67909... .................. A Revise eyelid defect..... 5.40 7.53 6.35 0.48 13.41 12.23 090
67911... .................. A Revise eyelid defect..... 5.27 NA 6.44 0.79 NA 12.50 090
67914... .................. A Repair eyelid defect..... 3.68 7.24 4.03 0.39 11.31 8.10 090
67915... .................. A Repair eyelid defect..... 3.18 9.88 3.11 0.07 13.13 6.36 090
67916... .................. A Repair eyelid defect..... 5.31 9.05 5.26 0.38 14.74 10.95 090
67917... .................. A Repair eyelid defect..... 6.02 8.08 6.91 0.47 14.57 13.40 090
67921... .................. A Repair eyelid defect..... 3.40 7.03 3.86 0.20 10.63 7.46 090
67922... .................. A Repair eyelid defect..... 3.06 5.76 3.05 0.07 8.89 6.18 090
67923... .................. A Repair eyelid defect..... 5.88 9.31 5.60 0.38 15.57 11.86 090
67924... .................. A Repair eyelid defect..... 5.79 7.64 6.50 0.43 13.86 12.72 090
67930... .................. A Repair eyelid wound...... 3.61 7.30 3.72 0.08 10.99 7.41 010
67935... .................. A Repair eyelid wound...... 6.22 9.27 5.41 0.24 15.73 11.87 090
67938... .................. A Remove eyelid foreign 1.33 4.21 0.52 0.03 5.57 1.88 010
body.
67950... .................. A Revision of eyelid....... 5.82 6.42 9.88 0.45 12.69 16.15 090
67961... .................. A Revision of eyelid....... 5.69 6.37 6.29 0.50 12.56 12.48 090
67966... .................. A Revision of eyelid....... 6.57 6.92 9.56 0.66 14.15 16.79 090
67971... .................. A Reconstruction of eyelid. 9.79 NA 8.88 0.64 NA 19.31 090
67973... .................. A Reconstruction of eyelid. 12.87 NA 10.87 0.91 NA 24.65 090
67974... .................. A Reconstruction of eyelid. 12.84 NA 10.76 0.87 NA 24.47 090
67975... .................. A Reconstruction of eyelid. 9.13 NA 8.31 0.24 NA 17.68 090
68020... .................. A Incise/drain eyelid 1.37 4.39 0.77 0.03 5.79 2.17 010
lining.
68040... .................. A Treatment of eyelid 0.85 3.48 0.47 0.02 4.35 1.34 000
lesions.
68100... .................. A Biopsy of eyelid lining.. 1.35 4.02 1.09 0.06 5.43 2.50 000
68110... .................. A Remove eyelid lining 1.77 4.74 2.01 0.07 6.58 3.85 010
lesion.
68115... .................. A Remove eyelid lining 2.36 5.69 2.53 0.11 8.16 5.00 010
lesion.
68130... .................. A Remove eyelid lining 4.93 NA 5.74 0.22 NA 10.89 090
lesion.
68135... .................. A Remove eyelid lining 1.84 4.77 2.06 0.04 6.65 3.94 010
lesion.
68200... .................. A Treat eyelid by injection 0.49 3.00 0.49 0.03 3.52 1.01 000
68320... .................. A Revise/graft eyelid 5.37 4.91 5.81 0.42 10.70 11.60 090
lining.
68325... .................. A Revise/graft eyelid 7.36 NA 6.86 0.62 NA 14.84 090
lining.
68326... .................. A Revise/graft eyelid 7.15 NA 6.88 0.49 NA 14.52 090
lining.
68328... .................. A Revise/graft eyelid 8.18 NA 7.39 0.82 NA 16.39 090
lining.
68330... .................. A Revise eyelid lining..... 4.83 6.09 5.65 0.35 11.27 10.83 090
68335... .................. A Revise/graft eyelid 7.19 NA 5.70 0.68 NA 13.57 090
lining.
68340... .................. A Separate eyelid adhesions 4.17 8.46 4.33 0.17 12.80 8.67 090
68360... .................. A Revise eyelid lining..... 4.37 5.79 5.39 0.33 10.49 10.09 090
68362... .................. A Revise eyelid lining..... 7.34 NA 7.77 0.42 NA 15.53 090
68400... .................. A Incise/drain tear gland.. 1.69 5.80 2.63 0.06 7.55 4.38 010
68420... .................. A Incise/drain tear sac.... 2.30 6.09 2.95 0.06 8.45 5.31 010
68440... .................. A Incise tear duct opening. 0.94 4.28 1.55 0.04 5.26 2.53 010
68500... .................. A Removal of tear gland.... 11.02 NA 9.77 0.75 NA 21.54 090
68505... .................. A Partial removal tear 10.94 NA 10.06 0.49 NA 21.49 090
gland.
68510... .................. A Biopsy of tear gland..... 4.61 7.41 3.32 0.28 12.30 8.21 000
[[Page 30966]]
68520... .................. A Removal of tear sac...... 7.51 NA 7.37 0.51 NA 15.39 090
68525... .................. A Biopsy of tear sac....... 4.43 NA 3.24 0.23 NA 7.90 000
68530... .................. A Clearance of tear duct... 3.66 7.39 3.45 0.17 11.22 7.28 010
68540... .................. A Remove tear gland lesion. 10.60 NA 9.51 0.50 NA 20.61 090
68550... .................. A Remove tear gland lesion. 13.26 NA 11.83 0.74 NA 25.83 090
68700... .................. A Repair tear ducts........ 6.60 NA 6.79 0.15 NA 13.54 090
68705... .................. A Revise tear duct opening. 2.06 4.94 2.18 0.05 7.05 4.29 010
68720... .................. A Create tear sac drain.... 8.96 NA 8.39 0.74 NA 18.09 090
68745... .................. A Create tear duct drain... 8.63 NA 7.87 0.45 NA 16.95 090
68750... .................. A Create tear duct drain... 8.66 NA 8.38 0.83 NA 17.87 090
68760... .................. A Close tear duct opening.. 1.73 4.63 0.98 0.04 6.40 2.75 010
68761... .................. A Close tear duct opening.. 1.36 3.31 0.76 0.04 4.71 2.16 010
68770... .................. A Close tear system fistula 7.02 10.08 6.07 0.23 17.33 13.32 090
68801... .................. A Dilate tear duct opening. 0.94 3.99 0.51 0.02 4.95 1.47 010
68810... .................. A Probe nasolacrimal duct.. 1.90 5.34 2.26 0.03 7.27 4.19 010
68811... .................. A Probe nasolacrimal duct.. 2.35 NA 2.51 0.09 NA 4.95 010
68815... .................. A Probe nasolacrimal duct.. 3.20 6.01 3.16 0.10 9.31 6.46 010
68840... .................. A Explore/irrigate tear 1.25 4.43 0.69 0.03 5.71 1.97 010
ducts.
68850... .................. A Injection for tear sac x- 0.80 8.95 0.33 0.04 9.79 1.17 000
ray.
69000... .................. A Drain external ear lesion 1.45 1.35 0.59 0.03 2.83 2.07 010
69005... .................. A Drain external ear lesion 2.11 1.83 1.62 0.13 4.07 3.86 010
69020... .................. A Drain outer ear canal 1.48 1.48 0.71 0.04 3.00 2.23 010
lesion.
69100... .................. A Biopsy of external ear... 0.81 0.92 0.45 0.07 1.80 1.33 000
69105... .................. A Biopsy of external ear 0.85 0.95 0.71 0.09 1.89 1.65 000
canal.
69110... .................. A Partial removal external 3.44 2.58 2.33 0.37 6.39 6.14 090
ear.
69120... .................. A Removal of external ear.. 4.05 NA 4.35 0.07 NA 8.47 090
69140... .................. A Remove ear canal 7.97 NA 7.56 0.88 NA 16.41 090
lesion(s).
69145... .................. A Remove ear canal 2.62 2.43 2.01 0.28 5.33 4.91 090
lesion(s).
69150... .................. A Extensive ear canal 13.43 NA 10.95 1.25 NA 25.63 090
surgery.
69155... .................. A Extensive ear/neck 20.80 NA 14.75 1.61 NA 37.16 090
surgery.
69200... .................. A Clear outer ear canal.... 0.77 0.89 0.34 0.04 1.70 1.15 000
69205... .................. A Clear outer ear canal.... 1.20 NA 1.03 0.11 NA 2.34 010
69210... .................. A Remove impacted ear wax.. 0.61 0.79 0.22 0.02 1.42 0.85 000
69220... .................. A Clean out mastoid cavity. 0.83 0.95 0.52 0.05 1.83 1.40 000
69222... .................. A Clean out mastoid cavity. 1.40 1.45 1.20 0.08 2.93 2.68 010
69300... .................. R Revise external ear...... 6.36 NA 5.44 0.28 NA 12.08 YYY
69310... .................. A Rebuild outer ear canal.. 10.79 NA 9.33 1.08 NA 21.20 090
69320... .................. A Rebuild outer ear canal.. 16.96 NA 13.20 1.66 NA 31.82 090
69400... .................. A Inflate middle ear canal. 0.83 0.94 0.38 0.05 1.82 1.26 000
69401... .................. A Inflate middle ear canal. 0.63 0.82 0.39 0.03 1.48 1.05 000
69405... .................. A Catheterize middle ear 2.63 2.26 1.19 0.04 4.93 3.86 010
canal.
69410... .................. A Inset middle ear baffle.. 0.33 0.66 0.19 0.07 1.06 0.59 000
69420... .................. A Incision of eardrum...... 1.33 1.44 0.79 0.08 2.85 2.20 010
69421... .................. A Incision of eardrum...... 1.73 1.68 1.43 0.13 3.54 3.29 010
69424... .................. A Remove ventilating tube.. 0.85 1.00 0.59 0.06 1.91 1.50 000
69433... .................. A Create eardrum opening... 1.52 1.53 0.96 0.15 3.20 2.63 010
69436... .................. A Create eardrum opening... 1.96 NA 1.56 0.23 NA 3.75 010
69440... .................. A Exploration of middle ear 7.57 NA 7.13 0.93 NA 15.63 090
69450... .................. A Eardrum revision......... 5.57 NA 5.87 1.15 NA 12.59 090
69501... .................. A Mastoidectomy............ 9.07 NA 8.01 1.17 NA 18.25 090
69502... .................. A Mastoidectomy............ 12.38 NA 10.43 1.45 NA 24.26 090
69505... .................. A Remove mastoid structures 12.99 NA 10.68 1.79 NA 25.46 090
69511... .................. A Extensive mastoid surgery 13.52 NA 11.17 1.84 NA 26.53 090
69530... .................. A Extensive mastoid surgery 19.19 NA 14.85 1.72 NA 35.76 090
69535... .................. A Remove part of temporal 36.14 NA 25.22 2.85 NA 64.21 090
bone.
69540... .................. A Remove ear lesion........ 1.20 1.35 1.07 0.14 2.69 2.41 010
69550... .................. A Remove ear lesion........ 10.99 NA 9.30 2.00 NA 22.29 090
69552... .................. A Remove ear lesion........ 19.46 NA 14.98 1.86 NA 36.30 090
69554... .................. A Remove ear lesion........ 33.16 NA 23.94 2.63 NA 59.73 090
69601... .................. A Mastoid surgery revision. 13.24 NA 11.10 1.55 NA 25.89 090
69602... .................. A Mastoid surgery revision. 13.58 NA 11.23 1.75 NA 26.56 090
69603... .................. A Mastoid surgery revision. 14.02 NA 11.38 1.88 NA 27.28 090
69604... .................. A Mastoid surgery revision. 14.02 NA 11.25 2.70 NA 27.97 090
69605... .................. A Mastoid surgery revision. 18.49 NA 14.22 1.86 NA 34.57 090
69610... .................. A Repair of eardrum........ 4.43 3.46 3.10 0.10 7.99 7.63 010
69620... .................. A Repair of eardrum........ 5.89 5.11 3.79 1.16 12.16 10.84 090
69631... .................. A Repair eardrum structures 9.86 NA 8.81 1.61 NA 20.28 090
69632... .................. A Rebuild eardrum 12.75 NA 10.85 1.73 NA 25.33 090
structures.
69633... .................. A Rebuild eardrum 12.10 NA 10.47 1.78 NA 24.35 090
structures.
69635... .................. A Repair eardrum structures 13.33 NA 11.05 1.91 NA 26.29 090
69636... .................. A Rebuild eardrum 15.22 NA 12.59 2.11 NA 29.92 090
structures.
69637... .................. A Rebuild eardrum 15.11 NA 12.49 2.22 NA 29.82 090
structures.
69641... .................. A Revise middle ear & 12.71 NA 10.64 1.87 NA 25.22 090
mastoid.
69642... .................. A Revise middle ear & 16.84 NA 13.41 2.21 NA 32.46 090
mastoid.
[[Page 30967]]
69643... .................. A Revise middle ear & 15.32 NA 12.50 2.51 NA 30.33 090
mastoid.
69644... .................. A Revise middle ear & 16.97 NA 13.65 2.70 NA 33.32 090
mastoid.
69645... .................. A Revise middle ear & 16.38 NA 13.21 2.51 NA 32.10 090
mastoid.
69646... .................. A Revise middle ear & 17.99 NA 14.31 2.40 NA 34.70 090
mastoid.
69650... .................. A Release middle ear bone.. 9.66 NA 8.44 1.33 NA 19.43 090
69660... .................. A Revise middle ear bone... 11.90 NA 9.85 1.82 NA 23.57 090
69661... .................. A Revise middle ear bone... 15.74 NA 12.46 1.93 NA 30.13 090
69662... .................. A Revise middle ear bone... 15.44 NA 12.39 1.94 NA 29.77 090
69666... .................. A Repair middle ear 9.75 NA 8.52 1.77 NA 20.04 090
structures.
69667... .................. A Repair middle ear 9.76 NA 8.54 1.66 NA 19.96 090
structures.
69670... .................. A Remove mastoid air cells. 11.51 NA 9.98 1.08 NA 22.57 090
69676... .................. A Remove middle ear nerve.. 9.52 NA 8.60 0.86 NA 18.98 090
69700... .................. A Close mastoid fistula.... 8.23 NA 5.34 0.84 NA 14.41 090
69711... .................. A Remove/repair hearing aid 10.44 NA 9.25 0.44 NA 20.13 090
69720... .................. A Release facial nerve..... 14.38 NA 11.86 2.27 NA 28.51 090
69725... .................. A Release facial nerve..... 25.38 NA 18.41 1.51 NA 45.30 090
69740... .................. A Repair facial nerve...... 15.96 NA 11.67 1.69 NA 29.32 090
69745... .................. A Repair facial nerve...... 16.69 NA 13.17 1.53 NA 31.39 090
69801... .................. A Incise inner ear......... 8.56 NA 7.69 1.84 NA 18.09 090
69802... .................. A Incise inner ear......... 13.10 NA 10.98 1.22 NA 25.30 090
69805... .................. A Explore inner ear........ 13.82 NA 11.15 2.00 NA 26.97 090
69806... .................. A Explore inner ear........ 12.35 NA 10.47 2.54 NA 25.36 090
69820... .................. A Establish inner ear 10.34 NA 8.82 1.00 NA 20.16 090
window.
69840... .................. A Revise inner ear window.. 10.26 NA 12.01 0.51 NA 22.78 090
69905... .................. A Remove inner ear......... 11.10 NA 9.53 2.07 NA 22.70 090
69910... .................. A Remove inner ear & 13.63 NA 11.12 2.34 NA 27.09 090
mastoid.
69915... .................. A Incise inner ear nerve... 21.23 NA 16.10 2.02 NA 39.35 090
69930... .................. A Implant cochlear device.. 16.81 NA 12.89 3.34 NA 33.04 090
69950... .................. A Incise inner ear nerve... 25.64 NA 17.75 2.31 NA 45.70 090
69955... .................. A Release facial nerve..... 27.04 NA 20.01 2.25 NA 49.30 090
69960... .................. A Release inner ear canal.. 27.04 NA 18.59 1.93 NA 47.56 090
69970... .................. A Remove inner ear lesion.. 30.04 NA 21.22 2.26 NA 53.52 090
70010... .................. A Contrast x-ray of brain.. 1.19 3.46 3.46 0.34 4.99 4.99 XXX
70010... 26 A Contrast x-ray of brain.. 1.19 0.39 0.39 0.08 1.66 1.66 XXX
70010... TC A Contrast x-ray of brain.. 0.00 3.07 3.07 0.26 3.33 3.33 XXX
70015... .................. A Contrast x-ray of brain.. 1.19 1.35 1.35 0.17 2.71 2.71 XXX
70015... 26 A Contrast x-ray of brain.. 1.19 0.39 0.39 0.08 1.66 1.66 XXX
70015... TC A Contrast x-ray of brain.. 0.00 0.96 0.96 0.09 1.05 1.05 XXX
70030... .................. A X-ray eye for foreign 0.17 0.36 0.36 0.04 0.57 0.57 XXX
body.
70030... 26 A X-ray eye for foreign 0.17 0.06 0.06 0.01 0.24 0.24 XXX
body.
70030... TC A X-ray eye for foreign 0.00 0.30 0.30 0.03 0.33 0.33 XXX
body.
70100... .................. A X-ray exam of jaw........ 0.18 0.44 0.44 0.04 0.66 0.66 XXX
70100... 26 A X-ray exam of jaw........ 0.18 0.07 0.07 0.01 0.26 0.26 XXX
70100... TC A X-ray exam of jaw........ 0.00 0.37 0.37 0.03 0.40 0.40 XXX
70110... .................. A X-ray exam of jaw........ 0.25 0.53 0.53 0.06 0.84 0.84 XXX
70110... 26 A X-ray exam of jaw........ 0.25 0.09 0.09 0.02 0.36 0.36 XXX
70110... TC A X-ray exam of jaw........ 0.00 0.44 0.44 0.04 0.48 0.48 XXX
70120... .................. A X-ray exam of mastoids... 0.18 0.51 0.51 0.05 0.74 0.74 XXX
70120... 26 A X-ray exam of mastoids... 0.18 0.07 0.07 0.01 0.26 0.26 XXX
70120... TC A X-ray exam of mastoids... 0.00 0.44 0.44 0.04 0.48 0.48 XXX
70130... .................. A X-ray exam of mastoids... 0.34 0.68 0.68 0.07 1.09 1.09 XXX
70130... 26 A X-ray exam of mastoids... 0.34 0.12 0.12 0.02 0.48 0.48 XXX
70130... TC A X-ray exam of mastoids... 0.00 0.56 0.56 0.05 0.61 0.61 XXX
70134... .................. A X-ray exam of middle ear. 0.34 0.64 0.64 0.07 1.05 1.05 XXX
70134... 26 A X-ray exam of middle ear. 0.34 0.12 0.12 0.02 0.48 0.48 XXX
70134... TC A X-ray exam of middle ear. 0.00 0.52 0.52 0.05 0.57 0.57 XXX
70140... .................. A X-ray exam of facial 0.19 0.51 0.51 0.05 0.75 0.75 XXX
bones.
70140... 26 A X-ray exam of facial 0.19 0.07 0.07 0.01 0.27 0.27 XXX
bones.
70140... TC A X-ray exam of facial 0.00 0.44 0.44 0.04 0.48 0.48 XXX
bones.
70150... .................. A X-ray exam of facial 0.26 0.65 0.65 0.07 0.98 0.98 XXX
bones.
70150... 26 A X-ray exam of facial 0.26 0.09 0.09 0.02 0.37 0.37 XXX
bones.
70150... TC A X-ray exam of facial 0.00 0.56 0.56 0.05 0.61 0.61 XXX
bones.
70160... .................. A X-ray exam of nasal bones 0.17 0.43 0.43 0.04 0.64 0.64 XXX
70160... 26 A X-ray exam of nasal bones 0.17 0.06 0.06 0.01 0.24 0.24 XXX
70160... TC A X-ray exam of nasal bones 0.00 0.37 0.37 0.03 0.40 0.40 XXX
70170... .................. A X-ray exam of tear duct.. 0.30 0.77 0.77 0.08 1.15 1.15 XXX
70170... 26 A X-ray exam of tear duct.. 0.30 0.10 0.10 0.02 0.42 0.42 XXX
70170... TC A X-ray exam of tear duct.. 0.00 0.67 0.67 0.06 0.73 0.73 XXX
70190... .................. A X-ray exam of eye sockets 0.21 0.51 0.51 0.05 0.77 0.77 XXX
70190... 26 A X-ray exam of eye sockets 0.21 0.07 0.07 0.01 0.29 0.29 XXX
70190... TC A X-ray exam of eye sockets 0.00 0.44 0.44 0.04 0.48 0.48 XXX
70200... .................. A X-ray exam of eye sockets 0.28 0.65 0.65 0.07 1.00 1.00 XXX
70200... 26 A X-ray exam of eye sockets 0.28 0.10 0.10 0.02 0.40 0.40 XXX
70200... TC A X-ray exam of eye sockets 0.00 0.56 0.56 0.05 0.61 0.61 XXX
[[Page 30968]]
70210... .................. A X-ray exam of sinuses.... 0.17 0.50 0.50 0.05 0.72 0.72 XXX
70210... 26 A X-ray exam of sinuses.... 0.17 0.06 0.06 0.01 0.24 0.24 XXX
70210... TC A X-ray exam of sinuses.... 0.00 0.44 0.44 0.04 0.48 0.48 XXX
70220... .................. A X-ray exam of sinuses.... 0.25 0.65 0.65 0.07 0.97 0.97 XXX
70220... 26 A X-ray exam of sinuses.... 0.25 0.09 0.09 0.02 0.36 0.36 XXX
70220... TC A X-ray exam of sinuses.... 0.00 0.56 0.56 0.05 0.61 0.61 XXX
70240... .................. A X-ray exam pituitary 0.19 0.36 0.36 0.04 0.59 0.59 XXX
saddle.
70240... 26 A X-ray exam pituitary 0.19 0.07 0.07 0.01 0.27 0.27 XXX
saddle.
70240... TC A X-ray exam pituitary 0.00 0.30 0.30 0.03 0.33 0.33 XXX
saddle.
70250... .................. A X-ray exam of skull...... 0.24 0.52 0.52 0.06 0.82 0.82 XXX
70250... 26 A X-ray exam of skull...... 0.24 0.08 0.08 0.02 0.34 0.34 XXX
70250... TC A X-ray exam of skull...... 0.00 0.44 0.44 0.04 0.48 0.48 XXX
70260... .................. A X-ray exam of skull...... 0.34 0.75 0.75 0.08 1.17 1.17 XXX
70260... 26 A X-ray exam of skull...... 0.34 0.12 0.12 0.02 0.48 0.48 XXX
70260... TC A X-ray exam of skull...... 0.00 0.63 0.63 0.06 0.69 0.69 XXX
70300... .................. A X-ray exam of teeth...... 0.10 0.22 0.22 0.03 0.35 0.35 XXX
70300... 26 A X-ray exam of teeth...... 0.10 0.04 0.04 0.01 0.15 0.15 XXX
70300... TC A X-ray exam of teeth...... 0.00 0.19 0.19 0.02 0.21 0.21 XXX
70310... .................. A X-ray exam of teeth...... 0.16 0.35 0.35 0.04 0.55 0.55 XXX
70310... 26 A X-ray exam of teeth...... 0.16 0.05 0.05 0.01 0.22 0.22 XXX
70310... TC A X-ray exam of teeth...... 0.00 0.30 0.30 0.03 0.33 0.33 XXX
70320... .................. A Full mouth x-ray of teeth 0.22 0.63 0.63 0.07 0.92 0.92 XXX
70320... 26 A Full mouth x-ray of teeth 0.22 0.07 0.07 0.02 0.31 0.31 XXX
70320... TC A Full mouth x-ray of teeth 0.00 0.56 0.56 0.05 0.61 0.61 XXX
70328... .................. A X-ray exam of jaw joint.. 0.18 0.42 0.42 0.04 0.64 0.64 XXX
70328... 26 A X-ray exam of jaw joint.. 0.18 0.07 0.07 0.01 0.26 0.26 XXX
70328... TC A X-ray exam of jaw joint.. 0.00 0.35 0.35 0.03 0.38 0.38 XXX
70330... .................. A X-ray exam of jaw joints. 0.24 0.68 0.68 0.07 0.99 0.99 XXX
70330... 26 A X-ray exam of jaw joints. 0.24 0.08 0.08 0.02 0.34 0.34 XXX
70330... TC A X-ray exam of jaw joints. 0.00 0.60 0.60 0.05 0.65 0.65 XXX
70332... .................. A X-ray exam of jaw joint.. 0.54 1.67 1.67 0.17 2.38 2.38 XXX
70332... 26 A X-ray exam of jaw joint.. 0.54 0.19 0.19 0.04 0.77 0.77 XXX
70332... TC A X-ray exam of jaw joint.. 0.00 1.49 1.49 0.13 1.62 1.62 XXX
70336... .................. A Magnetic image jaw joint. 1.48 8.27 8.27 0.73 10.48 10.48 XXX
70336... 26 A Magnetic image jaw joint. 1.48 0.32 0.32 0.06 1.86 1.86 XXX
70336... TC A Magnetic image jaw joint. 0.00 7.95 7.95 0.67 8.62 8.62 XXX
70350... .................. A X-ray head for 0.17 0.33 0.33 0.03 0.53 0.53 XXX
orthodontia.
70350... 26 A X-ray head for 0.17 0.06 0.06 0.01 0.24 0.24 XXX
orthodontia.
70350... TC A X-ray head for 0.00 0.27 0.27 0.02 0.29 0.29 XXX
orthodontia.
70355... .................. A Panoramic x-ray of jaws.. 0.20 0.47 0.47 0.05 0.72 0.72 XXX
70355... 26 A Panoramic x-ray of jaws.. 0.20 0.07 0.07 0.01 0.28 0.28 XXX
70355... TC A Panoramic x-ray of jaws.. 0.00 0.40 0.40 0.04 0.44 0.44 XXX
70360... .................. A X-ray exam of neck....... 0.17 0.36 0.36 0.04 0.57 0.57 XXX
70360... 26 A X-ray exam of neck....... 0.17 0.06 0.06 0.01 0.24 0.24 XXX
70360... TC A X-ray exam of neck....... 0.00 0.30 0.30 0.03 0.33 0.33 XXX
70370... .................. A Throat x-ray & 0.32 1.03 1.03 0.10 1.45 1.45 XXX
fluoroscopy.
70370... 26 A Throat x-ray & 0.32 0.11 0.11 0.02 0.45 0.45 XXX
fluoroscopy.
70370... TC A Throat x-ray & 0.00 0.92 0.92 0.08 1.00 1.00 XXX
fluoroscopy.
70371... .................. A Speech evaluation, 0.84 1.77 1.77 0.19 2.80 2.80 XXX
complex.
70371... 26 A Speech evaluation, 0.84 0.28 0.28 0.06 1.18 1.18 XXX
complex.
70371... TC A Speech evaluation, 0.00 1.49 1.49 0.13 1.62 1.62 XXX
complex.
70373... .................. A Contrast x-ray of larynx. 0.44 1.41 1.41 0.14 1.99 1.99 XXX
70373... 26 A Contrast x-ray of larynx. 0.44 0.15 0.15 0.03 0.62 0.62 XXX
70373... TC A Contrast x-ray of larynx. 0.00 1.27 1.27 0.11 1.38 1.38 XXX
70380... .................. A X-ray exam of salivary 0.17 0.54 0.54 0.05 0.76 0.76 XXX
gland.
70380... 26 A X-ray exam of salivary 0.17 0.06 0.06 0.01 0.24 0.24 XXX
gland.
70380... TC A X-ray exam of salivary 0.00 0.48 0.48 0.04 0.52 0.52 XXX
gland.
70390... .................. A X-ray exam of salivary 0.38 1.39 1.39 0.14 1.91 1.91 XXX
duct.
70390... 26 A X-ray exam of salivary 0.38 0.13 0.13 0.03 0.54 0.54 XXX
duct.
70390... TC A X-ray exam of salivary 0.00 1.27 1.27 0.11 1.38 1.38 XXX
duct.
70450... .................. A CAT scan of head or brain 0.85 3.63 3.63 0.35 4.83 4.83 XXX
70450... 26 A CAT scan of head or brain 0.85 0.28 0.28 0.06 1.19 1.19 XXX
70450... TC A CAT scan of head or brain 0.00 3.35 3.35 0.29 3.64 3.64 XXX
70460... .................. A Contrast CAT scan of head 1.13 4.38 4.38 0.43 5.94 5.94 XXX
70460... 26 A Contrast CAT scan of head 1.13 0.37 0.37 0.08 1.58 1.58 XXX
70460... TC A Contrast CAT scan of head 0.00 4.01 4.01 0.35 4.36 4.36 XXX
70470... .................. A Contrast CAT scans of 1.27 5.43 5.43 0.52 7.22 7.22 XXX
head.
70470... 26 A Contrast CAT scans of 1.27 0.42 0.42 0.09 1.78 1.78 XXX
head.
70470... TC A Contrast CAT scans of 0.00 5.02 5.02 0.43 5.45 5.45 XXX
head.
70480... .................. A CAT scan of skull........ 1.28 3.77 3.77 0.38 5.43 5.43 XXX
70480... 26 A CAT scan of skull........ 1.28 0.42 0.42 0.09 1.79 1.79 XXX
70480... TC A CAT scan of skull........ 0.00 3.35 3.35 0.29 3.64 3.64 XXX
70481... .................. A Contrast CAT scan of 1.38 4.47 4.47 0.44 6.29 6.29 XXX
skull.
70481... 26 A Contrast CAT scan of 1.38 0.45 0.45 0.09 1.92 1.92 XXX
skull.
[[Page 30969]]
70481... TC A Contrast CAT scan of 0.00 4.01 4.01 0.35 4.36 4.36 XXX
skull.
70482... .................. A Contrast CAT scans of 1.45 5.49 5.49 0.53 7.47 7.47 XXX
skull.
70482... 26 A Contrast CAT scans of 1.45 0.48 0.48 0.10 2.03 2.03 XXX
skull.
70482... TC A Contrast CAT scans of 0.00 5.02 5.02 0.43 5.45 5.45 XXX
skull.
70486... .................. A CAT scan of face, jaw.... 1.14 3.72 3.72 0.37 5.23 5.23 XXX
70486... 26 A CAT scan of face, jaw.... 1.14 0.37 0.37 0.08 1.59 1.59 XXX
70486... TC A CAT scan of face, jaw.... 0.00 3.35 3.35 0.29 3.64 3.64 XXX
70487... .................. A Contrast CAT scan, face/ 1.30 4.44 4.44 0.44 6.18 6.18 XXX
jaw.
70487... 26 A Contrast CAT scan, face/ 1.30 0.42 0.42 0.09 1.81 1.81 XXX
jaw.
70487... TC A Contrast CAT scan, face/ 0.00 4.01 4.01 0.35 4.36 4.36 XXX
jaw.
70488... .................. A Contrast CAT scans face/ 1.42 5.49 5.49 0.53 7.44 7.44 XXX
jaw.
70488... 26 A Contrast CAT scans face/ 1.42 0.47 0.47 0.10 1.99 1.99 XXX
jaw.
70488... TC A Contrast CAT scans face/ 0.00 5.02 5.02 0.43 5.45 5.45 XXX
jaw.
70490... .................. A CAT scan of neck tissue.. 1.28 3.77 3.77 0.38 5.43 5.43 XXX
70490... 26 A CAT scan of neck tissue.. 1.28 0.42 0.42 0.09 1.79 1.79 XXX
70490... TC A CAT scan of neck tissue.. 0.00 3.35 3.35 0.29 3.64 3.64 XXX
70491... .................. A Contrast CAT of neck 1.38 4.47 4.47 0.44 6.29 6.29 XXX
tissue.
70491... 26 A Contrast CAT of neck 1.38 0.45 0.45 0.09 1.92 1.92 XXX
tissue.
70491... TC A Contrast CAT of neck 0.00 4.01 4.01 0.35 4.36 4.36 XXX
tissue.
70492... .................. A Contrast CAT of neck 1.45 5.49 5.49 0.53 7.47 7.47 XXX
tissue.
70492... 26 A Contrast CAT of neck 1.45 0.48 0.48 0.10 2.03 2.03 XXX
tissue.
70492... TC A Contrast CAT of neck 0.00 5.02 5.02 0.43 5.45 5.45 XXX
tissue.
70540... .................. A Magnetic image, face, 1.48 8.44 8.44 0.77 10.69 10.69 XXX
neck.
70540... 26 A Magnetic image, face, 1.48 0.49 0.49 0.10 2.07 2.07 XXX
neck.
70540... TC A Magnetic image, face, 0.00 7.95 7.95 0.67 8.62 8.62 XXX
neck.
70541... .................. R Magnetic image, head 1.81 8.44 8.44 0.77 11.02 11.02 XXX
(MRA).
70541... 26 R Magnetic image, head 1.81 0.49 0.49 0.10 2.40 2.40 XXX
(MRA).
70541... TC R Magnetic image, head 0.00 7.95 7.95 0.67 8.62 8.62 XXX
(MRA).
70551... .................. A Magnetic image, brain 1.48 8.44 8.44 0.77 10.69 10.69 XXX
(MRI).
70551... 26 A Magnetic image, brain 1.48 0.49 0.49 0.10 2.07 2.07 XXX
(MRI).
70551... TC A Magnetic image, brain 0.00 7.95 7.95 0.67 8.62 8.62 XXX
(MRI).
70552... .................. A Magnetic image, brain 1.78 10.13 10.13 0.93 12.84 12.84 XXX
(MRI).
70552... 26 A Magnetic image, brain 1.78 0.60 0.60 0.12 2.50 2.50 XXX
(MRI).
70552... TC A Magnetic image, brain 0.00 9.53 9.53 0.81 10.34 10.34 XXX
(MRI).
70553... .................. A Magnetic image, brain.... 2.36 18.45 18.45 1.65 22.46 22.46 XXX
70553... 26 A Magnetic image, brain.... 2.36 0.80 0.80 0.16 3.32 3.32 XXX
70553... TC A Magnetic image, brain.... 0.00 17.65 17.65 1.49 19.14 19.14 XXX
71010... .................. A Chest x-ray.............. 0.18 0.39 0.39 0.04 0.61 0.61 XXX
71010... 26 A Chest x-ray.............. 0.18 0.06 0.06 0.01 0.25 0.25 XXX
71010... TC A Chest x-ray.............. 0.00 0.33 0.33 0.03 0.36 0.36 XXX
71015... .................. A X-ray exam of chest...... 0.21 0.45 0.45 0.04 0.70 0.70 XXX
71015... 26 A X-ray exam of chest...... 0.21 0.07 0.07 0.01 0.29 0.29 XXX
71015... TC A X-ray exam of chest...... 0.00 0.37 0.37 0.03 0.40 0.40 XXX
71020... .................. A Chest x-ray.............. 0.22 0.51 0.51 0.05 0.78 0.78 XXX
71020... 26 A Chest x-ray.............. 0.22 0.07 0.07 0.01 0.30 0.30 XXX
71020... TC A Chest x-ray.............. 0.00 0.44 0.44 0.04 0.48 0.48 XXX
71021... .................. A Chest x-ray.............. 0.27 0.61 0.61 0.07 0.95 0.95 XXX
71021... 26 A Chest x-ray.............. 0.27 0.09 0.09 0.02 0.38 0.38 XXX
71021... TC A Chest x-ray.............. 0.00 0.52 0.52 0.05 0.57 0.57 XXX
71022... .................. A Chest x-ray.............. 0.31 0.63 0.63 0.07 1.01 1.01 XXX
71022... 26 A Chest x-ray.............. 0.31 0.10 0.10 0.02 0.43 0.43 XXX
71022... TC A Chest x-ray.............. 0.00 0.52 0.52 0.05 0.57 0.57 XXX
71023... .................. A Chest x-ray and 0.38 0.68 0.68 0.08 1.14 1.14 XXX
fluoroscopy.
71023... 26 A Chest x-ray and 0.38 0.13 0.13 0.03 0.54 0.54 XXX
fluoroscopy.
71023... TC A Chest x-ray and 0.00 0.56 0.56 0.05 0.61 0.61 XXX
fluoroscopy.
71030... .................. A Chest x-ray.............. 0.31 0.66 0.66 0.07 1.04 1.04 XXX
71030... 26 A Chest x-ray.............. 0.31 0.10 0.10 0.02 0.43 0.43 XXX
71030... TC A Chest x-ray.............. 0.00 0.56 0.56 0.05 0.61 0.61 XXX
71034... .................. A Chest x-ray & fluoroscopy 0.46 1.18 1.18 0.12 1.76 1.76 XXX
71034... 26 A Chest x-ray & fluoroscopy 0.46 0.16 0.16 0.03 0.65 0.65 XXX
71034... TC A Chest x-ray & fluoroscopy 0.00 1.02 1.02 0.09 1.11 1.11 XXX
71035... .................. A Chest x-ray.............. 0.18 0.43 0.43 0.04 0.65 0.65 XXX
71035... 26 A Chest x-ray.............. 0.18 0.06 0.06 0.01 0.25 0.25 XXX
71035... TC A Chest x-ray.............. 0.00 0.37 0.37 0.03 0.40 0.40 XXX
71036... .................. A X-ray guidance for biopsy 0.54 1.30 1.30 0.14 1.98 1.98 XXX
71036... 26 A X-ray guidance for biopsy 0.54 0.19 0.19 0.04 0.77 0.77 XXX
71036... TC A X-ray guidance for biopsy 0.00 1.12 1.12 0.10 1.22 1.22 XXX
71038... .................. A X-ray guidance for biopsy 0.54 1.38 1.38 0.15 2.07 2.07 XXX
71038... 26 A X-ray guidance for biopsy 0.54 0.19 0.19 0.04 0.77 0.77 XXX
71038... TC A X-ray guidance for biopsy 0.00 1.19 1.19 0.11 1.30 1.30 XXX
71040... .................. A Contrast x-ray of bronchi 0.58 1.24 1.24 0.13 1.95 1.95 XXX
71040... 26 A Contrast x-ray of bronchi 0.58 0.20 0.20 0.04 0.82 0.82 XXX
71040... TC A Contrast x-ray of bronchi 0.00 1.03 1.03 0.09 1.12 1.12 XXX
71060... .................. A Contrast x-ray of bronchi 0.74 1.82 1.82 0.19 2.75 2.75 XXX
[[Page 30970]]
71060... 26 A Contrast x-ray of bronchi 0.74 0.25 0.25 0.05 1.04 1.04 XXX
71060... TC A Contrast x-ray of bronchi 0.00 1.56 1.56 0.14 1.70 1.70 XXX
71090... .................. A X-ray & pacemaker 0.54 1.38 1.38 0.15 2.07 2.07 XXX
insertion.
71090... 26 A X-ray & pacemaker 0.54 0.19 0.19 0.04 0.77 0.77 XXX
insertion.
71090... TC A X-ray & pacemaker 0.00 1.19 1.19 0.11 1.30 1.30 XXX
insertion.
71100... .................. A X-ray exam of ribs....... 0.22 0.48 0.48 0.06 0.76 0.76 XXX
71100... 26 A X-ray exam of ribs....... 0.22 0.07 0.07 0.02 0.31 0.31 XXX
71100... TC A X-ray exam of ribs....... 0.00 0.40 0.40 0.04 0.44 0.44 XXX
71101... .................. A X-ray exam of ribs, chest 0.27 0.57 0.57 0.06 0.90 0.90 XXX
71101... 26 A X-ray exam of ribs, chest 0.27 0.10 0.10 0.02 0.39 0.39 XXX
71101... TC A X-ray exam of ribs, chest 0.00 0.48 0.48 0.04 0.52 0.52 XXX
71110... .................. A X-ray exam of ribs....... 0.27 0.65 0.65 0.07 0.99 0.99 XXX
71110... 26 A X-ray exam of ribs....... 0.27 0.10 0.10 0.02 0.39 0.39 XXX
71110... TC A X-ray exam of ribs....... 0.00 0.56 0.56 0.05 0.61 0.61 XXX
71111... .................. A X-ray exam of ribs, chest 0.32 0.74 0.74 0.08 1.14 1.14 XXX
71111... 26 A X-ray exam of ribs, chest 0.32 0.11 0.11 0.02 0.45 0.45 XXX
71111... TC A X-ray exam of ribs, chest 0.00 0.63 0.63 0.06 0.69 0.69 XXX
71120... .................. A X-ray exam of breastbone. 0.20 0.53 0.53 0.05 0.78 0.78 XXX
71120... 26 A X-ray exam of breastbone. 0.20 0.07 0.07 0.01 0.28 0.28 XXX
71120... TC A X-ray exam of breastbone. 0.00 0.46 0.46 0.04 0.50 0.50 XXX
71130... .................. A X-ray exam of breastbone. 0.22 0.57 0.57 0.05 0.84 0.84 XXX
71130... 26 A X-ray exam of breastbone. 0.22 0.07 0.07 0.01 0.30 0.30 XXX
71130... TC A X-ray exam of breastbone. 0.00 0.50 0.50 0.04 0.54 0.54 XXX
71250... .................. A Cat scan of chest........ 1.16 4.57 4.57 0.44 6.17 6.17 XXX
71250... 26 A Cat scan of chest........ 1.16 0.38 0.38 0.08 1.62 1.62 XXX
71250... TC A Cat scan of chest........ 0.00 4.19 4.19 0.36 4.55 4.55 XXX
71260... .................. A Contrast CAT scan of 1.24 5.43 5.43 0.51 7.18 7.18 XXX
chest.
71260... 26 A Contrast CAT scan of 1.24 0.41 0.41 0.08 1.73 1.73 XXX
chest.
71260... TC A Contrast CAT scan of 0.00 5.02 5.02 0.43 5.45 5.45 XXX
chest.
71270... .................. A Contrast CAT scans of 1.38 6.73 6.73 0.61 8.72 8.72 XXX
chest.
71270... 26 A Contrast CAT scans of 1.38 0.45 0.45 0.09 1.92 1.92 XXX
chest.
71270... TC A Contrast CAT scans of 0.00 6.27 6.27 0.52 6.79 6.79 XXX
chest.
71550... .................. A Magnetic image, chest.... 1.60 8.48 8.48 0.78 10.86 10.86 XXX
71550... 26 A Magnetic image, chest.... 1.60 0.54 0.54 0.11 2.25 2.25 XXX
71550... TC A Magnetic image, chest.... 0.00 7.95 7.95 0.67 8.62 8.62 XXX
71555... .................. N Magnetic imaging/chest +1.81 8.48 8.48 0.78 11.07 11.07 XXX
(MRA).
71555... 26 N Magnetic imaging/chest +1.81 0.54 0.54 0.11 2.46 2.46 XXX
(MRA).
71555... TC N Magnetic imaging/chest +0.00 7.95 7.95 0.67 8.62 8.62 XXX
(MRA).
72010... .................. A X-ray exam of spine...... 0.45 0.88 0.88 0.09 1.42 1.42 XXX
72010... 26 A X-ray exam of spine...... 0.45 0.15 0.15 0.03 0.63 0.63 XXX
72010... TC A X-ray exam of spine...... 0.00 0.73 0.73 0.06 0.79 0.79 XXX
72020... .................. A X-ray exam of spine...... 0.15 0.35 0.35 0.04 0.54 0.54 XXX
72020... 26 A X-ray exam of spine...... 0.15 0.05 0.05 0.01 0.21 0.21 XXX
72020... TC A X-ray exam of spine...... 0.00 0.30 0.30 0.03 0.33 0.33 XXX
72040... .................. A X-ray exam of neck spine. 0.22 0.50 0.50 0.05 0.77 0.77 XXX
72040... 26 A X-ray exam of neck spine. 0.22 0.07 0.07 0.01 0.30 0.30 XXX
72040... TC A X-ray exam of neck spine. 0.00 0.42 0.42 0.04 0.46 0.46 XXX
72050... .................. A X-ray exam of neck spine. 0.31 0.74 0.74 0.08 1.13 1.13 XXX
72050... 26 A X-ray exam of neck spine. 0.31 0.10 0.10 0.02 0.43 0.43 XXX
72050... TC A X-ray exam of neck spine. 0.00 0.63 0.63 0.06 0.69 0.69 XXX
72052... .................. A X-ray exam of neck spine. 0.36 0.93 0.93 0.09 1.38 1.38 XXX
72052... 26 A X-ray exam of neck spine. 0.36 0.13 0.13 0.02 0.51 0.51 XXX
72052... TC A X-ray exam of neck spine. 0.00 0.80 0.80 0.07 0.87 0.87 XXX
72069... .................. A X-ray exam of trunk spine 0.22 0.42 0.42 0.04 0.68 0.68 XXX
72069... 26 A X-ray exam of trunk spine 0.22 0.07 0.07 0.01 0.30 0.30 XXX
72069... TC A X-ray exam of trunk spine 0.00 0.35 0.35 0.03 0.38 0.38 XXX
72070... .................. A X-ray exam of thorax 0.22 0.54 0.54 0.05 0.81 0.81 XXX
spine.
72070... 26 A X-ray exam of thorax 0.22 0.07 0.07 0.01 0.30 0.30 XXX
spine.
72070... TC A X-ray exam of thorax 0.00 0.46 0.46 0.04 0.50 0.50 XXX
spine.
72072... .................. A X-ray exam of thoracic 0.22 0.60 0.60 0.06 0.88 0.88 XXX
spine.
72072... 26 A X-ray exam of thoracic 0.22 0.07 0.07 0.01 0.30 0.30 XXX
spine.
72072... TC A X-ray exam of thoracic 0.00 0.52 0.52 0.05 0.57 0.57 XXX
spine.
72074... .................. A X-ray exam of thoracic 0.22 0.72 0.72 0.07 1.01 1.01 XXX
spine.
72074... 26 A X-ray exam of thoracic 0.22 0.07 0.07 0.01 0.30 0.30 XXX
spine.
72074... TC A X-ray exam of thoracic 0.00 0.65 0.65 0.06 0.71 0.71 XXX
spine.
72080... .................. A X-ray exam of trunk spine 0.22 0.55 0.55 0.05 0.82 0.82 XXX
72080... 26 A X-ray exam of trunk spine 0.22 0.07 0.07 0.01 0.30 0.30 XXX
72080... TC A X-ray exam of trunk spine 0.00 0.48 0.48 0.04 0.52 0.52 XXX
72090... .................. A X-ray exam of trunk spine 0.28 0.57 0.57 0.06 0.91 0.91 XXX
72090... 26 A X-ray exam of trunk spine 0.28 0.10 0.10 0.02 0.40 0.40 XXX
72090... TC A X-ray exam of trunk spine 0.00 0.48 0.48 0.04 0.52 0.52 XXX
72100... .................. A X-ray exam of lower spine 0.22 0.55 0.55 0.05 0.82 0.82 XXX
72100... 26 A X-ray exam of lower spine 0.22 0.07 0.07 0.01 0.30 0.30 XXX
72100... TC A X-ray exam of lower spine 0.00 0.48 0.48 0.04 0.52 0.52 XXX
[[Page 30971]]
72110... .................. A X-ray exam of lower spine 0.31 0.75 0.75 0.08 1.14 1.14 XXX
72110... 26 A X-ray exam of lower spine 0.31 0.10 0.10 0.02 0.43 0.43 XXX
72110... TC A X-ray exam of lower spine 0.00 0.65 0.65 0.06 0.71 0.71 XXX
72114... .................. A X-ray exam of lower spine 0.36 0.97 0.97 0.09 1.42 1.42 XXX
72114... 26 A X-ray exam of lower spine 0.36 0.13 0.13 0.02 0.51 0.51 XXX
72114... TC A X-ray exam of lower spine 0.00 0.84 0.84 0.07 0.91 0.91 XXX
72120... .................. A X-ray exam of lower spine 0.22 0.71 0.71 0.07 1.00 1.00 XXX
72120... 26 A X-ray exam of lower spine 0.22 0.07 0.07 0.01 0.30 0.30 XXX
72120... TC A X-ray exam of lower spine 0.00 0.63 0.63 0.06 0.69 0.69 XXX
72125... .................. A CAT scan of neck spine... 1.16 4.57 4.57 0.44 6.17 6.17 XXX
72125... 26 A CAT scan of neck spine... 1.16 0.38 0.38 0.08 1.62 1.62 XXX
72125... TC A CAT scan of neck spine... 0.00 4.19 4.19 0.36 4.55 4.55 XXX
72126... .................. A Contrast CAT scan of neck 1.22 5.41 5.41 0.51 7.14 7.14 XXX
72126... 26 A Contrast CAT scan of neck 1.22 0.39 0.39 0.08 1.69 1.69 XXX
72126... TC A Contrast CAT scan of neck 0.00 5.02 5.02 0.43 5.45 5.45 XXX
72127... .................. A Contrast CAT scans of 1.27 6.69 6.69 0.61 8.57 8.57 XXX
neck.
72127... 26 A Contrast CAT scans of 1.27 0.42 0.42 0.09 1.78 1.78 XXX
neck.
72127... TC A Contrast CAT scans of 0.00 6.27 6.27 0.52 6.79 6.79 XXX
neck.
72128... .................. A CAT scan of thorax spine. 1.16 4.57 4.57 0.44 6.17 6.17 XXX
72128... 26 A CAT scan of thorax spine. 1.16 0.38 0.38 0.08 1.62 1.62 XXX
72128... TC A CAT scan of thorax spine. 0.00 4.19 4.19 0.36 4.55 4.55 XXX
72129... .................. A Contrast CAT scan of 1.22 5.41 5.41 0.51 7.14 7.14 XXX
thorax.
72129... 26 A Contrast CAT scan of 1.22 0.39 0.39 0.08 1.69 1.69 XXX
thorax.
72129... TC A Contrast CAT scan of 0.00 5.02 5.02 0.43 5.45 5.45 XXX
thorax.
72130... .................. A Contrast CAT scans of 1.27 6.69 6.69 0.61 8.57 8.57 XXX
thorax.
72130... 26 A Contrast CAT scans of 1.27 0.42 0.42 0.09 1.78 1.78 XXX
thorax.
72130... TC A Contrast CAT scans of 0.00 6.27 6.27 0.52 6.79 6.79 XXX
thorax.
72131... .................. A CAT scan of lower spine.. 1.16 4.57 4.57 0.44 6.17 6.17 XXX
72131... 26 A CAT scan of lower spine.. 1.16 0.38 0.38 0.08 1.62 1.62 XXX
72131... TC A CAT scan of lower spine.. 0.00 4.19 4.19 0.36 4.55 4.55 XXX
72132... .................. A Contrast CAT of lower 1.22 5.41 5.41 0.51 7.14 7.14 XXX
spine.
72132... 26 A Contrast CAT of lower 1.22 0.39 0.39 0.08 1.69 1.69 XXX
spine.
72132... TC A Contrast CAT of lower 0.00 5.02 5.02 0.43 5.45 5.45 XXX
spine.
72133... .................. A Contrast CAT scans, low 1.27 6.69 6.69 0.61 8.57 8.57 XXX
spine.
72133... 26 A Contrast CAT scans, low 1.27 0.42 0.42 0.09 1.78 1.78 XXX
spine.
72133... TC A Contrast CAT scans, low 0.00 6.27 6.27 0.52 6.79 6.79 XXX
spine.
72141... .................. A Magnetic image, neck 1.60 8.48 8.48 0.78 10.86 10.86 XXX
spine.
72141... 26 A Magnetic image, neck 1.60 0.54 0.54 0.11 2.25 2.25 XXX
spine.
72141... TC A Magnetic image, neck 0.00 7.95 7.95 0.67 8.62 8.62 XXX
spine.
72142... .................. A Magnetic image, neck 1.92 10.17 10.17 0.94 13.03 13.03 XXX
spine.
72142... 26 A Magnetic image, neck 1.92 0.64 0.64 0.13 2.69 2.69 XXX
spine.
72142... TC A Magnetic image, neck 0.00 9.53 9.53 0.81 10.34 10.34 XXX
spine.
72146... .................. A Magnetic image, chest 1.60 9.36 9.36 0.85 11.81 11.81 XXX
spine.
72146... 26 A Magnetic image, chest 1.60 0.54 0.54 0.11 2.25 2.25 XXX
spine.
72146... TC A Magnetic image, chest 0.00 8.83 8.83 0.74 9.57 9.57 XXX
spine.
72147... .................. A Magnetic image, chest 1.92 10.17 10.17 0.94 13.03 13.03 XXX
spine.
72147... 26 A Magnetic image, chest 1.92 0.64 0.64 0.13 2.69 2.69 XXX
spine.
72147... TC A Magnetic image, chest 0.00 9.53 9.53 0.81 10.34 10.34 XXX
spine.
72148... .................. A Magnetic image, lumbar 1.48 9.32 9.32 0.84 11.64 11.64 XXX
spine.
72148... 26 A Magnetic image, lumbar 1.48 0.49 0.49 0.10 2.07 2.07 XXX
spine.
72148... TC A Magnetic image, lumbar 0.00 8.83 8.83 0.74 9.57 9.57 XXX
spine.
72149... .................. A Magnetic image, lumbar 1.78 10.13 10.13 0.93 12.84 12.84 XXX
spine.
72149... 26 A Magnetic image, lumbar 1.78 0.60 0.60 0.12 2.50 2.50 XXX
spine.
72149... TC A Magnetic image, lumbar 0.00 9.53 9.53 0.81 10.34 10.34 XXX
spine.
72156... .................. A Magnetic image, neck 2.57 18.51 18.51 1.66 22.74 22.74 XXX
spine.
72156... 26 A Magnetic image, neck 2.57 0.86 0.86 0.17 3.60 3.60 XXX
spine.
72156... TC A Magnetic image, neck 0.00 17.65 17.65 1.49 19.14 19.14 XXX
spine.
72157... .................. A Magnetic image, chest 2.57 18.51 18.51 1.66 22.74 22.74 XXX
spine.
72157... 26 A Magnetic image, chest 2.57 0.86 0.86 0.17 3.60 3.60 XXX
spine.
72157... TC A Magnetic image, chest 0.00 17.65 17.65 1.49 19.14 19.14 XXX
spine.
72158... .................. A Magnetic image, lumbar 2.36 18.45 18.45 1.65 22.46 22.46 XXX
spine.
72158... 26 A Magnetic image, lumbar 2.36 0.80 0.80 0.16 3.32 3.32 XXX
spine.
72158... TC A Magnetic image, lumbar 0.00 17.65 17.65 1.49 19.14 19.14 XXX
spine.
72159... .................. N Magnetic imaging/spine +1.80 9.32 9.32 0.84 11.96 11.96 XXX
(MRA).
72159... 26 N Magnetic imaging/spine +1.80 0.49 0.49 0.10 2.39 2.39 XXX
(MRA).
72159... TC N Magnetic imaging/spine +0.00 8.83 8.83 0.74 9.57 9.57 XXX
(MRA).
72170... .................. A X-ray exam of pelvis..... 0.17 0.42 0.42 0.04 0.63 0.63 XXX
72170... 26 A X-ray exam of pelvis..... 0.17 0.05 0.05 0.01 0.23 0.23 XXX
72170... TC A X-ray exam of pelvis..... 0.00 0.37 0.37 0.03 0.40 0.40 XXX
72190... .................. A X-ray exam of pelvis..... 0.21 0.55 0.55 0.05 0.81 0.81 XXX
72190... 26 A X-ray exam of pelvis..... 0.21 0.07 0.07 0.01 0.29 0.29 XXX
72190... TC A X-ray exam of pelvis..... 0.00 0.48 0.48 0.04 0.52 0.52 XXX
72192... .................. A CAT scan of pelvis....... 1.09 4.55 4.55 0.43 6.07 6.07 XXX
72192... 26 A CAT scan of pelvis....... 1.09 0.36 0.36 0.07 1.52 1.52 XXX
[[Page 30972]]
72192... TC A CAT scan of pelvis....... 0.00 4.19 4.19 0.36 4.55 4.55 XXX
72193... .................. A Contrast CAT scan of 1.16 5.23 5.23 0.49 6.88 6.88 XXX
pelvis.
72193... 26 A Contrast CAT scan of 1.16 0.38 0.38 0.08 1.62 1.62 XXX
pelvis.
72193... TC A Contrast CAT scan of 0.00 4.85 4.85 0.41 5.26 5.26 XXX
pelvis.
72194... .................. A Contrast CAT scans of 1.22 6.42 6.42 0.58 8.22 8.22 XXX
pelvis.
72194... 26 A Contrast CAT scans of 1.22 0.39 0.39 0.08 1.69 1.69 XXX
pelvis.
72194... TC A Contrast CAT scans of 0.00 6.02 6.02 0.50 6.52 6.52 XXX
pelvis.
72196... .................. A Magnetic image, pelvis... 1.60 8.48 8.48 0.78 10.86 10.86 XXX
72196... 26 A Magnetic image, pelvis... 1.60 0.54 0.54 0.11 2.25 2.25 XXX
72196... TC A Magnetic image, pelvis... 0.00 7.95 7.95 0.67 8.62 8.62 XXX
72198... .................. N Magnetic imaging/pelvis +1.80 8.48 8.48 0.78 11.06 11.06 XXX
(MRA).
72198... 26 N Magnetic imaging/pelvis +1.80 0.54 0.54 0.11 2.45 2.45 XXX
(MRA).
72198... TC N Magnetic imaging/pelvis +0.00 7.95 7.95 0.67 8.62 8.62 XXX
(MRA).
72200... .................. A X-ray exam sacroiliac 0.17 0.43 0.43 0.04 0.64 0.64 XXX
joints.
72200... 26 A X-ray exam sacroiliac 0.17 0.06 0.06 0.01 0.24 0.24 XXX
joints.
72200... TC A X-ray exam sacroiliac 0.00 0.37 0.37 0.03 0.40 0.40 XXX
joints.
72202... .................. A X-ray exam sacroiliac 0.19 0.51 0.51 0.05 0.75 0.75 XXX
joints.
72202... 26 A X-ray exam sacroiliac 0.19 0.07 0.07 0.01 0.27 0.27 XXX
joints.
72202... TC A X-ray exam sacroiliac 0.00 0.44 0.44 0.04 0.48 0.48 XXX
joints.
72220... .................. A X-ray exam of tailbone... 0.17 0.46 0.46 0.05 0.68 0.68 XXX
72220... 26 A X-ray exam of tailbone... 0.17 0.06 0.06 0.01 0.24 0.24 XXX
72220... TC A X-ray exam of tailbone... 0.00 0.40 0.40 0.04 0.44 0.44 XXX
72240... .................. A Contrast x-ray of neck 0.91 3.67 3.67 0.35 4.93 4.93 XXX
spine.
72240... 26 A Contrast x-ray of neck 0.91 0.31 0.31 0.06 1.28 1.28 XXX
spine.
72240... TC A Contrast x-ray of neck 0.00 3.36 3.36 0.29 3.65 3.65 XXX
spine.
72255... .................. A Contrast x-ray thorax 0.91 3.38 3.38 0.32 4.61 4.61 XXX
spine.
72255... 26 A Contrast x-ray thorax 0.91 0.31 0.31 0.06 1.28 1.28 XXX
spine.
72255... TC A Contrast x-ray thorax 0.00 3.07 3.07 0.26 3.33 3.33 XXX
spine.
72265... .................. A Contrast x-ray lower 0.83 3.17 3.17 0.31 4.31 4.31 XXX
spine.
72265... 26 A Contrast x-ray lower 0.83 0.28 0.28 0.06 1.17 1.17 XXX
spine.
72265... TC A Contrast x-ray lower 0.00 2.89 2.89 0.25 3.14 3.14 XXX
spine.
72270... .................. A Contrast x-ray of spine.. 1.33 4.76 4.76 0.46 6.55 6.55 XXX
72270... 26 A Contrast x-ray of spine.. 1.33 0.44 0.44 0.09 1.86 1.86 XXX
72270... TC A Contrast x-ray of spine.. 0.00 4.32 4.32 0.37 4.69 4.69 XXX
72285... .................. A X-ray of neck spine disk. 0.83 6.23 6.23 0.56 7.62 7.62 XXX
72285... 26 A X-ray of neck spine disk. 0.83 0.28 0.28 0.06 1.17 1.17 XXX
72285... TC A X-ray of neck spine disk. 0.00 5.95 5.95 0.50 6.45 6.45 XXX
72295... .................. A X-ray of lower spine disk 0.83 5.86 5.86 0.52 7.21 7.21 XXX
72295... 26 A X-ray of lower spine disk 0.83 0.28 0.28 0.06 1.17 1.17 XXX
72295... TC A X-ray of lower spine disk 0.00 5.57 5.57 0.46 6.03 6.03 XXX
73000... .................. A X-ray exam of collarbone. 0.16 0.42 0.42 0.04 0.62 0.62 XXX
73000... 26 A X-ray exam of collarbone. 0.16 0.05 0.05 0.01 0.22 0.22 XXX
73000... TC A X-ray exam of collarbone. 0.00 0.37 0.37 0.03 0.40 0.40 XXX
73010... .................. A X-ray exam of shoulder 0.17 0.43 0.43 0.04 0.64 0.64 XXX
blade.
73010... 26 A X-ray exam of shoulder 0.17 0.06 0.06 0.01 0.24 0.24 XXX
blade.
73010... TC A X-ray exam of shoulder 0.00 0.37 0.37 0.03 0.40 0.40 XXX
blade.
73020... .................. A X-ray exam of shoulder... 0.15 0.39 0.39 0.04 0.58 0.58 XXX
73020... 26 A X-ray exam of shoulder... 0.15 0.05 0.05 0.01 0.21 0.21 XXX
73020... TC A X-ray exam of shoulder... 0.00 0.33 0.33 0.03 0.36 0.36 XXX
73030... .................. A X-ray exam of shoulder... 0.18 0.46 0.46 0.05 0.69 0.69 XXX
73030... 26 A X-ray exam of shoulder... 0.18 0.06 0.06 0.01 0.25 0.25 XXX
73030... TC A X-ray exam of shoulder... 0.00 0.40 0.40 0.04 0.44 0.44 XXX
73040... .................. A Contrast x-ray of 0.54 1.67 1.67 0.17 2.38 2.38 XXX
shoulder.
73040... 26 A Contrast x-ray of 0.54 0.19 0.19 0.04 0.77 0.77 XXX
shoulder.
73040... TC A Contrast x-ray of 0.00 1.49 1.49 0.13 1.62 1.62 XXX
shoulder.
73050... .................. A X-ray exam of shoulders.. 0.20 0.54 0.54 0.05 0.79 0.79 XXX
73050... 26 A X-ray exam of shoulders.. 0.20 0.07 0.07 0.01 0.28 0.28 XXX
73050... TC A X-ray exam of shoulders.. 0.00 0.48 0.48 0.04 0.52 0.52 XXX
73060... .................. A X-ray exam of humerus.... 0.17 0.46 0.46 0.05 0.68 0.68 XXX
73060... 26 A X-ray exam of humerus.... 0.17 0.06 0.06 0.01 0.24 0.24 XXX
73060... TC A X-ray exam of humerus.... 0.00 0.40 0.40 0.04 0.44 0.44 XXX
73070... .................. A X-ray exam of elbow...... 0.15 0.42 0.42 0.04 0.61 0.61 XXX
73070... 26 A X-ray exam of elbow...... 0.15 0.05 0.05 0.01 0.21 0.21 XXX
73070... TC A X-ray exam of elbow...... 0.00 0.37 0.37 0.03 0.40 0.40 XXX
73080... .................. A X-ray exam of elbow...... 0.17 0.46 0.46 0.05 0.68 0.68 XXX
73080... 26 A X-ray exam of elbow...... 0.17 0.06 0.06 0.01 0.24 0.24 XXX
73080... TC A X-ray exam of elbow...... 0.00 0.40 0.40 0.04 0.44 0.44 XXX
73085... .................. A Contrast x-ray of elbow.. 0.54 1.67 1.67 0.17 2.38 2.38 XXX
73085... 26 A Contrast x-ray of elbow.. 0.54 0.19 0.19 0.04 0.77 0.77 XXX
73085... TC A Contrast x-ray of elbow.. 0.00 1.49 1.49 0.13 1.62 1.62 XXX
73090... .................. A X-ray exam of forearm.... 0.16 0.42 0.42 0.04 0.62 0.62 XXX
73090... 26 A X-ray exam of forearm.... 0.16 0.05 0.05 0.01 0.22 0.22 XXX
73090... TC A X-ray exam of forearm.... 0.00 0.37 0.37 0.03 0.40 0.40 XXX
73092... .................. A X-ray exam of arm, infant 0.16 0.40 0.40 0.04 0.60 0.60 XXX
[[Page 30973]]
73092... 26 A X-ray exam of arm, infant 0.16 0.05 0.05 0.01 0.22 0.22 XXX
73092... TC A X-ray exam of arm, infant 0.00 0.35 0.35 0.03 0.38 0.38 XXX
73100... .................. A X-ray exam of wrist...... 0.16 0.40 0.40 0.04 0.60 0.60 XXX
73100... 26 A X-ray exam of wrist...... 0.16 0.05 0.05 0.01 0.22 0.22 XXX
73100... TC A X-ray exam of wrist...... 0.00 0.35 0.35 0.03 0.38 0.38 XXX
73110... .................. A X-ray exam of wrist...... 0.17 0.44 0.44 0.04 0.65 0.65 XXX
73110... 26 A X-ray exam of wrist...... 0.17 0.06 0.06 0.01 0.24 0.24 XXX
73110... TC A X-ray exam of wrist...... 0.00 0.38 0.38 0.03 0.41 0.41 XXX
73115... .................. A Contrast x-ray of wrist.. 0.54 1.30 1.30 0.14 1.98 1.98 XXX
73115... 26 A Contrast x-ray of wrist.. 0.54 0.19 0.19 0.04 0.77 0.77 XXX
73115... TC A Contrast x-ray of wrist.. 0.00 1.12 1.12 0.10 1.22 1.22 XXX
73120... A X-ray exam of hand....... 0.16 0.40 0.40 0.04 0.60 0.60 XXX
73120... 26................ A X-ray exam of hand....... 0.16 0.05 0.05 0.01 0.22 0.22 XXX
73120... TC A X-ray exam of hand....... 0.00 0.35 0.35 0.03 0.38 0.38 XXX
73130... .................. A X-ray exam of hand....... 0.17 0.44 0.44 0.04 0.65 0.65 XXX
73130... 26 A X-ray exam of hand....... 0.17 0.06 0.06 0.01 0.24 0.24 XXX
73130... TC A X-ray exam of hand....... 0.00 0.38 0.38 0.03 0.41 0.41 XXX
73140... .................. A X-ray exam of finger(s).. 0.13 0.34 0.34 0.04 0.51 0.51 XXX
73140... 26 A X-ray exam of finger(s).. 0.13 0.04 0.04 0.01 0.18 0.18 XXX
73140... TC A X-ray exam of finger(s).. 0.00 0.30 0.30 0.03 0.33 0.33 XXX
73200... .................. A CAT scan of arm.......... 1.09 3.88 3.88 0.37 5.34 5.34 XXX
73200... 26 A CAT scan of arm.......... 1.09 0.36 0.36 0.07 1.52 1.52 XXX
73200... TC A CAT scan of arm.......... 0.00 3.52 3.52 0.30 3.82 3.82 XXX
73201... .................. A Contrast CAT scan of arm. 1.16 4.57 4.57 0.44 6.17 6.17 XXX
73201... 26 A Contrast CAT scan of arm. 1.16 0.38 0.38 0.08 1.62 1.62 XXX
73201... TC A Contrast CAT scan of arm. 0.00 4.19 4.19 0.36 4.55 4.55 XXX
73202... .................. A Contrast CAT scans of arm 1.22 5.66 5.66 0.53 7.41 7.41 XXX
73202... 26 A Contrast CAT scans of arm 1.22 0.39 0.39 0.08 1.69 1.69 XXX
73202... TC A Contrast CAT scans of arm 0.00 5.27 5.27 0.45 5.72 5.72 XXX
73220... .................. A Magnetic image, arm, hand 1.48 8.44 8.44 0.77 10.69 10.69 XXX
73220... 26 A Magnetic image, arm, hand 1.48 0.49 0.49 0.10 2.07 2.07 XXX
73220... TC A Magnetic image, arm, hand 0.00 7.95 7.95 0.67 8.62 8.62 XXX
73221... .................. A Magnetic image, joint of 1.48 8.27 8.27 0.73 10.48 10.48 XXX
arm.
73221... 26 A Magnetic image, joint of 1.48 0.32 0.32 0.06 1.86 1.86 XXX
arm.
73221... TC A Magnetic image, joint of 0.00 7.95 7.95 0.67 8.62 8.62 XXX
arm.
73225... .................. N Magnetic imaging/upper +1.73 8.44 8.44 0.77 10.94 10.94 XXX
(MRA).
73225... 26 N Magnetic imaging/upper +1.73 0.49 0.49 0.10 2.32 2.32 XXX
(MRA).
73225... TC N Magnetic imaging/upper +0.00 7.95 7.95 0.67 8.62 8.62 XXX
(MRA).
73500... .................. A X-ray exam of hip........ 0.17 0.39 0.39 0.04 0.60 0.60 XXX
73500... 26 A X-ray exam of hip........ 0.17 0.06 0.06 0.01 0.24 0.24 XXX
73500... TC A X-ray exam of hip........ 0.00 0.33 0.33 0.03 0.36 0.36 XXX
73510... .................. A X-ray exam of hip........ 0.21 0.48 0.48 0.05 0.74 0.74 XXX
73510... 26 A X-ray exam of hip........ 0.21 0.07 0.07 0.01 0.29 0.29 XXX
73510... TC A X-ray exam of hip........ 0.00 0.40 0.40 0.04 0.44 0.44 XXX
73520... .................. A X-ray exam of hips....... 0.26 0.57 0.57 0.06 0.89 0.89 XXX
73520... 26 A X-ray exam of hips....... 0.26 0.09 0.09 0.02 0.37 0.37 XXX
73520... TC A X-ray exam of hips....... 0.00 0.48 0.48 0.04 0.52 0.52 XXX
73525... .................. A Contrast x-ray of hip.... 0.54 1.67 1.67 0.17 2.38 2.38 XXX
73525... 26 A Contrast x-ray of hip.... 0.54 0.19 0.19 0.04 0.77 0.77 XXX
73525... TC A Contrast x-ray of hip.... 0.00 1.49 1.49 0.13 1.62 1.62 XXX
73530... .................. A X-ray exam of hip........ 0.29 0.47 0.47 0.05 0.81 0.81 XXX
73530... 26 A X-ray exam of hip........ 0.29 0.10 0.10 0.02 0.41 0.41 XXX
73530... TC A X-ray exam of hip........ 0.00 0.37 0.37 0.03 0.40 0.40 XXX
73540... .................. A X-ray exam of pelvis & 0.20 0.48 0.48 0.05 0.73 0.73 XXX
hips.
73540... 26 A X-ray exam of pelvis & 0.20 0.07 0.07 0.01 0.28 0.28 XXX
hips.
73540... TC A X-ray exam of pelvis & 0.00 0.40 0.40 0.04 0.44 0.44 XXX
hips.
73550... .................. A X-ray exam of thigh...... 0.17 0.46 0.46 0.05 0.68 0.68 XXX
73550... 26 A X-ray exam of thigh...... 0.17 0.06 0.06 0.01 0.24 0.24 XXX
73550... TC A X-ray exam of thigh...... 0.00 0.40 0.40 0.04 0.44 0.44 XXX
73560... .................. A X-ray exam of knee....... 0.17 0.42 0.42 0.04 0.63 0.63 XXX
73560... 26 A X-ray exam of knee....... 0.17 0.05 0.05 0.01 0.23 0.23 XXX
73560... TC A X-ray exam of knee....... 0.00 0.37 0.37 0.03 0.40 0.40 XXX
73562... .................. A X-ray exam of knee....... 0.18 0.47 0.47 0.05 0.70 0.70 XXX
73562... 26 A X-ray exam of knee....... 0.18 0.07 0.07 0.01 0.26 0.26 XXX
73562... TC A X-ray exam of knee....... 0.00 0.40 0.40 0.04 0.44 0.44 XXX
73564... .................. A X-ray exam of knee....... 0.22 0.51 0.51 0.06 0.79 0.79 XXX
73564... 26 A X-ray exam of knee....... 0.22 0.07 0.07 0.02 0.31 0.31 XXX
73564... TC A X-ray exam of knee....... 0.00 0.44 0.44 0.04 0.48 0.48 XXX
73565... .................. A X-ray exam of knee....... 0.17 0.40 0.40 0.04 0.61 0.61 XXX
73565... 26 A X-ray exam of knee....... 0.17 0.05 0.05 0.01 0.23 0.23 XXX
73565... TC A X-ray exam of knee....... 0.00 0.35 0.35 0.03 0.38 0.38 XXX
73580... .................. A Contrast x-ray of knee 0.54 2.05 2.05 0.21 2.80 2.80 XXX
joint.
73580... 26 A Contrast x-ray of knee 0.54 0.19 0.19 0.04 0.77 0.77 XXX
joint.
73580... TC A Contrast x-ray of knee 0.00 1.86 1.86 0.17 2.03 2.03 XXX
joint.
[[Page 30974]]
73590... .................. A X-ray exam of lower leg.. 0.17 0.42 0.42 0.04 0.63 0.63 XXX
73590... 26 A X-ray exam of lower leg.. 0.17 0.05 0.05 0.01 0.23 0.23 XXX
73590... TC A X-ray exam of lower leg.. 0.00 0.37 0.37 0.03 0.40 0.40 XXX
73592... .................. A X-ray exam of leg, infant 0.16 0.40 0.40 0.04 0.60 0.60 XXX
73592... 26 A X-ray exam of leg, infant 0.16 0.05 0.05 0.01 0.22 0.22 XXX
73592... TC A X-ray exam of leg, infant 0.00 0.35 0.35 0.03 0.38 0.38 XXX
73600... .................. A X-ray exam of ankle...... 0.16 0.40 0.40 0.04 0.60 0.60 XXX
73600... 26 A X-ray exam of ankle...... 0.16 0.05 0.05 0.01 0.22 0.22 XXX
73600... TC A X-ray exam of ankle...... 0.00 0.35 0.35 0.03 0.38 0.38 XXX
73610... .................. A X-ray exam of ankle...... 0.17 0.44 0.44 0.04 0.65 0.65 XXX
73610... 26 A X-ray exam of ankle...... 0.17 0.06 0.06 0.01 0.24 0.24 XXX
73610... TC A X-ray exam of ankle...... 0.00 0.38 0.38 0.03 0.41 0.41 XXX
73615... .................. A Contrast x-ray of ankle.. 0.54 1.67 1.67 0.17 2.38 2.38 XXX
73615... 26 A Contrast x-ray of ankle.. 0.54 0.19 0.19 0.04 0.77 0.77 XXX
73615... TC A Contrast x-ray of ankle.. 0.00 1.49 1.49 0.13 1.62 1.62 XXX
73620... .................. A X-ray exam of foot....... 0.16 0.40 0.40 0.04 0.60 0.60 XXX
73620... 26 A X-ray exam of foot....... 0.16 0.05 0.05 0.01 0.22 0.22 XXX
73620... TC A X-ray exam of foot....... 0.00 0.35 0.35 0.03 0.38 0.38 XXX
73630... .................. A X-ray exam of foot....... 0.17 0.44 0.44 0.04 0.65 0.65 XXX
73630... 26 A X-ray exam of foot....... 0.17 0.06 0.06 0.01 0.24 0.24 XXX
73630... TC A X-ray exam of foot....... 0.00 0.38 0.38 0.03 0.41 0.41 XXX
73650... .................. A X-ray exam of heel....... 0.16 0.39 0.39 0.04 0.59 0.59 XXX
73650... 26 A X-ray exam of heel....... 0.16 0.05 0.05 0.01 0.22 0.22 XXX
73650... TC A X-ray exam of heel....... 0.00 0.33 0.33 0.03 0.36 0.36 XXX
73660... .................. A X-ray exam of toe(s)..... 0.13 0.34 0.34 0.04 0.51 0.51 XXX
73660... 26 A X-ray exam of toe(s)..... 0.13 0.04 0.04 0.01 0.18 0.18 XXX
73660... TC A X-ray exam of toe(s)..... 0.00 0.30 0.30 0.03 0.33 0.33 XXX
73700... .................. A CAT scan of leg.......... 1.09 3.88 3.88 0.37 5.34 5.34 XXX
73700... 26 A CAT scan of leg.......... 1.09 0.36 0.36 0.07 1.52 1.52 XXX
73700... TC A CAT scan of leg.......... 0.00 3.52 3.52 0.30 3.82 3.82 XXX
73701... .................. A Contrast CAT scan of leg. 1.16 4.57 4.57 0.44 6.17 6.17 XXX
73701... 26 A Contrast CAT scan of leg. 1.16 0.38 0.38 0.08 1.62 1.62 XXX
73701... TC A Contrast CAT scan of leg. 0.00 4.19 4.19 0.36 4.55 4.55 XXX
73702... .................. A Contrast CAT scans of leg 1.22 5.66 5.66 0.53 7.41 7.41 XXX
73702... 26 A Contrast CAT scans of leg 1.22 0.39 0.39 0.08 1.69 1.69 XXX
73702... TC A Contrast CAT scans of leg 0.00 5.27 5.27 0.45 5.72 5.72 XXX
73720... .................. A Magnetic image, leg, foot 1.48 8.44 8.44 0.77 10.69 10.69 XXX
73720... 26 A Magnetic image, leg, foot 1.48 0.49 0.49 0.10 2.07 2.07 XXX
73720... TC A Magnetic image, leg, foot 0.00 7.95 7.95 0.67 8.62 8.62 XXX
73721... .................. A Magnetic image, joint of 1.48 8.27 8.27 0.73 10.48 10.48 XXX
leg.
73721... 26 A Magnetic image, joint of 1.48 0.32 0.32 0.06 1.86 1.86 XXX
leg.
73721... TC A Magnetic image, joint of 0.00 7.95 7.95 0.67 8.62 8.62 XXX
leg.
73725... .................. R Magnetic imaging/lower 1.82 8.44 8.44 0.77 11.03 11.03 XXX
(MRA).
73725... 26 R Magnetic imaging/lower 1.82 0.49 0.49 0.10 2.41 2.41 XXX
(MRA).
73725... TC R Magnetic imaging/lower 0.00 7.95 7.95 0.67 8.62 8.62 XXX
(MRA).
74000... .................. A X-ray exam of abdomen.... 0.18 0.43 0.43 0.04 0.65 0.65 XXX
74000... 26 A X-ray exam of abdomen.... 0.18 0.06 0.06 0.01 0.25 0.25 XXX
74000... TC A X-ray exam of abdomen.... 0.00 0.37 0.37 0.03 0.40 0.40 XXX
74010... .................. A X-ray exam of abdomen.... 0.23 0.48 0.48 0.06 0.77 0.77 XXX
74010... 26 A X-ray exam of abdomen.... 0.23 0.08 0.08 0.02 0.33 0.33 XXX
74010... TC A X-ray exam of abdomen.... 0.00 0.40 0.40 0.04 0.44 0.44 XXX
74020... .................. A X-ray exam of abdomen.... 0.27 0.54 0.54 0.06 0.87 0.87 XXX
74020... 26 A X-ray exam of abdomen.... 0.27 0.10 0.10 0.02 0.39 0.39 XXX
74020... TC A X-ray exam of abdomen.... 0.00 0.44 0.44 0.04 0.48 0.48 XXX
74022... .................. A X-ray exam series, 0.32 0.63 0.63 0.07 1.02 1.02 XXX
abdomen.
74022... 26 A X-ray exam series, 0.32 0.11 0.11 0.02 0.45 0.45 XXX
abdomen.
74022... TC A X-ray exam series, 0.00 0.52 0.52 0.05 0.57 0.57 XXX
abdomen.
74150... .................. A CAT scan of abdomen...... 1.19 4.40 4.40 0.43 6.02 6.02 XXX
74150... 26 A CAT scan of abdomen...... 1.19 0.39 0.39 0.08 1.66 1.66 XXX
74150... TC A CAT scan of abdomen...... 0.00 4.01 4.01 0.35 4.36 4.36 XXX
74160... .................. A Contrast CAT scan of 1.27 5.27 5.27 0.50 7.04 7.04 XXX
abdomen.
74160... 26 A Contrast CAT scan of 1.27 0.42 0.42 0.09 1.78 1.78 XXX
abdomen.
74160... TC A Contrast CAT scan of 0.00 4.85 4.85 0.41 5.26 5.26 XXX
abdomen.
74170... .................. A Contrast CAT scans, 1.40 6.48 6.48 0.60 8.48 8.48 XXX
abdomen.
74170... 26 A Contrast CAT scans, 1.40 0.46 0.46 0.10 1.96 1.96 XXX
abdomen.
74170... TC A Contrast CAT scans, 0.00 6.02 6.02 0.50 6.52 6.52 XXX
abdomen.
74181... .................. A Magnetic image, abdomen 1.60 8.48 8.48 0.78 10.86 10.86 XXX
(MRI).
74181... 26 A Magnetic image, abdomen 1.60 0.54 0.54 0.11 2.25 2.25 XXX
(MRI).
74181... TC A Magnetic image, abdomen 0.00 7.95 7.95 0.67 8.62 8.62 XXX
(MRI).
74185... .................. N Magnetic image/abdomen +1.80 8.48 8.48 0.78 11.06 11.06 XXX
(MRA).
74185... 26 N Magnetic image/abdomen +1.80 0.54 0.54 0.11 2.45 2.45 XXX
(MRA).
74185... TC N Magnetic image/abdomen +0.00 7.95 7.95 0.67 8.62 8.62 XXX
(MRA).
74190... .................. A X-ray exam of peritoneum. 0.48 1.02 1.02 0.10 1.60 1.60 XXX
74190... 26 A X-ray exam of peritoneum. 0.48 0.10 0.10 0.02 0.60 0.60 XXX
[[Page 30975]]
74190... TC A X-ray exam of peritoneum. 0.00 0.92 0.92 0.08 1.00 1.00 XXX
74210... .................. A Contrast xray exam of 0.36 0.96 0.96 0.09 1.41 1.41 XXX
throat.
74210... 26 A Contrast xray exam of 0.36 0.12 0.12 0.02 0.50 0.50 XXX
throat.
74210... TC A Contrast xray exam of 0.00 0.84 0.84 0.07 0.91 0.91 XXX
throat.
74220... .................. A Contrast xray exam, 0.46 1.00 1.00 0.10 1.56 1.56 XXX
esophagus.
74220... 26 A Contrast xray exam, 0.46 0.16 0.16 0.03 0.65 0.65 XXX
esophagus.
74220... TC A Contrast xray exam, 0.00 0.84 0.84 0.07 0.91 0.91 XXX
esophagus.
74230... .................. A Cinema xray throat/ 0.53 1.11 1.11 0.12 1.76 1.76 XXX
esophagus.
74230... 26 A Cinema xray throat/ 0.53 0.19 0.19 0.04 0.76 0.76 XXX
esophagus.
74230... TC A Cinema xray throat/ 0.00 0.92 0.92 0.08 1.00 1.00 XXX
esophagus.
74235... .................. A Remove esophagus 1.19 2.25 2.25 0.25 3.69 3.69 XXX
obstruction.
74235... 26 A Remove esophagus 1.19 0.39 0.39 0.08 1.66 1.66 XXX
obstruction.
74235... TC A Remove esophagus 0.00 1.86 1.86 0.17 2.03 2.03 XXX
obstruction.
74240... .................. A X-ray exam upper GI tract 0.69 1.27 1.27 0.14 2.10 2.10 XXX
74240... 26 A X-ray exam upper GI tract 0.69 0.24 0.24 0.05 0.98 0.98 XXX
74240... TC A X-ray exam upper GI tract 0.00 1.03 1.03 0.09 1.12 1.12 XXX
74241... .................. A X-ray exam upper GI tract 0.69 1.30 1.30 0.14 2.13 2.13 XXX
74241... 26 A X-ray exam upper GI tract 0.69 0.24 0.24 0.05 0.98 0.98 XXX
74241... TC A X-ray exam upper GI tract 0.00 1.06 1.06 0.09 1.15 1.15 XXX
74245... .................. A X-ray exam upper GI tract 0.91 1.99 1.99 0.21 3.11 3.11 XXX
74245... 26 A X-ray exam upper GI tract 0.91 0.31 0.31 0.06 1.28 1.28 XXX
74245... TC A X-ray exam upper GI tract 0.00 1.69 1.69 0.15 1.84 1.84 XXX
74246... .................. A Contrast xray upper GI 0.69 1.41 1.41 0.15 2.25 2.25 XXX
tract.
74246... 26 A Contrast xray upper GI 0.69 0.24 0.24 0.05 0.98 0.98 XXX
tract.
74246... TC A Contrast xray upper GI 0.00 1.17 1.17 0.10 1.27 1.27 XXX
tract.
74247... .................. A Contrast xray upper GI 0.69 1.43 1.43 0.16 2.28 2.28 XXX
tract.
74247... 26 A Contrast xray upper GI 0.69 0.24 0.24 0.05 0.98 0.98 XXX
tract.
74247... TC A Contrast xray upper GI 0.00 1.19 1.19 0.11 1.30 1.30 XXX
tract.
74249... .................. A Contrast xray upper GI 0.91 2.13 2.13 0.22 3.26 3.26 XXX
tract.
74249... 26 A Contrast xray upper GI 0.91 0.31 0.31 0.06 1.28 1.28 XXX
tract.
74249... TC A Contrast xray upper GI 0.00 1.82 1.82 0.16 1.98 1.98 XXX
tract.
74250... .................. A X-ray exam of small bowel 0.47 1.08 1.08 0.11 1.66 1.66 XXX
74250... 26 A X-ray exam of small bowel 0.47 0.16 0.16 0.03 0.66 0.66 XXX
74250... TC A X-ray exam of small bowel 0.00 0.92 0.92 0.08 1.00 1.00 XXX
74251... .................. A X-ray exam of small bowel 0.69 1.08 1.08 0.11 1.88 1.88 XXX
74251... 26 A X-ray exam of small bowel 0.69 0.16 0.16 0.03 0.88 0.88 XXX
74251... TC A X-ray exam of small bowel 0.00 0.92 0.92 0.08 1.00 1.00 XXX
74260... .................. A X-ray exam of small bowel 0.50 1.23 1.23 0.12 1.85 1.85 XXX
74260... 26 A X-ray exam of small bowel 0.50 0.17 0.17 0.03 0.70 0.70 XXX
74260... TC A X-ray exam of small bowel 0.00 1.06 1.06 0.09 1.15 1.15 XXX
74270... .................. A Contrast x-ray exam of 0.69 1.44 1.44 0.16 2.29 2.29 XXX
colon.
74270... 26 A Contrast x-ray exam of 0.69 0.24 0.24 0.05 0.98 0.98 XXX
colon.
74270... TC A Contrast x-ray exam of 0.00 1.21 1.21 0.11 1.32 1.32 XXX
colon.
74280... .................. A Contrast x-ray exam of 0.99 1.92 1.92 0.21 3.12 3.12 XXX
colon.
74280... 26 A Contrast x-ray exam of 0.99 0.33 0.33 0.07 1.39 1.39 XXX
colon.
74280... TC A Contrast x-ray exam of 0.00 1.59 1.59 0.14 1.73 1.73 XXX
colon.
74283... .................. A Contrast x-ray exam of 2.02 2.49 2.49 0.30 4.81 4.81 XXX
colon.
74283... 26 A Contrast x-ray exam of 2.02 0.67 0.67 0.14 2.83 2.83 XXX
colon.
74283... TC A Contrast x-ray exam of 0.00 1.82 1.82 0.16 1.98 1.98 XXX
colon.
74290... .................. A Contrast x-ray, 0.32 0.63 0.63 0.07 1.02 1.02 XXX
gallbladder.
74290... 26 A Contrast x-ray, 0.32 0.11 0.11 0.02 0.45 0.45 XXX
gallbladder.
74290... TC A Contrast x-ray, 0.00 0.52 0.52 0.05 0.57 0.57 XXX
gallbladder.
74291... .................. A Contrast x-rays, 0.20 0.36 0.36 0.04 0.60 0.60 XXX
gallbladder.
74291... 26 A Contrast x-rays, 0.20 0.07 0.07 0.01 0.28 0.28 XXX
gallbladder.
74291... TC A Contrast x-rays, 0.00 0.30 0.30 0.03 0.33 0.33 XXX
gallbladder.
74300... 26 A X-ray bile ducts, 0.36 0.13 0.13 0.02 0.51 0.51 XXX
pancreas.
74301... 26 A Additional x-rays at 0.21 0.07 0.07 0.01 0.29 0.29 XXX
surgery.
74305... .................. A X-ray bile ducts, 0.42 0.70 0.70 0.08 1.20 1.20 XXX
pancreas.
74305... 26 A X-ray bile ducts, 0.42 0.14 0.14 0.03 0.59 0.59 XXX
pancreas.
74305... TC A X-ray bile ducts, 0.00 0.56 0.56 0.05 0.61 0.61 XXX
pancreas.
74320... .................. A Contrast x-ray of bile 0.54 2.42 2.42 0.23 3.19 3.19 XXX
ducts.
74320... 26 A Contrast x-ray of bile 0.54 0.19 0.19 0.04 0.77 0.77 XXX
ducts.
74320... TC A Contrast x-ray of bile 0.00 2.23 2.23 0.19 2.42 2.42 XXX
ducts.
74327... .................. A X-ray for bile stone 0.70 1.49 1.49 0.16 2.35 2.35 XXX
removal.
74327... 26 A X-ray for bile stone 0.70 0.24 0.24 0.05 0.99 0.99 XXX
removal.
74327... TC A X-ray for bile stone 0.00 1.25 1.25 0.11 1.36 1.36 XXX
removal.
74328... .................. A X-ray for bile duct 0.70 2.47 2.47 0.24 3.41 3.41 XXX
endoscopy.
74328... 26 A X-ray for bile duct 0.70 0.24 0.24 0.05 0.99 0.99 XXX
endoscopy.
74328... TC A X-ray for bile duct 0.00 2.23 2.23 0.19 2.42 2.42 XXX
endoscopy.
74329... .................. A X-ray for pancreas 0.70 2.47 2.47 0.24 3.41 3.41 XXX
endoscopy.
74329... 26 A X-ray for pancreas 0.70 0.24 0.24 0.05 0.99 0.99 XXX
endoscopy.
74329... TC A X-ray for pancreas 0.00 2.23 2.23 0.19 2.42 2.42 XXX
endoscopy.
74330... .................. A Xray, bile/pancreas 0.90 2.47 2.47 0.24 3.61 3.61 XXX
endoscopy.
74330... 26 A Xray, bile/pancreas 0.90 0.24 0.24 0.05 1.19 1.19 XXX
endoscopy.
[[Page 30976]]
74330... TC A Xray, bile/pancreas 0.00 2.23 2.23 0.19 2.42 2.42 XXX
endoscopy.
74340... .................. A X-ray guide for GI tube.. 0.54 2.05 2.05 0.21 2.80 2.80 XXX
74340... 26 A X-ray guide for GI tube.. 0.54 0.19 0.19 0.04 0.77 0.77 XXX
74340... TC A X-ray guide for GI tube.. 0.00 1.86 1.86 0.17 2.03 2.03 XXX
74350... .................. A X-ray guide, stomach tube 0.76 2.49 2.49 0.24 3.49 3.49 XXX
74350... 26 A X-ray guide, stomach tube 0.76 0.26 0.26 0.05 1.07 1.07 XXX
74350... TC A X-ray guide, stomach tube 0.00 2.23 2.23 0.19 2.42 2.42 XXX
74355... .................. A X-ray guide, intestinal 0.76 2.12 2.12 0.22 3.10 3.10 XXX
tube.
74355... 26 A X-ray guide, intestinal 0.76 0.26 0.26 0.05 1.07 1.07 XXX
tube.
74355... TC A X-ray guide, intestinal 0.00 1.86 1.86 0.17 2.03 2.03 XXX
tube.
74360... .................. A X-ray guide, GI dilation. 0.54 2.42 2.42 0.23 3.19 3.19 XXX
74360... 26 A X-ray guide, GI dilation. 0.54 0.19 0.19 0.04 0.77 0.77 XXX
74360... TC A X-ray guide, GI dilation. 0.00 2.23 2.23 0.19 2.42 2.42 XXX
74363... .................. A X-ray, bile duct dilation 0.88 4.62 4.62 0.43 5.93 5.93 XXX
74363... 26 A X-ray, bile duct dilation 0.88 0.30 0.30 0.06 1.24 1.24 XXX
74363... TC A X-ray, bile duct dilation 0.00 4.32 4.32 0.37 4.69 4.69 XXX
74400... .................. A Contrast x-ray urinary 0.49 1.35 1.35 0.14 1.98 1.98 XXX
tract.
74400... 26 A Contrast x-ray urinary 0.49 0.16 0.16 0.03 0.68 0.68 XXX
tract.
74400... TC A Contrast x-ray urinary 0.00 1.19 1.19 0.11 1.30 1.30 XXX
tract.
74405... .................. A Contrast x-ray urinary 0.49 1.57 1.57 0.16 2.22 2.22 XXX
tract.
74405... 26 A Contrast x-ray urinary 0.49 0.16 0.16 0.03 0.68 0.68 XXX
tract.
74405... TC A Contrast x-ray urinary 0.00 1.41 1.41 0.13 1.54 1.54 XXX
tract.
74410... .................. A Contrast x-ray urinary 0.49 1.55 1.55 0.15 2.19 2.19 XXX
tract.
74410... 26 A Contrast x-ray urinary 0.49 0.16 0.16 0.03 0.68 0.68 XXX
tract.
74410... TC A Contrast x-ray urinary 0.00 1.38 1.38 0.12 1.50 1.50 XXX
tract.
74415... .................. A Contrast x-ray urinary 0.49 1.67 1.67 0.16 2.32 2.32 XXX
tract.
74415... 26 A Contrast x-ray urinary 0.49 0.16 0.16 0.03 0.68 0.68 XXX
tract.
74415... TC A Contrast x-ray urinary 0.00 1.50 1.50 0.13 1.63 1.63 XXX
tract.
74420... .................. A Contrast x-ray urinary 0.36 1.98 1.98 0.19 2.53 2.53 XXX
tract.
74420... 26 A Contrast x-ray urinary 0.36 0.12 0.12 0.02 0.50 0.50 XXX
tract.
74420... TC A Contrast x-ray urinary 0.00 1.86 1.86 0.17 2.03 2.03 XXX
tract.
74425... .................. A Contrast x-ray urinary 0.36 1.04 1.04 0.10 1.50 1.50 XXX
tract.
74425... 26 A Contrast x-ray urinary 0.36 0.12 0.12 0.02 0.50 0.50 XXX
tract.
74425... TC A Contrast x-ray urinary 0.00 0.92 0.92 0.08 1.00 1.00 XXX
tract.
74430... .................. A Contrast x-ray of bladder 0.32 0.86 0.86 0.09 1.27 1.27 XXX
74430... 26 A Contrast x-ray of bladder 0.32 0.11 0.11 0.02 0.45 0.45 XXX
74430... TC A Contrast x-ray of bladder 0.00 0.74 0.74 0.07 0.81 0.81 XXX
74440... .................. A X-ray exam male genital 0.38 0.93 0.93 0.10 1.41 1.41 XXX
tract.
74440... 26 A X-ray exam male genital 0.38 0.13 0.13 0.03 0.54 0.54 XXX
tract.
74440... TC A X-ray exam male genital 0.00 0.80 0.80 0.07 0.87 0.87 XXX
tract.
74445... .................. A X-ray exam of penis...... 1.14 1.18 1.18 0.15 2.47 2.47 XXX
74445... 26 A X-ray exam of penis...... 1.14 0.37 0.37 0.08 1.59 1.59 XXX
74445... TC A X-ray exam of penis...... 0.00 0.80 0.80 0.07 0.87 0.87 XXX
74450... .................. A X-ray exam urethra/ 0.33 1.15 1.15 0.11 1.59 1.59 XXX
bladder.
74450... 26 A X-ray exam urethra/ 0.33 0.11 0.11 0.02 0.46 0.46 XXX
bladder.
74450... TC A X-ray exam urethra/ 0.00 1.03 1.03 0.09 1.12 1.12 XXX
bladder.
74455... .................. A X-ray exam urethra/ 0.33 1.23 1.23 0.12 1.68 1.68 XXX
bladder.
74455... 26 A X-ray exam urethra/ 0.33 0.11 0.11 0.02 0.46 0.46 XXX
bladder.
74455... TC A X-ray exam urethra/ 0.00 1.12 1.12 0.10 1.22 1.22 XXX
bladder.
74470... .................. A X-ray exam of kidney 0.54 1.07 1.07 0.12 1.73 1.73 XXX
lesion.
74470... 26 A X-ray exam of kidney 0.54 0.19 0.19 0.04 0.77 0.77 XXX
lesion.
74470... TC A X-ray exam of kidney 0.00 0.89 0.89 0.08 0.97 0.97 XXX
lesion.
74475... .................. A X-ray control catheter 0.54 3.07 3.07 0.29 3.90 3.90 XXX
insert.
74475... 26 A X-ray control catheter 0.54 0.19 0.19 0.04 0.77 0.77 XXX
insert.
74475... TC A X-ray control catheter 0.00 2.89 2.89 0.25 3.14 3.14 XXX
insert.
74480... .................. A X-ray control catheter 0.54 3.07 3.07 0.29 3.90 3.90 XXX
insert.
74480... 26 A X-ray control catheter 0.54 0.19 0.19 0.04 0.77 0.77 XXX
insert.
74480... TC A X-ray control catheter 0.00 2.89 2.89 0.25 3.14 3.14 XXX
insert.
74485... .................. A X-ray guide, GU dilation. 0.54 2.42 2.42 0.23 3.19 3.19 XXX
74485... 26 A X-ray guide, GU dilation. 0.54 0.19 0.19 0.04 0.77 0.77 XXX
74485... TC A X-ray guide, GU dilation. 0.00 2.23 2.23 0.19 2.42 2.42 XXX
74710... .................. A X-ray measurement of 0.34 0.86 0.86 0.09 1.29 1.29 XXX
pelvis.
74710... 26 A X-ray measurement of 0.34 0.12 0.12 0.02 0.48 0.48 XXX
pelvis.
74710... TC A X-ray measurement of 0.00 0.74 0.74 0.07 0.81 0.81 XXX
pelvis.
74740... .................. A X-ray female genital 0.38 1.05 1.05 0.11 1.54 1.54 XXX
tract.
74740... 26 A X-ray female genital 0.38 0.13 0.13 0.03 0.54 0.54 XXX
tract.
74740... TC A X-ray female genital 0.00 0.92 0.92 0.08 1.00 1.00 XXX
tract.
74742... .................. A X-ray fallopian tube..... 0.61 2.42 2.42 0.23 3.26 3.26 XXX
74742... 26 A X-ray fallopian tube..... 0.61 0.19 0.19 0.04 0.84 0.84 XXX
74742... TC A X-ray fallopian tube..... 0.00 2.23 2.23 0.19 2.42 2.42 XXX
74775... .................. A X-ray exam of perineum... 0.62 1.25 1.25 0.13 2.00 2.00 XXX
74775... 26 A X-ray exam of perineum... 0.62 0.22 0.22 0.04 0.88 0.88 XXX
74775... TC A X-ray exam of perineum... 0.00 1.03 1.03 0.09 1.12 1.12 XXX
75552... .................. A Magnetic image, 1.60 8.48 8.48 0.78 10.86 10.86 XXX
myocardium.
[[Page 30977]]
75552... 26 A Magnetic image, 1.60 0.54 0.54 0.11 2.25 2.25 XXX
myocardium.
75552... TC A Magnetic image, 0.00 7.95 7.95 0.67 8.62 8.62 XXX
myocardium.
75553... .................. A Magnetic image, 2.00 8.48 8.48 0.78 11.26 11.26 XXX
myocardium.
75553... 26 A Magnetic image, 2.00 0.54 0.54 0.11 2.65 2.65 XXX
myocardium.
75553... TC A Magnetic image, 0.00 7.95 7.95 0.67 8.62 8.62 XXX
myocardium.
75554... .................. A Cardiac MRI/function..... 1.83 8.48 8.48 0.78 11.09 11.09 XXX
75554... 26 A Cardiac MRI/function..... 1.83 0.54 0.54 0.11 2.48 2.48 XXX
75554... TC A Cardiac MRI/function..... 0.00 7.95 7.95 0.67 8.62 8.62 XXX
75555... .................. A Cardiac MRI/limited study 1.74 8.48 8.48 0.78 11.00 11.00 XXX
75555... 26 A Cardiac MRI/limited study 1.74 0.54 0.54 0.11 2.39 2.39 XXX
75555... TC A Cardiac MRI/limited study 0.00 7.95 7.95 0.67 8.62 8.62 XXX
75600... .................. A Contrast x-ray exam of 0.49 9.10 9.10 0.78 10.37 10.37 XXX
aorta.
75600... 26 A Contrast x-ray exam of 0.49 0.16 0.16 0.03 0.68 0.68 XXX
aorta.
75600... TC A Contrast x-ray exam of 0.00 8.94 8.94 0.75 9.69 9.69 XXX
aorta.
75605... .................. A Contrast x-ray exam of 1.14 9.31 9.31 0.83 11.28 11.28 XXX
aorta.
75605... 26 A Contrast x-ray exam of 1.14 0.37 0.37 0.08 1.59 1.59 XXX
aorta.
75605... TC A Contrast x-ray exam of 0.00 8.94 8.94 0.75 9.69 9.69 XXX
aorta.
75625... .................. A Contrast x-ray exam of 1.14 9.31 9.31 0.83 11.28 11.28 XXX
aorta.
75625... 26 A Contrast x-ray exam of 1.14 0.37 0.37 0.08 1.59 1.59 XXX
aorta.
75625... TC A Contrast x-ray exam of 0.00 8.94 8.94 0.75 9.69 9.69 XXX
aorta.
75630... .................. A X-ray aorta, leg arteries 1.79 9.74 9.74 0.88 12.41 12.41 XXX
75630... 26 A X-ray aorta, leg arteries 1.79 0.43 0.43 0.09 2.31 2.31 XXX
75630... TC A X-ray aorta, leg arteries 0.00 9.31 9.31 0.79 10.10 10.10 XXX
75650... .................. A Artery x-rays, head & 1.49 9.43 9.43 0.85 11.77 11.77 XXX
neck.
75650... 26 A Artery x-rays, head & 1.49 0.49 0.49 0.10 2.08 2.08 XXX
neck.
75650... TC A Artery x-rays, head & 0.00 8.94 8.94 0.75 9.69 9.69 XXX
neck.
75658... .................. A X-ray exam of arm 1.31 9.37 9.37 0.84 11.52 11.52 XXX
arteries.
75658... 26 A X-ray exam of arm 1.31 0.43 0.43 0.09 1.83 1.83 XXX
arteries.
75658... TC A X-ray exam of arm 0.00 8.94 8.94 0.75 9.69 9.69 XXX
arteries.
75660... .................. A Artery x-rays, head & 1.31 9.37 9.37 0.84 11.52 11.52 XXX
neck.
75660... 26 A Artery x-rays, head & 1.31 0.43 0.43 0.09 1.83 1.83 XXX
neck.
75660... TC A Artery x-rays, head & 0.00 8.94 8.94 0.75 9.69 9.69 XXX
neck.
75662... .................. A Artery x-rays, head & 1.66 9.49 9.49 0.86 12.01 12.01 XXX
neck.
75662... 26 A Artery x-rays, head & 1.66 0.55 0.55 0.11 2.32 2.32 XXX
neck.
75662... TC A Artery x-rays, head & 0.00 8.94 8.94 0.75 9.69 9.69 XXX
neck.
75665... .................. A Artery x-rays, head & 1.31 9.37 9.37 0.84 11.52 11.52 XXX
neck.
75665... 26 A Artery x-rays, head & 1.31 0.43 0.43 0.09 1.83 1.83 XXX
neck.
75665... TC A Artery x-rays, head & 0.00 8.94 8.94 0.75 9.69 9.69 XXX
neck.
75671... .................. A Artery x-rays, head & 1.66 9.49 9.49 0.86 12.01 12.01 XXX
neck.
75671... 26 A Artery x-rays, head & 1.66 0.55 0.55 0.11 2.32 2.32 XXX
neck.
75671... TC A Artery x-rays, head & 0.00 8.94 8.94 0.75 9.69 9.69 XXX
neck.
75676... .................. A Artery x-rays, neck...... 1.31 9.37 9.37 0.84 11.52 11.52 XXX
75676... 26 A Artery x-rays, neck...... 1.31 0.43 0.43 0.09 1.83 1.83 XXX
75676... TC A Artery x-rays, neck...... 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75680... .................. A Artery x-rays, neck...... 1.66 9.49 9.49 0.86 12.01 12.01 XXX
75680... 26 A Artery x-rays, neck...... 1.66 0.55 0.55 0.11 2.32 2.32 XXX
75680... TC A Artery x-rays, neck...... 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75685... .................. A Artery x-rays, spine..... 1.31 9.37 9.37 0.84 11.52 11.52 XXX
75685... 26 A Artery x-rays, spine..... 1.31 0.43 0.43 0.09 1.83 1.83 XXX
75685... TC A Artery x-rays, spine..... 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75705... .................. A Artery x-rays, spine..... 2.18 9.67 9.67 0.90 12.75 12.75 XXX
75705... 26 A Artery x-rays, spine..... 2.18 0.73 0.73 0.15 3.06 3.06 XXX
75705... TC A Artery x-rays, spine..... 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75710... .................. A Artery x-rays, arm/leg... 1.14 9.31 9.31 0.83 11.28 11.28 XXX
75710... 26 A Artery x-rays, arm/leg... 1.14 0.37 0.37 0.08 1.59 1.59 XXX
75710... TC A Artery x-rays, arm/leg... 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75716... .................. A Artery x-rays, arms/legs. 1.31 9.37 9.37 0.84 11.52 11.52 XXX
75716... 26 A Artery x-rays, arms/legs. 1.31 0.43 0.43 0.09 1.83 1.83 XXX
75716... TC A Artery x-rays, arms/legs. 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75722... .................. A Artery x-rays, kidney.... 1.14 9.31 9.31 0.83 11.28 11.28 XXX
75722... 26 A Artery x-rays, kidney.... 1.14 0.37 0.37 0.08 1.59 1.59 XXX
75722... TC A Artery x-rays, kidney.... 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75724... .................. A Artery x-rays, kidneys... 1.49 9.43 9.43 0.85 11.77 11.77 XXX
75724... 26 A Artery x-rays, kidneys... 1.49 0.49 0.49 0.10 2.08 2.08 XXX
75724... TC A Artery x-rays, kidneys... 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75726... .................. A Artery x-rays, abdomen... 1.14 9.31 9.31 0.83 11.28 11.28 XXX
75726... 26 A Artery x-rays, abdomen... 1.14 0.37 0.37 0.08 1.59 1.59 XXX
75726... TC A Artery x-rays, abdomen... 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75731... .................. A Artery x-rays, adrenal 1.14 9.31 9.31 0.83 11.28 11.28 XXX
gland.
75731... 26 A Artery x-rays, adrenal 1.14 0.37 0.37 0.08 1.59 1.59 XXX
gland.
75731... TC A Artery x-rays, adrenal 0.00 8.94 8.94 0.75 9.69 9.69 XXX
gland.
75733... .................. A Artery x-rays, adrenal 1.31 9.37 9.37 0.84 11.52 11.52 XXX
glands.
75733... 26 A Artery x-rays, adrenal 1.31 0.43 0.43 0.09 1.83 1.83 XXX
glands.
75733... TC A Artery x-rays, adrenal 0.00 8.94 8.94 0.75 9.69 9.69 XXX
glands.
[[Page 30978]]
75736... .................. A Artery x-rays, pelvis.... 1.14 9.31 9.31 0.83 11.28 11.28 XXX
75736... 26 A Artery x-rays, pelvis.... 1.14 0.37 0.37 0.08 1.59 1.59 XXX
75736... TC A Artery x-rays, pelvis.... 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75741... .................. A Artery x-rays, lung...... 1.31 9.37 9.37 0.84 11.52 11.52 XXX
75741... 26 A Artery x-rays, lung...... 1.31 0.43 0.43 0.09 1.83 1.83 XXX
75741... TC A Artery x-rays, lung...... 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75743... .................. A Artery x-rays, lungs..... 1.66 9.49 9.49 0.86 12.01 12.01 XXX
75743... 26 A Artery x-rays, lungs..... 1.66 0.55 0.55 0.11 2.32 2.32 XXX
75743... TC A Artery x-rays, lungs..... 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75746... .................. A Artery x-rays, lung...... 1.14 9.31 9.31 0.83 11.28 11.28 XXX
75746... 26 A Artery x-rays, lung...... 1.14 0.37 0.37 0.08 1.59 1.59 XXX
75746... TC A Artery x-rays, lung...... 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75756... .................. A Artery x-rays, chest..... 1.14 9.31 9.31 0.83 11.28 11.28 XXX
75756... 26 A Artery x-rays, chest..... 1.14 0.37 0.37 0.08 1.59 1.59 XXX
75756... TC A Artery x-rays, chest..... 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75774... .................. A Artery x-ray, each vessel 0.36 9.06 9.06 0.77 10.19 10.19 XXX
75774... 26 A Artery x-ray, each vessel 0.36 0.12 0.12 0.02 0.50 0.50 XXX
75774... TC A Artery x-ray, each vessel 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75790... .................. A Visualize A-V shunt...... 1.84 1.58 1.58 0.21 3.63 3.63 XXX
75790... 26 A Visualize A-V shunt...... 1.84 0.62 0.62 0.12 2.58 2.58 XXX
75790... TC A Visualize A-V shunt...... 0.00 0.96 0.96 0.09 1.05 1.05 XXX
75801... .................. A Lymph vessel x-ray, arm/ 0.81 4.12 4.12 0.38 5.31 5.31 XXX
leg.
75801... 26 A Lymph vessel x-ray, arm/ 0.81 0.28 0.28 0.05 1.14 1.14 XXX
leg.
75801... TC A Lymph vessel x-ray, arm/ 0.00 3.84 3.84 0.33 4.17 4.17 XXX
leg.
75803... .................. A Lymph vessel x-ray, arms/ 1.17 4.22 4.22 0.41 5.80 5.80 XXX
legs.
75803... 26 A Lymph vessel x-ray, arms/ 1.17 0.38 0.38 0.08 1.63 1.63 XXX
legs.
75803... TC A Lymph vessel x-ray, arms/ 0.00 3.84 3.84 0.33 4.17 4.17 XXX
legs.
75805... .................. A Lymph vessel x-ray, trunk 0.81 4.60 4.60 0.42 5.83 5.83 XXX
75805... 26 A Lymph vessel x-ray, trunk 0.81 0.28 0.28 0.05 1.14 1.14 XXX
75805... TC A Lymph vessel x-ray, trunk 0.00 4.32 4.32 0.37 4.69 4.69 XXX
75807... .................. A Lymph vessel x-ray, trunk 1.17 4.70 4.70 0.45 6.32 6.32 XXX
75807... 26 A Lymph vessel x-ray, trunk 1.17 0.38 0.38 0.08 1.63 1.63 XXX
75807... TC A Lymph vessel x-ray, trunk 0.00 4.32 4.32 0.37 4.69 4.69 XXX
75809... .................. A Nonvascular shunt, x-ray. 0.47 0.70 0.70 0.08 1.25 1.25 XXX
75809... 26 A Nonvascular shunt, x-ray. 0.47 0.14 0.14 0.03 0.64 0.64 XXX
75809... TC A Nonvascular shunt, x-ray. 0.00 0.56 0.56 0.05 0.61 0.61 XXX
75810... .................. A Vein x-ray, spleen/liver. 1.14 9.31 9.31 0.83 11.28 11.28 XXX
75810... 26 A Vein x-ray, spleen/liver. 1.14 0.37 0.37 0.08 1.59 1.59 XXX
75810... TC A Vein x-ray, spleen/liver. 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75820... .................. A Vein x-ray, arm/leg...... 0.70 0.91 0.91 0.11 1.72 1.72 XXX
75820... 26 A Vein x-ray, arm/leg...... 0.70 0.24 0.24 0.05 0.99 0.99 XXX
75820... TC A Vein x-ray, arm/leg...... 0.00 0.67 0.67 0.06 0.73 0.73 XXX
75822... .................. A Vein x-ray, arms/legs.... 1.06 1.40 1.40 0.16 2.62 2.62 XXX
75822... 26 A Vein x-ray, arms/legs.... 1.06 0.35 0.35 0.07 1.48 1.48 XXX
75822... TC A Vein x-ray, arms/legs.... 0.00 1.05 1.05 0.09 1.14 1.14 XXX
75825... .................. A Vein x-ray, trunk........ 1.14 9.31 9.31 0.83 11.28 11.28 XXX
75825... 26 A Vein x-ray, trunk........ 1.14 0.37 0.37 0.08 1.59 1.59 XXX
75825... TC A Vein x-ray, trunk........ 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75827... .................. A Vein x-ray, chest........ 1.14 9.31 9.31 0.83 11.28 11.28 XXX
75827... 26 A Vein x-ray, chest........ 1.14 0.37 0.37 0.08 1.59 1.59 XXX
75827... TC A Vein x-ray, chest........ 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75831... .................. A Vein x-ray, kidney....... 1.14 9.31 9.31 0.83 11.28 11.28 XXX
75831... 26 A Vein x-ray, kidney....... 1.14 0.37 0.37 0.08 1.59 1.59 XXX
75831... TC A Vein x-ray, kidney....... 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75833... .................. A Vein x-ray, kidneys...... 1.49 9.43 9.43 0.85 11.77 11.77 XXX
75833... 26 A Vein x-ray, kidneys...... 1.49 0.49 0.49 0.10 2.08 2.08 XXX
75833... TC A Vein x-ray, kidneys...... 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75840... .................. A Vein x-ray, adrenal gland 1.14 9.31 9.31 0.83 11.28 11.28 XXX
75840... 26 A Vein x-ray, adrenal gland 1.14 0.37 0.37 0.08 1.59 1.59 XXX
75840... TC A Vein x-ray, adrenal gland 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75842... .................. A Vein x-ray, adrenal 1.49 9.43 9.43 0.85 11.77 11.77 XXX
glands.
75842... 26 A Vein x-ray, adrenal 1.49 0.49 0.49 0.10 2.08 2.08 XXX
glands.
75842... TC A Vein x-ray, adrenal 0.00 8.94 8.94 0.75 9.69 9.69 XXX
glands.
75860... .................. A Vein x-ray, neck......... 1.14 9.31 9.31 0.83 11.28 11.28 XXX
75860... 26 A Vein x-ray, neck......... 1.14 0.37 0.37 0.08 1.59 1.59 XXX
75860... TC A Vein x-ray, neck......... 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75870... .................. A Vein x-ray, skull........ 1.14 9.31 9.31 0.83 11.28 11.28 XXX
75870... 26 A Vein x-ray, skull........ 1.14 0.37 0.37 0.08 1.59 1.59 XXX
75870... TC A Vein x-ray, skull........ 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75872... .................. A Vein x-ray, skull........ 1.14 9.31 9.31 0.83 11.28 11.28 XXX
75872... 26 A Vein x-ray, skull........ 1.14 0.37 0.37 0.08 1.59 1.59 XXX
75872... TC A Vein x-ray, skull........ 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75880... .................. A Vein x-ray, eye socket... 0.70 0.91 0.91 0.11 1.72 1.72 XXX
75880... 26 A Vein x-ray, eye socket... 0.70 0.24 0.24 0.05 0.99 0.99 XXX
[[Page 30979]]
75880... TC A Vein x-ray, eye socket... 0.00 0.67 0.67 0.06 0.73 0.73 XXX
75885... .................. A Vein x-ray, liver........ 1.44 9.42 9.42 0.85 11.71 11.71 XXX
75885... 26 A Vein x-ray, liver........ 1.44 0.48 0.48 0.10 2.02 2.02 XXX
75885... TC A Vein x-ray, liver........ 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75887... .................. A Vein x-ray, liver........ 1.44 9.42 9.42 0.85 11.71 11.71 XXX
75887... 26 A Vein x-ray, liver........ 1.44 0.48 0.48 0.10 2.02 2.02 XXX
75887... TC A Vein x-ray, liver........ 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75889... .................. A Vein x-ray, liver........ 1.14 9.31 9.31 0.83 11.28 11.28 XXX
75889... 26 A Vein x-ray, liver........ 1.14 0.37 0.37 0.08 1.59 1.59 XXX
75889... TC A Vein x-ray, liver........ 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75891... .................. A Vein x-ray, liver........ 1.14 9.31 9.31 0.83 11.28 11.28 XXX
75891... 26 A Vein x-ray, liver........ 1.14 0.37 0.37 0.08 1.59 1.59 XXX
75891... TC A Vein x-ray, liver........ 0.00 8.94 8.94 0.75 9.69 9.69 XXX
75893... .................. A Venous sampling by 0.54 9.12 9.12 0.79 10.45 10.45 XXX
catheter.
75893... 26 A Venous sampling by 0.54 0.19 0.19 0.04 0.77 0.77 XXX
catheter.
75893... TC A Venous sampling by 0.00 8.94 8.94 0.75 9.69 9.69 XXX
catheter.
75894... .................. A X-rays, transcatheter 1.31 17.55 17.55 1.53 20.39 20.39 XXX
therapy.
75894... 26 A X-rays, transcatheter 1.31 0.43 0.43 0.09 1.83 1.83 XXX
therapy.
75894... TC A X-rays, transcatheter 0.00 17.12 17.12 1.44 18.56 18.56 XXX
therapy.
75896... .................. A X-rays, transcatheter 1.31 15.32 15.32 1.34 17.97 17.97 XXX
therapy.
75896... 26 A X-rays, transcatheter 1.31 0.43 0.43 0.09 1.83 1.83 XXX
therapy.
75896... TC A X-rays, transcatheter 0.00 14.89 14.89 1.25 16.14 16.14 XXX
therapy.
75898... .................. A Follow-up angiogram...... 1.65 1.30 1.30 0.18 3.13 3.13 XXX
75898... 26 A Follow-up angiogram...... 1.65 0.55 0.55 0.11 2.31 2.31 XXX
75898... TC A Follow-up angiogram...... 0.00 0.74 0.74 0.07 0.81 0.81 XXX
75900... .................. A Arterial catheter 0.49 15.05 15.05 1.29 16.83 16.83 XXX
exchange.
75900... 26 A Arterial catheter 0.49 0.17 0.17 0.03 0.69 0.69 XXX
exchange.
75900... TC A Arterial catheter 0.00 14.88 14.88 1.26 16.14 16.14 XXX
exchange.
75940... .................. A X-ray placement, vein 0.54 9.12 9.12 0.79 10.45 10.45 XXX
filter.
75940... 26 A X-ray placement, vein 0.54 0.19 0.19 0.04 0.77 0.77 XXX
filter.
75940... TC A X-ray placement, vein 0.00 8.94 8.94 0.75 9.69 9.69 XXX
filter.
75945... .................. A Intravascular us......... 0.40 NA 3.40 0.31 NA 4.11 XXX
75945... 26 A Intravascular us......... 0.40 NA 0.16 0.03 NA 0.59 XXX
75945... TC A Intravascular us......... 0.00 NA 3.24 0.28 NA 3.52 XXX
75946... .................. A Intravascular us......... 0.40 NA 1.79 0.17 NA 2.36 XXX
75946... 26 A Intravascular us......... 0.40 NA 0.16 0.03 NA 0.59 XXX
75946... TC A Intravascular us......... 0.00 NA 1.62 0.14 NA 1.76 XXX
75960... .................. A Transcatheter intro, 0.82 10.84 10.84 0.94 12.60 12.60 XXX
stent.
75960... 26 A Transcatheter intro, 0.82 0.28 0.28 0.06 1.16 1.16 XXX
stent.
75960... TC A Transcatheter intro, 0.00 10.57 10.57 0.88 11.45 11.45 XXX
stent.
75961... .................. A Retrieval, broken 4.25 8.86 8.86 0.90 14.01 14.01 XXX
catheter.
75961... 26 A Retrieval, broken 4.25 1.41 1.41 0.28 5.94 5.94 XXX
catheter.
75961... TC A Retrieval, broken 0.00 7.45 7.45 0.62 8.07 8.07 XXX
catheter.
75962... .................. A Repair arterial blockage. 0.54 11.35 11.35 0.98 12.87 12.87 XXX
75962... 26 A Repair arterial blockage. 0.54 0.19 0.19 0.04 0.77 0.77 XXX
75962... TC A Repair arterial blockage. 0.00 11.16 11.16 0.94 12.10 12.10 XXX
75964... .................. A Repair artery blockage, 0.36 6.07 6.07 0.52 6.95 6.95 XXX
each.
75964... 26 A Repair artery blockage, 0.36 0.12 0.12 0.02 0.50 0.50 XXX
each.
75964... TC A Repair artery blockage, 0.00 5.95 5.95 0.50 6.45 6.45 XXX
each.
75966... .................. A Repair arterial blockage. 1.31 11.60 11.60 1.03 13.94 13.94 XXX
75966... 26 A Repair arterial blockage. 1.31 0.43 0.43 0.09 1.83 1.83 XXX
75966... TC A Repair arterial blockage. 0.00 11.16 11.16 0.94 12.10 12.10 XXX
75968... .................. A Repair artery blockage, 0.36 6.07 6.07 0.52 6.95 6.95 XXX
each.
75968... 26 A Repair artery blockage, 0.36 0.12 0.12 0.02 0.50 0.50 XXX
each.
75968... TC A Repair artery blockage, 0.00 5.95 5.95 0.50 6.45 6.45 XXX
each.
75970... .................. A Vascular biopsy.......... 0.83 8.47 8.47 0.75 10.05 10.05 XXX
75970... 26 A Vascular biopsy.......... 0.83 0.28 0.28 0.06 1.17 1.17 XXX
75970... TC A Vascular biopsy.......... 0.00 8.19 8.19 0.69 8.88 8.88 XXX
75978... .................. A Repair venous blockage... 0.54 11.52 11.52 0.98 13.04 13.04 XXX
75978... 26 A Repair venous blockage... 0.54 0.36 0.36 0.04 0.94 0.94 XXX
75978... TC A Repair venous blockage... 0.00 11.16 11.16 0.94 12.10 12.10 XXX
75980... .................. A Contrast xray exam bile 1.44 4.32 4.32 0.43 6.19 6.19 XXX
duct.
75980... 26 A Contrast xray exam bile 1.44 0.48 0.48 0.10 2.02 2.02 XXX
duct.
75980... TC A Contrast xray exam bile 0.00 3.84 3.84 0.33 4.17 4.17 XXX
duct.
75982... .................. A Contrast xray exam bile 1.44 4.80 4.80 0.47 6.71 6.71 XXX
duct.
75982... 26 A Contrast xray exam bile 1.44 0.48 0.48 0.10 2.02 2.02 XXX
duct.
75982... TC A Contrast xray exam bile 0.00 4.32 4.32 0.37 4.69 4.69 XXX
duct.
75984... .................. A X-ray control catheter 0.72 1.63 1.63 0.17 2.52 2.52 XXX
change.
75984... 26 A X-ray control catheter 0.72 0.25 0.25 0.05 1.02 1.02 XXX
change.
75984... TC A X-ray control catheter 0.00 1.38 1.38 0.12 1.50 1.50 XXX
change.
75989... .................. A Abscess drainage under x- 1.19 2.62 2.62 0.27 4.08 4.08 XXX
ray.
75989... 26 A Abscess drainage under x- 1.19 0.39 0.39 0.08 1.66 1.66 XXX
ray.
75989... TC A Abscess drainage under x- 0.00 2.23 2.23 0.19 2.42 2.42 XXX
ray.
75992... .................. A Atherectomy, x-ray exam.. 0.54 11.35 11.35 0.98 12.87 12.87 XXX
[[Page 30980]]
75992... 26 A Atherectomy, x-ray exam.. 0.54 0.19 0.19 0.04 0.77 0.77 XXX
75992... TC A Atherectomy, x-ray exam.. 0.00 11.16 11.16 0.94 12.10 12.10 XXX
75993... .................. A Atherectomy, x-ray exam.. 0.36 6.07 6.07 0.52 6.95 6.95 XXX
75993... 26 A Atherectomy, x-ray exam.. 0.36 0.12 0.12 0.02 0.50 0.50 XXX
75993... TC A Atherectomy, x-ray exam.. 0.00 5.95 5.95 0.50 6.45 6.45 XXX
75994... .................. A Atherectomy, x-ray exam.. 1.31 11.60 11.60 1.03 13.94 13.94 XXX
75994... 26 A Atherectomy, x-ray exam.. 1.31 0.43 0.43 0.09 1.83 1.83 XXX
75994... TC A Atherectomy, x-ray exam.. 0.00 11.16 11.16 0.94 12.10 12.10 XXX
75995... .................. A Atherectomy, x-ray exam.. 1.31 11.60 11.60 1.03 13.94 13.94 XXX
75995... 26 A Atherectomy, x-ray exam.. 1.31 0.43 0.43 0.09 1.83 1.83 XXX
75995... TC A Atherectomy, x-ray exam.. 0.00 11.16 11.16 0.94 12.10 12.10 XXX
75996... .................. A Atherectomy, x-ray exam.. 0.36 6.07 6.07 0.52 6.95 6.95 XXX
75996... 26 A Atherectomy, x-ray exam.. 0.36 0.12 0.12 0.02 0.50 0.50 XXX
75996... TC A Atherectomy, x-ray exam.. 0.00 5.95 5.95 0.50 6.45 6.45 XXX
76000... .................. A Fluoroscope examination.. 0.17 0.98 0.98 0.09 1.24 1.24 XXX
76000... 26 A Fluoroscope examination.. 0.17 0.05 0.05 0.01 0.23 0.23 XXX
76000... TC A Fluoroscope examination.. 0.00 0.92 0.92 0.08 1.00 1.00 XXX
76001... .................. A Fluoroscope exam, 0.67 2.09 2.09 0.22 2.98 2.98 XXX
extensive.
76001... 26 A Fluoroscope exam, 0.67 0.23 0.23 0.05 0.95 0.95 XXX
extensive.
76001... TC A Fluoroscope exam, 0.00 1.86 1.86 0.17 2.03 2.03 XXX
extensive.
76003... .................. A Needle localization by x- 0.54 1.11 1.11 0.12 1.77 1.77 XXX
ray.
76003... 26 A Needle localization by x- 0.54 0.19 0.19 0.04 0.77 0.77 XXX
ray.
76003... TC A Needle localization by x- 0.00 0.92 0.92 0.08 1.00 1.00 XXX
ray.
76010... .................. A X-ray, nose to rectum.... 0.18 0.43 0.43 0.04 0.65 0.65 XXX
76010... 26 A X-ray, nose to rectum.... 0.18 0.06 0.06 0.01 0.25 0.25 XXX
76010... TC A X-ray, nose to rectum.... 0.00 0.37 0.37 0.03 0.40 0.40 XXX
76020... .................. A X-rays for bone age...... 0.19 0.44 0.44 0.04 0.67 0.67 XXX
76020... 26 A X-rays for bone age...... 0.19 0.07 0.07 0.01 0.27 0.27 XXX
76020... TC A X-rays for bone age...... 0.00 0.37 0.37 0.03 0.40 0.40 XXX
76040... .................. A X-rays, bone evaluation.. 0.27 0.65 0.65 0.07 0.99 0.99 XXX
76040... 26 A X-rays, bone evaluation.. 0.27 0.10 0.10 0.02 0.39 0.39 XXX
76040... TC A X-rays, bone evaluation.. 0.00 0.56 0.56 0.05 0.61 0.61 XXX
76061... .................. A X-rays, bone survey...... 0.45 0.86 0.86 0.09 1.40 1.40 XXX
76061... 26 A X-rays, bone survey...... 0.45 0.15 0.15 0.03 0.63 0.63 XXX
76061... TC A X-rays, bone survey...... 0.00 0.71 0.71 0.06 0.77 0.77 XXX
76062... .................. A X-rays, bone survey...... 0.54 1.21 1.21 0.13 1.88 1.88 XXX
76062... 26 A X-rays, bone survey...... 0.54 0.19 0.19 0.04 0.77 0.77 XXX
76062... TC A X-rays, bone survey...... 0.00 1.02 1.02 0.09 1.11 1.11 XXX
76065... .................. A X-rays, bone evaluation.. 0.28 0.62 0.62 0.07 0.97 0.97 XXX
76065... 26 A X-rays, bone evaluation.. 0.28 0.10 0.10 0.02 0.40 0.40 XXX
76065... TC A X-rays, bone evaluation.. 0.00 0.52 0.52 0.05 0.57 0.57 XXX
76066... .................. A Joint(s) survey, single 0.31 0.89 0.89 0.09 1.29 1.29 XXX
film.
76066... 26 A Joint(s) survey, single 0.31 0.10 0.10 0.02 0.43 0.43 XXX
film.
76066... TC A Joint(s) survey, single 0.00 0.79 0.79 0.07 0.86 0.86 XXX
film.
76070... .................. A CT scan, bone density 0.25 2.18 2.18 0.20 2.63 2.63 XXX
study.
76070... 26 A CT scan, bone density 0.25 0.09 0.09 0.02 0.36 0.36 XXX
study.
76070... TC A CT scan, bone density 0.00 2.09 2.09 0.18 2.27 2.27 XXX
study.
76075... .................. A Dual energy x-ray study.. 0.30 2.28 2.28 0.21 2.79 2.79 XXX
76075... 26 A Dual energy x-ray study.. 0.30 0.09 0.09 0.02 0.41 0.41 XXX
76075... TC A Dual energy x-ray study.. 0.00 2.20 2.20 0.19 2.39 2.39 XXX
76076... .................. A Dual energy x-ray study.. 0.22 0.61 0.61 0.07 0.90 0.90 XXX
76076... 26 A Dual energy x-ray study.. 0.22 0.07 0.07 0.02 0.31 0.31 XXX
76076... TC A Dual energy x-ray study.. 0.00 0.54 0.54 0.05 0.59 0.59 XXX
76078... .................. A Photodensitometry........ 0.20 0.61 0.61 0.07 0.88 0.88 XXX
76078... 26 A Photodensitometry........ 0.20 0.07 0.07 0.02 0.29 0.29 XXX
76078... TC A Photodensitometry........ 0.00 0.54 0.54 0.05 0.59 0.59 XXX
76080... .................. A X-ray exam of fistula.... 0.54 0.93 0.93 0.11 1.58 1.58 XXX
76080... 26 A X-ray exam of fistula.... 0.54 0.19 0.19 0.04 0.77 0.77 XXX
76080... TC A X-ray exam of fistula.... 0.00 0.74 0.74 0.07 0.81 0.81 XXX
76086... .................. A X-ray of mammary duct.... 0.36 1.99 1.99 0.19 2.54 2.54 XXX
76086... 26 A X-ray of mammary duct.... 0.36 0.13 0.13 0.02 0.51 0.51 XXX
76086... TC A X-ray of mammary duct.... 0.00 1.86 1.86 0.17 2.03 2.03 XXX
76088... .................. A X-ray of mammary ducts... 0.45 2.75 2.75 0.25 3.45 3.45 XXX
76088... 26 A X-ray of mammary ducts... 0.45 0.15 0.15 0.03 0.63 0.63 XXX
76088... TC A X-ray of mammary ducts... 0.00 2.60 2.60 0.22 2.82 2.82 XXX
76090... .................. A Mammogram, one breast.... 0.58 0.83 0.83 0.09 1.50 1.50 XXX
76090... 26 A Mammogram, one breast.... 0.58 0.09 0.09 0.02 0.69 0.69 XXX
76090... TC A Mammogram, one breast.... 0.00 0.74 0.74 0.07 0.81 0.81 XXX
76091... .................. A Mammogram, both breasts.. 0.69 1.06 1.06 0.11 1.86 1.86 XXX
76091... 26 A Mammogram, both breasts.. 0.69 0.13 0.13 0.03 0.85 0.85 XXX
76091... TC A Mammogram, both breasts.. 0.00 0.92 0.92 0.08 1.00 1.00 XXX
76093... .................. A Magnetic image, breast... 1.63 13.04 13.04 1.16 15.83 15.83 XXX
76093... 26 A Magnetic image, breast... 1.63 0.54 0.54 0.11 2.28 2.28 XXX
76093... TC A Magnetic image, breast... 0.00 12.50 12.50 1.05 13.55 13.55 XXX
[[Page 30981]]
76094... .................. A Magnetic image, both 1.63 17.50 17.50 1.53 20.66 20.66 XXX
breasts.
76094... 26 A Magnetic image, both 1.63 0.54 0.54 0.11 2.28 2.28 XXX
breasts.
76094... TC A Magnetic image, both 0.00 16.96 16.96 1.42 18.38 18.38 XXX
breasts.
76095... .................. A Stereotactic breast 1.59 5.61 5.61 0.54 7.74 7.74 XXX
biopsy.
76095... 26 A Stereotactic breast 1.59 0.53 0.53 0.11 2.23 2.23 XXX
biopsy.
76095... TC A Stereotactic breast 0.00 5.08 5.08 0.43 5.51 5.51 XXX
biopsy.
76096... .................. A X-ray of needle wire, 0.56 1.12 1.12 0.12 1.80 1.80 XXX
breast.
76096... 26 A X-ray of needle wire, 0.56 0.19 0.19 0.04 0.79 0.79 XXX
breast.
76096... TC A X-ray of needle wire, 0.00 0.92 0.92 0.08 1.00 1.00 XXX
breast.
76098... .................. A X-ray exam, breast 0.16 0.35 0.35 0.04 0.55 0.55 XXX
specimen.
76098... 26 A X-ray exam, breast 0.16 0.05 0.05 0.01 0.22 0.22 XXX
specimen.
76098... TC A X-ray exam, breast 0.00 0.30 0.30 0.03 0.33 0.33 XXX
specimen.
76100... .................. A X-ray exam of body 0.58 1.09 1.09 0.12 1.79 1.79 XXX
section.
76100... 26 A X-ray exam of body 0.58 0.20 0.20 0.04 0.82 0.82 XXX
section.
76100... TC A X-ray exam of body 0.00 0.89 0.89 0.08 0.97 0.97 XXX
section.
76101... .................. A Complex body section x- 0.58 1.21 1.21 0.13 1.92 1.92 XXX
ray.
76101... 26 A Complex body section x- 0.58 0.20 0.20 0.04 0.82 0.82 XXX
ray.
76101... TC A Complex body section x- 0.00 1.00 1.00 0.09 1.09 1.09 XXX
ray.
76102... .................. A Complex body section x- 0.58 1.43 1.43 0.15 2.16 2.16 XXX
rays.
76102... 26 A Complex body section x- 0.58 0.20 0.20 0.04 0.82 0.82 XXX
rays.
76102... TC A Complex body section x- 0.00 1.23 1.23 0.11 1.34 1.34 XXX
rays.
76120... .................. A Cinematic x-rays......... 0.38 0.87 0.87 0.10 1.35 1.35 XXX
76120... 26 A Cinematic x-rays......... 0.38 0.13 0.13 0.03 0.54 0.54 XXX
76120... TC A Cinematic x-rays......... 0.00 0.74 0.74 0.07 0.81 0.81 XXX
76125... .................. A Cinematic x-rays......... 0.27 0.65 0.65 0.07 0.99 0.99 XXX
76125... 26 A Cinematic x-rays......... 0.27 0.09 0.09 0.02 0.38 0.38 XXX
76125... TC A Cinematic x-rays......... 0.00 0.56 0.56 0.05 0.61 0.61 XXX
76150... .................. A X-ray exam, dry process.. 0.00 0.30 0.30 0.03 0.33 0.33 XXX
76355... .................. A CAT scan for localization 1.21 6.25 6.25 0.57 8.03 8.03 XXX
76355... 26 A CAT scan for localization 1.21 0.39 0.39 0.08 1.68 1.68 XXX
76355... TC A CAT scan for localization 0.00 5.86 5.86 0.49 6.35 6.35 XXX
76360... .................. A CAT scan for needle 1.16 6.23 6.23 0.57 7.96 7.96 XXX
biopsy.
76360... 26 A CAT scan for needle 1.16 0.37 0.37 0.08 1.61 1.61 XXX
biopsy.
76360... TC A CAT scan for needle 0.00 5.86 5.86 0.49 6.35 6.35 XXX
biopsy.
76365... .................. A CAT scan for cyst 1.16 6.23 6.23 0.57 7.96 7.96 XXX
aspiration.
76365... 26 A CAT scan for cyst 1.16 0.37 0.37 0.08 1.61 1.61 XXX
aspiration.
76365... TC A CAT scan for cyst 0.00 5.86 5.86 0.49 6.35 6.35 XXX
aspiration.
76370... .................. A CAT scan for therapy 0.85 2.37 2.37 0.24 3.46 3.46 XXX
guide.
76370... 26 A CAT scan for therapy 0.85 0.28 0.28 0.06 1.19 1.19 XXX
guide.
76370... TC A CAT scan for therapy 0.00 2.09 2.09 0.18 2.27 2.27 XXX
guide.
76375... .................. A 3d/holograph reconstr add- 0.16 2.56 2.56 0.22 2.94 2.94 XXX
on.
76375... 26 A 3d/holograph reconstr add- 0.16 0.05 0.05 0.01 0.22 0.22 XXX
on.
76375... TC A 3d/holograph reconstr add- 0.00 2.51 2.51 0.21 2.72 2.72 XXX
on.
76380... .................. A CAT scan follow-up study. 0.98 2.81 2.81 0.28 4.07 4.07 XXX
76380... 26 A CAT scan follow-up study. 0.98 0.33 0.33 0.07 1.38 1.38 XXX
76380... TC A CAT scan follow-up study. 0.00 2.49 2.49 0.21 2.70 2.70 XXX
76390... .................. A Mr spectroscopy.......... 1.40 8.44 8.44 0.77 10.61 10.61 XXX
76390... 26 A Mr spectroscopy.......... 1.40 0.49 0.49 0.10 1.99 1.99 XXX
76390... TC A Mr spectroscopy.......... 0.00 7.95 7.95 0.67 8.62 8.62 XXX
76400... .................. A Magnetic image, bone 1.60 8.48 8.48 0.78 10.86 10.86 XXX
marrow.
76400... 26 A Magnetic image, bone 1.60 0.54 0.54 0.11 2.25 2.25 XXX
marrow.
76400... TC A Magnetic image, bone 0.00 7.95 7.95 0.67 8.62 8.62 XXX
marrow.
76506... .................. A Echo exam of head........ 0.63 1.22 1.22 0.13 1.98 1.98 XXX
76506... 26 A Echo exam of head........ 0.63 0.22 0.22 0.04 0.89 0.89 XXX
76506... TC A Echo exam of head........ 0.00 1.00 1.00 0.09 1.09 1.09 XXX
76511... .................. A Echo exam of eye......... 0.94 1.07 1.07 0.12 2.13 2.13 XXX
76511... 26 A Echo exam of eye......... 0.94 0.19 0.19 0.04 1.17 1.17 XXX
76511... TC A Echo exam of eye......... 0.00 0.89 0.89 0.08 0.97 0.97 XXX
76512... .................. A Echo exam of eye......... 0.66 1.30 1.30 0.15 2.11 2.11 XXX
76512... 26 A Echo exam of eye......... 0.66 0.22 0.22 0.05 0.93 0.93 XXX
76512... TC A Echo exam of eye......... 0.00 1.08 1.08 0.10 1.18 1.18 XXX
76513... .................. A Echo exam of eye, water 0.66 1.30 1.30 0.15 2.11 2.11 XXX
bath.
76513... 26 A Echo exam of eye, water 0.66 0.22 0.22 0.05 0.93 0.93 XXX
bath.
76513... TC A Echo exam of eye, water 0.00 1.08 1.08 0.10 1.18 1.18 XXX
bath.
76516... .................. A Echo exam of eye......... 0.54 1.07 1.07 0.12 1.73 1.73 XXX
76516... 26 A Echo exam of eye......... 0.54 0.19 0.19 0.04 0.77 0.77 XXX
76516... TC A Echo exam of eye......... 0.00 0.89 0.89 0.08 0.97 0.97 XXX
76519... .................. A Echo exam of eye......... 0.54 1.07 1.07 0.12 1.73 1.73 XXX
76519... 26 A Echo exam of eye......... 0.54 0.19 0.19 0.04 0.77 0.77 XXX
76519... TC A Echo exam of eye......... 0.00 0.89 0.89 0.08 0.97 0.97 XXX
76529... .................. A Echo exam of eye......... 0.57 1.16 1.16 0.13 1.86 1.86 XXX
76529... 26 A Echo exam of eye......... 0.57 0.19 0.19 0.04 0.80 0.80 XXX
76529... TC A Echo exam of eye......... 0.00 0.97 0.97 0.09 1.06 1.06 XXX
76536... .................. A Echo exam of head and 0.56 1.20 1.20 0.13 1.89 1.89 XXX
neck.
[[Page 30982]]
76536... 26 A Echo exam of head and 0.56 0.19 0.19 0.04 0.79 0.79 XXX
neck.
76536... TC A Echo exam of head and 0.00 1.00 1.00 0.09 1.09 1.09 XXX
neck.
76604... .................. A Echo exam of chest....... 0.55 1.12 1.12 0.12 1.79 1.79 XXX
76604... 26 A Echo exam of chest....... 0.55 0.19 0.19 0.04 0.78 0.78 XXX
76604... TC A Echo exam of chest....... 0.00 0.92 0.92 0.08 1.00 1.00 XXX
76645... .................. A Echo exam of breast...... 0.54 0.93 0.93 0.11 1.58 1.58 XXX
76645... 26 A Echo exam of breast...... 0.54 0.19 0.19 0.04 0.77 0.77 XXX
76645... TC A Echo exam of breast...... 0.00 0.74 0.74 0.07 0.81 0.81 XXX
76700... .................. A Echo exam of abdomen..... 0.81 1.67 1.67 0.17 2.65 2.65 XXX
76700... 26 A Echo exam of abdomen..... 0.81 0.28 0.28 0.05 1.14 1.14 XXX
76700... TC A Echo exam of abdomen..... 0.00 1.40 1.40 0.12 1.52 1.52 XXX
76705... .................. A Echo exam of abdomen..... 0.59 1.21 1.21 0.13 1.93 1.93 XXX
76705... 26 A Echo exam of abdomen..... 0.59 0.20 0.20 0.04 0.83 0.83 XXX
76705... TC A Echo exam of abdomen..... 0.00 1.00 1.00 0.09 1.09 1.09 XXX
76770... .................. A Echo exam abdomen back 0.74 1.65 1.65 0.17 2.56 2.56 XXX
wall.
76770... 26 A Echo exam abdomen back 0.74 0.25 0.25 0.05 1.04 1.04 XXX
wall.
76770... TC A Echo exam abdomen back 0.00 1.40 1.40 0.12 1.52 1.52 XXX
wall.
76775... .................. A Echo exam abdomen back 0.58 1.21 1.21 0.13 1.92 1.92 XXX
wall.
76775... 26 A Echo exam abdomen back 0.58 0.20 0.20 0.04 0.82 0.82 XXX
wall.
76775... TC A Echo exam abdomen back 0.00 1.00 1.00 0.09 1.09 1.09 XXX
wall.
76778... .................. A Echo exam kidney 0.74 1.65 1.65 0.17 2.56 2.56 XXX
transplant.
76778... 26 A Echo exam kidney 0.74 0.25 0.25 0.05 1.04 1.04 XXX
transplant.
76778... TC A Echo exam kidney 0.00 1.40 1.40 0.12 1.52 1.52 XXX
transplant.
76800... .................. A Echo exam spinal canal... 1.13 1.38 1.38 0.17 2.68 2.68 XXX
76800... 26 A Echo exam spinal canal... 1.13 0.37 0.37 0.08 1.58 1.58 XXX
76800... TC A Echo exam spinal canal... 0.00 1.00 1.00 0.09 1.09 1.09 XXX
76805... .................. A Echo exam of pregnant 0.99 1.82 1.82 0.20 3.01 3.01 XXX
uterus.
76805... 26 A Echo exam of pregnant 0.99 0.33 0.33 0.07 1.39 1.39 XXX
uterus.
76805... TC A Echo exam of pregnant 0.00 1.49 1.49 0.13 1.62 1.62 XXX
uterus.
76810... .................. A Echo exam of pregnant 1.97 3.63 3.63 0.38 5.98 5.98 XXX
uterus.
76810... 26 A Echo exam of pregnant 1.97 0.65 0.65 0.13 2.75 2.75 XXX
uterus.
76810... TC A Echo exam of pregnant 0.00 2.98 2.98 0.25 3.23 3.23 XXX
uterus.
76815... .................. A Echo exam of pregnant 0.65 1.23 1.23 0.13 2.01 2.01 XXX
uterus.
76815... 26 A Echo exam of pregnant 0.65 0.22 0.22 0.04 0.91 0.91 XXX
uterus.
76815... TC A Echo exam of pregnant 0.00 1.00 1.00 0.09 1.09 1.09 XXX
uterus.
76816... .................. A Echo exam followup or 0.57 0.98 0.98 0.11 1.66 1.66 XXX
repeat.
76816... 26 A Echo exam followup or 0.57 0.19 0.19 0.04 0.80 0.80 XXX
repeat.
76816... TC A Echo exam followup or 0.00 0.79 0.79 0.07 0.86 0.86 XXX
repeat.
76818... .................. A Fetal biophysical profile 0.77 1.41 1.41 0.15 2.33 2.33 XXX
76818... 26 A Fetal biophysical profile 0.77 0.26 0.26 0.05 1.08 1.08 XXX
76818... TC A Fetal biophysical profile 0.00 1.15 1.15 0.10 1.25 1.25 XXX
76825... .................. A Echo exam of fetal heart. 1.67 1.66 1.66 0.17 3.50 3.50 XXX
76825... 26 A Echo exam of fetal heart. 1.67 0.26 0.26 0.05 1.98 1.98 XXX
76825... TC A Echo exam of fetal heart. 0.00 1.40 1.40 0.12 1.52 1.52 XXX
76826... .................. A Echo exam of fetal heart. 0.83 1.00 1.00 0.10 1.93 1.93 XXX
76826... 26 A Echo exam of fetal heart. 0.83 0.51 0.51 0.05 1.39 1.39 XXX
76826... TC A Echo exam of fetal heart. 0.00 0.50 0.50 0.05 0.55 0.55 XXX
76827... .................. A Echo exam of fetal heart. 0.58 1.70 1.70 0.18 2.46 2.46 XXX
76827... 26 A Echo exam of fetal heart. 0.58 0.48 0.48 0.05 1.11 1.11 XXX
76827... TC A Echo exam of fetal heart. 0.00 1.22 1.22 0.13 1.35 1.35 XXX
76828... .................. A Echo exam of fetal heart. 0.56 1.00 1.00 0.11 1.67 1.67 XXX
76828... 26 A Echo exam of fetal heart. 0.56 0.21 0.21 0.02 0.79 0.79 XXX
76828... TC A Echo exam of fetal heart. 0.00 0.79 0.79 0.09 0.88 0.88 XXX
76830... .................. A Echo exam, transvaginal.. 0.69 1.32 1.32 0.15 2.16 2.16 XXX
76830... 26 A Echo exam, transvaginal.. 0.69 0.24 0.24 0.05 0.98 0.98 XXX
76830... TC A Echo exam, transvaginal.. 0.00 1.08 1.08 0.10 1.18 1.18 XXX
76831... .................. A Echo exam, uterus........ 0.72 1.32 1.32 0.15 2.19 2.19 XXX
76831... 26 A Echo exam, uterus........ 0.72 0.24 0.24 0.05 1.01 1.01 XXX
76831... TC A Echo exam, uterus........ 0.00 1.08 1.08 0.10 1.18 1.18 XXX
76856... .................. A Echo exam of pelvis...... 0.69 1.32 1.32 0.15 2.16 2.16 XXX
76856... 26 A Echo exam of pelvis...... 0.69 0.24 0.24 0.05 0.98 0.98 XXX
76856... TC A Echo exam of pelvis...... 0.00 1.08 1.08 0.10 1.18 1.18 XXX
76857... .................. A Echo exam of pelvis...... 0.38 0.87 0.87 0.10 1.35 1.35 XXX
76857... 26 A Echo exam of pelvis...... 0.38 0.13 0.13 0.03 0.54 0.54 XXX
76857... TC A Echo exam of pelvis...... 0.00 0.74 0.74 0.07 0.81 0.81 XXX
76870... .................. A Echo exam of scrotum..... 0.64 1.30 1.30 0.14 2.08 2.08 XXX
76870... 26 A Echo exam of scrotum..... 0.64 0.22 0.22 0.04 0.90 0.90 XXX
76870... TC A Echo exam of scrotum..... 0.00 1.08 1.08 0.10 1.18 1.18 XXX
76872... .................. A Echo exam, transrectal... 0.69 1.32 1.32 0.15 2.16 2.16 XXX
76872... 26 A Echo exam, transrectal... 0.69 0.24 0.24 0.05 0.98 0.98 XXX
76872... TC A Echo exam, transrectal... 0.00 1.08 1.08 0.10 1.18 1.18 XXX
76880... .................. A Echo exam of extremity... 0.59 1.21 1.21 0.13 1.93 1.93 XXX
76880... 26 A Echo exam of extremity... 0.59 0.20 0.20 0.04 0.83 0.83 XXX
76880... TC A Echo exam of extremity... 0.00 1.00 1.00 0.09 1.09 1.09 XXX
[[Page 30983]]
76885... .................. A Echo exam, infant hips... 0.74 1.32 1.32 0.15 2.21 2.21 XXX
76885... 26 A Echo exam, infant hips... 0.74 0.24 0.24 0.05 1.03 1.03 XXX
76885... TC A Echo exam, infant hips... 0.00 1.08 1.08 0.10 1.18 1.18 XXX
76886... .................. A Echo exam, infant hips... 0.62 1.21 1.21 0.13 1.96 1.96 XXX
76886... 26 A Echo exam, infant hips... 0.62 0.20 0.20 0.04 0.86 0.86 XXX
76886... TC A Echo exam, infant hips... 0.00 1.00 1.00 0.09 1.09 1.09 XXX
76930... .................. A Echo guide for heart sac 0.67 1.31 1.31 0.15 2.13 2.13 XXX
tap.
76930... 26 A Echo guide for heart sac 0.67 0.23 0.23 0.05 0.95 0.95 XXX
tap.
76930... TC A Echo guide for heart sac 0.00 1.08 1.08 0.10 1.18 1.18 XXX
tap.
76932... .................. A Echo guide for heart 0.67 1.31 1.31 0.15 2.13 2.13 XXX
biopsy.
76932... 26 A Echo guide for heart 0.67 0.23 0.23 0.05 0.95 0.95 XXX
biopsy.
76932... TC A Echo guide for heart 0.00 1.08 1.08 0.10 1.18 1.18 XXX
biopsy.
76934... .................. A Echo guide for chest tap. 0.67 1.31 1.31 0.15 2.13 2.13 XXX
76934... 26 A Echo guide for chest tap. 0.67 0.23 0.23 0.05 0.95 0.95 XXX
76934... TC A Echo guide for chest tap. 0.00 1.08 1.08 0.10 1.18 1.18 XXX
76936... .................. A Echo guide for artery 1.99 5.39 5.39 0.48 7.86 7.86 XXX
repair.
76936... 26 A Echo guide for artery 1.99 0.92 0.92 0.10 3.01 3.01 XXX
repair.
76936... TC A Echo guide for artery 0.00 4.47 4.47 0.38 4.85 4.85 XXX
repair.
76938... .................. A Echo exam for drainage... 0.67 1.31 1.31 0.15 2.13 2.13 XXX
76938... 26 A Echo exam for drainage... 0.67 0.23 0.23 0.05 0.95 0.95 XXX
76938... TC A Echo exam for drainage... 0.00 1.08 1.08 0.10 1.18 1.18 XXX
76941... .................. A Echo guide for 1.34 1.54 1.54 0.19 3.07 3.07 XXX
transfusion.
76941... 26 A Echo guide for 1.34 0.45 0.45 0.10 1.89 1.89 XXX
transfusion.
76941... TC A Echo guide for 0.00 1.09 1.09 0.09 1.18 1.18 XXX
transfusion.
76942... .................. A Echo guide for biopsy.... 0.67 1.31 1.31 0.15 2.13 2.13 XXX
76942... 26 A Echo guide for biopsy.... 0.67 0.23 0.23 0.05 0.95 0.95 XXX
76942... TC A Echo guide for biopsy.... 0.00 1.08 1.08 0.10 1.18 1.18 XXX
76945... .................. A Echo guide, villus 0.67 1.54 1.54 0.19 2.40 2.40 XXX
sampling.
76945... 26 A Echo guide, villus 0.67 0.45 0.45 0.10 1.22 1.22 XXX
sampling.
76945... TC A Echo guide, villus 0.00 1.09 1.09 0.09 1.18 1.18 XXX
sampling.
76946... .................. A Echo guide for 0.38 1.21 1.21 0.13 1.72 1.72 XXX
amniocentesis.
76946... 26 A Echo guide for 0.38 0.13 0.13 0.03 0.54 0.54 XXX
amniocentesis.
76946... TC A Echo guide for 0.00 1.08 1.08 0.10 1.18 1.18 XXX
amniocentesis.
76948... .................. A Echo guide, ova 0.38 1.21 1.21 0.13 1.72 1.72 XXX
aspiration.
76948... 26 A Echo guide, ova 0.38 0.13 0.13 0.03 0.54 0.54 XXX
aspiration.
76948... TC A Echo guide, ova 0.00 1.08 1.08 0.10 1.18 1.18 XXX
aspiration.
76950... .................. A Echo guidance 0.58 1.12 1.12 0.12 1.82 1.82 XXX
radiotherapy.
76950... 26 A Echo guidance 0.58 0.20 0.20 0.04 0.82 0.82 XXX
radiotherapy.
76950... TC A Echo guidance 0.00 0.92 0.92 0.08 1.00 1.00 XXX
radiotherapy.
76960... .................. A Echo guidance 0.58 1.12 1.12 0.12 1.82 1.82 XXX
radiotherapy.
76960... 26 A Echo guidance 0.58 0.20 0.20 0.04 0.82 0.82 XXX
radiotherapy.
76960... TC A Echo guidance 0.00 0.92 0.92 0.08 1.00 1.00 XXX
radiotherapy.
76965... .................. A Echo guidance 1.34 5.05 5.05 0.52 6.91 6.91 XXX
radiotherapy.
76965... 26 A Echo guidance 1.34 1.09 1.09 0.19 2.62 2.62 XXX
radiotherapy.
76965... TC A Echo guidance 0.00 3.95 3.95 0.33 4.28 4.28 XXX
radiotherapy.
76970... .................. A Ultrasound exam follow-up 0.40 0.88 0.88 0.10 1.38 1.38 XXX
76970... 26 A Ultrasound exam follow-up 0.40 0.13 0.13 0.03 0.56 0.56 XXX
76970... TC A Ultrasound exam follow-up 0.00 0.74 0.74 0.07 0.81 0.81 XXX
76975... .................. A GI endoscopic ultrasound. 0.81 1.33 1.33 0.15 2.29 2.29 XXX
76975... 26 A GI endoscopic ultrasound. 0.81 0.25 0.25 0.05 1.11 1.11 XXX
76975... TC A GI endoscopic ultrasound. 0.00 1.08 1.08 0.10 1.18 1.18 XXX
76986... .................. A Echo exam at surgery..... 1.20 2.26 2.26 0.25 3.71 3.71 XXX
76986... 26 A Echo exam at surgery..... 1.20 0.39 0.39 0.08 1.67 1.67 XXX
76986... TC A Echo exam at surgery..... 0.00 1.86 1.86 0.17 2.03 2.03 XXX
77261... .................. A Radiation therapy 1.39 0.46 0.46 0.09 1.94 1.94 XXX
planning.
77262... .................. A Radiation therapy 2.11 0.70 0.70 0.14 2.95 2.95 XXX
planning.
77263... .................. A Radiation therapy 3.14 1.04 1.04 0.20 4.38 4.38 XXX
planning.
77280... .................. A Set radiation therapy 0.70 2.70 2.70 0.26 3.66 3.66 XXX
field.
77280... 26 A Set radiation therapy 0.70 0.24 0.24 0.05 0.99 0.99 XXX
field.
77280... TC A Set radiation therapy 0.00 2.46 2.46 0.21 2.67 2.67 XXX
field.
77285... .................. A Set radiation therapy 1.05 4.29 4.29 0.41 5.75 5.75 XXX
field.
77285... 26 A Set radiation therapy 1.05 0.34 0.34 0.07 1.46 1.46 XXX
field.
77285... TC A Set radiation therapy 0.00 3.95 3.95 0.34 4.29 4.29 XXX
field.
77290... .................. A Set radiation therapy 1.56 5.14 5.14 0.50 7.20 7.20 XXX
field.
77290... 26 A Set radiation therapy 1.56 0.52 0.52 0.11 2.19 2.19 XXX
field.
77290... TC A Set radiation therapy 0.00 4.61 4.61 0.39 5.00 5.00 XXX
field.
77295... .................. A Set radiation therapy 4.57 21.35 21.35 1.93 27.85 27.85 XXX
field.
77295... 26 A Set radiation therapy 4.57 1.53 1.53 0.23 6.33 6.33 XXX
field.
77295... TC A Set radiation therapy 0.00 19.81 19.81 1.70 21.51 21.51 XXX
field.
77300... .................. A Radiation therapy dose 0.62 1.16 1.16 0.12 1.90 1.90 XXX
plan.
77300... 26 A Radiation therapy dose 0.62 0.21 0.21 0.04 0.87 0.87 XXX
plan.
77300... TC A Radiation therapy dose 0.00 0.95 0.95 0.08 1.03 1.03 XXX
plan.
77305... .................. A Radiation therapy dose 0.70 1.56 1.56 0.17 2.43 2.43 XXX
plan.
77305... 26 A Radiation therapy dose 0.70 0.24 0.24 0.05 0.99 0.99 XXX
plan.
[[Page 30984]]
77305... TC A Radiation therapy dose 0.00 1.32 1.32 0.12 1.44 1.44 XXX
plan.
77310... .................. A Radiation therapy dose 1.05 1.99 1.99 0.22 3.26 3.26 XXX
plan.
77310... 26 A Radiation therapy dose 1.05 0.34 0.34 0.07 1.46 1.46 XXX
plan.
77310... TC A Radiation therapy dose 0.00 1.65 1.65 0.15 1.80 1.80 XXX
plan.
77315... .................. A Radiation therapy dose 1.56 2.40 2.40 0.28 4.24 4.24 XXX
plan.
77315... 26 A Radiation therapy dose 1.56 0.52 0.52 0.11 2.19 2.19 XXX
plan.
77315... TC A Radiation therapy dose 0.00 1.88 1.88 0.17 2.05 2.05 XXX
plan.
77321... .................. A Radiation therapy port 0.95 3.19 3.19 0.30 4.44 4.44 XXX
plan.
77321... 26 A Radiation therapy port 0.95 0.32 0.32 0.06 1.33 1.33 XXX
plan.
77321... TC A Radiation therapy port 0.00 2.87 2.87 0.24 3.11 3.11 XXX
plan.
77326... .................. A Radiation therapy dose 0.93 1.99 1.99 0.21 3.13 3.13 XXX
plan.
77326... 26 A Radiation therapy dose 0.93 0.31 0.31 0.06 1.30 1.30 XXX
plan.
77326... TC A Radiation therapy dose 0.00 1.67 1.67 0.15 1.82 1.82 XXX
plan.
77327... .................. A Radiation therapy dose 1.39 2.93 2.93 0.30 4.62 4.62 XXX
plan.
77327... 26 A Radiation therapy dose 1.39 0.46 0.46 0.09 1.94 1.94 XXX
plan.
77327... TC A Radiation therapy dose 0.00 2.46 2.46 0.21 2.67 2.67 XXX
plan.
77328... .................. A Radiation therapy dose 2.09 4.21 4.21 0.44 6.74 6.74 XXX
plan.
77328... 26 A Radiation therapy dose 2.09 0.69 0.69 0.14 2.92 2.92 XXX
plan.
77328... TC A Radiation therapy dose 0.00 3.52 3.52 0.30 3.82 3.82 XXX
plan.
77331... .................. A Special radiation 0.87 0.65 0.65 0.09 1.61 1.61 XXX
dosimetry.
77331... 26 A Special radiation 0.87 0.29 0.29 0.06 1.22 1.22 XXX
dosimetry.
77331... TC A Special radiation 0.00 0.36 0.36 0.03 0.39 0.39 XXX
dosimetry.
77332... .................. A Radiation treatment 0.54 1.14 1.14 0.12 1.80 1.80 XXX
aid(s).
77332... 26 A Radiation treatment 0.54 0.19 0.19 0.04 0.77 0.77 XXX
aid(s).
77332... TC A Radiation treatment 0.00 0.95 0.95 0.08 1.03 1.03 XXX
aid(s).
77333... .................. A Radiation treatment 0.84 1.63 1.63 0.18 2.65 2.65 XXX
aid(s).
77333... 26 A Radiation treatment 0.84 0.28 0.28 0.06 1.18 1.18 XXX
aid(s).
77333... TC A Radiation treatment 0.00 1.35 1.35 0.12 1.47 1.47 XXX
aid(s).
77334... .................. A Radiation treatment 1.24 2.71 2.71 0.27 4.22 4.22 XXX
aid(s).
77334... 26 A Radiation treatment 1.24 0.40 0.40 0.08 1.72 1.72 XXX
aid(s).
77334... TC A Radiation treatment 0.00 2.31 2.31 0.19 2.50 2.50 XXX
aid(s).
77336... .................. A Radiation physics consu.. 0.00 2.11 2.11 0.18 2.29 2.29 XXX
77370... .................. A Radiation physics consult 0.00 2.48 2.48 0.21 2.69 2.69 XXX
77401... .................. A Radiation treatment 0.00 1.26 1.26 0.11 1.37 1.37 XXX
delivery.
77402... .................. A Radiation treatment 0.00 1.26 1.26 0.11 1.37 1.37 XXX
delivery.
77403... .................. A Radiation treatment 0.00 1.26 1.26 0.11 1.37 1.37 XXX
delivery.
77404... .................. A Radiation treatment 0.00 1.26 1.26 0.11 1.37 1.37 XXX
delivery.
77406... .................. A Radiation treatment 0.00 1.26 1.26 0.11 1.37 1.37 XXX
delivery.
77407... .................. A Radiation treatment 0.00 1.48 1.48 0.13 1.61 1.61 XXX
delivery.
77408... .................. A Radiation treatment 0.00 1.48 1.48 0.13 1.61 1.61 XXX
delivery.
77409... .................. A Radiation treatment 0.00 1.48 1.48 0.13 1.61 1.61 XXX
delivery.
77411... .................. A Radiation treatment 0.00 1.48 1.48 0.13 1.61 1.61 XXX
delivery.
77412... .................. A Radiation treatment 0.00 1.65 1.65 0.15 1.80 1.80 XXX
delivery.
77413... .................. A Radiation treatment 0.00 1.65 1.65 0.15 1.80 1.80 XXX
delivery.
77414... .................. A Radiation treatment 0.00 1.65 1.65 0.15 1.80 1.80 XXX
delivery.
77416... .................. A Radiation treatment 0.00 1.65 1.65 0.15 1.80 1.80 XXX
delivery.
77417... .................. A Radiology port film(s)... 0.00 0.42 0.42 0.04 0.46 0.46 XXX
77419... .................. A Weekly radiation therapy. 3.60 1.20 1.20 0.23 5.03 5.03 XXX
77420... .................. A Weekly radiation therapy. 1.61 0.54 0.54 0.11 2.26 2.26 XXX
77425... .................. A Weekly radiation therapy. 2.44 0.82 0.82 0.17 3.43 3.43 XXX
77430... .................. A Weekly radiation therapy. 3.60 1.20 1.20 0.23 5.03 5.03 XXX
77431... .................. A Radiation therapy 1.81 0.60 0.60 0.12 2.53 2.53 XXX
management.
77432... .................. A Stereotactic radiation 7.93 3.68 3.68 0.40 12.01 12.01 XXX
trmt.
77470... .................. A Special radiation 2.09 8.60 8.60 0.80 11.49 11.49 XXX
treatment.
77470... 26 A Special radiation 2.09 0.69 0.69 0.14 2.92 2.92 XXX
treatment.
77470... TC A Special radiation 0.00 7.90 7.90 0.66 8.56 8.56 XXX
treatment.
77600... .................. R Hyperthermia treatment... 1.56 2.68 2.68 0.29 4.53 4.53 ZZZ
77600... 26 R Hyperthermia treatment... 1.56 0.52 0.52 0.11 2.19 2.19 ZZZ
77600... TC R Hyperthermia treatment... 0.00 2.16 2.16 0.18 2.34 2.34 ZZZ
77605... .................. R Hyperthermia treatment... 2.09 3.57 3.57 0.39 6.05 6.05 ZZZ
77605... 26 R Hyperthermia treatment... 2.09 0.69 0.69 0.14 2.92 2.92 ZZZ
77605... TC R Hyperthermia treatment... 0.00 2.88 2.88 0.25 3.13 3.13 ZZZ
77610... .................. R Hyperthermia treatment... 1.56 2.68 2.68 0.29 4.53 4.53 ZZZ
77610... 26 R Hyperthermia treatment... 1.56 0.52 0.52 0.11 2.19 2.19 ZZZ
77610... TC R Hyperthermia treatment... 0.00 2.16 2.16 0.18 2.34 2.34 ZZZ
77615... .................. R Hyperthermia treatment... 2.09 3.57 3.57 0.39 6.05 6.05 ZZZ
77615... 26 R Hyperthermia treatment... 2.09 0.69 0.69 0.14 2.92 2.92 ZZZ
77615... TC R Hyperthermia treatment... 0.00 2.88 2.88 0.25 3.13 3.13 ZZZ
77620... .................. R Hyperthermia treatment... 1.56 2.68 2.68 0.29 4.53 4.53 ZZZ
77620... 26 R Hyperthermia treatment... 1.56 0.52 0.52 0.11 2.19 2.19 ZZZ
77620... TC R Hyperthermia treatment... 0.00 2.16 2.16 0.18 2.34 2.34 ZZZ
77750... .................. A Infuse radioactive 4.91 2.47 2.47 0.38 7.76 7.76 090
materials.
77750... 26 A Infuse radioactive 4.91 1.53 1.53 0.30 6.74 6.74 090
materials.
77750... TC A Infuse radioactive 0.00 0.95 0.95 0.08 1.03 1.03 090
materials.
[[Page 30985]]
77761... .................. A Radioelement application. 3.81 2.96 2.96 0.39 7.16 7.16 090
77761... 26 A Radioelement application. 3.81 1.18 1.18 0.23 5.22 5.22 090
77761... TC A Radioelement application. 0.00 1.78 1.78 0.16 1.94 1.94 090
77762... .................. A Radioelement application. 5.72 4.34 4.34 0.57 10.63 10.63 090
77762... 26 A Radioelement application. 5.72 1.78 1.78 0.35 7.85 7.85 090
77762... TC A Radioelement application. 0.00 2.56 2.56 0.22 2.78 2.78 090
77763... .................. A Radioelement application. 8.57 5.85 5.85 0.77 15.19 15.19 090
77763... 26 A Radioelement application. 8.57 2.66 2.66 0.50 11.73 11.73 090
77763... TC A Radioelement application. 0.00 3.19 3.19 0.27 3.46 3.46 090
77776... .................. A Radioelement application. 4.66 3.10 3.10 0.45 8.21 8.21 XXX
77776... 26 A Radioelement application. 4.66 1.56 1.56 0.31 6.53 6.53 XXX
77776... TC A Radioelement application. 0.00 1.54 1.54 0.14 1.68 1.68 XXX
77777... .................. A Radioelement application. 7.48 5.34 5.34 0.71 13.53 13.53 090
77777... 26 A Radioelement application. 7.48 2.33 2.33 0.45 10.26 10.26 090
77777... TC A Radioelement application. 0.00 3.01 3.01 0.26 3.27 3.27 090
77778... .................. A Radioelement application. 11.19 7.13 7.13 0.98 19.30 19.30 090
77778... 26 A Radioelement application. 11.19 3.49 3.49 0.67 15.35 15.35 090
77778... TC A Radioelement application. 0.00 3.64 3.64 0.31 3.95 3.95 090
77781... .................. A High intensity 1.66 14.92 14.92 1.32 17.90 17.90 090
brachytherapy.
77781... 26 A High intensity 1.66 0.51 0.51 0.11 2.28 2.28 090
brachytherapy.
77781... TC A High intensity 0.00 14.40 14.40 1.21 15.61 15.61 090
brachytherapy.
77782... .................. A High intensity 2.49 15.18 15.18 1.37 19.04 19.04 090
brachytherapy.
77782... 26 A High intensity 2.49 0.78 0.78 0.16 3.43 3.43 090
brachytherapy.
77782... TC A High intensity 0.00 14.40 14.40 1.21 15.61 15.61 090
brachytherapy.
77783... .................. A High intensity 3.73 15.56 15.56 1.44 20.73 20.73 090
brachytherapy.
77783... 26 A High intensity 3.73 1.15 1.15 0.23 5.11 5.11 090
brachytherapy.
77783... TC A High intensity 0.00 14.40 14.40 1.21 15.61 15.61 090
brachytherapy.
77784... .................. A High intensity 5.61 16.14 16.14 1.56 23.31 23.31 090
brachytherapy.
77784... 26 A High intensity 5.61 1.74 1.74 0.35 7.70 7.70 090
brachytherapy.
77784... TC A High intensity 0.00 14.40 14.40 1.21 15.61 15.61 090
brachytherapy.
77789... .................. A Radioelement application. 1.12 0.66 0.66 0.10 1.88 1.88 090
77789... 26 A Radioelement application. 1.12 0.34 0.34 0.07 1.53 1.53 090
77789... TC A Radioelement application. 0.00 0.32 0.32 0.03 0.35 0.35 090
77790... .................. A Radioelement handling.... 1.05 0.70 0.70 0.10 1.85 1.85 XXX
77790... 26 A Radioelement handling.... 1.05 0.34 0.34 0.07 1.46 1.46 XXX
77790... TC A Radioelement handling.... 0.00 0.36 0.36 0.03 0.39 0.39 XXX
78000... .................. A Thyroid, single uptake... 0.19 0.75 0.75 0.07 1.01 1.01 XXX
78000... 26 A Thyroid, single uptake... 0.19 0.07 0.07 0.01 0.27 0.27 XXX
78000... TC A Thyroid, single uptake... 0.00 0.68 0.68 0.06 0.74 0.74 XXX
78001... .................. A Thyroid, multiple uptakes 0.26 1.01 1.01 0.10 1.37 1.37 XXX
78001... 26 A Thyroid, multiple uptakes 0.26 0.09 0.09 0.02 0.37 0.37 XXX
78001... TC A Thyroid, multiple uptakes 0.00 0.92 0.92 0.08 1.00 1.00 XXX
78003... .................. A Thyroid suppress/stimul.. 0.33 0.80 0.80 0.08 1.21 1.21 XXX
78003... 26 A Thyroid suppress/stimul.. 0.33 0.11 0.11 0.02 0.46 0.46 XXX
78003... TC A Thyroid suppress/stimul.. 0.00 0.68 0.68 0.06 0.74 0.74 XXX
78006... .................. A Thyroid,imaging with 0.49 1.85 1.85 0.18 2.52 2.52 XXX
uptake.
78006... 26 A Thyroid,imaging with 0.49 0.16 0.16 0.03 0.68 0.68 XXX
uptake.
78006... TC A Thyroid,imaging with 0.00 1.69 1.69 0.15 1.84 1.84 XXX
uptake.
78007... .................. A Thyroid, image, mult 0.50 1.99 1.99 0.19 2.68 2.68 XXX
uptakes.
78007... 26 A Thyroid, image, mult 0.50 0.17 0.17 0.03 0.70 0.70 XXX
uptakes.
78007... TC A Thyroid, image, mult 0.00 1.82 1.82 0.16 1.98 1.98 XXX
uptakes.
78010... .................. A Thyroid imaging.......... 0.39 1.41 1.41 0.14 1.94 1.94 XXX
78010... 26 A Thyroid imaging.......... 0.39 0.13 0.13 0.03 0.55 0.55 XXX
78010... TC A Thyroid imaging.......... 0.00 1.29 1.29 0.11 1.40 1.40 XXX
78011... .................. A Thyroid imaging with flow 0.45 1.86 1.86 0.18 2.49 2.49 XXX
78011... 26 A Thyroid imaging with flow 0.45 0.16 0.16 0.03 0.64 0.64 XXX
78011... TC A Thyroid imaging with flow 0.00 1.70 1.70 0.15 1.85 1.85 XXX
78015... .................. A Thyroid met imaging...... 0.67 2.05 2.05 0.21 2.93 2.93 XXX
78015... 26 A Thyroid met imaging...... 0.67 0.23 0.23 0.05 0.95 0.95 XXX
78015... TC A Thyroid met imaging...... 0.00 1.82 1.82 0.16 1.98 1.98 XXX
78016... .................. A Thyroid met imaging/ 0.82 2.75 2.75 0.27 3.84 3.84 XXX
studies.
78016... 26 A Thyroid met imaging/ 0.82 0.28 0.28 0.06 1.16 1.16 XXX
studies.
78016... TC A Thyroid met imaging/ 0.00 2.47 2.47 0.21 2.68 2.68 XXX
studies.
78017... .................. A Thyroid met imaging, mult 0.87 2.93 2.93 0.28 4.08 4.08 XXX
78017... 26 A Thyroid met imaging, mult 0.87 0.29 0.29 0.06 1.22 1.22 XXX
78017... TC A Thyroid met imaging, mult 0.00 2.64 2.64 0.22 2.86 2.86 XXX
78018... .................. A Thyroid, met imaging, 0.95 4.17 4.17 0.39 5.51 5.51 XXX
body.
78018... 26 A Thyroid, met imaging, 0.95 0.32 0.32 0.06 1.33 1.33 XXX
body.
78018... TC A Thyroid, met imaging, 0.00 3.85 3.85 0.33 4.18 4.18 XXX
body.
78070... .................. A Parathyroid nuclear 0.82 1.46 1.46 0.15 2.43 2.43 XXX
imaging.
78070... 26 A Parathyroid nuclear 0.82 0.17 0.17 0.04 1.03 1.03 XXX
imaging.
78070... TC A Parathyroid nuclear 0.00 1.29 1.29 0.11 1.40 1.40 XXX
imaging.
78075... .................. A Adrenal nuclear imaging.. 0.74 4.10 4.10 0.38 5.22 5.22 XXX
78075... 26 A Adrenal nuclear imaging.. 0.74 0.25 0.25 0.05 1.04 1.04 XXX
[[Page 30986]]
78075... TC A Adrenal nuclear imaging.. 0.00 3.85 3.85 0.33 4.18 4.18 XXX
78102... .................. A Bone marrow imaging, ltd. 0.55 1.63 1.63 0.17 2.35 2.35 XXX
78102... 26 A Bone marrow imaging, ltd. 0.55 0.19 0.19 0.04 0.78 0.78 XXX
78102... TC A Bone marrow imaging, ltd. 0.00 1.44 1.44 0.13 1.57 1.57 XXX
78103... .................. A Bone marrow imaging, mult 0.75 2.50 2.50 0.24 3.49 3.49 XXX
78103... 26 A Bone marrow imaging, mult 0.75 0.25 0.25 0.05 1.05 1.05 XXX
78103... TC A Bone marrow imaging, mult 0.00 2.25 2.25 0.19 2.44 2.44 XXX
78104... .................. A Bone marrow imaging, body 0.80 3.16 3.16 0.30 4.26 4.26 XXX
78104... 26 A Bone marrow imaging, body 0.80 0.28 0.28 0.05 1.13 1.13 XXX
78104... TC A Bone marrow imaging, body 0.00 2.89 2.89 0.25 3.14 3.14 XXX
78110... .................. A Plasma volume, single.... 0.19 0.74 0.74 0.07 1.00 1.00 XXX
78110... 26 A Plasma volume, single.... 0.19 0.07 0.07 0.01 0.27 0.27 XXX
78110... TC A Plasma volume, single.... 0.00 0.67 0.67 0.06 0.73 0.73 XXX
78111... .................. A Plasma volume, multiple.. 0.22 1.90 1.90 0.18 2.30 2.30 XXX
78111... 26 A Plasma volume, multiple.. 0.22 0.07 0.07 0.02 0.31 0.31 XXX
78111... TC A Plasma volume, multiple.. 0.00 1.82 1.82 0.16 1.98 1.98 XXX
78120... .................. A Red cell mass, single.... 0.23 1.31 1.31 0.13 1.67 1.67 XXX
78120... 26 A Red cell mass, single.... 0.23 0.08 0.08 0.02 0.33 0.33 XXX
78120... TC A Red cell mass, single.... 0.00 1.23 1.23 0.11 1.34 1.34 XXX
78121... .................. A Red cell mass, multiple.. 0.32 2.17 2.17 0.19 2.68 2.68 XXX
78121... 26 A Red cell mass, multiple.. 0.32 0.11 0.11 0.02 0.45 0.45 XXX
78121... TC A Red cell mass, multiple.. 0.00 2.06 2.06 0.17 2.23 2.23 XXX
78122... .................. A Blood volume............. 0.45 3.42 3.42 0.31 4.18 4.18 XXX
78122... 26 A Blood volume............. 0.45 0.15 0.15 0.03 0.63 0.63 XXX
78122... TC A Blood volume............. 0.00 3.27 3.27 0.28 3.55 3.55 XXX
78130... .................. A Red cell survival study.. 0.61 2.23 2.23 0.21 3.05 3.05 XXX
78130... 26 A Red cell survival study.. 0.61 0.21 0.21 0.04 0.86 0.86 XXX
78130... TC A Red cell survival study.. 0.00 2.02 2.02 0.17 2.19 2.19 XXX
78135... .................. A Red cell survival 0.64 3.67 3.67 0.34 4.65 4.65 XXX
kinetics.
78135... 26 A Red cell survival 0.64 0.22 0.22 0.04 0.90 0.90 XXX
kinetics.
78135... TC A Red cell survival 0.00 3.45 3.45 0.30 3.75 3.75 XXX
kinetics.
78140... .................. A Red cell sequestration... 0.61 3.00 3.00 0.28 3.89 3.89 XXX
78140... 26 A Red cell sequestration... 0.61 0.21 0.21 0.04 0.86 0.86 XXX
78140... TC A Red cell sequestration... 0.00 2.79 2.79 0.24 3.03 3.03 XXX
78160... .................. A Plasma iron turnover..... 0.33 2.71 2.71 0.24 3.28 3.28 XXX
78160... 26 A Plasma iron turnover..... 0.33 0.11 0.11 0.02 0.46 0.46 XXX
78160... TC A Plasma iron turnover..... 0.00 2.60 2.60 0.22 2.82 2.82 XXX
78162... .................. A Iron absorption exam..... 0.45 2.42 2.42 0.22 3.09 3.09 XXX
78162... 26 A Iron absorption exam..... 0.45 0.15 0.15 0.03 0.63 0.63 XXX
78162... TC A Iron absorption exam..... 0.00 2.27 2.27 0.19 2.46 2.46 XXX
78170... .................. A Red cell iron utilization 0.41 3.90 3.90 0.35 4.66 4.66 XXX
78170... 26 A Red cell iron utilization 0.41 0.13 0.13 0.03 0.57 0.57 XXX
78170... TC A Red cell iron utilization 0.00 3.77 3.77 0.32 4.09 4.09 XXX
78172... 26 A Total body iron 0.53 0.19 0.19 0.04 0.76 0.76 XXX
estimation.
78185... .................. A Spleen imaging........... 0.40 1.81 1.81 0.18 2.39 2.39 XXX
78185... 26 A Spleen imaging........... 0.40 0.13 0.13 0.03 0.56 0.56 XXX
78185... TC A Spleen imaging........... 0.00 1.67 1.67 0.15 1.82 1.82 XXX
78190... .................. A Platelet survival, 1.09 4.41 4.41 0.42 5.92 5.92 XXX
kinetics.
78190... 26 A Platelet survival, 1.09 0.36 0.36 0.07 1.52 1.52 XXX
kinetics.
78190... TC A Platelet survival, 0.00 4.06 4.06 0.35 4.41 4.41 XXX
kinetics.
78191... .................. A Platelet survival........ 0.61 5.41 5.41 0.48 6.50 6.50 XXX
78191... 26 A Platelet survival........ 0.61 0.21 0.21 0.04 0.86 0.86 XXX
78191... TC A Platelet survival........ 0.00 5.20 5.20 0.44 5.64 5.64 XXX
78195... .................. A Lymph system imaging..... 1.20 3.13 3.13 0.30 4.63 4.63 XXX
78195... 26 A Lymph system imaging..... 1.20 0.24 0.24 0.05 1.49 1.49 XXX
78195... TC A Lymph system imaging..... 0.00 2.89 2.89 0.25 3.14 3.14 XXX
78201... .................. A Liver imaging............ 0.44 1.82 1.82 0.18 2.44 2.44 XXX
78201... 26 A Liver imaging............ 0.44 0.14 0.14 0.03 0.61 0.61 XXX
78201... TC A Liver imaging............ 0.00 1.67 1.67 0.15 1.82 1.82 XXX
78202... .................. A Liver imaging with flow.. 0.51 2.22 2.22 0.21 2.94 2.94 XXX
78202... 26 A Liver imaging with flow.. 0.51 0.17 0.17 0.04 0.72 0.72 XXX
78202... TC A Liver imaging with flow.. 0.00 2.05 2.05 0.17 2.22 2.22 XXX
78205... .................. A Liver imaging (3D)....... 0.71 4.44 4.44 0.41 5.56 5.56 XXX
78205... 26 A Liver imaging (3D)....... 0.71 0.25 0.25 0.05 1.01 1.01 XXX
78205... TC A Liver imaging (3D)....... 0.00 4.19 4.19 0.36 4.55 4.55 XXX
78215... .................. A Liver and spleen imaging. 0.49 2.25 2.25 0.20 2.94 2.94 XXX
78215... 26 A Liver and spleen imaging. 0.49 0.16 0.16 0.03 0.68 0.68 XXX
78215... TC A Liver and spleen imaging. 0.00 2.08 2.08 0.17 2.25 2.25 XXX
78216... .................. A Liver & spleen image, 0.57 2.66 2.66 0.25 3.48 3.48 XXX
flow.
78216... 26 A Liver & spleen image, 0.57 0.19 0.19 0.04 0.80 0.80 XXX
flow.
78216... TC A Liver & spleen image, 0.00 2.47 2.47 0.21 2.68 2.68 XXX
flow.
78220... .................. A Liver function study..... 0.49 2.81 2.81 0.25 3.55 3.55 XXX
78220... 26 A Liver function study..... 0.49 0.16 0.16 0.03 0.68 0.68 XXX
78220... TC A Liver function study..... 0.00 2.64 2.64 0.22 2.86 2.86 XXX
[[Page 30987]]
78223... .................. A Hepatobiliary imaging.... 0.84 2.88 2.88 0.28 4.00 4.00 XXX
78223... 26 A Hepatobiliary imaging.... 0.84 0.28 0.28 0.06 1.18 1.18 XXX
78223... TC A Hepatobiliary imaging.... 0.00 2.60 2.60 0.22 2.82 2.82 XXX
78230... .................. A Salivary gland imaging... 0.45 1.70 1.70 0.17 2.32 2.32 XXX
78230... 26 A Salivary gland imaging... 0.45 0.16 0.16 0.03 0.64 0.64 XXX
78230... TC A Salivary gland imaging... 0.00 1.54 1.54 0.14 1.68 1.68 XXX
78231... .................. A Serial salivary imaging.. 0.52 2.43 2.43 0.23 3.18 3.18 XXX
78231... 26 A Serial salivary imaging.. 0.52 0.18 0.18 0.04 0.74 0.74 XXX
78231... TC A Serial salivary imaging.. 0.00 2.25 2.25 0.19 2.44 2.44 XXX
78232... .................. A Salivary gland function 0.47 2.67 2.67 0.24 3.38 3.38 XXX
exam.
78232... 26 A Salivary gland function 0.47 0.16 0.16 0.03 0.66 0.66 XXX
exam.
78232... TC A Salivary gland function 0.00 2.51 2.51 0.21 2.72 2.72 XXX
exam.
78258... .................. A Esophageal motility study 0.74 2.30 2.30 0.22 3.26 3.26 XXX
78258... 26 A Esophageal motility study 0.74 0.25 0.25 0.05 1.04 1.04 XXX
78258... TC A Esophageal motility study 0.00 2.05 2.05 0.17 2.22 2.22 XXX
78261... .................. A Gastric mucosa imaging... 0.69 3.15 3.15 0.30 4.14 4.14 XXX
78261... 26 A Gastric mucosa imaging... 0.69 0.24 0.24 0.05 0.98 0.98 XXX
78261... TC A Gastric mucosa imaging... 0.00 2.91 2.91 0.25 3.16 3.16 XXX
78262... .................. A Gastroesophageal reflux 0.68 3.25 3.25 0.31 4.24 4.24 XXX
exam.
78262... 26 A Gastroesophageal reflux 0.68 0.23 0.23 0.05 0.96 0.96 XXX
exam.
78262... TC A Gastroesophageal reflux 0.00 3.01 3.01 0.26 3.27 3.27 XXX
exam.
78264... .................. A Gastric emptying study... 0.78 3.19 3.19 0.30 4.27 4.27 XXX
78264... 26 A Gastric emptying study... 0.78 0.27 0.27 0.05 1.10 1.10 XXX
78264... TC A Gastric emptying study... 0.00 2.93 2.93 0.25 3.18 3.18 XXX
78270... .................. A Vit B-12 absorption exam. 0.20 1.17 1.17 0.11 1.48 1.48 XXX
78270... 26 A Vit B-12 absorption exam. 0.20 0.07 0.07 0.01 0.28 0.28 XXX
78270... TC A Vit B-12 absorption exam. 0.00 1.09 1.09 0.10 1.19 1.19 XXX
78271... .................. A Vit B-12 absorp exam, IF. 0.20 1.24 1.24 0.11 1.55 1.55 XXX
78271... 26 A Vit B-12 absorp exam, IF. 0.20 0.07 0.07 0.01 0.28 0.28 XXX
78271... TC A Vit B-12 absorp exam, IF. 0.00 1.17 1.17 0.10 1.27 1.27 XXX
78272... .................. A Vit B-12 absorp, combined 0.27 1.74 1.74 0.17 2.18 2.18 XXX
78272... 26 A Vit B-12 absorp, combined 0.27 0.10 0.10 0.02 0.39 0.39 XXX
78272... TC A Vit B-12 absorp, combined 0.00 1.64 1.64 0.15 1.79 1.79 XXX
78278... .................. A Acute GI blood loss 0.99 3.79 3.79 0.37 5.15 5.15 XXX
imaging.
78278... 26 A Acute GI blood loss 0.99 0.33 0.33 0.07 1.39 1.39 XXX
imaging.
78278... TC A Acute GI blood loss 0.00 3.45 3.45 0.30 3.75 3.75 XXX
imaging.
78282... 26 A GI protein loss exam..... 0.38 0.13 0.13 0.03 0.54 0.54 XXX
78290... .................. A Meckel's divert exam..... 0.68 2.39 2.39 0.23 3.30 3.30 XXX
78290... 26 A Meckel's divert exam..... 0.68 0.23 0.23 0.05 0.96 0.96 XXX
78290... TC A Meckel's divert exam..... 0.00 2.16 2.16 0.18 2.34 2.34 XXX
78291... .................. A Leveen/shunt patency exam 0.88 2.46 2.46 0.24 3.58 3.58 XXX
78291... 26 A Leveen/shunt patency exam 0.88 0.29 0.29 0.06 1.23 1.23 XXX
78291... TC A Leveen/shunt patency exam 0.00 2.17 2.17 0.18 2.35 2.35 XXX
78300... .................. A Bone imaging, limited 0.62 1.98 1.98 0.20 2.80 2.80 XXX
area.
78300... 26 A Bone imaging, limited 0.62 0.22 0.22 0.04 0.88 0.88 XXX
area.
78300... TC A Bone imaging, limited 0.00 1.76 1.76 0.16 1.92 1.92 XXX
area.
78305... .................. A Bone imaging, multiple 0.83 2.88 2.88 0.28 3.99 3.99 XXX
areas.
78305... 26 A Bone imaging, multiple 0.83 0.28 0.28 0.06 1.17 1.17 XXX
areas.
78305... TC A Bone imaging, multiple 0.00 2.60 2.60 0.22 2.82 2.82 XXX
areas.
78306... .................. A Bone imaging, whole body. 0.86 3.32 3.32 0.32 4.50 4.50 XXX
78306... 26 A Bone imaging, whole body. 0.86 0.29 0.29 0.06 1.21 1.21 XXX
78306... TC A Bone imaging, whole body. 0.00 3.03 3.03 0.26 3.29 3.29 XXX
78315... .................. A Bone imaging, 3 phase.... 1.02 3.72 3.72 0.36 5.10 5.10 XXX
78315... 26 A Bone imaging, 3 phase.... 1.02 0.33 0.33 0.07 1.42 1.42 XXX
78315... TC A Bone imaging, 3 phase.... 0.00 3.39 3.39 0.29 3.68 3.68 XXX
78320... .................. A Bone imaging (3D)........ 1.04 4.53 4.53 0.43 6.00 6.00 XXX
78320... 26 A Bone imaging (3D)........ 1.04 0.34 0.34 0.07 1.45 1.45 XXX
78320... TC A Bone imaging (3D)........ 0.00 4.19 4.19 0.36 4.55 4.55 XXX
78350... .................. A Bone mineral, single 0.22 0.61 0.61 0.07 0.90 0.90 XXX
photon.
78350... 26 A Bone mineral, single 0.22 0.07 0.07 0.02 0.31 0.31 XXX
photon.
78350... TC A Bone mineral, single 0.00 0.54 0.54 0.05 0.59 0.59 XXX
photon.
78351... .................. N Bone mineral, dual photon +0.30 0.14 0.14 0.02 0.46 0.46 XXX
78414... 26 A Non-imaging heart 0.45 0.15 0.15 0.03 0.63 0.63 XXX
function.
78428... .................. A Cardiac shunt imaging.... 0.78 1.87 1.87 0.19 2.84 2.84 XXX
78428... 26 A Cardiac shunt imaging.... 0.78 0.27 0.27 0.05 1.10 1.10 XXX
78428... TC A Cardiac shunt imaging.... 0.00 1.60 1.60 0.14 1.74 1.74 XXX
78445... .................. A Vascular flow imaging.... 0.49 1.50 1.50 0.15 2.14 2.14 XXX
78445... 26 A Vascular flow imaging.... 0.49 0.18 0.18 0.04 0.71 0.71 XXX
78445... TC A Vascular flow imaging.... 0.00 1.32 1.32 0.11 1.43 1.43 XXX
78455... .................. A Venous thrombosis study.. 0.73 3.07 3.07 0.29 4.09 4.09 XXX
78455... 26 A Venous thrombosis study.. 0.73 0.25 0.25 0.05 1.03 1.03 XXX
78455... TC A Venous thrombosis study.. 0.00 2.83 2.83 0.24 3.07 3.07 XXX
78457... .................. A Venous thrombosis imaging 0.77 2.14 2.14 0.22 3.13 3.13 XXX
78457... 26 A Venous thrombosis imaging 0.77 0.26 0.26 0.05 1.08 1.08 XXX
[[Page 30988]]
78457... TC A Venous thrombosis imaging 0.00 1.88 1.88 0.17 2.05 2.05 XXX
78458... .................. A Ven thrombosis images, 0.90 3.15 3.15 0.30 4.35 4.35 XXX
bilat.
78458... 26 A Ven thrombosis images, 0.90 0.30 0.30 0.06 1.26 1.26 XXX
bilat.
78458... TC A Ven thrombosis images, 0.00 2.85 2.85 0.24 3.09 3.09 XXX
bilat.
78459... 26 I Heart muscle imaging +1.88 1.00 1.00 0.10 2.98 2.98 XXX
(PET).
78460... .................. A Heart muscle blood single 0.86 1.96 1.96 0.21 3.03 3.03 XXX
78460... 26 A Heart muscle blood single 0.86 0.29 0.29 0.06 1.21 1.21 XXX
78460... TC A Heart muscle blood single 0.00 1.67 1.67 0.15 1.82 1.82 XXX
78461... .................. A Heart muscle blood 1.23 3.75 3.75 0.37 5.35 5.35 XXX
multiple.
78461... 26 A Heart muscle blood 1.23 0.40 0.40 0.08 1.71 1.71 XXX
multiple.
78461... TC A Heart muscle blood 0.00 3.35 3.35 0.29 3.64 3.64 XXX
multiple.
78464... .................. A Heart image (3D) single.. 1.09 5.37 5.37 0.50 6.96 6.96 XXX
78464... 26 A Heart image (3D) single.. 1.09 0.36 0.36 0.07 1.52 1.52 XXX
78464... TC A Heart image (3D) single.. 0.00 5.02 5.02 0.43 5.45 5.45 XXX
78465... .................. A Heart image (3D) multiple 1.46 8.85 8.85 0.80 11.11 11.11 XXX
78465... 26 A Heart image (3D) multiple 1.46 0.48 0.48 0.10 2.04 2.04 XXX
78465... TC A Heart image (3D) multiple 0.00 8.37 8.37 0.70 9.07 9.07 XXX
78466... .................. A Heart infarct image...... 0.69 2.10 2.10 0.22 3.01 3.01 XXX
78466... 26 A Heart infarct image...... 0.69 0.24 0.24 0.05 0.98 0.98 XXX
78466... TC A Heart infarct image...... 0.00 1.86 1.86 0.17 2.03 2.03 XXX
78468... .................. A Heart infarct image, EF.. 0.80 2.87 2.87 0.27 3.94 3.94 XXX
78468... 26 A Heart infarct image, EF.. 0.80 0.27 0.27 0.05 1.12 1.12 XXX
78468... TC A Heart infarct image, EF.. 0.00 2.60 2.60 0.22 2.82 2.82 XXX
78469... .................. A Heart infarct image (3D). 0.92 4.01 4.01 0.38 5.31 5.31 XXX
78469... 26 A Heart infarct image (3D). 0.92 0.31 0.31 0.06 1.29 1.29 XXX
78469... TC A Heart infarct image (3D). 0.00 3.71 3.71 0.32 4.03 4.03 XXX
78472... .................. A Gated heart, resting..... 0.98 4.23 4.23 0.41 5.62 5.62 XXX
78472... 26 A Gated heart, resting..... 0.98 0.33 0.33 0.07 1.38 1.38 XXX
78472... TC A Gated heart, resting..... 0.00 3.91 3.91 0.34 4.25 4.25 XXX
78473... .................. A Gated heart, multiple.... 1.47 6.34 6.34 0.59 8.40 8.40 XXX
78473... 26 A Gated heart, multiple.... 1.47 0.48 0.48 0.10 2.05 2.05 XXX
78473... TC A Gated heart, multiple.... 0.00 5.86 5.86 0.49 6.35 6.35 XXX
78478... .................. A Heart wall motion (add- 0.62 1.31 1.31 0.14 2.07 2.07 XXX
on).
78478... 26 A Heart wall motion (add- 0.62 0.21 0.21 0.04 0.87 0.87 XXX
on).
78478... TC A Heart wall motion (add- 0.00 1.10 1.10 0.10 1.20 1.20 XXX
on).
78480... .................. A Heart function, (add-on). 0.62 1.31 1.31 0.14 2.07 2.07 XXX
78480... 26 A Heart function, (add-on). 0.62 0.21 0.21 0.04 0.87 0.87 XXX
78480... TC A Heart function, (add-on). 0.00 1.10 1.10 0.10 1.20 1.20 XXX
78481... .................. A Heart first pass single.. 0.98 4.03 4.03 0.39 5.40 5.40 XXX
78481... 26 A Heart first pass single.. 0.98 0.33 0.33 0.07 1.38 1.38 XXX
78481... TC A Heart first pass single.. 0.00 3.71 3.71 0.32 4.03 4.03 XXX
78483... .................. A Heart first pass multiple 1.47 6.07 6.07 0.57 8.11 8.11 XXX
78483... 26 A Heart first pass multiple 1.47 0.48 0.48 0.10 2.05 2.05 XXX
78483... TC A Heart first pass multiple 0.00 5.58 5.58 0.47 6.05 6.05 XXX
78491... 26 I Heart image (pet) single. +1.50 1.00 1.00 0.10 2.60 2.60 XXX
78492... 26 I Heart image (pet) +1.87 1.00 1.00 0.10 2.97 2.97 XXX
multiple.
78580... .................. A Lung perfusion imaging... 0.74 2.69 2.69 0.26 3.69 3.69 XXX
78580... 26 A Lung perfusion imaging... 0.74 0.25 0.25 0.05 1.04 1.04 XXX
78580... TC A Lung perfusion imaging... 0.00 2.43 2.43 0.21 2.64 2.64 XXX
78584... .................. A Lung V/Q image single 0.99 2.60 2.60 0.26 3.85 3.85 XXX
breath.
78584... 26 A Lung V/Q image single 0.99 0.33 0.33 0.07 1.39 1.39 XXX
breath.
78584... TC A Lung V/Q image single 0.00 2.27 2.27 0.19 2.46 2.46 XXX
breath.
78585... .................. A Lung V/Q imaging......... 1.09 4.35 4.35 0.41 5.85 5.85 XXX
78585... 26 A Lung V/Q imaging......... 1.09 0.36 0.36 0.07 1.52 1.52 XXX
78585... TC A Lung V/Q imaging......... 0.00 4.00 4.00 0.34 4.34 4.34 XXX
78586... .................. A Aerosol lung image, 0.40 1.97 1.97 0.19 2.56 2.56 XXX
single.
78586... 26 A Aerosol lung image, 0.40 0.13 0.13 0.03 0.56 0.56 XXX
single.
78586... TC A Aerosol lung image, 0.00 1.84 1.84 0.16 2.00 2.00 XXX
single.
78587... .................. A Aerosol lung image, 0.49 2.15 2.15 0.20 2.84 2.84 XXX
multiple.
78587... 26 A Aerosol lung image, 0.49 0.16 0.16 0.03 0.68 0.68 XXX
multiple.
78587... TC A Aerosol lung image, 0.00 1.99 1.99 0.17 2.16 2.16 XXX
multiple.
78591... .................. A Vent image, 1 breath, 1 0.40 2.16 2.16 0.20 2.76 2.76 XXX
proj.
78591... 26 A Vent image, 1 breath, 1 0.40 0.13 0.13 0.03 0.56 0.56 XXX
proj.
78591... TC A Vent image, 1 breath, 1 0.00 2.02 2.02 0.17 2.19 2.19 XXX
proj.
78593... .................. A Vent image, 1 proj, gas.. 0.49 2.61 2.61 0.24 3.34 3.34 XXX
78593... 26 A Vent image, 1 proj, gas.. 0.49 0.16 0.16 0.03 0.68 0.68 XXX
78593... TC A Vent image, 1 proj, gas.. 0.00 2.45 2.45 0.21 2.66 2.66 XXX
78594... .................. A Vent image, mult proj, 0.53 3.72 3.72 0.34 4.59 4.59 XXX
gas.
78594... 26 A Vent image, mult proj, 0.53 0.19 0.19 0.04 0.76 0.76 XXX
gas.
78594... TC A Vent image, mult proj, 0.00 3.54 3.54 0.30 3.84 3.84 XXX
gas.
78596... .................. A Lung differential 1.27 5.43 5.43 0.52 7.22 7.22 XXX
function.
78596... 26 A Lung differential 1.27 0.42 0.42 0.09 1.78 1.78 XXX
function.
78596... TC A Lung differential 0.00 5.02 5.02 0.43 5.45 5.45 XXX
function.
78600... .................. A Brain imaging, ltd static 0.44 2.20 2.20 0.20 2.84 2.84 XXX
[[Page 30989]]
78600... 26 A Brain imaging, ltd static 0.44 0.15 0.15 0.03 0.62 0.62 XXX
78600... TC A Brain imaging, ltd static 0.00 2.05 2.05 0.17 2.22 2.22 XXX
78601... .................. A Brain ltd imaging & flow. 0.51 2.59 2.59 0.24 3.34 3.34 XXX
78601... 26 A Brain ltd imaging & flow. 0.51 0.18 0.18 0.04 0.73 0.73 XXX
78601... TC A Brain ltd imaging & flow. 0.00 2.41 2.41 0.20 2.61 2.61 XXX
78605... .................. A Brain imaging, complete.. 0.53 2.60 2.60 0.24 3.37 3.37 XXX
78605... 26 A Brain imaging, complete.. 0.53 0.19 0.19 0.04 0.76 0.76 XXX
78605... TC A Brain imaging, complete.. 0.00 2.41 2.41 0.20 2.61 2.61 XXX
78606... .................. A Brain imaging comp & flow 0.64 2.96 2.96 0.27 3.87 3.87 XXX
78606... 26 A Brain imaging comp & flow 0.64 0.22 0.22 0.04 0.90 0.90 XXX
78606... TC A Brain imaging comp & flow 0.00 2.75 2.75 0.23 2.98 2.98 XXX
78607... .................. A Brain imaging (3D)....... 1.23 5.05 5.05 0.47 6.75 6.75 XXX
78607... 26 A Brain imaging (3D)....... 1.23 0.40 0.40 0.08 1.71 1.71 XXX
78607... TC A Brain imaging (3D)....... 0.00 4.65 4.65 0.39 5.04 5.04 XXX
78610... .................. A Brain flow imaging only.. 0.30 1.22 1.22 0.12 1.64 1.64 XXX
78610... 26 A Brain flow imaging only.. 0.30 0.10 0.10 0.02 0.42 0.42 XXX
78610... TC A Brain flow imaging only.. 0.00 1.12 1.12 0.10 1.22 1.22 XXX
78615... .................. A Cerebral blood flow 0.42 2.87 2.87 0.26 3.55 3.55 XXX
imaging.
78615... 26 A Cerebral blood flow 0.42 0.14 0.14 0.03 0.59 0.59 XXX
imaging.
78615... TC A Cerebral blood flow 0.00 2.73 2.73 0.23 2.96 2.96 XXX
imaging.
78630... .................. A Cerebrospinal fluid scan. 0.68 3.80 3.80 0.36 4.84 4.84 XXX
78630... 26 A Cerebrospinal fluid scan. 0.68 0.23 0.23 0.05 0.96 0.96 XXX
78630... TC A Cerebrospinal fluid scan. 0.00 3.57 3.57 0.31 3.88 3.88 XXX
78635... .................. A CSF ventriculography..... 0.61 2.01 2.01 0.20 2.82 2.82 XXX
78635... 26 A CSF ventriculography..... 0.61 0.21 0.21 0.04 0.86 0.86 XXX
78635... TC A CSF ventriculography..... 0.00 1.80 1.80 0.16 1.96 1.96 XXX
78645... .................. A CSF shunt evaluation..... 0.57 2.63 2.63 0.25 3.45 3.45 XXX
78645... 26 A CSF shunt evaluation..... 0.57 0.19 0.19 0.04 0.80 0.80 XXX
78645... TC A CSF shunt evaluation..... 0.00 2.43 2.43 0.21 2.64 2.64 XXX
78647... .................. A Cerebrospinal fluid scan. 0.90 4.50 4.50 0.42 5.82 5.82 XXX
78647... 26 A Cerebrospinal fluid scan. 0.90 0.31 0.31 0.06 1.27 1.27 XXX
78647... TC A Cerebrospinal fluid scan. 0.00 4.19 4.19 0.36 4.55 4.55 XXX
78650... .................. A CSF leakage imaging...... 0.61 3.50 3.50 0.32 4.43 4.43 XXX
78650... 26 A CSF leakage imaging...... 0.61 0.21 0.21 0.04 0.86 0.86 XXX
78650... TC A CSF leakage imaging...... 0.00 3.29 3.29 0.28 3.57 3.57 XXX
78660... .................. A Nuclear exam of tear flow 0.53 1.69 1.69 0.17 2.39 2.39 XXX
78660... 26 A Nuclear exam of tear flow 0.53 0.19 0.19 0.04 0.76 0.76 XXX
78660... TC A Nuclear exam of tear flow 0.00 1.50 1.50 0.13 1.63 1.63 XXX
78700... .................. A Kidney imaging, static... 0.45 2.31 2.31 0.21 2.97 2.97 XXX
78700... 26 A Kidney imaging, static... 0.45 0.15 0.15 0.03 0.63 0.63 XXX
78700... TC A Kidney imaging, static... 0.00 2.16 2.16 0.18 2.34 2.34 XXX
78701... .................. A Kidney imaging with flow. 0.49 2.69 2.69 0.24 3.42 3.42 XXX
78701... 26 A Kidney imaging with flow. 0.49 0.16 0.16 0.03 0.68 0.68 XXX
78701... TC A Kidney imaging with flow. 0.00 2.52 2.52 0.21 2.73 2.73 XXX
78704... .................. A Imaging renogram......... 0.74 3.06 3.06 0.29 4.09 4.09 XXX
78704... 26 A Imaging renogram......... 0.74 0.25 0.25 0.05 1.04 1.04 XXX
78704... TC A Imaging renogram......... 0.00 2.81 2.81 0.24 3.05 3.05 XXX
78707... .................. A Kidney flow & function 0.96 3.48 3.48 0.33 4.77 4.77 XXX
image.
78707... 26 A Kidney flow & function 0.96 0.31 0.31 0.06 1.33 1.33 XXX
image.
78707... TC A Kidney flow & function 0.00 3.17 3.17 0.27 3.44 3.44 XXX
image.
78708... .................. A Kidney flow & function 1.21 3.48 3.48 0.33 5.02 5.02 XXX
image.
78708... 26 A Kidney flow & function 1.21 0.31 0.31 0.06 1.58 1.58 XXX
image.
78708... TC A Kidney flow & function 0.00 3.17 3.17 0.27 3.44 3.44 XXX
image.
78709... .................. A Kidney flow & function 1.41 3.48 3.48 0.33 5.22 5.22 XXX
image.
78709... 26 A Kidney flow & function 1.41 0.31 0.31 0.06 1.78 1.78 XXX
image.
78709... TC A Kidney flow & function 0.00 3.17 3.17 0.27 3.44 3.44 XXX
image.
78710... .................. A Kidney imaging (3D)...... 0.66 4.41 4.41 0.41 5.48 5.48 XXX
78710... 26 A Kidney imaging (3D)...... 0.66 0.22 0.22 0.05 0.93 0.93 XXX
78710... TC A Kidney imaging (3D)...... 0.00 4.19 4.19 0.36 4.55 4.55 XXX
78715... .................. A Renal vascular flow exam. 0.30 1.22 1.22 0.12 1.64 1.64 XXX
78715... 26 A Renal vascular flow exam. 0.30 0.10 0.10 0.02 0.42 0.42 XXX
78715... TC A Renal vascular flow exam. 0.00 1.12 1.12 0.10 1.22 1.22 XXX
78725... .................. A Kidney function study.... 0.38 1.39 1.39 0.14 1.91 1.91 XXX
78725... 26 A Kidney function study.... 0.38 0.13 0.13 0.03 0.54 0.54 XXX
78725... TC A Kidney function study.... 0.00 1.27 1.27 0.11 1.38 1.38 XXX
78730... .................. A Urinary bladder retention 0.36 1.15 1.15 0.11 1.62 1.62 XXX
78730... 26 A Urinary bladder retention 0.36 0.12 0.12 0.02 0.50 0.50 XXX
78730... TC A Urinary bladder retention 0.00 1.03 1.03 0.09 1.12 1.12 XXX
78740... .................. A Ureteral reflux study.... 0.57 1.70 1.70 0.17 2.44 2.44 XXX
78740... 26 A Ureteral reflux study.... 0.57 0.19 0.19 0.04 0.80 0.80 XXX
78740... TC A Ureteral reflux study.... 0.00 1.50 1.50 0.13 1.63 1.63 XXX
78760... .................. A Testicular imaging....... 0.66 2.12 2.12 0.21 2.99 2.99 XXX
78760... 26 A Testicular imaging....... 0.66 0.22 0.22 0.04 0.92 0.92 XXX
78760... TC A Testicular imaging....... 0.00 1.90 1.90 0.17 2.07 2.07 XXX
[[Page 30990]]
78761... .................. A Testicular imaging & flow 0.71 2.52 2.52 0.24 3.47 3.47 XXX
78761... 26 A Testicular imaging & flow 0.71 0.25 0.25 0.05 1.01 1.01 XXX
78761... TC A Testicular imaging & flow 0.00 2.27 2.27 0.19 2.46 2.46 XXX
78800... .................. A Tumor imaging, limited 0.66 2.63 2.63 0.24 3.53 3.53 XXX
area.
78800... 26 A Tumor imaging, limited 0.66 0.22 0.22 0.04 0.92 0.92 XXX
area.
78800... TC A Tumor imaging, limited 0.00 2.41 2.41 0.20 2.61 2.61 XXX
area.
78801... .................. A Tumor imaging, mult areas 0.79 3.27 3.27 0.31 4.37 4.37 XXX
78801... 26 A Tumor imaging, mult areas 0.79 0.27 0.27 0.05 1.11 1.11 XXX
78801... TC A Tumor imaging, mult areas 0.00 3.00 3.00 0.26 3.26 3.26 XXX
78802... .................. A Tumor imaging, whole body 0.86 4.21 4.21 0.40 5.47 5.47 XXX
78802... 26 A Tumor imaging, whole body 0.86 0.29 0.29 0.06 1.21 1.21 XXX
78802... TC A Tumor imaging, whole body 0.00 3.92 3.92 0.34 4.26 4.26 XXX
78803... .................. A Tumor imaging (3D)....... 1.09 5.01 5.01 0.46 6.56 6.56 XXX
78803... 26 A Tumor imaging (3D)....... 1.09 0.36 0.36 0.07 1.52 1.52 XXX
78803... TC A Tumor imaging (3D)....... 0.00 4.65 4.65 0.39 5.04 5.04 XXX
78805... .................. A Abscess imaging, ltd area 0.73 2.66 2.66 0.25 3.64 3.64 XXX
78805... 26 A Abscess imaging, ltd area 0.73 0.25 0.25 0.05 1.03 1.03 XXX
78805... TC A Abscess imaging, ltd area 0.00 2.41 2.41 0.20 2.61 2.61 XXX
78806... .................. A Abscess imaging, whole 0.86 4.85 4.85 0.45 6.16 6.16 XXX
body.
78806... 26 A Abscess imaging, whole 0.86 0.28 0.28 0.06 1.20 1.20 XXX
body.
78806... TC A Abscess imaging, whole 0.00 4.56 4.56 0.39 4.95 4.95 XXX
body.
78807... .................. A Nuclear localization/ 1.09 5.01 5.01 0.46 6.56 6.56 XXX
abscess.
78807... 26 A Nuclear localization/ 1.09 0.36 0.36 0.07 1.52 1.52 XXX
abscess.
78807... TC A Nuclear localization/ 0.00 4.65 4.65 0.39 5.04 5.04 XXX
abscess.
78810... 26 N Tumor imaging (PET)...... +1.93 1.02 1.02 0.10 3.05 3.05 XXX
78890... .................. B Nuclear medicine data +0.05 0.94 0.94 0.08 1.07 1.07 XXX
proc.
78890... 26 B Nuclear medicine data +0.05 0.01 0.01 0.00 0.06 0.06 XXX
proc.
78890... TC B Nuclear medicine data +0.00 0.92 0.92 0.08 1.00 1.00 XXX
proc.
78891... .................. B Nuclear med data proc.... +0.10 1.90 1.90 0.18 2.18 2.18 XXX
78891... 26 B Nuclear med data proc.... +0.10 0.04 0.04 0.01 0.15 0.15 XXX
78891... TC B Nuclear med data proc.... +0.00 1.86 1.86 0.17 2.03 2.03 XXX
79000... .................. A Intial hyperthyroid 1.80 2.46 2.46 0.29 4.55 4.55 XXX
therapy.
79000... 26 A Intial hyperthyroid 1.80 0.60 0.60 0.12 2.52 2.52 XXX
therapy.
79000... TC A Intial hyperthyroid 0.00 1.86 1.86 0.17 2.03 2.03 XXX
therapy.
79001... .................. A Repeat hyperthyroid 1.05 1.27 1.27 0.15 2.47 2.47 XXX
therapy.
79001... 26 A Repeat hyperthyroid 1.05 0.34 0.34 0.07 1.46 1.46 XXX
therapy.
79001... TC A Repeat hyperthyroid 0.00 0.92 0.92 0.08 1.00 1.00 XXX
therapy.
79020... .................. A Thyroid ablation......... 1.81 2.46 2.46 0.29 4.56 4.56 XXX
79020... 26 A Thyroid ablation......... 1.81 0.60 0.60 0.12 2.53 2.53 XXX
79020... TC A Thyroid ablation......... 0.00 1.86 1.86 0.17 2.03 2.03 XXX
79030... .................. A Thyroid ablation, 2.10 2.56 2.56 0.31 4.97 4.97 XXX
carcinoma.
79030... 26 A Thyroid ablation, 2.10 0.70 0.70 0.14 2.94 2.94 XXX
carcinoma.
79030... TC A Thyroid ablation, 0.00 1.86 1.86 0.17 2.03 2.03 XXX
carcinoma.
79035... .................. A Thyroid metastatic 2.52 2.70 2.70 0.34 5.56 5.56 XXX
therapy.
79035... 26 A Thyroid metastatic 2.52 0.84 0.84 0.17 3.53 3.53 XXX
therapy.
79035... TC A Thyroid metastatic 0.00 1.86 1.86 0.17 2.03 2.03 XXX
therapy.
79100... .................. A Hematopoetic nuclear 1.32 2.29 2.29 0.26 3.87 3.87 XXX
therapy.
79100... 26 A Hematopoetic nuclear 1.32 0.43 0.43 0.09 1.84 1.84 XXX
therapy.
79100... TC A Hematopoetic nuclear 0.00 1.86 1.86 0.17 2.03 2.03 XXX
therapy.
79200... .................. A Intracavitary nuc 1.99 2.52 2.52 0.31 4.82 4.82 XXX
treatment.
79200... 26 A Intracavitary nuc 1.99 0.66 0.66 0.14 2.79 2.79 XXX
treatment.
79200... TC A Intracavitary nuc 0.00 1.86 1.86 0.17 2.03 2.03 XXX
treatment.
79300... 26 A Interstitial nuclear 1.60 0.53 0.53 0.11 2.24 2.24 XXX
therapy.
79400... .................. A Nonhemato nuclear therapy 1.96 2.51 2.51 0.30 4.77 4.77 XXX
79400... 26 A Nonhemato nuclear therapy 1.96 0.65 0.65 0.13 2.74 2.74 XXX
79400... TC A Nonhemato nuclear therapy 0.00 1.86 1.86 0.17 2.03 2.03 XXX
79420... 26 A Intravascular nuc therapy 1.51 0.50 0.50 0.10 2.11 2.11 XXX
79440... .................. A Nuclear joint therapy.... 1.99 2.52 2.52 0.31 4.82 4.82 XXX
79440... 26 A Nuclear joint therapy.... 1.99 0.66 0.66 0.14 2.79 2.79 XXX
79440... TC A Nuclear joint therapy.... 0.00 1.86 1.86 0.17 2.03 2.03 XXX
80500... .................. A Lab pathology 0.37 0.20 0.18 0.01 0.58 0.56 XXX
consultation.
80502... .................. A Lab pathology 1.33 0.59 0.49 0.02 1.94 1.84 XXX
consultation.
83020... 26 A Assay hemoglobin......... 0.37 0.24 0.23 0.01 0.62 0.61 XXX
83912... 26 A Genetic examination...... 0.37 0.20 0.23 0.01 0.58 0.61 XXX
84165... 26 A Assay serum proteins..... 0.37 0.24 0.23 0.01 0.62 0.61 XXX
84181... 26 A Western blot test........ 0.37 0.25 0.23 0.01 0.63 0.61 XXX
84182... 26 A Protein, western blot 0.37 0.30 0.22 0.01 0.68 0.60 XXX
test.
85060... .................. A Blood smear 0.45 0.42 0.17 0.02 0.89 0.64 XXX
interpretation.
85095... .................. A Bone marrow aspiration... 1.08 1.74 0.48 0.05 2.87 1.61 XXX
85097... .................. A Bone marrow 0.94 1.41 0.35 0.04 2.39 1.33 XXX
interpretation.
85102... .................. A Bone marrow biopsy....... 1.37 1.86 0.59 0.05 3.28 2.01 XXX
85390... 26 A Fibrinolysins screen..... 0.37 0.31 0.22 0.01 0.69 0.60 XXX
85576... 26 A Blood platelet 0.37 0.32 0.23 0.01 0.70 0.61 XXX
aggregation.
86077... .................. A Physician blood bank 0.94 0.44 0.35 0.02 1.40 1.31 XXX
service.
[[Page 30991]]
86078... .................. A Physician blood bank 0.94 0.44 0.35 0.02 1.40 1.31 XXX
service.
86079... .................. A Physician blood bank 0.94 0.44 0.34 0.02 1.40 1.30 XXX
service.
86255... 26 A Fluorescent antibody; 0.37 0.33 0.25 0.01 0.71 0.63 XXX
screen.
86256... 26 A Fluorescent antibody; 0.37 0.35 0.25 0.01 0.73 0.63 XXX
titer.
86320... 26 A Serum 0.37 0.29 0.23 0.01 0.67 0.61 XXX
immunoelectrophoresis.
86325... 26 A Other 0.37 0.27 0.23 0.01 0.65 0.61 XXX
immunoelectrophoresis.
86327... 26 A Immunoelectrophoresis 0.42 0.35 0.25 0.01 0.78 0.68 XXX
assay.
86334... 26 A Immunofixation procedure. 0.37 0.28 0.23 0.01 0.66 0.61 XXX
86490... .................. A Coccidioidomycosis skin 0.00 0.10 0.10 0.02 0.12 0.12 XXX
test.
86510... .................. A Histoplasmosis skin test. 0.00 0.12 0.12 0.02 0.14 0.14 XXX
86580... .................. A TB intradermal test...... 0.00 0.12 0.12 0.02 0.14 0.14 XXX
86585... .................. A TB tine test............. 0.00 0.14 0.14 0.01 0.15 0.15 XXX
87164... 26 A Dark field examination... 0.37 0.21 0.22 0.01 0.59 0.60 XXX
87207... 26 A Smear, stain & interpret. 0.37 0.30 0.27 0.01 0.68 0.65 XXX
88104... .................. A Cytopathology, fluids.... 0.56 0.66 0.66 0.04 1.26 1.26 XXX
88104... 26 A Cytopathology, fluids.... 0.56 0.20 0.20 0.02 0.78 0.78 XXX
88104... TC A Cytopathology, fluids.... 0.00 0.45 0.45 0.02 0.47 0.47 XXX
88106... .................. A Cytopathology, fluids.... 0.56 0.62 0.62 0.03 1.21 1.21 XXX
88106... 26 A Cytopathology, fluids.... 0.56 0.26 0.26 0.01 0.83 0.83 XXX
88106... TC A Cytopathology, fluids.... 0.00 0.36 0.36 0.02 0.38 0.38 XXX
88107... .................. A Cytopathology, fluids.... 0.76 0.64 0.64 0.04 1.44 1.44 XXX
88107... 26 A Cytopathology, fluids.... 0.76 0.32 0.32 0.02 1.10 1.10 XXX
88107... TC A Cytopathology, fluids.... 0.00 0.32 0.32 0.02 0.34 0.34 XXX
88108... .................. A Cytopath, concentrate 0.56 0.64 0.64 0.04 1.24 1.24 XXX
tech.
88108... 26 A Cytopath, concentrate 0.56 0.23 0.23 0.02 0.81 0.81 XXX
tech.
88108... TC A Cytopath, concentrate 0.00 0.41 0.41 0.02 0.43 0.43 XXX
tech.
88125... .................. A Forensic cytopathology... 0.26 0.30 0.30 0.00 0.56 0.56 XXX
88125... 26 A Forensic cytopathology... 0.26 0.07 0.07 0.00 0.33 0.33 XXX
88125... TC A Forensic cytopathology... 0.00 0.23 0.23 0.00 0.23 0.23 XXX
88141... .................. A Cytopath cerv/vag 0.42 0.89 0.15 0.04 1.35 0.61 XXX
interpret.
88160... .................. A Cytopath smear, other 0.50 0.73 0.73 0.03 1.26 1.26 XXX
source.
88160... 26 A Cytopath smear, other 0.50 0.15 0.15 0.01 0.66 0.66 XXX
source.
88160... TC A Cytopath smear, other 0.00 0.59 0.59 0.02 0.61 0.61 XXX
source.
88161... .................. A Cytopath smear, other 0.50 0.69 0.69 0.03 1.22 1.22 XXX
source.
88161... 26 A Cytopath smear, other 0.50 0.18 0.18 0.01 0.69 0.69 XXX
source.
88161... TC A Cytopath smear, other 0.00 0.51 0.51 0.02 0.53 0.53 XXX
source.
88162... .................. A Cytopath smear, other 0.76 0.66 0.66 0.05 1.47 1.47 XXX
source.
88162... 26 A Cytopath smear, other 0.76 0.31 0.31 0.03 1.10 1.10 XXX
source.
88162... TC A Cytopath smear, other 0.00 0.35 0.35 0.02 0.37 0.37 XXX
source.
88170... .................. A Fine needle aspiration... 1.27 0.77 0.77 0.09 2.13 2.13 XXX
88170... 26 A Fine needle aspiration... 1.27 0.57 0.57 0.05 1.89 1.89 XXX
88170... TC A Fine needle aspiration... 0.00 0.20 0.20 0.04 0.24 0.24 XXX
88171... .................. A Fine needle aspiration... 1.27 0.63 0.63 0.09 1.99 1.99 XXX
88171... 26 A Fine needle aspiration... 1.27 0.49 0.49 0.05 1.81 1.81 XXX
88171... TC A Fine needle aspiration... 0.00 0.15 0.15 0.04 0.19 0.19 XXX
88172... .................. A Evaluation of smear...... 0.60 0.72 0.72 0.05 1.37 1.37 XXX
88172... 26 A Evaluation of smear...... 0.60 0.24 0.24 0.03 0.87 0.87 XXX
88172... TC A Evaluation of smear...... 0.00 0.48 0.48 0.02 0.50 0.50 XXX
88173... .................. A Interpretation of smear.. 1.39 1.17 1.17 0.05 2.61 2.61 XXX
88173... 26 A Interpretation of smear.. 1.39 0.52 0.52 0.03 1.94 1.94 XXX
88173... TC A Interpretation of smear.. 0.00 0.64 0.64 0.02 0.66 0.66 XXX
88180... .................. A Cell marker study........ 0.36 0.38 0.38 0.03 0.77 0.77 XXX
88180... 26 A Cell marker study........ 0.36 0.13 0.13 0.01 0.50 0.50 XXX
88180... TC A Cell marker study........ 0.00 0.25 0.25 0.02 0.27 0.27 XXX
88182... .................. A Cell marker study........ 0.77 0.89 0.89 0.07 1.73 1.73 XXX
88182... 26 A Cell marker study........ 0.77 0.26 0.26 0.03 1.06 1.06 XXX
88182... TC A Cell marker study........ 0.00 0.63 0.63 0.04 0.67 0.67 XXX
88300... .................. A Surg path, gross......... 0.08 0.36 0.36 0.01 0.45 0.45 XXX
88300... 26 A Surg path, gross......... 0.08 0.03 0.03 0.01 0.12 0.12 XXX
88300... TC A Surg path, gross......... 0.00 0.33 0.33 0.00 0.33 0.33 XXX
88302... .................. A Tissue exam by 0.13 0.63 0.63 0.04 0.80 0.80 XXX
pathologist.
88302... 26 A Tissue exam by 0.13 0.06 0.06 0.02 0.21 0.21 XXX
pathologist.
88302... TC A Tissue exam by 0.00 0.58 0.58 0.02 0.60 0.60 XXX
pathologist.
88304... .................. A Tissue exam by 0.22 0.72 0.72 0.04 0.98 0.98 XXX
pathologist.
88304... 26 A Tissue exam by 0.22 0.09 0.09 0.02 0.33 0.33 XXX
pathologist.
88304... TC A Tissue exam by 0.00 0.62 0.62 0.02 0.64 0.64 XXX
pathologist.
88305... .................. A Tissue exam by 0.75 1.06 1.06 0.08 1.89 1.89 XXX
pathologist.
88305... 26 A Tissue exam by 0.75 0.31 0.31 0.04 1.10 1.10 XXX
pathologist.
88305... TC A Tissue exam by 0.00 0.75 0.75 0.04 0.79 0.79 XXX
pathologist.
88307... .................. A Tissue exam by 1.59 1.71 1.71 0.12 3.42 3.42 XXX
pathologist.
88307... 26 A Tissue exam by 1.59 0.61 0.61 0.06 2.26 2.26 XXX
pathologist.
88307... TC A Tissue exam by 0.00 1.10 1.10 0.06 1.16 1.16 XXX
pathologist.
88309... .................. A Tissue exam by 2.28 2.49 2.49 0.13 4.90 4.90 XXX
pathologist.
88309... 26 A Tissue exam by 2.28 0.89 0.89 0.07 3.24 3.24 XXX
pathologist.
[[Page 30992]]
88309... TC A Tissue exam by 0.00 1.60 1.60 0.06 1.66 1.66 XXX
pathologist.
88311... .................. A Decalcify tissue......... 0.24 0.15 0.15 0.01 0.40 0.40 XXX
88311... 26 A Decalcify tissue......... 0.24 0.09 0.09 0.01 0.34 0.34 XXX
88311... TC A Decalcify tissue......... 0.00 0.06 0.06 0.00 0.06 0.06 XXX
88312... .................. A Special stains........... 0.54 1.11 1.11 0.01 1.66 1.66 XXX
88312... 26 A Special stains........... 0.54 0.20 0.20 0.01 0.75 0.75 XXX
88312... TC A Special stains........... 0.00 0.91 0.91 0.00 0.91 0.91 XXX
88313... .................. A Special stains........... 0.24 0.73 0.73 0.01 0.98 0.98 XXX
88313... 26 A Special stains........... 0.24 0.09 0.09 0.01 0.34 0.34 XXX
88313... TC A Special stains........... 0.00 0.65 0.65 0.00 0.65 0.65 XXX
88314... .................. A Histochemical stain...... 0.45 1.30 1.30 0.04 1.79 1.79 XXX
88314... 26 A Histochemical stain...... 0.45 0.35 0.35 0.02 0.82 0.82 XXX
88314... TC A Histochemical stain...... 0.00 0.95 0.95 0.02 0.97 0.97 XXX
88318... .................. A Chemical histochemistry.. 0.42 0.58 0.58 0.01 1.01 1.01 XXX
88318... 26 A Chemical histochemistry.. 0.42 0.18 0.18 0.01 0.61 0.61 XXX
88318... TC A Chemical histochemistry.. 0.00 0.39 0.39 0.00 0.39 0.39 XXX
88319... .................. A Enzyme histochemistry.... 0.53 2.53 2.53 0.04 3.10 3.10 XXX
88319... 26 A Enzyme histochemistry.... 0.53 0.31 0.31 0.02 0.86 0.86 XXX
88319... TC A Enzyme histochemistry.... 0.00 2.21 2.21 0.02 2.23 2.23 XXX
88321... .................. A Microslide consultation.. 1.30 0.81 0.48 0.03 2.14 1.81 XXX
88323... .................. A Microslide consultation.. 1.35 1.20 1.20 0.05 2.60 2.60 XXX
88323... 26 A Microslide consultation.. 1.35 0.68 0.68 0.03 2.06 2.06 XXX
88323... TC A Microslide consultation.. 0.00 0.52 0.52 0.02 0.54 0.54 XXX
88325... .................. A Comprehensive review of 2.22 1.10 0.82 0.04 3.36 3.08 XXX
data.
88329... .................. A Pathology consult in 0.67 0.34 0.25 0.03 1.04 0.95 XXX
surgery.
88331... .................. A Pathology consult in 1.19 0.68 0.68 0.08 1.95 1.95 XXX
surgery.
88331... 26 A Pathology consult in 1.19 0.45 0.45 0.04 1.68 1.68 XXX
surgery.
88331... TC A Pathology consult in 0.00 0.23 0.23 0.04 0.27 0.27 XXX
surgery.
88332... .................. A Pathology consult in 0.59 0.32 0.32 0.04 0.95 0.95 XXX
surgery.
88332... 26 A Pathology consult in 0.59 0.22 0.22 0.02 0.83 0.83 XXX
surgery.
88332... TC A Pathology consult in 0.00 0.10 0.10 0.02 0.12 0.12 XXX
surgery.
88342... .................. A Immunocytochemistry...... 0.85 0.98 0.98 0.04 1.87 1.87 XXX
88342... 26 A Immunocytochemistry...... 0.85 0.31 0.31 0.02 1.18 1.18 XXX
88342... TC A Immunocytochemistry...... 0.00 0.67 0.67 0.02 0.69 0.69 XXX
88346... .................. A Immunofluorescent study.. 0.86 1.00 1.00 0.04 1.90 1.90 XXX
88346... 26 A Immunofluorescent study.. 0.86 0.30 0.30 0.02 1.18 1.18 XXX
88346... TC A Immunofluorescent study.. 0.00 0.70 0.70 0.02 0.72 0.72 XXX
88347... .................. A Immunofluorescent study.. 0.86 0.78 0.78 0.04 1.68 1.68 XXX
88347... 26 A Immunofluorescent study.. 0.86 0.42 0.42 0.02 1.30 1.30 XXX
88347... TC A Immunofluorescent study.. 0.00 0.35 0.35 0.02 0.37 0.37 XXX
88348... .................. A Electron microscopy...... 1.51 3.80 3.80 0.16 5.47 5.47 XXX
88348... 26 A Electron microscopy...... 1.51 0.34 0.34 0.08 1.93 1.93 XXX
88348... TC A Electron microscopy...... 0.00 3.46 3.46 0.08 3.54 3.54 XXX
88349... .................. A Scanning electron 0.76 8.14 8.14 0.12 9.02 9.02 XXX
microscopy.
88349... 26 A Scanning electron 0.76 0.17 0.17 0.06 0.99 0.99 XXX
microscopy.
88349... TC A Scanning electron 0.00 7.97 7.97 0.06 8.03 8.03 XXX
microscopy.
88355... .................. A Analysis, skeletal muscle 1.85 3.00 3.00 0.13 4.98 4.98 XXX
88355... 26 A Analysis, skeletal muscle 1.85 0.81 0.81 0.07 2.73 2.73 XXX
88355... TC A Analysis, skeletal muscle 0.00 2.19 2.19 0.06 2.25 2.25 XXX
88356... .................. A Analysis, nerve.......... 3.02 4.19 4.19 0.18 7.39 7.39 XXX
88356... 26 A Analysis, nerve.......... 3.02 0.84 0.84 0.10 3.96 3.96 XXX
88356... TC A Analysis, nerve.......... 0.00 3.35 3.35 0.08 3.43 3.43 XXX
88358... .................. A Analysis, tumor.......... 2.82 1.74 1.74 0.16 4.72 4.72 XXX
88358... 26 A Analysis, tumor.......... 2.82 1.26 1.26 0.08 4.16 4.16 XXX
88358... TC A Analysis, tumor.......... 0.00 0.48 0.48 0.08 0.56 0.56 XXX
88362... .................. A Nerve teasing 2.17 3.27 3.27 0.13 5.57 5.57 XXX
preparations.
88362... 26 A Nerve teasing 2.17 0.50 0.50 0.07 2.74 2.74 XXX
preparations.
88362... TC A Nerve teasing 0.00 2.77 2.77 0.06 2.83 2.83 XXX
preparations.
88365... .................. A Tissue hybridization..... 0.93 1.82 1.82 0.05 2.80 2.80 XXX
88365... 26 A Tissue hybridization..... 0.93 0.39 0.39 0.03 1.35 1.35 XXX
88365... TC A Tissue hybridization..... 0.00 1.43 1.43 0.02 1.45 1.45 XXX
88371... 26 A Protein, western blot 0.37 0.33 0.23 0.01 0.71 0.61 XXX
tissue.
88372... 26 A Protein analysis w/probe. 0.37 0.33 0.23 0.01 0.71 0.61 XXX
89060... 26 A Exam, synovial fluid 0.37 0.31 0.24 0.01 0.69 0.62 XXX
crystals.
89100... .................. A Sample intestinal 0.60 0.90 0.27 0.03 1.53 0.90 XXX
contents.
89105... .................. A Sample intestinal 0.50 1.93 0.23 0.03 2.46 0.76 XXX
contents.
89130... .................. A Sample stomach contents.. 0.45 0.93 0.17 0.03 1.41 0.65 XXX
89132... .................. A Sample stomach contents.. 0.19 1.21 0.11 0.02 1.42 0.32 XXX
89135... .................. A Sample stomach contents.. 0.79 1.31 0.31 0.04 2.14 1.14 XXX
89136... .................. A Sample stomach contents.. 0.21 0.51 0.14 0.02 0.74 0.37 XXX
89140... .................. A Sample stomach contents.. 0.94 0.98 0.29 0.07 1.99 1.30 XXX
89141... .................. A Sample stomach contents.. 0.85 1.59 0.28 0.06 2.50 1.19 XXX
89350... .................. A Sputum specimen 0.00 0.13 0.13 0.03 0.16 0.16 XXX
collection.
89360... .................. A Collect sweat for test... 0.00 0.03 0.03 0.03 0.06 0.06 XXX
[[Page 30993]]
90780... .................. A IV infusion therapy, 1 0.00 0.90 0.06 0.08 0.98 0.14 XXX
hour.
90781... .................. A IV infusion, additional 0.00 0.64 0.18 0.04 0.68 0.22 XXX
hour.
90782... .................. T Injection (SC)/(IM)...... 0.00 0.12 0.03 0.01 0.13 0.04 XXX
90783... .................. T Injection (IA)........... 0.00 0.21 0.06 0.03 0.24 0.09 XXX
90784... .................. T Injection (IV)........... 0.00 0.22 0.06 0.04 0.26 0.10 XXX
90788... .................. T Injection of antibiotic.. 0.00 0.11 0.03 0.01 0.12 0.04 XXX
90801... .................. A Psy dx interview......... 2.80 1.09 1.05 0.09 3.98 3.94 XXX
90802... .................. A Intac psy dx interview... 3.01 1.24 1.15 0.05 4.30 4.21 XXX
90804... .................. A Psytx, office (20-30).... 1.11 0.45 0.40 0.05 1.61 1.56 XXX
90805... .................. A Psytx, office (20-30) w/ 1.47 0.58 0.52 0.05 2.10 2.04 XXX
e&m.
90806... .................. A Psytx, office (45-50).... 1.73 0.71 0.61 0.08 2.52 2.42 XXX
90807... .................. A Psytx, office (45-50) w/ 2.00 0.81 0.70 0.08 2.89 2.78 XXX
e&m.
90808... .................. A Psytx, office (75-80).... 2.76 1.11 1.06 0.15 4.02 3.97 XXX
90809... .................. A Psytx, office (75-80) w/ 3.15 1.26 1.20 0.15 4.56 4.50 XXX
e&m.
90810... .................. A Intac psytx, office (20- 1.19 0.47 0.40 0.09 1.75 1.68 XXX
30).
90811... .................. A Intac psytx, off 20-30 w/ 1.58 0.68 0.58 0.09 2.35 2.25 XXX
e&m.
90812... .................. A Intac psytx, office (45- 1.86 0.69 0.61 0.09 2.64 2.56 XXX
50).
90813... .................. A Intac psytx, off 45-50 w/ 2.15 0.87 0.75 0.09 3.11 2.99 XXX
e&m.
90814... .................. A Intac psytx, office (75- 2.97 1.08 0.96 0.09 4.14 4.02 XXX
80).
90815... .................. A Intac psytx, off 75-80 w/ 3.39 1.31 1.15 0.09 4.79 4.63 XXX
e&m.
90816... .................. A Psytx, hosp (20-30)...... 1.24 0.50 0.44 0.05 1.79 1.73 XXX
90817... .................. A Psytx, hosp (20-30) w/e&m 1.65 0.71 0.63 0.05 2.41 2.33 XXX
90818... .................. A Psytx, hosp (45-50)...... 1.94 0.79 0.68 0.08 2.81 2.70 XXX
90819... .................. A Psytx, hosp (45-50) w/e&m 2.24 0.98 0.83 0.08 3.30 3.15 XXX
90821... .................. A Psytx, hosp (75-80)...... 3.09 1.24 1.18 0.15 4.48 4.42 XXX
90822... .................. A Psytx, hosp (75-80) w/e&m 3.53 1.48 1.43 0.15 5.16 5.11 XXX
90823... .................. A Intac psytx, hosp (20-30) 1.33 0.51 0.44 0.09 1.93 1.86 XXX
90824... .................. A Intac psytx, hsp 20-30 w/ 1.77 0.74 0.63 0.09 2.60 2.49 XXX
e&m.
90826... .................. A Intac psytx, hosp (45-50) 2.08 0.77 0.67 0.09 2.94 2.84 XXX
90827... .................. A Intac psytx, hsp 45-50 w/ 2.41 0.95 0.82 0.09 3.45 3.32 XXX
e&m.
90828... .................. A Intac psytx, hosp (75-80) 3.32 1.20 1.07 0.09 4.61 4.48 XXX
90829... .................. A Intac psytx, hsp 75-80 w/ 3.80 1.44 1.27 0.09 5.33 5.16 XXX
e&m.
90845... .................. A Psychoanalysis........... 1.79 0.64 0.58 0.05 2.48 2.42 XXX
90846... .................. R Family psytx w/o patient. 1.83 0.76 0.67 0.08 2.67 2.58 XXX
90847... .................. R Family psytx w/patient... 2.21 0.86 0.79 0.08 3.15 3.08 XXX
90849... .................. R Multiple family group 0.59 0.31 0.30 0.03 0.93 0.92 XXX
psytx.
90853... .................. A Group psychotherapy...... 0.59 0.31 0.29 0.03 0.93 0.91 XXX
90857... .................. A Intac group psytx........ 0.63 0.34 0.31 0.02 0.99 0.96 XXX
90862... .................. A Medication management.... 0.95 0.36 0.35 0.05 1.36 1.35 XXX
90865... .................. A Narcosynthesis........... 2.84 5.14 0.88 0.07 8.05 3.79 XXX
90870... .................. A Electroconvulsive therapy 1.88 0.64 0.71 0.08 2.60 2.67 000
90871... .................. A Electroconvulsive therapy 2.72 NA 0.89 0.13 NA 3.74 000
90880... .................. A Hypnotherapy............. 2.19 0.88 0.80 0.07 3.14 3.06 XXX
90885... .................. B Psy evaluation of records +0.97 0.97 0.97 0.04 1.98 1.98 XXX
90887... .................. B Consultation with family. +1.48 1.82 1.73 0.04 3.34 3.25 XXX
90901... .................. A Biofeedback, any method.. 0.41 0.43 0.33 0.07 0.91 0.81 000
90911... .................. A Biofeedback peri/uro/ 0.89 0.60 0.59 0.27 1.76 1.75 000
rectal.
90918... .................. A ESRD related services, 11.18 4.46 4.46 0.14 15.78 15.78 XXX
month.
90919... .................. A ESRD related services, 8.54 3.59 3.59 0.14 12.27 12.27 XXX
month.
90920... .................. A ESRD related services, 7.27 2.98 2.98 0.14 10.39 10.39 XXX
month.
90921... .................. A ESRD related services, 4.47 2.02 2.02 0.14 6.63 6.63 XXX
month.
90922... .................. A ESRD related services, 0.37 0.13 0.13 0.01 0.51 0.51 XXX
day.
90923... .................. A Esrd related services, 0.28 0.12 0.12 0.01 0.41 0.41 XXX
day.
90924... .................. A Esrd related services, 0.24 0.10 0.10 0.01 0.35 0.35 XXX
day.
90925... .................. A Esrd related services, 0.15 0.07 0.07 0.01 0.23 0.23 XXX
day.
90935... .................. A Hemodialysis, one 1.22 NA 0.58 0.10 NA 1.90 000
evaluation.
90937... .................. A Hemodialysis, repeated 2.11 NA 0.86 0.18 NA 3.15 000
eval..
90945... .................. A Dialysis, one evaluation. 1.28 NA 0.60 0.08 NA 1.96 000
90947... .................. A Dialysis, repeated eval.. 2.16 NA 0.88 0.14 NA 3.18 000
90997... .................. A Hemoperfusion............ 1.84 NA 0.77 0.16 NA 2.77 000
91000... .................. A Esophageal intubation.... 0.73 1.47 1.47 0.06 2.26 2.26 000
91000... 26 A Esophageal intubation.... 0.73 0.15 0.15 0.05 0.93 0.93 000
91000... TC A Esophageal intubation.... 0.00 1.33 1.33 0.01 1.34 1.34 000
91010... .................. A Esophagus motility study. 1.25 1.38 1.38 0.17 2.80 2.80 000
91010... 26 A Esophagus motility study. 1.25 0.45 0.45 0.11 1.81 1.81 000
91010... TC A Esophagus motility study. 0.00 0.94 0.94 0.06 1.00 1.00 000
91011... .................. A Esophagus motility study. 1.50 2.81 2.81 0.18 4.49 4.49 000
91011... 26 A Esophagus motility study. 1.50 0.41 0.41 0.11 2.02 2.02 000
91011... TC A Esophagus motility study. 0.00 2.40 2.40 0.07 2.47 2.47 000
91012... .................. A Esophagus motility study. 1.46 2.29 2.29 0.23 3.98 3.98 000
91012... 26 A Esophagus motility study. 1.46 0.46 0.46 0.15 2.07 2.07 000
91012... TC A Esophagus motility study. 0.00 1.83 1.83 0.08 1.91 1.91 000
91020... .................. A Gastric motility......... 1.44 2.01 2.01 0.18 3.63 3.63 000
91020... 26 A Gastric motility......... 1.44 0.44 0.44 0.12 2.00 2.00 000
[[Page 30994]]
91020... TC A Gastric motility......... 0.00 1.57 1.57 0.06 1.63 1.63 000
91030... .................. A Acid perfusion of 0.91 2.27 2.27 0.05 3.23 3.23 000
esophagus.
91030... 26 A Acid perfusion of 0.91 0.26 0.26 0.03 1.20 1.20 000
esophagus.
91030... TC A Acid perfusion of 0.00 2.01 2.01 0.02 2.03 2.03 000
esophagus.
91032... .................. A Esophagus, acid reflux 1.21 2.08 2.08 0.16 3.45 3.45 000
test.
91032... 26 A Esophagus, acid reflux 1.21 0.30 0.30 0.10 1.61 1.61 000
test.
91032... TC A Esophagus, acid reflux 0.00 1.78 1.78 0.06 1.84 1.84 000
test.
91033... .................. A Prolonged acid reflux 1.30 1.39 1.39 0.25 2.94 2.94 000
test.
91033... 26 A Prolonged acid reflux 1.30 0.45 0.45 0.14 1.89 1.89 000
test.
91033... TC A Prolonged acid reflux 0.00 0.94 0.94 0.11 1.05 1.05 000
test.
91052... .................. A Gastric analysis test.... 0.79 1.68 1.68 0.07 2.54 2.54 000
91052... 26 A Gastric analysis test.... 0.79 0.16 0.16 0.04 0.99 0.99 000
91052... TC A Gastric analysis test.... 0.00 1.52 1.52 0.03 1.55 1.55 000
91055... .................. A Gastric intubation for 0.94 2.06 2.06 0.06 3.06 3.06 000
smear.
91055... 26 A Gastric intubation for 0.94 0.21 0.21 0.04 1.19 1.19 000
smear.
91055... TC A Gastric intubation for 0.00 1.85 1.85 0.02 1.87 1.87 000
smear.
91060... .................. A Gastric saline load test. 0.45 0.25 0.25 0.06 0.76 0.76 000
91060... 26 A Gastric saline load test. 0.45 0.11 0.11 0.04 0.60 0.60 000
91060... TC A Gastric saline load test. 0.00 0.14 0.14 0.02 0.16 0.16 000
91065... .................. A Breath hydrogen test..... 0.20 1.59 1.59 0.05 1.84 1.84 000
91065... 26 A Breath hydrogen test..... 0.20 0.08 0.08 0.03 0.31 0.31 000
91065... TC A Breath hydrogen test..... 0.00 1.51 1.51 0.02 1.53 1.53 000
91100... .................. A Pass intestine bleeding 1.08 NA 0.26 0.05 NA 1.39 000
tube.
91105... .................. A Gastric intubation 0.37 NA 0.11 0.04 NA 0.52 000
treatment.
91122... .................. A Anal pressure record..... 1.77 2.21 2.21 0.22 4.20 4.20 000
91122... 26 A Anal pressure record..... 1.77 0.80 0.80 0.13 2.70 2.70 000
91122... TC A Anal pressure record..... 0.00 1.41 1.41 0.09 1.50 1.50 000
92002... .................. A Eye exam, new patient.... 0.88 0.96 0.36 0.02 1.86 1.26 XXX
92004... .................. A Eye exam, new patient.... 1.67 1.58 0.87 0.02 3.27 2.56 XXX
92012... .................. A Eye exam established pt.. 0.67 1.26 0.35 0.02 1.95 1.04 XXX
92014... .................. A Eye exam & treatment..... 1.10 1.25 0.58 0.02 2.37 1.70 XXX
92015... .................. N Refraction............... +0.38 1.93 0.38 0.02 2.33 0.78 XXX
92018... .................. A New eye exam & treatment. 1.51 NA 1.11 0.03 NA 2.65 XXX
92019... .................. A Eye exam & treatment..... 1.31 NA 0.85 0.03 NA 2.19 XXX
92020... .................. A Special eye evaluation... 0.37 0.51 0.20 0.01 0.89 0.58 XXX
92060... .................. A Special eye evaluation... 0.69 1.34 1.34 0.02 2.05 2.05 XXX
92060... 26 A Special eye evaluation... 0.69 0.32 0.32 0.01 1.02 1.02 XXX
92060... TC A Special eye evaluation... 0.00 1.02 1.02 0.01 1.03 1.03 XXX
92065... .................. A Orthoptic/pleoptic 0.37 0.62 0.62 0.01 1.00 1.00 XXX
training.
92065... 26 A Orthoptic/pleoptic 0.37 0.06 0.06 0.01 0.44 0.44 XXX
training.
92065... TC A Orthoptic/pleoptic 0.00 0.56 0.56 0.00 0.56 0.56 XXX
training.
92070... .................. A Fitting of contact lens.. 0.70 0.87 0.40 0.06 1.63 1.16 XXX
92081... .................. A Visual field 0.36 0.80 0.80 0.01 1.17 1.17 XXX
examination(s).
92081... 26 A Visual field 0.36 0.16 0.16 0.01 0.53 0.53 XXX
examination(s).
92081... TC A Visual field 0.00 0.64 0.64 0.00 0.64 0.64 XXX
examination(s).
92082... .................. A Visual field 0.44 1.05 1.05 0.02 1.51 1.51 XXX
examination(s).
92082... 26 A Visual field 0.44 0.23 0.23 0.01 0.68 0.68 XXX
examination(s).
92082... TC A Visual field 0.00 0.82 0.82 0.01 0.83 0.83 XXX
examination(s).
92083... .................. A Visual field 0.50 1.33 1.33 0.04 1.87 1.87 XXX
examination(s).
92083... 26 A Visual field 0.50 0.28 0.28 0.03 0.81 0.81 XXX
examination(s).
92083... TC A Visual field 0.00 1.05 1.05 0.01 1.06 1.06 XXX
examination(s).
92100... .................. A Serial tonometry exam(s). 0.92 0.73 0.26 0.01 1.66 1.19 XXX
92120... .................. A Tonography & eye 0.81 0.72 0.30 0.02 1.55 1.13 XXX
evaluation.
92130... .................. A Water provocation 0.81 0.80 0.26 0.02 1.63 1.09 XXX
tonography.
92140... .................. A Glaucoma provocative 0.50 0.77 0.27 0.01 1.28 0.78 XXX
tests.
92225... .................. A Special eye exam, initial 0.38 0.96 0.21 0.02 1.36 0.61 XXX
92226... .................. A Special eye exam, 0.33 1.01 0.19 0.02 1.36 0.54 XXX
subsequent.
92230... .................. A Eye exam with photos..... 0.60 1.74 0.18 0.04 2.38 0.82 XXX
92235... .................. A Eye exam with photos..... 0.81 2.67 2.67 0.09 3.57 3.57 XXX
92235... 26 A Eye exam with photos..... 0.81 0.49 0.49 0.03 1.33 1.33 XXX
92235... TC A Eye exam with photos..... 0.00 2.18 2.18 0.06 2.24 2.24 XXX
92240... .................. A Icg angiography.......... 1.10 2.84 2.84 0.09 4.03 4.03 XXX
92240... 26 A Icg angiography.......... 1.10 0.66 0.66 0.03 1.79 1.79 XXX
92240... TC A Icg angiography.......... 0.00 2.17 2.17 0.06 2.23 2.23 XXX
92250... .................. A Eye exam with photos..... 0.44 1.38 1.38 0.02 1.84 1.84 XXX
92250... 26 A Eye exam with photos..... 0.44 0.24 0.24 0.01 0.69 0.69 XXX
92250... TC A Eye exam with photos..... 0.00 1.14 1.14 0.01 1.15 1.15 XXX
92260... .................. A Ophthalmoscopy/ 0.20 0.18 0.09 0.03 0.41 0.32 XXX
dynamometry.
92265... .................. A Eye muscle evaluation.... 0.81 1.10 1.10 0.02 1.93 1.93 XXX
92265... 26 A Eye muscle evaluation.... 0.81 0.21 0.21 0.00 1.02 1.02 XXX
92265... TC A Eye muscle evaluation.... 0.00 0.89 0.89 0.02 0.91 0.91 XXX
92270... .................. A Electro-oculography...... 0.81 1.19 1.19 0.05 2.05 2.05 XXX
92270... 26 A Electro-oculography...... 0.81 0.41 0.41 0.03 1.25 1.25 XXX
92270... TC A Electro-oculography...... 0.00 0.79 0.79 0.02 0.81 0.81 XXX
[[Page 30995]]
92275... .................. A Electroretinography...... 1.01 1.89 1.89 0.05 2.95 2.95 XXX
92275... 26 A Electroretinography...... 1.01 0.38 0.38 0.03 1.42 1.42 XXX
92275... TC A Electroretinography...... 0.00 1.51 1.51 0.02 1.53 1.53 XXX
92283... .................. A Color vision examination. 0.17 0.63 0.63 0.01 0.81 0.81 XXX
92283... 26 A Color vision examination. 0.17 0.05 0.05 0.01 0.23 0.23 XXX
92283... TC A Color vision examination. 0.00 0.59 0.59 0.00 0.59 0.59 XXX
92284... .................. A Dark adaptation eye exam. 0.24 1.66 1.66 0.02 1.92 1.92 XXX
92284... 26 A Dark adaptation eye exam. 0.24 0.09 0.09 0.01 0.34 0.34 XXX
92284... TC A Dark adaptation eye exam. 0.00 1.57 1.57 0.01 1.58 1.58 XXX
92285... .................. A Eye photography.......... 0.20 1.26 1.26 0.01 1.47 1.47 XXX
92285... 26 A Eye photography.......... 0.20 0.10 0.10 0.01 0.31 0.31 XXX
92285... TC A Eye photography.......... 0.00 1.16 1.16 0.00 1.16 1.16 XXX
92286... .................. A Internal eye photography. 0.66 1.56 1.56 0.07 2.29 2.29 XXX
92286... 26 A Internal eye photography. 0.66 0.34 0.34 0.05 1.05 1.05 XXX
92286... TC A Internal eye photography. 0.00 1.21 1.21 0.02 1.23 1.23 XXX
92287... .................. A Internal eye photography. 0.81 2.65 0.38 0.08 3.54 1.27 XXX
92310... .................. N Contact lens fitting..... +1.17 1.99 1.17 0.00 3.16 2.34 XXX
92311... .................. A Contact lens fitting..... 1.08 0.93 0.41 0.03 2.04 1.52 XXX
92312... .................. A Contact lens fitting..... 1.26 0.93 0.51 0.03 2.22 1.80 XXX
92313... .................. A Contact lens fitting..... 0.92 0.86 0.40 0.03 1.81 1.35 XXX
92314... .................. N Prescription of contact +0.69 1.51 0.69 0.00 2.20 1.38 XXX
lens.
92315... .................. A Prescription of contact 0.45 0.60 0.07 0.03 1.08 0.55 XXX
lens.
92316... .................. A Prescription of contact 0.68 0.61 0.27 0.04 1.33 0.99 XXX
lens.
92317... .................. A Prescription of contact 0.45 0.76 0.25 0.02 1.23 0.72 XXX
lens.
92325... .................. A Modification of contact 0.00 0.33 0.12 0.01 0.34 0.13 XXX
lens.
92326... .................. A Replacement of contact 0.00 0.26 0.09 0.06 0.32 0.15 XXX
lens.
92330... .................. A Fitting of artificial eye 1.08 0.83 0.33 0.09 2.00 1.50 XXX
92335... .................. A Fitting of artificial eye 0.45 0.66 0.19 0.11 1.22 0.75 XXX
92340... .................. N Fitting of spectacles.... +0.37 1.05 0.37 0.00 1.42 0.74 XXX
92341... .................. N Fitting of spectacles.... +0.47 1.15 0.47 0.00 1.62 0.94 XXX
92342... .................. N Fitting of spectacles.... +0.53 1.21 0.53 0.00 1.74 1.06 XXX
92352... .................. B Special spectacles +0.37 1.05 0.37 0.01 1.43 0.75 XXX
fitting.
92353... .................. B Special spectacles +0.50 1.18 0.50 0.01 1.69 1.01 XXX
fitting.
92354... .................. B Special spectacles +0.00 0.81 0.41 0.10 0.91 0.51 XXX
fitting.
92355... .................. B Special spectacles +0.00 0.81 0.41 0.01 0.82 0.42 XXX
fitting.
92358... .................. B Eye prosthesis service... +0.00 0.47 0.24 0.05 0.52 0.29 XXX
92370... .................. N Repair & adjust +0.32 0.79 0.32 0.00 1.11 0.64 XXX
spectacles.
92371... .................. B Repair & adjust +0.00 0.47 0.24 0.02 0.49 0.26 XXX
spectacles.
92392... .................. I Supply of low vision aids +0.00 0.47 0.24 0.02 0.49 0.26 XXX
92393... .................. I Supply of artificial eye. +0.00 0.47 0.24 0.67 1.14 0.91 XXX
92395... .................. I Supply of spectacles..... +0.00 0.47 0.24 0.10 0.57 0.34 XXX
92396... .................. I Supply of contact lenses. +0.00 0.47 0.24 0.08 0.55 0.32 XXX
92502... .................. A Ear and throat 1.51 NA 1.11 0.12 NA 2.74 000
examination.
92504... .................. A Ear microscopy 0.18 0.49 0.11 0.02 0.69 0.31 XXX
examination.
92506... .................. A Speech & hearing 0.86 0.89 0.86 0.05 1.80 1.77 XXX
evaluation.
92507... .................. A Speech/hearing therapy... 0.52 0.73 0.65 0.03 1.28 1.20 XXX
92508... .................. A Speech/hearing therapy... 0.26 0.70 0.56 0.02 0.98 0.84 XXX
92510... .................. A Rehab for ear implant.... 1.50 1.35 1.35 0.15 3.00 3.00 XXX
92511... .................. A Nasopharyngoscopy........ 0.84 0.79 0.49 0.09 1.72 1.42 000
92512... .................. A Nasal function studies... 0.55 0.62 0.20 0.05 1.22 0.80 XXX
92516... .................. A Facial nerve function 0.43 0.54 0.21 0.04 1.01 0.68 XXX
test.
92520... .................. A Laryngeal function 0.76 0.57 0.54 0.05 1.38 1.35 XXX
studies.
92525... .................. A Oral function evaluation. 1.50 1.23 1.20 0.11 2.84 2.81 XXX
92526... .................. A Oral function therapy.... 0.55 0.69 0.70 0.05 1.29 1.30 XXX
92541... .................. A Spontaneous nystagmus 0.40 0.75 0.75 0.07 1.22 1.22 XXX
test.
92541... 26 A Spontaneous nystagmus 0.40 0.21 0.21 0.05 0.66 0.66 XXX
test.
92541... TC A Spontaneous nystagmus 0.00 0.54 0.54 0.02 0.56 0.56 XXX
test.
92542... .................. A Positional nystagmus test 0.33 0.71 0.71 0.07 1.11 1.11 XXX
92542... 26 A Positional nystagmus test 0.33 0.18 0.18 0.04 0.55 0.55 XXX
92542... TC A Positional nystagmus test 0.00 0.54 0.54 0.03 0.57 0.57 XXX
92543... .................. A Caloric vestibular test.. 0.10 0.57 0.57 0.02 0.69 0.69 XXX
92543... 26 A Caloric vestibular test.. 0.10 0.05 0.05 0.01 0.16 0.16 XXX
92543... TC A Caloric vestibular test.. 0.00 0.52 0.52 0.01 0.53 0.53 XXX
92544... .................. A Optokinetic nystagmus 0.26 0.67 0.67 0.05 0.98 0.98 XXX
test.
92544... 26 A Optokinetic nystagmus 0.26 0.13 0.13 0.03 0.42 0.42 XXX
test.
92544... TC A Optokinetic nystagmus 0.00 0.53 0.53 0.02 0.55 0.55 XXX
test.
92545... .................. A Oscillating tracking test 0.23 0.65 0.65 0.04 0.92 0.92 XXX
92545... 26 A Oscillating tracking test 0.23 0.12 0.12 0.02 0.37 0.37 XXX
92545... TC A Oscillating tracking test 0.00 0.53 0.53 0.02 0.55 0.55 XXX
92546... .................. A Sinusoidal rotational 0.29 1.17 1.17 0.05 1.51 1.51 XXX
test.
92546... 26 A Sinusoidal rotational 0.29 0.15 0.15 0.03 0.47 0.47 XXX
test.
92546... TC A Sinusoidal rotational 0.00 1.02 1.02 0.02 1.04 1.04 XXX
test.
92547... .................. A Supplemental electrical 0.00 0.50 0.50 0.06 0.56 0.56 XXX
test.
92548... .................. A Posturography............ 0.50 1.41 1.41 0.19 2.10 2.10 XXX
[[Page 30996]]
92548... 26 A Posturography............ 0.50 0.22 0.22 0.05 0.77 0.77 XXX
92548... TC A Posturography............ 0.00 1.19 1.19 0.14 1.33 1.33 XXX
92552... .................. A Pure tone audiometry, air 0.00 0.50 0.50 0.04 0.54 0.54 XXX
92553... .................. A Audiometry, air & bone... 0.00 0.51 0.51 0.07 0.58 0.58 XXX
92555... .................. A Speech threshold 0.00 0.51 0.51 0.04 0.55 0.55 XXX
audiometry.
92556... .................. A Speech audiometry, 0.00 0.51 0.51 0.06 0.57 0.57 XXX
complete.
92557... .................. A Comprehensive hearing 0.00 0.51 0.51 0.13 0.64 0.64 XXX
test.
92561... .................. A Bekesy audiometry, 0.00 0.45 0.45 0.07 0.52 0.52 XXX
diagnosis.
92562... .................. A Loudness balance test.... 0.00 0.53 0.53 0.04 0.57 0.57 XXX
92563... .................. A Tone decay hearing test.. 0.00 0.51 0.51 0.04 0.55 0.55 XXX
92564... .................. A Sisi hearing test........ 0.00 0.51 0.51 0.05 0.56 0.56 XXX
92565... .................. A Stenger test, pure tone.. 0.00 0.50 0.50 0.04 0.54 0.54 XXX
92567... .................. A Tympanometry............. 0.00 0.44 0.44 0.06 0.50 0.50 XXX
92568... .................. A Acoustic reflex testing.. 0.00 0.44 0.44 0.04 0.48 0.48 XXX
92569... .................. A Acoustic reflex decay 0.00 0.44 0.44 0.04 0.48 0.48 XXX
test.
92571... .................. A Filtered speech hearing 0.00 0.51 0.51 0.04 0.55 0.55 XXX
test.
92572... .................. A Staggered spondaic word 0.00 0.51 0.51 0.01 0.52 0.52 XXX
test.
92573... .................. A Lombard test............. 0.00 0.51 0.51 0.04 0.55 0.55 XXX
92575... .................. A Sensorineural acuity test 0.00 0.39 0.39 0.03 0.42 0.42 XXX
92576... .................. A Synthetic sentence test.. 0.00 0.51 0.51 0.05 0.56 0.56 XXX
92577... .................. A Stenger test, speech..... 0.00 0.51 0.51 0.08 0.59 0.59 XXX
92579... .................. A Visual audiometry (vra).. 0.00 1.00 1.00 0.07 1.07 1.07 XXX
92582... .................. A Conditioning play 0.00 0.99 0.99 0.07 1.06 1.06 XXX
audiometry.
92583... .................. A Select picture audiometry 0.00 1.23 1.23 0.09 1.32 1.32 XXX
92584... .................. A Electrocochleography..... 0.00 0.72 0.72 0.25 0.97 0.97 XXX
92585... .................. A Auditory evoked potential 0.50 1.82 1.82 0.31 2.63 2.63 XXX
92585... 26 A Auditory evoked potential 0.50 0.21 0.21 0.14 0.85 0.85 XXX
92585... TC A Auditory evoked potential 0.00 1.60 1.60 0.17 1.77 1.77 XXX
92587... .................. A Evoked auditory test..... 0.13 0.54 0.54 0.13 0.80 0.80 XXX
92587... 26 A Evoked auditory test..... 0.13 0.07 0.07 0.01 0.21 0.21 XXX
92587... TC A Evoked auditory test..... 0.00 0.48 0.48 0.12 0.60 0.60 XXX
92588... .................. A Evoked auditory test..... 0.36 0.68 0.68 0.16 1.20 1.20 XXX
92588... 26 A Evoked auditory test..... 0.36 0.23 0.23 0.02 0.61 0.61 XXX
92588... TC A Evoked auditory test..... 0.00 0.45 0.45 0.14 0.59 0.59 XXX
92589... .................. A Auditory function test(s) 0.00 0.76 0.76 0.06 0.82 0.82 XXX
92596... .................. A Ear protector evaluation. 0.00 0.51 0.51 0.06 0.57 0.57 XXX
92597... .................. A Oral speech device eval.. 1.35 1.20 1.10 0.11 2.66 2.56 XXX
92598... .................. A Modify oral speech device 0.99 0.85 0.64 0.07 1.91 1.70 XXX
92950... .................. A Heart/lung resuscitation 3.80 1.37 0.91 0.17 5.34 4.88 000
(CPR).
92953... .................. A Temporary external pacing 0.23 NA 0.18 0.15 NA 0.56 000
92960... .................. A Heart electroconversion.. 2.25 1.54 2.11 0.16 3.95 4.52 000
92970... .................. A Cardioassist, internal... 3.52 NA 2.95 0.41 NA 6.88 000
92971... .................. A Cardioassist, external... 1.77 NA 0.82 0.08 NA 2.67 000
92975... .................. A Dissolve clot, heart 7.25 NA 7.60 0.42 NA 15.27 000
vessel.
92977... .................. A Dissolve clot, heart 0.00 NA 0.05 0.54 NA 0.59 XXX
vessel.
92978... .................. A Intravas us, heart (add- 1.80 NA 3.53 0.36 NA 5.69 ZZZ
on).
92978... 26 A Intravas us, heart (add- 1.80 NA 1.80 0.08 NA 3.68 ZZZ
on).
92978... TC A Intravas us, heart (add- 0.00 NA 1.73 0.28 NA 2.01 ZZZ
on).
92979... .................. A Intravas us, heart (add- 1.44 NA 1.78 0.20 NA 3.42 ZZZ
on).
92979... 26 A Intravas us, heart (add- 1.44 NA 1.44 0.06 NA 2.94 ZZZ
on).
92979... TC A Intravas us, heart (add- 0.00 NA 0.34 0.14 NA 0.48 ZZZ
on).
92980... .................. A Insert intracoronary 14.84 NA 10.01 1.22 NA 26.07 000
stent.
92981... .................. A Insert intracoronary 4.17 NA 2.05 0.44 NA 6.66 ZZZ
stent.
92982... .................. A Coronary artery dilation. 10.98 NA 7.50 1.22 NA 19.70 000
92984... .................. A Coronary artery dilation. 2.97 NA 1.51 0.44 NA 4.92 ZZZ
92986... .................. A Revision of aortic valve. 21.80 NA 11.60 0.90 NA 34.30 090
92987... .................. A Revision of mitral valve. 22.70 NA 12.14 0.91 NA 35.75 090
92990... .................. A Revision of pulmonary 17.34 NA 9.28 0.71 NA 27.33 090
valve.
92995... .................. A Coronary atherectomy..... 12.09 NA 8.11 1.22 NA 21.42 000
92996... .................. A Coronary atherectomy..... 3.26 NA 1.55 0.44 NA 5.25 ZZZ
92997... .................. A Pul art balloon repair, 12.00 NA 17.22 1.22 NA 30.44 000
perc.
92998... .................. A Pul art balloon repair, 6.00 NA 6.16 0.44 NA 12.60 ZZZ
perc.
93000... .................. A Electrocardiogram, 0.17 0.24 0.24 0.04 0.45 0.45 XXX
complete.
93005... .................. A Electrocardiogram, 0.00 0.16 0.16 0.03 0.19 0.19 XXX
tracing.
93010... .................. A Electrocardiogram report. 0.17 0.07 0.07 0.01 0.25 0.25 XXX
93012... .................. A Transmission of ecg...... 0.00 0.27 0.27 0.22 0.49 0.49 XXX
93014... .................. A Report on transmitted ecg 0.52 0.24 0.24 0.05 0.81 0.81 XXX
93015... .................. A Cardiovascular stress 0.75 1.86 1.86 0.18 2.79 2.79 XXX
test.
93016... .................. A Cardiovascular stress 0.45 0.19 0.19 0.03 0.67 0.67 XXX
test.
93017... .................. A Cardiovascular stress 0.00 1.40 1.40 0.12 1.52 1.52 XXX
test.
93018... .................. A Cardiovascular stress 0.30 0.13 0.13 0.03 0.46 0.46 XXX
test.
93024... .................. A Cardiac drug stress test. 1.17 1.38 1.38 0.23 2.78 2.78 XXX
93024... 26 A Cardiac drug stress test. 1.17 0.58 0.58 0.14 1.89 1.89 XXX
93024... TC A Cardiac drug stress test. 0.00 0.80 0.80 0.09 0.89 0.89 XXX
[[Page 30997]]
93040... .................. A Rhythm ECG with report... 0.16 0.25 0.25 0.02 0.43 0.43 XXX
93041... .................. A Rhythm ECG, tracing...... 0.00 0.04 0.04 0.01 0.05 0.05 XXX
93042... .................. A Rhythm ECG, report....... 0.16 0.04 0.04 0.01 0.21 0.21 XXX
93224... .................. A ECG monitor/report, 24 0.52 0.54 0.54 0.31 1.37 1.37 XXX
hrs.
93225... .................. A ECG monitor/record, 24 0.00 0.09 0.09 0.09 0.18 0.18 XXX
hrs.
93226... .................. A ECG monitor/report, 24 0.00 0.25 0.25 0.16 0.41 0.41 XXX
hrs.
93227... .................. A ECG monitor/review, 24 0.52 0.22 0.22 0.06 0.80 0.80 XXX
hrs.
93230... .................. A ECG monitor/report, 24 0.52 0.51 0.51 0.34 1.37 1.37 XXX
hrs.
93231... .................. A Ecg monitor/record, 24 0.00 0.09 0.09 0.11 0.20 0.20 XXX
hrs.
93232... .................. A ECG monitor/report, 24 0.00 0.25 0.25 0.15 0.40 0.40 XXX
hrs.
93233... .................. A ECG monitor/review, 24 0.52 0.22 0.22 0.08 0.82 0.82 XXX
hrs.
93235... .................. A ECG monitor/report, 24 0.45 0.41 0.41 0.23 1.09 1.09 XXX
hrs.
93236... .................. A ECG monitor/report, 24 0.00 0.26 0.26 0.17 0.43 0.43 XXX
hrs.
93237... .................. A ECG monitor/review, 24 0.45 0.18 0.18 0.06 0.69 0.69 XXX
hrs.
93268... .................. A ECG record/review........ 0.52 0.66 0.66 0.36 1.54 1.54 XXX
93270... .................. A ECG recording............ 0.00 0.14 0.14 0.09 0.23 0.23 XXX
93271... .................. A Ecg/monitoring and 0.00 0.27 0.27 0.22 0.49 0.49 XXX
anaylysis.
93272... .................. A Ecg/review, interpret 0.52 0.23 0.23 0.05 0.80 0.80 XXX
only.
93278... .................. A ECG/signal-averaged...... 0.25 0.37 0.37 0.18 0.80 0.80 XXX
93278... 26 A ECG/signal-averaged...... 0.25 0.12 0.12 0.06 0.43 0.43 XXX
93278... TC A ECG/signal-averaged...... 0.00 0.24 0.24 0.12 0.36 0.36 XXX
93303... .................. A Echo transthoracic....... 1.30 2.23 2.23 0.36 3.89 3.89 XXX
93303... 26 A Echo transthoracic....... 1.30 0.63 0.63 0.09 2.02 2.02 XXX
93303... TC A Echo transthoracic....... 0.00 1.60 1.60 0.27 1.87 1.87 XXX
93304... .................. A Echo transthoracic....... 0.75 1.83 1.83 0.19 2.77 2.77 XXX
93304... 26 A Echo transthoracic....... 0.75 0.33 0.33 0.05 1.13 1.13 XXX
93304... TC A Echo transthoracic....... 0.00 1.50 1.50 0.14 1.64 1.64 XXX
93307... .................. A Echo exam of heart....... 0.92 1.65 1.65 0.36 2.93 2.93 XXX
93307... 26 A Echo exam of heart....... 0.92 0.47 0.47 0.09 1.48 1.48 XXX
93307... TC A Echo exam of heart....... 0.00 1.18 1.18 0.27 1.45 1.45 XXX
93308... .................. A Echo exam of heart....... 0.53 1.53 1.53 0.19 2.25 2.25 XXX
93308... 26 A Echo exam of heart....... 0.53 0.22 0.22 0.05 0.80 0.80 XXX
93308... TC A Echo exam of heart....... 0.00 1.31 1.31 0.14 1.45 1.45 XXX
93312... .................. A Echo transesophageal..... 2.20 6.02 6.02 0.45 8.67 8.67 XXX
93312... 26 A Echo transesophageal..... 2.20 0.84 0.84 0.12 3.16 3.16 XXX
93312... TC A Echo transesophageal..... 0.00 5.18 5.18 0.33 5.51 5.51 XXX
93313... .................. A Echo transesophageal..... 0.95 4.58 0.45 0.06 5.59 1.46 XXX
93314... .................. A Echo transesophageal..... 1.25 4.32 4.32 0.39 5.96 5.96 XXX
93314... 26 A Echo transesophageal..... 1.25 0.60 0.60 0.06 1.91 1.91 XXX
93314... TC A Echo transesophageal..... 0.00 3.72 3.72 0.33 4.05 4.05 XXX
93315... .................. A Echo transesophageal..... 2.78 7.36 7.36 0.45 10.59 10.59 XXX
93315... 26 A Echo transesophageal..... 2.78 1.30 1.30 0.12 4.20 4.20 XXX
93315... TC A Echo transesophageal..... 0.00 6.06 6.06 0.33 6.39 6.39 XXX
93316... .................. A Echo transesophageal..... 0.95 0.79 0.46 0.06 1.80 1.47 XXX
93317... .................. A Echo transesophageal..... 1.83 1.64 1.64 0.39 3.86 3.86 XXX
93317... 26 A Echo transesophageal..... 1.83 0.68 0.68 0.06 2.57 2.57 XXX
93317... TC A Echo transesophageal..... 0.00 0.96 0.96 0.33 1.29 1.29 XXX
93320... .................. A Doppler echo exam, heart. 0.38 0.81 0.81 0.18 1.37 1.37 ZZZ
93320... 26 A Doppler echo exam, heart. 0.38 0.21 0.21 0.05 0.64 0.64 ZZZ
93320... TC A Doppler echo exam, heart. 0.00 0.60 0.60 0.13 0.73 0.73 ZZZ
93321... .................. A Doppler echo exam, heart. 0.15 0.58 0.58 0.11 0.84 0.84 ZZZ
93321... 26 A Doppler echo exam, heart. 0.15 0.08 0.08 0.02 0.25 0.25 ZZZ
93321... TC A Doppler echo exam, heart. 0.00 0.50 0.50 0.09 0.59 0.59 ZZZ
93325... .................. A Doppler color flow....... 0.07 0.39 0.39 0.25 0.71 0.71 ZZZ
93325... 26 A Doppler color flow....... 0.07 0.04 0.04 0.01 0.12 0.12 ZZZ
93325... TC A Doppler color flow....... 0.00 0.35 0.35 0.24 0.59 0.59 ZZZ
93350... .................. A Echo transthoracic....... 0.78 7.46 7.46 0.24 8.48 8.48 XXX
93350... 26 A Echo transthoracic....... 0.78 0.43 0.43 0.10 1.31 1.31 XXX
93350... TC A Echo transthoracic....... 0.00 7.04 7.04 0.14 7.18 7.18 XXX
93501... .................. A Right heart 3.02 17.41 17.41 1.54 21.97 21.97 000
catheterization.
93501... 26 A Right heart 3.02 1.27 1.27 0.34 4.63 4.63 000
catheterization.
93501... TC A Right heart 0.00 16.13 16.13 1.20 17.33 17.33 000
catheterization.
93503... .................. A Insert/place heart 2.91 1.14 0.72 0.36 4.41 3.99 000
catheter.
93505... .................. A Biopsy of heart lining... 4.38 3.83 3.83 0.46 8.67 8.67 000
93505... 26 A Biopsy of heart lining... 4.38 1.94 1.94 0.28 6.60 6.60 000
93505... TC A Biopsy of heart lining... 0.00 1.89 1.89 0.18 2.07 2.07 000
93508... .................. A Cath placement, 4.10 16.13 16.13 0.98 21.21 21.21 000
angiography.
93508... 26 A Cath placement, 4.10 4.11 4.11 0.23 8.44 8.44 000
angiography.
93508... TC A Cath placement, 0.00 12.03 12.03 0.75 12.78 12.78 000
angiography.
93510... .................. A Left heart 4.33 37.21 37.21 2.86 44.40 44.40 000
catheterization.
93510... 26 A Left heart 4.33 1.94 1.94 0.23 6.50 6.50 000
catheterization.
93510... TC A Left heart 0.00 35.27 35.27 2.63 37.90 37.90 000
catheterization.
93511... .................. A Left heart 5.03 36.62 36.62 2.76 44.41 44.41 000
catheterization.
93511... 26 A Left heart 5.03 2.28 2.28 0.20 7.51 7.51 000
catheterization.
[[Page 30998]]
93511... TC A Left heart 0.00 34.34 34.34 2.56 36.90 36.90 000
catheterization.
93514... .................. A Left heart 7.05 37.51 37.51 2.94 47.50 47.50 000
catheterization.
93514... 26 A Left heart 7.05 3.17 3.17 0.38 10.60 10.60 000
catheterization.
93514... TC A Left heart 0.00 34.34 34.34 2.56 36.90 36.90 000
catheterization.
93524... .................. A Left heart 6.95 48.01 48.01 3.69 58.65 58.65 000
catheterization.
93524... 26 A Left heart 6.95 3.15 3.15 0.34 10.44 10.44 000
catheterization.
93524... TC A Left heart 0.00 44.86 44.86 3.35 48.21 48.21 000
catheterization.
93526... .................. A Rt & Lt heart catheters.. 5.99 48.77 48.77 3.83 58.59 58.59 000
93526... 26 A Rt & Lt heart catheters.. 5.99 2.67 2.67 0.39 9.05 9.05 000
93526... TC A Rt & Lt heart catheters.. 0.00 46.10 46.10 3.44 49.54 49.54 000
93527... .................. A Rt & Lt heart catheters.. 7.28 48.10 48.10 3.85 59.23 59.23 000
93527... 26 A Rt & Lt heart catheters.. 7.28 3.23 3.23 0.50 11.01 11.01 000
93527... TC A Rt & Lt heart catheters.. 0.00 44.86 44.86 3.35 48.21 48.21 000
93528... .................. A Rt & Lt heart catheters.. 9.00 48.89 48.89 3.68 61.57 61.57 000
93528... 26 A Rt & Lt heart catheters.. 9.00 4.02 4.02 0.33 13.35 13.35 000
93528... TC A Rt & Lt heart catheters.. 0.00 44.86 44.86 3.35 48.21 48.21 000
93529... .................. A Rt, Lt heart 4.80 46.95 46.95 3.57 55.32 55.32 000
catheterization.
93529... 26 A Rt, Lt heart 4.80 2.09 2.09 0.22 7.11 7.11 000
catheterization.
93529... TC A Rt, Lt heart 0.00 44.86 44.86 3.35 48.21 48.21 000
catheterization.
93530... .................. A Rt heart cath, congenital 4.23 17.84 17.84 1.54 23.61 23.61 000
93530... 26 A Rt heart cath, congenital 4.23 1.70 1.70 0.34 6.27 6.27 000
93530... TC A Rt heart cath, congenital 0.00 16.13 16.13 1.20 17.33 17.33 000
93531... .................. A R & l heart cath, 8.35 49.83 49.83 3.83 62.01 62.01 000
congenital.
93531... 26 A R & l heart cath, 8.35 3.73 3.73 0.39 12.47 12.47 000
congenital.
93531... TC A R & l heart cath, 0.00 46.10 46.10 3.44 49.54 49.54 000
congenital.
93532... .................. A R & l heart cath, 10.00 49.02 49.02 3.85 62.87 62.87 000
congenital.
93532... 26 A R & l heart cath, 10.00 4.15 4.15 0.50 14.65 14.65 000
congenital.
93532... TC A R & l heart cath, 0.00 44.86 44.86 3.35 48.21 48.21 000
congenital.
93533... .................. A R & l heart cath, 6.70 47.27 47.27 3.57 57.54 57.54 000
congenital.
93533... 26 A R & l heart cath, 6.70 2.40 2.40 0.22 9.32 9.32 000
congenital.
93533... TC A R & l heart cath, 0.00 44.86 44.86 3.35 48.21 48.21 000
congenital.
93536... .................. A Insert circulation assi.. 4.85 NA 3.18 0.71 NA 8.74 000
93539... .................. A Injection, cardiac cath.. 0.40 0.19 0.52 0.20 0.79 1.12 000
93540... .................. A Injection, cardiac cath.. 0.43 0.20 0.53 0.20 0.83 1.16 000
93541... .................. A Injection for lung 0.29 NA 0.21 0.16 NA 0.66 000
angiogram.
93542... .................. A Injection for heart x- 0.29 NA 0.34 0.16 NA 0.79 000
rays.
93543... .................. A Injection for heart x- 0.29 0.35 0.55 0.11 0.75 0.95 000
rays.
93544... .................. A Injection for aortography 0.25 0.11 0.32 0.11 0.47 0.68 000
93545... .................. A Injection for coronary 0.40 0.53 0.85 0.24 1.17 1.49 000
xrays.
93555... .................. A Imaging, cardiac cath.... 0.81 6.35 6.35 0.42 7.58 7.58 XXX
93555... 26 A Imaging, cardiac cath.... 0.81 0.36 0.36 0.04 1.21 1.21 XXX
93555... TC A Imaging, cardiac cath.... 0.00 5.99 5.99 0.38 6.37 6.37 XXX
93556... .................. A Imaging, cardiac cath.... 0.83 9.81 9.81 0.65 11.29 11.29 XXX
93556... 26 A Imaging, cardiac cath.... 0.83 0.37 0.37 0.07 1.27 1.27 XXX
93556... TC A Imaging, cardiac cath.... 0.00 9.44 9.44 0.58 10.02 10.02 XXX
93561... .................. A Cardiac output 0.50 0.64 0.64 0.16 1.30 1.30 000
measurement.
93561... 26 A Cardiac output 0.50 0.14 0.14 0.09 0.73 0.73 000
measurement.
93561... TC A Cardiac output 0.00 0.50 0.50 0.07 0.57 0.57 000
measurement.
93562... .................. A Cardiac output 0.16 0.35 0.35 0.10 0.61 0.61 000
measurement.
93562... 26 A Cardiac output 0.16 0.05 0.05 0.06 0.27 0.27 000
measurement.
93562... TC A Cardiac output 0.00 0.30 0.30 0.04 0.34 0.34 000
measurement.
93600... .................. A Bundle of His recording.. 2.12 2.18 2.18 0.38 4.68 4.68 000
93600... 26 A Bundle of His recording.. 2.12 0.86 0.86 0.24 3.22 3.22 000
93600... TC A Bundle of His recording.. 0.00 1.32 1.32 0.14 1.46 1.46 000
93602... .................. A Intra-atrial recording... 2.12 2.39 2.39 0.22 4.73 4.73 000
93602... 26 A Intra-atrial recording... 2.12 0.94 0.94 0.14 3.20 3.20 000
93602... TC A Intra-atrial recording... 0.00 1.45 1.45 0.08 1.53 1.53 000
93603... .................. A Right ventricular 2.12 1.75 1.75 0.28 4.15 4.15 000
recording.
93603... 26 A Right ventricular 2.12 0.68 0.68 0.16 2.96 2.96 000
recording.
93603... TC A Right ventricular 0.00 1.07 1.07 0.12 1.19 1.19 000
recording.
93607... .................. A Right ventricular 3.26 2.86 2.86 0.28 6.40 6.40 000
recording.
93607... 26 A Right ventricular 3.26 1.42 1.42 0.17 4.85 4.85 000
recording.
93607... TC A Right ventricular 0.00 1.44 1.44 0.11 1.55 1.55 000
recording.
93609... .................. A Mapping of tachycardia... 10.07 8.41 8.41 0.47 18.95 18.95 000
93609... 26 A Mapping of tachycardia... 10.07 4.37 4.37 0.28 14.72 14.72 000
93609... TC A Mapping of tachycardia... 0.00 4.04 4.04 0.19 4.23 4.23 000
93610... .................. A Intra-atrial pacing...... 3.02 3.91 3.91 0.27 7.20 7.20 000
93610... 26 A Intra-atrial pacing...... 3.02 1.31 1.31 0.17 4.50 4.50 000
93610... TC A Intra-atrial pacing...... 0.00 2.60 2.60 0.10 2.70 2.70 000
93612... .................. A Intraventricular pacing.. 3.02 4.00 4.00 0.29 7.31 7.31 000
93612... 26 A Intraventricular pacing.. 3.02 1.35 1.35 0.17 4.54 4.54 000
93612... TC A Intraventricular pacing.. 0.00 2.65 2.65 0.12 2.77 2.77 000
93615... .................. A Esophageal recording..... 0.99 0.98 0.98 0.04 2.01 2.01 000
93615... 26 A Esophageal recording..... 0.99 0.20 0.20 0.02 1.21 1.21 000
[[Page 30999]]
93615... TC A Esophageal recording..... 0.00 0.78 0.78 0.02 0.80 0.80 000
93616... .................. A Esophageal recording..... 1.49 1.25 1.25 0.10 2.84 2.84 000
93616... 26 A Esophageal recording..... 1.49 0.43 0.43 0.08 2.00 2.00 000
93616... TC A Esophageal recording..... 0.00 0.82 0.82 0.02 0.84 0.84 000
93618... .................. A Heart rhythm pacing...... 4.26 3.90 3.90 0.72 8.88 8.88 000
93618... 26 A Heart rhythm pacing...... 4.26 1.87 1.87 0.44 6.57 6.57 000
93618... TC A Heart rhythm pacing...... 0.00 2.03 2.03 0.28 2.31 2.31 000
93619... .................. A Electrophysiology 7.32 6.28 6.28 1.40 15.00 15.00 000
evaluation.
93619... 26 A Electrophysiology 7.32 3.24 3.24 0.86 11.42 11.42 000
evaluation.
93619... TC A Electrophysiology 0.00 3.05 3.05 0.54 3.59 3.59 000
evaluation.
93620... .................. A Electrophysiology 11.59 6.65 6.65 1.55 19.79 19.79 000
evaluation.
93620... 26 A Electrophysiology 11.59 5.10 5.10 0.95 17.64 17.64 000
evaluation.
93620... TC A Electrophysiology 0.00 1.55 1.55 0.60 2.15 2.15 000
evaluation.
93621... 26 A Electrophysiology 12.66 5.66 5.66 1.11 19.43 19.43 000
evaluation.
93622... 26 A Electrophysiology 12.74 5.71 5.71 1.07 19.52 19.52 000
evaluation.
93623... 26 A Stimulation, pacing heart 2.85 1.27 1.27 0.20 4.32 4.32 000
93624... .................. A Electrophysiologic study. 4.81 4.05 4.05 0.35 9.21 9.21 000
93624... 26 A Electrophysiologic study. 4.81 2.06 2.06 0.21 7.08 7.08 000
93624... TC A Electrophysiologic study. 0.00 1.99 1.99 0.14 2.13 2.13 000
93631... .................. A Heart pacing, mapping.... 7.60 4.14 4.14 1.37 13.11 13.11 000
93631... 26 A Heart pacing, mapping.... 7.60 3.35 3.35 0.67 11.62 11.62 000
93631... TC A Heart pacing, mapping.... 0.00 0.78 0.78 0.70 1.48 1.48 000
93640... .................. A Evaluation heart device.. 3.52 3.38 3.38 1.09 7.99 7.99 000
93640... 26 A Evaluation heart device.. 3.52 1.58 1.58 0.61 5.71 5.71 000
93640... TC A Evaluation heart device.. 0.00 1.80 1.80 0.48 2.28 2.28 000
93641... .................. A Electrophysiology 5.93 5.93 5.93 1.09 12.95 12.95 000
evaluation.
93641... 26 A Electrophysiology 5.93 2.64 2.64 0.61 9.18 9.18 000
evaluation.
93641... TC A Electrophysiology 0.00 3.30 3.30 0.48 3.78 3.78 000
evaluation.
93642... .................. A Electrophysiology 4.89 3.97 3.97 1.09 9.95 9.95 000
evaluation.
93642... 26 A Electrophysiology 4.89 2.17 2.17 0.61 7.67 7.67 000
evaluation.
93642... TC A Electrophysiology 0.00 1.80 1.80 0.48 2.28 2.28 000
evaluation.
93650... .................. A Ablate heart dysrhythm 10.51 NA 6.17 1.34 NA 18.02 000
focus.
93651... .................. A Ablate heart dysrhythm 16.25 NA 10.49 1.34 NA 28.08 000
focus.
93652... .................. A Ablate heart dysrhythm 17.68 NA 10.98 1.34 NA 30.00 000
focus.
93660... 26 A Tilt table evaluation.... 1.89 0.84 0.84 0.17 2.90 2.90 000
93720... .................. A Total body 0.17 0.55 0.55 0.10 0.82 0.82 XXX
plethysmography.
93721... .................. A Plethysmography tracing.. 0.00 0.55 0.55 0.07 0.62 0.62 XXX
93722... .................. A Plethysmography report... 0.17 0.05 0.05 0.03 0.25 0.25 XXX
93724... .................. A Analyze pacemaker system. 4.89 2.85 2.85 0.50 8.24 8.24 000
93724... 26 A Analyze pacemaker system. 4.89 2.14 2.14 0.22 7.25 7.25 000
93724... TC A Analyze pacemaker system. 0.00 0.71 0.71 0.28 0.99 0.99 000
93731... .................. A Analyze pacemaker system. 0.45 0.59 0.59 0.07 1.11 1.11 XXX
93731... 26 A Analyze pacemaker system. 0.45 0.21 0.21 0.03 0.69 0.69 XXX
93731... TC A Analyze pacemaker system. 0.00 0.38 0.38 0.04 0.42 0.42 XXX
93732... .................. A Analyze pacemaker system. 0.92 0.85 0.85 0.08 1.85 1.85 XXX
93732... 26 A Analyze pacemaker system. 0.92 0.42 0.42 0.04 1.38 1.38 XXX
93732... TC A Analyze pacemaker system. 0.00 0.44 0.44 0.04 0.48 0.48 XXX
93733... .................. A Telephone analysis, 0.17 0.21 0.21 0.08 0.46 0.46 XXX
pacemaker.
93733... 26 A Telephone analysis, 0.17 0.09 0.09 0.02 0.28 0.28 XXX
pacemaker.
93733... TC A Telephone analysis, 0.00 0.11 0.11 0.06 0.17 0.17 XXX
pacemaker.
93734... .................. A Analyze pacemaker system. 0.38 0.50 0.50 0.06 0.94 0.94 XXX
93734... 26 A Analyze pacemaker system. 0.38 0.18 0.18 0.03 0.59 0.59 XXX
93734... TC A Analyze pacemaker system. 0.00 0.32 0.32 0.03 0.35 0.35 XXX
93735... .................. A Analyze pacemaker system. 0.74 0.68 0.68 0.08 1.50 1.50 XXX
93735... 26 A Analyze pacemaker system. 0.74 0.33 0.33 0.04 1.11 1.11 XXX
93735... TC A Analyze pacemaker system. 0.00 0.35 0.35 0.04 0.39 0.39 XXX
93736... .................. A Telephone analysis, 0.15 0.20 0.20 0.09 0.44 0.44 XXX
pacemaker.
93736... 26 A Telephone analysis, 0.15 0.09 0.09 0.03 0.27 0.27 XXX
pacemaker.
93736... TC A Telephone analysis, 0.00 0.11 0.11 0.06 0.17 0.17 XXX
pacemaker.
93737... .................. A Analyze cardio/ 0.45 0.60 0.60 0.06 1.11 1.11 XXX
defibrillator.
93737... 26 A Analyze cardio/ 0.45 0.21 0.21 0.02 0.68 0.68 XXX
defibrillator.
93737... TC A Analyze cardio/ 0.00 0.39 0.39 0.04 0.43 0.43 XXX
defibrillator.
93738... .................. A Analyze cardio/ 0.92 0.86 0.86 0.07 1.85 1.85 XXX
defibrillator.
93738... 26 A Analyze cardio/ 0.92 0.43 0.43 0.03 1.38 1.38 XXX
defibrillator.
93738... TC A Analyze cardio/ 0.00 0.43 0.43 0.04 0.47 0.47 XXX
defibrillator.
93740... .................. A Temperature gradient 0.16 0.49 0.49 0.04 0.69 0.69 XXX
studies.
93740... 26 A Temperature gradient 0.16 0.03 0.03 0.03 0.22 0.22 XXX
studies.
93740... TC A Temperature gradient 0.00 0.46 0.46 0.01 0.47 0.47 XXX
studies.
93770... .................. A Measure venous pressure.. 0.16 0.52 0.52 0.02 0.70 0.70 XXX
93770... 26 A Measure venous pressure.. 0.16 0.09 0.09 0.02 0.27 0.27 XXX
93770... TC A Measure venous pressure.. 0.00 0.43 0.43 0.00 0.43 0.43 XXX
93797... .................. A Cardiac rehab............ 0.18 0.27 0.08 0.02 0.47 0.28 000
93798... .................. A Cardiac rehab/monitor.... 0.28 0.41 0.12 0.04 0.73 0.44 000
93875... .................. A Extracranial study....... 0.22 0.95 0.95 0.18 1.35 1.35 XXX
[[Page 31000]]
93875... 26 A Extracranial study....... 0.22 0.11 0.11 0.06 0.39 0.39 XXX
93875... TC A Extracranial study....... 0.00 0.84 0.84 0.12 0.96 0.96 XXX
93880... .................. A Extracranial study....... 0.60 2.31 2.31 0.44 3.35 3.35 XXX
93880... 26 A Extracranial study....... 0.60 0.26 0.26 0.04 0.90 0.90 XXX
93880... TC A Extracranial study....... 0.00 2.05 2.05 0.40 2.45 2.45 XXX
93882... .................. A Extracranial study....... 0.40 2.02 2.02 0.29 2.71 2.71 XXX
93882... 26 A Extracranial study....... 0.40 0.20 0.20 0.03 0.63 0.63 XXX
93882... TC A Extracranial study....... 0.00 1.82 1.82 0.26 2.08 2.08 XXX
93886... .................. A Intracranial study....... 0.94 2.55 2.55 0.50 3.99 3.99 XXX
93886... 26 A Intracranial study....... 0.94 0.45 0.45 0.05 1.44 1.44 XXX
93886... TC A Intracranial study....... 0.00 2.10 2.10 0.45 2.55 2.55 XXX
93888... .................. A Intracranial study....... 0.62 1.85 1.85 0.34 2.81 2.81 XXX
93888... 26 A Intracranial study....... 0.62 0.26 0.26 0.03 0.91 0.91 XXX
93888... TC A Intracranial study....... 0.00 1.60 1.60 0.31 1.91 1.91 XXX
93922... .................. A Extremity study.......... 0.25 1.22 1.22 0.19 1.66 1.66 XXX
93922... 26 A Extremity study.......... 0.25 0.12 0.12 0.05 0.42 0.42 XXX
93922... TC A Extremity study.......... 0.00 1.10 1.10 0.14 1.24 1.24 XXX
93923... .................. A Extremity study.......... 0.45 1.50 1.50 0.35 2.30 2.30 XXX
93923... 26 A Extremity study.......... 0.45 0.25 0.25 0.09 0.79 0.79 XXX
93923... TC A Extremity study.......... 0.00 1.25 1.25 0.26 1.51 1.51 XXX
93924... .................. A Extremity study.......... 0.50 2.30 2.30 0.39 3.19 3.19 XXX
93924... 26 A Extremity study.......... 0.50 0.20 0.20 0.10 0.80 0.80 XXX
93924... TC A Extremity study.......... 0.00 2.10 2.10 0.29 2.39 2.39 XXX
93925... .................. A Lower extremity study.... 0.58 2.47 2.47 0.44 3.49 3.49 XXX
93925... 26 A Lower extremity study.... 0.58 0.29 0.29 0.04 0.91 0.91 XXX
93925... TC A Lower extremity study.... 0.00 2.18 2.18 0.40 2.58 2.58 XXX
93926... .................. A Lower extremity study.... 0.39 1.86 1.86 0.30 2.55 2.55 XXX
93926... 26 A Lower extremity study.... 0.39 0.15 0.15 0.03 0.57 0.57 XXX
93926... TC A Lower extremity study.... 0.00 1.72 1.72 0.27 1.99 1.99 XXX
93930... .................. A Upper extremity study.... 0.46 2.31 2.31 0.47 3.24 3.24 XXX
93930... 26 A Upper extremity study.... 0.46 0.24 0.24 0.05 0.75 0.75 XXX
93930... TC A Upper extremity study.... 0.00 2.07 2.07 0.42 2.49 2.49 XXX
93931... .................. A Upper extremity study.... 0.31 1.56 1.56 0.31 2.18 2.18 XXX
93931... 26 A Upper extremity study.... 0.31 0.16 0.16 0.03 0.50 0.50 XXX
93931... TC A Upper extremity study.... 0.00 1.40 1.40 0.28 1.68 1.68 XXX
93965... .................. A Extremity study.......... 0.35 1.05 1.05 0.19 1.59 1.59 XXX
93965... 26 A Extremity study.......... 0.35 0.16 0.16 0.06 0.57 0.57 XXX
93965... TC A Extremity study.......... 0.00 0.88 0.88 0.13 1.01 1.01 XXX
93970... .................. A Extremity study.......... 0.68 2.30 2.30 0.51 3.49 3.49 XXX
93970... 26 A Extremity study.......... 0.68 0.30 0.30 0.05 1.03 1.03 XXX
93970... TC A Extremity study.......... 0.00 2.01 2.01 0.46 2.47 2.47 XXX
93971... .................. A Extremity study.......... 0.45 1.57 1.57 0.34 2.36 2.36 XXX
93971... 26 A Extremity study.......... 0.45 0.18 0.18 0.03 0.66 0.66 XXX
93971... TC A Extremity study.......... 0.00 1.39 1.39 0.31 1.70 1.70 XXX
93975... .................. A Vascular study........... 1.80 3.03 3.03 0.55 5.38 5.38 XXX
93975... 26 A Vascular study........... 1.80 0.69 0.69 0.05 2.54 2.54 XXX
93975... TC A Vascular study........... 0.00 2.34 2.34 0.50 2.84 2.84 XXX
93976... .................. A Vascular study........... 1.21 1.94 1.94 0.37 3.52 3.52 XXX
93976... 26 A Vascular study........... 1.21 0.43 0.43 0.03 1.67 1.67 XXX
93976... TC A Vascular study........... 0.00 1.52 1.52 0.34 1.86 1.86 XXX
93978... .................. A Vascular study........... 0.65 2.62 2.62 0.47 3.74 3.74 XXX
93978... 26 A Vascular study........... 0.65 0.35 0.35 0.05 1.05 1.05 XXX
93978... TC A Vascular study........... 0.00 2.28 2.28 0.42 2.70 2.70 XXX
93979... .................. A Vascular study........... 0.44 1.69 1.69 0.31 2.44 2.44 XXX
93979... 26 A Vascular study........... 0.44 0.25 0.25 0.03 0.72 0.72 XXX
93979... TC A Vascular study........... 0.00 1.44 1.44 0.28 1.72 1.72 XXX
93980... .................. A Penile vascular study.... 1.25 2.84 2.84 0.45 4.54 4.54 XXX
93980... 26 A Penile vascular study.... 1.25 0.67 0.67 0.07 1.99 1.99 XXX
93980... TC A Penile vascular study.... 0.00 2.17 2.17 0.38 2.55 2.55 XXX
93981... .................. A Penile vascular study.... 0.44 2.27 2.27 0.39 3.10 3.10 XXX
93981... 26 A Penile vascular study.... 0.44 0.15 0.15 0.03 0.62 0.62 XXX
93981... TC A Penile vascular study.... 0.00 2.12 2.12 0.36 2.48 2.48 XXX
93990... .................. A Doppler flow testing..... 0.25 1.60 1.60 0.29 2.14 2.14 XXX
93990... 26 A Doppler flow testing..... 0.25 0.15 0.15 0.02 0.42 0.42 XXX
93990... TC A Doppler flow testing..... 0.00 1.45 1.45 0.27 1.72 1.72 XXX
94010... .................. A Breathing capacity test.. 0.17 0.45 0.45 0.05 0.67 0.67 XXX
94010... 26 A Breathing capacity test.. 0.17 0.06 0.06 0.02 0.25 0.25 XXX
94010... TC A Breathing capacity test.. 0.00 0.39 0.39 0.03 0.42 0.42 XXX
94060... .................. A Evaluation of wheezing... 0.31 0.58 0.58 0.09 0.98 0.98 XXX
94060... 26 A Evaluation of wheezing... 0.31 0.09 0.09 0.03 0.43 0.43 XXX
94060... TC A Evaluation of wheezing... 0.00 0.49 0.49 0.06 0.55 0.55 XXX
94070... .................. A Evaluation of wheezing... 0.60 2.56 2.56 0.13 3.29 3.29 XXX
94070... 26 A Evaluation of wheezing... 0.60 0.18 0.18 0.03 0.81 0.81 XXX
94070... TC A Evaluation of wheezing... 0.00 2.38 2.38 0.10 2.48 2.48 XXX
[[Page 31001]]
94150... .................. B Vital capacity test...... +0.07 0.88 0.88 0.02 0.97 0.97 XXX
94150... 26 B Vital capacity test...... +0.07 0.07 0.07 0.01 0.15 0.15 XXX
94150... TC B Vital capacity test...... +0.00 0.81 0.81 0.01 0.82 0.82 XXX
94200... .................. A Lung function test (MBC/ 0.11 0.40 0.40 0.03 0.54 0.54 XXX
MVV).
94200... 26 A Lung function test (MBC/ 0.11 0.03 0.03 0.01 0.15 0.15 XXX
MVV).
94200... TC A Lung function test (MBC/ 0.00 0.37 0.37 0.02 0.39 0.39 XXX
MVV).
94240... .................. A Residual lung capacity... 0.26 1.31 1.31 0.07 1.64 1.64 XXX
94240... 26 A Residual lung capacity... 0.26 0.08 0.08 0.02 0.36 0.36 XXX
94240... TC A Residual lung capacity... 0.00 1.23 1.23 0.05 1.28 1.28 XXX
94250... .................. A Expired gas collection... 0.11 0.41 0.41 0.02 0.54 0.54 XXX
94250... 26 A Expired gas collection... 0.11 0.03 0.03 0.01 0.15 0.15 XXX
94250... TC A Expired gas collection... 0.00 0.37 0.37 0.01 0.38 0.38 XXX
94260... .................. A Thoracic gas volume...... 0.13 0.31 0.31 0.06 0.50 0.50 XXX
94260... 26 A Thoracic gas volume...... 0.13 0.04 0.04 0.02 0.19 0.19 XXX
94260... TC A Thoracic gas volume...... 0.00 0.28 0.28 0.04 0.32 0.32 XXX
94350... .................. A Lung nitrogen washout 0.26 1.37 1.37 0.05 1.68 1.68 XXX
curve.
94350... 26 A Lung nitrogen washout 0.26 0.08 0.08 0.01 0.35 0.35 XXX
curve.
94350... TC A Lung nitrogen washout 0.00 1.29 1.29 0.04 1.33 1.33 XXX
curve.
94360... .................. A Measure airflow 0.26 0.39 0.39 0.07 0.72 0.72 XXX
resistance.
94360... 26 A Measure airflow 0.26 0.08 0.08 0.01 0.35 0.35 XXX
resistance.
94360... TC A Measure airflow 0.00 0.31 0.31 0.06 0.37 0.37 XXX
resistance.
94370... .................. A Breath airway closing 0.26 1.58 1.58 0.03 1.87 1.87 XXX
volume.
94370... 26 A Breath airway closing 0.26 0.09 0.09 0.01 0.36 0.36 XXX
volume.
94370... TC A Breath airway closing 0.00 1.49 1.49 0.02 1.51 1.51 XXX
volume.
94375... .................. A Respiratory flow volume 0.31 0.48 0.48 0.04 0.83 0.83 XXX
loop.
94375... 26 A Respiratory flow volume 0.31 0.10 0.10 0.01 0.42 0.42 XXX
loop.
94375... TC A Respiratory flow volume 0.00 0.38 0.38 0.03 0.41 0.41 XXX
loop.
94400... .................. A CO2 breathing response 0.40 0.62 0.62 0.19 1.21 1.21 XXX
curve.
94400... 26 A CO2 breathing response 0.40 0.13 0.13 0.13 0.66 0.66 XXX
curve.
94400... TC A CO2 breathing response 0.00 0.49 0.49 0.06 0.55 0.55 XXX
curve.
94450... .................. A Hypoxia response curve... 0.40 0.91 0.91 0.05 1.36 1.36 XXX
94450... 26 A Hypoxia response curve... 0.40 0.42 0.42 0.02 0.84 0.84 XXX
94450... TC A Hypoxia response curve... 0.00 0.49 0.49 0.03 0.52 0.52 XXX
94620... .................. A Pulmonary stress testing. 0.88 2.00 2.00 0.15 3.03 3.03 XXX
94620... 26 A Pulmonary stress testing. 0.88 0.30 0.30 0.05 1.23 1.23 XXX
94620... TC A Pulmonary stress testing. 0.00 1.70 1.70 0.10 1.80 1.80 XXX
94640... .................. A Airway inhalation 0.00 0.35 0.02 0.03 0.38 0.05 XXX
treatment.
94650... .................. A Pressure breathing (IPPB) 0.00 0.36 0.02 0.03 0.39 0.05 XXX
94651... .................. A Pressure breathing (IPPB) 0.00 0.36 0.02 0.03 0.39 0.05 XXX
94652... .................. A Pressure breathing (IPPB) 0.00 NA 0.02 0.08 NA 0.10 XXX
94656... .................. A Initial ventilator mgmt.. 1.22 NA 0.37 0.12 NA 1.71 XXX
94657... .................. A Cont. ventilator......... 0.83 NA 0.29 0.05 NA 1.17 XXX
94660... .................. A Pos airway pressure, CPAP 0.76 0.48 0.28 0.06 1.30 1.10 XXX
94662... .................. A Neg pressure 0.76 NA 0.30 0.02 NA 1.08 XXX
ventilation,cnp.
94664... .................. A Aerosol or vapor 0.00 0.27 0.02 0.04 0.31 0.06 XXX
inhalations.
94665... .................. A Aerosol or vapor 0.00 0.31 0.02 0.05 0.36 0.07 XXX
inhalations.
94667... .................. A Chest wall manipulation.. 0.00 0.43 0.02 0.05 0.48 0.07 XXX
94668... .................. A Chest wall manipulation.. 0.00 0.43 0.02 0.03 0.46 0.05 XXX
94680... .................. A Exhaled air analysis: O2. 0.26 1.12 1.12 0.10 1.48 1.48 XXX
94680... 26 A Exhaled air analysis: O2. 0.26 0.06 0.06 0.03 0.35 0.35 XXX
94680... TC A Exhaled air analysis: O2. 0.00 1.05 1.05 0.07 1.12 1.12 XXX
94681... .................. A Exhaled air analysis: 0.20 1.74 1.74 0.17 2.11 2.11 XXX
O2,CO2.
94681... 26 A Exhaled air analysis: 0.20 0.08 0.08 0.04 0.32 0.32 XXX
O2,CO2.
94681... TC A Exhaled air analysis: 0.00 1.66 1.66 0.13 1.79 1.79 XXX
O2,CO2.
94690... .................. A Exhaled air analysis..... 0.07 1.30 1.30 0.04 1.41 1.41 XXX
94690... 26 A Exhaled air analysis..... 0.07 0.03 0.03 0.00 0.10 0.10 XXX
94690... TC A Exhaled air analysis..... 0.00 1.26 1.26 0.04 1.30 1.30 XXX
94720... .................. A Monoxide diffusing 0.26 1.04 1.04 0.08 1.38 1.38 XXX
capacity.
94720... 26 A Monoxide diffusing 0.26 0.07 0.07 0.02 0.35 0.35 XXX
capacity.
94720... TC A Monoxide diffusing 0.00 0.97 0.97 0.06 1.03 1.03 XXX
capacity.
94725... .................. A Membrane diffusion 0.26 1.88 1.88 0.14 2.28 2.28 XXX
capacity.
94725... 26 A Membrane diffusion 0.26 0.09 0.09 0.01 0.36 0.36 XXX
capacity.
94725... TC A Membrane diffusion 0.00 1.79 1.79 0.13 1.92 1.92 XXX
capacity.
94750... .................. A Pulmonary compliance 0.23 2.78 2.78 0.06 3.07 3.07 XXX
study.
94750... 26 A Pulmonary compliance 0.23 0.15 0.15 0.02 0.40 0.40 XXX
study.
94750... TC A Pulmonary compliance 0.00 2.63 2.63 0.04 2.67 2.67 XXX
study.
94760... .................. A Measure blood oxygen 0.00 0.04 0.04 0.02 0.06 0.06 XXX
level.
94761... .................. A Measure blood oxygen 0.00 0.09 0.09 0.06 0.15 0.15 XXX
level.
94762... .................. A Measure blood oxygen 0.00 0.11 0.11 0.10 0.21 0.21 XXX
level.
94770... .................. A Exhaled carbon dioxide 0.15 1.23 1.23 0.11 1.49 1.49 XXX
test.
94770... 26 A Exhaled carbon dioxide 0.15 0.03 0.03 0.03 0.21 0.21 XXX
test.
94770... TC A Exhaled carbon dioxide 0.00 1.20 1.20 0.08 1.28 1.28 XXX
test.
95004... .................. A Allergy skin tests....... 0.00 0.11 0.04 0.01 0.12 0.05 XXX
95010... .................. A Sensitivity skin tests... 0.15 0.22 0.08 0.01 0.38 0.24 XXX
[[Page 31002]]
95015... .................. A Sensitivity skin tests... 0.15 0.25 0.07 0.01 0.41 0.23 XXX
95024... .................. A Allergy skin tests....... 0.00 0.13 0.05 0.01 0.14 0.06 XXX
95027... .................. A Skin end point titration. 0.00 0.17 0.17 0.01 0.18 0.18 XXX
95028... .................. A Allergy skin tests....... 0.00 0.21 0.21 0.01 0.22 0.22 XXX
95044... .................. A Allergy patch tests...... 0.00 0.11 0.04 0.01 0.12 0.05 XXX
95052... .................. A Photo patch test......... 0.00 0.11 0.04 0.01 0.12 0.05 XXX
95056... .................. A Photosensitivity tests... 0.00 0.12 0.04 0.01 0.13 0.05 XXX
95060... .................. A Eye allergy tests........ 0.00 0.48 0.48 0.02 0.50 0.50 XXX
95065... .................. A Nose allergy test........ 0.00 0.33 0.33 0.01 0.34 0.34 XXX
95070... .................. A Bronchial allergy tests.. 0.00 0.06 0.06 0.02 0.08 0.08 XXX
95071... .................. A Bronchial allergy tests.. 0.00 0.13 0.13 0.02 0.15 0.15 XXX
95075... .................. A Ingestion challenge test. 0.95 0.72 0.45 0.02 1.69 1.42 XXX
95078... .................. A Provocative testing...... 0.00 0.10 0.10 0.02 0.12 0.12 XXX
95115... .................. A Immunotherapy, one 0.00 0.28 0.09 0.02 0.30 0.11 000
injection.
95117... .................. A Immunotherapy injections. 0.00 0.25 0.08 0.02 0.27 0.10 000
95144... .................. A Antigen therapy services. 0.06 0.12 0.03 0.01 0.19 0.10 000
95145... .................. A Antigen therapy services. 0.06 0.20 0.03 0.03 0.29 0.12 000
95146... .................. A Antigen therapy services. 0.06 0.14 0.02 0.03 0.23 0.11 000
95147... .................. A Antigen therapy services. 0.06 0.15 0.04 0.03 0.24 0.13 000
95148... .................. A Antigen therapy services. 0.06 0.16 0.04 0.03 0.25 0.13 000
95149... .................. A Antigen therapy services. 0.06 0.21 0.04 0.03 0.30 0.13 000
95165... .................. A Antigen therapy services. 0.06 0.13 0.03 0.01 0.20 0.10 000
95170... .................. A Antigen therapy services. 0.06 0.14 0.03 0.03 0.23 0.12 000
95180... .................. A Rapid desensitization.... 2.01 1.37 1.06 0.01 3.39 3.08 000
95805... .................. A Multiple sleep latency 1.88 6.89 6.89 0.45 9.22 9.22 XXX
test.
95805... 26 A Multiple sleep latency 1.88 0.71 0.71 0.07 2.66 2.66 XXX
test.
95805... TC A Multiple sleep latency 0.00 6.18 6.18 0.38 6.56 6.56 XXX
test.
95806... .................. A Sleep study, unattended.. 1.66 2.84 2.84 0.55 5.05 5.05 XXX
95806... 26 A Sleep study, unattended.. 1.66 0.75 0.75 0.19 2.60 2.60 XXX
95806... TC A Sleep study, unattended.. 0.00 2.10 2.10 0.36 2.46 2.46 XXX
95807... .................. A Sleep study, attended.... 1.66 10.24 10.24 0.67 12.57 12.57 XXX
95807... 26 A Sleep study, attended.... 1.66 0.59 0.59 0.19 2.44 2.44 XXX
95807... TC A Sleep study, attended.... 0.00 9.65 9.65 0.48 10.13 10.13 XXX
95808... .................. A Polysomnography, 1-3..... 2.65 10.49 10.49 0.67 13.81 13.81 XXX
95808... 26 A Polysomnography, 1-3..... 2.65 0.85 0.85 0.19 3.69 3.69 XXX
95808... TC A Polysomnography, 1-3..... 0.00 9.64 9.64 0.48 10.12 10.12 XXX
95810... .................. A Polysomnography, 4 or 3.53 14.22 14.22 0.67 18.42 18.42 XXX
more.
95810... 26 A Polysomnography, 4 or 3.53 1.39 1.39 0.19 5.11 5.11 XXX
more.
95810... TC A Polysomnography, 4 or 0.00 12.83 12.83 0.48 13.31 13.31 XXX
more.
95811... .................. A Polysomnography w/cpap... 3.80 14.68 14.68 0.70 19.18 19.18 XXX
95811... 26 A Polysomnography w/cpap... 3.80 1.53 1.53 0.20 5.53 5.53 XXX
95811... TC A Polysomnography w/cpap... 0.00 13.15 13.15 0.50 13.65 13.65 XXX
95812... .................. A Electroencephalogram 1.08 2.58 2.58 0.15 3.81 3.81 XXX
(EEG).
95812... 26 A Electroencephalogram 1.08 0.46 0.46 0.04 1.58 1.58 XXX
(EEG).
95812... TC A Electroencephalogram 0.00 2.12 2.12 0.11 2.23 2.23 XXX
(EEG).
95813... .................. A Electroencephalogram 1.73 3.93 3.93 0.15 5.81 5.81 XXX
(EEG).
95813... 26 A Electroencephalogram 1.73 0.79 0.79 0.04 2.56 2.56 XXX
(EEG).
95813... TC A Electroencephalogram 0.00 3.14 3.14 0.11 3.25 3.25 XXX
(EEG).
95816... .................. A Electroencephalogram 1.08 2.34 2.34 0.13 3.55 3.55 XXX
(EEG).
95816... 26 A Electroencephalogram 1.08 0.46 0.46 0.03 1.57 1.57 XXX
(EEG).
95816... TC A Electroencephalogram 0.00 1.88 1.88 0.10 1.98 1.98 XXX
(EEG).
95819... .................. A Electroencephalogram 1.08 2.42 2.42 0.14 3.64 3.64 XXX
(EEG).
95819... 26 A Electroencephalogram 1.08 0.46 0.46 0.04 1.58 1.58 XXX
(EEG).
95819... TC A Electroencephalogram 0.00 1.97 1.97 0.10 2.07 2.07 XXX
(EEG).
95822... .................. A Sleep 1.08 2.52 2.52 0.18 3.78 3.78 XXX
electroencephalogram.
95822... 26 A Sleep 1.08 0.49 0.49 0.04 1.61 1.61 XXX
electroencephalogram.
95822... TC A Sleep 0.00 2.04 2.04 0.14 2.18 2.18 XXX
electroencephalogram.
95824... .................. A Electroencephalography... 0.74 0.42 0.42 0.07 1.23 1.23 XXX
95824... 26 A Electroencephalography... 0.74 0.31 0.31 0.04 1.09 1.09 XXX
95824... TC A Electroencephalography... 0.00 0.11 0.11 0.03 0.14 0.14 XXX
95827... .................. A Night 1.08 6.64 6.64 0.24 7.96 7.96 XXX
electroencephalogram.
95827... 26 A Night 1.08 0.42 0.42 0.07 1.57 1.57 XXX
electroencephalogram.
95827... TC A Night 0.00 6.22 6.22 0.17 6.39 6.39 XXX
electroencephalogram.
95829... .................. A Surgery 6.21 10.17 10.17 0.05 16.43 16.43 XXX
electrocorticogram.
95829... 26 A Surgery 6.21 2.53 2.53 0.03 8.77 8.77 XXX
electrocorticogram.
95829... TC A Surgery 0.00 7.64 7.64 0.02 7.66 7.66 XXX
electrocorticogram.
95830... .................. A Insert electrodes for EEG 1.70 2.27 0.70 0.07 4.04 2.47 XXX
95831... .................. A Limb muscle testing, 0.28 0.33 0.14 0.03 0.64 0.45 XXX
manual.
95832... .................. A Hand muscle testing, 0.29 0.27 0.12 0.02 0.58 0.43 XXX
manual.
95833... .................. A Body muscle testing, 0.47 0.41 0.22 0.05 0.93 0.74 XXX
manual.
95834... .................. A Body muscle testing, 0.60 0.51 0.30 0.06 1.17 0.96 XXX
manual.
95851... .................. A Range of motion 0.16 0.27 0.08 0.02 0.45 0.26 XXX
measurements.
95852... .................. A Range of motion 0.11 0.25 0.06 0.02 0.38 0.19 XXX
measurements.
95857... .................. A Tensilon test............ 0.53 0.50 0.23 0.04 1.07 0.80 XXX
[[Page 31003]]
95858... .................. A Tensilon test & myogram.. 1.56 0.76 0.76 0.09 2.41 2.41 XXX
95858... 26 A Tensilon test & myogram.. 1.56 0.43 0.43 0.05 2.04 2.04 XXX
95858... TC A Tensilon test & myogram.. 0.00 0.33 0.33 0.04 0.37 0.37 XXX
95860... .................. A Muscle test, one limb.... 0.96 0.77 0.77 0.09 1.82 1.82 XXX
95860... 26 A Muscle test, one limb.... 0.96 0.46 0.46 0.06 1.48 1.48 XXX
95860... TC A Muscle test, one limb.... 0.00 0.31 0.31 0.03 0.34 0.34 XXX
95861... .................. A Muscle test, two limbs... 1.54 1.11 1.11 0.16 2.81 2.81 XXX
95861... 26 A Muscle test, two limbs... 1.54 0.72 0.72 0.10 2.36 2.36 XXX
95861... TC A Muscle test, two limbs... 0.00 0.39 0.39 0.06 0.45 0.45 XXX
95863... .................. A Muscle test, 3 limbs..... 1.87 1.25 1.25 0.18 3.30 3.30 XXX
95863... 26 A Muscle test, 3 limbs..... 1.87 0.76 0.76 0.11 2.74 2.74 XXX
95863... TC A Muscle test, 3 limbs..... 0.00 0.49 0.49 0.07 0.56 0.56 XXX
95864... .................. A Muscle test, 4 limbs..... 1.99 1.27 1.27 0.27 3.53 3.53 XXX
95864... 26 A Muscle test, 4 limbs..... 1.99 0.92 0.92 0.14 3.05 3.05 XXX
95864... TC A Muscle test, 4 limbs..... 0.00 0.35 0.35 0.13 0.48 0.48 XXX
95867... .................. A Muscle test, head or neck 0.79 0.71 0.71 0.09 1.59 1.59 XXX
95867... 26 A Muscle test, head or neck 0.79 0.26 0.26 0.05 1.10 1.10 XXX
95867... TC A Muscle test, head or neck 0.00 0.46 0.46 0.04 0.50 0.50 XXX
95868... .................. A Muscle test, head or neck 1.18 0.93 0.93 0.15 2.26 2.26 XXX
95868... 26 A Muscle test, head or neck 1.18 0.54 0.54 0.10 1.82 1.82 XXX
95868... TC A Muscle test, head or neck 0.00 0.39 0.39 0.05 0.44 0.44 XXX
95869... .................. A Muscle test, thor 0.37 0.40 0.40 0.05 0.82 0.82 XXX
paraspinal.
95869... 26 A Muscle test, thor 0.37 0.19 0.19 0.03 0.59 0.59 XXX
paraspinal.
95869... TC A Muscle test, thor 0.00 0.21 0.21 0.02 0.23 0.23 XXX
paraspinal.
95870... .................. A Muscle test, non- 0.37 0.87 0.87 0.05 1.29 1.29 XXX
paraspinal.
95870... 26 A Muscle test, non- 0.37 0.37 0.37 0.03 0.77 0.77 XXX
paraspinal.
95870... TC A Muscle test, non- 0.00 0.50 0.50 0.02 0.52 0.52 XXX
paraspinal.
95872... .................. A Muscle test, one fiber... 1.50 1.39 1.39 0.11 3.00 3.00 XXX
95872... 26 A Muscle test, one fiber... 1.50 0.56 0.56 0.06 2.12 2.12 XXX
95872... TC A Muscle test, one fiber... 0.00 0.83 0.83 0.05 0.88 0.88 XXX
95875... .................. A Limb exercise test....... 1.34 1.50 1.50 0.10 2.94 2.94 XXX
95875... 26 A Limb exercise test....... 1.34 0.49 0.49 0.04 1.87 1.87 XXX
95875... TC A Limb exercise test....... 0.00 1.01 1.01 0.06 1.07 1.07 XXX
95900... .................. A Motor nerve conduction 0.42 0.39 0.39 0.05 0.86 0.86 XXX
test.
95900... 26 A Motor nerve conduction 0.42 0.20 0.20 0.03 0.65 0.65 XXX
test.
95900... TC A Motor nerve conduction 0.00 0.19 0.19 0.02 0.21 0.21 XXX
test.
95903... .................. A Motor nerve conduction 0.60 0.54 0.54 0.05 1.19 1.19 XXX
test.
95903... 26 A Motor nerve conduction 0.60 0.26 0.26 0.03 0.89 0.89 XXX
test.
95903... TC A Motor nerve conduction 0.00 0.27 0.27 0.02 0.29 0.29 XXX
test.
95904... .................. A Sense nerve conduction 0.34 0.34 0.34 0.05 0.73 0.73 XXX
test.
95904... 26 A Sense nerve conduction 0.34 0.15 0.15 0.03 0.52 0.52 XXX
test.
95904... TC A Sense nerve conduction 0.00 0.19 0.19 0.02 0.21 0.21 XXX
test.
95920... .................. A Intraoperative nerve 2.11 NA 5.56 0.20 NA 7.87 XXX
testing.
95920... 26 A Intraoperative nerve 2.11 NA 0.98 0.12 NA 3.21 XXX
testing.
95920... TC A Intraoperative nerve 0.00 NA 4.58 0.08 NA 4.66 XXX
testing.
95921... .................. A Autonomic nervous func 0.90 5.48 5.48 0.05 6.43 6.43 XXX
test.
95921... 26 A Autonomic nervous func 0.90 0.90 0.90 0.02 1.82 1.82 XXX
test.
95921... TC A Autonomic nervous func 0.00 4.58 4.58 0.03 4.61 4.61 XXX
test.
95922... .................. A Autonomic nervous func 0.96 5.54 5.54 0.06 6.56 6.56 XXX
test.
95922... 26 A Autonomic nervous func 0.96 0.96 0.96 0.03 1.95 1.95 XXX
test.
95922... TC A Autonomic nervous func 0.00 4.58 4.58 0.03 4.61 4.61 XXX
test.
95923... .................. A Autonomic nervous func 0.90 5.48 5.48 0.05 6.43 6.43 XXX
test.
95923... 26 A Autonomic nervous func 0.90 0.90 0.90 0.02 1.82 1.82 XXX
test.
95923... TC A Autonomic nervous func 0.00 4.58 4.58 0.03 4.61 4.61 XXX
test.
95925... .................. A Somatosensory testing.... 0.54 2.65 2.65 0.12 3.31 3.31 XXX
95925... 26 A Somatosensory testing.... 0.54 0.28 0.28 0.05 0.87 0.87 XXX
95925... TC A Somatosensory testing.... 0.00 2.37 2.37 0.07 2.44 2.44 XXX
95926... .................. A Somatosensory testing.... 0.54 2.57 2.57 0.12 3.23 3.23 XXX
95926... 26 A Somatosensory testing.... 0.54 0.28 0.28 0.05 0.87 0.87 XXX
95926... TC A Somatosensory testing.... 0.00 2.29 2.29 0.07 2.36 2.36 XXX
95927... .................. A Somatosensory testing.... 0.54 2.40 2.40 0.12 3.06 3.06 XXX
95927... 26 A Somatosensory testing.... 0.54 0.27 0.27 0.05 0.86 0.86 XXX
95927... TC A Somatosensory testing.... 0.00 2.13 2.13 0.07 2.20 2.20 XXX
95930... .................. A Visual evoked potential 0.35 1.34 1.34 0.05 1.74 1.74 XXX
test.
95930... 26 A Visual evoked potential 0.35 0.16 0.16 0.04 0.55 0.55 XXX
test.
95930... TC A Visual evoked potential 0.00 1.18 1.18 0.01 1.19 1.19 XXX
test.
95933... .................. A Blink reflex test........ 0.59 0.44 0.44 0.10 1.13 1.13 XXX
95933... 26 A Blink reflex test........ 0.59 0.21 0.21 0.04 0.84 0.84 XXX
95933... TC A Blink reflex test........ 0.00 0.24 0.24 0.06 0.30 0.30 XXX
95934... .................. A `h' reflex test.......... 0.51 0.50 0.50 0.05 1.06 1.06 XXX
95934... 26 A `h' reflex test.......... 0.51 0.23 0.23 0.03 0.77 0.77 XXX
95934... TC A `h' reflex test.......... 0.00 0.27 0.27 0.02 0.29 0.29 XXX
95936... .................. A `h' reflex test.......... 0.55 0.50 0.50 0.05 1.10 1.10 XXX
95936... 26 A `h' reflex test.......... 0.55 0.26 0.26 0.03 0.84 0.84 XXX
[[Page 31004]]
95936... TC A `h' reflex test.......... 0.00 0.24 0.24 0.02 0.26 0.26 XXX
95937... .................. A Neuromuscular junction 0.65 0.52 0.52 0.07 1.24 1.24 XXX
test.
95937... 26 A Neuromuscular junction 0.65 0.24 0.24 0.04 0.93 0.93 XXX
test.
95937... TC A Neuromuscular junction 0.00 0.28 0.28 0.03 0.31 0.31 XXX
test.
95950... .................. A Ambulatory eeg monitoring 1.51 4.32 4.32 0.60 6.43 6.43 XXX
95950... 26 A Ambulatory eeg monitoring 1.51 0.66 0.66 0.10 2.27 2.27 XXX
95950... TC A Ambulatory eeg monitoring 0.00 3.65 3.65 0.50 4.15 4.15 XXX
95951... .................. A EEG monitoring/ 6.00 18.23 18.23 0.64 24.87 24.87 XXX
videorecord.
95951... 26 A EEG monitoring/ 6.00 2.53 2.53 0.11 8.64 8.64 XXX
videorecord.
95951... TC A EEG monitoring/ 0.00 15.70 15.70 0.53 16.23 16.23 XXX
videorecord.
95953... .................. A EEG monitoring/computer.. 3.08 3.79 3.79 0.60 7.47 7.47 XXX
95953... 26 A EEG monitoring/computer.. 3.08 1.46 1.46 0.10 4.64 4.64 XXX
95953... TC A EEG monitoring/computer.. 0.00 2.33 2.33 0.50 2.83 2.83 XXX
95954... .................. A EEG monitoring/giving 2.45 3.26 3.26 0.28 5.99 5.99 XXX
drugs.
95954... 26 A EEG monitoring/giving 2.45 0.98 0.98 0.22 3.65 3.65 XXX
drugs.
95954... TC A EEG monitoring/giving 0.00 2.27 2.27 0.06 2.33 2.33 XXX
drugs.
95955... .................. A EEG during surgery....... 1.01 3.88 3.88 0.30 5.19 5.19 XXX
95955... 26 A EEG during surgery....... 1.01 0.35 0.35 0.11 1.47 1.47 XXX
95955... TC A EEG during surgery....... 0.00 3.53 3.53 0.19 3.72 3.72 XXX
95956... .................. A EEG monitoring/cable/ 3.08 44.02 44.02 0.61 47.71 47.71 XXX
radio.
95956... 26 A EEG monitoring/cable/ 3.08 1.08 1.08 0.11 4.27 4.27 XXX
radio.
95956... TC A EEG monitoring/cable/ 0.00 42.94 42.94 0.50 43.44 43.44 XXX
radio.
95957... .................. A EEG digital analysis..... 1.98 2.51 2.51 0.18 4.67 4.67 XXX
95957... 26 A EEG digital analysis..... 1.98 0.95 0.95 0.05 2.98 2.98 XXX
95957... TC A EEG digital analysis..... 0.00 1.56 1.56 0.13 1.69 1.69 XXX
95958... .................. A EEG monitoring/function 4.25 8.40 8.40 0.52 13.17 13.17 XXX
test.
95958... 26 A EEG monitoring/function 4.25 1.63 1.63 0.38 6.26 6.26 XXX
test.
95958... TC A EEG monitoring/function 0.00 6.77 6.77 0.14 6.91 6.91 XXX
test.
95961... .................. A Electrode stimulation, 2.97 4.99 4.99 0.20 8.16 8.16 XXX
brain.
95961... 26 A Electrode stimulation, 2.97 1.17 1.17 0.12 4.26 4.26 XXX
brain.
95961... TC A Electrode stimulation, 0.00 3.82 3.82 0.08 3.90 3.90 XXX
brain.
95962... .................. A Electrode stimulation, 3.21 3.87 3.87 0.20 7.28 7.28 XXX
brain.
95962... 26 A Electrode stimulation, 3.21 1.42 1.42 0.12 4.75 4.75 XXX
brain.
95962... TC A Electrode stimulation, 0.00 2.45 2.45 0.08 2.53 2.53 XXX
brain.
96100... .................. A Psychological testing.... 0.00 0.40 0.37 0.20 0.60 0.57 XXX
96105... .................. A Assessment of aphasia.... 0.00 0.49 0.38 0.20 0.69 0.58 XXX
96111... .................. A Developmental test, 0.00 0.54 0.41 0.20 0.74 0.61 XXX
extend.
96115... .................. A Neurobehavior status exam 0.00 0.70 0.54 0.20 0.90 0.74 XXX
96117... .................. A Neuropsych test battery.. 0.00 0.54 0.49 0.20 0.74 0.69 XXX
96400... .................. A Chemotherapy, (SC)/(IM).. 0.00 1.06 0.29 0.01 1.07 0.30 XXX
96405... .................. A Intralesional chemo admin 0.52 0.95 0.25 0.03 1.50 0.80 000
96406... .................. A Intralesional chemo admin 0.80 1.10 0.30 0.04 1.94 1.14 000
96408... .................. A Chemotherapy, push 0.00 1.04 0.31 0.06 1.10 0.37 XXX
technique.
96410... .................. A Chemotherapy, infusion 0.00 1.16 0.34 0.09 1.25 0.43 XXX
method.
96412... .................. A Chemotherapy, infusion 0.00 0.52 0.15 0.08 0.60 0.23 XXX
method.
96414... .................. A Chemotherapy, infusion 0.00 1.16 0.35 0.09 1.25 0.44 XXX
method.
96420... .................. A Chemotherapy, push 0.00 1.15 0.34 0.09 1.24 0.43 XXX
technique.
96422... .................. A Chemotherapy, infusion 0.00 1.16 0.35 0.09 1.25 0.44 XXX
method.
96423... .................. A Chemotherapy, infusion 0.00 0.94 0.27 0.03 0.97 0.30 XXX
method.
96425... .................. A Chemotherapy, infusion 0.00 1.24 0.36 0.09 1.33 0.45 XXX
method.
96440... .................. A Chemotherapy, 2.37 2.83 1.03 0.06 5.26 3.46 000
intracavitary.
96445... .................. A Chemotherapy, 2.20 2.79 1.01 0.09 5.08 3.30 000
intracavitary.
96450... .................. A Chemotherapy, into CNS... 1.89 2.42 0.84 0.06 4.37 2.79 000
96520... .................. A Pump refilling, 0.00 0.85 0.25 0.06 0.91 0.31 XXX
maintenance.
96530... .................. A Pump refilling, 0.00 0.93 0.27 0.07 1.00 0.34 XXX
maintenance.
96542... .................. A Chemotherapy injection... 1.42 1.76 0.67 0.13 3.31 2.22 XXX
96900... .................. A Ultraviolet light therapy 0.00 0.17 0.06 0.03 0.20 0.09 XXX
96902... .................. B Trichogram............... +0.41 0.54 0.54 0.02 0.97 0.97 XXX
96910... .................. A Photochemotherapy with UV- 0.00 0.17 0.06 0.04 0.21 0.10 XXX
B.
96912... .................. A Photochemotherapy with UV- 0.00 0.23 0.08 0.05 0.28 0.13 XXX
A.
96913... .................. A Photochemotherapy, UV-A 0.00 0.40 0.14 0.10 0.50 0.24 XXX
or B.
97001... .................. A Pt evaluation............ 1.20 0.34 0.47 0.11 1.65 1.78 XXX
97002... .................. A Pt re-evaluation......... 0.60 0.25 0.23 0.01 0.86 0.84 XXX
97003... .................. A Ot evaluation............ 1.20 0.54 0.54 0.11 1.85 1.85 XXX
97004... .................. A Ot re-evaluation......... 0.60 0.21 0.14 0.01 0.82 0.75 XXX
97010... .................. B Hot or cold packs therapy +0.06 0.13 0.02 0.02 0.21 0.10 XXX
97012... .................. A Mechanical traction 0.25 0.14 0.03 0.02 0.41 0.30 XXX
therapy.
97014... .................. A Electric stimulation 0.18 0.13 0.02 0.02 0.33 0.22 XXX
therapy.
97016... .................. A Vasopneumatic device 0.18 0.13 0.02 0.02 0.33 0.22 XXX
therapy.
97018... .................. A Paraffin bath therapy.... 0.06 0.11 0.01 0.03 0.20 0.10 XXX
97020... .................. A Microwave therapy........ 0.06 0.12 0.01 0.02 0.20 0.09 XXX
97022... .................. A Whirlpool therapy........ 0.17 0.13 0.02 0.02 0.32 0.21 XXX
97024... .................. A Diathermy treatment...... 0.06 0.12 0.01 0.02 0.20 0.09 XXX
97026... .................. A Infrared therapy......... 0.06 0.11 0.01 0.02 0.19 0.09 XXX
[[Page 31005]]
97028... .................. A Ultraviolet therapy...... 0.08 0.11 0.01 0.01 0.20 0.10 XXX
97032... .................. A Electrical stimulation... 0.25 0.15 0.03 0.01 0.41 0.29 XXX
97033... .................. A Electric current therapy. 0.26 0.16 0.03 0.02 0.44 0.31 XXX
97034... .................. A Contrast bath therapy.... 0.21 0.14 0.02 0.01 0.36 0.24 XXX
97035... .................. A Ultrasound therapy....... 0.21 0.14 0.02 0.01 0.36 0.24 XXX
97036... .................. A Hydrotherapy............. 0.28 0.17 0.03 0.02 0.47 0.33 XXX
97039... .................. A Physical therapy 0.20 0.14 0.02 0.03 0.37 0.25 XXX
treatment.
97110... .................. A Therapeutic exercises.... 0.45 0.18 0.05 0.02 0.65 0.52 XXX
97112... .................. A Neuromuscular reeducation 0.45 0.16 0.05 0.01 0.62 0.51 XXX
97113... .................. A Aquatic therapy/exercises 0.44 0.16 0.05 0.02 0.62 0.51 XXX
97116... .................. A Gait training therapy.... 0.40 0.15 0.04 0.01 0.56 0.45 XXX
97122... .................. A Manual traction therapy.. 0.42 0.15 0.04 0.01 0.58 0.47 XXX
97124... .................. A Massage therapy.......... 0.35 0.15 0.04 0.01 0.51 0.40 XXX
97139... .................. A Physical medicine 0.21 0.13 0.02 0.02 0.36 0.25 XXX
procedure.
97150... .................. A Group therapeutic 0.27 0.14 0.03 0.02 0.43 0.32 XXX
procedures.
97250... .................. A Myofascial release....... 0.45 0.17 0.05 0.04 0.66 0.54 000
97260... .................. A Regional manipulation.... 0.19 0.13 0.02 0.02 0.34 0.23 000
97261... .................. A Supplemental 0.12 0.15 0.01 0.01 0.28 0.14 000
manipulations.
97265... .................. A Joint mobilization....... 0.45 0.16 0.05 0.04 0.65 0.54 XXX
97504... .................. A Orthotic training........ 0.45 0.14 0.05 0.02 0.61 0.52 XXX
97520... .................. A Prosthetic training...... 0.45 0.16 0.05 0.02 0.63 0.52 XXX
97530... .................. A Therapeutic activities... 0.44 0.16 0.05 0.02 0.62 0.51 XXX
97535... .................. A Self care mngment 0.45 0.16 0.05 0.02 0.63 0.52 XXX
training.
97537... .................. A Community/work 0.45 0.16 0.05 0.02 0.63 0.52 XXX
reintegration.
97542... .................. A Wheelchair mngement 0.25 0.14 0.03 0.02 0.41 0.30 XXX
training.
97703... .................. A Prosthetic checkout...... 0.25 0.06 0.03 0.03 0.34 0.31 XXX
97750... .................. A Physical performance test 0.45 0.15 0.05 0.03 0.63 0.53 XXX
97770... .................. A Cognitive skills 0.44 0.14 0.05 0.03 0.61 0.52 XXX
development.
98925... .................. A Osteopathic manipulation. 0.45 0.29 0.17 0.02 0.76 0.64 000
98926... .................. A Osteopathic manipulation. 0.65 0.38 0.28 0.03 1.06 0.96 000
98927... .................. A Osteopathic manipulation. 0.87 0.44 0.32 0.03 1.34 1.22 000
98928... .................. A Osteopathic manipulation. 1.03 0.52 0.36 0.04 1.59 1.43 000
98929... .................. A Osteopathic manipulation. 1.19 0.56 0.40 0.03 1.78 1.62 000
98940... .................. A Chiropractic manipulation 0.45 0.24 0.12 0.01 0.70 0.58 000
98941... .................. A Chiropractic manipulation 0.65 0.29 0.17 0.01 0.95 0.83 000
98942... .................. A Chiropractic manipulation 0.87 0.35 0.23 0.01 1.23 1.11 000
98943... .................. N Chiropractic manipulation +0.40 0.72 0.40 0.01 1.13 0.81 XXX
99141... .................. B Sedation, iv/im or +0.80 2.82 0.97 0.05 3.67 1.82 XXX
inhalant.
99142... .................. B Sedation, oral/rectal/ +0.60 2.62 0.77 0.04 3.26 1.41 XXX
nasal.
99175... .................. A Induction of vomiting.... 0.00 0.28 0.07 0.10 0.38 0.17 XXX
99183... .................. A Hyperbaric oxygen therapy 2.34 0.75 0.73 0.11 3.20 3.18 XXX
99185... .................. A Regional hypothermia..... 0.00 NA 0.05 0.04 NA 0.09 XXX
99186... .................. A Total body hypothermia... 0.00 NA 0.05 0.52 NA 0.57 XXX
99195... .................. A Phlebotomy............... 0.00 1.26 0.11 0.03 1.29 0.14 XXX
99201... .................. A Office/outpatient visit, 0.45 0.83 0.32 0.04 1.32 0.81 XXX
new.
99202... .................. A Office/outpatient visit, 0.88 1.11 0.50 0.05 2.04 1.43 XXX
new.
99203... .................. A Office/outpatient visit, 1.34 1.49 0.73 0.06 2.89 2.13 XXX
new.
99204... .................. A Office/outpatient visit, 2.00 2.00 1.00 0.08 4.08 3.08 XXX
new.
99205... .................. A Office/outpatient visit, 2.67 2.24 1.21 0.09 5.00 3.97 XXX
new.
99211... .................. A Office/outpatient visit, 0.17 0.32 0.16 0.02 0.51 0.35 XXX
est.
99212... .................. A Office/outpatient visit, 0.45 0.45 0.28 0.02 0.92 0.75 XXX
est.
99213... .................. A Office/outpatient visit, 0.67 0.55 0.35 0.03 1.25 1.05 XXX
est.
99214... .................. A Office/outpatient visit, 1.10 0.84 0.55 0.04 1.98 1.69 XXX
est.
99215... .................. A Office/outpatient visit, 1.77 1.12 0.80 0.07 2.96 2.64 XXX
est.
99217... .................. A Observation care 1.28 NA 0.55 0.04 NA 1.87 XXX
discharge.
99218... .................. A Observation care......... 1.28 NA 0.62 0.06 NA 1.96 XXX
99219... .................. A Observation care......... 2.14 NA 0.92 0.09 NA 3.15 XXX
99220... .................. A Observation care......... 2.99 NA 1.27 0.09 NA 4.35 XXX
99221... .................. A Initial hospital care.... 1.28 NA 0.64 0.06 NA 1.98 XXX
99222... .................. A Initial hospital care.... 2.14 NA 0.94 0.09 NA 3.17 XXX
99223... .................. A Initial hospital care.... 2.99 NA 1.26 0.08 NA 4.33 XXX
99231... .................. A Subsequent hospital care. 0.64 NA 0.28 0.03 NA 0.95 XXX
99232... .................. A Subsequent hospital care. 1.06 NA 0.43 0.04 NA 1.53 XXX
99233... .................. A Subsequent hospital care. 1.51 NA 0.60 0.05 NA 2.16 XXX
99234... .................. A Observ/hosp same date.... 2.56 NA 1.09 0.06 NA 3.71 XXX
99235... .................. A Observ/hosp same date.... 3.42 NA 1.38 0.09 NA 4.89 XXX
99236... .................. A Observ/hosp same date.... 4.27 NA 1.72 0.09 NA 6.08 XXX
99238... .................. A Hospital discharge day... 1.28 NA 0.57 0.04 NA 1.89 XXX
99239... .................. A Hospital discharge day... 1.75 NA 0.73 0.04 NA 2.52 XXX
99241... .................. A Office consultation...... 0.64 0.72 0.40 0.08 1.44 1.12 XXX
99242... .................. A Office consultation...... 1.29 1.12 0.66 0.09 2.50 2.04 XXX
99243... .................. A Office consultation...... 1.72 1.41 0.87 0.10 3.23 2.69 XXX
99244... .................. A Office consultation...... 2.58 1.80 1.19 0.11 4.49 3.88 XXX
99245... .................. A Office consultation...... 3.43 2.12 1.52 0.16 5.71 5.11 XXX
[[Page 31006]]
99251... .................. A Initial inpatient consult 0.66 NA 0.40 0.08 NA 1.14 XXX
99252... .................. A Initial inpatient consult 1.32 NA 0.71 0.09 NA 2.12 XXX
99253... .................. A Initial inpatient consult 1.82 NA 0.94 0.10 NA 2.86 XXX
99254... .................. A Initial inpatient consult 2.64 NA 1.26 0.11 NA 4.01 XXX
99255... .................. A Initial inpatient consult 3.65 NA 1.66 0.14 NA 5.45 XXX
99261... .................. A Follow-up inpatient 0.42 NA 0.30 0.03 NA 0.75 XXX
consult.
99262... .................. A Follow-up inpatient 0.85 NA 0.48 0.04 NA 1.37 XXX
consult.
99263... .................. A Follow-up inpatient 1.27 NA 0.65 0.04 NA 1.96 XXX
consult.
99271... .................. A Confirmatory consultation 0.45 0.46 0.32 0.07 0.98 0.84 XXX
99272... .................. A Confirmatory consultation 0.84 0.65 0.50 0.09 1.58 1.43 XXX
99273... .................. A Confirmatory consultation 1.19 0.90 0.65 0.11 2.20 1.95 XXX
99274... .................. A Confirmatory consultation 1.73 1.19 0.85 0.11 3.03 2.69 XXX
99275... .................. A Confirmatory consultation 2.31 1.34 1.05 0.17 3.82 3.53 XXX
99281... .................. A Emergency dept visit..... 0.33 NA 0.11 0.01 NA 0.45 XXX
99282... .................. A Emergency dept visit..... 0.55 NA 0.15 0.03 NA 0.73 XXX
99283... .................. A Emergency dept visit..... 1.24 NA 0.27 0.04 NA 1.55 XXX
99284... .................. A Emergency dept visit..... 1.95 NA 0.39 0.06 NA 2.40 XXX
99285... .................. A Emergency dept visit..... 3.06 NA 0.57 0.08 NA 3.71 XXX
99291... .................. A Critical care, first hour 4.00 1.45 1.50 0.11 5.56 5.61 XXX
99292... .................. A Critical care, addl 30 2.00 0.78 0.79 0.04 2.82 2.83 XXX
min.
99295... .................. A Neonatal critical care... 16.00 NA 5.32 1.55 NA 22.87 XXX
99296... .................. A Neonatal critical care... 8.00 NA 4.60 0.77 NA 13.37 XXX
99297... .................. A Neonatal critical care... 4.00 NA 3.54 0.38 NA 7.92 XXX
99301... .................. A Nursing facility care.... 1.20 NA 0.69 0.03 NA 1.92 XXX
99302... .................. A Nursing facility care.... 1.61 NA 0.89 0.04 NA 2.54 XXX
99303... .................. A Nursing facility care.... 2.01 NA 1.05 0.07 NA 3.13 XXX
99311... .................. A Nursing facility care, 0.60 NA 0.38 0.03 NA 1.01 XXX
subseq.
99312... .................. A Nursing facility care, 1.00 NA 0.52 0.03 NA 1.55 XXX
subseq.
99313... .................. A Nursing facility care, 1.42 NA 0.68 0.04 NA 2.14 XXX
subseq.
99315... .................. A Nursing fac discharge day 1.13 NA 1.48 0.04 NA 2.65 XXX
99316... .................. A Nursing fac discharge day 1.50 NA 1.85 0.04 NA 3.39 XXX
99321... .................. A Rest home visit, new 0.71 0.36 0.61 0.03 1.10 1.35 XXX
patient.
99322... .................. A Rest home visit, new 1.01 0.55 0.89 0.05 1.61 1.95 XXX
patient.
99323... .................. A Rest home visit, new 1.28 0.70 0.97 0.06 2.04 2.31 XXX
patient.
99331... .................. A Rest home visit, estab 0.60 0.35 0.53 0.02 0.97 1.15 XXX
pat.
99332... .................. A Rest home visit, estab 0.80 0.45 0.60 0.03 1.28 1.43 XXX
pat.
99333... .................. A Rest home visit, estab 1.00 0.54 1.06 0.02 1.56 2.08 XXX
pat.
99341... .................. A Home visit, new patient.. 1.01 0.48 0.60 0.05 1.54 1.66 XXX
99342... .................. A Home visit, new patient.. 1.52 0.73 1.02 0.05 2.30 2.59 XXX
99343... .................. A Home visit, new patient.. 2.27 1.07 1.45 0.06 3.40 3.78 XXX
99344... .................. A Home visit, new patient.. 3.03 1.34 1.74 0.09 4.46 4.86 XXX
99345... .................. A Home visit, new patient.. 3.79 1.61 2.04 0.09 5.49 5.92 XXX
99347... .................. A Home visit, estab patient 0.76 0.39 0.68 0.04 1.19 1.48 XXX
99348... .................. A Home visit, estab patient 1.26 0.61 0.86 0.04 1.91 2.16 XXX
99349... .................. A Home visit, estab patient 2.02 0.90 0.83 0.05 2.97 2.90 XXX
99350... .................. A Home visit, estab patient 3.03 1.24 1.06 0.07 4.34 4.16 XXX
99354... .................. A Prolonged service, office 1.77 1.03 0.73 0.07 2.87 2.57 XXX
99355... .................. A Prolonged service, office 1.77 0.92 0.66 0.07 2.76 2.50 XXX
99356... .................. A Prolonged service, 1.71 NA 0.63 0.08 NA 2.42 XXX
inpatient.
99357... .................. A Prolonged service, 1.71 NA 0.67 0.08 NA 2.46 XXX
inpatient.
99374... .................. B Home health care +1.10 2.51 1.99 0.04 3.65 3.13 XXX
supervision.
99375... .................. A Home health care 1.73 1.03 0.87 0.04 2.80 2.64 XXX
supervision.
99377... .................. B Hospice care supervision. +1.10 2.51 1.99 0.04 3.65 3.13 XXX
99378... .................. A Hospice care supervision. 1.73 1.03 0.87 0.04 2.80 2.64 XXX
99379... .................. B Nursing fac care +1.10 2.51 1.99 0.04 3.65 3.13 XXX
supervision.
99380... .................. B Nursing fac care +1.73 3.14 2.62 0.04 4.91 4.39 XXX
supervision.
99381... .................. N Preventive visit, new, +1.19 2.61 1.19 0.08 3.88 2.46 XXX
infant.
99382... .................. N Preventive visit, new, +1.36 2.74 1.36 0.09 4.19 2.81 XXX
age 1-4.
99383... .................. N Preventive visit, new, +1.36 2.66 1.36 0.09 4.11 2.81 XXX
age 5-11.
99384... .................. N Preventive visit, new, 12- +1.53 2.83 1.53 0.10 4.46 3.16 XXX
17.
99385... .................. N Preventive visit, new, 18- +1.53 2.83 1.53 0.09 4.45 3.15 XXX
39.
99386... .................. N Preventive visit, new, 40- +1.88 3.25 1.88 0.10 5.23 3.86 XXX
64.
99387... .................. N Preventive visit, new, 65 +2.06 3.51 2.06 0.11 5.68 4.23 XXX
& over.
99391... .................. N Preventive visit, est, +1.02 1.86 1.02 0.07 2.95 2.11 XXX
infant.
99392... .................. N Preventive visit, est, +1.19 2.03 1.19 0.08 3.30 2.46 XXX
age 1-4.
99393... .................. N Preventive visit, est, +1.19 1.99 1.19 0.08 3.26 2.46 XXX
age 5-11.
99394... .................. N Preventive visit, est, 12- +1.36 2.18 1.36 0.09 3.63 2.81 XXX
17.
99395... .................. N Preventive visit, est, 18- +1.36 2.23 1.98 0.08 3.67 3.42 XXX
39.
99396... .................. N Preventive visit, est, 40- +1.53 2.43 2.15 0.09 4.05 3.77 XXX
64.
99397... .................. N Preventive visit, est, 65 +1.71 2.65 2.33 0.10 4.46 4.14 XXX
& over.
99401... .................. N Preventive counseling, +0.48 1.06 0.87 0.03 1.57 1.38 XXX
indiv.
99402... .................. N Preventive counseling, +0.98 1.63 1.37 0.05 2.66 2.40 XXX
indiv.
99403... .................. N Preventive counseling, +1.46 2.18 1.85 0.08 3.72 3.39 XXX
indiv.
99404... .................. N Preventive counseling, +1.95 2.73 2.34 0.11 4.79 4.40 XXX
indiv.
[[Page 31007]]
99411... .................. N Preventive counseling, +0.15 0.31 0.25 0.01 0.47 0.41 XXX
group.
99412... .................. N Preventive counseling, +0.25 0.45 0.35 0.01 0.71 0.61 XXX
group.
99431... .................. A Initial care, normal 1.17 NA 0.55 0.08 NA 1.80 XXX
newborn.
99432... .................. A Newborn care not in 1.26 0.93 0.42 0.08 2.27 1.76 XXX
hospital.
99433... .................. A Normal newborn care, 0.62 NA 0.33 0.04 NA 0.99 XXX
hospital.
99435... .................. A Hospital NB discharge day 1.50 NA 0.64 0.10 NA 2.24 XXX
99436... .................. A Attendance, birth........ 1.50 2.89 2.55 0.10 4.49 4.15 XXX
99440... .................. A Newborn resuscitation.... 2.93 NA 3.10 0.19 NA 6.22 XXX
A4263... .................. A Permanent tear duct plug. 0.00 2.60 0.90 0.00 2.60 0.90 XXX
A4300... .................. A Cath impl vasc access 0.00 0.00 0.00 0.00 0.00 0.00 XXX
portal.
A4550... .................. A Surgical trays........... 0.00 0.00 0.00 0.00 0.00 0.00 XXX
G0002... .................. A Temporary urinary 0.50 2.34 0.19 0.02 2.86 0.71 000
catheter.
G0004... .................. A ECG transm phys review & 0.52 0.63 0.63 0.65 1.80 1.80 XXX
int.
G0005... .................. A ECG 24 hour recording.... 0.00 0.12 0.12 0.09 0.21 0.21 XXX
G0006... .................. A ECG transmission & 0.00 0.32 0.32 0.51 0.83 0.83 XXX
analysis.
G0007... .................. A ECG phy review & 0.52 0.26 0.26 0.05 0.83 0.83 XXX
interpret.
G0015... .................. A Post symptom ECG tracing. 0.00 0.32 0.32 0.51 0.83 0.83 XXX
G0016... .................. A Post symptom ECG md 0.52 0.48 0.48 0.05 1.05 1.05 XXX
review.
G0025... .................. A Collagen skin test kit... 0.00 1.17 0.32 0.00 1.17 0.32 XXX
G0030... 26 A PET imaging prev PET 1.50 0.36 0.36 0.07 1.93 1.93 XXX
single.
G0031... 26 A PET imaging prev PET 1.87 0.48 0.48 0.10 2.45 2.45 XXX
multple.
G0032... 26 A PET follow SPECT 78464 1.50 0.36 0.36 0.07 1.93 1.93 XXX
singl.
G0033... 26 A PET follow SPECT 78464 1.87 0.48 0.48 0.10 2.45 2.45 XXX
mult.
G0034... 26 A PET follow SPECT 76865 1.50 0.36 0.36 0.07 1.93 1.93 XXX
singl.
G0035... 26 A PET follow SPECT 78465 1.87 0.48 0.48 0.10 2.45 2.45 XXX
mult.
G0036... 26 A PET follow cornry angio 1.50 0.36 0.36 0.07 1.93 1.93 XXX
sing.
G0037... 26 A PET follow cornry angio 1.87 0.48 0.48 0.10 2.45 2.45 XXX
mult.
G0038... 26 A PET follow myocard perf 1.50 0.36 0.36 0.07 1.93 1.93 XXX
sing.
G0039... 26 A PET follow myocard perf 1.87 0.48 0.48 0.10 2.45 2.45 XXX
mult.
G0040... 26 A PET follow stress echo 1.50 0.36 0.36 0.07 1.93 1.93 XXX
singl.
G0041... 26 A PET follow stress echo 1.87 0.48 0.48 0.10 2.45 2.45 XXX
mult.
G0042... 26 A PET follow ventriculogm 1.50 0.36 0.36 0.07 1.93 1.93 XXX
sing.
G0043... 26 A PET follow ventriculogm 1.87 0.48 0.48 0.10 2.45 2.45 XXX
mult.
G0044... 26 A PET following rest ECG 1.50 0.36 0.36 0.07 1.93 1.93 XXX
singl.
G0045... 26 A PET following rest ECG 1.87 0.48 0.48 0.10 2.45 2.45 XXX
mult.
G0046... 26 A PET follow stress ECG 1.50 0.36 0.36 0.07 1.93 1.93 XXX
singl.
G0047... 26 A PET follow stress ECG 1.87 0.48 0.48 0.10 2.45 2.45 XXX
mult.
G0050... .................. A Residual urine by 0.00 0.60 0.60 0.05 0.65 0.65 XXX
ultrasound.
G0101... .................. A CA screen; pelvic/breast 0.45 1.17 0.81 0.02 1.64 1.28 XXX
exam.
G0104... .................. A CA screen; flexi 0.96 6.84 1.15 0.12 7.92 2.23 000
sigmoidscope.
G0105... .................. A Colorectal scrn; hi risk 3.70 12.28 5.01 0.39 16.37 9.10 000
ind.
G0106... .................. A Colon CA screen; barium 0.99 1.92 1.92 0.21 3.12 3.12 XXX
enema.
G0106... 26 A Colon CA screen; barium 0.99 0.33 0.33 0.07 1.39 1.39 XXX
enema.
G0106... TC A Colon CA screen; barium 0.00 1.59 1.59 0.14 1.73 1.73 XXX
enema.
G0110... .................. R Nett pulm-rehab educ; ind 0.90 1.70 0.90 0.04 2.64 1.84 XXX
G0111... .................. R Nett pulm-rehab educ; 0.27 0.59 0.27 0.02 0.88 0.56 XXX
group.
G0112... .................. R Nett; nutrition guid, 1.72 3.32 2.36 0.10 5.14 4.18 XXX
initial.
G0113... .................. R Nett; nutrition guid, 1.29 2.77 1.86 0.09 4.15 3.24 XXX
subseqnt.
G0114... .................. R Nett; psychosocial 1.20 1.36 1.20 0.11 2.67 2.51 XXX
consult.
G0115... .................. R Nett; psychological 1.20 1.53 1.20 0.11 2.84 2.51 XXX
testing.
G0116... .................. R Nett; psychosocial 1.11 1.70 1.52 0.05 2.86 2.68 XXX
counsel.
G0120... .................. A Colon ca scrn; barium 0.99 1.92 1.92 0.21 3.12 3.12 XXX
enema.
G0120... 26 A Colon ca scrn; barium 0.99 0.33 0.33 0.07 1.39 1.39 XXX
enema.
G0120... TC A Colon ca scrn; barium 0.00 1.59 1.59 0.14 1.73 1.73 XXX
enema.
G0121... .................. N Colon ca scrn; barium +3.70 12.28 5.01 0.39 16.37 9.10 XXX
enema.
G0122... .................. N Colon ca scrn; barium +0.99 1.92 1.92 0.21 3.12 3.12 XXX
enema.
G0122... 26 N Colon ca scrn; barium +0.99 0.33 0.33 0.07 1.39 1.39 XXX
enema.
G0122... TC N Colon ca scrn; barium +0.00 1.59 1.59 0.14 1.73 1.73 XXX
enema.
G0124... 26 A Screen c/v thin layer by 0.42 1.70 0.42 0.04 2.16 0.88 XXX
MD.
G0125... 26 A Lung image (PET)......... 1.50 0.36 0.36 0.07 1.93 1.93 XXX
G0126... 26 A Lung image (PET), staging 1.87 0.48 0.48 0.10 2.45 2.45 XXX
G0127... .................. R Trim nail(s)............. 0.11 1.59 0.11 0.02 1.72 0.24 000
M0064... .................. A Visit for drug monitoring 0.37 0.19 0.23 0.03 0.59 0.63 XXX
M0101... .................. G Foot care hygienic/pm.... 0.43 1.91 0.43 0.03 2.37 0.89 XXX
P3001... 26 A Screening pap smear by 0.42 1.00 0.15 0.04 1.46 0.61 XXX
phys.
Q0035... .................. A Cardiokymography......... 0.17 0.32 0.32 0.04 0.53 0.53 XXX
Q0035... 26 A Cardiokymography......... 0.17 0.10 0.10 0.01 0.28 0.28 XXX
Q0035... TC A Cardiokymography......... 0.00 0.22 0.22 0.03 0.25 0.25 XXX
Q0068... .................. A Extracorpeal 1.67 3.38 0.68 0.16 5.21 2.51 000
plasmapheresis.
Q0091... .................. A Obtaining screen pap 0.37 0.58 0.14 0.03 0.98 0.54 XXX
smear.
Q0092... .................. A Set up port xray 0.00 0.22 0.22 0.01 0.23 0.23 XXX
equipment.
R0070... .................. A Transport portable x-ray. 0.00 0.77 0.77 0.01 0.78 0.78 XXX
R0075... .................. A Transport port x-ray 0.00 0.19 0.19 0.01 0.20 0.20 XXX
multipl.
--------------------------------------------------------------------------------------------------------------------------------------------------------
[[Page 31008]]
Addendum D.--Physician Codes Always Subject to the Outpatient
Rehabilitation Financial Limitation
------------------------------------------------------------------------
CPT \1\
code Description
------------------------------------------------------------------------
29126.... APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); DYNAMIC
29131.... APPLICATION OF FINGER SPLINT; DYNAMIC
64550.... APPLICATION OF SURFACE (TRANSCUTANEOUS) NEUROSTIMULATOR
90901.... BIOFEEDBACK TRAINING BY ANY MODALITY
90911.... BIOFEEDBACK TRAINING, PERINEAL MUSCLES, ANORECTAL OR URETHRAL
SPHINCTER, INCLUDING EMG AND/OR MANOMETRY
92506.... EVALUATION OF SPEECH, LANGUAGE, VOICE, COMMUNICATION,
AUDITORY PROCESSING, AND/OR AURAL REHABILITATION STATUS
92507.... TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR
AUDITORY PROCESSING DISORDER (INCLUDES AURAL
REHABILITATION); INDIVIDUAL
92508.... TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR
AUDITORY PROCESSING DISORDER (INCLUDES AURAL
REHABILITATION); GROUP, TWO OR MORE INDIVIDUALS
92510.... AURAL REHABILITATION FOLLOWING COCHLEAR IMPLANT (INCLUDES
EVALUATION OF AURAL REHABILITATION STATUS AND HEARING,
THERAPEUTIC SERVICES) WITH OR WITHOUT SPEECH PROCESSOR
PROGRAMMING
92525.... EVALUATION OF SWALLOWING AND ORAL FUNCTION FOR FEEDING
92526.... TREATMENT OF SWALLOWING DYSFUNCTION AND/OR ORAL FUNCTION FOR
FEEDING
92597.... EVALUATION FOR USE AND/OR FITTING OF VOICE PROSTHETIC OR
AUGMENTATIVE/ ALTERNATIVE COMMUNICATION DEVICE TO SUPPLEMENT
ORAL SPEECH
92598.... MODIFICATION OF VOICE PROSTHETIC OR AUGMENTATIVE/ALTERNATIVE
COMMUNICATION DEVICE TO SUPPLEMENT ORAL SPEECH
95831.... MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); EXTREMITY
(EXCLUDING HAND) OR TRUNK, WITH REPORT
95832.... MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); HAND, WITH OR
WITHOUT COMPARISON WITH NORMAL SIDE
95833.... MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); TOTAL EVALUATION
OF BODY, EXCLUDING HANDS
95834.... MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); TOTAL EVALUATION
OF BODY, INCLUDING HANDS
95851.... RANGE OF MOTION MEASUREMENTS AND REPORT (SEPARATE PROCEDURE);
EACH EXTREMITY (EXCLUDING HAND) OR EACH TRUNK SECTION
(SPINE)
95852.... RANGE OF MOTION MEASUREMENTS AND REPORT (SEPARATE PROCEDURE);
HAND, WITH OR WITHOUT COMPARISON WITH NORMAL SIDE
96105.... ASSESSMENT OF APHASIA (INCLUDES ASSESSMENT OF EXPRESSIVE AND
RECEPTIVE SPEECH AND LANGUAGE FUNCTION, LANGUAGE
COMPREHENSION, SPEECH PRODUCTION ABILITY, READING, SPELLING,
WRITING, EG, BY BOSTON DIAGNOSTIC APHASIA EXAMINATION) WITH
INTERPRETATION AND REPOR
97001.... PHYSICAL THERAPY EVALUATION
97002.... PHYSICAL THERAPY RE-EVALUATION
97003.... OCCUPATIONAL THERAPY EVALUATION
97004.... OCCUPATIONAL THERAPY RE-EVALUATION
97010.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; HOT OR COLD
PACKS
97012.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; TRACTION,
MECHANICAL
97014.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL
STIMULATION (UNATTENDED)
97016.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; VASOPNEUMATIC
DEVICES
97018.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; PARAFFIN BATH
97020.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; MICROWAVE
97022.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; WHIRLPOOL
97024.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; DIATHERMY
97026.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; INFRARED
97028.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRAVIOLET
97032.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL
STIMULATION (MANUAL), EACH 15 MINUTES
97033.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS;
IONTOPHORESIS, EACH 15 MINUTES
97034.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; CONTRAST
BATHS, EACH 15 MINUTES
97035.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRASOUND,
EACH 15 MINUTES
97036.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; HUBBARD TANK,
EACH 15 MINUTES
97039.... UNLISTED MODALITY (SPECIFY TYPE AND TIME IF CONSTANT
ATTENDANCE)
97110.... THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES;
THERAPEUTIC EXERCISES TO DEVELOP STRENGTH AND ENDURANCE,
RANGE OF MOTION AND FLEXIBILITY
97112.... THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES;
NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALANCE,
COORDINATION, KINESTHETIC SENSE, POSTURE, AND PROPRIOCEPTION
97113.... THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES;
AQUATIC THERAPY WITH THERAPEUTIC EXERCISES
97116.... THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES;
GAIT TRAINING (INCLUDES STAIR CLIMBING)
97122.... THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES;
TRACTION, MANUAL
97124.... THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES;
MASSAGE, INCLUDING EFFLEURAGE, PETRISSAGE AND/OR TAPOTEMENT
(STROKING, COMPRESSION, PERCUSSION)
97139.... THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES;
UNLISTED THERAPEUTIC PROCEDURE (SPECIFY)
97150.... THERAPEUTIC PROCEDURE(S), GROUP (2 OR MORE INDIVIDUALS)
97250.... MYOFASCIAL RELEASE/SOFT TISSUE MOBILIZATION, ONE OR MORE
REGIONS
97260.... MANIPULATION (CERVICAL, THORACIC, LUMBOSACRAL, SACROILIAC,
HAND, WRIST) (SEPARATE PROCEDURE), PERFORMED BY PHYSICIAN;
ONE AREA
[[Page 31009]]
97261.... MANIPULATION (CERVICAL, THORACIC, LUMBOSACRAL, SACROILIAC,
HAND, WRIST) (SEPARATE PROCEDURE), PERFORMED BY PHYSICIAN;
EACH ADDITIONAL AREA
97265.... JOINT MOBILIZATION, ONE OR MORE AREAS (PERIPHERAL OR SPINAL)
97504.... ORTHOTICS FITTING AND TRAINING, UPPER AND/OR LOWER
EXTREMITIES, EACH 15 MINUTES
97520.... PROSTHETIC TRAINING, UPPER AND/OR LOWER EXTREMITIES, EACH 15
MINUTES
97530.... THERAPEUTIC ACTIVITIES, DIRECT (ONE ON ONE) PATIENT CONTACT
BY THE PROVIDER (USE OF DYNAMIC ACTIVITIES TO IMPROVE
FUNCTIONAL PERFORMANCE), EACH 15 MINUTES
97535.... SELF CARE/HOME MANAGEMENT TRAINING (EG, ACTIVITIES OF DAILY
LIVING (ADL) AND COMPENSATORY TRAINING, MEAL PREPARATION,
SAFETY PROCEDURES, AND INSTRUCTIONS IN USE OF ADAPTIVE
EQUIPMENT) DIRECT ONE ON ONE CONTACT BY PROVIDER, EACH 15
MINUTES
97537.... COMMUNITY/WORK REINTEGRATION TRAINING (EG, SHOPPING,
TRANSPORTATION, MONEY MANAGEMENT, AVOCATIONAL ACTIVITIES AND/
OR WORK ENVIRONMENT/MODIFICATION ANALYSIS, WORK TASK
ANALYSIS), DIRECT ONE ON ONE CONTACT BY PROVIDER, EACH 15
MINUTES
97542.... WHEELCHAIR MANAGEMENT/PROPULSION TRAINING, EACH 15 MINUTES
97545.... WORK HARDENING/CONDITIONING; INITIAL 2 HOURS
97546.... WORK HARDENING/CONDITIONING; EACH ADDITIONAL HOUR
97703.... CHECKOUT FOR ORTHOTIC/PROSTHETIC USE, ESTABLISHED PATIENT,
EACH 15 MINUTES
97750.... PHYSICAL PERFORMANCE TEST OR MEASUREMENT (EG,
MUSCULOSKELETAL, FUNCTIONAL CAPACITY), WITH WRITTEN REPORT,
EACH 15 MINUTES
97770.... DEVELOPMENT OF COGNITIVE SKILLS TO IMPROVE ATTENTION, MEMORY,
PROBLEM SOLVING, INCLUDES COMPENSATORY TRAINING AND/OR
SENSORY INTEGRATIVE ACTIVITIES, DIRECT (ONE ON ONE) PATIENT
CONTACT BY THE PROVIDER, EACH 15 MINUTES
97780.... ACUPUNCTURE, ONE OR MORE NEEDLES; WITHOUT ELECTRICAL
STIMULATION
97781.... ACUPUNCTURE, ONE OR MORE NEEDLES; WITH ELECTRICAL STIMULATION
97799.... UNLISTED PHYSICAL MEDICINE/REHABILITATION SERVICE OR
PROCEDURE
------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 1997 American Medical
Association. All Rights Reserved. Applicable FARS/DFARS apply.
\2\ Not all listed services are covered by the Medicare program.
Addendum E.--Physician Codes Potentially Subject to the Outpatient
Rehabilitation Financial Limitation
------------------------------------------------------------------------
CPT \1\
code Description
------------------------------------------------------------------------
29065.... APPLICATION; SHOULDER TO HAND (LONG ARM)
29075.... APPLICATION; ELBOW TO FINGER (SHORT ARM)
29085.... APPLICATION; HAND AND LOWER FOREARM (GAUNTLET)
29105.... APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND)
29125.... APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC
29130.... APPLICATION OF FINGER SPLINT; STATIC
29200.... STRAPPING; THORAX
29220.... STRAPPING; LOW BACK
29240.... STRAPPING; SHOULDER (EG, VELPEAU)
29260.... STRAPPING; ELBOW OR WRIST
29280.... STRAPPING; HAND OR FINGER
29345.... APPLICATION OF LONG LEG CAST (THIGH TO TOES);
29355.... APPLICATION OF LONG LEG CAST (THIGH TO TOES); WALKER OR
AMBULATORY TYPE
29358.... APPLICATION OF LONG LEG CAST BRACE
29365.... APPLICATION OF CYLINDER CAST (THIGH TO ANKLE)
29405.... APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES);
29425.... APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES); WALKING
OR AMBULATORY TYPE
29435.... APPLICATION OF PATELLAR TENDON BEARING (PTB) CAST
29445.... APPLICATION OF RIGID TOTAL CONTACT LEG CAST
29505.... APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR TOES)
29515.... APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT)
29520.... STRAPPING; HIP
29530.... STRAPPING; KNEE
29540.... STRAPPING; ANKLE
29550.... STRAPPING; TOES
29580.... STRAPPING; UNNA BOOT
29590.... DENIS-BROWNE SPLINT STRAPPING
------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 1997 American Medical
Association. All Rights Reserved. Applicable FARS/DFARS apply.
\2\ Not all listed services are covered by the Medicare program.
[[Page 31010]]
Addendum F.--Outpatient Rehabilitation Therapy Codes
------------------------------------------------------------------------
CPT1/code Description
------------------------------------------------------------------------
11040.... DEBRIDEMENT; SKIN, PARTIAL THICKNESS
11041.... DEBRIDEMENT; SKIN, FULL THICKNESS
11042.... DEBRIDEMENT; SKIN, AND SUBCUTANEOUS TISSUE
11043.... DEBRIDEMENT; SKIN, SUBCUTANEOUS TISSUE, AND MUSCLE
11044.... DEBRIDEMENT; SKIN, SUBCUTANEOUS TISSUE, MUSCLE, AND BONE
29065.... APPLICATION; SHOULDER TO HAND (LONG ARM)
29075.... APPLICATION; ELBOW TO FINGER (SHORT ARM)
29085.... APPLICATION; HAND AND LOWER FOREARM (GAUNTLET)
29345.... APPLICATION OF LONG LEG CAST (THIGH TO TOES);
29365.... APPLICATION OF CYLINDER CAST (THIGH TO ANKLE)
29405.... APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES);
29445.... APPLICATION OF RIGID TOTAL CONTACT LEG CAST
29105.... APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND)
29125.... APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC
29126.... APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); DYNAMIC
29130.... APPLICATION OF FINGER SPLINT; STATIC
29131.... APPLICATION OF FINGER SPLINT; DYNAMIC
29200.... STRAPPING; THORAX
29220.... STRAPPING; LOW BACK
29240.... STRAPPING; SHOULDER (EG, VELPEAU)
29260.... STRAPPING; ELBOW OR WRIST
29280.... STRAPPING; HAND OR FINGER
29505.... APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR TOES)
29515.... APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT)
29520.... STRAPPING; HIP
29530.... STRAPPING; KNEE
29540.... STRAPPING; ANKLE
29550.... STRAPPING; TOES
29580.... STRAPPING; UNNA BOOT
29590.... DENIS-BROWNE SPLINT STRAPPING
64550.... APPLICATION OF SURFACE (TRANSCUTANEOUS) NEUROSTIMULATOR
90724.... IMMUNIZATION, ACTIVE; INFLUENZA VIRUS VACCINE
90732.... IMMUNIZATION, ACTIVE; PNEUMOCOCCAL VACCINE, POLYVALENT
90744.... IMMUNIZATION, ACTIVE; HEPATITIS B VACCINE; NEWBORN TO 11
YEARS
90745.... IMMUNIZATION, ACTIVE; HEPATITIS B VACCINE; 11-19 YEARS
90746.... IMMUNIZATION, ACTIVE; HEPATITIS B VACCINE; 20 YEARS AND ABOVE
90747.... IMMUNIZATION, ACTIVE; HEPATITIS B VACCINE; DIALYSIS OR
IMMUNOSUPPRESSED PATIENT, ANY AGE
90804.... INDIVIDUAL PSYCHOTHERAPY, INSIGHT ORIENTED, BEHAVIOR
MODIFYING AND/OR SUPPORTIVE, IN AN OFFICE OR OUTPATIENT
FACILITY, APPROXIMATELY 20 TO 30 MINUTES FACT-TO-FACE WITH
THE PATIENT
90901.... BIOFEEDBACK TRAINING BY ANY MODALITY
90911.... BIOFEEDBACK TRAINING, PERINEAL MUSCLES, ANORECTAL OR URETHRAL
SPHINCTER, INCLUDING EMG AND/OR MANOMETRY
92506.... EVALUATION OF SPEECH, LANGUAGE, VOICE, COMMUNICATION,
AUDITORY PROCESSING, AND/OR AURAL REHABILITATION STATUS
92507.... TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/ OR
AUDITORY PROCESSING DISORDER (INCLUDES AURAL
REHABILITATION); INDIVIDUAL
92508.... TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/ OR
AUDITORY PROCESSING DISORDER (INCLUDES AURAL
REHABILITATION); GROUP, TWO OR MORE INDIVIDUALS
92510.... AURAL REHABILITATION FOLLOWING COCHLEAR IMPLANT (INCLUDES
EVALUATION OF AURAL REHABILITATION STATUS AND HEARING,
THERAPEUTIC SERVICES) WITH OR WITHOUT SPEECH PROCESSOR
PROGRAMMING
92525.... EVALUATION OF SWALLOWING AND ORAL FUNCTION FOR FEEDING
92526.... TREATMENT OF SWALLOWING DYSFUNCTION AND/OR ORAL FUNCTION FOR
FEEDING
92597.... EVALUATION FOR USE AND/OR FITTING OF VOICE PROSTHETIC OR
AUGMENTATIVE/ ALTERNATIVE COMMUNICATION DEVICE TO SUPPLEMENT
ORAL SPEECH
92598.... MODIFICATION OF VOICE PROSTHETIC OR AUGMENTATIVE/ALTERNATIVE
COMMUNICATION DEVICE TO SUPPLEMENT ORAL SPEECH
94664.... AEROSOL OR VAPOR INHALATIONS FOR SPUTUM MOBILIZATION,
BRONCHODILATION, OR SPUTUM INDUCTION FOR DIAGNOSTIC
PURPOSES; INITIAL DEMONSTRATION AND/OR EVALUATION
94665.... AEROSOL OR VAPOR INHALATIONS FOR SPUTUM MOBILIZATION,
BRONCHODILATION, OR SPUTUM INDUCTION FOR DIAGNOSTIC
PURPOSES; SUBSEQUENT
94667.... MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING, AND
VIBRATION TO FACILITATE LUNG FUNCTION; INITIAL DEMONSTRATION
AND/OR EVALUATION
94668.... MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING, AND
VIBRATION TO FACILITATE LUNG FUNCTION; SUBSEQUENT
95831.... MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); EXTREMITY
(EXCLUDING HAND) OR TRUNK, WITH REPORT
95832.... MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); HAND, WITH OR
WITHOUT COMPARISON WITH NORMAL SIDE
95833.... MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); TOTAL EVALUATION
OF BODY, EXCLUDING HANDS
95834.... MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); TOTAL EVALUATION
OF BODY, INCLUDING HANDS
[[Page 31011]]
95851.... RANGE OF MOTION MEASUREMENTS AND REPORT (SEPARATE PROCEDURE);
EACH EXTREMITY (EXCLUDING HAND) OR EACH TRUNK SECTION
(SPINE)
95852.... RANGE OF MOTION MEASUREMENTS AND REPORT (SEPARATE PROCEDURE);
HAND, WITH OR WITHOUT COMPARISON WITH NORMAL SIDE
96105.... ASSESSMENT OF APHASIA (INCLUDES ASSESSMENT OF EXPRESSIVE AND
RECEPTIVE SPEECH AND LANGUAGE FUNCTION, LANGUAGE
COMPREHENSION, SPEECH PRODUCTION ABILITY, READING, SPELLING,
WRITING, EG, BY BOSTON DIAGNOSTIC APHASIA EXAMINATION) WITH
INTERPRETATION AND REPOR
96110.... DEVELOPMENT TESTING; LIMITED (EG, DEVELOPMENTAL SCREENING
TEST II, EARLY LANGUAGE MILESTONE SCREEN), WITH
INTERPRETATION AND REPORT
96111.... DEVELOPMENTAL TESTING; EXTENDED (INCLUDES ASSESSMENT OF
MOTOR, LANGUAGE, SOCIAL, ADAPTIVE AND/OR COGNITIVE
FUNCTIONING BY STANDARDIZED DEVELOPMENTAL INSTRUMENTS, EG,
BAYLEY SCALES OF INFANT DEVELOPMENT) WITH INTERPRETATION AND
REPORT, PER HOUR
96115.... NEUROBEHAVIORAL STATUS EXAM (CLINICAL ASSESSMENT OF THINKING,
REASONING AND JUDGMENT, EG, ACQUIRED KNOWLEDGE,
ATTENTION,MEMORY, VISUAL SPATIAL ABILITIES, LANGUAGE
FUNCTIONS, PLANNING) WITH INTERPRETATION AND REPORT, PER
HOUR
97001.... PHYSICAL THERAPY EVALUATION
97002.... PHYSICAL THERAPY RE-EVALUATION
97003.... OCCUPATIONAL THERAPY EVALUATION
97004.... OCCUPATIONAL THERAPY RE-EVALUATION
97010.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; HOT OR COLD
PACKS
97012.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; TRACTION,
MECHANICAL
97014.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL
STIMULATION (UNATTENDED)
97016.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; VASOPNEUMATIC
DEVICES
97018.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; PARAFFIN BATH
97020.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; MICROWAVE
97022.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; WHIRLPOOL
97024.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; DIATHERMY
97026.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; INFRARED
97028.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRAVIOLET
97032.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL
STIMULATION (MANUAL), EACH 15 MINUTES
97033.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS;
IONTOPHORESIS, EACH 15 MINUTES
97034.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; CONTRAST
BATHS, EACH 15 MINUTES
97035.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRASOUND,
EACH 15 MINUTES
97036.... APPLICATION OF A MODALITY TO ONE OR MORE AREAS; HUBBARD TANK,
EACH 15 MINUTES
97039.... UNLISTED MODALITY (SPECIFY TYPE AND TIME IF CONSTANT
ATTENDANCE)
97110.... THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES;
THERAPEUTIC EXERCISES TO DEVELOP STRENGTH AND ENDURANCE,
RANGE OF MOTION AND FLEXIBILITY
97112.... THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES;
NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALANCE,
COORDINATION, KINESTHETIC SENSE, POSTURE, AND PROPRIOCEPTION
97113.... THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES;
AQUATIC THERAPY WITH THERAPEUTIC EXERCISES
97116.... THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES;
GAIT TRAINING (INCLUDES STAIR CLIMBING)
97122.... THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES;
TRACTION, MANUAL
97124.... THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES;
MASSAGE, INCLUDING EFFLEURAGE, PETRISSAGE AND/OR TAPOTEMENT
(STROKING, COMPRESSION, PERCUSSION)
97139.... THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES;
UNLISTED THERAPEUTIC PROCEDURE (SPECIFY)
97150.... THERAPEUTIC PROCEDURE(S), GROUP (2 OR MORE INDIVIDUALS)
97250.... MYOFASCIAL RELEASE/SOFT TISSUE MOBILIZATION, ONE OR MORE
REGIONS
97260.... MANIPULATION (CERVICAL, THORACIC, LUMBOSACRAL, SACROILIAC,
HAND, WRIST) (SEPARATE PROCEDURE), PERFORMED BY PHYSICIAN;
ONE AREA
97261.... MANIPULATION (CERVICAL, THORACIC, LUMBOSACRAL, SACROILIAC,
HAND, WRIST) (SEPARATE PROCEDURE), PERFORMED BY PHYSICIAN;
EACH ADDITIONAL AREA
97265.... JOINT MOBILIZATION, ONE OR MORE AREAS (PERIPHERAL OR SPINAL)
97504.... ORTHOTICS FITTING AND TRAINING, UPPER AND/OR LOWER
EXTREMITIES, EACH 15 MINUTES
97520.... PROSTHETIC TRAINING, UPPER AND/OR LOWER EXTREMITIES, EACH 15
MINUTES
97530.... THERAPEUTIC ACTIVITIES, DIRECT (ONE ON ONE) PATIENT CONTACT
BY THE PROVIDER (USE OF DYNAMIC ACTIVITIES TO IMPROVE
FUNCTIONAL PERFORMANCE), EACH 15 MINUTES
97535.... SELF CARE/HOME MANAGEMENT TRAINING (EG, ACTIVITIES OF DAILY
LIVING (ADL) AND COMPENSATORY TRAINING, MEAL PREPARATION,
SAFETY PROCEDURES, AND INSTRUCTIONS IN USE OF ADAPTIVE
EQUIPMENT) DIRECT ONE ON ONE CONTACT BY PROVIDER, EACH 15
MINUTES
97537.... COMMUNITY/WORK REINTEGRATION TRAINING (EG, SHOPPING,
TRANSPORTATION, MONEY MANAGEMENT, AVOCATIONAL ACTIVITIES AND/
OR WORK ENVIRONMENT/ MODIFICATION ANALYSIS, WORK TASK
ANALYSIS), DIRECT ONE ON ONE CONTACT BY PROVIDER, EACH 15
MINUTES
97542.... WHEELCHAIR MANAGEMENT/PROPULSION TRAINING, EACH 15 MINUTES
97545.... WORK HARDENING/CONDITIONING; INITIAL 2 HOURS
97546.... WORK HARDENING/CONDITIONING; EACH ADDITIONAL HOUR
97703.... CHECKOUT FOR ORTHOTIC/PROSTHETIC USE, ESTABLISHED PATIENT,
EACH 15 MINUTES
[[Page 31012]]
97750.... PHYSICAL PERFORMANCE TEST OR MEASUREMENT (EG,
MUSCULOSKELETAL, FUNCTIONAL CAPACITY), WITH WRITTEN REPORT,
EACH 15 MINUTES
97770.... DEVELOPMENT OF COGNITIVE SKILLS TO IMPROVE ATTENTION, MEMORY,
PROBLEM SOLVING, INCLUDES COMPENSATORY TRAINING AND/OR
SENSORY INTEGRATIVE ACTIVITIES, DIRECT (ONE ON ONE) PATIENT
CONTACT BY THE PROVIDER, EACH 15 MINUTES
97780.... ACUPUNCTURE, ONE OR MORE NEEDLES; WITHOUT ELECTRICAL
STIMULATION
97781.... ACUPUNCTURE, ONE OR MORE NEEDLES; WITH ELECTRICAL STIMULATION
97799.... UNLISTED PHYSICAL MEDICINE/REHABILITATION SERVICE OR
PROCEDURE DESCRIPTION
V5362.... SPEECH SCREENING
V5363.... LANGUAGE SCREENING
V5364.... DYSPHAGIA SCREENING
------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 1997 American Medical
Association. All Rights Reserved. Applicable FARS/DFARS apply.
\2\ Not all listed services are covered by the Medical program.
[FR Doc. 98-14650 Filed 6-1-98; 9:59 am]
BILLING CODE 4120-03-P