[Federal Register Volume 64, Number 125 (Wednesday, June 30, 1999)]
[Proposed Rules]
[Pages 35258-35513]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-16550]
[[Page 35257]]
_______________________________________________________________________
Part II
Department of Health and Human Services
_______________________________________________________________________
Health Care Financing Administration
_______________________________________________________________________
Office of Inspector General
_______________________________________________________________________
42 CFR Part 409 et al.
Medicare Program; Prospective Payment System for Hospital Outpatient
Services; Correction; Proposed Rule
Federal Register / Vol. 64, No. 125 / Wednesday, June 30, 1999 /
Proposed Rules
[[Page 35258]]
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
Office of Inspector General
42 CFR Parts 409, 410, 411, 412, 413, 419, 489, 498, and 1003
[HCFA-1005-CN]
RIN 0938-A156
Medicare Program; Prospective Payment System for Hospital
Outpatient Services; Correction
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Correction of proposed rule.
-----------------------------------------------------------------------
SUMMARY: This document corrects technical and typographic errors that
appeared in the proposed rule published in the Federal Register on
September 8, 1998 entitled ``Medicare Program; Prospective Payment
System for Hospital Outpatient Services.
FOR FURTHER INFORMATION CONTACT:
Janet Wellham, (410) 786-4510 (for general information).
Kitty Ahern, (410) 786-4515 (for information related to the
classification of services into ambulatory payment classification (APC)
groups).
Suzanne Letsch (410) 786-4558 (for information related to volume
control measures and updates).
Janet Samen (410) 789-9161 (for information on the application of APCs
to community health centers).
SUPPLEMENTARY INFORMATION:
Background
In FR Doc. 98-23383 of September 8, 1998 (63 FR 47551), we
published a proposed rule that reflected a number of technical errors,
resulting in inconsistencies between the proposed policies and the
associated numerical values. Specifically, the numerical values in the
proposed rule reflected incorrect data and data programming. This
document sets forth corrected numerical values.
The problems in the data and data programming are a direct result
of the frequent modifications to our databases during the initial
development of the model prospective payment system and the changes we
made during the development of the proposed rule to reflect the final
legislative provision enacted on August 5, 1997 in the Balanced Budget
Act of 1997 (BBA 1997), Public Law 105-33. We have corrected our
databases and our data programming, and this document corrects the
numerical values published in the September 8, 1998 proposed rule.
Correcting the data errors does not mean that the proposed policies
themselves need to be revised. Correcting the data changes the impacts
of the proposed policies to a very limited extent, but this document
does not revise any of the policies reflected in the September 8, 1998
proposed rule.
Accordingly, we have recalculated the current payment, total
services (total units) and corrected relative weights, proposed payment
rates, national unadjusted coinsurance, minimum unadjusted coinsurance,
and service-mix index that were published on September 8, 1998.
The service-mix indices previously published in the proposed rule
are significantly different from the service-mix index published in
this correction notice (in Addendum I) because the ambulatory payment
classification (APC) relative weights used to calculate the service mix
published in the proposed rule were scaled using a factor ``for a high-
level clinic visit for cardiovascular services (that is, APC 91356)
rather than a mid-level clinic visit for cardiovascular services,
identified as APC 91336.'' In addition, the service-mix index published
in this correction notice incorporates the discount policy applied to
multiple surgeries. However, the relative differences among hospitals
did not change substantially between the proposed and corrected
service-mix indices.
These data corrections required that we also correct our
simulations of current payment, costs, and total units, leading to
slight differences from the September 8, 1998 published version. Fully
modeling proposed payment after accounting for data corrections, we
calculated a new calendar year (CY) 1996 conversion factor of $46.87,
which is slightly higher than the published CY 1996 conversion factor
of $46.32. In addition to the data corrections mentioned above, we also
made a correction in the computation of the conversion factor to
appropriately account for wage index adjustments in proposed payments.
The adjusted CY 1999 conversion factor is $51.42.
Corrected simulations of costs and total units impacted the results
of the regression analyses that we use in conjunction with payment
simulations to determine whether the payment system should include
adjustments for specific classes of hospitals. However, the results do
not change our conclusion hat no adjustments be proposed at this time.
These corrections require revisions to the impact tables and they
also affect entries contained in Addendum A, Addendum B, Addendum C,
Addendum D, and Addendum G. Addendum J, Addendum K, and Addendum L are
revised to reflect the correct version of the wage index. Because of
the many corrections to these ``materials, we are reprinting portions
of the impact analysis and the entire impact tables and agenda, below,
in this notice.
The September 8, 1998 proposed rule also contained other technical
and typographic errors. Errors related to the incorrect assignment of
status indicators to certain CPT codes listed in Addendum B are
corrected and reflected in the revised Addendum B printed in full
below.
In FR Doc. 98-23383 of September 8, 1998, make the following
corrections to the preamble, regulations text and addenda:
Correction of Errors in the Preamble
1. On pages 47564 through 47565, the table titled ``Packaged
Services by Revenue Center'' is corrected to read as follows:
Packaged Services by Revenue Center
------------------------------------------------------------------------
------------------------------------------------------------------------
SURGERY
------------------------------------------------------------------------
250............................... PHARMACY
251............................... GENERIC
252............................... NONGENERIC
257............................... NONPRESCRIPTION DRUGS
258............................... IV SOLUTIONS
259............................... OTHER PHARMACY
270............................... M&S SUPPLIES
271............................... NONSTERILE SUPPLIES
272............................... STERILE SUPPLIES
276............................... INTRAOCULAR LENS
279............................... OTHER M&S SUPPLIES
370............................... ANESTHESIA
379............................... OTHER ANESTHESIA
380............................... BLOOD, GENERAL CLASS
381............................... PACKED RED CELLS
382............................... WHOLE BLOOD
383............................... PLASMA
384............................... PLATELETS
385............................... LEUCOCYTES
386............................... OTHER COMPONENTS
387............................... OTHER DERIVATIVES
389............................... OTHER BLOOD
390............................... BLOOD STORAGE AND PROCESSING
391............................... BLOOD ADMINISTRATION
399............................... OTHER BLOOD PROC/STORAGE
700............................... CAST ROOM
709............................... OTHER CAST ROOM
710............................... RECOVERY ROOM
719............................... OTHER RECOVERY ROOM
720............................... LABOR ROOM
721............................... LABOR
723............................... CIRCUMCISION
762............................... OBSERVATION ROOM
810............................... ORGAN ACQUISITION
[[Page 35259]]
819............................... OTHER ORGAN ACQUISITION
890............................... OTHER DONOR BANK
891............................... BONE
892............................... ORGAN
893............................... SKIN
899............................... OTHER DONOR BANK, OTHER
------------------------------------------------------------------------
MEDICAL VISIT
------------------------------------------------------------------------
250............................... PHARMACY
251............................... GENERIC
252............................... NONGENERIC
257............................... NONPRESCRIPTION DRUGS
258............................... IV SOLUTIONS
259............................... OTHER PHARMACY
270............................... M&S SUPPLIES
271............................... NONSTERILE SUPPLIES
272............................... STERILE SUPPLIES
279............................... OTHER M&S SUPPLIES
380............................... BLOOD, GENERAL CLASS
381............................... PACKED RED CELLS
382............................... WHOLE BLOOD
383............................... PLASMA
384............................... PLATELETS
385............................... LEUCOCYTES
386............................... OTHER COMPONENTS
387............................... OTHER DERIVATIVES
389............................... OTHER BLOOD
390............................... BLOOD STORAGE AND PROCESSING
391............................... BLOOD ADMINISTRATION
399............................... OTHER BLOOD PROC/STORAGE
700............................... CAST ROOM
709............................... OTHER CAST ROOM
762............................... OBSERVATION ROOM
------------------------------------------------------------------------
OTHER DIAGNOSTIC (BLENDED SERVICES)
------------------------------------------------------------------------
254............................... PHARMACY INCIDENT TO OTHER
DIAGNOSTIC
372............................... ANESTHESIA INCIDENT TO OTHER
DIAGNOSTIC
380............................... BLOOD, GENERAL CLASS
381............................... PACKED RED CELLS
382............................... WHOLE BLOOD
383............................... PLASMA
384............................... PLATELETS
385............................... LEUCOCYTES
386............................... OTHER COMPONENTS
397............................... OTHER DERIVATIVES
389............................... OTHER BLOOD
390............................... BLOOD STORAGE AND PROCESSING
391............................... BLOOD ADMINISTRATION
399............................... OTHER BLOOD PROC/STORAGE
622............................... SUPPLIES INCIDENT TO OTHER
DIAGNOSTIC
710............................... RECOVERY ROOM
719............................... OTHER RECOVERY ROOM
762............................... OBSERVATION ROOM
------------------------------------------------------------------------
RADIOLOGY
------------------------------------------------------------------------
255............................... PHARMACY INCIDENT TO RADIOLOGY
371............................... ANESTHESIA INCIDENT TO RADIOLOGY
380............................... BLOOD, GENERAL CLASS
381............................... PACKED RED CELLS
382............................... WHOLE BLOOD
383............................... PLASMA
384............................... PLATELETS
385............................... LEUCOCYTES
386............................... OTHER COMPONENTS
387............................... OTHER DERIVATIVES
389............................... OTHER BLOOD
390............................... BLOOD STORAGE AND PROCESSING
391............................... BLOOD ADMINISTRATION
399............................... OTHER BLOOD PROC/STORAGE
621............................... SUPPLIES INCIDENT TO RADIOLOGY
710............................... RECOVERY ROOM
719............................... OTHER RECOVERY ROOM
762............................... OBSERVATION ROOM
------------------------------------------------------------------------
ALL OTHER APC GROUPS
------------------------------------------------------------------------
250............................... PHARMACY
251............................... GENERIC
252............................... NONGENERIC
257............................... NONPRESCRIPTION DRUGS
258............................... IV SOLUTIONS
259............................... OTHER PHARMACY
270............................... M&S SUPPLIES
271............................... NONSTERILE SUPPLIES
272............................... STERILE SUPPLIES
279............................... OTHER M&S SUPPLIES
380............................... BLOOD, GENERAL CLASS
381............................... PACKED RED CELLS
382............................... WHOLE BLOOD
383............................... PLASMA
384............................... PLATELETS
385............................... LEUCOCYTES
386............................... OTHER COMPONENTS
387............................... OTHER DERIVATIVES
389............................... OTHER BLOOD
390............................... BLOOD STORAGE AND PROCESSING
391............................... BLOOD ADMINISTRATION
399............................... OTHER BLOOD PROC/STORAGE
762............................... OBSERVATION ROOM
------------------------------------------------------------------------
2. On page 47568, column two, line 16, the figure ``$208.25'' is
corrected to read ``$206.71''.
3. On page 47572, column one, last paragraph, the date and Federal
Register citation are corrected to read as follows: August 29, 1997 (62
FR 45984).
4. On page 47573, column three, line nine, ``$46.32'' is corrected
to read ``$46.87''.
5. On page 47573, column three, line 12, ``1.0939'' is corrected to
read ``1.097''.
6. On page 47573, column three, line 24, the text beginning with
the sentence ``In estimating the update factor, HCFA's Office of the
Actuary assumed * * *'' through the phrase ending ``Medicare absorbing
this impact'' in line 44 is removed.
7. On page 47573, column three, line 46, ``$50.67'' is corrected to
read ``$51.42''.
8. On page 47574, column two, in section 2(a)(ii), line four,
``29.2'' is corrected to read ``13.0''.
9. On page 47576, column two, line 26, ``1999'' is corrected to
read ``1998''.
10. On page 47576, column two, line 28, the Federal Register title,
date, and citation are corrected to read as follows: ``Changes to the
Hospital Inpatient Prospective Payment Systems and Fiscal Year 1998
Rates (BPD-878-FC) published in the Federal Register on August 29, 1997
(62 FR 45995)''.
11. On page 47577, column one, paragraph two, line 39, ``1996'' is
corrected to read ``1998''.
12. On page 47577, column two, last paragraph, line nine, ``$105''
is corrected to read ``$120''.
13. On page 47578, column two, second full paragraph, line four,
the following new sentence is added to read as follows: ``The edits
referred to in this section were not used in the development of the
weights or the impact analysis described in this proposed rule.''
14. On page 47580, column one, First line, the words ``level 1''
are added after the words ``hospitals with'' and before the word
``trauma''.
15. On page 47580, column one, line two, the sentence beginning
``These costs were * * *'' is removed and is replaced with the
following: ``These costs were 200 percent or more higher than the
average cost per unit for all hospitals.''
16. On page 47580, column one, last paragraph, line one, ``83'' is
corrected to read ``96''.
17. On page 47580, column one, last paragraph, line three, ``51''
is corrected to read ``46''.
18. On page 47580, column one, last paragraph, line six, ``32'' is
corrected to read ``50''.
19. On page 47580, column two, line five, ``5,419'' is corrected to
read ``5,335''.
20. On page 47580, column two, second full paragraph, line 14, the
words ``level 1'' are added before the words ``trauma unit''.
21. On page 47580, column two, last paragraph, line four, the
sentence beginning ``We also calculated * * *'' is removed and is
replaced with the following: ``This service mix is ``discounted'' to
reflect the reduced weight for additional surgical procedures performed
at the same time, which is consistent with the proposed payment
system.''
22. On page 47580, column two, last paragraph, line 10, the
sentence beginning ``The national average * * *'' is removed and is
replaced with the following: ``The national average service mix
discounted for multiple procedures is 2.05.''
[[Page 35260]]
23. On page 47580, column two, last paragraph, last line, remove
text from the sentence beginning ``The differences between * * *''
through line seven in column three.
24. On page 47580, column three, first full paragraph, line 13,
``0.68'' is corrected to read ``0.76''.
25. On page 47580, column three, first full paragraph, line 17,
``6.8 percent'' is corrected to read ``7.6 percent''.
26. On page 47580, column three, paragraph two, line 25, ``7.5
percent'' is corrected to read ``8.9 percent''.
27. On page 47580, column three, the third full paragraph through
page 47581, column one, line 10, is removed and is replaced with the
following: ``While the regression analysis shows less than a
proportional relationship between the service mix and the cost per
unit, the difference is relatively small. The coefficient of service
mix ranged from 0.76 to 0.92 over the regression models we examined. We
will continue to monitor the method of basing payments on median APC
costs to ascertain whether it is representative of both high-weighted
and low-weighted procedures.''
28. On page 47581, column one, first full paragraph, line nine,
``0.51 to 0.68'' is corrected to read ``0.40 to 0.58.''
29. On page 47581, column one, first full paragraph, lines 10 to
11, ``50 and 70 percent.'' is corrected to read ``40 and 60 percent.''
30. On page 47581, column one, first full paragraph, line 29, the
sentence beginning ``The explanatory regression * * *'' is removed.
31. On page 47581, column two, first full paragraph, line 10, the
word ``not'' is added before ``significant''.
32. On page 47581, column two, first full paragraph, line 13, ``4.5
percent [calculated (eDSHP*0.11-1)*100]'' is corrected read
``1.6 percent [calculated (eDSHP*0.04-1)*100]''.
33. On page 47581, column two, first full paragraph, line 16, the
text beginning with ``Teaching intensity * * *'' through line 21 ending
with ``services.'' is removed and is replaced with the following: ``The
extremely small percentage difference in costs reflects the lack of
significance observed for the disproportionate share variable. In most
regression specifications, the teaching intensity variables were
positive, significant (p<0.05), but small in magnitude.''
34. On page 47581, column two, last paragraph, line five, the text
beginning with ``We determined * * *'' through line 23 in column three,
is removed and is replaced with the following: ``The results of our
threshold analysis of disproportionate share percentage reflected the
lack of significance observed above. We could not identify a threshold
at which hospitals with a disproportionate share of low-income patients
evidenced higher standardized costs. The connection between
disproportionate share and volume warrants further analysis. However,
at this time, we cannot identify a threshold and, therefore, did not
calculate a new disproportionate share variable. Positive and
significant effects for the teaching variable do not occur for
hospitals whose ratio of residents to inpatient and outpatient days is
less than 0.28. We used these results to estimate a new ratio of
residents to inpatient and outpatient ``days'' based on a 0.28
threshold. We subtracted this threshold from the original variable to
create a new teaching variable. Subtracting The threshold removes the
effect of values that are not significantly related to cost per unit
and eliminates the sudden increase (notch effect) in the teaching
variable at the threshold level. The new variable suggests that a
hospital with a ratio of residents to inpatient and outpatient
utilization 0.07 higher than the 0.28 threshold is approximately 1
percent more costly [calculated ((1+IME)0.14-1)*100].''
35. On page 47581, column three, first full paragraph, line eight,
``8 percent'' is corrected to read ``12 percent''.
36. On page 47581, column three, first full paragraph, line nine,
``other'' is added before ``urban''.
37. On page 47581, column three, second full paragraph, line two,
``(long-term care, children's, and psychiatric)'' is corrected to read
``(long-term care and children's)''.
38. On page 47581, column three, second full paragraph, line six,
``Cancer, children's and long-term care'' is removed and is replaced
with ``These''.
39. On pages 47581 through 47582 and continued on page 47585,
through line five of the first full paragraph in column two, the text
in the section titled ``Estimated Payments'' is removed and is replaced
with the following:
The appropriateness of potential payment adjustments must be based
on both cost effects estimated by regression analysis and other factors
including simulated payment impacts. We simulated the impact of the
proposed system on hospitals by calculating the percentage difference
between payments made under current law and payments under the proposed
system (column 3). Section X. contains a more complete table that
considers the impact of proposed payments on additional classes of
hospitals, including TEFRA and cancer hospitals. Although Column 3
represents the net effect of the new PPS on hospitals, we though it was
necessary to show the impacts on hospitals of simply changing the
payment system without including the effects of the overall reduced
payment to hospitals because the PPS system is not budget neutral to
current payment. To reiterate, the conversion factor is set by summing
Medicare payments under the current system and beneficiary copayment
under the new system and dividing by the sum of the relative weights.
Beneficiary copayments under the new system will reduce overall
payments to most hospitals because 20 percent of the median group
charges is less than 20 percent of actual charges. Therefore, we
simulated the impacts as though the conversion factor were set as if
the system were to be budget neutral. Column 4 demonstrates the
distributional impacts resulting from implementing the new system after
eliminating the overall reduction in payment most hospitals will
experience due to the effect of the methodology used to set the
conversion factor. We believe the column 4 percentage differences are
what we should examine since any adjustment we would consider should
correct for inequities caused by moving to a PPS (not the legislated
reduction in total payment). Therefore, we based our decision about
adjustments on these percentage differences rather than percentages
combining the PPS and the overall reduction in coinsurance amounts
required by law. We also estimated payment-to-cost ratios associated
with the new payment methods and the percent change in total Medicare
payments. All simulations used a labor share of 60 percent. The table
below shows the results of two simulations. The first contains only the
wage index adjustment to the APC rates. The second also includes the
threshold adjustment for teaching intensity discussed above.
Based on our analyses, we are not proposing to make adjustments to
the outpatient payment rates for disproportionate share patient
percentage and teaching intensity and rural location for the following
reasons.
1. Estimated effects of disproportionate share patient percentage
on costs were small and most often not statistically significant.
2. After removing the copay effect, most teaching hospitals gain
under the proposed system payments relative to current law. Although
teaching hospitals with a large number of residents relative to
outpatient and inpatient utilization demonstrate slightly higher costs,
targeting these hospitals with a small adjustment does not greatly
improve their payment
[[Page 35261]]
impacts. These impacts should also be evaluated in terms of the overall
effect on Medicare payments because on average, outpatient services
account for 10 percent of hospitals' Medicare payments. For example,
the associated reduction of total Medicare payments for major teaching
hospitals would be about 1 percent.
3. With the teaching adjustment we considered, estimated overall
payment reductions for rural hospitals would be 7.9 percent under the
proposed system, rather than 7.4 percent. These hospitals also receive
a greater percent of their Medicare income (14.7 percent) from
providing outpatient services. Similarly, payment reductions for low-
volume rural hospitals would be 17.8 percent of current payments,
rather than 17.4 percent, and these hospitals also earn a greater
percentage of their Medicare income (18.4 percent) from providing
outpatient services. Because of these potential shifts in payments, any
adjustment should be based on stronger analytic results then those
found with the current data.
4. We also believe the issue of payment adjustments should be
reexamined using data from initial years of the implemented system
because current cost calculations and relationships among key factors
and costs probably are affected by variation in coding patterns.
5. HCFA is working towards standardizing payment across all sites
of service. Fewer adjustments to the outpatient PPS would allow HCFA to
move ahead more quickly with this approach.
6. We believe that we should monitor the impact of basing APC
weight calculations on the median rather than the geometric mean
because better correlation between costs and service mix would impact
the size of adjustments.
Although the payment simulations show potentially large percentage
losses and low payment-to-cost ratios for low-volume hospitals, we are
not proposing an adjustment for volume. The low-volume hospitals get a
much greater percent of their Medicare income from the provision of
outpatient services than the average, and total Medicare payments would
drop by 3.2 percent for rural low-volume hospitals and 1.7 percent for
urban low-volume hospitals. Low-volume hospitals have higher than
average standardized unit costs, which may be attributable to economies
of scale, undercoding, or cost allocations to the outpatient
departments that are not volume related. However, an adjustment to the
rates based on volume alone might reward inefficiency and create
adverse incentives such as a reduction in services in order to increase
payment rates.
We are particularly concerned about the potential impact of the
outpatient PPS on low-volume rural hospitals that are sole community
hospitals or Medicare-dependent hospitals.
39a. On page 47585, column two, first full paragraph, line six, the
sentence beginning ``Approximately 60 percent * * * is removed.
39b. On page 47585, the text in column three, first full paragraph,
through the third full paragraph is removed and replaced with the
following:
We also are not proposing adjustments for cancer or TEFRA hospitals
at this time. We believe that claims from cancer and TEFRA hospitals
have been undercoded, due to the lack of payment incentives for proper
coding of these services under the current system. Further analysis
will be conducted to determine if current coding practices explain the
negative impact. If we determine that cancer hospitals would be unduly
harmed because of the new outpatient PPS, we will consider whether an
adjustment or perhaps a transition period is needed to moderate the
impact. By statute, any adjustment would have to be budget neutral.
We do not believe that this action will restrict beneficiary access
because other hospitals provide many of the same services provided at
TEFRA hospitals. In addition, rehabilitation and long-term care
hospitals are less dependent than other hospitals on Medicare
outpatient revenues.
We are not proposing adjustments for any eye and ear hospitals
because payment simulations demonstrated an increase in payments under
the proposed PPS. We also are not proposing an adjustment for trauma
hospitals because these hospitals did not demonstrate significantly
higher costs and only lose a modest percentage of their total Medicare
payments, 0.8 percent, compared to all hospitals. We will assess the
need for additional adjustments and make any appropriate changes as
data become available under the new system.''
40. On pages 47583 through 47584, the table ``Changes for 1999
Outpatient Prospective Payment System'' is retitled ``Changes for
Outpatient Prospective Payment Systems'' and is corrected to read as
follows:
Changes for Outpatient Prospective Payment System
--------------------------------------------------------------------------------------------------------------------------------------------------------
No teaching adjustment Teaching adjustment
---------------------------------------------------------------------------------------
Percent Percent
change Percent change Percent
Number of Outpatient in Copay Standardized change in Copay Standardized change
hospitals percent Medicare Effect payment to is total Medicare Effect payment to in total
out- removed cost ratio Medicare out- removed cost ratio Medicare
patient payments patient payments
payments payments
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
--------------------------------------------------------------------------------------------------------------------------------------------------------
ALL HOSPITALS............................ 5,335 9.9 -5.7 0.0 1.0000 -0.6 -5.7 0.0 1.0000 -0.6
NON-TEFRA HOSPITALS..................
4,818 10.0 -5.7 0.0 1.0001 -0.6 -5.7 0.0 1.0001 -0.6
NON-TEFRA HOSPITALS
GEOGRAPHIC LOCATION:
URBAN HOSPITALS...................... 2,643 9.3 -5.3 0.4 1.0053 -0.5 -5.2 0.5 1.0065 -0.5
LARGE URBAN AREAS................ 1,492 9.1 -6.6 -0.9 0.9890 -0.6 -6.3 -0.6 0.9928 -0.6
OTHER URBAN AREAS................ 1,151 9.6 -3.5 2.4 1.0287 -0.3 -3.7 2.1 1.0262 -0.4
RURAL HOSPITALS...................... 2,173 14.7 -7.4 -1.8 0.9784 -1.1 -7.9 -2.3 0.9734 -1.2
VOLUME (URBAN):
0-4,999 UNITS........................ 357 12.2 -13.6 -8.3 0.8493 -1.7 -13.9 -8.7 0.8458 -1.7
5,000-10, 999 UNITS.................. 502 9.6 -6.6 -0.9 0.9577 -0.6 -7.0 -1.3 0.9535 -0.7
11,000-20,999 UNITS.................. 597 9.0 -5.7 0.0 0.9839 -0.5 -6.1 -0.4 0.9802 -0.5
21,000-42,999 UNITS.................. 756 8.8 -4.2 1.6 1.0202 -0.4 -4.4 1.4 1.0180 -0.4
43,000 OR MORE UNITS................. 431 9.7 -5.7 0.0 1.0133 -0.6 -5.1 0.7 1.0201 -0.5
[[Page 35262]]
VOLUME (RURAL):
0-4,999 UNITS........................ 1,047 18.4 -17.4 -12.4 0.8216 -3.2 -17.8 -12.8 0.8170 -3.3
5,000-10,999 UNITS................... 601 15.3 -10.1 -4.6 0.9384 -1.5 -10.6 -5.2 0.9332 -1.6
11,000- 20,999 UNITS................. 333 13.7 -6.5 -0.8 0.9962 -0.9 -7.0 -1.4 0.9910 -1.0
21,000- 42,999 UNITS................. 170 13.5 -3.2 2.7 1.0435 -0.4 -3.7 2.2 1.0376 -0.5
43,000 OR MORE UNITS................. 22 13.3 -2.6 +3.3 1.0674 -0.3 -2.6 3.3 1.0677 -0.3
TEACHING STATUS:
NON-TEACHING......................... 3,814 11.2 -5.1 0.7 1.0029 -0.6 -5.6 0.1 0.9973 -0.6
FEWER THAN 100 RESIDENTS............. 758 9.1 -4.4 1.4 1.0256 -0.4 -4.9 0.9 1.0204 -0.4
100 OR MORE RESIDENTS................ 245 9.2 -10.6 -5.2 0.9414 -1.0 -7.9 -2.3 0.9697 -0.7
DISPROPORTIONATE SHARE PATIENT RATIO:
0.................................... 17 20.3 -20.0 -15.1 0.7376 -4.1 -20.0 -15.1 0.7377 -4.1
0.001-0.099.......................... 904 10.3 -6.6 -0.9 0.9860 -0.7 -6.9 -1.2 0.9825 -0.7
0.100-0.159.......................... 1,008 10.9 -3.7 2.2 1.0307 -0.4 -4.1 1.7 1.0261 -0.4
0.160-0.229.......................... 971 10.2 -4.8 1.0 1.0143 -0.5 -4.9 0.9 1.0132 -0.5
0.230-0.349.......................... 956 9.6 -6.2 -0.5 0.9977 -0.6 -6.0 -0.3 1.0001 -0.6
0.350 AND GREATER.................... 962 9.2 -8.4 -2.9 0.9579 -0.8 -7.5 -1.9 0.9675 -0.7
--------------------------------------------------------------------------------------------------------------------------------------------------------
Note: Urban and rural breakouts in this table are based on MSA status/location only.
41. On page 47596, in the table titled ``Estimated Annual Burden'',
column one, line two, ``419.42(b) and (d)'' is corrected to read
``419.42(b) and (c)''.
42. On page 47596, in the table titled ``Estimated Annual Burden'',
column one, line three, ``419.42(f)'' is corrected to read
``419.42(e)''.
42a. On page 47597, column one, first full paragraph, line 14,
``$300'' is corrected to read ``$600''.
42b. On page 47597, column two, the table is corrected to read as
follows:
------------------------------------------------------------------------
Impact ($
Fiscal year millions)
------------------------------------------------------------------------
1998.................................................... -940
1999.................................................... -1640
2000.................................................... -1320
2001.................................................... -1070
2002.................................................... -990
2003.................................................... -700
------------------------------------------------------------------------
42c. On page 47597, column two, line five of text, ``6.9'' is
corrected to read ``10.9''.
43. On pages 47597 through 47598, entire section F. is removed and
replaced with the following:
F. Quantitative Impact Analysis of the Proposed Policy Changes Under
the Prospective Payment System for Operating Costs and Capital Costs
Basis and Methodology of Estimates
The data used in developing quantitative analyses presented below
are taken from the CY 1996 cost and charge data and the most current
provider-specific file that is used for payment purposes. Our analysis
has several qualifications. First, we draw upon various sources for the
data used to categorize hospitals in the tables. In some cases, there
is a fair degree of variation in the data from different sources. We
have attempted to construct these variables with the best available
source overall. For individual hospitals, however, some
miscategorizations are possible.
Using CY 1996 cost and charge data, we simulated payments using the
current and proposed payment methodologies. We used both single and
multiple bills to calculate current and proposed Medicare and
beneficiary hospital outpatient payment amounts. Both current and
proposed payment estimates include operating and capital costs. We
excluded Kaiser, New York Health and Hospital Corporation, and all-
inclusive providers because reported charges on their cost reports are
not actual charges. Cost-to-charge ratios for these hospitals are not
comparable to all other hospitals. The exempted Maryland hospitals were
also excluded from the simulations; however, we included the 10 cancer
hospitals that will be paid under the proposed system.
We also trimmed outlier hospitals from the impact analysis because
we had indications that hospitals with extreme unit costs would not
allow us to access the impacts among the various classes of hospitals
accurately. First, we identified all the outlier hospitals by using an
edit of three standard deviations from the mean of the logged unit
costs. Trimming the data in this manner ensures that only the hospitals
with extremely high and low costs are eliminated from the impacts. In
doing this, we removed 96 hospitals of which 50 hospitals had extremely
low unit costs and 46 hospitals had extremely high unit costs. We
conducted a thorough analysis of these hospitals to ensure that we did
not remove any particular type of hospital (for example, teaching
hospitals) that would further harm the integrity of the data. We
speculate many of these hospitals are not coding accurately, and we
will continue to perform further analysis in this area after
implementation of the new APC system.
After removing the 54 exempted Maryland hospitals, the all-
inclusive rate hospitals, the outlier hospitals, and hospitals for
which we could not identify payment variables, we included 5,335
hospitals in our analysis. The impact analysis focuses on this set of
hospitals. The table below demonstrates the results of our analysis.
The table categorizes hospitals by various geographic and special
payment consideration groups to illustrate the varying impacts on
different types of hospitals. The first column represents the number of
hospitals in each category. The second column is the hospitals'
Medicate outpatient payments as a percentage of the hospitals' total
Medicare payment. The third column shows the percentage change in
Medicare outpatient payments comparing the current and proposed payment
systems. The fourth column shows the change in total Medicare
[[Page 35263]]
payments, resulting from implementing the PPS for outpatient services.
The top row of the table shows the overall impact on the 5,335
hospitals included in the analysis. We included as much of the data as
possible to the extent that we were able to capture all the provider
information necessary to determine payment. Further, our estimates
include the same set of services for both current and proposed APC
payments so that we could determine the impact as accurately as
possible. Since payment under the proposed APC system can only be
determined if bills are accurately coded, the data upon which the
impacts were developed do not reflect all CY 1996 hospital outpatient
services, but only those that were coded using valid HCPCS.
The second row identifies the hospitals in our analysis with the
exception of psychiatric, long-term care, children, and rehabilitation
hospitals, which account for 4,818 hospitals.
The next four rows of the table contain hospitals categorized
according to their geographic location (all urban, which is further
divided into large urban and other urban, or rural). There are 2,643
hospitals located in urban areas (MSAs or NECMAs) included in our
analysis. Among these, there are 1,492 hospitals located in large urban
areas (populations over 1 million), and 1,151 hospitals in other urban
areas (populations of 1 million or fewer). In addition, there are 2,173
hospitals in rural areas. The next two groupings are by bed-size
categories, shown separately for urban and rural hospitals. The next
category includes the volume of outpatient services, also shown
separately for urban and rural hospitals. The final groupings by
geographic location are by census divisions, also shown separately for
urban and rural hospitals.
The next three groupings examine the impacts of the proposed
changes on hospitals grouped by whether or not they have residency
programs (teaching hospitals that receive an indirect medical education
(IME) adjustment), receive disproportionate share hospital (DSH)
payments, or some combination of these two adjustments. There are 3,814
non-teaching hospitals in our analysis, 758 teaching hospitals with
fewer than 100 residents, and 245 teaching hospitals with 100 or more
residents.
In the DSH categories, hospitals are grouped according to their DSH
payment status. The next category groups hospitals considered urban
after geographic reclassification, in terms of whether they receive the
IME adjustment, the DSH adjustment, both, or neither. The next five
rows examine the impacts of the proposed changes on rural hospitals by
special payment groups (rural referral centers (RRCs), sole community
hospitals/essential access community hospitals (SCHs/EACHs), Medicare
dependent hospitals (MDHs), and SCHs and RRCs), as well as rural
hospitals not receiving a special payment designation. The RRCs (168),
SCH/EACHs (626), MDHs (365), and SCH and RRCs (55) shown here were not
reclassified for purposes of the standardized amount.
The next grouping is based on type of ownership. These data are
taken primarily from the FY 1995 Medicare cost report files, if
available (otherwise, FY 1994 data are used).
The next groupings are the specialty hospitals. The first set
includes the categorizations of eye and ear hospitals and trauma
hospitals (hospitals having a level one trauma center) and cancer
hospitals. The final groupings are the TEFRA hospitals, specifically
rehabilitation, psychiatric, long-term care, and children hospitals.
43a. On page 47598, the text in section G. Beginning in column two,
first full paragraph, through page 47599, column three, line 16, is
removed and replaced with the following:
G. Estimated Impact of the New APC System
Column 3 compares our estimate of payments, incorporating statutory
and policy changes reflected in this proposed rule for CY 1996, to our
estimate of payments in CY 1996 under the current payment system.
Percent differences between current and proposed payment reflect the
combined impact of a proportionally equal reduction in payments due to
the calculation of the conversion factor and distributional differences
attributable to variation in cost and charge structures among
hospitals. The methodology described in section 1833(t)(3)(C) of the
Act outlining the calculation of the conversion factor reduces payment
to hospitals overall by 5.7 percent relative to current law. As noted,
section 1833(t)(3)(C) of the Act requires us to set the conversion
factor so that total 1999 payments to hospitals under the proposed PPS
system equal Medicare payment amounts as calculated under the current
payment system plus beneficiary copayments as calculated under the
proposed system (20 percent of the APC median charge or, at minimum, 20
percent of the APC rate). The 5.7 percent loss implies that the
difference between the median and charges higher than the median was
proportionally larger than the difference between the median and
charges lower than the median. Because this reduction is incorporated
into the conversion factor, the 5.7 percent is distributed among
hospitals proportional to their total payments. After removing the
effect of the conversion factor calculation on total payments, the
remaining percent differences demonstrate the redistribution of
payments among hospitals and can be attributed to variation in both
costs and charge structures. Variation in costs among hospitals results
in differences between current and proposed Medicare payments, and
variation in charge structures results in differences between current
and proposed beneficiary copayment.
Redistributions may also occur as a result of current payment
methods. Total Medicare outpatient payments are less than reported
total costs because (in addition to the 5.8 and 10 percent reductions
for operating and capital costs) the blended payment methods applicable
to many surgical and diagnostic services often result in payments that
are less than reported costs. Other services such as medical visits,
chemotherapy services, and non-ASC approved surgeries are paid based on
hospital costs. The new system redistributes the current total Medicare
payments, based in part on cost-based payments and in part on blended
payment amounts, across all services. Hospitals, in the aggregate, will
receive proportionately less for services that are currently paid based
on costs and more for services that had been paid under blended payment
methods.
The impact on TEFRA hospitals is shown separately at the end of the
table; however, these hospitals were not included in determining the
impact on any of the other categories (for example, geographic
location, bed size, volume, etc.). These hospitals demonstrated a very
low service mix, but an average unit cost that approximates the
national average. We believe that billing practices may account for
this phenomenon. Some TEFRA hospitals appear to undercode HCPCS and
units. This may be because correct coding is not required for payment
or because they bill an all-inclusive rate. Undercoding or billing an
all-inclusive rate could account for their low-volume, low-service mix,
and average cost per unit. We expect that once these hospitals begin to
code HCPCS according to the new payment system, new payments will
better reflect current payments.
In general, differences among hospital classifications for short-
term acute care
[[Page 35264]]
hospitals were relatively small. This is, payments under the proposed
outpatient system were within a few percentage points of payments made
under current law. The following discussion highlights some of the
variation in payments among hospital classifications.
Based on comparing current and proposed payment estimates, minor
teaching hospitals lose 4.4 percent, while major teaching hospitals
experience a reduction of 10.6 percent. Non-teaching hospitals
experience a decrease of 5.1 percent. However, major teaching hospitals
gain less of their total Medicare income (9.2 percent) from outpatient
services than the national average (10 percent). This results in a 1
percent loss in their total Medicare income.
Hospitals with a high percentage of low-income patients
(disproportionate share patient percentage greater than or equal to
0.35) appear to experience payment reductions of 8.4 percent relative
to current law. These hospitals have lower than average volume, and
like major teaching hospitals, they receive a smaller than average
percent of their Medicare income from outpatient services.
Rural hospitals would lose about 7.4 percent, large urban hospitals
would lose about 6.6 percent, and other urban hospitals would lose 3.5
under the new system. Rural hospitals get a greater percentage of their
Medicare income (14.7 percent) from outpatient services compared to the
national average of 10 percent.
Low-volume hospitals appear to lose a large percentage of their
payments under the new payment system (17.4 percent for rural and 13.6
percent for urban hospitals with less than 5,000 units of service). We
believe several factors are contributing to this outcome, including
undercoding, lack of economies of scale, and underpayment due to the
reliance on the median instead of the geometric mean in the calculation
of APC weights. The majority of these hospitals (about 75 percent) are
rural. For these small hospitals, some of the higher standardized unit
costs could be attributed to economies of scale. These low-volume rural
hospitals also receive a greater percentage of their Medicare income
(18.4 percent) from outpatient services than the average.
43b. On page 47599, the table titled: Estimated Impact of a
Transition Policy on Medicare Outpatient Payment for Medicare-Dependent
and Sole Community Hospitals,'' is corrected to read as follows:
Estimated Impact of a Transition Policy on Medicare Outpatient Payments
for Medicare-Dependent and Sole Community Hospitals
[In percent]
------------------------------------------------------------------------
Year 1 Year 2 Year 3 Year 4
------------------------------------------------------------------------
MDH......................... -2.8 -5.6 -8.5 -11.3
SCH......................... -3.2 -6.4 -9.7 -12.9
SCH/RRC..................... -1.9 -3.8 -5.8 -7.7
------------------------------------------------------------------------
43c. On page 47599, the text in section G. beginning in column two,
line seven from the bottom through page 47600, is corrected to read as
follows:
As noted above, rural hospitals lose a larger percent of their
payments than urban hospitals. Among the census divisions, rural New
England hospitals experience the largest negative payment impact of
12.2 percent. This could be attributed to higher nonlabor costs in New
England.
Urban census division breakouts reveal that Middle Atlantic urban
hospitals have the largest negative payment impact of 9.7 percent.
Hospitals located in Puerto Rico gain because of the change in the
beneficiary copayment. Previously these hospitals received 20 percent
of their charges from the beneficiary, whereas under the new PPS they
would receive 20 percent of the APC median charge or, at minimum, they
would receive 20 percent of the payment rate. Hospitals in Puerto Rico
gain under the new proposed system because 20 percent of their charges
are lower than 20 percent of the APC median charges or 20 percent of
the rates
Among special categories of rural hospitals, MDHs and SCHs/EACHs
would experience decreases of 11.3 and 12.9 percent, respectively, Some
of this decrease may be attributed to the impact on low-volume rural
hospitals.
Cancer hospitals experience a 32.4 percent loss. Several factors
may contribute to this loss. Undercoding could be a factor contributing
to the percentage loss. In addition, the current requirements for batch
billing of services such as chemotherapy and radiation therapy and the
fact that we used only single procedure bills to calculate group
weights may also have contributed to the impact on these hospitals.
Further analysis will be conducted to determine if current coding
practices explain the negative impact. We will be verifying the
accuracy of the rates for these types of procedures. Specifically, the
APC weights were calculated using single bill procedures. Using single
bill procedures to compute a weight for services that are not typically
billed as a single procedure could result in rates that are not
accurate for these services. We will verify the accuracy of the rates
for these types of procedures by analyzing the costs from the multiple
bills. If further analysis reveals that cancer hospitals would be
unduly harmed because of the new outpatient PPS, we will consider
whether an adjustment or perhaps a transition period is needed to
moderate the impact. By statute, any adjustment would have to be budget
neutral. Until further analysis can be conducted, we are not proposing
an adjustment for cancer hospitals.
In accordance with the provisions of Executive Order 12866, this
regulation was reviewed by the Office of Management and Budget.
44. On pages 47601 through 47604, the table titled ``Changes for
Outpatient Prospective Payment System'' is re-titled ``Impact of
Outpatient Prospective Payment System'' and corrected to read as
follows:
[[Page 35265]]
Impact of Outpatient Prospective Payment System
----------------------------------------------------------------------------------------------------------------
Percent Percent
change in change in
Number of Outpatient Medicare total
hospitals percent outpatient Medicare
payments payments
(1) (2) (3) (4)
----------------------------------------------------------------------------------------------------------------
ALL HOSPITALS............................................... 5,335 9.9 -5.7 -0.6
NON-TEFRA HOSPITALS.....................................
4,819 10.0 -5.7 -0.6
NON-TEFRA HOSPITALS
GEOGRAPHIC LOCATION:
URBAN HOSPITALS......................................... 2,643 9.3 -5.3 -0.5
LARGE URBAN AREAS................................... 1,492 9.1 -6.6 -0.6
OTHER URBAN AREAS................................... 1,151 9.6 -3.5 -0.3
RURAL HOSPITALS......................................... 2,173 14.7 -7.4 -1.1
BED SIZE (URBAN):
0-99 BEDS............................................... 646 15.4 -7.3 -1.1
100-199 BEDS............................................ 910 10.4 -4.2 -0.4
200-299 BEDS............................................ 531 9.2 -3.8 -0.3
300-499 BEDS............................................ 418 8.6 -4.8 -0.4
500 OR MORE BEDS........................................ 138 8.3 -9.7 -0.8
BED SIZE (RURAL):
0-49 BEDS............................................... 1,138 19.6 -13.8 -2.7
50-99 BEDS.............................................. 641 15.5 -8.4 -1.3
100-149 BEDS............................................ 229 13.5 -6.0 -0.8
150-199 BEDS............................................ 91 13.0 -4.3 -0.6
200 OR MORE BEDS........................................ 74 11.4 -2.9 -0.3
VOLUME (URBAN):
0-4,999 UNITS........................................... 357 12.2 -13.6 -1.7
5,000-10,999 UNITS...................................... 502 9.6 -6.6 -0.6
11,000-20,999 UNITS..................................... 597 9.0 -5.7 -0.5
21,000-42,999 UNITS..................................... 756 8.8 -4.2 -0.4
43,000 OR MORE UNITS.................................... 431 9.7 -5.7 -0.6
VOLUME (RURAL):
0-4,999 UNITS........................................... 1,047 18.4 -17.4 -3.2
5,000-10,999 UNITS...................................... 601 15.3 -10.1 -1.5
11,000-20,999 UNITS..................................... 333 13.7 -6.5 -0.9
21,000-42,999 UNITS..................................... 170 13.5 -3.2 -0.4
43,000 OR MORE UNITS.................................... 22 13.3 -2.6 -0.3
URBAN BY CENSUS DIV.:
NEW ENGLAND............................................. 148 10.8 -3.2 -0.3
MIDDLE ATLANTIC......................................... 391 8.3 -9.7 -0.8
SOUTH ATLANTIC.......................................... 393 8.6 -5.8 -0.5
EAST NORTH CENTRAL...................................... 446 10.6 -4.3 -0.5
EAST SOUTH CENTRAL...................................... 158 7.9 -1.8 -0.1
WEST NORTH CENTRAL...................................... 187 9.5 -6.5 -0.6
WEST SOUTH CENTRAL...................................... 337 9.7 -7.4 -0.7
MOUNTAIN................................................ 120 10.3 -2.2 -0.2
PACIFIC................................................. 428 9.3 -1.8 -0.2
PUERTO RICO............................................. 35 6.6 8.5 0.6
RURAL BY CENSUS DIV.:
NEW ENGLAND............................................. 56 16.9 -12.2 -2.1
MIDDLE ATLANTIC......................................... 81 13.5 0.2 0.0
SOUTH ATLANTIC.......................................... 282 11.8 -7.7 -0.9
EAST NORTH CENTRAL...................................... 287 15.8 -6.1 -1.0
EAST SOUTH CENTRAL...................................... 266 11.2 -6.5 -0.7
WEST NORTH CENTRAL...................................... 516 19.6 -10.9 -2.1
WEST SOUTH CENTRAL...................................... 339 14.2 -10.6 -1.5
MOUNTAIN................................................ 207 16.7 -8.3 -1.4
PACIFIC................................................. 137 16.4 -3.4 -0.6
PUERTO RICO............................................. 2 6.6 28.5 1.9
TEACHING STATUS:
NON-TEACHING............................................ 3,814 11.2 -5.1 -0.6
FEWER THAN 100 RESIDENTS................................ 758 9.1 -4.4 -0.4
100 OR MORE RESIDENTS................................... 245 9.2 -10.6 -1.0
DISPROPORTIONATE SHARE PATIENT RATIO:
0....................................................... 17 20.3 -20.0 -4.1
0.001-0.099............................................. 904 10.3 -6.6 -0.7
0.100-0.159............................................. 1,008 10.9 -3.7 -0.4
0.160-0.229............................................. 971 10.2 -4.8 -0.5
0.230-0.349............................................. 956 9.6 -6.2 -0.6
0.350 AND GREATER....................................... 962 9.2 -8.4 -0.8
[[Page 35266]]
URBAN TEACHING AND DSH:
BOTH TEACHING AND DSH................................... 944 9.0 -6.6 -0.6
TEACHING AND NO DSH..................................... 2 19.8 -31.0 -6.1
NO TEACHING AND DSH..................................... 1,688 9.8 -3.7 -0.4
NO TEACHING AND NO DSH.................................. 9 30.4 7.2 2.2
RURAL HOSPITAL TYPES:
NONSPECIAL STATUS HOSPITALS............................. 944 15.0 -6.8 -1.0
RRC..................................................... 168 12.4 -2.3 -0.3
SCH/EACH................................................ 626 16.4 -12.9 -2.1
MDH..................................................... 365 18.2 -11.3 -2.1
SCHM/EACH AND RRC....................................... 55 13.7 -7.7 -1.1
TYPE OF OWNERSHIP:
VOLUNTARY............................................... 2,839 9.9 -5.6 -0.6
PROPRIETARY............................................. 671 7.9 -4.7 -0.4
GOVERNMENT.............................................. 1,308 12.3 -7.4 -0.9
SPECIALTY HOSPITALS:
EYE AND EAR............................................. 10 31.1 10.4 3.2
TRAUMA.................................................. 157 9.1 -8.4 -0.8
CANCER.................................................. 10 22.0 -32.4 -7.1
TEFRA HOSPITALS:
REHABILITATION.......................................... 138 3.7 -11.1 -0.4
PSYCHIATRIC............................................. 278 10.7 -0.5 -0.1
LONG-TERM CARE.......................................... 63 3.7 -19.6 -0.7
CHILDREN'S.............................................. 38 9.4 -23.9 -2.2
----------------------------------------------------------------------------------------------------------------
Note: Urban and rural breakouts in this table are based on MSA status/location only.
Correction to the Regulations Text
Sec. 419.32 [Corrected]
45. On page 47613, in the regulations text, in column one, in
paragraph (b)(1), in the second line, ``paragraph (c)(2)'' is corrected
to read ``paragraph (b)(2)''; and in paragraph (b)(2), in the fourth
line, ``paragraph (c)(1)'' is corrected to read ``paragraph (b)(1)''.
Corrections to the Addenda
46. On pages 47615 through 47620, Addendum A is corrected to read
as follows:
Addendum A.--List of Proposed Hospital Outpatient Ambulatory Payment Classes with Status Indicators, Relative
Weights, Payment Rates, and Coinsurance Amounts
----------------------------------------------------------------------------------------------------------------
\7\ Minimum
APC Group title Status Relative Payment National unadjusted
indicator weight rate unadjusted coinsurance
----------------------------------------------------------------------------------------coinsurance-------------
\6\ 020 Partial ................... P 4.02 $206.71 $46.78 $41.34
Hospitalizaiton.
031 Dental procedures.. ................... S 1.37 $70.45 $14.09 $14.09
061 Level I ................... X 1.15 $59.13 $37.52 $11.83
Chemotherapeutic
agents.
062 Level II ................... X 1.78 $91.53 $36.61 $18.31
Chemotherapeutic
agents.
063 Level III ................... X 2.94 $151.17 $110.97 $30.24
Chemotherapeutic
agents.
064 Level IV ................... X 4.15 $213.39 $138.99 $42.68
Chemotherapeutic
agents.
089 Neuropsychological ................... X 4.06 $208.77 $46.10 $41.75
Testing.
090 Monitoring ................... X 0.85 $43.71 $12.20 $8.74
psychiatric drugs.
\1\ 091 Brief Individual ................... S 1.09 $56.05 $14.01 $11.21
Psychotherapy.
\2\ 092 Extended Individual ................... S 1.63 $83.81 $21.47 $16.76
Psychotherapy.
093 Family ................... S 1.56 $80.22 $20.11 $16.04
Psychotherapy.
094 Group Psychotherapy ................... S 1.31 $67.36 $19.89 $13.47
121 Level I needle ................... T 0.63 $32.39 $21.02 $6.48
biopsy/aspiration.
122 Level II needle ................... T 4.59 $236.02 $113.00 $47.20
biopsy/aspiration.
131 Level I incision & ................... T 1.93 $99.24 $36.61 $19.85
drainage.
132 Level II incision & ................... T 5.63 $289.49 $132.89 $57.90
drainage.
137 Nail procedures.... ................... T 0.60 $30.85 $9.27 $6.17
141 Level I Destruction ................... T 0.52 $26.74 $9.49 $5.35
of lesion.
142 Level II ................... T 2.94 $151.17 $54.24 $30.24
Destruction of
lesion.
151 Level I debridement/ ................... T 1.63 $83.81 $33.22 $16.76
destruction.
152 Level II ................... T 10.07 $517.80 $251.54 $103.56
debridement/
destruction.
161 Level I excision/ ................... T 3.43 $176.37 $75.71 $35.27
biopsy.
162 Level II excision/ ................... T 5.59 $287.44 $125.66 $57.49
biopsy.
163 Level III excision/ ................... T 10.48 $538.88 $260.80 $107.78
biopsy.
181 Level I skin repair ................... T 2.17 $111.58 $44.07 $22.32
182 Level II skin ................... T 4.11 $211.34 $92.43 $42.27
repair.
183 Level III skin ................... T 11.04 $567.68 $283.18 $113.54
repair.
[[Page 35267]]
184 Level IV skin ................... T 14.85 $763.59 $397.99 $152.72
repair.
197 Incision/excision ................... T 11.94 $613.95 $308.26 $122.79
breast.
198 Breast ................... T 18.63 $957.95 $523.42 $191.59
reconstruction/
mastectomy.
200 Arthrocentesis & ................... T 1.76 $90.50 $39.10 $18.10
Ligament/Tendon
Injection.
207 Closed treatment ................... T 1.70 $87.41 $32.32 $17.48
fracture finger/
toe/trunk.
209 Closed treatment ................... T 1.94 $99.75 $37.74 $19.95
fracture/
dislocation/except
finger/toe/trunk.
210 Bone/joint ................... T 10.06 $517.29 $279.34 $103.46
manipulation under
anesthesia.
216 Open/percutaneous ................... T 20.09 $1,033.03 $524.09 $206.61
treatment fracture
or dislocation.
217 Arthroplasty....... ................... T 20.54 $1,056.17 $530.42 $211.23
218 Arthroplasty with ................... T 27.80 $1,429.48 $720.71 $285.90
prosthesis.
226 Maxillofacial ................... T 1.56 $80.22 $21.92 $16.04
prostheses.
231 Level I skull and ................... T 11.31 $581.56 $286.79 $116.31
facial bone
procedures.
232 Level II skull and ................... T 23.82 $1,224.82 $636.87 $244.96
facial bone
procedures.
251 Level I ................... T 13.88 $713.71 $365.89 $142.74
musculoskeletal
procedures.
252 Level II ................... T 19.24 $989.32 $512.34 $197.86
Musculoskeletal
Procedures.
253 Level III ................... T 25.74 $1,323.55 $684.55 $264.71
Musculoskeletal
Procedures.
254 Level IV ................... T 32.70 $1,681.43 $922.98 $336.29
Musculoskeletal
Procedures.
261 Level I Hand ................... T 10.41 $535.28 $259.00 $107.06
Musculoskeletal
Procedures.
262 Level II Hand ................... T 18.07 $929.16 $475.96 $185.83
Musculoskeletal
Procedures.
271 Level I Foot ................... T 14.12 $726.05 $365.44 $145.21
Musculoskeletal
Procedures.
272 Level II Foot ................... T 16.11 $828.38 $411.09 $165.68
Musculoskeletal
Procedures.
276 Bunion Procedures.. ................... T 19.00 $976.98 $495.39 $195.40
280 Diagnostic ................... T 22.15 $1,138.95 $581.72 $227.79
Arthroscopy.
281 Level I Surgical ................... T 22.37 $1,150.27 $589.18 $230.05
Arthroscopy.
282 Level II Surgical ................... T 23.65 $1,216.08 $609.97 $243.22
Arthroscopy.
286 Arthroscopically- ................... T 27.69 $1,423.82 $791.90 $284.76
Aided Procedures.
311 Level I ENT ................... T 1.41 $72.50 $20.57 $14.50
Procedures.
312 Level II ENT ................... T 7.07 $363.54 $170.86 $72.71
Procedures.
313 Level III ENT ................... T 15.46 $794.95 $407.70 $158.99
Procedures.
314 Level IV ENT ................... T 25.15 $1,293.21 $687.72 $258.64
Procedures.
\5\ 317 Implantation of ................... T ......... ......... ........... ...........
Cochlear Device.
318 Nasal Cauterization/ ................... T 2.07 $106.44 $38.87 $21.29
Packing.
319 Tonsil/Adenoid ................... T 16.20 $833.00 $463.53 $166.60
Procedures.
320 Thoracentesis/ ................... T 3.09 $158.89 $80.91 $31.78
Lavage Procedures.
331 Level I Endoscopy ................... T 0.57 $29.31 $14.01 $5.86
Upper Airway.
332 Level II Endoscopy ................... T 9.67 $497.23 $242.72 $99.45
Upper Airway.
333 Level III Endoscopy ................... T 16.81 $864.37 $461.04 $172.87
Upper Airway.
336 Endoscopy Lower ................... T 7.24 $372.28 $195.49 $74.46
Airway.
339 Injection of ................... T 0.98 $50.39 $19.66 $10.08
Sclerosing
Solution.
341 Level I Needle and ................... T 0.09 $4.63 $2.49 $0.93
Catheter Placement.
342 Level II Needle and ................... T 2.61 $134.21 $68.70 $26.84
Catheter Placement.
343 Level III Needle ................... T 8.76 $450.44 $240.24 $90.09
and Catheter
Placement.
346 Placement ................... T 4.63 $238.07 $121.59 $47.61
Transvenous Caths/
Cutdown.
347 Injection ................... T 2.57 $132.15 $62.38 $26.43
Procedures for
Interventional
Radiology.
360 Removal/Revision, ................... T 6.04 $310.58 $138.54 $62.12
Pacemaker/Vascular
Device.
367 Vascular Ligation.. ................... T 17.02 $875.17 $441.15 $175.03
368 Vascular Repair/ ................... T 22.59 $1,161.58 $647.49 $232.32
Fistula
Construction.
369 Blood and Blood ................... T 6.33 $325.49 $155.49 $65.10
Product Exchange.
396 Lymph Node ................... T 12.98 $667.43 $334.48 $133.49
Excisions.
397 Thyroid/ ................... T 19.12 $983.15 $542.17 $196.63
Lymphadenectomy
Procedures.
406 Esophageal Dilation ................... T 4.17 $214.42 $106.67 $42.88
without Endoscopy.
407 Esophagoscopy...... ................... T 6.89 $354.28 $189.39 $70.86
417 Diagnostic Upper GI ................... T 6.35 $326.52 $179.22 $65.30
Endoscopy.
418 Therapeutic Upper ................... T 7.44 $382.56 $213.57 $76.51
GI Endoscopy.
419 Small Intestine ................... T 6.83 $351.20 $164.08 $70.24
Endoscopy.
426 Diagnostic Lower GI ................... T 6.74 $346.57 $185.32 $69.31
Endoscopy.
427 Therapeutic Lower ................... T 8.09 $415.99 $222.84 $83.20
GI Endoscopy.
437 Therapeutic ................... T 6.54 $336.29 $173.79 $67.26
Anoscopy.
446 Diagnostic ................... T 2.54 $130.61 $64.86 $26.12
Sigmoidoscopy.
447 Therapeutic ................... T 7.06 $363.03 $191.87 $72.61
Proctosigmoidoscop
y.
448 Therapeutic ................... T 5.28 $271.50 $139.22 $54.30
Flexible
Sigmoidoscopy.
449 Complex GI ................... T 7.63 $392.33 $213.57 $78.47
Endoscopy.
451 Level I Anal/Rectal ................... T 2.42 $124.44 $53.56 $24.89
Procedures.
452 Level II Anal/ ................... T 4.52 $232.42 $103.06 $46.48
Rectal Procedures.
453 Level III Anal/ ................... T 16.26 $836.09 $440.47 $167.22
Rectal Procedures.
456 Endoscopic ................... T 9.61 $494.15 $249.05 $98.83
Retrograde
Cholangio-
Pancreatography
(ERCP).
458 Percutaneous ................... T 6.81 $350.17 $181.70 $70.03
Biliary Endoscopic
Procedures.
459 Peritoneal and ................... T 17.85 $917.85 $497.88 $183.57
Abdominal
Procedures.
466 Hernia/Hydrocele ................... T 20.67 $1,062.85 $556.64 $212.57
Procedures.
470 Tube Procedures.... ................... T 2.19 $112.61 $54.92 $22.52
521 Level I ................... T 4.89 $251.44 $110.06 $50.29
Cystourethroscopy
and other
Genitourinary
Procedures.
[[Page 35268]]
522 Level II ................... T 10.15 $521.91 $259.45 $104.38
Cystourethroscopy
and other
Genitourinary
Procedures.
523 Level III ................... T 16.35 $840.72 $438.89 $168.14
Cystourethroscopy
and other
Genitourinary
Procedures.
524 Level IV ................... T 27.20 $1,398.62 $824.90 $279.72
Cystourethroscopy
and other
Genitourinary
Procedures.
527 Lithotripsy........ ................... T 43.48 $2,235.74 $1,372.95 $447.15
529 Simple Urinary ................... T 2.33 $119.81 $59.66 $23.96
Studies and
Procedures.
530 Genitourinary ................... T 2.46 $126.49 $53.34 $25.30
Procedures.
531 Level I Urethral ................... T 18.59 $955.90 $531.55 $191.18
Procedures.
532 Level II Urethral ................... T 23.02 $1,183.69 $588.50 $236.74
Procedures.
536 Circumcision....... ................... T 12.89 $662.80 $321.60 $132.56
537 Penile Procedures.. ................... T 28.65 $1,473.18 $872.36 $294.64
538 Insertion of Penile ................... T 48.41 $2,489.24 $1,563.47 $497.85
Prosthesis.
546 Testes/Epididymis ................... T 16.54 $850.49 $449.51 $170.10
Procedures.
547 Prostate Biopsy.... ................... T 4.39 $225.73 $125.20 $45.15
550 Surgical ................... T 16.46 $846.37 $445.22 $169.27
Hysteroscopy.
551 Level I Laparoscopy ................... T 24.61 $1,265.45 $701.73 $253.09
552 Level II ................... T 37.09 $1,907.17 $1,053.84 $381.43
Laparoscopy.
561 Level I Female ................... T 1.46 $75.07 $24.41 $15.01
Reproductive
Procedures.
562 Level II Female ................... T 12.30 $632.47 $325.44 $126.49
Reproductive
Procedures.
563 Level III Female ................... T 16.50 $848.43 $461.72 $169.69
Reproductive
Procedures.
567 D & C.............. ................... T 13.18 $677.72 $360.70 $135.54
568 Infertility ................... T 2.79 $143.46 $55.60 $28.69
Procedures.
578 Pregnancy and ................... T 1.17 $60.16 $32.77 $12.03
Neonatal Care
Procedures.
580 Vaginal Delivery... ................... T 4.31 $221.62 $44.32 $44.32
586 Therapeutic ................... T 11.98 $616.01 $409.29 $123.20
Abortion.
587 Spontaneous ................... T 12.96 $666.40 $347.14 $133.28
Abortion.
600 Spinal Tap......... ................... T 2.41 $123.92 $61.47 $24.78
601 Level I Nervous ................... T 3.00 $154.26 $74.13 $30.85
System Injections.
602 Level II Nervous ................... T 3.19 $164.03 $87.01 $32.81
System Injections.
616 Implantation of ................... T 11.85 $609.33 $329.06 $121.87
Neurostimulator
Electrodes.
617 Revision/Removal ................... T 11.31 $581.56 $280.01 $116.31
Neurological
Device.
618 Implantation of ................... T 24.78 $1,274.19 $808.18 $254.84
Neurological
Device.
631 Level I Nerve ................... T 12.70 $653.03 $329.06 $130.61
Procedures.
632 Level II Nerve ................... T 16.48 $847.40 $453.58 $169.48
Procedures.
648 Laser Retinal ................... T 3.76 $193.34 $93.56 $38.67
Procedures.
649 Laser Eye ................... T 4.37 $224.71 $111.64 $44.94
Procedures except
Retinal.
651 Level I Anterior ................... T 6.85 $352.23 $171.99 $70.45
Segment Eye
Procedures.
652 Level II Anterior ................... T 16.35 $840.72 $433.92 $168.14
Segment Eye
Procedures.
667 Cataract Procedures ................... T 20.35 $1,046.40 $538.11 $209.28
668 Cataract Procedures ................... T 22.02 $1,132.27 $617.21 $226.45
with IOL Insert.
670 Corneal Transplant. ................... T 30.78 $1,582.71 $885.92 $316.54
676 Posterior Segment ................... T 5.87 $301.84 $138.54 $60.37
Eye Procedures.
677 Strabismus/Muscle ................... T 16.11 $828.38 $428.95 $165.68
Procedures.
681 Level I Eye ................... T 1.65 $84.84 $30.51 $16.97
Procedures.
682 Level II Eye ................... T 3.41 $175.34 $80.68 $35.07
Procedures.
683 Level III Eye ................... T 9.56 $491.58 $252.44 $98.32
Procedures.
684 Level IV Eye ................... T 13.26 $681.83 $341.94 $136.37
Procedures.
690 Vitrectomy......... ................... T 30.39 $1,562.65 $845.69 $312.53
700 Plain Film......... ................... X 0.80 $41.14 $22.37 $8.23
706 Miscellaneous ................... X 1.43 $73.53 $39.10 $14.71
Radiological
Procedures.
710 Computerized Axial ................... S 4.98 $256.07 $173.12 $51.21
Tomography.
716 Fluoroscopy........ ................... X 1.39 $71.47 $40.00 $14.29
720 Magnetic Resonance ................... S 6.37 $327.55 $204.98 $65.51
Angiography.
726 Magnetic Resonance ................... S 7.91 $406.73 $256.06 $81.35
Imaging.
728 Myelography........ ................... S 3.50 $179.97 $91.98 $35.99
730 Arthography........ ................... S 2.30 $118.27 $65.77 $23.65
736 Digestive Radiology ................... S 1.85 $95.13 $53.79 $19.03
737 Diagnostic ................... S 2.69 $138.32 $81.81 $27.66
Urography.
738 Therapeutic ................... S 3.74 $192.31 $104.86 $38.46
Radiologic
Procedures.
739 Diagnostic ................... S 5.33 $274.07 $150.74 $54.81
Angiography and
Venography.
746 Mammography........ ................... S 0.69 $35.48 $19.44 $7.10
747 Diagnostic ................... S 1.65 $84.84 $54.47 $16.97
Ultrasound Except
Vascular.
749 Guidance under ................... X 2.22 $114.15 $70.06 $22.83
Ultrasound.
750 Therapeutic ................... X 0.96 $49.36 $25.99 $9.87
Radiation
Treatment Planning.
751 Level I Therapeutic ................... X 1.15 $59.13 $33.22 $11.83
Radiation
Treatment
Preparation.
752 Level II ................... X 3.48 $178.94 $86.56 $35.79
Therapeutic
Radiation
Treatment
Preparation.
757 Radiation Therapy.. ................... S 2.26 $116.21 $52.43 $23.24
758 Hyperthermic ................... S 5.08 $261.21 $137.18 $52.24
Therapies.
759 Brachytherapy and ................... S 7.98 $410.33 $157.97 $82.07
Complex
Radioelement
Applications.
760 PET Scans.......... ................... S 14.89 $765.64 $419.46 $153.13
761 Standard Non- ................... S 1.80 $92.56 $54.01 $18.51
Imaging Nuclear
Medicine.
762 Complex Non-Imaging ................... S 2.02 $103.87 $55.82 $20.77
Nuclear Medicine.
771 Standard Planar ................... S 3.81 $195.91 $117.29 $39.18
Nuclear Medicine.
[[Page 35269]]
772 Complex Planar ................... S 4.26 $219.05 $128.37 $43.81
Nuclear Medicine.
781 Standard SPECT ................... S 5.43 $279.21 $155.04 $55.84
Nuclear Medicine.
782 Complex SPECT ................... S 9.00 $462.78 $267.13 $92.56
Nuclear Medicine.
791 Standard ................... S 14.74 $757.93 $539.91 $151.59
Therapeutic
Nuclear Medicine.
792 Complex Therapeutic ................... S 4.81 $247.33 $143.06 $49.47
Nuclear Medicine.
861 Immunology Tests... ................... X 0.13 $6.68 $3.62 $1.34
881 Level I Pathology.. ................... X 0.22 $11.31 $6.78 $2.26
882 Level II Pathology. ................... X 0.39 $20.05 $11.75 $4.01
883 Level III Pathology ................... X 0.69 $35.48 $20.34 $7.10
900 Critical Care...... ................... S 7.54 $387.71 $145.09 $77.54
901 Level I ................... X 0.07 $3.60 $2.49 $0.72
Immunization.
902 Level II ................... X 1.31 $67.36 $38.19 $13.47
Immunization.
903 Level III ................... X 1.00 $51.42 $24.86 $10.28
Immunization.
906 Infusion Therapy ................... X 1.93 $99.24 $57.18 $19.85
except
Chemotherapy.
907 Intramuscular ................... X 0.74 $38.05 $11.53 $7.61
Injections.
\3\ 911 Low Level Clinic Well care and V 1.24 $63.76 $15.14 $12.75
11 Visits. administrative.
91118 Low Level Clinic Skin and breast V 0.83 $42.68 $9.27 $8.54
Visits. diseases.
91124 Low Level Clinic Musculoskeletal V 0.87 $44.74 $9.49 $8.95
Visits. diseases.
91131 Low Level Clinic Ear, nose, mouth V 0.81 $41.65 $9.04 $8.33
Visits. and throat
diseases.
91133 Low Level Clinic Respiratory system V 0.83 $42.68 $8.59 $8.54
Visits. diseases.
91136 Low Level Clinic Cardiovascular V 0.87 $44.74 $8.95 $8.95
Visits. system diseases.
91141 Low Level Clinic Digestive system V 0.96 $49.36 $10.40 $9.87
Visits. diseases.
91153 Low Level Clinic Kidney, urinary V 0.91 $46.79 $9.49 $9.36
Visits. tract and male
genital diseases.
91156 Low Level Clinic Female genital V 0.93 $47.82 $9.56 $9.56
Visits. system diseases.
91157 Low Level Clinic Pregnancy and V 1.37 $70.45 $17.85 $14.09
Visits. neonatal care.
91163 Low Level Clinic Nervous system V 0.98 $50.39 $10.17 $10.08
Visits. diseases.
91168 Low Level Clinic Eye diseases....... V 0.96 $49.36 $10.40 $9.87
Visits.
91172 Low Level Clinic Trauma and V 1.06 $54.51 $14.24 $10.90
Visits. poisoning.
91178 Low Level Clinic Major signs, V 1.52 $78.16 $21.47 $15.63
Visits. symptoms and
findings.
91182 Low Level Clinic Endocrine, V 0.87 $44.74 $9.04 $8.95
Visits. nutritional and
metabolic diseases.
91186 Low Level Clinic Immunologic and V 1.07 $55.02 $11.53 $11.00
Visits. hematologic
diseases.
91188 Low Level Clinic Malignancy......... V 0.72 $37.02 $8.14 $7.40
Visits.
\1\ 911 Low Level Clinic Psychiatric V 1.09 $56.05 $14.01 $11.21
91 Visits. disorders.
91197 Low Level Clinic Infectious disease. V 1.02 $52.45 $11.53 $10.49
Visits.
\4\ 911 Low Level Clinic Unknown cause of V 1.41 $72.50 $24.86 $14.50
99 Visits. mortality.
\3\ 913 Mid Level Clinic Well care and V 1.24 $63.76 $15.14 $12.75
11 Visits. administrative.
91318 Mid Level Clinic Skin and breast V 0.98 $50.39 $10.08 $10.08
Visits. diseases.
91324 Mid Level Clinic Musculoskeletal V 0.96 $49.36 $9.87 $9.87
Visits. diseases.
91331 Mid Level Clinic Ear, nose, mouth V 0.94 $48.33 $9.67 $9.67
Visits. and throat
diseases.
91333 Mid Level Clinic Respiratory system V 0.93 $47.82 $9.56 $9.56
Visits. diseases.
91336 Mid Level Clinic Cardiovascular V 1.00 $51.42 $10.28 $10.28
Visits. system diseases.
91341 Mid Level Clinic Digestive system V 1.00 $51.42 $10.28 $10.28
Visits. diseases.
91353 Mid Level Clinic Kidney, urinary V 1.00 $51.42 $10.28 $10.28
Visits. tract and male
genital diseases.
91356 Mid Level Clinic Female genital V 1.04 $53.48 $10.70 $10.70
Visits. system diseases.
91357 Mid Level Clinic Pregnancy and V 1.33 $68.39 $13.68 $13.68
Visits. neonatal care.
91363 Mid Level Clinic Nervous system V 1.04 $53.48 $10.70 $10.70
Visits. diseases.
91368 Mid Level Clinic Eye diseases....... V 0.85 $43.71 $8.74 $8.74
Visits.
91372 Mid Level Clinic Trauma and V 1.06 $54.51 $10.90 $10.90
Visits. poisoning.
91378 Mid Level Clinic Major signs, V 1.13 $58.10 $11.62 $11.62
Visits. symptoms and
findings.
91382 Mid Level Clinic Endocrine, V 1.00 $51.42 $10.28 $10.28
Visits. nutritional and
metabolic diseases.
91386 Mid Level Clinic Immunologic and V 1.04 $53.48 $10.70 $10.70
Visits. hematologic
diseases.
91388 Mid Level Clinic Malignancy......... V 0.83 $42.68 $8.54 $8.54
Visits.
\1\ 913 Mid Level Clinic Psychiatric V 1.09 $56.05 $14.01 $11.21
91 Visits. disorders.
91397 Mid Level Clinic Infectious disease. V 1.04 $53.48 $10.70 $10.70
Visits.
\4\ 913 Mid Level Clinic Unknown cause of V 1.41 $72.50 $24.86 $14.50
99 Visits. mortality.
\3\ 915 High Level Clinic Well care and V 1.24 $63.76 $15.14 $12.75
11 Visits. administrative.
91518 High Level Clinic Skin and breast V 1.72 $88.44 $19.21 $17.69
Visits. diseases.
91524 High Level Clinic Musculoskeletal V 1.46 $75.07 $15.37 $15.01
Visits. diseases.
91531 High Level Clinic Ear, nose, mouth V 1.35 $69.42 $14.24 $13.88
Visits. and throat
diseases.
91533 High Level Clinic Respiratory system V 1.44 $74.04 $14.81 $14.81
Visits. diseases.
91536 High Level Clinic Cardiovascular V 1.46 $75.07 $15.37 $15.01
Visits. system diseases.
91541 High Level Clinic Digestive system V 1.54 $79.19 $15.84 $15.84
Visits. diseases.
91553 High Level Clinic Kidney, urinary V 1.44 $74.04 $14.81 $14.81
Visits. tract and male
genital diseases.
91556 High Level Clinic Female genital V 1.44 $74.04 $15.14 $14.81
Visits. system diseases.
91557 High Level Clinic Pregnancy and V 1.76 $90.50 $22.83 $18.10
Visits. neonatal care.
91563 High Level Clinic Nervous system V 1.50 $77.13 $16.05 $15.43
Visits. diseases.
91568 High Level Clinic Eye diseases....... V 1.33 $68.39 $13.79 $13.68
Visits.
91572 High Level Clinic Trauma and V 1.72 $88.44 $22.15 $17.69
Visits. poisoning.
91578 High Level Clinic Major signs, V 1.89 $97.18 $29.15 $19.44
Visits. symptoms and
findings.
91582 High Level Clinic Endocrine, V 1.46 $75.07 $15.14 $15.01
Visits. nutritional and
metabolic diseases.
91586 High Level Clinic Immunologic and V 1.76 $90.50 $19.21 $18.10
Visits. hematologic
diseases.
91588 High Level Clinic Malignancy......... V 1.19 $61.19 $12.88 $12.24
Visits.
[[Page 35270]]
\2\ 915 High Level Clinic Psychiatric V 1.63 $83.81 $21.47 $16.76
91 Visits. disorders.
91597 High Level Clinic Infectious disease. V 1.76 $90.50 $19.66 $18.10
Visits.
\4\ 915 High Level Clinic Unknown cause of V 1.41 $72.50 $24.86 $14.50
99 Visits. mortality.
919 Electroconvulsive ................... S 3.09 $158.89 $80.00 $31.78
Therapy.
920 Biofeedback and ................... S 1.17 $60.16 $29.61 $12.03
other Training.
\5\ 921 Diabetes Education. ................... S ......... ......... ........... ...........
926 Dialysis for other ................... S 4.22 $216.99 $69.83 $43.40
than ESRD patients.
928 Alimentary Tests... ................... X 2.91 $149.63 $79.78 $29.93
930 Minor Eye ................... X 1.04 $53.48 $22.83 $10.70
Examinations.
931 Level I Eye Tests.. ................... X 0.74 $38.05 $21.47 $7.61
932 Level II Eye Tests. ................... X 2.41 $123.92 $63.73 $24.78
936 Fitting of Vision ................... X 0.48 $24.68 $9.49 $4.94
Aids.
940 Otorhinolaryngologi ................... X 3.13 $160.94 $52.21 $32.19
c Function Tests.
941 Level I Audiometry. ................... X 0.74 $38.05 $13.33 $7.61
942 Level II Audiometry ................... X 1.46 $75.07 $22.15 $15.01
947 Resuscitation and ................... S 4.11 $211.34 $106.22 $42.27
Cardioversion.
948 Cardiac ................... X 0.81 $41.65 $16.95 $8.33
Rehabilitation.
949 Cardiovascular ................... X 1.43 $73.53 $61.92 $14.71
Stress Test.
950 Electrocardiogram ................... X 0.35 $18.00 $15.82 $3.60
(ECG).
\3\ 951 Low Level ER Visits Well care and V 1.24 $63.76 $15.14 $12.75
11 administrative.
95118 Low Level ER Visits Skin and breast V 1.17 $60.16 $19.21 $12.03
diseases.
95124 Low Level ER Visits Musculoskeletal V 1.17 $60.16 $20.11 $12.03
diseases.
95131 Low Level ER Visits Ear, nose, mouth V 1.11 $57.08 $17.63 $11.42
and throat
diseases.
95133 Low Level ER Visits Respiratory system V 1.15 $59.13 $18.53 $11.83
diseases.
95136 Low Level ER Visits Cardiovascular V 1.26 $64.79 $19.89 $12.96
system diseases.
95141 Low Level ER Visits Digestive system V 1.30 $66.85 $21.02 $13.37
diseases.
95153 Low Level ER Visits Kidney, urinary V 1.43 $73.53 $24.86 $14.71
tract and male
genital diseases.
95156 Low Level ER Visits Female genital V 1.41 $72.50 $23.96 $14.50
system diseases.
95157 Low Level ER Visits Pregnancy and V 1.46 $75.07 $24.63 $15.01
neonatal care.
95163 Low Level ER Visits Nervous system V 1.30 $66.85 $22.60 $13.37
diseases.
95168 Low Level ER Visits Eye diseases....... V 1.20 $61.70 $20.79 $12.34
95172 Low Level ER Visits Trauma and V 1.28 $65.82 $22.15 $13.16
poisoning.
95178 Low Level ER Visits Major signs, V 1.94 $99.75 $36.39 $19.95
symptoms and
findings.
95182 Low Level ER Visits Endocrine, V 1.50 $77.13 $24.63 $15.43
nutritional and
metabolic diseases.
95186 Low Level ER Visits Immunologic and V 1.46 $75.07 $26.89 $15.01
hematologic
diseases.
95188 Low Level ER Visits Malignancy......... V 1.57 $80.73 $27.35 $16.15
\1\ 951 Low Level ER Visits Psychiatric V 1.09 $56.05 $14.01 $11.21
91 Disorders.
95197 Low Level ER Visits Infectious disease. V 1.24 $63.76 $20.57 $12.75
\4\ 951 Low Level ER Visits Unknown cause of V 1.41 $72.50 $24.86 $14.50
99 mortality.
\3\ 953 Mid Level ER Visits Well care and V 1.24 $63.76 $15.14 $12.75
11 administrative.
95318 Mid Level ER Visits Skin and breast V 1.89 $97.18 $34.80 $19.44
diseases.
95324 Mid Level ER Visits Musculoskeletal V 1.78 $91.53 $32.32 $18.31
diseases.
95331 Mid Level ER Visits Ear, nose, mouth V 1.80 $92.56 $31.64 $18.51
and throat
diseases.
95333 Mid Level ER Visits Respiratory system V 1.91 $98.21 $33.67 $19.64
diseases.
95336 Mid Level ER Visits Cardiovascular V 2.02 $103.87 $36.16 $20.77
system diseases.
95341 Mid Level ER Visits Digestive system V 2.02 $103.87 $36.61 $20.77
diseases.
95353 Mid Level ER Visits Kidney, urinary V 2.06 $105.93 $38.65 $21.19
tract and male
genital diseases.
95356 Mid Level ER Visits Female genital V 2.06 $105.93 $36.84 $21.19
system diseases.
95357 Mid Level ER Visits Pregnancy and V 2.10 $107.98 $40.68 $21.60
neonatal care.
95363 Mid Level ER Visits Nervous system V 1.89 $97.18 $35.03 $19.44
diseases.
95368 Mid Level ER Visits Eye diseases....... V 1.67 $85.87 $33.00 $17.17
95372 Mid Level ER Visits Trauma and V 2.02 $103.87 $39.10 $20.77
poisoning.
95378 Mid Level ER Visits Major signs, V 3.07 $157.86 $58.76 $31.57
symptoms and
findings.
95382 Mid Level ER Visits Endocrine, V 2.30 $118.27 $43.84 $23.65
nutritional and
metabolic diseases.
95386 Mid Level ER Visits Immunologic and V 2.48 $127.52 $49.27 $25.50
hematologic
diseases.
95388 Mid Level ER Visits Malignancy......... V 2.17 $111.58 $42.26 $22.32
95391 Mid Level ER Visits Psychiatric V 2.02 $103.87 $35.93 $20.77
Disorders.
95397 Mid Level ER Visits Infectious disease. V 1.99 $102.33 $36.61 $20.47
\4\ 953 Mid Level ER Visits Unknown cause of V 1.41 $72.50 $24.86 $14.50
99 mortality.
\3\ 955 High Level ER Well care and V 1.24 $63.76 $15.14 $12.75
11 Visits. administrative.
95518 High Level ER Skin and breast V 2.59 $133.18 $46.78 $26.64
Visits. diseases.
95524 High Level ER Musculoskeletal V 2.46 $126.49 $41.36 $25.30
Visits. diseases.
95531 High Level ER Ear, nose, mouth V 2.57 $132.15 $44.07 $26.43
Visits. and throat
diseases.
95533 High Level ER Respiratory system V 3.13 $160.94 $54.69 $32.19
Visits. diseases.
95536 High Level ER Cardiovascular V 3.13 $160.94 $54.69 $32.19
Visits. system diseases.
95541 High Level ER Digestive system V 2.89 $148.60 $54.69 $29.72
Visits. diseases.
95553 High Level ER Kidney, urinary V 2.87 $147.58 $54.69 $29.52
Visits. tract and male
genital diseases.
95556 High Level ER Female genital V 2.70 $138.83 $51.08 $27.77
Visits. system diseases.
95557 High Level ER Pregnancy and V 2.89 $148.60 $54.92 $29.72
Visits. neonatal care.
95563 High Level ER Nervous system V 2.74 $140.89 $52.43 $28.18
Visits. diseases.
95568 High Level ER Eye diseases....... V 2.33 $119.81 $40.23 $23.96
Visits.
95572 High Level ER Trauma and V 2.72 $139.86 $50.17 $27.97
Visits. poisoning.
95578 High Level ER Major signs, V 6.83 $351.20 $148.48 $70.24
Visits. symptoms and
findings.
[[Page 35271]]
95582 High Level ER Endocrine, V 3.26 $167.63 $64.86 $33.53
Visits. nutritional and
metabolic diseases.
95586 High Level ER Immunologic and V 3.89 $200.02 $81.81 $40.00
Visits. hematologic
diseases.
95588 High Level ER Malignancy......... V 3.63 $186.65 $68.48 $37.33
Visits.
95591 High Level ER Psychiatric V 3.48 $178.94 $62.60 $35.79
Visits. Disorders.
95597 High Level ER Infectious disease. V 2.78 $142.95 $53.11 $28.59
Visits.
\4\ 955 High Level ER Unknown cause of V 1.41 $72.50 $24.86 $14.50
99 Visits. mortality.
956 Continuous ECG and ................... X 1.09 $56.05 $54.47 $11.21
Blood Pressure
Monitoring.
957 Echocardiography... ................... S 4.04 $207.74 $114.13 $41.55
958 Diagnostic Cardiac ................... S 23.74 $1,220.71 $705.57 $244.14
Catheterization.
960 Cardiac ................... S 4.80 $246.82 $143.74 $49.36
Electrophysiologic
Tests/Procedures.
966 Electronic Analysis ................... X 0.39 $20.05 $12.43 $4.01
of Pacemakers/
other Devices.
967 Non-Invasive ................... X 1.70 $87.41 $57.40 $17.48
Vascular Studies.
968 Vascular Ultrasound ................... X 2.39 $122.89 $79.55 $24.58
969 Hyperbaric Oxygen.. ................... S 2.65 $136.26 $141.70 $27.25
971 Level I Pulmonary ................... X 0.98 $50.39 $26.44 $10.08
Tests.
972 Level II Pulmonary ................... X 1.00 $51.42 $29.38 $10.28
Tests.
973 Level III Pulmonary ................... S 1.81 $93.07 $55.82 $18.61
Tests.
976 Pulmonary Therapy.. ................... S 0.44 $22.62 $14.69 $4.53
977 Allergy Tests...... ................... X 0.56 $28.80 $11.30 $5.76
978 Allergy Injections. ................... X 0.30 $15.43 $3.39 $3.09
979 Extended EEG ................... S 10.15 $521.91 $287.25 $104.38
Studies and Sleep
Studies.
980 Electroencephalogra ................... S 2.15 $110.55 $57.86 $22.11
m.
981 Level I Nerve and ................... X 1.22 $62.73 $34.35 $12.55
Muscle Tests.
982 Level II Nerve and ................... X 1.37 $70.45 $38.42 $14.09
Muscle Tests.
987 Subcutaneous or ................... S 2.09 $107.47 $65.09 $21.49
Intramuscular
Chemotherapy.
988 Chemotherapy except ................... S 4.02 $206.71 $110.29 $41.34
by Extended
Infusion.
989 Chemotherapy by ................... S 1.91 $98.21 $44.52 $19.64
Extended Infusion.
990 Photochemotherapy.. ................... S 0.43 $22.11 $8.14 $4.42
997 Manipulation ................... S 0.69 $35.48 $7.46 $7.10
Therapy.
999 Therapeutic ................... X 0.43 $22.11 $11.07 $4.42
Phlebotomy.
----------------------------------------------------------------------------------------------------------------
Notes:
\1\ Median costs APCs 091, 91191, 91391, 95191 computed together because there is no differences in facility
resources.
\2\ Median costs APCs 092 and 91591 computed together because there is no differences in facility resources.
\3\ Median costs for all claims in combined visit levels for MDC 11; one rate is paid for multiple levels.
\4\ Median costs for all claims in combined visit levels for MDC 99; one rate is paid for multiple levels.
\5\ APCs 317 and 921 have anomalous weights. Refer to preamble for discussion.
\6\ This APC reflects the per-diem payment for patients recieving services under a partial hospitalization
program.
\7\ The national unadjusted coinsurance amount is subtracted from the proposed payment rate to determine the
amount Medicare pays.
47. On pages 47621 through 47761, Addendum B is corrected to read
as follows:
CPT codes and descriptions only are
copyright 1997 American Medical Association. All rights reserved.
Applicable FARS/DFARS apply.
Copyright 1994 American Dental Association. All rights reserved.
[[Page 35271]]
Addendum B.--Proposed Hospital Outpatient Department (HOPD) Payment Status by HCPCS Code and Related Information
----------------------------------------------------------------------------------------------------------------
Proposed National Minimum
CPT/ HOPD status Description Proposed Relative payment unadjusted unadjusted
HCPCS indicator APC weight rate coinsurance coinsurance
----------------------------------------------------------------------------------------------------------------
00100 N Anesth, skin surgery... ......... ......... ......... ........... ...........
00102 N Anesth, repair of cleft ......... ......... ......... ........... ...........
lip.
00103 N Anesth, blepharoplasty. ......... ......... ......... ........... ...........
00104 N Anesth for electroshock ......... ......... ......... ........... ...........
00120 N Anesthesia for ear ......... ......... ......... ........... ...........
surgery.
00124 N Anesthesia for ear exam ......... ......... ......... ........... ...........
00126 N Anesth, tympanotomy.... ......... ......... ......... ........... ...........
00140 N Anesth, procedures on ......... ......... ......... ........... ...........
eye.
00142 N Anesthesia for lens ......... ......... ......... ........... ...........
surgery.
00144 N Anesth, corneal ......... ......... ......... ........... ...........
transplant.
00145 N Anesth, vitrectomy..... ......... ......... ......... ........... ...........
00147 N Anesth, iridectomy..... ......... ......... ......... ........... ...........
00148 N Anesthesia for eye exam ......... ......... ......... ........... ...........
00160 N Anesth, nose, sinus ......... ......... ......... ........... ...........
surgery.
00162 N Anesth, nose, sinus ......... ......... ......... ........... ...........
surgery.
00164 N Anesth, biopsy of nose. ......... ......... ......... ........... ...........
00170 N Anesth, procedure on ......... ......... ......... ........... ...........
mouth.
00172 N Anesth, cleft palate ......... ......... ......... ........... ...........
repair.
00174 C Anesth, pharyngeal ......... ......... ......... ........... ...........
surgery.
00176 C Anesth, pharyngeal ......... ......... ......... ........... ...........
surgery.
[[Page 35272]]
00190 N Anesth, facial bone ......... ......... ......... ........... ...........
surgery.
00192 C Anesth, facial bone ......... ......... ......... ........... ...........
surgery.
00210 N Anesth, open head ......... ......... ......... ........... ...........
surgery.
00212 N Anesth, skull drainage. ......... ......... ......... ........... ...........
00214 C Anesth, skull drainage. ......... ......... ......... ........... ...........
00215 C Anesth, skull fracture. ......... ......... ......... ........... ...........
00216 N Anesth, head vessel ......... ......... ......... ........... ...........
surgery.
00218 N Anesth, special head ......... ......... ......... ........... ...........
surgery.
00220 N Anesth, spinal fluid ......... ......... ......... ........... ...........
shunt.
00222 N Anesth, head nerve ......... ......... ......... ........... ...........
surgery.
00300 N Anesth, skin surgery, ......... ......... ......... ........... ...........
neck.
00320 N Anesth, neck organ ......... ......... ......... ........... ...........
surgery.
00322 N Anesth, biopsy of ......... ......... ......... ........... ...........
thyroid.
00350 N Anesth, neck vessel ......... ......... ......... ........... ...........
surgery.
00352 N Anesth, neck vessel ......... ......... ......... ........... ...........
surgery.
00400 N Anesth, chest skin ......... ......... ......... ........... ...........
surgery.
00402 N Anesth, surgery of ......... ......... ......... ........... ...........
breast.
00404 C Anesth, surgery of ......... ......... ......... ........... ...........
breast.
00406 C Anesth, surgery of ......... ......... ......... ........... ...........
breast.
00410 N Anesth, correct heart ......... ......... ......... ........... ...........
rhythm.
00420 N Anesth, skin surgery, ......... ......... ......... ........... ...........
back.
00450 N Anesth, surgery of ......... ......... ......... ........... ...........
shoulder.
00452 C Anesth, surgery of ......... ......... ......... ........... ...........
shoulder.
00454 N Anesth, collar bone ......... ......... ......... ........... ...........
biopsy.
00470 N Anesth, removal of rib. ......... ......... ......... ........... ...........
00472 N Anesth, chest wall ......... ......... ......... ........... ...........
repair.
00474 C Anesth, surgery of ......... ......... ......... ........... ...........
rib(s).
00500 N Anesth, esophageal ......... ......... ......... ........... ...........
surgery.
00520 N Anesth, chest procedure ......... ......... ......... ........... ...........
00522 N Anesth, chest lining ......... ......... ......... ........... ...........
biopsy.
00524 C Anesth, chest drainage. ......... ......... ......... ........... ...........
00528 N Anesth, chest partition ......... ......... ......... ........... ...........
view.
00530 C Anesth, pacemaker ......... ......... ......... ........... ...........
insertion.
00532 N Anesth, vascular access ......... ......... ......... ........... ...........
00534 N Anesth, cardioverter/ ......... ......... ......... ........... ...........
defib.
00540 C Anesth, chest surgery.. ......... ......... ......... ........... ...........
00542 C Anesth, release of lung ......... ......... ......... ........... ...........
00544 C Anesth, chest lining ......... ......... ......... ........... ...........
removal.
00546 C Anesth, lung,chest wall ......... ......... ......... ........... ...........
surg.
00548 N Anesth, trachea,bronchi ......... ......... ......... ........... ...........
surg.
00560 C Anesth, open heart ......... ......... ......... ........... ...........
surgery.
00562 C Anesth, open heart ......... ......... ......... ........... ...........
surgery.
00580 C Anesth,heart/lung ......... ......... ......... ........... ...........
transplant.
00600 N Anesth, spine, cord ......... ......... ......... ........... ...........
surgery.
00604 C Anesth, surgery of ......... ......... ......... ........... ...........
vertebra.
00620 N Anesth, spine, cord ......... ......... ......... ........... ...........
surgery.
00622 C Anesth, removal of ......... ......... ......... ........... ...........
nerves.
00630 N Anesth, spine, cord ......... ......... ......... ........... ...........
surgery.
00632 C Anesth, removal of ......... ......... ......... ........... ...........
nerves.
00634 C Anesth for ......... ......... ......... ........... ...........
chemonucleolysis.
00670 C Anesth, spine, cord ......... ......... ......... ........... ...........
surgery.
00700 N Anesth, abdominal wall ......... ......... ......... ........... ...........
surg.
00702 N Anesth, for liver ......... ......... ......... ........... ...........
biopsy.
00730 N Anesth, abdominal wall ......... ......... ......... ........... ...........
surg.
00740 N Anesth, gi ......... ......... ......... ........... ...........
visualization.
00750 N Anesth, repair of ......... ......... ......... ........... ...........
hernia.
00752 N Anesth, repair of ......... ......... ......... ........... ...........
hernia.
00754 N Anesth, repair of ......... ......... ......... ........... ...........
hernia.
00756 N Anesth, repair of ......... ......... ......... ........... ...........
hernia.
00770 N Anesth, blood vessel ......... ......... ......... ........... ...........
repair.
00790 N Anesth, surg upper ......... ......... ......... ........... ...........
abdomen.
00792 C Anesth, part liver ......... ......... ......... ........... ...........
removal.
00794 C Anesth, pancreas ......... ......... ......... ........... ...........
removal.
00796 C Anesth, for liver ......... ......... ......... ........... ...........
transplant.
00800 N Anesth, abdominal wall ......... ......... ......... ........... ...........
surg.
00802 C Anesth, fat layer ......... ......... ......... ........... ...........
removal.
00810 N Anesth, intestine ......... ......... ......... ........... ...........
endoscopy.
00820 N Anesth, abdominal wall ......... ......... ......... ........... ...........
surg.
00830 N Anesth, repair of ......... ......... ......... ........... ...........
hernia.
00832 N Anesth, repair of ......... ......... ......... ........... ...........
hernia.
00840 N Anesth, surg lower ......... ......... ......... ........... ...........
abdomen.
00842 N Anesth, amniocentesis.. ......... ......... ......... ........... ...........
00844 C Anesth, pelvis surgery. ......... ......... ......... ........... ...........
00846 C Anesth, hysterectomy... ......... ......... ......... ........... ...........
00848 C Anesth, pelvic organ ......... ......... ......... ........... ...........
surg.
[[Page 35273]]
00850 C Anesth, cesarean ......... ......... ......... ........... ...........
section.
00855 C Anesth, hysterectomy... ......... ......... ......... ........... ...........
00857 C Analgesia, labor & c- ......... ......... ......... ........... ...........
section.
00860 N Anesth, surgery of ......... ......... ......... ........... ...........
abdomen.
00862 N Anesth, kidney, ureter ......... ......... ......... ........... ...........
surg.
00864 C Anesth, removal of ......... ......... ......... ........... ...........
bladder.
00865 C Anesth, removal of ......... ......... ......... ........... ...........
prostate.
00866 C Anesth, removal of ......... ......... ......... ........... ...........
adrenal.
00868 C Anesth, kidney ......... ......... ......... ........... ...........
transplant.
00870 N Anesth, bladder stone ......... ......... ......... ........... ...........
surg.
00872 N Anesth,kidney stone ......... ......... ......... ........... ...........
destruct.
00873 N Anesth,kidney stone ......... ......... ......... ........... ...........
destruct.
00880 N Anesth, abdomen vessel ......... ......... ......... ........... ...........
surg.
00882 C Anesth, major vein ......... ......... ......... ........... ...........
ligation.
00884 C Anesth, major vein ......... ......... ......... ........... ...........
revision.
00900 N Anesth, perineal ......... ......... ......... ........... ...........
procedure.
00902 N Anesth, anorectal ......... ......... ......... ........... ...........
surgery.
00904 C Anesth, perineal ......... ......... ......... ........... ...........
surgery.
00906 N Anesth, removal of ......... ......... ......... ........... ...........
vulva.
00908 C Anesth, removal of ......... ......... ......... ........... ...........
prostate.
00910 N Anesth, bladder surgery ......... ......... ......... ........... ...........
00912 N Anesth, bladder tumor ......... ......... ......... ........... ...........
surg.
00914 N Anesth, removal of ......... ......... ......... ........... ...........
prostate.
00916 N Anesth, bleeding ......... ......... ......... ........... ...........
control.
00918 N Anesth, stone removal.. ......... ......... ......... ........... ...........
00920 N Anesth, genitalia ......... ......... ......... ........... ...........
surgery.
00922 N Anesth, sperm duct ......... ......... ......... ........... ...........
surgery.
00924 N Anesth, testis ......... ......... ......... ........... ...........
exploration.
00926 N Anesth, removal of ......... ......... ......... ........... ...........
testis.
00928 C Anesth, removal of ......... ......... ......... ........... ...........
testis.
00930 N Anesth, testis ......... ......... ......... ........... ...........
suspension.
00932 C Anesth, amputation of ......... ......... ......... ........... ...........
penis.
00934 C Anesth, penis, nodes ......... ......... ......... ........... ...........
removal.
00936 C Anesth, penis, nodes ......... ......... ......... ........... ...........
removal.
00938 N Anesth, insert penis ......... ......... ......... ........... ...........
device.
00940 N Anesth, vaginal ......... ......... ......... ........... ...........
procedures.
00942 N Anesth, surgery on ......... ......... ......... ........... ...........
vagina.
00944 C Anesth, vaginal ......... ......... ......... ........... ...........
hysterectomy.
00946 N Anesth, vaginal ......... ......... ......... ........... ...........
delivery.
00948 N Anesth, repair of ......... ......... ......... ........... ...........
cervix.
00950 N Anesth, vaginal ......... ......... ......... ........... ...........
endoscopy.
00952 N Anesth, uterine ......... ......... ......... ........... ...........
endoscopy.
00955 C Analgesia, vaginal ......... ......... ......... ........... ...........
delivery.
01000 N Anesth, skin surgery, ......... ......... ......... ........... ...........
pelvis.
01110 N Anesth, skin surgery, ......... ......... ......... ........... ...........
pelvis.
01120 N Anesth, pelvis surgery. ......... ......... ......... ........... ...........
01130 N Anesth, body cast ......... ......... ......... ........... ...........
procedure.
01140 C Anesth, amputation at ......... ......... ......... ........... ...........
pelvis.
01150 C Anesth, pelvic tumor ......... ......... ......... ........... ...........
surgery.
01160 N Anesth, pelvis ......... ......... ......... ........... ...........
procedure.
01170 N Anesth, pelvis surgery. ......... ......... ......... ........... ...........
01180 N Anesth, pelvis nerve ......... ......... ......... ........... ...........
removal.
01190 C Anesth, pelvis nerve ......... ......... ......... ........... ...........
removal.
01200 N Anesth, hip joint ......... ......... ......... ........... ...........
procedure.
01202 N Anesth, arthroscopy of ......... ......... ......... ........... ...........
hip.
01210 N Anesth, hip joint ......... ......... ......... ........... ...........
surgery.
01212 C Anesth, hip ......... ......... ......... ........... ...........
disarticulation.
01214 C Anesth, replacement of ......... ......... ......... ........... ...........
hip.
01220 N Anesth, procedure on ......... ......... ......... ........... ...........
femur.
01230 N Anesth, surgery of ......... ......... ......... ........... ...........
femur.
01232 C Anesth, amputation of ......... ......... ......... ........... ...........
femur.
01234 C Anesth, radical femur ......... ......... ......... ........... ...........
surg.
01240 N Anesth, upper leg skin ......... ......... ......... ........... ...........
surg.
01250 N Anesth, upper leg ......... ......... ......... ........... ...........
surgery.
01260 N Anesth, upper leg veins ......... ......... ......... ........... ...........
surg.
01270 N Anesth, thigh arteries ......... ......... ......... ........... ...........
surg.
01272 C Anesth, femoral artery ......... ......... ......... ........... ...........
surg.
01274 C Anesth, femoral ......... ......... ......... ........... ...........
embolectomy.
01300 N Anesth, skin surgery, ......... ......... ......... ........... ...........
knee.
01320 N Anesth, knee area ......... ......... ......... ........... ...........
surgery.
01340 N Anesth, knee area ......... ......... ......... ........... ...........
procedure.
01360 N Anesth, knee area ......... ......... ......... ........... ...........
surgery.
01380 N Anesth, knee joint ......... ......... ......... ........... ...........
procedure.
01382 N Anesth, knee ......... ......... ......... ........... ...........
arthroscopy.
01390 N Anesth, knee area ......... ......... ......... ........... ...........
procedure.
[[Page 35274]]
01392 N Anesth, knee area ......... ......... ......... ........... ...........
surgery.
01400 N Anesth, knee joint ......... ......... ......... ........... ...........
surgery.
01402 C Anesth, replacement of ......... ......... ......... ........... ...........
knee.
01404 C Anesth, amputation at ......... ......... ......... ........... ...........
knee.
01420 N Anesth, knee joint ......... ......... ......... ........... ...........
casting.
01430 N Anesth, knee veins ......... ......... ......... ........... ...........
surgery.
01432 N Anesth, knee vessel ......... ......... ......... ........... ...........
surg.
01440 N Anesth, knee arteries ......... ......... ......... ........... ...........
surg.
01442 C Anesth, knee artery ......... ......... ......... ........... ...........
surg.
01444 C Anesth, knee artery ......... ......... ......... ........... ...........
repair.
01460 N Anesth, lower leg skin ......... ......... ......... ........... ...........
surg.
01462 N Anesth, lower leg ......... ......... ......... ........... ...........
procedure.
01464 N Anesth, ankle ......... ......... ......... ........... ...........
arthroscopy.
01470 N Anesth, lower leg ......... ......... ......... ........... ...........
surgery.
01472 N Anesth, achilles tendon ......... ......... ......... ........... ...........
surg.
01474 N Anesth, lower leg ......... ......... ......... ........... ...........
surgery.
01480 N Anesth, lower leg bone ......... ......... ......... ........... ...........
surg.
01482 N Anesth, radical leg ......... ......... ......... ........... ...........
surgery.
01484 N Anesth, lower leg ......... ......... ......... ........... ...........
revision.
01486 C Anesth, ankle ......... ......... ......... ........... ...........
replacement.
01490 N Anesth, lower leg ......... ......... ......... ........... ...........
casting.
01500 N Anesth, leg arteries ......... ......... ......... ........... ...........
surg.
01502 C Anesth, lowerleg ......... ......... ......... ........... ...........
embolectomy.
01520 N Anesth, lower leg vein ......... ......... ......... ........... ...........
surg.
01522 N Anesth, lower leg vein ......... ......... ......... ........... ...........
surg.
01600 N Anesth, shoulder skin ......... ......... ......... ........... ...........
surg.
01610 N Anesth, surgery of ......... ......... ......... ........... ...........
shoulder.
01620 N Anesth, shoulder ......... ......... ......... ........... ...........
procedure.
01622 N Anesth, shoulder ......... ......... ......... ........... ...........
arthroscopy.
01630 N Anesth, surgery of ......... ......... ......... ........... ...........
shoulder.
01632 C Anesth, surgery of ......... ......... ......... ........... ...........
shoulder.
01634 C Anesth, shoulder joint ......... ......... ......... ........... ...........
amput.
01636 C Anesth, forequarter ......... ......... ......... ........... ...........
amput.
01638 C Anesth, shoulder ......... ......... ......... ........... ...........
replacement.
01650 N Anesth, shoulder artery ......... ......... ......... ........... ...........
surg.
01652 C Anesth, shoulder vessel ......... ......... ......... ........... ...........
surg.
01654 C Anesth, shoulder vessel ......... ......... ......... ........... ...........
surg.
01656 C Anesth, arm-leg vessel ......... ......... ......... ........... ...........
surg.
01670 N Anesth, shoulder vein ......... ......... ......... ........... ...........
surg.
01680 N Anesth, shoulder ......... ......... ......... ........... ...........
casting.
01682 N Anesth, airplane cast.. ......... ......... ......... ........... ...........
01700 N Anesth, elbow area skin ......... ......... ......... ........... ...........
surg.
01710 N Anesth, elbow area ......... ......... ......... ........... ...........
surgery.
01712 N Anesth, upperarm tendon ......... ......... ......... ........... ...........
surg.
01714 N Anesth, upperarm tendon ......... ......... ......... ........... ...........
surg.
01716 N Anesth, biceps tendon ......... ......... ......... ........... ...........
repair.
01730 N Anesth, upperarm ......... ......... ......... ........... ...........
procedure.
01732 N Anesth, elbow ......... ......... ......... ........... ...........
arthroscopy.
01740 N Anesth, upper arm ......... ......... ......... ........... ...........
surgery.
01742 N Anesth, humerus surgery ......... ......... ......... ........... ...........
01744 N Anesth, humerus repair. ......... ......... ......... ........... ...........
01756 C Anesth, radical humerus ......... ......... ......... ........... ...........
surg.
01758 N Anesth, humeral lesion ......... ......... ......... ........... ...........
surg.
01760 N Anesth, elbow ......... ......... ......... ........... ...........
replacement.
01770 N Anesth, upperarm artery ......... ......... ......... ........... ...........
surg.
01772 C Anesth, upperarm ......... ......... ......... ........... ...........
embolectomy.
01780 N Anesth, upper arm vein ......... ......... ......... ........... ...........
surg.
01782 C Anesth, upperarm vein ......... ......... ......... ........... ...........
repair.
01784 N Anesth, av fistula ......... ......... ......... ........... ...........
repair.
01800 N Anesth, lower arm skin ......... ......... ......... ........... ...........
surg.
01810 N Anesth, lower arm ......... ......... ......... ........... ...........
surgery.
01820 N Anesth, lower arm ......... ......... ......... ........... ...........
procedure.
01830 N Anesth, lower arm ......... ......... ......... ........... ...........
surgery.
01832 N Anesth, wrist ......... ......... ......... ........... ...........
replacement.
01840 N Anesth, lowerarm artery ......... ......... ......... ........... ...........
surg.
01842 C Anesth, lowerarm ......... ......... ......... ........... ...........
embolectomy.
01844 N Anesth, vascular shunt ......... ......... ......... ........... ...........
surg.
01850 N Anesth, lower arm vein ......... ......... ......... ........... ...........
surg.
01852 C Anesth, lowerarm vein ......... ......... ......... ........... ...........
repair.
01860 N Anesth, lower arm ......... ......... ......... ........... ...........
casting.
01900 N Anesth, uterus/tube ......... ......... ......... ........... ...........
inject.
01902 C Anesth, burr holes, ......... ......... ......... ........... ...........
skull.
01904 C Anesth, skull x-ray ......... ......... ......... ........... ...........
inject.
01906 N Anesth, lumbar ......... ......... ......... ........... ...........
myelography.
01908 N Anesth, cervical ......... ......... ......... ........... ...........
myelography.
[[Page 35275]]
01910 N Anesth, skull ......... ......... ......... ........... ...........
myelography.
01912 N Anesth, lumbar ......... ......... ......... ........... ...........
discography.
01914 N Anesth, cervical ......... ......... ......... ........... ...........
discography.
01916 C Anesth, head ......... ......... ......... ........... ...........
arteriogram.
01918 C Anesth, limb ......... ......... ......... ........... ...........
arteriogram.
01920 N Anesth, catheterize ......... ......... ......... ........... ...........
heart.
01921 C Anesth, vessel surgery. ......... ......... ......... ........... ...........
01922 N Anesth, cat or MRI scan ......... ......... ......... ........... ...........
01990 C Support for organ donor ......... ......... ......... ........... ...........
01995 N Regional anesthesia, ......... ......... ......... ........... ...........
limb.
01996 N Manage daily drug ......... ......... ......... ........... ...........
therapy.
01999 N Unlisted anesth ......... ......... ......... ........... ...........
procedure.
10040 T Acne surgery of skin 131 1.93 $99.24 $36.61 $19.85
abscess.
10060 T Drainage of skin 131 1.93 $99.24 $36.61 $19.85
abscess.
10061 T Drainage of skin 131 1.93 $99.24 $36.61 $19.85
abscess.
10080 T Drainage of pilonidal 131 1.93 $99.24 $36.61 $19.85
cyst.
10081 T Drainage of pilonidal 131 1.93 $99.24 $36.61 $19.85
cyst.
10120 T Remove foreign body.... 131 1.93 $99.24 $36.61 $19.85
10121 T Remove foreign body.... 163 10.48 $538.88 $260.80 $107.78
10140 T Drainage of hematoma/ 131 1.93 $99.24 $36.61 $19.85
fluid.
10160 T Puncture drainage of 131 1.93 $99.24 $36.61 $19.85
lesion.
10180 T Complex drainage, wound 131 1.93 $99.24 $36.61 $19.85
11000 T Debride infected skin.. 151 1.63 $83.81 $33.22 $16.76
11001 T Debride infect skin add- 151 1.63 $83.81 $33.22 $16.76
on.
11010 T Debride skin, fx....... 163 10.48 $538.88 $260.80 $107.78
11011 T Debride skin/muscle, fx 163 10.48 $538.88 $260.80 $107.78
11012 T Debride skin/muscle/ 163 10.48 $538.88 $260.80 $107.78
bone, fx.
11040 T Debride skin partial... 151 1.63 $83.81 $33.22 $16.76
11041 T Debride skin full...... 151 1.63 $83.81 $33.22 $16.76
11042 T Debride skin/tissue.... 151 1.63 $83.81 $33.22 $16.76
11043 T Debride tissue/muscle.. 162 5.59 $287.44 $125.66 $57.49
11044 T Debride tissue/muscle/ 162 5.59 $287.44 $125.66 $57.49
bone.
\2\ 1105 T Trim skin lesion....... 151 1.63 $83.81 $33.22 $16.76
0
\2\ 1105 T Trim 2 to 4 skin 151 1.63 $83.81 $33.22 $16.76
1 lesions.
\2\ 1105 T Trim over 4 skin 151 1.63 $83.81 $33.22 $16.76
2 lesions.
11055 T Trim skin lesion....... 151 1.63 $83.81 $33.22 $16.76
11056 T Trim 2 to 4 skin 151 1.63 $83.81 $33.22 $16.76
lesions.
11057 T Trim over 4 skin 151 1.63 $83.81 $33.22 $16.76
lesions.
11100 T Biopsy of skin lesion.. 161 3.43 $176.37 $75.71 $35.27
11101 T Biopsy, skin add-on.... 161 3.43 $176.37 $75.71 $35.27
11200 T Removal of skin tags... 151 1.63 $83.81 $33.22 $16.76
11201 T Remove skin tags add-on 151 1.63 $83.81 $33.22 $16.76
11300 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11301 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11302 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11303 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11305 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11306 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11307 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11308 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11310 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11311 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11312 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11313 T Shave skin lesion...... 151 1.63 $83.81 $33.22 $16.76
11400 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11401 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11402 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11403 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11404 T Removal of skin lesion. 162 5.59 $287.44 $125.66 $57.49
11406 T Removal of skin lesion. 163 10.48 $538.88 $260.80 $107.78
11420 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11421 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11422 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11423 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11424 T Removal of skin lesion. 162 5.59 $287.44 $125.66 $57.49
11426 T Removal of skin lesion. 163 10.48 $538.88 $260.80 $107.78
11440 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11441 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11442 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11443 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11444 T Removal of skin lesion. 162 5.59 $287.44 $125.66 $57.49
11446 T Removal of skin lesion. 163 10.48 $538.88 $260.80 $107.78
11450 T Removal, sweat gland 163 10.48 $538.88 $260.80 $107.78
lesion.
11451 T Removal, sweat gland 163 10.48 $538.88 $260.80 $107.78
lesion.
11462 T Removal, sweat gland 163 10.48 $538.88 $260.80 $107.78
lesion.
[[Page 35276]]
11463 T Removal, sweat gland 163 10.48 $538.88 $260.80 $107.78
lesion.
11470 T Removal, sweat gland 163 10.48 $538.88 $260.80 $107.78
lesion.
11471 T Removal, sweat gland 163 10.48 $538.88 $260.80 $107.78
lesion.
11600 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11601 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11602 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11603 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11604 T Removal of skin lesion. 162 5.59 $287.44 $125.66 $57.49
11606 T Removal of skin lesion. 163 10.48 $538.88 $260.80 $107.78
11620 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11621 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11622 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11623 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11624 T Removal of skin lesion. 163 10.48 $538.88 $260.80 $107.78
11626 T Removal of skin lesion. 163 10.48 $538.88 $260.80 $107.78
11640 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11641 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11642 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11643 T Removal of skin lesion. 161 3.43 $176.37 $75.71 $35.27
11644 T Removal of skin lesion. 163 10.48 $538.88 $260.80 $107.78
11646 T Removal of skin lesion. 163 10.48 $538.88 $260.80 $107.78
\2\ 1170 T Scraping of 1-5 nails.. 137 0.60 $30.85 $9.27 $6.17
0
\2\ 1170 T Scraping of additional 137 0.60 $30.85 $9.27 $6.17
1 nails.
\2\ 1171 T Scraping of 1-5 nails.. 137 0.60 $30.85 $9.27 $6.17
0
\2\ 1171 T Scraping of additional 137 0.60 $30.85 $9.27 $6.17
1 nails.
11719 T Trim nail(s)........... 137 0.60 $30.85 $9.27 $6.17
11720 T Debride nail, 1-5...... 137 0.60 $30.85 $9.27 $6.17
11721 T Debride nail, 6 or more 137 0.60 $30.85 $9.27 $6.17
11730 T Removal of nail plate.. 151 1.63 $83.81 $33.22 $16.76
\2\ 1173 T Removal of second nail 151 1.63 $83.81 $33.22 $16.76
1 plate.
11732 T Remove additional nail 151 1.63 $83.81 $33.22 $16.76
plate.
11740 T Drain blood from under 137 0.60 $30.85 $9.27 $6.17
nail.
11750 T Removal of nail bed.... 161 3.43 $176.37 $75.71 $35.27
11752 T Remove nail bed/finger 163 10.48 $538.88 $260.80 $107.78
tip.
11755 T Biopsy, nail unit...... 137 0.60 $30.85 $9.27 $6.17
11760 T Reconstruction of nail 181 2.17 $111.58 $44.07 $22.32
bed.
11762 T Reconstruction of nail 181 2.17 $111.58 $44.07 $22.32
bed.
11765 T Excision of nail fold, 151 1.63 $83.81 $33.22 $16.76
toe.
11770 T Removal of pilonidal 162 5.59 $287.44 $125.66 $57.49
lesion.
11771 T Removal of pilonidal 163 10.48 $538.88 $260.80 $107.78
lesion.
11772 T Removal of pilonidal 163 10.48 $538.88 $260.80 $107.78
lesion.
11900 T Injection into skin 151 1.63 $83.81 $33.22 $16.76
lesions.
11901 T Added skin lesions 151 1.63 $83.81 $33.22 $16.76
injection.
11920 T Correct skin color 181 2.17 $111.58 $44.07 $22.32
defects.
11921 T Correct skin color 181 2.17 $111.58 $44.07 $22.32
defects.
11922 T Correct skin color 181 2.17 $111.58 $44.07 $22.32
defects.
11950 T Therapy for contour 181 2.17 $111.58 $44.07 $22.32
defects.
11951 T Therapy for contour 181 2.17 $111.58 $44.07 $22.32
defects.
11952 T Therapy for contour 181 2.17 $111.58 $44.07 $22.32
defects.
11954 T Therapy for contour 181 2.17 $111.58 $44.07 $22.32
defects.
11960 T Insert tissue 183 11.04 $567.68 $283.18 $113.54
expander(s).
11970 T Replace tissue expander 183 11.04 $567.68 $283.18 $113.54
11971 T Remove tissue 163 10.48 $538.88 $260.80 $107.78
expander(s).
11975 E Insert contraceptive ......... ......... ......... ........... ...........
cap.
11976 T Removal of 131 1.93 $99.24 $36.61 $19.85
contraceptive cap.
11977 E Removal/reinsert contra ......... ......... ......... ........... ...........
cap.
12001 T Repair superficial 181 2.17 $111.58 $44.07 $22.32
wound(s).
12002 T Repair superficial 181 2.17 $111.58 $44.07 $22.32
wound(s).
12004 T Repair superficial 181 2.17 $111.58 $44.07 $22.32
wound(s).
12005 T Repair superficial 181 2.17 $111.58 $44.07 $22.32
wound(s).
12006 T Repair superficial 181 2.17 $111.58 $44.07 $22.32
wound(s).
12007 T Repair superficial 181 2.17 $111.58 $44.07 $22.32
wound(s).
12011 T Repair superficial 181 2.17 $111.58 $44.07 $22.32
wound(s).
12013 T Repair superficial 181 2.17 $111.58 $44.07 $22.32
wound(s).
12014 T Repair superficial 181 2.17 $111.58 $44.07 $22.32
wound(s).
12015 T Repair superficial 181 2.17 $111.58 $44.07 $22.32
wound(s).
12016 T Repair superficial 181 2.17 $111.58 $44.07 $22.32
wound(s).
12017 T Repair superficial 181 2.17 $111.58 $44.07 $22.32
wound(s).
12018 T Repair superficial 181 2.17 $111.58 $44.07 $22.32
wound(s).
12020 T Closure of split wound. 181 2.17 $111.58 $44.07 $22.32
12021 T Closure of split wound. 181 2.17 $111.58 $44.07 $22.32
12031 T Layer closure of 181 2.17 $111.58 $44.07 $22.32
wound(s).
12032 T Layer closure of 181 2.17 $111.58 $44.07 $22.32
wound(s).
12034 T Layer closure of 181 2.17 $111.58 $44.07 $22.32
wound(s).
12035 T Layer closure of 181 2.17 $111.58 $44.07 $22.32
wound(s).
[[Page 35277]]
12036 T Layer closure of 181 2.17 $111.58 $44.07 $22.32
wound(s).
12037 T Layer closure of 183 11.04 $567.68 $283.18 $113.54
wound(s).
12041 T Layer closure of 181 2.17 $111.58 $44.07 $22.32
wound(s).
12042 T Layer closure of 181 2.17 $111.58 $44.07 $22.32
wound(s).
12044 T Layer closure of 181 2.17 $111.58 $44.07 $22.32
wound(s).
12045 T Layer closure of 181 2.17 $111.58 $44.07 $22.32
wound(s).
12046 T Layer closure of 181 2.17 $111.58 $44.07 $22.32
wound(s).
12047 T Layer closure of 183 11.04 $567.68 $283.18 $113.54
wound(s).
12051 T Layer closure of 181 2.17 $111.58 $44.07 $22.32
wound(s).
12052 T Layer closure of 181 2.17 $111.58 $44.07 $22.32
wound(s).
12053 T Layer closure of 181 2.17 $111.58 $44.07 $22.32
wound(s).
12054 T Layer closure of 181 2.17 $111.58 $44.07 $22.32
wound(s).
12055 T Layer closure of 181 2.17 $111.58 $44.07 $22.32
wound(s).
12056 T Layer closure of 181 2.17 $111.58 $44.07 $22.32
wound(s).
12057 T Layer closure of 183 11.04 $567.68 $283.18 $113.54
wound(s).
13100 T Repair of wound or 182 4.11 $211.34 $92.43 $42.27
lesion.
13101 T Repair of wound or 182 4.11 $211.34 $92.43 $42.27
lesion.
13120 T Repair of wound or 182 4.11 $211.34 $92.43 $42.27
lesion.
13121 T Repair of wound or 182 4.11 $211.34 $92.43 $42.27
lesion.
13131 T Repair of wound or 182 4.11 $211.34 $92.43 $42.27
lesion.
13132 T Repair of wound or 182 4.11 $211.34 $92.43 $42.27
lesion.
13150 T Repair of wound or 182 4.11 $211.34 $92.43 $42.27
lesion.
13151 T Repair of wound or 182 4.11 $211.34 $92.43 $42.27
lesion.
13152 T Repair of wound or 182 4.11 $211.34 $92.43 $42.27
lesion.
13160 T Late closure of wound.. 182 4.11 $211.34 $92.43 $42.27
13300 T Repair of wound or 182 4.11 $211.34 $92.43 $42.27
lesion.
14000 T Skin tissue 183 11.04 $567.68 $283.18 $113.54
rearrangement.
14001 T Skin tissue 183 11.04 $567.68 $283.18 $113.54
rearrangement.
14020 T Skin tissue 183 11.04 $567.68 $283.18 $113.54
rearrangement.
14021 T Skin tissue 183 11.04 $567.68 $283.18 $113.54
rearrangement.
14040 T Skin tissue 183 11.04 $567.68 $283.18 $113.54
rearrangement.
14041 T Skin tissue 183 11.04 $567.68 $283.18 $113.54
rearrangement.
14060 T Skin tissue 183 11.04 $567.68 $283.18 $113.54
rearrangement.
14061 T Skin tissue 183 11.04 $567.68 $283.18 $113.54
rearrangement.
14300 T Skin tissue 183 11.04 $567.68 $283.18 $113.54
rearrangement.
14350 T Skin tissue 183 11.04 $567.68 $283.18 $113.54
rearrangement.
15000 T Skin graft............. 183 11.04 $567.68 $283.18 $113.54
15050 T Skin pinch graft....... 183 11.04 $567.68 $283.18 $113.54
15100 T Skin split graft....... 183 11.04 $567.68 $283.18 $113.54
15101 T Skin split graft add-on 183 11.04 $567.68 $283.18 $113.54
15120 T Skin split graft....... 183 11.04 $567.68 $283.18 $113.54
15121 T Skin split graft add-on 183 11.04 $567.68 $283.18 $113.54
15200 T Skin full graft........ 183 11.04 $567.68 $283.18 $113.54
15201 T Skin full graft add-on. 183 11.04 $567.68 $283.18 $113.54
15220 T Skin full graft........ 183 11.04 $567.68 $283.18 $113.54
15221 T Skin full graft add-on. 183 11.04 $567.68 $283.18 $113.54
15240 T Skin full graft........ 183 11.04 $567.68 $283.18 $113.54
15241 T Skin full graft add-on. 183 11.04 $567.68 $283.18 $113.54
15260 T Skin full graft........ 183 11.04 $567.68 $283.18 $113.54
15261 T Skin full graft add-on. 183 11.04 $567.68 $283.18 $113.54
15350 T Skin homograft......... 183 11.04 $567.68 $283.18 $113.54
15400 T Skin heterograft....... 183 11.04 $567.68 $283.18 $113.54
15570 T Form skin pedicle flap. 183 11.04 $567.68 $283.18 $113.54
15572 T Form skin pedicle flap. 183 11.04 $567.68 $283.18 $113.54
15574 T Form skin pedicle flap. 183 11.04 $567.68 $283.18 $113.54
15576 T Form skin pedicle flap. 183 11.04 $567.68 $283.18 $113.54
15580 T Attach skin pedicle 183 11.04 $567.68 $283.18 $113.54
graft.
15600 T Skin graft............. 183 11.04 $567.68 $283.18 $113.54
15610 T Skin graft............. 183 11.04 $567.68 $283.18 $113.54
15620 T Skin graft............. 183 11.04 $567.68 $283.18 $113.54
15625 T Skin graft............. 183 11.04 $567.68 $283.18 $113.54
15630 T Skin graft............. 183 11.04 $567.68 $283.18 $113.54
15650 T Transfer skin pedicle 183 11.04 $567.68 $283.18 $113.54
flap.
15732 T Muscle-skin graft, head/ 184 14.85 $763.59 $397.99 $152.72
neck.
15734 T Muscle-skin graft, 184 14.85 $763.59 $397.99 $152.72
trunk.
15736 T Muscle-skin graft, arm. 184 14.85 $763.59 $397.99 $152.72
15738 T Muscle-skin graft, leg. 184 14.85 $763.59 $397.99 $152.72
15740 T Island pedicle flap 184 14.85 $763.59 $397.99 $152.72
graft.
15750 T Neurovascular pedicle 184 14.85 $763.59 $397.99 $152.72
graft.
\2\ 1575 C Microvascular flap ......... ......... ......... ........... ...........
5 graft.
15756 C Free muscle flap, ......... ......... ......... ........... ...........
microvasc.
15757 C Free skin flap, ......... ......... ......... ........... ...........
microvasc.
15758 C Free fascial flap, ......... ......... ......... ........... ...........
microvasc.
15760 T Composite skin graft... 184 14.85 $763.59 $397.99 $152.72
15770 T Derma-fat-fascia graft. 184 14.85 $763.59 $397.99 $152.72
[[Page 35278]]
15775 T Hair transplant punch 183 11.04 $567.68 $283.18 $113.54
grafts.
15776 T Hair transplant punch 183 11.04 $567.68 $283.18 $113.54
grafts.
15780 T Abrasion treatment of 163 10.48 $538.88 $260.80 $107.78
skin.
15781 T Abrasion treatment of 163 10.48 $538.88 $260.80 $107.78
skin.
15782 T Abrasion treatment of 163 10.48 $538.88 $260.80 $107.78
skin.
15783 T Abrasion treatment of 151 1.63 $83.81 $33.22 $16.76
skin.
15786 T Abrasion, lesion, 151 1.63 $83.81 $33.22 $16.76
single.
15787 T Abrasion, lesions, add- 151 1.63 $83.81 $33.22 $16.76
on.
15788 T Chemical peel, face, 151 1.63 $83.81 $33.22 $16.76
epiderm.
15789 T Chemical peel, face, 151 1.63 $83.81 $33.22 $16.76
dermal.
15792 T Chemical peel, 151 1.63 $83.81 $33.22 $16.76
nonfacial.
15793 T Chemical peel, 151 1.63 $83.81 $33.22 $16.76
nonfacial.
15810 T Salabrasion............ 151 1.63 $83.81 $33.22 $16.76
15811 T Salabrasion............ 163 10.48 $538.88 $260.80 $107.78
15819 T Plastic surgery, neck.. 183 11.04 $567.68 $283.18 $113.54
15820 T Revision of lower 183 11.04 $567.68 $283.18 $113.54
eyelid.
15821 T Revision of lower 183 11.04 $567.68 $283.18 $113.54
eyelid.
15822 T Revision of upper 183 11.04 $567.68 $283.18 $113.54
eyelid.
15823 T Revision of upper 183 11.04 $567.68 $283.18 $113.54
eyelid.
15824 T Removal of forehead 184 14.85 $763.59 $397.99 $152.72
wrinkles.
15825 T Removal of neck 183 11.04 $567.68 $283.18 $113.54
wrinkles.
15826 T Removal of brow 184 14.85 $763.59 $397.99 $152.72
wrinkles.
15828 T Removal of face 184 14.85 $763.59 $397.99 $152.72
wrinkles.
15829 T Removal of skin 183 11.04 $567.68 $283.18 $113.54
wrinkles.
15831 T Excise excessive skin 184 14.85 $763.59 $397.99 $152.72
tissue.
15832 T Excise excessive skin 184 14.85 $763.59 $397.99 $152.72
tissue.
15833 T Excise excessive skin 184 14.85 $763.59 $397.99 $152.72
tissue.
15834 T Excise excessive skin 184 14.85 $763.59 $397.99 $152.72
tissue.
15835 T Excise excessive skin 183 11.04 $567.68 $283.18 $113.54
tissue.
15836 T Excise excessive skin 184 14.85 $763.59 $397.99 $152.72
tissue.
15837 T Excise excessive skin 184 14.85 $763.59 $397.99 $152.72
tissue.
15838 T Excise excessive skin 163 10.48 $538.88 $260.80 $107.78
tissue.
15839 T Excise excessive skin 184 14.85 $763.59 $397.99 $152.72
tissue.
15840 T Graft for face nerve 184 14.85 $763.59 $397.99 $152.72
palsy.
15841 T Graft for face nerve 184 14.85 $763.59 $397.99 $152.72
palsy.
15842 T Graft for face nerve 184 14.85 $763.59 $397.99 $152.72
palsy.
15845 T Skin and muscle repair, 184 14.85 $763.59 $397.99 $152.72
face.
15850 T Removal of sutures..... 151 1.63 $83.81 $33.22 $16.76
15851 T Removal of sutures..... 151 1.63 $83.81 $33.22 $16.76
15852 T Dressing change,not for 151 1.63 $83.81 $33.22 $16.76
burn.
15860 N Test for blood flow in ......... ......... ......... ........... ...........
graft.
15876 T Suction assisted 184 14.85 $763.59 $397.99 $152.72
lipectomy.
15877 T Suction assisted 184 14.85 $763.59 $397.99 $152.72
lipectomy.
15878 T Suction assisted 184 14.85 $763.59 $397.99 $152.72
lipectomy.
15879 T Suction assisted 184 14.85 $763.59 $397.99 $152.72
lipectomy.
15920 T Removal of tail bone 163 10.48 $538.88 $260.80 $107.78
ulcer.
15922 T Removal of tail bone 184 14.85 $763.59 $397.99 $152.72
ulcer.
15931 T Remove sacrum pressure 163 10.48 $538.88 $260.80 $107.78
sore.
15933 T Remove sacrum pressure 163 10.48 $538.88 $260.80 $107.78
sore.
15934 T Remove sacrum pressure 184 14.85 $763.59 $397.99 $152.72
sore.
15935 T Remove sacrum pressure 184 14.85 $763.59 $397.99 $152.72
sore.
15936 T Remove sacrum pressure 184 14.85 $763.59 $397.99 $152.72
sore.
15937 T Remove sacrum pressure 184 14.85 $763.59 $397.99 $152.72
sore.
15940 T Removal of pressure 163 10.48 $538.88 $260.80 $107.78
sore.
15941 T Removal of pressure 163 10.48 $538.88 $260.80 $107.78
sore.
15944 T Removal of pressure 184 14.85 $763.59 $397.99 $152.72
sore.
15945 T Removal of pressure 184 14.85 $763.59 $397.99 $152.72
sore.
15946 T Removal of pressure 184 14.85 $763.59 $397.99 $152.72
sore.
15950 T Remove thigh pressure 163 10.48 $538.88 $260.80 $107.78
sore.
15951 T Remove thigh pressure 163 10.48 $538.88 $260.80 $107.78
sore.
15952 T Remove thigh pressure 184 14.85 $763.59 $397.99 $152.72
sore.
15953 T Remove thigh pressure 184 14.85 $763.59 $397.99 $152.72
sore.
15956 T Remove thigh pressure 184 14.85 $763.59 $397.99 $152.72
sore.
15958 T Remove thigh pressure 184 14.85 $763.59 $397.99 $152.72
sore.
15999 T Removal of pressure 163 10.48 $538.88 $260.80 $107.78
sore.
16000 T Initial treatment of 151 1.63 $83.81 $33.22 $16.76
burn(s).
16010 T Treatment of burn(s)... 152 10.07 $517.80 $251.54 $103.56
16015 T Treatment of burn(s)... 152 10.07 $517.80 $251.54 $103.56
16020 T Treatment of burn(s)... 151 1.63 $83.81 $33.22 $16.76
16025 T Treatment of burn(s)... 151 1.63 $83.81 $33.22 $16.76
16030 T Treatment of burn(s)... 151 1.63 $83.81 $33.22 $16.76
16035 T Incision of burn scab.. 162 5.59 $287.44 $125.66 $57.49
\2\ 1604 T Burn wound excision.... 162 5.59 $287.44 $125.66 $57.49
0
\2\ 1604 T Burn wound excision.... 162 5.59 $287.44 $125.66 $57.49
1
\2\ 1604 T Burn wound excision.... 162 5.59 $287.44 $125.66 $57.49
2
[[Page 35279]]
17000 T Destroy benign/premal 141 0.52 $26.74 $9.49 $5.35
lesion.
\2\ 1700 T Destruction of add'l 141 0.52 $26.74 $9.49 $5.35
1 lesions.
\2\ 1700 T Destruction of add'l 141 0.52 $26.74 $9.49 $5.35
2 lesions.
17003 T Destroy 2-14 lesions... 141 0.52 $26.74 $9.49 $5.35
17004 T Destroy 15 & more 142 2.94 $151.17 $54.24 $30.24
lesions.
\2\ 1710 T Destruction of skin 141 0.52 $26.74 $9.49 $5.35
0 lesion.
\2\ 1710 T Destruction of 2nd 141 0.52 $26.74 $9.49 $5.35
1 lesion.
\2\ 1710 T Destruction of add'l 141 0.52 $26.74 $9.49 $5.35
2 lesions.
\2\ 1710 T Destruction of skin 142 2.94 $151.17 $54.24 $30.24
4 lesions.
\2\ 1710 T Destruction of skin 142 2.94 $151.17 $54.24 $30.24
5 lesions.
17106 T Destruction of skin 141 0.52 $26.74 $9.49 $5.35
lesions.
17107 T Destruction of skin 142 2.94 $151.17 $54.24 $30.24
lesions.
17108 T Destruction of skin 142 2.94 $151.17 $54.24 $30.24
lesions.
17110 T Destruct lesion, 1-14.. 141 0.52 $26.74 $9.49 $5.35
17111 T Destruct lesion, 15 or 142 2.94 $151.17 $54.24 $30.24
more.
\2\ 1720 T Electrocautery of skin 151 1.63 $83.81 $33.22 $16.76
0 tags.
\2\ 1720 T Electrocautery added 151 1.63 $83.81 $33.22 $16.76
1 lesions.
17250 T Chemical cautery, 151 1.63 $83.81 $33.22 $16.76
tissue.
17260 T Destruction of skin 151 1.63 $83.81 $33.22 $16.76
lesions.
17261 T Destruction of skin 151 1.63 $83.81 $33.22 $16.76
lesions.
17262 T Destruction of skin 151 1.63 $83.81 $33.22 $16.76
lesions.
17263 T Destruction of skin 151 1.63 $83.81 $33.22 $16.76
lesions.
17264 T Destruction of skin 151 1.63 $83.81 $33.22 $16.76
lesions.
17266 T Destruction of skin 151 1.63 $83.81 $33.22 $16.76
lesions.
17270 T Destruction of skin 151 1.63 $83.81 $33.22 $16.76
lesions.
17271 T Destruction of skin 151 1.63 $83.81 $33.22 $16.76
lesions.
17272 T Destruction of skin 151 1.63 $83.81 $33.22 $16.76
lesions.
17273 T Destruction of skin 151 1.63 $83.81 $33.22 $16.76
lesions.
17274 T Destruction of skin 151 1.63 $83.81 $33.22 $16.76
lesions.
17276 T Destruction of skin 151 1.63 $83.81 $33.22 $16.76
lesions.
17280 T Destruction of skin 151 1.63 $83.81 $33.22 $16.76
lesions.
17281 T Destruction of skin 151 1.63 $83.81 $33.22 $16.76
lesions.
17282 T Destruction of skin 151 1.63 $83.81 $33.22 $16.76
lesions.
17283 T Destruction of skin 151 1.63 $83.81 $33.22 $16.76
lesions.
17284 T Destruction of skin 151 1.63 $83.81 $33.22 $16.76
lesions.
17286 T Destruction of skin 151 1.63 $83.81 $33.22 $16.76
lesions.
17304 T Chemosurgery of skin 162 5.59 $287.44 $125.66 $57.49
lesion.
17305 T 2nd stage chemosurgery. 162 5.59 $287.44 $125.66 $57.49
17306 T 3rd stage chemosurgery. 162 5.59 $287.44 $125.66 $57.49
17307 T Followup skin lesion 162 5.59 $287.44 $125.66 $57.49
therapy.
17310 T Extensive skin 162 5.59 $287.44 $125.66 $57.49
chemosurgery.
17340 T Cryotherapy of skin.... 151 1.63 $83.81 $33.22 $16.76
17360 T Skin peel therapy...... 151 1.63 $83.81 $33.22 $16.76
17380 T Hair removal by 151 1.63 $83.81 $33.22 $16.76
electrolysis.
17999 T Skin tissue procedure.. 121 0.63 $32.39 $21.02 $6.48
19000 T Drainage of breast 121 0.63 $32.39 $21.02 $6.48
lesion.
19001 T Drain breast lesion add- 121 0.63 $32.39 $21.02 $6.48
on.
19020 T Incision of breast 132 5.63 $289.49 $132.89 $57.90
lesion.
19030 T Injection for breast x- 347 2.57 $132.15 $62.38 $26.43
ray.
19100 T Biopsy of breast....... 122 4.59 $236.02 $113.00 $47.20
19101 T Biopsy of breast....... 197 11.94 $613.95 $308.26 $122.79
19110 T Nipple exploration..... 197 11.94 $613.95 $308.26 $122.79
19112 T Excise breast duct 197 11.94 $613.95 $308.26 $122.79
fistula.
19120 T Removal of breast 197 11.94 $613.95 $308.26 $122.79
lesion.
19125 T Excision, breast lesion 197 11.94 $613.95 $308.26 $122.79
19126 T Excision,add'l breast 197 11.94 $613.95 $308.26 $122.79
lesion.
19140 T Removal of breast 197 11.94 $613.95 $308.26 $122.79
tissue.
19160 T Removal of breast 198 18.63 $957.95 $523.42 $191.59
tissue.
19162 T Remove breast tissue, 198 18.63 $957.95 $523.42 $191.59
nodes.
19180 T Removal of breast...... 198 18.63 $957.95 $523.42 $191.59
19182 T Removal of breast...... 198 18.63 $957.95 $523.42 $191.59
19200 C Removal of breast...... ......... ......... ......... ........... ...........
19220 C Removal of breast...... ......... ......... ......... ........... ...........
19240 C Removal of breast...... ......... ......... ......... ........... ...........
19260 C Removal of chest wall ......... ......... ......... ........... ...........
lesion.
19271 C Revision of chest wall. ......... ......... ......... ........... ...........
19272 C Extensive chest wall ......... ......... ......... ........... ...........
surgery.
19290 T Place needle wire, 197 11.94 $613.95 $308.26 $122.79
breast.
19291 T Place needle wire, 197 11.94 $613.95 $308.26 $122.79
breast.
19316 T Suspension of breast... 198 18.63 $957.95 $523.42 $191.59
19318 T Reduction of large 198 18.63 $957.95 $523.42 $191.59
breast.
19324 T Enlarge breast......... 198 18.63 $957.95 $523.42 $191.59
19325 T Enlarge breast with 198 18.63 $957.95 $523.42 $191.59
implant.
19328 T Removal of breast 198 18.63 $957.95 $523.42 $191.59
implant.
19330 T Removal of implant 198 18.63 $957.95 $523.42 $191.59
material.
[[Page 35280]]
19340 T Immediate breast 198 18.63 $957.95 $523.42 $191.59
prosthesis.
19342 T Delayed breast 198 18.63 $957.95 $523.42 $191.59
prosthesis.
19350 T Breast reconstruction.. 198 18.63 $957.95 $523.42 $191.59
19355 T Correct inverted 198 18.63 $957.95 $523.42 $191.59
nipple(s).
19357 T Breast reconstruction.. 198 18.63 $957.95 $523.42 $191.59
19361 C Breast reconstruction.. ......... ......... ......... ........... ...........
19364 C Breast reconstruction.. ......... ......... ......... ........... ...........
19366 T Breast reconstruction.. 198 18.63 $957.95 $523.42 $191.59
19367 C Breast reconstruction.. ......... ......... ......... ........... ...........
19368 C Breast reconstruction.. ......... ......... ......... ........... ...........
19369 C Breast reconstruction.. ......... ......... ......... ........... ...........
19370 T Surgery of breast 198 18.63 $957.95 $523.42 $191.59
capsule.
19371 T Removal of breast 198 18.63 $957.95 $523.42 $191.59
capsule.
19380 T Revise breast 198 18.63 $957.95 $523.42 $191.59
reconstruction.
19396 T Design custom breast 197 11.94 $613.95 $308.26 $122.79
implant.
19499 T Breast surgery 197 11.94 $613.95 $308.26 $122.79
procedure.
20000 T Incision of abscess.... 131 1.93 $99.24 $36.61 $19.85
20005 T Incision of deep 251 13.88 $713.71 $365.89 $142.74
abscess.
20100 C Explore wound, neck.... ......... ......... ......... ........... ...........
20101 C Explore wound, chest... ......... ......... ......... ........... ...........
20102 C Explore wound, abdomen. ......... ......... ......... ........... ...........
20103 C Explore wound, ......... ......... ......... ........... ...........
extremity.
20150 C Excise epiphyseal bar.. ......... ......... ......... ........... ...........
20200 T Muscle biopsy.......... 162 5.59 $287.44 $125.66 $57.49
20205 T Deep muscle biopsy..... 162 5.59 $287.44 $125.66 $57.49
20206 T Needle biopsy, muscle.. 122 4.59 $236.02 $113.00 $47.20
20220 T Bone biopsy, trocar/ 162 5.59 $287.44 $125.66 $57.49
needle.
20225 T Bone biopsy, trocar/ 162 5.59 $287.44 $125.66 $57.49
needle.
20240 T Bone biopsy, excisional 163 10.48 $538.88 $260.80 $107.78
20245 T Bone biopsy, excisional 163 10.48 $538.88 $260.80 $107.78
20250 T Open bone biopsy....... 251 13.88 $713.71 $365.89 $142.74
20251 T Open bone biopsy....... 251 13.88 $713.71 $365.89 $142.74
20500 T Injection of sinus 181 2.17 $111.58 $44.07 $22.32
tract.
20501 T Inject sinus tract for 347 2.57 $132.15 $62.38 $26.43
x-ray.
20520 T Removal of foreign body 161 3.43 $176.37 $75.71 $35.27
20525 T Removal of foreign body 163 10.48 $538.88 $260.80 $107.78
20550 T Inj tendon/ligament/ 200 1.76 $90.50 $39.10 $18.10
cyst.
20600 T Drain/inject joint/ 200 1.76 $90.50 $39.10 $18.10
bursa.
20605 T Drain/inject joint/ 200 1.76 $90.50 $39.10 $18.10
bursa.
20610 T Drain/inject joint/ 200 1.76 $90.50 $39.10 $18.10
bursa.
20615 T Treatment of bone cyst. 121 0.63 $32.39 $21.02 $6.48
20650 T Insert and remove bone 251 13.88 $713.71 $365.89 $142.74
pin.
20660 C Apply,remove fixation ......... ......... ......... ........... ...........
device.
20661 C Application of head ......... ......... ......... ........... ...........
brace.
20662 C Application of pelvis ......... ......... ......... ........... ...........
brace.
20663 C Application of thigh ......... ......... ......... ........... ...........
brace.
20664 C Halo brace application. ......... ......... ......... ........... ...........
20665 N Removal of fixation ......... ......... ......... ........... ...........
device.
20670 T Removal of support 162 5.59 $287.44 $125.66 $57.49
implant.
20680 T Removal of support 163 10.48 $538.88 $260.80 $107.78
implant.
20690 T Apply bone fixation 252 19.24 $989.32 $512.34 $197.86
device.
20692 T Apply bone fixation 252 19.24 $989.32 $512.34 $197.86
device.
20693 T Adjust bone fixation 251 13.88 $713.71 $365.89 $142.74
device.
20694 T Remove bone fixation 251 13.88 $713.71 $365.89 $142.74
device.
20802 C Replantation, arm, ......... ......... ......... ........... ...........
complete.
20805 C Replant forearm, ......... ......... ......... ........... ...........
complete.
20808 C Replantation, hand, ......... ......... ......... ........... ...........
complete.
20816 C Replantation digit, ......... ......... ......... ........... ...........
complete.
20822 C Replantation digit, ......... ......... ......... ........... ...........
complete.
20824 C Replantation thumb, ......... ......... ......... ........... ...........
complete.
20827 C Replantation thumb, ......... ......... ......... ........... ...........
complete.
20838 C Replantation, foot, ......... ......... ......... ........... ...........
complete.
20900 T Removal of bone for 252 19.24 $989.32 $512.34 $197.86
graft.
20902 T Removal of bone for 252 19.24 $989.32 $512.34 $197.86
graft.
20910 T Remove cartilage for 183 11.04 $567.68 $283.18 $113.54
graft.
20912 T Remove cartilage for 183 11.04 $567.68 $283.18 $113.54
graft.
20920 T Removal of fascia for 183 11.04 $567.68 $283.18 $113.54
graft.
20922 T Removal of fascia for 183 11.04 $567.68 $283.18 $113.54
graft.
20924 T Removal of tendon for 252 19.24 $989.32 $512.34 $197.86
graft.
20926 T Removal of tissue for 183 11.04 $567.68 $283.18 $113.54
graft.
20930 C Spinal bone allograft.. ......... ......... ......... ........... ...........
20931 C Spinal bone allograft.. ......... ......... ......... ........... ...........
20936 C Spinal bone autograft.. ......... ......... ......... ........... ...........
20937 C Spinal bone autograft.. ......... ......... ......... ........... ...........
20938 C Spinal bone autograft.. ......... ......... ......... ........... ...........
[[Page 35281]]
20950 T Record fluid 132 5.63 $289.49 $132.89 $57.90
pressure,muscle.
20955 C Fibula bone graft, ......... ......... ......... ........... ...........
microvasc.
20956 C Iliac bone graft, ......... ......... ......... ........... ...........
microvasc.
20957 C Mt bone graft, ......... ......... ......... ........... ...........
microvasc.
\2\ 2096 C Microvascular rib graft ......... ......... ......... ........... ...........
0
20962 C Other bone graft, ......... ......... ......... ........... ...........
microvasc.
20969 C Bone/skin graft, ......... ......... ......... ........... ...........
microvasc.
20970 C Bone/skin graft, iliac ......... ......... ......... ........... ...........
crest.
\2\ 2097 C Bone-skin graft, rib... ......... ......... ......... ........... ...........
1
20972 C Bone-skin graft, ......... ......... ......... ........... ...........
metatarsal.
20973 C Bone-skin graft, great ......... ......... ......... ........... ...........
toe.
20974 A Electrical bone ......... ......... ......... ........... ...........
stimulation.
20975 T Electrical bone 251 13.88 $713.71 $365.89 $142.74
stimulation.
20999 N Musculoskeletal surgery ......... ......... ......... ........... ...........
21010 T Incision of jaw joint.. 232 23.82 $1,224.82 $636.87 $244.96
21015 T Resection of facial 231 11.31 $581.56 $286.79 $116.31
tumor.
21025 T Excision of bone, lower 231 11.31 $581.56 $286.79 $116.31
jaw.
21026 T Excision of facial 231 11.31 $581.56 $286.79 $116.31
bone(s).
21029 T Contour of face bone 231 11.31 $581.56 $286.79 $116.31
lesion.
21030 T Removal of face bone 231 11.31 $581.56 $286.79 $116.31
lesion.
21031 T Remove exostosis, 231 11.31 $581.56 $286.79 $116.31
mandible.
21032 T Remove exostosis, 231 11.31 $581.56 $286.79 $116.31
maxilla.
21034 T Removal of face bone 232 23.82 $1,224.82 $636.87 $244.96
lesion.
21040 T Removal of jaw bone 231 11.31 $581.56 $286.79 $116.31
lesion.
21041 T Removal of jaw bone 231 11.31 $581.56 $286.79 $116.31
lesion.
21044 T Removal of jaw bone 232 23.82 $1,224.82 $636.87 $244.96
lesion.
21045 C Extensive jaw surgery.. ......... ......... ......... ........... ...........
21050 T Removal of jaw joint... 232 23.82 $1,224.82 $636.87 $244.96
21060 T Remove jaw joint 232 23.82 $1,224.82 $636.87 $244.96
cartilage.
21070 T Remove coronoid process 232 23.82 $1,224.82 $636.87 $244.96
21076 T Prepare face/oral 226 1.56 $80.22 $21.92 $16.04
prosthesis.
21077 T Prepare face/oral 226 1.56 $80.22 $21.92 $16.04
prosthesis.
21079 T Prepare face/oral 226 1.56 $80.22 $21.92 $16.04
prosthesis.
21080 T Prepare face/oral 226 1.56 $80.22 $21.92 $16.04
prosthesis.
21081 T Prepare face/oral 226 1.56 $80.22 $21.92 $16.04
prosthesis.
21082 T Prepare face/oral 226 1.56 $80.22 $21.92 $16.04
prosthesis.
21083 T Prepare face/oral 226 1.56 $80.22 $21.92 $16.04
prosthesis.
21084 T Prepare face/oral 226 1.56 $80.22 $21.92 $16.04
prosthesis.
21085 N Prepare face/oral ......... ......... ......... ........... ...........
prosthesis.
21086 T Prepare face/oral 226 1.56 $80.22 $21.92 $16.04
prosthesis.
21087 T Prepare face/oral 226 1.56 $80.22 $21.92 $16.04
prosthesis.
21088 T Prepare face/oral 226 1.56 $80.22 $21.92 $16.04
prosthesis.
21089 T Prepare face/oral 226 1.56 $80.22 $21.92 $16.04
prosthesis.
21100 T Maxillofacial fixation. 231 11.31 $581.56 $286.79 $116.31
21110 T Interdental fixation... 231 11.31 $581.56 $286.79 $116.31
21116 T Injection, jaw joint x- 347 2.57 $132.15 $62.38 $26.43
ray.
21120 T Reconstruction of chin. 231 11.31 $581.56 $286.79 $116.31
21121 T Reconstruction of chin. 232 23.82 $1,224.82 $636.87 $244.96
21122 T Reconstruction of chin. 232 23.82 $1,224.82 $636.87 $244.96
21123 T Reconstruction of chin. 232 23.82 $1,224.82 $636.87 $244.96
21125 T Augmentation lower jaw 231 11.31 $581.56 $286.79 $116.31
bone.
21127 T Augmentation lower jaw 232 23.82 $1,224.82 $636.87 $244.96
bone.
21137 C Reduction of forehead.. ......... ......... ......... ........... ...........
21138 C Reduction of forehead.. ......... ......... ......... ........... ...........
21139 C Reduction of forehead.. ......... ......... ......... ........... ...........
21141 C Reconstruct midface, ......... ......... ......... ........... ...........
lefort.
21142 C Reconstruct midface, ......... ......... ......... ........... ...........
lefort.
21143 C Reconstruct midface, ......... ......... ......... ........... ...........
lefort.
21145 C Reconstruct midface, ......... ......... ......... ........... ...........
lefort.
21146 C Reconstruct midface, ......... ......... ......... ........... ...........
lefort.
21147 C Reconstruct midface, ......... ......... ......... ........... ...........
lefort.
21150 C Reconstruct midface, ......... ......... ......... ........... ...........
lefort.
21151 C Reconstruct midface, ......... ......... ......... ........... ...........
lefort.
21154 C Reconstruct midface, ......... ......... ......... ........... ...........
lefort.
21155 C Reconstruct midface, ......... ......... ......... ........... ...........
lefort.
21159 C Reconstruct midface, ......... ......... ......... ........... ...........
lefort.
21160 C Reconstruct midface, ......... ......... ......... ........... ...........
lefort.
21172 C Reconstruct orbit/ ......... ......... ......... ........... ...........
forehead.
21175 C Reconstruct orbit/ ......... ......... ......... ........... ...........
forehead.
21179 C Reconstruct entire ......... ......... ......... ........... ...........
forehead.
21180 C Reconstruct entire ......... ......... ......... ........... ...........
forehead.
21181 T Contour cranial bone 232 23.82 $1,224.82 $636.87 $244.96
lesion.
21182 C Reconstruct cranial ......... ......... ......... ........... ...........
bone.
21183 C Reconstruct cranial ......... ......... ......... ........... ...........
bone.
21184 C Reconstruct cranial ......... ......... ......... ........... ...........
bone.
[[Page 35282]]
21188 C Reconstruction of ......... ......... ......... ........... ...........
midface.
21193 C Reconstruct lower jaw ......... ......... ......... ........... ...........
bone.
21194 C Reconstruct lower jaw ......... ......... ......... ........... ...........
bone.
21195 C Reconstruct lower jaw ......... ......... ......... ........... ...........
bone.
21196 C Reconstruct lower jaw ......... ......... ......... ........... ...........
bone.
21198 C Reconstruct lower jaw ......... ......... ......... ........... ...........
bone.
21206 T Reconstruct upper jaw 232 23.82 $1,224.82 $636.87 $244.96
bone.
21208 T Augmentation of facial 232 23.82 $1,224.82 $636.87 $244.96
bones.
21209 T Reduction of facial 232 23.82 $1,224.82 $636.87 $244.96
bones.
21210 T Face bone graft........ 232 23.82 $1,224.82 $636.87 $244.96
21215 T Lower jaw bone graft... 232 23.82 $1,224.82 $636.87 $244.96
21230 T Rib cartilage graft.... 232 23.82 $1,224.82 $636.87 $244.96
21235 T Ear cartilage graft.... 232 23.82 $1,224.82 $636.87 $244.96
21240 T Reconstruction of jaw 232 23.82 $1,224.82 $636.87 $244.96
joint.
21242 T Reconstruction of jaw 232 23.82 $1,224.82 $636.87 $244.96
joint.
21243 T Reconstruction of jaw 218 27.80 $1,429.48 $720.71 $285.90
joint.
21244 T Reconstruction of lower 232 23.82 $1,224.82 $636.87 $244.96
jaw.
21245 T Reconstruction of jaw.. 232 23.82 $1,224.82 $636.87 $244.96
21246 T Reconstruction of jaw.. 232 23.82 $1,224.82 $636.87 $244.96
21247 C Reconstruct lower jaw ......... ......... ......... ........... ...........
bone.
21248 T Reconstruction of jaw.. 232 23.82 $1,224.82 $636.87 $244.96
21249 T Reconstruction of jaw.. 232 23.82 $1,224.82 $636.87 $244.96
21255 C Reconstruct lower jaw ......... ......... ......... ........... ...........
bone.
21256 C Reconstruction of orbit ......... ......... ......... ........... ...........
21260 T Revise eye sockets..... 232 23.82 $1,224.82 $636.87 $244.96
21261 C Revise eye sockets..... ......... ......... ......... ........... ...........
21263 C Revise eye sockets..... ......... ......... ......... ........... ...........
21267 T Revise eye sockets..... 232 23.82 $1,224.82 $636.87 $244.96
21268 C Revise eye sockets..... ......... ......... ......... ........... ...........
21270 T Augmentation cheek bone 232 23.82 $1,224.82 $636.87 $244.96
21275 T Revision orbitofacial 232 23.82 $1,224.82 $636.87 $244.96
bones.
21280 T Revision of eyelid..... 231 11.31 $581.56 $286.79 $116.31
21282 T Revision of eyelid..... 231 11.31 $581.56 $286.79 $116.31
21295 T Revision of jaw muscle/ 231 11.31 $581.56 $286.79 $116.31
bone.
21296 T Revision of jaw muscle/ 231 11.31 $581.56 $286.79 $116.31
bone.
21299 T Cranio/maxillofacial 231 11.31 $581.56 $286.79 $116.31
surgery.
21300 T Treatment of skull 231 11.31 $581.56 $286.79 $116.31
fracture.
21310 T Treatment of nose 231 11.31 $581.56 $286.79 $116.31
fracture.
21315 T Treatment of nose 231 11.31 $581.56 $286.79 $116.31
fracture.
21320 T Treatment of nose 231 11.31 $581.56 $286.79 $116.31
fracture.
21325 T Repair of nose fracture 231 11.31 $581.56 $286.79 $116.31
21330 T Repair of nose fracture 232 23.82 $1,224.82 $636.87 $244.96
21335 T Repair of nose fracture 232 23.82 $1,224.82 $636.87 $244.96
21336 T Repair nasal septal 216 20.09 $1,033.03 $524.09 $206.61
fracture.
21337 T Repair nasal septal 231 11.31 $581.56 $286.79 $116.31
fracture.
21338 T Repair nasoethmoid 232 23.82 $1,224.82 $636.87 $244.96
fracture.
21339 T Repair nasoethmoid 232 23.82 $1,224.82 $636.87 $244.96
fracture.
21340 T Repair of nose fracture 232 23.82 $1,224.82 $636.87 $244.96
21343 T Repair of sinus 232 23.82 $1,224.82 $636.87 $244.96
fracture.
21344 C Repair of sinus ......... ......... ......... ........... ...........
fracture.
21345 T Repair of nose/jaw 232 23.82 $1,224.82 $636.87 $244.96
fracture.
21346 C Repair of nose/jaw ......... ......... ......... ........... ...........
fracture.
21347 C Repair of nose/jaw ......... ......... ......... ........... ...........
fracture.
21348 C Repair of nose/jaw ......... ......... ......... ........... ...........
fracture.
21355 T Repair cheek bone 231 11.31 $581.56 $286.79 $116.31
fracture.
21356 C Repair cheek bone ......... ......... ......... ........... ...........
fracture.
21360 C Repair cheek bone ......... ......... ......... ........... ...........
fracture.
21365 C Repair cheek bone ......... ......... ......... ........... ...........
fracture.
21366 C Repair cheek bone ......... ......... ......... ........... ...........
fracture.
21385 C Repair eye socket ......... ......... ......... ........... ...........
fracture.
21386 C Repair eye socket ......... ......... ......... ........... ...........
fracture.
21387 C Repair eye socket ......... ......... ......... ........... ...........
fracture.
21390 C Repair eye socket ......... ......... ......... ........... ...........
fracture.
21395 C Repair eye socket ......... ......... ......... ........... ...........
fracture.
21400 T Treat eye socket 231 11.31 $581.56 $286.79 $116.31
fracture.
21401 T Repair eye socket 231 11.31 $581.56 $286.79 $116.31
fracture.
21406 C Repair eye socket ......... ......... ......... ........... ...........
fracture.
21407 C Repair eye socket ......... ......... ......... ........... ...........
fracture.
21408 C Repair eye socket ......... ......... ......... ........... ...........
fracture.
21421 T Treat mouth roof 232 23.82 $1,224.82 $636.87 $244.96
fracture.
21422 C Repair mouth roof ......... ......... ......... ........... ...........
fracture.
21423 C Repair mouth roof ......... ......... ......... ........... ...........
fracture.
21431 C Treat craniofacial ......... ......... ......... ........... ...........
fracture.
21432 C Repair craniofacial ......... ......... ......... ........... ...........
fracture.
21433 C Repair craniofacial ......... ......... ......... ........... ...........
fracture.
[[Page 35283]]
21435 C Repair craniofacial ......... ......... ......... ........... ...........
fracture.
21436 C Repair craniofacial ......... ......... ......... ........... ...........
fracture.
21440 T Repair dental ridge 231 11.31 $581.56 $286.79 $116.31
fracture.
21445 T Repair dental ridge 232 23.82 $1,224.82 $636.87 $244.96
fracture.
21450 T Treat lower jaw 232 23.82 $1,224.82 $636.87 $244.96
fracture.
21451 T Treat lower jaw 231 11.31 $581.56 $286.79 $116.31
fracture.
21452 T Treat lower jaw 232 23.82 $1,224.82 $636.87 $244.96
fracture.
21453 T Treat lower jaw 232 23.82 $1,224.82 $636.87 $244.96
fracture.
21454 T Treat lower jaw 232 23.82 $1,224.82 $636.87 $244.96
fracture.
21461 T Repair lower jaw 232 23.82 $1,224.82 $636.87 $244.96
fracture.
21462 T Repair lower jaw 232 23.82 $1,224.82 $636.87 $244.96
fracture.
21465 T Repair lower jaw 232 23.82 $1,224.82 $636.87 $244.96
fracture.
21470 C Repair lower jaw ......... ......... ......... ........... ...........
fracture.
21480 T Reset dislocated jaw... 231 11.31 $581.56 $286.79 $116.31
21485 T Reset dislocated jaw... 231 11.31 $581.56 $286.79 $116.31
21490 T Repair dislocated jaw.. 232 23.82 $1,224.82 $636.87 $244.96
21493 T Treat hyoid bone 231 11.31 $581.56 $286.79 $116.31
fracture.
21494 T Repair hyoid bone 231 11.31 $581.56 $286.79 $116.31
fracture.
21495 C Repair hyoid bone ......... ......... ......... ........... ...........
fracture.
21497 T Interdental wiring..... 231 11.31 $581.56 $286.79 $116.31
21499 T Head surgery procedure. 231 11.31 $581.56 $286.79 $116.31
21501 T Drain neck/chest lesion 132 5.63 $289.49 $132.89 $57.90
21502 T Drain chest lesion..... 252 19.24 $989.32 $512.34 $197.86
21510 C Drainage of bone lesion ......... ......... ......... ........... ...........
21550 T Biopsy of neck/chest... 161 3.43 $176.37 $75.71 $35.27
21555 T Remove lesion neck/ 163 10.48 $538.88 $260.80 $107.78
chest.
21556 T Remove lesion neck/ 163 10.48 $538.88 $260.80 $107.78
chest.
21557 C Remove tumor, neck or ......... ......... ......... ........... ...........
chest.
21600 T Partial removal of rib. 252 19.24 $989.32 $512.34 $197.86
21610 T Partial removal of rib. 252 19.24 $989.32 $512.34 $197.86
21615 C Removal of rib......... ......... ......... ......... ........... ...........
21616 C Removal of rib and ......... ......... ......... ........... ...........
nerves.
21620 C Partial removal of ......... ......... ......... ........... ...........
sternum.
21627 C Sternal debridement.... ......... ......... ......... ........... ...........
21630 C Extensive sternum ......... ......... ......... ........... ...........
surgery.
21632 C Extensive sternum ......... ......... ......... ........... ...........
surgery.
21700 T Revision of neck muscle 132 5.63 $289.49 $132.89 $57.90
21705 C Revision of neck muscle/ ......... ......... ......... ........... ...........
rib.
21720 T Revision of neck muscle 132 5.63 $289.49 $132.89 $57.90
21725 T Revision of neck muscle 132 5.63 $289.49 $132.89 $57.90
21740 C Reconstruction of ......... ......... ......... ........... ...........
sternum.
21750 C Repair of sternum ......... ......... ......... ........... ...........
separation.
21800 T Treatment of rib 207 1.70 $87.41 $32.32 $17.48
fracture.
21805 T Treatment of rib 216 20.09 $1,033.03 $524.09 $206.61
fracture.
21810 C Treatment of rib ......... ......... ......... ........... ...........
fracture(s).
21820 T Treat sternum fracture. 207 1.70 $87.41 $32.32 $17.48
21825 C Repair sternum fracture ......... ......... ......... ........... ...........
21899 T Neck/chest surgery 207 1.70 $87.41 $32.32 $17.48
procedure.
21920 T Biopsy soft tissue of 161 3.43 $176.37 $75.71 $35.27
back.
21925 T Biopsy soft tissue of 163 10.48 $538.88 $260.80 $107.78
back.
21930 T Remove lesion, back or 163 10.48 $538.88 $260.80 $107.78
flank.
21935 T Remove tumor of back... 163 10.48 $538.88 $260.80 $107.78
22100 C Remove part of neck ......... ......... ......... ........... ...........
vertebra.
22101 C Remove part, thorax ......... ......... ......... ........... ...........
vertebra.
22102 C Remove part, lumbar ......... ......... ......... ........... ...........
vertebra.
22103 C Remove extra spine ......... ......... ......... ........... ...........
segment.
22110 C Remove part of neck ......... ......... ......... ........... ...........
vertebra.
22112 C Remove part, thorax ......... ......... ......... ........... ...........
vertebra.
22114 C Remove part, lumbar ......... ......... ......... ........... ...........
vertebra.
22116 C Remove extra spine ......... ......... ......... ........... ...........
segment.
22210 C Revision of neck spine. ......... ......... ......... ........... ...........
22212 C Revision of thorax ......... ......... ......... ........... ...........
spine.
22214 C Revision of lumbar ......... ......... ......... ........... ...........
spine.
22216 C Revise, extra spine ......... ......... ......... ........... ...........
segment.
22220 C Revision of neck spine. ......... ......... ......... ........... ...........
22222 C Revision of thorax ......... ......... ......... ........... ...........
spine.
22224 C Revision of lumbar ......... ......... ......... ........... ...........
spine.
22226 C Revise, extra spine ......... ......... ......... ........... ...........
segment.
22305 T Treat spine process 207 1.70 $87.41 $32.32 $17.48
fracture.
22310 T Treat spine fracture... 207 1.70 $87.41 $32.32 $17.48
22315 T Treat spine fracture... 207 1.70 $87.41 $32.32 $17.48
22325 C Repair of spine ......... ......... ......... ........... ...........
fracture.
22326 C Repair neck spine ......... ......... ......... ........... ...........
fracture.
22327 C Repair thorax spine ......... ......... ......... ........... ...........
fracture.
22328 C Repair each add spine ......... ......... ......... ........... ...........
fx.
[[Page 35284]]
22505 T Manipulation of spine.. 210 10.06 $517.29 $279.34 $103.46
22548 C Neck spine fusion...... ......... ......... ......... ........... ...........
22554 C Neck spine fusion...... ......... ......... ......... ........... ...........
22556 C Thorax spine fusion.... ......... ......... ......... ........... ...........
22558 C Lumbar spine fusion.... ......... ......... ......... ........... ...........
22585 C Additional spinal ......... ......... ......... ........... ...........
fusion.
22590 C Spine & skull spinal ......... ......... ......... ........... ...........
fusion.
22595 C Neck spinal fusion..... ......... ......... ......... ........... ...........
22600 C Neck spine fusion...... ......... ......... ......... ........... ...........
22610 C Thorax spine fusion.... ......... ......... ......... ........... ...........
22612 C Lumbar spine fusion.... ......... ......... ......... ........... ...........
22614 C Spine fusion, extra ......... ......... ......... ........... ...........
segment.
22630 C Lumbar spine fusion.... ......... ......... ......... ........... ...........
22632 C Spine fusion, extra ......... ......... ......... ........... ...........
segment.
22800 C Fusion of spine........ ......... ......... ......... ........... ...........
22802 C Fusion of spine........ ......... ......... ......... ........... ...........
22804 C Fusion of spine........ ......... ......... ......... ........... ...........
22808 C Fusion of spine........ ......... ......... ......... ........... ...........
22810 C Fusion of spine........ ......... ......... ......... ........... ...........
22812 C Fusion of spine........ ......... ......... ......... ........... ...........
22818 C Kyphectomy, 1-2 ......... ......... ......... ........... ...........
segments.
22819 C Kyphectomy, 3 & more ......... ......... ......... ........... ...........
segment.
22830 C Exploration of spinal ......... ......... ......... ........... ...........
fusion.
22840 C Insert spine fixation ......... ......... ......... ........... ...........
device.
22841 C Insert spine fixation ......... ......... ......... ........... ...........
device.
22842 C Insert spine fixation ......... ......... ......... ........... ...........
device.
22843 C Insert spine fixation ......... ......... ......... ........... ...........
device.
22844 C Insert spine fixation ......... ......... ......... ........... ...........
device.
22845 C Insert spine fixation ......... ......... ......... ........... ...........
device.
22846 C Insert spine fixation ......... ......... ......... ........... ...........
device.
22847 C Insert spine fixation ......... ......... ......... ........... ...........
device.
22848 C Insert pelvic ......... ......... ......... ........... ...........
fixationdevice.
22849 C Reinsert spinal ......... ......... ......... ........... ...........
fixation.
22850 C Remove spine fixation ......... ......... ......... ........... ...........
device.
22851 C Apply spine prosth ......... ......... ......... ........... ...........
device.
22852 C Remove spine fixation ......... ......... ......... ........... ...........
device.
22855 C Remove spine fixation ......... ......... ......... ........... ...........
device.
22899 T Spine surgery procedure 207 1.70 $87.41 $32.32 $17.48
22900 T Remove abdominal wall 163 10.48 $538.88 $260.80 $107.78
lesion.
22999 T Abdomen surgery 163 10.48 $538.88 $260.80 $107.78
procedure.
23000 T Removal of calcium 162 5.59 $287.44 $125.66 $57.49
deposits.
23020 T Release shoulder joint. 253 25.74 $1,323.55 $684.55 $264.71
23030 T Drain shoulder lesion.. 132 5.63 $289.49 $132.89 $57.90
23031 T Drain shoulder bursa... 132 5.63 $289.49 $132.89 $57.90
23035 C Drain shoulder bone ......... ......... ......... ........... ...........
lesion.
23040 T Exploratory shoulder 252 19.24 $989.32 $512.34 $197.86
surgery.
23044 T Exploratory shoulder 252 19.24 $989.32 $512.34 $197.86
surgery.
23065 T Biopsy shoulder tissues 161 3.43 $176.37 $75.71 $35.27
23066 T Biopsy shoulder tissues 163 10.48 $538.88 $260.80 $107.78
23075 T Removal of shoulder 162 5.59 $287.44 $125.66 $57.49
lesion.
23076 T Removal of shoulder 163 10.48 $538.88 $260.80 $107.78
lesion.
23077 T Remove tumor of 163 10.48 $538.88 $260.80 $107.78
shoulder.
23100 T Biopsy of shoulder 251 13.88 $713.71 $365.89 $142.74
joint.
23101 T Shoulder joint surgery. 252 19.24 $989.32 $512.34 $197.86
23105 T Remove shoulder joint 252 19.24 $989.32 $512.34 $197.86
lining.
23106 T Incision of collarbone 252 19.24 $989.32 $512.34 $197.86
joint.
23107 T Explore,treat shoulder 252 19.24 $989.32 $512.34 $197.86
joint.
23120 T Partial removal, collar 253 25.74 $1,323.55 $684.55 $264.71
bone.
23125 C Removal of collarbone.. ......... ......... ......... ........... ...........
23130 T Partial 253 25.74 $1,323.55 $684.55 $264.71
removal,shoulderbone.
23140 T Removal of bone lesion. 251 13.88 $713.71 $365.89 $142.74
23145 T Removal of bone lesion. 252 19.24 $989.32 $512.34 $197.86
23146 T Removal of bone lesion. 252 19.24 $989.32 $512.34 $197.86
23150 T Removal of humerus 252 19.24 $989.32 $512.34 $197.86
lesion.
23155 T Removal of humerus 252 19.24 $989.32 $512.34 $197.86
lesion.
23156 T Removal of humerus 252 19.24 $989.32 $512.34 $197.86
lesion.
23170 T Remove collarbone 252 19.24 $989.32 $512.34 $197.86
lesion.
23172 T Remove shoulder blade 252 19.24 $989.32 $512.34 $197.86
lesion.
23174 T Remove humerus lesion.. 252 19.24 $989.32 $512.34 $197.86
23180 T Remove collar bone 252 19.24 $989.32 $512.34 $197.86
lesion.
23182 T Remove shoulder blade 252 19.24 $989.32 $512.34 $197.86
lesion.
23184 T Remove humerus lesion.. 252 19.24 $989.32 $512.34 $197.86
23190 T Partial removal of 252 19.24 $989.32 $512.34 $197.86
scapula.
23195 C Removal of head of ......... ......... ......... ........... ...........
humerus.
23200 C Removal of collar bone. ......... ......... ......... ........... ...........
[[Page 35285]]
23210 C Removal of ......... ......... ......... ........... ...........
shoulderblade.
23220 C Partial removal of ......... ......... ......... ........... ...........
humerus.
23221 C Partial removal of ......... ......... ......... ........... ...........
humerus.
23222 C Partial removal of ......... ......... ......... ........... ...........
humerus.
23330 T Remove shoulder foreign 163 10.48 $538.88 $260.80 $107.78
body.
23331 T Remove shoulder foreign 163 10.48 $538.88 $260.80 $107.78
body.
23332 C Remove shoulder foreign ......... ......... ......... ........... ...........
body.
23350 T Injection for shoulder 347 2.57 $132.15 $62.38 $26.43
x-ray.
23395 C Muscle ......... ......... ......... ........... ...........
transfer,shoulder/arm.
23397 C Muscle transfers....... ......... ......... ......... ........... ...........
23400 C Fixation of shoulder ......... ......... ......... ........... ...........
blade.
23405 T Incision of tendon & 252 19.24 $989.32 $512.34 $197.86
muscle.
23406 T Incise tendon(s) & 252 19.24 $989.32 $512.34 $197.86
muscle(s).
23410 T Repair of tendon(s).... 254 32.70 $1,681.43 $922.98 $336.29
23412 T Repair of tendon(s).... 254 32.70 $1,681.43 $922.98 $336.29
23415 T Release of shoulder 253 25.74 $1,323.55 $684.55 $264.71
ligament.
23420 T Repair of shoulder..... 254 32.70 $1,681.43 $922.98 $336.29
23430 T Repair biceps tendon... 254 32.70 $1,681.43 $922.98 $336.29
23440 C Removal/transplant ......... ......... ......... ........... ...........
tendon.
23450 T Repair shoulder capsule 254 32.70 $1,681.43 $922.98 $336.29
23455 T Repair shoulder capsule 254 32.70 $1,681.43 $922.98 $336.29
23460 T Repair shoulder capsule 254 32.70 $1,681.43 $922.98 $336.29
23462 T Repair shoulder capsule 254 32.70 $1,681.43 $922.98 $336.29
23465 T Repair shoulder capsule 254 32.70 $1,681.43 $922.98 $336.29
23466 T Repair shoulder capsule 254 32.70 $1,681.43 $922.98 $336.29
23470 C Reconstruct shoulder ......... ......... ......... ........... ...........
joint.
23472 C Reconstruct shoulder ......... ......... ......... ........... ...........
joint.
23480 T Revision of collarbone. 253 25.74 $1,323.55 $684.55 $264.71
23485 T Revision of collar bone 253 25.74 $1,323.55 $684.55 $264.71
23490 T Reinforce clavicle..... 253 25.74 $1,323.55 $684.55 $264.71
23491 T Reinforce shoulder 253 25.74 $1,323.55 $684.55 $264.71
bones.
23500 T Treat clavicle fracture 207 1.70 $87.41 $32.32 $17.48
23505 T Treat clavicle fracture 207 1.70 $87.41 $32.32 $17.48
23515 T Repair clavicle 216 20.09 $1,033.03 $524.09 $206.61
fracture.
23520 T Treat clavicle 207 1.70 $87.41 $32.32 $17.48
dislocation.
23525 T Treat clavicle 207 1.70 $87.41 $32.32 $17.48
dislocation.
23530 T Repair clavicle 216 20.09 $1,033.03 $524.09 $206.61
dislocation.
23532 T Repair clavicle 216 20.09 $1,033.03 $524.09 $206.61
dislocation.
23540 T Treat clavicle 207 1.70 $87.41 $32.32 $17.48
dislocation.
23545 T Treat clavicle 207 1.70 $87.41 $32.32 $17.48
dislocation.
23550 T Repair clavicle 216 20.09 $1,033.03 $524.09 $206.61
dislocation.
23552 T Repair clavicle 216 20.09 $1,033.03 $524.09 $206.61
dislocation.
23570 T Treat shoulderblade 207 1.70 $87.41 $32.32 $17.48
fracture.
23575 T Treat shoulderblade 207 1.70 $87.41 $32.32 $17.48
fracture.
23585 T Repair scapula fracture 216 20.09 $1,033.03 $524.09 $206.61
23600 T Treat humerus fracture. 209 1.94 $99.75 $37.74 $19.95
23605 T Treat humerus fracture. 209 1.94 $99.75 $37.74 $19.95
23615 T Repair humerus fracture 216 20.09 $1,033.03 $524.09 $206.61
23616 T Repair humerus fracture 216 20.09 $1,033.03 $524.09 $206.61
23620 T Treat humerus fracture. 209 1.94 $99.75 $37.74 $19.95
23625 T Treat humerus fracture. 209 1.94 $99.75 $37.74 $19.95
23630 T Repair humerus fracture 216 20.09 $1,033.03 $524.09 $206.61
23650 T Treat shoulder 207 1.70 $87.41 $32.32 $17.48
dislocation.
23655 T Treat shoulder 210 10.06 $517.29 $279.34 $103.46
dislocation.
23660 T Repair shoulder 216 20.09 $1,033.03 $524.09 $206.61
dislocation.
23665 T Treat dislocation/ 209 1.94 $99.75 $37.74 $19.95
fracture.
23670 T Repair dislocation/ 216 20.09 $1,033.03 $524.09 $206.61
fracture.
23675 T Treat dislocation/ 209 1.94 $99.75 $37.74 $19.95
fracture.
23680 T Repair dislocation/ 216 20.09 $1,033.03 $524.09 $206.61
fracture.
23700 T Fixation of shoulder... 210 10.06 $517.29 $279.34 $103.46
23800 T Fusion of shoulder 253 25.74 $1,323.55 $684.55 $264.71
joint.
23802 T Fusion of shoulder 253 25.74 $1,323.55 $684.55 $264.71
joint.
23900 C Amputation of arm & ......... ......... ......... ........... ...........
girdle.
23920 C Amputation at shoulder ......... ......... ......... ........... ...........
joint.
23921 T Amputation follow-up 183 11.04 $567.68 $283.18 $113.54
surgery.
23929 T Shoulder surgery 207 1.70 $87.41 $32.32 $17.48
procedure.
23930 T Drainage of arm lesion. 132 5.63 $289.49 $132.89 $57.90
23931 T Drainage of arm bursa.. 132 5.63 $289.49 $132.89 $57.90
23935 T Drain arm/elbow bone 251 13.88 $713.71 $365.89 $142.74
lesion.
24000 T Exploratory elbow 252 19.24 $989.32 $512.34 $197.86
surgery.
24006 T Release elbow joint.... 252 19.24 $989.32 $512.34 $197.86
24065 T Biopsy arm/elbow soft 161 3.43 $176.37 $75.71 $35.27
tissue.
24066 T Biopsy arm/elbow soft 163 10.48 $538.88 $260.80 $107.78
tissue.
24075 T Remove arm/elbow lesion 162 5.59 $287.44 $125.66 $57.49
24076 T Remove arm/elbow lesion 163 10.48 $538.88 $260.80 $107.78
[[Page 35286]]
24077 T Remove tumor of arm/ 163 10.48 $538.88 $260.80 $107.78
elbow.
24100 T Biopsy elbow joint 251 13.88 $713.71 $365.89 $142.74
lining.
24101 T Explore/treat elbow 252 19.24 $989.32 $512.34 $197.86
joint.
24102 T Remove elbow joint 252 19.24 $989.32 $512.34 $197.86
lining.
24105 T Removal of elbow bursa. 251 13.88 $713.71 $365.89 $142.74
24110 T Remove humerus lesion.. 251 13.88 $713.71 $365.89 $142.74
24115 T Remove/graft bone 252 19.24 $989.32 $512.34 $197.86
lesion.
24116 T Remove/graft bone 252 19.24 $989.32 $512.34 $197.86
lesion.
24120 T Remove elbow lesion.... 251 13.88 $713.71 $365.89 $142.74
24125 T Remove/graft bone 252 19.24 $989.32 $512.34 $197.86
lesion.
24126 T Remove/graft bone 252 19.24 $989.32 $512.34 $197.86
lesion.
24130 T Removal of head of 252 19.24 $989.32 $512.34 $197.86
radius.
24134 T Removal of arm bone 252 19.24 $989.32 $512.34 $197.86
lesion.
24136 T Remove radius bone 252 19.24 $989.32 $512.34 $197.86
lesion.
24138 T Remove elbow bone 252 19.24 $989.32 $512.34 $197.86
lesion.
24140 T Partial removal of arm 252 19.24 $989.32 $512.34 $197.86
bone.
24145 T Partial removal of 252 19.24 $989.32 $512.34 $197.86
radius.
24147 T Partial removal of 252 19.24 $989.32 $512.34 $197.86
elbow.
24149 C Radical resection of ......... ......... ......... ........... ...........
elbow.
24150 C Extensive humerus ......... ......... ......... ........... ...........
surgery.
24151 C Extensive humerus ......... ......... ......... ........... ...........
surgery.
24152 C Extensive radius ......... ......... ......... ........... ...........
surgery.
24153 C Extensive radius ......... ......... ......... ........... ...........
surgery.
24155 T Removal of elbow joint. 253 25.74 $1,323.55 $684.55 $264.71
24160 T Remove elbow joint 252 19.24 $989.32 $512.34 $197.86
implant.
24164 T Remove radius head 252 19.24 $989.32 $512.34 $197.86
implant.
24200 T Removal of arm foreign 161 3.43 $176.37 $75.71 $35.27
body.
24201 T Removal of arm foreign 163 10.48 $538.88 $260.80 $107.78
body.
24220 T Injection for elbow x- 347 2.57 $132.15 $62.38 $26.43
ray.
24301 T Muscle/tendon transfer. 252 19.24 $989.32 $512.34 $197.86
24305 T Arm tendon lengthening. 252 19.24 $989.32 $512.34 $197.86
24310 T Revision of arm tendon. 251 13.88 $713.71 $365.89 $142.74
24320 T Repair of arm tendon... 253 25.74 $1,323.55 $684.55 $264.71
24330 T Revision of arm muscles 253 25.74 $1,323.55 $684.55 $264.71
24331 T Revision of arm muscles 253 25.74 $1,323.55 $684.55 $264.71
24340 T Repair of biceps tendon 253 25.74 $1,323.55 $684.55 $264.71
24341 T Repair tendon/muscle 253 25.74 $1,323.55 $684.55 $264.71
arm.
24342 T Repair of ruptured 253 25.74 $1,323.55 $684.55 $264.71
tendon.
24350 T Repair of tennis elbow. 252 19.24 $989.32 $512.34 $197.86
24351 T Repair of tennis elbow. 252 19.24 $989.32 $512.34 $197.86
24352 T Repair of tennis elbow. 252 19.24 $989.32 $512.34 $197.86
24354 T Repair of tennis elbow. 252 19.24 $989.32 $512.34 $197.86
24356 T Revision of tennis 252 19.24 $989.32 $512.34 $197.86
elbow.
24360 T Reconstruct elbow joint 217 20.54 $1,056.17 $530.42 $211.23
24361 T Reconstruct elbow joint 218 27.80 $1,429.48 $720.71 $285.90
24362 T Reconstruct elbow joint 218 27.80 $1,429.48 $720.71 $285.90
24363 T Replace elbow joint.... 218 27.80 $1,429.48 $720.71 $285.90
24365 T Reconstruct head of 217 20.54 $1,056.17 $530.42 $211.23
radius.
24366 T Reconstruct head of 218 27.80 $1,429.48 $720.71 $285.90
radius.
24400 T Revision of humerus.... 252 19.24 $989.32 $512.34 $197.86
24410 T Revision of humerus.... 252 19.24 $989.32 $512.34 $197.86
24420 T Revision of humerus.... 253 25.74 $1,323.55 $684.55 $264.71
24430 T Repair of humerus...... 253 25.74 $1,323.55 $684.55 $264.71
24435 T Repair humerus with 253 25.74 $1,323.55 $684.55 $264.71
graft.
24470 T Revision of elbow joint 253 25.74 $1,323.55 $684.55 $264.71
24495 T Decompression of 252 19.24 $989.32 $512.34 $197.86
forearm.
24498 T Reinforce humerus...... 253 25.74 $1,323.55 $684.55 $264.71
24500 T Treat humerus fracture. 209 1.94 $99.75 $37.74 $19.95
24505 T Treat humerus fracture. 209 1.94 $99.75 $37.74 $19.95
24515 T Repair humerus fracture 216 20.09 $1,033.03 $524.09 $206.61
24516 T Repair humerus fracture 216 20.09 $1,033.03 $524.09 $206.61
24530 T Treat humerus fracture. 209 1.94 $99.75 $37.74 $19.95
24535 T Treat humerus fracture. 209 1.94 $99.75 $37.74 $19.95
24538 T Treat humerus fracture. 216 20.09 $1,033.03 $524.09 $206.61
24545 T Repair humerus fracture 216 20.09 $1,033.03 $524.09 $206.61
24546 T Repair humerus fracture 216 20.09 $1,033.03 $524.09 $206.61
24560 T Treat humerus fracture. 209 1.94 $99.75 $37.74 $19.95
24565 T Treat humerus fracture. 209 1.94 $99.75 $37.74 $19.95
24566 T Treat humerus fracture. 216 20.09 $1,033.03 $524.09 $206.61
24575 T Repair humerus fracture 216 20.09 $1,033.03 $524.09 $206.61
24576 T Treat humerus fracture. 209 1.94 $99.75 $37.74 $19.95
24577 T Treat humerus fracture. 209 1.94 $99.75 $37.74 $19.95
24579 T Repair humerus fracture 216 20.09 $1,033.03 $524.09 $206.61
24582 T Treat humerus fracture. 216 20.09 $1,033.03 $524.09 $206.61
24586 T Repair elbow fracture.. 216 20.09 $1,033.03 $524.09 $206.61
[[Page 35287]]
24587 T Repair elbow fracture.. 216 20.09 $1,033.03 $524.09 $206.61
24600 T Treat elbow dislocation 209 1.94 $99.75 $37.74 $19.95
24605 T Treat elbow dislocation 210 10.06 $517.29 $279.34 $103.46
24615 T Repair elbow 216 20.09 $1,033.03 $524.09 $206.61
dislocation.
24620 T Treat elbow fracture... 209 1.94 $99.75 $37.74 $19.95
24635 T Repair elbow fracture.. 216 20.09 $1,033.03 $524.09 $206.61
24640 T Treat elbow dislocation 209 1.94 $99.75 $37.74 $19.95
24650 T Treat radius fracture.. 209 1.94 $99.75 $37.74 $19.95
24655 T Treat radius fracture.. 209 1.94 $99.75 $37.74 $19.95
24665 T Repair radius fracture. 216 20.09 $1,033.03 $524.09 $206.61
24666 T Repair radius fracture. 216 20.09 $1,033.03 $524.09 $206.61
24670 T Treatment of ulna 209 1.94 $99.75 $37.74 $19.95
fracture.
24675 T Treatment of ulna 209 1.94 $99.75 $37.74 $19.95
fracture.
24685 T Repair ulna fracture... 216 20.09 $1,033.03 $524.09 $206.61
24800 T Fusion of elbow joint.. 253 25.74 $1,323.55 $684.55 $264.71
24802 T Fusion/graft of elbow 253 25.74 $1,323.55 $684.55 $264.71
joint.
24900 C Amputation of upper arm ......... ......... ......... ........... ...........
24920 C Amputation of upper arm ......... ......... ......... ........... ...........
24925 T Amputation follow-up 251 13.88 $713.71 $365.89 $142.74
surgery.
24930 C Amputation follow-up ......... ......... ......... ........... ...........
surgery.
24931 C Amputate upper arm & ......... ......... ......... ........... ...........
implant.
24935 C Revision of amputation. ......... ......... ......... ........... ...........
24940 C Revision of upper arm.. ......... ......... ......... ........... ...........
24999 T Upper arm/elbow surgery 209 1.94 $99.75 $37.74 $19.95
25000 T Incision of tendon 251 13.88 $713.71 $365.89 $142.74
sheath.
25020 T Decompression of 251 13.88 $713.71 $365.89 $142.74
forearm.
25023 T Decompression of 252 19.24 $989.32 $512.34 $197.86
forearm.
25028 T Drainage of forearm 251 13.88 $713.71 $365.89 $142.74
lesion.
25031 T Drainage of forearm 251 13.88 $713.71 $365.89 $142.74
bursa.
25035 T Treat forearm bone 251 13.88 $713.71 $365.89 $142.74
lesion.
25040 T Explore/treat wrist 252 19.24 $989.32 $512.34 $197.86
joint.
25065 T Biopsy forearm soft 161 3.43 $176.37 $75.71 $35.27
tissues.
25066 T Biopsy forearm soft 163 10.48 $538.88 $260.80 $107.78
tissues.
25075 T Removal of forearm 162 5.59 $287.44 $125.66 $57.49
lesion.
25076 T Removal of forearm 163 10.48 $538.88 $260.80 $107.78
lesion.
25077 T Remove tumor, forearm/ 163 10.48 $538.88 $260.80 $107.78
wrist.
25085 T Incision of wrist 251 13.88 $713.71 $365.89 $142.74
capsule.
25100 T Biopsy of wrist joint.. 251 13.88 $713.71 $365.89 $142.74
25101 T Explore/treat wrist 252 19.24 $989.32 $512.34 $197.86
joint.
25105 T Remove wrist joint 252 19.24 $989.32 $512.34 $197.86
lining.
25107 T Remove wrist joint 252 19.24 $989.32 $512.34 $197.86
cartilage.
25110 T Remove wrist tendon 251 13.88 $713.71 $365.89 $142.74
lesion.
25111 T Remove wrist tendon 261 10.41 $535.28 $259.00 $107.06
lesion.
25112 T Reremove wrist tendon 261 10.41 $535.28 $259.00 $107.06
lesion.
25115 T Remove wrist/forearm 251 13.88 $713.71 $365.89 $142.74
lesion.
25116 T Remove wrist/forearm 251 13.88 $713.71 $365.89 $142.74
lesion.
25118 T Excise wrist tendon 252 19.24 $989.32 $512.34 $197.86
sheath.
25119 T Partial removal of ulna 252 19.24 $989.32 $512.34 $197.86
25120 T Removal of forearm 252 19.24 $989.32 $512.34 $197.86
lesion.
25125 T Remove/graft forearm 252 19.24 $989.32 $512.34 $197.86
lesion.
25126 T Remove/graft forearm 252 19.24 $989.32 $512.34 $197.86
lesion.
25130 T Removal of wrist lesion 252 19.24 $989.32 $512.34 $197.86
25135 T Remove & graft wrist 252 19.24 $989.32 $512.34 $197.86
lesion.
25136 T Remove & graft wrist 252 19.24 $989.32 $512.34 $197.86
lesion.
25145 T Remove forearm bone 252 19.24 $989.32 $512.34 $197.86
lesion.
25150 T Partial removal of ulna 252 19.24 $989.32 $512.34 $197.86
25151 T Partial removal of 252 19.24 $989.32 $512.34 $197.86
radius.
25170 C Extensive forearm ......... ......... ......... ........... ...........
surgery.
25210 T Removal of wrist bone.. 262 18.07 $929.16 $475.96 $185.83
25215 T Removal of wrist bones. 262 18.07 $929.16 $475.96 $185.83
25230 T Partial removal of 252 19.24 $989.32 $512.34 $197.86
radius.
25240 T Partial removal of ulna 252 19.24 $989.32 $512.34 $197.86
25246 T Injection for wrist x- 347 2.57 $132.15 $62.38 $26.43
ray.
25248 T Remove forearm foreign 251 13.88 $713.71 $365.89 $142.74
body.
25250 T Removal of wrist 252 19.24 $989.32 $512.34 $197.86
prosthesis.
25251 T Removal of wrist 252 19.24 $989.32 $512.34 $197.86
prosthesis.
25260 T Repair forearm tendon/ 252 19.24 $989.32 $512.34 $197.86
muscle.
25263 T Repair forearm tendon/ 252 19.24 $989.32 $512.34 $197.86
muscle.
25265 T Repair forearm tendon/ 252 19.24 $989.32 $512.34 $197.86
muscle.
25270 T Repair forearm tendon/ 252 19.24 $989.32 $512.34 $197.86
muscle.
25272 T Repair forearm tendon/ 252 19.24 $989.32 $512.34 $197.86
muscle.
25274 T Repair forearm tendon/ 252 19.24 $989.32 $512.34 $197.86
muscle.
25280 T Revise wrist/forearm 252 19.24 $989.32 $512.34 $197.86
tendon.
25290 T Incise wrist/forearm 252 19.24 $989.32 $512.34 $197.86
tendon.
25295 T Release wrist/forearm 251 13.88 $713.71 $365.89 $142.74
tendon.
[[Page 35288]]
25300 T Fusion of tendons at 252 19.24 $989.32 $512.34 $197.86
wrist.
25301 T Fusion of tendons at 252 19.24 $989.32 $512.34 $197.86
wrist.
25310 T Transplant forearm 253 25.74 $1,323.55 $684.55 $264.71
tendon.
25312 T Transplant forearm 253 25.74 $1,323.55 $684.55 $264.71
tendon.
25315 T Revise palsy hand 253 25.74 $1,323.55 $684.55 $264.71
tendon(s).
25316 T Revise palsy hand 253 25.74 $1,323.55 $684.55 $264.71
tendon(s).
25320 T Repair/revise wrist 253 25.74 $1,323.55 $684.55 $264.71
joint.
\2\ 2533 T Revise wrist joint..... 217 20.54 $1,056.17 $530.42 $211.23
0
\2\ 2533 T Revise wrist joint..... 217 20.54 $1,056.17 $530.42 $211.23
1
25332 T Revise wrist joint..... 217 20.54 $1,056.17 $530.42 $211.23
25335 T Realignment of hand.... 253 25.74 $1,323.55 $684.55 $264.71
25337 T Reconstruct ulna/ 253 25.74 $1,323.55 $684.55 $264.71
radioulnar.
25350 T Revision of radius..... 253 25.74 $1,323.55 $684.55 $264.71
25355 T Revision of radius..... 253 25.74 $1,323.55 $684.55 $264.71
25360 T Revision of ulna....... 252 19.24 $989.32 $512.34 $197.86
25365 T Revise radius & ulna... 252 19.24 $989.32 $512.34 $197.86
25370 T Revise radius or ulna.. 253 25.74 $1,323.55 $684.55 $264.71
25375 T Revise radius & ulna... 253 25.74 $1,323.55 $684.55 $264.71
25390 C Shorten radius/ulna.... ......... ......... ......... ........... ...........
25391 C Lengthen radius/ulna... ......... ......... ......... ........... ...........
25392 C Shorten radius & ulna.. ......... ......... ......... ........... ...........
25393 C Lengthen radius & ulna. ......... ......... ......... ........... ...........
25400 T Repair radius or ulna.. 252 19.24 $989.32 $512.34 $197.86
25405 C Repair/graft radius or ......... ......... ......... ........... ...........
ulna.
25415 T Repair radius & ulna... 252 19.24 $989.32 $512.34 $197.86
25420 C Repair/graft radius & ......... ......... ......... ........... ...........
ulna.
25425 T Repair/graft radius or 253 25.74 $1,323.55 $684.55 $264.71
ulna.
25426 T Repair/graft radius & 253 25.74 $1,323.55 $684.55 $264.71
ulna.
25440 T Repair/graft wrist bone 253 25.74 $1,323.55 $684.55 $264.71
25441 T Reconstruct wrist joint 218 27.80 $1,429.48 $720.71 $285.90
25442 T Reconstruct wrist joint 218 27.80 $1,429.48 $720.71 $285.90
25443 T Reconstruct wrist joint 218 27.80 $1,429.48 $720.71 $285.90
25444 T Reconstruct wrist joint 218 27.80 $1,429.48 $720.71 $285.90
25445 T Reconstruct wrist joint 218 27.80 $1,429.48 $720.71 $285.90
25446 T Wrist replacement...... 218 27.80 $1,429.48 $720.71 $285.90
25447 T Repair wrist joint(s).. 217 20.54 $1,056.17 $530.42 $211.23
25449 T Remove wrist joint 217 20.54 $1,056.17 $530.42 $211.23
implant.
25450 T Revision of wrist joint 253 25.74 $1,323.55 $684.55 $264.71
25455 T Revision of wrist joint 253 25.74 $1,323.55 $684.55 $264.71
25490 T Reinforce radius....... 253 25.74 $1,323.55 $684.55 $264.71
25491 T Reinforce ulna......... 253 25.74 $1,323.55 $684.55 $264.71
25492 T Reinforce radius and 253 25.74 $1,323.55 $684.55 $264.71
ulna.
25500 T Treat fracture of 209 1.94 $99.75 $37.74 $19.95
radius.
25505 T Treat fracture of 209 1.94 $99.75 $37.74 $19.95
radius.
25515 T Repair fracture of 216 20.09 $1,033.03 $524.09 $206.61
radius.
25520 T Repair fracture of 209 1.94 $99.75 $37.74 $19.95
radius.
25525 T Repair fracture of 216 20.09 $1,033.03 $524.09 $206.61
radius.
25526 T Repair fracture of 216 20.09 $1,033.03 $524.09 $206.61
radius.
25530 T Treat fracture of ulna. 209 1.94 $99.75 $37.74 $19.95
25535 T Treat fracture of ulna. 209 1.94 $99.75 $37.74 $19.95
25545 T Repair fracture of ulna 216 20.09 $1,033.03 $524.09 $206.61
25560 T Treat fracture radius & 209 1.94 $99.75 $37.74 $19.95
ulna.
25565 T Treat fracture radius & 209 1.94 $99.75 $37.74 $19.95
ulna.
25574 T Treat fracture radius & 216 20.09 $1,033.03 $524.09 $206.61
ulna.
25575 T Repair fracture radius/ 216 20.09 $1,033.03 $524.09 $206.61
ulna.
25600 T Treat fracture radius/ 209 1.94 $99.75 $37.74 $19.95
ulna.
25605 T Treat fracture radius/ 209 1.94 $99.75 $37.74 $19.95
ulna.
25611 T Repair fracture radius/ 216 20.09 $1,033.03 $524.09 $206.61
ulna.
25620 T Repair fracture radius/ 216 20.09 $1,033.03 $524.09 $206.61
ulna.
25622 T Treat wrist bone 209 1.94 $99.75 $37.74 $19.95
fracture.
25624 T Treat wrist bone 209 1.94 $99.75 $37.74 $19.95
fracture.
25628 T Repair wrist bone 216 20.09 $1,033.03 $524.09 $206.61
fracture.
25630 T Treat wrist bone 209 1.94 $99.75 $37.74 $19.95
fracture.
25635 T Treat wrist bone 209 1.94 $99.75 $37.74 $19.95
fracture.
25645 T Repair wrist bone 216 20.09 $1,033.03 $524.09 $206.61
fracture.
25650 T Repair wrist bone 209 1.94 $99.75 $37.74 $19.95
fracture.
25660 T Treat wrist dislocation 209 1.94 $99.75 $37.74 $19.95
25670 T Repair wrist 216 20.09 $1,033.03 $524.09 $206.61
dislocation.
25675 T Treat wrist dislocation 209 1.94 $99.75 $37.74 $19.95
25676 T Repair wrist 216 20.09 $1,033.03 $524.09 $206.61
dislocation.
25680 T Treat wrist fracture... 209 1.94 $99.75 $37.74 $19.95
25685 T Repair wrist fracture.. 216 20.09 $1,033.03 $524.09 $206.61
25690 T Treat wrist dislocation 209 1.94 $99.75 $37.74 $19.95
25695 T Repair wrist 216 20.09 $1,033.03 $524.09 $206.61
dislocation.
25800 T Fusion of wrist joint.. 253 25.74 $1,323.55 $684.55 $264.71
[[Page 35289]]
25805 T Fusion/graft of wrist 253 25.74 $1,323.55 $684.55 $264.71
joint.
25810 T Fusion/graft of wrist 253 25.74 $1,323.55 $684.55 $264.71
joint.
25820 T Fusion of hand bones... 261 10.41 $535.28 $259.00 $107.06
25825 T Fusion hand bones with 262 18.07 $929.16 $475.96 $185.83
graft.
25830 T Fusion radioulnar jnt/ 253 25.74 $1,323.55 $684.55 $264.71
ulna.
25900 C Amputation of forearm.. ......... ......... ......... ........... ...........
25905 C Amputation of forearm.. ......... ......... ......... ........... ...........
25907 T Amputation follow-up 251 13.88 $713.71 $365.89 $142.74
surgery.
25909 C Amputation follow-up ......... ......... ......... ........... ...........
surgery.
25915 C Amputation of forearm.. ......... ......... ......... ........... ...........
25920 C Amputate hand at wrist. ......... ......... ......... ........... ...........
25922 T Amputate hand at wrist. 251 13.88 $713.71 $365.89 $142.74
25924 C Amputation follow-up ......... ......... ......... ........... ...........
surgery.
25927 C Amputation of hand..... ......... ......... ......... ........... ...........
25929 T Amputation follow-up 183 11.04 $567.68 $283.18 $113.54
surgery.
25931 C Amputation follow-up ......... ......... ......... ........... ...........
surgery.
25999 T Forearm or wrist 209 1.94 $99.75 $37.74 $19.95
surgery.
26010 T Drainage of finger 131 1.93 $99.24 $36.61 $19.85
abscess.
26011 T Drainage of finger 131 1.93 $99.24 $36.61 $19.85
abscess.
26020 T Drain hand tendon 261 10.41 $535.28 $259.00 $107.06
sheath.
26025 T Drainage of palm bursa. 261 10.41 $535.28 $259.00 $107.06
26030 T Drainage of palm 261 10.41 $535.28 $259.00 $107.06
bursa(s).
26034 T Treat hand bone lesion. 261 10.41 $535.28 $259.00 $107.06
26035 T Decompress fingers/hand 261 10.41 $535.28 $259.00 $107.06
26037 T Decompress fingers/hand 261 10.41 $535.28 $259.00 $107.06
26040 T Release palm 262 18.07 $929.16 $475.96 $185.83
contracture.
26045 T Release palm 262 18.07 $929.16 $475.96 $185.83
contracture.
26055 T Incise finger tendon 261 10.41 $535.28 $259.00 $107.06
sheath.
26060 T Incision of finger 261 10.41 $535.28 $259.00 $107.06
tendon.
26070 T Explore/treat hand 261 10.41 $535.28 $259.00 $107.06
joint.
26075 T Explore/treat finger 261 10.41 $535.28 $259.00 $107.06
joint.
26080 T Explore/treat finger 261 10.41 $535.28 $259.00 $107.06
joint.
26100 T Biopsy hand joint 261 10.41 $535.28 $259.00 $107.06
lining.
26105 T Biopsy finger joint 261 10.41 $535.28 $259.00 $107.06
lining.
26110 T Biopsy finger joint 261 10.41 $535.28 $259.00 $107.06
lining.
26115 T Removal of hand lesion. 163 10.48 $538.88 $260.80 $107.78
26116 T Removal of hand lesion. 163 10.48 $538.88 $260.80 $107.78
26117 T Remove tumor, hand/ 163 10.48 $538.88 $260.80 $107.78
finger.
26121 T Release palm 262 18.07 $929.16 $475.96 $185.83
contracture.
26123 T Release palm 262 18.07 $929.16 $475.96 $185.83
contracture.
26125 T Release palm 262 18.07 $929.16 $475.96 $185.83
contracture.
26130 T Remove wrist joint 261 10.41 $535.28 $259.00 $107.06
lining.
26135 T Revise finger joint, 262 18.07 $929.16 $475.96 $185.83
each.
26140 T Revise finger joint, 261 10.41 $535.28 $259.00 $107.06
each.
26145 T Tendon excision, palm/ 261 10.41 $535.28 $259.00 $107.06
finger.
26160 T Remove tendon sheath 261 10.41 $535.28 $259.00 $107.06
lesion.
26170 T Removal of palm tendon, 261 10.41 $535.28 $259.00 $107.06
each.
26180 T Removal of finger 261 10.41 $535.28 $259.00 $107.06
tendon.
26185 T Remove finger bone..... 261 10.41 $535.28 $259.00 $107.06
26200 T Remove hand bone lesion 261 10.41 $535.28 $259.00 $107.06
26205 T Remove/graft bone 262 18.07 $929.16 $475.96 $185.83
lesion.
26210 T Removal of finger 261 10.41 $535.28 $259.00 $107.06
lesion.
26215 T Remove/graft finger 261 10.41 $535.28 $259.00 $107.06
lesion.
26230 T Partial removal of hand 261 10.41 $535.28 $259.00 $107.06
bone.
26235 T Partial removal, finger 261 10.41 $535.28 $259.00 $107.06
bone.
26236 T Partial removal, finger 261 10.41 $535.28 $259.00 $107.06
bone.
26250 T Extensive hand surgery. 261 10.41 $535.28 $259.00 $107.06
26255 T Extensive hand surgery. 262 18.07 $929.16 $475.96 $185.83
26260 T Extensive finger 261 10.41 $535.28 $259.00 $107.06
surgery.
26261 T Extensive finger 261 10.41 $535.28 $259.00 $107.06
surgery.
26262 T Partial removal of 261 10.41 $535.28 $259.00 $107.06
finger.
26320 T Removal of implant from 163 10.48 $538.88 $260.80 $107.78
hand.
26350 T Repair finger/hand 262 18.07 $929.16 $475.96 $185.83
tendon.
26352 T Repair/graft hand 262 18.07 $929.16 $475.96 $185.83
tendon.
26356 T Repair finger/hand 262 18.07 $929.16 $475.96 $185.83
tendon.
26357 T Repair finger/hand 262 18.07 $929.16 $475.96 $185.83
tendon.
26358 T Repair/graft hand 262 18.07 $929.16 $475.96 $185.83
tendon.
26370 T Repair finger/hand 262 18.07 $929.16 $475.96 $185.83
tendon.
26372 T Repair/graft hand 262 18.07 $929.16 $475.96 $185.83
tendon.
26373 T Repair finger/hand 262 18.07 $929.16 $475.96 $185.83
tendon.
26390 T Revise hand/finger 262 18.07 $929.16 $475.96 $185.83
tendon.
26392 T Repair/graft hand 262 18.07 $929.16 $475.96 $185.83
tendon.
26410 T Repair hand tendon..... 261 10.41 $535.28 $259.00 $107.06
26412 T Repair/graft hand 262 18.07 $929.16 $475.96 $185.83
tendon.
26415 T Excision, hand/finger 262 18.07 $929.16 $475.96 $185.83
tendon.
[[Page 35290]]
26416 T Graft hand or finger 262 18.07 $929.16 $475.96 $185.83
tendon.
26418 T Repair finger tendon... 261 10.41 $535.28 $259.00 $107.06
26420 T Repair/graft finger 262 18.07 $929.16 $475.96 $185.83
tendon.
26426 T Repair finger/hand 262 18.07 $929.16 $475.96 $185.83
tendon.
26428 T Repair/graft finger 262 18.07 $929.16 $475.96 $185.83
tendon.
26432 T Repair finger tendon... 261 10.41 $535.28 $259.00 $107.06
26433 T Repair finger tendon... 261 10.41 $535.28 $259.00 $107.06
26434 T Repair/graft finger 262 18.07 $929.16 $475.96 $185.83
tendon.
26437 T Realignment of tendons. 261 10.41 $535.28 $259.00 $107.06
26440 T Release palm/finger 261 10.41 $535.28 $259.00 $107.06
tendon.
26442 T Release palm & finger 262 18.07 $929.16 $475.96 $185.83
tendon.
26445 T Release hand/finger 261 10.41 $535.28 $259.00 $107.06
tendon.
26449 T Release forearm/hand 262 18.07 $929.16 $475.96 $185.83
tendon.
26450 T Incision of palm tendon 261 10.41 $535.28 $259.00 $107.06
26455 T Incision of finger 261 10.41 $535.28 $259.00 $107.06
tendon.
26460 T Incise hand/finger 261 10.41 $535.28 $259.00 $107.06
tendon.
26471 T Fusion of finger 261 10.41 $535.28 $259.00 $107.06
tendons.
26474 T Fusion of finger 261 10.41 $535.28 $259.00 $107.06
tendons.
26476 T Tendon lengthening..... 261 10.41 $535.28 $259.00 $107.06
26477 T Tendon shortening...... 261 10.41 $535.28 $259.00 $107.06
26478 T Lengthening of hand 261 10.41 $535.28 $259.00 $107.06
tendon.
26479 T Shortening of hand 261 10.41 $535.28 $259.00 $107.06
tendon.
26480 T Transplant hand tendon. 262 18.07 $929.16 $475.96 $185.83
26483 T Transplant/graft hand 262 18.07 $929.16 $475.96 $185.83
tendon.
26485 T Transplant palm tendon. 262 18.07 $929.16 $475.96 $185.83
26489 T Transplant/graft palm 262 18.07 $929.16 $475.96 $185.83
tendon.
26490 T Revise thumb tendon.... 262 18.07 $929.16 $475.96 $185.83
26492 T Tendon transfer with 262 18.07 $929.16 $475.96 $185.83
graft.
26494 T Hand tendon/muscle 262 18.07 $929.16 $475.96 $185.83
transfer.
26496 T Revise thumb tendon.... 262 18.07 $929.16 $475.96 $185.83
26497 T Finger tendon transfer. 262 18.07 $929.16 $475.96 $185.83
26498 T Finger tendon transfer. 262 18.07 $929.16 $475.96 $185.83
26499 T Revision of finger..... 262 18.07 $929.16 $475.96 $185.83
26500 T Hand tendon 261 10.41 $535.28 $259.00 $107.06
reconstruction.
26502 T Hand tendon 262 18.07 $929.16 $475.96 $185.83
reconstruction.
26504 T Hand tendon 262 18.07 $929.16 $475.96 $185.83
reconstruction.
26508 T Release thumb 261 10.41 $535.28 $259.00 $107.06
contracture.
26510 T Thumb tendon transfer.. 262 18.07 $929.16 $475.96 $185.83
26516 T Fusion of knuckle joint 262 18.07 $929.16 $475.96 $185.83
26517 T Fusion of knuckle 262 18.07 $929.16 $475.96 $185.83
joints.
26518 T Fusion of knuckle 262 18.07 $929.16 $475.96 $185.83
joints.
26520 T Release knuckle 261 10.41 $535.28 $259.00 $107.06
contracture.
26525 T Release finger 261 10.41 $535.28 $259.00 $107.06
contracture.
26530 T Revise knuckle joint... 217 20.54 $1,056.17 $530.42 $211.23
26531 T Revise knuckle with 218 27.80 $1,429.48 $720.71 $285.90
implant.
26535 T Revise finger joint.... 217 20.54 $1,056.17 $530.42 $211.23
26536 T Revise/implant finger 218 27.80 $1,429.48 $720.71 $285.90
joint.
26540 T Repair hand joint...... 261 10.41 $535.28 $259.00 $107.06
26541 T Repair hand joint with 262 18.07 $929.16 $475.96 $185.83
graft.
26542 T Repair hand joint with 261 10.41 $535.28 $259.00 $107.06
graft.
26545 T Reconstruct finger 262 18.07 $929.16 $475.96 $185.83
joint.
26546 T Repair non-union hand.. 262 18.07 $929.16 $475.96 $185.83
26548 T Reconstruct finger 262 18.07 $929.16 $475.96 $185.83
joint.
26550 T Construct thumb 262 18.07 $929.16 $475.96 $185.83
replacement.
26551 C Great toe-hand transfer ......... ......... ......... ........... ...........
\2\ 2655 C Construct thumb ......... ......... ......... ........... ...........
2 replacement.
26553 C Single toe-hand ......... ......... ......... ........... ...........
transfer.
26554 C Double toe-hand ......... ......... ......... ........... ...........
transfer.
26555 T Positional change of 262 18.07 $929.16 $475.96 $185.83
finger.
26556 C Toe joint transfer..... ......... ......... ......... ........... ...........
\2\ 2655 C Construct finger ......... ......... ......... ........... ...........
7 replacement.
\2\ 2655 C Added finger surgery... ......... ......... ......... ........... ...........
8
\2\ 2655 C Added finger surgery... ......... ......... ......... ........... ...........
9
26560 T Repair of web finger... 261 10.41 $535.28 $259.00 $107.06
26561 T Repair of web finger... 262 18.07 $929.16 $475.96 $185.83
26562 T Repair of web finger... 262 18.07 $929.16 $475.96 $185.83
26565 T Correct metacarpal flaw 262 18.07 $929.16 $475.96 $185.83
26567 T Correct finger 262 18.07 $929.16 $475.96 $185.83
deformity.
26568 T Lengthen metacarpal/ 262 18.07 $929.16 $475.96 $185.83
finger.
26580 T Repair hand deformity.. 262 18.07 $929.16 $475.96 $185.83
26585 T Repair finger deformity 262 18.07 $929.16 $475.96 $185.83
26587 T Reconstruct extra 261 10.41 $535.28 $259.00 $107.06
finger.
26590 T Repair finger deformity 262 18.07 $929.16 $475.96 $185.83
26591 T Repair muscles of hand. 262 18.07 $929.16 $475.96 $185.83
26593 T Release muscles of hand 261 10.41 $535.28 $259.00 $107.06
[[Page 35291]]
26596 T Excision constricting 262 18.07 $929.16 $475.96 $185.83
tissue.
26597 T Release of scar 262 18.07 $929.16 $475.96 $185.83
contracture.
26600 T Treat metacarpal 209 1.94 $99.75 $37.74 $19.95
fracture.
26605 T Treat metacarpal 209 1.94 $99.75 $37.74 $19.95
fracture.
26607 T Treat metacarpal 209 1.94 $99.75 $37.74 $19.95
fracture.
26608 T Treat metacarpal 216 20.09 $1,033.03 $524.09 $206.61
fracture.
26615 T Repair metacarpal 216 20.09 $1,033.03 $524.09 $206.61
fracture.
26641 T Treat thumb dislocation 209 1.94 $99.75 $37.74 $19.95
26645 T Treat thumb fracture... 209 1.94 $99.75 $37.74 $19.95
26650 T Repair thumb fracture.. 216 20.09 $1,033.03 $524.09 $206.61
26665 T Repair thumb fracture.. 216 20.09 $1,033.03 $524.09 $206.61
26670 T Treat hand dislocation. 209 1.94 $99.75 $37.74 $19.95
26675 T Treat hand dislocation. 210 10.06 $517.29 $279.34 $103.46
26676 T Pin hand dislocation... 216 20.09 $1,033.03 $524.09 $206.61
26685 T Repair hand dislocation 216 20.09 $1,033.03 $524.09 $206.61
26686 T Repair hand dislocation 216 20.09 $1,033.03 $524.09 $206.61
26700 T Treat knuckle 207 1.70 $87.41 $32.32 $17.48
dislocation.
26705 T Treat knuckle 210 10.06 $517.29 $279.34 $103.46
dislocation.
26706 T Pin knuckle dislocation 209 1.94 $99.75 $37.74 $19.95
26715 T Repair knuckle 216 20.09 $1,033.03 $524.09 $206.61
dislocation.
26720 T Treat finger fracture, 207 1.70 $87.41 $32.32 $17.48
each.
26725 T Treat finger fracture, 207 1.70 $87.41 $32.32 $17.48
each.
26727 T Treat finger fracture, 216 20.09 $1,033.03 $524.09 $206.61
each.
26735 T Repair finger fracture, 216 20.09 $1,033.03 $524.09 $206.61
each.
26740 T Treat finger fracture, 207 1.70 $87.41 $32.32 $17.48
each.
26742 T Treat finger fracture, 209 1.94 $99.75 $37.74 $19.95
each.
26746 T Repair finger fracture, 216 20.09 $1,033.03 $524.09 $206.61
each.
26750 T Treat finger fracture, 207 1.70 $87.41 $32.32 $17.48
each.
26755 T Treat finger fracture, 207 1.70 $87.41 $32.32 $17.48
each.
26756 T Pin finger fracture, 216 20.09 $1,033.03 $524.09 $206.61
each.
26765 T Repair finger fracture, 216 20.09 $1,033.03 $524.09 $206.61
each.
26770 T Treat finger 207 1.70 $87.41 $32.32 $17.48
dislocation.
26775 T Treat finger 210 10.06 $517.29 $279.34 $103.46
dislocation.
26776 T Pin finger dislocation. 216 20.09 $1,033.03 $524.09 $206.61
26785 T Repair finger 216 20.09 $1,033.03 $524.09 $206.61
dislocation.
26820 T Thumb fusion with graft 262 18.07 $929.16 $475.96 $185.83
26841 T Fusion of thumb........ 262 18.07 $929.16 $475.96 $185.83
26842 T Thumb fusion with graft 262 18.07 $929.16 $475.96 $185.83
26843 T Fusion of hand joint... 262 18.07 $929.16 $475.96 $185.83
26844 T Fusion/graft of hand 262 18.07 $929.16 $475.96 $185.83
joint.
26850 T Fusion of knuckle...... 262 18.07 $929.16 $475.96 $185.83
26852 T Fusion of knuckle with 262 18.07 $929.16 $475.96 $185.83
graft.
26860 T Fusion of finger joint. 262 18.07 $929.16 $475.96 $185.83
26861 T Fusion of finger 262 18.07 $929.16 $475.96 $185.83
joint,added.
26862 T Fusion/graft of finger 262 18.07 $929.16 $475.96 $185.83
joint.
26863 T Fuse/graft added joint. 262 18.07 $929.16 $475.96 $185.83
26910 T Amputate metacarpal 262 18.07 $929.16 $475.96 $185.83
bone.
26951 T Amputation of finger/ 261 10.41 $535.28 $259.00 $107.06
thumb.
26952 T Amputation of finger/ 261 10.41 $535.28 $259.00 $107.06
thumb.
26989 T Hand/finger surgery.... 207 1.70 $87.41 $32.32 $17.48
26990 T Drainage of pelvis 251 13.88 $713.71 $365.89 $142.74
lesion.
26991 T Drainage of pelvis 251 13.88 $713.71 $365.89 $142.74
bursa.
26992 C Drainage of bone lesion ......... ......... ......... ........... ...........
27000 T Incision of hip tendon. 251 13.88 $713.71 $365.89 $142.74
27001 T Incision of hip tendon. 252 19.24 $989.32 $512.34 $197.86
27003 T Incision of hip tendon. 252 19.24 $989.32 $512.34 $197.86
27005 C Incision of hip tendon. ......... ......... ......... ........... ...........
27006 C Incision of hip tendons ......... ......... ......... ........... ...........
27025 C Incision of hip/thigh ......... ......... ......... ........... ...........
fascia.
27030 C Drainage of hip joint.. ......... ......... ......... ........... ...........
27033 T Exploration of hip 253 25.74 $1,323.55 $684.55 $264.71
joint.
27035 C Denervation of hip ......... ......... ......... ........... ...........
joint.
27036 C Excision of hip joint/ ......... ......... ......... ........... ...........
muscle.
27040 T Biopsy of soft tissues. 162 5.59 $287.44 $125.66 $57.49
27041 T Biopsy of soft tissues. 163 10.48 $538.88 $260.80 $107.78
27047 T Remove hip/pelvis 163 10.48 $538.88 $260.80 $107.78
lesion.
27048 T Remove hip/pelvis 163 10.48 $538.88 $260.80 $107.78
lesion.
27049 T Remove tumor, hip/ 163 10.48 $538.88 $260.80 $107.78
pelvis.
27050 T Biopsy of sacroiliac 251 13.88 $713.71 $365.89 $142.74
joint.
27052 T Biopsy of hip joint.... 251 13.88 $713.71 $365.89 $142.74
27054 C Removal of hip joint ......... ......... ......... ........... ...........
lining.
27060 T Removal of ischial 251 13.88 $713.71 $365.89 $142.74
bursa.
27062 T Remove femur lesion/ 251 13.88 $713.71 $365.89 $142.74
bursa.
27065 T Removal of hip bone 251 13.88 $713.71 $365.89 $142.74
lesion.
27066 T Removal of hip bone 252 19.24 $989.32 $512.34 $197.86
lesion.
[[Page 35292]]
27067 T Remove/graft hip bone 252 19.24 $989.32 $512.34 $197.86
lesion.
27070 C Partial removal of hip ......... ......... ......... ........... ...........
bone.
27071 C Partial removal of hip ......... ......... ......... ........... ...........
bone.
27075 C Extensive hip surgery.. ......... ......... ......... ........... ...........
27076 C Extensive hip surgery.. ......... ......... ......... ........... ...........
27077 C Extensive hip surgery.. ......... ......... ......... ........... ...........
27078 C Extensive hip surgery.. ......... ......... ......... ........... ...........
27079 C Extensive hip surgery.. ......... ......... ......... ........... ...........
27080 T Removal of tail bone... 252 19.24 $989.32 $512.34 $197.86
27086 T Remove hip foreign body 251 13.88 $713.71 $365.89 $142.74
27087 T Remove hip foreign body 251 13.88 $713.71 $365.89 $142.74
27090 C Removal of hip ......... ......... ......... ........... ...........
prosthesis.
27091 C Removal of hip ......... ......... ......... ........... ...........
prosthesis.
27093 T Injection for hip x-ray 347 2.57 $132.15 $62.38 $26.43
27095 T Injection for hip x-ray 347 2.57 $132.15 $62.38 $26.43
27097 T Revision of hip tendon. 252 19.24 $989.32 $512.34 $197.86
27098 T Transfer tendon to 252 19.24 $989.32 $512.34 $197.86
pelvis.
27100 T Transfer of abdominal 253 25.74 $1,323.55 $684.55 $264.71
muscle.
27105 T Transfer of spinal 253 25.74 $1,323.55 $684.55 $264.71
muscle.
27110 T Transfer of iliopsoas 253 25.74 $1,323.55 $684.55 $264.71
muscle.
27111 T Transfer of iliopsoas 253 25.74 $1,323.55 $684.55 $264.71
muscle.
27120 C Reconstruction of hip ......... ......... ......... ........... ...........
socket.
27122 C Reconstruction of hip ......... ......... ......... ........... ...........
socket.
27125 C Partial hip replacement ......... ......... ......... ........... ...........
27130 C Total hip replacement.. ......... ......... ......... ........... ...........
27132 C Total hip replacement.. ......... ......... ......... ........... ...........
27134 C Revise hip joint ......... ......... ......... ........... ...........
replacement.
27137 C Revise hip joint ......... ......... ......... ........... ...........
replacement.
27138 C Revise hip joint ......... ......... ......... ........... ...........
replacement.
27140 C Transplant of femur ......... ......... ......... ........... ...........
ridge.
27146 C Incision of hip bone... ......... ......... ......... ........... ...........
27147 C Revision of hip bone... ......... ......... ......... ........... ...........
27151 C Incision of hip bones.. ......... ......... ......... ........... ...........
27156 C Revision of hip bones.. ......... ......... ......... ........... ...........
27158 C Revision of pelvis..... ......... ......... ......... ........... ...........
27161 C Incision of neck of ......... ......... ......... ........... ...........
femur.
27165 C Incision/fixation of ......... ......... ......... ........... ...........
femur.
27170 C Repair/graft femur head/ ......... ......... ......... ........... ...........
neck.
27175 C Treat slipped epiphysis ......... ......... ......... ........... ...........
27176 C Treat slipped epiphysis ......... ......... ......... ........... ...........
27177 C Repair slipped ......... ......... ......... ........... ...........
epiphysis.
27178 C Repair slipped ......... ......... ......... ........... ...........
epiphysis.
27179 C Revise head/neck of ......... ......... ......... ........... ...........
femur.
27181 C Repair slipped ......... ......... ......... ........... ...........
epiphysis.
27185 C Revision of femur ......... ......... ......... ........... ...........
epiphysis.
27187 C Reinforce hip bones.... ......... ......... ......... ........... ...........
27193 T Treat pelvic ring 209 1.94 $99.75 $37.74 $19.95
fracture.
27194 T Treat pelvic ring 210 10.06 $517.29 $279.34 $103.46
fracture.
27200 T Treat tail bone 207 1.70 $87.41 $32.32 $17.48
fracture.
27202 T Repair tail bone 216 20.09 $1,033.03 $524.09 $206.61
fracture.
27215 C Pelvic fracture(s) ......... ......... ......... ........... ...........
treatment.
27216 C Treat pelvic ring ......... ......... ......... ........... ...........
fracture.
27217 C Treat pelvic ring ......... ......... ......... ........... ...........
fracture.
27218 C Treat pelvic ring ......... ......... ......... ........... ...........
fracture.
27220 T Treat hip socket 209 1.94 $99.75 $37.74 $19.95
fracture.
27222 C Treat hip socket ......... ......... ......... ........... ...........
fracture.
27226 C Treat hip wall fracture ......... ......... ......... ........... ...........
27227 C Treat hip fracture(s).. ......... ......... ......... ........... ...........
27228 C Treat hip fracture(s).. ......... ......... ......... ........... ...........
27230 T Treat fracture of thigh 209 1.94 $99.75 $37.74 $19.95
27232 C Treat fracture of thigh ......... ......... ......... ........... ...........
27235 C Repair of thigh ......... ......... ......... ........... ...........
fracture.
27236 C Repair of thigh ......... ......... ......... ........... ...........
fracture.
27238 T Treatment of thigh 209 1.94 $99.75 $37.74 $19.95
fracture.
27240 C Treatment of thigh ......... ......... ......... ........... ...........
fracture.
27244 C Repair of thigh ......... ......... ......... ........... ...........
fracture.
27245 C Repair of thigh ......... ......... ......... ........... ...........
fracture.
27246 T Treatment of thigh 209 1.94 $99.75 $37.74 $19.95
fracture.
27248 C Repair of thigh ......... ......... ......... ........... ...........
fracture.
27250 T Treat hip dislocation.. 209 1.94 $99.75 $37.74 $19.95
27252 T Treat hip dislocation.. 210 10.06 $517.29 $279.34 $103.46
27253 C Repair of hip ......... ......... ......... ........... ...........
dislocation.
27254 C Repair of hip ......... ......... ......... ........... ...........
dislocation.
27256 T Treatment of hip 209 1.94 $99.75 $37.74 $19.95
dislocation.
27257 T Treatment of hip 210 10.06 $517.29 $279.34 $103.46
dislocation.
[[Page 35293]]
27258 C Repair of hip ......... ......... ......... ........... ...........
dislocation.
27259 C Repair of hip ......... ......... ......... ........... ...........
dislocation.
27265 T Treatment of hip 209 1.94 $99.75 $37.74 $19.95
dislocation.
27266 T Treatment of hip 217 20.54 $1,056.17 $530.42 $211.23
dislocation.
27275 T Manipulation of hip 210 10.06 $517.29 $279.34 $103.46
joint.
27280 C Fusion of sacroiliac ......... ......... ......... ........... ...........
joint.
27282 C Fusion of pubic bones.. ......... ......... ......... ........... ...........
27284 C Fusion of hip joint.... ......... ......... ......... ........... ...........
27286 C Fusion of hip joint.... ......... ......... ......... ........... ...........
27290 C Amputation of leg at ......... ......... ......... ........... ...........
hip.
27295 C Amputation of leg at ......... ......... ......... ........... ...........
hip.
27299 T Pelvis/hip joint 207 1.70 $87.41 $32.32 $17.48
surgery.
27301 T Drain thigh/knee lesion 132 5.63 $289.49 $132.89 $57.90
27303 C Drainage of bone lesion ......... ......... ......... ........... ...........
27305 T Incise thigh tendon & 251 13.88 $713.71 $365.89 $142.74
fascia.
27306 T Incision of thigh 251 13.88 $713.71 $365.89 $142.74
tendon.
27307 T Incision of thigh 251 13.88 $713.71 $365.89 $142.74
tendons.
27310 T Exploration of knee 252 19.24 $989.32 $512.34 $197.86
joint.
27315 T Partial removal, thigh 631 12.70 $653.03 $329.06 $130.61
nerve.
27320 T Partial removal, thigh 631 12.70 $653.03 $329.06 $130.61
nerve.
27323 T Biopsy thigh soft 162 5.59 $287.44 $125.66 $57.49
tissues.
27324 T Biopsy thigh soft 163 10.48 $538.88 $260.80 $107.78
tissues.
27327 T Removal of thigh lesion 163 10.48 $538.88 $260.80 $107.78
27328 T Removal of thigh lesion 163 10.48 $538.88 $260.80 $107.78
27329 T Remove tumor, thigh/ 163 10.48 $538.88 $260.80 $107.78
knee.
27330 T Biopsy knee joint 252 19.24 $989.32 $512.34 $197.86
lining.
27331 T Explore/treat knee 252 19.24 $989.32 $512.34 $197.86
joint.
27332 T Removal of knee 252 19.24 $989.32 $512.34 $197.86
cartilage.
27333 T Removal of knee 252 19.24 $989.32 $512.34 $197.86
cartilage.
27334 T Remove knee joint 252 19.24 $989.32 $512.34 $197.86
lining.
27335 T Remove knee joint 252 19.24 $989.32 $512.34 $197.86
lining.
27340 T Removal of kneecap 251 13.88 $713.71 $365.89 $142.74
bursa.
27345 T Removal of knee cyst... 251 13.88 $713.71 $365.89 $142.74
27350 T Removal of kneecap..... 252 19.24 $989.32 $512.34 $197.86
27355 T Remove femur lesion.... 252 19.24 $989.32 $512.34 $197.86
27356 T Remove femur lesion/ 252 19.24 $989.32 $512.34 $197.86
graft.
27357 T Remove femur lesion/ 252 19.24 $989.32 $512.34 $197.86
graft.
27358 T Remove femur lesion/ 252 19.24 $989.32 $512.34 $197.86
fixation.
27360 T Partial removal leg 252 19.24 $989.32 $512.34 $197.86
bone(s).
27365 C Extensive leg surgery.. ......... ......... ......... ........... ...........
27370 T Injection for knee x- 347 2.57 $132.15 $62.38 $26.43
ray.
27372 T Removal of foreign body 163 10.48 $538.88 $260.80 $107.78
27380 T Repair of kneecap 251 13.88 $713.71 $365.89 $142.74
tendon.
27381 T Repair/graft kneecap 251 13.88 $713.71 $365.89 $142.74
tendon.
27385 T Repair of thigh muscle. 251 13.88 $713.71 $365.89 $142.74
27386 T Repair/graft of thigh 251 13.88 $713.71 $365.89 $142.74
muscle.
27390 T Incision of thigh 251 13.88 $713.71 $365.89 $142.74
tendon.
27391 T Incision of thigh 251 13.88 $713.71 $365.89 $142.74
tendons.
27392 T Incision of thigh 251 13.88 $713.71 $365.89 $142.74
tendons.
27393 T Lengthening of thigh 252 19.24 $989.32 $512.34 $197.86
tendon.
27394 T Lengthening of thigh 252 19.24 $989.32 $512.34 $197.86
tendons.
27395 T Lengthening of thigh 253 25.74 $1,323.55 $684.55 $264.71
tendons.
27396 T Transplant of thigh 252 19.24 $989.32 $512.34 $197.86
tendon.
27397 T Transplants of thigh 253 25.74 $1,323.55 $684.55 $264.71
tendons.
27400 T Revise thigh muscles/ 253 25.74 $1,323.55 $684.55 $264.71
tendons.
27403 T Repair of knee 252 19.24 $989.32 $512.34 $197.86
cartilage.
27405 T Repair of knee ligament 253 25.74 $1,323.55 $684.55 $264.71
27407 T Repair of knee ligament 253 25.74 $1,323.55 $684.55 $264.71
27409 T Repair of knee 253 25.74 $1,323.55 $684.55 $264.71
ligaments.
27418 T Repair degenerated 253 25.74 $1,323.55 $684.55 $264.71
kneecap.
27420 T Revision of unstable 253 25.74 $1,323.55 $684.55 $264.71
kneecap.
27422 T Revision of unstable 253 25.74 $1,323.55 $684.55 $264.71
kneecap.
27424 T Revision/removal of 253 25.74 $1,323.55 $684.55 $264.71
kneecap.
27425 T Lateral retinacular 252 19.24 $989.32 $512.34 $197.86
release.
27427 T Reconstruction, knee... 254 32.70 $1,681.43 $922.98 $336.29
27428 T Reconstruction, knee... 254 32.70 $1,681.43 $922.98 $336.29
27429 T Reconstruction, knee... 254 32.70 $1,681.43 $922.98 $336.29
27430 T Revision of thigh 253 25.74 $1,323.55 $684.55 $264.71
muscles.
27435 T Incision of knee joint. 253 25.74 $1,323.55 $684.55 $264.71
27437 T Revise kneecap......... 217 20.54 $1,056.17 $530.42 $211.23
27438 T Revise kneecap with 218 27.80 $1,429.48 $720.71 $285.90
implant.
27440 T Revision of knee joint. 217 20.54 $1,056.17 $530.42 $211.23
27441 T Revision of knee joint. 217 20.54 $1,056.17 $530.42 $211.23
27442 T Revision of knee joint. 217 20.54 $1,056.17 $530.42 $211.23
27443 T Revision of knee joint. 217 20.54 $1,056.17 $530.42 $211.23
[[Page 35294]]
27445 C Revision of knee joint. ......... ......... ......... ........... ...........
27446 C Revision of knee joint. ......... ......... ......... ........... ...........
27447 C Total knee replacement. ......... ......... ......... ........... ...........
27448 C Incision of thigh...... ......... ......... ......... ........... ...........
27450 C Incision of thigh...... ......... ......... ......... ........... ...........
27454 C Realignment of thigh ......... ......... ......... ........... ...........
bone.
27455 C Realignment of knee.... ......... ......... ......... ........... ...........
27457 C Realignment of knee.... ......... ......... ......... ........... ...........
27465 C Shortening of thigh ......... ......... ......... ........... ...........
bone.
27466 C Lengthening of thigh ......... ......... ......... ........... ...........
bone.
27468 C Shorten/lengthen thighs ......... ......... ......... ........... ...........
27470 C Repair of thigh........ ......... ......... ......... ........... ...........
27472 C Repair/graft of thigh.. ......... ......... ......... ........... ...........
27475 C Surgery to stop leg ......... ......... ......... ........... ...........
growth.
27477 C Surgery to stop leg ......... ......... ......... ........... ...........
growth.
27479 C Surgery to stop leg ......... ......... ......... ........... ...........
growth.
27485 C Surgery to stop leg ......... ......... ......... ........... ...........
growth.
27486 C Revise knee joint ......... ......... ......... ........... ...........
replace.
27487 C Revise knee joint ......... ......... ......... ........... ...........
replace.
27488 C Removal of knee ......... ......... ......... ........... ...........
prosthesis.
27495 C Reinforce thigh........ ......... ......... ......... ........... ...........
27496 T Decompression of thigh/ 251 13.88 $713.71 $365.89 $142.74
knee.
27497 T Decompression of thigh/ 251 13.88 $713.71 $365.89 $142.74
knee.
27498 T Decompression of thigh/ 251 13.88 $713.71 $365.89 $142.74
knee.
27499 T Decompression of thigh/ 251 13.88 $713.71 $365.89 $142.74
knee.
27500 T Treatment of thigh 209 1.94 $99.75 $37.74 $19.95
fracture.
27501 T Treatment of thigh 209 1.94 $99.75 $37.74 $19.95
fracture.
27502 T Treatment of thigh 209 1.94 $99.75 $37.74 $19.95
fracture.
27503 T Treatment of thigh 209 1.94 $99.75 $37.74 $19.95
fracture.
27506 C Repair of thigh ......... ......... ......... ........... ...........
fracture.
27507 C Treatment of thigh ......... ......... ......... ........... ...........
fracture.
27508 T Treatment of thigh 209 1.94 $99.75 $37.74 $19.95
fracture.
27509 T Treatment of thigh 216 20.09 $1,033.03 $524.09 $206.61
fracture.
27510 T Treatment of thigh 209 1.94 $99.75 $37.74 $19.95
fracture.
27511 C Treatment of thigh ......... ......... ......... ........... ...........
fracture.
27513 C Treatment of thigh ......... ......... ......... ........... ...........
fracture.
27514 C Repair of thigh ......... ......... ......... ........... ...........
fracture.
27516 T Repair of thigh growth 209 1.94 $99.75 $37.74 $19.95
plate.
27517 T Repair of thigh growth 209 1.94 $99.75 $37.74 $19.95
plate.
27519 C Repair of thigh growth ......... ......... ......... ........... ...........
plate.
27520 T Treat kneecap fracture. 209 1.94 $99.75 $37.74 $19.95
27524 C Repair of kneecap ......... ......... ......... ........... ...........
fracture.
27530 T Treatment of knee 209 1.94 $99.75 $37.74 $19.95
fracture.
27532 T Treatment of knee 209 1.94 $99.75 $37.74 $19.95
fracture.
27535 C Treatment of knee ......... ......... ......... ........... ...........
fracture.
27536 C Repair of knee fracture ......... ......... ......... ........... ...........
27538 T Treat knee fracture(s). 209 1.94 $99.75 $37.74 $19.95
27540 C Repair of knee fracture ......... ......... ......... ........... ...........
27550 T Treat knee dislocation. 209 1.94 $99.75 $37.74 $19.95
27552 T Treat knee dislocation. 210 10.06 $517.29 $279.34 $103.46
27556 T Repair of knee 216 20.09 $1,033.03 $524.09 $206.61
dislocation.
27557 C Repair of knee ......... ......... ......... ........... ...........
dislocation.
27558 C Repair of knee ......... ......... ......... ........... ...........
dislocation.
27560 T Treat kneecap 209 1.94 $99.75 $37.74 $19.95
dislocation.
27562 T Treat kneecap 210 10.06 $517.29 $279.34 $103.46
dislocation.
27566 T Repair kneecap 216 20.09 $1,033.03 $524.09 $206.61
dislocation.
27570 T Fixation of knee joint. 210 10.06 $517.29 $279.34 $103.46
27580 C Fusion of knee......... ......... ......... ......... ........... ...........
27590 C Amputate leg at thigh.. ......... ......... ......... ........... ...........
27591 C Amputate leg at thigh.. ......... ......... ......... ........... ...........
27592 C Amputate leg at thigh.. ......... ......... ......... ........... ...........
27594 T Amputation follow-up 251 13.88 $713.71 $365.89 $142.74
surgery.
27596 C Amputation follow-up ......... ......... ......... ........... ...........
surgery.
27598 C Amputate lower leg at ......... ......... ......... ........... ...........
knee.
27599 T Leg surgery procedure.. 209 1.94 $99.75 $37.74 $19.95
27600 T Decompression of lower 251 13.88 $713.71 $365.89 $142.74
leg.
27601 T Decompression of lower 251 13.88 $713.71 $365.89 $142.74
leg.
27602 T Decompression of lower 251 13.88 $713.71 $365.89 $142.74
leg.
27603 T Drain lower leg lesion. 132 5.63 $289.49 $132.89 $57.90
27604 T Drain lower leg bursa.. 251 13.88 $713.71 $365.89 $142.74
27605 T Incision of achilles 271 14.12 $726.05 $365.44 $145.21
tendon.
27606 T Incision of achilles 251 13.88 $713.71 $365.89 $142.74
tendon.
27607 T Treat lower leg bone 251 13.88 $713.71 $365.89 $142.74
lesion.
27610 T Explore/treat ankle 252 19.24 $989.32 $512.34 $197.86
joint.
27612 T Exploration of ankle 252 19.24 $989.32 $512.34 $197.86
joint.
[[Page 35295]]
27613 T Biopsy lower leg soft 161 3.43 $176.37 $75.71 $35.27
tissue.
27614 T Biopsy lower leg soft 163 10.48 $538.88 $260.80 $107.78
tissue.
27615 T Remove tumor, lower leg 216 20.09 $1,033.03 $524.09 $206.61
27618 T Remove lower leg lesion 163 10.48 $538.88 $260.80 $107.78
27619 T Remove lower leg lesion 163 10.48 $538.88 $260.80 $107.78
27620 T Explore, treat ankle 252 19.24 $989.32 $512.34 $197.86
joint.
27625 T Remove ankle joint 252 19.24 $989.32 $512.34 $197.86
lining.
27626 T Remove ankle joint 252 19.24 $989.32 $512.34 $197.86
lining.
27630 T Removal of tendon 251 13.88 $713.71 $365.89 $142.74
lesion.
27635 T Remove lower leg bone 252 19.24 $989.32 $512.34 $197.86
lesion.
27637 T Remove/graft leg bone 252 19.24 $989.32 $512.34 $197.86
lesion.
27638 T Remove/graft leg bone 252 19.24 $989.32 $512.34 $197.86
lesion.
27640 T Partial removal of 253 25.74 $1,323.55 $684.55 $264.71
tibia.
27641 T Partial removal of 252 19.24 $989.32 $512.34 $197.86
fibula.
27645 C Extensive lower leg ......... ......... ......... ........... ...........
surgery.
27646 C Extensive lower leg ......... ......... ......... ........... ...........
surgery.
27647 T Extensive ankle/heel 253 25.74 $1,323.55 $684.55 $264.71
surgery.
27648 T Injection for ankle x- 347 2.57 $132.15 $62.38 $26.43
ray.
27650 T Repair achilles tendon. 253 25.74 $1,323.55 $684.55 $264.71
27652 T Repair/graft achilles 253 25.74 $1,323.55 $684.55 $264.71
tendon.
27654 T Repair of achilles 253 25.74 $1,323.55 $684.55 $264.71
tendon.
27656 T Repair leg fascia 251 13.88 $713.71 $365.89 $142.74
defect.
27658 T Repair of leg tendon, 251 13.88 $713.71 $365.89 $142.74
each.
27659 T Repair of leg tendon, 251 13.88 $713.71 $365.89 $142.74
each.
27664 T Repair of leg tendon, 251 13.88 $713.71 $365.89 $142.74
each.
27665 T Repair of leg tendon, 252 19.24 $989.32 $512.34 $197.86
each.
27675 T Repair lower leg 251 13.88 $713.71 $365.89 $142.74
tendons.
27676 T Repair lower leg 252 19.24 $989.32 $512.34 $197.86
tendons.
27680 T Release of lower leg 252 19.24 $989.32 $512.34 $197.86
tendon.
27681 T Release of lower leg 252 19.24 $989.32 $512.34 $197.86
tendons.
27685 T Revision of lower leg 252 19.24 $989.32 $512.34 $197.86
tendon.
27686 T Revise lower leg 252 19.24 $989.32 $512.34 $197.86
tendons.
27687 T Revision of calf tendon 252 19.24 $989.32 $512.34 $197.86
27690 T Revise lower leg tendon 253 25.74 $1,323.55 $684.55 $264.71
27691 T Revise lower leg tendon 253 25.74 $1,323.55 $684.55 $264.71
27692 T Revise additional leg 253 25.74 $1,323.55 $684.55 $264.71
tendon.
27695 T Repair of ankle 252 19.24 $989.32 $512.34 $197.86
ligament.
27696 T Repair of ankle 252 19.24 $989.32 $512.34 $197.86
ligaments.
27698 T Repair of ankle 252 19.24 $989.32 $512.34 $197.86
ligament.
27700 T Revision of ankle joint 217 20.54 $1,056.17 $530.42 $211.23
27702 C Reconstruct ankle joint ......... ......... ......... ........... ...........
27703 C Reconstruction, ankle ......... ......... ......... ........... ...........
joint.
27704 T Removal of ankle 251 13.88 $713.71 $365.89 $142.74
implant.
27705 T Incision of tibia...... 253 25.74 $1,323.55 $684.55 $264.71
27707 T Incision of fibula..... 251 13.88 $713.71 $365.89 $142.74
27709 T Incision of tibia & 252 19.24 $989.32 $512.34 $197.86
fibula.
27712 C Realignment of lower ......... ......... ......... ........... ...........
leg.
27715 C Revision of lower leg.. ......... ......... ......... ........... ...........
27720 C Repair of tibia........ ......... ......... ......... ........... ...........
27722 C Repair/graft of tibia.. ......... ......... ......... ........... ...........
27724 C Repair/graft of tibia.. ......... ......... ......... ........... ...........
27725 C Repair of lower leg.... ......... ......... ......... ........... ...........
27727 C Repair of lower leg.... ......... ......... ......... ........... ...........
27730 T Repair of tibia 252 19.24 $989.32 $512.34 $197.86
epiphysis.
27732 T Repair of fibula 252 19.24 $989.32 $512.34 $197.86
epiphysis.
27734 T Repair lower leg 252 19.24 $989.32 $512.34 $197.86
epiphyses.
27740 T Repair of leg epiphyses 252 19.24 $989.32 $512.34 $197.86
27742 T Repair of leg epiphyses 253 25.74 $1,323.55 $684.55 $264.71
27745 T Reinforce tibia........ 253 25.74 $1,323.55 $684.55 $264.71
27750 T Treatment of tibia 209 1.94 $99.75 $37.74 $19.95
fracture.
27752 T Treatment of tibia 209 1.94 $99.75 $37.74 $19.95
fracture.
27756 T Repair of tibia 216 20.09 $1,033.03 $524.09 $206.61
fracture.
27758 T Repair of tibia 216 20.09 $1,033.03 $524.09 $206.61
fracture.
27759 T Repair of tibia 216 20.09 $1,033.03 $524.09 $206.61
fracture.
27760 T Treatment of ankle 209 1.94 $99.75 $37.74 $19.95
fracture.
27762 T Treatment of ankle 209 1.94 $99.75 $37.74 $19.95
fracture.
27766 T Repair of ankle 216 20.09 $1,033.03 $524.09 $206.61
fracture.
27780 T Treatment of fibula 209 1.94 $99.75 $37.74 $19.95
fracture.
27781 T Treatment of fibula 209 1.94 $99.75 $37.74 $19.95
fracture.
27784 T Repair of fibula 216 20.09 $1,033.03 $524.09 $206.61
fracture.
27786 T Treatment of ankle 209 1.94 $99.75 $37.74 $19.95
fracture.
27788 T Treatment of ankle 209 1.94 $99.75 $37.74 $19.95
fracture.
27792 T Repair of ankle 216 20.09 $1,033.03 $524.09 $206.61
fracture.
27808 T Treatment of ankle 209 1.94 $99.75 $37.74 $19.95
fracture.
27810 T Treatment of ankle 209 1.94 $99.75 $37.74 $19.95
fracture.
[[Page 35296]]
27814 T Repair of ankle 216 20.09 $1,033.03 $524.09 $206.61
fracture.
27816 T Treatment of ankle 209 1.94 $99.75 $37.74 $19.95
fracture.
27818 T Treatment of ankle 209 1.94 $99.75 $37.74 $19.95
fracture.
27822 T Repair of ankle 216 20.09 $1,033.03 $524.09 $206.61
fracture.
27823 T Repair of ankle 216 20.09 $1,033.03 $524.09 $206.61
fracture.
27824 T Treat lower leg 209 1.94 $99.75 $37.74 $19.95
fracture.
27825 T Treat lower leg 209 1.94 $99.75 $37.74 $19.95
fracture.
27826 T Treat lower leg 216 20.09 $1,033.03 $524.09 $206.61
fracture.
27827 T Treat lower leg 216 20.09 $1,033.03 $524.09 $206.61
fracture.
27828 T Treat lower leg 216 20.09 $1,033.03 $524.09 $206.61
fracture.
27829 T Treat lower leg joint.. 216 20.09 $1,033.03 $524.09 $206.61
27830 T Treat lower leg 209 1.94 $99.75 $37.74 $19.95
dislocation.
27831 T Treat lower leg 210 10.06 $517.29 $279.34 $103.46
dislocation.
27832 T Repair lower leg 216 20.09 $1,033.03 $524.09 $206.61
dislocation.
27840 T Treat ankle dislocation 209 1.94 $99.75 $37.74 $19.95
27842 T Treat ankle dislocation 210 10.06 $517.29 $279.34 $103.46
27846 T Repair ankle 216 20.09 $1,033.03 $524.09 $206.61
dislocation.
27848 T Repair ankle 216 20.09 $1,033.03 $524.09 $206.61
dislocation.
27860 T Fixation of ankle joint 210 10.06 $517.29 $279.34 $103.46
27870 T Fusion of ankle joint.. 253 25.74 $1,323.55 $684.55 $264.71
27871 T Fusion of tibiofibular 253 25.74 $1,323.55 $684.55 $264.71
joint.
27880 C Amputation of lower leg ......... ......... ......... ........... ...........
27881 C Amputation of lower leg ......... ......... ......... ........... ...........
27882 C Amputation of lower leg ......... ......... ......... ........... ...........
27884 T Amputation follow-up 251 13.88 $713.71 $365.89 $142.74
surgery.
27886 C Amputation follow-up ......... ......... ......... ........... ...........
surgery.
27888 C Amputation of foot at ......... ......... ......... ........... ...........
ankle.
27889 T Amputation of foot at 252 19.24 $989.32 $512.34 $197.86
ankle.
27892 T Decompression of leg... 251 13.88 $713.71 $365.89 $142.74
27893 T Decompression of leg... 251 13.88 $713.71 $365.89 $142.74
27894 T Decompression of leg... 251 13.88 $713.71 $365.89 $142.74
27899 T Leg/ankle surgery 209 1.94 $99.75 $37.74 $19.95
procedure.
28001 T Drainage of bursa of 132 5.63 $289.49 $132.89 $57.90
foot.
28002 T Treatment of foot 251 13.88 $713.71 $365.89 $142.74
infection.
28003 T Treatment of foot 251 13.88 $713.71 $365.89 $142.74
infection.
28005 T Treat foot bone lesion. 271 14.12 $726.05 $365.44 $145.21
28008 T Incision of foot fascia 271 14.12 $726.05 $365.44 $145.21
28010 T Incision of toe tendon. 271 14.12 $726.05 $365.44 $145.21
28011 T Incision of toe tendons 271 14.12 $726.05 $365.44 $145.21
28020 T Exploration of a foot 271 14.12 $726.05 $365.44 $145.21
joint.
28022 T Exploration of a foot 271 14.12 $726.05 $365.44 $145.21
joint.
28024 T Exploration of a toe 271 14.12 $726.05 $365.44 $145.21
joint.
28030 T Removal of foot nerve.. 631 12.70 $653.03 $329.06 $130.61
28035 T Decompression of tibia 631 12.70 $653.03 $329.06 $130.61
nerve.
28043 T Excision of foot lesion 162 5.59 $287.44 $125.66 $57.49
28045 T Excision of foot lesion 271 14.12 $726.05 $365.44 $145.21
28046 T Resection of tumor, 271 14.12 $726.05 $365.44 $145.21
foot.
28050 T Biopsy of foot joint 271 14.12 $726.05 $365.44 $145.21
lining.
28052 T Biopsy of foot joint 271 14.12 $726.05 $365.44 $145.21
lining.
28054 T Biopsy of toe joint 271 14.12 $726.05 $365.44 $145.21
lining.
28060 T Partial removal foot 272 16.11 $828.38 $411.09 $165.68
fascia.
28062 T Removal of foot fascia. 272 16.11 $828.38 $411.09 $165.68
28070 T Removal of foot joint 272 16.11 $828.38 $411.09 $165.68
lining.
28072 T Removal of foot joint 272 16.11 $828.38 $411.09 $165.68
lining.
28080 T Removal of foot lesion. 271 14.12 $726.05 $365.44 $145.21
28086 T Excise foot tendon 271 14.12 $726.05 $365.44 $145.21
sheath.
28088 T Excise foot tendon 271 14.12 $726.05 $365.44 $145.21
sheath.
28090 T Removal of foot lesion. 271 14.12 $726.05 $365.44 $145.21
28092 T Removal of toe lesions. 271 14.12 $726.05 $365.44 $145.21
28100 T Removal of ankle/heel 271 14.12 $726.05 $365.44 $145.21
lesion.
28102 T Remove/graft foot 272 16.11 $828.38 $411.09 $165.68
lesion.
28103 T Remove/graft foot 272 16.11 $828.38 $411.09 $165.68
lesion.
28104 T Removal of foot lesion. 271 14.12 $726.05 $365.44 $145.21
28106 T Remove/graft foot 272 16.11 $828.38 $411.09 $165.68
lesion.
28107 T Remove/graft foot 272 16.11 $828.38 $411.09 $165.68
lesion.
28108 T Removal of toe lesions. 271 14.12 $726.05 $365.44 $145.21
28110 T Part removal of 276 19.00 $976.98 $495.39 $195.40
metatarsal.
28111 T Part removal of 271 14.12 $726.05 $365.44 $145.21
metatarsal.
28112 T Part removal of 271 14.12 $726.05 $365.44 $145.21
metatarsal.
28113 T Part removal of 271 14.12 $726.05 $365.44 $145.21
metatarsal.
28114 T Removal of metatarsal 271 14.12 $726.05 $365.44 $145.21
heads.
28116 T Revision of foot....... 271 14.12 $726.05 $365.44 $145.21
28118 T Removal of heel bone... 271 14.12 $726.05 $365.44 $145.21
28119 T Removal of heel spur... 271 14.12 $726.05 $365.44 $145.21
28120 T Part removal of ankle/ 271 14.12 $726.05 $365.44 $145.21
heel.
[[Page 35297]]
28122 T Partial removal of foot 271 14.12 $726.05 $365.44 $145.21
bone.
28124 T Partial removal of toe. 271 14.12 $726.05 $365.44 $145.21
28126 T Partial removal of toe. 271 14.12 $726.05 $365.44 $145.21
28130 T Removal of ankle bone.. 271 14.12 $726.05 $365.44 $145.21
28140 T Removal of metatarsal.. 271 14.12 $726.05 $365.44 $145.21
28150 T Removal of toe......... 271 14.12 $726.05 $365.44 $145.21
28153 T Partial removal of toe. 271 14.12 $726.05 $365.44 $145.21
28160 T Partial removal of toe. 271 14.12 $726.05 $365.44 $145.21
28171 T Extensive foot surgery. 271 14.12 $726.05 $365.44 $145.21
28173 T Extensive foot surgery. 271 14.12 $726.05 $365.44 $145.21
28175 T Extensive foot surgery. 271 14.12 $726.05 $365.44 $145.21
28190 T Removal of foot foreign 161 3.43 $176.37 $75.71 $35.27
body.
28192 T Removal of foot foreign 163 10.48 $538.88 $260.80 $107.78
body.
28193 T Removal of foot foreign 163 10.48 $538.88 $260.80 $107.78
body.
28200 T Repair of foot tendon.. 271 14.12 $726.05 $365.44 $145.21
28202 T Repair/graft of foot 272 16.11 $828.38 $411.09 $165.68
tendon.
28208 T Repair of foot tendon.. 271 14.12 $726.05 $365.44 $145.21
28210 T Repair/graft of foot 271 14.12 $726.05 $365.44 $145.21
tendon.
28220 T Release of foot tendon. 271 14.12 $726.05 $365.44 $145.21
28222 T Release of foot tendons 271 14.12 $726.05 $365.44 $145.21
28225 T Release of foot tendon. 271 14.12 $726.05 $365.44 $145.21
28226 T Release of foot tendons 271 14.12 $726.05 $365.44 $145.21
28230 T Incision of foot 271 14.12 $726.05 $365.44 $145.21
tendon(s).
28232 T Incision of toe tendon. 271 14.12 $726.05 $365.44 $145.21
28234 T Incision of foot tendon 271 14.12 $726.05 $365.44 $145.21
28238 T Revision of foot tendon 272 16.11 $828.38 $411.09 $165.68
28240 T Release of big toe..... 271 14.12 $726.05 $365.44 $145.21
28250 T Revision of foot fascia 272 16.11 $828.38 $411.09 $165.68
28260 T Release of midfoot 272 16.11 $828.38 $411.09 $165.68
joint.
28261 T Revision of foot tendon 272 16.11 $828.38 $411.09 $165.68
28262 T Revision of foot and 272 16.11 $828.38 $411.09 $165.68
ankle.
28264 T Release of midfoot 272 16.11 $828.38 $411.09 $165.68
joint.
28270 T Release of foot 271 14.12 $726.05 $365.44 $145.21
contracture.
28272 T Release of toe joint, 271 14.12 $726.05 $365.44 $145.21
each.
28280 T Fusion of toes......... 271 14.12 $726.05 $365.44 $145.21
28285 T Repair of hammertoe.... 271 14.12 $726.05 $365.44 $145.21
28286 T Repair of hammertoe.... 271 14.12 $726.05 $365.44 $145.21
28288 T Partial removal of foot 272 16.11 $828.38 $411.09 $165.68
bone.
28290 T Correction of bunion... 276 19.00 $976.98 $495.39 $195.40
28292 T Correction of bunion... 276 19.00 $976.98 $495.39 $195.40
28293 T Correction of bunion... 276 19.00 $976.98 $495.39 $195.40
28294 T Correction of bunion... 276 19.00 $976.98 $495.39 $195.40
28296 T Correction of bunion... 276 19.00 $976.98 $495.39 $195.40
28297 T Correction of bunion... 276 19.00 $976.98 $495.39 $195.40
28298 T Correction of bunion... 276 19.00 $976.98 $495.39 $195.40
28299 T Correction of bunion... 276 19.00 $976.98 $495.39 $195.40
28300 T Incision of heel bone.. 272 16.11 $828.38 $411.09 $165.68
28302 T Incision of ankle bone. 272 16.11 $828.38 $411.09 $165.68
28304 T Incision of midfoot 272 16.11 $828.38 $411.09 $165.68
bones.
28305 T Incise/graft midfoot 272 16.11 $828.38 $411.09 $165.68
bones.
28306 T Incision of metatarsal. 272 16.11 $828.38 $411.09 $165.68
28307 T Incision of metatarsal. 272 16.11 $828.38 $411.09 $165.68
28308 T Incision of metatarsal. 272 16.11 $828.38 $411.09 $165.68
28309 T Incision of metatarsals 272 16.11 $828.38 $411.09 $165.68
28310 T Revision of big toe.... 271 14.12 $726.05 $365.44 $145.21
28312 T Revision of toe........ 271 14.12 $726.05 $365.44 $145.21
28313 T Repair deformity of toe 271 14.12 $726.05 $365.44 $145.21
28315 T Removal of sesamoid 271 14.12 $726.05 $365.44 $145.21
bone.
28320 T Repair of foot bones... 272 16.11 $828.38 $411.09 $165.68
28322 T Repair of metatarsals.. 272 16.11 $828.38 $411.09 $165.68
28340 T Resect enlarged toe 271 14.12 $726.05 $365.44 $145.21
tissue.
28341 T Resect enlarged toe.... 271 14.12 $726.05 $365.44 $145.21
28344 T Repair extra toe(s).... 272 16.11 $828.38 $411.09 $165.68
28345 T Repair webbed toe(s)... 272 16.11 $828.38 $411.09 $165.68
28360 T Reconstruct cleft foot. 272 16.11 $828.38 $411.09 $165.68
28400 T Treatment of heel 209 1.94 $99.75 $37.74 $19.95
fracture.
28405 T Treatment of heel 209 1.94 $99.75 $37.74 $19.95
fracture.
28406 T Treatment of heel 216 20.09 $1,033.03 $524.09 $206.61
fracture.
28415 T Repair of heel fracture 216 20.09 $1,033.03 $524.09 $206.61
28420 T Repair/graft heel 216 20.09 $1,033.03 $524.09 $206.61
fracture.
28430 T Treatment of ankle 209 1.94 $99.75 $37.74 $19.95
fracture.
28435 T Treatment of ankle 209 1.94 $99.75 $37.74 $19.95
fracture.
28436 T Treatment of ankle 216 20.09 $1,033.03 $524.09 $206.61
fracture.
28445 T Repair of ankle 216 20.09 $1,033.03 $524.09 $206.61
fracture.
28450 T Treat midfoot fracture, 209 1.94 $99.75 $37.74 $19.95
each.
[[Page 35298]]
28455 T Treat midfoot fracture, 209 1.94 $99.75 $37.74 $19.95
each.
28456 T Repair midfoot fracture 216 20.09 $1,033.03 $524.09 $206.61
28465 T Repair midfoot 216 20.09 $1,033.03 $524.09 $206.61
fracture,each.
28470 T Treat metatarsal 209 1.94 $99.75 $37.74 $19.95
fracture.
28475 T Treat metatarsal 209 1.94 $99.75 $37.74 $19.95
fracture.
28476 T Repair metatarsal 216 20.09 $1,033.03 $524.09 $206.61
fracture.
28485 T Repair metatarsal 216 20.09 $1,033.03 $524.09 $206.61
fracture.
28490 T Treat big toe fracture. 207 1.70 $87.41 $32.32 $17.48
28495 T Treat big toe fracture. 207 1.70 $87.41 $32.32 $17.48
28496 T Repair big toe fracture 216 20.09 $1,033.03 $524.09 $206.61
28505 T Repair big toe fracture 216 20.09 $1,033.03 $524.09 $206.61
28510 T Treatment of toe 207 1.70 $87.41 $32.32 $17.48
fracture.
28515 T Treatment of toe 207 1.70 $87.41 $32.32 $17.48
fracture.
28525 T Repair of toe fracture. 216 20.09 $1,033.03 $524.09 $206.61
28530 T Treat sesamoid bone 209 1.94 $99.75 $37.74 $19.95
fracture.
28531 T Treat sesamoid bone 216 20.09 $1,033.03 $524.09 $206.61
fracture.
28540 T Treat foot dislocation. 209 1.94 $99.75 $37.74 $19.95
28545 T Treat foot dislocation. 210 10.06 $517.29 $279.34 $103.46
28546 T Treat foot dislocation. 216 20.09 $1,033.03 $524.09 $206.61
28555 T Repair foot dislocation 216 20.09 $1,033.03 $524.09 $206.61
28570 T Treat foot dislocation. 209 1.94 $99.75 $37.74 $19.95
28575 T Treat foot dislocation. 210 10.06 $517.29 $279.34 $103.46
28576 T Treat foot dislocation. 216 20.09 $1,033.03 $524.09 $206.61
28585 T Repair foot dislocation 216 20.09 $1,033.03 $524.09 $206.61
28600 T Treat foot dislocation. 209 1.94 $99.75 $37.74 $19.95
28605 T Treat foot dislocation. 210 10.06 $517.29 $279.34 $103.46
28606 T Treat foot dislocation. 216 20.09 $1,033.03 $524.09 $206.61
28615 T Repair foot dislocation 216 20.09 $1,033.03 $524.09 $206.61
28630 T Treat toe dislocation.. 207 1.70 $87.41 $32.32 $17.48
28635 T Treat toe dislocation.. 210 10.06 $517.29 $279.34 $103.46
28636 T Treat toe dislocation.. 216 20.09 $1,033.03 $524.09 $206.61
28645 T Repair toe dislocation. 216 20.09 $1,033.03 $524.09 $206.61
28660 T Treat toe dislocation.. 207 1.70 $87.41 $32.32 $17.48
28665 T Treat toe dislocation.. 210 10.06 $517.29 $279.34 $103.46
28666 T Treat toe dislocation.. 216 20.09 $1,033.03 $524.09 $206.61
28675 T Repair of toe 216 20.09 $1,033.03 $524.09 $206.61
dislocation.
28705 T Fusion of foot bones... 272 16.11 $828.38 $411.09 $165.68
28715 T Fusion of foot bones... 272 16.11 $828.38 $411.09 $165.68
28725 T Fusion of foot bones... 272 16.11 $828.38 $411.09 $165.68
28730 T Fusion of foot bones... 272 16.11 $828.38 $411.09 $165.68
28735 T Fusion of foot bones... 272 16.11 $828.38 $411.09 $165.68
28737 T Revision of foot bones. 271 14.12 $726.05 $365.44 $145.21
28740 T Fusion of foot bones... 272 16.11 $828.38 $411.09 $165.68
28750 T Fusion of big toe joint 271 14.12 $726.05 $365.44 $145.21
28755 T Fusion of big toe joint 271 14.12 $726.05 $365.44 $145.21
28760 T Fusion of big toe joint 272 16.11 $828.38 $411.09 $165.68
28800 C Amputation of midfoot.. ......... ......... ......... ........... ...........
28805 C Amputation thru ......... ......... ......... ........... ...........
metatarsal.
28810 T Amputation toe & 271 14.12 $726.05 $365.44 $145.21
metatarsal.
28820 T Amputation of toe...... 271 14.12 $726.05 $365.44 $145.21
28825 T Partial amputation of 271 14.12 $726.05 $365.44 $145.21
toe.
28899 T Foot/toes surgery 207 1.70 $87.41 $32.32 $17.48
procedure.
29000 N Application of body ......... ......... ......... ........... ...........
cast.
29010 N Application of body ......... ......... ......... ........... ...........
cast.
29015 N Application of body ......... ......... ......... ........... ...........
cast.
29020 N Application of body ......... ......... ......... ........... ...........
cast.
29025 N Application of body ......... ......... ......... ........... ...........
cast.
29035 N Application of body ......... ......... ......... ........... ...........
cast.
29040 N Application of body ......... ......... ......... ........... ...........
cast.
29044 N Application of body ......... ......... ......... ........... ...........
cast.
29046 N Application of body ......... ......... ......... ........... ...........
cast.
29049 N Application of figure ......... ......... ......... ........... ...........
eight.
29055 N Application of shoulder ......... ......... ......... ........... ...........
cast.
29058 N Application of shoulder ......... ......... ......... ........... ...........
cast.
29065 N Application of long arm ......... ......... ......... ........... ...........
cast.
29075 N Application of forearm ......... ......... ......... ........... ...........
cast.
29085 N Apply hand/wrist cast.. ......... ......... ......... ........... ...........
29105 N Apply long arm splint.. ......... ......... ......... ........... ...........
29125 N Apply forearm splint... ......... ......... ......... ........... ...........
29126 N Apply forearm splint... ......... ......... ......... ........... ...........
29130 N Application of finger ......... ......... ......... ........... ...........
splint.
29131 N Application of finger ......... ......... ......... ........... ...........
splint.
29200 N Strapping of chest..... ......... ......... ......... ........... ...........
29220 N Strapping of low back.. ......... ......... ......... ........... ...........
29240 N Strapping of shoulder.. ......... ......... ......... ........... ...........
[[Page 35299]]
29260 N Strapping of elbow or ......... ......... ......... ........... ...........
wrist.
29280 N Strapping of hand or ......... ......... ......... ........... ...........
finger.
29305 N Application of hip cast ......... ......... ......... ........... ...........
29325 N Application of hip ......... ......... ......... ........... ...........
casts.
29345 N Application of long leg ......... ......... ......... ........... ...........
cast.
29355 N Application of long leg ......... ......... ......... ........... ...........
cast.
29358 N Apply long leg cast ......... ......... ......... ........... ...........
brace.
29365 N Application of long leg ......... ......... ......... ........... ...........
cast.
29405 N Apply short leg cast... ......... ......... ......... ........... ...........
29425 N Apply short leg cast... ......... ......... ......... ........... ...........
29435 N Apply short leg cast... ......... ......... ......... ........... ...........
29440 N Addition of walker to ......... ......... ......... ........... ...........
cast.
29445 N Apply rigid leg cast... ......... ......... ......... ........... ...........
29450 N Application of leg cast ......... ......... ......... ........... ...........
29505 N Application long leg ......... ......... ......... ........... ...........
splint.
29515 N Application lower leg ......... ......... ......... ........... ...........
splint.
29520 N Strapping of hip....... ......... ......... ......... ........... ...........
29530 N Strapping of knee...... ......... ......... ......... ........... ...........
29540 N Strapping of ankle..... ......... ......... ......... ........... ...........
29550 N Strapping of toes...... ......... ......... ......... ........... ...........
29580 N Application of paste ......... ......... ......... ........... ...........
boot.
29590 N Application of foot ......... ......... ......... ........... ...........
splint.
29700 N Removal/revision of ......... ......... ......... ........... ...........
cast.
29705 N Removal/revision of ......... ......... ......... ........... ...........
cast.
29710 N Removal/revision of ......... ......... ......... ........... ...........
cast.
29715 N Removal/revision of ......... ......... ......... ........... ...........
cast.
29720 N Repair of body cast.... ......... ......... ......... ........... ...........
29730 N Windowing of cast...... ......... ......... ......... ........... ...........
29740 N Wedging of cast........ ......... ......... ......... ........... ...........
29750 N Wedging of clubfoot ......... ......... ......... ........... ...........
cast.
29799 N Casting/strapping ......... ......... ......... ........... ...........
procedure.
29800 T Jaw arthroscopy/surgery 280 22.15 $1,138.95 $581.72 $227.79
29804 T Jaw arthroscopy/surgery 281 22.37 $1,150.27 $589.18 $230.05
29815 T Shoulder arthroscopy... 280 22.15 $1,138.95 $581.72 $227.79
29819 T Shoulder arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29820 T Shoulder arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29821 T Shoulder arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29822 T Shoulder arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29823 T Shoulder arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29825 T Shoulder arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29826 T Shoulder arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29830 T Elbow arthroscopy...... 280 22.15 $1,138.95 $581.72 $227.79
29834 T Elbow arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29835 T Elbow arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29836 T Elbow arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29837 T Elbow arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29838 T Elbow arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29840 T Wrist arthroscopy...... 280 22.15 $1,138.95 $581.72 $227.79
29843 T Wrist arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29844 T Wrist arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29845 T Wrist arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29846 T Wrist arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29847 T Wrist arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29848 T Wrist endoscopy/surgery 281 22.37 $1,150.27 $589.18 $230.05
29850 T Knee arthroscopy/ 286 27.69 $1,423.82 $791.90 $284.76
surgery.
29851 T Knee arthroscopy/ 286 27.69 $1,423.82 $791.90 $284.76
surgery.
29855 T Tibial arthroscopy/ 286 27.69 $1,423.82 $791.90 $284.76
surgery.
29856 T Tibial arthroscopy/ 286 27.69 $1,423.82 $791.90 $284.76
surgery.
29860 T Hip arthroscopy, dx.... 281 22.37 $1,150.27 $589.18 $230.05
29861 T Hip arthroscopy/surgery 281 22.37 $1,150.27 $589.18 $230.05
29862 T Hip arthroscopy/surgery 281 22.37 $1,150.27 $589.18 $230.05
29863 T Hip arthroscopy/surgery 281 22.37 $1,150.27 $589.18 $230.05
29870 T Knee arthroscopy, 280 22.15 $1,138.95 $581.72 $227.79
diagnostic.
29871 T Knee arthroscopy/ 282 23.65 $1,216.08 $609.97 $243.22
drainage.
29874 T Knee arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29875 T Knee arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29876 T Knee arthroscopy/ 282 23.65 $1,216.08 $609.97 $243.22
surgery.
29877 T Knee arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29879 T Knee arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29880 T Knee arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29881 T Knee arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29882 T Knee arthroscopy/ 282 23.65 $1,216.08 $609.97 $243.22
surgery.
29883 T Knee arthroscopy/ 282 23.65 $1,216.08 $609.97 $243.22
surgery.
29884 T Knee arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29885 T Knee arthroscopy/ 282 23.65 $1,216.08 $609.97 $243.22
surgery.
[[Page 35300]]
29886 T Knee arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29887 T Knee arthroscopy/ 282 23.65 $1,216.08 $609.97 $243.22
surgery.
29888 T Knee arthroscopy/ 286 27.69 $1,423.82 $791.90 $284.76
surgery.
29889 T Knee arthroscopy/ 286 27.69 $1,423.82 $791.90 $284.76
surgery.
29891 T Ankle arthroscopy/ 282 23.65 $1,216.08 $609.97 $243.22
surgery.
29892 T Ankle arthroscopy/ 286 27.69 $1,423.82 $791.90 $284.76
surgery.
29893 T Scope, plantar 271 14.12 $726.05 $365.44 $145.21
fasciotomy.
29894 T Ankle arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29895 T Ankle arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29897 T Ankle arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29898 T Ankle arthroscopy/ 281 22.37 $1,150.27 $589.18 $230.05
surgery.
29909 T Arthroscopy of joint... 280 22.15 $1,138.95 $581.72 $227.79
30000 T Drainage of nose lesion 311 1.41 $72.50 $20.57 $14.50
30020 T Drainage of nose lesion 311 1.41 $72.50 $20.57 $14.50
30100 T Intranasal biopsy...... 311 1.41 $72.50 $20.57 $14.50
30110 T Removal of nose 311 1.41 $72.50 $20.57 $14.50
polyp(s).
30115 T Removal of nose 313 15.46 $794.95 $407.70 $158.99
polyp(s).
30117 T Removal of intranasal 311 1.41 $72.50 $20.57 $14.50
lesion.
30118 T Removal of intranasal 313 15.46 $794.95 $407.70 $158.99
lesion.
30120 T Revision of nose....... 313 15.46 $794.95 $407.70 $158.99
30124 T Removal of nose lesion. 311 1.41 $72.50 $20.57 $14.50
30125 T Removal of nose lesion. 313 15.46 $794.95 $407.70 $158.99
30130 T Removal of turbinate 313 15.46 $794.95 $407.70 $158.99
bones.
30140 T Removal of turbinate 313 15.46 $794.95 $407.70 $158.99
bones.
30150 T Partial removal of nose 313 15.46 $794.95 $407.70 $158.99
30160 T Removal of nose........ 313 15.46 $794.95 $407.70 $158.99
30200 T Injection treatment of 347 2.57 $132.15 $62.38 $26.43
nose.
30210 T Nasal sinus therapy.... 311 1.41 $72.50 $20.57 $14.50
30220 T Insert nasal septal 311 1.41 $72.50 $20.57 $14.50
button.
30300 T Remove nasal foreign 311 1.41 $72.50 $20.57 $14.50
body.
30310 T Remove nasal foreign 313 15.46 $794.95 $407.70 $158.99
body.
30320 T Remove nasal foreign 313 15.46 $794.95 $407.70 $158.99
body.
30400 T Reconstruction of nose. 314 25.15 $1,293.21 $687.72 $258.64
30410 T Reconstruction of nose. 314 25.15 $1,293.21 $687.72 $258.64
30420 T Reconstruction of nose. 314 25.15 $1,293.21 $687.72 $258.64
30430 T Revision of nose....... 313 15.46 $794.95 $407.70 $158.99
30435 T Revision of nose....... 314 25.15 $1,293.21 $687.72 $258.64
30450 T Revision of nose....... 314 25.15 $1,293.21 $687.72 $258.64
30460 T Revision of nose....... 314 25.15 $1,293.21 $687.72 $258.64
30462 T Revision of nose....... 314 25.15 $1,293.21 $687.72 $258.64
30520 T Repair of nasal septum. 313 15.46 $794.95 $407.70 $158.99
30540 T Repair nasal defect.... 313 15.46 $794.95 $407.70 $158.99
30545 T Repair nasal defect.... 314 25.15 $1,293.21 $687.72 $258.64
30560 T Release of nasal 311 1.41 $72.50 $20.57 $14.50
adhesions.
30580 T Repair upper jaw 313 15.46 $794.95 $407.70 $158.99
fistula.
30600 T Repair mouth/nose 313 15.46 $794.95 $407.70 $158.99
fistula.
30620 T Intranasal 313 15.46 $794.95 $407.70 $158.99
reconstruction.
30630 T Repair nasal septum 313 15.46 $794.95 $407.70 $158.99
defect.
30801 T Cauterization inner 312 7.07 $363.54 $170.86 $72.71
nose.
30802 T Cauterization inner 312 7.07 $363.54 $170.86 $72.71
nose.
30901 T Control of nosebleed... 318 2.07 $106.44 $38.87 $21.29
30903 T Control of nosebleed... 318 2.07 $106.44 $38.87 $21.29
30905 T Control of nosebleed... 318 2.07 $106.44 $38.87 $21.29
30906 T Repeat control of 318 2.07 $106.44 $38.87 $21.29
nosebleed.
30915 T Ligation nasal sinus 367 17.02 $875.17 $441.15 $175.03
artery.
30920 T Ligation upper jaw 367 17.02 $875.17 $441.15 $175.03
artery.
30930 T Therapy fracture of 312 7.07 $363.54 $170.86 $72.71
nose.
30999 T Nasal surgery procedure 318 2.07 $106.44 $38.87 $21.29
31000 T Irrigation maxillary 311 1.41 $72.50 $20.57 $14.50
sinus.
31002 T Irrigation sphenoid 311 1.41 $72.50 $20.57 $14.50
sinus.
31020 T Exploration maxillary 313 15.46 $794.95 $407.70 $158.99
sinus.
31030 T Exploration maxillary 313 15.46 $794.95 $407.70 $158.99
sinus.
31032 T Explore sinus,remove 313 15.46 $794.95 $407.70 $158.99
polyps.
31040 T Exploration behind 314 25.15 $1,293.21 $687.72 $258.64
upper jaw.
31050 T Exploration sphenoid 313 15.46 $794.95 $407.70 $158.99
sinus.
31051 T Sphenoid sinus surgery. 313 15.46 $794.95 $407.70 $158.99
31070 T Exploration of frontal 313 15.46 $794.95 $407.70 $158.99
sinus.
31075 T Exploration of frontal 314 25.15 $1,293.21 $687.72 $258.64
sinus.
31080 T Removal of frontal 314 25.15 $1,293.21 $687.72 $258.64
sinus.
31081 T Removal of frontal 314 25.15 $1,293.21 $687.72 $258.64
sinus.
31084 T Removal of frontal 314 25.15 $1,293.21 $687.72 $258.64
sinus.
31085 T Removal of frontal 314 25.15 $1,293.21 $687.72 $258.64
sinus.
31086 T Removal of frontal 314 25.15 $1,293.21 $687.72 $258.64
sinus.
31087 T Removal of frontal 314 25.15 $1,293.21 $687.72 $258.64
sinus.
31090 T Exploration of sinuses. 314 25.15 $1,293.21 $687.72 $258.64
[[Page 35301]]
31200 T Removal of ethmoid 313 15.46 $794.95 $407.70 $158.99
sinus.
31201 T Removal of ethmoid 314 25.15 $1,293.21 $687.72 $258.64
sinus.
31205 T Removal of ethmoid 314 25.15 $1,293.21 $687.72 $258.64
sinus.
31225 C Removal of upper jaw... ......... ......... ......... ........... ...........
31230 C Removal of upper jaw... ......... ......... ......... ........... ...........
31231 T Nasal endoscopy, dx.... 331 0.57 $29.31 $14.01 $5.86
31233 T Nasal/sinus endoscopy, 332 9.67 $497.23 $242.72 $99.45
dx.
31235 T Nasal/sinus endoscopy, 332 9.67 $497.23 $242.72 $99.45
dx.
31237 T Nasal/sinus endoscopy, 332 9.67 $497.23 $242.72 $99.45
surg.
31238 T Nasal/sinus endoscopy, 332 9.67 $497.23 $242.72 $99.45
surg.
31239 T Nasal/sinus endoscopy, 333 16.81 $864.37 $461.04 $172.87
surg.
31240 T Nasal/sinus endoscopy, 332 9.67 $497.23 $242.72 $99.45
surg.
31254 T Revision of ethmoid 333 16.81 $864.37 $461.04 $172.87
sinus.
31255 T Removal of ethmoid 333 16.81 $864.37 $461.04 $172.87
sinus.
31256 T Exploration maxillary 333 16.81 $864.37 $461.04 $172.87
sinus.
31267 T Endoscopy, maxillary 333 16.81 $864.37 $461.04 $172.87
sinus.
31276 T Sinus surgical 333 16.81 $864.37 $461.04 $172.87
endoscopy.
31287 T Nasal/sinus endoscopy, 333 16.81 $864.37 $461.04 $172.87
surg.
31288 T Nasal/sinus endoscopy, 333 16.81 $864.37 $461.04 $172.87
surg.
31290 C Nasal/sinus endoscopy, ......... ......... ......... ........... ...........
surg.
31291 C Nasal/sinus endoscopy, ......... ......... ......... ........... ...........
surg.
31292 C Nasal/sinus endoscopy, ......... ......... ......... ........... ...........
surg.
31293 C Nasal/sinus endoscopy, ......... ......... ......... ........... ...........
surg.
31294 C Nasal/sinus endoscopy, ......... ......... ......... ........... ...........
surg.
31299 T Sinus surgery procedure 331 0.57 $29.31 $14.01 $5.86
31300 T Removal of larynx 314 25.15 $1,293.21 $687.72 $258.64
lesion.
31320 T Diagnostic incision 313 15.46 $794.95 $407.70 $158.99
larynx.
31360 C Removal of larynx...... ......... ......... ......... ........... ...........
31365 C Removal of larynx...... ......... ......... ......... ........... ...........
31367 C Partial removal of ......... ......... ......... ........... ...........
larynx.
31368 C Partial removal of ......... ......... ......... ........... ...........
larynx.
31370 C Partial removal of ......... ......... ......... ........... ...........
larynx.
31375 C Partial removal of ......... ......... ......... ........... ...........
larynx.
31380 C Partial removal of ......... ......... ......... ........... ...........
larynx.
31382 C Partial removal of ......... ......... ......... ........... ...........
larynx.
31390 C Removal of larynx & ......... ......... ......... ........... ...........
pharynx.
31395 C Reconstruct larynx & ......... ......... ......... ........... ...........
pharynx.
31400 T Revision of larynx..... 314 25.15 $1,293.21 $687.72 $258.64
31420 T Removal of epiglottis.. 314 25.15 $1,293.21 $687.72 $258.64
31500 S Insert emergency airway 947 4.11 $211.34 $106.22 $42.27
31502 T Change of windpipe 470 2.19 $112.61 $54.92 $22.52
airway.
31505 T Diagnostic laryngoscopy 331 0.57 $29.31 $14.01 $5.86
31510 T Laryngoscopy with 332 9.67 $497.23 $242.72 $99.45
biopsy.
31511 T Remove foreign body, 332 9.67 $497.23 $242.72 $99.45
larynx.
31512 T Removal of larynx 332 9.67 $497.23 $242.72 $99.45
lesion.
31513 T Injection into vocal 332 9.67 $497.23 $242.72 $99.45
cord.
31515 T Laryngoscopy for 332 9.67 $497.23 $242.72 $99.45
aspiration.
31520 T Diagnostic laryngoscopy 332 9.67 $497.23 $242.72 $99.45
31525 T Diagnostic laryngoscopy 332 9.67 $497.23 $242.72 $99.45
31526 T Diagnostic laryngoscopy 332 9.67 $497.23 $242.72 $99.45
31527 T Laryngoscopy for 333 16.81 $864.37 $461.04 $172.87
treatment.
31528 T Laryngoscopy and 332 9.67 $497.23 $242.72 $99.45
dilatation.
31529 T Laryngoscopy and 332 9.67 $497.23 $242.72 $99.45
dilatation.
31530 T Operative laryngoscopy. 333 16.81 $864.37 $461.04 $172.87
31531 T Operative laryngoscopy. 333 16.81 $864.37 $461.04 $172.87
31535 T Operative laryngoscopy. 333 16.81 $864.37 $461.04 $172.87
31536 T Operative laryngoscopy. 333 16.81 $864.37 $461.04 $172.87
31540 T Operative laryngoscopy. 333 16.81 $864.37 $461.04 $172.87
31541 T Operative laryngoscopy. 333 16.81 $864.37 $461.04 $172.87
31560 T Operative laryngoscopy. 333 16.81 $864.37 $461.04 $172.87
31561 T Operative laryngoscopy. 333 16.81 $864.37 $461.04 $172.87
31570 T Laryngoscopy with 333 16.81 $864.37 $461.04 $172.87
injection.
31571 T Laryngoscopy with 333 16.81 $864.37 $461.04 $172.87
injection.
31575 T Diagnostic laryngoscopy 331 0.57 $29.31 $14.01 $5.86
31576 T Laryngoscopy with 332 9.67 $497.23 $242.72 $99.45
biopsy.
31577 T Remove foreign body, 332 9.67 $497.23 $242.72 $99.45
larynx.
31578 T Removal of larynx 332 9.67 $497.23 $242.72 $99.45
lesion.
31579 T Diagnostic laryngoscopy 331 0.57 $29.31 $14.01 $5.86
31580 C Revision of larynx..... ......... ......... ......... ........... ...........
31582 C Revision of larynx..... ......... ......... ......... ........... ...........
31584 C Repair of larynx ......... ......... ......... ........... ...........
fracture.
31585 T Repair of larynx 207 1.70 $87.41 $32.32 $17.48
fracture.
31586 T Repair of larynx 209 1.94 $99.75 $37.74 $19.95
fracture.
31587 C Revision of larynx..... ......... ......... ......... ........... ...........
31588 T Revision of larynx..... 314 25.15 $1,293.21 $687.72 $258.64
[[Page 35302]]
31590 T Reinnervate larynx..... 314 25.15 $1,293.21 $687.72 $258.64
31595 T Larynx nerve surgery... 313 15.46 $794.95 $407.70 $158.99
31599 T Larynx surgery 207 1.70 $87.41 $32.32 $17.48
procedure.
31600 C Incision of windpipe... ......... ......... ......... ........... ...........
31601 C Incision of windpipe... ......... ......... ......... ........... ...........
31603 T Incision of windpipe... 311 1.41 $72.50 $20.57 $14.50
31605 T Incision of windpipe... 311 1.41 $72.50 $20.57 $14.50
31610 C Incision of windpipe... ......... ......... ......... ........... ...........
31611 T Surgery/speech 313 15.46 $794.95 $407.70 $158.99
prosthesis.
31612 T Puncture/clear windpipe 312 7.07 $363.54 $170.86 $72.71
31613 T Repair windpipe opening 313 15.46 $794.95 $407.70 $158.99
31614 T Repair windpipe opening 313 15.46 $794.95 $407.70 $158.99
31615 T Visualization of 336 7.24 $372.28 $195.49 $74.46
windpipe.
31622 T Dx bronchoscope/wash... 336 7.24 $372.28 $195.49 $74.46
31625 T Bronchoscopy with 336 7.24 $372.28 $195.49 $74.46
biopsy.
31628 T Bronchoscopy with 336 7.24 $372.28 $195.49 $74.46
biopsy.
31629 T Bronchoscopy with 336 7.24 $372.28 $195.49 $74.46
biopsy.
31630 T Bronchoscopy with 336 7.24 $372.28 $195.49 $74.46
repair.
31631 T Bronchoscopy with 336 7.24 $372.28 $195.49 $74.46
dilation.
31635 T Remove foreign body, 336 7.24 $372.28 $195.49 $74.46
airway.
31640 T Bronchoscopy & remove 336 7.24 $372.28 $195.49 $74.46
lesion.
31641 T Bronchoscopy, treat 336 7.24 $372.28 $195.49 $74.46
blockage.
31645 T Bronchoscopy, clear 336 7.24 $372.28 $195.49 $74.46
airways.
31646 T Bronchoscopy,reclear 336 7.24 $372.28 $195.49 $74.46
airways.
31656 T Bronchoscopy,inject for 336 7.24 $372.28 $195.49 $74.46
xray.
31700 T Insertion of airway 332 9.67 $497.23 $242.72 $99.45
catheter.
31708 T Instill airway contrast 347 2.57 $132.15 $62.38 $26.43
dye.
31710 T Insertion of airway 347 2.57 $132.15 $62.38 $26.43
catheter.
31715 T Injection for bronchus 347 2.57 $132.15 $62.38 $26.43
x-ray.
31717 T Bronchial brush biopsy. 332 9.67 $497.23 $242.72 $99.45
31720 T Clearance of airways... 332 9.67 $497.23 $242.72 $99.45
31725 C Clearance of airways... ......... ......... ......... ........... ...........
31730 T Intro windpipe wire/ 332 9.67 $497.23 $242.72 $99.45
tube.
31750 T Repair of windpipe..... 314 25.15 $1,293.21 $687.72 $258.64
31755 T Repair of windpipe..... 314 25.15 $1,293.21 $687.72 $258.64
31760 C Repair of windpipe..... ......... ......... ......... ........... ...........
31766 C Reconstruction of ......... ......... ......... ........... ...........
windpipe.
31770 C Repair/graft of ......... ......... ......... ........... ...........
bronchus.
31775 C Reconstruct bronchus... ......... ......... ......... ........... ...........
31780 C Reconstruct windpipe... ......... ......... ......... ........... ...........
31781 C Reconstruct windpipe... ......... ......... ......... ........... ...........
31785 C Remove windpipe lesion. ......... ......... ......... ........... ...........
31786 C Remove windpipe lesion. ......... ......... ......... ........... ...........
31800 C Repair of windpipe ......... ......... ......... ........... ...........
injury.
31805 C Repair of windpipe ......... ......... ......... ........... ...........
injury.
31820 T Closure of windpipe 313 15.46 $794.95 $407.70 $158.99
lesion.
31825 T Repair of windpipe 313 15.46 $794.95 $407.70 $158.99
defect.
31830 T Revise windpipe scar... 313 15.46 $794.95 $407.70 $158.99
31899 T Airways surgical 336 7.24 $372.28 $195.49 $74.46
procedure.
32000 T Drainage of chest...... 320 3.09 $158.89 $80.91 $31.78
32002 T Treatment of collapsed 320 3.09 $158.89 $80.91 $31.78
lung.
32005 C Treat lung lining ......... ......... ......... ........... ...........
chemically.
32020 T Insertion of chest tube 320 3.09 $158.89 $80.91 $31.78
32035 C Exploration of chest... ......... ......... ......... ........... ...........
32036 C Exploration of chest... ......... ......... ......... ........... ...........
32095 C Biopsy through chest ......... ......... ......... ........... ...........
wall.
32100 C Exploration/biopsy of ......... ......... ......... ........... ...........
chest.
32110 C Explore/repair chest... ......... ......... ......... ........... ...........
32120 C Re-exploration of chest ......... ......... ......... ........... ...........
32124 C Explore chest,free ......... ......... ......... ........... ...........
adhesions.
32140 C Removal of lung ......... ......... ......... ........... ...........
lesion(s).
32141 C Remove/treat lung ......... ......... ......... ........... ...........
lesions.
32150 C Removal of lung ......... ......... ......... ........... ...........
lesion(s).
32151 C Remove lung foreign ......... ......... ......... ........... ...........
body.
32160 C Open chest heart ......... ......... ......... ........... ...........
massage.
32200 C Open drainage, lung ......... ......... ......... ........... ...........
lesion.
32201 C Percut drainage, lung ......... ......... ......... ........... ...........
lesion.
32215 C Treat chest lining..... ......... ......... ......... ........... ...........
32220 C Release of lung........ ......... ......... ......... ........... ...........
32225 C Partial release of lung ......... ......... ......... ........... ...........
32310 C Removal of chest lining ......... ......... ......... ........... ...........
32320 C Free/remove chest ......... ......... ......... ........... ...........
lining.
32400 T Needle biopsy chest 122 4.59 $236.02 $113.00 $47.20
lining.
32402 C Open biopsy chest ......... ......... ......... ........... ...........
lining.
32405 T Biopsy, lung or 122 4.59 $236.02 $113.00 $47.20
mediastinum.
[[Page 35303]]
32420 T Puncture/clear lung.... 320 3.09 $158.89 $80.91 $31.78
32440 C Removal of lung........ ......... ......... ......... ........... ...........
32442 C Sleeve pneumonectomy... ......... ......... ......... ........... ...........
32445 C Removal of lung........ ......... ......... ......... ........... ...........
32480 C Partial removal of lung ......... ......... ......... ........... ...........
32482 C Bilobectomy............ ......... ......... ......... ........... ...........
32484 C Segmentectomy.......... ......... ......... ......... ........... ...........
32486 C Sleeve lobectomy....... ......... ......... ......... ........... ...........
32488 C Completion ......... ......... ......... ........... ...........
pneumonectomy.
32491 C Lung volume reduction.. ......... ......... ......... ........... ...........
32500 C Partial removal of lung ......... ......... ......... ........... ...........
32501 C Repair bronchus (add- ......... ......... ......... ........... ...........
on).
32520 C Remove lung & revise ......... ......... ......... ........... ...........
chest.
32522 C Remove lung & revise ......... ......... ......... ........... ...........
chest.
32525 C Remove lung & revise ......... ......... ......... ........... ...........
chest.
32540 C Removal of lung lesion. ......... ......... ......... ........... ...........
32601 C Thoracoscopy, ......... ......... ......... ........... ...........
diagnostic.
32602 C Thoracoscopy, ......... ......... ......... ........... ...........
diagnostic.
32603 C Thoracoscopy, ......... ......... ......... ........... ...........
diagnostic.
32604 C Thoracoscopy, ......... ......... ......... ........... ...........
diagnostic.
32605 C Thoracoscopy, ......... ......... ......... ........... ...........
diagnostic.
32606 C Thoracoscopy, ......... ......... ......... ........... ...........
diagnostic.
32650 C Thoracoscopy, surgical. ......... ......... ......... ........... ...........
32651 C Thoracoscopy, surgical. ......... ......... ......... ........... ...........
32652 C Thoracoscopy, surgical. ......... ......... ......... ........... ...........
32653 C Thoracoscopy, surgical. ......... ......... ......... ........... ...........
32654 C Thoracoscopy, surgical. ......... ......... ......... ........... ...........
32655 C Thoracoscopy, surgical. ......... ......... ......... ........... ...........
32656 C Thoracoscopy, surgical. ......... ......... ......... ........... ...........
32657 C Thoracoscopy, surgical. ......... ......... ......... ........... ...........
32658 C Thoracoscopy, surgical. ......... ......... ......... ........... ...........
32659 C Thoracoscopy, surgical. ......... ......... ......... ........... ...........
32660 C Thoracoscopy, surgical. ......... ......... ......... ........... ...........
32661 C Thoracoscopy, surgical. ......... ......... ......... ........... ...........
32662 C Thoracoscopy, surgical. ......... ......... ......... ........... ...........
32663 C Thoracoscopy, surgical. ......... ......... ......... ........... ...........
32664 C Thoracoscopy, surgical. ......... ......... ......... ........... ...........
32665 C Thoracoscopy, surgical. ......... ......... ......... ........... ...........
32800 C Repair lung hernia..... ......... ......... ......... ........... ...........
32810 C Close chest after ......... ......... ......... ........... ...........
drainage.
32815 C Close bronchial fistula ......... ......... ......... ........... ...........
32820 C Reconstruct injured ......... ......... ......... ........... ...........
chest.
32850 C Donor pneumonectomy.... ......... ......... ......... ........... ...........
32851 C Lung transplant, single ......... ......... ......... ........... ...........
32852 C Lung transplant w/ ......... ......... ......... ........... ...........
bypass.
32853 C Lung transplant, double ......... ......... ......... ........... ...........
32854 C Lung transplant w/ ......... ......... ......... ........... ...........
bypass.
32900 C Removal of rib(s)...... ......... ......... ......... ........... ...........
32905 C Revise & repair chest ......... ......... ......... ........... ...........
wall.
32906 C Revise & repair chest ......... ......... ......... ........... ...........
wall.
32940 C Revision of lung....... ......... ......... ......... ........... ...........
32960 T Therapeutic 320 3.09 $158.89 $80.91 $31.78
pneumothorax.
32999 T Chest surgery procedure 320 3.09 $158.89 $80.91 $31.78
33010 T Drainage of heart sac.. 320 3.09 $158.89 $80.91 $31.78
33011 T Repeat drainage of 320 3.09 $158.89 $80.91 $31.78
heart sac.
33015 C Incision of heart sac.. ......... ......... ......... ........... ...........
33020 C Incision of heart sac.. ......... ......... ......... ........... ...........
33025 C Incision of heart sac.. ......... ......... ......... ........... ...........
33030 C Partial removal of ......... ......... ......... ........... ...........
heart sac.
33031 C Partial removal of ......... ......... ......... ........... ...........
heart sac.
33050 C Removal of heart sac ......... ......... ......... ........... ...........
lesion.
33120 C Removal of heart lesion ......... ......... ......... ........... ...........
33130 C Removal of heart lesion ......... ......... ......... ........... ...........
33200 C Insertion of heart ......... ......... ......... ........... ...........
pacemaker.
33201 C Insertion of heart ......... ......... ......... ........... ...........
pacemaker.
33206 C Insertion of heart ......... ......... ......... ........... ...........
pacemaker.
33207 C Insertion of heart ......... ......... ......... ........... ...........
pacemaker.
33208 C Insertion of heart ......... ......... ......... ........... ...........
pacemaker.
33210 C Insertion of heart ......... ......... ......... ........... ...........
electrode.
33211 C Insertion of heart ......... ......... ......... ........... ...........
electrode.
33212 C Insertion of pulse ......... ......... ......... ........... ...........
generator.
33213 C Insertion of pulse ......... ......... ......... ........... ...........
generator.
33214 C Upgrade of pacemaker ......... ......... ......... ........... ...........
system.
33216 C Revision implanted ......... ......... ......... ........... ...........
electrode.
33217 C Insert/revise electrode ......... ......... ......... ........... ...........
[[Page 35304]]
33218 C Repair pacemaker ......... ......... ......... ........... ...........
electrodes.
33220 C Repair pacemaker ......... ......... ......... ........... ...........
electrode.
33222 T Pacemaker aicd pocket.. 360 6.04 $310.58 $138.54 $62.12
33223 T Pacemaker aicd pocket.. 360 6.04 $310.58 $138.54 $62.12
33233 C Removal of pacemaker ......... ......... ......... ........... ...........
system.
33234 C Removal of pacemaker ......... ......... ......... ........... ...........
system.
33235 C Removal pacemaker ......... ......... ......... ........... ...........
electrode.
33236 C Remove electrode/ ......... ......... ......... ........... ...........
thoracotomy.
33237 C Remove electrode/ ......... ......... ......... ........... ...........
thoracotomy.
33238 C Remove electrode/ ......... ......... ......... ........... ...........
thoracotomy.
33240 C Insert/replace pulse ......... ......... ......... ........... ...........
gener.
33241 C Remove pulse generator ......... ......... ......... ........... ...........
only.
33242 C Repair pulse generator/ ......... ......... ......... ........... ...........
leads.
33243 C Remove generator/ ......... ......... ......... ........... ...........
thoracotomy.
33244 C Remove generator....... ......... ......... ......... ........... ...........
33245 C Implant heart ......... ......... ......... ........... ...........
defibrillator.
33246 C Implant heart ......... ......... ......... ........... ...........
defibrillator.
33247 C Insert/replace leads... ......... ......... ......... ........... ...........
33249 C Insert/replace leads/ ......... ......... ......... ........... ...........
gener.
33250 C Ablate heart dysrhythm ......... ......... ......... ........... ...........
focus.
33251 C Ablate heart dysrhythm ......... ......... ......... ........... ...........
focus.
33253 C Reconstruct atria...... ......... ......... ......... ........... ...........
33261 C Ablate heart dysrhythm ......... ......... ......... ........... ...........
focus.
33300 C Repair of heart wound.. ......... ......... ......... ........... ...........
33305 C Repair of heart wound.. ......... ......... ......... ........... ...........
33310 C Exploratory heart ......... ......... ......... ........... ...........
surgery.
33315 C Exploratory heart ......... ......... ......... ........... ...........
surgery.
33320 C Repair major blood ......... ......... ......... ........... ...........
vessel(s).
33321 C Repair major vessel.... ......... ......... ......... ........... ...........
33322 C Repair major blood ......... ......... ......... ........... ...........
vessel(s).
33330 C Insert major vessel ......... ......... ......... ........... ...........
graft.
33332 C Insert major vessel ......... ......... ......... ........... ...........
graft.
33335 C Insert major vessel ......... ......... ......... ........... ...........
graft.
33400 C Repair of aortic valve. ......... ......... ......... ........... ...........
33401 C Valvuloplasty, open.... ......... ......... ......... ........... ...........
33403 C Valvuloplasty, w/cp ......... ......... ......... ........... ...........
bypass.
33404 C Prepare heart-aorta ......... ......... ......... ........... ...........
conduit.
33405 C Replacement of aortic ......... ......... ......... ........... ...........
valve.
33406 C Replacement, aortic ......... ......... ......... ........... ...........
valve.
33411 C Replacement of aortic ......... ......... ......... ........... ...........
valve.
33412 C Replacement of aortic ......... ......... ......... ........... ...........
valve.
33413 C Replacement, aortic ......... ......... ......... ........... ...........
valve.
33414 C Repair, aortic valve... ......... ......... ......... ........... ...........
33415 C Revision, subvalvular ......... ......... ......... ........... ...........
tissue.
33416 C Revise ventricle muscle ......... ......... ......... ........... ...........
33417 C Repair of aortic valve. ......... ......... ......... ........... ...........
33420 C Revision of mitral ......... ......... ......... ........... ...........
valve.
33422 C Revision of mitral ......... ......... ......... ........... ...........
valve.
33425 C Repair of mitral valve. ......... ......... ......... ........... ...........
33426 C Repair of mitral valve. ......... ......... ......... ........... ...........
33427 C Repair of mitral valve. ......... ......... ......... ........... ...........
33430 C Replacement of mitral ......... ......... ......... ........... ...........
valve.
33460 C Revision of tricuspid ......... ......... ......... ........... ...........
valve.
33463 C Valvuloplasty, ......... ......... ......... ........... ...........
tricuspid.
33464 C Valvuloplasty, ......... ......... ......... ........... ...........
tricuspid.
33465 C Replace tricuspid valve ......... ......... ......... ........... ...........
33468 C Revision of tricuspid ......... ......... ......... ........... ...........
valve.
33470 C Revision of pulmonary ......... ......... ......... ........... ...........
valve.
33471 C Valvotomy, pulmonary ......... ......... ......... ........... ...........
valve.
33472 C Revision of pulmonary ......... ......... ......... ........... ...........
valve.
33474 C Revision of pulmonary ......... ......... ......... ........... ...........
valve.
33475 C Replacement, pulmonary ......... ......... ......... ........... ...........
valve.
33476 C Revision of heart ......... ......... ......... ........... ...........
chamber.
33478 C Revision of heart ......... ......... ......... ........... ...........
chamber.
33496 C Repair, prosth valve ......... ......... ......... ........... ...........
clot.
33500 C Repair heart vessel ......... ......... ......... ........... ...........
fistula.
33501 C Repair heart vessel ......... ......... ......... ........... ...........
fistula.
33502 C Coronary artery ......... ......... ......... ........... ...........
correction.
33503 C Coronary artery graft.. ......... ......... ......... ........... ...........
33504 C Coronary artery graft.. ......... ......... ......... ........... ...........
33505 C Repair artery w/tunnel. ......... ......... ......... ........... ...........
33506 C Repair artery, ......... ......... ......... ........... ...........
translocation.
33510 C CABG, vein, single..... ......... ......... ......... ........... ...........
33511 C CABG, vein, two........ ......... ......... ......... ........... ...........
33512 C CABG, vein, three...... ......... ......... ......... ........... ...........
[[Page 35305]]
33513 C CABG, vein, four....... ......... ......... ......... ........... ...........
33514 C CABG, vein, five....... ......... ......... ......... ........... ...........
33516 C CABG, vein, six+....... ......... ......... ......... ........... ...........
33517 C CABG, artery-vein, ......... ......... ......... ........... ...........
single.
33518 C CABG, artery-vein, two. ......... ......... ......... ........... ...........
33519 C CABG, artery-vein, ......... ......... ......... ........... ...........
three.
33521 C CABG, artery-vein, four ......... ......... ......... ........... ...........
33522 C CABG, artery-vein, five ......... ......... ......... ........... ...........
33523 C CABG, artery-vein, six+ ......... ......... ......... ........... ...........
33530 C Coronary artery, bypass/ ......... ......... ......... ........... ...........
reop.
33533 C CABG, arterial, single. ......... ......... ......... ........... ...........
33534 C CABG, arterial, two.... ......... ......... ......... ........... ...........
33535 C CABG, arterial, three.. ......... ......... ......... ........... ...........
33536 C CABG, arterial, four+.. ......... ......... ......... ........... ...........
33542 C Removal of heart lesion ......... ......... ......... ........... ...........
33545 C Repair of heart damage. ......... ......... ......... ........... ...........
33572 C Open coronary ......... ......... ......... ........... ...........
endarterectomy.
33600 C Closure of valve....... ......... ......... ......... ........... ...........
33602 C Closure of valve....... ......... ......... ......... ........... ...........
33606 C Anastomosis/artery- ......... ......... ......... ........... ...........
aorta.
33608 C Repair anomaly w/ ......... ......... ......... ........... ...........
conduit.
33610 C Repair by enlargement.. ......... ......... ......... ........... ...........
33611 C Repair double ventricle ......... ......... ......... ........... ...........
33612 C Repair double ventricle ......... ......... ......... ........... ...........
33615 C Repair (simple fontan). ......... ......... ......... ........... ...........
33617 C Repair by modified ......... ......... ......... ........... ...........
fontan.
33619 C Repair single ventricle ......... ......... ......... ........... ...........
33641 C Repair heart septum ......... ......... ......... ........... ...........
defect.
33645 C Revision of heart veins ......... ......... ......... ........... ...........
33647 C Repair heart septum ......... ......... ......... ........... ...........
defects.
33660 C Repair of heart defects ......... ......... ......... ........... ...........
33665 C Repair of heart defects ......... ......... ......... ........... ...........
33670 C Repair of heart ......... ......... ......... ........... ...........
chambers.
33681 C Repair heart septum ......... ......... ......... ........... ...........
defect.
33684 C Repair heart septum ......... ......... ......... ........... ...........
defect.
33688 C Repair heart septum ......... ......... ......... ........... ...........
defect.
33690 C Reinforce pulmonary ......... ......... ......... ........... ...........
artery.
33692 C Repair of heart defects ......... ......... ......... ........... ...........
33694 C Repair of heart defects ......... ......... ......... ........... ...........
33697 C Repair of heart defects ......... ......... ......... ........... ...........
33702 C Repair of heart defects ......... ......... ......... ........... ...........
33710 C Repair of heart defects ......... ......... ......... ........... ...........
33720 C Repair of heart defect. ......... ......... ......... ........... ...........
33722 C Repair of heart defect. ......... ......... ......... ........... ...........
33730 C Repair heart-vein ......... ......... ......... ........... ...........
defect(s).
33732 C Repair heart-vein ......... ......... ......... ........... ...........
defect.
33735 C Revision of heart ......... ......... ......... ........... ...........
chamber.
33736 C Revision of heart ......... ......... ......... ........... ...........
chamber.
33737 C Revision of heart ......... ......... ......... ........... ...........
chamber.
33750 C Major vessel shunt..... ......... ......... ......... ........... ...........
33755 C Major vessel shunt..... ......... ......... ......... ........... ...........
33762 C Major vessel shunt..... ......... ......... ......... ........... ...........
33764 C Major vessel shunt & ......... ......... ......... ........... ...........
graft.
33766 C Major vessel shunt..... ......... ......... ......... ........... ...........
33767 C Major vessel shunt..... ......... ......... ......... ........... ...........
33770 C Repair great vessels ......... ......... ......... ........... ...........
defect.
33771 C Repair great vessels ......... ......... ......... ........... ...........
defect.
33774 C Repair great vessels ......... ......... ......... ........... ...........
defect.
33775 C Repair great vessels ......... ......... ......... ........... ...........
defect.
33776 C Repair great vessels ......... ......... ......... ........... ...........
defect.
33777 C Repair great vessels ......... ......... ......... ........... ...........
defect.
33778 C Repair great vessels ......... ......... ......... ........... ...........
defect.
33779 C Repair great vessels ......... ......... ......... ........... ...........
defect.
33780 C Repair great vessels ......... ......... ......... ........... ...........
defect.
33781 C Repair great vessels ......... ......... ......... ........... ...........
defect.
33786 C Repair arterial trunk.. ......... ......... ......... ........... ...........
33788 C Revision of pulmonary ......... ......... ......... ........... ...........
artery.
33800 C Aortic suspension...... ......... ......... ......... ........... ...........
33802 C Repair vessel defect... ......... ......... ......... ........... ...........
33803 C Repair vessel defect... ......... ......... ......... ........... ...........
33813 C Repair septal defect... ......... ......... ......... ........... ...........
33814 C Repair septal defect... ......... ......... ......... ........... ...........
33820 C Revise major vessel.... ......... ......... ......... ........... ...........
33822 C Revise major vessel.... ......... ......... ......... ........... ...........
33824 C Revise major vessel.... ......... ......... ......... ........... ...........
[[Page 35306]]
33840 C Remove aorta ......... ......... ......... ........... ...........
constriction.
33845 C Remove aorta ......... ......... ......... ........... ...........
constriction.
33851 C Remove aorta ......... ......... ......... ........... ...........
constriction.
33852 C Repair septal defect... ......... ......... ......... ........... ...........
33853 C Repair septal defect... ......... ......... ......... ........... ...........
33860 C Ascending aorta graft.. ......... ......... ......... ........... ...........
33861 C Ascending aorta graft.. ......... ......... ......... ........... ...........
33863 C Ascending aorta graft.. ......... ......... ......... ........... ...........
33870 C Transverse aortic arch ......... ......... ......... ........... ...........
graft.
33875 C Thoracic aorta graft... ......... ......... ......... ........... ...........
33877 C Thoracoabdominal graft. ......... ......... ......... ........... ...........
33910 C Remove lung artery ......... ......... ......... ........... ...........
emboli.
33915 C Remove lung artery ......... ......... ......... ........... ...........
emboli.
33916 C Surgery of great vessel ......... ......... ......... ........... ...........
33917 C Repair pulmonary artery ......... ......... ......... ........... ...........
33918 C Repair pulmonary ......... ......... ......... ........... ...........
atresia.
33919 C Repair pulmonary ......... ......... ......... ........... ...........
atresia.
33920 C Repair pulmonary ......... ......... ......... ........... ...........
atresia.
33922 C Transect pulmonary ......... ......... ......... ........... ...........
artery.
33924 C Remove pulmonary shunt. ......... ......... ......... ........... ...........
33930 C Removal of donor heart/ ......... ......... ......... ........... ...........
lung.
33935 C Transplantation, heart/ ......... ......... ......... ........... ...........
lung.
33940 C Removal of donor heart. ......... ......... ......... ........... ...........
33945 C Transplantation of ......... ......... ......... ........... ...........
heart.
33960 C External circulation ......... ......... ......... ........... ...........
assist.
33961 C External circulation ......... ......... ......... ........... ...........
assist.
33970 C Aortic circulation ......... ......... ......... ........... ...........
assist.
33971 C Aortic circulation ......... ......... ......... ........... ...........
assist.
33973 C Insert balloon device.. ......... ......... ......... ........... ...........
33974 C Remove intra-aortic ......... ......... ......... ........... ...........
balloon.
33975 C Implant ventricular ......... ......... ......... ........... ...........
device.
33976 C Implant ventricular ......... ......... ......... ........... ...........
device.
33977 C Remove ventricular ......... ......... ......... ........... ...........
device.
33978 C Remove ventricular ......... ......... ......... ........... ...........
device.
33999 T Cardiac surgery 320 3.09 $158.89 $80.91 $31.78
procedure.
34001 C Removal of artery clot. ......... ......... ......... ........... ...........
34051 C Removal of artery clot. ......... ......... ......... ........... ...........
34101 C Removal of artery clot. ......... ......... ......... ........... ...........
34111 C Removal of arm artery ......... ......... ......... ........... ...........
clot.
34151 C Removal of artery clot. ......... ......... ......... ........... ...........
34201 C Removal of artery clot. ......... ......... ......... ........... ...........
34203 C Removal of leg artery ......... ......... ......... ........... ...........
clot.
34401 C Removal of vein clot... ......... ......... ......... ........... ...........
34421 C Removal of vein clot... ......... ......... ......... ........... ...........
34451 C Removal of vein clot... ......... ......... ......... ........... ...........
34471 C Removal of vein clot... ......... ......... ......... ........... ...........
34490 C Removal of vein clot... ......... ......... ......... ........... ...........
34501 C Repair valve, femoral ......... ......... ......... ........... ...........
vein.
34502 C Reconstruct, vena cava. ......... ......... ......... ........... ...........
34510 C Transposition of vein ......... ......... ......... ........... ...........
valve.
34520 C Cross-over vein graft.. ......... ......... ......... ........... ...........
34530 C Leg vein fusion........ ......... ......... ......... ........... ...........
35001 C Repair defect of artery ......... ......... ......... ........... ...........
35002 C Repair artery rupture, ......... ......... ......... ........... ...........
neck.
35005 C Repair defect of artery ......... ......... ......... ........... ...........
35011 C Repair defect of artery ......... ......... ......... ........... ...........
35013 C Repair artery rupture, ......... ......... ......... ........... ...........
arm.
35021 C Repair defect of artery ......... ......... ......... ........... ...........
35022 C Repair artery rupture, ......... ......... ......... ........... ...........
chest.
35045 C Repair defect of arm ......... ......... ......... ........... ...........
artery.
35081 C Repair defect of artery ......... ......... ......... ........... ...........
35082 C Repair artery rupture, ......... ......... ......... ........... ...........
aorta.
35091 C Repair defect of artery ......... ......... ......... ........... ...........
35092 C Repair artery rupture, ......... ......... ......... ........... ...........
aorta.
35102 C Repair defect of artery ......... ......... ......... ........... ...........
35103 C Repair artery rupture, ......... ......... ......... ........... ...........
groin.
35111 C Repair defect of artery ......... ......... ......... ........... ...........
35112 C Repair artery ......... ......... ......... ........... ...........
rupture,spleen.
35121 C Repair defect of artery ......... ......... ......... ........... ...........
35122 C Repair artery rupture, ......... ......... ......... ........... ...........
belly.
35131 C Repair defect of artery ......... ......... ......... ........... ...........
35132 C Repair artery rupture, ......... ......... ......... ........... ...........
groin.
35141 C Repair defect of artery ......... ......... ......... ........... ...........
35142 C Repair artery rupture, ......... ......... ......... ........... ...........
thigh.
35151 C Repair defect of artery ......... ......... ......... ........... ...........
[[Page 35307]]
35152 C Repair artery rupture, ......... ......... ......... ........... ...........
knee.
35161 C Repair defect of artery ......... ......... ......... ........... ...........
35162 C Repair artery rupture.. ......... ......... ......... ........... ...........
35180 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35182 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35184 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35188 T Repair blood vessel 368 22.59 $1,161.58 $647.49 $232.32
lesion.
35189 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35190 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35201 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35206 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35207 T Repair blood vessel 368 22.59 $1,161.58 $647.49 $232.32
lesion.
35211 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35216 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35221 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35226 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35231 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35236 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35241 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35246 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35251 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35256 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35261 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35266 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35271 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35276 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35281 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35286 C Repair blood vessel ......... ......... ......... ........... ...........
lesion.
35301 C Rechanneling of artery. ......... ......... ......... ........... ...........
35311 C Rechanneling of artery. ......... ......... ......... ........... ...........
35321 C Rechanneling of artery. ......... ......... ......... ........... ...........
35331 C Rechanneling of artery. ......... ......... ......... ........... ...........
35341 C Rechanneling of artery. ......... ......... ......... ........... ...........
35351 C Rechanneling of artery. ......... ......... ......... ........... ...........
35355 C Rechanneling of artery. ......... ......... ......... ........... ...........
35361 C Rechanneling of artery. ......... ......... ......... ........... ...........
35363 C Rechanneling of artery. ......... ......... ......... ........... ...........
35371 C Rechanneling of artery. ......... ......... ......... ........... ...........
35372 C Rechanneling of artery. ......... ......... ......... ........... ...........
35381 C Rechanneling of artery. ......... ......... ......... ........... ...........
35390 C Reoperation, carotid ......... ......... ......... ........... ...........
add-on.
35400 C Angioscopy............. ......... ......... ......... ........... ...........
35450 C Repair arterial ......... ......... ......... ........... ...........
blockage.
35452 C Repair arterial ......... ......... ......... ........... ...........
blockage.
35454 C Repair arterial ......... ......... ......... ........... ...........
blockage.
35456 C Repair arterial ......... ......... ......... ........... ...........
blockage.
35458 C Repair arterial ......... ......... ......... ........... ...........
blockage.
35459 C Repair arterial ......... ......... ......... ........... ...........
blockage.
35460 C Repair venous blockage. ......... ......... ......... ........... ...........
35470 C Repair arterial ......... ......... ......... ........... ...........
blockage.
35471 C Repair arterial ......... ......... ......... ........... ...........
blockage.
35472 C Repair arterial ......... ......... ......... ........... ...........
blockage.
35473 C Repair arterial ......... ......... ......... ........... ...........
blockage.
35474 C Repair arterial ......... ......... ......... ........... ...........
blockage.
35475 C Repair arterial ......... ......... ......... ........... ...........
blockage.
35476 C Repair venous blockage. ......... ......... ......... ........... ...........
35480 C Atherectomy, open...... ......... ......... ......... ........... ...........
35481 C Atherectomy, open...... ......... ......... ......... ........... ...........
35482 C Atherectomy, open...... ......... ......... ......... ........... ...........
35483 C Atherectomy, open...... ......... ......... ......... ........... ...........
35484 C Atherectomy, open...... ......... ......... ......... ........... ...........
35485 C Atherectomy, open...... ......... ......... ......... ........... ...........
35490 C Atherectomy, ......... ......... ......... ........... ...........
percutaneous.
35491 C Atherectomy, ......... ......... ......... ........... ...........
percutaneous.
35492 C Atherectomy, ......... ......... ......... ........... ...........
percutaneous.
35493 C Atherectomy, ......... ......... ......... ........... ...........
percutaneous.
35494 C Atherectomy, ......... ......... ......... ........... ...........
percutaneous.
35495 C Atherectomy, ......... ......... ......... ........... ...........
percutaneous.
35501 C Artery bypass graft.... ......... ......... ......... ........... ...........
35506 C Artery bypass graft.... ......... ......... ......... ........... ...........
35507 C Artery bypass graft.... ......... ......... ......... ........... ...........
35508 C Artery bypass graft.... ......... ......... ......... ........... ...........
35509 C Artery bypass graft.... ......... ......... ......... ........... ...........
35511 C Artery bypass graft.... ......... ......... ......... ........... ...........
35515 C Artery bypass graft.... ......... ......... ......... ........... ...........
[[Page 35308]]
35516 C Artery bypass graft.... ......... ......... ......... ........... ...........
35518 C Artery bypass graft.... ......... ......... ......... ........... ...........
35521 C Artery bypass graft.... ......... ......... ......... ........... ...........
35526 C Artery bypass graft.... ......... ......... ......... ........... ...........
35531 C Artery bypass graft.... ......... ......... ......... ........... ...........
35533 C Artery bypass graft.... ......... ......... ......... ........... ...........
35536 C Artery bypass graft.... ......... ......... ......... ........... ...........
35541 C Artery bypass graft.... ......... ......... ......... ........... ...........
35546 C Artery bypass graft.... ......... ......... ......... ........... ...........
35548 C Artery bypass graft.... ......... ......... ......... ........... ...........
35549 C Artery bypass graft.... ......... ......... ......... ........... ...........
35551 C Artery bypass graft.... ......... ......... ......... ........... ...........
35556 C Artery bypass graft.... ......... ......... ......... ........... ...........
35558 C Artery bypass graft.... ......... ......... ......... ........... ...........
35560 C Artery bypass graft.... ......... ......... ......... ........... ...........
35563 C Artery bypass graft.... ......... ......... ......... ........... ...........
35565 C Artery bypass graft.... ......... ......... ......... ........... ...........
35566 C Artery bypass graft.... ......... ......... ......... ........... ...........
35571 C Artery bypass graft.... ......... ......... ......... ........... ...........
35582 C Vein bypass graft...... ......... ......... ......... ........... ...........
35583 C Vein bypass graft...... ......... ......... ......... ........... ...........
35585 C Vein bypass graft...... ......... ......... ......... ........... ...........
35587 C Vein bypass graft...... ......... ......... ......... ........... ...........
35601 C Artery bypass graft.... ......... ......... ......... ........... ...........
35606 C Artery bypass graft.... ......... ......... ......... ........... ...........
35612 C Artery bypass graft.... ......... ......... ......... ........... ...........
35616 C Artery bypass graft.... ......... ......... ......... ........... ...........
35621 C Artery bypass graft.... ......... ......... ......... ........... ...........
35623 C Bypass graft, not vein. ......... ......... ......... ........... ...........
35626 C Artery bypass graft.... ......... ......... ......... ........... ...........
35631 C Artery bypass graft.... ......... ......... ......... ........... ...........
35636 C Artery bypass graft.... ......... ......... ......... ........... ...........
35641 C Artery bypass graft.... ......... ......... ......... ........... ...........
35642 C Artery bypass graft.... ......... ......... ......... ........... ...........
35645 C Artery bypass graft.... ......... ......... ......... ........... ...........
35646 C Artery bypass graft.... ......... ......... ......... ........... ...........
35650 C Artery bypass graft.... ......... ......... ......... ........... ...........
35651 C Artery bypass graft.... ......... ......... ......... ........... ...........
35654 C Artery bypass graft.... ......... ......... ......... ........... ...........
35656 C Artery bypass graft.... ......... ......... ......... ........... ...........
35661 C Artery bypass graft.... ......... ......... ......... ........... ...........
35663 C Artery bypass graft.... ......... ......... ......... ........... ...........
35665 C Artery bypass graft.... ......... ......... ......... ........... ...........
35666 C Artery bypass graft.... ......... ......... ......... ........... ...........
35671 C Artery bypass graft.... ......... ......... ......... ........... ...........
35681 C Composite bypass graft. ......... ......... ......... ........... ...........
35691 C Arterial transposition. ......... ......... ......... ........... ...........
35693 C Arterial transposition. ......... ......... ......... ........... ...........
35694 C Arterial transposition. ......... ......... ......... ........... ...........
35695 C Arterial transposition. ......... ......... ......... ........... ...........
35700 C Reoperation, bypass ......... ......... ......... ........... ...........
graft.
35701 C Exploration, carotid ......... ......... ......... ........... ...........
artery.
35721 C Exploration, femoral ......... ......... ......... ........... ...........
artery.
35741 C Exploration popliteal ......... ......... ......... ........... ...........
artery.
35761 C Exploration of artery/ ......... ......... ......... ........... ...........
vein.
35800 C Explore neck vessels... ......... ......... ......... ........... ...........
35820 C Explore chest vessels.. ......... ......... ......... ........... ...........
35840 C Explore abdominal ......... ......... ......... ........... ...........
vessels.
35860 C Explore limb vessels... ......... ......... ......... ........... ...........
35870 C Repair vessel graft ......... ......... ......... ........... ...........
defect.
35875 T Removal of clot in 368 22.59 $1,161.58 $647.49 $232.32
graft.
35876 T Removal of clot in 368 22.59 $1,161.58 $647.49 $232.32
graft.
35901 C Excision, graft, neck.. ......... ......... ......... ........... ...........
35903 C Excision, graft, ......... ......... ......... ........... ...........
extremity.
35905 C Excision, graft, thorax ......... ......... ......... ........... ...........
35907 C Excision, graft, ......... ......... ......... ........... ...........
abdomen.
36000 N Place needle in vein... ......... ......... ......... ........... ...........
36005 T Injection, venography.. 347 2.57 $132.15 $62.38 $26.43
36010 T Place catheter in vein. 342 2.61 $134.21 $68.70 $26.84
36011 T Place catheter in vein. 342 2.61 $134.21 $68.70 $26.84
36012 T Place catheter in vein. 342 2.61 $134.21 $68.70 $26.84
36013 T Place catheter in 342 2.61 $134.21 $68.70 $26.84
artery.
36014 T Place catheter in 342 2.61 $134.21 $68.70 $26.84
artery.
36015 T Place catheter in 342 2.61 $134.21 $68.70 $26.84
artery.
36100 T Establish access to 342 2.61 $134.21 $68.70 $26.84
artery.
[[Page 35309]]
36120 T Establish access to 342 2.61 $134.21 $68.70 $26.84
artery.
36140 T Establish access to 342 2.61 $134.21 $68.70 $26.84
artery.
36145 N Artery to vein shunt... ......... ......... ......... ........... ...........
36160 T Establish access to 342 2.61 $134.21 $68.70 $26.84
aorta.
36200 T Place catheter in aorta 342 2.61 $134.21 $68.70 $26.84
36215 T Place catheter in 343 8.76 $450.44 $240.24 $90.09
artery.
36216 T Place catheter in 343 8.76 $450.44 $240.24 $90.09
artery.
36217 T Place catheter in 343 8.76 $450.44 $240.24 $90.09
artery.
36218 T Place catheter in 343 8.76 $450.44 $240.24 $90.09
artery.
36245 T Place catheter in 343 8.76 $450.44 $240.24 $90.09
artery.
36246 T Place catheter in 343 8.76 $450.44 $240.24 $90.09
artery.
36247 T Place catheter in 343 8.76 $450.44 $240.24 $90.09
artery.
36248 T Place catheter in 343 8.76 $450.44 $240.24 $90.09
artery.
36260 T Insertion of infusion 368 22.59 $1,161.58 $647.49 $232.32
pump.
36261 T Revision of infusion 360 6.04 $310.58 $138.54 $62.12
pump.
36262 T Removal of infusion 360 6.04 $310.58 $138.54 $62.12
pump.
36299 T Vessel injection 360 6.04 $310.58 $138.54 $62.12
procedure.
36400 N Drawing blood.......... ......... ......... ......... ........... ...........
36405 N Drawing blood.......... ......... ......... ......... ........... ...........
36406 N Drawing blood.......... ......... ......... ......... ........... ...........
36410 T Drawing blood.......... 341 0.09 $4.63 $2.49 $0.93
36415 E Drawing blood.......... ......... ......... ......... ........... ...........
36420 T Establish access to 341 0.09 $4.63 $2.49 $0.93
vein.
36425 T Establish access to 341 0.09 $4.63 $2.49 $0.93
vein.
36430 T Blood transfusion 369 6.33 $325.49 $155.49 $65.10
service.
36440 T Blood transfusion 369 6.33 $325.49 $155.49 $65.10
service.
36450 T Exchange transfusion 369 6.33 $325.49 $155.49 $65.10
service.
36455 T Exchange transfusion 369 6.33 $325.49 $155.49 $65.10
service.
36460 T Transfusion service, 369 6.33 $325.49 $155.49 $65.10
fetal.
36468 T Injection(s); spider 339 0.98 $50.39 $19.66 $10.08
veins.
36469 T Injection(s); spider 339 0.98 $50.39 $19.66 $10.08
veins.
36470 T Injection therapy of 339 0.98 $50.39 $19.66 $10.08
vein.
36471 T Injection therapy of 339 0.98 $50.39 $19.66 $10.08
veins.
36481 T Insertion of catheter, 343 8.76 $450.44 $240.24 $90.09
vein.
36488 T Insertion of catheter, 346 4.63 $238.07 $121.59 $47.61
vein.
36489 T Insertion of catheter, 346 4.63 $238.07 $121.59 $47.61
vein.
36490 T Insertion of catheter, 346 4.63 $238.07 $121.59 $47.61
vein.
36491 T Insertion of catheter, 346 4.63 $238.07 $121.59 $47.61
vein.
36493 T Repositioning of cvc... 346 4.63 $238.07 $121.59 $47.61
36500 T Insertion of catheter, 342 2.61 $134.21 $68.70 $26.84
vein.
36510 C Insertion of catheter, ......... ......... ......... ........... ...........
vein.
36520 T Plasma and/or cell 369 6.33 $325.49 $155.49 $65.10
exchange.
36522 T Photopheresis.......... 369 6.33 $325.49 $155.49 $65.10
36530 T Insertion of infusion 368 22.59 $1,161.58 $647.49 $232.32
pump.
36531 T Revision of infusion 360 6.04 $310.58 $138.54 $62.12
pump.
36532 T Removal of infusion 360 6.04 $310.58 $138.54 $62.12
pump.
36533 T Insertion of access 368 22.59 $1,161.58 $647.49 $232.32
port.
36534 T Revision of access port 360 6.04 $310.58 $138.54 $62.12
36535 T Removal of access port. 360 6.04 $310.58 $138.54 $62.12
36600 N Withdrawal of arterial ......... ......... ......... ........... ...........
blood.
36620 T Insertion catheter, 342 2.61 $134.21 $68.70 $26.84
artery.
36625 T Insertion catheter, 342 2.61 $134.21 $68.70 $6.84
artery.
36640 T Insertion catheter, 346 4.63 $238.07 $121.59 $47.61
artery.
36660 C Insertion catheter, ......... ......... ......... ........... ...........
artery.
36680 X Insert needle, bone 906 1.93 $99.24 $57.18 $19.85
cavity.
36800 T Insertion of cannula... 368 22.59 $1,161.58 $647.49 $232.32
36810 T Insertion of cannula... 368 22.59 $1,161.58 $647.49 $232.32
36815 T Insertion of cannula... 368 22.59 $1,161.58 $647.49 $232.32
36821 T Artery-vein fusion..... 368 22.59 $1,161.58 $647.49 $232.32
36822 C Insertion of cannula(s) ......... ......... ......... ........... ...........
36825 T Artery-vein graft...... 368 22.59 $1,161.58 $647.49 $232.32
36830 T Artery-vein graft...... 368 22.59 $1,161.58 $647.49 $232.32
36832 T Av fistula revision.... 368 22.59 $1,161.58 $647.49 $232.32
36834 C Repair A-V aneurysm.... ......... ......... ......... ........... ...........
36835 T Artery to vein shunt... 368 22.59 $1,161.58 $647.49 $232.32
36860 T External cannula 368 22.59 $1,161.58 $647.49 $232.32
declotting.
36861 T Cannula declotting..... 368 22.59 $1,161.58 $647.49 $232.32
37140 C Revision of circulation ......... ......... ......... ........... ...........
37145 C Revision of circulation ......... ......... ......... ........... ...........
37160 C Revision of circulation ......... ......... ......... ........... ...........
37180 C Revision of circulation ......... ......... ......... ........... ...........
37181 C Splice spleen/kidney ......... ......... ......... ........... ...........
veins.
37195 C Thrombolytic therapy, ......... ......... ......... ........... ...........
stroke.
37200 C Transcatheter biopsy... ......... ......... ......... ........... ...........
37201 C Transcatheter therapy ......... ......... ......... ........... ...........
infuse.
[[Page 35310]]
37202 C Transcatheter therapy ......... ......... ......... ........... ...........
infuse.
37203 T Transcatheter retrieval 360 6.04 $310.58 $138.54 $62.12
37204 C Transcatheter occlusion ......... ......... ......... ........... ...........
37205 C Transcatheter stent.... ......... ......... ......... ........... ...........
37206 C Transcatheter stent add- ......... ......... ......... ........... ...........
on.
37207 C Transcatheter stent.... ......... ......... ......... ........... ...........
37208 C Transcatheter stent add- ......... ......... ......... ........... ...........
on.
37209 C Exchange arterial ......... ......... ......... ........... ...........
catheter.
37250 C Intravascular us....... ......... ......... ......... ........... ...........
37251 C Intravascular us....... ......... ......... ......... ........... ...........
37565 C Ligation of neck vein.. ......... ......... ......... ........... ...........
37600 C Ligation of neck artery ......... ......... ......... ........... ...........
37605 C Ligation of neck artery ......... ......... ......... ........... ...........
37606 C Ligation of neck artery ......... ......... ......... ........... ...........
37607 T Ligation of fistula.... 368 22.59 $1,161.58 $647.49 $232.32
37609 T Temporal artery 162 5.59 $287.44 $125.66 $57.49
procedure.
37615 C Ligation of neck artery ......... ......... ......... ........... ...........
37616 C Ligation of chest ......... ......... ......... ........... ...........
artery.
37617 C Ligation of abdomen ......... ......... ......... ........... ...........
artery.
37618 T Ligation of extremity 367 17.02 $875.17 $441.15 $175.03
artery.
37620 C Revision of major vein. ......... ......... ......... ........... ...........
37650 T Revision of major vein. 367 17.02 $875.17 $441.15 $175.03
37660 C Revision of major vein. ......... ......... ......... ........... ...........
37700 T Revise leg vein........ 367 17.02 $875.17 $441.15 $175.03
37720 T Removal of leg vein.... 367 17.02 $875.17 $441.15 $175.03
37730 T Removal of leg veins... 367 17.02 $875.17 $441.15 $175.03
37735 T Removal of leg veins/ 367 17.02 $875.17 $441.15 $175.03
lesion.
37760 T Revision of leg veins.. 367 17.02 $875.17 $441.15 $175.03
37780 T Revision of leg vein... 367 17.02 $875.17 $441.15 $175.03
37785 T Revise secondary 367 17.02 $875.17 $441.15 $175.03
varicosity.
37788 C Revascularization, ......... ......... ......... ........... ...........
penis.
37790 T Penile venous occlusion 537 28.65 $1,473.18 $872.36 $294.64
37799 T Vascular surgery 162 5.59 $287.44 $125.66 $57.49
procedure.
38100 C Removal of spleen, ......... ......... ......... ........... ...........
total.
38101 C Removal of spleen, ......... ......... ......... ........... ...........
partial.
38102 C Removal of spleen, ......... ......... ......... ........... ...........
total.
38115 C Repair of ruptured ......... ......... ......... ........... ...........
spleen.
38200 T Injection for spleen x- 347 2.57 $132.15 $62.38 $26.43
ray.
38230 T Bone marrow collection. 369 6.33 $325.49 $155.49 $65.10
38231 T Stem cell collection... 369 6.33 $325.49 $155.49 $65.10
38240 C Bone marrow/stem ......... ......... ......... ........... ...........
transplant.
38241 C Bone marrow/stem ......... ......... ......... ........... ...........
transplant.
38300 T Drainage lymph node 132 5.63 $289.49 $132.89 $57.90
lesion.
38305 T Drainage lymph node 132 5.63 $289.49 $132.89 $57.90
lesion.
38308 T Incision of lymph 396 12.98 $667.43 $334.48 $133.49
channels.
38380 C Thoracic duct procedure ......... ......... ......... ........... ...........
38381 C Thoracic duct procedure ......... ......... ......... ........... ...........
38382 C Thoracic duct procedure ......... ......... ......... ........... ...........
38500 T Biopsy/removal,lymph 396 12.98 $667.43 $334.48 $133.49
node(s).
38505 T Needle biopsy, lymph 122 4.59 $236.02 $113.00 $47.20
node(s).
38510 T Biopsy/removal,lymph 396 12.98 $667.43 $334.48 $133.49
node(s).
38520 T Biopsy/removal,lymph 396 12.98 $667.43 $334.48 $133.49
node(s).
38525 T Biopsy/removal,lymph 396 12.98 $667.43 $334.48 $133.49
node(s).
38530 T Biopsy/removal,lymph 396 12.98 $667.43 $334.48 $133.49
node(s).
38542 T Explore deep node(s), 397 19.12 $983.15 $542.17 $196.63
neck.
38550 T Removal neck/armpit 396 12.98 $667.43 $334.48 $133.49
lesion.
38555 T Removal neck/armpit 397 19.12 $983.15 $542.17 $196.63
lesion.
38562 C Removal, pelvic lymph ......... ......... ......... ........... ...........
nodes.
38564 C Removal, abdomen lymph ......... ......... ......... ........... ...........
nodes.
38700 C Removal of lymph nodes, ......... ......... ......... ........... ...........
neck.
38720 C Removal of lymph nodes, ......... ......... ......... ........... ...........
neck.
38724 C Removal of lymph nodes, ......... ......... ......... ........... ...........
neck.
38740 T Remove armpit lymph 397 19.12 $983.15 $542.17 $196.63
nodes.
38745 T Remove armpits lymph 397 19.12 $983.15 $542.17 $196.63
nodes.
38746 C Remove thoracic lymph ......... ......... ......... ........... ...........
nodes.
38747 C Remove abdominal lymph ......... ......... ......... ........... ...........
nodes.
38760 T Remove groin lymph 397 19.12 $983.15 $542.17 $196.63
nodes.
38765 C Remove groin lymph ......... ......... ......... ........... ...........
nodes.
38770 C Remove pelvis lymph ......... ......... ......... ........... ...........
nodes.
38780 C Remove abdomen lymph ......... ......... ......... ........... ...........
nodes.
38790 T Injection for lymphatic 347 2.57 $132.15 $62.38 $26.43
xray.
38794 T Access thoracic lymph 342 2.61 $134.21 $68.70 $26.84
duct.
38999 T Blood/lymph system 132 5.63 $289.49 $132.89 $57.90
procedure.
39000 C Exploration of chest... ......... ......... ......... ........... ...........
39010 C Exploration of chest... ......... ......... ......... ........... ...........
[[Page 35311]]
39200 C Removal chest lesion... ......... ......... ......... ........... ...........
39220 C Removal chest lesion... ......... ......... ......... ........... ...........
39400 C Visualization of chest. ......... ......... ......... ........... ...........
39499 C Chest procedure........ ......... ......... ......... ........... ...........
39501 C Repair diaphragm ......... ......... ......... ........... ...........
laceration.
39502 C Repair paraesophageal ......... ......... ......... ........... ...........
hernia.
39503 C Repair of diaphragm ......... ......... ......... ........... ...........
hernia.
39520 C Repair of diaphragm ......... ......... ......... ........... ...........
hernia.
39530 C Repair of diaphragm ......... ......... ......... ........... ...........
hernia.
39531 C Repair of diaphragm ......... ......... ......... ........... ...........
hernia.
39540 C Repair of diaphragm ......... ......... ......... ........... ...........
hernia.
39541 C Repair of diaphragm ......... ......... ......... ........... ...........
hernia.
39545 C Revision of diaphragm.. ......... ......... ......... ........... ...........
39599 C Diaphragm surgery ......... ......... ......... ........... ...........
procedure.
40490 T Biopsy of lip.......... 311 1.41 $72.50 $20.57 $14.50
40500 T Partial excision of lip 313 15.46 $794.95 $407.70 $158.99
40510 T Partial excision of lip 313 15.46 $794.95 $407.70 $158.99
40520 T Partial excision of lip 313 15.46 $794.95 $407.70 $158.99
40525 T Reconstruct lip with 313 15.46 $794.95 $407.70 $158.99
flap.
40527 T Reconstruct lip with 313 15.46 $794.95 $407.70 $158.99
flap.
40530 T Partial removal of lip. 313 15.46 $794.95 $407.70 $158.99
40650 T Repair lip............. 313 15.46 $794.95 $407.70 $158.99
40652 T Repair lip............. 313 15.46 $794.95 $407.70 $158.99
40654 T Repair lip............. 313 15.46 $794.95 $407.70 $158.99
40700 T Repair cleft lip/nasal. 314 25.15 $1,293.21 $687.72 $258.64
40701 T Repair cleft lip/nasal. 314 25.15 $1,293.21 $687.72 $258.64
40702 T Repair cleft lip/nasal. 314 25.15 $1,293.21 $687.72 $258.64
40720 T Repair cleft lip/nasal. 314 25.15 $1,293.21 $687.72 $258.64
40761 T Repair cleft lip/nasal. 314 25.15 $1,293.21 $687.72 $258.64
40799 T Lip surgery procedure.. 311 1.41 $72.50 $20.57 $14.50
40800 T Drainage of mouth 311 1.41 $72.50 $20.57 $14.50
lesion.
40801 T Drainage of mouth 311 1.41 $72.50 $20.57 $14.50
lesion.
40804 T Removal foreign body, 311 1.41 $72.50 $20.57 $14.50
mouth.
40805 T Removal foreign body, 311 1.41 $72.50 $20.57 $14.50
mouth.
40806 T Incision of lip fold... 311 1.41 $72.50 $20.57 $14.50
40808 T Biopsy of mouth lesion. 311 1.41 $72.50 $20.57 $14.50
40810 T Excision of mouth 311 1.41 $72.50 $20.57 $14.50
lesion.
40812 T Excise/repair mouth 311 1.41 $72.50 $20.57 $14.50
lesion.
40814 T Excise/repair mouth 313 15.46 $794.95 $407.70 $158.99
lesion.
40816 T Excision of mouth 313 15.46 $794.95 $407.70 $158.99
lesion.
40818 T Excise oral mucosa for 313 15.46 $794.95 $407.70 $158.99
graft.
40819 T Excise lip or cheek 313 15.46 $794.95 $407.70 $158.99
fold.
40820 T Treatment of mouth 311 1.41 $72.50 $20.57 $14.50
lesion.
40830 T Repair mouth laceration 312 7.07 $363.54 $170.86 $72.71
40831 T Repair mouth laceration 312 7.07 $363.54 $170.86 $72.71
40840 T Reconstruction of mouth 313 15.46 $794.95 $407.70 $158.99
40842 T Reconstruction of mouth 313 15.46 $794.95 $407.70 $158.99
40843 T Reconstruction of mouth 314 25.15 $1,293.21 $687.72 $258.64
40844 T Reconstruction of mouth 314 25.15 $1,293.21 $687.72 $258.64
40845 T Reconstruction of mouth 314 25.15 $1,293.21 $687.72 $258.64
40899 T Mouth surgery procedure 311 1.41 $72.50 $20.57 $14.50
41000 T Drainage of mouth 311 1.41 $72.50 $20.57 $14.50
lesion.
41005 T Drainage of mouth 311 1.41 $72.50 $20.57 $14.50
lesion.
41006 T Drainage of mouth 313 15.46 $794.95 $407.70 $158.99
lesion.
41007 T Drainage of mouth 313 15.46 $794.95 $407.70 $158.99
lesion.
41008 T Drainage of mouth 313 15.46 $794.95 $407.70 $158.99
lesion.
41009 T Drainage of mouth 313 15.46 $794.95 $407.70 $158.99
lesion.
41010 T Incision of tongue fold 313 15.46 $794.95 $407.70 $158.99
41015 T Drainage of mouth 313 15.46 $794.95 $407.70 $158.99
lesion.
41016 T Drainage of mouth 313 15.46 $794.95 $407.70 $158.99
lesion.
41017 T Drainage of mouth 313 15.46 $794.95 $407.70 $158.99
lesion.
41018 T Drainage of mouth 313 15.46 $794.95 $407.70 $158.99
lesion.
41100 T Biopsy of tongue....... 311 1.41 $72.50 $20.57 $14.50
41105 T Biopsy of tongue....... 311 1.41 $72.50 $20.57 $14.50
41108 T Biopsy of floor of 311 1.41 $72.50 $20.57 $14.50
mouth.
41110 T Excision of tongue 311 1.41 $72.50 $20.57 $14.50
lesion.
41112 T Excision of tongue 313 15.46 $794.95 $407.70 $158.99
lesion.
41113 T Excision of tongue 313 15.46 $794.95 $407.70 $158.99
lesion.
41114 T Excision of tongue 313 15.46 $794.95 $407.70 $158.99
lesion.
41115 T Excision of tongue fold 311 1.41 $72.50 $20.57 $14.50
41116 T Excision of mouth 313 15.46 $794.95 $407.70 $158.99
lesion.
41120 T Partial removal of 313 15.46 $794.95 $407.70 $158.99
tongue.
41130 C Partial removal of ......... ......... ......... ........... ...........
tongue.
41135 C Tongue and neck surgery ......... ......... ......... ........... ...........
41140 C Removal of tongue...... ......... ......... ......... ........... ...........
[[Page 35312]]
41145 C Tongue removal; neck ......... ......... ......... ........... ...........
surgery.
41150 C Tongue, mouth, jaw ......... ......... ......... ........... ...........
surgery.
41153 C Tongue, mouth, neck ......... ......... ......... ........... ...........
surgery.
41155 C Tongue, jaw, & neck ......... ......... ......... ........... ...........
surgery.
41250 T Repair tongue 312 7.07 $363.54 $170.86 $72.71
laceration.
41251 T Repair tongue 312 7.07 $363.54 $170.86 $72.71
laceration.
41252 T Repair tongue 312 7.07 $363.54 $170.86 $72.71
laceration.
41500 T Fixation of tongue..... 312 7.07 $363.54 $170.86 $72.71
41510 T Tongue to lip surgery.. 312 7.07 $363.54 $170.86 $72.71
41520 T Reconstruction, tongue 313 15.46 $794.95 $407.70 $158.99
fold.
41599 T Tongue and mouth 311 1.41 $72.50 $20.57 $14.50
surgery.
41800 T Drainage of gum lesion. 312 7.07 $363.54 $170.86 $72.71
41805 T Removal foreign body, 311 1.41 $72.50 $20.57 $14.50
gum.
41806 T Removal foreign 311 1.41 $72.50 $20.57 $14.50
body,jawbone.
41820 T Excision, gum, each 311 1.41 $72.50 $20.57 $14.50
quadrant.
41821 T Excision of gum flap... 311 1.41 $72.50 $20.57 $14.50
41822 T Excision of gum lesion. 231 11.31 $581.56 $286.79 $116.31
41823 T Excision of gum lesion. 231 11.31 $581.56 $286.79 $116.31
41825 T Excision of gum lesion. 311 1.41 $72.50 $20.57 $14.50
41826 T Excision of gum lesion. 311 1.41 $72.50 $20.57 $14.50
41827 T Excision of gum lesion. 313 15.46 $794.95 $407.70 $158.99
41828 T Excision of gum lesion. 311 1.41 $72.50 $20.57 $14.50
41830 T Removal of gum tissue.. 311 1.41 $72.50 $20.57 $14.50
41850 T Treatment of gum lesion 311 1.41 $72.50 $20.57 $14.50
41870 T Gum graft.............. 311 1.41 $72.50 $20.57 $14.50
41872 T Repair gum............. 311 1.41 $72.50 $20.57 $14.50
41874 T Repair tooth socket.... 311 1.41 $72.50 $20.57 $14.50
41899 T Dental surgery 311 1.41 $72.50 $20.57 $14.50
procedure.
42000 T Drainage mouth roof 311 1.41 $72.50 $20.57 $14.50
lesion.
42100 T Biopsy roof of mouth... 311 1.41 $72.50 $20.57 $14.50
42104 T Excision lesion, mouth 311 1.41 $72.50 $20.57 $14.50
roof.
42106 T Excision lesion, mouth 311 1.41 $72.50 $20.57 $14.50
roof.
42107 T Excision lesion, mouth 313 15.46 $794.95 $407.70 $158.99
roof.
42120 T Remove palate/lesion... 313 15.46 $794.95 $407.70 $158.99
42140 T Excision of uvula...... 311 1.41 $72.50 $20.57 $14.50
42145 C Repair, palate,pharynx/ ......... ......... ......... ........... ...........
uvula.
42160 T Treatment mouth roof 311 1.41 $72.50 $20.57 $14.50
lesion.
42180 T Repair palate.......... 313 15.46 $794.95 $407.70 $158.99
42182 T Repair palate.......... 313 15.46 $794.95 $407.70 $158.99
42200 T Reconstruct cleft 313 15.46 $794.95 $407.70 $158.99
palate.
42205 T Reconstruct cleft 313 15.46 $794.95 $407.70 $158.99
palate.
42210 T Reconstruct cleft 314 25.15 $1,293.21 $687.72 $258.64
palate.
42215 T Reconstruct cleft 313 15.46 $794.95 $407.70 $158.99
palate.
42220 T Reconstruct cleft 313 15.46 $794.95 $407.70 $158.99
palate.
42225 T Reconstruct cleft 314 25.15 $1,293.21 $687.72 $258.64
palate.
42226 T Lengthening of palate.. 314 25.15 $1,293.21 $687.72 $258.64
42227 T Lengthening of palate.. 314 25.15 $1,293.21 $687.72 $258.64
42235 T Repair palate.......... 313 15.46 $794.95 $407.70 $158.99
42260 T Repair nose to lip 313 15.46 $794.95 $407.70 $158.99
fistula.
42280 T Preparation, palate 311 1.41 $72.50 $20.57 $14.50
mold.
42281 T Insertion, palate 311 1.41 $72.50 $20.57 $14.50
prosthesis.
42299 T Palate/uvula surgery... 311 1.41 $72.50 $20.57 $14.50
42300 T Drainage of salivary 312 7.07 $363.54 $170.86 $72.71
gland.
42305 T Drainage of salivary 312 7.07 $363.54 $170.86 $72.71
gland.
42310 T Drainage of salivary 312 7.07 $363.54 $170.86 $72.71
gland.
42320 T Drainage of salivary 312 7.07 $363.54 $170.86 $72.71
gland.
42325 T Create salivary cyst 313 15.46 $794.95 $407.70 $158.99
drain.
42326 T Create salivary cyst 313 15.46 $794.95 $407.70 $158.99
drain.
42330 T Removal of salivary 311 1.41 $72.50 $20.57 $14.50
stone.
42335 T Removal of salivary 311 1.41 $72.50 $20.57 $14.50
stone.
42340 T Removal of salivary 313 15.46 $794.95 $407.70 $158.99
stone.
42400 T Biopsy of salivary 122 4.59 $236.02 $113.00 $47.20
gland.
42405 T Biopsy of salivary 312 7.07 $363.54 $170.86 $72.71
gland.
42408 T Excision of salivary 313 15.46 $794.95 $407.70 $158.99
cyst.
42409 T Drainage of salivary 313 15.46 $794.95 $407.70 $158.99
cyst.
42410 T Excise parotid gland/ 313 15.46 $794.95 $407.70 $158.99
lesion.
42415 T Excise parotid gland/ 314 25.15 $1,293.21 $687.72 $258.64
lesion.
42420 T Excise parotid gland/ 314 25.15 $1,293.21 $687.72 $258.64
lesion.
42425 T Excise parotid gland/ 314 25.15 $1,293.21 $687.72 $258.64
lesion.
42426 C Excise parotid gland/ ......... ......... ......... ........... ...........
lesion.
42440 T Excision submaxillary 313 15.46 $794.95 $407.70 $158.99
gland.
42450 T Excision sublingual 313 15.46 $794.95 $407.70 $158.99
gland.
42500 T Repair salivary duct... 313 15.46 $794.95 $407.70 $158.99
42505 T Repair salivary duct... 313 15.46 $794.95 $407.70 $158.99
42507 T Parotid duct diversion. 313 15.46 $794.95 $407.70 $158.99
[[Page 35313]]
42508 T Parotid duct diversion. 313 15.46 $794.95 $407.70 $158.99
42509 T Parotid duct diversion. 314 25.15 $1,293.21 $687.72 $258.64
42510 T Parotid duct diversion. 313 15.46 $794.95 $407.70 $158.99
42550 T Injection for salivary 347 2.57 $132.15 $62.38 $26.43
x-ray.
42600 T Closure of salivary 313 15.46 $794.95 $407.70 $158.99
fistula.
42650 T Dilation of salivary 311 1.41 $72.50 $20.57 $14.50
duct.
42660 T Dilation of salivary 311 1.41 $72.50 $20.57 $14.50
duct.
42665 T Ligation of salivary 311 1.41 $72.50 $20.57 $14.50
duct.
42699 T Salivary surgery 311 1.41 $72.50 $20.57 $14.50
procedure.
42700 T Drainage of tonsil 312 7.07 $363.54 $170.86 $72.71
abscess.
42720 T Drainage of throat 312 7.07 $363.54 $170.86 $72.71
abscess.
42725 T Drainage of throat 313 15.46 $794.95 $407.70 $158.99
abscess.
42800 T Biopsy of throat....... 312 7.07 $363.54 $170.86 $72.71
42802 T Biopsy of throat....... 312 7.07 $363.54 $170.86 $72.71
42804 T Biopsy of upper nose/ 312 7.07 $363.54 $170.86 $72.71
throat.
42806 T Biopsy of upper nose/ 312 7.07 $363.54 $170.86 $72.71
throat.
42808 T Excise pharynx lesion.. 312 7.07 $363.54 $170.86 $72.71
42809 T Remove pharynx foreign 151 1.63 $83.81 $33.22 $16.76
body.
42810 T Excision of neck cyst.. 313 15.46 $794.95 $407.70 $158.99
42815 T Excision of neck cyst.. 313 15.46 $794.95 $407.70 $158.99
42820 T Remove tonsils and 319 16.20 $833.00 $463.53 $166.60
adenoids.
42821 T Remove tonsils and 319 16.20 $833.00 $463.53 $166.60
adenoids.
42825 T Removal of tonsils..... 319 16.20 $833.00 $463.53 $166.60
42826 T Removal of tonsils..... 319 16.20 $833.00 $463.53 $166.60
42830 T Removal of adenoids.... 319 16.20 $833.00 $463.53 $166.60
42831 T Removal of adenoids.... 319 16.20 $833.00 $463.53 $166.60
42835 T Removal of adenoids.... 319 16.20 $833.00 $463.53 $166.60
42836 T Removal of adenoids.... 319 16.20 $833.00 $463.53 $166.60
42842 T Extensive surgery of 314 25.15 $1,293.21 $687.72 $258.64
throat.
42844 T Extensive surgery of 314 25.15 $1,293.21 $687.72 $258.64
throat.
42845 C Extensive surgery of ......... ......... ......... ........... ...........
throat.
42860 T Excision of tonsil tags 319 16.20 $833.00 $463.53 $166.60
42870 T Excision of lingual 319 16.20 $833.00 $463.53 $166.60
tonsil.
\2\ 4288 C Excise nose/throat ......... ......... ......... ........... ...........
0 lesion.
42890 T Partial removal of 314 25.15 $1,293.21 $687.72 $258.64
pharynx.
42892 T Revision of pharyngeal 314 25.15 $1,293.21 $687.72 $258.64
walls.
42894 C Revision of pharyngeal ......... ......... ......... ........... ...........
walls.
42900 T Repair throat wound.... 313 15.46 $794.95 $407.70 $158.99
42950 T Reconstruction of 313 15.46 $794.95 $407.70 $158.99
throat.
42953 C Repair throat, ......... ......... ......... ........... ...........
esophagus.
42955 T Surgical opening of 313 15.46 $794.95 $407.70 $158.99
throat.
42960 T Control throat bleeding 318 2.07 $106.44 $38.87 $21.29
42961 C Control throat bleeding ......... ......... ......... ........... ...........
42962 T Control throat bleeding 313 15.46 $794.95 $407.70 $158.99
42970 T Control nose/throat 318 2.07 $106.44 $38.87 $21.29
bleeding.
42971 C Control nose/throat ......... ......... ......... ........... ...........
bleeding.
42972 T Control nose/throat 313 15.46 $794.95 $407.70 $158.99
bleeding.
42999 T Throat surgery 318 2.07 $106.44 $38.87 $21.29
procedure.
43020 T Incision of esophagus.. 313 15.46 $794.95 $407.70 $158.99
43030 T Throat muscle surgery.. 313 15.46 $794.95 $407.70 $158.99
43045 C Incision of esophagus.. ......... ......... ......... ........... ...........
43100 C Excision of esophagus ......... ......... ......... ........... ...........
lesion.
43101 C Excision of esophagus ......... ......... ......... ........... ...........
lesion.
43107 C Removal of esophagus... ......... ......... ......... ........... ...........
43108 C Removal of esophagus... ......... ......... ......... ........... ...........
43112 C Removal of esophagus... ......... ......... ......... ........... ...........
43113 C Removal of esophagus... ......... ......... ......... ........... ...........
43116 C Partial removal of ......... ......... ......... ........... ...........
esophagus.
43117 C Partial removal of ......... ......... ......... ........... ...........
esophagus.
43118 C Partial removal of ......... ......... ......... ........... ...........
esophagus.
43121 C Partial removal of ......... ......... ......... ........... ...........
esophagus.
43122 C Parital removal of ......... ......... ......... ........... ...........
esophagus.
43123 C Partial removal of ......... ......... ......... ........... ...........
esophagus.
43124 C Removal of esophagus... ......... ......... ......... ........... ...........
43130 C Removal of esophagus ......... ......... ......... ........... ...........
pouch.
43135 C Removal of esophagus ......... ......... ......... ........... ...........
pouch.
43200 T Esophagus endoscopy.... 417 6.35 $326.52 $179.22 $65.30
43202 T Esophagus endoscopy, 417 6.35 $326.52 $179.22 $65.30
biopsy.
43204 T Esophagus endoscopy & 407 6.89 $354.28 $189.39 $70.86
inject.
43205 T Esophagus endoscopy/ 407 6.89 $354.28 $189.39 $70.86
ligation.
43215 T Esophagus endoscopy.... 407 6.89 $354.28 $189.39 $70.86
43216 T Esophagus endoscopy/ 407 6.89 $354.28 $189.39 $70.86
lesion.
43217 T Esophagus endoscopy.... 407 6.89 $354.28 $189.39 $70.86
43219 T Esophagus endoscopy.... 449 7.63 $392.33 $213.57 $78.47
43220 T Esophagus 407 6.89 $354.28 $189.39 $70.86
endoscopy,dilation.
[[Page 35314]]
43226 T Esophagus 407 6.89 $354.28 $189.39 $70.86
endoscopy,dilation.
43227 T Esophagus endoscopy, 407 6.89 $354.28 $189.39 $70.86
repair.
43228 T Esophagus 449 7.63 $392.33 $213.57 $78.47
endoscopy,ablation.
43234 T Upper GI endoscopy, 417 6.35 $326.52 $179.22 $65.30
exam.
43235 T Upper gi 417 6.35 $326.52 $179.22 $65.30
endoscopy,diagnosis.
43239 T Upper GI endoscopy, 417 6.35 $326.52 $179.22 $65.30
biopsy.
43241 T Upper GI endoscopy with 418 7.44 $382.56 $213.57 $76.51
tube.
43243 T Upper GI endoscopy & 418 7.44 $382.56 $213.57 $76.51
inject..
43244 T Upper GI endoscopy/ 418 7.44 $382.56 $213.57 $76.51
ligation.
43245 T Operative upper GI 418 7.44 $382.56 $213.57 $76.51
endoscopy.
43246 T Place gastrostomy tube. 418 7.44 $382.56 $213.57 $76.51
43247 T Operative upper GI 418 7.44 $382.56 $213.57 $76.51
endoscopy.
43248 T Upper GI endoscopy/ 418 7.44 $382.56 $213.57 $76.51
guidewire.
43249 T Esophagus 418 7.44 $382.56 $213.57 $76.51
endoscopy,dilation.
43250 T Upper GI endoscopy/ 418 7.44 $382.56 $213.57 $76.51
tumor.
43251 T Operative upper GI 418 7.44 $382.56 $213.57 $76.51
endoscopy.
43255 T Operative upper GI 418 7.44 $382.56 $213.57 $76.51
endoscopy.
43258 T Operative upper GI 449 7.63 $392.33 $213.57 $78.47
endoscopy.
43259 T Endoscopic ultrasound 449 7.63 $392.33 $213.57 $78.47
exam.
43260 T Endoscopy,bile duct/ 456 9.61 $494.15 $249.05 $98.83
pancreas.
43261 T Endoscopy,bile duct/ 456 9.61 $494.15 $249.05 $98.83
pancreas.
43262 T Endoscopy,bile duct/ 456 9.61 $494.15 $249.05 $98.83
pancreas.
43263 T Endoscopy,bile duct/ 456 9.61 $494.15 $249.05 $98.83
pancreas.
43264 T Endoscopy,bile duct/ 456 9.61 $494.15 $249.05 $98.83
pancreas.
43265 T Endoscopy,bile duct/ 456 9.61 $494.15 $249.05 $98.83
pancreas.
43267 T Endoscopy,bile duct/ 456 9.61 $494.15 $249.05 $98.83
pancreas.
43268 T Endoscopy,bile duct/ 456 9.61 $494.15 $249.05 $98.83
pancreas.
43269 T Endoscopy,bile duct/ 456 9.61 $494.15 $249.05 $98.83
pancreas.
43271 T Endoscopy,bile duct/ 456 9.61 $494.15 $249.05 $98.83
pancreas.
43272 T Endoscopy,bile duct/ 449 7.63 $392.33 $213.57 $78.47
pancreas.
43300 C Repair of esophagus.... ......... ......... ......... ........... ...........
43305 C Repair esophagus and ......... ......... ......... ........... ...........
fistula.
43310 C Repair of esophagus.... ......... ......... ......... ........... ...........
43312 C Repair esophagus and ......... ......... ......... ........... ...........
fistula.
43320 C Fuse esophagus & ......... ......... ......... ........... ...........
stomach.
43324 C Revise esophagus & ......... ......... ......... ........... ...........
stomach.
43325 C Revise esophagus & ......... ......... ......... ........... ...........
stomach.
43326 C Revise esophagus & ......... ......... ......... ........... ...........
stomach.
43330 C Repair of esophagus.... ......... ......... ......... ........... ...........
43331 C Repair of esophagus.... ......... ......... ......... ........... ...........
43340 C Fuse esophagus & ......... ......... ......... ........... ...........
intestine.
43341 C Fuse esophagus & ......... ......... ......... ........... ...........
intestine.
43350 C Surgical opening, ......... ......... ......... ........... ...........
esophagus.
43351 C Surgical opening, ......... ......... ......... ........... ...........
esophagus.
43352 C Surgical opening, ......... ......... ......... ........... ...........
esophagus.
43360 C Gastrointestinal repair ......... ......... ......... ........... ...........
43361 C Gastrointestinal repair ......... ......... ......... ........... ...........
43400 C Ligate esophagus veins. ......... ......... ......... ........... ...........
43401 C Esophagus surgery for ......... ......... ......... ........... ...........
veins.
43405 C Ligate/staple esophagus ......... ......... ......... ........... ...........
43410 C Repair esophagus wound. ......... ......... ......... ........... ...........
43415 C Repair esophagus wound. ......... ......... ......... ........... ...........
43420 C Repair esophagus ......... ......... ......... ........... ...........
opening.
43425 C Repair esophagus ......... ......... ......... ........... ...........
opening.
43450 T Dilate esophagus....... 406 4.17 $214.42 $106.67 $42.88
43453 T Dilate esophagus....... 406 4.17 $214.42 $106.67 $42.88
43456 T Dilate esophagus....... 406 4.17 $214.42 $106.67 $42.88
43458 T Dilation of esophagus.. 406 4.17 $214.42 $106.67 $42.88
43460 C Pressure treatment ......... ......... ......... ........... ...........
esophagus.
43496 C Free jejunum flap, ......... ......... ......... ........... ...........
microvasc.
43499 T Esophagus surgery 406 4.17 $214.42 $106.67 $42.88
procedure.
43500 C Surgical opening of ......... ......... ......... ........... ...........
stomach.
43501 C Surgical repair of ......... ......... ......... ........... ...........
stomach.
43502 C Surgical repair of ......... ......... ......... ........... ...........
stomach.
43510 C Surgical opening of ......... ......... ......... ........... ...........
stomach.
43520 C Incision of pyloric ......... ......... ......... ........... ...........
muscle.
43600 T Biopsy of stomach...... 417 6.35 $326.52 $179.22 $65.30
43605 C Biopsy of stomach...... ......... ......... ......... ........... ...........
43610 C Excision of stomach ......... ......... ......... ........... ...........
lesion.
43611 C Excision of stomach ......... ......... ......... ........... ...........
lesion.
43620 C Removal of stomach..... ......... ......... ......... ........... ...........
43621 C Removal of stomach..... ......... ......... ......... ........... ...........
43622 C Removal of stomach..... ......... ......... ......... ........... ...........
43631 C Removal of stomach, ......... ......... ......... ........... ...........
partial.
43632 C Removal stomach, ......... ......... ......... ........... ...........
partial.
[[Page 35315]]
43633 C Removal stomach, ......... ......... ......... ........... ...........
partial.
43634 C Removal stomach, ......... ......... ......... ........... ...........
partial.
43635 C Partial removal of ......... ......... ......... ........... ...........
stomach.
43638 C Partial removal of ......... ......... ......... ........... ...........
stomach.
43639 C Removal stomach, ......... ......... ......... ........... ...........
partial.
43640 C Vagotomy & pylorus ......... ......... ......... ........... ...........
repair.
43641 C Vagotomy & pylorus ......... ......... ......... ........... ...........
repair.
43750 T Place gastrostomy tube. 418 7.44 $382.56 $213.57 $76.51
43760 T Change gastrostomy tube 470 2.19 $112.61 $54.92 $22.52
43761 T Reposition gastrostomy 470 2.19 $112.61 $54.92 $22.52
tube.
43800 C Reconstruction of ......... ......... ......... ........... ...........
pylorus.
43810 C Fusion of stomach and ......... ......... ......... ........... ...........
bowel.
43820 C Fusion of stomach and ......... ......... ......... ........... ...........
bowel.
43825 C Fusion of stomach and ......... ......... ......... ........... ...........
bowel.
43830 C Place gastrostomy tube. ......... ......... ......... ........... ...........
43831 C Place gastrostomy tube. ......... ......... ......... ........... ...........
43832 C Place gastrostomy tube. ......... ......... ......... ........... ...........
43840 C Repair of stomach ......... ......... ......... ........... ...........
lesion.
43842 C Gastroplasty for ......... ......... ......... ........... ...........
obesity.
43843 C Gastroplasty for ......... ......... ......... ........... ...........
obesity.
43846 C Gastric bypass for ......... ......... ......... ........... ...........
obesity.
43847 C Gastric bypass for ......... ......... ......... ........... ...........
obesity.
43848 C Revision gastroplasty.. ......... ......... ......... ........... ...........
43850 C Revise stomach-bowel ......... ......... ......... ........... ...........
fusion.
43855 C Revise stomach-bowel ......... ......... ......... ........... ...........
fusion.
43860 C Revise stomach-bowel ......... ......... ......... ........... ...........
fusion.
43865 C Revise stomach-bowel ......... ......... ......... ........... ...........
fusion.
43870 T Repair stomach opening. 182 4.11 $211.34 $92.43 $42.27
43880 C Repair stomach-bowel ......... ......... ......... ........... ...........
fistula.
43999 T Stomach surgery 470 2.19 $112.61 $54.92 $22.52
procedure.
44005 C Freeing of bowel ......... ......... ......... ........... ...........
adhesion.
44010 C Incision of small bowel ......... ......... ......... ........... ...........
44015 C Insert needle catheter, ......... ......... ......... ........... ...........
bowel.
44020 C Exploration of small ......... ......... ......... ........... ...........
bowel.
44021 C Decompress small bowel. ......... ......... ......... ........... ...........
44025 C Incision of large bowel ......... ......... ......... ........... ...........
44050 C Reduce bowel ......... ......... ......... ........... ...........
obstruction.
44055 C Correct malrotation of ......... ......... ......... ........... ...........
bowel.
44100 T Biopsy of bowel........ 417 6.35 $326.52 $179.22 $65.30
44110 C Excision of bowel ......... ......... ......... ........... ...........
lesion(s).
44111 C Excision of bowel ......... ......... ......... ........... ...........
lesion(s).
44120 C Removal of small ......... ......... ......... ........... ...........
intestine.
44121 C Removal of small ......... ......... ......... ........... ...........
intestine.
44125 C Removal of small ......... ......... ......... ........... ...........
intestine.
44130 C Bowel to bowel fusion.. ......... ......... ......... ........... ...........
44139 C Mobilization of colon.. ......... ......... ......... ........... ...........
44140 C Partial removal of ......... ......... ......... ........... ...........
colon.
44141 C Partial removal of ......... ......... ......... ........... ...........
colon.
44143 C Partial removal of ......... ......... ......... ........... ...........
colon.
44144 C Partial removal of ......... ......... ......... ........... ...........
colon.
44145 C Partial removal of ......... ......... ......... ........... ...........
colon.
44146 C Partial removal of ......... ......... ......... ........... ...........
colon.
44147 C Partial removal of ......... ......... ......... ........... ...........
colon.
44150 C Removal of colon....... ......... ......... ......... ........... ...........
44151 C Removal of colon/ ......... ......... ......... ........... ...........
ileostomy.
44152 C Removal of colon/ ......... ......... ......... ........... ...........
ileostomy.
44153 C Removal of colon/ ......... ......... ......... ........... ...........
ileostomy.
44155 C Removal of colon....... ......... ......... ......... ........... ...........
44156 C Removal of colon/ ......... ......... ......... ........... ...........
ileostomy.
44160 C Removal of colon....... ......... ......... ......... ........... ...........
44300 C Open bowel to skin..... ......... ......... ......... ........... ...........
44310 C Ileostomy/jejunostomy.. ......... ......... ......... ........... ...........
44312 T Revision of ileostomy.. 183 11.04 $567.68 $283.18 $113.54
44314 C Revision of ileostomy.. ......... ......... ......... ........... ...........
44316 C Devise bowel pouch..... ......... ......... ......... ........... ...........
44320 C Colostomy.............. ......... ......... ......... ........... ...........
44322 C Colostomy with biopsies ......... ......... ......... ........... ...........
44340 T Revision of colostomy.. 183 11.04 $567.68 $283.18 $113.54
44345 C Revision of colostomy.. ......... ......... ......... ........... ...........
44346 C Revision of colostomy.. ......... ......... ......... ........... ...........
44360 T Small bowel endoscopy.. 419 6.83 $351.20 $164.08 $70.24
44361 T Small bowel 419 6.83 $351.20 $164.08 $70.24
endoscopy,biopsy.
44363 T Small bowel endoscopy.. 419 6.83 $351.20 $164.08 $70.24
44364 T Small bowel endoscopy.. 419 6.83 $351.20 $164.08 $70.24
44365 T Small bowel endoscopy.. 419 6.83 $351.20 $164.08 $70.24
[[Page 35316]]
44366 T Small bowel endoscopy.. 419 6.83 $351.20 $164.08 $70.24
44369 T Small bowel endoscopy.. 449 7.63 $392.33 $213.57 $78.47
44372 T Small bowel endoscopy.. 419 6.83 $351.20 $164.08 $70.24
44373 T Small bowel endoscopy.. 419 6.83 $351.20 $164.08 $70.24
44376 T Small bowel endoscopy.. 419 6.83 $351.20 $164.08 $70.24
44377 T Small bowel endoscopy.. 419 6.83 $351.20 $164.08 $70.24
44378 T Small bowel endoscopy.. 419 6.83 $351.20 $164.08 $70.24
44380 T Small bowel endoscopy.. 426 6.74 $346.57 $185.32 $69.31
44382 T Small bowel endoscopy.. 426 6.74 $346.57 $185.32 $69.31
44385 T Endoscopy of bowel 426 6.74 $346.57 $185.32 $69.31
pouch.
44386 T Endoscopy,bowel pouch, 426 6.74 $346.57 $185.32 $69.31
biopsy.
44388 T Colon endoscopy........ 426 6.74 $346.57 $185.32 $69.31
44389 T Colonoscopy with biopsy 426 6.74 $346.57 $185.32 $69.31
44390 T Colonoscopy for foreign 427 8.09 $415.99 $222.84 $83.20
body.
44391 T Colonoscopy for 427 8.09 $415.99 $222.84 $83.20
bleeding.
44392 T Colonoscopy & 427 8.09 $415.99 $222.84 $83.20
polypectomy.
44393 T Colonoscopy, lesion 449 7.63 $392.33 $213.57 $78.47
removal.
44394 T Colonoscopy w/snare.... 427 8.09 $415.99 $222.84 $83.20
44500 C Intro, gastrointestinal ......... ......... ......... ........... ...........
tube.
44602 C Suture, small intestine ......... ......... ......... ........... ...........
44603 C Suture, small intestine ......... ......... ......... ........... ...........
44604 C Suture, large intestine ......... ......... ......... ........... ...........
44605 C Repair of bowel lesion. ......... ......... ......... ........... ...........
44615 C Intestinal ......... ......... ......... ........... ...........
stricturoplasty.
44620 C Repair bowel opening... ......... ......... ......... ........... ...........
44625 C Repair bowel opening... ......... ......... ......... ........... ...........
44626 C Repair bowel opening... ......... ......... ......... ........... ...........
44640 C Repair bowel-skin ......... ......... ......... ........... ...........
fistula.
44650 C Repair bowel fistula... ......... ......... ......... ........... ...........
44660 C Repair bowel-bladder ......... ......... ......... ........... ...........
fistula.
44661 C Repair bowel-bladder ......... ......... ......... ........... ...........
fistula.
44680 C Surgical revision, ......... ......... ......... ........... ...........
intestine.
44700 C Suspend bowel w/ ......... ......... ......... ........... ...........
prosthesis.
44799 T Intestine surgery 419 6.83 $351.20 $164.08 $70.24
procedure.
44800 C Excision of bowel pouch ......... ......... ......... ........... ...........
44820 C Excision of mesentery ......... ......... ......... ........... ...........
lesion.
44850 C Repair of mesentery.... ......... ......... ......... ........... ...........
44899 C Bowel surgery procedure ......... ......... ......... ........... ...........
44900 C Drain, app abscess, ......... ......... ......... ........... ...........
open.
44901 C Drain, app abscess, ......... ......... ......... ........... ...........
perc.
44950 C Appendectomy........... ......... ......... ......... ........... ...........
44955 C Appendectomy add-on.... ......... ......... ......... ........... ...........
44960 C Appendectomy........... ......... ......... ......... ........... ...........
45000 T Drainage of pelvic 452 4.52 $232.42 $103.06 $46.48
abscess.
45005 T Drainage of rectal 452 4.52 $232.42 $103.06 $46.48
abscess.
45020 T Drainage of rectal 452 4.52 $232.42 $103.06 $46.48
abscess.
45100 T Biopsy of rectum....... 452 4.52 $232.42 $103.06 $46.48
45108 T Removal of anorectal 453 16.26 $836.09 $440.47 $167.22
lesion.
45110 C Removal of rectum...... ......... ......... ......... ........... ...........
45111 C Partial removal of ......... ......... ......... ........... ...........
rectum.
45112 C Removal of rectum...... ......... ......... ......... ........... ...........
45113 C Partial proctectomy.... ......... ......... ......... ........... ...........
45114 C Partial removal of ......... ......... ......... ........... ...........
rectum.
45116 C Partial removal of ......... ......... ......... ........... ...........
rectum.
45119 C Remove, rectum w/ ......... ......... ......... ........... ...........
reservoir.
45120 C Removal of rectum...... ......... ......... ......... ........... ...........
45121 C Removal of rectum and ......... ......... ......... ........... ...........
colon.
45123 C Partial proctectomy.... ......... ......... ......... ........... ...........
45130 C Excision of rectal ......... ......... ......... ........... ...........
prolapse.
45135 C Excision of rectal ......... ......... ......... ........... ...........
prolapse.
45150 T Excision of rectal 453 16.26 $836.09 $440.47 $167.22
stricture.
45160 T Excision of rectal 453 16.26 $836.09 $440.47 $167.22
lesion.
45170 T Excision of rectal 453 16.26 $836.09 $440.47 $167.22
lesion.
45190 T Destruction, rectal 453 16.26 $836.09 $440.47 $167.22
tumor.
45300 T Proctosigmoidoscopy.... 446 2.54 $130.61 $64.86 $26.12
45303 T Proctosigmoidoscopy.... 447 7.06 $363.03 $191.87 $72.61
45305 T Proctosigmoidoscopy; 446 2.54 $130.61 $64.86 $26.12
biopsy.
45307 T Proctosigmoidoscopy.... 447 7.06 $363.03 $191.87 $72.61
45308 T Proctosigmoidoscopy.... 447 7.06 $363.03 $191.87 $72.61
45309 T Proctosigmoidoscopy.... 447 7.06 $363.03 $191.87 $72.61
45315 T Proctosigmoidoscopy.... 447 7.06 $363.03 $191.87 $72.61
45317 T Proctosigmoidoscopy.... 447 7.06 $363.03 $191.87 $72.61
45320 T Proctosigmoidoscopy.... 447 7.06 $363.03 $191.87 $72.61
45321 T Proctosigmoidoscopy.... 447 7.06 $363.03 $191.87 $72.61
45330 T Sigmoidoscopy, 446 2.54 $130.61 $64.86 $26.12
diagnostic.
[[Page 35317]]
45331 T Sigmoidoscopy and 446 2.54 $130.61 $64.86 $26.12
biopsy.
45332 T Sigmoidoscopy.......... 448 5.28 $271.50 $139.22 $54.30
45333 T Sigmoidoscopy & 448 5.28 $271.50 $139.22 $54.30
polypectomy.
45334 T Sigmoidoscopy for 448 5.28 $271.50 $139.22 $54.30
bleeding.
45337 T Sigmoidoscopy, 458 5.28 $271.50 $139.22 $54.30
decompression.
45338 T Sigmoidoscopy.......... 448 5.28 $271.50 $139.22 $54.30
45339 T Sigmoidoscopy.......... 449 7.63 $392.33 $213.57 $78.47
45355 T Surgical colonoscopy... 427 8.09 $415.99 $222.84 $83.20
45378 T Diagnostic colonoscopy. 426 6.74 $346.57 $185.32 $69.31
45379 T Colonoscopy............ 427 8.09 $415.99 $222.84 $83.20
45380 T Colonoscopy and biopsy. 426 6.74 $346.57 $185.32 $69.31
45382 T Colonoscopy,control 427 8.09 $415.99 $222.84 $83.20
bleeding.
45383 T Colonoscopy, lesion 449 7.63 $392.33 $213.57 $78.47
removal.
45384 T Colonoscopy............ 427 8.09 $415.99 $222.84 $83.20
45385 T Colonoscopy, lesion 427 8.09 $415.99 $222.84 $83.20
removal.
45500 T Repair of rectum....... 453 16.26 $836.09 $440.47 $167.22
45505 T Repair of rectum....... 453 16.26 $836.09 $440.47 $167.22
45520 T Treatment of rectal 339 0.98 $50.39 $19.66 $10.08
prolapse.
45540 C Correct rectal prolapse ......... ......... ......... ........... ...........
45541 C Correct rectal prolapse ......... ......... ......... ........... ...........
45550 C Repair rectum;remove ......... ......... ......... ........... ...........
sigmoid.
45560 T Repair of rectocele.... 453 16.26 $836.09 $440.47 $167.22
45562 C Exploration/repair of ......... ......... ......... ........... ...........
rectum.
45563 C Exploration/repair of ......... ......... ......... ........... ...........
rectum.
45800 C Repair rectumbladder ......... ......... ......... ........... ...........
fistula.
45805 C Repair fistula; ......... ......... ......... ........... ...........
colostomy.
45820 C Repair rectourethral ......... ......... ......... ........... ...........
fistula.
45825 C Repair fistula; ......... ......... ......... ........... ...........
colostomy.
45900 T Reduction of rectal 452 4.52 $232.42 $103.06 $46.48
prolapse.
45905 T Dilation of anal 452 4.52 $232.42 $103.06 $46.48
sphincter.
45910 T Dilation of rectal 452 4.52 $232.42 $103.06 $46.48
narrowing.
45915 T Remove rectal 452 4.52 $232.42 $103.06 $46.48
obstruction.
45999 T Rectum surgery 452 4.52 $232.42 $103.06 $46.48
procedure.
46030 T Removal of rectal 452 4.52 $232.42 $103.06 $46.48
marker.
46040 T Incision of rectal 452 4.52 $232.42 $103.06 $46.48
abscess.
46045 T Incision of rectal 453 16.26 $836.09 $440.47 $167.22
abscess.
46050 T Incision of anal 452 4.52 $232.42 $103.06 $46.48
abscess.
46060 T Incision of rectal 453 16.26 $836.09 $440.47 $167.22
abscess.
46070 T Incision of anal septum 451 2.42 $124.44 $53.56 $24.89
46080 T Incision of anal 452 4.52 $232.42 $103.06 $46.48
sphincter.
46083 T Incise external 451 2.42 $124.44 $53.56 $24.89
hemorrhoid.
46200 T Removal of anal fissure 453 16.26 $836.09 $440.47 $167.22
46210 T Removal of anal crypt.. 452 4.52 $232.42 $103.06 $46.48
46211 T Removal of anal crypts. 453 16.26 $836.09 $440.47 $167.22
46220 T Removal of anal tab.... 451 2.42 $124.44 $53.56 $24.89
46221 T Ligation of 451 2.42 $124.44 $53.56 $24.89
hemorrhoid(s).
46230 T Removal of anal tabs... 451 2.42 $124.44 $53.56 $24.89
46250 T Hemorrhoidectomy....... 453 16.26 $836.09 $440.47 $167.22
46255 T Hemorrhoidectomy....... 453 16.26 $836.09 $440.47 $167.22
46257 T Remove hemorrhoids & 453 16.26 $836.09 $440.47 $167.22
fissure.
46258 T Remove hemorrhoids & 453 16.26 $836.09 $440.47 $167.22
fistula.
46260 T Hemorrhoidectomy....... 453 16.26 $836.09 $440.47 $167.22
46261 T Remove hemorrhoids & 453 16.26 $836.09 $440.47 $167.22
fissure.
46262 T Remove hemorrhoids & 453 16.26 $836.09 $440.47 $167.22
fistula.
46270 T Removal of anal fistula 453 16.26 $836.09 $440.47 $167.22
46275 T Removal of anal fistula 453 16.26 $836.09 $440.47 $167.22
46280 T Removal of anal fistula 453 16.26 $836.09 $440.47 $167.22
46285 T Removal of anal fistula 453 16.26 $836.09 $440.47 $167.22
46288 T Repair anal fistula.... 453 16.26 $836.09 $440.47 $167.22
46320 T Removal of hemorrhoid 451 2.42 $124.44 $53.56 $24.89
clot.
46500 T Injection into 451 2.42 $124.44 $53.56 $24.89
hemorrhoids.
46600 N Diagnostic anoscopy.... ......... ......... ......... ........... ...........
46604 N Anoscopy and dilation.. ......... ......... ......... ........... ...........
46606 T Anoscopy and biopsy.... 437 6.54 $336.29 $173.79 $67.26
46608 T Anoscopy;remove foreign 437 6.54 $336.29 $173.79 $67.26
body.
46610 T Anoscopy; remove lesion 437 6.54 $336.29 $173.79 $67.26
46611 T Anoscopy............... 437 6.54 $336.29 $173.79 $67.26
46612 T Anoscopy; remove 437 6.54 $336.29 $173.79 $67.26
lesions.
46614 T Anoscopy; control 437 6.54 $336.29 $173.79 $67.26
bleeding.
46615 T Anoscopy............... 437 6.54 $336.29 $173.79 $67.26
46700 T Repair of anal 453 16.26 $836.09 $440.47 $167.22
stricture.
46705 C Repair of anal ......... ......... ......... ........... ...........
stricture.
46715 C Repair of anovaginal ......... ......... ......... ........... ...........
fistula.
46716 C Repair of anovaginal ......... ......... ......... ........... ...........
fistula.
46730 C Construction of absent ......... ......... ......... ........... ...........
anus.
[[Page 35318]]
46735 C Construction of absent ......... ......... ......... ........... ...........
anus.
46740 C Construction of absent ......... ......... ......... ........... ...........
anus.
46742 C Repair, imperforated ......... ......... ......... ........... ...........
anus.
46744 C Repair, cloacal anomaly ......... ......... ......... ........... ...........
46746 C Repair, cloacal anomaly ......... ......... ......... ........... ...........
46748 C Repair, cloacal anomaly ......... ......... ......... ........... ...........
46750 T Repair of anal 453 16.26 $836.09 $440.47 $167.22
sphincter.
46751 C Repair of anal ......... ......... ......... ........... ...........
sphincter.
46753 T Reconstruction of anus. 453 16.26 $836.09 $440.47 $167.22
46754 T Removal of suture from 452 4.52 $232.42 $103.06 $46.48
anus.
46760 T Repair of anal 453 16.26 $836.09 $440.47 $167.22
sphincter.
46761 T Repair of anal 453 16.26 $836.09 $440.47 $167.22
sphincter.
46762 T Implant artificial 453 16.26 $836.09 $440.47 $167.22
sphincter.
46900 T Destruction, anal 152 10.07 $517.80 $251.54 $103.56
lesion(s).
46910 T Destruction, anal 152 10.07 $517.80 $251.54 $103.56
lesion(s).
46916 T Cryosurgery, anal 152 10.07 $517.80 $251.54 $103.56
lesion(s).
46917 T Laser surgery,anal 152 10.07 $517.80 $251.54 $103.56
lesion(s).
46922 T Excision of anal 152 10.07 $517.80 $251.54 $103.56
lesion(s).
46924 T Destruction, anal 152 10.07 $517.80 $251.54 $103.56
lesion(s).
46934 T Destruction of 451 2.42 $124.44 $53.56 $24.89
hemorrhoids.
46935 T Destruction of 451 2.42 $124.44 $53.56 $24.89
hemorrhoids.
46936 T Destruction of 451 2.42 $124.44 $53.56 $24.89
hemorrhoids.
46937 T Cryotherapy of rectal 453 16.26 $836.09 $440.47 $167.22
lesion.
46938 T Cryotherapy of rectal 453 16.26 $836.09 $440.47 $167.22
lesion.
46940 T Treatment of anal 451 2.42 $124.44 $53.56 $24.89
fissure.
46942 T Treatment of anal 451 2.42 $124.44 $53.56 $24.89
fissure.
46945 T Ligation of hemorrhoids 451 2.42 $124.44 $53.56 $24.89
46946 T Ligation of hemorrhoids 451 2.42 $124.44 $53.56 $24.89
46999 T Anus surgery procedure. 452 4.52 $232.42 $103.06 $46.48
47000 T Needle biopsy of liver. 122 4.59 $236.02 $113.00 $47.20
47001 C Needle biopsy, liver ......... ......... ......... ........... ...........
add-on.
47010 C Open drainage, liver ......... ......... ......... ........... ...........
lesion.
47011 C Percut drain, liver ......... ......... ......... ........... ...........
lesion.
47015 C Inject/aspirate liver ......... ......... ......... ........... ...........
cyst.
47100 C Wedge biopsy of liver.. ......... ......... ......... ........... ...........
47120 C Partial removal of ......... ......... ......... ........... ...........
liver.
47122 C Extensive removal of ......... ......... ......... ........... ...........
liver.
47125 C Partial removal of ......... ......... ......... ........... ...........
liver.
47130 C Partial removal of ......... ......... ......... ........... ...........
liver.
47133 C Removal of donor liver. ......... ......... ......... ........... ...........
47134 C Partial removal, donor ......... ......... ......... ........... ...........
liver.
47135 C Transplantation of ......... ......... ......... ........... ...........
liver.
47136 C Transplantation of ......... ......... ......... ........... ...........
liver.
47300 C Surgery for liver ......... ......... ......... ........... ...........
lesion.
47350 C Repair liver wound..... ......... ......... ......... ........... ...........
47360 C Repair liver wound..... ......... ......... ......... ........... ...........
47361 C Repair liver wound..... ......... ......... ......... ........... ...........
47362 C Repair liver wound..... ......... ......... ......... ........... ...........
47399 T Liver surgery procedure 122 4.59 $236.02 $113.00 $47.20
47400 C Incision of liver duct. ......... ......... ......... ........... ...........
47420 C Incision of bile duct.. ......... ......... ......... ........... ...........
47425 C Incision of bile duct.. ......... ......... ......... ........... ...........
47460 C Incise bile duct ......... ......... ......... ........... ...........
sphincter.
47480 C Incision of gallbladder ......... ......... ......... ........... ...........
47490 C Incision of gallbladder ......... ......... ......... ........... ...........
47500 T Injection for liver x- 347 2.57 $132.15 $62.38 $26.43
rays.
47505 T Injection for liver x- 347 2.57 $132.15 $62.38 $26.43
rays.
47510 T Insert catheter, bile 458 6.81 $350.17 $181.70 $70.03
duct.
47511 T Insert bile duct drain. 458 6.81 $350.17 $181.70 $70.03
47525 T Change bile duct 470 2.19 $112.61 $54.92 $22.52
catheter.
47530 T Revise, reinsert bile 470 2.19 $112.61 $54.92 $22.52
tube.
47550 C Bile duct endoscopy add- ......... ......... ......... ........... ...........
on.
47552 T Biliary endoscopy, thru 458 6.81 $350.17 $181.70 $70.03
skin.
47553 T Biliary endoscopy, thru 458 6.81 $350.17 $181.70 $70.03
skin.
47554 T Biliary endoscopy, thru 458 6.81 $350.17 $181.70 $70.03
skin.
47555 T Biliary endoscopy, thru 458 6.81 $350.17 $181.70 $70.03
skin.
47556 T Biliary endoscopy, thru 458 6.81 $350.17 $181.70 $70.03
skin.
47600 C Removal of gallbladder. ......... ......... ......... ........... ...........
47605 C Removal of gallbladder. ......... ......... ......... ........... ...........
47610 C Removal of gallbladder. ......... ......... ......... ........... ...........
47612 C Removal of gallbladder. ......... ......... ......... ........... ...........
47620 C Removal of gallbladder. ......... ......... ......... ........... ...........
47630 T Remove bile duct stone. 458 6.81 $350.17 $181.70 $70.03
47700 C Exploration of bile ......... ......... ......... ........... ...........
ducts.
47701 C Bile duct revision..... ......... ......... ......... ........... ...........
[[Page 35319]]
47711 C Excision of bile duct ......... ......... ......... ........... ...........
tumor.
47712 C Excision of bile duct ......... ......... ......... ........... ...........
tumor.
47715 C Excision of bile duct ......... ......... ......... ........... ...........
cyst.
47716 C Fusion of bile duct ......... ......... ......... ........... ...........
cyst.
47720 C Fuse gallbladder & ......... ......... ......... ........... ...........
bowel.
47721 C Fuse upper gi ......... ......... ......... ........... ...........
structures.
47740 C Fuse gallbladder & ......... ......... ......... ........... ...........
bowel.
47741 C Fuse gallbladder & ......... ......... ......... ........... ...........
bowel.
47760 C Fuse bile ducts and ......... ......... ......... ........... ...........
bowel.
47765 C Fuse liver ducts & ......... ......... ......... ........... ...........
bowel.
47780 C Fuse bile ducts and ......... ......... ......... ........... ...........
bowel.
47785 C Fuse bile ducts and ......... ......... ......... ........... ...........
bowel.
47800 C Reconstruction of bile ......... ......... ......... ........... ...........
ducts.
47801 C Placement, bile duct ......... ......... ......... ........... ...........
support.
47802 C Fuse liver duct & ......... ......... ......... ........... ...........
intestine.
47900 C Suture bile duct injury ......... ......... ......... ........... ...........
47999 T Bile tract surgery 470 2.19 $112.61 $54.92 $22.52
procedure.
48000 C Drainage of abdomen.... ......... ......... ......... ........... ...........
48001 C Placement of drain, ......... ......... ......... ........... ...........
pancreas.
48005 C Resect/debride pancreas ......... ......... ......... ........... ...........
48020 C Removal of pancreatic ......... ......... ......... ........... ...........
stone.
48100 C Biopsy of pancreas..... ......... ......... ......... ........... ...........
48102 T Needle biopsy, pancreas 122 4.59 $236.02 $113.00 $47.20
48120 C Removal of pancreas ......... ......... ......... ........... ...........
lesion.
48140 C Partial removal of ......... ......... ......... ........... ...........
pancreas.
48145 C Partial removal of ......... ......... ......... ........... ...........
pancreas.
48146 C Pancreatectomy......... ......... ......... ......... ........... ...........
48148 C Removal of pancreatic ......... ......... ......... ........... ...........
duct.
48150 C Partial removal of ......... ......... ......... ........... ...........
pancreas.
48152 C Pancreatectomy......... ......... ......... ......... ........... ...........
48153 C Pancreatectomy......... ......... ......... ......... ........... ...........
48154 C Pancreatectomy......... ......... ......... ......... ........... ...........
48155 C Removal of pancreas.... ......... ......... ......... ........... ...........
48160 E Pancreas removal, ......... ......... ......... ........... ...........
transplant.
48180 C Fuse pancreas and bowel ......... ......... ......... ........... ...........
48400 C Injection, intraop add- ......... ......... ......... ........... ...........
on.
48500 C Surgery of pancreas ......... ......... ......... ........... ...........
cyst.
48510 C Drain pancreatic ......... ......... ......... ........... ...........
pseudocyst.
48511 C Drain pancreatic ......... ......... ......... ........... ...........
pseudocyst.
48520 C Fuse pancreas cyst and ......... ......... ......... ........... ...........
bowel.
48540 C Fuse pancreas cyst and ......... ......... ......... ........... ...........
bowel.
48545 C Pancreatorrhaphy....... ......... ......... ......... ........... ...........
48547 C Duodenal exclusion..... ......... ......... ......... ........... ...........
48550 E Donor pancreatectomy... ......... ......... ......... ........... ...........
48554 E Transplantallograft ......... ......... ......... ........... ...........
pancreas.
48556 C Removal, allograft ......... ......... ......... ........... ...........
pancreas.
48999 T Pancreas surgery 122 4.59 $236.02 $113.00 $47.20
procedure.
49000 C Exploration of abdomen. ......... ......... ......... ........... ...........
49002 C Reopening of abdomen... ......... ......... ......... ........... ...........
49010 C Exploration behind ......... ......... ......... ........... ...........
abdomen.
49020 C Drain abdominal abscess ......... ......... ......... ........... ...........
49021 C Drain abdominal abscess ......... ......... ......... ........... ...........
49040 C Open drainage abdom ......... ......... ......... ........... ...........
abscess.
49041 C Percut drain abdom ......... ......... ......... ........... ...........
abscess.
49060 C Open drain retroper ......... ......... ......... ........... ...........
abscess.
49061 C Percutdrain retroper ......... ......... ......... ........... ...........
abscess.
49062 C Drain to peritoneal ......... ......... ......... ........... ...........
cavity.
49080 T Puncture, peritoneal 320 3.09 $158.89 $80.91 $31.78
cavity.
49081 T Removal of abdominal 320 3.09 $158.89 $80.91 $31.78
fluid.
49085 T Remove abdomen foreign 459 17.85 $917.85 $497.88 $183.57
body.
49180 T Biopsy, abdominal mass. 122 4.59 $236.02 $113.00 $47.20
49200 C Removal of abdominal ......... ......... ......... ........... ...........
lesion.
49201 C Removal of abdominal ......... ......... ......... ........... ...........
lesion.
49215 C Excise sacral spine ......... ......... ......... ........... ...........
tumor.
49220 C Multiple surgery, ......... ......... ......... ........... ...........
abdomen.
49250 T Excision of umbilicus.. 459 17.85 $917.85 $497.88 $183.57
49255 C Removal of omentum..... ......... ......... ......... ........... ...........
49400 T Air injection into 347 2.57 $132.15 $62.38 $26.43
abdomen.
49420 T Insert abdominal drain. 459 17.85 $917.85 $497.88 $183.57
49421 T Insert abdominal drain. 459 17.85 $917.85 $497.88 $183.57
49422 T Remove perm cannula/ 470 2.19 $112.61 $54.92 $22.52
catheter.
49423 T Exchange drainage cath. 459 17.85 $917.85 $497.88 $183.57
49424 T Assess cyst, contrast 347 2.57 $132.15 $62.38 $26.43
inj.
49425 C Insert abdomen-venous ......... ......... ......... ........... ...........
drain.
49426 T Revise abdomen-venous 459 17.85 $917.85 $497.88 $183.57
shunt.
[[Page 35320]]
49427 T Injection, abdominal 347 2.57 $132.15 $62.38 $26.43
shunt.
49428 C Ligation of shunt...... ......... ......... ......... ........... ...........
49429 T Removal of shunt....... 470 2.19 $112.61 $54.92 $22.52
49495 T Repair inguinal hernia, 466 20.67 $1,062.85 $556.64 $212.57
init.
49496 T Repair inguinal hernia, 466 20.67 $1,062.85 $556.64 $212.57
init.
49500 T Repair inguinal hernia. 466 20.67 $1,062.85 $556.64 $212.57
49501 T Repair inguinal hernia, 466 20.67 $1,062.85 $556.64 $212.57
init.
49505 T Repair inguinal hernia. 466 20.67 $1,062.85 $556.64 $212.57
49507 T Repair, inguinal hernia 466 20.67 $1,062.85 $556.64 $212.57
49520 T Rerepair inguinal 466 20.67 $1,062.85 $556.64 $212.57
hernia.
49521 T Repair inguinal hernia, 466 20.67 $1,062.85 $556.64 $212.57
rec.
49525 T Repair inguinal hernia. 466 20.67 $1,062.85 $556.64 $212.57
49540 T Repair lumbar hernia... 466 20.67 $1,062.85 $556.64 $212.57
49550 T Repair femoral hernia.. 466 20.67 $1,062.85 $556.64 $212.57
49553 T Repair femoral hernia, 466 20.67 $1,062.85 $556.64 $212.57
init.
49555 T Repair femoral hernia.. 466 20.67 $1,062.85 $556.64 $212.57
49557 T Repair femoral hernia, 466 20.67 $1,062.85 $556.64 $212.57
recur.
49560 T Repair abdominal hernia 466 20.67 $1,062.85 $556.64 $212.57
49561 T Repair incisional 466 20.67 $1,062.85 $556.64 $212.57
hernia.
49565 T Rerepair abdominal 466 20.67 $1,062.85 $556.64 $212.57
hernia.
49566 T Repair incisional 466 20.67 $1,062.85 $556.64 $212.57
hernia.
49568 T Hernia repair w/mesh... 466 20.67 $1,062.85 $556.64 $212.57
49570 T Repair epigastric 466 20.67 $1,062.85 $556.64 $212.57
hernia.
49572 T Repair, epigastric 466 20.67 $1,062.85 $556.64 $212.57
hernia.
49580 T Repair umbilical hernia 466 20.67 $1,062.85 $556.64 $212.57
49582 T Repair umbilical hernia 466 20.67 $1,062.85 $556.64 $212.57
49585 T Repair umbilical hernia 466 20.67 $1,062.85 $556.64 $212.57
49587 T Repair umbilical hernia 466 20.67 $1,062.85 $556.64 $212.57
49590 T Repair abdominal hernia 466 20.67 $1,062.85 $556.64 $212.57
49600 T Repair umbilical lesion 466 20.67 $1,062.85 $556.64 $212.57
49605 C Repair umbilical lesion ......... ......... ......... ........... ...........
49606 C Repair umbilical lesion ......... ......... ......... ........... ...........
49610 C Repair umbilical lesion ......... ......... ......... ........... ...........
49611 C Repair umbilical lesion ......... ......... ......... ........... ...........
49900 C Repair of abdominal ......... ......... ......... ........... ...........
wall.
49905 C Omental flap........... ......... ......... ......... ........... ...........
49906 C Free omental flap, ......... ......... ......... ........... ...........
microvasc.
49999 T Abdomen surgery 470 2.19 $112.61 $54.92 $22.52
procedure.
50010 C Exploration of kidney.. ......... ......... ......... ........... ...........
50020 C Open drain renal ......... ......... ......... ........... ...........
abscess.
50021 C Percut drain renal ......... ......... ......... ........... ...........
abscess.
50040 C Drainage of kidney..... ......... ......... ......... ........... ...........
50045 C Exploration of kidney.. ......... ......... ......... ........... ...........
50060 C Removal of kidney stone ......... ......... ......... ........... ...........
50065 C Incision of kidney..... ......... ......... ......... ........... ...........
50070 C Incision of kidney..... ......... ......... ......... ........... ...........
50075 C Removal of kidney stone ......... ......... ......... ........... ...........
50080 C Removal of kidney stone ......... ......... ......... ........... ...........
50081 C Removal of kidney stone ......... ......... ......... ........... ...........
50100 C Revise kidney blood ......... ......... ......... ........... ...........
vessels.
50120 C Exploration of kidney.. ......... ......... ......... ........... ...........
50125 C Explore and drain ......... ......... ......... ........... ...........
kidney.
50130 C Removal of kidney stone ......... ......... ......... ........... ...........
50135 C Exploration of kidney.. ......... ......... ......... ........... ...........
50200 T Biopsy of kidney....... 122 4.59 $236.02 $113.00 $47.20
50205 C Biopsy of kidney....... ......... ......... ......... ........... ...........
50220 C Removal of kidney...... ......... ......... ......... ........... ...........
50225 C Removal of kidney...... ......... ......... ......... ........... ...........
50230 C Removal of kidney...... ......... ......... ......... ........... ...........
50234 C Removal of kidney & ......... ......... ......... ........... ...........
ureter.
50236 C Removal of kidney & ......... ......... ......... ........... ...........
ureter.
50240 C Partial removal of ......... ......... ......... ........... ...........
kidney.
50280 C Removal of kidney ......... ......... ......... ........... ...........
lesion.
50290 C Removal of kidney ......... ......... ......... ........... ...........
lesion.
50300 C Removal of donor kidney ......... ......... ......... ........... ...........
50320 C Removal of donor kidney ......... ......... ......... ........... ...........
50340 C Removal of kidney...... ......... ......... ......... ........... ...........
50360 C Transplantation of ......... ......... ......... ........... ...........
kidney.
50365 C Transplantation of ......... ......... ......... ........... ...........
kidney.
50370 C Remove transplanted ......... ......... ......... ........... ...........
kidney.
50380 C Reimplantation of ......... ......... ......... ........... ...........
kidney.
50390 T Drainage of kidney 122 4.59 $236.02 $113.00 $47.20
lesion.
50392 T Insert kidney drain.... 347 2.57 $132.15 $62.38 $26.43
50393 T Insert ureteral tube... 347 2.57 $132.15 $62.38 $26.43
50394 T Injection for kidney x- 347 2.57 $132.15 $62.38 $26.43
ray.
[[Page 35321]]
50395 T Create passage to 347 2.57 $132.15 $62.38 $26.43
kidney.
50396 T Measure kidney pressure 529 2.33 $119.81 $59.66 $23.96
50398 T Change kidney tube..... 521 4.89 $251.44 $110.06 $50.29
50400 C Revision of kidney/ ......... ......... ......... ........... ...........
ureter.
50405 C Revision of kidney/ ......... ......... ......... ........... ...........
ureter.
50500 C Repair of kidney wound. ......... ......... ......... ........... ...........
50520 C Close kidney-skin ......... ......... ......... ........... ...........
fistula.
50525 C Repair renal-abdomen ......... ......... ......... ........... ...........
fistula.
50526 C Repair renal-abdomen ......... ......... ......... ........... ...........
fistula.
50540 C Revision of horseshoe ......... ......... ......... ........... ...........
kidney.
50551 T Kidney endoscopy....... 522 10.15 $521.91 $259.45 $104.38
50553 T Kidney endoscopy....... 522 10.15 $521.91 $259.45 $104.38
50555 T Kidney endoscopy & 522 10.15 $521.91 $259.45 $104.38
biopsy.
50557 T Kidney endoscopy & 522 10.15 $521.91 $259.45 $104.38
treatment.
50559 T Renal endoscopy; 522 10.15 $521.91 $259.45 $104.38
radiotracer.
50561 T Kidney endoscopy & 522 10.15 $521.91 $259.45 $104.38
treatment.
50570 C Kidney endoscopy....... ......... ......... ......... ........... ...........
50572 C Kidney endoscopy....... ......... ......... ......... ........... ...........
50574 C Kidney endoscopy & ......... ......... ......... ........... ...........
biopsy.
50575 C Kidney endoscopy....... ......... ......... ......... ........... ...........
50576 C Kidney endoscopy & ......... ......... ......... ........... ...........
treatment.
50578 C Renal endoscopy; ......... ......... ......... ........... ...........
radiotracer.
50580 C Kidney endoscopy & ......... ......... ......... ........... ...........
treatment.
50590 T Fragmenting of kidney 527 43.48 $2,235.74 $1,372.95 $447.15
stone.
50600 C Exploration of ureter.. ......... ......... ......... ........... ...........
50605 C Insert ureteral support ......... ......... ......... ........... ...........
50610 C Removal of ureter stone ......... ......... ......... ........... ...........
50620 C Removal of ureter stone ......... ......... ......... ........... ...........
50630 C Removal of ureter stone ......... ......... ......... ........... ...........
50650 C Removal of ureter...... ......... ......... ......... ........... ...........
50660 C Removal of ureter...... ......... ......... ......... ........... ...........
50684 T Injection for ureter x- 347 2.57 $132.15 $62.38 $26.43
ray.
50686 T Measure ureter pressure 529 2.33 $119.81 $59.66 $23.96
50688 T Change of ureter tube.. 470 2.19 $112.61 $54.92 $22.52
50690 T Injection for ureter x- 347 2.57 $132.15 $62.38 $26.43
ray.
50700 C Revision of ureter..... ......... ......... ......... ........... ...........
50715 C Release of ureter...... ......... ......... ......... ........... ...........
50722 C Release of ureter...... ......... ......... ......... ........... ...........
50725 C Release/revise ureter.. ......... ......... ......... ........... ...........
50727 C Revise ureter.......... ......... ......... ......... ........... ...........
50728 C Revise ureter.......... ......... ......... ......... ........... ...........
50740 C Fusion of ureter & ......... ......... ......... ........... ...........
kidney.
50750 C Fusion of ureter & ......... ......... ......... ........... ...........
kidney.
50760 C Fusion of ureters...... ......... ......... ......... ........... ...........
50770 C Splicing of ureters.... ......... ......... ......... ........... ...........
50780 C Reimplant ureter in ......... ......... ......... ........... ...........
bladder.
50782 C Reimplant ureter in ......... ......... ......... ........... ...........
bladder.
50783 C Reimplant ureter in ......... ......... ......... ........... ...........
bladder.
50785 C Reimplant ureter in ......... ......... ......... ........... ...........
bladder.
50800 C Implant ureter in bowel ......... ......... ......... ........... ...........
50810 C Fusion of ureter & ......... ......... ......... ........... ...........
bowel.
50815 C Urine shunt to bowel... ......... ......... ......... ........... ...........
50820 C Construct bowel bladder ......... ......... ......... ........... ...........
50825 C Construct bowel bladder ......... ......... ......... ........... ...........
50830 C Revise urine flow...... ......... ......... ......... ........... ...........
50840 C Replace ureter by bowel ......... ......... ......... ........... ...........
50845 C Appendico-vesicostomy.. ......... ......... ......... ........... ...........
50860 C Transplant ureter to ......... ......... ......... ........... ...........
skin.
50900 C Repair of ureter....... ......... ......... ......... ........... ...........
50920 C Closure ureter/skin ......... ......... ......... ........... ...........
fistula.
50930 C Closure ureter/bowel ......... ......... ......... ........... ...........
fistula.
50940 C Release of ureter...... ......... ......... ......... ........... ...........
50951 T Endoscopy of ureter.... 523 16.35 $840.72 $438.89 $168.14
50953 T Endoscopy of ureter.... 523 16.35 $840.72 $438.89 $168.14
50955 T Ureter endoscopy & 523 16.35 $840.72 $438.89 $168.14
biopsy.
50957 T Ureter endoscopy & 523 16.35 $840.72 $438.89 $168.14
treatment.
50959 T Ureter endoscopy & 523 16.35 $840.72 $438.89 $168.14
tracer.
50961 T Ureter endoscopy & 523 16.35 $840.72 $438.89 $168.14
treatment.
50970 C Ureter endoscopy....... ......... ......... ......... ........... ...........
50972 C Ureter endoscopy & ......... ......... ......... ........... ...........
catheter.
50974 C Ureter endoscopy & ......... ......... ......... ........... ...........
biopsy.
50976 C Ureter endoscopy & ......... ......... ......... ........... ...........
treatment.
50978 C Ureter endoscopy & ......... ......... ......... ........... ...........
tracer.
50980 C Ureter endoscopy & ......... ......... ......... ........... ...........
treatment.
51000 T Drainage of bladder.... 530 2.46 $126.49 $53.34 $25.30
[[Page 35322]]
51005 T Drainage of bladder.... 530 2.46 $126.49 $53.34 $25.30
51010 T Drainage of bladder.... 530 2.46 $126.49 $53.34 $25.30
51020 T Incise & treat bladder. 523 16.35 $840.72 $438.89 $168.14
51030 T Incise & treat bladder. 523 16.35 $840.72 $438.89 $168.14
51040 T Incise & drain bladder. 523 16.35 $840.72 $438.89 $168.14
51045 T Incise bladder, drain 523 16.35 $840.72 $438.89 $168.14
ureter.
51050 T Removal of bladder 523 16.35 $840.72 $438.89 $168.14
stone.
51060 C Removal of ureter stone ......... ......... ......... ........... ...........
51065 T Removal of ureter stone 523 16.35 $840.72 $438.89 $168.14
51080 T Drainage of bladder 132 5.63 $289.49 $132.89 $57.90
abscess.
51500 T Removal of bladder cyst 466 20.67 $1,062.85 $556.64 $212.57
51520 T Removal of bladder 523 16.35 $840.72 $438.89 $168.14
lesion.
51525 C Removal of bladder ......... ......... ......... ........... ...........
lesion.
51530 C Removal of bladder ......... ......... ......... ........... ...........
lesion.
51535 C Repair of ureter lesion ......... ......... ......... ........... ...........
51550 C Partial removal of ......... ......... ......... ........... ...........
bladder.
51555 C Partial removal of ......... ......... ......... ........... ...........
bladder.
51565 C Revise bladder & ......... ......... ......... ........... ...........
ureter(s).
51570 C Removal of bladder..... ......... ......... ......... ........... ...........
51575 C Removal of bladder & ......... ......... ......... ........... ...........
nodes.
51580 C Remove bladder; revise ......... ......... ......... ........... ...........
tract.
51585 C Removal of bladder & ......... ......... ......... ........... ...........
nodes.
51590 C Remove bladder; revise ......... ......... ......... ........... ...........
tract.
51595 C Remove bladder; revise ......... ......... ......... ........... ...........
tract.
51596 C Remove bladder, create ......... ......... ......... ........... ...........
pouch.
51597 C Removal of pelvic ......... ......... ......... ........... ...........
structures.
51600 T Injection for bladder x- 347 2.57 $132.15 $62.38 $26.43
ray.
51605 T Preparation for bladder 347 2.57 $132.15 $62.38 $26.43
x-ray.
51610 T Injection for bladder x- 347 2.57 $132.15 $62.38 $26.43
ray.
51700 T Irrigation of bladder.. 530 2.46 $126.49 $53.34 $25.30
51705 T Change of bladder tube. 470 2.19 $112.61 $54.92 $22.52
51710 T Change of bladder tube. 470 2.19 $112.61 $54.92 $22.52
51715 T Endoscopic injection/ 531 18.59 $955.90 $531.55 $191.18
implant.
51720 T Treatment of bladder 530 2.46 $126.49 $53.34 $25.30
lesion.
51725 T Simple cystometrogram.. 529 2.33 $119.81 $59.66 $23.96
51726 T Complex cystometrogram. 529 2.33 $119.81 $59.66 $23.96
51736 T Urine flow measurement. 529 2.33 $119.81 $59.66 $23.96
51741 T Electro-uroflowmetry, 529 2.33 $119.81 $59.66 $23.96
first.
51772 T Urethra pressure 529 2.33 $119.81 $59.66 $23.96
profile.
51784 T Anal/urinary muscle 529 2.33 $119.81 $59.66 $23.96
study.
51785 T Anal/urinary muscle 529 2.33 $119.81 $59.66 $23.96
study.
51792 T Urinary reflex study... 529 2.33 $119.81 $59.66 $23.96
51795 T Urine voiding pressure 529 2.33 $119.81 $59.66 $23.96
study.
51797 T Intraabdominal pressure 529 2.33 $119.81 $59.66 $23.96
test.
51800 C Revision of bladder/ ......... ......... ......... ........... ...........
urethra.
51820 C Revision of urinary ......... ......... ......... ........... ...........
tract.
51840 C Attach bladder/urethra. ......... ......... ......... ........... ...........
51841 C Attach bladder/urethra. ......... ......... ......... ........... ...........
51845 C Repair bladder neck.... ......... ......... ......... ........... ...........
51860 C Repair of bladder wound ......... ......... ......... ........... ...........
51865 C Repair of bladder wound ......... ......... ......... ........... ...........
51880 T Repair of bladder 523 16.35 $840.72 $438.89 $168.14
opening.
51900 C Repair bladder/vagina ......... ......... ......... ........... ...........
lesion.
51920 C Close bladder-uterus ......... ......... ......... ........... ...........
fistula.
51925 C Hysterectomy/bladder ......... ......... ......... ........... ...........
repair.
51940 C Correction of bladder ......... ......... ......... ........... ...........
defect.
51960 C Revision of bladder & ......... ......... ......... ........... ...........
bowel.
51980 C Construct bladder ......... ......... ......... ........... ...........
opening.
52000 T Cystoscopy............. 521 4.89 $251.44 $110.06 $50.29
52005 T Cystoscopy & ureter 522 10.15 $521.91 $259.45 $104.38
catheter.
52007 T Cystoscopy and biopsy.. 522 10.15 $521.91 $259.45 $104.38
52010 T Cystoscopy & duct 522 10.15 $521.91 $259.45 $104.38
catheter.
52204 T Cystoscopy............. 522 10.15 $521.91 $259.45 $104.38
52214 T Cystoscopy and 522 10.15 $521.91 $259.45 $104.38
treatment.
52224 T Cystoscopy and 522 10.15 $521.91 $259.45 $104.38
treatment.
52234 T Cystoscopy and 523 16.35 $840.72 $438.89 $168.14
treatment.
52235 T Cystoscopy and 523 16.35 $840.72 $438.89 $168.14
treatment.
52240 T Cystoscopy and 523 16.35 $840.72 $438.89 $168.14
treatment.
52250 T Cystoscopy & 523 16.35 $840.72 $438.89 $168.14
radiotracer.
52260 T Cystoscopy & treatment. 522 10.15 $521.91 $259.45 $104.38
52265 T Cystoscopy & treatment. 521 4.89 $251.44 $110.06 $50.29
52270 T Cystoscopy & revise 522 10.15 $521.91 $259.45 $104.38
urethra.
52275 T Cystoscopy & revise 522 10.15 $521.91 $259.45 $104.38
urethra.
52276 T Cystoscopy and 522 10.15 $521.91 $259.45 $104.38
treatment.
52277 T Cystoscopy and 523 16.35 $840.72 $438.89 $168.14
treatment.
[[Page 35323]]
52281 T Cystoscopy and 522 10.15 $521.91 $259.45 $104.38
treatment.
52282 T Cystoscopy, implant 523 16.35 $840.72 $438.89 $168.14
stent.
52283 T Cystoscopy and 522 10.15 $521.91 $259.45 $104.38
treatment.
52285 T Cystoscopy and 522 10.15 $521.91 $259.45 $104.38
treatment.
52290 T Cystoscopy and 522 10.15 $521.91 $259.45 $104.38
treatment.
52300 T Cystoscopy and 522 10.15 $521.91 $259.45 $104.38
treatment.
52301 T Cystoscopy and 522 10.15 $521.91 $259.45 $104.38
treatment.
52305 T Cystoscopy and 522 10.15 $521.91 $259.45 $104.38
treatment.
52310 T Cystoscopy and 522 10.15 $521.91 $259.45 $104.38
treatment.
52315 T Cystoscopy and 522 10.15 $521.91 $259.45 $104.38
treatment.
52317 T Remove bladder stone... 523 16.35 $840.72 $438.89 $168.14
52318 T Remove bladder stone... 523 16.35 $840.72 $438.89 $168.14
52320 T Cystoscopy and 523 16.35 $840.72 $438.89 $168.14
treatment.
52325 T Cystoscopy, stone 523 16.35 $840.72 $438.89 $168.14
removal.
52327 T Cystoscopy, inject 522 10.15 $521.91 $259.45 $104.38
material.
52330 T Cystoscopy and 523 16.35 $840.72 $438.89 $168.14
treatment.
52332 T Cystoscopy and 523 16.35 $840.72 $438.89 $168.14
treatment.
52334 T Create passage to 523 16.35 $840.72 $438.89 $168.14
kidney.
52335 T Endoscopy of urinary 523 16.35 $840.72 $438.89 $168.14
tract.
52336 T Cystoscopy, stone 523 16.35 $840.72 $438.89 $168.14
removal.
52337 T Cystoscopy, stone 524 27.20 $1,398.62 $824.90 $279.72
removal.
52338 T Cystoscopy and 523 16.35 $840.72 $438.89 $168.14
treatment.
52339 T Cystoscopy and 523 16.35 $840.72 $438.89 $168.14
treatment.
52340 T Cystoscopy and 523 16.35 $840.72 $438.89 $168.14
treatment.
52450 T Incision of prostate... 523 16.35 $840.72 $438.89 $168.14
52500 T Revision of bladder 523 16.35 $840.72 $438.89 $168.14
neck.
52510 T Dilation prostatic 522 10.15 $521.91 $259.45 $104.38
urethra.
52601 T Prostatectomy (TURP)... 524 27.20 $1,398.62 $824.90 $279.72
52606 T Control postop bleeding 523 16.35 $840.72 $438.89 $168.14
52612 T Prostatectomy, first 524 27.20 $1,398.62 $824.90 $279.72
stage.
52614 T Prostatectomy, second 524 27.20 $1,398.62 $824.90 $279.72
stage.
52620 T Remove residual 524 27.20 $1,398.62 $824.90 $279.72
prostate.
52630 T Remove prostate 524 27.20 $1,398.62 $824.90 $279.72
regrowth.
52640 T Relieve bladder 523 16.35 $840.72 $438.89 $168.14
contracture.
52647 T Laser surgery of 524 27.20 $1,398.62 $824.90 $279.72
prostate.
52648 T Laser surgery of 524 27.20 $1,398.62 $824.90 $279.72
prostate.
52700 T Drainage of prostate 523 16.35 $840.72 $438.89 $168.14
abscess.
53000 T Incision of urethra.... 531 18.59 $955.90 $531.55 $191.18
53010 T Incision of urethra.... 531 18.59 $955.90 $531.55 $191.18
53020 T Incision of urethra.... 531 18.59 $955.90 $531.55 $191.18
53025 T Incision of urethra.... 531 18.59 $955.90 $531.55 $191.18
53040 T Drainage of urethra 531 18.59 $955.90 $531.55 $191.18
abscess.
53060 T Drainage of urethra 531 18.59 $955.90 $531.55 $191.18
abscess.
53080 T Drainage of urinary 531 18.59 $955.90 $531.55 $191.18
leakage.
53085 C Drainage of urinary ......... ......... ......... ........... ...........
leakage.
53200 T Biopsy of urethra...... 531 18.59 $955.90 $531.55 $191.18
53210 T Removal of urethra..... 532 23.02 $1,183.69 $588.50 $236.74
53215 T Removal of urethra..... 532 23.02 $1,183.69 $588.50 $236.74
53220 T Treatment of urethra 532 23.02 $1,183.69 $588.50 $236.74
lesion.
53230 T Removal of urethra 532 23.02 $1,183.69 $588.50 $236.74
lesion.
53235 T Removal of urethra 532 23.02 $1,183.69 $588.50 $236.74
lesion.
53240 T Surgery for urethra 532 23.02 $1,183.69 $588.50 $236.74
pouch.
53250 T Removal of urethra 531 18.59 $955.90 $531.55 $191.18
gland.
53260 T Treatment of urethra 531 18.59 $955.90 $531.55 $191.18
lesion.
53265 T Treatment of urethra 531 18.59 $955.90 $531.55 $191.18
lesion.
53270 T Removal of urethra 531 18.59 $955.90 $531.55 $191.18
gland.
53275 T Repair of urethra 531 18.59 $955.90 $531.55 $191.18
defect.
53400 T Revise urethra, 1st 532 23.02 $1,183.69 $588.50 $236.74
stage.
53405 T Revise urethra, 2nd 532 23.02 $1,183.69 $588.50 $236.74
stage.
53410 T Reconstruction of 532 23.02 $1,183.69 $588.50 $236.74
urethra.
53415 C Reconstruction of ......... ......... ......... ........... ...........
urethra.
53420 T Reconstruct urethra, 532 23.02 $1,183.69 $588.50 $236.74
stage 1.
53425 T Reconstruct urethra, 532 23.02 $1,183.69 $588.50 $236.74
stage 2.
53430 T Reconstruction of 532 23.02 $1,183.69 $588.50 $236.74
urethra.
53440 T Correct bladder 538 48.41 $2,489.24 $1,563.47 $497.85
function.
53442 T Remove perineal 531 18.59 $955.90 $531.55 $191.18
prosthesis.
53443 C Reconstruction of ......... ......... ......... ........... ...........
urethra.
53445 T Correct urine flow 538 48.41 $2,489.24 $1,563.47 $497.85
control.
53447 T Remove artificial 532 23.02 $1,183.69 $588.50 $236.74
sphincter.
53449 T Correct artificial 532 23.02 $1,183.69 $588.50 $236.74
sphincter.
53450 T Revision of urethra.... 532 23.02 $1,183.69 $588.50 $236.74
53460 T Revision of urethra.... 532 23.02 $1,183.69 $588.50 $236.74
53502 T Repair of urethra 531 18.59 $955.90 $531.55 $191.18
injury.
53505 T Repair of urethra 531 18.59 $955.90 $531.55 $191.18
injury.
53510 T Repair of urethra 531 18.59 $955.90 $531.55 $191.18
injury.
[[Page 35324]]
53515 T Repair of urethra 532 23.02 $1,183.69 $588.50 $236.74
injury.
53520 T Repair of urethra 532 23.02 $1,183.69 $588.50 $236.74
defect.
53600 T Dilate urethra 530 2.46 $126.49 $53.34 $25.30
stricture.
53601 T Dilate urethra 530 2.46 $126.49 $53.34 $25.30
stricture.
53605 T Dilate urethra 522 10.15 $521.91 $259.45 $104.38
stricture.
53620 T Dilate urethra 530 2.46 $126.49 $53.34 $25.30
stricture.
53621 T Dilate urethra 530 2.46 $126.49 $53.34 $25.30
stricture.
\2\ 5364 T Relieve bladder 530 2.46 $126.49 $53.34 $25.30
0 retention.
53660 T Dilation of urethra.... 530 2.46 $126.49 $53.34 $25.30
53661 T Dilation of urethra.... 530 2.46 $126.49 $53.34 $25.30
53665 T Dilation of urethra.... 531 18.59 $955.90 $531.55 $191.18
53670 N Insert urinary catheter ......... ......... ......... ........... ...........
53675 T Insert urinary catheter 530 2.46 $126.49 $53.34 $25.30
53850 T Prostatic microwave 524 27.20 $1,398.62 $824.90 $279.72
thermotx.
53852 T Prostatic rf thermotx.. 524 27.20 $1,398.62 $824.90 $279.72
53899 T Urology surgery 530 2.46 $126.49 $53.34 $25.30
procedure.
54000 T Slitting of prepuce.... 531 18.59 $955.90 $531.55 $191.18
54001 T Slitting of prepuce.... 531 18.59 $955.90 $531.55 $191.18
54015 T Drain penis lesion..... 132 5.63 $289.49 $132.89 $57.90
54050 T Destruction, penis 152 10.07 $517.80 $251.54 $103.56
lesion(s).
54055 T Destruction, penis 152 10.07 $517.80 $251.54 $103.56
lesion(s).
54056 T Cryosurgery, penis 152 10.07 $517.80 $251.54 $103.56
lesion(s).
54057 T Laser surg, penis 152 10.07 $517.80 $251.54 $103.56
lesion(s).
54060 T Excision of penis 152 10.07 $517.80 $251.54 $103.56
lesion(s).
54065 T Destruction, penis 152 10.07 $517.80 $251.54 $103.56
lesion(s).
54100 T Biopsy of penis........ 162 5.59 $287.44 $125.66 $57.49
54105 T Biopsy of penis........ 162 5.59 $287.44 $125.66 $57.49
54110 T Treatment of penis 537 28.65 $1,473.18 $872.36 $294.64
lesion.
54111 T Treat penis lesion, 537 28.65 $1,473.18 $872.36 $294.64
graft.
54112 T Treat penis lesion, 537 28.65 $1,473.18 $872.36 $294.64
graft.
54115 T Treatment of penis 132 5.63 $289.49 $132.89 $57.90
lesion.
54120 T Partial removal of 537 28.65 $1,473.18 $872.36 $294.64
penis.
54125 C Removal of penis....... ......... ......... ......... ........... ...........
54130 C Remove penis & nodes... ......... ......... ......... ........... ...........
54135 C Remove penis & nodes... ......... ......... ......... ........... ...........
54150 T Circumcision........... 536 12.89 $662.80 $321.60 $132.56
54152 T Circumcision........... 536 12.89 $662.80 $321.60 $132.56
54160 T Circumcision........... 536 12.89 $662.80 $321.60 $132.56
54161 T Circumcision........... 536 12.89 $662.80 $321.60 $132.56
54200 T Treatment of penis 530 2.46 $126.49 $53.34 $25.30
lesion.
54205 T Treatment of penis 537 28.65 $1,473.18 $872.36 $294.64
lesion.
54220 T Treatment of penis 530 2.46 $126.49 $53.34 $25.30
lesion.
54230 T Prepare penis study.... 347 2.57 $132.15 $62.38 $26.43
54231 T Dynamic cavernosometry. 530 2.46 $126.49 $53.34 $25.30
54235 T Penile injection....... 530 2.46 $126.49 $53.34 $25.30
54240 T Penis study............ 529 2.33 $119.81 $59.66 $23.96
54250 T Penis study............ 529 2.33 $119.81 $59.66 $23.96
54300 T Revision of penis...... 537 28.65 $1,473.18 $872.36 $294.64
54304 T Revision of penis...... 537 28.65 $1,473.18 $872.36 $294.64
54308 T Reconstruction of 537 28.65 $1,473.18 $872.36 $294.64
urethra.
54312 T Reconstruction of 537 28.65 $1,473.18 $872.36 $294.64
urethra.
54316 T Reconstruction of 537 28.65 $1,473.18 $872.36 $294.64
urethra.
54318 T Reconstruction of 537 28.65 $1,473.18 $872.36 $294.64
urethra.
54322 T Reconstruction of 537 28.65 $1,473.18 $872.36 $294.64
urethra.
54324 T Reconstruction of 537 28.65 $1,473.18 $872.36 $294.64
urethra.
54326 T Reconstruction of 537 28.65 $1,473.18 $872.36 $294.64
urethra.
54328 T Revise penis, urethra.. 537 28.65 $1,473.18 $872.36 $294.64
54332 C Revise penis, urethra.. ......... ......... ......... ........... ...........
54336 C Revise penis, urethra.. ......... ......... ......... ........... ...........
54340 T Secondary urethral 537 28.65 $1,473.18 $872.36 $294.64
surgery.
54344 T Secondary urethral 537 28.65 $1,473.18 $872.36 $294.64
surgery.
54348 T Secondary urethral 537 28.65 $1,473.18 $872.36 $294.64
surgery.
54352 T Reconstruct urethra, 537 28.65 $1,473.18 $872.36 $294.64
penis.
54360 T Penis plastic surgery.. 537 28.65 $1,473.18 $872.36 $294.64
54380 T Repair penis........... 537 28.65 $1,473.18 $872.36 $294.64
54385 T Repair penis........... 537 28.65 $1,473.18 $872.36 $294.64
54390 C Repair penis and ......... ......... ......... ........... ...........
bladder.
54400 T Insert semi-rigid 538 48.41 $2,489.24 $1,563.47 $497.85
prosthesis.
54401 T Insert self-contd 538 48.41 $2,489.24 $1,563.47 $497.85
prosthesis.
54402 T Remove penis prosthesis 537 28.65 $1,473.18 $872.36 $294.64
54405 T Insert multi-comp 538 48.41 $2,489.24 $1,563.47 $497.85
prosthesis.
54407 T Remove multi-comp 537 28.65 $1,473.18 $872.36 $294.64
prosthesis.
54409 T Revise penis prosthesis 537 28.65 $1,473.18 $872.36 $294.64
54420 T Revision of penis...... 537 28.65 $1,473.18 $872.36 $294.64
54430 C Revision of penis...... ......... ......... ......... ........... ...........
[[Page 35325]]
54435 T Revision of penis...... 537 28.65 $1,473.18 $872.36 $294.64
54440 T Repair of penis........ 537 28.65 $1,473.18 $872.36 $294.64
54450 T Preputial stretching... 530 2.46 $126.49 $53.34 $25.30
54500 T Biopsy of testis....... 122 4.59 $236.02 $113.00 $47.20
54505 T Biopsy of testis....... 546 16.54 $850.49 $449.51 $170.10
54510 T Removal of testis 546 16.54 $850.49 $449.51 $170.10
lesion.
54520 T Removal of testis...... 546 16.54 $850.49 $449.51 $170.10
54530 T Removal of testis...... 546 16.54 $850.49 $449.51 $170.10
54535 C Extensive testis ......... ......... ......... ........... ...........
surgery.
54550 T Exploration for testis. 546 16.54 $850.49 $449.51 $170.10
54560 C Exploration for testis. ......... ......... ......... ........... ...........
54600 T Reduce testis torsion.. 546 16.54 $850.49 $449.51 $170.10
54620 T Suspension of testis... 546 16.54 $850.49 $449.51 $170.10
54640 T Suspension of testis... 546 16.54 $850.49 $449.51 $170.10
54650 C Orchiopexy (Fowler- ......... ......... ......... ........... ...........
Stephens).
54660 T Revision of testis..... 546 16.54 $850.49 $449.51 $170.10
54670 T Repair testis injury... 546 16.54 $850.49 $449.51 $170.10
54680 T Relocation of 546 16.54 $850.49 $449.51 $170.10
testis(es).
54700 T Drainage of scrotum.... 546 16.54 $850.49 $449.51 $170.10
54800 T Biopsy of epididymis... 122 4.59 $236.02 $113.00 $47.20
54820 T Exploration of 546 16.54 $850.49 $449.51 $170.10
epididymis.
54830 T Remove epididymis 546 16.54 $850.49 $449.51 $170.10
lesion.
54840 T Remove epididymis 546 16.54 $850.49 $449.51 $170.10
lesion.
54860 T Removal of epididymis.. 546 16.54 $850.49 $449.51 $170.10
54861 T Removal of epididymis.. 546 16.54 $850.49 $449.51 $170.10
54900 T Fusion of spermatic 546 16.54 $850.49 $449.51 $170.10
ducts.
54901 T Fusion of spermatic 546 16.54 $850.49 $449.51 $170.10
ducts.
55000 T Drainage of hydrocele.. 121 0.63 $32.39 $21.02 $6.48
55040 T Removal of hydrocele... 466 20.67 $1,062.85 $556.64 $212.57
55041 T Removal of hydroceles.. 466 20.67 $1,062.85 $556.64 $212.57
55060 T Repair of hydrocele.... 546 16.54 $850.49 $449.51 $170.10
55100 T Drainage of scrotum 132 5.63 $289.49 $132.89 $57.90
abscess.
55110 T Explore scrotum........ 546 16.54 $850.49 $449.51 $170.10
55120 T Removal of scrotum 546 16.54 $850.49 $449.51 $170.10
lesion.
55150 T Removal of scrotum..... 546 16.54 $850.49 $449.51 $170.10
55175 T Revision of scrotum.... 546 16.54 $850.49 $449.51 $170.10
55180 T Revision of scrotum.... 546 16.54 $850.49 $449.51 $170.10
55200 T Incision of sperm duct. 546 16.54 $850.49 $449.51 $170.10
55250 T Removal of sperm 546 16.54 $850.49 $449.51 $170.10
duct(s).
55300 T Preparation,sperm duct 347 2.57 $132.15 $62.38 $26.43
x-ray.
55400 T Repair of sperm duct... 546 16.54 $850.49 $449.51 $170.10
55450 T Ligation of sperm duct. 546 16.54 $850.49 $449.51 $170.10
55500 T Removal of hydrocele... 546 16.54 $850.49 $449.51 $170.10
55520 T Removal of sperm cord 546 16.54 $850.49 $449.51 $170.10
lesion.
55530 T Revise spermatic cord 546 16.54 $850.49 $449.51 $170.10
veins.
55535 T Revise spermatic cord 546 16.54 $850.49 $449.51 $170.10
veins.
55540 T Revise hernia & sperm 546 16.54 $850.49 $449.51 $170.10
veins.
55600 C Incise sperm duct pouch ......... ......... ......... ........... ...........
55605 C Incise sperm duct pouch ......... ......... ......... ........... ...........
55650 C Remove sperm duct pouch ......... ......... ......... ........... ...........
55680 T Remove sperm pouch 546 16.54 $850.49 $449.51 $170.10
lesion.
55700 T Biopsy of prostate..... 547 4.39 $225.73 $125.20 $45.15
55705 T Biopsy of prostate..... 547 4.39 $225.73 $125.20 $45.15
55720 T Drainage of prostate 523 16.35 $840.72 $438.89 $168.14
abscess.
55725 T Drainage of prostate 523 16.35 $840.72 $438.89 $168.14
abscess.
55801 C Removal of prostate.... ......... ......... ......... ........... ...........
55810 C Extensive prostate ......... ......... ......... ........... ...........
surgery.
55812 C Extensive prostate ......... ......... ......... ........... ...........
surgery.
55815 C Extensive prostate ......... ......... ......... ........... ...........
surgery.
55821 C Removal of prostate.... ......... ......... ......... ........... ...........
55831 C Removal of prostate.... ......... ......... ......... ........... ...........
55840 C Extensive prostate ......... ......... ......... ........... ...........
surgery.
55842 C Extensive prostate ......... ......... ......... ........... ...........
surgery.
55845 C Extensive prostate ......... ......... ......... ........... ...........
surgery.
55859 T Percut/needle insert, 523 16.35 $840.72 $438.89 $168.14
pros.
55860 C Surgical exposure, ......... ......... ......... ........... ...........
prostate.
55862 C Extensive prostate ......... ......... ......... ........... ...........
surgery.
55865 C Extensive prostate ......... ......... ......... ........... ...........
surgery.
55870 T Electroejaculation..... 568 2.79 $143.46 $55.60 $28.69
55899 T Genital surgery 530 2.46 $126.49 $53.34 $25.30
procedure.
55970 E Sex transformation, M ......... ......... ......... ........... ...........
to F.
55980 E Sex transformation, F ......... ......... ......... ........... ...........
to M.
56300 T Laparoscopy; diagnostic 551 24.61 $1,265.45 $701.73 $253.09
56301 T Laparoscopy; tubal 551 24.61 $1,265.45 $701.73 $253.09
cautery.
56302 T Laparoscopy; tubal 551 24.61 $1,265.45 $701.73 $253.09
block.
[[Page 35326]]
56303 T Laparoscopy; excise 551 24.61 $1,265.45 $701.73 $253.09
lesions.
56304 T Laparoscopy; lysis..... 551 24.61 $1,265.45 $701.73 $253.09
56305 T Laparoscopy; biopsy.... 551 24.61 $1,265.45 $701.73 $253.09
56306 T Laparoscopy; aspiration 551 24.61 $1,265.45 $701.73 $253.09
56307 T Laparoscopy; remove 552 37.09 $1,907.17 $1,053.84 $381.43
adnexa.
56308 C Laparoscopy; ......... ......... ......... ........... ...........
hysterectomy.
56309 T Laparoscopy; remove 552 37.09 $1,907.17 $1,053.84 $381.43
myoma.
56310 C Laparoscopic ......... ......... ......... ........... ...........
enterolysis.
56311 T Laparoscopic lymph node 552 37.09 $1,907.17 $1,053.84 $381.43
biop.
56312 T Laparoscopic 552 37.09 $1,907.17 $1,053.84 $381.43
lymphadenectomy.
56313 T Laparoscopic 552 37.09 $1,907.17 $1,053.84 $381.43
lymphadenectomy.
56314 C Lapar; drain lymphocele ......... ......... ......... ........... ...........
56315 C Laparoscopic ......... ......... ......... ........... ...........
appendectomy.
56316 T Laparoscopic hernia 552 37.09 $1,907.17 $1,053.84 $381.43
repair.
56317 T Laparoscopic hernia 552 37.09 $1,907.17 $1,053.84 $381.43
repair.
56318 T Laparoscopic 552 37.09 $1,907.17 $1,053.84 $381.43
orchiectomy.
56320 T Laparoscopy, spermatic 552 37.09 $1,907.17 $1,053.84 $381.43
veins.
56322 C Laparoscopy, vagus ......... ......... ......... ........... ...........
nerves.
56323 C Laparoscopy, vagus ......... ......... ......... ........... ...........
nerves.
56324 C Laparoscopy, ......... ......... ......... ........... ...........
cholecystoenter.
56340 C Laparoscopic ......... ......... ......... ........... ...........
cholecystectomy.
56341 C Laparoscopic ......... ......... ......... ........... ...........
cholecystectomy.
56342 C Laparoscopic ......... ......... ......... ........... ...........
cholecystectomy.
56343 T Laparoscopic 552 37.09 $1,907.17 $1,053.84 $381.43
salpingostomy.
56344 T Laparoscopic 552 37.09 $1,907.17 $1,053.84 $381.43
fimbrioplasty.
56345 C Laparoscopic ......... ......... ......... ........... ...........
splenectomy.
56346 T Laparoscopic 551 24.61 $1,265.45 $701.73 $253.09
gastrostomy.
56347 C Laparoscopic ......... ......... ......... ........... ...........
jejunostomy.
56348 C Laparo; resect ......... ......... ......... ........... ...........
intestine.
56349 C Laparoscopy; ......... ......... ......... ........... ...........
fundoplasty.
56350 T Hysteroscopy; 562 12.30 $632.47 $325.44 $126.49
diagnostic.
56351 T Hysteroscopy; biopsy... 550 16.46 $846.37 $445.22 $169.27
56352 T Hysteroscopy; lysis.... 550 16.46 $846.37 $445.22 $169.27
56353 T Hysteroscopy; resect 550 16.46 $846.37 $445.22 $169.27
septum.
56354 T Hysteroscopy; remove 550 16.46 $846.37 $445.22 $169.27
myoma.
56355 T Hysteroscopy; remove 550 16.46 $846.37 $445.22 $169.27
impact.
56356 T Hysteroscopy; ablation. 550 16.46 $846.37 $445.22 $169.27
\2\ 5636 T Peritoneoscopy......... 551 24.61 $1,265.45 $701.73 $253.09
0
\2\ 5636 T Peritoneoscopy w/biopsy 551 24.61 $1,265.45 $701.73 $253.09
1
56362 T Laparoscopy w/cholangio 552 37.09 $1,907.17 $1,053.84 $381.43
56363 T Laparoscopy w/biopsy... 552 37.09 $1,907.17 $1,053.84 $381.43
56399 T Laparoscopy procedure.. 562 12.30 $632.47 $325.44 $126.49
56405 T I & D of vulva/perineum 561 1.46 $75.07 $24.41 $15.01
56420 T Drainage of gland 561 1.46 $75.07 $24.41 $15.01
abscess.
56440 T Surgery for vulva 562 12.30 $632.47 $325.44 $126.49
lesion.
56441 T Lysis of labial 561 1.46 $75.07 $24.41 $15.01
lesion(s).
56501 T Destruction, vulva 152 10.07 $517.80 $251.54 $103.56
lesion(s).
56515 T Destruction, vulva 152 10.07 $517.80 $251.54 $103.56
lesion(s).
56605 T Biopsy of vulva/ 161 3.43 $176.37 $75.71 $35.27
perineum.
56606 T Biopsy of vulva/ 161 3.43 $176.37 $75.71 $35.27
perineum.
56620 T Partial removal of 563 16.50 $848.43 $461.72 $169.69
vulva.
56625 T Complete removal of 563 16.50 $848.43 $461.72 $169.69
vulva.
56630 C Extensive vulva surgery ......... ......... ......... ........... ...........
56631 C Extensive vulva surgery ......... ......... ......... ........... ...........
56632 C Extensive vulva surgery ......... ......... ......... ........... ...........
56633 C Extensive vulva surgery ......... ......... ......... ........... ...........
56634 C Extensive vulva surgery ......... ......... ......... ........... ...........
56637 C Extensive vulva surgery ......... ......... ......... ........... ...........
56640 C Extensive vulva surgery ......... ......... ......... ........... ...........
56700 T Partial removal of 562 12.30 $632.47 $325.44 $126.49
hymen.
56720 T Incision of hymen...... 562 12.30 $632.47 $325.44 $126.49
56740 T Remove vagina gland 562 12.30 $632.47 $325.44 $126.49
lesion.
56800 T Repair of vagina....... 562 12.30 $632.47 $325.44 $126.49
56805 C Repair clitoris........ ......... ......... ......... ........... ...........
56810 T Repair of perineum..... 562 12.30 $632.47 $325.44 $126.49
57000 T Exploration of vagina.. 562 12.30 $632.47 $325.44 $126.49
57010 T Drainage of pelvic 562 12.30 $632.47 $325.44 $126.49
abscess.
57020 T Drainage of pelvic 562 12.30 $632.47 $325.44 $126.49
fluid.
57061 T Destruction vagina 561 1.46 $75.07 $24.41 $15.01
lesion(s).
57065 T Destruction vagina 562 12.30 $632.47 $325.44 $126.49
lesion(s).
57100 T Biopsy of vagina....... 561 1.46 $75.07 $24.41 $15.01
57105 T Biopsy of vagina....... 562 12.30 $632.47 $325.44 $126.49
\2\ 5710 C Partial removal of ......... ......... ......... ........... ...........
8 vagina.
57110 C Remove vagina wall, ......... ......... ......... ........... ...........
complete.
57120 C Closure of vagina...... ......... ......... ......... ........... ...........
[[Page 35327]]
57130 T Remove vagina lesion... 562 12.30 $632.47 $325.44 $126.49
57135 T Remove vagina lesion... 562 12.30 $632.47 $325.44 $126.49
57150 T Treat vagina infection. 561 1.46 $75.07 $24.41 $15.01
57160 T Insertion of pessary/ 561 1.46 $75.07 $24.41 $15.01
device.
57170 T Fitting of diaphragm/ 561 1.46 $75.07 $24.41 $15.01
cap.
57180 T Treat vaginal bleeding. 561 1.46 $75.07 $24.41 $15.01
57200 T Repair of vagina....... 562 12.30 $632.47 $325.44 $126.49
57210 T Repair vagina/perineum. 562 12.30 $632.47 $325.44 $126.49
57220 T Revision of urethra.... 563 16.50 $848.43 $461.72 $169.69
57230 T Repair of urethral 562 12.30 $632.47 $325.44 $126.49
lesion.
57240 T Repair bladder & vagina 563 16.50 $848.43 $461.72 $169.69
57250 T Repair rectum & vagina. 563 16.50 $848.43 $461.72 $169.69
57260 T Repair of vagina....... 563 16.50 $848.43 $461.72 $169.69
57265 T Extensive repair of 563 16.50 $848.43 $461.72 $169.69
vagina.
57268 T Repair of bowel bulge.. 563 16.50 $848.43 $461.72 $169.69
57270 C Repair of bowel pouch.. ......... ......... ......... ........... ...........
57280 C Suspension of vagina... ......... ......... ......... ........... ...........
57282 C Repair of vaginal ......... ......... ......... ........... ...........
prolapse.
57284 T Repair paravaginal 563 16.50 $848.43 $461.72 $169.69
defect.
57288 T Repair bladder defect.. 563 16.50 $848.43 $461.72 $169.69
57289 T Repair bladder & vagina 563 16.50 $848.43 $461.72 $169.69
57291 T Construction of vagina. 563 16.50 $848.43 $461.72 $169.69
57292 C Construct vagina with ......... ......... ......... ........... ...........
graft.
57300 T Repair rectum-vagina 563 16.50 $848.43 $461.72 $169.69
fistula.
57305 C Repair rectum-vagina ......... ......... ......... ........... ...........
fistula.
57307 C Fistula repair & ......... ......... ......... ........... ...........
colostomy.
57308 C Fistula repair, ......... ......... ......... ........... ...........
transperine.
57310 C Repair urethrovaginal ......... ......... ......... ........... ...........
lesion.
57311 C Repair urethrovaginal ......... ......... ......... ........... ...........
lesion.
57320 C Repair bladder-vagina ......... ......... ......... ........... ...........
lesion.
57330 C Repair bladder-vagina ......... ......... ......... ........... ...........
lesion.
57335 C Repair vagina.......... ......... ......... ......... ........... ...........
57400 T Dilation of vagina..... 562 12.30 $632.47 $325.44 $126.49
57410 T Pelvic examination..... 562 12.30 $632.47 $325.44 $126.49
57415 T Removal vaginal foreign 562 12.30 $632.47 $325.44 $126.49
body.
57452 T Examination of vagina.. 561 1.46 $75.07 $24.41 $15.01
57454 T Vagina examination & 561 1.46 $75.07 $24.41 $15.01
biopsy.
57460 T Cervix excision........ 562 12.30 $632.47 $325.44 $126.49
57500 T Biopsy of cervix....... 561 1.46 $75.07 $24.41 $15.01
57505 T Endocervical curettage. 561 1.46 $75.07 $24.41 $15.01
57510 T Cauterization of cervix 561 1.46 $75.07 $24.41 $15.01
57511 T Cryocautery of cervix.. 561 1.46 $75.07 $24.41 $15.01
57513 T Laser surgery of cervix 561 1.46 $75.07 $24.41 $15.01
57520 T Conization of cervix... 563 16.50 $848.43 $461.72 $169.69
57522 T Conization of cervix... 563 16.50 $848.43 $461.72 $169.69
57530 T Removal of cervix...... 563 16.50 $848.43 $461.72 $169.69
57531 C Removal of cervix, ......... ......... ......... ........... ...........
radical.
57540 C Removal of residual ......... ......... ......... ........... ...........
cervix.
57545 C Remove cervix, repair ......... ......... ......... ........... ...........
pelvis.
57550 T Removal of residual 563 16.50 $848.43 $461.72 $169.69
cervix.
57555 T Remove cervix, repair 563 16.50 $848.43 $461.72 $169.69
vagina.
57556 T Remove cervix, repair 563 16.50 $848.43 $461.72 $169.69
bowel.
57700 T Revision of cervix..... 562 12.30 $632.47 $325.44 $126.49
57720 T Revision of cervix..... 562 12.30 $632.47 $325.44 $126.49
57800 T Dilation of cervical 561 1.46 $75.07 $24.41 $15.01
canal.
57820 T D&c of residual cervix. 567 13.18 $677.72 $360.70 $135.54
58100 T Biopsy of uterus lining 561 1.46 $75.07 $24.41 $15.01
58120 T Dilation and curettage 567 13.18 $677.72 $360.70 $135.54
(D&C).
58140 C Removal of uterus ......... ......... ......... ........... ...........
lesion.
58145 T Removal of uterus 563 16.50 $848.43 $461.72 $169.69
lesion.
58150 C Total hysterectomy..... ......... ......... ......... ........... ...........
58152 C Total hysterectomy..... ......... ......... ......... ........... ...........
58180 C Partial hysterectomy... ......... ......... ......... ........... ...........
58200 C Extensive hysterectomy. ......... ......... ......... ........... ...........
58210 C Extensive hysterectomy. ......... ......... ......... ........... ...........
58240 C Removal of pelvis ......... ......... ......... ........... ...........
contents.
58260 C Vaginal hysterectomy... ......... ......... ......... ........... ...........
58262 C Vaginal hysterectomy... ......... ......... ......... ........... ...........
58263 C Vaginal hysterectomy... ......... ......... ......... ........... ...........
58267 C Hysterectomy & vagina ......... ......... ......... ........... ...........
repair.
58270 C Hysterectomy & vagina ......... ......... ......... ........... ...........
repair.
58275 C Hysterectomy, revise ......... ......... ......... ........... ...........
vagina.
58280 C Hysterectomy, revise ......... ......... ......... ........... ...........
vagina.
58285 C Extensive hysterectomy. ......... ......... ......... ........... ...........
58300 E Insert intrauterine ......... ......... ......... ........... ...........
device.
[[Page 35328]]
58301 T Remove intrauterine 561 1.46 $75.07 $24.41 $15.01
device.
58321 T Artificial insemination 568 2.79 $143.46 $55.60 $28.69
58322 T Artificial insemination 568 2.79 $143.46 $55.60 $28.69
58323 T Sperm washing.......... 568 2.79 $143.46 $55.60 $28.69
58340 T Catheter for 347 2.57 $132.15 $62.38 $26.43
hysterography.
58345 T Reopen fallopian tube.. 562 12.30 $632.47 $325.44 $126.49
58350 T Reopen fallopian tube.. 562 12.30 $632.47 $325.44 $126.49
58400 C Suspension of uterus... ......... ......... ......... ........... ...........
58410 C Suspension of uterus... ......... ......... ......... ........... ...........
58520 C Repair of ruptured ......... ......... ......... ........... ...........
uterus.
58540 C Revision of uterus..... ......... ......... ......... ........... ...........
58600 C Division of fallopian ......... ......... ......... ........... ...........
tube.
58605 C Division of fallopian ......... ......... ......... ........... ...........
tube.
58611 C Ligate oviduct(s) add- ......... ......... ......... ........... ...........
on.
58615 C Occlude fallopian ......... ......... ......... ........... ...........
tube(s).
58700 C Removal of fallopian ......... ......... ......... ........... ...........
tube.
58720 C Removal of ovary/ ......... ......... ......... ........... ...........
tube(s).
58740 C Revise fallopian ......... ......... ......... ........... ...........
tube(s).
58750 C Repair oviduct......... ......... ......... ......... ........... ...........
58752 C Revise ovarian tube(s). ......... ......... ......... ........... ...........
58760 C Remove tubal ......... ......... ......... ........... ...........
obstruction.
58770 C Create new tubal ......... ......... ......... ........... ...........
opening.
58800 T Drainage of ovarian 563 16.50 $848.43 $461.72 $169.69
cyst(s).
58805 C Drainage of ovarian ......... ......... ......... ........... ...........
cyst(s).
58820 T Open drain ovary 563 16.50 $848.43 $461.72 $169.69
abscess.
58822 C Percut drain ovary ......... ......... ......... ........... ...........
abscess.
58823 C Percut drain pelvic ......... ......... ......... ........... ...........
abscess.
58825 C Transposition, ovary(s) ......... ......... ......... ........... ...........
58900 C Biopsy of ovary(s)..... ......... ......... ......... ........... ...........
58920 C Partial removal of ......... ......... ......... ........... ...........
ovary(s).
58925 C Removal of ovarian ......... ......... ......... ........... ...........
cyst(s).
58940 C Removal of ovary(s).... ......... ......... ......... ........... ...........
58943 C Removal of ovary(s).... ......... ......... ......... ........... ...........
58950 C Resect ovarian ......... ......... ......... ........... ...........
malignancy.
58951 C Resect ovarian ......... ......... ......... ........... ...........
malignancy.
58952 C Resect ovarian ......... ......... ......... ........... ...........
malignancy.
58960 C Exploration of abdomen. ......... ......... ......... ........... ...........
58970 T Retrieval of oocyte.... 562 12.30 $632.47 $325.44 $126.49
58974 T Transfer of embryo..... 568 2.79 $143.46 $55.60 $28.69
58976 T Transfer of embryo..... 568 2.79 $143.46 $55.60 $28.69
58999 T Genital surgery 161 3.43 $176.37 $75.71 $35.27
procedure.
59000 T Amniocentesis.......... 578 1.17 $60.16 $32.77 $12.03
59012 T Fetal cord 578 1.17 $60.16 $32.77 $12.03
puncture,prenatal.
59015 T Chorion biopsy......... 578 1.17 $60.16 $32.77 $12.03
59020 T Fetal contract stress 578 1.17 $60.16 $32.77 $12.03
test.
59025 T Fetal non-stress test.. 578 1.17 $60.16 $32.77 $12.03
59030 T Fetal scalp blood 578 1.17 $60.16 $32.77 $12.03
sample.
59050 T Fetal monitor w/report. 578 1.17 $60.16 $32.77 $12.03
59051 N Fetal monitor/interpret ......... ......... ......... ........... ...........
only.
59100 C Remove uterus lesion... ......... ......... ......... ........... ...........
59120 C Treat ectopic pregnancy ......... ......... ......... ........... ...........
59121 C Treat ectopic pregnancy ......... ......... ......... ........... ...........
59130 C Treat ectopic pregnancy ......... ......... ......... ........... ...........
59135 C Treat ectopic pregnancy ......... ......... ......... ........... ...........
59136 C Treat ectopic pregnancy ......... ......... ......... ........... ...........
59140 C Treat ectopic pregnancy ......... ......... ......... ........... ...........
59150 C Treat ectopic pregnancy ......... ......... ......... ........... ...........
59151 C Treat ectopic pregnancy ......... ......... ......... ........... ...........
59160 T D&C after delivery..... 567 13.18 $677.72 $360.70 $135.54
59200 T Insert cervical dilator 561 1.46 $75.07 $24.41 $15.01
59300 T Episiotomy or vaginal 562 12.30 $632.47 $325.44 $126.49
repair.
59320 T Revision of cervix..... 562 12.30 $632.47 $325.44 $126.49
59325 C Revision of cervix..... ......... ......... ......... ........... ...........
59350 C Repair of uterus....... ......... ......... ......... ........... ...........
59400 E Obstetrical care....... ......... ......... ......... ........... ...........
59409 T Obstetrical care....... 580 4.31 $221.62 $44.32 $44.32
59410 E Obstetrical care....... ......... ......... ......... ........... ...........
59412 T Antepartum manipulation 580 4.31 $221.62 $44.32 $44.32
59414 T Deliver placenta....... 580 4.31 $221.62 $44.32 $44.32
59425 E Antepartum care only... ......... ......... ......... ........... ...........
59426 E Antepartum care only... ......... ......... ......... ........... ...........
59430 E Care after delivery.... ......... ......... ......... ........... ...........
59510 E Cesarean delivery...... ......... ......... ......... ........... ...........
59514 C Cesarean delivery only. ......... ......... ......... ........... ...........
59515 E Cesarean delivery...... ......... ......... ......... ........... ...........
[[Page 35329]]
59525 C Remove uterus after ......... ......... ......... ........... ...........
cesarean.
59610 E Vbac delivery.......... ......... ......... ......... ........... ...........
59612 T Vbac delivery only..... 580 4.31 $221.62 $44.32 $44.32
59614 E Vbac care after ......... ......... ......... ........... ...........
delivery.
59618 E Attempted vbac delivery ......... ......... ......... ........... ...........
59620 C Attempted vbac delivery ......... ......... ......... ........... ...........
only.
59622 E Attempted vbac after ......... ......... ......... ........... ...........
care.
59812 T Treatment of 587 12.96 $666.40 $347.14 $133.28
miscarriage.
59820 T Care of miscarriage.... 587 12.96 $666.40 $347.14 $133.28
59821 T Treatment of 587 12.96 $666.40 $347.14 $33.28
miscarriage.
59830 C Treat uterus infection. ......... ......... ......... ........... ...........
59840 T Abortion............... 586 11.98 $616.01 $409.29 $123.20
59841 T Abortion............... 586 11.98 $616.01 $409.29 $123.20
59850 C Abortion............... ......... ......... ......... ........... ...........
59851 C Abortion............... ......... ......... ......... ........... ...........
59852 C Abortion............... ......... ......... ......... ........... ...........
59855 C Abortion............... ......... ......... ......... ........... ...........
59856 C Abortion............... ......... ......... ......... ........... ...........
59857 C Abortion............... ......... ......... ......... ........... ...........
59866 C Abortion............... ......... ......... ......... ........... ...........
59870 T Evacuate mole of uterus 587 12.96 $666.40 $347.14 $133.28
59871 T Remove cerclage suture. 562 12.30 $632.47 $325.44 $126.49
59899 T Maternity care 578 1.17 $60.16 $32.77 $12.03
procedure.
60000 T Drain thyroid/tongue 312 7.07 $363.54 $170.86 $72.71
cyst.
60001 T Aspirate/inject thyriod 121 0.63 $32.39 $21.02 $6.48
cyst.
60100 T Biopsy of thyroid...... 122 4.59 $236.02 $113.00 $47.20
60200 T Remove thyroid lesion.. 397 19.12 $983.15 $542.17 $196.63
60210 T Partial excision 397 19.12 $983.15 $542.17 $196.63
thyroid.
60212 C Parital thyroid ......... ......... ......... ........... ...........
excision.
60220 T Partial removal of 397 19.12 $983.15 $542.17 $196.63
thyroid.
60225 T Partial removal of 397 19.12 $983.15 $542.17 $196.63
thyroid.
60240 T Removal of thyroid..... 397 19.12 $983.15 $542.17 $196.63
60252 C Removal of thyroid..... ......... ......... ......... ........... ...........
60254 C Extensive thyroid ......... ......... ......... ........... ...........
surgery.
60260 C Repeat thyroid surgery. ......... ......... ......... ........... ...........
60270 C Removal of thyroid..... ......... ......... ......... ........... ...........
60271 C Removal of thyroid..... ......... ......... ......... ........... ...........
60280 T Remove thyroid duct 397 19.12 $983.15 $542.17 $196.63
lesion.
60281 T Remove thyroid duct 397 19.12 $983.15 $542.17 $196.63
lesion.
60500 C Explore parathyroid ......... ......... ......... ........... ...........
glands.
60502 C Re-explore parathyroids ......... ......... ......... ........... ...........
60505 C Explore parathyroid ......... ......... ......... ........... ...........
glands.
60512 C Autotransplant, ......... ......... ......... ........... ...........
parathyroid.
60520 C Removal of thymus gland ......... ......... ......... ........... ...........
60521 C Removal thymus gland... ......... ......... ......... ........... ...........
60522 C Removal of thymus gland ......... ......... ......... ........... ...........
60540 C Explore adrenal gland.. ......... ......... ......... ........... ...........
60545 C Explore adrenal gland.. ......... ......... ......... ........... ...........
60600 C Remove carotid body ......... ......... ......... ........... ...........
lesion.
60605 C Remove carotid body ......... ......... ......... ........... ...........
lesion.
60699 T Endocrine surgery 121 0.63 $32.39 $21.02 $6.48
procedure.
61000 T Remove cranial cavity 602 3.19 $164.03 $87.01 $32.81
fluid.
61001 T Remove cranial cavity 602 3.19 $164.03 $87.01 $32.81
fluid.
61020 T Remove brain cavity 602 3.19 $164.03 $87.01 $32.81
fluid.
61026 T Injection into brain 602 3.19 $164.03 $87.01 $32.81
canal.
61050 T Remove brain canal 602 3.19 $164.03 $87.01 $32.81
fluid.
61055 T Injection into brain 602 3.19 $164.03 $87.01 $32.81
canal.
61070 T Brain canal shunt 602 3.19 $164.03 $87.01 $32.81
procedure.
61105 C Twist drill hole....... ......... ......... ......... ........... ...........
\2\ 6110 C Drill skull for exam/ ......... ......... ......... ........... ...........
6 surgery.
61107 C Drill skull for ......... ......... ......... ........... ...........
implantation.
61108 C Drill skull for ......... ......... ......... ........... ...........
drainage.
61120 C Burr hole for puncture. ......... ......... ......... ........... ...........
\2\ 6113 C Pierce skull, exam/ ......... ......... ......... ........... ...........
0 surgery.
61140 C Pierce skull for biopsy ......... ......... ......... ........... ...........
61150 C Pierce skull for ......... ......... ......... ........... ...........
drainage.
61151 C Pierce skull for ......... ......... ......... ........... ...........
drainage.
61154 C Pierce skull, remove ......... ......... ......... ........... ...........
clot.
61156 C Pierce skull for ......... ......... ......... ........... ...........
drainage.
61210 C Pierce skull; implant ......... ......... ......... ........... ...........
device.
61215 T Insert brain-fluid 618 24.78 $1,274.19 $808.18 $254.84
device.
61250 C Pierce skull & explore. ......... ......... ......... ........... ...........
61253 C Pierce skull & explore. ......... ......... ......... ........... ...........
61304 C Open skull for ......... ......... ......... ........... ...........
exploration.
61305 C Open skull for ......... ......... ......... ........... ...........
exploration.
[[Page 35330]]
61312 C Open skull for drainage ......... ......... ......... ........... ...........
61313 C Open skull for drainage ......... ......... ......... ........... ...........
61314 C Open skull for drainage ......... ......... ......... ........... ...........
61315 C Open skull for drainage ......... ......... ......... ........... ...........
61320 C Open skull for drainage ......... ......... ......... ........... ...........
61321 C Open skull for drainage ......... ......... ......... ........... ...........
61330 C Decompress eye socket.. ......... ......... ......... ........... ...........
61332 C Explore/biopsy eye ......... ......... ......... ........... ...........
socket.
61333 C Explore orbit; remove ......... ......... ......... ........... ...........
lesion.
61334 C Explore orbit; remove ......... ......... ......... ........... ...........
object.
61340 C Relieve cranial ......... ......... ......... ........... ...........
pressure.
61343 C Incise skull,pressure ......... ......... ......... ........... ...........
relief.
61345 C Relieve cranial ......... ......... ......... ........... ...........
pressure.
61440 C Incise skull for ......... ......... ......... ........... ...........
surgery.
61450 C Incise skull for ......... ......... ......... ........... ...........
surgery.
61458 C Incise skull for brain ......... ......... ......... ........... ...........
wound.
61460 C Incise skull for ......... ......... ......... ........... ...........
surgery.
61470 C Incise skull for ......... ......... ......... ........... ...........
surgery.
61480 C Incise skull for ......... ......... ......... ........... ...........
surgery.
61490 C Incise skull for ......... ......... ......... ........... ...........
surgery.
61500 C Removal of skull lesion ......... ......... ......... ........... ...........
61501 C Remove infected skull ......... ......... ......... ........... ...........
bone.
61510 C Removal of brain lesion ......... ......... ......... ........... ...........
61512 C Remove brain lining ......... ......... ......... ........... ...........
lesion.
61514 C Removal of brain ......... ......... ......... ........... ...........
abscess.
61516 C Removal of brain lesion ......... ......... ......... ........... ...........
61518 C Removal of brain lesion ......... ......... ......... ........... ...........
61519 C Remove brain lining ......... ......... ......... ........... ...........
lesion.
61520 C Removal of brain lesion ......... ......... ......... ........... ...........
61521 C Removal of brain lesion ......... ......... ......... ........... ...........
61522 C Removal of brain ......... ......... ......... ........... ...........
abscess.
61524 C Removal of brain lesion ......... ......... ......... ........... ...........
61526 C Removal of brain lesion ......... ......... ......... ........... ...........
61530 C Removal of brain lesion ......... ......... ......... ........... ...........
61531 C Implant brain ......... ......... ......... ........... ...........
electrodes.
61533 C Implant brain ......... ......... ......... ........... ...........
electrodes.
61534 C Removal of brain lesion ......... ......... ......... ........... ...........
61535 C Remove brain electrodes ......... ......... ......... ........... ...........
61536 C Removal of brain lesion ......... ......... ......... ........... ...........
61538 C Removal of brain tissue ......... ......... ......... ........... ...........
61539 C Removal of brain tissue ......... ......... ......... ........... ...........
61541 C Incision of brain ......... ......... ......... ........... ...........
tissue.
61542 C Removal of brain tissue ......... ......... ......... ........... ...........
61543 C Removal of brain tissue ......... ......... ......... ........... ...........
61544 C Remove & treat brain ......... ......... ......... ........... ...........
lesion.
61545 C Excision of brain tumor ......... ......... ......... ........... ...........
61546 C Removal of pituitary ......... ......... ......... ........... ...........
gland.
61548 C Removal of pituitary ......... ......... ......... ........... ...........
gland.
61550 C Release of skull seams. ......... ......... ......... ........... ...........
61552 C Release of skull seams. ......... ......... ......... ........... ...........
61556 C Incise skull/sutures... ......... ......... ......... ........... ...........
61557 C Incise skull/sutures... ......... ......... ......... ........... ...........
61558 C Excision of skull/ ......... ......... ......... ........... ...........
sutures.
61559 C Excision of skull/ ......... ......... ......... ........... ...........
sutures.
61563 C Excision of skull tumor ......... ......... ......... ........... ...........
61564 C Excision of skull tumor ......... ......... ......... ........... ...........
61570 C Remove brain foreign ......... ......... ......... ........... ...........
body.
61571 C Incise skull for brain ......... ......... ......... ........... ...........
wound.
61575 C Skull base/brainstem ......... ......... ......... ........... ...........
surgery.
61576 C Skull base/brainstem ......... ......... ......... ........... ...........
surgery.
61580 C Craniofacial approach, ......... ......... ......... ........... ...........
skull.
61581 C Craniofacial approach, ......... ......... ......... ........... ...........
skull.
61582 C Craniofacial approach, ......... ......... ......... ........... ...........
skull.
61583 C Craniofacial approach, ......... ......... ......... ........... ...........
skull.
61584 C Orbitocranial approach/ ......... ......... ......... ........... ...........
skull.
61585 C Orbitocranial approach/ ......... ......... ......... ........... ...........
skull.
61586 C Resect nasopharynx, ......... ......... ......... ........... ...........
skull.
61590 C Infratemporal approach/ ......... ......... ......... ........... ...........
skull.
61591 C Infratemporal approach/ ......... ......... ......... ........... ...........
skull.
61592 C Orbitocranial approach/ ......... ......... ......... ........... ...........
skull.
61595 C Transtemporal approach/ ......... ......... ......... ........... ...........
skull.
61596 C Transcochlear approach/ ......... ......... ......... ........... ...........
skull.
61597 C Transcondylar approach/ ......... ......... ......... ........... ...........
skull.
61598 C Transpetrosal approach/ ......... ......... ......... ........... ...........
skull.
61600 C Resect/excise cranial ......... ......... ......... ........... ...........
lesion.
[[Page 35331]]
61601 C Resect/excise cranial ......... ......... ......... ........... ...........
lesion.
61605 C Resect/excise cranial ......... ......... ......... ........... ...........
lesion.
61606 C Resect/excise cranial ......... ......... ......... ........... ...........
lesion.
61607 C Resect/excise cranial ......... ......... ......... ........... ...........
lesion.
61608 C Resect/excise cranial ......... ......... ......... ........... ...........
lesion.
61609 C Transect, artery, sinus ......... ......... ......... ........... ...........
61610 C Transect, artery, sinus ......... ......... ......... ........... ...........
61611 C Transect, artery, sinus ......... ......... ......... ........... ...........
61612 C Transect, artery, sinus ......... ......... ......... ........... ...........
61613 C Remove aneurysm, sinus. ......... ......... ......... ........... ...........
61615 C Resect/excise lesion, ......... ......... ......... ........... ...........
skull.
61616 C Resect/excise lesion, ......... ......... ......... ........... ...........
skull.
61618 C Repair dura............ ......... ......... ......... ........... ...........
61619 C Repair dura............ ......... ......... ......... ........... ...........
61624 C Occlusion/embolization ......... ......... ......... ........... ...........
cath.
61626 C Occlusion/embolization ......... ......... ......... ........... ...........
cath.
61680 C Intracranial vessel ......... ......... ......... ........... ...........
surgery.
61682 C Intracranial vessel ......... ......... ......... ........... ...........
surgery.
61684 C Intracranial vessel ......... ......... ......... ........... ...........
surgery.
61686 C Intracranial vessel ......... ......... ......... ........... ...........
surgery.
61690 C Intracranial vessel ......... ......... ......... ........... ...........
surgery.
61692 C Intracranial vessel ......... ......... ......... ........... ...........
surgery.
61700 C Inner skull vessel ......... ......... ......... ........... ...........
surgery.
61702 C Inner skull vessel ......... ......... ......... ........... ...........
surgery.
61703 C Clamp neck artery...... ......... ......... ......... ........... ...........
61705 C Revise circulation to ......... ......... ......... ........... ...........
head.
61708 C Revise circulation to ......... ......... ......... ........... ...........
head.
61710 C Revise circulation to ......... ......... ......... ........... ...........
head.
61711 C Fusion of skull ......... ......... ......... ........... ...........
arteries.
\2\ 6171 C Skull or spine ......... ......... ......... ........... ...........
2 microsurgery.
61720 C Incise skull/brain ......... ......... ......... ........... ...........
surgery.
61735 C Incise skull/brain ......... ......... ......... ........... ...........
surgery.
61750 C Incise skull; brain ......... ......... ......... ........... ...........
biopsy.
61751 C Brain biopsy with cat ......... ......... ......... ........... ...........
scan.
61760 C Implant brain ......... ......... ......... ........... ...........
electrodes.
61770 C Incise skull for ......... ......... ......... ........... ...........
treatment.
61790 T Treat trigeminal nerve. 631 12.70 $653.03 $329.06 $130.61
61791 C Treat trigeminal tract. ......... ......... ......... ........... ...........
61793 S Focus radiation beam... 757 2.26 $116.21 $52.43 $23.24
61795 C Brain surgery using ......... ......... ......... ........... ...........
computer.
61850 C Implant neuroelectrodes ......... ......... ......... ........... ...........
61855 C Implant neuroelectrodes ......... ......... ......... ........... ...........
61860 C Implant neuroelectrodes ......... ......... ......... ........... ...........
61865 C Implant neuroelectrodes ......... ......... ......... ........... ...........
61870 C Implant neuroelectrodes ......... ......... ......... ........... ...........
61875 C Implant neuroelectrodes ......... ......... ......... ........... ...........
61880 C Revise/remove ......... ......... ......... ........... ...........
neuroelectrode.
61885 T Implant neuroreceiver.. 618 24.78 $1,274.19 $808.18 $254.84
61888 C Revise/remove ......... ......... ......... ........... ...........
neuroreceiver.
62000 C Repair of skull ......... ......... ......... ........... ...........
fracture.
62005 C Repair of skull ......... ......... ......... ........... ...........
fracture.
62010 C Treatment of head ......... ......... ......... ........... ...........
injury.
62100 C Repair brain fluid ......... ......... ......... ........... ...........
leakage.
62115 C Reduction of skull ......... ......... ......... ........... ...........
defect.
62116 C Reduction of skull ......... ......... ......... ........... ...........
defect.
62117 C Reduction of skull ......... ......... ......... ........... ...........
defect.
62120 C Repair skull cavity ......... ......... ......... ........... ...........
lesion.
62121 C Incise skull repair.... ......... ......... ......... ........... ...........
62140 C Repair of skull defect. ......... ......... ......... ........... ...........
62141 C Repair of skull defect. ......... ......... ......... ........... ...........
62142 C Remove skull plate/flap ......... ......... ......... ........... ...........
62143 C Replace skull plate/ ......... ......... ......... ........... ...........
flap.
62145 C Repair of skull & brain ......... ......... ......... ........... ...........
62146 C Repair of skull with ......... ......... ......... ........... ...........
graft.
62147 C Repair of skull with ......... ......... ......... ........... ...........
graft.
62180 C Establish brain cavity ......... ......... ......... ........... ...........
shunt.
62190 C Establish brain cavity ......... ......... ......... ........... ...........
shunt.
62192 C Establish brain cavity ......... ......... ......... ........... ...........
shunt.
62194 T Replace/irrigate 602 3.19 $164.03 $87.01 $32.81
catheter.
62200 C Establish brain cavity ......... ......... ......... ........... ...........
shunt.
62201 C Establish brain cavity ......... ......... ......... ........... ...........
shunt.
62220 C Establish brain cavity ......... ......... ......... ........... ...........
shunt.
62223 C Establish brain cavity ......... ......... ......... ........... ...........
shunt.
62225 T Replace/irrigate 602 3.19 $164.03 $87.01 $32.81
catheter.
62230 T Replace/revise brain 617 11.31 $581.56 $280.01 $116.31
shunt.
[[Page 35332]]
62256 C Remove brain cavity ......... ......... ......... ........... ...........
shunt.
62258 C Replace brain cavity ......... ......... ......... ........... ...........
shunt.
62268 T Drain spinal cord cyst. 602 3.19 $164.03 $87.01 $32.81
62269 T Needle biopsy spinal 122 4.59 $236.02 $113.00 $47.20
cord.
62270 T Spinal fluid tap, 600 2.41 $123.92 $61.47 $24.78
diagnostic.
62272 T Drain spinal fluid..... 600 2.41 $123.92 $61.47 $24.78
62273 T Treat lumbar spine 602 3.19 $164.03 $87.01 $32.81
lesion.
62274 T Inject spinal 602 3.19 $164.03 $87.01 $32.81
anesthetic.
62275 T Inject spinal 602 3.19 $164.03 $87.01 $32.81
anesthetic.
62276 T Inject spinal 602 3.19 $164.03 $87.01 $32.81
anesthetic.
62277 T Inject spinal 602 3.19 $164.03 $87.01 $32.81
anesthetic.
62278 T Inject spinal 602 3.19 $164.03 $87.01 $32.81
anesthetic.
62279 T Inject spinal 602 3.19 $164.03 $87.01 $32.81
anesthetic.
62280 T Treat spinal cord 602 3.19 $164.03 $87.01 $32.81
lesion.
62281 T Treat spinal cord 602 3.19 $164.03 $87.01 $32.81
lesion.
62282 T Treat spinal canal 602 3.19 $164.03 $87.01 $32.81
lesion.
62284 T Injection for myelogram 347 2.57 $132.15 $62.38 $26.43
62287 T Percutaneous diskectomy 631 12.70 $653.03 $329.06 $130.61
62288 T Injection into spinal 602 3.19 $164.03 $87.01 $32.81
canal.
62289 T Injection into spinal 602 3.19 $164.03 $87.01 $32.81
canal.
62290 T Inject for spine disk x- 347 2.57 $132.15 $62.38 $26.43
ray.
62291 T Inject for spine disk x- 347 2.57 $132.15 $62.38 $26.43
ray.
62292 T Injection into disk 602 3.19 $164.03 $87.01 $32.81
lesion.
62294 T Injection into spinal 602 3.19 $164.03 $87.01 $32.81
artery.
62298 T Injection into spinal 602 3.19 $164.03 $87.01 $32.81
canal.
62350 T Implant spinal catheter 617 11.31 $581.56 $280.01 $116.31
62351 C Implant spinal catheter ......... ......... ......... ........... ...........
62355 T Remove spinal canal 617 11.31 $581.56 $280.01 $116.31
catheter.
62360 T Insert spine infusion 618 24.78 $1,274.19 $808.18 $254.84
device.
62361 T Implant spine infusion 618 24.78 $1,274.19 $808.18 $254.84
pump.
62362 T Implant spine infusion 618 24.78 $1,274.19 $808.18 $254.84
pump.
62365 T Remove spine infusion 617 11.31 $581.56 $280.01 $116.31
device.
62367 X Analyze spine infusion 966 0.39 $20.05 $12.43 $4.01
pump.
62368 X Analyze spine infusion 966 0.39 $20.05 $12.43 $4.01
pump.
63001 C Removal of spinal ......... ......... ......... ........... ...........
lamina.
63003 C Removal of spinal ......... ......... ......... ........... ...........
lamina.
63005 C Removal of spinal ......... ......... ......... ........... ...........
lamina.
63011 C Removal of spinal ......... ......... ......... ........... ...........
lamina.
63012 C Removal of spinal ......... ......... ......... ........... ...........
lamina.
63015 C Removal of spinal ......... ......... ......... ........... ...........
lamina.
63016 C Removal of spinal ......... ......... ......... ........... ...........
lamina.
63017 C Removal of spinal ......... ......... ......... ........... ...........
lamina.
63020 C Neck spine disk surgery ......... ......... ......... ........... ...........
63030 C Low back disk surgery.. ......... ......... ......... ........... ...........
63035 C Spinal disk surgery add- ......... ......... ......... ........... ...........
on.
63040 C Neck spine disk surgery ......... ......... ......... ........... ...........
63042 C Low back disk surgery.. ......... ......... ......... ........... ...........
63045 C Removal of spinal ......... ......... ......... ........... ...........
lamina.
63046 C Removal of spinal ......... ......... ......... ........... ...........
lamina.
63047 C Removal of spinal ......... ......... ......... ........... ...........
lamina.
63048 C Remove spinal lamina ......... ......... ......... ........... ...........
add-on.
63055 C Decompress spinal cord. ......... ......... ......... ........... ...........
63056 C Decompress spinal cord. ......... ......... ......... ........... ...........
63057 C Decompress spine cord ......... ......... ......... ........... ...........
add-on.
63064 C Decompress spinal cord. ......... ......... ......... ........... ...........
63066 C Decompress spine cord ......... ......... ......... ........... ...........
add-on.
63075 C Neck spine disk surgery ......... ......... ......... ........... ...........
63076 C Neck spine disk surgery ......... ......... ......... ........... ...........
63077 C Spine disk surgery, ......... ......... ......... ........... ...........
thorax.
63078 C Spine disk surgery, ......... ......... ......... ........... ...........
thorax.
63081 C Removal of vertebral ......... ......... ......... ........... ...........
body.
63082 C Remove vertebral body ......... ......... ......... ........... ...........
add-on.
63085 C Removal of vertebral ......... ......... ......... ........... ...........
body.
63086 C Remove vertebral body ......... ......... ......... ........... ...........
add-on.
63087 C Removal of vertebral ......... ......... ......... ........... ...........
body.
63088 C Remove vertebral body ......... ......... ......... ........... ...........
add-on.
63090 C Removal of vertebral ......... ......... ......... ........... ...........
body.
63091 C Remove vertebral body ......... ......... ......... ........... ...........
add-on.
63170 C Incise spinal cord ......... ......... ......... ........... ...........
tract(s).
63172 C Drainage of spinal cyst ......... ......... ......... ........... ...........
63173 C Drainage of spinal cyst ......... ......... ......... ........... ...........
63180 C Revise spinal cord ......... ......... ......... ........... ...........
ligaments.
63182 C Revise spinal cord ......... ......... ......... ........... ...........
ligaments.
63185 C Incise spinal column/ ......... ......... ......... ........... ...........
nerves.
63190 C Incise spinal column/ ......... ......... ......... ........... ...........
nerves.
[[Page 35333]]
63191 C Incise spinal column/ ......... ......... ......... ........... ...........
nerves.
63194 C Incise spinal column & ......... ......... ......... ........... ...........
cord.
63195 C Incise spinal column & ......... ......... ......... ........... ...........
cord.
63196 C Incise spinal column & ......... ......... ......... ........... ...........
cord.
63197 C Incise spinal column & ......... ......... ......... ........... ...........
cord.
63198 C Incise spinal column & ......... ......... ......... ........... ...........
cord.
63199 C Incise spinal column & ......... ......... ......... ........... ...........
cord.
63200 C Release of spinal cord. ......... ......... ......... ........... ...........
63250 C Revise spinal cord ......... ......... ......... ........... ...........
vessels.
63251 C Revise spinal cord ......... ......... ......... ........... ...........
vessels.
63252 C Revise spinal cord ......... ......... ......... ........... ...........
vessels.
63265 C Excise intraspinal ......... ......... ......... ........... ...........
lesion.
63266 C Excise intraspinal ......... ......... ......... ........... ...........
lesion.
63267 C Excise intraspinal ......... ......... ......... ........... ...........
lesion.
63268 C Excise intraspinal ......... ......... ......... ........... ...........
lesion.
63270 C Excise intraspinal ......... ......... ......... ........... ...........
lesion.
63271 C Excise intraspinal ......... ......... ......... ........... ...........
lesion.
63272 C Excise intraspinal ......... ......... ......... ........... ...........
lesion.
63273 C Excise intraspinal ......... ......... ......... ........... ...........
lesion.
63275 C Biopsy/excise spinal ......... ......... ......... ........... ...........
tumor.
63276 C Biopsy/excise spinal ......... ......... ......... ........... ...........
tumor.
63277 C Biopsy/excise spinal ......... ......... ......... ........... ...........
tumor.
63278 C Biopsy/excise spinal ......... ......... ......... ........... ...........
tumor.
63280 C Biopsy/excise spinal ......... ......... ......... ........... ...........
tumor.
63281 C Biopsy/excise spinal ......... ......... ......... ........... ...........
tumor.
63282 C Biopsy/excise spinal ......... ......... ......... ........... ...........
tumor.
63283 C Biopsy/excise spinal ......... ......... ......... ........... ...........
tumor.
63285 C Biopsy/excise spinal ......... ......... ......... ........... ...........
tumor.
63286 C Biopsy/excise spinal ......... ......... ......... ........... ...........
tumor.
63287 C Biopsy/excise spinal ......... ......... ......... ........... ...........
tumor.
63290 C Biopsy/excise spinal ......... ......... ......... ........... ...........
tumor.
63300 C Removal of vertebral ......... ......... ......... ........... ...........
body.
63301 C Removal of vertebral ......... ......... ......... ........... ...........
body.
63302 C Removal of vertebral ......... ......... ......... ........... ...........
body.
63303 C Removal of vertebral ......... ......... ......... ........... ...........
body.
63304 C Removal of vertebral ......... ......... ......... ........... ...........
body.
63305 C Removal of vertebral ......... ......... ......... ........... ...........
body.
63306 C Removal of vertebral ......... ......... ......... ........... ...........
body.
63307 C Removal of vertebral ......... ......... ......... ........... ...........
body.
63308 C Remove vertebral body ......... ......... ......... ........... ...........
add-on.
63600 T Remove spinal cord 631 12.70 $653.03 $329.06 $130.61
lesion.
63610 T Stimulation of spinal 631 12.70 $653.03 $329.06 $130.61
cord.
63615 T Remove lesion of spinal 631 12.70 $653.03 $329.06 $130.61
cord.
63650 T Implant neuroelectrodes 616 11.85 $609.33 $329.06 $121.87
63655 C Implant neuroelectrodes ......... ......... ......... ........... ...........
63660 T Revise/remove 617 11.31 $581.56 $280.01 $116.31
neuroelectrode.
63685 T Implant neuroreceiver.. 618 24.78 $1,274.19 $808.18 $254.84
63688 T Revise/remove 617 11.31 $581.56 $280.01 $116.31
neuroreceiver.
\2\ 6369 X Analysis of 966 0.39 $20.05 $12.43 $4.01
0 neuroreceiver.
\2\ 6369 X Analysis of 966 0.39 $20.05 $12.43 $4.01
1 neuroreceiver.
63700 C Repair of spinal ......... ......... ......... ........... ...........
herniation.
63702 C Repair of spinal ......... ......... ......... ........... ...........
herniation.
63704 C Repair of spinal ......... ......... ......... ........... ...........
herniation.
63706 C Repair of spinal ......... ......... ......... ........... ...........
herniation.
63707 C Repair spinal fluid ......... ......... ......... ........... ...........
leakage.
63709 C Repair spinal fluid ......... ......... ......... ........... ...........
leakage.
63710 C Graft repair of spine ......... ......... ......... ........... ...........
defect.
63740 C Install spinal shunt... ......... ......... ......... ........... ...........
63741 C Install spinal shunt... ......... ......... ......... ........... ...........
63744 T Revision of spinal 617 11.31 $581.56 $280.01 $116.31
shunt.
63746 T Removal of spinal shunt 617 11.31 $581.56 $280.01 $116.31
64400 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64402 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64405 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64408 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64410 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64412 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64413 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64415 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64417 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64418 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64420 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64421 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64425 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64430 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
[[Page 35334]]
64435 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64440 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64441 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64442 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64443 T Inject, nerve block add- 601 3.00 $154.26 $74.13 $30.85
on.
64445 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64450 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64505 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64508 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64510 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64520 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64530 T Injection for nerve 601 3.00 $154.26 $74.13 $30.85
block.
64550 A Apply neurostimulator.. ......... ......... ......... ........... ...........
64553 T Implant neuroelectrodes 616 11.85 $609.33 $329.06 $121.87
64555 T Implant neuroelectrodes 616 11.85 $609.33 $329.06 $121.87
64560 T Implant neuroelectrodes 616 11.85 $609.33 $329.06 $121.87
64565 T Implant neuroelectrodes 616 11.85 $609.33 $329.06 $121.87
64573 T Implant neuroelectrodes 616 11.85 $609.33 $329.06 $121.87
64575 T Implant neuroelectrodes 616 11.85 $609.33 $329.06 $121.87
64577 T Implant neuroelectrodes 616 11.85 $609.33 $329.06 $121.87
64580 T Implant neuroelectrodes 616 11.85 $609.33 $329.06 $121.87
64585 T Revise/remove 617 11.31 $581.56 $280.01 $116.31
neuroelectrode.
64590 T Implant neuroreceiver.. 618 24.78 $1,274.19 $808.18 $254.84
64595 T Revise/remove 617 11.31 $581.56 $280.01 $116.31
neuroreceiver.
64600 T Injection treatment of 601 3.00 $154.26 $74.13 $30.85
nerve.
64605 T Injection treatment of 601 3.00 $154.26 $74.13 $30.85
nerve.
64610 T Injection treatment of 601 3.00 $154.26 $74.13 $30.85
nerve.
64612 T Destroy nerve, face 601 3.00 $154.26 $74.13 $30.85
muscle.
64613 T Destroy nerve, spine 601 3.00 $154.26 $74.13 $30.85
muscle.
64620 T Injection treatment of 601 3.00 $154.26 $74.13 $30.85
nerve.
64622 T Injection treatment of 601 3.00 $154.26 $74.13 $30.85
nerve.
64623 T Inject, tx of nerve add- 601 3.00 $154.26 $74.13 $30.85
on.
64630 T Injection treatment of 601 3.00 $154.26 $74.13 $30.85
nerve.
64640 T Injection treatment of 601 3.00 $154.26 $74.13 $30.85
nerve.
64680 T Injection treatment of 601 3.00 $154.26 $74.13 $30.85
nerve.
64702 T Revise finger/toe nerve 631 12.70 $653.03 $329.06 $130.61
64704 T Revise hand/foot nerve. 631 12.70 $653.03 $329.06 $130.61
64708 T Revise arm/leg nerve... 631 12.70 $653.03 $329.06 $130.61
64712 T Revision of sciatic 631 12.70 $653.03 $329.06 $130.61
nerve.
64713 T Revision of arm 631 12.70 $653.03 $329.06 $130.61
nerve(s).
64714 T Revise low back 631 12.70 $653.03 $329.06 $130.61
nerve(s).
64716 T Revision of cranial 631 12.70 $653.03 $329.06 $130.61
nerve.
64718 T Revise ulnar nerve at 631 12.70 $653.03 $329.06 $130.61
elbow.
64719 T Revise ulnar nerve at 631 12.70 $653.03 $329.06 $130.61
wrist.
64721 T Carpal tunnel surgery.. 631 12.70 $653.03 $329.06 $130.61
64722 T Relieve pressure on 631 12.70 $653.03 $329.06 $130.61
nerve(s).
64726 T Release foot/toe nerve. 631 12.70 $653.03 $329.06 $130.61
64727 T Internal nerve revision 631 12.70 $653.03 $329.06 $130.61
64732 T Incision of brow nerve. 631 12.70 $653.03 $329.06 $130.61
64734 T Incision of cheek nerve 631 12.70 $653.03 $329.06 $130.61
64736 T Incision of chin nerve. 631 12.70 $653.03 $329.06 $130.61
64738 T Incision of jaw nerve.. 631 12.70 $653.03 $329.06 $130.61
64740 T Incision of tongue 631 12.70 $653.03 $329.06 $130.61
nerve.
64742 T Incision of facial 631 12.70 $653.03 $329.06 $130.61
nerve.
64744 T Incise nerve, back of 631 12.70 $653.03 $329.06 $130.61
head.
64746 T Incise diaphragm nerve. 631 12.70 $653.03 $329.06 $130.61
64752 C Incision of vagus nerve ......... ......... ......... ........... ...........
64755 C Incision of stomach ......... ......... ......... ........... ...........
nerves.
64760 C Incision of vagus nerve ......... ......... ......... ........... ...........
64761 T Incision of pelvis 631 12.70 $653.03 $329.06 $130.61
nerve.
64763 C Incise hip/thigh nerve. ......... ......... ......... ........... ...........
64766 C Incise hip/thigh nerve. ......... ......... ......... ........... ...........
64771 T Sever cranial nerve.... 631 12.70 $653.03 $329.06 $130.61
64772 T Incision of spinal 631 12.70 $653.03 $329.06 $130.61
nerve.
64774 T Remove skin nerve 631 12.70 $653.03 $329.06 $130.61
lesion.
64776 T Remove digit nerve 631 12.70 $653.03 $329.06 $130.61
lesion.
64778 T Digit nerve surgery add- 631 12.70 $653.03 $329.06 $130.61
on.
64782 T Remove limb nerve 631 12.70 $653.03 $329.06 $130.61
lesion.
64783 T Limb nerve surgery add- 631 12.70 $653.03 $329.06 $130.61
on.
64784 T Remove nerve lesion.... 631 12.70 $653.03 $329.06 $130.61
64786 T Remove sciatic nerve 632 16.48 $847.40 $453.58 $169.48
lesion.
64787 T Implant nerve end...... 631 12.70 $653.03 $329.06 $130.61
64788 T Remove skin nerve 631 12.70 $653.03 $329.06 $130.61
lesion.
64790 T Removal of nerve lesion 631 12.70 $653.03 $329.06 $130.61
64792 T Removal of nerve lesion 632 16.48 $847.40 $453.58 $169.48
[[Page 35335]]
64795 T Biopsy of nerve........ 631 12.70 $653.03 $329.06 $130.61
64802 C Remove sympathetic ......... ......... ......... ........... ...........
nerves.
64804 C Remove sympathetic ......... ......... ......... ........... ...........
nerves.
64809 C Remove sympathetic ......... ......... ......... ........... ...........
nerves.
64818 C Remove sympathetic ......... ......... ......... ........... ...........
nerves.
64820 C Remove sympathetic ......... ......... ......... ........... ...........
nerves.
\2\ 6483 T Microrepair of nerve... 631 12.70 $653.03 $329.06 $130.61
0
64831 T Repair of digit nerve.. 632 16.48 $847.40 $453.58 $169.48
64832 T Repair nerve add-on.... 632 16.48 $847.40 $453.58 $169.48
64834 T Repair of hand or foot 632 16.48 $847.40 $453.58 $169.48
nerve.
64835 T Repair of hand or foot 632 16.48 $847.40 $453.58 $169.48
nerve.
64836 T Repair of hand or foot 632 16.48 $847.40 $453.58 $169.48
nerve.
64837 T Repair nerve add-on.... 632 16.48 $847.40 $453.58 $169.48
64840 T Repair of leg nerve.... 632 16.48 $847.40 $453.58 $169.48
64856 T Repair/transpose nerve. 632 16.48 $847.40 $453.58 $169.48
64857 T Repair arm/leg nerve... 632 16.48 $847.40 $453.58 $169.48
64858 T Repair sciatic nerve... 632 16.48 $847.40 $453.58 $169.48
64859 T Nerve surgery.......... 632 16.48 $847.40 $453.58 $169.48
64861 T Repair of arm nerves... 632 16.48 $847.40 $453.58 $169.48
64862 T Repair of low back 632 16.48 $847.40 $453.58 $169.48
nerves.
64864 T Repair of facial nerve. 632 16.48 $847.40 $453.58 $169.48
64865 T Repair of facial nerve. 632 16.48 $847.40 $453.58 $169.48
64866 C Fusion of facial/other ......... ......... ......... ........... ...........
nerve.
64868 C Fusion of facial/other ......... ......... ......... ........... ...........
nerve.
64870 T Fusion of facial/other 632 16.48 $847.40 $453.58 $169.48
nerve.
64872 T Subsequent repair of 632 16.48 $847.40 $453.58 $169.48
nerve.
64874 T Repair & revise nerve 632 16.48 $847.40 $453.58 $169.48
add-on.
64876 T Repair nerve; shorten 632 16.48 $847.40 $453.58 $169.48
bone.
64885 T Nerve graft, head or 632 16.48 $847.40 $453.58 $169.48
neck.
64886 T Nerve graft, head or 632 16.48 $847.40 $453.58 $169.48
neck.
64890 T Nerve graft, hand or 632 16.48 $847.40 $453.58 $169.48
foot.
64891 T Nerve graft, hand or 632 16.48 $847.40 $453.58 $169.48
foot.
64892 T Nerve graft, arm or leg 632 16.48 $847.40 $453.58 $169.48
64893 T Nerve graft, arm or leg 632 16.48 $847.40 $453.58 $169.48
64895 T Nerve graft, hand or 632 16.48 $847.40 $453.58 $169.48
foot.
64896 T Nerve graft, hand or 632 16.48 $847.40 $453.58 $169.48
foot.
64897 T Nerve graft, arm or leg 632 16.48 $847.40 $453.58 $169.48
64898 T Nerve graft, arm or leg 632 16.48 $847.40 $453.58 $169.48
64901 T Nerve graft add-on..... 632 16.48 $847.40 $453.58 $169.48
64902 T Nerve graft add-on..... 632 16.48 $847.40 $453.58 $169.48
64905 T Nerve pedicle transfer. 632 16.48 $847.40 $453.58 $169.48
64907 T Nerve pedicle transfer. 632 16.48 $847.40 $453.58 $169.48
64999 T Nervous system surgery. 601 3.00 $154.26 $74.13 $30.85
65091 T Revise eye............. 684 13.26 $681.83 $341.94 $136.37
65093 T Revise eye with implant 684 13.26 $681.83 $341.94 $136.37
65101 T Removal of eye......... 684 13.26 $681.83 $341.94 $136.37
65103 T Remove eye/insert 684 13.26 $681.83 $341.94 $136.37
implant.
65105 T Remove eye/attach 684 13.26 $681.83 $341.94 $136.37
implant.
65110 C Removal of eye......... ......... ......... ......... ........... ...........
65112 C Remove eye, revise ......... ......... ......... ........... ...........
socket.
65114 C Remove eye, revise ......... ......... ......... ........... ...........
socket.
65125 T Revise ocular implant.. 681 1.65 $84.84 $30.51 $16.97
65130 T Insert ocular implant.. 684 13.26 $681.83 $341.94 $136.37
65135 T Insert ocular implant.. 684 13.26 $681.83 $341.94 $136.37
65140 T Attach ocular implant.. 684 13.26 $681.83 $341.94 $136.37
65150 T Revise ocular implant.. 684 13.26 $681.83 $341.94 $136.37
65155 T Reinsert ocular implant 684 13.26 $681.83 $341.94 $136.37
65175 T Removal of ocular 683 9.56 $491.58 $252.44 $98.32
implant.
65205 T Remove foreign body 681 1.65 $84.84 $30.51 $16.97
from eye.
65210 T Remove foreign body 681 1.65 $84.84 $30.51 $16.97
from eye.
65220 T Remove foreign body 681 1.65 $84.84 $30.51 $16.97
from eye.
65222 T Remove foreign body 681 1.65 $84.84 $30.51 $16.97
from eye.
65235 T Remove foreign body 652 16.35 $840.72 $433.92 $168.14
from eye.
65260 T Remove foreign body 676 5.87 $301.84 $138.54 $60.37
from eye.
65265 T Remove foreign body 676 5.87 $301.84 $138.54 $60.37
from eye.
65270 T Repair of eye wound.... 183 11.04 $567.68 $283.18 $113.54
65272 T Repair of eye wound.... 651 6.85 $352.23 $171.99 $70.45
65273 C Repair of eye wound.... ......... ......... ......... ........... ...........
65275 T Repair of eye wound.... 651 6.85 $352.23 $171.99 $70.45
65280 T Repair of eye wound.... 652 16.35 $840.72 $433.92 $168.14
65285 T Repair of eye wound.... 652 16.35 $840.72 $433.92 $168.14
65286 T Repair of eye wound.... 651 6.85 $352.23 $171.99 $70.45
65290 T Repair of eye socket 677 16.11 $828.38 $428.95 $165.68
wound.
65400 T Removal of eye lesion.. 652 16.35 $840.72 $433.92 $168.14
65410 T Biopsy of cornea....... 683 9.56 $491.58 $252.44 $98.32
[[Page 35336]]
65420 T Removal of eye lesion.. 651 6.85 $352.23 $171.99 $70.45
65426 T Removal of eye lesion.. 652 16.35 $840.72 $433.92 $168.14
65430 T Corneal smear.......... 681 1.65 $84.84 $30.51 $16.97
65435 T Curette/treat cornea... 681 1.65 $84.84 $30.51 $16.97
65436 T Curette/treat cornea... 651 6.85 $352.23 $171.99 $70.45
65450 T Treatment of corneal 651 6.85 $352.23 $171.99 $70.45
lesion.
65600 T Revision of cornea..... 681 1.65 $84.84 $30.51 $16.97
65710 T Corneal transplant..... 670 30.78 $1,582.71 $885.92 $316.54
65730 T Corneal transplant..... 670 30.78 $1,582.71 $885.92 $316.54
65750 T Corneal transplant..... 670 30.78 $1,582.71 $885.92 $316.54
65755 T Corneal transplant..... 670 30.78 $1,582.71 $885.92 $316.54
65760 E Revision of cornea..... ......... ......... ......... ........... ...........
65765 E Revision of cornea..... ......... ......... ......... ........... ...........
65767 E Corneal tissue ......... ......... ......... ........... ...........
transplant.
65770 T Revise cornea with 652 16.35 $840.72 $433.92 $168.14
implant.
65771 E Radial keratotomy...... ......... ......... ......... ........... ...........
65772 T Correction of 651 6.85 $352.23 $171.99 $70.45
astigmatism.
65775 T Correction of 652 16.35 $840.72 $433.92 $168.14
astigmatism.
65800 T Drainage of eye........ 683 9.56 $491.58 $252.44 $98.32
65805 T Drainage of eye........ 683 9.56 $491.58 $252.44 $98.32
65810 T Drainage of eye........ 651 6.85 $352.23 $171.99 $70.45
65815 T Drainage of eye........ 651 6.85 $352.23 $171.99 $70.45
65820 T Relieve inner eye 651 6.85 $352.23 $171.99 $70.45
pressure.
65850 T Incision of eye........ 652 16.35 $840.72 $433.92 $168.14
65855 T Laser surgery of eye... 649 4.37 $224.71 $111.64 $44.94
65860 T Incise inner eye 649 4.37 $224.71 $111.64 $44.94
adhesions.
65865 T Incise inner eye 652 16.35 $840.72 $433.92 $168.14
adhesions.
65870 T Incise inner eye 652 16.35 $840.72 $433.92 $168.14
adhesions.
65875 T Incise inner eye 652 16.35 $840.72 $433.92 $168.14
adhesions.
65880 T Incise inner eye 652 16.35 $840.72 $433.92 $168.14
adhesions.
65900 T Remove eye lesion...... 652 16.35 $840.72 $433.92 $168.14
65920 T Remove implant from eye 652 16.35 $840.72 $433.92 $168.14
65930 T Remove blood clot from 652 16.35 $840.72 $433.92 $168.14
eye.
66020 T Injection treatment of 683 9.56 $491.58 $252.44 $98.32
eye.
66030 T Injection treatment of 683 9.56 $491.58 $252.44 $98.32
eye.
66130 T Remove eye lesion...... 651 6.85 $352.23 $171.99 $70.45
66150 T Glaucoma surgery....... 652 16.35 $840.72 $433.92 $168.14
66155 T Glaucoma surgery....... 652 16.35 $840.72 $433.92 $168.14
66160 T Glaucoma surgery....... 652 16.35 $840.72 $433.92 $168.14
66165 T Glaucoma surgery....... 652 16.35 $840.72 $433.92 $168.14
66170 T Glaucoma surgery....... 652 16.35 $840.72 $433.92 $168.14
66172 T Incision of eye........ 652 16.35 $840.72 $433.92 $168.14
66180 T Implant eye shunt...... 652 16.35 $840.72 $433.92 $168.14
66185 T Revise eye shunt....... 652 16.35 $840.72 $433.92 $168.14
66220 T Repair eye lesion...... 676 5.87 $301.84 $138.54 $60.37
66225 T Repair/graft eye lesion 652 16.35 $840.72 $433.92 $168.14
66250 T Follow-up surgery of 652 16.35 $840.72 $433.92 $168.14
eye.
66500 T Incision of iris....... 651 6.85 $352.23 $171.99 $70.45
66505 T Incision of iris....... 651 6.85 $352.23 $171.99 $70.45
66600 T Remove iris and lesion. 651 6.85 $352.23 $171.99 $70.45
66605 T Removal of iris........ 652 16.35 $840.72 $433.92 $168.14
66625 T Removal of iris........ 651 6.85 $352.23 $171.99 $70.45
66630 T Removal of iris........ 651 6.85 $352.23 $171.99 $70.45
66635 T Removal of iris........ 652 16.35 $840.72 $433.92 $168.14
66680 T Repair iris & ciliary 652 16.35 $840.72 $433.92 $168.14
body.
66682 T Repair iris and ciliary 652 16.35 $840.72 $433.92 $168.14
body.
66700 T Destruction, ciliary 651 6.85 $352.23 $171.99 $70.45
body.
66710 T Destruction, ciliary 651 6.85 $352.23 $171.99 $70.45
body.
66720 T Destruction, ciliary 651 6.85 $352.23 $171.99 $70.45
body.
66740 T Destruction, ciliary 652 16.35 $840.72 $433.92 $168.14
body.
66761 T Revision of iris....... 649 4.37 $224.71 $111.64 $44.94
66762 T Revision of iris....... 649 4.37 $224.71 $111.64 $44.94
66770 T Removal of inner eye 649 4.37 $224.71 $111.64 $44.94
lesion.
66820 T Incision, secondary 651 6.85 $352.23 $171.99 $70.45
cataract.
66821 T After cataract laser 649 4.37 $224.71 $111.64 $44.94
surgery.
66825 T Reposition intraocular 651 6.85 $352.23 $171.99 $70.45
lens.
66830 T Removal of lens lesion. 652 16.35 $840.72 $433.92 $168.14
66840 T Removal of lens 667 20.35 $1,046.40 $538.11 $209.28
material.
66850 T Removal of lens 667 20.35 $1,046.40 $538.11 $209.28
material.
66852 T Removal of lens 667 20.35 $1,046.40 $538.11 $209.28
material.
66920 T Extraction of lens..... 667 20.35 $1,046.40 $538.11 $209.28
66930 T Extraction of lens..... 667 20.35 $1,046.40 $538.11 $209.28
66940 T Extraction of lens..... 667 20.35 $1,046.40 $538.11 $209.28
66983 T Remove cataract, insert 668 22.02 $1,132.27 $617.21 $226.45
lens.
66984 T Remove cataract, insert 668 22.02 $1,132.27 $617.21 $226.45
lens.
[[Page 35337]]
66985 T Insert lens prosthesis. 668 22.02 $1,132.27 $617.21 $226.45
66986 T Exchange lens 668 22.02 $1,132.27 $617.21 $226.45
prosthesis.
66999 T Eye surgery procedure.. 649 4.37 $224.71 $111.64 $44.94
67005 T Partial removal of eye 676 5.87 $301.84 $138.54 $60.37
fluid.
67010 T Partial removal of eye 676 5.87 $301.84 $138.54 $60.37
fluid.
67015 T Release of eye fluid... 676 5.87 $301.84 $138.54 $60.37
67025 T Replace eye fluid...... 683 9.56 $491.58 $252.44 $98.32
67027 T Implant eye drug system 690 30.39 $1,562.65 $845.69 $312.53
67028 T Injection eye drug..... 682 3.41 $175.34 $80.68 $35.07
67030 T Incise inner eye 676 5.87 $301.84 $138.54 $60.37
strands.
67031 T Laser surgery, eye 649 4.37 $224.71 $111.64 $44.94
strands.
67036 T Removal of inner eye 690 30.39 $1,562.65 $845.69 $312.53
fluid.
67038 T Strip retinal membrane. 690 30.39 $1,562.65 $845.69 $312.53
67039 T Laser treatment of 690 30.39 $1,562.65 $845.69 $312.53
retina.
67040 T Laser treatment of 690 30.39 $1,562.65 $845.69 $312.53
retina.
67101 T Repair, detached retina 676 5.87 $301.84 $138.54 $60.37
67105 T Repair, detached retina 648 3.76 $193.34 $93.56 $38.67
67107 T Repair detached retina. 690 30.39 $1,562.65 $845.69 $312.53
67108 T Repair detached retina. 690 30.39 $1,562.65 $845.69 $312.53
67110 T Repair detached retina. 676 5.87 $301.84 $138.54 $60.37
67112 T Re-repair detached 690 30.39 $1,562.65 $845.69 $312.53
retina.
67115 T Release, encircling 676 5.87 $301.84 $138.54 $60.37
material.
67120 T Remove eye implant 676 5.87 $301.84 $138.54 $60.37
material.
67121 T Remove eye implant 676 5.87 $301.84 $138.54 $60.37
material.
67141 T Treatment of retina.... 676 5.87 $301.84 $138.54 $60.37
67145 T Treatment of retina.... 648 3.76 $193.34 $93.56 $38.67
67208 T Treatment of retinal 676 5.87 $301.84 $138.54 $60.37
lesion.
67210 T Treatment of retinal 648 3.76 $193.34 $93.56 $38.67
lesion.
67218 T Treatment of retinal 676 5.87 $301.84 $138.54 $60.37
lesion.
67227 T Treatment of retinal 676 5.87 $301.84 $138.54 $60.37
lesion.
67228 T Treatment of retinal 648 3.76 $193.34 $93.56 $38.67
lesion.
67250 T Reinforce eye wall..... 684 13.26 $681.83 $341.94 $136.37
67255 T Reinforce/graft eye 684 13.26 $681.83 $341.94 $136.37
wall.
67299 T Eye surgery procedure.. 649 4.37 $224.71 $111.64 $44.94
67311 T Revise eye muscle...... 677 16.11 $828.38 $428.95 $165.68
67312 T Revise two eye muscles. 677 16.11 $828.38 $428.95 $165.68
67314 T Revise eye muscle...... 677 16.11 $828.38 $428.95 $165.68
67316 T Revise two eye muscles. 677 16.11 $828.38 $428.95 $165.68
67318 T Revise eye muscle(s)... 677 16.11 $828.38 $428.95 $165.68
67320 T Revise eye muscle(s) 677 16.11 $828.38 $428.95 $165.68
add-on.
67331 T Eye surgery follow-up 677 16.11 $828.38 $428.95 $165.68
add-on.
67332 T Rerevise eye muscles 677 16.11 $828.38 $428.95 $165.68
add-on.
67334 T Revise eye muscle w/ 677 16.11 $828.38 $428.95 $165.68
suture.
67335 T Eye suture during 677 16.11 $828.38 $428.95 $165.68
surgery.
67340 T Revise eye muscle add- 677 16.11 $828.38 $428.95 $165.68
on.
67343 T Release eye tissue..... 677 16.11 $828.38 $428.95 $165.68
67345 T Destroy nerve of eye 681 1.65 $84.84 $30.51 $16.97
muscle.
67350 T Biopsy eye muscle...... 162 5.59 $287.44 $125.66 $57.49
67399 T Eye muscle surgery 162 5.59 $287.44 $125.66 $57.49
procedure.
67400 T Explore/biopsy eye 684 13.26 $681.83 $341.94 $136.37
socket.
67405 T Explore/drain eye 684 13.26 $681.83 $341.94 $136.37
socket.
67412 T Explore/treat eye 684 13.26 $681.83 $341.94 $136.37
socket.
67413 T Explore/treat eye 684 13.26 $681.83 $341.94 $136.37
socket.
67414 C Explore/decompress eye ......... ......... ......... ........... ...........
socke.
67415 T Aspiration orbital 122 4.59 $236.02 $113.00 $47.20
contents.
67420 T Explore/treat eye 232 23.82 $1,224.82 $636.87 $244.96
socket.
67430 T Explore/treat eye 232 23.82 $1,224.82 $636.87 $244.96
socket.
67440 T Explore/drain eye 232 23.82 $1,224.82 $636.87 $244.96
socket.
67445 C Explore/decompress eye ......... ......... ......... ........... ...........
socke.
67450 T Explore/biopsy eye 232 23.82 $1,224.82 $636.87 $244.96
socket.
67500 T Inject/treat eye socket 681 1.65 $84.84 $30.51 $16.97
67505 T Inject/treat eye socket 681 1.65 $84.84 $30.51 $16.97
67515 T Inject/treat eye socket 681 1.65 $84.84 $30.51 $16.97
67550 T Insert eye socket 684 13.26 $681.83 $341.94 $136.37
implant.
67560 T Revise eye socket 684 13.26 $681.83 $341.94 $136.37
implant.
67570 C Decompress optic nerve. ......... ......... ......... ........... ...........
67599 T Orbit surgery procedure 681 1.65 $84.84 $30.51 $16.97
67700 T Drainage of eyelid 682 3.41 $175.34 $80.68 $35.07
abscess.
67710 T Incision of eyelid..... 682 3.41 $175.34 $80.68 $35.07
67715 T Incision of eyelid fold 683 9.56 $491.58 $252.44 $98.32
67800 T Remove eyelid lesion... 682 3.41 $175.34 $80.68 $35.07
67801 T Remove eyelid lesions.. 682 3.41 $175.34 $80.68 $35.07
67805 T Remove eyelid lesions.. 682 3.41 $175.34 $80.68 $35.07
67808 T Remove eyelid lesion(s) 684 13.26 $681.83 $341.94 $136.37
67810 T Biopsy of eyelid....... 682 3.41 $175.34 $80.68 $35.07
[[Page 35338]]
67820 T Revise eyelashes....... 682 3.41 $175.34 $80.68 $35.07
67825 T Revise eyelashes....... 682 3.41 $175.34 $80.68 $35.07
67830 T Revise eyelashes....... 683 9.56 $491.58 $252.44 $98.32
67835 T Revise eyelashes....... 684 13.26 $681.83 $341.94 $136.37
67840 T Remove eyelid lesion... 682 3.41 $175.34 $80.68 $35.07
67850 T Treat eyelid lesion.... 682 3.41 $175.34 $80.68 $35.07
67875 T Closure of eyelid by 682 3.41 $175.34 $80.68 $35.07
suture.
67880 T Revision of eyelid..... 683 9.56 $491.58 $252.44 $98.32
67882 T Revision of eyelid..... 684 13.26 $681.83 $341.94 $136.37
67900 T Repair brow defect..... 684 13.26 $681.83 $341.94 $136.37
67901 T Repair eyelid defect... 684 13.26 $681.83 $341.94 $136.37
67902 T Repair eyelid defect... 684 13.26 $681.83 $341.94 $136.37
67903 T Repair eyelid defect... 684 13.26 $681.83 $341.94 $136.37
67904 T Repair eyelid defect... 684 13.26 $681.83 $341.94 $136.37
67906 T Repair eyelid defect... 684 13.26 $681.83 $341.94 $136.37
67908 T Repair eyelid defect... 684 13.26 $681.83 $341.94 $136.37
67909 T Revise eyelid defect... 684 13.26 $681.83 $341.94 $136.37
67911 T Revise eyelid defect... 684 13.26 $681.83 $341.94 $136.37
67914 T Repair eyelid defect... 684 13.26 $681.83 $341.94 $136.37
67915 T Repair eyelid defect... 682 3.41 $175.34 $80.68 $35.07
67916 T Repair eyelid defect... 684 13.26 $681.83 $341.94 $136.37
67917 T Repair eyelid defect... 684 13.26 $681.83 $341.94 $136.37
67921 T Repair eyelid defect... 684 13.26 $681.83 $341.94 $136.37
67922 T Repair eyelid defect... 682 3.41 $175.34 $80.68 $35.07
67923 T Repair eyelid defect... 684 13.26 $681.83 $341.94 $136.37
67924 T Repair eyelid defect... 684 13.26 $681.83 $341.94 $136.37
67930 T Repair eyelid wound.... 682 3.41 $175.34 $80.68 $35.07
67935 T Repair eyelid wound.... 683 9.56 $491.58 $252.44 $98.32
67938 T Remove eyelid foreign 682 3.41 $175.34 $80.68 $35.07
body.
67950 T Revision of eyelid..... 684 13.26 $681.83 $341.94 $136.37
67961 T Revision of eyelid..... 684 13.26 $681.83 $341.94 $136.37
67966 T Revision of eyelid..... 684 13.26 $681.83 $341.94 $136.37
67971 T Reconstruction of 684 13.26 $681.83 $341.94 $136.37
eyelid.
67973 T Reconstruction of 684 13.26 $681.83 $341.94 $136.37
eyelid.
67974 T Reconstruction of 684 13.26 $681.83 $341.94 $136.37
eyelid.
67975 T Reconstruction of 684 13.26 $681.83 $341.94 $136.37
eyelid.
67999 T Revision of eyelid..... 682 3.41 $175.34 $80.68 $35.07
68020 T Incise/drain eyelid 682 3.41 $175.34 $80.68 $35.07
lining.
68040 T Treatment of eyelid 682 3.41 $175.34 $80.68 $35.07
lesions.
68100 T Biopsy of eyelid lining 162 5.59 $287.44 $125.66 $57.49
68110 T Remove eyelid lining 162 5.59 $287.44 $125.66 $57.49
lesion.
68115 T Remove eyelid lining 162 5.59 $287.44 $125.66 $57.49
lesion.
68130 T Remove eyelid lining 652 16.35 $840.72 $433.92 $168.14
lesion.
68135 T Remove eyelid lining 162 5.59 $287.44 $125.66 $57.49
lesion.
68200 T Treat eyelid by 681 1.65 $84.84 $30.51 $16.97
injection.
68320 T Revise/graft eyelid 684 13.26 $681.83 $341.94 $136.37
lining.
68325 T Revise/graft eyelid 684 13.26 $681.83 $341.94 $136.37
lining.
68326 T Revise/graft eyelid 684 13.26 $681.83 $341.94 $136.37
lining.
68328 T Revise/graft eyelid 684 13.26 $681.83 $341.94 $136.37
lining.
68330 T Revise eyelid lining... 652 16.35 $840.72 $433.92 $168.14
68335 T Revise/graft eyelid 684 13.26 $681.83 $341.94 $136.37
lining.
68340 T Separate eyelid 684 13.26 $681.83 $341.94 $136.37
adhesions.
68360 T Revise eyelid lining... 652 16.35 $840.72 $433.92 $168.14
68362 T Revise eyelid lining... 652 16.35 $840.72 $433.92 $168.14
68399 T Eyelid lining surgery.. 162 5.59 $287.44 $125.66 $57.49
68400 T Incise/drain tear gland 682 3.41 $175.34 $80.68 $35.07
68420 T Incise/drain tear sac.. 682 3.41 $175.34 $80.68 $35.07
68440 T Incise tear duct 682 3.41 $175.34 $80.68 $35.07
opening.
68500 T Removal of tear gland.. 684 13.26 $681.83 $341.94 $136.37
68505 T Partial removal tear 684 13.26 $681.83 $341.94 $136.37
gland.
68510 T Biopsy of tear gland... 683 9.56 $491.58 $252.44 $98.32
68520 T Removal of tear sac.... 684 13.26 $681.83 $341.94 $136.37
68525 T Biopsy of tear sac..... 683 9.56 $491.58 $252.44 $98.32
68530 T Clearance of tear duct. 682 3.41 $175.34 $80.68 $35.07
68540 T Remove tear gland 684 13.26 $681.83 $341.94 $136.37
lesion.
68550 T Remove tear gland 684 13.26 $681.83 $341.94 $136.37
lesion.
68700 T Repair tear ducts...... 684 13.26 $681.83 $341.94 $136.37
68705 T Revise tear duct 682 3.41 $175.34 $80.68 $35.07
opening.
68720 T Create tear sac drain.. 684 13.26 $681.83 $341.94 $136.37
68745 T Create tear duct drain. 684 13.26 $681.83 $341.94 $136.37
68750 T Create tear duct drain. 684 13.26 $681.83 $341.94 $136.37
68760 T Close tear duct opening 682 3.41 $175.34 $80.68 $35.07
68761 T Close tear duct opening 681 1.65 $84.84 $30.51 $16.97
68770 T Close tear system 684 13.26 $681.83 $341.94 $136.37
fistula.
\2\ 6880 T Dilate tear duct 682 3.41 $175.34 $80.68 $35.07
0 opening(s).
[[Page 35339]]
68801 T Dilate tear duct 682 3.41 $175.34 $80.68 $35.07
opening.
68810 T Probe nasolacrimal duct 683 9.56 $491.58 $252.44 $98.32
68811 T Probe nasolacrimal duct 684 13.26 $681.83 $341.94 $136.37
68815 T Probe nasolacrimal duct 684 13.26 $681.83 $341.94 $136.37
\2\ 6882 T Explore tear duct 683 9.56 $491.58 $252.44 $98.32
0 system.
\2\ 6882 T Explore tear duct 683 9.56 $491.58 $252.44 $98.32
5 system.
\2\ 6883 T Reopen tear duct 683 9.56 $491.58 $252.44 $98.32
0 channel.
68840 T Explore/irrigate tear 682 3.41 $175.34 $80.68 $35.07
ducts.
68850 T Injection for tear sac 347 2.57 $132.15 $62.38 $26.43
x-ray.
68899 T Tear duct system 681 1.65 $84.84 $30.51 $16.97
surgery.
69000 T Drain external ear 131 1.93 $99.24 $36.61 $19.85
lesion.
69005 T Drain external ear 131 1.93 $99.24 $36.61 $19.85
lesion.
69020 T Drain outer ear canal 131 1.93 $99.24 $36.61 $19.85
lesion.
69090 E Pierce earlobes........ ......... ......... ......... ........... ...........
69100 T Biopsy of external ear. 161 3.43 $176.37 $75.71 $35.27
69105 T Biopsy of external ear 161 3.43 $176.37 $75.71 $35.27
canal.
69110 T Partial removal 163 10.48 $538.88 $260.80 $107.78
external ear.
69120 T Removal of external ear 313 15.46 $794.95 $407.70 $158.99
69140 T Remove ear canal 313 15.46 $794.95 $407.70 $158.99
lesion(s).
69145 T Remove ear canal 163 10.48 $538.88 $260.80 $107.78
lesion(s).
69150 T Extensive ear canal 314 25.15 $1,293.21 $687.72 $258.64
surgery.
69155 C Extensive ear/neck ......... ......... ......... ........... ...........
surgery.
69200 T Clear outer ear canal.. 311 1.41 $72.50 $20.57 $14.50
69205 T Clear outer ear canal.. 163 10.48 $538.88 $260.80 $107.78
69210 T Remove impacted ear wax 311 1.41 $72.50 $20.57 $14.50
69220 T Clean out mastoid 151 1.63 $83.81 $33.22 $16.76
cavity.
69222 T Clean out mastoid 311 1.41 $72.50 $20.57 $14.50
cavity.
69300 T Revise external ear.... 313 15.46 $794.95 $407.70 $158.99
69310 T Rebuild outer ear canal 314 25.15 $1,293.21 $687.72 $258.64
69320 T Rebuild outer ear canal 314 25.15 $1,293.21 $687.72 $258.64
69399 T Outer ear surgery 311 1.41 $72.50 $20.57 $14.50
procedure.
69400 T Inflate middle ear 311 1.41 $72.50 $20.57 $14.50
canal.
69401 N Inflate middle ear ......... ......... ......... ........... ...........
canal.
69405 T Catheterize middle ear 311 1.41 $72.50 $20.57 $14.50
canal.
69410 T Inset middle ear baffle 311 1.41 $72.50 $20.57 $14.50
69420 T Incision of eardrum.... 311 1.41 $72.50 $20.57 $14.50
69421 T Incision of eardrum.... 312 7.07 $363.54 $170.86 $72.71
69424 T Remove ventilating tube 311 1.41 $72.50 $20.57 $14.50
69433 T Create eardrum opening. 312 7.07 $363.54 $170.86 $72.71
69436 T Create eardrum opening. 312 7.07 $363.54 $170.86 $72.71
69440 T Exploration of middle 313 15.46 $794.95 $407.70 $158.99
ear.
69450 T Eardrum revision....... 313 15.46 $794.95 $407.70 $158.99
69501 T Mastoidectomy.......... 314 25.15 $1,293.21 $687.72 $258.64
69502 T Mastoidectomy.......... 314 25.15 $1,293.21 $687.72 $258.64
69505 T Remove mastoid 314 25.15 $1,293.21 $687.72 $258.64
structures.
69511 T Extensive mastoid 314 25.15 $1,293.21 $687.72 $258.64
surgery.
69530 T Extensive mastoid 314 25.15 $1,293.21 $687.72 $258.64
surgery.
69535 C Remove part of temporal ......... ......... ......... ........... ...........
bone.
69540 T Remove ear lesion...... 311 1.41 $72.50 $20.57 $14.50
69550 T Remove ear lesion...... 314 25.15 $1,293.21 $687.72 $258.64
69552 T Remove ear lesion...... 314 25.15 $1,293.21 $687.72 $258.64
69554 C Remove ear lesion...... ......... ......... ......... ........... ...........
69601 T Mastoid surgery 314 25.15 $1,293.21 $687.72 $258.64
revision.
69602 T Mastoid surgery 314 25.15 $1,293.21 $687.72 $258.64
revision.
69603 T Mastoid surgery 314 25.15 $1,293.21 $687.72 $258.64
revision.
69604 T Mastoid surgery 314 25.15 $1,293.21 $687.72 $258.64
revision.
69605 T Mastoid surgery 314 25.15 $1,293.21 $687.72 $258.64
revision.
69610 T Repair of eardrum...... 311 1.41 $72.50 $20.57 $14.50
69620 T Repair of eardrum...... 313 15.46 $794.95 $407.70 $158.99
69631 T Repair eardrum 314 25.15 $1,293.21 $687.72 $258.64
structures.
69632 T Rebuild eardrum 314 25.15 $1,293.21 $687.72 $258.64
structures.
69633 T Rebuild eardrum 314 25.15 $1,293.21 $687.72 $258.64
structures.
69635 T Repair eardrum 314 25.15 $1,293.21 $687.72 $258.64
structures.
69636 T Rebuild eardrum 314 25.15 $1,293.21 $687.72 $258.64
structures.
69637 T Rebuild eardrum 314 25.15 $1,293.21 $687.72 $258.64
structures.
69641 T Revise middle ear & 314 25.15 $1,293.21 $687.72 $258.64
mastoid.
69642 T Revise middle ear & 314 25.15 $1,293.21 $687.72 $258.64
mastoid.
69643 T Revise middle ear & 314 25.15 $1,293.21 $687.72 $258.64
mastoid.
69644 T Revise middle ear & 314 25.15 $1,293.21 $687.72 $258.64
mastoid.
69645 T Revise middle ear & 314 25.15 $1,293.21 $687.72 $258.64
mastoid.
69646 T Revise middle ear & 314 25.15 $1,293.21 $687.72 $258.64
mastoid.
69650 T Release middle ear bone 314 25.15 $1,293.21 $687.72 $258.64
69660 T Revise middle ear bone. 314 25.15 $1,293.21 $687.72 $258.64
69661 T Revise middle ear bone. 314 25.15 $1,293.21 $687.72 $258.64
69662 T Revise middle ear bone. 314 25.15 $1,293.21 $687.72 $258.64
[[Page 35340]]
69666 T Repair middle ear 314 25.15 $1,293.21 $687.72 $258.64
structures.
69667 T Repair middle ear 314 25.15 $1,293.21 $687.72 $258.64
structures.
69670 T Remove mastoid air 314 25.15 $1,293.21 $687.72 $258.64
cells.
69676 T Remove middle ear nerve 314 25.15 $1,293.21 $687.72 $258.64
69700 T Close mastoid fistula.. 314 25.15 $1,293.21 $687.72 $258.64
69710 E Implant/replace hearing ......... ......... ......... ........... ...........
aid.
69711 T Remove/repair hearing 314 25.15 $1,293.21 $687.72 $258.64
aid.
69720 T Release facial nerve... 314 25.15 $1,293.21 $687.72 $258.64
69725 T Release facial nerve... 314 25.15 $1,293.21 $687.72 $258.64
69740 T Repair facial nerve.... 314 25.15 $1,293.21 $687.72 $258.64
69745 T Repair facial nerve.... 314 25.15 $1,293.21 $687.72 $258.64
69799 T Middle ear surgery 311 1.41 $72.50 $20.57 $14.50
procedure.
69801 T Incise inner ear....... 314 25.15 $1,293.21 $687.72 $258.64
69802 T Incise inner ear....... 314 25.15 $1,293.21 $687.72 $258.64
69805 T Explore inner ear...... 314 25.15 $1,293.21 $687.72 $258.64
69806 T Explore inner ear...... 314 25.15 $1,293.21 $687.72 $258.64
69820 T Establish inner ear 314 25.15 $1,293.21 $687.72 $258.64
window.
69840 T Revise inner ear window 314 25.15 $1,293.21 $687.72 $258.64
69905 T Remove inner ear....... 314 25.15 $1,293.21 $687.72 $258.64
69910 T Remove inner ear & 314 25.15 $1,293.21 $687.72 $258.64
mastoid.
69915 T Incise inner ear nerve. 314 25.15 $1,293.21 $687.72 $258.64
69930 T Implant cochlear device 317 ......... ......... ........... ...........
69949 T Inner ear surgery 314 25.15 $1,293.21 $687.72 $258.64
procedure.
69950 C Incise inner ear nerve. ......... ......... ......... ........... ...........
69955 C Release facial nerve... ......... ......... ......... ........... ...........
69960 C Release inner ear canal ......... ......... ......... ........... ...........
69970 C Remove inner ear lesion ......... ......... ......... ........... ...........
69979 C Temporal bone surgery.. ......... ......... ......... ........... ...........
70010 S Contrast x-ray of brain 728 3.50 $179.97 $91.98 $35.99
70015 S Contrast x-ray of brain 728 3.50 $179.97 $91.98 $35.99
70030 X X-ray eye for foreign 700 0.80 $41.14 $22.37 $8.23
body.
70100 X X-ray exam of jaw...... 700 0.80 $41.14 $22.37 $8.23
70110 X X-ray exam of jaw...... 700 0.80 $41.14 $22.37 $8.23
70120 X X-ray exam of mastoids. 700 0.80 $41.14 $22.37 $8.23
70130 X X-ray exam of mastoids. 700 0.80 $41.14 $22.37 $8.23
70134 X X-ray exam of middle 700 0.80 $41.14 $22.37 $8.23
ear.
70140 X X-ray exam of facial 700 0.80 $41.14 $22.37 $8.23
bones.
70150 X X-ray exam of facial 700 0.80 $41.14 $22.37 $8.23
bones.
70160 X X-ray exam of nasal 700 0.80 $41.14 $22.37 $8.23
bones.
70170 X X-ray exam of tear duct 706 1.43 $73.53 $39.10 $14.71
70190 X X-ray exam of eye 700 0.80 $41.14 $22.37 $8.23
sockets.
70200 X X-ray exam of eye 700 0.80 $41.14 $22.37 $8.23
sockets.
70210 X X-ray exam of sinuses.. 700 0.80 $41.14 $22.37 $8.23
70220 X X-ray exam of sinuses.. 700 0.80 $41.14 $22.37 $8.23
70240 X X-ray exam pituitary 700 0.80 $41.14 $22.37 $8.23
saddle.
70250 X X-ray exam of skull.... 700 0.80 $41.14 $22.37 $8.23
70260 X X-ray exam of skull.... 700 0.80 $41.14 $22.37 $8.23
70300 X X-ray exam of teeth.... 700 0.80 $41.14 $22.37 $8.23
70310 X X-ray exam of teeth.... 700 0.80 $41.14 $22.37 $8.23
70320 X Full mouth x-ray of 700 0.80 $41.14 $22.37 $8.23
teeth.
70328 X X-ray exam of jaw joint 700 0.80 $41.14 $22.37 $8.23
70330 X X-ray exam of jaw 700 0.80 $41.14 $22.37 $8.23
joints.
70332 S X-ray exam of jaw joint 730 2.30 $118.27 $65.77 $23.65
70336 S Magnetic image jaw 726 7.91 $406.73 $256.06 $81.35
joint.
70350 X X-ray head for 700 0.80 $41.14 $22.37 $8.23
orthodontia.
70355 X Panoramic x-ray of jaws 700 0.80 $41.14 $22.37 $8.23
70360 X X-ray exam of neck..... 700 0.80 $41.14 $22.37 $8.23
70370 X Throat x-ray & 716 1.39 $71.47 $40.00 $14.29
fluoroscopy.
70371 X Speech evaluation, 716 1.39 $71.47 $40.00 $14.29
complex.
70373 X Contrast x-ray of 706 1.43 $73.53 $39.10 $14.71
larynx.
70380 X X-ray exam of salivary 700 0.80 $41.14 $22.37 $8.23
gland.
70390 X X-ray exam of salivary 706 1.43 $73.53 $39.10 $14.71
duct.
70450 S CAT scan of head or 710 4.98 $256.07 $173.12 $51.21
brain.
70460 S Contrast CAT scan of 710 4.98 $256.07 $173.12 $51.21
head.
70470 S Contrast CAT scans of 710 4.98 $256.07 $173.12 $51.21
head.
70480 S CAT scan of skull...... 710 4.98 $256.07 $173.12 $51.21
70481 S Contrast CAT scan of 710 4.98 $256.07 $173.12 $51.21
skull.
70482 S Contrast CAT scans of 710 4.98 $256.07 $173.12 $51.21
skull.
70486 S CAT scan of face, jaw.. 710 4.98 $256.07 $173.12 $51.21
70487 S Contrast CAT scan, face/ 710 4.98 $256.07 $173.12 $51.21
jaw.
70488 S Contrast CAT scans face/ 710 4.98 $256.07 $173.12 $51.21
jaw.
70490 S CAT scan of neck tissue 710 4.98 $256.07 $173.12 $51.21
70491 S Contrast CAT of neck 710 4.98 $256.07 $173.12 $51.21
tissue.
70492 S Contrast CAT of neck 710 4.98 $256.07 $173.12 $51.21
tissue.
70540 S Magnetic image, face, 726 7.91 $406.73 $256.06 $81.35
neck.
[[Page 35341]]
70541 S Magnetic image, head 720 6.37 $327.55 $204.98 $65.51
(MRA).
70551 S Magnetic image, brain 726 7.91 $406.73 $256.06 $81.35
(MRI).
70552 S Magnetic image, brain 726 7.91 $406.73 $256.06 $81.35
(MRI).
70553 S Magnetic image, brain.. 726 7.91 $406.73 $256.06 $81.35
71010 X Chest x-ray............ 700 0.80 $41.14 $22.37 $8.23
71015 X X-ray exam of chest.... 700 0.80 $41.14 $22.37 $8.23
71020 X Chest x-ray............ 700 0.80 $41.14 $22.37 $8.23
71021 X Chest x-ray............ 700 0.80 $41.14 $22.37 $8.23
71022 X Chest x-ray............ 700 0.80 $41.14 $22.37 $8.23
71023 X Chest x-ray and 716 1.39 $71.47 $40.00 $14.29
fluoroscopy.
71030 X Chest x-ray............ 700 0.80 $41.14 $22.37 $8.23
71034 X Chest x-ray & 716 1.39 $71.47 $40.00 $14.29
fluoroscopy.
71035 X Chest x-ray............ 700 0.80 $41.14 $22.37 $8.23
71036 X X-ray guidance for 716 1.39 $71.47 $40.00 $14.29
biopsy.
\2\ 7103 X X-ray guidance for 716 1.39 $71.47 $40.00 $14.29
8 biopsy.
71040 X Contrast x-ray of 706 1.43 $73.53 $39.10 $14.71
bronchi.
71060 X Contrast x-ray of 706 1.43 $73.53 $39.10 $14.71
bronchi.
71090 X X-ray & pacemaker 716 1.39 $71.47 $40.00 $14.29
insertion.
71100 X X-ray exam of ribs..... 700 0.80 $41.14 $22.37 $8.23
71101 X X-ray exam of ribs, 700 0.80 $41.14 $22.37 $8.23
chest.
71110 X X-ray exam of ribs..... 700 0.80 $41.14 $22.37 $8.23
71111 X X-ray exam of ribs, 700 0.80 $41.14 $22.37 $8.23
chest.
71120 X X-ray exam of 700 0.80 $41.14 $22.37 $8.23
breastbone.
71130 X X-ray exam of 700 0.80 $41.14 $22.37 $8.23
breastbone.
71250 S Cat scan of chest...... 710 4.98 $256.07 $173.12 $51.21
71260 S Contrast CAT scan of 710 4.98 $256.07 $173.12 $51.21
chest.
71270 S Contrast CAT scans of 710 4.98 $256.07 $173.12 $51.21
chest.
71550 S Magnetic image, chest.. 726 7.91 $406.73 $256.06 $81.35
71555 E Magnetic imaging/chest ......... ......... ......... ........... ...........
(MRA).
72010 X X-ray exam of spine.... 700 0.80 $41.14 $22.37 $8.23
72020 X X-ray exam of spine.... 700 0.80 $41.14 $22.37 $8.23
72040 X X-ray exam of neck 700 0.80 $41.14 $22.37 $8.23
spine.
72050 X X-ray exam of neck 700 0.80 $41.14 $22.37 $8.23
spine.
72052 X X-ray exam of neck 700 0.80 $41.14 $22.37 $8.23
spine.
72069 X X-ray exam of trunk 700 0.80 $41.14 $22.37 $8.23
spine.
72070 X X-ray exam of thorax 700 0.80 $41.14 $22.37 $8.23
spine.
72072 X X-ray exam of thoracic 700 0.80 $41.14 $22.37 $8.23
spine.
72074 X X-ray exam of thoracic 700 0.80 $41.14 $22.37 $8.23
spine.
72080 X X-ray exam of trunk 700 0.80 $41.14 $22.37 $8.23
spine.
72090 X X-ray exam of trunk 700 0.80 $41.14 $22.37 $8.23
spine.
72100 X X-ray exam of lower 700 0.80 $41.14 $22.37 $8.23
spine.
72110 X X-ray exam of lower 700 0.80 $41.14 $22.37 $8.23
spine.
72114 X X-ray exam of lower 700 0.80 $41.14 $22.37 $8.23
spine.
72120 X X-ray exam of lower 700 0.80 $41.14 $22.37 $8.23
spine.
72125 S CAT scan of neck spine. 710 4.98 $256.07 $173.12 $51.21
72126 S Contrast CAT scan of 710 4.98 $256.07 $173.12 $51.21
neck.
72127 S Contrast CAT scans of 710 4.98 $256.07 $173.12 $51.21
neck.
72128 S CAT scan of thorax 710 4.98 $256.07 $173.12 $51.21
spine.
72129 S Contrast CAT scan of 710 4.98 $256.07 $173.12 $51.21
thorax.
72130 S Contrast CAT scans of 710 4.98 $256.07 $173.12 $51.21
thorax.
72131 S CAT scan of lower spine 710 4.98 $256.07 $173.12 $51.21
72132 S Contrast CAT of lower 710 4.98 $256.07 $173.12 $51.21
spine.
72133 S Contrast CAT scans,low 710 4.98 $256.07 $173.12 $51.21
spine.
72141 S Magnetic image, neck 726 7.91 $406.73 $256.06 $81.35
spine.
72142 S Magnetic image, neck 726 7.91 $406.73 $256.06 $81.35
spine.
72146 S Magnetic image, chest 726 7.91 $406.73 $256.06 $81.35
spine.
72147 S Magnetic image, chest 726 7.91 $406.73 $256.06 $81.35
spine.
72148 S Magnetic image, lumbar 726 7.91 $406.73 $256.06 $81.35
spine.
72149 S Magnetic image, lumbar 726 7.91 $406.73 $256.06 $81.35
spine.
72156 S Magnetic image, neck 726 7.91 $406.73 $256.06 $81.35
spine.
72157 S Magnetic image, chest 726 7.91 $406.73 $256.06 $81.35
spine.
72158 S Magnetic image, lumbar 726 7.91 $406.73 $256.06 $81.35
spine.
72159 E Magnetic imaging/spine ......... ......... ......... ........... ...........
(MRA).
72170 X X-ray exam of pelvis... 700 0.80 $41.14 $22.37 $8.23
72190 X X-ray exam of pelvis... 700 0.80 $41.14 $22.37 $8.23
72192 S CAT scan of pelvis..... 710 4.98 $256.07 $173.12 $51.21
72193 S Contrast CAT scan of 710 4.98 $256.07 $173.12 $51.21
pelvis.
72194 S Contrast CAT scans of 710 4.98 $256.07 $173.12 $51.21
pelvis.
72196 S Magnetic image, pelvis. 726 7.91 $406.73 $256.06 $81.35
72198 E Magnetic imaging/ ......... ......... ......... ........... ...........
pelvis(MRA).
72200 X X-ray exam sacroiliac 700 0.80 $41.14 $22.37 $8.23
joints.
72202 X X-ray exam sacroiliac 700 0.80 $41.14 $22.37 $8.23
joints.
72220 X X-ray exam of tailbone. 700 0.80 $41.14 $22.37 $8.23
72240 S Contrast x-ray of neck 728 3.50 $179.97 $91.98 $35.99
spine.
72255 S Contrast x-ray thorax 728 3.50 $179.97 $91.98 $35.99
spine.
[[Page 35342]]
72265 S Contrast x-ray lower 728 3.50 $179.97 $91.98 $35.99
spine.
72270 S Contrast x-ray of spine 728 3.50 $179.97 $91.98 $35.99
72285 S X-ray of neck spine 728 3.50 $179.97 $91.98 $35.99
disk.
72295 S X-ray of lower spine 728 3.50 $179.97 $91.98 $35.99
disk.
73000 X X-ray exam of 700 0.80 $41.14 $22.37 $8.23
collarbone.
73010 X X-ray exam of shoulder 700 0.80 $41.14 $22.37 $8.23
blade.
73020 X X-ray exam of shoulder. 700 0.80 $41.14 $22.37 $8.23
73030 X X-ray exam of shoulder. 700 0.80 $41.14 $22.37 $8.23
73040 S Contrast x-ray of 730 2.30 $118.27 $65.77 $23.65
shoulder.
73050 X X-ray exam of shoulders 700 0.80 $41.14 $22.37 $8.23
73060 X X-ray exam of humerus.. 700 0.80 $41.14 $22.37 $8.23
73070 X X-ray exam of elbow.... 700 0.80 $41.14 $22.37 $8.23
73080 X X-ray exam of elbow.... 700 0.80 $41.14 $22.37 $8.23
73085 S Contrast x-ray of elbow 730 2.30 $118.27 $65.77 $23.65
73090 X X-ray exam of forearm.. 700 0.80 $41.14 $22.37 $8.23
73092 X X-ray exam of arm, 700 0.80 $41.14 $22.37 $8.23
infant.
73100 X X-ray exam of wrist.... 700 0.80 $41.14 $22.37 $8.23
73110 X X-ray exam of wrist.... 700 0.80 $41.14 $22.37 $8.23
73115 S Contrast x-ray of wrist 730 2.30 $118.27 $65.77 $23.65
73120 X X-ray exam of hand..... 700 0.80 $41.14 $22.37 $8.23
73130 X X-ray exam of hand..... 700 0.80 $41.14 $22.37 $8.23
73140 X X-ray exam of finger(s) 700 0.80 $41.14 $22.37 $8.23
73200 S CAT scan of arm........ 710 4.98 $256.07 $173.12 $51.21
73201 S Contrast CAT scan of 710 4.98 $256.07 $173.12 $51.21
arm.
73202 S Contrast CAT scans of 710 4.98 $256.07 $173.12 $51.21
arm.
73220 S Magnetic image, arm, 726 7.91 $406.73 $256.06 $81.35
hand.
73221 S Magnetic image, joint 726 7.91 $406.73 $256.06 $81.35
of arm.
73225 E Magnetic imaging/upper ......... ......... ......... ........... ...........
(MRA).
73500 X X-ray exam of hip...... 700 0.80 $41.14 $22.37 $8.23
73510 X X-ray exam of hip...... 700 0.80 $41.14 $22.37 $8.23
73520 X X-ray exam of hips..... 700 0.80 $41.14 $22.37 $8.23
73525 S Contrast x-ray of hip.. 730 2.30 $118.27 $65.77 $23.65
73530 X X-ray exam of hip...... 700 0.80 $41.14 $22.37 $8.23
73540 X X-ray exam of pelvis & 700 0.80 $41.14 $22.37 $8.23
hips.
73550 X X-ray exam of thigh.... 700 0.80 $41.14 $22.37 $8.23
73560 X X-ray exam of knee, 1 700 0.80 $41.14 $22.37 $8.23
or 2.
73562 X X-ray exam of knee, 3.. 700 0.80 $41.14 $22.37 $8.23
73564 X X-ray exam of knee, 4+. 700 0.80 $41.14 $22.37 $8.23
73565 X X-ray exam of knee..... 700 0.80 $41.14 $22.37 $8.23
73580 S Contrast x-ray of knee 730 2.30 $118.27 $65.77 $23.65
joint.
73590 X X-ray exam of lower leg 700 0.80 $41.14 $22.37 $8.23
73592 X X-ray exam of leg, 700 0.80 $41.14 $22.37 $8.23
infant.
73600 X X-ray exam of ankle.... 700 0.80 $41.14 $22.37 $8.23
73610 X X-ray exam of ankle.... 700 0.80 $41.14 $22.37 $8.23
73615 S Contrast x-ray of ankle 730 2.30 $118.27 $65.77 $23.65
73620 X X-ray exam of foot..... 700 0.80 $41.14 $22.37 $8.23
73630 X X-ray exam of foot..... 700 0.80 $41.14 $22.37 $8.23
73650 X X-ray exam of heel..... 700 0.80 $41.14 $22.37 $8.23
73660 X X-ray exam of toe(s)... 700 0.80 $41.14 $22.37 $8.23
73700 S CAT scan of leg........ 710 4.98 $256.07 $173.12 $51.21
73701 S Contrast CAT scan of 710 4.98 $256.07 $173.12 $51.21
leg.
73702 S Contrast CAT scans of 710 4.98 $256.07 $173.12 $51.21
leg.
73720 S Magnetic image, leg, 726 7.91 $406.73 $256.06 $81.35
foot.
73721 S Magnetic image, joint 726 7.91 $406.73 $256.06 $81.35
of leg.
73725 E Magnetic imaging/lower ......... ......... ......... ........... ...........
(MRA).
74000 X X-ray exam of abdomen.. 700 0.80 $41.14 $22.37 $8.23
74010 X X-ray exam of abdomen.. 700 0.80 $41.14 $22.37 $8.23
74020 X X-ray exam of abdomen.. 700 0.80 $41.14 $22.37 $8.23
74022 X X-ray exam series, 700 0.80 $41.14 $22.37 $8.23
abdomen.
74150 S CAT scan of abdomen.... 710 4.98 $256.07 $173.12 $51.21
74160 S Contrast CAT scan of 710 4.98 $256.07 $173.12 $51.21
abdomen.
74170 S Contrast CAT scans, 710 4.98 $256.07 $173.12 $51.21
abdomen.
74181 S Magnetic image,abdomen 726 7.91 $406.73 $256.06 $81.35
(MRI).
74185 E Magnetic image/abdomen ......... ......... ......... ........... ...........
(MRA).
74190 X X-ray exam of 706 1.43 $73.53 $39.10 $14.71
peritoneum.
74210 S Contrast xray exam of 736 1.85 $95.13 $53.79 $19.03
throat.
74220 S Contrast xray 736 1.85 $95.13 $53.79 $19.03
exam,esophagus.
74230 S Cinema xray throat/ 736 1.85 $95.13 $53.79 $19.03
esophagus.
74235 S Remove esophagus 738 3.74 $192.31 $104.86 $38.46
obstruction.
74240 S X-ray exam upper GI 736 1.85 $95.13 $53.79 $19.03
tract.
74241 S X-ray exam upper GI 736 1.85 $95.13 $53.79 $19.03
tract.
74245 S X-ray exam upper GI 736 1.85 $95.13 $53.79 $19.03
tract.
74246 S Contrast xray upper GI 736 1.85 $95.13 $53.79 $19.03
tract.
74247 S Contrast xray upper GI 736 1.85 $95.13 $53.79 $19.03
tract.
74249 S Contrast xray upper GI 736 1.85 $95.13 $53.79 $19.03
tract.
[[Page 35343]]
74250 S X-ray exam of small 736 1.85 $95.13 $53.79 $19.03
bowel.
74251 S X-ray exam of small 736 1.85 $95.13 $53.79 $19.03
bowel.
74260 S X-ray exam of small 736 1.85 $95.13 $53.79 $19.03
bowel.
74270 S Contrast x-ray exam of 736 1.85 $95.13 $53.79 $19.03
colon.
74280 S Contrast x-ray exam of 736 1.85 $95.13 $53.79 $19.03
colon.
74283 S Contrast x-ray exam of 736 1.85 $95.13 $53.79 $19.03
colon.
74290 S Contrast x-ray, 736 1.85 $95.13 $53.79 $19.03
gallbladder.
74291 S Contrast x-rays, 736 1.85 $95.13 $53.79 $19.03
gallbladder.
74300 C X-ray bile ducts, ......... ......... ......... ........... ...........
pancreas.
74301 C X-rays at surgery add- ......... ......... ......... ........... ...........
on.
74305 X X-ray bile ducts, 706 1.43 $73.53 $39.10 $14.71
pancreas.
74320 X Contrast x-ray of bile 706 1.43 $73.53 $39.10 $14.71
ducts.
74327 S X-ray for bile stone 738 3.74 $192.31 $104.86 $38.46
removal.
74328 X X-ray for bile duct 706 1.43 $73.53 $39.10 $14.71
endoscopy.
74329 X X-ray for pancreas 706 1.43 $73.53 $39.10 $14.71
endoscopy.
74330 X X-ray, bile/pancreas 706 1.43 $73.53 $39.10 $14.71
endoscopy.
74340 X X-ray guide for GI tube 716 1.39 $71.47 $40.00 $14.29
74350 X X-ray guide, stomach 706 1.43 $73.53 $39.10 $14.71
tube.
74355 X X-ray guide, intestinal 706 1.43 $73.53 $39.10 $14.71
tube.
74360 S X-ray guide, GI 738 3.74 $192.31 $104.86 $38.46
dilation.
74363 S X-ray, bile duct 738 3.74 $192.31 $104.86 $38.46
dilation.
74400 S Contrast x-ray urinary 737 2.69 $138.32 $81.81 $27.66
tract.
\2\ 7440 S Contrast x-ray urinary 737 2.69 $138.32 $81.81 $27.66
5 tract.
74410 S Contrast x-ray urinary 737 2.69 $138.32 $81.81 $27.66
tract.
74415 S Contrast x-ray urinary 737 2.69 $138.32 $81.81 $27.66
tract.
74420 S Contrast x-ray urinary 737 2.69 $138.32 $81.81 $27.66
tract.
74425 S Contrast x-ray urinary 737 2.69 $138.32 $81.81 $27.66
tract.
74430 S Contrast x-ray of 737 2.69 $138.32 $81.81 $27.66
bladder.
74440 S X-ray exam male genital 737 2.69 $138.32 $81.81 $27.66
tract.
74445 S X-ray exam of penis.... 737 2.69 $138.32 $81.81 $27.66
74450 S X-ray exam urethra/ 737 2.69 $138.32 $81.81 $27.66
bladder.
74455 S X-ray exam urethra/ 737 2.69 $138.32 $81.81 $27.66
bladder.
74470 X X-ray exam of kidney 706 1.43 $73.53 $39.10 $14.71
lesion.
74475 S X-ray control catheter 738 3.74 $192.31 $104.86 $38.46
insert.
74480 S X-ray control catheter 738 3.74 $192.31 $104.86 $38.46
insert.
74485 S X-ray guide, GU 738 3.74 $192.31 $104.86 $38.46
dilation.
74710 X X-ray measurement of 700 0.80 $41.14 $22.37 $8.23
pelvis.
74740 X X-ray female genital 706 1.43 $73.53 $39.10 $14.71
tract.
74742 X X-ray fallopian tube... 706 1.43 $73.53 $39.10 $14.71
74775 S X-ray exam of perineum. 737 2.69 $138.32 $81.81 $27.66
75552 S Magnetic image, 726 7.91 $406.73 $256.06 $81.35
myocardium.
75553 S Magnetic image, 726 7.91 $406.73 $256.06 $81.35
myocardium.
75554 S Cardiac MRI/function... 726 7.91 $406.73 $256.06 $81.35
75555 S Cardiac MRI/limited 726 7.91 $406.73 $256.06 $81.35
study.
75556 E Cardiac MRI/flow ......... ......... ......... ........... ...........
mapping.
75600 S Contrast x-ray exam of 739 5.33 $274.07 $150.74 $54.81
aorta.
75605 S Contrast x-ray exam of 739 5.33 $274.07 $150.74 $54.81
aorta.
75625 S Contrast x-ray exam of 739 5.33 $274.07 $150.74 $54.81
aorta.
75630 S X-ray aorta, leg 739 5.33 $274.07 $150.74 $54.81
arteries.
75650 S Artery x-rays, head & 739 5.33 $274.07 $150.74 $54.81
neck.
75658 S X-ray exam of arm 739 5.33 $274.07 $150.74 $54.81
arteries.
75660 S Artery x-rays, head & 739 5.33 $274.07 $150.74 $54.81
neck.
75662 S Artery x-rays, head & 739 5.33 $274.07 $150.74 $54.81
neck.
75665 S Artery x-rays, head & 739 5.33 $274.07 $150.74 $54.81
neck.
75671 S Artery x-rays, head & 739 5.33 $274.07 $150.74 $54.81
neck.
75676 S Artery x-rays, neck.... 739 5.33 $274.07 $150.74 $54.81
75680 S Artery x-rays, neck.... 739 5.33 $274.07 $150.74 $54.81
75685 S Artery x-rays, spine... 739 5.33 $274.07 $150.74 $54.81
75705 S Artery x-rays, spine... 739 5.33 $274.07 $150.74 $54.81
75710 S Artery x-rays, arm/leg. 739 5.33 $274.07 $150.74 $54.81
75716 S Artery x-rays, arms/ 739 5.33 $274.07 $150.74 $54.81
legs.
75722 S Artery x-rays, kidney.. 739 5.33 $274.07 $150.74 $54.81
75724 S Artery x-rays, kidneys. 739 5.33 $274.07 $150.74 $54.81
75726 S Artery x-rays, abdomen. 739 5.33 $274.07 $150.74 $54.81
75731 S Artery x-rays, adrenal 739 5.33 $274.07 $150.74 $54.81
gland.
75733 S Artery x-rays,adrenal 739 5.33 $274.07 $150.74 $54.81
glands.
75736 S Artery x-rays, pelvis.. 739 5.33 $274.07 $150.74 $54.81
75741 S Artery x-rays, lung.... 739 5.33 $274.07 $150.74 $54.81
75743 S Artery x-rays, lungs... 739 5.33 $274.07 $150.74 $54.81
75746 S Artery x-rays, lung.... 739 5.33 $274.07 $150.74 $54.81
75756 S Artery x-rays, chest... 739 5.33 $274.07 $150.74 $54.81
75774 S Artery x-ray, each 739 5.33 $274.07 $150.74 $54.81
vessel.
75790 S Visualize A-V shunt.... 739 5.33 $274.07 $150.74 $54.81
75801 X Lymph vessel x-ray, arm/ 706 1.43 $73.53 $39.10 $14.71
leg.
75803 X Lymph vessel x-ray, 706 1.43 $73.53 $39.10 $14.71
arms/legs.
[[Page 35344]]
75805 X Lymph vessel x-ray, 706 1.43 $73.53 $39.10 $14.71
trunk.
75807 X Lymph vessel x-ray, 706 1.43 $73.53 $39.10 $14.71
trunk.
75809 X Nonvascular shunt, x- 706 1.43 $73.53 $39.10 $14.71
ray.
75810 S Vein x-ray, spleen/ 739 5.33 $274.07 $150.74 $54.81
liver.
75820 S Vein x-ray, arm/leg.... 739 5.33 $274.07 $150.74 $54.81
75822 S Vein x-ray, arms/legs.. 739 5.33 $274.07 $150.74 $54.81
75825 S Vein x-ray, trunk...... 739 5.33 $274.07 $150.74 $54.81
75827 S Vein x-ray, chest...... 739 5.33 $274.07 $150.74 $54.81
75831 S Vein x-ray, kidney..... 739 5.33 $274.07 $150.74 $54.81
75833 S Vein x-ray, kidneys.... 739 5.33 $274.07 $150.74 $54.81
75840 S Vein x-ray, adrenal 739 5.33 $274.07 $150.74 $54.81
gland.
75842 S Vein x-ray, adrenal 739 5.33 $274.07 $150.74 $54.81
glands.
75860 S Vein x-ray, neck....... 739 5.33 $274.07 $150.74 $54.81
75870 S Vein x-ray, skull...... 739 5.33 $274.07 $150.74 $54.81
75872 S Vein x-ray, skull...... 739 5.33 $274.07 $150.74 $54.81
75880 S Vein x-ray, eye socket. 739 5.33 $274.07 $150.74 $54.81
75885 S Vein x-ray, liver...... 739 5.33 $274.07 $150.74 $54.81
75887 S Vein x-ray, liver...... 739 5.33 $274.07 $150.74 $54.81
75889 S Vein x-ray, liver...... 739 5.33 $274.07 $150.74 $54.81
75891 S Vein x-ray, liver...... 739 5.33 $274.07 $150.74 $54.81
75893 N Venous sampling by ......... ......... ......... ........... ...........
catheter.
75894 C X-rays, transcatheter ......... ......... ......... ........... ...........
therapy.
75896 C X-rays, transcatheter ......... ......... ......... ........... ...........
therapy.
75898 X Follow-up angiogram.... 706 1.43 $73.53 $39.10 $14.71
75900 C Arterial catheter ......... ......... ......... ........... ...........
exchange.
75940 C X-ray placement, vein ......... ......... ......... ........... ...........
filter.
75945 C Intravascular us....... ......... ......... ......... ........... ...........
75946 C Intravascular us add-on ......... ......... ......... ........... ...........
75960 C Transcatheter intro, ......... ......... ......... ........... ...........
stent.
75961 C Retrieval, broken ......... ......... ......... ........... ...........
catheter.
75962 C Repair arterial ......... ......... ......... ........... ...........
blockage.
75964 C Repair artery blockage, ......... ......... ......... ........... ...........
each.
75966 C Repair arterial ......... ......... ......... ........... ...........
blockage.
75968 C Repair artery blockage, ......... ......... ......... ........... ...........
each.
75970 C Vascular biopsy........ ......... ......... ......... ........... ...........
75978 C Repair venous blockage. ......... ......... ......... ........... ...........
75980 S Contrast xray exam bile 738 3.74 $192.31 $104.86 $38.46
duct.
75982 S Contrast xray exam bile 738 3.74 $192.31 $104.86 $38.46
duct.
75984 S X-ray control catheter 738 3.74 $192.31 $104.86 $38.46
change.
75989 X Abscess drainage under 716 1.39 $71.47 $40.00 $14.29
x-ray.
75992 C Atherectomy, x-ray exam ......... ......... ......... ........... ...........
75993 C Atherectomy, x-ray exam ......... ......... ......... ........... ...........
75994 C Atherectomy, x-ray exam ......... ......... ......... ........... ...........
75995 C Atherectomy, x-ray exam ......... ......... ......... ........... ...........
75996 C Atherectomy, x-ray exam ......... ......... ......... ........... ...........
76000 X Fluoroscope examination 716 1.39 $71.47 $40.00 $14.29
76001 X Fluoroscope exam, 716 1.39 $71.47 $40.00 $14.29
extensive.
76003 X Needle localization by 716 1.39 $71.47 $40.00 $14.29
x-ray.
76010 X X-ray, nose to rectum.. 700 0.80 $41.14 $22.37 $8.23
76020 X X-rays for bone age.... 700 0.80 $41.14 $22.37 $8.23
76040 X X-rays, bone evaluation 700 0.80 $41.14 $22.37 $8.23
76061 X X-rays, bone survey.... 700 0.80 $41.14 $22.37 $8.23
76062 X X-rays, bone survey.... 700 0.80 $41.14 $22.37 $8.23
76065 X X-rays, bone evaluation 700 0.80 $41.14 $22.37 $8.23
76066 X Joint(s) survey, single 700 0.80 $41.14 $22.37 $8.23
film.
76070 E CT scan, bone density ......... ......... ......... ........... ...........
study.
76075 X Dual energy x-ray study 706 1.43 $73.53 $39.10 $14.71
76076 X Dual energy x-ray study 700 0.80 $41.14 $22.37 $8.23
76078 X Photodensitometry...... 700 0.80 $41.14 $22.37 $8.23
76080 X X-ray exam of fistula.. 706 1.43 $73.53 $39.10 $14.71
76086 X X-ray of mammary duct.. 706 1.43 $73.53 $39.10 $14.71
76088 X X-ray of mammary ducts. 706 1.43 $73.53 $39.10 $14.71
76090 S Mammogram, one breast.. 746 0.69 $35.48 $19.44 $7.10
76091 S Mammogram, both breasts 746 0.69 $35.48 $19.44 $7.10
76092 A Mammogram, screening... ......... ......... ......... ........... ...........
76093 S Magnetic image, breast. 726 7.91 $406.73 $256.06 $81.35
76094 S Magnetic image, both 726 7.91 $406.73 $256.06 $81.35
breasts.
76095 X Stereotactic breast 706 1.43 $73.53 $39.10 $14.71
biopsy.
76096 X X-ray of needle wire, 706 1.43 $73.53 $39.10 $14.71
breast.
76098 X X-ray exam, breast 700 0.80 $41.14 $22.37 $8.23
specimen.
76100 X X-ray exam of body 700 0.80 $41.14 $22.37 $8.23
section.
76101 X Complex body section x- 706 1.43 $73.53 $39.10 $14.71
ray.
76102 X Complex body section x- 706 1.43 $73.53 $39.10 $14.71
rays.
76120 X Cinematic x-rays....... 700 0.80 $41.14 $22.37 $8.23
76125 X Cinematic x-rays add-on 700 0.80 $41.14 $22.37 $8.23
[[Page 35345]]
76140 E X-ray consultation..... ......... ......... ......... ........... ...........
76150 X X-ray exam, dry process 700 0.80 $41.14 $22.37 $8.23
76350 N Special x-ray contrast ......... ......... ......... ........... ...........
study.
76355 S CAT scan for 710 4.98 $256.07 $173.12 $51.21
localization.
76360 S CAT scan for needle 710 4.98 $256.07 $173.12 $51.21
biopsy.
76365 S CAT scan for cyst 710 4.98 $256.07 $173.12 $51.21
aspiration.
76370 S CAT scan for therapy 710 4.98 $256.07 $173.12 $51.21
guide.
76375 S 3d/holograph reconstr 710 4.98 $256.07 $173.12 $51.21
add-on.
76380 S CAT scan follow-up 710 4.98 $256.07 $173.12 $51.21
study.
76390 S Mr spectroscopy........ 726 7.91 $406.73 $256.06 $81.35
76400 S Magnetic image, bone 726 7.91 $406.73 $256.06 $81.35
marrow.
76499 X Radiographic procedure. 700 0.80 $41.14 $22.37 $8.23
76506 S Echo exam of head...... 747 1.65 $84.84 $54.47 $16.97
76511 S Echo exam of eye....... 747 1.65 $84.84 $54.47 $16.97
76512 S Echo exam of eye....... 747 1.65 $84.84 $54.47 $16.97
76513 S Echo exam of eye, water 747 1.65 $84.84 $54.47 $16.97
bath.
76516 S Echo exam of eye....... 747 1.65 $84.84 $54.47 $16.97
76519 S Echo exam of eye....... 747 1.65 $84.84 $54.47 $16.97
76529 S Echo exam of eye....... 747 1.65 $84.84 $54.47 $16.97
76536 S Echo exam of head and 747 1.65 $84.84 $54.47 $16.97
neck.
76604 S Echo exam of chest..... 747 1.65 $84.84 $54.47 $16.97
76645 S Echo exam of breast.... 747 1.65 $84.84 $54.47 $16.97
76700 S Echo exam of abdomen... 747 1.65 $84.84 $54.47 $16.97
76705 S Echo exam of abdomen... 747 1.65 $84.84 $54.47 $16.97
76770 S Echo exam abdomen back 747 1.65 $84.84 $54.47 $16.97
wall.
76775 S Echo exam abdomen back 747 1.65 $84.84 $54.47 $16.97
wall.
76778 S Echo exam kidney 747 1.65 $84.84 $54.47 $16.97
transplant.
76800 S Echo exam spinal canal. 747 1.65 $84.84 $54.47 $16.97
76805 S Echo exam of pregnant 747 1.65 $84.84 $54.47 $16.97
uterus.
76810 S Echo exam of pregnant 747 1.65 $84.84 $54.47 $16.97
uterus.
76815 S Echo exam of pregnant 747 1.65 $84.84 $54.47 $16.97
uterus.
76816 S Echo exam followup or 747 1.65 $84.84 $54.47 $16.97
repeat.
76818 S Fetal biophysical 747 1.65 $84.84 $54.47 $16.97
profile.
76825 S Echo exam of fetal 957 4.04 $207.74 $114.13 $41.55
heart.
76826 S Echo exam of fetal 957 4.04 $207.74 $114.13 $41.55
heart.
76827 S Echo exam of fetal 957 4.04 $207.74 $114.13 $41.55
heart.
76828 S Echo exam of fetal 957 4.04 $207.74 $114.13 $41.55
heart.
76830 S Echo exam, transvaginal 747 1.65 $84.84 $54.47 $16.97
76831 S Echo exam, uterus...... 747 1.65 $84.84 $54.47 $16.97
76856 S Echo exam of pelvis.... 747 1.65 $84.84 $54.47 $16.97
76857 S Echo exam of pelvis.... 747 1.65 $84.84 $54.47 $16.97
76870 S Echo exam of scrotum... 747 1.65 $84.84 $54.47 $16.97
76872 S Echo exam, transrectal. 747 1.65 $84.84 $54.47 $16.97
76880 S Echo exam of extremity. 747 1.65 $84.84 $54.47 $16.97
76885 S Echo exam, infant hips. 747 1.65 $84.84 $54.47 $16.97
76886 S Echo exam, infant hips. 747 1.65 $84.84 $54.47 $16.97
76930 X Echo guide for heart 749 2.22 $114.15 $70.06 $22.83
sac tap.
76932 X Echo guide for heart 749 2.22 $114.15 $70.06 $22.83
biopsy.
76934 X Echo guide for chest 749 2.22 $114.15 $70.06 $22.83
tap.
76936 X Echo guide for artery 749 2.22 $114.15 $70.06 $22.83
repair.
76938 X Echo exam for drainage. 749 2.22 $114.15 $70.06 $22.83
76941 X Echo guide for 749 2.22 $114.15 $70.06 $22.83
transfusion.
76942 X Echo guide for biopsy.. 749 2.22 $114.15 $70.06 $22.83
76945 X Echo guide, villus 749 2.22 $114.15 $70.06 $22.83
sampling.
76946 X Echo guide for 749 2.22 $114.15 $70.06 $22.83
amniocentesis.
76948 X Echo guide, ova 749 2.22 $114.15 $70.06 $22.83
aspiration.
76950 X Echo guidance 749 2.22 $114.15 $70.06 $22.83
radiotherapy.
76960 X Echo guidance 749 2.22 $114.15 $70.06 $22.83
radiotherapy.
76965 X Echo guidance 749 2.22 $114.15 $70.06 $22.83
radiotherapy.
76970 S Ultrasound exam follow- 747 1.65 $84.84 $54.47 $16.97
up.
76975 S GI endoscopic 747 1.65 $84.84 $54.47 $16.97
ultrasound.
76986 S Echo exam at surgery... 747 1.65 $84.84 $54.47 $16.97
76999 S Echo examination 747 1.65 $84.84 $54.47 $16.97
procedure.
77261 X Radiation therapy 750 0.96 $49.36 $25.99 $9.87
planning.
77262 X Radiation therapy 750 0.96 $49.36 $25.99 $9.87
planning.
77263 X Radiation therapy 750 0.96 $49.36 $25.99 $9.87
planning.
77280 X Set radiation therapy 752 3.48 $178.94 $86.56 $35.79
field.
77285 X Set radiation therapy 752 3.48 $178.94 $86.56 $35.79
field.
77290 X Set radiation therapy 752 3.48 $178.94 $86.56 $35.79
field.
77295 X Set radiation therapy 752 3.48 $178.94 $86.56 $35.79
field.
77299 X Radiation therapy 751 1.15 $59.13 $33.22 $11.83
planning.
77300 X Radiation therapy dose 751 1.15 $59.13 $33.22 $11.83
plan.
77305 X Radiation therapy dose 751 1.15 $59.13 $33.22 $11.83
plan.
77310 X Radiation therapy dose 751 1.15 $59.13 $33.22 $11.83
plan.
77315 X Radiation therapy dose 751 1.15 $59.13 $33.22 $11.83
plan.
[[Page 35346]]
77321 X Radiation therapy port 751 1.15 $59.13 $33.22 $11.83
plan.
77326 X Radiation therapy dose 751 1.15 $59.13 $33.22 $11.83
plan.
77327 X Radiation therapy dose 751 1.15 $59.13 $33.22 $11.83
plan.
77328 X Radiation therapy dose 751 1.15 $59.13 $33.22 $11.83
plan.
77331 X Special radiation 751 1.15 $59.13 $33.22 $11.83
dosimetry.
77332 X Radiation treatment 751 1.15 $59.13 $33.22 $11.83
aid(s).
77333 X Radiation treatment 751 1.15 $59.13 $33.22 $11.83
aid(s).
77334 X Radiation treatment 751 1.15 $59.13 $33.22 $11.83
aid(s).
77336 X Radiation physics 750 0.96 $49.36 $25.99 $9.87
consult.
77370 X Radiation physics 750 0.96 $49.36 $25.99 $9.87
consult.
77399 X External radiation 750 0.96 $49.36 $25.99 $9.87
dosimetry.
77401 S Radiation treatment 757 2.26 $116.21 $52.43 $23.24
delivery.
77402 S Radiation treatment 757 2.26 $116.21 $52.43 $23.24
delivery.
77403 S Radiation treatment 757 2.26 $116.21 $52.43 $23.24
delivery.
77404 S Radiation treatment 757 2.26 $116.21 $52.43 $23.24
delivery.
77406 S Radiation treatment 757 2.26 $116.21 $52.43 $23.24
delivery.
77407 S Radiation treatment 757 2.26 $116.21 $52.43 $23.24
delivery.
77408 S Radiation treatment 757 2.26 $116.21 $52.43 $23.24
delivery.
77409 S Radiation treatment 757 2.26 $116.21 $52.43 $23.24
delivery.
77411 S Radiation treatment 757 2.26 $116.21 $52.43 $23.24
delivery.
77412 S Radiation treatment 757 2.26 $116.21 $52.43 $23.24
delivery.
77413 S Radiation treatment 757 2.26 $116.21 $52.43 $23.24
delivery.
77414 S Radiation treatment 757 2.26 $116.21 $52.43 $23.24
delivery.
77416 S Radiation treatment 757 2.26 $116.21 $52.43 $23.24
delivery.
77417 X Radiology port film(s). 700 0.80 $41.14 $22.37 $8.23
77419 E Weekly radiation ......... ......... ......... ........... ...........
therapy.
77420 E Weekly radiation ......... ......... ......... ........... ...........
therapy.
77425 E Weekly radiation ......... ......... ......... ........... ...........
therapy.
77430 E Weekly radiation ......... ......... ......... ........... ...........
therapy.
77431 X Radiation therapy 750 0.96 $49.36 $25.99 $9.87
management.
77432 X Stereotactic radiation 750 0.96 $49.36 $25.99 $9.87
trmt.
77470 S Special radiation 757 2.26 $116.21 $52.43 $23.24
treatment.
77499 N Radiation therapy ......... ......... ......... ........... ...........
management.
77600 S Hyperthermia treatment. 758 5.08 $261.21 $137.18 $52.24
77605 S Hyperthermia treatment. 758 5.08 $261.21 $137.18 $52.24
77610 S Hyperthermia treatment. 758 5.08 $261.21 $137.18 $52.24
77615 S Hyperthermia treatment. 758 5.08 $261.21 $137.18 $52.24
77620 S Hyperthermia treatment. 758 5.08 $261.21 $137.18 $52.24
77750 S Infuse radioactive 759 7.98 $410.33 $157.97 $82.07
materials.
77761 S Radioelement 759 7.98 $410.33 $157.97 $82.07
application.
77762 S Radioelement 759 7.98 $410.33 $157.97 $82.07
application.
77763 S Radioelement 759 7.98 $410.33 $157.97 $82.07
application.
77776 S Radioelement 759 7.98 $410.33 $157.97 $82.07
application.
77777 S Radioelement 759 7.98 $410.33 $157.97 $82.07
application.
77778 S Radioelement 759 7.98 $410.33 $157.97 $82.07
application.
77781 S High intensity 759 7.98 $410.33 $157.97 $82.07
brachytherapy.
77782 S High intensity 759 7.98 $410.33 $157.97 $82.07
brachytherapy.
77783 S High intensity 759 7.98 $410.33 $157.97 $82.07
brachytherapy.
77784 S High intensity 759 7.98 $410.33 $157.97 $82.07
brachytherapy.
77789 S Radioelement 759 7.98 $410.33 $157.97 $82.07
application.
77790 N Radioelement handling.. ......... ......... ......... ........... ...........
77799 S Radium/radioisotope 759 7.98 $410.33 $157.97 $82.07
therapy.
78000 S Thyroid, single uptake. 761 1.80 $92.56 $54.01 $18.51
78001 S Thyroid, multiple 762 2.02 $103.87 $55.82 $20.77
uptakes.
78003 S Thyroid suppress/stimul 762 2.02 $103.87 $55.82 $20.77
78006 S Thyroid,imaging with 771 3.81 $195.91 $117.29 $39.18
uptake.
78007 S Thyroid, image, mult 772 4.26 $219.05 $128.37 $43.81
uptakes.
78010 S Thyroid imaging........ 771 3.81 $195.91 $117.29 $39.18
78011 S Thyroid imaging with 771 3.81 $195.91 $117.29 $39.18
flow.
78015 S Thyroid met imaging.... 771 3.81 $195.91 $117.29 $39.18
78016 S Thyroid met imaging/ 772 4.26 $219.05 $128.37 $43.81
studies.
\2\ 7801 S Thyroid met imaging, 772 4.26 $219.05 $128.37 $43.81
7 mult.
78018 S Thyroid, met imaging, 772 4.26 $219.05 $128.37 $43.81
body.
78070 S Parathyroid nuclear 772 4.26 $219.05 $128.37 $43.81
imaging.
78075 S Adrenal nuclear imaging 772 4.26 $219.05 $128.37 $43.81
78099 S Endocrine nuclear 761 1.80 $92.56 $54.01 $18.51
procedure.
78102 S Bone marrow imaging, 771 3.81 $195.91 $117.29 $39.18
ltd.
78103 S Bone marrow imaging, 771 3.81 $195.91 $117.29 $39.18
mult.
78104 S Bone marrow imaging, 771 3.81 $195.91 $117.29 $39.18
body.
78110 S Plasma volume, single.. 761 1.80 $92.56 $54.01 $18.51
78111 S Plasma volume, multiple 761 1.80 $92.56 $54.01 $18.51
78120 S Red cell mass, single.. 761 1.80 $92.56 $54.01 $18.51
78121 S Red cell mass, multiple 762 2.02 $103.87 $55.82 $20.77
78122 S Blood volume........... 762 2.02 $103.87 $55.82 $20.77
78130 S Red cell survival study 762 2.02 $103.87 $55.82 $20.77
[[Page 35347]]
78135 S Red cell survival 762 2.02 $103.87 $55.82 $20.77
kinetics.
78140 S Red cell sequestration. 762 2.02 $103.87 $55.82 $20.77
78160 S Plasma iron turnover... 762 2.02 $103.87 $55.82 $20.77
78162 S Iron absorption exam... 762 2.02 $103.87 $55.82 $20.77
78170 S Red cell iron 762 2.02 $103.87 $55.82 $20.77
utilization.
78172 S Total body iron 762 2.02 $103.87 $55.82 $20.77
estimation.
78185 S Spleen imaging......... 771 3.81 $195.91 $117.29 $39.18
78190 S Platelet survival, 762 2.02 $103.87 $55.82 $20.77
kinetics.
78191 S Platelet survival...... 762 2.02 $103.87 $55.82 $20.77
78195 S Lymph system imaging... 772 4.26 $219.05 $128.37 $43.81
78199 S Blood/lymph nuclear 761 1.80 $92.56 $54.01 $18.51
exam.
78201 S Liver imaging.......... 771 3.81 $195.91 $117.29 $39.18
78202 S Liver imaging with flow 771 3.81 $195.91 $117.29 $39.18
78205 S Liver imaging (3D)..... 781 5.43 $279.21 $155.04 $55.84
78215 S Liver and spleen 771 3.81 $195.91 $117.29 $39.18
imaging.
78216 S Liver & spleen image, 771 3.81 $195.91 $117.29 $39.18
flow.
78220 S Liver function study... 772 4.26 $219.05 $128.37 $43.81
78223 S Hepatobiliary imaging.. 772 4.26 $219.05 $128.37 $43.81
78230 S Salivary gland imaging. 771 3.81 $195.91 $117.29 $39.18
78231 S Serial salivary imaging 771 3.81 $195.91 $117.29 $39.18
78232 S Salivary gland function 772 4.26 $219.05 $128.37 $43.81
exam.
78258 S Esophageal motility 772 4.26 $219.05 $128.37 $43.81
study.
78261 S Gastric mucosa imaging. 771 3.81 $195.91 $117.29 $39.18
78262 S Gastroesophageal reflux 772 4.26 $219.05 $128.37 $43.81
exam.
78264 S Gastric emptying study. 772 4.26 $219.05 $128.37 $43.81
78270 S Vit B-12 absorption 761 1.80 $92.56 $54.01 $18.51
exam.
78271 S Vit B-12 absorp exam, 761 1.80 $92.56 $54.01 $18.51
IF.
78272 S Vit B-12 absorp, 761 1.80 $92.56 $54.01 $18.51
combined.
78278 S Acute GI blood loss 772 4.26 $219.05 $128.37 $43.81
imaging.
78282 S GI protein loss exam... 761 1.80 $92.56 $54.01 $18.51
78290 S Meckel's divert exam... 771 3.81 $195.91 $117.29 $39.18
78291 S Leveen/shunt patency 772 4.26 $219.05 $128.37 $43.81
exam.
78299 S GI nuclear procedure... 761 1.80 $92.56 $54.01 $18.51
78300 S Bone imaging, limited 771 3.81 $195.91 $117.29 $39.18
area.
78305 S Bone imaging, multiple 771 3.81 $195.91 $117.29 $39.18
areas.
78306 S Bone imaging, whole 771 3.81 $195.91 $117.29 $39.18
body.
78315 S Bone imaging, 3 phase.. 772 4.26 $219.05 $128.37 $43.81
78320 S Bone imaging (3D)...... 781 5.43 $279.21 $155.04 $55.84
78350 X Bone mineral, single 700 0.80 $41.14 $22.37 $8.23
photon.
78351 E Bone mineral, dual ......... ......... ......... ........... ...........
photon.
78399 S Musculoskeletal nuclear 771 3.81 $195.91 $117.29 $39.18
exam.
78414 S Non-imaging heart 762 2.02 $103.87 $55.82 $20.77
function.
78428 S Cardiac shunt imaging.. 771 3.81 $195.91 $117.29 $39.18
78445 S Vascular flow imaging.. 771 3.81 $195.91 $117.29 $39.18
78455 S Venous thrombosis study 762 2.02 $103.87 $55.82 $20.77
78457 S Venous thrombosis 771 3.81 $195.91 $117.29 $39.18
imaging.
78458 S Ven thrombosis images, 771 3.81 $195.91 $117.29 $39.18
bilat.
78459 S Heart muscle imaging 760 14.89 $765.64 $419.46 $153.13
(PET).
78460 S Heart muscle blood 771 3.81 $195.91 $117.29 $39.18
single.
78461 S Heart muscle blood 772 4.26 $219.05 $128.37 $43.81
multiple.
78464 S Heart image (3D) single 781 5.43 $279.21 $155.04 $55.84
78465 S Heart image (3D) 782 9.00 $462.78 $267.13 $92.56
multiple.
78466 S Heart infarct image.... 771 3.81 $195.91 $117.29 $39.18
78468 S Heart infarct image, EF 772 4.26 $219.05 $128.37 $43.81
78469 S Heart infarct image 781 5.43 $279.21 $155.04 $55.84
(3D).
78472 S Gated heart, planar 772 4.26 $219.05 $128.37 $43.81
single.
78473 S Gated heart, multiple.. 772 4.26 $219.05 $128.37 $43.81
78478 S Heart wall motion add- 771 3.81 $195.91 $117.29 $39.18
on.
78480 S Heart function add-on.. 771 3.81 $195.91 $117.29 $39.18
78481 S Heart first pass single 771 3.81 $195.91 $117.29 $39.18
78483 S Heart first pass 772 4.26 $219.05 $128.37 $43.81
multiple.
78491 E Heart image (pet) ......... ......... ......... ........... ...........
single.
78492 E Heart image (pet) ......... ......... ......... ........... ...........
multiple.
78499 S Cardiovascular nuclear 762 2.02 $103.87 $55.82 $20.77
exam.
78580 S Lung perfusion imaging. 771 3.81 $195.91 $117.29 $39.18
78584 S Lung V/Q image single 772 4.26 $219.05 $128.37 $43.81
breath.
78585 S Lung V/Q imaging....... 772 4.26 $219.05 $128.37 $43.81
78586 S Aerosol lung image, 771 3.81 $195.91 $117.29 $39.18
single.
78587 S Aerosol lung image, 771 3.81 $195.91 $117.29 $39.18
multiple.
78591 S Vent image, 1 breath, 1 771 3.81 $195.91 $117.29 $39.18
proj.
78593 S Vent image, 1 proj, gas 771 3.81 $195.91 $117.29 $39.18
78594 S Vent image, mult proj, 772 4.26 $219.05 $128.37 $43.81
gas.
78596 S Lung differential 772 4.26 $219.05 $128.37 $43.81
function.
78599 S Respiratory nuclear 771 3.81 $195.91 $117.29 $39.18
exam.
78600 S Brain imaging, ltd 771 3.81 $195.91 $117.29 $39.18
static.
[[Page 35348]]
78601 S Brain ltd imaging & 771 3.81 $195.91 $117.29 $39.18
flow.
78605 S Brain imaging, complete 771 3.81 $195.91 $117.29 $39.18
78606 S Brain imaging comp & 772 4.26 $219.05 $128.37 $43.81
flow.
78607 S Brain imaging (3D)..... 781 5.43 $279.21 $155.04 $55.84
78608 S Brain imaging (PET).... 760 14.89 $765.64 $419.46 $153.13
78609 S Brain imaging (PET).... 760 14.89 $765.64 $419.46 $153.13
78610 S Brain flow imaging only 771 3.81 $195.91 $117.29 $39.18
78615 S Cerebral blood flow 772 4.26 $219.05 $128.37 $43.81
imaging.
78630 S Cerebrospinal fluid 772 4.26 $219.05 $128.37 $43.81
scan.
78635 S CSF ventriculography... 772 4.26 $219.05 $128.37 $43.81
78645 S CSF shunt evaluation... 772 4.26 $219.05 $128.37 $43.81
78647 S Cerebrospinal fluid 781 5.43 $279.21 $155.04 $55.84
scan.
78650 S CSF leakage imaging.... 772 4.26 $219.05 $128.37 $43.81
78660 S Nuclear exam of tear 771 3.81 $195.91 $117.29 $39.18
flow.
78699 S Nervous system nuclear 771 3.81 $195.91 $117.29 $39.18
exam.
78700 S Kidney imaging, static. 771 3.81 $195.91 $117.29 $39.18
78701 S Kidney imaging with 771 3.81 $195.91 $117.29 $39.18
flow.
78704 S Imaging renogram....... 771 3.81 $195.91 $117.29 $39.18
78707 S Kidney flow & function 771 3.81 $195.91 $117.29 $39.18
image.
78708 S Kidney flow & function 772 4.26 $219.05 $128.37 $43.81
image.
78709 S Kidney flow & function 772 4.26 $219.05 $128.37 $43.81
image.
78710 S Kidney imaging (3D).... 781 5.43 $279.21 $155.04 $55.84
78715 S Renal vascular flow 771 3.81 $195.91 $117.29 $39.18
exam.
78725 S Kidney function study.. 761 1.80 $92.56 $54.01 $18.51
78730 S Urinary bladder 771 3.81 $195.91 $117.29 $39.18
retention.
78740 S Ureteral reflux study.. 772 4.26 $219.05 $128.37 $43.81
78760 S Testicular imaging..... 771 3.81 $195.91 $117.29 $39.18
78761 S Testicular imaging & 771 3.81 $195.91 $117.29 $39.18
flow.
78799 S Genitourinary nuclear 771 3.81 $195.91 $117.29 $39.18
exam.
78800 S Tumor imaging, limited 772 4.26 $219.05 $128.37 $43.81
area.
78801 S Tumor imaging, mult 772 4.26 $219.05 $128.37 $43.81
areas.
78802 S Tumor imaging, whole 772 4.26 $219.05 $128.37 $43.81
body.
78803 S Tumor imaging (3D)..... 782 9.00 $462.78 $267.13 $92.56
78805 S Abscess imaging, ltd 772 4.26 $219.05 $128.37 $43.81
area.
78806 S Abscess imaging, whole 772 4.26 $219.05 $128.37 $43.81
body.
78807 S Nuclear localization/ 782 9.00 $462.78 $267.13 $92.56
abscess.
78810 S Tumor imaging (PET).... 760 14.89 $765.64 $419.46 $153.13
78890 N Nuclear medicine data ......... ......... ......... ........... ...........
proc.
78891 N Nuclear med data proc.. ......... ......... ......... ........... ...........
78990 N Provide diag ......... ......... ......... ........... ...........
radionuclide(s).
78999 S Nuclear diagnostic exam 761 1.80 $92.56 $54.01 $18.51
79000 S Intial hyperthyroid 792 4.81 $247.33 $143.06 $49.47
therapy.
79001 S Repeat hyperthyroid 791 14.74 $757.93 $539.91 $151.59
therapy.
79020 S Thyroid ablation....... 792 4.81 $247.33 $143.06 $49.47
79030 S Thyroid ablation, 792 4.81 $247.33 $143.06 $49.47
carcinoma.
79035 S Thyroid metastatic 792 4.81 $247.33 $143.06 $49.47
therapy.
79100 S Hematopoetic nuclear 791 14.74 $757.93 $539.91 $151.59
therapy.
79200 S Intracavitary nuc 792 4.81 $247.33 $143.06 $49.47
treatment.
79300 S Interstitial nuclear 791 14.74 $757.93 $539.91 $151.59
therapy.
79400 S Nonhemato nuclear 791 14.74 $757.93 $539.91 $151.59
therapy.
79420 S Intravascular nuc 791 14.74 $757.93 $539.91 $151.59
therapy.
79440 S Nuclear joint therapy.. 791 14.74 $757.93 $539.91 $151.59
79900 N Provide ther ......... ......... ......... ........... ...........
radiopharm(s).
79999 S Nuclear medicine 791 14.74 $757.93 $539.91 $151.59
therapy.
80049 A Metabolic panel, basic. ......... ......... ......... ........... ...........
80050 A General health panel... ......... ......... ......... ........... ...........
80051 A Electrolyte panel...... ......... ......... ......... ........... ...........
80054 A Comprehen metabolic ......... ......... ......... ........... ...........
panel.
80055 A Obstetric panel........ ......... ......... ......... ........... ...........
80058 A Hepatic function panel. ......... ......... ......... ........... ...........
80059 A Hepatitis panel........ ......... ......... ......... ........... ...........
80061 A Lipid panel............ ......... ......... ......... ........... ...........
80072 A Arthritis panel........ ......... ......... ......... ........... ...........
80090 A Torch antibody panel... ......... ......... ......... ........... ...........
80091 A Thyroid panel.......... ......... ......... ......... ........... ...........
80092 A Thyroid panel w/TSH.... ......... ......... ......... ........... ...........
80100 A Drug screen............ ......... ......... ......... ........... ...........
80101 A Drug screen............ ......... ......... ......... ........... ...........
80102 A Drug confirmation...... ......... ......... ......... ........... ...........
80103 N Drug analysis, tissue ......... ......... ......... ........... ...........
prep.
80150 A Assay of amikacin...... ......... ......... ......... ........... ...........
80152 A Assay of amitriptyline. ......... ......... ......... ........... ...........
80154 A Assay of ......... ......... ......... ........... ...........
benzodiazepines.
80156 A Assay carbamazepine.... ......... ......... ......... ........... ...........
80158 A Assay of cyclosporine.. ......... ......... ......... ........... ...........
[[Page 35349]]
80160 A Assay of desipramine... ......... ......... ......... ........... ...........
80162 A Assay for digoxin...... ......... ......... ......... ........... ...........
80164 A Assay, dipropylacetic ......... ......... ......... ........... ...........
acid.
80166 A Assay of doxepin....... ......... ......... ......... ........... ...........
80168 A Assay of ethosuximide.. ......... ......... ......... ........... ...........
80170 A Gentamicin............. ......... ......... ......... ........... ...........
80172 A Assay for gold......... ......... ......... ......... ........... ...........
80174 A Assay of imipramine.... ......... ......... ......... ........... ...........
80176 A Assay for lidocaine.... ......... ......... ......... ........... ...........
80178 A Assay for lithium...... ......... ......... ......... ........... ...........
80182 A Assay for nortriptyline ......... ......... ......... ........... ...........
80184 A Assay for phenobarbital ......... ......... ......... ........... ...........
80185 A Assay for phenytoin.... ......... ......... ......... ........... ...........
80186 A Assay for phenytoin, ......... ......... ......... ........... ...........
free.
80188 A Assay for primidone.... ......... ......... ......... ........... ...........
80190 A Assay for procainamide. ......... ......... ......... ........... ...........
80192 A Assay for procainamide. ......... ......... ......... ........... ...........
80194 A Assay for quinidine.... ......... ......... ......... ........... ...........
80196 A Assay for salicylate... ......... ......... ......... ........... ...........
80197 A Assay for tacrolimus... ......... ......... ......... ........... ...........
80198 A Assay for theophylline. ......... ......... ......... ........... ...........
80200 A Assay for tobramycin... ......... ......... ......... ........... ...........
80201 A Assay for topiramate... ......... ......... ......... ........... ...........
80202 A Assay for vancomycin... ......... ......... ......... ........... ...........
80299 A Quantitative assay, ......... ......... ......... ........... ...........
drug.
80400 A Acth stimulation panel. ......... ......... ......... ........... ...........
80402 A Acth stimulation panel. ......... ......... ......... ........... ...........
80406 A Acth stimulation panel. ......... ......... ......... ........... ...........
80408 A Aldosterone suppression ......... ......... ......... ........... ...........
eval.
80410 A Calcitonin stimul panel ......... ......... ......... ........... ...........
80412 A CRH stimulation panel.. ......... ......... ......... ........... ...........
80414 A Testosterone response.. ......... ......... ......... ........... ...........
80415 A Estradiol response ......... ......... ......... ........... ...........
panel.
80416 A Renin stimulation panel ......... ......... ......... ........... ...........
80417 A Renin stimulation panel ......... ......... ......... ........... ...........
80418 A Pituitary evaluation ......... ......... ......... ........... ...........
panel.
80420 A Dexamethasone panel.... ......... ......... ......... ........... ...........
80422 A Glucagon tolerance ......... ......... ......... ........... ...........
panel.
80424 A Glucagon tolerance ......... ......... ......... ........... ...........
panel.
80426 A Gonadotropin hormone ......... ......... ......... ........... ...........
panel.
80428 A Growth hormone panel... ......... ......... ......... ........... ...........
80430 A Growth hormone panel... ......... ......... ......... ........... ...........
80432 A Insulin suppression ......... ......... ......... ........... ...........
panel.
80434 A Insulin tolerance panel ......... ......... ......... ........... ...........
80435 A Insulin tolerance panel ......... ......... ......... ........... ...........
80436 A Metyrapone panel....... ......... ......... ......... ........... ...........
80438 A TRH stimulation panel.. ......... ......... ......... ........... ...........
80439 A TRH stimulation panel.. ......... ......... ......... ........... ...........
80440 A TRH stimulation panel.. ......... ......... ......... ........... ...........
80500 X Lab pathology 882 0.39 $20.05 $11.75 $4.01
consultation.
80502 X Lab pathology 882 0.39 $20.05 $11.75 $4.01
consultation.
81000 A Urinalysis, nonauto, w/ ......... ......... ......... ........... ...........
scope.
81001 A Urinalysis, auto, w/ ......... ......... ......... ........... ...........
scope.
81002 A Urinalysis nonauto w/o ......... ......... ......... ........... ...........
scope.
81003 A Urinalysis, auto, w/o ......... ......... ......... ........... ...........
scope.
81005 A Urinalysis............. ......... ......... ......... ........... ...........
81007 A Urine screen for ......... ......... ......... ........... ...........
bacteria.
81015 A Microscopic exam of ......... ......... ......... ........... ...........
urine.
81020 A Urinalysis, glass test. ......... ......... ......... ........... ...........
81025 A Urine pregnancy test... ......... ......... ......... ........... ...........
81050 A Urinalysis, volume ......... ......... ......... ........... ...........
measure.
81099 A Urinalysis test ......... ......... ......... ........... ...........
procedure.
82000 A Assay blood ......... ......... ......... ........... ...........
acetaldehyde.
82003 A Assay acetaminophen.... ......... ......... ......... ........... ...........
82009 A Test for acetone/ ......... ......... ......... ........... ...........
ketones.
82010 A Acetone assay.......... ......... ......... ......... ........... ...........
82013 A Acetylcholinesterase ......... ......... ......... ........... ...........
assay.
82024 A ACTH................... ......... ......... ......... ........... ...........
82030 A ADP & AMP.............. ......... ......... ......... ........... ...........
82040 A Assay serum albumin.... ......... ......... ......... ........... ...........
82042 A Assay urine albumin.... ......... ......... ......... ........... ...........
82043 A Microalbumin, ......... ......... ......... ........... ...........
quantitative.
82044 A Microalbumin, semiquant ......... ......... ......... ........... ...........
82055 A Assay ethanol.......... ......... ......... ......... ........... ...........
82075 A Assay breath ethanol... ......... ......... ......... ........... ...........
[[Page 35350]]
82085 A Assay of aldolase...... ......... ......... ......... ........... ...........
82088 A Aldosterone............ ......... ......... ......... ........... ...........
82101 A Assay of urine ......... ......... ......... ........... ...........
alkaloids.
82103 A Alpha-1-antitrypsin, ......... ......... ......... ........... ...........
total.
82104 A Alpha-1-antitrypsin, ......... ......... ......... ........... ...........
pheno.
82105 A Alpha-fetoprotein, ......... ......... ......... ........... ...........
serum.
82106 A Alpha-fetoprotein; ......... ......... ......... ........... ...........
amniotic.
82108 A Assay, aluminum........ ......... ......... ......... ........... ...........
82128 A Amino acids, mult qual. ......... ......... ......... ........... ...........
\2\ 8213 A Amino acids analysis... ......... ......... ......... ........... ...........
0
82131 A Amino acids, single ......... ......... ......... ........... ...........
quant.
82135 A Assay, aminolevulinic ......... ......... ......... ........... ...........
acid.
82140 A Assay of ammonia....... ......... ......... ......... ........... ...........
82143 A Amniotic fluid scan.... ......... ......... ......... ........... ...........
82145 A Assay of amphetamines.. ......... ......... ......... ........... ...........
82150 A Assay of amylase....... ......... ......... ......... ........... ...........
82154 A Androstanediol ......... ......... ......... ........... ...........
glucuronide.
82157 A Assay of ......... ......... ......... ........... ...........
androstenedione.
82160 A Androsterone assay..... ......... ......... ......... ........... ...........
82163 A Assay of angiotensin II ......... ......... ......... ........... ...........
82164 A Angiotensin I enzyme ......... ......... ......... ........... ...........
test.
82172 A Apolipoprotein......... ......... ......... ......... ........... ...........
82175 A Assay of arsenic....... ......... ......... ......... ........... ...........
82180 A Assay of ascorbic acid. ......... ......... ......... ........... ...........
82190 A Atomic absorption...... ......... ......... ......... ........... ...........
82205 A Assay of barbiturates.. ......... ......... ......... ........... ...........
82232 A Beta-2 protein......... ......... ......... ......... ........... ...........
82239 A Bile acids, total...... ......... ......... ......... ........... ...........
82240 A Bile acids, ......... ......... ......... ........... ...........
cholylglycine.
\2\ 8225 A Assay bilirubin........ ......... ......... ......... ........... ...........
0
82251 A Assay bilirubin........ ......... ......... ......... ........... ...........
82252 A Fecal bilirubin test... ......... ......... ......... ........... ...........
82270 A Test feces for blood... ......... ......... ......... ........... ...........
82273 A Test for blood, other ......... ......... ......... ........... ...........
source.
82286 A Assay of bradykinin.... ......... ......... ......... ........... ...........
82300 A Assay cadmium.......... ......... ......... ......... ........... ...........
82306 A Assay of vitamin D..... ......... ......... ......... ........... ...........
82307 A Assay of vitamin D..... ......... ......... ......... ........... ...........
82308 A Assay of calcitonin.... ......... ......... ......... ........... ...........
82310 A Assay calcium.......... ......... ......... ......... ........... ...........
82330 A Assay calcium.......... ......... ......... ......... ........... ...........
82331 A Calcium infusion test.. ......... ......... ......... ........... ...........
82340 A Assay calcium in urine. ......... ......... ......... ........... ...........
82355 A Calculus (stone) ......... ......... ......... ........... ...........
analysis.
82360 A Calculus (stone) assay. ......... ......... ......... ........... ...........
82365 A Calculus (stone) assay. ......... ......... ......... ........... ...........
82370 A X-ray assay,calculus ......... ......... ......... ........... ...........
(stone).
82374 A Assay blood carbon ......... ......... ......... ........... ...........
dioxide.
82375 A Assay blood carbon ......... ......... ......... ........... ...........
monoxide.
82376 A Test for carbon ......... ......... ......... ........... ...........
monoxide.
82378 A Carcinoembryonic ......... ......... ......... ........... ...........
antigen.
82380 A Assay carotene......... ......... ......... ......... ........... ...........
82382 A Assay urine ......... ......... ......... ........... ...........
catecholamines.
82383 A Assay blood ......... ......... ......... ........... ...........
catecholamines.
82384 A Assay three ......... ......... ......... ........... ...........
catecholamines.
82387 A Cathepsin-D............ ......... ......... ......... ........... ...........
82390 A Assay ceruloplasmin.... ......... ......... ......... ........... ...........
82397 A Chemiluminescent assay. ......... ......... ......... ........... ...........
82415 A Assay chloramphenicol.. ......... ......... ......... ........... ...........
82435 A Assay blood chloride... ......... ......... ......... ........... ...........
82436 A Assay urine chloride... ......... ......... ......... ........... ...........
82438 A Assay other fluid ......... ......... ......... ........... ...........
chlorides.
82441 A Test for ......... ......... ......... ........... ...........
chlorohydrocarbons.
82465 A Assay serum cholesterol ......... ......... ......... ........... ...........
82480 A Assay serum ......... ......... ......... ........... ...........
cholinesterase.
82482 A Assay rbc ......... ......... ......... ........... ...........
cholinesterase.
82485 A Assay chondroitin ......... ......... ......... ........... ...........
sulfate.
82486 A Gas/liquid ......... ......... ......... ........... ...........
chromatography.
82487 A Paper chromatography... ......... ......... ......... ........... ...........
82488 A Paper chromatography... ......... ......... ......... ........... ...........
82489 A Thin layer ......... ......... ......... ........... ...........
chromatography.
82491 A Chromotography, ......... ......... ......... ........... ...........
quantitative.
82495 A Assay chromium......... ......... ......... ......... ........... ...........
82507 A Assay citrate.......... ......... ......... ......... ........... ...........
82520 A Assay for cocaine...... ......... ......... ......... ........... ...........
[[Page 35351]]
82523 A Collagen crosslinks.... ......... ......... ......... ........... ...........
82525 A Assay copper........... ......... ......... ......... ........... ...........
82528 A Assay corticosterone... ......... ......... ......... ........... ...........
82530 A Cortisol, free......... ......... ......... ......... ........... ...........
82533 A Total cortisol......... ......... ......... ......... ........... ...........
82540 A Assay creatine......... ......... ......... ......... ........... ...........
82550 A Assay CK (CPK)......... ......... ......... ......... ........... ...........
82552 A Assay CPK in blood..... ......... ......... ......... ........... ...........
82553 A Creatine, MB fraction.. ......... ......... ......... ........... ...........
82554 A Creatine, isoforms..... ......... ......... ......... ........... ...........
82565 A Assay creatinine....... ......... ......... ......... ........... ...........
82570 A Assay urine creatinine. ......... ......... ......... ........... ...........
82575 A Creatinine clearance ......... ......... ......... ........... ...........
test.
82585 A Assay cryofibrinogen... ......... ......... ......... ........... ...........
82595 A Assay cryoglobulin..... ......... ......... ......... ........... ...........
82600 A Assay cyanide.......... ......... ......... ......... ........... ...........
82607 A Vitamin B-12........... ......... ......... ......... ........... ...........
82608 A B-12 binding capacity.. ......... ......... ......... ........... ...........
82615 A Test for urine cystines ......... ......... ......... ........... ...........
82626 A Dehydroepiandrosterone. ......... ......... ......... ........... ...........
82627 A Dehydroepiandrosterone. ......... ......... ......... ........... ...........
82633 A Desoxycorticosterone... ......... ......... ......... ........... ...........
82634 A Deoxycortisol.......... ......... ......... ......... ........... ...........
82638 A Assay dibucaine number. ......... ......... ......... ........... ...........
82646 A Assay of ......... ......... ......... ........... ...........
dihydrocodeinone.
82649 A Assay of ......... ......... ......... ........... ...........
dihydromorphinone.
82651 A Dihydrotestosterone ......... ......... ......... ........... ...........
assay.
82652 A Assay, dihydroxyvitamin ......... ......... ......... ........... ...........
D.
82654 A Assay of dimethadione.. ......... ......... ......... ........... ...........
82664 A Electrophoretic test... ......... ......... ......... ........... ...........
82666 A Epiandrosterone assay.. ......... ......... ......... ........... ...........
82668 A Erythropoietin......... ......... ......... ......... ........... ...........
82670 A Estradiol.............. ......... ......... ......... ........... ...........
82671 A Estrogens assay........ ......... ......... ......... ........... ...........
82672 A Estrogen assay......... ......... ......... ......... ........... ...........
82677 A Estriol................ ......... ......... ......... ........... ...........
82679 A Estrone................ ......... ......... ......... ........... ...........
82690 A Ethchlorvynol.......... ......... ......... ......... ........... ...........
82693 A Ethylene glycol........ ......... ......... ......... ........... ...........
82696 A Etiocholanolone........ ......... ......... ......... ........... ...........
82705 A Fats/ ......... ......... ......... ........... ...........
lipids,feces,qualitati
v.
82710 A Fats/ ......... ......... ......... ........... ...........
lipids,feces,quantitat
i.
82715 A Fecal fat assay........ ......... ......... ......... ........... ...........
82725 A Assay blood fatty acids ......... ......... ......... ........... ...........
82728 A Assay ferritin......... ......... ......... ......... ........... ...........
82735 A Assay fluoride......... ......... ......... ......... ........... ...........
82742 A Assay of flurazepam.... ......... ......... ......... ........... ...........
82746 A Blood folic acid serum. ......... ......... ......... ........... ...........
82747 A Folic acid, RBC........ ......... ......... ......... ........... ...........
82757 A Assay semen fructose... ......... ......... ......... ........... ...........
82759 A RBC galactokinase assay ......... ......... ......... ........... ...........
82760 A Assay galactose........ ......... ......... ......... ........... ...........
82775 A Assay galactose ......... ......... ......... ........... ...........
transferase.
82776 A Galactose transferase ......... ......... ......... ........... ...........
test.
82784 A Assay gammaglobulin IgM ......... ......... ......... ........... ...........
82785 A Assay, gammaglobulin ......... ......... ......... ........... ...........
IgE.
82787 A IgG1, 2, 3 and 4....... ......... ......... ......... ........... ...........
82800 A Blood pH............... ......... ......... ......... ........... ...........
82803 A Blood gases: pH, pO2 & ......... ......... ......... ........... ...........
pCO2.
82805 A Blood gases W/02 ......... ......... ......... ........... ...........
saturation.
82810 A Blood gases, O2 sat ......... ......... ......... ........... ...........
only.
82820 A Hemoglobin-oxygen ......... ......... ......... ........... ...........
affinity.
82926 A Assay gastric acid..... ......... ......... ......... ........... ...........
82928 A Assay gastric acid..... ......... ......... ......... ........... ...........
82938 A Gastrin test........... ......... ......... ......... ........... ...........
82941 A Assay of gastrin....... ......... ......... ......... ........... ...........
82943 A Assay of glucagon...... ......... ......... ......... ........... ...........
82946 A Glucagon tolerance test ......... ......... ......... ........... ...........
82947 A Assay quantitative, ......... ......... ......... ........... ...........
glucose.
82948 A Reagent strip/blood ......... ......... ......... ........... ...........
glucose.
82950 A Glucose test........... ......... ......... ......... ........... ...........
82951 A Glucose tolerance test ......... ......... ......... ........... ...........
(GTT).
82952 A GTT-added samples...... ......... ......... ......... ........... ...........
82953 A Glucose-tolbutamide ......... ......... ......... ........... ...........
test.
82955 A Assay G6PD enzyme...... ......... ......... ......... ........... ...........
[[Page 35352]]
82960 A Test for G6PD enzyme... ......... ......... ......... ........... ...........
82962 A Glucose blood test..... ......... ......... ......... ........... ...........
82963 A Glucosidase assay...... ......... ......... ......... ........... ...........
82965 A Assay GDH enzyme....... ......... ......... ......... ........... ...........
82975 A Assay glutamine........ ......... ......... ......... ........... ...........
82977 A Assay of GGT........... ......... ......... ......... ........... ...........
82978 A Glutathione assay...... ......... ......... ......... ........... ...........
82979 A Assay RBC glutathione ......... ......... ......... ........... ...........
enzyme.
82980 A Assay of glutethimide.. ......... ......... ......... ........... ...........
82985 A Glycated protein....... ......... ......... ......... ........... ...........
83001 A Gonadotropin (FSH)..... ......... ......... ......... ........... ...........
83002 A Gonadotropin (LH)...... ......... ......... ......... ........... ...........
83003 A Assay growth hormone ......... ......... ......... ........... ...........
(HGH).
83008 A Assay guanosine........ ......... ......... ......... ........... ...........
83010 A Quant assay haptoglobin ......... ......... ......... ........... ...........
83012 A Assay haptoglobins..... ......... ......... ......... ........... ...........
83015 A Heavy metal screen..... ......... ......... ......... ........... ...........
83018 A Quantitative screen, ......... ......... ......... ........... ...........
metals.
\2\ 8301 A Breath isotope test.... ......... ......... ......... ........... ...........
9
83020 A Hemoglobin ......... ......... ......... ........... ...........
electrophoresis.
83026 A Hemoglobin, copper ......... ......... ......... ........... ...........
sulfate.
83030 A Fetal hemoglobin assay. ......... ......... ......... ........... ...........
83033 A Fetal fecal hemoglobin ......... ......... ......... ........... ...........
assay.
83036 A Glycated hemoglobin ......... ......... ......... ........... ...........
test.
83045 A Blood methemoglobin ......... ......... ......... ........... ...........
test.
83050 A Blood methemoglobin ......... ......... ......... ........... ...........
assay.
83051 A Assay plasma hemoglobin ......... ......... ......... ........... ...........
83055 A Blood sulfhemoglobin ......... ......... ......... ........... ...........
test.
83060 A Blood sulfhemoglobin ......... ......... ......... ........... ...........
assay.
83065 A Hemoglobin heat assay.. ......... ......... ......... ........... ...........
83068 A Hemoglobin stability ......... ......... ......... ........... ...........
screen.
83069 A Assay urine hemoglobin. ......... ......... ......... ........... ...........
83070 A Qualt assay hemosiderin ......... ......... ......... ........... ...........
83071 A Quant assay of ......... ......... ......... ........... ...........
hemosiderin.
83088 A Assay histamine........ ......... ......... ......... ........... ...........
83150 A Assay for HVA.......... ......... ......... ......... ........... ...........
83491 A Assay of ......... ......... ......... ........... ...........
corticosteroids.
83497 A Assay 5-HIAA........... ......... ......... ......... ........... ...........
83498 A Assay of progesterone.. ......... ......... ......... ........... ...........
83499 A Assay of progesterone.. ......... ......... ......... ........... ...........
83500 A Assay free ......... ......... ......... ........... ...........
hydroxyproline.
83505 A Assay total ......... ......... ......... ........... ...........
hydroxyproline.
83516 A Immunoassay, non ......... ......... ......... ........... ...........
antibody.
83518 A Immunoassay, dipstick.. ......... ......... ......... ........... ...........
83519 A Immunoassay nonantibody ......... ......... ......... ........... ...........
83520 A Immunoassay, RIA....... ......... ......... ......... ........... ...........
83525 A Assay of insulin....... ......... ......... ......... ........... ...........
83527 A Assay of insulin....... ......... ......... ......... ........... ...........
83528 A Assay intrinsic factor. ......... ......... ......... ........... ...........
83540 A Assay iron............. ......... ......... ......... ........... ...........
83550 A Iron binding test...... ......... ......... ......... ........... ...........
83570 A Assay IDH enzyme....... ......... ......... ......... ........... ...........
83582 A Assay ketogenic ......... ......... ......... ........... ...........
steroids.
83586 A Assay 17-(17- ......... ......... ......... ........... ...........
KS)ketosteroids.
83593 A Fractionation ......... ......... ......... ........... ...........
ketosteroids.
83605 A Lactic acid assay...... ......... ......... ......... ........... ...........
83615 A Lactate (LD) (LDH) ......... ......... ......... ........... ...........
enzyme.
83625 A Assay LDH enzymes...... ......... ......... ......... ........... ...........
83632 A Placental lactogen..... ......... ......... ......... ........... ...........
83633 A Test urine for lactose. ......... ......... ......... ........... ...........
83634 A Assay urine for lactose ......... ......... ......... ........... ...........
83655 A Assay for lead......... ......... ......... ......... ........... ...........
83661 A Assay L/S ratio........ ......... ......... ......... ........... ...........
83662 A L/S ratio, foam ......... ......... ......... ........... ...........
stability.
83670 A Assay LAP enzyme....... ......... ......... ......... ........... ...........
83690 A Assay lipase........... ......... ......... ......... ........... ...........
83715 A Assay blood ......... ......... ......... ........... ...........
lipoproteins.
\2\ 8371 A Assay blood ......... ......... ......... ........... ...........
7 lipoproteins.
83718 A Blood lipoprotein assay ......... ......... ......... ........... ...........
83719 A Blood lipoprotein assay ......... ......... ......... ........... ...........
83721 A Blood lipoprotein assay ......... ......... ......... ........... ...........
83727 A LRH hormone assay...... ......... ......... ......... ........... ...........
83735 A Assay magnesium........ ......... ......... ......... ........... ...........
83775 A Assay of md enzyme..... ......... ......... ......... ........... ...........
83785 A Assay of manganese..... ......... ......... ......... ........... ...........
[[Page 35353]]
83805 A Assay of meprobamate... ......... ......... ......... ........... ...........
83825 A Assay mercury.......... ......... ......... ......... ........... ...........
83835 A Assay metanephrines.... ......... ......... ......... ........... ...........
83840 A Assay methadone........ ......... ......... ......... ........... ...........
83857 A Assay methemalbumin.... ......... ......... ......... ........... ...........
83858 A Assay methsuximide..... ......... ......... ......... ........... ...........
83864 A Mucopolysaccharides.... ......... ......... ......... ........... ...........
83866 A Mucopolysaccharides ......... ......... ......... ........... ...........
screen.
83872 A Assay synovial fluid ......... ......... ......... ........... ...........
mucin.
83873 A Assay, CSF protein..... ......... ......... ......... ........... ...........
83874 A Myoglobin.............. ......... ......... ......... ........... ...........
83883 A Nephelometry, not ......... ......... ......... ........... ...........
specified.
83885 A Assay for nickel....... ......... ......... ......... ........... ...........
83887 A Assay nicotine......... ......... ......... ......... ........... ...........
83890 A Molecule isolate....... ......... ......... ......... ........... ...........
83892 A Molecular diagnostics.. ......... ......... ......... ........... ...........
83894 A Molecule gel ......... ......... ......... ........... ...........
electrophor.
83896 A Molecular diagnostics.. ......... ......... ......... ........... ...........
83898 A Molecule nucleic amp... ......... ......... ......... ........... ...........
83902 A Molecular diagnostics.. ......... ......... ......... ........... ...........
83912 A Genetic examination.... ......... ......... ......... ........... ...........
83915 A Assay nucleotidase..... ......... ......... ......... ........... ...........
83916 A Oligoclonal bands...... ......... ......... ......... ........... ...........
83918 A Assay organic acids ......... ......... ......... ........... ...........
quant.
83925 A Opiates................ ......... ......... ......... ........... ...........
83930 A Assay blood osmolality. ......... ......... ......... ........... ...........
83935 A Assay urine osmolality. ......... ......... ......... ........... ...........
83937 A Assay for osteocalcin.. ......... ......... ......... ........... ...........
83945 A Assay oxalate.......... ......... ......... ......... ........... ...........
83970 A Assay of parathormone.. ......... ......... ......... ........... ...........
83986 A Assay body fluid ......... ......... ......... ........... ...........
acidity.
83992 A Assay for phencyclidine ......... ......... ......... ........... ...........
84022 A Assay of phenothiazine. ......... ......... ......... ........... ...........
84030 A Assay blood PKU........ ......... ......... ......... ........... ...........
84035 A Assay phenylketones.... ......... ......... ......... ........... ...........
84060 A Assay acid phosphatase. ......... ......... ......... ........... ...........
84061 A Phosphatase, forensic ......... ......... ......... ........... ...........
exam.
84066 A Assay prostate ......... ......... ......... ........... ...........
phosphatase.
84075 A Assay alkaline ......... ......... ......... ........... ...........
phosphatase.
84078 A Assay alkaline ......... ......... ......... ........... ...........
phosphatase.
84080 A Assay alkaline ......... ......... ......... ........... ...........
phosphatases.
84081 A Amniotic fluid enzyme ......... ......... ......... ........... ...........
test.
84085 A Assay RBC PG6D enzyme.. ......... ......... ......... ........... ...........
84087 A Assay phosphohexose ......... ......... ......... ........... ...........
enzymes.
84100 A Assay phosphorus....... ......... ......... ......... ........... ...........
84105 A Assay urine phosphorus. ......... ......... ......... ........... ...........
84106 A Test for ......... ......... ......... ........... ...........
porphobilinogen.
84110 A Assay porphobilinogen.. ......... ......... ......... ........... ...........
84119 A Test urine for ......... ......... ......... ........... ...........
porphyrins.
84120 A Assay urine porphyrins. ......... ......... ......... ........... ...........
84126 A Assay feces porphyrins. ......... ......... ......... ........... ...........
84127 A Porphyrins, feces...... ......... ......... ......... ........... ...........
84132 A Assay serum potassium.. ......... ......... ......... ........... ...........
84133 A Assay urine potassium.. ......... ......... ......... ........... ...........
84134 A Prealbumin............. ......... ......... ......... ........... ...........
84135 A Assay pregnanediol..... ......... ......... ......... ........... ...........
84138 A Assay pregnanetriol.... ......... ......... ......... ........... ...........
84140 A Assay for pregnenolone. ......... ......... ......... ........... ...........
84143 A Assay/17- ......... ......... ......... ........... ...........
hydroxypregnenolone.
84144 A Assay progesterone..... ......... ......... ......... ........... ...........
84146 A Assay for prolactin.... ......... ......... ......... ........... ...........
84150 A Assay of prostaglandin. ......... ......... ......... ........... ...........
84153 A Psa total.............. ......... ......... ......... ........... ...........
84155 A Assay protein.......... ......... ......... ......... ........... ...........
84160 A Assay serum protein.... ......... ......... ......... ........... ...........
84165 A Assay serum proteins... ......... ......... ......... ........... ...........
84181 A Western blot test...... ......... ......... ......... ........... ...........
84182 A Protein, western blot ......... ......... ......... ........... ...........
test.
84202 A Assay RBC ......... ......... ......... ........... ...........
protoporphyrin.
84203 A Test RBC protoporphyrin ......... ......... ......... ........... ...........
84206 A Assay of proinsulin.... ......... ......... ......... ........... ...........
84207 A Assay vitamin B-6...... ......... ......... ......... ........... ...........
84210 A Assay pyruvate......... ......... ......... ......... ........... ...........
84220 A Assay pyruvate kinase.. ......... ......... ......... ........... ...........
84228 A Assay quinine.......... ......... ......... ......... ........... ...........
[[Page 35354]]
84233 A Assay estrogen......... ......... ......... ......... ........... ...........
84234 A Assay progesterone..... ......... ......... ......... ........... ...........
84235 A Assay endocrine hormone ......... ......... ......... ........... ...........
84238 A Assay non-endocrine ......... ......... ......... ........... ...........
receptor.
84244 A Assay of renin......... ......... ......... ......... ........... ...........
84252 A Assay vitamin B-2...... ......... ......... ......... ........... ...........
84255 A Assay selenium......... ......... ......... ......... ........... ...........
84260 A Assay serotonin........ ......... ......... ......... ........... ...........
84270 A Sex hormone globulin ......... ......... ......... ........... ...........
(SHBG).
84275 A Assay sialic acid...... ......... ......... ......... ........... ...........
84285 A Assay silica........... ......... ......... ......... ........... ...........
84295 A Assay serum sodium..... ......... ......... ......... ........... ...........
84300 A Assay urine sodium..... ......... ......... ......... ........... ...........
84305 A Somatomedin............ ......... ......... ......... ........... ...........
84307 A Somatostatin........... ......... ......... ......... ........... ...........
84311 A Spectrophotometry...... ......... ......... ......... ........... ...........
84315 A Body fluid specific ......... ......... ......... ........... ...........
gravity.
84375 A Chromatogram assay, ......... ......... ......... ........... ...........
sugars.
84392 A Assay urine sulfate.... ......... ......... ......... ........... ...........
84402 A Testosterone........... ......... ......... ......... ........... ...........
84403 A Assay total ......... ......... ......... ........... ...........
testosterone.
84425 A Assay vitamin B-1...... ......... ......... ......... ........... ...........
84430 A Assay thiocyanate...... ......... ......... ......... ........... ...........
84432 A Thyroglobulin.......... ......... ......... ......... ........... ...........
84436 A Assay, total thyroxine. ......... ......... ......... ........... ...........
84437 A Assay neonatal ......... ......... ......... ........... ...........
thyroxine.
84439 A Assay, free thyroxine.. ......... ......... ......... ........... ...........
84442 A Thyroid activity (TBG) ......... ......... ......... ........... ...........
assay.
84443 A Assay thyroid stim ......... ......... ......... ........... ...........
hormone.
84445 A Thyroid immunoglobulins ......... ......... ......... ........... ...........
TSI.
84446 A Assay vitamin E........ ......... ......... ......... ........... ...........
84449 A Assay for transcortin.. ......... ......... ......... ........... ...........
84450 A Transferase (AST) ......... ......... ......... ........... ...........
(SGOT).
84460 A Alanine amino (ALT) ......... ......... ......... ........... ...........
(SGPT).
84466 A Transferrin............ ......... ......... ......... ........... ...........
84478 A Assay triglycerides.... ......... ......... ......... ........... ...........
84479 A Assay thyroid (t-3 or t- ......... ......... ......... ........... ...........
4).
84480 A Assay triiodothyronine ......... ......... ......... ........... ...........
(t-3).
84481 A Free assay (FT-3)...... ......... ......... ......... ........... ...........
84482 A T3 reverse............. ......... ......... ......... ........... ...........
84484 A Troponin, quant........ ......... ......... ......... ........... ...........
84485 A Assay duodenal fluid ......... ......... ......... ........... ...........
trypsin.
84488 A Test feces for trypsin. ......... ......... ......... ........... ...........
84490 A Assay feces for trypsin ......... ......... ......... ........... ...........
84510 A Assay tyrosine......... ......... ......... ......... ........... ...........
84512 A Troponin, qual......... ......... ......... ......... ........... ...........
84520 A Assay urea nitrogen.... ......... ......... ......... ........... ...........
84525 A Urea nitrogen semi- ......... ......... ......... ........... ...........
quant.
84540 A Assay urine urea-N..... ......... ......... ......... ........... ...........
84545 A Urea-N clearance test.. ......... ......... ......... ........... ...........
84550 A Assay blood uric acid.. ......... ......... ......... ........... ...........
84560 A Assay urine uric acid.. ......... ......... ......... ........... ...........
84577 A Assay feces ......... ......... ......... ........... ...........
urobilinogen.
84578 A Test urine urobilinogen ......... ......... ......... ........... ...........
84580 A Assay urine ......... ......... ......... ........... ...........
urobilinogen.
84583 A Assay urine ......... ......... ......... ........... ...........
urobilinogen.
84585 A Assay urine VMA........ ......... ......... ......... ........... ...........
84586 A VIP assay.............. ......... ......... ......... ........... ...........
84588 A Assay vasopressin...... ......... ......... ......... ........... ...........
84590 A Assay vitamin-A........ ......... ......... ......... ........... ...........
84597 A Assay vitamin-K........ ......... ......... ......... ........... ...........
84600 A Assay for volatiles.... ......... ......... ......... ........... ...........
84620 A Xylose tolerance test.. ......... ......... ......... ........... ...........
84630 A Assay zinc............. ......... ......... ......... ........... ...........
84681 A Assay C-peptide........ ......... ......... ......... ........... ...........
84702 A Chorionic gonadotropin ......... ......... ......... ........... ...........
test.
84703 A Chorionic gonadotropin ......... ......... ......... ........... ...........
assay.
84830 A Ovulation tests........ ......... ......... ......... ........... ...........
84999 A Clinical chemistry test ......... ......... ......... ........... ...........
85002 A Bleeding time test..... ......... ......... ......... ........... ...........
85007 A Differential WBC count. ......... ......... ......... ........... ...........
85008 A Nondifferential WBC ......... ......... ......... ........... ...........
count.
85009 A Differential WBC count. ......... ......... ......... ........... ...........
85013 A Hematocrit............. ......... ......... ......... ........... ...........
85014 A Hematocrit............. ......... ......... ......... ........... ...........
[[Page 35355]]
85018 A Hemoglobin............. ......... ......... ......... ........... ...........
85021 A Automated hemogram..... ......... ......... ......... ........... ...........
85022 A Automated hemogram..... ......... ......... ......... ........... ...........
85023 A Automated hemogram..... ......... ......... ......... ........... ...........
85024 A Automated hemogram..... ......... ......... ......... ........... ...........
85025 A Automated hemogram..... ......... ......... ......... ........... ...........
85027 A Automated hemogram..... ......... ......... ......... ........... ...........
\2\ 8502 A Automated hemogram..... ......... ......... ......... ........... ...........
9
\2\ 8503 A Automated hemogram..... ......... ......... ......... ........... ...........
0
85031 A Manual ......... ......... ......... ........... ...........
hemogram,complete cbc.
85041 A Red blood cell (RBC) ......... ......... ......... ........... ...........
count.
85044 A Reticulocyte count..... ......... ......... ......... ........... ...........
85045 A Reticulocyte count..... ......... ......... ......... ........... ...........
85048 A White blood cell (WBC) ......... ......... ......... ........... ...........
count.
85060 X Blood smear 882 0.39 $20.05 $11.75 $4.01
interpretation.
85095 S Bone marrow aspiration. 121 0.63 $32.39 $21.02 $6.48
85097 X Bone marrow 882 0.39 $20.05 $11.75 $4.01
interpretation.
85102 S Bone marrow biopsy..... 121 0.63 $32.39 $21.02 $6.48
85130 A Chromogenic substrate ......... ......... ......... ........... ...........
assay.
85170 A Blood clot retraction.. ......... ......... ......... ........... ...........
85175 A Blood clot lysis time.. ......... ......... ......... ........... ...........
85210 A Blood clot factor II ......... ......... ......... ........... ...........
test.
85220 A Blood clot factor V ......... ......... ......... ........... ...........
test.
85230 A Blood clot factor VII ......... ......... ......... ........... ...........
test.
85240 A Blood clot factor VIII ......... ......... ......... ........... ...........
test.
85244 A Blood clot factor VIII ......... ......... ......... ........... ...........
test.
85245 A Blood clot factor VIII ......... ......... ......... ........... ...........
test.
85246 A Blood clot factor VIII ......... ......... ......... ........... ...........
test.
85247 A Blood clot factor VIII ......... ......... ......... ........... ...........
test.
85250 A Blood clot factor IX ......... ......... ......... ........... ...........
test.
85260 A Blood clot factor X ......... ......... ......... ........... ...........
test.
85270 A Blood clot factor XI ......... ......... ......... ........... ...........
test.
85280 A Blood clot factor XII ......... ......... ......... ........... ...........
test.
85290 A Blood clot factor XIII ......... ......... ......... ........... ...........
test.
85291 A Blood clot factor XIII ......... ......... ......... ........... ...........
test.
85292 A Blood clot factor assay ......... ......... ......... ........... ...........
85293 A Blood clot factor assay ......... ......... ......... ........... ...........
85300 A Antithrombin III test.. ......... ......... ......... ........... ...........
85301 A Antithrombin III test.. ......... ......... ......... ........... ...........
85302 A Blood clot inhibitor ......... ......... ......... ........... ...........
antigen.
85303 A Blood clot inhibitor ......... ......... ......... ........... ...........
test.
85305 A Blood clot inhibitor ......... ......... ......... ........... ...........
assay.
85306 A Blood clot inhibitor ......... ......... ......... ........... ...........
test.
85335 A Factor inhibitor test.. ......... ......... ......... ........... ...........
85337 A Thrombomodulin......... ......... ......... ......... ........... ...........
85345 A Coagulation time....... ......... ......... ......... ........... ...........
85347 A Coagulation time....... ......... ......... ......... ........... ...........
85348 A Coagulation time....... ......... ......... ......... ........... ...........
85360 A Euglobulin lysis....... ......... ......... ......... ........... ...........
85362 A Fibrin degradation ......... ......... ......... ........... ...........
products.
85366 A Fibrinogen test........ ......... ......... ......... ........... ...........
85370 A Fibrinogen test........ ......... ......... ......... ........... ...........
85378 A Fibrin degradation..... ......... ......... ......... ........... ...........
85379 A Fibrin degradation..... ......... ......... ......... ........... ...........
85384 A Fibrinogen............. ......... ......... ......... ........... ...........
85385 A Fibrinogen............. ......... ......... ......... ........... ...........
85390 A Fibrinolysins screen... ......... ......... ......... ........... ...........
85400 A Fibrinolytic plasmin... ......... ......... ......... ........... ...........
85410 A Fibrinolytic ......... ......... ......... ........... ...........
antiplasmin.
85415 A Fibrinolytic ......... ......... ......... ........... ...........
plasminogen.
85420 A Fibrinolytic ......... ......... ......... ........... ...........
plasminogen.
85421 A Fibrinolytic ......... ......... ......... ........... ...........
plasminogen.
85441 A Heinz bodies; direct... ......... ......... ......... ........... ...........
85445 A Heinz bodies; induced.. ......... ......... ......... ........... ...........
85460 A Hemoglobin, fetal...... ......... ......... ......... ........... ...........
85461 A Hemoglobin, fetal...... ......... ......... ......... ........... ...........
85475 A Hemolysin.............. ......... ......... ......... ........... ...........
85520 A Heparin assay.......... ......... ......... ......... ........... ...........
85525 A Heparin................ ......... ......... ......... ........... ...........
85530 A Heparin-protamine ......... ......... ......... ........... ...........
tolerance.
85535 A Iron stain, blood cells ......... ......... ......... ........... ...........
85540 A Wbc alkaline ......... ......... ......... ........... ...........
phosphatase.
85547 A RBC mechanical ......... ......... ......... ........... ...........
fragility.
85549 A Muramidase............. ......... ......... ......... ........... ...........
85555 A RBC osmotic fragility.. ......... ......... ......... ........... ...........
[[Page 35356]]
85557 A RBC osmotic fragility.. ......... ......... ......... ........... ...........
85576 A Blood platelet ......... ......... ......... ........... ...........
aggregation.
85585 A Blood platelet ......... ......... ......... ........... ...........
estimation.
85590 A Platelet manual count.. ......... ......... ......... ........... ...........
85595 A Platelet count, ......... ......... ......... ........... ...........
automated.
85597 A Platelet neutralization ......... ......... ......... ........... ...........
85610 A Prothrombin time....... ......... ......... ......... ........... ...........
85611 A Prothrombin test....... ......... ......... ......... ........... ...........
85612 A Viper venom prothrombin ......... ......... ......... ........... ...........
time.
85613 A Russell viper venom, ......... ......... ......... ........... ...........
diluted.
85635 A Reptilase test......... ......... ......... ......... ........... ...........
85651 A Rbc sed rate, nonauto.. ......... ......... ......... ........... ...........
85652 A Rbc sed rate, auto..... ......... ......... ......... ........... ...........
85660 A RBC sickle cell test... ......... ......... ......... ........... ...........
85670 A Thrombin time, plasma.. ......... ......... ......... ........... ...........
85675 A Thrombin time, titer... ......... ......... ......... ........... ...........
85705 A Thromboplastin ......... ......... ......... ........... ...........
inhibition.
85730 A Thromboplastin time, ......... ......... ......... ........... ...........
partial.
85732 A Thromboplastin time, ......... ......... ......... ........... ...........
partial.
85810 A Blood viscosity ......... ......... ......... ........... ...........
examination.
85999 A Hematology procedure... ......... ......... ......... ........... ...........
86000 A Agglutinins; febrile... ......... ......... ......... ........... ...........
86003 A Allergen specific IgE.. ......... ......... ......... ........... ...........
86005 A Allergen specific IgE.. ......... ......... ......... ........... ...........
86021 A WBC antibody ......... ......... ......... ........... ...........
identification.
86022 A Platelet antibodies.... ......... ......... ......... ........... ...........
86023 A Immunoglobulin assay... ......... ......... ......... ........... ...........
86038 A Antinuclear antibodies. ......... ......... ......... ........... ...........
86039 A Antinuclear antibodies ......... ......... ......... ........... ...........
(ANA).
86060 A Antistreptolysin O ......... ......... ......... ........... ...........
titer.
86063 A Antistreptolysin O ......... ......... ......... ........... ...........
screen.
86077 X Physician blood bank 882 0.39 $20.05 $11.75 $4.01
service.
86078 X Physician blood bank 882 0.39 $20.05 $11.75 $4.01
service.
86079 X Physician blood bank 882 0.39 $20.05 $11.75 $4.01
service.
86140 A C-reactive protein..... ......... ......... ......... ........... ...........
86147 A Cardiolipin antibody... ......... ......... ......... ........... ...........
86148 A Phospholipid antibody.. ......... ......... ......... ........... ...........
86155 A Chemotaxis assay....... ......... ......... ......... ........... ...........
86156 A Cold agglutinin screen. ......... ......... ......... ........... ...........
86157 A Cold agglutinin, titer. ......... ......... ......... ........... ...........
86160 A Complement, antigen.... ......... ......... ......... ........... ...........
86161 A Complement/function ......... ......... ......... ........... ...........
activity.
86162 A Complement, total ......... ......... ......... ........... ...........
(CH50).
86171 A Complement fixation, ......... ......... ......... ........... ...........
each.
86185 A Counterimmunoelectropho ......... ......... ......... ........... ...........
resis.
86215 A Deoxyribonuclease, ......... ......... ......... ........... ...........
antibody.
86225 A DNA antibody........... ......... ......... ......... ........... ...........
86226 A DNA antibody, single ......... ......... ......... ........... ...........
strand.
86235 A Nuclear antigen ......... ......... ......... ........... ...........
antibody.
86243 A Fc receptor............ ......... ......... ......... ........... ...........
86255 A Fluorescent antibody; ......... ......... ......... ........... ...........
screen.
86256 A Fluorescent antibody; ......... ......... ......... ........... ...........
titer.
86277 A Growth hormone antibody ......... ......... ......... ........... ...........
86280 A Hemagglutination ......... ......... ......... ........... ...........
inhibition.
86308 A Heterophile antibodies. ......... ......... ......... ........... ...........
86309 A Heterophile antibodies. ......... ......... ......... ........... ...........
86310 A Heterophile antibodies. ......... ......... ......... ........... ...........
86316 A Immunoassay, tumor ......... ......... ......... ........... ...........
antigen.
86317 A Immunoassay, infectious ......... ......... ......... ........... ...........
agent.
86318 A Immunoassay, infectious ......... ......... ......... ........... ...........
agent.
86320 A Serum ......... ......... ......... ........... ...........
immunoelectrophoresis.
86325 A Other ......... ......... ......... ........... ...........
immunoelectrophoresis.
86327 A Immunoelectrophoresis ......... ......... ......... ........... ...........
assay.
86329 A Immunodiffusion........ ......... ......... ......... ........... ...........
86331 A Immunodiffusion ......... ......... ......... ........... ...........
ouchterlony.
86332 A Immune complex assay... ......... ......... ......... ........... ...........
86334 A Immunofixation ......... ......... ......... ........... ...........
procedure.
86337 A Insulin antibodies..... ......... ......... ......... ........... ...........
86340 A Intrinsic factor ......... ......... ......... ........... ...........
antibody.
86341 A Islet cell antibody.... ......... ......... ......... ........... ...........
86343 A Leukocyte histamine ......... ......... ......... ........... ...........
release.
86344 A Leukocyte phagocytosis. ......... ......... ......... ........... ...........
86353 A Lymphocyte ......... ......... ......... ........... ...........
transformation.
86359 A T cells, total count... ......... ......... ......... ........... ...........
86360 A T cell absolute count/ ......... ......... ......... ........... ...........
ratio.
[[Page 35357]]
86361 A T cell absolute count.. ......... ......... ......... ........... ...........
86376 A Microsomal antibody.... ......... ......... ......... ........... ...........
86378 A Migration inhibitory ......... ......... ......... ........... ...........
factor.
86382 A Neutralization test, ......... ......... ......... ........... ...........
viral.
86384 A Nitroblue tetrazolium ......... ......... ......... ........... ...........
dye.
86403 A Particle agglutination ......... ......... ......... ........... ...........
test.
86406 A Particle agglutination ......... ......... ......... ........... ...........
test.
86430 A Rheumatoid factor test. ......... ......... ......... ........... ...........
86431 A Rheumatoid factor, ......... ......... ......... ........... ...........
quant.
86485 X Skin test, candida..... 861 0.13 $6.68 $3.62 $1.34
86490 X Coccidioidomycosis skin 861 0.13 $6.68 $3.62 $1.34
test.
86510 X Histoplasmosis skin 861 0.13 $6.68 $3.62 $1.34
test.
86580 X TB intradermal test.... 861 0.13 $6.68 $3.62 $1.34
86585 X TB tine test........... 861 0.13 $6.68 $3.62 $1.34
86586 X Skin test, unlisted.... 861 0.13 $6.68 $3.62 $1.34
86588 A Streptocollus, direct ......... ......... ......... ........... ...........
screen.
86590 A Streptokinase, antibody ......... ......... ......... ........... ...........
86592 A Blood serology, ......... ......... ......... ........... ...........
qualitative.
86593 A Blood serology, ......... ......... ......... ........... ...........
quantitative.
86602 A Antinomyces antibody... ......... ......... ......... ........... ...........
86603 A Adenovirus, antibody... ......... ......... ......... ........... ...........
86606 A Aspergillus antibody... ......... ......... ......... ........... ...........
86609 A Bacterium, antibody.... ......... ......... ......... ........... ...........
86612 A Blastomyces, antibody.. ......... ......... ......... ........... ...........
86615 A Bordetella antibody.... ......... ......... ......... ........... ...........
86617 A Lyme disease antibody.. ......... ......... ......... ........... ...........
86618 A Lyme disease antibody.. ......... ......... ......... ........... ...........
86619 A Borrelia antibody...... ......... ......... ......... ........... ...........
86622 A Brucella, antibody..... ......... ......... ......... ........... ...........
86625 A Campylobacter, antibody ......... ......... ......... ........... ...........
86628 A Candida, antibody...... ......... ......... ......... ........... ...........
86631 A Chlamydia, antibody.... ......... ......... ......... ........... ...........
86632 A Chlamydia, IgM, ......... ......... ......... ........... ...........
antibody.
86635 A Coccidioides, antibody. ......... ......... ......... ........... ...........
86638 A Q fever antibody....... ......... ......... ......... ........... ...........
86641 A Cryptococcus antibody.. ......... ......... ......... ........... ...........
86644 A CMV antibody........... ......... ......... ......... ........... ...........
86645 A CMV antibody, IgM...... ......... ......... ......... ........... ...........
86648 A Diphtheria antibody.... ......... ......... ......... ........... ...........
86651 A Encephalitis antibody.. ......... ......... ......... ........... ...........
86652 A Encephalitis antibody.. ......... ......... ......... ........... ...........
86653 A Encephalitis, antibody. ......... ......... ......... ........... ...........
86654 A Encephalitis, antibody. ......... ......... ......... ........... ...........
86658 A Enterovirus, antibody.. ......... ......... ......... ........... ...........
86663 A Epstein-barr antibody.. ......... ......... ......... ........... ...........
86664 A Epstein-barr antibody.. ......... ......... ......... ........... ...........
86665 A Epstein-barr, antibody. ......... ......... ......... ........... ...........
86668 A Francisella tularensis. ......... ......... ......... ........... ...........
86671 A Fungus, antibody....... ......... ......... ......... ........... ...........
86674 A Giardia lamblia........ ......... ......... ......... ........... ...........
86677 A Helicobacter pylori.... ......... ......... ......... ........... ...........
86682 A Helminth, antibody..... ......... ......... ......... ........... ...........
86684 A Hemophilus influenza... ......... ......... ......... ........... ...........
86687 A HTLV I................. ......... ......... ......... ........... ...........
86688 A HTLV-II................ ......... ......... ......... ........... ...........
86689 A HTLV/HIV confirmatory ......... ......... ......... ........... ...........
test.
86692 A Hepatitis, delta agent. ......... ......... ......... ........... ...........
86694 A Herpes simplex test.... ......... ......... ......... ........... ...........
86695 A Herpes simplex test.... ......... ......... ......... ........... ...........
86698 A Histoplasma............ ......... ......... ......... ........... ...........
86701 A HIV-1.................. ......... ......... ......... ........... ...........
86702 A HIV-2.................. ......... ......... ......... ........... ...........
86703 A HIV-1/HIV-2, single ......... ......... ......... ........... ...........
assay.
86704 A Hep b core ab test, igg ......... ......... ......... ........... ...........
& m.
86705 A Hep b core ab test, igm ......... ......... ......... ........... ...........
86706 A Hepatitis b surface ab ......... ......... ......... ........... ...........
test.
86707 A Hepatitis be ab test... ......... ......... ......... ........... ...........
86708 A Hep a ab test, igg & m. ......... ......... ......... ........... ...........
86709 A Hep a ab test, igm..... ......... ......... ......... ........... ...........
86710 A Influenza virus........ ......... ......... ......... ........... ...........
86713 A Legionella............. ......... ......... ......... ........... ...........
86717 A Leishmania............. ......... ......... ......... ........... ...........
86720 A Leptospira............. ......... ......... ......... ........... ...........
86723 A Listeria monocytogenes. ......... ......... ......... ........... ...........
86727 A Lymph choriomeningitis. ......... ......... ......... ........... ...........
[[Page 35358]]
86729 A Lympho venereum........ ......... ......... ......... ........... ...........
86732 A Mucormycosis........... ......... ......... ......... ........... ...........
86735 A Mumps.................. ......... ......... ......... ........... ...........
86738 A Mycoplasma............. ......... ......... ......... ........... ...........
86741 A Neisseria meningitidis. ......... ......... ......... ........... ...........
86744 A Nocardia............... ......... ......... ......... ........... ...........
86747 A Parvovirus............. ......... ......... ......... ........... ...........
86750 A Malaria................ ......... ......... ......... ........... ...........
86753 A Protozoa, not elsewhere ......... ......... ......... ........... ...........
86756 A Respiratory virus...... ......... ......... ......... ........... ...........
86759 A Rotavirus.............. ......... ......... ......... ........... ...........
86762 A Rubella................ ......... ......... ......... ........... ...........
86765 A Rubeola................ ......... ......... ......... ........... ...........
86768 A Salmonella............. ......... ......... ......... ........... ...........
86771 A Shigella............... ......... ......... ......... ........... ...........
86774 A Tetanus................ ......... ......... ......... ........... ...........
86777 A Toxoplasma............. ......... ......... ......... ........... ...........
86778 A Toxoplasma, IgM........ ......... ......... ......... ........... ...........
86781 A Treponema pallidum ......... ......... ......... ........... ...........
confirm.
86784 A Trichinella............ ......... ......... ......... ........... ...........
86787 A Varicella-zoster....... ......... ......... ......... ........... ...........
86790 A Virus, not specified... ......... ......... ......... ........... ...........
86793 A Yersinia............... ......... ......... ......... ........... ...........
86800 A Thyroglobulin antibody. ......... ......... ......... ........... ...........
86803 A Hepatitis c ab test.... ......... ......... ......... ........... ...........
86804 A Hep c ab test, confirm. ......... ......... ......... ........... ...........
86805 A Lymphocytotoxicity ......... ......... ......... ........... ...........
assay.
86806 A Lymphocytotoxicity ......... ......... ......... ........... ...........
assay.
86807 A Cytotoxic antibody ......... ......... ......... ........... ...........
screening.
86808 A Cytotoxic antibody ......... ......... ......... ........... ...........
screening.
86812 A HLA typing, A, B, or C. ......... ......... ......... ........... ...........
86813 A HLA typing, A, B, or C. ......... ......... ......... ........... ...........
86816 A HLA typing, DR/DQ...... ......... ......... ......... ........... ...........
86817 A HLA typing, DR/DQ...... ......... ......... ......... ........... ...........
86821 A Lymphocyte culture, ......... ......... ......... ........... ...........
mixed.
86822 A Lymphocyte culture, ......... ......... ......... ........... ...........
primed.
86849 A Immunology procedure... ......... ......... ......... ........... ...........
86850 A RBC antibody screen.... ......... ......... ......... ........... ...........
86860 A RBC antibody elution... ......... ......... ......... ........... ...........
86870 A RBC antibody ......... ......... ......... ........... ...........
identification.
86880 A Coombs test............ ......... ......... ......... ........... ...........
86885 A Coombs test............ ......... ......... ......... ........... ...........
86886 A Coombs test............ ......... ......... ......... ........... ...........
86890 A Autologous blood ......... ......... ......... ........... ...........
process.
86891 A Autologous blood, op ......... ......... ......... ........... ...........
salvage.
86900 A Blood typing, ABO...... ......... ......... ......... ........... ...........
86901 A Blood typing, Rh (D)... ......... ......... ......... ........... ...........
86903 A Blood typing, antigen ......... ......... ......... ........... ...........
screen.
86904 A Blood typing, patient ......... ......... ......... ........... ...........
serum.
86905 A Blood typing, RBC ......... ......... ......... ........... ...........
antigens.
86906 A Blood typing, Rh ......... ......... ......... ........... ...........
phenotype.
86910 E Blood typing, paternity ......... ......... ......... ........... ...........
test.
86911 E Blood typing, antigen ......... ......... ......... ........... ...........
system.
86915 A Bone marrow............ ......... ......... ......... ........... ...........
86920 A Compatibility test..... ......... ......... ......... ........... ...........
86921 A Compatibility test..... ......... ......... ......... ........... ...........
86922 A Compatibility test..... ......... ......... ......... ........... ...........
86927 A Plasma, fresh frozen... ......... ......... ......... ........... ...........
86930 A Frozen blood prep...... ......... ......... ......... ........... ...........
86931 A Frozen blood thaw...... ......... ......... ......... ........... ...........
86932 A Frozen blood, freeze/ ......... ......... ......... ........... ...........
thaw.
86940 A Hemolysins/agglutinins ......... ......... ......... ........... ...........
auto.
86941 A Hemolysins/agglutinins. ......... ......... ......... ........... ...........
86945 A Blood product/ ......... ......... ......... ........... ...........
irradiation.
86950 A Leukacyte transfusion.. ......... ......... ......... ........... ...........
86965 A Pooling blood platelets ......... ......... ......... ........... ...........
86970 A RBC pretreatment....... ......... ......... ......... ........... ...........
86971 A RBC pretreatment....... ......... ......... ......... ........... ...........
86972 A RBC pretreatment....... ......... ......... ......... ........... ...........
86975 A RBC pretreatment, serum ......... ......... ......... ........... ...........
86976 A RBC pretreatment, serum ......... ......... ......... ........... ...........
86977 A RBC pretreatment, serum ......... ......... ......... ........... ...........
86978 A RBC pretreatment, serum ......... ......... ......... ........... ...........
86985 A Split blood or products ......... ......... ......... ........... ...........
86999 A Transfusion procedure.. ......... ......... ......... ........... ...........
[[Page 35359]]
87001 A Small animal ......... ......... ......... ........... ...........
inoculation.
87003 A Small animal ......... ......... ......... ........... ...........
inoculation.
87015 A Specimen concentration. ......... ......... ......... ........... ...........
87040 A Blood culture for ......... ......... ......... ........... ...........
bacteria.
87045 A Stool culture for ......... ......... ......... ........... ...........
bacteria.
87060 A Nose/throat ......... ......... ......... ........... ...........
culture,bacteria.
87070 A Culture specimen, ......... ......... ......... ........... ...........
bacteria.
87072 A Culture of specimen by ......... ......... ......... ........... ...........
kit.
87075 A Culture specimen, ......... ......... ......... ........... ...........
bacteria.
87076 A Bacteria identification ......... ......... ......... ........... ...........
87081 A Bacteria culture screen ......... ......... ......... ........... ...........
87082 A Culture of specimen by ......... ......... ......... ........... ...........
kit.
87083 A Culture of specimen by ......... ......... ......... ........... ...........
kit.
87084 A Culture of specimen by ......... ......... ......... ........... ...........
kit.
87085 A Culture of specimen by ......... ......... ......... ........... ...........
kit.
87086 A Urine culture, colony ......... ......... ......... ........... ...........
count.
87087 A Urine bacteria culture. ......... ......... ......... ........... ...........
87088 A Urine bacteria culture. ......... ......... ......... ........... ...........
87101 A Skin fungus culture.... ......... ......... ......... ........... ...........
87102 A Fungus isolation ......... ......... ......... ........... ...........
culture.
87103 A Blood fungus culture... ......... ......... ......... ........... ...........
87106 A Fungus identification.. ......... ......... ......... ........... ...........
87109 A Mycoplasma culture..... ......... ......... ......... ........... ...........
87110 A Culture, chlamydia..... ......... ......... ......... ........... ...........
87116 A Mycobacteria culture... ......... ......... ......... ........... ...........
87117 A Mycobacteria culture... ......... ......... ......... ........... ...........
87118 A Mycobacteria ......... ......... ......... ........... ...........
identification.
87140 A Culture typing, ......... ......... ......... ........... ...........
fluorescent.
87143 A Culture typing, GLC ......... ......... ......... ........... ...........
method.
87145 A Culture typing, phage ......... ......... ......... ........... ...........
method.
87147 A Culture typing, ......... ......... ......... ........... ...........
serologic.
87151 A Culture typing, ......... ......... ......... ........... ...........
serologic.
87155 A Culture typing, ......... ......... ......... ........... ...........
precipitin.
87158 A Culture typing, added ......... ......... ......... ........... ...........
method.
87163 A Special microbiology ......... ......... ......... ........... ...........
culture.
87164 A Dark field examination. ......... ......... ......... ........... ...........
87166 A Dark field examination. ......... ......... ......... ........... ...........
87174 A Endotoxin, bacterial... ......... ......... ......... ........... ...........
87175 A Assay, endotoxin, ......... ......... ......... ........... ...........
bacterial.
87176 A Endotoxin, bacterial... ......... ......... ......... ........... ...........
87177 A Ova and parasites ......... ......... ......... ........... ...........
smears.
87181 A Antibiotic sensitivity, ......... ......... ......... ........... ...........
each.
87184 A Antibiotic sensitivity, ......... ......... ......... ........... ...........
each.
87186 A Antibiotic sensitivity, ......... ......... ......... ........... ...........
MIC.
87187 A Antibiotic sensitivity, ......... ......... ......... ........... ...........
MBC.
87188 A Antibiotic sensitivity, ......... ......... ......... ........... ...........
each.
87190 A TB antibiotic ......... ......... ......... ........... ...........
sensitivity.
87192 A Antibiotic sensitivity, ......... ......... ......... ........... ...........
each.
87197 A Bactericidal level, ......... ......... ......... ........... ...........
serum.
87205 A Smear, stain & ......... ......... ......... ........... ...........
interpret.
87206 A Smear, stain & ......... ......... ......... ........... ...........
interpret.
87207 A Smear, stain & ......... ......... ......... ........... ...........
interpret.
87208 A Smear, stain & ......... ......... ......... ........... ...........
interpret.
87210 A Smear, stain & ......... ......... ......... ........... ...........
interpret.
87211 A Smear, stain & ......... ......... ......... ........... ...........
interpret.
87220 A Tissue exam for fungi.. ......... ......... ......... ........... ...........
87230 A Assay, toxin or ......... ......... ......... ........... ...........
antitoxin.
87250 A Virus inoculation for ......... ......... ......... ........... ...........
test.
87252 A Virus inoculation for ......... ......... ......... ........... ...........
test.
87253 A Virus inoculation for ......... ......... ......... ........... ...........
test.
87260 A Adenovirus ag, dfa..... ......... ......... ......... ........... ...........
87265 A Pertussis ag, dfa...... ......... ......... ......... ........... ...........
87270 A Chylmd trach ag, dfa... ......... ......... ......... ........... ...........
87272 A Cryptosporidum ag, dfa. ......... ......... ......... ........... ...........
87274 A Herpes simplex ag, dfa. ......... ......... ......... ........... ...........
87276 A Influenza ag, dfa...... ......... ......... ......... ........... ...........
87278 A Legion pneumo ag, dfa.. ......... ......... ......... ........... ...........
87280 A Resp syncytial ag, dfa. ......... ......... ......... ........... ...........
87285 A Trepon pallidum ag, dfa ......... ......... ......... ........... ...........
87290 A Varicella ag, dfa...... ......... ......... ......... ........... ...........
87299 A Ag detection nos, dfa.. ......... ......... ......... ........... ...........
87301 A Adenovirus ag, eia..... ......... ......... ......... ........... ...........
87320 A Chylmd trach ag, eia... ......... ......... ......... ........... ...........
87324 A Clostridium ag, eia.... ......... ......... ......... ........... ...........
87328 A Cryptospor ag, eia..... ......... ......... ......... ........... ...........
[[Page 35360]]
87332 A Cytomegalovirus ag, eia ......... ......... ......... ........... ...........
87335 A E coli 0157 ag, eia.... ......... ......... ......... ........... ...........
87340 A Hepatitis b surface ag, ......... ......... ......... ........... ...........
eia.
87350 A Hepatitis b ag, eia.... ......... ......... ......... ........... ...........
87380 A Hepatitis delta ag, eia ......... ......... ......... ........... ...........
87385 A Histoplasma capsul ag, ......... ......... ......... ........... ...........
eia.
87390 A Hiv-1 ag, eia.......... ......... ......... ......... ........... ...........
87391 A Hiv-2 ag, eia.......... ......... ......... ......... ........... ...........
87420 A Resp syncytial ag, eia. ......... ......... ......... ........... ...........
87425 A Rotavirus ag, eia...... ......... ......... ......... ........... ...........
87430 A Strep a ag, eia........ ......... ......... ......... ........... ...........
87449 A Ag detect nos, eia, ......... ......... ......... ........... ...........
mult.
87450 A Ag detect nos, eia, ......... ......... ......... ........... ...........
single.
87470 A Bartonella, dna, dir ......... ......... ......... ........... ...........
probe.
87471 A Bartonella, dna, amp ......... ......... ......... ........... ...........
probe.
87472 A Bartonella, dna, quant. ......... ......... ......... ........... ...........
87475 A Lyme dis, dna, dir ......... ......... ......... ........... ...........
probe.
87476 A Lyme dis, dna, amp ......... ......... ......... ........... ...........
probe.
87477 A Lyme dis, dna, quant... ......... ......... ......... ........... ...........
87480 A Candida, dna, dir probe ......... ......... ......... ........... ...........
87481 A Candida, dna, amp probe ......... ......... ......... ........... ...........
87482 A Candida, dna, quant.... ......... ......... ......... ........... ...........
87485 A Chylmd pneum, dna, dir ......... ......... ......... ........... ...........
probe.
87486 A Chylmd pneum, dna, amp ......... ......... ......... ........... ...........
probe.
87487 A Chylmd pneum, dna, ......... ......... ......... ........... ...........
quant.
87490 A Chylmd trach, dna, dir ......... ......... ......... ........... ...........
probe.
87491 A Chylmd trach, dna, amp ......... ......... ......... ........... ...........
probe.
87492 A Chylmd trach, dna, ......... ......... ......... ........... ...........
quant.
87495 A Cytomeg, dna, dir probe ......... ......... ......... ........... ...........
87496 A Cytomeg, dna, amp probe ......... ......... ......... ........... ...........
87497 A Cytomeg, dna, quant.... ......... ......... ......... ........... ...........
87510 A Gardner vag, dna, dir ......... ......... ......... ........... ...........
probe.
87511 A Gardner vag, dna, amp ......... ......... ......... ........... ...........
probe.
87512 A Gardner vag, dna, quant ......... ......... ......... ........... ...........
87515 A Hepatitis b, dna, dir ......... ......... ......... ........... ...........
probe.
87516 A Hepatitis b, dna, amp ......... ......... ......... ........... ...........
probe.
87517 A Hepatitis b, dna, quant ......... ......... ......... ........... ...........
87520 A Hepatitis c, rna, dir ......... ......... ......... ........... ...........
probe.
87521 A Hepatitis c, rna, amp ......... ......... ......... ........... ...........
probe.
87522 A Hepatitis c, rna, quant ......... ......... ......... ........... ...........
87525 A Hepatitis g, dna, dir ......... ......... ......... ........... ...........
probe.
87526 A Hepatitis g, dna, amp ......... ......... ......... ........... ...........
probe.
87527 A Hepatitis g, dna, quant ......... ......... ......... ........... ...........
87528 A Hsv, dna, dir probe.... ......... ......... ......... ........... ...........
87529 A Hsv, dna, amp probe.... ......... ......... ......... ........... ...........
87530 A Hsv, dna, quant........ ......... ......... ......... ........... ...........
87531 A Hhv-6, dna, dir probe.. ......... ......... ......... ........... ...........
87532 A Hhv-6, dna, amp probe.. ......... ......... ......... ........... ...........
87533 A Hhv-6, dna, quant...... ......... ......... ......... ........... ...........
87534 A Hiv-1, dna, dir probe.. ......... ......... ......... ........... ...........
87535 A Hiv-1, dna, amp probe.. ......... ......... ......... ........... ...........
87536 A Hiv-1, dna, quant...... ......... ......... ......... ........... ...........
87537 A Hiv-2, dna, dir probe.. ......... ......... ......... ........... ...........
87538 A Hiv-2, dna, amp probe.. ......... ......... ......... ........... ...........
87539 A Hiv-2, dna, quant...... ......... ......... ......... ........... ...........
87540 A Legion pneumo, dna, dir ......... ......... ......... ........... ...........
prob.
87541 A Legion pneumo, dna, amp ......... ......... ......... ........... ...........
prob.
87542 A Legion pneumo, dna, ......... ......... ......... ........... ...........
quant.
87550 A Mycobacteria, dna, dir ......... ......... ......... ........... ...........
probe.
87551 A Mycobacteria, dna, amp ......... ......... ......... ........... ...........
probe.
87552 A Mycobacteria, dna, ......... ......... ......... ........... ...........
quant.
87555 A M.tuberculo, dna, dir ......... ......... ......... ........... ...........
probe.
87556 A M.tuberculo, dna, amp ......... ......... ......... ........... ...........
probe.
87557 A M.tuberculo, dna, quant ......... ......... ......... ........... ...........
87560 A M.avium-intra, dna, dir ......... ......... ......... ........... ...........
prob.
87561 A M.avium-intra, dna, amp ......... ......... ......... ........... ...........
prob.
87562 A M.avium-intra, dna, ......... ......... ......... ........... ...........
quant.
87580 A M.pneumon, dna, dir ......... ......... ......... ........... ...........
probe.
87581 A M.pneumon, dna, amp ......... ......... ......... ........... ...........
probe.
87582 A M.pneumon, dna, quant.. ......... ......... ......... ........... ...........
87590 A N.gonorrhoeae, dna, dir ......... ......... ......... ........... ...........
prob.
87591 A N.gonorrhoeae, dna, amp ......... ......... ......... ........... ...........
prob.
87592 A N.gonorrhoeae, dna, ......... ......... ......... ........... ...........
quant.
87620 A Hpv, dna, dir probe.... ......... ......... ......... ........... ...........
87621 A Hpv, dna, amp probe.... ......... ......... ......... ........... ...........
[[Page 35361]]
87622 A Hpv, dna, quant........ ......... ......... ......... ........... ...........
87650 A Strep a, dna, dir probe ......... ......... ......... ........... ...........
87651 A Strep a, dna, amp probe ......... ......... ......... ........... ...........
87652 A Strep a, dna, quant.... ......... ......... ......... ........... ...........
87797 A Detect agent nos, dna, ......... ......... ......... ........... ...........
dir.
87798 A Detect agent nos, dna, ......... ......... ......... ........... ...........
amp.
87799 A Detect agent nos, dna, ......... ......... ......... ........... ...........
quant.
87810 A Chylmd trach assay w/ ......... ......... ......... ........... ...........
optic.
87850 A N. gonorrhoeae assay w/ ......... ......... ......... ........... ...........
optic.
87880 A Strep a assay w/optic.. ......... ......... ......... ........... ...........
87899 A Agent nos assay w/optic ......... ......... ......... ........... ...........
87999 A Microbiology procedure. ......... ......... ......... ........... ...........
88000 E Autopsy (necropsy), ......... ......... ......... ........... ...........
gross.
88005 E Autopsy (necropsy), ......... ......... ......... ........... ...........
gross.
88007 E Autopsy (necropsy), ......... ......... ......... ........... ...........
gross.
88012 E Autopsy (necropsy), ......... ......... ......... ........... ...........
gross.
88014 E Autopsy (necropsy), ......... ......... ......... ........... ...........
gross.
88016 E Autopsy (necropsy), ......... ......... ......... ........... ...........
gross.
88020 E Autopsy (necropsy), ......... ......... ......... ........... ...........
complete.
88025 E Autopsy (necropsy), ......... ......... ......... ........... ...........
complete.
88027 E Autopsy (necropsy), ......... ......... ......... ........... ...........
complete.
88028 E Autopsy (necropsy), ......... ......... ......... ........... ...........
complete.
88029 E Autopsy (necropsy), ......... ......... ......... ........... ...........
complete.
88036 E Limited autopsy........ ......... ......... ......... ........... ...........
88037 E Limited autopsy........ ......... ......... ......... ........... ...........
88040 E Forensic autopsy ......... ......... ......... ........... ...........
(necropsy).
88045 E Coroner's autopsy ......... ......... ......... ........... ...........
(necropsy).
88099 E Necropsy (autopsy) ......... ......... ......... ........... ...........
procedure.
88104 X Cytopathology, fluids.. 882 0.39 $20.05 $11.75 $4.01
88106 X Cytopathology, fluids.. 882 0.39 $20.05 $11.75 $4.01
88107 X Cytopathology, fluids.. 882 0.39 $20.05 $11.75 $4.01
88108 X Cytopath, concentrate 882 0.39 $20.05 $11.75 $4.01
tech.
88125 X Forensic cytopathology. 881 0.22 $11.31 $6.78 $2.26
88130 A Sex chromatin ......... ......... ......... ........... ...........
identification.
88140 A Sex chromatin ......... ......... ......... ........... ...........
identification.
88141 N Cytpath c/vag interpret ......... ......... ......... ........... ...........
88142 A Cytpath c/vag t/layer.. ......... ......... ......... ........... ...........
88150 A Cytpath c/vag manual... ......... ......... ......... ........... ...........
88152 A Cytpath c/vag auto redo ......... ......... ......... ........... ...........
88155 A Cytpath c/vag index add- ......... ......... ......... ........... ...........
on.
\2\ 8815 A Cytopath cerv/vag tbs.. ......... ......... ......... ........... ...........
6
\2\ 8815 A Cytopath cerv/vag tbs ......... ......... ......... ........... ...........
8 auto.
88160 X Cytopath smear, other 882 0.39 $20.05 $11.75 $4.01
source.
88161 X Cytopath smear, other 882 0.39 $20.05 $11.75 $4.01
source.
88162 X Cytopath smear, other 882 0.39 $20.05 $11.75 $4.01
source.
88170 S Fine needle aspiration. 121 0.63 $32.39 $21.02 $6.48
88171 S Fine needle aspiration. 121 0.63 $32.39 $21.02 $6.48
88172 X Evaluation of smear.... 882 0.39 $20.05 $11.75 $4.01
88173 X Interpretation of smear 882 0.39 $20.05 $11.75 $4.01
88180 X Cell marker study...... 882 0.39 $20.05 $11.75 $4.01
88182 X Cell marker study...... 882 0.39 $20.05 $11.75 $4.01
88199 X Cytopathology procedure 881 0.22 $11.31 $6.78 $2.26
88230 A Tissue culture, ......... ......... ......... ........... ...........
lymphocyte.
88233 A Tissue culture, skin/ ......... ......... ......... ........... ...........
biopsy.
88235 A Tissue culture, ......... ......... ......... ........... ...........
placenta.
88237 A Tissue culture, bone ......... ......... ......... ........... ...........
marrow.
88239 A Tissue culture, tumor.. ......... ......... ......... ........... ...........
88245 A Chromosome analysis, 20- ......... ......... ......... ........... ...........
25.
88248 A Chromosome analysis, 50- ......... ......... ......... ........... ...........
100.
\2\ 8825 A Chromosome analysis.... ......... ......... ......... ........... ...........
0
\2\ 8826 A Chromosome analysis: 5 ......... ......... ......... ........... ...........
0 cells.
88261 A Chromosome analysis, 5. ......... ......... ......... ........... ...........
88262 A Chromosome analysis, 15- ......... ......... ......... ........... ...........
20.
88263 A Chromosome analysis, 45 ......... ......... ......... ........... ...........
88267 A Chromosome analysis: ......... ......... ......... ........... ...........
placenta.
88269 A Chromosome analysis: ......... ......... ......... ........... ...........
amniotic.
88280 A Chromosome karyotype ......... ......... ......... ........... ...........
study.
88283 A Chromosome banding ......... ......... ......... ........... ...........
study.
88285 A Chromosome count: ......... ......... ......... ........... ...........
additional.
88289 A Chromosome study: ......... ......... ......... ........... ...........
additional.
88299 A Cytogenetic study...... ......... ......... ......... ........... ...........
88300 X Surg path, gross....... 881 0.22 $11.31 $6.78 $2.26
88302 X Tissue exam by 882 0.39 $20.05 $11.75 $4.01
pathologist.
88304 X Tissue exam by 882 0.39 $20.05 $11.75 $4.01
pathologist.
88305 X Tissue exam by 882 0.39 $20.05 $11.75 $4.01
pathologist.
[[Page 35362]]
88307 X Tissue exam by 883 0.69 $35.48 $20.34 $7.10
pathologist.
88309 X Tissue exam by 883 0.69 $35.48 $20.34 $7.10
pathologist.
88311 X Decalcify tissue....... 881 0.22 $11.31 $6.78 $2.26
88312 X Special stains......... 882 0.39 $20.05 $11.75 $4.01
88313 X Special stains......... 881 0.22 $11.31 $6.78 $2.26
88314 X Histochemical stain.... 882 0.39 $20.05 $11.75 $4.01
88318 X Chemical histochemistry 882 0.39 $20.05 $11.75 $4.01
88319 X Enzyme histochemistry.. 882 0.39 $20.05 $11.75 $4.01
88321 X Microslide consultation 882 0.39 $20.05 $11.75 $4.01
88323 X Microslide consultation 882 0.39 $20.05 $11.75 $4.01
88325 X Comprehensive review of 882 0.39 $20.05 $11.75 $4.01
data.
88329 X Pathology consult in 882 0.39 $20.05 $11.75 $4.01
surgery.
88331 X Pathology consult in 882 0.39 $20.05 $11.75 $4.01
surgery.
88332 X Pathology consult in 882 0.39 $20.05 $11.75 $4.01
surgery.
88342 X Immunocytochemistry.... 882 0.39 $20.05 $11.75 $4.01
88346 X Immunofluorescent study 882 0.39 $20.05 $11.75 $4.01
88347 X Immunofluorescent study 882 0.39 $20.05 $11.75 $4.01
88348 X Electron microscopy.... 883 0.69 $35.48 $20.34 $7.10
88349 X Scanning electron 883 0.69 $35.48 $20.34 $7.10
microscopy.
88355 X Analysis, skeletal 883 0.69 $35.48 $20.34 $7.10
muscle.
88356 X Analysis, nerve........ 883 0.69 $35.48 $20.34 $7.10
88358 X Analysis, tumor........ 883 0.69 $35.48 $20.34 $7.10
88362 X Nerve teasing 883 0.69 $35.48 $20.34 $7.10
preparations.
88365 X Tissue hybridization... 883 0.69 $35.48 $20.34 $7.10
88371 A Protein, western blot ......... ......... ......... ........... ...........
tissue.
88372 A Protein analysis w/ ......... ......... ......... ........... ...........
probe.
88399 X Surgical pathology 881 0.22 $11.31 $6.78 $2.26
procedure.
89050 A Body fluid cell count.. ......... ......... ......... ........... ...........
89051 A Body fluid cell count.. ......... ......... ......... ........... ...........
89060 A Exam,synovial fluid ......... ......... ......... ........... ...........
crystals.
89100 X Sample intestinal 928 2.91 $149.63 $79.78 $29.93
contents.
89105 X Sample intestinal 928 2.91 $149.63 $79.78 $29.93
contents.
89125 A Specimen fat stain..... ......... ......... ......... ........... ...........
89130 X Sample stomach contents 928 2.91 $149.63 $79.78 $29.93
89132 X Sample stomach contents 928 2.91 $149.63 $79.78 $29.93
89135 X Sample stomach contents 928 2.91 $149.63 $79.78 $29.93
89136 X Sample stomach contents 928 2.91 $149.63 $79.78 $29.93
89140 X Sample stomach contents 928 2.91 $149.63 $79.78 $29.93
89141 X Sample stomach contents 928 2.91 $149.63 $79.78 $29.93
89160 A Exam feces for meat ......... ......... ......... ........... ...........
fibers.
89190 A Nasal smear for ......... ......... ......... ........... ...........
eosinophils.
89250 A Fertilization of oocyte ......... ......... ......... ........... ...........
89251 A Culture oocyte w/ ......... ......... ......... ........... ...........
embryos.
89252 A Assist oocyte ......... ......... ......... ........... ...........
fertilization.
89253 A Embryo hatching........ ......... ......... ......... ........... ...........
89254 A Oocyte identification.. ......... ......... ......... ........... ...........
89255 A Prepare embryo for ......... ......... ......... ........... ...........
transfer.
89256 A Prepare cryopreserved ......... ......... ......... ........... ...........
embryo.
89257 A Sperm identification... ......... ......... ......... ........... ...........
89258 A Cryopreservation, ......... ......... ......... ........... ...........
embryo.
89259 A Cryopreservation, sperm ......... ......... ......... ........... ...........
89260 A Sperm isolation, simple ......... ......... ......... ........... ...........
89261 A Sperm isolation, ......... ......... ......... ........... ...........
complex.
89300 A Semen analysis......... ......... ......... ......... ........... ...........
89310 A Semen analysis......... ......... ......... ......... ........... ...........
89320 A Semen analysis......... ......... ......... ......... ........... ...........
89325 A Sperm antibody test.... ......... ......... ......... ........... ...........
89329 A Sperm evaluation test.. ......... ......... ......... ........... ...........
89330 A Evaluation, cervical ......... ......... ......... ........... ...........
mucus.
89350 X Sputum specimen 881 0.22 $11.31 $6.78 $2.26
collection.
89355 A Exam feces for starch.. ......... ......... ......... ........... ...........
89360 X Collect sweat for test. 881 0.22 $11.31 $6.78 $2.26
89365 A Water load test........ ......... ......... ......... ........... ...........
89399 X Pathology lab procedure 881 0.22 $11.31 $6.78 $2.26
90700 X Dtap vaccine, im....... 901 0.07 $3.60 $2.49 $0.72
90701 X Dtp vaccine, im........ 901 0.07 $3.60 $2.49 $0.72
90702 X Dt vaccine, im......... 901 0.07 $3.60 $2.49 $0.72
90703 X Tetanus vaccine, im.... 901 0.07 $3.60 $2.49 $0.72
90704 X Mumps vaccine, sc...... 901 0.07 $3.60 $2.49 $0.72
90705 X Measles vaccine, sc.... 901 0.07 $3.60 $2.49 $0.72
90706 X Rubella vaccine, sc.... 901 0.07 $3.60 $2.49 $0.72
90707 X Mmr vaccine, sc........ 902 1.31 $67.36 $38.19 $13.47
90708 X Measles-rubella vaccine 901 0.07 $3.60 $2.49 $0.72
sc.
90709 X Rubella & mumps vaccine 901 0.07 $3.60 $2.49 $0.72
sc.
90710 X Mmrv vaccine, sc....... 901 0.07 $3.60 $2.49 $0.72
[[Page 35363]]
\2\ 9071 X Combined vaccine....... 901 0.07 $3.60 $2.49 $0.72
1
90712 X Oral poliovirus vaccine 902 1.31 $67.36 $38.19 $13.47
90713 X Poliovirus, ipv, sc.... 902 1.31 $67.36 $38.19 $13.47
\2\ 9071 X Typhoid immunization... 901 0.07 $3.60 $2.49 $0.72
4
90716 X Chicken pox vaccine, sc 902 1.31 $67.36 $38.19 $13.47
90717 X Yellow fever vaccine, 902 1.31 $67.36 $38.19 $13.47
sc.
90718 X Td vaccine, im......... 901 0.07 $3.60 $2.49 $0.72
90719 X Diphtheria vaccine, im. 901 0.07 $3.60 $2.49 $0.72
90720 X Dtp/hib vaccine, im.... 902 1.31 $67.36 $38.19 $13.47
90721 X Dtap/hib vaccine, im... 903 1.00 $51.42 $24.86 $10.28
\2\ 9072 X Influenza immunization. 901 0.07 $3.60 $2.49 $0.72
4
90725 X Cholera vaccine, 901 0.07 $3.60 $2.49 $0.72
injectable.
\2\ 9072 X Rabies immunization.... 903 1.00 $51.42 $24.86 $10.28
6
90727 X Plague vaccine, im..... 903 1.00 $51.42 $24.86 $10.28
\2\ 9072 X BCG immunization....... 903 1.00 $51.42 $24.86 $10.28
8
\2\ 9073 X Hepatitis A vaccine.... 901 0.07 $3.60 $2.49 $0.72
0
90732 X Pneumococcal vaccine, 901 0.07 $3.60 $2.49 $0.72
adult.
90733 X Meningococcal vaccine, 902 1.31 $67.36 $38.19 $13.47
sc.
90735 X Encephalitis vaccine, 903 1.00 $51.42 $24.86 $10.28
sc.
\2\ 9073 X Influenza B 902 1.31 $67.36 $38.19 $13.47
7 immunization.
\2\ 9074 X Passive immunization, 902 1.31 $67.36 $38.19 $13.47
1 ISG.
\2\ 9074 X Special passive 903 1.00 $51.42 $24.86 $10.28
2 immunization.
90744 X Hepb vaccine, ped/adol, 902 1.31 $67.36 $38.19 $13.47
im.
90745 X Hepb vaccine, adol/ 902 1.31 $67.36 $38.19 $13.47
risk, im.
90746 X Hepb vaccine, adult, im 902 1.31 $67.36 $38.19 $13.47
90747 X Hepb vaccine, ill pat, 902 1.31 $67.36 $38.19 $13.47
im.
90748 X Hepb/hib vaccine, im... 901 0.07 $3.60 $2.49 $0.72
90749 X Vaccine toxoid......... 901 0.07 $3.60 $2.49 $0.72
90780 X IV infusion therapy, 1 906 1.93 $99.24 $57.18 $19.85
hour.
90781 X IV infusion, additional 906 1.93 $99.24 $57.18 $19.85
hour.
90782 X Injection (SC)/(IM).... 907 0.74 $38.05 $11.53 $7.61
90783 X Injection (IA)......... 907 0.74 $38.05 $11.53 $7.61
90784 X Injection (IV)......... 907 0.74 $38.05 $11.53 $7.61
90788 X Injection of antibiotic 907 0.74 $38.05 $11.53 $7.61
90799 X Therapeutic/diag 907 0.74 $38.05 $11.53 $7.61
injection.
\1\ 9080 S Psy dx interview....... 092 1.63 $83.81 $21.47 $16.76
1
90802 S Intac psy dx interview. 092 1.63 $83.81 $21.47 $16.76
90804 S Psytx, office (20-30).. 091 1.09 $56.05 $14.01 $11.21
90805 S Psytx, office (20-30) w/ 091 1.09 $56.05 $14.01 $11.21
e&m.
90806 S Psytx, office (45-50).. 092 1.63 $83.81 $21.47 $16.76
90807 S Psytx, office (45-50) w/ 092 1.63 $83.81 $21.47 $16.76
e&m.
90808 S Psytx, office (75-80).. 092 1.63 $83.81 $21.47 $16.76
90809 S Psytx, office (75-80) w/ 092 1.63 $83.81 $21.47 $16.76
e&m.
90810 S Intac psytx, office (20- 091 1.09 $56.05 $14.01 $11.21
30).
90811 S Intac psytx, off 20-30 091 1.09 $56.05 $14.01 $11.21
w/e&m.
90812 S Intac psytx, office (45- 092 1.63 $83.81 $21.47 $16.76
50).
90813 S Intac psytx, off 45-50 092 1.63 $83.81 $21.47 $16.76
w/e&m.
90814 S Intac psytx, office (75- 092 1.63 $83.81 $21.47 $16.76
80).
90815 S Intac psytx, off 75-80 092 1.63 $83.81 $21.47 $16.76
w/e&m.
90816 S Psytx, hosp (20-30).... 091 1.09 $56.05 $14.01 $11.21
90817 S Psytx, hosp (20-30) w/ 091 1.09 $56.05 $14.01 $11.21
e&m.
90818 S Psytx, hosp (45-50).... 092 1.63 $83.81 $21.47 $16.76
90819 S Psytx, hosp (45-50) w/ 092 1.63 $83.81 $21.47 $16.76
e&m.
\1\ \2\ S Diagnostic interview... 092 1.63 $83.81 $21.47 $16.76
90820
90821 S Psytx, hosp (75-80).... 092 1.63 $83.81 $21.47 $16.76
90822 S Psytx, hosp (75-80) w/ 092 1.63 $83.81 $21.47 $16.76
e&m.
90823 S Intac psytx, hosp (20- 091 1.09 $56.05 $14.01 $11.21
30).
90824 S Intac psytx, hsp 20-30 091 1.09 $56.05 $14.01 $11.21
w/e&m.
90826 S Intac psytx, hosp (45- 092 1.63 $83.81 $21.47 $16.76
50).
90827 S Intac psytx, hsp 45-50 092 1.63 $83.81 $21.47 $16.76
w/e&m.
90828 S Intac psytx, hosp (75- 092 1.63 $83.81 $21.47 $16.76
80).
90829 S Intac psytx, hsp 75-80 092 1.63 $83.81 $21.47 $16.76
w/e&m.
\1\ \2\ S Special interview...... 092 1.63 $83.81 $21.47 $16.76
90835
\1\ \2\ S Psychotherapy, 75-80 092 1.63 $83.81 $21.47 $16.76
90842 min..
\1\ \2\ S Psychotherapy, 20-30 091 1.09 $56.05 $14.01 $11.21
90843 min..
\1\ \2\ S Psychotherapy, 45-50 092 1.63 $83.81 $21.47 $16.76
90844 min..
\1\ 9084 S Psychoanalysis......... 092 1.63 $83.81 $21.47 $16.76
5
\1\ 9084 S Family psytx w/o 093 1.56 $80.22 $20.11 $16.04
6 patient.
\1\ 9084 S Family psytx w/patient. 093 1.56 $80.22 $20.11 $16.04
7
\1\ 9084 S Multiple family group 094 1.31 $67.36 $19.89 $13.47
9 psytx.
\1\ 9085 S Group psychotherapy.... 094 1.31 $67.36 $19.89 $13.47
3
\1\ \2\ S Individual 092 1.63 $83.81 $21.47 $16.76
90855 psychotherapy.
\1\ 9085 S Intac group psytx...... 094 1.31 $67.36 $19.89 $13.47
7
\1\ 9086 X Medication management.. 090 0.85 $43.71 $12.20 $8.74
2
90865 S Narcosynthesis......... 092 1.63 $83.81 $21.47 $16.76
[[Page 35364]]
90870 S Electroconvulsive 919 3.09 $158.89 $80.00 $31.78
therapy.
90871 S Electroconvulsive 919 3.09 $158.89 $80.00 $31.78
therapy.
90875 E Psychophysiological ......... ......... ......... ........... ...........
therapy.
90876 E Psychophysiological ......... ......... ......... ........... ...........
therapy.
\1\ 9088 S Hypnotherapy........... 092 1.63 $83.81 $21.47 $16.76
0
90882 E Environmental ......... ......... ......... ........... ...........
manipulation.
90885 N Psy evaluation of ......... ......... ......... ........... ...........
records.
90887 N Consultation with ......... ......... ......... ........... ...........
family.
90889 N Preparation of report.. ......... ......... ......... ........... ...........
\1\ 9089 S Psychiatric service/ 091 1.09 $56.05 $14.01 $11.21
9 therapy.
\2\ 9090 S Biofeedback, 920 1.17 $60.16 $29.61 $12.03
0 electromyogram.
90901 S Biofeedback, any method 920 1.17 $60.16 $29.61 $12.03
\2\ 9090 S Biofeedback, nerve 920 1.17 $60.16 $29.61 $12.03
2 impulse.
\2\ 9090 S Biofeedback, blood 920 1.17 $60.16 $29.61 $12.03
4 pressure.
\2\ 9090 S Biofeedback, blood flow 920 1.17 $60.16 $29.61 $12.03
6
\2\ 9090 S Biofeedback, brain 920 1.17 $60.16 $29.61 $12.03
8 waves.
\2\ 9091 S Biofeedback, oculogram. 920 1.17 $60.16 $29.61 $12.03
0
90911 S Biofeedback peri/uro/ 920 1.17 $60.16 $29.61 $12.03
rectal.
\2\ 9091 S Biofeedback, 920 1.17 $60.16 $29.61 $12.03
5 unspecified.
90918 A ESRD related services, ......... ......... ......... ........... ...........
month.
90919 A ESRD related services, ......... ......... ......... ........... ...........
month.
90920 A ESRD related services, ......... ......... ......... ........... ...........
month.
90921 A ESRD related services, ......... ......... ......... ........... ...........
month.
90922 A ESRD related services, ......... ......... ......... ........... ...........
day.
90923 A Esrd related services, ......... ......... ......... ........... ...........
day.
90924 A Esrd related services, ......... ......... ......... ........... ...........
day.
90925 A Esrd related services, ......... ......... ......... ........... ...........
day.
90935 S Hemodialysis, one 926 4.22 $216.99 $69.83 $43.40
evaluation.
90937 S Hemodialysis, repeated 926 4.22 $216.99 $69.83 $43.40
eval..
90945 S Dialysis, one 926 4.22 $216.99 $69.83 $43.40
evaluation.
90947 S Dialysis, repeated 926 4.22 $216.99 $69.83 $43.40
eval..
90989 E Dialysis training/ ......... ......... ......... ........... ...........
complete.
90993 N Dialysis training/ ......... ......... ......... ........... ...........
incomplete.
90997 S Hemoperfusion.......... 926 4.22 $216.99 $69.83 $43.40
90999 S Dialysis procedure..... 926 4.22 $216.99 $69.83 $43.40
91000 X Esophageal intubation.. 928 2.91 $149.63 $79.78 $29.93
91010 X Esophagus motility 928 2.91 $149.63 $79.78 $29.93
study.
91011 X Esophagus motility 928 2.91 $149.63 $79.78 $29.93
study.
91012 X Esophagus motility 928 2.91 $149.63 $79.78 $29.93
study.
91020 X Gastric motility....... 928 2.91 $149.63 $79.78 $29.93
91030 X Acid perfusion of 928 2.91 $149.63 $79.78 $29.93
esophagus.
91032 X Esophagus, acid reflux 928 2.91 $149.63 $79.78 $29.93
test.
91033 X Prolonged acid reflux 928 2.91 $149.63 $79.78 $29.93
test.
91052 X Gastric analysis test.. 928 2.91 $149.63 $79.78 $29.93
91055 X Gastric intubation for 928 2.91 $149.63 $79.78 $29.93
smear.
91060 X Gastric saline load 928 2.91 $149.63 $79.78 $29.93
test.
91065 X Breath hydrogen test... 928 2.91 $149.63 $79.78 $29.93
91100 X Pass intestine bleeding 928 2.91 $149.63 $79.78 $29.93
tube.
91105 X Gastric intubation 928 2.91 $149.63 $79.78 $29.93
treatment.
91122 N Anal pressure record... ......... ......... ......... ........... ...........
91299 X Gastroenterology 928 2.91 $149.63 $79.78 $29.93
procedure.
92002 V Eye exam, new patient.. 913 ......... ......... ........... ...........
92004 V Eye exam, new patient.. 915 ......... ......... ........... ...........
92012 V Eye exam established pt 913 ......... ......... ........... ...........
92014 V Eye exam & treatment... 915 ......... ......... ........... ...........
92015 E Refraction............. ......... ......... ......... ........... ...........
92018 S New eye exam & 676 5.87 $301.84 $138.54 $60.37
treatment.
92019 S Eye exam & treatment... 676 5.87 $301.84 $138.54 $60.37
92020 N Special eye evaluation. ......... ......... ......... ........... ...........
92060 X Special eye evaluation. 930 1.04 $53.48 $22.83 $10.70
92065 X Orthoptic/pleoptic 930 1.04 $53.48 $22.83 $10.70
training.
92070 N Fitting of contact lens ......... ......... ......... ........... ...........
92081 X Visual field 930 1.04 $53.48 $22.83 $10.70
examination(s).
92082 X Visual field 930 1.04 $53.48 $22.83 $10.70
examination(s).
92083 X Visual field 930 1.04 $53.48 $22.83 $10.70
examination(s).
92100 N Serial tonometry ......... ......... ......... ........... ...........
exam(s).
92120 X Tonography & eye 931 0.74 $38.05 $21.47 $7.61
evaluation.
92130 X Water provocation 931 0.74 $38.05 $21.47 $7.61
tonography.
92140 X Glaucoma provocative 930 1.04 $53.48 $22.83 $10.70
tests.
92225 N Special eye exam, ......... ......... ......... ........... ...........
initial.
92226 N Special eye exam, ......... ......... ......... ........... ...........
subsequent.
92230 X Eye exam with photos... 931 0.74 $38.05 $21.47 $7.61
92235 X Eye exam with photos... 932 2.41 $123.92 $63.73 $24.78
92240 X Icg angiography........ 931 0.74 $38.05 $21.47 $7.61
92250 X Eye exam with photos... 931 0.74 $38.05 $21.47 $7.61
[[Page 35365]]
92260 N Ophthalmoscopy/ ......... ......... ......... ........... ...........
dynamometry.
92265 X Eye muscle evaluation.. 932 2.41 $123.92 $63.73 $24.78
92270 X Electro-oculography.... 932 2.41 $123.92 $63.73 $24.78
92275 X Electroretinography.... 981 1.22 $62.73 $34.35 $12.55
92283 X Color vision 930 1.04 $53.48 $22.83 $10.70
examination.
92284 X Dark adaptation eye 930 1.04 $53.48 $22.83 $10.70
exam.
92285 X Eye photography........ 930 1.04 $53.48 $22.83 $10.70
92286 X Internal eye 932 2.41 $123.92 $63.73 $24.78
photography.
92287 X Internal eye 932 2.41 $123.92 $63.73 $24.78
photography.
92310 E Contact lens fitting... ......... ......... ......... ........... ...........
92311 X Contact lens fitting... 936 0.48 $24.68 $9.49 $4.94
92312 X Contact lens fitting... 936 0.48 $24.68 $9.49 $4.94
92313 X Contact lens fitting... 936 0.48 $24.68 $9.49 $4.94
92314 E Prescription of contact ......... ......... ......... ........... ...........
lens.
92315 X Prescription of contact 936 0.48 $24.68 $9.49 $4.94
lens.
92316 X Prescription of contact 936 0.48 $24.68 $9.49 $4.94
lens.
92317 X Prescription of contact 936 0.48 $24.68 $9.49 $4.94
lens.
92325 X Modification of contact 936 0.48 $24.68 $9.49 $4.94
lens.
92326 X Replacement of contact 936 0.48 $24.68 $9.49 $4.94
lens.
92330 X Fitting of artificial 936 0.48 $24.68 $9.49 $4.94
eye.
92335 N Fitting of artificial ......... ......... ......... ........... ...........
eye.
92340 E Fitting of spectacles.. ......... ......... ......... ........... ...........
92341 E Fitting of spectacles.. ......... ......... ......... ........... ...........
92342 E Fitting of spectacles.. ......... ......... ......... ........... ...........
92352 X Special spectacles 936 0.48 $24.68 $9.49 $4.94
fitting.
92353 X Special spectacles 936 0.48 $24.68 $9.49 $4.94
fitting.
92354 X Special spectacles 936 0.48 $24.68 $9.49 $4.94
fitting.
92355 X Special spectacles 936 0.48 $24.68 $9.49 $4.94
fitting.
92358 X Eye prosthesis service. 936 0.48 $24.68 $9.49 $4.94
92370 E Repair & adjust ......... ......... ......... ........... ...........
spectacles.
92371 X Repair & adjust 936 0.48 $24.68 $9.49 $4.94
spectacles.
92390 E Supply of spectacles... ......... ......... ......... ........... ...........
92391 E Supply of contact ......... ......... ......... ........... ...........
lenses.
92392 E Supply of low vision ......... ......... ......... ........... ...........
aids.
92393 E Supply of artificial ......... ......... ......... ........... ...........
eye.
92395 E Supply of spectacles... ......... ......... ......... ........... ...........
92396 E Supply of contact ......... ......... ......... ........... ...........
lenses.
92499 X Eye service or 931 0.74 $38.05 $21.47 $7.61
procedure.
92502 S Ear and throat 311 1.41 $72.50 $20.57 $14.50
examination.
92504 N Ear microscopy ......... ......... ......... ........... ...........
examination.
92506 A Speech & hearing ......... ......... ......... ........... ...........
evaluation.
92507 A Speech/hearing therapy. ......... ......... ......... ........... ...........
92508 A Speech/hearing therapy. ......... ......... ......... ........... ...........
92510 A Rehab for ear implant.. ......... ......... ......... ........... ...........
92511 S Nasopharyngoscopy...... 331 0.57 $29.31 $14.01 $5.86
92512 X Nasal function studies. 940 3.13 $160.94 $52.21 $32.19
92516 X Facial nerve function 940 3.13 $160.94 $52.21 $32.19
test.
92520 X Laryngeal function 940 3.13 $160.94 $52.21 $32.19
studies.
92525 A Oral function ......... ......... ......... ........... ...........
evaluation.
92526 A Oral function therapy.. ......... ......... ......... ........... ...........
92531 N Spontaneous nystagmus ......... ......... ......... ........... ...........
study.
92532 N Positional nystagmus ......... ......... ......... ........... ...........
study.
92533 N Caloric vestibular test ......... ......... ......... ........... ...........
92534 N Optokinetic nystagmus.. ......... ......... ......... ........... ...........
92541 X Spontaneous nystagmus 940 3.13 $160.94 $52.21 $32.19
test.
92542 X Positional nystagmus 940 3.13 $160.94 $52.21 $32.19
test.
92543 X Caloric vestibular test 940 3.13 $160.94 $52.21 $32.19
92544 X Optokinetic nystagmus 940 3.13 $160.94 $52.21 $32.19
test.
92545 X Oscillating tracking 940 3.13 $160.94 $52.21 $32.19
test.
92546 X Sinusoidal rotational 940 3.13 $160.94 $52.21 $32.19
test.
92547 X Supplemental electrical 940 3.13 $160.94 $52.21 $32.19
test.
92548 X Posturography.......... 940 3.13 $160.94 $52.21 $32.19
92551 E Pure tone hearing test, ......... ......... ......... ........... ...........
air.
92552 X Pure tone audiometry, 941 0.74 $38.05 $13.33 $7.61
air.
92553 X Audiometry, air & bone. 941 0.74 $38.05 $13.33 $7.61
92555 X Speech threshold 941 0.74 $38.05 $13.33 $7.61
audiometry.
92556 X Speech audiometry, 941 0.74 $38.05 $13.33 $7.61
complete.
92557 X Comprehensive hearing 942 1.46 $75.07 $22.15 $15.01
test.
92559 E Group audiometric ......... ......... ......... ........... ...........
testing.
92560 E Bekesy audiometry, ......... ......... ......... ........... ...........
screen.
92561 X Bekesy audiometry, 942 1.46 $75.07 $22.15 $15.01
diagnosis.
92562 X Loudness balance test.. 942 1.46 $75.07 $22.15 $15.01
92563 X Tone decay hearing test 942 1.46 $75.07 $22.15 $15.01
92564 X Sisi hearing test...... 942 1.46 $75.07 $22.15 $15.01
92565 X Stenger test, pure tone 942 1.46 $75.07 $22.15 $15.01
[[Page 35366]]
92567 X Tympanometry........... 941 0.74 $38.05 $13.33 $7.61
92568 X Acoustic reflex testing 942 1.46 $75.07 $22.15 $15.01
92569 X Acoustic reflex decay 942 1.46 $75.07 $22.15 $15.01
test.
92571 X Filtered speech hearing 942 1.46 $75.07 $22.15 $15.01
test.
92572 X Staggered spondaic word 942 1.46 $75.07 $22.15 $15.01
test.
92573 X Lombard test........... 942 1.46 $75.07 $22.15 $15.01
92575 X Sensorineural acuity 942 1.46 $75.07 $22.15 $15.01
test.
92576 X Synthetic sentence test 942 1.46 $75.07 $22.15 $15.01
92577 X Stenger test, speech... 942 1.46 $75.07 $22.15 $15.01
92579 X Visual audiometry (vra) 942 1.46 $75.07 $22.15 $15.01
92582 X Conditioning play 942 1.46 $75.07 $22.15 $15.01
audiometry.
92583 X Select picture 942 1.46 $75.07 $22.15 $15.01
audiometry.
92584 X Electrocochleography... 940 3.13 $160.94 $52.21 $32.19
92585 X Auditory evoked 982 1.37 $70.45 $38.42 $14.09
potential.
92587 X Evoked auditory test... 940 3.13 $160.94 $52.21 $32.19
92588 X Evoked auditory test... 940 3.13 $160.94 $52.21 $32.19
92589 X Auditory function 942 1.46 $75.07 $22.15 $15.01
test(s).
92590 E Hearing aid exam, one ......... ......... ......... ........... ...........
ear.
92591 E Hearing aid exam, both ......... ......... ......... ........... ...........
ears.
92592 E Hearing aid check, one ......... ......... ......... ........... ...........
ear.
92593 E Hearing aid check, both ......... ......... ......... ........... ...........
ears.
92594 E Electro hearing aid ......... ......... ......... ........... ...........
test,one.
92595 E Electro hearingaid ......... ......... ......... ........... ...........
test,both.
92596 X Ear protector 942 1.46 $75.07 $22.15 $15.01
evaluation.
92597 A Oral speech device eval ......... ......... ......... ........... ...........
92598 A Modify oral speech ......... ......... ......... ........... ...........
device.
92599 X ENT procedure/service.. 941 0.74 $38.05 $13.33 $7.61
92950 S Heart/lung 947 4.11 $211.34 $106.22 $42.27
resuscitation(CPR.
92953 S Temporary external 947 4.11 $211.34 $106.22 $42.27
pacing.
92960 S Heart electroconversion 947 4.11 $211.34 $106.22 $42.27
92970 C Cardioassist, internal. ......... ......... ......... ........... ...........
92971 C Cardioassist, external. ......... ......... ......... ........... ...........
92975 C Dissolve clot, heart ......... ......... ......... ........... ...........
vessel.
92977 C Dissolve clot, heart ......... ......... ......... ........... ...........
vessel.
92978 C Intravas us, heart add- ......... ......... ......... ........... ...........
on.
92979 C Intravas us, heart (add- ......... ......... ......... ........... ...........
on).
92980 C Insert intracoronary ......... ......... ......... ........... ...........
stent.
92981 C Insert intracoronary ......... ......... ......... ........... ...........
stent.
92982 C Coronary artery ......... ......... ......... ........... ...........
dilation.
92984 C Coronary artery ......... ......... ......... ........... ...........
dilation.
92986 C Revision of aortic ......... ......... ......... ........... ...........
valve.
92987 C Revision of mitral ......... ......... ......... ........... ...........
valve.
92990 C Revision of pulmonary ......... ......... ......... ........... ...........
valve.
92992 C Revision of heart ......... ......... ......... ........... ...........
chamber.
92993 C Revision of heart ......... ......... ......... ........... ...........
chamber.
92995 C Coronary atherectomy... ......... ......... ......... ........... ...........
92996 C Coronary atherectomy ......... ......... ......... ........... ...........
add-on.
92997 C Pul art balloon repair, ......... ......... ......... ........... ...........
perc.
92998 C Pul art balloon repair, ......... ......... ......... ........... ...........
perc.
93000 N Electrocardiogram, ......... ......... ......... ........... ...........
complete.
93005 X Electrocardiogram, 950 0.35 $18.00 $15.82 $3.60
tracing.
93010 N Electrocardiogram ......... ......... ......... ........... ...........
report.
93012 X Transmission of ecg.... 956 1.09 $56.05 $54.47 $11.21
93014 N Report on transmitted ......... ......... ......... ........... ...........
ecg.
93015 N Cardiovascular stress ......... ......... ......... ........... ...........
test.
93016 N Cardiovascular stress ......... ......... ......... ........... ...........
test.
93017 X Cardiovascular stress 949 1.43 $73.53 $61.92 $14.71
test.
93018 N Cardiovascular stress ......... ......... ......... ........... ...........
test.
93024 X Cardiac drug stress 949 1.43 $73.53 $61.92 $14.71
test.
93040 N Rhythm ECG with report. ......... ......... ......... ........... ...........
93041 X Rhythm ECG, tracing.... 950 0.35 $18.00 $15.82 $3.60
93042 N Rhythm ECG, report..... ......... ......... ......... ........... ...........
93224 X ECG monitor/report, 24 956 1.09 $56.05 $54.47 $11.21
hrs.
93225 X ECG monitor/record, 24 956 1.09 $56.05 $54.47 $11.21
hrs.
93226 X ECG monitor/report, 24 956 1.09 $56.05 $54.47 $11.21
hrs.
93227 N ECG monitor/review, 24 ......... ......... ......... ........... ...........
hrs.
93230 X ECG monitor/report, 24 956 1.09 $56.05 $54.47 $11.21
hrs.
93231 X Ecg monitor/record, 24 956 1.09 $56.05 $54.47 $11.21
hrs.
93232 X ECG monitor/report, 24 956 1.09 $56.05 $54.47 $11.21
hrs.
93233 N ECG monitor/review, 24 ......... ......... ......... ........... ...........
hrs.
93235 X ECG monitor/report, 24 956 1.09 $56.05 $54.47 $11.21
hrs.
93236 X ECG monitor/report, 24 956 1.09 $56.05 $54.47 $11.21
hrs.
93237 N ECG monitor/review, 24 ......... ......... ......... ........... ...........
hrs.
93268 X ECG record/review...... 956 1.09 $56.05 $54.47 $11.21
93270 X ECG recording.......... 956 1.09 $56.05 $54.47 $11.21
[[Page 35367]]
93271 X Ecg/monitoring and 956 1.09 $56.05 $54.47 $11.21
anaylysis.
93272 N Ecg/review, interpret ......... ......... ......... ........... ...........
only.
93278 X ECG/signal-averaged.... 956 1.09 $56.05 $54.47 $11.21
93303 S Echo transthoracic..... 957 4.04 $207.74 $114.13 $41.55
93304 S Echo transthoracic..... 957 4.04 $207.74 $114.13 $41.55
93307 S Echo exam of heart..... 957 4.04 $207.74 $114.13 $41.55
93308 S Echo exam of heart..... 957 4.04 $207.74 $114.13 $41.55
93312 S Echo transesophageal... 957 4.04 $207.74 $114.13 $41.55
93313 S Echo transesophageal... 957 4.04 $207.74 $114.13 $41.55
93314 N Echo transesophageal... ......... ......... ......... ........... ...........
93315 S Echo transesophageal... 957 4.04 $207.74 $114.13 $41.55
93316 S Echo transesophageal... 957 4.04 $207.74 $114.13 $41.55
93317 N Echo transesophageal... ......... ......... ......... ........... ...........
93320 S Doppler echo exam, 957 4.04 $207.74 $114.13 $41.55
heart.
93321 S Doppler echo exam, 957 4.04 $207.74 $114.13 $41.55
heart.
93325 S Doppler color flow add- 957 4.04 $207.74 $114.13 $41.55
on.
93350 S Echo transthoracic..... 957 4.04 $207.74 $114.13 $41.55
93501 S Right heart 958 23.74 $1,220.71 $705.57 $244.14
catheterization.
93503 S Insert/place heart 958 23.74 $1,220.71 $705.57 $244.14
catheter.
93505 S Biopsy of heart lining. 958 23.74 $1,220.71 $705.57 $244.14
93508 S Cath placement, 343 8.76 $450.44 $240.24 $90.09
angiography.
93510 S Left heart 958 23.74 $1,220.71 $705.57 $244.14
catheterization.
93511 S Left heart 958 23.74 $1,220.71 $705.57 $244.14
catheterization.
93514 S Left heart 958 23.74 $1,220.71 $705.57 $244.14
catheterization.
93524 S Left heart 958 23.74 $1,220.71 $705.57 $244.14
catheterization.
93526 S Rt & Lt heart catheters 958 23.74 $1,220.71 $705.57 $244.14
93527 S Rt & Lt heart catheters 958 23.74 $1,220.71 $705.57 $244.14
93528 S Rt & Lt heart catheters 958 23.74 $1,220.71 $705.57 $244.14
93529 S Rt, Lt heart 958 23.74 $1,220.71 $705.57 $244.14
catheterization.
93530 S Rt heart cath, 958 23.74 $1,220.71 $705.57 $244.14
congenital.
93531 S R & l heart cath, 958 23.74 $1,220.71 $705.57 $244.14
congenital.
93532 S R & l heart cath, 958 23.74 $1,220.71 $705.57 $244.14
congenital.
93533 S R & l heart cath, 958 23.74 $1,220.71 $705.57 $244.14
congenital.
93536 S Insert circulation assi 958 23.74 $1,220.71 $705.57 $244.14
93539 N Injection, cardiac cath ......... ......... ......... ........... ...........
93540 N Injection, cardiac cath ......... ......... ......... ........... ...........
93541 N Injection for lung ......... ......... ......... ........... ...........
angiogram.
93542 N Injection for heart x- ......... ......... ......... ........... ...........
rays.
93543 N Injection for heart x- ......... ......... ......... ........... ...........
rays.
93544 N Injection for ......... ......... ......... ........... ...........
aortography.
93545 N Injection for coronary ......... ......... ......... ........... ...........
x-rays.
93555 N Imaging, cardiac cath.. ......... ......... ......... ........... ...........
93556 N Imaging, cardiac cath.. ......... ......... ......... ........... ...........
93561 N Cardiac output ......... ......... ......... ........... ...........
measurement.
93562 N Cardiac output ......... ......... ......... ........... ...........
measurement.
93600 S Bundle of His recording 960 4.80 $246.82 $143.74 $49.36
93602 S Intra-atrial recording. 960 4.80 $246.82 $143.74 $49.36
93603 S Right ventricular 960 4.80 $246.82 $143.74 $49.36
recording.
93607 S Right ventricular 960 4.80 $246.82 $143.74 $49.36
recording.
93609 S Mapping of tachycardia. 960 4.80 $246.82 $143.74 $49.36
93610 S Intra-atrial pacing.... 960 4.80 $246.82 $143.74 $49.36
93612 S Intraventricular pacing 960 4.80 $246.82 $143.74 $49.36
93615 S Esophageal recording... 960 4.80 $246.82 $143.74 $49.36
93616 S Esophageal recording... 960 4.80 $246.82 $143.74 $49.36
93618 S Heart rhythm pacing.... 960 4.80 $246.82 $143.74 $49.36
93619 S Electrophysiology 960 4.80 $246.82 $143.74 $49.36
evaluation.
93620 S Electrophysiology 960 4.80 $246.82 $143.74 $49.36
evaluation.
93621 S Electrophysiology 960 4.80 $246.82 $143.74 $49.36
evaluation.
93622 S Electrophysiology 960 4.80 $246.82 $143.74 $49.36
evaluation.
93623 S Stimulation, pacing 960 4.80 $246.82 $143.74 $49.36
heart.
93624 S Electrophysiologic 960 4.80 $246.82 $143.74 $49.36
study.
93631 S Heart pacing, mapping.. 960 4.80 $246.82 $143.74 $49.36
93640 S Evaluation heart device 960 4.80 $246.82 $143.74 $49.36
93641 S Electrophysiology 960 4.80 $246.82 $143.74 $49.36
evaluation.
93642 S Electrophysiology 960 4.80 $246.82 $143.74 $49.36
evaluation.
93650 S Ablate heart dysrhythm 960 4.80 $246.82 $143.74 $49.36
focus.
93651 S Ablate heart dysrhythm 960 4.80 $246.82 $143.74 $49.36
focus.
93652 S Ablate heart dysrhythm 960 4.80 $246.82 $143.74 $49.36
focus.
93660 S Tilt table evaluation.. 960 4.80 $246.82 $143.74 $49.36
93720 X Total body 967 1.70 $87.41 $57.40 $17.48
plethysmography.
93721 X Plethysmography tracing 967 1.70 $87.41 $57.40 $17.48
93722 N Plethysmography report. ......... ......... ......... ........... ...........
93724 S Analyze pacemaker 960 4.80 $246.82 $143.74 $49.36
system.
93731 X Analyze pacemaker 966 0.39 $20.05 $12.43 $4.01
system.
93732 X Analyze pacemaker 966 0.39 $20.05 $12.43 $4.01
system.
[[Page 35368]]
93733 X Telephone analysis, 966 0.39 $20.05 $12.43 $4.01
pacemaker.
93734 X Analyze pacemaker 966 0.39 $20.05 $12.43 $4.01
system.
93735 X Analyze pacemaker 966 0.39 $20.05 $12.43 $4.01
system.
93736 X Telephone analysis, 966 0.39 $20.05 $12.43 $4.01
pacemaker.
93737 X Analyze cardio/ 966 0.39 $20.05 $12.43 $4.01
defibrillator.
93738 X Analyze cardio/ 966 0.39 $20.05 $12.43 $4.01
defibrillator.
93740 X Temperature gradient 967 1.70 $87.41 $57.40 $17.48
studies.
93760 E Cephalic thermogram.... ......... ......... ......... ........... ...........
93762 E Peripheral thermogram.. ......... ......... ......... ........... ...........
93770 N Measure venous pressure ......... ......... ......... ........... ...........
93784 E Ambulatory BP ......... ......... ......... ........... ...........
monitoring.
93786 E Ambulatory BP recording ......... ......... ......... ........... ...........
93788 E Ambulatory BP analysis. ......... ......... ......... ........... ...........
93790 E Review/report BP ......... ......... ......... ........... ...........
recording.
93797 X Cardiac rehab.......... 948 0.81 $41.65 $16.95 $8.33
93798 X Cardiac rehab/monitor.. 948 0.81 $41.65 $16.95 $8.33
93799 X Cardiovascular 967 1.70 $87.41 $57.40 $17.48
procedure.
93875 X Extracranial study..... 968 2.39 $122.89 $79.55 $24.58
93880 X Extracranial study..... 968 2.39 $122.89 $79.55 $24.58
93882 X Extracranial study..... 968 2.39 $122.89 $79.55 $24.58
93886 X Intracranial study..... 968 2.39 $122.89 $79.55 $24.58
93888 X Intracranial study..... 968 2.39 $122.89 $79.55 $24.58
93922 X Extremity study........ 967 1.70 $87.41 $57.40 $17.48
93923 X Extremity study........ 967 1.70 $87.41 $57.40 $17.48
93924 X Extremity study........ 967 1.70 $87.41 $57.40 $17.48
93925 X Lower extremity study.. 968 2.39 $122.89 $79.55 $24.58
93926 X Lower extremity study.. 968 2.39 $122.89 $79.55 $24.58
93930 X Upper extremity study.. 968 2.39 $122.89 $79.55 $24.58
93931 X Upper extremity study.. 968 2.39 $122.89 $79.55 $24.58
93965 X Extremity study........ 967 1.70 $87.41 $57.40 $17.48
93970 X Extremity study........ 968 2.39 $122.89 $79.55 $24.58
93971 X Extremity study........ 968 2.39 $122.89 $79.55 $24.58
93975 X Vascular study......... 968 2.39 $122.89 $79.55 $24.58
93976 X Vascular study......... 968 2.39 $122.89 $79.55 $24.58
93978 X Vascular study......... 968 2.39 $122.89 $79.55 $24.58
93979 X Vascular study......... 968 2.39 $122.89 $79.55 $24.58
93980 X Penile vascular study.. 968 2.39 $122.89 $79.55 $24.58
93981 X Penile vascular study.. 968 2.39 $122.89 $79.55 $24.58
93990 X Doppler flow testing... 968 2.39 $122.89 $79.55 $24.58
94010 X Breathing capacity test 971 0.98 $50.39 $26.44 $10.08
94060 X Evaluation of wheezing. 971 0.98 $50.39 $26.44 $10.08
94070 S Evaluation of wheezing. 973 1.81 $93.07 $55.82 $18.61
94150 N Vital capacity test.... ......... ......... ......... ........... ...........
\2\ 9416 X Vital capacity 971 0.98 $50.39 $26.44 $10.08
0 screening.
94200 X Lung function test (MBC/ 971 0.98 $50.39 $26.44 $10.08
MVV).
94240 X Residual lung capacity. 972 1.00 $51.42 $29.38 $10.28
94250 X Expired gas collection. 971 0.98 $50.39 $26.44 $10.08
94260 X Thoracic gas volume.... 971 0.98 $50.39 $26.44 $10.08
94350 X Lung nitrogen washout 972 1.00 $51.42 $29.38 $10.28
curve.
94360 X Measure airflow 971 0.98 $50.39 $26.44 $10.08
resistance.
94370 X Breath airway closing 972 1.00 $51.42 $29.38 $10.28
volume.
94375 X Respiratory flow volume 971 0.98 $50.39 $26.44 $10.08
loop.
94400 X CO2 breathing response 971 0.98 $50.39 $26.44 $10.08
curve.
94450 X Hypoxia response curve. 971 0.98 $50.39 $26.44 $10.08
94620 S Pulmonary stress test/ 973 1.81 $93.07 $55.82 $18.61
simple.
94640 S Airway inhalation 976 0.44 $22.62 $14.69 $4.53
treatment.
94642 S Aerosol inhalation 976 0.44 $22.62 $14.69 $4.53
treatment.
94650 S Pressure breathing 976 0.44 $22.62 $14.69 $4.53
(IPPB).
94651 S Pressure breathing 976 0.44 $22.62 $14.69 $4.53
(IPPB).
94652 C Pressure breathing ......... ......... ......... ........... ...........
(IPPB).
94656 C Initial ventilator mgmt ......... ......... ......... ........... ...........
94657 S Cont. ventilator....... 976 0.44 $22.62 $14.69 $4.53
94660 S Pos airway pressure, 976 0.44 $22.62 $14.69 $4.53
CPAP.
94662 S Neg pressure 976 0.44 $22.62 $14.69 $4.53
ventilation, cnp.
94664 S Aerosol or vapor 976 0.44 $22.62 $14.69 $4.53
inhalations.
94665 S Aerosol or vapor 976 0.44 $22.62 $14.69 $4.53
inhalations.
94667 S Chest wall manipulation 976 0.44 $22.62 $14.69 $4.53
94668 S Chest wall manipulation 976 0.44 $22.62 $14.69 $4.53
94680 X Exhaled air analysis: 972 1.00 $51.42 $29.38 $10.28
O2.
94681 X Exhaled air analysis: 972 1.00 $51.42 $29.38 $10.28
O2, CO2.
94690 X Exhaled air analysis... 972 1.00 $51.42 $29.38 $10.28
94720 X Monoxide diffusing 972 1.00 $51.42 $29.38 $10.28
capacity.
94725 X Membrane diffusion 972 1.00 $51.42 $29.38 $10.28
capacity.
94750 S Pulmonary compliance 973 1.81 $93.07 $55.82 $18.61
study.
94760 N Measure blood oxygen ......... ......... ......... ........... ...........
level.
[[Page 35369]]
94761 N Measure blood oxygen ......... ......... ......... ........... ...........
level.
94762 X Measure blood oxygen 971 0.98 $50.39 $26.44 $10.08
level.
94770 X Exhaled carbon dioxide 971 0.98 $50.39 $26.44 $10.08
test.
94772 S Breath recording, 973 1.81 $93.07 $55.82 $18.61
infant.
94799 X Pulmonary service/ 971 0.98 $50.39 $26.44 $10.08
procedure.
95004 X Allergy skin tests..... 977 0.56 $28.80 $11.30 $5.76
95010 X Sensitivity skin tests. 977 0.56 $28.80 $11.30 $5.76
95015 X Sensitivity skin tests. 977 0.56 $28.80 $11.30 $5.76
95024 X Allergy skin tests..... 977 0.56 $28.80 $11.30 $5.76
95027 X Skin end point 977 0.56 $28.80 $11.30 $5.76
titration.
95028 X Allergy skin tests..... 977 0.56 $28.80 $11.30 $5.76
95044 X Allergy patch tests.... 977 0.56 $28.80 $11.30 $5.76
95052 X Photo patch test....... 977 0.56 $28.80 $11.30 $5.76
95056 X Photosensitivity tests. 977 0.56 $28.80 $11.30 $5.76
95060 X Eye allergy tests...... 977 0.56 $28.80 $11.30 $5.76
95065 X Nose allergy test...... 977 0.56 $28.80 $11.30 $5.76
95070 S Bronchial allergy tests 973 1.81 $93.07 $55.82 $18.61
95071 S Bronchial allergy tests 973 1.81 $93.07 $55.82 $18.61
95075 X Ingestion challenge 928 2.91 $149.63 $79.78 $29.93
test.
95078 X Provocative testing.... 977 0.56 $28.80 $11.30 $5.76
95115 X Immunotherapy, one 978 0.30 $15.43 $3.39 $3.09
injection.
95117 X Immunotherapy 978 0.30 $15.43 $3.39 $3.09
injections.
95120 E Immunotherapy, one ......... ......... ......... ........... ...........
injection.
95125 E Immunotherapy, many ......... ......... ......... ........... ...........
antigens.
95130 E Immunotherapy, insect ......... ......... ......... ........... ...........
venom.
95131 E Immunotherapy, insect ......... ......... ......... ........... ...........
venoms.
95132 E Immunotherapy, insect ......... ......... ......... ........... ...........
venoms.
95133 E Immunotherapy, insect ......... ......... ......... ........... ...........
venoms.
95134 E Immunotherapy, insect ......... ......... ......... ........... ...........
venoms.
95144 X Antigen therapy 978 0.30 $15.43 $3.39 $3.09
services.
95145 X Antigen therapy 978 0.30 $15.43 $3.39 $3.09
services.
95146 X Antigen therapy 978 0.30 $15.43 $3.39 $3.09
services.
95147 X Antigen therapy 978 0.30 $15.43 $3.39 $3.09
services.
95148 X Antigen therapy 978 0.30 $15.43 $3.39 $3.09
services.
95149 X Antigen therapy 901 0.07 $3.60 $2.49 $0.72
services.
95165 X Antigen therapy 978 0.30 $15.43 $3.39 $3.09
services.
95170 X Antigen therapy 901 0.07 $3.60 $2.49 $0.72
services.
95180 X Rapid desensitization.. 977 0.56 $28.80 $11.30 $5.76
95199 X Allergy immunology 977 0.56 $28.80 $11.30 $5.76
services.
95805 S Multiple sleep latency 979 10.15 $521.91 $287.25 $104.38
test.
95806 S Sleep study, unattended 979 10.15 $521.91 $287.25 $104.38
95807 S Sleep study, attended.. 979 10.15 $521.91 $287.25 $104.38
95808 S Polysomnography, 1-3... 979 10.15 $521.91 $287.25 $104.38
95810 S Polysomnography, 4 or 979 10.15 $521.91 $287.25 $104.38
more.
95811 S Polysomnography w/cpap. 979 10.15 $521.91 $287.25 $104.38
95812 S Electroencephalogram 979 10.15 $521.91 $287.25 $104.38
(EEG).
95813 S Electroencephalogram 979 10.15 $521.91 $287.25 $104.38
(EEG).
95816 S Electroencephalogram 980 2.15 $110.55 $57.86 $22.11
(EEG).
95819 S Electroencephalogram 980 2.15 $110.55 $57.86 $22.11
(EEG).
95822 S Sleep 980 2.15 $110.55 $57.86 $22.11
electroencephalogram.
95824 S Electroencephalography. 980 2.15 $110.55 $57.86 $22.11
95827 S Night 979 10.15 $521.91 $287.25 $104.38
electroencephalogram.
95829 S Surgery 980 2.15 $110.55 $57.86 $22.11
electrocorticogram.
95830 N Insert electrodes for ......... ......... ......... ........... ...........
EEG.
95831 N Limb muscle testing, ......... ......... ......... ........... ...........
manual.
95832 N Hand muscle testing, ......... ......... ......... ........... ...........
manual.
95833 N Body muscle testing, ......... ......... ......... ........... ...........
manual.
95834 N Body muscle testing, ......... ......... ......... ........... ...........
manual.
95851 N Range of motion ......... ......... ......... ........... ...........
measurements.
95852 N Range of motion ......... ......... ......... ........... ...........
measurements.
95857 X Tensilon test.......... 981 1.22 $62.73 $34.35 $12.55
95858 X Tensilon test & myogram 982 1.37 $70.45 $38.42 $14.09
95860 X Muscle test, one limb.. 982 1.37 $70.45 $38.42 $14.09
95861 X Muscle test, two limbs. 982 1.37 $70.45 $38.42 $14.09
95863 X Muscle test, 3 limbs... 982 1.37 $70.45 $38.42 $14.09
95864 X Muscle test, 4 limbs... 982 1.37 $70.45 $38.42 $14.09
95867 X Muscle test, head or 981 1.22 $62.73 $34.35 $12.55
neck.
95868 X Muscle test, head or 982 1.37 $70.45 $38.42 $14.09
neck.
95869 X Muscle test, thor 981 1.22 $62.73 $34.35 $12.55
paraspinal.
95870 X Muscle test, non- 981 1.22 $62.73 $34.35 $12.55
paraspinal.
95872 X Muscle test, one fiber. 982 1.37 $70.45 $38.42 $14.09
95875 X Limb exercise test..... 982 1.37 $70.45 $38.42 $14.09
95900 X Motor nerve conduction 981 1.22 $62.73 $34.35 $12.55
test.
95903 X Motor nerve conduction 982 1.37 $70.45 $38.42 $14.09
test.
95904 X Sense nerve conduction 982 1.37 $70.45 $38.42 $14.09
test.
[[Page 35370]]
95920 C Intraop nerve test add- ......... ......... ......... ........... ...........
on.
95921 X Autonomic nervous func 981 1.22 $62.73 $34.35 $12.55
test.
95922 X Autonomic nervous func 981 1.22 $62.73 $34.35 $12.55
test.
95923 X Autonomic nervous func 981 1.22 $62.73 $34.35 $12.55
test.
95925 X Somatosensory testing.. 982 1.37 $70.45 $38.42 $14.09
95926 X Somatosensory testing.. 981 1.22 $62.73 $34.35 $12.55
95927 X Somatosensory testing.. 981 1.22 $62.73 $34.35 $12.55
95930 X Visual evoked potential 981 1.22 $62.73 $34.35 $12.55
test.
95933 X Blink reflex test...... 981 1.22 $62.73 $34.35 $12.55
95934 X 'h' reflex test........ 981 1.22 $62.73 $34.35 $12.55
95936 X 'h' reflex test........ 981 1.22 $62.73 $34.35 $12.55
95937 X Neuromuscular junction 981 1.22 $62.73 $34.35 $12.55
test.
95950 X Ambulatory eeg 981 1.22 $62.73 $34.35 $12.55
monitoring.
95951 S EEG monitoring/ 979 10.15 $521.91 $287.25 $104.38
videorecord.
95953 S EEG monitoring/computer 979 10.15 $521.91 $287.25 $104.38
95954 S EEG monitoring/giving 979 10.15 $521.91 $287.25 $104.38
drugs.
95955 S EEG during surgery..... 980 2.15 $110.55 $57.86 $22.11
95956 N EEG monitoring/cable/ ......... ......... ......... ........... ...........
radio.
95957 N EEG digital analysis... ......... ......... ......... ........... ...........
95958 S EEG monitoring/function 979 10.15 $521.91 $287.25 $104.38
test.
95961 C Electrode stimulation, ......... ......... ......... ........... ...........
brain.
95962 C Electrode stimulation, ......... ......... ......... ........... ...........
brain.
95999 N Neurological procedure. ......... ......... ......... ........... ...........
\1\ 9610 X Psychological testing.. 089 4.06 $208.77 $46.10 $41.75
0
96105 X Assessment of aphasia.. 089 4.06 $208.77 $46.10 $41.75
96110 X Developmental test, lim 089 4.06 $208.77 $46.10 $41.75
96111 X Developmental test, 089 4.06 $208.77 $46.10 $41.75
extend.
\1\ 9611 X Neurobehavior status 089 4.06 $208.77 $46.10 $41.75
5 exam.
\1\ 9611 X Neuropsych test battery 089 4.06 $208.77 $46.10 $41.75
7
96400 S Chemotherapy, (SC)/(IM) 987 2.09 $107.47 $65.09 $21.49
96405 S Intralesional chemo 987 2.09 $107.47 $65.09 $21.49
admin.
96406 S Intralesional chemo 987 2.09 $107.47 $65.09 $21.49
admin.
96408 S Chemotherapy, push 988 4.02 $206.71 $110.29 $41.34
technique.
96410 S Chemotherapy,infusion 988 4.02 $206.71 $110.29 $41.34
method.
96412 S Chemotx infuse method 988 4.02 $206.71 $110.29 $41.34
add-on.
96414 S Chemotx infuse method 989 1.91 $98.21 $44.52 $19.64
add-on.
96420 S Chemotherapy, push 988 4.02 $206.71 $110.29 $41.34
technique.
96422 S Chemotherapy,infusion 988 4.02 $206.71 $110.29 $41.34
method.
96423 S Chemotx infuse method 988 4.02 $206.71 $110.29 $41.34
add-on.
96425 S Chemotherapy,infusion 989 1.91 $98.21 $44.52 $19.64
method.
96440 S Chemotherapy, 989 1.91 $98.21 $44.52 $19.64
intracavitary.
96445 S Chemotherapy, 989 1.91 $98.21 $44.52 $19.64
intracavitary.
96450 S Chemotherapy, into CNS. 989 1.91 $98.21 $44.52 $19.64
96520 E Pump refilling, ......... ......... ......... ........... ...........
maintenance.
96530 E Pump refilling, ......... ......... ......... ........... ...........
maintenance.
96542 S Chemotherapy injection. 989 1.91 $98.21 $44.52 $19.64
96545 E Provide chemotherapy ......... ......... ......... ........... ...........
agent.
96549 S Chemotherapy, 987 2.09 $107.47 $65.09 $21.49
unspecified.
96900 S Ultraviolet light 990 0.43 $22.11 $8.14 $4.42
therapy.
96902 N Trichogram............. ......... ......... ......... ........... ...........
96910 S Photochemotherapy with 990 0.43 $22.11 $8.14 $4.42
UV-B.
96912 S Photochemotherapy with 990 0.43 $22.11 $8.14 $4.42
UV-A.
96913 S Photochemotherapy, UV-A 990 0.43 $22.11 $8.14 $4.42
or B.
96999 S Dermatological 990 0.43 $22.11 $8.14 $4.42
procedure.
97001 A Pt evaluation.......... ......... ......... ......... ........... ...........
97002 A Pt re-evaluation....... ......... ......... ......... ........... ...........
97003 A Ot evaluation.......... ......... ......... ......... ........... ...........
97004 A Ot re-evaluation....... ......... ......... ......... ........... ...........
97010 A Hot or cold packs ......... ......... ......... ........... ...........
therapy.
97012 A Mechanical traction ......... ......... ......... ........... ...........
therapy.
97014 A Electric stimulation ......... ......... ......... ........... ...........
therapy.
97016 A Vasopneumatic device ......... ......... ......... ........... ...........
therapy.
97018 A Paraffin bath therapy.. ......... ......... ......... ........... ...........
97020 A Microwave therapy...... ......... ......... ......... ........... ...........
97022 A Whirlpool therapy...... ......... ......... ......... ........... ...........
97024 A Diathermy treatment.... ......... ......... ......... ........... ...........
97026 A Infrared therapy....... ......... ......... ......... ........... ...........
97028 A Ultraviolet therapy.... ......... ......... ......... ........... ...........
97032 A Electrical stimulation. ......... ......... ......... ........... ...........
97033 A Electric current ......... ......... ......... ........... ...........
therapy.
97034 A Contrast bath therapy.. ......... ......... ......... ........... ...........
97035 A Ultrasound therapy..... ......... ......... ......... ........... ...........
97036 A Hydrotherapy........... ......... ......... ......... ........... ...........
97039 A Physical therapy ......... ......... ......... ........... ...........
treatment.
97110 A Therapeutic exercises.. ......... ......... ......... ........... ...........
[[Page 35371]]
97112 A Neuromuscular ......... ......... ......... ........... ...........
reeducation.
97113 A Aquatic therapy/ ......... ......... ......... ........... ...........
exercises.
97116 A Gait training therapy.. ......... ......... ......... ........... ...........
\2\ 9712 A Manual traction therapy ......... ......... ......... ........... ...........
2
97124 A Massage therapy........ ......... ......... ......... ........... ...........
97139 A Physical medicine ......... ......... ......... ........... ...........
procedure.
97150 A Group therapeutic ......... ......... ......... ........... ...........
procedures.
\2\ 9725 S Myofascial release..... 997 0.69 $35.48 $7.46 $7.10
0
\2\ 9726 S Regional manipulation.. 997 0.69 $35.48 $7.46 $7.10
0
\2\ 9726 S Supplemental 997 0.69 $35.48 $7.46 $7.10
1 manipulations.
\2\ 9726 A Joint mobilization..... ......... ......... ......... ........... ...........
5
97504 A Orthotic training...... ......... ......... ......... ........... ...........
97520 A Prosthetic training.... ......... ......... ......... ........... ...........
\1\ 9753 A Therapeutic activities. ......... ......... ......... ........... ...........
0
97535 A Self care mngment ......... ......... ......... ........... ...........
training.
\1\ 9753 A Community/work ......... ......... ......... ........... ...........
7 reintegration.
97542 A Wheelchair mngement ......... ......... ......... ........... ...........
training.
97545 A Work hardening......... ......... ......... ......... ........... ...........
97546 A Work hardening add-on.. ......... ......... ......... ........... ...........
97703 A Prosthetic checkout.... ......... ......... ......... ........... ...........
97750 A Physical performance ......... ......... ......... ........... ...........
test.
\1\ 9777 A Cognitive skills ......... ......... ......... ........... ...........
0 development.
97780 E Acupuncture w/o stim... ......... ......... ......... ........... ...........
97781 E Acupuncture w/stim..... ......... ......... ......... ........... ...........
97799 A Physical medicine ......... ......... ......... ........... ...........
procedure.
98925 S Osteopathic 997 0.69 $35.48 $7.46 $7.10
manipulation.
98926 S Osteopathic 997 0.69 $35.48 $7.46 $7.10
manipulation.
98927 S Osteopathic 997 0.69 $35.48 $7.46 $7.10
manipulation.
98928 S Osteopathic 997 0.69 $35.48 $7.46 $7.10
manipulation.
98929 S Osteopathic 997 0.69 $35.48 $7.46 $7.10
manipulation.
98940 S Chiropractic 997 0.69 $35.48 $7.46 $7.10
manipulation.
98941 S Chiropractic 997 0.69 $35.48 $7.46 $7.10
manipulation.
98942 S Chiropractic 997 0.69 $35.48 $7.46 $7.10
manipulation.
98943 E Chiropractic ......... ......... ......... ........... ...........
manipulation.
99000 E Specimen handling...... ......... ......... ......... ........... ...........
99001 N Specimen handling...... ......... ......... ......... ........... ...........
99002 E Device handling........ ......... ......... ......... ........... ...........
99024 N Post-op follow-up visit ......... ......... ......... ........... ...........
99025 N Initial surgical ......... ......... ......... ........... ...........
evaluation.
99050 E Medical services after ......... ......... ......... ........... ...........
hrs.
99052 E Medical services at ......... ......... ......... ........... ...........
night.
99054 E Medical services, ......... ......... ......... ........... ...........
unusual hrs.
99056 E Non-office medical ......... ......... ......... ........... ...........
services.
99058 E Office emergency care.. ......... ......... ......... ........... ...........
99070 E Special supplies....... ......... ......... ......... ........... ...........
99071 E Patient education ......... ......... ......... ........... ...........
materials.
99075 E Medical testimony...... ......... ......... ......... ........... ...........
99078 S Group health education. 921 ......... ......... ........... ...........
99080 E Special reports or ......... ......... ......... ........... ...........
forms.
99082 E Unusual physician ......... ......... ......... ........... ...........
travel.
99090 E Computer data analysis. ......... ......... ......... ........... ...........
99100 N Special anesthesia ......... ......... ......... ........... ...........
service.
99116 N Anesthesia with ......... ......... ......... ........... ...........
hypothermia.
99135 N Special anesthesia ......... ......... ......... ........... ...........
procedure.
99140 N Emergency anesthesia... ......... ......... ......... ........... ...........
99141 N Sedation, iv/im or ......... ......... ......... ........... ...........
inhalant.
99142 N Sedation, oral/rectal/ ......... ......... ......... ........... ...........
nasal.
99175 N Induction of vomiting.. ......... ......... ......... ........... ...........
99183 S Hyperbaric oxygen 969 2.65 $136.26 $141.70 $27.25
therapy.
99185 N Regional hypothermia... ......... ......... ......... ........... ...........
99186 N Total body hypothermia. ......... ......... ......... ........... ...........
99190 C Special pump services.. ......... ......... ......... ........... ...........
99191 C Special pump services.. ......... ......... ......... ........... ...........
99192 C Special pump services.. ......... ......... ......... ........... ...........
99195 X Phlebotomy............. 999 0.43 $22.11 $11.07 $4.42
99199 N Special service or ......... ......... ......... ........... ...........
report.
99201 V Office/outpatient 911 ......... ......... ........... ...........
visit, new.
99202 V Office/outpatient 911 ......... ......... ........... ...........
visit, new.
99203 V Office/outpatient 913 ......... ......... ........... ...........
visit, new.
99204 V Office/outpatient 915 ......... ......... ........... ...........
visit, new.
99205 V Office/outpatient 915 ......... ......... ........... ...........
visit, new.
99211 V Office/outpatient 911 ......... ......... ........... ...........
visit, est.
99212 V Office/outpatient 911 ......... ......... ........... ...........
visit, est.
99213 V Office/outpatient 913 ......... ......... ........... ...........
visit, est.
99214 V Office/outpatient 915 ......... ......... ........... ...........
visit, est.
[[Page 35372]]
99215 V Office/outpatient 915 ......... ......... ........... ...........
visit, est.
99217 N Observation care ......... ......... ......... ........... ...........
discharge.
99218 N Observation care....... ......... ......... ......... ........... ...........
99219 N Observation care....... ......... ......... ......... ........... ...........
99220 N Observation care....... ......... ......... ......... ........... ...........
99221 E Initial hospital care.. ......... ......... ......... ........... ...........
99222 E Initial hospital care.. ......... ......... ......... ........... ...........
99223 E Initial hospital care.. ......... ......... ......... ........... ...........
99231 E Subsequent hospital ......... ......... ......... ........... ...........
care.
99232 E Subsequent hospital ......... ......... ......... ........... ...........
care.
99233 E Subsequent hospital ......... ......... ......... ........... ...........
care.
99234 C Observ/hosp same date.. ......... ......... ......... ........... ...........
99235 C Observ/hosp same date.. ......... ......... ......... ........... ...........
99236 C Observ/hosp same date.. ......... ......... ......... ........... ...........
99238 E Hospital discharge day. ......... ......... ......... ........... ...........
99239 E Hospital discharge day. ......... ......... ......... ........... ...........
99241 V Office consultation.... 911 ......... ......... ........... ...........
99242 V Office consultation.... 911 ......... ......... ........... ...........
99243 V Office consultation.... 913 ......... ......... ........... ...........
99244 V Office consultation.... 915 ......... ......... ........... ...........
99245 V Office consultation.... 915 ......... ......... ........... ...........
99251 C Initial inpatient ......... ......... ......... ........... ...........
consult.
99252 C Initial inpatient ......... ......... ......... ........... ...........
consult.
99253 C Initial inpatient ......... ......... ......... ........... ...........
consult.
99254 C Initial inpatient ......... ......... ......... ........... ...........
consult.
99255 C Initial inpatient ......... ......... ......... ........... ...........
consult.
99261 C Follow-up inpatient ......... ......... ......... ........... ...........
consult.
99262 C Follow-up inpatient ......... ......... ......... ........... ...........
consult.
99263 C Follow-up inpatient ......... ......... ......... ........... ...........
consult.
99271 V Confirmatory 911 ......... ......... ........... ...........
consultation.
99272 V Confirmatory 911 ......... ......... ........... ...........
consultation.
99273 V Confirmatory 913 ......... ......... ........... ...........
consultation.
99274 V Confirmatory 915 ......... ......... ........... ...........
consultation.
99275 V Confirmatory 915 ......... ......... ........... ...........
consultation.
99281 V Emergency dept visit... 951 ......... ......... ........... ...........
99282 V Emergency dept visit... 951 ......... ......... ........... ...........
99283 V Emergency dept visit... 953 ......... ......... ........... ...........
99284 V Emergency dept visit... 955 ......... ......... ........... ...........
99285 V Emergency dept visit... 955 ......... ......... ........... ...........
99288 E Direct advanced life ......... ......... ......... ........... ...........
support.
99291 S Critical care, first 900 7.54 $387.71 $145.09 $77.54
hour.
99292 N Critical care, addt'l ......... ......... ......... ........... ...........
30 min.
99295 C Neonatal critical care. ......... ......... ......... ........... ...........
99296 C Neonatal critical care. ......... ......... ......... ........... ...........
99297 C Neonatal critical care. ......... ......... ......... ........... ...........
99301 E Nursing facility care.. ......... ......... ......... ........... ...........
99302 E Nursing facility care.. ......... ......... ......... ........... ...........
99303 E Nursing facility care.. ......... ......... ......... ........... ...........
99311 E Nursing facility care, ......... ......... ......... ........... ...........
subseq.
99312 E Nursing facility care, ......... ......... ......... ........... ...........
subseq.
99313 E Nursing facility care, ......... ......... ......... ........... ...........
subseq.
99315 E Nursing fac discharge ......... ......... ......... ........... ...........
day.
99316 E Nursing fac discharge ......... ......... ......... ........... ...........
day.
99321 E Rest home visit, new ......... ......... ......... ........... ...........
patient.
99322 E Rest home visit, new ......... ......... ......... ........... ...........
patient.
99323 E Rest home visit, new ......... ......... ......... ........... ...........
patient.
99331 E Rest home visit, estab ......... ......... ......... ........... ...........
pat.
99332 E Rest home visit, estab ......... ......... ......... ........... ...........
pat.
99333 E Rest home visit, estab ......... ......... ......... ........... ...........
pat.
99341 E Home visit, new patient ......... ......... ......... ........... ...........
99342 E Home visit, new patient ......... ......... ......... ........... ...........
99343 E Home visit, new patient ......... ......... ......... ........... ...........
99344 E Home visit, new patient ......... ......... ......... ........... ...........
99345 E Home visit, new patient ......... ......... ......... ........... ...........
99347 E Home visit, estab ......... ......... ......... ........... ...........
patient.
99348 E Home visit, estab ......... ......... ......... ........... ...........
patient.
99349 E Home visit, estab ......... ......... ......... ........... ...........
patient.
99350 E Home visit, estab ......... ......... ......... ........... ...........
patient.
99354 N Prolonged service, ......... ......... ......... ........... ...........
office.
99355 N Prolonged service, ......... ......... ......... ........... ...........
office.
99356 C Prolonged service, ......... ......... ......... ........... ...........
inpatient.
99357 C Prolonged service, ......... ......... ......... ........... ...........
inpatient.
99358 N Prolonged serv, w/o ......... ......... ......... ........... ...........
contact.
99359 N Prolonged serv, w/o ......... ......... ......... ........... ...........
contact.
99360 E Physician standby ......... ......... ......... ........... ...........
services.
[[Page 35373]]
99361 E Physician/team ......... ......... ......... ........... ...........
conference.
99362 E Physician/team ......... ......... ......... ........... ...........
conference.
99371 E Physician phone ......... ......... ......... ........... ...........
consultation.
99372 E Physician phone ......... ......... ......... ........... ...........
consultation.
99373 E Physician phone ......... ......... ......... ........... ...........
consultation.
99374 E Home health care ......... ......... ......... ........... ...........
supervision.
99375 E Home health care ......... ......... ......... ........... ...........
supervision.
99377 E Hospice care ......... ......... ......... ........... ...........
supervision.
99378 E Hospice care ......... ......... ......... ........... ...........
supervision.
99379 E Nursing fac care ......... ......... ......... ........... ...........
supervision.
99380 E Nursing fac care ......... ......... ......... ........... ...........
supervision.
99381 E Preventive visit, new, ......... ......... ......... ........... ...........
infant.
99382 E Preventive visit, new, ......... ......... ......... ........... ...........
age 1-4.
99383 E Preventive visit, new, ......... ......... ......... ........... ...........
age 5-11.
99384 E Preventive visit, new, ......... ......... ......... ........... ...........
12-17.
99385 E Preventive visit, new, ......... ......... ......... ........... ...........
18-39.
99386 E Preventive visit, new, ......... ......... ......... ........... ...........
40-64.
99387 E Preventive visit, new, ......... ......... ......... ........... ...........
65 & over.
99391 E Preventive visit, est, ......... ......... ......... ........... ...........
infant.
99392 E Preventive visit, est, ......... ......... ......... ........... ...........
age 1-4.
99393 E Preventive visit, est, ......... ......... ......... ........... ...........
age 5-11.
99394 E Preventive visit, est, ......... ......... ......... ........... ...........
12-17.
99395 E Preventive visit, est, ......... ......... ......... ........... ...........
18-39.
99396 E Preventive visit, est, ......... ......... ......... ........... ...........
40-64.
99397 E Preventive visit, est, ......... ......... ......... ........... ...........
65 & over.
99401 E Preventive counseling, ......... ......... ......... ........... ...........
indiv.
99402 E Preventive counseling, ......... ......... ......... ........... ...........
indiv.
99403 E Preventive counseling, ......... ......... ......... ........... ...........
indiv.
99404 E Preventive counseling, ......... ......... ......... ........... ...........
indiv.
99411 E Preventive counseling, ......... ......... ......... ........... ...........
group.
99412 E Preventive counseling, ......... ......... ......... ........... ...........
group.
99420 E Health risk assessment ......... ......... ......... ........... ...........
test.
99429 E Unlisted preventive ......... ......... ......... ........... ...........
service.
99431 N Initial care, normal ......... ......... ......... ........... ...........
newborn.
99432 N Newborn care not in ......... ......... ......... ........... ...........
hospital.
99433 C Normal newborn ......... ......... ......... ........... ...........
care,hospital.
99435 E Hospital NB discharge ......... ......... ......... ........... ...........
day.
99436 N Attendance, birth...... ......... ......... ......... ........... ...........
99440 S Newborn resuscitation.. 947 4.11 $211.34 $106.22 $42.27
99450 E Life/disability ......... ......... ......... ........... ...........
evaluation.
99455 E Disability examination. ......... ......... ......... ........... ...........
99456 E Disability examination. ......... ......... ......... ........... ...........
99499 E Unlisted E/M service... ......... ......... ......... ........... ...........
A0021 E Outside state ambulance ......... ......... ......... ........... ...........
serv.
A0030 A Air ambulance service.. ......... ......... ......... ........... ...........
A0040 A Helicopter ambulance ......... ......... ......... ........... ...........
service.
A0050 A Water amb service ......... ......... ......... ........... ...........
emergency.
A0080 E Noninterest escort in ......... ......... ......... ........... ...........
non er.
A0090 E Interest escort in non ......... ......... ......... ........... ...........
er.
A0100 E Nonemergency transport ......... ......... ......... ........... ...........
taxi.
A0110 E Nonemergency transport ......... ......... ......... ........... ...........
bus.
A0120 E Noner transport mini- ......... ......... ......... ........... ...........
bus.
A0130 E Noner transport wheelch ......... ......... ......... ........... ...........
van.
A0140 E Nonemergency transport ......... ......... ......... ........... ...........
air.
A0160 E Noner transport case ......... ......... ......... ........... ...........
worker.
A0170 E Noner transport parking ......... ......... ......... ........... ...........
fees.
A0180 E Noner transport lodgng ......... ......... ......... ........... ...........
recip.
A0190 E Noner transport meals ......... ......... ......... ........... ...........
recip.
A0200 E Noner transport lodgng ......... ......... ......... ........... ...........
escrt.
A0210 E Noner transport meals ......... ......... ......... ........... ...........
escort.
A0225 A Neonatal emergency ......... ......... ......... ........... ...........
transport.
A0300 A Ambulance basic non- ......... ......... ......... ........... ...........
emer all.
A0302 A Ambulance basic ......... ......... ......... ........... ...........
emergeny all.
A0304 A Amb adv non-er no serv ......... ......... ......... ........... ...........
all.
A0306 A Amb adv non-er spec ......... ......... ......... ........... ...........
serv all.
A0308 A Amb adv er no spec serv ......... ......... ......... ........... ...........
all.
A0310 A Amb adv er spec serv ......... ......... ......... ........... ...........
all.
A0320 A Amb basic non-er + ......... ......... ......... ........... ...........
supplies.
A0322 A Amb basic emerg + ......... ......... ......... ........... ...........
supplies.
A0324 A Adv non-er serv sep ......... ......... ......... ........... ...........
mileage.
A0326 A Adv non-er no serv sep ......... ......... ......... ........... ...........
mile.
A0328 A Adv er no serv sep ......... ......... ......... ........... ...........
mileage.
A0330 A Adv er spec serv sep ......... ......... ......... ........... ...........
mile.
A0340 A Amb basic non-er + ......... ......... ......... ........... ...........
mileage.
A0342 A Ambul basic emer + ......... ......... ......... ........... ...........
mileage.
[[Page 35374]]
A0344 A Amb adv non-er no serv ......... ......... ......... ........... ...........
+mile.
A0346 A Amb adv non-er serv + ......... ......... ......... ........... ...........
mile.
A0348 A Adv emer no spec serv + ......... ......... ......... ........... ...........
mile.
A0350 A Adv emer spec serv + ......... ......... ......... ........... ...........
mileage.
A0360 A Basic non-er sep mile & ......... ......... ......... ........... ...........
supp.
A0362 A Basic emer sep mile & ......... ......... ......... ........... ...........
supply.
A0364 A Adv non-er no serv sep ......... ......... ......... ........... ...........
mi&su.
A0366 A Adv non-er serv sep ......... ......... ......... ........... ...........
mil&supp.
A0368 A Adv er no serv sep ......... ......... ......... ........... ...........
mile&supp.
A0370 A Adv er spec serv sep ......... ......... ......... ........... ...........
mi&supp.
A0380 A Basic life support ......... ......... ......... ........... ...........
mileage.
A0382 A Basic support routine ......... ......... ......... ........... ...........
suppls.
A0384 A Bls defibrillation ......... ......... ......... ........... ...........
supplies.
A0390 A Advanced life support ......... ......... ......... ........... ...........
mileag.
A0392 A Als defibrillation ......... ......... ......... ........... ...........
supplies.
A0394 A Als IV drug therapy ......... ......... ......... ........... ...........
supplies.
A0396 A Als esophageal intub ......... ......... ......... ........... ...........
suppls.
A0398 A Als routine disposble ......... ......... ......... ........... ...........
suppls.
A0420 A Ambulance waiting 1/2 ......... ......... ......... ........... ...........
hr.
A0422 A Ambulance 02 life ......... ......... ......... ........... ...........
sustaining.
A0424 A Extra ambulance ......... ......... ......... ........... ...........
attendant.
A0888 E Noncovered ambulance ......... ......... ......... ........... ...........
mileage.
A0999 A Unlisted ambulance ......... ......... ......... ........... ...........
service.
A4206 A 1 CC sterile syringe & ......... ......... ......... ........... ...........
needle.
A4207 A 2 CC sterile syringe & ......... ......... ......... ........... ...........
needle.
A4208 A 3 CC sterile syringe & ......... ......... ......... ........... ...........
needle.
A4209 A 5+ CC sterile syringe & ......... ......... ......... ........... ...........
needle.
A4210 E Nonneedle injection ......... ......... ......... ........... ...........
device.
A4211 A Supp for self-adm ......... ......... ......... ........... ...........
injections.
A4212 A Non coring needle or ......... ......... ......... ........... ...........
stylet.
A4213 A 20+ CC syringe only.... ......... ......... ......... ........... ...........
A4214 A 30 CC sterile water/ ......... ......... ......... ........... ...........
saline.
A4215 A Sterile needle......... ......... ......... ......... ........... ...........
A4220 A Infusion pump refill ......... ......... ......... ........... ...........
kit.
A4221 A Maint drug infus cath ......... ......... ......... ........... ...........
per wk.
A4222 A Drug infusion pump ......... ......... ......... ........... ...........
supplies.
A4230 E Infus insulin pump non ......... ......... ......... ........... ...........
needl.
A4231 E Infusion insulin pump ......... ......... ......... ........... ...........
needle.
A4232 E Syringe w/needle ......... ......... ......... ........... ...........
insulin 3cc.
A4244 A Alcohol or peroxide per ......... ......... ......... ........... ...........
pint.
A4245 A Alcohol wipes per box.. ......... ......... ......... ........... ...........
A4246 A Betadine/phisohex ......... ......... ......... ........... ...........
solution.
A4247 A Betadine/iodine swabs/ ......... ......... ......... ........... ...........
wipes.
A4250 E Urine reagent strips/ ......... ......... ......... ........... ...........
tablets.
A4253 A Blood glucose/reagent ......... ......... ......... ........... ...........
strips.
A4254 A Battery for glucose ......... ......... ......... ........... ...........
monitor.
A4255 A Glucose monitor ......... ......... ......... ........... ...........
platforms.
A4256 A Calibrator solution/ ......... ......... ......... ........... ...........
chips.
A4258 A Lancet device each..... ......... ......... ......... ........... ...........
A4259 A Lancets per box........ ......... ......... ......... ........... ...........
A4260 E Levonorgestrel implant. ......... ......... ......... ........... ...........
A4262 N Temporary tear duct ......... ......... ......... ........... ...........
plug.
A4263 A Permanent tear duct ......... ......... ......... ........... ...........
plug.
A4265 A Paraffin............... ......... ......... ......... ........... ...........
A4270 A Disposable endoscope ......... ......... ......... ........... ...........
sheath.
A4300 A Cath impl vasc access ......... ......... ......... ........... ...........
portal.
A4301 A Implantable access syst ......... ......... ......... ........... ...........
perc.
A4305 A Drug delivery system ......... ......... ......... ........... ...........
=50 ML.
A4306 A Drug delivery system ......... ......... ......... ........... ...........
<=5 ML.
A4310 A Insert tray w/o bag/ ......... ......... ......... ........... ...........
cath.
A4311 A Catheter w/o bag 2-way ......... ......... ......... ........... ...........
latex.
A4312 A Cath w/o bag 2-way ......... ......... ......... ........... ...........
silicone.
A4313 A Catheter w/bag 3-way... ......... ......... ......... ........... ...........
A4314 A Cath w/drainage 2-way ......... ......... ......... ........... ...........
latex.
A4315 A Cath w/drainage 2-way ......... ......... ......... ........... ...........
silcne.
A4316 A Cath w/drainage 3-way.. ......... ......... ......... ........... ...........
A4320 A Irrigation tray........ ......... ......... ......... ........... ...........
A4321 A Cath therapeutic irrig ......... ......... ......... ........... ...........
agent.
A4322 A Irrigation syringe..... ......... ......... ......... ........... ...........
A4323 A Saline irrigation ......... ......... ......... ........... ...........
solution.
A4326 A Male external catheter. ......... ......... ......... ........... ...........
A4327 A Fem urinary collect dev ......... ......... ......... ........... ...........
cup.
A4328 A Fem urinary collect ......... ......... ......... ........... ...........
pouch.
A4329 A External catheter start ......... ......... ......... ........... ...........
set.
A4330 A Stool collection pouch. ......... ......... ......... ........... ...........
[[Page 35375]]
A4335 A Incontinence supply.... ......... ......... ......... ........... ...........
A4338 A Indwelling catheter ......... ......... ......... ........... ...........
latex.
A4340 A Indwelling catheter ......... ......... ......... ........... ...........
special.
A4344 A Cath indw foley 2 way ......... ......... ......... ........... ...........
silicn.
A4346 A Cath indw foley 3 way.. ......... ......... ......... ........... ...........
A4347 A Male external catheter. ......... ......... ......... ........... ...........
A4351 A Straight tip urine ......... ......... ......... ........... ...........
catheter.
A4352 A Coude tip urinary ......... ......... ......... ........... ...........
catheter.
A4353 A Intermittent urinary ......... ......... ......... ........... ...........
cath.
A4354 A Cath insertion tray w/ ......... ......... ......... ........... ...........
bag.
A4355 A Bladder irrigation ......... ......... ......... ........... ...........
tubing.
A4356 A Ext ureth clmp or compr ......... ......... ......... ........... ...........
dvc.
A4357 A Bedside drainage bag... ......... ......... ......... ........... ...........
A4358 A Urinary leg bag........ ......... ......... ......... ........... ...........
A4359 A Urinary suspensory w/o ......... ......... ......... ........... ...........
leg b.
A4361 A Ostomy face plate...... ......... ......... ......... ........... ...........
A4362 A Solid skin barrier..... ......... ......... ......... ........... ...........
A4363 A Liquid skin barrier.... ......... ......... ......... ........... ...........
A4364 A Ostomy/cath adhesive... ......... ......... ......... ........... ...........
A4365 A Ostomy adhesive remover ......... ......... ......... ........... ...........
wipe.
A4367 A Ostomy belt............ ......... ......... ......... ........... ...........
A4368 A Ostomy filter.......... ......... ......... ......... ........... ...........
A4397 A Irrigation supply ......... ......... ......... ........... ...........
sleeve.
A4398 A Ostomy irrigation bag.. ......... ......... ......... ........... ...........
A4399 A Ostomy irrig cone/cath ......... ......... ......... ........... ...........
w brs.
A4400 A Ostomy irrigation set.. ......... ......... ......... ........... ...........
A4402 A Lubricant per ounce.... ......... ......... ......... ........... ...........
A4404 A Ostomy ring each....... ......... ......... ......... ........... ...........
A4421 A Ostomy supply misc..... ......... ......... ......... ........... ...........
A4454 A Tape all types all ......... ......... ......... ........... ...........
sizes.
A4455 A Adhesive remover per ......... ......... ......... ........... ...........
ounce.
A4460 A Elastic compression ......... ......... ......... ........... ...........
bandage.
A4462 A Abdmnl drssng holder/ ......... ......... ......... ........... ...........
binder.
A4465 A Non-elastic extremity ......... ......... ......... ........... ...........
binder.
A4470 A Gravlee jet washer..... ......... ......... ......... ........... ...........
A4480 A Vabra aspirator........ ......... ......... ......... ........... ...........
A4481 A Tracheostoma filter.... ......... ......... ......... ........... ...........
A4490 E Above knee surgical ......... ......... ......... ........... ...........
stocking.
A4495 E Thigh length surg ......... ......... ......... ........... ...........
stocking.
A4500 E Below knee surgical ......... ......... ......... ........... ...........
stocking.
A4510 E Full length surg ......... ......... ......... ........... ...........
stocking.
A4550 E Surgical trays......... ......... ......... ......... ........... ...........
A4554 E Disposable underpads... ......... ......... ......... ........... ...........
A4556 A Electrodes............. ......... ......... ......... ........... ...........
A4557 A Lead wires............. ......... ......... ......... ........... ...........
A4558 A Conductive paste or gel ......... ......... ......... ........... ...........
A4560 A Pessary................ ......... ......... ......... ........... ...........
A4565 A Slings................. ......... ......... ......... ........... ...........
A4570 A Splint................. ......... ......... ......... ........... ...........
A4572 A Rib belt............... ......... ......... ......... ........... ...........
A4575 E Hyperbaric o2 chamber ......... ......... ......... ........... ...........
disps.
A4580 A Cast supplies (plaster) ......... ......... ......... ........... ...........
A4590 A Special casting ......... ......... ......... ........... ...........
material.
A4595 A TENS suppl 2 lead per ......... ......... ......... ........... ...........
month.
A4611 A Heavy duty battery..... ......... ......... ......... ........... ...........
A4612 A Battery cables......... ......... ......... ......... ........... ...........
A4613 A Battery charger........ ......... ......... ......... ........... ...........
A4615 A Cannula nasal.......... ......... ......... ......... ........... ...........
A4616 A Tubing (oxygen) per ......... ......... ......... ........... ...........
foot.
A4617 A Mouth piece............ ......... ......... ......... ........... ...........
A4618 A Breathing circuits..... ......... ......... ......... ........... ...........
A4619 A Face tent.............. ......... ......... ......... ........... ...........
A4620 A Variable concentration ......... ......... ......... ........... ...........
mask.
A4621 A Tracheotomy mask or ......... ......... ......... ........... ...........
collar.
A4622 A Tracheostomy or ......... ......... ......... ........... ...........
larngectomy.
A4623 A Tracheostomy inner ......... ......... ......... ........... ...........
cannula.
A4624 A Tracheal suction tube.. ......... ......... ......... ........... ...........
A4625 A Trach care kit for new ......... ......... ......... ........... ...........
trach.
A4626 A Tracheostomy cleaning ......... ......... ......... ........... ...........
brush.
A4627 E Spacer bag/reservoir... ......... ......... ......... ........... ...........
A4628 A Oropharyngeal suction ......... ......... ......... ........... ...........
cath.
A4629 A Tracheostomy care kit.. ......... ......... ......... ........... ...........
A4630 A Repl bat t.e.n.s. own ......... ......... ......... ........... ...........
by pt.
A4631 A Wheelchair battery..... ......... ......... ......... ........... ...........
A4635 A Underarm crutch pad.... ......... ......... ......... ........... ...........
[[Page 35376]]
A4636 A Handgrip for cane etc.. ......... ......... ......... ........... ...........
A4637 A Repl tip cane/crutch/ ......... ......... ......... ........... ...........
walker.
A4640 A Alternating pressure ......... ......... ......... ........... ...........
pad.
A4641 N Diagnostic imaging ......... ......... ......... ........... ...........
agent.
A4642 N Satumomab pendetide per ......... ......... ......... ........... ...........
dose.
A4643 N High dose contrast MRI. ......... ......... ......... ........... ...........
A4644 N Contrast 100-199 MGs ......... ......... ......... ........... ...........
iodine.
A4645 N Contrast 200-299 MGs ......... ......... ......... ........... ...........
iodine.
A4646 N Contrast 300-399 MGs ......... ......... ......... ........... ...........
iodine.
A4647 N Supp- paramagnetic ......... ......... ......... ........... ...........
contr mat.
A4649 A Surgical supplies...... ......... ......... ......... ........... ...........
A4650 A Supp esrd centrifuge... ......... ......... ......... ........... ...........
A4655 A Esrd syringe/needle.... ......... ......... ......... ........... ...........
A4660 A Esrd blood pressure ......... ......... ......... ........... ...........
device.
A4663 A Esrd blood pressure ......... ......... ......... ........... ...........
cuff.
A4670 E Auto blood pressure ......... ......... ......... ........... ...........
monitor.
A4680 A Activated carbon ......... ......... ......... ........... ...........
filters.
A4690 A Dialyzers.............. ......... ......... ......... ........... ...........
A4700 A Standard dialysate ......... ......... ......... ........... ...........
solution.
A4705 A Bicarb dialysate ......... ......... ......... ........... ...........
solution.
A4712 A Sterile water.......... ......... ......... ......... ........... ...........
A4714 A Treated water for ......... ......... ......... ........... ...........
dialysis.
A4730 A Fistula cannulation set ......... ......... ......... ........... ...........
dial.
A4735 A Local/topical ......... ......... ......... ........... ...........
anesthetics.
A4740 A Esrd shunt accessory... ......... ......... ......... ........... ...........
A4750 A Arterial or venous ......... ......... ......... ........... ...........
tubing.
A4755 A Arterial and venous ......... ......... ......... ........... ...........
tubing.
A4760 A Standard testing ......... ......... ......... ........... ...........
solution.
A4765 A Dialysate concentrate.. ......... ......... ......... ........... ...........
A4770 A Blood testing supplies. ......... ......... ......... ........... ...........
A4771 A Blood clotting time ......... ......... ......... ........... ...........
tube.
A4772 A Dextrostick/glucose ......... ......... ......... ........... ...........
strips.
A4773 A Hemostix............... ......... ......... ......... ........... ...........
A4774 A Ammonia test paper..... ......... ......... ......... ........... ...........
A4780 A Esrd sterilizing agent. ......... ......... ......... ........... ...........
A4790 A Esrd cleansing agents.. ......... ......... ......... ........... ...........
A4800 A Heparin/antidote ......... ......... ......... ........... ...........
dialysis.
A4820 A Supplies hemodialysis ......... ......... ......... ........... ...........
kit.
A4850 A Rubber tipped hemostats ......... ......... ......... ........... ...........
A4860 A Disposable catheter ......... ......... ......... ........... ...........
caps.
A4870 A Plumbing/electrical ......... ......... ......... ........... ...........
work.
A4880 A Water storage tanks.... ......... ......... ......... ........... ...........
A4890 A Contracts/repair/ ......... ......... ......... ........... ...........
maintenance.
A4900 A Capd supply kit........ ......... ......... ......... ........... ...........
A4901 A Ccpd supply kit........ ......... ......... ......... ........... ...........
A4905 A Ipd supply kit......... ......... ......... ......... ........... ...........
A4910 A Esrd nonmedical ......... ......... ......... ........... ...........
supplies.
A4912 A Gomco drain bottle..... ......... ......... ......... ........... ...........
A4913 A Esrd supply............ ......... ......... ......... ........... ...........
A4914 A Preparation kit........ ......... ......... ......... ........... ...........
A4918 A Venous pressure clamp.. ......... ......... ......... ........... ...........
A4919 A Supp dialysis dialyzer ......... ......... ......... ........... ...........
holde.
A4920 A Harvard pressure clamp. ......... ......... ......... ........... ...........
A4921 A Measuring cylinder..... ......... ......... ......... ........... ...........
A4927 A Gloves................. ......... ......... ......... ........... ...........
A5051 A Pouch clsd w barr ......... ......... ......... ........... ...........
attached.
A5052 A Clsd ostomy pouch w/o ......... ......... ......... ........... ...........
barr.
A5053 A Clsd ostomy pouch ......... ......... ......... ........... ...........
faceplate.
A5054 A Clsd ostomy pouch w/ ......... ......... ......... ........... ...........
flange.
A5055 A Stoma cap.............. ......... ......... ......... ........... ...........
A5061 A Pouch drainable w ......... ......... ......... ........... ...........
barrier at.
A5062 A Drnble ostomy pouch w/o ......... ......... ......... ........... ...........
barr.
A5063 A Drain ostomy pouch w/ ......... ......... ......... ........... ...........
flange.
A5064 E Drain ostomy pouch w/ ......... ......... ......... ........... ...........
fceplte.
A5065 E Drain ostomy pouch on ......... ......... ......... ........... ...........
fcplte.
A5071 A Urinary pouch w/barrier ......... ......... ......... ........... ...........
A5072 A Urinary pouch w/o ......... ......... ......... ........... ...........
barrier.
A5073 A Urinary pouch on barr w/ ......... ......... ......... ........... ...........
flng.
A5074 E Urinary pouch w/ ......... ......... ......... ........... ...........
faceplate.
A5075 E Urinary pouch on ......... ......... ......... ........... ...........
faceplate.
A5081 A Continent stoma plug... ......... ......... ......... ........... ...........
A5082 A Continent stoma ......... ......... ......... ........... ...........
catheter.
A5093 A Ostomy accessory convex ......... ......... ......... ........... ...........
inse.
A5102 A Bedside drain btl w/wo ......... ......... ......... ........... ...........
tube.
A5105 A Urinary suspensory..... ......... ......... ......... ........... ...........
[[Page 35377]]
A5112 A Urinary leg bag........ ......... ......... ......... ........... ...........
A5113 A Latex leg strap........ ......... ......... ......... ........... ...........
A5114 A Foam/fabric leg strap.. ......... ......... ......... ........... ...........
A5119 A Skin barrier wipes box ......... ......... ......... ........... ...........
pr 50.
A5121 A Solid skin barrier 6x6. ......... ......... ......... ........... ...........
A5122 A Solid skin barrier 8x8. ......... ......... ......... ........... ...........
A5123 A Skin barrier with ......... ......... ......... ........... ...........
flange.
A5126 A Adhesive disc/foam pad. ......... ......... ......... ........... ...........
A5131 A Appliance cleaner...... ......... ......... ......... ........... ...........
A5149 A Incontinence/ostomy ......... ......... ......... ........... ...........
supply.
A5500 A Diab shoe for density ......... ......... ......... ........... ...........
insert.
A5501 A Diabetic custom molded ......... ......... ......... ........... ...........
shoe.
A5502 A Diabetic shoe density ......... ......... ......... ........... ...........
insert.
A5503 A Diabetic shoe w/roller/ ......... ......... ......... ........... ...........
rockr.
A5504 A Diabetic shoe with ......... ......... ......... ........... ...........
wedge.
A5505 A Diab shoe w/metatarsal ......... ......... ......... ........... ...........
bar.
A5506 A Diabetic shoe w/off set ......... ......... ......... ........... ...........
heel.
A5507 A Modification diabetic ......... ......... ......... ........... ...........
shoe.
A6020 A Collagen wound dressing ......... ......... ......... ........... ...........
A6025 E Silicone gel sheet, ......... ......... ......... ........... ...........
each.
A6154 A Wound pouch each....... ......... ......... ......... ........... ...........
A6196 A Alginate dressing <=16 ......... ......... ......... ........... ...........
sq in.
A6197 A Alginate drsg >16 <=48 ......... ......... ......... ........... ...........
sq in.
A6198 A alginate dressing > 48 ......... ......... ......... ........... ...........
sq in.
A6199 A Alginate drsg wound ......... ......... ......... ........... ...........
filler.
A6203 A Composite drsg <= 16 sq ......... ......... ......... ........... ...........
in.
A6204 A Composite drsg >16<=48 ......... ......... ......... ........... ...........
sq in.
A6205 A Composite drsg > 48 sq ......... ......... ......... ........... ...........
in.
A6206 A Contact layer <= 16 sq ......... ......... ......... ........... ...........
in.
A6207 A Contact layer >16<= 48 ......... ......... ......... ........... ...........
sq in.
A6208 A Contact layer > 48 sq ......... ......... ......... ........... ...........
in.
A6209 A Foam drsg <=16 sq in w/ ......... ......... ......... ........... ...........
o bdr.
A6210 A Foam drg >16<=48 sq in ......... ......... ......... ........... ...........
w/o b.
A6211 A Foam drg > 48 sq in w/o ......... ......... ......... ........... ...........
brdr.
A6212 A Foam drg <=16 sq in w/ ......... ......... ......... ........... ...........
border.
A6213 A Foam drg >16<=48 sq in ......... ......... ......... ........... ...........
w/bdr.
A6214 A Foam drg > 48 sq in w/ ......... ......... ......... ........... ...........
border.
A6215 A Foam dressing wound ......... ......... ......... ........... ...........
filler.
A6216 A Non-sterile gauze<=16 ......... ......... ......... ........... ...........
sq in.
A6217 A Non-sterile gauze ......... ......... ......... ........... ...........
>16<=48 sq.
A6218 A Non-sterile gauze > 48 ......... ......... ......... ........... ...........
sq in.
A6219 A Gauze <= 16 sq in w/ ......... ......... ......... ........... ...........
border.
A6220 A Gauze >16 <=48 sq in w/ ......... ......... ......... ........... ...........
bordr.
A6221 A Gauze > 48 sq in w/ ......... ......... ......... ........... ...........
border.
A6222 A Gauze <=16 in no w/sal ......... ......... ......... ........... ...........
w/o b.
A6223 A Gauze >16<=48 no w/sal ......... ......... ......... ........... ...........
w/o b.
A6224 A Gauze > 48 in no w/sal ......... ......... ......... ........... ...........
w/o b.
A6228 A Gauze <= 16 sq in water/ ......... ......... ......... ........... ...........
sal.
A6229 A Gauze >16<=48 sq in ......... ......... ......... ........... ...........
watr/sal.
A6230 A Gauze > 48 sq in water/ ......... ......... ......... ........... ...........
salne.
A6234 A Hydrocolld drg <=16 w/o ......... ......... ......... ........... ...........
bdr.
A6235 A Hydrocolld drg >16<=48 ......... ......... ......... ........... ...........
w/o b.
A6236 A Hydrocolld drg > 48 in ......... ......... ......... ........... ...........
w/o b.
A6237 A Hydrocolld drg <=16 in ......... ......... ......... ........... ...........
w/bdr.
A6238 A Hydrocolld drg >16<=48 ......... ......... ......... ........... ...........
w/bdr.
A6239 A Hydrocolld drg > 48 in ......... ......... ......... ........... ...........
w/bdr.
A6240 A Hydrocolld drg filler ......... ......... ......... ........... ...........
paste.
A6241 A Hydrocolloid drg filler ......... ......... ......... ........... ...........
dry.
A6242 A Hydrogel drg <=16 in w/ ......... ......... ......... ........... ...........
o bdr.
A6243 A Hydrogel drg >16<=48 w/ ......... ......... ......... ........... ...........
o bdr.
A6244 A Hydrogel drg >48 in w/o ......... ......... ......... ........... ...........
bdr.
A6245 A Hydrogel drg <= 16 in w/ ......... ......... ......... ........... ...........
bdr.
A6246 A Hydrogel drg >16<=48 in ......... ......... ......... ........... ...........
w/b.
A6247 A Hydrogel drg > 48 sq in ......... ......... ......... ........... ...........
w/b.
A6248 A Hydrogel drsg gel ......... ......... ......... ........... ...........
filler.
A6250 A Skin seal protect ......... ......... ......... ........... ...........
moisturizr.
A6251 A Absorpt drg <=16 sq in ......... ......... ......... ........... ...........
w/o b.
A6252 A Absorpt drg >16 <=48 w/ ......... ......... ......... ........... ...........
o bdr.
A6253 A Absorpt drg > 48 sq in ......... ......... ......... ........... ...........
w/o b.
A6254 A Absorpt drg <=16 sq in ......... ......... ......... ........... ...........
w/bdr.
A6255 A Absorpt drg >16<=48 in ......... ......... ......... ........... ...........
w/bdr.
A6256 A Absorpt drg > 48 sq in ......... ......... ......... ........... ...........
w/bdr.
A6257 A Transparent film <= 16 ......... ......... ......... ........... ...........
sq in.
A6258 A Transparent film ......... ......... ......... ........... ...........
>16<=48 in.
A6259 A Transparent film > 48 ......... ......... ......... ........... ...........
sq in.
[[Page 35378]]
A6260 A Wound cleanser any type/ ......... ......... ......... ........... ...........
size.
A6261 A Wound filler gel/paste / ......... ......... ......... ........... ...........
oz.
A6262 A Wound filler dry form / ......... ......... ......... ........... ...........
gram.
A6263 A Non-sterile elastic ......... ......... ......... ........... ...........
gauze/yd.
A6264 A Non-sterile no elastic ......... ......... ......... ........... ...........
gauze.
A6265 A Tape per 18 sq inches.. ......... ......... ......... ........... ...........
A6266 A Impreg gauze no h20/sal/ ......... ......... ......... ........... ...........
yard.
A6402 A Sterile gauze <= 16 sq ......... ......... ......... ........... ...........
in.
A6403 A Sterile gauze >16 <= 48 ......... ......... ......... ........... ...........
sq in.
A6404 A Sterile gauze > 48 sq ......... ......... ......... ........... ...........
in.
A6405 A Sterile elastic gauze / ......... ......... ......... ........... ...........
yd.
A6406 A Sterile non-elastic ......... ......... ......... ........... ...........
gauze/yd.
A9150 E Misc/exper non- ......... ......... ......... ........... ...........
prescript dru.
A9160 E Podiatrist non-covered ......... ......... ......... ........... ...........
servi.
A9170 E Chiropractor non- ......... ......... ......... ........... ...........
covered ser.
A9190 E Misc/expe personal ......... ......... ......... ........... ...........
comfort i.
A9270 E Non-covered item or ......... ......... ......... ........... ...........
service.
A9300 E Exercise equipment..... ......... ......... ......... ........... ...........
A9500 N Technetium TC 99m ......... ......... ......... ........... ...........
sestamibi.
A9502 N Technetium TC99M ......... ......... ......... ........... ...........
tetrofosmin.
A9503 N Technetium TC 99m ......... ......... ......... ........... ...........
medronate.
A9505 N Thallous chloride TL ......... ......... ......... ........... ...........
201/mci.
A9600 N Strontium-89 chloride.. ......... ......... ......... ........... ...........
B4034 A Enter feed supkit syr ......... ......... ......... ........... ...........
by day.
B4035 A Enteral feed supp pump ......... ......... ......... ........... ...........
per d.
B4036 A Enteral feed sup kit ......... ......... ......... ........... ...........
grav by.
B4081 A Enteral ng tubing w/ ......... ......... ......... ........... ...........
stylet.
B4082 A Enteral ng tubing w/o ......... ......... ......... ........... ...........
stylet.
B4083 A Enteral stomach tube ......... ......... ......... ........... ...........
levine.
B4084 A Gastrostomy/jejunostomy ......... ......... ......... ........... ...........
tubi.
B4085 A Gastrostomy tube w/ring ......... ......... ......... ........... ...........
each.
B4150 A Enteral formulae ......... ......... ......... ........... ...........
category i.
B4151 A Enteral formulae ......... ......... ......... ........... ...........
category i-.
B4152 A Enteral formulae ......... ......... ......... ........... ...........
category ii.
B4153 A Enteral formulae ......... ......... ......... ........... ...........
category ii.
B4154 A Enteral formulae ......... ......... ......... ........... ...........
category IV.
B4155 A Enteral formulae ......... ......... ......... ........... ...........
category v.
B4156 A Enteral formulae ......... ......... ......... ........... ...........
category vi.
B4164 A Parenteral 50% dextrose ......... ......... ......... ........... ...........
solu.
B4168 A Parenteral sol amino ......... ......... ......... ........... ...........
acid 3..
B4172 A Parenteral sol amino ......... ......... ......... ........... ...........
acid 5..
B4176 A Parenteral sol amino ......... ......... ......... ........... ...........
acid 7-.
B4178 A Parenteral sol amino ......... ......... ......... ........... ...........
acid >.
B4180 A Parenteral sol carb > ......... ......... ......... ........... ...........
50%.
B4184 A Parenteral sol lipids ......... ......... ......... ........... ...........
10%.
B4186 A Parenteral sol lipids ......... ......... ......... ........... ...........
20%.
B4189 A Parenteral sol amino ......... ......... ......... ........... ...........
acid &.
B4193 A Parenteral sol 52-73 gm ......... ......... ......... ........... ...........
prot.
B4197 A Parenteral sol 74-100 ......... ......... ......... ........... ...........
gm pro.
B4199 A Parenteral sol > 100gm ......... ......... ......... ........... ...........
prote.
B4216 A Parenteral nutrition ......... ......... ......... ........... ...........
additiv.
B4220 A Parenteral supply kit ......... ......... ......... ........... ...........
premix.
B4222 A Parenteral supply kit ......... ......... ......... ........... ...........
homemi.
B4224 A Parenteral ......... ......... ......... ........... ...........
administration ki.
B5000 A Parenteral sol renal- ......... ......... ......... ........... ...........
amirosy.
B5100 A Parenteral sol hepatic- ......... ......... ......... ........... ...........
fream.
B5200 A Parenteral sol stres- ......... ......... ......... ........... ...........
brnch c.
B9000 A Enter infusion pump w/o ......... ......... ......... ........... ...........
alrm.
B9002 A Enteral infusion pump w/ ......... ......... ......... ........... ...........
ala.
B9004 A Parenteral infus pump ......... ......... ......... ........... ...........
portab.
B9006 A Parenteral infus pump ......... ......... ......... ........... ...........
statio.
B9998 A Enteral supp not ......... ......... ......... ........... ...........
otherwise c.
B9999 A Parenteral supp not ......... ......... ......... ........... ...........
othrws c.
D0120 E Periodic oral ......... ......... ......... ........... ...........
evaluation.
D0140 E Limit oral eval problm ......... ......... ......... ........... ...........
focus.
D0150 S Comprehensve oral 031 1.37 $70.45 $14.09 $14.09
evaluation.
D0160 E Extensv oral eval prob ......... ......... ......... ........... ...........
focus.
D0210 E Intraor complete film ......... ......... ......... ........... ...........
series.
D0220 E Intraoral periapical ......... ......... ......... ........... ...........
first f.
D0230 E Intraoral periapical ea ......... ......... ......... ........... ...........
add.
D0240 S Intraoral occlusal film 031 1.37 $70.45 $14.09 $14.09
D0250 S Extraoral first film... 031 1.37 $70.45 $14.09 $14.09
D0260 S Extraoral ea additional 031 1.37 $70.45 $14.09 $14.09
film.
D0270 S Dental bitewing single 031 1.37 $70.45 $14.09 $14.09
film.
D0272 S Dental bitewings two 031 1.37 $70.45 $14.09 $14.09
films.
[[Page 35379]]
D0274 S Dental bitewings four 031 1.37 $70.45 $14.09 $14.09
films.
D0290 E Dental film skull/ ......... ......... ......... ........... ...........
facial bon.
D0310 E Dental saliography..... ......... ......... ......... ........... ...........
D0320 E Dental tmj arthrogram ......... ......... ......... ........... ...........
incl i.
D0321 E Dental other tmj films. ......... ......... ......... ........... ...........
D0322 E Dental tomographic ......... ......... ......... ........... ...........
survey.
D0330 E Dental panoramic film.. ......... ......... ......... ........... ...........
D0340 E Dental cephalometric ......... ......... ......... ........... ...........
film.
D0415 E Bacteriologic study.... ......... ......... ......... ........... ...........
D0425 E Caries susceptibility ......... ......... ......... ........... ...........
test.
D0460 S Pulp vitality test..... 031 1.37 $70.45 $14.09 $14.09
D0470 E Diagnostic casts....... ......... ......... ......... ........... ...........
D0471 S Diagnostic photographs. 031 1.37 $70.45 $14.09 $14.09
D0501 S Histopathologic 031 1.37 $70.45 $14.09 $14.09
examinations.
D0502 S Other oral pathology 031 1.37 $70.45 $14.09 $14.09
procedu.
D0999 S Unspecified diagnostic 031 1.37 $70.45 $14.09 $14.09
proce.
D1110 E Dental prophylaxis ......... ......... ......... ........... ...........
adult.
D1120 E Dental prophylaxis ......... ......... ......... ........... ...........
child.
D1201 E Topical fluor w prophy ......... ......... ......... ........... ...........
child.
D1203 E Topical fluor w/o ......... ......... ......... ........... ...........
prophy chi.
D1204 E Topical fluor w/o ......... ......... ......... ........... ...........
prophy adu.
D1205 E Topical fluoride w/ ......... ......... ......... ........... ...........
prophy a.
D1310 E Nutri counsel-control ......... ......... ......... ........... ...........
caries.
D1320 E Tobacco counseling..... ......... ......... ......... ........... ...........
D1330 E Oral hygiene ......... ......... ......... ........... ...........
instruction.
D1351 E Dental sealant per ......... ......... ......... ........... ...........
tooth.
D1510 S Space maintainer fxd 031 1.37 $70.45 $14.09 $14.09
unilat.
D1515 S Fixed bilat space 031 1.37 $70.45 $14.09 $14.09
maintainer.
D1520 S Remove unilat space 031 1.37 $70.45 $14.09 $14.09
maintain.
D1525 S Remove bilat space 031 1.37 $70.45 $14.09 $14.09
maintain.
D1550 S Recement space 031 1.37 $70.45 $14.09 $14.09
maintainer.
D2110 E Amalgam one surface ......... ......... ......... ........... ...........
primary.
D2120 E Amalgam two surfaces ......... ......... ......... ........... ...........
primary.
D2130 E Amalgam three surfaces ......... ......... ......... ........... ...........
prima.
D2131 E Amalgam four/more surf ......... ......... ......... ........... ...........
prima.
D2140 E Amalgam one surface ......... ......... ......... ........... ...........
permanen.
D2150 E Amalgam two surfaces ......... ......... ......... ........... ...........
permane.
D2160 E Amalgam three surfaces ......... ......... ......... ........... ...........
perma.
D2161 E Amalgam 4 or > surfaces ......... ......... ......... ........... ...........
perm.
D2210 E Slcate cement per ......... ......... ......... ........... ...........
restorat.
D2330 E Resin one surface- ......... ......... ......... ........... ...........
anterior.
D2331 E Resin two surfaces- ......... ......... ......... ........... ...........
anterior.
D2332 E Resin three surfaces- ......... ......... ......... ........... ...........
anterio.
D2335 E Resin 4/> surf or w ......... ......... ......... ........... ...........
incis an.
D2336 E Composite resin crown.. ......... ......... ......... ........... ...........
D2380 E Resin one surf poster ......... ......... ......... ........... ...........
primar.
D2381 E Resin two surf poster ......... ......... ......... ........... ...........
primar.
D2382 E Resin three/more surf ......... ......... ......... ........... ...........
post p.
D2385 E Resin one surf poster ......... ......... ......... ........... ...........
perman.
D2386 E Resin two surf poster ......... ......... ......... ........... ...........
perman.
D2387 E Resin three/more surf ......... ......... ......... ........... ...........
post p.
D2410 E Dental gold foil one ......... ......... ......... ........... ...........
surface.
D2420 E Dental gold foil two ......... ......... ......... ........... ...........
surface.
D2430 E Dental gold foil three ......... ......... ......... ........... ...........
surfa.
D2510 E Dental inlay metalic 1 ......... ......... ......... ........... ...........
surf.
D2520 E Dental inlay metallic 2 ......... ......... ......... ........... ...........
surf.
D2530 E Dental inlay metl 3/ ......... ......... ......... ........... ...........
more sur.
D2543 E Dental onlay metallic 3 ......... ......... ......... ........... ...........
surf.
D2544 E Dental onlay metl 4/ ......... ......... ......... ........... ...........
more sur.
D2610 E Inlay porcelain/ceramic ......... ......... ......... ........... ...........
1 su.
D2620 E Inlay porcelain/ceramic ......... ......... ......... ........... ...........
2 su.
D2630 E Dental onlay porc 3/ ......... ......... ......... ........... ...........
more sur.
D2642 E Dental onlay porcelin 2 ......... ......... ......... ........... ...........
surf.
D2643 E Dental onlay porcelin 3 ......... ......... ......... ........... ...........
surf.
D2644 E Dental onlay porc 4/ ......... ......... ......... ........... ...........
more sur.
D2650 E Inlay composite/resin ......... ......... ......... ........... ...........
one su.
D2651 E Inlay composite/resin ......... ......... ......... ........... ...........
two su.
D2652 E Dental inlay resin 3/ ......... ......... ......... ........... ...........
mre sur.
D2662 E Dental onlay resin 2 ......... ......... ......... ........... ...........
surface.
D2663 E Dental onlay resin 3 ......... ......... ......... ........... ...........
surface.
D2664 E Dental onlay resin 4/ ......... ......... ......... ........... ...........
mre sur.
D2710 E Crown resin laboratory. ......... ......... ......... ........... ...........
D2720 E Crown resin w/ high ......... ......... ......... ........... ...........
noble me.
D2721 E Crown resin w/ base ......... ......... ......... ........... ...........
metal.
D2722 E Crown resin w/ noble ......... ......... ......... ........... ...........
metal.
[[Page 35380]]
D2740 E Crown porcelain/ceramic ......... ......... ......... ........... ...........
subs.
D2750 E Crown porcelain w/ h ......... ......... ......... ........... ...........
noble m.
D2751 E Crown porcelain fused ......... ......... ......... ........... ...........
base m.
D2752 E Crown porcelain w/ ......... ......... ......... ........... ...........
noble met.
D2790 E Crown full cast high ......... ......... ......... ........... ...........
noble m.
D2791 E Crown full cast base ......... ......... ......... ........... ...........
metal.
D2792 E Crown full cast noble ......... ......... ......... ........... ...........
metal.
D2810 E Crown 3/4 cast metallic ......... ......... ......... ........... ...........
D2910 E Dental recement inlay.. ......... ......... ......... ........... ...........
D2920 E Dental recement crown.. ......... ......... ......... ........... ...........
D2930 E Prefab stnlss steel ......... ......... ......... ........... ...........
crwn pri.
D2931 E Prefab stnlss steel ......... ......... ......... ........... ...........
crown pe.
D2932 E Prefabricated resin ......... ......... ......... ........... ...........
crown.
D2933 E Prefab stainless steel ......... ......... ......... ........... ...........
crown.
D2940 E Dental sedative filling ......... ......... ......... ........... ...........
D2950 E Core build-up incl any ......... ......... ......... ........... ...........
pins.
D2951 E Tooth pin retention.... ......... ......... ......... ........... ...........
D2952 E Post and core cast + ......... ......... ......... ........... ...........
crown.
D2954 E Prefab post/core + ......... ......... ......... ........... ...........
crown.
D2955 E Post removal........... ......... ......... ......... ........... ...........
D2960 E Laminate labial veneer. ......... ......... ......... ........... ...........
D2961 E Lab labial veneer resin ......... ......... ......... ........... ...........
D2962 E Lab labial veneer ......... ......... ......... ........... ...........
porcelain.
D2970 S Temporary- fractured 031 1.37 $70.45 $14.09 $14.09
tooth.
D2980 E Crown repair........... ......... ......... ......... ........... ...........
D2999 S Dental unspec 031 1.37 $70.45 $14.09 $14.09
restorative pr.
D3110 E Pulp cap direct........ ......... ......... ......... ........... ...........
D3120 E Pulp cap indirect...... ......... ......... ......... ........... ...........
D3220 E Therapeutic pulpotomy.. ......... ......... ......... ........... ...........
D3230 E Pulpal therapy anterior ......... ......... ......... ........... ...........
prim.
D3240 E Pulpal therapy ......... ......... ......... ........... ...........
posterior pri.
D3310 E Anterior............... ......... ......... ......... ........... ...........
D3320 E Root canal therapy 2 ......... ......... ......... ........... ...........
canals.
D3330 E Root canal therapy 3 ......... ......... ......... ........... ...........
canals.
D3346 E Retreat root canal ......... ......... ......... ........... ...........
anterior.
D3347 E Retreat root canal ......... ......... ......... ........... ...........
bicuspid.
D3348 E Retreat root canal ......... ......... ......... ........... ...........
molar.
D3351 E Apexification/recalc ......... ......... ......... ........... ...........
initial.
D3352 E Apexification/recalc ......... ......... ......... ........... ...........
interim.
D3353 E Apexification/recalc ......... ......... ......... ........... ...........
final.
D3410 E Apicoect/perirad surg ......... ......... ......... ........... ...........
anter.
D3421 E Root surgery bicuspid.. ......... ......... ......... ........... ...........
D3425 E Root surgery molar..... ......... ......... ......... ........... ...........
D3426 E Root surgery ea add ......... ......... ......... ........... ...........
root.
D3430 E Retrograde filling..... ......... ......... ......... ........... ...........
D3450 E Root amputation........ ......... ......... ......... ........... ...........
D3460 S Endodontic endosseous 031 1.37 $70.45 $14.09 $14.09
implan.
D3470 E Intentional ......... ......... ......... ........... ...........
replantation.
D3910 E Isolation- tooth w rubb ......... ......... ......... ........... ...........
dam.
D3920 E Tooth splitting........ ......... ......... ......... ........... ...........
D3950 E Canal prep/fitting of ......... ......... ......... ........... ...........
dowel.
D3960 E Bleaching of discolored ......... ......... ......... ........... ...........
toot.
D3999 S Endodontic procedure... 031 1.37 $70.45 $14.09 $14.09
D4210 E Gingivectomy/plasty per ......... ......... ......... ........... ...........
quad.
D4211 E Gingivectomy/plasty per ......... ......... ......... ........... ...........
toot.
D4220 E Gingival curettage per ......... ......... ......... ........... ...........
quadr.
D4240 E Gingival flap proc w/ ......... ......... ......... ........... ...........
planin.
D4249 E Crown lengthen hard ......... ......... ......... ........... ...........
tissue.
D4250 S Mucogingival surg per 031 1.37 $70.45 $14.09 $14.09
quadra.
D4260 S Osseous surgery per 031 1.37 $70.45 $14.09 $14.09
quadrant.
D4263 S Bone replce graft first 031 1.37 $70.45 $14.09 $14.09
site.
D4264 S Bone replce graft each 031 1.37 $70.45 $14.09 $14.09
add.
D4266 E Guided tiss regen ......... ......... ......... ........... ...........
resorble.
D4267 E Guided tiss regen ......... ......... ......... ........... ...........
nonresorb.
D4270 S Pedicle soft tissue 031 1.37 $70.45 $14.09 $14.09
graft pr.
D4271 S Free soft tissue graft 031 1.37 $70.45 $14.09 $14.09
proc.
D4273 S Subepithelial tissue 031 1.37 $70.45 $14.09 $14.09
graft.
D4274 E Distal/proximal wedge ......... ......... ......... ........... ...........
proc.
D4320 E Provision splnt ......... ......... ......... ........... ...........
intracoronal.
D4321 E Provisional splint ......... ......... ......... ........... ...........
extracoro.
D4341 E Periodontal scaling & ......... ......... ......... ........... ...........
root.
D4355 S Full mouth debridement. 031 1.37 $70.45 $14.09 $14.09
D4381 S Localized chemo 031 1.37 $70.45 $14.09 $14.09
delivery.
D4910 E Periodontal maint ......... ......... ......... ........... ...........
procedures.
D4920 E Unscheduled dressing ......... ......... ......... ........... ...........
change.
[[Page 35381]]
D4999 E Unspecified periodontal ......... ......... ......... ........... ...........
proc.
D5110 E Dentures complete ......... ......... ......... ........... ...........
maxillary.
D5120 E Dentures complete ......... ......... ......... ........... ...........
mandible.
D5130 E Dentures immediat ......... ......... ......... ........... ...........
maxillary.
D5140 E Dentures immediat ......... ......... ......... ........... ...........
mandible.
D5211 E Dentures maxill part ......... ......... ......... ........... ...........
resin.
D5212 E Dentures mand part ......... ......... ......... ........... ...........
resin.
D5213 E Dentures maxill part ......... ......... ......... ........... ...........
metal.
D5214 E Dentures mandibl part ......... ......... ......... ........... ...........
metal.
D5281 E Removable partial ......... ......... ......... ........... ...........
denture.
D5410 E Dentures adjust cmplt ......... ......... ......... ........... ...........
maxil.
D5411 E Dentures adjust cmplt ......... ......... ......... ........... ...........
mand.
D5421 E Dentures adjust part ......... ......... ......... ........... ...........
maxill.
D5422 E Dentures adjust part ......... ......... ......... ........... ...........
mandbl.
D5510 E Dentur repr broken ......... ......... ......... ........... ...........
compl bas.
D5520 E Replace denture teeth ......... ......... ......... ........... ...........
complt.
D5610 E Dentures repair resin ......... ......... ......... ........... ...........
base.
D5620 E Rep part denture cast ......... ......... ......... ........... ...........
frame.
D5630 E Rep partial denture ......... ......... ......... ........... ...........
clasp.
D5640 E Replace part denture ......... ......... ......... ........... ...........
teeth.
D5650 E Add tooth to partial ......... ......... ......... ........... ...........
denture.
D5660 E Add clasp to partial ......... ......... ......... ........... ...........
denture.
D5710 E Dentures rebase cmplt ......... ......... ......... ........... ...........
maxil.
D5711 E Dentures rebase cmplt ......... ......... ......... ........... ...........
mand.
D5720 E Dentures rebase part ......... ......... ......... ........... ...........
maxill.
D5721 E Dentures rebase part ......... ......... ......... ........... ...........
mandbl.
D5730 E Denture reln cmplt ......... ......... ......... ........... ...........
maxil ch.
D5731 E Denture reln cmplt mand ......... ......... ......... ........... ...........
chr.
D5740 E Denture reln part maxil ......... ......... ......... ........... ...........
chr.
D5741 E Denture reln part mand ......... ......... ......... ........... ...........
chr.
D5750 E Denture reln cmplt max ......... ......... ......... ........... ...........
lab.
D5751 E Denture reln cmplt mand ......... ......... ......... ........... ...........
lab.
D5760 E Denture reln part maxil ......... ......... ......... ........... ...........
lab.
D5761 E Denture reln part mand ......... ......... ......... ........... ...........
lab.
D5810 E Denture interm cmplt ......... ......... ......... ........... ...........
maxill.
D5811 E Denture interm cmplt ......... ......... ......... ........... ...........
mandbl.
D5820 E Denture interm part ......... ......... ......... ........... ...........
maxill.
D5821 E Denture interm part ......... ......... ......... ........... ...........
mandbl.
D5850 E Denture tiss conditn ......... ......... ......... ........... ...........
maxill.
D5851 E Denture tiss condtin ......... ......... ......... ........... ...........
mandbl.
D5860 E Overdenture complete... ......... ......... ......... ........... ...........
D5861 E Overdenture partial.... ......... ......... ......... ........... ...........
D5862 E Precision attachment... ......... ......... ......... ........... ...........
D5899 E Removable prosthodontic ......... ......... ......... ........... ...........
proc.
D5911 S Facial moulage 031 1.37 $70.45 $14.09 $14.09
sectional.
D5912 S Facial moulage complete 031 1.37 $70.45 $14.09 $14.09
D5913 E Nasal prosthesis....... ......... ......... ......... ........... ...........
D5914 E Auricular prosthesis... ......... ......... ......... ........... ...........
D5915 E Orbital prosthesis..... ......... ......... ......... ........... ...........
D5916 E Ocular prosthesis...... ......... ......... ......... ........... ...........
D5919 E Facial prosthesis...... ......... ......... ......... ........... ...........
D5922 E Nasal septal prosthesis ......... ......... ......... ........... ...........
D5923 E Ocular prosthesis ......... ......... ......... ........... ...........
interim.
D5924 E Cranial prosthesis..... ......... ......... ......... ........... ...........
D5925 E Facial augmentation ......... ......... ......... ........... ...........
implant.
D5926 E Replacement nasal ......... ......... ......... ........... ...........
prosthesis.
D5927 E Auricular replacement.. ......... ......... ......... ........... ...........
D5928 E Orbital replacement.... ......... ......... ......... ........... ...........
D5929 E Facial replacement..... ......... ......... ......... ........... ...........
D5931 E Surgical obturator..... ......... ......... ......... ........... ...........
D5932 E Postsurgical obturator. ......... ......... ......... ........... ...........
D5933 E Refitting of obturator. ......... ......... ......... ........... ...........
D5934 E Mandibular flange ......... ......... ......... ........... ...........
prosthesis.
D5935 E Mandibular denture ......... ......... ......... ........... ...........
prosth.
D5936 E Temp obturator ......... ......... ......... ........... ...........
prosthesis.
D5937 E Trismus appliance...... ......... ......... ......... ........... ...........
D5951 E Feeding aid............ ......... ......... ......... ........... ...........
D5952 E Pediatric speech aid... ......... ......... ......... ........... ...........
D5953 E Adult speech aid....... ......... ......... ......... ........... ...........
D5954 E Superimposed prosthesis ......... ......... ......... ........... ...........
D5955 E Palatal lift prosthesis ......... ......... ......... ........... ...........
D5958 E Intraoral con def inter ......... ......... ......... ........... ...........
plt.
D5959 E Intraoral con def mod ......... ......... ......... ........... ...........
palat.
D5960 E Modify speech aid ......... ......... ......... ........... ...........
prosthesis.
D5982 E Surgical stent......... ......... ......... ......... ........... ...........
[[Page 35382]]
D5983 S Radiation applicator... 031 1.37 $70.45 $14.09 $14.09
D5984 S Radiation shield....... 031 1.37 $70.45 $14.09 $14.09
D5985 S Radiation cone locator. 031 1.37 $70.45 $14.09 $14.09
D5986 E Fluoride applicator.... ......... ......... ......... ........... ...........
D5987 S Commissure splint...... 031 1.37 $70.45 $14.09 $14.09
D5988 E Surgical splint........ ......... ......... ......... ........... ...........
D5999 E Maxillofacial ......... ......... ......... ........... ...........
prosthesis.
D6010 E Odontics endosteal ......... ......... ......... ........... ...........
implant.
D6020 E Odontics abutment ......... ......... ......... ........... ...........
placement.
D6040 E Odontics eposteal ......... ......... ......... ........... ...........
implant.
D6050 E Odontics transosteal ......... ......... ......... ........... ...........
implnt.
D6055 E Implant connecting bar. ......... ......... ......... ........... ...........
D6080 E Implant maintenance.... ......... ......... ......... ........... ...........
D6090 E Repair implant......... ......... ......... ......... ........... ...........
D6095 E Odontics repr abutment. ......... ......... ......... ........... ...........
D6100 E Removal of implant..... ......... ......... ......... ........... ...........
D6199 E Implant procedure...... ......... ......... ......... ........... ...........
D6210 E Prosthodont high noble ......... ......... ......... ........... ...........
metal.
D6211 E Bridge base metal cast. ......... ......... ......... ........... ...........
D6212 E Bridge noble metal cast ......... ......... ......... ........... ...........
D6240 E Bridge porcelain high ......... ......... ......... ........... ...........
noble.
D6241 E Bridge porcelain base ......... ......... ......... ........... ...........
metal.
D6242 E Bridge porcelain nobel ......... ......... ......... ........... ...........
metal.
D6250 E Bridge resin w/high ......... ......... ......... ........... ...........
noble.
D6251 E Bridge resin base metal ......... ......... ......... ........... ...........
D6252 E Bridge resin w/noble ......... ......... ......... ........... ...........
metal.
D6520 E Dental retainer two ......... ......... ......... ........... ...........
surfaces.
D6530 E Retainer metallic 3+ ......... ......... ......... ........... ...........
surface.
D6543 E Dental retainr onlay 3 ......... ......... ......... ........... ...........
surf.
D6544 E Dental retainr onlay 4/ ......... ......... ......... ........... ...........
more.
D6545 E Dental retainr cast ......... ......... ......... ........... ...........
metl.
D6720 E Retain crown resin w hi ......... ......... ......... ........... ...........
nble.
D6721 E Crown resin w/base ......... ......... ......... ........... ...........
metal.
D6722 E Crown resin w/noble ......... ......... ......... ........... ...........
metal.
D6750 E Crown porcelain high ......... ......... ......... ........... ...........
noble.
D6751 E Crown porcelain base ......... ......... ......... ........... ...........
metal.
D6752 E Crown porcelain noble ......... ......... ......... ........... ...........
metal.
D6780 E Crown 3/4 high noble ......... ......... ......... ........... ...........
metal.
D6790 E Crown full high noble ......... ......... ......... ........... ...........
metal.
D6791 E Crown full base metal ......... ......... ......... ........... ...........
cast.
D6792 E Crown full noble metal ......... ......... ......... ........... ...........
cast.
D6920 S Dental connector bar... 031 1.37 $70.45 $14.09 $14.09
D6930 E Dental recement bridge. ......... ......... ......... ........... ...........
D6940 E Stress breaker......... ......... ......... ......... ........... ...........
D6950 E Precision attachment... ......... ......... ......... ........... ...........
D6970 E Post & core plus ......... ......... ......... ........... ...........
retainer.
D6971 E Cast post bridge ......... ......... ......... ........... ...........
retainer.
D6972 E Prefab post & core plus ......... ......... ......... ........... ...........
reta.
D6973 E Core build up for ......... ......... ......... ........... ...........
retainer.
D6975 E Coping metal........... ......... ......... ......... ........... ...........
D6980 E Bridge repair.......... ......... ......... ......... ........... ...........
D6999 E Fixed prosthodontic ......... ......... ......... ........... ...........
proc.
D7110 S Oral surgery single 031 1.37 $70.45 $14.09 $14.09
tooth.
D7120 S Each add tooth 031 1.37 $70.45 $14.09 $14.09
extraction.
D7130 S Tooth root removal..... 031 1.37 $70.45 $14.09 $14.09
D7210 S Rem imp tooth w mucoper 031 1.37 $70.45 $14.09 $14.09
flp.
D7220 S Impact tooth remov soft 031 1.37 $70.45 $14.09 $14.09
tiss.
D7230 S Impact tooth remov part 031 1.37 $70.45 $14.09 $14.09
bony.
D7240 S Impact tooth remov comp 031 1.37 $70.45 $14.09 $14.09
bony.
D7241 S Impact tooth rem bony w/ 031 1.37 $70.45 $14.09 $14.09
comp.
D7250 S Tooth root removal..... 031 1.37 $70.45 $14.09 $14.09
D7260 S Oral antral fistula 031 1.37 $70.45 $14.09 $14.09
closure.
D7270 E Tooth reimplantation... ......... ......... ......... ........... ...........
D7272 E Tooth transplantation.. ......... ......... ......... ........... ...........
D7280 E Exposure impact tooth ......... ......... ......... ........... ...........
orthod.
D7281 E Exposure tooth aid ......... ......... ......... ........... ...........
eruption.
D7285 E Biopsy of oral tissue ......... ......... ......... ........... ...........
hard.
D7286 E Biopsy of oral tissue ......... ......... ......... ........... ...........
soft.
D7290 E Repositioning of teeth. ......... ......... ......... ........... ...........
D7291 S Transseptal fiberotomy. 031 1.37 $70.45 $14.09 $14.09
D7310 E Alveoplasty w/ ......... ......... ......... ........... ...........
extraction.
D7320 E Alveoplasty w/o ......... ......... ......... ........... ...........
extraction.
D7340 E Vestibuloplasty ridge ......... ......... ......... ........... ...........
extens.
D7350 E Vestibuloplasty exten ......... ......... ......... ........... ...........
graft.
D7410 E Rad exc lesion up to ......... ......... ......... ........... ...........
1.25 cm.
[[Page 35383]]
D7420 E Lesion > 1.25 cm....... ......... ......... ......... ........... ...........
D7430 E Exc benign tumor to ......... ......... ......... ........... ...........
1.25 cm.
D7431 E Benign tumor exc > 1.25 ......... ......... ......... ........... ...........
cm.
D7440 E Malig tumor exc to 1.25 ......... ......... ......... ........... ...........
cm.
D7441 E Malig tumor > 1.25 cm.. ......... ......... ......... ........... ...........
D7450 E Rem odontogen cyst to ......... ......... ......... ........... ...........
1.25cm.
D7451 E Rem odontogen cyst > ......... ......... ......... ........... ...........
1.25 cm.
D7460 E Rem nonodonto cyst to ......... ......... ......... ........... ...........
1.25cm.
D7461 E Rem nonodonto cyst > ......... ......... ......... ........... ...........
1.25 cm.
D7465 E Lesion destruction..... ......... ......... ......... ........... ...........
D7470 E Rem exostosis maxilla/ ......... ......... ......... ........... ...........
mandib.
D7480 E Partial ostectomy...... ......... ......... ......... ........... ...........
D7490 E Mandible resection..... ......... ......... ......... ........... ...........
D7510 E I&d absc intraoral soft ......... ......... ......... ........... ...........
tiss.
D7520 E I&d abscess extraoral.. ......... ......... ......... ........... ...........
D7530 E Removal fb skin/areolar ......... ......... ......... ........... ...........
tiss.
D7540 E Removal of fb reaction. ......... ......... ......... ........... ...........
D7550 E Removal of sloughed off ......... ......... ......... ........... ...........
bone.
D7560 E Maxillary sinusotomy... ......... ......... ......... ........... ...........
D7610 E Maxilla open reduct ......... ......... ......... ........... ...........
simple.
D7620 E Clsd reduct simpl ......... ......... ......... ........... ...........
maxilla fx.
D7630 E Open red simpl mandible ......... ......... ......... ........... ...........
fx.
D7640 E Clsd red simpl mandible ......... ......... ......... ........... ...........
fx.
D7650 E Open red simp malar/ ......... ......... ......... ........... ...........
zygom fx.
D7660 E Clsd red simp malar/ ......... ......... ......... ........... ...........
zygom fx.
D7670 E Open red simple ......... ......... ......... ........... ...........
alveolus fx.
D7680 E Reduct simple facial ......... ......... ......... ........... ...........
bone fx.
D7710 E Maxilla open reduct ......... ......... ......... ........... ...........
compound.
D7720 E Clsd reduct compd ......... ......... ......... ........... ...........
maxilla fx.
D7730 E Open reduct compd ......... ......... ......... ........... ...........
mandble fx.
D7740 E Clsd reduct compd ......... ......... ......... ........... ...........
mandble fx.
D7750 E Open red comp malar/ ......... ......... ......... ........... ...........
zygma fx.
D7760 E Clsd red comp malar/ ......... ......... ......... ........... ...........
zygma fx.
D7770 E Open reduc compd ......... ......... ......... ........... ...........
alveolus fx.
D7780 E Reduct compnd facial ......... ......... ......... ........... ...........
bone fx.
D7810 E Tmj open reduct- ......... ......... ......... ........... ...........
dislocation.
D7820 E Closed tmp manipulation ......... ......... ......... ........... ...........
D7830 E Tmj manipulation under ......... ......... ......... ........... ...........
anest.
D7840 E Removal of tmj condyle. ......... ......... ......... ........... ...........
D7850 E Tmj meniscectomy....... ......... ......... ......... ........... ...........
D7852 E Tmj repair of joint ......... ......... ......... ........... ...........
disc.
D7854 E Tmj excisn of joint ......... ......... ......... ........... ...........
membrane.
D7856 E Tmj cutting of a muscle ......... ......... ......... ........... ...........
D7858 E Tmj reconstruction..... ......... ......... ......... ........... ...........
D7860 E Tmj cutting into joint. ......... ......... ......... ........... ...........
D7865 E Tmj reshaping ......... ......... ......... ........... ...........
components.
D7870 E Tmj aspiration joint ......... ......... ......... ........... ...........
fluid.
D7872 E Tmj diagnostic ......... ......... ......... ........... ...........
arthroscopy.
D7873 E Tmj arthroscopy lysis ......... ......... ......... ........... ...........
adhesn.
D7874 E Tmj arthroscopy disc ......... ......... ......... ........... ...........
reposit.
D7875 E Tmj arthroscopy ......... ......... ......... ........... ...........
synovectomy.
D7876 E Tmj arthroscopy ......... ......... ......... ........... ...........
discectomy.
D7877 E Tmj arthroscopy ......... ......... ......... ........... ...........
debridement.
D7880 E Occlusal orthotic ......... ......... ......... ........... ...........
appliance.
D7899 E Tmj unspecified therapy ......... ......... ......... ........... ...........
D7910 E Dent sutur recent wnd ......... ......... ......... ........... ...........
to 5cm.
D7911 E Dental suture wound to ......... ......... ......... ........... ...........
5 cm.
D7912 E Suture complicate wnd > ......... ......... ......... ........... ...........
5 cm.
D7920 E Dental skin graft...... ......... ......... ......... ........... ...........
D7940 S Reshaping bone 031 1.37 $70.45 $14.09 $14.09
orthognathic.
D7941 E Bone cutting ramus ......... ......... ......... ........... ...........
closed.
D7942 E Bone cutting ramus open ......... ......... ......... ........... ...........
D7943 E Cutting ramus open w/ ......... ......... ......... ........... ...........
graft.
D7944 E Bone cutting segmented. ......... ......... ......... ........... ...........
D7945 E Bone cutting body ......... ......... ......... ........... ...........
mandible.
D7946 E Reconstruction maxilla ......... ......... ......... ........... ...........
total.
D7947 E Reconstruct maxilla ......... ......... ......... ........... ...........
segment.
D7948 E Reconstruct midface no ......... ......... ......... ........... ...........
graft.
D7949 E Reconstruct midface w/ ......... ......... ......... ........... ...........
graft.
D7950 E Mandible graft......... ......... ......... ......... ........... ...........
D7955 E Repair maxillofacial ......... ......... ......... ........... ...........
defects.
D7960 E Frenulectomy/ ......... ......... ......... ........... ...........
frenulotomy.
D7970 E Excision hyperplastic ......... ......... ......... ........... ...........
tissue.
D7971 E Excision pericoronal ......... ......... ......... ........... ...........
gingiva.
D7980 E Sialolithotomy......... ......... ......... ......... ........... ...........
[[Page 35384]]
D7981 E Excision of salivary ......... ......... ......... ........... ...........
gland.
D7982 E Sialodochoplasty....... ......... ......... ......... ........... ...........
D7983 E Closure of salivary ......... ......... ......... ........... ...........
fistula.
D7990 E Emergency tracheotomy.. ......... ......... ......... ........... ...........
D7991 E Dental coronoidectomy.. ......... ......... ......... ........... ...........
D7995 E Synthetic graft facial ......... ......... ......... ........... ...........
bones.
D7996 E Implant mandible for ......... ......... ......... ........... ...........
augment.
D7999 E Oral surgery procedure. ......... ......... ......... ........... ...........
D8010 E Limited dental tx ......... ......... ......... ........... ...........
primary.
D8020 E Limited dental tx ......... ......... ......... ........... ...........
transition.
D8030 E Limited dental tx ......... ......... ......... ........... ...........
adolescent.
D8040 E Limited dental tx adult ......... ......... ......... ........... ...........
D8050 E Intercep dental tx ......... ......... ......... ........... ...........
primary.
D8060 E Intercep dental tx ......... ......... ......... ........... ...........
transitn.
D8070 E Compre dental tx ......... ......... ......... ........... ...........
transition.
D8080 E Compre dental tx ......... ......... ......... ........... ...........
adolescent.
D8090 E Compre dental tx adult. ......... ......... ......... ........... ...........
D8210 E Orthodontic rem ......... ......... ......... ........... ...........
appliance tx.
D8220 E Fixed appliance therapy ......... ......... ......... ........... ...........
habt.
D8660 E Preorthodontic tx visit ......... ......... ......... ........... ...........
D8670 E Periodic orthodontc tx ......... ......... ......... ........... ...........
visit.
D8680 E Orthodontic retention.. ......... ......... ......... ........... ...........
D8690 E Orthodontic treatment.. ......... ......... ......... ........... ...........
D8999 E Orthodontic procedure.. ......... ......... ......... ........... ...........
D9110 N Tx dental pain minor ......... ......... ......... ........... ...........
proc.
D9210 E Dent anesthesia w/o ......... ......... ......... ........... ...........
surgery.
D9211 E Regional block ......... ......... ......... ........... ...........
anesthesia.
D9212 E Trigeminal block ......... ......... ......... ........... ...........
anesthesia.
D9215 E Local anesthesia....... ......... ......... ......... ........... ...........
D9220 E General anesthesia..... ......... ......... ......... ........... ...........
D9221 E General anesthesia ea ......... ......... ......... ........... ...........
ad 15m.
D9230 N Analgesia.............. ......... ......... ......... ........... ...........
D9240 E Intravenous sedation... ......... ......... ......... ........... ...........
D9310 E Dental consultation.... ......... ......... ......... ........... ...........
D9410 E Dental house call...... ......... ......... ......... ........... ...........
D9420 E Hospital call.......... ......... ......... ......... ........... ...........
D9430 E Office visit during ......... ......... ......... ........... ...........
hours.
D9440 E Office visit after ......... ......... ......... ........... ...........
hours.
D9610 E Dent therapeutic drug ......... ......... ......... ........... ...........
inject.
D9630 S Other drugs/medicaments 031 1.37 $70.45 $14.09 $14.09
D9910 E Dent appl desensitizing ......... ......... ......... ........... ...........
med.
D9920 E Behavior management.... ......... ......... ......... ........... ...........
D9930 S Treatment of 031 1.37 $70.45 $14.09 $14.09
complications.
D9940 S Dental occlusal guard.. 031 1.37 $70.45 $14.09 $14.09
D9941 E Fabrication athletic ......... ......... ......... ........... ...........
guard.
D9950 S Occlusion analysis..... 031 1.37 $70.45 $14.09 $14.09
D9951 S Limited occlusal 031 1.37 $70.45 $14.09 $14.09
adjustment.
D9952 S Complete occlusal 031 1.37 $70.45 $14.09 $14.09
adjustment.
D9970 E Enamel microabrasion... ......... ......... ......... ........... ...........
D9999 E Adjunctive procedure... ......... ......... ......... ........... ...........
E0100 A Cane adjust/fixed with ......... ......... ......... ........... ...........
tip.
E0105 A Cane adjust/fixed quad/ ......... ......... ......... ........... ...........
3 pro.
E0110 A Crutch forearm pair.... ......... ......... ......... ........... ...........
E0111 A Crutch forearm each.... ......... ......... ......... ........... ...........
E0112 A Crutch underarm pair ......... ......... ......... ........... ...........
wood.
E0113 A Crutch underarm each ......... ......... ......... ........... ...........
wood.
E0114 A Crutch underarm pair no ......... ......... ......... ........... ...........
wood.
E0116 A Crutch underarm each no ......... ......... ......... ........... ...........
wood.
E0130 A Walker rigid adjust/ ......... ......... ......... ........... ...........
fixed ht.
E0135 A Walker folding adjust/ ......... ......... ......... ........... ...........
fixed.
E0141 A Rigid walker wheeled wo ......... ......... ......... ........... ...........
seat.
E0142 A Walker rigid wheeled ......... ......... ......... ........... ...........
with se.
E0143 A Walker folding wheeled ......... ......... ......... ........... ...........
w/o s.
E0145 A Walker whled seat/ ......... ......... ......... ........... ...........
crutch att.
E0146 A Folding walker wheels w ......... ......... ......... ........... ...........
seat.
E0147 A Walker variable wheel ......... ......... ......... ........... ...........
resist.
E0153 A Forearm crutch platform ......... ......... ......... ........... ...........
atta.
E0154 A Walker platform ......... ......... ......... ........... ...........
attachment.
E0155 A Walker rigd pick-up/ ......... ......... ......... ........... ...........
wheel at.
E0156 A Walker seat attachment. ......... ......... ......... ........... ...........
E0157 A Walker crutch ......... ......... ......... ........... ...........
attachment.
E0158 A Walker leg extensions.. ......... ......... ......... ........... ...........
E0159 A Brake for wheeled ......... ......... ......... ........... ...........
walker.
E0160 A Sitz type bath or ......... ......... ......... ........... ...........
equipment.
E0161 A Sitz bath/equipment w/ ......... ......... ......... ........... ...........
faucet.
[[Page 35385]]
E0162 A Sitz bath chair........ ......... ......... ......... ........... ...........
E0163 A Commode chair stationry ......... ......... ......... ........... ...........
fxd.
E0164 A Commode chair mobile ......... ......... ......... ........... ...........
fixed a.
E0165 A Commode chair stationry ......... ......... ......... ........... ...........
det.
E0166 A Commode chair mobile ......... ......... ......... ........... ...........
detach.
E0167 A Commode chair pail or ......... ......... ......... ........... ...........
pan.
E0175 A Commode chair foot rest ......... ......... ......... ........... ...........
E0176 A Air pressre pad/cushion ......... ......... ......... ........... ...........
nonp.
E0177 A Water press pad/cushion ......... ......... ......... ........... ...........
nonp.
E0178 A Gel pressre pad/cushion ......... ......... ......... ........... ...........
nonp.
E0179 A Dry pressre pad/cushion ......... ......... ......... ........... ...........
nonp.
E0180 A Press pad alternating w ......... ......... ......... ........... ...........
pump.
E0181 A Press pad alternating w/ ......... ......... ......... ........... ...........
pum.
E0182 A Pressure pad ......... ......... ......... ........... ...........
alternating pum.
E0184 A Dry pressure mattress.. ......... ......... ......... ........... ...........
E0185 A Gel pressure mattress ......... ......... ......... ........... ...........
pad.
E0186 A Air pressure mattress.. ......... ......... ......... ........... ...........
E0187 A Water pressure mattress ......... ......... ......... ........... ...........
E0188 E Synthetic sheepskin pad ......... ......... ......... ........... ...........
E0189 E Lambswool sheepskin pad ......... ......... ......... ........... ...........
E0191 A Protector heel or elbow ......... ......... ......... ........... ...........
E0192 A Pad wheelchr low press/ ......... ......... ......... ........... ...........
posit.
E0193 A Powered air flotation ......... ......... ......... ........... ...........
bed.
E0194 A Air fluidized bed...... ......... ......... ......... ........... ...........
E0196 A Gel pressure mattress.. ......... ......... ......... ........... ...........
E0197 A Air pressure pad for ......... ......... ......... ........... ...........
mattres.
E0198 A Water pressure pad for ......... ......... ......... ........... ...........
mattr.
E0199 A Dry pressure pad for ......... ......... ......... ........... ...........
mattres.
E0200 A Heat lamp without stand ......... ......... ......... ........... ...........
E0202 A Phototherapy light w/ ......... ......... ......... ........... ...........
photom.
E0205 A Heat lamp with stand... ......... ......... ......... ........... ...........
E0210 A Electric heat pad ......... ......... ......... ........... ...........
standard.
E0215 A Electric heat pad moist ......... ......... ......... ........... ...........
E0217 A Water circ heat pad w ......... ......... ......... ........... ...........
pump.
E0218 A Water circ cold pad w ......... ......... ......... ........... ...........
pump.
E0220 A Hot water bottle....... ......... ......... ......... ........... ...........
E0225 A Hydrocollator unit..... ......... ......... ......... ........... ...........
E0230 A Ice cap or collar...... ......... ......... ......... ........... ...........
E0235 A Paraffin bath unit ......... ......... ......... ........... ...........
portable.
E0236 A Pump for water ......... ......... ......... ........... ...........
circulating p.
E0238 A Heat pad non-electric ......... ......... ......... ........... ...........
moist.
E0239 A Hydrocollator unit ......... ......... ......... ........... ...........
portable.
E0241 E Bath tub wall rail..... ......... ......... ......... ........... ...........
E0242 E Bath tub rail floor.... ......... ......... ......... ........... ...........
E0243 E Toilet rail............ ......... ......... ......... ........... ...........
E0244 E Toilet seat raised..... ......... ......... ......... ........... ...........
E0245 E Tub stool or bench..... ......... ......... ......... ........... ...........
E0246 A Transfer tub rail ......... ......... ......... ........... ...........
attachment.
E0249 A Pad water circulating ......... ......... ......... ........... ...........
heat u.
E0250 A Hosp bed fixed ht w/ ......... ......... ......... ........... ...........
mattres.
E0251 A Hosp bed fixd ht w/o ......... ......... ......... ........... ...........
mattres.
E0255 A Hospital bed var ht w/ ......... ......... ......... ........... ...........
mattr.
E0256 A Hospital bed var ht w/o ......... ......... ......... ........... ...........
matt.
E0260 A Hosp bed semi-electr w/ ......... ......... ......... ........... ...........
matt.
E0261 A Hosp bed semi-electr w/ ......... ......... ......... ........... ...........
o mat.
E0265 A Hosp bed total electr w/ ......... ......... ......... ........... ...........
mat.
E0266 A Hosp bed total elec w/o ......... ......... ......... ........... ...........
matt.
E0270 A Hospital bed ......... ......... ......... ........... ...........
institutional t.
E0271 A Mattress innerspring... ......... ......... ......... ........... ...........
E0272 A Mattress foam rubber... ......... ......... ......... ........... ...........
E0273 A Bed board.............. ......... ......... ......... ........... ...........
E0274 A Over-bed table......... ......... ......... ......... ........... ...........
E0275 A Bed pan standard....... ......... ......... ......... ........... ...........
E0276 A Bed pan fracture....... ......... ......... ......... ........... ...........
E0277 A Powered pres-redu air ......... ......... ......... ........... ...........
mattrs.
E0280 A Bed cradle............. ......... ......... ......... ........... ...........
E0290 A Hosp bed fx ht w/o ......... ......... ......... ........... ...........
rails w/m.
E0291 A Hosp bed fx ht w/o rail ......... ......... ......... ........... ...........
w/o.
E0292 A Hosp bed var ht w/o ......... ......... ......... ........... ...........
rail w/o.
E0293 A Hosp bed var ht w/o ......... ......... ......... ........... ...........
rail w/.
E0294 A Hosp bed semi-elect w/ ......... ......... ......... ........... ...........
mattr.
E0295 A Hosp bed semi-elect w/o ......... ......... ......... ........... ...........
matt.
E0296 A Hosp bed total elect w/ ......... ......... ......... ........... ...........
matt.
E0297 A Hosp bed total elect w/ ......... ......... ......... ........... ...........
o mat.
E0305 A Rails bed side half ......... ......... ......... ........... ...........
length.
[[Page 35386]]
E0310 A Rails bed side full ......... ......... ......... ........... ...........
length.
E0315 A Bed accessory brd/tbl/ ......... ......... ......... ........... ...........
supprt.
E0325 A Urinal male jug-type... ......... ......... ......... ........... ...........
E0326 A Urinal female jug-type. ......... ......... ......... ........... ...........
E0350 A Control unit bowel ......... ......... ......... ........... ...........
system.
E0352 A Disposable pack w/bowel ......... ......... ......... ........... ...........
syst.
E0370 A Air elevator for heel.. ......... ......... ......... ........... ...........
E0371 A Nonpower mattress ......... ......... ......... ........... ...........
overlay.
E0372 A Powered air mattress ......... ......... ......... ........... ...........
overlay.
E0373 A Nonpowered pressure ......... ......... ......... ........... ...........
mattress.
E0424 A Stationary compressed ......... ......... ......... ........... ...........
gas 02.
E0425 A Gas system stationary ......... ......... ......... ........... ...........
compre.
E0430 A Oxygen system gas ......... ......... ......... ........... ...........
portable.
E0431 A Portable gaseous 02.... ......... ......... ......... ........... ...........
E0434 A Portable liquid 02..... ......... ......... ......... ........... ...........
E0435 A Oxygen system liquid ......... ......... ......... ........... ...........
portabl.
E0439 A Stationary liquid 02... ......... ......... ......... ........... ...........
E0440 A Oxygen system liquid ......... ......... ......... ........... ...........
station.
E0441 A Oxygen contents gas per/ ......... ......... ......... ........... ...........
unit.
E0442 A Oxygen contents liq per/ ......... ......... ......... ........... ...........
unit.
E0443 A Port 02 contents gas/ ......... ......... ......... ........... ...........
unit.
E0444 A Port 02 contents liq/ ......... ......... ......... ........... ...........
unit.
E0450 A Volume vent stationary/ ......... ......... ......... ........... ...........
porta.
E0452 A Intermit assis device w ......... ......... ......... ........... ...........
cpap.
E0453 A Ventilator 12 hrs/less ......... ......... ......... ........... ...........
per d.
E0455 A Oxygen tent excl croup/ ......... ......... ......... ........... ...........
ped t.
E0457 A Chest shell............ ......... ......... ......... ........... ...........
E0459 A Chest wrap............. ......... ......... ......... ........... ...........
E0460 A Neg press vent portabl/ ......... ......... ......... ........... ...........
statn.
E0462 A Rocking bed w/ or w/o ......... ......... ......... ........... ...........
side r.
E0480 A Percussor elect/pneum ......... ......... ......... ........... ...........
home m.
E0500 A Ippb all types......... ......... ......... ......... ........... ...........
E0550 A Humidif extens supple w ......... ......... ......... ........... ...........
ippb.
E0555 A Humidifier for use w/ ......... ......... ......... ........... ...........
regula.
E0560 A Humidifier supplemental ......... ......... ......... ........... ...........
w/ i.
E0565 A Compressor air power ......... ......... ......... ........... ...........
source.
E0570 A Nebulizer with ......... ......... ......... ........... ...........
compression.
E0575 A Nebulizer ultrasonic... ......... ......... ......... ........... ...........
E0580 A Nebulizer for use w/ ......... ......... ......... ........... ...........
regulat.
E0585 A Nebulizer w/ compressor ......... ......... ......... ........... ...........
& he.
E0600 A Suction pump portab hom ......... ......... ......... ........... ...........
modl.
E0601 A Cont airway pressure ......... ......... ......... ........... ...........
device.
E0605 A Vaporizer room type.... ......... ......... ......... ........... ...........
E0606 A Drainage board postural ......... ......... ......... ........... ...........
E0607 A Blood glucose monitor ......... ......... ......... ........... ...........
home.
E0608 A Apnea monitor.......... ......... ......... ......... ........... ...........
E0609 A Blood gluc mon w/ ......... ......... ......... ........... ...........
special fea.
E0610 A Pacemaker monitr ......... ......... ......... ........... ...........
audible/vis.
E0615 A Pacemaker monitr ......... ......... ......... ........... ...........
digital/vis.
E0621 A Patient lift sling or ......... ......... ......... ........... ...........
seat.
E0625 A Patient lift bathroom ......... ......... ......... ........... ...........
or toi.
E0627 A Seat lift incorp lift- ......... ......... ......... ........... ...........
chair.
E0628 A Seat lift for pt furn- ......... ......... ......... ........... ...........
electr.
E0629 A Seat lift for pt furn- ......... ......... ......... ........... ...........
non-el.
E0630 A Patient lift hydraulic. ......... ......... ......... ........... ...........
E0635 A Patient lift electric.. ......... ......... ......... ........... ...........
E0650 A Pneuma compresor non- ......... ......... ......... ........... ...........
segment.
E0651 A Pneum compressor ......... ......... ......... ........... ...........
segmental.
E0652 A Pneum compres w/cal ......... ......... ......... ........... ...........
pressure.
E0655 A Pneumatic appliance ......... ......... ......... ........... ...........
half arm.
E0660 A Pneumatic appliance ......... ......... ......... ........... ...........
full leg.
E0665 A Pneumatic appliance ......... ......... ......... ........... ...........
full arm.
E0666 A Pneumatic appliance ......... ......... ......... ........... ...........
half leg.
E0667 A Seg pneumatic appl full ......... ......... ......... ........... ...........
leg.
E0668 A Seg pneumatic appl full ......... ......... ......... ........... ...........
arm.
E0669 A Seg pneumatic appli ......... ......... ......... ........... ...........
half leg.
E0671 A Pressure pneum appl ......... ......... ......... ........... ...........
full leg.
E0672 A Pressure pneum appl ......... ......... ......... ........... ...........
full arm.
E0673 A Pressure pneum appl ......... ......... ......... ........... ...........
half leg.
E0690 A Ultraviolet cabinet.... ......... ......... ......... ........... ...........
E0700 A Safety equipment....... ......... ......... ......... ........... ...........
E0710 A Restraints any type.... ......... ......... ......... ........... ...........
E0720 A Tens two lead.......... ......... ......... ......... ........... ...........
E0730 A Tens four lead......... ......... ......... ......... ........... ...........
E0731 A Conductive garment for ......... ......... ......... ........... ...........
tens/.
[[Page 35387]]
E0740 A Incontinence treatment ......... ......... ......... ........... ...........
systm.
E0744 A Neuromuscular stim for ......... ......... ......... ........... ...........
scoli.
E0745 A Neuromuscular stim for ......... ......... ......... ........... ...........
shock.
E0746 A Electromyograph ......... ......... ......... ........... ...........
biofeedback.
E0747 A Elec osteogen stim not ......... ......... ......... ........... ...........
spine.
E0748 A Elec osteogen stim ......... ......... ......... ........... ...........
spinal.
E0749 A Elec osteogen stim ......... ......... ......... ........... ...........
implanted.
E0751 A Pulse generator or ......... ......... ......... ........... ...........
receiver.
E0753 A Neurostimulator ......... ......... ......... ........... ...........
electrodes.
E0755 A Electronic salivary ......... ......... ......... ........... ...........
reflex s.
E0760 A Osteogen ultrasound ......... ......... ......... ........... ...........
stimltor.
E0776 A Iv pole................ ......... ......... ......... ........... ...........
E0781 A External ambulatory ......... ......... ......... ........... ...........
infus pu.
E0782 A Non-programble infusion ......... ......... ......... ........... ...........
pump.
E0783 A Programmable infusion ......... ......... ......... ........... ...........
pump.
E0784 A Ext amb infusn pump ......... ......... ......... ........... ...........
insulin.
E0791 A Parenteral infusion ......... ......... ......... ........... ...........
pump sta.
E0840 A Tract frame attach ......... ......... ......... ........... ...........
headboard.
E0850 A Traction stand free ......... ......... ......... ........... ...........
standing.
E0855 A Cervical traction ......... ......... ......... ........... ...........
equipment.
E0860 A Tract equip cervical ......... ......... ......... ........... ...........
tract.
E0870 A Tract frame attach ......... ......... ......... ........... ...........
footboard.
E0880 A Trac stand free stand ......... ......... ......... ........... ...........
extrem.
E0890 A Traction frame attach ......... ......... ......... ........... ...........
pelvic.
E0900 A Trac stand free stand ......... ......... ......... ........... ...........
pelvic.
E0910 A Trapeze bar attached to ......... ......... ......... ........... ...........
bed.
E0920 A Fracture frame attached ......... ......... ......... ........... ...........
to b.
E0930 A Fracture frame free ......... ......... ......... ........... ...........
standing.
E0935 A Exercise device passive ......... ......... ......... ........... ...........
moti.
E0940 A Trapeze bar free ......... ......... ......... ........... ...........
standing.
E0941 A Gravity assisted ......... ......... ......... ........... ...........
traction de.
E0942 A Cervical head harness/ ......... ......... ......... ........... ...........
halter.
E0943 A Cervical pillow........ ......... ......... ......... ........... ...........
E0944 A Pelvic belt/harness/ ......... ......... ......... ........... ...........
boot.
E0945 A Belt/harness extremity. ......... ......... ......... ........... ...........
E0946 A Fracture frame dual w ......... ......... ......... ........... ...........
cross.
E0947 A Fracture frame ......... ......... ......... ........... ...........
attachmnts pe.
E0948 A Fracture frame ......... ......... ......... ........... ...........
attachmnts ce.
E0950 A Tray................... ......... ......... ......... ........... ...........
E0951 A Loop heel.............. ......... ......... ......... ........... ...........
E0952 A Loop tie............... ......... ......... ......... ........... ...........
E0953 A Pneumatic tire......... ......... ......... ......... ........... ...........
E0954 A Wheelchair semi- ......... ......... ......... ........... ...........
pneumatic ca.
E0958 A Whlchr att- conv 1 arm ......... ......... ......... ........... ...........
drive.
E0959 A Amputee adapter........ ......... ......... ......... ........... ...........
E0961 A Wheelchair brake ......... ......... ......... ........... ...........
extension.
E0962 A Wheelchair 1 inch ......... ......... ......... ........... ...........
cushion.
E0963 A Wheelchair 2 inch ......... ......... ......... ........... ...........
cushion.
E0964 A Wheelchair 3 inch ......... ......... ......... ........... ...........
cushion.
E0965 A Wheelchair 4 inch ......... ......... ......... ........... ...........
cushion.
E0966 A Wheelchair head rest ......... ......... ......... ........... ...........
extensi.
E0967 A Wheelchair hand rims... ......... ......... ......... ........... ...........
E0968 A Wheelchair commode seat ......... ......... ......... ........... ...........
E0969 A Wheelchair narrowing ......... ......... ......... ........... ...........
device.
E0970 A Wheelchair no. 2 ......... ......... ......... ........... ...........
footplates.
E0971 A Wheelchair anti-tipping ......... ......... ......... ........... ...........
devi.
E0972 A Transfer board or ......... ......... ......... ........... ...........
device.
E0973 A Wheelchair adjustabl ......... ......... ......... ........... ...........
height.
E0974 A Wheelchair grade-aid... ......... ......... ......... ........... ...........
E0975 A Wheelchair reinforced ......... ......... ......... ........... ...........
seat u.
E0976 A Wheelchair reinforced ......... ......... ......... ........... ...........
back u.
E0977 A Wheelchair wedge ......... ......... ......... ........... ...........
cushion.
E0978 A Wheelchair belt w/ ......... ......... ......... ........... ...........
airplane b.
E0979 A Wheelchair belt with ......... ......... ......... ........... ...........
velcro.
E0980 A Wheelchair safety vest. ......... ......... ......... ........... ...........
E0990 A Whellchair elevating ......... ......... ......... ........... ...........
leg res.
E0991 A Wheelchair upholstry ......... ......... ......... ........... ...........
seat.
E0992 A Wheelchair solid seat ......... ......... ......... ........... ...........
insert.
E0993 A Wheelchair back ......... ......... ......... ........... ...........
upholstery.
E0994 A Wheelchair arm rest.... ......... ......... ......... ........... ...........
E0995 A Wheelchair calf rest... ......... ......... ......... ........... ...........
E0996 A Wheelchair tire solid.. ......... ......... ......... ........... ...........
E0997 A Wheelchair caster w/ a ......... ......... ......... ........... ...........
fork.
E0998 A Wheelchair caster w/o a ......... ......... ......... ........... ...........
fork.
E0999 A Wheelchr pneumatic tire ......... ......... ......... ........... ...........
w/wh.
[[Page 35388]]
E1000 A Wheelchair tire ......... ......... ......... ........... ...........
pneumatic ca.
E1001 A Wheelchair wheel....... ......... ......... ......... ........... ...........
E1031 A Rollabout chair with ......... ......... ......... ........... ...........
casters.
E1050 A Whelchr fxd full length ......... ......... ......... ........... ...........
arms.
E1060 A Wheelchair detachable ......... ......... ......... ........... ...........
arms.
E1065 A Wheelchair power ......... ......... ......... ........... ...........
attachment.
E1066 A Wheelchair battery ......... ......... ......... ........... ...........
charger.
E1069 A Wheelchair deep cycle ......... ......... ......... ........... ...........
batter.
E1070 A Wheelchair detachable ......... ......... ......... ........... ...........
foot r.
E1083 A Hemi-wheelchair fixed ......... ......... ......... ........... ...........
arms.
E1084 A Hemi-wheelchair ......... ......... ......... ........... ...........
detachable a.
E1085 A Hemi-wheelchair fixed ......... ......... ......... ........... ...........
arms.
E1086 A Hemi-wheelchair ......... ......... ......... ........... ...........
detachable a.
E1087 A Wheelchair lightwt ......... ......... ......... ........... ...........
fixed arm.
E1088 A Wheelchair lightweight ......... ......... ......... ........... ...........
det a.
E1089 A Wheelchair lightwt ......... ......... ......... ........... ...........
fixed arm.
E1090 A Wheelchair lightweight ......... ......... ......... ........... ...........
det a.
E1091 A Wheelchair youth....... ......... ......... ......... ........... ...........
E1092 A Wheelchair wide w/ leg ......... ......... ......... ........... ...........
rests.
E1093 A Wheelchair wide w/ foot ......... ......... ......... ........... ...........
rest.
E1100 A Whchr s-recl fxd arm ......... ......... ......... ........... ...........
leg res.
E1110 A Wheelchair semi-recl ......... ......... ......... ........... ...........
detach.
E1130 A Whlchr stand fxd arm ft ......... ......... ......... ........... ...........
rest.
E1140 A Wheelchair standard ......... ......... ......... ........... ...........
detach a.
E1150 A Wheelchair standard w/ ......... ......... ......... ........... ...........
leg r.
E1160 A Wheelchair fixed arms.. ......... ......... ......... ........... ...........
E1170 A Whlchr ampu fxd arm leg ......... ......... ......... ........... ...........
rest.
E1171 A Wheelchair amputee w/o ......... ......... ......... ........... ...........
leg r.
E1172 A Wheelchair amputee ......... ......... ......... ........... ...........
detach ar.
E1180 A Wheelchair amputee w/ ......... ......... ......... ........... ...........
foot r.
E1190 A Wheelchair amputee w/ ......... ......... ......... ........... ...........
leg re.
E1195 A Wheelchair amputee ......... ......... ......... ........... ...........
heavy dut.
E1200 A Wheelchair amputee ......... ......... ......... ........... ...........
fixed arm.
E1210 A Whlchr moto ful arm leg ......... ......... ......... ........... ...........
rest.
E1211 A Wheelchair motorized w/ ......... ......... ......... ........... ...........
det.
E1212 A Wheelchair motorized w ......... ......... ......... ........... ...........
full.
E1213 A Wheelchair motorized w/ ......... ......... ......... ........... ...........
det.
E1220 A Whlchr special size/ ......... ......... ......... ........... ...........
constrc.
E1221 A Wheelchair spec size w ......... ......... ......... ........... ...........
foot.
E1222 A Wheelchair spec size w/ ......... ......... ......... ........... ...........
leg.
E1223 A Wheelchair spec size w ......... ......... ......... ........... ...........
foot.
E1224 A Wheelchair spec size w/ ......... ......... ......... ........... ...........
leg.
E1225 A Wheelchair spec sz semi- ......... ......... ......... ........... ...........
recl.
E1226 A Wheelchair spec sz full- ......... ......... ......... ........... ...........
recl.
E1227 A Wheelchair spec sz spec ......... ......... ......... ........... ...........
ht a.
E1228 A Wheelchair spec sz spec ......... ......... ......... ........... ...........
ht b.
E1230 A Power operated vehicle. ......... ......... ......... ........... ...........
E1240 A Whchr litwt det arm leg ......... ......... ......... ........... ...........
rest.
E1250 A Wheelchair lightwt ......... ......... ......... ........... ...........
fixed arm.
E1260 A Wheelchair lightwt foot ......... ......... ......... ........... ...........
rest.
E1270 A Wheelchair lightweight ......... ......... ......... ........... ...........
leg r.
E1280 A Whchr h-duty det arm ......... ......... ......... ........... ...........
leg res.
E1285 A Wheelchair heavy duty ......... ......... ......... ........... ...........
fixed.
E1290 A Wheelchair hvy duty ......... ......... ......... ........... ...........
detach a.
E1295 A Wheelchair heavy duty ......... ......... ......... ........... ...........
fixed.
E1296 A Wheelchair special seat ......... ......... ......... ........... ...........
heig.
E1297 A Wheelchair special seat ......... ......... ......... ........... ...........
dept.
E1298 A Wheelchair spec seat ......... ......... ......... ........... ...........
depth/w.
E1300 A Whirlpool portable..... ......... ......... ......... ........... ...........
E1310 A Whirlpool non-portable. ......... ......... ......... ........... ...........
E1340 A Repair for DME, per 15 ......... ......... ......... ........... ...........
min.
E1353 A Oxygen supplies ......... ......... ......... ........... ...........
regulator.
E1355 A Oxygen supplies stand/ ......... ......... ......... ........... ...........
rack.
E1372 A Oxy suppl heater for ......... ......... ......... ........... ...........
nebuliz.
E1375 A Oxygen suppl nebulizer ......... ......... ......... ........... ...........
porta.
E1377 A Oxygen concentrator to ......... ......... ......... ........... ...........
244 c.
E1378 A Oxygen concentrator to ......... ......... ......... ........... ...........
488 c.
E1379 A Oxygen concentrator to ......... ......... ......... ........... ...........
732 c.
E1380 A Oxygen concentrator to ......... ......... ......... ........... ...........
D976 c.
E1381 A Oxygen concentrat to ......... ......... ......... ........... ...........
1220 cu.
E1382 A Oxygen concentrat to ......... ......... ......... ........... ...........
1464 cu.
E1383 A Oxygen concentrat to ......... ......... ......... ........... ...........
1708 cu.
E1384 A Oxygen concentrat to ......... ......... ......... ........... ...........
1952 cu.
E1385 A Oxygen concentrator > ......... ......... ......... ........... ...........
1952 c.
E1399 A Durable medical ......... ......... ......... ........... ...........
equipment mi.
[[Page 35389]]
E1400 A Oxygen concentrator < 2 ......... ......... ......... ........... ...........
lite.
E1401 A Oxygen concentrator 2-3 ......... ......... ......... ........... ...........
lite.
E1402 A Oxygen concentrator 3-4 ......... ......... ......... ........... ...........
lite.
E1403 A Oxygen concentrator 4-5 ......... ......... ......... ........... ...........
lite.
E1404 A Oxygen concentrator > 5 ......... ......... ......... ........... ...........
lite.
E1405 A O2/water vapor enrich w/ ......... ......... ......... ........... ...........
heat.
E1406 A O2/water vapor enrich w/ ......... ......... ......... ........... ...........
o he.
E1510 A Kidney dialysate ......... ......... ......... ........... ...........
delivry sys.
E1520 A Heparin infusion pump ......... ......... ......... ........... ...........
for di.
E1530 A Air bubble detector for ......... ......... ......... ........... ...........
dial.
E1540 A Pressure alarm for ......... ......... ......... ........... ...........
dialysis.
E1550 A Bath conductivity meter ......... ......... ......... ........... ...........
E1560 A Blood leak detector for ......... ......... ......... ........... ...........
dial.
E1570 A Adjustable chair for ......... ......... ......... ........... ...........
esrd pt.
E1575 A Transducer protector/ ......... ......... ......... ........... ...........
fluid b.
E1580 A Unipuncture control ......... ......... ......... ........... ...........
system.
E1590 A Hemodialysis machine... ......... ......... ......... ........... ...........
E1592 A Auto interm peritoneal ......... ......... ......... ........... ...........
dialy.
E1594 A Cycler dialysis machine ......... ......... ......... ........... ...........
E1600 A Deliv/install equip for ......... ......... ......... ........... ...........
dial.
E1610 A Reverse osmosis water ......... ......... ......... ........... ...........
purifi.
E1615 A Deionizer water ......... ......... ......... ........... ...........
purification.
E1620 A Blood pump for dialysis ......... ......... ......... ........... ...........
E1625 A Water softening system. ......... ......... ......... ........... ...........
E1630 A Reciprocating ......... ......... ......... ........... ...........
peritoneal dia.
E1632 A Wearable artificial ......... ......... ......... ........... ...........
kidney.
E1635 A Compact travel ......... ......... ......... ........... ...........
hemodialyzer.
E1636 A Sorbent cartridges for ......... ......... ......... ........... ...........
dialy.
E1640 A Replacement components ......... ......... ......... ........... ...........
for d.
E1699 A Dialysis equipment ......... ......... ......... ........... ...........
unspecifi.
E1700 A Jaw motion rehab system ......... ......... ......... ........... ...........
E1701 A Repl cushions for jaw ......... ......... ......... ........... ...........
motion.
E1702 A Repl measr scales jaw ......... ......... ......... ........... ...........
motion.
E1800 A Adjust elbow ext/flex ......... ......... ......... ........... ...........
device.
E1805 A Adjust wrist ext/flex ......... ......... ......... ........... ...........
device.
E1810 A Adjust knee ext/flex ......... ......... ......... ........... ...........
device.
E1815 A Adjust ankle ext/flex ......... ......... ......... ........... ...........
device.
E1820 A Soft interface material ......... ......... ......... ........... ...........
E1825 A Adjust finger ext/flex ......... ......... ......... ........... ...........
devc.
E1830 A Adjust toe ext/flex ......... ......... ......... ........... ...........
device.
G0001 A Drawing blood for ......... ......... ......... ........... ...........
specimen.
G0002 N Temporary urinary ......... ......... ......... ........... ...........
catheter.
G0004 X ECG transm phys review 956 1.09 $56.05 $54.47 $11.21
& int.
G0005 X ECG 24 hour recording.. 956 1.09 $56.05 $54.47 $11.21
G0006 X ECG transmission & 956 1.09 $56.05 $54.47 $11.21
analysis.
G0007 N ECG phy review & ......... ......... ......... ........... ...........
interpret.
G0008 X Admin influenza virus 901 0.07 $3.60 $2.49 $0.72
vac.
G0009 X Admin pneumococcal 901 0.07 $3.60 $2.49 $0.72
vaccine.
G0010 X Admin hepatitis b 902 1.31 $67.36 $38.19 $13.47
vaccine.
G0015 X Post symptom ECG 956 1.09 $56.05 $54.47 $11.21
tracing.
G0016 N Post symptom ECG md ......... ......... ......... ........... ...........
review.
G0025 X Collagen skin test kit. 881 0.22 $11.31 $6.78 $2.26
G0026 A Fecal leukocyte ......... ......... ......... ........... ...........
examination.
G0027 A Semen analysis......... ......... ......... ......... ........... ...........
G0030 S PET imaging prev PET 760 14.89 $765.64 $419.46 $153.13
single.
G0031 S PET imaging prev PET 760 14.89 $765.64 $419.46 $153.13
multple.
G0032 S PET follow SPECT 78464 760 14.89 $765.64 $419.46 $153.13
singl.
G0033 S PET follow SPECT 78464 760 14.89 $765.64 $419.46 $153.13
mult.
G0034 S PET follow SPECT 76865 760 14.89 $765.64 $419.46 $153.13
singl.
G0035 S PET follow SPECT 78465 760 14.89 $765.64 $419.46 $153.13
mult.
G0036 S PET follow cornry angio 760 14.89 $765.64 $419.46 $153.13
sing.
G0037 S PET follow cornry angio 760 14.89 $765.64 $419.46 $153.13
mult.
G0038 S PET follow myocard perf 760 14.89 $765.64 $419.46 $153.13
sing.
G0039 S PET follow myocard perf 760 14.89 $765.64 $419.46 $153.13
mult.
G0040 S PET follow stress echo 760 14.89 $765.64 $419.46 $153.13
singl.
G0041 S PET follow stress echo 760 14.89 $765.64 $419.46 $153.13
mult.
G0042 S PET follow ventriculogm 760 14.89 $765.64 $419.46 $153.13
sing.
G0043 S PET follow ventriculogm 760 14.89 $765.64 $419.46 $153.13
mult.
G0044 S PET following rest ECG 760 14.89 $765.64 $419.46 $153.13
singl.
G0045 S PET following rest ECG 760 14.89 $765.64 $419.46 $153.13
mult.
G0046 S PET follow stress ECG 760 14.89 $765.64 $419.46 $153.13
singl.
G0047 S PET follow stress ECG 760 14.89 $765.64 $419.46 $153.13
mult.
G0050 S Residual urine by 747 1.65 $84.84 $54.47 $16.97
ultrasound.
G0101 V CA screen;pelvic/breast 913 ......... ......... ........... ...........
exam.
G0104 S CA screen;flexi 446 2.54 $130.61 $64.86 $26.12
sigmoidscope.
[[Page 35390]]
G0105 S Colorectal scrn; hi 426 6.74 $346.57 $185.32 $69.31
risk ind.
G0106 S Colon CA screen;barium 736 1.85 $95.13 $53.79 $19.03
enema.
G0107 A CA screen; fecal blood ......... ......... ......... ........... ...........
test.
G0110 A Nett pulm-rehab educ; ......... ......... ......... ........... ...........
ind.
G0111 A Nett pulm-rehab educ; ......... ......... ......... ........... ...........
group.
G0112 A Nett;nutrition guid, ......... ......... ......... ........... ...........
initial.
G0113 A Nett;nutrition ......... ......... ......... ........... ...........
guid,subseqnt.
G0114 A Nett; psychosocial ......... ......... ......... ........... ...........
consult.
G0115 A Nett; psychological ......... ......... ......... ........... ...........
testing.
G0116 A Nett; psychosocial ......... ......... ......... ........... ...........
counsel.
G0120 S Colon ca scrn; barium 736 1.85 $95.13 $53.79 $19.03
enema.
G0121 E Colon ca scrn not hi ......... ......... ......... ........... ...........
rsk ind.
G0122 E Colon ca scrn; barium ......... ......... ......... ........... ...........
enema.
J0120 N Tetracyclin injection.. ......... ......... ......... ........... ...........
J0150 N Injection adenosine 6 ......... ......... ......... ........... ...........
MG.
J0170 N Adrenalin epinephrin ......... ......... ......... ........... ...........
inject.
J0190 N Inj biperiden lactate/5 ......... ......... ......... ........... ...........
mg.
J0205 N Alglucerase injection.. ......... ......... ......... ........... ...........
J0207 N Amifostine............. ......... ......... ......... ........... ...........
J0210 N Methyldopate hcl ......... ......... ......... ........... ...........
injection.
J0256 N Alpha 1 proteinase ......... ......... ......... ........... ...........
inhibitor.
J0270 E Alprostadil for ......... ......... ......... ........... ...........
injection.
J0280 N Aminophyllin 250 MG inj ......... ......... ......... ........... ...........
J0290 N Ampicillin 500 MG inj.. ......... ......... ......... ........... ...........
J0295 N Ampicillin sodium per ......... ......... ......... ........... ...........
1.5 gm.
J0300 N Amobarbital 125 MG inj. ......... ......... ......... ........... ...........
J0330 N Succinycholine chloride ......... ......... ......... ........... ...........
inj.
J0340 N Nandrolon ......... ......... ......... ........... ...........
phenpropionate inj.
J0350 N Injection anistreplase ......... ......... ......... ........... ...........
30 u.
J0360 N Hydralazine hcl ......... ......... ......... ........... ...........
injection.
J0380 N Inj metaraminol ......... ......... ......... ........... ...........
bitartrate.
J0390 N Chloroquine injection.. ......... ......... ......... ........... ...........
J0400 N Inj trimethaphan ......... ......... ......... ........... ...........
camsylate.
J0460 N Atropine sulfate ......... ......... ......... ........... ...........
injection.
J0470 N Dimecaprol injection... ......... ......... ......... ........... ...........
J0475 N Baclofen 10 MG ......... ......... ......... ........... ...........
injection.
J0500 N Dicyclomine injection.. ......... ......... ......... ........... ...........
J0510 N Benzquinamide injection ......... ......... ......... ........... ...........
J0515 N Inj benztropine ......... ......... ......... ........... ...........
mesylate.
J0520 N Bethanechol chloride ......... ......... ......... ........... ...........
inject.
J0530 N Penicillin g benzathine ......... ......... ......... ........... ...........
inj.
J0540 N Penicillin g benzathine ......... ......... ......... ........... ...........
inj.
J0550 N Penicillin g benzathine ......... ......... ......... ........... ...........
inj.
J0560 N Penicillin g benzathine ......... ......... ......... ........... ...........
inj.
J0570 N Penicillin g benzathine ......... ......... ......... ........... ...........
inj.
J0580 N Penicillin g benzathine ......... ......... ......... ........... ...........
inj.
J0585 N Botulinum toxin a per ......... ......... ......... ........... ...........
unit.
J0590 N Ethylnorepinephrine hcl ......... ......... ......... ........... ...........
inj.
J0600 N Edetate calcium ......... ......... ......... ........... ...........
disodium inj.
J0610 N Calcium gluconate ......... ......... ......... ........... ...........
injection.
J0620 N Calcium glycer & lact/ ......... ......... ......... ........... ...........
10 ML.
J0630 N Calcitonin salmon ......... ......... ......... ........... ...........
injection.
J0635 N Calcitriol injection... ......... ......... ......... ........... ...........
J0640 X Leucovorin calcium 064 4.15 $213.39 $138.99 $42.68
injection.
J0670 N Inj mepivacaine HCL/10 ......... ......... ......... ........... ...........
ml.
J0690 N Cefazolin sodium ......... ......... ......... ........... ...........
injection.
J0694 N Cefoxitin sodium ......... ......... ......... ........... ...........
injection.
J0695 N Cefonocid sodium ......... ......... ......... ........... ...........
injection.
J0696 N Ceftriaxone sodium ......... ......... ......... ........... ...........
injection.
J0697 N Sterile cefuroxime ......... ......... ......... ........... ...........
injection.
J0698 N Cefotaxime sodium ......... ......... ......... ........... ...........
injection.
J0702 N Betamethasone acet&sod ......... ......... ......... ........... ...........
phosp.
J0704 N Betamethasone sod phosp/ ......... ......... ......... ........... ...........
4 MG.
J0710 N Cephapirin sodium ......... ......... ......... ........... ...........
injection.
J0713 N Inj ceftazidime per 500 ......... ......... ......... ........... ...........
mg.
J0715 N Ceftizoxime sodium/500 ......... ......... ......... ........... ...........
MG.
J0720 N Chloramphenicol sodium ......... ......... ......... ........... ...........
injec.
J0725 N Chorionic gonadotropin/ ......... ......... ......... ........... ...........
1000u.
J0730 N Chlorpheniramin maleate ......... ......... ......... ........... ...........
inj.
J0735 N Clonidine hydrochloride ......... ......... ......... ........... ...........
J0740 N Cidofovir injection.... ......... ......... ......... ........... ...........
J0743 N Cilastatin sodium ......... ......... ......... ........... ...........
injection.
J0745 N Inj codeine phosphate / ......... ......... ......... ........... ...........
30 MG.
J0760 N Colchicine injection... ......... ......... ......... ........... ...........
J0770 N Colistimethate sodium ......... ......... ......... ........... ...........
inj.
[[Page 35391]]
J0780 N Prochlorperazine ......... ......... ......... ........... ...........
injection.
J0800 N Corticotropin injection ......... ......... ......... ........... ...........
J0810 N Cortisone injection.... ......... ......... ......... ........... ...........
J0835 N Inj cosyntropin per ......... ......... ......... ........... ...........
0.25 MG.
J0850 N Cytomegalovirus imm IV / ......... ......... ......... ........... ...........
vial.
J0895 N Deferoxamine mesylate ......... ......... ......... ........... ...........
inj.
J0900 N Testosterone enanthate ......... ......... ......... ........... ...........
inj.
J0945 N Brompheniramine maleate ......... ......... ......... ........... ...........
inj.
J0970 N Estradiol valerate ......... ......... ......... ........... ...........
injection.
J1000 N Depo-estradiol ......... ......... ......... ........... ...........
cypionate inj.
J1020 N Methylprednisolone 20 ......... ......... ......... ........... ...........
MG inj.
J1030 N Methylprednisolone 40 ......... ......... ......... ........... ...........
MG inj.
J1040 N Methylprednisolone 80 ......... ......... ......... ........... ...........
MG inj.
J1050 N Medroxyprogesterone inj ......... ......... ......... ........... ...........
J1055 E Medrxyprogester acetate ......... ......... ......... ........... ...........
inj.
J1060 N Testosterone cypionate ......... ......... ......... ........... ...........
1 ML.
J1070 N Testosterone cypionat ......... ......... ......... ........... ...........
100 MG.
J1080 N Testosterone cypionat ......... ......... ......... ........... ...........
200 MG.
J1090 N Testosterone cypionate ......... ......... ......... ........... ...........
50 MG.
J1095 N Inj dexamethasone ......... ......... ......... ........... ...........
acetate.
J1100 N Dexamethosone sodium ......... ......... ......... ........... ...........
phos.
J1110 N Inj dihydroergotamine ......... ......... ......... ........... ...........
mesylt.
J1120 N Acetazolamid sodium ......... ......... ......... ........... ...........
injectio.
J1160 N Digoxin injection...... ......... ......... ......... ........... ...........
J1165 N Phenytoin sodium ......... ......... ......... ........... ...........
injection.
J1170 N Hydromorphone injection ......... ......... ......... ........... ...........
J1180 N Dyphylline injection... ......... ......... ......... ........... ...........
J1190 N Dexrazoxane HCl ......... ......... ......... ........... ...........
injection.
J1200 N Diphenhydramine hcl ......... ......... ......... ........... ...........
injectio.
J1205 N Chlorothiazide sodium ......... ......... ......... ........... ...........
inj.
J1212 N Dimethyl sulfoxide 50% ......... ......... ......... ........... ...........
50 ML.
J1230 N Methadone injection.... ......... ......... ......... ........... ...........
J1240 N Dimenhydrinate ......... ......... ......... ........... ...........
injection.
J1245 N Dipyridamole injection. ......... ......... ......... ........... ...........
J1250 N Inj dobutamine HCL/250 ......... ......... ......... ........... ...........
mg.
J1320 N Amitriptyline injection ......... ......... ......... ........... ...........
J1325 N Epoprostenol injection. ......... ......... ......... ........... ...........
J1330 N Ergonovine maleate ......... ......... ......... ........... ...........
injection.
J1362 N Erythromycin glucep/250 ......... ......... ......... ........... ...........
MG.
J1364 N Erythro lactobionate/ ......... ......... ......... ........... ...........
500 MG.
J1380 N Estradiol valerate 10 ......... ......... ......... ........... ...........
MG inj.
J1390 N Estradiol valerate 20 ......... ......... ......... ........... ...........
MG inj.
J1410 N Inj estrogen conjugate ......... ......... ......... ........... ...........
25 MG.
J1435 N Injection estrone per 1 ......... ......... ......... ........... ...........
MG.
J1436 N Etidronate disodium inj ......... ......... ......... ........... ...........
J1440 N grastim 300 mcg ......... ......... ......... ........... ...........
injeciton.
J1441 N Filgrastim 480 mcg ......... ......... ......... ........... ...........
injection.
J1455 N Foscarnet sodium ......... ......... ......... ........... ...........
injection.
J1460 N Gamma globulin 1 CC inj ......... ......... ......... ........... ...........
J1470 N Gamma globulin 2 CC inj ......... ......... ......... ........... ...........
J1480 N Gamma globulin 3 CC inj ......... ......... ......... ........... ...........
J1490 N Gamma globulin 4 CC inj ......... ......... ......... ........... ...........
J1500 N Gamma globulin 5 CC inj ......... ......... ......... ........... ...........
J1510 N Gamma globulin 6 CC inj ......... ......... ......... ........... ...........
J1520 N Gamma globulin 7 CC inj ......... ......... ......... ........... ...........
J1530 N Gamma globulin 8 CC inj ......... ......... ......... ........... ...........
J1540 N Gamma globulin 9 CC inj ......... ......... ......... ........... ...........
J1550 N Gamma globulin 10 CC ......... ......... ......... ........... ...........
inj.
J1560 N Gamma globulin > 10 CC ......... ......... ......... ........... ...........
inj.
J1561 N Immune globulin 500 mg. ......... ......... ......... ........... ...........
J1562 N Immune globulin 5 gms.. ......... ......... ......... ........... ...........
J1565 N RSV-ivig............... ......... ......... ......... ........... ...........
J1570 N Ganciclovir sodium ......... ......... ......... ........... ...........
injection.
J1580 N Garamycin gentamicin ......... ......... ......... ........... ...........
inj.
J1600 N Gold sodium thiomaleate ......... ......... ......... ........... ...........
inj.
J1610 N Glucagon hydrochloride/ ......... ......... ......... ........... ...........
1 MG.
J1620 N Gonadorelin hydroch/ ......... ......... ......... ........... ...........
100 mcg.
J1626 N Granisetron HCl ......... ......... ......... ........... ...........
injection.
J1630 N Haloperidol injection.. ......... ......... ......... ........... ...........
J1631 N Haloperidol decanoate ......... ......... ......... ........... ...........
inj.
J1642 N Inj heparin sodium per ......... ......... ......... ........... ...........
10 u.
J1644 N Inj heparin sodium per ......... ......... ......... ........... ...........
1000u.
J1645 N Dalteparin sodium...... ......... ......... ......... ........... ...........
J1650 N Inj enoxaparin sodium ......... ......... ......... ........... ...........
30 mg.
J1670 N Tetanus immune globulin ......... ......... ......... ........... ...........
inj.
[[Page 35392]]
J1690 N Prednisolone tebutate ......... ......... ......... ........... ...........
inj.
J1700 N Hydrocortisone acetate ......... ......... ......... ........... ...........
inj.
J1710 N Hydrocortisone sodium ......... ......... ......... ........... ...........
ph inj.
J1720 N Hydrocortisone sodium ......... ......... ......... ........... ...........
succ i.
J1730 N Diazoxide injection.... ......... ......... ......... ........... ...........
J1739 N Hydroxyprogesterone cap ......... ......... ......... ........... ...........
125.
J1741 N Hydroxyprogesterone cap ......... ......... ......... ........... ...........
250.
J1742 N Ibutilide fumarate ......... ......... ......... ........... ...........
injection.
J1760 N Iron dextran 2 CC inj.. ......... ......... ......... ........... ...........
J1770 N Iron dextran 5 CC inj.. ......... ......... ......... ........... ...........
J1780 N Iron dextran 10 CC inj. ......... ......... ......... ........... ...........
J1785 N Injection imiglucerase / ......... ......... ......... ........... ...........
unit.
J1790 N Droperidol injection... ......... ......... ......... ........... ...........
J1800 N Propranolol injection.. ......... ......... ......... ........... ...........
J1810 N Droperidol/fentanyl inj ......... ......... ......... ........... ...........
J1820 N Insulin injection...... ......... ......... ......... ........... ...........
J1825 N Interferon beta-1a..... ......... ......... ......... ........... ...........
J1830 N Interferon beta-1b / ......... ......... ......... ........... ...........
.25 MG.
J1840 N Kanamycin sulfate 500 ......... ......... ......... ........... ...........
MG inj.
J1850 N Kanamycin sulfate 75 MG ......... ......... ......... ........... ...........
inj.
J1885 N Ketorolac tromethamine ......... ......... ......... ........... ...........
inj.
J1890 N Cephalothin sodium ......... ......... ......... ........... ...........
injection.
J1910 N Kutapressin injection.. ......... ......... ......... ........... ...........
J1930 N Propiomazine injection. ......... ......... ......... ........... ...........
J1940 N Furosemide injection... ......... ......... ......... ........... ...........
J1950 X Leuprolide acetate / 064 4.15 $213.39 $138.99 $42.68
3.75 MG.
J1955 N Inj levocarnitine per 1 ......... ......... ......... ........... ...........
gm.
J1960 N Levorphanol tartrate ......... ......... ......... ........... ...........
inj.
J1970 N Methotrimeprazine ......... ......... ......... ........... ...........
injection.
J1980 N Hyoscyamine sulfate inj ......... ......... ......... ........... ...........
J1990 N Chlordiazepoxide ......... ......... ......... ........... ...........
injection.
J2000 N Lidocaine injection.... ......... ......... ......... ........... ...........
J2010 N Lincomycin injection... ......... ......... ......... ........... ...........
J2060 N Lorazepam injection.... ......... ......... ......... ........... ...........
J2150 N Mannitol injection..... ......... ......... ......... ........... ...........
J2175 N Meperidine hydrochl / ......... ......... ......... ........... ...........
100 MG.
J2180 N Meperidine/promethazine ......... ......... ......... ........... ...........
inj.
J2210 N Methylergonovin maleate ......... ......... ......... ........... ...........
inj.
J2240 N Metocurine iodide ......... ......... ......... ........... ...........
injection.
J2250 N Inj midazolam ......... ......... ......... ........... ...........
hydrochloride.
J2260 N Inj milrinone lactate / ......... ......... ......... ........... ...........
5 ML.
J2270 N Morphine sulfate ......... ......... ......... ........... ...........
injection.
J2275 N Morphine sulfate ......... ......... ......... ........... ...........
injection.
J2300 N Inj nalbuphine ......... ......... ......... ........... ...........
hydrochloride.
J2310 N Inj naloxone ......... ......... ......... ........... ...........
hydrochloride.
J2320 N Nandrolone decanoate 50 ......... ......... ......... ........... ...........
MG.
J2321 N Nandrolone decanoate ......... ......... ......... ........... ...........
100 MG.
J2322 N Nandrolone decanoate ......... ......... ......... ........... ...........
200 MG.
J2330 N Thiothixene injection.. ......... ......... ......... ........... ...........
J2350 N Niacinamide/niacin ......... ......... ......... ........... ...........
injection.
J2360 N Orphenadrine injection. ......... ......... ......... ........... ...........
J2370 N Phenylephrine hcl ......... ......... ......... ........... ...........
injection.
J2400 N Chloroprocaine hcl ......... ......... ......... ........... ...........
injection.
J2405 N Ondansetron hcl ......... ......... ......... ........... ...........
injection.
J2410 N Oxymorphone hcl ......... ......... ......... ........... ...........
injection.
J2430 N Pamidronate disodium / ......... ......... ......... ........... ...........
30 MG.
J2440 N Papaverin hcl injection ......... ......... ......... ........... ...........
J2460 N Oxytetracycline ......... ......... ......... ........... ...........
injection.
J2480 N Hydrochlorides of opium ......... ......... ......... ........... ...........
inj.
J2510 N Penicillin g procaine ......... ......... ......... ........... ...........
inj.
J2512 N Inj pentagastrin per 2 ......... ......... ......... ........... ...........
ML.
J2515 N Pentobarbital sodium ......... ......... ......... ........... ...........
inj.
J2540 N Penicillin g potassium ......... ......... ......... ........... ...........
inj.
J2545 A Pentamidine isethionte/ ......... ......... ......... ........... ...........
300mg.
J2550 N Promethazine hcl ......... ......... ......... ........... ...........
injection.
J2560 N Phenobarbital sodium ......... ......... ......... ........... ...........
inj.
J2590 N Oxytocin injection..... ......... ......... ......... ........... ...........
J2597 N Inj desmopressin ......... ......... ......... ........... ...........
acetate.
J2640 N Prednisolone sodium ph ......... ......... ......... ........... ...........
inj.
J2650 N Prednisolone acetate ......... ......... ......... ........... ...........
inj.
J2670 N Totazoline hcl ......... ......... ......... ........... ...........
injection.
J2675 N Inj progesterone per 50 ......... ......... ......... ........... ...........
MG.
J2680 N Fluphenazine decanoate ......... ......... ......... ........... ...........
25 MG.
J2690 N Procainamide hcl ......... ......... ......... ........... ...........
injection.
J2700 N Oxacillin sodium ......... ......... ......... ........... ...........
injeciton.
[[Page 35393]]
J2710 N Neostigmine methylslfte ......... ......... ......... ........... ...........
inj.
J2720 N Inj protamine sulfate/ ......... ......... ......... ........... ...........
10 MG.
J2725 N Inj protirelin per 250 ......... ......... ......... ........... ...........
mcg.
J2730 N Pralidoxime chloride ......... ......... ......... ........... ...........
inj.
J2760 N Phentolaine mesylate ......... ......... ......... ........... ...........
inj.
J2765 N Metoclopramide hcl ......... ......... ......... ........... ...........
injection.
J2790 N Rho d immune globulin ......... ......... ......... ........... ...........
inj.
J2800 N Methocarbamol injection ......... ......... ......... ........... ...........
J2810 N Inj theophylline per 40 ......... ......... ......... ........... ...........
MG.
J2820 N Sargramostim injection. ......... ......... ......... ........... ...........
J2860 N Secobarbital sodium inj ......... ......... ......... ........... ...........
J2910 N Aurothioglucose ......... ......... ......... ........... ...........
injeciton.
J2912 N Sodium chloride ......... ......... ......... ........... ...........
injection.
J2920 N Methylprednisolone ......... ......... ......... ........... ...........
injection.
J2930 N Methylprednisolone ......... ......... ......... ........... ...........
injection.
J2950 N Promazine hcl injeciton ......... ......... ......... ........... ...........
J2970 N Methicillin sodium ......... ......... ......... ........... ...........
injection.
J2995 N Inj streptokinase / ......... ......... ......... ........... ...........
250000 IU.
J2996 N Alteplase recombinant ......... ......... ......... ........... ...........
inj.
J3000 N Streptomycin injection. ......... ......... ......... ........... ...........
J3010 N Fentanyl citrate ......... ......... ......... ........... ...........
injeciton.
J3030 N Sumatriptan succinate / ......... ......... ......... ........... ...........
6 MG.
J3070 N Pentazocine hcl ......... ......... ......... ........... ...........
injeciton.
J3080 N Chlorprothixene ......... ......... ......... ........... ...........
injection.
J3105 N Terbutaline sulfate inj ......... ......... ......... ........... ...........
J3120 N Testosterone enanthate ......... ......... ......... ........... ...........
inj.
J3130 N Testosterone enanthate ......... ......... ......... ........... ...........
inj.
J3140 N Testosterone suspension ......... ......... ......... ........... ...........
inj.
J3150 N Testosteron propionate ......... ......... ......... ........... ...........
inj.
J3230 N Chlorpromazine hcl ......... ......... ......... ........... ...........
injection.
J3240 N Thyrotropin injection.. ......... ......... ......... ........... ...........
J3250 N Trimethobenzamide hcl ......... ......... ......... ........... ...........
inj.
J3260 N Tobramycin sulfate ......... ......... ......... ........... ...........
injection.
J3265 N Injection torsemide 10 ......... ......... ......... ........... ...........
mg/ml.
J3270 N Imipramine hcl ......... ......... ......... ........... ...........
injection.
J3280 N Thiethylperazine ......... ......... ......... ........... ...........
maleate inj.
J3301 N Triamcinolone acetonide ......... ......... ......... ........... ...........
inj.
J3302 N Triamcinolone diacetate ......... ......... ......... ........... ...........
inj.
J3303 N Triamcinolone ......... ......... ......... ........... ...........
hexacetonl inj.
J3305 N Inj trimetrexate ......... ......... ......... ........... ...........
glucoronate.
J3310 N Perphenazine injeciton. ......... ......... ......... ........... ...........
J3320 N Spectinomycn di-hcl inj ......... ......... ......... ........... ...........
J3350 N Urea injection......... ......... ......... ......... ........... ...........
J3360 N Diazepam injection..... ......... ......... ......... ........... ...........
J3364 N Urokinase 5000 IU ......... ......... ......... ........... ...........
injection.
J3365 N Urokinase 250,000 IU ......... ......... ......... ........... ...........
inj.
J3370 N Vancomycin hcl ......... ......... ......... ........... ...........
injeciton.
J3390 N Methoxamine injection.. ......... ......... ......... ........... ...........
J3400 N Triflupromazine hcl inj ......... ......... ......... ........... ...........
J3410 N Hydroxyzine hcl ......... ......... ......... ........... ...........
injeciton.
J3420 N Vitamin b12 injection.. ......... ......... ......... ........... ...........
J3430 N Vitamin k phytonadione ......... ......... ......... ........... ...........
inj.
J3450 N Mephentermine sulfate ......... ......... ......... ........... ...........
inj.
J3470 N Hyaluronidase injection ......... ......... ......... ........... ...........
J3475 N Inj magnesium sulfate.. ......... ......... ......... ........... ...........
J3480 N Inj potassium chloride. ......... ......... ......... ........... ...........
J3490 N Drugs unclassified ......... ......... ......... ........... ...........
injection.
J3520 E Edetate disodium per ......... ......... ......... ........... ...........
150 mg.
J3530 N Nasal vaccine ......... ......... ......... ........... ...........
inhalation.
J3535 E Metered dose inhaler ......... ......... ......... ........... ...........
drug.
J3570 E Laetrile amygdalin vit ......... ......... ......... ........... ...........
B17.
J7030 N Normal saline solution ......... ......... ......... ........... ...........
infus.
J7040 N Normal saline solution ......... ......... ......... ........... ...........
infus.
J7042 N 5% dextrose/normal ......... ......... ......... ........... ...........
saline.
J7050 N Normal saline solution ......... ......... ......... ........... ...........
infus.
J7051 N Sterile saline/water... ......... ......... ......... ........... ...........
J7060 N 5% dextrose/water...... ......... ......... ......... ........... ...........
J7070 N D5w infusion........... ......... ......... ......... ........... ...........
J7100 N Dextran 40 infusion.... ......... ......... ......... ........... ...........
J7110 N Dextran 75 infusion.... ......... ......... ......... ........... ...........
J7120 N Ringers lactate ......... ......... ......... ........... ...........
infusion.
J7130 N Hypertonic saline ......... ......... ......... ........... ...........
solution.
J7190 N Factor viii............ ......... ......... ......... ........... ...........
J7191 N Factor VIII (porcine).. ......... ......... ......... ........... ...........
J7192 N Factor viii recombinant ......... ......... ......... ........... ...........
[[Page 35394]]
J7194 N Factor ix complex...... ......... ......... ......... ........... ...........
J7196 N Othr hemophilia clot ......... ......... ......... ........... ...........
factors.
J7197 N Antithrombin iii ......... ......... ......... ........... ...........
injection.
J7300 E Intraut copper ......... ......... ......... ........... ...........
contraceptive.
J7310 N Ganciclovir long act ......... ......... ......... ........... ...........
implant.
J7500 N Azathiop po tab 50mg ......... ......... ......... ........... ...........
100s ea.
J7501 N Azathioprine parenteral ......... ......... ......... ........... ...........
J7503 N Cyclosporine parenteral ......... ......... ......... ........... ...........
J7504 N Lymphocyte immune ......... ......... ......... ........... ...........
globulin.
J7505 N Monoclonal antibodies.. ......... ......... ......... ........... ...........
J7506 N Prednisone oral........ ......... ......... ......... ........... ...........
J7507 N Tacrolimus oral per 1 ......... ......... ......... ........... ...........
MG.
J7508 N Tacrolimus oral per 5 ......... ......... ......... ........... ...........
MG.
J7509 N Methylprednisolone oral ......... ......... ......... ........... ...........
J7510 N Prednisolone oral per 5 ......... ......... ......... ........... ...........
mg.
J7599 N Immunosuppressive drug ......... ......... ......... ........... ...........
noc.
J7610 A Acetylcysteine 10% ......... ......... ......... ........... ...........
injection.
J7615 A Acetylcysteine 20% ......... ......... ......... ........... ...........
injection.
J7620 A Albuterol sulfate .083%/ ......... ......... ......... ........... ...........
ml.
J7625 A Albuterol sulfate .5% ......... ......... ......... ........... ...........
inj.
J7627 A Bitolterolmesylate ......... ......... ......... ........... ...........
inhal sol.
J7630 A Cromolyn sodium ......... ......... ......... ........... ...........
injeciton.
J7640 A Epinephrine injection.. ......... ......... ......... ........... ...........
J7645 A Ipratropium bromide ......... ......... ......... ........... ...........
.02%/ml.
J7650 A Isoetharine hcl .1% inj ......... ......... ......... ........... ...........
J7651 A Isoetharine hcl .125% ......... ......... ......... ........... ...........
inj.
J7652 A Isoetharine hcl .167% ......... ......... ......... ........... ...........
inj.
J7653 A Isoetharine hcl .2%/ ......... ......... ......... ........... ...........
inj.
J7654 A Isoetharine hcl .25% ......... ......... ......... ........... ...........
inj.
J7655 A Isoetharine hcl 1% inj. ......... ......... ......... ........... ...........
J7660 A Isoproterenol hcl .5% ......... ......... ......... ........... ...........
inj.
J7665 A Isoproterenol hcl 1% ......... ......... ......... ........... ...........
inj.
J7670 A Metaproterenol sulfate ......... ......... ......... ........... ...........
.4%.
J7672 A Metaproterenol sulfate ......... ......... ......... ........... ...........
.6%.
J7675 A Metaproterenol sulfate ......... ......... ......... ........... ...........
5%.
J7699 A Inhalation solution for ......... ......... ......... ........... ...........
DME.
J7799 A Non-inhalation drug for ......... ......... ......... ........... ...........
DME.
J8499 E Oral prescrip drug non ......... ......... ......... ........... ...........
chemo.
J8530 N Cyclophosphamide oral ......... ......... ......... ........... ...........
25 MG.
J8560 N Etoposide oral 50 MG... ......... ......... ......... ........... ...........
J8600 N Melphalan oral 2 MG.... ......... ......... ......... ........... ...........
J8610 X Methotrexate oral 2.5 061 1.15 $59.13 $37.52 $11.83
MG.
J8999 X Oral prescription drug 061 1.15 $59.13 $37.52 $11.83
chemo.
J9000 X Doxorubic hcl 10 MG vl 062 1.78 $91.53 $36.61 $18.31
chemo.
\2\ J901 X Doxorubicin hcl 50 MG 063 2.94 $151.17 $110.97 $30.24
0 inj.
J9015 X Aldesleukin/single use 061 1.15 $59.13 $37.52 $11.83
vial.
J9020 X Asparaginase injection. 062 1.78 $91.53 $36.61 $18.31
J9031 X Bcg live intravesical 063 2.94 $151.17 $110.97 $30.24
vac.
J9040 X Bleomycin sulfate 063 2.94 $151.17 $110.97 $30.24
injection.
J9045 X Carboplatin injection.. 063 2.94 $151.17 $110.97 $30.24
J9050 X Carmus bischl nitro inj 063 2.94 $151.17 $110.97 $30.24
J9060 X Cisplatin 10 MG 062 1.78 $91.53 $36.61 $18.31
injection.
J9062 X Cisplatin 50 MG 063 2.94 $151.17 $110.97 $30.24
injection.
J9065 X Inj cladribine per 1 MG 062 1.78 $91.53 $36.61 $18.31
J9070 X Cyclophosphamide 100 MG 061 1.15 $59.13 $37.52 $11.83
inj.
J9080 X Cyclophosphamide 200 MG 061 1.15 $59.13 $37.52 $11.83
inj.
J9090 X Cyclophosphamide 500 MG 061 1.15 $59.13 $37.52 $11.83
inj.
J9091 X Cyclophosphamide 1.0 062 1.78 $91.53 $36.61 $18.31
grm inj.
J9092 X Cyclophosphamide 2.0 062 1.78 $91.53 $36.61 $18.31
grm inj.
J9093 X Cyclophosphamide 061 1.15 $59.13 $37.52 $11.83
lyophilized.
J9094 X Cyclophosphamide 061 1.15 $59.13 $37.52 $11.83
lyophilized.
J9095 X Cyclophosphamide 061 1.15 $59.13 $37.52 $11.83
lyophilized.
J9096 X Cyclophosphamide 062 1.78 $91.53 $36.61 $18.31
lyophilized.
J9097 X Cyclophosphamide 062 1.78 $91.53 $36.61 $18.31
lyophilized.
J9100 X Cytarabine hcl 100 MG 061 1.15 $59.13 $37.52 $11.83
inj.
J9110 X Cytarabine hcl 500 MG 061 1.15 $59.13 $37.52 $11.83
inj.
J9120 X Dactinomycin 061 1.15 $59.13 $37.52 $11.83
actinomycin d.
J9130 X Dacarbazine 10 MG inj.. 061 1.15 $59.13 $37.52 $11.83
J9140 X Dacarbazine 200 MG inj. 061 1.15 $59.13 $37.52 $11.83
J9150 X Daunorubicin........... 062 1.78 $91.53 $36.61 $18.31
J9165 X Diethylstilbestrol 061 1.15 $59.13 $37.52 $11.83
injection.
J9170 X Docetaxel.............. 061 1.15 $59.13 $37.52 $11.83
J9181 X Etoposide 10 MG inj.... 061 1.15 $59.13 $37.52 $11.83
J9182 X Etoposide 100 MG inj... 063 2.94 $151.17 $110.97 $30.24
J9185 X Fludarabine phosphate 063 2.94 $151.17 $110.97 $30.24
inj.
[[Page 35395]]
J9190 X Fluorouracil injection. 061 1.15 $59.13 $37.52 $11.83
J9200 X Floxuridine injection.. 063 2.94 $151.17 $110.97 $30.24
J9201 X Gemcitabine HCl........ 061 1.15 $59.13 $37.52 $11.83
J9202 X Goserelin acetate 063 2.94 $151.17 $110.97 $30.24
implant.
J9206 X Irinotecan injection... 061 1.15 $59.13 $37.52 $11.83
J9208 X Ifosfomide injection... 063 2.94 $151.17 $110.97 $30.24
J9209 X Mesna injection........ 063 2.94 $151.17 $110.97 $30.24
J9211 X Idarubicin hcl 062 1.78 $91.53 $36.61 $18.31
injeciton.
J9213 X Interferon alfa-2a inj. 062 1.78 $91.53 $36.61 $18.31
J9214 X Interferon alfa-2b inj. 061 1.15 $59.13 $37.52 $11.83
J9215 X Interferon alfa-n3 inj. 061 1.15 $59.13 $37.52 $11.83
J9216 X Interferon gamma 1-b 063 2.94 $151.17 $110.97 $30.24
inj.
J9217 X Leuprolide acetate 064 4.15 $213.39 $138.99 $42.68
suspnsion.
J9218 X Leuprolide acetate 061 1.15 $59.13 $37.52 $11.83
injeciton.
J9230 X Mechlorethamine hcl inj 061 1.15 $59.13 $37.52 $11.83
J9245 X Inj melphalan hydrochl 064 4.15 $213.39 $138.99 $42.68
50 MG.
J9250 X Methotrexate sodium inj 061 1.15 $59.13 $37.52 $11.83
J9260 X Methotrexate sodium inj 061 1.15 $59.13 $37.52 $11.83
J9265 X Paclitaxel injection... 062 1.78 $91.53 $36.61 $18.31
J9266 X Pegaspargase/singl dose 061 1.15 $59.13 $37.52 $11.83
vial.
J9268 X Pentostatin injection.. 062 1.78 $91.53 $36.61 $18.31
J9270 X Plicamycin 063 2.94 $151.17 $110.97 $30.24
(mithramycin) inj.
J9280 X Mitomycin 5 MG inj..... 063 2.94 $151.17 $110.97 $30.24
J9290 X Mitomycin 20 MG inj.... 064 4.15 $213.39 $138.99 $42.68
J9291 X Mitomycin 40 MG inj.... 064 4.15 $213.39 $138.99 $42.68
J9293 X Mitoxantrone hydrochl / 064 4.15 $213.39 $138.99 $42.68
5 MG.
J9320 X Streptozocin injection. 063 2.94 $151.17 $110.97 $30.24
J9340 X Thiotepa injection..... 063 2.94 $151.17 $110.97 $30.24
J9350 X Topotecan.............. 061 1.15 $59.13 $37.52 $11.83
J9360 X Vinblastine sulfate inj 061 1.15 $59.13 $37.52 $11.83
J9370 X Vincristine sulfate 1 062 1.78 $91.53 $36.61 $18.31
MG inj.
J9375 X Vincristine sulfate 2 063 2.94 $151.17 $110.97 $30.24
MG inj.
J9380 X Vincristine sulfate 5 063 2.94 $151.17 $110.97 $30.24
MG inj.
J9390 X Vinorelbine tartrate/10 061 1.15 $59.13 $37.52 $11.83
mg.
J9600 X Porfimer sodium........ 061 1.15 $59.13 $37.52 $11.83
J9999 X Chemotherapy drug...... 061 1.15 $59.13 $37.52 $11.83
K0001 A Standard wheelchair.... ......... ......... ......... ........... ...........
K0002 A Stnd hemi (low seat) ......... ......... ......... ........... ...........
whlchr.
K0003 A Lightweight wheelchair. ......... ......... ......... ........... ...........
K0004 A High strength ltwt ......... ......... ......... ........... ...........
whlchr.
K0005 A Ultralightweight ......... ......... ......... ........... ...........
wheelchair.
K0006 A Heavy duty wheelchair.. ......... ......... ......... ........... ...........
K0007 A Extra heavy duty ......... ......... ......... ........... ...........
wheelchair.
K0008 A Cstm manual wheelchair/ ......... ......... ......... ........... ...........
base.
K0009 A Other manual wheelchair/ ......... ......... ......... ........... ...........
base.
K0010 A Stnd wt frame power ......... ......... ......... ........... ...........
whlchr.
K0011 A Stnd wt pwr whlchr w ......... ......... ......... ........... ...........
control.
K0012 A Ltwt portbl power ......... ......... ......... ........... ...........
whlchr.
K0013 A Custom power whlchr ......... ......... ......... ........... ...........
base.
K0014 A Other power whlchr base ......... ......... ......... ........... ...........
K0015 A Detach non-adjus hght ......... ......... ......... ........... ...........
armrst.
K0016 A Detach adjust armrst ......... ......... ......... ........... ...........
cmplete.
K0017 A Detach adjust armrest ......... ......... ......... ........... ...........
base.
K0018 A Detach adjust armrst ......... ......... ......... ........... ...........
upper.
K0019 A Arm pad each........... ......... ......... ......... ........... ...........
K0020 A Fixed adjust armrest ......... ......... ......... ........... ...........
pair.
K0021 A Anti-tipping device ......... ......... ......... ........... ...........
each.
K0022 A Reinforced back ......... ......... ......... ........... ...........
upholstery.
K0023 A Planr back insrt foam w/ ......... ......... ......... ........... ...........
strp.
K0024 A Plnr back insrt foam w/ ......... ......... ......... ........... ...........
hrdwr.
K0025 A Hook-on headrest ......... ......... ......... ........... ...........
extension.
K0026 A Back upholst lgtwt ......... ......... ......... ........... ...........
whlchr.
K0027 A Back upholst other ......... ......... ......... ........... ...........
whlchr.
K0028 A Fully reclining back... ......... ......... ......... ........... ...........
K0029 A Reinforced seat ......... ......... ......... ........... ...........
upholstery.
K0030 A Solid plnr seat sngl ......... ......... ......... ........... ...........
dnsfoam.
K0031 A Safety belt/pelvic ......... ......... ......... ........... ...........
strap.
K0032 A Seat uphols lgtwt ......... ......... ......... ........... ...........
whlchr.
K0033 A Seat upholstery other ......... ......... ......... ........... ...........
whlchr.
K0034 A Heel loop each......... ......... ......... ......... ........... ...........
K0035 A Heel loop with ankle ......... ......... ......... ........... ...........
strap.
K0036 A Toe loop each.......... ......... ......... ......... ........... ...........
K0037 A High mount flip-up ......... ......... ......... ........... ...........
footrest.
K0038 A Leg strap each......... ......... ......... ......... ........... ...........
K0039 A Leg strap h style each. ......... ......... ......... ........... ...........
[[Page 35396]]
K0040 A Adjustable angle ......... ......... ......... ........... ...........
footplate.
K0041 A Large size footplate ......... ......... ......... ........... ...........
each.
K0042 A Standard size footplate ......... ......... ......... ........... ...........
each.
K0043 A Ftrst lower extension ......... ......... ......... ........... ...........
tube.
K0044 A Ftrst upper hanger ......... ......... ......... ........... ...........
bracket.
K0045 A Footrest complete ......... ......... ......... ........... ...........
assembly.
K0046 A Elevat legrst low ......... ......... ......... ........... ...........
extension.
K0047 A Elevat legrst up hangr ......... ......... ......... ........... ...........
brack.
K0048 A Elevate legrest ......... ......... ......... ........... ...........
complete.
K0049 A Calf pad each.......... ......... ......... ......... ........... ...........
K0050 A Ratchet assembly....... ......... ......... ......... ........... ...........
K0051 A Cam relese assem ftrst/ ......... ......... ......... ........... ...........
lgrst.
K0052 A Swingaway detach ......... ......... ......... ........... ...........
footrest.
K0053 A Elevate footrest ......... ......... ......... ........... ...........
articulate.
K0054 A Seat wdth 10-12/15/17/ ......... ......... ......... ........... ...........
20 wc.
K0055 A Seat dpth 15/17/18 ltwt ......... ......... ......... ........... ...........
wc.
K0056 A Seat ht <17 or >=21 ......... ......... ......... ........... ...........
ltwt wc.
K0057 A Seat wdth 19/20 hvy dty ......... ......... ......... ........... ...........
wc.
K0058 A Seat dpth 17/18 power ......... ......... ......... ........... ...........
wc.
K0059 A Plastic coated handrim ......... ......... ......... ........... ...........
each.
K0060 A Steel handrim each..... ......... ......... ......... ........... ...........
K0061 A Aluminum handrim each.. ......... ......... ......... ........... ...........
K0062 A Handrim 8-10 vert/obliq ......... ......... ......... ........... ...........
proj.
K0063 A Hndrm 12-16 vert/obliq ......... ......... ......... ........... ...........
proj.
K0064 A Zero pressure tube flat ......... ......... ......... ........... ...........
free.
K0065 A Spoke protectors....... ......... ......... ......... ........... ...........
K0066 A Solid tire any size ......... ......... ......... ........... ...........
each.
K0067 A Pneumatic tire any size ......... ......... ......... ........... ...........
each.
K0068 A Pneumatic tire tube ......... ......... ......... ........... ...........
each.
K0069 A Rear whl complete solid ......... ......... ......... ........... ...........
tire.
K0070 A Rear whl compl pneum ......... ......... ......... ........... ...........
tire.
K0071 A Front castr compl pneum ......... ......... ......... ........... ...........
tire.
K0072 A Frnt cstr cmpl sem- ......... ......... ......... ........... ...........
pneum tir.
K0073 A Caster pin lock each... ......... ......... ......... ........... ...........
K0074 A Pneumatic caster tire ......... ......... ......... ........... ...........
each.
K0075 A Semi-pneumatic caster ......... ......... ......... ........... ...........
tire.
K0076 A Solid caster tire each. ......... ......... ......... ........... ...........
K0077 A Front caster assem ......... ......... ......... ........... ...........
complete.
K0078 A Pneumatic caster tire ......... ......... ......... ........... ...........
tube.
K0079 A Wheel lock extension ......... ......... ......... ........... ...........
pair.
K0080 A Anti-rollback device ......... ......... ......... ........... ...........
pair.
K0081 A Wheel lock assembly ......... ......... ......... ........... ...........
complete.
K0082 A 22 nf deep cycl acid ......... ......... ......... ........... ...........
battery.
K0083 A 22 nf gel cell battery ......... ......... ......... ........... ...........
each.
K0084 A Grp 24 deep cycl acid ......... ......... ......... ........... ...........
battry.
K0085 A Group 24 gel cell ......... ......... ......... ........... ...........
battery.
K0086 A U-1 lead acid battery ......... ......... ......... ........... ...........
each.
K0087 A U-1 gel cell battery ......... ......... ......... ........... ...........
each.
K0088 A Battry chrgr acid/gel ......... ......... ......... ........... ...........
cell.
K0089 A Battery charger dual ......... ......... ......... ........... ...........
mode.
K0090 A Rear tire power ......... ......... ......... ........... ...........
wheelchair.
K0091 A Rear tire tube power ......... ......... ......... ........... ...........
whlchr.
K0092 A Rear assem cmplt powr ......... ......... ......... ........... ...........
whlchr.
K0093 A Rear zero pressure tire ......... ......... ......... ........... ...........
tube.
K0094 A Wheel tire for power ......... ......... ......... ........... ...........
base.
K0095 A Wheel tire tube each ......... ......... ......... ........... ...........
base.
K0096 A Wheel assem powr base ......... ......... ......... ........... ...........
complt.
K0097 A Wheel zero presure tire ......... ......... ......... ........... ...........
tube.
K0098 A Drive belt power ......... ......... ......... ........... ...........
wheelchair.
K0099 A Front caster power ......... ......... ......... ........... ...........
whelchair.
K0100 A Amputee adapter pair... ......... ......... ......... ........... ...........
K0101 A One-arm drive ......... ......... ......... ........... ...........
attachment.
K0102 A Crutch and cane holder. ......... ......... ......... ........... ...........
K0103 A Transfer board < 25"... ......... ......... ......... ........... ...........
K0104 A Cylinder tank carrier.. ......... ......... ......... ........... ...........
K0105 A Iv hanger.............. ......... ......... ......... ........... ...........
K0106 A Arm trough each........ ......... ......... ......... ........... ...........
K0107 A Wheelchair tray........ ......... ......... ......... ........... ...........
K0108 A Other accessories...... ......... ......... ......... ........... ...........
K0109 A Customize whlchr base ......... ......... ......... ........... ...........
frame.
K0112 A Trunk vest supprt innr ......... ......... ......... ........... ...........
frame.
K0113 A Trunk vest suprt w/o ......... ......... ......... ........... ...........
inr frm.
K0114 A Whlchr back suprt inr ......... ......... ......... ........... ...........
frame.
K0115 A Back module orthotic ......... ......... ......... ........... ...........
system.
K0116 A Back & seat modul ......... ......... ......... ........... ...........
orthot sys.
[[Page 35397]]
K0119 N Azathioprine oral tab ......... ......... ......... ........... ...........
50 MG.
K0120 N Azathioprine prentrl ......... ......... ......... ........... ...........
100 MG.
K0121 N Cyclosporine oral 25 MG ......... ......... ......... ........... ...........
K0122 N Cyclosporine prentrl ......... ......... ......... ........... ...........
250 MG.
K0123 N Imun/antitymocyt glob ......... ......... ......... ........... ...........
250 MG.
K0137 A Skin barrier liquid per ......... ......... ......... ........... ...........
oz.
K0138 A Skin barrier paste per ......... ......... ......... ........... ...........
oz.
K0139 A Skin barrier powder per ......... ......... ......... ........... ...........
oz.
K0168 A Disposable nebulizer ......... ......... ......... ........... ...........
set.
K0169 A Disposable nebulizer ......... ......... ......... ........... ...........
small.
K0170 A Non disposable ......... ......... ......... ........... ...........
nebulizer set.
K0171 A Filtered nebulizer set. ......... ......... ......... ........... ...........
K0172 A Disposable nebulizer ......... ......... ......... ........... ...........
unfill.
K0173 A Disposable nebulizer ......... ......... ......... ........... ...........
prefill.
K0174 A Reservoir bottle w ......... ......... ......... ........... ...........
nebulizer.
K0175 A Disposable corrugated ......... ......... ......... ........... ...........
tubing.
K0176 A Non dispos corrugated ......... ......... ......... ........... ...........
tubing.
K0177 A Water collec dev w ......... ......... ......... ........... ...........
nebulizer.
K0178 A Disposbl filter w ......... ......... ......... ........... ...........
compressor.
K0179 A Non-dispos filter w/ ......... ......... ......... ........... ...........
compress.
K0180 A Aerosol mask with ......... ......... ......... ........... ...........
nebulizer.
K0181 A Dome & mouthpiece w/ ......... ......... ......... ........... ...........
nebuliz.
K0182 A Water distilled w/ ......... ......... ......... ........... ...........
nebulizer.
K0183 A Nasal application ......... ......... ......... ........... ...........
device.
K0184 A Nasal pillows/seals ......... ......... ......... ........... ...........
pair.
K0185 A Pos airway pressure ......... ......... ......... ........... ...........
headgear.
K0186 A Pos airway prssure ......... ......... ......... ........... ...........
chinstrap.
K0187 A Pos airway pressure ......... ......... ......... ........... ...........
tubing.
K0188 A Pos airway pressure ......... ......... ......... ........... ...........
filter.
K0189 A Filter nondisposable w ......... ......... ......... ........... ...........
PAP.
K0190 A Disposable canister w/ ......... ......... ......... ........... ...........
pump.
K0191 A Non-disposbl canister w/ ......... ......... ......... ........... ...........
pump.
K0192 A Tubing used w/ suction ......... ......... ......... ........... ...........
pump.
K0193 A Airway pressure dev/w ......... ......... ......... ........... ...........
hmdfer.
K0194 A Assist device w/ ......... ......... ......... ........... ...........
humidifier.
K0195 A Elevating whlchair leg ......... ......... ......... ........... ...........
rests.
K0268 A Humidifier nonheated w ......... ......... ......... ........... ...........
PAP.
K0269 A Aerosol compressor cpap ......... ......... ......... ........... ...........
dev.
K0270 A Ultrasonic generator w ......... ......... ......... ........... ...........
nebul.
K0277 A Skin barrier solid 4x4 ......... ......... ......... ........... ...........
equiv.
K0278 A Skin barrier with ......... ......... ......... ........... ...........
flange.
K0279 A Skin barrier extended ......... ......... ......... ........... ...........
wear.
K0280 A Extension drainage ......... ......... ......... ........... ...........
tubing.
K0281 A Lubricant catheter ......... ......... ......... ........... ...........
insertion.
K0283 A Saline solution ......... ......... ......... ........... ...........
dispenser.
K0284 A External infusion pump ......... ......... ......... ........... ...........
reuse.
K0400 A Skin support attachment ......... ......... ......... ........... ...........
each.
K0401 A Diabetic deluxe shoe... ......... ......... ......... ........... ...........
K0407 A Urinary cath skin ......... ......... ......... ........... ...........
attachment.
K0408 A Urinary cath leg strap. ......... ......... ......... ........... ...........
K0409 A Sterile H2O irrigation ......... ......... ......... ........... ...........
solut.
K0410 A Male ext cath w/adh ......... ......... ......... ........... ...........
coating.
K0411 A Male ext cath w/adh ......... ......... ......... ........... ...........
strip.
K0412 N Mycophenolate mofetil ......... ......... ......... ........... ...........
25o mg.
K0415 N RX antiemetic drg, oral ......... ......... ......... ........... ...........
NOS.
K0416 N Rx antiemetic ......... ......... ......... ........... ...........
drg,rectal NOS.
K0417 A Mech infus pump sht trm ......... ......... ......... ........... ...........
drug.
K0418 N Oral cyclosporin....... ......... ......... ......... ........... ...........
K0419 A Drainable plstic pch w ......... ......... ......... ........... ...........
fcplt.
K0420 A Drainable rubber pch w ......... ......... ......... ........... ...........
fcplt.
K0421 A drainable plstic pch w/ ......... ......... ......... ........... ...........
o fp.
K0422 A Drainable rubber pch w/ ......... ......... ......... ........... ...........
o fp.
K0423 A Urinary plstic pouch w ......... ......... ......... ........... ...........
fcplt.
K0424 A Urinary rubber pouch w ......... ......... ......... ........... ...........
fcplt.
K0425 A Urinary plstic pouch w/ ......... ......... ......... ........... ...........
o fp.
K0426 A Urinary hvy plstc pch w/ ......... ......... ......... ........... ...........
o fp.
K0427 A Urinary rubber pouch w/ ......... ......... ......... ........... ...........
o fp.
K0428 A Ostomy faceplt/silicone ......... ......... ......... ........... ...........
ring.
K0429 A Skin barrier solid ext ......... ......... ......... ........... ...........
wear.
K0430 A Skin barrier w flang ex ......... ......... ......... ........... ...........
wear.
K0431 A Closed pouch w st wear ......... ......... ......... ........... ...........
bar.
K0432 A Drainable pch w ex wear ......... ......... ......... ........... ...........
bar.
K0433 A Drainable pch w st wear ......... ......... ......... ........... ...........
bar.
K0434 A Drainable pch ex wear ......... ......... ......... ........... ...........
convex.
K0435 A Urinary pouch w ex wear ......... ......... ......... ........... ...........
bar.
[[Page 35398]]
K0436 A Urinary pouch w st wear ......... ......... ......... ........... ...........
bar.
K0437 A Urine pch w ex wear bar ......... ......... ......... ........... ...........
conv.
K0438 A Ostomy pouch liq ......... ......... ......... ........... ...........
deodorant.
K0439 A Ostomy pouch solid ......... ......... ......... ........... ...........
deodorant.
K0440 A Nasal prosthesis....... ......... ......... ......... ........... ...........
K0441 A Midfacial prosthesis... ......... ......... ......... ........... ...........
K0442 A Orbital prosthesis..... ......... ......... ......... ........... ...........
K0443 A Upper facial prosthesis ......... ......... ......... ........... ...........
K0444 A Hemi-facial prosthesis. ......... ......... ......... ........... ...........
K0445 A Auricular prosthesis... ......... ......... ......... ........... ...........
K0446 A Partial facial ......... ......... ......... ........... ...........
prosthesis.
K0447 A Nasal septal prosthesis ......... ......... ......... ........... ...........
K0448 A Unspec maxillofacial ......... ......... ......... ........... ...........
prosth.
K0449 A Repair maxillofacial ......... ......... ......... ........... ...........
prosth.
K0450 A Liq adhes for facial ......... ......... ......... ........... ...........
prosth.
K0451 A Adhesive remover wipes. ......... ......... ......... ........... ...........
K0452 A Wheelchair bearings.... ......... ......... ......... ........... ...........
\2\ K045 N Amphotericin B......... ......... ......... ......... ........... ...........
3
K0455 A Pump uninterrupted ......... ......... ......... ........... ...........
infusion.
K0501 A Aerosol compressor for ......... ......... ......... ........... ...........
svneb.
K0503 A Acetylcysteine inh sol ......... ......... ......... ........... ...........
u d.
K0504 A Albuterol inh sol con.. ......... ......... ......... ........... ...........
K0505 A Albuterol inh sol u d.. ......... ......... ......... ........... ...........
K0506 A Atropine inh sol con... ......... ......... ......... ........... ...........
K0507 A Atropine inh sol u d... ......... ......... ......... ........... ...........
K0508 A Bitolterol mes inh sol ......... ......... ......... ........... ...........
con.
K0509 A Bitolterol mes inh sol ......... ......... ......... ........... ...........
u d.
K0511 A Cromolyn sodium inh sol ......... ......... ......... ........... ...........
u d.
K0512 A Dexamethasone inh sol ......... ......... ......... ........... ...........
con.
K0513 A Dexamethasone inh sol u ......... ......... ......... ........... ...........
d.
K0514 A Dornase alpha inh sol u ......... ......... ......... ........... ...........
d.
K0515 A Glycopyrrolate inh sol ......... ......... ......... ........... ...........
con.
K0516 A Glycopyrrolate inh sol ......... ......... ......... ........... ...........
u d.
K0518 A Ipratropium brom inh ......... ......... ......... ........... ...........
sol u d.
K0519 A Isoetharine HCl inh sol ......... ......... ......... ........... ...........
con.
K0520 A Isoetharine HCl inh sol ......... ......... ......... ........... ...........
u d.
K0521 A IsoproterenolHCl inh ......... ......... ......... ........... ...........
sol con.
K0522 A IsoproterenolHCl inh ......... ......... ......... ........... ...........
sol u d.
K0523 A Metaproterenol inh sol ......... ......... ......... ........... ...........
con.
K0524 A Metaproterenol inh sol ......... ......... ......... ........... ...........
u d.
K0525 A Terbutaline SO4 inh sol ......... ......... ......... ........... ...........
con.
K0526 A Terbutaline SO4 inh sol ......... ......... ......... ........... ...........
u d.
K0527 A Triamcinolone inh sol ......... ......... ......... ........... ...........
con.
K0528 A Triamcinolone inh sol u ......... ......... ......... ........... ...........
d.
K0529 A Sterile H20 or nss w lv ......... ......... ......... ........... ...........
neb.
K0530 A Nebulizer not used w ......... ......... ......... ........... ...........
oxygen.
L0100 A Cerv craniosten helmet ......... ......... ......... ........... ...........
mold.
L0110 A Cerv craniostenosis hel ......... ......... ......... ........... ...........
non-.
L0120 A Cerv flexible non- ......... ......... ......... ........... ...........
adjustable.
L0130 A Flex thermoplastic ......... ......... ......... ........... ...........
collar mo.
L0140 A Cervical semi-rigid ......... ......... ......... ........... ...........
adjustab.
L0150 A Cerv semi-rig adj ......... ......... ......... ........... ...........
molded chn.
L0160 A Cerv semi-rig wire occ/ ......... ......... ......... ........... ...........
mand.
L0170 A Cervical collar molded ......... ......... ......... ........... ...........
to pt.
L0172 A Cerv col thermplas foam ......... ......... ......... ........... ...........
2 pi.
L0174 A Cerv col foam 2 piece w ......... ......... ......... ........... ...........
thor.
L0180 A Cer post col occ/man ......... ......... ......... ........... ...........
sup adj.
L0190 A Cerv collar supp adj ......... ......... ......... ........... ...........
cerv ba.
L0200 A Cerv col supp adj bar & ......... ......... ......... ........... ...........
thor.
L0210 A Thoracic rib belt...... ......... ......... ......... ........... ...........
L0220 A Thor rib belt custom ......... ......... ......... ........... ...........
fabrica.
L0300 A TLSO flex surgical ......... ......... ......... ........... ...........
support.
L0310 A Tlso flexible custom ......... ......... ......... ........... ...........
fabrica.
L0315 A Tlso flex elas rigid ......... ......... ......... ........... ...........
post pa.
L0317 A Tlso flex hypext elas ......... ......... ......... ........... ...........
post p.
L0320 A Tlso a-p contrl w apron ......... ......... ......... ........... ...........
frnt.
L0330 A Tlso ant-pos-lateral ......... ......... ......... ........... ...........
control.
L0340 A Tlso a-p-l-rotary with ......... ......... ......... ........... ...........
apron.
L0350 A Tlso flex compress ......... ......... ......... ........... ...........
jacket cu.
L0360 A Tlso flex compress ......... ......... ......... ........... ...........
jacket mo.
L0370 A Tlso a-p-l-rotary ......... ......... ......... ........... ...........
hyperexten.
L0380 A Tlso a-p-l-rot w/ pos ......... ......... ......... ........... ...........
extens.
L0390 A Tlso a-p-l control ......... ......... ......... ........... ...........
molded.
L0400 A Tlso a-p-l w interface ......... ......... ......... ........... ...........
mater.
L0410 A Tlso a-p-l two piece ......... ......... ......... ........... ...........
constr.
[[Page 35399]]
L0420 A Tlso a-p-l 2 piece w ......... ......... ......... ........... ...........
interfa.
L0430 A Tlso a-p-l w interface ......... ......... ......... ........... ...........
custm.
L0440 A Tlso a-p-l overlap frnt ......... ......... ......... ........... ...........
cust.
L0500 A Lso flex surgical ......... ......... ......... ........... ...........
support.
L0510 A Lso flexible custom ......... ......... ......... ........... ...........
fabricat.
L0515 A Lso flex elas w/ rig ......... ......... ......... ........... ...........
post pa.
L0520 A Lso a-p-l control with ......... ......... ......... ........... ...........
apron.
L0530 A Lso ant-pos control w ......... ......... ......... ........... ...........
apron.
L0540 A Lso lumbar flexion a-p- ......... ......... ......... ........... ...........
l.
L0550 A Lso a-p-l control ......... ......... ......... ........... ...........
molded.
L0560 A Lso a-p-l w interface.. ......... ......... ......... ........... ...........
L0565 A Lso a-p-l control ......... ......... ......... ........... ...........
custom.
L0600 A Sacroiliac flex surg ......... ......... ......... ........... ...........
support.
L0610 A Sacroiliac flexible ......... ......... ......... ........... ...........
custm fa.
L0620 A Sacroiliac semi-rig w ......... ......... ......... ........... ...........
apron.
L0700 A Ctlso a-p-l control ......... ......... ......... ........... ...........
molded.
L0710 A Ctlso a-p-l control w/ ......... ......... ......... ........... ...........
inter.
L0810 A Halo cervical into jckt ......... ......... ......... ........... ...........
vest.
L0820 A Halo cervical into body ......... ......... ......... ........... ...........
jack.
L0830 A Halo cerv into ......... ......... ......... ........... ...........
milwaukee typ.
L0860 A Magnetic resonanc image ......... ......... ......... ........... ...........
comp.
L0900 A Torso/ptosis support... ......... ......... ......... ........... ...........
L0910 A Torso & ptosis supp ......... ......... ......... ........... ...........
custm fa.
L0920 A Torso/pendulous abd ......... ......... ......... ........... ...........
support.
L0930 A Pendulous abdomen supp ......... ......... ......... ........... ...........
custm.
L0940 A Torso/postsurgical ......... ......... ......... ........... ...........
support.
L0950 A Post surg support ......... ......... ......... ........... ...........
custom fab.
L0960 A Post surgical support ......... ......... ......... ........... ...........
pads.
L0970 A Tlso corset front...... ......... ......... ......... ........... ...........
L0972 A Lso corset front....... ......... ......... ......... ........... ...........
L0974 A Tlso full corset....... ......... ......... ......... ........... ...........
L0976 A Lso full corset........ ......... ......... ......... ........... ...........
L0978 A Axillary crutch ......... ......... ......... ........... ...........
extension.
L0980 A Peroneal straps pair... ......... ......... ......... ........... ...........
L0982 A Stocking supp grips set ......... ......... ......... ........... ...........
of f.
L0984 A Protective body sock ......... ......... ......... ........... ...........
each.
L0999 A Add to spinal orthosis ......... ......... ......... ........... ...........
NOS.
L1000 A Ctlso milwauke initial ......... ......... ......... ........... ...........
model.
L1010 A Ctlso axilla sling..... ......... ......... ......... ........... ...........
L1020 A Kyphosis pad........... ......... ......... ......... ........... ...........
L1025 A Kyphosis pad floating.. ......... ......... ......... ........... ...........
L1030 A Lumbar bolster pad..... ......... ......... ......... ........... ...........
L1040 A Lumbar or lumbar rib ......... ......... ......... ........... ...........
pad.
L1050 A Sternal pad............ ......... ......... ......... ........... ...........
L1060 A Thoracic pad........... ......... ......... ......... ........... ...........
L1070 A Trapezius sling........ ......... ......... ......... ........... ...........
L1080 A Outrigger.............. ......... ......... ......... ........... ...........
L1085 A Outrigger bil w/ vert ......... ......... ......... ........... ...........
extens.
L1090 A Lumbar sling........... ......... ......... ......... ........... ...........
L1100 A Ring flange plastic/ ......... ......... ......... ........... ...........
leather.
L1110 A Ring flange plas/ ......... ......... ......... ........... ...........
leather mol.
L1120 A Covers for upright each ......... ......... ......... ........... ...........
L1200 A Furnsh initial orthosis ......... ......... ......... ........... ...........
only.
L1210 A Lateral thoracic ......... ......... ......... ........... ...........
extension.
L1220 A Anterior thoracic ......... ......... ......... ........... ...........
extension.
L1230 A Milwaukee type ......... ......... ......... ........... ...........
superstructur.
L1240 A Lumbar derotation pad.. ......... ......... ......... ........... ...........
L1250 A Anterior asis pad...... ......... ......... ......... ........... ...........
L1260 A Anterior thoracic ......... ......... ......... ........... ...........
derotation.
L1270 A Abdominal pad.......... ......... ......... ......... ........... ...........
L1280 A Rib gusset (elastic) ......... ......... ......... ........... ...........
each.
L1290 A Lateral trochanteric ......... ......... ......... ........... ...........
pad.
L1300 A Body jacket mold to ......... ......... ......... ........... ...........
patient.
L1310 A Post-operative body ......... ......... ......... ........... ...........
jacket.
L1499 A Spinal orthosis NOS.... ......... ......... ......... ........... ...........
L1500 A Thkao mobility frame... ......... ......... ......... ........... ...........
L1510 A Thkao standing frame... ......... ......... ......... ........... ...........
L1520 A Thkao swivel walker.... ......... ......... ......... ........... ...........
L1600 A Abduct hip flex frejka ......... ......... ......... ........... ...........
w cvr.
L1610 A Abduct hip flex frejka ......... ......... ......... ........... ...........
covr.
L1620 A Abduct hip flex pavlik ......... ......... ......... ........... ...........
harne.
L1630 A Abduct control hip semi- ......... ......... ......... ........... ...........
flex.
L1640 A Pelv band/spread bar ......... ......... ......... ........... ...........
thigh c.
L1650 A HO abduction hip ......... ......... ......... ........... ...........
adjustable.
L1660 A HO abduction static ......... ......... ......... ........... ...........
plastic.
[[Page 35400]]
L1680 A Pelvic & hip control ......... ......... ......... ........... ...........
thigh c.
L1685 A Post-op hip abduct ......... ......... ......... ........... ...........
custom fa.
L1686 A HO post-op hip ......... ......... ......... ........... ...........
abduction.
L1700 A Leg perthes orth ......... ......... ......... ........... ...........
toronto typ.
L1710 A Legg perthes orth ......... ......... ......... ........... ...........
newington.
L1720 A Legg perthes orthosis ......... ......... ......... ........... ...........
trilat.
L1730 A Legg perthes orth ......... ......... ......... ........... ...........
scottish r.
L1750 A Legg perthes sling..... ......... ......... ......... ........... ...........
L1755 A Legg perthes patten ......... ......... ......... ........... ...........
bottom t.
L1800 A Knee orthoses elas w ......... ......... ......... ........... ...........
stays.
L1810 A Ko elastic with joints. ......... ......... ......... ........... ...........
L1815 A Elastic with condylar ......... ......... ......... ........... ...........
pads.
L1820 A Ko elas w/ condyle pads ......... ......... ......... ........... ...........
& jo.
L1825 A Ko elastic knee cap.... ......... ......... ......... ........... ...........
L1830 A Ko immobilizer canvas ......... ......... ......... ........... ...........
longit.
L1832 A Ko adj jnt pos rigid ......... ......... ......... ........... ...........
support.
L1834 A Ko w/0 joint rigid ......... ......... ......... ........... ...........
molded to.
L1840 A Ko derot ant cruciate ......... ......... ......... ........... ...........
custom.
L1843 A Ko single upright ......... ......... ......... ........... ...........
custom fit.
L1844 A Ko w/adj jt rot cntrl ......... ......... ......... ........... ...........
molded.
L1845 A Ko w/ adj flex/ext ......... ......... ......... ........... ...........
rotat cus.
L1846 A Ko w adj flex/ext rotat ......... ......... ......... ........... ...........
mold.
L1850 A Ko swedish type........ ......... ......... ......... ........... ...........
L1855 A Ko plas doub upright ......... ......... ......... ........... ...........
jnt mol.
L1858 A Ko polycentric ......... ......... ......... ........... ...........
pneumatic pad.
L1860 A Ko supracondylar socket ......... ......... ......... ........... ...........
mold.
L1870 A Ko doub upright lacers ......... ......... ......... ........... ...........
molde.
L1880 A Ko doub upright cuffs/ ......... ......... ......... ........... ...........
lacers.
L1885 A Knee upright w/ ......... ......... ......... ........... ...........
resistance.
L1900 A Afo sprng wir drsflx ......... ......... ......... ........... ...........
calf bd.
L1902 A Afo ankle gauntlet..... ......... ......... ......... ........... ...........
L1904 A Afo molded ankle ......... ......... ......... ........... ...........
gauntlet.
L1906 A Afo multiligamentus ......... ......... ......... ........... ...........
ankle su.
L1910 A Afo sing bar clasp ......... ......... ......... ........... ...........
attach sh.
L1920 A Afo sing upright w/ ......... ......... ......... ........... ...........
adjust s.
L1930 A Afo plastic............ ......... ......... ......... ........... ...........
L1940 A Afo molded to patient ......... ......... ......... ........... ...........
plasti.
L1945 A Afo molded plas rig ant ......... ......... ......... ........... ...........
tib.
L1950 A Afo spiral molded to pt ......... ......... ......... ........... ...........
plas.
L1960 A Afo pos solid ank ......... ......... ......... ........... ...........
plastic mo.
L1970 A Afo plastic molded w/ ......... ......... ......... ........... ...........
ankle j.
L1980 A Afo sing solid stirrup ......... ......... ......... ........... ...........
calf.
L1990 A Afo doub solid stirrup ......... ......... ......... ........... ...........
calf.
L2000 A Kafo sing fre stirr thi/ ......... ......... ......... ........... ...........
calf.
L2010 A Kafo sng solid stirrup ......... ......... ......... ........... ...........
w/o j.
L2020 A Kafo dbl solid stirrup ......... ......... ......... ........... ...........
band/.
L2030 A Kafo dbl solid stirrup ......... ......... ......... ........... ...........
w/o j.
L2035 A KAFO plastic pediatric ......... ......... ......... ........... ...........
size.
L2036 A Kafo plas doub free ......... ......... ......... ........... ...........
knee mol.
L2037 A Kafo plas sing free ......... ......... ......... ........... ...........
knee mol.
L2038 A Kafo w/o joint multi- ......... ......... ......... ........... ...........
axis an.
L2039 A KAFO, plstic, medlat ......... ......... ......... ........... ...........
rotat con.
L2040 A Hkafo torsion bil rot ......... ......... ......... ........... ...........
straps.
L2050 A Hkafo torsion cable hip ......... ......... ......... ........... ...........
pelv.
L2060 A Hkafo torsion ball ......... ......... ......... ........... ...........
bearing j.
L2070 A Hkafo torsion unilat ......... ......... ......... ........... ...........
rot str.
L2080 A Hkafo unilat torsion ......... ......... ......... ........... ...........
cable.
L2090 A Hkafo unilat torsion ......... ......... ......... ........... ...........
ball br.
L2102 A Afo tibial fx cast ......... ......... ......... ........... ...........
plstr mol.
L2104 A Afo tib fx cast ......... ......... ......... ........... ...........
synthetic mo.
L2106 A Afo tib fx cast plaster ......... ......... ......... ........... ...........
mold.
L2108 A Afo tib fx cast molded ......... ......... ......... ........... ...........
to pt.
L2112 A Afo tibial fracture ......... ......... ......... ........... ...........
soft.
L2114 A Afo tib fx semi-rigid.. ......... ......... ......... ........... ...........
L2116 A Afo tibial fracture ......... ......... ......... ........... ...........
rigid.
L2122 A Kafo fem fx cast ......... ......... ......... ........... ...........
plaster mol.
L2124 A Kafo fem fx cast ......... ......... ......... ........... ...........
synthet mol.
L2126 A Kafo fem fx cast ......... ......... ......... ........... ...........
thermoplas.
L2128 A Kafo fem fx cast molded ......... ......... ......... ........... ...........
to p.
L2132 A Kafo femoral fx cast ......... ......... ......... ........... ...........
soft.
L2134 A Kafo fem fx cast semi- ......... ......... ......... ........... ...........
rigid.
L2136 A Kafo femoral fx cast ......... ......... ......... ........... ...........
rigid.
L2180 A Plas shoe insert w ank ......... ......... ......... ........... ...........
joint.
L2182 A Drop lock knee......... ......... ......... ......... ........... ...........
L2184 A Limited motion knee ......... ......... ......... ........... ...........
joint.
[[Page 35401]]
L2186 A Adj motion knee jnt ......... ......... ......... ........... ...........
lerman t.
L2188 A Quadrilateral brim..... ......... ......... ......... ........... ...........
L2190 A Waist belt............. ......... ......... ......... ........... ...........
L2192 A Pelvic band & belt ......... ......... ......... ........... ...........
thigh fla.
L2200 A Limited ankle motion ea ......... ......... ......... ........... ...........
jnt.
L2210 A Dorsiflexion assist ......... ......... ......... ........... ...........
each joi.
L2220 A Dorsi & plantar flex ......... ......... ......... ........... ...........
ass/res.
L2230 A Split flat caliper ......... ......... ......... ........... ...........
stirr & p.
L2240 A Round caliper and plate ......... ......... ......... ........... ...........
atta.
L2250 A Foot plate molded ......... ......... ......... ........... ...........
stirrup at.
L2260 A Reinforced solid ......... ......... ......... ........... ...........
stirrup.
L2265 A Long tongue stirrup.... ......... ......... ......... ........... ...........
L2270 A Varus/valgus strap ......... ......... ......... ........... ...........
padded/li.
L2275 A Plastic mod low ext pad/ ......... ......... ......... ........... ...........
line.
L2280 A Molded inner boot...... ......... ......... ......... ........... ...........
L2300 A Abduction bar jointed ......... ......... ......... ........... ...........
adjust.
L2310 A Abduction bar-straight. ......... ......... ......... ........... ...........
L2320 A Non-molded lacer....... ......... ......... ......... ........... ...........
L2330 A Lacer molded to patient ......... ......... ......... ........... ...........
mode.
L2335 A Anterior swing band.... ......... ......... ......... ........... ...........
L2340 A Pre-tibial shell molded ......... ......... ......... ........... ...........
to p.
L2350 A Prosthetic type socket ......... ......... ......... ........... ...........
molde.
L2360 A Extended steel shank... ......... ......... ......... ........... ...........
L2370 A Patten bottom.......... ......... ......... ......... ........... ...........
L2375 A Torsion ank & half ......... ......... ......... ........... ...........
solid sti.
L2380 A Torsion straight knee ......... ......... ......... ........... ...........
joint.
L2385 A Straight knee joint ......... ......... ......... ........... ...........
heavy du.
L2390 A Offset knee joint each. ......... ......... ......... ........... ...........
L2395 A Offset knee joint heavy ......... ......... ......... ........... ...........
duty.
L2397 A Suspension sleeve lower ......... ......... ......... ........... ...........
ext.
L2405 A Knee joint drop lock ea ......... ......... ......... ........... ...........
jnt.
L2415 A Knee joint cam lock ......... ......... ......... ........... ...........
each joi.
L2425 A Knee disc/dial lock/adj ......... ......... ......... ........... ...........
flex.
L2430 A Knee jnt ratchet lock ......... ......... ......... ........... ...........
ea jnt.
L2435 A Knee joint polycentric ......... ......... ......... ........... ...........
joint.
L2492 A Knee lift loop drop ......... ......... ......... ........... ...........
lock rin.
L2500 A Thi/glut/ischia wgt ......... ......... ......... ........... ...........
bearing.
L2510 A Th/wght bear quad-lat ......... ......... ......... ........... ...........
brim m.
L2520 A Th/wght bear quad-lat ......... ......... ......... ........... ...........
brim c.
L2525 A Th/wght bear nar m-l ......... ......... ......... ........... ...........
brim mo.
L2526 A Th/wght bear nar m-l ......... ......... ......... ........... ...........
brim cu.
L2530 A Thigh/wght bear lacer ......... ......... ......... ........... ...........
non-mo.
L2540 A Thigh/wght bear lacer ......... ......... ......... ........... ...........
molded.
L2550 A Thigh/wght bear high ......... ......... ......... ........... ...........
roll cu.
L2570 A Hip clevis type 2 posit ......... ......... ......... ........... ...........
jnt.
L2580 A Pelvic control pelvic ......... ......... ......... ........... ...........
sling.
L2600 A Hip clevis/thrust ......... ......... ......... ........... ...........
bearing fr.
L2610 A Hip clevis/thrust ......... ......... ......... ........... ...........
bearing lo.
L2620 A Pelvic control hip ......... ......... ......... ........... ...........
heavy dut.
L2622 A Hip joint adjustable ......... ......... ......... ........... ...........
flexion.
L2624 A Hip adj flex ext abduct ......... ......... ......... ........... ...........
cont.
L2627 A Plastic mold recipro ......... ......... ......... ........... ...........
hip & c.
L2628 A Metal frame recipro hip ......... ......... ......... ........... ...........
& ca.
L2630 A Pelvic control band & ......... ......... ......... ........... ...........
belt u.
L2640 A Pelvic control band & ......... ......... ......... ........... ...........
belt b.
L2650 A Pelv & thor control ......... ......... ......... ........... ...........
gluteal.
L2660 A Thoracic control ......... ......... ......... ........... ...........
thoracic ba.
L2670 A Thorac cont paraspinal ......... ......... ......... ........... ...........
uprig.
L2680 A Thorac cont lat support ......... ......... ......... ........... ...........
upri.
L2750 A Plating chrome/nickel ......... ......... ......... ........... ...........
pr bar.
L2755 A Carbon graphite ......... ......... ......... ........... ...........
lamination.
L2760 A Extension per extension ......... ......... ......... ........... ...........
per.
L2770 A Low ext orthosis per ......... ......... ......... ........... ...........
bar/jnt.
L2780 A Non-corrosive finish... ......... ......... ......... ........... ...........
L2785 A Drop lock retainer each ......... ......... ......... ........... ...........
L2795 A Knee control full ......... ......... ......... ........... ...........
kneecap.
L2800 A Knee cap medial or ......... ......... ......... ........... ...........
lateral p.
L2810 A Knee control condylar ......... ......... ......... ........... ...........
pad.
L2820 A Soft interface below ......... ......... ......... ........... ...........
knee se.
L2830 A Soft interface above ......... ......... ......... ........... ...........
knee se.
L2840 A Tibial length sock fx ......... ......... ......... ........... ...........
or equ.
L2850 A Femoral lgth sock fx or ......... ......... ......... ........... ...........
equa.
L2860 A Torsion mechanism knee/ ......... ......... ......... ........... ...........
ankle.
L2999 A Lower extremity ......... ......... ......... ........... ...........
orthosis NOS.
L3000 A Ft insert ucb berkeley ......... ......... ......... ........... ...........
shell.
[[Page 35402]]
L3001 A Foot insert remov ......... ......... ......... ........... ...........
molded spe.
L3002 A Foot insert plastazote ......... ......... ......... ........... ...........
or eq.
L3003 A Foot insert silicone ......... ......... ......... ........... ...........
gel eac.
L3010 A Foot longitudinal arch ......... ......... ......... ........... ...........
suppo.
L3020 A Foot longitud/ ......... ......... ......... ........... ...........
metatarsal sup.
L3030 A Foot arch support remov ......... ......... ......... ........... ...........
prem.
L3040 A Ft arch suprt premold ......... ......... ......... ........... ...........
longit.
L3050 A Foot arch supp premold ......... ......... ......... ........... ...........
metat.
L3060 A Foot arch supp longitud/ ......... ......... ......... ........... ...........
meta.
L3070 A Arch suprt att to sho ......... ......... ......... ........... ...........
longit.
L3080 A Arch supp att to shoe ......... ......... ......... ........... ...........
metata.
L3090 A Arch supp att to shoe ......... ......... ......... ........... ...........
long/m.
L3100 A Hallus-valgus nght ......... ......... ......... ........... ...........
dynamic s.
L3140 A Abduction rotation bar ......... ......... ......... ........... ...........
shoe.
L3150 A Abduct rotation bar w/o ......... ......... ......... ........... ...........
shoe.
L3160 A Shoe styled positioning ......... ......... ......... ........... ...........
dev.
L3170 A Foot plastic heel ......... ......... ......... ........... ...........
stabilizer.
L3201 A Oxford w supinat/pronat ......... ......... ......... ........... ...........
inf.
L3202 A Oxford w/ supinat/ ......... ......... ......... ........... ...........
pronator c.
L3203 A Oxford w/ supinator/ ......... ......... ......... ........... ...........
pronator.
L3204 A Hightop w/ supp/ ......... ......... ......... ........... ...........
pronator inf.
L3206 A Hightop w/ supp/ ......... ......... ......... ........... ...........
pronator chi.
L3207 A Hightop w/ supp/ ......... ......... ......... ........... ...........
pronator jun.
L3208 A Surgical boot each ......... ......... ......... ........... ...........
infant.
L3209 A Surgical boot each ......... ......... ......... ........... ...........
child.
L3211 A Surgical boot each ......... ......... ......... ........... ...........
junior.
L3212 A Benesch boot pair ......... ......... ......... ........... ...........
infant.
L3213 A Benesch boot pair child ......... ......... ......... ........... ...........
L3214 A Benesch boot pair ......... ......... ......... ........... ...........
junior.
L3215 A Orthopedic ftwear ......... ......... ......... ........... ...........
ladies oxf.
L3216 A Orthoped ladies shoes ......... ......... ......... ........... ...........
dpth i.
L3217 A Ladies shoes hightop ......... ......... ......... ........... ...........
depth i.
L3218 A Ladies surgical boot ......... ......... ......... ........... ...........
each.
L3219 A Orthopedic mens shoes ......... ......... ......... ........... ...........
oxford.
L3221 A Orthopedic mens shoes ......... ......... ......... ........... ...........
dpth i.
L3222 A Mens shoes hightop ......... ......... ......... ........... ...........
depth inl.
L3223 A Mens surgical boot each ......... ......... ......... ........... ...........
L3224 A Woman's shoe oxford ......... ......... ......... ........... ...........
brace.
L3225 A Man's shoe oxford brace ......... ......... ......... ........... ...........
L3230 A Custom shoes depth ......... ......... ......... ........... ...........
inlay.
L3250 A Custom mold shoe remov ......... ......... ......... ........... ...........
prost.
L3251 A Shoe molded to pt ......... ......... ......... ........... ...........
silicone s.
L3252 A Shoe molded plastazote ......... ......... ......... ........... ...........
cust.
L3253 A Shoe molded plastazote ......... ......... ......... ........... ...........
cust.
L3254 A Orth foot non-stndard ......... ......... ......... ........... ...........
size/w.
L3255 A Orth foot non-standard ......... ......... ......... ........... ...........
size/.
L3257 A Orth foot add charge ......... ......... ......... ........... ...........
split s.
L3260 A Ambulatory surgical ......... ......... ......... ........... ...........
boot eac.
L3265 A Plastazote sandal each. ......... ......... ......... ........... ...........
L3300 A Sho lift taper to ......... ......... ......... ........... ...........
metatarsal.
L3310 A Shoe lift elev heel/ ......... ......... ......... ........... ...........
sole neo.
L3320 A Shoe lift elev heel/ ......... ......... ......... ........... ...........
sole cor.
L3330 A Lifts elevation metal ......... ......... ......... ........... ...........
extens.
L3332 A Shoe lifts tapered to ......... ......... ......... ........... ...........
one-ha.
L3334 A Shoe lifts elevation ......... ......... ......... ........... ...........
heel /i.
L3340 A Shoe wedge sach........ ......... ......... ......... ........... ...........
L3350 A Shoe heel wedge........ ......... ......... ......... ........... ...........
L3360 A Shoe sole wedge outside ......... ......... ......... ........... ...........
sole.
L3370 A Shoe sole wedge between ......... ......... ......... ........... ...........
sole.
L3380 A Shoe clubfoot wedge.... ......... ......... ......... ........... ...........
L3390 A Shoe outflare wedge.... ......... ......... ......... ........... ...........
L3400 A Shoe metatarsal bar ......... ......... ......... ........... ...........
wedge ro.
L3410 A Shoe metatarsal bar ......... ......... ......... ........... ...........
between.
L3420 A Full sole/heel wedge ......... ......... ......... ........... ...........
btween.
L3430 A Sho heel count plast ......... ......... ......... ........... ...........
reinfor.
L3440 A Heel leather reinforced ......... ......... ......... ........... ...........
L3450 A Shoe heel sach cushion ......... ......... ......... ........... ...........
type.
L3455 A Shoe heel new leather ......... ......... ......... ........... ...........
standa.
L3460 A Shoe heel new rubber ......... ......... ......... ........... ...........
standar.
L3465 A Shoe heel thomas with ......... ......... ......... ........... ...........
wedge.
L3470 A Shoe heel thomas extend ......... ......... ......... ........... ...........
to b.
L3480 A Shoe heel pad & depress ......... ......... ......... ........... ...........
for.
L3485 A Shoe heel pad removable ......... ......... ......... ........... ...........
for.
L3500 A Ortho shoe add leather ......... ......... ......... ........... ...........
insol.
L3510 A Orthopedic shoe add rub ......... ......... ......... ........... ...........
insl.
[[Page 35403]]
L3520 A O shoe add felt w leath ......... ......... ......... ........... ...........
insl.
L3530 A Ortho shoe add half ......... ......... ......... ........... ...........
sole.
L3540 A Ortho shoe add full ......... ......... ......... ........... ...........
sole.
L3550 A O shoe add standard toe ......... ......... ......... ........... ...........
tap.
L3560 A O shoe add horseshoe ......... ......... ......... ........... ...........
toe tap.
L3570 A O shoe add instep ......... ......... ......... ........... ...........
extension.
L3580 A O shoe add instep ......... ......... ......... ........... ...........
velcro clo.
L3590 A O shoe convert to sof ......... ......... ......... ........... ...........
counte.
L3595 A Ortho shoe add march ......... ......... ......... ........... ...........
bar.
L3600 A Trans shoe calip plate ......... ......... ......... ........... ...........
exist.
L3610 A Trans shoe caliper ......... ......... ......... ........... ...........
plate new.
L3620 A Trans shoe solid ......... ......... ......... ........... ...........
stirrup exi.
L3630 A Trans shoe solid ......... ......... ......... ........... ...........
stirrup new.
L3640 A Shoe dennis browne ......... ......... ......... ........... ...........
splint bo.
L3649 A Orthopedic shoe ......... ......... ......... ........... ...........
modifica NOS.
L3650 A Shlder fig 8 abduct ......... ......... ......... ........... ...........
restrain.
L3660 A Abduct restrainer ......... ......... ......... ........... ...........
canvas&web.
L3670 A Acromio/clavicular ......... ......... ......... ........... ...........
canvas&we.
L3700 A Elbow orthoses elas w ......... ......... ......... ........... ...........
stays.
L3710 A Elbow elastic with ......... ......... ......... ........... ...........
metal joi.
L3720 A Forearm/arm cuffs free ......... ......... ......... ........... ...........
motio.
L3730 A Forearm/arm cuffs ext/ ......... ......... ......... ........... ...........
flex a.
L3740 A Cuffs adj lock w/ ......... ......... ......... ........... ...........
active con.
L3800 A Whfo short opponen no ......... ......... ......... ........... ...........
attach.
L3805 A Whfo long opponens no ......... ......... ......... ........... ...........
attach.
L3810 A Whfo thumb abduction ......... ......... ......... ........... ...........
bar.
L3815 A Whfo second m.p. ......... ......... ......... ........... ...........
abduction a.
L3820 A Whfo ip ext asst w/ mp ......... ......... ......... ........... ...........
ext s.
L3825 A Whfo m.p. extension ......... ......... ......... ........... ...........
stop.
L3830 A Whfo m.p. extension ......... ......... ......... ........... ...........
assist.
L3835 A Whfo m.p. spring ......... ......... ......... ........... ...........
extension a.
L3840 A Whfo spring swivel ......... ......... ......... ........... ...........
thumb.
L3845 A Whfo thumb ip ext ass w/ ......... ......... ......... ........... ...........
mp.
L3850 A Action wrist w/ ......... ......... ......... ........... ...........
dorsiflex as.
L3855 A Whfo adj m.p. flexion ......... ......... ......... ........... ...........
contro.
L3860 A Whfo adj m.p. flex ctrl ......... ......... ......... ........... ...........
& i..
L3890 A Torsion mechanism wrist/ ......... ......... ......... ........... ...........
elbo.
L3900 A Hinge extension/flex ......... ......... ......... ........... ...........
wrist/f.
L3901 A Hinge ext/flex wrist ......... ......... ......... ........... ...........
finger.
L3902 A Whfo ext power compress ......... ......... ......... ........... ...........
gas.
L3904 A Whfo electric custom ......... ......... ......... ........... ...........
fitted.
L3906 A Wrist gauntlet molded ......... ......... ......... ........... ...........
to pt.
L3907 A Whfo wrst gauntlt thmb ......... ......... ......... ........... ...........
spica.
L3908 A Wrist cock-up non- ......... ......... ......... ........... ...........
molded.
L3910 A Whfo swanson design.... ......... ......... ......... ........... ...........
L3912 A Flex glove w/elastic ......... ......... ......... ........... ...........
finger.
L3914 A WHO wrist extension ......... ......... ......... ........... ...........
cock-up.
L3916 A Whfo wrist extens w/ ......... ......... ......... ........... ...........
outrigg.
L3918 A HFO knuckle bender..... ......... ......... ......... ........... ...........
L3920 A Knuckle bender with ......... ......... ......... ........... ...........
outrigge.
L3922 A Knuckle bend 2 seg to ......... ......... ......... ........... ...........
flex j.
L3924 A Oppenheimer............ ......... ......... ......... ........... ...........
L3926 A Thomas suspension...... ......... ......... ......... ........... ...........
L3928 A Finger extension w/ ......... ......... ......... ........... ...........
clock sp.
L3930 A Finger extension with ......... ......... ......... ........... ...........
wrist.
L3932 A Safety pin spring wire. ......... ......... ......... ........... ...........
L3934 A Safety pin modified.... ......... ......... ......... ........... ...........
L3936 A Palmer................. ......... ......... ......... ........... ...........
L3938 A Dorsal wrist........... ......... ......... ......... ........... ...........
L3940 A Dorsal wrist w/ ......... ......... ......... ........... ...........
outrigger at.
L3942 A Reverse knuckle bender. ......... ......... ......... ........... ...........
L3944 A Reverse knuckle bend w/ ......... ......... ......... ........... ...........
outr.
L3946 A HFO composite elastic.. ......... ......... ......... ........... ...........
L3948 A Finger knuckle bender.. ......... ......... ......... ........... ...........
L3950 A Oppenheimer w/ knuckle ......... ......... ......... ........... ...........
bend.
L3952 A Oppenheimer w/ rev ......... ......... ......... ........... ...........
knuckle 2.
L3954 A Spreading hand......... ......... ......... ......... ........... ...........
L3956 A Add joint upper ext ......... ......... ......... ........... ...........
orthosis.
L3960 A Sewho airplan desig ......... ......... ......... ........... ...........
abdu pos.
L3962 A Sewho erbs palsey ......... ......... ......... ........... ...........
design abd.
L3963 A Molded w/ articulating ......... ......... ......... ........... ...........
elbow.
L3964 A Seo mobile arm sup att ......... ......... ......... ........... ...........
to wc.
L3965 A Arm supp att to wc ......... ......... ......... ........... ...........
rancho ty.
L3966 A Mobile arm supports ......... ......... ......... ........... ...........
reclinin.
L3968 A Friction dampening arm ......... ......... ......... ........... ...........
supp.
[[Page 35404]]
L3969 A Monosuspension arm/hand ......... ......... ......... ........... ...........
supp.
L3970 A Elevat proximal arm ......... ......... ......... ........... ...........
support.
L3972 A Offset/lat rocker arm w/ ......... ......... ......... ........... ...........
ela.
L3974 A Mobile arm support ......... ......... ......... ........... ...........
supinator.
L3980 A Upp ext fx orthosis ......... ......... ......... ........... ...........
humeral.
L3982 A Upper ext fx orthosis ......... ......... ......... ........... ...........
rad/ul.
L3984 A Upper ext fx orthosis ......... ......... ......... ........... ...........
wrist.
L3985 A Forearm hand fx orth w/ ......... ......... ......... ........... ...........
wr h.
L3986 A Humeral rad/ulna wrist ......... ......... ......... ........... ...........
fx or.
L3995 A Sock fracture or equal ......... ......... ......... ........... ...........
each.
L3999 A Upper limb orthosis NOS ......... ......... ......... ........... ...........
L4000 A Repl girdle milwaukee ......... ......... ......... ........... ...........
orth.
L4010 A Replace trilateral ......... ......... ......... ........... ...........
socket br.
L4020 A Replace quadlat socket ......... ......... ......... ........... ...........
brim.
L4030 A Replace socket brim ......... ......... ......... ........... ...........
cust fit.
L4040 A Replace molded thigh ......... ......... ......... ........... ...........
lacer.
L4045 A Replace non-molded ......... ......... ......... ........... ...........
thigh lac.
L4050 A Replace molded calf ......... ......... ......... ........... ...........
lacer.
L4055 A Replace non-molded calf ......... ......... ......... ........... ...........
lace.
L4060 A Replace high roll cuff. ......... ......... ......... ........... ...........
L4070 A Replace prox & dist ......... ......... ......... ........... ...........
upright.
L4080 A Repl met band kafo-afo ......... ......... ......... ........... ...........
prox.
L4090 A Repl met band kafo-afo ......... ......... ......... ........... ...........
calf/.
L4100 A Repl leath cuff kafo ......... ......... ......... ........... ...........
prox th.
L4110 A Repl leath cuff kafo- ......... ......... ......... ........... ...........
afo cal.
L4130 A Replace pretibial shell ......... ......... ......... ........... ...........
L4205 A Ortho dvc repair per 15 ......... ......... ......... ........... ...........
min.
L4210 A Orth dev repair/repl ......... ......... ......... ........... ...........
minor p.
\2\ L431 A Mult-podus/eq orth prep ......... ......... ......... ........... ...........
0 mgmt.
\2\ L432 A Low ext mgmt sys ft pos ......... ......... ......... ........... ...........
0 afo.
L4350 A Pneumatic ankle cntrl ......... ......... ......... ........... ...........
splint.
L4360 A Pneumatic walking ......... ......... ......... ........... ...........
splint.
L4370 A Pneumatic full leg ......... ......... ......... ........... ...........
splint.
L4380 A Pneumatic knee splint.. ......... ......... ......... ........... ...........
\2\ L439 A Replace multi-podus ......... ......... ......... ........... ...........
0 splint.
L4392 A Replace ankle contrac ......... ......... ......... ........... ...........
splint.
L4394 A Replace foot drop spint ......... ......... ......... ........... ...........
L4396 A Ankle contracture ......... ......... ......... ........... ...........
splint.
L4398 A Foot drop splint ......... ......... ......... ........... ...........
recumbent.
L5000 A Sho insert w arch toe ......... ......... ......... ........... ...........
filler.
L5010 A Mold socket ank hgt w/ ......... ......... ......... ........... ...........
toe f.
L5020 A Tibial tubercle hgt w/ ......... ......... ......... ........... ...........
toe f.
L5050 A Ank symes mold sckt ......... ......... ......... ........... ...........
sach ft.
L5060 A Symes met fr leath ......... ......... ......... ........... ...........
socket ar.
L5100 A Molded socket shin sach ......... ......... ......... ........... ...........
foot.
L5105 A Plast socket jts/thgh ......... ......... ......... ........... ...........
lacer.
L5150 A Mold sckt ext knee shin ......... ......... ......... ........... ...........
sach.
L5160 A Mold socket bent knee ......... ......... ......... ........... ...........
shin s.
L5200 A Kne sing axis fric shin ......... ......... ......... ........... ...........
sach.
L5210 A No knee/ankle joints w/ ......... ......... ......... ........... ...........
ft b.
L5220 A No knee joint with ......... ......... ......... ........... ...........
artic ali.
L5230 A Fem focal defic ......... ......... ......... ........... ...........
constant fri.
L5250 A Hip canad sing axi cons ......... ......... ......... ........... ...........
fric.
L5270 A Tilt table locking hip ......... ......... ......... ........... ...........
sing.
L5280 A Hemipelvect canad sing ......... ......... ......... ........... ...........
axis.
L5300 A Bk sach soft cover & ......... ......... ......... ........... ...........
finish.
L5310 A Knee disart sach soft ......... ......... ......... ........... ...........
cv/fin.
L5320 A Ak open end sach soft ......... ......... ......... ........... ...........
cv/fin.
L5330 A Hip canadian sach sft ......... ......... ......... ........... ...........
cv/fin.
L5340 A Hemipelvectomy canad cv/ ......... ......... ......... ........... ...........
fin.
L5400 A Postop dress & 1 cast ......... ......... ......... ........... ...........
chg bk.
L5410 A Postop dsg bk ea add ......... ......... ......... ........... ...........
cast ch.
L5420 A Postop dsg & 1 cast chg ......... ......... ......... ........... ...........
ak/d.
L5430 A Postop dsg ak ea add ......... ......... ......... ........... ...........
cast ch.
L5450 A Postop app non-wgt bear ......... ......... ......... ........... ...........
dsg.
L5460 A Postop app non-wgt bear ......... ......... ......... ........... ...........
dsg.
L5500 A Init bk ptb plaster ......... ......... ......... ........... ...........
direct.
L5505 A Init ak ischal plstr ......... ......... ......... ........... ...........
direct.
L5510 A Prep BK ptb plaster ......... ......... ......... ........... ...........
molded.
L5520 A Perp BK ptb thermopls ......... ......... ......... ........... ...........
direct.
L5530 A Prep BK ptb thermopls ......... ......... ......... ........... ...........
molded.
L5535 A Prep BK ptb open end ......... ......... ......... ........... ...........
socket.
L5540 A Prep BK ptb laminated ......... ......... ......... ........... ...........
socket.
L5560 A Prep AK ischial plast ......... ......... ......... ........... ...........
molded.
L5570 A Prep AK ischial direct ......... ......... ......... ........... ...........
form.
[[Page 35405]]
L5580 A Prep AK ischial thermo ......... ......... ......... ........... ...........
mold.
L5585 A Prep AK ischial open ......... ......... ......... ........... ...........
end.
L5590 A Prep AK ischial ......... ......... ......... ........... ...........
laminated.
L5595 A Hip disartic sach ......... ......... ......... ........... ...........
thermopls.
L5600 A Hip disart sach laminat ......... ......... ......... ........... ...........
mold.
L5610 A Above knee hydracadence ......... ......... ......... ........... ...........
L5611 A Ak 4 bar link w/fric ......... ......... ......... ........... ...........
swing.
L5613 A Ak 4 bar ling w/hydraul ......... ......... ......... ........... ...........
swig.
L5614 A 4-bar link above knee w/ ......... ......... ......... ........... ...........
swng.
L5616 A Ak univ multiplex sys ......... ......... ......... ........... ...........
frict.
L5617 A AK/BK self-aligning ......... ......... ......... ........... ...........
unit ea.
L5618 A Test socket symes...... ......... ......... ......... ........... ...........
L5620 A Test socket below knee. ......... ......... ......... ........... ...........
L5622 A Test socket knee ......... ......... ......... ........... ...........
disarticula.
L5624 A Test socket above knee. ......... ......... ......... ........... ...........
L5626 A Test socket hip ......... ......... ......... ........... ...........
disarticulat.
L5628 A Test socket ......... ......... ......... ........... ...........
hemipelvectomy.
L5629 A Below knee acrylic ......... ......... ......... ........... ...........
socket.
L5630 A Syme typ expandabl wall ......... ......... ......... ........... ...........
sckt.
L5631 A Ak/knee disartic ......... ......... ......... ........... ...........
acrylic soc.
L5632 A Symes type ptb brim ......... ......... ......... ........... ...........
design s.
L5634 A Symes type poster ......... ......... ......... ........... ...........
opening so.
L5636 A Symes type medial ......... ......... ......... ........... ...........
opening so.
L5637 A Below knee total ......... ......... ......... ........... ...........
contact.
L5638 A Below knee leather ......... ......... ......... ........... ...........
socket.
L5639 A Below knee wood socket. ......... ......... ......... ........... ...........
L5640 A Knee disarticulat ......... ......... ......... ........... ...........
leather so.
L5642 A Above knee leather ......... ......... ......... ........... ...........
socket.
L5643 A Hip flex inner socket ......... ......... ......... ........... ...........
ext fr.
L5644 A Above knee wood socket. ......... ......... ......... ........... ...........
L5645 A Ak flexibl inner socket ......... ......... ......... ........... ...........
ext.
L5646 A Below knee air cushion ......... ......... ......... ........... ...........
socke.
L5647 A Below knee suction ......... ......... ......... ........... ...........
socket.
L5648 A Above knee air cushion ......... ......... ......... ........... ...........
socke.
L5649 A Isch containmt/narrow m- ......... ......... ......... ........... ...........
l so.
L5650 A Tot contact ak/knee ......... ......... ......... ........... ...........
disart s.
L5651 A Ak flex inner socket ......... ......... ......... ........... ...........
ext fra.
L5652 A Suction susp ak/knee ......... ......... ......... ........... ...........
disart.
L5653 A Knee disart expand wall ......... ......... ......... ........... ...........
sock.
L5654 A Socket insert symes.... ......... ......... ......... ........... ...........
L5655 A Socket insert below ......... ......... ......... ........... ...........
knee.
L5656 A Socket insert knee ......... ......... ......... ........... ...........
articulat.
L5658 A Socket insert above ......... ......... ......... ........... ...........
knee.
L5660 A Sock insrt syme ......... ......... ......... ........... ...........
silicone gel.
L5661 A Multi-durometer symes.. ......... ......... ......... ........... ...........
L5662 A Socket insert bk ......... ......... ......... ........... ...........
silicone ge.
L5663 A Sock knee disartic ......... ......... ......... ........... ...........
silicone.
L5664 A Socket insert ak ......... ......... ......... ........... ...........
silicone ge.
L5665 A Multi-durometer below ......... ......... ......... ........... ...........
knee.
L5666 A Below knee cuff ......... ......... ......... ........... ...........
suspension.
L5667 A Socket insert w lock ......... ......... ......... ........... ...........
lower.
L5668 A Socket insert w/o lock ......... ......... ......... ........... ...........
lower.
L5669 A Below knee socket w/o ......... ......... ......... ........... ...........
lock.
L5670 A Bk molded supracondylar ......... ......... ......... ........... ...........
susp.
L5672 A Bk removable medial ......... ......... ......... ........... ...........
brim sus.
L5674 A Bk latex sleeve ......... ......... ......... ........... ...........
suspension/e.
L5675 A Bk latex sleeve susp/eq ......... ......... ......... ........... ...........
hvy.
L5676 A Bk knee joints single ......... ......... ......... ........... ...........
axis p.
L5677 A Bk knee joints ......... ......... ......... ........... ...........
polycentric p.
L5678 A Bk joint covers pair... ......... ......... ......... ........... ...........
L5680 A Bk thigh lacer non- ......... ......... ......... ........... ...........
molded.
L5682 A Bk thigh lacer glut/ ......... ......... ......... ........... ...........
ischia m.
L5684 A Bk fork strap.......... ......... ......... ......... ........... ...........
L5686 A Bk back check.......... ......... ......... ......... ........... ...........
L5688 A Bk waist belt webbing.. ......... ......... ......... ........... ...........
L5690 A Bk waist belt padded ......... ......... ......... ........... ...........
and lin.
L5692 A Ak pelvic control belt ......... ......... ......... ........... ...........
light.
L5694 A Ak pelvic control belt ......... ......... ......... ........... ...........
pad/l.
L5695 A Ak sleeve susp neoprene/ ......... ......... ......... ........... ...........
equa.
L5696 A Ak/knee disartic pelvic ......... ......... ......... ........... ...........
join.
L5697 A Ak/knee disartic pelvic ......... ......... ......... ........... ...........
band.
L5698 A Ak/knee disartic ......... ......... ......... ........... ...........
silesian ba.
L5699 A Shoulder harness....... ......... ......... ......... ........... ...........
L5700 A Replace socket below ......... ......... ......... ........... ...........
knee.
L5701 A Replace socket above ......... ......... ......... ........... ...........
knee.
[[Page 35406]]
L5702 A Replace socket hip..... ......... ......... ......... ........... ...........
L5704 A Custom shape covr below ......... ......... ......... ........... ...........
knee.
L5705 A Custm shape cover above ......... ......... ......... ........... ...........
knee.
L5706 A Custm shape cvr knee ......... ......... ......... ........... ...........
disart.
L5707 A Custm shape cover hip ......... ......... ......... ........... ...........
disart.
L5710 A Kne-shin exo sng axi ......... ......... ......... ........... ...........
mnl loc.
L5711 A Knee-shin exo mnl lock ......... ......... ......... ........... ...........
ultra.
L5712 A Knee-shin exo frict swg ......... ......... ......... ........... ...........
& st.
L5714 A Knee-shin exo variable ......... ......... ......... ........... ...........
frict.
L5716 A Knee-shin exo mech ......... ......... ......... ........... ...........
stance ph.
L5718 A Knee-shin exo frct swg ......... ......... ......... ........... ...........
& sta.
L5722 A Knee-shin pneum swg ......... ......... ......... ........... ...........
frct exo.
L5724 A Knee-shin exo fluid ......... ......... ......... ........... ...........
swing ph.
L5726 A Knee-shin ext jnts fld ......... ......... ......... ........... ...........
swg e.
L5728 A Knee-shin fluid swg & ......... ......... ......... ........... ...........
stance.
L5780 A Knee-shin pneum/hydra ......... ......... ......... ........... ...........
pneum.
L5785 A Exoskeletal bk ultralt ......... ......... ......... ........... ...........
mater.
L5790 A Exoskeletal ak ultra- ......... ......... ......... ........... ...........
light m.
L5795 A Exoskel hip ultra-light ......... ......... ......... ........... ...........
mate.
L5810 A Endoskel knee-shin mnl ......... ......... ......... ........... ...........
lock.
L5811 A Endo knee-shin mnl lck ......... ......... ......... ........... ...........
ultra.
L5812 A Endo knee-shin frct swg ......... ......... ......... ........... ...........
& st.
L5814 A Endo knee-shin hydral ......... ......... ......... ........... ...........
swg ph.
L5816 A Endo knee-shin polyc ......... ......... ......... ........... ...........
mch sta.
L5818 A Endo knee-shin frct swg ......... ......... ......... ........... ...........
& st.
L5822 A Endo knee-shin pneum ......... ......... ......... ........... ...........
swg frc.
L5824 A Endo knee-shin fluid ......... ......... ......... ........... ...........
swing p.
L5826 A Miniature knee joint... ......... ......... ......... ........... ...........
L5828 A Endo knee-shin fluid ......... ......... ......... ........... ...........
swg/sta.
L5830 A Endo knee-shin pneum/ ......... ......... ......... ........... ...........
swg pha.
L5840 A Multi-axial knee/shin ......... ......... ......... ........... ...........
system.
L5845 A Knee-shin sys stance ......... ......... ......... ........... ...........
flexion.
L5846 A Knee-shin sys ......... ......... ......... ........... ...........
microprocessor.
L5850 A Endo ak/hip knee extens ......... ......... ......... ........... ...........
assi.
L5855 A Mech hip extension ......... ......... ......... ........... ...........
assist.
L5910 A Endo below knee ......... ......... ......... ........... ...........
alignable sy.
L5920 A Endo ak/hip alignable ......... ......... ......... ........... ...........
system.
L5925 A Above knee manual lock. ......... ......... ......... ........... ...........
L5930 A High activity knee ......... ......... ......... ........... ...........
frame.
L5940 A Endo bk ultra-light ......... ......... ......... ........... ...........
material.
L5950 A Endo ak ultra-light ......... ......... ......... ........... ...........
material.
L5960 A Endo hip ultra-light ......... ......... ......... ........... ...........
materia.
L5962 A Below knee flex cover ......... ......... ......... ........... ...........
system.
L5964 A Above knee flex cover ......... ......... ......... ........... ...........
system.
L5966 A Hip flexible cover ......... ......... ......... ........... ...........
system.
L5970 A Foot external keel sach ......... ......... ......... ........... ...........
foot.
L5972 A Flexible keel foot..... ......... ......... ......... ........... ...........
L5974 A Foot single axis ankle/ ......... ......... ......... ........... ...........
foot.
L5976 A Energy storing foot.... ......... ......... ......... ........... ...........
L5978 A Ft prosth multiaxial ......... ......... ......... ........... ...........
ankl/ft.
L5979 A Multi-axial ankle/ft ......... ......... ......... ........... ...........
prosth.
L5980 A Flex foot system....... ......... ......... ......... ........... ...........
L5981 A Flex-walk sys low ext ......... ......... ......... ........... ...........
prosth.
L5982 A Exoskeletal axial ......... ......... ......... ........... ...........
rotation u.
L5984 A Endoskeletal axial ......... ......... ......... ........... ...........
rotation.
L5985 A Lwr ext dynamic prosth ......... ......... ......... ........... ...........
pylon.
L5986 A Multi-axial rotation ......... ......... ......... ........... ...........
unit.
L5987 A Shank ft w vert load ......... ......... ......... ........... ...........
pylon.
L5999 A Lowr extremity prosthes ......... ......... ......... ........... ...........
NOS.
L6000 A Par hand robin-aids ......... ......... ......... ........... ...........
thum rem.
L6010 A Hand robin-aids little/ ......... ......... ......... ........... ...........
ring.
L6020 A Part hand robin-aids no ......... ......... ......... ........... ...........
fing.
L6050 A Wrst MLd sck flx hng ......... ......... ......... ........... ...........
tri pad.
L6055 A Wrst mold sock w/exp ......... ......... ......... ........... ...........
interfa.
L6100 A Elb mold sock flex ......... ......... ......... ........... ...........
hinge pad.
L6110 A Elbow mold sock ......... ......... ......... ........... ...........
suspension t.
L6120 A Elbow mold doub splt ......... ......... ......... ........... ...........
soc ste.
L6130 A Elbow stump activated ......... ......... ......... ........... ...........
lock h.
L6200 A Elbow mold outsid lock ......... ......... ......... ........... ...........
hinge.
L6205 A Elbow molded w/ expand ......... ......... ......... ........... ...........
inter.
L6250 A Elbow inter loc elbow ......... ......... ......... ........... ...........
forarm.
L6300 A Shlder disart int lock ......... ......... ......... ........... ...........
elbow.
L6310 A Shoulder passive restor ......... ......... ......... ........... ...........
comp.
L6320 A Shoulder passive restor ......... ......... ......... ........... ...........
cap.
L6350 A Thoracic intern lock ......... ......... ......... ........... ...........
elbow.
[[Page 35407]]
L6360 A Thoracic passive restor ......... ......... ......... ........... ...........
comp.
L6370 A Thoracic passive restor ......... ......... ......... ........... ...........
cap.
L6380 A Postop dsg cast chg ......... ......... ......... ........... ...........
wrst/elb.
L6382 A Postop dsg cast chg elb ......... ......... ......... ........... ...........
dis/.
L6384 A Postop dsg cast chg ......... ......... ......... ........... ...........
shlder/t.
L6386 A Postop ea cast chg & ......... ......... ......... ........... ...........
realign.
L6388 A Postop applicat rigid ......... ......... ......... ........... ...........
dsg on.
L6400 A Below elbow prosth tiss ......... ......... ......... ........... ...........
shap.
L6450 A Elb disart prosth tiss ......... ......... ......... ........... ...........
shap.
L6500 A Above elbow prosth tiss ......... ......... ......... ........... ...........
shap.
L6550 A Shldr disar prosth tiss ......... ......... ......... ........... ...........
shap.
L6570 A Scap thorac prosth tiss ......... ......... ......... ........... ...........
shap.
L6580 A Wrist/elbow bowden ......... ......... ......... ........... ...........
cable mol.
L6582 A Wrist/elbow bowden cbl ......... ......... ......... ........... ...........
dir f.
L6584 A Elbow fair lead cable ......... ......... ......... ........... ...........
molded.
L6586 A Elbow fair lead cable ......... ......... ......... ........... ...........
dir fo.
L6588 A Shdr fair lead cable ......... ......... ......... ........... ...........
molded.
L6590 A Shdr fair lead cable ......... ......... ......... ........... ...........
direct.
L6600 A Polycentric hinge pair. ......... ......... ......... ........... ...........
L6605 A Single pivot hinge pair ......... ......... ......... ........... ...........
L6610 A Flexible metal hinge ......... ......... ......... ........... ...........
pair.
L6615 A Disconnect locking ......... ......... ......... ........... ...........
wrist uni.
L6616 A Disconnect insert ......... ......... ......... ........... ...........
locking wr.
L6620 A Flexion-friction wrist ......... ......... ......... ........... ...........
unit.
L6623 A Spring-ass rot wrst w/ ......... ......... ......... ........... ...........
latch.
L6625 A Rotation wrst w/ cable ......... ......... ......... ........... ...........
lock.
L6628 A Quick disconn hook ......... ......... ......... ........... ...........
adapter o.
L6629 A Lamination collar w/ ......... ......... ......... ........... ...........
couplin.
L6630 A Stainless steel any ......... ......... ......... ........... ...........
wrist.
L6632 A Latex suspension sleeve ......... ......... ......... ........... ...........
each.
L6635 A Lift assist for elbow.. ......... ......... ......... ........... ...........
L6637 A Nudge control elbow ......... ......... ......... ........... ...........
lock.
L6640 A Shoulder abduction ......... ......... ......... ........... ...........
joint pai.
L6641 A Excursion amplifier ......... ......... ......... ........... ...........
pulley t.
L6642 A Excursion amplifier ......... ......... ......... ........... ...........
lever ty.
L6645 A Shoulder flexion- ......... ......... ......... ........... ...........
abduction j.
L6650 A Shoulder universal ......... ......... ......... ........... ...........
joint.
L6655 A Standard control cable ......... ......... ......... ........... ...........
extra.
L6660 A Heavy duty control ......... ......... ......... ........... ...........
cable.
L6665 A Teflon or equal cable ......... ......... ......... ........... ...........
lining.
L6670 A Hook to hand cable ......... ......... ......... ........... ...........
adapter.
L6672 A Harness chest/shlder ......... ......... ......... ........... ...........
saddle.
L6675 A Harness figure of 8 ......... ......... ......... ........... ...........
sing con.
L6676 A Harness figure of 8 ......... ......... ......... ........... ...........
dual con.
L6680 A Test sock wrist disart/ ......... ......... ......... ........... ...........
bel e.
L6682 A Test sock elbw disart/ ......... ......... ......... ........... ...........
above.
L6684 A Test socket shldr ......... ......... ......... ........... ...........
disart/tho.
L6686 A Suction socket......... ......... ......... ......... ........... ...........
L6687 A Frame typ socket bel ......... ......... ......... ........... ...........
elbow/w.
L6688 A Frame typ sock above ......... ......... ......... ........... ...........
elb/dis.
L6689 A Frame typ socket ......... ......... ......... ........... ...........
shoulder di.
L6690 A Frame typ sock ......... ......... ......... ........... ...........
interscap-tho.
L6691 A Removable insert each.. ......... ......... ......... ........... ...........
L6692 A Silicone gel insert or ......... ......... ......... ........... ...........
equal.
L6700 A Terminal device model ......... ......... ......... ........... ...........
#3.
L6705 A Terminal device model ......... ......... ......... ........... ...........
#5.
L6710 A Terminal device model ......... ......... ......... ........... ...........
#5x.
L6715 A Terminal device model ......... ......... ......... ........... ...........
#5xa.
L6720 A Terminal device model ......... ......... ......... ........... ...........
#6.
L6725 A Terminal device model ......... ......... ......... ........... ...........
#7.
L6730 A Terminal device model ......... ......... ......... ........... ...........
#7lo.
L6735 A Terminal device model ......... ......... ......... ........... ...........
#8.
L6740 A Terminal device model ......... ......... ......... ........... ...........
#8x.
L6745 A Terminal device model ......... ......... ......... ........... ...........
#88x.
L6750 A Terminal device model ......... ......... ......... ........... ...........
#10p.
L6755 A Terminal device model ......... ......... ......... ........... ...........
#10x.
L6765 A Terminal device model ......... ......... ......... ........... ...........
#12p.
L6770 A Terminal device model ......... ......... ......... ........... ...........
#99x.
L6775 A Terminal device model ......... ......... ......... ........... ...........
#555.
L6780 A Terminal device model ......... ......... ......... ........... ...........
#ss555.
L6790 A Hooks-accu hook or ......... ......... ......... ........... ...........
equal.
L6795 A Hooks-2 load or equal.. ......... ......... ......... ........... ...........
L6800 A Hooks-aprl vc or equal. ......... ......... ......... ........... ...........
L6805 A Modifier wrist flexion ......... ......... ......... ........... ...........
unit.
L6806 A Trs grip vc or equal... ......... ......... ......... ........... ...........
[[Page 35408]]
L6807 A Term device grip1/2 or ......... ......... ......... ........... ...........
equal.
L6808 A Term device infant or ......... ......... ......... ........... ...........
child.
L6809 A Trs super sport passive ......... ......... ......... ........... ...........
L6810 A Pincher tool otto bock ......... ......... ......... ........... ...........
or eq.
L6825 A Hands dorrance vo...... ......... ......... ......... ........... ...........
L6830 A Hand aprl vc........... ......... ......... ......... ........... ...........
L6835 A Hand sierra vo......... ......... ......... ......... ........... ...........
L6840 A Hand becker imperial... ......... ......... ......... ........... ...........
L6845 A Hand becker lock grip.. ......... ......... ......... ........... ...........
L6850 A Term dvc-hand becker ......... ......... ......... ........... ...........
plylite.
L6855 A Hand robin-aids vo..... ......... ......... ......... ........... ...........
L6860 A Hand robin-aids vo soft ......... ......... ......... ........... ...........
L6865 A Hand passive hand...... ......... ......... ......... ........... ...........
L6867 A Hand detroit infant ......... ......... ......... ........... ...........
hand.
L6868 A Passive inf hand ......... ......... ......... ........... ...........
steeper/hos.
L6870 A Hand child mitt........ ......... ......... ......... ........... ...........
L6872 A Hand nyu child hand.... ......... ......... ......... ........... ...........
L6873 A Hand mech inf steeper ......... ......... ......... ........... ...........
or equ.
L6875 A Hand bock vc........... ......... ......... ......... ........... ...........
L6880 A Hand bock vo........... ......... ......... ......... ........... ...........
L6890 A Production glove....... ......... ......... ......... ........... ...........
L6895 A Custom glove........... ......... ......... ......... ........... ...........
L6900 A Hand restorat thumb/1 ......... ......... ......... ........... ...........
finger.
L6905 A Hand restoration ......... ......... ......... ........... ...........
multiple fi.
L6910 A Hand restoration no ......... ......... ......... ........... ...........
fingers.
L6915 A Hand restoration ......... ......... ......... ........... ...........
replacmnt g.
L6920 A Wrist disarticul switch ......... ......... ......... ........... ...........
ctrl.
L6925 A Wrist disart ......... ......... ......... ........... ...........
myoelectronic c.
L6930 A Below elbow switch ......... ......... ......... ........... ...........
control.
L6935 A Below elbow ......... ......... ......... ........... ...........
myoelectronic ct.
L6940 A Elbow disarticulation ......... ......... ......... ........... ...........
switch.
L6945 A Elbow disart ......... ......... ......... ........... ...........
myoelectronic c.
L6950 A Above elbow switch ......... ......... ......... ........... ...........
control.
L6955 A Above elbow ......... ......... ......... ........... ...........
myoelectronic ct.
L6960 A Shldr disartic switch ......... ......... ......... ........... ...........
contro.
L6965 A Shldr disartic ......... ......... ......... ........... ...........
myoelectronic.
L6970 A Interscapular-thor ......... ......... ......... ........... ...........
switch ct.
L6975 A Interscap-thor ......... ......... ......... ........... ...........
myoelectronic.
L7010 A Hand otto back steeper/ ......... ......... ......... ........... ...........
eq sw.
L7015 A Hand sys teknik village ......... ......... ......... ........... ...........
swit.
L7020 A Electronic greifer ......... ......... ......... ........... ...........
switch ct.
L7025 A Electron hand ......... ......... ......... ........... ...........
myoelectronic.
L7030 A Hand sys teknik vill ......... ......... ......... ........... ...........
myoelec.
L7035 A Electron greifer ......... ......... ......... ........... ...........
myoelectro.
L7040 A Prehensile actuator ......... ......... ......... ........... ...........
hosmer s.
L7045 A Electron hook child ......... ......... ......... ........... ...........
michigan.
L7170 A Electronic elbow hosmer ......... ......... ......... ........... ...........
swit.
L7180 A Electronic elbow utah ......... ......... ......... ........... ...........
myoele.
L7185 A Electron elbow ......... ......... ......... ........... ...........
adolescent sw.
L7186 A Electron elbow child ......... ......... ......... ........... ...........
switch.
L7190 A Elbow adolescent ......... ......... ......... ........... ...........
myoelectron.
L7191 A Elbow child ......... ......... ......... ........... ...........
myoelectronic ct.
L7260 A Electron wrist rotator ......... ......... ......... ........... ...........
otto.
L7261 A Electron wrist rotator ......... ......... ......... ........... ...........
utah.
L7266 A Servo control steeper ......... ......... ......... ........... ...........
or equ.
L7272 A Analogue control unb or ......... ......... ......... ........... ...........
equa.
L7274 A Proportional ctl 12 ......... ......... ......... ........... ...........
volt uta.
L7360 A Six volt bat otto bock/ ......... ......... ......... ........... ...........
eq ea.
L7362 A Battery chrgr six volt ......... ......... ......... ........... ...........
otto.
L7364 A Twelve volt battery ......... ......... ......... ........... ...........
utah/equ.
L7366 A Battery chrgr 12 volt ......... ......... ......... ........... ...........
utah/e.
L7499 A Upper extremity ......... ......... ......... ........... ...........
prosthes NOS.
L7500 A Prosthetic dvc repair ......... ......... ......... ........... ...........
hourly.
L7510 A Prosthetic device ......... ......... ......... ........... ...........
repair rep.
L7520 A Repair prosthesis per ......... ......... ......... ........... ...........
15 min.
L7900 A Vacuum erection system. ......... ......... ......... ........... ...........
L8000 A Mastectomy bra......... ......... ......... ......... ........... ...........
L8010 A Mastectomy sleeve...... ......... ......... ......... ........... ...........
L8020 A Mastectomy form........ ......... ......... ......... ........... ...........
L8030 A Breast prosthesis ......... ......... ......... ........... ...........
silicone/e.
L8039 A Breast prosthesis NOS.. ......... ......... ......... ........... ...........
L8100 A Compression stocking ......... ......... ......... ........... ...........
BK18-30.
L8110 A Compression stocking ......... ......... ......... ........... ...........
BK30-40.
L8120 A Compression stocking ......... ......... ......... ........... ...........
BK40-50.
L8130 A Gc stocking thighlngth ......... ......... ......... ........... ...........
18-30.
[[Page 35409]]
L8140 A Gc stocking thighlngth ......... ......... ......... ........... ...........
30-40.
L8150 A Gc stocking thighlngth ......... ......... ......... ........... ...........
40-50.
L8160 A Gc stocking full lngth ......... ......... ......... ........... ...........
18-30.
L8170 A Gc stocking full lngth ......... ......... ......... ........... ...........
30-40.
L8180 A Gc stocking full lngth ......... ......... ......... ........... ...........
40-50.
L8190 A Gc stocking waistlngth ......... ......... ......... ........... ...........
18-30.
L8200 A Gc stocking waistlngth ......... ......... ......... ........... ...........
40-50.
L8210 A Gc stocking custom made ......... ......... ......... ........... ...........
L8220 A Gc stocking lymphedema. ......... ......... ......... ........... ...........
L8230 A Gc stocking garter belt ......... ......... ......... ........... ...........
L8239 A G compression stocking ......... ......... ......... ........... ...........
NOS.
L8300 A Truss single w/ ......... ......... ......... ........... ...........
standard pad.
L8310 A Truss double w/ ......... ......... ......... ........... ...........
standard pad.
L8320 A Truss addition to std ......... ......... ......... ........... ...........
pad wa.
L8330 A Truss add to std pad ......... ......... ......... ........... ...........
scrotal.
L8400 A Sheath below knee...... ......... ......... ......... ........... ...........
L8410 A Sheath above knee...... ......... ......... ......... ........... ...........
L8415 A Sheath upper limb...... ......... ......... ......... ........... ...........
L8417 A Pros sheath/sock w gel ......... ......... ......... ........... ...........
cushn.
L8420 A Prosthetic sock multi ......... ......... ......... ........... ...........
ply BK.
L8430 A Prosthetic sock multi ......... ......... ......... ........... ...........
ply AK.
L8435 A Pros sock multi ply ......... ......... ......... ........... ...........
upper lm.
L8440 A Shrinker below knee.... ......... ......... ......... ........... ...........
L8460 A Shrinker above knee.... ......... ......... ......... ........... ...........
L8465 A Shrinker upper limb.... ......... ......... ......... ........... ...........
L8470 A Pros sock single ply BK ......... ......... ......... ........... ...........
L8480 A Pros sock single ply AK ......... ......... ......... ........... ...........
L8485 A Pros sock single ply ......... ......... ......... ........... ...........
upper l.
L8490 A Air seal suction reten ......... ......... ......... ........... ...........
systm.
L8499 A Unlisted misc ......... ......... ......... ........... ...........
prosthetic ser.
L8500 A Artificial larynx...... ......... ......... ......... ........... ...........
L8501 A Tracheostomy speaking ......... ......... ......... ........... ...........
valve.
L8600 A Implant breast silicone/ ......... ......... ......... ........... ...........
eq.
L8603 A Collagen imp urinary ......... ......... ......... ........... ...........
2.5 CC.
L8610 A Ocular implant......... ......... ......... ......... ........... ...........
L8612 A Aqueous shunt ......... ......... ......... ........... ...........
prosthesis.
L8613 A Ossicular implant...... ......... ......... ......... ........... ...........
L8614 A Cochlear device/system. ......... ......... ......... ........... ...........
L8619 A Replace cochlear ......... ......... ......... ........... ...........
processor.
L8630 A Metacarpophalangeal ......... ......... ......... ........... ...........
implant.
L8641 A Metatarsal joint ......... ......... ......... ........... ...........
implant.
L8642 A Hallux implant......... ......... ......... ......... ........... ...........
L8658 A Interphalangeal joint ......... ......... ......... ........... ...........
implnt.
L8670 A Vascular graft, ......... ......... ......... ........... ...........
synthetic.
L8699 A Prosthetic implant NOS. ......... ......... ......... ........... ...........
M0064 X Visit for drug 090 0.85 $43.71 $12.20 $8.74
monitoring.
M0075 E Cellular therapy....... ......... ......... ......... ........... ...........
M0076 E Prolotherapy........... ......... ......... ......... ........... ...........
M0100 E Intragastric ......... ......... ......... ........... ...........
hypothermia.
\2\ M010 E Foot care hygienic/pm.. ......... ......... ......... ........... ...........
1
M0300 E IV chelationtherapy.... ......... ......... ......... ........... ...........
M0301 E Fabric wrapping of ......... ......... ......... ........... ...........
aneurysm.
M0302 E Assessment of cardiac ......... ......... ......... ........... ...........
output.
P2028 A Cephalin floculation ......... ......... ......... ........... ...........
test.
P2029 A Congo red blood test... ......... ......... ......... ........... ...........
P2031 E Hair analysis.......... ......... ......... ......... ........... ...........
P2033 A Blood thymol turbidity. ......... ......... ......... ........... ...........
P2038 A Blood mucoprotein...... ......... ......... ......... ........... ...........
P3000 A Screen pap by tech w md ......... ......... ......... ........... ...........
supv.
P3001 A Screening pap smear by ......... ......... ......... ........... ...........
phys.
P7001 E Culture bacterial urine ......... ......... ......... ........... ...........
P9010 N Whole blood for ......... ......... ......... ........... ...........
transfusion.
P9011 N Blood split unit....... ......... ......... ......... ........... ...........
P9012 N Cryoprecipitate each ......... ......... ......... ........... ...........
unit.
P9013 N Unit/s blood fibrinogen ......... ......... ......... ........... ...........
\2\ P901 N Gamma globulin 1 ML.... ......... ......... ......... ........... ...........
4
\2\ P901 N Rh immune globulin 1 ML ......... ......... ......... ........... ...........
5
P9016 N Leukocyte poor blood, ......... ......... ......... ........... ...........
unit.
P9017 N One donor fresh frozn ......... ......... ......... ........... ...........
plasma.
P9018 N Plasma protein fract, ......... ......... ......... ........... ...........
unit.
P9019 N Platelet concentrate ......... ......... ......... ........... ...........
unit.
P9020 N Plaelet rich plasma ......... ......... ......... ........... ...........
unit.
P9021 N Red blood cells unit... ......... ......... ......... ........... ...........
P9022 N Washed red blood cells ......... ......... ......... ........... ...........
unit.
P9603 N One-way allow prorated ......... ......... ......... ........... ...........
miles.
[[Page 35410]]
P9604 N One-way allow prorated ......... ......... ......... ........... ...........
trip.
\2\ P961 E Urine specimen collect ......... ......... ......... ........... ...........
0 singl.
P9615 E Urine specimen collect ......... ......... ......... ........... ...........
mult.
Q0034 X Admin of influenza 901 0.07 $3.60 $2.49 $0.72
vaccine.
Q0035 X Cardiokymography....... 950 0.35 $18.00 $15.82 $3.60
Q0068 S Extracorpeal 369 6.33 $325.49 $155.49 $65.10
plasmapheresis.
Q0081 X Infusion ther other 906 1.93 $99.24 $57.18 $19.85
than che.
Q0083 S Chemo by other than 987 2.09 $107.47 $65.09 $21.49
infusion.
Q0084 S Chemotherapy by 989 1.91 $98.21 $44.52 $19.64
infusion.
Q0085 S Chemo by both infusion 989 1.91 $98.21 $44.52 $19.64
and o.
Q0086 A Physical therapy ......... ......... ......... ........... ...........
evaluation/.
Q0091 S Obtaining screen pap 561 1.46 $75.07 $24.41 $15.01
smear.
Q0092 N Set up port xray ......... ......... ......... ........... ...........
equipment.
Q0111 A Wet mounts/ w ......... ......... ......... ........... ...........
preparations.
Q0112 A Potassium hydroxide ......... ......... ......... ........... ...........
preps.
Q0113 A Pinworm examinations... ......... ......... ......... ........... ...........
Q0114 A Fern test.............. ......... ......... ......... ........... ...........
Q0115 A Post-coital mucous exam ......... ......... ......... ........... ...........
Q0132 A Dispensing fee DME neb ......... ......... ......... ........... ...........
drug.
Q0136 N Non esrd epoetin alpha ......... ......... ......... ........... ...........
inj.
Q0144 E Azithromycin dihydrate, ......... ......... ......... ........... ...........
oral.
Q0156 N Human albumin 5%....... ......... ......... ......... ........... ...........
Q0157 N Human albumin 25%...... ......... ......... ......... ........... ...........
Q9920 A Epoetin with hct <= 20. ......... ......... ......... ........... ...........
Q9921 A Epoetin with hct = 21.. ......... ......... ......... ........... ...........
Q9922 A Epoetin with hct = 22.. ......... ......... ......... ........... ...........
Q9923 A Epoetin with hct = 23.. ......... ......... ......... ........... ...........
Q9924 A Epoetin with hct = 24.. ......... ......... ......... ........... ...........
Q9925 A Epoetin with hct = 25.. ......... ......... ......... ........... ...........
Q9926 A Epoetin with hct = 26.. ......... ......... ......... ........... ...........
Q9927 A Epoetin with hct = 27.. ......... ......... ......... ........... ...........
Q9928 A Epoetin with hct = 28.. ......... ......... ......... ........... ...........
Q9929 A Epoetin with hct = 29.. ......... ......... ......... ........... ...........
Q9930 A Epoetin with hct = 30.. ......... ......... ......... ........... ...........
Q9931 A Epoetin with hct = 31.. ......... ......... ......... ........... ...........
Q9932 A Epoetin with hct = 32.. ......... ......... ......... ........... ...........
Q9933 A Epoetin with hct = 33.. ......... ......... ......... ........... ...........
Q9934 A Epoetin with hct = 34.. ......... ......... ......... ........... ...........
Q9935 A Epoetin with hct = 35.. ......... ......... ......... ........... ...........
Q9936 A Epoetin with hct = 36.. ......... ......... ......... ........... ...........
Q9937 A Epoetin with hct = 37.. ......... ......... ......... ........... ...........
Q9938 A Epoetin with hct = 38.. ......... ......... ......... ........... ...........
Q9939 A Epoetin with hct = 39.. ......... ......... ......... ........... ...........
Q9940 A Epoetin with hct >= 40. ......... ......... ......... ........... ...........
R0070 N Transport portable x- ......... ......... ......... ........... ...........
ray.
R0075 N Transport port x-ray ......... ......... ......... ........... ...........
multipl.
R0076 N Transport portable EKG. ......... ......... ......... ........... ...........
V2020 A Vision svcs frames ......... ......... ......... ........... ...........
purchases.
V2025 E Eyeglasses delux frames ......... ......... ......... ........... ...........
V2100 A Lens spher single plano ......... ......... ......... ........... ...........
4.00.
V2101 A Single visn sphere 4.12- ......... ......... ......... ........... ...........
7.00.
V2102 A Singl visn sphere 7.12- ......... ......... ......... ........... ...........
20.00.
V2103 A Spherocylindr 4.00d/12- ......... ......... ......... ........... ...........
2.00d.
V2104 A Spherocylindr 4.00d/ ......... ......... ......... ........... ...........
2.12-4d.
V2105 A Spherocylinder 4.00d/ ......... ......... ......... ........... ...........
4.25-6d.
V2106 A Spherocylinder 4.00d/ ......... ......... ......... ........... ...........
>6.00d.
V2107 A Spherocylinder 4.25d/12- ......... ......... ......... ........... ...........
2d.
V2108 A Spherocylinder 4.25d/ ......... ......... ......... ........... ...........
2.12-4d.
V2109 A Spherocylinder 4.25d/ ......... ......... ......... ........... ...........
4.25-6d.
V2110 A Spherocylinder 4.25d/ ......... ......... ......... ........... ...........
over 6d.
V2111 A Spherocylindr 7.25d/.25- ......... ......... ......... ........... ...........
2.25.
V2112 A Spherocylindr 7.25d/ ......... ......... ......... ........... ...........
2.25-4d.
V2113 A Spherocylindr 7.25d/ ......... ......... ......... ........... ...........
4.25-6d.
V2114 A Spherocylinder over ......... ......... ......... ........... ...........
12.00d.
V2115 A Lens lenticular bifocal ......... ......... ......... ........... ...........
V2116 A Nonaspheric lens ......... ......... ......... ........... ...........
bifocal.
V2117 A Aspheric lens bifocal.. ......... ......... ......... ........... ...........
V2118 A Lens aniseikonic single ......... ......... ......... ........... ...........
V2199 A Lens single vision not ......... ......... ......... ........... ...........
oth c.
V2200 A Lens spher bifoc plano ......... ......... ......... ........... ...........
4.00d.
V2201 A Lens sphere bifocal ......... ......... ......... ........... ...........
4.12-7.0.
V2202 A Lens sphere bifocal ......... ......... ......... ........... ...........
7.12-20..
V2203 A Lens sphcyl bifocal ......... ......... ......... ........... ...........
4.00d/.1.
V2204 A Lens sphcy bifocal ......... ......... ......... ........... ...........
4.00d/2.1.
V2205 A Lens sphcy bifocal ......... ......... ......... ........... ...........
4.00d/4.2.
[[Page 35411]]
V2206 A Lens sphcy bifocal ......... ......... ......... ........... ...........
4.00d/ove.
V2207 A Lens sphcy bifocal 4.25- ......... ......... ......... ........... ...........
7d/..
V2208 A Lens sphcy bifocal 4.25- ......... ......... ......... ........... ...........
7/2..
V2209 A Lens sphcy bifocal 4.25- ......... ......... ......... ........... ...........
7/4..
V2210 A Lens sphcy bifocal 4.25- ......... ......... ......... ........... ...........
7/ov.
V2211 A Lens sphcy bifo 7.25-12/ ......... ......... ......... ........... ...........
.25-.
V2212 A Lens sphcyl bifo 7.25- ......... ......... ......... ........... ...........
12/2.2.
V2213 A Lens sphcyl bifo 7.25- ......... ......... ......... ........... ...........
12/4.2.
V2214 A Lens sphcyl bifocal ......... ......... ......... ........... ...........
over 12..
V2215 A Lens lenticular bifocal ......... ......... ......... ........... ...........
V2216 A Lens lenticular ......... ......... ......... ........... ...........
nonaspheric.
V2217 A Lens lenticular ......... ......... ......... ........... ...........
aspheric bif.
V2218 A Lens aniseikonic ......... ......... ......... ........... ...........
bifocal.
V2219 A Lens bifocal seg width ......... ......... ......... ........... ...........
over.
V2220 A Lens bifocal add over ......... ......... ......... ........... ...........
3.25d.
V2299 A Lens bifocal speciality ......... ......... ......... ........... ...........
V2300 A Lens sphere trifocal ......... ......... ......... ........... ...........
4.00d.
V2301 A Lens sphere trifocal ......... ......... ......... ........... ...........
4.12-7..
V2302 A Lens sphere trifocal ......... ......... ......... ........... ...........
7.12-20.
V2303 A Lens sphcy trifocal 4.0/ ......... ......... ......... ........... ...........
.12-.
V2304 A Lens sphcy trifocal 4.0/ ......... ......... ......... ........... ...........
2.25.
V2305 A Lens sphcy trifocal 4.0/ ......... ......... ......... ........... ...........
4.25.
V2306 A Lens sphcyl trifocal ......... ......... ......... ........... ...........
4.00/>6.
V2307 A Lens sphcy trifocal ......... ......... ......... ........... ...........
4.25-7/..
V2308 A Lens sphc trifocal 4.25- ......... ......... ......... ........... ...........
7/2..
V2309 A Lens sphc trifocal 4.25- ......... ......... ......... ........... ...........
7/4..
V2310 A Lens sphc trifocal 4.25- ......... ......... ......... ........... ...........
7/>6.
V2311 A Lens sphc trifo 7.25-12/ ......... ......... ......... ........... ...........
.25-.
V2312 A Lens sphc trifo 7.25-12/ ......... ......... ......... ........... ...........
2.25.
V2313 A Lens sphc trifo 7.25-12/ ......... ......... ......... ........... ...........
4.25.
V2314 A Lens sphcyl trifocal ......... ......... ......... ........... ...........
over 12.
V2315 A Lens lenticular ......... ......... ......... ........... ...........
trifocal.
V2316 A Lens lenticular ......... ......... ......... ........... ...........
nonaspheric.
V2317 A Lens lenticular ......... ......... ......... ........... ...........
aspheric tri.
V2318 A Lens aniseikonic ......... ......... ......... ........... ...........
trifocal.
V2319 A Lens trifocal seg width ......... ......... ......... ........... ...........
> 28.
V2320 A Lens trifocal add over ......... ......... ......... ........... ...........
3.25d.
V2399 A Lens trifocal ......... ......... ......... ........... ...........
speciality.
V2410 A Lens variab asphericity ......... ......... ......... ........... ...........
sing.
V2430 A Lens variable ......... ......... ......... ........... ...........
asphericity bi.
V2499 A Variable asphericity ......... ......... ......... ........... ...........
lens.
V2500 A Contact lens pmma ......... ......... ......... ........... ...........
spherical.
V2501 A Cntct lens pmma-toric/ ......... ......... ......... ........... ...........
prism.
V2502 A Contact lens pmma ......... ......... ......... ........... ...........
bifocal.
V2503 A Cntct lens pmma color ......... ......... ......... ........... ...........
vision.
V2510 A Cntct gas permeable ......... ......... ......... ........... ...........
sphericl.
V2511 A Cntct toric prism ......... ......... ......... ........... ...........
ballast.
V2512 A Cntct lens gas permbl ......... ......... ......... ........... ...........
bifocl.
V2513 A Contact lens extended ......... ......... ......... ........... ...........
wear.
V2520 A Contact lens ......... ......... ......... ........... ...........
hydrophilic.
V2521 A Cntct lens hydrophilic ......... ......... ......... ........... ...........
toric.
V2522 A Cntct lens hydrophil ......... ......... ......... ........... ...........
bifocl.
V2523 A Cntct lens hydrophil ......... ......... ......... ........... ...........
extend.
V2530 A Contact lens gas ......... ......... ......... ........... ...........
impermeable.
V2531 A Contact lens gas ......... ......... ......... ........... ...........
permeable.
V2599 A Contact lens/es other ......... ......... ......... ........... ...........
type.
V2600 A Hand held low vision ......... ......... ......... ........... ...........
aids.
V2610 A Single lens spectacle ......... ......... ......... ........... ...........
mount.
V2615 A Telescop/othr compound ......... ......... ......... ........... ...........
lens.
V2623 A Plastic eye prosth ......... ......... ......... ........... ...........
custom.
V2624 A Polishing artifical eye ......... ......... ......... ........... ...........
V2625 A Enlargemnt of eye ......... ......... ......... ........... ...........
prosthesis.
V2626 A Reduction of eye ......... ......... ......... ........... ...........
prosthesis.
V2627 A Scleral cover shell.... ......... ......... ......... ........... ...........
V2628 A Fabrication & fitting.. ......... ......... ......... ........... ...........
V2629 A Prosthetic eye other ......... ......... ......... ........... ...........
type.
V2630 N Anter chamber intraocul ......... ......... ......... ........... ...........
lens.
V2631 N Iris support intraoclr ......... ......... ......... ........... ...........
lens.
V2632 N Post chmbr intraocular ......... ......... ......... ........... ...........
lens.
V2700 A Balance lens........... ......... ......... ......... ........... ...........
V2710 A Glass/plastic slab off ......... ......... ......... ........... ...........
prism.
V2715 A Prism lens/es.......... ......... ......... ......... ........... ...........
V2718 A Fresnell prism press-on ......... ......... ......... ........... ...........
lens.
V2730 A Special base curve..... ......... ......... ......... ........... ...........
V2740 A Rose tint plastic...... ......... ......... ......... ........... ...........
[[Page 35412]]
V2741 A Non-rose tint plastic.. ......... ......... ......... ........... ...........
V2742 A Rose tint glass........ ......... ......... ......... ........... ...........
V2743 A Non-rose tint glass.... ......... ......... ......... ........... ...........
V2744 A Tint photochromatic ......... ......... ......... ........... ...........
lens/es.
V2750 A Anti-reflective coating ......... ......... ......... ........... ...........
V2755 A UV lens/es............. ......... ......... ......... ........... ...........
V2760 A Scratch resistant ......... ......... ......... ........... ...........
coating.
V2770 A Occluder lens/es....... ......... ......... ......... ........... ...........
V2780 A Oversize lens/es....... ......... ......... ......... ........... ...........
V2781 A Progressive lens per ......... ......... ......... ........... ...........
lens.
V2785 N Corneal tissue ......... ......... ......... ........... ...........
processing.
V2799 A Miscellaneous vision ......... ......... ......... ........... ...........
service.
V5008 E Hearing screening...... ......... ......... ......... ........... ...........
V5010 E Assessment for hearing ......... ......... ......... ........... ...........
aid.
V5011 E Hearing aid fitting/ ......... ......... ......... ........... ...........
checking.
V5014 E Hearing aid repair/ ......... ......... ......... ........... ...........
modifying.
V5020 E Conformity evaluation.. ......... ......... ......... ........... ...........
V5030 E Body-worn hearing aid ......... ......... ......... ........... ...........
air.
V5040 E Body-worn hearing aid ......... ......... ......... ........... ...........
bone.
V5050 E Body-worn hearing aid ......... ......... ......... ........... ...........
in ear.
V5060 E Behind ear hearing aid. ......... ......... ......... ........... ...........
V5070 E Glasses air conduction. ......... ......... ......... ........... ...........
V5080 E Glasses bone conduction ......... ......... ......... ........... ...........
V5090 E Hearing aid dispensing ......... ......... ......... ........... ...........
fee.
V5100 E Body-worn bilat hearing ......... ......... ......... ........... ...........
aid.
V5110 E Hearing aid dispensing ......... ......... ......... ........... ...........
fee.
V5120 E Body-worn binaur ......... ......... ......... ........... ...........
hearing aid.
V5130 E In ear binaural hearing ......... ......... ......... ........... ...........
aid.
V5140 E Behind ear binaur ......... ......... ......... ........... ...........
hearing ai.
V5150 E Glasses binaural ......... ......... ......... ........... ...........
hearing aid.
V5160 E Dispensing fee binaural ......... ......... ......... ........... ...........
V5170 E Within ear cros hearing ......... ......... ......... ........... ...........
aid.
V5180 E Behind ear cros hearing ......... ......... ......... ........... ...........
aid.
V5190 E Glasses cros hearing ......... ......... ......... ........... ...........
aid.
V5200 E Cros hearing aid ......... ......... ......... ........... ...........
dispens fee.
V5210 E In ear bicros hearing ......... ......... ......... ........... ...........
aid.
V5220 E Behind ear bicros ......... ......... ......... ........... ...........
hearing ai.
V5230 E Glasses bicros hearing ......... ......... ......... ........... ...........
aid.
V5240 E Dispensing fee bicros.. ......... ......... ......... ........... ...........
V5299 A Hearing service........ ......... ......... ......... ........... ...........
V5336 E Repair communication ......... ......... ......... ........... ...........
device.
V5362 A Speech screening....... ......... ......... ......... ........... ...........
V5363 A Language screening..... ......... ......... ......... ........... ...........
V5364 A Dysphagia screening.... ......... ......... ......... ........... ...........
----------------------------------------------------------------------------------------------------------------
\1\ This APC assignment will not apply to services furnished under a partial hospitalization program. Instead,
services furnished as part of a partial hospitalization program are paid on a per-diem basis via APC 020.
\2\ This code was valid in 1996 and therefore was available for use in calculating weights. However, it has
since been terminated and will not be paid upon implementation.
CPT codes and descriptions only are copyright 1997 American Medical Association. All rights reserved. Applicable
FARS/DFARS apply.
Copyright 1994 American Dental Association. All rights reserved.
48. On pages 47761 through 47833, Addendum C is corrected to read
as follows:
CPT codes and descriptions only are
copyright 1997 American Medical Association. All rights reserved.
Applicable FARS/DFARS apply.
Copyright 1994 American Dental Association. All rights reserved.
[[Page 35412]]
Addendum C.--Proposed Hospital Outpatient Department (HOPD) Payment for Procedures by APC
----------------------------------------------------------------------------------------------------------------
Proposed National Minimum
APC CPT Description Status indicator Relative payment unadjusted unadjusted
HCPCS weight rate coinsurance coinsurance
----------------------------------------------------------------------------------------------------------------
031 DENTAL PROCEDURES S 1.37 $70.45 $14.09 $14.09
031 D0150 Comprehensve oral
evaluation.
031 D0240 Intraoral occlusal film.
031 D0250 Extraoral first film....
031 D0260 Extraoral ea additional
film.
031 D0270 Dental bitewing single
film.
031 D0272 Dental bitewings two
films.
031 D0274 Dental bitewings four
films.
031 D0460 Pulp vitality test......
031 D0471 Diagnostic photographs..
031 D0501 Histopathologic
examinations.
031 D0502 Other oral pathology
procedu.
031 D0999 Unspecified diagnostic
proce.
031 D1510 Space maintainer fxd
unilat.
[[Page 35413]]
031 D1515 Fixed bilat space
maintainer.
031 D1520 Remove unilat space
maintain.
031 D1525 Remove bilat space
maintain.
031 D1550 Recement space
maintainer.
031 D2970 Temporary- fractured
tooth.
031 D2999 Dental unspec
restorative pr.
031 D3460 Endodontic endosseous
implan.
031 D3999 Endodontic procedure....
031 D4250 Mucogingival surg per
quadra.
031 D4260 Osseous surgery per
quadrant.
031 D4263 Bone replce graft first
site.
031 D4264 Bone replce graft each
add.
031 D4270 Pedicle soft tissue
graft pr.
031 D4271 Free soft tissue graft
proc.
031 D4273 Subepithelial tissue
graft.
031 D4355 Full mouth debridement..
031 D4381 Localized chemo delivery
031 D5911 Facial moulage sectional
031 D5912 Facial moulage complete.
031 D5983 Radiation applicator....
031 D5984 Radiation shield........
031 D5985 Radiation cone locator..
031 D5987 Commissure splint.......
031 D6920 Dental connector bar....
031 D7110 Oral surgery single
tooth.
031 D7120 Each add tooth
extraction.
031 D7130 Tooth root removal......
031 D7210 Rem imp tooth w mucoper
flp.
031 D7220 Impact tooth remov soft
tiss.
031 D7230 Impact tooth remov part
bony.
031 D7240 Impact tooth remov comp
bony.
031 D7241 Impact tooth rem bony w/
comp.
031 D7250 Tooth root removal......
031 D7260 Oral antral fistula
closure.
031 D7291 Transseptal fiberotomy..
031 D7940 Reshaping bone
orthognathic.
031 D9630 Other drugs/medicaments.
031 D9930 Treatment of
complications.
031 D9940 Dental occlusal guard...
031 D9950 Occlusion analysis......
031 D9951 Limited occlusal
adjustment.
031 D9952 Complete occlusal
adjustment.
061 LEVEL I CHEMOTHERAPEUTIC AGENTS X 1.15 $59.13 $37.52 $11.83
061 J8610 Methotrexate oral 2.5 MG
061 J8999 Oral prescription drug
chemo.
061 J9015 Aldesleukin/single use
vial.
061 J9070 Cyclophosphamide 100 MG
inj.
061 J9080 Cyclophosphamide 200 MG
inj.
061 J9090 Cyclophosphamide 500 MG
inj.
061 J9093 Cyclophosphamide
lyophilized.
061 J9094 Cyclophosphamide
lyophilized.
061 J9095 Cyclophosphamide
lyophilized.
061 J9100 Cytarabine hcl 100 MG
inj.
061 J9110 Cytarabine hcl 500 MG
inj.
061 J9120 Dactinomycin actinomycin
d.
061 J9130 Dacarbazine 10 MG inj...
061 J9140 Dacarbazine 200 MG inj..
061 J9165 Diethylstilbestrol
injection.
061 J9170 Docetaxel...............
061 J9181 Etoposide 10 MG inj.....
061 J9190 Fluorouracil injection..
061 J9201 Gemcitabine HCl.........
061 J9206 Irinotecan injection....
061 J9214 Interferon alfa-2b inj..
061 J9215 Interferon alfa-n3 inj..
061 J9218 Leuprolide acetate
injeciton.
061 J9230 Mechlorethamine hcl inj.
061 J9250 Methotrexate sodium inj.
061 J9260 Methotrexate sodium inj.
061 J9266 Pegaspargase/singl dose
vial.
061 J9350 Topotecan...............
061 J9360 Vinblastine sulfate inj.
061 J9390 Vinorelbine tartrate/10
mg.
061 J9600 Porfimer sodium.........
061 J9999 Chemotherapy drug.......
[[Page 35414]]
062 LEVEL II CHEMOTHERAPEUTIC AGENTS X 1.78 $91.53 $36.61 $18.31
062 J9000 Doxorubic hcl 10 MG vl
chemo.
062 J9020 Asparaginase injection..
062 J9060 Cisplatin 10 MG
injeciton.
062 J9065 Inj cladribine per 1 MG.
062 J9091 Cyclophosphamide 1.0 grm
inj.
062 J9092 Cyclophosphamide 2.0 grm
inj.
062 J9096 Cyclophosphamide
lyophilized.
062 J9097 Cyclophosphamide
lyophilized.
062 J9150 Daunorubicin............
062 J9211 Idarubicin hcl injeciton
062 J9213 Interferon alfa-2a inj..
062 J9265 Paclitaxel injection....
062 J9268 Pentostatin injection...
062 J9370 Vincristine sulfate 1 MG
inj.
063 LEVEL III CHEMOTHERAPEUTIC AGENTS X 2.94 $151.17 $110.97 $30.24
\2\ 063 J9010 Doxorubicin hcl 50 MG
inj.
063 J9031 Bcg live intravesical
vac.
063 J9040 Bleomycin sulfate
injection.
063 J9045 Carboplatin injection...
063 J9050 Carmus bischl nitro inj.
063 J9062 Cisplatin 50 MG
injeciton.
063 J9182 Etoposide 100 MG inj....
063 J9185 Fludarabine phosphate
inj.
063 J9200 Floxuridine injection...
063 J9202 Goserelin acetate
implant.
063 J9208 Ifosfomide injection....
063 J9209 Mesna injection.........
063 J9216 Interferon gamma 1-b inj
063 J9270 Plicamycin (mithramycin)
inj.
063 J9280 Mitomycin 5 MG inj......
063 J9320 Streptozocin injection..
063 J9340 Thiotepa injection......
063 J9375 Vincristine sulfate 2 MG
inj.
063 J9380 Vincristine sulfate 5 MG
inj.
064 LEVEL IV CHEMOTHERAPEUTIC AGENTS X 4.15 $213.39 $138.99 $42.68
064 J0640 Leucovorin calcium
injection.
064 J1950 Leuprolide acetate /3.75
MG.
064 J9217 Leuprolide acetate
suspnsion.
064 J9245 Inj melphalan hydrochl
50 MG.
064 J9290 Mitomycin 20 MG inj.....
064 J9291 Mitomycin 40 MG inj.....
064 J9293 Mitoxantrone hydrochl /
5 MG.
089 NEUROPSYCHOLOGICAL TESTING X 4.06 $208.77 $46.10 $41.75
\1\ 089 96100 Psychological testing...
089 96105 Assessment of aphasia...
089 96110 Developmental test, lim.
089 96111 Developmental test,
extend.
\1\ 089 96115 Neurobehavior status
exam.
\1\ 089 96117 Neuropsych test battery.
090 MONITORING PSYCHIATRIC DRUGS X 0.85 $43.71 $12.20 $8.74
\1\ 090 90862 Medication management...
090 M0064 Visit for drug
monitoring.
091 BRIEF INDIVIDUAL PSYCHOTHERAPY S 1.09 $56.05 $14.01 $11.21
091 90804 Psytx, office (20-30)...
091 90805 Psytx, office (20-30) w/
e&m.
091 90810 Intac psytx, office (20-
30).
091 90811 Intac psytx, off 20-30 w/
e&m.
091 90816 Psytx, hosp (20-30).....
091 90817 Psytx, hosp (20-30) w/
e&m.
091 90823 Intac psytx, hosp (20-
30).
091 90824 Intac psytx, hsp 20-30 w/
e&m.
\1\ \2\ 90843 Psychotherapy, 20-30 min
091
\1\ 091 90899 Psychiatric service/
therapy.
092 EXTENDED INDIVIDUAL PSYCHOTHERAPY S 1.63 $83.81 $21.47 $16.76
\1\ 092 90801 Psy dx interview........
092 90802 Intac psy dx interview..
092 90806 Psytx, office (45-50)...
092 90807 Psytx, office (45-50) w/
e&m.
092 90808 Psytx, office (75-80)...
092 90809 Psytx, office (75-80) w/
e&m.
092 90812 Intac psytx, office (45-
50).
092 90813 Intac psytx, off 45-50 w/
e&m.
092 90814 Intac psytx, office (75-
80).
092 90815 Intac psytx, off 75-80 w/
e&m.
[[Page 35415]]
092 90818 Psytx, hosp (45-50).....
092 90819 Psytx, hosp (45-50) w/
e&m.
\1\ \2\ 90820 Diagnostic interview....
092
092 90821 Psytx, hosp (75-80).....
092 90822 Psytx, hosp (75-80) w/
e&m.
092 90826 Intac psytx, hosp (45-
50).
092 90827 Intac psytx, hsp 45-50 w/
e&m.
092 90828 Intac psytx, hosp (75-
80).
092 90829 Intac psytx, hsp 75-80 w/
e&m.
\1\ \2\ 90835 Special interview.......
092
\1\ \2\ 90842 Psychotherapy, 75-80 min
092
\1\ \2\ 90844 Psychotherapy, 45-50 min
092
\1\ 092 90845 Psychoanalysis..........
\1\ \2\ 90855 Individual psychotherapy
092
092 90865 Narcosynthesis..........
\1\ 092 90880 Hypnotherapy............
093 FAMILY PSYCHOTHERAPY S 1.56 $80.22 $20.11 $16.04
\1\ 093 90846 Family psytx w/o patient
\1\ 093 90847 Family psytx w/patient..
094 GROUP PSYCHOTHERAPY S 1.31 $67.36 $19.89 $13.47
\1\ 094 90849 Multiple family group
psytx.
\1\ 094 90853 Group psychotherapy.....
\1\ 094 90857 Intac group psytx.......
121 LEVEL I NEEDLE BIOPSY/ASPIRATION T 0.63 $32.39 $21.02 $6.48
121 17999 Skin tissue procedure...
121 19000 Drainage of breast
lesion.
121 19001 Drain breast lesion add-
on.
121 20615 Treatment of bone cyst..
121 55000 Drainage of hydrocele...
121 60001 Aspirate/inject thyriod
cyst.
121 60699 Endocrine surgery
procedure.
121 85095 Bone marrow aspiration..
121 85102 Bone marrow biopsy......
121 88170 Fine needle aspiration..
121 88171 Fine needle aspiration..
122 LEVEL II NEEDLE BIOPSY/ASPIRATION T 4.59 $236.02 $113.00 $47.20
122 19100 Biopsy of breast........
122 20206 Needle biopsy, muscle...
122 32400 Needle biopsy chest
lining.
122 32405 Biopsy, lung or
mediastinum.
122 38505 Needle biopsy, lymph
node(s).
122 42400 Biopsy of salivary gland
122 47000 Needle biopsy of liver..
122 47399 Liver surgery procedure.
122 48102 Needle biopsy, pancreas.
122 48999 Pancreas surgery
procedure.
122 49180 Biopsy, abdominal mass..
122 50200 Biopsy of kidney........
122 50390 Drainage of kidney
lesion.
122 54500 Biopsy of testis........
122 54800 Biopsy of epididymis....
122 60100 Biopsy of thyroid.......
122 62269 Needle biopsy spinal
cord.
122 67415 Aspiration orbital
contents.
131 LEVEL I INCISION & DRAINAGE T 1.93 $99.24 $36.61 $19.85
131 10040 Acne surgery of skin
abscess.
131 10060 Drainage of skin abscess
131 10061 Drainage of skin abscess
131 10080 Drainage of pilonidal
cyst.
131 10081 Drainage of pilonidal
cyst.
131 10120 Remove foreign body.....
131 10140 Drainage of hematoma/
fluid.
131 10160 Puncture drainage of
lesion.
131 10180 Complex drainage, wound.
131 11976 Removal of contraceptive
cap.
131 20000 Incision of abscess.....
131 26010 Drainage of finger
abscess.
131 26011 Drainage of finger
abscess.
131 69000 Drain external ear
lesion.
131 69005 Drain external ear
lesion.
131 69020 Drain outer ear canal
lesion.
132 LEVEL II INCISION & DRAINAGE T 5.63 $289.49 $132.89 $57.90
132 19020 Incision of breast
lesion.
132 20950 Record fluid
pressure,muscle.
132 21501 Drain neck/chest lesion.
[[Page 35416]]
132 21700 Revision of neck muscle.
132 21720 Revision of neck muscle.
132 21725 Revision of neck muscle.
132 23030 Drain shoulder lesion...
132 23031 Drain shoulder bursa....
132 23930 Drainage of arm lesion..
132 23931 Drainage of arm bursa...
132 27301 Drain thigh/knee lesion.
132 27603 Drain lower leg lesion..
132 28001 Drainage of bursa of
foot.
132 38300 Drainage lymph node
lesion.
132 38305 Drainage lymph node
lesion.
132 38999 Blood/lymph system
procedure.
132 51080 Drainage of bladder
abscess.
132 54015 Drain penis lesion......
132 54115 Treatment of penis
lesion.
132 55100 Drainage of scrotum
abscess.
137 NAIL PROCEDURES T 0.60 $30.85 $9.27 $6.17
\2\ 137 11700 Scraping of 1-5 nails...
\2\ 137 11701 Scraping of additional
nails.
\2\ 137 11710 Scraping of 1-5 nails...
\2\ 137 11711 Scraping of additional
nails.
137 11719 Trim nail(s)............
137 11720 Debride nail, 1-5.......
137 11721 Debride nail, 6 or more.
137 11740 Drain blood from under
nail.
137 11755 Biopsy, nail unit.......
141 LEVEL I DESTRUCTION OF LESION T 0.52 $26.74 $9.49 $5.35
141 17000 Destroy benign/premal
lesion.
\2\ 141 17001 Destruction of add'l
lesions.
\2\ 141 17002 Destruction of add'l
lesions.
141 17003 Destroy 2-14 lesions....
\2\ 141 17100 Destruction of skin
lesion.
\2\ 141 17101 Destruction of 2nd
lesion.
\2\ 141 17102 Destruction of add'l
lesions.
141 17106 Destruction of skin
lesions.
141 17110 Destruct lesion, 1-14...
142 LEVEL II DESTRUCTION OF LESION T 2.94 $151.17 $54.24 $30.24
142 17004 Destroy 15 & more
lesions.
\2\ 142 17104 Destruction of skin
lesions.
\2\ 142 17105 Destruction of skin
lesions.
142 17107 Destruction of skin
lesions.
142 17108 Destruction of skin
lesions.
142 17111 Destruct lesion, 15 or
more.
151 LEVEL I DEBRIDEMENT/DESTRUCTION T 1.63 $83.81 $33.22 $16.76
151 11000 Debride infected skin...
151 11001 Debride infect skin add-
on.
151 11040 Debride skin partial....
151 11041 Debride skin full.......
151 11042 Debride skin/tissue.....
\2\ 151 11050 Trim skin lesion........
\2\ 151 11051 Trim 2 to 4 skin lesions
\2\ 151 11052 Trim over 4 skin lesions
151 11055 Trim skin lesion........
151 11056 Trim 2 to 4 skin lesions
151 11057 Trim over 4 skin lesions
151 11200 Removal of skin tags....
151 11201 Remove skin tags add-on.
151 11300 Shave skin lesion.......
151 11301 Shave skin lesion.......
151 11302 Shave skin lesion.......
151 11303 Shave skin lesion.......
151 11305 Shave skin lesion.......
151 11306 Shave skin lesion.......
151 11307 Shave skin lesion.......
151 11308 Shave skin lesion.......
151 11310 Shave skin lesion.......
151 11311 Shave skin lesion.......
151 11312 Shave skin lesion.......
151 11313 Shave skin lesion.......
151 11730 Removal of nail plate...
\2\ 151 11731 Removal of second nail
plate.
151 11732 Remove additional nail
plate.
151 11765 Excision of nail fold,
toe.
151 11900 Injection into skin
lesions.
[[Page 35417]]
151 11901 Added skin lesions
injection.
151 15783 Abrasion treatment of
skin.
151 15786 Abrasion, lesion, single
151 15787 Abrasion, lesions, add-
on.
151 15788 Chemical peel, face,
epiderm.
151 15789 Chemical peel, face,
dermal.
151 15792 Chemical peel, nonfacial
151 15793 Chemical peel, nonfacial
151 15810 Salabrasion.............
151 15850 Removal of sutures......
151 15851 Removal of sutures......
151 15852 Dressing change,not for
burn.
151 16000 Initial treatment of
burn(s).
151 16020 Treatment of burn(s)....
151 16025 Treatment of burn(s)....
151 16030 Treatment of burn(s)....
\2\ 151 17200 Electrocautery of skin
tags.
\2\ 151 17201 Electrocautery added
lesions.
151 17250 Chemical cautery, tissue
151 17260 Destruction of skin
lesions.
151 17261 Destruction of skin
lesions.
151 17262 Destruction of skin
lesions.
151 17263 Destruction of skin
lesions.
151 17264 Destruction of skin
lesions.
151 17266 Destruction of skin
lesions.
151 17270 Destruction of skin
lesions.
151 17271 Destruction of skin
lesions.
151 17272 Destruction of skin
lesions.
151 17273 Destruction of skin
lesions.
151 17274 Destruction of skin
lesions.
151 17276 Destruction of skin
lesions.
151 17280 Destruction of skin
lesions.
151 17281 Destruction of skin
lesions.
151 17282 Destruction of skin
lesions.
151 17283 Destruction of skin
lesions.
151 17284 Destruction of skin
lesions.
151 17286 Destruction of skin
lesions.
151 17340 Cryotherapy of skin.....
151 17360 Skin peel therapy.......
151 17380 Hair removal by
electrolysis.
151 42809 Remove pharynx foreign
body.
151 69220 Clean out mastoid cavity
152 LEVEL II DEBRIDEMENT/DESTRUCTION T 10.07 $517.80 $251.54 $103.56
152 16010 Treatment of burn(s)....
152 16015 Treatment of burn(s)....
152 46900 Destruction, anal
lesion(s).
152 46910 Destruction, anal
lesion(s).
152 46916 Cryosurgery, anal
lesion(s).
152 46917 Laser surgery, anal
lesion(s).
152 46922 Excision of anal
lesion(s).
152 46924 Destruction, anal
lesion(s).
152 54050 Destruction, penis
lesion(s).
152 54055 Destruction, penis
lesion(s).
152 54056 Cryosurgery, penis
lesion(s).
152 54057 Laser surg, penis
lesion(s).
152 54060 Excision of penis
lesion(s).
152 54065 Destruction, penis
lesion(s).
152 56501 Destruction, vulva
lesion(s).
152 56515 Destruction, vulva
lesion(s).
161 LEVEL I EXCISION/BIOPSY T 3.43 $176.37 $75.71 $35.27
161 11100 Biopsy of skin lesion...
161 11101 Biopsy, skin add-on.....
161 11400 Removal of skin lesion..
161 11401 Removal of skin lesion..
161 11402 Removal of skin lesion..
161 11403 Removal of skin lesion..
161 11420 Removal of skin lesion..
161 11421 Removal of skin lesion..
161 11422 Removal of skin lesion..
161 11423 Removal of skin lesion..
161 11440 Removal of skin lesion..
161 11441 Removal of skin lesion..
161 11442 Removal of skin lesion..
161 11443 Removal of skin lesion..
161 11600 Removal of skin lesion..
[[Page 35418]]
161 11601 Removal of skin lesion..
161 11602 Removal of skin lesion..
161 11603 Removal of skin lesion..
161 11620 Removal of skin lesion..
161 11621 Removal of skin lesion..
161 11622 Removal of skin lesion..
161 11623 Removal of skin lesion..
161 11640 Removal of skin lesion..
161 11641 Removal of skin lesion..
161 11642 Removal of skin lesion..
161 11643 Removal of skin lesion..
161 11750 Removal of nail bed.....
161 20520 Removal of foreign body.
161 21550 Biopsy of neck/chest....
161 21920 Biopsy soft tissue of
back.
161 23065 Biopsy shoulder tissues.
161 24065 Biopsy arm/elbow soft
tissue.
161 24200 Removal of arm foreign
body.
161 25065 Biopsy forearm soft
tissues.
161 27613 Biopsy lower leg soft
tissue.
161 28190 Removal of foot foreign
body.
161 56605 Biopsy of vulva/perineum
161 56606 Biopsy of vulva/perineum
161 58999 Genital surgery
procedure.
161 69100 Biopsy of external ear..
161 69105 Biopsy of external ear
canal.
162 LEVEL II EXCISION/BIOPSY T 5.59 $287.44 $125.66 $57.49
162 11043 Debride tissue/muscle...
162 11044 Debride tissue/muscle/
bone.
162 11404 Removal of skin lesion..
162 11424 Removal of skin lesion..
162 11444 Removal of skin lesion..
162 11604 Removal of skin lesion..
162 11770 Removal of pilonidal
lesion.
162 16035 Incision of burn scab...
\2\ 162 16040 Burn wound excision.....
\2\ 162 16041 Burn wound excision.....
\2\ 162 16042 Burn wound excision.....
162 17304 Chemosurgery of skin
lesion.
162 17305 2nd stage chemosurgery..
162 17306 3rd stage chemosurgery..
162 17307 Followup skin lesion
therapy.
162 17310 Extensive skin
chemosurgery.
162 20200 Muscle biopsy...........
162 20205 Deep muscle biopsy......
162 20220 Bone biopsy, trocar/
needle.
162 20225 Bone biopsy, trocar/
needle.
162 20670 Removal of support
implant.
162 23000 Removal of calcium
deposits.
162 23075 Removal of shoulder
lesion.
162 24075 Remove arm/elbow lesion.
162 25075 Removal of forearm
lesion.
162 27040 Biopsy of soft tissues..
162 27323 Biopsy thigh soft
tissues.
162 28043 Excision of foot lesion.
162 37609 Temporal artery
procedure.
162 37799 Vascular surgery
procedure.
162 54100 Biopsy of penis.........
162 54105 Biopsy of penis.........
162 67350 Biopsy eye muscle.......
162 67399 Eye muscle surgery
procedure.
162 68100 Biopsy of eyelid lining.
162 68110 Remove eyelid lining
lesion.
162 68115 Remove eyelid lining
lesion.
162 68135 Remove eyelid lining
lesion.
162 68399 Eyelid lining surgery...
163 LEVEL III EXCISION/BIOPSY T 10.48 $538.88 $260.80 $107.78
163 10121 Remove foreign body.....
163 11010 Debride skin, fx........
163 11011 Debride skin/muscle, fx.
163 11012 Debride skin/muscle/
bone, fx.
163 11406 Removal of skin lesion..
163 11426 Removal of skin lesion..
163 11446 Removal of skin lesion..
163 11450 Removal, sweat gland
lesion.
[[Page 35419]]
163 11451 Removal, sweat gland
lesion.
163 11462 Removal, sweat gland
lesion.
163 11463 Removal, sweat gland
lesion.
163 11470 Removal, sweat gland
lesion.
163 11471 Removal, sweat gland
lesion.
163 11606 Removal of skin lesion..
163 11624 Removal of skin lesion..
163 11626 Removal of skin lesion..
163 11644 Removal of skin lesion..
163 11646 Removal of skin lesion..
163 11752 Remove nail bed/finger
tip.
163 11771 Removal of pilonidal
lesion.
163 11772 Removal of pilonidal
lesion.
163 11971 Remove tissue
expander(s).
163 15780 Abrasion treatment of
skin.
163 15781 Abrasion treatment of
skin.
163 15782 Abrasion treatment of
skin.
163 15811 Salabrasion.............
163 15838 Excise excessive skin
tissue.
163 15920 Removal of tail bone
ulcer.
163 15931 Remove sacrum pressure
sore.
163 15933 Remove sacrum pressure
sore.
163 15940 Removal of pressure sore
163 15941 Removal of pressure sore
163 15950 Remove thigh pressure
sore.
163 15951 Remove thigh pressure
sore.
163 15999 Removal of pressure sore
163 20240 Bone biopsy, excisional.
163 20245 Bone biopsy, excisional.
163 20525 Removal of foreign body.
163 20680 Removal of support
implant.
163 21555 Remove lesion neck/chest
163 21556 Remove lesion neck/chest
163 21925 Biopsy soft tissue of
back.
163 21930 Remove lesion, back or
flank.
163 21935 Remove tumor of back....
163 22900 Remove abdominal wall
lesion.
163 22999 Abdomen surgery
procedure.
163 23066 Biopsy shoulder tissues.
163 23076 Removal of shoulder
lesion.
163 23077 Remove tumor of shoulder
163 23330 Remove shoulder foreign
body.
163 23331 Remove shoulder foreign
body.
163 24066 Biopsy arm/elbow soft
tissue.
163 24076 Remove arm/elbow lesion.
163 24077 Remove tumor of arm/
elbow.
163 24201 Removal of arm foreign
body.
163 25066 Biopsy forearm soft
tissues.
163 25076 Removal of forearm
lesion.
163 25077 Remove tumor, forearm/
wrist.
163 26115 Removal of hand lesion..
163 26116 Removal of hand lesion..
163 26117 Remove tumor, hand/
finger.
163 26320 Removal of implant from
hand.
163 27041 Biopsy of soft tissues..
163 27047 Remove hip/pelvis lesion
163 27048 Remove hip/pelvis lesion
163 27049 Remove tumor, hip/pelvis
163 27324 Biopsy thigh soft
tissues.
163 27327 Removal of thigh lesion.
163 27328 Removal of thigh lesion.
163 27329 Remove tumor, thigh/knee
163 27372 Removal of foreign body.
163 27614 Biopsy lower leg soft
tissue.
163 27618 Remove lower leg lesion.
163 27619 Remove lower leg lesion.
163 28192 Removal of foot foreign
body.
163 28193 Removal of foot foreign
body.
163 69110 Partial removal external
ear.
163 69145 Remove ear canal
lesion(s).
163 69205 Clear outer ear canal...
181 LEVEL I SKIN REPAIR T 2.17 $111.58 $44.07 $22.32
181 11760 Reconstruction of nail
bed.
181 11762 Reconstruction of nail
bed.
181 11920 Correct skin color
defects.
[[Page 35420]]
181 11921 Correct skin color
defects.
181 11922 Correct skin color
defects.
181 11950 Therapy for contour
defects.
181 11951 Therapy for contour
defects.
181 11952 Therapy for contour
defects.
181 11954 Therapy for contour
defects.
181 12001 Repair superficial
wound(s).
181 12002 Repair superficial
wound(s).
181 12004 Repair superficial
wound(s).
181 12005 Repair superficial
wound(s).
181 12006 Repair superficial
wound(s).
181 12007 Repair superficial
wound(s).
181 12011 Repair superficial
wound(s).
181 12013 Repair superficial
wound(s).
181 12014 Repair superficial
wound(s).
181 12015 Repair superficial
wound(s).
181 12016 Repair superficial
wound(s).
181 12017 Repair superficial
wound(s).
181 12018 Repair superficial
wound(s).
181 12020 Closure of split wound..
181 12021 Closure of split wound..
181 12031 Layer closure of
wound(s).
181 12032 Layer closure of
wound(s).
181 12034 Layer closure of
wound(s).
181 12035 Layer closure of
wound(s).
181 12036 Layer closure of
wound(s).
181 12041 Layer closure of
wound(s).
181 12042 Layer closure of
wound(s).
181 12044 Layer closure of
wound(s).
181 12045 Layer closure of
wound(s).
181 12046 Layer closure of
wound(s).
181 12051 Layer closure of
wound(s).
181 12052 Layer closure of
wound(s).
181 12053 Layer closure of
wound(s).
181 12054 Layer closure of
wound(s).
181 12055 Layer closure of
wound(s).
181 12056 Layer closure of
wound(s).
181 20500 Injection of sinus tract
182 LEVEL II SKIN REPAIR T 4.11 $211.34 $92.43 $42.27
182 13100 Repair of wound or
lesion.
182 13101 Repair of wound or
lesion.
182 13120 Repair of wound or
lesion.
182 13121 Repair of wound or
lesion.
182 13131 Repair of wound or
lesion.
182 13132 Repair of wound or
lesion.
182 13150 Repair of wound or
lesion.
182 13151 Repair of wound or
lesion.
182 13152 Repair of wound or
lesion.
182 13160 Late closure of wound...
182 13300 Repair of wound or
lesion.
182 43870 Repair stomach opening..
183 LEVEL III SKIN REPAIR T 11.04 $567.68 $283.18 $113.54
183 11960 Insert tissue
expander(s).
183 11970 Replace tissue expander.
183 12037 Layer closure of
wound(s).
183 12047 Layer closure of
wound(s).
183 12057 Layer closure of
wound(s).
183 14000 Skin tissue
rearrangement.
183 14001 Skin tissue
rearrangement.
183 14020 Skin tissue
rearrangement.
183 14021 Skin tissue
rearrangement.
183 14040 Skin tissue
rearrangement.
183 14041 Skin tissue
rearrangement.
183 14060 Skin tissue
rearrangement.
183 14061 Skin tissue
rearrangement.
183 14300 Skin tissue
rearrangement.
183 14350 Skin tissue
rearrangement.
183 15000 Skin graft..............
183 15050 Skin pinch graft........
183 15100 Skin split graft........
183 15101 Skin split graft add-on.
183 15120 Skin split graft........
183 15121 Skin split graft add-on.
183 15200 Skin full graft.........
183 15201 Skin full graft add-on..
[[Page 35421]]
183 15220 Skin full graft.........
183 15221 Skin full graft add-on..
183 15240 Skin full graft.........
183 15241 Skin full graft add-on..
183 15260 Skin full graft.........
183 15261 Skin full graft add-on..
183 15350 Skin homograft..........
183 15400 Skin heterograft........
183 15570 Form skin pedicle flap..
183 15572 Form skin pedicle flap..
183 15574 Form skin pedicle flap..
183 15576 Form skin pedicle flap..
183 15580 Attach skin pedicle
graft.
183 15600 Skin graft..............
183 15610 Skin graft..............
183 15620 Skin graft..............
183 15625 Skin graft..............
183 15630 Skin graft..............
183 15650 Transfer skin pedicle
flap.
183 15775 Hair transplant punch
grafts.
183 15776 Hair transplant punch
grafts.
183 15819 Plastic surgery, neck...
183 15820 Revision of lower eyelid
183 15821 Revision of lower eyelid
183 15822 Revision of upper eyelid
183 15823 Revision of upper eyelid
183 15825 Removal of neck wrinkles
183 15829 Removal of skin wrinkles
183 15835 Excise excessive skin
tissue.
183 20910 Remove cartilage for
graft.
183 20912 Remove cartilage for
graft.
183 20920 Removal of fascia for
graft.
183 20922 Removal of fascia for
graft.
183 20926 Removal of tissue for
graft.
183 23921 Amputation follow-up
surgery.
183 25929 Amputation follow-up
surgery.
183 44312 Revision of ileostomy...
183 44340 Revision of colostomy...
183 65270 Repair of eye wound.....
184 LEVEL IV SKIN REPAIR T 14.85 $763.59 $397.99 $152.72
184 15732 Muscle-skin graft, head/
neck.
184 15734 Muscle-skin graft, trunk
184 15736 Muscle-skin graft, arm..
184 15738 Muscle-skin graft, leg..
184 15740 Island pedicle flap
graft.
184 15750 Neurovascular pedicle
graft.
184 15760 Composite skin graft....
184 15770 Derma-fat-fascia graft..
184 15824 Removal of forehead
wrinkles.
184 15826 Removal of brow wrinkles
184 15828 Removal of face wrinkles
184 15831 Excise excessive skin
tissue.
184 15832 Excise excessive skin
tissue.
184 15833 Excise excessive skin
tissue.
184 15834 Excise excessive skin
tissue.
184 15836 Excise excessive skin
tissue.
184 15837 Excise excessive skin
tissue.
184 15839 Excise excessive skin
tissue.
184 15840 Graft for face nerve
palsy.
184 15841 Graft for face nerve
palsy.
184 15842 Graft for face nerve
palsy.
184 15845 Skin and muscle repair,
face.
184 15876 Suction assisted
lipectomy.
184 15877 Suction assisted
lipectomy.
184 15878 Suction assisted
lipectomy.
184 15879 Suction assisted
lipectomy.
184 15922 Removal of tail bone
ulcer.
184 15934 Remove sacrum pressure
sore.
184 15935 Remove sacrum pressure
sore.
184 15936 Remove sacrum pressure
sore.
184 15937 Remove sacrum pressure
sore.
184 15944 Removal of pressure sore
184 15945 Removal of pressure sore
184 15946 Removal of pressure sore
184 15952 Remove thigh pressure
sore.
[[Page 35422]]
184 15953 Remove thigh pressure
sore.
184 15956 Remove thigh pressure
sore.
184 15958 Remove thigh pressure
sore.
197 INCISION/EXCISION BREAST T 11.94 $613.95 $308.26 $122.79
197 19101 Biopsy of breast........
197 19110 Nipple exploration......
197 19112 Excise breast duct
fistula.
197 19120 Removal of breast lesion
197 19125 Excision, breast lesion.
197 19126 Excision,addl breast
lesion.
197 19140 Removal of breast tissue
197 19290 Place needle wire,
breast.
197 19291 Place needle wire,
breast.
197 19396 Design custom breast
implant.
197 19499 Breast surgery procedure
198 BREAST RECONSTRUCTION/MASTECTOMY T 18.63 $957.95 $523.42 $191.59
198 19160 Removal of breast tissue
198 19162 Remove breast tissue,
nodes.
198 19180 Removal of breast.......
198 19182 Removal of breast.......
198 19316 Suspension of breast....
198 19318 Reduction of large
breast.
198 19324 Enlarge breast..........
198 19325 Enlarge breast with
implant.
198 19328 Removal of breast
implant.
198 19330 Removal of implant
material.
198 19340 Immediate breast
prosthesis.
198 19342 Delayed breast
prosthesis.
198 19350 Breast reconstruction...
198 19355 Correct inverted
nipple(s).
198 19357 Breast reconstruction...
198 19366 Breast reconstruction...
198 19370 Surgery of breast
capsule.
198 19371 Removal of breast
capsule.
198 19380 Revise breast
reconstruction.
200 ARTHROCENTESIS & LIGAMENT/TENDON T 1.76 $90.50 $39.10 $18.10
INJECTION
200 20550 Inj tendon/ligament/cyst
200 20600 Drain/inject joint/bursa
200 20605 Drain/inject joint/bursa
200 20610 Drain/inject joint/bursa
207 CLOSED TREATMENT FRACTURE FINGER/ T 1.70 $87.41 $32.32 $17.48
TOE/TRUNK
207 21800 Treatment of rib
fracture.
207 21820 Treat sternum fracture..
207 21899 Neck/chest surgery
procedure.
207 22305 Treat spine process
fracture.
207 22310 Treat spine fracture....
207 22315 Treat spine fracture....
207 22899 Spine surgery procedure.
207 23500 Treat clavicle fracture.
207 23505 Treat clavicle fracture.
207 23520 Treat clavicle
dislocation.
207 23525 Treat clavicle
dislocation.
207 23540 Treat clavicle
dislocation.
207 23545 Treat clavicle
dislocation.
207 23570 Treat shoulderblade
fracture.
207 23575 Treat shoulderblade
fracture.
207 23650 Treat shoulder
dislocation.
207 23929 Shoulder surgery
procedure.
207 26700 Treat knuckle
dislocation.
207 26720 Treat finger fracture,
each.
207 26725 Treat finger fracture,
each.
207 26740 Treat finger fracture,
each.
207 26750 Treat finger fracture,
each.
207 26755 Treat finger fracture,
each.
207 26770 Treat finger dislocation
207 26989 Hand/finger surgery.....
207 27200 Treat tail bone fracture
207 27299 Pelvis/hip joint surgery
207 28490 Treat big toe fracture..
207 28495 Treat big toe fracture..
207 28510 Treatment of toe
fracture.
207 28515 Treatment of toe
fracture.
207 28630 Treat toe dislocation...
207 28660 Treat toe dislocation...
207 28899 Foot/toes surgery
procedure.
[[Page 35423]]
207 31585 Repair of larynx
fracture.
207 31599 Larynx surgery procedure
209 CLOSED TREATMENT FRACTURE/ T 1.94 $99.75 $37.74 $19.95
DISLOCATION/EXCEPT FINGER/TOE/
TRUNK
209 23600 Treat humerus fracture..
209 23605 Treat humerus fracture..
209 23620 Treat humerus fracture..
209 23625 Treat humerus fracture..
209 23665 Treat dislocation/
fracture.
209 23675 Treat dislocation/
fracture.
209 24500 Treat humerus fracture..
209 24505 Treat humerus fracture..
209 24530 Treat humerus fracture..
209 24535 Treat humerus fracture..
209 24560 Treat humerus fracture..
209 24565 Treat humerus fracture..
209 24576 Treat humerus fracture..
209 24577 Treat humerus fracture..
209 24600 Treat elbow dislocation.
209 24620 Treat elbow fracture....
209 24640 Treat elbow dislocation.
209 24650 Treat radius fracture...
209 24655 Treat radius fracture...
209 24670 Treatment of ulna
fracture.
209 24675 Treatment of ulna
fracture.
209 24999 Upper arm/elbow surgery.
209 25500 Treat fracture of radius
209 25505 Treat fracture of radius
209 25520 Repair fracture of
radius.
209 25530 Treat fracture of ulna..
209 25535 Treat fracture of ulna..
209 25560 Treat fracture radius &
ulna.
209 25565 Treat fracture radius &
ulna.
209 25600 Treat fracture radius/
ulna.
209 25605 Treat fracture radius/
ulna.
209 25622 Treat wrist bone
fracture.
209 25624 Treat wrist bone
fracture.
209 25630 Treat wrist bone
fracture.
209 25635 Treat wrist bone
fracture.
209 25650 Repair wrist bone
fracture.
209 25660 Treat wrist dislocation.
209 25675 Treat wrist dislocation.
209 25680 Treat wrist fracture....
209 25690 Treat wrist dislocation.
209 25999 Forearm or wrist surgery
209 26600 Treat metacarpal
fracture.
209 26605 Treat metacarpal
fracture.
209 26607 Treat metacarpal
fracture.
209 26641 Treat thumb dislocation.
209 26645 Treat thumb fracture....
209 26670 Treat hand dislocation..
209 26706 Pin knuckle dislocation.
209 26742 Treat finger fracture,
each.
209 27193 Treat pelvic ring
fracture.
209 27220 Treat hip socket
fracture.
209 27230 Treat fracture of thigh.
209 27238 Treatment of thigh
fracture.
209 27246 Treatment of thigh
fracture.
209 27250 Treat hip dislocation...
209 27256 Treatment of hip
dislocation.
209 27265 Treatment of hip
dislocation.
209 27500 Treatment of thigh
fracture.
209 27501 Treatment of thigh
fracture.
209 27502 Treatment of thigh
fracture.
209 27503 Treatment of thigh
fracture.
209 27508 Treatment of thigh
fracture.
209 27510 Treatment of thigh
fracture.
209 27516 Repair of thigh growth
plate.
209 27517 Repair of thigh growth
plate.
209 27520 Treat kneecap fracture..
209 27530 Treatment of knee
fracture.
209 27532 Treatment of knee
fracture.
209 27538 Treat knee fracture(s)..
209 27550 Treat knee dislocation..
209 27560 Treat kneecap
dislocation.
209 27599 Leg surgery procedure...
[[Page 35424]]
209 27750 Treatment of tibia
fracture.
209 27752 Treatment of tibia
fracture.
209 27760 Treatment of ankle
fracture.
209 27762 Treatment of ankle
fracture.
209 27780 Treatment of fibula
fracture.
209 27781 Treatment of fibula
fracture.
209 27786 Treatment of ankle
fracture.
209 27788 Treatment of ankle
fracture.
209 27808 Treatment of ankle
fracture.
209 27810 Treatment of ankle
fracture.
209 27816 Treatment of ankle
fracture.
209 27818 Treatment of ankle
fracture.
209 27824 Treat lower leg fracture
209 27825 Treat lower leg fracture
209 27830 Treat lower leg
dislocation.
209 27840 Treat ankle dislocation.
209 27899 Leg/ankle surgery
procedure.
209 28400 Treatment of heel
fracture.
209 28405 Treatment of heel
fracture.
209 28430 Treatment of ankle
fracture.
209 28435 Treatment of ankle
fracture.
209 28450 Treat midfoot fracture,
each.
209 28455 Treat midfoot fracture,
each.
209 28470 Treat metatarsal
fracture.
209 28475 Treat metatarsal
fracture.
209 28530 Treat sesamoid bone
fracture.
209 28540 Treat foot dislocation..
209 28570 Treat foot dislocation..
209 28600 Treat foot dislocation..
209 31586 Repair of larynx
fracture.
210 BONE/JOINT MANIPULATION UNDER T 10.06 $517.29 $279.34 $103.46
ANESTHESIA
210 22505 Manipulation of spine...
210 23655 Treat shoulder
dislocation.
210 23700 Fixation of shoulder....
210 24605 Treat elbow dislocation.
210 26675 Treat hand dislocation..
210 26705 Treat knuckle
dislocation.
210 26775 Treat finger dislocation
210 27194 Treat pelvic ring
fracture.
210 27252 Treat hip dislocation...
210 27257 Treatment of hip
dislocation.
210 27275 Manipulation of hip
joint.
210 27552 Treat knee dislocation..
210 27562 Treat kneecap
dislocation.
210 27570 Fixation of knee joint..
210 27831 Treat lower leg
dislocation.
210 27842 Treat ankle dislocation.
210 27860 Fixation of ankle joint.
210 28545 Treat foot dislocation..
210 28575 Treat foot dislocation..
210 28605 Treat foot dislocation..
210 28635 Treat toe dislocation...
210 28665 Treat toe dislocation...
216 OPEN/PERCUTANEOUS TREATMENT T 20.09 $1,033.03 $524.09 $206.61
FRACTURE OR DISLOCATION
216 21336 Repair nasal septal
fracture.
216 21805 Treatment of rib
fracture.
216 23515 Repair clavicle fracture
216 23530 Repair clavicle
dislocation.
216 23532 Repair clavicle
dislocation.
216 23550 Repair clavicle
dislocation.
216 23552 Repair clavicle
dislocation.
216 23585 Repair scapula fracture.
216 23615 Repair humerus fracture.
216 23616 Repair humerus fracture.
216 23630 Repair humerus fracture.
216 23660 Repair shoulder
dislocation.
216 23670 Repair dislocation/
fracture.
216 23680 Repair dislocation/
fracture.
216 24515 Repair humerus fracture.
216 24516 Repair humerus fracture.
216 24538 Treat humerus fracture..
216 24545 Repair humerus fracture.
216 24546 Repair humerus fracture.
216 24566 Treat humerus fracture..
216 24575 Repair humerus fracture.
[[Page 35425]]
216 24579 Repair humerus fracture.
216 24582 Treat humerus fracture..
216 24586 Repair elbow fracture...
216 24587 Repair elbow fracture...
216 24615 Repair elbow dislocation
216 24635 Repair elbow fracture...
216 24665 Repair radius fracture..
216 24666 Repair radius fracture..
216 24685 Repair ulna fracture....
216 25515 Repair fracture of
radius.
216 25525 Repair fracture of
radius.
216 25526 Repair fracture of
radius.
216 25545 Repair fracture of ulna.
216 25574 Treat fracture radius &
ulna.
216 25575 Repair fracture radius/
ulna.
216 25611 Repair fracture radius/
ulna.
216 25620 Repair fracture radius/
ulna.
216 25628 Repair wrist bone
fracture.
216 25645 Repair wrist bone
fracture.
216 25670 Repair wrist dislocation
216 25676 Repair wrist dislocation
216 25685 Repair wrist fracture...
216 25695 Repair wrist dislocation
216 26608 Treat metacarpal
fracture.
216 26615 Repair metacarpal
fracture.
216 26650 Repair thumb fracture...
216 26665 Repair thumb fracture...
216 26676 Pin hand dislocation....
216 26685 Repair hand dislocation.
216 26686 Repair hand dislocation.
216 26715 Repair knuckle
dislocation.
216 26727 Treat finger fracture,
each.
216 26735 Repair finger fracture,
each.
216 26746 Repair finger fracture,
each.
216 26756 Pin finger fracture,
each.
216 26765 Repair finger fracture,
each.
216 26776 Pin finger dislocation..
216 26785 Repair finger
dislocation.
216 27202 Repair tail bone
fracture.
216 27509 Treatment of thigh
fracture.
216 27556 Repair of knee
dislocation.
216 27566 Repair kneecap
dislocation.
216 27615 Remove tumor, lower leg.
216 27756 Repair of tibia fracture
216 27758 Repair of tibia fracture
216 27759 Repair of tibia fracture
216 27766 Repair of ankle fracture
216 27784 Repair of fibula
fracture.
216 27792 Repair of ankle fracture
216 27814 Repair of ankle fracture
216 27822 Repair of ankle fracture
216 27823 Repair of ankle fracture
216 27826 Treat lower leg fracture
216 27827 Treat lower leg fracture
216 27828 Treat lower leg fracture
216 27829 Treat lower leg joint...
216 27832 Repair lower leg
dislocation.
216 27846 Repair ankle dislocation
216 27848 Repair ankle dislocation
216 28406 Treatment of heel
fracture.
216 28415 Repair of heel fracture.
216 28420 Repair/graft heel
fracture.
216 28436 Treatment of ankle
fracture.
216 28445 Repair of ankle fracture
216 28456 Repair midfoot fracture.
216 28465 Repair midfoot
fracture,each.
216 28476 Repair metatarsal
fracture.
216 28485 Repair metatarsal
fracture.
216 28496 Repair big toe fracture.
216 28505 Repair big toe fracture.
216 28525 Repair of toe fracture..
216 28531 Treat sesamoid bone
fracture.
216 28546 Treat foot dislocation..
216 28555 Repair foot dislocation.
216 28576 Treat foot dislocation..
[[Page 35426]]
216 28585 Repair foot dislocation.
216 28606 Treat foot dislocation..
216 28615 Repair foot dislocation.
216 28636 Treat toe dislocation...
216 28645 Repair toe dislocation..
216 28666 Treat toe dislocation...
216 28675 Repair of toe
dislocation.
217 ARTHROPLASTY T 20.54 $1,056.17 $530.42 $211.23
217 24360 Reconstruct elbow joint.
217 24365 Reconstruct head of
radius.
\2\ 217 25330 Revise wrist joint......
\2\ 217 25331 Revise wrist joint......
217 25332 Revise wrist joint......
217 25447 Repair wrist joint(s)...
217 25449 Remove wrist joint
implant.
217 26530 Revise knuckle joint....
217 26535 Revise finger joint.....
217 27266 Treatment of hip
dislocation.
217 27437 Revise kneecap..........
217 27440 Revision of knee joint..
217 27441 Revision of knee joint..
217 27442 Revision of knee joint..
217 27443 Revision of knee joint..
217 27700 Revision of ankle joint.
218 ARTHROPLASTY WITH PROSTHESIS T 27.80 $1,429.48 $720.71 $285.90
218 21243 Reconstruction of jaw
joint.
218 24361 Reconstruct elbow joint.
218 24362 Reconstruct elbow joint.
218 24363 Replace elbow joint.....
218 24366 Reconstruct head of
radius.
218 25441 Reconstruct wrist joint.
218 25442 Reconstruct wrist joint.
218 25443 Reconstruct wrist joint.
218 25444 Reconstruct wrist joint.
218 25445 Reconstruct wrist joint.
218 25446 Wrist replacement.......
218 26531 Revise knuckle with
implant.
218 26536 Revise/implant finger
joint.
218 27438 Revise kneecap with
implant.
226 MAXILLOFACIAL PROSTHESES T 1.56 $80.22 $21.92 $16.04
226 21076 Prepare face/oral
prosthesis.
226 21077 Prepare face/oral
prosthesis.
226 21079 Prepare face/oral
prosthesis.
226 21080 Prepare face/oral
prosthesis.
226 21081 Prepare face/oral
prosthesis.
226 21082 Prepare face/oral
prosthesis.
226 21083 Prepare face/oral
prosthesis.
226 21084 Prepare face/oral
prosthesis.
226 21086 Prepare face/oral
prosthesis.
226 21087 Prepare face/oral
prosthesis.
226 21088 Prepare face/oral
prosthesis.
226 21089 Prepare face/oral
prosthesis.
231 LEVEL I SKULL AND FACIAL BONE T 11.31 $581.56 $286.79 $116.31
PROCEDURES
231 21015 Resection of facial
tumor.
231 21025 Excision of bone, lower
jaw.
231 21026 Excision of facial
bone(s).
231 21029 Contour of face bone
lesion.
231 21030 Removal of face bone
lesion.
231 21031 Remove exostosis,
mandible.
231 21032 Remove exostosis,
maxilla.
231 21040 Removal of jaw bone
lesion.
231 21041 Removal of jaw bone
lesion.
231 21100 Maxillofacial fixation..
231 21110 Interdental fixation....
231 21120 Reconstruction of chin..
231 21125 Augmentation lower jaw
bone.
231 21280 Revision of eyelid......
231 21282 Revision of eyelid......
231 21295 Revision of jaw muscle/
bone.
231 21296 Revision of jaw muscle/
bone.
231 21299 Cranio/maxillofacial
surgery.
231 21300 Treatment of skull
fracture.
231 21310 Treatment of nose
fracture.
231 21315 Treatment of nose
fracture.
231 21320 Treatment of nose
fracture.
[[Page 35427]]
231 21325 Repair of nose fracture.
231 21337 Repair nasal septal
fracture.
231 21355 Repair cheek bone
fracture.
231 21400 Treat eye socket
fracture.
231 21401 Repair eye socket
fracture.
231 21440 Repair dental ridge
fracture.
231 21451 Treat lower jaw fracture
231 21480 Reset dislocated jaw....
231 21485 Reset dislocated jaw....
231 21493 Treat hyoid bone
fracture.
231 21494 Repair hyoid bone
fracture.
231 21497 Interdental wiring......
231 21499 Head surgery procedure..
231 41822 Excision of gum lesion..
231 41823 Excision of gum lesion..
232 LEVEL II SKULL AND FACIAL BONE T 23.82 $1,224.82 $636.87 $244.96
PROCEDURES
232 21010 Incision of jaw joint...
232 21034 Removal of face bone
lesion.
232 21044 Removal of jaw bone
lesion.
232 21050 Removal of jaw joint....
232 21060 Remove jaw joint
cartilage.
232 21070 Remove coronoid process.
232 21121 Reconstruction of chin..
232 21122 Reconstruction of chin..
232 21123 Reconstruction of chin..
232 21127 Augmentation lower jaw
bone.
232 21181 Contour cranial bone
lesion.
232 21206 Reconstruct upper jaw
bone.
232 21208 Augmentation of facial
bones.
232 21209 Reduction of facial
bones.
232 21210 Face bone graft.........
232 21215 Lower jaw bone graft....
232 21230 Rib cartilage graft.....
232 21235 Ear cartilage graft.....
232 21240 Reconstruction of jaw
joint.
232 21242 Reconstruction of jaw
joint.
232 21244 Reconstruction of lower
jaw.
232 21245 Reconstruction of jaw...
232 21246 Reconstruction of jaw...
232 21248 Reconstruction of jaw...
232 21249 Reconstruction of jaw...
232 21260 Revise eye sockets......
232 21267 Revise eye sockets......
232 21270 Augmentation cheek bone.
232 21275 Revision orbitofacial
bones.
232 21330 Repair of nose fracture.
232 21335 Repair of nose fracture.
232 21338 Repair nasoethmoid
fracture.
232 21339 Repair nasoethmoid
fracture.
232 21340 Repair of nose fracture.
232 21343 Repair of sinus fracture
232 21345 Repair of nose/jaw
fracture.
232 21421 Treat mouth roof
fracture.
232 21445 Repair dental ridge
fracture.
232 21450 Treat lower jaw fracture
232 21452 Treat lower jaw fracture
232 21453 Treat lower jaw fracture
232 21454 Treat lower jaw fracture
232 21461 Repair lower jaw
fracture.
232 21462 Repair lower jaw
fracture.
232 21465 Repair lower jaw
fracture.
232 21490 Repair dislocated jaw...
232 67420 Explore/treat eye socket
232 67430 Explore/treat eye socket
232 67440 Explore/drain eye socket
232 67450 Explore/biopsy eye
socket.
251 LEVEL I MUSCULOSKELETAL T 13.88 $713.71 $365.89 $142.74
PROCEDURES
251 20005 Incision of deep abscess
251 20250 Open bone biopsy........
251 20251 Open bone biopsy........
251 20650 Insert and remove bone
pin.
251 20693 Adjust bone fixation
device.
251 20694 Remove bone fixation
device.
251 20975 Electrical bone
stimulation.
251 23100 Biopsy of shoulder joint
[[Page 35428]]
251 23140 Removal of bone lesion..
251 23935 Drain arm/elbow bone
lesion.
251 24100 Biopsy elbow joint
lining.
251 24105 Removal of elbow bursa..
251 24110 Remove humerus lesion...
251 24120 Remove elbow lesion.....
251 24310 Revision of arm tendon..
251 24925 Amputation follow-up
surgery.
251 25000 Incision of tendon
sheath.
251 25020 Decompression of forearm
251 25028 Drainage of forearm
lesion.
251 25031 Drainage of forearm
bursa.
251 25035 Treat forearm bone
lesion.
251 25085 Incision of wrist
capsule.
251 25100 Biopsy of wrist joint...
251 25110 Remove wrist tendon
lesion.
251 25115 Remove wrist/forearm
lesion.
251 25116 Remove wrist/forearm
lesion.
251 25248 Remove forearm foreign
body.
251 25295 Release wrist/forearm
tendon.
251 25907 Amputation follow-up
surgery.
251 25922 Amputate hand at wrist..
251 26990 Drainage of pelvis
lesion.
251 26991 Drainage of pelvis bursa
251 27000 Incision of hip tendon..
251 27050 Biopsy of sacroiliac
joint.
251 27052 Biopsy of hip joint.....
251 27060 Removal of ischial bursa
251 27062 Remove femur lesion/
bursa.
251 27065 Removal of hip bone
lesion.
251 27086 Remove hip foreign body.
251 27087 Remove hip foreign body.
251 27305 Incise thigh tendon &
fascia.
251 27306 Incision of thigh tendon
251 27307 Incision of thigh
tendons.
251 27340 Removal of kneecap bursa
251 27345 Removal of knee cyst....
251 27380 Repair of kneecap tendon
251 27381 Repair/graft kneecap
tendon.
251 27385 Repair of thigh muscle..
251 27386 Repair/graft of thigh
muscle.
251 27390 Incision of thigh tendon
251 27391 Incision of thigh
tendons.
251 27392 Incision of thigh
tendons.
251 27496 Decompression of thigh/
knee.
251 27497 Decompression of thigh/
knee.
251 27498 Decompression of thigh/
knee.
251 27499 Decompression of thigh/
knee.
251 27594 Amputation follow-up
surgery.
251 27600 Decompression of lower
leg.
251 27601 Decompression of lower
leg.
251 27602 Decompression of lower
leg.
251 27604 Drain lower leg bursa...
251 27606 Incision of achilles
tendon.
251 27607 Treat lower leg bone
lesion.
251 27630 Removal of tendon lesion
251 27656 Repair leg fascia defect
251 27658 Repair of leg tendon,
each.
251 27659 Repair of leg tendon,
each.
251 27664 Repair of leg tendon,
each.
251 27675 Repair lower leg tendons
251 27704 Removal of ankle implant
251 27707 Incision of fibula......
251 27884 Amputation follow-up
surgery.
251 27892 Decompression of leg....
251 27893 Decompression of leg....
251 27894 Decompression of leg....
251 28002 Treatment of foot
infection.
251 28003 Treatment of foot
infection.
252 LEVEL II MUSCULOSKELETAL T 19.24 $989.32 $512.34 $197.86
PROCEDURES
252 20690 Apply bone fixation
device.
252 20692 Apply bone fixation
device.
252 20900 Removal of bone for
graft.
252 20902 Removal of bone for
graft.
252 20924 Removal of tendon for
graft.
[[Page 35429]]
252 21502 Drain chest lesion......
252 21600 Partial removal of rib..
252 21610 Partial removal of rib..
252 23040 Exploratory shoulder
surgery.
252 23044 Exploratory shoulder
surgery.
252 23101 Shoulder joint surgery..
252 23105 Remove shoulder joint
lining.
252 23106 Incision of collarbone
joint.
252 23107 Explore,treat shoulder
joint.
252 23145 Removal of bone lesion..
252 23146 Removal of bone lesion..
252 23150 Removal of humerus
lesion.
252 23155 Removal of humerus
lesion.
252 23156 Removal of humerus
lesion.
252 23170 Remove collarbone lesion
252 23172 Remove shoulder blade
lesion.
252 23174 Remove humerus lesion...
252 23180 Remove collar bone
lesion.
252 23182 Remove shoulder blade
lesion.
252 23184 Remove humerus lesion...
252 23190 Partial removal of
scapula.
252 23405 Incision of tendon &
muscle.
252 23406 Incise tendon(s) &
muscle(s).
252 24000 Exploratory elbow
surgery.
252 24006 Release elbow joint.....
252 24101 Explore/treat elbow
joint.
252 24102 Remove elbow joint
lining.
252 24115 Remove/graft bone lesion
252 24116 Remove/graft bone lesion
252 24125 Remove/graft bone lesion
252 24126 Remove/graft bone lesion
252 24130 Removal of head of
radius.
252 24134 Removal of arm bone
lesion.
252 24136 Remove radius bone
lesion.
252 24138 Remove elbow bone lesion
252 24140 Partial removal of arm
bone.
252 24145 Partial removal of
radius.
252 24147 Partial removal of elbow
252 24160 Remove elbow joint
implant.
252 24164 Remove radius head
implant.
252 24301 Muscle/tendon transfer..
252 24305 Arm tendon lengthening..
252 24350 Repair of tennis elbow..
252 24351 Repair of tennis elbow..
252 24352 Repair of tennis elbow..
252 24354 Repair of tennis elbow..
252 24356 Revision of tennis elbow
252 24400 Revision of humerus.....
252 24410 Revision of humerus.....
252 24495 Decompression of forearm
252 25023 Decompression of forearm
252 25040 Explore/treat wrist
joint.
252 25101 Explore/treat wrist
joint.
252 25105 Remove wrist joint
lining.
252 25107 Remove wrist joint
cartilage.
252 25118 Excise wrist tendon
sheath.
252 25119 Partial removal of ulna.
252 25120 Removal of forearm
lesion.
252 25125 Remove/graft forearm
lesion.
252 25126 Remove/graft forearm
lesion.
252 25130 Removal of wrist lesion.
252 25135 Remove & graft wrist
lesion.
252 25136 Remove & graft wrist
lesion.
252 25145 Remove forearm bone
lesion.
252 25150 Partial removal of ulna.
252 25151 Partial removal of
radius.
252 25230 Partial removal of
radius.
252 25240 Partial removal of ulna.
252 25250 Removal of wrist
prosthesis.
252 25251 Removal of wrist
prosthesis.
252 25260 Repair forearm tendon/
muscle.
252 25263 Repair forearm tendon/
muscle.
252 25265 Repair forearm tendon/
muscle.
252 25270 Repair forearm tendon/
muscle.
252 25272 Repair forearm tendon/
muscle.
[[Page 35430]]
252 25274 Repair forearm tendon/
muscle.
252 25280 Revise wrist/forearm
tendon.
252 25290 Incise wrist/forearm
tendon.
252 25300 Fusion of tendons at
wrist.
252 25301 Fusion of tendons at
wrist.
252 25360 Revision of ulna........
252 25365 Revise radius & ulna....
252 25400 Repair radius or ulna...
252 25415 Repair radius & ulna....
252 27001 Incision of hip tendon..
252 27003 Incision of hip tendon..
252 27066 Removal of hip bone
lesion.
252 27067 Remove/graft hip bone
lesion.
252 27080 Removal of tail bone....
252 27097 Revision of hip tendon..
252 27098 Transfer tendon to
pelvis.
252 27310 Exploration of knee
joint.
252 27330 Biopsy knee joint lining
252 27331 Explore/treat knee joint
252 27332 Removal of knee
cartilage.
252 27333 Removal of knee
cartilage.
252 27334 Remove knee joint lining
252 27335 Remove knee joint lining
252 27350 Removal of kneecap......
252 27355 Remove femur lesion.....
252 27356 Remove femur lesion/
graft.
252 27357 Remove femur lesion/
graft.
252 27358 Remove femur lesion/
fixation.
252 27360 Partial removal leg
bone(s).
252 27393 Lengthening of thigh
tendon.
252 27394 Lengthening of thigh
tendons.
252 27396 Transplant of thigh
tendon.
252 27403 Repair of knee cartilage
252 27425 Lateral retinacular
release.
252 27610 Explore/treat ankle
joint.
252 27612 Exploration of ankle
joint.
252 27620 Explore, treat ankle
joint.
252 27625 Remove ankle joint
lining.
252 27626 Remove ankle joint
lining.
252 27635 Remove lower leg bone
lesion.
252 27637 Remove/graft leg bone
lesion.
252 27638 Remove/graft leg bone
lesion.
252 27641 Partial removal of
fibula.
252 27665 Repair of leg tendon,
each.
252 27676 Repair lower leg tendons
252 27680 Release of lower leg
tendon.
252 27681 Release of lower leg
tendons.
252 27685 Revision of lower leg
tendon.
252 27686 Revise lower leg tendons
252 27687 Revision of calf tendon.
252 27695 Repair of ankle ligament
252 27696 Repair of ankle
ligaments.
252 27698 Repair of ankle ligament
252 27709 Incision of tibia &
fibula.
252 27730 Repair of tibia
epiphysis.
252 27732 Repair of fibula
epiphysis.
252 27734 Repair lower leg
epiphyses.
252 27740 Repair of leg epiphyses.
252 27889 Amputation of foot at
ankle.
253 LEVEL III MUSCULOSKELETAL T 25.74 $1,323.55 $684.55 $264.71
PROCEDURES
253 23020 Release shoulder joint..
253 23120 Partial removal, collar
bone.
253 23130 Partial
removal,shoulderbone.
253 23415 Release of shoulder
ligament.
253 23480 Revision of collarbone..
253 23485 Revision of collar bone.
253 23490 Reinforce clavicle......
253 23491 Reinforce shoulder bones
253 23800 Fusion of shoulder joint
253 23802 Fusion of shoulder joint
253 24155 Removal of elbow joint..
253 24320 Repair of arm tendon....
253 24330 Revision of arm muscles.
253 24331 Revision of arm muscles.
253 24340 Repair of biceps tendon.
[[Page 35431]]
253 24341 Repair tendon/muscle arm
253 24342 Repair of ruptured
tendon.
253 24420 Revision of humerus.....
253 24430 Repair of humerus.......
253 24435 Repair humerus with
graft.
253 24470 Revision of elbow joint.
253 24498 Reinforce humerus.......
253 24800 Fusion of elbow joint...
253 24802 Fusion/graft of elbow
joint.
253 25310 Transplant forearm
tendon.
253 25312 Transplant forearm
tendon.
253 25315 Revise palsy hand
tendon(s).
253 25316 Revise palsy hand
tendon(s).
253 25320 Repair/revise wrist
joint.
253 25335 Realignment of hand.....
253 25337 Reconstruct ulna/
radioulnar.
253 25350 Revision of radius......
253 25355 Revision of radius......
253 25370 Revise radius or ulna...
253 25375 Revise radius & ulna....
253 25425 Repair/graft radius or
ulna.
253 25426 Repair/graft radius &
ulna.
253 25440 Repair/graft wrist bone.
253 25450 Revision of wrist joint.
253 25455 Revision of wrist joint.
253 25490 Reinforce radius........
253 25491 Reinforce ulna..........
253 25492 Reinforce radius and
ulna.
253 25800 Fusion of wrist joint...
253 25805 Fusion/graft of wrist
joint.
253 25810 Fusion/graft of wrist
joint.
253 25830 Fusion radioulnar jnt/
ulna.
253 27033 Exploration of hip joint
253 27100 Transfer of abdominal
muscle.
253 27105 Transfer of spinal
muscle.
253 27110 Transfer of iliopsoas
muscle.
253 27111 Transfer of iliopsoas
muscle.
253 27395 Lengthening of thigh
tendons.
253 27397 Transplants of thigh
tendons.
253 27400 Revise thigh muscles/
tendons.
253 27405 Repair of knee ligament.
253 27407 Repair of knee ligament.
253 27409 Repair of knee ligaments
253 27418 Repair degenerated
kneecap.
253 27420 Revision of unstable
kneecap.
253 27422 Revision of unstable
kneecap.
253 27424 Revision/removal of
kneecap.
253 27430 Revision of thigh
muscles.
253 27435 Incision of knee joint..
253 27640 Partial removal of tibia
253 27647 Extensive ankle/heel
surgery.
253 27650 Repair achilles tendon..
253 27652 Repair/graft achilles
tendon.
253 27654 Repair of achilles
tendon.
253 27690 Revise lower leg tendon.
253 27691 Revise lower leg tendon.
253 27692 Revise additional leg
tendon.
253 27705 Incision of tibia.......
253 27742 Repair of leg epiphyses.
253 27745 Reinforce tibia.........
253 27870 Fusion of ankle joint...
253 27871 Fusion of tibiofibular
joint.
254 LEVEL IV MUSCULOSKELETAL T 32.70 $1,681.43 $922.98 $336.29
PROCEDURES
254 23410 Repair of tendon(s).....
254 23412 Repair of tendon(s).....
254 23420 Repair of shoulder......
254 23430 Repair biceps tendon....
254 23450 Repair shoulder capsule.
254 23455 Repair shoulder capsule.
254 23460 Repair shoulder capsule.
254 23462 Repair shoulder capsule.
254 23465 Repair shoulder capsule.
254 23466 Repair shoulder capsule.
254 27427 Reconstruction, knee....
254 27428 Reconstruction, knee....
[[Page 35432]]
254 27429 Reconstruction, knee....
261 LEVEL I HAND MUSCULOSKELETAL T 10.41 $535.28 $259.00 $107.06
PROCEDURES
261 25111 Remove wrist tendon
lesion.
261 25112 Reremove wrist tendon
lesion.
261 25820 Fusion of hand bones....
261 26020 Drain hand tendon sheath
261 26025 Drainage of palm bursa..
261 26030 Drainage of palm
bursa(s).
261 26034 Treat hand bone lesion..
261 26035 Decompress fingers/hand.
261 26037 Decompress fingers/hand.
261 26055 Incise finger tendon
sheath.
261 26060 Incision of finger
tendon.
261 26070 Explore/treat hand joint
261 26075 Explore/treat finger
joint.
261 26080 Explore/treat finger
joint.
261 26100 Biopsy hand joint lining
261 26105 Biopsy finger joint
lining.
261 26110 Biopsy finger joint
lining.
261 26130 Remove wrist joint
lining.
261 26140 Revise finger joint,
each.
261 26145 Tendon excision, palm/
finger.
261 26160 Remove tendon sheath
lesion.
261 26170 Removal of palm tendon,
each.
261 26180 Removal of finger tendon
261 26185 Remove finger bone......
261 26200 Remove hand bone lesion.
261 26210 Removal of finger lesion
261 26215 Remove/graft finger
lesion.
261 26230 Partial removal of hand
bone.
261 26235 Partial removal, finger
bone.
261 26236 Partial removal, finger
bone.
261 26250 Extensive hand surgery..
261 26260 Extensive finger surgery
261 26261 Extensive finger surgery
261 26262 Partial removal of
finger.
261 26410 Repair hand tendon......
261 26418 Repair finger tendon....
261 26432 Repair finger tendon....
261 26433 Repair finger tendon....
261 26437 Realignment of tendons..
261 26440 Release palm/finger
tendon.
261 26445 Release hand/finger
tendon.
261 26450 Incision of palm tendon.
261 26455 Incision of finger
tendon.
261 26460 Incise hand/finger
tendon.
261 26471 Fusion of finger tendons
261 26474 Fusion of finger tendons
261 26476 Tendon lengthening......
261 26477 Tendon shortening.......
261 26478 Lengthening of hand
tendon.
261 26479 Shortening of hand
tendon.
261 26500 Hand tendon
reconstruction.
261 26508 Release thumb
contracture.
261 26520 Release knuckle
contracture.
261 26525 Release finger
contracture.
261 26540 Repair hand joint.......
261 26542 Repair hand joint with
graft.
261 26560 Repair of web finger....
261 26587 Reconstruct extra finger
261 26593 Release muscles of hand.
261 26951 Amputation of finger/
thumb.
261 26952 Amputation of finger/
thumb.
262 LEVEL II HAND MUSCULOSKELETAL T 18.07 $929.16 $475.96 $185.83
PROCEDURES
262 25210 Removal of wrist bone...
262 25215 Removal of wrist bones..
262 25825 Fusion hand bones with
graft.
262 26040 Release palm contracture
262 26045 Release palm contracture
262 26121 Release palm contracture
262 26123 Release palm contracture
262 26125 Release palm contracture
262 26135 Revise finger joint,
each.
262 26205 Remove/graft bone lesion
262 26255 Extensive hand surgery..
[[Page 35433]]
262 26350 Repair finger/hand
tendon.
262 26352 Repair/graft hand tendon
262 26356 Repair finger/hand
tendon.
262 26357 Repair finger/hand
tendon.
262 26358 Repair/graft hand tendon
262 26370 Repair finger/hand
tendon.
262 26372 Repair/graft hand tendon
262 26373 Repair finger/hand
tendon.
262 26390 Revise hand/finger
tendon.
262 26392 Repair/graft hand tendon
262 26412 Repair/graft hand tendon
262 26415 Excision, hand/finger
tendon.
262 26416 Graft hand or finger
tendon.
262 26420 Repair/graft finger
tendon.
262 26426 Repair finger/hand
tendon.
262 26428 Repair/graft finger
tendon.
262 26434 Repair/graft finger
tendon.
262 26442 Release palm & finger
tendon.
262 26449 Release forearm/hand
tendon.
262 26480 Transplant hand tendon..
262 26483 Transplant/graft hand
tendon.
262 26485 Transplant palm tendon..
262 26489 Transplant/graft palm
tendon.
262 26490 Revise thumb tendon.....
262 26492 Tendon transfer with
graft.
262 26494 Hand tendon/muscle
transfer.
262 26496 Revise thumb tendon.....
262 26497 Finger tendon transfer..
262 26498 Finger tendon transfer..
262 26499 Revision of finger......
262 26502 Hand tendon
reconstruction.
262 26504 Hand tendon
reconstruction.
262 26510 Thumb tendon transfer...
262 26516 Fusion of knuckle joint.
262 26517 Fusion of knuckle joints
262 26518 Fusion of knuckle joints
262 26541 Repair hand joint with
graft.
262 26545 Reconstruct finger joint
262 26546 Repair non-union hand...
262 26548 Reconstruct finger joint
262 26550 Construct thumb
replacement.
262 26555 Positional change of
finger.
262 26561 Repair of web finger....
262 26562 Repair of web finger....
262 26565 Correct metacarpal flaw.
262 26567 Correct finger deformity
262 26568 Lengthen metacarpal/
finger.
262 26580 Repair hand deformity...
262 26585 Repair finger deformity.
262 26590 Repair finger deformity.
262 26591 Repair muscles of hand..
262 26596 Excision constricting
tissue.
262 26597 Release of scar
contracture.
262 26820 Thumb fusion with graft.
262 26841 Fusion of thumb.........
262 26842 Thumb fusion with graft.
262 26843 Fusion of hand joint....
262 26844 Fusion/graft of hand
joint.
262 26850 Fusion of knuckle.......
262 26852 Fusion of knuckle with
graft.
262 26860 Fusion of finger joint..
262 26861 Fusion of finger
joint,added.
262 26862 Fusion/graft of finger
joint.
262 26863 Fuse/graft added joint..
262 26910 Amputate metacarpal bone
271 LEVEL I FOOT MUSCULOSKELETAL T 14.12 $726.05 $365.44 $145.21
PROCEDURES
271 27605 Incision of achilles
tendon.
271 28005 Treat foot bone lesion..
271 28008 Incision of foot fascia.
271 28010 Incision of toe tendon..
271 28011 Incision of toe tendons.
271 28020 Exploration of a foot
joint.
271 28022 Exploration of a foot
joint.
271 28024 Exploration of a toe
joint.
271 28045 Excision of foot lesion.
[[Page 35434]]
271 28046 Resection of tumor, foot
271 28050 Biopsy of foot joint
lining.
271 28052 Biopsy of foot joint
lining.
271 28054 Biopsy of toe joint
lining.
271 28080 Removal of foot lesion..
271 28086 Excise foot tendon
sheath.
271 28088 Excise foot tendon
sheath.
271 28090 Removal of foot lesion..
271 28092 Removal of toe lesions..
271 28100 Removal of ankle/heel
lesion.
271 28104 Removal of foot lesion..
271 28108 Removal of toe lesions..
271 28111 Part removal of
metatarsal.
271 28112 Part removal of
metatarsal.
271 28113 Part removal of
metatarsal.
271 28114 Removal of metatarsal
heads.
271 28116 Revision of foot........
271 28118 Removal of heel bone....
271 28119 Removal of heel spur....
271 28120 Part removal of ankle/
heel.
271 28122 Partial removal of foot
bone.
271 28124 Partial removal of toe..
271 28126 Partial removal of toe..
271 28130 Removal of ankle bone...
271 28140 Removal of metatarsal...
271 28150 Removal of toe..........
271 28153 Partial removal of toe..
271 28160 Partial removal of toe..
271 28171 Extensive foot surgery..
271 28173 Extensive foot surgery..
271 28175 Extensive foot surgery..
271 28200 Repair of foot tendon...
271 28208 Repair of foot tendon...
271 28210 Repair/graft of foot
tendon.
271 28220 Release of foot tendon..
271 28222 Release of foot tendons.
271 28225 Release of foot tendon..
271 28226 Release of foot tendons.
271 28230 Incision of foot
tendon(s).
271 28232 Incision of toe tendon..
271 28234 Incision of foot tendon.
271 28240 Release of big toe......
271 28270 Release of foot
contracture.
271 28272 Release of toe joint,
each.
271 28280 Fusion of toes..........
271 28285 Repair of hammertoe.....
271 28286 Repair of hammertoe.....
271 28310 Revision of big toe.....
271 28312 Revision of toe.........
271 28313 Repair deformity of toe.
271 28315 Removal of sesamoid bone
271 28340 Resect enlarged toe
tissue.
271 28341 Resect enlarged toe.....
271 28737 Revision of foot bones..
271 28750 Fusion of big toe joint.
271 28755 Fusion of big toe joint.
271 28810 Amputation toe &
metatarsal.
271 28820 Amputation of toe.......
271 28825 Partial amputation of
toe.
271 29893 Scope, plantar
fasciotomy.
272 LEVEL II FOOT MUSCULOSKELETAL T 16.11 $828.38 $411.09 $165.68
PROCEDURES
272 28060 Partial removal foot
fascia.
272 28062 Removal of foot fascia..
272 28070 Removal of foot joint
lining.
272 28072 Removal of foot joint
lining.
272 28102 Remove/graft foot lesion
272 28103 Remove/graft foot lesion
272 28106 Remove/graft foot lesion
272 28107 Remove/graft foot lesion
272 28202 Repair/graft of foot
tendon.
272 28238 Revision of foot tendon.
272 28250 Revision of foot fascia.
272 28260 Release of midfoot joint
272 28261 Revision of foot tendon.
272 28262 Revision of foot and
ankle.
[[Page 35435]]
272 28264 Release of midfoot joint
272 28288 Partial removal of foot
bone.
272 28300 Incision of heel bone...
272 28302 Incision of ankle bone..
272 28304 Incision of midfoot
bones.
272 28305 Incise/graft midfoot
bones.
272 28306 Incision of metatarsal..
272 28307 Incision of metatarsal..
272 28308 Incision of metatarsal..
272 28309 Incision of metatarsals.
272 28320 Repair of foot bones....
272 28322 Repair of metatarsals...
272 28344 Repair extra toe(s).....
272 28345 Repair webbed toe(s)....
272 28360 Reconstruct cleft foot..
272 28705 Fusion of foot bones....
272 28715 Fusion of foot bones....
272 28725 Fusion of foot bones....
272 28730 Fusion of foot bones....
272 28735 Fusion of foot bones....
272 28740 Fusion of foot bones....
272 28760 Fusion of big toe joint.
276 BUNION PROCEDURES T 19.00 $976.98 $495.39 $195.40
276 28110 Part removal of
metatarsal.
276 28290 Correction of bunion....
276 28292 Correction of bunion....
276 28293 Correction of bunion....
276 28294 Correction of bunion....
276 28296 Correction of bunion....
276 28297 Correction of bunion....
276 28298 Correction of bunion....
276 28299 Correction of bunion....
280 DIAGNOSTIC ARTHROSCOPY T 22.15 $1,138.95 $581.72 $227.79
280 29800 Jaw arthroscopy/surgery.
280 29815 Shoulder arthroscopy....
280 29830 Elbow arthroscopy.......
280 29840 Wrist arthroscopy.......
280 29870 Knee arthroscopy,
diagnostic.
280 29909 Arthroscopy of joint....
281 LEVEL I SURGICAL ARTHROSCOPY T 22.37 $1,150.27 $589.18 $230.05
281 29804 Jaw arthroscopy/surgery.
281 29819 Shoulder arthroscopy/
surgery.
281 29820 Shoulder arthroscopy/
surgery.
281 29821 Shoulder arthroscopy/
surgery.
281 29822 Shoulder arthroscopy/
surgery.
281 29823 Shoulder arthroscopy/
surgery.
281 29825 Shoulder arthroscopy/
surgery.
281 29826 Shoulder arthroscopy/
surgery.
281 29834 Elbow arthroscopy/
surgery.
281 29835 Elbow arthroscopy/
surgery.
281 29836 Elbow arthroscopy/
surgery.
281 29837 Elbow arthroscopy/
surgery.
281 29838 Elbow arthroscopy/
surgery.
281 29843 Wrist arthroscopy/
surgery.
281 29844 Wrist arthroscopy/
surgery.
281 29845 Wrist arthroscopy/
surgery.
281 29846 Wrist arthroscopy/
surgery.
281 29847 Wrist arthroscopy/
surgery.
281 29848 Wrist endoscopy/surgery.
281 29860 Hip arthroscopy, dx.....
281 29861 Hip arthroscopy/surgery.
281 29862 Hip arthroscopy/surgery.
281 29863 Hip arthroscopy/surgery.
281 29874 Knee arthroscopy/surgery
281 29875 Knee arthroscopy/surgery
281 29877 Knee arthroscopy/surgery
281 29879 Knee arthroscopy/surgery
281 29880 Knee arthroscopy/surgery
281 29881 Knee arthroscopy/surgery
281 29884 Knee arthroscopy/surgery
281 29886 Knee arthroscopy/surgery
281 29894 Ankle arthroscopy/
surgery.
281 29895 Ankle arthroscopy/
surgery.
281 29897 Ankle arthroscopy/
surgery.
281 29898 Ankle arthroscopy/
surgery.
[[Page 35436]]
282 LEVEL II SURGICAL ARTHROSCOPY T 23.65 $1,216.08 $609.97 $243.22
282 29871 Knee arthroscopy/
drainage.
282 29876 Knee arthroscopy/surgery
282 29882 Knee arthroscopy/surgery
282 29883 Knee arthroscopy/surgery
282 29885 Knee arthroscopy/surgery
282 29887 Knee arthroscopy/surgery
282 29891 Ankle arthroscopy/
surgery.
286 ARTHROSCOPICALLY-AIDED PROCEDURES T 27.69 $1,423.82 $791.90 $284.76
286 29850 Knee arthroscopy/surgery
286 29851 Knee arthroscopy/surgery
286 29855 Tibial arthroscopy/
surgery.
286 29856 Tibial arthroscopy/
surgery.
286 29888 Knee arthroscopy/surgery
286 29889 Knee arthroscopy/surgery
286 29892 Ankle arthroscopy/
surgery.
311 LEVEL I ENT PROCEDURES T 1.41 $72.50 $20.57 $14.50
311 30000 Drainage of nose lesion.
311 30020 Drainage of nose lesion.
311 30100 Intranasal biopsy.......
311 30110 Removal of nose polyp(s)
311 30117 Removal of intranasal
lesion.
311 30124 Removal of nose lesion..
311 30210 Nasal sinus therapy.....
311 30220 Insert nasal septal
button.
311 30300 Remove nasal foreign
body.
311 30560 Release of nasal
adhesions.
311 31000 Irrigation maxillary
sinus.
311 31002 Irrigation sphenoid
sinus.
311 31603 Incision of windpipe....
311 31605 Incision of windpipe....
311 40490 Biopsy of lip...........
311 40799 Lip surgery procedure...
311 40800 Drainage of mouth lesion
311 40801 Drainage of mouth lesion
311 40804 Removal foreign body,
mouth.
311 40805 Removal foreign body,
mouth.
311 40806 Incision of lip fold....
311 40808 Biopsy of mouth lesion..
311 40810 Excision of mouth lesion
311 40812 Excise/repair mouth
lesion.
311 40820 Treatment of mouth
lesion.
311 40899 Mouth surgery procedure.
311 41000 Drainage of mouth lesion
311 41005 Drainage of mouth lesion
311 41100 Biopsy of tongue........
311 41105 Biopsy of tongue........
311 41108 Biopsy of floor of mouth
311 41110 Excision of tongue
lesion.
311 41115 Excision of tongue fold.
311 41599 Tongue and mouth surgery
311 41805 Removal foreign body,
gum.
311 41806 Removal foreign
body,jawbone.
311 41820 Excision, gum, each
quadrant.
311 41821 Excision of gum flap....
311 41825 Excision of gum lesion..
311 41826 Excision of gum lesion..
311 41828 Excision of gum lesion..
311 41830 Removal of gum tissue...
311 41850 Treatment of gum lesion.
311 41870 Gum graft...............
311 41872 Repair gum..............
311 41874 Repair tooth socket.....
311 41899 Dental surgery procedure
311 42000 Drainage mouth roof
lesion.
311 42100 Biopsy roof of mouth....
311 42104 Excision lesion, mouth
roof.
311 42106 Excision lesion, mouth
roof.
311 42140 Excision of uvula.......
311 42160 Treatment mouth roof
lesion.
311 42280 Preparation, palate mold
311 42281 Insertion, palate
prosthesis.
311 42299 Palate/uvula surgery....
311 42330 Removal of salivary
stone.
311 42335 Removal of salivary
stone.
[[Page 35437]]
311 42650 Dilation of salivary
duct.
311 42660 Dilation of salivary
duct.
311 42665 Ligation of salivary
duct.
311 42699 Salivary surgery
procedure.
311 69200 Clear outer ear canal...
311 69210 Remove impacted ear wax.
311 69222 Clean out mastoid cavity
311 69399 Outer ear surgery
procedure.
311 69400 Inflate middle ear canal
311 69405 Catheterize middle ear
canal.
311 69410 Inset middle ear baffle.
311 69420 Incision of eardrum.....
311 69424 Remove ventilating tube.
311 69540 Remove ear lesion.......
311 69610 Repair of eardrum.......
311 69799 Middle ear surgery
procedure.
311 92502 Ear and throat
examination.
312 LEVEL II ENT PROCEDURES T 7.07 $363.54 $170.86 $72.71
312 30801 Cauterization inner nose
312 30802 Cauterization inner nose
312 30930 Therapy fracture of nose
312 31612 Puncture/clear windpipe.
312 40830 Repair mouth laceration.
312 40831 Repair mouth laceration.
312 41250 Repair tongue laceration
312 41251 Repair tongue laceration
312 41252 Repair tongue laceration
312 41500 Fixation of tongue......
312 41510 Tongue to lip surgery...
312 41800 Drainage of gum lesion..
312 42300 Drainage of salivary
gland.
312 42305 Drainage of salivary
gland.
312 42310 Drainage of salivary
gland.
312 42320 Drainage of salivary
gland.
312 42405 Biopsy of salivary gland
312 42700 Drainage of tonsil
abscess.
312 42720 Drainage of throat
abscess.
312 42800 Biopsy of throat........
312 42802 Biopsy of throat........
312 42804 Biopsy of upper nose/
throat.
312 42806 Biopsy of upper nose/
throat.
312 42808 Excise pharynx lesion...
312 60000 Drain thyroid/tongue
cyst.
312 69421 Incision of eardrum.....
312 69433 Create eardrum opening..
312 69436 Create eardrum opening..
313 LEVEL III ENT PROCEDURES T 15.46 $794.95 $407.70 $158.99
313 30115 Removal of nose polyp(s)
313 30118 Removal of intranasal
lesion.
313 30120 Revision of nose........
313 30125 Removal of nose lesion..
313 30130 Removal of turbinate
bones.
313 30140 Removal of turbinate
bones.
313 30150 Partial removal of nose.
313 30160 Removal of nose.........
313 30310 Remove nasal foreign
body.
313 30320 Remove nasal foreign
body.
313 30430 Revision of nose........
313 30520 Repair of nasal septum..
313 30540 Repair nasal defect.....
313 30580 Repair upper jaw fistula
313 30600 Repair mouth/nose
fistula.
313 30620 Intranasal
reconstruction.
313 30630 Repair nasal septum
defect.
313 31020 Exploration maxillary
sinus.
313 31030 Exploration maxillary
sinus.
313 31032 Explore sinus, remove
polyps.
313 31050 Exploration sphenoid
sinus.
313 31051 Sphenoid sinus surgery..
313 31070 Exploration of frontal
sinus.
313 31200 Removal of ethmoid sinus
313 31320 Diagnostic incision
larynx.
313 31595 Larynx nerve surgery....
313 31611 Surgery/speech
prosthesis.
313 31613 Repair windpipe opening.
[[Page 35438]]
313 31614 Repair windpipe opening.
313 31820 Closure of windpipe
lesion.
313 31825 Repair of windpipe
defect.
313 31830 Revise windpipe scar....
313 40500 Partial excision of lip.
313 40510 Partial excision of lip.
313 40520 Partial excision of lip.
313 40525 Reconstruct lip with
flap.
313 40527 Reconstruct lip with
flap.
313 40530 Partial removal of lip..
313 40650 Repair lip..............
313 40652 Repair lip..............
313 40654 Repair lip..............
313 40814 Excise/repair mouth
lesion.
313 40816 Excision of mouth lesion
313 40818 Excise oral mucosa for
graft.
313 40819 Excise lip or cheek fold
313 40840 Reconstruction of mouth.
313 40842 Reconstruction of mouth.
313 41006 Drainage of mouth lesion
313 41007 Drainage of mouth lesion
313 41008 Drainage of mouth lesion
313 41009 Drainage of mouth lesion
313 41010 Incision of tongue fold.
313 41015 Drainage of mouth lesion
313 41016 Drainage of mouth lesion
313 41017 Drainage of mouth lesion
313 41018 Drainage of mouth lesion
313 41112 Excision of tongue
lesion.
313 41113 Excision of tongue
lesion.
313 41114 Excision of tongue
lesion.
313 41116 Excision of mouth lesion
313 41120 Partial removal of
tongue.
313 41520 Reconstruction, tongue
fold.
313 41827 Excision of gum lesion..
313 42107 Excision lesion, mouth
roof.
313 42120 Remove palate/lesion....
313 42180 Repair palate...........
313 42182 Repair palate...........
313 42200 Reconstruct cleft palate
313 42205 Reconstruct cleft palate
313 42215 Reconstruct cleft palate
313 42220 Reconstruct cleft palate
313 42235 Repair palate...........
313 42260 Repair nose to lip
fistula.
313 42325 Create salivary cyst
drain.
313 42326 Create salivary cyst
drain.
313 42340 Removal of salivary
stone.
313 42408 Excision of salivary
cyst.
313 42409 Drainage of salivary
cyst.
313 42410 Excise parotid gland/
lesion.
313 42440 Excision submaxillary
gland.
313 42450 Excision sublingual
gland.
313 42500 Repair salivary duct....
313 42505 Repair salivary duct....
313 42507 Parotid duct diversion..
313 42508 Parotid duct diversion..
313 42510 Parotid duct diversion..
313 42600 Closure of salivary
fistula.
313 42725 Drainage of throat
abscess.
313 42810 Excision of neck cyst...
313 42815 Excision of neck cyst...
313 42900 Repair throat wound.....
313 42950 Reconstruction of throat
313 42955 Surgical opening of
throat.
313 42962 Control throat bleeding.
313 42972 Control nose/throat
bleeding.
313 43020 Incision of esophagus...
313 43030 Throat muscle surgery...
313 69120 Removal of external ear.
313 69140 Remove ear canal
lesion(s).
313 69300 Revise external ear.....
313 69440 Exploration of middle
ear.
313 69450 Eardrum revision........
313 69620 Repair of eardrum.......
[[Page 35439]]
314 LEVEL IV ENT PROCEDURES T 25.15 $1,293.21 $687.72 $258.64
314 30400 Reconstruction of nose..
314 30410 Reconstruction of nose..
314 30420 Reconstruction of nose..
314 30435 Revision of nose........
314 30450 Revision of nose........
314 30460 Revision of nose........
314 30462 Revision of nose........
314 30545 Repair nasal defect.....
314 31040 Exploration behind upper
jaw.
314 31075 Exploration of frontal
sinus.
314 31080 Removal of frontal sinus
314 31081 Removal of frontal sinus
314 31084 Removal of frontal sinus
314 31085 Removal of frontal sinus
314 31086 Removal of frontal sinus
314 31087 Removal of frontal sinus
314 31090 Exploration of sinuses..
314 31201 Removal of ethmoid sinus
314 31205 Removal of ethmoid sinus
314 31300 Removal of larynx lesion
314 31400 Revision of larynx......
314 31420 Removal of epiglottis...
314 31588 Revision of larynx......
314 31590 Reinnervate larynx......
314 31750 Repair of windpipe......
314 31755 Repair of windpipe......
314 40700 Repair cleft lip/nasal..
314 40701 Repair cleft lip/nasal..
314 40702 Repair cleft lip/nasal..
314 40720 Repair cleft lip/nasal..
314 40761 Repair cleft lip/nasal..
314 40843 Reconstruction of mouth.
314 40844 Reconstruction of mouth.
314 40845 Reconstruction of mouth.
314 42210 Reconstruct cleft palate
314 42225 Reconstruct cleft palate
314 42226 Lengthening of palate...
314 42227 Lengthening of palate...
314 42415 Excise parotid gland/
lesion.
314 42420 Excise parotid gland/
lesion.
314 42425 Excise parotid gland/
lesion.
314 42509 Parotid duct diversion..
314 42842 Extensive surgery of
throat.
314 42844 Extensive surgery of
throat.
314 42890 Partial removal of
pharynx.
314 42892 Revision of pharyngeal
walls.
314 69150 Extensive ear canal
surgery.
314 69310 Rebuild outer ear canal.
314 69320 Rebuild outer ear canal.
314 69501 Mastoidectomy...........
314 69502 Mastoidectomy...........
314 69505 Remove mastoid
structures.
314 69511 Extensive mastoid
surgery.
314 69530 Extensive mastoid
surgery.
314 69550 Remove ear lesion.......
314 69552 Remove ear lesion.......
314 69601 Mastoid surgery revision
314 69602 Mastoid surgery revision
314 69603 Mastoid surgery revision
314 69604 Mastoid surgery revision
314 69605 Mastoid surgery revision
314 69631 Repair eardrum
structures.
314 69632 Rebuild eardrum
structures.
314 69633 Rebuild eardrum
structures.
314 69635 Repair eardrum
structures.
314 69636 Rebuild eardrum
structures.
314 69637 Rebuild eardrum
structures.
314 69641 Revise middle ear &
mastoid.
314 69642 Revise middle ear &
mastoid.
314 69643 Revise middle ear &
mastoid.
314 69644 Revise middle ear &
mastoid.
314 69645 Revise middle ear &
mastoid.
314 69646 Revise middle ear &
mastoid.
314 69650 Release middle ear bone.
[[Page 35440]]
314 69660 Revise middle ear bone..
314 69661 Revise middle ear bone..
314 69662 Revise middle ear bone..
314 69666 Repair middle ear
structures.
314 69667 Repair middle ear
structures.
314 69670 Remove mastoid air cells
314 69676 Remove middle ear nerve.
314 69700 Close mastoid fistula...
314 69711 Remove/repair hearing
aid.
314 69720 Release facial nerve....
314 69725 Release facial nerve....
314 69740 Repair facial nerve.....
314 69745 Repair facial nerve.....
314 69801 Incise inner ear........
314 69802 Incise inner ear........
314 69805 Explore inner ear.......
314 69806 Explore inner ear.......
314 69820 Establish inner ear
window.
314 69840 Revise inner ear window.
314 69905 Remove inner ear........
314 69910 Remove inner ear &
mastoid.
314 69915 Incise inner ear nerve..
314 69949 Inner ear surgery
procedure.
317 IMPLANTATION OF COCHLEAR DEVICE T
317 69930 Implant cochlear device.
318 NASAL CAUTERIZATION/PACKING T 2.07 $106.44 $38.87 $21.29
318 30901 Control of nosebleed....
318 30903 Control of nosebleed....
318 30905 Control of nosebleed....
318 30906 Repeat control of
nosebleed.
318 30999 Nasal surgery procedure.
318 42960 Control throat bleeding.
318 42970 Control nose/throat
bleeding.
318 42999 Throat surgery procedure
319 TONSIL/ADENOID PROCEDURES T 16.20 $833.00 $463.53 $166.60
319 42820 Remove tonsils and
adenoids.
319 42821 Remove tonsils and
adenoids.
319 42825 Removal of tonsils......
319 42826 Removal of tonsils......
319 42830 Removal of adenoids.....
319 42831 Removal of adenoids.....
319 42835 Removal of adenoids.....
319 42836 Removal of adenoids.....
319 42860 Excision of tonsil tags.
319 42870 Excision of lingual
tonsil.
320 THORACENTESIS/LAVAGE PROCEDURES T 3.09 $158.89 $80.91 $31.78
320 32000 Drainage of chest.......
320 32002 Treatment of collapsed
lung.
320 32020 Insertion of chest tube.
320 32420 Puncture/clear lung.....
320 32960 Therapeutic pneumothorax
320 32999 Chest surgery procedure.
320 33010 Drainage of heart sac...
320 33011 Repeat drainage of heart
sac.
320 33999 Cardiac surgery
procedure.
320 49080 Puncture, peritoneal
cavity.
320 49081 Removal of abdominal
fluid.
331 LEVEL I ENDOSCOPY UPPER AIRWAY T 0.57 $29.31 $14.01 $5.86
331 31231 Nasal endoscopy, dx.....
331 31299 Sinus surgery procedure.
331 31505 Diagnostic laryngoscopy.
331 31575 Diagnostic laryngoscopy.
331 31579 Diagnostic laryngoscopy.
331 92511 Nasopharyngoscopy.......
332 LEVEL II ENDOSCOPY UPPER AIRWAY T 9.67 $497.23 $242.72 $99.45
332 31233 Nasal/sinus endoscopy,
dx.
332 31235 Nasal/sinus endoscopy,
dx.
332 31237 Nasal/sinus endoscopy,
surg.
332 31238 Nasal/sinus endoscopy,
surg.
332 31240 Nasal/sinus endoscopy,
surg.
332 31510 Laryngoscopy with biopsy
332 31511 Remove foreign body,
larynx.
332 31512 Removal of larynx lesion
332 31513 Injection into vocal
cord.
332 31515 Laryngoscopy for
aspiration.
[[Page 35441]]
332 31520 Diagnostic laryngoscopy.
332 31525 Diagnostic laryngoscopy.
332 31526 Diagnostic laryngoscopy.
332 31528 Laryngoscopy and
dilatation.
332 31529 Laryngoscopy and
dilatation.
332 31576 Laryngoscopy with biopsy
332 31577 Remove foreign body,
larynx.
332 31578 Removal of larynx lesion
332 31700 Insertion of airway
catheter.
332 31717 Bronchial brush biopsy..
332 31720 Clearance of airways....
332 31730 Intro windpipe wire/tube
333 LEVEL III ENDOSCOPY UPPER AIRWAY T 16.81 $864.37 $461.04 $172.87
333 31239 Nasal/sinus endoscopy,
surg.
333 31254 Revision of ethmoid
sinus.
333 31255 Removal of ethmoid sinus
333 31256 Exploration maxillary
sinus.
333 31267 Endoscopy, maxillary
sinus.
333 31276 Sinus surgical endoscopy
333 31287 Nasal/sinus endoscopy,
surg.
333 31288 Nasal/sinus endoscopy,
surg.
333 31527 Laryngoscopy for
treatment.
333 31530 Operative laryngoscopy..
333 31531 Operative laryngoscopy..
333 31535 Operative laryngoscopy..
333 31536 Operative laryngoscopy..
333 31540 Operative laryngoscopy..
333 31541 Operative laryngoscopy..
333 31560 Operative laryngoscopy..
333 31561 Operative laryngoscopy..
333 31570 Laryngoscopy with
injection.
333 31571 Laryngoscopy with
injection.
336 ENDOSCOPY LOWER AIRWAY T 7.24 $372.28 $195.49 $74.46
336 31615 Visualization of
windpipe.
336 31622 Dx bronchoscope/wash....
336 31625 Bronchoscopy with biopsy
336 31628 Bronchoscopy with biopsy
336 31629 Bronchoscopy with biopsy
336 31630 Bronchoscopy with repair
336 31631 Bronchoscopy with
dilation.
336 31635 Remove foreign body,
airway.
336 31640 Bronchoscopy & remove
lesion.
336 31641 Bronchoscopy, treat
blockage.
336 31645 Bronchoscopy, clear
airways.
336 31646 Bronchoscopy,reclear
airways.
336 31656 Bronchoscopy,inject for
xray.
336 31899 Airways surgical
procedure.
339 INJECTION OF SCLEROSING SOLUTION T 0.98 $50.39 $19.66 $10.08
339 36468 Injection(s); spider
veins.
339 36469 Injection(s); spider
veins.
339 36470 Injection therapy of
vein.
339 36471 Injection therapy of
veins.
339 45520 Treatment of rectal
prolapse.
341 LEVEL I NEEDLE AND CATHETER T 0.09 $4.63 $2.49 $0.93
PLACEMENT
341 36410 Drawing blood...........
341 36420 Establish access to vein
341 36425 Establish access to vein
342 LEVEL II NEEDLE AND CATHETER T 2.61 $134.21 $68.70 $26.84
PLACEMENT
342 36010 Place catheter in vein..
342 36011 Place catheter in vein..
342 36012 Place catheter in vein..
342 36013 Place catheter in artery
342 36014 Place catheter in artery
342 36015 Place catheter in artery
342 36100 Establish access to
artery.
342 36120 Establish access to
artery.
342 36140 Establish access to
artery.
342 36160 Establish access to
aorta.
342 36200 Place catheter in aorta.
342 36500 Insertion of catheter,
vein.
342 36620 Insertion catheter,
artery.
342 36625 Insertion catheter,
artery.
342 38794 Access thoracic lymph
duct.
343 LEVEL III NEEDLE AND CATHETER T 8.76 $450.44 $240.24 $90.09
PLACEMENT
343 36215 Place catheter in artery
[[Page 35442]]
343 36216 Place catheter in artery
343 36217 Place catheter in artery
343 36218 Place catheter in artery
343 36245 Place catheter in artery
343 36246 Place catheter in artery
343 36247 Place catheter in artery
343 36248 Place catheter in artery
343 36481 Insertion of catheter,
vein.
343 93508 Cath placement,
angiography.
346 PLACEMENT TRANSVENOUS CATHS/ T 4.63 $238.07 $121.59 $47.61
CUTDOWN
346 36488 Insertion of catheter,
vein.
346 36489 Insertion of catheter,
vein.
346 36490 Insertion of catheter,
vein.
346 36491 Insertion of catheter,
vein.
346 36493 Repositioning of cvc....
346 36640 Insertion catheter,
artery.
347 INJECTION PROCEDURES FOR T 2.57 $132.15 $62.38 $26.43
INTERVENTIONAL RADIOLOGY
347 19030 Injection for breast x-
ray.
347 20501 Inject sinus tract for x-
ray.
347 21116 Injection, jaw joint x-
ray.
347 23350 Injection for shoulder x-
ray.
347 24220 Injection for elbow x-
ray.
347 25246 Injection for wrist x-
ray.
347 27093 Injection for hip x-ray.
347 27095 Injection for hip x-ray.
347 27370 Injection for knee x-ray
347 27648 Injection for ankle x-
ray.
347 30200 Injection treatment of
nose.
347 31708 Instill airway contrast
dye.
347 31710 Insertion of airway
catheter.
347 31715 Injection for bronchus x-
ray.
347 36005 Injection, venography...
347 38200 Injection for spleen x-
ray.
347 38790 Injection for lymphatic
x-ray.
347 42550 Injection for salivary x-
ray.
347 47500 Injection for liver x-
rays.
347 47505 Injection for liver x-
rays.
347 49400 Air injection into
abdomen.
347 49424 Assess cyst, contrast
inj.
347 49427 Injection, abdominal
shunt.
347 50392 Insert kidney drain.....
347 50393 Insert ureteral tube....
347 50394 Injection for kidney x-
ray.
347 50395 Create passage to kidney
347 50684 Injection for ureter x-
ray.
347 50690 Injection for ureter x-
ray.
347 51600 Injection for bladder x-
ray.
347 51605 Preparation for bladder
xray.
347 51610 Injection for bladder x-
ray.
347 54230 Prepare penis study.....
347 55300 Preparation,sperm duct x-
ray.
347 58340 Catheter for
hysterography.
347 62284 Injection for myelogram.
347 62290 Inject for spine disk x-
ray.
347 62291 Inject for spine disk x-
ray.
347 68850 Injection for tear sac x-
ray.
360 REMOVAL/REVISION, PACEMAKER/ T 6.04 $310.58 $138.54 $62.12
VASCULAR DEVICE
360 33222 Pacemaker aicd pocket...
360 33223 Pacemaker aicd pocket...
360 36261 Revision of infusion
pump.
360 36262 Removal of infusion pump
360 36299 Vessel injection
procedure.
360 36531 Revision of infusion
pump.
360 36532 Removal of infusion pump
360 36534 Revision of access port.
360 36535 Removal of access port..
360 37203 Transcatheter retrieval.
367 VASCULAR LIGATION T 17.02 $875.17 $441.15 $175.03
367 30915 Ligation nasal sinus
artery.
367 30920 Ligation upper jaw
artery.
367 37618 Ligation of extremity
artery.
367 37650 Revision of major vein..
367 37700 Revise leg vein.........
367 37720 Removal of leg vein.....
367 37730 Removal of leg veins....
[[Page 35443]]
367 37735 Removal of leg veins/
lesion.
367 37760 Revision of leg veins...
367 37780 Revision of leg vein....
367 37785 Revise secondary
varicosity.
368 VASCULAR REPAIR/FISTULA T 22.59 $1,161.58 $647.49 $232.32
CONSTRUCTION
368 35188 Repair blood vessel
lesion.
368 35207 Repair blood vessel
lesion.
368 35875 Removal of clot in graft
368 35876 Removal of clot in graft
368 36260 Insertion of infusion
pump.
368 36530 Insertion of infusion
pump.
368 36533 Insertion of access port
368 36800 Insertion of cannula....
368 36810 Insertion of cannula....
368 36815 Insertion of cannula....
368 36821 Artery-vein fusion......
368 36825 Artery-vein graft.......
368 36830 Artery-vein graft.......
368 36832 Av fistula revision.....
368 36835 Artery to vein shunt....
368 36860 External cannula
declotting.
368 36861 Cannula declotting......
368 37607 Ligation of fistula.....
369 BLOOD AND BLOOD PRODUCT EXCHANGE T 6.33 $325.49 $155.49 $65.10
369 36430 Blood transfusion
service.
369 36440 Blood transfusion
service.
369 36450 Exchange transfusion
service.
369 36455 Exchange transfusion
service.
369 36460 Transfusion service,
fetal.
369 36520 Plasma and/or cell
exchange.
369 36522 Photopheresis...........
369 38230 Bone marrow collection..
369 38231 Stem cell collection....
369 Q0068 Extracorpeal
plasmapheresis.
396 LYMPH NODE EXCISIONS T 12.98 $667.43 $334.48 $133.49
396 38308 Incision of lymph
channels.
396 38500 Biopsy/removal,lymph
node(s).
396 38510 Biopsy/removal,lymph
node(s).
396 38520 Biopsy/removal,lymph
node(s).
396 38525 Biopsy/removal,lymph
node(s).
396 38530 Biopsy/removal,lymph
node(s).
396 38550 Removal neck/armpit
lesion.
397 THYROID/LYMPHADENECTOMY T 19.12 $983.15 $542.17 $196.63
PROCEDURES
397 38542 Explore deep node(s),
neck.
397 38555 Removal neck/armpit
lesion.
397 38740 Remove armpit lymph
nodes.
397 38745 Remove armpits lymph
nodes.
397 38760 Remove groin lymph nodes
397 60200 Remove thyroid lesion...
397 60210 Partial excision thyroid
397 60220 Partial removal of
thyroid.
397 60225 Partial removal of
thyroid.
397 60240 Removal of thyroid......
397 60280 Remove thyroid duct
lesion.
397 60281 Remove thyroid duct
lesion.
406 ESOPHAGEAL DILATION WITHOUT T 4.17 $214.42 $106.67 $42.88
ENDOSCOPY
406 43450 Dilate esophagus........
406 43453 Dilate esophagus........
406 43456 Dilate esophagus........
406 43458 Dilation of esophagus...
406 43499 Esophagus surgery
procedure.
407 ESOPHAGOSCOPY T 6.89 $354.28 $189.39 $70.86
407 43204 Esophagus endoscopy &
inject.
407 43205 Esophagus endoscopy/
ligation.
407 43215 Esophagus endoscopy.....
407 43216 Esophagus endoscopy/
lesion.
407 43217 Esophagus endoscopy.....
407 43220 Esophagus endoscopy,
dilation.
407 43226 Esophagus endoscopy,
dilation.
407 43227 Esophagus endoscopy,
repair.
417 DIAGNOSTIC UPPER GI ENDOSCOPY T 6.35 $326.52 $179.22 $65.30
417 43200 Esophagus endoscopy.....
417 43202 Esophagus endoscopy,
biopsy.
417 43234 Upper GI endoscopy, exam
417 43235 Upper gi endoscopy,
diagnosis.
[[Page 35444]]
417 43239 Upper GI endoscopy,
biopsy.
417 43600 Biopsy of stomach.......
417 44100 Biopsy of bowel.........
418 THERAPEUTIC UPPER GI ENDOSCOPY T 7.44 $382.56 $213.57 $76.51
418 43241 Upper GI endoscopy with
tube.
418 43243 Upper GI endoscopy &
inject.
418 43244 Upper GI endoscopy/
ligation.
418 43245 Operative upper GI
endoscopy.
418 43246 Place gastrostomy tube..
418 43247 Operative upper GI
endoscopy.
418 43248 Upper GI endoscopy/
guidewire.
418 43249 Esophagus
endoscopy,dilation.
418 43250 Upper GI endoscopy/tumor
418 43251 Operative upper GI
endoscopy.
418 43255 Operative upper GI
endoscopy.
418 43750 Place gastrostomy tube..
419 SMALL INTESTINE ENDOSCOPY T 6.83 $351.20 $164.08 $70.24
419 44360 Small bowel endoscopy...
419 44361 Small bowel
endoscopy,biopsy.
419 44363 Small bowel endoscopy...
419 44364 Small bowel endoscopy...
419 44365 Small bowel endoscopy...
419 44366 Small bowel endoscopy...
419 44372 Small bowel endoscopy...
419 44373 Small bowel endoscopy...
419 44376 Small bowel endoscopy...
419 44377 Small bowel endoscopy...
419 44378 Small bowel endoscopy...
419 44799 Intestine surgery
procedure.
426 DIAGNOSTIC LOWER GI ENDOSCOPY T 6.74 $346.57 $185.32 $69.31
426 44380 Small bowel endoscopy...
426 44382 Small bowel endoscopy...
426 44385 Endoscopy of bowel pouch
426 44386 Endoscopy, bowel pouch,
biopsy.
426 44388 Colon endoscopy.........
426 44389 Colonoscopy with biopsy.
426 45378 Diagnostic colonoscopy..
426 45380 Colonoscopy and biopsy..
426 G0105 Colorectal scrn; hi risk
ind.
427 THERAPEUTIC LOWER GI ENDOSCOPY T 8.09 $415.99 $222.84 $83.20
427 44390 Colonoscopy for foreign
body.
427 44391 Colonoscopy for bleeding
427 44392 Colonoscopy &
polypectomy.
427 44394 Colonoscopy w/snare.....
427 45355 Surgical colonoscopy....
427 45379 Colonoscopy.............
427 45382 Colonoscopy,control
bleeding.
427 45384 Colonoscopy.............
427 45385 Colonoscopy, lesion
removal.
437 THERAPEUTIC ANOSCOPY T 6.54 $336.29 $173.79 $67.26
437 46606 Anoscopy and biopsy.....
437 46608 Anoscopy; remove foreign
body.
437 46610 Anoscopy; remove lesion.
437 46611 Anoscopy................
437 46612 Anoscopy; remove lesions
437 46614 Anoscopy; control
bleeding.
437 46615 Anoscopy................
446 DIAGNOSTIC SIGMOIDOSCOPY T 2.54 $130.61 $64.86 $26.12
446 45300 Proctosigmoidoscopy.....
446 45305 Proctosigmoidoscopy;
biopsy.
446 45330 Sigmoidoscopy,
diagnostic.
446 45331 Sigmoidoscopy and biopsy
446 G0104 CA screen; flexi
sigmoidscope.
447 THERAPEUTIC PROCTOSIGMOIDOSCOPY T 7.06 $363.03 $191.87 $72.61
447 45303 Proctosigmoidoscopy.....
447 45307 Proctosigmoidoscopy.....
447 45308 Proctosigmoidoscopy.....
447 45309 Proctosigmoidoscopy.....
447 45315 Proctosigmoidoscopy.....
447 45317 Proctosigmoidoscopy.....
447 45320 Proctosigmoidoscopy.....
447 45321 Proctosigmoidoscopy.....
448 THERAPEUTIC FLEXIBLE T 5.28 $271.50 $139.22 $54.30
SIGMOIDOSCOPY
448 45332 Sigmoidoscopy...........
448 45333 Sigmoidoscopy &
polypectomy.
[[Page 35445]]
448 45334 Sigmoidoscopy for
bleeding.
448 45337 Sigmoidoscopy,
decompression.
448 45338 Sigmoidoscopy...........
449 COMPLEX GI ENDOSCOPY T 7.63 $392.33 $213.57 $78.47
449 43219 Esophagus endoscopy.....
449 43228 Esophagus endoscopy,
ablation.
449 43258 Operative upper GI
endoscopy.
449 43259 Endoscopic ultrasound
exam.
449 43272 Endoscopy, bile duct/
pancreas.
449 44369 Small bowel endoscopy...
449 44393 Colonoscopy, lesion
removal.
449 45339 Sigmoidoscopy...........
449 45383 Colonoscopy, lesion
removal.
451 LEVEL I ANAL/RECTAL PROCEDURES T 2.42 $124.44 $53.56 $24.89
451 46070 Incision of anal septum.
451 46083 Incise external
hemorrhoid.
451 46220 Removal of anal tab.....
451 46221 Ligation of
hemorrhoid(s).
451 46230 Removal of anal tabs....
451 46320 Removal of hemorrhoid
clot.
451 46500 Injection into
hemorrhoids.
451 46934 Destruction of
hemorrhoids.
451 46935 Destruction of
hemorrhoids.
451 46936 Destruction of
hemorrhoids.
451 46940 Treatment of anal
fissure.
451 46942 Treatment of anal
fissure.
451 46945 Ligation of hemorrhoids.
451 46946 Ligation of hemorrhoids.
452 LEVEL II ANAL/RECTAL PROCEDURES T 4.52 $232.42 $103.06 $46.48
452 45000 Drainage of pelvic
abscess.
452 45005 Drainage of rectal
abscess.
452 45020 Drainage of rectal
abscess.
452 45100 Biopsy of rectum........
452 45900 Reduction of rectal
prolapse.
452 45905 Dilation of anal
sphincter.
452 45910 Dilation of rectal
narrowing.
452 45915 Remove rectal
obstruction.
452 45999 Rectum surgery procedure
452 46030 Removal of rectal marker
452 46040 Incision of rectal
abscess.
452 46050 Incision of anal abscess
452 46080 Incision of anal
sphincter.
452 46210 Removal of anal crypt...
452 46754 Removal of suture from
anus.
452 46999 Anus surgery procedure..
453 LEVEL III ANAL/RECTAL PROCEDURES T 16.26 $836.09 $440.47 $167.22
453 45108 Removal of anorectal
lesion.
453 45150 Excision of rectal
stricture.
453 45160 Excision of rectal
lesion.
453 45170 Excision of rectal
lesion.
453 45190 Destruction, rectal
tumor.
453 45500 Repair of rectum........
453 45505 Repair of rectum........
453 45560 Repair of rectocele.....
453 46045 Incision of rectal
abscess.
453 46060 Incision of rectal
abscess.
453 46200 Removal of anal fissure.
453 46211 Removal of anal crypts..
453 46250 Hemorrhoidectomy........
453 46255 Hemorrhoidectomy........
453 46257 Remove hemorrhoids &
fissure.
453 46258 Remove hemorrhoids &
fistula.
453 46260 Hemorrhoidectomy........
453 46261 Remove hemorrhoids &
fissure.
453 46262 Remove hemorrhoids &
fistula.
453 46270 Removal of anal fistula.
453 46275 Removal of anal fistula.
453 46280 Removal of anal fistula.
453 46285 Removal of anal fistula.
453 46288 Repair anal fistula.....
453 46700 Repair of anal stricture
453 46750 Repair of anal sphincter
453 46753 Reconstruction of anus..
453 46760 Repair of anal sphincter
453 46761 Repair of anal sphincter
[[Page 35446]]
453 46762 Implant artificial
sphincter.
453 46937 Cryotherapy of rectal
lesion.
453 46938 Cryotherapy of rectal
lesion.
456 ENDOSCOPIC RETROGRADE CHOLANGIO- T 9.61 $494.15 $249.05 $98.83
PANCREATOGRAPHY (ERCP)
456 43260 Endoscopy, bile duct/
pancreas.
456 43261 Endoscopy, bile duct/
pancreas.
456 43262 Endoscopy, bile duct/
pancreas.
456 43263 Endoscopy, bile duct/
pancreas.
456 43264 Endoscopy, bile duct/
pancreas.
456 43265 Endoscopy, bile duct/
pancreas.
456 43267 Endoscopy, bile duct/
pancreas.
456 43268 Endoscopy, bile duct/
pancreas.
456 43269 Endoscopy, bile duct/
pancreas.
456 43271 Endoscopy, bile duct/
pancreas.
458 PERCUTANEOUS BILIARY ENDOSCOPIC T 6.81 $350.17 $181.70 $70.03
PROCEDURES
458 47510 Insert catheter, bile
duct.
458 47511 Insert bile duct drain..
458 47552 Biliary endoscopy, thru
skin.
458 47553 Biliary endoscopy, thru
skin.
458 47554 Biliary endoscopy, thru
skin.
458 47555 Biliary endoscopy, thru
skin.
458 47556 Biliary endoscopy, thru
skin.
458 47630 Remove bile duct stone..
459 PERITONEAL AND ABDOMINAL T 17.85 $917.85 $497.88 $183.57
PROCEDURES
459 49085 Remove abdomen foreign
body.
459 49250 Excision of umbilicus...
459 49420 Insert abdominal drain..
459 49421 Insert abdominal drain..
459 49423 Exchange drainage cath..
459 49426 Revise abdomen-venous
shunt.
466 HERNIA/HYDROCELE PROCEDURES T 20.67 $1,062.85 $556.64 $212.57
466 49495 Repair inguinal hernia,
init.
466 49496 Repair inguinal hernia,
init.
466 49500 Repair inguinal hernia..
466 49501 Repair inguinal hernia,
init.
466 49505 Repair inguinal hernia..
466 49507 Repair, inguinal hernia.
466 49520 Rerepair inguinal hernia
466 49521 Repair inguinal hernia,
rec.
466 49525 Repair inguinal hernia..
466 49540 Repair lumbar hernia....
466 49550 Repair femoral hernia...
466 49553 Repair femoral hernia,
init.
466 49555 Repair femoral hernia...
466 49557 Repair femoral hernia,
recur.
466 49560 Repair abdominal hernia.
466 49561 Repair incisional hernia
466 49565 Rerepair abdominal
hernia.
466 49566 Repair incisional hernia
466 49568 Hernia repair w/mesh....
466 49570 Repair epigastric hernia
466 49572 Repair, epigastric
hernia.
466 49580 Repair umbilical hernia.
466 49582 Repair umbilical hernia.
466 49585 Repair umbilical hernia.
466 49587 Repair umbilical hernia.
466 49590 Repair abdominal hernia.
466 49600 Repair umbilical lesion.
466 51500 Removal of bladder cyst.
466 55040 Removal of hydrocele....
466 55041 Removal of hydroceles...
470 TUBE PROCEDURES T 2.19 $112.61 $54.92 $22.52
470 31502 Change of windpipe
airway.
470 43760 Change gastrostomy tube.
470 43761 Reposition gastrostomy
tube.
470 43999 Stomach surgery
procedure.
470 47525 Change bile duct
catheter.
470 47530 Revise, reinsert bile
tube.
470 47999 Bile tract surgery
procedure.
470 49422 Remove perm cannula/
catheter.
470 49429 Removal of shunt........
470 49999 Abdomen surgery
procedure.
470 50688 Change of ureter tube...
470 51705 Change of bladder tube..
470 51710 Change of bladder tube..
[[Page 35447]]
521 LEVEL I CYSTOURETHROSCOPY AND T 4.89 $251.44 $110.06 $50.29
OTHER GENITOURINARY PROCEDURES
521 50398 Change kidney tube......
521 52000 Cystoscopy..............
521 52265 Cystoscopy & treatment..
522 LEVEL II CYSTOURETHROSCOPY AND T 10.15 $521.91 $259.45 $104.38
OTHER GENITOURINARY PROCEDURES
522 50551 Kidney endoscopy........
522 50553 Kidney endoscopy........
522 50555 Kidney endoscopy &
biopsy.
522 50557 Kidney endoscopy &
treatment.
522 50559 Renal endoscopy;
radiotracer.
522 50561 Kidney endoscopy &
treatment.
522 52005 Cystoscopy & ureter
catheter.
522 52007 Cystoscopy and biopsy...
522 52010 Cystoscopy & duct
catheter.
522 52204 Cystoscopy..............
522 52214 Cystoscopy and treatment
522 52224 Cystoscopy and treatment
522 52260 Cystoscopy & treatment..
522 52270 Cystoscopy & revise
urethra.
522 52275 Cystoscopy & revise
urethra.
522 52276 Cystoscopy and treatment
522 52281 Cystoscopy and treatment
522 52283 Cystoscopy and treatment
522 52285 Cystoscopy and treatment
522 52290 Cystoscopy and treatment
522 52300 Cystoscopy and treatment
522 52301 Cystoscopy and treatment
522 52305 Cystoscopy and treatment
522 52310 Cystoscopy and treatment
522 52315 Cystoscopy and treatment
522 52327 Cystoscopy, inject
material.
522 52510 Dilation prostatic
urethra.
522 53605 Dilate urethra stricture
523 LEVEL III CYSTOURETHROSCOPY AND T 16.35 $840.72 $438.89 $168.14
OTHER GENITOURINARY PROCEDURES
523 50951 Endoscopy of ureter.....
523 50953 Endoscopy of ureter.....
523 50955 Ureter endoscopy &
biopsy.
523 50957 Ureter endoscopy &
treatment.
523 50959 Ureter endoscopy &
tracer.
523 50961 Ureter endoscopy &
treatment.
523 51020 Incise & treat bladder..
523 51030 Incise & treat bladder..
523 51040 Incise & drain bladder..
523 51045 Incise bladder, drain
ureter.
523 51050 Removal of bladder stone
523 51065 Removal of ureter stone.
523 51520 Removal of bladder
lesion.
523 51880 Repair of bladder
opening.
523 52234 Cystoscopy and treatment
523 52235 Cystoscopy and treatment
523 52240 Cystoscopy and treatment
523 52250 Cystoscopy & radiotracer
523 52277 Cystoscopy and treatment
523 52282 Cystoscopy, implant
stent.
523 52317 Remove bladder stone....
523 52318 Remove bladder stone....
523 52320 Cystoscopy and treatment
523 52325 Cystoscopy, stone
removal.
523 52330 Cystoscopy and treatment
523 52332 Cystoscopy and treatment
523 52334 Create passage to kidney
523 52335 Endoscopy of urinary
tract.
523 52336 Cystoscopy, stone
removal.
523 52338 Cystoscopy and treatment
523 52339 Cystoscopy and treatment
523 52340 Cystoscopy and treatment
523 52450 Incision of prostate....
523 52500 Revision of bladder neck
523 52606 Control postop bleeding.
523 52640 Relieve bladder
contracture.
523 52700 Drainage of prostate
abscess.
523 55720 Drainage of prostate
abscess.
523 55725 Drainage of prostate
abscess.
523 55859 Percut/needle insert,
pros.
[[Page 35448]]
524 LEVEL IV CYSTOURETHROSCOPY AND T 27.20 $1,398.62 $824.90 $279.72
OTHER GENITOURINARY PROCEDURES
524 52337 Cystoscopy, stone
removal.
524 52601 Prostatectomy (TURP)....
524 52612 Prostatectomy, first
stage.
524 52614 Prostatectomy, second
stage.
524 52620 Remove residual prostate
524 52630 Remove prostate regrowth
524 52647 Laser surgery of
prostate.
524 52648 Laser surgery of
prostate.
524 53850 Prostatic microwave
thermotx.
524 53852 Prostatic rf thermotx...
527 LITHOTRIPSY T 43.48 $2,235.74 $1,372.95 $447.15
527 50590 Fragmenting of kidney
stone.
529 SIMPLE URINARY STUDIES AND T 2.33 $119.81 $59.66 $23.96
PROCEDURES
529 50396 Measure kidney pressure.
529 50686 Measure ureter pressure.
529 51725 Simple cystometrogram...
529 51726 Complex cystometrogram..
529 51736 Urine flow measurement..
529 51741 Electro-uroflowmetry,
first.
529 51772 Urethra pressure profile
529 51784 Anal/urinary muscle
study.
529 51785 Anal/urinary muscle
study.
529 51792 Urinary reflex study....
529 51795 Urine voiding pressure
study.
529 51797 Intraabdominal pressure
test.
529 54240 Penis study.............
529 54250 Penis study.............
530 GENITOURINARY PROCEDURES T 2.46 $126.49 $53.34 $25.30
530 51000 Drainage of bladder.....
530 51005 Drainage of bladder.....
530 51010 Drainage of bladder.....
530 51700 Irrigation of bladder...
530 51720 Treatment of bladder
lesion.
530 53600 Dilate urethra stricture
530 53601 Dilate urethra stricture
530 53620 Dilate urethra stricture
530 53621 Dilate urethra stricture
\2\ 530 53640 Relieve bladder
retention.
530 53660 Dilation of urethra.....
530 53661 Dilation of urethra.....
530 53675 Insert urinary catheter.
530 53899 Urology surgery
procedure.
530 54200 Treatment of penis
lesion.
530 54220 Treatment of penis
lesion.
530 54231 Dynamic cavernosometry..
530 54235 Penile injection........
530 54450 Preputial stretching....
530 55899 Genital surgery
procedure.
531 LEVEL I URETHRAL PROCEDURES T 18.59 $955.90 $531.55 $191.18
531 51715 Endoscopic injection/
implant.
531 53000 Incision of urethra.....
531 53010 Incision of urethra.....
531 53020 Incision of urethra.....
531 53025 Incision of urethra.....
531 53040 Drainage of urethra
abscess.
531 53060 Drainage of urethra
abscess.
531 53080 Drainage of urinary
leakage.
531 53200 Biopsy of urethra.......
531 53250 Removal of urethra gland
531 53260 Treatment of urethra
lesion.
531 53265 Treatment of urethra
lesion.
531 53270 Removal of urethra gland
531 53275 Repair of urethra defect
531 53442 Remove perineal
prosthesis.
531 53502 Repair of urethra injury
531 53505 Repair of urethra injury
531 53510 Repair of urethra injury
531 53665 Dilation of urethra.....
531 54000 Slitting of prepuce.....
531 54001 Slitting of prepuce.....
532 LEVEL II URETHRAL PROCEDURES T 23.02 $1,183.69 $588.50 $236.74
532 53210 Removal of urethra......
532 53215 Removal of urethra......
532 53220 Treatment of urethra
lesion.
532 53230 Removal of urethra
lesion.
[[Page 35449]]
532 53235 Removal of urethra
lesion.
532 53240 Surgery for urethra
pouch.
532 53400 Revise urethra, 1st
stage.
532 53405 Revise urethra, 2nd
stage.
532 53410 Reconstruction of
urethra.
532 53420 Reconstruct urethra,
stage 1.
532 53425 Reconstruct urethra,
stage 2.
532 53430 Reconstruction of
urethra.
532 53447 Remove artificial
sphincter.
532 53449 Correct artificial
sphincter.
532 53450 Revision of urethra.....
532 53460 Revision of urethra.....
532 53515 Repair of urethra injury
532 53520 Repair of urethra defect
536 CIRCUMCISION T 12.89 $662.80 $321.60 $132.56
536 54150 Circumcision............
536 54152 Circumcision............
536 54160 Circumcision............
536 54161 Circumcision............
537 PENILE PROCEDURES T 28.65 $1,473.18 $872.36 $294.64
537 37790 Penile venous occlusion.
537 54110 Treatment of penis
lesion.
537 54111 Treat penis lesion,
graft.
537 54112 Treat penis lesion,
graft.
537 54120 Partial removal of penis
537 54205 Treatment of penis
lesion.
537 54300 Revision of penis.......
537 54304 Revision of penis.......
537 54308 Reconstruction of
urethra.
537 54312 Reconstruction of
urethra.
537 54316 Reconstruction of
urethra.
537 54318 Reconstruction of
urethra.
537 54322 Reconstruction of
urethra.
537 54324 Reconstruction of
urethra.
537 54326 Reconstruction of
urethra.
537 54328 Revise penis, urethra...
537 54340 Secondary urethral
surgery.
537 54344 Secondary urethral
surgery.
537 54348 Secondary urethral
surgery.
537 54352 Reconstruct urethra,
penis.
537 54360 Penis plastic surgery...
537 54380 Repair penis............
537 54385 Repair penis............
537 54402 Remove penis prosthesis.
537 54407 Remove multi-comp
prosthesis.
537 54409 Revise penis prosthesis.
537 54420 Revision of penis.......
537 54435 Revision of penis.......
537 54440 Repair of penis.........
538 INSERTION OF PENILE PROSTHESIS T 48.41 $2,489.24 $1,563.47 $497.85
538 53440 Correct bladder function
538 53445 Correct urine flow
control.
538 54400 Insert semi-rigid
prosthesis.
538 54401 Insert self-contd
prosthesis.
538 54405 Insert multi-comp
prosthesis.
546 TESTES/EPIDIDYMIS PROCEDURES T 16.54 $850.49 $449.51 $170.10
546 54505 Biopsy of testis........
546 54510 Removal of testis lesion
546 54520 Removal of testis.......
546 54530 Removal of testis.......
546 54550 Exploration for testis..
546 54600 Reduce testis torsion...
546 54620 Suspension of testis....
546 54640 Suspension of testis....
546 54660 Revision of testis......
546 54670 Repair testis injury....
546 54680 Relocation of testis(es)
546 54700 Drainage of scrotum.....
546 54820 Exploration of
epididymis.
546 54830 Remove epididymis lesion
546 54840 Remove epididymis lesion
546 54860 Removal of epididymis...
546 54861 Removal of epididymis...
546 54900 Fusion of spermatic
ducts.
546 54901 Fusion of spermatic
ducts.
[[Page 35450]]
546 55060 Repair of hydrocele.....
546 55110 Explore scrotum.........
546 55120 Removal of scrotum
lesion.
546 55150 Removal of scrotum......
546 55175 Revision of scrotum.....
546 55180 Revision of scrotum.....
546 55200 Incision of sperm duct..
546 55250 Removal of sperm duct(s)
546 55400 Repair of sperm duct....
546 55450 Ligation of sperm duct..
546 55500 Removal of hydrocele....
546 55520 Removal of sperm cord
lesion.
546 55530 Revise spermatic cord
veins.
546 55535 Revise spermatic cord
veins.
546 55540 Revise hernia & sperm
veins.
546 55680 Remove sperm pouch
lesion.
547 PROSTATE BIOPSY T 4.39 $225.73 $125.20 $45.15
547 55700 Biopsy of prostate......
547 55705 Biopsy of prostate......
550 SURGICAL HYSTEROSCOPY T 16.46 $846.37 $445.22 $169.27
550 56351 Hysteroscopy; biopsy....
550 56352 Hysteroscopy; lysis.....
550 56353 Hysteroscopy; resect
septum.
550 56354 Hysteroscopy; remove
myoma.
550 56355 Hysteroscopy; remove
impact.
550 56356 Hysteroscopy; ablation..
551 LEVEL I LAPAROSCOPY T 24.61 $1,265.45 $701.73 $253.09
551 56300 Laparoscopy; diagnostic.
551 56301 Laparoscopy; tubal
cautery.
551 56302 Laparoscopy; tubal block
551 56303 Laparoscopy; excise
lesions.
551 56304 Laparoscopy; lysis......
551 56305 Laparoscopy; biopsy.....
551 56306 Laparoscopy; aspiration.
551 56346 Laparoscopic gastrostomy
\2\ 551 56360 Peritoneoscopy..........
\2\ 551 56361 Peritoneoscopy w/biopsy.
552 LEVEL II LAPAROSCOPY T 37.09 $1,907.17 $1,053.84 $381.43
552 56307 Laparoscopy; remove
adnexa.
552 56309 Laparoscopy; remove
myoma.
552 56311 Laparoscopic lymph node
biop.
552 56312 Laparoscopic
lymphadenectomy.
552 56313 Laparoscopic
lymphadenectomy.
552 56316 Laparoscopic hernia
repair.
552 56317 Laparoscopic hernia
repair.
552 56318 Laparoscopic orchiectomy
552 56320 Laparoscopy, spermatic
veins.
552 56343 Laparoscopic
salpingostomy.
552 56344 Laparoscopic
fimbrioplasty.
552 56362 Laparoscopy w/cholangio.
552 56363 Laparoscopy w/biopsy....
561 LEVEL I FEMALE REPRODUCTIVE T 1.46 $75.07 $24.41 $15.01
PROCEDURES
561 56405 I & D of vulva/perineum.
561 56420 Drainage of gland
abscess.
561 56441 Lysis of labial
lesion(s).
561 57061 Destruction vagina
lesion(s).
561 57100 Biopsy of vagina........
561 57150 Treat vagina infection..
561 57160 Insertion of pessary/
device.
561 57170 Fitting of diaphragm/cap
561 57180 Treat vaginal bleeding..
561 57452 Examination of vagina...
561 57454 Vagina examination &
biopsy.
561 57500 Biopsy of cervix........
561 57505 Endocervical curettage..
561 57510 Cauterization of cervix.
561 57511 Cryocautery of cervix...
561 57513 Laser surgery of cervix.
561 57800 Dilation of cervical
canal.
561 58100 Biopsy of uterus lining.
561 58301 Remove intrauterine
device.
561 59200 Insert cervical dilator.
561 Q0091 Obtaining screen pap
smear.
562 LEVEL II FEMALE REPRODUCTIVE T 12.30 $632.47 $325.44 $126.49
PROCEDURES
562 56350 Hysteroscopy; diagnostic
[[Page 35451]]
562 56399 Laparoscopy procedure...
562 56440 Surgery for vulva lesion
562 56700 Partial removal of hymen
562 56720 Incision of hymen.......
562 56740 Remove vagina gland
lesion.
562 56800 Repair of vagina........
562 56810 Repair of perineum......
562 57000 Exploration of vagina...
562 57010 Drainage of pelvic
abscess.
562 57020 Drainage of pelvic fluid
562 57065 Destruction vagina
lesion(s).
562 57105 Biopsy of vagina........
562 57130 Remove vagina lesion....
562 57135 Remove vagina lesion....
562 57200 Repair of vagina........
562 57210 Repair vagina/perineum..
562 57230 Repair of urethral
lesion.
562 57400 Dilation of vagina......
562 57410 Pelvic examination......
562 57415 Removal vaginal foreign
body.
562 57460 Cervix excision.........
562 57700 Revision of cervix......
562 57720 Revision of cervix......
562 58345 Reopen fallopian tube...
562 58350 Reopen fallopian tube...
562 58970 Retrieval of oocyte.....
562 59300 Episiotomy or vaginal
repair.
562 59320 Revision of cervix......
562 59871 Remove cerclage suture..
563 LEVEL III FEMALE REPRODUCTIVE T 16.50 $848.43 $461.72 $169.69
PROCEDURES
563 56620 Partial removal of vulva
563 56625 Complete removal of
vulva.
563 57220 Revision of urethra.....
563 57240 Repair bladder & vagina.
563 57250 Repair rectum & vagina..
563 57260 Repair of vagina........
563 57265 Extensive repair of
vagina.
563 57268 Repair of bowel bulge...
563 57284 Repair paravaginal
defect.
563 57288 Repair bladder defect...
563 57289 Repair bladder & vagina.
563 57291 Construction of vagina..
563 57300 Repair rectum-vagina
fistula.
563 57520 Conization of cervix....
563 57522 Conization of cervix....
563 57530 Removal of cervix.......
563 57550 Removal of residual
cervix.
563 57555 Remove cervix, repair
vagina.
563 57556 Remove cervix, repair
bowel.
563 58145 Removal of uterus lesion
563 58800 Drainage of ovarian
cyst(s).
563 58820 Open drain ovary abscess
567 D & C T 13.18 $677.72 $360.70 $135.54
567 57820 D&c of residual cervix..
567 58120 Dilation and curettage
(D&C).
567 59160 D&C after delivery......
568 INFERTILITY PROCEDURES T 2.79 $143.46 $55.60 $28.69
568 55870 Electroejaculation......
568 58321 Artificial insemination.
568 58322 Artificial insemination.
568 58323 Sperm washing...........
568 58974 Transfer of embryo......
568 58976 Transfer of embryo......
578 PREGNANCY AND NEONATAL CARE T 1.17 $60.16 $32.77 $12.03
PROCEDURES
578 59000 Amniocentesis...........
578 59012 Fetal cord puncture,
prenatal.
578 59015 Chorion biopsy..........
578 59020 Fetal contract stress
test.
578 59025 Fetal non-stress test...
578 59030 Fetal scalp blood sample
578 59050 Fetal monitor w/report..
578 59899 Maternity care procedure
580 VAGINAL DELIVERY T 4.31 $221.62 $44.32 $44.32
580 59409 Obstetrical care........
580 59412 Antepartum manipulation.
[[Page 35452]]
580 59414 Deliver placenta........
580 59612 Vbac delivery only......
586 THERAPEUTIC ABORTION T 11.98 $616.01 $409.29 $123.20
586 59840 Abortion................
586 59841 Abortion................
587 SPONTANEOUS ABORTION T 12.96 $666.40 $347.14 $133.28
587 59812 Treatment of miscarriage
587 59820 Care of miscarriage.....
587 59821 Treatment of miscarriage
587 59870 Evacuate mole of uterus.
600 SPINAL TAP T 2.41 $123.92 $61.47 $24.78
600 62270 Spinal fluid tap,
diagnostic.
600 62272 Drain spinal fluid......
601 LEVEL I NERVOUS SYSTEM INJECTIONS T 3.00 $154.26 $74.13 $30.85
601 64400 Injection for nerve
block.
601 64402 Injection for nerve
block.
601 64405 Injection for nerve
block.
601 64408 Injection for nerve
block.
601 64410 Injection for nerve
block.
601 64412 Injection for nerve
block.
601 64413 Injection for nerve
block.
601 64415 Injection for nerve
block.
601 64417 Injection for nerve
block.
601 64418 Injection for nerve
block.
601 64420 Injection for nerve
block.
601 64421 Injection for nerve
block.
601 64425 Injection for nerve
block.
601 64430 Injection for nerve
block.
601 64435 Injection for nerve
block.
601 64440 Injection for nerve
block.
601 64441 Injection for nerve
block.
601 64442 Injection for nerve
block.
601 64443 Inject, nerve block add-
on.
601 64445 Injection for nerve
block.
601 64450 Injection for nerve
block.
601 64505 Injection for nerve
block.
601 64508 Injection for nerve
block.
601 64510 Injection for nerve
block.
601 64520 Injection for nerve
block.
601 64530 Injection for nerve
block.
601 64600 Injection treatment of
nerve.
601 64605 Injection treatment of
nerve.
601 64610 Injection treatment of
nerve.
601 64612 Destroy nerve, face
muscle.
601 64613 Destroy nerve, spine
muscle.
601 64620 Injection treatment of
nerve.
601 64622 Injection treatment of
nerve.
601 64623 Inject, tx of nerve add-
on.
601 64630 Injection treatment of
nerve.
601 64640 Injection treatment of
nerve.
601 64680 Injection treatment of
nerve.
601 64999 Nervous system surgery..
602 LEVEL II NERVOUS SYSTEM T 3.19 $164.03 $87.01 $32.81
INJECTIONS
602 61000 Remove cranial cavity
fluid.
602 61001 Remove cranial cavity
fluid.
602 61020 Remove brain cavity
fluid.
602 61026 Injection into brain
canal.
602 61050 Remove brain canal fluid
602 61055 Injection into brain
canal.
602 61070 Brain canal shunt
procedure.
602 62194 Replace/irrigate
catheter.
602 62225 Replace/irrigate
catheter.
602 62268 Drain spinal cord cyst..
602 62273 Treat lumbar spine
lesion.
602 62274 Inject spinal anesthetic
602 62275 Inject spinal anesthetic
602 62276 Inject spinal anesthetic
602 62277 Inject spinal anesthetic
602 62278 Inject spinal anesthetic
602 62279 Inject spinal anesthetic
602 62280 Treat spinal cord lesion
602 62281 Treat spinal cord lesion
602 62282 Treat spinal canal
lesion.
602 62288 Injection into spinal
canal.
602 62289 Injection into spinal
canal.
[[Page 35453]]
602 62292 Injection into disk
lesion.
602 62294 Injection into spinal
artery.
602 62298 Injection into spinal
canal.
616 IMPLANTATION OF NEUROSTIMULATOR T 11.85 $609.33 $329.06 $121.87
ELECTRODES
616 63650 Implant neuroelectrodes.
616 64553 Implant neuroelectrodes.
616 64555 Implant neuroelectrodes.
616 64560 Implant neuroelectrodes.
616 64565 Implant neuroelectrodes.
616 64573 Implant neuroelectrodes.
616 64575 Implant neuroelectrodes.
616 64577 Implant neuroelectrodes.
616 64580 Implant neuroelectrodes.
617 REVISION/REMOVAL NEUROLOGICAL T 11.31 $581.56 $280.01 $116.31
DEVICE
617 62230 Replace/revise brain
shunt.
617 62350 Implant spinal catheter.
617 62355 Remove spinal canal
catheter.
617 62365 Remove spine infusion
device.
617 63660 Revise/remove
neuroelectrode.
617 63688 Revise/remove
neuroreceiver.
617 63744 Revision of spinal shunt
617 63746 Removal of spinal shunt.
617 64585 Revise/remove
neuroelectrode.
617 64595 Revise/remove
neuroreceiver.
618 IMPLANTATION OF NEUROLOGICAL T 24.78 $1,274.19 $808.18 $254.84
DEVICE
618 61215 Insert brain-fluid
device.
618 61885 Implant neuroreceiver...
618 62360 Insert spine infusion
device.
618 62361 Implant spine infusion
pump.
618 62362 Implant spine infusion
pump.
618 63685 Implant neuroreceiver...
618 64590 Implant neuroreceiver...
631 LEVEL I NERVE PROCEDURES T 12.70 $653.03 $329.06 $130.61
631 27315 Partial removal, thigh
nerve.
631 27320 Partial removal, thigh
nerve.
631 28030 Removal of foot nerve...
631 28035 Decompression of tibia
nerve.
631 61790 Treat trigeminal nerve..
631 62287 Percutaneous diskectomy.
631 63600 Remove spinal cord
lesion.
631 63610 Stimulation of spinal
cord.
631 63615 Remove lesion of spinal
cord.
631 64702 Revise finger/toe nerve.
631 64704 Revise hand/foot nerve..
631 64708 Revise arm/leg nerve....
631 64712 Revision of sciatic
nerve.
631 64713 Revision of arm nerve(s)
631 64714 Revise low back nerve(s)
631 64716 Revision of cranial
nerve.
631 64718 Revise ulnar nerve at
elbow.
631 64719 Revise ulnar nerve at
wrist.
631 64721 Carpal tunnel surgery...
631 64722 Relieve pressure on
nerve(s).
631 64726 Release foot/toe nerve..
631 64727 Internal nerve revision.
631 64732 Incision of brow nerve..
631 64734 Incision of cheek nerve.
631 64736 Incision of chin nerve..
631 64738 Incision of jaw nerve...
631 64740 Incision of tongue nerve
631 64742 Incision of facial nerve
631 64744 Incise nerve, back of
head.
631 64746 Incise diaphragm nerve..
631 64761 Incision of pelvis nerve
631 64771 Sever cranial nerve.....
631 64772 Incision of spinal nerve
631 64774 Remove skin nerve lesion
631 64776 Remove digit nerve
lesion.
631 64778 Digit nerve surgery add-
on.
631 64782 Remove limb nerve lesion
631 64783 Limb nerve surgery add-
on.
631 64784 Remove nerve lesion.....
631 64787 Implant nerve end.......
631 64788 Remove skin nerve lesion
631 64790 Removal of nerve lesion.
[[Page 35454]]
631 64795 Biopsy of nerve.........
\2\ 631 64830 Microrepair of nerve....
632 LEVEL II NERVE PROCEDURES T 16.48 $847.40 $453.58 $169.48
632 64786 Remove sciatic nerve
lesion.
632 64792 Removal of nerve lesion.
632 64831 Repair of digit nerve...
632 64832 Repair nerve add-on.....
632 64834 Repair of hand or foot
nerve.
632 64835 Repair of hand or foot
nerve.
632 64836 Repair of hand or foot
nerve.
632 64837 Repair nerve add-on.....
632 64840 Repair of leg nerve.....
632 64856 Repair/transpose nerve..
632 64857 Repair arm/leg nerve....
632 64858 Repair sciatic nerve....
632 64859 Nerve surgery...........
632 64861 Repair of arm nerves....
632 64862 Repair of low back
nerves.
632 64864 Repair of facial nerve..
632 64865 Repair of facial nerve..
632 64870 Fusion of facial/other
nerve.
632 64872 Subsequent repair of
nerve.
632 64874 Repair & revise nerve
add-on.
632 64876 Repair nerve; shorten
bone.
632 64885 Nerve graft, head or
neck.
632 64886 Nerve graft, head or
neck.
632 64890 Nerve graft, hand or
foot.
632 64891 Nerve graft, hand or
foot.
632 64892 Nerve graft, arm or leg.
632 64893 Nerve graft, arm or leg.
632 64895 Nerve graft, hand or
foot.
632 64896 Nerve graft, hand or
foot.
632 64897 Nerve graft, arm or leg.
632 64898 Nerve graft, arm or leg.
632 64901 Nerve graft add-on......
632 64902 Nerve graft add-on......
632 64905 Nerve pedicle transfer..
632 64907 Nerve pedicle transfer..
648 LASER RETINAL PROCEDURES T 3.76 $193.34 $93.56 $38.67
648 67105 Repair, detached retina.
648 67145 Treatment of retina.....
648 67210 Treatment of retinal
lesion.
648 67228 Treatment of retinal
lesion.
649 LASER EYE PROCEDURES EXCEPT T 4.37 $224.71 $111.64 $44.94
RETINAL
649 65855 Laser surgery of eye....
649 65860 Incise inner eye
adhesions.
649 66761 Revision of iris........
649 66762 Revision of iris........
649 66770 Removal of inner eye
lesion.
649 66821 After cataract laser
surgery.
649 66999 Eye surgery procedure...
649 67031 Laser surgery, eye
strands.
649 67299 Eye surgery procedure...
651 LEVEL I ANTERIOR SEGMENT EYE T 6.85 $352.23 $171.99 $70.45
PROCEDURES
651 65272 Repair of eye wound.....
651 65275 Repair of eye wound.....
651 65286 Repair of eye wound.....
651 65420 Removal of eye lesion...
651 65436 Curette/treat cornea....
651 65450 Treatment of corneal
lesion.
651 65772 Correction of
astigmatism.
651 65810 Drainage of eye.........
651 65815 Drainage of eye.........
651 65820 Relieve inner eye
pressure.
651 66130 Remove eye lesion.......
651 66500 Incision of iris........
651 66505 Incision of iris........
651 66600 Remove iris and lesion..
651 66625 Removal of iris.........
651 66630 Removal of iris.........
651 66700 Destruction, ciliary
body.
651 66710 Destruction, ciliary
body.
651 66720 Destruction, ciliary
body.
651 66820 Incision, secondary
cataract.
651 66825 Reposition intraocular
lens.
[[Page 35455]]
652 LEVEL II ANTERIOR SEGMENT EYE T 16.35 $840.72 $433.92 $168.14
PROCEDURES
652 65235 Remove foreign body from
eye.
652 65280 Repair of eye wound.....
652 65285 Repair of eye wound.....
652 65400 Removal of eye lesion...
652 65426 Removal of eye lesion...
652 65770 Revise cornea with
implant.
652 65775 Correction of
astigmatism.
652 65850 Incision of eye.........
652 65865 Incise inner eye
adhesions.
652 65870 Incise inner eye
adhesions.
652 65875 Incise inner eye
adhesions.
652 65880 Incise inner eye
adhesions.
652 65900 Remove eye lesion.......
652 65920 Remove implant from eye.
652 65930 Remove blood clot from
eye.
652 66150 Glaucoma surgery........
652 66155 Glaucoma surgery........
652 66160 Glaucoma surgery........
652 66165 Glaucoma surgery........
652 66170 Glaucoma surgery........
652 66172 Incision of eye.........
652 66180 Implant eye shunt.......
652 66185 Revise eye shunt........
652 66225 Repair/graft eye lesion.
652 66250 Follow-up surgery of eye
652 66605 Removal of iris.........
652 66635 Removal of iris.........
652 66680 Repair iris & ciliary
body.
652 66682 Repair iris and ciliary
body.
652 66740 Destruction, ciliary
body.
652 66830 Removal of lens lesion..
652 68130 Remove eyelid lining
lesion.
652 68330 Revise eyelid lining....
652 68360 Revise eyelid lining....
652 68362 Revise eyelid lining....
667 CATARACT PROCEDURES T 20.35 $1,046.40 $538.11 $209.28
667 66840 Removal of lens material
667 66850 Removal of lens material
667 66852 Removal of lens material
667 66920 Extraction of lens......
667 66930 Extraction of lens......
667 66940 Extraction of lens......
668 CATARACT PROCEDURES WITH IOL T 22.02 $1,132.27 $617.21 $226.45
INSERT
668 66983 Remove cataract, insert
lens.
668 66984 Remove cataract, insert
lens.
668 66985 Insert lens prosthesis..
668 66986 Exchange lens prosthesis
670 CORNEAL TRANSPLANT T 30.78 $1,582.71 $885.92 $316.54
670 65710 Corneal transplant......
670 65730 Corneal transplant......
670 65750 Corneal transplant......
670 65755 Corneal transplant......
676 POSTERIOR SEGMENT EYE PROCEDURES T 5.87 $301.84 $138.54 $60.37
676 65260 Remove foreign body from
eye.
676 65265 Remove foreign body from
eye.
676 66220 Repair eye lesion.......
676 67005 Partial removal of eye
fluid.
676 67010 Partial removal of eye
fluid.
676 67015 Release of eye fluid....
676 67030 Incise inner eye strands
676 67101 Repair, detached retina.
676 67110 Repair detached retina..
676 67115 Release, encircling
material.
676 67120 Remove eye implant
material.
676 67121 Remove eye implant
material.
676 67141 Treatment of retina.....
676 67208 Treatment of retinal
lesion.
676 67218 Treatment of retinal
lesion.
676 67227 Treatment of retinal
lesion.
676 92018 New eye exam & treatment
676 92019 Eye exam & treatment....
677 STRABISMUS/MUSCLE PROCEDURES T 16.11 $828.38 $428.95 $165.68
677 65290 Repair of eye socket
wound.
677 67311 Revise eye muscle.......
[[Page 35456]]
677 67312 Revise two eye muscles..
677 67314 Revise eye muscle.......
677 67316 Revise two eye muscles..
677 67318 Revise eye muscle(s)....
677 67320 Revise eye muscle(s) add-
on.
677 67331 Eye surgery follow-up
add-on.
677 67332 Rerevise eye muscles add-
on.
677 67334 Revise eye muscle w/
suture.
677 67335 Eye suture during
surgery.
677 67340 Revise eye muscle add-on
677 67343 Release eye tissue......
681 LEVEL I EYE PROCEDURES T 1.65 $84.84 $30.51 $16.97
681 65125 Revise ocular implant...
681 65205 Remove foreign body from
eye.
681 65210 Remove foreign body from
eye.
681 65220 Remove foreign body from
eye.
681 65222 Remove foreign body from
eye.
681 65430 Corneal smear...........
681 65435 Curette/treat cornea....
681 65600 Revision of cornea......
681 67345 Destroy nerve of eye
muscle.
681 67500 Inject/treat eye socket.
681 67505 Inject/treat eye socket.
681 67515 Inject/treat eye socket.
681 67599 Orbit surgery procedure.
681 68200 Treat eyelid by
injection.
681 68761 Close tear duct opening.
681 68899 Tear duct system surgery
682 LEVEL II EYE PROCEDURES T 3.41 $175.34 $80.68 $35.07
682 67028 Injection eye drug......
682 67700 Drainage of eyelid
abscess.
682 67710 Incision of eyelid......
682 67800 Remove eyelid lesion....
682 67801 Remove eyelid lesions...
682 67805 Remove eyelid lesions...
682 67810 Biopsy of eyelid........
682 67820 Revise eyelashes........
682 67825 Revise eyelashes........
682 67840 Remove eyelid lesion....
682 67850 Treat eyelid lesion.....
682 67875 Closure of eyelid by
suture.
682 67915 Repair eyelid defect....
682 67922 Repair eyelid defect....
682 67930 Repair eyelid wound.....
682 67938 Remove eyelid foreign
body.
682 67999 Revision of eyelid......
682 68020 Incise/drain eyelid
lining.
682 68040 Treatment of eyelid
lesions.
682 68400 Incise/drain tear gland.
682 68420 Incise/drain tear sac...
682 68440 Incise tear duct opening
682 68530 Clearance of tear duct..
682 68705 Revise tear duct opening
682 68760 Close tear duct opening.
\2\ 682 68800 Dilate tear duct
opening(s).
682 68801 Dilate tear duct opening
682 68840 Explore/irrigate tear
ducts.
683 LEVEL III EYE PROCEDURES T 9.56 $491.58 $252.44 $98.32
683 65175 Removal of ocular
implant.
683 65410 Biopsy of cornea........
683 65800 Drainage of eye.........
683 65805 Drainage of eye.........
683 66020 Injection treatment of
eye.
683 66030 Injection treatment of
eye.
683 67025 Replace eye fluid.......
683 67715 Incision of eyelid fold.
683 67830 Revise eyelashes........
683 67880 Revision of eyelid......
683 67935 Repair eyelid wound.....
683 68510 Biopsy of tear gland....
683 68525 Biopsy of tear sac......
683 68810 Probe nasolacrimal duct.
\2\ 683 68820 Explore tear duct system
\2\ 683 68825 Explore tear duct system
\2\ 683 68830 Reopen tear duct channel
[[Page 35457]]
684 LEVEL IV EYE PROCEDURES T 13.26 $681.83 $341.94 $136.37
684 65091 Revise eye..............
684 65093 Revise eye with implant.
684 65101 Removal of eye..........
684 65103 Remove eye/insert
implant.
684 65105 Remove eye/attach
implant.
684 65130 Insert ocular implant...
684 65135 Insert ocular implant...
684 65140 Attach ocular implant...
684 65150 Revise ocular implant...
684 65155 Reinsert ocular implant.
684 67250 Reinforce eye wall......
684 67255 Reinforce/graft eye wall
684 67400 Explore/biopsy eye
socket.
684 67405 Explore/drain eye socket
684 67412 Explore/treat eye socket
684 67413 Explore/treat eye socket
684 67550 Insert eye socket
implant.
684 67560 Revise eye socket
implant.
684 67808 Remove eyelid lesion(s).
684 67835 Revise eyelashes........
684 67882 Revision of eyelid......
684 67900 Repair brow defect......
684 67901 Repair eyelid defect....
684 67902 Repair eyelid defect....
684 67903 Repair eyelid defect....
684 67904 Repair eyelid defect....
684 67906 Repair eyelid defect....
684 67908 Repair eyelid defect....
684 67909 Revise eyelid defect....
684 67911 Revise eyelid defect....
684 67914 Repair eyelid defect....
684 67916 Repair eyelid defect....
684 67917 Repair eyelid defect....
684 67921 Repair eyelid defect....
684 67923 Repair eyelid defect....
684 67924 Repair eyelid defect....
684 67950 Revision of eyelid......
684 67961 Revision of eyelid......
684 67966 Revision of eyelid......
684 67971 Reconstruction of eyelid
684 67973 Reconstruction of eyelid
684 67974 Reconstruction of eyelid
684 67975 Reconstruction of eyelid
684 68320 Revise/graft eyelid
lining.
684 68325 Revise/graft eyelid
lining.
684 68326 Revise/graft eyelid
lining.
684 68328 Revise/graft eyelid
lining.
684 68335 Revise/graft eyelid
lining.
684 68340 Separate eyelid
adhesions.
684 68500 Removal of tear gland...
684 68505 Partial removal tear
gland.
684 68520 Removal of tear sac.....
684 68540 Remove tear gland lesion
684 68550 Remove tear gland lesion
684 68700 Repair tear ducts.......
684 68720 Create tear sac drain...
684 68745 Create tear duct drain..
684 68750 Create tear duct drain..
684 68770 Close tear system
fistula.
684 68811 Probe nasolacrimal duct.
684 68815 Probe nasolacrimal duct.
690 VITRECTOMY T 30.39 $1,562.65 $845.69 $312.53
690 67027 Implant eye drug system.
690 67036 Removal of inner eye
fluid.
690 67038 Strip retinal membrane..
690 67039 Laser treatment of
retina.
690 67040 Laser treatment of
retina.
690 67107 Repair detached retina..
690 67108 Repair detached retina..
690 67112 Re-repair detached
retina.
700 PLAIN FILM X 0.80 $41.14 $22.37 $8.23
700 70030 X-ray eye for foreign
body.
700 70100 X-ray exam of jaw.......
700 70110 X-ray exam of jaw.......
[[Page 35458]]
700 70120 X-ray exam of mastoids..
700 70130 X-ray exam of mastoids..
700 70134 X-ray exam of middle ear
700 70140 X-ray exam of facial
bones.
700 70150 X-ray exam of facial
bones.
700 70160 X-ray exam of nasal
bones.
700 70190 X-ray exam of eye
sockets.
700 70200 X-ray exam of eye
sockets.
700 70210 X-ray exam of sinuses...
700 70220 X-ray exam of sinuses...
700 70240 X-ray exam pituitary
saddle.
700 70250 X-ray exam of skull.....
700 70260 X-ray exam of skull.....
700 70300 X-ray exam of teeth.....
700 70310 X-ray exam of teeth.....
700 70320 Full mouth x-ray of
teeth.
700 70328 X-ray exam of jaw joint.
700 70330 X-ray exam of jaw joints
700 70350 X-ray head for
orthodontia.
700 70355 Panoramic x-ray of jaws.
700 70360 X-ray exam of neck......
700 70380 X-ray exam of salivary
gland.
700 71010 Chest x-ray.............
700 71015 X-ray exam of chest.....
700 71020 Chest x-ray.............
700 71021 Chest x-ray.............
700 71022 Chest x-ray.............
700 71030 Chest x-ray.............
700 71035 Chest x-ray.............
700 71100 X-ray exam of ribs......
700 71101 X-ray exam of ribs,
chest.
700 71110 X-ray exam of ribs......
700 71111 X-ray exam of ribs,
chest.
700 71120 X-ray exam of breastbone
700 71130 X-ray exam of breastbone
700 72010 X-ray exam of spine.....
700 72020 X-ray exam of spine.....
700 72040 X-ray exam of neck spine
700 72050 X-ray exam of neck spine
700 72052 X-ray exam of neck spine
700 72069 X-ray exam of trunk
spine.
700 72070 X-ray exam of thorax
spine.
700 72072 X-ray exam of thoracic
spine.
700 72074 X-ray exam of thoracic
spine.
700 72080 X-ray exam of trunk
spine.
700 72090 X-ray exam of trunk
spine.
700 72100 X-ray exam of lower
spine.
700 72110 X-ray exam of lower
spine.
700 72114 X-ray exam of lower
spine.
700 72120 X-ray exam of lower
spine.
700 72170 X-ray exam of pelvis....
700 72190 X-ray exam of pelvis....
700 72200 X-ray exam sacroiliac
joints.
700 72202 X-ray exam sacroiliac
joints.
700 72220 X-ray exam of tailbone..
700 73000 X-ray exam of collarbone
700 73010 X-ray exam of shoulder
blade.
700 73020 X-ray exam of shoulder..
700 73030 X-ray exam of shoulder..
700 73050 X-ray exam of shoulders.
700 73060 X-ray exam of humerus...
700 73070 X-ray exam of elbow.....
700 73080 X-ray exam of elbow.....
700 73090 X-ray exam of forearm...
700 73092 X-ray exam of arm,
infant.
700 73100 X-ray exam of wrist.....
700 73110 X-ray exam of wrist.....
700 73120 X-ray exam of hand......
700 73130 X-ray exam of hand......
700 73140 X-ray exam of finger(s).
700 73500 X-ray exam of hip.......
700 73510 X-ray exam of hip.......
700 73520 X-ray exam of hips......
700 73530 X-ray exam of hip.......
700 73540 X-ray exam of pelvis &
hips.
[[Page 35459]]
700 73550 X-ray exam of thigh.....
700 73560 X-ray exam of knee, 1 or
2.
700 73562 X-ray exam of knee, 3...
700 73564 X-ray exam of knee, 4+..
700 73565 X-ray exam of knee......
700 73590 X-ray exam of lower leg.
700 73592 X-ray exam of leg,
infant.
700 73600 X-ray exam of ankle.....
700 73610 X-ray exam of ankle.....
700 73620 X-ray exam of foot......
700 73630 X-ray exam of foot......
700 73650 X-ray exam of heel......
700 73660 X-ray exam of toe(s)....
700 74000 X-ray exam of abdomen...
700 74010 X-ray exam of abdomen...
700 74020 X-ray exam of abdomen...
700 74022 X-ray exam series,
abdomen.
700 74710 X-ray measurement of
pelvis.
700 76010 X-ray, nose to rectum...
700 76020 X-rays for bone age.....
700 76040 X-rays, bone evaluation.
700 76061 X-rays, bone survey.....
700 76062 X-rays, bone survey.....
700 76065 X-rays, bone evaluation.
700 76066 Joint(s) survey, single
film.
700 76076 Dual energy x-ray study.
700 76078 Photodensitometry.......
700 76098 X-ray exam, breast
specimen.
700 76100 X-ray exam of body
section.
700 76120 Cinematic x-rays........
700 76125 Cinematic x-rays add-on.
700 76150 X-ray exam, dry process.
700 76499 Radiographic procedure..
700 77417 Radiology port film(s)..
700 78350 Bone mineral, single
photon.
706 MISCELLANEOUS RADIOLOGICAL X 1.43 $73.53 $39.10 $14.71
PROCEDURES
706 70170 X-ray exam of tear duct.
706 70373 Contrast x-ray of larynx
706 70390 X-ray exam of salivary
duct.
706 71040 Contrast x-ray of
bronchi.
706 71060 Contrast x-ray of
bronchi.
706 74190 X-ray exam of peritoneum
706 74305 X-ray bile ducts,
pancreas.
706 74320 Contrast x-ray of bile
ducts.
706 74328 X-ray for bile duct
endoscopy.
706 74329 X-ray for pancreas
endoscopy.
706 74330 X-ray, bile/pancreas
endoscopy.
706 74350 X-ray guide, stomach
tube.
706 74355 X-ray guide, intestinal
tube.
706 74470 X-ray exam of kidney
lesion.
706 74740 X-ray female genital
tract.
706 74742 X-ray fallopian tube....
706 75801 Lymph vessel x-ray, arm/
leg.
706 75803 Lymph vessel x-ray,arms/
legs.
706 75805 Lymph vessel x-ray,
trunk.
706 75807 Lymph vessel x-ray,
trunk.
706 75809 Nonvascular shunt, x-ray
706 75898 Follow-up angiogram.....
706 76075 Dual energy x-ray study.
706 76080 X-ray exam of fistula...
706 76086 X-ray of mammary duct...
706 76088 X-ray of mammary ducts..
706 76095 Stereotactic breast
biopsy.
706 76096 X-ray of needle wire,
breast.
706 76101 Complex body section x-
ray.
706 76102 Complex body section x-
rays.
710 COMPUTERIZED AXIAL TOMOGRAPHY S 4.98 $256.07 $173.12 $51.21
710 70450 CAT scan of head or
brain.
710 70460 Contrast CAT scan of
head.
710 70470 Contrast CAT scans of
head.
710 70480 CAT scan of skull.......
710 70481 Contrast CAT scan of
skull.
710 70482 Contrast CAT scans of
skull.
710 70486 CAT scan of face, jaw...
710 70487 Contrast CAT scan, face/
jaw.
[[Page 35460]]
710 70488 Contrast CAT scans face/
jaw.
710 70490 CAT scan of neck tissue.
710 70491 Contrast CAT of neck
tissue.
710 70492 Contrast CAT of neck
tissue.
710 71250 Cat scan of chest.......
710 71260 Contrast CAT scan of
chest.
710 71270 Contrast CAT scans of
chest.
710 72125 CAT scan of neck spine..
710 72126 Contrast CAT scan of
neck.
710 72127 Contrast CAT scans of
neck.
710 72128 CAT scan of thorax spine
710 72129 Contrast CAT scan of
thorax.
710 72130 Contrast CAT scans of
thorax.
710 72131 CAT scan of lower spine.
710 72132 Contrast CAT of lower
spine.
710 72133 Contrast CAT scans,low
spine.
710 72192 CAT scan of pelvis......
710 72193 Contrast CAT scan of
pelvis.
710 72194 Contrast CAT scans of
pelvis.
710 73200 CAT scan of arm.........
710 73201 Contrast CAT scan of arm
710 73202 Contrast CAT scans of
arm.
710 73700 CAT scan of leg.........
710 73701 Contrast CAT scan of leg
710 73702 Contrast CAT scans of
leg.
710 74150 CAT scan of abdomen.....
710 74160 Contrast CAT scan of
abdomen.
710 74170 Contrast CAT scans,
abdomen.
710 76355 CAT scan for
localization.
710 76360 CAT scan for needle
biopsy.
710 76365 CAT scan for cyst
aspiration.
710 76370 CAT scan for therapy
guide.
710 76375 3d/holograph reconstr
add-on.
710 76380 CAT scan follow-up study
716 FLUOROSCOPY X 1.39 $71.47 $40.00 $14.29
716 70370 Throat x-ray &
fluoroscopy.
716 70371 Speech evaluation,
complex.
716 71023 Chest x-ray and
fluoroscopy.
716 71034 Chest x-ray &
fluoroscopy.
716 71036 X-ray guidance for
biopsy.
\2\ 716 71038 X-ray guidance for
biopsy.
716 71090 X-ray & pacemaker
insertion.
716 74340 X-ray guide for GI tube.
716 75989 Abscess drainage under x-
ray.
716 76000 Fluoroscope examination.
716 76001 Fluoroscope exam,
extensive.
716 76003 Needle localization by x-
ray.
720 MAGNETIC RESONANCE ANGIOGRAPHY S 6.37 $327.55 $204.98 $65.51
720 70541 Magnetic image, head
(MRA).
726 MAGNETIC RESONANCE IMAGING S 7.91 $406.73 $256.06 $81.35
726 70336 Magnetic image jaw joint
726 70540 Magnetic image, face,
neck.
726 70551 Magnetic image, brain
(MRI).
726 70552 Magnetic image, brain
(MRI).
726 70553 Magnetic image, brain...
726 71550 Magnetic image, chest...
726 72141 Magnetic image, neck
spine.
726 72142 Magnetic image, neck
spine.
726 72146 Magnetic image, chest
spine.
726 72147 Magnetic image, chest
spine.
726 72148 Magnetic image, lumbar
spine.
726 72149 Magnetic image, lumbar
spine.
726 72156 Magnetic image, neck
spine.
726 72157 Magnetic image, chest
spine.
726 72158 Magnetic image, lumbar
spine.
726 72196 Magnetic image, pelvis..
726 73220 Magnetic image, arm,
hand.
726 73221 Magnetic image, joint of
arm.
726 73720 Magnetic image, leg,
foot.
726 73721 Magnetic image, joint of
leg.
726 74181 Magnetic image, abdomen
(MRI).
726 75552 Magnetic image,
myocardium.
726 75553 Magnetic image,
myocardium.
726 75554 Cardiac MRI/function....
726 75555 Cardiac MRI/limited
study.
[[Page 35461]]
726 76093 Magnetic image, breast..
726 76094 Magnetic image, both
breasts.
726 76390 Mr spectroscopy.........
726 76400 Magnetic image, bone
marrow.
728 MYELOGRAPHY S 3.50 $179.97 $91.98 $35.99
728 70010 Contrast x-ray of brain.
728 70015 Contrast x-ray of brain.
728 72240 Contrast x-ray of neck
spine.
728 72255 Contrast x-ray thorax
spine.
728 72265 Contrast x-ray lower
spine.
728 72270 Contrast x-ray of spine.
728 72285 X-ray of neck spine disk
728 72295 X-ray of lower spine
disk.
730 ARTHOGRAPHY S 2.30 $118.27 $65.77 $23.65
730 70332 X-ray exam of jaw joint.
730 73040 Contrast x-ray of
shoulder.
730 73085 Contrast x-ray of elbow.
730 73115 Contrast x-ray of wrist.
730 73525 Contrast x-ray of hip...
730 73580 Contrast x-ray of knee
joint.
730 73615 Contrast x-ray of ankle.
736 DIGESTIVE RADIOLOGY S 1.85 $95.13 $53.79 $19.03
736 74210 Contrast xray exam of
throat.
736 74220 Contrast xray exam,
esophagus.
736 74230 Cinema xray throat/
esophagus.
736 74240 X-ray exam upper GI
tract.
736 74241 X-ray exam upper GI
tract.
736 74245 X-ray exam upper GI
tract.
736 74246 Contrast x-ray upper GI
tract.
736 74247 Contrast x-ray upper GI
tract.
736 74249 Contrast x-ray upper GI
tract.
736 74250 X-ray exam of small
bowel.
736 74251 X-ray exam of small
bowel.
736 74260 X-ray exam of small
bowel.
736 74270 Contrast x-ray exam of
colon.
736 74280 Contrast x-ray exam of
colon.
736 74283 Contrast x-ray exam of
colon.
736 74290 Contrast x-ray,
gallbladder.
736 74291 Contrast x-rays,
gallbladder.
736 G0106 Colon CA screen; barium
enema.
736 G0120 Colon ca scrn; barium
enema.
737 DIAGNOSTIC UROGRAPHY S 2.69 $138.32 $81.81 $27.66
737 74400 Contrast x-ray urinary
tract.
\2\ 737 74405 Contrast x-ray urinary
tract.
737 74410 Contrast x-ray urinary
tract.
737 74415 Contrast x-ray urinary
tract.
737 74420 Contrast x-ray urinary
tract.
737 74425 Contrast x-ray urinary
tract.
737 74430 Contrast x-ray of
bladder.
737 74440 X-ray exam male genital
tract.
737 74445 X-ray exam of penis.....
737 74450 X-ray exam urethra/
bladder.
737 74455 X-ray exam urethra/
bladder.
737 74775 X-ray exam of perineum..
738 THERAPEUTIC RADIOLOGIC PROCEDURES S 3.74 $192.31 $104.86 $38.46
738 74235 Remove esophagus
obstruction.
738 74327 X-ray for bile stone
removal.
738 74360 X-ray guide, GI dilation
738 74363 X-ray, bile duct
dilation.
738 74475 X-ray control catheter
insert.
738 74480 X-ray control catheter
insert.
738 74485 X-ray guide, GU dilation
738 75980 Contrast x-ray exam bile
duct.
738 75982 Contrast x-ray exam bile
duct.
738 75984 X-ray control catheter
change.
739 DIAGNOSTIC ANGIOGRAPHY AND S 5.33 $274.07 $150.74 $54.81
VENOGRAPHY
739 75600 Contrast x-ray exam of
aorta.
739 75605 Contrast x-ray exam of
aorta.
739 75625 Contrast x-ray exam of
aorta.
739 75630 X-ray aorta, leg
arteries.
739 75650 Artery x-rays, head &
neck.
739 75658 X-ray exam of arm
arteries.
739 75660 Artery x-rays, head &
neck.
739 75662 Artery x-rays, head &
neck.
739 75665 Artery x-rays, head &
neck.
[[Page 35462]]
739 75671 Artery x-rays, head &
neck.
739 75676 Artery x-rays, neck.....
739 75680 Artery x-rays, neck.....
739 75685 Artery x-rays, spine....
739 75705 Artery x-rays, spine....
739 75710 Artery x-rays, arm/leg..
739 75716 Artery x-rays, arms/legs
739 75722 Artery x-rays, kidney...
739 75724 Artery x-rays, kidneys..
739 75726 Artery x-rays, abdomen..
739 75731 Artery x-rays, adrenal
gland.
739 75733 Artery x-rays, adrenal
glands.
739 75736 Artery x-rays, pelvis...
739 75741 Artery x-rays, lung.....
739 75743 Artery x-rays, lungs....
739 75746 Artery x-rays, lung.....
739 75756 Artery x-rays, chest....
739 75774 Artery x-ray, each
vessel.
739 75790 Visualize A-V shunt.....
739 75810 Vein x-ray, spleen/liver
739 75820 Vein x-ray, arm/leg.....
739 75822 Vein x-ray, arms/legs...
739 75825 Vein x-ray, trunk.......
739 75827 Vein x-ray, chest.......
739 75831 Vein x-ray, kidney......
739 75833 Vein x-ray, kidneys.....
739 75840 Vein x-ray, adrenal
gland.
739 75842 Vein x-ray, adrenal
glands.
739 75860 Vein x-ray, neck........
739 75870 Vein x-ray, skull.......
739 75872 Vein x-ray, skull.......
739 75880 Vein x-ray, eye socket..
739 75885 Vein x-ray, liver.......
739 75887 Vein x-ray, liver.......
739 75889 Vein x-ray, liver.......
739 75891 Vein x-ray, liver.......
746 MAMMOGRAPHY S 0.69 $35.48 $19.44 $7.10
746 76090 Mammogram, one breast...
746 76091 Mammogram, both breasts.
747 DIAGNOSTIC ULTRASOUND EXCEPT S 1.65 $84.84 $54.47 $16.97
VASCULAR
747 76506 Echo exam of head.......
747 76511 Echo exam of eye........
747 76512 Echo exam of eye........
747 76513 Echo exam of eye, water
bath.
747 76516 Echo exam of eye........
747 76519 Echo exam of eye........
747 76529 Echo exam of eye........
747 76536 Echo exam of head and
neck.
747 76604 Echo exam of chest......
747 76645 Echo exam of breast.....
747 76700 Echo exam of abdomen....
747 76705 Echo exam of abdomen....
747 76770 Echo exam abdomen back
wall.
747 76775 Echo exam abdomen back
wall.
747 76778 Echo exam kidney
transplant.
747 76800 Echo exam spinal canal..
747 76805 Echo exam of pregnant
uterus.
747 76810 Echo exam of pregnant
uterus.
747 76815 Echo exam of pregnant
uterus.
747 76816 Echo exam followup or
repeat.
747 76818 Fetal biophysical
profile.
747 76830 Echo exam, transvaginal.
747 76831 Echo exam, uterus.......
747 76856 Echo exam of pelvis.....
747 76857 Echo exam of pelvis.....
747 76870 Echo exam of scrotum....
747 76872 Echo exam, transrectal..
747 76880 Echo exam of extremity..
747 76885 Echo exam, infant hips..
747 76886 Echo exam, infant hips..
747 76970 Ultrasound exam follow-
up.
747 76975 GI endoscopic ultrasound
747 76986 Echo exam at surgery....
747 76999 Echo examination
procedure.
747 G0050 Residual urine by
ultrasound.
[[Page 35463]]
749 GUIDANCE UNDER ULTRASOUND X 2.22 $114.15 $70.06 $22.83
749 76930 Echo guide for heart sac
tap.
749 76932 Echo guide for heart
biopsy.
749 76934 Echo guide for chest tap
749 76936 Echo guide for artery
repair.
749 76938 Echo exam for drainage..
749 76941 Echo guide for
transfusion.
749 76942 Echo guide for biopsy...
749 76945 Echo guide, villus
sampling.
749 76946 Echo guide for
amniocentesis.
749 76948 Echo guide, ova
aspiration.
749 76950 Echo guidance
radiotherapy.
749 76960 Echo guidance
radiotherapy.
749 76965 Echo guidance
radiotherapy.
750 THERAPEUTIC RADIATION TREATMENT X 0.96 $49.36 $25.99 $9.87
PLANNING
750 77261 Radiation therapy
planning.
750 77262 Radiation therapy
planning.
750 77263 Radiation therapy
planning.
750 77336 Radiation physics
consult.
750 77370 Radiation physics
consult.
750 77399 External radiation
dosimetry.
750 77431 Radiation therapy
management.
750 77432 Stereotactic radiation
trmt.
751 LEVEL I THERAPEUTIC RADIATION X 1.15 $59.13 $33.22 $11.83
TREATMENT PREPARATION
751 77299 Radiation therapy
planning.
751 77300 Radiation therapy dose
plan.
751 77305 Radiation therapy dose
plan.
751 77310 Radiation therapy dose
plan.
751 77315 Radiation therapy dose
plan.
751 77321 Radiation therapy port
plan.
751 77326 Radiation therapy dose
plan.
751 77327 Radiation therapy dose
plan.
751 77328 Radiation therapy dose
plan.
751 77331 Special radiation
dosimetry.
751 77332 Radiation treatment
aid(s).
751 77333 Radiation treatment
aid(s).
751 77334 Radiation treatment
aid(s).
752 LEVEL II THERAPEUTIC RADIATION X 3.48 $178.94 $86.56 $35.79
TREATMENT PREPARATION
752 77280 Set radiation therapy
field.
752 77285 Set radiation therapy
field.
752 77290 Set radiation therapy
field.
752 77295 Set radiation therapy
field.
757 RADIATION THERAPY S 2.26 $116.21 $52.43 $23.24
757 61793 Focus radiation beam....
757 77401 Radiation treatment
delivery.
757 77402 Radiation treatment
delivery.
757 77403 Radiation treatment
delivery.
757 77404 Radiation treatment
delivery.
757 77406 Radiation treatment
delivery.
757 77407 Radiation treatment
delivery.
757 77408 Radiation treatment
delivery.
757 77409 Radiation treatment
delivery.
757 77411 Radiation treatment
delivery.
757 77412 Radiation treatment
delivery.
757 77413 Radiation treatment
delivery.
757 77414 Radiation treatment
delivery.
757 77416 Radiation treatment
delivery.
757 77470 Special radiation
treatment.
758 HYPERTHERMIC THERAPIES S 5.08 $261.21 $137.18 $52.24
758 77600 Hyperthermia treatment..
758 77605 Hyperthermia treatment..
758 77610 Hyperthermia treatment..
758 77615 Hyperthermia treatment..
758 77620 Hyperthermia treatment..
759 BRACHYTHERAPY AND COMPLEX S 7.98 $410.33 $157.97 $82.07
RADIOELEMENT APPLICATIONS
759 77750 Infuse radioactive
materials.
759 77761 Radioelement application
759 77762 Radioelement application
759 77763 Radioelement application
759 77776 Radioelement application
759 77777 Radioelement application
759 77778 Radioelement application
759 77781 High intensity
brachytherapy.
759 77782 High intensity
brachytherapy.
759 77783 High intensity
brachytherapy.
[[Page 35464]]
759 77784 High intensity
brachytherapy.
759 77789 Radioelement application
759 77799 Radium/radioisotope
therapy.
760 PET SCANS S 14.89 $765.64 $419.46 $153.13
760 78459 Heart muscle imaging
(PET).
760 78608 Brain imaging (PET).....
760 78609 Brain imaging (PET).....
760 78810 Tumor imaging (PET).....
760 G0030 PET imaging prev PET
single.
760 G0031 PET imaging prev PET
multple.
760 G0032 PET follow SPECT 78464
singl.
760 G0033 PET follow SPECT 78464
mult.
760 G0034 PET follow SPECT 76865
singl.
760 G0035 PET follow SPECT 78465
mult.
760 G0036 PET follow cornry angio
sing.
760 G0037 PET follow cornry angio
mult.
760 G0038 PET follow myocard perf
sing.
760 G0039 PET follow myocard perf
mult.
760 G0040 PET follow stress echo
singl.
760 G0041 PET follow stress echo
mult.
760 G0042 PET follow ventriculogm
sing.
760 G0043 PET follow ventriculogm
mult.
760 G0044 PET following rest ECG
singl.
760 G0045 PET following rest ECG
mult.
760 G0046 PET follow stress ECG
singl.
760 G0047 PET follow stress ECG
mult.
761 STANDARD NON-IMAGING NUCLEAR S 1.80 $92.56 $54.01 $18.51
MEDICINE
761 78000 Thyroid, single uptake..
761 78099 Endocrine nuclear
procedure.
761 78110 Plasma volume, single...
761 78111 Plasma volume, multiple.
761 78120 Red cell mass, single...
761 78199 Blood/lymph nuclear exam
761 78270 Vit B-12 absorption exam
761 78271 Vit B-12 absorp exam, IF
761 78272 Vit B-12 absorp,
combined.
761 78282 GI protein loss exam....
761 78299 GI nuclear procedure....
761 78725 Kidney function study...
761 78999 Nuclear diagnostic exam.
762 COMPLEX NON-IMAGING NUCLEAR S 2.02 $103.87 $55.82 $20.77
MEDICINE
762 78001 Thyroid, multiple
uptakes.
762 78003 Thyroid suppress/stimul.
762 78121 Red cell mass, multiple.
762 78122 Blood volume............
762 78130 Red cell survival study.
762 78135 Red cell survival
kinetics.
762 78140 Red cell sequestration..
762 78160 Plasma iron turnover....
762 78162 Iron absorption exam....
762 78170 Red cell iron
utilization.
762 78172 Total body iron
estimation.
762 78190 Platelet survival,
kinetics.
762 78191 Platelet survival.......
762 78414 Non-imaging heart
function.
762 78455 Venous thrombosis study.
762 78499 Cardiovascular nuclear
exam.
771 STANDARD PLANAR NUCLEAR MEDICINE S 3.81 $195.91 $117.29 $39.18
771 78006 Thyroid,imaging with
uptake.
771 78010 Thyroid imaging.........
771 78011 Thyroid imaging with
flow.
771 78015 Thyroid met imaging.....
771 78102 Bone marrow imaging, ltd
771 78103 Bone marrow imaging,
mult.
771 78104 Bone marrow imaging,
body.
771 78185 Spleen imaging..........
771 78201 Liver imaging...........
771 78202 Liver imaging with flow.
771 78215 Liver and spleen imaging
771 78216 Liver & spleen image,
flow.
771 78230 Salivary gland imaging..
771 78231 Serial salivary imaging.
771 78261 Gastric mucosa imaging..
771 78290 Meckels divert exam.....
771 78300 Bone imaging, limited
area.
[[Page 35465]]
771 78305 Bone imaging, multiple
areas.
771 78306 Bone imaging, whole body
771 78399 Musculoskeletal nuclear
exam.
771 78428 Cardiac shunt imaging...
771 78445 Vascular flow imaging...
771 78457 Venous thrombosis
imaging.
771 78458 Ven thrombosis images,
bilat.
771 78460 Heart muscle blood
single.
771 78466 Heart infarct image.....
771 78478 Heart wall motion add-on
771 78480 Heart function add-on...
771 78481 Heart first pass single.
771 78580 Lung perfusion imaging..
771 78586 Aerosol lung image,
single.
771 78587 Aerosol lung image,
multiple.
771 78591 Vent image, 1 breath, 1
proj.
771 78593 Vent image, 1 proj, gas.
771 78599 Respiratory nuclear exam
771 78600 Brain imaging, ltd
static.
771 78601 Brain ltd imaging & flow
771 78605 Brain imaging, complete.
771 78610 Brain flow imaging only.
771 78660 Nuclear exam of tear
flow.
771 78699 Nervous system nuclear
exam.
771 78700 Kidney imaging, static..
771 78701 Kidney imaging with flow
771 78704 Imaging renogram........
771 78707 Kidney flow & function
image.
771 78715 Renal vascular flow exam
771 78730 Urinary bladder
retention.
771 78760 Testicular imaging......
771 78761 Testicular imaging &
flow.
771 78799 Genitourinary nuclear
exam.
772 COMPLEX PLANAR NUCLEAR MEDICINE S 4.26 $219.05 $128.37 $43.81
772 78007 Thyroid, image, mult
uptakes.
772 78016 Thyroid met imaging/
studies.
\2\ 772 78017 Thyroid met imaging,
mult.
772 78018 Thyroid, met imaging,
body.
772 78070 Parathyroid nuclear
imaging.
772 78075 Adrenal nuclear imaging.
772 78195 Lymph system imaging....
772 78220 Liver function study....
772 78223 Hepatobiliary imaging...
772 78232 Salivary gland function
exam.
772 78258 Esophageal motility
study.
772 78262 Gastroesophageal reflux
exam.
772 78264 Gastric emptying study..
772 78278 Acute GI blood loss
imaging.
772 78291 Leveen/shunt patency
exam.
772 78315 Bone imaging, 3 phase...
772 78461 Heart muscle blood
multiple.
772 78468 Heart infarct image, EF.
772 78472 Gated heart, planar
single.
772 78473 Gated heart, multiple...
772 78483 Heart first pass
multiple.
772 78584 Lung V/Q image single
breath.
772 78585 Lung V/Q imaging........
772 78594 Vent image, mult proj,
gas.
772 78596 Lung differential
function.
772 78606 Brain imaging comp &
flow.
772 78615 Cerebral blood flow
imaging.
772 78630 Cerebrospinal fluid scan
772 78635 CSF ventriculography....
772 78645 CSF shunt evaluation....
772 78650 CSF leakage imaging.....
772 78708 Kidney flow & function
image.
772 78709 Kidney flow & function
image.
772 78740 Ureteral reflux study...
772 78800 Tumor imaging, limited
area.
772 78801 Tumor imaging, mult
areas.
772 78802 Tumor imaging, whole
body.
772 78805 Abscess imaging, ltd
area.
772 78806 Abscess imaging, whole
body.
781 STANDARD SPECT NUCLEAR MEDICINE S 5.43 $279.21 $155.04 $55.84
781 78205 Liver imaging (3D)......
[[Page 35466]]
781 78320 Bone imaging (3D).......
781 78464 Heart image (3D) single.
781 78469 Heart infarct image (3D)
781 78607 Brain imaging (3D)......
781 78647 Cerebrospinal fluid scan
781 78710 Kidney imaging (3D).....
782 COMPLEX SPECT NUCLEAR MEDICINE S 9.00 $462.78 $267.13 $92.56
782 78465 Heart image (3D)
multiple.
782 78803 Tumor imaging (3D)......
782 78807 Nuclear localization/
abscess.
791 STANDARD THERAPEUTIC NUCLEAR S 14.74 $757.93 $539.91 $151.59
MEDICINE
791 79001 Repeat hyperthyroid
therapy.
791 79100 Hematopoetic nuclear
therapy.
791 79300 Interstitial nuclear
therapy.
791 79400 Nonhemato nuclear
therapy.
791 79420 Intravascular nuc
therapy.
791 79440 Nuclear joint therapy...
791 79999 Nuclear medicine therapy
792 COMPLEX THERAPEUTIC NUCLEAR S 4.81 $247.33 $143.06 $49.47
MEDICINE
792 79000 Intial hyperthyroid
therapy.
792 79020 Thyroid ablation........
792 79030 Thyroid ablation,
carcinoma.
792 79035 Thyroid metastatic
therapy.
792 79200 Intracavitary nuc
treatment.
861 IMMUNOLOGY TESTS X 0.13 $6.68 $3.62 $1.34
861 86485 Skin test, candida......
861 86490 Coccidioidomycosis skin
test.
861 86510 Histoplasmosis skin test
861 86580 TB intradermal test.....
861 86585 TB tine test............
861 86586 Skin test, unlisted.....
881 LEVEL I PATHOLOGY X 0.22 $11.31 $6.78 $2.26
881 88125 Forensic cytopathology..
881 88199 Cytopathology procedure.
881 88300 Surg path, gross........
881 88311 Decalcify tissue........
881 88313 Special stains..........
881 88399 Surgical pathology
procedure.
881 89350 Sputum specimen
collection.
881 89360 Collect sweat for test..
881 89399 Pathology lab procedure.
881 G0025 Collagen skin test kit..
882 LEVEL II PATHOLOGY X 0.39 $20.05 $11.75 $4.01
882 80500 Lab pathology
consultation.
882 80502 Lab pathology
consultation.
882 85060 Blood smear
interpretation.
882 85097 Bone marrow
interpretation.
882 86077 Physician blood bank
service.
882 86078 Physician blood bank
service.
882 86079 Physician blood bank
service.
882 88104 Cytopathology, fluids...
882 88106 Cytopathology, fluids...
882 88107 Cytopathology, fluids...
882 88108 Cytopath, concentrate
tech.
882 88160 Cytopath smear, other
source.
882 88161 Cytopath smear, other
source.
882 88162 Cytopath smear, other
source.
882 88172 Evaluation of smear.....
882 88173 Interpretation of smear.
882 88180 Cell marker study.......
882 88182 Cell marker study.......
882 88302 Tissue exam by
pathologist.
882 88304 Tissue exam by
pathologist.
882 88305 Tissue exam by
pathologist.
882 88312 Special stains..........
882 88314 Histochemical stain.....
882 88318 Chemical histochemistry.
882 88319 Enzyme histochemistry...
882 88321 Microslide consultation.
882 88323 Microslide consultation.
882 88325 Comprehensive review of
data.
882 88329 Pathology consult in
surgery.
882 88331 Pathology consult in
surgery.
882 88332 Pathology consult in
surgery.
882 88342 Immunocytochemistry.....
[[Page 35467]]
882 88346 Immunofluorescent study.
882 88347 Immunofluorescent study.
883 LEVEL III PATHOLOGY X 0.69 $35.48 $20.34 $7.10
883 88307 Tissue exam by
pathologist.
883 88309 Tissue exam by
pathologist.
883 88348 Electron microscopy.....
883 88349 Scanning electron
microscopy.
883 88355 Analysis, skeletal
muscle.
883 88356 Analysis, nerve.........
883 88358 Analysis, tumor.........
883 88362 Nerve teasing
preparations.
883 88365 Tissue hybridization....
900 CRITICAL CARE S 7.54 $387.71 $145.09 $77.54
900 99291 Critical care, first
hour.
901 LEVEL I IMMUNIZATION X 0.07 $3.60 $2.49 $0.72
901 90700 Dtap vaccine, im........
901 90701 Dtp vaccine, im.........
901 90702 Dt vaccine, im..........
901 90703 Tetanus vaccine, im.....
901 90704 Mumps vaccine, sc.......
901 90705 Measles vaccine, sc.....
901 90706 Rubella vaccine, sc.....
901 90708 Measles-rubella vaccine
sc.
901 90709 Rubella & mumps vaccine
sc.
901 90710 Mmrv vaccine, sc........
\2\ 901 90711 Combined vaccine........
\2\ 901 90714 Typhoid immunization....
901 90718 Td vaccine, im..........
901 90719 Diphtheria vaccine, im..
\2\ 901 90724 Influenza immunization..
901 90725 Cholera vaccine,
injectable.
\2\ 901 90730 Hepatitis A vaccine.....
901 90732 Pneumococcal vaccine,
adult.
901 90748 Hepb/hib vaccine, im....
901 90749 Vaccine toxoid..........
901 95149 Antigen therapy services
901 95170 Antigen therapy services
901 G0008 Admin influenza virus
vac.
901 G0009 Admin pneumococcal
vaccine.
901 Q0034 Admin of influenza
vaccine.
902 LEVEL II IMMUNIZATION X 1.31 $67.36 $38.19 $13.47
902 90707 Mmr vaccine, sc.........
902 90712 Oral poliovirus vaccine.
902 90713 Poliovirus, ipv, sc.....
902 90716 Chicken pox vaccine, sc.
902 90717 Yellow fever vaccine, sc
902 90720 Dtp/hib vaccine, im.....
902 90733 Meningococcal vaccine,
sc.
\2\ 902 90737 Influenza B immunization
\2\ 902 90741 Passive immunization,
ISG.
902 90744 Hepb vaccine, ped/adol,
im.
902 90745 Hepb vaccine, adol/risk,
im.
902 90746 Hepb vaccine, adult, im.
902 90747 Hepb vaccine, ill pat,
im.
902 G0010 Admin hepatitis b
vaccine.
903 LEVEL III IMMUNIZATION X 1.00 $51.42 $24.86 $10.28
903 90721 Dtap/hib vaccine, im....
\2\ 903 90726 Rabies immunization.....
903 90727 Plague vaccine, im......
\2\ 903 90728 BCG immunization........
903 90735 Encephalitis vaccine, sc
\2\ 903 90742 Special passive
immunization.
906 INFUSION THERAPY EXCEPT X 1.93 $99.24 $57.18 $19.85
CHEMOTHERAPY
906 36680 Insert needle, bone
cavity.
906 90780 IV infusion therapy, 1
hour.
906 90781 IV infusion, additional
hour.
906 Q0081 Infusion ther other than
che.
907 INTRAMUSCULAR INJECTIONS X 0.74 $38.05 $11.53 $7.61
907 90782 Injection (SC)/(IM).....
907 90783 Injection (IA)..........
907 90784 Injection (IV)..........
907 90788 Injection of antibiotic.
907 90799 Therapeutic/diag
injection.
919 ELECTROCONVULSIVE THERAPY S 3.09 $158.89 $80.00 $31.78
919 90870 Electroconvulsive
therapy.
[[Page 35468]]
919 90871 Electroconvulsive
therapy.
920 BIOFEEDBACK AND OTHER TRAINING S 1.17 $60.16 $29.61 $12.03
\2\ 920 90900 Biofeedback,
electromyogram.
920 90901 Biofeedback, any method.
\2\ 920 90902 Biofeedback, nerve
impulse.
\2\ 920 90904 Biofeedback, blood
pressure.
\2\ 920 90906 Biofeedback, blood flow.
\2\ 920 90908 Biofeedback, brain waves
\2\ 920 90910 Biofeedback, oculogram..
920 90911 Biofeedback peri/uro/
rectal.
\2\ 920 90915 Biofeedback, unspecified
921 DIABETES EDUCATION S
921 99078 Group health education..
926 DIALYSIS FOR OTHER THAN ESRD S 4.22 $216.99 $69.83 $43.40
PATIENTS
926 90935 Hemodialysis, one
evaluation.
926 90937 Hemodialysis, repeated
eval..
926 90945 Dialysis, one evaluation
926 90947 Dialysis, repeated eval.
926 90997 Hemoperfusion...........
926 90999 Dialysis procedure......
928 ALIMENTARY TESTS X 2.91 $149.63 $79.78 $29.93
928 89100 Sample intestinal
contents.
928 89105 Sample intestinal
contents.
928 89130 Sample stomach contents.
928 89132 Sample stomach contents.
928 89135 Sample stomach contents.
928 89136 Sample stomach contents.
928 89140 Sample stomach contents.
928 89141 Sample stomach contents.
928 91000 Esophageal intubation...
928 91010 Esophagus motility study
928 91011 Esophagus motility study
928 91012 Esophagus motility study
928 91020 Gastric motility........
928 91030 Acid perfusion of
esophagus.
928 91032 Esophagus, acid reflux
test.
928 91033 Prolonged acid reflux
test.
928 91052 Gastric analysis test...
928 91055 Gastric intubation for
smear.
928 91060 Gastric saline load test
928 91065 Breath hydrogen test....
928 91100 Pass intestine bleeding
tube.
928 91105 Gastric intubation
treatment.
928 91299 Gastroenterology
procedure.
928 95075 Ingestion challenge test
930 MINOR EYE EXAMINATIONS X 1.04 $53.48 $22.83 $10.70
930 92060 Special eye evaluation..
930 92065 Orthoptic/pleoptic
training.
930 92081 Visual field
examination(s).
930 92082 Visual field
examination(s).
930 92083 Visual field
examination(s).
930 92140 Glaucoma provocative
tests.
930 92283 Color vision examination
930 92284 Dark adaptation eye exam
930 92285 Eye photography.........
931 LEVEL I EYE TESTS X 0.74 $38.05 $21.47 $7.61
931 92120 Tonography & eye
evaluation.
931 92130 Water provocation
tonography.
931 92230 Eye exam with photos....
931 92240 Icg angiography.........
931 92250 Eye exam with photos....
931 92499 Eye service or procedure
932 LEVEL II EYE TESTS X 2.41 $123.92 $63.73 $24.78
932 92235 Eye exam with photos....
932 92265 Eye muscle evaluation...
932 92270 Electro-oculography.....
932 92286 Internal eye photography
932 92287 Internal eye photography
936 FITTING OF VISION AIDS X 0.48 $24.68 $9.49 $4.94
936 92311 Contact lens fitting....
936 92312 Contact lens fitting....
936 92313 Contact lens fitting....
936 92315 Prescription of contact
lens.
936 92316 Prescription of contact
lens.
936 92317 Prescription of contact
lens.
[[Page 35469]]
936 92325 Modification of contact
lens.
936 92326 Replacement of contact
lens.
936 92330 Fitting of artificial
eye.
936 92352 Special spectacles
fitting.
936 92353 Special spectacles
fitting.
936 92354 Special spectacles
fitting.
936 92355 Special spectacles
fitting.
936 92358 Eye prosthesis service..
936 92371 Repair & adjust
spectacles.
940 OTORHINOLARYNGOLOGIC FUNCTION X 3.13 $160.94 $52.21 $32.19
TESTS
940 92512 Nasal function studies..
940 92516 Facial nerve function
test.
940 92520 Laryngeal function
studies.
940 92541 Spontaneous nystagmus
test.
940 92542 Positional nystagmus
test.
940 92543 Caloric vestibular test.
940 92544 Optokinetic nystagmus
test.
940 92545 Oscillating tracking
test.
940 92546 Sinusoidal rotational
test.
940 92547 Supplemental electrical
test.
940 92548 Posturography...........
940 92584 Electrocochleography....
940 92587 Evoked auditory test....
940 92588 Evoked auditory test....
941 LEVEL I AUDIOMETRY X 0.74 $38.05 $13.33 $7.61
941 92552 Pure tone audiometry,
air.
941 92553 Audiometry, air & bone..
941 92555 Speech threshold
audiometry.
941 92556 Speech audiometry,
complete.
941 92567 Tympanometry............
941 92599 ENT procedure/service...
942 LEVEL II AUDIOMETRY X 1.46 $75.07 $22.15 $15.01
942 92557 Comprehensive hearing
test.
942 92561 Bekesy audiometry,
diagnosis.
942 92562 Loudness balance test...
942 92563 Tone decay hearing test.
942 92564 Sisi hearing test.......
942 92565 Stenger test, pure tone.
942 92568 Acoustic reflex testing.
942 92569 Acoustic reflex decay
test.
942 92571 Filtered speech hearing
test.
942 92572 Staggered spondaic word
test.
942 92573 Lombard test............
942 92575 Sensorineural acuity
test.
942 92576 Synthetic sentence test.
942 92577 Stenger test, speech....
942 92579 Visual audiometry (vra).
942 92582 Conditioning play
audiometry.
942 92583 Select picture
audiometry.
942 92589 Auditory function
test(s).
942 92596 Ear protector evaluation
947 RESUSCITATION AND CARDIOVERSION S 4.11 $211.34 $106.22 $42.27
947 31500 Insert emergency airway.
947 92950 Heart/lung
resuscitation(CPR.
947 92953 Temporary external
pacing.
947 92960 Heart electroconversion.
947 99440 Newborn resuscitation...
948 CARDIAC REHABILITATION X 0.81 $41.65 $16.95 $8.33
948 93797 Cardiac rehab...........
948 93798 Cardiac rehab/monitor...
949 CARDIOVASCULAR STRESS TEST X 1.43 $73.53 $61.92 $14.71
949 93017 Cardiovascular stress
test.
949 93024 Cardiac drug stress test
950 ELECTROCARDIOGRAM (ECG) X 0.35 $18.00 $15.82 $3.60
950 93005 Electrocardiogram,
tracing.
950 93041 Rhythm ECG, tracing.....
950 Q0035 Cardiokymography........
956 CONTINUOUS ECG AND BLOOD PRESSURE X 1.09 $56.05 $54.47 $11.21
MONITORING
956 93012 Transmission of ecg.....
956 93224 ECG monitor/report, 24
hrs.
956 93225 ECG monitor/record, 24
hrs.
956 93226 ECG monitor/report, 24
hrs.
956 93230 ECG monitor/report, 24
hrs.
956 93231 ECG monitor/record, 24
hrs.
956 93232 ECG monitor/report, 24
hrs.
[[Page 35470]]
956 93235 ECG monitor/report, 24
hrs.
956 93236 ECG monitor/report, 24
hrs.
956 93268 ECG record/review.......
956 93270 ECG recording...........
956 93271 ECG/monitoring and
anaylysis.
956 93278 ECG/signal-averaged.....
956 G0004 ECG transm phys review &
int.
956 G0005 ECG 24 hour recording...
956 G0006 ECG transmission &
analysis.
956 G0015 Post symptom ECG tracing
957 ECHOCARDIOGRAPHY S 4.04 $207.74 $114.13 $41.55
957 76825 Echo exam of fetal heart
957 76826 Echo exam of fetal heart
957 76827 Echo exam of fetal heart
957 76828 Echo exam of fetal heart
957 93303 Echo transthoracic......
957 93304 Echo transthoracic......
957 93307 Echo exam of heart......
957 93308 Echo exam of heart......
957 93312 Echo transesophageal....
957 93313 Echo transesophageal....
957 93315 Echo transesophageal....
957 93316 Echo transesophageal....
957 93320 Doppler echo exam, heart
957 93321 Doppler echo exam, heart
957 93325 Doppler color flow add-
on.
957 93350 Echo transthoracic......
958 DIAGNOSTIC CARDIAC S 23.74 $1,220.71 $705.57 $244.14
CATHETERIZATION
958 93501 Right heart
catheterization.
958 93503 Insert/place heart
catheter.
958 93505 Biopsy of heart lining..
958 93510 Left heart
catheterization.
958 93511 Left heart
catheterization.
958 93514 Left heart
catheterization.
958 93524 Left heart
catheterization.
958 93526 Rt & Lt heart catheters.
958 93527 Rt & Lt heart catheters.
958 93528 Rt & Lt heart catheters.
958 93529 Rt, Lt heart
catheterization.
958 93530 Rt heart cath,
congenital.
958 93531 R & l heart cath,
congenital.
958 93532 R & l heart cath,
congenital.
958 93533 R & l heart cath,
congenital.
958 93536 Insert circulation assi.
960 CARDIAC ELECTROPHYSIOLOGIC TESTS/ S 4.80 $246.82 $143.74 $49.36
PROCEDURES
960 93600 Bundle of His recording.
960 93602 Intra-atrial recording..
960 93603 Right ventricular
recording.
960 93607 Right ventricular
recording.
960 93609 Mapping of tachycardia..
960 93610 Intra-atrial pacing.....
960 93612 Intraventricular pacing.
960 93615 Esophageal recording....
960 93616 Esophageal recording....
960 93618 Heart rhythm pacing.....
960 93619 Electrophysiology
evaluation.
960 93620 Electrophysiology
evaluation.
960 93621 Electrophysiology
evaluation.
960 93622 Electrophysiology
evaluation.
960 93623 Stimulation, pacing
heart.
960 93624 Electrophysiologic study
960 93631 Heart pacing, mapping...
960 93640 Evaluation heart device.
960 93641 Electrophysiology
evaluation.
960 93642 Electrophysiology
evaluation.
960 93650 Ablate heart dysrhythm
focus.
960 93651 Ablate heart dysrhythm
focus.
960 93652 Ablate heart dysrhythm
focus.
960 93660 Tilt table evaluation...
960 93724 Analyze pacemaker system
966 ELECTRONIC ANALYSIS OF PACEMAKERS/ X 0.39 $20.05 $12.43 $4.01
OTHER DEVICES
966 62367 Analyze spine infusion
pump.
966 62368 Analyze spine infusion
pump.
\2\ 966 63690 Analysis of
neuroreceiver.
\2\ 966 63691 Analysis of
neuroreceiver.
[[Page 35471]]
966 93731 Analyze pacemaker system
966 93732 Analyze pacemaker system
966 93733 Telephone analysis,
pacemaker.
966 93734 Analyze pacemaker system
966 93735 Analyze pacemaker system
966 93736 Telephone analysis,
pacemaker.
966 93737 Analyze cardio/
defibrillator.
966 93738 Analyze cardio/
defibrillator.
967 NON-INVASIVE VASCULAR STUDIES X 1.70 $87.41 $57.40 $17.48
967 93720 Total body
plethysmography.
967 93721 Plethysmography tracing.
967 93740 Temperature gradient
studies.
967 93799 Cardiovascular procedure
967 93922 Extremity study.........
967 93923 Extremity study.........
967 93924 Extremity study.........
967 93965 Extremity study.........
968 VASCULAR ULTRASOUND X 2.39 $122.89 $79.55 $24.58
968 93875 Extracranial study......
968 93880 Extracranial study......
968 93882 Extracranial study......
968 93886 Intracranial study......
968 93888 Intracranial study......
968 93925 Lower extremity study...
968 93926 Lower extremity study...
968 93930 Upper extremity study...
968 93931 Upper extremity study...
968 93970 Extremity study.........
968 93971 Extremity study.........
968 93975 Vascular study..........
968 93976 Vascular study..........
968 93978 Vascular study..........
968 93979 Vascular study..........
968 93980 Penile vascular study...
968 93981 Penile vascular study...
968 93990 Doppler flow testing....
969 HYPERBARIC OXYGEN S 2.65 $136.26 $141.70 $27.25
969 99183 Hyperbaric oxygen
therapy.
971 LEVEL I PULMONARY TESTS X 0.98 $50.39 $26.44 $10.08
971 94010 Breathing capacity test.
971 94060 Evaluation of wheezing..
\2\ 971 94160 Vital capacity screening
971 94200 Lung function test (MBC/
MVV).
971 94250 Expired gas collection..
971 94260 Thoracic gas volume.....
971 94360 Measure airflow
resistance.
971 94375 Respiratory flow volume
loop.
971 94400 CO2 breathing response
curve.
971 94450 Hypoxia response curve..
971 94762 Measure blood oxygen
level.
971 94770 Exhaled carbon dioxide
test.
971 94799 Pulmonary service/
procedure.
972 LEVEL II PULMONARY TESTS X 1.00 $51.42 $29.38 $10.28
972 94240 Residual lung capacity..
972 94350 Lung nitrogen washout
curve.
972 94370 Breath airway closing
volume.
972 94680 Exhaled air analysis: O2
972 94681 Exhaled air analysis:
O2,CO2.
972 94690 Exhaled air analysis....
972 94720 Monoxide diffusing
capacity.
972 94725 Membrane diffusion
capacity.
973 LEVEL III PULMONARY TESTS S 1.81 $93.07 $55.82 $18.61
973 94070 Evaluation of wheezing..
973 94620 Pulmonary stress test/
simple.
973 94750 Pulmonary compliance
study.
973 94772 Breath recording, infant
973 95070 Bronchial allergy tests.
973 95071 Bronchial allergy tests.
976 PULMONARY THERAPY S 0.44 $22.62 $14.69 $4.53
976 94640 Airway inhalation
treatment.
976 94642 Aerosol inhalation
treatment.
976 94650 Pressure breathing
(IPPB).
976 94651 Pressure breathing
(IPPB).
976 94657 Cont. ventilator........
976 94660 Pos airway pressure,
CPAP.
[[Page 35472]]
976 94662 Neg pressure
ventilation, cnp.
976 94664 Aerosol or vapor
inhalations.
976 94665 Aerosol or vapor
inhalations.
976 94667 Chest wall manipulation.
976 94668 Chest wall manipulation.
977 ALLERGY TESTS X 0.56 $28.80 $11.30 $5.76
977 95004 Allergy skin tests......
977 95010 Sensitivity skin tests..
977 95015 Sensitivity skin tests..
977 95024 Allergy skin tests......
977 95027 Skin end point titration
977 95028 Allergy skin tests......
977 95044 Allergy patch tests.....
977 95052 Photo patch test........
977 95056 Photosensitivity tests..
977 95060 Eye allergy tests.......
977 95065 Nose allergy test.......
977 95078 Provocative testing.....
977 95180 Rapid desensitization...
977 95199 Allergy immunology
services.
978 ALLERGY INJECTIONS X 0.30 $15.43 $3.39 $3.09
978 95115 Immunotherapy, one
injection.
978 95117 Immunotherapy injections
978 95144 Antigen therapy services
978 95145 Antigen therapy services
978 95146 Antigen therapy services
978 95147 Antigen therapy services
978 95148 Antigen therapy services
978 95165 Antigen therapy services
979 EXTENDED EEG STUDIES AND SLEEP S 10.15 $521.91 $287.25 $104.38
STUDIES
979 95805 Multiple sleep latency
test.
979 95806 Sleep study, unattended.
979 95807 Sleep study, attended...
979 95808 Polysomnography, 1-3....
979 95810 Polysomnography, 4 or
more.
979 95811 Polysomnography w/cpap..
979 95812 Electroencephalogram
(EEG).
979 95813 Electroencephalogram
(EEG).
979 95827 Night
electroencephalogram.
979 95951 EEG monitoring/
videorecord.
979 95953 EEG monitoring/computer.
979 95954 EEG monitoring/giving
drugs.
979 95958 EEG monitoring/function
test.
980 ELECTROENCEPHALOGRAM S 2.15 $110.55 $57.86 $22.11
980 95816 Electroencephalogram
(EEG).
980 95819 Electroencephalogram
(EEG).
980 95822 Sleep
electroencephalogram.
980 95824 Electroencephalography..
980 95829 Surgery
electrocorticogram.
980 95955 EEG during surgery......
981 LEVEL I NERVE AND MUSCLE TESTS X 1.22 $62.73 $34.35 $12.55
981 92275 Electroretinography.....
981 95857 Tensilon test...........
981 95867 Muscle test, head or
neck.
981 95869 Muscle test, thor
paraspinal.
981 95870 Muscle test, non-
paraspinal.
981 95900 Motor nerve conduction
test.
981 95921 Autonomic nervous func
test.
981 95922 Autonomic nervous func
test.
981 95923 Autonomic nervous func
test.
981 95926 Somatosensory testing...
981 95927 Somatosensory testing...
981 95930 Visual evoked potential
test.
981 95933 Blink reflex test.......
981 95934 `h' reflex test.........
981 95936 `h' reflex test.........
981 95937 Neuromuscular junction
test.
981 95950 Ambulatory eeg
monitoring.
982 LEVEL II NERVE AND MUSCLE TESTS X 1.37 $70.45 $38.42 $14.09
982 92585 Auditory evoked
potential.
982 95858 Tensilon test & myogram.
982 95860 Muscle test, one limb...
982 95861 Muscle test, two limbs..
982 95863 Muscle test, 3 limbs....
982 95864 Muscle test, 4 limbs....
[[Page 35473]]
982 95868 Muscle test, head or
neck.
982 95872 Muscle test, one fiber..
982 95875 Limb exercise test......
982 95903 Motor nerve conduction
test.
982 95904 Sense nerve conduction
test.
982 95925 Somatosensory testing...
987 SUBCUTANEOUS OR INTRAMUSCULAR S 2.09 $107.47 $65.09 $21.49
CHEMOTHERAPY
987 96400 Chemotherapy, (SC)/(IM).
987 96405 Intralesional chemo
admin.
987 96406 Intralesional chemo
admin.
987 96549 Chemotherapy,
unspecified.
987 Q0083 Chemo by other than
infusion.
988 CHEMOTHERAPY EXCEPT BY EXTENDED S 4.02 $206.71 $110.29 $41.34
INFUSION
988 96408 Chemotherapy, push
technique.
988 96410 Chemotherapy, infusion
method.
988 96412 Chemotx infuse method
add-on.
988 96420 Chemotherapy, push
technique.
988 96422 Chemotherapy, infusion
method.
988 96423 Chemotx infuse method
add-on.
989 CHEMOTHERAPY BY EXTENDED INFUSION S 1.91 $98.21 $44.52 $19.64
989 96414 Chemotx infuse method
add-on.
989 96425 Chemotherapy, infusion
method.
989 96440 Chemotherapy,
intracavitary.
989 96445 Chemotherapy,
intracavitary.
989 96450 Chemotherapy, into CNS..
989 96542 Chemotherapy injection..
989 Q0084 Chemotherapy by infusion
989 Q0085 Chemo by both infusion
and o.
990 PHOTOCHEMOTHERAPY S 0.43 $22.11 $8.14 $4.42
990 96900 Ultraviolet light
therapy.
990 96910 Photochemotherapy with
UV-B.
990 96912 Photochemotherapy with
UV-A.
990 96913 Photochemotherapy, UV-A
or B.
990 96999 Dermatological procedure
997 MANIPULATION THERAPY S 0.69 $35.48 $7.46 $7.10
\2\ 997 97250 Myofascial release......
\2\ 997 97260 Regional manipulation...
\2\ 997 97261 Supplemental
manipulations.
997 98925 Osteopathic manipulation
997 98926 Osteopathic manipulation
997 98927 Osteopathic manipulation
997 98928 Osteopathic manipulation
997 98929 Osteopathic manipulation
997 98940 Chiropractic
manipulation.
997 98941 Chiropractic
manipulation.
997 98942 Chiropractic
manipulation.
999 THERAPEUTIC PHLEBOTOMY X 0.43 $22.11 $11.07 $4.42
999 99195 Phlebotomy..............
----------------------------------------------------------------------------------------------------------------
\1\ This APC assignment will not apply to services furnished under a partial hospitalization program. Instead,
services furnished as part of a partial hospitalization program are paid on a per-diem basis via APC 020.
\2\ This code was valid in 1996 and therefore was available for use in calculating weights. However, it has
since been terminated and will not be paid upon implementation.
CPT codes and descriptions only are copyright 1997 American Medical Association. All rights reserved. Applicable
FARS/DFARS apply.
Copyright 1994 American Dental Association. All rights reserved.
49. On page 47834, Addendum D is corrected to read as follows:
[[Page 35473]]
Addendum D.--Summary of Medical APCs
----------------------------------------------------------------------------------------------------------------
APC Code Description
----------------------------------------------------------------------------------------------------------------
911 Low Level Clinic Visits
99201 Office/outpatient visit, new
99202 Office/outpatient visit, new
99211 Office/outpatient visit, est
99212 Office/outpatient visit, est
99241 Office consultation
99242 Office consultation
99271 Confirmatory consultation
99272 Confirmatory consultation
913 Mid Level Clinic Visits
92002 Eye exam, new patient
92012 Eye exam established pt
99203 Office/outpatient visit, new
[[Page 35474]]
99213 Office/outpatient visit, est
99243 Office consultation
99273 Confirmatory consultation
G0101 Cancer Screening Exam, Women
915 High Level Clinic Visits
92004 Eye exam, new patient
92014 Eye exam & treatment
99204 Office/outpatient visit, new
99205 Office/outpatient visit, new
99214 Office/outpatient visit, est
99215 Office/outpatient visit, est
99244 Office consultation
99245 Office consultation
99274 Confirmatory consultation
99275 Confirmatory consultation
951 Low Level Emergency Visits
99281 Emergency dept visit
99282 Emergency dept visit
953 Mid Level Emergency Visits
99283 Emergency dept visit
955 High Level Emergency Visits
99284 Emergency dept visit
99285 Emergency dept visit
----------------------------------------------------------------------------------------------------------------
Note: CPT codes and descriptions only are copyright 1997 American Medical Association. All rights reserved.
Applicable FARS/DFARS apply.
50. On pages 47996 through 48005, Addendum G is corrected to read
as follows:
[[Page 35474]]
Addendum G.--CPT Codes Which Would Be Paid Only as Inpatient Procedures
------------------------------------------------------------------------
CPT\1\
HCPCS\2\ HOPD status indicator Description
------------------------------------------------------------------------
00174 C Anesth, pharyngeal surgery
00176 C Anesth, pharyngeal surgery
00192 C Anesth, facial bone surgery
00214 C Anesth, skull drainage
00215 C Anesth, skull fracture
00404 C Anesth, surgery of breast
00406 C Anesth, surgery of breast
00452 C Anesth, surgery of shoulder
00474 C Anesth, surgery of rib(s)
00524 C Anesth, chest drainage
00530 C Anesth, pacemaker insertion
00540 C Anesth, chest surgery
00542 C Anesth, release of lung
00544 C Anesth, chest lining removal
00546 C Anesth, lung, chest wall surg
00560 C Anesth, open heart surgery
00562 C Anesth, open heart surgery
00580 C Anesth, heart/lung transplant
00604 C Anesth, surgery of vertebra
00622 C Anesth, removal of nerves
00632 C Anesth, removal of nerves
00634 C Anesth for chemonucleolysis
00670 C Anesth, spine, cord surgery
00792 C Anesth, part liver removal
00794 C Anesth, pancreas removal
00796 C Anesth, for liver transplant
00802 C Anesth, fat layer removal
00844 C Anesth, pelvis surgery
00846 C Anesth, hysterectomy
00848 C Anesth, pelvic organ surg
00850 C Anesth, cesarean section
00855 C Anesth, hysterectomy
00857 C Analgesia, labor & c-section
00864 C Anesth, removal of bladder
00865 C Anesth, removal of prostate
00866 C Anesth, removal of adrenal
00868 C Anesth, kidney transplant
00882 C Anesth, major vein ligation
00884 C Anesth, major vein revision
00904 C Anesth, perineal surgery
00908 C Anesth, removal of prostate
00928 C Anesth, removal of testis
00932 C Anesth, amputation of penis
00934 C Anesth, penis, nodes removal
00936 C Anesth, penis, nodes removal
00944 C Anesth, vaginal hysterectomy
00955 C Analgesia, vaginal delivery
01140 C Anesth, amputation at pelvis
01150 C Anesth, pelvic tumor surgery
01190 C Anesth, pelvis nerve removal
01212 C Anesth, hip disarticulation
01214 C Anesth, replacement of hip
01232 C Anesth, amputation of femur
01234 C Anesth, radical femur surg
01272 C Anesth, femoral artery surg
01274 C Anesth, femoral embolectomy
01402 C Anesth, replacement of knee
01404 C Anesth, amputation at knee
01442 C Anesth, knee artery surg
01444 C Anesth, knee artery repair
01486 C Anesth, ankle replacement
01502 C Anesth, lowerleg embolectomy
01632 C Anesth, surgery of shoulder
01634 C Anesth, shoulder joint amput
01636 C Anesth, forequarter amput
01638 C Anesth, shoulder replacement
01652 C Anesth, shoulder vessel surg
01654 C Anesth, shoulder vessel surg
01656 C Anesth, arm-leg vessel surg
01756 C Anesth, radical humerus surg
01772 C Anesth, upperarm embolectomy
01782 C Anesth, upperarm vein repair
01842 C Anesth, lowerarm embolectomy
01852 C Anesth, lowerarm vein repair
01902 C Anesth, burr holes, skull
01904 C Anesth, skull x-ray inject
01916 C Anesth, head arteriogram
01918 C Anesth, limb arteriogram
01921 C Anesth, vessel surgery
01990 C Support for organ donor
15755 C Microvascular flap graft
15756 C Free muscle flap, microvasc
15757 C Free skin flap, microvasc
15758 C Free fascial flap, microvasc
19200 C Removal of breast
19220 C Removal of breast
19240 C Removal of breast
19260 C Removal of chest wall lesion
19271 C Revision of chest wall
19272 C Extensive chest wall surgery
19361 C Breast reconstruction
19364 C Breast reconstruction
19367 C Breast reconstruction
19368 C Breast reconstruction
19369 C Breast reconstruction
20100 C Explore wound, neck
20101 C Explore wound, chest
20102 C Explore wound, abdomen
20103 C Explore wound, extremity
20150 C Excise epiphyseal bar
20660 C Apply,remove fixation device
20661 C Application of head brace
20662 C Application of pelvis brace
20663 C Application of thigh brace
20664 C Halo brace application
20802 C Replantation, arm, complete
20805 C Replant forearm, complete
20808 C Replantation, hand, complete
20816 C Replantation digit, complete
20822 C Replantation digit, complete
20824 C Replantation thumb, complete
20827 C Replantation thumb, complete
20838 C Replantation, foot, complete
20930 C Spinal bone allograft
20931 C Spinal bone allograft
20936 C Spinal bone autograft
20937 C Spinal bone autograft
20938 C Spinal bone autograft
20955 C Fibula bone graft, microvasc
20956 C Iliac bone graft, microvasc
20957 C Mt bone graft, microvasc
20960 C Microvascular rib graft
20962 C Other bone graft, microvasc
20969 C Bone/skin graft, microvasc
[[Page 35475]]
20970 C Bone/skin graft, iliac crest
20971 C Bone-skin graft, rib
20972 C Bone-skin graft, metatarsal
20973 C Bone-skin graft, great toe
21045 C Extensive jaw surgery
21137 C Reduction of forehead
21138 C Reduction of forehead
21139 C Reduction of forehead
21141 C Reconstruct midface, lefort
21142 C Reconstruct midface, lefort
21143 C Reconstruct midface, lefort
21145 C Reconstruct midface, lefort
21146 C Reconstruct midface, lefort
21147 C Reconstruct midface, lefort
21150 C Reconstruct midface, lefort
21151 C Reconstruct midface, lefort
21154 C Reconstruct midface, lefort
21155 C Reconstruct midface, lefort
21159 C Reconstruct midface, lefort
21160 C Reconstruct midface, lefort
21172 C Reconstruct orbit/forehead
21175 C Reconstruct orbit/forehead
21179 C Reconstruct entire forehead
21180 C Reconstruct entire forehead
21182 C Reconstruct cranial bone
21183 C Reconstruct cranial bone
21184 C Reconstruct cranial bone
21188 C Reconstruction of midface
21193 C Reconstruct lower jaw bone
21194 C Reconstruct lower jaw bone
21195 C Reconstruct lower jaw bone
21196 C Reconstruct lower jaw bone
21198 C Reconstruct lower jaw bone
21247 C Reconstruct lower jaw bone
21255 C Reconstruct lower jaw bone
21256 C Reconstruction of orbit
21261 C Revise eye sockets
21263 C Revise eye sockets
21268 C Revise eye sockets
21344 C Repair of sinus fracture
21346 C Repair of nose/jaw fracture
21347 C Repair of nose/jaw fracture
21348 C Repair of nose/jaw fracture
21356 C Repair cheek bone fracture
21360 C Repair cheek bone fracture
21365 C Repair cheek bone fracture
21366 C Repair cheek bone fracture
21385 C Repair eye socket fracture
21386 C Repair eye socket fracture
21387 C Repair eye socket fracture
21390 C Repair eye socket fracture
21395 C Repair eye socket fracture
21406 C Repair eye socket fracture
21407 C Repair eye socket fracture
21408 C Repair eye socket fracture
21422 C Repair mouth roof fracture
21423 C Repair mouth roof fracture
21431 C Treat craniofacial fracture
21432 C Repair craniofacial fracture
21433 C Repair craniofacial fracture
21435 C Repair craniofacial fracture
21436 C Repair craniofacial fracture
21470 C Repair lower jaw fracture
21495 C Repair hyoid bone fracture
21510 C Drainage of bone lesion
21557 C Remove tumor, neck or chest
21615 C Removal of rib
21616 C Removal of rib and nerves
21620 C Partial removal of sternum
21627 C Sternal debridement
21630 C Extensive sternum surgery
21632 C Extensive sternum surgery
21705 C Revision of neck muscle/rib
21740 C Reconstruction of sternum
21750 C Repair of sternum separation
21810 C Treatment of rib fracture(s)
21825 C Repair sternum fracture
22100 C Remove part of neck vertebra
22101 C Remove part, thorax vertebra
22102 C Remove part, lumbar vertebra
22103 C Remove extra spine segment
22110 C Remove part of neck vertebra
22112 C Remove part, thorax vertebra
22114 C Remove part, lumbar vertebra
22116 C Remove extra spine segment
22210 C Revision of neck spine
22212 C Revision of thorax spine
22214 C Revision of lumbar spine
22216 C Revise, extra spine segment
22220 C Revision of neck spine
22222 C Revision of thorax spine
22224 C Revision of lumbar spine
22226 C Revise, extra spine segment
22325 C Repair of spine fracture
22326 C Repair neck spine fracture
22327 C Repair thorax spine fracture
22328 C Repair each add spine fx
22548 C Neck spine fusion
22554 C Neck spine fusion
22556 C Thorax spine fusion
22558 C Lumbar spine fusion
22585 C Additional spinal fusion
22590 C Spine & skull spinal fusion
22595 C Neck spinal fusion
22600 C Neck spine fusion
22610 C Thorax spine fusion
22612 C Lumbar spine fusion
22614 C Spine fusion, extra segment
22630 C Lumbar spine fusion
22632 C Spine fusion, extra segment
22800 C Fusion of spine
22802 C Fusion of spine
22804 C Fusion of spine
22808 C Fusion of spine
22810 C Fusion of spine
22812 C Fusion of spine
22818 C Kyphectomy, 1-2 segments
22819 C Kyphectomy, 3 & more segment
22830 C Exploration of spinal fusion
22840 C Insert spine fixation device
22841 C Insert spine fixation device
22842 C Insert spine fixation device
22843 C Insert spine fixation device
22844 C Insert spine fixation device
22845 C Insert spine fixation device
22846 C Insert spine fixation device
22847 C Insert spine fixation device
22848 C Insert pelvic fixationdevice
22849 C Reinsert spinal fixation
22850 C Remove spine fixation device
22851 C Apply spine prosth device
22852 C Remove spine fixation device
22855 C Remove spine fixation device
23035 C Drain shoulder bone lesion
23125 C Removal of collarbone
23195 C Removal of head of humerus
23200 C Removal of collar bone
23210 C Removal of shoulderblade
23220 C Partial removal of humerus
23221 C Partial removal of humerus
23222 C Partial removal of humerus
23332 C Remove shoulder foreign body
23395 C Muscle transfer, shoulder/arm
23397 C Muscle transfers
23400 C Fixation of shoulder blade
23440 C Removal/transplant tendon
23470 C Reconstruct shoulder joint
23472 C Reconstruct shoulder joint
23900 C Amputation of arm & girdle
23920 C Amputation at shoulder joint
24149 C Radical resection of elbow
24150 C Extensive humerus surgery
24151 C Extensive humerus surgery
24152 C Extensive radius surgery
24153 C Extensive radius surgery
24900 C Amputation of upper arm
24920 C Amputation of upper arm
24930 C Amputation follow-up surgery
24931 C Amputate upper arm & implant
24935 C Revision of amputation
24940 C Revision of upper arm
25170 C Extensive forearm surgery
25390 C Shorten radius/ulna
25391 C Lengthen radius/ulna
25392 C Shorten radius & ulna
25393 C Lengthen radius & ulna
25405 C Repair/graft radius or ulna
25420 C Repair/graft radius & ulna
25900 C Amputation of forearm
25905 C Amputation of forearm
25909 C Amputation follow-up surgery
25915 C Amputation of forearm
25920 C Amputate hand at wrist
25924 C Amputation follow-up surgery
25927 C Amputation of hand
25931 C Amputation follow-up surgery
26551 C Great toe-hand transfer
26552 C Construct thumb replacement
26553 C Single toe-hand transfer
26554 C Double toe-hand transfer
26556 C Toe joint transfer
26557 C Construct finger replacement
26558 C Added finger surgery
26559 C Added finger surgery
26992 C Drainage of bone lesion
27005 C Incision of hip tendon
27006 C Incision of hip tendons
27025 C Incision of hip/thigh fascia
27030 C Drainage of hip joint
27035 C Denervation of hip joint
27036 C Excision of hip joint/muscle
27054 C Removal of hip joint lining
27070 C Partial removal of hip bone
27071 C Partial removal of hip bone
27075 C Extensive hip surgery
27076 C Extensive hip surgery
27077 C Extensive hip surgery
27078 C Extensive hip surgery
27079 C Extensive hip surgery
27090 C Removal of hip prosthesis
27091 C Removal of hip prosthesis
27120 C Reconstruction of hip socket
27122 C Reconstruction of hip socket
27125 C Partial hip replacement
27130 C Total hip replacement
27132 C Total hip replacement
27134 C Revise hip joint replacement
27137 C Revise hip joint replacement
27138 C Revise hip joint replacement
27140 C Transplant of femur ridge
27146 C Incision of hip bone
27147 C Revision of hip bone
27151 C Incision of hip bones
27156 C Revision of hip bones
27158 C Revision of pelvis
27161 C Incision of neck of femur
27165 C Incision/fixation of femur
27170 C Repair/graft femur head/neck
[[Page 35476]]
27175 C Treat slipped epiphysis
27176 C Treat slipped epiphysis
27177 C Repair slipped epiphysis
27178 C Repair slipped epiphysis
27179 C Revise head/neck of femur
27181 C Repair slipped epiphysis
27185 C Revision of femur epiphysis
27187 C Reinforce hip bones
27215 C Pelvic fracture(s) treatment
27216 C Treat pelvic ring fracture
27217 C Treat pelvic ring fracture
27218 C Treat pelvic ring fracture
27222 C Treat hip socket fracture
27226 C Treat hip wall fracture
27227 C Treat hip fracture(s)
27228 C Treat hip fracture(s)
27232 C Treat fracture of thigh
27235 C Repair of thigh fracture
27236 C Repair of thigh fracture
27240 C Treatment of thigh fracture
27244 C Repair of thigh fracture
27245 C Repair of thigh fracture
27248 C Repair of thigh fracture
27253 C Repair of hip dislocation
27254 C Repair of hip dislocation
27258 C Repair of hip dislocation
27259 C Repair of hip dislocation
27280 C Fusion of sacroiliac joint
27282 C Fusion of pubic bones
27284 C Fusion of hip joint
27286 C Fusion of hip joint
27290 C Amputation of leg at hip
27295 C Amputation of leg at hip
27303 C Drainage of bone lesion
27365 C Extensive leg surgery
27445 C Revision of knee joint
27446 C Revision of knee joint
27447 C Total knee replacement
27448 C Incision of thigh
27450 C Incision of thigh
27454 C Realignment of thigh bone
27455 C Realignment of knee
27457 C Realignment of knee
27465 C Shortening of thigh bone
27466 C Lengthening of thigh bone
27468 C Shorten/lengthen thighs
27470 C Repair of thigh
27472 C Repair/graft of thigh
27475 C Surgery to stop leg growth
27477 C Surgery to stop leg growth
27479 C Surgery to stop leg growth
27485 C Surgery to stop leg growth
27486 C Revise knee joint replace
27487 C Revise knee joint replace
27488 C Removal of knee prosthesis
27495 C Reinforce thigh
27506 C Repair of thigh fracture
27507 C Treatment of thigh fracture
27511 C Treatment of thigh fracture
27513 C Treatment of thigh fracture
27514 C Repair of thigh fracture
27519 C Repair of thigh growth plate
27524 C Repair of kneecap fracture
27535 C Treatment of knee fracture
27536 C Repair of knee fracture
27540 C Repair of knee fracture
27557 C Repair of knee dislocation
27558 C Repair of knee dislocation
27580 C Fusion of knee
27590 C Amputate leg at thigh
27591 C Amputate leg at thigh
27592 C Amputate leg at thigh
27596 C Amputation follow-up surgery
27598 C Amputate lower leg at knee
27645 C Extensive lower leg surgery
27646 C Extensive lower leg surgery
27702 C Reconstruct ankle joint
27703 C Reconstruction, ankle joint
27712 C Realignment of lower leg
27715 C Revision of lower leg
27720 C Repair of tibia
27722 C Repair/graft of tibia
27724 C Repair/graft of tibia
27725 C Repair of lower leg
27727 C Repair of lower leg
27880 C Amputation of lower leg
27881 C Amputation of lower leg
27882 C Amputation of lower leg
27886 C Amputation follow-up surgery
27888 C Amputation of foot at ankle
28800 C Amputation of midfoot
28805 C Amputation thru metatarsal
31225 C Removal of upper jaw
31230 C Removal of upper jaw
31290 C Nasal/sinus endoscopy, surg
31291 C Nasal/sinus endoscopy, surg
31292 C Nasal/sinus endoscopy, surg
31293 C Nasal/sinus endoscopy, surg
31294 C Nasal/sinus endoscopy, surg
31360 C Removal of larynx
31365 C Removal of larynx
31367 C Partial removal of larynx
31368 C Partial removal of larynx
31370 C Partial removal of larynx
31375 C Partial removal of larynx
31380 C Partial removal of larynx
31382 C Partial removal of larynx
31390 C Removal of larynx & pharynx
31395 C Reconstruct larynx & pharynx
31580 C Revision of larynx
31582 C Revision of larynx
31584 C Repair of larynx fracture
31587 C Revision of larynx
31600 C Incision of windpipe
31601 C Incision of windpipe
31610 C Incision of windpipe
31725 C Clearance of airways
31760 C Repair of windpipe
31766 C Reconstruction of windpipe
31770 C Repair/graft of bronchus
31775 C Reconstruct bronchus
31780 C Reconstruct windpipe
31781 C Reconstruct windpipe
31785 C Remove windpipe lesion
31786 C Remove windpipe lesion
31800 C Repair of windpipe injury
31805 C Repair of windpipe injury
32005 C Treat lung lining chemically
32035 C Exploration of chest
32036 C Exploration of chest
32095 C Biopsy through chest wall
32100 C Exploration/biopsy of chest
32110 C Explore/repair chest
32120 C Re-exploration of chest
32124 C Explore chest,free adhesions
32140 C Removal of lung lesion(s)
32141 C Remove/treat lung lesions
32150 C Removal of lung lesion(s)
32151 C Remove lung foreign body
32160 C Open chest heart massage
32200 C Open drainage, lung lesion
32201 C Percut drainage, lung lesion
32215 C Treat chest lining
32220 C Release of lung
32225 C Partial release of lung
32310 C Removal of chest lining
32320 C Free/remove chest lining
32402 C Open biopsy chest lining
32440 C Removal of lung
32442 C Sleeve pneumonectomy
32445 C Removal of lung
32480 C Partial removal of lung
32482 C Bilobectomy
32484 C Segmentectomy
32486 C Sleeve lobectomy
32488 C Completion pneumonectomy
32491 C Lung volume reduction
32500 C Partial removal of lung
32501 C Repair bronchus (add-on)
32520 C Remove lung & revise chest
32522 C Remove lung & revise chest
32525 C Remove lung & revise chest
32540 C Removal of lung lesion
32601 C Thoracoscopy, diagnostic
32602 C Thoracoscopy, diagnostic
32603 C Thoracoscopy, diagnostic
32604 C Thoracoscopy, diagnostic
32605 C Thoracoscopy, diagnostic
32606 C Thoracoscopy, diagnostic
32650 C Thoracoscopy, surgical
32651 C Thoracoscopy, surgical
32652 C Thoracoscopy, surgical
32653 C Thoracoscopy, surgical
32654 C Thoracoscopy, surgical
32655 C Thoracoscopy, surgical
32656 C Thoracoscopy, surgical
32657 C Thoracoscopy, surgical
32658 C Thoracoscopy, surgical
32659 C Thoracoscopy, surgical
32660 C Thoracoscopy, surgical
32661 C Thoracoscopy, surgical
32662 C Thoracoscopy, surgical
32663 C Thoracoscopy, surgical
32664 C Thoracoscopy, surgical
32665 C Thoracoscopy, surgical
32800 C Repair lung hernia
32810 C Close chest after drainage
32815 C Close bronchial fistula
32820 C Reconstruct injured chest
32850 C Donor pneumonectomy
32851 C Lung transplant, single
32852 C Lung transplant w/bypass
32853 C Lung transplant, double
32854 C Lung transplant w/bypass
32900 C Removal of rib(s)
32905 C Revise & repair chest wall
32906 C Revise & repair chest wall
32940 C Revision of lung
33015 C Incision of heart sac
33020 C Incision of heart sac
33025 C Incision of heart sac
33030 C Partial removal of heart sac
33031 C Partial removal of heart sac
33050 C Removal of heart sac lesion
33120 C Removal of heart lesion
33130 C Removal of heart lesion
33200 C Insertion of heart pacemaker
33201 C Insertion of heart pacemaker
33206 C Insertion of heart pacemaker
33207 C Insertion of heart pacemaker
33208 C Insertion of heart pacemaker
33210 C Insertion of heart electrode
33211 C Insertion of heart electrode
33212 C Insertion of pulse generator
33213 C Insertion of pulse generator
33214 C Upgrade of pacemaker system
33216 C Revision implanted electrode
33217 C Insert/revise electrode
33218 C Repair pacemaker electrodes
[[Page 35477]]
33220 C Repair pacemaker electrode
33233 C Removal of pacemaker system
33234 C Removal of pacemaker system
33235 C Removal pacemaker electrode
33236 C Remove electrode/thoracotomy
33237 C Remove electrode/thoracotomy
33238 C Remove electrode/thoracotomy
33240 C Insert/replace pulse gener
33241 C Remove pulse generator only
33242 C Repair pulse generator/leads
33243 C Remove generator/thoracotomy
33244 C Remove generator
33245 C Implant heart defibrillator
33246 C Implant heart defibrillator
33247 C Insert/replace leads
33249 C Insert/replace leads/gener
33250 C Ablate heart dysrhythm focus
33251 C Ablate heart dysrhythm focus
33253 C Reconstruct atria
33261 C Ablate heart dysrhythm focus
33300 C Repair of heart wound
33305 C Repair of heart wound
33310 C Exploratory heart surgery
33315 C Exploratory heart surgery
33320 C Repair major blood vessel(s)
33321 C Repair major vessel
33322 C Repair major blood vessel(s)
33330 C Insert major vessel graft
33332 C Insert major vessel graft
33335 C Insert major vessel graft
33400 C Repair of aortic valve
33401 C Valvuloplasty, open
33403 C Valvuloplasty, w/cp bypass
33404 C Prepare heart-aorta conduit
33405 C Replacement of aortic valve
33406 C Replacement, aortic valve
33411 C Replacement of aortic valve
33412 C Replacement of aortic valve
33413 C Replacement, aortic valve
33414 C Repair, aortic valve
33415 C Revision, subvalvular tissue
33416 C Revise ventricle muscle
33417 C Repair of aortic valve
33420 C Revision of mitral valve
33422 C Revision of mitral valve
33425 C Repair of mitral valve
33426 C Repair of mitral valve
33427 C Repair of mitral valve
33430 C Replacement of mitral valve
33460 C Revision of tricuspid valve
33463 C Valvuloplasty, tricuspid
33464 C Valvuloplasty, tricuspid
33465 C Replace tricuspid valve
33468 C Revision of tricuspid valve
33470 C Revision of pulmonary valve
33471 C Valvotomy, pulmonary valve
33472 C Revision of pulmonary valve
33474 C Revision of pulmonary valve
33475 C Replacement, pulmonary valve
33476 C Revision of heart chamber
33478 C Revision of heart chamber
33496 C Repair, prosth valve clot
33500 C Repair heart vessel fistula
33501 C Repair heart vessel fistula
33502 C Coronary artery correction
33503 C Coronary artery graft
33504 C Coronary artery graft
33505 C Repair artery w/tunnel
33506 C Repair artery, translocation
33510 C CABG, vein, single
33511 C CABG, vein, two
33512 C CABG, vein, three
33513 C CABG, vein, four
33514 C CABG, vein, five
33516 C CABG, vein, six+
33517 C CABG, artery-vein, single
33518 C CABG, artery-vein, two
33519 C CABG, artery-vein, three
33521 C CABG, artery-vein, four
33522 C CABG, artery-vein, five
33523 C CABG, artery-vein, six+
33530 C Coronary artery, bypass/reop
33533 C CABG, arterial, single
33534 C CABG, arterial, two
33535 C CABG, arterial, three
33536 C CABG, arterial, four+
33542 C Removal of heart lesion
33545 C Repair of heart damage
33572 C Open coronary endarterectomy
33600 C Closure of valve
33602 C Closure of valve
33606 C Anastomosis/artery-aorta
33608 C Repair anomaly w/conduit
33610 C Repair by enlargement
33611 C Repair double ventricle
33612 C Repair double ventricle
33615 C Repair (simple fontan)
33617 C Repair by modified fontan
33619 C Repair single ventricle
33641 C Repair heart septum defect
33645 C Revision of heart veins
33647 C Repair heart septum defects
33660 C Repair of heart defects
33665 C Repair of heart defects
33670 C Repair of heart chambers
33681 C Repair heart septum defect
33684 C Repair heart septum defect
33688 C Repair heart septum defect
33690 C Reinforce pulmonary artery
33692 C Repair of heart defects
33694 C Repair of heart defects
33697 C Repair of heart defects
33702 C Repair of heart defects
33710 C Repair of heart defects
33720 C Repair of heart defect
33722 C Repair of heart defect
33730 C Repair heart-vein defect(s)
33732 C Repair heart-vein defect
33735 C Revision of heart chamber
33736 C Revision of heart chamber
33737 C Revision of heart chamber
33750 C Major vessel shunt
33755 C Major vessel shunt
33762 C Major vessel shunt
33764 C Major vessel shunt & graft
33766 C Major vessel shunt
33767 C Major vessel shunt
33770 C Repair great vessels defect
33771 C Repair great vessels defect
33774 C Repair great vessels defect
33775 C Repair great vessels defect
33776 C Repair great vessels defect
33777 C Repair great vessels defect
33778 C Repair great vessels defect
33779 C Repair great vessels defect
33780 C Repair great vessels defect
33781 C Repair great vessels defect
33786 C Repair arterial trunk
33788 C Revision of pulmonary artery
33800 C Aortic suspension
33802 C Repair vessel defect
33803 C Repair vessel defect
33813 C Repair septal defect
33814 C Repair septal defect
33820 C Revise major vessel
33822 C Revise major vessel
33824 C Revise major vessel
33840 C Remove aorta constriction
33845 C Remove aorta constriction
33851 C Remove aorta constriction
33852 C Repair septal defect
33853 C Repair septal defect
33860 C Ascending aorta graft
33861 C Ascending aorta graft
33863 C Ascending aorta graft
33870 C Transverse aortic arch graft
33875 C Thoracic aorta graft
33877 C Thoracoabdominal graft
33910 C Remove lung artery emboli
33915 C Remove lung artery emboli
33916 C Surgery of great vessel
33917 C Repair pulmonary artery
33918 C Repair pulmonary atresia
33919 C Repair pulmonary atresia
33920 C Repair pulmonary atresia
33922 C Transect pulmonary artery
33924 C Remove pulmonary shunt
33930 C Removal of donor heart/lung
33935 C Transplantation, heart/lung
33940 C Removal of donor heart
33945 C Transplantation of heart
33960 C External circulation assist
33961 C External circulation assist
33970 C Aortic circulation assist
33971 C Aortic circulation assist
33973 C Insert balloon device
33974 C Remove intra-aortic balloon
33975 C Implant ventricular device
33976 C Implant ventricular device
33977 C Remove ventricular device
33978 C Remove ventricular device
34001 C Removal of artery clot
34051 C Removal of artery clot
34101 C Removal of artery clot
34111 C Removal of arm artery clot
34151 C Removal of artery clot
34201 C Removal of artery clot
34203 C Removal of leg artery clot
34401 C Removal of vein clot
34421 C Removal of vein clot
34451 C Removal of vein clot
34471 C Removal of vein clot
34490 C Removal of vein clot
34501 C Repair valve, femoral vein
34502 C Reconstruct, vena cava
34510 C Transposition of vein valve
34520 C Cross-over vein graft
34530 C Leg vein fusion
35001 C Repair defect of artery
35002 C Repair artery rupture, neck
35005 C Repair defect of artery
35011 C Repair defect of artery
35013 C Repair artery rupture, arm
35021 C Repair defect of artery
35022 C Repair artery rupture, chest
35045 C Repair defect of arm artery
35081 C Repair defect of artery
35082 C Repair artery rupture, aorta
35091 C Repair defect of artery
35092 C Repair artery rupture, aorta
35102 C Repair defect of artery
[[Page 35478]]
35103 C Repair artery rupture, groin
35111 C Repair defect of artery
35112 C Repair artery rupture, spleen
35121 C Repair defect of artery
35122 C Repair artery rupture, belly
35131 C Repair defect of artery
35132 C Repair artery rupture, groin
35141 C Repair defect of artery
35142 C Repair artery rupture, thigh
35151 C Repair defect of artery
35152 C Repair artery rupture, knee
35161 C Repair defect of artery
35162 C Repair artery rupture
35180 C Repair blood vessel lesion
35182 C Repair blood vessel lesion
35184 C Repair blood vessel lesion
35189 C Repair blood vessel lesion
35190 C Repair blood vessel lesion
35201 C Repair blood vessel lesion
35206 C Repair blood vessel lesion
35211 C Repair blood vessel lesion
35216 C Repair blood vessel lesion
35221 C Repair blood vessel lesion
35226 C Repair blood vessel lesion
35231 C Repair blood vessel lesion
35236 C Repair blood vessel lesion
35241 C Repair blood vessel lesion
35246 C Repair blood vessel lesion
35251 C Repair blood vessel lesion
35256 C Repair blood vessel lesion
35261 C Repair blood vessel lesion
35266 C Repair blood vessel lesion
35271 C Repair blood vessel lesion
35276 C Repair blood vessel lesion
35281 C Repair blood vessel lesion
35286 C Repair blood vessel lesion
35301 C Rechanneling of artery
35311 C Rechanneling of artery
35321 C Rechanneling of artery
35331 C Rechanneling of artery
35341 C Rechanneling of artery
35351 C Rechanneling of artery
35355 C Rechanneling of artery
35361 C Rechanneling of artery
35363 C Rechanneling of artery
35371 C Rechanneling of artery
35372 C Rechanneling of artery
35381 C Rechanneling of artery
35390 C Reoperation, carotid add-on
35400 C Angioscopy
35450 C Repair arterial blockage
35452 C Repair arterial blockage
35454 C Repair arterial blockage
35456 C Repair arterial blockage
35458 C Repair arterial blockage
35459 C Repair arterial blockage
35460 C Repair venous blockage
35470 C Repair arterial blockage
35471 C Repair arterial blockage
35472 C Repair arterial blockage
35473 C Repair arterial blockage
35474 C Repair arterial blockage
35475 C Repair arterial blockage
35476 C Repair venous blockage
35480 C Atherectomy, open
35481 C Atherectomy, open
35482 C Atherectomy, open
35483 C Atherectomy, open
35484 C Atherectomy, open
35485 C Atherectomy, open
35490 C Atherectomy, percutaneous
35491 C Atherectomy, percutaneous
35492 C Atherectomy, percutaneous
35493 C Atherectomy, percutaneous
35494 C Atherectomy, percutaneous
35495 C Atherectomy, percutaneous
35501 C Artery bypass graft
35506 C Artery bypass graft
35507 C Artery bypass graft
35508 C Artery bypass graft
35509 C Artery bypass graft
35511 C Artery bypass graft
35515 C Artery bypass graft
35516 C Artery bypass graft
35518 C Artery bypass graft
35521 C Artery bypass graft
35526 C Artery bypass graft
35531 C Artery bypass graft
35533 C Artery bypass graft
35536 C Artery bypass graft
35541 C Artery bypass graft
35546 C Artery bypass graft
35548 C Artery bypass graft
35549 C Artery bypass graft
35551 C Artery bypass graft
35556 C Artery bypass graft
35558 C Artery bypass graft
35560 C Artery bypass graft
35563 C Artery bypass graft
35565 C Artery bypass graft
35566 C Artery bypass graft
35571 C Artery bypass graft
35582 C Vein bypass graft
35583 C Vein bypass graft
35585 C Vein bypass graft
35587 C Vein bypass graft
35601 C Artery bypass graft
35606 C Artery bypass graft
35612 C Artery bypass graft
35616 C Artery bypass graft
35621 C Artery bypass graft
35623 C Bypass graft, not vein
35626 C Artery bypass graft
35631 C Artery bypass graft
35636 C Artery bypass graft
35641 C Artery bypass graft
35642 C Artery bypass graft
35645 C Artery bypass graft
35646 C Artery bypass graft
35650 C Artery bypass graft
35651 C Artery bypass graft
35654 C Artery bypass graft
35656 C Artery bypass graft
35661 C Artery bypass graft
35663 C Artery bypass graft
35665 C Artery bypass graft
35666 C Artery bypass graft
35671 C Artery bypass graft
35681 C Composite bypass graft
35691 C Arterial transposition
35693 C Arterial transposition
35694 C Arterial transposition
35695 C Arterial transposition
35700 C Reoperation, bypass graft
35701 C Exploration, carotid artery
35721 C Exploration, femoral artery
35741 C Exploration popliteal artery
35761 C Exploration of artery/vein
35800 C Explore neck vessels
35820 C Explore chest vessels
35840 C Explore abdominal vessels
35860 C Explore limb vessels
35870 C Repair vessel graft defect
35901 C Excision, graft, neck
35903 C Excision, graft, extremity
35905 C Excision, graft, thorax
35907 C Excision, graft, abdomen
36510 C Insertion of catheter, vein
36660 C Insertion catheter, artery
36822 C Insertion of cannula(s)
36834 C Repair A-V aneurysm
37140 C Revision of circulation
37145 C Revision of circulation
37160 C Revision of circulation
37180 C Revision of circulation
37181 C Splice spleen/kidney veins
37195 C Thrombolytic therapy, stroke
37200 C Transcatheter biopsy
37201 C Transcatheter therapy infuse
37202 C Transcatheter therapy infuse
37204 C Transcatheter occlusion
37205 C Transcatheter stent
37206 C Transcatheter stent add-on
37207 C Transcatheter stent
37208 C Transcatheter stent add-on
37209 C Exchange arterial catheter
37250 C Intravascular us
37251 C Intravascular us
37565 C Ligation of neck vein
37600 C Ligation of neck artery
37605 C Ligation of neck artery
37606 C Ligation of neck artery
37615 C Ligation of neck artery
37616 C Ligation of chest artery
37617 C Ligation of abdomen artery
37620 C Revision of major vein
37660 C Revision of major vein
37788 C Revascularization, penis
38100 C Removal of spleen, total
38101 C Removal of spleen, partial
38102 C Removal of spleen, total
38115 C Repair of ruptured spleen
38240 C Bone marrow/stem transplant
38241 C Bone marrow/stem transplant
38380 C Thoracic duct procedure
38381 C Thoracic duct procedure
38382 C Thoracic duct procedure
38562 C Removal, pelvic lymph nodes
38564 C Removal, abdomen lymph nodes
38700 C Removal of lymph nodes, neck
38720 C Removal of lymph nodes, neck
38724 C Removal of lymph nodes, neck
38746 C Remove thoracic lymph nodes
38747 C Remove abdominal lymph nodes
38765 C Remove groin lymph nodes
38770 C Remove pelvis lymph nodes
38780 C Remove abdomen lymph nodes
39000 C Exploration of chest
39010 C Exploration of chest
39200 C Removal chest lesion
39220 C Removal chest lesion
39400 C Visualization of chest
39499 C Chest procedure
39501 C Repair diaphragm laceration
39502 C Repair paraesophageal hernia
39503 C Repair of diaphragm hernia
39520 C Repair of diaphragm hernia
39530 C Repair of diaphragm hernia
39531 C Repair of diaphragm hernia
39540 C Repair of diaphragm hernia
39541 C Repair of diaphragm hernia
39545 C Revision of diaphragm
39599 C Diaphragm surgery procedure
[[Page 35479]]
41130 C Partial removal of tongue
41135 C Tongue and neck surgery
41140 C Removal of tongue
41145 C Tongue removal; neck surgery
41150 C Tongue, mouth, jaw surgery
41153 C Tongue, mouth, neck surgery
41155 C Tongue, jaw, & neck surgery
42145 C Repair, palate, pharynx/uvula
42426 C Excise parotid gland/lesion
42845 C Extensive surgery of throat
42880 C Excise nose/throat lesion
42894 C Revision of pharyngeal walls
42953 C Repair throat, esophagus
42961 C Control throat bleeding
42971 C Control nose/throat bleeding
43045 C Incision of esophagus
43100 C Excision of esophagus lesion
43101 C Excision of esophagus lesion
43107 C Removal of esophagus
43108 C Removal of esophagus
43112 C Removal of esophagus
43113 C Removal of esophagus
43116 C Partial removal of esophagus
43117 C Partial removal of esophagus
43118 C Partial removal of esophagus
43121 C Partial removal of esophagus
43122 C Parital removal of esophagus
43123 C Partial removal of esophagus
43124 C Removal of esophagus
43130 C Removal of esophagus pouch
43135 C Removal of esophagus pouch
43300 C Repair of esophagus
43305 C Repair esophagus and fistula
43310 C Repair of esophagus
43312 C Repair esophagus and fistula
43320 C Fuse esophagus & stomach
43324 C Revise esophagus & stomach
43325 C Revise esophagus & stomach
43326 C Revise esophagus & stomach
43330 C Repair of esophagus
43331 C Repair of esophagus
43340 C Fuse esophagus & intestine
43341 C Fuse esophagus & intestine
43350 C Surgical opening, esophagus
43351 C Surgical opening, esophagus
43352 C Surgical opening, esophagus
43360 C Gastrointestinal repair
43361 C Gastrointestinal repair
43400 C Ligate esophagus veins
43401 C Esophagus surgery for veins
43405 C Ligate/staple esophagus
43410 C Repair esophagus wound
43415 C Repair esophagus wound
43420 C Repair esophagus opening
43425 C Repair esophagus opening
43460 C Pressure treatment esophagus
43496 C Free jejunum flap, microvasc
43500 C Surgical opening of stomach
43501 C Surgical repair of stomach
43502 C Surgical repair of stomach
43510 C Surgical opening of stomach
43520 C Incision of pyloric muscle
43605 C Biopsy of stomach
43610 C Excision of stomach lesion
43611 C Excision of stomach lesion
43620 C Removal of stomach
43621 C Removal of stomach
43622 C Removal of stomach
43631 C Removal of stomach, partial
43632 C Removal stomach, partial
43633 C Removal stomach, partial
43634 C Removal stomach, partial
43635 C Partial removal of stomach
43638 C Partial removal of stomach
43639 C Removal stomach, partial
43640 C Vagotomy & pylorus repair
43641 C Vagotomy & pylorus repair
43800 C Reconstruction of pylorus
43810 C Fusion of stomach and bowel
43820 C Fusion of stomach and bowel
43825 C Fusion of stomach and bowel
43830 C Place gastrostomy tube
43831 C Place gastrostomy tube
43832 C Place gastrostomy tube
43840 C Repair of stomach lesion
43842 C Gastroplasty for obesity
43843 C Gastroplasty for obesity
43846 C Gastric bypass for obesity
43847 C Gastric bypass for obesity
43848 C Revision gastroplasty
43850 C Revise stomach-bowel fusion
43855 C Revise stomach-bowel fusion
43860 C Revise stomach-bowel fusion
43865 C Revise stomach-bowel fusion
43880 C Repair stomach-bowel fistula
44005 C Freeing of bowel adhesion
44010 C Incision of small bowel
44015 C Insert needle catheter, bowel
44020 C Exploration of small bowel
44021 C Decompress small bowel
44025 C Incision of large bowel
44050 C Reduce bowel obstruction
44055 C Correct malrotation of bowel
44110 C Excision of bowel lesion(s)
44111 C Excision of bowel lesion(s)
44120 C Removal of small intestine
44121 C Removal of small intestine
44125 C Removal of small intestine
44130 C Bowel to bowel fusion
44139 C Mobilization of colon
44140 C Partial removal of colon
44141 C Partial removal of colon
44143 C Partial removal of colon
44144 C Partial removal of colon
44145 C Partial removal of colon
44146 C Partial removal of colon
44147 C Partial removal of colon
44150 C Removal of colon
44151 C Removal of colon/ileostomy
44152 C Removal of colon/ileostomy
44153 C Removal of colon/ileostomy
44155 C Removal of colon
44156 C Removal of colon/ileostomy
44160 C Removal of colon
44300 C Open bowel to skin
44310 C Ileostomy/jejunostomy
44314 C Revision of ileostomy
44316 C Devise bowel pouch
44320 C Colostomy
44322 C Colostomy with biopsies
44345 C Revision of colostomy
44346 C Revision of colostomy
44500 C Intro, gastrointestinal tube
44602 C Suture, small intestine
44603 C Suture, small intestine
44604 C Suture, large intestine
44605 C Repair of bowel lesion
44615 C Intestinal stricturoplasty
44620 C Repair bowel opening
44625 C Repair bowel opening
44626 C Repair bowel opening
44640 C Repair bowel-skin fistula
44650 C Repair bowel fistula
44660 C Repair bowel-bladder fistula
44661 C Repair bowel-bladder fistula
44680 C Surgical revision, intestine
44700 C Suspend bowel w/prosthesis
44800 C Excision of bowel pouch
44820 C Excision of mesentery lesion
44850 C Repair of mesentery
44899 C Bowel surgery procedure
44900 C Drain, app abscess, open
44901 C Drain, app abscess, perc
44950 C Appendectomy
44955 C Appendectomy add-on
44960 C Appendectomy
45110 C Removal of rectum
45111 C Partial removal of rectum
45112 C Removal of rectum
45113 C Partial proctectomy
45114 C Partial removal of rectum
45116 C Partial removal of rectum
45119 C Remove, rectum w/reservoir
45120 C Removal of rectum
45121 C Removal of rectum and colon
45123 C Partial proctectomy
45130 C Excision of rectal prolapse
45135 C Excision of rectal prolapse
45540 C Correct rectal prolapse
45541 C Correct rectal prolapse
45550 C Repair rectum;remove sigmoid
45562 C Exploration/repair of rectum
45563 C Exploration/repair of rectum
45800 C Repair rectumbladder fistula
45805 C Repair fistula; colostomy
45820 C Repair rectourethral fistula
45825 C Repair fistula; colostomy
46705 C Repair of anal stricture
46715 C Repair of anovaginal fistula
46716 C Repair of anovaginal fistula
46730 C Construction of absent anus
46735 C Construction of absent anus
46740 C Construction of absent anus
46742 C Repair, imperforated anus
46744 C Repair, cloacal anomaly
46746 C Repair, cloacal anomaly
46748 C Repair, cloacal anomaly
46751 C Repair of anal sphincter
47001 C Needle biopsy, liver add-on
47010 C Open drainage, liver lesion
47011 C Percut drain, liver lesion
47015 C Inject/aspirate liver cyst
47100 C Wedge biopsy of liver
47120 C Partial removal of liver
47122 C Extensive removal of liver
47125 C Partial removal of liver
47130 C Partial removal of liver
47133 C Removal of donor liver
47134 C Partial removal, donor liver
47135 C Transplantation of liver
47136 C Transplantation of liver
47300 C Surgery for liver lesion
47350 C Repair liver wound
47360 C Repair liver wound
47361 C Repair liver wound
47362 C Repair liver wound
47400 C Incision of liver duct
47420 C Incision of bile duct
47425 C Incision of bile duct
47460 C Incise bile duct sphincter
47480 C Incision of gallbladder
47490 C Incision of gallbladder
47550 C Bile duct endoscopy add-on
47600 C Removal of gallbladder
47605 C Removal of gallbladder
47610 C Removal of gallbladder
47612 C Removal of gallbladder
47620 C Removal of gallbladder
47700 C Exploration of bile ducts
[[Page 35480]]
47701 C Bile duct revision
47711 C Excision of bile duct tumor
47712 C Excision of bile duct tumor
47715 C Excision of bile duct cyst
47716 C Fusion of bile duct cyst
47720 C Fuse gallbladder & bowel
47721 C Fuse upper gi structures
47740 C Fuse gallbladder & bowel
47741 C Fuse gallbladder & bowel
47760 C Fuse bile ducts and bowel
47765 C Fuse liver ducts & bowel
47780 C Fuse bile ducts and bowel
47785 C Fuse bile ducts and bowel
47800 C Reconstruction of bile ducts
47801 C Placement, bile duct support
47802 C Fuse liver duct & intestine
47900 C Suture bile duct injury
48000 C Drainage of abdomen
48001 C Placement of drain, pancreas
48005 C Resect/debride pancreas
48020 C Removal of pancreatic stone
48100 C Biopsy of pancreas
48120 C Removal of pancreas lesion
48140 C Partial removal of pancreas
48145 C Partial removal of pancreas
48146 C Pancreatectomy
48148 C Removal of pancreatic duct
48150 C Partial removal of pancreas
48152 C Pancreatectomy
48153 C Pancreatectomy
48154 C Pancreatectomy
48155 C Removal of pancreas
48180 C Fuse pancreas and bowel
48400 C Injection, intraop add-on
48500 C Surgery of pancreas cyst
48510 C Drain pancreatic pseudocyst
48511 C Drain pancreatic pseudocyst
48520 C Fuse pancreas cyst and bowel
48540 C Fuse pancreas cyst and bowel
48545 C Pancreatorrhaphy
48547 C Duodenal exclusion
48556 C Removal, allograft pancreas
49000 C Exploration of abdomen
49002 C Reopening of abdomen
49010 C Exploration behind abdomen
49020 C Drain abdominal abscess
49021 C Drain abdominal abscess
49040 C Open drainage abdom abscess
49041 C Percut drain abdom abscess
49060 C Open drain retroper abscess
49061 C Percutdrain retroper abscess
49062 C Drain to peritoneal cavity
49200 C Removal of abdominal lesion
49201 C Removal of abdominal lesion
49215 C Excise sacral spine tumor
49220 C Multiple surgery, abdomen
49255 C Removal of omentum
49425 C Insert abdomen-venous drain
49428 C Ligation of shunt
49605 C Repair umbilical lesion
49606 C Repair umbilical lesion
49610 C Repair umbilical lesion
49611 C Repair umbilical lesion
49900 C Repair of abdominal wall
49905 C Omental flap
49906 C Free omental flap, microvasc
50010 C Exploration of kidney
50020 C Open drain renal abscess
50021 C Percut drain renal abscess
50040 C Drainage of kidney
50045 C Exploration of kidney
50060 C Removal of kidney stone
50065 C Incision of kidney
50070 C Incision of kidney
50075 C Removal of kidney stone
50080 C Removal of kidney stone
50081 C Removal of kidney stone
50100 C Revise kidney blood vessels
50120 C Exploration of kidney
50125 C Explore and drain kidney
50130 C Removal of kidney stone
50135 C Exploration of kidney
50205 C Biopsy of kidney
50220 C Removal of kidney
50225 C Removal of kidney
50230 C Removal of kidney
50234 C Removal of kidney & ureter
50236 C Removal of kidney & ureter
50240 C Partial removal of kidney
50280 C Removal of kidney lesion
50290 C Removal of kidney lesion
50300 C Removal of donor kidney
50320 C Removal of donor kidney
50340 C Removal of kidney
50360 C Transplantation of kidney
50365 C Transplantation of kidney
50370 C Remove transplanted kidney
50380 C Reimplantation of kidney
50400 C Revision of kidney/ureter
50405 C Revision of kidney/ureter
50500 C Repair of kidney wound
50520 C Close kidney-skin fistula
50525 C Repair renal-abdomen fistula
50526 C Repair renal-abdomen fistula
50540 C Revision of horseshoe kidney
50570 C Kidney endoscopy
50572 C Kidney endoscopy
50574 C Kidney endoscopy & biopsy
50575 C Kidney endoscopy
50576 C Kidney endoscopy & treatment
50578 C Renal endoscopy; radiotracer
50580 C Kidney endoscopy & treatment
50600 C Exploration of ureter
50605 C Insert ureteral support
50610 C Removal of ureter stone
50620 C Removal of ureter stone
50630 C Removal of ureter stone
50650 C Removal of ureter
50660 C Removal of ureter
50700 C Revision of ureter
50715 C Release of ureter
50722 C Release of ureter
50725 C Release/revise ureter
50727 C Revise ureter
50728 C Revise ureter
50740 C Fusion of ureter & kidney
50750 C Fusion of ureter & kidney
50760 C Fusion of ureters
50770 C Splicing of ureters
50780 C Reimplant ureter in bladder
50782 C Reimplant ureter in bladder
50783 C Reimplant ureter in bladder
50785 C Reimplant ureter in bladder
50800 C Implant ureter in bowel
50810 C Fusion of ureter & bowel
50815 C Urine shunt to bowel
50820 C Construct bowel bladder
50825 C Construct bowel bladder
50830 C Revise urine flow
50840 C Replace ureter by bowel
50845 C Appendico-vesicostomy
50860 C Transplant ureter to skin
50900 C Repair of ureter
50920 C Closure ureter/skin fistula
50930 C Closure ureter/bowel fistula
50940 C Release of ureter
50970 C Ureter endoscopy
50972 C Ureter endoscopy & catheter
50974 C Ureter endoscopy & biopsy
50976 C Ureter endoscopy & treatment
50978 C Ureter endoscopy & tracer
50980 C Ureter endoscopy & treatment
51060 C Removal of ureter stone
51525 C Removal of bladder lesion
51530 C Removal of bladder lesion
51535 C Repair of ureter lesion
51550 C Partial removal of bladder
51555 C Partial removal of bladder
51565 C Revise bladder & ureter(s)
51570 C Removal of bladder
51575 C Removal of bladder & nodes
51580 C Remove bladder; revise tract
51585 C Removal of bladder & nodes
51590 C Remove bladder; revise tract
51595 C Remove bladder; revise tract
51596 C Remove bladder, create pouch
51597 C Removal of pelvic structures
51800 C Revision of bladder/urethra
51820 C Revision of urinary tract
51840 C Attach bladder/urethra
51841 C Attach bladder/urethra
51845 C Repair bladder neck
51860 C Repair of bladder wound
51865 C Repair of bladder wound
51900 C Repair bladder/vagina lesion
51920 C Close bladder-uterus fistula
51925 C Hysterectomy/bladder repair
51940 C Correction of bladder defect
51960 C Revision of bladder & bowel
51980 C Construct bladder opening
53085 C Drainage of urinary leakage
53415 C Reconstruction of urethra
53443 C Reconstruction of urethra
54125 C Removal of penis
54130 C Remove penis & nodes
54135 C Remove penis & nodes
54332 C Revise penis, urethra
54336 C Revise penis, urethra
54390 C Repair penis and bladder
54430 C Revision of penis
54535 C Extensive testis surgery
54560 C Exploration for testis
54650 C Orchiopexy (Fowler-Stephens)
55600 C Incise sperm duct pouch
55605 C Incise sperm duct pouch
55650 C Remove sperm duct pouch
55801 C Removal of prostate
55810 C Extensive prostate surgery
55812 C Extensive prostate surgery
55815 C Extensive prostate surgery
55821 C Removal of prostate
55831 C Removal of prostate
55840 C Extensive prostate surgery
55842 C Extensive prostate surgery
55845 C Extensive prostate surgery
55860 C Surgical exposure, prostate
55862 C Extensive prostate surgery
55865 C Extensive prostate surgery
56308 C Laparoscopy; hysterectomy
56310 C Laparoscopic enterolysis
56314 C Lapar; drain lymphocele
56315 C Laparoscopic appendectomy
56322 C Laparoscopy, vagus nerves
56323 C Laparoscopy, vagus nerves
56324 C Laparoscopy, cholecystoenter
56340 C Laparoscopic cholecystectomy
56341 C Laparoscopic cholecystectomy
[[Page 35481]]
56342 C Laparoscopic cholecystectomy
56345 C Laparoscopic splenectomy
56347 C Laparoscopic jejunostomy
56348 C Laparo; resect intestine
56349 C Laparoscopy; fundoplasty
56630 C Extensive vulva surgery
56631 C Extensive vulva surgery
56632 C Extensive vulva surgery
56633 C Extensive vulva surgery
56634 C Extensive vulva surgery
56637 C Extensive vulva surgery
56640 C Extensive vulva surgery
56805 C Repair clitoris
57108 C Partial removal of vagina
57110 C Remove vagina wall, complete
57120 C Closure of vagina
57270 C Repair of bowel pouch
57280 C Suspension of vagina
57282 C Repair of vaginal prolapse
57292 C Construct vagina with graft
57305 C Repair rectum-vagina fistula
57307 C Fistula repair & colostomy
57308 C Fistula repair, transperine
57310 C Repair urethrovaginal lesion
57311 C Repair urethrovaginal lesion
57320 C Repair bladder-vagina lesion
57330 C Repair bladder-vagina lesion
57335 C Repair vagina
57531 C Removal of cervix, radical
57540 C Removal of residual cervix
57545 C Remove cervix, repair pelvis
58140 C Removal of uterus lesion
58150 C Total hysterectomy
58152 C Total hysterectomy
58180 C Partial hysterectomy
58200 C Extensive hysterectomy
58210 C Extensive hysterectomy
58240 C Removal of pelvis contents
58260 C Vaginal hysterectomy
58262 C Vaginal hysterectomy
58263 C Vaginal hysterectomy
58267 C Hysterectomy & vagina repair
58270 C Hysterectomy & vagina repair
58275 C Hysterectomy, revise vagina
58280 C Hysterectomy, revise vagina
58285 C Extensive hysterectomy
58400 C Suspension of uterus
58410 C Suspension of uterus
58520 C Repair of ruptured uterus
58540 C Revision of uterus
58600 C Division of fallopian tube
58605 C Division of fallopian tube
58611 C Ligate oviduct(s) add-on
58615 C Occlude fallopian tube(s)
58700 C Removal of fallopian tube
58720 C Removal of ovary/tube(s)
58740 C Revise fallopian tube(s)
58750 C Repair oviduct
58752 C Revise ovarian tube(s)
58760 C Remove tubal obstruction
58770 C Create new tubal opening
58805 C Drainage of ovarian cyst(s)
58822 C Percut drain ovary abscess
58823 C Percut drain pelvic abscess
58825 C Transposition, ovary(s)
58900 C Biopsy of ovary(s)
58920 C Partial removal of ovary(s)
58925 C Removal of ovarian cyst(s)
58940 C Removal of ovary(s)
58943 C Removal of ovary(s)
58950 C Resect ovarian malignancy
58951 C Resect ovarian malignancy
58952 C Resect ovarian malignancy
58960 C Exploration of abdomen
59100 C Remove uterus lesion
59120 C Treat ectopic pregnancy
59121 C Treat ectopic pregnancy
59130 C Treat ectopic pregnancy
59135 C Treat ectopic pregnancy
59136 C Treat ectopic pregnancy
59140 C Treat ectopic pregnancy
59150 C Treat ectopic pregnancy
59151 C Treat ectopic pregnancy
59325 C Revision of cervix
59350 C Repair of uterus
59514 C Cesarean delivery only
59525 C Remove uterus after cesarean
59620 C Attempted vbac delivery only
59830 C Treat uterus infection
59850 C Abortion
59851 C Abortion
59852 C Abortion
59855 C Abortion
59856 C Abortion
59857 C Abortion
59866 C Abortion
60212 C Parital thyroid excision
60252 C Removal of thyroid
60254 C Extensive thyroid surgery
60260 C Repeat thyroid surgery
60270 C Removal of thyroid
60271 C Removal of thyroid
60500 C Explore parathyroid glands
60502 C Re-explore parathyroids
60505 C Explore parathyroid glands
60512 C Autotransplant, parathyroid
60520 C Removal of thymus gland
60521 C Removal thymus gland
60522 C Removal of thymus gland
60540 C Explore adrenal gland
60545 C Explore adrenal gland
60600 C Remove carotid body lesion
60605 C Remove carotid body lesion
61105 C Twist drill hole
61106 C Drill skull for exam/surgery
61107 C Drill skull for implantation
61108 C Drill skull for drainage
61120 C Burr hole for puncture
61130 C Pierce skull, exam/surgery
61140 C Pierce skull for biopsy
61150 C Pierce skull for drainage
61151 C Pierce skull for drainage
61154 C Pierce skull, remove clot
61156 C Pierce skull for drainage
61210 C Pierce skull; implant device
61250 C Pierce skull & explore
61253 C Pierce skull & explore
61304 C Open skull for exploration
61305 C Open skull for exploration
61312 C Open skull for drainage
61313 C Open skull for drainage
61314 C Open skull for drainage
61315 C Open skull for drainage
61320 C Open skull for drainage
61321 C Open skull for drainage
61330 C Decompress eye socket
61332 C Explore/biopsy eye socket
61333 C Explore orbit; remove lesion
61334 C Explore orbit; remove object
61340 C Relieve cranial pressure
61343 C Incise skull, pressure relief
61345 C Relieve cranial pressure
61440 C Incise skull for surgery
61450 C Incise skull for surgery
61458 C Incise skull for brain wound
61460 C Incise skull for surgery
61470 C Incise skull for surgery
61480 C Incise skull for surgery
61490 C Incise skull for surgery
61500 C Removal of skull lesion
61501 C Remove infected skull bone
61510 C Removal of brain lesion
61512 C Remove brain lining lesion
61514 C Removal of brain abscess
61516 C Removal of brain lesion
61518 C Removal of brain lesion
61519 C Remove brain lining lesion
61520 C Removal of brain lesion
61521 C Removal of brain lesion
61522 C Removal of brain abscess
61524 C Removal of brain lesion
61526 C Removal of brain lesion
61530 C Removal of brain lesion
61531 C Implant brain electrodes
61533 C Implant brain electrodes
61534 C Removal of brain lesion
61535 C Remove brain electrodes
61536 C Removal of brain lesion
61538 C Removal of brain tissue
61539 C Removal of brain tissue
61541 C Incision of brain tissue
61542 C Removal of brain tissue
61543 C Removal of brain tissue
61544 C Remove & treat brain lesion
61545 C Excision of brain tumor
61546 C Removal of pituitary gland
61548 C Removal of pituitary gland
61550 C Release of skull seams
61552 C Release of skull seams
61556 C Incise skull/sutures
61557 C Incise skull/sutures
61558 C Excision of skull/sutures
61559 C Excision of skull/sutures
61563 C Excision of skull tumor
61564 C Excision of skull tumor
61570 C Remove brain foreign body
61571 C Incise skull for brain wound
61575 C Skull base/brainstem surgery
61576 C Skull base/brainstem surgery
61580 C Craniofacial approach, skull
61581 C Craniofacial approach, skull
61582 C Craniofacial approach, skull
61583 C Craniofacial approach, skull
61584 C Orbitocranial approach/skull
61585 C Orbitocranial approach/skull
61586 C Resect nasopharynx, skull
61590 C Infratemporal approach/skull
61591 C Infratemporal approach/skull
61592 C Orbitocranial approach/skull
61595 C Transtemporal approach/skull
61596 C Transcochlear approach/skull
61597 C Transcondylar approach/skull
61598 C Transpetrosal approach/skull
61600 C Resect/excise cranial lesion
61601 C Resect/excise cranial lesion
61605 C Resect/excise cranial lesion
61606 C Resect/excise cranial lesion
61607 C Resect/excise cranial lesion
61608 C Resect/excise cranial lesion
61609 C Transect, artery, sinus
61610 C Transect, artery, sinus
61611 C Transect, artery, sinus
61612 C Transect, artery, sinus
61613 C Remove aneurysm, sinus
61615 C Resect/excise lesion, skull
61616 C Resect/excise lesion, skull
61618 C Repair dura
61619 C Repair dura
61624 C Occlusion/embolization cath
[[Page 35482]]
61626 C Occlusion/embolization cath
61680 C Intracranial vessel surgery
61682 C Intracranial vessel surgery
61684 C Intracranial vessel surgery
61686 C Intracranial vessel surgery
61690 C Intracranial vessel surgery
61692 C Intracranial vessel surgery
61700 C Inner skull vessel surgery
61702 C Inner skull vessel surgery
61703 C Clamp neck artery
61705 C Revise circulation to head
61708 C Revise circulation to head
61710 C Revise circulation to head
61711 C Fusion of skull arteries
61712 C Skull or spine microsurgery
61720 C Incise skull/brain surgery
61735 C Incise skull/brain surgery
61750 C Incise skull; brain biopsy
61751 C Brain biopsy with cat scan
61760 C Implant brain electrodes
61770 C Incise skull for treatment
61791 C Treat trigeminal tract
61795 C Brain surgery using computer
61850 C Implant neuroelectrodes
61855 C Implant neuroelectrodes
61860 C Implant neuroelectrodes
61865 C Implant neuroelectrodes
61870 C Implant neuroelectrodes
61875 C Implant neuroelectrodes
61880 C Revise/remove neuroelectrode
61888 C Revise/remove neuroreceiver
62000 C Repair of skull fracture
62005 C Repair of skull fracture
62010 C Treatment of head injury
62100 C Repair brain fluid leakage
62115 C Reduction of skull defect
62116 C Reduction of skull defect
62117 C Reduction of skull defect
62120 C Repair skull cavity lesion
62121 C Incise skull repair
62140 C Repair of skull defect
62141 C Repair of skull defect
62142 C Remove skull plate/flap
62143 C Replace skull plate/flap
62145 C Repair of skull & brain
62146 C Repair of skull with graft
62147 C Repair of skull with graft
62180 C Establish brain cavity shunt
62190 C Establish brain cavity shunt
62192 C Establish brain cavity shunt
62200 C Establish brain cavity shunt
62201 C Establish brain cavity shunt
62220 C Establish brain cavity shunt
62223 C Establish brain cavity shunt
62256 C Remove brain cavity shunt
62258 C Replace brain cavity shunt
62351 C Implant spinal catheter
63001 C Removal of spinal lamina
63003 C Removal of spinal lamina
63005 C Removal of spinal lamina
63011 C Removal of spinal lamina
63012 C Removal of spinal lamina
63015 C Removal of spinal lamina
63016 C Removal of spinal lamina
63017 C Removal of spinal lamina
63020 C Neck spine disk surgery
63030 C Low back disk surgery
63035 C Spinal disk surgery add-on
63040 C Neck spine disk surgery
63042 C Low back disk surgery
63045 C Removal of spinal lamina
63046 C Removal of spinal lamina
63047 C Removal of spinal lamina
63048 C Remove spinal lamina add-on
63055 C Decompress spinal cord
63056 C Decompress spinal cord
63057 C Decompress spine cord add-on
63064 C Decompress spinal cord
63066 C Decompress spine cord add-on
63075 C Neck spine disk surgery
63076 C Neck spine disk surgery
63077 C Spine disk surgery, thorax
63078 C Spine disk surgery, thorax
63081 C Removal of vertebral body
63082 C Remove vertebral body add-on
63085 C Removal of vertebral body
63086 C Remove vertebral body add-on
63087 C Removal of vertebral body
63088 C Remove vertebral body add-on
63090 C Removal of vertebral body
63091 C Remove vertebral body add-on
63170 C Incise spinal cord tract(s)
63172 C Drainage of spinal cyst
63173 C Drainage of spinal cyst
63180 C Revise spinal cord ligaments
63182 C Revise spinal cord ligaments
63185 C Incise spinal column/nerves
63190 C Incise spinal column/nerves
63191 C Incise spinal column/nerves
63194 C Incise spinal column & cord
63195 C Incise spinal column & cord
63196 C Incise spinal column & cord
63197 C Incise spinal column & cord
63198 C Incise spinal column & cord
63199 C Incise spinal column & cord
63200 C Release of spinal cord
63250 C Revise spinal cord vessels
63251 C Revise spinal cord vessels
63252 C Revise spinal cord vessels
63265 C Excise intraspinal lesion
63266 C Excise intraspinal lesion
63267 C Excise intraspinal lesion
63268 C Excise intraspinal lesion
63270 C Excise intraspinal lesion
63271 C Excise intraspinal lesion
63272 C Excise intraspinal lesion
63273 C Excise intraspinal lesion
63275 C Biopsy/excise spinal tumor
63276 C Biopsy/excise spinal tumor
63277 C Biopsy/excise spinal tumor
63278 C Biopsy/excise spinal tumor
63280 C Biopsy/excise spinal tumor
63281 C Biopsy/excise spinal tumor
63282 C Biopsy/excise spinal tumor
63283 C Biopsy/excise spinal tumor
63285 C Biopsy/excise spinal tumor
63286 C Biopsy/excise spinal tumor
63287 C Biopsy/excise spinal tumor
63290 C Biopsy/excise spinal tumor
63300 C Removal of vertebral body
63301 C Removal of vertebral body
63302 C Removal of vertebral body
63303 C Removal of vertebral body
63304 C Removal of vertebral body
63305 C Removal of vertebral body
63306 C Removal of vertebral body
63307 C Removal of vertebral body
63308 C Remove vertebral body add-on
63655 C Implant neuroelectrodes
63700 C Repair of spinal herniation
63702 C Repair of spinal herniation
63704 C Repair of spinal herniation
63706 C Repair of spinal herniation
63707 C Repair spinal fluid leakage
63709 C Repair spinal fluid leakage
63710 C Graft repair of spine defect
63740 C Install spinal shunt
63741 C Install spinal shunt
64752 C Incision of vagus nerve
64755 C Incision of stomach nerves
64760 C Incision of vagus nerve
64763 C Incise hip/thigh nerve
64766 C Incise hip/thigh nerve
64802 C Remove sympathetic nerves
64804 C Remove sympathetic nerves
64809 C Remove sympathetic nerves
64818 C Remove sympathetic nerves
64820 C Remove sympathetic nerves
64866 C Fusion of facial/other nerve
64868 C Fusion of facial/other nerve
65110 C Removal of eye
65112 C Remove eye, revise socket
65114 C Remove eye, revise socket
65273 C Repair of eye wound
67414 C Explore/decompress eye socke
67445 C Explore/decompress eye socke
67570 C Decompress optic nerve
69155 C Extensive ear/neck surgery
69535 C Remove part of temporal bone
69554 C Remove ear lesion
69950 C Incise inner ear nerve
69955 C Release facial nerve
69960 C Release inner ear canal
69970 C Remove inner ear lesion
69979 C Temporal bone surgery
74300 C X-ray bile ducts, pancreas
74301 C X-rays at surgery add-on
75894 C X-rays, transcatheter therapy
75896 C X-rays, transcatheter therapy
75900 C Arterial catheter exchange
75940 C X-ray placement, vein filter
75945 C Intravascular us
75946 C Intravascular us add-on
75960 C Transcatheter intro, stent
75961 C Retrieval, broken catheter
75962 C Repair arterial blockage
75964 C Repair artery blockage, each
75966 C Repair arterial blockage
75968 C Repair artery blockage, each
75970 C Vascular biopsy
75978 C Repair venous blockage
75992 C Atherectomy, x-ray exam
75993 C Atherectomy, x-ray exam
75994 C Atherectomy, x-ray exam
75995 C Atherectomy, x-ray exam
75996 C Atherectomy, x-ray exam
92970 C Cardioassist, internal
92971 C Cardioassist, external
92975 C Dissolve clot, heart vessel
92977 C Dissolve clot, heart vessel
92978 C Intravas us, heart add-on
92979 C Intravas us, heart (add-on)
92980 C Insert intracoronary stent
92981 C Insert intracoronary stent
92982 C Coronary artery dilation
92984 C Coronary artery dilation
92986 C Revision of aortic valve
92987 C Revision of mitral valve
92990 C Revision of pulmonary valve
92992 C Revision of heart chamber
[[Page 35483]]
92993 C Revision of heart chamber
92995 C Coronary atherectomy
92996 C Coronary atherectomy add-on
92997 C Pul art balloon repair, perc
92998 C Pul art balloon repair, perc
94652 C Pressure breathing (IPPB)
94656 C Initial ventilator mgmt
95920 C Intraop nerve test add-on
95961 C Electrode stimulation, brain
95962 C Electrode stimulation, brain
99190 C Special pump services
99191 C Special pump services
99192 C Special pump services
99234 C Observ/hosp same date
99235 C Observ/hosp same date
99236 C Observ/hosp same date
99251 C Initial inpatient consult
99252 C Initial inpatient consult
99253 C Initial inpatient consult
99254 C Initial inpatient consult
99255 C Initial inpatient consult
99261 C Follow-up inpatient consult
99262 C Follow-up inpatient consult
99263 C Follow-up inpatient consult
99295 C Neonatal critical care
99296 C Neonatal critical care
99297 C Neonatal critical care
99356 C Prolonged service, inpatient
99357 C Prolonged service, inpatient
99433 C Normal newborn care,hospital
------------------------------------------------------------------------
\1\ CPT codes and descriptions only are copyright 1997 American Medical
Association. All rights reserved. Applicable FARS/DFARS apply.
\2\ Copyright 1994 American Dental Association. All rights reserved.
51. On pages 48005 through 48030, Addendum I is corrected to read
as follows:
[[Page 35483]]
Addendum I.--Service Mix Indices by Hospital
------------------------------------------------------------------------
Hospital SMI
------------------------------------------------------------------------
10001.......................................................... 2.87
10004.......................................................... 1.70
10005.......................................................... 2.04
10006.......................................................... 2.81
10007.......................................................... 1.56
10008.......................................................... 1.77
10009.......................................................... 1.47
10010.......................................................... 2.30
10011.......................................................... 2.42
10012.......................................................... 2.01
10015.......................................................... 2.11
10016.......................................................... 2.49
10018.......................................................... 6.17
10019.......................................................... 2.24
10021.......................................................... 1.64
10022.......................................................... 1.86
10023.......................................................... 2.47
10024.......................................................... 2.75
10025.......................................................... 2.02
10027.......................................................... 1.00
10029.......................................................... 2.98
10031.......................................................... 1.85
10032.......................................................... 1.27
10033.......................................................... 1.47
10034.......................................................... 2.41
10035.......................................................... 2.82
10036.......................................................... 2.42
10038.......................................................... 4.13
10039.......................................................... 2.05
10040.......................................................... 2.42
10043.......................................................... 2.17
10044.......................................................... 2.03
10045.......................................................... 1.82
10046.......................................................... 2.00
10047.......................................................... 1.55
10049.......................................................... 2.86
10050.......................................................... 1.79
10051.......................................................... 1.49
10052.......................................................... 1.48
10053.......................................................... 1.88
10054.......................................................... 1.79
10055.......................................................... 2.63
10056.......................................................... 2.61
10058.......................................................... 1.16
10059.......................................................... 1.76
10061.......................................................... 2.48
10062.......................................................... 1.64
10064.......................................................... 3.07
10065.......................................................... 2.25
10066.......................................................... 1.32
10068.......................................................... 1.35
10069.......................................................... 2.15
10072.......................................................... 2.44
10073.......................................................... 2.43
10078.......................................................... 2.31
10079.......................................................... 2.33
10080.......................................................... 1.05
10081.......................................................... 2.33
10083.......................................................... 2.10
10084.......................................................... 3.82
10087.......................................................... 2.56
10089.......................................................... 2.42
10090.......................................................... 2.33
10091.......................................................... 1.55
10092.......................................................... 2.36
10094.......................................................... 2.36
10095.......................................................... 1.36
10097.......................................................... 1.92
10098.......................................................... 1.68
10099.......................................................... 1.89
10100.......................................................... 2.58
10101.......................................................... 2.26
10102.......................................................... 1.23
10103.......................................................... 2.19
10104.......................................................... 2.47
10108.......................................................... 1.82
10109.......................................................... 2.17
10110.......................................................... 1.14
10112.......................................................... 1.73
10113.......................................................... 2.55
10114.......................................................... 2.24
10115.......................................................... 1.40
10117.......................................................... 1.19
10118.......................................................... 2.43
10119.......................................................... 2.05
10120.......................................................... 1.91
10123.......................................................... 2.90
10124.......................................................... 3.20
10125.......................................................... 1.38
10126.......................................................... 2.00
10127.......................................................... 3.04
10128.......................................................... 1.28
10129.......................................................... 1.76
10130.......................................................... 1.59
10131.......................................................... 2.58
10134.......................................................... 1.44
10137.......................................................... 1.41
10138.......................................................... 1.21
10139.......................................................... 2.54
10143.......................................................... 1.80
10144.......................................................... 2.52
10145.......................................................... 1.51
10146.......................................................... 2.79
10148.......................................................... 1.83
10149.......................................................... 2.67
10150.......................................................... 1.99
10152.......................................................... 2.08
10155.......................................................... 1.50
13025.......................................................... 1.76
13027.......................................................... 1.08
13028.......................................................... 0.89
13300.......................................................... 1.38
14000.......................................................... 1.26
14002.......................................................... 1.20
20001.......................................................... 2.64
20002.......................................................... 1.99
20004.......................................................... 1.80
20005.......................................................... 1.03
20006.......................................................... 1.87
20007.......................................................... 0.84
20008.......................................................... 2.08
20009.......................................................... 1.03
20010.......................................................... 0.53
20011.......................................................... 0.98
20012.......................................................... 3.12
20013.......................................................... 1.76
20014.......................................................... 1.70
20017.......................................................... 3.05
20024.......................................................... 1.78
20025.......................................................... 1.00
24001.......................................................... 1.40
30001.......................................................... 2.48
30002.......................................................... 2.35
30003.......................................................... 1.98
30004.......................................................... 0.83
30006.......................................................... 2.66
30007.......................................................... 2.48
30009.......................................................... 1.32
30010.......................................................... 2.44
30011.......................................................... 3.35
30012.......................................................... 1.86
30014.......................................................... 2.89
30016.......................................................... 1.75
30017.......................................................... 2.70
30018.......................................................... 2.90
30019.......................................................... 2.27
30022.......................................................... 1.64
30023.......................................................... 2.67
30024.......................................................... 3.42
30025.......................................................... 1.66
30027.......................................................... 1.62
30030.......................................................... 2.79
30033.......................................................... 2.36
30034.......................................................... 1.24
30035.......................................................... 2.92
30036.......................................................... 2.27
[[Page 35484]]
30037.......................................................... 3.90
30038.......................................................... 3.06
30040.......................................................... 1.83
30041.......................................................... 1.23
30043.......................................................... 2.41
30044.......................................................... 1.97
30047.......................................................... 1.57
30049.......................................................... 0.75
30054.......................................................... 0.84
30055.......................................................... 2.33
30059.......................................................... 2.44
30060.......................................................... 2.14
30061.......................................................... 1.90
30062.......................................................... 2.33
30064.......................................................... 2.43
30065.......................................................... 2.75
30067.......................................................... 1.56
30068.......................................................... 2.35
30069.......................................................... 2.80
30080.......................................................... 2.53
30083.......................................................... 2.40
30085.......................................................... 2.32
30086.......................................................... 2.18
30087.......................................................... 3.31
30088.......................................................... 2.05
30089.......................................................... 2.52
30092.......................................................... 2.52
30093.......................................................... 1.60
30094.......................................................... 1.96
30095.......................................................... 2.95
33025.......................................................... 1.61
33026.......................................................... 1.81
33028.......................................................... 1.49
34004.......................................................... 1.34
34008.......................................................... 1.57
34009.......................................................... 1.31
34010.......................................................... 1.31
34013.......................................................... 1.33
34015.......................................................... 1.31
34019.......................................................... 1.28
40001.......................................................... 2.26
40002.......................................................... 2.09
40003.......................................................... 1.80
40004.......................................................... 3.63
40005.......................................................... 1.89
40007.......................................................... 3.84
40008.......................................................... 1.26
40010.......................................................... 2.98
40011.......................................................... 1.94
40014.......................................................... 2.54
40015.......................................................... 1.65
40016.......................................................... 1.93
40017.......................................................... 2.35
40018.......................................................... 2.70
40019.......................................................... 2.29
40020.......................................................... 2.73
40021.......................................................... 2.97
40022.......................................................... 2.23
40024.......................................................... 1.68
40025.......................................................... 1.72
40026.......................................................... 2.41
40027.......................................................... 2.93
40028.......................................................... 2.00
40029.......................................................... 3.25
40030.......................................................... 1.26
40032.......................................................... 0.91
40035.......................................................... 1.12
40036.......................................................... 2.94
40037.......................................................... 1.85
40039.......................................................... 2.44
40040.......................................................... 1.27
40041.......................................................... 3.11
40042.......................................................... 2.04
40044.......................................................... 1.28
40045.......................................................... 1.60
40047.......................................................... 1.71
40048.......................................................... 2.33
40050.......................................................... 2.67
40051.......................................................... 2.02
40053.......................................................... 1.59
40054.......................................................... 2.96
40055.......................................................... 2.47
40058.......................................................... 2.12
40060.......................................................... 1.33
40062.......................................................... 2.30
40064.......................................................... 1.40
40066.......................................................... 3.24
40067.......................................................... 1.18
40069.......................................................... 2.76
40070.......................................................... 1.70
40071.......................................................... 2.52
40072.......................................................... 2.19
40074.......................................................... 2.70
40075.......................................................... 1.63
40076.......................................................... 1.70
40077.......................................................... 1.63
40078.......................................................... 2.58
40080.......................................................... 1.69
40081.......................................................... 0.93
40082.......................................................... 1.71
40084.......................................................... 2.89
40085.......................................................... 1.83
40088.......................................................... 2.99
40090.......................................................... 1.25
40091.......................................................... 1.63
40093.......................................................... 1.19
40100.......................................................... 2.21
40105.......................................................... 1.22
40106.......................................................... 1.95
40107.......................................................... 1.50
40109.......................................................... 1.91
40114.......................................................... 4.32
40116.......................................................... 2.81
40118.......................................................... 2.62
40119.......................................................... 2.76
40124.......................................................... 2.31
40126.......................................................... 1.82
40132.......................................................... 0.96
43026.......................................................... 1.42
43027.......................................................... 0.87
43028.......................................................... 1.19
43029.......................................................... 1.76
43031.......................................................... 0.82
43032.......................................................... 2.80
43300.......................................................... 1.51
44004.......................................................... 1.29
44005.......................................................... 1.32
44006.......................................................... 1.38
44010.......................................................... 1.52
44011.......................................................... 1.69
44012.......................................................... 1.32
50002.......................................................... 1.89
50006.......................................................... 2.28
50007.......................................................... 2.11
50009.......................................................... 2.75
50013.......................................................... 2.93
50014.......................................................... 2.65
50015.......................................................... 2.21
50016.......................................................... 2.00
50017.......................................................... 4.45
50018.......................................................... 2.36
50021.......................................................... 2.13
50022.......................................................... 2.57
50024.......................................................... 2.06
50025.......................................................... 2.08
50026.......................................................... 2.05
50028.......................................................... 2.32
50029.......................................................... 2.13
50030.......................................................... 1.75
50032.......................................................... 2.91
50033.......................................................... 2.05
50036.......................................................... 2.58
50038.......................................................... 1.39
50039.......................................................... 2.62
50042.......................................................... 3.00
50043.......................................................... 2.66
50045.......................................................... 3.04
50046.......................................................... 2.17
50047.......................................................... 2.86
50051.......................................................... 1.45
50054.......................................................... 1.57
50055.......................................................... 1.71
50056.......................................................... 3.32
50057.......................................................... 3.01
50058.......................................................... 2.70
50060.......................................................... 1.93
50061.......................................................... 4.86
50063.......................................................... 2.56
50065.......................................................... 2.34
50066.......................................................... 2.25
50067.......................................................... 1.80
50068.......................................................... 2.45
50069.......................................................... 2.55
50077.......................................................... 2.72
50078.......................................................... 2.45
50079.......................................................... 2.02
50080.......................................................... 1.68
50081.......................................................... 1.10
50082.......................................................... 2.59
50084.......................................................... 2.23
50088.......................................................... 1.30
50089.......................................................... 1.99
50090.......................................................... 2.38
50091.......................................................... 2.33
50092.......................................................... 1.71
50093.......................................................... 3.45
50095.......................................................... 3.59
50096.......................................................... 2.44
50097.......................................................... 3.49
50099.......................................................... 2.11
50100.......................................................... 2.37
50101.......................................................... 2.56
50102.......................................................... 1.86
50103.......................................................... 2.79
50104.......................................................... 2.16
50107.......................................................... 2.48
50108.......................................................... 2.48
50109.......................................................... 2.25
50110.......................................................... 3.14
50111.......................................................... 4.66
50112.......................................................... 2.51
50113.......................................................... 1.26
50114.......................................................... 2.19
50115.......................................................... 1.87
50116.......................................................... 2.62
50117.......................................................... 2.82
50118.......................................................... 2.37
50121.......................................................... 2.97
50122.......................................................... 2.74
50124.......................................................... 2.34
50125.......................................................... 2.92
50126.......................................................... 2.67
50127.......................................................... 1.96
50128.......................................................... 2.19
50129.......................................................... 2.61
50131.......................................................... 2.34
50132.......................................................... 2.44
50133.......................................................... 1.99
50135.......................................................... 1.34
50136.......................................................... 2.46
50144.......................................................... 2.21
50145.......................................................... 2.53
50146.......................................................... 1.30
50148.......................................................... 2.21
50149.......................................................... 2.20
50150.......................................................... 2.29
50152.......................................................... 2.15
50153.......................................................... 2.32
[[Page 35485]]
50155.......................................................... 2.05
50158.......................................................... 3.24
50159.......................................................... 1.34
50167.......................................................... 1.30
50168.......................................................... 3.18
50169.......................................................... 2.48
50170.......................................................... 2.63
50172.......................................................... 1.71
50173.......................................................... 2.59
50174.......................................................... 3.12
50175.......................................................... 3.10
50177.......................................................... 1.80
50179.......................................................... 2.45
50180.......................................................... 2.09
50183.......................................................... 1.22
50186.......................................................... 1.67
50188.......................................................... 3.47
50189.......................................................... 2.28
50191.......................................................... 2.39
50192.......................................................... 1.45
50193.......................................................... 1.68
50194.......................................................... 2.48
50195.......................................................... 2.14
50196.......................................................... 2.11
50197.......................................................... 2.49
50204.......................................................... 3.00
50205.......................................................... 2.12
50207.......................................................... 3.11
50208.......................................................... 2.02
50211.......................................................... 2.50
50213.......................................................... 1.26
50214.......................................................... 2.16
50215.......................................................... 2.83
50217.......................................................... 2.07
50219.......................................................... 1.77
50222.......................................................... 2.39
50224.......................................................... 2.49
50225.......................................................... 2.08
50226.......................................................... 2.63
50228.......................................................... 1.13
50230.......................................................... 2.69
50231.......................................................... 3.45
50232.......................................................... 2.78
50233.......................................................... 2.70
50234.......................................................... 1.56
50235.......................................................... 2.48
50236.......................................................... 2.04
50238.......................................................... 2.03
50239.......................................................... 2.50
50240.......................................................... 2.55
50241.......................................................... 2.21
50242.......................................................... 2.13
50243.......................................................... 1.94
50245.......................................................... 1.15
50248.......................................................... 1.39
50251.......................................................... 2.10
50253.......................................................... 1.33
50254.......................................................... 2.98
50256.......................................................... 1.36
50257.......................................................... 1.66
50260.......................................................... 1.32
50261.......................................................... 1.98
50262.......................................................... 2.09
50264.......................................................... 2.13
50267.......................................................... 2.56
50270.......................................................... 2.48
50272.......................................................... 1.77
50274.......................................................... 1.44
50276.......................................................... 1.18
50277.......................................................... 2.32
50278.......................................................... 2.44
50279.......................................................... 1.81
50280.......................................................... 2.50
50281.......................................................... 3.59
50282.......................................................... 2.19
50283.......................................................... 1.12
50286.......................................................... 0.95
50289.......................................................... 2.46
50290.......................................................... 2.28
50291.......................................................... 1.60
50292.......................................................... 1.37
50293.......................................................... 1.30
50295.......................................................... 2.45
50296.......................................................... 2.25
50298.......................................................... 2.00
50299.......................................................... 2.87
50300.......................................................... 2.80
50301.......................................................... 2.81
50302.......................................................... 2.65
50305.......................................................... 1.97
50307.......................................................... 3.51
50308.......................................................... 2.19
50309.......................................................... 2.76
50310.......................................................... 2.76
50312.......................................................... 2.34
50313.......................................................... 2.89
50315.......................................................... 1.13
50317.......................................................... 1.79
50320.......................................................... 1.18
50324.......................................................... 2.91
50325.......................................................... 1.66
50327.......................................................... 2.26
50328.......................................................... 2.48
50329.......................................................... 1.65
50331.......................................................... 1.93
50333.......................................................... 1.02
50334.......................................................... 3.18
50335.......................................................... 1.25
50336.......................................................... 2.31
50337.......................................................... 1.66
50342.......................................................... 2.71
50343.......................................................... 3.02
50348.......................................................... 1.58
50349.......................................................... 1.14
50350.......................................................... 2.08
50351.......................................................... 3.05
50352.......................................................... 1.73
50353.......................................................... 2.37
50355.......................................................... 1.01
50357.......................................................... 2.29
50359.......................................................... 3.22
50360.......................................................... 3.01
50366.......................................................... 1.90
50367.......................................................... 1.81
50369.......................................................... 2.21
50377.......................................................... 0.87
50378.......................................................... 2.01
50379.......................................................... 1.42
50380.......................................................... 3.09
50382.......................................................... 2.50
50385.......................................................... 2.10
50388.......................................................... 0.92
50390.......................................................... 2.47
50391.......................................................... 1.88
50392.......................................................... 1.28
50393.......................................................... 2.75
50394.......................................................... 3.09
50396.......................................................... 3.93
50397.......................................................... 1.31
50401.......................................................... 2.18
50404.......................................................... 1.43
50406.......................................................... 1.38
50407.......................................................... 2.72
50410.......................................................... 0.95
50414.......................................................... 2.49
50417.......................................................... 2.79
50418.......................................................... 1.26
50419.......................................................... 2.46
50420.......................................................... 1.85
50421.......................................................... 2.33
50423.......................................................... 2.09
50424.......................................................... 2.77
50426.......................................................... 2.46
50427.......................................................... 0.76
50430.......................................................... 1.39
50431.......................................................... 3.59
50432.......................................................... 2.32
50433.......................................................... 1.44
50434.......................................................... 1.36
50435.......................................................... 2.34
50436.......................................................... 1.48
50438.......................................................... 2.38
50440.......................................................... 1.46
50441.......................................................... 2.01
50443.......................................................... 1.47
50444.......................................................... 2.14
50446.......................................................... 1.32
50447.......................................................... 1.58
50448.......................................................... 2.94
50449.......................................................... 3.19
50454.......................................................... 1.62
50455.......................................................... 3.08
50456.......................................................... 4.96
50457.......................................................... 2.05
50459.......................................................... 2.34
50464.......................................................... 2.94
50468.......................................................... 1.50
50469.......................................................... 1.60
50470.......................................................... 2.00
50471.......................................................... 2.87
50476.......................................................... 2.46
50477.......................................................... 4.20
50478.......................................................... 1.52
50481.......................................................... 2.61
50482.......................................................... 1.02
50483.......................................................... 3.02
50485.......................................................... 2.90
50486.......................................................... 2.29
50488.......................................................... 2.09
50491.......................................................... 2.30
50492.......................................................... 2.24
50494.......................................................... 3.06
50496.......................................................... 2.35
50497.......................................................... 0.98
50498.......................................................... 2.38
50502.......................................................... 3.39
50503.......................................................... 3.27
50506.......................................................... 2.28
50516.......................................................... 3.02
50517.......................................................... 2.24
50522.......................................................... 2.30
50523.......................................................... 2.05
50526.......................................................... 2.36
50528.......................................................... 2.01
50531.......................................................... 3.13
50534.......................................................... 2.28
50535.......................................................... 2.67
50537.......................................................... 2.62
50539.......................................................... 2.08
50542.......................................................... 1.93
50543.......................................................... 2.53
50545.......................................................... 0.96
50546.......................................................... 0.93
50547.......................................................... 1.07
50548.......................................................... 0.78
50549.......................................................... 2.47
50550.......................................................... 2.23
50551.......................................................... 2.38
50552.......................................................... 1.24
50557.......................................................... 2.14
50559.......................................................... 2.43
50560.......................................................... 1.94
50564.......................................................... 2.41
50565.......................................................... 1.80
50566.......................................................... 1.51
50567.......................................................... 2.22
50568.......................................................... 2.50
50569.......................................................... 2.37
[[Page 35486]]
50570.......................................................... 3.06
50571.......................................................... 3.05
50573.......................................................... 2.27
50577.......................................................... 4.04
50579.......................................................... 2.31
50580.......................................................... 2.21
50581.......................................................... 2.22
50583.......................................................... 2.97
50584.......................................................... 1.93
50585.......................................................... 2.47
50586.......................................................... 2.74
50588.......................................................... 2.48
50589.......................................................... 2.89
50590.......................................................... 3.11
50591.......................................................... 2.47
50592.......................................................... 2.82
50593.......................................................... 2.00
50594.......................................................... 2.75
50597.......................................................... 2.74
50598.......................................................... 2.46
50599.......................................................... 1.45
50601.......................................................... 2.48
50603.......................................................... 1.64
50607.......................................................... 1.59
50608.......................................................... 1.68
50613.......................................................... 0.69
50615.......................................................... 2.53
50616.......................................................... 2.40
50618.......................................................... 1.29
50624.......................................................... 2.73
50625.......................................................... 2.47
50633.......................................................... 2.48
50636.......................................................... 2.91
50638.......................................................... 1.48
50641.......................................................... 2.02
50644.......................................................... 2.56
50660.......................................................... 1.41
50661.......................................................... 1.30
50662.......................................................... 1.02
50663.......................................................... 2.15
50666.......................................................... 1.06
50667.......................................................... 1.07
50668.......................................................... 1.03
50676.......................................................... 0.87
50678.......................................................... 2.02
50680.......................................................... 1.50
50682.......................................................... 1.18
50684.......................................................... 2.01
50685.......................................................... 2.37
50688.......................................................... 1.62
50689.......................................................... 2.32
50693.......................................................... 2.05
50694.......................................................... 2.01
50695.......................................................... 1.64
50696.......................................................... 3.01
50697.......................................................... 4.28
50699.......................................................... 2.19
50700.......................................................... 2.33
50701.......................................................... 1.92
50702.......................................................... 0.89
50704.......................................................... 1.87
50709.......................................................... 2.69
52031.......................................................... 1.05
53026.......................................................... 1.72
53027.......................................................... 1.00
53028.......................................................... 1.05
53029.......................................................... 1.33
53030.......................................................... 1.05
53031.......................................................... 1.08
53032.......................................................... 0.98
53033.......................................................... 1.30
53034.......................................................... 1.63
53035.......................................................... 1.40
53036.......................................................... 1.24
53037.......................................................... 1.25
53300.......................................................... 1.41
53301.......................................................... 1.98
53302.......................................................... 1.59
53304.......................................................... 1.24
53305.......................................................... 0.98
54001.......................................................... 1.31
54003.......................................................... 1.76
54012.......................................................... 1.35
54032.......................................................... 1.31
54053.......................................................... 1.43
54055.......................................................... 1.09
54060.......................................................... 1.31
54064.......................................................... 1.09
54065.......................................................... 1.31
54069.......................................................... 1.31
54074.......................................................... 1.31
54075.......................................................... 1.31
54078.......................................................... 1.65
54087.......................................................... 1.30
54091.......................................................... 1.57
54093.......................................................... 1.51
54095.......................................................... 1.31
54096.......................................................... 1.33
54097.......................................................... 1.34
54098.......................................................... 1.31
54099.......................................................... 1.32
54104.......................................................... 1.50
54105.......................................................... 1.31
54106.......................................................... 1.32
54108.......................................................... 1.22
54110.......................................................... 1.31
54111.......................................................... 1.31
54113.......................................................... 1.31
54116.......................................................... 1.33
54119.......................................................... 1.31
54122.......................................................... 1.16
54123.......................................................... 1.34
54125.......................................................... 1.60
54130.......................................................... 1.31
54131.......................................................... 1.63
54133.......................................................... 0.88
54139.......................................................... 1.20
60001.......................................................... 2.91
60003.......................................................... 2.83
60004.......................................................... 1.55
60006.......................................................... 2.08
60007.......................................................... 1.50
60008.......................................................... 2.08
60009.......................................................... 2.23
60010.......................................................... 2.35
60011.......................................................... 1.26
60012.......................................................... 1.83
60013.......................................................... 1.79
60014.......................................................... 2.41
60015.......................................................... 1.70
60016.......................................................... 2.01
60018.......................................................... 2.17
60020.......................................................... 1.96
60022.......................................................... 1.73
60023.......................................................... 2.50
60024.......................................................... 1.52
60027.......................................................... 2.15
60028.......................................................... 2.48
60029.......................................................... 1.17
60030.......................................................... 2.74
60031.......................................................... 2.20
60032.......................................................... 2.73
60033.......................................................... 1.65
60034.......................................................... 1.97
60036.......................................................... 1.85
60037.......................................................... 1.43
60038.......................................................... 1.39
60041.......................................................... 1.00
60042.......................................................... 1.58
60043.......................................................... 1.34
60044.......................................................... 2.09
60046.......................................................... 2.82
60047.......................................................... 0.89
60049.......................................................... 2.70
60050.......................................................... 1.95
60052.......................................................... 1.66
60053.......................................................... 1.68
60054.......................................................... 2.42
60056.......................................................... 1.27
60057.......................................................... 2.07
60058.......................................................... 1.27
60060.......................................................... 1.31
60062.......................................................... 1.48
60063.......................................................... 0.77
60064.......................................................... 3.00
60065.......................................................... 2.24
60068.......................................................... 1.24
60070.......................................................... 1.33
60071.......................................................... 2.09
60073.......................................................... 1.27
60075.......................................................... 2.56
60076.......................................................... 1.84
60085.......................................................... 1.11
60088.......................................................... 1.55
60090.......................................................... 1.55
60096.......................................................... 2.20
60100.......................................................... 2.02
60103.......................................................... 4.08
60104.......................................................... 2.29
62009.......................................................... 0.81
62011.......................................................... 2.20
63027.......................................................... 1.45
63030.......................................................... 1.82
63301.......................................................... 1.57
64007.......................................................... 1.31
64009.......................................................... 1.09
64012.......................................................... 1.26
64016.......................................................... 1.41
70001.......................................................... 2.72
70002.......................................................... 2.47
70003.......................................................... 2.00
70004.......................................................... 2.24
70005.......................................................... 1.71
70006.......................................................... 2.31
70007.......................................................... 2.73
70008.......................................................... 1.95
70009.......................................................... 2.65
70010.......................................................... 2.41
70011.......................................................... 2.06
70012.......................................................... 2.13
70015.......................................................... 2.17
70016.......................................................... 2.03
70017.......................................................... 2.24
70018.......................................................... 2.16
70019.......................................................... 2.80
70020.......................................................... 2.10
70021.......................................................... 2.56
70022.......................................................... 2.37
70024.......................................................... 2.24
70025.......................................................... 2.75
70026.......................................................... 2.05
70027.......................................................... 2.14
70028.......................................................... 2.17
70029.......................................................... 2.29
70030.......................................................... 2.44
70031.......................................................... 2.07
70033.......................................................... 1.93
70035.......................................................... 2.35
70036.......................................................... 1.96
70039.......................................................... 1.06
72003.......................................................... 1.04
72004.......................................................... 0.79
74000.......................................................... 1.25
74007.......................................................... 1.31
74008.......................................................... 1.53
80001.......................................................... 2.94
80002.......................................................... 2.15
80003.......................................................... 2.63
[[Page 35487]]
80004.......................................................... 2.42
80005.......................................................... 2.70
80006.......................................................... 2.31
80007.......................................................... 2.07
83300.......................................................... 3.40
84002.......................................................... 1.43
90001.......................................................... 3.34
90002.......................................................... 1.80
90003.......................................................... 1.70
90004.......................................................... 2.38
90006.......................................................... 2.41
90007.......................................................... 1.18
90008.......................................................... 2.36
90010.......................................................... 1.96
90011.......................................................... 2.42
90015.......................................................... 0.65
93025.......................................................... 1.03
93300.......................................................... 1.98
94004.......................................................... 1.10
100001......................................................... 1.48
100002......................................................... 2.47
100004......................................................... 1.78
100006......................................................... 2.29
100007......................................................... 2.82
100008......................................................... 3.02
100009......................................................... 2.29
100010......................................................... 2.56
100012......................................................... 2.75
100014......................................................... 2.53
100015......................................................... 2.49
100017......................................................... 2.55
100018......................................................... 1.83
100019......................................................... 3.21
100020......................................................... 2.87
100022......................................................... 1.37
100023......................................................... 2.44
100024......................................................... 2.88
100025......................................................... 2.21
100026......................................................... 2.63
100027......................................................... 1.37
100028......................................................... 2.73
100029......................................................... 2.42
100030......................................................... 2.91
100032......................................................... 1.98
100034......................................................... 2.35
100035......................................................... 2.31
100038......................................................... 2.22
100039......................................................... 2.68
100040......................................................... 2.85
100043......................................................... 2.28
100044......................................................... 2.35
100045......................................................... 2.20
100046......................................................... 2.21
100047......................................................... 1.91
100048......................................................... 1.58
100049......................................................... 2.46
100050......................................................... 2.15
100051......................................................... 2.51
100052......................................................... 3.58
100053......................................................... 2.46
100054......................................................... 2.02
100055......................................................... 2.20
100056......................................................... 3.26
100057......................................................... 2.88
100060......................................................... 2.36
100061......................................................... 2.52
100062......................................................... 2.43
100063......................................................... 2.19
100067......................................................... 2.29
100068......................................................... 2.00
100069......................................................... 2.45
100070......................................................... 2.40
100071......................................................... 2.15
100072......................................................... 2.29
100073......................................................... 1.88
100075......................................................... 2.01
100076......................................................... 2.37
100077......................................................... 3.09
100078......................................................... 1.05
100079......................................................... 1.68
100080......................................................... 2.30
100081......................................................... 1.76
100082......................................................... 2.14
100084......................................................... 1.98
100085......................................................... 2.15
100086......................................................... 2.33
100087......................................................... 3.40
100088......................................................... 3.10
100090......................................................... 2.72
100098......................................................... 1.47
100099......................................................... 2.72
100102......................................................... 2.00
100103......................................................... 1.20
100105......................................................... 2.58
100106......................................................... 2.64
100107......................................................... 2.48
100108......................................................... 2.05
100109......................................................... 2.66
100110......................................................... 2.13
100112......................................................... 0.99
100113......................................................... 2.67
100114......................................................... 2.37
100117......................................................... 2.94
100118......................................................... 1.88
100121......................................................... 2.58
100122......................................................... 2.60
100124......................................................... 1.82
100125......................................................... 2.35
100126......................................................... 2.07
100127......................................................... 2.70
100128......................................................... 2.41
100129......................................................... 3.11
100130......................................................... 2.11
100131......................................................... 2.89
100132......................................................... 2.24
100134......................................................... 1.52
100135......................................................... 3.73
100137......................................................... 2.25
100138......................................................... 1.19
100139......................................................... 1.41
100140......................................................... 2.43
100142......................................................... 1.88
100144......................................................... 2.72
100145......................................................... 2.11
100146......................................................... 1.91
100147......................................................... 1.77
100150......................................................... 2.52
100151......................................................... 3.45
100154......................................................... 3.18
100156......................................................... 2.31
100157......................................................... 3.23
100159......................................................... 1.44
100160......................................................... 1.89
100161......................................................... 2.14
100162......................................................... 2.11
100165......................................................... 2.07
100166......................................................... 2.27
100167......................................................... 3.78
100168......................................................... 2.45
100169......................................................... 2.54
100170......................................................... 2.65
100172......................................................... 2.26
100173......................................................... 2.85
100174......................................................... 2.00
100175......................................................... 1.89
100176......................................................... 1.87
100177......................................................... 2.79
100179......................................................... 3.41
100181......................................................... 4.01
100183......................................................... 2.58
100187......................................................... 2.35
100189......................................................... 2.51
100191......................................................... 2.40
100199......................................................... 2.93
100200......................................................... 3.81
100203......................................................... 2.11
100204......................................................... 2.40
100206......................................................... 2.36
100208......................................................... 2.03
100209......................................................... 2.53
100210......................................................... 2.25
100211......................................................... 1.90
100212......................................................... 2.25
100213......................................................... 1.83
100217......................................................... 3.37
100220......................................................... 2.88
100221......................................................... 2.29
100222......................................................... 1.41
100223......................................................... 2.22
100224......................................................... 2.20
100225......................................................... 2.50
100226......................................................... 1.62
100228......................................................... 2.06
100229......................................................... 1.80
100230......................................................... 1.78
100231......................................................... 2.12
100232......................................................... 2.49
100234......................................................... 1.92
100235......................................................... 2.09
100236......................................................... 2.00
100237......................................................... 2.69
100238......................................................... 2.97
100239......................................................... 2.43
100240......................................................... 4.60
100241......................................................... 2.37
100242......................................................... 2.68
100243......................................................... 1.87
100244......................................................... 2.34
100246......................................................... 2.81
100248......................................................... 1.80
100249......................................................... 2.23
100252......................................................... 2.30
100253......................................................... 2.46
100254......................................................... 2.05
100255......................................................... 2.16
100256......................................................... 2.07
100258......................................................... 2.31
100259......................................................... 2.62
100260......................................................... 3.34
100262......................................................... 3.13
100263......................................................... 2.32
100264......................................................... 1.95
100265......................................................... 2.18
100266......................................................... 2.60
100267......................................................... 2.57
100268......................................................... 2.27
100269......................................................... 2.58
100270......................................................... 1.01
100271......................................................... 1.78
100275......................................................... 2.20
100276......................................................... 2.85
100277......................................................... 0.95
100279......................................................... 1.98
100280......................................................... 1.80
100281......................................................... 2.14
100282......................................................... 1.60
102006......................................................... 0.97
102008......................................................... 1.00
102009......................................................... 0.91
102013......................................................... 3.31
103026......................................................... 1.43
103027......................................................... 1.40
103028......................................................... 1.43
103030......................................................... 0.91
103031......................................................... 1.29
103032......................................................... 1.78
103034......................................................... 1.17
103300......................................................... 8.70
[[Page 35488]]
103301......................................................... 2.40
104002......................................................... 0.57
104008......................................................... 1.36
104015......................................................... 1.31
104017......................................................... 1.31
104018......................................................... 1.32
104024......................................................... 1.52
104029......................................................... 1.31
104034......................................................... 1.31
104036......................................................... 1.33
104037......................................................... 1.31
104038......................................................... 1.43
104040......................................................... 1.28
104045......................................................... 1.43
104046......................................................... 1.32
104054......................................................... 1.34
104057......................................................... 1.30
104060......................................................... 1.33
110001......................................................... 2.49
110002......................................................... 1.69
110003......................................................... 2.51
110004......................................................... 2.40
110005......................................................... 2.24
110006......................................................... 3.00
110007......................................................... 2.42
110008......................................................... 2.22
110009......................................................... 1.12
110010......................................................... 2.73
110011......................................................... 2.22
110013......................................................... 1.39
110014......................................................... 1.57
110015......................................................... 1.62
110016......................................................... 2.92
110017......................................................... 1.24
110018......................................................... 2.17
110020......................................................... 2.99
110023......................................................... 2.32
110024......................................................... 3.45
110025......................................................... 2.66
110026......................................................... 1.66
110027......................................................... 1.50
110028......................................................... 2.54
110029......................................................... 1.98
110030......................................................... 2.84
110031......................................................... 2.38
110032......................................................... 2.54
110033......................................................... 2.76
110034......................................................... 1.35
110035......................................................... 2.61
110037......................................................... 1.54
110038......................................................... 2.10
110039......................................................... 2.72
110040......................................................... 1.90
110041......................................................... 2.00
110042......................................................... 2.27
110043......................................................... 3.05
110044......................................................... 2.46
110045......................................................... 2.26
110046......................................................... 2.07
110048......................................................... 1.44
110049......................................................... 1.26
110050......................................................... 1.62
110051......................................................... 1.80
110052......................................................... 1.00
110054......................................................... 2.03
110056......................................................... 1.25
110059......................................................... 2.26
110061......................................................... 1.19
110062......................................................... 0.89
110063......................................................... 1.62
110064......................................................... 1.87
110065......................................................... 1.08
110066......................................................... 2.35
110069......................................................... 2.46
110070......................................................... 1.69
110071......................................................... 1.22
110072......................................................... 1.44
110073......................................................... 2.05
110074......................................................... 2.58
110075......................................................... 2.22
110076......................................................... 2.61
110078......................................................... 2.61
110079......................................................... 1.15
110080......................................................... 1.91
110082......................................................... 3.13
110083......................................................... 2.93
110086......................................................... 1.89
110087......................................................... 2.56
110088......................................................... 0.89
110089......................................................... 2.16
110091......................................................... 2.89
110092......................................................... 1.60
110093......................................................... 1.40
110094......................................................... 0.94
110095......................................................... 2.83
110096......................................................... 1.35
110097......................................................... 1.24
110098......................................................... 1.64
110100......................................................... 1.23
110101......................................................... 1.49
110103......................................................... 1.22
110104......................................................... 2.04
110105......................................................... 2.37
110107......................................................... 1.94
110108......................................................... 0.79
110109......................................................... 1.48
110111......................................................... 1.70
110112......................................................... 1.38
110113......................................................... 1.35
110114......................................................... 1.60
110115......................................................... 2.37
110118......................................................... 0.74
110120......................................................... 1.08
110121......................................................... 4.41
110122......................................................... 2.62
110124......................................................... 2.05
110125......................................................... 3.01
110127......................................................... 1.48
110128......................................................... 2.26
110129......................................................... 2.64
110130......................................................... 1.69
110132......................................................... 1.92
110134......................................................... 1.16
110135......................................................... 4.19
110140......................................................... 2.22
110141......................................................... 1.13
110142......................................................... 1.42
110143......................................................... 2.84
110144......................................................... 1.82
110146......................................................... 1.73
110149......................................................... 1.52
110150......................................................... 2.35
110152......................................................... 1.73
110153......................................................... 1.88
110155......................................................... 1.29
110156......................................................... 1.45
110161......................................................... 3.12
110163......................................................... 3.02
110164......................................................... 2.27
110165......................................................... 2.58
110166......................................................... 2.36
110168......................................................... 2.64
110169......................................................... 6.44
110171......................................................... 2.04
110172......................................................... 3.19
110174......................................................... 1.74
110176......................................................... 2.56
110177......................................................... 2.52
110178......................................................... 7.50
110179......................................................... 2.12
110181......................................................... 1.11
110183......................................................... 2.23
110184......................................................... 2.04
110185......................................................... 1.36
110186......................................................... 3.11
110187......................................................... 2.20
110188......................................................... 2.72
110189......................................................... 1.74
110190......................................................... 1.62
110191......................................................... 3.24
110192......................................................... 2.27
110193......................................................... 2.89
110194......................................................... 1.37
110195......................................................... 1.06
110198......................................................... 2.85
110200......................................................... 4.09
110201......................................................... 2.16
110203......................................................... 1.30
110205......................................................... 1.62
110207......................................................... 1.20
110208......................................................... 1.51
110209......................................................... 1.32
112000......................................................... 1.03
112003......................................................... 1.55
112004......................................................... 0.80
113026......................................................... 1.20
113027......................................................... 1.41
113300......................................................... 2.09
114000......................................................... 1.31
114003......................................................... 1.31
114008......................................................... 1.31
114010......................................................... 1.60
114015......................................................... 1.31
114016......................................................... 1.31
114017......................................................... 1.33
114020......................................................... 1.31
114022......................................................... 1.31
114023......................................................... 1.42
114024......................................................... 1.34
114025......................................................... 1.35
114030......................................................... 1.44
114031......................................................... 1.31
114032......................................................... 1.32
114033......................................................... 1.30
114034......................................................... 1.30
120001......................................................... 2.73
120002......................................................... 2.74
120003......................................................... 1.92
120004......................................................... 2.04
120005......................................................... 3.07
120006......................................................... 2.08
120007......................................................... 3.04
120009......................................................... 1.13
120010......................................................... 2.52
120012......................................................... 1.30
120014......................................................... 2.80
120018......................................................... 0.71
120019......................................................... 2.43
120022......................................................... 1.25
120024......................................................... 0.80
120025......................................................... 0.78
120026......................................................... 2.86
120027......................................................... 1.83
123025......................................................... 1.46
123300......................................................... 1.55
124001......................................................... 1.31
130001......................................................... 1.53
130002......................................................... 2.87
130003......................................................... 2.91
130005......................................................... 3.26
130006......................................................... 1.88
130007......................................................... 3.34
130008......................................................... 1.84
130009......................................................... 2.31
130010......................................................... 0.87
130011......................................................... 2.35
130012......................................................... 1.55
130013......................................................... 2.53
[[Page 35489]]
130014......................................................... 3.08
130015......................................................... 1.13
130016......................................................... 1.96
130017......................................................... 1.83
130018......................................................... 2.96
130019......................................................... 1.76
130021......................................................... 1.04
130022......................................................... 2.25
130024......................................................... 2.67
130025......................................................... 1.81
130026......................................................... 3.37
130027......................................................... 1.54
130028......................................................... 2.15
130029......................................................... 1.95
130030......................................................... 0.84
130031......................................................... 2.21
130034......................................................... 1.50
130035......................................................... 1.89
130036......................................................... 3.68
130037......................................................... 1.67
130043......................................................... 1.57
130044......................................................... 1.53
130045......................................................... 1.51
130048......................................................... 1.22
130049......................................................... 2.37
130054......................................................... 0.60
130056......................................................... 0.73
130060......................................................... 2.53
130061......................................................... 1.44
133025......................................................... 1.42
134002......................................................... 1.31
134009......................................................... 1.36
140001......................................................... 2.07
140002......................................................... 2.23
140003......................................................... 1.57
140005......................................................... 1.34
140007......................................................... 2.46
140008......................................................... 2.40
140010......................................................... 2.28
140011......................................................... 1.68
140012......................................................... 2.14
140013......................................................... 2.56
140014......................................................... 2.22
140015......................................................... 2.68
140016......................................................... 1.86
140018......................................................... 1.75
140019......................................................... 1.56
140024......................................................... 1.72
140025......................................................... 1.42
140026......................................................... 2.32
140027......................................................... 1.85
140029......................................................... 1.98
140030......................................................... 2.68
140031......................................................... 1.58
140032......................................................... 2.80
140033......................................................... 2.48
140034......................................................... 2.22
140035......................................................... 1.61
140036......................................................... 2.46
140037......................................................... 1.51
140038......................................................... 1.53
140040......................................................... 2.19
140041......................................................... 1.99
140042......................................................... 1.54
140043......................................................... 2.63
140045......................................................... 1.53
140046......................................................... 2.29
140047......................................................... 1.34
140048......................................................... 2.09
140049......................................................... 1.91
140051......................................................... 2.45
140052......................................................... 2.55
140053......................................................... 2.92
140054......................................................... 2.35
140055......................................................... 1.52
140058......................................................... 2.12
140059......................................................... 2.32
140061......................................................... 1.59
140062......................................................... 2.05
140063......................................................... 2.09
140064......................................................... 3.62
140065......................................................... 2.29
140066......................................................... 2.02
140067......................................................... 2.43
140068......................................................... 1.68
140069......................................................... 1.76
140070......................................................... 1.87
140074......................................................... 1.20
140075......................................................... 2.27
140077......................................................... 1.56
140079......................................................... 2.30
140080......................................................... 2.01
140081......................................................... 1.61
140082......................................................... 1.82
140083......................................................... 1.36
140084......................................................... 2.86
140086......................................................... 1.95
140087......................................................... 2.22
140088......................................................... 1.53
140089......................................................... 2.66
140090......................................................... 2.45
140091......................................................... 4.81
140093......................................................... 2.54
140094......................................................... 2.15
140095......................................................... 1.75
140097......................................................... 1.31
140100......................................................... 2.67
140101......................................................... 1.88
140102......................................................... 1.91
140103......................................................... 1.54
140105......................................................... 2.53
140107......................................................... 1.64
140108......................................................... 2.71
140109......................................................... 1.61
140110......................................................... 2.14
140112......................................................... 1.78
140113......................................................... 2.28
140114......................................................... 2.31
140115......................................................... 1.78
140116......................................................... 2.45
140117......................................................... 2.57
140118......................................................... 2.62
140119......................................................... 2.46
140120......................................................... 2.27
140121......................................................... 2.34
140122......................................................... 2.29
140125......................................................... 2.03
140127......................................................... 4.03
140128......................................................... 1.69
140129......................................................... 1.93
140130......................................................... 2.34
140132......................................................... 2.79
140133......................................................... 2.04
140135......................................................... 2.48
140137......................................................... 1.68
140138......................................................... 1.91
140139......................................................... 1.66
140140......................................................... 1.68
140141......................................................... 2.11
140143......................................................... 2.27
140144......................................................... 1.53
140145......................................................... 1.91
140146......................................................... 1.89
140147......................................................... 2.23
140148......................................................... 2.69
140150......................................................... 1.51
140151......................................................... 1.28
140152......................................................... 1.66
140155......................................................... 2.27
140158......................................................... 1.63
140160......................................................... 3.01
140161......................................................... 2.34
140162......................................................... 2.26
140164......................................................... 2.67
140165......................................................... 2.12
140166......................................................... 1.79
140167......................................................... 2.44
140168......................................................... 1.86
140170......................................................... 1.49
140171......................................................... 1.29
140172......................................................... 1.48
140173......................................................... 1.21
140174......................................................... 2.00
140176......................................................... 2.53
140177......................................................... 1.95
140179......................................................... 2.43
140180......................................................... 1.88
140181......................................................... 1.81
140182......................................................... 1.74
140184......................................................... 1.80
140185......................................................... 2.35
140186......................................................... 2.04
140187......................................................... 2.01
140188......................................................... 1.25
140189......................................................... 2.04
140190......................................................... 1.71
140191......................................................... 1.93
140193......................................................... 2.35
140197......................................................... 1.79
140199......................................................... 1.71
140200......................................................... 1.91
140202......................................................... 2.35
140203......................................................... 2.36
140205......................................................... 3.84
140206......................................................... 2.06
140207......................................................... 2.69
140208......................................................... 2.26
140209......................................................... 2.56
140210......................................................... 2.02
140211......................................................... 2.32
140212......................................................... 1.18
140213......................................................... 2.38
140215......................................................... 1.27
140217......................................................... 2.16
140218......................................................... 1.82
140220......................................................... 1.84
140223......................................................... 2.62
140224......................................................... 2.14
140228......................................................... 2.13
140230......................................................... 1.09
140231......................................................... 2.27
140233......................................................... 2.45
140234......................................................... 2.29
140236......................................................... 1.27
140239......................................................... 2.53
140240......................................................... 1.97
140242......................................................... 2.56
140245......................................................... 1.73
140246......................................................... 1.65
140250......................................................... 1.90
140251......................................................... 2.78
140252......................................................... 1.97
140253......................................................... 3.18
140258......................................................... 2.20
140271......................................................... 1.96
140275......................................................... 2.32
140276......................................................... 2.23
140280......................................................... 2.36
140281......................................................... 2.44
140285......................................................... 2.00
140286......................................................... 2.05
140288......................................................... 1.95
140289......................................................... 2.20
140290......................................................... 3.07
140291......................................................... 2.46
140292......................................................... 2.27
140294......................................................... 2.59
140297......................................................... 1.53
[[Page 35490]]
140300......................................................... 1.19
142006......................................................... 0.92
142009......................................................... 4.17
143025......................................................... 1.17
143026......................................................... 1.24
143027......................................................... 1.30
144005......................................................... 1.38
144019......................................................... 0.89
144026......................................................... 1.31
144029......................................................... 1.09
144030......................................................... 1.37
144031......................................................... 1.21
144035......................................................... 1.31
144036......................................................... 1.31
150001......................................................... 1.96
150002......................................................... 2.05
150003......................................................... 2.20
150004......................................................... 2.00
150005......................................................... 2.22
150006......................................................... 2.64
150007......................................................... 2.24
150008......................................................... 2.28
150009......................................................... 2.61
150011......................................................... 1.81
150012......................................................... 2.54
150013......................................................... 1.99
150014......................................................... 2.02
150015......................................................... 2.54
150018......................................................... 2.76
150019......................................................... 2.03
150020......................................................... 2.50
150022......................................................... 2.46
150023......................................................... 2.43
150024......................................................... 1.25
150026......................................................... 2.55
150027......................................................... 1.64
150029......................................................... 3.50
150030......................................................... 2.38
150031......................................................... 1.59
150033......................................................... 2.22
150034......................................................... 2.56
150036......................................................... 1.82
150037......................................................... 2.45
150038......................................................... 1.62
150039......................................................... 1.99
150042......................................................... 2.61
150043......................................................... 1.77
150044......................................................... 2.22
150045......................................................... 1.61
150046......................................................... 2.49
150047......................................................... 1.78
150049......................................................... 1.43
150050......................................................... 1.64
150051......................................................... 2.00
150052......................................................... 2.23
150053......................................................... 1.90
150054......................................................... 1.55
150057......................................................... 2.05
150058......................................................... 2.74
150059......................................................... 2.27
150060......................................................... 1.58
150061......................................................... 1.85
150062......................................................... 2.07
150063......................................................... 1.43
150064......................................................... 1.90
150065......................................................... 2.26
150066......................................................... 1.37
150067......................................................... 2.01
150069......................................................... 2.47
150070......................................................... 1.79
150071......................................................... 1.48
150072......................................................... 1.97
150073......................................................... 1.83
150074......................................................... 2.23
150075......................................................... 1.94
150076......................................................... 1.96
150078......................................................... 1.76
150079......................................................... 1.62
150084......................................................... 3.13
150089......................................................... 2.37
150090......................................................... 1.74
150091......................................................... 1.80
150092......................................................... 1.46
150094......................................................... 2.06
150095......................................................... 2.20
150096......................................................... 2.05
150097......................................................... 2.00
150098......................................................... 1.65
150099......................................................... 2.33
150101......................................................... 1.89
150102......................................................... 1.61
150103......................................................... 1.25
150104......................................................... 1.91
150105......................................................... 1.89
150106......................................................... 1.78
150109......................................................... 3.04
150110......................................................... 1.51
150111......................................................... 1.58
150112......................................................... 2.38
150114......................................................... 1.54
150115......................................................... 2.66
150122......................................................... 1.98
150123......................................................... 1.16
150124......................................................... 1.65
150125......................................................... 2.13
150126......................................................... 2.50
150127......................................................... 1.15
150128......................................................... 2.44
150129......................................................... 1.93
150130......................................................... 1.33
150132......................................................... 2.49
150133......................................................... 2.13
150134......................................................... 1.68
150136......................................................... 2.41
152007......................................................... 0.58
152009......................................................... 0.50
153025......................................................... 1.67
153027......................................................... 2.54
153029......................................................... 1.25
153030......................................................... 1.65
154009......................................................... 1.49
154011......................................................... 1.63
154013......................................................... 1.41
154014......................................................... 1.30
154026......................................................... 1.41
154028......................................................... 1.21
154031......................................................... 1.38
154032......................................................... 1.56
154035......................................................... 1.35
154036......................................................... 1.32
154037......................................................... 1.43
154038......................................................... 1.47
154042......................................................... 1.44
160001......................................................... 3.07
160002......................................................... 2.01
160003......................................................... 1.86
160005......................................................... 2.09
160007......................................................... 1.11
160008......................................................... 2.11
160009......................................................... 1.94
160012......................................................... 1.52
160013......................................................... 2.88
160014......................................................... 1.68
160016......................................................... 2.75
160018......................................................... 1.50
160020......................................................... 1.59
160021......................................................... 2.33
160023......................................................... 1.66
160024......................................................... 2.57
160026......................................................... 1.81
160027......................................................... 1.84
160028......................................................... 2.31
160029......................................................... 3.20
160030......................................................... 3.22
160031......................................................... 1.61
160032......................................................... 2.21
160033......................................................... 2.76
160034......................................................... 2.04
160035......................................................... 0.99
160036......................................................... 1.97
160037......................................................... 1.95
160039......................................................... 1.57
160040......................................................... 3.33
160041......................................................... 1.46
160043......................................................... 1.59
160044......................................................... 2.22
160045......................................................... 2.62
160046......................................................... 2.10
160047......................................................... 2.24
160048......................................................... 1.62
160049......................................................... 1.03
160050......................................................... 2.38
160051......................................................... 1.73
160052......................................................... 1.77
160054......................................................... 1.83
160055......................................................... 2.01
160056......................................................... 1.61
160057......................................................... 2.60
160058......................................................... 1.56
160060......................................................... 1.79
160061......................................................... 2.05
160062......................................................... 1.56
160063......................................................... 1.78
160064......................................................... 2.89
160065......................................................... 1.92
160066......................................................... 2.25
160067......................................................... 2.30
160069......................................................... 3.06
160070......................................................... 1.57
160072......................................................... 2.16
160073......................................................... 1.27
160074......................................................... 1.49
160075......................................................... 1.74
160076......................................................... 2.40
160077......................................................... 1.75
160079......................................................... 3.18
160080......................................................... 2.54
160081......................................................... 1.81
160082......................................................... 3.05
160083......................................................... 2.70
160085......................................................... 1.47
160086......................................................... 1.29
160088......................................................... 1.55
160089......................................................... 2.63
160090......................................................... 1.56
160091......................................................... 1.64
160092......................................................... 1.79
160093......................................................... 1.35
160094......................................................... 2.74
160095......................................................... 1.10
160097......................................................... 2.05
160098......................................................... 1.49
160099......................................................... 1.74
160101......................................................... 1.12
160102......................................................... 2.60
160103......................................................... 1.26
160104......................................................... 1.96
160106......................................................... 2.86
160107......................................................... 1.46
160108......................................................... 2.22
160109......................................................... 1.59
160110......................................................... 2.09
160111......................................................... 1.60
160112......................................................... 3.03
160113......................................................... 1.29
160114......................................................... 2.53
160115......................................................... 2.31
160116......................................................... 1.94
[[Page 35491]]
160117......................................................... 2.69
160118......................................................... 1.74
160120......................................................... 0.91
160122......................................................... 2.22
160124......................................................... 2.12
160126......................................................... 1.72
160129......................................................... 2.78
160130......................................................... 1.44
160131......................................................... 1.59
160134......................................................... 1.11
160135......................................................... 1.71
160138......................................................... 1.29
160140......................................................... 1.62
160142......................................................... 1.33
160143......................................................... 1.84
160145......................................................... 1.63
160146......................................................... 2.66
160147......................................................... 1.64
160151......................................................... 1.37
160152......................................................... 1.42
160153......................................................... 2.57
164002......................................................... 2.09
170001......................................................... 3.10
170004......................................................... 1.53
170006......................................................... 1.97
170008......................................................... 2.10
170009......................................................... 2.13
170010......................................................... 2.63
170012......................................................... 2.93
170013......................................................... 3.30
170014......................................................... 1.84
170015......................................................... 2.32
170016......................................................... 2.49
170017......................................................... 2.45
170018......................................................... 1.60
170019......................................................... 3.08
170020......................................................... 3.38
170022......................................................... 2.37
170023......................................................... 5.05
170024......................................................... 2.18
170025......................................................... 1.96
170026......................................................... 2.92
170027......................................................... 3.06
170030......................................................... 1.50
170031......................................................... 1.88
170032......................................................... 1.53
170033......................................................... 2.49
170034......................................................... 1.77
170035......................................................... 1.44
170036......................................................... 0.97
170037......................................................... 2.84
170038......................................................... 0.99
170039......................................................... 1.58
170040......................................................... 2.29
170041......................................................... 1.34
170043......................................................... 1.11
170044......................................................... 1.52
170045......................................................... 1.67
170049......................................................... 2.82
170051......................................................... 0.97
170052......................................................... 1.48
170053......................................................... 0.98
170054......................................................... 1.59
170055......................................................... 1.66
170056......................................................... 0.98
170057......................................................... 1.53
170058......................................................... 4.02
170060......................................................... 2.32
170061......................................................... 2.01
170063......................................................... 1.24
170064......................................................... 1.47
170066......................................................... 1.12
170067......................................................... 2.05
170068......................................................... 3.20
170070......................................................... 2.12
170072......................................................... 1.23
170073......................................................... 1.28
170074......................................................... 2.04
170075......................................................... 1.02
170076......................................................... 1.87
170077......................................................... 1.94
170079......................................................... 1.38
170080......................................................... 1.48
170081......................................................... 1.30
170082......................................................... 1.90
170084......................................................... 1.68
170085......................................................... 1.61
170086......................................................... 3.15
170088......................................................... 1.42
170089......................................................... 1.21
170090......................................................... 1.24
170092......................................................... 1.28
170093......................................................... 1.47
170094......................................................... 1.87
170095......................................................... 2.66
170097......................................................... 1.78
170098......................................................... 2.43
170099......................................................... 2.05
170100......................................................... 0.74
170101......................................................... 1.38
170102......................................................... 1.65
170103......................................................... 4.11
170104......................................................... 3.30
170105......................................................... 1.98
170106......................................................... 1.13
170109......................................................... 1.90
170110......................................................... 1.61
170112......................................................... 1.38
170113......................................................... 2.22
170114......................................................... 2.28
170115......................................................... 1.73
170116......................................................... 2.67
170117......................................................... 0.88
170119......................................................... 1.35
170120......................................................... 3.00
170122......................................................... 2.51
170123......................................................... 3.32
170124......................................................... 1.94
170126......................................................... 1.13
170128......................................................... 1.84
170131......................................................... 1.83
170133......................................................... 3.36
170134......................................................... 1.67
170137......................................................... 2.62
170139......................................................... 0.66
170142......................................................... 2.84
170143......................................................... 2.81
170144......................................................... 2.74
170145......................................................... 2.12
170146......................................................... 2.79
170147......................................................... 1.36
170148......................................................... 2.40
170150......................................................... 3.13
170151......................................................... 1.82
170152......................................................... 1.35
170160......................................................... 1.38
170164......................................................... 1.63
170166......................................................... 1.34
170168......................................................... 1.13
170171......................................................... 1.33
170175......................................................... 4.10
170176......................................................... 2.39
170182......................................................... 3.25
172004......................................................... 0.74
173025......................................................... 1.24
173026......................................................... 1.14
173027......................................................... 1.93
173028......................................................... 1.30
174003......................................................... 1.39
174006......................................................... 0.83
174012......................................................... 1.31
174014......................................................... 1.63
174016......................................................... 1.42
174018......................................................... 1.32
180001......................................................... 2.14
180004......................................................... 1.75
180005......................................................... 2.13
180006......................................................... 1.14
180007......................................................... 2.57
180009......................................................... 2.62
180010......................................................... 2.50
180011......................................................... 2.15
180012......................................................... 2.43
180013......................................................... 2.50
180014......................................................... 2.91
180015......................................................... 1.71
180016......................................................... 2.19
180017......................................................... 2.33
180018......................................................... 2.49
180019......................................................... 2.80
180021......................................................... 1.77
180023......................................................... 1.79
180024......................................................... 1.97
180025......................................................... 2.16
180026......................................................... 1.90
180027......................................................... 2.73
180030......................................................... 1.32
180031......................................................... 1.47
180032......................................................... 1.24
180033......................................................... 1.72
180034......................................................... 1.83
180035......................................................... 2.38
180036......................................................... 2.52
180037......................................................... 2.40
180038......................................................... 2.07
180040......................................................... 3.16
180041......................................................... 2.19
180042......................................................... 1.81
180043......................................................... 1.33
180044......................................................... 2.31
180045......................................................... 2.37
180046......................................................... 2.15
180047......................................................... 1.57
180048......................................................... 2.13
180049......................................................... 2.97
180051......................................................... 2.73
180054......................................................... 2.10
180055......................................................... 1.84
180056......................................................... 2.22
180058......................................................... 1.35
180059......................................................... 1.43
180060......................................................... 0.79
180063......................................................... 1.36
180064......................................................... 2.15
180065......................................................... 1.29
180066......................................................... 2.34
180067......................................................... 2.38
180070......................................................... 1.70
180072......................................................... 1.61
180075......................................................... 1.70
180078......................................................... 2.06
180079......................................................... 1.62
180080......................................................... 3.07
180087......................................................... 2.76
180088......................................................... 3.19
180092......................................................... 2.05
180093......................................................... 2.56
180094......................................................... 1.48
180095......................................................... 1.79
180099......................................................... 1.62
180101......................................................... 1.63
180102......................................................... 2.50
180103......................................................... 2.74
180104......................................................... 2.27
180105......................................................... 1.53
180106......................................................... 1.44
180108......................................................... 1.39
180115......................................................... 1.53
[[Page 35492]]
180116......................................................... 2.27
180117......................................................... 2.17
180118......................................................... 1.48
180120......................................................... 1.47
180121......................................................... 2.30
180122......................................................... 1.58
180123......................................................... 2.48
180124......................................................... 2.94
180126......................................................... 1.39
180127......................................................... 2.61
180128......................................................... 1.87
180129......................................................... 1.29
180130......................................................... 2.61
180132......................................................... 2.46
180133......................................................... 2.23
180134......................................................... 1.80
180136......................................................... 4.00
180137......................................................... 1.72
180138......................................................... 1.98
180139......................................................... 1.43
180140......................................................... 1.17
183026......................................................... 0.99
183027......................................................... 1.09
183028......................................................... 1.28
184000......................................................... 1.58
184002......................................................... 0.78
184007......................................................... 1.31
184008......................................................... 2.67
184009......................................................... 1.35
184015......................................................... 0.84
190003......................................................... 1.93
190004......................................................... 2.30
190007......................................................... 1.77
190013......................................................... 1.76
190014......................................................... 2.37
190015......................................................... 2.21
190017......................................................... 2.01
190018......................................................... 2.04
190019......................................................... 2.01
190020......................................................... 2.33
190025......................................................... 1.90
190026......................................................... 2.13
190027......................................................... 1.96
190029......................................................... 1.89
190033......................................................... 1.10
190034......................................................... 1.95
190035......................................................... 3.11
190036......................................................... 2.52
190037......................................................... 0.98
190039......................................................... 1.93
190040......................................................... 2.27
190041......................................................... 2.45
190043......................................................... 1.08
190044......................................................... 1.95
190045......................................................... 2.08
190046......................................................... 1.76
190048......................................................... 1.93
190049......................................................... 2.50
190050......................................................... 1.87
190053......................................................... 1.45
190054......................................................... 2.16
190059......................................................... 1.65
190060......................................................... 2.74
190064......................................................... 3.53
190065......................................................... 2.15
190071......................................................... 1.38
190077......................................................... 0.83
190078......................................................... 2.94
190079......................................................... 2.02
190081......................................................... 1.06
190083......................................................... 1.40
190086......................................................... 2.59
190088......................................................... 2.25
190089......................................................... 1.67
190090......................................................... 1.64
190092......................................................... 1.81
190095......................................................... 1.86
190098......................................................... 1.45
190099......................................................... 1.34
190102......................................................... 2.88
190103......................................................... 0.93
190106......................................................... 1.61
190109......................................................... 1.89
190110......................................................... 1.41
190111......................................................... 3.17
190112......................................................... 2.61
190113......................................................... 2.92
190114......................................................... 1.72
190115......................................................... 4.31
190116......................................................... 2.10
190118......................................................... 1.69
190120......................................................... 1.45
190124......................................................... 2.27
190125......................................................... 2.02
190128......................................................... 1.98
190130......................................................... 1.69
190131......................................................... 1.33
190133......................................................... 1.48
190134......................................................... 1.13
190135......................................................... 2.31
190136......................................................... 0.99
190138......................................................... 6.32
190140......................................................... 1.71
190142......................................................... 1.01
190144......................................................... 2.45
190145......................................................... 1.46
190146......................................................... 1.83
190147......................................................... 1.72
190148......................................................... 1.12
190149......................................................... 1.62
190151......................................................... 1.77
190155......................................................... 1.37
190156......................................................... 0.93
190158......................................................... 2.29
190160......................................................... 2.59
190162......................................................... 1.60
190164......................................................... 2.97
190167......................................................... 1.86
190170......................................................... 0.92
190173......................................................... 1.95
190175......................................................... 2.30
190176......................................................... 1.55
190177......................................................... 2.38
190178......................................................... 1.19
190182......................................................... 2.06
190184......................................................... 1.21
190185......................................................... 2.55
190186......................................................... 1.13
190189......................................................... 0.88
190190......................................................... 1.37
190191......................................................... 2.04
190196......................................................... 2.35
190197......................................................... 2.41
190200......................................................... 2.51
190201......................................................... 2.07
190202......................................................... 1.79
190203......................................................... 2.56
190204......................................................... 2.25
190205......................................................... 2.38
190206......................................................... 1.85
190207......................................................... 2.90
190208......................................................... 1.03
190218......................................................... 2.28
190231......................................................... 4.22
192004......................................................... 1.24
192005......................................................... 1.34
192006......................................................... 1.68
192008......................................................... 1.32
192016......................................................... 3.42
193027......................................................... 1.59
193028......................................................... 1.51
193034......................................................... 1.19
193038......................................................... 1.34
193041......................................................... 0.77
193044......................................................... 2.33
193300......................................................... 1.34
194014......................................................... 1.31
194019......................................................... 1.32
194022......................................................... 1.09
194023......................................................... 1.26
194024......................................................... 1.39
194031......................................................... 1.39
194044......................................................... 1.30
194058......................................................... 1.31
200001......................................................... 2.58
200002......................................................... 2.11
200003......................................................... 1.73
200006......................................................... 1.31
200007......................................................... 1.58
200008......................................................... 1.99
200009......................................................... 2.10
200012......................................................... 1.59
200013......................................................... 1.91
200015......................................................... 2.04
200016......................................................... 1.77
200017......................................................... 2.54
200018......................................................... 1.96
200019......................................................... 2.07
200020......................................................... 2.09
200021......................................................... 2.31
200023......................................................... 0.98
200024......................................................... 2.28
200025......................................................... 2.33
200026......................................................... 1.72
200027......................................................... 1.64
200028......................................................... 1.76
200031......................................................... 1.76
200032......................................................... 1.84
200033......................................................... 2.02
200034......................................................... 2.48
200037......................................................... 1.82
200038......................................................... 2.22
200039......................................................... 2.30
200040......................................................... 2.69
200041......................................................... 2.24
200043......................................................... 1.20
200050......................................................... 2.60
200051......................................................... 2.45
200052......................................................... 1.70
200055......................................................... 1.38
200062......................................................... 1.35
200063......................................................... 2.32
200066......................................................... 1.94
204005......................................................... 1.45
204006......................................................... 1.30
204007......................................................... 0.66
213027......................................................... .41
213028......................................................... 3.88
214000......................................................... 1.30
214003......................................................... 1.30
214015......................................................... 1.09
214017......................................................... 1.35
220001......................................................... 2.08
220003......................................................... 2.07
220004......................................................... 2.17
220006......................................................... 2.14
220008......................................................... 2.00
220010......................................................... 2.51
220011......................................................... 1.51
220015......................................................... 2.08
220016......................................................... 2.06
220017......................................................... 1.98
220019......................................................... 2.21
220020......................................................... 1.72
220021......................................................... 2.02
220023......................................................... 1.93
220024......................................................... 2.16
220025......................................................... 1.66
[[Page 35493]]
220028......................................................... 1.90
220029......................................................... 2.03
220030......................................................... 1.43
220031......................................................... 1.69
220033......................................................... 2.00
220035......................................................... 2.24
220038......................................................... 2.00
220041......................................................... 2.17
220042......................................................... 2.00
220046......................................................... 2.55
220049......................................................... 2.27
220050......................................................... 2.08
220051......................................................... 2.36
220052......................................................... 1.99
220053......................................................... 1.93
220055......................................................... 2.41
220057......................................................... 2.17
220058......................................................... 1.95
220060......................................................... 2.24
220062......................................................... 1.56
220063......................................................... 2.06
220064......................................................... 1.81
220065......................................................... 1.84
220066......................................................... 2.41
220067......................................................... 2.26
220068......................................................... 1.19
220070......................................................... 1.90
220071......................................................... 1.75
220073......................................................... 1.91
220074......................................................... 1.97
220075......................................................... 2.55
220076......................................................... 1.89
220077......................................................... 1.97
220079......................................................... 1.86
220080......................................................... 1.99
220081......................................................... 1.87
220082......................................................... 2.17
220083......................................................... 1.84
220084......................................................... 2.44
220086......................................................... 1.81
220088......................................................... 1.99
220089......................................................... 2.00
220090......................................................... 1.93
220092......................................................... 2.05
220094......................................................... 1.85
220095......................................................... 1.81
220098......................................................... 2.14
220100......................................................... 1.87
220101......................................................... 2.12
220104......................................................... 1.34
220105......................................................... 2.03
220106......................................................... 2.07
220107......................................................... 2.22
220108......................................................... 2.01
220111......................................................... 2.23
220116......................................................... 1.65
220119......................................................... 1.83
220123......................................................... 1.80
220126......................................................... 2.22
220128......................................................... 1.87
220135......................................................... 2.09
220162......................................................... 1.54
220163......................................................... 1.49
220171......................................................... 1.51
222000......................................................... 1.46
222002......................................................... 0.96
222006......................................................... 1.18
222008......................................................... 0.91
222024......................................................... 2.77
222026......................................................... 0.89
222027......................................................... 0.98
222029......................................................... 1.19
222035......................................................... 1.15
222043......................................................... 0.89
222044......................................................... 1.63
222045......................................................... 4.98
223026......................................................... 1.28
223027......................................................... 1.35
223028......................................................... 1.60
223029......................................................... 1.09
223030......................................................... 1.67
223302......................................................... 1.88
224007......................................................... 1.45
224013......................................................... 1.55
224018......................................................... 1.40
224021......................................................... 1.29
224022......................................................... 2.16
224023......................................................... 2.45
224029......................................................... 1.30
224034......................................................... 1.41
224035......................................................... 1.37
230001......................................................... 1.86
230002......................................................... 2.82
230003......................................................... 1.83
230004......................................................... 2.55
230005......................................................... 2.21
230006......................................................... 2.01
230007......................................................... 2.65
230012......................................................... 1.06
230013......................................................... 2.04
230015......................................................... 2.08
230017......................................................... 2.61
230019......................................................... 2.88
230020......................................................... 3.03
230021......................................................... 2.71
230022......................................................... 2.48
230024......................................................... 2.64
230027......................................................... 1.89
230029......................................................... 2.40
230030......................................................... 2.65
230031......................................................... 2.42
230032......................................................... 3.13
230034......................................................... 2.04
230035......................................................... 2.09
230036......................................................... 2.40
230037......................................................... 2.23
230038......................................................... 2.72
230040......................................................... 2.46
230041......................................................... 2.39
230042......................................................... 1.93
230046......................................................... 1.88
230047......................................................... 2.86
230053......................................................... 1.35
230054......................................................... 2.40
230055......................................................... 1.96
230056......................................................... 1.74
230058......................................................... 2.52
230059......................................................... 2.92
230060......................................................... 2.26
230062......................................................... 1.67
230063......................................................... 2.10
230065......................................................... 2.52
230066......................................................... 2.45
230068......................................................... 2.61
230069......................................................... 1.91
230070......................................................... 3.08
230071......................................................... 1.75
230072......................................................... 2.17
230075......................................................... 2.53
230076......................................................... 4.12
230077......................................................... 3.10
230078......................................................... 2.03
230080......................................................... 3.05
230081......................................................... 2.32
230082......................................................... 1.93
230085......................................................... 3.46
230086......................................................... 1.74
230087......................................................... 2.10
230089......................................................... 2.32
230092......................................................... 2.54
230093......................................................... 2.75
230095......................................................... 2.54
230096......................................................... 2.19
230097......................................................... 2.92
230099......................................................... 2.08
230100......................................................... 1.63
230101......................................................... 2.07
230103......................................................... 2.02
230104......................................................... 2.33
230105......................................................... 3.26
230106......................................................... 1.92
230107......................................................... 1.32
230108......................................................... 2.20
230110......................................................... 2.43
230111......................................................... 1.65
230113......................................................... 1.30
230114......................................................... 6.78
230115......................................................... 1.73
230116......................................................... 1.53
230117......................................................... 2.37
230118......................................................... 2.01
230119......................................................... 2.04
230120......................................................... 2.55
230121......................................................... 2.38
230122......................................................... 3.08
230124......................................................... 2.14
230125......................................................... 1.74
230128......................................................... 3.16
230129......................................................... 2.41
230130......................................................... 2.71
230132......................................................... 2.19
230133......................................................... 2.34
230134......................................................... 2.25
230135......................................................... 2.53
230137......................................................... 2.29
230141......................................................... 2.25
230142......................................................... 2.32
230143......................................................... 2.41
230144......................................................... 2.34
230145......................................................... 2.29
230146......................................................... 1.96
230147......................................................... 1.81
230149......................................................... 1.53
230151......................................................... 1.96
230153......................................................... 2.02
230154......................................................... 1.40
230155......................................................... 1.56
230156......................................................... 2.14
230157......................................................... 2.56
230159......................................................... 2.60
230162......................................................... 1.02
230165......................................................... 2.96
230167......................................................... 2.68
230169......................................................... 2.53
230171......................................................... 1.46
230172......................................................... 1.73
230174......................................................... 2.08
230175......................................................... 1.29
230176......................................................... 2.75
230178......................................................... 1.77
230180......................................................... 1.93
230184......................................................... 4.93
230186......................................................... 1.78
230188......................................................... 2.23
230189......................................................... 1.32
230190......................................................... 1.19
230191......................................................... 1.96
230193......................................................... 2.13
230194......................................................... 1.12
230195......................................................... 2.63
230197......................................................... 3.23
230199......................................................... 2.08
230201......................................................... 2.40
230204......................................................... 2.62
230205......................................................... 2.36
230207......................................................... 2.08
230208......................................................... 2.25
230211......................................................... 0.92
[[Page 35494]]
230212......................................................... 1.94
230213......................................................... 1.32
230216......................................................... 1.91
230217......................................................... 2.45
230219......................................................... 2.39
230221......................................................... 2.12
230222......................................................... 2.46
230223......................................................... 2.71
230227......................................................... 2.45
230230......................................................... 2.74
230232......................................................... 1.07
230235......................................................... 2.06
230236......................................................... 2.56
230239......................................................... 2.22
230241......................................................... 2.32
230244......................................................... 2.38
230253......................................................... 2.24
230254......................................................... 2.45
230257......................................................... 4.97
230259......................................................... 2.62
230264......................................................... 2.86
230269......................................................... 2.63
230270......................................................... 3.10
230273......................................................... 1.84
230275......................................................... 2.24
230276......................................................... 1.21
230278......................................................... 1.76
230279......................................................... 1.35
230280......................................................... 2.02
233025......................................................... 1.25
233026......................................................... 1.06
233027......................................................... 1.20
233300......................................................... 3.11
234006......................................................... 1.37
234011......................................................... 1.34
234021......................................................... 1.09
234030......................................................... 2.61
240001......................................................... 3.00
240002......................................................... 2.77
240004......................................................... 1.26
240005......................................................... 1.28
240006......................................................... 2.65
240007......................................................... 2.69
240008......................................................... 2.77
240009......................................................... 1.46
240010......................................................... 3.32
240011......................................................... 2.39
240013......................................................... 2.37
240014......................................................... 2.42
240016......................................................... 2.88
240017......................................................... 3.49
240018......................................................... 3.00
240019......................................................... 2.66
240020......................................................... 2.02
240021......................................................... 1.89
240022......................................................... 2.19
240023......................................................... 2.28
240025......................................................... 1.95
240027......................................................... 2.58
240028......................................................... 2.10
240029......................................................... 2.69
240030......................................................... 2.93
240031......................................................... 2.12
240036......................................................... 2.25
240037......................................................... 1.80
240038......................................................... 2.90
240040......................................................... 2.37
240041......................................................... 2.44
240043......................................................... 3.09
240044......................................................... 2.40
240045......................................................... 1.84
240047......................................................... 2.92
240048......................................................... 3.42
240049......................................................... 1.82
240050......................................................... 2.90
240051......................................................... 1.90
240052......................................................... 2.04
240053......................................................... 2.93
240056......................................................... 2.93
240057......................................................... 2.22
240058......................................................... 1.40
240059......................................................... 3.22
240061......................................................... 4.29
240063......................................................... 2.50
240064......................................................... 2.83
240065......................................................... 1.64
240066......................................................... 3.84
240069......................................................... 3.35
240071......................................................... 2.27
240072......................................................... 2.60
240073......................................................... 1.57
240075......................................................... 2.27
240076......................................................... 2.59
240077......................................................... 2.36
240078......................................................... 3.37
240079......................................................... 1.84
240080......................................................... 1.91
240082......................................................... 1.77
240083......................................................... 2.22
240084......................................................... 2.68
240085......................................................... 1.45
240086......................................................... 2.13
240087......................................................... 2.13
240088......................................................... 1.83
240089......................................................... 1.22
240090......................................................... 3.11
240093......................................................... 2.50
240094......................................................... 1.51
240096......................................................... 1.45
240097......................................................... 5.89
240098......................................................... 2.02
240099......................................................... 1.71
240100......................................................... 2.66
240101......................................................... 2.00
240102......................................................... 1.58
240103......................................................... 1.80
240104......................................................... 2.59
240105......................................................... 1.27
240106......................................................... 1.37
240107......................................................... 1.65
240108......................................................... 2.35
240109......................................................... 1.83
240110......................................................... 2.25
240111......................................................... 2.24
240112......................................................... 1.89
240114......................................................... 1.77
240115......................................................... 2.91
240116......................................................... 1.60
240117......................................................... 1.21
240119......................................................... 1.18
240121......................................................... 2.15
240122......................................................... 1.34
240123......................................................... 2.15
240124......................................................... 2.17
240125......................................................... 1.73
240127......................................................... 1.60
240128......................................................... 2.46
240129......................................................... 2.03
240130......................................................... 2.83
240132......................................................... 2.62
240133......................................................... 3.09
240135......................................................... 0.79
240137......................................................... 3.34
240138......................................................... 1.34
240139......................................................... 2.00
240141......................................................... 2.37
240142......................................................... 1.76
240143......................................................... 1.48
240144......................................................... 2.59
240145......................................................... 1.51
240146......................................................... 2.00
240148......................................................... 1.75
240150......................................................... 1.14
240152......................................................... 2.44
240153......................................................... 1.78
240154......................................................... 1.43
240155......................................................... 2.44
240157......................................................... 2.23
240160......................................................... 2.45
240161......................................................... 1.78
240162......................................................... 2.04
240163......................................................... 1.81
240166......................................................... 3.39
240169......................................................... 2.32
240170......................................................... 1.78
240171......................................................... 2.78
240172......................................................... 1.84
240173......................................................... 2.46
240179......................................................... 1.69
240184......................................................... 1.73
240187......................................................... 3.17
240193......................................................... 2.03
240200......................................................... 0.89
240207......................................................... 2.57
240210......................................................... 2.57
240211......................................................... 0.95
242004......................................................... 1.50
243300......................................................... 1.31
243302......................................................... 5.75
250001......................................................... 2.19
250002......................................................... 1.48
250003......................................................... 1.01
250004......................................................... 2.14
250005......................................................... 0.90
250006......................................................... 2.02
250007......................................................... 1.83
250008......................................................... 1.07
250009......................................................... 2.75
250010......................................................... 1.53
250012......................................................... 1.37
250015......................................................... 2.17
250017......................................................... 1.30
250018......................................................... 0.62
250019......................................................... 2.13
250020......................................................... 1.32
250021......................................................... 0.78
250023......................................................... 0.67
250024......................................................... 0.90
250025......................................................... 1.89
250027......................................................... 1.65
250029......................................................... 1.56
250030......................................................... 1.04
250031......................................................... 2.41
250032......................................................... 1.96
250033......................................................... 1.61
250034......................................................... 3.37
250035......................................................... 1.68
250036......................................................... 1.76
250037......................................................... 1.43
250038......................................................... 1.30
250039......................................................... 1.02
250040......................................................... 2.33
250042......................................................... 2.15
250043......................................................... 1.74
250044......................................................... 1.82
250045......................................................... 1.71
250048......................................................... 2.91
250049......................................................... 1.35
250050......................................................... 2.03
250051......................................................... 1.16
250057......................................................... 2.24
250058......................................................... 2.47
250059......................................................... 1.78
250060......................................................... 0.97
250061......................................................... 1.52
250063......................................................... 1.31
250065......................................................... 1.35
250066......................................................... 1.07
[[Page 35495]]
250067......................................................... 1.34
250068......................................................... 1.43
250069......................................................... 3.24
250071......................................................... 1.12
250072......................................................... 2.22
250076......................................................... 0.66
250077......................................................... 1.33
250078......................................................... 2.40
250079......................................................... 1.17
250081......................................................... 3.07
250082......................................................... 2.61
250083......................................................... 1.25
250084......................................................... 2.71
250085......................................................... 1.31
250088......................................................... 1.89
250089......................................................... 1.57
250093......................................................... 1.81
250094......................................................... 3.47
250095......................................................... 1.95
250096......................................................... 1.82
250097......................................................... 1.96
250098......................................................... 1.24
250099......................................................... 2.80
250100......................................................... 2.62
250101......................................................... 1.06
250102......................................................... 2.62
250104......................................................... 3.07
250105......................................................... 1.30
250107......................................................... 1.15
250109......................................................... 1.19
250112......................................................... 1.19
250117......................................................... 1.37
250119......................................................... 1.59
250120......................................................... 2.08
250122......................................................... 2.53
250123......................................................... 2.87
250124......................................................... 1.28
250125......................................................... 2.08
250126......................................................... 1.19
250128......................................................... 1.63
250131......................................................... 1.57
250134......................................................... 0.91
250136......................................................... 2.70
250138......................................................... 3.12
250141......................................................... 2.85
250145......................................................... 1.26
250146......................................................... 1.23
250148......................................................... 2.11
250149......................................................... 1.22
253025......................................................... 1.78
254001......................................................... 1.32
260001......................................................... 2.22
260002......................................................... 2.23
260003......................................................... 1.52
260004......................................................... 1.43
260005......................................................... 2.38
260006......................................................... 2.06
260007......................................................... 2.52
260008......................................................... 1.08
260009......................................................... 2.43
260011......................................................... 2.21
260012......................................................... 1.45
260013......................................................... 1.95
260014......................................................... 2.34
260015......................................................... 2.15
260017......................................................... 2.67
260018......................................................... 1.11
260019......................................................... 1.63
260020......................................................... 2.17
260021......................................................... 2.00
260022......................................................... 2.25
260023......................................................... 2.29
260024......................................................... 1.52
260025......................................................... 3.21
260027......................................................... 2.35
260029......................................................... 2.02
260030......................................................... 1.21
260031......................................................... 2.38
260032......................................................... 2.31
260034......................................................... 1.31
260035......................................................... 1.46
260036......................................................... 1.79
260039......................................................... 1.52
260040......................................................... 2.36
260042......................................................... 2.08
260044......................................................... 1.84
260047......................................................... 2.09
260048......................................................... 1.87
260050......................................................... 2.38
260052......................................................... 2.07
260053......................................................... 1.65
260054......................................................... 2.14
260055......................................................... 1.65
260057......................................................... 1.64
260059......................................................... 2.22
260061......................................................... 2.44
260062......................................................... 2.33
260063......................................................... 2.01
260064......................................................... 2.31
260065......................................................... 2.34
260066......................................................... 1.93
260067......................................................... 1.18
260068......................................................... 2.74
260070......................................................... 1.36
260073......................................................... 1.72
260074......................................................... 1.67
260077......................................................... 2.44
260078......................................................... 2.50
260079......................................................... 1.54
260080......................................................... 1.95
260081......................................................... 2.05
260082......................................................... 1.49
260085......................................................... 2.58
260086......................................................... 1.73
260091......................................................... 2.81
260094......................................................... 2.31
260095......................................................... 2.09
260096......................................................... 2.94
260097......................................................... 2.94
260100......................................................... 1.81
260102......................................................... 1.05
260103......................................................... 1.83
260104......................................................... 2.19
260105......................................................... 2.45
260107......................................................... 3.26
260108......................................................... 2.24
260109......................................................... 1.90
260110......................................................... 2.14
260113......................................................... 2.22
260115......................................................... 1.63
260116......................................................... 2.21
260119......................................................... 2.50
260120......................................................... 2.07
260122......................................................... 1.92
260123......................................................... 1.29
260127......................................................... 1.79
260128......................................................... 1.31
260129......................................................... 2.04
260131......................................................... 1.92
260134......................................................... 2.23
260137......................................................... 2.83
260138......................................................... 2.22
260141......................................................... 1.89
260142......................................................... 2.46
260143......................................................... 1.27
260147......................................................... 1.70
260148......................................................... 1.26
260158......................................................... 1.63
260159......................................................... 2.15
260160......................................................... 1.64
260162......................................................... 2.65
260163......................................................... 1.78
260164......................................................... 1.66
260166......................................................... 2.19
260172......................................................... 1.86
260173......................................................... 1.23
260175......................................................... 2.64
260176......................................................... 2.50
260177......................................................... 3.17
260178......................................................... 3.40
260179......................................................... 2.25
260180......................................................... 2.10
260183......................................................... 2.52
260186......................................................... 2.55
260188......................................................... 2.19
260189......................................................... 0.89
260190......................................................... 2.45
260191......................................................... 2.55
260193......................................................... 2.25
260195......................................................... 2.05
260197......................................................... 2.16
260198......................................................... 2.48
260200......................................................... 1.87
262001......................................................... 1.06
262011......................................................... 0.81
263025......................................................... 1.40
263026......................................................... 2.48
263300......................................................... 2.06
263301......................................................... 1.47
263302......................................................... 1.74
264005......................................................... 1.09
264007......................................................... 1.07
264008......................................................... 1.09
264010......................................................... 0.89
264013......................................................... 1.32
264016......................................................... 2.84
264017......................................................... 1.50
264021......................................................... 1.31
264024......................................................... 1.31
264025......................................................... 1.03
264026......................................................... 1.33
270002......................................................... 2.30
270003......................................................... 2.42
270004......................................................... 2.99
270006......................................................... 0.57
270007......................................................... 1.05
270009......................................................... 1.55
270011......................................................... 2.44
270012......................................................... 3.15
270013......................................................... 2.49
270014......................................................... 2.85
270016......................................................... 1.06
270017......................................................... 1.94
270019......................................................... 1.17
270021......................................................... 1.95
270023......................................................... 2.70
270024......................................................... 1.00
270026......................................................... 1.72
270027......................................................... 1.31
270028......................................................... 2.26
270029......................................................... 1.80
270032......................................................... 2.54
270033......................................................... 0.94
270035......................................................... 1.59
270036......................................................... 1.21
270039......................................................... 1.81
270040......................................................... 1.80
270041......................................................... 1.49
270044......................................................... 2.51
270046......................................................... 1.19
270048......................................................... 1.93
270049......................................................... 1.78
270050......................................................... 1.92
270051......................................................... 2.52
270052......................................................... 1.09
270053......................................................... 0.99
270057......................................................... 2.21
270058......................................................... 1.58
[[Page 35496]]
270059......................................................... 0.64
270060......................................................... 0.97
270063......................................................... 1.11
270068......................................................... 2.08
270072......................................................... 0.62
270073......................................................... 1.13
270079......................................................... 1.45
270080......................................................... 1.92
270081......................................................... 1.03
270082......................................................... 0.96
270083......................................................... 1.27
270084......................................................... 1.53
280001......................................................... 1.87
280005......................................................... 2.46
280009......................................................... 3.31
280010......................................................... 1.00
280011......................................................... 1.45
280012......................................................... 1.98
280013......................................................... 1.90
280014......................................................... 1.72
280015......................................................... 1.98
280017......................................................... 1.89
280018......................................................... 1.69
280020......................................................... 2.20
280021......................................................... 2.58
280022......................................................... 1.17
280023......................................................... 2.68
280024......................................................... 1.49
280025......................................................... 1.11
280026......................................................... 1.45
280028......................................................... 2.22
280029......................................................... 1.36
280030......................................................... 2.09
280031......................................................... 1.38
280032......................................................... 2.87
280033......................................................... 1.58
280034......................................................... 2.38
280035......................................................... 1.60
280037......................................................... 1.27
280038......................................................... 2.06
280039......................................................... 2.08
280040......................................................... 2.88
280041......................................................... 1.31
280042......................................................... 1.18
280043......................................................... 1.85
280045......................................................... 1.83
280046......................................................... 1.52
280047......................................................... 2.11
280048......................................................... 1.56
280049......................................................... 1.40
280050......................................................... 2.04
280051......................................................... 2.51
280052......................................................... 2.47
280054......................................................... 1.88
280055......................................................... 1.71
280056......................................................... 1.41
280057......................................................... 2.35
280058......................................................... 1.81
280060......................................................... 2.10
280061......................................................... 3.34
280062......................................................... 1.89
280064......................................................... 2.35
280065......................................................... 2.32
280066......................................................... 1.63
280068......................................................... 1.39
280070......................................................... 1.93
280073......................................................... 1.72
280074......................................................... 1.51
280075......................................................... 2.66
280076......................................................... 1.76
280077......................................................... 2.47
280079......................................................... 1.13
280080......................................................... 1.48
280081......................................................... 2.37
280082......................................................... 1.49
280083......................................................... 1.73
280084......................................................... 1.67
280085......................................................... 2.28
280088......................................................... 2.91
280089......................................................... 1.83
280090......................................................... 1.18
280091......................................................... 2.26
280092......................................................... 1.58
280094......................................................... 1.76
280097......................................................... 1.48
280098......................................................... 1.04
280101......................................................... 1.06
280102......................................................... 1.49
280104......................................................... 1.86
280105......................................................... 2.44
280106......................................................... 2.10
280107......................................................... 1.98
280108......................................................... 3.67
280109......................................................... 1.21
280110......................................................... 2.48
280111......................................................... 1.90
280114......................................................... 1.42
280115......................................................... 2.11
280117......................................................... 2.21
280118......................................................... 1.72
283301......................................................... 1.81
284007......................................................... 2.57
290001......................................................... 2.08
290002......................................................... 0.73
290003......................................................... 2.66
290005......................................................... 2.98
290006......................................................... 1.79
290007......................................................... 1.41
290008......................................................... 2.63
290009......................................................... 2.00
290010......................................................... 2.06
290011......................................................... 1.05
290012......................................................... 2.32
290013......................................................... 0.98
290014......................................................... 1.98
290015......................................................... 1.35
290016......................................................... 2.02
290019......................................................... 2.27
290020......................................................... 0.90
290021......................................................... 2.21
290022......................................................... 2.62
290027......................................................... 1.16
290032......................................................... 2.00
290038......................................................... 1.59
292002......................................................... 0.95
293027......................................................... 1.20
294003......................................................... 1.33
294004......................................................... 1.32
294005......................................................... 1.48
300001......................................................... 2.49
300003......................................................... 1.71
300005......................................................... 2.35
300006......................................................... 1.52
300007......................................................... 2.44
300008......................................................... 2.45
300009......................................................... 1.98
300010......................................................... 1.69
300011......................................................... 2.13
300013......................................................... 1.55
300014......................................................... 2.25
300015......................................................... 2.41
300016......................................................... 1.86
300017......................................................... 1.86
300018......................................................... 2.31
300019......................................................... 2.10
300021......................................................... 1.85
300022......................................................... 2.17
300023......................................................... 2.01
300024......................................................... 2.07
300028......................................................... 1.60
300029......................................................... 2.69
300033......................................................... 1.51
303026......................................................... 1.74
303027......................................................... 1.41
304000......................................................... 0.79
304001......................................................... 0.15
304003......................................................... 1.31
310001......................................................... 2.12
310002......................................................... 1.95
310005......................................................... 2.21
310006......................................................... 2.54
310008......................................................... 2.74
310009......................................................... 2.32
310010......................................................... 1.94
310011......................................................... 2.77
310013......................................................... 2.10
310015......................................................... 2.12
310016......................................................... 2.26
310017......................................................... 2.52
310018......................................................... 2.00
310019......................................................... 2.37
310020......................................................... 2.19
310021......................................................... 2.07
310022......................................................... 2.26
310024......................................................... 2.26
310025......................................................... 2.20
310026......................................................... 1.99
310027......................................................... 2.07
310028......................................................... 1.95
310029......................................................... 3.34
310031......................................................... 2.06
310032......................................................... 2.11
310034......................................................... 2.51
310036......................................................... 1.71
310037......................................................... 2.22
310039......................................................... 2.60
310041......................................................... 2.21
310042......................................................... 2.41
310043......................................................... 2.06
310044......................................................... 2.07
310045......................................................... 2.46
310047......................................................... 2.44
310048......................................................... 2.36
310050......................................................... 1.75
310051......................................................... 2.59
310052......................................................... 1.99
310054......................................................... 2.18
310056......................................................... 1.80
310057......................................................... 2.31
310058......................................................... 1.19
310060......................................................... 2.81
310061......................................................... 2.27
310063......................................................... 2.25
310064......................................................... 2.23
310067......................................................... 2.45
310069......................................................... 2.50
310070......................................................... 2.28
310072......................................................... 2.60
310073......................................................... 1.84
310074......................................................... 1.39
310076......................................................... 2.17
310077......................................................... 2.45
310078......................................................... 1.89
310081......................................................... 2.28
310083......................................................... 1.46
310084......................................................... 2.00
310086......................................................... 2.18
310088......................................................... 1.73
310090......................................................... 2.19
310091......................................................... 2.53
310092......................................................... 2.22
310093......................................................... 1.92
310096......................................................... 2.50
310105......................................................... 1.36
310111......................................................... 1.95
310112......................................................... 2.22
310113......................................................... 2.25
310115......................................................... 1.86
[[Page 35497]]
310116......................................................... 2.33
310118......................................................... 2.24
310120......................................................... 1.58
312014......................................................... 0.98
313025......................................................... 1.34
313027......................................................... 1.42
313029......................................................... 1.53
313030......................................................... 1.15
314010......................................................... 1.42
314011......................................................... 1.32
314012......................................................... 1.70
314021......................................................... 1.45
314022......................................................... 1.30
320001......................................................... 1.41
320002......................................................... 1.71
320003......................................................... 2.33
320004......................................................... 2.32
320005......................................................... 2.82
320006......................................................... 2.64
320009......................................................... 2.35
320011......................................................... 1.66
320012......................................................... 2.37
320013......................................................... 2.07
320014......................................................... 1.76
320016......................................................... 2.76
320017......................................................... 1.93
320018......................................................... 2.60
320019......................................................... 1.14
320021......................................................... 1.66
320022......................................................... 2.97
320023......................................................... 1.26
320030......................................................... 1.81
320031......................................................... 1.20
320032......................................................... 1.34
320033......................................................... 2.12
320035......................................................... 1.12
320037......................................................... 2.03
320038......................................................... 2.52
320046......................................................... 2.05
320048......................................................... 1.44
320063......................................................... 2.18
320065......................................................... 2.14
320067......................................................... 1.20
320068......................................................... 2.13
320069......................................................... 1.80
320074......................................................... 2.06
320079......................................................... 2.13
322002......................................................... 2.00
322003......................................................... 0.74
323027......................................................... 1.44
323028......................................................... 1.66
323029......................................................... 1.20
324003......................................................... 1.32
324004......................................................... 1.31
324007......................................................... 1.46
324008......................................................... 1.46
330001......................................................... 2.00
330002......................................................... 2.17
330003......................................................... 2.16
330004......................................................... 2.21
330005......................................................... 2.18
330006......................................................... 2.13
330007......................................................... 2.13
330008......................................................... 2.17
330010......................................................... 2.00
330011......................................................... 1.61
330012......................................................... 2.04
330013......................................................... 2.44
330014......................................................... 1.85
330016......................................................... 1.78
330023......................................................... 2.34
330024......................................................... 2.20
330025......................................................... 1.76
330027......................................................... 0.83
330028......................................................... 1.77
330029......................................................... 1.46
330030......................................................... 2.34
330033......................................................... 1.55
330034......................................................... 1.02
330036......................................................... 2.14
330037......................................................... 2.37
330038......................................................... 1.73
330039......................................................... 1.11
330041......................................................... 2.91
330043......................................................... 1.81
330044......................................................... 2.16
330045......................................................... 2.61
330046......................................................... 1.89
330047......................................................... 2.17
330048......................................................... 2.66
330049......................................................... 2.29
330053......................................................... 1.74
330055......................................................... 2.33
330056......................................................... 1.81
330057......................................................... 2.21
330058......................................................... 1.99
330059......................................................... 2.00
330061......................................................... 2.62
330062......................................................... 1.41
330064......................................................... 2.24
330065......................................................... 2.30
330066......................................................... 1.93
330067......................................................... 2.38
330072......................................................... 1.82
330073......................................................... 1.85
330074......................................................... 2.73
330075......................................................... 1.93
330078......................................................... 2.18
330079......................................................... 1.95
330084......................................................... 2.11
330085......................................................... 1.69
330086......................................................... 1.82
330088......................................................... 1.57
330090......................................................... 2.19
330091......................................................... 2.13
330092......................................................... 1.18
330094......................................................... 1.99
330095......................................................... 2.31
330096......................................................... 2.18
330097......................................................... 1.68
330100......................................................... 4.58
330101......................................................... 2.26
330102......................................................... 2.67
330103......................................................... 2.51
330104......................................................... 1.94
330106......................................................... 2.48
330107......................................................... 2.31
330108......................................................... 2.12
330111......................................................... 1.83
330114......................................................... 0.86
330115......................................................... 2.27
330116......................................................... 1.85
330118......................................................... 2.36
330119......................................................... 2.54
330121......................................................... 1.27
330122......................................................... 2.60
330125......................................................... 1.75
330126......................................................... 2.15
330132......................................................... 1.38
330133......................................................... 2.64
330135......................................................... 2.26
330136......................................................... 1.16
330140......................................................... 2.29
330141......................................................... 2.22
330144......................................................... 2.28
330148......................................................... 1.67
330151......................................................... 1.94
330152......................................................... 2.34
330153......................................................... 2.07
330154......................................................... 2.03
330157......................................................... 1.84
330158......................................................... 2.38
330159......................................................... 2.19
330160......................................................... 1.92
330161......................................................... 1.25
330162......................................................... 3.67
330163......................................................... 2.40
330164......................................................... 1.79
330166......................................................... 1.95
330167......................................................... 3.04
330171......................................................... 2.39
330175......................................................... 1.90
330177......................................................... 1.82
330179......................................................... 1.18
330180......................................................... 1.79
330181......................................................... 2.08
330182......................................................... 3.55
330183......................................................... 1.79
330184......................................................... 2.21
330185......................................................... 1.65
330186......................................................... 0.39
330188......................................................... 2.38
330189......................................................... 6.34
330191......................................................... 2.03
330193......................................................... 2.41
330194......................................................... 1.88
330197......................................................... 1.95
330198......................................................... 2.21
330203......................................................... 3.62
330205......................................................... 1.98
330208......................................................... 2.27
330209......................................................... 2.09
330211......................................................... 1.91
330212......................................................... 2.23
330213......................................................... 1.64
330214......................................................... 2.26
330215......................................................... 2.38
330218......................................................... 1.68
330219......................................................... 1.74
330221......................................................... 1.98
330222......................................................... 2.46
330223......................................................... 1.85
330224......................................................... 2.43
330225......................................................... 2.13
330226......................................................... 2.16
330229......................................................... 1.99
330230......................................................... 2.20
330232......................................................... 1.94
330235......................................................... 2.65
330236......................................................... 1.88
330238......................................................... 2.18
330239......................................................... 2.06
330241......................................................... 2.01
330242......................................................... 2.15
330245......................................................... 2.11
330246......................................................... 2.37
330249......................................................... 1.92
330250......................................................... 2.16
330252......................................................... 1.09
330254......................................................... 2.00
330258......................................................... 1.41
330259......................................................... 2.14
330261......................................................... 2.09
330263......................................................... 2.52
330264......................................................... 2.19
330265......................................................... 1.58
330267......................................................... 2.03
330268......................................................... 1.43
330270......................................................... 1.79
330273......................................................... 2.36
330275......................................................... 1.82
330276......................................................... 1.74
330277......................................................... 2.17
330279......................................................... 2.54
330285......................................................... 1.92
330286......................................................... 2.18
330288......................................................... 0.97
330290......................................................... 1.82
[[Page 35498]]
330293......................................................... 1.54
330304......................................................... 2.53
330306......................................................... 1.70
330307......................................................... 2.33
330308......................................................... 2.67
330314......................................................... 2.43
330316......................................................... 2.96
330327......................................................... 1.61
330331......................................................... 2.10
330332......................................................... 3.12
330333......................................................... 2.90
330336......................................................... 1.88
330338......................................................... 2.46
330339......................................................... 1.90
330340......................................................... 2.38
330350......................................................... 2.04
330353......................................................... 2.62
330354......................................................... 1.65
330357......................................................... 1.88
330359......................................................... 0.93
330372......................................................... 2.66
330381......................................................... 1.89
330386......................................................... 1.90
330389......................................................... 1.66
330390......................................................... 1.31
330393......................................................... 2.43
330394......................................................... 2.31
330395......................................................... 2.16
330397......................................................... 1.38
330398......................................................... 2.74
330399......................................................... 1.25
332012......................................................... 1.27
332022......................................................... 1.06
333025......................................................... 1.16
333027......................................................... 1.18
333028......................................................... 0.83
333300......................................................... 1.97
334002......................................................... 1.31
334023......................................................... 1.63
334027......................................................... 1.35
334048......................................................... 1.90
334049......................................................... 1.27
334055......................................................... 1.34
340001......................................................... 1.74
340002......................................................... 3.11
340003......................................................... 2.06
340004......................................................... 2.45
340005......................................................... 2.06
340006......................................................... 1.74
340007......................................................... 1.78
340008......................................................... 2.04
340010......................................................... 2.74
340011......................................................... 1.74
340012......................................................... 2.11
340013......................................................... 1.76
340014......................................................... 1.42
340015......................................................... 2.74
340016......................................................... 2.80
340017......................................................... 2.49
340018......................................................... 2.19
340019......................................................... 1.62
340020......................................................... 1.91
340021......................................................... 2.46
340022......................................................... 1.83
340023......................................................... 1.80
340024......................................................... 2.03
340025......................................................... 2.51
340027......................................................... 2.77
340028......................................................... 2.20
340030......................................................... 2.05
340031......................................................... 1.83
340032......................................................... 2.25
340035......................................................... 2.11
340036......................................................... 1.62
340037......................................................... 1.65
340038......................................................... 2.85
340039......................................................... 2.43
340040......................................................... 2.67
340041......................................................... 1.79
340042......................................................... 1.96
340044......................................................... 1.63
340045......................................................... 1.18
340047......................................................... 2.12
340049......................................................... 6.30
340050......................................................... 2.19
340051......................................................... 2.47
340052......................................................... 1.73
340053......................................................... 2.81
340054......................................................... 2.34
340055......................................................... 1.87
340060......................................................... 2.11
340061......................................................... 1.79
340063......................................................... 1.37
340064......................................................... 2.00
340065......................................................... 1.85
340067......................................................... 2.31
340068......................................................... 2.28
340069......................................................... 2.13
340070......................................................... 2.45
340071......................................................... 1.89
340072......................................................... 2.14
340073......................................................... 2.93
340075......................................................... 2.03
340080......................................................... 1.60
340084......................................................... 1.63
340085......................................................... 2.13
340087......................................................... 1.89
340088......................................................... 2.90
340089......................................................... 1.50
340090......................................................... 1.88
340091......................................................... 2.67
340093......................................................... 1.77
340094......................................................... 3.18
340096......................................................... 2.26
340097......................................................... 2.48
340098......................................................... 2.29
340099......................................................... 1.96
340101......................................................... 2.33
340104......................................................... 1.55
340105......................................................... 3.43
340106......................................................... 1.67
340107......................................................... 2.68
340109......................................................... 3.18
340111......................................................... 2.00
340112......................................................... 1.70
340113......................................................... 2.24
340114......................................................... 1.84
340115......................................................... 2.33
340116......................................................... 2.54
340119......................................................... 2.20
340120......................................................... 1.81
340121......................................................... 2.07
340123......................................................... 2.04
340124......................................................... 1.85
340125......................................................... 3.31
340126......................................................... 2.36
340127......................................................... 1.80
340129......................................................... 2.35
340130......................................................... 2.31
340131......................................................... 2.43
340132......................................................... 1.87
340133......................................................... 1.45
340141......................................................... 2.50
340142......................................................... 1.97
340143......................................................... 2.56
340144......................................................... 2.69
340145......................................................... 2.30
340146......................................................... 1.82
340147......................................................... 2.77
340148......................................................... 3.86
340151......................................................... 2.31
340153......................................................... 3.73
340155......................................................... 2.22
340158......................................................... 2.63
340159......................................................... 1.46
340160......................................................... 2.30
340162......................................................... 1.70
340164......................................................... 1.88
340166......................................................... 2.00
340171......................................................... 2.59
342012......................................................... 0.80
343025......................................................... 1.53
344005......................................................... 1.31
344006......................................................... 1.31
344010......................................................... 1.47
344011......................................................... 1.43
344014......................................................... 0.71
344015......................................................... 1.31
344016......................................................... 1.09
344019......................................................... 1.31
350001......................................................... 1.12
350002......................................................... 3.45
350003......................................................... 2.22
350004......................................................... 3.44
350005......................................................... 1.99
350006......................................................... 1.93
350007......................................................... 2.58
350008......................................................... 1.70
350009......................................................... 2.96
350010......................................................... 2.90
350011......................................................... 2.89
350012......................................................... 2.14
350013......................................................... 1.84
350014......................................................... 1.86
350015......................................................... 3.03
350016......................................................... 1.06
350017......................................................... 2.50
350018......................................................... 2.51
350019......................................................... 3.11
350020......................................................... 1.39
350021......................................................... 2.41
350023......................................................... 1.92
350024......................................................... 1.91
350025......................................................... 1.12
350027......................................................... 1.38
350029......................................................... 1.36
350030......................................................... 2.63
350033......................................................... 1.95
350034......................................................... 1.96
350035......................................................... 0.81
350038......................................................... 2.94
350039......................................................... 1.96
350041......................................................... 1.45
350042......................................................... 3.18
350043......................................................... 2.85
350044......................................................... 1.65
350047......................................................... 1.92
350049......................................................... 2.09
350050......................................................... 1.45
350051......................................................... 1.67
350053......................................................... 1.27
350055......................................................... 1.18
350056......................................................... 1.89
350058......................................................... 1.67
350060......................................................... 0.77
350061......................................................... 2.48
360001......................................................... 2.64
360002......................................................... 2.29
360003......................................................... 1.85
360006......................................................... 2.89
360007......................................................... 1.80
360008......................................................... 2.13
360009......................................................... 2.29
360010......................................................... 2.65
360011......................................................... 1.92
360012......................................................... 2.66
360013......................................................... 2.14
360014......................................................... 2.53
[[Page 35499]]
360016......................................................... 1.81
360017......................................................... 3.33
360018......................................................... 2.33
360019......................................................... 1.98
360020......................................................... 2.08
360021......................................................... 5.43
360024......................................................... 2.14
360025......................................................... 1.91
360026......................................................... 1.75
360027......................................................... 2.33
360028......................................................... 3.86
360029......................................................... 2.40
360030......................................................... 2.23
360031......................................................... 1.96
360032......................................................... 2.43
360034......................................................... 1.83
360035......................................................... 1.99
360036......................................................... 2.27
360037......................................................... 2.14
360039......................................................... 2.10
360040......................................................... 2.00
360041......................................................... 2.04
360042......................................................... 2.06
360044......................................................... 2.15
360045......................................................... 1.77
360046......................................................... 2.26
360047......................................................... 1.50
360048......................................................... 2.09
360049......................................................... 2.55
360050......................................................... 1.48
360051......................................................... 2.75
360052......................................................... 2.24
360054......................................................... 2.54
360055......................................................... 2.36
360056......................................................... 2.33
360057......................................................... 1.64
360058......................................................... 2.00
360059......................................................... 1.56
360062......................................................... 2.57
360063......................................................... 1.65
360064......................................................... 2.42
360065......................................................... 2.08
360066......................................................... 2.38
360067......................................................... 1.63
360068......................................................... 2.26
360069......................................................... 1.71
360070......................................................... 1.90
360071......................................................... 2.19
360072......................................................... 2.20
360074......................................................... 2.05
360075......................................................... 2.04
360076......................................................... 2.47
360077......................................................... 2.20
360078......................................................... 2.40
360079......................................................... 2.59
360080......................................................... 2.08
360081......................................................... 2.19
360082......................................................... 2.65
360083......................................................... 2.23
360084......................................................... 2.31
360085......................................................... 2.57
360086......................................................... 2.40
360087......................................................... 2.16
360088......................................................... 1.91
360089......................................................... 2.00
360090......................................................... 3.18
360091......................................................... 2.21
360092......................................................... 1.73
360093......................................................... 2.81
360094......................................................... 1.82
360095......................................................... 2.56
360096......................................................... 2.20
360098......................................................... 2.80
360099......................................................... 2.12
360100......................................................... 2.42
360101......................................................... 2.92
360102......................................................... 2.51
360103......................................................... 1.96
360106......................................................... 1.58
360107......................................................... 2.01
360108......................................................... 1.64
360109......................................................... 2.24
360112......................................................... 2.44
360113......................................................... 2.40
360114......................................................... 1.97
360115......................................................... 1.97
360116......................................................... 1.68
360118......................................................... 2.05
360121......................................................... 2.65
360123......................................................... 2.13
360125......................................................... 1.64
360126......................................................... 1.77
360127......................................................... 2.13
360128......................................................... 1.63
360129......................................................... 1.65
360130......................................................... 1.88
360131......................................................... 2.14
360132......................................................... 2.30
360133......................................................... 2.40
360134......................................................... 2.32
360136......................................................... 1.52
360137......................................................... 2.10
360140......................................................... 1.69
360141......................................................... 2.57
360142......................................................... 1.91
360143......................................................... 2.16
360144......................................................... 2.43
360145......................................................... 2.33
360147......................................................... 2.16
360148......................................................... 1.98
360149......................................................... 2.50
360150......................................................... 2.91
360151......................................................... 2.57
360152......................................................... 2.41
360153......................................................... 1.78
360154......................................................... 1.51
360155......................................................... 2.43
360156......................................................... 2.12
360159......................................................... 2.11
360161......................................................... 2.22
360162......................................................... 2.00
360163......................................................... 2.68
360164......................................................... 1.58
360165......................................................... 1.72
360166......................................................... 1.56
360170......................................................... 1.92
360172......................................................... 2.63
360174......................................................... 2.39
360175......................................................... 2.41
360176......................................................... 1.68
360177......................................................... 1.47
360178......................................................... 2.36
360179......................................................... 2.17
360180......................................................... 2.46
360184......................................................... 1.43
360185......................................................... 1.74
360186......................................................... 1.49
360187......................................................... 2.34
360188......................................................... 1.73
360189......................................................... 2.21
360192......................................................... 2.11
360193......................................................... 2.29
360194......................................................... 2.06
360195......................................................... 2.55
360197......................................................... 1.83
360200......................................................... 1.69
360203......................................................... 2.33
360204......................................................... 1.85
360210......................................................... 2.48
360211......................................................... 2.08
360212......................................................... 2.15
360213......................................................... 1.96
360218......................................................... 2.25
360230......................................................... 2.64
360231......................................................... 1.39
360234......................................................... 1.96
360236......................................................... 2.29
360239......................................................... 2.44
360241......................................................... 1.12
360242......................................................... 1.60
360244......................................................... 1.31
360245......................................................... 1.34
362004......................................................... 2.12
362007......................................................... 0.46
362014......................................................... 6.82
362015......................................................... 1.36
363300......................................................... 1.79
363303......................................................... 2.00
363305......................................................... 1.79
363306......................................................... 1.23
364003......................................................... 1.44
364017......................................................... 1.22
364026......................................................... 1.35
364029......................................................... 1.39
364038......................................................... 1.63
370001......................................................... 2.91
370002......................................................... 2.47
370004......................................................... 2.61
370005......................................................... 1.38
370006......................................................... 2.35
370007......................................................... 1.70
370008......................................................... 2.57
370011......................................................... 1.83
370012......................................................... 1.32
370013......................................................... 2.58
370014......................................................... 2.48
370015......................................................... 1.80
370016......................................................... 2.30
370017......................................................... 1.70
370018......................................................... 2.92
370019......................................................... 2.26
370020......................................................... 2.07
370021......................................................... 1.30
370022......................................................... 2.66
370023......................................................... 2.24
370025......................................................... 2.32
370026......................................................... 2.80
370028......................................................... 2.84
370029......................................................... 2.17
370030......................................................... 1.94
370032......................................................... 3.38
370033......................................................... 2.36
370034......................................................... 2.42
370035......................................................... 1.77
370036......................................................... 0.72
370037......................................................... 3.59
370038......................................................... 1.46
370039......................................................... 1.82
370040......................................................... 2.84
370041......................................................... 1.57
370042......................................................... 1.32
370043......................................................... 1.07
370045......................................................... 1.52
370046......................................................... 1.86
370047......................................................... 2.19
370048......................................................... 1.83
370049......................................................... 2.76
370051......................................................... 1.23
370054......................................................... 2.15
370056......................................................... 2.68
370057......................................................... 1.86
370059......................................................... 0.96
370060......................................................... 2.06
370063......................................................... 1.47
370064......................................................... 1.48
370065......................................................... 2.33
370071......................................................... 1.48
370072......................................................... 1.27
[[Page 35500]]
370076......................................................... 2.23
370077......................................................... 1.87
370078......................................................... 3.26
370079......................................................... 1.68
370080......................................................... 1.82
370082......................................................... 1.22
370083......................................................... 2.29
370084......................................................... 1.49
370085......................................................... 1.70
370086......................................................... 2.07
370089......................................................... 2.06
370091......................................................... 2.79
370092......................................................... 2.14
370093......................................................... 3.92
370094......................................................... 2.86
370095......................................................... 1.34
370097......................................................... 1.94
370099......................................................... 1.98
370100......................................................... 1.24
370103......................................................... 1.55
370105......................................................... 2.79
370106......................................................... 3.64
370108......................................................... 1.53
370112......................................................... 1.50
370113......................................................... 1.90
370114......................................................... 2.83
370121......................................................... 2.39
370122......................................................... 0.92
370123......................................................... 2.24
370125......................................................... 1.87
370126......................................................... 1.24
370131......................................................... 1.18
370133......................................................... 1.80
370138......................................................... 2.26
370139......................................................... 1.64
370140......................................................... 1.76
370141......................................................... 1.68
370146......................................................... 1.52
370148......................................................... 2.10
370149......................................................... 2.65
370153......................................................... 2.37
370154......................................................... 2.41
370156......................................................... 2.29
370158......................................................... 1.44
370159......................................................... 2.14
370163......................................................... 1.19
370165......................................................... 1.28
370166......................................................... 1.79
370169......................................................... 1.91
370176......................................................... 1.99
370177......................................................... 1.48
370178......................................................... 2.01
370179......................................................... 1.40
370183......................................................... 1.38
370186......................................................... 2.40
370190......................................................... 2.72
370192......................................................... 2.64
372004......................................................... 0.74
373025......................................................... 1.44
373026......................................................... 1.05
374003......................................................... 1.43
374006......................................................... 1.09
374008......................................................... 1.62
374012......................................................... 1.25
374018......................................................... 1.30
374020......................................................... 1.38
380001......................................................... 2.56
380002......................................................... 3.62
380003......................................................... 3.00
380004......................................................... 3.26
380005......................................................... 4.66
380006......................................................... 2.69
380007......................................................... 2.88
380008......................................................... 1.60
380009......................................................... 2.04
380010......................................................... 1.71
380011......................................................... 2.19
380013......................................................... 1.52
380014......................................................... 2.51
380017......................................................... 3.48
380018......................................................... 2.29
380019......................................................... 1.71
380020......................................................... 3.29
380021......................................................... 2.50
380022......................................................... 2.52
380023......................................................... 2.25
380025......................................................... 2.54
380026......................................................... 2.19
380027......................................................... 1.81
380029......................................................... 2.00
380031......................................................... 1.56
380033......................................................... 2.83
380035......................................................... 2.69
380036......................................................... 2.23
380037......................................................... 2.24
380038......................................................... 2.80
380039......................................................... 1.87
380040......................................................... 2.03
380042......................................................... 1.73
380047......................................................... 3.41
380048......................................................... 2.03
380050......................................................... 2.26
380051......................................................... 2.84
380052......................................................... 2.34
380056......................................................... 1.38
380060......................................................... 2.26
380061......................................................... 2.53
380062......................................................... 0.85
380063......................................................... 1.64
380064......................................................... 1.85
380065......................................................... 1.72
380066......................................................... 2.76
380068......................................................... 1.29
380069......................................................... 1.67
380070......................................................... 1.83
380071......................................................... 3.16
380072......................................................... 1.67
380075......................................................... 2.82
380078......................................................... 1.79
380081......................................................... 0.94
380082......................................................... 2.43
380083......................................................... 2.28
380084......................................................... 1.97
380087......................................................... 2.29
380088......................................................... 1.95
380089......................................................... 2.67
380090......................................................... 2.69
390001......................................................... 2.28
390002......................................................... 2.31
390003......................................................... 1.68
390004......................................................... 2.37
390005......................................................... 2.13
390006......................................................... 1.56
390007......................................................... 3.01
390008......................................................... 1.88
390009......................................................... 2.27
390010......................................................... 2.46
390011......................................................... 2.35
390012......................................................... 2.52
390013......................................................... 2.64
390015......................................................... 1.83
390016......................................................... 2.19
390017......................................................... 2.05
390018......................................................... 2.64
390019......................................................... 2.13
390022......................................................... 2.62
390023......................................................... 1.66
390024......................................................... 2.86
390025......................................................... 1.01
390026......................................................... 1.87
390028......................................................... 2.81
390029......................................................... 2.48
390030......................................................... 2.03
390031......................................................... 2.04
390032......................................................... 2.24
390035......................................................... 2.44
390036......................................................... 2.41
390037......................................................... 2.41
390039......................................................... 2.16
390040......................................................... 1.67
390041......................................................... 2.43
390042......................................................... 2.15
390043......................................................... 2.81
390044......................................................... 2.47
390045......................................................... 2.07
390046......................................................... 1.82
390047......................................................... 2.37
390048......................................................... 2.18
390049......................................................... 2.55
390051......................................................... 2.39
390052......................................................... 2.37
390054......................................................... 1.88
390055......................................................... 2.50
390056......................................................... 1.93
390057......................................................... 2.26
390058......................................................... 2.88
390060......................................................... 1.55
390061......................................................... 2.09
390062......................................................... 2.64
390063......................................................... 3.18
390065......................................................... 2.18
390066......................................................... 1.97
390067......................................................... 2.36
390068......................................................... 1.71
390069......................................................... 2.07
390070......................................................... 2.99
390071......................................................... 2.38
390072......................................................... 2.07
390073......................................................... 2.34
390074......................................................... 2.49
390075......................................................... 2.39
390076......................................................... 2.35
390078......................................................... 2.72
390079......................................................... 2.76
390080......................................................... 2.27
390083......................................................... 1.70
390084......................................................... 1.63
390086......................................................... 2.12
390088......................................................... 1.82
390090......................................................... 2.61
390091......................................................... 2.07
390093......................................................... 1.88
390095......................................................... 2.17
390096......................................................... 2.12
390097......................................................... 2.24
390100......................................................... 2.36
390101......................................................... 1.57
390102......................................................... 2.62
390103......................................................... 1.99
390104......................................................... 1.86
390106......................................................... 1.90
390107......................................................... 2.35
390108......................................................... 2.27
390109......................................................... 1.45
390110......................................................... 2.02
390111......................................................... 1.83
390112......................................................... 2.15
390113......................................................... 2.24
390114......................................................... 2.04
390115......................................................... 2.23
390116......................................................... 2.11
390118......................................................... 2.53
390119......................................................... 2.35
390121......................................................... 2.40
390122......................................................... 2.01
390123......................................................... 2.78
390125......................................................... 2.16
390127......................................................... 2.39
[[Page 35501]]
390128......................................................... 2.69
390130......................................................... 2.00
390131......................................................... 2.36
390132......................................................... 1.94
390133......................................................... 2.42
390135......................................................... 2.00
390136......................................................... 3.53
390137......................................................... 2.30
390138......................................................... 2.02
390139......................................................... 2.41
390142......................................................... 1.82
390145......................................................... 2.23
390146......................................................... 2.08
390147......................................................... 2.32
390150......................................................... 1.87
390151......................................................... 2.28
390152......................................................... 2.31
390153......................................................... 1.89
390154......................................................... 2.53
390155......................................................... 1.33
390156......................................................... 2.31
390157......................................................... 2.37
390158......................................................... 2.27
390160......................................................... 2.65
390161......................................................... 2.45
390162......................................................... 2.22
390163......................................................... 2.32
390164......................................................... 2.01
390166......................................................... 1.65
390167......................................................... 2.15
390168......................................................... 2.09
390169......................................................... 2.95
390173......................................................... 1.97
390174......................................................... 2.26
390176......................................................... 2.00
390178......................................................... 2.45
390179......................................................... 2.23
390180......................................................... 2.28
390181......................................................... 2.25
390183......................................................... 2.37
390184......................................................... 1.62
390185......................................................... 2.69
390189......................................................... 2.17
390191......................................................... 2.94
390192......................................................... 1.97
390193......................................................... 2.44
390194......................................................... 2.11
390195......................................................... 2.67
390196......................................................... 2.10
390197......................................................... 2.87
390198......................................................... 1.52
390199......................................................... 1.66
390200......................................................... 1.45
390201......................................................... 2.13
390203......................................................... 2.45
390204......................................................... 2.30
390205......................................................... 2.28
390206......................................................... 1.93
390209......................................................... 1.92
390211......................................................... 2.50
390213......................................................... 1.01
390215......................................................... 2.33
390217......................................................... 2.12
390219......................................................... 1.77
390222......................................................... 2.63
390224......................................................... 1.59
390225......................................................... 2.14
390226......................................................... 2.14
390228......................................................... 2.10
390231......................................................... 2.05
390233......................................................... 1.89
390235......................................................... 1.76
390236......................................................... 2.00
390237......................................................... 2.10
390238......................................................... 2.27
390242......................................................... 2.31
390244......................................................... 0.99
390245......................................................... 1.98
390246......................................................... 2.30
390247......................................................... 1.06
390249......................................................... 1.03
390256......................................................... 1.74
390258......................................................... 2.34
390260......................................................... 3.40
390262......................................................... 2.54
390263......................................................... 2.66
390265......................................................... 1.46
390266......................................................... 2.94
390267......................................................... 2.51
390268......................................................... 2.47
390270......................................................... 2.41
390277......................................................... 1.09
390279......................................................... 2.19
392024......................................................... 1.54
392025......................................................... 1.67
392026......................................................... 1.05
393025......................................................... 1.10
393026......................................................... 1.57
393027......................................................... 1.76
393031......................................................... 1.45
393032......................................................... 1.06
393035......................................................... 0.85
393037......................................................... 1.35
393038......................................................... 1.63
393039......................................................... 1.00
393040......................................................... 3.14
393042......................................................... 1.68
393043......................................................... 0.88
393301......................................................... 1.76
393302......................................................... 1.48
394006......................................................... 1.31
394007......................................................... 1.38
394008......................................................... 2.75
394020......................................................... 1.14
394023......................................................... 1.34
394034......................................................... 1.22
394041......................................................... 1.09
400001......................................................... 1.56
400002......................................................... 3.46
400003......................................................... 1.44
400004......................................................... 1.88
400005......................................................... 1.64
400006......................................................... 2.37
400007......................................................... 1.13
400009......................................................... 1.77
400011......................................................... 2.23
400012......................................................... 1.03
400013......................................................... 1.35
400014......................................................... 4.33
400016......................................................... 2.08
400017......................................................... 1.95
400018......................................................... 1.33
400019......................................................... 3.06
400021......................................................... 1.89
400022......................................................... 1.78
400027......................................................... 0.85
400028......................................................... 1.51
400029......................................................... 1.06
400032......................................................... 1.10
400094......................................................... 1.07
400098......................................................... 1.33
400102......................................................... 1.90
400106......................................................... 1.48
400109......................................................... 1.91
400111......................................................... 1.29
400113......................................................... 1.98
400114......................................................... 1.37
400115......................................................... 1.11
400117......................................................... 2.09
400118......................................................... 1.61
400120......................................................... 2.23
400122......................................................... 0.93
400123......................................................... 3.45
400124......................................................... 8.61
404002......................................................... 2.33
410001......................................................... 2.10
410004......................................................... 1.90
410005......................................................... 2.63
410006......................................................... 2.14
410007......................................................... 2.36
410008......................................................... 2.45
410009......................................................... 2.76
410010......................................................... 1.74
410011......................................................... 2.21
410012......................................................... 2.51
410013......................................................... 2.44
413025......................................................... 1.43
414000......................................................... 1.92
420002......................................................... 2.45
420004......................................................... 1.85
420005......................................................... 2.31
420006......................................................... 1.21
420007......................................................... 2.47
420009......................................................... 2.69
420010......................................................... 2.32
420011......................................................... 1.69
420014......................................................... 1.38
420015......................................................... 2.30
420016......................................................... 1.68
420018......................................................... 1.86
420019......................................................... 2.11
420020......................................................... 2.41
420023......................................................... 2.81
420026......................................................... 3.52
420027......................................................... 2.14
420030......................................................... 2.06
420031......................................................... 1.34
420033......................................................... 1.82
420036......................................................... 2.49
420037......................................................... 1.69
420038......................................................... 1.69
420039......................................................... 1.85
420042......................................................... 1.78
420043......................................................... 2.04
420048......................................................... 2.19
420049......................................................... 2.64
420051......................................................... 2.34
420053......................................................... 2.21
420054......................................................... 1.65
420055......................................................... 1.77
420056......................................................... 2.63
420057......................................................... 1.70
420059......................................................... 1.53
420061......................................................... 1.79
420062......................................................... 2.16
420064......................................................... 1.55
420065......................................................... 2.64
420066......................................................... 1.91
420067......................................................... 3.06
420068......................................................... 2.80
420069......................................................... 1.57
420070......................................................... 2.37
420071......................................................... 2.47
420072......................................................... 1.30
420073......................................................... 2.50
420074......................................................... 1.11
420075......................................................... 1.79
420078......................................................... 2.50
420079......................................................... 1.75
420080......................................................... 2.41
420081......................................................... 0.87
420082......................................................... 2.27
420083......................................................... 3.31
420085......................................................... 2.03
420086......................................................... 2.36
420087......................................................... 2.53
420088......................................................... 2.47
420089......................................................... 2.60
[[Page 35502]]
420091......................................................... 2.75
423025......................................................... 2.50
423026......................................................... 1.63
424006......................................................... 1.31
424007......................................................... 1.20
424009......................................................... 1.29
424010......................................................... 1.40
430004......................................................... 1.89
430005......................................................... 2.74
430007......................................................... 2.48
430008......................................................... 2.62
430010......................................................... 2.27
430011......................................................... 3.02
430012......................................................... 3.46
430013......................................................... 2.95
430014......................................................... 2.66
430015......................................................... 2.99
430016......................................................... 2.57
430018......................................................... 1.57
430022......................................................... 1.16
430023......................................................... 1.43
430024......................................................... 1.04
430026......................................................... 1.20
430027......................................................... 3.75
430028......................................................... 2.35
430029......................................................... 1.91
430031......................................................... 1.67
430033......................................................... 1.68
430034......................................................... 1.40
430036......................................................... 1.94
430037......................................................... 2.47
430038......................................................... 2.48
430040......................................................... 2.01
430041......................................................... 1.67
430043......................................................... 2.11
430044......................................................... 1.45
430047......................................................... 1.89
430048......................................................... 2.07
430049......................................................... 1.31
430051......................................................... 1.01
430054......................................................... 1.79
430056......................................................... 1.30
430057......................................................... 1.62
430060......................................................... 0.98
430062......................................................... 1.70
430064......................................................... 1.93
430065......................................................... 1.32
430066......................................................... 1.16
430073......................................................... 1.57
430076......................................................... 1.02
430077......................................................... 2.99
430079......................................................... 1.01
430087......................................................... 1.14
434004......................................................... 1.52
440001......................................................... 2.05
440002......................................................... 3.46
440003......................................................... 2.67
440006......................................................... 2.96
440007......................................................... 1.14
440008......................................................... 2.07
440009......................................................... 2.91
440010......................................................... 1.65
440011......................................................... 2.26
440012......................................................... 1.81
440014......................................................... 1.62
440015......................................................... 2.82
440016......................................................... 1.92
440017......................................................... 2.44
440018......................................................... 1.54
440019......................................................... 2.38
440020......................................................... 1.95
440022......................................................... 1.48
440023......................................................... 1.54
440024......................................................... 2.81
440025......................................................... 2.13
440026......................................................... 0.99
440029......................................................... 2.89
440030......................................................... 2.65
440031......................................................... 2.25
440032......................................................... 1.48
440033......................................................... 1.82
440034......................................................... 2.53
440035......................................................... 2.40
440039......................................................... 2.02
440040......................................................... 1.54
440041......................................................... 1.67
440046......................................................... 2.35
440047......................................................... 1.66
440048......................................................... 2.88
440049......................................................... 2.45
440050......................................................... 2.22
440051......................................................... 1.56
440052......................................................... 1.54
440053......................................................... 2.74
440054......................................................... 1.97
440056......................................................... 1.73
440057......................................................... 1.88
440058......................................................... 2.80
440059......................................................... 2.36
440060......................................................... 1.53
440061......................................................... 1.87
440063......................................................... 2.54
440064......................................................... 1.66
440065......................................................... 2.27
440067......................................................... 2.61
440068......................................................... 2.32
440070......................................................... 1.68
440071......................................................... 2.37
440072......................................................... 2.63
440073......................................................... 2.55
440078......................................................... 1.59
440081......................................................... 1.92
440082......................................................... 2.63
440083......................................................... 1.62
440084......................................................... 1.41
440090......................................................... 1.47
440091......................................................... 2.83
440100......................................................... 1.70
440102......................................................... 1.92
440103......................................................... 2.37
440104......................................................... 2.39
440105......................................................... 5.91
440109......................................................... 1.94
440110......................................................... 1.93
440111......................................................... 1.26
440114......................................................... 1.86
440115......................................................... 1.85
440120......................................................... 3.10
440125......................................................... 2.59
440130......................................................... 2.76
440131......................................................... 2.59
440132......................................................... 2.11
440133......................................................... 2.76
440135......................................................... 2.10
440137......................................................... 2.03
440141......................................................... 1.08
440142......................................................... 1.41
440143......................................................... 1.54
440144......................................................... 3.51
440145......................................................... 1.31
440147......................................................... 6.45
440148......................................................... 2.30
440149......................................................... 1.44
440150......................................................... 3.11
440151......................................................... 1.85
440152......................................................... 1.54
440153......................................................... 1.95
440156......................................................... 2.88
440157......................................................... 1.64
440159......................................................... 2.22
440161......................................................... 3.36
440162......................................................... 1.30
440166......................................................... 2.53
440168......................................................... 2.06
440173......................................................... 3.78
440174......................................................... 1.91
440175......................................................... 2.45
440176......................................................... 2.77
440178......................................................... 2.12
440180......................................................... 1.62
440181......................................................... 1.87
440182......................................................... 2.10
440183......................................................... 3.04
440184......................................................... 2.78
440185......................................................... 2.30
440186......................................................... 2.08
440187......................................................... 1.86
440189......................................................... 3.14
440192......................................................... 1.68
440193......................................................... 2.95
440194......................................................... 1.92
440197......................................................... 2.70
440200......................................................... 1.92
440203......................................................... 1.79
440205......................................................... 1.34
440206......................................................... 1.91
442007......................................................... 0.98
443025......................................................... 1.66
443026......................................................... 1.44
443029......................................................... 2.87
444003......................................................... 1.07
444004......................................................... 1.32
444006......................................................... 1.27
444010......................................................... 1.20
444017......................................................... 1.31
450002......................................................... 2.26
450004......................................................... 1.66
450005......................................................... 1.97
450007......................................................... 2.83
450008......................................................... 1.73
450010......................................................... 2.35
450011......................................................... 2.73
450014......................................................... 1.64
450015......................................................... 1.21
450016......................................................... 2.92
450018......................................................... 1.48
450020......................................................... 2.07
450021......................................................... 1.73
450023......................................................... 2.65
450024......................................................... 1.46
450025......................................................... 2.71
450028......................................................... 2.11
450029......................................................... 1.95
450031......................................................... 2.08
450032......................................................... 1.52
450033......................................................... 1.92
450034......................................................... 2.15
450035......................................................... 2.37
450037......................................................... 2.25
450039......................................................... 1.07
450040......................................................... 1.90
450042......................................................... 2.14
450044......................................................... 2.21
450046......................................................... 2.65
450047......................................................... 2.20
450050......................................................... 1.26
450051......................................................... 1.77
450052......................................................... 1.46
450053......................................................... 2.23
450054......................................................... 3.01
450055......................................................... 1.70
450056......................................................... 3.09
450058......................................................... 3.08
450059......................................................... 2.53
450063......................................................... 0.92
450064......................................................... 2.79
450065......................................................... 1.59
450068......................................................... 1.97
[[Page 35503]]
450072......................................................... 2.22
450073......................................................... 1.42
450076......................................................... 1.67
450078......................................................... 1.11
450079......................................................... 2.56
450080......................................................... 2.84
450081......................................................... 1.87
450082......................................................... 1.57
450083......................................................... 3.18
450085......................................................... 1.71
450087......................................................... 1.84
450090......................................................... 2.26
450092......................................................... 1.78
450094......................................................... 2.42
450096......................................................... 1.75
450097......................................................... 2.99
450098......................................................... 1.12
450099......................................................... 1.97
450101......................................................... 2.43
450102......................................................... 3.08
450104......................................................... 2.70
450107......................................................... 1.99
450108......................................................... 1.31
450109......................................................... 1.54
450111......................................................... 2.41
450112......................................................... 2.57
450113......................................................... 2.56
450118......................................................... 3.04
450119......................................................... 2.38
450121......................................................... 2.47
450123......................................................... 1.71
450124......................................................... 2.02
450126......................................................... 1.69
450128......................................................... 1.91
450130......................................................... 3.22
450131......................................................... 1.77
450132......................................................... 2.15
450133......................................................... 2.21
450135......................................................... 2.15
450137......................................................... 2.08
450140......................................................... 1.34
450142......................................................... 1.99
450143......................................................... 1.70
450144......................................................... 1.63
450145......................................................... 1.26
450146......................................................... 0.98
450147......................................................... 1.84
450148......................................................... 2.15
450149......................................................... 1.90
450150......................................................... 1.58
450151......................................................... 1.52
450152......................................................... 2.19
450153......................................................... 2.25
450154......................................................... 1.66
450155......................................................... 1.57
450157......................................................... 1.30
450160......................................................... 1.78
450162......................................................... 1.98
450163......................................................... 1.61
450164......................................................... 1.25
450165......................................................... 1.71
450166......................................................... 0.89
450169......................................................... 1.16
450170......................................................... 1.46
450176......................................................... 2.20
450177......................................................... 2.12
450178......................................................... 1.40
450181......................................................... 1.33
450184......................................................... 2.79
450185......................................................... 1.43
450187......................................................... 2.03
450188......................................................... 1.72
450190......................................................... 2.71
450191......................................................... 2.51
450192......................................................... 1.65
450193......................................................... 3.61
450194......................................................... 2.17
450196......................................................... 2.52
450200......................................................... 2.33
450201......................................................... 2.06
450203......................................................... 1.84
450209......................................................... 1.76
450210......................................................... 1.63
450211......................................................... 2.19
450214......................................................... 2.43
450217......................................................... 1.05
450219......................................................... 2.22
450221......................................................... 1.20
450222......................................................... 2.22
450224......................................................... 1.90
450229......................................................... 2.52
450231......................................................... 2.65
450234......................................................... 1.39
450235......................................................... 1.93
450236......................................................... 2.48
450237......................................................... 1.78
450239......................................................... 1.35
450241......................................................... 1.31
450243......................................................... 1.41
450246......................................................... 1.43
450249......................................................... 1.22
450250......................................................... 1.22
450253......................................................... 2.38
450258......................................................... 1.08
450259......................................................... 2.05
450264......................................................... 0.91
450269......................................................... 1.24
450270......................................................... 1.46
450271......................................................... 1.30
450272......................................................... 2.76
450276......................................................... 1.36
450278......................................................... 1.34
450280......................................................... 1.76
450283......................................................... 1.29
450286......................................................... 1.18
450288......................................................... 1.59
450289......................................................... 1.04
450292......................................................... 1.74
450293......................................................... 1.60
450296......................................................... 2.13
450299......................................................... 2.26
450303......................................................... 1.03
450306......................................................... 3.30
450307......................................................... 1.00
450309......................................................... 1.49
450315......................................................... 2.47
450320......................................................... 1.79
450321......................................................... 1.16
450322......................................................... 1.06
450324......................................................... 2.35
450327......................................................... 0.95
450330......................................................... 1.67
450334......................................................... 1.07
450337......................................................... 1.39
450340......................................................... 2.47
450341......................................................... 1.87
450346......................................................... 1.98
450347......................................................... 2.27
450348......................................................... 1.14
450351......................................................... 3.89
450352......................................................... 2.17
450353......................................................... 1.66
450355......................................................... 1.15
450358......................................................... 2.48
450362......................................................... 2.40
450369......................................................... 1.44
450370......................................................... 4.40
450371......................................................... 2.02
450372......................................................... 2.61
450373......................................................... 1.32
450374......................................................... 0.99
450376......................................................... 2.22
450378......................................................... 1.66
450379......................................................... 2.29
450381......................................................... 1.67
450388......................................................... 2.66
450389......................................................... 2.00
450393......................................................... 1.84
450395......................................................... 1.50
450399......................................................... 1.00
450400......................................................... 1.73
450403......................................................... 1.71
450411......................................................... 1.61
450417......................................................... 1.75
450418......................................................... 1.83
450419......................................................... 1.49
450423......................................................... 2.32
450424......................................................... 2.41
450429......................................................... 0.88
450431......................................................... 2.86
450438......................................................... 2.68
450446......................................................... 1.32
450447......................................................... 2.77
450451......................................................... 2.08
450457......................................................... 2.85
450460......................................................... 1.72
450462......................................................... 2.03
450464......................................................... 1.46
450465......................................................... 3.04
450467......................................................... 1.47
450469......................................................... 2.64
450473......................................................... 1.17
450475......................................................... 2.22
450484......................................................... 2.18
450488......................................................... 1.84
450489......................................................... 1.13
450497......................................................... 1.79
450498......................................................... 2.12
450508......................................................... 1.87
450514......................................................... 2.09
450517......................................................... 1.31
450518......................................................... 2.10
450523......................................................... 2.59
450530......................................................... 2.37
450534......................................................... 1.17
450535......................................................... 2.21
450537......................................................... 1.87
450538......................................................... 1.64
450539......................................................... 2.33
450544......................................................... 1.93
450545......................................................... 3.48
450547......................................................... 1.52
450550......................................................... 1.97
450551......................................................... 2.22
450558......................................................... 1.97
450559......................................................... 1.22
450561......................................................... 2.18
450563......................................................... 2.44
450565......................................................... 2.10
450570......................................................... 1.46
450571......................................................... 2.45
450573......................................................... 1.52
450574......................................................... 0.84
450575......................................................... 1.17
450578......................................................... 1.02
450580......................................................... 2.14
450583......................................................... 1.10
450584......................................................... 1.71
450586......................................................... 1.56
450587......................................................... 1.86
450591......................................................... 2.51
450596......................................................... 2.29
450597......................................................... 1.60
450603......................................................... 1.05
450604......................................................... 2.39
450605......................................................... 1.92
450609......................................................... 1.06
450610......................................................... 2.47
[[Page 35504]]
450614......................................................... 1.50
450615......................................................... 1.98
450617......................................................... 2.12
450620......................................................... 1.38
450623......................................................... 1.81
450626......................................................... 1.13
450628......................................................... 1.17
450630......................................................... 2.17
450631......................................................... 2.20
450632......................................................... 0.78
450633......................................................... 2.27
450634......................................................... 2.37
450638......................................................... 2.97
450639......................................................... 2.27
450641......................................................... 1.70
450643......................................................... 2.16
450644......................................................... 2.47
450646......................................................... 2.32
450647......................................................... 2.94
450648......................................................... 1.75
450649......................................................... 1.37
450651......................................................... 2.04
450652......................................................... 1.21
450653......................................................... 2.35
450654......................................................... 1.19
450656......................................................... 2.51
450658......................................................... 1.93
450659......................................................... 2.36
450661......................................................... 2.98
450662......................................................... 1.63
450665......................................................... 1.61
450666......................................................... 1.81
450668......................................................... 2.66
450669......................................................... 2.18
450670......................................................... 2.34
450672......................................................... 2.64
450673......................................................... 1.22
450674......................................................... 2.94
450675......................................................... 2.10
450677......................................................... 2.23
450678......................................................... 2.58
450683......................................................... 2.18
450684......................................................... 1.93
450686......................................................... 2.16
450688......................................................... 1.96
450690......................................................... 1.50
450691......................................................... 1.76
450694......................................................... 2.35
450696......................................................... 9.87
450697......................................................... 1.90
450698......................................................... 0.94
450700......................................................... 1.36
450702......................................................... 2.25
450703......................................................... 1.20
450704......................................................... 2.16
450705......................................................... 1.61
450706......................................................... 2.12
450709......................................................... 2.77
450711......................................................... 2.40
450712......................................................... 1.34
450713......................................................... 2.35
450715......................................................... 1.59
450716......................................................... 2.51
450717......................................................... 1.98
450718......................................................... 2.23
450723......................................................... 1.80
450724......................................................... 3.48
450725......................................................... 1.70
450727......................................................... 1.85
450728......................................................... 1.09
450730......................................................... 2.03
450733......................................................... 2.29
450735......................................................... 0.59
450742......................................................... 2.15
450743......................................................... 2.75
450746......................................................... 1.34
450747......................................................... 2.56
450749......................................................... 1.11
450750......................................................... 1.40
450751......................................................... 2.18
450754......................................................... 1.69
450755......................................................... 1.71
450757......................................................... 1.08
450758......................................................... 2.03
450760......................................................... 2.45
450761......................................................... 1.18
450763......................................................... 1.70
450766......................................................... 5.27
450769......................................................... 1.08
450770......................................................... 1.35
450774......................................................... 4.58
450775......................................................... 2.11
450776......................................................... 1.34
450777......................................................... 1.52
450779......................................................... 1.89
450780......................................................... 5.46
450788......................................................... 1.72
450795......................................................... 0.93
450797......................................................... 8.56
450801......................................................... 2.42
450802......................................................... 2.75
450803......................................................... 1.22
450804......................................................... 5.75
450809......................................................... 2.15
452013......................................................... 0.93
452019......................................................... 1.81
452022......................................................... 1.41
452033......................................................... 0.93
452036......................................................... 0.74
452038......................................................... 1.26
452039......................................................... 0.96
452043......................................................... 1.02
453025......................................................... 1.17
453028......................................................... 0.84
453029......................................................... 1.13
453031......................................................... 1.57
453033......................................................... 0.88
453034......................................................... 1.09
453035......................................................... 1.98
453036......................................................... 2.77
453037......................................................... 1.31
453038......................................................... 1.26
453040......................................................... 1.19
453041......................................................... 1.14
453042......................................................... 1.06
453044......................................................... 1.79
453047......................................................... 1.21
453048......................................................... 1.06
453052......................................................... 1.51
453053......................................................... 1.38
453054......................................................... 1.51
453056......................................................... 1.47
453057......................................................... 1.33
453059......................................................... 0.80
453065......................................................... 3.10
453300......................................................... 1.21
453302......................................................... 1.60
453304......................................................... 1.53
453305......................................................... 1.02
454012......................................................... 1.31
454018......................................................... 1.31
454026......................................................... 1.47
454028......................................................... 1.31
454029......................................................... 1.95
454030......................................................... 1.31
454032......................................................... 1.18
454037......................................................... 1.32
454038......................................................... 1.31
454042......................................................... 1.30
454043......................................................... 1.31
454045......................................................... 1.34
454050......................................................... 1.31
454056......................................................... 1.63
454057......................................................... 1.36
454063......................................................... 1.20
454064......................................................... 1.32
454065......................................................... 1.36
454066......................................................... 1.32
454069......................................................... 1.70
454072......................................................... 1.31
454073......................................................... 1.57
454089......................................................... 1.35
460001......................................................... 2.75
460003......................................................... 2.99
460004......................................................... 2.40
460005......................................................... 2.35
460006......................................................... 3.47
460007......................................................... 2.73
460008......................................................... 2.45
460009......................................................... 2.52
460010......................................................... 2.34
460011......................................................... 2.11
460013......................................................... 2.58
460014......................................................... 1.33
460015......................................................... 2.71
460016......................................................... 1.42
460017......................................................... 3.03
460018......................................................... 1.58
460019......................................................... 2.12
460020......................................................... 1.83
460021......................................................... 2.11
460022......................................................... 1.27
460023......................................................... 2.88
460024......................................................... 1.09
460025......................................................... 0.83
460026......................................................... 1.91
460027......................................................... 1.49
460029......................................................... 1.75
460030......................................................... 1.87
460032......................................................... 1.72
460033......................................................... 1.59
460035......................................................... 1.17
460036......................................................... 2.03
460037......................................................... 1.91
460039......................................................... 1.53
460041......................................................... 2.64
460042......................................................... 2.59
460044......................................................... 2.05
460046......................................................... 9.51
460047......................................................... 1.74
460049......................................................... 0.11
460050......................................................... 2.03
463025......................................................... 1.64
463301......................................................... 2.17
464003......................................................... 1.31
464010......................................................... 1.25
470001......................................................... 1.93
470003......................................................... 2.50
470004......................................................... 1.49
470005......................................................... 2.09
470006......................................................... 2.45
470008......................................................... 1.83
470010......................................................... 1.87
470011......................................................... 2.21
470012......................................................... 2.75
470015......................................................... 1.83
470018......................................................... 2.05
470020......................................................... 1.15
470023......................................................... 2.39
470024......................................................... 2.06
474001......................................................... 0.86
480001......................................................... 1.58
480002......................................................... 2.11
490001......................................................... 1.56
490002......................................................... 1.62
490004......................................................... 2.19
490005......................................................... 2.42
490006......................................................... 2.01
[[Page 35505]]
490007......................................................... 2.39
490009......................................................... 1.81
490011......................................................... 2.62
490012......................................................... 1.52
490013......................................................... 2.55
490014......................................................... 1.79
490015......................................................... 2.92
490017......................................................... 2.63
490018......................................................... 2.78
490019......................................................... 2.15
490020......................................................... 2.57
490022......................................................... 2.29
490023......................................................... 2.27
490024......................................................... 2.28
490027......................................................... 1.89
490030......................................................... 2.58
490031......................................................... 1.86
490032......................................................... 1.67
490033......................................................... 1.73
490035......................................................... 2.10
490037......................................................... 2.37
490038......................................................... 2.27
490040......................................................... 2.89
490041......................................................... 2.95
490042......................................................... 2.46
490043......................................................... 1.96
490044......................................................... 2.22
490045......................................................... 2.14
490046......................................................... 2.85
490047......................................................... 1.45
490048......................................................... 2.34
490050......................................................... 2.65
490052......................................................... 2.31
490053......................................................... 2.76
490054......................................................... 1.45
490057......................................................... 2.40
490059......................................................... 3.04
490060......................................................... 2.36
490063......................................................... 3.55
490066......................................................... 2.47
490067......................................................... 2.62
490069......................................................... 1.40
490071......................................................... 2.92
490073......................................................... 3.67
490074......................................................... 3.72
490075......................................................... 2.54
490077......................................................... 2.50
490079......................................................... 2.06
490084......................................................... 2.18
490085......................................................... 1.89
490088......................................................... 2.53
490089......................................................... 1.56
490090......................................................... 2.33
490091......................................................... 2.37
490092......................................................... 2.19
490093......................................................... 2.28
490094......................................................... 1.60
490095......................................................... 2.11
490097......................................................... 1.97
490098......................................................... 2.04
490099......................................................... 1.12
490100......................................................... 3.24
490101......................................................... 2.39
490107......................................................... 2.90
490110......................................................... 3.18
490111......................................................... 2.23
490112......................................................... 2.39
490113......................................................... 2.42
490114......................................................... 1.63
490115......................................................... 2.12
490116......................................................... 1.97
490117......................................................... 1.31
490118......................................................... 2.42
490119......................................................... 2.43
490120......................................................... 2.37
490122......................................................... 2.68
490123......................................................... 2.23
490124......................................................... 1.89
490126......................................................... 2.27
490127......................................................... 1.57
490130......................................................... 2.03
490131......................................................... 1.68
492001......................................................... 0.79
493025......................................................... 1.24
493026......................................................... 0.92
493027......................................................... 2.34
493028......................................................... 1.39
493301......................................................... 1.94
494001......................................................... 1.31
494011......................................................... 1.09
494018......................................................... 1.34
494020......................................................... 1.31
494022......................................................... 1.30
494023......................................................... 1.28
494025......................................................... 1.17
494026......................................................... 1.32
494028......................................................... 1.31
500001......................................................... 2.51
500002......................................................... 2.10
500003......................................................... 2.36
500005......................................................... 2.14
500007......................................................... 3.03
500008......................................................... 1.60
500011......................................................... 2.13
500012......................................................... 2.76
500014......................................................... 2.57
500015......................................................... 2.03
500019......................................................... 2.49
500021......................................................... 2.22
500023......................................................... 2.13
500024......................................................... 3.90
500025......................................................... 3.10
500026......................................................... 2.20
500027......................................................... 2.86
500029......................................................... 1.05
500030......................................................... 2.59
500031......................................................... 2.08
500033......................................................... 2.66
500036......................................................... 2.56
500037......................................................... 1.71
500039......................................................... 2.90
500041......................................................... 2.29
500042......................................................... 3.14
500043......................................................... 1.85
500044......................................................... 2.56
500045......................................................... 2.36
500048......................................................... 1.65
500049......................................................... 3.17
500050......................................................... 2.47
500051......................................................... 2.62
500053......................................................... 2.42
500054......................................................... 2.27
500055......................................................... 1.86
500057......................................................... 2.65
500058......................................................... 2.50
500059......................................................... 2.45
500060......................................................... 2.25
500061......................................................... 1.15
500062......................................................... 0.99
500064......................................................... 1.29
500065......................................................... 2.66
500068......................................................... 1.09
500069......................................................... 1.25
500071......................................................... 3.04
500072......................................................... 2.25
500073......................................................... 1.39
500074......................................................... 2.39
500077......................................................... 2.29
500079......................................................... 1.61
500080......................................................... 1.14
500084......................................................... 2.32
500085......................................................... 1.66
500086......................................................... 2.05
500088......................................................... 2.78
500089......................................................... 1.93
500090......................................................... 0.71
500092......................................................... 1.77
500094......................................................... 0.83
500096......................................................... 1.79
500097......................................................... 1.33
500098......................................................... 1.45
500101......................................................... 1.17
500102......................................................... 1.74
500104......................................................... 2.07
500106......................................................... 0.71
500107......................................................... 1.77
500108......................................................... 2.64
500110......................................................... 2.79
500118......................................................... 2.52
500119......................................................... 1.78
500122......................................................... 2.31
500123......................................................... 0.86
500124......................................................... 2.21
500125......................................................... 1.40
500129......................................................... 2.04
500132......................................................... 1.48
500138......................................................... 1.08
500139......................................................... 2.56
500141......................................................... 3.07
500146......................................................... 2.18
502002......................................................... 3.69
503300......................................................... 2.70
504002......................................................... 1.43
510001......................................................... 2.11
510002......................................................... 2.26
510004......................................................... 1.10
510005......................................................... 1.47
510006......................................................... 2.66
510007......................................................... 2.10
510008......................................................... 2.40
510012......................................................... 1.99
510013......................................................... 1.57
510015......................................................... 1.15
510016......................................................... 1.15
510018......................................................... 1.65
510020......................................................... 1.23
510022......................................................... 2.33
510023......................................................... 1.92
510024......................................................... 3.05
510026......................................................... 1.48
510027......................................................... 1.61
510028......................................................... 1.46
510029......................................................... 2.51
510030......................................................... 2.23
510031......................................................... 3.05
510033......................................................... 2.05
510038......................................................... 1.64
510039......................................................... 2.31
510043......................................................... 0.96
510046......................................................... 2.03
510047......................................................... 2.56
510048......................................................... 1.45
510050......................................................... 2.19
510053......................................................... 1.54
510055......................................................... 2.17
510058......................................................... 2.37
510059......................................................... 8.02
510060......................................................... 1.66
510063......................................................... 1.20
510065......................................................... 1.24
510066......................................................... 2.03
510067......................................................... 2.36
510068......................................................... 2.25
510070......................................................... 3.03
510071......................................................... 2.10
510072......................................................... 1.56
510077......................................................... 2.09
510081......................................................... 1.31
[[Page 35506]]
510082......................................................... 1.70
510084......................................................... 1.44
510085......................................................... 1.78
510086......................................................... 1.15
513026......................................................... 1.19
513027......................................................... 1.33
513028......................................................... 1.63
513030......................................................... 1.49
514001......................................................... 1.44
514007......................................................... 5.99
514008......................................................... 1.86
520002......................................................... 2.56
520003......................................................... 2.35
520004......................................................... 2.57
520006......................................................... 2.22
520007......................................................... 1.57
520008......................................................... 2.29
520009......................................................... 2.07
520010......................................................... 2.33
520011......................................................... 2.95
520013......................................................... 1.97
520014......................................................... 2.25
520015......................................................... 2.51
520016......................................................... 1.83
520017......................................................... 2.02
520018......................................................... 2.11
520019......................................................... 2.23
520021......................................................... 2.57
520024......................................................... 1.96
520025......................................................... 1.95
520026......................................................... 2.28
520028......................................................... 3.23
520029......................................................... 1.34
520030......................................................... 3.15
520031......................................................... 3.82
520032......................................................... 1.84
520033......................................................... 2.11
520034......................................................... 2.43
520035......................................................... 2.87
520037......................................................... 2.62
520038......................................................... 3.13
520039......................................................... 1.77
520040......................................................... 2.01
520041......................................................... 1.95
520042......................................................... 1.95
520044......................................................... 3.00
520045......................................................... 2.24
520047......................................................... 2.03
520048......................................................... 2.34
520049......................................................... 2.90
520053......................................................... 1.70
520054......................................................... 1.58
520057......................................................... 2.90
520058......................................................... 2.71
520059......................................................... 2.73
520060......................................................... 1.66
520062......................................................... 2.38
520063......................................................... 2.99
520064......................................................... 1.79
520066......................................................... 2.95
520068......................................................... 1.68
520069......................................................... 1.98
520070......................................................... 2.35
520071......................................................... 2.40
520074......................................................... 1.57
520075......................................................... 2.44
520076......................................................... 2.50
520077......................................................... 1.14
520078......................................................... 1.91
520082......................................................... 2.79
520083......................................................... 1.70
520087......................................................... 1.22
520088......................................................... 2.40
520089......................................................... 3.23
520090......................................................... 1.99
520091......................................................... 3.56
520092......................................................... 1.99
520094......................................................... 1.92
520095......................................................... 2.55
520096......................................................... 2.31
520097......................................................... 2.23
520098......................................................... 1.46
520100......................................................... 2.48
520101......................................................... 1.53
520102......................................................... 2.46
520103......................................................... 2.51
520107......................................................... 1.83
520109......................................................... 1.99
520110......................................................... 1.71
520111......................................................... 2.05
520112......................................................... 3.22
520113......................................................... 2.58
520114......................................................... 2.06
520115......................................................... 1.98
520116......................................................... 2.48
520117......................................................... 1.79
520118......................................................... 1.11
520120......................................................... 1.08
520121......................................................... 1.72
520122......................................................... 1.44
520123......................................................... 1.81
520124......................................................... 1.88
520130......................................................... 2.49
520131......................................................... 2.06
520132......................................................... 2.46
520134......................................................... 1.58
520135......................................................... 1.84
520136......................................................... 2.30
520138......................................................... 2.32
520139......................................................... 2.50
520140......................................................... 2.42
520141......................................................... 2.11
520142......................................................... 1.24
520144......................................................... 2.14
520145......................................................... 1.48
520146......................................................... 2.23
520148......................................................... 1.82
520149......................................................... 1.13
520151......................................................... 2.45
520152......................................................... 2.03
520153......................................................... 1.50
520154......................................................... 2.23
520156......................................................... 3.09
520157......................................................... 1.54
520160......................................................... 2.62
520161......................................................... 2.22
520170......................................................... 2.85
520171......................................................... 1.82
520173......................................................... 2.67
520177......................................................... 2.29
520178......................................................... 2.28
523025......................................................... 1.44
523300......................................................... 2.56
524000......................................................... 1.41
524003......................................................... 1.23
524017......................................................... 0.45
524034......................................................... 1.27
524035......................................................... 1.26
524038......................................................... 1.57
530002......................................................... 2.18
530003......................................................... 1.37
530004......................................................... 1.80
530005......................................................... 1.67
530006......................................................... 2.14
530008......................................................... 2.36
530009......................................................... 1.94
530010......................................................... 2.28
530011......................................................... 2.08
530012......................................................... 2.20
530014......................................................... 2.54
530015......................................................... 2.19
530016......................................................... 1.93
530017......................................................... 1.93
530018......................................................... 2.15
530019......................................................... 1.56
530022......................................................... 2.04
530023......................................................... 1.51
530025......................................................... 2.00
530026......................................................... 1.48
530027......................................................... 1.60
530029......................................................... 0.99
530031......................................................... 0.96
530032......................................................... 2.14
------------------------------------------------------------------------
Note: The national average service mix discounted for multiple
procedures is 2.05.
52. On pages 48030 through 48035, Addendum J is corrected to read
as follows:
[[Page 35506]]
Addendum J.--Wage Index for Urban Areas
------------------------------------------------------------------------
Wage
Urban code/Urban area (constituent counties) index
------------------------------------------------------------------------
0040 Abilene, TX.............................................. 0.8287
Taylor, TX
0060 Aguadilla, PR \2\........................................ 0.4188
Aguada, PR
Aguadilla, PR
Moca, PR
0080 Akron, OH................................................ 0.9728
Portage, OH
Summit, OH
0120 Albany, GA............................................... 0.7914
Dougherty, GA
Lee, GA
0160 Albany-Schenectady-Troy, NY.............................. 0.8480
Albany, NY
Montgomery, NY
Rensselaer, NY
Saratoga, NY
Schenectady, NY
Schoharie, NY
0200 Albuquerque, NM.......................................... 0.9329
Bernalillo, NM
Sandoval, NM
Valencia, NM
0220 Alexandria, LA........................................... 0.8269
Rapides, LA
0240 Allentown-Bethlehem-Easton, PA........................... 1.0086
Carbon, PA
Lehigh, PA
Northampton, PA
0280 Altoona, PA.............................................. 0.9137
[[Page 35507]]
Blair, PA
0320 Amarillo, TX............................................. 0.9425
Potter, TX
Randall, TX
0380 Anchorage, AK............................................ 1.2998
Anchorage, AK
0440 Ann Arbor, MI............................................ 1.1785
Lenawee, MI
Livingston, MI
Washtenaw, MI
0450 Anniston, AL............................................. 0.8266
Calhoun, AL
0460 Appleton-Oshkosh-Neenah, WI.............................. 0.8996
Calumet, WI
Outagamie, WI
Winnebago, WI
0470 Arecibo, PR \2\.......................................... 0.4218
Arecibo, PR
Camuy, PR
Hatillo, PR
0480 Asheville, NC............................................ 0.9072
Buncombe, NC
Madison, NC
0500 Athens, GA............................................... 0.9087
Clarke, GA
Madison, GA
Oconee, GA
0520 Atlanta, GA \1\.......................................... 0.9823
Barrow, GA
Bartow, GA
Carroll, GA
Cherokee, GA
Clayton, GA
Cobb, GA
Coweta, GA
DeKalb, GA
Douglas, GA
Fayette, GA
Forsyth, GA
Fulton, GA
Gwinnett, GA
Henry, GA
Newton, GA
Paulding, GA
Pickens, GA
Rockdale, GA
Spalding, GA
Walton, GA
0560 Atlantic-Cape May, NJ.................................... 1.0724
Atlantic, NJ
Cape May, NJ
0600 Augusta-Aiken, GA-SC..................................... 0.9333
Columbia, GA
McDuffie, GA
Richmond, GA
Aiken, SC
Edgefield, SC
0640 Austin-San Marcos, TX \1\................................ 0.9133
Bastrop, TX
Caldwell, TX
Hays, TX
Travis, TX
Williamson, TX
0680 Bakersfield, CA.......................................... 1.0014
Kern, CA
0720 Baltimore, MD \1\........................................ 0.9689
Anne Arundel, MD
Baltimore, MD
BaltimoreCity, MD
Carroll, MD
Harford, MD
Howard, MD
Queen Anne's, MD
0733 Bangor, ME............................................... 0.9478
Penobscot, ME
0743 Barnstable-Yarmouth, MA.................................. 1.4291
Barnstable, MA
0760 Baton Rouge, LA.......................................... 0.8382
Ascension, LA
East Baton Rouge, LA
Livingston, LA
West Baton Rouge, LA
0840 Beaumont-Port Arthur, TX................................. 0.8593
Hardin, TX
Jefferson, TX
Orange, TX
0860 Bellingham, WA........................................... 1.1221
Whatcom, WA
0870 Benton Harbor, MI \2\.................................... 0.8923
Berrien, MI
0875 Bergen-Passaic, NJ \1\................................... 1.1570
Bergen, NJ
Passaic, NJ
0880 Billings, MT............................................. 0.9783
Yellowstone, MT
0920 Biloxi-Gulfport-Pascagoula, MS........................... 0.8415
Hancock, MS
Harrison, MS
Jackson, MS
0960 Binghamton, NY........................................... 0.8914
Broome, NY
Tioga, NY
1000 Birmingham, AL........................................... 0.9005
Blount, AL
Jefferson, AL
St. Clair, AL
Shelby, AL
1010 Bismarck, ND............................................. 0.7859
Burleigh, ND
Morton, ND
1020 Bloomington, IN.......................................... 0.9128
Monroe, IN
1040 Bloomington-Normal, IL................................... 0.8733
McLean, IL
1080 Boise City, ID........................................... 0.8887
Ada, ID
Canyon, ID
1123 Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH \1\..... 1.1498
Bristol, MA
Essex, MA
Middlesex, MA
Norfolk, MA
Plymouth, MA
Suffolk, MA
Worcester, MA
Hillsborough, NH
Merrimack, NH
Rockingham, NH
Strafford, NH
1125 Boulder-Longmont, CO..................................... 1.0015
Boulder, CO
1145 Brazoria, TX............................................. 0.9129
Brazoria, TX
1150 Bremerton, WA............................................ 1.0999
Kitsap, WA
1240 Brownsville-Harlingen-San Benito, TX..................... 0.8740
Cameron, TX
1260 Bryan-College Station, TX................................ 0.8571
Brazos, TX
1280 Buffalo-Niagara Falls, NY \1\............................ 0.9272
Erie, NY
Niagara, NY
1303 Burlington, VT........................................... 1.0142
Chittenden, VT
Franklin, VT
GrandIsle, VT
1310 Caguas, PR............................................... 0.4508
Caguas, PR
Cayey, PR
Cidra, PR
Gurabo, PR
San Lorenzo, PR
1320 Canton-Massillon, OH..................................... 0.8961
Carroll, OH
Stark, OH
1350 Casper, WY............................................... 0.9013
Natrona, WY
1360 Cedar Rapids, IA......................................... 0.8529
Linn, IA
1400 Champaign-Urbana, IL..................................... 0.8824
Champaign, IL
1440 Charleston-North Charleston, SC.......................... 0.8807
Berkeley, SC
Charleston, SC
Dorchester, SC
1480 Charleston, WV........................................... 0.9142
Kanawha, WV
Putnam, WV
1520 Charlotte-Gastonia-Rock Hill, NC-SC \1\.................. 0.9710
Cabarrus, NC
Gaston, NC
Lincoln, NC
Mecklenburg, NC
Rowan, NC
Stanly, NC
Union, NC
York, SC
1540 Charlottesville, VA...................................... 0.9051
Albemarle, VA
Charlottesville City, VA
Fluvanna, VA
Greene, VA
1560 Chattanooga, TN-GA....................................... 0.8658
Catoosa, GA
Dade, GA
Walker, GA
Hamilton, TN
Marion, TN
1580 Cheyenne, WY \2\......................................... 0.8247
Laramie, WY
1600 Chicago, IL \1\.......................................... 1.0860
Cook, IL
DeKalb, IL
DuPage, IL
Grundy, IL
Kane, IL
Kendall, IL
Lake, IL
McHenry, IL
Will, IL
1620 Chico-Paradise, CA....................................... 1.0429
Butte, CA
1640 Cincinnati, OH-KY-IN \1\................................. 0.9521
Dearborn, IN
Ohio, IN
Boone, KY
Campbell, KY
Gallatin, KY
Grant, KY
Kenton, KY
Pendleton, KY
Brown, OH
Clermont, OH
Hamilton, OH
Warren, OH
1660 Clarksville-Hopkinsville, TN-KY.......................... 0.7852
Christian, KY
Montgomery, TN
1680 Cleveland-Lorain-Elyria, OH \1\.......................... 0.9804
Ashtabula, OH
Cuyahoga, OH
Geauga, OH
[[Page 35508]]
Lake, OH
Lorain, OH
Medina, OH
1720 Colorado Springs, CO..................................... 0.9316
ElPaso, CO
1740 Columbia, MO............................................. 0.9001
Boone, MO
1760 Columbia, SC............................................. 0.9192
Lexington, SC
Richland, SC
1800 Columbus, GA-AL.......................................... 0.8288
Russell, AL
Chattahoochee, GA
Harris, GA
Muscogee, GA
1840 Columbus, OH \1\......................................... 0.9793
Delaware, OH
Fairfield, OH
Franklin, OH
Licking, OH
Madison, OH
Pickaway, OH
1880 Corpus Christi, TX....................................... 0.8945
Nueces, TX
San Patricio, TX
1900 Cumberland, MD-WV........................................ 0.8822
Allegany, MD
Mineral, WV
1920 Dallas, TX \1\........................................... 0.9674
Collin, TX
Dallas, TX
Denton, TX
Ellis, TX
Henderson, TX
Hunt, TX
Kaufman, TX
Rockwall, TX
1950 Danville, VA............................................. 0.8146
Danville City, VA
Pittsylvania, VA
1960 Davenport-Moline-Rock Island, IA-IL...................... 0.8405
Scott, IA
Henry, IL
Rock Island, IL
2000 Dayton-Springfield, OH................................... 0.9279
Clark, OH
Greene, OH
Miami, OH
Montgomery, OH
2020 Daytona Beach, FL \2\.................................... 0.8838
Flagler, FL
Volusia, FL
2030 Decatur, AL.............................................. 0.8286
Lawrence, AL
Morgan, AL
2040 Decatur, IL.............................................. 0.7915
Macon, IL
2080 Denver, CO \1\........................................... 1.0386
Adams, CO
Arapahoe, CO
Denver, CO
Douglas, CO
Jefferson, CO
2120 Des Moines, IA........................................... 0.8837
Dallas, IA
Polk, IA
Warren, IA
2160 Detroit, MI \1\.......................................... 1.0840
Lapeer, MI
Macomb, MI
Monroe, MI
Oakland, MI
St. Clair, MI
Wayne, MI
2180 Dothan, AL............................................... 0.8070
Dale, AL
Houston, AL
2190 Dover, DE................................................ 0.9303
Kent, DE
2200 Dubuque, IA.............................................. 0.8088
Dubuque, IA
2240 Duluth-Superior, MN-WI................................... 0.9779
St. Louis, MN
Douglas, WI
2281 Dutchess County, NY...................................... 1.0632
Dutchess, NY
2290 Eau Claire, WI........................................... 0.8764
Chippewa, WI
Eau Claire, WI
2320 El Paso, TX.............................................. 1.0123
El Paso, TX
2330 Elkhart-Goshen, IN....................................... 0.9081
Elkhart, IN
2335 Elmira, NY \2\........................................... 0.8401
Chemung, NY
2340 Enid, OK................................................. 0.7962
Garfield, OK
2360 Erie, PA................................................. 0.8862
Erie, PA
2400 Eugene-Springfield, OR................................... 1.1659
Lane, OR
2440 Evansville-Henderson, IN-KY.............................. 0.8641
Posey, IN
Vanderburgh, IN
Warrick, IN
Henderson, KY
2520 Fargo-Moorhead, ND-MN.................................... 0.8837
Clay, MN
Cass, ND
2560 Fayetteville, NC......................................... 0.8734
Cumberland, NC
2580 Fayetteville-Springdale-Rogers, AR....................... 0.7461
Benton, AR
Washington, AR
2620 Flagstaff, AZ-UT......................................... 0.9115
Coconino, AZ
Kane, UT
2640 Flint, MI................................................ 1.1171
Genesee, MI
2650 Florence, AL............................................. 0.7716
Colbert, AL
Lauderdale, AL
2655 Florence, SC............................................. 0.8711
Florence, SC
2670 Fort Collins-Loveland, CO................................ 1.0248
Larimer, CO
2680 Ft. Lauderdale, FL \1\................................... 1.0487
Broward, FL
2700 Fort Myers-Cape Coral, FL \2\............................ 0.8838
Lee, FL
2710 Fort Pierce-Port St. Lucie, FL........................... 1.0257
Martin, FL
St. Lucie, FL
2720 Fort Smith, AR-OK........................................ 0.7769
Crawford, AR
Sebastian, AR
Sequoyah, OK
2750 Fort Walton Beach, FL \2\................................ 0.8838
Okaloosa, FL
2760 Fort Wayne, IN........................................... 0.8901
Adams, IN
Allen, IN
DeKalb, IN
Huntington, IN
Wells, IN
Whitley, IN
2800 Forth Worth-Arlington, TX \1\............................ 0.9997
Hood, TX
Johnson, TX
Parker, TX
Tarrant, TX
2840 Fresno, CA............................................... 1.0607
Fresno, CA
Madera, CA
2880 Gadsden, AL.............................................. 0.8815
Etowah, AL
2900 Gainesville, FL.......................................... 0.9616
Alachua, FL
2920 Galveston-Texas City, TX................................. 1.0564
Galveston, TX
2960 Gary, IN................................................. 0.9270
Lake, IN
Porter, IN
2975 Glens Falls, NY \2\...................................... 0.8401
Warren, NY
Washington, NY
2980 Goldsboro, NC............................................ 0.8443
Wayne, NC
2985 Grand Forks, ND-MN....................................... 0.8815
Polk, MN
Grand Forks, ND
2995 Grand Junction, CO....................................... 0.9491
Mesa, CO
3000 Grand Rapids-Muskegon-Holland, MI \1\.................... 1.0147
Allegan, MI
Kent, MI
Muskegon, MI
Ottawa, MI
3040 Great Falls, MT.......................................... 0.9306
Cascade, MT
3060 Greeley, CO.............................................. 1.0097
Weld, CO
3080 Green Bay, WI............................................ 0.9585
Brown, WI
3120 Greensboro-Winston-Salem-High Point, NC \1\.............. 0.9351
Alamance, NC
Davidson, NC
Davie, NC
Forsyth, NC
Guilford, NC
Randolph, NC
Stokes, NC
Yadkin, NC
3150 Greenville, NC........................................... 0.9064
Pitt, NC
3160 Greenville-Spartanburg-Anderson, SC...................... 0.9059
Anderson, SC
Cherokee, SC
Greenville, SC
Pickens, SC
Spartanburg, SC
3180 Hagerstown, MD........................................... 0.9681
Washington, MD
3200 Hamilton-Middletown, OH.................................. 0.8767
Butler, OH
3240 Harrisburg-Lebanon-Carlisle, PA.......................... 1.0187
Cumberland, PA
Dauphin, PA
Lebanon, PA
Perry, PA
3283 Hartford, CT \1\ \2\.................................... 1.2617
Hartford, CT
Litchfield, CT
Middlesex, CT
Tolland, CT
3285 Hattiesburg, MS.......................................... 0.7192
Forrest, MS
Lamar, MS
3290 Hickory-Morganton-Lenoir, NC............................. 0.8285
Alexander, NC
[[Page 35509]]
Burke, NC
Caldwell, NC
Catawba, NC
3320 Honolulu, HI............................................. 1.1817
Honolulu, HI
3350 Houma, LA................................................ 0.7854
Lafourche, LA
Terrebonne, LA
3360 Houston, TX \1\.......................................... 0.9855
Chambers, TX
FortBend, TX
Harris, TX
Liberty, TX
Montgomery, TX
Waller, TX
3400 Huntington-Ashland, WV-KY-OH............................. 0.9160
Boyd, KY
Carter, KY
Greenup, KY
Lawrence, OH
Cabell, WV
Wayne, WV
3440 Huntsville, AL........................................... 0.8485
Limestone, AL
Madison, AL
3480 Indianapolis, IN \1\..................................... 0.9848
Boone, IN
Hamilton, IN
Hancock, IN
Hendricks, IN
Johnson, IN
Madison, IN
Marion, IN
Morgan, IN
Shelby, IN
3500 Iowa City, IA............................................ 0.9413
Johnson, IA
3520 Jackson, MI.............................................. 0.9052
Jackson, MI
3560 Jackson, MS.............................................. 0.7790
Hinds, MS
Madison, MS
Rankin, MS
3580 Jackson, TN.............................................. 0.8522
Madison, TN
Chester, TN
3600 Jacksonville, FL \1\..................................... 0.8969
Clay, FL
Duval, FL
Nassau, FL
St. Johns, FL
3605 Jacksonville, NC \2\..................................... 0.7939
Onslow, NC
3610 Jamestown, NY \2\........................................ 0.8401
Chautauqua, NY
3620 Janesville-Beloit, WI.................................... 0.8824
Rock, WI
3640 Jersey City, NJ.......................................... 1.1412
Hudson, NJ
3660 Johnson City-Kingsport-Bristol, TN-VA.................... 0.9114
Carter, TN
Hawkins, TN
Sullivan, TN
Unicoi, TN
Washington, TN
Bristol City, VA
Scott, VA
Washington, VA
3680 Johnstown, PA \2\........................................ 0.8421
Cambria, PA
Somerset, PA
3700 Jonesboro, AR............................................ 0.7443
Craighead, AR
3710 Joplin, MO............................................... 0.7541
Jasper, MO
Newton, MO
3720 Kalamazoo-Battlecreek, MI................................ 1.0668
Calhoun, MI
Kalamazoo, MI
Van Buren, MI
3740 Kankakee, IL............................................. 0.8653
Kankakee, IL
3760 Kansas City, KS-MO \1\................................... 0.9564
Johnson, KS
Leavenworth, KS
Miami, KS
Wyandotte, KS
Cass, MO
Clay, MO
Clinton, MO
Jackson, MO
Lafayette, MO
Platte, MO
Ray, MO
3800 Kenosha, WI.............................................. 0.9196
Kenosha, WI
3810 Killeen-Temple, TX....................................... 1.0252
Bell, TX
Coryell, TX
3840 Knoxville, TN............................................ 0.8831
Anderson, TN
Blount, TN
Knox, TN
Loudon, TN
Sevier, TN
Union, TN
3850 Kokomo, IN............................................... 0.8416
Howard, IN
Tipton, IN
3870 LaCrosse, WI-MN.......................................... 0.8749
Houston, MN
LaCrosse, WI
3880 Lafayette, LA............................................ 0.8227
Acadia, LA
Lafayette, LA
St. Landry, LA
St. Martin, LA
3920 Lafayette, IN............................................ 0.9174
Clinton, IN
Tippecanoe, IN
3960 Lake Charles, LA......................................... 0.7776
Calcasieu, LA
3980 Lakeland-Winter Haven, FL \2\............................ 0.8838
Polk, FL
4000 Lancaster, PA............................................ 0.9481
Lancaster, PA
4040 Lansing-East Lansing, MI................................. 1.0088
Clinton, MI
Eaton, MI
Ingham, MI
4080 Laredo, TX \2\........................................... 0.7404
Webb, TX
4100 Las Cruces, NM........................................... 0.8658
Dona Ana, NM
4120 Las Vegas, NV-AZ \1\..................................... 1.0592
Mohave, AZ
Clark, NV
Nye, NV
4150 Lawrence, KS............................................. 0.8608
Douglas, KS
4200 Lawton, OK............................................... 0.9045
Comanche, OK
4243 Lewiston-Auburn, ME...................................... 0.9536
Androscoggin, ME
4280 Lexington, KY............................................ 0.8416
Bourbon, KY
Clark, KY
Fayette, KY
Jessamine, KY
Madison, KY
Scott, KY
Woodford, KY
4320 Lima, OH................................................. 0.9185
Allen, OH
Auglaize, OH
4360 Lincoln, NE.............................................. 0.9231
Lancaster, NE
4400 Little Rock-North Little Rock, AR........................ 0.8490
Faulkner, AR
Lonoke, AR
Pulaski, AR
Saline, AR
4420 Longview-Marshall, TX.................................... 0.8613
Gregg, TX
Harrison, TX
Upshur, TX
4480 Los Angeles-Long Beach, CA \1\........................... 1.2268
Los Angeles, CA
4520 Louisville, KY-IN........................................ 0.9507
Clark, IN
Floyd, IN
Harrison, IN
Scott, IN
Bullitt, KY
Jefferson, KY
Oldham, KY
4600 Lubbock, TX.............................................. 0.8400
Lubbock, TX
4640 Lynchburg, VA............................................ 0.8228
Amherst, VA
Bedford, VA
Bedford City, VA
Campbell, VA
Lynchburg City, VA
4680 Macon, GA................................................ 0.9227
Bibb, GA
Houston, GA
Jones, GA
Peach, GA
Twiggs, GA
4720 Madison, WI.............................................. 1.0055
Dane, WI
4800 Mansfield, OH............................................ 0.8639
Crawford, OH
Richland, OH
4840 Mayaguez, PR............................................. 0.4475
Anasco, PR
Cabo Rojo, PR
Hormigueros, PR
Mayaguez, PR
Sabana Grande, PR
San German, PR
4880 McAllen-Edinburg-Mission, TX............................. 0.8371
Hidalgo, TX
4890 Medford-Ashland, OR...................................... 1.0354
Jackson, OR
4900 Melbourne-Titusville-Palm Bay, FL \2\.................... 0.8838
Brevard, Fl
4920 Memphis, TN-AR-MS \1\.................................... 0.8589
Crittenden, AR
DeSoto, MS
Fayette, TN
Shelby, TN
Tipton, TN
4940 Merced, CA............................................... 1.0947
Merced, CA
5000 Miami, FL \1\............................................ 0.9859
Dade, FL
5015 Middlesex-Somerset-Hunterdon, NJ \1\..................... 1.0875
Hunterdon, NJ
Middlesex, NJ
Somerset, NJ
[[Page 35510]]
5080 Milwaukee-Waukesha, WI \1\............................... 0.9819
Milwaukee, WI
Ozaukee, WI
Washington, WI
Waukesha, WI
5120 Minneapolis-St. Paul, MN-WI \1\.......................... 1.0733
Anoka, MN
Carver, MN
Chisago, MN
Dakota, MN
Hennepin, MN
Isanti, MN
Ramsey, MN
Scott, MN
Sherburne, MN
Washington, MN
Wright, MN
Pierce, WI
St. Croix, WI
5160 Mobile, AL............................................... 0.8455
Baldwin, AL
Mobile, AL
5170 Modesto, CA.............................................. 1.0377
Stanislaus, CA
5190 Monmouth-Ocean, NJ \1\................................... 1.0934
Monmouth, NJ
Ocean, NJ
5200 Monroe, LA............................................... 0.8414
Ouachita, LA
5240 Montgomery, AL........................................... 0.7813
Autauga, AL
Elmore, AL
Montgomery, AL
5280 Muncie, IN............................................... 0.9173
Delaware, IN
5330 Myrtle Beach, SC......................................... 0.8072
Horry, SC
5345 Naples, FL............................................... 1.0109
Collier, FL
5360 Nashville, TN \1\........................................ 0.9182
Cheatham, TN
Davidson, TN
Dickson, TN
Robertson, TN
RutherfordTN
Sumner, TN
Williamson, TN
Wilson, TN
5380 Nassau-Suffolk, NY \1\................................... 1.3807
Nassau, NY
Suffolk, NY
5483 New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT \1\.. 1.2619
Fairfield, CT
New Haven, CT
5523 New London-Norwich, CT \2\............................... 1.2617
New London, CT
5560 New Orleans, LA \1\...................................... 0.9566
Jefferson, LA
Orleans, LA
Plaquemines, LA
St. Bernard, LA
St. Charles, LA
St. James, LA
St. John The Baptist, LA
St. Tammany, LA
5600 New York, NY \1\......................................... 1.4449
Bronx, NY
Kings, NY
New York, NY
Putnam, NY
Queens, NY
Richmond, NY
Rockland, NY
Westchester, NY
5640 Newark, NJ \1\........................................... 1.1111
Essex, NJ
Morris, NJ
Sussex, NJ
Union, NJ
Warren, NJ
5660 Newburgh, NY-PA.......................................... 1.1283
Orange, NY
Pike, PA
5720 Norfolk-Virginia Beach-Newport News, VA-NC \1\........... 0.8316
Currituck, NC
Chesapeake City, VA
Gloucester, VA
Hampton City, VA
Isle of Wight, VA
James City, VA
Mathews, VA
Newport News City, VA
Norfolk City, VA
Poquoson City, VA
Portsmouth City, VA
Suffolk City, VA
Virginia Beach City, VA
Williamsburg City, VA
York, VA
5775 Oakland, CA \1\.......................................... 1.5158
Alameda, CA
Contra Costa, CA
5790 Ocala, FL................................................ 0.9032
Marion, FL
5800 Odessa-Midland, TX....................................... 0.8660
Ector, TX
Midland, TX
5880 Oklahoma City, OK \1\.................................... 0.8481
Canadian, OK
Cleveland, OK
Logan, OK
McClain, OK
Oklahoma, OK
Pottawatomie, OK
5910 Olympia, WA.............................................. 1.0901
Thurston, WA
5920 Omaha, NE-IA............................................. 0.9421
Pottawattamie, IA
Cass, NE
Douglas, NE
Sarpy, NE
Washington, NE
5945 Orange County, CA \1\.................................... 1.1532
Orange, CA
5960 Orlando, FL \1\.......................................... 0.9397
Lake, FL
Orange, FL
Osceola, FL
Seminole, FL
5990 Owensboro, KY \2\........................................ 0.7772
Daviess, KY
6015 Panama City, FL \2\...................................... 0.8838
Bay, FL
6020 Parkersburg-Marietta, WV-OH (West Virginia Hospitals) \2\ 0.8046
Washington, OH
Wood, WV
6020 Parkersburg-Marietta, WV-OH (Ohio Hospitals) \2\......... 0.8434
Washington, OH
Wood, WV
6080 Pensacola, FL \2\........................................ 0.8838
Escambia, FL
Santa Rosa, FL
6120 Peoria-Pekin, IL......................................... 0.8571
Peoria, IL
Tazewell, IL
Woodford, IL
6160 Philadelphia, PA-NJ \1\.................................. 1.1398
Burlington, NJ
Camden, NJ
Gloucester, NJ
Salem, NJ
Bucks, PA
Chester, PA
Delaware, PA
Montgomery, PA
Philadelphia, PA
6200 Phoenix-Mesa, AZ \1\..................................... 0.9606
Maricopa, AZ
Pinal, AZ
6240 Pine Bluff, AR........................................... 0.7826
Jefferson, AR
6280 Pittsburgh, PA \1\....................................... 0.9725
Allegheny, PA
Beaver, PA
Butler, PA
Fayette, PA
Washington, PA
Westmoreland, PA
6323 Pittsfield, MA........................................... 1.0960
Berkshire, MA
6340 Pocatello, ID............................................ 0.9586
Bannock, ID
6360 Ponce, PR................................................ 0.4589
Guayanilla, PR
Juana Diaz, PR
Penuelas, PR
Ponce, PR
Villalba, PR
Yauco, PR
6403 Portland, ME............................................. 0.9627
Cumberland, ME
Sagadahoc, ME
York, ME
6440 Portland-Vancouver, OR-WA \1\............................ 1.1344
Clackamas, OR
Columbia, OR
Multnomah, OR
Washington, OR
Yamhill, OR
Clark, WA
6483 Providence-Warwick-Pawtucket, RI \1\..................... 1.1049
Bristol, RI
Kent, RI
Newport, RI
Providence, RI
Washington, RI
6520 Provo-Orem, UT........................................... 1.0073
Utah, UT
6560 Pueblo, CO............................................... 0.8450
Pueblo, CO
6580 Punta Gorda, FL \2\...................................... 0.8838
Charlotte, FL
6600 Racine, WI............................................... 0.8934
Racine, WI
6640 Raleigh-Durham-Chapel Hill, NC \2\....................... 0.9818
Chatham, NC
Durham, NC
Franklin, NC
Johnston, NC
Orange, NC
Wake, NC
6660 Rapid City, SD........................................... 0.8345
Pennington, SD
6680 Reading, PA.............................................. 0.9516
Berks, PA
6690 Redding, CA.............................................. 1.1790
Shasta, CA
6720 Reno, NV................................................. 1.0768
Washoe, NV
6740 Richland-Kennewick-Pasco, WA \2\......................... 1.0221
[[Page 35511]]
Benton, WA
Franklin, WA
6760 Richmond-Petersburg, VA.................................. 0.9152
Charles City County, VA
Chesterfield, VA
Colonial Heights City, VA
Dinwiddie, VA
Goochland, VA
Hanover, VA
Henrico, VA
Hopewell City, VA
NewKent, VA
Petersburg City, VA
Powhatan, VA
Prince George, VA
Richmond City, VA
6780 Riverside-San Bernardino, CA \1\......................... 1.1145
Riverside, CA
San Bernardino, CA
6800 Roanoke, VA.............................................. 0.8402
Botetourt, VA
Roanoke, VA
Roanoke City, VA
Salem City, VA
6820 Rochester, MN............................................ 1.0502
Olmsted, MN
6840 Rochester, NY \1\........................................ 0.9524
Genesee, NY
Livingston, NY
Monroe, NY
Ontario, NY
Orleans, NY
Wayne, NY
6880 Rockford, IL............................................. 0.9081
Boone, IL
Ogle, IL
Winnebago, IL
6895 Rocky Mount, NC.......................................... 0.9029
Edgecombe, NC
Nash, NC
6920 Sacramento, CA \1\....................................... 1.2202
El Dorado, CA
Placer, CA
Sacramento, CA
6960 Saginaw-Bay City-Midland, MI............................. 0.9564
Bay, MI
Midland, MI
Saginaw, MI
6980 St. Cloud, MN............................................ 0.9544
Benton, MN
Stearns, MN
7000 St. Joseph, MO........................................... 0.8366
Andrew, MO
Buchanan, MO
7040 St. Louis, MO-IL \1\..................................... 0.9130
Clinton, IL
Jersey, IL
Madison, IL
Monroe, IL
St. Clair, IL
Franklin, MO
Jefferson, MO
Lincoln, MO
St. Charles, MO
St. Louis, MO
St. Louis City, MO
Warren, MO
7080 Salem, OR \2\............................................ 0.9976
Marion, OR
Polk, OR
7120 Salinas, CA.............................................. 1.4513
Monterey, CA
7160 Salt Lake City-Ogden, UT \1\............................. 0.9862
Davis, UT
Salt Lake, UT
Weber, UT
7200 San Angelo, TX........................................... 0.7780
Tom Green, TX
7240 San Antonio, TX \1\...................................... 0.8499
Bexar, TX
Comal, TX
Guadalupe, TX
Wilson, TX
7320 San Diego, CA \1\........................................ 1.2225
San Diego, CA
7360 San Francisco, CA \1\.................................... 1.4091
Marin, CA
San Francisco, CA
San Mateo, CA
7400 San Jose, CA \1\......................................... 1.4332
Santa Clara, CA
7440 San Juan-Bayamon, PR \1\................................. 0.4625
Aguas Buenas, PR
Barceloneta, PR
Bayamon, PR
Canovanas, PR
Carolina, PR
Catano, PR
Ceiba, PR
Comerio, PR
Corozal, PR
Dorado, PR
Fajardo, PR
Florida, PR
Guaynabo, PR
Humacao, PR
Juncos, PR
Los Piedras, PR
Loiza, PR
Luguillo, PR
Manati, PR
Morovis, PR
Naguabo, PR
Naranjito, PR
Rio Grande, PR
San Juan, PR
Toa Alta, PR
Toa Baja, PR
Trujillo Alto, PR
Vega Alta, PR
Vega Baja, PR
Yabucoa, PR
7460 San Luis Obispo-Atascadero-Paso Robles, CA............... 1.1374
San Luis Obispo, CA
7480 Santa Barbara-Santa Maria-Lompoc, CA..................... 1.0688
Santa Barbara, CA
7485 Santa Cruz-Watsonville, CA............................... 1.4187
Santa Cruz, CA
7490 Santa Fe, NM............................................. 1.0332
Los Alamos, NM
Santa Fe, NM
7500 Santa Rosa, CA........................................... 1.2267
Sonoma, CA
7510 Sarasota-Bradenton, FL................................... 0.9757
Manatee, FL
Sarasota, FL
7520 Savannah, GA............................................. 0.8638
Bryan, GA
Chatham, GA
Effingham, GA
7560 Scranton--Wilkes-Barre--Hazleton, PA..................... 0.8539
Columbia, PA
Lackawanna, PA
Luzerne, PA
Wyoming, PA
7600 Seattle-Bellevue-Everett, WA \1\......................... 1.1375
Island, WA
King, WA
Snohomish, WA
7610 Sharon, PA............................................... 0.8783
Mercer, PA
7620 Sheboygan, WI \2\........................................ 0.8471
Sheboygan, WI
7640 Sherman-Denison, TX...................................... 0.8499
Grayson, TX
7680 Shreveport-Bossier City, LA.............................. 0.9381
Bossier, LA
Caddo, LA
Webster, LA
7720 Sioux City, IA-NE........................................ 0.8031
Woodbury, IA
Dakota, NE
7760 Sioux Falls, SD.......................................... 0.8712
Lincoln, SD
Minnehaha, SD
7800 South Bend, IN........................................... 0.9880
St. Joseph, IN
7840 Spokane, WA.............................................. 1.0486
Spokane, WA
7880 Springfield, IL.......................................... 0.8713
Menard, IL
Sangamon, IL
7920 Springfield, MO.......................................... 0.8036
Christian, MO
Greene, MO
Webster, MO
8003 Springfield, MA \2\...................................... 1.0718
Hampden, MA
Hampshire, MA
8050 State College, PA........................................ 0.9635
Centre, PA
8080 Steubenville-Weirton, OH-WV.............................. 0.8645
Jefferson, OH
Brooke, WV
Hancock, WV
8120 Stockton-Lodi, CA........................................ 1.1518
San Joaquin, CA
8140 Sumter, SC \2\........................................... 0.7921
Sumter, SC
8160 Syracuse, NY............................................. 0.9480
Cayuga, NY
Madison, NY
Onondaga, NY
Oswego, NY
8200 Tacoma, WA............................................... 1.1016
Pierce, WA
8240 Tallahassee, FL \2\...................................... 0.8838
Gadsden, FL
Leon, FL
8280 Tampa-St. Petersburg-Clearwater, FL \1\.................. 0.9196
Hernando, FL
Hillsborough, FL
Pasco, FL
Pinellas, FL
8320 Terre Haute, IN.......................................... 0.8614
Clay, IN
Vermillion, IN
Vigo, IN
8360 Texarkana, AR-Texarkana, TX.............................. 0.8699
Miller, AR
Bowie, TX
8400 Toledo, OH............................................... 1.0140
Fulton, OH
Lucas, OH
Wood, OH
8440 Topeka, KS............................................... 0.9438
Shawnee, KS
8480 Trenton, NJ.............................................. 1.0380
Mercer, NJ
8520 Tucson, AZ............................................... 0.9180
Pima, AZ
[[Page 35512]]
8560 Tulsa, OK................................................ 0.8074
Creek, OK
Osage, OK
Rogers, OK
Tulsa, OK
Wagoner, OK
8600 Tuscaloosa, AL........................................... 0.8187
Tuscaloosa, AL
8640 Tyler, TX................................................ 0.9567
Smith, TX
8680 Utica-Rome, NY \2\....................................... 0.8401
Herkimer, NY
Oneida, NY
8720 Vallejo-Fairfield-Napa, CA............................... 1.3528
Napa, CA
Solano, CA
8735 Ventura, CA.............................................. 1.0544
Ventura, CA
8750 Victoria, TX............................................. 0.8474
Victoria, TX
8760 Vineland-Millville-Bridgeton, NJ......................... 1.0110
Cumberland, NJ
8780 Visalia-Tulare-Porterville, CA \2\....................... 0.9977
Tulare, CA
8800 Waco, TX................................................. 0.7696
McLennan, TX
8840 Washington, DC-MD-VA-WV \1\.............................. 1.0911
District of Columbia, DC
Calvert, MD
Charles, MD
Frederick, MD
Montgomery, MD
Prince Georges, MD
Alexandria City, VA
Arlington, VA
Clarke, VA
Culpeper, VA
Fairfax, VA
Fairfax City, VA
Falls Church City, VA
Fauquier, VA
Fredericksburg City, VA
King George, VA
Loudoun, VA
Manassas City, VA
Manassas Park City, VA
Prince William, VA
Spotsylvania, VA
Stafford, VA
Warren, VA
Berkeley, WV
Jefferson, WV
8920 Waterloo-Cedar Falls, IA................................. 0.8643
Black Hawk, IA
8940 Wausau, WI............................................... 1.0545
Marathon, WI
8960 West Palm Beach-Boca Raton, FL........................... 1.0309
Palm Beach, FL
9000 Wheeling, WV-OH (West Virginia Hospitals) \1\............ 0.7966
Belmont, OH
Marshall, WV
Ohio, WV
9000 Wheeling, WV-OH (Ohio Hospitals) \2\..................... 0.8434
Belmont, OH
Marshall, WV
Ohio, WV
9040 Wichita, KS.............................................. 0.9403
Butler, KS
Harvey, KS
Sedgwick, KS
9080 Wichita Falls, TX........................................ 0.7646
Archer, TX
Wichita, TX
9140 Williamsport, PA......................................... 0.8548
Lycoming, PA
9160 Wilmington-Newark, DE-MD................................. 1.1538
New Castle, DE
Cecil, MD
9200 Wilmington, NC........................................... 0.9322
New Hanover, NC
Brunswick, NC
9260 Yakima, WA \2\........................................... 1.0221
Yakima, WA
9270 Yolo, CA................................................. 1.1431
Yolo, CA
9280 York, PA................................................. 0.9415
York, PA
9320 Youngstown-Warren, OH.................................... 0.9937
Columbiana, OH
Mahoning, OH
Trumbull, OH
9340 Yuba City, CA............................................ 1.0324
Sutter, CA
Yuba, CA
9360 Yuma, AZ................................................. 0.9732
Yuma, AZ
------------------------------------------------------------------------
\1\ Large Urban Area
\2\ Hospitals geographically located in the area are assigned the
statewide rural wage index for FY 1998.
53. On pages 48035 through 48036, Addendum K is corrected to read
as follows:
[[Page 35512]]
Addendum K.--Wage Index for Rural Areas
------------------------------------------------------------------------
Wage
Nonurban area index
------------------------------------------------------------------------
Alabama........................................................ 0.7260
Alaska......................................................... 1.2302
Arizona........................................................ 0.7989
Arkansas....................................................... 0.6995
California..................................................... 0.9977
Colorado....................................................... 0.8129
Connecticut.................................................... 1.2617
Delaware....................................................... 0.8925
Florida........................................................ 0.8838
Georgia........................................................ 0.7761
Hawaii......................................................... 1.0229
Idaho.......................................................... 0.8221
Illinois....................................................... 0.7644
Indiana........................................................ 0.8161
Iowa........................................................... 0.7391
Kansas......................................................... 0.7203
Kentucky....................................................... 0.7772
Louisiana...................................................... 0.7383
Maine.......................................................... 0.8468
Maryland....................................................... 0.8617
Massachusetts.................................................. 1.0718
Michigan....................................................... 0.8923
Minnesota...................................................... 0.8180
Mississippi.................................................... 0.6911
Missouri....................................................... 0.7207
Montana........................................................ 0.8302
Nebraska....................................................... 0.7401
Nevada......................................................... 0.8914
New Hampshire.................................................. 0.9724
New Jersey \1\................................................. .......
New Mexico..................................................... 0.8110
New York....................................................... 0.8401
North Carolina................................................. 0.7939
North Dakota................................................... 0.7360
Ohio........................................................... 0.8434
Oklahoma....................................................... 0.7072
Oregon......................................................... 0.9976
Pennsylvania................................................... 0.8421
Puerto Rico.................................................... 0.3939
Rhode Island \1\............................................... .......
South Carolina................................................. 0.7921
South Dakota................................................... 0.6983
Tennessee...................................................... 0.7353
Texas.......................................................... 0.7404
Utah........................................................... 0.8926
Vermont........................................................ 0.9314
Virginia....................................................... 0.7782
Washington..................................................... 1.0221
West Virginia.................................................. 0.7966
Wisconsin...................................................... 0.8471
Wyoming........................................................ 0.8247
------------------------------------------------------------------------
\1\All counties within state are classified as urban.
54. On page 48036, Addendum L is corrected to read as follows:
Addendum L.--Wage Index for Hospitals That Are Reclassified
------------------------------------------------------------------------
Wage
Area index
------------------------------------------------------------------------
Abilene, TX.................................................... 0.8287
Albuquerque, NM................................................ 0.9329
Alexandria, LA................................................. 0.8269
Amarillo, TX................................................... 0.9277
Anchorage, AK.................................................. 1.2998
Asheville, NC.................................................. 0.9072
Athens, GA..................................................... 0.9087
Atlanta, GA.................................................... 0.9823
Austin-San Marcos, TX.......................................... 0.9133
Bangor, ME..................................................... 0.9478
Barnstable-Yarmouth, MA........................................ 1.3827
Baton Rouge, LA................................................ 0.8382
Benton Harbor, MI.............................................. 0.8923
Bergen-Passaic, NJ............................................. 1.1570
Billings, MT................................................... 0.9609
Birmingham, AL................................................. 0.9005
Bismarck, ND................................................... 0.7859
Boise City, ID................................................. 0.8887
Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH............... 1.1498
Caguas, PR..................................................... 0.4508
Casper, WY..................................................... 0.9013
Champaign-Urbana, IL........................................... 0.8706
Charlotte-Gastonia-Rock Hill, NC-SC............................ 0.9710
Charlottesville, VA............................................ 0.8885
Chattanooga, TN-GA............................................. 0.8658
Chicago, IL.................................................... 1.0759
Cincinnati, OH-KY-IN........................................... 0.9521
Cleveland-Lorain-Elyria, OH.................................... 0.9804
Columbia, MO................................................... 0.8759
Columbus, OH................................................... 0.9793
[[Page 35513]]
Dallas, TX..................................................... 0.9674
Davenport-Moline-Rock Island, IA-IL............................ 0.8405
Denver, CO..................................................... 1.0386
Des Moines, IA................................................. 0.8837
Detroit, MI.................................................... 1.0840
Duluth-Superior, MN-WI......................................... 0.9779
Dutchess County, NY............................................ 1.0364
Eugene-Springfield, OR......................................... 1.1659
Fargo-Moorhead, ND-MN.......................................... 0.8729
Fayetteville, NC............................................... 0.8491
Flint, MI...................................................... 1.1171
Florence, AL................................................... 0.7716
Florence, SC................................................... 0.8711
Ft. Lauderdale, FL............................................. 1.0487
Fort Pierce-Port St. Lucie, FL................................. 1.0008
Fort Walton Beach, FL.......................................... 0.8653
Forth Worth-Arlington, TX...................................... 0.9997
Gadsden, AL.................................................... 0.8815
Gainesville, FL................................................ 0.9616
Gary, IN....................................................... 0.9114
Grand Forks, ND-MN............................................. 0.8815
Grand Junction, CO............................................. 0.9491
Great Falls, MT................................................ 0.9306
Greeley, CO.................................................... 0.9791
Green Bay, WI.................................................. 0.9585
Greensboro-Winston-Salem-High Point, NC........................ 0.9351
Harrisburg-Lebanon-Carlisle, PA................................ 1.0076
Hartford, CT................................................... 1.2373
Honolulu, HI................................................... 1.1817
Houma, LA...................................................... 0.7854
Houston, TX.................................................... 0.9855
Huntington-Ashland, WV-KY-OH................................... 0.9160
Huntsville, AL................................................. 0.8485
Indianapolis, IN............................................... 0.9848
Iowa City, IA.................................................. 0.9208
Jackson, MS.................................................... 0.7790
Johnson City-Kingsport-Bristol, TN-VA.......................... 0.9114
Jonesboro, AR.................................................. 0.7443
Joplin, MO..................................................... 0.7541
Kalamazoo-Battlecreek, MI...................................... 1.0668
Kansas City, KS-MO............................................. 0.9564
Knoxville, TN.................................................. 0.8831
Lafayette, LA.................................................. 0.8227
Lafayette, IN.................................................. 0.9174
Lansing-East Lansing, MI....................................... 1.0088
Las Cruces, NM................................................. 0.8658
Las Vegas, NV-AZ............................................... 1.0592
Lexington, KY.................................................. 0.8416
Lima, OH....................................................... 0.9185
Lincoln, NE.................................................... 0.9035
Little Rock-North Little Rock, AR.............................. 0.8490
Longview-Marshall, TX.......................................... 0.8509
Los Angeles-Long Beach, CA..................................... 1.2268
Louisville, KY-IN.............................................. 0.9507
Macon, GA...................................................... 0.9227
Madison, WI.................................................... 1.0055
Mansfield, OH.................................................. 0.8639
Medford-Ashland, OR............................................ 1.0354
Memphis, TN-AR-MS.............................................. 0.8589
Milwaukee-Waukesha, WI......................................... 0.9819
Minneapolis-St. Paul, MN-WI.................................... 1.0733
Monroe, LA..................................................... 0.8414
Montgomery, AL................................................. 0.7813
Nashville, TN.................................................. 0.9182
New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT............ 1.2619
New London-Norwich, CT......................................... 1.2258
New Orleans, LA................................................ 0.9566
New York, NY................................................... 1.4449
Newark, NJ..................................................... 1.1111
Newburgh, NY-PA................................................ 1.1283
Oakland, CA.................................................... 1.5158
Odessa-Midland, TX............................................. 0.8516
Oklahoma City, OK.............................................. 0.8481
Omaha, NE-IA................................................... 0.9421
Orange County, CA.............................................. 1.1532
Peoria-Pekin, IL............................................... 0.8571
Philadelphia, PA-NJ............................................ 1.1398
Pittsburgh, PA................................................. 0.9583
Pocatello, ID.................................................. 0.9000
Portland, ME................................................... 0.9627
Portland-Vancouver, OR-WA...................................... 1.1344
Provo-Orem, UT................................................. 1.0073
Raleigh-Durham-Chapel Hill, NC................................. 0.9818
Rapid City, SD................................................. 0.8345
Rochester, MN.................................................. 1.0502
Rockford, IL................................................... 0.9081
Sacramento, CA................................................. 1.2202
Saginaw-Bay City-Midland, MI................................... 0.9564
St. Cloud, MN.................................................. 0.9544
St. Louis, MO-IL............................................... 0.9130
Salinas, CA.................................................... 1.4299
Salt Lake City-Ogden, UT....................................... 0.9862
San Diego, CA.................................................. 1.2225
San Francisco, CA.............................................. 1.4091
Santa Fe, NM................................................... 1.0007
Santa Rosa, CA................................................. 1.2146
Seattle-Bellevue-Everett, WA................................... 1.1375
Sherman-Denison, TX............................................ 0.8324
Sioux City, IA-NE.............................................. 0.8031
Sioux Falls, SD................................................ 0.8607
South Bend, IN................................................. 0.9880
Spokane, WA.................................................... 1.0311
Springfield, IL................................................ 0.8610
Springfield, MO................................................ 0.8036
Stockton-Lodi, CA.............................................. 1.1518
Syracuse, NY................................................... 0.9480
Tampa-St. Petersburg-Clearwater, FL............................ 0.9196
Texarkana, AR-Texarkana, TX.................................... 0.8699
Topeka, KS..................................................... 0.9310
Tucson, AZ..................................................... 0.9180
Tulsa, OK...................................................... 0.8074
Tyler, TX...................................................... 0.9421
Vallejo-Fairfield-Napa, CA..................................... 1.3528
Washington, DC-MD-VA-WV........................................ 1.0911
Waterloo-Cedar Falls, IA....................................... 0.8643
Wausau, WI..................................................... 0.9845
Wichita, KS.................................................... 0.9157
Wichita Falls, TX.............................................. 0.7646
Rural Florida.................................................. 0.8838
Rural Louisiana................................................ 0.7383
Rural Minnesota................................................ 0.8180
Rural Missouri................................................. 0.7207
Rural New Hampshire............................................ 0.9724
Rural New Mexico............................................... 0.8110
Rural North Carolina........................................... 0.7939
Rural Oregon................................................... 0.9976
Rural Washington............................................... 1.0221
Rural West Virginia............................................ 0.7966
Rural Wyoming.................................................. 0.8247
------------------------------------------------------------------------
(Catalog of Federal Domestic Assistance 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: June 22, 1999.
Kerry Weems,
Acting Deputy Assistant, Secretary for Information Resources
Management.
[FR Doc. 99-16550 Filed 6-29-99; 8:45 am]
BILLING CODE 4120-01-P