[Federal Register Volume 65, Number 68 (Friday, April 7, 2000)]
[Rules and Regulations]
[Pages 18434-18820]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-8215]
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Part II
Department of Health and Human Services
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Health Care Financing Administration
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42 CFR Parts 409, et al.
Office of the Inspector General; Medicare Program Prospective Payment
System for Hospital Outpatient Services; Final Rule
Federal Register / Vol. 65, No. 68 / Friday, April 7, 2000 / Rules
and Regulations
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Parts 409, 410, 411, 412, 413, 419, 424, 489, 498, and 1003
[HCFA-1005-FC]
RIN 0938-AI56
Office of Inspector General; Medicare Program; Prospective
Payment System for Hospital Outpatient Services
AGENCY: Health Care Financing Administration (HCFA), HHS, and Office of
Inspector General (OIG), HHS.
ACTION: Final rule with comment period.
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SUMMARY: This final rule with comment period implements a prospective
payment system for hospital outpatient services furnished to Medicare
beneficiaries, as set forth in section 1833(t) of the Social Security
Act. It also establishes requirements for provider departments and
provider-based entities, and it implements section 9343(c) of the
Omnibus Budget Reconciliation Act of 1986, which prohibits Medicare
payment for nonphysician services furnished to a hospital outpatient by
a provider or supplier other than a hospital, unless the services are
furnished under an arrangement with the hospital. In addition, this
rule establishes in regulations the extension of reductions in payment
for costs of hospital outpatient services required by section 4522 of
the Balanced Budget Act of 1997, as amended by section 201(k) of the
Balanced Budget Refinement Act of 1999.
DATES: Effective date: July 1, 2000, except that the changes to
Sec. 412.24(d)(6), new Sec. 413.65, and the changes to Sec. 489.24(h),
Sec. 498.2, and Sec. 498.3 are effective October 10, 2000.
Applicability date: For Medicare services furnished by all
hospitals, including hospitals excluded from the inpatient prospective
payment system, and by community mental health centers, the
applicability date for implementation of the hospital outpatient
prospective payment system is July 1, 2000.
Comment date: Comments on the provisions of this rule resulting
from the Balanced Budget Refinement Act of 1999 will be considered if
we receive them at the appropriate address, as provided below, no later
than 5 p.m. on June 6, 2000. We will not consider comments concerning
provisions that remain unchanged from the September 8, 1998 proposed
rule or that were revised based on public comment.
See section VIII for a more detailed discussion of the provisions
subject to comment.
ADDRESSES: Mail written comments (one original and three copies) to the
following address ONLY: Health Care Financing Administration,
Department of Health and Human Services, Attention: HCFA-1005-FC, P.O.
Box 8013, Baltimore, MD 21244-8013.
If you prefer, you may deliver, by courier, your written comments
(one original and three copies) to one of the following addresses:
Room 443-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW.,
Washington, DC 20201, or
C5-14-03, Central Building, 7500 Security Boulevard, Baltimore, MD
21244-1850.
Comments mailed to those addresses may be delayed and could be
considered late.
Because of staffing and resource limitations, we cannot accept
comments by facsimile (FAX) transmission. In commenting, please refer
to file code HCFA-1005-FC.
Comments received timely will be available for public inspection as
they are received, generally beginning approximately 3 weeks after
publication of a document, in Room 443-G of the Department's offices at
200 Independence Avenue, SW., Washington, DC, on Monday through Friday
of each week from 8:30 a.m. to 5 p.m. (Phone (202) 690-7890).
For comments that relate to information collection requirements,
mail a copy of comments to:
Health Care Financing Administration, Office of Information Services,
Security and Standards Group, Division of HCFA Enterprise Standards,
Room N2-14-26, 7500 Security Boulevard, Baltimore, MD 21244-1850, Attn:
John Burke, HCFA-1005-FC; and
Lauren Oliven, HCFA Desk Officer, Office of Information and Regulatory
Affairs, Room 3001, New Executive Office Building, Washington, DC
20503.
Copies: To order copies of the Federal Register containing this
document, send your request to: New Orders, Superintendent of
Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date
of the issue requested and enclose a check or money order payable to
the Superintendent of Documents, or enclose your Visa or Master Card
number and expiration date. Credit card orders can also be placed by
calling the order desk at (202) 512-1800 or by faxing to (202) 512-
2250. The cost for each copy is $8. As an alternative, you can view and
photocopy the Federal Register document at most libraries designated as
Federal Depository Libraries and at many other public and academic
libraries throughout the country that receive the Federal Register.
FOR FURTHER INFORMATION CONTACT:
Janet Wellham, (410) 786-4510 or Chuck Braver, (410) 786-6719 (for
general information)
Joel Schaer (OIG), (202) 619-0089 (for information concerning civil
money penalties)
Kitty Ahern, (410) 786-4515 (for information related to the
classification of services into ambulatory payment classification (APC)
groups)
George Morey (410) 786-4653 (for information related to the
determination of provider-based status)
Janet Samen (410) 786-9161 (for information on the application of APCs
to community mental health centers)
SUPPLEMENTARY INFORMATION: To assist readers in referencing sections
contained in this document, we are providing the following table of
contents. Within each section, we summarize pertinent material from our
proposed rule of September 8, 1998 (63 FR 47552) followed by public
comments and our responses.
Table of Contents
I. Background
A. General and Legislative History
B. Summary of Provisions of the Balanced Budget Act of 1997 (the
BBA 1997)
1. Prospective Payment System (PPS)
2. Elimination of Formula-Driven Overpayment
3. Extension of Cost Reductions
C. The September 8, 1998 Proposed Rule
D. Overview of Public Comments
E. Summary of Relevant Provisions in the Balanced Budget
Refinement Act of 1999 (the BBRA 1999)
1. Outlier Adjustment
2. Transitional Pass-Through for Additional Costs of Innovative
Medical Devices, Drugs, and Biologicals
3. Budget Neutrality Applied to New Adjustments
4. Limitation on Judicial Review
5. Inclusion in the Hospital Outpatient PPS of Certain
Implantable Items
6. Payment Weights Based on Mean Hospital Costs
7. Limitation on Variation of Costs of Services Classified
Within a Group
8. Annual Review of the Hospital Outpatient PPS Components
9. Coinsurance Not Affected by Pass-Throughs
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10. Extension of Cost Reductions
11. Clarification of Congressional Intent Regarding Base Amounts
Used in Determining the Hospital Outpatient PPS
12. Transitional Corridors For Application of Outpatient PPS
13. Limitation on Coinsurance for a Procedure
14. Reclassification of Certain Hospitals
II. Prohibition Against Unbundling of Hospital Outpatient Services
A. Background
B. Office of Inspector General (OIG) Civil Money Penalty
Authority and Civil Money Penalties for Unbundling Hospital
Outpatient Services
C. Summary of Final Regulations on Bundling of Hospital
Outpatient Services
D. Comments and Responses
III. Hospital Outpatient Prospective Payment System (PPS)
A. Hospitals Included In or Excluded From the Outpatient PPS
B. Scope of Facility Services
1. Services Excluded from the Scope of Services Paid Under the
Hospital Outpatient PPS
a. Background
b. Comments and Responses
c. Payment for Certain Implantable Items Under the BBRA 1999
d. Summary of Final Action
2. Services Included Within the Scope of the Hospital Outpatient
PPS
a. Services for Patients Who Have Exhausted Their Part A
Benefits
b. Partial Hospitalization Services
c. Services Designated by the Secretary
d. Summary of Final Action
3. Hospital Outpatient PPS Payment Indicators
C. Description of the Ambulatory Payment Classification (APC)
Groups
1. Setting Payment Rates Based on Groups of Services Rather than
on Individual Services
2. Packaging Under the APC System
a. Summary of Proposal
b. General Comments and Responses (Supporting or Objecting to
Packaging)
c. Packaging of Casts and Splints
d. Packaging of Observation Services
e. Packaging Costs of Procuring Corneal Tissue
f. Packaging Costs of Blood and Blood Products
g. Packaging Costs for Drugs, Pharmaceuticals, and Biologicals
h. Summary of Final Action
3. Treatment of Clinic and Emergency Department Visits
a. Provisions of the Proposed Rule
b. Comments and Responses
4. Treatment of Partial Hospitalization Services
5. Inpatient Only Procedures
6. Modification of APC Groups
a. How the Groups Were Constructed
b. Comments on Classification of Procedures and Services Within
APC Groups
c. Effect of the BBRA 1999 on Final APC Groups
d. Summary of APC Modifications
e. Exceptions to the BBRA 1999 Limit on Variation of Costs
Within APC Groups
7. Discounting of Surgical Procedures
8. Payment for New Technology Services
a. Background
b. Comments and Responses
D. Transitional Pass-Through for Innovative Medical Devices,
Drugs, and Biologicals
1. Statutory Basis
2. Identifying Eligible Pass-Through Items
a. Drugs and Biologicals
b. Medical Devices
3. Criteria to Define New or Innovative Medical Devices Eligible
for Pass-through Payments
4. Determination of ``Not Insignificant'' Cost of New Items
5. Calculating the Additional Payment
6. Process to Identify Items and to Obtain Codes for Items
Subject to Transitional Pass-Throughs
E. Calculation of Group Weights and Conversion Factor
1. Group Weights (Includes Table 1, Packaged Services by Revenue
Center)
2. Conversion Factor
a. Calculating Aggregate Calendar Year 1996 Medicare and
Beneficiary Payments for Hospital Outpatient Services (Pre-PPS)
b. Sum of the Relative Weights
F. Calculation of Coinsurance Payments and Medicare Payments
Under the PPS
1. Background
2. Determining the Unadjusted Coinsurance Amount and Program
Payment Percentage
a. Calculating the Unadjusted Coinsurance Amount for Each APC
Group
b. Calculating the Program Payment Percentage (Pre-deductible
Payment Percentage)
3. Calculating the Medicare Payment Amount and Beneficiary
Coinsurance Amount
a. Calculating the Medicare Payment Amount
b. Calculating the Coinsurance Amount
4. Hospital Election to Offer Reduced Coinsurance
G. Adjustment for Area Wage Differences
1. Proposed Wage Index
2. Labor-Related Portion of Hospital Outpatient Department PPS
Payment Rates
3. Adjustment of Hospital Outpatient Department PPS Payment and
Coinsurance Amounts for Geographic Wage Variations
4. Special Rules Under the BBRA 1999
H. Other Adjustments
1. Outlier Payments
2. Transitional Corridors/Interim Payments
3. Cancer Centers and Small Rural Hospitals
I. Annual Updates
1. Revisions to APC Groups, Weights and the Wage and Other
Adjustments
2. Annual Update to the Conversion Factor
3. Advisory Panel for APC Updates
J. Volume Control Measures
K. Claims Submission and Processing and Medical Review
L. Prohibition Against Administrative or Judicial Review
IV. Provider-Based Status
A. Background
B. Provisions of the Proposed Rule
C. Comments and Responses
D. Requirements for Payment
V. Summary of and Response to MedPAC Recommendations
VI. Provisions of the Final Rule
VII. Collection of Information Requirements
VIII. Response to Comments
IX. Regulatory Impact Analysis
A. Introduction
B. Estimated Impact on the Medicare Program
C. Objectives
D. Limitations of Our Analysis
E. Hospitals Included In and Excluded From the Prospective
Payment System
F. Quantitative Analysis of the Impact of Policy Changes on
Payment Under the Hospital Outpatient PPS: Basis and Methodology of
Estimates
G. Estimated Impact of the New APC System (Includes Table 2,
Annual Impact of Hospital Outpatient Prospective Payment System in
CY2000-CY2001)
X. Federalism
XI. Waiver of Proposed Rulemaking Regulations Text
Addenda
Addendum A--List of Hospital Outpatient Ambulatory Payment
Classification Groups with Status Indicators, Relative Weights,
Payment Rates, and Coinsurance Amounts
Addendum B--Hospital Outpatient Department (HOPD) Payment Rates and
Payment Status by HCPCS, and Related Information
Addendum C--Hospital Outpatient Payment for Procedures by APC
Addendum D--1996 HCPCS Codes Used to Calculate Payment Rates That
Are Not Active CY 2000 Codes
Addendum E--CPT Codes Which Will Be Paid Only As Inpatient
Procedures
Addendum F--Status Indicators
Addendum G--Service Mix Indices by Hospital
Addendum H--Wage Index for Urban Areas
Addendum I--Wage Index for Rural Areas
Addendum J--Wage Index for Hospitals That Are Reclassified
Addendum K--Drugs, Biologicals, and Medical Devices Subject to
Transitional Pass-Through Payment
Alphabetical List of Acronyms Appearing in the Final Rule
APC Ambulatory payment classification
APG Ambulatory patient group
ASC Ambulatory surgical center
AWP Average wholesale price
BBA 1997 Balanced Budget Act of 1997
BBRA 1999 Balanced Budget Refinement Act of 1999
CAH Critical access hospital
CAT Computerized axial tomography
CCI [HCFA's] Correct Coding Initiative
CCR Cost center specific cost-to-charge ratio
CCU Coronary care unit
CMHC Community mental health center
CMP Civil money penalty
CORF Comprehensive outpatient rehabilitation facility
CPI Consumer Price Index
CPT [Physicians'] Current Procedural Terminology, 4th Edition,
2000,
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copyrighted by the American Medical Association
DME Durable medical equipment
DMEPOS DME, orthotics, prosthetics, prosthetic devices, prosthetic
implants and supplies
DRG Diagnosis-related group
DSH Disproportionate share hospital
EACH Essential access community hospital
EBAA Eye Bank Association of America
ED Emergency department
EMS Emergency medical services
EMTALA Emergency Medical Treatment and Active Labor Act
ENT Ear/Nose/Throat
ESRD End-stage renal disease
FDA Food and Drug Administration
FDO Formula-driven overpayment
FQHC Federally qualified health center
HCPCS HCFA Common Procedure Coding System
HHA Home health agency
HRSA Health Resources and Services Administration
ICD-9-CM International Classification of Diseases, Ninth Edition,
Clinical Modification
ICU Intensive care unit
IHS Indian Health Service
IME Indirect medical education
IOL Intraocular lens
JCAHO Joint Commission on Accreditation of Healthcare Organizations
LTH Long-term hospital
MDH Medicare-dependent hospital
MedPAC Medicare Payment Advisory Commission
MRI Magnetic resonance imaging
MSA Metropolitan statistical area
NECMA New England County Metropolitan Area
OBRA Omnibus Budget Reconciliation Act
OT Occupational therapy
PPO Preferred provider organization
PPS Prospective payment system
RFA Regulatory Flexibility Act
RHC Rural health clinic
RPCH Rural primary care hospital
RRC Rural referral center
SCH Sole community hospital
SGR Sustainable growth rate
SNF Skilled nursing facility
TEFRA Tax Equity and Fiscal Responsibility Act of 1982
TPA Tissue Plasminogen Activator
Y2K Year 2000
I. Background
A. General and Legislative History
When the Medicare program was first implemented, it paid for
hospital services (inpatient and outpatient) based on hospital-specific
reasonable costs attributable to serving Medicare beneficiaries. Later,
the law was amended to limit payment to the lesser of a hospital's
reasonable costs or its customary charges. In 1983, section 601 of the
Social Security Amendments of 1983 (Pub. L. 98-21) completely revised
the cost-based payment system for most hospital inpatient services by
enacting section 1886(d) of the Social Security Act (the Act). This
section provided for a prospective payment system (PPS) for acute
hospital inpatient stays, effective with hospital cost reporting
periods beginning on or after October 1, 1983.
Although payment for most inpatient services became subject to the
PPS, Medicare hospital outpatient services continued to be paid based
on hospital-specific costs, which provided little incentive for
hospitals to furnish outpatient services efficiently. At the same time,
advances in medical technology and changes in practice patterns were
bringing about a shift in the site of medical care from the inpatient
to the outpatient setting. During the 1980s, the Congress took steps to
control the escalating costs of providing outpatient care. The Congress
amended the statute to implement across-the-board reductions of 5.8
percent and 10 percent to the amounts otherwise payable by Medicare for
hospital operating costs and capital costs, respectively, and enacted a
number of different payment methods for specific types of hospital
outpatient services. These methods included fee schedules for clinical
diagnostic laboratory tests, orthotics, prosthetics, and durable
medical equipment (DME); composite rate payment for dialysis for
persons with end-stage renal disease (ESRD); and payments based on
blends of hospital costs and the rates paid in other ambulatory
settings such as separately certified ambulatory surgical centers
(ASCs) or physician offices for certain surgery, radiology, and other
diagnostic procedures. However, Medicare payment for services performed
in the hospital outpatient setting remains largely cost-based.
In the Omnibus Budget Reconciliation Act of 1986 (OBRA 1986) (Pub.
L. 99-509), the Congress paved the way for development of a PPS for
hospital outpatient services. Section 9343(g) of OBRA 1986 mandated
that fiscal intermediaries require hospitals to report claims for
services under the HCFA Common Procedure Coding System (HCPCS). Section
9343(c) of OBRA 1986 extended the prohibition against unbundling of
hospital services under section 1862(a)(14) of the Act to include
outpatient services as well as inpatient services. The HCPCS coding
enabled us to determine which specific procedures and services were
being billed, while the extension of the prohibition against unbundling
ensured that all nonphysician services provided to hospital outpatients
would be billed only by the hospital, not by an outside supplier, and,
therefore, would be reported on hospital bills and captured in the
hospital outpatient data that could be used to develop an outpatient
PPS.
A proposed rule to implement section 9343(c) was published in the
Federal Register on August 5, 1988. However, those regulations were
never published as a final rule, so we included them in the hospital
outpatient PPS proposed rule published in the Federal Register on
September 8, 1998 (63 FR 47552) and will implement them as part of this
final rule.
Section 1866(g) of the Act, as added by section 9343(c) of OBRA
1986, and amended by section 4085(i)(17) of the Omnibus Budget
Reconciliation Act of 1987 (OBRA 1987) (Pub. L. 100-203), authorizes
the Department of Health and Human Services' Office of Inspector
General to impose a civil money penalty (CMP), not to exceed $2,000,
against any individual or entity who knowingly and willfully presents a
bill in violation of an arrangement (as defined in section 1861(w)(1)
of the Act).
In section 9343(f) of the OBRA 1986 and section 4151(b)(2) of the
Omnibus Budget Reconciliation Act of 1990 (Pub. L. 101-508), the
Congress required that we develop a proposal to replace the current
hospital outpatient payment system with a PPS and submit a report to
the Congress on the proposed system.
The Secretary submitted a report to the Congress on March 17, 1995,
summarizing the research we conducted searching for a way to classify
outpatient services for purposes of developing an outpatient PPS. The
report cited ambulatory patient groups (APGs), developed by 3M-Health
Information Systems (3M-HIS) under a cooperative grant with HCFA, as
the most promising classification system for grouping outpatient
services and recommended that APG-like groups be used in designing a
hospital outpatient PPS.
The report also presented a number of options that could be used,
once a PPS was in place, for addressing the issue of rapidly growing
beneficiary coinsurance. As a separate issue, we recommended that the
Congress amend the provisions of the law pertaining to the blended
payment methods for ASC surgery, radiology, and other diagnostic
services to correct an anomaly that resulted in a less than full
recognition of the amount paid by the beneficiary in calculating
program payment (referred to as the formula-driven overpayment).
Three sections of the Balanced Budget Act of 1997 (the BBA 1997)
(Pub. L. 105-33), enacted on August 5, 1997, affect Medicare payment
for hospital outpatient services. Section 4521 of the BBA 1997
eliminates the formula-driven overpayment for ambulatory surgical
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center procedures, radiology services, and diagnostic procedures
furnished on or after October 1, 1997. In November 1998, we issued cost
report instructions (Provider Reimbursement Manual, Part II, Chapter
36, Transmittal 4) that implemented this provision for services
furnished on or after October 1, 1997. Section 4522 of the BBA 1997
amends section 1861(v)(1)(S)(ii) of the Act by extending cost
reductions in payment for hospital outpatient operating costs and
hospital capital costs, 5.8 percent and 10 percent respectively, before
January 1, 2000. Section 4523 of the BBA 1997 amends section 1833 of
the Act by adding subsection (t), which provides for implementation of
a PPS for outpatient services. (Under Section 4523 of the BBA 1997 the
outpatient PPS does not apply to cancer hospitals before January 1,
2000.) Set forth below in section I.B is a detailed description of the
changes made by the BBA 1997.
On November 29, 1999, the Balanced Budget Refinement Act of 1999
(the BBRA 1999), Pub. L. 106-113, was enacted. This Act made major
changes that affect the proposed hospital outpatient PPS. The
legislative changes are summarized in section I.E, below. More specific
details on individual provisions that we are implementing in this final
rule with comment period are included under the various sections of
this preamble.
B. Summary of Provisions in the Balanced Budget Act of 1997 (the BBA
1997)
1. Prospective Payment System (PPS)
Section 4523 of the BBA 1997 amended section 1833 of the Act by
adding subsection (t), which provides for a PPS for hospital outpatient
department services. (The following citations reflect the statute as
enacted by the BBA 1997.) Section 1833(t)(1)(B) of the Act authorizes
the Secretary to designate the hospital outpatient services that would
be paid under the PPS. That section also requires that the hospital
outpatient PPS include hospital inpatient services designated by the
Secretary that are covered under Part B for beneficiaries who are
entitled to Part A benefits but who have exhausted them or otherwise
are not entitled to them. Section 1833(t)(1)(B)(iii) of the Act
specifically excludes ambulance, physical and occupational therapy, and
speech-language pathology services, for which payment is made under a
fee schedule.
Section 1833(t)(2) of the Act sets forth certain requirements for
the hospital outpatient PPS. The Secretary is required to develop a
classification system for covered outpatient services that may consist
of groups arranged so that the services within each group are
comparable clinically and with respect to the use of resources.
Section 1833(t)(2)(C) of the Act specifies data requirements for
establishing relative payment weights. The weights are to be based on
the median hospital costs determined by 1996 claims data and data from
the most recent available cost reports. Section 1833(t)(2)(D) of the
Act requires that the portion of the Medicare payment and the
beneficiary coinsurance that are attributable to labor and labor-
related costs be adjusted for geographic wage differences in a budget
neutral manner.
The Secretary is authorized under section 1833(t)(2)(E) of the Act
to establish, in a budget neutral manner, other adjustments, such as
outlier adjustments or adjustments for certain classes of hospitals,
that are necessary to ensure equitable payments. Section 1833(t)(2)(F)
of the Act requires the Secretary to develop a method for controlling
unnecessary increases in the volume of covered outpatient services.
Section 1833(t)(3) of the Act specifies how beneficiary deductibles
are to be treated in calculating the Medicare payment and beneficiary
coinsurance amounts and requires that rules be established regarding
determination of coinsurance amounts for covered services that were not
furnished in 1996. The statute freezes beneficiary coinsurance at 20
percent of the national median charges for covered services (or group
of covered services) furnished during 1996 and updated to 1999 using
the Secretary's estimated charge growth from 1996 to 1999.
Section 1833(t)(3) of the Act also prescribes the formula for
calculating the initial conversion factor used to determine Medicare
payment amounts for 1999 and the method for updating the conversion
factor in subsequent years.
Sections 1833(t)(4) and (t)(5) of the Act describe the method for
determining the Medicare payment amount and the beneficiary coinsurance
amount for services covered under the outpatient PPS. Section
1833(t)(5)(B) of the Act requires the Secretary to establish a
procedure whereby hospitals may voluntarily elect to reduce beneficiary
coinsurance for some or all covered services to an amount not less than
20 percent of the Medicare payment amount. Hospitals are further
allowed to disseminate information on any such reductions of
coinsurance amounts. Section 4451 of the BBA 1997 added section
1861(v)(1)(T) to the Act, which provides that any reduction in
coinsurance must not be treated as a bad debt.
Section 1833(t)(6) authorizes periodic review and revision of the
payment groups, relative payment weights, wage index, and conversion
factor.
Section 1833(t)(7) of the Act describes how payment is to be made
for ambulance services, which are specifically excluded from the
outpatient PPS under section 1833(t)(1)(B) of the Act.
Section 1833(t)(8) of the Act provides that the Secretary may
establish a separate conversion factor for services furnished by cancer
hospitals that are excluded from hospital inpatient PPS.
Section 1833(t)(9) of the Act prohibits administrative or judicial
review of the hospital outpatient PPS classification system, the
groups, relative payment weights, wage adjustment factors, other
adjustments, calculation of base amounts, periodic adjustments, and the
establishment of a separate conversion factor for those cancer
hospitals excluded from hospital inpatient PPS.
Section 4523(d) of the BBA 1997 made a conforming
amendment to section 1833(a)(2)(B) of the Act to provide for
payment under the hospital outpatient PPS for some services described
in section 1832(a)(2) that are currently paid on a cost basis and
furnished by providers of services, such as comprehensive outpatient
rehabilitation facilities (CORFs), home health agencies (HHAs),
hospices, and community mental health centers (CMHCs). This amendment
provides that partial hospitalization services furnished by CMHCs be
paid under the PPS.
2. Elimination of Formula-Driven Overpayment
Before enactment of section 4521(b) of the BBA 1997, using the
blended payment formulas for ASC procedures, radiology, and other
diagnostic services, the ASC or physician fee schedule portion was
calculated as if the beneficiary paid 20 percent of the ASC rate or
physician fee schedule amount instead of the actual amount paid, which
was 20 percent of the hospital's billed charges. Section 4521(b), which
amended sections 1833(i)(3)(B)(i)(II) and 1833(n)(1)(B)(i) of the Act,
corrects this anomaly by changing the blended calculations so that all
amounts paid by the beneficiary are subtracted from the total payment
in the calculation to determine the amount due from the program.
Effective for services furnished on or after October 1, 1997, payment
for surgery, radiology, and other diagnostic services calculated by
blended payment methods is now calculated by
[[Page 18438]]
subtracting the full amount of coinsurance due from the beneficiary
(based on 20 percent of the hospital's billed charges).
3. Extension of Cost Reductions
Section 1861(v)(1)(S)(ii) of the Act was amended by section 4522 of
the BBA 1997 to require that the amounts otherwise payable for hospital
outpatient operating costs and capital costs be reduced by 5.8 percent
and 10 percent, respectively, through December 31, 1999.
C. The September 8, 1998 Proposed Rule
We published a proposed rule in the Federal Register on September
8, 1998 (63 FR 47552) setting forth the proposed PPS for hospital
outpatient services. In that proposed rule, we explained that, due to
Year 2000 (Y2K) systems concerns, implementation of the new payment
system would be delayed until after January 1, 1999. (The statement in
the rule that the statute requires implementation ``effective January
1, 1999,'' and other similar statements in other rules, were not
intended to mean that the statute requires retroactive implementation
of the hospital outpatient PPS. As noted elsewhere in this rule, the
statute does not impose such a requirement.) As noted in that document,
the scope of systems changes required to implement the hospital
outpatient PPS is so enormous as to be impossible to accomplish
concurrently with the critical work that we, our contractors, and our
provider-partners had to perform to ensure that all of our respective
systems were Y2K compliant. Section XI of the proposed rule (63 FR
47605) explains in greater detail the reasons for delaying
implementation.
The proposed rule originally provided for a 60-day comment period.
However, the comment period was extended four times, ultimately ending
on July 30, 1999. (See 63 FR 63429, November 13, 1998; 64 FR 1784,
January 12, 1999; 64 FR 12277, March 12, 1999; and 64 FR 36320; July 6,
1999.)
On June 30, 1999, we published a correction notice (64 FR 35258) to
correct a number of technical and typographical errors contained in the
September 8, 1998 proposed rule. The numerical values in the proposed
rule reflected incorrect data and data programming. Among other
corrections, the notice set forth revised numerical values for the
current payment, total services (total units), relative weights,
proposed payment rates, national unadjusted coinsurance, minimum
unadjusted coinsurance, and service-mix index.
D. Overview of Public Comments
We received approximately 10,500 comments in response to our
September 8, 1998 proposed rule. That count includes the numerous
requests from hospital and other interested groups and organizations
that we extend the public comment period to allow additional time for
analysis of the impact of our proposals. As we explain above, we
extended the comment period four times, to end finally on July 30,
1999.
In addition to receiving comments from a number of organizations
representing the full spectrum of the hospital industry, we received
comments from beneficiaries and their families, physicians, health care
workers, individual hospitals, professional associations and societies,
legal and nonlegal representatives and spokespersons for beneficiaries
and hospitals, members of the Congress, and other interested citizens.
The majority of comments addressed our proposals regarding payment for:
Corneal tissue; payment for high-cost technologies, both existing and
future; payment for blood and blood products; and payment for high cost
drugs, including chemotherapy agents. We also received numerous
comments addressing: Our approach to ratesetting using the ambulatory
payment classification (APC) system; our method of calculating the
payment conversion factor; and the potentially negative impact of the
proposed hospital outpatient PPS on hospital revenues. In addition, we
received many comments concerning the proposed regulations for
provider-based entities.
We carefully reviewed and considered all comments received timely.
The many modifications that we made to our proposed regulations in
response to commenters' suggestions and recommendations are reflected
in the provisions of this final rule. Comments and our responses are
addressed by topic in the sections that follow.
E. Summary of Relevant Provisions in the Balanced Budget Refinement Act
of 1999 (the BBRA 1999)
As noted above, subsequent to publication of the proposed rule, the
BBRA 1999 was enacted on November 29, 1999. The BBRA 1999 made major
changes that affect the proposed hospital outpatient PPS. Because these
changes are effective with the implementation of the PPS, we have had
to make some revisions from the September 8, 1998 proposed rule. The
provisions of the BBRA 1999 that we are implementing in this final rule
with comment period follow.
1. Outlier Adjustment
Section 201(a) of the BBRA 1999 amends section 1833(t) by
redesignating paragraphs (5) through (9) as paragraphs (7) through (11)
and adding a new paragraph (5). New section 1833(t)(5) of the Act
provides that the Secretary will make payment adjustments for covered
services whose costs exceed a given threshold (that is, an outlier
payment). This section describes how the additional payments are to be
calculated and caps the projected outlier payments at no more than 2.5
percent of the total projected payments (sum of both Medicare and
beneficiary payments to the hospital) made under hospital outpatient
PPS for years before 2004 and 3.0 percent of the total projected
payments for 2004 and subsequent years.
2. Transitional Pass-Through for Additional Costs of Innovative Medical
Devices, Drugs, and Biologicals
Section 201(b) of the BBRA 1999 adds new section 1833(t)(6) to the
Act, establishing transitional pass-through payments for certain
medical devices, drugs, and biologicals. This provision does the
following: Specifies the types of items for which additional payments
must be made; describes the amount of the additional payment; limits
these payments to at least 2 years but not more than 3 years; and caps
the projected payment adjustments annually at 2.5 percent of the total
projected payments for hospital outpatient services each year before
2004 and no more than 2.0 percent in subsequent years. Under this
provision, the Secretary has the authority to reduce pro rata the
amount of the additional payments if, before the beginning of a year,
she estimates that these payments would otherwise exceed the caps.
3. Budget Neutrality Applied to New Adjustments
Section 201(c) of the BBRA 1999 amends section 1833(t)(2)(E) of the
Act to require that the establishment of outlier and transitional pass-
through payment adjustments is to be made in a budget neutral manner.
4. Limitation on Judicial Review
Section 201(d) of the BBRA 1999 amends redesignated section
1833(t)(11) of the Act by extending the prohibition of administrative
or judicial review to include the factors for determining outlier
payments (that is, the fixed multiple, or a fixed dollar cutoff amount,
the marginal cost of care, or applicable total payment percentage), and
the determination of additional payments for certain medical devices,
[[Page 18439]]
drugs, and biologicals, the insignificant cost determination for these
items, the duration of the additional payment or portion of the PPS
payment amount associated with particular devices, drugs, or
biologicals, and any pro rata reduction.
5. Inclusion in the Hospital Outpatient PPS of Certain Implantable
Items
Section 201(e) of the BBRA 1999 amends section 1833(t)(1)(B) of the
Act to include as covered outpatient services implantable prosthetics
and DME and diagnostic x-ray, laboratory, and other tests associated
with those implantable items.
6. Payment Weights Based on Mean Hospital Costs
Section 201(f) of the BBRA 1999 amends section 1833(t)(2)(C) of the
Act, which specifies data requirements for establishing relative
payment weights, to allow the Secretary the discretion to base the
weights on either the median or mean hospital costs determined by data
from the most recent available cost reports.
7. Limitation on Variation of Costs of Services Classified Within a
Group
Section 201(g) of the BBRA 1999 amends section 1833(t)(2) of the
Act to limit the variation of costs of services within each payment
classification group by providing that the highest median (or mean
cost, if elected by the Secretary) for an item or service within the
group cannot be more than 2 times greater than the lowest median (or
mean) cost for an item or service within the group. The provision
allows the Secretary to make exceptions in unusual cases, such as for
low volume items and services.
8. Annual Review of the Hospital Outpatient PPS Components
Section 201(h) of the BBRA 1999 amends redesignated section
1833(t)(8) of the Act to require at least annual review of the groups,
relative payment weights, and the wage and other adjustments made by
the Secretary to take into account changes in medical practice, the
addition of new services, new cost data, and other relevant information
and factors. That section of the Act is further amended to require the
Secretary to consult with an expert outside advisory panel composed of
an appropriate selection of provider representatives who will review
the clinical integrity of the groups and weights and advise the
Secretary accordingly. The panel may use data other than those
collected or developed by the Department of HHS for the review and
advisory purposes.
9. Coinsurance Not Affected by Pass-Throughs
Section 201(i) of the BBRA 1999 amends redesignated section
1833(t)(7) of the Act to provide that the beneficiary coinsurance
amount will be calculated as if the outlier and transitional pass-
throughs had not occurred; that is, there will be no coinsurance
collected from beneficiaries for the additional payments made to
hospitals by Medicare for these adjustments.
10. Extension of Cost Reductions
Section 201(k) of the BBRA 1999 amends section 1861(v)(1)(S)(ii) of
the Act to extend until the first date that the hospital outpatient PPS
is implemented, the 5.8 and 10 percent reductions for hospital
operating and capital costs, respectively.
11. Clarification of Congressional Intent Regarding Base Amounts Used
in Determining the Hospital Outpatient PPS
Section 201(l) of the BBRA 1999 provides that, ``With respect to
determining the amount of copayments described in paragraph (3)(A)(ii)
of section 1833(t) of the Social Security Act, as added by section
4523(a) of the BBA, Congress finds that such amount should be
determined without regard to such section, in a budget neutral manner
with respect to aggregate payments to hospitals, and that the Secretary
of Health and Human Services has the authority to determine such amount
without regard to such section.'' Pursuant to this provision, we are
calculating the aggregate PPS payment to hospitals in a budget neutral
manner.
12. Transitional Corridors for Application of Outpatient PPS
Section 202 of the BBRA 1999 amends section 1833(t) of the Act by
redesignating paragraphs (7) through (11) as paragraphs (8) through
(12), and adding a new paragraph (7), which provides for a transitional
adjustment to limit payment reductions under the hospital outpatient
PPS. More specifically, for the years 2000 through 2003, a provider,
including a CMHC, will receive an adjustment if its payment-to-cost
ratio for outpatient services furnished during the year is less than a
set percentage of its payment-to-cost ratio for those services in its
cost reporting period ending in 1996 (the base year). Two categories of
hospitals, rural hospitals with 100 or fewer beds and cancer hospitals,
will be held harmless under this provision. Small rural hospitals, for
services furnished before January 1, 2004, will be maintained at the
same payment-to-cost ratio as their base year cost report if their PPS
payment-to-cost ratio is less. The hold-harmless provision applies
permanently to cancer centers. Section 202 also requires the Secretary
to make interim payments to affected hospitals subject to retrospective
adjustments and requires that the provisions of this section do not
affect beneficiary coinsurance. Finally, this provision is not subject
to budget neutrality.
13. Limitation on Coinsurance for a Procedure
Section 204 of the BBRA 1999 amends redesignated section 1833(t)(8)
of the Act to provide that the coinsurance amount for a procedure
performed in a year cannot exceed the hospital inpatient deductible for
that year.
14. Reclassification of Certain Hospitals
Section 401 of the BBRA 1999 adds section 1886(d)(8)(E) to the Act
to permit reclassification of certain urban hospitals as rural
hospitals. Section 401 adds section 1833(t)(13) to the Act to provide
that a hospital being treated as a rural hospital under section
1886(d)(8)(E) also be treated as a rural hospital under the hospital
outpatient PPS.
II. Prohibition Against Unbundling of Hospital Outpatient Services
A. Background
Sections 9343(c)(1) and (c)(2) of OBRA 1986 amended sections
1862(a)(14) and 1866(a)(1)(H) of the Act, respectively. As revised,
section 1862(a)(14) of the Act prohibits payment for nonphysician
services furnished to hospital patients (inpatients and outpatients),
unless the services are furnished by the hospital, either directly or
under an arrangement (as defined in section 1861(w)(1) of the Act). As
revised, section 1866(a)(1)(H) of the Act requires each Medicare-
participating hospital to agree to furnish directly all covered
nonphysician services required by its patients (inpatients and
outpatients) or to have the services furnished under an arrangement (as
defined in section 1861(w)(1) of the Act). Section 9338(a)(3) of OBRA
1986 affected implementation of the bundling mandate by amending
section 1861(s)(2)(K) of the Act to permit services of physician
assistants to be covered and billed separately. Sections 4511(a)(2)(C)
and (D) of the BBA 1997 further revised sections 1862(a)(14) and
1866(a)(1)(H) of the Act, respectively, to exclude services of nurse
practitioners
[[Page 18440]]
and clinical nurse specialists, described in section 1861(s)(2)(K)(ii)
of the Act, from the bundling requirement.
B. Office of Inspector General (OIG) Civil Money Penalty Authority and
Civil Money Penalties for Unbundling Hospital Outpatient Services
In order to deter the unbundling of nonphysician hospital services,
section 9343(c)(3) of OBRA 1986 added section 1866(g) to the Act to
provide for the imposition of civil money penalties (CMPs), not to
exceed $2,000, against any person who knowingly and willfully presents,
or causes to be presented, a bill or request for payment for a hospital
outpatient service under Part B of Medicare that violates the
requirement for billing under arrangements specified in section
1866(a)(1)(H) of the Act. In addition, section 1866(g) includes
authorization to impose a CMP, in the same manner as other CMPs are
imposed under section 1128A of the Act when arrangements should have
been made but were not. Section 4085(i)(17) of OBRA 1987 amended
section 1866(g) of the Act by deleting all references to hospital
outpatient services under Part B of Medicare. The result of this
amendment is that the CMP is now applicable for services furnished to
hospital patients, whether paid for under Medicare Part A or B.
In order to implement section 1866(g) of the Act, we proposed in
our August 5, 1988 proposed rule that the OIG would impose a CMP
against any person who knowingly and willfully presents, or causes to
be presented, a bill or request for payment for a hospital outpatient
service under Part B of Medicare that violates the billing arrangement
under section 1866(a)(1)(H) of the Act or the requirement for an
arrangement. The amount of the CMP is to be limited to $2,000 for each
improper bill or request, even if the bill or request included more
than one item or service.
C. Summary of Final Regulations on Bundling of Hospital Outpatient
Services
In our September 8, 1998 proposed rule, we proposed to make final
most of the provisions of the August 5, 1988 proposed rule but with a
number of revisions that we describe in detail in the proposed rule (63
FR 47558 through 47559). We are adopting as final regulations what we
proposed in the September 8, 1998 rule with the following additional
changes:
We are adding a new paragraph (b)(7) to Sec. 410.42
(Limitations on coverage of certain services furnished to hospital
outpatients) to provide an exception to the hospital bundling
requirements for services hospitals furnish to SNF residents as defined
in Sec. 411.15(p). (Section 410.42 has been redesignated from
Sec. 410.39 in the proposed rule.)
We are making a minor change to newly redesignated
paragraph (m)(2) (this language was formerly included in paragraph
(m)(1)) in Sec. 411.15 (Particular services excluded from coverage) to
make it clearer that the exclusion discussed in this section is
referring to excluding certain services from coverage.
Except for minor wording changes in introductory paragraph
(b) of Sec. 1003.102 (Basis for civil money penalties and assessments),
that section remains as it appeared in the August 5, 1988 proposed
rule. Paragraph (b)(15) is redesignated from proposed paragraph (b)(4)
in the August 5, 1988 proposed rule and (b)(14) in the September 8,
1998 proposed rule. Paragraphs (b)(12) through (b)(14) of Sec. 1003.102
are reserved.
We are adding a new paragraph (k) to Sec. 1003.103 (Amount
of penalty) to indicate that the OIG may impose a penalty of not more
than $2,000 for each bill or request for items and services furnished
to hospital patients in violation of the bundling requirements.
We are also amending Sec. 1003.105 (Exclusion from
participation in Medicare, Medicaid and other Federal health care
programs) by revising paragraph (a)(1)(i) to reflect that the basis for
imposition of a CMP is also a basis for exclusion from participation in
Medicare, Medicaid and other Federal health care programs.
D. Comments and Responses
Comment: One association requested that we clarify whether lab
tests are subject to the bundling requirement or whether those services
are included in the definition of diagnostic tests that are not
required to be bundled. If lab tests are bundled, the association asked
that we seek a legislative change to permit a provider, other than the
lab that performs the test, to bill for the test.
Response: Laboratory tests, like all other services furnished to
hospital patients, must be provided directly or under arrangements by
the hospital and only the hospital may bill the program. Section
1833(h)(5)(A)(iii) of the Act provides an exception to the requirement
that payment for a clinical diagnostic lab may be made only to the
person or entity that performed or supervised the performance of the
test. This section provides that in the case of a clinical diagnostic
laboratory test provided under arrangement made by a hospital or CAH,
payment is made to the hospital.
All diagnostic tests that are furnished by a hospital, directly or
under arrangements, to a registered hospital outpatient during an
encounter at a hospital are subject to the bundling requirements. The
hospital is not responsible for billing for the diagnostic test if a
hospital patient leaves the hospital and goes elsewhere to obtain the
diagnostic test.
Comment: The same association asked us to clarify that services
billed to skilled nursing facilities (SNFs) under the consolidated
billing requirement would be exempt from the bundling requirement for
hospital outpatient services.
Response: We agree that in situations where a beneficiary receives
outpatient services from a Medicare participating hospital or CAH while
temporarily absent from the SNF, the beneficiary continues to be
considered a SNF resident specifically with regard to the comprehensive
care plan required under Sec. 483.20(b). Such services are, therefore,
subject to the SNF consolidated billing provision and should be exempt
from the hospital outpatient bundling requirements. The final
regulations at Sec. 410.42(b)(7) reflect this exception.
We note that the SNF consolidated billing requirements, under
Sec. 411.15(p)(3)(iii), do not apply to a limited number of
exceptionally intensive hospital outpatient services that lie well
beyond the scope of care that SNFs would ordinarily furnish, and thus
beyond the ordinary scope of SNF care plans. The hospital outpatient
services that are currently included in this policy are: Cardiac
catheterization; computerized axial tomography (CAT) scans; MRIs;
ambulatory surgery involving the use of an operating room; emergency
room services; radiation therapy; angiography; and lymphatic and venous
procedures. When a hospital or CAH provides these services to a
beneficiary, the beneficiary's status as a SNF resident ends, but only
with respect to these services. The beneficiary is now considered to be
a hospital outpatient and the services are subject to hospital
outpatient bundling requirements. In November 1998, we issued Program
Memorandum transmittal number A-98-37, which provides additional
clarification on this exclusion as well as a list of specific HCPCS
codes that identify the services that are excluded from SNF
consolidated billing but subject to hospital outpatient bundling.
Comment: One commenter understood that the proposed rule
[[Page 18441]]
would permit payment for all diagnostic tests that are furnished by a
hospital or other entity if the patient leaves the hospital and obtains
the service elsewhere; however, the commenter requested clarification
as to the treatment of ``outsourced'' hospital departments. The
commenter stated that hospitals are increasingly outsourcing
departments to providers that can furnish services efficiently. Often
these providers do not operate as ``under arrangements'' providers to
the hospital, but as free-standing providers offering outpatient
services on hospital grounds. The commenter specifically asked whether
a free-standing entity providing outpatient services on hospital
grounds, but operated independently of the hospital is able to bill
separately for services furnished or is the entity considered to be
part of the hospital and required to furnish services ``under
arrangement.''
Response: A free-standing entity, that is, one that is not
provider-based, may bill for services furnished to beneficiaries who do
not meet the definition of a hospital outpatient at the time the
service is furnished. Our bundling requirements apply to services
furnished to a ``hospital outpatient,'' as defined in Sec. 410.2,
during an ``encounter,'' also defined in Sec. 410.2.
Comment: One commenter indicated that while the proposed revision
to Sec. 1003.102(b) accurately reflected the statutory directive that
the basis for imposing a CMP is a ``bill or request for payment,'' the
proposed amendment to Sec. 1003.103(a) regarding the appropriate
penalty amount to be imposed for bundling violations was in error. The
commenter indicated that the OIG lacks the authority to impose a CMP in
the amount of $10,000 for these violations, and that such a penalty
should be not more than $2,000 for each violation.
Response: The commenter is correct. While section 231(c) of the
Health Insurance Portability and Accountability Act of 1996, Pub. L.
104-191, increased the CMP maximum amount from $2,000 to $10,000, the
statute sets forth ``items or services'' as the basis upon which a
higher CMP amount may be assessed. However, with regard to bundling
violations, the Secretary may impose a CMP only on the basis of a
``bill or request for payment'' rather than ``for each item and
service'' as stated in the proposed revision to Sec. 1003.103. We are
correcting this error by adding a new Sec. 1003.103(k) to indicate that
the OIG may impose a penalty of not more than $2,000 for each bill or
request for items and services furnished to hospital patients in
violation of the bundling requirements.
III. Hospital Outpatient Prospective Payment System (PPS)
In this section, we designate the services for which Medicare will
make payment under the hospital outpatient PPS, the payment rates set
for those services, and the method by which we determined the
outpatient PPS payment and coinsurance amounts.
We explain the structure of the hospital outpatient PPS, respond to
comments that we received about the proposed PPS, and describe
modifications that we made to the proposed PPS in response to comments,
such as provisions we are making to expedite appropriate payment for
new technologies and provisions to pay for blood and blood products.
In this section, we also discuss how we will implement requirements
enacted by the BBRA 1999, including transitional payment corridors and
other payment adjustments such as outliers and transitional pass-
throughs.
A. Hospitals Included In or Excluded From the Outpatient PPS
This PPS applies to covered hospital outpatient services furnished
by all hospitals participating in the Medicare program, except as noted
below. Partial hospitalization services in community mental health
centers (CMHCs) are also paid under this PPS. Exclusions from
outpatient PPS are different and more limited than exclusions from
inpatient PPS. Thus, hospitals or distinct parts of hospitals that are
excluded from the inpatient PPS are included in the outpatient PPS, to
the extent that the hospital or distinct part furnishes outpatient
services. For example, we will make payment under the outpatient PPS
for outpatient psychiatric services. The outpatient services provided
by hospitals of the Indian Health Service (IHS) will continue to be
paid under separately established rates which are published annually in
the Federal Register. We intend to develop a plan that will help these
facilities transition to the PPS and will consult with the IHS to
develop this plan.
The following hospitals are excluded from the outpatient PPS:
Certain hospitals in Maryland qualify under section
1814(b)(3) of the Act for payment under the State's payment system. The
excluded services are limited to those paid under the State's payment
system as described in section 1814(b)(3) of the Act. Any other
outpatient services furnished by the hospital are paid under the
outpatient PPS.
Critical access hospitals that are paid under a reasonable
cost based system, as required under section 1834(g) of the Act.
Comment: National and State associations representing children's
hospitals and a number of individual children's hospitals located
across the country strongly recommended that their hospitals be
excluded from the hospital outpatient PPS just as they have been
excluded from the hospital inpatient PPS. These commenters argued that
the exclusion should apply to outpatient services furnished by
children's hospitals because these hospitals treat a unique patient
group whose health needs are different from those of adult
beneficiaries entitled to Medicare benefits. The commenters further
argued that services to Medicare patients are, on average, only 1
percent of the total inpatient and outpatient services that children's
hospitals furnish and that these services are largely ESRD services
that are already excluded from the hospital outpatient PPS. The
commenters were concerned that the resources required to implement and
comply with the new system would be disproportionately high relative to
the small number of patients who would be affected by the new system.
In addition, the impact analysis that accompanied the proposed rule
estimated that children's hospitals would lose more than 20 percent of
their Medicare revenues under the new system. Commenters expressed
great concern about this loss of revenue.
Response: Our most recent analysis of the impact on hospitals of
the PPS shows a negative effect for children's hospitals of 11.9
percent, which is significantly less than what we estimated in the
proposed rule. However, the transitional corridor payments provided by
the BBRA 1999 will protect these hospitals from even this level of loss
through 2004. The estimated loss for CY 2000-2001 for children's
hospitals is only 3.2 percent. (See Table 2 in section IX of this
preamble.) As we discuss in section III.H.2 below, we will conduct
extensive analyses during the first years of implementation of the PPS
to determine whether we should propose adjustments for certain types of
hospitals, including children's hospitals, when the transitional
corridor provision expires. In the meantime, we are not excluding any
special class of hospital from the PPS.
B. Scope of Facility Services
Section 1833(t)(1)(B)(i) of the Act gives us the authority to
designate the services to be covered under the hospital outpatient PPS.
In this section of the final rule, we designate the types
[[Page 18442]]
of services included or excluded under the hospital outpatient PPS.
1. Services Excluded From the Scope of Services Paid Under the Hospital
Outpatient PPS
a. Background
In developing a hospital outpatient PPS, we want to ensure that all
services furnished in a hospital outpatient setting will be paid on a
prospective basis. We have already been paying, in part, for some
hospital outpatient services such as clinical diagnostic laboratory
services, orthotics, and end-stage renal disease (ESRD) dialysis
services based on fee schedules or other prospectively determined rates
that also apply across other sites of ambulatory care. Rather than
duplicate existing payment systems that are effectively achieving
consistency of payments across different service delivery sites, we
proposed to exclude from the outpatient PPS those services furnished in
a hospital outpatient setting that were already subject to an existing
fee schedule or other prospectively determined payment rate. The
similar payments across various settings create a more level playing
field in which Medicare makes virtually the same payment for the same
service, without regard to where the service is furnished.
We therefore proposed to exclude from the scope of services paid
under the hospital outpatient PPS the following:
Services already paid under fee schedules or other payment
systems including, but not limited to: screening mammographies,
services for patients with ESRD that are paid for under the ESRD
composite rate; the professional services of physicians and non-
physician practitioners paid under the Medicare physician fee schedule;
laboratory services paid under the clinical diagnostic laboratory fee
schedule; and DME, orthotics, prosthetics, and prosthetics devices,
prosthetic implants, and supplies (DMEPOS) paid under the DMEPOS fee
schedule when the hospital is acting as a supplier of these items. An
item such as crutches or a walker that is given to the patient to take
home, but that may also be used while the patient is at the hospital,
would be billed to the DME regional carrier rather than paid for under
the hospital outpatient PPS.
Hospital outpatient services furnished to SNF inpatients
as part of his or her resident assessment or comprehensive care plan
(and thus included under the SNF PPS) that are furnished by the
hospital ``under arrangements'' but billable only by the SNF,
regardless of whether or not the patient is in a Part A SNF stay.
Services and procedures that require inpatient care.
The statute excludes from the definition of ``covered OPD
services'' ambulance services, physical and occupational therapy, and
speech-language pathology services, specified in section
1833(t)(1)(B)(iii) of the Act (redesignated as section
1833(t)(1)(B)(iv) by section 201(e) of the BBRA 1999). These services
are to be paid under fee schedules in all settings.
b. Comments and Responses
Comment: One commenter urged that we exclude services furnished to
ESRD patients from the scope of the hospital outpatient PPS.
Response: Services furnished to ESRD patients include dialysis,
Epoietin (EPO), drugs, and supplies provided outside the composite
rate, surgery specific to access grafts, and many other medical
services related to renal disease or to other coexisting conditions. We
will continue to base payment for dialysis services on the composite
rate, and we will continue to pay for EPO based on the current rate
established for that service. The drugs and supplies that are used
within a dialysis session, but for which payment is not included in the
composite rate, are paid outside that rate. We have to conduct further
analyses in order to develop appropriate APC groups upon which to base
payment. In the meantime, we will continue to pay on a reasonable cost
basis for dialysis related drugs and supplies that are paid outside the
composite rate.
Comment: A hospital industry association took exception to the
requirement that hospitals obtain a separate supplier number, post a
bond, and bill separately to the DME regional carrier for DME supplies
such as crutches. They believe that this is an unnecessary requirement
that results in additional costs for small rural hospitals. The
commenter recommended that we include within the PPS rate supplies such
as crutches that are directly related to the provison of the hospital
outpatient services or that we permit hospitals to bill under the DME
fee schedule without having to obtain a DME supplier number or post a
bond.
Response: Section 1834(j)(1)(A) of the Act provides that no payment
may be made for items furnished by a supplier of medical equipment and
supplies unless the supplier obtains a supplier number. Section
1834(a)(1)(C) of the Act provides that payment for DME can be made only
under the DME fee schedule. Therefore, to receive payment for DME under
Medicare, a hospital must obtain a supplier number and must meet the
other requirements set by applicable Medicare rules and regulations.
Comment: Several major hospital associations and a number of other
commenters opposed our proposal to exclude from payment certain
procedures that we designate as ``inpatient only.'' Other commenters,
including a physician professional society, agree that many of the
procedures that we designated in the proposed rule as ``inpatient
only'' are currently performed appropriately and safely only in the
inpatient setting. However, these commenters believe that our explicit
exclusion of individual procedures, besides being unnecessary, could
have an adverse effect on advances in surgical care. Some commenters
alleged that we provided no concrete support for designating procedures
as ``inpatient only.'' A number of commenters argued that medicine is
not practiced uniformly across the nation and that some services listed
among the exclusions are currently being performed on an outpatient
basis in various parts of the country with positive outcomes.
An industry association stated that we failed to consider surgical
judgment and patient choice in determining the appropriate treatment
setting for certain services that we proposed to exclude from coverage.
Other commenters believe that the appropriate site for performing a
medical service is best determined by physicians and their patients.
One professional society stated that case law including medical
malpractice case law is sufficient to ensure that medical services are
delivered in the appropriate treatment setting and in conformance with
prevailing medical standards.
Response: We recognize and acknowledge that our assigning
``inpatient only'' status to certain services and procedures raises
numerous questions and concerns, and that some individual
determinations can be reasonably debated. However, section
1833(t)(1)(B) of the Act explicitly authorizes the Secretary to
designate which hospital outpatient services are to be ``covered OPD
services'' subject to payment under the hospital outpatient PPS.
Therefore, we have had to select from the universe of possible services
those that we determine are reasonable, necessary, and appropriate for
Medicare payment under the hospital outpatient PPS. We note that our
designation of a service as ``inpatient only'' does not necessarily
preclude the service from being furnished in a hospital outpatient
[[Page 18443]]
setting, but means only that Medicare will not make payment for the
service were it to be furnished to a Medicare beneficiary in that
setting. This unfortunately leaves the beneficiary liable for payment
if the procedure is in fact performed in the outpatient setting. We
hope that hospitals will advise beneficiaries of the consequences if
procedures on the inpatient list are provided as outpatient services
(that is, denial of Medicare payment with concomitant beneficiary
liability). In section III.C.5 of this preamble, we discuss in greater
detail our rationale for designating specific procedures as ``inpatient
only.'' In response to comments, we have removed the ``inpatient only''
status from a number of services, which will allow them to be paid
under the hospital outpatient PPS. We emphasize our intention to review
annually, in consultation with hospital and professional societies and
associations and the expert outside advisory panel mandated by the BBRA
1999, those procedures classified as ``inpatient only'' to ensure that
the designation remains consistent with current standards of practice.
Comment: One industry association contends that the statutory and
regulatory authorities that we cite in the proposed rule (section
1862(a)(1)(A) of the Act and 42 CFR 411.15(k)(1), respectively) do not
support the proposed medical services exclusions. The commenter argues
that those provisions are the basis for prohibiting coverage for
services that are not reasonable and necessary for the diagnosis or
treatment of an illness or injury or to improve the functioning of a
malformed body member. The commenter states that these provisions are
not the basis upon which we identified services for the ``inpatient
only'' list. The commenter further states that use of these provisions
as a basis for denying coverage of the services would be confusing to
beneficiaries.
Response: The commenter is correct that the proper citations are
not section 1862(a)(1) of the Act and 42 CFR 411.15(k)(1). In fact, the
basis for our designating certain procedures as ``inpatient only'' is
dependent on medical judgment regarding the proper site of service, and
the proper citation for such designation is section 1833(t)(1)(B) of
the Act. In some instances, the identification of services to be
included or excluded from this PPS was perfectly clear. For example,
emergency departments (EDs) are outpatient departments of hospitals.
Thus emergency services rendered in EDs qualify as outpatient services.
On the other hand, coronary artery bypass graft surgery (CABG) requires
many hours in surgery, part of the time with the patient's life being
sustained by artificial means; a period of hours, if not days, in the
surgical intensive care unit (ICU); and further care in an inpatient
unit with frequent nursing attention. It clearly cannot be an
outpatient procedure, and it would not be reasonable to consider it for
inclusion in this PPS. There are many procedures which require similar
intensity of care, including periods in specialty ICUs and several days
of intense nursing attention.
Some procedures formerly performed only in the inpatient setting,
however, have moved to the outpatient site of service. This movement
has taken place due to new, less-invasive surgical techniques, such as
laparoscopy, or new anesthesia agents that clear from the body more
rapidly, allowing some patients to have general anesthesia in the
morning and return home that afternoon. Thus we have had to decide
which procedures may reasonably be performed in the outpatient setting,
and which cannot. We have been guided in this decision by our medical
advisors' clinical judgment regarding what is reasonable in various
settings, comments we received in response to the proposed rule, and
bill data which shows movement from one site to another. In section
III.C.5, we discuss the criteria we considered in defining ``inpatient
only'' procedures.
Comment: One hospital asked how we would pay a hospital that
routinely performs on an outpatient basis a procedure that we proposed
to designate as ``inpatient only.'' The commenter recommended that a
specific billing mechanism be used to guarantee payment in these
situations.
Response: Services designated as ``inpatient only'' will be
excluded from Medicare payment under the hospital outpatient PPS. If
the service is performed on an outpatient basis and a claim is
submitted, the claim will be denied, and the beneficiary may be billed
for the service. We would consider this a very poor policy on the
hospital's part, and would hope that hospitals decide to abide by the
constraints of the inpatient list.
Comment: One commenter noted that hospital outpatient departments
have never been limited to a list of approved procedures as are
Medicare participating ASCs. The commenter stated that the ``inpatient
only'' policy would exclude payment for a significant number of
procedures that have traditionally been performed in the hospital
outpatient setting. The commenter stated that some of the excluded
procedures incorporate an observation stay in a recovery care center.
The commenter contended that many of the excluded procedures could be
safely performed in the outpatient setting particularly if a 24 to 72
hour recovery care center is part of the outpatient surgical care
provided.
Response: Routinely billing an observation stay for patients
recovering from outpatient surgery is not allowed under current
Medicare rules nor will it be allowed under the hospital outpatient
PPS. As we state in section III.C.5 of this preamble, one of the
primary factors we considered as an indicator for the ``inpatient
only'' designation is the need for at least 24 hours of postoperative
care.
Comment: One commenter asked what option a hospital has if a
beneficiary's secondary insurer requires that a procedure included on
the Medicare inpatient only list be performed on an outpatient basis.
Response: Upon implementation, the provisions of this final rule
will govern payment for Medicare covered outpatient services furnished
by hospitals to Medicare beneficiaries. Medicare payment policy and
rules are not binding on employer-provided retiree coverage that may
supplement Medicare coverage. Medigap insurers, however, must follow
Medicare's coverage determinations.
c. Payment for Certain Implantable Items Under the BBRA 1999
In the course of identifying items and services whose costs we
proposed to designate for payment under the hospital outpatient PPS, we
gave considerable thought to including implantable items and services
because these items and services are such an integral part of the
procedure by which they are inserted or implanted. However, a number of
the more common implants such as aqueous shunts, hallux valgus
implants, infusion pumps, and neurostimulators, are classified as
implantable prosthetics or DME. The statutory language governing
payment for DMEPOS provides that, notwithstanding any other provision
of the Medicare statute, DMEPOS must be paid for using the DMEPOS fee
schedule. Therefore, under the proposed rule, the scope of services
paid under the hospital outpatient PPS did not include implantable
prosthetics and DME paid under the DMEPOS fee schedule. However, we did
propose to package payment for implanted items such as stents, vascular
catheters, and venous ports within the APC payment rate for the
procedure related to the insertion of these items because we
[[Page 18444]]
define these items as supplies rather than as prosthetic implants or
implantable DME.
Section 201(e) of the BBRA 1999 amends section 1833(t)(1)(B) of the
Act to provide that ``covered OPD services'' include implantable items
described in paragraph (3), (6), or (8) of section 1861(s) of the Act.
The conference report accompanying the BBRA 1999, H. R. Rep. No. 436
(Part I), 106th Cong., 1st Sess. (1999), expresses the belief of the
conferees that the current DMEPOS fee schedule is not appropriate for
certain implantable medical items such as pacemakers, defibrillators,
cardiac sensors, venous grafts, drug pumps, stents, neurostimulators,
and orthopedic implants as well as items that come into contact with
internal human tissue during invasive medical procedures, but are not
permanently implanted. In the conference report agreement, the
conferees state their intention that payment for these items be made
through the outpatient PPS, regardless of how these products might be
classified on current HCFA fee schedules. The implantable items
affected by this BBRA 1999 requirement include prosthetic implants
(other than dental) that replace all or part of an internal body organ
(including colostomy bags and supplies directly related to colostomy
care and including replacement of these devices); implantable DME; and
implantable items used in performing diagnostic x-rays, diagnostic
laboratory tests, and other diagnostic tests.
Comment: A number of commenters disagreed with our proposal to pay
under the DMEPOS fee schedule for implantable items and devices that
require surgical insertion. We received comments on specific
implantable items, including Vitrasert (a drug delivery system that is
implanted in the eye); cochlear devices, which allow the profoundly
deaf to hear sound and in some cases recognize speech; nerve
stimulators that treat intractable epilepsy and other diseases; new
technology intraocular lenses implanted following cataract surgery; and
access devices for dialysis treatment. Commenters were also concerned
that the costs of some implantable devices not paid under the DMEPOS
fee schedule, which we packaged in our proposed rule, were not properly
recognized in the APC payment.
Response: As we explain above, the amendments made to the statute
by section 201(e) of the BBRA 1999 provide for payment to be made under
the hospital outpatient PPS for implantable items that are part of
diagnostic x-rays, diagnostic laboratory tests, and other diagnostic
tests; implantable durable medical equipment; and implantable
prosthetic devices (other than dental). This BBRA 1999 provision
requires that an implantable item be classified to the group that
includes the service to which the item relates. Thus, under this final
rule with comment period, we are including within the scope of the
hospital outpatient PPS items such as aqueous shunts that would, absent
the BBRA 1999 provision, have been paid under the DMEPOS fee schedule.
Because implantable items are now packaged into the APC payment rate
for the service or procedure with which they are associated, certain
items may be candidates for the transitional pass-through payment,
which is discussed in detail in section III.D of this preamble. The APC
rates may not in every case perfectly recognize the cost of implantable
items. We will continue to review the impact of packaging implantables
in future updates.
d. Summary of Final Action
We are modifying proposed Sec. 419.22 to remove prosthetic implants
from the list of services excluded from payment under the hospital
outpatient PPS. We are adding subparagraphs (9), (10), and (11) to
proposed Sec. 419.2(b), to include the following in the list of items
and services whose costs are included in hospital outpatient PPS
payment rates: prosthetic implants (other than dental) that replace all
or part of an internal body organ (including colostomy bags and
supplies directly related to colostomy care), and including replacement
of these devices; implantable DME; and implantable items used in
performing diagnostic x-rays, diagnostic laboratory tests, and other
diagnostic tests.
2. Services Included Within the Scope of the Hospital Outpatient PPS
We proposed to include three categories of services within the
scope of the outpatient PPS, as follows:
a. Services for Patients Who Have Exhausted Their Part A Benefits
Section 1833(t)(1)(B)(ii) of the Act provides for Medicare payment
under the hospital outpatient PPS for certain services designated by
the Secretary that are furnished to inpatients who have exhausted their
Part A benefits or who are otherwise not in a covered Part A stay.
Examples of services covered under this provision include diagnostic x-
rays and certain other diagnostic services and radiation therapy
covered under section 1832 of the Act.
b. Partial Hospitalization Services
Section 1833(a)(2)(B) of the Act provides that partial
hospitalization services furnished in CMHCs be paid under the hospital
outpatient PPS. Partial hospitalization is a distinct and organized
intensive psychiatric outpatient day treatment program, designed to
provide patients who have profound and disabling mental health
conditions with an individualized, coordinated, comprehensive, and
multidisciplinary treatment program.
c. Services Designated by the Secretary
We proposed to designate the following services to be paid under
the hospital outpatient PPS:
All hospital outpatient services, except those that are
identified as excluded, above, in section III.B.1 of this final rule.
The types of services subject to payment under the hospital outpatient
PPS include the following: surgical procedures; radiology, including
radiation therapy; clinic visits; emergency department visits;
diagnostic services and other diagnostic tests; partial hospitalization
for the mentally ill; surgical pathology; and cancer chemotherapy.
Specific hospital outpatient services furnished to a
beneficiary who is admitted to a Medicare-participating SNF but who is
not considered to be a SNF resident, for purposes of SNF consolidated
billing, with respect to those services that are beyond the scope of
SNF comprehensive care plans. The specific hospital outpatient services
that are excluded from SNF consolidated billing are cardiac
catheterization, computerized axial tomography (CAT) scans, MRIs,
ambulatory surgery involving the use of an operating room, emergency
room services, radiation therapy, angiography, and lymphatic and venous
procedures.
Supplies such as surgical dressings used during surgery or
other treatments in the hospital outpatient setting that are also paid
under the DMEPOS fee schedule. Payment for these supplies, when they
are furnished in a hospital outpatient setting, is packaged into the
APC payment rate for the procedure or service with which the items are
associated.
Certain preventive services furnished to healthy persons,
such as colorectal cancer screening.
Section 4523(d)(3) of the BBA 1997 amended section 1833(a)(2)(B) of
the Act to provide that we discontinue reasonable cost based payment
and instead make Part B payment under the hospital outpatient PPS for
certain medical and other health services when
[[Page 18445]]
they are furnished by other providers such as hospices, SNFs, and HHAs.
Specifically, we proposed to pay under the hospital outpatient PPS for
the following medical and other health services when they are furnished
by a provider of services:
Antigens (as defined in 1861(s)(2)(G) of the Act);
Splints and casts (1861(s)(5) of the Act);
Pneumococcal vaccine, influenza vaccine, hepatitis B
vaccine (1861(s)(10) of the Act).
Upon implementation of the hospital outpatient PPS, we would make
Part B payment for the above services under the outpatient PPS when
they are furnished by an HHA or hospice program. We would also make
payment for antigens and the vaccines under the PPS when they are
furnished by CORFs. (Splints and casts furnished by CORFs are paid
under the rehabilitation fee schedule.) However, this provision would
not apply to services furnished by a CORF that fall within the
definition of CORF services at section 1861(cc)(1) of the Act. It also
would not apply to services furnished by a hospice within the scope of
the hospice benefit. Nor would it apply to services furnished by HHAs
to individuals under an HHA plan of treatment within the scope of the
home health benefit.
d. Summary of Final Action
We received no comments about the services we proposed to include
within the scope of the hospital outpatient PPS. As noted in the
preceding section III.B.1, we added certain implantable items to
Sec. 419.2(b) to implement section 201(e) of the BBRA 1999.
3. Hospital Outpatient PPS Payment Indicators
In the September 8, 1998 proposed rule in the Federal Register, we
proposed a payment status indicator for every code in the HCPCS to
identify how the service or procedure described by the code would be
paid under the hospital outpatient PPS. We received no comments on our
proposal to assign a payment status indicator to every HCPCS code. (In
section III.C.6, below, we respond to commenters who disagreed with the
payment status indicator that we proposed for individual codes.)
Therefore, we are implementing payment status indicators as part of the
hospital outpatient PPS. Addendum B displays the final payment status
indicator for each HCPCS code, including codes for incidental services
that are packaged into APC payment rates. Addendum E identifies the
HCPCS codes to which we have assigned payment status indicator ``C'' to
identify inpatient services that are not payable under outpatient PPS
as implemented by this final rule. We respond below, in section
III.C.5, to public comments about the specific codes we classified as
inpatient services in the proposed rule and our final determination
regarding the payment status of those codes.
The following are the payment status indicators and description of
the particular services each indicator identifies:
We use ``A'' to indicate services that are paid under some
other method such as the DMEPOS fee schedule or the physician fee
schedule.
We use ``C'' to indicate inpatient services that are not
paid under the outpatient PPS.
We use ``E'' to indicate services for which payment is not
allowed under the hospital outpatient PPS. In some instances, the
service is not covered by Medicare. In other instances, Medicare does
not use the code in question, but does use another code to describe the
service.
We use ``F'' to indicate corneal tissue acquisition costs,
which are paid separately.
We use ``G'' to indicate a current drug or biological for
which payment is made under the transitional pass-through.
We use ``H'' to indicate a device for which payment is
made under the transitional pass-through.
We use ``J'' to indicate a new drug or biological for
which payment is made under the transitional pass-through.
We use ``N'' to indicate services that are incidental,
with payment packaged into another service or APC group.
We use ``P'' to indicate services that are paid only in
partial hospitalization programs.
We use ``S'' to indicate significant procedures for which
payment is allowed under the hospital outpatient PPS but to which the
multiple procedure reduction does not apply.
We use ``T'' to indicate surgical services for which
payment is allowed under the hospital outpatient PPS. Services with
this payment indicator are the only services to which the multiple
procedure payment reduction applies.
We use ``V'' to indicate medical visits for which payment
is allowed under the hospital outpatient PPS.
We use ``X'' to indicate ancillary services for which
payment is allowed under the hospital outpatient PPS.
The table below lists types of services, the hospital outpatient
PPS payment status indicator assigned to each type of service, and the
basis for Medicare payment for the service.
Medicare Hospital Outpatient PPS Payment Status Indicators: How Medicare
Pays for Various Services When They Are Billed for Hospital Outpatients
------------------------------------------------------------------------
Indicator Service Status
------------------------------------------------------------------------
A................... Pulmonary Not paid.
Rehabilitation;
Clinical Trial.
C................... Inpatient Procedures.... Not paid.
A................... Orthotics, and Non- DMEPOS Fee Schedule.
implantable Durable
Medical Equipment and
Prosthetics.
E................... Nonallowed Items and Not paid.
Services.
A................... Physical, Occupational Rehab Fee Schedule.
and Speech Therapy.
A................... Ambulance............... Reasonable cost or
charge or, when
implemented, Ambulance
Fee Schedule.
A................... EPO for ESRD Patients... National Rate.
A................... Clinical Diagnostic Lab Fee Schedule.
Laboratory Services.
A................... Physician Services for Bill to Carrier.
ESRD Patients.
A................... Screening Mammography... Lower of Charge or
National Rate.
N................... Incidental Services, Packaged; No Additional
Packaged into APC Rate. Payment Allowed.
P................... Partial Hospitalization Paid Per Diem.
Services.
S................... Significant Procedure, Paid Under Hospital
Not Reduced When Outpatient PPS (APC
Multiple Procedures Rate).
Performed.
T................... Significant Procedure, Hospital Paid Under
Multiple Procedure Outpatient PPS (APC
Reduction Applies. Rate).
[[Page 18446]]
V................... Visit to Clinic or Paid Under Hospital
Emergency Department. Outpatient PPS (APC
Rate).
X................... Ancillary Service....... Paid Under Hospital
Outpatient PPS (APC
Rate).
F................... Acquisition of Corneal Paid at reasonable cost.
Tissue.
G................... Current Drug/Biological Additional payment.
Pass-Through.
H................... Device Pass-Through..... Additional payment.
J................... New Drug/Biological Pass- Additional payment.
Through.
------------------------------------------------------------------------
C. Description of the Ambulatory Payment Classification (APC) Groups
1. Setting Payment Rates Based on Groups of Services Rather Than on
Individual Services
In our March 17, 1995 report to Congress, we recommended that
groups similar to the ambulatory patient groups (APGs) developed by 3M
Health Information Systems (3M) be used as the basis for the hospital
outpatient PPS. We made this recommendation after examining a number of
other payment systems that were already in place or under development,
including DRGs that are the basis for Medicare payment for hospital
inpatient services, the Medicare physician fee schedule that was
implemented in 1992, and the payment groups that have been the basis
for Medicare payments for ambulatory surgical center (ASC) facility
services since 1982.
As provided by the BBA 1997, section 1833(t)(2)(A) of the Act
requires the Secretary to develop a classification system for covered
outpatient services. Section 1833(t)(2)(B) provides that this
classification system may be composed of groups, so that services
within each group are comparable clinically and with respect to the use
of resources. The statute refers to ``each such service (or group of
services),'' confirming that the Secretary may choose or not choose to
group services.
We explain in our proposed rule that we revised the APGs, based on
more recent Medicare data than that used by 3M, to create the
ambulatory payment classification (APC) system. We proposed to group
services identified by HCPCS codes and descriptors within APC groups as
the basis for setting payment rates under the hospital outpatient PPS.
We indicated that we organized the APC groups so that the services
within each group would be homogeneous both clinically and in terms of
resource utilization. We invited comments on our proposal to set rates
on the basis of groups of services rather than on individual codes.
Comments: Some commenters claimed that basing payment on APC groups
rather than on individual services would result in underpayment for
services that are more resource intensive, causing hospitals with a
more resource intensive case mix to lose money. An organization
representing physicians strongly opposed the use of APCs, because it
believes that it is not possible to achieve an incentive-neutral,
``level playing field'' payment system using groups of codes or
services. This organization favored replacing the APC system with a fee
schedule based on individual services, similar to the Medicare
physician fee schedule, as MedPAC recommends in its 1999 report to
Congress. (We address the MedPAC recommendation later in this section.)
The same physician organization is concerned that the broad range of
services included in each APC will create an incentive for hospitals to
provide lower cost services, even though a patient might require higher
cost services. This organization expressed concern about the negative
impact on physicians if a payment methodology similar to the APC system
were applied to payment for physician services. To facilitate pricing
new codes using individual services rather than APC groups, the same
organization suggested that we establish a ``relative value
relationship in direct costs'' between the new code and a comparable
code, or that we consult AMA's Specialty Society RVS Updating Committee
(RUC) for advice on relative cost relationships.
One major hospital association expressed its preference for a
service-specific fee schedule because of the wide variation in costs
represented by groups of codes. Another hospital association advocated
using individual services rather than groups of services as the basis
for ratesetting, but recommended, if we were to use some form of
grouping, that we apply tight limits on the variations of costs for
services within a group.
Response: We understand the concerns of commenters that setting
payment weights using groups of services rather than individual
services could result in payment for particular services that might not
fully offset the costs that hospitals incur when they furnish
expensive, resource-intensive services. However, we believe these
concerns are in large measure addressed by the provisions of this final
rule. As we explain in section III.C.6, we significantly restructured
the proposed APC groups, first in response to comments and, second, to
comply with section 1833(t)(2) of the Act, as amended by the BBRA 1999,
which limits the variation of costs of services classified within a
group. The result is more APC groups with fewer codes and a narrower
range of costs in each group. In addition, other provisions of the BBRA
1999, such as the transitional pass-throughs (see section III.D,
below), and outlier payments and transitional corridors (see section
III.H, below) protect hospital revenues while hospitals gain experience
with the PPS.
Medicare Payment Advisory Commission (MedPAC) Recommendation
In both its March 1998 and March 1999 reports to the Congress on
Medicare payment policy, MedPAC recommends that payment rates under the
hospital outpatient PPS be based upon costs of individual services
rather than groups of similar services to help ensure consistent
payments across ambulatory settings. In its March 1999 report, MedPAC
asserts its belief that the burden imposed by our proposed APC system
outweighs its benefits in ambulatory settings. MedPAC gives several
reasons to support its position.
The use of groups to calculate weights masks questionable
cost data for low volume and new procedures.
Different classes of hospitals face disproportionate
impacts, suggesting APC groups may not be as homogeneous as we believe.
Grouping services will likely create additional
administrative burdens for hospitals, because hospitals may have to
purchase or develop new software and will experience additional
education and training costs.
Response: We carefully reviewed the concerns about using groups of
services
[[Page 18447]]
expressed by MedPAC in its March 1998 report, and we responded to those
concerns in our proposed rule (63 FR 47562). Even though MedPAC
concedes in its March 1999 report that using groups to set rates has
certain potential advantages, MedPAC continues to oppose using groups
because, according to MedPAC, they entail considerable costs and
drawbacks and necessitate ``a much more complicated design logic'' than
would be required using a service-level fee schedule.
We do not share MedPAC's concerns. We have a high level of
confidence in the ratesetting method using APC groups that we implement
in this final rule with comment period. As we explain below, in section
III.C.6, we have extensively restructured the APC groups to respond to
comments on the proposed rule, to incorporate specific provisions of
the BBRA 1999, and to correct some errors that had come to our
attention. We believe that by using median costs in the calculation of
group weights, we limit the extent to which infrequently performed
services with suspect costs can affect the payment rate of an APC
group.
As discussed below in the impact analysis (section IX of this
preamble), the provisions of this final rule with comment period, which
include setting rates using APC groups, alleviate to a large extent the
disproportionate impacts on different classes of hospitals estimated in
our proposed rule. In addition, as we explain in section III.C.6, when
we restructured the APC groups, we were particularly attentive to the
degree of provider concentration associated with the individual
services within a group in order to avoid biasing the payment system
against any subset of hospitals.
Finally, none of the commenters cited increased administrative
burden as an argument against using groups. Even though we are using
APC groups to set rates under the hospital outpatient PPS, hospitals
will bill for services using HCPCS codes (not APCs) using the same
claims forms that they use currently. Although to receive payment under
the new system, hospitals will have to more fully code the services
they furnish, they will not have to know to which APC the service is
assigned in order to determine the payment amount. We are publishing
the payment rate applicable to each HCPCS code in Addendum B of this
final rule. Any burdens on hospitals necessitating additional technical
assistance, training, or systems changes are more a function of
implementing an entirely new payment system than of our setting rates
on the basis of groups of services.
Final Action: The payment rates implemented by this final rule with
comment period are determined based on APC groups that use HCPCS codes
to describe individual services. The codes assigned to an APC group are
comparable clinically and in terms of resource use.
2. Packaging Under the APC System
a. Summary of Proposal
In our proposed rule, we described packaged services as those items
or services that we recognized as contributing to the cost of the
procedures or services in an APC group, and for which we would not make
separate payment. We proposed to include as packaged services use of
the operating room and recovery room, anesthesia, medical/surgical
supplies, pharmaceuticals, observation, blood, intraocular lenses,
casts and splints, the costs of acquiring tissue such as corneal tissue
for surgical insertion and various incidental services such as
venipuncture. We packaged the services (and their costs) within the APC
group of procedures with which they were delivered in the base year.
For a list of proposed packaged services grouped by hospital revenue
centers, refer to the June 30, 1999 correction notice (64 FR 35258).
b. General Comments and Responses (Supporting or Objecting to
Packaging)
Comment: Few commenters disagreed with our proposal to aggregate
into one payment the costs for a ``package'' of services variously
related to a procedure or to the principal service being furnished.
However, many commenters did object to our packaging costs for certain
specific items such as expensive drugs and pharmaceuticals, observation
services in the emergency department, blood and blood products, corneal
tissue acquisition costs, and chemotherapy and supportive drugs.
Commenters, fearful that packaging items and services will result in
lower payments that do not offset the high costs of particularly
expensive items, raised the prospect of dire consequences such as
forcing hospitals to use only the cheapest drugs, being unable to
employ oncology nurses, eliminating otherwise clinically necessary
ancillary services, or not being able to hold emergency room patients
for observation.
Response: We are persuaded by commenters' arguments that packaging
payment for certain expensive items and services into an APC group rate
could have such a potentially negative impact as to jeopardize
beneficiary access to these items and services in the hospital
outpatient setting. Therefore, in response to comments, we are not
packaging within an APC payment rate the costs associated with certain
specified items and services. Instead, we will make a separate APC
payment for these particular items and services under the outpatient
PPS. However, as we explain in section III.C.2.d, we do not concur with
commenters who urge separate payment for observation services; rather,
we are packaging the costs in the APC for each service with which
observation services were billed in our 1996 database. We discuss in
further detail below, in section III.C.2.d through section III.C.2.g,
and in section III.C.6, the changes that we are making to the packaging
we originally proposed. We address in section III.B.1, above, the BBRA
1999 provision that requires us to package into APC group rates payment
for certain implantable items and devices. In section III.D, below, we
describe additional payments for certain packaged medical devices,
drugs, and biologicals that are provided as transitional pass-throughs
under section 201(b) of the BBRA 1999.
As we gain experience with and collect additional cost data under
the hospital outpatient PPS, we will review our policy to pay
separately for certain items and services that would otherwise be
packaged into the APC payment. Should we decide to modify this policy,
we will do so through the rulemaking process as part of our annual
hospital outpatient PPS update.
MedPAC Recommendation: In its March 1999 report to the Congress,
MedPAC cites two models that Medicare uses to define a unit of payment:
the DRG-based payment model for hospital inpatient services, and the
Medicare physician fee schedule. MedPAC contends that services provided
in the hospital outpatient setting more closely parallel those
furnished in an office-based setting than those furnished as part of a
hospital inpatient admission. Therefore, MedPAC recommends that, in
establishing ambulatory care prospective payment systems in general, we
define the unit of payment for ambulatory care facilities as an
individually coded service, consisting of the primary service that is
the reason for the encounter, and the necessary and essential ancillary
services and supplies integral to it, including limited follow-up care
if it is integral to the primary service, but not including physicians'
services. MedPAC further recommends that the unit of payment be defined
consistently across all ambulatory care settings.
[[Page 18448]]
Response: The packaging that we proposed as the basis for
determining APC payment rates and that we will implement under the
hospital outpatient PPS is generally consistent with MedPAC's
recommendation. However, we did not propose to include ``limited
follow-up services'' in our packaged groups under the hospital
outpatient PPS because of the difficulty of matching in our database
the costs of these services with their associated primary encounter.
For now, hospitals are to bill follow-up care, such as suture removal,
using an appropriate medical visit code. We did not propose, nor have
we included in this final rule with comment period, provision for a
global period for hospital outpatient services analogous to the global
period affecting payments for professional services made under the
Medicare physician fee schedule.
c. Packaging of Casts and Splints
Comment: One commenter stated that we should not package costs for
casts and splints with other procedures.
Response: We proposed to assign payment status indicator ``N'' to
CPT codes for strapping and casting services (CPT codes 29000-29750) to
designate that these are incidental services for which payment is
packaged into the APC rate for another service or procedure, in this
case, the repair or reduction of a fracture or dislocation. After
further review, we determined that strapping and casting services can
be performed independently, for example, when a cast placed as a part
of a procedure must later be replaced with another cast. Therefore, we
have decided that strapping and casting services will not be packaged
and we are creating two APCs (0058 and 0059) to pay for these services.
The BBA 1997 required that we pay under the outpatient PPS for casting
and strapping services furnished in HHAs and hospices, to the extent
that these services are provided and are not within the patient's plan
of care.
d. Packaging of Observation Services
We received many comments urging us to pay separately for
observation services, particularly when patients are seen in the
emergency department. Observation service is placing a patient in an
inpatient area, adjacent to the emergency department, or, according to
some comments, in the intensive care unit (ICU) or coronary care unit
(CCU), in order to monitor the patient while determining whether he or
she needs to be admitted, have further outpatient treatment, or be
discharged. After 1983, many hospitals began to rely heavily on the use
of observation services when peer review organizations questioned
admissions under the hospital inpatient prospective payment system.
However, in some cases, patients were kept in ``outpatient''
observation for days or even weeks at a time. This resulted in excess
payments both from the Medicare program and from beneficiaries who
generally paid a higher coinsurance. In response to this practice, in
November 1996, we issued instructions limiting covered observation
services to no more than 48 hours except in the most extreme
circumstances. However, the cost data upon which the APC system is
based contain all costs for observation in 1996, including those that
exceeded the 48-hour limit imposed at the end of that year. We have
packaged those costs into the service with which they were furnished in
the base year. Thus, APC payments for emergency room visits include the
costs of observation within the payment.
Comment: Some commenters acknowledged that being paid separately
for observation following a surgical procedure was not necessary; the
packaged recovery room and observation services were sufficient.
However, a major concern of commenters was observation of patients with
chest pain who had equivocal results on initial diagnostic testing.
Commenters were concerned that the APC payment for these cases would
not be adequate.
Response: We assume that chest pain patients, such as those
described by the commenters, are sent to the CCU or ICU for
observation. We believe that, in general, if a patient needs to be
monitored in the ICU or CCU for any length of time, then that patient
should be admitted as an inpatient. Furthermore, we have never
considered care furnished in an ICU or CCU to be outpatient services.
Existing cost reporting instructions allow for the use of these
specialty beds during a shortage of regular inpatient beds, but charges
are to reflect routine care, not intensive care.
Although, as noted above, we received many comments urging that
observation services be covered as a separate APC, we continue to
believe that these services have been used so inappropriately in the
past that we will have to gather data under the PPS before considering
constructing a separate APC. We have packaged observation wherever it
was billed. Roughly $139 million was identified by revenue code 762 as
representing observation services. An additional $253 million was
identified in revenue codes 760, 761, and 769, which could be used for
either observation or treatment room use. That $253 million is also
packaged. (Both figures are in 1996 dollars.)
Further analyses will be necessary on the use of observation as an
adjunct to emergency treatment, as in the case of chest pain. In order
to ensure that we will have sufficient data for our future analyses,
hospitals must continue to bill for observation using revenue center
762 and showing hours in the units field. Observation that is billed
must represent some level of active monitoring by medical personnel. It
must not be billed as a way to capture room and board for outpatients.
During our first review of the APC groups, we will assess whether
patients with certain conditions use observation services that should
be separately recognized. Thus, correct diagnosis coding is required.
e. Packaging Costs of Procuring Corneal Tissue
Comment: We received about 2,000 comments from physicians, eye
banks, and health care associations opposing our proposal to package
corneal tissue acquisition costs into the APC payment for corneal
transplant procedures. Most commenters argued that the payment for the
procedures in proposed APC group 670, Corneal transplant, is grossly
inadequate and that we have failed to recognize the high costs
associated with tissue screening and testing procedures required by the
Food and Drug Administration that are reflected in the fees charged by
eye banks. In addition, commenters contended that we failed to
recognize the wide variation in tissue acquisition costs resulting from
the level of philanthropic contributions in different areas of the
country and in different years. Commenters asserted that by packaging
corneal tissue acquisition costs with the payment for corneal
transplant surgery, we would limit beneficiary access to quality care,
force eye banks that are nonprofit, low-cost operations to close,
provide disincentives for philanthropic contributions, and impede our
goal to increase tissue availability.
As part of their comments, the Eye Bank Association of America
(EBAA) submitted a report of a study the EBAA commissioned on corneal
tissue acquisition costs. The study was conducted by the Lewin Group
which collected and analyzed data on corneal tissue acquisition costs
incurred by 74 of EBAA's 100 members that are charitable nonprofit
organizations. The report states that these 74 eye banks supplied
approximately 82 percent of the corneal tissue distributed
[[Page 18449]]
throughout the United States in 1997. Based on the data that they
collected, the Lewin Group found that the median gross acquisition cost
per transplant is $1,689 in 1999 dollars. Of this amount, approximately
$233 represents the national median value of donated in-kind services
such as volunteer staff. The Lewin Group concluded that the proposed
hospital outpatient PPS payment of $1,583 did not adequately reflect
the cost of procuring corneal tissue.
Additionally, the report states that ``fund raising and in-kind
service values are not as well centered on their median values as the
underlying cost data. Variability in fund raising and in-kind
contributions not only exists between eye banks, but from year to year,
within the same eye bank.'' According to the study, charitable
contributions in the form of cash and in-kind services represented 28
percent of the eye banks' total gross cost for tissues furnished in
1997. The Lewin Group finds that ``If HCFA were to move to fee schedule
or other fixed-payment rate, and pays the adjusted median Gross cost
Per Transplant * * * payment of $1689, HCFA would overpay some banks
and underpay others, depending on philanthropy and in-kind services
which varies from community to community and from year to year. The
variation is too extreme to determine a fair rate-based system, without
destroying the philanthropy the community is built upon.''
Response: Based on the concerns raised by the commenters and the
data presented in the Lewin Group study, we have decided not to package
payment for corneal tissue acquisition costs with the APC payment for
corneal transplant surgical procedures at this time. Instead, we will
make separate payment, based on the hospital's reasonable costs
incurred to acquire corneal tissue. Final payment will be subject to
cost report settlement. To receive payment for corneal acquisition
costs, hospitals must submit a bill using HCPCS code V2785, Processing,
preserving and transporting corneal tissue, and indicate the
acquisition cost rather than the hospital's charge on the bill. We
intend to review this policy after we have acquired updated data on
corneal procedures.
f. Packaging Costs of Blood and Blood Products
Comment: Many commenters, including the American Red Cross, a major
medical association, teaching hospitals, and community oncology
centers, believe that the payments we proposed for blood and blood-
related products and for APCs that required the use of blood and blood-
related products, were too low. Commenters claimed that the proposed
payments are so much lower than actual costs that hospitals might be
forced to stop providing a range of blood services, especially those
more complex than a simple transfusion. The commenters were concerned
that our proposed payment would not allow hospitals to furnish the most
clinically appropriate blood products and services. The commenters also
stated that blood and blood product exchange were not assigned to
appropriate APCs, thus skewing payment rates and not recognizing the
true costs of services with which blood and blood product exchange are
associated. Commenters attributed this deficiency to the fact that
certain blood-related products were incorrectly billed in the 1996 data
we used as the basis for pricing APCs. Commenters were also concerned
that we excluded procedures whose costs fell outside 3 standard
deviations of the mean cost. One major organization recommended that we
separate payment for blood and blood products from the service with
which it is associated. This commenter also recommended separate
payment for infusible blood-derived drugs, and that we base payment for
transfusable blood products on costs. Some commenters recommended a
transition period prior to full implementation of the proposed PPS.
Response: Based on the recommendations of commenters, we have
created separate APC groups to pay for blood and blood products. We
agree with the commenters that blood use varies enough that packaging
blood units with their administration could lead to inequities. Because
we were not able to capture enough claims data in the base year to
accurately price the blood and blood-product APCs, we have based
payment rates for these APCs on data provided by commenters, including
suppliers of blood and blood products. We have based payment on current
costs rather than 1996 costs so that we recognize the costs of recently
developed blood safety tests. The safety of the nation's blood supply
is a major concern of the Department of Health and Human Services, and
we want to encourage appropriate testing and follow-up care.
g. Packaging Costs for Drugs, Pharmaceuticals, and Biologicals
We proposed to package the cost of drugs, pharmaceuticals, and
biologicals with APC groups because we believe drugs are usually
provided in connection with some other treatment or procedure. We
collected aggregate cost data on all drugs that were billed with HCPCS
codes and those billed with revenue center codes, whether or not a
HCPCS was entered. By so doing, we captured historical patterns of drug
use within the APC groups with which the drugs were billed during the
base year. However, because we did not require HCPCS coding of drugs,
we could not isolate costs associated with individual drugs, some of
which are very expensive even though they are rarely used and may be
used by only a few hospitals. As a result, we acknowledge that our
proposed APC payment rates may not fully reflect costs of very
expensive drugs or biologicals.
We also proposed to create separate drug groups for
chemotherapeutic agents because those were separately identified in the
APG system designed by 3M. However, because we did not have bills that
were coded to identify drugs individually, we were concerned that the
APC groups for chemotherapeutic groups may not have completely
reflected the costs of these drugs.
Comment: Many commenters criticized the proposed APC payment rates
because they were developed using cost data from 1996 that do not
reflect the cost of many new drugs, pharmaceuticals, and biologicals.
Some commenters expressed particular concern about oncology drugs such
as paclitaxil (Taxol) and topotecan. Some advised that Taxol and
carboplatin chemotherapy have become the standard treatment for ovarian
carcinoma. A number of commenters believe that our proposal did not
provide sufficient financial incentives to dissuade hospitals from
using the older less effective chemotherapy regimens even though there
is significantly greater toxicity and reduced chances of favorable
outcomes associated with their use. Many commenters strongly suggested
that we carve out new drugs and biologicals and those introduced after
1996 from the PPS and pay for them on a reasonable cost basis. Several
commenters asserted that packaging drugs and pharmaceuticals within the
APC groups understates their cost to hospitals and their value to
patients.
Response: We believe the commenters' concerns have, to a great
extent, been addressed by implementation of the BBRA 1999 pass-through
provisions for drugs and biologicals. Addendum K includes a complete
list of all drugs, biologicals, and medical devices that are eligible
for pass-through payments. We encourage interested parties to follow
the process outlined below in section III.I.4 of this
[[Page 18450]]
preamble to submit requests for consideration of drugs, biologicals,
and medical devices that may be eligible for additional payment under
the transitional pass-through provision but that are not listed in
Addendum K.
h. Summary of Final Action
After consideration of comments received about packaging of
services and of the requirements set forth in the amendments made to
section 1833(t) of the Act by section 201(b) and section 201(e) of the
BBRA 1999, we have revised the package of services directly related and
integral to performing a procedure or furnishing a service on an
outpatient basis whose costs will determine the national payment rate
for that procedure or service under the hospital outpatient PPS.
We will package into the APC payment rate for a given
procedure or service any costs incurred to furnish the following items
and services: Use of an operating suite, procedure room or treatment
room; use of the recovery room or area; use of an observation bed;
anesthesia; medical and surgical supplies and equipment; surgical
dressings; supplies and equipment for administering and monitoring
anesthesia or sedation; intraocular lenses; capital-related costs;
costs incurred to procure donor tissue other than corneal tissue; and,
various incidental services such as venipuncture.
In general, we will package the cost of drugs,
pharmaceuticals and biologicals into the APC payment rate for the
primary procedure or treatment with which they are used. Additional
payment for some drugs, pharmaceuticals, and biologics may be allowed
under the transitional pass-through provisions, which we explain below,
in section III.D.
We will not package payment for corneal tissue acquisition
costs into the payment rate for corneal transplant surgical procedures
at this time. We will make separate payment for these acquisition costs
based on the hospital's reasonable costs incurred to acquire corneal
tissue.
We will not package into the APC payment rate for another
procedure or service costs incurred to furnish the following items and
services: blood and blood products, including anti-hemophilic agents;
casting, splinting, and strapping services; immunosuppressive drugs for
patients following organ transplant; and certain other high cost drugs
that are infrequently administered. We have created new APC groups for
these items and services, which allows separate payment to be made for
them.
3. Treatment of Clinic and Emergency Department Visits
a. Provisions of the Proposed Rule
As we discussed in our proposed rule, determining payment for
hospital clinic and emergency department (ED) visits requires a variety
of considerations such as the following:
The impact of packaging on setting payment rates.
How to code visits in a manner that recognizes variations
in service intensity and levels of resource consumption.
How to keep the system administratively manageable.
How to define critical care in terms of facility as
opposed to physician input.
Data problems associated with identifying costs from
claims that list multiple services.
How to move toward greater uniformity of payments across
ambulatory settings so as to remove payment as an incentive for
determining site of service.
The major issue we faced in determining payment for hospital clinic
and ED visits is whether to include diagnosis as well as Physicians'
Current Procedural Terminology (CPT) codes in setting payment rates.
In our proposed rule, we considered several approaches to setting
prospective payment rates for hospital clinic and ED visits. Potential
options included: (1) Using diagnosis codes only; (2) using CPT codes
only; and (3) using a CPT-diagnosis code hybrid. We solicited comments
on these approaches to setting payment rates for clinic and ED visits
as well as comments on alternative approaches that we did not set forth
in the proposed rule. In the proposed rule, we discussed in detail our
assessment of the advantages and disadvantages of each approach.
In addition, we proposed to create a HCPCS code that would be used
to bill when a patient presents to an ED, requests a screening, and is
screened in accordance with section 1867(a) of the Act. Payment for
this new code would be minimal because we included no treatment costs
in the screening service. Payment for the screening APC would be made
only when no additional services were furnished by the emergency
department. If nonemergency treatment was furnished, the appropriate
emergency department visit would be billed, and not the screening.
Similarly, if the screening reveals that an emergency does exist and
treatment is instituted immediately, the screening would not be billed
because we would consider payment to be subsumed into the payment for
further treatment.
We proposed paying for critical care as the highest level of
``visit.'' In our proposed rule, we stated that hospitals would use CPT
code 99291 to bill for outpatient encounters in which critical care
services are furnished.
We used the CPT definition of ``critical care'' which is the
evaluation and management of the critically ill or injured patient.
Under the outpatient PPS, we would allow the hospital to use CPT code
99291 in place of, but not in addition to, a code for a medical visit
or for an emergency department service. Although the CPT system allows
the physician to bill in 30-minute increments following the first 74-
minute period of providing critical care, we proposed to pay separately
for only the initial period (CPT code 99291), packaging the few
instances in which the 30-minute increments (CPT code 99292) were
billed. If other services, such as surgery, x-rays, or cardiopulmonary
resuscitation, were furnished on the same day as the critical care
services, we would allow the hospital to bill for them separately.
b. Comments and Responses
Comment: The major hospital associations argued that none of our
three proposed approaches fully explains facility resource use in
connection with clinic and emergency visits. Hospitals did not see a
clear benefit in the payment ranges created by using the CPT and
diagnosis hybrid approach. A major medical association adamantly
opposed the use of diagnosis codes. One major HMO that does not
currently use CPT codes was opposed to the use of CPT codes to describe
clinic and emergency visits.
Response: In this final rule, we are not using patient diagnosis
codes to compute payment rates for medical visits to clinics and
emergency departments under the outpatient PPS because a number of
concerns were raised about basing payment for medical visits on both
HCPCS codes and ICD-9 diagnosis codes. The final payment groups for
medical visits are constructed using CPT procedure codes only, which is
consistent with our overall PPS grouping strategy and with the approach
we have followed to establish payment groups for surgical and
diagnostic services. However, we will continue to require hospitals to
provide accurate diagnosis coding on claims for payment. We will
continue to assess the value of using patient diagnosis for application
[[Page 18451]]
to our payment system for possible use in the future.
In developing medical visit APCs based on CPT procedure codes only
(a change from the proposed rule), we are collapsing 31 CPT codes that
define clinic and emergency visits into six groups, three each for the
clinics and the emergency department. The final APC groups for clinic
and emergency visits are as follows: APC 0600, Low Level Clinic Visits;
APC 0601, Mid-Level Clinic Visits; APC 0602, High Level Clinic Visits;
APC 0603, Interdisciplinary Team Conference; APC 0610, Low Level
Emergency Visits; APC 0611, Mid-Level Emergency Visits; APC 0612, High
Level Emergency Visits; and APC 0620, Critical Care.
When basing payment on CPT codes alone, the range of costs reflects
hospitals' billing patterns in increasing level of intensity. However,
those increasing increments are due largely to hospitals' use of
``chargemaster'' systems, which generate bills using predetermined
charges for codes. Thus, billing patterns reflect standard bills, not
the resources used in any particular case.
We had been concerned that certain hospitals' use of the lowest
level code, CPT code 99201, to bill for all clinic visits would distort
the data, causing inflation in both the volume and cost of low-level
clinic visits, and a corresponding underreporting of mid- and high-
level visits. (Costs for mid- and high-level visits would presumably
have been correct, because individual hospitals would have reported
appropriate charges with these codes; there simply would have been
fewer reported visits at those levels.)
We have developed the weights for clinic visits by using claims
data only from a subset of hospitals that billed a wider range of
visits rather than relying solely on claims with CPT code 99201. We
chose to use this subset of hospitals (for this purpose only) because
we do not know what CPT code 99201 indicates when hospitals use it
exclusively to bill all visits.
We emphasize the importance of hospitals assessing from the outset
the intensity of their clinic visits and reporting codes properly based
on internal assessment of the charges for those codes, rather than
failing to distinguish between low-and mid-level visits ``because the
payment is the same.'' The billing information that hospitals report
during the first years of implementation of the hospital outpatient PPS
will be vitally important to our revision of weights and other
adjustments that affect payment in future years. We realize that while
these HCPCS codes appropriately represent different levels of physician
effort, they do not adequately describe nonphysician resources.
However, in the same way that each HCPCS code represents a different
degree of physician effort, the same concept can be applied to each
code in terms of the differences in resource utilization. Therefore,
each facility should develop a system for mapping the provided services
or combination of services furnished to the different levels of effort
represented by the codes. (The meaning of ``new'' and ``established''
pertain to whether or not the patient already has a hospital medical
record number.)
We will hold each facility accountable for following its own system
for assigning the different levels of HCPCS codes. As long as the
services furnished are documented and medically necessary and the
facility is following its own system, which reasonably relates the
intensity of hospital resources to the different levels of HCPCS codes,
we will assume that it is in compliance with these reporting
requirements as they relate to the clinic/emergency department visit
code reported on the bill. Therefore, we would not expect to see a high
degree of correlation between the code reported by the physician and
that reported by the facility.
Hospitals are required to use HCPCS code 99291 to report outpatient
encounters in which critical care services are furnished. (See the
American Medical Association's CPT 2000 coding manual for the
definition of this code.) The hospital is required to use HCPCS code
99291 in place of, but not in addition to, a code for a medical visit
or for an emergency department service.
We will work with the American Hospital Association and the
American Medical Association to propose the establishment of
appropriate facility-based patient visit codes in time for the next
proposed rule.
Comment: Several commenters expressed concern that resources
expended in the emergency department are not fully explained by the
codes at their disposal. One commenter pointed out that some hospitals
use internal coding systems to capture differing charges based on
whether or not a case requires one-on-one nursing care.
Response: While we share commenters' concerns on this point, we
remind hospitals that they can receive additional payment under the
outpatient PPS for services such as diagnostic testing and
administration of infused drugs, and for therapeutic procedures
including resuscitation that are furnished during the course of an
emergency visit. We will also pay separately for certain high cost
drugs, such as the expensive ``clotbuster'' drugs that must be given
within a short period of time following a heart attack or stroke, if
these drugs are furnished during an emergency visit. Even though some
ED patients will be transferred to another hospital for inpatient
treatment, the hospital that administers the drugs will be paid for
them. Cases that fall far outside the normal range of costs will be
eligible for an outlier adjustment established by section 201(a) of the
BBRA 1999. (See section III.H, below.) In addition, one of the first
topics of review to be addressed by the expert outside advisory panel,
required by section 201(h)(1)(B) of the BBRA 1999, will be to determine
if emergency department visits can be categorized in a way that better
recognizes the underlying resources, especially nursing resources,
involved in the visit.
Comment: Several commenters expressed concern about the appropriate
level of payment for patients who die in the ED. One commenter believes
that services furnished to these patients are resource-intensive and
recommends that we continue to pay for the services on a reasonable
cost basis.
Response: We are directing fiscal intermediaries to use the
following guidelines in determining how to make payment when a patient
dies in the ED or is sent directly to surgery and dies there.
If the patient dies in the ED, make payment under the
outpatient PPS for services furnished.
If the ED or other physician orders the patient to the
operating room for a surgical procedure, and the patient dies in
surgery, payment will be made based on the status of the patient. If
the patient had been admitted as an inpatient, pay under the hospital
inpatient PPS (a DRG-based payment). If the patient was not admitted as
an inpatient, pay under the outpatient PPS (an APC-based payment). If
the patient was not admitted as an inpatient and the procedure is
designated as an inpatient-only procedure (payment status indicator
``C''), no Medicare payment will be made for the procedure, but payment
will be made for ED services.
Comment: Some commenters objected to our proposal to restrict
payment for critical care services to CPT code 99291 and not allow
payment for CPT code 99292. One commenter recommended that we create an
APC group for the additional increments of time a physician spends in
critical care for which the physician may bill.
[[Page 18452]]
Response: We do not believe that paying hospitals for incremental
time as critical care would better reflect facility resources. The most
resource-intensive period for the hospital is generally the first hour
of critical care. In addition, we believe it would be burdensome for
hospitals to keep track of minutes for billing purposes. Therefore, we
will pay for critical care as the most resource-intensive visit
possible as defined by CPT code 99291. Critical care services will be
assigned to APC 0620.
Comment: Several commenters advised that a screening code was not
necessary because an emergency visit code could be billed for ED
screening services.
Response: We agree with the commenters, and we will instead use the
appropriate emergency department codes for screening services (as
defined in section 1867(a) of the Act). If no treatment is furnished,
we would expect screening to be billed with a low-level emergency
department code.
Comment: Some commenters expressed concern about our proposal to
allow hospitals to create a separate claim for each visit when two or
more medical visits occur on the same day for different diagnoses.
Commenters feared that this would result in our paying under the
outpatient PPS for clinic care furnished at sites other than hospital
outpatient departments, and that we are promoting fragmented care. One
commenter was concerned that, to the extent that patients see multiple
specialists, tests will be repeated unnecessarily, hospitalizations
will rise, and beneficiaries and the Medicare program will be burdened
with additional, unnecessary costs.
Response: Our decision not to use diagnosis codes as a factor in
determining payment for clinic visits largely negates these concerns
because the need to prepare different claims for visits for different
diagnoses has been eliminated. When patients are seen in different
clinics on the same day, hospitals should bill using the proper codes
for the level of the visits, using the units field if appropriate to
reflect more than one visit at the same level.
However, we note that the comment did prompt us to develop a code
for billing those visits during which numerous physicians see a patient
concurrently, for example, a surgeon, medical oncologist, and radiation
oncologist for a cancer patient, to discuss treatment options and to
ensure that the patient is fully informed. In this instance, each
physician is addressing the patient's care from a unique perspective.
If several physicians see a patient concurrently in the same clinic for
the same reason, the hospital would bill for one clinic visit using an
appropriate visit code even though each physician would bill
individually for his or her professional services. We have established
a code for hospitals to use in reporting a scheduled medical conference
with the patient involving a combination of at least three health care
professionals, at least one of whom is a physician. That code is G0175,
Scheduled interdisciplinary team conference (minimum of three,
exclusive of patient care nursing staff) with patient present.
4. Treatment of Partial Hospitalization Services
As we explained in the proposed rule, partial hospitalization is an
intensive outpatient program of psychiatric services provided to
patients in lieu of inpatient psychiatric care. Partial hospitalization
may be provided by a hospital to its outpatients or by a Medicare-
certified community mental health center (CMHC). It is important to
note that the services of physicians, clinical psychologists, clinical
nurse specialists (CNSs), nurse practitioners (NPs), and physician
assistants (PAs) furnished to partial hospitalization patients would
continue to be billed separately to the carrier as professional
services and are not considered to be partial hospitalization services.
Thus, payment for partial hospitalization services represents the
provider's overhead costs, support staff, and the services of clinical
social workers (CSWs) and occupational therapists (OTs), whose
professional services are considered to be partial hospitalization
services for which payment is made to the provider. Including CSW and
OT services reflects historical patterns of treatment billed during the
base year.
Because a day of care is the unit that defines the structure and
scheduling of partial hospitalization services, we proposed a per diem
payment methodology for the partial hospitalization APC. We analyzed
the service components billed by hospitals over the course of a billing
period and determined the median hospital cost of furnishing a day of
partial hospitalization. As noted in the June 30, 1999 correction
notice, this analysis resulted in a proposed APC payment rate of
$206.71 per day, of which $46.78 is the beneficiary's coinsurance.
We also solicited comments on a number of issues related to partial
hospitalization. We asked for information on the mix of services that
constitute a typical partial hospitalization day and average duration
of a partial hospitalization episode, whether we should impose a
minimum number of services for each covered partial hospitalization
day, and whether we should establish a limit on routine outpatient
mental health services furnished on a given day to equal the partial
hospitalization per diem amount. Finally, we indicated that we are
considering specifying a timeframe for physician recertification of
need for partial hospitalization services as a method of ensuring that
a patient's condition continues to require the intensity of a partial
hospitalization program.
We did not receive a significant number of public comments on this
issue. A summary of the comments we received and our responses follow.
Comment: We received many similar comments from rural hospitals
that operate partial hospitalization programs. The hospitals indicated
that the proposed per diem amount does not cover their direct cost of
providing services. Each commenter included an estimate of their
partial hospitalization program cost (without depreciation or
allocation of overhead costs). The estimates range from $270 to $325
per patient per day. The commenters indicated that approximately 65 to
70 percent of the costs are personnel-related.
Response: The commenters did not indicate why their costs were
higher than the per diem amount, but only that a significant proportion
of their costs are related to personnel. In the future, we are
committed to assessing the extent to which the per diem reflects
special needs of rural hospitals. In the meantime, the BBRA 1999
includes provisions that offer relief to rural hospitals during the
early years of the outpatient PPS. (See section III.H of this
preamble.)
Comment: We received several other comments regarding the proposed
per diem amount. One commenter stated that the proposed per diem rate
is equivalent to 3.3 psychotherapy units. The commenter believed this
is an inadequate level of therapy for partial hospitalization patients
and suggested that a per diem rate equal to 4 psychotherapy units would
provide payment for a more appropriate level of service intensity.
Several other commenters suggested that we set a single rate using a
therapeutic hour of treatment (for example, the group psychotherapy APC
rate) as the unit of service coupled with an overall aggregate limit
for a course of treatment. These commenters estimated that a typical
partial hospitalization day costs $275. Another commenter, a national
association, conducted a survey of its
[[Page 18453]]
member hospitals which showed that the median cost per day of treatment
was approximately $210. Other commenters urged us to establish separate
per diem amounts for partial hospitalization programs serving geriatric
beneficiaries and those serving disabled beneficiaries under age 65.
They indicated that programs designed to serve geriatric beneficiaries
consist of different treatment modalities that are costlier than
programs that serve younger beneficiaries. One commenter stated that
programs serving younger beneficiaries typically average high patient
volume and therefore have much lower costs per patient day than do the
programs that serve geriatric patients. Other commenters urged us to
establish a half day rate, although some stated that a half-day benefit
does not reduce administrative costs appreciably.
Response: In accordance with section 1833(t)(2)(C) of the Act, the
proposed per diem amount represents the national median cost of
providing partial hospitalization services. We used all the data from
hospital bills that included the condition code 41, which identifies
the claim as partial hospitalization. Because providers do not report
on the claim the specific services provided each day, we do not
currently have data that would permit us to establish an aggregate
limit for a course of treatment or to analyze differences in the mix of
services provided to various populations. As discussed in the preamble
to the proposed rule and in Transmittal 7 of the CMHC Manual (issued
November 1999) and Transmittal 747 of the Hospital Manual (issued
December 1999), beginning April 1, 2000, hospitals and CMHCs will be
required to indicate line item dates of service on claims. Once we have
accumulated these data, we will be better able to determine if
refinements to the per diem methodology are warranted, including the
extent to which half-days are utilized.
Comment: Several commenters expressed concern that no CMHC data
were used to establish the partial hospitalization per diem payment
rate. The commenters stated that CMHC costs are significantly different
from hospital-based programs and urged us to collect CMHC cost data and
base payments to CMHCs on CMHC-specific information. Another commenter
stated that implementing PPS for partial hospitalization services
provided by CMHCs is intended to contain costs and urged us to track
the impact of the PPS on CMHCs. Still another commenter expressed
concern that the per diem amount is insufficient for CMHCs to provide
quality services. The commenter admitted, however, that historically
their service area has had limited resources to provide minimum support
for the persistent and chronically mentally ill. Two commenters
expressed concern about certification requirements for CMHCs. One urged
us to require accreditation by a national accrediting body and another
commenter noted that reliance on the statutory definition established
for CMHCs under the Public Health Service Act in 1963 is no longer
appropriate and urged us to redefine a CMHC for Medicare certification
purposes.
Response: Partial hospitalization services are covered services
under the hospital outpatient PPS. Section 1833(a)(2)(B) of the Act
provides that partial hospitalization services furnished by CMHCs are
to be paid under the hospital outpatient PPS. And, section
1833(t)(2)(C) of the Act requires that we establish relative payment
weights based on median (or mean, at the election of the Secretary)
hospital costs determined by 1996 claims data and data from the most
recent available cost reports. As stated above, we are committed to
analyzing future data from hospitals and CMHCs to determine if
refinements to the per diem are warranted. As we noted in the proposed
rule, the Medicare partial hospitalization benefit is designed to
furnish services to patients who have been discharged from inpatient
psychiatric care, and partial hospitalization services are provided in
lieu of continued inpatient treatment, and for patients who exhibit
disabling psychiatric/psychological symptoms or experience an acute
exacerbation of a severe and persistent mental disorder. Because the
statute requires a physician to certify that the patient would
otherwise require inpatient psychiatric care in the absence of the
partial hospitalization services, we do not believe the Medicare
partial hospitalization benefit was intended to provide support for the
persistent and chronically mentally ill except when they are in an
acute phase of their mental illness. With regard to accreditation
requirements for CMHCs and substantively revising the definition of a
CMHC, this final rule is not the appropriate vehicle in which to
address these issues. We are, however, amending Sec. 410.2 to remove an
obsolete provision from the definition of a CMHC.
Comment: Several commenters questioned whether the proposed per
diem approach meets the definition of an APC, that is, a group of
services that are comparable clinically and in resource use. They
believed that partial hospitalizations vary widely in their treatment
approach and cost. Therefore, creating one payment amount for all
partial hospitalization days is not consistent with our proposed
classification system.
Response: We continue to believe that the structure of the average
partial hospitalization day is more similar than the commenters
believe. We followed the basic analytical methodology used to establish
all the APC payment amounts, except that we determined that, for
partial hospitalization services, the unit of service is a day.
Nonetheless, requiring providers to submit claims by date of service
and by service provided will allow for future analysis to determine if
the APC grouping for partial hospitalization can be improved.
Comment: One commenter expressed concern about the use of 1996 data
as the basis for the per diem amount. They referenced testimony by the
Inspector General that indicated a significant improvement in the
accuracy of provider billing in 1998 audits. They urged us to use 1997
or 1998 cost reports by region to develop the APC rate.
Response: Section 1833(t)(2)(C) of the Act requires that we use
1996 claims data and the most recent cost reports as the basis for
ratesetting under the hospital outpatient PPS. For purposes of the
final rule, we primarily used cost reports for periods beginning in FY
1997.
Comment: Several commenters, including national industry
associations, expressed concern that partial hospitalization programs
are required by their individual fiscal intermediaries to meet
different medical necessity and programmatic requirements. For this
reason, programs vary widely in program content and resultant cost. The
commenters urged us to establish national coverage criteria before
implementing a PPS for partial hospitalization services. Another
commenter urged us to rely on more recent claims data that identify all
services provided on each date of service in order to determine the
relative resource cost of various outpatient mental health treatment
programs.
Response: Section 1833(a)(2)(B) of the Act provides that partial
hospitalization services are paid under section 1833(t). We will refine
the system, as needed, based on our review of more specific bill data.
Movement to a per diem payment methodology will necessitate changes in
the medical review approach used by fiscal intermediaries. It will
become necessary to ensure that all patients receive the level of
service their
[[Page 18454]]
individual condition requires. Some patients will require days of
service that cost the provider more than the per diem payment amount.
Other patients may require less intensive days of service during an
acute episode of partial hospitalization care or as they transition out
of the partial hospitalization program. We will be developing medical
review guidance for fiscal intermediaries, which we believe will lead
to more consistency in medical review.
Comment: One commenter noted that, in the past, a daily or partial-
day payment approach was commonly used and was abandoned in favor of
component billing for each partial hospitalization service. The
commenter now believes that component billing provides a more accurate
indication of the services provided to individual patients.
Response: We believe that a per diem payment approach is a more
appropriate methodology than billing for each program component. This
approach is supported by the major industry groups involved with
partial hospitalization and is used by other governmental and private
insurers to pay for partial hospitalization program services. A per
diem approach also incorporates and recognizes the cost of services
that are not separately billable as outpatient psychiatric services,
such as nursing services, training and education services, activity
therapy, and support staff costs.
Comment: Several commenters requested additional information on the
HCPCS codes to which the partial hospitalization indicator applies and
questioned how codes will group to APC 20 rather than grouping to
psychotherapy APCs 91 through 94. They also asked whether substance
abuse day programs will group to APC 20.
Response: We issued revised billing instructions for partial
hospitalization services provided by CMHCs in November 1999 and for
hospital programs in December 1999. We instructed CMHCs to use HCPCS
codes to bill for their partial hospitalization services; we required
hospitals and CMHCs to report line item dates of service; and we
established new HCPCS codes for occupational therapy and training and
educational services furnished as a component of a partial
hospitalization treatment program. We included in the instructions a
complete listing of the revenue codes and HCPCS codes that may be
billed as partial hospitalization services as follows:
------------------------------------------------------------------------
Revenue codes Description HCPCS code
------------------------------------------------------------------------
43X................. Occupational Therapy G0129.
(Partial
Hospitalization).
904................. Activity Therapy Q0082.
(Partial
Hospitalization).
910................. Psychiatric General 90801, 90802, 90875,
Services. 90876, 90899, or 97770.
914................. Individual Psychotherapy 90816, 90818, 90821,
90823, 90826, or 90828.
915................. Group Psychotherapy..... 90849, 90853, or 90857.
916................. Family Psychotherapy.... 90846, 90847, or 90849.
918................. Psychiatric Testing..... 96100, 96115, or 96117.
942................. Education Training G0172.
(Partial
Hospitalization).
------------------------------------------------------------------------
To bill for partial hospitalization services under the hospital
outpatient PPS, hospitals are to use these HCPCS and revenue codes and
are to specify condition code 41 on the HCFA-1450 claim form. Before
assigning a claim for payment to APC 0033 (the final APC for partial
hospitalization services), the outpatient code editor (OCE) will check
for errors; for example, the OCE will verify that the claim includes a
mental health diagnosis, and at least three partial hospitalization
HCPCS codes for each day of service, one of which must be a
psychotherapy HCPCS code (other than brief). Claims that do not pass
the OCE edits will undergo further prepayment review.
With regard to the comments regarding substance abuse day programs,
the Medicare benefit category is partial hospitalization services.
Because there is no separate benefit category for substance abuse
programs, any such program would have to meet requirements established
for partial hospitalization programs in order for claims to group to
APC 0033, including the requirements that a physician certify that the
patient would otherwise require inpatient psychiatric care in the
absence of the partial hospitalization services and that the program
provides active treatment.
Comment: In regard to physician recertification, we received
several comments expressing support for establishing a specific
timeframe and recommending a range from 7 to 31 days.
Response: We agree that physicians should initially certify a
patient's need for partial hospitalization services and recertify
continued need for this intensive level of treatment. Because partial
hospitalization is the outpatient substitute for inpatient psychiatric
care, we believe it is appropriate to adopt the standard currently used
for inpatient psychiatric care. Therefore, in this final rule, we are
amending Sec. 424.24(e) to establish physician recertification
requirements for partial hospitalization services. The initial
physician certification establishing the need for partial
hospitalization must be received by the partial hospitalization program
upon admission. Thus, services provided to establish a patient's need
for partial hospitalization services would continue to be billed to the
carrier as professional services. The first recertification is required
as of the 18th day of services and subsequent recertifications are
required no less frequently than every 30 days. Each recertification
must address the patient's response to the intensive, therapeutic
interventions provided by the active treatment program which make up
partial hospitalization services, changes in functioning and status of
the serious psychiatric symptoms that place the patient at risk of
hospitalization, and treatment plan and goals for coordination of
services such as community supports and less intensive treatment
options to facilitate discharge from the partial hospitalization
program.
Comment: We received several comments regarding our proposal to
limit payment for less intensive outpatient mental health treatment at
the partial hospitalization per diem rate. One commenter did not
believe the law supports establishment of a payment ceiling and that
any such action is arbitrary. Other commenters believe that treatment
should be determined by the clinical needs of each patient. However,
the commenters conceded that additional requirements may have to be
added to the final rule to prevent duplication or overlap of partial
[[Page 18455]]
hospitalization and routine outpatient mental health services.
Response: Our rationale for this proposal was that the costs
associated with administering a partial hospitalization program
represent the most resource intensive of all outpatient mental health
treatment and, therefore, we should not pay more for a day of
individual services. We are also concerned that a provider may
disregard a patient's need for the intensive active treatment offered
by a partial hospitalization program and opt to bill for individual
services. In addition, the per diem amount represents the cost of an
average day of partial hospitalization because the data used to
calculate the per diem were derived from all the partial
hospitalization data and include the most and the least intensive days.
It would not be appropriate for a provider to obtain more payment
through component billing.
Comment: Several commenters expressed concern about staffing
services that are bundled in the per diem payment and other staffing
issues. One commenter stated that due to increased medical review by
the fiscal intermediary, no partial hospitalization services may be
furnished by unlicensed personnel. The commenter urged that the
necessity for upgrades in staffing be taken into consideration in
establishing a per diem rate. One commenter believes that all services,
except for physician services, should be bundled into the per diem
rate.
Response: The list of covered partial hospitalization services is
located in section 1861(ff) of the Act. The list includes several
services such as patient education and training and activity therapy
that may be provided by unlicensed but qualified staff who are
specifically trained to work with the mentally ill. We note that the
billing instructions issued in November 1999 (for CMHCs) and in
December 1999 (for hospitals) announced a new HCPCS code for patient
training and education services as a component of a partial
hospitalization program. (A HCPCS code for activity therapy as part of
a partial hospitalization program has been in place for several years.)
Although the list also specifically references the services of social
workers, trained psychiatric nurses, and other staff trained to work
with psychiatric patients, there are no specific HCPCS codes for these
services. Certain other partial hospitalization services, for example,
individual and group psychotherapy, family counseling, occupational
therapy (OT), and diagnostic services, must be provided by licensed
staff, authorized by the State to provide these services.
With regard to the content and staffing of partial hospitalization
programs, we believe that all the covered services listed in section
1861(ff) of the Act and the disciplines of the staff who provide the
services, that is, the multidisciplinary team, are an important element
in creating the therapeutic milieu that distinguishes partial
hospitalization programs from other outpatient mental health treatment.
We believe it would be inappropriate if providers no longer offered the
full range of partial hospitalization services, especially services
such as OT that continue to be bundled in the per diem amount. We plan
to monitor the extent to which providers change their programming in
response to implementation of the PPS. Because the data on which the
per diem was based included the full range of services and the use of
certain bundled professionals, we will monitor changes in services or
increased use of unbundled practitioners to evaluate and update the per
diem rate. In response to the comment recommending that we bundle more
professional services into the per diem rate, we captured historical
patterns of treatment and staffing during the base year. Thus, the
partial hospitalization per diem amount is limited to the provider's
overhead costs, support staff, and the services of clinical social
workers and occupational therapists, whose professional services are
defined as partial hospitalization services. We have amended
Sec. 410.43(b) to update the list of services that are not paid as
partial hospitalization services.
Comment: One commenter took issue with our characterizing partial
hospitalization to be the result of an acute exacerbation of a
beneficiary's severe and persistent mental illness for which partial
hospitalization services are provided in lieu of an inpatient
psychiatric admission. They urged us to clarify that admission to a
partial hospitalization is based on a physician certification that the
patient would otherwise require inpatient psychiatric care, but
continued stay in a partial hospitalization program would serve as a
maintenance program for the chronically mentally ill. The commenter
raised many other concerns about how we described partial
hospitalization in the proposed rule, noting specific concern with
regard to active treatment, community-based support, and frequency and
duration of services.
Response: It was not our intention in the proposed rule to generate
public comment on the nature and coverage of partial hospitalization
under the Medicare program. Rather, the information presented has
appeared in various program memoranda and was included to describe the
benefit and explain the per diem payment methodology. We continue to
believe that partial hospitalization is a covered Medicare benefit
category only when provided as an alternative to inpatient psychiatric
care for acutely mentally ill beneficiaries.
Result of Evaluation of Comments
We are adopting as final our proposal to--
Establish a per diem payment of $202.19 for the partial
hospitalization APC (APC 0033); and
Limit the payment for outpatient mental health treatment
furnished on a day of services to the partial hospitalization APC
payment amount.
In addition, we are amending Sec. 424.24(e) to establish
requirements for physician recertification for partial hospitalization
services.
5. Inpatient Only Procedures
In our proposed rule, we assigned payment status indicator ``C'' to
1,803 codes that represent procedures that our medical advisors and
staff determined require inpatient care because of the invasive nature
of the procedure, the need for postoperative care, or the underlying
physical condition of the patient who would require the surgery. We did
not assign these procedures to an APC group, and we proposed to make no
payment for these services under the hospital outpatient PPS. Above, in
section III.B.1.b of this preamble, we respond to the numerous general
comments we received challenging both our classification of various
procedures as inpatient procedures and our exclusion of these
procedures from the scope of services paid under the hospital
outpatient PPS.
Comment: Commenters objected on the grounds that medical practice
and new technology have allowed many procedures that formerly were
performed only in the inpatient setting to be safely and effectively
performed on an outpatient basis. In addition, they believe we are
making decisions that should be left to the discretion of surgeons and
their patients. Finally, the commenters believe that it is better for
the patient if procedures are performed on an outpatient basis whenever
possible. Commenters requested that we remove the payment status
indicator of ``inpatient only'' from 195 codes and include them in an
appropriate APC.
Response: Under section 1833(t)(1)(B)(i) of the Act, the Secretary
has broad authority to designate which
[[Page 18456]]
services fall within the definition of ``covered OPD [outpatient
department] services'' that will be subject to payment under the
prospective payment system. We believe that certain surgically invasive
procedures on the brain, heart, and abdomen, such as craniotomies,
coronary-artery bypass grafting, and laparotomies, indisputably require
inpatient care, and therefore are outside the scope of outpatient
services. Certain other procedures that we proposed as ``inpatient
only'' may not be so clearly classified as such, but they are performed
virtually always on an inpatient basis for the Medicare population. We
acknowledge that emerging new technologies and innovative medical
practice are blurring the difference between the need for inpatient
care and the sufficiency of outpatient care for many procedures,
although we are concerned that some of the procedures that commenters
claim to be performing on an outpatient basis may actually have been
performed with overnight postoperative care furnished in observation
units. And, regardless of how a procedure is classified for purposes of
payment, we expect, as we stated in our proposed rule, that in every
case the surgeon and the hospital will assess the risk of a procedure
or service to the individual patient, taking site of service into
account, and will act in that patient's best interests.
After a careful review of comments by our medical advisors and
staff, we have assigned to APC groups certain procedures that we had
proposed as inpatient only. We made some changes because we were
convinced by commenters' arguments that certain procedures are often
performed safely in the outpatient setting; others because we believe
that the simplest procedure described by the code may be performed
safely in the outpatient setting; and yet others because they were
related to codes we moved (for example, the radiologic part of an
interventional cardiology procedure). The procedures we moved to the
outpatient APCs include codes from within the following families:
Explorations of penetrating wounds; repairs of some cranial and facial
fractures; planned tracheostomies; diagnostic thoracoscopies; some
insertion/removal/replacement of pacemakers, pulse generators,
electrodes and cardioverter-defibrillators; embolectomies and
thrombectomies; transluminal balloon angioplasty and peripheral
atherectomy; transcatheter therapies; bone marrow transplantation;
gastrostomies; percutaneous nephrostolithotomy; surgical laparoscopies,
including cholecystectomies; ovarian biopsies; and surgeries on the
orbit. Although we are moving these procedures into APC groups and they
can receive outpatient payment, we emphasize that we expect only the
simplest and least resource intensive procedures of each type to be
performed in the outpatient setting. For example, several codes could
be used to describe initial insertion of a pacemaker or replacement of
the pacemaker or its electrodes. We believe most initial pacemaker
insertions are performed on an inpatient basis, so codes billed in this
range are most likely to be for replacement of a pacemaker, which
requires fewer facility resources.
Because of the risk involved with invasive cardiovascular
procedures, including angioplasty and atherectomy, we are placing an
additional requirement on their performance that we do not think is
necessary with other procedures. That is, Medicare will pay for these
procedures only in those settings in which the patient can immediately
be placed on cardiopulmonary bypass in the event of a complication such
as perforation of a coronary artery, which would require an immediate
thoracotomy.
When our medical advisors and staff disagreed with the
recommendation of commenters to reclassify a particular procedure, they
based their decision to retain a procedure as ``inpatient only'' on
several considerations. In general terms, as stated above, we define
inpatient procedures as those that require inpatient care because of
the invasive nature of the procedure, the need for at least 24 hours of
postoperative recovery time or monitoring before the patient can be
safely discharged, or the underlying physical condition of the patient
who would require the surgery. In other words, inpatient procedures are
those that, in the judgment of our medical advisors and staff, would
not be safe, appropriate, or considered to fall within the boundaries
of acceptable medical practice if they were performed on other than a
hospital inpatient basis.
Among the procedures cited by commenters that we believe should
remain as ``inpatient only'' are: Breast reconstruction using
myocutaneous flaps; radical resections of tumors of the mandible; open
treatment of certain craniofacial fractures; osteotomies of the femur
and tibia; sinus endoscopy with repair of cerebrospinal fluid leaks;
carinal reconstruction; surgical thoracoscopies; pacemaker procedures
by thoracotomy; certain thromboendarterectomies; excision of
mediastinal cysts and tumors; excisions of stomach tumors;
enterostomies; hepatotomies; ureterotomies and ureteral endoscopies
through ureterotomies; transcranial approaches to the orbit; and
laminectomies. Our medical advisors and staff, as well as consulting
physicians, believe these procedures are too invasive (for example,
thoracotomies), too extensive (for example, breast reconstruction with
myocutaneous flaps), or too risky by virtue of proximity to major
organs (for example, repairs of spinal fluid leaks and carinal
reconstruction) to be performed on an outpatient basis. The procedures
that we exclude from outpatient payment because we believe they should
be performed on an inpatient basis are listed in Addendum E. This list
represents national Medicare policy and is binding on fiscal
intermediaries and peer review organizations as well as on hospitals
and Medicare participating ASCs. Note, however, that services included
in outpatient PPS and assigned to an APC may be performed on an
inpatient basis when the patient's condition warrants inpatient
admission.
In the future, as part of our annual update process, we will be
working with professional societies and hospital associations, as well
as with the expert outside advisory panel that we will be convening as
required by new section 1833(t)(9)(A) of the Act, to reevaluate
procedures on the ``inpatient only'' list and we will propose to move
procedures to the outpatient setting whenever we determine it to be
appropriate. For example, a decreasing length of inpatient stay for a
procedure may signal that it is appropriate for consideration for
payment under the outpatient PPS. If hospitals find that surgeons are
discharging patients successfully on the day of surgery, they should
bring this to our attention as well, because hospitals may become aware
of this trend before our payment data disclose it. Thus, assignment of
a ``C'' payment status indicator in this final rule should not be
considered as a permanent or irrevocable designation.
Comment: One professional society recommended that we assign
payment status indicator ``C'' to CPT codes 21343, open treatment of
depressed frontal sinus fracture, 42842, radical resection of tonsil,
tonsillar pillars, and/or retromolar trigone--without closure, and
69150, radical excision external auditory canal lesion--without neck
dissection, because these procedures require inpatient care.
Response: We accepted the commenters' recommendation that these CPT
codes should not be performed in an outpatient setting. We also
reclassified as an inpatient procedure
[[Page 18457]]
CPT code 94762, noninvasive ear or pulse oximetry for oxygen
saturation; by continuous overnight monitoring (separate procedure),
because it requires an overnight stay.
Comment: One commenter noted that, to the extent that we require
that certain surgical procedures be performed in an inpatient setting
in order to receive Medicare payment, the beneficiary will incur the
higher deductible associated with a hospital inpatient service.
Response: The commenter is correct that the Part A hospital
inpatient deductible amount that a beneficiary will have to pay may be
higher than coinsurance and deductibles the beneficiary would have paid
as an outpatient for a surgical procedure. However, our decisions
concerning whether to pay for certain surgical procedures under the PPS
are based on patient safety concerns and the medical appropriateness of
performing the procedures in the hospital inpatient versus outpatient
setting.
Final Action
Under the hospital outpatient PPS, we will not make payment for
procedures that are designated as ``inpatient only.'' We have, however,
revised the list of procedures that are designated as ``inpatient
only'' based on comments. (See Addendum E.)
6. Modification of APC Groups
a. How the Groups Were Constructed
Section 1833(t)(2)(A) of the Act requires the Secretary to develop
a classification system for covered outpatient services. Within that
classification system, the Secretary is given the authority under
section 1833(t)(2)(B) of the Act to establish groups of covered
services so that the services within each group are comparable
clinically and with respect to the use of resources. In the proposed
rule, we explain how we constructed the APC groups that are the basis
for ratesetting under the hospital outpatient PPS.
Our medical advisors and staff used the ambulatory patient groups
(APGs) developed by 3M-Health Information Systems as a starting point
for the APC groups, but we modified the APGs to take into account 1996
outpatient claims data, data collected in a 1994 survey of ambulatory
surgical center (ASC) costs and charges, data collected in 1995 and
1996 to establish resource-based practice expense relative values under
the Medicare physician fee schedule, and comments offered by a broad
range of professional and trade societies and associations. For a more
detailed discussion of this process, see section V.B of the proposed
rule (63 FR 47561).
b. Comments on Classification of Procedures and Services Within APC
Groups
In the proposed rule, we invited comments on the composition of the
APC groups, and we requested that commenters support their
recommendations for changes with resource cost data and clinical
arguments. We received a large number of comments on our proposed
grouping of individual procedures and services. The most common comment
was that the APC groups generally lacked consistency in terms of
clinical characteristics and resource utilization. Below, in section
III.C.6.d of this preamble, we address recommendations from commenters
that specific HCPCS codes be assigned to a group other than the one we
proposed. In addition to reviewing the APC groups that were the subject
of comments, our medical advisors and staff reviewed every APC group to
take into account the effect across all related groups of commenters'
recommended changes.
Criteria for Evaluating Changes Recommended by Commenters
In determining whether or not to accept a recommended change, we
focused on five criteria that are fundamental to the definition of a
group within the APC system. The decision to accept or decline a
modification to an APC group was measured by whether the change
enhanced, detracted from, or had no effect on the integrity of an APC
group within the context of these five criteria. The five criteria are
as follows:
Resource Homogeneity
The amount and type of facility resources, for example, operating
room time, medical surgical supplies, and equipment, that are used to
furnish or perform the individual procedures or services within each
APC should be homogeneous. That is, the resources used are relatively
constant across all procedures or services even though resource use may
vary somewhat among individual patients. If the procedures within an
APC require widely varying resources, it would be difficult to develop
equitable payment rates. Aggregated payments to a facility that
performed a disproportionate share of either the expensive or
inexpensive procedures within an APC would be distorted. Further, the
facility might be encouraged to furnish only the less costly procedures
within the APC, resulting in a potential access problem for the more
costly services.
It is important to note that procedures within an individual HCPCS
code can vary widely in resource use. The coefficient of variation of
cost for the procedures within one HCPCS code can be as high as the
overall coefficient of variation across all the HCPCS codes that
comprise an APC group. Thus, a significant amount of the variability in
resource use within some APC groups can be attributed to the
variability of resources within individual HCPCS codes. Nevertheless,
if resource use is reasonably homogeneous among the HCPCS codes within
an APC group, the average pattern of resource use among a group of
cases in an APC can be accurately predicted. In section III.C.6.c,
below, we discuss the BBRA 1999 provision that sets limits on the
variation in resource cost within an APC.
Clinical Homogeneity
The definition of each APC group should be ``clinically
meaningful,'' that is, the procedures or services included within the
APC group relate generally to a common organ system or etiology, have
the same degree of extensiveness, and utilize the same method of
treatment, for example, surgical, endoscopic, etc. The definition of
clinical meaningfulness is, of course, dependent on the goal of the
classification system. For APCs, the definition of clinical
meaningfulness relates to the medical rationale for differences in
resource use. If, on the other hand, classifying patient prognosis were
the goal, the definition of patient characteristics that were
clinically meaningful might be different.
Provider Concentration
We considered the degree of provider concentration associated with
the individual services that comprise the APC. If a particular service
is offered only in a limited number of hospitals, then the impact of
payment for the service is concentrated in a subset of hospitals.
Therefore, it is particularly important to have an accurate payment
level for services with a high degree of provider concentration.
Conversely, the accuracy of payment levels for services that are
routinely offered by most hospitals does not bias the payment system
against any subset of hospitals. Thus, differences in the resource
requirements for individual services within an APC are of less
significance if all the services within the APC are routinely offered
by most hospitals because the impact of the difference should average
out at the hospital level.
Frequency of Service
Unless we found a high degree of provider concentration, we avoided
creating separate APC groups for
[[Page 18458]]
services that are infrequently performed. It is difficult to establish
reliable payment rates for low volume APC groups. Therefore, we
assigned the HCPCS codes to the APC that was the most similar in terms
of resource use and clinical coherence.
Some procedures, such as craniotomies, are clearly inpatient
procedures, and are rarely performed in an outpatient setting. However,
there are some procedures that, while they are normally performed on an
inpatient basis, can also be safely performed on an outpatient basis.
The performance of those procedures on an outpatient basis is
infrequent and is limited to the simplest cases. Therefore, when we
included these procedures in APC groups, we assumed a level of resource
use that would apply only to the simplest cases rather than that
typical of more complex cases that would be performed on an inpatient
basis.
Minimal Opportunities for Upcoding and Code Fragmentation
The APC system is intended to discourage using a code in a higher
paying group to define a case. That is, putting two related codes, such
as the codes for excising a lesion of 1.1 cm and one of 1.0 cm, in
different APC groups may create an incentive to exaggerate the size of
the lesions in order to justify the incrementally higher payment. APC
groups based on subtle distinctions would be susceptible to this kind
of upcoding. Therefore, we kept the APC groups as broad and inclusive
as possible without sacrificing resource or clinical homogeneity.
In general, HCPCS codes that are nonspecific (such as 20999,
``unlisted procedure, musculoskeletal system, general'') were assigned
to the lowest paying APC that was consistent with the clinical
characteristics of the service. In the case of 20999, the codes to
which it is related are in the range 20000-20979. The APCs to which
they group range from 0004, with a payment rate of $89.22, to 0050,
with a payment rate of $1,024.53. We placed 20999 in the lowest paying,
related group, 0004.
c. Effect of the BBRA 1999 on Final APC Groups
Section 201(g) of the BBRA 1999 amends section 1833(t)(2) of the
Act to limit the variation in resource use among the procedures or
services within an APC group. Specifically, section 1833(t)(2) of the
Act now provides that the items and services within a group cannot be
considered comparable with respect to the use of resources if the
highest cost item or service within a group is more than 2 times
greater than the lowest cost item or service within the same group. The
Secretary is to use either the mean or median cost of the item or
service. We are using the median cost because we have continued to set
the relative payment weights for each APC based on median hospital
costs in this final rule. (See the discussion in section III.E of this
preamble.)
Section 1833(t)(2) of the Act as amended also allows the Secretary
to make exceptions to this limit on the variation of costs within each
group in unusual cases such as low volume items and services, although
we may not make such an exception in the case of a drug or biological
that has been designated as an orphan drug under section 526 of the
Federal Food, Drug, and Cosmetic Act. See the discussion of the
classification of orphan drugs in section II.D of this preamble and the
discussion of APC groups that we excepted from the ``2 times'' limit in
section III.C.6.e.
We applied the limit on variation on median costs required by
section 201(g) to the revised APC groups. (See section C.6.d, below.)
As a result of our analysis of the array of median costs within the
revised APC groups, we had to split some otherwise clinically
homogeneous APC groups into smaller groups. We are concerned that this
further subdivision of groups may create vulnerabilities for upcoding,
which conflicts with one of the five criteria described above that we
used to evaluate the construction of the APC groups. We will be
examining the extent to which the APC reorganization due to the ``2
times'' rule results in upcoding.
d. Summary of APC Modifications
In this section, we summarize and explain our response to comments
on individual or serial APCs. We use the APC number that appeared in
the proposed rule to identify a group that was changed. In most
instances, we moved a HCPCS code from its proposed APC group to a
different APC group either in response to comments or to comply with
section 1833(t)(2)(C) of the Act. In some cases, we moved codes when a
change in response to a comment or the cost variation limit resulted in
a grouping that seriously compromised one of the criteria we used to
evaluate changes recommended by commenters. Because we made so many
changes in the APC groups, we renumbered all the groups and, in many
cases, renamed groups. In our response to comments in connection with
an APC, the final designation for a HCPCS code corresponds to the
renumbered APC group found in the addenda.
APC 121: Level I Needle Biopsy/Aspiration
Comment: One specialty society commented that there was significant
variation in resource consumption for the procedures performed in this
APC and that the proposed payment rate of $33.95 for APC 121 does not
accurately reflect the preparation, examination, and consultation
expenses for a pathologist to thoroughly perform these procedures. The
commenter recommended including CPT codes 85095, 85102, 88170, and
88171 in proposed APC 122.
Response: The procedures we proposed to classify in APC 121 were
considered sufficiently similar from a clinical perspective. We found
no provider concentration associated with the procedures proposed for
this APC. Therefore, any variation in cost across the procedures in
this APC should average out at the hospital level. However, to be
consistent with the BBRA 1999 ``two times'' provision concerning
comparable resources, we have moved CPT codes 85095 and 85102 to final
APC 0003, and CPT codes 88170 and 88171 remain in final APC 0002.
APC 122: Level II Needle Biopsy/Aspiration
Comment: A number of commenters indicated that there was
significant variation in resource consumption for the procedures
proposed in this APC group. For example, one commenter stated that
although all the codes within this group are needle biopsies, they
range dramatically in complexity, they are quite dissimilar in terms of
resource use, they are not clinically similar, and the proposed
grouping results in inappropriate payment for the more complex
procedures.
Response: We decided that CPT code 67415, Fine needle aspiration of
orbital contents, was more appropriately grouped from a clinical
perspective with ophthalmic procedures in final APC 0239. We further
divided the codes in proposed APC groups 121 and 122 for needle biopsy/
aspiration into final APC groups 0002, 0003, 0004, and 0005 to be
consistent with the BBRA 1999 ``two times'' requirement.
APC 131: Level I incision & drainage
Although we received no comments on proposed APC group 131, based
on internal review of this APC, we moved CPT code 11976, Removal,
implantable contraceptive capsules, to final APC 019 because this
procedure represents an excision rather than an incision. We divided
proposed APC 131 into final
[[Page 18459]]
APC groups 0006, 0007, and 0008 to be consistent with the BBRA 1999
``two times'' requirement.
APC 141: Level I Destruction of lesion
APC 142: Level II Destruction of lesion
Comment: One commenter questioned our proposed assignment of CPT
codes 17106 through 17108, which describe destruction of cutaneous
vascular proliferative lesions, to APC groups 141 and 142.
Response: We moved CPT code 17106 to final APC 0011 because its
median cost is significantly higher than the other codes in 0010.
However, the median cost for that code is greater than we would have
expected it to be. We will review the appropriateness of this placement
in the course of future updates of the APC groups.
APC 151: Level I debridement/destruction
APC 152: Level II debridement/destruction
Comment: We received general comments questioning the resource
homogeneity of the proposed skin APC groups. One commenter recommended
including removal of skin lesion with laser on other body parts in
proposed APC 152 rather than restricting the APC to vulva, anus, and
penis procedures. The commenter believes that removal of these benign
lesions, including papillomas, should include other areas of the body.
Response: We agree with commenters' general concerns about resource
homogeneity. We reclassified the codes in proposed APCs 151 and 152
into final APC groups 00012 through 00017 to better differentiate
resource use and clinical characteristics and to be consistent with the
``two times'' BBRA 1999 requirement. We also moved CPT code 42809,
Removal of foreign body from pharynx, to final APC 251 because it is an
otorhinolaryngology (Ear/Nose/Throat (ENT)) procedure.
APC 161: Level I excision/biopsy
APC 162: Level II excision/biopsy
APC 163: Level III excision/biopsy
Comment: Numerous commenters were concerned about the variation of
resource use among the procedures in proposed APC groups 161, 162, and
163. Commenters requested that we consider classifying procedures in
these groups based on anatomic location where functionality is of high
importance in combination with the size of excision.
Response: We made a number of modifications to the excision APC
groups to satisfy the BBRA 1999 ``two times'' requirement, resulting in
final APC groups 0018 through 0022. We reclassified CPT codes 11043 and
11044 to APC groups 0016 and 0017 because these codes describe
debridement of skin, subcutaneous tissue, muscle, and bone.
In the final excision/biopsy APC groups, we endeavored to make
distinctions based on the location and size of the excision. For
example, excisions of malignant lesions from the face, ears, eyelids,
nose, lips greater than 4 cm were placed in an APC requiring more
resource use than excisions of malignant lesions from the trunk, arms
or legs greater than 4 cm because ``functionality'' is of greater
importance when the site is the face, ears, eyelids, nose, or lips. We
moved excisions involving the eye to ophthalmic procedure APCs. We did
not make grouping distinctions between benign and malignant lesions of
the same size and location because resource use for both types is
similar.
We moved benign and malignant excisions larger than 2 cm to final
APC group 0020 because these excisions require more resources than, for
example, excisions smaller than 1 cm.
We moved CPT code 20220, superficial biopsy of bone (e.g., ilium,
sternum, spinous process, ribs) with trocar or needle, to final APC
0019, because the resources used in connection with this procedure are
similar to those required for excisions of small benign or malignant
lesions.
As noted above, we classified two debridement procedures (CPT codes
11043 and 11044) to final APC groups 0016 and 0017, respectively.
We also moved seven codes from proposed APC 162 to the ophthalmic
APC groups.
APC 181: Level I skin repair
APC 182: Level II skin repair
APC 183: Level III skin repair
APC 184: Level IV skin repair
Comment: We received numerous comments expressing concern about the
consistency of resource use and clinical homogeneity of the procedures
in the four proposed skin repair APC groups. Many commenters
recommended moving more complex procedures, such as large layer
closures, to an APC with a higher payment rate because the procedures
require more operating room and recovery time. Some commenters
recommended moving some of the skin repair codes to other body systems.
Response: Our review of proposed APC groups 181, 182, 183, and 184
resulted in our regrouping the skin repair codes based more on cost
than on clinical considerations. The volume of claims in most of the
codes, however, is quite low. In addition, we moved CPT code 33222,
Revision or relocation of skin pocket for pacemaker, from proposed APC
360 to final APC 0026, because this procedure is so similar to the
other skin repair procedures in terms of clinical content and resource
consumption. We will review these groups carefully as data become
available.
APC 197: Incision/excision breast
APC 198: Breast reconstruction/mastectomy
Comment: One commenter observed that the procedures in proposed APC
group 198 are related both to the definitive treatment of breast cancer
and to plastic and reconstructive operations of the breast. The
commenter recommended moving CPT code 19162, Mastectomy, partial with
axillary lymphadenectomy, and CPT code 19182, Mastectomy, subcutaneous,
into an APC group with a higher payment rate because both procedures
are more complex and involve more time and resources than the other
procedures in proposed APC group 198. Another commenter stated that CPT
code 19162, and CPT code 19318, Reduction mammoplasty, require
significantly longer operating times than the other procedures in
proposed APC group 198. The same commenter further observed that CPT
code 19162 essentially involves performing two procedures.
Response: Our medical advisors and staff carefully reviewed the
comments submitted in connection with the procedures in proposed APC
group 198 within the context of the criteria that we discuss at the
beginning of this section. They concluded that, although reduction
mammoplasty (CPT code 19318) could require slightly more resources, a
reduction mammoplasty is still fundamentally similar to other
procedures in proposed APC 198 such as CPT code 19162, Partial
mastectomy with axillary lymphadenectomy. Our medical advisors and
staff concluded that the procedures in proposed APC groups 197 and 198
were sufficiently similar clinically and in terms of resource use to
retain the proposed groupings. Therefore, we are retaining our proposed
grouping in final APC groups 0029 and 0030.
APC 207: Closed treatment fracture finger/toe/trunk
Although we did not receive comments about this APC group, our
medical advisors and staff determined that treatment of closed
fractures
[[Page 18460]]
pertaining to the larynx should be moved to the ENT APC groups because
they are more similar from a clinical and resource use perspective to
ENT procedures. The larynx procedures do not involve casts and, more
importantly, they require completely different resources and ancillary
personnel than, for example, the setting of a finger fracture. Proposed
APC 207 is renumbered final APC 0043.
APC 209: Closed treatment fracture/dislocation except finger/toe/trunk
Comment: One commenter objected to including multiple procedures
for dislocation and fractures in proposed APC group 209, when the cost
of drugs and supplies alone for these procedures probably exceeds $100.
The commenter believed that the proposed payment rate for APC 209 was
$71.00.
Response: We note that the proposed payment for APC 209 was $98.75,
rather than $71.00, as the commenter quoted. Although we included in
proposed APC 209 some procedures that could involve considerable time
and resources, only the simplest cases of these potentially more
complex procedures would be performed on an outpatient basis, with
proportionally lower costs than would be incurred when the procedures
are performed in an inpatient setting. Therefore, we retained in final
APC 0044 the codes in proposed APC 209, except we moved CPT code 31586,
Treatment of closed laryngeal fracture, to final APC 0256, because this
is primarily an ENT procedure.
APC 216: Open/percutaneous treatment fracture or dislocation
Comment: Numerous commenters took issue with the variation in
resource use among the procedures that include the open treatment of
almost all bone fractures, ranging from relatively simple finger and
toe fractures to major long bone fractures.
Response: We expect that only the simplest of the procedures
proposed in APC group 216 would be performed on an outpatient basis.
Therefore, we kept open/percutaneous treatment of fractures in one APC
rather than splitting these procedures into multiple APCs. We find it
unlikely that one provider would specialize in, for example, only open
fractures of fingers or only open fractures of long bones. Because the
CPT code descriptors for so many procedures in this APC group indicate
``with and/or without internal fixation,'' it is impossible to make
distinctions based on whether or not internal fixation is applied.
Proposed APC 216 is renumbered final APC 0046.
APC 226: Maxillofacial prostheses
APC 231: Level I skull and facial bone procedures
APC 232: Level II skull and facial bone procedures
Although we did not receive specific recommendations for these
APCs, our medical advisors and staff determined that the procedures in
these groups are more similar to ENT procedures from a clinical and
resource use perspective. Therefore, we moved all of the procedures in
these proposed APC groups to the final APCs 0251 through 0256, the ENT
APCs.
APC 251: Level I Musculoskeletal Procedures
APC 252: Level II Musculoskeletal Procedures
Comment: One commenter expressed concerns about the clinical
homogeneity of the codes in these two groups. The commenter stated that
proposed APC 251 contains 77 widely disparate procedures, including CPT
code 23100 and CPT code 24100, which describe arthrotomies with
biopsies, CPT code 25248, Exploration with removal of deep foreign
body, forearm or wrist, and CPT code 27704, Removal of ankle implant.
The commenter further stated that proposed APC 252 contains equally
diverse procedures ranging from: CPT code 20900, Bone graft, any donor
area; minor or small, to CPT code 25251, Removal of wrist prosthesis;
complicated, including ``total wrist,'' to CPT codes 27396, 27580, and
27665, which are different types of tendon procedures. The commenter
recommended that procedures that require specialized equipment and more
operating room time be moved into a group with a higher payment rate.
Response: Our medical advisors and staff, after careful
consideration of the commenter's concerns and after reviewing
alternative groupings of the numerous codes in these two proposed
musculoskeletal APC groups, concluded that splitting these groups to
address the disparities cited by the commenter would result in too many
small, low-volume groups for which we would be unable to establish
reliable payment rates. The broad inclusiveness of these two APC groups
is in part a reflection of the magnitude of the musculoskeletal system.
Given the homogeneity of resource use across the many procedures within
each group, we concluded that the factors supporting retention of the
two groups outweighed the concerns raised by the commenter. We did,
however, move CPT code 27086, Removal of foreign body, pelvis or hip;
subcutaneous tissue, to final APC 0019.
APC 280: Diagnostic Arthroscopy
APC 281: Level I Surgical Arthroscopy
APC 282: Level II Surgical Arthroscopy
Comment: A number of commenters expressed concerns about the
homogeneity of codes in the proposed surgical arthroscopy APC groups.
In particular, commenters stated that while an arthroscope is needed
for all the procedures assigned to proposed APC group 281, the nature
of the repair may mandate different additional equipment and differing
times to complete. Commenters did not find the procedures in proposed
APC 281 to be homogeneous with respect to the time required to perform
the procedures nor their associated costs. Commenters specifically
recommended transferring complex elbow and wrist procedures represented
by CPT codes 29826, 29838, 29839, 29846, 29847, 29848, 29861, 29862,
and 29863 into an APC group with a higher payment rate.
Response: Upon revisiting the assignment of codes to proposed APC
groups 280, 281, and 282, and considering the concerns expressed by
commenters, our medical advisors and staff concluded that collapsing
the three proposed APC groups into a single group would result in a
more homogeneous grouping in terms of resource use. Hence, final APC
0041 contains the codes proposed as APC groups 280, 281, and 282. The
relatively low volume of many of the procedures in the proposed APCs
supports combining them into a single group. Further, we found that,
from a facility perspective, the resource use for all the codes in
final APC 0041 is similar. For example, we had proposed to place CPT
code 29881, Arthroscopy, knee, surgical; with meniscectomy (medial or
lateral, including any meniscal shaving), and CPT code 29882,
Arthroscopy, knee, surgical; with meniscus repair (medial or lateral),
in two different APC groups. However, the resources required for these
two procedures is sufficiently comparable to warrant placing both into
the same APC.
APC 286: Arthroscopically-Aided Procedures
We considered including the procedures in proposed APC group 286
with the other arthroscopic procedures in final APC 0041 because they
are so infrequently performed in an outpatient setting for Medicare
beneficiaries. However, the resources required to perform the
procedures in proposed
[[Page 18461]]
APC 286 are so strikingly distinct from those used in connection with
the procedures in final APC group 0041 as to warrant being retained in
a separate group. Further, it is unlikely that an individual provider
specializes in the particular type of arthroscopic procedure contained
in this APC, so separating all of the codes in final APC 042 from those
in APC 041 should not disadvantage any one hospital.
APC 311: Level I ENT Procedures
APC 312: Level II ENT Procedures
APC 313: Level III ENT Procedures
APC 314: Level IV ENT Procedures
We received numerous comments about the composition of the four
proposed ENT APC groups. After careful review of the comments, our
medical advisors and staff recognized the need for a major
reorganization of the groups we proposed for ENT procedures. The
outcome of our review was the creation of five final APC groups for ENT
procedures: APC groups 0251, 0252, 0253, 0254, and 0256. We moved a
large number of bone procedures involving the facial and ENT areas from
musculoskeletal groups to ENT groups. We transferred some codes out of
the ENT groups altogether, and we shifted codes among the five final
ENT groups to comply with the BBRA 1999 ``two times'' requirement. We
respond to recommendations regarding specific codes below.
Comment: One commenter observed that CPT codes 31603 and 31605,
emergency tracheostomy procedures, are risky and life-threatening no
matter how quickly they are performed, and, as such, they should not be
grouped with procedures for removing a foreign body from the ear canal
or removing cerumen (proposed APC 311).
Response: We agree. We created new APC group 0340 to which we
assigned CPT code 69200, removal of foreign body from external auditory
canal; without general anesthesia, and CPT code 69210, Removal impacted
cerumen (separate procedure), one or both ears. We shifted these two
procedures to the Minor Ancillary Procedures APC group because of their
relative high frequency, their low cost in terms of resource use with
low disposable equipment cost, and because these procedures generally
do not require scheduling. Removing CPT code 69210 from the final ENT
groups also corrects any pricing distortions that may have resulted
from the disproportionately high volume of that procedure.
We also moved the tracheostomy emergency procedures to final APC
0254.
We moved several other procedures such as CPT code 41870,
Periodontal mucosal grafting, to final APC 0253, a group with higher
cost procedures.
We moved several abscess drainage procedures such as CPT code
41800, Drainage of abscess, cyst, hematoma from dentoalveolar
structures, to final APC group 0251 because of their relatively low
cost.
Comment: One commenter stated that all the procedures in proposed
APC 312 appear to be reasonably priced with the exception of CPT code
69436, Tympanostomy (requiring insertion of ventilating tube), general
anesthesia. In the view of the commenter, the extra supplies and time
required for this procedure necessitate a higher payment.
Response: We moved CPT code 69433, Tympanostomy (requiring
insertion of ventilating tube, local or topical anesthesia), to final
APC 0252 because of its lower resource use relative to CPT code 69436.
CPT code 69436 is assigned to final APC 0253.
We moved a large number of procedures such as CPT code 42335,
Sialolithotomy; submandibular (submaxillary), complicated, intraoral
from original APC 313 to final APC 0253 to reflect a similarity of
resource use. In terms of resource use, CPT code 30115, Excision, nasal
polyp(s), extensive, is more similar to CPT code 42300, Drainage of
abscess, parotid, simple, than it is to CPT 42410, Excision of parotid
tumor or parotid gland; lateral lobe without nerve dissection.
We shifted CPT code 21040, Excision of benign cyst or tumor of
mandible, from the musculoskeletal group to final APC 0253 with other
ENT procedures.
Comment: One commenter stated that procedures directed towards
cancer treatment were inappropriately assigned to proposed APC 313. As
examples, the commenter cited CPT codes 30150 and 30160, rhinectomy
procedures; CPT code 41120, Glossectomy; less than one-half tongue; and
CPT code 69210, Excision external ear, complete amputation. The
commenter also indicated concern that proposed APC group 313 includes a
disproportionately large percentage of resource-consuming ENT
procedures and commonly performed sinus procedures. Other commenters
recommended that more complex otorhinolaryngology procedures in the
group that have longer operating and recovery room times be moved to a
group with a higher payment rate.
Response: We moved CPT code 69210 to final APC group 0340, and we
assigned CPT codes 30150, 30160, and 41120 to final APC group 0256. We
also moved CPT code 42215, Palatoplasty for cleft palate; major
revision to final APC group 0256.
Comment: One commenter suggested placing certain thyroid procedures
in the ENT groups.
Response: While we agree that CPT code 60280, Thyroglossal cyst
excisions, is somewhat similar to CPT code 42440, Excision of
submandibular, submaxillary gland, we nonetheless believe that the
former type of excision is more appropriately placed from a clinical
perspective with other thyroid procedures.
APC 318: Nasal Cauterization/Packing
Comment: A number of commenters addressed generally the range of
resource use among the procedures within this proposed APC. One
commenter observed that CPT code 30901 is almost always a simple office
procedure within the context of an otolaryngology practice. The same
commenter indicated that CPT codes 30903, 30905, and 30906 frequently
require several hours of direct physician contact and monitoring and
recommended that we consider reclassifying CPT codes 30903, 30905, and
30906 to proposed APC group 332, Level II Endoscopy Upper Airway.
Another commenter was concerned that CPT codes 30905 and 30906 stand
out as inappropriate for this APC level because they require much more
time and expertise and are used in more life-threatening situations
than the other codes in the group.
Response: While there is a range of procedures in this APC
pertaining to control of nasal hemorrhage, hospitals normally treat the
entire range of these procedures, and there is no concentration of
certain of these procedures in a subset of hospitals. Our medical
advisors and staff also found that there can be a range of resource
consumption within many of the procedures themselves as well as across
procedures in this APC. We therefore are not reassigning the codes.
We did, however, move CPT codes 30999 and 42999 for unlisted
procedures to final APC 0251 and 0252, respectively, to be consistent
with our policy of placing unlisted codes in the lowest paid related
group.
APC 331: Level I Endoscopy Upper Airway
Comment: One commenter noted that the relative weight and payment
rate proposed for APC group 331 approximated the relative weight and
payment rate proposed for APC groups 997 or 987. The commenter stated
that CPT codes 31575 and 31579 should have a higher relative weight and
[[Page 18462]]
payment rate than that proposed for APC 331 because both procedures
require more time, higher skill levels, and more equipment than the
procedures in APC 997 or 987. A professional association, echoing the
first commenter, noted that CPT codes 31575 and 31579 are the most
complex of all noninvasive laryngeal diagnostic procedures performed by
otolaryngologists and speech language pathologists, further justifying
a higher relative weight and payment rate for these procedures.
Response: Proposed APC groups 997 and 987, Manipulation therapy and
Subcutaneous chemotherapy, respectively, are clinically very different
from proposed APC group 331. The professional skill and expertise of
the physician performing the laryngoscopy are recognized separately and
are not costs that are packaged with the payment rate for services
furnished by the hospital in connection with the procedure. Further, it
is very unlikely that there will be systematic differences among
facilities with some only doing the most difficult of the basic
laryngoscopies that are contained in this group and others only
specializing in the simplest variety. However, we have reorganized the
proposed endoscopy, upper airway groups into final APC groups 0071
through 0075 to be consistent with the BBRA 1999 ``two times''
requirement.
APC 341: Level I Needle and Catheter Placement
APC 342: Level II Needle and Catheter Placement
APC 343: Level III Needle and Catheter Placement
APC 347: Injection Procedures for Interventional Radiology
Based on our cost data, our medical advisors and staff determined
that the codes in these proposed APC groups should be assigned status
indicator ``N,'' which designates incidental services whose costs are
packaged into the APC payment rate. Injection procedures themselves are
low cost but, more importantly, they are an integral portion of another
procedure. The needle and catheter placement are typically an integral
portion of interventional radiology procedures. An exception was made
for CPT code 36420, cutdown on a child under age one, which was placed
in final APC 0032, to recognize its infrequent use but high median
cost.
APC 360: Removal/Revision, Pacemaker/Vascular Device
Comment: Most commenters recommended changing a number of pacemaker
codes from ``inpatient only'' payment status to allow payment under the
hospital outpatient PPS. One commenter noted that whereas we proposed
to exclude most pacemaker and implantable cardioverter defibrillator
(ICD) replacement procedures from the outpatient PPS, we did include
pacemaker revision/removal procedures in proposed APC 360 even though
both types of procedures require very similar steps to perform. The
commenter is concerned that by not paying for pacemaker replacement
procedures under the outpatient PPS, we are forcing physicians to
perform these replacement procedures on an inpatient basis. By so
doing, the commenter suggested that we are adding costs to the entire
system that could be saved, because the pacemaker replacement
procedures can be safely performed in the outpatient setting, with less
inconvenience to the patient.
Response: After careful consideration of commenters'
recommendations, our medical advisors and staff agreed that paying for
pacemaker insertion or replacement codes under the outpatient PPS is
appropriate if the outpatient setting is determined to be reasonable
and medically necessary for the individual beneficiary. We assigned
procedures for revising or removing implanted infusion pumps and venous
access ports in proposed APC 360 and pacemaker insertion or replacement
codes payable under the outpatient PPS to final APCs 0089 and 0090.
Also, we moved CPT code 33222, Revision or relocation of skin pocket
for pacemaker, and CPT code 33223, Revision or relocation of skin
pocket for implantable cardioverter-defibrillator, to final APC 0026
because the resource use for these two procedures is similar to that of
the skin repair procedures in APC 0027.
APC 367: Vascular Ligation
Comment: One commenter wrote that the procedures in proposed APC
367 include ligation of major arteries and veins, which are usually
performed as emergencies in the inpatient setting, and elective
ligation and stripping of lower extremity varicose veins of variable
complexity. The commenter contended that costs for these procedures
vary dramatically, with simple ligation and division of the saphenous
vein at the low end of the cost scale, and the stripping of long and
saphenous veins at the high end.
Response: We split proposed APC 367 into two groups, final APCs
0091 and 0092, to conform with the BBRA 1999 ``two times'' requirement.
Although we are not sure to which codes the comment refers, codes 37780
and 37730 are now in different groups. These represent ligation and
division of the short saphenous vein, and ligation, division and
stripping of long and short saphenous veins, respectively.
APC 368: Vascular Repair/Fistula Construction
Comment: Commenters disagreed with the codes assigned to proposed
APC 368, especially services related to insertion of implantable
hemodialysis access ports. Commenters did not find the services in APC
368 to be comparable clinically. In particular, they recommended moving
cannula insertion and declotting procedures to proposed APC groups 341,
342, and 343, which consist of needle and catheter placement
procedures.
Response: We split the codes in proposed APC 368 into APC groups
0088, 0090, 0092, and 0093. The resulting classifications are more
clinically homogeneous, and they meet the BBRA 1999 ``two times''
requirement. We also moved CPT code 35875, Thrombectomy of arterial or
venous graft (other than hemodialysis graft or fistula), into final APC
0088.
APC 369: Blood and Blood Product Exchange
Comments: As we noted in section III.C.2.f, above, many commenters
disagreed with both our proposed payment rates and our proposed
classification for blood and blood-related products. Most commenters
disagreed with our classifying in one APC group therapeutic apheresis,
stem cell procedures, and blood transfusion services. The commenters
stated that therapeutic apheresis and stem cell procedures are very
costly and resource intensive procedures which cost more than 3 times
the proposed payment rate for APC 369, yet we are proposing to pay a
median amount for these services that is appropriate for blood
transfusions only. Commenters questioned whether we had taken into
account the costs associated with the specialized equipment, supplies
and personnel that are required to perform therapeutic apheresis and
stem cell procedures. Commenters stated that the payment rate proposed
for APC 369 would not offset the costs hospitals incur to furnish
therapeutic apheresis services because outpatient apheresis procedures
often combine dissimilar kinds and combinations of plasma replacement
products, causing widely differing costs per service.
A major association representing community cancer centers stated
that our data for stem cell harvesting claims (CPT 38231) include a
range of costs so
[[Page 18463]]
large as to suggest that there are errors in the data. The commenter
believes that the very small sample of claims (reduced by HCFA's
exclusion of multiple procedure claims and claims without codes)
further renders the data unreliable. The same commenter cited bone
marrow harvesting (CPT 38230) as an example to argue that our data,
which indicates a median cost of $18.00 for what is normally a lengthy
procedure performed under general anesthesia, are problematic.
Some commenters stated that the proposed payment rate was not
sufficient for transfusion services if the rate was supposed to pay for
both the blood product and the transfusion procedure, because even
though outpatient transfusion services are relatively simple and low-
cost, they are associated with a costly blood product that is far more
variable.
Commenters expressed concern that the proposed payment rate for APC
369 was insufficient to pay for extracorporeal photopheresis (CPT
36522), whose actual cost is approximately $1,000, and would have an
especially negative impact for patients with cutaneous T-cell lymphoma.
A major organization recommended that we separate payment for a
service from payment for the blood product associated with that
service. The same commenter also recommends separate payment for
infusible blood-derived drugs, and that payment for transfusable blood
products be based on costs. This organization recommends that APC 369
be split into several APCs because payment for services such as
transfusion services, therapeutic apheresis, stem cell collection,
Staph column pheresis, and others are distinct, and deserve separate
APC payments. The same commenter also recommended that we accelerate
the HCPCS coding process for blood-related products.
Response: In response to commenters' recommendations, we are
creating different APC groups for blood-related procedures and
transfusions, and we are paying for blood and blood products
separately, instead of packaging them with the procedures or services
with which they are associated. We were convinced by commenters'
illustrations of the variability in the use of blood and blood products
in various procedures, and by our desire to recognize the costs of
tests now being performed on donated blood that were not captured in
our 1996 data. The procedures we proposed in APC 369 are split among
final APC groups 0109, 0110, 0111, and 0112. We have also created
individual APC groups for blood and blood related products. The final
APC 0109 that we created to capture bone marrow harvesting and bone
marrow/stem cell transplant had a median cost of only $15.00. This is
due to the few, highly variable claims in our database. Based on the
information available to us at this time, we have assigned a rate of
$200.00, and will adjust the rate to reflect actual claims as we
collect data under PPS.
APC 407: Esophagoscopy
APC 417: Diagnostic Upper GI Endoscopy
APC 418: Therapeutic Upper GI Endoscopy
Comment: Commenters were concerned about low payment rates set for
these three proposed APC groups.
Response: Our medical advisors reviewed the proposed groups and
determined that combining the codes into a single APC group for upper
gastrointestinal endoscopic procedures conformed with the criteria we
used to define APC coherence and resulted in a reasonable payment rate
supported by cost data. Resource use for all procedures in final APC
0141 is similar because each procedure involves an endoscopic
examination. In addition, most of the procedures involve diagnostic and
therapeutic tests such as brushings or fulgurations.
APC 426: Diagnostic Lower GI Endoscopy
APC 427: Therapeutic Lower GI Endoscopy
Comment: Commenters were concerned that the payment rates proposed
for APC groups 426 and 427 were too low to offset costs incurred to
perform these procedures. One commenter indicated that a diagnostic
colonoscopy (CPT code 45379), without any mark up or consideration of
room time and equipment use, costs $350, with additional costs if a
polyp has to be removed ($155 just for a bicap). The commenter
indicated that the current cost of a hot biopsy forceps is $45. Given
these costs, the provider would necessarily incur a loss when
performing these procedures.
Response: Our medical advisors and staff, after reviewing the cost
data for these two proposed groups, combined the diagnostic and
therapeutic APCs into a single group, final APC 0143. Resource use for
the procedures in this APC is similar because they all involve an
endoscopic examination. More importantly, even though resource use may
vary relative to the clinical requirements of individual cases,
facilities are not likely to specialize in just therapeutic or
diagnostic endoscopic services. Therefore, costs should even out across
all cases.
Comment: One commenter found the low rate proposed for CPT code
45378, Diagnostic colonoscopy, to be inconsistent with our major policy
initiative to screen persons at high risk for colorectal cancer.
Response: We moved HCPCS code G0105, Colorectal Cancer Screening:
Colonoscopy,to its own group, final APC 0158, because it is preventive
rather than diagnostic or therapeutic in nature.
APC 446: Diagnostic Sigmoidoscopy
APC 447: Therapeutic Proctosigmoidoscopy
APC 448: Therapeutic Flexible Sigmoidoscopy
We reassigned the different types of sigmoidoscopy procedures into
two groups, final APC 0146 and final APC 0147. The procedures within
each group are similar both clinically and in terms of resource use. We
moved HCPCS code G0104, CA screening; flexible sigmoidoscopy, to its
own group, final APC 0159, because it is preventive rather than
diagnostic or therapeutic in nature.
APC 451: Level I Anal/Rectal Procedures
APC 452: Level II Anal/Rectal Procedures
To conform with the BBRA 1999 ``two times'' requirement, our
medical advisors and staff reclassified procedures in the proposed APC
groups resulting in final APC groups 0148 and 0149. We believe the
final APC groups are more consistent both clinically and in terms of
resource use.
APC 470: Tube Procedures
Comments: We split the codes in proposed APC group 470 into final
APC groups 0121, 0122, and 0123 to conform with the BBRA 1999 ``two
times'' requirement. Also, we moved CPT code 50398, Change of
nephrostomy or pyelostomy tube, from proposed APC 521 to final APC
0122.
APC 523: Level III Cystourethroscopy and Other Genitourinary Procedures
Comment: A number of commenters recommended moving CPT code 52240,
Cystourethroscopy, with fulguration (including cryosurgery or laser
surgery) and/or resection of; large bladder tumor(s), to the APC for
Level IV Cystourethroscopy and other Genitourinary Procedures because
the magnitude of the procedure most
[[Page 18464]]
closely resembles that of the codes in the higher payment group.
Response: We agree with commenters' recommendations; we moved CPT
code 52240 to final APC group 0163 because of the extensive time and
equipment required to perform the procedure.
Comment: One commenter recommended placing CPT codes 52335 through
52338 in their own group, given the complexity and technical demands of
these ureteroscopic procedures. The same commenter suggested as an
acceptable alternative placing these codes in the APC group for Level
IV Cystourethroscopy and other Genitourinary Procedures, to reflect
more accurately their cost, complexity, and need for expensive single
use items such as dilation balloons, baskets and stents. Other
commenters recommended moving CPT codes 51020 through 51880 (cystotomy
procedures) to the APC group for Level IV Cystourethroscopy and other
Genitourinary Procedures.
Response: After a careful review of comments and our cost data, our
medical advisors and staff concluded that the cystotomy codes are
similar enough in terms of equipment and the time required to perform
the procedures to justify keeping them together in final APC 162. Our
medical advisors and staff also concluded that the facility equipment
and time duration for CPT code 52335, Cystourethroscopy, with
ureteroscopy and/or pyeloscopy (includes dilation of the ureter and/or
pyeloureteral junction by any method), was sufficiently similar to be
retained with the other procedures in final APC 0162.
APC 524: Level IV Cystourethroscopy and other Genitourinary Procedures
Comment: Numerous commenters were concerned that the payment rate
proposed for APC 524 was insufficient to offset the costs associated
with CPT code 53850, Transurethral destruction of prostate tissue, by
microwave thermotherapy (TUMT). The commenters argue that TUMT is a
very expensive procedure due to its high capital equipment costs and
the need to construct a special microwave area, the high cost of
disposable probes and other disposable supplies required for the
procedure, and the need for specially trained nursing staff. The
commenters urged us to establish a unique APC group for this procedure
and to provide a payment rate that is consistent with its anticipated
costs, which they predict would total approximately $2,200.
Response: After careful consideration of comments and available
cost data, our medical advisors and staff determined that CPT code
53850 satisfies the criteria discussed below, in section III.C.8, as a
new technology service. Payment for this procedure will be made under
new technology APC 0980.
APC 529: Simple Urinary Studies and Procedures
Comment: A number of commenters proposed that we classify CPT code
51726, Complex cystometrogram, to its own unique APC and keep the other
urinary study procedures together in proposed APC 529.
Response: After a careful review of comments and our data, our
medical advisors and staff agreed with commenters' concerns and
subdivided proposed APC group 529. The resulting final APC groups 0164
and 0165 are more homogeneous both in terms of clinical coherence and
resource use. We also added simple anal procedures such as CPT code
91122, Anorectal manometry, to final APC 0165 because of the similarity
of resource use.
APC 546: Testes/Epididymis Procedures
Comment: A number of commenters disagreed with our classification
of scrotal procedures with inguinal procedures in proposed APC group
546. The commenters observed that the scrotal procedures vary
considerably from the inguinal procedures in terms of resource usage.
The commenters recommended that we move CPT codes 54530, 54550, 54640,
55520, 55530, 55535 and 55540 to proposed APC 466, Hernia/Hydrocele
Procedures, because they all involve operating on vessels at the
internal ring, and are therefore similar to a hernia repair.
Response: We agree with comments that these procedures are similar
to hernia repairs. We moved CPT codes 54530, 54550, 54640, 55535, and
55540 to final APC group 0154.
APC 551: Level I Laparoscopy
APC 552: Level II Laparoscopy
Comment: We received two categories of comments pertaining to
laparoscopic procedures: Numerous commenters disagreed with our
proposal to define certain laparoscopic procedures as inpatient only,
and numerous commenters claimed that the resource costs among the
procedures within proposed APC groups 551 and 552 varied too greatly
for the groups to be considered homogeneous. Most commenters stated
that the costs associated with the procedures in proposed APC groups
551 and 552 exceed their respective proposed payment rates because of
the expensive equipment and disposable supplies and the length of time
required to perform laparoscopic procedures.
Response: Our medical advisors and staff, after a thorough review
and consideration of comments, agreed with commenters who claimed that
most laparoscopic procedures can and are being safely and appropriately
performed in an outpatient setting. We therefore moved most of the
laparoscopic codes to which we proposed to assign a payment status
indicator ``C,'' indicating that the procedures would not be covered
under the hospital outpatient PPS, into an APC group with a payment
status indicator ``T'' (significant procedure, multiple procedure
reduction applies, payable under the outpatient PPS). In order to
absorb these additional procedures within the APC system, we created a
third laparoscopic APC group in order to accommodate the wide range of
resource use and time that is required to perform the expanded list of
laparoscopic procedures.
Although the AMA revised the coding of laparoscopic procedures in
CPT 2000, in order to set rates for the laparoscopy APC groups, we used
the codes that were in our database of 1996 claims. That is, we moved
CPT codes 56362 and 56363 to the Level I laparoscopic group, final APC
group 0130, because the resources used in connection with these
procedures are less compared to the Level II procedures generally. For
example, CPT code 56362, Laparoscopy with guided transhepatic
cholangiography, primarily involves the laparoscopy without any
associated removal of tissue. Conversely, we shifted CPT codes 56303
and 56304 from Level I to Level II (final APC 0131). CPT code 56303,
Laparoscopy, surgical, with fulguration or excision of lesions of the
ovary, pelvic viscera, or peritoneal surface, requires more resources
than, for example, CPT code 56300, Diagnostic laparoscopy, the most
common laparoscopic procedure within Level I, final APC group 0130.
The new Level III laparoscopy group, final APC group 0132, consists
largely of laparoscopic procedures that we had proposed to classify as
inpatient. In addition, we moved CPT code 56312, Laparoscopy, surgical;
with bilateral total pelvic lymphadenectomy, and CPT code 56313,
Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and
peri-aortic lymph node sampling (biopsy), single or multiple, to final
APC group 0132 because of the extensive resources and time involved in
performing these procedures. Refer to Current Procedural Terminology
2000, published by the American Medical Association, for a summary of
coding
[[Page 18465]]
changes and crosswalks for laparoscopic procedures.
APC 561: Level I Female Reproductive Procedures
APC 562: Level II Female Reproductive Procedures
APC 563: Level III Female Reproductive Procedures
Comment: One commenter expressed concern that the payment rate for
proposed APC group 563 would have a negative effect on certain
treatment options for women suffering with incontinence. The commenter
contrasted the proposed payment of $848 with a current median cost
calculated at $1,931 for CPT code 57288, Sling operation for stress
incontinence (e.g., fascia or synthetic).
Response: After reviewing the procedures in proposed APCs 561, 562,
and 563, and to be consistent with the BBRA 1999 ``two times''
requirement, we split the proposed groups into final APCs 0191 through
0195. The cost of CPT code 57288, to which the commenter refers, is
still at the high end of the highest weighted group, but the volume of
claims for that service is so low that splitting the group again would
be problematic. If these more intense surgeries move to the outpatient
setting in greater numbers, we will be able to price them more
precisely.
APC 601: Level I Nervous System Injections
APC 602: Level II Nervous System Injections
Comment: Commenters contended that there are no similarities among
the procedures in the proposed APC groups for nervous system
injections.
Response: We disagree. We find the range of services included
within each APC group to be generally consistent from a clinical
perspective. And, even though an injection into the subarachnoid space
may be a more complex injection than some of the others in the group,
no institution is likely to specialize solely in one kind of injection.
Because all the services within the APC group are offered by most
hospitals, the impact of the variation in resource consumption among
the different codes should average out at the hospital level.
Therefore, we are keeping intact in final APC groups 0211 and 0212 the
two levels of nervous system injections that we proposed, with the
exception of CPT codes 62194 and 62225, which we moved to final APC
group 0121 because they are catheter replacement procedures.
APC 616: Implantation of Neurostimulator Electrodes
APC 617: Revision/Removal Neurological Device
APC 618: Implantation of Neurological Device
Comment: One commenter was concerned that the payment rate proposed
for APC group 616 falls far short of the costs incurred to implant a
neurostimulator system that embodies a vagus nerve stimulator for the
treatment of patients with refractory epilepsy. The commenter estimated
that hospitals incur costs between $2,000 and $5,000 to surgically
insert the Neurocybernetic Prosthesis system (NCP), which includes an
implantable neurostimulator, pulse generator, and implantable
electrodes. The commenter stated that the NCP costs $9,100. The
commenter recommended that we create a separate APC group for the
procedure to ensure appropriate payment. The commenter also expressed
concern that the broad range of procedures in proposed APC 618 results
in inappropriate payment rates. The commenter noted that the median
cost of the procedures in proposed APC group 618 varies from a low of
$269.44 to a high of $3,890.70, with a proposed payment rate of $1,274.
Another commenter stated that vagus nerve stimulation, approved by
the FDA in 1997, which can sometimes be performed as an outpatient
procedure, would be inappropriately paid under our PPS. The commenter
stated that the reported cost for the device is $6,900 for the
implantable neurostimulator pulse generator and $2,030 for the
implantable vagus nerve stimulator leads. A manufacturer of this new
system, which is used in treating intractable epilepsy, also expressed
concern that the proposed PPS will underpay hospitals for new
technologies such as its system and deny beneficiaries access to them.
Response: In response to these and other comments, we made several
changes in proposed APC groups 616, 617, and 618. We moved CPT code
63650, Percutaneous implantation of neurostimulator electrodes,
peripheral, to final APC 0224 because the procedure is less time
intensive and uses fewer facility resources than the implant procedures
in final APC 0225. We also shifted CPT codes 64585 and 64595 to final
APC 0225. We will re-evaluate APCs 0223, 0224, and 0225 as we
accumulate data and will incorporate our findings in a subsequent
hospital outpatient PPS rule. Additionally, we will determine whether
the implantable neurostimulator system is eligible for treatment as a
``pass-through'' device under section 201(b) of the BBRA 1999. The
criteria for assessing a medical device's eligibility for additional
payment under this provision are discussed in section III.D.4, below.
Ophthalmic Procedures: We received numerous comments concerning the
APC groups proposed for eye procedures. Based on their analysis of
these comments and recommended changes, a review of our data, and
consideration of the limit on variation within a group required by
section 201(g) of the BBRA 1999, our medical advisors and staff have
significantly restructured the ophthalmic APC groups. Eye procedures
and services are assigned to final APC groups 0230 through 0248.
APC 930: Minor Eye Examinations
APC 931: Level I Eye Tests
APC 932: Level II Eye Tests
We assigned to final APC groups 0230 and 0231 the procedures in
proposed APC groups 930, 931, and 932 in addition to codes from
proposed APC groups 681, 682, and 683 that are either tests or minor
ophthalmologic procedures requiring relatively low resource use.
APC 651: Level I Anterior Segment Eye Procedure
APC 652: Level II Anterior Segment Procedure
Comment: We received a number of comments about these proposed APC
groups. Commenters were primarily concerned that the payment rates
proposed for the two levels of anterior segment eye procedures are
significantly less than the costs incurred to perform the procedures
assigned to these groups, especially those for glaucoma surgery (CPT
codes 66150 through 66170). One commenter indicated that the rate
proposed for CPT 66180 is acceptable only if separate payment is made
for the aqueous shunt and patch graft.
Response: Based on their review of comments and to be consistent
with the BBRA 1999 ``two times'' requirement, our medical advisors and
staff added a third APC group for anterior segment eye procedures. The
anterior segment eye procedures are assigned to final APC groups 0232,
0233, and 0234. We made a number of code changes among the three
groups. We moved CPT codes 66155, 66160, 66165, and 66170 for glaucoma
surgery to final APC group 0234. We shifted CPT code 65800,
Paracentesis of anterior chamber of eye (separate procedure) with
diagnostic aspiration of aqueous, from proposed APC 683 to final APC
0232 because the
[[Page 18466]]
instruments used in connection with CPT code 65800 are similar to those
used in all procedures that are primarily paracentesis and because
operating room time is likewise similar.
APC 667: Cataract Procedures
APC 668: Cataract Procedures With IOL Insert
Based on our data, the median cost for final APC group 0245
(cataract extraction without lens insert) was slightly higher than that
for final APC group 0246 (cataract extraction with lens insertion). We
attribute the discrepancy to poor coding, and we have increased the
payment rate for APC group 0246 to equal the payment rate for APC group
0245. Proper coding in the future should result in better
differentiated costs between these two groups.
Comment: One commenter objected to assigning payment status
indicator ``T,'' Significant procedure, multiple procedure reduction
applies, to the procedures in proposed APC group 668. The commenter
contended that CPT code 66984, Cataract removal with lens insertion, is
often performed in conjunction with other procedures such as CPT code
67010, partial removal of eye fluid, CPT code 65875, incise inner eye
adhesions, and 66170, Glaucoma surgery, which also have a ``T'' payment
status indicator. The commenter believes that the multiple procedure
reduction would undercompensate for these services and that all these
procedures should be given an ``S'' payment status indicator, which
would not subject them to the multiple procedure discount.
Response: We disagree. When more than one surgical procedure is
performed during a single operative session, full Medicare payment and
the full beneficiary coinsurance payment are made for the procedure
that has the highest payment rate. The costs associated with
anesthesia, operating and recovery room use, and other services for any
additional procedures are incremental and are accounted for within the
discounted additional payment.
APC 670: Corneal Transplant
Comment: The numerous comments that we received about this proposed
APC focused on our proposal to package the cost of procuring corneal
tissue as part of the costs associated with corneal transplant surgery.
Commenters feared that this fixed payment method would underpay some
hospitals while overpaying others because hospitals acquire corneal
tissue from eye banks whose charges are dependent upon the amount of
philanthropic contributions the bank receives during the course of a
year. A national association representing eye banks reported that fee
data from different member facilities show that the corneal tissue
acquisition fee alone nearly consumes or, in some cases, exceeds, the
entire payment rate proposed for APC group 670. Commenters expressed
great concern that we would significantly reduce the supply of corneas
available for transplant if we were to package corneal tissue
acquisition costs within the APC rate.
Response: Given the current basis for pricing corneal tissue, we
are accepting commenters' recommendations that corneal tissue
acquisition costs be paid separately and in addition to the payment
rate for corneal transplant procedures. At least until we gather data
regarding costs associated with the acquisition of corneal tissue, this
will ensure that individual hospital's reasonable corneal tissue
procurement costs are covered under the PPS. Corneal transplant
procedures are in final APC group 0244.
APC 676: Posterior Segment Eye Procedures
Comment: Commenters were concerned that the payment rate for
proposed APC group 676 was too low given the costs incurred to perform
a number of procedures in the group. For example, one commenter noted
that CPT code 67005 requires the same draping as a cataract extraction.
Response: In response to commenters' concerns and to be consistent
with the BBRA 1999 ``two times'' requirement, we split the procedures
in proposed APC group 676 into final APC groups 0235 through 0237. We
also moved procedures such as CPT code 67025, Replace eye fluid, and
CPT code 67027, Implant eye drug system, to final APC 0237 because of
the similarity of resource use. CPT code 67025 involves injection of a
vitreous substitute, usually gas, silicone, or a similar substance, and
the procedure may also involve an aspiration.
APC 681: Level I Eye Procedure
APC 682: Level II Eye Procedure
APC 683: Level III Eye Procedure
APC 684: Level IV Eye Procedure
Comment: Commenters were concerned about the wide variation of
resource use and clinical characteristics among the procedures within
proposed APC groups 681, 682, 683, and 684. Commenters noted that the
surgical complexity of individual procedures in proposed APC group 684
ranges from simple suturing (CPT code 67914, Repair of ectropion;
suture) to complex eyelid reconstructions with full thickness
tarsoconjunctival flap transfer (CPT code 67971). Commenters
recommended that these proposed APC groups be revised and that the more
complex procedures that require longer operating room time be paid a
higher rate.
Response: We agree. Guided by commenters' recommendations as well
as the ``two times'' limit on cost variation required by the BBRA 1999,
we created several new groups and we completely reorganized the
procedures in proposed APC groups 681, 682, 683, and 684 into the final
APC groups 0230 through 0234 and 0238 through 0242.
APC 690: Vitrectomy
Comment: Several commenters were concerned that the cost of an
intravitreal implant ($4,000, according to one commenter) would not be
adequately recognized if payment for the device were to be packaged
with payment for the insertion procedure (CPT code 67027, Implant eye
drug system). Commenters were concerned that beneficiary access to this
implant would be restricted if we did not make adequate payment.
Commenters supported our proposal to make separate payment for the
intravitreal implant.
Response: We assigned all of the procedures in proposed APC 690 to
final APC group 0237. As we explain in section III.B.1.c, above,
section 201(e) of the BBRA 1999 requires us to classify implantable
items to the group that includes the service to which the item relates.
However, the intravitreal implant that dispenses ganciclovir is an
orphan drug that qualifies for a transitional pass-through payment
under the BBRA 1999, which is explained in section III.D, below. Thus,
we have assigned the entire drug delivery system to its own APC, 0913.
We believe that the payment rate set for CPT code 67027 combined with
the additional payment for ganciclovir results in an appropriate
payment for this service.
APC 700: Plain Film
Comment: We received numerous comments about the structure of
proposed APC group 700. Commenters recommended breaking down the
proposed APC group into a number of smaller, more congruous groups. For
example, one commenter found no justification for the assumption that
resource costs are the same for all plain films listed in APC 700,
noting that
[[Page 18467]]
there is a significant difference in capital costs, room costs, and
maintenance costs between an x-ray room that is designed to take chest
x-rays compared to an x-ray room with a table used to take abdominal x-
rays. The commenter pointed out that there is a substantial increase in
cost when cineradiography capabilities are added. The same commenter
questioned our assumption that therapeutic radiology port films are
clinically similar to diagnostic radiology films or that bone density
studies are clinically similar to and have the same resource costs as
plain film radiography.
Response: We agree with commenters' concerns about the composition
of proposed APC group 700. In response to commenters' recommendations
and applying the ``two times'' limit on cost variation required by the
BBRA 1999, we split proposed APC group 700 into final APC groups 0260
through 0262. We assigned CPT code 70300, Radiologic examination,
teeth; single view; CPT code 70310, Radiologic examination, teeth;
partial examination, less than full mouth; and, CPT code 70320,
Radiologic examination, teeth; complete, full mouth, to their own
group, final APC group 0262, because these procedures require minimal
time and relatively little radiographic film and technical equipment.
We classified the remaining codes to final APC groups 0260 and 0261. We
believe that these two groups are sufficient to distinguish clinical
consistency and similar resource use. Facilities perform, relatively, a
similar proportion of the different plain film procedures, and
hospitals do not systematically use one type of plain film over another
type, with the exception of dental films, which we moved to a separate
group. The absolute magnitude of the difference in resource use among
different plain films is not as significant as the difference between
dental and other types of plain film. Additionally, our data indicate
minimal differences in the amount of resource use between bone density
measurement tests and plain films.
APC 706: Miscellaneous Radiological Procedures
Comment: A number of commenters found the tests grouped in proposed
APC group 706 to vary significantly in the amount of time, effort, and
costs required to provide the service.
Response: As a result of applying the ``two times'' limit on cost
variation required by the BBRA 1999, we divided proposed APC 706 into
two levels: final APC 0263 and final APC 0264. We also moved CPT code
76075, Bone Density Study, one or more sites, to final APC 0261. We
explain below, in section III.C.6.e, why we are making an exception to
the BBRA 1999 ``two times'' limit on cost variation in the case of
final APC group 264.
APC 710: Computerized Axial Tomography
APC 720: Magnetic Resonance Angiography
APC 726: Magnetic Resonance Imaging
Comment: A number of commenters believe that assigning all
computerized axial tomography (CAT) to a single group and all magnetic
resonance imaging (MRI) to a single group results in a lack of
homogeneity among the procedures within each group. These commenters
were concerned that we ignored the cost of contrast materials, labor,
and equipment within proposed APC group 710 and proposed APC group 726
and that combining contrast and non-contrast studies represents an
inconsistency in resource use because an examination that uses contrast
will be more costly than one without contrast. One commenter observed
that an MRI examination with the use of contrast material requires
approximately 30 percent more time and effort than an examination
performed without contrast material and that a bilateral examination
requires 50 percent more staff time and effort to complete. The same
commenter expressed concern that proposed APC 720 consists of only one
procedure, CPT code 70541, Magnetic image, head (MRA). The commenter
recommended that we place this code and the other MRA codes that we now
cover into two APC groups, one with and the other without contrast. A
number of commenters recommended that we pay separately for contrast
material, as a cost pass-through. One commenter believes that including
diagnostic studies with placement of radiation therapy fields in
proposed APC 710 violates the ``clinically similar'' criterion.
Response: Our medical advisors and staff carefully reviewed our
data for the procedures in proposed APC group 710, proposed APC group
720, and proposed APC group 726 in light of commenters' concerns about
the extent to which these groups take into account the costs associated
with the use of contrast material. We concluded that costs associated
with the use of contrast material are reflected in the payment rate in
proportion to its frequency of use. We believe it is reasonable to have
the CAT scans and MRIs with and without contrast together in their
respective APC groups because facilities do not specialize based on
whether or not they use contrast material. Further, the cost of
contrast material relative to the overall inherent cost of CAT scans
and MRI procedures alone is small. Moreover, the use of contrast
material with CAT scans and MRI procedures differs significantly when
compared to the use of contrast with plain films. Contrast comprises a
significant portion of the cost of plain film services, and not all
facilities perform plain films with contrast. A plain film can be
ordered without being scheduled, but any plain film with contrast has
to be scheduled. This scheduling distinction does not apply to a CAT or
MRI scan with or without contrast. We did find that applying the ``two
times'' limit on cost variation required by the BBRA 1999 resulted in
the creation of two CAT groups, final APC groups 0282, to which we
assigned CPT codes 70486, 76370, 76375, and 76380, and final APC 0283,
to which the remaining codes in proposed APC group 710 are assigned. We
further eliminated proposed APC group 720 and combined CPT code 70541,
Magnetic image, head (MRA), with the other MRI procedures in final APC
group 0284 because the base procedure, magnetic resonance imaging, is
the same.
APC 716: Fluoroscopy
Comment: A number of commenters recommended that we pay separately
for the fluoroscopy portion of procedures that include this radiologic
service.
Response: We have assigned payment status indicator ``X'' to the
procedures in final APC groups 0272 and 0273 to indicate that these are
ancillary services that are paid separately under the hospital
outpatient PPS.
Comment: A professional society commented that CPT code 74340, X-
ray guide for GI tube, requires approximately 10 times the amount of
radiologic technologist and room time, approximately 15 times the
amount of film and many more supplies than does CPT code 71023, Chest
x-ray and fluoroscopy. The commenter recommended that we divide
proposed APC 716 into three separate and distinct levels based on the
extent of the procedures and that we recalculate the relative weight
and associated payment rate for the resulting groups.
Response: We disagree with the commenter. Our medical advisors and
staff, after reviewing the procedures in proposed APC group 716,
concluded that the fluoroscopic portion of these procedures is
sufficiently similar in terms of clinical characteristics and resource
requirements to be grouped together. However, applying the ``two
times'' limit on cost variation required
[[Page 18468]]
by the BBRA 1999 results in the formation of two groups, final APC
groups 0272 and 0273.
APC 728: Myelography
Comment: Commenters objected to assigning the same payment amount
to procedures regardless of whether or not a contrast agent is used.
One commenter was concerned that this payment policy will dissuade
hospitals from utilizing contrast agents even in cases where the use of
contrast is medically appropriate.
Response: We agree that median costs vary more among the procedures
in proposed APC 728 than their clinical similarities would suggest.
However, although we found that final APC group 0274 did not satisfy
the ``two times'' limit on cost variation required by the BBRA 1999, we
are making an exception in this case as we explain below, in section
III.C.6.e., and we are retaining all myelographic procedures in final
APC 0274.
APC 730: Arthrography
Comment: Some commenters suggested reassigning various
arthrographic procedures that were assigned to proposed APC 730.
Response: We find the procedures in this group to be sufficiently
homogeneous in terms of clinical definition and resource use. The
procedures are comparable with respect to the use of resources in that
the highest median cost procedure is less than twice the lowest median
cost procedure, consistent with the standard set by the BBRA 1999.
Therefore, we are retaining the proposed grouping of arthrographic
procedures in final APC 0275.
APC 736: Digestive Radiology
To be consistent with the limit on cost variation required by
section 201(g) of the BBRA 1999, we divided the procedures in proposed
APC 736 into final APC groups 0276 and 0277.
APC 738: Therapeutic Radiologic Procedures
To be consistent with the limit on cost variation required by
section 201(g) of the BBRA 1999, we split the procedures in proposed
APC 738 into final APC groups 0296 and 0297.
APC 739: Diagnostic Angiography and Venography
Comment: Numerous commenters expressed concern about the lack of
homogeneity among procedures in proposed APC 739. One commenter
recommended that we divide proposed APC 739 into three groups: one for
CPT code 75790, Angiography, arteriovenous shunt; one for all other
angiography procedures; and one for venography procedures.
Response: In response to these comments, we created final APC group
0281, Venography of Extremity, to reflect the significant clinical and
resource consumption differences between venographic procedures
performed on extremities and diagnostic angiography and venography
performed on other parts of the body. Venographic procedures on the
extremities consume less time and fewer resources than other
angiography and venography procedures. To be consistent with the limit
on cost variation required by the BBRA 1999, we split the other
procedures in proposed APC 739 into final APC groups 0279 and 0280.
With respect to final APC group 0279, we explain in section III.C.6.e
why we are making an exception to the BBRA 1999 limit on cost
variation.
APC 747: Diagnostic Ultrasound Except Vascular
Comment: A number of commenters suggested that we restructure
proposed APC group 747 according to body site because the APC criterion
of clinical homogeneity is violated by including within one group body
sites that range from the eye to the pregnant uterus to the scrotum and
contents.
Response: Our medical advisors and staff carefully weighed the
suggestion of commenters that clinical homogeneity would be better
served if the procedures in proposed APC group 747 were divided into
groups according to body site. We concluded that resource costs based
on the type of technology used are what primarily dictates the
definition of groups for various diagnostic services. Thus, we did not
assign plain film of the chest in the same APC group with MRI of the
chest. Because ultrasound is the type of technology common to all
procedures in proposed APC group 747 and because resource use for the
various procedures is similar irrespective of body site, we did not
break this group up according to body site. However, to be consistent
with the limit on cost variation required by the BBRA 1999, we split
the procedures in proposed APC 747 into final APC groups 0265 and 0266.
APC 749: Guidance Under Ultrasound
Although there is a range of sites for the procedures in proposed
APC group 749, as we explain above in our response to the comments
submitted in connection with proposed APC 747, we are keeping this
group intact in final APC group 0268 because the base procedure,
ultrasonography, is the same for all procedures. Also, the procedures
in final APC group 0268 are comparable with respect to the use of
resources in accordance with the ``two times'' limit on cost variation.
APC 750: Therapeutic Radiation Treatment Planning
Comment: Commenters were concerned that radiation physics services
are not appropriately recognized in proposed APC group 750. One
commenter observed that proposed APC 750 lacks clinical homogeneity by
including HCPCS codes for calculations and computer-based treatment
planning with codes for the construction of treatment devices. Another
commenter objected to including CPT codes 77261, 77262, 77263, 77431,
and 77432 in proposed APC 750 because these codes are for professional
services only and do not include a technical or facility component. As
such, there are no facility costs associated with the codes. The
commenter noted that if these codes were removed from proposed APC
group 750, three medical physics consultation codes, CPT codes 77336,
77370, and 77399 would remain in the group. The commenter suggested
that the resource requirements for two of the three remaining codes are
dramatically different.
Response: We agree with commenters' concerns about proposed APC
group 750, and we modified this group accordingly. First, we assigned
payment status indicator ``E,'' which designates certain items and
services that are not paid under the hospital outpatient PPS, to five
codes that describe professional services, which would not be billed by
hospitals: CPT code 77261, Therapeutic radiology treatment planning;
simple; CPT code 77262, Therapeutic radiology treatment planning;
intermediate; CPT code 77263, Therapeutic radiology treatment planning;
complex; CPT code 77431, Radiation therapy management with complete
course of therapy consisting of one or two factions only; and CPT code
77432, Stereotactic radiation treatment management of cerebral
lesion(s) (complete course of treatment consisting of one session).
We renamed the remaining group of codes as final APC 0311,
Radiation Physics Services. The codes specific to radiation physics
that we classified in this APC are CPT code 77336, Continuing medical
physics consultation, including assessment of treatment parameters,
quality assurance of dose delivery, and review of patient treatment
documentation in support of the radiation oncologist, reported per week
of therapy; CPT code 77370, Special medical radiation physics
[[Page 18469]]
consultation; and CPT code 77399, Unlisted procedure, medical radiation
physics, dosimetry and treatment devices, and special services.
APC 751: Level I Therapeutic Radiation Treatment Preparation
APC 752: Level II Therapeutic Radiation Treatment Preparation
Comment: One commenter objected to including CPT code 77295,
Therapeutic radiology simulation-aided field setting; three-
dimensional, in proposed APC 752 because this service has dramatically
different resource requirements than the other CPT codes in group.
Another commenter believes that the resources used in connection with
simple intracavitatory applications, which are normally performed with
re-usable Cs-137 sources, are totally dissimilar from the resources
required for remote afterloading high intensity brachytherapy in
proposed APC 751. This commenter noted that the equipment and room
costs associated with remote afterloading high intensity brachytherapy
may well exceed $500,000.
Response: We agree. In response to commenters' concerns, we made a
number of modifications to proposed APC group 751 and proposed APC
group 752. First, we assigned payment status indicator ``E,'' which
designates certain items and services that are not paid under the
hospital outpatient PPS, to CPT code 77299, Unlisted procedure,
therapeutic radiology clinical treatment planning, thereby removing it
from an APC group.
We created final APC group 0303, which consists of the following
three codes: CPT code 77332, Unlisted procedure, therapeutic radiology
clinical treatment planning; CPT code 77333, Treatment devices, design
and construction; intermediate (multiple blocks, stents, bite blocks,
special bolus); and, CPT code 77334, Treatment devices, design and
construction; complex (irregular blocks, special shields, compensators,
wedges, molds or casts). We created final APC 0303 because the
resources needed for device construction are unique. We decided to put
these three codes together in one group rather than assigning each to
its own individual group because we could make no clear cost
distinctions among the three codes and because we expect that
facilities do not specialize in one type of device over another, but
rather construct all of the types of devices encompassed within the
three codes.
We created final APC group 0310, to which we assigned CPT code
77295, Therapeutic radiology simulation-aided field setting, three-
dimensional. We assigned CPT code 77295 to its own individual APC group
because it requires significantly greater resource consumption than the
procedures in either final APC group 0304 or final APC group 0305.
We assigned the codes remaining in proposed APC groups 751 and 752
to final APC groups 0304 and 0305. Both APC groups 0304 and 0305 are
comparable with respect to the use of resources in accordance with the
``two times'' requirement set by the BBRA 1999.
APC 757: Radiation Therapy
Comment: We received a number of comments about the assignment to
proposed APC 757 of CPT code 61793, Stereotactic radiosurgery, particle
beam, gamma ray or linear accelerator, one or more sessions. Commenters
indicated that CPT code 61793 is clinically distinct from other forms
of radiation treatment delivery and that this service generally
involves significantly greater treatment time and costs. One commenter
stated that if we were to keep CPT code 61793 in proposed APC 757, we
would be prejudicing use of this new, proven technology. Another
commenter contended that radiation therapy is not the same as a
surgical procedure. The commenter urged us to separate stereotactic
radiation therapy (SRT) and intensity-modulated radiation therapy
(IMRT) services from the conventional radiation therapy procedures in
APC 757 and to assign them a higher payment rate due to their higher
cost.
Response: We created final APC group 0302, to which we assigned
stereotactic radiosurgery, which requires significantly more costly
resources than the procedures assigned to final APC groups 0300 and
0301. Note that we have created two codes, G0173 and G0174, to use in
place of CPT code 61793. They represent stereotactic radiosurgery
completed in one session, and that which requires multiple sessions,
respectively. We also assigned CPT code 77470 to APC 0302, since we
believe it requires resources similar to those required for
radiosurgery. We will continue to track the data for these codes to
ensure their proper placement. The procedures in final APC group 300
and in final APC group 301 are comparable with respect to the use of
resources in accordance with the ``two times'' limit on cost variation.
APC 759: Brachytherapy and Complex Radioelement Applications
Comment: One commenter expressed concern because we did not
identify a payment amount for the radioactive seeds used in
brachytherapy. Another commenter referred to low dose rate interstitial
brachytherapy that is used to treat complex gynecologic tumors,
prostate cancers, and head and neck cancers, noting that this type of
radiation therapy employs single-use radioactive sources (iodine, gold,
iridium, and palladium seeds) and various disposable applicators. The
commenter pointed out that only a limited number of vendors produce
these radioactive sources and that the seeds cost as much as $200 each
with the number of implants varying depending on the size, stage, and
location of the cancer. The commenter stated that some patients with
prostate cancer may require as many as 100 to 150 seeds. The commenter
asserted that we have not captured the costs of these
radiopharmaceuticals in the APC payment.
Response: We have changed how we pay for brachytherapy and the
other services we proposed to classify to APC 759 in response both to
comments and to the provisions of section 201(b) of the BBRA 1999,
which provide for an additional payment to be made for innovative
medical devices, including ``a (current) device of brachytherapy.''
(See section III.D., below.) Within this framework, we recognize the
seeds provided during brachytherapy. For bill processing purposes, we
have assigned brachytherapy seeds to APC 0918. We will make payment for
brachytherapy seeds under the transitional pass-through rules explained
in section III.D., below.
Based on commenters' suggestions, a review of our data, and the
BBRA 1999 ``two times'' requirement, we have classified the procedures
in proposed APC 759 in final APC 0312, Radioelement Applications, and
final APC 0313, Brachytherapy. APC 0313 consists of CPT code 77781,
Remote afterloading high intensity brachytherapy; 1-4 source positions
or catheters; CPT code 77782, Remote afterloading high intensity
brachytherapy; 5-8 source positions or catheters; CPT code 77783,
Remote afterloading high intensity brachytherapy; 9-12 source positions
or catheters; CPT code 77784, Remote afterloading high intensity
brachytherapy; over 12 source positions or catheters; and, CPT code
77799, Unlisted procedure, clinical brachytherapy. Because these
[[Page 18470]]
procedures are all different types of brachytherapy, final APC 313 is
more coherent clinically than was proposed APC 759.
We moved CPT code 77750, Infusion or instillation of radioelement
solution, to final APC 301, Level II Radiation Therapy, and CPT code
77789, Surface application of radioelement, were moved to final APC
300, Level I Radiation Therapy. The remaining procedures from proposed
APC 759 constitute final APC 312, Radioelement Applications. The
procedures in final APC group 312 and in final APC group 313 are
comparable with respect to the use of resources in accordance with the
``two times'' limit on cost variation.
APC 761: Standard Non-Imaging Nuclear Medicine
APC 762: Complex Non-Imaging Nuclear Medicine
APC 771: Standard Planar Nuclear Medicine
APC 772: Complex Planar Nuclear Medicine
APC 781: Standard SPECT Nuclear Medicine
APC 782: Complex SPECT Nuclear Medicine
APC 791: Standard Therapeutic Nuclear Medicine
APC 792: Complex Therapeutic Nuclear Medicine
Comment: We received numerous comments about the proposed nuclear
medicine APC groups. Commenters addressed what they believe to be
discrepancies in the payment weights among the proposed groups.
Commenters also asserted that the proposed payment levels are
inadequate to offset the cost of radiopharmaceuticals. They believe, in
part, that our use of single-procedure claims in constructing our
database failed to capture the costs associated with the various
radiopharmaceuticals that may be used in combination during multiple
procedures performed during a single session on various patients. One
commenter disagrees with our decision to consider therapeutic
radiopharmaceuticals and radionuclides as incidental services, bundling
their costs into nuclear medicine and radiation therapy procedures. The
commenter recommended that we develop unique APC groups for
radiopharmaceuticals and radionuclides. One manufacturer expressed
particular concern about our proposed payment for a radiopharmaceutical
used to relieve the pain of bone metastasis (CPT code 79400) that we
proposed to package into APC 791 for which the proposed payment was
$758. The commenter stated that this new radiopharmaceutical, which has
generated a very high clinical response rate, costs more than $2,000
per dose.
Response: In response to these and other comments, as well as the
changes made by the BBRA 1999 to the outpatient PPS, our medical
advisors and staff have reconstructed the nuclear medicine APC groups.
First, we have placed radiopharmaceuticals into a separate set of APC
groups that are listed in Addendum K. As we state above, new section
1833(t)(6) of the Act provides for additional payment for current and
new radiopharmaceuticals. We list in Addendum K those
radiopharmaceuticals that are eligible for additional payment effective
with services furnished on or after July 1, 2000. In accordance with
the process outlined below, in section III.D.4, we invite requests to
consider other radiopharmaceuticals as potential candidates for
additional pass-through payments.
Next, we reconfigured the nuclear medicine APC groups based on the
resources required for the procedures themselves, exclusive of costly
radiopharmaceuticals. We took into account the fact that SPECT
equipment, which costs significantly more than the non-SPECT equipment
that was initially used most frequently for planar medicine, is now
commonly used to conduct planar studies. As a final step, we further
reorganized the groups to satisfy the requirement set by the BBRA 1999
``two times'' requirement, resulting in final APC groups 0286, 0290,
0291, 0292, 0294, and 0295.
Comment: We received a number of comments concerning the clinical
efficacy of iodine 131 tositumomab in the treatment of cancer. One
commenter stated that iodine 131 tositumomab, which was reported to be
pending final FDA approval, has the potential to be the first
radioimmunotherapeutic agent to be approved for the treatment of
cancer. The commenter expected this pharmaceutical to be the first in
its class, and characterized it as neither a chemotherapeutic agent nor
a radiopharmaceutical. The commenter stated that the cost of this
pharmaceutical will be significantly higher than the payment amount
proposed for any of the APC groups containing drugs used for cancer
therapies. The commenter believes that we should have proposed an
outlier policy to ensure equitable payment for pharmaceuticals such as
iodine 131 tositumomab.
Response: If iodine 131 tositumomab receives final FDA approval, we
strongly encourage interested parties to submit the appropriate
materials to us for determination of this product's eligibility for
additional payment under the pass-through provision as described below
in section II.D.6.
Comment: One commenter finds our method of paying for new products
to be flawed. The commenter sees it as highly probable that a new
product will be inserted into an APC procedure category where the
payment rate is significantly lower than the actual cost of the newly
developed product. The commenter cites our proposed payment for a new
product, In-111 Octreo Scan, which is used for tumor imaging. The
product costs four times the payment rate for proposed APC 772, Complex
Planar Nuclear Medicine. The commenter believes that this enormous
discrepancy will discourage hospital outpatient departments from
utilizing procedures that require this product and that Medicare
beneficiaries may be denied access to the most appropriate care
available as a result.
Response: We are firmly committed to ensuring that the provisions
of the hospital outpatient PPS do not in any way obstruct or limit
Medicare beneficiaries' access to reasonable medically necessary and
appropriate care. We further recognize that the development of new
technology and products is a highly dynamic enterprise that is
constantly evolving and changing the character and cost of current
diagnostic and treatment modalities. New section 1833(t)(6) of the Act
provides for an additional transitional pass-through payment for
certain innovative medical devices, drugs, and biologicals. We are also
creating a series of transitional APCs for the express purpose of
providing appropriate payment for new technology services when they
emerge into the marketplace while we collect data to enable us
ultimately to incorporate the new technology service within an APC
group, making payment adjustments as needed. We expect to continue
working closely with hospitals and their representatives throughout
this process to ensure that payment does not inhibit beneficiary access
to appropriate care. We discuss the transitional pass-through payment
groups in greater detail in section III.D and provisions for payment
for new technology in section III.C.8.
[[Page 18471]]
APC 881: Level I Pathology
APC 882: Level II Pathology
APC 883: Level III Pathology
Comment: We received numerous comments on the proposed pathology
APC groups. One commenter expressed concern that our proposed
assignment of tests among the three groups may create an incentive for
physicians to order complex and unnecessary tests when simpler, less
comprehensive tests may be adequate, because we have grouped together
and are paying the same amount for tests that are clinically similar
but that are comprehensively more difficult than one another.
Response: Our medical advisors and staff reviewed and completely
reorganized the grouping of pathology tests in light of commenters'
concerns and the BBRA 1999 ``two times'' requirement. Pathology tests
are in final APC groups 0342, 0343, and 0344.
APC 906: Infusion Therapy Except Chemotherapy
APC 907: Intramuscular Injections
Comment: We received many comments about proposed APC groups 906
and 907. The commenters were generally concerned that packaging payment
for nonchemotherapeutic infused and injected drugs in the payment rates
for the administration of nonchemotherapy drugs does not take into
account the great variation among these products with regard to their
indication/application and cost nor the cost of new drugs that have
been introduced since 1996. Commenters fear that we will underpay
hospitals and inhibit the introduction of new drugs into the system.
Response: In response to the concerns expressed by commenters, we
have created additional groups for certain expensive pharmaceuticals.
These high-cost, nonchemotherapy, nonorphan drugs are captured in the
following APCs: 0886-0891, 0907, 0908, 0911, 0914, 0915, 0917, 7007,
7036, and 7042. We have set the rates for these high-cost drug APCs
based on data we obtained from a contracted study of drug costs. In
section III.D, below, we discuss the process for pricing new high cost
drugs as they are introduced into the marketplace to assure adequate
payment until these new drugs can be assigned to an appropriate APC.
Final APC 120, Infusion Therapy Except Chemotherapy, and final APC 359,
Intramuscular injections, are priced based on the resources used to
perform the procedures, including many less expensive drugs that are
packaged into the two APCs.
APC 957: Echocardiography
Comment: Numerous commenters remarked on the lack of homogeneity in
resource consumption in this APC. One commenter objected to our not
distinguishing between procedures performed with or without contrast
agents. Another commenter contends that proposed APC 957 does not
account for the diversity of services in costs based on type of
equipment, use of conscious sedation medication, and use of contrast
agents.
Response: Conscious sedation and contrast media were packaged where
they were used in the base year. We believe that packaging of items
into the payment amount is appropriate because hospitals do not
specialize in providing only services with or only services without
sedation or contrast. To the extent that different equipment is used
for different procedures, and has different costs, those differing
costs are captured and recognized in our payment algorithm.
Comment: Several commenters referred to the fact that some of the
echocardiograms are part of more comprehensive codes pertaining to
echocardiograms that are in the same APC. For example, one commenter
noted that CPT code 93880, the basic vascular ultrasound service, is
defined as a ``duplex scan.'' The commenter stated that all duplex
vascular ultrasound codes involve three components and that, to the
extent all three components are incorporated into this single vascular
code, a provider is paid for only one procedure. On the other hand, CPT
code 93307, the basic echocardiography service, incorporates only one
of the three types of services included in the basic vascular service,
CPT code 93880. Other codes, CPT 93320 and 93325 are used to bill for
the other services that are a standard part of all vascular ultrasound
procedures like CPT code 93880. This approach results in a provider
receiving three separate payments for an echocardiogram with Doppler
and color flow mapping as compared to a single payment for an
equivalent vascular study.
Response: We agree that duplex vascular ultrasound scanning
procedures include two dimensional and doppler signal display. However,
for the example cited by the commenter, there is no separate code that
includes both the two dimensional and the doppler ultrasound spectral
analysis. To report a duplex vascular ultrasound of the heart, the only
codes available are CPT codes 93307, 93320 and 93325, unlike the duplex
vascular ultrasound scan of the extracranial arteries, which is coded
with CPT code 93880. We agree that this limitation of the coding system
affects the payment system, since the APC system is based on charges
associated with each of the codes. We will bring this issue to the
attention of the American Medical Association's CPT Editorial Panel.
However, in those instances where there is a code for the
comprehensive service and separate codes for services that are inherent
components of the comprehensive service, the Correct Coding Initiative
(CCI) edits, which we are incorporating into the hospital outpatient
PPS claims processing system, will address this concern. The CCI edits
have been in place in the Part B claims processing system since January
1996. These edits detect when codes representing component services are
reported with the code for the more comprehensive service. For example,
there is an edit that prohibits the payment of CPT code 93875, a
doppler study of the extracranial arteries when reported with CPT code
93880, the duplex scan of the extracranial arteries.
APC 960: Cardiac Electrophysiologic Tests/Procedures APC
Comment: Many commenters cited extreme variations in resource use
among the procedures in proposed APC 960. One commenter noted that the
procedures involve the use of one or more catheters, and argued that
the proposed payment does not cover the cost of even one catheter.
Another commenter claims that, at a minimum, the total cost of the four
diagnostic catheters and one ablation catheter used in performing these
procedures is $1,955.
Response: In response to these concerns, we moved CPT code 93660,
Evaluation of cardiovascular function with tilt table evaluation, with
continuous ECG monitoring and intermittent blood pressure monitoring,
with or without pharmacological intervention, to final APC 0101, and
CPT code 93724, Electronic analysis of antitachycardia pacemaker
system, to final APC 0100. We reclassified the remaining procedures in
proposed CPT 960 into final APC groups 0084, 0085, 0086, and 0087 to be
consistent with the BBRA 1999 ``two times'' requirement.
APC 966: Electronic Analysis of Pacemakers/Other Devices
Comment: A number of commenters stated that the procedures in
proposed APC 966 are not related clinically or in terms of resource
cost. One commenter indicated that analyzing a spine infusion pump or
neuroreceiver is a very different process from analyzing a
[[Page 18472]]
pacemaker or cardio/defibrillator and hence uses very different
resources.
Response: Although the devices that are the subject of electronic
analysis in proposed APC group 966 differ, we believe that the resource
use among the services in the group is, on average, relatively similar.
We determined that the procedures in proposed APC 966 meet the ``two
times'' test for comparability with respect to the use of resources set
by the BBRA 1999. In addition, we find it unlikely that facilities will
specialize in one particular type of electronic analysis of pacemakers/
other devices to the exclusion of others. Therefore, we did not change
the procedures in final APC group 102 from what we had proposed.
APC 968: Vascular Ultrasound
Comment: One commenter recommended removing CPT code 93875, Non-
invasive physiologic studies of extracranial arteries, complete
bilateral study (for example, periorbital flow direction with arterial
compression, ocular pneumoplethysmography, Doppler ultrasound spectral
analysis), from proposed APC 968 because this study is a physiologic
procedure and should be in the same group with other noninvasive
physiologic vascular studies.
Response: We agree. We moved CPT code 93875 to final APC 0096.
Comment: One commenter recommended creating additional APC groups
for CAT, MRI, and general ultrasound procedures to distinguish between
diagnostic procedures that utilize contrast media and those that do
not. The commenter believes that additional APC groups that properly
recognize the resources required for contrast agents will encourage
hospitals to use the procedures most suitable for the clinical needs of
different patients.
Response: As we explained above, in our response to comments about
proposed APC groups 710, 720, and 726, our medical advisors and staff
carefully reviewed our data and concluded that costs associated with
the use of contrast material are reflected in the payment rate for
vascular ultrasound procedures in proportion to its frequency of use.
We believe it is reasonable to have vascular ultrasound procedures with
and without contrast together in one group because facilities do not
specialize based on whether or not they use contrast material. Further,
the cost of contrast material is small relative to the overall cost of
the ultrasound. Moreover, facilities are not likely to schedule
ultrasound according to whether or not contrast is used. Therefore,
with the exception of moving CPT code 93875, we did not further change
the procedures in final APC group 0267. Final APC group 0267 is within
the limit on cost variation required by the BBRA 1999.
APC 969: Hyperbaric Oxygen
Comment: Many commenters were concerned that our cost data for
hyperbaric oxygen therapy are flawed because of poor coding, and that
the proposed payment rate is, as a consequence, inadequate. One
commenter suggested that we did not use a common definition of
hyperbaric oxygen therapy across all hospitals and that, due to
ambiguity in codes, there is wide variation in how hyperbaric oxygen
therapy services are defined for billing purposes.
Response: We cannot subdivide final APC 0031 because we have no
mechanism for creating clinically distinct groups related to
differences in resource consumption among facilities within a single
CPT code. However, we explain below, in section III.H, that we intend
to make adjustments in future years to APC group weights, once the
hospital outpatient PPS is implemented. If commenters believe that
current codes are inadequate to describe these services, they should
seek new CPT codes from the American Medical Association.
Comment: One commenter was concerned about not only the low payment
rate proposed for hyperbaric oxygen therapy, but also the fact that the
proposed national unadjusted coinsurance amount exceeds the proposed
total payment rate for the service.
Response: We calculated the payment rate and coinsurance amount for
APC 0031 using the same method that we followed for the other APC
groups. Charges for hyperbaric oxygen are much higher than their costs,
which accounts for the unusually high national unadjusted coinsurance
rate relative to the total payment rate for CPT code 99183. Note,
however, that hospitals may elect to offer a reduced coinsurance rate
for the service as described below in section III.F.4.
APC 971: Level 1 Pulmonary Tests
APC 972: Level II Pulmonary Tests
APC 973: Level III Pulmonary Tests
Comment: Commenters generally questioned the clinical consistency
of procedures in the proposed pulmonary test APC groups and expressed
concern about the variability of resources required to perform the
procedures within each group. One commenter disagreed with our
combining procedures before and after medication with procedures before
rest and after exercise.
Response: After carefully reviewing the assignment of codes among
the three proposed pulmonary test groups, our medical advisors and
staff made a number of changes. To better recognize their median costs,
we moved CPT code 94060, Bronchospasm evaluation before and after
bronchodilator, and CPT code 94260, Thoracic gas volume, to final APC
group 0368, and classified CPT code 94720, Carbon monoxide diffusing
capacity, to final APC group 0367. We made additional changes among the
three groups to ensure comparability of resources within each pulmonary
test APC group in accordance with the ``two times'' standard set by the
BBRA 1999.
APC 976: Pulmonary Therapy
Comment: Commenters generally questioned the clinical consistency
of procedures in the proposed pulmonary therapy APC group and expressed
concern about the variability of resources required to perform the
procedures within the group. One professional association wrote that
the respiratory therapy procedures in proposed APC group 976 are
significantly different in complexity and require significantly
different equipment and expertise to perform. The same commenter noted
that CPT code 94657, Ventilation assist and management, initiation of
pressure or volume preset ventilators for assisted or controlled
breathing, subsequent days; CPT code 94660, Continuous positive airway
pressure ventilation (CPAP), initiation and management; and, CPT code
94662, Continuous negative pressure ventilation (CNP), initiation and
management, all require close monitoring, more costly equipment, and,
often, more expertise than do other therapies in proposed APC group
976.
Response: We agree with the commenter. We moved the CPT codes
describing ventilation initiation and management (CPT codes 94657,
94660, 94662) into their own APC, final APC 0079, Ventilation
Initiation and Management, to recognize that these procedures represent
a completely different type of clinical service and because they
utilize resources that are materially different from those used in
connection with other pulmonary therapy procedures. We further divided
the procedures in proposed APC 976 to meet the definition of comparable
resources required by the BBRA 1999, resulting in final APC groups 0077
and 0078.
[[Page 18473]]
APC 979: Extended EEG Studies and Sleep Studies
APC 980: Electroencephalogram
APC 981: Level I Nerve and Muscle Tests
APC 982: Level II Nerve and Muscle Tests
Comment: One commenter expressed concern about our grouping sleep
medicine services in proposed APC 979 with EEG and Epilepsy diagnostic
services. Another commenter is concerned about the clinical homogeneity
of our proposed groups for the numerous different neurologic and
neuromuscular diagnostic codes that are encompassed within the range of
services described by CPT code 95805 through CPT code 95958. The
commenter believes that our proposed groups do not make appropriate
distinctions among the many different tests relating to different parts
of the body, taking different amounts of time, using different
equipment, and measuring different outcomes. One commenter asked that
we add two codes created in 1998 for sleep services to the list of
procedures in the APC system. The commenter recommended assigning CPT
95811, Polysomnography with CPAPP, to proposed APC group 979. The
commenter also recommended that CPT code 95806, Sleep study, unattended
by a technologist, not be assigned to proposed APC group 979 to avoid
creating an incentive for hospitals to use that procedure, which the
commenter asserts is both less costly and less conclusive than other
studies in proposed APC 979, in place of more comprehensive tests. One
commenter claimed that the variety of neurological and neuromuscular
diagnostic tests warrants an expansion of the number of APCs for these
procedures to six, because the resources used vary widely. The
commenter prefers that payments be made on a per service rather than on
a per group basis. However, if we retain groups, the commenter
recommended, on the basis of cost-based practice expenses, separate
APCs for sleep and polysomnography services, for EEG studies, for EEG
monitoring codes, for EMG codes, for nerve conduction and H reflex
tests, and for sensory evoked potential and autonomic nerve function
tests.
Response: Our medical advisors and staff decided that CPT codes
95806 and 95811 are both most appropriately assigned to final APC 0213.
While sleep studies unattended by a technologist may consume less
resources than those studies which involve the presence of a
technologist, we believe that physicians are likely to order a mix of
sleep studies, and that institutions are unlikely to specialize in
sleep studies with or without the presence of a technologist. We added
CPT code 95951 to APC group 0213. We believe the codes we proposed in
APC groups 979 and 980 are sufficiently comparable clinically and in
terms of resource use not to require further subdivision into smaller
groups. Therefore, we retained our proposed classification in final APC
groups 213 and 214.
We created a third APC group for the nerve and muscle test codes,
and we split the codes in proposed APCs 981 and 982 among final APC
groups 0215, 0216, and 0217 to ensure comparability of resources within
each of the three nerve and muscle test APC groups in accordance with
the ``two times'' requirement set by section 201(g) of the BBRA 1999.
APC 987: Subcutaneous or Intramuscular Chemotherapy
APC 988: Chemotherapy except by Extended Infusion
APC 989: Chemotherapy by Extended Infusion
APC 990: Photochemotherapy
Comments: We received numerous comments that criticized our
proposed payments for chemotherapy services. The commenters argued that
the proposed payment for chemotherapy and radiation therapy would
severely reduce payments to hospitals and create perverse incentives
for hospitals to substitute the older, less effective therapies for the
newer ones. The commenters asserted that the proposed payment would not
cover the costs of supportive care such as drugs to control nausea and
vomiting. They expected that low payment rates to hospitals would force
them to discontinue chemotherapy services, and that patients would be
faced with trips to distant facilities to obtain services.
Response: We believe that the concerns raised by the commenters
have been addressed through the transitional pass-through provision set
forth in section 1833(t)(6) of the Act, as added by section 201(b) of
the BBRA 1999. In accordance with that provision, we have separately
identified current drugs and biologicals used in the treatment of
cancer. These are listed in Addendum K of this final rule, and are
eligible for additional payment under this provision. We have obtained
codes for any anticancer, supportive, or adjunctive drugs we could
identify. Thus, we will pay for chemotherapy by recognizing the mode(s)
of administration and each of the covered drugs given, whether they are
to treat the cancer, to protect the patient against the toxic effects
of the treatment, or to relieve the side effects of treatment. In
section III.D.4, below, we discuss how to request codes for new drugs.
Note that we moved CPT-based chemotherapy infusion codes into the
``E'' (noncovered) category because HCPCS ``Q'' codes for these
services will be used to identify chemotherapy infusions. Hospitals had
been instructed in the past not to bill using the CPT codes.
APC 999: Therapeutic Phlebotomy
Comment: One commenter is concerned that facilities will lose money
because the proposed payment rate does not cover the cost incurred to
provide the nursing care, phlebotomy bag and other supplies, overhead,
scheduling time and disposal of hazardous waste that are all required
to furnish this service.
Response: We have carefully reviewed the costs associated with APC
999 and believe that the CPT code 99195 was mistakenly used to report
simple venipuncture in some cases, thus lowering the cost of proposed
APC 999. However, we believe it is appropriate to base payment for this
APC on the median amount billed, since CPT code 99195 was billed more
than 20,000 times. Hospitals must use this code only when therapeutic
phlebotomy is furnished, and charge an appropriate rate for the
resources involved. Appropriate reporting will enable us to determine a
more precise weight for this APC in future years.
Final APC 081: Non-Coronary Angioplasty or Atherectomy
Final APC 082: Coronary Atherectomy
Final APC 083: Coronary Angioplasty
We created these three new APC groups to accommodate atherectomy
and angioplasty procedures that we originally proposed to classify as
inpatient only. We discuss in section III.C.5 our response to
commenters' concerns about our proposing to designate certain
procedures as ``inpatient only'' and our final decision to change the
status of these atherectomy and angioplasty procedures.
Final APC 058: Strapping
Final APC 059: Casting
We proposed to assign the procedures in these new APC groups a
payment status indicator ``N'' as incidental services for which payment
is packaged into the APC rate for another service or procedure.
However, we determined
[[Page 18474]]
that the procedures in the final APC groups 0058 and 0059 could be
performed independently, that is, the procedures for which a strapping
has been previously applied and/or a new cast has previously been
placed. We explain in more detail in section III.C.2.c our rationale
for not packaging the costs associated with these services. We
therefore created APC groups 0058 and 0059 for these codes to which we
assigned payment status indicator ``S'' to indicate that these are
significant procedures paid under the hospital outpatient PPS to which
the multiple procedure discount does not apply.
e. Exceptions to BBRA 1999 Limit on Variation of Costs Within APC
Groups
As we note above, section 201(g) of BBRA 1999 amends section
1833(t)(2) of the Act to define what constitutes comparable use of
resources among the procedures or services within an ambulatory payment
classification group under the hospital outpatient PPS. The standard
set by section 1833(t)(2) of the Act is that the items and services
within a group cannot be considered comparable with respect to the use
of resources if the highest median (elected by the Secretary, as
opposed to the mean) cost item or service within a group is more than 2
times greater than the lowest median cost item or service within the
same group (the ``two-times'' requirement).
Section 1833(t)(2) of the Act allows the Secretary to make
exceptions to the ``two-times'' requirement in unusual cases, such as
low volume items and services, although the Secretary may not make such
an exception in the case of a drug or biological that has been
designated as an orphan drug under section 526 of the Federal Food,
Drug, and Cosmetic Act. As we explain in the preceding section of this
preamble, after we had modified the composition of the APC groups based
on the recommendations of commenters, we made numerous additional
changes to the APC groups to conform with the BBRA 1999 ``two times''
requirement. In the resulting groups, we found certain anomalies that
were irreconcilable with the principles underlying formation of the APC
groups. After carefully evaluating the various combinations resulting
from further subdividing groups or reassigning codes to other groups to
resolve the anomalies, and after reviewing our data, we decided to
maintain the composition of certain APC groups, as exceptions to the
``two times'' requirement. We based exceptions on factors such as low
procedure volume, suspect or incomplete cost data, concerns about
inaccurate or incorrect coding, or compelling clinical arguments. We
believe that as hospitals gain experience under the hospital outpatient
PPS, and as they refine their coding of services, a number of the
apparent anomalies within the groups that we are treating as exceptions
to the ``two times'' will be resolved.
Below we list the APC groups that are exceptions to the ``two
times'' requirement, and our reasons for the exception. We use the
final APC number to identify the group.
APC 0016: Level IV Debridement and Destruction
We are retaining CPT code 56501 in final APC group 0016, even
though its median cost exceeds the ``two times limit.'' We believe the
higher costs that are reflected in the data are the result of incorrect
coding. The descriptor for CPT code 56501 defines the procedure as the
simple destruction of skin and superficial subcutaneous tissues. In the
judgment of our medical advisors, costs associated with simple
destruction of skin and superficial subcutaneous tissues are typically
within the range of costs associated with the other procedures in final
APC group 0016, and the median cost that our data attribute to CPT code
56501 is higher than the code description warrants.
APC 0030: Breast Reconstruction/Mastectomy
Although the range of costs for procedures in final APC group 0030
exceeds the ``two times limit,'' we believe that only the simplest
breast procedures will be done in the outpatient setting. Most of the
procedures with median costs over $1000 used observation services in
order to provide an overnight stay. We expect these cases to revert to
the more appropriate inpatient setting.
APC 0058: Level I Strapping/Casting
The codes in final APC group 0058 are the simpler casting,
splinting, and strapping procedures. Costs associated with the more
resource-intensive procedures in final APC group 0059 are fairly
uniform, but the median costs of procedures in final APC group 0058
vary widely. We are excepting final APC group 0058 from the ``two times
limit'' until we can review the data for the first year of the
outpatient PPS.
APC 0060: Manipulation Therapy
Taken collectively, the codes in final APC group 0060 are low in
volume and erratically priced. For example, although the number of
areas treated increases within the range of CPT codes 98925 through
98929, suggesting progressively increasing resource utilization, our
data show median costs associated with the codes in the range 98925-
98929 as $38, $11, $16, $17, and $19, respectively. Although costs
associated with treating 9 to 10 body regions might not be 5 to 10
times greater than treating one or two regions, we would still expect
costs for the more extensive procedures to be higher than those for the
less extensive procedures, and certainly not lower as suggested by our
data. Nor do we expect a hospital to specialize in treating more or
fewer body areas. Therefore, the median payment set for final APC 0060
should average out, providing adequate payment for any number of body
areas treated.
APC 0079: Ventilation Initiation and Management
These codes all represent respiratory treatment and support within
the outpatient setting. Their costs should be roughly the same, even
though our data suggest otherwise. We are excepting final APC group
0079 from the ``two times limit'' at this time, pending the collection
of more conclusive cost data.
APC 0080: Diagnostic Cardiac Catheterization
The data for CPT code 93524 reflect costs that are lower than we
would expect. We can find no apparent explanation for the wide
variation in costs among the cardiac catheterization codes, although we
suspect that the accuracy of the chargemaster system, when assigning
charges in other than the surgical suite, may be problematic. We expect
costs to even out once hospitals decide which cases may be handled on
an outpatient basis without requiring an overnight stay.
APC 0081: Non-Coronary Angioplasty
We are excepting final APC group 0081 from the ``two times limit''
because of the low volume of cases for the codes in the group. For some
of the codes in this group, the data reflect lower than expected median
costs, which we attribute to low volume and to miscoding, which would
account for the erratic sequences of costs found in our data.
APC 0093: Vascular Repair/Fistula Construction
We believe the median costs for CPT codes 36530 and 36810 are
aberrant. These codes are very similar clinically to the other codes in
APC 0093, and we would expect their costs to be similar. We believe low
volume may account for the variability in cost.
[[Page 18475]]
APC 0094: Resuscitation and Cardioversion
We believe the median costs for CPT codes 92953 and 31500 are
aberrant, perhaps due to misuse of the codes. Therefore, we are
excepting this APC group from the ``two times limit,'' until we collect
and analyze more accurate data once the hospital outpatient PPS is
implemented.
APC 210: Spinal Tap
The two CPT codes that comprise this group are essentially the same
procedure, one performed for diagnostic reasons and the other
therapeutic. We suspect the disparity in median costs is attributable
to the much higher volume of diagnostic spinal taps. Therefore, we are
excepting this APC group from the ``two times limit,'' until we collect
and analyze more accurate data once the hospital outpatient PPS is
implemented.
APC 0233: Level II Anterior Segment Eye
We are excepting final APC group 233 from the ``two times limit''
because many of the codes in this APC are low volume and the coding
seems erratic. For example, CPT designates a number of codes that are
in final APC group 0233 as ``relatively small'' surgical procedures,
which suggests that miscoding may have resulted in inflated cost data.
APC 0251: Level I ENT Procedures
A combination of low volume and unlisted codes obscures the fact
that this APC represents the least intense ENT procedures. Because
there are so many ENT codes, consistent agreement on what the codes
represent may be difficult to achieve. Therefore, we are excepting this
APC group from the ``two times limit,'' until we collect more accurate
data under outpatient PPS.
APC 0264: Level II Miscellaneous Radiology Procedures
In the judgment of our medical advisors, the median costs for CPT
codes 74740 and 76102 are aberrant. These procedures would be underpaid
if they were paid separately and on the basis of what our data show to
be their median cost. Therefore, we are excepting this APC group from
the ``two times limit,'' until we collect more accurate cost data under
outpatient PPS.
APC 0274: Myelography
In the judgment of our medical advisors, the median costs for CPT
codes 70010 and 70015 are aberrant. These codes would be underpaid if
they were moved to their own APC and paid on the basis of their median
cost. All codes in this APC should cluster around the same cost.
Therefore, we are excepting this APC group from the ``two times
limit,'' until we collect more accurate cost data under outpatient PPS.
APC 0279: Level I Diagnostic Angiography
We believe the median costs for the codes at the low end of this
APC may be inaccurate, because, clinically, these codes are
homogeneous. Therefore, we are excepting this APC group from the ``two
times limit,'' until we collect more accurate cost data under
outpatient PPS.
APC 0302: Level III Radiation Therapy
We are retaining CPT code 77470 in final APC group 302, because the
median cost seems low for the code description, possibly because this
code may have been billed improperly in the past. We are also uncertain
of the appropriate median cost of CPT code 61793, because we have been
told that CPT code 61793 was used for both single-session gamma knife
procedures and for each of multiple sessions of treatment with linear
accelerators. Therefore, we have created two codes to be used in place
of CPT code 61793, in order to collect more reliable data: G0173
(Stereotactic radiosurgery, complete course of therapy in one session),
and G0174 (Stereotactic radiosurgery, requiring more than one session).
We will initially pay both codes at the same rate; however, we
expect differences in cost would become apparent during the first year
or 18 months of the outpatient PPS.
APC 0311: Radiation Physics Services
We are retaining CPT code 77370 in final APC group 0311, because we
believe a special medical radiation physics consultation (outside the
weekly management of a patient) is probably more costly than our data
indicate.
APC 0341: Immunology Tests
We think the variation in costs among the procedures within final
APC group 0341 may be the result of erratic coding. Because these
services are so similar clinically, we would expect their individual
costs to cluster around the median. Therefore, we are excepting this
APC group from the ``two times limit,'' until we collect more accurate
cost data under outpatient PPS.
APC 0371: Allergy Injections
We attribute the variation in median costs among the procedures
within final APC group 0371 to erratic coding. Because these services
are so similar clinically, we would expect their individual costs to
cluster around the median. Therefore, we are excepting this APC group
from the ``two times limit,'' until we collect more accurate cost data
under outpatient PPS.
APC 0373: Neuropsychological Testing
With one exception, the codes in final APC group 0373 are billed
per hour, so facility costs should all cluster around the median.
Therefore, we are excepting this APC group from the ``two times
limit,'' until we collect more accurate cost data under outpatient PPS.
7. Discounting of Surgical Procedures
To be consistent with Medicare policy and regulations governing
payment for ambulatory surgical services furnished in a physician's
office and in an ASC, we proposed under the hospital outpatient PPS to
discount payment amounts when more than one procedure is performed
during a single operative session or when a surgical procedure is
terminated prior to completion. Specifically, we proposed that when
more than one surgical procedure with payment status indicator ``T'' is
performed during a single operative session, we would pay the full
Medicare payment and the beneficiary would pay the coinsurance for the
procedure having the highest payment rate. Fifty percent of the usual
Medicare PPS payment amount and beneficiary coinsurance amount would be
paid for all other procedures performed during the same operative
session to reflect the savings associated with having to prepare the
patient only once and the incremental costs associated with anesthesia,
operating and recovery room use, and other services required for the
second and subsequent procedures.
We also proposed to require hospitals to use modifiers on bills to
indicate procedures that are terminated before completion. Modifier -73
(Discontinued Outpatient Procedure Prior to Anesthesia Administration)
would identify a procedure that is terminated after the patient has
been prepared for surgery, including sedation when provided, and taken
to the room where the procedure is to be performed, but before
anesthesia is induced (for example, local, regional block(s), or
general anesthesia). Modifier-52 (Reduced Services) would be used to
indicate a procedure that did not require anesthesia, but was
terminated after the patient has been prepared for the procedure,
including sedation when provided and taken to the room where the
procedure is to be performed. We proposed to pay 50 percent of the
usual Medicare PPS payment amount and
[[Page 18476]]
beneficiary coinsurance amount for a procedure terminated before
anesthesia is induced. Modifier-74 (Discontinued Procedure) would be
used to indicate that a surgical procedure was started but discontinued
after the induction of anesthesia (for example, local, regional block,
or general anesthesia), or after the procedure was started (incision
made, intubation begun, scope inserted) due to extenuating
circumstances or circumstances that threatened the well-being of the
patient. To recognize the costs incurred by the hospital to prepare the
patient for surgery and the resources expended in the operating room
and recovery room, the hospital will receive full payment for a
procedure that was started but discontinued after the induction of
anesthesia or after the procedure was started, as indicated by a
modifier-74. The elective cancellation of procedures would not be
reported. If multiple procedures were planned, only the procedure
actually initiated would be billed.
Comment: Some commenters asked us to clarify how the policy would
be applied. For example, one commenter asked whether the surgical
discounting methodology would apply in the following situation:
Contrast x-ray of lower spine (CPT code 72265) is followed by contrast
CAT of the spine (CPT code 72132). Both procedures have related
surgical codes (CPT codes 62270 and 62284). Other commenters provided
examples that were similar in nature but involved other codes.
Response: We proposed to apply the reduced payment for multiple
procedures to surgical procedures only, that is, those CPT codes that
have a payment status indicator ``T.'' Therefore, services such as CPT
codes 72265 and 72132 that have a payment status indicator of ``S''
would not be subject to the multiple procedure discount, whereas CPT
codes 62270 and 62284, which are surgical procedures and have a payment
status indicator of ``T,'' would be subject to the multiple procedure
discount. Hypothetically, if all four codes were provided in a single
operative session, as suggested by this commenter, then the reduced
payment would apply only to the surgical procedure with the lower
payment rate. (For the record, we have responded to the commenter's
example in order to clarify how the multiple procedure discount would
apply in a hypothetical situation. However, we question whether the
suggested combination of codes would be covered if actually performed
during the course of a single patient encounter.)
Comment: Commenters asked what factors guided our assignment of
payment status indicator ``T'' to a code.
Response: We generally assigned the payment status indicator ``T''
to surgical services. Our medical advisors and staff will continue to
review the designation of status indicators and we may propose
revisions in the future.
Comment: A variety of commenters stated that the reduced payments
for multiple procedures would inappropriately reduce payments for a
second procedure. Some were concerned that application of the multiple
procedure discount could result in hospitals being less likely to offer
procedures assigned the payment status indicator ``T.'' These
commenters recommended that we change all ``T'' payment indicators to a
different indicator such as ``S,'' which we define as a significant
procedure not reduced when multiple, until we have had an opportunity
to collect reliable cost data upon which to base payment decisions
about discounting.
Response: We continue to believe that the proposed reduced payment
for multiple surgical procedures is reasonable. We disagree that
hospitals would be less likely to provide these services. We believe
there clearly are savings achieved when more than one surgical
procedure is performed during a single operative session. The patient
has to be prepared for surgery only once, and the costs associated with
anesthesia, operating and recovery room use, and other services
required for the second procedure are incremental.
Comment: Some commenters questioned whether the reduced payment for
multiple procedures applied to the beneficiary coinsurance as well as
to the Medicare program payment. Others did not understand how this
reduced payment was accounted for in determining the conversion factor.
Response: The reduced payment for multiple procedures would apply
to both the beneficiary coinsurance and the Medicare payment. In order
to do this in a ``budget neutral'' manner, we increased the conversion
factor to account for the reduced payments for multiple procedures. In
this way, total payments in the aggregate are not affected.
Comment: One commenter believes we should exclude from the
multiple-procedure discount those procedures that were subject to a 50
percent reduction under the previous cost-based system because those
procedures were recognized as being an adjunct to a primary procedure.
The commenter believes that we had already factored these discounts
into our cost determinations and would therefore be inappropriately
reducing payment even further for these procedures.
Response: We disagree with the commenter. In determining the
weights for the APC groups, we included only single procedure claims.
Multiple procedure reductions existing under the previous cost-based
system would not have been reflected in these single procedure claims,
and, therefore, do not affect the APC payment weights.
Final Action
Under the hospital outpatient PPS, we will discount payment amounts
for surgical procedures when more than one procedure is performed
during a single operative session or when a surgical procedure is
terminated prior to completion. Parallel discounts will apply to
beneficiary coinsurance amounts.
8. Payment for New Technology Services
a. Background
We proposed to price a new item or service that was assigned a new
HCPCS code by classifying the new code to whichever existing APC group
most closely resembled the item or service in terms of its clinical
characteristics and estimated resource use. We proposed to use the
group weight, payment rate, and coinsurance amount established for the
existing APC to price the new code for at least 2 years to give us an
opportunity to collect cost data for the new item or service.
After we published our proposed rule, the Congress expressed
concern in the conference report accompanying the BBRA 1999, that our
proposed PPS does not adequately address ``issues pertaining to the
treatment of * * * new technology.'' (See H. R. Rep. No. 436 (Part I),
106th Cong., 1st Sess. 868 (1999).) Therefore, the Congress enacted
``transitional pass-throughs'' in section 201(b) of the BBRA 1999 that
provide an additional payment for ``new medical devices, drugs, and
biologicals'' that do not otherwise meet the definition of current
orphan drugs, or current cancer therapy drugs and biologicals and
brachytherapy, or current radiopharmaceutical drugs and biological
products. (See section III.D of this preamble for a discussion of how
we are implementing the transitional pass-throughs.)
b. Comments and Responses
Comment: The most frequent commenters regarding our treatment of
new technology under the proposed
[[Page 18477]]
hospital outpatient PPS were device manufacturers and pharmaceutical
companies and their trade associations. Commenters were concerned
because the proposed APC payment rates were developed using 1996 cost
data that do not reflect the cost of many new technologies introduced
subsequent to 1996. Commenters believe that the proposed method of
ratesetting under the APC system lacks the flexibility needed to
recognize emergent technologies in a timely manner. In the view of the
commenters, assigning new technologies to existing APC groups pending
the collection of cost data would result in underpayment, thereby
discouraging the adoption of new technologies.
Commenters further stated that the proposed payment rates for
current yet relatively new devices were too low and would favor
continued use of older, less effective regimens on the basis of
financial pressures rather than on the improved clinical outcomes of
newer technology. Some commenters, concerned that we will not update
codes or payment rates quickly enough to allow hospitals to pay for new
technologies, recommended that we assign HCPCS codes as soon as
products become available and alter APC group weights to account for a
new technology. These commenters believe that the time lapse between
coding updates is a barrier to innovation because it can take several
years for a code to be issued for a new surgical technique, and until a
new code is issued, facilities must bill for new surgical techniques as
``unlisted procedures'' resulting in the lowest payment rate for the
category of surgery.
One commenter urged that we implement a payment carve-out for
certain drug and biological therapies and pay for these items on a
reasonable cost basis in order to provide timely patient access to many
new pharmaceutical and biotechnology products. The same commenter
recommended that if we reject a complete carve-out, then, at a minimum,
we should pay for new products introduced after 1996 on a reasonable
cost basis for 1 year to adequately compensate companies for developing
new and more effective products. Another commenter recommended that we
increase the number of APC groups to better reflect services with
similar cost structures.
One professional association recommended abandoning the APC group
system altogether and pricing services individually because assigning
new technology and most costly procedures to APC groups with
established lower cost procedures creates a strong disincentive for
hospitals to provide new or improved items or services and, in the case
of newer, higher cost drugs, encourages hospitals to develop
formularies and practice patterns based on financial considerations
rather than on the medical value of drugs.
Technologies that commenters cited as being inadequately addressed
by the proposed outpatient PPS include new technologies based on
molecular genetics; gamma knife procedures used in radiation surgery;
and prostatic microwave thermotherapy (transurethral microwave
thermotherapy (TUMT)) which a commenter said has a direct cost of
$1,918 and, factoring in indirect costs, a total cost of $2,623.
Response: The concerns expressed by commenters regarding new
technology items and services highlight two issues. The first is
specific to the data used to construct APC groups and calculate their
prices at the start of the PPS. As required by section 1833(t)(2)(C) of
the Act, we are using claims data from 1996 as the basis for
determining APC group weights and payment rates under the new system.
The 1996 data do not capture items and services that have emerged since
that time and that are now in use. The second issue relates to new
items and services that will be introduced in the future, after the
outpatient PPS is implemented. Postponing the adjustment of APC groups
and weights for several years to allow for the collection of cost data
would potentially inhibit the dissemination of medically desirable
innovations.
We recognize the concerns raised by commenters about our proposed
treatment of new codes under the hospital outpatient PPS. We therefore
have developed a process that we believe will allow us to recognize new
technologies on an ongoing basis as expeditiously as our systems
permit. We expect that this process, which we explain below, combined
with the transitional pass-throughs established by section 201(b) of
the BBRA 1999 (which we describe in section III.D of this preamble),
will provide additional payment for a significant share of new
technologies.
In this final rule, we have created special APC groups to
accommodate payment for new technology services. In contrast to the
other APC groups, the new technology APC groups do not take into
account clinical aspects of the services they are to contain, but only
their costs. We will assign new items and services that we determine
cannot appropriately be placed in existing APC groups for established
procedures and services to the new technology APC groups.
The new technology APC groups, which are now largely unpopulated,
are already defined in our claims processing system for the outpatient
PPS, and we have established payment rates for the APC groups based on
the midpoint of ranges of possible costs, for example, the payment
amount for a new technology APC group reflecting a range of costs from
$300 to $500 would be set at $400. The cost range for the groups
reflects current cost distributions, and we reserve the right to modify
the ranges as we gain experience under the outpatient PPS. The final
APC groups for new technology are groups 0970 through 0984 and cover a
range of costs from less than $50 to $6,000. Upon implementation of the
outpatient PPS, we will make payment for the following new technology
services under the new technology APCs:
53850 Transurethral destruction of prostate tissue; by microwave
thermotherapy
53852 Transurethral destruction of prostate tissue; by
radiofrequency thermotherapy
96570 Photodynamic therapy, first 30 minutes
96751 Photodynamic therapy, each additional 15 minutes
G0125 PET lung imaging of solitary pulmonary nodules, using 2-
(Fluorine-18)-Fluoro-2-Deoxy-D-Glucose (FDG), following CT (71250/
71260 or 71270)
G0126 PET lung imaging of solitary pulmonary nodules, using 2-
(Fluorine-18)-Fluoro-2-Deoxy-D-Glucose (FDG), following CT (71250/
71260 or 71270); initial staging of pathologically diagnosed non-
small cell lung cancer
G0163 Positron emission tomography (PET), whole body, for
recurrence of colorectal metastatic cancer
G0164 Positron emission tomography (PET), whole body, for staging
and characterization of lymphoma
G0165 Positron emission tomography (PET), whole body, for
recurrence of melanoma or melanoma metastatic cancer
G0166 External counterpulsation, per treatment session
G0168 Wound closure by adhesive
The new technology APC groups give us a mechanism for initiating
payment at an appropriate level within a relatively short timeframe,
and certainly less than the 2 or 3 years that we contemplated in our
proposed rule. As in the case of items qualifying for the transitional
pass-through payment, placement in a new technology APC will be
temporary. After we gain information about actual hospital costs
incurred to furnish a new technology service, we will move it to a
clinically-related APC group with comparable resource costs. If we
cannot move the new technology service to an existing
[[Page 18478]]
APC because it is dissimilar clinically and with respect to resource
costs from all other APCs, we will create a separate APC for such
service. We will retain a service within a new technology APC group for
at least 2 years, but no more than 3 years, consistent with the time
duration allowed for the transitional pass-through payments. Movement
from a new technology APC to a clinically-related APC would occur as
part of the annual update of APC groups. Beneficiary coinsurance
amounts for items and services in the new technology APC groups are 20
percent of the payment rate set for the new technology APCs.
We ask that interested parties take the following steps to bring to
our attention services that they believe merit consideration for
pricing using the new technology APC groups. Mail requests for
consideration of possible new technology services that have established
HCPCS codes to the following address ONLY: PPS New Tech/Pass-Throughs,
Division of Practitioner and Ambulatory Care, Mailstop C4-03-06, Health
Care Financing Administration, 7500 Security Boulevard, Baltimore, MD
21244-1850.
To be considered, requests MUST include the following information:
Trade/brand name of item.
A detailed description of the clinical application of the
item, including HCPCS code(s) to identify the procedure(s) with which
the item is used.
Current cost of the item to hospitals (i.e., actual cost
paid by hospitals net of all discounts, rebates, and incentives in cash
or in-kind). In other words, submit the best and latest information
available that provides evidence of the hospital's actual cost for a
specific item.
If the item is a service, itemize the costs required to
perform the procedure, e.g., labor, equipment, supplies, overhead, etc.
If the item requires FDA approval/clearance, submit
information that confirms receipt of FDA approval/clearance and the
date obtained.
If the item already has an assigned HCPCS code, include
the code and its descriptor in your submission plus a dated copy of the
HCPCS code ``recommendation application'' previously submitted for this
item.
If the item does not have an assigned HCPCS code, follow
the procedure discussed, below, for obtaining HCPCS codes and submit a
copy of the application with our payment request.
Name, address, and telephone number of the party making
the request.
Other information as HCFA may require to evaluate specific
requests.
We believe some items not yet known to us do not yet have assigned
HCPCS codes. We expect to use national HCPCS codes in the hospital
outpatient PPS to the greatest extent possible. These codes are
established by a well-ordered process that operates on an annual cycle,
starting with submission of information by interested parties due by
April 1 and leading to announcement of new codes in October of each
year. This process is described, and relevant application forms are
available, on the following HCFA website: http://www.hcfa.gov/medicare/hcpcs.htm.
Considering the exigencies of implementing a new system, we intend
to establish temporary codes in 2000 to permit implementation of
additional payments for other eligible items effective beginning
October 1, 2000. The process for submitting information will be the
same as for national codes.
For new technology services that DO NOT have established HCPCS
codes, submit the regular application for a national HCPCS code in
accordance with the instructions found on the internet at http://www.hcfa.gov/medicare/hcpcs.htm. Send applications for national HCPCS
codes to: C. Kaye Riley, HCPCS Coordinator, Health Care Financing
Administration, Mailstop C5-08-27, 7500 Security Boulevard, Baltimore,
Maryland 21244-1850. A fuller discussion of the HCPCS process and
schedule is in section III.D.6 of this preamble.
Because of staffing and resource limitations, we cannot accept
requests by facsimile (FAX) transmission. Because of claims processing
systems constraints, a new technology payment rate can only be
initiated at the start of a calendar quarter. Since we will update our
outpatient PPS quarterly to include new technology additional services,
October 1, 2000 is the earliest date that we will implement payment for
additional new technology services other than for those items beginning
on July 1, 2000. In general, we expect to be able to complete action on
requests to assign an item or service to a new technology APC group in
about 6 months from the date we receive the request.
In order to be considered for assignment to a new technology APC
group, an item or service must meet the following criteria:
The item or service is one that could not have been billed
to the Medicare program in 1996 or, if it was available in 1996, the
costs of the item or service could not have been adequately represented
in 1996 data.
The item or service does not qualify for an additional
payment under the transitional pass-through provided for by section
1833(t)(6) of the Act, as amended by section 201(b) of the BBRA 1999,
and 42 CFR 419.43(e) as a current orphan drug, as a current cancer
therapy drug or biological or brachytherapy, as a current
radiopharmaceutical drug or biological product, or as a new medical
device, drug, or biological.
The item or service has a HCPCS code. (See section III.D
for additional information about obtaining HCPCS codes.)
The item or service falls within the scope of Medicare
benefits under section 1832(a) of the Act.
The item or service has been determined to be reasonable
and necessary in accordance with section 1862(a)(1)(A) of the Act.
Final Action
We are initiating a method to pay for new technology services that
are not addressed by the transitional pass-through provisions of the
BBRA 1999.
D. Transitional Pass-Through for Innovative Medical Devices, Drugs, and
Biologicals
1. Statutory Basis
Section 201(b) of the BBRA 1999 amended section 1833(t) of the Act
by adding a new section 1833(t)(6). This provision requires the
Secretary to make additional payments to hospitals for a period of 2 to
3 years for specific items. The items designated by the law are the
following: current orphan drugs, as designated under section 526 of the
Federal Food, Drug, and Cosmetic Act; current drugs, biologic agents,
and brachytherapy devices used for treatment of cancer; current
radiopharmaceutical drugs and biological products; and new medical
devices, drugs, and biologic agents, in instances where the item was
not being paid for as a hospital outpatient service as of December 31,
1996, and where the cost of the item is ``not insignificant'' in
relation to the hospital outpatient PPS payment amount. In this
context, ``current'' refers to those items for which hospital
outpatient payment is being made on the first date the new PPS is
implemented.
Section 1833(t)(6)(C)(i) of the Act sets the additional payment
amounts for the drugs and biologicals as the amount by which the amount
determined under section 1842(o) of the Act (95 percent of the average
wholesale price (AWP)) exceeds the portion of the otherwise applicable
hospital outpatient department fee schedule amount that
[[Page 18479]]
the Secretary determines to be associated with the drug or biological.
Section 1833(t)(6)(C)(ii) provides that the additional payment for
medical devices be the amount by which the hospital's charges for the
device, adjusted to cost, exceed the portion of the otherwise
applicable hospital outpatient department fee schedule amount
determined by the Secretary to be associated with the device. Under
section 1833(t)(6)(D), the total amount of pass-through payments for a
given year cannot be projected to exceed an ``applicable percentage''
of total payments. For a year (or a portion of a year) before 2004, the
applicable percentage is 2.5 percent; for 2004 and subsequent years,
the applicable percentage is 2.0 percent. If the Secretary estimates
that total pass-through payments would exceed the caps, the statute
requires the Secretary to reduce the additional payments uniformly to
ensure the ceiling is not exceeded.
Section 201(c) of the BBRA amended section 1833(t)(2)(E) of the Act
to require that these pass-through payments be made in a budget neutral
manner. In accordance with section 1833(t)(7) of the Act, as amended by
section 201(i) of the BBRA 1999, these additional payments do not
affect the computation of the beneficiary coinsurance amount.
Implementation of this pass-through provision requires us to--
Identify eligible pass-through items;
Designate a Billing Code for each;
Determine the term ``not insignificant'' in the context of
determining whether an additional payment is appropriate;
Determine an appropriate cost-to-charge ratio to use to
adjust the hospital's charges for a new medical device to cost;
Determine the portion of the applicable APC that would be
associated with the drug, biological or device; and
Determine the additional payment amount.
As with other provisions of this final rule that reflect
implementation of the BBRA 1999, we are soliciting comments on our
implementation of the transitional pass-through payments, as set forth
below.
2. Identifying Eligible Pass-Through Items
a. Drugs and Biologicals
Section 1833(t)(6)(A) of the Act establishes definitions and
examples of the drugs and biologicals that are candidates for pass-
through payments. As indicated above, these drugs and biologicals are
characterized as both current and new. Current refers to those drugs
and biologicals for which payment is made on the first date the
hospital outpatient PPS is implemented, that is, on July 1, 2000. They
include the following:
1. Orphan drugs. These are drugs or biologicals that have been
designated as an orphan drug under section 526 of the Federal Food,
Drug and Cosmetic Act.
2. Cancer therapy drugs, biologicals, and brachytherapy. These
items are those drugs or biologicals that are used in cancer therapy,
including (but not limited to) chemotherapeutic agents, antiemetics,
hematopoietic growth factors, colony stimulating factors, biological
response modifiers, bisphosphonates, and a device of brachytherapy.
3. Radiopharmaceutical drugs and biological products. These are
radiopharmaceutical drug or biological products used in nuclear
medicine for diagnostic, monitoring, or therapeutic purposes.
A new drug or biological is defined as a product that was not paid
as a hospital outpatient service prior to January 1, 1997 and for which
the cost is not insignificant in relation to the payment for the APC to
which it is assigned. These items are not reflected in the 1996 claims
data we are required to use in developing the outpatient PPS. Before
payment can be made for these new drugs and biologicals, a
determination must be made that these items are reasonable and
necessary for the diagnosis or treatment of an illness or injury or to
improve the functioning of a malformed body member as required by
section 1862(a)(1)(A) of the Act. Drugs that can be self-administered
are not covered under Part B of Medicare (with specific exemptions for
certain oral chemotherapeutic agents and antiemetics, blood-clotting
factors, immunosuppressives, and erythropoietin for dialysis patients).
b. Medical Devices
Under section 201(b) of the BBRA 1999, for purposes of making pass-
through payments, a new or innovative medical device is one for which
payment as a hospital outpatient service was not being made as of
December 31, 1996 and for which the cost of the device ``is not
insignificant'' in relation to the hospital outpatient department fee
schedule amount payable for the service involved. For the purpose of
identifying ``new medical devices'' that may be eligible for pass-
through payments, we are excluding equipment, instruments, apparatuses,
implements or items that are generally used for diagnostic or
therapeutic purposes, that are not implanted or incorporated into a
body part, and that are used on more than one patient (that is, are
reusable). This material is generally considered to be hospital
overhead costs and the depreciation expenses associated with them are
reflected in the APC payments. The unit of payment for the outpatient
PPS is a service or procedure. Equipment or instrumentation is a method
or means of delivering that service. We are not establishing separate
APC payments for equipment, instruments, apparatuses, implements, or
items because payment for these types of devices is packaged in the APC
payment for the service or item with which they are used. However, as
we discuss above in section III.C.8, we have created new technology
APCs to accommodate new technology services that may be performed using
equipment or instrumentation that is capitalized and depreciated and
used on more than one patient. An example of a new technology service
is CPT code 53850, Transurethral destruction of prostate tissue; by
microwave thermotherapy. We have assigned this procedure to new
technology APC 0980. (See section III.C.8 of this preamble for further
discussion of payment for new technology under the hospital outpatient
PPS.)
Section 201(e) of the BBRA 1999 amends section 1833(t)(1)(B) of the
Act to include as ``covered OPD services'' implantable items described
in paragraphs (3), (6), or (8) of section 1861(s) of the Act. Paragraph
(3) refers to diagnostic tests including diagnostic x-rays,
mammographies, laboratory tests, and other diagnostic tests. Paragraph
(6) refers to implantable durable medical equipment (DME), and
paragraph (8) refers to prosthetic devices that replace all or part of
an internal body organ (including colostomy bags and supplies directly
related to colostomy care). Implantables are not mentioned specifically
in these paragraphs, but we consider a prosthetic device that replaces
all or part of an internal body organ that is mentioned in section
1861(s)(8) to be an implantable. The BBRA 1999 Conference Report lists
pacemakers, defibrillators, cardiac sensors, venous grafts, drug pumps,
stents, neurostimulators, and orthopedic implants, as well as items
that come in contact with human tissue during invasive procedures as
examples of implantable items.
Implantable items covered under section 201(e) of the BBRA 1999 may
be considered eligible for the transitional pass-through payments
allowed under
[[Page 18480]]
section 201(b) of the BBRA 1999 to the extent that these implantables
meet the statutory requirements set forth in section 201(b) and the
criteria established in this final rule for payment of these devices.
Although we are recognizing the implantable items identified in
section 201(e) of the BBRA 1999 for possible pass-through payments, we
are not applying the pass-through provision to any DME, orthotics, and
prosthetic devices that are not covered under section 201(e) of the
BBRA 1999. Rather, we will pay for these items under the DMEPOS fee
schedule when the hospital is acting as a supplier.
3. Criteria To Define New or Innovative Medical Devices Eligible for
Pass-Through Payments
In summary, we will make pass-through payment for new or innovative
medical devices that meet the following criteria:
a. They were not recognized for payment as a hospital outpatient
service prior to 1997.
b. They have been approved/cleared for use by the FDA.
c. They are determined to be reasonable and necessary for the
diagnosis or treatment of an illness or injury or to improve the
functioning of a malformed body part, as required by section
1862(a)(1)(A) of the Act. We recognize that some investigational
devices are refinements of existing technologies or replications of
existing technologies and may be considered reasonable and necessary.
We will consider devices for coverage under the outpatient PPS if they
have received an FDA investigational device exemption (IDE) and are
classified by the FDA as Category B devices. (See Secs. 405.203 to
405.215.) However, in accordance with Sec. 405.209, payment for a
nonexperimental investigational device ``is based on, and may not
exceed, the amount that would have been paid for a currently used
device serving the same medical purpose that has been approved or
cleared for marketing by the FDA.''
d. They are an integral and subordinate part of the procedure
performed, are used for one patient only, are surgically implanted or
inserted, and remain with that patient after the patient is released
from the hospital outpatient department.
e. The associated cost is not insignificant in relation to the APC
payment for the service in which the innovative medical equipment is
packaged. (See section III.D.4 below for the definition of ``not
insignificant.'')
f. They are not equipment, instruments, apparatuses, implements, or
such items for which depreciation and financing expenses are recovered
as depreciable assets as defined in Chapter 1 of the Medicare Provider
Reimbursement Manual (HCFA Pub. 15-1). (As indicated above, these costs
are considered overhead expenses that have been factored into the APC
payment.)
g. They are not materials and supplies such as sutures, clips, or
customized surgical kits furnished incident to a service or procedure.
h. They are not materials such as biologicals or synthetics that
may be used to replace human skin.
Comment: Some commenters asked how we would pay for new technology
intraocular lenses (IOLs) under the hospital outpatient PPS.
Response: We will use the same criteria established in the June 16,
1999 final rule (64 FR 32198) titled ``Medicare Program; Adjustment in
Payment Amounts for New Technology Intraocular Lenses Furnished by
Ambulatory Surgical Centers'' to identify IOLs that may be considered
new technology and eligible for pass-through payments. In accordance
with that rule, IOLs must first be approved by the FDA before they can
be considered as a new technology IOL. The rule establishes only one
criterion for distinguishing new technology IOLs from other IOLs.
Specifically, all claims of the IOL's clinical advantages and
superiority over existing IOLs must have been approved by the FDA for
labeling and advertising purposes. For further discussion on the
reasons for relying on the FDA's determination, we refer the reader to
the IOL proposed rule published on September 4, 1997 (62 FR 46700
through 46701). We recognize that this criterion has been developed to
define the characteristics that distinguish a new technology IOL from
other IOLs in order to comply with section 141(b) of the Social
Security Act Amendments of 1994 (Pub. L. 103-432) that is specific to
IOLs furnished in ASCs and not hospital outpatient departments.
However, we believe that it is appropriate to rely on an established
approach to assist us in distinguishing this new technology since more
than 1 million IOLs are inserted annually during or subsequent to
cataract surgery performed in the outpatient setting. Moreover, we
believe that consistent application of the criterion in both the ASC
and hospital outpatient prospective payment systems is less burdensome
to those requesting recognition of new technology IOLs. Therefore, when
IOLs that are recognized as ``new technology IOLs'' in accordance with
the provisions of the June 16, 1999 final rule are furnished in a
hospital outpatient setting, we will pay for such new technology IOLs
in accordance with the hospital outpatient PPS method for determining
additional payments under the pass-through provision set forth in this
final rule.
Comment: We received many comments urging that we establish
appropriate payments for brachytherapy seeds used in the treatment of
prostate cancer.
Response: In accordance with section 1833(t)(6)(A)(ii), as added by
section 201(b) of the BBRA 1999, we will provide additional payments
for brachytherapy seeds as an implanted device. The brachytherapy
device is assigned to APC 0918.
4. Determination of ``Not Insignificant'' Cost of New Items
Section 1833(t)(6)(A)(iv)(II) of the Act, as added by section
201(b) of the BBRA 1999 provides that the transitional pass-throughs
apply to new drugs, biologicals, and devices whose cost is not
insignificant in relation to the hospital outpatient PPS payment
amount. Section 1833(t)(6)(C) defines the additional payment as the
difference between an amount specified by the law and the portion of
the applicable fee schedule amount determined to be associated with the
item. The objective of this section is to prevent the hospital
outpatient PPS from creating disincentives for the diffusion of
valuable new technology by initially paying a rate significantly below
the costs of these items. We believe that the ``not insignificant''
criterion was included in recognition that: (1) The costs of some new
technologies would not be large enough relative to the fee schedule
amount to provide disincentives for their use in the short run; and (2)
that an excessive number of pass-through items could place a
substantial burden on the claims processing systems of both HCFA and
individual hospitals in a way that could hamper the rapid processing of
pass-through payments for those items that would be significantly more
costly than the applicable fee schedule amount. Therefore, in order to
be consistent with the objectives of this section, we are establishing
the following criteria for determining whether the costs of drugs,
biologicals, and devices are ``not insignificant'' relative to the
hospital outpatient department fee schedule amount:
(1) Its expected reasonable cost exceeds 25 percent of the
applicable fee schedule amount for the associated service.
[[Page 18481]]
(2) The expected reasonable cost of the new drug, biological, or
device must exceed the portion of the fee schedule amount determined to
be associated with the drug, biological, or device by 25 percent.
(3) The difference between the expected, reasonable cost of the
item and the portion of the hospital outpatient department fee schedule
amount determined to be associated with the item exceed 10 percent of
the applicable hospital outpatient department fee schedule amount.
The following illustrates the application of these three criteria.
Example: Let us assume that the reasonable cost of the new device
ZZ is $32.00. ZZ is associated with HCPCS code 00000 assigned to APC
0001. The fee schedule amount for APC 0001 is $100.00. The portion of
the fee schedule amount included in APC 0001 that represents the cost
associated with the former device is $25.00.
1. (a) Multiply the fee schedule amount for APC 0001 by 25 percent
$100.00 x .25 = $25.00
(b) Compare the reasonable cost for ZZ to the product derived in
Step 1
$32.00 > $25.00
Finding: The first criterion is met.
2. (a) Multiply the portion of the fee schedule amount for APC 0001
that is associated with a device by 25 percent
$25.00 x .25 = $6.25
(b) Subtract the portion of the fee schedule amount for APC 0001
attributable to a device from the reasonable cost for ZZ
$32.00 - $25.00 = $7.00
(c) Compare the remainder in Step 4 to the product in Step 2(a)
$7.00 > $6.25
Finding: The second criterion is met.
3. (a) Multiply the fee schedule amount for APC 0001 by 10 percent
$100.00 x .10 = $10.00
(b) Compare the remainder in Step 3 to the product derived in Step
3(a)
$7.00 $10.00
Finding: The third criterion is not met. Therefore, new device ZZ
is not eligible for transitional pass-through payment.
5. Calculating the Additional Payment
Section 1833(t)(6)(C)(i) of the Act requires that for drugs,
biologicals, and radiopharmaceuticals, the additional payment be
determined as the difference between the amount determined under
section 1842(o) of the Act (95 percent of AWP) and the portion of the
hospital outpatient department fee schedule amount determined by the
Secretary to be associated with those items. For devices, the
additional payment is the difference between the hospital's charges
adjusted to costs and the portion of the applicable hospital outpatient
department fee schedule amount associated with the device. Under
section 1833(t)(7) of the Act, as added by section 201(i) of the BBRA
1999, the coinsurance amounts for beneficiaries are not affected by
pass-through payments.
We will determine, on an item-by-item basis, the amount of the
applicable fee schedule amount associated with the relevant drug,
biological, or device. To the extent possible, hospital outpatient
department claims data will be used to make these estimates. When
necessary, external data pertaining to the costs of the drugs,
biologicals and devices already included in the fee schedule amounts
will be used to make these determinations.
Before January 1, 2002, charges for devices eligible for pass-
throughs will be adjusted to cost on each claim by applying the
individual hospital's average cost-to-charge ratio across all
outpatient departments. The 1996 data do not allow for determination of
which revenue center-specific ratios might be used for this purpose. We
will examine claims for the latter half of 2000 and for 2001 in order
to determine if a revenue center-specific set of cost-to-charge ratios
should be used for 2002 and beyond.
A one-time exception to the general methodology described above
pertains to current drugs and biologicals that will be eligible for
transitional pass-throughs when the PPS is implemented. For this final
rule, we revised many APC groups by removing, to the extent possible,
many of these drugs and radiopharmaceuticals. Therefore, the payment
rates for the APC groups with which these drugs are associated exclude
the costs of these drugs and the total amount paid to hospitals for the
drugs will be 95 percent of the applicable AWP. In order to be able to
determine a coinsurance amount for these drugs, we needed to estimate
what portion of this payment would have been included as part of the
APC payment amount associated with these drugs and what portion would
be the pass-through amount. Using an external survey of hospitals' drug
acquisition costs, we determined the APC payment amount for many of
these drugs as their average acquisition cost adjusted to year 2000
dollars. Where valid cost data were not available for individual drugs,
we applied the following average ratios of acquisition cost to AWP
calculated from the survey to determine the fee schedule amount: .68
for drugs with one manufacturer, .61 for multi-source drugs, and .43
multi-source drugs with generic competitors. In either case, the
coinsurance amounts were determined as 20 percent of these fee schedule
amounts. It is important to note that these estimates do not affect the
total payment to hospitals for these drugs (95 percent of AWP).
Because claims data are not available for most items that will be
eligible for transitional pass-through payments for 2000 and 2001, it
is extremely difficult to project expenditures under this provision.
For this reason, and because many eligible items will be added after
the system's implementation, we cannot estimate if, and to what extent,
these payments would exceed 2.5 percent of total payments in 2000 and
2001. Therefore, there will be no uniform reduction factor applied to
these payments during this period.
6. Process To Identify Items and To Obtain Codes for Items Subject to
Transitional Pass-Throughs
We have identified a large number of items subject to the
transitional pass-through payment through our own data-gathering
activities or through comments on the proposed rule. Many of them
already have HCPCS codes, and we are taking steps to establish
temporary codes for the remaining items. We will make additional
payments for these items when the hospital outpatient PPS system is
implemented on July 1. A list of the items already known to us is set
forth in Addendum K.
Other items potentially eligible for additional pass-through
payments may not be known to us at this time. Because of systems
limitations, if we do not know about an item, we will not be able to
make additional payments for those items beginning on July 1, 2000.
However, we will update our outpatient PPS on a quarterly basis
beginning October 1, 2000 to add other items that are eligible for
pass-through payments. Therefore, implementation of additional payment
for any such item must wait until a later release of systems
instructions, that is, in October 2000, January 2001 (annual update),
or later.
A manufacturer or other interested party who wishes to bring items
that may be eligible for additional transitional pass-through payments
to our attention should mail requests for consideration of items to the
following address ONLY: PPS New Tech/Pass-Throughs, Division of
Practitioner and Ambulatory Care, Mailstop C4-03-06, Health Care
Financing Administration,
[[Page 18482]]
7500 Security Boulevard, Baltimore, MD 21244-1850.
To be considered, requests MUST include the following information:
Trade/brand name of item.
A detailed description of the clinical application of the
item, including HCPCS code(s) to identify the procedure(s) with which
the item is used. If the item replaces or improves upon an existing
item, identify the predecessor item by trade/brand name and HCPCS code.
Current cost of the item to hospitals (i.e., actual cost
paid by hospitals net of all discounts, rebates, and incentives in cash
or in-kind). In other words, submit the best and latest information
available that provides evidence of the hospital's actual cost for a
specific item.
Date of sale of first unit.
For drugs, submit the most recent average wholesale price
(AWP) of the drug and the date associated with the AWP quote.
If the item requires FDA approval/clearance, submit
information that confirms receipt of FDA approval/clearance and the
date obtained.
If the item already has an assigned HCPCS code, include
the code and its descriptor in your submission plus a dated copy of the
HCPCS code ``recommendation application'' previously submitted for this
item.
If the item does not have an assigned HCPCS code, follow
the procedure discussed, below, for obtaining HCPCS codes and submit a
copy of the application with your payment request.
Name, address, and telephone number of the party making
the request.
Other information as HCFA may require to evaluate specific
requests.
We believe some items not yet known to us do not yet have assigned
HCPCS codes. We expect to use national HCPCS codes in the hospital
outpatient PPS to the greatest extent possible. These codes are
established by a well-ordered process that operates on an annual cycle,
starting with submission of information by interested parties due by
April 1 and leading to announcement of new codes in October of each
year. This process is described, and relevant application forms are
available, on the following HCFA website: http://www.hcfa.gov/medicare/hcpcs. htm.
Considering the exigencies of implementing a new system, we intend
to establish temporary codes in 2000 to permit implementation of
additional payments for other eligible items effective beginning
October 1, 2000. The process for submitting information will be the
same as for national codes.
For items that might be candidates for additional transitional
pass-through payments but that DO NOT have established HCPCS codes,
submit the regular application for a national HCPCS code in accordance
with the instructions found on the internet at http://www.hcfa.gov/medicare/hcpcs.htm. Send applications for national HCPCS codes to: C.
Kaye Riley, HCPCS Coordinator, Health Care Financing Administration,
Mailstop C5-08-27, 7500 Security Boulevard, Baltimore, Maryland 21244-
1850.
Because of staffing and resource limitations, we cannot accept
requests by facsimile (FAX) transmission.
As indicated in the instructions posted at our website address
cited above, the deadline for submission of applications for a national
HCPCS code for the CY 2001 cycle is April 1, 2000. The HCPCS process
will proceed to assign national codes as warranted, and we expect these
codes will be used in the hospital outpatient PPS starting January 1,
2001. Because the coding application will contain information vital to
determining a specific item or product's eligibility for pass-through
payments, we are requesting that a copy of the application be sent
concurrently to ATTN: PPS New Tech/Pass-Throughs at the address shown
above.
This year, we plan to implement additional payment for appropriate
items on October 1, 2000. Requests submitted to us with appropriate
information will be evaluated for payment effective October 1. We will
use the same submissions made for national HCPCS codes as the basis for
making temporary code assignments. However, a very large volume of
requests or systems constraints could affect our ability to achieve
this goal.
Any applications for HCPCS codes that are received after April 1
will be retained for the next cycle of the national HCPCS code
assignment process starting the following April 1. We will also
consider these items for assignment of temporary codes that might take
effect in January or later in the next year.
How quickly additional payment for a new item can be implemented
will depend on processing and systems constraints; it will in general
require at least 6 months and may require as many as 9 or more months.
Thus, a submission that we receive in May (which is too late for
October implementation) might be assigned a temporary code to be used
for implementing additional payments starting the following January.
As previously stated, pass-through payment for each item is
temporary. After we obtain information about actual hospital costs
incurred to furnish a pass-through item, we will package it into the
service with which it is clinically associated.
Comment: A number of commenters expressed concern about the
extensive amount of time required to obtain HCPCS codes for new items
or services. They argued that the lag-time in coding updates creates a
barrier to innovation, claiming that it can be several years before a
code is issued for a new surgical technique or product. Some commenters
noted that when facilities are forced to code new surgical techniques
as ``unlisted procedures,'' pending issuance of a specific code for the
procedure, it would result in the facility receiving payment for the
lowest related APC group. Some commenters recommended that we assign
HCPCS codes as soon as products become available.
Response: We recognize the urgency expressed by commenters. We
believe the process we have outlined above will assist interested
parties in obtaining HCPCS codes for new items and services in the most
expeditious manner possible within the constraints imposed by our
system requirements.
E. Calculation of Group Weights and Conversion Factor
1. Group Weights (Includes Table 1, Packaged Services by Revenue
Center)
Section 1833(t)(2)(C) of the Act requires the Secretary to
establish relative payment weights for covered hospital outpatient
services. That section requires that the weights be developed using
data on claims from 1996 and data from the most recent available
hospital cost reports. Before enactment of the BBRA 1999, we were
required to base the relative payment weights on median hospital costs.
Section 201(f) of the BBRA 1999 amended section 1833(t)(2)(ii) of the
Act to authorize the Secretary to base the relative payment weights on
either the median or mean hospital costs. In constructing the database
for the outpatient PPS proposed rule group weights and conversion
factor, we used a universe of approximately 98 million calendar year
1996 final action claims for hospital outpatient department services
received through June 1997 to match to the most recent hospital cost
reports available. We have decided to continue to base the relative
payments weights in this final rule on median (as opposed to mean)
costs because, among other things, reconstructing our database to
evaluate the impact of using mean costs after the BBRA 1999 was
[[Page 18483]]
enacted would have delayed implementation of the hospital outpatient
PPS.
To derive weights based on median hospital costs for services in
the hospital outpatient APC groups, we converted billed charges to
costs and aggregated them to the procedure or visit level. To
accomplish this, we first identified the cost-to-charge ratio that was
specific to each hospital's cost centers (``cost center specific cost-
to-charge ratios'' or CCRs). We then developed a crosswalk to match the
hospital's CCRs to revenue centers used on the hospital's 1996
outpatient bills. The CCRs included operating and capital costs but
excluded costs associated with direct graduate medical education and
allied health education.
To determine the hospital CCRs, the most recent available cost
report from each hospital was identified. For the proposed rule, we
used cost reports from cost reporting periods beginning on or after
October 1, 1994 and before October 1, 1995 (referred to as PPS-12) or
earlier. For this final rule, more recent cost reports were available
for hospitals. We used cost reports from cost reporting periods
beginning on or after October 1, 1996 and before October 1, 1997 (PPS-
14) for approximately 94 percent of the hospitals in our database.
If the most recent available cost report for a hospital was one
that had been submitted but not settled, we calculated a factor to
adjust for the differences that generally exist between settled and
``as submitted'' cost reports. The adjustment factor was determined by
dividing the outpatient department cost-to-charge ratio from the
hospital's most recent settled cost report by the outpatient department
cost-to-charge ratio from the hospital's ``as submitted'' cost report
for the same period. The resulting ratio was used to adjust each of the
CCRs in the hospital's most recent ``as submitted'' cost report. We
repeated this process for every hospital for which the most recent
available cost report was a cost report that had not been settled.
The Office of Inspector General (OIG) for DHHS is concerned that
the cost reports we are using may reflect some unallowable costs.
Therefore, the OIG, in conjunction with HCFA, is proposing to examine
the extent to which the cost reports used reflect costs that were
inappropriately allowed. If this examination reveals excessive
inappropriate costs, we will address this issue in a future proposed
rule, or perhaps seek legislation to adjust future payment rates
downward.
We next eliminated from the hospital CCR database 258 hospitals
that we have identified as having reported charges on their cost
reports that were not actual charges (for example, they make uniform
charges for all services). These excluded hospitals were Kaiser, New
York Health and Hospital Corporation, and all-inclusive rate hospitals.
After removing these hospitals, we calculated the geometric mean of the
total operating CCRs of hospitals remaining in our CCR database. We
identified 58 hospitals whose total operating CCR exceeded the
geometric mean by more than 3 standard deviations. These hospitals were
also removed from our CCR database.
After assembling and editing our new CCR database, we matched
revenue centers from approximately 80 million claims to CCRs of
approximately 5,700 hospitals. We excluded from the crosswalk
approximately 15 million claims in which the bill type denoted services
that would not be covered under the PPS (for example, bill type 72X for
dialysis services for patients with ESRD). We also excluded almost 3
million claims from the hospitals that we had removed or trimmed from
the hospital CCR database. The table below shows the five cost
reporting periods used and the percentage of the cost reports within
each PPS period for which we were able to match 1996 claims.
------------------------------------------------------------------------
Percentage
of cost
Reporting period reports
matched
------------------------------------------------------------------------
PPS-15 (cost reporting period beginning on or after 10/1/97 0.1
and before 10/1/98)........................................
PPS-14 (cost reporting period beginning on or after 10/1/96 94.2
and before 10/1/97)........................................
PPS-13 (cost reporting period beginning on or after 10/1/95 3.7
and before 10/1/96)........................................
PPS-12 (cost reporting period beginning on or after 10/1/94 1.7
and before 10/1/95)........................................
PPS-11 (cost reporting period beginning on or after 10/1/93 0.3
and before 10/1/94)........................................
-----------
Total................................................... 100.0
------------------------------------------------------------------------
Next, we took the estimated 80 million claims that we had matched
with a cost report and separated them into two distinct groups: Single-
procedure claims and multiple-procedure claims. Single-procedure claims
were those that included only one HCPCS code (other than laboratory and
incidentals such as packaged drugs and venipuncture) that could be
grouped to an APC. Multiple-procedure claims included more than one
HCPCS code that could be mapped to an APC. There were approximately
45.4 million single-procedure claims and 34.6 million multiple-
procedure claims.
To calculate median costs for services within an APC, we used only
the single-procedure bills. (Of the roughly 45.4 million single-
procedure claims, about 24 million were excluded from the conversion
process largely because the only HCPCS codes reported on the claims
were for laboratory procedures or other outpatient services not paid
under the outpatient PPS.) This approach was taken because the
information on claims does not enable us to specifically allocate
charges or costs for packaged items and services such as anesthesia,
recovery room, drugs, or supplies to a particular procedure when more
than one significant procedure or medical visit was billed on a claim.
Use of the single-procedure bills minimizes the risk of improperly
assigning costs to the wrong procedure or visit. Although we used only
single-procedure/visit bills to determine APC relative payment weights,
we used multiple-procedure bills in the conversion factor and service
mix calculations, regressions, and impact analyses.
For each single-procedure claim, we calculated a cost for every
billed line item charge by multiplying each revenue center charge by
the appropriate hospital-specific CCR. If the appropriate cost center
did not exist for a given hospital, we crosswalked the revenue center
to a secondary cost center when possible, or to the hospital's overall
cost-to-charge ratio for outpatient department services. We excluded
from this calculation all charges associated with HCPCS codes
previously defined as not paid under this PPS (for example, laboratory,
ambulance, and therapy services).
To calculate the per-procedure or per-visit costs, we used the
charges shown in the revenue centers that contained items integral to
performing the procedure or visit. These included those items that we
previously discussed as being subject to our proposed packaging
provision. For instance, in calculating the surgical procedure cost, we
included charges for the operating room, treatment rooms, recovery,
observation, medical and surgical supplies, pharmacy, anesthesia, casts
and splints, and donor tissue, bone, and organ. For medical visit cost
estimates, we included charges for items such as medical and surgical
supplies, drugs, and observation. A complete listing of the revenue
centers that we used is shown below in Table 1, Packaged Services by
Revenue Center.
[[Page 18484]]
Table 1.--Packaged Services by Revenue Center
ASC AND OTHER SURGERY
250 PHARMACY
251 GENERIC
252 NONGENERIC
257 NONPRESCRIPTION DRUGS
258 IV SOLUTIONS
259 OTHER PHARMACY
260 IV THERAPY, GENERAL CLASS
262 IV THERAPY/PHARMACY SERVICES
263 IV THERAPY/DRUG/SUPPLY/DELIVERY
264 IV THERAPY/SUPPLIES
269 OTHER IV THERAPY
270 M&S SUPPLIES
271 NONSTERILE SUPPLIES
272 STERILE SUPPLIES
276 INTRAOCULAR LENS
279 OTHER M&S SUPPLIES
370 ANESTHESIA
379 OTHER ANESTHESIA
390 BLOOD STORAGE AND PROCESSING
399 OTHER BLOOD STORAGE AND PROCESSING
630 DRUGS REQUIRING SPECIFIC IDENTIFICATION, GENERAL CLASS
631 SINGLE SOURCE DRUG
632 MULTIPLE SOURCE DRUG
633 RESTRICTIVE PRESCRIPTION
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
819 OTHER ORGAN ACQUISITION
890 OTHER DONOR BANK
891 BONE
892 ORGAN
893 SKIN
899 OTHER DONOR BANK
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
630 DRUGS REQUIRING SPECIFIC IDENTIFICATION, GENERAL CLASS
631 SINGLE SOURCE DRUG
632 MULTIPLE SOURCE DRUG
633 RESTRICTIVE PRESCRIPTION
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
622 SUPPLIES INCIDENT TO OTHER DIAGNOSTIC
710 RECOVERY ROOM
719 OTHER RECOVERY ROOM
762 OBSERVATION ROOM
RADIOLOGY SUBJECT TO THE FEE SCHEDULE AND OTHER RADIOLOGY
255 PHARMACY INCIDENT TO RADIOLOGY
371 ANESTHESIA INCIDENT TO RADIOLOGY
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
260 IV THERAPY, GENERAL CLASS
262 IV THERAPY PHARMACY SERVICES
263 IV THERAPY DRUG/SUPPLY/DELIVERY
264 IV THERAPY SUPPLIES
269 OTHER IV THERAPY
270 M&S SUPPLIES
271 NONSTERILE SUPPLIES
272 STERILE SUPPLIES
279 OTHER M&S SUPPLIES
630 DRUGS REQUIRING SPECIFIC IDENTIFICATION, GENERAL CLASS
631 SINGLE SOURCE DRUG
632 MULTIPLE SOURCE DRUG
633 RESTRICTIVE PRESCRIPTION
762 OBSERVATION ROOM
------------------------------------------------------------------------
We then applied to these cost estimates an adjustment to calibrate
the costs to calendar year 1996 for those services in hospitals whose
CCRs were calculated using FY 1997 or later cost reports. On average,
hospital charges were rising faster than costs in FY 1997. We therefore
made this adjustment for the calculation of the weights, as well as for
the hospital costs used in the conversion factor and impact model, to
ensure that we did not underestimate costs and payments. We based this
hospital specific CCR adjustment on the observed change in each
hospital's overall CCR (total operating + total capital) from the
proposed rule cost report database to the new final rule database. If
applicable, we then calculated a monthly rate of change and applied it
based on the number of months past 1996 encompassed in a hospital's
cost reporting period; if a hospital's period coincided completely
within calendar year 1996, no adjustment was made.
After calibrating the costs to calendar year 1996, we standardized
costs for geographic wage variation by dividing the labor-related
portion of the operating and capital costs for each billed item by the
FY 2000 hospital inpatient prospective payment system wage index
published in the Federal Register on July 30, 1999 (64 FR 41585). As in
the proposed rule and correction notice, we used 60 percent to
represent our estimate of that portion of costs attributable, on
average, to labor. A more detailed discussion of wage index adjustments
is found below in section III.G of this document.
The standardized labor-related cost and the nonlabor-related cost
component were summed for each billed item to derive the total
standardized cost for each procedure or medical visit. Extremely
unusual costs that appeared to be errors in the data were trimmed from
standardized procedure and visit costs. This trimming methodology is
analogous to that used in calculating the DRG weights for the inpatient
PPS: eliminate any bills with costs outside of 3 standard deviations
from the geometric mean. We used the geometric mean and the associated
standard deviation because the distribution of costs more closely
resembles a lognormal distribution than a normal distribution: There
are no negative costs, and the average cost is greater than the median
cost. Use of the geometric mean minimizes the impact of the most
unusual bills in the determination of the mean. The geometric mean is
calculated by taking the mean of the natural logarithm cost. Because
the distribution of the natural logarithms of a set of numbers is more
compact than the distribution of the numbers themselves, bills with
extreme costs do not appear as extreme as they would if non-logged
costs were examined. This ensures that only the most aberrant data will
be removed from the calculation.
After trimming the procedure and visit level costs, we mapped each
procedure or visit cost to its assigned APC and calculated the median
cost for each APC weighted by procedure volume. Using the median APC
costs, we calculated the relative payment weights for each APC. We
scaled all the relative payment weights to APC 601, a mid-level clinic
visit, because it is one of the most frequently performed services.
This approach is consistent with that used in developing relative value
units for the Medicare physician fee schedule. By assigning APC 601 a
relative payment weight of 1.0, hospitals can easily compare the
relative relationship of one APC to another. Next, we divided the
median cost for each APC by the median cost for a mid-level clinic
visit, APC 601, to derive the relative payment weight for each APC.
[[Page 18485]]
The median cost for APC 601 is $47.00. In the proposed rule, we also
used a mid-level clinic visit, APC 91336, which had a median cost of
$54.00, as the scaler of APC weights. On average, due to the reduced
value of the scaler used for this notice, the final weights will be
higher than those published in the proposed rule.
Comment: Some commenters believe that the ratesetting methodology
does not reflect complex cases because we eliminate statistical
``outlier'' claims from the calculation of the median costs and the
weights.
Response: As noted above, we trimmed claims with estimated costs
that were outside of three standard deviations from the geometric mean.
Because we removed claims above or below the mean, we corrected for
data errors that would have skewed the estimates of median costs and
group weights upward or downward. We believe this trim is a valid
method of removing extremely unusual costs that are most likely
associated with data submission errors and do not represent actual
costs. In addition, it is consistent with the method we use to set
inpatient hospital diagnosis-related group (DRG) weights.
Comment: Numerous commenters disagreed with our use of single-
procedure claims only in the calculation of the relative payment
weights. One commenter was concerned that we could be masking
differences in resource use attributable to patient characteristics by
using only single-procedure claims to calculate relative weights.
Response: We used single-procedure claims to calculate the relative
weight for each APC because we could not accurately allocate costs to a
particular procedure when the costs were part of a bill for multiple
procedures. Bills with a single major procedure provided are, in most
cases, the best estimate of relative procedure costs. It is important
to note that for all other calculations, including calculation of the
conversion factor, we used both single-procedure and multiple-procedure
bills.
We do not believe that using single-procedure bills biases the
relative cost of any particular procedure. Although patients with more
complex healthcare needs might have several procedures performed,
hospital charges for an individual procedure would not be greater. Our
most significant concern was that distribution of single bill
procedures within an APC would not reflect the correct distribution of
those procedure on all bills. However, careful statistical analyses
demonstrated that the distribution of procedures within an APC group
did not differ when single bill procedure frequencies were compared
with all bills. It is also important to note that when items or
services were to be packaged with a major procedure, we added their
costs to that procedure prior to making the single bill determination.
Therefore, the costs of contrast media, for example, are included in
the relative weights. In some cases, we agreed with the commenters that
this approach needed to be modified. For example, for chemotherapy, we
are not grouping drugs, but rather paying for each one separately.
Moreover, as a result of the transitional pass-through provisions of
the BBRA 1999, radiopharmaceuticals will be paid separately from the
nuclear medicine APCs.
Comment: Several commenters expressed concern that the 1996 claims
data are insufficient or inadequate to develop the PPS model. For
example, some commenters asserted that the 1996 data are not recent
enough to reflect the current mix of outpatient services. Some
commenters also argued that undercoding in the data would lead to
underestimates of median costs. Other commenters recommended that we
address alleged inadequacies in the data by gathering cost data on new
procedures and by basing payment on these data until we can determine
whether to place a new procedure in an existing APC or create a new
APC.
Response: While we acknowledge limitations of setting payment rates
with historical claims data, section 1833(t)(2)(C) of the Act requires
us to use 1996 claims in developing the PPS. We discuss how we will
price new procedures that are not reflected in our database in section
III.C.8 of this preamble.
Comment: Commenters were concerned about the cost-to-charge ratios
used to estimate median APC costs and pre-BBA payments. For example,
one medical organization recommended that we account for the capital-
intensive nature of radiology services by adjusting the cost-to-charge
ratios applicable to these services for the step-down methodology that
allocates capital expenses by square footage. The belief is that these
allocation methods underestimate radiological equipment costs and
certain cost-to-charge ratios, leading to underestimates of the median
costs for relevant APC groups.
Response: Although capital-related costs may be allocated to
routine and ancillary service cost centers using the step-down
methodology based on square footage, as an alternative, the ``dollar
value'' method may be used by hospitals. This method is made available
to hospitals in Worksheet B-1 of the hospital cost report (HCFA 2552-
96). The dollar value method more accurately distributes the capital
costs associated with equipment to the revenue-producing cost center to
which the equipment is assigned. We are not able to adjust the cost-to-
charge ratios of those hospitals that allocate equipment based on
square footage because we have no way of knowing which specific
equipment costs should be allocated to revenue-producing cost centers
in each hospital.
2. Conversion Factor
Section 1833(t)(3)(C)(i) of the Act requires that we establish a
conversion factor for 1999 to determine the Medicare payment amounts
for each covered group of services. For the proposed rule as corrected,
we derived the conversion factor from a base amount of payments
described in section 1833(t)(3)(A) of the Act, as enacted in the BBA
1997. Such base amount was calculated for the services included in the
outpatient PPS as an estimate of the sum of (1) total payments that
would be payable from the Trust Fund under the current (non-PPS)
payment system in 1999, plus (2) the beneficiary coinsurance that would
have been paid under the new (PPS) system in 1999. For the final rule,
however, we derived the conversion factor from a base amount that
includes beneficiary coinsurance that would have been made under the
current (non-PPS) system rather than the proposed (PPS) system. Section
201(l) of the BBRA 1999 states: ``With respect to determining the
amount of copayments described in paragraph (3)(A)(ii) of section
1833(t) of the Social Security Act, as added by section 4523(a) of the
BBA, Congress finds that such amount should be determined without
regard to such section, in a budget neutral manner with respect to
aggregate payments to hospitals, and that the Secretary of Health and
Human Services has the authority to determine such amount without
regard to such section.''
Section 1833(t)(2)(C) of the Act requires us to project utilization
for hospital outpatient services. We were unable to make precise
projections of increases in the volume and intensity of services
because we were not able to quantify some of the factors that affect
utilization. For instance, we would anticipate that Medicare
beneficiaries who choose to migrate to managed care plans may be
healthier than those who choose to stay in fee-for-service plans. Thus,
we could assume a decrease in the volume of services coupled with an
increase in the intensity of services
[[Page 18486]]
furnished for Medicare beneficiaries in the fee-for-service program.
Another factor that we believe will affect future utilization is the
incentive to code billed services more accurately. Currently, hospitals
are paid for the majority of the outpatient services they furnish on a
cost basis, and inaccurate or improper coding does not necessarily
affect the amount of payment. In contrast, under the PPS, hospitals are
required to use HCPCS codes in order to receive payment. We expect that
the frequency of some services may increase as a result of the coding
requirements. We believe each of these assumptions will affect the
reporting of volume and intensity of services, although we are not able
to quantify them individually to project 1999 utilization. Therefore,
we used what we believe to be a more reliable and valid approach to
computing the conversion factor under the methodology described below.
Comment: A large national trade association commented that the
exclusion of claims for unclassified services (for example, those
claims for which we cannot identify the service to be paid) from the
PPS model could bias the conversion factor downward if the excluded
claims have a disproportionate number of services with high payment to
cost ratios, such as clinic and emergency room visits.
Response: In order to set the conversion factor as accurately as
possible, we used only claims for which the costs and volume of
services could be identified on the bill. As noted by the commenter,
this decision resulted in the exclusion of claims with unclassifiable
services. Upon examination of these claims, we have determined that
services with high payment to cost ratios (those that would gain under
the PPS system) were not disproportionately represented. Therefore, we
believe the exclusion of unclassifiable services does not bias the
conversion factor.
Setting the Rates
In order to convert the relative weights determined for each APC
(see section III.E.1) into payment rates, we calculated a conversion
factor that would result in total estimated payments to hospitals under
the PPS in 1999 equal to the total estimated payments that would have
been payable from the Trust Fund in 1999 if PPS had not been enacted
plus estimated beneficiary coinsurance for the same services during the
same period. The prospective payment rate for each APC is calculated by
multiplying the APC's relative weight by the conversion factor. For the
calculation of the conversion factor, we have excluded all data from
the 58 Maryland providers that qualify under section 1814(b)(3) of the
Act for payment under the State's payment system. We computed the
conversion factor by first adding together the aggregate Medicare
hospital outpatient payments made under the cost-based payment system
(referred to in this section as pre-PPS payments) for calendar year
1996, plus the estimated beneficiary coinsurance amounts made under
pre-PPS law for the same services. We then divided that amount by a
wage-adjusted sum of the relative weights for all APCs under the
hospital outpatient PPS. The methodology we used to determine current
law Medicare hospital outpatient payments and beneficiary coinsurance
is discussed below in section III.E.2.a. A discussion of the sum of the
relative weights follows in section III.E.2.b.
a. Calculating Aggregate Calendar Year 1996 Medicare and Beneficiary
Payments for Hospital Outpatient Services (Pre-PPS)
To calculate Medicare hospital outpatient payment amounts before
implementation of the PPS, we first identified calendar year 1996
single and multiple procedure bills for all the services that we will
recognize under the outpatient PPS. As we identified services that will
be paid under the outpatient PPS, we eliminated invalid or noncovered
HCPCS codes.
Hospital payments include both operating and capital costs for the
HCPCS coded services for which payment is to be made under the
outpatient PPS. We summed these two types of costs by HCPCS code at the
provider level. Consolidating the data in this manner allowed us to
simulate provider payment on an aggregate basis. Then (as required by
section 1861(v)(1)(S)(ii) of the Act as amended by section 201(k) of
the BBRA 1999), we applied the capital cost reductions of 10 percent
and operating cost reductions of 5.8 percent.
We determined for each HCPCS code the applicable payment
methodology under the current system. Payment before implementation of
PPS for procedures in the baseline was calculated using one of the
following equations, as appropriate:
For radiology procedures paid for under the radiology fee
schedule, we determined payment in the aggregate for each provider as
the lower of the cost, charge, or blended amount. We use the following
equation to determine the radiology blended amount: (0.42 x lower of
cost or charge minus beneficiary coinsurance) + (0.58 x ((0.62 x
global physician fee schedule amount) - beneficiary coinsurance)).
For surgical procedures for which Medicare pays an ASC
facility fee, we determined payment in the aggregate for each provider
as the lower of the cost, charge, or blended amount. We used the
following equation to determine the ASC blended amount: (0.42 x lower
of cost or charge minus beneficiary coinsurance) + (0.58 x (ASC
payment rate - beneficiary coinsurance)).
For diagnostic procedures paid for under the diagnostic
fee schedule, we determined payment in the aggregate for each provider
as the lower of the cost, charge, or blended amount. We used the
following equation to determine the blended amount for diagnostic
procedures: (0.50 x lower of cost or charge minus beneficiary
coinsurance) + (0.50 x ((0.42 x global physician fee schedule
amount) - beneficiary coinsurance)).
For all other covered services not subject to one of the blended
payment method categories, we determined payment as the lower of costs
or charges less beneficiary coinsurance. Because the formula-driven
overpayment (FDO) was corrected beginning October 1, 1997, the blended
equations eliminate FDO.
We then determined the Medicare payment amount for each provider by
summing the aggregate amounts computed for each of the four types of
payment methodologies discussed above. In addition, we determined the
amount of the beneficiary coinsurance for each provider using the
beneficiary coinsurance amounts that would have been paid before
implementation of PPS. The total amount (Medicare and beneficiary
payments) reflects the amount hospitals would be paid under the PPS and
is the numerator in the equation for calculating the unadjusted
conversion factor.
b. Sum of the Relative Weights
Next we summed the discounted relative weights for services that
are within the scope of the outpatient PPS. (See discussion of
discounting for surgical procedures in section III.C.7.) Specifically,
we multiplied (using single and multiple procedure claims in a
hospital) the discounted volume of procedures or visits in each APC
group by the relative weights for each APC group; we wage-adjusted 60
percent of this total by each hospital's wage index, and we then summed
the wage-adjusted and nonadjusted weights across all hospitals. (The
wage indices used are included in Addenda H, I, and J.) The resulting
sum equals the denominator in the calculation of the conversion factor.
[[Page 18487]]
We calculated the conversion factor by dividing the sum of the
discounted relative weights into the total payment explained in section
III.E.2.a, above, including both Medicare payment and beneficiary
coinsurance. We then adjusted the conversion factor so that the outlier
and pass-through payments are implemented in a budget neutral manner,
as described in sections III.H.1 and III.D. The adjusted calendar year
1996 conversion factor is $43.023. To inflate the 1996 conversion
factor to 1999, our Office of the Actuary estimated an update factor of
1.106. Therefore, the adjusted 1999 conversion factor is $47.583.
For calendar year 2000, we updated the conversion factor as
specified in section 1833(t)(3)(C)(iii) of the Act. The update is the
market basket percentage increase applied to hospital discharges
occurring during the fiscal year ending in calendar year 2000 minus 1
percentage point. For 2000, the updated conversion factor is $48.487.
Comment: A number of commenters suggested that we remove the
behavioral offset that we proposed to apply to the conversion factor.
As proposed, the intent of the offset was to adjust for hospital coding
changes that take place in response to reductions in beneficiary
coinsurance.
Response: We have decided not to include a behavioral offset to the
conversion factor in this final rule. Hospital coding changes are
expected to occur under the outpatient PPS; however, we believe changes
that occur during the first PPS years will result from hospitals
billing more accurately under the new system. A behavioral offset
implemented in the initial PPS years may distort the incentives to bill
accurately. We may reconsider implementation of a behavioral offset in
future years as we gather data and gain experience under the new
system.
Comment: A large national trade association expressed concern that
application of the 5.8 percent and 10.0 percent reduction to costs for
all hospital outpatient services included in the PPS model
underestimates the conversion factor. They recommended that we exclude
the Part B services provided to inpatients who exhaust their Part A
benefits from the reductions.
Response: Our analysis shows that fewer than 5,000 of the more than
80 million claims used to set the conversion factor were associated
with these types of services. Total costs associated with these claims
were less than $1.4 million, which is too small to have a measurable
effect on the conversion factor.
Comment: Many commenters strongly argued that we misinterpreted the
provisions of section 1833(t)(3) of the Act in calculating beneficiary
coinsurance for purposes of setting the base amount of the conversion
factor. The commenters noted that this methodology contributed
significantly to the estimated 5.7 percent reduction in Medicare
outpatient payments to hospitals reflected in the proposed rule. Most
commenters further argued that the Congress did not intend for this
loss to occur and that we had the authority to interpret the
methodology described in the statute so that no net change in payments
would result from the conversion factor.
Response: Section 1833(t)(3)(A) of the Act, as added by the BBA
1997, states that, for purposes of calculating the base amount used to
determine the conversion factor, the Secretary shall calculate ``the
total amount of copayments estimated to be paid under this subsection.
* * *'' (Emphasis added.) For the proposed rule, we estimated the
coinsurance that would be paid under PPS. In section 201(l) of the BBRA
1999, the Congress addressed the calculation of the base amount,
stating, ``With respect to determining the amount of copayments
described in paragraph (3)(A)(ii) of section 1833(t) of the Social
Security Act, as added by section 4523(a) of the BBA, Congress finds
that such amount should be determined without regard to such section,
in a budget neutral manner with respect to aggregate payments to
hospitals, and the Secretary of Health and Human Services has the
authority to determine such amount without regard to such section.''
Therefore, for this final rule, we estimated the coinsurance that would
have been paid if PPS had not been enacted.
F. Calculation of Coinsurance Payments and Medicare Program Payments
Under the PPS
1. Background
In section III.E, above, we explained how we determined APC group
weights, calculated an outpatient PPS conversion factor, and determined
national prospective payment rates, standardized for area wage
variations, for the APC groups. We will now explain how we calculated
beneficiary coinsurance amounts for each APC group.
The outpatient PPS established by section 1833(t) of the Act
includes a mechanism designed to eventually achieve a beneficiary
coinsurance level equal to 20 percent of the prospectively determined
payment rate established for the service. As discussed in the proposed
rule, for each APC we calculate an amount referred to in section
1833(t)(3)(B) of the Act as the ``unadjusted copayment amount.'' The
unadjusted coinsurance amount is calculated by taking 20 percent of the
national median charges billed in 1996 for the services that are in the
APC, trended forward to 1999; however, the coinsurance amount cannot be
less than 20 percent of the APC payment rate. The unadjusted
coinsurance amount for an APC remains frozen, while the payment rate
for the APC is increased by adjustments based on the Medicare market
basket. As the APC rate increases and the coinsurance amount remains
frozen, the unadjusted coinsurance amount will eventually become 20
percent of the payment rate for all APC groups. Once the unadjusted
coinsurance amount is 20 percent of the payment amount, both the APC
payment rate and the unadjusted coinsurance amount will be updated by
the annual market basket adjustment.
In the proposed rule, we proposed to not adopt new APCs for new
procedures or services for at least 2 years, but instead assign them to
existing groups while accumulating data on their costs. In the final
rule we do provide for APCs for new procedures that do not fit well
into another APC. When an APC is added that consists of HCPCS codes for
which we do not have 1996 charge data upon which to calculate the
unadjusted coinsurance amount, coinsurance will be calculated as 20
percent of the APC payment amount.
There is an exception to the coinsurance provisions for screening
colonoscopies and screening sigmoidoscopies. Section 4104 of the BBA
1997 provided coverage for colorectal screening. This section, in part,
added new sections 1834(d)(2) and (3) to the Act, which provide that
for covered screening sigmoidoscopies and colonoscopies performed in
hospital outpatient departments and ambulatory surgical centers (ASCs),
payment is to be based on the lesser of the hospital or the ASC payment
rates and coinsurance for both screening colonoscopies and screening
sigmoidoscopies is to be 25 percent of the rate used for payment.
Section 4104 of the BBA 1997 also allows, at the Secretary's
discretion, coverage of screening barium enemas as a colorectal cancer
screening tool. We are including screening barium enemas as a covered
service under the hospital outpatient PPS. The payment rate for
screening barium enemas is the same as for diagnostic barium enemas.
Coinsurance for a screening barium enema is based on 20 percent of the
APC payment rate.
[[Page 18488]]
Sections 201(a) and (b) of the BBRA 1999 amend section 1833(t) of
the Act to provide for additional payments to hospitals for outlier
cases and for certain medical devices, drugs, and biologicals. These
additional payments to hospitals will not affect coinsurance amounts.
Redesignated section 1833(t)(8)(D) of the Act, as amended by section
201(i) of the BBRA 1999, provides that the coinsurance amount is to be
computed as if outlier adjustments, adjustments for certain medical
devices, drugs, and biologicals, as well as any other adjustments we
may establish under section 1833(t)(2)(E) of the Act, had not occurred.
Section 202 of the BBRA 1999 adds a new section 1833(t)(7) to the Act
to provide transitional corridor payments to certain hospitals through
calendar year 2003 and indefinitely for certain cancer centers.
Section 1833(t)(7)(H) of the Act provides that the transitional
corridor payment provisions will have no effect on determining
copayment amounts.
Section 204(a) of the BBRA 1999 amended redesignated section
1833(t)(8)(C) of the Act to provide that the coinsurance amount for a
hospital outpatient procedure cannot exceed the amount of the inpatient
hospital deductible for that year. The inpatient hospital deductible
for calendar year 2000 is $776.00. We will apply the limitation to the
wage adjusted coinsurance amount (not the unadjusted coinsurance
amount) after any Part B deductible amounts are taken into account.
Therefore, although the published unadjusted coinsurance amount for any
APC may be higher or lower than $776.00 in 2000, the actual coinsurance
amount for an APC, determined after any deductible amounts and
adjustments for variations in geographic areas are taken into account,
will be limited to the Medicare inpatient hospital deductible. Any
reductions in copayments that occur in applying the limitation will be
paid to hospitals as additional program payments. (See section
III.F.3.a, below, for discussion of calculating the Medicare payment
amount.)
MedPAC Comment: In its March 1999 report to the Congress, MedPAC
expressed concern that the statute's approach to addressing the
reduction in coinsurance could mean that it will be decades before
coinsurance is 20 percent of all APC payment rates. MedPAC recommended
that the Secretary seek and the Congress legislate a more rapid phase-
in and that the cost be financed by increases in program spending,
rather than through additional reductions in payments to hospitals.
MedPAC agrees that the approach to calculating the coinsurance
delineated in section 1833(t) of the Act is methodologically sound, but
they recommend a shorter period to complete the coinsurance reduction.
Response: The coinsurance reductions enacted by the BBA 1997
already provide significantly higher levels of financial protection for
beneficiaries than have existed in the past. While an acceleration of
this protection might be desirable, the costs of such a policy must be
balanced against other needs for increased Medicare spending and
protection of the trust funds. The President's budget for FY 2001 does
not contain such a proposal.
Comment: Three commenters discussed the delay in implementing the
outpatient PPS until after January 1, 2000. A hospital association
stated that it strongly believes that the outpatient PPS should not be
implemented until all systems are ready, and suggested that
implementation occur at the start of a calendar year so that Medigap
insurers did not receive an unearned windfall by reason of a midyear
decrease in beneficiary coinsurance amounts. Stating that the delay in
implementation was of serious concern to it, an insurance group
strongly urged us to implement the outpatient PPS as soon as possible.
Finally, a beneficiary advocacy group stated that it is deeply
concerned about the delay in implementation. While stating that it
understood the magnitude of the Y2K problem, this group urged us to
find a way to proceed with the phase-down of beneficiary coinsurance
or, failing that, to offer our assurance that the phase-down will not
be delayed beyond January 1, 2000.
Response: As noted elsewhere in this final rule, we intend to
implement the outpatient PPS effective for services furnished on or
after July 1, 2000. As noted in the proposed rule, we concluded that
attempting to make the massive computer changes required to implement
PPS at the same time we were trying to ensure that Medicare's computers
were Y2K compliant would have jeopardized the compliance effort, which
was HCFA's highest priority. Now that HCFA's efforts to make its
computer systems, and those of its contractors, Y2K compliant are
complete, we believe that July 1, 2000 is the earliest date on which we
can feasibly implement the PPS. Pursuant to HCFA's contracts with the
contractors responsible for maintaining its computer systems, HCFA
makes programming changes such as those required to implement the
outpatient PPS at the beginning of fiscal quarters. Thus, pursuant to
this practice, after January 1, 2000, there are only three dates in
2000 on which the programming changes necessary to implement outpatient
PPS can be put into effect--April 1, 2000, July 1, 2000 and October 1,
2000.
The first step in changing HCFA's computer systems to allow for
implementation of the outpatient PPS is to expand the claim record of
several HCFA and contractor systems to accept and retain specific
information related to how a service is being paid or why it is denied.
The claim record expansion is an indispensable prerequisite to
implementation of outpatient PPS. Once expansion of the claim form is
completed, we can then make the remaining programming changes necessary
to implement the outpatient PPS. As we noted in the proposed rule, 63
FR 47605, these are massive changes that will require extensive
testing. We anticipate that these software coding changes cannot be
completed before the end of the second quarter of 2000. Therefore, the
earliest possible date on which they can be installed and made
operational is July 1, 2000.
We do not believe that it is technically feasible to complete
installation of both the claims-form line item expansion and the coding
changes needed to implement PPS any sooner than July 1, 2000. Each of
these two stages of preparing HCFA's computer system for PPS
constitutes major systems changes in and of itself. To attempt to make
both changes simultaneously would be to run the risk that the system
would not function properly at all, potentially requiring
implementation to be delayed beyond July 1, 2000. We believe that the
two-stage approach discussed above is the only feasible way to make the
systems changes necessary to implement PPS and to be certain that they
will work. The soonest date on which PPS can be implemented after the
millennium is therefore July 1, 2000.
Despite one commenter's request that we implement the outpatient
PPS at the start of a calendar year, we do not believe it would be
appropriate to delay implementation beyond July 1, 2000. We see no
reason to delay implementation beyond the time necessary for HCFA to
have completed its Y2K efforts and make all the systems changes
necessary for PPS. As with all of the other aspects of PPS, we believe
that the beneficiary coinsurance reform contained in the outpatient PPS
should be put into effect as soon as possible, so that beneficiaries
can be subject to the lower coinsurance amounts under the new payment
methodology at the
[[Page 18489]]
earliest date. We believe that this consideration outweighs any concern
that Medigap insurers might receive a windfall because they set
premiums for a given year assuming coinsurance amounts would be at one
level only to see those amounts decrease in the middle of the year. In
addition, we note that, if insurers received a large enough windfall
for the reasons described by the commenter, the insurers might be
required to refund premiums to beneficiaries or offer them a credit on
premiums pursuant to section 1882(r) of the Act.
While none of the commenters specifically requested that we do so,
we have considered the possibility of applying the outpatient PPS
payment methodology retroactively to services furnished on or after
January 1, 1999. We have decided not to make these retroactive payments
for the reasons described below.
The first reason is the practical problem that the information
needed to implement PPS retroactively does not exist in a usable form.
Under current payment methodologies for many outpatient services,
hospitals submit bills for furnished services based on their charges
for the services. For these services, HCFA does not require hospitals
to submit bills containing the HCPCS code for the furnished service and
other data (such as the dates of service of multiple services submitted
on the same bill) necessary to process bills under the new prospective
payment methodology. Without the HCPCS code for a given service, we
would be unable to determine retroactively into which APC group the
service should be placed for payment under PPS. In turn, that would
mean that we could not determine the appropriate payment amount for the
service. Thus, given the information currently available to us, we
could not now simply reprocess bills for outpatient services that had
been furnished between January 1, 1999 and July 1, 2000 and recompute
payment and coinsurance amounts for these services. As a result, the
data needed to implement PPS retroactively do not exist in a form that
would allow for such implementation.
Nor would it have been feasible to attempt to capture the
information necessary for retroactive application during 1999. As noted
above, we concluded that it would not have been prudent to make the
computer programming changes necessary to implement PPS until our Y2K
efforts were complete. Those same changes would have been necessary to
allow us to capture the more detailed claims data needed to perform a
retroactive application of PPS back to January 1, 1999 once the system
was implemented prospectively. Because we delayed those changes out of
concern that they would interfere with our Y2K efforts, no automated
process existed for the period January 1, 1999 through July 1, 2000 by
which we could have captured the more detailed claims data necessary to
effect an eventual retroactive implementation of PPS. Publication of a
final rule before January 1, 1999 would not have altered this
situation. Even if we had published such a rule, it could not have
become effective until we could make the computer changes necessary to
implement PPS--the functional equivalent of what we have done through
publication of the proposed rule and this final rule--and until we
could make those changes, we could not compile by computer the data
needed to later reprocess claims under PPS.
In theory, we might have been able to implement PPS retroactively
despite the lack of an automated method of compiling the data necessary
to do so. But it simply would not have been practicable to maintain and
later process by hand such data for the period between January 1, 1999
and July 1, 2000, given the millions of claims for outpatient services
submitted during that period. (Based on the latest data available, we
process approximately 160 million claims for outpatient services over
an 18-month period.) Neither HCFA nor its contractors have the staff
needed to accomplish such a task.
We might also have conceivably required hospitals to maintain the
data required for a later retroactive implementation of PPS, but this
approach has practical difficulties. First, during the interim period
between January 1, 1999 and implementation of PPS, hospitals themselves
were exerting significant efforts to ensure the Y2K compliance of their
own automated Medicare billing systems, and it is doubtful that those
systems could have accommodated the necessary programming changes any
more than Medicare's systems could have. Even if hospitals could have
maintained the information (or if HCFA could have maintained it by hand
or could obtain it from any source now), the burden associated with
attempting to implement the new prospective payment methodology both
retroactively and prospectively at the same time would have been
prohibitive. As noted in the proposed rule and in this final rule,
effecting the transition between the old payment methodologies and the
new prospective payment methodology constitutes a massive programmatic
undertaking. Any effort to reprocess the huge number of bills for
outpatient services that would be involved in any attempt to
retroactively implement PPS would compete for the same resources needed
to implement PPS prospectively, and would compromise our ability to
ensure the smoothest prospective implementation.
This is especially so if paper records of claims from the interim
period would have to be manually input into Medicare's automated
payment systems in order to make retroactive payments for services
furnished on or after January 1, 1999. Undertaking an effort, once PPS
is implemented, to review hospital records of every outpatient service
furnished between January 1, 1999 and July 1, 2000; translate those
records into the data needed to process a Medicare claim for the
service under PPS; and issue a retroactive payment reflecting the PPS
rate for the service would cause a huge backlog of current bills to be
processed (and of other carrier tasks), and thus would not be
practicable. Therefore, there was no feasible way to have captured the
information necessary to make PPS apply retroactively.
In addition to the practical problems described above, the statute
does not require retroactive application of PPS. The statutory
requirement to implement the PPS for services furnished on or after
January 1, 1999 is ambiguous. While section 1833(t)(1)(A)'s reference
to outpatient services ``furnished during a year beginning with 1999''
might be read as imposing such a requirement, it is also true that
section 1833(t)(1)(B)(i) does not expressly set a time limit for HCFA
to designate which services are ``covered'' outpatient services for
purposes of payment under PPS. Nor does it set a deadline for HCFA to
issue regulations implementing the outpatient PPS. As a result, the
statute can also be read to require implementation of PPS for services
furnished in a year beginning in 1999 if HCFA has designated in its
implementing regulations those services as covered services for
purposes of PPS. The better reading is that the system applies
prospectively only.
We recognize that, under section 1833(a)(2)(B), Congress arguably
made the old payment methodologies for outpatient services inapplicable
to services furnished on or after January 1, 1999. Again, though,
Congress imposed no corresponding limit on the time within which HCFA
must designate the services that would be ``covered'' services for
purposes of PPS. While it is therefore possible to read the statute in
such a way that an outpatient service
[[Page 18490]]
furnished after January 1, 1999 but not yet designated as a covered
outpatient service by HCFA for purposes of PPS would have no payment
methodology applicable to it, we do not believe that Congress intended
such a result. We believe that where HCFA, because of significant Y2K
concerns, has not yet designated a given outpatient service as a
covered service for purposes of PPS, the most appropriate reading of
section 1833(t)(1)(A) is that it authorizes the Secretary to continue
to pay for the service under the existing methodology until PPS can be
implemented. If the Congress had known about the Y2K problem at the
time it enacted the PPS statute, this is the only rational approach it
could have adopted.
We believe that a clear expression of Congressional intent not to
require retroactive application of PPS can be found in the legislative
history of amendments to section 1833(t) of the Act, enacted as
sections 201, 202, and 204 of the BBRA 1999. In each instance, the
legislation provides that the ``amendments made by this section shall
be effective as if included in the enactment of the BBA,'' that is, the
original enactment of PPS in section 1833(t) (sections 201(m), 202(b),
and 204(c) of the BBRA 1999). This language was taken from the House
version of the bill (H.R. Rep. No. 436 (Part I), 106th Cong., 1st Sess.
14, 16 (1999)). The House Report stated that the outpatient payment
reforms contained in the BBRA 1999 (and hence in the BBA 1997) were
intended to take effect ``upon implementation of the hospital
prospective payment system'' by HCFA, id. at 52, 55, 56, not on January
1, 1999. The House Conference Committee Report reiterated the
understanding that the payment and coinsurance provisions of the BBA
and BBRA do not take effect until after implementation by HCFA. H.
Conf. Rep. No. 479, 106th Cong., 1st Sess. 866 (1999) (''[c]urrently,
beneficiaries pay 20% of charges for outpatient services,'' but
``[u]nder the outpatient PPS, beneficiary coinsurance will be limited
to frozen dollar amounts based on 20% of national median charges for
services in 1996, updated to the year of implementation of the PPS'');
id. at 867 (``[t]he conferees fully expect that the beneficiary
coinsurance phase-down will commence, as scheduled, on July 1, 2000'');
870 (``[h]ospital outpatient PPS is to be implemented simultaneously
and in full for all services and hospitals (estimated for July
2000)'').
Both the House Report and the Conference Report expressly
acknowledge, without disapproval, HCFA's decision to delay
implementation of the outpatient PPS until after January 1, 2000. H.R.
Rep. No. 436 (Part I) at 51 (stating that Secretary ``delayed
implementation of the new system until after the start of CY 2000 in
order to ensure that `year 2000' data processing problems are fully
resolved before the new system is implemented'' and that ``HCFA
currently estimates that the outpatient department prospective payment
system will be implemented in July 2000''); 145 Cong. Rec. at H12529
(daily ed. Nov. 17, 1999) (H. Conf. Rep. No. 479) (acknowledging
``[t]here has already been a one-year delay in implementation of the
BBA 97 provision'' and stating that conferees ``fully expect'' that the
outpatient prospective payment system ``will commence, as scheduled, on
July 1, 2000''). These statements indicate Congressional intent that
payments and coinsurance for covered hospital outpatient services would
be governed prospectively by PPS only after HCFA promulgated and made
effective final implementing regulations.
Finally, there is a serious question as to whether retroactive
implementation of PPS might constitute prohibited retroactive
rulemaking. In Bowen v. Georgetown University Hospital, 488 U.S. 204,
208 (1988), the Supreme Court stated that a statutory grant of
legislative rulemaking authority does not encompass the power to
promulgate retroactive rules unless that power is conveyed by Congress
in express terms, even where some substantial justification for
retroactive rulemaking might exist. The Court then declined to find
this express authorization for retroactive rulemaking in the Medicare
statute's general grant of rulemaking authority.
We do not find this express authorization in section 1833(t) or any
other statutory provision concerning the outpatient PPS. Section
1833(t)(1) requires that payment for outpatient services that are
furnished during any calendar year beginning after January 1, 1999 and
that are designated by HCFA as ``covered'' outpatient services shall be
made under a prospective payment system. While Congress may have
presumed, when it enacted section 1833(t) as part of the BBA, that HCFA
would be able to designate covered outpatient services and implement
the outpatient PPS by January 1, 1999, Congress did not foresee at that
time that Y2K concerns would prevent the agency from doing so. As a
result, the statute is silent as to what was to occur if HCFA was
unable to designate covered outpatient services and implement PPS by
January 1, 1999. We do not believe that this silence constitutes the
express authorization of retroactive rulemaking required by the Supreme
Court's Georgetown decision.
Comment: Several commenters contended that the proposed rules for
beneficiary coinsurance are overly complex and that the phase-in period
is too long. One commenter asked HCFA to consider a less involved
method and a more aggressive time period for implementation. Another
commenter suggested using a 5-year phase-in period. One commenter
requested that we recommend a legislative change to the Congress to
reduce beneficiary coinsurance to 20 percent by January 1, 2003. Still
another commenter expressed concern that calculations of coinsurance
amounts for each hospital will be particularly burdensome to Medicare
fiscal intermediaries and, as a result of the increased workload,
errors may occur. The commenter also recommended a more rapid reduction
of coinsurance to 20 percent of the payment amount.
Response: We agree that the rules governing how coinsurance is to
be calculated under the PPS are complex, and the phase-in to 20 percent
coinsurance is a lengthy one. However, the methods for calculating
coinsurance are dictated by the statute. The legislative changes were
made in order to put some control on rapidly increasing beneficiary
coinsurance payments, to begin to decrease the proportion of
beneficiary liability for hospital outpatient services, and to continue
to reduce beneficiary liability over time. As we have stated, the
impetus to accelerate the reduction of beneficiary coinsurance has to
be viewed within the context of other needs for increased Medicare
expenditures and long-term protection of the trust funds. The delay in
implementing the hospital outpatient PPS past the statutory effective
date was unavoidable due to systems constraints imposed by Y2K
compliance requirements.
Comment: One commenter noted that the proposed rule set beneficiary
coinsurance at 20 percent of median charges, but the commenter believes
that coinsurance amounts should be recalculated to equal 20 percent of
the average charge for the applicable APC group. The commenter
indicates that such a change would provide some financial relief to
hospitals.
Response: Section 1833(t)(3)(B)(i) of the Act requires that
unadjusted coinsurance amounts be calculated as 20 percent of the
national median of the charges for services within the APC group.
[[Page 18491]]
Comment: One commenter stated that because coinsurance is based on
the median charges of the APC, some beneficiaries would pay a higher
coinsurance than they would under the current system. The commenter
believes that beneficiaries who require less intensive services in an
APC group will essentially subsidize other beneficiaries who receive
more intensive services within the group. The commenter asserted that
fairness would dictate beneficiaries be charged coinsurance amounts
that more appropriately reflect the services received, not an amount
based on a median of multiple services they did not receive.
Response: Section 1833(t)(3)(B)(ii) of the Act provides that the
unadjusted coinsurance amounts are based on the national median of the
charges for the ``services within'' an APC. Because an APC group
consists of services that are both clinically similar and similar with
respect to the resources required to perform the service, we would
expect that charges for the services should also be fairly homogeneous.
We believe that services within a group are homogeneous enough to
warrant a single payment amount and a single coinsurance amount.
In the following sections, we describe how we determined the
beneficiary coinsurance amount and the Medicare program payment amount
for services paid for under the hospital outpatient PPS.
2. Determining the Unadjusted Coinsurance Amount and Program Payment
Percentage
To calculate Medicare program payment amounts and beneficiary
coinsurance amounts, we first determined for each APC group two base
amounts, in accordance with statutory provisions:
An unadjusted copayment amount, described in section
1833(t)(3)(B) of the Act; and
The predeductible payment percentage, which we call the
program payment percentage, described in section 1833(t)(3)(E) of the
Act.
a. Calculating the Unadjusted Coinsurance Amount for Each APC Group
In the proposed rule, we described the specific steps used to
calculate the unadjusted coinsurance amounts for each APC group as
follows:
(i) We determined the national median of the charges billed in 1996
for the services that constitute an APC group after standardizing
charges for geographic variations attributable to labor costs. (To
determine the labor adjustment, we divided the portion of each charge
that we estimated was attributable to labor costs (60 percent) by the
hospital's inpatient wage index value and added the result to the
nonlabor portion of the charge (40 percent)).
(ii) We updated charge values to projected 1999 levels by
multiplying the 1996 median charge for the APC group by 13.0 percent
(increased to 14.7 percent in this final rule), which the HCFA Office
of the Actuary estimates to be the rate of growth of charges between
1996 and 1999.
(iii) To obtain the unadjusted coinsurance amount for the APC
group, we multiplied the estimated 1999 national median charge for the
APC group by 20 percent. The unadjusted coinsurance amount is frozen at
the 1999 level until such time as the program payment percentage (as
determined below) equals or exceeds 80 percent (section
1833(t)(3)(B)(ii) of the Act).
b. Calculating the Program Payment Percentage (Predeductible Payment
Percentage)
In the proposed rule and in this final rule, we use the term
``program payment percentage'' to replace the term ``pre-deductible
payment percentage,'' which is referred to in section 1833(t)(3)(E) of
the Act. The program payment percentage is calculated annually for each
APC group, until the value of the program payment percentage equals 80
percent. To determine the program payment percentage for each APC
group, we--
(i) Subtract the APC group's unadjusted coinsurance amount from the
payment rate set for the APC group; and
(ii) Divide the difference (APC payment rate minus unadjusted
coinsurance amount) by the APC payment rate, and multiply by 100.
The program payment percentage will be recalculated each year
because APC payment rates will change when APC rates are increased by
annual market basket updates and whenever we revise an APC.
Comment: One commenter expressed concern about how the coinsurance
amounts are determined. The commenter stated that the calculation is
flawed and penalizes beneficiaries in those States where charges for
services tend to be lower than in other States. The commenter alleged
that if the hospitals in those States where charges for services tend
to be lower accept a reduced coinsurance in order to hold beneficiaries
harmless, the hospitals will be penalized. The commenter also asserted
that Medigap policies and Medicaid programs will also be affected. The
commenter further stated that coinsurance should be based on regional,
not national, charges. The commenter contended that the provision does
not achieve the intended outcome of equalizing payment across the
nation.
Response: Sections 1833(t)(3) and (t)(8) of the Act prescribe how
coinsurance amounts are to be calculated under the PPS. Our method of
calculating unadjusted coinsurance amounts for each APC group based on
20 percent of national median charges follows the requirements of
section 1833(t)(3)(B) of the Act.
Comment: A number of commenters believe that the payment system as
proposed would create gross anomalies in coinsurance for particular
chemotherapy drugs. For example, the proposed $36.61 coinsurance for
fluorouracil is 10 times the hospital's cost to purchase that drug. The
commenters asserted that this excessive coinsurance represents an abuse
of patients and would undermine beneficiary confidence in the new
system. They recommended that coinsurance be limited to 20 percent of
the payment amount for each drug.
Several other commenters noted that classifying drugs with widely
varying costs in the same APC will have a significant negative effect
on beneficiary coinsurance, and in some cases beneficiaries could be
required to pay a greater percentage of coinsurance for less effective
therapies. For example, one commenter alleged that the coinsurance for
the drug 5-FU, which the commenter believes has a current coinsurance
of approximately $1, would increase to $40 under the proposed system.
Response: The coinsurance anomalies for chemotherapy drugs that
appeared in the proposed rule are not an issue under this final rule.
Unlike the proposed chemotherapy drug APCs, which grouped all
chemotherapy drugs under four APCs, in this final rule, each
chemotherapy drug is assigned to a separate APC. As discussed in
section III.D.5 of this preamble, the unadjusted coinsurance amounts
for these APCs is calculated as 20 percent of the APC payment rate.
Comment: One commenter noted that the proposed national unadjusted
coinsurance amounts for cardiovascular stress testing and perfusion
imaging result in beneficiaries bearing 85 percent of the total payment
for stress testing and 60 percent for perfusion imaging, which many
beneficiaries will be unable to afford. Another commenter
[[Page 18492]]
requested that we either exclude cataract procedures and angioplasty
from the hospital outpatient PPS or create an outlier policy that
affords special treatment for these procedures in order to protect
beneficiaries from excessive coinsurance amounts.
Response: Coinsurance amounts, by law, are based on 20 percent of
the median of the charges actually billed in 1996 (updated to 1999) for
the services within an APC. The fact that coinsurance is a larger
proportion of the total payment for some APCs than for others reflects
the differences in hospital charging practices for different services.
For example, in examining departmental cost-to-charge ratios reflected
on hospital cost reports, we have found that most hospitals have higher
mark-ups in charges for radiology and diagnostic services than they do
for clinic visits.
3. Calculating the Medicare Payment Amount and Beneficiary Coinsurance
Amount
a. Calculating the Medicare Payment Amount
The national APC payment rate that we calculate for each APC group
is the basis for determining the total payment (subject to wage-index
adjustment) the hospital will receive from the beneficiary and the
Medicare program. (A hospital that elects to reduce coinsurance, as
described below in section III.F.4, may receive a total payment that is
less than the APC payment rate.) The Medicare payment amount takes into
account the wage index adjustment and the beneficiary deductible and
coinsurance amounts. In addition, the amount calculated for an APC
group applies to all the services that are classified within that APC
group. The Medicare payment amount for a specific service classified
within an APC group under the outpatient PPS is calculated as follows:
(i) Apply the appropriate wage index adjustment to the national
payment rate that is set annually for each APC group.
(ii) Subtract from the adjusted APC payment rate the amount of any
applicable deductible as provided under Sec. 410.160.
(iii) Multiply the adjusted APC payment rate, from which the
applicable deductible has been subtracted, by the program payment
percentage determined for the APC group or 80 percent, whichever is
lower. This amount is the preliminary Medicare payment amount.
(iv) If the wage-index adjusted coinsurance amount for the APC is
reduced because it exceeds the inpatient deductible amount for the
calendar year, add the amount of this reduction to the amount
determined in (iii) above. The resulting amount is the final Medicare
payment amount.
b. Calculating the Coinsurance Amount
A coinsurance amount is calculated annually for each APC group. The
coinsurance amount calculated for an APC group applies to all the
services that are classified within the APC group. The beneficiary
coinsurance amount for an APC is calculated as follows:
Subtract the APC group's Medicare payment amount from the adjusted
APC group payment rate less deductible; for example, coinsurance amount
= (adjusted APC group payment rate less deductible)--APC group
preliminary Medicare payment amount. If the resulting amount does not
exceed the annual hospital inpatient deductible amount for the calendar
year, the resulting amount is the beneficiary coinsurance amount. If
the resulting amount exceeds the annual inpatient hospital deductible
amount, the beneficiary coinsurance amount is limited to the inpatient
hospital deductible. For example, assume that the wage-adjusted payment
rate for an APC is $300; the program payment percentage for the APC
group is 70 percent; the wage-adjusted coinsurance amount for the APC
group is $90; and the beneficiary has not yet satisfied any portion of
his or her $100 annual Part B deductible.
(A) Adjusted APC payment rate: $300.
(B) Subtract the applicable deductible:
$300-$100 = $200
(C) Multiply the remainder by the program payment percentage to
determine the preliminary Medicare payment amount:
0.7 x $200 = $140
(D) Subtract the Medicare payment amount from the adjusted APC
payment rate less deductible to determine the coinsurance amount, which
cannot exceed the inpatient hospital deductible for the calendar year:
$200 - $140 = $60
(E) Calculate the final Medicare payment amount by adding the
preliminary Medicare payment amount determined in step (C) to the
amount that the coinsurance was reduced as a result of the inpatient
hospital deductible limitation.
$140 + $0 = $140
In this case, the beneficiary pays a deductible of $100 and a $60
coinsurance, and the program pays $140, for a total payment to the
hospital of $300. Applying the program payment percentage ensures that
the program and the beneficiary pay the same proportion of payment that
they would have paid if no deductible were taken.
If the annual Part B deductible has already been satisfied, the
calculation is:
(A) Adjusted APC payment rate: $300.
(B) Subtract the applicable deductible:
$300 - 0 = $300
(C) Multiply the remainder by the program payment percentage to
determine the preliminary Medicare payment amount:
0.7 x $300 = $210
(D) Subtract the Medicare payment amount from the adjusted APC
payment rate less deductible to determine the coinsurance amount. The
coinsurance amount cannot exceed the amount of the inpatient hospital
deductible for the calendar year:
$300 - $210= $90
(E) Calculate the final Medicare payment amount by adding the
preliminary Medicare payment amount determined in step (C) to the
amount that the coinsurance was reduced as a result of the inpatient
hospital deductible limitation.
$210 + $0 = $210
In this case, the beneficiary makes a $90 coinsurance payment, and
the program pays $210, for a total payment to the hospital of $300.
The following example illustrates a case in which the inpatient
hospital deductible limit on coinsurance amounts applies. Assume that
the wage-adjusted payment rate for an APC is $2,000; the wage-adjusted
coinsurance amount for the APC is $900; the program payment percentage
is 55 percent; the inpatient hospital deductible amount for the
calendar year is $776 and the beneficiary has not yet satisfied any
portion of his or her $100 Part B deductible.
(A) Adjusted APC payment rate: $2,000.
(B) Subtract the applicable deductible:
$2000 - $100 = $1,900
(C) Multiply the remainder by the program payment percentage to
determine the preliminary Medicare payment amount:
0.55 x $1,900 = $1,045
(D) Subtract the preliminary Medicare payment amount from the
adjusted APC payment rate less deductible to determine the coinsurance
amount. The coinsurance amount cannot exceed the inpatient hospital
deductible amount of $776:
$1,900 - $1,045 = $855, but coinsurance limited to $776
(E) Calculate the final Medicare payment amount by adding the
[[Page 18493]]
preliminary Medicare payment amount determined in step (C) to the
amount that the coinsurance was reduced as a result of the inpatient
hospital deductible limitation ($855 - $776 = $79).
$1,045 + $79 = $1,124
In this case, the beneficiary pays a deductible of $100 and
coinsurance that is limited to $776. The program pays $1,124 (which
includes the amount of the reduction in beneficiary coinsurance due to
the inpatient hospital deductible limitation) for a total payment to
the hospital of $2,000.
4. Hospital Election To Offer Reduced Coinsurance
For most APCs, the transition to the standard Medicare coinsurance
rate (20 percent of the APC payment rate) will be gradual. For those
APC groups for which coinsurance is currently a relatively high
proportion of the total payment, the process will be correspondingly
lengthy. The law offers hospitals, but not CMHCs, the option of
electing to reduce coinsurance amounts and permits hospitals to
disseminate information on their reduced rates. In this section, we
discuss the procedure by which hospitals can elect to offer a reduced
coinsurance amount, and the effect of the election on calculation of
the program payment and beneficiary coinsurance.
Section 1833(t)(5)(B) of the Act, as added by section 4523 of the
BBA 1997, requires the Secretary to establish a procedure under which a
hospital, before the beginning of a year, may elect to reduce the
coinsurance amount otherwise established for some or all hospital
outpatient services to an amount that is not less than 20 percent of
the hospital outpatient prospective payment amount. The statute further
provides that the election of a reduced coinsurance amount will apply
without change for the entire year, and that the hospital may
disseminate information on its reduced copayments. Section
1833(t)(5)(C) of the Act, as added by the BBA 1997, provides that
deductibles cannot be waived. Finally, section 1861(v)(1)(T) of the Act
(as added by section 4451 of the BBA 1997) provides that no reduction
in coinsurance elected by the hospital under section 1833(t)(5)(B) of
the Act may be treated as a bad debt. We note that section 1833(t)(5)
of the Act has been redesignated as section 1833(t)(8) of the Act by
sections 201(a) and 202(a) of the BBRA 1999.
Elections to reduce coinsurance will not be taken into account in
calculating transitional corridor payments to hospitals (discussed in
section III.H.2 of this preamble). That is, a hospital's transitional
corridor payment will be determined as if the hospital received
unreduced coinsurance amounts from beneficiaries.
In the proposed rule, we stated that we would require that
hospitals make the election to reduce coinsurance on a calendar year
basis. The proposed rule required that the hospital must notify its
fiscal intermediary of its election to reduce coinsurance no later than
90 days prior to the date the PPS is implemented or 90 days prior to
the start of any subsequent calendar year and that the hospital's
notification must be in writing. It must specifically identify the APC
groups to which the hospital's election will apply and the coinsurance
amount (within the limits identified below) that the hospital has
elected for each group. The election of reduced coinsurance must remain
in effect and unchanged during the year for which the election is made.
Because the law states that hospitals may disseminate information on
any reduced coinsurance amounts, we provided in the proposed rule that
hospitals would be allowed to publicly advertise this information.
The proposed regulations provided that a hospital may elect to
reduce the coinsurance amount for any or all APC groups. A hospital may
not elect to reduce the coinsurance amount for some, but not all,
services within the same APC group.
As proposed, a hospital may not elect a coinsurance amount for an
APC group that is less than 20 percent of the adjusted APC payment rate
for that hospital. In determining whether to make such an election,
hospitals should note that the national coinsurance amount under this
system, based on 20 percent of national median charges for each APC,
may yield coinsurance amounts that are significantly higher or lower
than the coinsurance that the hospital previously has collected. This
is because the median of the national charges for an APC group, from
which the coinsurance amount is ultimately derived, may be higher or
lower than the hospital's historic charges. Therefore, in determining
whether to elect lower coinsurance and the level at which to make the
election, we advise that hospitals carefully study the wage-adjusted
coinsurance amounts for each APC group in relation to the coinsurance
amount that the hospital has previously collected.
As discussed in section III.F.1, under sections 1834(d)(2)(C)(ii)
and 1834(d)(3)(C)(ii) of the Act the coinsurance for screening
sigmoidoscopies furnished by hospitals and screening colonoscopies
furnished by hospital outpatient departments and ASCs is 25 percent of
the applicable payment rate. The payment rate for these colorectal
cancer screening tests is the lower of the hospital outpatient rate or
the ASC payment rate. The payment rate for screening barium enemas is
the same as that for diagnostic barium enemas. However, the coinsurance
amount for screening barium enemas is 20 percent of the APC payment
rate. Hospitals may not elect to reduce coinsurance for screening
sigmoidoscopies, screening colonoscopies, or screening barium enemas.
Calculation of coinsurance amounts on the basis of a hospital's
election of reduced coinsurance is similar to the formula described in
section III.F.3. For example, assume that the adjusted APC payment rate
is $300; the program payment percentage for the APC group is 60
percent; the hospital has elected a $60 reduced coinsurance amount for
the APC group; and the beneficiary has not satisfied the annual Part B
deductible.
(A) Adjusted APC payment rate: $300.
(B) Subtract the applicable deductible:
$300 - $100 = $200
(C) Multiply the remainder by the program payment percentage to
determine the Medicare payment amount:
0.6 x $200 = $120
(D) Beneficiary's coinsurance is the difference between the APC
payment rate reduced by any deductible amount and the Medicare payment
amount, but not to exceed the lesser of the reduced coinsurance amount
or the inpatient hospital deductible amount:
$200 - $120 = $80 (limited to $60 because of the hospital-elected
reduced coinsurance amount)
(E) Calculate the final Medicare payment amount by adding the
preliminary Medicare payment amount determined in step (C) to the
amount that the coinsurance was reduced as a result of the inpatient
hospital deductible limitation.
$120 + $0 = $120
In this case, Medicare makes its regular payment of $120, and the
beneficiary pays a $100 deductible and a reduced coinsurance amount of
$60. The hospital receives a total payment of $280 instead of the $300
that it would have received if it had not made its election to reduce
coinsurance.
Comment: One commenter stated that it is currently illegal to
accept lower coinsurance amounts from beneficiaries and asked for an
explanation as to how
[[Page 18494]]
we could propose to encourage hospitals to lower coinsurance.
Response: Although Medicare, in general, has prohibitions against
reducing beneficiary coinsurance, redesignated section 1833(t)(8)(B) of
the Act specifically provides the legal authority for hospitals to make
elections to reduce coinsurance amounts for purposes of the outpatient
PPS. However, those coinsurance amounts cannot be reduced below 20
percent of the adjusted APC payment rate for the hospital.
Comment: One commenter asked whether, in view of our proposal to
allow hospitals to elect lower coinsurance, Medigap insurance plans
will be permitted to offer a waiver of a participating hospital's
coinsurance. That is, can a Medigap plan act as a preferred provider
organization (PPO) with a financial incentive to select those hospitals
that elect to reduce coinsurance?
Response: There are two kinds of Medigap policies--regular Medigap
and Medicare SELECT. While regular Medigap policies must pay full
supplemental benefits on all claims that are submitted by all Medicare
providers and are approved by Medicare carriers and intermediaries,
Medicare SELECT plans, which are a managed care form of Medigap, may
restrict payment of supplemental benefits to network providers. Thus,
by design, Medicare SELECT plans are permitted to negotiate selectively
with hospitals. Ordinarily, Medicare SELECT plans contract with certain
hospitals to waive the hospital deductible for inpatient services.
Since the Congress has expressly permitted hospitals to reduce
outpatient coinsurance to no less than 20 percent of the PPS payment
amount, a Medicare SELECT plan is free to contract selectively with
these hospitals. We note that a hospital's election to reduce
coinsurance under redesignated section 1833(t)(8)(B) of the Act
requires that the reduction be across-the-board for some or all APC
groups. Thus, an agreement between a Medicare SELECT plan and a
hospital to reduce coinsurance would result in coinsurance reductions
for all beneficiaries who receive those APC group services at the
hospital, whether or not they are enrolled in the Medicare SELECT plan.
Comment: One commenter requested that we seek a legislative change
to offer hospitals more flexibility under the coinsurance reduction
provision by permitting them to review and revise coinsurance amounts
every 3 months.
Response: We believe that there would be a significant impact on
contractors if hospitals were allowed to revise their reduced
coinsurance more often than annually. More frequent coinsurance changes
may also be confusing to beneficiaries. Because we do not have a good
estimate of how many hospitals will make the elections and we do not
yet know whether those hospitals that do make elections will elect to
reduce coinsurance for just a few or for a significant number of APCs,
we do not support allowing hospitals to make or change elections more
often than annually. However, we may reconsider our position after we
gain more experience under the PPS and can better assess what the
impact of more frequent elections would be on hospitals, beneficiaries,
and HCFA and its contractors.
Comment: One commenter noted that if we intend to publish a final
rule no more than 90 days before implementation of the PPS, hospitals
would not have sufficient time to make coinsurance election decisions.
The commenter recommended that hospitals be permitted to make the
election 60 days before implementation of the system.
Response: This final rule will not be published more than 90 days
before the date of implementation of the PPS. Therefore, the final
regulations require that hospitals inform their fiscal intermediaries
(FIs) of their elections to reduce coinsurance not later than June 1,
2000. Beginning with elections for calendar year 2001, elections are
required to be made by December 1 preceding the calendar year. At this
time, we do not know how many hospitals will choose to reduce
coinsurance or for how many APCs these hospitals will elect reductions.
While we want to provide hospitals sufficient time to make their
elections, we also must provide fiscal intermediaries with enough time
to incorporate the elections into their systems.
Comment: Several commenters disagreed with our proposal to allow
hospitals to advertise reduced coinsurance amounts. They noted that,
although the BBA 1997 provision with respect to hospitals' election to
reduce coinsurance amounts provides that hospitals may ``disseminate
information'' on their reductions, we have interpreted that to mean
that hospitals may ``advertise'' their reductions. Two commenters
stated that disseminating information is not synonymous with granting
one category of hospitals the unique opportunity to advertise to
attract customers. They believe that this interpretation is
antithetical to the spirit underlying provisions of the Health
Insurance Portability and Accountability Act of 1996 (HIPAA) that
prohibit beneficiary inducements and may conflict with State anti-
kickback laws. Some commenters were also concerned that under our
proposal to allow hospitals to advertise, hospitals may issue a general
advertisement of reduced coinsurance when the reduction may apply only
to certain services. Other commenters were concerned that hospital
advertising may lead Medicare beneficiaries to believe that hospital
outpatient care is more economical than other ambulatory settings, even
when that is not the case, or beneficiaries may become confused and
believe that all ambulatory providers have the ability to reduce
coinsurance. These commenters asked us to reconsider our proposal to
allow hospitals to advertise rather than to disseminate information. In
addition, they asked us to establish additional requirements for
hospitals' dissemination of information concerning coinsurance
reductions so that beneficiaries are made aware that reduced
coinsurance applies only to certain specified services, that it applies
only to coinsurance billed by hospitals for those services, and that
the law does not permit reduced coinsurance for other Part B services
such as physician services.
Several other commenters stated that for the election to reduce
coinsurance to be effective, hospitals must have the right to advertise
and, therefore, the commenters supported our proposal to permit
hospitals to advertise coinsurance reductions.
Response: We believe that hospitals must be able to advertise their
coinsurance reductions in order to achieve what we believe to be the
intent of the BBA provision, that is, to provide hospitals with some
ability to compete with other ambulatory settings (where coinsurance is
already 20 percent of the applicable Medicare payment rate) and to
reduce beneficiary coinsurance liability.
Hospitals would have less incentive to reduce coinsurance if they
could not advertise. In addition, beneficiaries need to be fully
informed so that they can make informed decisions. We believe that
advertising as a way of disseminating information has merit.
We were persuaded by some commenters' concerns that beneficiaries
may not understand that reduced coinsurance applies to specific
hospital outpatient services furnished by specific hospitals that
choose to elect reductions and that similar reductions cannot be made
by other providers of ambulatory services. We, therefore, are amending
the regulations to require that all
[[Page 18495]]
advertisements or other information furnished to beneficiaries must
specify that the coinsurance reductions advertised apply only to the
specified services of that hospital and that these coinsurance
reductions are available only where a hospital elects to reduce
coinsurance for hospital outpatient services and reductions are not
allowed in other ambulatory settings or physician offices.
Comment: One commenter, noting the complexity of the PPS
coinsurance requirements, requested that we provide a phase-in period
in the final rule to allow hospitals sufficient time to implement the
changes necessary to meet the requirements.
Response: The method required to be used in calculating coinsurance
under the PPS results in an overall decrease in the total coinsurance
amounts beneficiaries pay for hospital outpatient services. Total
coinsurance is somewhat reduced in the first year of implementation and
will be reduced even more in future years, until coinsurance for all
PPS services equal 20 percent of the applicable APC payment rate. It is
only by fully implementing the coinsurance provisions under section
1833(t)(3)(B) of the Act that beneficiaries will realize these
reductions. We, therefore, do not support a phase-in period.
Comment: One commenter recommended that we include, as part of the
public record, year by year estimates of the total economic burden
placed on beneficiaries by the prolonged coinsurance phase-in period,
assuming hospitals charge the maximum and minimum coinsurance amounts.
The commenter believes these estimates would be useful as a basis for
future discussions of how to remedy the coinsurance problem.
Response: As a rule, we develop estimates of impacts for
legislative proposals that are under consideration by the Congress and
for final legislation as we are developing regulations to implement the
law. Although we do not have the resources available to model any
number of other data analyses that may have merit, our data are made
available to the public, so the commenter and any other interested
party may perform the coinsurance analysis.
Comment: One commenter stated that the proposed PPS creates new
complexities for Medicare beneficiaries in that they will have to wait
for hospitals to do the calculations necessary to determine
coinsurance. The beneficiaries will also receive multiple bills and
explanations of benefits for multiple hospital visits occurring on the
same day. The commenter stated that we will need to have an extensive
process in place to explain why, in most cases, beneficiaries are
paying 50 to 70 percent of their outpatient services and why they are
receiving separate statements when they have multiple visits on the
same day.
Response: In the proposed rule, we assigned medical visits, that
is, clinic and emergency room visits, to APCs based on both the level
of visit as defined by a HCPCS code and the diagnosis of the patient.
In order to implement that type of APC assignment, we would have to
require hospitals to submit a separate bill for each medical visit that
occurred on the same day; however, under the final rule, medical visits
are assigned to APCs based solely on the HCPCS code, and it will be
possible for hospitals to bill for multiple medical visits on the same
bill. We agree that the way coinsurance is determined under the PPS is
a significant change. We are developing a brochure for beneficiaries
that will explain the new system and the policies under the outpatient
PPS that will affect them.
Comment: One commenter recommended that we make information
available to beneficiaries that compares the average coinsurance for
high volume procedures performed at hospitals in a particular
geographic area so that beneficiaries can make informed health care
decisions about their care.
Response: We believe that beneficiaries will be informed about the
coinsurance reductions elected by hospitals in their area through
advertisements and other information made available by hospitals.
Comment: One commenter asked whether the EOMB (Explanation of
Medicare Benefits) notice to the beneficiary will clearly explain that
a hospital's decision to reduce coinsurance applies to a specific
service furnished at that specific hospital.
Response: We are reviewing the EOMB in light of the changes in
Medicare payments and coinsurance amounts under the PPS, but we have
not yet finalized our work. We will take the commenter's suggestion
into consideration as we investigate changes we will make to the EOMB.
G. Adjustment for Area Wage Differences
1. Proposed Wage Index
Under section 1833(t)(2)(D) of the Act, the Secretary is required
to determine a wage adjustment factor to adjust, in a budget-neutral
manner, the portion of the payment rate and the coinsurance amount that
is attributable to labor-related costs for relative differences in
labor and labor-related costs across geographic regions. As stated in
the proposed rule, we considered several options and we proposed using
the hospital inpatient PPS wage index as the source of an adjustment
factor for geographic wage differences for the hospital outpatient
department PPS. We believe that using the hospital inpatient PPS wage
index is both reasonable and logical, given the inseparable,
subordinate status of the outpatient department within the hospital
overall. Use of a hospital outpatient-specific wage index was not
required by the Congress and we did not have either the time or
resources necessary to construct one. We explained in our proposed rule
that there are several possible versions of the hospital inpatient wage
index that can be developed by extracting the basic wage and salary
data from hospital cost reports, depending on the methodology that is
applied to the data. For the hospital outpatient PPS, we proposed to
adopt the same version that is used to determine payments to hospitals
under the hospital inpatient PPS to adjust for relative differences in
labor and labor-related costs across geographic areas. This version
reflects the effect of hospital redesignation under 1886(d)(8)(B) of
the Act and hospital reclassification under 1886(d)(10) of the Act.
By statute, we implement the annual updates of the hospital
inpatient PPS on a fiscal year basis. However, we proposed to update
the hospital outpatient department PPS on a calendar year basis.
Therefore, the hospital inpatient PPS wage index values that are
updated annually on October 1 would be implemented for the hospital
outpatient department PPS on the January 1 immediately following. We
proposed this schedule so that wage index changes will be implemented
on a calendar year basis concurrently with other revisions and updates,
such as the conversion factor update or changes in the APC groups
resulting from new or deleted CPT codes. Subsequent to our proposal,
section 201(h) of the BBRA 1999 amended section 1833(t)(8)(A) of the
Act (as redesignated by section 201(a) of the BBRA 1999) to require the
Secretary to review and revise the outpatient PPS wage index adjustment
factor at least annually rather than on a periodic basis. (This section
of the Act was further redesignated as section 1833(t)(9)(A) by section
202(a) of the BBRA 1999.)
[[Page 18496]]
2. Labor-Related Portion of Hospital Outpatient Department PPS Payment
Rates
We proposed to recognize 60 percent of the hospital's outpatient
department costs as labor-related costs that would be standardized for
geographic wage differences. We initially estimated this percentage by
comparing the percentage of costs attributed to labor by other systems
(that is, hospital inpatient PPS and ASC) and by considering health
care market factors such as the shift in more complex services from the
inpatient to the outpatient setting, which could influence labor
intensity and costs. We stated that 60 percent represented a reasonable
estimate of outpatient costs attributable to labor, as it fell between
the hospital inpatient PPS operating cost labor factor of 71.1 percent
and the ASC labor factor of 34.45 percent, and is close to the labor-
related costs under the hospital inpatient operating cost PPS
attributed directly to wages, salaries, and employee benefits (61.4
percent) under the rebased 1992 hospital market basket that was used to
develop the fiscal year 1997 update factor for inpatient PPS rates
(published August 30, 1996 at 61 FR 46187).
We confirmed our estimate through regression analysis. Using this
approach, we analyzed the percentage change in hospital costs
attributable to a 1 percent increase in the wage index as expressed by
the hospital wage index coefficient. The coefficient from a fully
specified payment regression of the hospital cost per unit,
standardized for the service mix on the wage index, disproportionate
share patient percentage, modified teaching, rural, and urban
variables, is approximately 0.60, suggesting a labor share of 60
percent. Even though we decided not to propose additional adjustments,
we believed that the coefficient from this specification provided the
best estimate of the labor share for the proposed PPS. This judgment
was based on a policy to use a labor share that reflects the
relationship between the wage index and costs, rather than the effects
of correlated factors.
After calculating 60 percent of each hospital's total operating and
capital costs, we divided that amount by the hospital's FY 1998
hospital inpatient PPS wage index value to standardize costs to remove
the differences that are attributable to geographic wage differences.
Therefore, as we explained in the proposed rule, the total cost of
performing a procedure or visit would include standardized operating
and capital costs, as well as related costs (for example, operating
room time, medical/surgical supplies, anesthesia, recovery room,
observation) and minor ancillary procedures such as venipuncture that
we packaged.
Comment: Some commenters urged that we annually update the wage
index applied to the outpatient PPS as we do under the hospital
inpatient PPS.
Response: We proposed to update the wage index annually, on a
calendar year basis. In addition, section 1833(t)(9)(A) of the Act,
redesignated and amended by the BBRA 1999, requires us to review and
revise the wage adjustment at least annually.
Comment: A professional society recommended eliminating the
``regional variation for radiologic technologists working in small and
rural practices'' and applying the ``same wage scale'' used for their
urban counterparts. The commenter asserted that our wage index
methodology is biased against rural hospital radiology departments that
must compete with the urban areas to attract and retain radiologic
technologists. The commenter stated that hospitals are operating in a
very competitive labor market in which rural facilities are forced to
match or exceed wages paid in the urban areas for reduced workloads.
The commenter further stated that the impact of higher hourly
technologist wages does not result in a corresponding increase in a
higher wage index for radiologic technologists in rural hospitals
because these wages are averaged with those for all other hospital
inpatient personnel working in the same area.
Response: The commenter is correct that the wage index is
calculated based upon all of the wages paid and hours worked of
hospital personnel within areas of the hospital that are paid under the
inpatient PPS. The wages and hours are then totaled for a particular
labor market area (defined as a Metropolitan Statistical Area [MSA] or
all of the counties of a State that are not part of an MSA). We believe
the inpatient wage index is an appropriate measure of the relative
costs of labor across geographic areas for purposes of outpatient PPS.
Currently, we do not have data available that would allow us to
calculate the wage index for the costs of employing staff in particular
occupational categories. Collecting these data would require
significant recordkeeping and reporting efforts for hospitals, and the
impacts of adjusting the wage index using the data are uncertain.
Although some analyses have indicated that the wage indices of rural
areas could rise as a result of such an adjustment, these findings are
limited by the lack of a national database through which to fully
assess the impacts.
Comment: Several commenters viewed our proposal to establish a 60
percent labor share as an arbitrary decision for which we provided no
rational support. One commenter stated that ``Congress did not expect
HCFA to invent a number.''
Response: As we explained in the proposed rule (63 FR 47581), we
used a statistical tool, that is, regression analysis, to validate the
percentage of costs that we had initially estimated could be attributed
to labor and, therefore, subject to the wage adjustment. We adopted
this approach because we did not have adequate and appropriate data
readily available through a reputable source from which we could derive
a hospital outpatient labor share within the time allotted to develop
our new system. While hospital outpatient costs, including labor costs,
are reported annually on the hospital cost report, they are not
reported in a manner and format that allow us to capture the
statistical and cost data necessary to calculate a precise hospital
outpatient labor share. Therefore, we decided to use regression
analysis to test our estimate of that labor share. Within the
constraints imposed by a lack of accessible, reliable data and the
compressed timeframe under which we were working to develop the
outpatient PPS, we believe our approach was appropriate and the best
available option.
Comment: Several commenters urged us to use more current hospital
cost report data to determine the appropriate hospital outpatient labor
share.
Response: As stated above, at this time the Medicare hospital cost
report is not a feasible data source for determining a hospital
outpatient labor share.
Comment: One commenter asserted that setting the labor-related
share at 60 percent fails to recognize all labor costs associated with
the delivery of hospital outpatient services. The commenter stated that
the labor-related percentage for the outpatient PPS should be the same
as that used for the hospital inpatient PPS, that is, 71.1 percent.
Another commenter supported 60 percent as a ``maximum'' labor
percentage on an interim basis and suggested that we reconsider our
decision to use the inpatient PPS hospital wage index to adjust the
outpatient PPS payments because of the commenter's concerns about flaws
inherent in the system used to derive the inpatient PPS wage index
values. A third commenter proposed that the
[[Page 18497]]
labor-related portion should be closer to the 34.45 percent currently
applied to adjust ASC payment for wage variation. The latter commenter
contended that apportioning 60 percent of the outpatient PPS payment
rate for wage adjustment would adversely affect rural hospitals because
the wage index values for these areas are generally below 1.0.
Response: We note that commenters' opinions regarding an
appropriate labor percentage are mixed. However, beyond expressing a
preference for a percentage other than 60 percent, none of the
commenters provided data to assist us in re-evaluating our proposal. We
realize that rural hospitals would benefit from using a labor share
that is less than 60 percent and that some other hospitals would derive
advantages from a labor share greater than 60 percent. However, we
believe the approach that we used to determine the labor share that
will be applied to all hospitals paid under our new system is
reasonable and the best option available at this time. We will re-
evaluate our decision as we gain more experience with the new system
and as new data become available.
3. Adjustment of Hospital Outpatient Department PPS Payment and
Coinsurance Amounts for Geographic Wage Variations
In the proposed rule, we noted our intent to use fiscal year 1999
hospital inpatient PPS wage index values to compute the initial
outpatient PPS rates. However, we have decided to use fiscal year 2000
inpatient PPS wage index values in determining the payment rates set
forth in this final rule. The rationale for using the fiscal year 2000
wage index includes availability of the more recent wage index, that it
is more current than the 1999 wage index would have been, and that it
is being used to calculate FY 2000 payments under the hospital
inpatient PPS.
We proposed to use the annually updated hospital inpatient PPS wage
index values to adjust both program payment and coinsurance amounts
under the outpatient PPS for area wage variations. Under our proposal,
when intermediaries calculate actual payment amounts, they would
multiply the prospectively determined APC payment rate and coinsurance
amount by that labor-related percentage to determine the labor-related
portion of the base payment rate and coinsurance amount that is to be
adjusted using the applicable wage index factor. We proposed that the
labor-related portion would then be multiplied by the hospital's
inpatient PPS wage index factor, and the resulting wage-adjusted labor-
related portion would be added to the nonlabor-related portion,
resulting in wage-adjusted payment and coinsurance rates. The wage-
adjusted coinsurance amount would then be subtracted from the wage-
adjusted APC payment rate, and the remainder would be the Medicare
payment amount for the service or procedure. Note that even if a
hospital elects to reduce the coinsurance or if the coinsurance is
capped at the inpatient deductible, the full coinsurance is assumed for
purposes of determining the Medicare payment percentage. (See section
III.F.3 for a discussion on how Medicare program payments are
calculated when the Part B deductible applies.)
The following is an example of how an intermediary would calculate
the Medicare payment for a surgical procedure with a hypothetical APC
payment rate of $300 that is performed in the outpatient department of
a hospital located in Heartland, USA. The coinsurance amount for the
procedure is $120. The hospital inpatient PPS wage index value for
hospitals located in Heartland, USA is 1.0234. The labor-related
portion of the payment rate is $180 ($300 x 60 percent), and the
nonlabor-related portion of the payment rate is $120 ($300 x 40
percent). The labor-related portion of the unadjusted coinsurance
amount is $72 ($120 x 60 percent), and the nonlabor-related portion
of the unadjusted coinsurance amount is $48 ($120 x 40 percent). It
is assumed that the beneficiary deductible has been met.
Wage-Adjusted Payment Rate (rounded to nearest dollar):
= ($180 x 1.0234) + $120
= $184 + $120
= $304
Wage-Adjusted Coinsurance Amount (rounded to nearest dollar):
= ($72 x 1.0234) + $48
= $74 + $48
= $122
Calculate Medicare Program Payment Amount:
$304-$122 = $182
4. Special Rules Under the BBRA 1999
We issued the federal fiscal year (FY) 2000 hospital inpatient PPS
wage index values in the Federal Register on July 30, 1999, in a final
rule titled ``Changes to the Hospital Inpatient Prospective Payment
Systems and Fiscal Year 2000 Rates'' (64 FR 41490). Subsequent to that
publication, section 152 of the BBRA 1999 reclassified certain counties
and labor market areas for purposes of payment under the Medicare
hospital inpatient PPS; section 153 of the BBRA 1999 enacted a ``wage
index correction''; and section 154 of the BBRA 1999 provided for the
calculation and application of a wage index floor for a specified area.
These changes are effective for FY 2000 and will be explained in detail
in an interim final rule with comment that we expect to issue in the
Federal Register shortly. The wage index values in Addendum H, Addendum
I, and Addendum J reflect the changes made by the BBRA 1999.
H. Other Adjustments
1. Outlier Payments
Section 1833(t)(2)(E) of the Act, as enacted by the BBA 1997,
authorized, but did not require, an outlier adjustment. In the proposed
rule, we discussed our reasons for not implementing an outlier
adjustment policy. We explained that we had reached that decision after
carefully evaluating several factors. For the following reasons, we
believed an outlier policy was not necessary: (a) in the proposed PPS,
unlike the hospital inpatient PPS, we would use limited packaging of
services and allow payment for multiple services delivered to a given
patient on a given day; (b) payment for critical care services would
reflect the intensity and higher costs associated with providing this
type of medical care; and (c) we would make higher payment for serious
medical cases even if critical care were not provided and additional
payments would be made for any other laboratory work, x-rays, or
surgical interventions resulting from medical visits to the emergency
room.
Section 201(a) of the BBRA 1999 amended section 1833(t) of the Act
by adding an outlier adjustment provision, section 1833(t)(5). Under
this new provision, the statute now requires that we make an additional
payment (that is, an outlier adjustment) for outpatient services for
which a hospital's charges, adjusted to cost, exceed a fixed multiple
of the outpatient PPS payment as adjusted by pass-through payments. The
Secretary determines this fixed multiple and the percent of costs above
the threshold that is to be paid under this outlier provision. The
statute sets a limit on projected aggregate outlier payments. Under the
statute, projected outlier payments may not exceed an ``applicable
percentage'' of projected total payments. The applicable percentage
means a percentage specified by the Secretary (projected percentage of
outlier payments relative to total payments), subject to the following
limits: for years before 2004, the projected percentage that we specify
cannot exceed 2.5 percent; for 2004 and later, the projected percentage
cannot
[[Page 18498]]
exceed 3.0 percent. Section 201(c) of the BBRA 1999 amended section
1833(t)(2)(E) of the Act to require that these payments be budget
neutral.
Section 1833(t)(5)(D) of the Act grants the Secretary authority
until 2002 to identify outliers on a bill basis rather than on a
specific service basis and to use an overall hospital cost-to-charge
ratio (CCR) to calculate costs on the bill rather than using
department-specific CCRs for each hospital.
To set the threshold or fixed multiple and the payment percent of
costs above that multiple for which an outlier payment would be made,
we first had to determine what specified percentage of total program
payment, up to 2.5 percent, we should select. We decided to set the
outlier target at 2.0 percent. In order to set the fixed multiple
outlier threshold and payment percentage, we simulated PPS payments, as
described below in section G of the preamble. As explained further
below, we calibrated the threshold and the payment percentage applying
an iterative process so that the simulated outlier payments were 2.5
percent of simulated total payments. For purposes of the simulation, we
set a ``target'' of 2.5 percent (rather than 2.0 percent), because we
believe that a given set of numerical criteria would result in a higher
percentage of outlier payments under the simulation using 1996 data
than under the PPS. This is because we believe that the 1996 data
reflects undercoding of services, which means simulated total payments
would likely be understated and it in turn means the percentage of
outlier payments would be overstated. In addition, we are unable to
fully estimate the amount and distribution of pass-through payments
using the 1996 data. Our inability to make these estimates further
understates the total payments under the simulation. We believe that a
set of numerical criteria that results in simulated outlier payments of
2.5 percent using the 1996 data would result in outlier payments of 2.0
percent under PPS. The difference arises from the effect of undercoding
in the historical data and the payment of pass-throughs under PPS.
Under the budget neutrality requirement in section 1833(t)(2)(E) of the
Act, as amended by section 201(c) of the BBRA 1999, we make a
corresponding 2.0 percent reduction to the otherwise applicable
conversion factor. We will monitor outlier payment and make any
necessary refinements to the outlier methodology when we set outlier
policies for CY 2002.
After setting the outlier target percentage and reducing the
unadjusted conversion factor to reflect the 2 percent outlier reduction
and the 2.5 percent pass-through adjustment (see discussion in section
III.D), we identified those claims in our 1996 database with at least
one payable service under the PPS system. For these bills, we first
calculated the total PPS payment for the bill using the reduced
conversion factor. Next, we calculated for each claim the total charges
attributed to services being paid under the PPS system. These charges
were then adjusted to cost, using a hospital-specific CCR. We used the
sum of the hospital's total operating CCR and total capital CCR as the
hospital specific CCR. These CCRs were calculated from the most current
cost report data available and were adjusted to calendar year 1996.
We also identified all bills for the 1,800-plus hospitals that we
had previously identified as having coded only the lowest level clinic
visit code (CPT code 99201) for all visits. For these hospitals, we
isolated those claims with at least one service with the CPT code 99201
and one or more additional PPS covered service. Due to the undercoding
on these bills and the inherent problem in determining a possible
outlier condition, we excluded these bills from the calculation process
but set aside a proportional amount of outlier payments based on the
proportional cost of these bills to the total cost of all bills used in
the outlier calculation.
After determining the PPS payment and the cost for all 42 million
claims for which there was at least one billable service under the PPS
system, we experimented with several combinations of thresholds or
fixed multiples and payment percent of costs over these multiples. We
found that the combination of using a multiple of 2.5 for the threshold
and the use of a payment percent of 75 percent of cost over this
threshold achieved our target of a 2.5 percent outlier payment.
Approximately 1.6 million claims in our 1996 claims database had
calculated bill costs that exceeded the PPS payments on the claim by
more than 2.5 times and thus qualified for an outlier payment in our
model.
Comment: We received several comments that supported our proposal
not to create outlier payments. However, most commenters opposed it and
supported including an outlier policy. Several commenters disagreed
that multiple payment for multiple services furnished during a given
visit would absolve the need for outliers. One commenter stated that
outlier payments are necessary because of the limited number of APC
groups. Several commenters believe that outlier payments are necessary
to recognize variability in APC groups stemming from treatment options
and patient complexity. Some argued that our own data demonstrate that
an outlier policy is necessary to ensure equitable payments. Several
commenters stated that the data trimming algorithm that we used,
excluding from our PPS database claims that were greater than three
standard deviations from the geometric mean, probably eliminated claims
that included high cost items and services that should have been
reflected in our data and that may have been associated with the later
technologies. A professional association noted that an examination of
our PPS data indicated that ``20 percent of outpatient services subject
to the PPS (excluding clinic and emergency room visits) include maximum
costs that are at least 10 times higher than the corresponding rate;
100 services have maximum costs that are at least 40 times higher than
the corresponding payment rate.''
One commenter believes that an outlier policy is necessary for a
payment system based on averaging to provide additional payments for
potentially variable and expensive items such as pharmaceuticals and
supplies. Several commenters suggested that outlier payments would be
necessary if we did implement their option to carve out all
pharmaceuticals and certain supplies from the hospital outpatient PPS
and pay them separately based on reasonable costs or average wholesale
price (AWP). Most commenters who urged establishing outlier payments
advocated them for high cost drugs, supplies, and new technologies.
Some commenters advised that a drug such as Activase administered to a
cardiac patient in the emergency room prior to inpatient admission or
transfer to another hospital for inpatient admission would be costly.
One commenter estimated that the cost for two doses of the drug would
exceed $4,000. One commenter urged an outlier policy that would
adequately pay for iodine I 131 tositomomab. Another commenter
recommended that we make an outlier payment for Hemophilia Factor
Concentrate that could be packaged in APC 906 (Infusion Therapy, except
Chemotherapy) or APC 907 (Intramuscular Injections) and Tissue
Plasminogen Activator (TPA) and IV therapy drugs as outliers.
A professional association expressed the need for an outlier policy
for tests whose costs exceed a reasonable range of costs for similar
procedures. They identified CPT codes 95951 and 95956 as examples of
those tests. Another association recommended adoption of
[[Page 18499]]
an outlier policy to recognize higher costs associated with new
technologies. The commenter suggested that the policy remain in effect
a full year after the hospital outpatient PPS is implemented to allow
us adequate time to collect the appropriate data for use in updating
the payment rates. Several other commenters believe that we may need to
adopt an outlier policy on an interim basis while data are collected to
determine the appropriate assignment of certain services and items to
an APC. One commenter advocated outlier payments for hospitals whose
aggregate costs exceed total payments under the hospital outpatient PPS
in a given year. A number of other commenters stated that the hospital
outpatient PPS outlier policy should be similar to that currently used
for the inpatient PPS.
Response: As we discussed above, section 201(a) of the BBRA 1999
amended the Act by adding a new section 1833(t)(5). This provision now
requires the Secretary to make an additional outlier payment for
outpatient services for which a hospital's or a CMHC's charges,
adjusted to cost, exceed a fixed multiple of the new PPS payment as
adjusted by pass-through payments. The Secretary is required to
determine the fixed multiple and the percent of costs above the
threshold that is to be paid under the outlier provision. As we explain
above, to implement the outlier adjustment, we have determined that an
outlier payment will be made when calculated bill costs exceed the PPS
payments on a claim by more than 2.5 times. In addition, the provision
of transitional pass-throughs under section 201(b) of the BBRA 1999,
which requires the Secretary to make an additional payment for certain
high cost medical devices, drugs, and biologicals, constitutes a kind
of outlier adjustment (see section III.D of this preamble), and our
decision to create special transitional payments for new technology
items and services (see section III.C.8) will also provide additional
payments to hospitals that incur higher costs under the outpatient PPS.
2. Transitional Corridors/Interim Payments
As we developed the proposed rule, we conducted extensive
regression analysis of the relationship between outpatient hospital
costs and several factors that affect costs, such as teaching intensity
and disproportionate share percentage, as part of the analysis to
determine whether payment adjustments should be proposed for the
outpatient PPS. Ultimately, we did not propose any adjustments other
than the wage index used to adjust for local variation in labor costs.
One of the main reasons we did not propose any special adjustments was
that the estimated effects of measured factors on costs were small and,
in most cases, not statistically significant. In addition, we believe
that the negative impacts estimated in the proposed rule for certain
classes of hospitals were partially attributable to undercoding and
coding variations in the data because coding did not affect the payment
of many services under the current payment system, especially medical
visits.
Since publication of our proposed policy, section 202(a)(3) of the
BBRA 1999 added new paragraph (7) to section 1833(t) of the Act to
require the Secretary to make payment adjustments during a transition
period to limit the decline in payments under PPS for hospitals. These
additional payments are to be implemented without regard to budget
neutrality and are in effect through 2003.
Under paragraphs (A), (B), and (C) of section 1833(t)(7) of the
Act, the amount of the payment adjustment for an individual hospital
depends on the difference between the hospital's ``PPS amount'' and the
hospital's ``pre-BBA amount.'' Section 1833(t)(7)(E) of the Act defines
the ``PPS amount'' as the amount payable under PPS for the hospital's
covered outpatient department services, excluding the effects of the
transitional corridor and including coinsurance and deductibles. For
purposes of calculating the PPS amount, we include the full copayment
amounts; if a hospital chooses to reduce the copayment for some or all
of the services that it furnishes, we will count the full copayment
amounts rather than the reduced copayment amounts. Section
1833(t)(7)(F) of the Act defines the ``pre-BBA amount'' for a period as
the amount equal to the product of (1) the hospital's reasonable cost
for covered outpatient department services, and (2) the base outpatient
department payment-to-cost ratio for the hospital. The statute defines
``base payment-to-cost ratio'' as the ratio of (1) the hospital's
reimbursement for covered outpatient department services during the
cost reporting period ending in 1996, to (2) the reasonable cost of the
services for the period. The base payment-to-cost ratio will be
calculated as if the amendments to sections 1833(i)(3)(B)(i)(II) and
1833(n)(1)(B)(i) of the Act made by section 4521 of the BBA 1997, to
require that the full amount beneficiaries paid as coinsurance under
section 1862(a)(2)(A) of the Act are taken into account in determining
Medicare Part B Trust Fund payment to the hospital, were in effect in
1996.
For calendar years 2000 and 2001, payment to hospitals whose PPS
payment is less than 100 percent, but is at least 90 percent, of the
pre-BBA payment, is increased by 80 percent of the difference.
Hospitals whose PPS payment is less than 90 percent, but is at least 80
percent, of the pre-BBA payment, will receive additional payment equal
to the amount by which 71 percent of the estimated pre-BBA payment
exceeds 70 percent of the PPS payment. Hospitals whose PPS payment is
less than 80 percent, but is at least 70 percent, of the pre-BBA
payment will receive additional payment equal to the amount by which 63
percent of the pre-BBA payment exceeds 60 percent of the PPS payment.
Payments to hospitals whose PPS payment is less than 70 percent of the
pre-BBA payment will be increased by 21 percent of the pre-BBA payment.
For calendar years 2001 through 2003, the number of corridors and the
associated percentage increases decline over time. As required by
statute, interim payments will be made subject to retrospective
adjustments. Section 1833(t)(7) of the Act provides special transition
payments for cancer centers and small rural hospitals, which are
discussed below in section III.H.3.
Comment: Hundreds of commenters, including associations, hospitals,
and entities providing goods and services to hospitals, expressed grave
concerns about the estimated impact of our proposed system on certain
classes of hospitals. Many commenters noted that the case mix and
service mix for specific classes of hospitals such as rehabilitation,
cancer, children's, rural, and teaching hospitals are different than
for other hospitals. They argued that a number of these hospitals deal
with patients who typically require more resources. The commenters
noted that we have authority under the statute to make adjustments for
specific classes of hospitals. Some reasoned that given our estimates
of substantial losses for certain classes of hospitals under the
proposed hospital outpatient PPS, we should use our authority to
exclude these classes of hospitals from the outpatient PPS for 2 years,
require proper coding of bills from those hospitals, and have an
opportunity to analyze the results of the improved coding. These
commenters urged that we examine reasons other than coding that may
contribute to the disparity. Many commenters recommended that a
separate conversion factor be developed
[[Page 18500]]
for the hospitals whose payments are adversely affected by the new
system.
Response: As discussed above, section 1833(t)(7) of the Act, as
added by section 202(a) of the BBRA 1999, provides that, for several
years, additional payments be made to any facility for which the PPS
payment is less than an estimate of the hospital's pre-PPS payment and
that these payments are in addition to the total payments under the
PPS. Our estimate of the impacts of this change in policy along with
other payment-related provisions of the BBRA 1999 (discussed in further
detail in section IX) show improved payments under PPS relative to pre-
BBRA law for nearly all classes of hospitals. Our simulations show that
hospitals overall receive an additional 4.6 percent in payments under
PPS compared to pre-PPS law. Long-term care and children's hospitals
show losses (1.7 percent and 3.2 percent, respectively). Moreover,
urban hospitals with no indirect teaching or disproportionate share
inpatient adjustments show a loss of 0.3 percent. In addition, we
reexamined and reestimated the multivariate regression specifications
described in the proposed rule to reflect the changes described in this
rule. Based on the results of regression analysis, we believe further
adjustments are not warranted at this time. We found, for example, the
disproportionate share percentage did not have a statistically
significant effect on unit costs standardized by service mix. In
addition, positive and significant results did not occur for most
teaching variables that we specified. For instance, positive and
significant results did not occur for hospitals whose ratio of
residents to inpatient and outpatient days was less than .28. Hospitals
with a large number of residents to inpatient and outpatient days did
demonstrate slightly higher standardized costs, but only when the
regression model included independent variables for urban/rural
location. Moreover, the parameter estimate was small and payment was
not greatly improved when a corresponding adjustment was made to these
teaching hospitals. Therefore, we are not making such adjustments for
these hospital groups. We do not believe that this action will restrict
beneficiary access to care because the projected losses are relatively
small and could reflect undercoding on the part of these hospitals
before PPS.
We will begin comprehensive analyses of cost and payment
differentials between different classes of hospitals as soon as there
is a sufficient amount of claims data submitted under the PPS. We will
use data from the initial years of the PPS to conduct regression and
simulation analyses. In addition, we will carefully track and analyze
the additional payment made to hospitals under section 1833(t)(7) of
the Act. These analyses will be used to consider and possibly propose
adjustments in the system, particularly beginning in 2004 when the BBRA
1999 transition provisions expire.
Comment: Commenters from organizations representing teaching
hospitals recommended that we include a budget-neutral payment
adjustment for certain classes of hospitals such as teaching hospitals.
For example, the concern is that PPS payments are not adequate for
academic medical centers because they provide more resource-intensive
outpatient services than other hospital types.
Response: As noted above, we are not making adjustments for
specific classes of hospitals in this final rule. The primary reason
for this decision is that section 1833(t)(7) of the Act requires
additional payments through 2003 to all hospitals whose PPS payment
falls below estimates of pre-PPS payment. We will conduct analyses and
studies of cost and payment differential among different classes of
hospitals, including teaching facilities, when sufficient data under
the PPS have been submitted. We will carefully consider whether
permanent adjustments should be made in the system once the BBRA 1999
transition provisions expire.
3. Cancer Centers and Small Rural Hospitals
Cancer Centers
In the BBA 1997, the Congress did not exclude from the hospital
outpatient PPS the 10 cancer centers that are currently excluded from
the inpatient PPS, but section 1833(t)(8) of the Act (as enacted in the
BBA 1997) provides special consideration for these hospitals under the
outpatient PPS. More specifically, that section provides that the
outpatient PPS would not apply to the 10 cancer centers before January
1, 2000, and that the Secretary may establish a separate conversion
factor for cancer centers to take into account the unique costs they
incur due to their patient population and the intensity of their
services.
In the proposed rule, we stated that, because we had no choice but
to delay implementation of the PPS for all hospitals until sometime
after January 1, 2000 due to Y2K concerns, we would begin paying cancer
centers under hospital outpatient PPS at the same time. Also, we did
not propose a separate conversion factor for cancer centers. Although
our proposed impact analysis indicated that, under the PPS, the cancer
centers could lose 32 percent of their current outpatient Medicare
payments, we proposed to do additional work to try to explain the
impact before we provided for a separate conversion factor or other
payment adjustment.
Section 1833(t)(7)(D)(ii) of the Act, as added by the BBRA 1999,
provides that the 10 cancer centers excluded from the inpatient PPS are
permanently held harmless with respect to their pre-BBA 1997 amount.
Comment: The cancer centers commented that they are unlike other
hospitals in that they treat the most difficult cases (patients often
referred by community hospitals) and they are usually the first
hospitals to use the latest technology related to cancer treatments.
They also pointed out that their clinic visits often involve
consultations with a number of physicians and therefore are longer and
require more hospital resources than clinic visits in other hospitals.
They believe that our proposed payments for clinic visits would
seriously underpay them for their more comprehensive visits. The cancer
centers also stated that any delay in recognizing and paying
appropriately for new technology would affect them more adversely than
it would other hospitals.
During the comment period for the proposed rule, the cancer centers
submitted for our consideration an alternative payment methodology.
Under their methodology, we would calculate a separate conversion
factor for each of the 10 centers based on their individual base year
Medicare payments and service mix. Subsequently, the conversion factors
would be updated using the Congressionally determined update factor
applicable to all hospitals. Hospitals would be paid interim payment
amounts during the year, but payment would ultimately be based on the
lesser of--
The PPS payments they would receive using their individual
conversion factor; or
The payments they would receive based on their cost
reports by applying the current (that is, pre-PPS) outpatient services
payment methodology.
Capital costs would be excluded from this comparison and be paid on
a reasonable cost pass-through basis. The proposal also envisioned some
payment penalties and incentives similar to the penalties and
incentives provided under the reasonable payment cost limit methodology
applicable to hospitals excluded from the inpatient PPS.
[[Page 18501]]
Response: As noted above, new section 1833(t)(7)(D)(ii) of the Act
holds cancer centers harmless on a permanent basis by providing that,
in instances where Medicare payment to a cancer center under the
hospital outpatient PPS would be lower than a specified pre-BBA
Medicare payment for the same services, we are to pay the full pre-BBA
amount. Therefore, an alternative approach to paying cancer centers
under the hospital outpatient PPS is no longer needed.
Small Rural Hospitals
We noted in the proposed rule that rural hospitals generally
receive a relatively high percentage of their Medicare income from
outpatient services (greater than the national average), which
compounds the impact of the reduction in Medicare payments to rural
hospitals that we projected would result upon implementation of the
hospital outpatient PPS. We attributed these reduced revenues to
undercoding, lack of economies of scale, and reliance on the median
instead of the geometric mean in the calculation of APC weights.
Because our impact analysis revealed that low-volume rural hospitals
that are sole community hospitals or Medicare-dependent hospitals could
experience a considerable reduction in revenues under the outpatient
PPS, we solicited comments in the proposed rule on two possible
approaches to phasing in the outpatient PPS for these types of
hospitals.
Section 1833(t)(7)(D)(i) of the Act provides that hospitals located
in a rural area with 100 or fewer beds are held harmless with respect
to their pre-BBA 1997 amount for outpatient services furnished before
January 1, 2004. For purposes of implementing this provision, bed size
will be determined in the same way it is for inpatient PPS for the
indirect medical education adjustment as defined in Sec. 412.105(b),
Determination of number of beds. A hospital's location in a rural area
will also be determined as it is in the inpatient PPS; see
Sec. 412.63(b), Geographic classifications.
Comment: Many commenters were concerned that the projected negative
impact of the proposed outpatient PPS on rural hospitals would be
magnified because outpatient revenues make up such a large part of
rural hospitals' total revenues. Some commenters believe that our
proposed PPS ratesetting method favors high volume, urban hospitals.
Some commenters supported phasing in the outpatient PPS for rural
disproportionate share hospitals because those facilities may not have
the resources to improve their coding in the near future. One
association opposed phasing in the PPS because doing so would postpone
but not resolve the financial jeopardy imposed on rural hospitals by
the hospital outpatient PPS. Some commenters recommended that we
provide an ``add-on'' to the prospective rate for emergency services in
low-volume sole community and rural disproportionate share hospitals.
One commenter expressed concern about the numerous factors contributing
to rural hospitals' negative margins that limit their ability to absorb
losses, including a disproportionately high share of Medicare,
Medicaid, and indigent patients, significant problems recruiting
practitioners, low population density, and limited patient volume.
Numerous commenters recommended that we establish a payment floor for
low-volume rural hospitals. One association requested that we either
revise the payment methodology or put in place a payment floor that
guarantees health care services will continue to be available to
Medicare beneficiaries served by rural hospitals.
Response: As we discuss above, in order to limit potential
reductions in payment to hospitals under the outpatient PPS, section
1833(t)(7) of the Act, as added by section 202(a)(3) of the BBRA 1999,
requires us to establish payment adjustments for hospitals whose PPS
payments are less than our estimate of the hospital's pre-BBA payments.
These additional payments are to be implemented in a non-budget neutral
manner and are to be paid through 2003. Section 1833(t)(7)(D)(i) of the
Act includes a special ``hold harmless'' provision, which is to be paid
through 2003, for hospitals that are located in a rural area and that
have no more than 100 beds. Under section 1833(t)(7)(D)(i) of the Act,
as added by the BBRA 1999, small rural hospitals will be paid a
predetermined pre-BBA amount for services covered under the outpatient
PPS if payment under the PPS would be less than the pre-BBA amount.
This hold harmless provision establishes a payment floor until January
1, 2004 for small rural hospitals. During this period, we will collect
and analyze data under the PPS in order to assess whether any special
adjustments will need to be made for rural hospitals once the hold
harmless provision expires.
I. Annual Updates
1. Revisions to APC Groups, Weights and the Wage and Other Adjustments
Prior to enactment of the BBRA 1999, section 1833(t)(6)(A) of the
Act required the Secretary to periodically review and revise the APC
groups, the relative payment weights, and the wage and other
adjustments to take into account changes in medical practice, changes
in technology, the addition of new services, new cost data, and other
relevant information and factors.
In the proposed rule, we described our plan to update the various
components of the outpatient PPS. We proposed to keep the composition
of all the APC groups essentially intact from one year to the next,
with the exception of the few changes that may be necessary as a
consequence of annual revisions to HCPCS and ICD-9-CM (International
Classification of Diseases, Ninth Edition, Clinical Modification)
codes. We stated that we did not plan to routinely reclassify services
and procedures from one APC to another. We proposed to make these
changes based on evidence that a reassignment would improve the
group(s) either clinically or with respect to resource consumption.
However, we specifically solicited comments on how frequently to
recalibrate the APC weights and on the method and data that should be
used. We defined recalibration as the updating of all the APC group
weights based on more recent information.
We proposed to update the wage index values used to calculate
program payment and coinsurance amounts on a calendar year basis,
adopting, effective for services furnished each January 1, the wage
index value established for a hospital under the inpatient PPS the
previous October 1. The first update to the wage index values will be
effective for calendar year 2001 beginning January 1, 2001.
Section 201(h)(1)(A) of the BBRA 1999 amended section 1833(t)(8)(A)
of the Act (as redesignated by section 201(a) of the BBRA 1999) to
require the Secretary to review the components of the outpatient PPS
not less often than annually and revise the groups, the relative
payment weights, and the wage and other adjustments to take into
account changes in medical practice, changes in technology, and the
addition of new services, new cost data, and other relevant information
and factors. (Section 202(a) of the BBRA 1999 further redesignated
section 1833(t)(8) as section 1833(t)(9).)
Section 201(h)(1)(B) of the BBRA 1999 further amended this section
of the Act to require that the Secretary consult
[[Page 18502]]
with an expert outside advisory panel composed of an appropriate
selection of representatives of providers to review (and advise the
Secretary concerning) the clinical integrity of the groups and weights.
This provision allows these experts to use data other than those
collected or developed by us during our review of the APC groups and
weights. Section 201(h)(2) of the BBRA 1999 requires the Secretary to
initiate the annual review process beginning in 2001 for the PPS
payments that would take effect January 1, 2002.
Comment: A number of commenters urged that we adopt an annual
update cycle for APC recalibration. Some commented that the APC update
frequency should not be less often than the annual cycles that we have
instituted for both the hospital inpatient PPS and physician fee
schedule payment system. Many commenters maintained that annual
updating is necessary to ensure that the APCs appropriately reflect
changes in new technologies, standards of care, and other marketplace
patterns. Several commenters stated that an annual update cycle is
needed to take into account changes in drug prices and appropriately
reflect advancements in nuclear medicine. Some commenters believe that
updating the APCs less frequently than annually would adversely impact
hospitals that would incur financial losses attributable to
inappropriate payment for new technologies. Some commenters contended
that infrequent updating would be a disincentive for manufacturers to
develop new outpatient therapies.
Response: In accordance with the amendments enacted by the BBRA
1999, we will review and update annually, for implementation effective
January 1 of each year, the APC groups, the relative payment weights,
and the wage and other adjustments that are components of the
outpatient PPS, beginning with the update to be effective January 1,
2002.
2. Annual Update to the Conversion Factor
We stated in the proposed rule that section 1833(t)(3)(C)(ii) of
the Act requires us to update annually the conversion factor used to
determine APC payment rates. Section 1833(t)(3)(C)(iii) of the Act
provides that the update be equal to the hospital inpatient market
basket percentage increase applicable to hospital discharges under
section 1886(b)(3)(B)(iii) of the Act, reduced by one percentage point
for the years 2000, 2001, and 2002. The Secretary also has the option
(under section 1833(t)(3)(C)(iii) of the Act) of developing a market
basket that is specific to hospital outpatient services. We advised in
our proposed rule that we are considering this option, and specifically
invited comments on possible sources of data that are suitable for
constructing a market basket specific to hospital outpatient services.
We did not receive any comments regarding potential data sources for
constructing a hospital outpatient-specific market basket. Therefore,
we will update the conversion factor annually by the hospital inpatient
market basket increase (as specified in section 1886(b)(3)(B) of the
Act), reduced by one percentage point for the years 2000, 2001, and
2002.
3. Advisory Panel for APC Updates
As stated above, section 1833(t)(9)(A) of the Act (as redesignated
by section 201(a) of the BBRA 1999 and further redesignated by section
202(a) of the BBRA 1999) requires the Secretary, beginning in 2001, to
consult with an expert outside advisory panel of appropriately selected
provider representatives when annually reviewing and updating the APC
groups and the relative group weights. The statute specifies that the
expert panel will act in an advisory capacity on matters pertaining to
the clinical integrity of the groups and weights and that it may use
data other than those developed or collected by us in executing this
function. We will initiate this review process in 2001 for the hospital
outpatient PPS payments that will take effect for services furnished on
or after January 1, 2002. We will adopt a process for identifying and
appropriately selecting provider representatives to serve as members of
an expert advisory panel. We anticipate informing the hospital
community of the formation of an expert advisory panel through timely
notice in the Federal Register.
J. Volume Control Measures
Section 1833(t)(2)(F) of the Act requires the Secretary to develop
a method for controlling unnecessary increases in the volume of covered
outpatient department services. Section 1833(t)(6)(C) of the Act, as
added by the BBA 1997, authorizes the Secretary to adjust the update of
the conversion factor if we determine that the volume of services paid
for under the outpatient PPS increases beyond amounts we establish
under section 1833(t)(2)(F) of the Act.
In the proposed rule, we proposed a volume control measure for
services furnished in CY 2000 only. We discussed several long-term
alternatives to control volume for services furnished in subsequent
years, and we solicited comments on those options. We stated that we
would propose an appropriate volume control mechanism for services
furnished in CY 2001 and beyond after we completed further analysis.
Given the complexities of developing an appropriate volume control
mechanism for hospital outpatient services, we believed additional
study was necessary.
For CY 2000, we proposed to use a modified version of the physician
sustainable growth rate system (SGR), which is required under section
1848(d)(3) of the Act, for purposes of the hospital outpatient PPS. As
we stated in the proposed rule, this appeared to be the most feasible
initial approach. Using this approach, we proposed to update the target
amount specified under section 1833(t)(3)(A) for CY 1999 as an
expenditure target for services furnished in CY 2000. We stated that we
would update the CY 1999 target for inflation (based on the projected
change in the hospital market basket minus one percentage point),
estimate changes in the volume and intensity of hospital outpatient
services, and estimate Part B fee-for-service changes in enrollment. If
volume exceeded the target for CY 2000, we proposed to adjust the
update to the conversion factor for CY 2002. We further stated that we
would compare the CY 2000 target to an estimate of CY 2000 actual
payments to hospitals as determined by our Office of the Actuary using
the best available data. We proposed that if unnecessary volume
increases, as reflected by expenditure levels, caused payment to exceed
the target, we would determine the percentage by which the target is
exceeded, and adjust the CY 2002 update to the conversion factor by the
same percentage.
We indicated that we would respond in the final rule to comments on
our proposed volume control measure for services furnished in CY 2000,
but not to comments about volume control options for services furnished
after CY 2000, which will be addressed in a later proposed rule.
Comment: We received many comments opposing our proposed use of an
SGR-like system to control unnecessary volume increases under the
hospital outpatient PPS. Most commenters strongly urged us to exercise
the discretionary authority allowed under section 1833(t)(9)(C) of the
Act (as redesignated) not to adjust the update to the conversion
factor. A few commenters endorsed the provision
[[Page 18503]]
of the ``President's Plan to Modernize and Strengthen Medicare for the
21st Century'' (issued July 2, 1999) to delay adoption of a volume
control measure in order to give hospitals additional time to adjust to
the new system. Several commenters, including one national physicians'
association, contended that we did not have the statutory authority to
establish and use an expenditure target in the manner that we had
proposed. The physicians' association stated that the law limits use of
the SGR system to physician services. Some commenters believe that we
lack the expertise needed to set an accurate target amount. Others
argued that an expenditure target is not a reliable way to distinguish
the growth of necessary versus unnecessary services and that our
proposal would therefore have consequences not intended by the statute
(that is, affecting all services rather than only those that would be
considered unnecessary). Some commenters stated that expenditure caps
only work when they directly affect those who control the volume. These
commenters contended that a volume control measure is unfair to
hospitals because it is physicians, not hospitals, who order services
and therefore control volume. Some commenters were concerned that
adopting a volume control measure would penalize hospitals for
increases in outpatient volume attributable to technological changes
that appropriately shift service delivery from the inpatient to
outpatient setting. In addition, numerous organizations recommended
that we not implement the volume expenditure targets and control
measures because payments would be reduced to inadequate levels and
affect beneficiary access to care.
Response: We are delaying implementation of a volume control
mechanism as suggested by the ``President's Plan to Modernize and
Strengthen Medicare for the 21st Century'' (the statute does not
specify an implementation date). This delay gives hospitals time to
adjust to the PPS, and it gives us additional time to study appropriate
methods of controlling outpatient volume over the long term. We are
currently working with a contractor to study options for volume control
measures for outpatient services. In the future, before we make any
final decision, we will publish a notice in which we will discuss our
proposal and will provide a public comment period.
K. Claims Submission and Processing and Medical Review
Comment: Numerous commenters expressed a variety of concerns
related to information exchange processes required by the new PPS.
Several commenters stated that the remittance advice documents will
need to reflect all of the components used in calculating payment for
each claim, as well as possible coinsurance reductions. The commenters
also were concerned that, with the complexity of the APC system,
hospitals will need the ability to verify payment. One health system
that had experience with 3M's APGs offered the experience of their
member hospitals to assist us by providing input on the data needed by
hospitals to manage APCs. This same commenter stated that hospitals
must be given detailed instructions on claims submission, changes to
the UB-92, and changes to the Correct Coding Initiative (CCI) in
advance to ensure that systems and personnel can comply with Medicare
requirements.
Response: We released specific hospital billing instructions that
address line item reporting and reporting of service units on December
23, 1999 (Transmittals 1787 and 747). We will be issuing final
instructions for implementation of this PPS in a program memorandum to
fiscal intermediaries. The program memorandum addresses a range of
issues such as appropriate use of revenue center/HCPCS codes for
compliance with Medicare requirements and changes to Remittance Advice
messages and Medicare Summary Notices/EOMBs.
All current correct coding initiative (CCI) edits with the
exception of laboratory and anesthesiology edits have been incorporated
in the outpatient code editor (OCE) that fiscal intermediaries use to
process claims for hospital outpatient services for payment. We will
address OCE changes in a program memorandum to fiscal intermediaries.
The effective date of these edits is July 1, 2000.
We have decided not to pursue changes to the UB-92 claim form to
allow line item diagnosis because, as we discuss in section III.C.3, we
will not be using diagnosis to determine payments for clinic and
emergency visits when the PPS is first implemented. Diagnosis codes,
however, are still required to be reported on hospital outpatient
bills.
Medical Review Under the Hospital Outpatient PPS
We have received inquiries regarding the anticipated medical review
process for hospital outpatient PPS claims. The methodology of review
for outpatient claims does not change under the PPS. The goal of
medical review is to identify inappropriate billing and to ensure that
payment is not made for noncovered services. Contractors may review any
claim at any time, including requesting medical records, to ensure that
payment is appropriate. In accordance with this final rule, Medicare
will make payment under the PPS for hospital outpatient services
including partial hospitalization services; certain Part B services
furnished to inpatients who have no Part A coverage; partial
hospitalization services furnished by CMHCs; vaccines, splints, casts
and antigens provided by HHAs and CORFs that provide medical and other
health services; and splints, casts and antigens provided to hospice
patients for the treatment of a nonterminal illness. In addition, we
expect focused reviews will include the adjustments we have made to the
hospital outpatient PPS as a result of the enactment of the BBRA 1999,
especially the transitional pass-through payments for innovative drugs,
biologicals, and medical devices that are discussed in section III.D.
Fiscal intermediaries will continue focused and random review of
services such as ambulance, clinical diagnostic laboratory, orthotics,
prosthetics, take home surgical dressings, chronic dialysis, screening
mammographies, and outpatient rehabilitation (physical therapy
including speech language pathology and occupational therapy) even
though these services are excluded from the scope of services paid
under the hospital outpatient PPS.
L. Prohibition Against Administrative or Judicial Review
Section 1833(t)(9) of the Act, as added by the BBA 1997, prohibits
administrative or judicial review of the development of the PPS
classification system, the groups, relative payment weights, wage
adjustment factors, other adjustments, volume control methods,
calculation of base amounts, periodic control methods, periodic
adjustments, and the establishment of a separate conversion factor for
cancer hospitals. Section 201(a) of the BBRA 1999 redesignates this
section as section 1833(t)(11) of the Act, and section 201(d) of the
BBRA 1999 amends the section by adding the following to the list of
adjustments subject to the limitation on judicial review: the factors
used to determine outlier payments, that is, the fixed multiple, or a
fixed dollar cutoff amount; the marginal cost of care, or applicable
total payment percentage; and the factors used to determine additional
payments for certain medical devices, drugs, and biologicals such as
the determination of insignificant cost, the duration of the additional
payments, the portion of the outpatient PPS
[[Page 18504]]
payment amount associated with particular devices, drugs, or
biologicals, and any pro rata reduction. Section 202(a) of the BBRA
1999 further redesignates section 1833(t)(11) as section 1833(t)(12).
IV. Provider-Based Status
A. Background
The Medicare law (section 1861(u) of the Act) lists the types of
facilities that are regarded as providers of services, but does not use
or define the term ``provider-based.'' However, from the beginning of
the Medicare program, some providers, which we refer to in this section
as ``main providers,'' have owned and operated other facilities, such
as SNFs or HHAs, that were administered financially and clinically by
the main provider. The subordinate facilities may have been located on
the main provider campus or may have been located away from the main
provider. In order to accommodate the financial integration of the two
facilities without creating an administrative burden, we have permitted
the subordinate facility to be considered provider-based. The
determination of provider-based status allowed the main provider to
achieve certain economies of scale. To the extent that overhead costs
of the main provider, such as administrative, general, housekeeping,
etc., were shared by the subsidiary facility, these costs were allowed
to flow to the subordinate facility through the cost allocation process
in the cost report. This was considered appropriate because these
facilities were also operationally integrated, and the provider-based
facility was sharing the overhead costs and revenue producing services
controlled by the main provider.
Before implementation of the hospital inpatient PPS in 1983, there
was little incentive for providers to affiliate with one another merely
to increase Medicare revenues or to misrepresent themselves as being
provider-based, because at that time each provider was paid primarily
on a retrospective, cost-based system. At that time, it was in the best
interest of both the Medicare program and the providers to allow the
subordinate facilities to claim provider-based status, because the main
providers achieved certain economies, primarily on overhead costs, due
to the low incremental nature of the additional costs incurred.
In the proposed rule, we pointed out the increase of provider-based
facilities and the financial and organizational incentives for that
increase since 1983. A variety of factors such as the emergence of
integrated delivery systems and the pressure to enhance revenues have
combined to create incentives for providers to affiliate with one
another and to acquire control of nonprovider treatment settings, such
as physician offices.
We noted in the proposed rule that it is essential that we make
decisions regarding provider-based status appropriately, and that we
have clear rules for identifying provider-based entities. By failing to
distinguish properly between provider-based and free-standing
facilities or organizations, we risk increasing program payments and
beneficiary coinsurance with no commensurate benefit to the Medicare
program or its beneficiaries and we jeopardize the delivery of safe and
appropriate health care services to our beneficiaries.
Although there is no direct statutory requirement to maintain
explicit criteria for determination of provider-based status, there are
statutory references acknowledging the existence of this payment
outcome. For example, section 1881(b) of the Act provides for separate
payment rates for hospital-based ESRD facilities. There is currently no
general definition of ``provider-based facility'' in the CFR. However,
in the proposed rule, we cited issuances that do contain provisions for
recognition of specific types of entities as provider-based, including
Program Memorandum A-96-7, published on August 27, 1996, which pulled
together instructions for specific entity types from previously
published documents and consolidated them into a general instruction
for the designation of provider-based status for all facilities or
organizations. That Program Memorandum was subsequently reissued,
without substantive change, as Program Memoranda A-98-15 and A-99-24
and, in October 1999, was manualized by the Provider Reimbursement
Manual, Part I, Transmittal 411 (adding new section 2446), and the
State Operations Manual, Transmittal 11 (replacing previous section
2003 and adding new section 2004). Our policy will continue to follow
the principles we articulated in Program Memorandum A-96-7 and the
Provider Reimbursement Manual and State Operations Manual sections
cited above until October 10, 2000. After that date, we shall apply the
policies set forth in these final regulations.
B. Provisions of the Proposed Rule
We announced our intention to implement Secs. 413.24(d)(6)(i) and
(ii), 413.65, 489.24(b), and 498.3, as revised based on our
consideration of public comments, with respect to services furnished on
or after 30 days following publication of a final rule. We describe
these sections below and explain that we have now provided a 6-month
delay in the effective date of the regulations on provider-based
status.
We proposed to add a new Sec. 413.65 on the determination of
provider-based status. In paragraph (a), we proposed to define the
following terms: department of a provider, free-standing facility, main
provider, provider-based entity, and provider-based status. In
paragraph (b), we proposed that a facility or organization would not be
entitled to be treated as provider-based simply because it or the
provider believe it to be provider-based. The facility or organization,
or the provider, would have to contact HCFA and obtain an affirmative
provider-based determination before billing of the facility's or
organization's costs through the main provider, or inclusion of those
costs on the main provider's cost report, is initiated. Further, we
proposed to presume a facility not located on the campus of a hospital
and used as a site of physician services of the kind ordinarily
furnished in physician offices to be a free-standing facility unless we
determined it to have provider-based status.
We proposed to require, in paragraph (c), that a main provider that
acquires a facility or organization for which it wishes to claim
provider-based status must report its acquisition of the facility or
organization to us if the facility or organization is off the campus of
the main provider, or is located on the campus of the main provider
and, if acquired, would increase the main provider's costs by 5 percent
or more. The main provider must also furnish all information needed for
a determination as to whether the facility or organization meets the
criteria in this section for provider-based status. A main provider
that has had one or more facilities or organizations determined to have
provider-based status also must report to us any material change in the
relationship between it and any department or provider-based entity,
such as a change in ownership of the entity or entry into a new or
different management contract, that could affect the provider-based
status of the department or entity.
In paragraph (d), we proposed the requirements for a determination
of provider-based status. In paragraph (d)(1), we proposed to set forth
licensure requirements for facilities or organizations seeking
provider-based status.
In paragraph (d)(2), we proposed to require that a facility or
organization be
[[Page 18505]]
under the ownership and control of the main provider.
In paragraph (d)(3), with respect to administration and direct
supervision of the main provider, we proposed to require that a
facility or organization seeking provider-based status have a reporting
relationship to the main provider that is characterized by the same
frequency, intensity, and level of accountability that exists in the
relationship between the main provider and one of its departments.
In paragraph (d)(4), we proposed that a facility or organization
seeking provider-based status and the main provider share integrated
clinical services, as evidenced by privileging of the professional
staff of the department or entity at the main provider, and the main
provider's maintenance of the same monitoring and oversight of the
department or entity as of other departments. Also, the medical
director of the department or entity would be required to maintain a
day-to-day reporting relationship with the chief medical officer (or
equivalent) of the main provider, and be under the same supervision as
any other director of the main provider.
In paragraph (d)(5), we proposed to require that the department or
entity and the main provider be fully financially integrated within the
main provider's financial system, as evidenced by the sharing of income
and expenses. The department's or entity's costs should be reported in
a cost center of the provider, and the department's or entity's
financial status should be incorporated into, and readily identifiable
in, the main provider's trial balance.
In paragraph (d)(6), we proposed to require that the main provider
and the facility seeking status as a department of the provider be held
out to the public as a single entity, so that when patients enter the
department they are aware that they are entering the provider and will
be billed accordingly. (This requirement would not apply to a provider-
based entity that is itself a provider, such as a SNF.)
In paragraph (d)(7), we proposed to require that the department of
a provider or provider-based entity and the main provider be located on
the same campus, except where requirements relating to service to the
same patient population are met.
Paragraph (e) would specifically prohibit the approval of provider-
based status for any proposed department or entity that is owned by two
or more providers engaged in a joint venture.
In proposed paragraph (f), we proposed to state that facilities or
organizations operated under management contracts would be considered
provider-based only if specific requirements are met related to: Staff
employment, administrative functions, day-to-day control of operations,
and holding of the management contract by the provider itself rather
than by a parent organization.
In proposed paragraph (g), we proposed to specify nine obligations
of hospital outpatient departments and hospital-based entities. We
explained that these obligations ensure that facilities seeking
recognition as hospital outpatient departments or hospital-based
entities are in fact what they represent themselves to be, and are not
simply the private offices of individual physicians or of physicians in
group practices.
We also proposed to preclude any facility or organization that
furnishes all services under arrangements from qualifying as provider-
based. We believe the provision of services under arrangement was
intended to be allowed only to a limited extent, in situations where
cost-effectiveness or clinical considerations, or both, necessitate the
provision of services by someone other than the provider's own staff.
The ``under arrangement'' provision in section 1861(w)(1) of the Act
and Sec. 409.3 is not intended to allow a facility merely to act as a
billing agent for another.
Proposed paragraph (h) states that, if we learn of a provider that
has inappropriately treated a facility or organization as provider-
based, before obtaining our determination of provider-based status, we
would reconsider all payments to that main provider for those periods
subject to reopening, and we would investigate to determine whether the
designation was appropriate.
In proposed paragraph (i), we would apply the principles in
paragraph (h) to situations involving inappropriate billing for
services furnished in a physician's office or other facility or
organization as if they had been furnished in a hospital outpatient or
other department of a provider or in a provider-based entity.
We also proposed to add a new paragraph (j) that would allow us to
review past determinations. If we find that a designation was in error,
and the facility or organization in question does not meet the
requirements of this section, we will notify the main provider that the
provider-based status will cease as of the first day of the next cost
report period following notification of the redetermination.
In addition, we proposed to add to Sec. 413.24(d) new paragraphs
(6)(i) and (6)(ii) to clarify that main providers, in completing their
Medicare cost reports, may not allocate overhead costs to the provider-
based or other cost centers that incur similar costs directly through
management contracts or other arrangements. These changes are needed to
prevent misallocation of management costs, which would result in
excessive payment to those types of providers paid on a reasonable cost
basis.
To provide an administrative appeals process for entities that have
been denied provider-based status, we proposed to revise the
regulations on provider appeals at Sec. 498.3. As revised, these rules
would specify that a provider seeking a determination that a facility
or an organization is a department of the provider or a provider-based
entity under proposed Sec. 413.65 would be included in the definition
of ``prospective provider'' for purposes of part 498, and would be
afforded the same appeal rights as a prospective provider, such as a
hospital or SNF, that we have found not to qualify for participation as
a provider.
C. Comments and Responses
In response to our proposals, we received approximately 120 letters
of comment, most of which raised a number of issues. Included among the
commenters were hospitals and hospital and other provider associations,
physicians, attorneys, and other individuals. Here we respond to
comments submitted on the proposed rule.
General Comments
Many comments were not directed to a specific provision or
criterion, but concerned the implementation of the regulations or the
application of provider-based criteria to specific types of facilities.
These are summarized below.
Effective Date
Comment: A commenter requested clarification as to when the parts
of the final rule setting forth criteria for provider-based status
would be effective, and a number of commenters requested an extended
grace period or a delay in effective date of the final rules, with some
commenters requesting delays as long as 12 to 18 months. Various
reasons were cited, including the pressures on providers to prepare
their systems and staff for the outpatient PPS, the need to bring
operations into compliance with the provider-based criteria, and the
anticipated workloads of HCFA regional offices that may
[[Page 18506]]
receive a large number of requests for provider-based determinations.
Commenters argued that it is unrealistic to expect that a hospital
would engage in a full-blown analysis of its provider-based
arrangements and modify each arrangement until it knows against which
exact criteria it is measuring those arrangements. Any changes in
status will require hospitals to implement billing and other
operational changes. Thus, commenters argued that it is not reasonable
to expect hospitals to complete such steps within a 30-day period.
Response: We agree, and are providing a delay in the effective date
until October 10, 2000. Moreover, as stated in our response to comments
on proposed Sec. 413.65(j) below, any redetermination of provider-based
status that finds the facility or organization not to be provider-based
will not take effect for at least 6 months after the date the provider
is notified of the redetermination.
Application to Specific Facilities
Comment: One commenter stated that under the Balanced Budget Act of
1997 (the BBA 1997) long-term hospitals established on or before
September 30, 1995 are entitled to retain their long-term hospital
classification notwithstanding their location in the same building or
campus of another hospital. In the commenter's view, these hospitals
should not now have this classification revoked by this proposed
regulation.
Response: The provision referred to by the commenter, section
4417(a) of the BBA 1997, is codified in section 1886(d)(1)(B) of the
Act and is implemented under regulations at Sec. 412.22(f). That
provision authorizes certain hospitals to continue being excluded from
the Medicare hospital inpatient prospective payment system (PPS) based
on their exclusion status and configuration on or before September 30,
1995, even though they would not otherwise qualify for this exclusion.
The criteria for provider-based status do not conflict with or even
directly relate to the section 4417(a) provision, and we have therefore
not made any change in the regulations based on this comment.
Comment: The commenter believes that rural health clinics (RHCs)
should be exempted from provider-based designation requirements if they
meet the intent of the enabling regulation. The commenter requested
that an RHC be granted provider-based status if it meets one of the
following criteria: Is the sole source of primary care for the
community; has traditionally served the community with an open door
policy; or treats a disproportionate share of the community's Medicare
and Medicaid population.
Response: We share the commenter's concern, but believe the
criteria suggested are overly inclusive and could lead to a
proliferation of RHCs in areas where there are no true shortages of
care. While we do not believe a blanket exemption from the criteria is
warranted, we have developed a special provision for RHCs affiliated
with small rural hospitals, as described below in our responses to
comments on Sec. 415.65(d)(7), Location in immediate vicinity.
Comment: A commenter stated that there may be instances where the
Medicare regulations related to provider-based definitions conflict
with the Medicaid provider-based regulations, and asked whether
Medicaid will be required to comply with the new Medicare provider-
based regulations.
Response: Because hospitals under Medicaid are required to meet the
same standards as Medicare facilities, these final rules would affect
the Medicaid definition of these facilities as well as the Medicare
definitions.
Comment: Commenters stated that the reasons cited for establishing
provider-based requirements that are found in the preamble do not apply
to clinical laboratories and thus these requirements should not apply.
The commenters asked that we explicitly state in the final regulations
that the provider-based requirements are not applicable to clinical
laboratories. They believe the regulations have little bearing where,
as with clinical laboratory services, reimbursement is under a fee
schedule amount, and neither the Medicare program nor the beneficiary
will pay anyone differently as a result of the treatment of the
laboratory in the manner proposed.
Response: As explained more fully in the preamble to the proposed
rule, our objective in issuing specific criteria for provider-based
status is to ensure that higher levels of Medicare payment and
increases in beneficiary liability for deductibles or coinsurance
(which can all be associated with provider-based status) are limited to
situations where the facility or organization is clearly and
unequivocally an integral and subordinate part of a provider. Under
this principle, we agree with the commenter's view that it would not be
either necessary or appropriate to make provider-based determinations
with respect to facilities or organizations if by law their status
(that is, provider-based or free-standing) would not affect either
Medicare payment levels or beneficiary liability. However, we believe
that it is not necessary to specify in the regulations that specific
facility types are excluded, since these facilities or organizations
are unlikely to seek a provider-based determination. We will be careful
to clarify this policy in program operating instructions.
Comment: A commenter stated that the proposed provider-based
requirements seem to preclude the possibility of a Comprehensive
Outpatient Rehabilitation Facility (CORF) meeting these new
requirements. The commenter believes that in the past, CORFs have been
permitted to be either provider-based or free-standing and asked
whether the final rules will give CORFs the option of being either
free-standing or provider-based.
Response: As explained more fully in the preamble to the proposed
rule, our objective in issuing specific criteria for provider-based
status is to ensure that higher levels of Medicare payment and
increases in beneficiary liability for deductibles or coinsurance
(which can all be associated with provider-based status) are limited to
situations where the facility or organization is clearly and
unequivocally an integral and subordinate part of a provider. We are
aware that, under the cost-based payment system that applied to CORFs
prior to January 1, 1999, approximately 17 percent of participating
CORFs claimed provider-based status. However, effective January 1,
1999, in accordance with the BBA 1997, payment for all CORF services is
made no longer on the basis of cost reimbursement but on the basis of
the physician fee schedule. Beneficiary liability is also determined
under the fee schedule, regardless of the organizational structure or
affiliations of the CORF. The switch to fee schedule payment from a
cost-based system eliminates or removes any payment incentives to be a
provider-based rather than a free-standing CORF. Thus, as in the case
of the preceding comment, we agree with the commenter's view that it
would not be either necessary or appropriate to make provider-based
determinations with respect to facilities or organizations if by law
their status (that is, provider-based or free-standing) would not
affect either Medicare payment levels or beneficiary liability. We also
note that existing regulations at Sec. 413.174 specify rules for
determining whether ESRD facilities are independent or hospital-based,
and we have revised Sec. 413.65(a) to state that determinations with
respect to ESRD facilities will continue to be made under Sec. 413.174,
[[Page 18507]]
not Sec. 413.65. However, we believe that it is not necessary to
specify in the regulations that most specific facility types are
excluded, since these facilities or organizations are unlikely to seek
a provider-based determination. We will be careful to clarify this
policy in program operating instructions.
Application to Specific Facilities--Indian Health Service (IHS)
Comment: Several commenters requested an exception or exemption
from the rules for IHS and tribal facilities. One commenter was
concerned that the implementation of these proposed regulations will
have the effect of denying Medicare participation as provider-based
entities to a number of IHS facilities that are currently operated by
Indian tribes under the auspices of Public Law 93-638. They will also
cause a disruption of the coordinated health care delivery system(s)
that exist between IHS and numerous tribes, and jeopardize statutorily
authorized contracting and compacting relationships between the IHS and
these tribes due to the conflict between these proposed regulations and
the statutory opportunities for self-determination by the Indian
tribes. The IHS strongly recommended that these proposed regulations
not apply to IHS and tribal health systems as written. Recommendations
were also made to deem satellite facilities within a discrete Indian
reservation as meeting the definition of a provider-based entity as
well as satellite facilities within a historical service unit. Finally,
the IHS recommended that the current system be ``grandfathered'' to
meet the definition of provider-based entity.
Response: We share many of these concerns and have provided special
treatment for IHS and tribal facilities as described below.
Comment: A commenter was concerned that the proposed regulations
would severely restrict a number of IHS satellite clinics from
receiving reimbursement for the provision of Medicare Part B services.
The commenter believes that a number of the requirements that must be
met before an entity can be designated as provider-based for Medicare
payment purposes are unrealistic for IHS satellite clinics, which are
often the only Medicare providers on remote tribal lands. The commenter
recommended that HCFA provide for an exemption for IHS satellite
facilities that are generally located on a main hospital campus or
within a short distance of a hospital. Also, the commenter recommended
that the final rule clarify that IHS and tribal outpatient departments
or satellite clinics are eligible to receive designation as a
department of a provider or a provider-based entity and are eligible
for Part B reimbursement.
Response: We share many of these concerns and have provided special
treatment for IHS and tribal facilities as described below.
Comment: Many tribes have acquired operations of outpatient
facilities and are in the process of acquiring the affiliated
hospitals. The commenter stated that this trend, coupled with the
complexities of the Indian Self-Determination Act (Pub. L. 93-638), the
Indian Health Care Improvement Act (Pub. L. 94-437), and a moratorium
on tribal compacting and contracting, requires special consideration by
HCFA. The commenter requested that facilities be recognized as
provider-based if--
(1) The outpatient facility is owned and operated by the tribe that
owns the majority of the tribal shares utilized in funding the main
hospital;
(2) The tribe has previously compacted programs that were
historically administered by the hospital and are now administered
through a committee or board comprised of medical staff of both
facilities;
(3) The outpatient facility is in the same State as the hospital;
(4) There is coordination and integration of services, to the
extent practicable, between the outpatient facility seeking provider-
based status and the main provider.
Response: We recognize that the provision of health services to
members of Federally recognized Tribes is based on a special and
legally recognized relationship between Indian tribes and the United
States Government. To address this relationship, the IHS has developed
an integrated system to provide care that has its foundation in IHS
hospitals. Because of these special circumstances, not present in the
case of private, non-Federal facilities and organizations that serve
patients generally, we agree that it would not be appropriate to apply
the provider-based criteria to IHS facilities or organizations or to
most tribal facilities or organizations. Therefore, we have revised the
final rule to state that facilities and organizations operated by the
IHS or Tribes will be considered to be departments of hospitals
operated by the Indian Health Service or Tribes if, on or before April
7, 2000, they furnished only services that were billed as if they had
been furnished by a department of a hospital operated by the Indian
Health Service or a Tribe and they are: (1) owned and operated by the
IHS; (2) owned by the Tribe but leased from the Tribe by the IHS under
the Indian Self-Determination Act in accordance with applicable
regulations and policies of the Indian Health Service in consultation
with Tribes: or (3) owned by the IHS but leased and operated by the
Tribe under the Indian Self-Determination Act in accordance with
applicable regulations and policies of the Indian Health Service in
consultation with Tribes. Facilities or organizations that are neither
leased nor owned by the IHS would not be eligible for this special
treatment, even if operated on Tribal land by members of the Tribe.
These facilities would, of course, be eligible to participate in
Medicare as FQHCs if applicable requirements in our regulations at 42
CFR part 405, subpart X are met. We did not adopt the conditions
recommended by one commenter because we believe they may not apply to
all Tribes.
Application to Specific Facilities--Federally Qualified Health Centers
(FQHCs)
Comment: A commenter stated that despite specific acknowledgment of
the eligibility of FQHCs to qualify as provider-based entities, certain
proposed ownership, governance, and supervision criteria in connection
with the determination of provider-based status would effectively
prohibit entities from maintaining concurrent provider-based and FQHC
designations. The commenter believe the criteria should be modified, or
some other special provision created, to allow FQHCs to be departments
of a provider.
Response: We understand the commenter's concerns and have provided
special treatment for FQHCs as described below.
Comment: The commenter, a hospital that is affiliated with a number
of off-site community health centers, believes the criteria in the
proposed rule would deny provider-based status to community controlled,
urban tax-exempt health centers operated under the license of a ``main
provider.'' Several of the commenter's health centers are FQHCs that
must fulfill certain criteria to maintain this status. In the
commenter's view, it is not feasible to require the ``main provider''
to own and control these health centers or to require that the health
centers and the ``main provider'' strictly meet all of the requirements
set forth in the proposed rule. The commenter asked that the final rule
be revised to take into account these historical relationships and
``grandfather'' the provider-based status of health centers that have
been on the license of a disproportionate share hospital for at least
10 years. The recommended ``grandfathering''
[[Page 18508]]
provisions also could, in the commenter's view, require common Joint
Commission on Accreditation of Healthcare Organizations (JCAHO)
accreditation, integration of clinical care committees, main provider
approval of clinical guidelines and protocols, and financial oversight
and review by the main provider.
Response: We share many of these concerns and have provided special
treatment for FQHCs as described below.
Comment: A commenter requested that we provide a transition period
of at least five years for health centers that have been treated as
provider-based entities for a significant period of time (for example,
10 years or more), so that the centers will have adequate time to
achieve compliance with the provider-based criteria. In the commenter's
view, an extended time period for compliance would permit continuity of
care to the populations served by the health centers while granting the
affected health centers an opportunity to find alternative funding
streams.
Response: We recognize that FQHC qualification criteria effectively
require these facilities to be governed by community-based boards
independent of hospitals and other providers, while our provider-based
criteria require facilities seeking provider-based status to be
operated under the ownership and control of the main provider, and to
be under the direct supervision of that provider. This does not
preclude an FQHC from participating in Medicare as a free-standing
entity; on the contrary, this participation is entirely appropriate.
However, it does preclude the facility from qualifying as a department
of a hospital or other provider under our criteria.
Despite the difference between HRSA and HCFA requirements, we are
aware that some FQHCs may have been treated by hospitals as departments
for purposes of Medicare and Medicaid billing, and we are concerned
that an abrupt change in status for them could force some or all to
close, leading to shortages of care in some areas. Therefore, we plan
to establish special provisions for FQHCs and FQHC ``look-alikes''
(facilities that are structured like FQHCs and meet all requirements
for grant funding, but have not actually received these grants).
Specifically, we have revised the regulations to state that if a
facility has since April 7, 1995 furnished only services that were
billed as if they had been furnished by a department of a provider and
either (1) received a grant before 1995 under section 330 of the Public
Health Service Act or, before 1995, received funding from such a grant
under a contract with the recipient of such a grant and meets the
requirements to receive a grant under section 330 of the Public Health
Service Act; or (2) based on the recommendation of the PHS, was
determined by HCFA before 1995 to meet the requirements for receiving
such a grant, the facility will continue to be treated, for purposes of
this section, as a department of the provider without regard to whether
it complies with the criteria for provider-based status in Sec. 413.65.
We note that both types of facilities would be obligated, for as long
as they are treated as a department of a provider, to comply with the
applicable requirements for departments of providers as stated in
Sec. 413.65(g).
Application of Standards
Comment: One commenter believes that the proposed rule did not make
clear how it would apply to existing entities, because some language in
the rule could be read to require that existing entities would not
receive provider-based status until we have issued a determination
letter. Another commenter requested that we clarify whether we expect
to review all clinics prospectively or just new clinics. The commenter
stated that requirements that only new clinics seek designation does
not preclude us from auditing currently designated clinics. Another
commenter asked if there will be a set time frame during which current
providers with provider-based departments or entities under Program
Memorandum A-96-7 must contact us and receive an official designation
in order to continue billing as they currently do. More specifically,
the commenter asked whether, if there is such a time frame, compliance
with the criteria in the Program Memorandum would constitute a good
faith effort as referred to in Sec. 413.65(i)(2). Additional guidance
was also requested as to what providers should do now to demonstrate
that they have made a good faith effort.
Response: We plan to review all new requests for provider-based
status. At present, we have no plans to systematically review all
providers to determine whether they may be claiming provider-based
status for some facilities or organizations inappropriately. However,
we will review the status of specific facilities or organizations in
response to complaints or any other credible information that indicates
that provider-based status requirements are not being met. If the
regional office determines that this is the case, it will take action
in accordance with the rules in new Sec. 413.65(h) and (i). In response
to the comment about possible retroactive application of the new
regulations, we note that they will apply only on or after their
effective date of October 10, 2000. We will not apply the provider-
based criteria in the new regulations to periods prior to that date; on
the contrary, decisions for such periods will be reviewed only under
the criteria in effect at the time, as stated in Program Memoranda and
the Provider Reimbursement Manual and State Operations Manual.
Comment: Two commenters pointed out the proposed rules do not state
whether the required approval status is retroactive to when the
provider applied or to when we granted approval. These commenters
believe it should be retroactive to the date of the provider's
application for the determination.
Response: We plan to make provider-based status applicable as of
the earliest date on which a request for provider-based status has been
made and all requirements for provider-based status are shown to have
been met, not on the date of our determination. Thus, if a provider
requests provider-based status for a facility on May 1 and demonstrates
that applicable criteria were met on that date, but the regional office
did not make a formal determination until June 1, the determination
would be effective on May 1.
Comment: The commenter stated that we should not have published
important provider-based policies in a Federal Register document that
some providers, such as skilled nursing facilities and home health
agencies, may not have read. The commenter recommended that we re-issue
these proposed rules separately from the proposed hospital outpatient
prospective payment rules.
Response: We do not agree that the proposed rules were published in
an obscure location. On the contrary, the number of written comments
received, many of them from providers other than hospitals, indicates
that our proposals were widely known among providers that could be
affected. Therefore, we do not intend to republish the proposed rules.
Comment: A commenter expressed concern that these provider-based
provisions are unnecessarily restrictive and will unreasonably limit
practice arrangements. The commenter went on to state that in the
current health care environment, physicians and hospitals need
flexibility to adapt to local market conditions and participate in a
variety of practice arrangements to provide cost effective, high
quality care. An unnecessary strict definition of
[[Page 18509]]
``provider-based entity'' could have a chilling effect on the evolution
of new care delivery structures that would expand access to care,
especially in rural areas.
Response: We share the commenter's concern with preserving Medicare
beneficiaries' access to care, but do not agree that the provider-based
rules will limit access. We note that the rules do not prohibit
hospitals from purchasing physician practices or taking other actions
to enhance access to care in remote rural areas; they only set minimum
standards for the type of affiliations that will be recognized for
provider-based designation.
For example, an institutional provider such as a hospital or SNF
may elect to use part of its institutional complex to house physician
offices or other facilities that provide services complementing those
of the provider. Those facilities'costs will have to be included in the
trial balance of the institutional complex, in order to allow costs to
be allocated accurately to all parts of the complex, and permit the
costs of the provider to be determined. However, inclusion of such
facilities' costs on the institutional complex trial balance does not
make the facilities provider-based. On the contrary such facilities
would have to meet the criteria in Sec. 413.65 to qualify for provider-
based status.
Comment: Different views were expressed on how much
discretion regional offices should have in applying the provider-
based criteria. One commenter asked that we make the rules as clear and
concise as possible. The commenter argued that rules allowing for great
latitude in interpretation could be dangerous for the provider
community. On the other hand, another commenter stated that we should
allow Medicare regional offices greater latitude for determining when
sufficient integration exists for a facility to qualify as provider-
based, and should avoid adopting regulations that ``micro-manage'' a
hospital's operations. Another commenter suggested that rather than
requiring that all criteria must be met to achieve provider-based
status, we change the test to substantially all. There may be
circumstances where criteria are not fully met, but an overall
assessment supports a provider-based determination. This same commenter
recommended that a ``pending'' status be incorporated into the
evaluation process, whereby hospitals not meeting the criteria for
provider-based status would be afforded an opportunity to make the
modifications necessary. Another commenter asked that instead of
meeting all criteria, we permit the regional offices to evaluate a
facility's status with respect to the main provider with input from
local government and the fiscal intermediary. Another commenter also
suggested that the standards only be enforced to the extent that they
are applicable and relevant, consistent with state laws, and relate to
practices that are subject to the control of the particular provider.
Response: We have tried to balance the need to apply standards that
can be adapted to fit particular circumstances, and agree that the
standards should not be overly prescriptive, but rely on regional
judgment to ensure appropriate decision making. Because provider-based
status is a matter of extreme importance to many facilities, published
standards provide a basis for advance assessment and planning of
particular organizational and financial arrangements. Therefore, we
have decided that a facility or organization will be found to be
provider-based only when it is in compliance with all standards set
forth in these final rules.
With respect to the comment regarding situations in which all but a
few criteria for provider-based status are met, we note that nothing
prohibits the main provider from re-applying for approval of provider-
based status for a facility or organization after having made the
changes necessary to come into compliance. Regional offices would in
such cases only need to verify compliance with whatever criteria had
not been previously met, unless the amount of time that elapses between
requests, or other factors, make a full re-evaluation necessary.
Because facilities have this flexibility under the rules as proposed,
we did not make any changes based on this comment.
Comment: One commenter believes that we had not fully addressed the
impact of these rules on service delivery. The commenter suggested that
changes would affect deemed status, survey and certification
requirements, state licensure requirements, physician referral
requirements, and a host of related issues. Another commenter stated
that the new requirement regarding administration and supervision found
in Sec. 413.65(d)(3) could impact more than our estimated 105
providers. The commenter believes that if providers are required to
convert management firm employees to hospital employees and then revert
back when outpatient PPS becomes effective, this could impact 5,000
inpatient PPS hospitals.
Response: We again reviewed our requirements, but do not believe
they will have the far-reaching effects envisioned by these commenters.
In particular, to the extent a facility or organization that claims to
be a department of a provider must be accredited, surveyed, or licensed
as a part of that provider, or must adapt to the physician referral
requirements of the main provider, that result does not flow from the
existence of criteria for provider-based status, but instead is a
direct result of the provider's decision to claim the facility or
entity as a department. We also do not think it is reasonable to assume
that any significant number of hospitals will restructure themselves
repeatedly because of the final rules set forth below. As noted
earlier, both the proposed and final rules closely parallel policies
that have been stated explicitly on program instructions since 1996,
and we are providing a 6-month delay in effective date for the final
rule. Thus, hospitals and other providers have had ample time to assess
the impact of any changes and to make necessary adjustments in an
orderly way.
Comment: A commenter requested clarification as to how the proposed
rules would apply to two hospitals seeking consolidation into a single
provider. The commenter also asked whether two small PPS hospitals
located approximately 15 to 25 miles apart in separate towns within a
metropolitan statistical area (MSA) who wish to consolidate would be
prohibited from doing so because of patient population or licensure
requirements. Furthermore, if these two hospitals are already certified
as a single provider, would the proposed rules require them to separate
and create separate providers? Another commenter requested that the
final regulatory text state that the provider-based requirements do not
apply to any facility where there are inpatient beds since such a
facility would be viewed as a ``main provider.'' The provider-based
requirements should apply only to facilities or organizations other
than main providers.
Response: Although the Program Memorandum and proposed rules were
issued in response to situations primarily involving outpatient
facilities, we believe the policies set forth in these documents are
equally applicable to inpatient facilities, and should be applied in
the many cases in which a determination about inpatient facilities must
be made. The rules would not prohibit two previously separate hospitals
from merging to become a single provider. However, for either facility
to be considered provider-based with respect to the main provider, the
facility would have to meet the criteria
[[Page 18510]]
in this final rule. To clarify the scope of application of these
regulations, we have added a definition of ``remote location of a
hospital'' and a reference to hospital satellite facilities to
Sec. 413.65(a) Definitions, and have clarified the wording of several
later sections by including references to remote locations and
satellites. We have defined a ``remote location of a hospital'' as a
facility or an organization that is either created by, or acquired by,
a hospital that is a main provider for the purpose of furnishing
inpatient hospital services under the name, ownership, and financial
and administrative control of the main provider, in accordance with the
provisions of this section. A remote location of a hospital may not be
licensed to provide inpatient hospital services in its own right, and
Medicare conditions of participation do not apply to a department as an
independent entity. The term ``remote location of a hospital'' does not
include a satellite facility as defined in Sec. 412.22(h)(1) and
Sec. 412.25(e)(1). Hospitals may acquire remote locations by various
means, but often do so by mergers or acquisitions, in which a single
hospital purchases other, previously separate hospitals, and operates
them as remote locations that are not separately organized as
departments, but instead furnish the same types of services as the
original hospital. For example, a long-term care or other specialty
hospital might acquire one or more other hospitals, terminate their
separate participation in Medicare, but continue to use them as sites
of the same type of care as the original hospital. Satellite facilities
are currently defined in our regulations at Sec. 412.22(h)(1) (for
hospitals) and Sec. 412.25(e)(1) (for units). In general, a satellite
facility is a part of a hospital (or of a hospital unit) that provides
services in a building also used by another hospital, or in one or more
buildings on the same campus as buildings also used by another
hospital. Satellite status always involves co-location with another
hospital, while remote locations are not co-located with other
hospitals' facilities.
Comment: A commenter requested clarification that the provider-
based requirements apply only to providers who are paid under the
reasonable cost methodology. The preamble language in section VI
implies that these requirements would also apply to providers under the
outpatient PPS. The commenter believe that if this were the case, the
requirements found in Secs. 413.24(d)(6) and 413.65 would be
appropriately placed in Subchapter E (for example, Part 482, Conditions
of Participation for Hospitals).
Response: The rules set forth below are not limited in their scope
to providers paid on a reasonable cost basis but, except where
specifically stated in the text of the rules, apply to all providers
and facilities seeking Medicare payment. While many of the problems
associated with inappropriate accordance of provider-based status
relate to cost reimbursement, the different payment systems used for
various providers may produce some unintended incentives for one type
of facility to gain an unfair payment advantage by misrepresenting
itself. The specific requirements cited do not, like the Medicare
conditions of participation, implement section 1861(e) of the Act, nor
do they primarily concern patient health and safety. Therefore, we did
not adopt the suggestion that the section be relocated to part 482.
Comment: A commenter would support a provision that prohibits
hospitals from acquiring free-standing physician practices and
converting them to hospital-based entities.
Response: We understand the commenter's concern, but do not have
authority under the Medicare law to prohibit this practice. We do
believe that the rules set forth below will keep hospitals from
misrepresenting physicians' practices as hospital outpatient
departments.
Section 413.24(d)(6) Adequate cost data and cost finding: Management
contracts
Comment: The proposed cost reporting requirements state that if an
overhead administrative cost center does not perform services for the
off-site clinic or department, no costs should be allocated to that
function. The commenter pointed out that this contradicts generally
established Medicare cost reporting principles that have always
required that the administrative costs be allocated to allowed and
nonallowed cost centers.
Response: Our position, as expressed in the Provider Reimbursement
Manual, Part II, Chapter 36 for hospitals, is to allow the provider to
bypass the allocation of overhead through the cost report to avoid
inappropriate allocations. An example of this would be lab services
under arrangement, where there is obviously no administrative activity
by the main provider. Our electronic cost report systems are set up to
``skip'' that particular cost center and to re-allocate the costs to
the remaining cost centers. Likewise, where administrative costs such
as billing are performed by the subordinate provider, no billing cost
from the main provider should be allocated to that cost center from the
main provider.
Comment: Several commenters suggested clarification of ``like''
costs by adding a definition or providing examples. Also, a commenter
stated that since the main concern is costs, this provision should be
applied when management costs exceed the hospital's operating costs of
the department by 10 percent on a comparable basis. Another commenter
stated that: (1) Management services benefit only the specific
department to which they are expensed, and provide no direct services
to other hospital departments; (2) A department under the management
contract receives necessary services from other hospital overhead
departments; (3) such overhead departments do not represent duplicate
services provided under the management contract. Since management
agreements can be drastically diverse, the commenter believes this
clarification would assist in avoiding any confusion, as well as allow
for consistency with generally accepted cost finding principles.
Another commenter stated that most entities that contract to manage an
area of a hospital manage just that area. Therefore, if they offer
assistance with a particular function, it is only for that area and not
for the whole hospital. The commenter believes the same principles of
reimbursement should be applied whether the hospital provides the
service directly or contracts for the service to be provided.
Response: Examples of similar costs when management contracts
provide services also available through the main provider are the
following: billing services, computer services, accounting services,
and, possibly, general administrative staff. When the same services are
included in the administrative and general costs of the main provider,
and allocated down to subordinate cost centers or providers incurring
and reporting these same costs in the trial balance, the result is a
duplication of costs to the subordinate cost center or provider. As
long as the main provider has the ability to identify these ``like''
service costs, these costs should be re-allocated to the remaining
reimbursable and non-reimbursable cost centers in proportion to each
cost center's total costs as prescribed in the Provider Reimbursement
Manual, Part II, Chapter 36. However, if the main provider is not able
to identify the costs of these same services to permit the exclusion of
allocation to the subordinate providers or cost centers,
[[Page 18511]]
the cost of the management contract of the subordinate provider or cost
center must be reclassified to the main provider's administrative and
general cost center, and allocated down to all reimbursable and non-
reimbursable cost centers in proportion to each cost center's total
cost.
Comment: With regard to the language in paragraph (d)(6)(ii),
Medicare principles of reimbursement require that, when two entities
are related, and one contracts from the other, reimbursement for these
services is at cost due to the ``related party principle.'' The
commenter stated that the cost of a service is both direct and
indirect; Medicare reimbursement has a longstanding methodology
concerning nonrevenue producing costs and their allocation on a
provider's cost report. A separate work paper should not be required.
The appropriate methodology for stepping down administrative costs
should be based on the cost of the entity utilizing the service. The
cost of the free-standing entity must be placed on the main provider's
cost report to step down cost appropriately. Additional work papers
would allow room for error and would delay any necessary adjustments.
Response: The intent of Sec. 413.24(d)(6)(ii) was to require the
main provider to report costs of related party entities that would not
be reported through their accounting system on the main provider's
books and records, for example, trial balance. Consequently, when there
is a sharing of administrative services, for example, managerial staff,
the related entity escapes any administrative overhead allocation when
that same related entity is not reported on the main provider's trial
balance of the cost report. While the commenter is correct regarding
the proper reporting of related transactions at cost of the related
entity, this regulation section goes further to require the main
provider to develop the total cost of the related entity, utilizing and
maintaining workpapers to justify the amount to be reported, and to
report those costs by the main provider on the cost report trial
balance.
Section 413.65(a) Definitions (retitled in this final rule as Section
413.65(a) Scope and definitions)
Comment: Two commenters requested that a definition be provided for
``a provider's campus.'' A definition would be important since the
proposed regulation specifies additional requirements for off-campus
locations.
Response: We agree that location on or off a hospital's campus is
important. To provide a clear standard, we have revised the final rule
to define ``campus'' as ``the physical area immediately adjacent to the
provider's main buildings, other areas and structures that are not
strictly contiguous to the main buildings but are located within 250
yards of the main buildings, and any other areas determined on an
individual case basis, by our regional office, to be part of the
provider's campus.'' This definition would encompass not only
institutions that are located in self-contained, well-defined settings,
but other locations, such as in central city areas, where there may be
a group of buildings that function as a campus but are not strictly
contiguous and may even be crossed by public streets. This would also
allow the regional offices to determine, on a case-by-case basis, what
comprises a hospital's campus. We believe allowing regional office
discretion to make these determinations will allow us to take a
flexible and realistic approach to the many physical configurations
that hospitals and other providers can adopt.
Comment: The commenter expressed concern regarding the definition
of provider-based facilities as many hospital-owned outpatient services
are often provided with leased employees with ambulatory care
experience. It is not clear that such an arrangement would satisfy the
intent of the regulation.
Response: The regulations do not explicitly prohibit the use of
leased employees, and each situation will be evaluated relative to the
criteria in the regulations set forth below.
Comment: One commenter stated that the difference between
``department of a provider'' and ``provider-based entity'' is not clear
from the definitions given of those terms. The commenter requested that
we clarify in the regulations text whether a provider-based entity must
be certified in its own right, and what type of certification this
encompasses. The commenter also requested clarification in the
regulations text concerning whether the term ``provider'' in the
definition is intended to mean only entities that satisfy the Medicare
definition of ``provider'' contained in Sec. 400.202.
Response: We have clarified Sec. 413.65(a) to state that a
``department of a provider'' is a facility or organization that could
not by itself be qualified to participate in Medicare as a provider
under Sec. 489.2, while a ``provider-based entity'' could be so
qualified. For example, a skilled nursing facility (SNF) could be a
``provider-based entity,'' whereas an entity that furnishes ambulatory
surgical services could not be a provider-based entity, and could
participate in Medicare (for example, receive Medicare payment for
services furnished to beneficiaries), only as a department of a
provider, as a physician office, or as an ambulatory surgical center
approved by Medicare under part 416, if at all. We have further revised
the final rule to clarify that a department of a provider furnishes
services of the same type as the main provider (for example, a
department of a hospital furnishes hospital services), while a
provider-based entity furnishes services of a different type from those
of the main provider (for example, a hospital-based RHC furnishes RHC
services, not hospital services).
Comment: A commenter believes the proposed rule should be revised
for medically underserved populations and health manpower shortage
areas to allow the referral of beneficiaries back to their community
for treatment of community-based therapy providers. Therapy services
provided under such a referral would be included under the provider-
based designation.
Response: We do not oppose use of such referrals where they are
medically appropriate, but believe that referral arrangements should
not be equated to provider-based status.
Comment: A commenter questioned the requirement that services be
furnished ``under the name'' of the main provider entity. The commenter
argued that the requirement is inconsistent with the commenter's view
that health care in the late 1990s is, and in many markets must be,
``marketed'' in a highly competitive environment. The commenter's view
is that having provider-based status turn on the names used will
inevitably invite micro-management of the way the main provider's name
is used by the department or other hospital-based entity.
Response: We disagree with any suggestion that health care is
merely a generic commodity that can be repackaged under another name
for marketing purposes. On the contrary, we believe that operating
under the name of the main provider, and holding oneself forward to
patients under that name, is an important indicator of status as an
integral and subordinate part of that provider. Therefore, we did not
make any changes in the regulation based on this comment.
Section 413.65(b) Responsibility for obtaining provider-based
determinations
Comment: A commenter stated that the proposed rule does not state
clearly enough whether our approval is required in order to permit
billing each
[[Page 18512]]
time a provider sets up a new service, regardless of whether the
service is acquired, managed, new, located on the main campus, or off
the main campus. Some commenters stated that if approval is required in
all instances, it will cause a significant paperwork backlog and will
be quite costly to administer.
Response: Section 413.65(b) states explicitly that a determination
by us that a facility or organization is provider-based is required
before the main provider may treat the facility or organization as
provider-based for billing or cost reporting purposes. We recognize
that this may generate some administrative cost, but believe the cost
will be much less than the amounts that would be spent improperly if
payment were made to a free-standing facility as if it were provider-
based.
Comment: A commenter urged that the new determination process be
applied to all current as well as new hospital-based services.
Response: We have no plans at present to review all hospitals and
other providers with respect to provider-based criteria, but will look
into any situations that come to our attention in which it appears that
a facility does not meet the requirements of the new regulations but is
being treated as provider-based. If the facility or organization does
not qualify as provider-based, action will be taken as described later
in this preamble and in Sec. 413.65(i).
Comment: A commenter stated that there should be some mechanism in
place for a long-term hospital (LTH) to seek an advance determination
or advisory ruling that a proposed LTH satellite will be granted
provider-based status. Because establishing an LTH requires a huge
expenditure of time and human resources, an LTH main provider needs to
know in advance whether or not its proposed satellite will receive a
favorable provider-based determination. It is suggested that we
institute a system by which advance rulings or determinations are
available before the satellite is established.
Response: We understand the commenter's concern, but do not have
the staff or facilities to provide advance approvals of restructuring
proposals. We suggest that providers review the new criteria carefully
and avoid forms of organization that are not clearly in compliance with
them.
Comment: Two commenters suggested that we provide guidance on the
application process providers must complete in order to receive a
provider-based determination. In addition, time limits for approval of
these determinations should be established. Furthermore, existing
provider-based entities should not be required to change their billing
and accounting procedures. A commenter also asked for clarification as
to whether the intermediary and regional office is to be the contact,
and who will make the actual determination of provider-based status.
Response: We are developing an application process and intend to
have it in place and ready for use before the effective date of the
regulation. We expect that determinations of provider-based status will
be made by our regional offices. Involvement by other entities, such as
fiscal intermediaries or State survey agencies, will be for
information-gathering purposes and under the direction of the regional
office.
Comment: A commenter suggested that if a determination goes against
the provider, the provider should be given the option to come into
compliance with the requirements or file an appeal.
Response: As noted earlier, the regulations do not prohibit a
provider that meets most but not all criteria from taking action to
fully meet the criteria, thus qualifying a facility or organization for
provider-based status. In the case of a provider that believes that the
determination of the regional office is incorrect, an appeals process
is provided under part 498.
Comment: A commenter stated that the requirement in paragraph
(b)(3) establishes an adverse presumption against provider status for
``off-campus'' physician practice sites, and that the focus on
``campus'' boundaries will prove elusive, and serve no real policy
purpose.
Response: As explained later, we believe location in the immediate
vicinity is an important indicator of provider-based status, and that
location can be a good basis for identifying facilities for further
scrutiny.
Section 413.65(c) Reporting
Comment: Several commenters pointed out that the regulatory
language does not reflect the preamble language regarding off-campus
entities and the five percent increase in a provider's costs.
Response: We have revised the final rule to correct this oversight.
Comment: One commenter asked whether this language applies only to
entities that are applying for provider-based status, or also applies
to entities that have already achieved provider-based status.
Response: The requirement applies to both types of providers, but
providers that have entities with provider-based status are required to
report only newly created or acquired facilities or organizations.
Comment: Two commenters stated that the five percent and off-campus
criteria with regard to provider-based status do not take into account
the characteristics of rural and frontier areas, and could lead to
lower payments to some facilities, thus reducing the flow of Federal
money into rural areas and possibly creating a shortage of care. In
addition, considering the small budget of RHCs and other rural
facilities, 5 percent is an inappropriately low and unreasonable growth
limit.
Response: We understand the commenter's concern but do not agree
that a 5 percent threshold for reporting is too low. Therefore, we made
no change based on this comment.
Comment: A commenter asked whether this reporting requirement also
applies to all newly developed services (that is, department on the
campus of the hospital).
Response: The requirement applies to all newly developed on-campus
services that could increase the costs of the provider by 5 percent or
more.
Comment: A commenter requested clarification that a main provider
that ``creates'' as well as ``acquires'' a facility or organization is
responsible for reporting to us. The commenter also suggested specific
items to be included in the reporting and approval process. These
include specific data elements to be reported by the main provider,
specifying our component with primary responsibility; specifying our
approval process; adding a preliminary conditional approval process;
adding a specific time period for our approval; and adding requirements
for the effective date that the costs of the provider-based entity can
be included on the main provider's cost report.
Response: We have revised the regulation to clarify that it applies
to facilities or organizations created by the main provider, as well as
those ongoing operations acquired by purchase or other means. We have
not included the procedural detail requested by the commenter in
regulations, but will consider including it in program instructions.
Comment: A commenter stated that the use of the phrase ``any
material change'' in paragraph (c)(2) of this section is too vague and
open to interpretation. It is suggested that the section be revised to
clearly designate changes of ownership and new management agreements as
the only two material changes that require reporting by provider-based
entities.
[[Page 18513]]
Response: We do not agree that the range of reportable events
should be limited in this way. On the contrary, we intend to require
reporting of any change that could have a significant (``material'')
effect on compliance with the provider-based criteria.
Comment: A commenter asked if the reporting requirements are
coordinated with the notification of change of ownership requirements
at Sec. 489.18(b), where notice is to be given in advance, and whether
there should be a cross reference or clarification with respect to the
change in ownership regulation and this proposed regulation.
Response: We believe this suggestion has merit, and will consider
revising our program instructions to specify that a report under
Sec. 489.18(b) should be reviewed for its applicability to provider-
based determinations.
Section 413.65(d) Requirements
Comment: A commenter suggested that we clarify whether all
requirements, or only a majority of the requirements, must be met to
obtain provider-based status.
Response: We have revised the first sentence of paragraph (d) to
state that all of the stated requirements must be met by a facility or
organization that wishes to be classified as provider-based.
Section 413.65(d)(1) Licensure
Comment: Many commenters objected to the requirement that provider-
based facilities share a common license with the main provider unless
the State requires separate licensure for the subordinate facility. One
commenter listed several reasons for this concern. First, in the
commenter's opinion, licensure determinations may be made based on
factors that are different from those that would be important for
provider-based determinations. Another reason cited by the commenter is
that State licensure laws may vary from State to State. Some State
hospital licensure definitions are building specific, and do not
include off-site outpatient facilities, thus giving what the commenter
argues is undue weight to physical location in evaluating provider-
based status. Finally, the commenter believes that requiring common
licensure will create a situation where some States may have a large
number of provider-based entities and others will have few or none,
thus leading to inconsistent application of our rules. One commenter
recommended that the same licensure requirement be waived for States
with idiosyncratic licensure requirements. An alternative would be
accreditation with the provider as a deemed status for meeting a common
license requirement. The commenter suggested that the proposed language
could be reworded to clarify that offsite clinics would not have to be
licensed or operated under the same license as the provider in those
States that do not license them.
Response: We recognize that licensure may not be an appropriate
indicator of provider-based status in all States, and have therefore
revised the regulations to require common licensure only in States with
laws that permit common licensure of the provider and the prospective
provider-based department under a single license. This means that in
States that do not allow licensure of certain types of facilities, such
as those providing ambulatory care or those located off the provider's
main campus, the licensure criterion would not be applied. We do not
agree that JCAHO or other accreditation should be accepted in lieu of
licensure, since such accreditation may not necessarily reflect an on-
site evaluation of the prospective provider-based department. In
recognition of the fact that some hospitals are not licensed by the
State because they are Indian Health Service (Federal) hospitals or are
located on Tribal lands, we also will not apply the licensure
requirement to departments of those hospitals.
Comment: Under paragraph (d)(1) as proposed, clinics in another
State from the main provider could not be under the hospital's license.
Several commenters argued that this requirement would arbitrarily
affect rural and urban health care delivery, where the main provider is
close to a State line. A commenter recommended that close proximity be
used instead, where a hospital-based clinic is in another State from
the main provider. For urban hospitals in large metropolitan
statistical areas that cross State boundaries, the commenter believes
that the market area of the main provider should be the primary
determinant of the potential for integration with the main provider.
Response: Under the regulations as revised based on the comments
summarized above, common licensure would not be required of facilities
located across State lines if the law of the State in which the main
provider is located does not allow such licensing. However, see the
discussion, later in this preamble, of Sec. 413.65(d)(7)(ii).
Comment: A commenter pointed out that the proposed rule appears to
limit the licensure requirement to ``departments'' of the main
provider. The commenter asked whether this requirement only applied to
``provider-based entities.'' The commenter also suggested that where a
State has two licensure schemes for the same type of facility, we
should not prefer one licensure scheme over the other for purposes of
determining the provider-based status of the facility.
Response: The commenter is correct in noting that the common
licensure requirement in the proposed rule would have applied only to
provider-based departments. We did not propose to apply a common
licensure requirement to provider-based entities such as SNFs and HHAs,
because they are providers of services in their own right, and
typically would be separately licensed without regard to their
affiliation with the provider. We disagree with the commenter's view
that licensure should not be viewed as an indicator of integration. On
the contrary, our view is that if a facility could be licensed as part
of a main provider but chooses not to be, the facility cannot
reasonably be seen as an integral and subordinate part of that
provider.
Comment: With regard to the proposed requirement that states that
our determination regarding provider-based status will be based on a
State health facilities' review commission, one commenter argued that
relying on the commission's criteria for purposes of making provider-
based determinations is arbitrary and inappropriate. The commenter
believes imposing this criterion could disadvantage providers and
discourage expansion to off-site locations, thus indirectly leading to
shortages of care. Another commenter requested that there be a delay in
implementation during which time changes can be made to the
commission's definition of what rates it can regulate.
Response: We continue to believe it would be inappropriate for a
facility to claim to be separate from the provider for State rate-
setting purposes while also claiming to be an integral and subordinate
part of the provider for Medicare purposes. To allow this practice
would authorize providers to misrepresent their structures and
affiliations in whatever way will yield the highest payment. Thus, we
did not make changes to reflect the comment.
Section 413.65(d)(2) Operation under the ownership and control of the
main provider
Comment: Regarding Sec. 413.65(d)(2), the commenter suggested that
the regulations provide a separate set of criteria that would allow a
provider that is operated within one legal entity to be provider-based
to a provider that is operated within another legal entity, as long as
the two entities are under common control. Another commenter
[[Page 18514]]
stated that this ownership and control requirement is unnecessarily
rigid, since a hospital-based clinic, which was strictly an
administrative division of the hospital, might qualify while another
similar clinic, wholly owned by the hospital with slightly different
governing bodies and documents, would not be eligible.
Response: We do not agree that common control of two separate
entities by the same parent organization should be sufficient to meet a
requirement for ownership and control by the main provider. While this
arrangement may be an appropriate way to manage two separate entities,
it does not establish provider-based status for either. With respect to
the second comment, we agree that the form of administration of an
entity can determine whether or not the entity is found to be provider-
based. We believe this would be an appropriate result, since it would
help ensure that only facilities that are organized as provider-based
entities or departments of a provider are given this status.
Comment: One commenter believes it is unrealistic to require a
potential provider-based facility or organization to be owned by the
main provider and share bylaws and an identical governing body. The
commenter stated that in the present business climate an entity can
operate as a provider-based entity without meeting these criteria. It
is recommended that we replace the proposed 100 percent ownership
standard with a majority standard, require only overlapping governing
bodies, and eliminate the requirement for organization under the same
organizational documents. Another commenter believes that the key
consideration should be whether the provider is in control of the day-
to-day operations of that portion of the facility in which the provider
seeks provider-based status, and not necessarily whether the building
is 100 percent owned by the provider. The commenter believes we should
rephrase this provision to require that the operations of that portion
of the facility or organization in which the provider is seeking
provider-based status be controlled by the provider.
Response: In response to the first comment, we recognize that many
organizations enter into business relationships that involve
overlapping of ownership, governance, and applicability of bylaws.
However, this degree of collaboration does not mean that one facility
is an integral and subordinate part of another. Therefore, we made no
change based on this comment. Regarding the second comment, we wish to
clarify that it is ownership of the business enterprise, not of the
buildings or other physical assets of the enterprise, that is required
under paragraph (b)(1). We have therefore revised the regulation text
to refer to ownership of the business enterprise.
Comment: A commenter stated that the requirements contained in
paragraph (d)(2) would preclude entities that are jointly owned through
legitimate joint ventures or those separately organized subordinate
facilities from qualifying for provider-based status. Additionally, to
require the level of integration suggested by our proposed rule would
prevent providers from establishing efficient systems of delegation and
management, solely to qualify for provider-based status.
Response: We agree that this criterion would have the stated
effect. As explained further in our discussion of comments on proposed
Sec. 413.65(e), facilities operated jointly by two or more providers
cannot appropriately be considered integral and subordinate parts of
either provider. With respect to the second comment, we do not oppose
systems of operation that stress separate, decentralized operation
where this leads to greater efficiency. However, we believe such
facilities or organizations should be recognized as the separate
enterprises that they are, not considered integral and subordinate
parts of another institution.
Comment: A commenter suggested that the requirement under paragraph
(d)(2) be modified for medically underserved populations and health
manpower shortage areas.
Response: We are also concerned that our criteria not limit access
to care for any vulnerable populations and have, to avoid this
potential problem, created special provisions for FQHCs and IHS and
tribal facilities. As described later in this preamble, we have also
created an exception to the location requirements in paragraph (d)(7),
which is designed to help avoid restricting access to primary care
furnished by RHCs in remote, underserved areas. In view of these
provisions, we do not believe it is necessary to also modify our
requirement relating to ownership of the facility or organization.
Comment: A commenter stated that the proposed requirements in
paragraph (d)(2) are inherently inconsistent with section 330 of the
Public Health Service Act statutory and regulatory requirements and the
Bureau of Primary Health Care expectations necessary to obtain and
maintain section 330 funding (and FQHC status). The commenter believes
HCFA should not require FQHCs to be 100 percent owned by the main
provider or share a common governing body and common bylaws with the
main provider. The commenter also suggested that we accept appropriate
reporting relationships and satisfaction of other criteria (for
example, licensure, quality assurance, integration of certain
administrative and clinical functions, such as billing, purchasing,
retention of medical records, quality assurance and utilization review
procedures; and public awareness of the relationship between the health
center and the main provider) as a sufficient basis for provider-based
status.
Response: As described earlier, we have provided a special
transition period for FQHCs. We believe this period will be adequate to
avoid the problems envisioned in this comment.
Section 413.65(d)(3) Administration and supervision
Comment: A commenter recommended that the daily reporting
relationship stated in Sec. 413.65(d)(3) should be replaced with the
standard of having the reporting relationships have the same intensity
as on-site departments. The commenter stated that in practice at the
hospital, there may be very little day-to-day contact between medical
directors of various hospital services. Also, the commenter believes it
is unlikely that departmental directors report directly to the chief
executive officer, but rather to a chief operating officer or other
designee. Finally, the commenter argued that under the common
governance requirement, while all hospital employees are theoretically
accountable to the governing body, the accountability may be directed
through the CEO, and multiple executives may not have an independent
reporting with the board. Another commenter also believes that the
standards for the provider-based entity should mirror those of the main
facility; personnel reporting structure needs to be respected within
the regulations. Still another commenter found ``intensity'' to be a
subjective standard and asked how it will be measured.
Response: We agree that reporting need not be daily in all cases,
and have revised the final rule to state that the reporting
relationship between the facility or organization seeking provider-
based status and the main provider must have the same frequency,
intensity, and level of accountability that exists in the relationship
between the main provider and one of its departments. We agree with the
commenter that the intensity of supervision will have to be assessed on
a case-by-case basis, but do not believe
[[Page 18515]]
this will lead to imprecise or poorly reasoned decisions.
Comment: Several commenters believe that this requirement limits
the flexibility of the entity to operate efficiently and effectively in
the current environment, since hospitals frequently turn to many
specialized management companies to operate more efficiently and
effectively than with hospital resources. Another commenter stated that
whether the administrative department utilizes employees at one
location and contracts at another location should be irrelevant as long
as the function is integrated with the main provider, follows the
policies and procedures of the main provider, and is accountable to the
governing body of the main provider as is any other department. Still
another disagreed, and believes that it may be appropriate to require
that the main provider manage such contracts.
Response: We do not agree that the provision unreasonably limits
hospital flexibility. Paragraph (3)(iii)(B) explicitly allows different
management contracts to be used for the facility or organization and
the main provider, as long as the provider manages the contracts. Thus,
we did not make any changes in the proposal based on these comments.
Comment: A commenter asked whether the administrative functions
listed in paragraph (d)(3)(iii) are the only services that must be
integrated between the main provider and the subordinate facility.
Response: The commenter was correct in understanding that the
functions listed are the only administrative functions that must be
integrated. There are also requirements for integration of certain
financial functions, as described below.
Comment: One commenter posed several questions concerning this
proposed requirement. First, in a certain situation, the facility fee
is billed to the intermediary by the hospital billing department using
the provider number, while the professional fee is billed to the Part B
carrier by the faculty practice billing organization under its
physician group number. The commenter asked if the different provider
number and tax identification impact on the provider-based status, and
if there is a more appropriate way to obtain billing numbers for
hospital-based clinics. Also, the commenter asked if clinic space can
be shared by two clinics, when one is provider-based and one is free-
standing, without impacting the provider-based status of the first
clinic.
Response: In the circumstances described, the use of separate
billing and tax identification numbers for provider and physician
services would not adversely affect a facility's request for provider-
based status, since such billings are required under Medicare to be
separate in the case of services in hospitals. The question regarding
sharing of space, however, can be answered only in the context of a
specific case, and we expect that such decisions will be made by our
regional offices.
Comment: With respect to the oversight of contracts under paragraph
(3)(B)(iii)(B), several commenters stated that it is common for
hospitals to subcontract out the billing for different departments,
especially the hospital outpatient department, due to the complexity
and number of claims. These commenters stated that while it may be
appropriate to require the main provider to manage such contracts,
departments other than the billing department should be permitted to
perform this management function. One commenter suggested revising the
criterion on billing under the integration of administrative functions
to state, ``common billing or the contract for billing services is held
by the provider where it is based.''
Response: We agree that departments other than the main provider's
billing department may appropriately manage billing contracts, and have
revised the criterion to state that the contract for a provider-based
facility or organization must be managed by the main provider.
Section 413.65(d)(4) Clinical services
Comment: A commenter asked for clarification of paragraph (4)(iv)
of this section, specifically concerning whether this language would
require a Medicare certified HHA's improvement activities to be
overseen by hospital medical staff, rather than the advisory committee
as is now being done. The commenter believes that having the hospital
medical staff overseeing the quality assurance activities of a HHA may
not be appropriate or cost effective and may even slow the process of
performance changes.
Response: The commenter is correct in understanding that compliance
with this criterion would require oversight of a hospital-based HHA's
quality improvement activities by the hospital's medical staff. We do
not agree with the commenter that the outcome would be to substitute
the judgment of the hospital for the HHA's own committee or that it
would be inappropriate. The hospital conditions of participation
contain a number of separate requirements that must be read together to
make complete sense of this provision. Conditions spelled out at
Sec. 482.12 (Governing body), Sec. 482.21 (Quality assurance), and
Sec. 482.22 (Medical staff) establish a chain of accountability in a
hospital for the quality of care it provides. The requirements are
clearly applicable to any activity (for example, provider-based entity)
that is an integral part of the hospital. Thus, a quality improvement
activity of the HHA is likely to be firmly grounded in the hospital's
operating and governance fabric even when the group is ``established''
by the HHA, and staffed by employees and physicians who work primarily
in home health. We would expect the linkages to be formal (that is,
known to the governing bodies and medical staffs of both providers),
and the quality assurance mechanisms interrelated to the extent that
shared patients are the subject of the effort.
Comment: Regarding paragraph (d)(4)(v) of this provision, some
commenters requested clarification of what is meant by a ``unified
retrieval system,'' or for guidance as to what types of cross
referencing are acceptable. Another commenter asked for an explanation
of the practical expectations regarding the maintenance of medical
records. Finally, a commenter expressed support for the requirement for
a unified retrieval system (or cross references), saying the latter
system would be used in States that mandate a unified system.
Response: We would like to clarify that what is intended is that a
system be maintained under which both the potential provider-based
entity or department of a provider and the main provider have access to
the beneficiary's record, so that practitioners in either location can
obtain relevant medical information about care in the other setting. We
did not, however, make any changes in the requirement based on these
comments.
Comment: A commenter believes that functions of operations should
not be regulated to dissuade cost efficiency, and that laundry and
housekeeping would be examples where shared services may not be the
most effective manner of operation.
Response: We agree that in some cases it may be less expensive for
a facility to obtain services independently, but continue to believe
such separateness is an indicator that the facility is not an integral
and subordinate part of a provider.
Comment: With regard to paragraph (d)(4)(vi) requiring integration
of services of the main and provider-based entity, the commenter
expressed concern about the potential impact of
[[Page 18516]]
this section on a patient's freedom of choice. The commenter believes
that the entity's efforts to meet this standard would limit a patient's
freedom of choice. The commenter suggested that we clarify our position
so that providers acting in good faith will not be sanctioned for
attempting to comply with this requirement.
Response: Paragraph (d)(4)(vi) requires only that patients have
access to the services of the main provider and that they be referred
to it where the referral is appropriate. We wish to clarify that these
criteria are not intended to restrict patient freedom of choice or the
practitioner's freedom to refer patients to other locations, where
doing so will result in better care for the patient.
Section 413.65(d)(5) Financial integration
Comment: A commenter believes that Sec. 413.65(d)(5), which
requires full integration of financial operations, is too rigid. An
alternative approach is suggested that would allow managers of
provider-based entities to retain some control over both the resources
and information required to administer these units.
Response: Section 413.65(d)(5) requires that there be financial
integration of the potential provider-based facility or organization
and the main provider, but does not preclude normal management control
of resources. Thus, we made no change in the regulation based on this
comment.
Comment: A commenter stated that the criteria for common resource
usage of building, equipment, and service personnel is not even
relevant for multi-campus systems or even buildings that are across the
street from each other, much less off-site hospital outpatient
departments.
Response: Although the provider-based program memoranda required
that there be significant common resource usage of buildings,
equipment, and service personnel on a daily basis, this requirement
does not appear in the proposed rule. Thus, we made no change in the
regulation based on this comment.
Comment: One commenter stated that the requirement for financial
integration seems unnecessary in light of the requirement for 100
percent ownership by the main provider. The commenter stated that some
providers may wish to segregate the operations of certain departments
in their financial systems, and expressed the view that as long as the
costs of a department can be adequately identified on the cost report,
the practice should be acceptable.
Response: We do not believe that these two requirements are
duplicative. On the contrary, in some cases a provider may own 100
percent of another facility or organization, but not be financially
integrated with it, either because the other facility or organization
is engaged in a different, non-health care activity, or because it is
organized and operated separately from the main provider. In these
circumstances, we believe the criteria on financial integration apply
appropriately to deny provider-based status to separate facilities or
organizations.
Section 413.65(d)(6) Public awareness
Comment: Section 413.65(d)(6) requires that provider-based entities
be identified as part of the main provider organization. The commenter
did not understand the importance of this criterion, particularly when
the provider-based organization is licensed and Medicare certified
separately from the main provider.
Response: The proposed rule would not apply this criterion to
provider-based entities (which may participate separately as
providers), but only to provider-based departments. In the latter case,
we think it is not unreasonable for such a department to be expected to
identify itself with the provider of which it claims to be a part.
Section 413.65(d)(7) Location in immediate vicinity
Comment: A commenter stated that if off-site RHCs cannot be
considered provider-based, it will be much harder to deliver care in
rural areas. The commenter asked that RHCs be allowed to continue as
provider-based RHCs even though they are off campus.
Response: We continue to believe close physical proximity is an
important indicator of provider-based status. We note, however, that
paragraph (d)(7) does allow off-campus facilities to be treated as
provider-based if they meet the criterion relating to service to the
same patient population.
Comment: Many commenters believe that more specific tests of
service to the same patient population are needed. One commenter
suggested that an appropriate criterion would be that the proposed
provider-based facility or organization be located within the same
geographic area that accounts for a high percentage of patients in the
main provider. The commenter believes this test is consistent with
Program Memorandum No. 96-7 and with the qualification requirements for
sole community hospitals. Other commenters suggested that the main
provider's geographical service area be considered the area from which
the main provider drew 80 percent of its Medicare inpatients for the
previous three years.
Response: We agree that more precise criteria are needed.
Therefore, we have revised the regulations to provide that a
prospective provider-based facility or organization will be considered
to serve the same patient population as the main provider if, during
the 12-month period immediately preceding the first day of the month in
which the application for provider-based status is filed with us, at
least 75 percent of the patients served by the facility or organization
seeking provider-based status reside in the same zip code areas as at
least 75 percent of the patients served by the main provider. As an
alternative, we would consider a facility or organization to serve the
same patient population if, during the same 12-month period described
above, at least 75 percent of the patients served by the prospective
provider-based facility or organization who required the type of care
furnished by the main provider received that care from the main
provider. We require this ``same patient population'' test to be met
for the 12-month period used to support an initial determination of
provider-based status, and it must continue to be met for each
subsequent 12-month period to justify a continuation of provider-based
status. Application of population/geographic standards to newly
established facilities or organizations is discussed below.
Comment: Commenters suggested we show some flexibility with regard
to the definition of patient population for teaching hospitals. The
commenter stated that it will not always be the case that the patient
populations for the teaching program will be the same as the overall
mix or patient population for the main provider.
Response: We recognize that patient populations will not be
identical in all cases, and thus have adopted a patient population
criterion under which there may be a divergence of up to 25 percent
between the main provider and the facility or organization seeking
provider-based status. We believe this provides a reasonable allowance
for differences in patient population. Moreover, we note that under
section 1886 of the Act, Medicare provides much flexibility for
teaching hospitals in other ways, for example, under section
1886(h)(4)(E), permitting the counting of residents for purposes of
payment to teaching hospitals for the time the residents spend in
nonhospital settings.
[[Page 18517]]
Comment: Two commenters suggested that the criterion on service to
the same patient population be dropped. One commenter believes the
criterion is overly vague, could limit access to care as facilities
seek to control their service patterns, and, in general, represents a
geographically based approach that is out of keeping with modern
technology and communications. Another commenter stated that the
criterion is unclear, and providers could find it burdensome to
assemble the data to show compliance. Other commenters shared the
second commenter's concern, but instead of recommending elimination of
the criterion, they suggested that a more administrable solution would
be to use regional or state standards to define ``same geographic
area,'' such as, health systems area, a specified mileage amount, or
our wage area.
Response: As described above, we have developed a more precisely
stated test of service to the same patient population. We believe that
test will be clear and understandable, not impose unrealistic burdens
on providers, and allow provider-based designations that parallel
service patterns.
Comment: With respect to paragraph (d)(7)(i), a commenter asserted
that many currently operating facilities that are treated as provider-
based by us provide types of service that are the same as those of the
main provider, but serve patient populations from different geographic
areas. The commenter believes these entities provide care under the
direction of, and utilize substantial services from, the main provider.
An example would be the geographically separate campuses of a single
parent hospital that are located at various sites throughout a region.
The commenter suggested that such campuses be presumed to be provider-
based if they provide substantially the same services as the main
provider, do not exceed the size of the main provider, and comply with
all other provider-based requirements. Another commenter stated that
the ``same patient population'' requirement should not apply to multi-
campus long term care hospital locations. These locations are
fundamentally different from other provider-based entities that the
regulation addresses, since a long-term care hospital main provider and
its remote campus furnish the same services, and offer the same
programs of care, but operate in slightly different geographic areas.
The commenter suggested that so long as all of the strict financial and
administrative integration requirements of the proposed provider-based
regulation are satisfied, the ``same patient population'' requirements
should not apply to long-term care hospitals. The result of this
criterion would be that satellites will not be established in many
underserved areas where long term services are needed. Another
commenter believes a specialty facility, such as a long-term care
hospital, should be exempt from the geographic proximity requirement if
it can demonstrate that it will improve the quality of patient care,
and offer services that are not otherwise provided in that area.
Response: We recognize that there may be some cases in which a
hospital and another facility seeking provider-based status as a remote
location of that hospital may meet most or all other criteria in
Sec. 413.65, yet not qualify because the two facilities serve different
patient populations. However, we do not agree that this result should
lead us to abandon the ``same patient population'' test. On the
contrary, we continue to believe that criterion is a valid indicator of
provider-based status. Thus, we did not revise the regulation based on
this comment. In this context, we note that there is no Medicare rule
that would prohibit a hospital from setting up another hospital in
another area. We do not agree with the commenter's assumption that
because the program memorandum and proposed rule were issued in
response to situations primarily involving outpatient facilities, they
can apply only to such facilities. On the contrary, we believe the
policies set forth in these documents are equally applicable to
inpatient facilities, and should be applied in the many cases in which
a determination about inpatient facilities must be made. In particular,
the rules apply to remote locations of long-term care and other
hospitals that are main providers, as well as to satellite facilities
of hospitals and hospital units that are excluded from the hospital
inpatient prospective payment system. Remote locations and satellite
facilities are discussed more fully earlier in this preamble, and
``satellite facilities'' are specifically described in our regulations
in Secs. 412.22(h) and 412.25(e). (As explained in that document, we
are concerned that establishment of satellites by hospitals and units
excluded from the inpatient PPS could lead to payment abuses, such as
circumvention of certain payment caps mandated by section 4414 of the
Balanced Budget Act of 1997, and we have therefore established special
payment rules for those facilities. Facilities seeking to qualify as
``satellites'' under the inpatient payment criteria in Secs. 412.22(h)
and 412.25(e) would first need to comply with the provider-based
requirements before being eligible for satellite status.) We have
revised the final rule to clarify its application to remote locations
of hospitals and satellite facilities.
Comment: The commenter believes that flexibility in the definition
of ``located in the immediate vicinity'' needs to be met with
additional considerations when viewing rural and underserved areas; for
example, it should not be our intention to eliminate the provider-based
designation of a rural health clinic (RHC), when the purpose of the RHC
is to be an outreach to geographically isolated areas.
Response: We share the commenter's concern and have developed a
special provision for RHCs, as described below.
Comment: A commenter believes that the requirement that provider-
based entities serve the same population as the main provider could
cause significant problems for RHCs. The unique situations addressed by
hospital-based RHCs attempting to satisfy the health care needs of
medically underserved areas should be considered as exceptions to the
proposed rule.
Response: We continue to believe close physical proximity is an
important indicator of provider-based status; however, we recognize
that small rural hospitals and their RHCs may not be able to
demonstrate that a substantial number of clinic patients receive
services from the main provider. Small rural hospitals typically
provide limited inpatient care compared to their urban counterparts,
which may cause the RHC patients to seek inpatient service from other
providers. In light of this, we believe small rural hospitals (less
than 50 beds) that own and operate RHCs should not be expected to
demonstrate that they serve the same patient population as the main
provider. Therefore, we are revising the regulation to allow off-campus
RHCs affiliated with small rural hospitals (less than 50 beds) to
retain their provider-based status without satisfying that requirement.
Comment: Several commenters opposed the inclusion of paragraph
(d)(7)(ii), since they view a State border as an arbitrary boundary
inhibiting a hospital's ability to serve patients, which seems
counterproductive. They also argued that a regulation that fails to
recognize the operation of health care systems that function across
State lines is unrealistic. Another commenter suggested that we rely on
the proposal concerning serving the same patient population. It was
also stated that in one case a provider can be located in a city
[[Page 18518]]
split by the State border with its related facility located one mile
away, but in another state, while in another case, the provider and its
subordinate facility can be a mile apart and in the same State. Another
commenter believes that, since Medicare beneficiaries often cross
borders for health care services, disallowing hospitals in these areas
from establishing provider-based entities eliminates choices and
prohibits the development of new services. The commenter recommended
that we revise or eliminate this criterion. Another commenter suggested
that LTHs and their satellites not be subject to this requirement if
the main provider and its satellite are located in two contiguous
States. Alternatively, the commenter suggested that we consider using
the wage index areas as guidelines for the areas to be served by
provider-based entities even if that area crosses State lines.
Response: After reviewing these comments, we have decided to revise
the regulations to allow providers in one State to have provider-based
facilities in an adjacent State, if doing so is not inconsistent with
the law of either State, and other criteria are met, including those
related to service to the same patient population.
Comment: With regard to paragraph (d)(7)(i), while the proposed
rule permits a provider to show that a ``high percentage'' of patients
of the main provider and the facility come from the same geographic
region, new facilities would not have any historical data upon which to
base this assertion, and therefore would fail to be able to demonstrate
the criteria prior to operation. Another commenter believes the
requirement may pose an impediment to new facilities being located in
underserved or outlying areas. Thus, the commenters believe the same
patient population requirement should not apply to new facilities,
including new long-term care hospital satellites.
Response: We agree that it would be appropriate to establish a
criterion that could be met by new facilities or organizations, and
therefore have revised the final rule to include a special provision
for new facilities or organizations. Under this revision, a new
facility or organization, (one that has not been in operation for all
of the 12-month period immediately preceding the first day of the month
in which the application for provider-based status is filed with us),
may be considered to meet the criterion on service to the same patient
population, if it is located in a zip code area included among those
that (during the 12-month period described above) accounted for at
least 75 percent of the patients served by the main provider. We note
that this provision would not be limited to long-term care hospitals'
satellites or their remote locations, but would be available to all new
facilities or organizations.
Section 413.65(e) Provider-based status not applicable to joint
ventures
Comment: Several commenters expressed concern that this criterion
would prohibit the use of joint ventures for entities that want to
participate as provider-based entities, and argued that such a
prohibition would unnecessarily restrict hospital flexibility. One
believes this provision should be eliminated. Another commenter
suggested modification of paragraph (d)(2) of the rule to establish
majority ownership as the standard rather than 100 percent ownership.
Still other commenters suggested that provider-based status for
facilities or organizations run as joint ventures should be permitted,
as long as the hospital at which the facility is located has the
equipment or service under its control.
Response: We reviewed these comments carefully, but did not make
any changes in the regulations based on them. When a facility or
organization is run as a joint venture of two or more providers, it is
by definition under their joint control, and therefore cannot be an
integral and subordinate part of any individual provider. We have no
interest in discouraging such ventures, but continue to believe they do
not qualify as provider-based.
Section 413.65(f) Management contracts
Comment: Several commenters expressed the view that the criterion
under which the staff of the facility or organization must be employed
by the provider or another organization other than a management company
is too restrictive, and should be deleted. One commenter argued that,
if the written contract maintains the responsibility and control for
services in the hands of the main provider, the employer of the staff
working at the site is not relevant. Another believes the criterion
will discourage economic efficiencies. If a provider is able to
demonstrate integration and subordination of the off-site facility
based upon other provider-based criteria, the fact that a hospital
chooses to provide certain services either directly through its own
employees or indirectly through an independent contractor/management
arrangements is irrelevant. Another commenter argued that the proposed
criterion is inconsistent with: the provision of the Medicare statute
that expressly permits coverage of ``services under arrangement''; with
the hospital conditions of participation that recognize that
contractors may be used to furnish patient care services; and with the
Provider Reimbursement Manual, which recognizes that providers commonly
contract for management services and the costs of the contract services
may be allowed under Medicare principles of reimbursement. Still
another commenter believes the proposed criterion would negatively
impact the therapy profession, and could impact the health and safety
of Medicare beneficiaries.
Response: We do not believe the criterion is overly restrictive,
nor do we agree that employment of the staff of a facility or
organization is irrelevant to the question of whether that facility or
organization is an integral and subordinate part of a provider. On the
contrary, employment of the staff of such a facility or organization
will normally give the provider significant control over it, thus
promoting integration. Conversely, if a facility or organization is
staffed by personnel who are employed by another entity that has only a
contractual relationship with the provider, the facility or
organization may well be an integral and subordinate part of the
management company, not of the provider.
We also do not agree that the criterion is inconsistent with
section 1861(w)(1) of the Act, which permits providers to make
arrangements for the provision of specific health services, nor do we
believe adopting this criterion will undercut the ability of providers
to have selective services provided under arrangements. In this regard,
we point out that existing Medicare policy, stated in section 207 of
the Medicare Hospital Manual (HCFA Publication 10), emphasizes the need
for the hospital to exercise professional responsibility for the
arranged-for services, not merely to serve as a billing mechanism for
the other party. This is consistent with our view that section
1861(w)(1) was intended to allow specific health care services to be
furnished under arrangements, but was never meant to be a vehicle by
which a provider could nominally operate a facility or organization,
but, in fact, contract out its operation to another entity. Finally, we
note that while there are various sections of the hospital conditions
of participation and the Provider Reimbursement Manual that recognize
the possibility that specialized health care services or management
services may be provided under contract, this does not indicate that
providers may
[[Page 18519]]
contract out entire departments or services while claiming them as
provider-based. To clarify the scope of the requirement on contracted
services, we have revised it to state that management staff of the
facility or organization (rather than health care or support staff)
need not be employed directly by the provider. We have also revised the
rule to clarify that if staff of the facility or organization (other
than management staff) are employed by an organization other than the
management company or the provider, it must be the same organization
that also employs the staff of the main provider.
Section 413.65(g) Obligations of hospital outpatient departments and
hospital-based entities
Section 413.65(g)(1)
Because of the direct relationship between the proposed changes in
this section and those in Sec. 489.24(b), comments on both proposals
are discussed later, under Sec. 489.24(b), ``Special responsibilities
of Medicare hospitals in emergency cases.''
Comment: A commenter requested clarification as to the application
of the anti-dumping requirement in the home health setting.
Response: Section 413.65(g)(1) states that the EMTALA requirements
apply to hospital outpatient departments. EMTALA requirements would not
apply to off-campus provider-based entities that are not hospital
departments, such as home health agencies.
Section 413.65(g)(2)
Comment: While one commenter agreed with the requirement under
Sec. 413.65(g)(2) for billing of physician services with the
appropriate site-of-service indicator, another commenter also believes
there should be clarification that correct billing is the
responsibility of the entity performing the billing function. Both
commenters suggested that the hospital notify physicians who do their
own billing that they must use the correct indicator; they agree that
it should not be the responsibility of the hospital.
Response: We agree that physicians (or those to whom they assign
their billing privileges) are responsible for appropriate billing, but
note that physicians who practice in hospitals, including off-site
hospital departments, do so under privileges granted by the hospital.
Thus, we believe the hospital has a role in ensuring proper billing.
Section 413.65(g)(5)
Comment: Presently, provider-based clinics bill Medicare for the
facility charge on a UB-92 form, and the physician fee is billed
separately on a HCFA-1500 form, while other payers may accept a single
bill for both charges. A commenter believes it is inappropriate to
mandate that two bills be submitted for all patients, as long as
charges for similar services are uniform regardless of payer.
Response: As explained further below, we have revised the final
rule to eliminate the part of this criterion relating to billing of
services to non-Medicare patients. We believe this responds to this
commenter's concern.
Comment: Many commenters stated that Medicare should treat a
facility that claims a facility fee as being provider-based even when
other payers do not do so, reasoning that as long as the hospital
claims that the patient is an outpatient for Medicare purposes, the
practices of other payers, with respect to similar patients, are not
significant, and should be ignored. Another commenter believes this
requirement should be eliminated, because, in the commenter's view, it
has no bearing on the outpatient services delivered to Medicare
beneficiaries, and therefore does not affect Medicare reimbursement. To
illustrate, a large commercial insurer does not have the capability to
accept certain types of outpatient claims from hospitals; therefore, it
requires claims for those services to be billed on a physician claim
form, so hospitals will receive the proper reimbursement. If this
criteria is retained as proposed, many hospital-based departments would
not meet our criteria due to the nuances of other payers' policies,
that are often contractual issues with providers. Still another
commenter believes that we should reexamine the proposal made in
paragraph (g)(5), and at a minimum, clarify what it means by its
proposal mandating uniform ``treatment of all patients, for billing
purposes, as hospital outpatients.'' If we are proposing to mandate
that all outpatients be billed on the same basis, this would
effectively extend Medicare direct billing or rebundling rules to all
payers. In addition, this proposed requirement would not only be
contrary to past policy and practice, but would affect departments that
have differentiated billing practices. Another commenter stated that
payers typically determine payments based upon how they define a
particular service or their individual market power; Medicare
certification of outpatient departments should not be influenced by how
unrelated third parties pay for services to the patients they cover at
these sites. Moreover, this criterion would be very difficult to
implement, because hospitals can have hundreds of contracts with
insurance companies and the providers that subcontract for part of the
risk for plans.
Response: After review of the comments on this section, we have
decided to revise it to restrict the requirement for uniform billing to
Medicare patients only, thus allowing hospitals to bill other payers in
whatever manner is appropriate under those payers' rules. As revised,
Sec. 413.65(g)(6) states that hospital outpatient departments (other
than RHCs) must treat all Medicare patients, for billing purposes, as
hospital outpatients. The department must not treat some Medicare
patients as hospital outpatients and others as physician office
patients.
Comment: A commenter stated that there appears to be some confusion
as to whether this requirement applies to ``departments'' or all
facilities and organizations seeking provider-based status. Also, the
commenter asked if there is a provision of the proposed rule that
mandates that a facility fee be charged to patients of facilities and
organizations receiving provider-based status.
Response: As noted earlier, the proposed rule would not apply this
criterion to provider-based entities (which may participate separately
as providers) but only to provider-based departments. Regarding the
second issue, we have, as described in response to the preceding
comment, revised the final rule to eliminate the criterion regarding
billing of payers other than Medicare.
Section 413.65(g)(7)
Comment: A commenter stated that requiring written notice for each
patient (presumably signed by the patient), would be an overly
burdensome requirement, and requested that the requirement allow for a
clear, prominently displayed sign in lieu of individual notice. Another
commenter believes that the proposed requirement would apply a standard
to hospital outpatient departments that is not applied to any other
site of service.
Response: First, we emphasize that notice is required only for
Medicare beneficiaries, not for all patients. We recognize that
providing notice will generate some burden for the provider, but
believe that the protection it affords to patients warrants the
requirement. We considered allowing the notice requirement to be
satisfied through the posting of signs, as recommended by one
commenter, but concluded that use of individual written notices would
more effectively ensure that each
[[Page 18520]]
beneficiary receives the necessary information. In response to the
comment concerning settings other than hospital outpatient departments,
we note that in other settings, a patient is unlikely to be misled as
to what type of facility is the site of treatment, so provision of
notice is not required. To avoid confusion as to when the requirement
applies, we have revised the final rule to state that notice is
required only if the hospital outpatient department or provider-based
entity is not located on the campus of the hospital that is the main
provider. We have revised this final rule to specify that the notice
must be in writing, must be one the beneficiary can read and
understand, and must be given to the beneficiary's authorized
representative if the beneficiary is unconscious, under great duress,
or for any other reason unable to read a written notice and understand
and act on his or her own rights.
Section 413.65(g)(9) (redesignated in this final rule as Section
413.65(h), Furnishing all services under arrangement)
Comment: A commenter observed that Sec. 413.65(g)(9) does not
preclude an outpatient facility from obtaining a certain type of
service from an off-site supplier. If this is correct, if the service
is provided on-site in the hospital's outpatient facility, it is not
clear how the proposed regulations are intended to be applied. It would
appear that if the facility is looked at as a whole, all services are
not provided ``under arrangements''; therefore, paragraph (g)(9) of
this section would not preclude the facility from being recognized as
provider-based. However, in this case, the commenter stated that both
licensure and ownership requirements would be difficult to satisfy. In
most cases, that portion of the facility that is operated ``under
arrangements'' with the hospital will not be on the hospital's license,
nor will that portion necessarily be owned by the hospital. Thus, the
commenter urged that the ``under arrangements'' portion of an
outpatient facility be excluded from the licensure and ownership
analyses.
Response: We agree that where a facility offers a variety of
services, provision of a single type of service under arrangement would
not prevent the facility from meeting this criterion. The criterion
could not, of course, be met by a facility that furnished only a
specific type of service (such as physical therapy), and provided that
service only under arrangement. In the case envisioned by the second
commenter, the facility would be out of compliance with licensure and
ownership requirements, as well as the requirement involving services
under arrangement, and we would agree that it could not be provider-
based.
Comment: A commenter asked for clarification of ``under
arrangements'', in reference to our other regulations that contain
these terms. Also, the commenter requested clarification on the types
of services to which this standard applies, that is, direct patient
care as opposed to facility related services.
Response: The term ``arrangements'' is defined in section
1861(w)(1) of the Act and the Medicare regulations Sec. 409.3, in that
``arrangements'' refers to arrangements that provide that Medicare
payment made to the provider that arranged for the services discharges
the liability of the beneficiary or any other person to pay for the
services. We wish to emphasize that the provision will apply to patient
care services, not housekeeping, security, billing, or other services
that are not patient care services but are needed to support their
provision.
Section 413.65(h) Inappropriate treatment of a facility or
organization as provider-based (redesignated in this final rule as
paragraph (i))
Comment: This section establishes sanctions that may be used to
address a main provider that has treated an entity as provider-based
without our review and approval. A commenter believes that the
investigation phase should precede the review of payments to the main
provider. A commenter was also concerned that the individuals involved
in these reviews and investigations are properly trained to make the
required determinations.
Response: We believe review of payments will encompass two
activities--investigation to determine whether applicable provider-
based requirements were met, and a calculation of the amount of
overpayment if they were not. Thus, investigation necessarily precedes
recovery, but is a part of the overall effort, which is to reconsider
payment amounts. To respond more effectively to concerns about how the
review and recovery activities will occur, and to clarify the specific
actions we will take in cases of inappropriate billing, we have
reorganized paragraph (i) to deal separately with the processes of
determination and review, recovery of overpayments, and the good faith
effort exception. With respect to determination and review, we state
that if we learn that a provider has treated a facility or organization
as provider-based and the provider had not obtained a determination of
provider-based status under this section, we will review current
payments and, if necessary, take action in accordance with the rules on
inappropriate billing in paragraph (j), investigate and determine
whether the requirements for provider-based status in paragraph (d) of
Sec. 413.65 (or, for periods prior to October 10, 2000, the
requirements in applicable program instructions) were met, and review
all previous payments to that provider for all cost reporting periods
subject to re-opening in accordance with Sec. 405.1885 and
Sec. 405.1889 of this chapter. With respect to recovery of overpayments
and the good faith exception, we have clarified that we will recover
only the difference between the amount of payments that actually were
made and the amount of payments that we estimate should have been made
in the absence of a determination of provider-based status, and that
recovery will not be made for any period prior to the effective date of
these final rules if during all of that period the management of the
entity made a good faith effort to operate it as a provider-based
facility or organization, as described in paragraph (h)(3) of
Sec. 413.65. In response to the comment about the competence of
individuals involved in these activities, we wish to emphasize that we
will ensure that staff involved in these activities have the necessary
expertise.
Comment: A commenter believes that it would be unfair to apply the
proposed regulations retroactively, that is, to periods before the
effective date of the final rule. Even though paragraphs (h) and (i)
provide for a good faith exception, it is still unfair to provide that
the conditions for this exception will apply prior to the effective
date of the final regulation. The commenter requested that these
sections be revised to provide that the period of recovery will not
extend to any period prior to the effective date of the final
regulations. Another commenter also believes that any payment changes
be prospective (unless the hospital did not make a good faith effort to
operate the site as provider-based).
Response: We agree that it would be inappropriate to apply the
rules in paragraph (h) to any period prior to their effective date, and
have revised the final rule to clarify that for such periods, we will
make determinations based on the program memoranda or other
instructions in effect at the time. However, the criteria in paragraph
(i) that form the basis for a good faith exception were in effect prior
to the issuance of these regulations. Regarding
[[Page 18521]]
the last comment, we cannot agree to ignore possible overpayments
resulting from noncompliance with published criteria in effect at that
time.
Comment: A commenter believes that the term ``good faith effort''
should be defined to provide more direction and opportunity to comply.
Also, entities making ``good faith efforts'' should be given an
opportunity to correct those factors or criteria that render it out of
compliance with the provider-based requirements.
Response: The conditions under which a provider will be found to
have made a good faith effort were clarified in Sec. 413.65(i)(2), and
have been restated in the final rule.
Section 413.65(i) Inappropriate billing (redesignated in this final
rule as paragraph (j))
Comment: A commenter believes that suspending all payments for
outpatient services to facilities that have billed inappropriately as
provider-based entities until the provider can demonstrate that
payments are proper is too onerous. Instead, the commenter suggested
that we consider suspending the reimbursement differential between a
provider-based entity and a nonprovider-based entity until a
determination is made or the facility has had a reasonable opportunity
to comply.
Response: We understand the commenter's concern and have revised
the final rule to authorize partial suspension of payment (that is, a
reduction in payment) to the extent needed to prevent creation of an
overpayment to the provider. This rule will allow payment to continue
at a reduced rate, thus avoiding creation of financial hardship for the
provider. To describe more clearly how we will deal with instances of
inappropriate billing, we have reorganized paragraph (j) of Sec. 413.65
to spell out more clearly the actions we will take, and the extent to
which payment will be adjusted. Specifically, we state that if we find
that a facility or organization is being treated as provider-based
without having obtained a determination of provider-based status under
this section, we will notify the provider, adjust future payments,
review previous payments, determine whether the facility or
organization qualifies for provider-based status under this paragraph,
and continue payments only under specific conditions. The notice to the
provider will explain that payments for past cost reporting periods may
be reviewed and recovered, that future payments for services in or of
the facility or organization will be adjusted, and that a determination
of provider-based status will be made.
We further state that we will not stop all payment in such cases,
but instead, will adjust future payments to approximate as closely as
possible the amounts that would be paid in the absence of a provider-
based determination, if all other requirements for billing were met. We
also explain that we will review previous payments and, if necessary,
take action in accordance with the rules on inappropriate treatment of
a facility or organization described above. The regulation states that
we will determine whether the facility or organization qualifies for
provider-based status under the criteria in this section. If we
determine that the facility or organization qualifies for provider-
based status, future payment for services at or by the facility or
organization will be adjusted to reflect that determination. Even if
the facility or organization does not qualify for provider-based
status, however, we will continue paying, at an appropriately adjusted
level, for a limited time period in order to avoid disruption of
services to program beneficiaries at that site and to allow an orderly
transition to freestanding status.
The notice of denial of provider-based status sent to the provider
will ask the provider to notify us in writing, within 30 days of the
date the notice is issued, as to whether the facility or organization
(or, where applicable, the practitioners who staff the facility or
organization) will be seeking to enroll and meet other requirements to
bill for services in a free-standing facility. If the provider
indicates that the facility, organization, or practitioners will not be
seeking to enroll, or if we do not receive a response within 30 days of
the date the notice was issued, all payment will end as of the 30th day
after the date of notice. If the provider indicates that the facility
or organization, or its practitioners, will be seeking to enroll and
meet other requirements for billing for services in a free-standing
facility, payment for services of the facility or organization will
continue, at the adjusted amounts described in paragraph (j)(2) of this
section for as long as is required for all billing requirements to be
met (but not longer than 6 months) if--
The facility or organization, or its practitioners, submit
a complete enrollment application and provide all other required
information within 90 days after the date of notice, and
The facility or organization, or its practitioners,
furnish all other information we need to process the enrollment
application and verify that other billing requirements are met.
If the necessary applications or information are not provided, we
will terminate all payment to the provider, facility, or organization
as of the date we issue notice that necessary applications or
information have not been submitted. We have clarified the final rule
to state that these reductions will occur where inappropriate billing
is or has been taking place.
Comment: A commenter believes that there are already existing
mechanisms for overpayment and recoupment that may be used in the
situations described in this section. At the very least, administrative
actions of this type should be subject to time frames in order to
protect providers from the impact of extended investigations.
Response: We plan to conduct any recovery efforts in accordance
with applicable law and regulations on overpayment recovery. However,
investigations may be complex and require examination of many records,
and we do not agree that they should be limited by additional, self-
imposed restrictions.
Comment: A commenter stated that a facility or organization that
requests a provider-based determination prior to the effective date of
the final rule, and meets the good faith requirements, should not be
subject to recovery of overpayment for periods either before or after
the effective date of the final rule. This will prevent disruptions to
existing arrangements that meet the good faith exception during the
time that the request is being processed.
Response: If we were to adopt this proposal, we would be
guaranteeing an overpayment to providers who, for a specific time
period, knowingly billed for services as those of provider-based
entities, even though they met only a few of the provider-based
criteria. Thus, we did not adopt this comment.
Comment: A commenter requested that the requirement found at
paragraph (i)(2)(iii) be clarified to state that management is only
responsible for professional services billed by the hospital.
Response: As explained earlier, we believe hospitals' privileging
mechanisms give them adequate leverage to prevent inappropriate billing
by practitioners using their facilities. Therefore, we did not adopt
this comment.
Comment: As to the good faith criteria found in paragraph (i)(2), a
commenter questioned why requirements related to public awareness were
chosen for inclusion. An organization can represent itself to the
public in any number of inaccurate ways in order to mislead our
officials and others. The
[[Page 18522]]
commenter believes that we should focus our attention on more tangible
expressions of good faith efforts to operate a provider based entity.
Response: We believe inclusion of this requirement is needed to
help ensure that beneficiaries are protected from unexpected deductible
and coinsurance liability. While we agree with the commenter that some
providers may misrepresent the status of off-site facilities, we
believe such providers cannot reasonably be said to have acted in good
faith, and should not receive favorable treatment with respect to past
overpayments.
Section 413.65(j) Correction of errors (redesignated in this final
rule as paragraph (k))
Comment: A commenter disagreed with the language in this subsection
that would allow us to review and rescind, if appropriate, any past
determinations. The commenter believes that this subsection should be
removed and any previous determinations should be grandfathered in
under the new regulations. Other commenters recommended that we
grandfather facilities or organizations that had previously been
determined by the regional office to be provider-based, or that have
not received such a determination but have been billing as provider-
based without a determination for a period of at least ten years, so
that those facilities or organizations could retain provider-based
status even though they do not meet the criteria in the regulations.
Response: We do not agree that it would be appropriate to
grandfather existing facilities or organizations, since this would in
effect create an ongoing double standard, under which some facilities
or organizations are held to higher standards than others. Moreover,
the fact that improper billing may have continued undetected for a long
period is not a reason to continue to permit such billing. As explained
in the response to the following comment, however, any adverse
determination regarding provider-based status of facilities or
organizations which we previously determined were provider-based will
not be effective until the start of the cost reporting period after the
period in which the provider is notified of the redetermination, or for
at least 6 months, whichever date is later.
Comment: A commenter believes that our proposal that we may review
past provider-based determinations inserts needless uncertainty into
the process for making provider-based designations. The commenter is
concerned that providers may file before the final rule is published in
order to avoid a crush of applications and subsequent disruption in
payment, if they do not have a determination within 30 days of the rule
becoming final. The commenter stated that providers need to be able to
receive prompt determinations on which they can rely.
Response: We understand the concern about avoiding the need to
process a large number of applications in a short time, and agree that
it would not be appropriate to make abrupt changes in provider-based
status. To avoid a possible crush of applications within a 30-day
period, as envisioned by the commenter, we are providing the delayed
effective date described earlier in this document. In addition, under
Sec. 413.65(j) of these regulations, when a facility or organization
that previously was determined to be provider-based is found to no
longer qualify for provider-based status, treatment of the facility or
organization as provider-based will not cease until the first day of
the first cost reporting period following notification of the
redetermination, but not less than 6 months after the date the provider
is notified of the redetermination. If there has been no prior
determination of provider-based status, and a facility or organization
is later found not to meet the criteria, that determination may be
effective up to 6 months after the date the provider is notified of the
determination, if within 30 days of the determination, the provider
indicates that the facility or organization, or its practitioners, will
enroll separately and, within 90 days, the facility or organization, or
its practitioners, take other necessary action to enroll.
Section 489.24(b) Special responsibilities of Medicare hospitals in
emergency cases
Comment: One commenter disagreed strongly with the proposed
revisions to the regulation defining ``comes to the emergency
department,'' and in particular expressed the view that patients
arriving on the campus, sidewalk, driveway, or parking lot of hospital
facilities should not be considered to have come to the emergency
department. The commenter stated the view that an obligation under
section 1867 of the Act (sometimes referred to as the Emergency Medical
Treatment and Active Labor Act (EMTALA), after the original title of
the legislation adding section 1867) and our regulations at
Secs. 489.20(l), (m), (q), and (r), and Sec. 489.24 should be triggered
only by a presentation to the emergency department, and that only in
exceptional situations should EMTALA apply to someone not technically
in the emergency department. The commenter recommended that the
regulations be revised to state that in these cases, the hospital may
rely on a variety of transport options, consistent with the
individual's condition and established policies that are applied in a
nondiscriminatory manner. The commenter also recommended that the
statute be interpreted as requiring only that hospitals with emergency
departments have policies and procedures to assure that a person who
presents to the hospital requesting emergency services is provided a
medical screening examination and, if needed, stabilization or an
appropriate transfer.
Another commenter raised several arguments against the proposed
change. The commenter stated that there is a legal and ethical conflict
in requiring hospital personnel to leave an area of patient care and
furnish assistance to another patient in a remote area of the hospital.
The commenter also believes that ED personnel are not well-trained or
practiced in immobilization or scene safety, and patients and staff may
be put at risk if staff are asked to go into the field and render aid
to a victim who needs the expert care and experience for which field
emergency medical services (EMS) personnel are trained. Finally, the
commenter expressed concern about possible increases in the liability
insurance cost to hospitals as a result of the proposed change.
Response: We do not agree that the proposed language
inappropriately extends the scope of hospitals' EMTALA
responsibilities. On the contrary, existing regulations at Sec. 489.24
make it clear that EMTALA applies to hospitals that offer services for
emergency medical conditions, and we believe it would defeat the
purpose of EMTALA if we were to allow hospitals to rely on narrow,
legalistic definitions of ``comes to the emergency department'' or of
``emergency department'' to escape their EMTALA obligations. We would
also note, as discussed further below, that there is no requirement
that all areas of the hospital be equipped to provide emergency care or
that treatment always be provided outside the emergency area or
department. Similarly, there is no prohibition of appropriate transfers
to other facilities where such a transfer is conducted in accordance
with Sec. 489.24. On the contrary, the intent of the revised regulation
is to ensure that patients who come to the hospital and request
examination or treatment for what may be an emergency medical condition
are not denied EMTALA protection simply because they enter the
[[Page 18523]]
wrong part of the hospital or fail to make their way to the emergency
room.
Comment: Two commenters recommended clarification of the
applicability of section 1867 of the Act regarding transfer
requirements to scheduled patients at an ``off-campus'' hospital site,
to ensure that the movement of scheduled patients unexpectedly
requiring a higher level of care to another site of the same hospital
is not construed as a ``transfer'' under the emergency access law, and
that only those patients taken from one hospital's off-campus facility
to another hospital's emergency department or inpatient unit be
considered ``transfers'' that must be in accordance with the
requirements of section 1867.
Response: We agree that movement of a patient from one part of a
hospital to another, including movement from a remote location to a
main hospital campus, does not constitute a ``transfer'' for EMTALA
purposes, nor does it require compliance with the appropriate transfer
requirements in Sec. 489.24(d). The final regulations at
Sec. 489.24(i)(3)(i) clarify this policy.
Comment: A commenter expressed the view that the proposed revision
to Sec. 489.24 does not recognize the role that EMS personnel play in
emergency situations and the true medical benefit provided by EMS
personnel to patients in emergency situations. The commenter
recommended that language be included in the regulation to authorize
hospitals' use of EMS in responding to emergency situations on hospital
grounds.
Response: We agree that EMS personnel can play a valuable role in
transporting patients to appropriate sources of emergency care. A
hospital may not, however, meet its EMTALA obligations merely by
summoning EMS personnel. EMS may be used appropriately in conjunction
with an appropriate hospital response to treat and move an individual
who is already on hospital property. We therefore did not make any
change to these regulations to authorize exclusive use of EMS to
respond to emergency situations on hospital property.
Comment: A number of commenters stated that the anti-dumping rules
implemented under section 1867 of the Act (EMTALA requirements) and our
regulations at Secs. 489.20(l), (m), (q), and (r), and Sec. 489.24
should apply to the hospital's main campus and to all emergency
departments. However, they argued that it is not reasonable to apply
these rules to outpatient departments located off-campus that would not
be set up to provide emergency services. In the commenters' view, it
should suffice that patients in an emergency situation be directed to
the hospital's emergency room. Another commenter stated that EMTALA
obligations should be limited to those hospital entities that hold
themselves out as providing emergency services, and should not be
enforceable anywhere outside the emergency department or anywhere on
hospital property, including an outpatient department or provider-based
entity. Another commenter stated that the enforcement of this
requirement would lead to the elimination of service-specific
outpatient departments located off a main campus, and asked that we
reconsider our policy. One commenter expressed concern that patients
identifying a facility as a hospital-based department could mistakenly
assume it is equipped to handle emergency cases. Another commenter
believes that hospitals should be required to have policies and
procedures in place to assure that all parts of the hospital are
prepared to deal with getting an individual the appropriate medical
screening.
Response: Existing regulations at Sec. 489.24(b) define ``hospital
with an emergency department'' to include all hospitals that offer
services for emergency medical conditions, not just those that have
organized emergency rooms or departments. To the extent a hospital
acquires or creates an off-campus location, identifies it to us and to
the public as a part of that hospital, and claims payment for services
at that location as hospital services, we believe it is not
unreasonable to expect that hospital also to assume the obligations,
including compliance with EMTALA requirements, which flow from hospital
status. This principle does not mean, of course, that a hospital must
have a fully equipped and staffed emergency department at each
location. It also does not mean that every appearance by an individual
at an off-campus hospital department that does not offer services for
emergency medical conditions will necessarily trigger an EMTALA
obligation on the part of the hospital. Individuals come to these
departments for many medical purposes which may not involve potential
emergency medical conditions. Under these circumstances, the hospital
would not have an EMTALA obligation with respect to that individual.
This principle does mean, however, that if an individual comes to an
off-campus department of a hospital and a request is made for
examination or treatment for a potential emergency medical condition,
the hospital incurs an obligation to provide, within its capability, an
appropriate medical screening examination and necessary stabilizing
treatment. In some cases, the patient may need to be taken back to the
main hospital campus for a full screening and/or stabilizing treatment.
Under these circumstances, the hospital is responsible for moving the
patient or arranging his or her safe transport, but this movement would
not be considered a ``transfer'' under Sec. 489.24(b), since the
patient is merely going from one part of the hospital to another. If it
is necessary to transfer the patient to another medical facility, the
hospital must provide an appropriate transfer in accordance with
Sec. 489.24(d).
After review of the comments on this issue, we have decided to
revise the regulations to state more clearly the extent of a hospital's
EMTALA obligations with respect to patients who come to a hospital
department located off the hospital's main campus. Provider-based
entities, such as SNFs or HHAs, located off the hospital campus would
not, of course, be subject to EMTALA since a patient coming to such an
entity would not have come to the hospital. We will require that each
off-campus hospital department, during its regular hours of operation,
have in effect procedures for: (1) assessing the possibility that an
emergency medical condition exists, and providing such screening (as
defined in Sec. 489.24(a) and (b)) and necessary stabilization (as
defined in Sec. 489.24(c)) at the off-campus site); (2) transporting
the patient to the hospital's emergency room or department for
screening and necessary stabilization meeting the requirements of
Sec. 489.24; or (3) providing an appropriate transfer to another
facility in accordance with the requirements in Sec. 489.24(c). To meet
these requirements, the hospital will need to develop procedures that
permit staff of the off-campus department to contact emergency
physicians or other qualified emergency practitioners at the main
hospital campus, to obtain advice and direction regarding the handling
of any potential emergencies, and to obtain prompt medical transport,
by hospital-owned or other ambulance or other appropriate vehicle,
either to the main hospital campus or, where an appropriate transfer is
being provided, to another medical facility.
Specifically, we are adding new paragraph (i) to Sec. 489.24 to
describe a hospital's obligations. The paragraph states that, if an
individual comes to a facility or organization that is located off the
main hospital campus as defined in Sec. 413.65(b), but has been
determined under Sec. 413.65 of this chapter to be a department of the
hospital, and a
[[Page 18524]]
request is made on the individual's behalf for examination or treatment
of a potential emergency medical condition as otherwise described in
paragraph (a) of Sec. 489.24, the hospital is obligated to provide the
individual with an appropriate medical screening examination and any
necessary stabilizing treatment.
The capability of the hospital includes that of the hospital as a
whole, not just the capability of the off-campus facility or
organization. Except for cases described in paragraph (i)(3)(iii)
(those in which the main hospital campus does not have the specialized
capability or facilities needed to treat the individual, or the
individual's condition is deteriorating so rapidly that transport to
the main campus would significantly jeopardize the life or health of
the individual), the obligation of a hospital under this section must
be discharged within the hospital as a whole. However, the hospital is
not required to locate additional personnel or staff to off-site
locations to be on standby for possible emergencies.
In Sec. 489.24(i)(2), Protocols for off-campus departments, we
further state that the hospital must establish protocols for the
handling of potential emergency cases at off-campus departments. These
protocols must include provision for direct contact between personnel
at the off-campus department and emergency personnel at the main
hospital campus, and may provide for dispatch of practitioners, when
appropriate, from the main hospital campus to the off-campus department
to provide screening or stabilization services. The intent of these
requirements is to ensure timely exchange of information between the
two sites, and to allow the hospital the flexibility to bring emergency
personnel to the patient, rather than the opposite, where doing so is
the best medical approach to meeting the patient's needs.
Under the final rule, if the off-campus department is an urgent
care center, primary care center, or other facility that is routinely
staffed by physicians, RNs, or LPNs, these personnel must be trained,
and given appropriate protocols, for the handling of emergency cases.
At least one individual on duty at the off-campus department during its
regular hours of operation must be designated as a qualified medical
person as described in paragraph (d). The qualified medical person must
initiate screening of individuals who come to the off-campus department
with a potential emergency medical condition, and may be able to
complete the screening and provide any necessary stabilizing treatment
at the off-campus department, or to arrange an appropriate transfer.
The final rule further states that if the off-campus department is
a physical therapy, radiology, or other facility not routinely staffed
with physicians, RNs, or LPNs, the department's personnel must be given
protocols that direct them to contact emergency personnel at the main
hospital campus for direction. Under this direction, and in accordance
with protocols established in advance by the hospital, the personnel at
the off-campus department must describe patient appearance and reported
symptoms and, if appropriate, arrange transportation of the individual
to the main hospital campus (if the main hospital campus has the
capability required by the individual, and movement to the main campus
would not significantly jeopardize the individual's life or health), or
assist in an appropriate transfer. Movement of the individual to the
main campus of the hospital is not considered a transfer under this
section, since the individual is simply being moved from one department
of a hospital to another department or facility of the same hospital.
Finally, specific rules apply if the individual's condition
warrants movement to a facility other than the main hospital campus,
either because the main hospital campus does not have the specialized
capability or facilities required by the individual, or because the
individual's condition is deteriorating so quickly that taking the time
required to move the individual to the main hospital campus could place
the life or health of the individual in significant jeopardy. Under
these circumstances, personnel at the off-campus department must, in
accordance with protocols established in advance by the hospital,
assist in arranging an appropriate transfer of the individual to a
medical facility other than the main hospital. The hospital must have
protocols to ensure that the movement is an appropriate transfer in
accordance with paragraph (d)(2) of this section. The protocol must
include procedures and agreements established in advance with other
hospitals or medical facilities in the area of the off-campus
department to facilitate these anticipated transfers. We note that the
interpretive guidelines for enforcement of EMTALA requirements will be
revised to conform to these new rules.
Section 498.3 Scope and applicability
Comment: A commenter asked for clarification as to whether appeal
rights would be available in the event of revocation by us of provider-
based status.
Response: We have revised Sec. 489.3(b)(2) to specify that a
determination that a facility or organization no longer qualifies for
provider-based status is an initial determination, thus providing an
administrative appeals mechanism for these decisions.
D. Requirements for Payment
We proposed to revise Sec. 410.27, Outpatient Hospital Services and
Supplies Incident to a Physician Service: Conditions, to require that
services furnished at a location other than an RHC or an FQHC that we
designate as having provider-based status under Sec. 413.65 must be
under the direct supervision of a physician as defined in
Sec. 410.32(b)(3)(ii).
Comment: Several commenters requested clarification of what we mean
by ``direct supervision.'' One commenter asked that we further define
the nature and extent of the supervision needed to comply with our
proposal. One commenter asked whether the supervision requirement would
be met if a physician is in the hospital or whether the physician must
be in the department while the procedure is being performed. The same
commenter asked whether the physician billing for the incident to
services must be of the same specialty as the procedure being
performed. A large trade association stated that we appear to be
replacing our current policy in section 3112.4(A) of the Intermediary
Manual, which states that we assume the physician supervision
requirement to be met when incident to services are furnished on
hospital premises, with a policy requiring direct physician supervision
at all times, in all outpatient departments, regardless of whether or
not they are located on the hospital campus. The commenter recommended
that if we retain a direct supervision requirement, it should be
limited to outpatient departments located off-site of the main
provider. One commenter stated that facilities and organizations
accorded provider-based status that are located on the main provider's
campus should be subject to the same physician supervision requirements
that apply to ``incident to'' services provided elsewhere on the
campus.
Response: We regret that our proposal to define ``direct
supervision'' by referring to the definition of ``direct supervision of
a physician'' given at Sec. 410.32(b)(3)(ii) may have been confusing to
some commenters. Section 410.32(b)(3)(ii) defines ``direct
supervision'' within (a physician) office
[[Page 18525]]
setting as meaning that the physician must be present in the office
suite and immediately available to furnish assistance and direction
throughout the performance of the procedure. The definition at
Sec. 410.32(b)(3)(ii) goes on to state that ``direct supervision'' does
not mean that the physician must be present in the room when the
procedure is performed.
Our intention in the proposed rule was to define ``direct
supervision'' of hospital outpatient services incident to physician
services when they are furnished at a department of a hospital to mean
that a physician must be present on the premises of the entity accorded
status as a department of the hospital and, therefore, immediately
available to furnish assistance and direction for as long as patients
are being treated at the site. By ``direct supervision'' we do not mean
that the physician must physically be in the room where a procedure or
service is furnished. Nor does the supervising physician necessarily
have to be of the same specialty as the procedure or service that is
being performed. We emphasize that our proposed amendment of
Sec. 410.27 to require direct supervision of hospital services
furnished incident to a physician service to outpatients applies to
services furnished at an entity that is located off the campus of a
hospital that we designate as having provider-based status as a
department of a hospital in accordance with the provisions of
Sec. 413.65. Our proposed amendment of Sec. 410.27 to require direct
supervision of hospital services furnished incident to a physician
service to outpatients does not apply to services furnished in a
department of a hospital that is located on the campus of that
hospital. For hospital services furnished incident to a physician
service to outpatients in a department of a hospital that is located on
the campus of the hospital, we assume the direct supervision
requirement to be met as we explain in section 3112.4(A) of the
Intermediary Manual. The requirement at Sec. 410.27 does not affect the
definition of physician supervision in section 3112.4(A) of the
Intermediary Manual. In response to these comments, we have revised our
definition of ``direct supervision by a physician'' in the final
regulation.
Comment: A major trade association asserted that requiring a
physician to be on-site at a provider-based entity throughout the
performance of all ``incident to'' services would be burdensome and
costly for hospitals where there are a limited number of physicians
available to provide coverage, particularly in rural settings. Another
commenter believes that entities with provider-based status should not
be subject to physician supervision requirements that are more
stringent than those applicable to free-standing facilities. A third
commenter believes that this requirement is unnecessary because the
requirements for integration with the hospital and other requirements
for provider-based status include adequate checks and balances to
ensure quality care. The commenter recommended that this proposal be
omitted from the final rule with the potential for a separate, better
defined, proposal at a later date.
Response: We disagree with commenters who believe the proposed
supervision requirement is not necessary or that it would be burdensome
to the hospital. First, the supervision requirement is separate from
and independent of the provider-based requirements, and hospitals and
physicians already have to meet a direct supervision of ``incident to''
services requirement that is unrelated to provider-based issues. That
is, we require that hospital services and supplies furnished to
outpatients that are incident to physician services be furnished on a
physician's order by hospital personnel and under a physician's
supervision (Intermediary Manual, section 3112.4(A)). We assume the
physician supervision requirement is met on hospital premises because
staff physicians would always be nearby within the hospital. The effect
of the regulations in this final rule is to extend this assumption to a
department of a provider that is located on the campus of a hospital.
However, the regulation does not extend the assumption of supervision
to a department of a hospital that is located off the campus of the
hospital. We would not extend this assumption to a provider-based
entity, regardless of its location, because the ``incident to''
requirement in Sec. 410.27(a)(1)(iii) applies only to hospitals. Also,
as we state above, satisfying the requirements to be designated
provider-based is unrelated to our requirement that hospital services
furnished incident to a physician service to outpatients at an entity
that has provider-based status be under the direct supervision of a
physician. Finally, this supervision requirement is entirely consistent
with the direct supervision requirements currently set forth in the
Medicare Carriers Manual, Part 3, section 2050.1(B).
Comment: One commenter suggested that partial hospitalization
services furnished by a hospital to its outpatients be exempt from the
outpatient department ``incident to'' requirements, or that other
requirements be drafted that would, in the commenter's opinion, be more
appropriate to the nature of this care.
Response: Section 1861(s)(2)(B) restricts coverage of partial
hospitalization services furnished by a hospital to its outpatients to
services that meet ``incident to'' requirements. We do not have the
discretion to ignore this statutory restriction.
Comment: One commenter asked that we provide an exception to the
direct supervision requirement in the case of physical therapy
services. The commenter questioned why therapists who furnish the same
services in a provider-based entity that they would furnish in an
independent practice should be subject to direct physician supervision
in one setting and not the other.
Response: The provision on coverage for outpatient physical therapy
and occupational therapy services does not require that they be
``incident to'' physician services (see section 1861(s)(2)(D) of the
Act). Therefore, there is no need to exempt them from the supervision
requirement for outpatient hospital services incident to a physician
service that is furnished at a provider-based entity. We therefore made
no change in the final regulation based on this comment.
Comment: One commenter suggested that we modify our proposed
regulation to waive the direct supervision requirement in entities with
provider-based status for certain procedures for which we already waive
the direct supervision requirement when the procedures are performed on
homebound patients, as set forth in section 2051 of the Medicare
Carriers Manual. The commenter believes that general supervision is
sufficient for these waived services, for example, the physician need
not be present, but the services must be performed under a physician's
overall supervision and control, and ordered by a physician.
Response: Under section 2050.2 of the Medicare Carriers Manual,
subject to certain requirements, we waive the direct supervision
requirement when the following services are furnished to homebound
patients: injections; venipuncture; EKGs; therapeutic exercises;
insertion and sterile irrigation of a catheter; changing of catheters
and collection of catheterized specimen for urinalysis and culture;
dressing changes, for example, the most common chronic conditions that
may need dressing changes are decubitus care and gangrene; replacement
and/or insertion of nasogastric tubes; removal of fecal
[[Page 18526]]
impaction, including enemas; sputum collection for gram stain and
culture, and possible acid-fast and/or fungal stain and culture;
paraffin bath therapy for hands and/or feet in rheumatoid arthritis or
osteoarthritis; and, teaching and training the patient for the care of
colostomy and ileostomy, the care of permanent tracheostomy, testing
urine and care of the feet (diabetic patients only), and blood pressure
monitoring. While we believe the commenter's suggestion has merit, we
do not believe it would be appropriate to adopt it before we have had
time to analyze the issue further. Therefore, we did not revise the
final rule based on this comment.
In our proposed rule, we proposed to require that the same
supervision levels established for diagnostic x-ray and other
diagnostic tests in accordance with Sec. 410.32(b)(3) be required when
these tests are furnished at an entity that has been accorded provider-
based status by us.
Comment: A large industry federation generally favored our
requiring that diagnostic tests be furnished at provider-based entities
under levels of physician supervision that we specify, consistent with
the definitions of general, direct, and personal supervision
established at Sec. 410.32(b)(3). The commenter suggested that we
modify the definition of general supervision to make it clear that the
training of nonphysician personnel and the maintenance of necessary
equipment and supplies are the responsibility of the hospital, not the
physicians.
Response: We agree and we will modify our regulation accordingly.
Comment: Numerous commenters, including radiology and imaging
specialty groups, neurologists, vascular technologists, and
sonographers, questioned the level of supervision required for various
specific diagnostic tests and services.
Response: Our model for this proposed requirement was the
requirement for physician supervision for diagnostic tests payable
under the Medicare physician fee schedule that was issued in the
October 31, 1997 physician fee schedule final rule (for CY 1998) (62 FR
59048). There have been issues raised about the appropriate level of
supervision for some specific diagnostic services, similar to the
comments we received about our proposed regulation. We have not yet
resolved these issues, and this final rule is not the place to convey
decisions about appropriate supervision levels for specific diagnostic
tests and services by individual HCPCS code. In January 1998, we sent a
memorandum to all Associate Regional Administrators advising them to
instruct carriers to follow their existing policies on physician
supervision of diagnostic tests until we provide further instruction.
We intend to instruct hospitals and intermediaries to use the October
31, 1997 physician supervision requirements as a guide, pending
issuance of updated requirements. In the meantime, fiscal
intermediaries, in consultation with their medical directors, will
define appropriate supervision levels for services not listed in the
October 31, 1997 final rule when those services are furnished at an
entity with provider-based status in order to determine whether claims
for these services are reasonable and necessary.
V. Summary of and Response to MedPAC Recommendations
The following are additional recommendations contained in the
report on Medicare payment policy that the Medicare Payment Advisory
Commission submitted to the Congress in March 1999. (MedPAC, Report to
the Congress: Medicare Payment Policy, March 1999.) We respond to
recommendations that are specifically related to a particular component
of the hospital outpatient PPS in the appropriate section of this
preamble.
MedPAC Recommendation: MedPAC recommends that the Secretary
evaluate payment amounts under the hospital outpatient PPS and the
ambulatory surgical center (ASC) PPS along with the practice expense
payments under the Medicare physician fee schedule for services
furnished in physicians' offices to ensure that the differing payments
made under the three payment systems do not create unwarranted
financial incentives regarding site of care.
Response: We agree that the three payment systems should avoid
creating unnecessary financial incentives to deliver care in particular
settings. We will consider this matter further and evaluate differences
in payments.
MedPAC Recommendation: MedPAC recommends that the Secretary study
means of adjusting base prospective payment rates across ambulatory
settings for patient characteristics such as age, frailty,
comorbidities and coexisting conditions, and other measurable traits.
Under this approach, payment would be less dependent on the type of
facility and more dependent on the relative costliness of furnishing
specific services to individual patients. MedPAC notes that no viable
patient-level adjuster currently exists that could be used in this
fashion.
As an interim measure, MedPAC recommends, with reservations, that
HCFA evaluate facility-level adjustments in order to preserve access to
care for particularly vulnerable segments of the Medicare population.
Response: The underlying premise in this recommendation, as MedPAC
states, is that HCFA should move toward development of a more unified
and rational payment system for ambulatory care. Many powerful
arguments favor such a system, but the challenges of creating and
implementing it are substantial. We will give further consideration to
the recommendation to study possible adjustments that could be used in
various settings.
We agree that we should evaluate the need for facility-level
adjustments. We believe the best course is to evaluate the need for
these adjustments during the next several years as we gain actual
experience with the operation of the hospital outpatient PPS and are
able to observe the effects on particular provider groups. In
consideration of the transitional protections provided by the BBRA
1999, we have not adopted facility-level adjustments, other than an
adjustment for local labor costs, at this time.
MedPAC Recommendation: MedPAC recommends that the Secretary seek
legislation to develop and implement a single update mechanism that
would link conversion factor updates to volume growth across all
ambulatory care settings. These settings include hospital outpatient
departments, physicians' offices, and ASCs, as well as other specific
settings mentioned.
Response: We believe that this proposal requires further study to
determine its feasibility and possible impact. Therefore, we are not
prepared to seek legislation at this time.
MedPAC Recommendation: MedPAC recommends that we not use patient
diagnosis to calculate relative weights or make payments for medical
visits, ``given the current state of the available data and the lack of
definitive rules for reporting patients' diagnoses under the proposed
system.''
Response: As discussed in section III.C.3, we have dropped
diagnosis from our characterization of medical visit APCs. We hope to
develop procedure codes for medical visits that are more descriptive of
hospital outpatient resource use, rather than physician services. Once
we revise procedure coding to better reflect hospital services, we will
assess whether accurate diagnosis coding further improves recognition
of resources.
MedPAC Recommendation: MedPAC recommends that the Secretary closely
[[Page 18527]]
monitor the use of hospital outpatient services to ensure that
beneficiary access to care is not compromised.
Response: We plan to evaluate the operation of the new PPS to
address a variety of issues, including beneficiary access to care. We
note that the provisions of the BBRA 1999 should mitigate substantially
any payment reductions and hence the possibility of reduced access.
MedPAC Recommendation: MedPAC recommends that the Secretary
consider making payment adjustments in addition to the proposed
adjustment for local area wages under the new system. These adjustments
should be tied to patient characteristics. The facility-level
adjustments that are made until the time that a patient-level adjuster
is available should reflect the population of Medicare patients treated
by facilities identified to receive the adjustments.
MedPAC points out that HCFA, in setting Medicare payment rates for
hospital inpatient services, adjusts payments based on the costs or
provider characteristics of hospitals (for example, sole community
hospitals). Rather than continuing this practice in the outpatient
setting, MedPAC recommends that HCFA move toward making adjustments
based on patient characteristics and the relative costliness of
resources required in furnishing care to differing patients. Any
differences in the payment of the same ambulatory care service should
be based on patient characteristics, rather than on the setting. MedPAC
recommends that HCFA evaluate any relationships between immutable
patient characteristics and the cost of furnishing care.
Response: Other than those adjustments specified in sections 201
and 202 of the BBRA 1999, we have made no additional adjustments in
this final rule. We will consider the possibility of adjustments in the
future once we have actual experience with operation of the hospital
outpatient PPS and can examine its effects. The extent to which
adjustments at the level of patient characteristics will be feasible is
unclear and would require further study.
VI. Provisions of the Final Rule
The provisions of this final rule reflect the provisions of the
September 8, 1998 proposed rule, except as noted elsewhere in this
preamble. Following is a synopsis of the major changes we have made,
either in response to comments or in order to implement provisions of
the BBRA 1999 that apply to the hospital outpatient prospective payment
system.
For our proposal to adjust the CY 2002 update of the conversion
factor by the percentage that actual CY 2000 payments exceed the
estimated CY 2000 expenditure target, we are delaying implementation of
the volume control mechanism for 2 years.
For our proposal to package costs that are directly related and
integral to performing a procedure or furnishing a service on an
outpatient basis, we are making the following changes:
We are creating separate APC groups to pay for blood,
blood products, and anti-hemophilic factors, for splints and casts, and
for certain very costly drugs that are not included in the transitional
pass-through payment provision.
We are paying separately, at cost, for the acquisition of
corneal tissue.
As required by section 201(e) of the BBRA 1999, we are not
paying for certain implantable items under the DMEPOS fee schedule, but
are including them as covered outpatient services. We are packaging the
costs of these items into the APC payment rate for the procedures or
services with which they are associated. These include implantable
items used in connection with diagnostic tests, implantable DME, and
implantable prosthetic devices.
For our proposal to base payment for medical visits to clinics and
emergency departments on diagnosis codes as well as HCPCS codes, we are
not using diagnosis codes at this time.
For our proposal to classify a new technology procedure or service
within the APC group that it most closely resembles in terms of
clinical characteristics and resource utilization, pending collection
of additional pricing data, we are creating separate APC groups to
which we can temporarily classify new technology services while we
gather additional data and gain pricing experience. We are also
creating a process under which interested parties may submit requests
for consideration of services that may be eligible for payment as new
technology.
For our proposal to pay for drugs, pharmaceuticals, and biologicals
(except for cancer therapy drugs and certain infrequently used but very
expensive drugs) as part of the APC payment for the service or
procedure with which they are used, we are establishing transitional
pass-through payments, as directed by section 201(b) of the BBRA 1999.
Under this provision, an additional payment will be made for current
orphan drugs, current cancer therapy drugs, biologicals, and
brachytherapy, and current radiopharmaceutical drugs and biological
products.
For our proposal to classify a new or innovative medical device,
drug or biological (for which we were not making payment as of December
31, 1996) within the APC group that it most closely resembles in terms
of clinical characteristics and resource utilization, pending
collection of additional pricing data, we are establishing transitional
pass-through payments. Under this provision, as directed by section
201(b) of the BBRA 1999, an additional payment will be made for new or
innovative devices, drugs, and biologicals whose cost is not
insignificant in relation to the APC payment for the group of services
with which they are used.
For our proposal not to establish an outlier adjustment, as
directed by section 201(a) of the BBRA 1999, we will make an outlier
payment when calculated bill costs exceed 2.5 times the PPS payment for
a service.
For our proposal to determine comparability of resources and
clinical characteristics among the codes within an APC group based on
our claims data and the analyses and judgment of our medical advisors,
supported by comments from medical specialty societies and trade
associations, as provided in section 201(g) of the BBRA 1999, we are
limiting the variation so that the highest median cost of an item or
service in an APC group is no more than two times the lowest median
cost of an item or service within that group. We will also consult with
an expert outside advisory panel regarding the clinical integrity of
the APC groups and weights as part of our update of the PPS.
For our proposal to periodically review and update payment weights,
APC groups, and other elements of the hospital outpatient PPS, as
required by section 201(h) of the BBRA 1999, we will annually review
the groups, relative payment weights, and the wage and other
adjustments that are a part of the PPS.
For our proposal to implement the hospital outpatient PPS fully and
in its entirety for all hospitals beginning as early as possible in CY
2000, with no phase-in period, as required by section 202(a) of the
BBRA 1999, we are establishing transitional corridors for services
furnished before January 1, 2004 to limit losses facilities might
otherwise face.
For our proposal not to make any adjustments for any specific
classes of hospitals, we are holding small rural hospitals harmless
through CY 2003 in accordance with the requirements set by section
202(a)(3) of the BBRA 1999,
[[Page 18528]]
which added section 1833(t)(7)(D)(i) to the Act. Also, we are holding
cancer centers permanently harmless in accordance with the requirements
set by section 202(a)(3) of the BBRA 1999.
For our proposal on beneficiary coinsurance payment amounts, we are
limiting the coinsurance amount for a procedure to be no more than the
hospital inpatient deductible, as specified in section 204(a)(3) of the
BBRA 1999.
The following is a synopsis of the principal changes that we are
making in the provider-based requirements:
For our proposal to require main providers and provider-based
entities to share a common license, we will require common licensure
only where State law permits it. Where State law prohibits it or is
silent, we will not apply the licensure requirement. We will also
exempt IHS facilities and facilities located on Tribal lands from this
requirement.
For our proposal requiring a main provider and a provider-based
entity to serve a common service area indicated largely by overlapping
patient populations, we have redefined ``common service area'' to mean
a 75 percent threshold of patients who reside in a zip code area that
is common to the main provider and the provider-based entity.
For our proposal to require provider-based entities to be in the
same State as the main provider, we will allow providers in one State
to have provider-based facilities in an adjacent State, if doing so is
consistent both with the law of the affected States and with other
criteria, including those related to a common service area.
For our proposal to require that a provider-based outpatient
department bill all payers as an outpatient department, we have
rescinded this requirement.
For our proposal to require FQHCs that have been billing Medicare
as hospital outpatient departments to comply with the provider-based
requirements, we are grandfathering both FQHCs and FQHC ``look-alikes''
(facilities that are organized as FQHCs but do not receive grants) so
that these facilities will be considered departments of providers
without having to meet Sec. 413.65 requirements.
For our proposal to apply the provider-based requirements to Indian
Health Service (including tribally operated) entities, we are creating
a permanent exception for those entities that were billing as
departments of IHS or Tribal hospitals on or before October 10, 2000.
For our proposal to consider provider-based entities to be part of
the hospital for Emergency Medical Treatment and Active Labor Act
(EMTALA) (``anti-dumping'' purposes), we are maintaining the principle
that off-site hospital facilities are subject to EMTALA. We have
clarified the obligations of hospitals with respect to these locations
to ensure they are consistent with staffing patterns and resources.
For our proposal to apply provider-based criteria to inpatient
facilities such as multi-campus hospitals created by mergers and
satellites of PPS-excluded hospitals that are created by hospitals
leasing space in other hospitals, we have clarified the applicability
of provider-based criteria to remote locations of hospitals and
hospital satellite facilities.
VII. Collection of Information Requirements
Under the Paperwork Reduction Act (PRA) of 1995, we are required to
provide 30-day notice in the Federal Register and solicit public
comment before a collection of information requirement is submitted to
the Office of Management and Budget (OMB) for review and approval. In
order to fairly evaluate whether an information collection should be
approved by OMB, section 3506(c)(2)(A) of the PRA requires that we
solicit comment on the following issues:
The need for the information collection and its usefulness
in carrying out the proper functions of our agency.
The accuracy of our estimate of the information collection
burden.
The quality, utility, and clarity of the information to be
collected.
Recommendations to minimize the information collection
burden on the affected public, including automated collection
techniques.
We are soliciting public comment on each of these issues for the
provisions summarized below that contain information collection
requirements:
Section 413.24 Adequate cost data and cost finding
Section 413.24(d)(6)(ii) states that a provider must develop
detailed work papers showing the exact cost of the services (including
overhead) provided to or by the free-standing entity and show those
carved out costs as nonreimbursable cost centers in the provider's
trial balance. While these information collection requirements are
subject to the PRA, the burden associated with these requirements is
captured under Secs. 413.65(c)(1) and (c)(2) below.
Section 413.65 Requirements for a determination that a facility or an
organization is a department of a provider or a provider-based entity
Section 413.65(b)(2) states that a provider or a facility or
organization must contact HCFA and the facility or organization must be
determined by HCFA to be provider-based before the main provider begins
billing for services of the facility or organization as if they were
furnished by a department of the provider-based entity, or before it
includes costs of those services on its cost report. While these
information collection requirements are subject to the PRA, the burden
associated with these requirements is captured under Secs. 413.65(c)(1)
and (c)(2) below.
Sections 413.65(c)(1) and (c)(2) state that a main provider that
acquires a facility or organization for which it wishes to claim
provider-based status, including any physician offices that a hospital
wishes to operate as a hospital outpatient department or clinic, must
report its acquisition of the facility or organization to HCFA and must
furnish all information needed for a determination as to whether the
facility or organization meets the requirements in paragraph (d) of
this section for provider-based status, if the facility or organization
is located off the campus of the provider or would increase the
provider's total costs by at least 5 percent. Furthermore, a main
provider that has had one or more entities considered provider-based
also must report to HCFA any material change in the relationship
between it and any provider-based facility or organization, such as a
change in ownership of the facility or organization or entry into a new
or different management contract that could affect the provider-based
status of the facility or organization.
The burden associated with this requirement is the time for the
main provider to report its acquisition to HCFA, furnish all
information needed for a determination, report to HCFA any material
change in the relationship between it and any provider-based facility
or organization, such as a change in ownership of the facility or
organization or entry into a new or different management contract that
could affect the provider-based status of the facility or organization.
It is estimated that 105 main providers will take 10 hours for a total
of 1,050 hours.
Section 413.65(d)(4)(v) states that medical records for patients
treated in a facility or organization must be integrated and maintained
into a unified retrieval system (or cross reference) of the main
provider. The burden
[[Page 18529]]
associated with this requirement is the time required for the main
provider to maintain medical records in a unified retrieval system.
While this requirement is subject to the PRA, we believe this
requirement is a usual and customary business activity and the burden
associated with this requirement is exempt from the PRA, as stipulated
under 5 CFR 1320.3(b)(2) and (b)(3).
Section 413.65(d)(7)(i) requires that for a facility or
organization and the main provider that is not located on the same
campus, the facility or organization must demonstrate a high level of
integration with the main provider by showing that it meets all of the
other provider-based criteria, and demonstrates that it serves the same
patient population as the main provider, by submitting records showing
that, during the 12-month period immediately preceding the first day of
the month in which the application for provider-based status is filed
with HCFA, and for each subsequent 12-month period meet the
requirements of paragraphs (d)(7)(i)(A), (B), or (C) of this section.
While the information collection requirements listed below are subject
to the PRA, the burden associated with these requirements is captured
under Secs. 413.65(c)(1) and (c)(2).
Section 413.65(g)(7) states that when a Medicare beneficiary is
treated in a hospital outpatient department or hospital-based entity,
the hospital has a duty to notify the beneficiary, prior to the
delivery of services, of the beneficiary's potential financial
liability (that is, a coinsurance liability for a facility visit as
well as for the physician service).
The burden associated with this requirement is the time for the
provider to disseminate information to each beneficiary of the
beneficiary's potential financial liability (that is, a coinsurance
liability for a facility visit as well as for the physician service).
It is estimated that 750 providers will make on average 667 disclosures
on an annual basis, at 3 minutes per disclosure, for a total annual
burden of 25,013 hours.
Section 413.65(j)(5) requires that upon notice of denial of
provider-based status sent to the provider by HCFA, the notice will ask
the provider to notify HCFA in writing, within 30 days of the date the
notice is issued, of whether the facility or organization (or, where
applicable, the practitioners who staff the facility or organization)
will be seeking to enroll and meet other requirements to bill for
services in a free-standing facility. This requirement is exempt from
the PRA as stipulated under 5 CFR 1320.4(a)(2).
Further, if the provider indicates that the facility or
organization, or its practitioners, will be seeking to meet enrollment
and other requirements for billing for services in a free-standing
facility, the facility or organization must submit a complete
enrollment application and provide all other required information
within 90 days after the date of notice; and the facility or
organization, or its practitioners, furnish all other information
needed by HCFA to process the enrollment application and verify that
other billing requirements are met. The requirements and burden
associated with the provider enrollment process are currently approved
under OMB control number 0938-0685, with a current expiration date of
September 30, 2001.
Section 424.24 Requirements for Medical and Other Health Services
Furnished by Providers Under Medicare Part B
Section 424.24(e)(3)(i) requires that when a partial
hospitalization service occurs the physician recertification must be
signed by a physician who is treating the patient and has knowledge of
the patient's response to treatment. While this signature requirement
is subject to the PRA, the overall requirements associated with
physician recertification, as currently referenced in HCFA regulation
number HCFA-1006, published in the Federal Register on June 5, 1998,
have not yet been approved by OMB under the PRA. Therefore, we continue
to solicit comment on all of the requirements and associated burden
referenced in Sec. 424.24.
Section 419.42 Hospital Election To Reduce Copayment
Sections 419.42(b) and (c) state that a hospital must notify its
fiscal intermediary of its election to reduce copayments no later than
June 1, 2000 prior to the date the PPS is implemented or for subsequent
calendar years, beginning with elections for calendar year 2001, no
later than December 1 of the preceding calendar year. The hospital's
election must be properly documented. It must specifically identify the
ambulatory payment classification to which it applies and the
coinsurance amounts (within the limits identified within this
regulation) that the hospital has elected for each group.
The burden associated with these requirements is the time it takes
a hospital to compile, review, and analyze data for both revenues and
coinsurance; prepare and present the data to the hospital board; make a
business decision as to whether the hospital would elect to reduce
coinsurance; and then notify its fiscal intermediary of its election. A
hospital would notify its fiscal intermediary of its election to reduce
coinsurance only if there were other providers, in close proximity,
that would attract a majority of the hospital's business if they did
not reduce their coinsurance. Since hospitals do not want to lose money
by absorbing coinsurance, we anticipate that this requirement will
affect 750 hospitals and take them 10 hours each for a total of 7,500
hours.
Section 419.42(e) states that the hospital may advertise and
otherwise disseminate information concerning the reduced level(s) of
coinsurance that it has elected. All advertisements and information
furnished to Medicare beneficiaries must specify that the coinsurance
reductions advertised apply only to the specified services of that
hospital and that these coinsurance reductions are available only for
hospitals that choose to reduce coinsurance for hospital outpatient
services and are not applicable in any other ambulatory settings or
physician offices.
The burden associated with this requirement is the time for the
hospital to disseminate information concerning its coinsurance
election. It is estimated that 750 hospitals will each take 10 hours
annually to disseminate this information via newsletters and
information sessions at senior citizen centers for a total of 7,500
hours.
We have submitted a copy of this final rule to OMB for its review
of the information collection requirements. These requirements are not
effective until they have been approved by OMB. A notice will be
published in the Federal Register when approval is obtained.
If you comment on any of these information collection and record
keeping requirements, please mail copies directly to the following:
Health Care Financing Administration, Office of Information Services,
Information Technology Investment Management Group, Division of HCFA
Enterprise Standards, Room C2-26-17, 7500 Security Boulevard,
Baltimore, MD 21244-1850, Attn: John Burke HCFA-1005-FC/R-240,
and
Office of Information and Regulatory Affairs, Office of Management and
Budget, Room 10235, New Executive Office Building, Washington, DC
20503, Attn.: Allison Herron Eydt, HCFA-1005-FC.
[[Page 18530]]
VIII. Response to Comments
Because of the large number of items of correspondence we normally
receive on Federal Register documents published for comment, we are not
able to acknowledge or respond to them individually. Comments on the
provision of this final rule that implement provisions of the BBRA 1999
will be considered if we receive them by the date and time specified in
the DATES section of this preamble. We will not consider comments
concerning provisions that remain unchanged from the September 8, 1998
proposed rule or that were changed based on public comments.
IX. Regulatory Impact Analysis
A. Introduction
Section 804(2) of title 5, United States Code (as added by section
251 of Pub. L. 104-121), specifies that a ``major rule'' is any rule
that the Office of Management and Budget finds is likely to result in--
An annual effect on the economy of $100 million or more;
A major increase in costs or prices for consumers,
individual industries, Federal, State, or local government agencies, or
geographic regions; or
Significant adverse effects on competition, employment,
investment productivity, innovation, or on the ability of United States
based enterprises to compete with foreign-based enterprises in domestic
and export markets.
We estimate, based on a simulation model, that the effect on
hospitals participating in the Medicare program associated with this
final rule would be to increase Medicare payments by $600 million in
calendar year 2000. This figure includes beneficiary copayments. We
estimate that the additional expenditures to hospitals from the Part B
Trust Fund associated with this final rule will be $490 million in
fiscal year 2000. Therefore, this rule is a major rule as defined in
Title 5, United States Code, section 804(2).
We have examined the impacts of this final rule as required by
Executive Order 12866, the Unfunded Mandates Reform Act of 1995, and
the Regulatory Flexibility Act (RFA) (Public Law 96-354). Executive
Order 12866 directs agencies to assess all costs and benefits of
available regulatory alternatives and, when regulation is necessary, to
select regulatory approaches that maximize net benefits (including
potential economic, environmental, public health and safety effects,
distributive impacts, and equity). A regulatory impact analysis (RIA)
must be prepared for major rules with economically significant effects
($100 million or more annually). Because the projected spending
resulting from this final rule is expected to exceed $100 million, it
is considered a major rule for purposes of the RFA.
The Unfunded Mandates Reform Act of 1995 also requires (in section
202) that agencies prepare an assessment of anticipated costs and
benefits for any rule that may result in an expenditure in any 1 year
by State, local, or tribal governments, in the aggregate, or by the
private sector, of $100 million. This final rule does not mandate any
requirements for State, local, or tribal governments.
We generally prepare a regulatory flexibility analysis that is
consistent with the RFA (5 U.S.C. 601 through 612), unless we certify
that a final rule will not have a significant economic impact on a
substantial number of small entities. For purposes of the RFA, we
consider all hospitals to be small entities.
Also, section 1102(b) of the Social Security Act requires us to
prepare a regulatory impact analysis for any final rule that may have a
significant impact on the operations of a substantial number of small
rural hospitals. Such an analysis must conform to the provisions of
section 604 of the RFA. With the exception of hospitals located in
certain New England counties, for purposes of section 1102(b) of the
Act, we define a small rural hospital as a hospital with fewer than 100
beds that is located outside of a Metropolitan Statistical Area (MSA)
or New England County Metropolitan Area (NECMA). Section 601(g) of the
Social Security Amendments of 1983 (Pub. L. 98-21) designated hospitals
in certain New England counties as belonging to the adjacent NECMA.
Thus, for purposes of the proposed prospective payment system, we
classify these hospitals as urban hospitals.
B. Estimated Impact on the Medicare Program
Our Office of the Actuary projects that the additional benefit
expenditures from the Part B Trust Fund resulting from implementation
of the hospital outpatient PPS for hospital outpatient services
furnished on or after July 1, 2000, and the hospital outpatient
provisions enacted by the BBRA 1999, are as follows:
------------------------------------------------------------------------
Impact (In millions of
Fiscal year dollars)
------------------------------------------------------------------------
2000...................................... 490
2001...................................... 3,030
2002...................................... 3,520
2003...................................... 4,230
2004...................................... 4,670
------------------------------------------------------------------------
C. Objectives
The primary objective of the hospital outpatient prospective
payment system is to simplify the payment system and encourage hospital
efficiency in providing outpatient services, while at the same time
ensuring that payments are sufficient to compensate hospitals
adequately for their legitimate costs. Another important goal of the
new system is to reduce beneficiaries' share of outpatient payment to
hospitals by freezing coinsurance amounts at an absolute level until
they equal 20 percent of the total payment amounts.
We believe that implementation of the final PPS will ultimately
further each of these goals while maintaining the financial viability
of the hospital industry and ensuring access to high quality health
care for Medicare beneficiaries. We expect that the provisions of this
final rule with comment period will ensure that the outcomes of the PPS
are reasonable and equitable while avoiding or minimizing unintended
adverse consequences.
D. Limitations of Our Analysis
The following quantitative analysis presents the projected effects
of our policy changes resulting from comments, as well as statutory
changes enacted by the BBRA 1999, on various hospital groups. We use
the best data available. In addition, we do not make adjustments for
future changes in such variables as volume and intensity. For this
final rule with comment period, we are soliciting comments and
information about the anticipated effects of the changes on hospitals
resulting from implementation of the hospital outpatient provisions of
the BBRA 1999, and our methodology for estimating them.
E. Hospitals Included In and Excluded From the Prospective Payment
System
The outpatient prospective payment system encompasses nearly all
hospitals that participate in the Medicare program. However, Maryland
hospitals that are paid under a cost containment waiver in accordance
with section 1814(b)(3) of the Act are excluded from the PPS. Critical
access hospitals (CAHs) are also excluded and are paid at cost under
section 1834(g) of the Act.
[[Page 18531]]
F. Quantitative Analysis of the Impact of Policy Changes on Payment
Under the Hospital Outpatient PPS: Basis and Methodology of Estimates
We have analyzed the impact on hospital payment under the
outpatient PPS. Our analysis compares the payment impact of PPS
compared to current law. The definition and calculation of current law
used in the impact analysis is the same used in estimating the
conversion factor. That is, current law reflects pre-PPS payment
methodologies in effect on January 1, 2000, and prior to July 1, 2000,
which include the elimination of the formula-driven overpayment and
application of the capital and operating cost reductions. A detailed
explanation of the current law calculation can be found in section
III.E.2.a.
The data used in developing the 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 Table 2, below. In
some cases, there is a degree of variation in the data from the
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
pre-PPS and PPS payment methodologies. Although we used only single-
procedure/visit bills to determine APC relative payment weights, we
used both single and multiple-procedure bills in the conversion factor
and service mix calculations, regressions, and impact analyses. Both
pre-PPS and PPS payment estimates include operating and capital costs,
adjusted to the calendar year 1996 cost reporting period. 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 excluded Maryland hospitals were not
included in the calculation of the conversion factor and the
simulations; however, we did include the 10 cancer hospitals that will
be paid under the PPS.
We also trimmed outlier hospitals from the impact analysis because
inclusion of hospitals with extremely high and low unit costs would not
allow us to assess the impacts among the various classes of hospitals
accurately. First, we identified all of the outlier hospitals by using
an edit of 3 standard deviations from the mean of the logged unit
costs. Trimming the data in this manner ensures that only the hospitals
with aberrantly high and low costs are eliminated from the impact
analysis. In doing this, we removed 97 hospitals of which 41 hospitals
had extremely low unit costs and 56 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 that many of these hospitals are not coding accurately,
and we will continue to perform further analysis in this area following
implementation of the PPS.
After we removed the 58 excluded Maryland hospitals, the all-
inclusive rate hospitals, the statistical outlier hospitals, and
hospitals for which we could not identify payment variables, we used
the remaining 5,362 hospitals as the basis for our analysis. Table 2,
Annual Impact of Outpatient Prospective Payment System in CY2000-
CY2001, 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 shows the hospitals' Medicare
outpatient payments under the current (non-PPS) payment system as a
percentage of the hospitals' total Medicare payment. The third and
fourth columns show the impact of the PPS excluding the transitional
corridor payments enacted by the BBRA 1999. Column three shows the
percentage change in total Medicare outpatient payments comparing pre-
PPS payments with payments under the PPS. The fourth column shows the
change in total (outpatient and inpatient) Medicare payments resulting
from implementation of the PPS for outpatient services. The fifth and
sixth columns show the impact of the PPS including the transitional
corridor payments enacted by the BBRA 1999. Column five shows the
percentage change in Medicare outpatient payments comparing pre-PPS
payments with payments under the PPS. Column six shows the change in
total (outpatient and inpatient) Medicare payments resulting from
implementation of the PPS for outpatient services.
The first row of Table 2 shows the overall impact on the 5,362
hospitals included in the analysis. We included as much data as
possible to the extent that we were able to capture all the provider
information necessary to determine payment. Our estimates include the
same set of services for both pre-PPS and PPS payments so that we could
determine the impact of the PPS as accurately as possible. Because
payment under the hospital outpatient PPS 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 codes.
The second row of Table 2 shows the overall impact of the PPS on
the 4,828 hospitals that remain when we exclude psychiatric, long-term
care, children's, and rehabilitation hospitals.
The next four rows of the table contain hospitals categorized
according to their geographic location (all urban, which is subdivided
into large urban and other urban, and rural). We include 2,665
hospitals located in urban areas (MSAs or NECMAs) in our analysis.
Among these, 1,505 hospitals are located in large urban areas
(populations over 1 million), and 1,160 hospitals are located in other
urban areas (populations of 1 million or less). In addition, we include
2,160 hospitals located in rural areas in our analysis. The next two
groupings are by bed-size categories, shown separately for urban and
rural hospitals. The next category groups urban and rural hospitals by
volume of outpatient services. We then show the distribution of urban
and rural hospitals by regional census divisions.
The next three categories group hospitals according to 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. In our analysis we show the impact of the PPS on the 3,738
nonteaching hospitals, the 821 teaching hospitals with fewer than 100
residents, and the 269 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 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 hospitals that are both SCHs and
[[Page 18532]]
RRCs), as well as rural hospitals not receiving a special payment
designation. The RRCs (164), SCH/EACHs (634), MDHs (358), and SCH and
RRCs (56) 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 1996 Medicare cost report files, if
available; otherwise, earlier cost report data are used.
The final two groups are specialty hospitals. The first set
includes eye and ear hospitals, trauma hospitals (hospitals having a
level one trauma center), and cancer hospitals, which are TEFRA
hospitals. The last group lists all other TEFRA hospitals,
specifically, rehabilitation, psychiatric, long-term care, and
children's hospitals.
G. Estimated Impact of the New APC System (Includes Table 2, Annual
Impact of Hospital Outpatient Prospective Payment System in CY2000-
CY2001)
Column 3 compares our estimate of PPS payments without application
of the BBRA 1999 transitional corridors, but incorporating policy
changes and all other BBRA 1999 provisions contained in this final
rule, to our estimate of payments under the current system. The percent
differences shown in columns 3 and 4 between current and PPS payment
(without the BBRA 1999 transitional corridors) reflect the impact of
the BBRA 1999 outlier and pass-through payment adjustments and
nonbudget-neutral hold-harmless provisions for cancer hospitals, as
well as distributional differences attributable to variation in cost
and charge structures among hospitals.
The percent changes in columns 5 and 6 are the result of comparing
our estimate of PPS payments with application of the BBRA 1999
transitional corridors, as well as the statutory and policy changes
contained in this final rule, to our estimate of payments under the
pre-PPS system. Percent differences between the pre-PPS and the PPS
payment (with the BBRA 1999 transition) reflect the combined impact of
the transitional corridor adjustments, outlier and pass-through payment
adjustments and the hold-harmless provision for cancer hospitals, in
addition to distributional differences attributable to variation in
cost and charge structures among hospitals.
Basing the conversion factor on pre-PPS program and pre-PPS
beneficiary payments and on budget-neutral outlier and pass-through
adjustments results in no net change in payments to hospitals overall
relative to pre-PPS payments. (As noted above, in section III.E.2 of
this preamble, pursuant to section 201(l) of the BBRA 1999, we set the
conversion factor by estimating pre-PPS rather than PPS copayments.)
However, the BBRA hold-harmless provision for cancer hospitals results
in a 0.2 percent increase in payments to hospitals overall because this
provision is not budget neutral. Including the BBRA 1999 transitional
corridor adjustments further increases payment to hospitals overall. We
estimate that in calendar year 2000, payment will increase by an annual
rate of 4.6 percent under the PPS compared to the pre-PPS payments.
Without the BBRA 1999 transitional corridor payments, the impact on
short-term acute care hospitals is negative for a substantial number of
hospital classifications. That is, for certain groups of hospitals,
payments under the PPS without the transitional corridor payments would
be several percentage points below pre-PPS payments. For nearly all of
these hospital groups, the BBRA 1999 transitional corridor payments
mitigate this negative impact. In addition, hospital groups that
experience net gains without the BBRA 1999 transitional corridor
payments experience even greater gains with them. The reason is that
even though the average impact for hospitals in these groups is
positive, some individual hospitals experience net losses in payments
and, thus, benefit from the transitional corridor payments. The
hospital groups that gain without the transitional corridor payments
receive even greater increases in payments with the transitional
corridor payments. The following discussion highlights some of the
changes in payments among hospital classifications.
Comparing the pre-PPS and PPS payment estimates, payment to low-
volume hospitals would decrease substantially without the BBRA 1999
transitional corridor payments (12.2 percent annually for rural and 7.7
percent annually for urban hospitals with fewer than 5,000 units of
service). These hospitals experience a net gain with the BBRA 1999
transitional corridor payments (2.5 percent annually and 0.2 percent
annually for low-volume rural and urban hospitals, respectively),
although these payment increases are relatively small compared to the
4.6 percent annual increase for hospitals overall. We believe several
factors contribute to this outcome, including undercoding, lack of
economies of scale, and 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 (18.5 percent) from outpatient
services than the national average (9.9 percent).
Major teaching hospitals, whose payments would decrease annually by
3.7 percentage points without the BBRA 1999 transitional corridor
payments, gain 2.6 percent annually with the BBRA 1999 transitional
corridor payments relative to pre-PPS payments. Major teaching
hospitals receive less of their total Medicare income (9.1 percent)
from outpatient services than the national average. This results in a
0.2 percent annual gain in their total Medicare payments. Minor
teaching and nonteaching hospitals would experience marginal gains in
outpatient payment without the BBRA 1999 transitional corridor
payments. Payment to both hospital groups increases by 5.0 percent
annually relative to the pre-PPS payment system.
Without the BBRA 1999 transitional corridor payments, hospitals
with a high percentage of low-income patients (disproportionate share
patient percentage greater than or equal to 0.35) would have a 2.5
percent annual decrease in payment relative to pre-PPS payments. But
payments to these hospitals increase annually by 3.5 percent relative
to pre-PPS payments with the BBRA 1999 transitional corridor payments.
These hospitals have lower than average volume, and, like major
teaching hospitals, receive a smaller than average percentage of their
Medicare income from outpatient services. Thus, their total Medicare
payments increase marginally, by 0.3 percent, with the BBRA 1999
transitional corridor payments.
Without the BBRA 1999 adjustments, payment to rural hospitals would
decrease 1.8 percent annually and payment to large urban hospitals
would decrease 0.3 percent annually, while payment to other urban
hospitals would increase 1.8 percent annually relative to pre-PPS
payments. These hospitals all experience net gains in PPS payment with
the BBRA 1999 transitional corridor payments, at an annual rate of 4.4
percent, 4.3 percent, and 5.1 percent, respectively. Even though rural
hospitals receive a greater percentage of their Medicare income (14.7
percent) from outpatient services compared to the national average,
their total Medicare payments increase by only a fraction, 0.6 percent.
Negative impacts for urban hospitals in the Mid-Atlantic and the
West North Central regions are also reversed under
[[Page 18533]]
the BBRA 1999 transitional corridor payments, changing from -3.4
percent to 2.4 percent on an annual basis, and from -3.5 percent to 2.5
percent on an annual basis, respectively. Similarly, rural hospitals in
nearly all census regions experience net increases in payment relative
to pre-PPS payments with the BBRA 1999 transitional corridor payments.
The impact on TEFRA hospitals is shown separately at the end of the
table. The TEFRA hospitals were not included in determining the impact
on any of the other categories discussed above (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 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 services accurately under the PPS, payments will more closely
approximate pre-PPS payments.
If the effect of the BBRA 1999 transition payments were removed,
differences between pre-PPS payments and PPS payments among hospitals
would still exist. These distributional differences are the result of
many factors. First, cost variations among hospitals result in
differences between pre-PPS payments and PPS payments, and charge
structure variations result in differences between pre-PPS payments and
PPS beneficiary copayment amounts. Hospitals whose costs are low
relative to payment would gain under the PPS even without the BBRA 1999
transitional corridor payments. Because the transitional corridor
payments are not budget neutral, these hospitals continue to gain
relative to pre-PPS payments.
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.
Table 2. Annual Impact Of Hospital Outpatient Prospective Payment System In CY2000-CY2001
----------------------------------------------------------------------------------------------------------------
Excluding BBRA Including BBRA
transitional corridors 1 transitional corridors
---------------------------------------------------
Number of Outpatient Percent Percent Percent Percent
hospitals percent change in change in change in change in
Medicare total Medicare total
outpatient Medicare outpatient Medicare
payments 3 payments payments 3 payments
(1) (2) (3) (4) (5) (6)
----------------------------------------------------------------------------------------------------------------
ALL HOSPITALS..................... 5,362 9.9 0.2 0.0 4.6 0.5
NON-TEFRA HOSPITALS............... 4,828 10 0.1 0.0 4.6 0.5
URBAN HOSPS 2..................... 2,665 9.3 0.6 0.1 4.6 0.4
LARGE URBAN 2 (GT 1 MILL.)........ 1,505 9.1 -0.3 0.0 4.3 0.4
OTHER URBAN 2 (LE 1 MILL.)........ 1,160 9.7 1.8 0.2 5.1 0.5
RURAL HOSPS....................... 2,160 14.7 -1.8 -0.3 4.4 0.6
BEDS (URBAN): 2
0--99 BEDS.................... 672 14.9 0.6 0.1 4.6 0.7
100-199 BEDS.................. 924 10.5 1.3 0.1 5.2 0.5
200-299 BEDS.................. 533 9.2 0.8 0.1 4.4 0.4
300-499 BEDS.................. 399 8.5 1.8 0.2 5.2 0.4
500 + BEDS.................... 137 8.4 -2.9 -0.2 2.8 0.2
BEDS (RURAL):
0--49 BEDS.................... 1,170 19.5 -8.5 -1.7 3.3 0.6
50-99 BEDS.................... 615 15.5 -2.7 -0.4 4.4 0.7
100-149 BEDS.................. 223 13.3 -0.2 0.0 3.8 0.5
150-199 BEDS.................. 81 13 2.5 0.3 5.5 0.7
200 + BEDS.................... 71 11.6 2.7 0.3 6.1 0.7
VOLUME (URBAN):
LT 5,000...................... 349 12 -7.7 -0.9 0.2 0.0
5,000-10,999.................. 504 9.8 0.0 0.0 4.2 0.4
11,000-20,999................. 596 9.1 0.1 0.0 4.4 0.4
21,000-42,999................. 773 8.8 1.3 0.1 4.9 0.4
GT 42,999..................... 443 9.7 0.4 0.0 4.6 0.4
VOLUME (RURAL):
LT 5,000...................... 1,049 18.5 -12.2 -2.3 2.5 0.5
5,000-10,999.................. 595 15.2 -5.2 -0.8 2.9 0.4
11,000-20,999................. 322 13.8 0.1 0.0 4.7 0.6
21,000-42,999................. 173 13.6 2.4 0.3 5.7 0.8
GT 42,999..................... 21 13.2 3.0 0.4 6.8 0.9
REGION (URBAN): 3
NEW ENGLAND................... 146 10.7 3.8 0.4 6.7 0.7
MIDDLE ATLANTIC............... 393 8.4 -3.4 -0.3 2.4 0.2
SOUTH ATLANTIC................ 401 8.6 0.3 0.0 4.2 0.4
EAST NORTH CENT............... 465 10.7 1.0 0.1 4.5 0.5
[[Page 18534]]
EAST SOUTH CENT............... 161 7.9 1.8 0.1 4.6 0.4
WEST NORTH CENT............... 183 9.5 0.9 0.1 4.9 0.5
WEST SOUTH CENT............... 335 9.7 -2.7 -0.3 2.5 0.2
MOUNTAIN...................... 123 10.2 3.1 0.3 6.1 0.6
PACIFIC....................... 423 9.4 5.6 0.5 8.6 0.8
PUERTO RICO................... 35 6.6 10.8 0.7 13.2 0.9
REGION (RURAL):
NEW ENGLAND................... 53 17.2 -3.2 -0.6 3.3 0.6
MIDDLE ATLANTIC............... 80 13.6 7.1 1.0 10.1 1.4
SOUTH ATLANTIC................ 285 11.8 -1.8 -0.2 3.6 0.4
EAST NORTH CENT............... 282 15.7 -1.2 -0.2 4.3 0.7
EAST SOUTH CENT............... 260 11.1 0.1 0.0 4.9 0.5
WEST NORTH CENT............... 508 19.8 -5.2 -1.0 3.0 0.6
WEST SOUTH CENT............... 337 14.2 -5.7 -0.8 3.0 0.4
MOUNTAIN...................... 213 16.9 -3.4 -0.6 4.7 0.8
PACIFIC....................... 140 15.9 0.7 0.1 6.3 1.0
PUERTO RICO................... 2 6.6 32.1 2.1 32.1 2.1
TEACHING STATUS:
NON-TEACHING.................. 3,738 11.3 0.5 0.1 5.0 0.6
MINOR......................... 821 9.1 1.6 0.1 5.0 0.5
MAJOR......................... 269 9.1 -3.7 -0.3 2.6 0.2
DSH PATIENT PERCENT:
0............................. 101 10.9 -5.8 -0.6 0.7 0.1
GT 0--0.10.................... 1,139 10.5 0.8 0.1 4.6 0.5
0.10-0.16..................... 986 11 2.0 0.2 5.6 0.6
0.16-0.23..................... 880 10.1 0.8 0.1 4.9 0.5
0.23-0.35..................... 855 9.5 -1.5 -0.1 3.7 0.4
GE 0.35....................... 867 9.2 -2.5 -0.2 3.5 0.3
URBAN IME/DSH: 2
IME & DSH..................... 994 9 -0.4 0.0 4.1 0.4
IME/NO DSH.................... 17 9.2 -3.6 -0.3 1.1 0.1
NO IME/DSH.................... 1,611 9.9 1.9 0.2 5.4 0.5
NO IME/NO DSH................. 43 14.7 -8.2 -1.2 -0.3 0.0
RURAL HOSP. TYPES:
NO SPECIAL STATUS............. 864 15 -2.2 -0.3 4.4 0.7
RRC........................... 164 12.3 5.0 0.6 7.3 0.9
SCH/EACH...................... 634 16.5 -7.7 -1.3 2.2 0.4
MDH........................... 358 18.3 -5.4 -1.0 3.5 0.6
SCH AND RRC................... 56 13.9 -1.4 -0.2 3.1 0.4
TYPE OF OWNERSHIP:
VOLUNTARY..................... 2,816 9.9 0.6 0.1 4.7 0.5
PROPRIETARY................... 752 8.3 -0.1 0.0 4.7 0.4
GOVERNMENT.................... 1,260 12.2 -2.3 -0.3 3.6 0.4
SPECIALTY HOSPITALS:
EYE AND EAR................... 10 31.1 20.1 6.3 20.2 6.3
TRAUMA........................ 159 9.1 -1.2 -0.1 4.0 0.4
CANCER........................ 10 22 0.8 0.2 0.8 0.2
TEFRA HOSPITALS (NOT INCLUDED ON
OTHER LINES):
REHAB......................... 147 3.7 -9.4 -0.3 1.7 0.1
PSYCH......................... 281 9 21.3 1.9 27.9 2.5
LTC........................... 65 3.7 -15.3 -0.6 -1.7 -0.1
CHILDREN...................... 41 16.5 -11.9 -2.0 -3.2 -0.5
----------------------------------------------------------------------------------------------------------------
Notes:
1 Includes all BBRA provisions except the transitional corridor provisions that expire 01/01/04.
2 Does not include impact of reclassifications as allowed under section 401 of the BBRA 1999.
3 Estimate of change compared to pre-PPS payments, which reflect the payment methodologies in effect as of
January 1, 2000, and prior to July 1, 2000.
[[Page 18535]]
X. Federalism
We have examined this rule in accordance with Executive Order
13132, Federalism, and have determined that this final rule will not
have any negative impact on the rights, roles, and responsibilities of
State, local or Tribal governments.
XI. Waiver of Proposed Rulemaking
We ordinarily publish a notice of proposed rulemaking in the
Federal Register and invite public comment on the proposed rule. The
notice of proposed rulemaking includes a reference to the legal
authority under which the rule is proposed, and the terms and substance
of the proposed rule or a description of the subjects and issues
involved. This procedure can be waived, however, if an agency finds
good cause that a notice-and-comment procedure is impracticable,
unnecessary, or contrary to the public interest, and incorporates a
statement of the finding and its reasons in the rule. We find that the
circumstances surrounding this rule make it impracticable to pursue a
process of notice-and-comment rulemaking before the provisions of this
rule take effect.
The BBRA 1999 was enacted on November 29, 1999. This final rule
incorporates the following hospital outpatient PPS provisions in the
BBRA 1999: outlier adjustment for high cost cases; transitional pass-
through payment adjustments for additional costs (over the payments for
APCs otherwise made) for new medical devices, drugs, and biologicals;
definition of APCs so that the variation of costs of items within an
APC is subject to certain limits; establishment of ``transitional
corridors'' for the first 3\1/2\ years of the new system that limit
losses hospitals might otherwise face; payment for implantable devices
under the hospital outpatient PPS, rather than under the Durable
Medical Equipment Fee Schedule; limitation of the copayment on an
outpatient procedure to the amount of the inpatient hospital
deductible; requirement to review annually the APC groups, relative
weights, and wage and other adjustments; and calculation of the
conversion factor in a budget-neutral manner, eliminating the 5.7
percent reduction indicated in the proposed rule.
As discussed earlier in this rule, July 1, 2000 is the earliest
date on which we can feasibly implement the PPS. The provisions of the
BBRA 1999, enacted on November 29, 1999, made numerous refinements to
the PPS. With respect to the BBRA 1999 provisions, it would have been
impracticable to complete notice and comment procedures by July 1,
2000. Given the limited timeframe, given the nature and scope of the
BBRA 1999 refinements, and given the time required to complete notice
and comment rulemaking (to develop proposed policies, draft the
proposed rule, provide a 60-day public comment period, consider public
comments, develop final policies, draft a final rule), it would not
have been possible to issue this document as a proposed rule and issue
a final rule by July 1.
In addition, it would not be feasible to implement the hospital
outpatient PPS without the BBRA 1999 provisions, not only because of
the nature of the BBRA 1999 provisions, but also because section 201(m)
of the BBRA 1999 states: ``Except as provided in this section, the
amendments made by this section shall be effective as if included in
the enactment of BBA.'' Therefore, if we undertook prior notice and
comment procedures with respect to the BBRA 1999 provisions, then
(because such procedures could not be completed by July 1, 2000) the
PPS would not be implemented by July 1, 2000.
Accordingly, we find good cause to waive the procedures for prior
notice and comment with respect to the provisions of this document that
implement the BBRA 1999 refinements to hospital outpatient PPS. We are
providing a 60-day period for public comment with respect to the
provisions of this final rule with comment period that implement the
BBRA refinements. We are not accepting comments with respect to the
other aspects of this document (for which the public has already had an
extensive opportunity to comment).
List of Subjects
42 CFR Part 409
Health facilities, Medicare.
42 CFR Part 410
Health facilities, Health professions, Kidney diseases,
Laboratories, Medicare, Rural areas, X-rays.
42 CFR Part 411
Kidney diseases, Medicare, Reporting and recordkeeping
requirements.
42 CFR Part 412
Administrative practice and procedure, Health facilities, Medicare,
Puerto Rico, Reporting and recordkeeping requirements.
42 CFR Part 413
Health facilities, Kidney diseases, Medicare, Puerto Rico,
Reporting and recordkeeping requirements.
42 CFR Part 419
Health facilities, Hospitals, Medicare.
42 CFR Part 424
Emergency medical services, Health facilities, Health professions,
Medicare.
42 CFR Part 489
Health facilities, Medicare, Reporting and recordkeeping
requirements.
42 CFR Part 498
Administrative practice and procedure, Health facilities, Health
professions, Medicare, Reporting and recordkeeping requirements.
42 CFR Part 1003
Administrative practice and procedure, Archives and records, Grant
program--social programs, Maternal and Child Health, Medicaid,
Medicare, Penalties.
For the reasons set forth in the preamble, 42 CFR chapter IV is
amended as follows:
PART 409--HOSPITAL INSURANCE BENEFITS
A. Part 409 is amended as set forth below:
1. The authority citation for part 409 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
Subpart B--Inpatient Hospital Services and Inpatient Critical
Access Hospital Services
2. In Sec. 409.10, paragraph (b) is revised to read as follows:
Sec. 409.10 Included services.
* * * * *
(b) Inpatient hospital services does not include the following
types of services:
(1) Posthospital SNF care, as described in Sec. 409.20, furnished
by a hospital or a critical access hospital that has a swing-bed
approval.
(2) Nursing facility services, described in Sec. 440.155 of this
chapter, that may be furnished as a Medicaid service under title XIX of
the Act in a swing-bed hospital that has an approval to furnish nursing
facility services.
(3) Physician services that meet the requirements of
Sec. 415.102(a) of this chapter for payment on a fee schedule basis.
(4) Physician assistant services, as defined in section
1861(s)(2)(K)(i) of the Act.
(5) Nurse practitioner and clinical nurse specialist services, as
defined in section 1861(s)(2)(K)(ii) of the Act.
[[Page 18536]]
(6) Certified nurse mid-wife services, as defined in section
1861(gg) of the Act.
(7) Qualified psychologist services, as defined in section 1861(ii)
of the Act.
(8) Services of an anesthetist, as defined in Sec. 410.69 of this
chapter.
PART 410--SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS
B. Part 410 is amended as set forth below:
1. The authority citation for part 410 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
Subpart A--General Provisions
2. In Sec. 410.2, the introductory text is republished, the
definition of ``Community mental health center (CMHC)'' is revised, and
the definitions of ``Encounter'' and ``Outpatient'' are added in
alphabetical order to read as follows:
Sec. 410.2 Definitions.
As used in this part--
Community mental health center (CMHC) means an entity that--
(1) Provides outpatient services, including specialized outpatient
services for children, the elderly, individuals who are chronically
mentally ill, and residents of its mental health service area who have
been discharged from inpatient treatment at a mental health facility;
(2) Provides 24-hour-a-day emergency care services;
(3) Provides day treatment or other partial hospitalization
services, or psychosocial rehabilitation services;
(4) Provides screening for patients being considered for admission
to State mental health facilities to determine the appropriateness of
this admission; and
(5) Meets applicable licensing or certification requirements for
CMHCs in the State in which it is located.
Encounter means a direct personal contact between a patient and a
physician, or other person who is authorized by State licensure law
and, if applicable, by hospital or CAH staff bylaws, to order or
furnish hospital services for diagnosis or treatment of the patient.
* * * * *
Outpatient means a person who has not been admitted as an inpatient
but who is registered on the hospital or CAH records as an outpatient
and receives services (rather than supplies alone) directly from the
hospital or CAH.
* * * * *
Subpart B--Medical and Other Health Services
3. In Sec. 410.27:
A. The section heading is revised;
B. The introductory text to paragraph (a) is revised;
C. The introductory text to paragraph (a)(1) is republished;
D. The word ``and'' at the end of paragraph (a)(1)(i) is removed;
and
E. New paragraphs (a)(1)(iii), (e), and (f) are added to read as
follows:
Sec. 410.27 Outpatient hospital services and supplies incident to a
physician service: Conditions.
(a) Medicare Part B pays for hospital services and supplies
furnished incident to a physician service to outpatients, including
drugs and biologicals that cannot be self-administered, if--
(1) They are furnished--
* * * * *
(iii) In the hospital or at a location (other than an RHC or an
FQHC) that HCFA designates as a department of a provider under
Sec. 413.65 of this chapter; and
* * * * *
(e) Services furnished by an entity other than the hospital are
subject to the limitations specified in Sec. 410.42(a).
(f) Services furnished at a location (other than an RHC or an FQHC)
that HCFA designates as a department of a provider under Sec. 413.65 of
this chapter must be under the direct supervision of a physician.
``Direct supervision'' means the physician must be present and on the
premises of the location and immediately available to furnish
assistance and direction throughout the performance of the procedure.
It does not mean that the physician must be present in the room when
the procedure is performed.
4. In Sec. 410.28, paragraph (a)(4) is removed, paragraph (c) is
redesignated as paragraph (d), and new paragraphs (c) and (e) are added
to read as follows:
Sec. 410.28 Hospital or CAH diagnostic services furnished to
outpatients: Conditions.
* * * * *
(c) Diagnostic services furnished by an entity other than the
hospital or CAH are subject to the limitations specified in
Sec. 410.42(a).
* * * * *
(e) Medicare Part B makes payment under section 1833(t) of the Act
for diagnostic services furnished at a facility (other than an RHC or
an FQHC) that HCFA designates as having provider-based status only when
the diagnostic services are furnished under the appropriate level of
physician supervision specified by HCFA in accordance with the
definitions in Sec. 410.32(b)(3)(i), (b)(3)(ii), and (b)(3)(iii). Under
general supervision at a facility accorded provider-based status, the
training of the nonphysician personnel who actually perform the
diagnostic procedure and the maintenance of the necessary equipment and
supplies are the continuing responsibility of the facility.
5. A new Sec. 410.42 is added to read as follows:
Sec. 410.42 Limitations on coverage of certain services furnished to
hospital outpatients.
(a) General rule. Except as provided in paragraph (b) of this
section, Medicare Part B does not pay for any item or service that is
furnished to a hospital outpatient (as defined in Sec. 410.2) during an
encounter (as defined in Sec. 410.2) by an entity other than the
hospital unless the hospital has an arrangement (as defined in
Sec. 409.3 of this chapter) with that entity to furnish that particular
service to its patients. As used in this paragraph, the term
``hospital'' includes a CAH.
(b) Exception. The limitations stated in paragraph (a) of this
section do not apply to the following services:
(1) Physician services that meet the requirements of
Sec. 415.102(a) of this chapter for payment on a fee schedule basis.
(2) Physician assistant services, as defined in section
1861(s)(2)(K)(i) of the Act.
(3) Nurse practitioner and clinical nurse specialist services, as
defined in section 1861(s)(2)(K)(ii) of the Act.
(4) Certified nurse mid-wife services, as defined in section
1861(gg) of the Act.
(5) Qualified psychologist services, as defined in section 1861(ii)
of the Act.
(6) Services of an anesthetist, as defined in Sec. 410.69.
(7) Services furnished to SNF residents as defined in
Sec. 411.15(p) of this chapter.
6. In Sec. 410.43, paragraph (b) is revised to read as follows:
Sec. 410.43 Partial hospitalization services: Conditions and
exclusions.
* * * * *
(b) The following services are separately covered and not paid as
partial hospitalization services:
(1) Physician services that meet the requirements of
Sec. 415.102(a) of this chapter for payment on a fee schedule basis.
[[Page 18537]]
(2) Physician assistant services, as defined in section
1861(s)(2)(K)(i) of the Act.
(3) Nurse practitioner and clinical nurse specialist services, as
defined in section 1861(s)(2)(K)(ii) of the Act.
(4) Qualified psychologist services, as defined in section 1861(ii)
of the Act.
(5) Services furnished to SNF residents as defined in
Sec. 411.15(p) of this chapter.
PART 411--EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE
PAYMENT
C. Part 411 is amended as set forth below:
1. The authority citation for part 411 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
Subpart A--General Exclusions and Exclusion of Particular Services
2. In Sec. 411.15:
A. The introductory text is republished;
B. The section heading to paragraph (m) is revised;
C. Paragraph (m)(1) is revised;
D. Paragraph (m)(2) is redesignated as paragraph (m)(3);
E. The introductory text to newly redesignated paragraph (m)(3) is
republished;
F. Newly redesignated paragraphs (m)(3)(iii), (m)(3)(iv), and
(m)(3)(v) are redesignated as paragraphs (m)(3)(iv), (m)(3)(v), and
(m)(3)(vi), respectively; and
G. New paragraphs (m)(2) and (m)(3)(iii) are added to read as
follows:
Sec. 411.15 Particular services excluded from coverage.
The following services are excluded from coverage:
* * * * *
(m) Services to hospital patients--(1) Basic rule. Except as
provided in paragraph (m)(3) of this section, any service furnished to
an inpatient of a hospital or to a hospital outpatient (as defined in
Sec. 410.2 of this chapter) during an encounter (as defined in
Sec. 410.2 of this chapter) by an entity other than the hospital unless
the hospital has an arrangement (as defined in Sec. 409.3 of this
chapter) with that entity to furnish that particular service to the
hospital's patients. As used in this paragraph (m)(1), the term
``hospital'' includes a CAH.
(2) Scope of exclusion. Services subject to exclusion from coverage
under the provisions of this paragraph (m) include, but are not limited
to, clinical laboratory services; pacemakers and other prostheses and
prosthetic devices (other than dental) that replace all or part of an
internal body organ (for example, intraocular lenses); artificial
limbs, knees, and hips; equipment and supplies covered under the
prosthetic device benefits; and services incident to a physician
service.
(3) Exceptions. The following services are not excluded from
coverage:
* * * * *
(iii) Nurse practitioner and clinical nurse specialist services, as
defined in section 1861(s)(2)(K)(ii) of the Act.
* * * * *
PART 412--PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL
SERVICES
D. Part 412 is amended as set forth below:
1. The authority citation for part 412 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
Subpart C--Conditions for Payment Under the Prospective Payment
Systems for Inpatient Operating Costs and Inpatient Capital-Related
Costs
2. In Sec. 412.50, paragraphs (a) and (b) are revised to read as
follows:
Sec. 412.50 Furnishing of inpatient hospital services directly or
under arrangements.
(a) The applicable payments made under the prospective payment
systems, as described in subparts H and M of this part, are payment in
full for all inpatient hospital services, as defined in Sec. 409.10 of
this chapter. Inpatient hospital services do not include the following
types of services:
(1) Physician services that meet the requirements of
Sec. 415.102(a) of this chapter for payment on a fee schedule basis.
(2) Physician assistant services, as defined in section
1861(s)(2)(K)(i) of the Act.
(3) Nurse practitioner and clinical nurse specialist services, as
defined in section 1861(s)(2)(K)(ii) of the Act.
(4) Certified nurse mid-wife services, as defined in section
1861(gg) of the Act.
(5) Qualified psychologist services, as defined in section 1861(ii)
of the Act.
(6) Services of an anesthetist, as defined in Sec. 410.69 of this
chapter.
(b) HCFA does not pay any provider or supplier other than the
hospital for services furnished to a beneficiary who is an inpatient,
except for the services described in paragraphs (a)(1) through (a)(6)
of this section.
* * * * *
PART 413--PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR
END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT
RATES FOR SKILLED NURSING FACILITIES
E. Part 413 is amended as set forth below:
1. The authority citation for part 413 continues to read as
follows:
Authority: Secs. 1102, 1812(d), 1814(b), 1815, 1833(a), (i), and
(n), 1871, 1881, 1883, and 1886 of the Social Security Act (42
U.S.C. 1302, 1395f(b), 1395g, 1395l, 1395l(a), (i), and (n),
1395x(v), 1395hh, 1395rr, 1395tt, and 1395ww).
Subpart A--Introduction and General Rules
Sec. 413.1 [Amended]
2. In Sec. 413.1, paragraph (a)(2)(viii) is removed.
Subpart B--Accounting Records and Reports
3. In Sec. 413.24, the heading to paragraph (d) is republished, and
a new paragraph (d)(6) is added to read as follows:
Sec. 413.24 Adequate cost data and cost finding.
* * * * *
(d) Cost finding methods. * * *
(6) Management contracts. (i) If the main provider purchases
services for a department of the provider or a provider-based entity
through a management contract or otherwise directly assigns costs to
the department or entity, the like costs of the main provider must be
carved out to ensure that they are not allocated to the department of
the provider or provider-based entity. However, if the like costs of
the main provider cannot be separately identified, the costs of the
services purchased through a management contract must be included in
the main provider's administrative and general costs and allocated
among the provider's overall statistics.
(ii) Costs of free-standing entities may not be shown in the
provider's trial balance for purposes of stepping down overhead costs
to these entities. The provider must develop detailed work papers
showing the exact cost of the services (including overhead) provided to
or by the free-standing entity and show those carved out costs as
[[Page 18538]]
nonreimbursable cost centers in the provider's trial balance.
* * * * *
Subpart E--Payments to Providers
4. A new Sec. 413.65 is added to read as follows:
Sec. 413.65 Requirements for a determination that a facility or an
organization has provider-based status.
(a) Scope and definitions. (1) Scope. This section applies to all
facilities or organizations for which provider-based status is sought,
including remote locations of hospitals, as defined in paragraph (a)(2)
of this section and satellite facilities as defined in
Sec. 412.22(h)(1) and Sec. 412.25(e)(1) of this chapter, other than
ESRD facilities. Determinations for ESRD facilities are made under
Sec. 413.174 of this chapter.
(2) Definitions. In this subpart E, unless the context indicates
otherwise--
Campus means the physical area immediately adjacent to the
provider's main buildings, other areas and structures that are not
strictly contiguous to the main buildings but are located within 250
yards of the main buildings, and any other areas determined on an
individual case basis, by the HCFA regional office, to be part of the
provider's campus.
Department of a provider means a facility or organization or a
physician office that is either created by, or acquired by, a main
provider for the purpose of furnishing health care services of the same
type as those furnished by the main provider under the name, ownership,
and financial and administrative control of the main provider, in
accordance with the provisions of this section. A department of a
provider may not be licensed to provide health care services in its own
right, may not by itself be qualified to participate in Medicare as a
provider under Sec. 489.2 of this chapter, and Medicare conditions of
participation do not apply to a department as an independent entity.
For purposes of this part, the term ``department of a provider'' does
not include an RHC or, except as specified in paragraph (m)(1) of this
section, an FQHC.
Free-standing facility means an entity that furnishes health care
services to Medicare beneficiaries and that is not integrated with any
other entity as a main provider, a department of a provider, remote
location of a hospital, satellite facility, or a provider-based entity.
Main provider means a provider that either creates, or acquires
ownership of, another entity to deliver additional health care services
under its name, ownership, and financial and administrative control.
Provider-based entity means a provider of health care services, or
an RHC or an FQHC as defined in Sec. 405.2401(b) of this chapter, that
is either created by, or acquired by, a main provider for the purpose
of furnishing health care services of a different type from those of
the main provider under the name, ownership, and administrative and
financial control of the main provider, in accordance with the
provisions of this section.
Provider-based status means the relationship between a main
provider and a provider-based entity or a department of a provider,
remote location of a hospital, or satellite facility, that complies
with the provisions of this section.
Remote location of a hospital means a facility or an organization
that is either created by, or acquired by, a hospital that is a main
provider for the purpose of furnishing inpatient hospital services
under the name, ownership, and financial and administrative control of
the main provider, in accordance with the provisions of this section. A
remote location of a hospital may not be licensed to provide inpatient
hospital services in its own right, and Medicare conditions of
participation do not apply to a remote location of a hospital as an
independent entity. For purposes of this part, the term ``remote
location of a hospital'' does not include a satellite facility as
defined in Sec. 412.22(h)(1) and Sec. 412.25(e)(1) of this chapter.
(b) Responsibility for obtaining provider-based determinations. (1)
A facility or organization is not entitled to be treated as provider-
based simply because it or the main provider believe it is provider-
based.
(2) A main provider or a facility or organization must contact HCFA
and the facility or organization must be determined by HCFA to be
provider-based before the main provider bills for services of the
facility or organization as if the facility or organization were
provider-based, or before it includes costs of those services on its
cost report.
(3) A facility that is not located on the campus of a hospital and
is used as a site of physician services of the kind ordinarily
furnished in physician offices will be presumed to be a free-standing
facility, unless it is determined by HCFA to have provider-based
status.
(c) Reporting. (1) A main provider that creates or acquires a
facility or organization for which it wishes to claim provider-based
status, including any physician offices that a hospital wishes to
operate as a hospital outpatient department or clinic, must report its
acquisition of the facility or organization to HCFA if the facility or
organization is located off the campus of the provider, or inclusion of
the costs of the facility or organization in the provider's cost report
would increase the total costs on the provider's cost report by at
least 5 percent, and must furnish all information needed for a
determination as to whether the facility or organization meets the
requirements in paragraph (d) of this section for provider-based
status.
(2) A main provider that has had one or more facilities or
organizations considered provider-based also must report to HCFA any
material change in the relationship between it and any provider-based
facility or organization, such as a change in ownership of the facility
or organization or entry into a new or different management contract
that could affect the provider-based status of the facility or
organization.
(d) Requirements. An entity must meet all of the following
requirements to be determined by HCFA to have provider-based status.
(1) Licensure. The department of the provider, remote location of a
hospital, or satellite facility and the main provider are operated
under the same license, except in areas where the State requires a
separate license for the department of the provider, remote location of
a hospital, or satellite facility, or in States where State law does
not permit licensure of the provider and the prospective department of
the provider, remote location of a hospital, or satellite facility
under a single license. If a State health facilities' cost review
commission or other agency that has authority to regulate the rates
charged by hospitals or other providers in a State finds that a
particular facility or organization is not part of a provider, HCFA
will determine that the facility or organization does not have
provider-based status.
(2) Operation under the ownership and control of the main provider.
The facility or organization seeking provider-based status is operated
under the ownership and control of the main provider, as evidenced by
the following:
(i) The business enterprise that constitutes the facility or
organization is 100 percent owned by the provider.
(ii) The main provider and the facility or organization seeking
status as a department of the provider, remote location of a hospital,
or satellite facility have the same governing body.
(iii) The facility or organization is operated under the same
organizational documents as the main provider. For
[[Page 18539]]
example, the facility or organization seeking provider-based status
must be subject to common bylaws and operating decisions of the
governing body of the provider where it is based.
(iv) The main provider has final responsibility for administrative
decisions, final approval for contracts with outside parties, final
approval for personnel actions, final responsibility for personnel
policies (such as fringe benefits/code of conduct), and final approval
for medical staff appointments in the facility or organization.
(3) Administration and supervision. The reporting relationship
between the facility or organization seeking provider-based status and
the main provider must have the same frequency, intensity, and level of
accountability that exists in the relationship between the main
provider and one of its departments, as evidenced by compliance with
all of the following requirements:
(i) The facility or organization is under the direct supervision of
the main provider.
(ii) The facility or organization is operated under the same
monitoring and oversight by the provider as any other department of the
provider, and is operated just as any other department of the provider
with regard to supervision and accountability. The facility or
organization director or individual responsible for daily operations at
the entity--
(A) Maintains a reporting relationship with a manager at the main
provider that has the same frequency, intensity, and level of
accountability that exists in the relationship between the main
provider and its departments; and
(B) Is accountable to the governing body of the main provider, in
the same manner as any department head of the provider.
(iii) The following administrative functions of the facility or
organization are integrated with those of the provider where the
facility or organization is based: billing services, records, human
resources, payroll, employee benefit package, salary structure, and
purchasing services. Either the same employees or group of employees
handle these administrative functions for the facility or organization
and the main provider, or the administrative functions for both the
facility or organization and the entity are--
(A) Contracted out under the same contract agreement; or
(B) Handled under different contract agreements, with the contract
of the facility or organization being managed by the main provider.
(4) Clinical services. The clinical services of the facility or
organization seeking provider-based status and the main provider are
integrated as evidenced by the following:
(i) Professional staff of the facility or organization have
clinical privileges at the main provider.
(ii) The main provider maintains the same monitoring and oversight
of the facility or organization as it does for any other department of
the provider.
(iii) The medical director of the facility or organization seeking
provider-based status maintains a reporting relationship with the Chief
Medical Officer or other similar official of the main provider that has
the same frequency, intensity, and level of accountability that exists
in the relationship between the medical director of a department of the
main provider and the Chief Medical Officer or other similar official
of the main provider, and is under the same type of supervision and
accountability as any other director, medical or otherwise, of the main
provider.
(iv) Medical staff committees or other professional committees at
the main provider are responsible for medical activities in the
facility or organization including quality assurance, utilization
review, and the coordination and integration of services, to the extent
practicable, between the facility or organization seeking provider-
based status and the main provider.
(v) Medical records for patients treated in the facility or
organization are integrated into a unified retrieval system (or cross
reference) of the main provider.
(vi) Inpatient and outpatient services of the facility or
organization and the main provider are integrated, and patients treated
at the facility or organization who require further care have full
access to all services of the main provider and are referred where
appropriate to the corresponding inpatient or outpatient department or
service of the main provider.
(5) Financial integration. The financial operations of the facility
or organization are fully integrated within the financial system of the
main provider, as evidenced by shared income and expenses between the
main provider and the facility or organization. The costs of the
facility or organization are reported in a cost center of the provider,
and the financial status of the facility or organization is
incorporated and readily identified in the main provider's trial
balance.
(6) Public awareness. The facility or organization seeking status
as a department of a provider, remote location of a hospital, or
satellite facility is held out to the public and other payers as part
of the main provider. When patients enter the provider-based facility
or organization, they are aware that they are entering the main
provider and are billed accordingly.
(7) Location in immediate vicinity. The facility or organization
and the main provider are located on the same campus, except where the
following requirements are met:
(i) The facility or organization demonstrates a high level of
integration with the main provider by showing that it meets all of the
other provider-based criteria, and demonstrates that it serves the same
patient population as the main provider, by submitting records showing
that, during the 12-month period immediately preceding the first day of
the month in which the application for provider-based status is filed
with HCFA, and for each subsequent 12-month period--
(A) At least 75 percent of the patients served by the facility or
organization reside in the same zip code areas as at least 75 percent
of the patients served by the main provider;
(B) At least 75 percent of the patients served by the facility or
organization who required the type of care furnished by the main
provider received that care from that provider (for example, at least
75 percent of the patients of an RHC seeking provider-based status
received inpatient hospital services from the hospital that is the main
provider); or
(C) If the facility or organization is unable to meet the criteria
in paragraph (d)(7)(i)(A) or (d)(7)(i)(B) of this section because it
was not in operation during all of the 12-month period described in the
previous sentence, the facility or organization is located in a zip
code area included among those that, during all of the 12-month period
described in the previous sentence, accounted for at least 75 percent
of the patients served by the main provider.
(ii) A facility or organization is not considered to be in the
``immediate vicinity'' of the main provider unless the facility or
organization and the main provider are located in the same State or,
where consistent with the laws of both States, adjacent States.
(iii) A rural health clinic that is otherwise qualified as a
provider-based entity of a hospital that is located in a rural area, as
defined in Sec. 412.62(f)(1)(iii) of this chapter, and has fewer than
50 beds, as determined under Sec. 412.105(b) of this chapter, is not
subject to the criterion in this paragraph (d)(7).
(e) Provider-based status not applicable to joint ventures. A
facility or
[[Page 18540]]
organization cannot be considered provider-based if the entity is owned
by two or more providers engaged in a joint venture. For example, where
a hospital has jointly purchased or jointly created free-standing
facilities under joint venture arrangements, neither party to the joint
venture arrangement can claim the free-standing facility as a provider-
based entity.
(f) Management contracts. Facilities and organizations that
otherwise meet the requirements of paragraph (d) of this section, but
are operated under management contracts, must also meet all of the
following criteria:
(1) The staff of the facility or organization, other than
management staff, are employed by the provider or by another
organization, other than the management company, which also employs the
staff of the main provider.
(2) The administrative functions of the facility or organization
are integrated with those of the main provider, as determined under
criteria in paragraph (d)(3)(iii) of this section.
(3) The main provider has significant control over the operations
of the facility or organization as determined under criteria in
paragraph (b)(3)(ii) of this section.
(4) The management contract is held by the main provider itself,
not by a parent organization that has control over both the main
provider and the facility or organization.
(g) Obligations of hospital outpatient departments and hospital-
based entities. (1) Hospital outpatient departments located either on
or off the campus of the hospital that is the main provider must comply
with the anti-dumping rules in Secs. 489.20(l), (m), (q), and (r) and
Sec. 489.24 of this chapter. If any individual comes to any hospital-
based entity (including an RHC) located on the main hospital campus,
and a request is made on the individual's behalf for examination or
treatment of a medical condition, as described in Sec. 489.24 of this
chapter, the hospital must comply with the anti-dumping rules in
Sec. 489.24 of this chapter.
(2) Physician services furnished in hospital outpatient departments
or hospital-based entities (other than RHCs) must be billed with the
correct site-of-service indicator, so that applicable site-of-service
reductions to physician and practitioner payment amounts can be
applied.
(3) Hospital outpatient departments must comply with all the terms
of the hospital's provider agreement.
(4) Physicians who work in hospital outpatient departments or
hospital-based entities are obligated to comply with the non-
discrimination provisions in Sec. 489.10(b) of this chapter.
(5) Hospital outpatient departments (other than RHCs) must treat
all Medicare patients, for billing purposes, as hospital outpatients.
The department must not treat some Medicare patients as hospital
outpatients and others as physician office patients.
(6) In the case of a patient admitted to the hospital as an
inpatient after receiving treatment in the hospital outpatient
department or hospital-based entity, payments for services in the
hospital outpatient department or hospital-based entity are subject to
the payment window provisions applicable to PPS hospitals and to
hospitals and units excluded from PPS set forth at Sec. 412.2(c)(5) of
this chapter and at Sec. 413.40(c)(2), respectively.
(7) When a Medicare beneficiary is treated in a hospital outpatient
department or hospital-based entity (other than an RHC) that is not
located on the main provider's campus, the hospital has a duty to
provide written notice to the beneficiary, prior to the delivery of
services, of the amount of the beneficiary's potential financial
liability (that is, of the fact that the beneficiary will incur a
coinsurance liability for an outpatient visit to the hospital as well
as for the physician service, and of the amount of that liability). The
notice must be one that the beneficiary can read and understand. If the
beneficiary is unconscious, under great duress, or for any other reason
unable to read a written notice and understand and act on his or her
own rights, the notice must be provided, prior to the delivery of
services, to the beneficiary's authorized representative.
(8) Hospital outpatient departments must meet applicable hospital
health and safety rules for Medicare-participating hospitals in part
482 of this chapter.
(h) Furnishing all services under arrangement. A facility or
organization may not qualify for provider-based status if all patient
care services furnished at the facility are furnished under
arrangement.
(i) Inappropriate treatment of a facility or organization as
provider-based. (1) Determination and review. If HCFA learns that a
provider has treated a facility or organization as provider-based and
the provider had not obtained a determination of provider-based status
under this section, HCFA will--
(i) Review current payments and, if necessary, take action in
accordance with the rules on inappropriate billing in paragraph (j) of
this section;
(ii) Investigate and determine whether the requirements in
paragraph (d) of this section (or, for periods prior to October 10,
2000, the requirements in applicable program instructions) were met;
and
(iii) Review all previous payments to that provider for all cost
reporting periods subject to re-opening in accordance with
Sec. 405.1885 and Sec. 405.1889 of this chapter.
(2) Recovery of overpayments. If HCFA finds that payments for
services at the facility or organization have been made as if the
facility or organization were provider-based, even though HCFA had not
previously determined that the facility or organization qualified for
provider-based status, HCFA will recover the difference between the
amount of payments that actually were made and the amount of payments
that HCFA estimates should have been made in the absence of a
determination of provider-based status, except that recovery will not
be made for any period prior to October 10, 2000 if during all of that
period the management of the entity made a good faith effort to operate
it as a provider-based facility or organization, as described in
paragraph (h)(3) of this section.
(3) Exception for good faith effort. HCFA determines that the
management of a facility or organization has made a good faith effort
to operate it as a provider-based entity if--
(i) The requirements regarding licensure and public awareness in
paragraphs (d)(1) and (d)(6) of this section are met;
(ii) All facility services were billed as if they had been
furnished by a department of a provider, remote location of a hospital,
satellite facility, or a provider-based entity of the main provider;
and
(iii) All professional services of physicians and other
practitioners were billed with the correct site-of-service indicator,
as described in paragraph (g)(2) of this section.
(j) Inappropriate billing. If HCFA finds that a facility or
organization is being treated as provider-based without having obtained
a determination of provider-based status under this section, HCFA will
notify the provider, adjust future payments, review previous payments,
determine whether the facility or organization qualifies for provider-
based status under this paragraph, and continue payments only under
specific conditions, as described in paragraphs (j)(1), (j)(2), (j)(3),
and (j)(4) of this section.
(1) Notice to provider. If HCFA finds that inappropriate billing
has occurred or is occurring since no provider-based
[[Page 18541]]
determination has been made by HCFA, HCFA will issue written notice to
the provider that payments for past cost reporting periods may be
reviewed and recovered as described in paragraph (i) of this section,
that future payments for services in or of the facility or organization
will be adjusted as described in paragraph (j)(2) of this section, and
that a determination of provider-based status will be made.
(2) Adjustment of payments. If HCFA finds that inappropriate
billing has occurred or is occurring since no provider-based
determination has been made by HCFA, HCFA will adjust future payments
to the provider, the facility or organization, or both, to approximate
as closely as possible the amounts that would be paid, in the absence
of a provider-based determination, if all other requirements for
billing were met.
(3) Review of previous payments. If HCFA finds that inappropriate
billing has occurred or is occurring since no provider-based
determination has been made by HCFA, HCFA will review previous payments
and, if necessary, take action in accordance with the rules on
inappropriate treatment of a facility or organization as provider-based
in paragraph (h) of this section.
(4) Determination regarding provider-based status. If HCFA finds
that inappropriate billing has occurred or is occurring since no
provider-based determination has been made by HCFA, HCFA will determine
whether the facility or organization qualifies for provider-based
status under the criteria in this section. If HCFA determines that the
facility or organization qualifies for provider-based status, future
payment for services at or by the facility or organization will be
adjusted to reflect that determination. If HCFA determines that the
facility or organization does not qualify for provider-based status,
future payment for services at or by the facility or organization will
be made only in accordance with the rules in paragraph (i)(5) of this
section.
(5) Continuation of payment. The notice of denial of provider-based
status sent to the provider will ask the provider to notify HCFA in
writing, within 30 days of the date the notice is issued, of whether
the facility or organization (or, where applicable, the practitioners
who staff the facility or organization) will be seeking to enroll and
meet other requirements to bill for services in a free-standing
facility. If the provider indicates that the facility, organization, or
practitioners will not be seeking to enroll, or if HCFA does not
receive a response within 30 days of the date the notice was issued,
all payment under this paragraph (i)(5) will end as of the 30th day
after the date of notice. If the provider indicates that the facility
or organization, or its practitioners, will be seeking to meet
enrollment and other requirements for billing for services in a free-
standing facility, payment for services of the facility or organization
will continue, at the adjusted amounts described in paragraph (j)(2) of
this section for as long as is required for all billing requirements to
be met (but not longer than 6 months) if the facility or organization,
or its practitioners, submit a complete enrollment application and
provide all other required information within 90 days after the date of
notice; and the facility or organization, or its practitioners, furnish
all other information needed by HCFA to process the enrollment
application and verify that other billing requirements are met. If the
necessary applications or information are not provided, HCFA will
terminate all payment to the provider, facility, or organization as of
the date HCFA issues notice that necessary applications or information
have not been submitted.
(k) Correction of errors. HCFA may review a past determination of
provider-based status for a facility or organization or may review the
status of a facility or organization (that is, whether the facility or
organization is provider-based) if no determination regarding provider-
based status has previously been made, if HCFA believes that status may
be inappropriate, based on the provisions of this section. If HCFA
determines that a previous determination was in error, and the entity
should not be considered provider-based, HCFA notifies the main
provider. Treatment of the facility or organization as provider-based
ceases with the first day of the next cost report period following
notification of the redetermination, but not less than 6 months after
the date of notification.
(l) Status of Indian Health Service and Tribal facilities and
organizations. Facilities and organizations operated by the Indian
Health Service or Tribes will be considered to be departments of
hospitals operated by the Indian Health Service or Tribes if, on or
before April 7, 2000, they furnished only services that were billed as
if they had been furnished by a department of a hospital operated by
the Indian Health Service or a Tribe and they are:
(1) Owned and operated by the Indian Health Service;
(2) Owned by the Tribe but leased from the Tribe by the IHS under
the Indian Self-Determination Act (Pub. L. 93-638) in accordance with
applicable regulations and policies of the Indian Health Service in
consultation with Tribes: or
(3) Owned by the Indian Health Service but leased and operated by
the Tribe under the Indian Self-Determination Act (Pub. L. 93-638) in
accordance with applicable regulations and policies of the Indian
Health Service in consultation with Tribes.
(m) FQHCs and ``look-alikes''. A facility that has, since April 7,
1995, furnished only services that were billed as if they had been
furnished by a department of a provider will continue to be treated,
for purposes of this section, as a department of the provider without
regard to whether it complies with the criteria for provider-based
status in this section, if the facility--
(1) Received a grant before 1995 under section 330 of the Public
Health Service Act, or is receiving funding from such a grant under a
contract with the recipient of such a grant and meets the requirements
to receive a grant under section 330 of the Public Health Service Act;
or
(2) Based on the recommendation of the Public Health Service, was
determined by HCFA before 1995 to meet the requirements for receiving
such a grant.
(n) Effective date of provider-based status. Provider-based status
for a facility or organization is effective on the earliest date on
which a request for provider-based status has been made, and all
requirements of this part have been met.
Subpart F--Specific Categories of Costs
5. In Sec. 413.118, the heading to paragraph (d) is republished,
and a new paragraph (d)(5) is added to read as follows:
Sec. 413.118 Payment for facility services related to covered ASC
surgical procedures performed in hospitals on an outpatient basis.
* * * * *
(d) Blended payment amount. * * *
(5) For portions of cost reporting periods beginning on or after
October 1, 1997, for purposes of calculating the blended payment amount
under paragraph (d)(4) of this section, the ASC payment amount is the
sum of the standard overhead amounts reduced by deductibles and
coinsurance as defined in section 1866(a)(2)(ii) of the Act.
* * * * *
6. In Sec. 413.122:
A. The heading to paragraph (b) is republished
B. A new paragraph (b)(5) is added
C. The heading to paragraph (c) is republished; and
[[Page 18542]]
D. A new paragraph (c)(4) is added to read as follows:
Sec. 413.122 Payment for hospital outpatient radiology services and
other diagnostic procedures.
* * * * *
(b) Payment for hospital outpatient radiology services. * * *
(5) For hospital outpatient radiology services furnished on or
after October 1, 1997, the blended payment amount is equal to the sum
of--
(i) 42 percent of the hospital-specific amount; and
(ii) 58 percent of the fee schedule amount calculated as 62 percent
of the sum of the fee schedule amounts payable for the same services
when furnished by participating physicians in their offices in the same
locality, less deductible and coinsurance as defined in section
1866(a)(2)(A)(ii) of the Act.
(c) Payment for other diagnostic procedures. * * *
(4) For other diagnostic services furnished on or after October 1,
1997, the blended payment amount is equal to the sum of--
(i) 50 percent of the hospital-specific amount; and
(ii) 50 percent of the fee schedule amount calculated as 42 percent
of the sum of the fee schedule amounts payable for the same services
when furnished by participating physicians in their offices in the same
locality less deductible and coinsurance as defined in section
1866(a)(2)(A)(ii) of the Act.
7. In Sec. 413.124, paragraph (a) is revised to read as follows:
Sec. 413.124 Reduction to hospital outpatient operating costs.
(a) Except for sole community hospitals, as defined in Sec. 412.92
of this chapter, and critical access hospitals, the reasonable costs of
outpatient hospital services (other than capital-related costs of these
services) are reduced by 5.8 percent for services furnished during
portions of cost reporting periods occurring on or after October 1,
1990 and until the first date that the prospective payment system under
part 419 of this chapter is implemented.
* * * * *
Subpart G--Capital-Related Costs
8. In Sec. 413.130, the heading to paragraph (j) and the
introductory text to paragraph (j)(1) are republished, and paragraph
(j)(1)(ii) is revised to read as follows:
Sec. 413.130 Introduction to capital-related costs.
* * * * *
(j) Reduction to capital-related costs. (1) Except for sole
community hospitals and critical access hospitals, the amount of
capital-related costs of all hospital outpatient services is reduced
by--
* * * * *
(ii) 10 percent for portions of cost reporting periods occurring on
or after October 1, 1991 and until the first date that the prospective
payment system under part 419 of this chapter is implemented.
* * * * *
F. A new part 419, consisting of Secs. 419.1, 419.2, 419.20,
419.21, 419.22, 419.30, 419.31, 419.32, 419.40, 419.41, 419.42, 419.43,
419.44, 419.50, 419.60, and 419.70, is added to read as follows:
PART 419--PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT
DEPARTMENT SERVICES
Subpart A--General Provisions
Sec.
419.1 Basis and scope.
419.2 Basis of payment.
Subpart B--Categories of Hospitals and Services Subject to and
Excluded From the Hospital Outpatient Prospective Payment System
419.20 Hospitals subject to the hospital outpatient prospective
payment system.
419.21 Hospital outpatient services subject to the outpatient
prospective payment system.
419.22 Hospital outpatient services excluded from payment under
the hospital outpatient prospective payment system.
Subpart C--Basic Methodology for Determining Prospective Payment
Rates for Hospital Outpatient Services
419.30 Base expenditure target for calendar year 1999.
419.31 Ambulatory payment classification (APC) system and payment
weights.
419.32 Calculation of prospective payment rates for hospital
outpatient services.
Subpart D--Payments to Hospitals
419.40 Payment concepts.
419.41 Calculation of national beneficiary copayment amounts and
national Medicare program payment amounts.
419.42 Hospital election to reduce copayment.
419.43 Adjustments to national program payment and beneficiary
copayment amounts.
419.44 Payment reductions for surgical procedures.
Subpart E--Updates
419.50 Annual updates.
Subpart F--Limitations on Review
419.60 Limitations on administrative and judicial review.
Subpart G--Transitional Corridors
419.70 Transitional adjustment to limit decline in payment.
Authority: Secs. 1102, 1833(t), and 1871 of the Social Security
Act (42 U.S.C. 1302, 1395l(t), and 1395hh).
PART 419--PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT
DEPARTMENT SERVICES
Subpart A--General Provisions
Sec. 419.1 Basis and scope.
(a) Basis. This part implements section 1833(t) of the Act by
establishing a prospective payment system for services furnished on or
after July 1, 2000 by hospital outpatient departments to Medicare
beneficiaries who are registered on hospital records as outpatients.
(b) Scope. This subpart describes the basis of payment for
outpatient hospital services under the prospective payment system.
Subpart B sets forth the categories of hospitals and services that are
subject to the outpatient hospital prospective payment system and those
categories of hospitals and services that are excluded from the
outpatient hospital prospective payment system. Subpart C sets forth
the basic methodology by which prospective payment rates for hospital
outpatient services are determined. Subpart D describes Medicare
payment amounts, beneficiary copayment amounts, and methods of payment
to hospitals under the hospital outpatient prospective payment system.
Subpart E describes how the hospital outpatient prospective payment
system may be updated. Subpart F describes limitations on
administrative and judicial review. Subpart G describes the
transitional payment adjustments that are made before 2004 to limit
declines in payment for outpatient services.
Sec. 419.2 Basis of payment.
(a) Unit of payment. Under the hospital outpatient prospective
payment system, predetermined amounts are paid for designated services
furnished to Medicare beneficiaries. These services are identified by
codes established under the Health Care Financing Administration Common
Procedure Coding System (HCPCS). The prospective payment rate for each
service or procedure for which payment is allowed under the hospital
outpatient prospective payment system is
[[Page 18543]]
determined according to the methodology described in subpart C of this
part. The manner in which the Medicare payment amount and the
beneficiary copayment amount for each service or procedure are
determined is described in subpart D of this part.
(b) Determination of hospital outpatient prospective payment rates:
Included costs. The prospective payment system establishes a national
payment rate, standardized for geographic wage differences, that
includes operating and capital-related costs that are directly related
and integral to performing a procedure or furnishing a service on an
outpatient basis. In general, these costs include, but are not limited
to--
(1) Use of an operating suite, procedure room, or treatment room;
(2) Use of recovery room;
(3) Use of an observation bed;
(4) Anesthesia, certain drugs, biologicals, and other
pharmaceuticals; medical and surgical supplies and equipment; surgical
dressings; and devices used for external reduction of fractures and
dislocations;
(5) Supplies and equipment for administering and monitoring
anesthesia or sedation;
(6) Intraocular lenses (IOLs);
(7) Incidental services such as venipuncture;
(8) Capital-related costs;
(9) Implantable items used in connection with diagnostic X-ray
tests, diagnostic laboratory tests, and other diagnostic tests;
(10) Durable medical equipment that is implantable;
(11) Implantable prosthetic devices (other than dental) which
replace all or part of an internal body organ (including colostomy bags
and supplies directly related to colostomy care), including replacement
of these devices; and
(12) Costs incurred to procure donor tissue other than corneal
tissue.
(c) Determination of hospital outpatient prospective payment rates:
Excluded costs. The following costs are excluded from the hospital
outpatient prospective payment rates:
(1) Medical education costs for approved nursing and allied health
education programs.
(2) Corneal tissue acquisition costs incurred by hospitals that are
paid for on a reasonable cost basis.
(3) Costs for services listed in Sec. 419.22.
Subpart B--Categories of Hospitals and Services Subject to and
Excluded From the Hospital Outpatient Prospective Payment System
Sec. 419.20 Hospitals subject to the hospital outpatient prospective
payment system.
(a) Applicability. The hospital outpatient prospective payment
system is applicable to any hospital participating in the Medicare
program, except those specified in paragraph (b) of this section, for
services furnished on or after July 1, 2000.
(b) Hospitals excluded from the outpatient prospective payment
system. (1) Those services furnished by Maryland hospitals that are
paid under a cost containment waiver in accordance with section
1814(b)(3) of the Act are excluded from the hospital outpatient
prospective payment system.
(2) Critical access hospitals (CAHs) are excluded from the hospital
outpatient prospective payment system.
Sec. 419.21 Hospital outpatient services subject to the outpatient
prospective payment system.
Except for services described in Sec. 419.22, effective for
services furnished on or after July 1, 2000, payment is made under the
hospital outpatient prospective payment system for the following:
(a) Medicare Part B services furnished to hospital outpatients
designated by the Secretary under this part.
(b) Services designated by the Secretary that are covered under
Medicare Part B when furnished to hospital inpatients who are either
not entitled to benefits under Part A or who have exhausted their Part
A benefits but are entitled to benefits under Part B of the program.
(c) Partial hospitalization services furnished by community mental
health centers (CMHCs).
(d) The following medical and other health services furnished by a
comprehensive outpatient rehabilitation facility (CORF) when they are
provided outside the patient's plan (of care); or by a home health
agency (HHA) to patients who are not under an HHA plan or treatment; or
by a hospice program furnishing services to patients outside the
hospice benefit:
(1) Antigens.
(2) Splints and casts.
(3) Pneumococcal vaccine, influenza vaccine, and hepatitis B
vaccine.
Sec. 419.22 Hospital outpatient services excluded from payment under
the hospital outpatient prospective payment system.
The following services are not paid for under the hospital
outpatient prospective payment system:
(a) Physician services that meet the requirements of
Sec. 415.102(a) of this chapter for payment on a fee schedule basis.
(b) Nurse practitioner and clinical nurse specialist services, as
defined in section 1861(s)(2)(K)(ii) of the Act.
(c) Physician assistant services, as defined in section
1861(s)(2)(K)(i) of the Act.
(d) Certified nurse-midwife services, as defined in section
1861(gg) of the Act.
(e) Services of qualified psychologists, as defined in section
1861(ii) of the Act.
(f) Services of an anesthetist as defined in Sec. 410.69 of this
chapter.
(g) Clinical social worker services as defined in section
1861(hh)(2) of the Act.
(h) Outpatient therapy services described in section 1833(a)(8) of
the Act.
(i) Ambulance services, as described in section 1861(v)(1)(U) of
the Act, or, if applicable, the fee schedule established under section
1834(l).
(j) Except as provided in Sec. 419.22(b)(11), prosthetic devices,
prosthetics, prosthetic supplies, and orthotic devices.
(k) Except as provided in Sec. 419.2(b)(10), durable medical
equipment supplied by the hospital for the patient to take home.
(l) Clinical diagnostic laboratory services.
(m) Services for patients with ESRD that are paid under the ESRD
composite rate and drugs and supplies furnished during dialysis but not
included in the composite rate.
(n) Services and procedures that the Secretary designates as
requiring inpatient care.
(o) Hospital outpatient services furnished to SNF residents (as
defined in Sec. 411.15(p) of this chapter) as part of the patient's
resident assessment or comprehensive care plan (and thus included under
the SNF PPS) that are furnished by the hospital ``under arrangements''
but billable only by the SNF, regardless of whether or not the patient
is in a Part A SNF stay.
(p) Services that are not covered by Medicare by statute.
(q) Services that are not reasonable or necessary for the diagnosis
or treatment of an illness or disease.
Subpart C--Basic Methodology for Determining Prospective Payment
Rates for Hospital Outpatient Services
Sec. 419.30 Base expenditure target for calendar year 1999.
(a) HCFA estimates the aggregate amount that would be payable for
[[Page 18544]]
hospital outpatient services in calendar year 1999 by summing--
(1) The total amounts that would be payable from the Trust Fund for
covered hospital outpatient services without regard to the outpatient
prospective payment system described in this part; and
(2) The total amounts of coinsurance that would be payable by
beneficiaries to hospitals for covered hospital outpatient services
without regard to the outpatient prospective payment system described
in this part.
(b) The estimated aggregate amount under paragraph (a) of this
section is determined as though the deductible required under section
1833(b) of the Act did not apply.
Sec. 419.31 Ambulatory payment classification (APC) system and payment
weights.
(a) APC groups. (1) HCFA classifies outpatient services and
procedures that are comparable clinically and in terms of resource use
into APC groups. Except as specified in paragraph (a)(2) of this
section, items and services within a group are not comparable with
respect to the use of resources if the highest median cost for an item
or service within the group is more than 2 times greater than the
lowest median cost for an item or service within the group.
(2) HCFA may make exceptions to the requirements set forth in
paragraph (a)(1) in unusual cases, such as low volume items and
services, but may not make such an exception in the case of a drug or
biological that has been designated as an orphan drug under section 526
of the Federal Food, Drug and Cosmetic Act.
(3) The payment rate determined for an APC group in accordance with
Sec. 419.32, and the copayment amount and program payment amount
determined for an APC group in accordance with subpart D of this part,
apply to every HCPCS code classified within an APC group.
(b) APC weighting factors. (1) Using hospital outpatient claims
data from calendar year 1996 and data from the most recent available
hospital cost reports, HCFA determines the median costs for the
services and procedures within each APC group.
(2) HCFA assigns to each APC group an appropriate weighting factor
to reflect the relative median costs for the services within the APC
group compared to the median costs for the services in all APC groups.
(c) Standardizing amounts. (1) HCFA determines the portion of costs
determined in paragraph (b)(1) of this section that is labor-related.
This is known as the ``labor-related portion'' of hospital outpatient
costs.
(2) HCFA standardizes the median costs determined in paragraph
(b)(1) of this section by adjusting for variations in hospital labor
costs across geographic areas.
Sec. 419.32 Calculation of prospective payment rates for hospital
outpatient services.
(a) Conversion factor for 1999. HCFA calculates a conversion factor
in such a manner that payment for hospital outpatient services
furnished in 1999 would have equaled the base expenditure target
calculated in Sec. 419.30, taking into account APC group weights and
estimated service frequencies and reduced by the amounts that would be
payable in 1999 as outlier payments under Sec. 419.43(d) and
transitional pass-through payments under Sec. 419.43(e).
(b) Conversion factor for calendar year 2000 and subsequent years.
(1) Subject to paragraph (b)(2) of this section, the conversion factor
for a calendar year is equal to the conversion factor calculated for
the previous year adjusted as follows:
(i) For calendar years 2000, 2001, and 2002, by the hospital
inpatient market basket percentage increase applicable under section
1886(b)(3)(B)(iii) of the Act reduced by one percentage point.
(ii) For calendar years 2003 and subsequent years, by the hospital
inpatient market basket percentage increase applicable under section
1886(b)(3)(B)(iii) of the Act.
(2) Beginning in calendar year 2000, HCFA may substitute for the
hospital inpatient market basket percentage in paragraph (b) of this
section a market basket percentage increase that is determined and
applied to hospital outpatient services in the same manner that the
hospital inpatient market basket percentage increase is determined and
applied to inpatient hospital services.
(c) Payment rates. The payment rate for services and procedures for
which payment is made under the hospital outpatient prospective payment
system is the product of the conversion factor calculated under
paragraph (a) or paragraph (b) of this section and the relative weight
determined under Sec. 419.31(b).
(d) Budget neutrality. HCFA adjusts the conversion factor as needed
to ensure that updates and adjustments under Sec. 419.50(a) are budget
neutral.
Subpart D--Payments to Hospitals
Sec. 419.40 Payment concepts.
(a) In addition to the payment rate described in Sec. 419.32, for
each APC group there is a predetermined beneficiary coinsurance amount
as described in Sec. 419.41(a). The Medicare program payment amount for
each APC group is calculated by applying the program payment percentage
as described in Sec. 419.41(b).
(b) For purposes of this section--
(1) Coinsurance percentage is calculated as the difference between
the program payment percentage and 100 percent. The coinsurance
percentage in any year is thus defined for each APC group as the
greater of the following: the ratio of the APC group unadjusted
copayment amount to the annual APC group payment rate, or 20 percent.
(2) Program payment percentage is calculated as the lower of the
following: the ratio of the APC group payment rate minus the APC group
unadjusted coinsurance amount, to the APC group payment rate, or 80
percent.
(3) Unadjusted coinsurance amount is calculated as 20 percent of
the wage-adjusted national median of charges for services within an APC
group furnished during 1996, updated to 1999 using an actuarial
projection of charge increases for hospital outpatient department
services during the period 1996 to 1999.
(c) Limitation of coinsurance amount to inpatient hospital
deductible amount. The coinsurance amount for a procedure performed in
a year cannot exceed the amount of the inpatient hospital deductible
established under section 1813(b) of the Act for that year.
Sec. 419.41 Calculation of national beneficiary coinsurance amounts
and national Medicare program payment amounts.
(a) To calculate the unadjusted coinsurance amount for each APC
group, HCFA--
(1) Standardizes 1996 hospital charges for the services within each
APC group to offset variations in hospital labor costs across
geographic areas;
(2) Identifies the median of the wage-neutralized 1996 charges for
each APC group; and
(3) Determines the value equal to 20 percent of the wage-
neutralized 1996 median charge for each APC group and multiplies that
value by an actuarial projection of increases in charges for hospital
outpatient department services during the period 1996 to 1999. The
result is the unadjusted beneficiary coinsurance amount for the APC
group.
(b) HCFA calculates annually the program payment percentage for
every APC group on the basis of each group's unadjusted coinsurance
amount and its payment rate after the payment rate is adjusted in
accordance with Sec. 419.32.
(c) To determine payment amounts due for a service paid under the
hospital
[[Page 18545]]
outpatient prospective payment system, HCFA makes the following
calculations:
(1) Makes the wage index adjustment in accordance with Sec. 419.43.
(2) Subtracts the amount of the applicable Part B deductible
provided under Sec. 410.160 of this chapter.
(3) Multiplies the remainder by the program payment percentage for
the group to determine the preliminary Medicare program payment amount.
(4) Subtracts the program payment amount from the amount determined
in paragraph (c)(2) of this section to determine the coinsurance
amount.
(i) The coinsurance amount for an APC cannot exceed the amount of
the inpatient hospital deductible established under section 1813(b) of
the Act for that year.
(ii) The coinsurance amount is computed as if the adjustments under
Sec. 419.43(d) and (e) (and any adjustment made under Sec. 419.43(f) in
relation to these adjustments) had not been paid.
(5) Adds the amount by which the coinsurance amount would have
exceeded the inpatient hospital deductible for that year to the
preliminary Medicare program payment amount determined in paragraph
(c)(3) of this section to determine the final Medicare program payment
amount.
Sec. 419.42 Hospital election to reduce coinsurance.
(a) A hospital may elect to reduce coinsurance for any or all APC
groups on a calendar year basis. A hospital may not elect to reduce
copayment for some, but not all, services within the same group.
(b) A hospital must notify its fiscal intermediary of its election
to reduce coinsurance no later than--
(1) June 1, 2000, for coinsurance elections for the period July 1,
2000 through December 31, 2000; or
(2) December 1 preceding the beginning of each subsequent calendar
year.
(c) The hospital's election must be properly documented. It must
specifically identify the APCs to which it applies and the coinsurance
amount (within the limits identified below) that the hospital has
selected for each group.
(d) The election of reduced coinsurance remains in effect unchanged
during the year for which the election was made.
(e) In electing reduced coinsurance, a hospital may elect a level
that is less than that year's wage-adjusted coinsurance amount for the
group but not less than 20 percent of the APC payment rate as
determined in Sec. 419.32.
(f) The hospital may advertise and otherwise disseminate
information concerning the reduced level of coinsurance that it has
elected. All advertisements and information furnished to Medicare
beneficiaries must specify that the coinsurance reductions advertised
apply only to the specified services of that hospital and that
coinsurance reductions are available only for hospitals that choose to
reduce coinsurance for hospital outpatient services and are not allowed
in any other ambulatory settings or physician offices.
Sec. 419.43 Adjustments to national program payment and beneficiary
coinsurance amounts.
(a) General rule. HCFA determines national prospective payment
rates for hospital outpatient department services and determines a wage
adjustment factor to adjust the portion of the APC payment and national
beneficiary coinsurance amount attributable to labor-related costs for
relative differences in labor and labor-related costs across geographic
regions in a budget neutral manner.
(b) Labor-related portion of payment and copayment rates for
hospital outpatient services. HCFA determines the portion of hospital
outpatient costs attributable to labor and labor-related costs (known
as the ``labor-related portion'' of hospital outpatient costs) in
accordance with Sec. 419.31(c)(1).
(c) Wage index factor. HCFA uses the hospital inpatient prospective
payment system wage index established in accordance with part 412 of
this chapter to make the adjustment referred to in paragraph (a) of
this section.
(d) Outlier adjustment--(1) General rule. Subject to paragraph
(d)(4) of this section, HCFA provides for an additional payment for
each hospital outpatient service (or group of services) for which a
hospital's charges, adjusted to cost, exceed the following:
(i) A fixed multiple of the sum of--
(A) The applicable Medicare hospital outpatient payment amount
determined under Sec. 419.32(c), as adjusted under Sec. 419.43 (other
than for adjustments under this paragraph (d) or paragraph (e) of this
section); and
(B) Any transitional pass-through payment under paragraph (e) of
this section.
(ii) At the option of HCFA, a fixed dollar amount.
(2) Amount of adjustment. The amount of the additional payment
under paragraph (d)(1) of this section is determined by HCFA and
approximates the marginal cost of care beyond the applicable cutoff
point under paragraph (d)(1) of this section.
(3) Limit on aggregate outlier adjustments--(i) In general. The
total of the additional payments made under this paragraph (d) for
covered hospital outpatient department services furnished in a year (as
estimated by HCFA before the beginning of the year) may not exceed the
applicable percentage specified in paragraph (d)(3)(ii) of this section
of the total program payments (sum of both the Medicare and beneficiary
payments to the hospital) estimated to be made under this part for all
hospital outpatient services furnished in that year. If this paragraph
is first applied to less than a full year, the limit applies only to
the portion of the year.
(ii) Applicable percentage. For purposes of paragraph (d)(3)(i) of
this section, the term ``applicable percentage'' means a percentage
specified by HCFA up to (but not to exceed)--
(A) For a year (or portion of a year) before 2004, 2.5 percent; and
(B) For 2004 and thereafter, 3.0 percent.
(4) Transitional authority. In applying paragraph (d)(1) of this
section for hospital outpatient services furnished before January 1,
2002, HCFA may--
(i) Apply paragraph (d)(1) of this section to a bill for these
services related to an outpatient encounter (rather than for a specific
service or group of services) using hospital outpatient payment amounts
and transitional pass-through payments covered under the bill; and
(ii) Use an appropriate cost-to-charge ratio for the hospital or
CMHC (as determined by HCFA), rather than for specific departments
within the hospital.
(e) Transitional pass-through for additional costs of innovative
medical devices, drugs, and biologicals--(1) General rule. HCFA
provides for an additional payment under this paragraph for any of the
following that are provided as part of a hospital outpatient service
(or group of services):
(i) Current orphan drugs. A drug or biological that is used for a
rare disease or condition with respect to which the drug or biological
has been designated as an orphan drug under section 526 of the Federal
Food, Drug and Cosmetic Act if payment for the drug or biological as an
outpatient hospital service under this part was being made on the first
date that the system under this part is implemented.
(ii) Current cancer therapy drugs and biologicals and
brachytherapy. A drug or biological that is used in cancer therapy,
including, but not limited to, a chemotherapeutic agent, an antiemetic,
[[Page 18546]]
a hematopoietic growth factor, a colony stimulating factor, a
biological response modifier, a bisphosphonate, and a device of
brachytherapy, if payment for the drug, biological, or device as an
outpatient hospital service under this part was being made on the first
date that the system under this part is implemented.
(iii) Current radiopharmaceutical drugs and biological products. A
radiopharmaceutical drug or biological product used in diagnostic,
monitoring, and therapeutic nuclear medicine procedures if payment for
the drug or biological as an outpatient hospital service under this
part was being made on the first date that the system under this part
is implemented.
(iv) New medical devices, drugs, and biologicals. A medical device,
drug, or biological not described in paragraph (e)(1)(i), (e)(1)(ii),
or (e)(1)(iii) of this section if--
(A) Payment for the device, drug, or biological as an outpatient
hospital service under this part was not being made as of December 31,
1996; and
(B) The cost of the device, drug, or biological is not
insignificant (as defined in paragraph (e)(1)(iv)(C) of this section)
in relation to the hospital outpatient fee schedule amount (as
calculated under Sec. 419.32(c)) payable for the service (or group of
services) involved.
(C) The cost of the device, drug, or biological is considered not
insignificant if it meets all of the following thresholds:
(1) Its expected reasonable cost exceeds 25 percent of the
applicable fee schedule amount for the associated service.
(2) The expected reasonable cost of the new drug, biological, or
device must exceed the current portion of the fee schedule amount
determined to be associated with the drug, biological, or device by 25
percent.
(3) The difference between the expected reasonable cost of the item
and the portion of the hospital outpatient fee schedule amount
determined to be associated with the item exceeds 10 percent of the
applicable hospital outpatient fee schedule amount.
(2) Limited period of payment. The payment under this paragraph (e)
with respect to a medical device, drug, or biological applies during a
period of at least 2 years, but not more than 3 years, that begins--
(i) On the first date this section is implemented in the case of a
drug, biological, or device described in paragraphs (e)(2)(i),
(e)(2)(ii), or (e)(2)(iii) of this section and in the case of a device,
drug, or biological described in paragraph (e)(1)(iv) of this section
and for which payment under this part is made as an outpatient hospital
service before the first date; or
(ii) In the case of a device, drug, or biological described in
paragraph (e)(1)(iv) of this section not described in paragraph
(e)(2)(i) of this section, on the first date on which payment is made
under this part for the device, drug, or biological as an outpatient
hospital service.
(3) Amount of additional payment. Subject to paragraph (e)(4)(iii)
of this section, the amount of the payment under this paragraph is--
(i) In the case of a drug or biological, the amount by which the
amount determined under section 1842(o) of the Act for the drug or
biological exceeds the portion of the otherwise applicable Medicare
hospital outpatient fee schedule amount that HCFA determines is
associated with the drug or biological; or
(ii) In the case of a medical device, the amount by which the
hospital's charges for the device, adjusted to cost, exceeds the
portion of the otherwise applicable Medicare hospital outpatient fee
schedule amount that HCFA determines is associated with the device.
(4) Limit on aggregate annual adjustment--(i) General rule. The
total of the additional payments made under this paragraph for hospital
outpatient services furnished in a year, as estimated by HCFA before
the beginning of the year, may not exceed the applicable percentage
specified in paragraph (e)(4)(ii) of this section of the total program
payments estimated to be made under this section for all hospital
outpatient services furnished in that year. If this paragraph is first
applied to less than a full year, the limit applies only to the portion
of the year.
(ii) Applicable percentage. For purposes of paragraph (e)(4)(i) of
this section, the term ``applicable percentage'' means--
(A) For a year (or portion of a year) before 2004, 2.5 percent; and
(B) For 2004 and thereafter, a percentage specified by HCFA up to
(but not to exceed) 2.0 percent.
(iii) Uniform prospective reduction if aggregate limit projected to
be exceeded. If HCFA estimates before the beginning of a year that the
amount of the additional payments under this paragraph (e) for the year
(or portion thereof) as determined under paragraph (e)(4)(i) of this
section without regard to this paragraph (e)(4)(iii) would exceed the
limit established under this paragraph (e)(4)(iii), HCFA reduces pro
rata the amount of each of the additional payments under this paragraph
for that year (or portion thereof) in order to ensure that the
aggregate additional payments under this paragraph (as so estimated) do
not exceed the limit.
(f) Budget neutrality. Outlier adjustments under paragraph (d) of
this section and transitional pass-through payments under paragraph (e)
of this section are established in a budget-neutral manner.
Sec. 419.44 Payment reductions for surgical procedures.
(a) Multiple surgical procedures. When more than one surgical
procedure for which payment is made under the hospital outpatient
prospective payment system is performed during a single surgical
encounter, the Medicare program payment amount and the beneficiary
copayment amount are based on--
(1) The full amounts for the procedure with the highest APC payment
rate; and
(2) One-half of the full program and the beneficiary payment
amounts for all other covered procedures.
(b) Terminated procedures. When a surgical procedure is terminated
prior to completion due to extenuating circumstances or circumstances
that threaten the well-being of the patient, the Medicare program
payment amount and the beneficiary copayment amount are based on--
(1) The full amounts if the procedure is discontinued after the
induction of anesthesia or after the procedure is started; or
(2) One-half of the full program and the beneficiary coinsurance
amounts if the procedure is discontinued after the patient is prepared
for surgery and taken to the room where the procedure is to be
performed but before anesthesia is induced.
Subpart E--Updates
Sec. 419.50 Annual review.
(a) General rule. Not less often than annually, HCFA reviews and
updates groups, relative payment weights, and the wage and other
adjustments to take into account changes in medical practice, changes
in technology, the addition of new services, new cost data, and other
relevant information and factors.
(b) Consultation requirement. HCFA will consult with an expert
outside advisory panel composed of an appropriate selection of
representatives of providers to review (and advise HCFA concerning) the
clinical integrity of the groups and weights. The panel may use data
collected or developed by entities and organizations (other than the
Department of Health and Human Services) in conducting the review.
[[Page 18547]]
(c) Effective dates. HCFA conducts the first annual review under
paragraph (a) of this section in 2001 for payments made in 2002.
Subpart F--Limitations on Review
Sec. 419.60 Limitations on administrative and judicial review.
There can be no administrative or judicial review under sections
1869 and 1878 of the Act or otherwise of the following:
(a) The development of the APC system, including--
(1) Establishment of the groups and relative payment weights;
(2) Wage adjustment factors;
(3) Other adjustments; and
(4) Methods for controlling unnecessary increases in volume.
(b) The calculation of base amounts described in section 1833(t)(3)
of the Act.
(c) Periodic adjustments described in section 1833(t)(9) of the
Act.
(d) The establishment of a separate conversion factor for hospitals
described in section 1886(d)(1)(B)(v) of the Act.
(e) The determination of the fixed multiple, or a fixed dollar
cutoff amount, the marginal cost of care, or applicable percentage
under Sec. 419.43(d) or the determination of insignificance of cost,
the duration of the additional payments (consistent with
Sec. 419.43(e)), the portion of the Medicare hospital outpatient fee
schedule amount associated with particular devices, drugs, or
biologicals, and the application of any pro rata reduction under
Sec. 419.43(e).
Subpart G--Transitional Corridors
Sec. 419.70 Transitional adjustment to limit decline in payment.
(a) Before 2002. Except as provided in paragraph (d) of this
section, for covered hospital outpatient services furnished before
January 1, 2002, for which the prospective payment system amount (as
defined in paragraph (e) of this section) is--
(1) At least 90 percent, but less than 100 percent, of the pre-BBA
amount (as defined in paragraph (f) of this section), the amount of
payment under this part is increased by 80 percent of the amount of
this difference;
(2) At least 80 percent, but less than 90 percent, of the pre-BBA
amount, the amount of payment under this part is increased by the
amount by which the product of 0.71 and the pre-BBA amount exceeds the
product of 0.70 and the prospective payment system amount;
(3) At least 70 percent, but less than 80 percent, of the pre-BBA
amount, the amount of payment under this part is increased by the
amount by which the product of 0.63 and the pre-BBA amount, exceeds the
product of 0.60 and the PPS amount; or
(4) Less than 70 percent of the pre-BBA amount, the amount of
payment under this part shall be increased by 21 percent of the pre-BBA
amount.
(b) For 2002. Except as provided in paragraph (d) of this section,
for covered hospital outpatient services furnished during 2002, for
which the prospective payment system amount is--
(1) At least 90 percent, but less than 100 percent, of the pre-BBA
amount, the amount of payment under this part is increased by 70
percent of the amount of this difference;
(2) At least 80 percent, but less than 90 percent, of the pre-BBA
amount, the amount of payment under this part is increased by the
amount by which the product of 0.61 and the pre-BBA amount exceeds the
product of 0.60 and the prospective payment system amount; or
(3) Less than 80 percent of the pre-BBA amount, the amount of
payment under this part is increased by 13 percent of the pre-BBA
amount.
(c) For 2003. Except as provided in paragraph (d) of this section,
for covered hospital outpatient services furnished during 2003, for
which the prospective payment system amount is--
(1) At least 90 percent, but less than 100 percent, of the pre-BBA
amount, the amount of payment under this part is increased by 60
percent of the amount of this difference; or
(2) Less than 90 percent of the pre-BBA amount, the amount of
payment under this part is increased by 6 percent of the pre-BBA
amount.
(d) Hold harmless provisions--(1) Temporary treatment for small
rural hospitals. For covered hospital outpatient services furnished in
a calendar year before January 1, 2004 for which the prospective
payment system amount is less than the pre-BBA amount, the amount of
payment under this part is increased by the amount of that difference
if the hospital--
(i) Is located in a rural area as defined in Sec. 412.63(b) of this
chapter or is treated as being located in a rural area under section
1886(d)(8)(E) of the Act; and
(ii) Has 100 or fewer beds as defined in Sec. 412.105(b) of this
chapter.
(2) Permanent treatment for cancer hospitals. In the case of a
hospital described in Sec. 412.23(f) of this chapter for which the
prospective payment system amount is less than the pre-BBA amount for
covered hospital outpatient services, the amount of payment under this
part is increased by the amount of this difference.
(e) Prospective payment system amount defined. In this paragraph,
the term ``prospective payment system amount'' means, with respect to
covered hospital outpatient services, the amount payable under this
part for these services (determined without regard to this paragraph or
any reduction in coinsurance elected under Sec. 419.42), including
amounts payable as copayment under Sec. 419.41, coinsurance under
section 1866(a)(2)(A)(ii) of the Act, and the deductible under section
1833(b) of the Act.
(f) Pre-BBA amount defined--(1) General rule. In this paragraph,
the ``pre-BBA amount'' means, with respect to covered hospital
outpatient services furnished by a hospital or a community mental
health center (CMHC) in a year, an amount equal to the product of the
reasonable cost of the provider for these services for the portions of
the provider's cost reporting period (or periods) occurring in the year
and the base provider outpatient payment-to-cost ratio for the provider
(as defined in paragraph (f)(2) of this section).
(2) Base payment-to-cost-ratio defined. For purposes of this
paragraph, HCFA shall determine these ratios as if the amendments to
sections 1833(i)(3)(B)(i)(II) and 1833(n)(1)(B)(i) of the Act made by
section 4521 of the BBA, to require that the full amount beneficiaries
paid as coinsurance under section 1862(a)(2)(A) of the Act are taken
into account in determining Medicare Part B Trust Fund payment to the
hospital, were in effect in 1996. The ``base payment-to-cost ratio''
for a hospital or CMHC means the ratio of--
(i) The provider's payment under this part for covered outpatient
services furnished during the cost reporting period ending in 1996,
including any payment for these services through cost-sharing described
in paragraph (e) of this section; and
(ii) The reasonable cost of these services for this period, without
applying the cost reductions under section 1861(v)(1)(S) of the Act.
(g) Interim payments. HCFA makes payments under this paragraph to
hospitals and CMHCs on an interim basis, subject to retrospective
adjustments based on settled cost reports.
(h) No effect on coinsurance. No payment made under this section
affects the unadjusted coinsurance amount or the coinsurance amount
described in Sec. 419.41.
(i) Application without regard to budget neutrality. The additional
payments made under this paragraph--
[[Page 18548]]
(1) Are not considered an adjustment under Sec. 419.43(f); and
(2) Are not implemented in a budget neutral manner.
PART 424--CONDITIONS FOR MEDICARE PAYMENT
G. Part 424 is amended as set forth below:
1. The authority citation for part 424 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
2. In Sec. 424.24, the heading to paragraph (e) is republished, and
a new paragraph (e)(3) is added to read as follows:
Sec. 424.24 Requirements for medical and other health services
furnished by providers under Medicare Part B.
* * * * *
(e) Partial hospitalization services: Content of certification and
plan of treatment requirements--
* * * * *
(3) Recertification requirements.
(i) Signature. The physician recertification must be signed by a
physician who is treating the patient and has knowledge of the
patient's response to treatment.
(ii) Timing. The first recertification is required as of the 18th
day of partial hospitalization services. Subsequent recertifications
are required at intervals established by the provider, but no less
frequently than every 30 days.
(iii) Content. The recertification must specify that the patient
would otherwise require inpatient psychiatric care in the absence of
continued stay in the partial hospitalization program and describe the
following:
(A) The patient's response to the therapeutic interventions
provided by the partial hospitalization program.
(B) The patient's psychiatric symptoms that continue to place the
patient at risk of hospitalization.
(C) Treatment goals for coordination of services to facilitate
discharge from the partial hospitalization program.
* * * * *
PART 489--PROVIDER AGREEMENTS AND SUPPLIER APPROVAL
H. Part 489 is amended as set forth below:
1. The authority citation to part 489 continues to read as follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
Subpart B--Essentials of Provider Agreements
2. In Sec. 489.20, the introductory text to the section is
republished; the introductory text to paragraph (d) is revised;
paragraphs (d)(3), (d)(4), and (d)(5) are redesignated as paragraphs
(d)(4), (d)(5), and (d)(6), respectively; and a new paragraph (d)(3) is
added to read as follows:
Sec. 489.20 Basic commitments.
The provider agrees to the following:
* * * * *
(d) In the case of a hospital or a CAH that furnishes services to
Medicare beneficiaries, either to furnish directly or to make
arrangements (as defined in Sec. 409.3 of this chapter) for all
Medicare-covered services to inpatients and outpatients of a hospital
or a CAH except the following:
* * * * *
(3) Nurse practitioner and clinical nurse specialist services, as
defined in section 1861(s)(2)(K)(ii) of the Act.
* * * * *
3. In Sec. 489.24, the definition for ``Comes to the emergency
department'' in paragraph (b) is revised, and a new paragraph (i) is
added to read as follows:
Sec. 489.24 Special responsibilities of Medicare hospitals in
emergency cases.
* * * * *
(b) * * *
Comes to the emergency department means, with respect to an
individual requesting examination or treatment, that the individual is
on the hospital property. For purposes of this section, ``property''
means the entire main hospital campus as defined in Sec. 413.65(b) of
this chapter, including the parking lot, sidewalk, and driveway, as
well as any facility or organization that is located off the main
hospital campus but has been determined under Sec. 413.65 of this
chapter to be a department of the hospital. The responsibilities of
hospitals with respect to these off-campus facilities or organizations
are described in paragraph (i) of this section. Property also includes
ambulances owned and operated by the hospital even if the ambulance is
not on hospital grounds. An individual in a nonhospital-owned ambulance
on hospital property is considered to have come to the hospital's
emergency department. An individual in a nonhospital-owned ambulance
off hospital property is not considered to have come to the hospital's
emergency department even if a member of the ambulance staff contacts
the hospital by telephone or telemetry communications and informs the
hospital that they want to transport the individual to the hospital for
examination and treatment. In these situations, the hospital may deny
access if it is in ``diversionary status,'' that is, it does not have
the staff or facilities to accept any additional emergency patients.
If, however, the ambulance staff disregards the hospital's instructions
and transports the individual on to hospital property, the individual
is considered to have come to the emergency department.
* * * * *
(i) Off-campus departments. If an individual comes to a facility or
organization that is located off the main hospital campus but has been
determined under Sec. 416.35 of this chapter to be a department of the
hospital and a request is made on the individual's behalf for
examination or treatment of a potential emergency medical condition as
otherwise described in paragraph (a) of this section, the hospital is
obligated in accordance with the rules in this paragraph to provide the
individual with an appropriate medical screening examination and any
necessary stabilizing treatment or an appropriate transfer.
(1) Capability of the hospital. The capability of the hospital
includes that of the hospital as a whole, not just the capability of
the off-campus department. Except for cases described in paragraph
(i)(3)(ii) of this section, the obligation of a hospital under this
section must be discharged within the hospital as a whole. However, the
hospital is not required to locate additional personnel or staff to
off-campus departments to be on standby for possible emergencies.
(2) Protocols for off-campus departments. The hospital must
establish protocols for the handling of individuals with potential
emergency conditions at off-campus departments. These protocols must
provide for direct contact between personnel at the off-campus
department and emergency personnel at the main hospital campus and may
provide for dispatch of practitioners, when appropriate, from the main
hospital campus to the off-campus department to provide screening or
stabilization services.
(i) If the off-campus department is an urgent care center, primary
care center, or other facility that is routinely staffed by physicians,
RNs, or LPNs, these department personnel must be trained, and given
appropriate protocols, for the handling of emergency cases. At least
one individual on duty at the off-campus department during its regular
hours of operation must be designated
[[Page 18549]]
as a qualified medical person as described in paragraph (d) of this
section. The qualified medical person must initiate screening of
individuals who come to the off-campus department with a potential
emergency medical condition, and may be able to complete the screening
and provide any necessary stabilizing treatment at the off-campus
department, or to arrange an appropriate transfer.
(ii) If the off-campus department is a physical therapy, radiology,
or other facility not routinely staffed with physicians, RNs, or LPNs,
the department's personnel must be given protocols that direct them to
contact emergency personnel at the main hospital campus for direction.
Under this direction, and in accordance with protocols established in
advance by the hospital, the personnel at the off-campus department
must describe patient appearance and report symptoms and, if
appropriate, either arrange transportation of the individual to the
main hospital campus in accordance with paragraph (i)(3)(i) of this
section or assist in an appropriate transfer as described in paragraphs
(i)(3)(ii) and (d)(2) of this section.
(3) Movement or appropriate transfer from off-campus departments--
(i) If the main hospital campus has the capability required by the
individual and movement of the individual to the main campus would not
significantly jeopardize the life or health of the individual, the
personnel at the off-campus department must assist in arranging this
movement. Movement of the individual to the main campus of the hospital
is not considered a transfer under this section, since the individual
is simply being moved from one department of a hospital to another
department or facility of the same hospital.
(ii) If transfer of an individual with a potential emergency
condition to a medical facility other than the main hospital campus is
warranted, either because the main hospital campus does not have the
specialized capability or facilities required by the individual, or
because the individual's condition is deteriorating so rapidly that
taking the time needed to move the individual to the main hospital
campus would significantly jeopardize the life or health of the
individual, personnel at the off-campus department must, in accordance
with protocols established in advance by the hospital, assist in
arranging an appropriate transfer of the individual to a medical
facility other than the main hospital. The protocols must include
procedures and agreements established in advance with other hospitals
or medical facilities in the area of the off-campus department to
facilitate these appropriate transfers. Such a transfer would require--
(A) That there be either a request by or on behalf of the
individual as described in paragraph (d)(1)(ii)(A) of this section or a
certification by a physician or a qualified medical person as described
in paragraph (d)(1)(ii)(B) or (d)(1)(ii)(C) of this section; and
(B) That the transfer comply with the requirements described in
paragraph (d)(2) of this section.
(iii) If the individual is being appropriately transferred to
another medical facility from the off-campus department, the
requirement for the provision of medical treatment in paragraph
(d)(2)(i) of this section would be met by provision of medical
treatment within the capability of the transferring off-campus
department.
PART 498--APPEALS PROCEDURES FOR DETERMINATIONS THAT AFFECT
PARTICIPATION IN THE MEDICARE PROGRAM AND FOR DETERMINATIONS THAT
AFFECT THE PARTICIPATION OF ICFs/MR AND CERTAIN NFs IN THE MEDICAID
PROGRAM
I. Part 498 is amended as set forth below:
1. The authority citation for part 498 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
2. In Sec. 498.2, the introductory text is republished, and the
definition of ``Provider'' is revised to read as follows:
Sec. 498.2 Definitions.
As used in this part--
* * * * *
Provider means a hospital, critical access hospital (CAH), skilled
nursing facility (SNF), comprehensive outpatient rehabilitation
facility (CORF), home health agency (HHA), or hospice, that has in
effect an agreement to participate in Medicare, that has in effect an
agreement to participate in Medicaid, or a clinic, rehabilitation
agency, or public health agency that has a similar agreement but only
to furnish outpatient physical therapy or outpatient speech pathology
services, and prospective provider means any of the listed entities
that seeks to participate in Medicare as a provider or to have any
facility or organization determined to be a department of the provider
or provider-based entity under Sec. 413.65 of this chapter.
* * * * *
3. In Sec. 498.3, the introductory text to paragraph (b) is
republished; paragraphs (b)(2) through (b)(15) are redesignated as
paragraphs (b)(3) through (b)(16), respectively; and a new paragraph
(b)(2) is added to read as follows:
Sec. 498.3 Scope and applicability.
* * * * *
(b) Initial determinations by HCFA. HCFA makes initial
determinations with respect to the following matters:
* * * * *
(2) Whether a prospective department of a provider, remote location
of a hospital, satellite facility, or provider-based entity qualifies
for provider-based status under Sec. 413.65 of this chapter, or whether
such a facility or entity currently treated as a department of a
provider, remote location of a hospital, satellite facility, or a
provider-based entity no longer qualifies for that status under
Sec. 413.65 of this chapter.
* * * * *
PART 1003--CIVIL MONEY PENALTIES, ASSESSMENTS AND EXCLUSIONS
J. Part 1003 is amended as set forth below:
1. The authority citation for part 1003 is revised to read as
follows:
Authority: 42 U.S.C. 1302, 1320-7, 1320a-7a, 1320a-7e, 1320b-10,
1395u(j), 1395u(k), 1395cc(g), 1395dd(d)(1), 1395mm, 1395nn(g),
1395ss(d), 1396(m), 11131(c), and 11137(b)(2).
2. Section 1003.100 is amended by revising paragraph (a), by
republishing the introductory text to paragraphs (b) and (b)(1), by
revising paragraphs (b)(1)(xi) and (b)(1)(xii), and by adding paragraph
(b)(1)(xiii) to read as follows:
Sec. 1003.100 Basis and purpose.
(a) Basis. This part implements sections 1128(c), 1128A, 1128E,
1140, 1866(g), 1876(i), 1877(g), 1882(d) and 1903(m)(5) of the Social
Security Act, and sections 421(c) and 427(b)(2) of Pub. L. 99-660 (42
U.S.C. 1320a-7, 1320a-7a, 1320a-7e, 1320a-7c, 1320b-10, 1395cc(g),
1395mm, 1395ss(d), 1396(m), 11131(c), and 11137(b)(2)).
(b) Purpose. This part--
(1) Provides for the imposition of civil money penalties and, as
applicable, assessments against persons who--
* * * * *
(xi) Are physicians or entities that enter into an arrangement or
scheme that they know or should know has as a principal purpose the
assuring of referrals by the physician to a particular entity that, if
made directly, would violate the provisions of Sec. 411.353 of this
title;
[[Page 18550]]
(xii) Violate the Federal health care programs' anti-kickback
statute as set forth in section 1128B of the Act; or
(xiii) Knowingly and willfully present, or cause to be presented, a
bill or request for payment for nonphysician services furnished to
hospital patients (unless the services are furnished by the hospital,
either directly or under an arrangement) in violation of sections
1862(a)(14) and 1866(a)(1)(H) of the Act.
* * * * *
3. Section 1003.102 is amended by republishing the introductory
text to paragraph (b), by adding and reserving paragraphs (b)(12)
through (b)(14), and by adding a new paragraph (b)(15) to read as
follows:
Sec. 1003.102 Basis for civil money penalties and assessments.
* * * * *
(b) The OIG may impose a penalty, and where authorized, an
assessment against any person (including an insurance company in the
case of paragraphs (b)(5) and (b)(6) of this section) whom it
determines in accordance with this part--
* * * * *
(15) Has knowingly and willfully presented, or caused to be
presented, a bill or request for payment for items and services
furnished to a hospital patient for which payment may be made under the
Medicare or another Federal health care program, if that bill or
request is inconsistent with an arrangement under section 1866(a)(1)(H)
of the Act, or violates the requirements for such an arrangement.
* * * * *
4. Section 1003.103 is amended by revising paragraph (a), by adding
and reserving paragraphs (i) and (j), and by adding a new paragraph (k)
to read as follows:
Sec. 1003.103 Amount of penalty.
(a) Except as provided in paragraphs (b) and (d) through (k) of
this section, the OIG may impose a penalty of not more than $10,000 for
each item or service that is subject to a determination under
Sec. 1003.102.
* * * * *
(k) For violations of section 1862(a)(14) of the Act and
Sec. 1003.102(b)(15), the OIG may impose a penalty of not more than
$2,000 for each bill or request for payment for items and services
furnished to a hospital patient.
5. Section 1003.105 is amended by republishing the introductory
text to paragraph (a)(1) and by revising paragraph (a)(1)(i) to read as
follows:
Sec. 1003.105 Exclusion from participation in Medicare, Medicaid and
other Federal health care programs.
(a)(1) Except as set forth in paragraph (b) of this section, in
lieu of or in addition to any penalty or assessment, the OIG may
exclude from participation in Medicare, Medicaid and other Federal
health care programs the following persons for a period of time
determined under Sec. 1003.107--
(i) Any person who is subject to a penalty or assessment under
Sec. 1003.102(a), (b)(1) through (b)(4), or (b)(15).
* * * * *
(Catalog of Federal Domestic Assistance 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: March 3, 2000.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.
Dated: March 28, 2000.
June G. Brown,
Inspector General, Department of Health and Human Services.
Approved: March 29, 2000.
Donna E. Shalala,
Secretary.
Note: The following addenda will not appear in the Code of
Federal Regulations.
Note to Addenda A, B, C, E and F: Addenda A, B, and C have a
number of errors in the following columns: APC, status indicator,
payment rate, and national unadjusted coinsurance and minimum
unadjusted coinsurance. We identified these errors too late in
preparing this rule for publication to correct them. Some of the
errors are related to the status codes assigned to the HCPCS codes
and APCs.
Some errors affect addenda B, C, and E. Several of these errors
involve procedures incorrectly identified as inpatient procedures,
and one inpatient procedure incorrectly identified as an outpatient
procedure. Certain PET scan codes and other codes are shown in
incorrect APCs. Screening sigmoidoscopy and colonoscopy APCs have
the wrong HCPCS codes and incorrect payment rates and coinsurance
amounts. Certain dental codes were inadvertently identified as
errors, so their correct APC assignments, payment rate and
coinsurance amounts were not shown in the addenda. Two breath tests
are subject to the clinical diagnostic lab fee schedule. We have
listed below the corrections that have payment implications.
Addendum F does not include status indicators G and H which
identify items that are eligible for pass-through payments. (See
section III.B.3 of the preamble for a complete description of all
status indications used in conjunction with this final rule.)
We also note that the word ``proposed'' should not appear on any
Addenda contained in this final rule such as on Addendum A or C.
The fiscal intermediaries will receive the necessary changes to
process outpatient PPS claims correctly. We will post the corrected
Addendum B on our Website and publish a correction document in the
Federal Register.
Our Website address is http://www.hcfa.gov/medicare/hopsmain.htm.
List Accompanying Note To Addenda A, B, C, E and F
--------------------------------------------------------------------------------------------------------------------------------------------------------
National Minimum
CPT/ HOPD Status Indicator Description APC Relative Proposed Unadjusted Unadjusted
HCPCS Weight Payment Rate Coinsurance Coinsurance
--------------------------------------------------------------------------------------------------------------------------------------------------------
20979 E US bone stimulation............
31375 C Partial removal of larynx......
35481 T Atherectomy, open.............. 0081 19.36 $938.71 $434.25 $187.74
61795 S Brain surgery using computer... 0302 8.21 $398.08 $216.55 $79.62
61886 T Implant neurostim arrays....... 0222 25.48 $1,235.45 $780.07 $247.09
75945 S Intravascular us............... 0267 2.72 $131.88 $80.06 $26.38
75946 S Intravascular us add-on........ 0267 2.72 $131.88 $80.06 $26.38
78267 A Breath test attain/anal, c-14..
78268 A Breath test analysis, c-14.....
92978 S Intravasc us, heart add-on..... 0267 2.72 $131.88 $80.06 $26.38
92979 S Intravasc us, heart add-on..... 0267 2.72 $131.88 $80.06 $26.38
96570 T Photodynamic Tx, 30 min........ 0973 5.16 $250.19 .............. $50.04
96571 T Photodynamic Tx, addl 15 min... 0973 5.16 $250.19 .............. $50.04
D0277 S Vert bitewings-sev to eight.... 0330 1.51 $73.22 $14.64 $14.64
D0472 S Gross exam, prep & report...... 0330 1.51 $73.22 $14.64 $14.64
[[Page 18551]]
D0473 S Micro exam, prep & report...... 0330 1.51 $73.22 $14.64 $14.64
D0474 S Micro w exam of surg margins... 0330 1.51 $73.22 $14.64 $14.64
D0480 S Cytopath smear prep & report... 0330 1.51 $73.22 $14.64 $14.64
D4268 S Surgical revision procedure.... 0330 1.51 $73.22 $14.64 $14.64
G0104 S CA screen; flexible 0159 2.83 $137.22 .............. $34.31
sigmoidscope.
G0105 S Colorectal screen; high risk 0158 7.98 $386.93 .............. $96.73
ind.
G0122 S Colon ca scrn; barium enema.... 0157 1.79 $86.79 .............. $17.36
G0125 S Lung Image (PET)............... 0981 46.40 $2,249.80 .............. $449.96
G0126 S Lung Image (PET) staging....... 0981 46.40 $2,249.80 .............. $449.96
G0163 S PET for rec of colorectal 0981 46.40 $2,249.80 .............. $449.96
cancer.
G0164 S PET for lymphoma staging....... 0981 46.40 $2,249.80 .............. $449.96
G0165 S PET, rec of melanoma/met cancer 0981 46.40 $2,249.80 .............. $449.96
G0168 T Wound closure by adhesive...... 0970 0.52 $25.21 .............. $5.04
G0169 T Removal tissue; no anesthesia.. 0013 0.91 $44.12 $17.66 $8.82
G0170 T Skin biograft.................. 0025 3.74 $181.34 $70.66 $36.27
G0171 T Skin biograft add-on........... 0025 3.74 $181.34 $70.66 $36.27
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------
\1\ Not subject to national coinsurance. Minimum unadjusted coinsurance
is 25% of the payment rate. The Payment rate is the lower of the HOPD
payment rate or the Ambulatory Surgical Center payment.
\2\ Not subject to national coinsurance.
\3\ Eligible for pass-through payments. See Preamble for payment rate
determination. See Addendum K for complete list of pass-through codes.
[[Page 18551]]
Addendum A.--List of Hospital Outpatient Ambulatory Payment Classes With Status Indicators, Relative Weights,
Payment Rates, and Coinsurance Amounts
----------------------------------------------------------------------------------------------------------------
National Minimum
APC Group Title Status Indicator Relative Payment Rate Unadjusted Unadjusted
Weight Coinsurance Coinsurance
----------------------------------------------------------------------------------------------------------------
0001 Photochemotherapy. S 0.47 $22.79 $8.49 $4.56
0002 Fine needle Biopsy/ T 0.62 $30.06 $17.66 $6.01
Aspiration.
0003 Bone Marrow Biopsy/ T 0.98 $47.52 $27.99 $9.50
Aspiration.
0004 Level I Needle T 1.84 $89.22 $32.57 $17.84
Biopsy/Aspiration
Except Bone
Marrow.
0005 Level II Needle T 5.41 $262.32 $119.75 $52.46
Biopsy/Aspiration
Except Bone
Marrow.
0006 Level I Incision & T 2.00 $96.97 $33.95 $19.39
Drainage.
0007 Level II Incision T 3.68 $178.43 $72.03 $35.69
& Drainage.
0008 Level III Incision T 6.15 $298.20 $113.67 $59.64
& Drainage.
0009 Nail Procedures... T 0.74 $35.88 $9.63 $7.18
0010 Level I T 0.55 $26.67 $9.86 $5.33
Destruction of
Lesion.
0011 Level II T 2.72 $131.88 $50.01 $26.38
Destruction of
Lesion.
0012 Level I T 0.53 $25.70 $9.18 $5.14
Debridement &
Destruction.
0013 Level II T 0.91 $44.12 $17.66 $8.82
Debridement &
Destruction.
0014 Level III T 1.50 $72.73 $24.55 $14.55
Debridement &
Destruction.
0015 Level IV T 1.77 $85.82 $31.20 $17.16
Debridement &
Destruction.
0016 Level V T 3.53 $171.16 $74.67 $34.23
Debridement &
Destruction.
0017 Level VI T 12.45 $603.66 $289.16 $120.73
Debridement &
Destruction.
0018 Biopsy Skin, T 0.94 $45.58 $17.66 $9.12
Subcutaneous
Tissue or Mucous
Membrane.
0019 Level I Excision/ T 4.00 $193.95 $78.91 $38.79
Biopsy.
0020 Level II Excision/ T 6.51 $315.65 $130.53 $63.13
Biopsy.
0021 Level III Excision/ T 10.49 $508.63 $236.51 $101.73
Biopsy.
0022 Level IV Excision/ T 12.49 $605.60 $292.94 $121.12
Biopsy.
0023 Exploration T 1.98 $96.00 $40.37 $19.20
Penetrating Wound.
0024 Level I Skin T 2.43 $117.82 $44.50 $23.56
Repair.
0025 Level II Skin T 3.74 $181.34 $70.66 $36.27
Repair.
0026 Level III Skin T 12.11 $587.18 $277.92 $117.44
Repair.
0027 Level IV Skin T 15.80 $766.10 $383.10 $153.22
Repair.
0029 Incision/Excision T 12.85 $623.06 $303.50 $124.61
Breast.
0030 Breast T 20.19 $978.95 $523.95 $195.79
Reconstruction/
Mastectomy.
0031 Hyperbaric Oxygen. S 3.00 $145.46 $140.85 $29.09
0032 Placement T 5.40 $261.83 $119.52 $52.37
Transvenous
Catheters/
Arterial Cutdown.
0033 Partial P 4.17 $202.19 $48.17 $40.44
Hospitalization.
0040 Arthrocentesis & T 2.11 $102.31 $40.60 $20.46
Ligament/Tendon
Injection.
0041 Arthroscopy....... T 24.57 $1,191.33 $592.08 $238.27
0042 Arthroscopically- T 29.22 $1,416.79 $804.74 $283.36
Aided Procedures.
0043 Closed Treatment T 1.64 $79.52 $25.46 $15.90
Fracture Finger/
Toe/Trunk.
0044 Closed Treatment T 2.17 $105.22 $38.08 $21.04
Fracture/
Dislocation
Except Finger/Toe/
Trunk.
0045 Bone/Joint T 11.02 $534.33 $277.12 $106.87
Manipulation
Under Anesthesia.
0046 Open/Percutaneous T 22.29 $1,080.78 $535.76 $216.16
Treatment
Fracture or
Dislocation.
0047 Arthroplasty T 22.09 $1,071.08 $537.03 $214.22
without
Prosthesis.
0048 Arthroplasty with T 29.06 $1,409.03 $725.94 $281.81
Prosthesis.
0049 Level I T 15.04 $729.25 $356.95 $145.85
Musculoskeletal
Procedures Except
Hand and Foot.
0050 Level II T 21.13 $1,024.53 $513.86 $204.91
Musculoskeletal
Procedures Except
Hand and Foot.
0051 Level III T 27.76 $1,346.00 $675.24 $269.20
Musculoskeletal
Procedures Except
Hand and Foot.
0052 Level IV T 36.16 $1,753.29 $930.91 $350.66
Musculoskeletal
Procedures Except
Hand and Foot.
0053 Level I Hand T 11.32 $548.87 $253.49 $109.77
Musculoskeletal
Procedures.
0054 Level II Hand T 19.66 $953.26 $472.33 $190.65
Musculoskeletal
Procedures.
0055 Level I Foot T 15.47 $750.10 $355.34 $150.02
Musculoskeletal
Procedures.
0056 Level II Foot T 17.30 $838.83 $405.81 $167.77
Musculoskeletal
Procedures.
[[Page 18552]]
0057 Bunion Procedures. T 21.00 $1,018.23 $496.65 $203.65
0058 Level I Strapping S 1.09 $52.85 $19.27 $10.57
and Cast
Application.
0059 Level II Strapping S 1.74 $84.37 $29.59 $16.87
and Cast
Application.
0060 Manipulation S 0.77 $37.34 $7.80 $7.47
Therapy.
0070 Thoracentesis/ T 3.64 $176.49 $79.60 $35.30
Lavage Procedures.
0071 Level I Endoscopy T 0.55 $26.67 $14.22 $5.33
Upper Airway.
0072 Level II Endoscopy T 1.26 $61.09 $41.52 $12.22
Upper Airway.
0073 Level III T 4.11 $199.28 $91.07 $39.86
Endoscopy Upper
Airway.
0074 Level IV Endoscopy T 13.61 $659.91 $347.54 $131.98
Upper Airway.
0075 Level V Endoscopy T 18.55 $899.44 $467.29 $179.89
Upper Airway.
0076 Endoscopy Lower T 8.06 $390.81 $197.05 $78.16
Airway.
0077 Level I Pulmonary S 0.43 $20.85 $12.62 $4.17
Treatment.
0078 Level II Pulmonary S 1.34 $64.97 $29.13 $12.99
Treatment.
0079 Ventilation S 3.18 $154.19 $107.70 $30.84
Initiation and
Management.
0080 Diagnostic Cardiac T 25.77 $1,249.51 $713.89 $249.90
Catheterization.
0081 Non-Coronary T 19.36 $938.71 $434.25 $187.74
Angioplasty or
Atherectomy.
0082 Coronary T 40.34 $1,955.97 $859.56 $391.19
Atherectomy.
0083 Coronary T 45.79 $2,220.22 $1,322.95 $444.04
Angiosplasty.
0084 Level I S 10.70 $518.81 $177.79 $103.76
Electrophysiologi
c Evaluation.
0085 Level II S 27.06 $1,312.06 $654.48 $262.41
Electrophysiologi
c Evaluation.
0086 Ablate Heart S 47.62 $2,308.95 $1,265.37 $461.79
Dysrhythm Focus.
0087 Cardiac S 9.53 $462.08 $214.72 $92.42
Electrophysiologi
c Recording/
Mapping.
0088 Thrombectomy...... T 26.49 $1,284.42 $678.68 $256.88
0089 Level I T 6.49 $314.68 $130.07 $62.94
Implantation/
Removal/Revision
of Pacemaker,
AICD or Vascular
Device.
0090 Level II T 20.96 $1,016.29 $573.04 $203.26
Implantation/
Removal/Revision
of Pacemaker,
AICD or Vascular
Device.
0091 Level I Vascular T 14.79 $717.12 $348.23 $143.42
Ligation.
0092 Level II Vascular T 20.21 $979.92 $505.37 $195.98
Ligation.
0093 Vascular Repair/ T 17.95 $870.34 $422.33 $174.07
Fistula
Construction.
0094 Resuscitation and S 4.51 $218.68 $105.29 $43.74
Cardioversion.
0095 Cardiac S 0.64 $31.03 $16.98 $6.21
Rehabilitation.
0096 Non-Invasive S 2.06 $99.88 $61.48 $19.98
Vascular Studies.
0097 Cardiovascular S 1.62 $78.55 $62.40 $15.71
Stress Test.
0098 Injection of T 1.19 $57.70 $20.88 $11.54
Sclerosing
Solution.
0099 Continuous Cardiac S 0.38 $18.43 $14.68 $3.69
Monitoring.
0100 Continuous ECG.... S 1.70 $82.43 $71.57 $16.49
0101 Tilt Table S 4.47 $216.74 $128.84 $43.35
Evaluation.
0102 Electronic S 0.45 $21.82 $12.62 $4.36
Analysis of
Pacemakers/other
Devices.
0109 Bone Marrow S 4.13 $200.25 $40.05 $40.05
Harvesting and
Bone Marrow/Stem
Cell Transplant.
0110 Transfusion....... S 5.83 $282.68 $122.73 $56.54
0111 Blood Product S 14.17 $687.06 $300.74 $137.41
Exchange.
0112 Extracorporeal S 39.60 $1,920.09 $663.65 $384.02
Photopheresis.
0113 Excision Lymphatic T 13.89 $673.49 $326.55 $134.70
System.
0114 Thyroid/ T 19.56 $948.41 $493.78 $189.68
Lymphadenectomy
Procedures.
0116 Chemotherapy S 2.34 $113.46 $22.69 $22.69
Administration by
Other Technique
Except Infusion.
0117 Chemotherapy S 1.84 $89.22 $71.80 $17.84
Administration by
Infusion Only.
0118 Chemotherapy S 2.90 $140.61 $72.03 $28.12
Administration by
Both Infusion and
Other Technique.
0120 Infusion Therapy S 1.66 $80.49 $42.67 $16.10
Except
Chemotherapy.
0121 Level I Tube T 2.36 $114.43 $52.53 $22.89
changes and
Repositioning.
0122 Level II Tube T 5.04 $244.37 $114.93 $48.88
changes and
Repositioning.
0123 Level III Tube T 13.89 $673.49 $350.75 $134.70
changes and
Repositioning.
0130 Level I T 25.36 $1,229.63 $659.53 $245.93
Laparoscopy.
0131 Level II T 41.81 $2,027.24 $1,089.88 $405.45
Laparoscopy.
0132 Level III T 48.91 $2,371.50 $1,239.22 $474.30
Laparoscopy.
0140 Esophageal T 4.74 $229.83 $107.24 $45.97
Dilation without
Endoscopy.
0141 Upper GI T 7.15 $346.68 $184.67 $69.34
Procedures.
0142 Small Intestine T 7.45 $361.23 $162.42 $72.25
Endoscopy.
0143 Lower GI Endoscopy T 7.98 $386.93 $199.12 $77.39
0144 Diagnostic T 2.23 $108.13 $49.32 $21.63
Anoscopy.
0145 Therapeutic T 7.46 $361.71 $179.39 $72.34
Anoscopy.
0146 Level I T 2.83 $137.22 $65.15 $27.44
Sigmoidoscopy.
0147 Level II T 6.26 $303.53 $149.11 $60.71
Sigmoidoscopy.
0148 Level I Anal/ T 2.34 $113.46 $43.59 $22.69
Rectal Procedure.
0149 Level II Anal/ T 12.86 $623.54 $293.06 $124.71
Rectal Procedure.
0150 Level III Anal/ T 17.68 $857.25 $437.12 $171.45
Rectal Procedure.
0151 Endoscopic T 10.53 $510.57 $245.46 $102.11
Retrograde
Cholangio-
Pancreatography
(ERCP).
0152 Percutaneous T 8.22 $398.56 $207.38 $79.71
Biliary
Endoscopic
Procedures.
0153 Peritoneal and T 19.62 $951.32 $496.31 $190.26
Abdominal
Procedures.
0154 Hernia/Hydrocele T 22.43 $1,087.57 $556.98 $217.51
Procedures.
2 0157 Colorectal Cancer S 1.79 $86.79 .............. $17.36
Screening: Barium
Enema.
1 0158 Colorectal Cancer S 7.98 $386.93 .............. $96.73
Screening:
Colonoscopy.
1 0159 Colorectal Cancer S 7.98 $137.22 .............. $34.31
Screening:
Flexible
Sigmoidoscopy.
[[Page 18553]]
0160 Level I T 5.43 $263.28 $110.11 $52.66
Cystourethroscopy
and other
Genitourinary
Procedures.
0161 Level II T 10.94 $530.45 $249.36 $106.09
Cystourethroscopy
and other
Genitourinary
Procedures.
0162 Level III T 17.49 $848.04 $427.49 $169.61
Cystourethroscopy
and other
Genitourinary
Procedures.
0163 Level IV T 28.98 $1,405.16 $792.58 $281.03
Cystourethroscopy
and other
Genitourinary
Procedures.
0164 Level I Urinary T 2.17 $105.23 $33.03 $21.05
and Anal
Procedures.
0165 Level II Urinary T 3.89 $188.61 $91.76 $37.72
and Anal
Procedures.
0166 Level I Urethral T 10.17 $493.11 $218.73 $98.62
Procedures.
0167 Level II Urethral T 21.06 $1,021.14 $555.84 $204.23
Procedures.
0168 Level III Urethral T 24.94 $1,209.27 $536.11 $241.85
Procedures.
0169 Lithotripsy....... T 46.72 $2,265.32 $1,384.20 $453.06
0170 Dialysis for Other S 6.68 $323.89 $72.26 $64.78
Than ESRD
Patients.
0180 Circumcision...... T 13.62 $660.39 $304.87 $132.08
0181 Penile Procedures. T 32.37 $1,569.53 $906.36 $313.91
0182 Insertion of T 52.11 $2,526.66 $1,525.05 $505.33
Penile Prosthesis.
0183 Testes/Epididymis T 18.26 $885.37 $448.94 $177.07
Procedures.
0184 Prostate Biopsy... T 4.94 $239.53 $122.96 $47.91
0190 Surgical T 17.85 $865.49 $443.89 $173.10
Hysteroscopy.
0191 Level I Female T 1.19 $57.70 $17.43 $11.54
Reproductive
Procedures.
0192 Level II Female T 2.38 $115.40 $35.33 $23.08
Reproductive
Procedures.
0193 Level III Female T 8.93 $432.99 $171.13 $86.60
Reproductive
Procedures.
0194 Level IV Female T 16.21 $785.98 $395.94 $157.20
Reproductive
Procedures.
0195 Level V Female T 18.68 $905.74 $483.80 $181.15
Reproductive
Procedures.
0196 Dilatation & T 14.47 $701.61 $357.98 $140.32
Curettage.
0197 Infertility T 2.40 $116.37 $49.55 $23.27
Procedures.
0198 Pregnancy and T 1.34 $64.97 $33.03 $12.99
Neonatal Care
Procedures.
0199 Vaginal Delivery.. T 11.20 $543.06 $157.83 $108.61
0200 Therapeutic T 13.89 $673.49 $373.23 $134.70
Abortion.
0201 Spontaneous T 13.00 $630.33 $329.65 $126.07
Abortion.
0210 Spinal Tap........ T 3.00 $145.46 $62.40 $29.09
0211 Level I Nervous T 3.32 $160.98 $74.78 $32.20
System Injections.
0212 Level II Nervous T 3.64 $176.49 $88.78 $35.30
System Injections.
0213 Extended EEG S 11.15 $540.63 $290.42 $108.13
Studies and Sleep
Studies.
0214 Electroencephalogr S 2.32 $112.49 $58.50 $22.50
am.
0215 Level I Nerve and S 1.15 $55.76 $30.05 $11.15
Muscle Tests.
0216 Level II Nerve and S 2.87 $139.16 $64.69 $27.83
Muscle Tests.
0217 Level III Nerve S 5.87 $284.62 $156.68 $56.92
and Muscle Tests.
0220 Level I Nerve T 13.96 $676.88 $326.21 $135.38
Procedures.
0221 Level II Nerve T 18.36 $890.22 $463.62 $178.04
Procedures.
0222 Implantation of T 25.48 $1,235.45 $780.07 $247.09
Neurological
Device.
0223 Level I Revision/ T 6.34 $307.41 $153.24 $61.48
Removal
Neurological
Device.
0224 Level II Revision/ T 15.94 $772.88 $374.61 $154.58
Removal
Neurological
Device.
0225 Implantation of T 3.43 $166.31 $64.46 $33.26
Neurostimulator
Electrodes.
0230 Level I Eye Tests. S 0.98 $47.52 $22.48 $9.50
0231 Level II Eye Tests S 2.64 $128.01 $59.87 $25.60
0232 Level I Anterior T 6.04 $292.86 $134.66 $58.57
Segment Eye.
0233 Level II Anterior T 13.79 $668.64 $331.60 $133.73
Segment Eye.
0234 Level III Anterior T 20.64 $1,000.77 $502.16 $200.15
Segment Eye
Procedures.
0235 Level I Posterior T 2.94 $142.55 $78.91 $28.51
Segment Eye
Procedures.
0236 Level II Posterior T 6.70 $324.86 $147.96 $64.97
Segment Eye
Procedures.
0237 Level III T 33.96 $1,646.62 $852.68 $329.32
Posterior Segment
Eye Procedures.
0238 Level I Repair and T 2.80 $135.76 $58.96 $27.15
Plastic Eye
Procedures.
0239 Level II Repair T 6.26 $303.53 $123.42 $60.71
and Plastic Eye
Procedures.
0240 Level III Repair T 13.47 $653.12 $315.31 $130.62
and Plastic Eye
Procedures.
0241 Level IV Repair T 16.60 $804.89 $384.47 $160.98
and Plastic Eye
Procedures.
0242 Level V Repair and T 23.70 $1,149.14 $597.36 $229.83
Plastic Eye
Procedures.
0243 Strabismus/Muscle T 17.99 $872.28 $431.39 $174.46
Procedures.
0244 Corneal Transplant T 32.88 $1,594.26 $851.42 $318.85
0245 Cataract T 26.55 $1,287.33 $623.85 $257.47
Procedures
without IOL
Insert.
0246 Cataract T 26.55 $1,287.33 $623.85 $257.47
Procedures with
IOL Insert.
0247 Laser Eye T 4.89 $237.10 $112.86 $47.42
Procedures Except
Retinal.
0248 Laser Retinal T 4.19 $203.16 $94.05 $40.63
Procedures.
0250 Nasal T 2.21 $107.16 $38.54 $21.43
Cauterization/
Packing.
0251 Level I ENT T 1.68 $81.46 $27.99 $16.29
Procedures.
0252 Level II ENT T 5.18 $251.16 $114.24 $50.23
Procedures.
0253 Level III ENT T 12.02 $582.81 $284.00 $116.56
Procedures.
0254 Level IV ENT T 12.45 $603.66 $272.41 $120.73
Procedures.
0256 Level V ENT T 25.40 $1,231.57 $623.05 $246.31
Procedures.
0257 Implantation of T 115.31 $5,591.04 $3,498.58 $1,118.21
Cochlear Device.
0258 Tonsil and Adenoid T 18.62 $902.83 $462.81 $180.57
Procedures.
0260 Level I Plain Film X 0.79 $38.30 $22.02 $7.66
Except Teeth.
0261 Level II Plain X 1.38 $66.91 $38.77 $13.38
Film Except Teeth
Including Bone
Density
Measurement.
0262 Plain Film of X 0.40 $19.39 $10.90 $3.88
Teeth.
[[Page 18554]]
0263 Level I X 1.68 $81.46 $45.88 $16.29
Miscellaneous
Radiology
Procedures.
0264 Level II X 3.83 $185.71 $108.97 $37.14
Miscellaneous
Radiology
Procedures.
0265 Level I Diagnostic S 1.17 $56.73 $38.08 $11.35
Ultrasound Except
Vascular.
0266 Level II S 1.79 $86.79 $57.35 $17.36
Diagnostic
Ultrasound Except
Vascular.
0267 Vascular S 2.72 $131.88 $80.06 $26.38
Ultrasound.
0268 Guidance Under X 2.23 $108.13 $69.51 $21.63
Ultrasound.
0269 Echocardiogram S 4.40 $213.34 $114.01 $42.67
Except
Transesophageal.
0270 Transesophageal S 5.55 $269.10 $150.26 $53.82
Echocardiogram.
0271 Mammography....... S 0.70 $33.94 $19.50 $6.79
0272 Level I X 1.40 $67.88 $39.00 $13.58
Fluoroscopy.
0273 Level II X 2.49 $120.73 $61.02 $24.15
Fluoroscopy.
0274 Myelography....... S 4.83 $234.19 $128.12 $46.84
0275 Arthrography...... S 2.74 $132.85 $72.26 $26.57
0276 Level I Digestive S 1.79 $86.79 $49.78 $17.36
Radiology.
0277 Level II Digestive S 2.47 $119.76 $69.28 $23.95
Radiology.
0278 Diagnostic S 2.85 $138.19 $81.67 $27.64
Urography.
0279 Level I Diagnostic S 6.30 $305.47 $174.57 $61.09
Angiography and
Venography Except
Extremity.
0280 Level II S 14.98 $726.34 $380.12 $145.27
Diagnostic
Angiography and
Venography Except
Extremity.
0281 Venography of S 4.40 $213.34 $115.16 $42.67
Extremity.
0282 Level I S 2.38 $115.40 $94.51 $23.08
Computerized
Axial Tomography.
0283 Level II S 4.89 $237.10 $179.39 $47.42
Computerized
Axial Tomography.
0284 Magnetic Resonance S 8.02 $388.87 $257.39 $77.77
Imaging.
0285 Positron Emission S 15.06 $730.22 $415.21 $146.04
Tomography (PET).
0286 Myocardial Scans.. S 7.28 $352.99 $200.04 $70.60
0290 Standard Non- S 1.94 $94.06 $55.51 $18.81
Imaging Nuclear
Medicine.
0291 Level I Diagnostic S 3.15 $152.73 $93.14 $30.55
Nuclear Medicine
Excluding
Myocardial Scans.
0292 Level II S 4.36 $211.40 $126.63 $42.28
Diagnostic
Nuclear Medicine
Excluding
Myocardial Scans.
0294 Level I S 5.13 $248.74 $144.06 $49.75
Therapeutic
Nuclear Medicine.
0295 Level II S 19.85 $962.47 $609.17 $192.49
Therapeutic
Nuclear Medicine.
0296 Level I S 3.57 $173.10 $100.25 $34.62
Therapeutic
Radiologic
Procedures.
0297 Level II S 6.13 $297.23 $172.51 $59.45
Therapeutic
Radiologic
Procedures.
0300 Level I Radiation S 1.98 $96.00 $47.72 $19.20
Therapy.
0301 Level II Radiation S 2.21 $107.16 $52.53 $21.43
Therapy.
0302 Level III S 8.21 $398.08 $216.55 $79.62
Radiation Therapy.
0303 Treatment Device X 2.83 $137.22 $69.28 $27.44
Construction.
0304 Level I X 1.49 $72.25 $41.52 $14.45
Therapeutic
Radiation
Treatment
Preparation.
0305 Level II X 4.06 $196.86 $97.50 $39.37
Therapeutic
Radiation
Treatment
Preparation.
0310 Level III X 13.98 $677.85 $339.05 $135.57
Therapeutic
Radiation
Treatment
Preparation.
0311 Radiation Physics X 1.32 $64.00 $31.66 $12.80
Services.
0312 Radioelement S 4.09 $198.31 $109.65 $39.66
Applications.
0313 Brachytherapy..... S 7.89 $382.56 $164.02 $76.51
0314 Hyperthermic S 5.88 $285.10 $150.95 $57.02
Therapies.
0320 Electroconvulsive S 3.68 $178.43 $80.06 $35.69
Therapy.
0321 Biofeedback and S 1.26 $61.09 $29.25 $12.22
Other Training.
0322 Brief Individual S 1.32 $64.00 $14.22 $12.80
Psychotherapy.
0323 Extended S 1.85 $89.70 $22.48 $17.94
Individual
Psychotherapy.
0324 Family S 1.87 $90.67 $20.19 $18.13
Psychotherapy.
0325 Group S 1.55 $75.16 $19.96 $15.03
Psychotherapy.
0330 Dental Procedures. S 1.51 $73.22 $14.64 $14.64
0340 Minor Ancillary X 1.04 $50.43 $12.85 $10.09
Procedures.
0341 Immunology Tests.. X 0.13 $6.30 $3.67 $1.26
0342 Level I Pathology. X 0.26 $12.61 $8.03 $2.52
0343 Level II Pathology X 0.45 $21.82 $12.16 $4.36
0344 Level III X 0.79 $38.30 $23.63 $7.66
Pathology.
2 0354 Administration of X 0.13 $6.19 .............. ..............
Influenza Vaccine.
0355 Level I X 0.19 $9.21 $5.05 $1.84
Immunizations.
0356 Level II X 0.36 $17.46 $4.82 $3.49
Immunizations.
0357 Level III X 1.85 $89.70 $38.31 $17.94
Immunizations.
0358 Level IV X 6.98 $338.44 $126.74 $67.69
Immunizations.
0359 Injections........ X 0.96 $46.55 $9.31 $9.31
0360 Level I Alimentary X 1.38 $66.91 $34.75 $13.38
Tests.
0361 Level II X 3.53 $171.16 $88.09 $34.23
Alimentary Tests.
0362 Fitting of Vision X 0.51 $24.73 $9.63 $4.95
Aids.
0363 Otorhinolaryngolog X 2.83 $137.22 $53.22 $27.44
ic Function Tests.
0364 Level I Audiometry X 0.68 $32.97 $13.31 $6.59
0365 Level II X 1.47 $71.28 $22.48 $14.26
Audiometry.
0366 Electrocardiogram X 0.38 $18.43 $15.60 $3.69
(ECG).
0367 Level I Pulmonary X 0.83 $40.24 $20.65 $8.05
Test.
0368 Level II Pulmonary X 1.66 $80.49 $42.44 $16.10
Tests.
0369 Level III X 2.34 $113.46 $58.50 $22.69
Pulmonary Tests.
0370 Allergy Tests..... X 0.57 $27.64 $11.81 $5.53
0371 Allergy Injections X 0.32 $15.52 $3.67 $3.10
0372 Therapeutic X 0.43 $20.85 $10.09 $4.17
Phlebotomy.
[[Page 18555]]
0373 Neuropsychological X 3.21 $155.64 $44.96 $31.13
Testing.
0374 Monitoring X 1.17 $56.73 $13.08 $11.35
Psychiatric Drugs.
0600 Low Level Clinic V 0.98 $47.52 $9.50 $9.50
Visits.
0601 Mid Level Clinic V 1.00 $48.49 $9.70 $9.70
Visits.
0602 High Level Clinic V 1.66 $80.49 $16.29 $16.10
Visits.
0603 Interdisciplinary V 1.66 $80.49 $16.29 $16.10
Team Conference.
0610 Low Level V 1.34 $64.97 $20.65 $12.99
Emergency Visits.
0611 Mid Level V 2.11 $102.31 $36.47 $20.46
Emergency Visits.
0612 High Level V 3.19 $154.67 $54.14 $30.93
Emergency Visits.
0620 Critical Care..... S 8.60 $416.99 $152.78 $83.40
3 0701 Strontium......... X .............. .............. .............. $84.76
3 0702 Samariam.......... X .............. .............. .............. $139.06
3 0704 Satumomab X .............. .............. .............. $63.13
Pendetide.
3 0705 Tc99 Tetrofosmin.. X .............. .............. .............. $71.08
3 0725 Leucovorin Calcium X .............. .............. .............. $1.07
3 0726 Dexrazoxane X .............. .............. .............. $18.81
Hydrochloride.
3 0727 Injection, X .............. .............. .............. $9.31
Etidronate
Disodium.
3 0728 Filgrastim (G-CSF) X .............. .............. .............. $25.21
3 0730 Pamidronate X .............. .............. .............. $30.93
Disodium.
3 0731 Sargramostim (GM- X .............. .............. .............. $16.97
CSF).
3 0732 Mesna............. X .............. .............. .............. $2.42
3 0733 Epoetin Alpha..... X .............. .............. .............. $1.75
3 0750 Dolasetron X .............. .............. .............. $1.94
Mesylate 10 mg.
3 0754 Metoclopramide HCL X .............. .............. .............. $.19
3 0755 Thiethylperazine X .............. .............. .............. $.68
Maleate.
3 0761 Oral Substitute X .............. .............. .............. $.10
for IV Antiemtic.
3 0762 Dronabinol........ X .............. .............. .............. $.48
3 0763 Dolasetron X .............. .............. .............. $8.53
Mesylate 100 mg
Oral.
3 0764 Granisetron HCL, X .............. .............. .............. $2.33
100 mcg.
3 0765 Granisetron HCL, X .............. .............. .............. $3.20
1mg Oral.
3 0768 Ondansetron X .............. .............. .............. $.87
Hydrochloride per
1 mg Injection.
3 0769 Ondansetron X .............. .............. .............. $2.62
Hydrochloride 8
mg oral.
3 0800 Leuprolide Acetate X .............. .............. .............. $68.56
per 3.75 mg.
3 0801 Cyclophosphamide.. X .............. .............. .............. $.19
3 0802 Etoposide......... X .............. .............. .............. $3.10
3 0803 Melphalan......... X .............. .............. .............. $.19
3 0807 Aldesleukin single X .............. .............. .............. $65.07
use vial.
3 0809 BCG (Intravesical) X .............. .............. .............. $19.78
one vial.
3 0810 Goserelin Acetate X .............. .............. .............. $59.74
Implant, per 3.6
mg.
3 0811 Carboplatin 50 mg. X .............. .............. .............. $13.96
3 0812 Carmustine 100 mg. X .............. .............. .............. $10.57
3 0813 Cisplatin 10 mg... X .............. .............. .............. $4.56
3 0814 Asparaginase, X .............. .............. .............. $8.34
10,000 units.
3 0815 Cyclophosphamide X .............. .............. .............. $.48
100 mg.
3 0816 Cyclophosphamide, X .............. .............. .............. $1.16
Lyophilized 100
mg.
3 0817 Cytrabine 100 mg.. X .............. .............. .............. $.68
3 0818 Dactinomycin 0.5 X .............. .............. .............. $1.75
mg.
3 0819 Dacarbazine 100 mg X .............. .............. .............. $1.26
3 0820 Daunorubicin HCI X .............. .............. .............. $11.64
10 mg.
3 0821 Daunorubicin X .............. .............. .............. $7.76
Citrate,
Liposomal
Formulation, 10
mg.
3 0822 Diethylstibestrol X .............. .............. .............. $2.13
Diphosphate 250
mg.
3 0823 Docetaxel 20 mg... X .............. .............. .............. $34.72
3 0824 Etoposide 10 mg... X .............. .............. .............. $.58
3 0826 Methotrexate Oral X .............. .............. .............. $.29
2.5 mg.
3 0827 Floxuridine 500 mg X .............. .............. .............. $18.81
3 0828 Gemcitabine HCL X .............. .............. .............. $9.31
200 mg.
3 0830 Irinotecan 20 mg.. X .............. .............. .............. $14.16
3 0831 Ifosfamide per 1 X .............. .............. .............. $13.58
gram.
3 0832 Idarubicin X .............. .............. .............. $46.45
Hydrochloride 5
mg.
3 0833 Interferon Alfacon- X .............. .............. .............. $.19
1, Recombinant, 1
mcg.
3 0834 Interferon, Alfa- X .............. .............. .............. $3.20
2A, Recombinant 3
million units.
3 0836 Interferon, Alfa- X .............. .............. .............. $1.36
2B, Recombinant,
1 million units.
3 0838 Interferon, Gamma X .............. .............. .............. $22.79
1-B, 3 million
units.
3 0839 Mechlorethamine X .............. .............. .............. $1.65
HCI 10 mg.
3 0840 Melphalan HCI 50 X .............. .............. .............. $44.71
mg.
3 0841 Methotrexate X .............. .............. .............. $.10
Sodium 5 mg.
3 0842 Fludarabine X .............. .............. .............. $30.84
Phosphate 50 mg.
3 0843 Pegaspargase per X .............. .............. .............. $178.72
single dose vial.
3 0844 Pentostatin 10 mg. X .............. .............. .............. $133.73
3 0847 Doxorubicin HCL 10 X .............. .............. .............. $2.81
mg.
3 0849 Rituximab, 100 mg. X .............. .............. .............. $51.40
3 0850 Streptozocin 1 gm. X .............. .............. .............. $14.64
3 0851 Thiotepa 15 mg.... X .............. .............. .............. $9.50
[[Page 18556]]
3 0852 Topotecan 4 mg.... X .............. .............. .............. $73.22
3 0853 Vinblastine X .............. .............. .............. $.39
Sulfate 1 mg.
3 0854 Vincristine X .............. .............. .............. $2.23
Sulfate 1 mg.
3 0855 Vinorelbine X .............. .............. .............. $9.60
Tartrate per 10
mg.
3 0856 Porfimer Sodium 75 X .............. .............. .............. $34.62
mg.
3 0857 Bleomycin Sulfate X .............. .............. .............. $48.29
15 units.
3 0858 Cladribine, 1mg... X .............. .............. .............. $8.24
3 0859 Fluorouracil...... X .............. .............. .............. $.19
3 0860 Plicamycin 2.5 mg. X .............. .............. .............. $1.36
3 0861 Leuprolide X .............. .............. .............. $19.39
Acetate 1 mg.
3 0862 Mitomycin, 5mg.... X .............. .............. .............. $19.88
3 0863 Paclitaxel, 30mg.. X .............. .............. .............. $30.16
3 0864 Mitoxantrone HCl, X .............. .............. .............. $25.80
per 5mg.
3 0865 Interferon alfa- X .............. .............. .............. $1.07
N3, 250,000 IU.
3 0884 Rho (D) Immune X .............. .............. .............. $3.78
Globulin, Human
one dose pack.
2 0886 Azathioprine, 50 X 0.02 $.97 .............. $.19
mg oral.
2 0887 Azathioprine, X 1.40 $67.88 .............. $13.58
Parenteral 100
mg, 20 ml each
injection.
2 0888 Cyclosporine, Oral X 0.08 $3.88 .............. $.78
100 mg.
2 0889 Cyclosporine, X 0.36 $17.46 .............. $3.49
Parenteral.
2 0890 Lymphocyte Immune X 3.79 $183.77 .............. $36.75
Globulin 50 mg/
ml, 5 ml each.
2 0891 Tacrolimus per 1 X 3.15 $152.73 .............. $30.55
mg oral.
3 0892 Daclizumab, X .............. .............. .............. $54.11
Parenteral, 25 mg.
3 0900 Injection, X .............. .............. .............. $5.14
Alglucerase per
10 units.
3 0901 Alpha I, X .............. .............. .............. $15.22
Proteinase
Inhibitor, Human
per 10mg.
3 0902 Botulinum Toxin, X .............. .............. .............. $56.05
Type A per unit.
3 0903 CMV Immune X .............. .............. .............. $54.11
Globulin.
3 0905 Immune Globulin X .............. .............. .............. $6.40
per 500 mg.
3 0906 RSV Immune X .............. .............. .............. $85.53
Globulin.
2 0907 Ganciclovir Sodium X 0.51 $24.73 .............. $4.95
500 mg injection.
2 0908 Tetanus Immune X 0.90 $43.64 .............. $8.73
Globulin, Human,
up to 250 units.
3 0909 Interferon Beta-- X .............. .............. .............. $28.70
1a 33 mcg.
3 0910 Interferon Beta-- X .............. .............. .............. $8.44
1b 0.25 mg.
2 0911 Streptokinase per X 1.64 $79.69 .............. $15.94
250,000 iu.
3 0913 Ganciclovir 4.5 X .............. .............. .............. $701.51
mg, Implant.
2 0914 Reteplase, 37.6 mg X 38.20 $1,852.21 .............. $370.44
(Two Single Use
Vials).
2 0915 Alteplase X 5.85 $283.70 .............. $56.74
recombinant, 10mg.
3 0916 Imiglucerase per X .............. .............. .............. $.58
unit.
2 0917 Dipyridamole, 10mg X 0.36 $17.46 .............. $3.49
Adenosine 6MG.
3 0918 Brachytherapy S .............. .............. .............. $9.99
Seeds, Any type,
Each.
3 0925 Factor VIII X .............. .............. .............. $.19
(Antihemophilic
Factor, Human)
per iu.
3 0926 Factor VIII X .............. .............. .............. $.19
(Antihemophilic
Factor, Porcine)
per iu.
3 0927 Factor VIII X .............. .............. .............. $.19
(Antihemophilic
Factor,
Recombinant) per
iu.
3 0928 Factor IX, Complex X .............. .............. .............. $.08
3 0929 Other Hemophilia X .............. .............. .............. $.27
Clotting Factors
per iu.
3 0930 Antithrombin III X .............. .............. .............. $.19
(Human) per iu.
3 0931 Factor IX X .............. .............. .............. $.04
(Antihemophilic
Factor, Purified,
Non-Recombinant).
3 0932 Factor IX X .............. .............. .............. $.10
(Antihemophilic
Factor,
Recombinant).
2 0949 Plasma, Pooled S 3.49 $169.22 .............. $33.84
Multiple Donor,
Solvent/Detergent
Treated, Frozen.
2 0950 Blood (Whole) For S 2.08 $101.02 .............. $20.20
Transfusion.
2 0952 Cryoprecipitate... S 0.70 $33.92 .............. $6.78
2 0953 Fibrinogen Unit... S 0.48 $23.27 .............. $4.65
2 0954 Leukocyte Poor S 2.83 $137.21 .............. $27.44
Blood.
2 0955 Plasma, Fresh S 2.26 $109.35 .............. $21.87
Frozen.
2 0956 Plasma Protein S 1.26 $61.09 .............. $12.22
Fraction.
2 0957 Platelet S 0.98 $47.46 .............. $9.49
Concentrate.
2 0958 Platelet Rich S 1.16 $56.25 .............. $11.25
Plasma.
2 0959 Red Blood Cells... S 2.04 $99.04 .............. $19.81
2 0960 Washed Red Blood S 3.81 $184.53 .............. $36.91
Cells.
2 0961 Infusion, Albumin X 2.77 $134.31 .............. $26.86
(Human) 5%, 500
ml.
2 0962 Infusion, Albumin X 1.38 $66.91 .............. $13.38
(Human) 25%, 50
ml.
2 0970 New Technology-- T 0.52 $25.21 .............. $5.04
Level I ($0-$50).
2 0971 New Technology-- S 1.55 $75.16 .............. $15.03
Level II ($50-
$100).
2 0972 New Technology-- T 3.09 $149.83 .............. $29.97
Level III ($100-
$200).
2 0973 New Technology-- T 5.16 $250.19 .............. $50.04
Level IV ($200-
$300).
2 0974 New Technology-- T 8.25 $400.02 .............. $80.00
Level V ($300-
$500).
2 0975 New Technology-- T 12.90 $625.48 .............. $125.10
Level VI ($500-
$750).
2 0976 New Technology-- T 18.05 $875.19 .............. $175.04
Level VII ($750-
$1000).
2 0977 New Technology-- T 23.20 $1,124.90 .............. $224.98
Level VIII ($1000-
$1250).
2 0978 New Technology-- T 28.36 $1,375.09 .............. $275.02
Level IX ($1250-
$1500).
2 0979 New Technology-- T 33.51 $1,624.80 .............. $324.96
Level X ($1500-
$1750).
2 0980 New Technology-- S 38.67 $1,875.00 .............. $375.00
Level XI ($1750-
$2000).
2 0981 New Technology-- T 46.40 $2,249.80 .............. $449.96
Level XII ($2000-
$2500).
2 0982 New Technology-- T 61.87 $2,999.90 .............. $599.98
Level XIII ($2500-
$3500).
[[Page 18557]]
2 0983 New Technology-- T 87.65 $4,249.89 .............. $849.98
Level XIV ($3500-
$5000).
2 0984 New Technology-- T 113.43 $5,499.89 .............. $1,099.98
Level XV ($5000-
$6000).
3 7000 Amifostine, 500 mg X .............. .............. .............. $41.99
3 7001 Amphotericin B X .............. .............. .............. $12.12
lipid complex, 50
mg, Inj.
3 7002 Clonidine, HCl, 1 X .............. .............. .............. $4.17
MG.
3 7003 Epoprostenol, 0.5 X .............. .............. .............. $2.23
MG, inj.
3 7004 Immune globulin X .............. .............. .............. $45.48
intravenous human
5g, inj.
3 7005 Gonadorelin hcI, X .............. .............. .............. $9.12
100 mcg.
2 7007 Milrinone X 0.47 $22.79 .............. $4.56
lacetate, per 5
ml, inj.
3 7010 Morphine sulfate X .............. .............. .............. $.68
concentrate
(preservative
free) per 10 mg.
3 7011 Oprelevekin, inj, X .............. .............. .............. $30.35
5 mg.
3 7012 Pentamidine X .............. .............. .............. $8.73
isethionate, 300
mg.
3 7014 Fentanyl citrate, X .............. .............. .............. $.19
inj, up to 2 ml.
3 7015 Busulfan, oral 2 X .............. .............. .............. $.19
mg.
3 7019 Aprotinin, 10,000 X .............. .............. .............. $2.42
kiu.
3 7021 Baclofen, X .............. .............. .............. $.10
intrathecal, 50
mcg.
3 7022 Elliotts B X .............. .............. .............. $19.20
Solution, per ml.
3 7023 Treatment for X .............. .............. .............. $4.46
bladder calculi,
I.e. Renacidin
per 500 ml.
3 7024 Corticorelin ovine X .............. .............. .............. $45.77
triflutate, 0.1
mg.
3 7025 Digoxin immune FAB X .............. .............. .............. $14.06
(Ovine), 10 mg.
3 7026 Ethanolamine X .............. .............. .............. $2.13
oleate, 1000 ml.
3 7027 Fomepizole, 1.5 G. X .............. .............. .............. $141.29
3 7028 Fosphenytoin, 50 X .............. .............. .............. $.78
mg.
3 7029 Glatiramer X .............. .............. .............. $3.59
acetate, 25 mg.
3 7030 Hemin, 1 mg....... X .............. .............. .............. $.10
3 7031 Octreotide X .............. .............. .............. $5.43
Acetate, 500 mcg.
3 7032 Sermorelin X .............. .............. .............. $53.34
acetate, 0.5 mg.
3 7033 Somatrem, 5 mg.... X .............. .............. .............. $28.03
3 7034 Somatropin, 1 mg.. X .............. .............. .............. $5.04
3 7035 Teniposide, 50 mg. X .............. .............. .............. $20.85
2 7036 Urokinase, inj, X 0.73 $35.40 .............. $7.08
IV, 250,000 I.U..
3 7037 Urofollitropin, 75 X .............. .............. .............. $8.24
I.U..
3 7038 Muromonab-CD3, 5 X .............. .............. .............. $89.60
mg.
3 7039 Pegademase bovine X .............. .............. .............. $1.16
inj 25 I.U..
3 7040 Pentastarch 10% X .............. .............. .............. $2.04
inj, 100 ml.
2 7041 Tirofiban HCL, 0.5 X 0.02 $.97 .............. $.19
mg.
3 7042 Capecitabine, oral X .............. .............. .............. $.19
150 mg.
3 7043 Infliximab, 10 MG. X .............. .............. .............. $6.89
3 7045 Trimetrexate X .............. .............. .............. $8.15
Glucoronate.
3 7046 Doxorubicin Hcl X .............. .............. .............. $39.18
Liposome.
----------------------------------------------------------------------------------------------------------------
--------------------
CPT codes and descriptions only are copyright American Medical
Association. All Rights Reserved. Applicable FARS/DFARS Apply.
Copyright American Dental Association. All rights reserved.
\1\ Not subject to national coinsurance. Minimum unadjusted coinsurance
is 25% of the payment rate. The payment rate is the lower of the HOPD
payment rate or the Ambulatory Surgical Center payment.
\2\ Not subject to national coinsurance.
\3\ Eligible for pass-through payments. See Preamble for payment rate
determination. See Addendum K for complete list of pass-through codes.
Addendum B.--Hospital Outpatient Department (HOPD) Payment Status by HCPCS Code and Related Information
--------------------------------------------------------------------------------------------------------------------------------------------------------
National Minimum
CPT/ HOPD Status Indicator Description APC Relative Payment Rate Unadjusted Unadjusted
HCPCS Weight Coinsurance Coinsurance
--------------------------------------------------------------------------------------------------------------------------------------------------------
00100 N Anesth, salivary gland......... .............. .............. .............. .............. ..............
00102 N Anesth, repair of cleft lip.... .............. .............. .............. .............. ..............
00103 N Anesth, blepharoplasty......... .............. .............. .............. .............. ..............
00104 N Anesth, electroshock........... .............. .............. .............. .............. ..............
00120 N Anesth, ear surgery............ .............. .............. .............. .............. ..............
00124 N Anesth, ear exam............... .............. .............. .............. .............. ..............
00126 N Anesth, tympanotomy............ .............. .............. .............. .............. ..............
00140 N Anesth, procedures on eye...... .............. .............. .............. .............. ..............
00142 N Anesth, lens surgery........... .............. .............. .............. .............. ..............
00144 N Anesth, corneal transplant..... .............. .............. .............. .............. ..............
00145 N Anesth, vitrectomy............. .............. .............. .............. .............. ..............
00147 N Anesth, iridectomy............. .............. .............. .............. .............. ..............
00148 N Anesth, 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..... .............. .............. .............. .............. ..............
00190 N Anesth, facial bone surgery.... .............. .............. .............. .............. ..............
00192 C Anesth, facial bone surgery.... .............. .............. .............. .............. ..............
00210 N Anesth, open head surgery...... .............. .............. .............. .............. ..............
00212 N Anesth, skull drainage......... .............. .............. .............. .............. ..............
[[Page 18558]]
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, head/neck/ptrunk....... .............. .............. .............. .............. ..............
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, skin, ext/per/atrunk... .............. .............. .............. .............. ..............
00402 N Anesth, surgery of breast...... .............. .............. .............. .............. ..............
00404 C Anesth, surgery of breast...... .............. .............. .............. .............. ..............
00406 C Anesth, surgery of breast...... .............. .............. .............. .............. ..............
00410 N Anesth, correct heart rhythm... .............. .............. .............. .............. ..............
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, upper gi visualize..... .............. .............. .............. .............. ..............
00750 N Anesth, repair of hernia....... .............. .............. .............. .............. ..............
00752 N Anesth, repair of hernia....... .............. .............. .............. .............. ..............
00754 N Anesth, repair of hernia....... .............. .............. .............. .............. ..............
00756 N Anesth, repair of hernia....... .............. .............. .............. .............. ..............
00770 N Anesth, blood vessel repair.... .............. .............. .............. .............. ..............
00790 N Anesth, surg upper abdomen..... .............. .............. .............. .............. ..............
00792 C Anesth, 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, low intestine scope.... .............. .............. .............. .............. ..............
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...... .............. .............. .............. .............. ..............
00850 C Anesth, cesarean section....... .............. .............. .............. .............. ..............
00855 C Anesth, hysterectomy........... .............. .............. .............. .............. ..............
00857 C Analgesia, labor & c-section... .............. .............. .............. .............. ..............
[[Page 18559]]
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, hysteroscope/graph..... .............. .............. .............. .............. ..............
00955 C Analgesia, vaginal delivery.... .............. .............. .............. .............. ..............
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..... .............. .............. .............. .............. ..............
01250 N Anesth, upper leg surgery...... .............. .............. .............. .............. ..............
01260 N Anesth, upper leg veins surg... .............. .............. .............. .............. ..............
01270 N Anesth, thigh arteries surg.... .............. .............. .............. .............. ..............
01272 C Anesth, femoral artery surg.... .............. .............. .............. .............. ..............
01274 C Anesth, femoral embolectomy.... .............. .............. .............. .............. ..............
01320 N Anesth, knee area surgery...... .............. .............. .............. .............. ..............
01340 N Anesth, knee area procedure.... .............. .............. .............. .............. ..............
01360 N Anesth, knee area surgery...... .............. .............. .............. .............. ..............
01380 N Anesth, knee joint procedure... .............. .............. .............. .............. ..............
01382 N Anesth, knee arthroscopy....... .............. .............. .............. .............. ..............
01390 N Anesth, knee area procedure.... .............. .............. .............. .............. ..............
01392 N Anesth, knee area surgery...... .............. .............. .............. .............. ..............
01400 N Anesth, knee joint surgery..... .............. .............. .............. .............. ..............
01402 C Anesth, replacement of knee.... .............. .............. .............. .............. ..............
01404 C Anesth, amputation at knee..... .............. .............. .............. .............. ..............
01420 N Anesth, knee joint casting..... .............. .............. .............. .............. ..............
[[Page 18560]]
01430 N Anesth, knee veins surgery..... .............. .............. .............. .............. ..............
01432 N Anesth, knee vessel surg....... .............. .............. .............. .............. ..............
01440 N Anesth, knee arteries surg..... .............. .............. .............. .............. ..............
01442 C Anesth, knee artery surg....... .............. .............. .............. .............. ..............
01444 C Anesth, knee artery repair..... .............. .............. .............. .............. ..............
01462 N Anesth, lower leg procedure.... .............. .............. .............. .............. ..............
01464 N Anesth, ankle arthroscopy...... .............. .............. .............. .............. ..............
01470 N Anesth, lower leg surgery...... .............. .............. .............. .............. ..............
01472 N Anesth, achilles tendon surg... .............. .............. .............. .............. ..............
01474 N Anesth, lower leg surgery...... .............. .............. .............. .............. ..............
01480 N Anesth, lower leg bone surg.... .............. .............. .............. .............. ..............
01482 N Anesth, radical leg surgery.... .............. .............. .............. .............. ..............
01484 N Anesth, lower leg revision..... .............. .............. .............. .............. ..............
01486 C Anesth, ankle replacement...... .............. .............. .............. .............. ..............
01490 N Anesth, lower leg casting...... .............. .............. .............. .............. ..............
01500 N Anesth, leg arteries surg...... .............. .............. .............. .............. ..............
01502 C Anesth, lwr leg embolectomy.... .............. .............. .............. .............. ..............
01520 N Anesth, lower leg vein surg.... .............. .............. .............. .............. ..............
01522 N Anesth, lower leg vein surg.... .............. .............. .............. .............. ..............
01610 N Anesth, surgery of shoulder.... .............. .............. .............. .............. ..............
01620 N Anesth, shoulder procedure..... .............. .............. .............. .............. ..............
01622 N Anesth, shoulder arthroscopy... .............. .............. .............. .............. ..............
01630 N Anesth, surgery of shoulder.... .............. .............. .............. .............. ..............
01632 C Anesth, surgery of shoulder.... .............. .............. .............. .............. ..............
01634 C Anesth, shoulder joint amput... .............. .............. .............. .............. ..............
01636 C Anesth, forequarter amput...... .............. .............. .............. .............. ..............
01638 C Anesth, shoulder replacement... .............. .............. .............. .............. ..............
01650 N Anesth, shoulder artery surg... .............. .............. .............. .............. ..............
01652 C Anesth, shoulder vessel surg... .............. .............. .............. .............. ..............
01654 C Anesth, shoulder vessel surg... .............. .............. .............. .............. ..............
01656 C Anesth, arm-leg vessel surg.... .............. .............. .............. .............. ..............
01670 N Anesth, shoulder vein surg..... .............. .............. .............. .............. ..............
01680 N Anesth, shoulder casting....... .............. .............. .............. .............. ..............
01682 N Anesth, airplane cast.......... .............. .............. .............. .............. ..............
01710 N Anesth, elbow area surgery..... .............. .............. .............. .............. ..............
01712 N Anesth, uppr arm tendon surg... .............. .............. .............. .............. ..............
01714 N Anesth, uppr arm tendon surg... .............. .............. .............. .............. ..............
01716 N Anesth, biceps tendon repair... .............. .............. .............. .............. ..............
01730 N Anesth, uppr arm procedure..... .............. .............. .............. .............. ..............
01732 N Anesth, elbow arthroscopy...... .............. .............. .............. .............. ..............
01740 N Anesth, upper arm surgery...... .............. .............. .............. .............. ..............
01742 N Anesth, humerus surgery........ .............. .............. .............. .............. ..............
01744 N Anesth, humerus repair......... .............. .............. .............. .............. ..............
01756 C Anesth, radical humerus surg... .............. .............. .............. .............. ..............
01758 N Anesth, humeral lesion surg.... .............. .............. .............. .............. ..............
01760 N Anesth, elbow replacement...... .............. .............. .............. .............. ..............
01770 N Anesth, uppr arm artery surg... .............. .............. .............. .............. ..............
01772 C Anesth, uppr arm embolectomy... .............. .............. .............. .............. ..............
01780 N Anesth, upper arm vein surg.... .............. .............. .............. .............. ..............
01782 C Anesth, uppr arm vein repair... .............. .............. .............. .............. ..............
01784 N Anesth, av fistula repair...... .............. .............. .............. .............. ..............
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, lwr arm artery surg.... .............. .............. .............. .............. ..............
01842 C Anesth, lwr arm embolectomy.... .............. .............. .............. .............. ..............
01844 N Anesth, vascular shunt surg.... .............. .............. .............. .............. ..............
01850 N Anesth, lower arm vein surg.... .............. .............. .............. .............. ..............
01852 C Anesth, lwr arm vein repair.... .............. .............. .............. .............. ..............
01860 N Anesth, lower arm casting...... .............. .............. .............. .............. ..............
01904 C Anesth, skull x-ray inject..... .............. .............. .............. .............. ..............
01906 N Anesth, lumbar myelography..... .............. .............. .............. .............. ..............
01908 N Anesth, cervical myelography... .............. .............. .............. .............. ..............
01910 N Anesth, skull myelography...... .............. .............. .............. .............. ..............
01912 N Anesth, lumbar diskography..... .............. .............. .............. .............. ..............
01914 N Anesth, cervical diskography... .............. .............. .............. .............. ..............
01916 N Anesth, head arteriogram....... .............. .............. .............. .............. ..............
01918 N Anesth, limb arteriogram....... .............. .............. .............. .............. ..............
01920 N Anesth, catheterize heart...... .............. .............. .............. .............. ..............
01921 N Anesth, vessel surgery......... .............. .............. .............. .............. ..............
01922 N Anesth, cat or MRI scan........ .............. .............. .............. .............. ..............
01990 C Support for organ donor........ .............. .............. .............. .............. ..............
[[Page 18561]]
01995 N Regional anesthesia, limb...... .............. .............. .............. .............. ..............
01996 N Manage daily drug therapy...... .............. .............. .............. .............. ..............
01999 N Unlisted anesth procedure...... .............. .............. .............. .............. ..............
10040 T Acne surgery of skin abscess... 0006 2.00 $96.97 $33.95 $19.39
10060 T Drainage of skin abscess....... 0006 2.00 $96.97 $33.95 $19.39
10061 T Drainage of skin abscess....... 0006 2.00 $96.97 $33.95 $19.39
10080 T Drainage of pilonidal cyst..... 0006 2.00 $96.97 $33.95 $19.39
10081 T Drainage of pilonidal cyst..... 0007 3.68 $178.43 $72.03 $35.69
10120 T Remove foreign body............ 0006 2.00 $96.97 $33.95 $19.39
10121 T Remove foreign body............ 0020 6.51 $315.65 $130.53 $63.13
10140 T Drainage of hematoma/fluid..... 0007 3.68 $178.43 $72.03 $35.69
10160 T Puncture drainage of lesion.... 0006 2.00 $96.97 $33.95 $19.39
10180 T Complex drainage, wound........ 0007 3.68 $178.43 $72.03 $35.69
11000 T Debride infected skin.......... 0015 1.77 $85.82 $31.20 $17.16
11001 T Debride infected skin add-on... 0015 1.77 $85.82 $31.20 $17.16
11010 T Debride skin, fx............... 0022 12.49 $605.60 $292.94 $121.12
11011 T Debride skin/muscle, fx........ 0022 12.49 $605.60 $292.94 $121.12
11012 T Debride skin/muscle/bone, fx... 0022 12.49 $605.60 $292.94 $121.12
11040 T Debride skin, partial.......... 0015 1.77 $85.82 $31.20 $17.16
11041 T Debride skin, full............. 0015 1.77 $85.82 $31.20 $17.16
11042 T Debride skin/tissue............ 0016 3.53 $171.16 $74.67 $34.23
11043 T Debride tissue/muscle.......... 0016 3.53 $171.16 $74.67 $34.23
11044 T Debride tissue/muscle/bone..... 0017 12.45 $603.66 $289.16 $120.73
11055 T Trim skin lesion............... 0015 1.77 $85.82 $31.20 $17.16
11056 T Trim skin lesions, 2 to 4...... 0015 1.77 $85.82 $31.20 $17.16
11057 T Trim skin lesions, over 4...... 0015 1.77 $85.82 $31.20 $17.16
11100 T Biopsy of skin lesion.......... 0018 0.94 $45.58 $17.66 $9.12
11101 T Biopsy, skin add-on............ 0018 0.94 $45.58 $17.66 $9.12
11200 T Removal of skin tags........... 0015 1.77 $85.82 $31.20 $17.16
11201 T Remove skin tags add-on........ 0015 1.77 $85.82 $31.20 $17.16
11300 T Shave skin lesion.............. 0013 0.91 $44.12 $17.66 $8.82
11301 T Shave skin lesion.............. 0013 0.91 $44.12 $17.66 $8.82
11302 T Shave skin lesion.............. 0014 1.50 $72.73 $24.55 $14.55
11303 T Shave skin lesion.............. 0015 1.77 $85.82 $31.20 $17.16
11305 T Shave skin lesion.............. 0013 0.91 $44.12 $17.66 $8.82
11306 T Shave skin lesion.............. 0013 0.91 $44.12 $17.66 $8.82
11307 T Shave skin lesion.............. 0014 1.50 $72.73 $24.55 $14.55
11308 T Shave skin lesion.............. 0015 1.77 $85.82 $31.20 $17.16
11310 T Shave skin lesion.............. 0013 0.91 $44.12 $17.66 $8.82
11311 T Shave skin lesion.............. 0013 0.91 $44.12 $17.66 $8.82
11312 T Shave skin lesion.............. 0015 1.77 $85.82 $31.20 $17.16
11313 T Shave skin lesion.............. 0016 3.53 $171.16 $74.67 $34.23
11400 T Removal of skin lesion......... 0019 4.00 $193.95 $78.91 $38.79
11401 T Removal of skin lesion......... 0019 4.00 $193.95 $78.91 $38.79
11402 T Removal of skin lesion......... 0019 4.00 $193.95 $78.91 $38.79
11403 T Removal of skin lesion......... 0020 6.51 $315.65 $130.53 $63.13
11404 T Removal of skin lesion......... 0020 6.51 $315.65 $130.53 $63.13
11406 T Removal of skin lesion......... 0020 6.51 $315.65 $130.53 $63.13
11420 T Removal of skin lesion......... 0019 4.00 $193.95 $78.91 $38.79
11421 T Removal of skin lesion......... 0019 4.00 $193.95 $78.91 $38.79
11422 T Removal of skin lesion......... 0019 4.00 $193.95 $78.91 $38.79
11423 T Removal of skin lesion......... 0020 6.51 $315.65 $130.53 $63.13
11424 T Removal of skin lesion......... 0020 6.51 $315.65 $130.53 $63.13
11426 T Removal of skin lesion......... 0022 12.49 $605.60 $292.94 $121.12
11440 T Removal of skin lesion......... 0019 4.00 $193.95 $78.91 $38.79
11441 T Removal of skin lesion......... 0019 4.00 $193.95 $78.91 $38.79
11442 T Removal of skin lesion......... 0019 4.00 $193.95 $78.91 $38.79
11443 T Removal of skin lesion......... 0020 6.51 $315.65 $130.53 $63.13
11444 T Removal of skin lesion......... 0020 6.51 $315.65 $130.53 $63.13
11446 T Removal of skin lesion......... 0022 12.49 $605.60 $292.94 $121.12
11450 T Removal, sweat gland lesion.... 0022 12.49 $605.60 $292.94 $121.12
11451 T Removal, sweat gland lesion.... 0022 12.49 $605.60 $292.94 $121.12
11462 T Removal, sweat gland lesion.... 0022 12.49 $605.60 $292.94 $121.12
11463 T Removal, sweat gland lesion.... 0022 12.49 $605.60 $292.94 $121.12
11470 T Removal, sweat gland lesion.... 0022 12.49 $605.60 $292.94 $121.12
11471 T Removal, sweat gland lesion.... 0022 12.49 $605.60 $292.94 $121.12
11600 T Removal of skin lesion......... 0019 4.00 $193.95 $78.91 $38.79
11601 T Removal of skin lesion......... 0019 4.00 $193.95 $78.91 $38.79
11602 T Removal of skin lesion......... 0019 4.00 $193.95 $78.91 $38.79
11603 T Removal of skin lesion......... 0020 6.51 $315.65 $130.53 $63.13
11604 T Removal of skin lesion......... 0020 6.51 $315.65 $130.53 $63.13
11606 T Removal of skin lesion......... 0021 10.49 $508.63 $236.51 $101.73
11620 T Removal of skin lesion......... 0019 4.00 $193.95 $78.91 $38.79
[[Page 18562]]
11621 T Removal of skin lesion......... 0019 4.00 $193.95 $78.91 $38.79
11622 T Removal of skin lesion......... 0019 4.00 $193.95 $78.91 $38.79
11623 T Removal of skin lesion......... 0020 6.51 $315.65 $130.53 $63.13
11624 T Removal of skin lesion......... 0020 6.51 $315.65 $130.53 $63.13
11626 T Removal of skin lesion......... 0022 12.49 $605.60 $292.94 $121.12
11640 T Removal of skin lesion......... 0019 4.00 $193.95 $78.91 $38.79
11641 T Removal of skin lesion......... 0019 4.00 $193.95 $78.91 $38.79
11642 T Removal of skin lesion......... 0019 4.00 $193.95 $78.91 $38.79
11643 T Removal of skin lesion......... 0020 6.51 $315.65 $130.53 $63.13
11644 T Removal of skin lesion......... 0020 6.51 $315.65 $130.53 $63.13
11646 T Removal of skin lesion......... 0022 12.49 $605.60 $292.94 $121.12
11719 T Trim nail(s)................... 0009 0.74 $35.88 $9.63 $7.18
11720 T Debride nail, 1-5.............. 0009 0.74 $35.88 $9.63 $7.18
11721 T Debride nail, 6 or more........ 0009 0.74 $35.88 $9.63 $7.18
11730 T Removal of nail plate.......... 0013 0.91 $44.12 $17.66 $8.82
11732 T Remove nail plate, add-on...... 0012 0.53 $25.70 $9.18 $5.14
11740 T Drain blood from under nail.... 0009 0.74 $35.88 $9.63 $7.18
11750 T Removal of nail bed............ 0019 4.00 $193.95 $78.91 $38.79
11752 T Remove nail bed/finger tip..... 0022 12.49 $605.60 $292.94 $121.12
11755 T Biopsy, nail unit.............. 0019 4.00 $193.95 $78.91 $38.79
11760 T Repair of nail bed............. 0024 2.43 $117.82 $44.50 $23.56
11762 T Reconstruction of nail bed..... 0024 2.43 $117.82 $44.50 $23.56
11765 T Excision of nail fold, toe..... 0015 1.77 $85.82 $31.20 $17.16
11770 T Removal of pilonidal lesion.... 0021 10.49 $508.63 $236.51 $101.73
11771 T Removal of pilonidal lesion.... 0022 12.49 $605.60 $292.94 $121.12
11772 T Removal of pilonidal lesion.... 0022 12.49 $605.60 $292.94 $121.12
11900 T Injection into skin lesions.... 0012 0.53 $25.70 $9.18 $5.14
11901 T Added skin lesions injection... 0013 0.91 $44.12 $17.66 $8.82
11920 T Correct skin color defects..... 0024 2.43 $117.82 $44.50 $23.56
11921 T Correct skin color defects..... 0024 2.43 $117.82 $44.50 $23.56
11922 T Correct skin color defects..... 0024 2.43 $117.82 $44.50 $23.56
11950 T Therapy for contour defects.... 0024 2.43 $117.82 $44.50 $23.56
11951 T Therapy for contour defects.... 0024 2.43 $117.82 $44.50 $23.56
11952 T Therapy for contour defects.... 0024 2.43 $117.82 $44.50 $23.56
11954 T Therapy for contour defects.... 0024 2.43 $117.82 $44.50 $23.56
11960 T Insert tissue expander(s)...... 0026 12.11 $587.18 $277.92 $117.44
11970 T Replace tissue expander........ 0026 12.11 $587.18 $277.92 $117.44
11971 T Remove tissue expander(s)...... 0022 12.49 $605.60 $292.94 $121.12
11975 E Insert contraceptive cap....... .............. .............. .............. .............. ..............
11976 T Removal of contraceptive cap... 0019 4.00 $193.95 $78.91 $38.79
11977 E Removal/reinsert contra cap.... .............. .............. .............. .............. ..............
11980 E Implant hormone pellet(s)...... .............. .............. .............. .............. ..............
12001 T Repair superficial wound(s).... 0024 2.43 $117.82 $44.50 $23.56
12002 T Repair superficial wound(s).... 0024 2.43 $117.82 $44.50 $23.56
12004 T Repair superficial wound(s).... 0024 2.43 $117.82 $44.50 $23.56
12005 T Repair superficial wound(s).... 0024 2.43 $117.82 $44.50 $23.56
12006 T Repair superficial wound(s).... 0024 2.43 $117.82 $44.50 $23.56
12007 T Repair superficial wound(s).... 0024 2.43 $117.82 $44.50 $23.56
12011 T Repair superficial wound(s).... 0024 2.43 $117.82 $44.50 $23.56
12013 T Repair superficial wound(s).... 0024 2.43 $117.82 $44.50 $23.56
12014 T Repair superficial wound(s).... 0024 2.43 $117.82 $44.50 $23.56
12015 T Repair superficial wound(s).... 0024 2.43 $117.82 $44.50 $23.56
12016 T Repair superficial wound(s).... 0024 2.43 $117.82 $44.50 $23.56
12017 T Repair superficial wound(s).... 0024 2.43 $117.82 $44.50 $23.56
12018 T Repair superficial wound(s).... 0024 2.43 $117.82 $44.50 $23.56
12020 T Closure of split wound......... 0024 2.43 $117.82 $44.50 $23.56
12021 T Closure of split wound......... 0024 2.43 $117.82 $44.50 $23.56
12031 T Layer closure of wound(s)...... 0024 2.43 $117.82 $44.50 $23.56
12032 T Layer closure of wound(s)...... 0024 2.43 $117.82 $44.50 $23.56
12034 T Layer closure of wound(s)...... 0024 2.43 $117.82 $44.50 $23.56
12035 T Layer closure of wound(s)...... 0024 2.43 $117.82 $44.50 $23.56
12036 T Layer closure of wound(s)...... 0024 2.43 $117.82 $44.50 $23.56
12037 T Layer closure of wound(s)...... 0026 12.11 $587.18 $277.92 $117.44
12041 T Layer closure of wound(s)...... 0024 2.43 $117.82 $44.50 $23.56
12042 T Layer closure of wound(s)...... 0024 2.43 $117.82 $44.50 $23.56
12044 T Layer closure of wound(s)...... 0024 2.43 $117.82 $44.50 $23.56
12045 T Layer closure of wound(s)...... 0024 2.43 $117.82 $44.50 $23.56
12046 T Layer closure of wound(s)...... 0024 2.43 $117.82 $44.50 $23.56
12047 T Layer closure of wound(s)...... 0026 12.11 $587.18 $277.92 $117.44
12051 T Layer closure of wound(s)...... 0024 2.43 $117.82 $44.50 $23.56
12052 T Layer closure of wound(s)...... 0024 2.43 $117.82 $44.50 $23.56
12053 T Layer closure of wound(s)...... 0024 2.43 $117.82 $44.50 $23.56
12054 T Layer closure of wound(s)...... 0024 2.43 $117.82 $44.50 $23.56
[[Page 18563]]
12055 T Layer closure of wound(s)...... 0024 2.43 $117.82 $44.50 $23.56
12056 T Layer closure of wound(s)...... 0024 2.43 $117.82 $44.50 $23.56
12057 T Layer closure of wound(s)...... 0026 12.11 $587.18 $277.92 $117.44
13100 T Repair of wound or lesion...... 0025 3.74 $181.34 $70.66 $36.27
13101 T Repair of wound or lesion...... 0025 3.74 $181.34 $70.66 $36.27
13102 T Repair wound/lesion add-on..... 0025 3.74 $181.34 $70.66 $36.27
13120 T Repair of wound or lesion...... 0025 3.74 $181.34 $70.66 $36.27
13121 T Repair of wound or lesion...... 0025 3.74 $181.34 $70.66 $36.27
13122 T Repair wound/lesion add-on..... 0025 3.74 $181.34 $70.66 $36.27
13131 T Repair of wound or lesion...... 0025 3.74 $181.34 $70.66 $36.27
13132 T Repair of wound or lesion...... 0025 3.74 $181.34 $70.66 $36.27
13133 T Repair wound/lesion add-on..... 0025 3.74 $181.34 $70.66 $36.27
13150 T Repair of wound or lesion...... 0026 12.11 $587.18 $277.92 $117.44
13151 T Repair of wound or lesion...... 0025 3.74 $181.34 $70.66 $36.27
13152 T Repair of wound or lesion...... 0025 3.74 $181.34 $70.66 $36.27
13153 T Repair wound/lesion add-on..... 0025 3.74 $181.34 $70.66 $36.27
13160 T Late closure of wound.......... 0026 12.11 $587.18 $277.92 $117.44
14000 T Skin tissue rearrangement...... 0026 12.11 $587.18 $277.92 $117.44
14001 T Skin tissue rearrangement...... 0026 12.11 $587.18 $277.92 $117.44
14020 T Skin tissue rearrangement...... 0026 12.11 $587.18 $277.92 $117.44
14021 T Skin tissue rearrangement...... 0026 12.11 $587.18 $277.92 $117.44
14040 T Skin tissue rearrangement...... 0026 12.11 $587.18 $277.92 $117.44
14041 T Skin tissue rearrangement...... 0026 12.11 $587.18 $277.92 $117.44
14060 T Skin tissue rearrangement...... 0026 12.11 $587.18 $277.92 $117.44
14061 T Skin tissue rearrangement...... 0026 12.11 $587.18 $277.92 $117.44
14300 T Skin tissue rearrangement...... 0026 12.11 $587.18 $277.92 $117.44
14350 T Skin tissue rearrangement...... 0026 12.11 $587.18 $277.92 $117.44
15000 T Skin graft..................... 0026 12.11 $587.18 $277.92 $117.44
15001 T Skin graft add-on.............. 0026 12.11 $587.18 $277.92 $117.44
15050 T Skin pinch graft............... 0026 12.11 $587.18 $277.92 $117.44
15100 T Skin split graft............... 0026 12.11 $587.18 $277.92 $117.44
15101 T Skin split graft add-on........ 0026 12.11 $587.18 $277.92 $117.44
15120 T Skin split graft............... 0026 12.11 $587.18 $277.92 $117.44
15121 T Skin split graft add-on........ 0026 12.11 $587.18 $277.92 $117.44
15200 T Skin full graft................ 0026 12.11 $587.18 $277.92 $117.44
15201 T Skin full graft add-on......... 0026 12.11 $587.18 $277.92 $117.44
15220 T Skin full graft................ 0026 12.11 $587.18 $277.92 $117.44
15221 T Skin full graft add-on......... 0026 12.11 $587.18 $277.92 $117.44
15240 T Skin full graft................ 0026 12.11 $587.18 $277.92 $117.44
15241 T Skin full graft add-on......... 0026 12.11 $587.18 $277.92 $117.44
15260 T Skin full graft................ 0026 12.11 $587.18 $277.92 $117.44
15261 T Skin full graft add-on......... 0026 12.11 $587.18 $277.92 $117.44
15350 T Skin homograft................. 0026 12.11 $587.18 $277.92 $117.44
15351 T Skin homograft add-on.......... 0026 12.11 $587.18 $277.92 $117.44
15400 T Skin heterograft............... 0026 12.11 $587.18 $277.92 $117.44
15401 T Skin heterograft add-on........ 0026 12.11 $587.18 $277.92 $117.44
15570 T Form skin pedicle flap......... 0026 12.11 $587.18 $277.92 $117.44
15572 T Form skin pedicle flap......... 0026 12.11 $587.18 $277.92 $117.44
15574 T Form skin pedicle flap......... 0026 12.11 $587.18 $277.92 $117.44
15576 T Form skin pedicle flap......... 0026 12.11 $587.18 $277.92 $117.44
15600 T Skin graft..................... 0026 12.11 $587.18 $277.92 $117.44
15610 T Skin graft..................... 0026 12.11 $587.18 $277.92 $117.44
15620 T Skin graft..................... 0026 12.11 $587.18 $277.92 $117.44
15630 T Skin graft..................... 0026 12.11 $587.18 $277.92 $117.44
15650 T Transfer skin pedicle flap..... 0026 12.11 $587.18 $277.92 $117.44
15732 T Muscle-skin graft, head/neck... 0027 15.80 $766.10 $383.10 $153.22
15734 T Muscle-skin graft, trunk....... 0027 15.80 $766.10 $383.10 $153.22
15736 T Muscle-skin graft, arm......... 0027 15.80 $766.10 $383.10 $153.22
15738 T Muscle-skin graft, leg......... 0027 15.80 $766.10 $383.10 $153.22
15740 T Island pedicle flap graft...... 0027 15.80 $766.10 $383.10 $153.22
15750 T Neurovascular pedicle graft.... 0027 15.80 $766.10 $383.10 $153.22
15756 C Free muscle flap, microvasc.... .............. .............. .............. .............. ..............
15757 C Free skin flap, microvasc...... .............. .............. .............. .............. ..............
15758 C Free fascial flap, microvasc... .............. .............. .............. .............. ..............
15760 T Composite skin graft........... 0027 15.80 $766.10 $383.10 $153.22
15770 T Derma-fat-fascia graft......... 0027 15.80 $766.10 $383.10 $153.22
15775 T Hair transplant punch grafts... 0026 12.11 $587.18 $277.92 $117.44
15776 T Hair transplant punch grafts... 0026 12.11 $587.18 $277.92 $117.44
15780 T Abrasion treatment of skin..... 0022 12.49 $605.60 $292.94 $121.12
15781 T Abrasion treatment of skin..... 0022 12.49 $605.60 $292.94 $121.12
15782 T Abrasion treatment of skin..... 0022 12.49 $605.60 $292.94 $121.12
15783 T Abrasion treatment of skin..... 0015 1.77 $85.82 $31.20 $17.16
15786 T Abrasion, lesion, single....... 0013 0.91 $44.12 $17.66 $8.82
[[Page 18564]]
15787 T Abrasion, lesions, add-on...... 0016 3.53 $171.16 $74.67 $34.23
15788 T Chemical peel, face, epiderm... 0013 0.91 $44.12 $17.66 $8.82
15789 T Chemical peel, face, dermal.... 0015 1.77 $85.82 $31.20 $17.16
15792 T Chemical peel, nonfacial....... 0016 3.53 $171.16 $74.67 $34.23
15793 T Chemical peel, nonfacial....... 0016 3.53 $171.16 $74.67 $34.23
15810 T Salabrasion.................... 0016 3.53 $171.16 $74.67 $34.23
15811 T Salabrasion.................... 0022 12.49 $605.60 $292.94 $121.12
15819 T Plastic surgery, neck.......... 0026 12.11 $587.18 $277.92 $117.44
15820 T Revision of lower eyelid....... 0026 12.11 $587.18 $277.92 $117.44
15821 T Revision of lower eyelid....... 0026 12.11 $587.18 $277.92 $117.44
15822 T Revision of upper eyelid....... 0026 12.11 $587.18 $277.92 $117.44
15823 T Revision of upper eyelid....... 0026 12.11 $587.18 $277.92 $117.44
15824 T Removal of forehead wrinkles... 0027 15.80 $766.10 $383.10 $153.22
15825 T Removal of neck wrinkles....... 0026 12.11 $587.18 $277.92 $117.44
15826 T Removal of brow wrinkles....... 0027 15.80 $766.10 $383.10 $153.22
15828 T Removal of face wrinkles....... 0027 15.80 $766.10 $383.10 $153.22
15829 T Removal of skin wrinkles....... 0026 12.11 $587.18 $277.92 $117.44
15831 T Excise excessive skin tissue... 0027 15.80 $766.10 $383.10 $153.22
15832 T Excise excessive skin tissue... 0027 15.80 $766.10 $383.10 $153.22
15833 T Excise excessive skin tissue... 0027 15.80 $766.10 $383.10 $153.22
15834 T Excise excessive skin tissue... 0027 15.80 $766.10 $383.10 $153.22
15835 T Excise excessive skin tissue... 0026 12.11 $587.18 $277.92 $117.44
15836 T Excise excessive skin tissue... 0027 15.80 $766.10 $383.10 $153.22
15837 T Excise excessive skin tissue... 0027 15.80 $766.10 $383.10 $153.22
15838 T Excise excessive skin tissue... 0022 12.49 $605.60 $292.94 $121.12
15839 T Excise excessive skin tissue... 0027 15.80 $766.10 $383.10 $153.22
15840 T Graft for face nerve palsy..... 0027 15.80 $766.10 $383.10 $153.22
15841 T Graft for face nerve palsy..... 0027 15.80 $766.10 $383.10 $153.22
15842 T Graft for face nerve palsy..... 0027 15.80 $766.10 $383.10 $153.22
15845 T Skin and muscle repair, face... 0027 15.80 $766.10 $383.10 $153.22
15850 T Removal of sutures............. 0013 0.91 $44.12 $17.66 $8.82
15851 T Removal of sutures............. 0013 0.91 $44.12 $17.66 $8.82
15852 T Dressing change, not for burn.. 0012 0.53 $25.70 $9.18 $5.14
15860 N Test for blood flow in graft... .............. .............. .............. .............. ..............
15876 T Suction assisted lipectomy..... 0027 15.80 $766.10 $383.10 $153.22
15877 T Suction assisted lipectomy..... 0027 15.80 $766.10 $383.10 $153.22
15878 T Suction assisted lipectomy..... 0027 15.80 $766.10 $383.10 $153.22
15879 T Suction assisted lipectomy..... 0027 15.80 $766.10 $383.10 $153.22
15920 T Removal of tail bone ulcer..... 0022 12.49 $605.60 $292.94 $121.12
15922 T Removal of tail bone ulcer..... 0027 15.80 $766.10 $383.10 $153.22
15931 T Remove sacrum pressure sore.... 0022 12.49 $605.60 $292.94 $121.12
15933 T Remove sacrum pressure sore.... 0022 12.49 $605.60 $292.94 $121.12
15934 T Remove sacrum pressure sore.... 0027 15.80 $766.10 $383.10 $153.22
15935 T Remove sacrum pressure sore.... 0027 15.80 $766.10 $383.10 $153.22
15936 T Remove sacrum pressure sore.... 0027 15.80 $766.10 $383.10 $153.22
15937 T Remove sacrum pressure sore.... 0027 15.80 $766.10 $383.10 $153.22
15940 T Remove hip pressure sore....... 0022 12.49 $605.60 $292.94 $121.12
15941 T Remove hip pressure sore....... 0022 12.49 $605.60 $292.94 $121.12
15944 T Remove hip pressure sore....... 0027 15.80 $766.10 $383.10 $153.22
15945 T Remove hip pressure sore....... 0027 15.80 $766.10 $383.10 $153.22
15946 T Remove hip pressure sore....... 0027 15.80 $766.10 $383.10 $153.22
15950 T Remove thigh pressure sore..... 0022 12.49 $605.60 $292.94 $121.12
15951 T Remove thigh pressure sore..... 0022 12.49 $605.60 $292.94 $121.12
15952 T Remove thigh pressure sore..... 0027 15.80 $766.10 $383.10 $153.22
15953 T Remove thigh pressure sore..... 0027 15.80 $766.10 $383.10 $153.22
15956 T Remove thigh pressure sore..... 0027 15.80 $766.10 $383.10 $153.22
15958 T Remove thigh pressure sore..... 0027 15.80 $766.10 $383.10 $153.22
15999 T Removal of pressure sore....... 0022 12.49 $605.60 $292.94 $121.12
16000 T Initial treatment of burn(s)... 0015 1.77 $85.82 $31.20 $17.16
16010 T Treatment of burn(s)........... 0015 1.77 $85.82 $31.20 $17.16
16015 T Treatment of burn(s)........... 0017 12.45 $603.66 $289.16 $120.73
16020 T Treatment of burn(s)........... 0015 1.77 $85.82 $31.20 $17.16
16025 T Treatment of burn(s)........... 0014 1.50 $72.73 $24.55 $14.55
16030 T Treatment of burn(s)........... 0015 1.77 $85.82 $31.20 $17.16
16035 T Incision of burn scab.......... 0020 6.51 $315.65 $130.53 $63.13
17000 T Destroy benign/premal lesion... 0010 0.55 $26.67 $9.86 $5.33
17003 T Destroy lesions, 2-14.......... 0010 0.55 $26.67 $9.86 $5.33
17004 T Destroy lesions, 15 or more.... 0011 2.72 $131.88 $50.01 $26.38
17106 T Destruction of skin lesions.... 0011 2.72 $131.88 $50.01 $26.38
17107 T Destruction of skin lesions.... 0011 2.72 $131.88 $50.01 $26.38
17108 T Destruction of skin lesions.... 0011 2.72 $131.88 $50.01 $26.38
17110 T Destruct lesion, 1-14.......... 0010 0.55 $26.67 $9.86 $5.33
17111 T Destruct lesion, 15 or more.... 0011 2.72 $131.88 $50.01 $26.38
[[Page 18565]]
17250 T Chemical cautery, tissue....... 0014 1.50 $72.73 $24.55 $14.55
17260 T Destruction of skin lesions.... 0013 0.91 $44.12 $17.66 $8.82
17261 T Destruction of skin lesions.... 0013 0.91 $44.12 $17.66 $8.82
17262 T Destruction of skin lesions.... 0013 0.91 $44.12 $17.66 $8.82
17263 T Destruction of skin lesions.... 0013 0.91 $44.12 $17.66 $8.82
17264 T Destruction of skin lesions.... 0015 1.77 $85.82 $31.20 $17.16
17266 T Destruction of skin lesions.... 0016 3.53 $171.16 $74.67 $34.23
17270 T Destruction of skin lesions.... 0015 1.77 $85.82 $31.20 $17.16
17271 T Destruction of skin lesions.... 0013 0.91 $44.12 $17.66 $8.82
17272 T Destruction of skin lesions.... 0013 0.91 $44.12 $17.66 $8.82
17273 T Destruction of skin lesions.... 0015 1.77 $85.82 $31.20 $17.16
17274 T Destruction of skin lesions.... 0015 1.77 $85.82 $31.20 $17.16
17276 T Destruction of skin lesions.... 0015 1.77 $85.82 $31.20 $17.16
17280 T Destruction of skin lesions.... 0015 1.77 $85.82 $31.20 $17.16
17281 T Destruction of skin lesions.... 0015 1.77 $85.82 $31.20 $17.16
17282 T Destruction of skin lesions.... 0015 1.77 $85.82 $31.20 $17.16
17283 T Destruction of skin lesions.... 0015 1.77 $85.82 $31.20 $17.16
17284 T Destruction of skin lesions.... 0016 3.53 $171.16 $74.67 $34.23
17286 T Destruction of skin lesions.... 0016 3.53 $171.16 $74.67 $34.23
17304 T Chemosurgery of skin lesion.... 0020 6.51 $315.65 $130.53 $63.13
17305 T 2nd stage chemosurgery......... 0020 6.51 $315.65 $130.53 $63.13
17306 T 3rd stage chemosurgery......... 0020 6.51 $315.65 $130.53 $63.13
17307 T Followup skin lesion therapy... 0020 6.51 $315.65 $130.53 $63.13
17310 T Extensive skin chemosurgery.... 0020 6.51 $315.65 $130.53 $63.13
17340 T Cryotherapy of skin............ 0012 0.53 $25.70 $9.18 $5.14
17360 T Skin peel therapy.............. 0016 3.53 $171.16 $74.67 $34.23
17380 T Hair removal by electrolysis... 0016 3.53 $171.16 $74.67 $34.23
17999 T Skin tissue procedure.......... 0004 1.84 $89.22 $32.57 $17.84
19000 T Drainage of breast lesion...... 0004 1.84 $89.22 $32.57 $17.84
19001 T Drain breast lesion add-on..... 0004 1.84 $89.22 $32.57 $17.84
19020 T Incision of breast lesion...... 0008 6.15 $298.20 $113.67 $59.64
19030 N Injection for breast x-ray..... .............. .............. .............. .............. ..............
19100 T Biopsy of breast............... 0005 5.41 $262.32 $119.75 $52.46
19101 T Biopsy of breast............... 0029 12.85 $623.06 $303.50 $124.61
19110 T Nipple exploration............. 0029 12.85 $623.06 $303.50 $124.61
19112 T Excise breast duct fistula..... 0029 12.85 $623.06 $303.50 $124.61
19120 T Removal of breast lesion....... 0029 12.85 $623.06 $303.50 $124.61
19125 T Excision, breast lesion........ 0029 12.85 $623.06 $303.50 $124.61
19126 T Excision, addl breast lesion... 0029 12.85 $623.06 $303.50 $124.61
19140 T Removal of breast tissue....... 0029 12.85 $623.06 $303.50 $124.61
19160 T Removal of breast tissue....... 0030 20.19 $978.95 $523.95 $195.79
19162 T Remove breast tissue, nodes.... 0030 20.19 $978.95 $523.95 $195.79
19180 T Removal of breast.............. 0030 20.19 $978.95 $523.95 $195.79
19182 T Removal of breast.............. 0030 20.19 $978.95 $523.95 $195.79
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, breast...... 0029 12.85 $623.06 $303.50 $124.61
19291 T Place needle wire, breast...... 0029 12.85 $623.06 $303.50 $124.61
19316 T Suspension of breast........... 0030 20.19 $978.95 $523.95 $195.79
19318 T Reduction of large breast...... 0030 20.19 $978.95 $523.95 $195.79
19324 T Enlarge breast................. 0030 20.19 $978.95 $523.95 $195.79
19325 T Enlarge breast with implant.... 0030 20.19 $978.95 $523.95 $195.79
19328 T Removal of breast implant...... 0030 20.19 $978.95 $523.95 $195.79
19330 T Removal of implant material.... 0030 20.19 $978.95 $523.95 $195.79
19340 T Immediate breast prosthesis.... 0030 20.19 $978.95 $523.95 $195.79
19342 T Delayed breast prosthesis...... 0030 20.19 $978.95 $523.95 $195.79
19350 T Breast reconstruction.......... 0030 20.19 $978.95 $523.95 $195.79
19355 T Correct inverted nipple(s)..... 0030 20.19 $978.95 $523.95 $195.79
19357 T Breast reconstruction.......... 0030 20.19 $978.95 $523.95 $195.79
19361 C Breast reconstruction.......... .............. .............. .............. .............. ..............
19364 C Breast reconstruction.......... .............. .............. .............. .............. ..............
19366 T Breast reconstruction.......... 0030 20.19 $978.95 $523.95 $195.79
19367 C Breast reconstruction.......... .............. .............. .............. .............. ..............
19368 C Breast reconstruction.......... .............. .............. .............. .............. ..............
19369 C Breast reconstruction.......... .............. .............. .............. .............. ..............
19370 T Surgery of breast capsule...... 0030 20.19 $978.95 $523.95 $195.79
19371 T Removal of breast capsule...... 0030 20.19 $978.95 $523.95 $195.79
19380 T Revise breast reconstruction... 0030 20.19 $978.95 $523.95 $195.79
19396 T Design custom breast implant... 0029 12.85 $623.06 $303.50 $124.61
[[Page 18566]]
19499 T Breast surgery procedure....... 0029 12.85 $623.06 $303.50 $124.61
20000 T Incision of abscess............ 0006 2.00 $96.97 $33.95 $19.39
20005 T Incision of deep abscess....... 0049 15.04 $729.25 $356.95 $145.85
20100 T Explore wound, neck............ 0023 1.98 $96.00 $40.37 $19.20
20101 T Explore wound, chest........... 0026 12.11 $587.18 $277.92 $117.44
20102 T Explore wound, abdomen......... 0026 12.11 $587.18 $277.92 $117.44
20103 T Explore wound, extremity....... 0023 1.98 $96.00 $40.37 $19.20
20150 T Excise epiphyseal bar.......... 0051 27.76 $1,346.00 $675.24 $269.20
20200 T Muscle biopsy.................. 0020 6.51 $315.65 $130.53 $63.13
20205 T Deep muscle biopsy............. 0021 10.49 $508.63 $236.51 $101.73
20206 T Needle biopsy, muscle.......... 0005 5.41 $262.32 $119.75 $52.46
20220 T Bone biopsy, trocar/needle..... 0019 4.00 $193.95 $78.91 $38.79
20225 T Bone biopsy, trocar/needle..... 0020 6.51 $315.65 $130.53 $63.13
20240 T Bone biopsy, excisional........ 0022 12.49 $605.60 $292.94 $121.12
20245 T Bone biopsy, excisional........ 0022 12.49 $605.60 $292.94 $121.12
20250 T Open bone biopsy............... 0049 15.04 $729.25 $356.95 $145.85
20251 T Open bone biopsy............... 0049 15.04 $729.25 $356.95 $145.85
20500 T Injection of sinus tract....... 0252 5.18 $251.16 $114.24 $50.23
20501 N Inject sinus tract for x-ray... .............. .............. .............. .............. ..............
20520 T Removal of foreign body........ 0019 4.00 $193.95 $78.91 $38.79
20525 T Removal of foreign body........ 0022 12.49 $605.60 $292.94 $121.12
20550 T Inject tendon/ligament/cyst.... 0040 2.11 $102.31 $40.60 $20.46
20600 T Drain/inject, joint/bursa...... 0040 2.11 $102.31 $40.60 $20.46
20605 T Drain/inject, joint/bursa...... 0040 2.11 $102.31 $40.60 $20.46
20610 T Drain/inject, joint/bursa...... 0040 2.11 $102.31 $40.60 $20.46
20615 T Treatment of bone cyst......... 0004 1.84 $89.22 $32.57 $17.84
20650 T Insert and remove bone pin..... 0049 15.04 $729.25 $356.95 $145.85
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 implant..... 0021 10.49 $508.63 $236.51 $101.73
20680 T Removal of support implant..... 0022 12.49 $605.60 $292.94 $121.12
20690 T Apply bone fixation device..... 0050 21.13 $1,024.53 $513.86 $204.91
20692 T Apply bone fixation device..... 0050 21.13 $1,024.53 $513.86 $204.91
20693 T Adjust bone fixation device.... 0049 15.04 $729.25 $356.95 $145.85
20694 T Remove bone fixation device.... 0049 15.04 $729.25 $356.95 $145.85
20802 C Replantation, arm, complete.... .............. .............. .............. .............. ..............
20805 C Replant, forearm, complete..... .............. .............. .............. .............. ..............
20808 C Replantation hand, complete.... .............. .............. .............. .............. ..............
20816 C Replantation digit, complete... .............. .............. .............. .............. ..............
20822 C Replantation digit, complete... .............. .............. .............. .............. ..............
20824 C Replantation thumb, complete... .............. .............. .............. .............. ..............
20827 C Replantation thumb, complete... .............. .............. .............. .............. ..............
20838 C Replantation foot, complete.... .............. .............. .............. .............. ..............
20900 T Removal of bone for graft...... 0050 21.13 $1,024.53 $513.86 $204.91
20902 T Removal of bone for graft...... 0050 21.13 $1,024.53 $513.86 $204.91
20910 T Remove cartilage for graft..... 0026 12.11 $587.18 $277.92 $117.44
20912 T Remove cartilage for graft..... 0026 12.11 $587.18 $277.92 $117.44
20920 T Removal of fascia for graft.... 0026 12.11 $587.18 $277.92 $117.44
20922 T Removal of fascia for graft.... 0026 12.11 $587.18 $277.92 $117.44
20924 T Removal of tendon for graft.... 0050 21.13 $1,024.53 $513.86 $204.91
20926 T Removal of tissue for graft.... 0026 12.11 $587.18 $277.92 $117.44
20930 C Spinal bone allograft.......... .............. .............. .............. .............. ..............
20931 C Spinal bone allograft.......... .............. .............. .............. .............. ..............
20936 C Spinal bone autograft.......... .............. .............. .............. .............. ..............
20937 C Spinal bone autograft.......... .............. .............. .............. .............. ..............
20938 C Spinal bone autograft.......... .............. .............. .............. .............. ..............
20950 T Fluid pressure, muscle......... 0008 6.15 $298.20 $113.67 $59.64
20955 C Fibula bone graft, microvasc... .............. .............. .............. .............. ..............
20956 C Iliac bone graft, microvasc.... .............. .............. .............. .............. ..............
20957 C Mt bone graft, microvasc....... .............. .............. .............. .............. ..............
20962 C Other bone graft, microvasc.... .............. .............. .............. .............. ..............
20969 C Bone/skin graft, microvasc..... .............. .............. .............. .............. ..............
20970 C Bone/skin graft, iliac crest... .............. .............. .............. .............. ..............
20972 C Bone/skin graft, metatarsal.... .............. .............. .............. .............. ..............
20973 C Bone/skin graft, great toe..... .............. .............. .............. .............. ..............
20974 A Electrical bone stimulation.... .............. .............. .............. .............. ..............
20975 T Electrical bone stimulation.... 0049 15.04 $729.25 $356.95 $145.85
20979 T Us bone stimulation............ 0049 15.04 $729.25 $356.95 $145.85
20999 N Musculoskeletal surgery........ .............. .............. .............. .............. ..............
[[Page 18567]]
21010 T Incision of jaw joint.......... 0254 12.45 $603.66 $272.41 $120.73
21015 T Resection of facial tumor...... 0254 12.45 $603.66 $272.41 $120.73
21025 T Excision of bone, lower jaw.... 0256 25.40 $1,231.57 $623.05 $246.31
21026 T Excision of facial bone(s)..... 0256 25.40 $1,231.57 $623.05 $246.31
21029 T Contour of face bone lesion.... 0256 25.40 $1,231.57 $623.05 $246.31
21030 T Removal of face bone lesion.... 0254 12.45 $603.66 $272.41 $120.73
21031 T Remove exostosis, mandible..... 0253 12.02 $582.81 $284.00 $116.56
21032 T Remove exostosis, maxilla...... 0253 12.02 $582.81 $284.00 $116.56
21034 T Removal of face bone lesion.... 0256 25.40 $1,231.57 $623.05 $246.31
21040 T Removal of jaw bone lesion..... 0253 12.02 $582.81 $284.00 $116.56
21041 T Removal of jaw bone lesion..... 0256 25.40 $1,231.57 $623.05 $246.31
21044 T Removal of jaw bone lesion..... 0256 25.40 $1,231.57 $623.05 $246.31
21045 C Extensive jaw surgery.......... .............. .............. .............. .............. ..............
21050 T Removal of jaw joint........... 0256 25.40 $1,231.57 $623.05 $246.31
21060 T Remove jaw joint cartilage..... 0256 25.40 $1,231.57 $623.05 $246.31
21070 T Remove coronoid process........ 0256 25.40 $1,231.57 $623.05 $246.31
21076 T Prepare face/oral prosthesis... 0254 12.45 $603.66 $272.41 $120.73
21077 T Prepare face/oral prosthesis... 0256 25.40 $1,231.57 $623.05 $246.31
21079 T Prepare face/oral prosthesis... 0256 25.40 $1,231.57 $623.05 $246.31
21080 T Prepare face/oral prosthesis... 0256 25.40 $1,231.57 $623.05 $246.31
21081 T Prepare face/oral prosthesis... 0256 25.40 $1,231.57 $623.05 $246.31
21082 T Prepare face/oral prosthesis... 0256 25.40 $1,231.57 $623.05 $246.31
21083 T Prepare face/oral prosthesis... 0256 25.40 $1,231.57 $623.05 $246.31
21084 T Prepare face/oral prosthesis... 0256 25.40 $1,231.57 $623.05 $246.31
21085 T Prepare face/oral prosthesis... 0253 12.02 $582.81 $284.00 $116.56
21086 T Prepare face/oral prosthesis... 0256 25.40 $1,231.57 $623.05 $246.31
21087 T Prepare face/oral prosthesis... 0256 25.40 $1,231.57 $623.05 $246.31
21088 T Prepare face/oral prosthesis... 0256 25.40 $1,231.57 $623.05 $246.31
21089 T Prepare face/oral prosthesis... 0253 12.02 $582.81 $284.00 $116.56
21100 T Maxillofacial fixation......... 0256 25.40 $1,231.57 $623.05 $246.31
21110 T Interdental fixation........... 0254 12.45 $603.66 $272.41 $120.73
21116 N Injection, jaw joint x-ray..... .............. .............. .............. .............. ..............
21120 T Reconstruction of chin......... 0254 12.45 $603.66 $272.41 $120.73
21121 T Reconstruction of chin......... 0254 12.45 $603.66 $272.41 $120.73
21122 T Reconstruction of chin......... 0254 12.45 $603.66 $272.41 $120.73
21123 T Reconstruction of chin......... 0254 12.45 $603.66 $272.41 $120.73
21125 T Augmentation, lower jaw bone... 0254 12.45 $603.66 $272.41 $120.73
21127 T Augmentation, lower jaw bone... 0256 25.40 $1,231.57 $623.05 $246.31
21137 T Reduction of forehead.......... 0254 12.45 $603.66 $272.41 $120.73
21138 T Reduction of forehead.......... 0256 25.40 $1,231.57 $623.05 $246.31
21139 T Reduction of forehead.......... 0256 25.40 $1,231.57 $623.05 $246.31
21141 C Reconstruct midface, lefort.... .............. .............. .............. .............. ..............
21142 C Reconstruct midface, lefort.... .............. .............. .............. .............. ..............
21143 C Reconstruct midface, lefort.... .............. .............. .............. .............. ..............
21145 C Reconstruct midface, lefort.... .............. .............. .............. .............. ..............
21146 C Reconstruct midface, lefort.... .............. .............. .............. .............. ..............
21147 C Reconstruct midface, lefort.... .............. .............. .............. .............. ..............
21150 C Reconstruct midface, lefort.... .............. .............. .............. .............. ..............
21151 C Reconstruct midface, lefort.... .............. .............. .............. .............. ..............
21154 C Reconstruct midface, lefort.... .............. .............. .............. .............. ..............
21155 C Reconstruct midface, lefort.... .............. .............. .............. .............. ..............
21159 C Reconstruct midface, lefort.... .............. .............. .............. .............. ..............
21160 C Reconstruct midface, lefort.... .............. .............. .............. .............. ..............
21172 C Reconstruct orbit/forehead..... .............. .............. .............. .............. ..............
21175 C Reconstruct orbit/forehead..... .............. .............. .............. .............. ..............
21179 C Reconstruct entire forehead.... .............. .............. .............. .............. ..............
21180 C Reconstruct entire forehead.... .............. .............. .............. .............. ..............
21181 T Contour cranial bone lesion.... 0254 12.45 $603.66 $272.41 $120.73
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 T Reconstruct lower jaw bone..... 0256 25.40 $1,231.57 $623.05 $246.31
21206 T Reconstruct upper jaw bone..... 0256 25.40 $1,231.57 $623.05 $246.31
21208 T Augmentation of facial bones... 0256 25.40 $1,231.57 $623.05 $246.31
21209 T Reduction of facial bones...... 0256 25.40 $1,231.57 $623.05 $246.31
21210 T Face bone graft................ 0256 25.40 $1,231.57 $623.05 $246.31
21215 T Lower jaw bone graft........... 0256 25.40 $1,231.57 $623.05 $246.31
21230 T Rib cartilage graft............ 0256 25.40 $1,231.57 $623.05 $246.31
[[Page 18568]]
21235 T Ear cartilage graft............ 0254 12.45 $603.66 $272.41 $120.73
21240 T Reconstruction of jaw joint.... 0256 25.40 $1,231.57 $623.05 $246.31
21242 T Reconstruction of jaw joint.... 0256 25.40 $1,231.57 $623.05 $246.31
21243 T Reconstruction of jaw joint.... 0256 25.40 $1,231.57 $623.05 $246.31
21244 T Reconstruction of lower jaw.... 0256 25.40 $1,231.57 $623.05 $246.31
21245 T Reconstruction of jaw.......... 0256 25.40 $1,231.57 $623.05 $246.31
21246 T Reconstruction of jaw.......... 0256 25.40 $1,231.57 $623.05 $246.31
21247 C Reconstruct lower jaw bone..... .............. .............. .............. .............. ..............
21248 T Reconstruction of jaw.......... 0256 25.40 $1,231.57 $623.05 $246.31
21249 T Reconstruction of jaw.......... 0256 25.40 $1,231.57 $623.05 $246.31
21255 C Reconstruct lower jaw bone..... .............. .............. .............. .............. ..............
21256 C Reconstruction of orbit........ .............. .............. .............. .............. ..............
21260 T Revise eye sockets............. 0256 25.40 $1,231.57 $623.05 $246.31
21261 T Revise eye sockets............. 0256 25.40 $1,231.57 $623.05 $246.31
21263 T Revise eye sockets............. 0256 25.40 $1,231.57 $623.05 $246.31
21267 T Revise eye sockets............. 0256 25.40 $1,231.57 $623.05 $246.31
21268 C Revise eye sockets............. .............. .............. .............. .............. ..............
21270 T Augmentation, cheek bone....... 0256 25.40 $1,231.57 $623.05 $246.31
21275 T Revision, orbitofacial bones... 0256 25.40 $1,231.57 $623.05 $246.31
21280 T Revision of eyelid............. 0256 25.40 $1,231.57 $623.05 $246.31
21282 T Revision of eyelid............. 0253 12.02 $582.81 $284.00 $116.56
21295 T Revision of jaw muscle/bone.... 0253 12.02 $582.81 $284.00 $116.56
21296 T Revision of jaw muscle/bone.... 0254 12.45 $603.66 $272.41 $120.73
21299 T Cranio/maxillofacial surgery... 0253 12.02 $582.81 $284.00 $116.56
21300 T Treatment of skull fracture.... 0253 12.02 $582.81 $284.00 $116.56
21310 T Treatment of nose fracture..... 0253 12.02 $582.81 $284.00 $116.56
21315 T Treatment of nose fracture..... 0253 12.02 $582.81 $284.00 $116.56
21320 T Treatment of nose fracture..... 0253 12.02 $582.81 $284.00 $116.56
21325 T Treatment of nose fracture..... 0253 12.02 $582.81 $284.00 $116.56
21330 T Treatment of nose fracture..... 0254 12.45 $603.66 $272.41 $120.73
21335 T Treatment of nose fracture..... 0254 12.45 $603.66 $272.41 $120.73
21336 T Treat nasal septal fracture.... 0046 22.29 $1,080.78 $535.76 $216.16
21337 T Treat nasal septal fracture.... 0253 12.02 $582.81 $284.00 $116.56
21338 T Treat nasoethmoid fracture..... 0254 12.45 $603.66 $272.41 $120.73
21339 T Treat nasoethmoid fracture..... 0254 12.45 $603.66 $272.41 $120.73
21340 T Treatment of nose fracture..... 0256 25.40 $1,231.57 $623.05 $246.31
21343 C Treatment of sinus fracture.... .............. .............. .............. .............. ..............
21344 C Treatment of sinus fracture.... .............. .............. .............. .............. ..............
21345 T Treat nose/jaw fracture........ 0254 12.45 $603.66 $272.41 $120.73
21346 C Treat nose/jaw fracture........ .............. .............. .............. .............. ..............
21347 C Treat nose/jaw fracture........ .............. .............. .............. .............. ..............
21348 C Treat nose/jaw fracture........ .............. .............. .............. .............. ..............
21355 T Treat cheek bone fracture...... 0256 25.40 $1,231.57 $623.05 $246.31
21356 C Treat cheek bone fracture...... .............. .............. .............. .............. ..............
21360 C Treat cheek bone fracture...... .............. .............. .............. .............. ..............
21365 C Treat cheek bone fracture...... .............. .............. .............. .............. ..............
21366 C Treat cheek bone fracture...... .............. .............. .............. .............. ..............
21385 C Treat eye socket fracture...... .............. .............. .............. .............. ..............
21386 C Treat eye socket fracture...... .............. .............. .............. .............. ..............
21387 C Treat eye socket fracture...... .............. .............. .............. .............. ..............
21390 C Treat eye socket fracture...... .............. .............. .............. .............. ..............
21395 C Treat eye socket fracture...... .............. .............. .............. .............. ..............
21400 T Treat eye socket fracture...... 0252 5.18 $251.16 $114.24 $50.23
21401 T Treat eye socket fracture...... 0253 12.02 $582.81 $284.00 $116.56
21406 T Treat eye socket fracture...... 0256 25.40 $1,231.57 $623.05 $246.31
21407 T Treat eye socket fracture...... 0256 25.40 $1,231.57 $623.05 $246.31
21408 C Treat eye socket fracture...... .............. .............. .............. .............. ..............
21421 T Treat mouth roof fracture...... 0254 12.45 $603.66 $272.41 $120.73
21422 C Treat mouth roof fracture...... .............. .............. .............. .............. ..............
21423 C Treat mouth roof fracture...... .............. .............. .............. .............. ..............
21431 C Treat craniofacial fracture.... .............. .............. .............. .............. ..............
21432 C Treat craniofacial fracture.... .............. .............. .............. .............. ..............
21433 C Treat craniofacial fracture.... .............. .............. .............. .............. ..............
21435 C Treat craniofacial fracture.... .............. .............. .............. .............. ..............
21436 C Treat craniofacial fracture.... .............. .............. .............. .............. ..............
21440 T Treat dental ridge fracture.... 0253 12.02 $582.81 $284.00 $116.56
21445 T Treat dental ridge fracture.... 0254 12.45 $603.66 $272.41 $120.73
21450 T Treat lower jaw fracture....... 0251 1.68 $81.46 $27.99 $16.29
21451 T Treat lower jaw fracture....... 0254 12.45 $603.66 $272.41 $120.73
21452 T Treat lower jaw fracture....... 0253 12.02 $582.81 $284.00 $116.56
21453 T Treat lower jaw fracture....... 0256 25.40 $1,231.57 $623.05 $246.31
21454 T Treat lower jaw fracture....... 0254 12.45 $603.66 $272.41 $120.73
21461 T Treat lower jaw fracture....... 0256 25.40 $1,231.57 $623.05 $246.31
[[Page 18569]]
21462 T Treat lower jaw fracture....... 0256 25.40 $1,231.57 $623.05 $246.31
21465 T Treat lower jaw fracture....... 0256 25.40 $1,231.57 $623.05 $246.31
21470 T Treat lower jaw fracture....... 0256 25.40 $1,231.57 $623.05 $246.31
21480 T Reset dislocated jaw........... 0251 1.68 $81.46 $27.99 $16.29
21485 T Reset dislocated jaw........... 0253 12.02 $582.81 $284.00 $116.56
21490 T Repair dislocated jaw.......... 0256 25.40 $1,231.57 $623.05 $246.31
21493 T Treat hyoid bone fracture...... 0252 5.18 $251.16 $114.24 $50.23
21494 T Treat hyoid bone fracture...... 0252 5.18 $251.16 $114.24 $50.23
21495 C Treat hyoid bone fracture...... .............. .............. .............. .............. ..............
21497 T Interdental wiring............. 0253 12.02 $582.81 $284.00 $116.56
21499 T Head surgery procedure......... 0253 12.02 $582.81 $284.00 $116.56
21501 T Drain neck/chest lesion........ 0008 6.15 $298.20 $113.67 $59.64
21502 T Drain chest lesion............. 0050 21.13 $1,024.53 $513.86 $204.91
21510 C Drainage of bone lesion........ .............. .............. .............. .............. ..............
21550 T Biopsy of neck/chest........... 0019 4.00 $193.95 $78.91 $38.79
21555 T Remove lesion, neck/chest...... 0022 12.49 $605.60 $292.94 $121.12
21556 T Remove lesion, neck/chest...... 0022 12.49 $605.60 $292.94 $121.12
21557 C Remove tumor, neck/chest....... .............. .............. .............. .............. ..............
21600 T Partial removal of rib......... 0050 21.13 $1,024.53 $513.86 $204.91
21610 T Partial removal of rib......... 0050 21.13 $1,024.53 $513.86 $204.91
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........ 0008 6.15 $298.20 $113.67 $59.64
21705 C Revision of neck muscle/rib.... .............. .............. .............. .............. ..............
21720 T Revision of neck muscle........ 0008 6.15 $298.20 $113.67 $59.64
21725 T Revision of neck muscle........ 0008 6.15 $298.20 $113.67 $59.64
21740 C Reconstruction of sternum...... .............. .............. .............. .............. ..............
21750 C Repair of sternum separation... .............. .............. .............. .............. ..............
21800 T Treatment of rib fracture...... 0043 1.64 $79.52 $25.46 $15.90
21805 T Treatment of rib fracture...... 0046 22.29 $1,080.78 $535.76 $216.16
21810 C Treatment of rib fracture(s)... .............. .............. .............. .............. ..............
21820 T Treat sternum fracture......... 0043 1.64 $79.52 $25.46 $15.90
21825 C Treat sternum fracture......... .............. .............. .............. .............. ..............
21899 T Neck/chest surgery procedure... 0252 5.18 $251.16 $114.24 $50.23
21920 T Biopsy soft tissue of back..... 0020 6.51 $315.65 $130.53 $63.13
21925 T Biopsy soft tissue of back..... 0022 12.49 $605.60 $292.94 $121.12
21930 T Remove lesion, back or flank... 0022 12.49 $605.60 $292.94 $121.12
1935 T Remove tumor, back............. 0022 12.49 $605.60 $292.94 $121.12
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 fracture... 0043 1.64 $79.52 $25.46 $15.90
22310 T Treat spine fracture........... 0043 1.64 $79.52 $25.46 $15.90
22315 T Treat spine fracture........... 0043 1.64 $79.52 $25.46 $15.90
22318 C Treat odontoid fx w/o graft.... .............. .............. .............. .............. ..............
22319 C Treat odontoid fx w/graft...... .............. .............. .............. .............. ..............
22325 C Treat spine fracture........... .............. .............. .............. .............. ..............
22326 C Treat neck spine fracture...... .............. .............. .............. .............. ..............
22327 C Treat thorax spine fracture.... .............. .............. .............. .............. ..............
22328 C Treat each add spine fx........ .............. .............. .............. .............. ..............
22505 T Manipulation of spine.......... 0045 11.02 $534.33 $277.12 $106.87
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....... .............. .............. .............. .............. ..............
[[Page 18570]]
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 or more.......... .............. .............. .............. .............. ..............
22830 C Exploration of spinal fusion... .............. .............. .............. .............. ..............
22840 C Insert spine fixation device... .............. .............. .............. .............. ..............
22841 C Insert spine fixation device... .............. .............. .............. .............. ..............
22842 C Insert spine fixation device... .............. .............. .............. .............. ..............
22843 C Insert spine fixation device... .............. .............. .............. .............. ..............
22844 C Insert spine fixation device... .............. .............. .............. .............. ..............
22845 C Insert spine fixation device... .............. .............. .............. .............. ..............
22846 C Insert spine fixation device... .............. .............. .............. .............. ..............
22847 C Insert spine fixation device... .............. .............. .............. .............. ..............
22848 C Insert pelv fixation device.... .............. .............. .............. .............. ..............
22849 C Reinsert spinal fixation....... .............. .............. .............. .............. ..............
22850 C Remove spine fixation device... .............. .............. .............. .............. ..............
22851 C Apply spine prosth device...... .............. .............. .............. .............. ..............
22852 C Remove spine fixation device... .............. .............. .............. .............. ..............
22855 C Remove spine fixation device... .............. .............. .............. .............. ..............
22899 T Spine surgery procedure........ 0043 1.64 $79.52 $25.46 $15.90
22900 T Remove abdominal wall lesion... 0022 12.49 $605.60 $292.94 $121.12
22999 T Abdomen surgery procedure...... 0022 12.49 $605.60 $292.94 $121.12
23000 T Removal of calcium deposits.... 0021 10.49 $508.63 $236.51 $101.73
23020 T Release shoulder joint......... 0051 27.76 $1,346.00 $675.24 $269.20
23030 T Drain shoulder lesion.......... 0008 6.15 $298.20 $113.67 $59.64
23031 T Drain shoulder bursa........... 0008 6.15 $298.20 $113.67 $59.64
23035 C Drain shoulder bone lesion..... .............. .............. .............. .............. ..............
23040 T Exploratory shoulder surgery... 0050 21.13 $1,024.53 $513.86 $204.91
23044 T Exploratory shoulder surgery... 0050 21.13 $1,024.53 $513.86 $204.91
23065 T Biopsy shoulder tissues........ 0021 10.49 $508.63 $236.51 $101.73
23066 T Biopsy shoulder tissues........ 0022 12.49 $605.60 $292.94 $121.12
23075 T Removal of shoulder lesion..... 0021 10.49 $508.63 $236.51 $101.73
23076 T Removal of shoulder lesion..... 0022 12.49 $605.60 $292.94 $121.12
23077 T Remove tumor of shoulder....... 0022 12.49 $605.60 $292.94 $121.12
23100 T Biopsy of shoulder joint....... 0049 15.04 $729.25 $356.95 $145.85
23101 T Shoulder joint surgery......... 0050 21.13 $1,024.53 $513.86 $204.91
23105 T Remove shoulder joint lining... 0050 21.13 $1,024.53 $513.86 $204.91
23106 T Incision of collarbone joint... 0050 21.13 $1,024.53 $513.86 $204.91
23107 T Explore treat shoulder joint... 0050 21.13 $1,024.53 $513.86 $204.91
23120 T Partial removal, collar bone... 0051 27.76 $1,346.00 $675.24 $269.20
23125 C Removal of collar bone......... .............. .............. .............. .............. ..............
23130 T Remove shoulder bone, part..... 0051 27.76 $1,346.00 $675.24 $269.20
23140 T Removal of bone lesion......... 0049 15.04 $729.25 $356.95 $145.85
23145 T Removal of bone lesion......... 0050 21.13 $1,024.53 $513.86 $204.91
23146 T Removal of bone lesion......... 0050 21.13 $1,024.53 $513.86 $204.91
23150 T Removal of humerus lesion...... 0050 21.13 $1,024.53 $513.86 $204.91
23155 T Removal of humerus lesion...... 0050 21.13 $1,024.53 $513.86 $204.91
23156 T Removal of humerus lesion...... 0050 21.13 $1,024.53 $513.86 $204.91
23170 T Remove collar bone lesion...... 0050 21.13 $1,024.53 $513.86 $204.91
23172 T Remove shoulder blade lesion... 0050 21.13 $1,024.53 $513.86 $204.91
23174 T Remove humerus lesion.......... 0050 21.13 $1,024.53 $513.86 $204.91
23180 T Remove collar bone lesion...... 0050 21.13 $1,024.53 $513.86 $204.91
23182 T Remove shoulder blade lesion... 0050 21.13 $1,024.53 $513.86 $204.91
23184 T Remove humerus lesion.......... 0050 21.13 $1,024.53 $513.86 $204.91
23190 T Partial removal of scapula..... 0050 21.13 $1,024.53 $513.86 $204.91
23195 C Removal of head of humerus..... .............. .............. .............. .............. ..............
23200 C Removal of collar bone......... .............. .............. .............. .............. ..............
23210 C Removal of shoulder blade...... .............. .............. .............. .............. ..............
23220 C Partial removal of humerus..... .............. .............. .............. .............. ..............
23221 C Partial removal of humerus..... .............. .............. .............. .............. ..............
23222 C Partial removal of humerus..... .............. .............. .............. .............. ..............
[[Page 18571]]
23330 T Remove shoulder foreign body... 0019 4.00 $193.95 $78.91 $38.79
23331 T Remove shoulder foreign body... 0022 12.49 $605.60 $292.94 $121.12
23332 C Remove shoulder foreign body... .............. .............. .............. .............. ..............
23350 N Injection for shoulder x-ray... .............. .............. .............. .............. ..............
23395 C Muscle transfer, shoulder/arm.. .............. .............. .............. .............. ..............
23397 C Muscle transfers............... .............. .............. .............. .............. ..............
23400 C Fixation of shoulder blade..... .............. .............. .............. .............. ..............
23405 T Incision of tendon & muscle.... 0050 21.13 $1,024.53 $513.86 $204.91
23406 T Incise tendon(s) & muscle(s)... 0050 21.13 $1,024.53 $513.86 $204.91
23410 T Repair of tendon(s)............ 0052 36.16 $1,753.29 $930.91 $350.66
23412 T Repair of tendon(s)............ 0052 36.16 $1,753.29 $930.91 $350.66
23415 T Release of shoulder ligament... 0051 27.76 $1,346.00 $675.24 $269.20
23420 T Repair of shoulder............. 0052 36.16 $1,753.29 $930.91 $350.66
23430 T Repair biceps tendon........... 0052 36.16 $1,753.29 $930.91 $350.66
23440 C Remove/transplant tendon....... .............. .............. .............. .............. ..............
23450 T Repair shoulder capsule........ 0052 36.16 $1,753.29 $930.91 $350.66
23455 T Repair shoulder capsule........ 0052 36.16 $1,753.29 $930.91 $350.66
23460 T Repair shoulder capsule........ 0052 36.16 $1,753.29 $930.91 $350.66
23462 T Repair shoulder capsule........ 0052 36.16 $1,753.29 $930.91 $350.66
23465 T Repair shoulder capsule........ 0052 36.16 $1,753.29 $930.91 $350.66
23466 T Repair shoulder capsule........ 0052 36.16 $1,753.29 $930.91 $350.66
23470 C Reconstruct shoulder joint..... .............. .............. .............. .............. ..............
23472 C Reconstruct shoulder joint..... .............. .............. .............. .............. ..............
23480 T Revision of collar bone........ 0051 27.76 $1,346.00 $675.24 $269.20
23485 T Revision of collar bone........ 0051 27.76 $1,346.00 $675.24 $269.20
23490 T Reinforce clavicle............. 0051 27.76 $1,346.00 $675.24 $269.20
23491 T Reinforce shoulder bones....... 0051 27.76 $1,346.00 $675.24 $269.20
23500 T Treat clavicle fracture........ 0043 1.64 $79.52 $25.46 $15.90
23505 T Treat clavicle fracture........ 0043 1.64 $79.52 $25.46 $15.90
23515 T Treat clavicle fracture........ 0046 22.29 $1,080.78 $535.76 $216.16
23520 T Treat clavicle dislocation..... 0043 1.64 $79.52 $25.46 $15.90
23525 T Treat clavicle dislocation..... 0043 1.64 $79.52 $25.46 $15.90
23530 T Treat clavicle dislocation..... 0046 22.29 $1,080.78 $535.76 $216.16
23532 T Treat clavicle dislocation..... 0046 22.29 $1,080.78 $535.76 $216.16
23540 T Treat clavicle dislocation..... 0043 1.64 $79.52 $25.46 $15.90
23545 T Treat clavicle dislocation..... 0043 1.64 $79.52 $25.46 $15.90
23550 T Treat clavicle dislocation..... 0046 22.29 $1,080.78 $535.76 $216.16
23552 T Treat clavicle dislocation..... 0046 22.29 $1,080.78 $535.76 $216.16
23570 T Treat shoulder blade fx........ 0043 1.64 $79.52 $25.46 $15.90
23575 T Treat shoulder blade fx........ 0043 1.64 $79.52 $25.46 $15.90
23585 T Treat scapula fracture......... 0046 22.29 $1,080.78 $535.76 $216.16
23600 T Treat humerus fracture......... 0044 2.17 $105.22 $38.08 $21.04
23605 T Treat humerus fracture......... 0044 2.17 $105.22 $38.08 $21.04
23615 T Treat humerus fracture......... 0046 22.29 $1,080.78 $535.76 $216.16
23616 T Treat humerus fracture......... 0046 22.29 $1,080.78 $535.76 $216.16
23620 T Treat humerus fracture......... 0044 2.17 $105.22 $38.08 $21.04
23625 T Treat humerus fracture......... 0044 2.17 $105.22 $38.08 $21.04
23630 T Treat humerus fracture......... 0046 22.29 $1,080.78 $535.76 $216.16
23650 T Treat shoulder dislocation..... 0043 1.64 $79.52 $25.46 $15.90
23655 T Treat shoulder dislocation..... 0045 11.02 $534.33 $277.12 $106.87
23660 T Treat shoulder dislocation..... 0046 22.29 $1,080.78 $535.76 $216.16
23665 T Treat dislocation/fracture..... 0044 2.17 $105.22 $38.08 $21.04
23670 T Treat dislocation/fracture..... 0046 22.29 $1,080.78 $535.76 $216.16
23675 T Treat dislocation/fracture..... 0044 2.17 $105.22 $38.08 $21.04
23680 T Treat dislocation/fracture..... 0046 22.29 $1,080.78 $535.76 $216.16
23700 T Fixation of shoulder........... 0045 11.02 $534.33 $277.12 $106.87
23800 T Fusion of shoulder joint....... 0051 27.76 $1,346.00 $675.24 $269.20
23802 T Fusion of shoulder joint....... 0051 27.76 $1,346.00 $675.24 $269.20
23900 C Amputation of arm & girdle..... .............. .............. .............. .............. ..............
23920 C Amputation at shoulder joint... .............. .............. .............. .............. ..............
23921 T Amputation follow-up surgery... 0026 12.11 $587.18 $277.92 $117.44
23929 T Shoulder surgery procedure..... 0043 1.64 $79.52 $25.46 $15.90
23930 T Drainage of arm lesion......... 0008 6.15 $298.20 $113.67 $59.64
23931 T Drainage of arm bursa.......... 0008 6.15 $298.20 $113.67 $59.64
23935 T Drain arm/elbow bone lesion.... 0049 15.04 $729.25 $356.95 $145.85
24000 T Exploratory elbow surgery...... 0050 21.13 $1,024.53 $513.86 $204.91
24006 T Release elbow joint............ 0050 21.13 $1,024.53 $513.86 $204.91
24065 T Biopsy arm/elbow soft tissue... 0020 6.51 $315.65 $130.53 $63.13
24066 T Biopsy arm/elbow soft tissue... 0020 6.51 $315.65 $130.53 $63.13
24075 T Remove arm/elbow lesion........ 0021 10.49 $508.63 $236.51 $101.73
24076 T Remove arm/elbow lesion........ 0022 12.49 $605.60 $292.94 $121.12
24077 T Remove tumor of arm/elbow...... 0022 12.49 $605.60 $292.94 $121.12
24100 T Biopsy elbow joint lining...... 0049 15.04 $729.25 $356.95 $145.85
[[Page 18572]]
24101 T Explore/treat elbow joint...... 0050 21.13 $1,024.53 $513.86 $204.91
24102 T Remove elbow joint lining...... 0050 21.13 $1,024.53 $513.86 $204.91
24105 T Removal of elbow bursa......... 0049 15.04 $729.25 $356.95 $145.85
24110 T Remove humerus lesion.......... 0049 15.04 $729.25 $356.95 $145.85
24115 T Remove/graft bone lesion....... 0050 21.13 $1,024.53 $513.86 $204.91
24116 T Remove/graft bone lesion....... 0050 21.13 $1,024.53 $513.86 $204.91
24120 T Remove elbow lesion............ 0049 15.04 $729.25 $356.95 $145.85
24125 T Remove/graft bone lesion....... 0050 21.13 $1,024.53 $513.86 $204.91
24126 T Remove/graft bone lesion....... 0050 21.13 $1,024.53 $513.86 $204.91
24130 T Removal of head of radius...... 0050 21.13 $1,024.53 $513.86 $204.91
24134 T Removal of arm bone lesion..... 0050 21.13 $1,024.53 $513.86 $204.91
24136 T Remove radius bone lesion...... 0050 21.13 $1,024.53 $513.86 $204.91
24138 T Remove elbow bone lesion....... 0050 21.13 $1,024.53 $513.86 $204.91
24140 T Partial removal of arm bone.... 0050 21.13 $1,024.53 $513.86 $204.91
24145 T Partial removal of radius...... 0050 21.13 $1,024.53 $513.86 $204.91
24147 T Partial removal of elbow....... 0050 21.13 $1,024.53 $513.86 $204.91
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......... 0051 27.76 $1,346.00 $675.24 $269.20
24160 T Remove elbow joint implant..... 0050 21.13 $1,024.53 $513.86 $204.91
24164 T Remove radius head implant..... 0050 21.13 $1,024.53 $513.86 $204.91
24200 T Removal of arm foreign body.... 0019 4.00 $193.95 $78.91 $38.79
24201 T Removal of arm foreign body.... 0021 10.49 $508.63 $236.51 $101.73
24220 N Injection for elbow x-ray...... .............. .............. .............. .............. ..............
24301 T Muscle/tendon transfer......... 0050 21.13 $1,024.53 $513.86 $204.91
24305 T Arm tendon lengthening......... 0050 21.13 $1,024.53 $513.86 $204.91
24310 T Revision of arm tendon......... 0049 15.04 $729.25 $356.95 $145.85
24320 T Repair of arm tendon........... 0051 27.76 $1,346.00 $675.24 $269.20
24330 T Revision of arm muscles........ 0051 27.76 $1,346.00 $675.24 $269.20
24331 T Revision of arm muscles........ 0051 27.76 $1,346.00 $675.24 $269.20
24340 T Repair of biceps tendon........ 0051 27.76 $1,346.00 $675.24 $269.20
24341 T Repair arm tendon/muscle....... 0051 27.76 $1,346.00 $675.24 $269.20
24342 T Repair of ruptured tendon...... 0051 27.76 $1,346.00 $675.24 $269.20
24350 T Repair of tennis elbow......... 0050 21.13 $1,024.53 $513.86 $204.91
24351 T Repair of tennis elbow......... 0050 21.13 $1,024.53 $513.86 $204.91
24352 T Repair of tennis elbow......... 0050 21.13 $1,024.53 $513.86 $204.91
24354 T Repair of tennis elbow......... 0050 21.13 $1,024.53 $513.86 $204.91
24356 T Revision of tennis elbow....... 0050 21.13 $1,024.53 $513.86 $204.91
24360 T Reconstruct elbow joint........ 0047 22.09 $1,071.08 $537.03 $214.22
24361 T Reconstruct elbow joint........ 0048 29.06 $1,409.03 $725.94 $281.81
24362 T Reconstruct elbow joint........ 0048 29.06 $1,409.03 $725.94 $281.81
24363 T Replace elbow joint............ 0048 29.06 $1,409.03 $725.94 $281.81
24365 T Reconstruct head of radius..... 0047 22.09 $1,071.08 $537.03 $214.22
24366 T Reconstruct head of radius..... 0048 29.06 $1,409.03 $725.94 $281.81
24400 T Revision of humerus............ 0050 21.13 $1,024.53 $513.86 $204.91
24410 T Revision of humerus............ 0050 21.13 $1,024.53 $513.86 $204.91
24420 T Revision of humerus............ 0051 27.76 $1,346.00 $675.24 $269.20
24430 T Repair of humerus.............. 0051 27.76 $1,346.00 $675.24 $269.20
24435 T Repair humerus with graft...... 0051 27.76 $1,346.00 $675.24 $269.20
24470 T Revision of elbow joint........ 0051 27.76 $1,346.00 $675.24 $269.20
24495 T Decompression of forearm....... 0050 21.13 $1,024.53 $513.86 $204.91
24498 T Reinforce humerus.............. 0051 27.76 $1,346.00 $675.24 $269.20
24500 T Treat humerus fracture......... 0044 2.17 $105.22 $38.08 $21.04
24505 T Treat humerus fracture......... 0044 2.17 $105.22 $38.08 $21.04
24515 T Treat humerus fracture......... 0046 22.29 $1,080.78 $535.76 $216.16
24516 T Treat humerus fracture......... 0046 22.29 $1,080.78 $535.76 $216.16
24530 T Treat humerus fracture......... 0044 2.17 $105.22 $38.08 $21.04
24535 T Treat humerus fracture......... 0044 2.17 $105.22 $38.08 $21.04
24538 T Treat humerus fracture......... 0046 22.29 $1,080.78 $535.76 $216.16
24545 T Treat humerus fracture......... 0046 22.29 $1,080.78 $535.76 $216.16
24546 T Treat humerus fracture......... 0046 22.29 $1,080.78 $535.76 $216.16
24560 T Treat humerus fracture......... 0044 2.17 $105.22 $38.08 $21.04
24565 T Treat humerus fracture......... 0044 2.17 $105.22 $38.08 $21.04
24566 T Treat humerus fracture......... 0046 22.29 $1,080.78 $535.76 $216.16
24575 T Treat humerus fracture......... 0046 22.29 $1,080.78 $535.76 $216.16
24576 T Treat humerus fracture......... 0044 2.17 $105.22 $38.08 $21.04
24577 T Treat humerus fracture......... 0044 2.17 $105.22 $38.08 $21.04
24579 T Treat humerus fracture......... 0046 22.29 $1,080.78 $535.76 $216.16
24582 T Treat humerus fracture......... 0046 22.29 $1,080.78 $535.76 $216.16
24586 T Treat elbow fracture........... 0046 22.29 $1,080.78 $535.76 $216.16
[[Page 18573]]
24587 T Treat elbow fracture........... 0046 22.29 $1,080.78 $535.76 $216.16
24600 T Treat elbow dislocation........ 0044 2.17 $105.22 $38.08 $21.04
24605 T Treat elbow dislocation........ 0045 11.02 $534.33 $277.12 $106.87
24615 T Treat elbow dislocation........ 0046 22.29 $1,080.78 $535.76 $216.16
24620 T Treat elbow fracture........... 0044 2.17 $105.22 $38.08 $21.04
24635 T Treat elbow fracture........... 0046 22.29 $1,080.78 $535.76 $216.16
24640 T Treat elbow dislocation........ 0044 2.17 $105.22 $38.08 $21.04
24650 T Treat radius fracture.......... 0044 2.17 $105.22 $38.08 $21.04
24655 T Treat radius fracture.......... 0044 2.17 $105.22 $38.08 $21.04
24665 T Treat radius fracture.......... 0046 22.29 $1,080.78 $535.76 $216.16
24666 T Treat radius fracture.......... 0046 22.29 $1,080.78 $535.76 $216.16
24670 T Treat ulnar fracture........... 0044 2.17 $105.22 $38.08 $21.04
24675 T Treat ulnar fracture........... 0044 2.17 $105.22 $38.08 $21.04
24685 T Treat ulnar fracture........... 0046 22.29 $1,080.78 $535.76 $216.16
24800 T Fusion of elbow joint.......... 0051 27.76 $1,346.00 $675.24 $269.20
24802 T Fusion/graft of elbow joint.... 0051 27.76 $1,346.00 $675.24 $269.20
24900 C Amputation of upper arm........ .............. .............. .............. .............. ..............
24920 C Amputation of upper arm........ .............. .............. .............. .............. ..............
24925 T Amputation follow-up surgery... 0049 15.04 $729.25 $356.95 $145.85
24930 C Amputation follow-up surgery... .............. .............. .............. .............. ..............
24931 C Amputate upper arm & implant... .............. .............. .............. .............. ..............
24935 T Revision of amputation......... 0052 36.16 $1,753.29 $930.91 $350.66
24940 C Revision of upper arm.......... .............. .............. .............. .............. ..............
24999 T Upper arm/elbow surgery........ 0044 2.17 $105.22 $38.08 $21.04
25000 T Incision of tendon sheath...... 0049 15.04 $729.25 $356.95 $145.85
25020 T Decompression of forearm....... 0049 15.04 $729.25 $356.95 $145.85
25023 T Decompression of forearm....... 0050 21.13 $1,024.53 $513.86 $204.91
25028 T Drainage of forearm lesion..... 0049 15.04 $729.25 $356.95 $145.85
25031 T Drainage of forearm bursa...... 0049 15.04 $729.25 $356.95 $145.85
25035 T Treat forearm bone lesion...... 0049 15.04 $729.25 $356.95 $145.85
25040 T Explore/treat wrist joint...... 0050 21.13 $1,024.53 $513.86 $204.91
25065 T Biopsy forearm soft tissues.... 0020 6.51 $315.65 $130.53 $63.13
25066 T Biopsy forearm soft tissues.... 0022 12.49 $605.60 $292.94 $121.12
25075 T Removal of forearm lesion...... 0020 6.51 $315.65 $130.53 $63.13
25076 T Removal of forearm lesion...... 0022 12.49 $605.60 $292.94 $121.12
25077 T Remove tumor, forearm/wrist.... 0022 12.49 $605.60 $292.94 $121.12
25085 T Incision of wrist capsule...... 0049 15.04 $729.25 $356.95 $145.85
25100 T Biopsy of wrist joint.......... 0049 15.04 $729.25 $356.95 $145.85
25101 T Explore/treat wrist joint...... 0050 21.13 $1,024.53 $513.86 $204.91
25105 T Remove wrist joint lining...... 0050 21.13 $1,024.53 $513.86 $204.91
25107 T Remove wrist joint cartilage... 0050 21.13 $1,024.53 $513.86 $204.91
25110 T Remove wrist tendon lesion..... 0049 15.04 $729.25 $356.95 $145.85
25111 T Remove wrist tendon lesion..... 0053 11.32 $548.87 $253.49 $109.77
25112 T Reremove wrist tendon lesion... 0053 11.32 $548.87 $253.49 $109.77
25115 T Remove wrist/forearm lesion.... 0049 15.04 $729.25 $356.95 $145.85
25116 T Remove wrist/forearm lesion.... 0049 15.04 $729.25 $356.95 $145.85
25118 T Excise wrist tendon sheath..... 0050 21.13 $1,024.53 $513.86 $204.91
25119 T Partial removal of ulna........ 0050 21.13 $1,024.53 $513.86 $204.91
25120 T Removal of forearm lesion...... 0050 21.13 $1,024.53 $513.86 $204.91
25125 T Remove/graft forearm lesion.... 0050 21.13 $1,024.53 $513.86 $204.91
25126 T Remove/graft forearm lesion.... 0050 21.13 $1,024.53 $513.86 $204.91
25130 T Removal of wrist lesion........ 0050 21.13 $1,024.53 $513.86 $204.91
25135 T Remove & graft wrist lesion.... 0050 21.13 $1,024.53 $513.86 $204.91
25136 T Remove & graft wrist lesion.... 0050 21.13 $1,024.53 $513.86 $204.91
25145 T Remove forearm bone lesion..... 0050 21.13 $1,024.53 $513.86 $204.91
25150 T Partial removal of ulna........ 0050 21.13 $1,024.53 $513.86 $204.91
25151 T Partial removal of radius...... 0050 21.13 $1,024.53 $513.86 $204.91
25170 C Extensive forearm surgery...... .............. .............. .............. .............. ..............
25210 T Removal of wrist bone.......... 0054 19.66 $953.26 $472.33 $190.65
25215 T Removal of wrist bones......... 0054 19.66 $953.26 $472.33 $190.65
25230 T Partial removal of radius...... 0050 21.13 $1,024.53 $513.86 $204.91
25240 T Partial removal of ulna........ 0050 21.13 $1,024.53 $513.86 $204.91
25246 N Injection for wrist x-ray...... .............. .............. .............. .............. ..............
25248 T Remove forearm foreign body.... 0049 15.04 $729.25 $356.95 $145.85
25250 T Removal of wrist prosthesis.... 0050 21.13 $1,024.53 $513.86 $204.91
25251 T Removal of wrist prosthesis.... 0050 21.13 $1,024.53 $513.86 $204.91
25260 T Repair forearm tendon/muscle... 0050 21.13 $1,024.53 $513.86 $204.91
25263 T Repair forearm tendon/muscle... 0050 21.13 $1,024.53 $513.86 $204.91
25265 T Repair forearm tendon/muscle... 0050 21.13 $1,024.53 $513.86 $204.91
25270 T Repair forearm tendon/muscle... 0050 21.13 $1,024.53 $513.86 $204.91
25272 T Repair forearm tendon/muscle... 0050 21.13 $1,024.53 $513.86 $204.91
25274 T Repair forearm tendon/muscle... 0050 21.13 $1,024.53 $513.86 $204.91
25280 T Revise wrist/forearm tendon.... 0050 21.13 $1,024.53 $513.86 $204.91
[[Page 18574]]
25290 T Incise wrist/forearm tendon.... 0050 21.13 $1,024.53 $513.86 $204.91
25295 T Release wrist/forearm tendon... 0049 15.04 $729.25 $356.95 $145.85
25300 T Fusion of tendons at wrist..... 0050 21.13 $1,024.53 $513.86 $204.91
25301 T Fusion of tendons at wrist..... 0050 21.13 $1,024.53 $513.86 $204.91
25310 T Transplant forearm tendon...... 0051 27.76 $1,346.00 $675.24 $269.20
25312 T Transplant forearm tendon...... 0051 27.76 $1,346.00 $675.24 $269.20
25315 T Revise palsy hand tendon(s).... 0051 27.76 $1,346.00 $675.24 $269.20
25316 T Revise palsy hand tendon(s).... 0051 27.76 $1,346.00 $675.24 $269.20
25320 T Repair/revise wrist joint...... 0051 27.76 $1,346.00 $675.24 $269.20
25332 T Revise wrist joint............. 0047 22.09 $1,071.08 $537.03 $214.22
25335 T Realignment of hand............ 0051 27.76 $1,346.00 $675.24 $269.20
25337 T Reconstruct ulna/radioulnar.... 0051 27.76 $1,346.00 $675.24 $269.20
25350 T Revision of radius............. 0051 27.76 $1,346.00 $675.24 $269.20
25355 T Revision of radius............. 0051 27.76 $1,346.00 $675.24 $269.20
25360 T Revision of ulna............... 0050 21.13 $1,024.53 $513.86 $204.91
25365 T Revise radius & ulna........... 0050 21.13 $1,024.53 $513.86 $204.91
25370 T Revise radius or ulna.......... 0051 27.76 $1,346.00 $675.24 $269.20
25375 T Revise radius & ulna........... 0051 27.76 $1,346.00 $675.24 $269.20
25390 C Shorten radius or ulna......... .............. .............. .............. .............. ..............
25391 C Lengthen radius or ulna........ .............. .............. .............. .............. ..............
25392 C Shorten radius & ulna.......... .............. .............. .............. .............. ..............
25393 C Lengthen radius & ulna......... .............. .............. .............. .............. ..............
25400 T Repair radius or ulna.......... 0050 21.13 $1,024.53 $513.86 $204.91
25405 C Repair/graft radius or ulna.... .............. .............. .............. .............. ..............
25415 T Repair radius & ulna........... 0050 21.13 $1,024.53 $513.86 $204.91
25420 C Repair/graft radius & ulna..... .............. .............. .............. .............. ..............
25425 T Repair/graft radius or ulna.... 0051 27.76 $1,346.00 $675.24 $269.20
25426 T Repair/graft radius & ulna..... 0051 27.76 $1,346.00 $675.24 $269.20
25440 T Repair/graft wrist bone........ 0051 27.76 $1,346.00 $675.24 $269.20
25441 T Reconstruct wrist joint........ 0048 29.06 $1,409.03 $725.94 $281.81
25442 T Reconstruct wrist joint........ 0048 29.06 $1,409.03 $725.94 $281.81
25443 T Reconstruct wrist joint........ 0048 29.06 $1,409.03 $725.94 $281.81
25444 T Reconstruct wrist joint........ 0048 29.06 $1,409.03 $725.94 $281.81
25445 T Reconstruct wrist joint........ 0048 29.06 $1,409.03 $725.94 $281.81
25446 T Wrist replacement.............. 0048 29.06 $1,409.03 $725.94 $281.81
25447 T Repair wrist joint(s).......... 0047 22.09 $1,071.08 $537.03 $214.22
25449 T Remove wrist joint implant..... 0047 22.09 $1,071.08 $537.03 $214.22
25450 T Revision of wrist joint........ 0051 27.76 $1,346.00 $675.24 $269.20
25455 T Revision of wrist joint........ 0051 27.76 $1,346.00 $675.24 $269.20
25490 T Reinforce radius............... 0051 27.76 $1,346.00 $675.24 $269.20
25491 T Reinforce ulna................. 0051 27.76 $1,346.00 $675.24 $269.20
25492 T Reinforce radius and ulna...... 0051 27.76 $1,346.00 $675.24 $269.20
25500 T Treat fracture of radius....... 0044 2.17 $105.22 $38.08 $21.04
25505 T Treat fracture of radius....... 0044 2.17 $105.22 $38.08 $21.04
25515 T Treat fracture of radius....... 0046 22.29 $1,080.78 $535.76 $216.16
25520 T Treat fracture of radius....... 0044 2.17 $105.22 $38.08 $21.04
25525 T Treat fracture of radius....... 0046 22.29 $1,080.78 $535.76 $216.16
25526 T Treat fracture of radius....... 0046 22.29 $1,080.78 $535.76 $216.16
25530 T Treat fracture of ulna......... 0044 2.17 $105.22 $38.08 $21.04
25535 T Treat fracture of ulna......... 0044 2.17 $105.22 $38.08 $21.04
25545 T Treat fracture of ulna......... 0046 22.29 $1,080.78 $535.76 $216.16
25560 T Treat fracture radius & ulna... 0044 2.17 $105.22 $38.08 $21.04
25565 T Treat fracture radius & ulna... 0044 2.17 $105.22 $38.08 $21.04
25574 T Treat fracture radius & ulna... 0046 22.29 $1,080.78 $535.76 $216.16
25575 T Treat fracture radius/ulna..... 0046 22.29 $1,080.78 $535.76 $216.16
25600 T Treat fracture radius/ulna..... 0044 2.17 $105.22 $38.08 $21.04
25605 T Treat fracture radius/ulna..... 0044 2.17 $105.22 $38.08 $21.04
25611 T Treat fracture radius/ulna..... 0046 22.29 $1,080.78 $535.76 $216.16
25620 T Treat fracture radius/ulna..... 0046 22.29 $1,080.78 $535.76 $216.16
25622 T Treat wrist bone fracture...... 0044 2.17 $105.22 $38.08 $21.04
25624 T Treat wrist bone fracture...... 0044 2.17 $105.22 $38.08 $21.04
25628 T Treat wrist bone fracture...... 0046 22.29 $1,080.78 $535.76 $216.16
25630 T Treat wrist bone fracture...... 0044 2.17 $105.22 $38.08 $21.04
25635 T Treat wrist bone fracture...... 0044 2.17 $105.22 $38.08 $21.04
25645 T Treat wrist bone fracture...... 0046 22.29 $1,080.78 $535.76 $216.16
25650 T Treat wrist bone fracture...... 0044 2.17 $105.22 $38.08 $21.04
25660 T Treat wrist dislocation........ 0044 2.17 $105.22 $38.08 $21.04
25670 T Treat wrist dislocation........ 0046 22.29 $1,080.78 $535.76 $216.16
25675 T Treat wrist dislocation........ 0044 2.17 $105.22 $38.08 $21.04
25676 T Treat wrist dislocation........ 0046 22.29 $1,080.78 $535.76 $216.16
25680 T Treat wrist fracture........... 0044 2.17 $105.22 $38.08 $21.04
25685 T Treat wrist fracture........... 0046 22.29 $1,080.78 $535.76 $216.16
25690 T Treat wrist dislocation........ 0044 2.17 $105.22 $38.08 $21.04
[[Page 18575]]
25695 T Treat wrist dislocation........ 0046 22.29 $1,080.78 $535.76 $216.16
25800 T Fusion of wrist joint.......... 0051 27.76 $1,346.00 $675.24 $269.20
25805 T Fusion/graft of wrist joint.... 0051 27.76 $1,346.00 $675.24 $269.20
25810 T Fusion/graft of wrist joint.... 0051 27.76 $1,346.00 $675.24 $269.20
25820 T Fusion of hand bones........... 0053 11.32 $548.87 $253.49 $109.77
25825 T Fuse hand bones with graft..... 0054 19.66 $953.26 $472.33 $190.65
25830 T Fusion, radioulnar jnt/ulna.... 0051 27.76 $1,346.00 $675.24 $269.20
25900 C Amputation of forearm.......... .............. .............. .............. .............. ..............
25905 C Amputation of forearm.......... .............. .............. .............. .............. ..............
25907 T Amputation follow-up surgery... 0049 15.04 $729.25 $356.95 $145.85
25909 C Amputation follow-up surgery... .............. .............. .............. .............. ..............
25915 C Amputation of forearm.......... .............. .............. .............. .............. ..............
25920 C Amputate hand at wrist......... .............. .............. .............. .............. ..............
25922 T Amputate hand at wrist......... 0049 15.04 $729.25 $356.95 $145.85
25924 C Amputation follow-up surgery... .............. .............. .............. .............. ..............
25927 C Amputation of hand............. .............. .............. .............. .............. ..............
25929 T Amputation follow-up surgery... 0026 12.11 $587.18 $277.92 $117.44
25931 C Amputation follow-up surgery... .............. .............. .............. .............. ..............
25999 T Forearm or wrist surgery....... 0044 2.17 $105.22 $38.08 $21.04
26010 T Drainage of finger abscess..... 0006 2.00 $96.97 $33.95 $19.39
26011 T Drainage of finger abscess..... 0007 3.68 $178.43 $72.03 $35.69
26020 T Drain hand tendon sheath....... 0053 11.32 $548.87 $253.49 $109.77
26025 T Drainage of palm bursa......... 0053 11.32 $548.87 $253.49 $109.77
26030 T Drainage of palm bursa(s)...... 0053 11.32 $548.87 $253.49 $109.77
26034 T Treat hand bone lesion......... 0053 11.32 $548.87 $253.49 $109.77
26035 T Decompress fingers/hand........ 0053 11.32 $548.87 $253.49 $109.77
26037 T Decompress fingers/hand........ 0053 11.32 $548.87 $253.49 $109.77
26040 T Release palm contracture....... 0054 19.66 $953.26 $472.33 $190.65
26045 T Release palm contracture....... 0054 19.66 $953.26 $472.33 $190.65
26055 T Incise finger tendon sheath.... 0053 11.32 $548.87 $253.49 $109.77
26060 T Incision of finger tendon...... 0053 11.32 $548.87 $253.49 $109.77
26070 T Explore/treat hand joint....... 0053 11.32 $548.87 $253.49 $109.77
26075 T Explore/treat finger joint..... 0053 11.32 $548.87 $253.49 $109.77
26080 T Explore/treat finger joint..... 0053 11.32 $548.87 $253.49 $109.77
26100 T Biopsy hand joint lining....... 0053 11.32 $548.87 $253.49 $109.77
26105 T Biopsy finger joint lining..... 0053 11.32 $548.87 $253.49 $109.77
26110 T Biopsy finger joint lining..... 0053 11.32 $548.87 $253.49 $109.77
26115 T Removal of hand lesion......... 0022 12.49 $605.60 $292.94 $121.12
26116 T Removal of hand lesion......... 0022 12.49 $605.60 $292.94 $121.12
26117 T Remove tumor, hand/finger...... 0022 12.49 $605.60 $292.94 $121.12
26121 T Release palm contracture....... 0054 19.66 $953.26 $472.33 $190.65
26123 T Release palm contracture....... 0054 19.66 $953.26 $472.33 $190.65
26125 T Release palm contracture....... 0054 19.66 $953.26 $472.33 $190.65
26130 T Remove wrist joint lining...... 0053 11.32 $548.87 $253.49 $109.77
26135 T Revise finger joint, each...... 0054 19.66 $953.26 $472.33 $190.65
26140 T Revise finger joint, each...... 0053 11.32 $548.87 $253.49 $109.77
26145 T Tendon excision, palm/finger... 0053 11.32 $548.87 $253.49 $109.77
26160 T Remove tendon sheath lesion.... 0053 11.32 $548.87 $253.49 $109.77
26170 T Removal of palm tendon, each... 0053 11.32 $548.87 $253.49 $109.77
26180 T Removal of finger tendon....... 0053 11.32 $548.87 $253.49 $109.77
26185 T Remove finger bone............. 0053 11.32 $548.87 $253.49 $109.77
26200 T Remove hand bone lesion........ 0053 11.32 $548.87 $253.49 $109.77
26205 T Remove/graft bone lesion....... 0054 19.66 $953.26 $472.33 $190.65
26210 T Removal of finger lesion....... 0053 11.32 $548.87 $253.49 $109.77
26215 T Remove/graft finger lesion..... 0053 11.32 $548.87 $253.49 $109.77
26230 T Partial removal of hand bone... 0053 11.32 $548.87 $253.49 $109.77
26235 T Partial removal, finger bone... 0053 11.32 $548.87 $253.49 $109.77
26236 T Partial removal, finger bone... 0053 11.32 $548.87 $253.49 $109.77
26250 T Extensive hand surgery......... 0053 11.32 $548.87 $253.49 $109.77
26255 T Extensive hand surgery......... 0054 19.66 $953.26 $472.33 $190.65
26260 T Extensive finger surgery....... 0053 11.32 $548.87 $253.49 $109.77
26261 T Extensive finger surgery....... 0053 11.32 $548.87 $253.49 $109.77
26262 T Partial removal of finger...... 0053 11.32 $548.87 $253.49 $109.77
26320 T Removal of implant from hand... 0020 6.51 $315.65 $130.53 $63.13
26350 T Repair finger/hand tendon...... 0054 19.66 $953.26 $472.33 $190.65
26352 T Repair/graft hand tendon....... 0054 19.66 $953.26 $472.33 $190.65
26356 T Repair finger/hand tendon...... 0054 19.66 $953.26 $472.33 $190.65
26357 T Repair finger/hand tendon...... 0054 19.66 $953.26 $472.33 $190.65
26358 T Repair/graft hand tendon....... 0054 19.66 $953.26 $472.33 $190.65
26370 T Repair finger/hand tendon...... 0054 19.66 $953.26 $472.33 $190.65
26372 T Repair/graft hand tendon....... 0054 19.66 $953.26 $472.33 $190.65
26373 T Repair finger/hand tendon...... 0054 19.66 $953.26 $472.33 $190.65
26390 T Revise hand/finger tendon...... 0054 19.66 $953.26 $472.33 $190.65
[[Page 18576]]
26392 T Repair/graft hand tendon....... 0054 19.66 $953.26 $472.33 $190.65
26410 T Repair hand tendon............. 0053 11.32 $548.87 $253.49 $109.77
26412 T Repair/graft hand tendon....... 0054 19.66 $953.26 $472.33 $190.65
26415 T Excision, hand/finger tendon... 0054 19.66 $953.26 $472.33 $190.65
26416 T Graft hand or finger tendon.... 0054 19.66 $953.26 $472.33 $190.65
26418 T Repair finger tendon........... 0053 11.32 $548.87 $253.49 $109.77
26420 T Repair/graft finger tendon..... 0054 19.66 $953.26 $472.33 $190.65
26426 T Repair finger/hand tendon...... 0054 19.66 $953.26 $472.33 $190.65
26428 T Repair/graft finger tendon..... 0054 19.66 $953.26 $472.33 $190.65
26432 T Repair finger tendon........... 0053 11.32 $548.87 $253.49 $109.77
26433 T Repair finger tendon........... 0053 11.32 $548.87 $253.49 $109.77
26434 T Repair/graft finger tendon..... 0054 19.66 $953.26 $472.33 $190.65
26437 T Realignment of tendons......... 0053 11.32 $548.87 $253.49 $109.77
26440 T Release palm/finger tendon..... 0053 11.32 $548.87 $253.49 $109.77
26442 T Release palm & finger tendon... 0054 19.66 $953.26 $472.33 $190.65
26445 T Release hand/finger tendon..... 0053 11.32 $548.87 $253.49 $109.77
26449 T Release forearm/hand tendon.... 0054 19.66 $953.26 $472.33 $190.65
26450 T Incision of palm tendon........ 0053 11.32 $548.87 $253.49 $109.77
26455 T Incision of finger tendon...... 0053 11.32 $548.87 $253.49 $109.77
26460 T Incise hand/finger tendon...... 0053 11.32 $548.87 $253.49 $109.77
26471 T Fusion of finger tendons....... 0053 11.32 $548.87 $253.49 $109.77
26474 T Fusion of finger tendons....... 0053 11.32 $548.87 $253.49 $109.77
26476 T Tendon lengthening............. 0053 11.32 $548.87 $253.49 $109.77
26477 T Tendon shortening.............. 0053 11.32 $548.87 $253.49 $109.77
26478 T Lengthening of hand tendon..... 0053 11.32 $548.87 $253.49 $109.77
26479 T Shortening of hand tendon...... 0053 11.32 $548.87 $253.49 $109.77
26480 T Transplant hand tendon......... 0054 19.66 $953.26 $472.33 $190.65
26483 T Transplant/graft hand tendon... 0054 19.66 $953.26 $472.33 $190.65
26485 T Transplant palm tendon......... 0054 19.66 $953.26 $472.33 $190.65
26489 T Transplant/graft palm tendon... 0054 19.66 $953.26 $472.33 $190.65
26490 T Revise thumb tendon............ 0054 19.66 $953.26 $472.33 $190.65
26492 T Tendon transfer with graft..... 0054 19.66 $953.26 $472.33 $190.65
26494 T Hand tendon/muscle transfer.... 0054 19.66 $953.26 $472.33 $190.65
26496 T Revise thumb tendon............ 0054 19.66 $953.26 $472.33 $190.65
26497 T Finger tendon transfer......... 0054 19.66 $953.26 $472.33 $190.65
26498 T Finger tendon transfer......... 0054 19.66 $953.26 $472.33 $190.65
26499 T Revision of finger............. 0054 19.66 $953.26 $472.33 $190.65
26500 T Hand tendon reconstruction..... 0053 11.32 $548.87 $253.49 $109.77
26502 T Hand tendon reconstruction..... 0054 19.66 $953.26 $472.33 $190.65
26504 T Hand tendon reconstruction..... 0054 19.66 $953.26 $472.33 $190.65
26508 T Release thumb contracture...... 0053 11.32 $548.87 $253.49 $109.77
26510 T Thumb tendon transfer.......... 0054 19.66 $953.26 $472.33 $190.65
26516 T Fusion of knuckle joint........ 0054 19.66 $953.26 $472.33 $190.65
26517 T Fusion of knuckle joints....... 0054 19.66 $953.26 $472.33 $190.65
26518 T Fusion of knuckle joints....... 0054 19.66 $953.26 $472.33 $190.65
26520 T Release knuckle contracture.... 0053 11.32 $548.87 $253.49 $109.77
26525 T Release finger contracture..... 0053 11.32 $548.87 $253.49 $109.77
26530 T Revise knuckle joint........... 0047 22.09 $1,071.08 $537.03 $214.22
26531 T Revise knuckle with implant.... 0048 29.06 $1,409.03 $725.94 $281.81
26535 T Revise finger joint............ 0047 22.09 $1,071.08 $537.03 $214.22
26536 T Revise/implant finger joint.... 0048 29.06 $1,409.03 $725.94 $281.81
26540 T Repair hand joint.............. 0053 11.32 $548.87 $253.49 $109.77
26541 T Repair hand joint with graft... 0054 19.66 $953.26 $472.33 $190.65
26542 T Repair hand joint with graft... 0053 11.32 $548.87 $253.49 $109.77
26545 T Reconstruct finger joint....... 0054 19.66 $953.26 $472.33 $190.65
26546 T Repair nonunion hand........... 0054 19.66 $953.26 $472.33 $190.65
26548 T Reconstruct finger joint....... 0054 19.66 $953.26 $472.33 $190.65
26550 T Construct thumb replacement.... 0054 19.66 $953.26 $472.33 $190.65
26551 C Great toe-hand transfer........ .............. .............. .............. .............. ..............
26553 C Single transfer, toe-hand...... .............. .............. .............. .............. ..............
26554 C Double transfer, toe-hand...... .............. .............. .............. .............. ..............
26555 T Positional change of finger.... 0054 19.66 $953.26 $472.33 $190.65
26556 C Toe joint transfer............. .............. .............. .............. .............. ..............
26560 T Repair of web finger........... 0053 11.32 $548.87 $253.49 $109.77
26561 T Repair of web finger........... 0054 19.66 $953.26 $472.33 $190.65
26562 T Repair of web finger........... 0054 19.66 $953.26 $472.33 $190.65
26565 T Correct metacarpal flaw........ 0054 19.66 $953.26 $472.33 $190.65
26567 T Correct finger deformity....... 0054 19.66 $953.26 $472.33 $190.65
26568 T Lengthen metacarpal/finger..... 0054 19.66 $953.26 $472.33 $190.65
26580 T Repair hand deformity.......... 0054 19.66 $953.26 $472.33 $190.65
26585 T Repair finger deformity........ 0054 19.66 $953.26 $472.33 $190.65
26587 T Reconstruct extra finger....... 0053 11.32 $548.87 $253.49 $109.77
26590 T Repair finger deformity........ 0054 19.66 $953.26 $472.33 $190.65
[[Page 18577]]
26591 T Repair muscles of hand......... 0054 19.66 $953.26 $472.33 $190.65
26593 T Release muscles of hand........ 0053 11.32 $548.87 $253.49 $109.77
26596 T Excision constricting tissue... 0054 19.66 $953.26 $472.33 $190.65
26597 T Release of scar contracture.... 0054 19.66 $953.26 $472.33 $190.65
26600 T Treat metacarpal fracture...... 0044 2.17 $105.22 $38.08 $21.04
26605 T Treat metacarpal fracture...... 0044 2.17 $105.22 $38.08 $21.04
26607 T Treat metacarpal fracture...... 0044 2.17 $105.22 $38.08 $21.04
26608 T Treat metacarpal fracture...... 0046 22.29 $1,080.78 $535.76 $216.16
26615 T Treat metacarpal fracture...... 0046 22.29 $1,080.78 $535.76 $216.16
26641 T Treat thumb dislocation........ 0044 2.17 $105.22 $38.08 $21.04
26645 T Treat thumb fracture........... 0044 2.17 $105.22 $38.08 $21.04
26650 T Treat thumb fracture........... 0046 22.29 $1,080.78 $535.76 $216.16
26665 T Treat thumb fracture........... 0046 22.29 $1,080.78 $535.76 $216.16
26670 T Treat hand dislocation......... 0044 2.17 $105.22 $38.08 $21.04
26675 T Treat hand dislocation......... 0045 11.02 $534.33 $277.12 $106.87
26676 T Pin hand dislocation........... 0046 22.29 $1,080.78 $535.76 $216.16
26685 T Treat hand dislocation......... 0046 22.29 $1,080.78 $535.76 $216.16
26686 T Treat hand dislocation......... 0046 22.29 $1,080.78 $535.76 $216.16
26700 T Treat knuckle dislocation...... 0043 1.64 $79.52 $25.46 $15.90
26705 T Treat knuckle dislocation...... 0045 11.02 $534.33 $277.12 $106.87
26706 T Pin knuckle dislocation........ 0044 2.17 $105.22 $38.08 $21.04
26715 T Treat knuckle dislocation...... 0046 22.29 $1,080.78 $535.76 $216.16
26720 T Treat finger fracture, each.... 0043 1.64 $79.52 $25.46 $15.90
26725 T Treat finger fracture, each.... 0043 1.64 $79.52 $25.46 $15.90
26727 T Treat finger fracture, each.... 0046 22.29 $1,080.78 $535.76 $216.16
26735 T Treat finger fracture, each.... 0046 22.29 $1,080.78 $535.76 $216.16
26740 T Treat finger fracture, each.... 0043 1.64 $79.52 $25.46 $15.90
26742 T Treat finger fracture, each.... 0044 2.17 $105.22 $38.08 $21.04
26746 T Treat finger fracture, each.... 0046 22.29 $1,080.78 $535.76 $216.16
26750 T Treat finger fracture, each.... 0043 1.64 $79.52 $25.46 $15.90
26755 T Treat finger fracture, each.... 0043 1.64 $79.52 $25.46 $15.90
26756 T Pin finger fracture, each...... 0046 22.29 $1,080.78 $535.76 $216.16
26765 T Treat finger fracture, each.... 0046 22.29 $1,080.78 $535.76 $216.16
26770 T Treat finger dislocation....... 0043 1.64 $79.52 $25.46 $15.90
26775 T Treat finger dislocation....... 0045 11.02 $534.33 $277.12 $106.87
26776 T Pin finger dislocation......... 0046 22.29 $1,080.78 $535.76 $216.16
26785 T Treat finger dislocation....... 0046 22.29 $1,080.78 $535.76 $216.16
26820 T Thumb fusion with graft........ 0054 19.66 $953.26 $472.33 $190.65
26841 T Fusion of thumb................ 0054 19.66 $953.26 $472.33 $190.65
26842 T Thumb fusion with graft........ 0054 19.66 $953.26 $472.33 $190.65
26843 T Fusion of hand joint........... 0054 19.66 $953.26 $472.33 $190.65
26844 T Fusion/graft of hand joint..... 0054 19.66 $953.26 $472.33 $190.65
26850 T Fusion of knuckle.............. 0054 19.66 $953.26 $472.33 $190.65
26852 T Fusion of knuckle with graft... 0054 19.66 $953.26 $472.33 $190.65
26860 T Fusion of finger joint......... 0054 19.66 $953.26 $472.33 $190.65
26861 T Fusion of finger jnt, add-on... 0054 19.66 $953.26 $472.33 $190.65
26862 T Fusion/graft of finger joint... 0054 19.66 $953.26 $472.33 $190.65
26863 T Fuse/graft added joint......... 0054 19.66 $953.26 $472.33 $190.65
26910 T Amputate metacarpal bone....... 0054 19.66 $953.26 $472.33 $190.65
26951 T Amputation of finger/thumb..... 0053 11.32 $548.87 $253.49 $109.77
26952 T Amputation of finger/thumb..... 0053 11.32 $548.87 $253.49 $109.77
26989 T Hand/finger surgery............ 0043 1.64 $79.52 $25.46 $15.90
26990 T Drainage of pelvis lesion...... 0049 15.04 $729.25 $356.95 $145.85
26991 T Drainage of pelvis bursa....... 0049 15.04 $729.25 $356.95 $145.85
26992 C Drainage of bone lesion........ .............. .............. .............. .............. ..............
27000 T Incision of hip tendon......... 0049 15.04 $729.25 $356.95 $145.85
27001 T Incision of hip tendon......... 0050 21.13 $1,024.53 $513.86 $204.91
27003 T Incision of hip tendon......... 0050 21.13 $1,024.53 $513.86 $204.91
27005 C Incision of hip tendon......... .............. .............. .............. .............. ..............
27006 C Incision of hip tendons........ .............. .............. .............. .............. ..............
27025 C Incision of hip/thigh fascia... .............. .............. .............. .............. ..............
27030 C Drainage of hip joint.......... .............. .............. .............. .............. ..............
27033 T Exploration of hip joint....... 0051 27.76 $1,346.00 $675.24 $269.20
27035 C Denervation of hip joint....... .............. .............. .............. .............. ..............
27036 C Excision of hip joint/muscle... .............. .............. .............. .............. ..............
27040 T Biopsy of soft tissues......... 0021 10.49 $508.63 $236.51 $101.73
27041 T Biopsy of soft tissues......... 0022 12.49 $605.60 $292.94 $121.12
27047 T Remove hip/pelvis lesion....... 0022 12.49 $605.60 $292.94 $121.12
27048 T Remove hip/pelvis lesion....... 0022 12.49 $605.60 $292.94 $121.12
27049 T Remove tumor, hip/pelvis....... 0022 12.49 $605.60 $292.94 $121.12
27050 T Biopsy of sacroiliac joint..... 0049 15.04 $729.25 $356.95 $145.85
27052 T Biopsy of hip joint............ 0049 15.04 $729.25 $356.95 $145.85
27054 C Removal of hip joint lining.... .............. .............. .............. .............. ..............
[[Page 18578]]
27060 T Removal of ischial bursa....... 0049 15.04 $729.25 $356.95 $145.85
27062 T Remove femur lesion/bursa...... 0049 15.04 $729.25 $356.95 $145.85
27065 T Removal of hip bone lesion..... 0049 15.04 $729.25 $356.95 $145.85
27066 T Removal of hip bone lesion..... 0050 21.13 $1,024.53 $513.86 $204.91
27067 T Remove/graft hip bone lesion... 0050 21.13 $1,024.53 $513.86 $204.91
27070 C Partial removal of hip bone.... .............. .............. .............. .............. ..............
27071 C Partial removal of hip bone.... .............. .............. .............. .............. ..............
27075 C Extensive hip surgery.......... .............. .............. .............. .............. ..............
27076 C Extensive hip surgery.......... .............. .............. .............. .............. ..............
27077 C Extensive hip surgery.......... .............. .............. .............. .............. ..............
27078 C Extensive hip surgery.......... .............. .............. .............. .............. ..............
27079 C Extensive hip surgery.......... .............. .............. .............. .............. ..............
27080 T Removal of tail bone........... 0050 21.13 $1,024.53 $513.86 $204.91
27086 T Remove hip foreign body........ 0019 4.00 $193.95 $78.91 $38.79
27087 T Remove hip foreign body........ 0049 15.04 $729.25 $356.95 $145.85
27090 C Removal of hip prosthesis...... .............. .............. .............. .............. ..............
27091 C Removal of hip prosthesis...... .............. .............. .............. .............. ..............
27093 N Injection for hip x-ray........ .............. .............. .............. .............. ..............
27095 N Injection for hip x-ray........ .............. .............. .............. .............. ..............
27096 N Inject sacroiliac joint........ .............. .............. .............. .............. ..............
27097 T Revision of hip tendon......... 0050 21.13 $1,024.53 $513.86 $204.91
27098 T Transfer tendon to pelvis...... 0050 21.13 $1,024.53 $513.86 $204.91
27100 T Transfer of abdominal muscle... 0051 27.76 $1,346.00 $675.24 $269.20
27105 T Transfer of spinal muscle...... 0051 27.76 $1,346.00 $675.24 $269.20
27110 T Transfer of iliopsoas muscle... 0051 27.76 $1,346.00 $675.24 $269.20
27111 T Transfer of iliopsoas muscle... 0051 27.76 $1,346.00 $675.24 $269.20
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 femur ridge......... .............. .............. .............. .............. ..............
27146 C Incision of hip bone........... .............. .............. .............. .............. ..............
27147 C Revision of hip bone........... .............. .............. .............. .............. ..............
27151 C Incision of hip bones.......... .............. .............. .............. .............. ..............
27156 C Revision of hip bones.......... .............. .............. .............. .............. ..............
27158 C Revision of pelvis............. .............. .............. .............. .............. ..............
27161 C Incision of neck of femur...... .............. .............. .............. .............. ..............
27165 C Incision/fixation of femur..... .............. .............. .............. .............. ..............
27170 C Repair/graft femur head/neck... .............. .............. .............. .............. ..............
27175 C Treat slipped epiphysis........ .............. .............. .............. .............. ..............
27176 C Treat slipped epiphysis........ .............. .............. .............. .............. ..............
27177 C Treat slipped epiphysis........ .............. .............. .............. .............. ..............
27178 C Treat slipped epiphysis........ .............. .............. .............. .............. ..............
27179 C Revise head/neck of femur...... .............. .............. .............. .............. ..............
27181 C Treat slipped epiphysis........ .............. .............. .............. .............. ..............
27185 C Revision of femur epiphysis.... .............. .............. .............. .............. ..............
27187 C Reinforce hip bones............ .............. .............. .............. .............. ..............
27193 T Treat pelvic ring fracture..... 0044 2.17 $105.22 $38.08 $21.04
27194 T Treat pelvic ring fracture..... 0045 11.02 $534.33 $277.12 $106.87
27200 T Treat tail bone fracture....... 0043 1.64 $79.52 $25.46 $15.90
27202 T Treat tail bone fracture....... 0046 22.29 $1,080.78 $535.76 $216.16
27215 C Treat pelvic fracture(s)....... .............. .............. .............. .............. ..............
27216 C Treat pelvic ring fracture..... .............. .............. .............. .............. ..............
27217 C Treat pelvic ring fracture..... .............. .............. .............. .............. ..............
27218 C Treat pelvic ring fracture..... .............. .............. .............. .............. ..............
27220 T Treat hip socket fracture...... 0044 2.17 $105.22 $38.08 $21.04
27222 C Treat hip socket fracture...... .............. .............. .............. .............. ..............
27226 C Treat hip wall fracture........ .............. .............. .............. .............. ..............
27227 C Treat hip fracture(s).......... .............. .............. .............. .............. ..............
27228 C Treat hip fracture(s).......... .............. .............. .............. .............. ..............
27230 T Treat thigh fracture........... 0044 2.17 $105.22 $38.08 $21.04
27232 C Treat thigh fracture........... .............. .............. .............. .............. ..............
27235 C Treat thigh fracture........... .............. .............. .............. .............. ..............
27236 C Treat thigh fracture........... .............. .............. .............. .............. ..............
27238 T Treat thigh fracture........... 0044 2.17 $105.22 $38.08 $21.04
27240 C Treat thigh fracture........... .............. .............. .............. .............. ..............
27244 C Treat thigh fracture........... .............. .............. .............. .............. ..............
27245 C Treat thigh fracture........... .............. .............. .............. .............. ..............
27246 T Treat thigh fracture........... 0044 2.17 $105.22 $38.08 $21.04
[[Page 18579]]
27248 C Treat thigh fracture........... .............. .............. .............. .............. ..............
27250 T Treat hip dislocation.......... 0044 2.17 $105.22 $38.08 $21.04
27252 T Treat hip dislocation.......... 0045 11.02 $534.33 $277.12 $106.87
27253 C Treat hip dislocation.......... .............. .............. .............. .............. ..............
27254 C Treat hip dislocation.......... .............. .............. .............. .............. ..............
27256 T Treat hip dislocation.......... 0044 2.17 $105.22 $38.08 $21.04
27257 T Treat hip dislocation.......... 0045 11.02 $534.33 $277.12 $106.87
27258 C Treat hip dislocation.......... .............. .............. .............. .............. ..............
27259 C Treat hip dislocation.......... .............. .............. .............. .............. ..............
27265 T Treat hip dislocation.......... 0044 2.17 $105.22 $38.08 $21.04
27266 T Treat hip dislocation.......... 0047 22.09 $1,071.08 $537.03 $214.22
27275 T Manipulation of hip joint...... 0045 11.02 $534.33 $277.12 $106.87
27280 C Fusion of sacroiliac joint..... .............. .............. .............. .............. ..............
27282 C Fusion of pubic bones.......... .............. .............. .............. .............. ..............
27284 C Fusion of hip joint............ .............. .............. .............. .............. ..............
27286 C Fusion of hip joint............ .............. .............. .............. .............. ..............
27290 C Amputation of leg at hip....... .............. .............. .............. .............. ..............
27295 C Amputation of leg at hip....... .............. .............. .............. .............. ..............
27299 T Pelvis/hip joint surgery....... 0043 1.64 $79.52 $25.46 $15.90
27301 T Drain thigh/knee lesion........ 0008 6.15 $298.20 $113.67 $59.64
27303 C Drainage of bone lesion........ .............. .............. .............. .............. ..............
27305 T Incise thigh tendon & fascia... 0049 15.04 $729.25 $356.95 $145.85
27306 T Incision of thigh tendon....... 0049 15.04 $729.25 $356.95 $145.85
27307 T Incision of thigh tendons...... 0049 15.04 $729.25 $356.95 $145.85
27310 T Exploration of knee joint...... 0050 21.13 $1,024.53 $513.86 $204.91
27315 T Partial removal, thigh nerve... 0220 13.96 $676.88 $326.21 $135.38
27320 T Partial removal, thigh nerve... 0220 13.96 $676.88 $326.21 $135.38
27323 T Biopsy, thigh soft tissues..... 0021 10.49 $508.63 $236.51 $101.73
27324 T Biopsy, thigh soft tissues..... 0022 12.49 $605.60 $292.94 $121.12
27327 T Removal of thigh lesion........ 0022 12.49 $605.60 $292.94 $121.12
27328 T Removal of thigh lesion........ 0022 12.49 $605.60 $292.94 $121.12
27329 T Remove tumor, thigh/knee....... 0022 12.49 $605.60 $292.94 $121.12
27330 T Biopsy, knee joint lining...... 0050 21.13 $1,024.53 $513.86 $204.91
27331 T Explore/treat knee joint....... 0050 21.13 $1,024.53 $513.86 $204.91
27332 T Removal of knee cartilage...... 0050 21.13 $1,024.53 $513.86 $204.91
27333 T Removal of knee cartilage...... 0050 21.13 $1,024.53 $513.86 $204.91
27334 T Remove knee joint lining....... 0050 21.13 $1,024.53 $513.86 $204.91
27335 T Remove knee joint lining....... 0050 21.13 $1,024.53 $513.86 $204.91
27340 T Removal of kneecap bursa....... 0049 15.04 $729.25 $356.95 $145.85
27345 T Removal of knee cyst........... 0049 15.04 $729.25 $356.95 $145.85
27347 T Remove knee cyst............... 0049 15.04 $729.25 $356.95 $145.85
27350 T Removal of kneecap............. 0050 21.13 $1,024.53 $513.86 $204.91
27355 T Remove femur lesion............ 0050 21.13 $1,024.53 $513.86 $204.91
27356 T Remove femur lesion/graft...... 0050 21.13 $1,024.53 $513.86 $204.91
27357 T Remove femur lesion/graft...... 0050 21.13 $1,024.53 $513.86 $204.91
27358 T Remove femur lesion/fixation... 0050 21.13 $1,024.53 $513.86 $204.91
27360 T Partial removal, leg bone(s)... 0050 21.13 $1,024.53 $513.86 $204.91
27365 C Extensive leg surgery.......... .............. .............. .............. .............. ..............
27370 N Injection for knee x-ray....... .............. .............. .............. .............. ..............
27372 T Removal of foreign body........ 0022 12.49 $605.60 $292.94 $121.12
27380 T Repair of kneecap tendon....... 0049 15.04 $729.25 $356.95 $145.85
27381 T Repair/graft kneecap tendon.... 0049 15.04 $729.25 $356.95 $145.85
27385 T Repair of thigh muscle......... 0049 15.04 $729.25 $356.95 $145.85
27386 T Repair/graft of thigh muscle... 0049 15.04 $729.25 $356.95 $145.85
27390 T Incision of thigh tendon....... 0049 15.04 $729.25 $356.95 $145.85
27391 T Incision of thigh tendons...... 0049 15.04 $729.25 $356.95 $145.85
27392 T Incision of thigh tendons...... 0049 15.04 $729.25 $356.95 $145.85
27393 T Lengthening of thigh tendon.... 0050 21.13 $1,024.53 $513.86 $204.91
27394 T Lengthening of thigh tendons... 0050 21.13 $1,024.53 $513.86 $204.91
27395 T Lengthening of thigh tendons... 0051 27.76 $1,346.00 $675.24 $269.20
27396 T Transplant of thigh tendon..... 0050 21.13 $1,024.53 $513.86 $204.91
27397 T Transplants of thigh tendons... 0051 27.76 $1,346.00 $675.24 $269.20
27400 T Revise thigh muscles/tendons... 0051 27.76 $1,346.00 $675.24 $269.20
27403 T Repair of knee cartilage....... 0050 21.13 $1,024.53 $513.86 $204.91
27405 T Repair of knee ligament........ 0051 27.76 $1,346.00 $675.24 $269.20
27407 T Repair of knee ligament........ 0051 27.76 $1,346.00 $675.24 $269.20
27409 T Repair of knee ligaments....... 0051 27.76 $1,346.00 $675.24 $269.20
27418 T Repair degenerated kneecap..... 0051 27.76 $1,346.00 $675.24 $269.20
27420 T Revision of unstable kneecap... 0051 27.76 $1,346.00 $675.24 $269.20
27422 T Revision of unstable kneecap... 0051 27.76 $1,346.00 $675.24 $269.20
27424 T Revision/removal of kneecap.... 0051 27.76 $1,346.00 $675.24 $269.20
27425 T Lateral retinacular release.... 0050 21.13 $1,024.53 $513.86 $204.91
27427 T Reconstruction, knee........... 0052 36.16 $1,753.29 $930.91 $350.66
[[Page 18580]]
27428 T Reconstruction, knee........... 0052 36.16 $1,753.29 $930.91 $350.66
27429 T Reconstruction, knee........... 0052 36.16 $1,753.29 $930.91 $350.66
27430 T Revision of thigh muscles...... 0051 27.76 $1,346.00 $675.24 $269.20
27435 T Incision of knee joint......... 0051 27.76 $1,346.00 $675.24 $269.20
27437 T Revise kneecap................. 0047 22.09 $1,071.08 $537.03 $214.22
27438 T Revise kneecap with implant.... 0048 29.06 $1,409.03 $725.94 $281.81
27440 T Revision of knee joint......... 0047 22.09 $1,071.08 $537.03 $214.22
27441 T Revision of knee joint......... 0047 22.09 $1,071.08 $537.03 $214.22
27442 T Revision of knee joint......... 0047 22.09 $1,071.08 $537.03 $214.22
27443 T Revision of knee joint......... 0047 22.09 $1,071.08 $537.03 $214.22
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/replace knee joint...... .............. .............. .............. .............. ..............
27487 C Revise/replace knee joint...... .............. .............. .............. .............. ..............
27488 C Removal of knee prosthesis..... .............. .............. .............. .............. ..............
27495 C Reinforce thigh................ .............. .............. .............. .............. ..............
27496 T Decompression of thigh/knee.... 0049 15.04 $729.25 $356.95 $145.85
27497 T Decompression of thigh/knee.... 0049 15.04 $729.25 $356.95 $145.85
27498 T Decompression of thigh/knee.... 0049 15.04 $729.25 $356.95 $145.85
27499 T Decompression of thigh/knee.... 0049 15.04 $729.25 $356.95 $145.85
27500 T Treatment of thigh fracture.... 0044 2.17 $105.22 $38.08 $21.04
27501 T Treatment of thigh fracture.... 0044 2.17 $105.22 $38.08 $21.04
27502 T Treatment of thigh fracture.... 0044 2.17 $105.22 $38.08 $21.04
27503 T Treatment of thigh fracture.... 0044 2.17 $105.22 $38.08 $21.04
27506 C Treatment of thigh fracture.... .............. .............. .............. .............. ..............
27507 C Treatment of thigh fracture.... .............. .............. .............. .............. ..............
27508 T Treatment of thigh fracture.... 0044 2.17 $105.22 $38.08 $21.04
27509 T Treatment of thigh fracture.... 0046 22.29 $1,080.78 $535.76 $216.16
27510 T Treatment of thigh fracture.... 0044 2.17 $105.22 $38.08 $21.04
27511 C Treatment of thigh fracture.... .............. .............. .............. .............. ..............
27513 C Treatment of thigh fracture.... .............. .............. .............. .............. ..............
27514 C Treatment of thigh fracture.... .............. .............. .............. .............. ..............
27516 T Treat thigh fx growth plate.... 0044 2.17 $105.22 $38.08 $21.04
27517 T Treat thigh fx growth plate.... 0044 2.17 $105.22 $38.08 $21.04
27519 C Treat thigh fx growth plate.... .............. .............. .............. .............. ..............
27520 T Treat kneecap fracture......... 0044 2.17 $105.22 $38.08 $21.04
27524 C Treat kneecap fracture......... .............. .............. .............. .............. ..............
27530 T Treat knee fracture............ 0044 2.17 $105.22 $38.08 $21.04
27532 T Treat knee fracture............ 0044 2.17 $105.22 $38.08 $21.04
27535 C Treat knee fracture............ .............. .............. .............. .............. ..............
27536 C Treat knee fracture............ .............. .............. .............. .............. ..............
27538 T Treat knee fracture(s)......... 0044 2.17 $105.22 $38.08 $21.04
27540 C Treat knee fracture............ .............. .............. .............. .............. ..............
27550 T Treat knee dislocation......... 0044 2.17 $105.22 $38.08 $21.04
27552 T Treat knee dislocation......... 0045 11.02 $534.33 $277.12 $106.87
27556 T Treat knee dislocation......... 0046 22.29 $1,080.78 $535.76 $216.16
27557 C Treat knee dislocation......... .............. .............. .............. .............. ..............
27558 C Treat knee dislocation......... .............. .............. .............. .............. ..............
27560 T Treat kneecap dislocation...... 0044 2.17 $105.22 $38.08 $21.04
27562 T Treat kneecap dislocation...... 0045 11.02 $534.33 $277.12 $106.87
27566 T Treat kneecap dislocation...... 0046 22.29 $1,080.78 $535.76 $216.16
27570 T Fixation of knee joint......... 0045 11.02 $534.33 $277.12 $106.87
27580 C Fusion of knee................. .............. .............. .............. .............. ..............
27590 C Amputate leg at thigh.......... .............. .............. .............. .............. ..............
27591 C Amputate leg at thigh.......... .............. .............. .............. .............. ..............
27592 C Amputate leg at thigh.......... .............. .............. .............. .............. ..............
27594 T Amputation follow-up surgery... 0049 15.04 $729.25 $356.95 $145.85
27596 C Amputation follow-up surgery... .............. .............. .............. .............. ..............
[[Page 18581]]
27598 C Amputate lower leg at knee..... .............. .............. .............. .............. ..............
27599 T Leg surgery procedure.......... 0044 2.17 $105.22 $38.08 $21.04
27600 T Decompression of lower leg..... 0049 15.04 $729.25 $356.95 $145.85
27601 T Decompression of lower leg..... 0049 15.04 $729.25 $356.95 $145.85
27602 T Decompression of lower leg..... 0049 15.04 $729.25 $356.95 $145.85
27603 T Drain lower leg lesion......... 0008 6.15 $298.20 $113.67 $59.64
27604 T Drain lower leg bursa.......... 0049 15.04 $729.25 $356.95 $145.85
27605 T Incision of achilles tendon.... 0055 15.47 $750.10 $355.34 $150.02
27606 T Incision of achilles tendon.... 0049 15.04 $729.25 $356.95 $145.85
27607 T Treat lower leg bone lesion.... 0049 15.04 $729.25 $356.95 $145.85
27610 T Explore/treat ankle joint...... 0050 21.13 $1,024.53 $513.86 $204.91
27612 T Exploration of ankle joint..... 0050 21.13 $1,024.53 $513.86 $204.91
27613 T Biopsy lower leg soft tissue... 0020 6.51 $315.65 $130.53 $63.13
27614 T Biopsy lower leg soft tissue... 0022 12.49 $605.60 $292.94 $121.12
27615 T Remove tumor, lower leg........ 0046 22.29 $1,080.78 $535.76 $216.16
27618 T Remove lower leg lesion........ 0021 10.49 $508.63 $236.51 $101.73
27619 T Remove lower leg lesion........ 0022 12.49 $605.60 $292.94 $121.12
27620 T Explore/treat ankle joint...... 0050 21.13 $1,024.53 $513.86 $204.91
27625 T Remove ankle joint lining...... 0050 21.13 $1,024.53 $513.86 $204.91
27626 T Remove ankle joint lining...... 0050 21.13 $1,024.53 $513.86 $204.91
27630 T Removal of tendon lesion....... 0049 15.04 $729.25 $356.95 $145.85
27635 T Remove lower leg bone lesion... 0050 21.13 $1,024.53 $513.86 $204.91
27637 T Remove/graft leg bone lesion... 0050 21.13 $1,024.53 $513.86 $204.91
27638 T Remove/graft leg bone lesion... 0050 21.13 $1,024.53 $513.86 $204.91
27640 T Partial removal of tibia....... 0051 27.76 $1,346.00 $675.24 $269.20
27641 T Partial removal of fibula...... 0050 21.13 $1,024.53 $513.86 $204.91
27645 C Extensive lower leg surgery.... .............. .............. .............. .............. ..............
27646 C Extensive lower leg surgery.... .............. .............. .............. .............. ..............
27647 T Extensive ankle/heel surgery... 0051 27.76 $1,346.00 $675.24 $269.20
27648 N Injection for ankle x-ray...... .............. .............. .............. .............. ..............
27650 T Repair achilles tendon......... 0051 27.76 $1,346.00 $675.24 $269.20
27652 T Repair/graft achilles tendon... 0051 27.76 $1,346.00 $675.24 $269.20
27654 T Repair of achilles tendon...... 0051 27.76 $1,346.00 $675.24 $269.20
27656 T Repair leg fascia defect....... 0049 15.04 $729.25 $356.95 $145.85
27658 T Repair of leg tendon, each..... 0049 15.04 $729.25 $356.95 $145.85
27659 T Repair of leg tendon, each..... 0049 15.04 $729.25 $356.95 $145.85
27664 T Repair of leg tendon, each..... 0049 15.04 $729.25 $356.95 $145.85
27665 T Repair of leg tendon, each..... 0050 21.13 $1,024.53 $513.86 $204.91
27675 T Repair lower leg tendons....... 0049 15.04 $729.25 $356.95 $145.85
27676 T Repair lower leg tendons....... 0050 21.13 $1,024.53 $513.86 $204.91
27680 T Release of lower leg tendon.... 0050 21.13 $1,024.53 $513.86 $204.91
27681 T Release of lower leg tendons... 0050 21.13 $1,024.53 $513.86 $204.91
27685 T Revision of lower leg tendon... 0050 21.13 $1,024.53 $513.86 $204.91
27686 T Revise lower leg tendons....... 0050 21.13 $1,024.53 $513.86 $204.91
27687 T Revision of calf tendon........ 0050 21.13 $1,024.53 $513.86 $204.91
27690 T Revise lower leg tendon........ 0051 27.76 $1,346.00 $675.24 $269.20
27691 T Revise lower leg tendon........ 0051 27.76 $1,346.00 $675.24 $269.20
27692 T Revise additional leg tendon... 0051 27.76 $1,346.00 $675.24 $269.20
27695 T Repair of ankle ligament....... 0050 21.13 $1,024.53 $513.86 $204.91
27696 T Repair of ankle ligaments...... 0050 21.13 $1,024.53 $513.86 $204.91
27698 T Repair of ankle ligament....... 0050 21.13 $1,024.53 $513.86 $204.91
27700 T Revision of ankle joint........ 0047 22.09 $1,071.08 $537.03 $214.22
27702 C Reconstruct ankle joint........ .............. .............. .............. .............. ..............
27703 C Reconstruction, ankle joint.... .............. .............. .............. .............. ..............
27704 T Removal of ankle implant....... 0049 15.04 $729.25 $356.95 $145.85
27705 T Incision of tibia.............. 0051 27.76 $1,346.00 $675.24 $269.20
27707 T Incision of fibula............. 0049 15.04 $729.25 $356.95 $145.85
27709 T Incision of tibia & fibula..... 0050 21.13 $1,024.53 $513.86 $204.91
27712 C Realignment of lower leg....... .............. .............. .............. .............. ..............
27715 C Revision of lower leg.......... .............. .............. .............. .............. ..............
27720 C Repair of tibia................ .............. .............. .............. .............. ..............
27722 C Repair/graft of tibia.......... .............. .............. .............. .............. ..............
27724 C Repair/graft of tibia.......... .............. .............. .............. .............. ..............
27725 C Repair of lower leg............ .............. .............. .............. .............. ..............
27727 C Repair of lower leg............ .............. .............. .............. .............. ..............
27730 T Repair of tibia epiphysis...... 0050 21.13 $1,024.53 $513.86 $204.91
27732 T Repair of fibula epiphysis..... 0050 21.13 $1,024.53 $513.86 $204.91
27734 T Repair lower leg epiphyses..... 0050 21.13 $1,024.53 $513.86 $204.91
27740 T Repair of leg epiphyses........ 0050 21.13 $1,024.53 $513.86 $204.91
27742 T Repair of leg epiphyses........ 0051 27.76 $1,346.00 $675.24 $269.20
27745 T Reinforce tibia................ 0051 27.76 $1,346.00 $675.24 $269.20
27750 T Treatment of tibia fracture.... 0044 2.17 $105.22 $38.08 $21.04
27752 T Treatment of tibia fracture.... 0044 2.17 $105.22 $38.08 $21.04
[[Page 18582]]
27756 T Treatment of tibia fracture.... 0046 22.29 $1,080.78 $535.76 $216.16
27758 T Treatment of tibia fracture.... 0046 22.29 $1,080.78 $535.76 $216.16
27759 T Treatment of tibia fracture.... 0046 22.29 $1,080.78 $535.76 $216.16
27760 T Treatment of ankle fracture.... 0044 2.17 $105.22 $38.08 $21.04
27762 T Treatment of ankle fracture.... 0044 2.17 $105.22 $38.08 $21.04
27766 T Treatment of ankle fracture.... 0046 22.29 $1,080.78 $535.76 $216.16
27780 T Treatment of fibula fracture... 0044 2.17 $105.22 $38.08 $21.04
27781 T Treatment of fibula fracture... 0044 2.17 $105.22 $38.08 $21.04
27784 T Treatment of fibula fracture... 0046 22.29 $1,080.78 $535.76 $216.16
27786 T Treatment of ankle fracture.... 0044 2.17 $105.22 $38.08 $21.04
27788 T Treatment of ankle fracture.... 0044 2.17 $105.22 $38.08 $21.04
27792 T Treatment of ankle fracture.... 0046 22.29 $1,080.78 $535.76 $216.16
27808 T Treatment of ankle fracture.... 0044 2.17 $105.22 $38.08 $21.04
27810 T Treatment of ankle fracture.... 0044 2.17 $105.22 $38.08 $21.04
27814 T Treatment of ankle fracture.... 0046 22.29 $1,080.78 $535.76 $216.16
27816 T Treatment of ankle fracture.... 0044 2.17 $105.22 $38.08 $21.04
27818 T Treatment of ankle fracture.... 0044 2.17 $105.22 $38.08 $21.04
27822 T Treatment of ankle fracture.... 0046 22.29 $1,080.78 $535.76 $216.16
27823 T Treatment of ankle fracture.... 0046 22.29 $1,080.78 $535.76 $216.16
27824 T Treat lower leg fracture....... 0044 2.17 $105.22 $38.08 $21.04
27825 T Treat lower leg fracture....... 0044 2.17 $105.22 $38.08 $21.04
27826 T Treat lower leg fracture....... 0046 22.29 $1,080.78 $535.76 $216.16
27827 T Treat lower leg fracture....... 0046 22.29 $1,080.78 $535.76 $216.16
27828 T Treat lower leg fracture....... 0046 22.29 $1,080.78 $535.76 $216.16
27829 T Treat lower leg joint.......... 0046 22.29 $1,080.78 $535.76 $216.16
27830 T Treat lower leg dislocation.... 0044 2.17 $105.22 $38.08 $21.04
27831 T Treat lower leg dislocation.... 0045 11.02 $534.33 $277.12 $106.87
27832 T Treat lower leg dislocation.... 0046 22.29 $1,080.78 $535.76 $216.16
27840 T Treat ankle dislocation........ 0044 2.17 $105.22 $38.08 $21.04
27842 T Treat ankle dislocation........ 0045 11.02 $534.33 $277.12 $106.87
27846 T Treat ankle dislocation........ 0046 22.29 $1,080.78 $535.76 $216.16
27848 T Treat ankle dislocation........ 0046 22.29 $1,080.78 $535.76 $216.16
27860 T Fixation of ankle joint........ 0045 11.02 $534.33 $277.12 $106.87
27870 T Fusion of ankle joint.......... 0051 27.76 $1,346.00 $675.24 $269.20
27871 T Fusion of tibiofibular joint... 0051 27.76 $1,346.00 $675.24 $269.20
27880 C Amputation of lower leg........ .............. .............. .............. .............. ..............
27881 C Amputation of lower leg........ .............. .............. .............. .............. ..............
27882 C Amputation of lower leg........ .............. .............. .............. .............. ..............
27884 T Amputation follow-up surgery... 0049 15.04 $729.25 $356.95 $145.85
27886 C Amputation follow-up surgery... .............. .............. .............. .............. ..............
27888 C Amputation of foot at ankle.... .............. .............. .............. .............. ..............
27889 T Amputation of foot at ankle.... 0050 21.13 $1,024.53 $513.86 $204.91
27892 T Decompression of leg........... 0049 15.04 $729.25 $356.95 $145.85
27893 T Decompression of leg........... 0049 15.04 $729.25 $356.95 $145.85
27894 T Decompression of leg........... 0049 15.04 $729.25 $356.95 $145.85
27899 T Leg/ankle surgery procedure.... 0044 2.17 $105.22 $38.08 $21.04
28001 T Drainage of bursa of foot...... 0008 6.15 $298.20 $113.67 $59.64
28002 T Treatment of foot infection.... 0049 15.04 $729.25 $356.95 $145.85
28003 T Treatment of foot infection.... 0049 15.04 $729.25 $356.95 $145.85
28005 T Treat foot bone lesion......... 0055 15.47 $750.10 $355.34 $150.02
28008 T Incision of foot fascia........ 0055 15.47 $750.10 $355.34 $150.02
28010 T Incision of toe tendon......... 0055 15.47 $750.10 $355.34 $150.02
28011 T Incision of toe tendons........ 0055 15.47 $750.10 $355.34 $150.02
28020 T Exploration of foot joint...... 0055 15.47 $750.10 $355.34 $150.02
28022 T Exploration of foot joint...... 0055 15.47 $750.10 $355.34 $150.02
28024 T Exploration of toe joint....... 0055 15.47 $750.10 $355.34 $150.02
28030 T Removal of foot nerve.......... 0220 13.96 $676.88 $326.21 $135.38
28035 T Decompression of tibia nerve... 0220 13.96 $676.88 $326.21 $135.38
28043 T Excision of foot lesion........ 0021 10.49 $508.63 $236.51 $101.73
28045 T Excision of foot lesion........ 0055 15.47 $750.10 $355.34 $150.02
28046 T Resection of tumor, foot....... 0055 15.47 $750.10 $355.34 $150.02
28050 T Biopsy of foot joint lining.... 0055 15.47 $750.10 $355.34 $150.02
28052 T Biopsy of foot joint lining.... 0055 15.47 $750.10 $355.34 $150.02
28054 T Biopsy of toe joint lining..... 0055 15.47 $750.10 $355.34 $150.02
28060 T Partial removal, foot fascia... 0056 17.30 $838.83 $405.81 $167.77
28062 T Removal of foot fascia......... 0056 17.30 $838.83 $405.81 $167.77
28070 T Removal of foot joint lining... 0056 17.30 $838.83 $405.81 $167.77
28072 T Removal of foot joint lining... 0056 17.30 $838.83 $405.81 $167.77
28080 T Removal of foot lesion......... 0055 15.47 $750.10 $355.34 $150.02
28086 T Excise foot tendon sheath...... 0055 15.47 $750.10 $355.34 $150.02
28088 T Excise foot tendon sheath...... 0055 15.47 $750.10 $355.34 $150.02
28090 T Removal of foot lesion......... 0055 15.47 $750.10 $355.34 $150.02
28092 T Removal of toe lesions......... 0055 15.47 $750.10 $355.34 $150.02
[[Page 18583]]
28100 T Removal of ankle/heel lesion... 0055 15.47 $750.10 $355.34 $150.02
28102 T Remove/graft foot lesion....... 0056 17.30 $838.83 $405.81 $167.77
28103 T Remove/graft foot lesion....... 0056 17.30 $838.83 $405.81 $167.77
28104 T Removal of foot lesion......... 0055 15.47 $750.10 $355.34 $150.02
28106 T Remove/graft foot lesion....... 0056 17.30 $838.83 $405.81 $167.77
28107 T Remove/graft foot lesion....... 0056 17.30 $838.83 $405.81 $167.77
28108 T Removal of toe lesions......... 0055 15.47 $750.10 $355.34 $150.02
28110 T Part removal of metatarsal..... 0057 21.00 $1,018.23 $496.65 $203.65
28111 T Part removal of metatarsal..... 0055 15.47 $750.10 $355.34 $150.02
28112 T Part removal of metatarsal..... 0055 15.47 $750.10 $355.34 $150.02
28113 T Part removal of metatarsal..... 0055 15.47 $750.10 $355.34 $150.02
28114 T Removal of metatarsal heads.... 0055 15.47 $750.10 $355.34 $150.02
28116 T Revision of foot............... 0055 15.47 $750.10 $355.34 $150.02
28118 T Removal of heel bone........... 0055 15.47 $750.10 $355.34 $150.02
28119 T Removal of heel spur........... 0055 15.47 $750.10 $355.34 $150.02
28120 T Part removal of ankle/heel..... 0055 15.47 $750.10 $355.34 $150.02
28122 T Partial removal of foot bone... 0055 15.47 $750.10 $355.34 $150.02
28124 T Partial removal of toe......... 0055 15.47 $750.10 $355.34 $150.02
28126 T Partial removal of toe......... 0055 15.47 $750.10 $355.34 $150.02
28130 T Removal of ankle bone.......... 0055 15.47 $750.10 $355.34 $150.02
28140 T Removal of metatarsal.......... 0055 15.47 $750.10 $355.34 $150.02
28150 T Removal of toe................. 0055 15.47 $750.10 $355.34 $150.02
28153 T Partial removal of toe......... 0055 15.47 $750.10 $355.34 $150.02
28160 T Partial removal of toe......... 0055 15.47 $750.10 $355.34 $150.02
28171 T Extensive foot surgery......... 0055 15.47 $750.10 $355.34 $150.02
28173 T Extensive foot surgery......... 0055 15.47 $750.10 $355.34 $150.02
28175 T Extensive foot surgery......... 0055 15.47 $750.10 $355.34 $150.02
28190 T Removal of foot foreign body... 0019 4.00 $193.95 $78.91 $38.79
28192 T Removal of foot foreign body... 0021 10.49 $508.63 $236.51 $101.73
28193 T Removal of foot foreign body... 0020 6.51 $315.65 $130.53 $63.13
28200 T Repair of foot tendon.......... 0055 15.47 $750.10 $355.34 $150.02
28202 T Repair/graft of foot tendon.... 0056 17.30 $838.83 $405.81 $167.77
28208 T Repair of foot tendon.......... 0055 15.47 $750.10 $355.34 $150.02
28210 T Repair/graft of foot tendon.... 0055 15.47 $750.10 $355.34 $150.02
28220 T Release of foot tendon......... 0055 15.47 $750.10 $355.34 $150.02
28222 T Release of foot tendons........ 0055 15.47 $750.10 $355.34 $150.02
28225 T Release of foot tendon......... 0055 15.47 $750.10 $355.34 $150.02
28226 T Release of foot tendons........ 0055 15.47 $750.10 $355.34 $150.02
28230 T Incision of foot tendon(s)..... 0055 15.47 $750.10 $355.34 $150.02
28232 T Incision of toe tendon......... 0055 15.47 $750.10 $355.34 $150.02
28234 T Incision of foot tendon........ 0055 15.47 $750.10 $355.34 $150.02
28238 T Revision of foot tendon........ 0056 17.30 $838.83 $405.81 $167.77
28240 T Release of big toe............. 0055 15.47 $750.10 $355.34 $150.02
28250 T Revision of foot fascia........ 0056 17.30 $838.83 $405.81 $167.77
28260 T Release of midfoot joint....... 0056 17.30 $838.83 $405.81 $167.77
28261 T Revision of foot tendon........ 0056 17.30 $838.83 $405.81 $167.77
28262 T Revision of foot and ankle..... 0056 17.30 $838.83 $405.81 $167.77
28264 T Release of midfoot joint....... 0056 17.30 $838.83 $405.81 $167.77
28270 T Release of foot contracture.... 0055 15.47 $750.10 $355.34 $150.02
28272 T Release of toe joint, each..... 0055 15.47 $750.10 $355.34 $150.02
28280 T Fusion of toes................. 0055 15.47 $750.10 $355.34 $150.02
28285 T Repair of hammertoe............ 0055 15.47 $750.10 $355.34 $150.02
28286 T Repair of hammertoe............ 0055 15.47 $750.10 $355.34 $150.02
28288 T Partial removal of foot bone... 0056 17.30 $838.83 $405.81 $167.77
28289 T Repair hallux rigidus.......... 0056 17.30 $838.83 $405.81 $167.77
28290 T Correction of bunion........... 0057 21.00 $1,018.23 $496.65 $203.65
28292 T Correction of bunion........... 0057 21.00 $1,018.23 $496.65 $203.65
28293 T Correction of bunion........... 0057 21.00 $1,018.23 $496.65 $203.65
28294 T Correction of bunion........... 0057 21.00 $1,018.23 $496.65 $203.65
28296 T Correction of bunion........... 0057 21.00 $1,018.23 $496.65 $203.65
28297 T Correction of bunion........... 0057 21.00 $1,018.23 $496.65 $203.65
28298 T Correction of bunion........... 0057 21.00 $1,018.23 $496.65 $203.65
28299 T Correction of bunion........... 0057 21.00 $1,018.23 $496.65 $203.65
28300 T Incision of heel bone.......... 0056 17.30 $838.83 $405.81 $167.77
28302 T Incision of ankle bone......... 0056 17.30 $838.83 $405.81 $167.77
28304 T Incision of midfoot bones...... 0056 17.30 $838.83 $405.81 $167.77
28305 T Incise/graft midfoot bones..... 0056 17.30 $838.83 $405.81 $167.77
28306 T Incision of metatarsal......... 0056 17.30 $838.83 $405.81 $167.77
28307 T Incision of metatarsal......... 0056 17.30 $838.83 $405.81 $167.77
28308 T Incision of metatarsal......... 0056 17.30 $838.83 $405.81 $167.77
28309 T Incision of metatarsals........ 0056 17.30 $838.83 $405.81 $167.77
28310 T Revision of big toe............ 0055 15.47 $750.10 $355.34 $150.02
28312 T Revision of toe................ 0055 15.47 $750.10 $355.34 $150.02
[[Page 18584]]
28313 T Repair deformity of toe........ 0055 15.47 $750.10 $355.34 $150.02
28315 T Removal of sesamoid bone....... 0055 15.47 $750.10 $355.34 $150.02
28320 T Repair of foot bones........... 0056 17.30 $838.83 $405.81 $167.77
28322 T Repair of metatarsals.......... 0056 17.30 $838.83 $405.81 $167.77
28340 T Resect enlarged toe tissue..... 0055 15.47 $750.10 $355.34 $150.02
28341 T Resect enlarged toe............ 0055 15.47 $750.10 $355.34 $150.02
28344 T Repair extra toe(s)............ 0056 17.30 $838.83 $405.81 $167.77
28345 T Repair webbed toe(s)........... 0056 17.30 $838.83 $405.81 $167.77
28360 T Reconstruct cleft foot......... 0056 17.30 $838.83 $405.81 $167.77
28400 T Treatment of heel fracture..... 0044 2.17 $105.22 $38.08 $21.04
28405 T Treatment of heel fracture..... 0044 2.17 $105.22 $38.08 $21.04
28406 T Treatment of heel fracture..... 0046 22.29 $1,080.78 $535.76 $216.16
28415 T Treat heel fracture............ 0046 22.29 $1,080.78 $535.76 $216.16
28420 T Treat/graft heel fracture...... 0046 22.29 $1,080.78 $535.76 $216.16
28430 T Treatment of ankle fracture.... 0044 2.17 $105.22 $38.08 $21.04
28435 T Treatment of ankle fracture.... 0044 2.17 $105.22 $38.08 $21.04
28436 T Treatment of ankle fracture.... 0046 22.29 $1,080.78 $535.76 $216.16
28445 T Treat ankle fracture........... 0046 22.29 $1,080.78 $535.76 $216.16
28450 T Treat midfoot fracture, each... 0044 2.17 $105.22 $38.08 $21.04
28455 T Treat midfoot fracture, each... 0044 2.17 $105.22 $38.08 $21.04
28456 T Treat midfoot fracture......... 0046 22.29 $1,080.78 $535.76 $216.16
28465 T Treat midfoot fracture, each... 0046 22.29 $1,080.78 $535.76 $216.16
28470 T Treat metatarsal fracture...... 0044 2.17 $105.22 $38.08 $21.04
28475 T Treat metatarsal fracture...... 0044 2.17 $105.22 $38.08 $21.04
28476 T Treat metatarsal fracture...... 0046 22.29 $1,080.78 $535.76 $216.16
28485 T Treat metatarsal fracture...... 0046 22.29 $1,080.78 $535.76 $216.16
28490 T Treat big toe fracture......... 0043 1.64 $79.52 $25.46 $15.90
28495 T Treat big toe fracture......... 0043 1.64 $79.52 $25.46 $15.90
28496 T Treat big toe fracture......... 0046 22.29 $1,080.78 $535.76 $216.16
28505 T Treat big toe fracture......... 0046 22.29 $1,080.78 $535.76 $216.16
28510 T Treatment of toe fracture...... 0043 1.64 $79.52 $25.46 $15.90
28515 T Treatment of toe fracture...... 0043 1.64 $79.52 $25.46 $15.90
28525 T Treat toe fracture............. 0046 22.29 $1,080.78 $535.76 $216.16
28530 T Treat sesamoid bone fracture... 0044 2.17 $105.22 $38.08 $21.04
28531 T Treat sesamoid bone fracture... 0046 22.29 $1,080.78 $535.76 $216.16
28540 T Treat foot dislocation......... 0044 2.17 $105.22 $38.08 $21.04
28545 T Treat foot dislocation......... 0045 11.02 $534.33 $277.12 $106.87
28546 T Treat foot dislocation......... 0046 22.29 $1,080.78 $535.76 $216.16
28555 T Repair foot dislocation........ 0046 22.29 $1,080.78 $535.76 $216.16
28570 T Treat foot dislocation......... 0044 2.17 $105.22 $38.08 $21.04
28575 T Treat foot dislocation......... 0045 11.02 $534.33 $277.12 $106.87
28576 T Treat foot dislocation......... 0046 22.29 $1,080.78 $535.76 $216.16
28585 T Repair foot dislocation........ 0046 22.29 $1,080.78 $535.76 $216.16
28600 T Treat foot dislocation......... 0044 2.17 $105.22 $38.08 $21.04
28605 T Treat foot dislocation......... 0045 11.02 $534.33 $277.12 $106.87
28606 T Treat foot dislocation......... 0046 22.29 $1,080.78 $535.76 $216.16
28615 T Repair foot dislocation........ 0046 22.29 $1,080.78 $535.76 $216.16
28630 T Treat toe dislocation.......... 0043 1.64 $79.52 $25.46 $15.90
28635 T Treat toe dislocation.......... 0045 11.02 $534.33 $277.12 $106.87
28636 T Treat toe dislocation.......... 0046 22.29 $1,080.78 $535.76 $216.16
28645 T Repair toe dislocation......... 0046 22.29 $1,080.78 $535.76 $216.16
28660 T Treat toe dislocation.......... 0043 1.64 $79.52 $25.46 $15.90
28665 T Treat toe dislocation.......... 0045 11.02 $534.33 $277.12 $106.87
28666 T Treat toe dislocation.......... 0046 22.29 $1,080.78 $535.76 $216.16
28675 T Repair of toe dislocation...... 0046 22.29 $1,080.78 $535.76 $216.16
28705 T Fusion of foot bones........... 0056 17.30 $838.83 $405.81 $167.77
28715 T Fusion of foot bones........... 0056 17.30 $838.83 $405.81 $167.77
28725 T Fusion of foot bones........... 0056 17.30 $838.83 $405.81 $167.77
28730 T Fusion of foot bones........... 0056 17.30 $838.83 $405.81 $167.77
28735 T Fusion of foot bones........... 0056 17.30 $838.83 $405.81 $167.77
28737 T Revision of foot bones......... 0055 15.47 $750.10 $355.34 $150.02
28740 T Fusion of foot bones........... 0056 17.30 $838.83 $405.81 $167.77
28750 T Fusion of big toe joint........ 0055 15.47 $750.10 $355.34 $150.02
28755 T Fusion of big toe joint........ 0055 15.47 $750.10 $355.34 $150.02
28760 T Fusion of big toe joint........ 0056 17.30 $838.83 $405.81 $167.77
28800 C Amputation of midfoot.......... .............. .............. .............. .............. ..............
28805 C Amputation thru metatarsal..... .............. .............. .............. .............. ..............
28810 T Amputation toe & metatarsal.... 0055 15.47 $750.10 $355.34 $150.02
28820 T Amputation of toe.............. 0055 15.47 $750.10 $355.34 $150.02
28825 T Partial amputation of toe...... 0055 15.47 $750.10 $355.34 $150.02
28899 T Foot/toes surgery procedure.... 0043 1.64 $79.52 $25.46 $15.90
29000 S Application of body cast....... 0059 1.74 $84.37 $29.59 $16.87
29010 S Application of body cast....... 0059 1.74 $84.37 $29.59 $16.87
[[Page 18585]]
29015 S Application of body cast....... 0059 1.74 $84.37 $29.59 $16.87
29020 S Application of body cast....... 0059 1.74 $84.37 $29.59 $16.87
29025 S Application of body cast....... 0059 1.74 $84.37 $29.59 $16.87
29035 S Application of body cast....... 0059 1.74 $84.37 $29.59 $16.87
29040 S Application of body cast....... 0059 1.74 $84.37 $29.59 $16.87
29044 S Application of body cast....... 0059 1.74 $84.37 $29.59 $16.87
29046 S Application of body cast....... 0059 1.74 $84.37 $29.59 $16.87
29049 S Application of figure eight.... 0059 1.74 $84.37 $29.59 $16.87
29055 S Application of shoulder cast... 0059 1.74 $84.37 $29.59 $16.87
29058 S Application of shoulder cast... 0059 1.74 $84.37 $29.59 $16.87
29065 S Application of long arm cast... 0059 1.74 $84.37 $29.59 $16.87
29075 S Application of forearm cast.... 0059 1.74 $84.37 $29.59 $16.87
29085 S Apply hand/wrist cast.......... 0059 1.74 $84.37 $29.59 $16.87
29105 S Apply long arm splint.......... 0059 1.74 $84.37 $29.59 $16.87
29125 S Apply forearm splint........... 0059 1.74 $84.37 $29.59 $16.87
29126 S Apply forearm splint........... 0059 1.74 $84.37 $29.59 $16.87
29130 S Application of finger splint... 0059 1.74 $84.37 $29.59 $16.87
29131 S Application of finger splint... 0059 1.74 $84.37 $29.59 $16.87
29200 S Strapping of chest............. 0059 1.74 $84.37 $29.59 $16.87
29220 S Strapping of low back.......... 0059 1.74 $84.37 $29.59 $16.87
29240 S Strapping of shoulder.......... 0059 1.74 $84.37 $29.59 $16.87
29260 S Strapping of elbow or wrist.... 0059 1.74 $84.37 $29.59 $16.87
29280 S Strapping of hand or finger.... 0059 1.74 $84.37 $29.59 $16.87
29305 S Application of hip cast........ 0059 1.74 $84.37 $29.59 $16.87
29325 S Application of hip casts....... 0059 1.74 $84.37 $29.59 $16.87
29345 S Application of long leg cast... 0059 1.74 $84.37 $29.59 $16.87
29355 S Application of long leg cast... 0059 1.74 $84.37 $29.59 $16.87
29358 S Apply long leg cast brace...... 0059 1.74 $84.37 $29.59 $16.87
29365 S Application of long leg cast... 0059 1.74 $84.37 $29.59 $16.87
29405 S Apply short leg cast........... 0059 1.74 $84.37 $29.59 $16.87
29425 S Apply short leg cast........... 0059 1.74 $84.37 $29.59 $16.87
29435 S Apply short leg cast........... 0059 1.74 $84.37 $29.59 $16.87
29440 S Addition of walker to cast..... 0059 1.74 $84.37 $29.59 $16.87
29445 S Apply rigid leg cast........... 0059 1.74 $84.37 $29.59 $16.87
29450 S Application of leg cast........ 0059 1.74 $84.37 $29.59 $16.87
29505 S Application, long leg splint... 0058 1.09 $52.85 $19.27 $10.57
29515 S Application lower leg splint... 0058 1.09 $52.85 $19.27 $10.57
29520 S Strapping of hip............... 0058 1.09 $52.85 $19.27 $10.57
29530 S Strapping of knee.............. 0058 1.09 $52.85 $19.27 $10.57
29540 S Strapping of ankle............. 0058 1.09 $52.85 $19.27 $10.57
29550 S Strapping of toes.............. 0058 1.09 $52.85 $19.27 $10.57
29580 S Application of paste boot...... 0058 1.09 $52.85 $19.27 $10.57
29590 S Application of foot splint..... 0058 1.09 $52.85 $19.27 $10.57
29700 S Removal/revision of cast....... 0058 1.09 $52.85 $19.27 $10.57
29705 S Removal/revision of cast....... 0058 1.09 $52.85 $19.27 $10.57
29710 S Removal/revision of cast....... 0058 1.09 $52.85 $19.27 $10.57
29715 S Removal/revision of cast....... 0058 1.09 $52.85 $19.27 $10.57
29720 S Repair of body cast............ 0058 1.09 $52.85 $19.27 $10.57
29730 S Windowing of cast.............. 0058 1.09 $52.85 $19.27 $10.57
29740 S Wedging of cast................ 0058 1.09 $52.85 $19.27 $10.57
29750 S Wedging of clubfoot cast....... 0058 1.09 $52.85 $19.27 $10.57
29799 S Casting/strapping procedure.... 0058 1.09 $52.85 $19.27 $10.57
29800 T Jaw arthroscopy/surgery........ 0041 24.57 $1,191.33 $592.08 $238.27
29804 T Jaw arthroscopy/surgery........ 0041 24.57 $1,191.33 $592.08 $238.27
29815 T Shoulder arthroscopy........... 0041 24.57 $1,191.33 $592.08 $238.27
29819 T Shoulder arthroscopy/surgery... 0041 24.57 $1,191.33 $592.08 $238.27
29820 T Shoulder arthroscopy/surgery... 0041 24.57 $1,191.33 $592.08 $238.27
29821 T Shoulder arthroscopy/surgery... 0041 24.57 $1,191.33 $592.08 $238.27
29822 T Shoulder arthroscopy/surgery... 0041 24.57 $1,191.33 $592.08 $238.27
29823 T Shoulder arthroscopy/surgery... 0041 24.57 $1,191.33 $592.08 $238.27
29825 T Shoulder arthroscopy/surgery... 0041 24.57 $1,191.33 $592.08 $238.27
29826 T Shoulder arthroscopy/surgery... 0041 24.57 $1,191.33 $592.08 $238.27
29830 T Elbow arthroscopy.............. 0041 24.57 $1,191.33 $592.08 $238.27
29834 T Elbow arthroscopy/surgery...... 0041 24.57 $1,191.33 $592.08 $238.27
29835 T Elbow arthroscopy/surgery...... 0041 24.57 $1,191.33 $592.08 $238.27
29836 T Elbow arthroscopy/surgery...... 0041 24.57 $1,191.33 $592.08 $238.27
29837 T Elbow arthroscopy/surgery...... 0041 24.57 $1,191.33 $592.08 $238.27
29838 T Elbow arthroscopy/surgery...... 0041 24.57 $1,191.33 $592.08 $238.27
29840 T Wrist arthroscopy.............. 0041 24.57 $1,191.33 $592.08 $238.27
29843 T Wrist arthroscopy/surgery...... 0041 24.57 $1,191.33 $592.08 $238.27
29844 T Wrist arthroscopy/surgery...... 0041 24.57 $1,191.33 $592.08 $238.27
29845 T Wrist arthroscopy/surgery...... 0041 24.57 $1,191.33 $592.08 $238.27
29846 T Wrist arthroscopy/surgery...... 0041 24.57 $1,191.33 $592.08 $238.27
[[Page 18586]]
29847 T Wrist arthroscopy/surgery...... 0041 24.57 $1,191.33 $592.08 $238.27
29848 T Wrist endoscopy/surgery........ 0041 24.57 $1,191.33 $592.08 $238.27
29850 T Knee arthroscopy/surgery....... 0042 29.22 $1,416.79 $804.74 $283.36
29851 T Knee arthroscopy/surgery....... 0042 29.22 $1,416.79 $804.74 $283.36
29855 T Tibial arthroscopy/surgery..... 0042 29.22 $1,416.79 $804.74 $283.36
29856 T Tibial arthroscopy/surgery..... 0042 29.22 $1,416.79 $804.74 $283.36
29860 T Hip arthroscopy, dx............ 0041 24.57 $1,191.33 $592.08 $238.27
29861 T Hip arthroscopy/surgery........ 0041 24.57 $1,191.33 $592.08 $238.27
29862 T Hip arthroscopy/surgery........ 0041 24.57 $1,191.33 $592.08 $238.27
29863 T Hip arthroscopy/surgery........ 0041 24.57 $1,191.33 $592.08 $238.27
29870 T Knee arthroscopy, dx........... 0041 24.57 $1,191.33 $592.08 $238.27
29871 T Knee arthroscopy/drainage...... 0041 24.57 $1,191.33 $592.08 $238.27
29874 T Knee arthroscopy/surgery....... 0041 24.57 $1,191.33 $592.08 $238.27
29875 T Knee arthroscopy/surgery....... 0041 24.57 $1,191.33 $592.08 $238.27
29876 T Knee arthroscopy/surgery....... 0041 24.57 $1,191.33 $592.08 $238.27
29877 T Knee arthroscopy/surgery....... 0041 24.57 $1,191.33 $592.08 $238.27
29879 T Knee arthroscopy/surgery....... 0041 24.57 $1,191.33 $592.08 $238.27
29880 T Knee arthroscopy/surgery....... 0041 24.57 $1,191.33 $592.08 $238.27
29881 T Knee arthroscopy/surgery....... 0041 24.57 $1,191.33 $592.08 $238.27
29882 T Knee arthroscopy/surgery....... 0041 24.57 $1,191.33 $592.08 $238.27
29883 T Knee arthroscopy/surgery....... 0041 24.57 $1,191.33 $592.08 $238.27
29884 T Knee arthroscopy/surgery....... 0041 24.57 $1,191.33 $592.08 $238.27
29885 T Knee arthroscopy/surgery....... 0042 29.22 $1,416.79 $804.74 $283.36
29886 T Knee arthroscopy/surgery....... 0041 24.57 $1,191.33 $592.08 $238.27
29887 T Knee arthroscopy/surgery....... 0041 24.57 $1,191.33 $592.08 $238.27
29888 T Knee arthroscopy/surgery....... 0042 29.22 $1,416.79 $804.74 $283.36
29889 T Knee arthroscopy/surgery....... 0042 29.22 $1,416.79 $804.74 $283.36
29891 T Ankle arthroscopy/surgery...... 0041 24.57 $1,191.33 $592.08 $238.27
29892 T Ankle arthroscopy/surgery...... 0042 29.22 $1,416.79 $804.74 $283.36
29893 T Scope, plantar fasciotomy...... 0055 15.47 $750.10 $355.34 $150.02
29894 T Ankle arthroscopy/surgery...... 0041 24.57 $1,191.33 $592.08 $238.27
29895 T Ankle arthroscopy/surgery...... 0041 24.57 $1,191.33 $592.08 $238.27
29897 T Ankle arthroscopy/surgery...... 0041 24.57 $1,191.33 $592.08 $238.27
29898 T Ankle arthroscopy/surgery...... 0041 24.57 $1,191.33 $592.08 $238.27
29909 T Arthroscopy of joint........... 0041 24.57 $1,191.33 $592.08 $238.27
30000 T Drainage of nose lesion........ 0251 1.68 $81.46 $27.99 $16.29
30020 T Drainage of nose lesion........ 0251 1.68 $81.46 $27.99 $16.29
30100 T Intranasal biopsy.............. 0252 5.18 $251.16 $114.24 $50.23
30110 T Removal of nose polyp(s)....... 0253 12.02 $582.81 $284.00 $116.56
30115 T Removal of nose polyp(s)....... 0253 12.02 $582.81 $284.00 $116.56
30117 T Removal of intranasal lesion... 0253 12.02 $582.81 $284.00 $116.56
30118 T Removal of intranasal lesion... 0254 12.45 $603.66 $272.41 $120.73
30120 T Revision of nose............... 0253 12.02 $582.81 $284.00 $116.56
30124 T Removal of nose lesion......... 0252 5.18 $251.16 $114.24 $50.23
30125 T Removal of nose lesion......... 0256 25.40 $1,231.57 $623.05 $246.31
30130 T Removal of turbinate bones..... 0253 12.02 $582.81 $284.00 $116.56
30140 T Removal of turbinate bones..... 0253 12.02 $582.81 $284.00 $116.56
30150 T Partial removal of nose........ 0256 25.40 $1,231.57 $623.05 $246.31
30160 T Removal of nose................ 0256 25.40 $1,231.57 $623.05 $246.31
30200 T Injection treatment of nose.... 0253 12.02 $582.81 $284.00 $116.56
30210 T Nasal sinus therapy............ 0252 5.18 $251.16 $114.24 $50.23
30220 T Insert nasal septal button..... 0252 5.18 $251.16 $114.24 $50.23
30300 T Remove nasal foreign body...... 0251 1.68 $81.46 $27.99 $16.29
30310 T Remove nasal foreign body...... 0253 12.02 $582.81 $284.00 $116.56
30320 T Remove nasal foreign body...... 0253 12.02 $582.81 $284.00 $116.56
30400 T Reconstruction of nose......... 0256 25.40 $1,231.57 $623.05 $246.31
30410 T Reconstruction of nose......... 0256 25.40 $1,231.57 $623.05 $246.31
30420 T Reconstruction of nose......... 0256 25.40 $1,231.57 $623.05 $246.31
30430 T Revision of nose............... 0254 12.45 $603.66 $272.41 $120.73
30435 T Revision of nose............... 0256 25.40 $1,231.57 $623.05 $246.31
30450 T Revision of nose............... 0256 25.40 $1,231.57 $623.05 $246.31
30460 T Revision of nose............... 0256 25.40 $1,231.57 $623.05 $246.31
30462 T Revision of nose............... 0256 25.40 $1,231.57 $623.05 $246.31
30520 T Repair of nasal septum......... 0256 25.40 $1,231.57 $623.05 $246.31
30540 T Repair nasal defect............ 0256 25.40 $1,231.57 $623.05 $246.31
30545 T Repair nasal defect............ 0256 25.40 $1,231.57 $623.05 $246.31
30560 T Release of nasal adhesions..... 0251 1.68 $81.46 $27.99 $16.29
30580 T Repair upper jaw fistula....... 0256 25.40 $1,231.57 $623.05 $246.31
30600 T Repair mouth/nose fistula...... 0256 25.40 $1,231.57 $623.05 $246.31
30620 T Intranasal reconstruction...... 0256 25.40 $1,231.57 $623.05 $246.31
30630 T Repair nasal septum defect..... 0254 12.45 $603.66 $272.41 $120.73
30801 T Cauterization, inner nose...... 0252 5.18 $251.16 $114.24 $50.23
30802 T Cauterization, inner nose...... 0253 12.02 $582.81 $284.00 $116.56
[[Page 18587]]
30901 T Control of nosebleed........... 0250 2.21 $107.16 $38.54 $21.43
30903 T Control of nosebleed........... 0250 2.21 $107.16 $38.54 $21.43
30905 T Control of nosebleed........... 0250 2.21 $107.16 $38.54 $21.43
30906 T Repeat control of nosebleed.... 0250 2.21 $107.16 $38.54 $21.43
30915 T Ligation, nasal sinus artery... 0091 14.79 $717.12 $348.23 $143.42
30920 T Ligation, upper jaw artery..... 0092 20.21 $979.92 $505.37 $195.98
30930 T Therapy, fracture of nose...... 0253 12.02 $582.81 $284.00 $116.56
30999 T Nasal surgery procedure........ 0251 1.68 $81.46 $27.99 $16.29
31000 T Irrigation, maxillary sinus.... 0251 1.68 $81.46 $27.99 $16.29
31002 T Irrigation, sphenoid sinus..... 0252 5.18 $251.16 $114.24 $50.23
31020 T Exploration, maxillary sinus... 0253 12.02 $582.81 $284.00 $116.56
31030 T Exploration, maxillary sinus... 0256 25.40 $1,231.57 $623.05 $246.31
31032 T Explore sinus, remove polyps... 0256 25.40 $1,231.57 $623.05 $246.31
31040 T Exploration behind upper jaw... 0254 12.45 $603.66 $272.41 $120.73
31050 T Exploration, sphenoid sinus.... 0256 25.40 $1,231.57 $623.05 $246.31
31051 T Sphenoid sinus surgery......... 0256 25.40 $1,231.57 $623.05 $246.31
31070 T Exploration of frontal sinus... 0254 12.45 $603.66 $272.41 $120.73
31075 T Exploration of frontal sinus... 0256 25.40 $1,231.57 $623.05 $246.31
31080 T Removal of frontal sinus....... 0256 25.40 $1,231.57 $623.05 $246.31
31081 T Removal of frontal sinus....... 0256 25.40 $1,231.57 $623.05 $246.31
31084 T Removal of frontal sinus....... 0256 25.40 $1,231.57 $623.05 $246.31
31085 T Removal of frontal sinus....... 0256 25.40 $1,231.57 $623.05 $246.31
31086 T Removal of frontal sinus....... 0256 25.40 $1,231.57 $623.05 $246.31
31087 T Removal of frontal sinus....... 0256 25.40 $1,231.57 $623.05 $246.31
31090 T Exploration of sinuses......... 0256 25.40 $1,231.57 $623.05 $246.31
31200 T Removal of ethmoid sinus....... 0256 25.40 $1,231.57 $623.05 $246.31
31201 T Removal of ethmoid sinus....... 0256 25.40 $1,231.57 $623.05 $246.31
31205 T Removal of ethmoid sinus....... 0256 25.40 $1,231.57 $623.05 $246.31
31225 C Removal of upper jaw........... .............. .............. .............. .............. ..............
31230 C Removal of upper jaw........... .............. .............. .............. .............. ..............
31231 T Nasal endoscopy, dx............ 0071 0.55 $26.67 $14.22 $5.33
31233 T Nasal/sinus endoscopy, dx...... 0072 1.26 $61.09 $41.52 $12.22
31235 T Nasal/sinus endoscopy, dx...... 0074 13.61 $659.91 $347.54 $131.98
31237 T Nasal/sinus endoscopy, surg.... 0074 13.61 $659.91 $347.54 $131.98
31238 T Nasal/sinus endoscopy, surg.... 0074 13.61 $659.91 $347.54 $131.98
31239 T Nasal/sinus endoscopy, surg.... 0075 18.55 $899.44 $467.29 $179.89
31240 T Nasal/sinus endoscopy, surg.... 0074 13.61 $659.91 $347.54 $131.98
31254 T Revision of ethmoid sinus...... 0075 18.55 $899.44 $467.29 $179.89
31255 T Removal of ethmoid sinus....... 0075 18.55 $899.44 $467.29 $179.89
31256 T Exploration maxillary sinus.... 0075 18.55 $899.44 $467.29 $179.89
31267 T Endoscopy, maxillary sinus..... 0075 18.55 $899.44 $467.29 $179.89
31276 T Sinus endoscopy, surgical...... 0075 18.55 $899.44 $467.29 $179.89
31287 T Nasal/sinus endoscopy, surg.... 0075 18.55 $899.44 $467.29 $179.89
31288 T Nasal/sinus endoscopy, surg.... 0075 18.55 $899.44 $467.29 $179.89
31290 C Nasal/sinus endoscopy, surg.... .............. .............. .............. .............. ..............
31291 C Nasal/sinus endoscopy, surg.... .............. .............. .............. .............. ..............
31292 C Nasal/sinus endoscopy, surg.... .............. .............. .............. .............. ..............
31293 C Nasal/sinus endoscopy, surg.... .............. .............. .............. .............. ..............
31294 C Nasal/sinus endoscopy, surg.... .............. .............. .............. .............. ..............
31299 T Sinus surgery procedure........ 0252 5.18 $251.16 $114.24 $50.23
31300 T Removal of larynx lesion....... 0256 25.40 $1,231.57 $623.05 $246.31
31320 T Diagnostic incision, larynx.... 0256 25.40 $1,231.57 $623.05 $246.31
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 T Partial removal of larynx...... 0256 25.40 $1,231.57 $623.05 $246.31
31380 C Partial removal of larynx...... .............. .............. .............. .............. ..............
31382 C Partial removal of larynx...... .............. .............. .............. .............. ..............
31390 C Removal of larynx & pharynx.... .............. .............. .............. .............. ..............
31395 C Reconstruct larynx & pharynx... .............. .............. .............. .............. ..............
31400 T Revision of larynx............. 0256 25.40 $1,231.57 $623.05 $246.31
31420 T Removal of epiglottis.......... 0256 25.40 $1,231.57 $623.05 $246.31
31500 S Insert emergency airway........ 0094 4.51 $218.68 $105.29 $43.74
31502 T Change of windpipe airway...... 0121 2.36 $114.43 $52.53 $22.89
31505 T Diagnostic laryngoscopy........ 0072 1.26 $61.09 $41.52 $12.22
31510 T Laryngoscopy with biopsy....... 0074 13.61 $659.91 $347.54 $131.98
31511 T Remove foreign body, larynx.... 0072 1.26 $61.09 $41.52 $12.22
31512 T Removal of larynx lesion....... 0074 13.61 $659.91 $347.54 $131.98
31513 T Injection into vocal cord...... 0073 4.11 $199.28 $91.07 $39.86
31515 T Laryngoscopy for aspiration.... 0074 13.61 $659.91 $347.54 $131.98
31520 T Diagnostic laryngoscopy........ 0072 1.26 $61.09 $41.52 $12.22
[[Page 18588]]
31525 T Diagnostic laryngoscopy........ 0074 13.61 $659.91 $347.54 $131.98
31526 T Diagnostic laryngoscopy........ 0074 13.61 $659.91 $347.54 $131.98
31527 T Laryngoscopy for treatment..... 0075 18.55 $899.44 $467.29 $179.89
31528 T Laryngoscopy and dilatation.... 0074 13.61 $659.91 $347.54 $131.98
31529 T Laryngoscopy and dilatation.... 0074 13.61 $659.91 $347.54 $131.98
31530 T Operative laryngoscopy......... 0075 18.55 $899.44 $467.29 $179.89
31531 T Operative laryngoscopy......... 0075 18.55 $899.44 $467.29 $179.89
31535 T Operative laryngoscopy......... 0075 18.55 $899.44 $467.29 $179.89
31536 T Operative laryngoscopy......... 0075 18.55 $899.44 $467.29 $179.89
31540 T Operative laryngoscopy......... 0075 18.55 $899.44 $467.29 $179.89
31541 T Operative laryngoscopy......... 0075 18.55 $899.44 $467.29 $179.89
31560 T Operative laryngoscopy......... 0075 18.55 $899.44 $467.29 $179.89
31561 T Operative laryngoscopy......... 0075 18.55 $899.44 $467.29 $179.89
31570 T Laryngoscopy with injection.... 0075 18.55 $899.44 $467.29 $179.89
31571 T Laryngoscopy with injection.... 0075 18.55 $899.44 $467.29 $179.89
31575 T Diagnostic laryngoscopy........ 0071 0.55 $26.67 $14.22 $5.33
31576 T Laryngoscopy with biopsy....... 0074 13.61 $659.91 $347.54 $131.98
31577 T Remove foreign body, larynx.... 0073 4.11 $199.28 $91.07 $39.86
31578 T Removal of larynx lesion....... 0074 13.61 $659.91 $347.54 $131.98
31579 T Diagnostic laryngoscopy........ 0073 4.11 $199.28 $91.07 $39.86
31580 T Revision of larynx............. 0256 25.40 $1,231.57 $623.05 $246.31
31582 C Revision of larynx............. .............. .............. .............. .............. ..............
31584 C Treat larynx fracture.......... .............. .............. .............. .............. ..............
31585 T Treat larynx fracture.......... 0253 12.02 $582.81 $284.00 $116.56
31586 T Treat larynx fracture.......... 0256 25.40 $1,231.57 $623.05 $246.31
31587 C Revision of larynx............. .............. .............. .............. .............. ..............
31588 T Revision of larynx............. 0256 25.40 $1,231.57 $623.05 $246.31
31590 T Reinnervate larynx............. 0256 25.40 $1,231.57 $623.05 $246.31
31595 T Larynx nerve surgery........... 0256 25.40 $1,231.57 $623.05 $246.31
31599 T Larynx surgery procedure....... 0253 12.02 $582.81 $284.00 $116.56
31600 T Incision of windpipe........... 0254 12.45 $603.66 $272.41 $120.73
31601 T Incision of windpipe........... 0254 12.45 $603.66 $272.41 $120.73
31603 T Incision of windpipe........... 0254 12.45 $603.66 $272.41 $120.73
31605 T Incision of windpipe........... 0254 12.45 $603.66 $272.41 $120.73
31610 T Incision of windpipe........... 0254 12.45 $603.66 $272.41 $120.73
31611 T Surgery/speech prosthesis...... 0254 12.45 $603.66 $272.41 $120.73
31612 T Puncture/clear windpipe........ 0253 12.02 $582.81 $284.00 $116.56
31613 T Repair windpipe opening........ 0254 12.45 $603.66 $272.41 $120.73
31614 T Repair windpipe opening........ 0256 25.40 $1,231.57 $623.05 $246.31
31615 T Visualization of windpipe...... 0076 8.06 $390.81 $197.05 $78.16
31622 T Dx bronchoscope/wash........... 0076 8.06 $390.81 $197.05 $78.16
31623 T Dx bronchoscope/brush.......... 0076 8.06 $390.81 $197.05 $78.16
31624 T Dx bronchoscope/lavage......... 0076 8.06 $390.81 $197.05 $78.16
31625 T Bronchoscopy with biopsy....... 0076 8.06 $390.81 $197.05 $78.16
31628 T Bronchoscopy with biopsy....... 0076 8.06 $390.81 $197.05 $78.16
31629 T Bronchoscopy with biopsy....... 0076 8.06 $390.81 $197.05 $78.16
31630 T Bronchoscopy with repair....... 0076 8.06 $390.81 $197.05 $78.16
31631 T Bronchoscopy with dilation..... 0076 8.06 $390.81 $197.05 $78.16
31635 T Remove foreign body, airway.... 0076 8.06 $390.81 $197.05 $78.16
31640 T Bronchoscopy & remove lesion... 0076 8.06 $390.81 $197.05 $78.16
31641 T Bronchoscopy, treat blockage... 0076 8.06 $390.81 $197.05 $78.16
31643 T Diag bronchoscope/catheter..... 0076 8.06 $390.81 $197.05 $78.16
31645 T Bronchoscopy, clear airways.... 0076 8.06 $390.81 $197.05 $78.16
31646 T Bronchoscopy, reclear airway... 0076 8.06 $390.81 $197.05 $78.16
31656 T Bronchoscopy, inj for x-ray.... 0076 8.06 $390.81 $197.05 $78.16
31700 T Insertion of airway catheter... 0072 1.26 $61.09 $41.52 $12.22
31708 N Instill airway contrast dye.... .............. .............. .............. .............. ..............
31710 N Insertion of airway catheter... .............. .............. .............. .............. ..............
31715 N Injection for bronchus x-ray... .............. .............. .............. .............. ..............
31717 T Bronchial brush biopsy......... 0073 4.11 $199.28 $91.07 $39.86
31720 T Clearance of airways........... 0072 1.26 $61.09 $41.52 $12.22
31725 C Clearance of airways........... .............. .............. .............. .............. ..............
31730 T Intro, windpipe wire/tube...... 0073 4.11 $199.28 $91.07 $39.86
31750 T Repair of windpipe............. 0256 25.40 $1,231.57 $623.05 $246.31
31755 T Repair of windpipe............. 0256 25.40 $1,231.57 $623.05 $246.31
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......... .............. .............. .............. .............. ..............
[[Page 18589]]
31800 C Repair of windpipe injury...... .............. .............. .............. .............. ..............
31805 C Repair of windpipe injury...... .............. .............. .............. .............. ..............
31820 T Closure of windpipe lesion..... 0253 12.02 $582.81 $284.00 $116.56
31825 T Repair of windpipe defect...... 0254 12.45 $603.66 $272.41 $120.73
31830 T Revise windpipe scar........... 0254 12.45 $603.66 $272.41 $120.73
31899 T Airways surgical procedure..... 0076 8.06 $390.81 $197.05 $78.16
32000 T Drainage of chest.............. 0070 3.64 $176.49 $79.60 $35.30
32002 T Treatment of collapsed lung.... 0070 3.64 $176.49 $79.60 $35.30
32005 T Treat lung lining chemically... 0070 3.64 $176.49 $79.60 $35.30
32020 T Insertion of chest tube........ 0070 3.64 $176.49 $79.60 $35.30
32035 C Exploration of chest........... .............. .............. .............. .............. ..............
32036 C Exploration of chest........... .............. .............. .............. .............. ..............
32095 C Biopsy through chest wall...... .............. .............. .............. .............. ..............
32100 C Exploration/biopsy of chest.... .............. .............. .............. .............. ..............
32110 C Explore/repair chest........... .............. .............. .............. .............. ..............
32120 C Re-exploration of chest........ .............. .............. .............. .............. ..............
32124 C Explore chest free adhesions... .............. .............. .............. .............. ..............
32140 C Removal of lung lesion(s)...... .............. .............. .............. .............. ..............
32141 C Remove/treat lung lesions...... .............. .............. .............. .............. ..............
32150 C Removal of lung lesion(s)...... .............. .............. .............. .............. ..............
32151 C Remove lung foreign body....... .............. .............. .............. .............. ..............
32160 C Open chest heart massage....... .............. .............. .............. .............. ..............
32200 C Drain, open, lung lesion....... .............. .............. .............. .............. ..............
32201 C Drain, percut, 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 lining..... 0005 5.41 $262.32 $119.75 $52.46
32402 C Open biopsy chest lining....... .............. .............. .............. .............. ..............
32405 T Biopsy, lung or mediastinum.... 0005 5.41 $262.32 $119.75 $52.46
32420 T Puncture/clear lung............ 0070 3.64 $176.49 $79.60 $35.30
32440 C Removal of lung................ .............. .............. .............. .............. ..............
32442 C Sleeve pneumonectomy........... .............. .............. .............. .............. ..............
32445 C Removal of lung................ .............. .............. .............. .............. ..............
32480 C Partial removal of lung........ .............. .............. .............. .............. ..............
32482 C Bilobectomy.................... .............. .............. .............. .............. ..............
32484 C Segmentectomy.................. .............. .............. .............. .............. ..............
32486 C Sleeve lobectomy............... .............. .............. .............. .............. ..............
32488 C Completion pneumonectomy....... .............. .............. .............. .............. ..............
32491 C Lung volume reduction.......... .............. .............. .............. .............. ..............
32500 C Partial removal of lung........ .............. .............. .............. .............. ..............
32501 C Repair bronchus add-on......... .............. .............. .............. .............. ..............
32520 C Remove lung & revise chest..... .............. .............. .............. .............. ..............
32522 C Remove lung & revise chest..... .............. .............. .............. .............. ..............
32525 C Remove lung & revise chest..... .............. .............. .............. .............. ..............
32540 C Removal of lung lesion......... .............. .............. .............. .............. ..............
32601 T Thoracoscopy, diagnostic....... 0076 8.06 $390.81 $197.05 $78.16
32602 T Thoracoscopy, diagnostic....... 0076 8.06 $390.81 $197.05 $78.16
32603 T Thoracoscopy, diagnostic....... 0076 8.06 $390.81 $197.05 $78.16
32604 T Thoracoscopy, diagnostic....... 0076 8.06 $390.81 $197.05 $78.16
32605 T Thoracoscopy, diagnostic....... 0076 8.06 $390.81 $197.05 $78.16
32606 T Thoracoscopy, diagnostic....... 0076 8.06 $390.81 $197.05 $78.16
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........ .............. .............. .............. .............. ..............
[[Page 18590]]
32820 C Reconstruct injured chest...... .............. .............. .............. .............. ..............
32850 C Donor pneumonectomy............ .............. .............. .............. .............. ..............
32851 C Lung transplant, single........ .............. .............. .............. .............. ..............
32852 C Lung transplant with bypass.... .............. .............. .............. .............. ..............
32853 C Lung transplant, double........ .............. .............. .............. .............. ..............
32854 C Lung transplant with bypass.... .............. .............. .............. .............. ..............
32900 C Removal of rib(s).............. .............. .............. .............. .............. ..............
32905 C Revise & repair chest wall..... .............. .............. .............. .............. ..............
32906 C Revise & repair chest wall..... .............. .............. .............. .............. ..............
32940 C Revision of lung............... .............. .............. .............. .............. ..............
32960 T Therapeutic pneumothorax....... 0070 3.64 $176.49 $79.60 $35.30
32997 C Total lung lavage.............. .............. .............. .............. .............. ..............
32999 T Chest surgery procedure........ 0070 3.64 $176.49 $79.60 $35.30
33010 T Drainage of heart sac.......... 0070 3.64 $176.49 $79.60 $35.30
33011 T Repeat drainage of heart sac... 0070 3.64 $176.49 $79.60 $35.30
33015 C Incision of heart sac.......... .............. .............. .............. .............. ..............
33020 C Incision of heart sac.......... .............. .............. .............. .............. ..............
33025 C Incision of heart sac.......... .............. .............. .............. .............. ..............
33030 C Partial removal of heart sac... .............. .............. .............. .............. ..............
33031 C Partial removal of heart sac... .............. .............. .............. .............. ..............
33050 C Removal of heart sac lesion.... .............. .............. .............. .............. ..............
33120 C Removal of heart lesion........ .............. .............. .............. .............. ..............
33130 C Removal of heart lesion........ .............. .............. .............. .............. ..............
33140 C Heart revascularize (tmr)...... .............. .............. .............. .............. ..............
33200 C Insertion of heart pacemaker... .............. .............. .............. .............. ..............
33201 C Insertion of heart pacemaker... .............. .............. .............. .............. ..............
33206 T Insertion of heart pacemaker... 0090 20.96 $1,016.29 $573.04 $203.26
33207 T Insertion of heart pacemaker... 0090 20.96 $1,016.29 $573.04 $203.26
33208 T Insertion of heart pacemaker... 0090 20.96 $1,016.29 $573.04 $203.26
33210 T Insertion of heart electrode... 0089 6.49 $314.68 $130.07 $62.94
33211 T Insertion of heart electrode... 0089 6.49 $314.68 $130.07 $62.94
33212 T Insertion of pulse generator... 0090 20.96 $1,016.29 $573.04 $203.26
33213 T Insertion of pulse generator... 0090 20.96 $1,016.29 $573.04 $203.26
33214 T Upgrade of pacemaker system.... 0090 20.96 $1,016.29 $573.04 $203.26
33216 T Revise eltrd pacing-defib...... 0090 20.96 $1,016.29 $573.04 $203.26
33217 T Revise eltrd pacing-defib...... 0090 20.96 $1,016.29 $573.04 $203.26
33218 T Revise eltrd pacing-defib...... 0090 20.96 $1,016.29 $573.04 $203.26
33220 T Revise eltrd pacing-defib...... 0089 6.49 $314.68 $130.07 $62.94
33222 T Revise pocket, pacemaker....... 0026 12.11 $587.18 $277.92 $117.44
33223 T Revise pocket, pacing-defib.... 0026 12.11 $587.18 $277.92 $117.44
33233 T Removal of pacemaker system.... 0090 20.96 $1,016.29 $573.04 $203.26
33234 T Removal of pacemaker system.... 0090 20.96 $1,016.29 $573.04 $203.26
33235 T Removal pacemaker electrode.... 0090 20.96 $1,016.29 $573.04 $203.26
33236 C Remove electrode/thoracotomy... .............. .............. .............. .............. ..............
33237 C Remove electrode/thoracotomy... .............. .............. .............. .............. ..............
33238 C Remove electrode/thoracotomy... .............. .............. .............. .............. ..............
33240 T Insert pulse generator......... 0090 20.96 $1,016.29 $573.04 $203.26
33241 T Remove pulse generator......... 0089 6.49 $314.68 $130.07 $62.94
33243 C Remove eltrd/thoracotomy....... .............. .............. .............. .............. ..............
33244 T Remove eltrd, transven......... 0090 20.96 $1,016.29 $573.04 $203.26
33245 C Insert epic eltrd pace-defib... .............. .............. .............. .............. ..............
33246 C Insert epic eltrd/generator.... .............. .............. .............. .............. ..............
33249 T Eltrd/insert pace-defib........ 0090 20.96 $1,016.29 $573.04 $203.26
33250 C Ablate heart dysrhythm focus... .............. .............. .............. .............. ..............
33251 C Ablate heart dysrhythm focus... .............. .............. .............. .............. ..............
33253 C Reconstruct atria.............. .............. .............. .............. .............. ..............
33261 C Ablate heart dysrhythm focus... .............. .............. .............. .............. ..............
33282 C Implant pat-active ht record... .............. .............. .............. .............. ..............
33284 C Remove pat-active ht record.... .............. .............. .............. .............. ..............
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.... .............. .............. .............. .............. ..............
[[Page 18591]]
33405 C Replacement of aortic valve.... .............. .............. .............. .............. ..............
33406 C Replacement of aortic valve.... .............. .............. .............. .............. ..............
33410 C Replacement of aortic valve.... .............. .............. .............. .............. ..............
33411 C Replacement of aortic valve.... .............. .............. .............. .............. ..............
33412 C Replacement of aortic valve.... .............. .............. .............. .............. ..............
33413 C Replacement of aortic valve.... .............. .............. .............. .............. ..............
33414 C Repair of aortic valve......... .............. .............. .............. .............. ..............
33415 C Revision, subvalvular tissue... .............. .............. .............. .............. ..............
33416 C Revise ventricle muscle........ .............. .............. .............. .............. ..............
33417 C Repair of aortic valve......... .............. .............. .............. .............. ..............
33420 C Revision of mitral valve....... .............. .............. .............. .............. ..............
33422 C Revision of mitral valve....... .............. .............. .............. .............. ..............
33425 C Repair of mitral valve......... .............. .............. .............. .............. ..............
33426 C Repair of mitral valve......... .............. .............. .............. .............. ..............
33427 C Repair of mitral valve......... .............. .............. .............. .............. ..............
33430 C Replacement of mitral valve.... .............. .............. .............. .............. ..............
33460 C Revision of tricuspid valve.... .............. .............. .............. .............. ..............
33463 C Valvuloplasty, tricuspid....... .............. .............. .............. .............. ..............
33464 C Valvuloplasty, tricuspid....... .............. .............. .............. .............. ..............
33465 C Replace tricuspid valve........ .............. .............. .............. .............. ..............
33468 C Revision of tricuspid valve.... .............. .............. .............. .............. ..............
33470 C Revision of pulmonary valve.... .............. .............. .............. .............. ..............
33471 C Valvotomy, pulmonary valve..... .............. .............. .............. .............. ..............
33472 C Revision of pulmonary valve.... .............. .............. .............. .............. ..............
33474 C Revision of pulmonary valve.... .............. .............. .............. .............. ..............
33475 C Replacement, pulmonary valve... .............. .............. .............. .............. ..............
33476 C Revision of heart chamber...... .............. .............. .............. .............. ..............
33478 C Revision of heart chamber...... .............. .............. .............. .............. ..............
33496 C Repair, prosth valve clot...... .............. .............. .............. .............. ..............
33500 C Repair heart vessel fistula.... .............. .............. .............. .............. ..............
33501 C Repair heart vessel fistula.... .............. .............. .............. .............. ..............
33502 C Coronary artery correction..... .............. .............. .............. .............. ..............
33503 C Coronary artery graft.......... .............. .............. .............. .............. ..............
33504 C Coronary artery graft.......... .............. .............. .............. .............. ..............
33505 C Repair artery w/tunnel......... .............. .............. .............. .............. ..............
33506 C Repair artery, translocation... .............. .............. .............. .............. ..............
33510 C CABG, vein, single............. .............. .............. .............. .............. ..............
33511 C CABG, vein, two................ .............. .............. .............. .............. ..............
33512 C CABG, vein, three.............. .............. .............. .............. .............. ..............
33513 C CABG, vein, four............... .............. .............. .............. .............. ..............
33514 C CABG, vein, five............... .............. .............. .............. .............. ..............
33516 C Cabg, vein, six or more........ .............. .............. .............. .............. ..............
33517 C CABG, artery-vein, single...... .............. .............. .............. .............. ..............
33518 C CABG, artery-vein, two......... .............. .............. .............. .............. ..............
33519 C CABG, artery-vein, three....... .............. .............. .............. .............. ..............
33521 C CABG, artery-vein, four........ .............. .............. .............. .............. ..............
33522 C CABG, artery-vein, five........ .............. .............. .............. .............. ..............
33523 C Cabg, art-vein, six or more.... .............. .............. .............. .............. ..............
33530 C Coronary artery, bypass/reop... .............. .............. .............. .............. ..............
33533 C CABG, arterial, single......... .............. .............. .............. .............. ..............
33534 C CABG, arterial, two............ .............. .............. .............. .............. ..............
33535 C CABG, arterial, three.......... .............. .............. .............. .............. ..............
33536 C Cabg, arterial, four or more... .............. .............. .............. .............. ..............
33542 C Removal of heart lesion........ .............. .............. .............. .............. ..............
33545 C Repair of heart damage......... .............. .............. .............. .............. ..............
33572 C Open coronary endarterectomy... .............. .............. .............. .............. ..............
33600 C Closure of valve............... .............. .............. .............. .............. ..............
33602 C Closure of valve............... .............. .............. .............. .............. ..............
33606 C Anastomosis/artery-aorta....... .............. .............. .............. .............. ..............
33608 C Repair anomaly w/conduit....... .............. .............. .............. .............. ..............
33610 C Repair by enlargement.......... .............. .............. .............. .............. ..............
33611 C Repair double ventricle........ .............. .............. .............. .............. ..............
33612 C Repair double ventricle........ .............. .............. .............. .............. ..............
33615 C Repair, simple fontan.......... .............. .............. .............. .............. ..............
33617 C Repair, 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..... .............. .............. .............. .............. ..............
[[Page 18592]]
33684 C Repair heart septum defect..... .............. .............. .............. .............. ..............
33688 C Repair heart septum defect..... .............. .............. .............. .............. ..............
33690 C Reinforce pulmonary artery..... .............. .............. .............. .............. ..............
33692 C Repair of heart defects........ .............. .............. .............. .............. ..............
33694 C Repair of heart defects........ .............. .............. .............. .............. ..............
33697 C Repair of heart defects........ .............. .............. .............. .............. ..............
33702 C Repair of heart defects........ .............. .............. .............. .............. ..............
33710 C Repair of heart defects........ .............. .............. .............. .............. ..............
33720 C Repair of heart defect......... .............. .............. .............. .............. ..............
33722 C Repair of heart defect......... .............. .............. .............. .............. ..............
33730 C Repair heart-vein defect(s).... .............. .............. .............. .............. ..............
33732 C Repair heart-vein defect....... .............. .............. .............. .............. ..............
33735 C Revision of heart chamber...... .............. .............. .............. .............. ..............
33736 C Revision of heart chamber...... .............. .............. .............. .............. ..............
33737 C Revision of heart chamber...... .............. .............. .............. .............. ..............
33750 C Major vessel shunt............. .............. .............. .............. .............. ..............
33755 C Major vessel shunt............. .............. .............. .............. .............. ..............
33762 C Major vessel shunt............. .............. .............. .............. .............. ..............
33764 C Major vessel shunt & graft..... .............. .............. .............. .............. ..............
33766 C Major vessel shunt............. .............. .............. .............. .............. ..............
33767 C Major vessel shunt............. .............. .............. .............. .............. ..............
33770 C Repair great vessels defect.... .............. .............. .............. .............. ..............
33771 C Repair great vessels defect.... .............. .............. .............. .............. ..............
33774 C Repair great vessels defect.... .............. .............. .............. .............. ..............
33775 C Repair great vessels defect.... .............. .............. .............. .............. ..............
33776 C Repair great vessels defect.... .............. .............. .............. .............. ..............
33777 C Repair great vessels defect.... .............. .............. .............. .............. ..............
33778 C Repair great vessels defect.... .............. .............. .............. .............. ..............
33779 C Repair great vessels defect.... .............. .............. .............. .............. ..............
33780 C Repair great vessels defect.... .............. .............. .............. .............. ..............
33781 C Repair great vessels defect.... .............. .............. .............. .............. ..............
33786 C Repair arterial trunk.......... .............. .............. .............. .............. ..............
33788 C Revision of pulmonary artery... .............. .............. .............. .............. ..............
33800 C Aortic suspension.............. .............. .............. .............. .............. ..............
33802 C Repair vessel defect........... .............. .............. .............. .............. ..............
33803 C Repair vessel defect........... .............. .............. .............. .............. ..............
33813 C Repair septal defect........... .............. .............. .............. .............. ..............
33814 C Repair septal defect........... .............. .............. .............. .............. ..............
33820 C Revise major vessel............ .............. .............. .............. .............. ..............
33822 C Revise major vessel............ .............. .............. .............. .............. ..............
33824 C Revise major vessel............ .............. .............. .............. .............. ..............
33840 C Remove aorta constriction...... .............. .............. .............. .............. ..............
33845 C Remove aorta constriction...... .............. .............. .............. .............. ..............
33851 C Remove aorta constriction...... .............. .............. .............. .............. ..............
33852 C Repair septal defect........... .............. .............. .............. .............. ..............
33853 C Repair septal defect........... .............. .............. .............. .............. ..............
33860 C Ascending aortic graft......... .............. .............. .............. .............. ..............
33861 C Ascending aortic graft......... .............. .............. .............. .............. ..............
33863 C Ascending aortic graft......... .............. .............. .............. .............. ..............
33870 C Transverse aortic arch graft... .............. .............. .............. .............. ..............
33875 C Thoracic aortic graft.......... .............. .............. .............. .............. ..............
33877 C Thoracoabdominal graft......... .............. .............. .............. .............. ..............
33910 C Remove lung artery emboli...... .............. .............. .............. .............. ..............
33915 C Remove lung artery emboli...... .............. .............. .............. .............. ..............
33916 C Surgery of great vessel........ .............. .............. .............. .............. ..............
33917 C Repair pulmonary artery........ .............. .............. .............. .............. ..............
33918 C Repair pulmonary atresia....... .............. .............. .............. .............. ..............
33919 C Repair pulmonary atresia....... .............. .............. .............. .............. ..............
33920 C Repair pulmonary atresia....... .............. .............. .............. .............. ..............
33922 C Transect pulmonary artery...... .............. .............. .............. .............. ..............
33924 C Remove pulmonary shunt......... .............. .............. .............. .............. ..............
33930 C Removal of donor heart/lung.... .............. .............. .............. .............. ..............
33935 C Transplantation, heart/lung.... .............. .............. .............. .............. ..............
33940 C Removal of donor heart......... .............. .............. .............. .............. ..............
33945 C Transplantation of heart....... .............. .............. .............. .............. ..............
33960 C External circulation assist.... .............. .............. .............. .............. ..............
33961 C External circulation assist.... .............. .............. .............. .............. ..............
33968 C Remove aortic assist device.... .............. .............. .............. .............. ..............
33970 C Aortic circulation assist...... .............. .............. .............. .............. ..............
33971 C Aortic circulation assist...... .............. .............. .............. .............. ..............
33973 C Insert balloon device.......... .............. .............. .............. .............. ..............
33974 C Remove intra-aortic balloon.... .............. .............. .............. .............. ..............
33975 C Implant ventricular device..... .............. .............. .............. .............. ..............
[[Page 18593]]
33976 C Implant ventricular device..... .............. .............. .............. .............. ..............
33977 C Remove ventricular device...... .............. .............. .............. .............. ..............
33978 C Remove ventricular device...... .............. .............. .............. .............. ..............
33999 T Cardiac surgery procedure...... 0070 3.64 $176.49 $79.60 $35.30
34001 C Removal of artery clot......... .............. .............. .............. .............. ..............
34051 C Removal of artery clot......... .............. .............. .............. .............. ..............
34101 T Removal of artery clot......... 0088 26.49 $1,284.42 $678.68 $256.88
34111 T Removal of arm artery clot..... 0088 26.49 $1,284.42 $678.68 $256.88
34151 C Removal of artery clot......... .............. .............. .............. .............. ..............
34201 T Removal of artery clot......... 0088 26.49 $1,284.42 $678.68 $256.88
34203 T Removal of leg artery clot..... 0088 26.49 $1,284.42 $678.68 $256.88
34401 C Removal of vein clot........... .............. .............. .............. .............. ..............
34421 C Removal of vein clot........... .............. .............. .............. .............. ..............
34451 C Removal of vein clot........... .............. .............. .............. .............. ..............
34471 T Removal of vein clot........... 0088 26.49 $1,284.42 $678.68 $256.88
34490 T Removal of vein clot........... 0088 26.49 $1,284.42 $678.68 $256.88
34501 T Repair valve, femoral vein..... 0088 26.49 $1,284.42 $678.68 $256.88
34502 C Reconstruct vena cava.......... .............. .............. .............. .............. ..............
34510 T Transposition of vein valve.... 0088 26.49 $1,284.42 $678.68 $256.88
34520 T Cross-over vein graft.......... 0088 26.49 $1,284.42 $678.68 $256.88
34530 T Leg vein fusion................ 0088 26.49 $1,284.42 $678.68 $256.88
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........ .............. .............. .............. .............. ..............
35152 C Repair artery rupture, knee.... .............. .............. .............. .............. ..............
35161 C Repair defect of artery........ .............. .............. .............. .............. ..............
35162 C Repair artery rupture.......... .............. .............. .............. .............. ..............
35180 T Repair blood vessel lesion..... 0081 19.36 $938.71 $434.25 $187.74
35182 C Repair blood vessel lesion..... .............. .............. .............. .............. ..............
35184 T Repair blood vessel lesion..... 0081 19.36 $938.71 $434.25 $187.74
35188 T Repair blood vessel lesion..... 0088 26.49 $1,284.42 $678.68 $256.88
35189 C Repair blood vessel lesion..... .............. .............. .............. .............. ..............
35190 T Repair blood vessel lesion..... 0081 19.36 $938.71 $434.25 $187.74
35201 T Repair blood vessel lesion..... 0081 19.36 $938.71 $434.25 $187.74
35206 T Repair blood vessel lesion..... 0081 19.36 $938.71 $434.25 $187.74
35207 T Repair blood vessel lesion..... 0088 26.49 $1,284.42 $678.68 $256.88
35211 C Repair blood vessel lesion..... .............. .............. .............. .............. ..............
35216 C Repair blood vessel lesion..... .............. .............. .............. .............. ..............
35221 C Repair blood vessel lesion..... .............. .............. .............. .............. ..............
35226 T Repair blood vessel lesion..... 0081 19.36 $938.71 $434.25 $187.74
35231 T Repair blood vessel lesion..... 0081 19.36 $938.71 $434.25 $187.74
35236 T Repair blood vessel lesion..... 0081 19.36 $938.71 $434.25 $187.74
35241 C Repair blood vessel lesion..... .............. .............. .............. .............. ..............
35246 C Repair blood vessel lesion..... .............. .............. .............. .............. ..............
35251 C Repair blood vessel lesion..... .............. .............. .............. .............. ..............
35256 T Repair blood vessel lesion..... 0081 19.36 $938.71 $434.25 $187.74
35261 T Repair blood vessel lesion..... 0081 19.36 $938.71 $434.25 $187.74
35266 T Repair blood vessel lesion..... 0081 19.36 $938.71 $434.25 $187.74
35271 C Repair blood vessel lesion..... .............. .............. .............. .............. ..............
35276 C Repair blood vessel lesion..... .............. .............. .............. .............. ..............
35281 C Repair blood vessel lesion..... .............. .............. .............. .............. ..............
35286 T Repair blood vessel lesion..... 0081 19.36 $938.71 $434.25 $187.74
35301 C Rechanneling of artery......... .............. .............. .............. .............. ..............
[[Page 18594]]
35311 C Rechanneling of artery......... .............. .............. .............. .............. ..............
35321 T Rechanneling of artery......... 0081 19.36 $938.71 $434.25 $187.74
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 T Repair arterial blockage....... 0081 19.36 $938.71 $434.25 $187.74
35460 T Repair venous blockage......... 0081 19.36 $938.71 $434.25 $187.74
35470 T Repair arterial blockage....... 0081 19.36 $938.71 $434.25 $187.74
35471 T Repair arterial blockage....... 0081 19.36 $938.71 $434.25 $187.74
35472 T Repair arterial blockage....... 0081 19.36 $938.71 $434.25 $187.74
35473 T Repair arterial blockage....... 0081 19.36 $938.71 $434.25 $187.74
35474 T Repair arterial blockage....... 0081 19.36 $938.71 $434.25 $187.74
35475 T Repair arterial blockage....... 0081 19.36 $938.71 $434.25 $187.74
35476 T Repair venous blockage......... 0081 19.36 $938.71 $434.25 $187.74
35480 C Atherectomy, open.............. .............. .............. .............. .............. ..............
35481 C Atherectomy, open.............. .............. .............. .............. .............. ..............
35482 C Atherectomy, open.............. .............. .............. .............. .............. ..............
35483 C Atherectomy, open.............. .............. .............. .............. .............. ..............
35484 T Atherectomy, open.............. 0081 19.36 $938.71 $434.25 $187.74
35485 T Atherectomy, open.............. 0081 19.36 $938.71 $434.25 $187.74
35490 T Atherectomy, percutaneous...... 0081 19.36 $938.71 $434.25 $187.74
35491 T Atherectomy, percutaneous...... 0081 19.36 $938.71 $434.25 $187.74
35492 T Atherectomy, percutaneous...... 0081 19.36 $938.71 $434.25 $187.74
35493 T Atherectomy, percutaneous...... 0081 19.36 $938.71 $434.25 $187.74
35494 T Atherectomy, percutaneous...... 0081 19.36 $938.71 $434.25 $187.74
35495 T Atherectomy, percutaneous...... 0081 19.36 $938.71 $434.25 $187.74
35500 T Harvest vein for bypass........ 0081 19.36 $938.71 $434.25 $187.74
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............ .............. .............. .............. .............. ..............
[[Page 18595]]
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......... .............. .............. .............. .............. ..............
35682 C Composite bypass graft......... .............. .............. .............. .............. ..............
35683 C Composite bypass graft......... .............. .............. .............. .............. ..............
35691 C Arterial transposition......... .............. .............. .............. .............. ..............
35693 C Arterial transposition......... .............. .............. .............. .............. ..............
35694 C Arterial transposition......... .............. .............. .............. .............. ..............
35695 C Arterial transposition......... .............. .............. .............. .............. ..............
35700 C Reoperation, bypass graft...... .............. .............. .............. .............. ..............
35701 C Exploration, carotid artery.... .............. .............. .............. .............. ..............
35721 C Exploration, femoral artery.... .............. .............. .............. .............. ..............
35741 C Exploration popliteal artery... .............. .............. .............. .............. ..............
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 graft....... 0088 26.49 $1,284.42 $678.68 $256.88
35876 T Removal of clot in graft....... 0088 26.49 $1,284.42 $678.68 $256.88
35879 T Revise graft w/vein............ 0088 26.49 $1,284.42 $678.68 $256.88
35881 T Revise graft w/vein............ 0088 26.49 $1,284.42 $678.68 $256.88
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 N Injection, venography.......... .............. .............. .............. .............. ..............
36010 N Place catheter in vein......... .............. .............. .............. .............. ..............
36011 N Place catheter in vein......... .............. .............. .............. .............. ..............
36012 N Place catheter in vein......... .............. .............. .............. .............. ..............
36013 N Place catheter in artery....... .............. .............. .............. .............. ..............
36014 N Place catheter in artery....... .............. .............. .............. .............. ..............
36015 N Place catheter in artery....... .............. .............. .............. .............. ..............
36100 N Establish access to artery..... .............. .............. .............. .............. ..............
36120 N Establish access to artery..... .............. .............. .............. .............. ..............
36140 N Establish access to artery..... .............. .............. .............. .............. ..............
36145 N Artery to vein shunt........... .............. .............. .............. .............. ..............
36160 N Establish access to aorta...... .............. .............. .............. .............. ..............
36200 N Place catheter in aorta........ .............. .............. .............. .............. ..............
36215 N Place catheter in artery....... .............. .............. .............. .............. ..............
36216 N Place catheter in artery....... .............. .............. .............. .............. ..............
36217 N Place catheter in artery....... .............. .............. .............. .............. ..............
36218 N Place catheter in artery....... .............. .............. .............. .............. ..............
36245 N Place catheter in artery....... .............. .............. .............. .............. ..............
36246 N Place catheter in artery....... .............. .............. .............. .............. ..............
36247 N Place catheter in artery....... .............. .............. .............. .............. ..............
36248 N Place catheter in artery....... .............. .............. .............. .............. ..............
36260 T Insertion of infusion pump..... 0093 17.95 $870.34 $422.33 $174.07
36261 T Revision of infusion pump...... 0089 6.49 $314.68 $130.07 $62.94
36262 T Removal of infusion pump....... 0089 6.49 $314.68 $130.07 $62.94
36299 T Vessel injection procedure..... 0089 6.49 $314.68 $130.07 $62.94
36400 N Drawing blood.................. .............. .............. .............. .............. ..............
36405 N Drawing blood.................. .............. .............. .............. .............. ..............
36406 N Drawing blood.................. .............. .............. .............. .............. ..............
[[Page 18596]]
36410 N Drawing blood.................. .............. .............. .............. .............. ..............
36415 E Drawing blood.................. .............. .............. .............. .............. ..............
36420 T Establish access to vein....... 0032 5.40 $261.83 $119.52 $52.37
36425 T Establish access to vein....... 0032 5.40 $261.83 $119.52 $52.37
36430 S Blood transfusion service...... 0110 5.83 $282.68 $122.73 $56.54
36440 S Blood transfusion service...... 0110 5.83 $282.68 $122.73 $56.54
36450 S Exchange transfusion service... 0110 5.83 $282.68 $122.73 $56.54
36455 S Exchange transfusion service... 0110 5.83 $282.68 $122.73 $56.54
36460 S Transfusion service, fetal..... 0110 5.83 $282.68 $122.73 $56.54
36468 T Injection(s), spider veins..... 0098 1.19 $57.70 $20.88 $11.54
36469 T Injection(s), spider veins..... 0098 1.19 $57.70 $20.88 $11.54
36470 T Injection therapy of vein...... 0098 1.19 $57.70 $20.88 $11.54
36471 T Injection therapy of veins..... 0098 1.19 $57.70 $20.88 $11.54
36481 N Insertion of catheter, vein.... .............. .............. .............. .............. ..............
36488 T Insertion of catheter, vein.... 0032 5.40 $261.83 $119.52 $52.37
36489 T Insertion of catheter, vein.... 0032 5.40 $261.83 $119.52 $52.37
36490 T Insertion of catheter, vein.... 0032 5.40 $261.83 $119.52 $52.37
36491 T Insertion of catheter, vein.... 0032 5.40 $261.83 $119.52 $52.37
36493 T Repositioning of cvc........... 0032 5.40 $261.83 $119.52 $52.37
36500 N Insertion of catheter, vein.... .............. .............. .............. .............. ..............
36510 C Insertion of catheter, vein.... .............. .............. .............. .............. ..............
36520 S Plasma and/or cell exchange.... 0111 14.17 $687.06 $300.74 $137.41
36521 S Apheresis w/adsorp/reinfuse.... 0111 14.17 $687.06 $300.74 $137.41
36522 S Photopheresis.................. 0112 39.60 $1,920.09 $663.65 $384.02
36530 T Insertion of infusion pump..... 0093 17.95 $870.34 $422.33 $174.07
36531 T Revision of infusion pump...... 0089 6.49 $314.68 $130.07 $62.94
36532 T Removal of infusion pump....... 0089 6.49 $314.68 $130.07 $62.94
36533 T Insertion of access device..... 0093 17.95 $870.34 $422.33 $174.07
36534 T Revision of access device...... 0089 6.49 $314.68 $130.07 $62.94
36535 T Removal of access device....... 0089 6.49 $314.68 $130.07 $62.94
36550 C Declot vascular device......... .............. .............. .............. .............. ..............
36600 N Withdrawal of arterial blood... .............. .............. .............. .............. ..............
36620 N Insertion catheter, artery..... .............. .............. .............. .............. ..............
36625 N Insertion catheter, artery..... .............. .............. .............. .............. ..............
36640 T Insertion catheter, artery..... 0032 5.40 $261.83 $119.52 $52.37
36660 C Insertion catheter, artery..... .............. .............. .............. .............. ..............
36680 S Insert needle, bone cavity..... 0120 1.66 $80.49 $42.67 $16.10
36800 T Insertion of cannula........... 0093 17.95 $870.34 $422.33 $174.07
36810 T Insertion of cannula........... 0093 17.95 $870.34 $422.33 $174.07
36815 T Insertion of cannula........... 0093 17.95 $870.34 $422.33 $174.07
36819 T Av fusion by basilic vein...... 0093 17.95 $870.34 $422.33 $174.07
36821 T Av fusion direct any site...... 0088 26.49 $1,284.42 $678.68 $256.88
36822 C Insertion of cannula(s)........ .............. .............. .............. .............. ..............
36823 C Insertion of cannula(s)........ .............. .............. .............. .............. ..............
36825 T Artery-vein graft.............. 0088 26.49 $1,284.42 $678.68 $256.88
36830 T Artery-vein graft.............. 0088 26.49 $1,284.42 $678.68 $256.88
36831 T Av fistula excision............ 0088 26.49 $1,284.42 $678.68 $256.88
36832 T Av fistula revision............ 0088 26.49 $1,284.42 $678.68 $256.88
36833 T Av fistula revision............ 0088 26.49 $1,284.42 $678.68 $256.88
36834 C Repair A-V aneurysm............ .............. .............. .............. .............. ..............
36835 T Artery to vein shunt........... 0093 17.95 $870.34 $422.33 $174.07
36860 T External cannula declotting.... 0090 20.96 $1,016.29 $573.04 $203.26
36861 T Cannula declotting............. 0090 20.96 $1,016.29 $573.04 $203.26
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... .............. .............. .............. .............. ..............
37203 T Transcatheter retrieval........ 0089 6.49 $314.68 $130.07 $62.94
37204 T Transcatheter occlusion........ 0081 19.36 $938.71 $434.25 $187.74
37205 T Transcatheter stent............ 0081 19.36 $938.71 $434.25 $187.74
37206 T Transcatheter stent add-on..... 0081 19.36 $938.71 $434.25 $187.74
37207 T Transcatheter stent............ 0081 19.36 $938.71 $434.25 $187.74
37208 T Transcatheter stent add-on..... 0081 19.36 $938.71 $434.25 $187.74
37209 T Exchange arterial catheter..... 0081 19.36 $938.71 $434.25 $187.74
37250 T Iv us first vessel add-on...... 0081 19.36 $938.71 $434.25 $187.74
37251 T Iv us each add vessel add-on... 0081 19.36 $938.71 $434.25 $187.74
37565 T Ligation of neck vein.......... 0081 19.36 $938.71 $434.25 $187.74
37600 T Ligation of neck artery........ 0081 19.36 $938.71 $434.25 $187.74
[[Page 18597]]
37605 T Ligation of neck artery........ 0091 14.79 $717.12 $348.23 $143.42
37606 T Ligation of neck artery........ 0091 14.79 $717.12 $348.23 $143.42
37607 T Ligation of a-v fistula........ 0092 20.21 $979.92 $505.37 $195.98
37609 T Temporal artery procedure...... 0020 6.51 $315.65 $130.53 $63.13
37615 T Ligation of neck artery........ 0091 14.79 $717.12 $348.23 $143.42
37616 C Ligation of chest artery....... .............. .............. .............. .............. ..............
37617 C Ligation of abdomen artery..... .............. .............. .............. .............. ..............
37618 E Ligation of extremity artery... .............. .............. .............. .............. ..............
37620 C Revision of major vein......... .............. .............. .............. .............. ..............
37650 T Revision of major vein......... 0091 14.79 $717.12 $348.23 $143.42
37660 C Revision of major vein......... .............. .............. .............. .............. ..............
37700 T Revise leg vein................ 0091 14.79 $717.12 $348.23 $143.42
37720 T Removal of leg vein............ 0092 20.21 $979.92 $505.37 $195.98
37730 T Removal of leg veins........... 0092 20.21 $979.92 $505.37 $195.98
37735 T Removal of leg veins/lesion.... 0092 20.21 $979.92 $505.37 $195.98
37760 T Revision of leg veins.......... 0091 14.79 $717.12 $348.23 $143.42
37780 T Revision of leg vein........... 0091 14.79 $717.12 $348.23 $143.42
37785 T Revise secondary varicosity.... 0091 14.79 $717.12 $348.23 $143.42
37788 C Revascularization, penis....... .............. .............. .............. .............. ..............
37790 T Penile venous occlusion........ 0181 32.37 $1,569.53 $906.36 $313.91
37799 T Vascular surgery procedure..... 0020 6.51 $315.65 $130.53 $63.13
38100 C Removal of spleen, total....... .............. .............. .............. .............. ..............
38101 C Removal of spleen, partial..... .............. .............. .............. .............. ..............
38102 C Removal of spleen, total....... .............. .............. .............. .............. ..............
38115 C Repair of ruptured spleen...... .............. .............. .............. .............. ..............
38120 T Laparoscopy, splenectomy....... 0131 41.81 $2,027.24 $1,089.88 $405.45
38129 T Laparoscope proc, spleen....... 0130 25.36 $1,229.63 $659.53 $245.93
38200 N Injection for spleen x-ray..... .............. .............. .............. .............. ..............
38230 S Bone marrow collection......... 0109 4.13 $200.25 $40.05 $40.05
38231 S Stem cell collection........... 0111 14.17 $687.06 $300.74 $137.41
38240 S Bone marrow/stem transplant.... 0109 4.13 $200.25 $40.05 $40.05
38241 S Bone marrow/stem transplant.... 0109 4.13 $200.25 $40.05 $40.05
38300 T Drainage, lymph node lesion.... 0008 6.15 $298.20 $113.67 $59.64
38305 T Drainage, lymph node lesion.... 0008 6.15 $298.20 $113.67 $59.64
38308 T Incision of lymph channels..... 0113 13.89 $673.49 $326.55 $134.70
38380 C Thoracic duct procedure........ .............. .............. .............. .............. ..............
38381 C Thoracic duct procedure........ .............. .............. .............. .............. ..............
38382 C Thoracic duct procedure........ .............. .............. .............. .............. ..............
38500 T Biopsy/removal, lymph nodes.... 0113 13.89 $673.49 $326.55 $134.70
38505 T Needle biopsy, lymph nodes..... 0005 5.41 $262.32 $119.75 $52.46
38510 T Biopsy/removal, lymph nodes.... 0113 13.89 $673.49 $326.55 $134.70
38520 T Biopsy/removal, lymph nodes.... 0113 13.89 $673.49 $326.55 $134.70
38525 T Biopsy/removal, lymph nodes.... 0113 13.89 $673.49 $326.55 $134.70
38530 T Biopsy/removal, lymph nodes.... 0113 13.89 $673.49 $326.55 $134.70
38542 T Explore deep node(s), neck..... 0114 19.56 $948.41 $493.78 $189.68
38550 T Removal, neck/armpit lesion.... 0113 13.89 $673.49 $326.55 $134.70
38555 T Removal, neck/armpit lesion.... 0114 19.56 $948.41 $493.78 $189.68
38562 C Removal, pelvic lymph nodes.... .............. .............. .............. .............. ..............
38564 C Removal, abdomen lymph nodes... .............. .............. .............. .............. ..............
38570 T Laparoscopy, lymph node biop... 0131 41.81 $2,027.24 $1,089.88 $405.45
38571 T Laparoscopy, lymphadenectomy... 0132 48.91 $2,371.50 $1,239.22 $474.30
38572 T Laparoscopy, lymphadenectomy... 0131 41.81 $2,027.24 $1,089.88 $405.45
38589 T Laparoscope proc, lymphatic.... 0130 25.36 $1,229.63 $659.53 $245.93
38700 C Removal of lymph nodes, neck... .............. .............. .............. .............. ..............
38720 T Removal of lymph nodes, neck... 0114 19.56 $948.41 $493.78 $189.68
38724 C Removal of lymph nodes, neck... .............. .............. .............. .............. ..............
38740 T Remove armpit lymph nodes...... 0114 19.56 $948.41 $493.78 $189.68
38745 T Remove armpit lymph nodes...... 0114 19.56 $948.41 $493.78 $189.68
38746 C Remove thoracic lymph nodes.... .............. .............. .............. .............. ..............
38747 C Remove abdominal lymph nodes... .............. .............. .............. .............. ..............
38760 T Remove groin lymph nodes....... 0114 19.56 $948.41 $493.78 $189.68
38765 C Remove groin lymph nodes....... .............. .............. .............. .............. ..............
38770 C Remove pelvis lymph nodes...... .............. .............. .............. .............. ..............
38780 C Remove abdomen lymph nodes..... .............. .............. .............. .............. ..............
38790 N Inject for lymphatic x-ray..... .............. .............. .............. .............. ..............
38792 N Identify sentinel node......... .............. .............. .............. .............. ..............
38794 N Access thoracic lymph duct..... .............. .............. .............. .............. ..............
38999 T Blood/lymph system procedure... 0008 6.15 $298.20 $113.67 $59.64
39000 C Exploration of chest........... .............. .............. .............. .............. ..............
39010 C Exploration of chest........... .............. .............. .............. .............. ..............
39200 C Removal chest lesion........... .............. .............. .............. .............. ..............
39220 C Removal chest lesion........... .............. .............. .............. .............. ..............
39400 T Visualization of chest......... 0076 8.06 $390.81 $197.05 $78.16
[[Page 18598]]
39499 C Chest procedure................ .............. .............. .............. .............. ..............
39501 C Repair diaphragm laceration.... .............. .............. .............. .............. ..............
39502 C Repair paraesophageal hernia... .............. .............. .............. .............. ..............
39503 C Repair of diaphragm hernia..... .............. .............. .............. .............. ..............
39520 C Repair of diaphragm hernia..... .............. .............. .............. .............. ..............
39530 C Repair of diaphragm hernia..... .............. .............. .............. .............. ..............
39531 C Repair of diaphragm hernia..... .............. .............. .............. .............. ..............
39540 C Repair of diaphragm hernia..... .............. .............. .............. .............. ..............
39541 C Repair of diaphragm hernia..... .............. .............. .............. .............. ..............
39545 C Revision of diaphragm.......... .............. .............. .............. .............. ..............
39560 C Resect diaphragm, simple....... .............. .............. .............. .............. ..............
39561 C Resect diaphragm, complex...... .............. .............. .............. .............. ..............
39599 C Diaphragm surgery procedure.... .............. .............. .............. .............. ..............
40490 T Biopsy of lip.................. 0252 5.18 $251.16 $114.24 $50.23
40500 T Partial excision of lip........ 0253 12.02 $582.81 $284.00 $116.56
40510 T Partial excision of lip........ 0254 12.45 $603.66 $272.41 $120.73
40520 T Partial excision of lip........ 0253 12.02 $582.81 $284.00 $116.56
40525 T Reconstruct lip with flap...... 0254 12.45 $603.66 $272.41 $120.73
40527 T Reconstruct lip with flap...... 0254 12.45 $603.66 $272.41 $120.73
40530 T Partial removal of lip......... 0254 12.45 $603.66 $272.41 $120.73
40650 T Repair lip..................... 0253 12.02 $582.81 $284.00 $116.56
40652 T Repair lip..................... 0253 12.02 $582.81 $284.00 $116.56
40654 T Repair lip..................... 0254 12.45 $603.66 $272.41 $120.73
40700 T Repair cleft lip/nasal......... 0256 25.40 $1,231.57 $623.05 $246.31
40701 T Repair cleft lip/nasal......... 0256 25.40 $1,231.57 $623.05 $246.31
40702 T Repair cleft lip/nasal......... 0256 25.40 $1,231.57 $623.05 $246.31
40720 T Repair cleft lip/nasal......... 0256 25.40 $1,231.57 $623.05 $246.31
40761 T Repair cleft lip/nasal......... 0256 25.40 $1,231.57 $623.05 $246.31
40799 T Lip surgery procedure.......... 0253 12.02 $582.81 $284.00 $116.56
40800 T Drainage of mouth lesion....... 0251 1.68 $81.46 $27.99 $16.29
40801 T Drainage of mouth lesion....... 0252 5.18 $251.16 $114.24 $50.23
40804 T Removal, foreign body, mouth... 0251 1.68 $81.46 $27.99 $16.29
40805 T Removal, foreign body, mouth... 0252 5.18 $251.16 $114.24 $50.23
40806 T Incision of lip fold........... 0251 1.68 $81.46 $27.99 $16.29
40808 T Biopsy of mouth lesion......... 0251 1.68 $81.46 $27.99 $16.29
40810 T Excision of mouth lesion....... 0253 12.02 $582.81 $284.00 $116.56
40812 T Excise/repair mouth lesion..... 0252 5.18 $251.16 $114.24 $50.23
40814 T Excise/repair mouth lesion..... 0253 12.02 $582.81 $284.00 $116.56
40816 T Excision of mouth lesion....... 0253 12.02 $582.81 $284.00 $116.56
40818 T Excise oral mucosa for graft... 0251 1.68 $81.46 $27.99 $16.29
40819 T Excise lip or cheek fold....... 0252 5.18 $251.16 $114.24 $50.23
40820 T Treatment of mouth lesion...... 0253 12.02 $582.81 $284.00 $116.56
40830 T Repair mouth laceration........ 0251 1.68 $81.46 $27.99 $16.29
40831 T Repair mouth laceration........ 0253 12.02 $582.81 $284.00 $116.56
40840 T Reconstruction of mouth........ 0254 12.45 $603.66 $272.41 $120.73
40842 T Reconstruction of mouth........ 0254 12.45 $603.66 $272.41 $120.73
40843 T Reconstruction of mouth........ 0254 12.45 $603.66 $272.41 $120.73
40844 T Reconstruction of mouth........ 0256 25.40 $1,231.57 $623.05 $246.31
40845 T Reconstruction of mouth........ 0256 25.40 $1,231.57 $623.05 $246.31
40899 T Mouth surgery procedure........ 0252 5.18 $251.16 $114.24 $50.23
41000 T Drainage of mouth lesion....... 0253 12.02 $582.81 $284.00 $116.56
41005 T Drainage of mouth lesion....... 0251 1.68 $81.46 $27.99 $16.29
41006 T Drainage of mouth lesion....... 0253 12.02 $582.81 $284.00 $116.56
41007 T Drainage of mouth lesion....... 0253 12.02 $582.81 $284.00 $116.56
41008 T Drainage of mouth lesion....... 0253 12.02 $582.81 $284.00 $116.56
41009 T Drainage of mouth lesion....... 0251 1.68 $81.46 $27.99 $16.29
41010 T Incision of tongue fold........ 0253 12.02 $582.81 $284.00 $116.56
41015 T Drainage of mouth lesion....... 0252 5.18 $251.16 $114.24 $50.23
41016 T Drainage of mouth lesion....... 0253 12.02 $582.81 $284.00 $116.56
41017 T Drainage of mouth lesion....... 0253 12.02 $582.81 $284.00 $116.56
41018 T Drainage of mouth lesion....... 0253 12.02 $582.81 $284.00 $116.56
41100 T Biopsy of tongue............... 0252 5.18 $251.16 $114.24 $50.23
41105 T Biopsy of tongue............... 0253 12.02 $582.81 $284.00 $116.56
41108 T Biopsy of floor of mouth....... 0252 5.18 $251.16 $114.24 $50.23
41110 T Excision of tongue lesion...... 0253 12.02 $582.81 $284.00 $116.56
41112 T Excision of tongue lesion...... 0253 12.02 $582.81 $284.00 $116.56
41113 T Excision of tongue lesion...... 0253 12.02 $582.81 $284.00 $116.56
41114 T Excision of tongue lesion...... 0254 12.45 $603.66 $272.41 $120.73
41115 T Excision of tongue fold........ 0253 12.02 $582.81 $284.00 $116.56
41116 T Excision of mouth lesion....... 0253 12.02 $582.81 $284.00 $116.56
41120 T Partial removal of tongue...... 0256 25.40 $1,231.57 $623.05 $246.31
41130 C Partial removal of tongue...... .............. .............. .............. .............. ..............
41135 C Tongue and neck surgery........ .............. .............. .............. .............. ..............
[[Page 18599]]
41140 C Removal of tongue.............. .............. .............. .............. .............. ..............
41145 C Tongue removal, neck surgery... .............. .............. .............. .............. ..............
41150 C Tongue, mouth, jaw surgery..... .............. .............. .............. .............. ..............
41153 C Tongue, mouth, neck surgery.... .............. .............. .............. .............. ..............
41155 C Tongue, jaw, & neck surgery.... .............. .............. .............. .............. ..............
41250 T Repair tongue laceration....... 0251 1.68 $81.46 $27.99 $16.29
41251 T Repair tongue laceration....... 0253 12.02 $582.81 $284.00 $116.56
41252 T Repair tongue laceration....... 0253 12.02 $582.81 $284.00 $116.56
41500 T Fixation of tongue............. 0253 12.02 $582.81 $284.00 $116.56
41510 T Tongue to lip surgery.......... 0253 12.02 $582.81 $284.00 $116.56
41520 T Reconstruction, tongue fold.... 0253 12.02 $582.81 $284.00 $116.56
41599 T Tongue and mouth surgery....... 0251 1.68 $81.46 $27.99 $16.29
41800 T Drainage of gum lesion......... 0251 1.68 $81.46 $27.99 $16.29
41805 T Removal foreign body, gum...... 0253 12.02 $582.81 $284.00 $116.56
41806 T Removal foreign body, jawbone.. 0253 12.02 $582.81 $284.00 $116.56
41820 T Excision, gum, each quadrant... 0252 5.18 $251.16 $114.24 $50.23
41821 T Excision of gum flap........... 0252 5.18 $251.16 $114.24 $50.23
41822 T Excision of gum lesion......... 0253 12.02 $582.81 $284.00 $116.56
41823 T Excision of gum lesion......... 0253 12.02 $582.81 $284.00 $116.56
41825 T Excision of gum lesion......... 0253 12.02 $582.81 $284.00 $116.56
41826 T Excision of gum lesion......... 0253 12.02 $582.81 $284.00 $116.56
41827 T Excision of gum lesion......... 0253 12.02 $582.81 $284.00 $116.56
41828 T Excision of gum lesion......... 0253 12.02 $582.81 $284.00 $116.56
41830 T Removal of gum tissue.......... 0253 12.02 $582.81 $284.00 $116.56
41850 T Treatment of gum lesion........ 0253 12.02 $582.81 $284.00 $116.56
41870 T Gum graft...................... 0253 12.02 $582.81 $284.00 $116.56
41872 T Repair gum..................... 0253 12.02 $582.81 $284.00 $116.56
41874 T Repair tooth socket............ 0253 12.02 $582.81 $284.00 $116.56
41899 T Dental surgery procedure....... 0253 12.02 $582.81 $284.00 $116.56
42000 T Drainage mouth roof lesion..... 0251 1.68 $81.46 $27.99 $16.29
42100 T Biopsy roof of mouth........... 0252 5.18 $251.16 $114.24 $50.23
42104 T Excision lesion, mouth roof.... 0253 12.02 $582.81 $284.00 $116.56
42106 T Excision lesion, mouth roof.... 0253 12.02 $582.81 $284.00 $116.56
42107 T Excision lesion, mouth roof.... 0254 12.45 $603.66 $272.41 $120.73
42120 T Remove palate/lesion........... 0256 25.40 $1,231.57 $623.05 $246.31
42140 T Excision of uvula.............. 0252 5.18 $251.16 $114.24 $50.23
42145 T Repair palate, pharynx/uvula... 0254 12.45 $603.66 $272.41 $120.73
42160 T Treatment mouth roof lesion.... 0253 12.02 $582.81 $284.00 $116.56
42180 T Repair palate.................. 0251 1.68 $81.46 $27.99 $16.29
42182 T Repair palate.................. 0256 25.40 $1,231.57 $623.05 $246.31
42200 T Reconstruct cleft palate....... 0256 25.40 $1,231.57 $623.05 $246.31
42205 T Reconstruct cleft palate....... 0256 25.40 $1,231.57 $623.05 $246.31
42210 T Reconstruct cleft palate....... 0256 25.40 $1,231.57 $623.05 $246.31
42215 T Reconstruct cleft palate....... 0256 25.40 $1,231.57 $623.05 $246.31
42220 T Reconstruct cleft palate....... 0256 25.40 $1,231.57 $623.05 $246.31
42225 T Reconstruct cleft palate....... 0256 25.40 $1,231.57 $623.05 $246.31
42226 T Lengthening of palate.......... 0256 25.40 $1,231.57 $623.05 $246.31
42227 T Lengthening of palate.......... 0256 25.40 $1,231.57 $623.05 $246.31
42235 T Repair palate.................. 0254 12.45 $603.66 $272.41 $120.73
42260 T Repair nose to lip fistula..... 0253 12.02 $582.81 $284.00 $116.56
42280 T Preparation, palate mold....... 0251 1.68 $81.46 $27.99 $16.29
42281 T Insertion, palate prosthesis... 0253 12.02 $582.81 $284.00 $116.56
42299 T Palate/uvula surgery........... 0251 1.68 $81.46 $27.99 $16.29
42300 T Drainage of salivary gland..... 0253 12.02 $582.81 $284.00 $116.56
42305 T Drainage of salivary gland..... 0253 12.02 $582.81 $284.00 $116.56
42310 T Drainage of salivary gland..... 0251 1.68 $81.46 $27.99 $16.29
42320 T Drainage of salivary gland..... 0251 1.68 $81.46 $27.99 $16.29
42325 T Create salivary cyst drain..... 0252 5.18 $251.16 $114.24 $50.23
42326 T Create salivary cyst drain..... 0252 5.18 $251.16 $114.24 $50.23
42330 T Removal of salivary stone...... 0252 5.18 $251.16 $114.24 $50.23
42335 T Removal of salivary stone...... 0253 12.02 $582.81 $284.00 $116.56
42340 T Removal of salivary stone...... 0253 12.02 $582.81 $284.00 $116.56
42400 T Biopsy of salivary gland....... 0004 1.84 $89.22 $32.57 $17.84
42405 T Biopsy of salivary gland....... 0253 12.02 $582.81 $284.00 $116.56
42408 T Excision of salivary cyst...... 0253 12.02 $582.81 $284.00 $116.56
42409 T Drainage of salivary cyst...... 0253 12.02 $582.81 $284.00 $116.56
42410 T Excise parotid gland/lesion.... 0256 25.40 $1,231.57 $623.05 $246.31
42415 T Excise parotid gland/lesion.... 0256 25.40 $1,231.57 $623.05 $246.31
42420 T Excise parotid gland/lesion.... 0256 25.40 $1,231.57 $623.05 $246.31
42425 T Excise parotid gland/lesion.... 0256 25.40 $1,231.57 $623.05 $246.31
42426 C Excise parotid gland/lesion.... .............. .............. .............. .............. ..............
42440 T Excise submaxillary gland...... 0256 25.40 $1,231.57 $623.05 $246.31
42450 T Excise sublingual gland........ 0253 12.02 $582.81 $284.00 $116.56
[[Page 18600]]
42500 T Repair salivary duct........... 0254 12.45 $603.66 $272.41 $120.73
42505 T Repair salivary duct........... 0256 25.40 $1,231.57 $623.05 $246.31
42507 T Parotid duct diversion......... 0256 25.40 $1,231.57 $623.05 $246.31
42508 T Parotid duct diversion......... 0256 25.40 $1,231.57 $623.05 $246.31
42509 T Parotid duct diversion......... 0256 25.40 $1,231.57 $623.05 $246.31
42510 T Parotid duct diversion......... 0256 25.40 $1,231.57 $623.05 $246.31
42550 N Injection for salivary x-ray... .............. .............. .............. .............. ..............
42600 T Closure of salivary fistula.... 0253 12.02 $582.81 $284.00 $116.56
42650 T Dilation of salivary duct...... 0252 5.18 $251.16 $114.24 $50.23
42660 T Dilation of salivary duct...... 0252 5.18 $251.16 $114.24 $50.23
42665 T Ligation of salivary duct...... 0253 12.02 $582.81 $284.00 $116.56
42699 T Salivary surgery procedure..... 0253 12.02 $582.81 $284.00 $116.56
42700 T Drainage of tonsil abscess..... 0251 1.68 $81.46 $27.99 $16.29
42720 T Drainage of throat abscess..... 0253 12.02 $582.81 $284.00 $116.56
42725 T Drainage of throat abscess..... 0256 25.40 $1,231.57 $623.05 $246.31
42800 T Biopsy of throat............... 0252 5.18 $251.16 $114.24 $50.23
42802 T Biopsy of throat............... 0253 12.02 $582.81 $284.00 $116.56
42804 T Biopsy of upper nose/throat.... 0253 12.02 $582.81 $284.00 $116.56
42806 T Biopsy of upper nose/throat.... 0253 12.02 $582.81 $284.00 $116.56
42808 T Excise pharynx lesion.......... 0253 12.02 $582.81 $284.00 $116.56
42809 T Remove pharynx foreign body.... 0251 1.68 $81.46 $27.99 $16.29
42810 T Excision of neck cyst.......... 0253 12.02 $582.81 $284.00 $116.56
42815 T Excision of neck cyst.......... 0256 25.40 $1,231.57 $623.05 $246.31
42820 T Remove tonsils and adenoids.... 0258 18.62 $902.83 $462.81 $180.57
42821 T Remove tonsils and adenoids.... 0258 18.62 $902.83 $462.81 $180.57
42825 T Removal of tonsils............. 0258 18.62 $902.83 $462.81 $180.57
42826 T Removal of tonsils............. 0258 18.62 $902.83 $462.81 $180.57
42830 T Removal of adenoids............ 0258 18.62 $902.83 $462.81 $180.57
42831 T Removal of adenoids............ 0258 18.62 $902.83 $462.81 $180.57
42835 T Removal of adenoids............ 0258 18.62 $902.83 $462.81 $180.57
42836 T Removal of adenoids............ 0258 18.62 $902.83 $462.81 $180.57
42842 C Extensive surgery of throat.... .............. .............. .............. .............. ..............
42844 T Extensive surgery of throat.... 0256 25.40 $1,231.57 $623.05 $246.31
42845 C Extensive surgery of throat.... .............. .............. .............. .............. ..............
42860 T Excision of tonsil tags........ 0258 18.62 $902.83 $462.81 $180.57
42870 T Excision of lingual tonsil..... 0258 18.62 $902.83 $462.81 $180.57
42890 T Partial removal of pharynx..... 0256 25.40 $1,231.57 $623.05 $246.31
42892 T Revision of pharyngeal walls... 0256 25.40 $1,231.57 $623.05 $246.31
42894 C Revision of pharyngeal walls... .............. .............. .............. .............. ..............
42900 T Repair throat wound............ 0253 12.02 $582.81 $284.00 $116.56
42950 T Reconstruction of throat....... 0254 12.45 $603.66 $272.41 $120.73
42953 C Repair throat, esophagus....... .............. .............. .............. .............. ..............
42955 T Surgical opening of throat..... 0254 12.45 $603.66 $272.41 $120.73
42960 T Control throat bleeding........ 0250 2.21 $107.16 $38.54 $21.43
42961 C Control throat bleeding........ .............. .............. .............. .............. ..............
42962 T Control throat bleeding........ 0256 25.40 $1,231.57 $623.05 $246.31
42970 T Control nose/throat bleeding... 0250 2.21 $107.16 $38.54 $21.43
42971 C Control nose/throat bleeding... .............. .............. .............. .............. ..............
42972 T Control nose/throat bleeding... 0253 12.02 $582.81 $284.00 $116.56
42999 T Throat surgery procedure....... 0252 5.18 $251.16 $114.24 $50.23
43020 T Incision of esophagus.......... 0254 12.45 $603.66 $272.41 $120.73
43030 C Throat muscle surgery.......... .............. .............. .............. .............. ..............
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............ 0141 7.15 $346.68 $184.67 $69.34
43202 T Esophagus endoscopy, biopsy.... 0141 7.15 $346.68 $184.67 $69.34
43204 T Esophagus endoscopy & inject... 0141 7.15 $346.68 $184.67 $69.34
43205 T Esophagus endoscopy/ligation... 0141 7.15 $346.68 $184.67 $69.34
43215 T Esophagus endoscopy............ 0141 7.15 $346.68 $184.67 $69.34
[[Page 18601]]
43216 T Esophagus endoscopy/lesion..... 0141 7.15 $346.68 $184.67 $69.34
43217 T Esophagus endoscopy............ 0141 7.15 $346.68 $184.67 $69.34
43219 T Esophagus endoscopy............ 0141 7.15 $346.68 $184.67 $69.34
43220 T Esoph endoscopy, dilation...... 0141 7.15 $346.68 $184.67 $69.34
43226 T Esoph endoscopy, dilation...... 0141 7.15 $346.68 $184.67 $69.34
43227 T Esoph endoscopy, repair........ 0141 7.15 $346.68 $184.67 $69.34
43228 T Esoph endoscopy, ablation...... 0141 7.15 $346.68 $184.67 $69.34
43234 T Upper GI endoscopy, exam....... 0141 7.15 $346.68 $184.67 $69.34
43235 T Uppr gi endoscopy, diagnosis... 0141 7.15 $346.68 $184.67 $69.34
43239 T Upper GI endoscopy, biopsy..... 0141 7.15 $346.68 $184.67 $69.34
43241 T Upper GI endoscopy with tube... 0141 7.15 $346.68 $184.67 $69.34
43243 T Upper gi endoscopy & inject.... 0141 7.15 $346.68 $184.67 $69.34
43244 T Upper GI endoscopy/ligation.... 0141 7.15 $346.68 $184.67 $69.34
43245 T Operative upper GI endoscopy... 0141 7.15 $346.68 $184.67 $69.34
43246 T Place gastrostomy tube......... 0141 7.15 $346.68 $184.67 $69.34
43247 T Operative upper GI endoscopy... 0141 7.15 $346.68 $184.67 $69.34
43248 T Uppr gi endoscopy/guide wire... 0141 7.15 $346.68 $184.67 $69.34
43249 T Esoph endoscopy, dilation...... 0141 7.15 $346.68 $184.67 $69.34
43250 T Upper GI endoscopy/tumor....... 0141 7.15 $346.68 $184.67 $69.34
43251 T Operative upper GI endoscopy... 0141 7.15 $346.68 $184.67 $69.34
43255 T Operative upper GI endoscopy... 0141 7.15 $346.68 $184.67 $69.34
43258 T Operative upper GI endoscopy... 0141 7.15 $346.68 $184.67 $69.34
43259 T Endoscopic ultrasound exam..... 0141 7.15 $346.68 $184.67 $69.34
43260 T Endo cholangiopancreatograph... 0151 10.53 $510.57 $245.46 $102.11
43261 T Endo cholangiopancreatograph... 0151 10.53 $510.57 $245.46 $102.11
43262 T Endo cholangiopancreatograph... 0151 10.53 $510.57 $245.46 $102.11
43263 T Endo cholangiopancreatograph... 0151 10.53 $510.57 $245.46 $102.11
43264 T Endo cholangiopancreatograph... 0151 10.53 $510.57 $245.46 $102.11
43265 T Endo cholangiopancreatograph... 0151 10.53 $510.57 $245.46 $102.11
43267 T Endo cholangiopancreatograph... 0151 10.53 $510.57 $245.46 $102.11
43268 T Endo cholangiopancreatograph... 0151 10.53 $510.57 $245.46 $102.11
43269 T Endo cholangiopancreatograph... 0151 10.53 $510.57 $245.46 $102.11
43271 T Endo cholangiopancreatograph... 0151 10.53 $510.57 $245.46 $102.11
43272 T Endo cholangiopancreatograph... 0151 10.53 $510.57 $245.46 $102.11
43280 T Laparoscopy, fundoplasty....... 0132 48.91 $2,371.50 $1,239.22 $474.30
43289 T Laparoscope proc, esoph........ 0130 25.36 $1,229.63 $659.53 $245.93
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............... 0140 4.74 $229.83 $107.24 $45.97
43453 T Dilate esophagus............... 0140 4.74 $229.83 $107.24 $45.97
43456 T Dilate esophagus............... 0140 4.74 $229.83 $107.24 $45.97
43458 T Dilate esophagus............... 0140 4.74 $229.83 $107.24 $45.97
43460 C Pressure treatment esophagus... .............. .............. .............. .............. ..............
43496 C Free jejunum flap, microvasc... .............. .............. .............. .............. ..............
43499 T Esophagus surgery procedure.... 0140 4.74 $229.83 $107.24 $45.97
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.............. 0141 7.15 $346.68 $184.67 $69.34
[[Page 18602]]
43605 C Biopsy of stomach.............. .............. .............. .............. .............. ..............
43610 C Excision of stomach lesion..... .............. .............. .............. .............. ..............
43611 C Excision of stomach lesion..... .............. .............. .............. .............. ..............
43620 C Removal of stomach............. .............. .............. .............. .............. ..............
43621 C Removal of stomach............. .............. .............. .............. .............. ..............
43622 C Removal of stomach............. .............. .............. .............. .............. ..............
43631 C Removal of stomach, partial.... .............. .............. .............. .............. ..............
43632 C Removal of stomach, partial.... .............. .............. .............. .............. ..............
43633 C Removal of stomach, partial.... .............. .............. .............. .............. ..............
43634 C Removal of stomach, partial.... .............. .............. .............. .............. ..............
43635 C Removal of stomach, partial.... .............. .............. .............. .............. ..............
43638 C Removal of stomach, partial.... .............. .............. .............. .............. ..............
43639 C Removal of stomach, partial.... .............. .............. .............. .............. ..............
43640 C Vagotomy & pylorus repair...... .............. .............. .............. .............. ..............
43641 C Vagotomy & pylorus repair...... .............. .............. .............. .............. ..............
43651 T Laparoscopy, vagus nerve....... 0132 48.91 $2,371.50 $1,239.22 $474.30
43652 T Laparoscopy, vagus nerve....... 0132 48.91 $2,371.50 $1,239.22 $474.30
43653 T Laparoscopy, gastrostomy....... 0131 41.81 $2,027.24 $1,089.88 $405.45
43659 T Laparoscope proc, stom......... 0130 25.36 $1,229.63 $659.53 $245.93
43750 T Place gastrostomy tube......... 0141 7.15 $346.68 $184.67 $69.34
43760 T Change gastrostomy tube........ 0121 2.36 $114.43 $52.53 $22.89
43761 T Reposition gastrostomy tube.... 0121 2.36 $114.43 $52.53 $22.89
43800 C Reconstruction of pylorus...... .............. .............. .............. .............. ..............
43810 C Fusion of stomach and bowel.... .............. .............. .............. .............. ..............
43820 C Fusion of stomach and bowel.... .............. .............. .............. .............. ..............
43825 C Fusion of stomach and bowel.... .............. .............. .............. .............. ..............
43830 T Place gastrostomy tube......... 0141 7.15 $346.68 $184.67 $69.34
43831 T Place gastrostomy tube......... 0141 7.15 $346.68 $184.67 $69.34
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......... 0025 3.74 $181.34 $70.66 $36.27
43880 C Repair stomach-bowel fistula... .............. .............. .............. .............. ..............
43999 T Stomach surgery procedure...... 0121 2.36 $114.43 $52.53 $22.89
44005 C Freeing of bowel adhesion...... .............. .............. .............. .............. ..............
44010 C Incision of small bowel........ .............. .............. .............. .............. ..............
44015 C Insert needle cath 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................ 0141 7.15 $346.68 $184.67 $69.34
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/ileostomy..... .............. .............. .............. .............. ..............
44156 C Removal of colon/ileostomy..... .............. .............. .............. .............. ..............
44160 C Removal of colon............... .............. .............. .............. .............. ..............
44200 T Laparoscopy, enterolysis....... 0131 41.81 $2,027.24 $1,089.88 $405.45
[[Page 18603]]
44201 T Laparoscopy, jejunostomy....... 0131 41.81 $2,027.24 $1,089.88 $405.45
44202 C Laparo, resect intestine....... .............. .............. .............. .............. ..............
44209 T Laparoscope proc, intestine.... 0130 25.36 $1,229.63 $659.53 $245.93
44300 C Open bowel to skin............. .............. .............. .............. .............. ..............
44310 C Ileostomy/jejunostomy.......... .............. .............. .............. .............. ..............
44312 T Revision of ileostomy.......... 0026 12.11 $587.18 $277.92 $117.44
44314 C Revision of ileostomy.......... .............. .............. .............. .............. ..............
44316 C Devise bowel pouch............. .............. .............. .............. .............. ..............
44320 C Colostomy...................... .............. .............. .............. .............. ..............
44322 C Colostomy with biopsies........ .............. .............. .............. .............. ..............
44340 T Revision of colostomy.......... 0026 12.11 $587.18 $277.92 $117.44
44345 C Revision of colostomy.......... .............. .............. .............. .............. ..............
44346 C Revision of colostomy.......... .............. .............. .............. .............. ..............
44360 T Small bowel endoscopy.......... 0142 7.45 $361.23 $162.42 $72.25
44361 T Small bowel endoscopy/biopsy... 0142 7.45 $361.23 $162.42 $72.25
44363 T Small bowel endoscopy.......... 0142 7.45 $361.23 $162.42 $72.25
44364 T Small bowel endoscopy.......... 0142 7.45 $361.23 $162.42 $72.25
44365 T Small bowel endoscopy.......... 0142 7.45 $361.23 $162.42 $72.25
44366 T Small bowel endoscopy.......... 0142 7.45 $361.23 $162.42 $72.25
44369 T Small bowel endoscopy.......... 0142 7.45 $361.23 $162.42 $72.25
44372 T Small bowel endoscopy.......... 0142 7.45 $361.23 $162.42 $72.25
44373 T Small bowel endoscopy.......... 0142 7.45 $361.23 $162.42 $72.25
44376 T Small bowel endoscopy.......... 0142 7.45 $361.23 $162.42 $72.25
44377 T Small bowel endoscopy/biopsy... 0142 7.45 $361.23 $162.42 $72.25
44378 T Small bowel endoscopy.......... 0142 7.45 $361.23 $162.42 $72.25
44380 T Small bowel endoscopy.......... 0142 7.45 $361.23 $162.42 $72.25
44382 T Small bowel endoscopy.......... 0142 7.45 $361.23 $162.42 $72.25
44385 T Endoscopy of bowel pouch....... 0143 7.98 $386.93 $199.12 $77.39
44386 T Endoscopy, bowel pouch/biop.... 0143 7.98 $386.93 $199.12 $77.39
44388 T Colon endoscopy................ 0143 7.98 $386.93 $199.12 $77.39
44389 T Colonoscopy with biopsy........ 0143 7.98 $386.93 $199.12 $77.39
44390 T Colonoscopy for foreign body... 0143 7.98 $386.93 $199.12 $77.39
44391 T Colonoscopy for bleeding....... 0143 7.98 $386.93 $199.12 $77.39
44392 T Colonoscopy & polypectomy...... 0143 7.98 $386.93 $199.12 $77.39
44393 T Colonoscopy, lesion removal.... 0143 7.98 $386.93 $199.12 $77.39
44394 T Colonoscopy w/snare............ 0143 7.98 $386.93 $199.12 $77.39
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 procedure.... 0142 7.45 $361.23 $162.42 $72.25
44800 C Excision of bowel pouch........ .............. .............. .............. .............. ..............
44820 C Excision of mesentery lesion... .............. .............. .............. .............. ..............
44850 C Repair of mesentery............ .............. .............. .............. .............. ..............
44899 C Bowel surgery procedure........ .............. .............. .............. .............. ..............
44900 C Drain app abscess, open........ .............. .............. .............. .............. ..............
44901 C Drain app abscess, percut...... .............. .............. .............. .............. ..............
44950 C Appendectomy................... .............. .............. .............. .............. ..............
44955 C Appendectomy add-on............ .............. .............. .............. .............. ..............
44960 C Appendectomy................... .............. .............. .............. .............. ..............
44970 T Laparoscopy, appendectomy...... 0130 25.36 $1,229.63 $659.53 $245.93
44979 T Laparoscope proc, app.......... 0130 25.36 $1,229.63 $659.53 $245.93
45000 T Drainage of pelvic abscess..... 0149 12.86 $623.54 $293.06 $124.71
45005 T Drainage of rectal abscess..... 0148 2.34 $113.46 $43.59 $22.69
45020 T Drainage of rectal abscess..... 0149 12.86 $623.54 $293.06 $124.71
45100 T Biopsy of rectum............... 0149 12.86 $623.54 $293.06 $124.71
45108 T Removal of anorectal lesion.... 0150 17.68 $857.25 $437.12 $171.45
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...... .............. .............. .............. .............. ..............
[[Page 18604]]
45116 C Partial removal of rectum...... .............. .............. .............. .............. ..............
45119 C Remove rectum w/reservoir...... .............. .............. .............. .............. ..............
45120 C Removal of rectum.............. .............. .............. .............. .............. ..............
45121 C Removal of rectum and colon.... .............. .............. .............. .............. ..............
45123 C Partial proctectomy............ .............. .............. .............. .............. ..............
45126 C Pelvic exenteration............ .............. .............. .............. .............. ..............
45130 C Excision of rectal prolapse.... .............. .............. .............. .............. ..............
45135 C Excision of rectal prolapse.... .............. .............. .............. .............. ..............
45150 T Excision of rectal stricture... 0150 17.68 $857.25 $437.12 $171.45
45160 T Excision of rectal lesion...... 0150 17.68 $857.25 $437.12 $171.45
45170 T Excision of rectal lesion...... 0150 17.68 $857.25 $437.12 $171.45
45190 T Destruction, rectal tumor...... 0150 17.68 $857.25 $437.12 $171.45
45300 T Proctosigmoidoscopy............ 0146 2.83 $137.22 $65.15 $27.44
45303 T Proctosigmoidoscopy............ 0146 2.83 $137.22 $65.15 $27.44
45305 T Proctosigmoidoscopy & biopsy... 0146 2.83 $137.22 $65.15 $27.44
45307 T Proctosigmoidoscopy............ 0146 2.83 $137.22 $65.15 $27.44
45308 T Proctosigmoidoscopy............ 0147 6.26 $303.53 $149.11 $60.71
45309 T Proctosigmoidoscopy............ 0147 6.26 $303.53 $149.11 $60.71
45315 T Proctosigmoidoscopy............ 0147 6.26 $303.53 $149.11 $60.71
45317 T Proctosigmoidoscopy............ 0146 2.83 $137.22 $65.15 $27.44
45320 T Proctosigmoidoscopy............ 0147 6.26 $303.53 $149.11 $60.71
45321 T Proctosigmoidoscopy............ 0147 6.26 $303.53 $149.11 $60.71
45330 T Diagnostic sigmoidoscopy....... 0146 2.83 $137.22 $65.15 $27.44
45331 T Sigmoidoscopy and biopsy....... 0146 2.83 $137.22 $65.15 $27.44
45332 T Sigmoidoscopy.................. 0146 2.83 $137.22 $65.15 $27.44
45333 T Sigmoidoscopy & polypectomy.... 0147 6.26 $303.53 $149.11 $60.71
45334 T Sigmoidoscopy for bleeding..... 0147 6.26 $303.53 $149.11 $60.71
45337 T Sigmoidoscopy & decompress..... 0147 6.26 $303.53 $149.11 $60.71
45338 T Sigmoidoscopy.................. 0147 6.26 $303.53 $149.11 $60.71
45339 T Sigmoidoscopy.................. 0147 6.26 $303.53 $149.11 $60.71
45355 T Surgical colonoscopy........... 0143 7.98 $386.93 $199.12 $77.39
45378 T Diagnostic colonoscopy......... 0143 7.98 $386.93 $199.12 $77.39
45379 T Colonoscopy.................... 0143 7.98 $386.93 $199.12 $77.39
45380 T Colonoscopy and biopsy......... 0143 7.98 $386.93 $199.12 $77.39
45382 T Colonoscopy/control bleeding... 0143 7.98 $386.93 $199.12 $77.39
45383 T Lesion removal colonoscopy..... 0143 7.98 $386.93 $199.12 $77.39
45384 T Colonoscopy.................... 0143 7.98 $386.93 $199.12 $77.39
45385 T Lesion removal colonoscopy..... 0143 7.98 $386.93 $199.12 $77.39
45500 T Repair of rectum............... 0150 17.68 $857.25 $437.12 $171.45
45505 T Repair of rectum............... 0150 17.68 $857.25 $437.12 $171.45
45520 T Treatment of rectal prolapse... 0098 1.19 $57.70 $20.88 $11.54
45540 C Correct rectal prolapse........ .............. .............. .............. .............. ..............
45541 C Correct rectal prolapse........ .............. .............. .............. .............. ..............
45550 C Repair rectum/remove sigmoid... .............. .............. .............. .............. ..............
45560 T Repair of rectocele............ 0150 17.68 $857.25 $437.12 $171.45
45562 C Exploration/repair of rectum... .............. .............. .............. .............. ..............
45563 C Exploration/repair of rectum... .............. .............. .............. .............. ..............
45800 C Repair rect/bladder fistula.... .............. .............. .............. .............. ..............
45805 C Repair fistula w/colostomy..... .............. .............. .............. .............. ..............
45820 C Repair rectourethral fistula... .............. .............. .............. .............. ..............
45825 C Repair fistula w/colostomy..... .............. .............. .............. .............. ..............
45900 T Reduction of rectal prolapse... 0148 2.34 $113.46 $43.59 $22.69
45905 T Dilation of anal sphincter..... 0149 12.86 $623.54 $293.06 $124.71
45910 T Dilation of rectal narrowing... 0149 12.86 $623.54 $293.06 $124.71
45915 T Remove rectal obstruction...... 0148 2.34 $113.46 $43.59 $22.69
45999 T Rectum surgery procedure....... 0148 2.34 $113.46 $43.59 $22.69
46030 T Removal of rectal marker....... 0149 12.86 $623.54 $293.06 $124.71
46040 T Incision of rectal abscess..... 0148 2.34 $113.46 $43.59 $22.69
46045 T Incision of rectal abscess..... 0150 17.68 $857.25 $437.12 $171.45
46050 T Incision of anal abscess....... 0148 2.34 $113.46 $43.59 $22.69
46060 T Incision of rectal abscess..... 0150 17.68 $857.25 $437.12 $171.45
46070 T Incision of anal septum........ 0148 2.34 $113.46 $43.59 $22.69
46080 T Incision of anal sphincter..... 0149 12.86 $623.54 $293.06 $124.71
46083 T Incise external hemorrhoid..... 0148 2.34 $113.46 $43.59 $22.69
46200 T Removal of anal fissure........ 0150 17.68 $857.25 $437.12 $171.45
46210 T Removal of anal crypt.......... 0149 12.86 $623.54 $293.06 $124.71
46211 T Removal of anal crypts......... 0150 17.68 $857.25 $437.12 $171.45
46220 T Removal of anal tab............ 0149 12.86 $623.54 $293.06 $124.71
46221 T Ligation of hemorrhoid(s)...... 0148 2.34 $113.46 $43.59 $22.69
46230 T Removal of anal tabs........... 0149 12.86 $623.54 $293.06 $124.71
46250 T Hemorrhoidectomy............... 0150 17.68 $857.25 $437.12 $171.45
46255 T Hemorrhoidectomy............... 0150 17.68 $857.25 $437.12 $171.45
46257 T Remove hemorrhoids & fissure... 0150 17.68 $857.25 $437.12 $171.45
[[Page 18605]]
46258 T Remove hemorrhoids & fistula... 0150 17.68 $857.25 $437.12 $171.45
46260 T Hemorrhoidectomy............... 0150 17.68 $857.25 $437.12 $171.45
46261 T Remove hemorrhoids & fissure... 0150 17.68 $857.25 $437.12 $171.45
46262 T Remove hemorrhoids & fistula... 0150 17.68 $857.25 $437.12 $171.45
46270 T Removal of anal fistula........ 0150 17.68 $857.25 $437.12 $171.45
46275 T Removal of anal fistula........ 0150 17.68 $857.25 $437.12 $171.45
46280 T Removal of anal fistula........ 0150 17.68 $857.25 $437.12 $171.45
46285 T Removal of anal fistula........ 0150 17.68 $857.25 $437.12 $171.45
46288 T Repair anal fistula............ 0150 17.68 $857.25 $437.12 $171.45
46320 T Removal of hemorrhoid clot..... 0148 2.34 $113.46 $43.59 $22.69
46500 T Injection into hemorrhoids..... 0148 2.34 $113.46 $43.59 $22.69
46600 N Diagnostic anoscopy............ .............. .............. .............. .............. ..............
46604 T Anoscopy and dilation.......... 0144 2.23 $108.13 $49.32 $21.63
46606 T Anoscopy and biopsy............ 0145 7.46 $361.71 $179.39 $72.34
46608 T Anoscopy/remove for body....... 0144 2.23 $108.13 $49.32 $21.63
46610 T Anoscopy/remove lesion......... 0145 7.46 $361.71 $179.39 $72.34
46611 T Anoscopy....................... 0145 7.46 $361.71 $179.39 $72.34
46612 T Anoscopy/remove lesions........ 0145 7.46 $361.71 $179.39 $72.34
46614 T Anoscopy/control bleeding...... 0145 7.46 $361.71 $179.39 $72.34
46615 T Anoscopy....................... 0145 7.46 $361.71 $179.39 $72.34
46700 T Repair of anal stricture....... 0150 17.68 $857.25 $437.12 $171.45
46705 C Repair of anal stricture....... .............. .............. .............. .............. ..............
46715 C Repair of anovaginal fistula... .............. .............. .............. .............. ..............
46716 C Repair of anovaginal fistula... .............. .............. .............. .............. ..............
46730 C Construction of absent anus.... .............. .............. .............. .............. ..............
46735 C Construction of absent anus.... .............. .............. .............. .............. ..............
46740 C Construction of absent anus.... .............. .............. .............. .............. ..............
46742 C Repair of imperforated anus.... .............. .............. .............. .............. ..............
46744 C Repair of cloacal anomaly...... .............. .............. .............. .............. ..............
46746 C Repair of cloacal anomaly...... .............. .............. .............. .............. ..............
46748 C Repair of cloacal anomaly...... .............. .............. .............. .............. ..............
46750 T Repair of anal sphincter....... 0150 17.68 $857.25 $437.12 $171.45
46751 C Repair of anal sphincter....... .............. .............. .............. .............. ..............
46753 T Reconstruction of anus......... 0150 17.68 $857.25 $437.12 $171.45
46754 T Removal of suture from anus.... 0149 12.86 $623.54 $293.06 $124.71
46760 T Repair of anal sphincter....... 0150 17.68 $857.25 $437.12 $171.45
46761 T Repair of anal sphincter....... 0150 17.68 $857.25 $437.12 $171.45
46762 T Implant artificial sphincter... 0150 17.68 $857.25 $437.12 $171.45
46900 T Destruction, anal lesion(s).... 0016 3.53 $171.16 $74.67 $34.23
46910 T Destruction, anal lesion(s).... 0016 3.53 $171.16 $74.67 $34.23
46916 T Cryosurgery, anal lesion(s).... 0016 3.53 $171.16 $74.67 $34.23
46917 T Laser surgery, anal lesions.... 0014 1.50 $72.73 $24.55 $14.55
46922 T Excision of anal lesion(s)..... 0017 12.45 $603.66 $289.16 $120.73
46924 T Destruction, anal lesion(s).... 0017 12.45 $603.66 $289.16 $120.73
46934 T Destruction of hemorrhoids..... 0148 2.34 $113.46 $43.59 $22.69
46935 T Destruction of hemorrhoids..... 0148 2.34 $113.46 $43.59 $22.69
46936 T Destruction of hemorrhoids..... 0149 12.86 $623.54 $293.06 $124.71
46937 T Cryotherapy of rectal lesion... 0150 17.68 $857.25 $437.12 $171.45
46938 T Cryotherapy of rectal lesion... 0150 17.68 $857.25 $437.12 $171.45
46940 T Treatment of anal fissure...... 0149 12.86 $623.54 $293.06 $124.71
46942 T Treatment of anal fissure...... 0149 12.86 $623.54 $293.06 $124.71
46945 T Ligation of hemorrhoids........ 0148 2.34 $113.46 $43.59 $22.69
46946 T Ligation of hemorrhoids........ 0148 2.34 $113.46 $43.59 $22.69
46999 T Anus surgery procedure......... 0149 12.86 $623.54 $293.06 $124.71
47000 T Needle biopsy of liver......... 0005 5.41 $262.32 $119.75 $52.46
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............. .............. .............. .............. .............. ..............
[[Page 18606]]
47399 T Liver surgery procedure........ 0005 5.41 $262.32 $119.75 $52.46
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 N Injection for liver x-rays..... .............. .............. .............. .............. ..............
47505 N Injection for liver x-rays..... .............. .............. .............. .............. ..............
47510 T Insert catheter, bile duct..... 0152 8.22 $398.56 $207.38 $79.71
47511 T Insert bile duct drain......... 0152 8.22 $398.56 $207.38 $79.71
47525 T Change bile duct catheter...... 0122 5.04 $244.37 $114.93 $48.88
47530 T Revise/reinsert bile tube...... 0121 2.36 $114.43 $52.53 $22.89
47550 C Bile duct endoscopy add-on..... .............. .............. .............. .............. ..............
47552 T Biliary endoscopy thru skin.... 0152 8.22 $398.56 $207.38 $79.71
47553 T Biliary endoscopy thru skin.... 0152 8.22 $398.56 $207.38 $79.71
47554 T Biliary endoscopy thru skin.... 0152 8.22 $398.56 $207.38 $79.71
47555 T Biliary endoscopy thru skin.... 0152 8.22 $398.56 $207.38 $79.71
47556 T Biliary endoscopy thru skin.... 0152 8.22 $398.56 $207.38 $79.71
47560 T Laparoscopy w/cholangio........ 0130 25.36 $1,229.63 $659.53 $245.93
47561 T Laparo w/cholangio/biopsy...... 0130 25.36 $1,229.63 $659.53 $245.93
47562 T Laparoscopic cholecystectomy... 0131 41.81 $2,027.24 $1,089.88 $405.45
47563 T Laparo cholecystectomy/graph... 0131 41.81 $2,027.24 $1,089.88 $405.45
47564 T Laparo cholecystectomy/explr... 0131 41.81 $2,027.24 $1,089.88 $405.45
47570 T Laparo cholecystoenterostomy... 0131 41.81 $2,027.24 $1,089.88 $405.45
47579 T Laparoscope proc, biliary...... 0130 25.36 $1,229.63 $659.53 $245.93
47600 C Removal of gallbladder......... .............. .............. .............. .............. ..............
47605 C Removal of gallbladder......... .............. .............. .............. .............. ..............
47610 C Removal of gallbladder......... .............. .............. .............. .............. ..............
47612 C Removal of gallbladder......... .............. .............. .............. .............. ..............
47620 C Removal of gallbladder......... .............. .............. .............. .............. ..............
47630 T Remove bile duct stone......... 0152 8.22 $398.56 $207.38 $79.71
47700 C Exploration of bile ducts...... .............. .............. .............. .............. ..............
47701 C Bile duct revision............. .............. .............. .............. .............. ..............
47711 C Excision of bile duct tumor.... .............. .............. .............. .............. ..............
47712 C Excision of bile duct tumor.... .............. .............. .............. .............. ..............
47715 C Excision of bile duct cyst..... .............. .............. .............. .............. ..............
47716 C Fusion of bile duct cyst....... .............. .............. .............. .............. ..............
47720 C Fuse gallbladder & bowel....... .............. .............. .............. .............. ..............
47721 C Fuse upper gi structures....... .............. .............. .............. .............. ..............
47740 C Fuse gallbladder & bowel....... .............. .............. .............. .............. ..............
47741 C Fuse gallbladder & bowel....... .............. .............. .............. .............. ..............
47760 C Fuse bile ducts and bowel...... .............. .............. .............. .............. ..............
47765 C Fuse liver ducts & bowel....... .............. .............. .............. .............. ..............
47780 C Fuse bile ducts and bowel...... .............. .............. .............. .............. ..............
47785 C Fuse bile ducts and bowel...... .............. .............. .............. .............. ..............
47800 C Reconstruction of bile ducts... .............. .............. .............. .............. ..............
47801 C Placement, bile duct support... .............. .............. .............. .............. ..............
47802 C Fuse liver duct & intestine.... .............. .............. .............. .............. ..............
47900 C Suture bile duct injury........ .............. .............. .............. .............. ..............
47999 T Bile tract surgery procedure... 0121 2.36 $114.43 $52.53 $22.89
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........ 0005 5.41 $262.32 $119.75 $52.46
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.... .............. .............. .............. .............. ..............
[[Page 18607]]
48520 C Fuse pancreas cyst and bowel... .............. .............. .............. .............. ..............
48540 C Fuse pancreas cyst and bowel... .............. .............. .............. .............. ..............
48545 C Pancreatorrhaphy............... .............. .............. .............. .............. ..............
48547 C Duodenal exclusion............. .............. .............. .............. .............. ..............
48550 E Donor pancreatectomy........... .............. .............. .............. .............. ..............
48554 E Transpl allograft pancreas..... .............. .............. .............. .............. ..............
48556 C Removal, allograft pancreas.... .............. .............. .............. .............. ..............
48999 T Pancreas surgery procedure..... 0005 5.41 $262.32 $119.75 $52.46
49000 C Exploration of abdomen......... .............. .............. .............. .............. ..............
49002 C Reopening of abdomen........... .............. .............. .............. .............. ..............
49010 C Exploration behind abdomen..... .............. .............. .............. .............. ..............
49020 C Drain abdominal abscess........ .............. .............. .............. .............. ..............
49021 C Drain abdominal abscess........ .............. .............. .............. .............. ..............
49040 C Drain, open, abdom abscess..... .............. .............. .............. .............. ..............
49041 C Drain, percut, abdom abscess... .............. .............. .............. .............. ..............
49060 C Drain, open, retrop abscess.... .............. .............. .............. .............. ..............
49061 C Drain, percut, retroper absc... .............. .............. .............. .............. ..............
49062 C Drain to peritoneal cavity..... .............. .............. .............. .............. ..............
49080 T Puncture, peritoneal cavity.... 0070 3.64 $176.49 $79.60 $35.30
49081 T Removal of abdominal fluid..... 0070 3.64 $176.49 $79.60 $35.30
49085 T Remove abdomen foreign body.... 0153 19.62 $951.32 $496.31 $190.26
49180 T Biopsy, abdominal mass......... 0005 5.41 $262.32 $119.75 $52.46
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.......... 0153 19.62 $951.32 $496.31 $190.26
49255 C Removal of omentum............. .............. .............. .............. .............. ..............
49320 T Diag laparo separate proc...... 0130 25.36 $1,229.63 $659.53 $245.93
49321 T Laparoscopy, biopsy............ 0130 25.36 $1,229.63 $659.53 $245.93
49322 T Laparoscopy, aspiration........ 0130 25.36 $1,229.63 $659.53 $245.93
49323 T Laparo drain lymphocele........ 0130 25.36 $1,229.63 $659.53 $245.93
49329 T Laparo proc, abdm/per/oment.... 0130 25.36 $1,229.63 $659.53 $245.93
49400 N Air injection into abdomen..... .............. .............. .............. .............. ..............
49420 T Insert abdominal drain......... 0153 19.62 $951.32 $496.31 $190.26
49421 T Insert abdominal drain......... 0153 19.62 $951.32 $496.31 $190.26
49422 T Remove perm cannula/catheter... 0123 13.89 $673.49 $350.75 $134.70
49423 T Exchange drainage catheter..... 0153 19.62 $951.32 $496.31 $190.26
49424 N Assess cyst, contrast inject... .............. .............. .............. .............. ..............
49425 C Insert abdomen-venous drain.... .............. .............. .............. .............. ..............
49426 T Revise abdomen-venous shunt.... 0153 19.62 $951.32 $496.31 $190.26
49427 N Injection, abdominal shunt..... .............. .............. .............. .............. ..............
49428 C Ligation of shunt.............. .............. .............. .............. .............. ..............
49429 T Removal of shunt............... 0123 13.89 $673.49 $350.75 $134.70
49495 T Repair inguinal hernia, init... 0154 22.43 $1,087.57 $556.98 $217.51
49496 T Repair inguinal hernia, init... 0154 22.43 $1,087.57 $556.98 $217.51
49500 T Repair inguinal hernia......... 0154 22.43 $1,087.57 $556.98 $217.51
49501 T Repair inguinal hernia, init... 0154 22.43 $1,087.57 $556.98 $217.51
49505 T Repair inguinal hernia......... 0154 22.43 $1,087.57 $556.98 $217.51
49507 T Repair inguinal hernia......... 0154 22.43 $1,087.57 $556.98 $217.51
49520 T Rerepair inguinal hernia....... 0154 22.43 $1,087.57 $556.98 $217.51
49521 T Repair inguinal hernia, rec.... 0154 22.43 $1,087.57 $556.98 $217.51
49525 T Repair inguinal hernia......... 0154 22.43 $1,087.57 $556.98 $217.51
49540 T Repair lumbar hernia........... 0154 22.43 $1,087.57 $556.98 $217.51
49550 T Repair femoral hernia.......... 0154 22.43 $1,087.57 $556.98 $217.51
49553 T Repair femoral hernia, init.... 0154 22.43 $1,087.57 $556.98 $217.51
49555 T Repair femoral hernia.......... 0154 22.43 $1,087.57 $556.98 $217.51
49557 T Repair femoral hernia, recur... 0154 22.43 $1,087.57 $556.98 $217.51
49560 T Repair abdominal hernia........ 0154 22.43 $1,087.57 $556.98 $217.51
49561 T Repair incisional hernia....... 0154 22.43 $1,087.57 $556.98 $217.51
49565 T Rerepair abdominal hernia...... 0154 22.43 $1,087.57 $556.98 $217.51
49566 T Repair incisional hernia....... 0154 22.43 $1,087.57 $556.98 $217.51
49568 T Hernia repair w/mesh........... 0154 22.43 $1,087.57 $556.98 $217.51
49570 T Repair epigastric hernia....... 0154 22.43 $1,087.57 $556.98 $217.51
49572 T Repair epigastric hernia....... 0154 22.43 $1,087.57 $556.98 $217.51
49580 T Repair umbilical hernia........ 0154 22.43 $1,087.57 $556.98 $217.51
49582 T Repair umbilical hernia........ 0154 22.43 $1,087.57 $556.98 $217.51
49585 T Repair umbilical hernia........ 0154 22.43 $1,087.57 $556.98 $217.51
49587 T Repair umbilical hernia........ 0154 22.43 $1,087.57 $556.98 $217.51
49590 T Repair abdominal hernia........ 0154 22.43 $1,087.57 $556.98 $217.51
49600 T Repair umbilical lesion........ 0154 22.43 $1,087.57 $556.98 $217.51
49605 C Repair umbilical lesion........ .............. .............. .............. .............. ..............
49606 C Repair umbilical lesion........ .............. .............. .............. .............. ..............
[[Page 18608]]
49610 C Repair umbilical lesion........ .............. .............. .............. .............. ..............
49611 C Repair umbilical lesion........ .............. .............. .............. .............. ..............
49650 T Laparo hernia repair initial... 0131 41.81 $2,027.24 $1,089.88 $405.45
49651 T Laparo hernia repair recur..... 0131 41.81 $2,027.24 $1,089.88 $405.45
49659 T Laparo proc, hernia repair..... 0131 41.81 $2,027.24 $1,089.88 $405.45
49900 C Repair of abdominal wall....... .............. .............. .............. .............. ..............
49905 C Omental flap................... .............. .............. .............. .............. ..............
49906 C Free omental flap, microvasc... .............. .............. .............. .............. ..............
49999 T Abdomen surgery procedure...... 0121 2.36 $114.43 $52.53 $22.89
50010 C Exploration of kidney.......... .............. .............. .............. .............. ..............
50020 C Renal abscess, open drain...... .............. .............. .............. .............. ..............
50021 C Renal abscess, percut drain.... .............. .............. .............. .............. ..............
50040 C Drainage of kidney............. .............. .............. .............. .............. ..............
50045 C Exploration of kidney.......... .............. .............. .............. .............. ..............
50060 C Removal of kidney stone........ .............. .............. .............. .............. ..............
50065 C Incision of kidney............. .............. .............. .............. .............. ..............
50070 C Incision of kidney............. .............. .............. .............. .............. ..............
50075 C Removal of kidney stone........ .............. .............. .............. .............. ..............
50080 T Removal of kidney stone........ 0163 28.98 $1,405.16 $792.58 $281.03
50081 T Removal of kidney stone........ 0163 28.98 $1,405.16 $792.58 $281.03
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............... 0005 5.41 $262.32 $119.75 $52.46
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 lesion...... 0005 5.41 $262.32 $119.75 $52.46
50392 T Insert kidney drain............ 0160 5.43 $263.28 $110.11 $52.66
50393 T Insert ureteral tube........... 0160 5.43 $263.28 $110.11 $52.66
50394 N Injection for kidney x-ray..... .............. .............. .............. .............. ..............
50395 T Create passage to kidney....... 0160 5.43 $263.28 $110.11 $52.66
50396 T Measure kidney pressure........ 0165 3.89 $188.61 $91.76 $37.72
50398 T Change kidney tube............. 0122 5.04 $244.37 $114.93 $48.88
50400 C Revision of kidney/ureter...... .............. .............. .............. .............. ..............
50405 C Revision of kidney/ureter...... .............. .............. .............. .............. ..............
50500 C Repair of kidney wound......... .............. .............. .............. .............. ..............
50520 C Close kidney-skin fistula...... .............. .............. .............. .............. ..............
50525 C Repair renal-abdomen fistula... .............. .............. .............. .............. ..............
50526 C Repair renal-abdomen fistula... .............. .............. .............. .............. ..............
50540 C Revision of horseshoe kidney... .............. .............. .............. .............. ..............
50541 T Laparo ablate renal cyst....... 0131 41.81 $2,027.24 $1,089.88 $405.45
50544 T Laparoscopy, pyeloplasty....... 0131 41.81 $2,027.24 $1,089.88 $405.45
50546 C Laparoscopic nephrectomy....... .............. .............. .............. .............. ..............
50547 C Laparo removal donor kidney.... .............. .............. .............. .............. ..............
50548 T Laparo-asst remove k/ureter.... 0132 48.91 $2,371.50 $1,239.22 $474.30
50549 T Laparoscope proc, renal........ 0130 25.36 $1,229.63 $659.53 $245.93
50551 T Kidney endoscopy............... 0161 10.94 $530.45 $249.36 $106.09
50553 T Kidney endoscopy............... 0161 10.94 $530.45 $249.36 $106.09
50555 T Kidney endoscopy & biopsy...... 0161 10.94 $530.45 $249.36 $106.09
50557 T Kidney endoscopy & treatment... 0161 10.94 $530.45 $249.36 $106.09
50559 T Renal endoscopy/radiotracer.... 0161 10.94 $530.45 $249.36 $106.09
50561 T Kidney endoscopy & treatment... 0161 10.94 $530.45 $249.36 $106.09
50570 C Kidney endoscopy............... .............. .............. .............. .............. ..............
50572 C Kidney endoscopy............... .............. .............. .............. .............. ..............
50574 C Kidney endoscopy & biopsy...... .............. .............. .............. .............. ..............
50575 C Kidney endoscopy............... .............. .............. .............. .............. ..............
50576 C Kidney endoscopy & treatment... .............. .............. .............. .............. ..............
[[Page 18609]]
50578 C Renal endoscopy/radiotracer.... .............. .............. .............. .............. ..............
50580 C Kidney endoscopy & treatment... .............. .............. .............. .............. ..............
50590 T Fragmenting of kidney stone.... 0169 46.72 $2,265.32 $1,384.20 $453.06
50600 C Exploration of ureter.......... .............. .............. .............. .............. ..............
50605 C Insert ureteral support........ .............. .............. .............. .............. ..............
50610 C Removal of ureter stone........ .............. .............. .............. .............. ..............
50620 C Removal of ureter stone........ .............. .............. .............. .............. ..............
50630 C Removal of ureter stone........ .............. .............. .............. .............. ..............
50650 C Removal of ureter.............. .............. .............. .............. .............. ..............
50660 C Removal of ureter.............. .............. .............. .............. .............. ..............
50684 N Injection for ureter x-ray..... .............. .............. .............. .............. ..............
50686 T Measure ureter pressure........ 0165 3.89 $188.61 $91.76 $37.72
50688 T Change of ureter tube.......... 0121 2.36 $114.43 $52.53 $22.89
50690 N Injection for ureter x-ray..... .............. .............. .............. .............. ..............
50700 C Revision of ureter............. .............. .............. .............. .............. ..............
50715 C Release of ureter.............. .............. .............. .............. .............. ..............
50722 C Release of ureter.............. .............. .............. .............. .............. ..............
50725 C Release/revise ureter.......... .............. .............. .............. .............. ..............
50727 C Revise ureter.................. .............. .............. .............. .............. ..............
50728 C Revise ureter.................. .............. .............. .............. .............. ..............
50740 C Fusion of ureter & kidney...... .............. .............. .............. .............. ..............
50750 C Fusion of ureter & kidney...... .............. .............. .............. .............. ..............
50760 C Fusion of ureters.............. .............. .............. .............. .............. ..............
50770 C Splicing of ureters............ .............. .............. .............. .............. ..............
50780 C Reimplant ureter in bladder.... .............. .............. .............. .............. ..............
50782 C Reimplant ureter in bladder.... .............. .............. .............. .............. ..............
50783 C Reimplant ureter in bladder.... .............. .............. .............. .............. ..............
50785 C Reimplant ureter in bladder.... .............. .............. .............. .............. ..............
50800 C Implant ureter in bowel........ .............. .............. .............. .............. ..............
50810 C Fusion of ureter & bowel....... .............. .............. .............. .............. ..............
50815 C Urine shunt to 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.............. .............. .............. .............. .............. ..............
50945 T Laparoscopy ureterolithotomy... 0131 41.81 $2,027.24 $1,089.88 $405.45
50951 T Endoscopy of ureter............ 0162 17.49 $848.04 $427.49 $169.61
50953 T Endoscopy of ureter............ 0162 17.49 $848.04 $427.49 $169.61
50955 T Ureter endoscopy & biopsy...... 0162 17.49 $848.04 $427.49 $169.61
50957 T Ureter endoscopy & treatment... 0162 17.49 $848.04 $427.49 $169.61
50959 T Ureter endoscopy & tracer...... 0162 17.49 $848.04 $427.49 $169.61
50961 T Ureter endoscopy & treatment... 0162 17.49 $848.04 $427.49 $169.61
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............ 0165 3.89 $188.61 $91.76 $37.72
51005 T Drainage of bladder............ 0164 2.17 $105.23 $33.03 $21.05
51010 T Drainage of bladder............ 0165 3.89 $188.61 $91.76 $37.72
51020 T Incise & treat bladder......... 0162 17.49 $848.04 $427.49 $169.61
51030 T Incise & treat bladder......... 0162 17.49 $848.04 $427.49 $169.61
51040 T Incise & drain bladder......... 0162 17.49 $848.04 $427.49 $169.61
51045 T Incise bladder/drain ureter.... 0162 17.49 $848.04 $427.49 $169.61
51050 T Removal of bladder stone....... 0162 17.49 $848.04 $427.49 $169.61
51060 C Removal of ureter stone........ .............. .............. .............. .............. ..............
51065 T Removal of ureter stone........ 0162 17.49 $848.04 $427.49 $169.61
51080 T Drainage of bladder abscess.... 0008 6.15 $298.20 $113.67 $59.64
51500 T Removal of bladder cyst........ 0154 22.43 $1,087.57 $556.98 $217.51
51520 T Removal of bladder lesion...... 0162 17.49 $848.04 $427.49 $169.61
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)..... .............. .............. .............. .............. ..............
[[Page 18610]]
51570 C Removal of bladder............. .............. .............. .............. .............. ..............
51575 C Removal of bladder & nodes..... .............. .............. .............. .............. ..............
51580 C Remove bladder/revise tract.... .............. .............. .............. .............. ..............
51585 C Removal of bladder & nodes..... .............. .............. .............. .............. ..............
51590 C Remove bladder/revise tract.... .............. .............. .............. .............. ..............
51595 C Remove bladder/revise tract.... .............. .............. .............. .............. ..............
51596 C Remove bladder/create pouch.... .............. .............. .............. .............. ..............
51597 C Removal of pelvic structures... .............. .............. .............. .............. ..............
51600 N Injection for bladder x-ray.... .............. .............. .............. .............. ..............
51605 N Preparation for bladder x-ray.. .............. .............. .............. .............. ..............
51610 N Injection for bladder x-ray.... .............. .............. .............. .............. ..............
51700 T Irrigation of bladder.......... 0164 2.17 $105.23 $33.03 $21.05
51705 T Change of bladder tube......... 0121 2.36 $114.43 $52.53 $22.89
51710 T Change of bladder tube......... 0121 2.36 $114.43 $52.53 $22.89
51715 T Endoscopic injection/implant... 0167 21.06 $1,021.14 $555.84 $204.23
51720 T Treatment of bladder lesion.... 0165 3.89 $188.61 $91.76 $37.72
51725 T Simple cystometrogram.......... 0165 3.89 $188.61 $91.76 $37.72
51726 T Complex cystometrogram......... 0165 3.89 $188.61 $91.76 $37.72
51736 T Urine flow measurement......... 0164 2.17 $105.23 $33.03 $21.05
51741 T Electro-uroflowmetry, first.... 0164 2.17 $105.23 $33.03 $21.05
51772 T Urethra pressure profile....... 0165 3.89 $188.61 $91.76 $37.72
51784 T Anal/urinary muscle study...... 0164 2.17 $105.23 $33.03 $21.05
51785 T Anal/urinary muscle study...... 0164 2.17 $105.23 $33.03 $21.05
51792 T Urinary reflex study........... 0165 3.89 $188.61 $91.76 $37.72
51795 T Urine voiding pressure study... 0164 2.17 $105.23 $33.03 $21.05
51797 T Intraabdominal pressure test... 0164 2.17 $105.23 $33.03 $21.05
51800 C Revision of bladder/urethra.... .............. .............. .............. .............. ..............
51820 C Revision of urinary tract...... .............. .............. .............. .............. ..............
51840 C Attach bladder/urethra......... .............. .............. .............. .............. ..............
51841 C Attach bladder/urethra......... .............. .............. .............. .............. ..............
51845 C Repair bladder neck............ .............. .............. .............. .............. ..............
51860 C Repair of bladder wound........ .............. .............. .............. .............. ..............
51865 C Repair of bladder wound........ .............. .............. .............. .............. ..............
51880 T Repair of bladder opening...... 0162 17.49 $848.04 $427.49 $169.61
51900 C Repair bladder/vagina lesion... .............. .............. .............. .............. ..............
51920 C Close bladder-uterus fistula... .............. .............. .............. .............. ..............
51925 C Hysterectomy/bladder repair.... .............. .............. .............. .............. ..............
51940 C Correction of bladder defect... .............. .............. .............. .............. ..............
51960 C Revision of bladder & bowel.... .............. .............. .............. .............. ..............
51980 C Construct bladder opening...... .............. .............. .............. .............. ..............
51990 T Laparo urethral suspension..... 0131 41.81 $2,027.24 $1,089.88 $405.45
51992 T Laparo sling operation......... 0132 48.91 $2,371.50 $1,239.22 $474.30
52000 T Cystoscopy..................... 0160 5.43 $263.28 $110.11 $52.66
52005 T Cystoscopy & ureter catheter... 0161 10.94 $530.45 $249.36 $106.09
52007 T Cystoscopy and biopsy.......... 0161 10.94 $530.45 $249.36 $106.09
52010 T Cystoscopy & duct catheter..... 0161 10.94 $530.45 $249.36 $106.09
52204 T Cystoscopy..................... 0161 10.94 $530.45 $249.36 $106.09
52214 T Cystoscopy and treatment....... 0161 10.94 $530.45 $249.36 $106.09
52224 T Cystoscopy and treatment....... 0161 10.94 $530.45 $249.36 $106.09
52234 T Cystoscopy and treatment....... 0162 17.49 $848.04 $427.49 $169.61
52235 T Cystoscopy and treatment....... 0162 17.49 $848.04 $427.49 $169.61
52240 T Cystoscopy and treatment....... 0163 28.98 $1,405.16 $792.58 $281.03
52250 T Cystoscopy and radiotracer..... 0162 17.49 $848.04 $427.49 $169.61
52260 T Cystoscopy and treatment....... 0161 10.94 $530.45 $249.36 $106.09
52265 T Cystoscopy and treatment....... 0160 5.43 $263.28 $110.11 $52.66
52270 T Cystoscopy & revise urethra.... 0161 10.94 $530.45 $249.36 $106.09
52275 T Cystoscopy & revise urethra.... 0161 10.94 $530.45 $249.36 $106.09
52276 T Cystoscopy and treatment....... 0161 10.94 $530.45 $249.36 $106.09
52277 T Cystoscopy and treatment....... 0162 17.49 $848.04 $427.49 $169.61
52281 T Cystoscopy and treatment....... 0161 10.94 $530.45 $249.36 $106.09
52282 T Cystoscopy, implant stent...... 0162 17.49 $848.04 $427.49 $169.61
52283 T Cystoscopy and treatment....... 0161 10.94 $530.45 $249.36 $106.09
52285 T Cystoscopy and treatment....... 0161 10.94 $530.45 $249.36 $106.09
52290 T Cystoscopy and treatment....... 0161 10.94 $530.45 $249.36 $106.09
52300 T Cystoscopy and treatment....... 0161 10.94 $530.45 $249.36 $106.09
52301 T Cystoscopy and treatment....... 0161 10.94 $530.45 $249.36 $106.09
52305 T Cystoscopy and treatment....... 0161 10.94 $530.45 $249.36 $106.09
52310 T Cystoscopy and treatment....... 0161 10.94 $530.45 $249.36 $106.09
52315 T Cystoscopy and treatment....... 0161 10.94 $530.45 $249.36 $106.09
52317 T Remove bladder stone........... 0162 17.49 $848.04 $427.49 $169.61
52318 T Remove bladder stone........... 0162 17.49 $848.04 $427.49 $169.61
52320 T Cystoscopy and treatment....... 0162 17.49 $848.04 $427.49 $169.61
52325 T Cystoscopy, stone removal...... 0162 17.49 $848.04 $427.49 $169.61
[[Page 18611]]
52327 T Cystoscopy, inject material.... 0161 10.94 $530.45 $249.36 $106.09
52330 T Cystoscopy and treatment....... 0162 17.49 $848.04 $427.49 $169.61
52332 T Cystoscopy and treatment....... 0162 17.49 $848.04 $427.49 $169.61
52334 T Create passage to kidney....... 0162 17.49 $848.04 $427.49 $169.61
52335 T Endoscopy of urinary tract..... 0162 17.49 $848.04 $427.49 $169.61
52336 T Cystoscopy, stone removal...... 0162 17.49 $848.04 $427.49 $169.61
52337 T Cystoscopy, stone removal...... 0162 17.49 $848.04 $427.49 $169.61
52338 T Cystoscopy and treatment....... 0162 17.49 $848.04 $427.49 $169.61
52339 T Cystoscopy and treatment....... 0162 17.49 $848.04 $427.49 $169.61
52340 T Cystoscopy and treatment....... 0162 17.49 $848.04 $427.49 $169.61
52450 T Incision of prostate........... 0162 17.49 $848.04 $427.49 $169.61
52500 T Revision of bladder neck....... 0162 17.49 $848.04 $427.49 $169.61
52510 T Dilation prostatic urethra..... 0161 10.94 $530.45 $249.36 $106.09
52601 T Prostatectomy (TURP)........... 0163 28.98 $1,405.16 $792.58 $281.03
52606 T Control postop bleeding........ 0162 17.49 $848.04 $427.49 $169.61
52612 T Prostatectomy, first stage..... 0163 28.98 $1,405.16 $792.58 $281.03
52614 T Prostatectomy, second stage.... 0163 28.98 $1,405.16 $792.58 $281.03
52620 T Remove residual prostate....... 0163 28.98 $1,405.16 $792.58 $281.03
52630 T Remove prostate regrowth....... 0163 28.98 $1,405.16 $792.58 $281.03
52640 T Relieve bladder contracture.... 0162 17.49 $848.04 $427.49 $169.61
52647 T Laser surgery of prostate...... 0163 28.98 $1,405.16 $792.58 $281.03
52648 T Laser surgery of prostate...... 0163 28.98 $1,405.16 $792.58 $281.03
52700 T Drainage of prostate abscess... 0162 17.49 $848.04 $427.49 $169.61
53000 T Incision of urethra............ 0166 10.17 $493.11 $218.73 $98.62
53010 T Incision of urethra............ 0166 10.17 $493.11 $218.73 $98.62
53020 T Incision of urethra............ 0166 10.17 $493.11 $218.73 $98.62
53025 T Incision of urethra............ 0166 10.17 $493.11 $218.73 $98.62
53040 T Drainage of urethra abscess.... 0166 10.17 $493.11 $218.73 $98.62
53060 T Drainage of urethra abscess.... 0166 10.17 $493.11 $218.73 $98.62
53080 T Drainage of urinary leakage.... 0166 10.17 $493.11 $218.73 $98.62
53085 C Drainage of urinary leakage.... .............. .............. .............. .............. ..............
53200 T Biopsy of urethra.............. 0166 10.17 $493.11 $218.73 $98.62
53210 T Removal of urethra............. 0168 24.94 $1,209.27 $536.11 $241.85
53215 T Removal of urethra............. 0168 24.94 $1,209.27 $536.11 $241.85
53220 T Treatment of urethra lesion.... 0168 24.94 $1,209.27 $536.11 $241.85
53230 T Removal of urethra lesion...... 0168 24.94 $1,209.27 $536.11 $241.85
53235 T Removal of urethra lesion...... 0168 24.94 $1,209.27 $536.11 $241.85
53240 T Surgery for urethra pouch...... 0168 24.94 $1,209.27 $536.11 $241.85
53250 T Removal of urethra gland....... 0166 10.17 $493.11 $218.73 $98.62
53260 T Treatment of urethra lesion.... 0166 10.17 $493.11 $218.73 $98.62
53265 T Treatment of urethra lesion.... 0166 10.17 $493.11 $218.73 $98.62
53270 T Removal of urethra gland....... 0167 21.06 $1,021.14 $555.84 $204.23
53275 T Repair of urethra defect....... 0166 10.17 $493.11 $218.73 $98.62
53400 T Revise urethra, stage 1........ 0168 24.94 $1,209.27 $536.11 $241.85
53405 T Revise urethra, stage 2........ 0168 24.94 $1,209.27 $536.11 $241.85
53410 T Reconstruction of urethra...... 0168 24.94 $1,209.27 $536.11 $241.85
53415 C Reconstruction of urethra...... .............. .............. .............. .............. ..............
53420 T Reconstruct urethra, stage 1... 0168 24.94 $1,209.27 $536.11 $241.85
53425 T Reconstruct urethra, stage 2... 0168 24.94 $1,209.27 $536.11 $241.85
53430 T Reconstruction of urethra...... 0168 24.94 $1,209.27 $536.11 $241.85
53440 T Correct bladder function....... 0182 52.11 $2,526.66 $1,525.05 $505.33
53442 T Remove perineal prosthesis..... 0166 10.17 $493.11 $218.73 $98.62
53443 C Reconstruction of urethra...... .............. .............. .............. .............. ..............
53445 T Correct urine flow control..... 0182 52.11 $2,526.66 $1,525.05 $505.33
53447 T Remove artificial sphincter.... 0168 24.94 $1,209.27 $536.11 $241.85
53449 T Correct artificial sphincter... 0168 24.94 $1,209.27 $536.11 $241.85
53450 T Revision of urethra............ 0168 24.94 $1,209.27 $536.11 $241.85
53460 T Revision of urethra............ 0168 24.94 $1,209.27 $536.11 $241.85
53502 T Repair of urethra injury....... 0166 10.17 $493.11 $218.73 $98.62
53505 T Repair of urethra injury....... 0167 21.06 $1,021.14 $555.84 $204.23
53510 T Repair of urethra injury....... 0166 10.17 $493.11 $218.73 $98.62
53515 T Repair of urethra injury....... 0168 24.94 $1,209.27 $536.11 $241.85
53520 T Repair of urethra defect....... 0168 24.94 $1,209.27 $536.11 $241.85
53600 T Dilate urethra stricture....... 0164 2.17 $105.23 $33.03 $21.05
53601 T Dilate urethra stricture....... 0164 2.17 $105.23 $33.03 $21.05
53605 T Dilate urethra stricture....... 0161 10.94 $530.45 $249.36 $106.09
53620 T Dilate urethra stricture....... 0165 3.89 $188.61 $91.76 $37.72
53621 T Dilate urethra stricture....... 0164 2.17 $105.23 $33.03 $21.05
53660 T Dilation of urethra............ 0164 2.17 $105.23 $33.03 $21.05
53661 T Dilation of urethra............ 0164 2.17 $105.23 $33.03 $21.05
53665 T Dilation of urethra............ 0166 10.17 $493.11 $218.73 $98.62
53670 N Insert urinary catheter........ .............. .............. .............. .............. ..............
53675 T Insert urinary catheter........ 0164 2.17 $105.23 $33.03 $21.05
[[Page 18612]]
2 53850 T Prostatic microwave thermotx... 0980 38.67 $1,875.00 .............. $375.00
2 53852 T Prostatic rf thermotx.......... 0980 38.67 $1,875.00 .............. $375.00
53899 T Urology surgery procedure...... 0165 3.89 $188.61 $91.76 $37.72
54000 T Slitting of prepuce............ 0166 10.17 $493.11 $218.73 $98.62
54001 T Slitting of prepuce............ 0166 10.17 $493.11 $218.73 $98.62
54015 T Drain penis lesion............. 0008 6.15 $298.20 $113.67 $59.64
54050 T Destruction, penis lesion(s)... 0013 0.91 $44.12 $17.66 $8.82
54055 T Destruction, penis lesion(s)... 0016 3.53 $171.16 $74.67 $34.23
54056 T Cryosurgery, penis lesion(s)... 0013 0.91 $44.12 $17.66 $8.82
54057 T Laser surg, penis lesion(s).... 0017 12.45 $603.66 $289.16 $120.73
54060 T Excision of penis lesion(s).... 0017 12.45 $603.66 $289.16 $120.73
54065 T Destruction, penis lesion(s)... 0017 12.45 $603.66 $289.16 $120.73
54100 T Biopsy of penis................ 0020 6.51 $315.65 $130.53 $63.13
54105 T Biopsy of penis................ 0021 10.49 $508.63 $236.51 $101.73
54110 T Treatment of penis lesion...... 0181 32.37 $1,569.53 $906.36 $313.91
54111 T Treat penis lesion, graft...... 0181 32.37 $1,569.53 $906.36 $313.91
54112 T Treat penis lesion, graft...... 0181 32.37 $1,569.53 $906.36 $313.91
54115 T Treatment of penis lesion...... 0008 6.15 $298.20 $113.67 $59.64
54120 T Partial removal of penis....... 0181 32.37 $1,569.53 $906.36 $313.91
54125 C Removal of penis............... .............. .............. .............. .............. ..............
54130 C Remove penis & nodes........... .............. .............. .............. .............. ..............
54135 C Remove penis & nodes........... .............. .............. .............. .............. ..............
54150 T Circumcision................... 0180 13.62 $660.39 $304.87 $132.08
54152 T Circumcision................... 0180 13.62 $660.39 $304.87 $132.08
54160 T Circumcision................... 0180 13.62 $660.39 $304.87 $132.08
54161 T Circumcision................... 0180 13.62 $660.39 $304.87 $132.08
54200 T Treatment of penis lesion...... 0165 3.89 $188.61 $91.76 $37.72
54205 T Treatment of penis lesion...... 0181 32.37 $1,569.53 $906.36 $313.91
54220 T Treatment of penis lesion...... 0165 3.89 $188.61 $91.76 $37.72
54230 N Prepare penis study............ .............. .............. .............. .............. ..............
54231 T Dynamic cavernosometry......... 0165 3.89 $188.61 $91.76 $37.72
54235 T Penile injection............... 0164 2.17 $105.23 $33.03 $21.05
54240 T Penis study.................... 0164 2.17 $105.23 $33.03 $21.05
54250 T Penis study.................... 0165 3.89 $188.61 $91.76 $37.72
54300 T Revision of penis.............. 0181 32.37 $1,569.53 $906.36 $313.91
54304 T Revision of penis.............. 0181 32.37 $1,569.53 $906.36 $313.91
54308 T Reconstruction of urethra...... 0181 32.37 $1,569.53 $906.36 $313.91
54312 T Reconstruction of urethra...... 0181 32.37 $1,569.53 $906.36 $313.91
54316 T Reconstruction of urethra...... 0181 32.37 $1,569.53 $906.36 $313.91
54318 T Reconstruction of urethra...... 0181 32.37 $1,569.53 $906.36 $313.91
54322 T Reconstruction of urethra...... 0181 32.37 $1,569.53 $906.36 $313.91
54324 T Reconstruction of urethra...... 0181 32.37 $1,569.53 $906.36 $313.91
54326 T Reconstruction of urethra...... 0181 32.37 $1,569.53 $906.36 $313.91
54328 T Revise penis/urethra........... 0181 32.37 $1,569.53 $906.36 $313.91
54332 C Revise penis/urethra........... .............. .............. .............. .............. ..............
54336 C Revise penis/urethra........... .............. .............. .............. .............. ..............
54340 T Secondary urethral surgery..... 0181 32.37 $1,569.53 $906.36 $313.91
54344 T Secondary urethral surgery..... 0181 32.37 $1,569.53 $906.36 $313.91
54348 T Secondary urethral surgery..... 0181 32.37 $1,569.53 $906.36 $313.91
54352 T Reconstruct urethra/penis...... 0181 32.37 $1,569.53 $906.36 $313.91
54360 T Penis plastic surgery.......... 0181 32.37 $1,569.53 $906.36 $313.91
54380 T Repair penis................... 0181 32.37 $1,569.53 $906.36 $313.91
54385 T Repair penis................... 0181 32.37 $1,569.53 $906.36 $313.91
54390 C Repair penis and bladder....... .............. .............. .............. .............. ..............
54400 T Insert semi-rigid prosthesis... 0182 52.11 $2,526.66 $1,525.05 $505.33
54401 T Insert self-contd prosthesis... 0182 52.11 $2,526.66 $1,525.05 $505.33
54402 T Remove penis prosthesis........ 0181 32.37 $1,569.53 $906.36 $313.91
54405 T Insert multi-comp prosthesis... 0182 52.11 $2,526.66 $1,525.05 $505.33
54407 T Remove multi-comp prosthesis... 0181 32.37 $1,569.53 $906.36 $313.91
54409 T Revise penis prosthesis........ 0181 32.37 $1,569.53 $906.36 $313.91
54420 T Revision of penis.............. 0181 32.37 $1,569.53 $906.36 $313.91
54430 C Revision of penis.............. .............. .............. .............. .............. ..............
54435 T Revision of penis.............. 0181 32.37 $1,569.53 $906.36 $313.91
54440 T Repair of penis................ 0181 32.37 $1,569.53 $906.36 $313.91
54450 T Preputial stretching........... 0165 3.89 $188.61 $91.76 $37.72
54500 T Biopsy of testis............... 0005 5.41 $262.32 $119.75 $52.46
54505 T Biopsy of testis............... 0183 18.26 $885.37 $448.94 $177.07
54510 T Removal of testis lesion....... 0183 18.26 $885.37 $448.94 $177.07
54520 T Removal of testis.............. 0183 18.26 $885.37 $448.94 $177.07
54530 T Removal of testis.............. 0154 22.43 $1,087.57 $556.98 $217.51
54535 C Extensive testis surgery....... .............. .............. .............. .............. ..............
54550 T Exploration for testis......... 0154 22.43 $1,087.57 $556.98 $217.51
54560 C Exploration for testis......... .............. .............. .............. .............. ..............
[[Page 18613]]
54600 T Reduce testis torsion.......... 0183 18.26 $885.37 $448.94 $177.07
54620 T Suspension of testis........... 0183 18.26 $885.37 $448.94 $177.07
54640 T Suspension of testis........... 0154 22.43 $1,087.57 $556.98 $217.51
54650 C Orchiopexy (Fowler-Stephens)... .............. .............. .............. .............. ..............
54660 T Revision of testis............. 0183 18.26 $885.37 $448.94 $177.07
54670 T Repair testis injury........... 0183 18.26 $885.37 $448.94 $177.07
54680 T Relocation of testis(es)....... 0183 18.26 $885.37 $448.94 $177.07
54690 T Laparoscopy, orchiectomy....... 0131 41.81 $2,027.24 $1,089.88 $405.45
54692 T Laparoscopy, orchiopexy........ 0132 48.91 $2,371.50 $1,239.22 $474.30
54699 T Laparoscope proc, testis....... 0130 25.36 $1,229.63 $659.53 $245.93
54700 T Drainage of scrotum............ 0183 18.26 $885.37 $448.94 $177.07
54800 T Biopsy of epididymis........... 0004 1.84 $89.22 $32.57 $17.84
54820 T Exploration of epididymis...... 0183 18.26 $885.37 $448.94 $177.07
54830 T Remove epididymis lesion....... 0183 18.26 $885.37 $448.94 $177.07
54840 T Remove epididymis lesion....... 0183 18.26 $885.37 $448.94 $177.07
54860 T Removal of epididymis.......... 0183 18.26 $885.37 $448.94 $177.07
54861 T Removal of epididymis.......... 0183 18.26 $885.37 $448.94 $177.07
54900 T Fusion of spermatic ducts...... 0183 18.26 $885.37 $448.94 $177.07
54901 T Fusion of spermatic ducts...... 0183 18.26 $885.37 $448.94 $177.07
55000 T Drainage of hydrocele.......... 0004 1.84 $89.22 $32.57 $17.84
55040 T Removal of hydrocele........... 0154 22.43 $1,087.57 $556.98 $217.51
55041 T Removal of hydroceles.......... 0154 22.43 $1,087.57 $556.98 $217.51
55060 T Repair of hydrocele............ 0183 18.26 $885.37 $448.94 $177.07
55100 T Drainage of scrotum abscess.... 0008 6.15 $298.20 $113.67 $59.64
55110 T Explore scrotum................ 0183 18.26 $885.37 $448.94 $177.07
55120 T Removal of scrotum lesion...... 0183 18.26 $885.37 $448.94 $177.07
55150 T Removal of scrotum............. 0183 18.26 $885.37 $448.94 $177.07
55175 T Revision of scrotum............ 0183 18.26 $885.37 $448.94 $177.07
55180 T Revision of scrotum............ 0183 18.26 $885.37 $448.94 $177.07
55200 T Incision of sperm duct......... 0183 18.26 $885.37 $448.94 $177.07
55250 T Removal of sperm duct(s)....... 0183 18.26 $885.37 $448.94 $177.07
55300 N Prepare, sperm duct x-ray...... .............. .............. .............. .............. ..............
55400 T Repair of sperm duct........... 0183 18.26 $885.37 $448.94 $177.07
55450 T Ligation of sperm duct......... 0183 18.26 $885.37 $448.94 $177.07
55500 T Removal of hydrocele........... 0183 18.26 $885.37 $448.94 $177.07
55520 T Removal of sperm cord lesion... 0183 18.26 $885.37 $448.94 $177.07
55530 T Revise spermatic cord veins.... 0183 18.26 $885.37 $448.94 $177.07
55535 T Revise spermatic cord veins.... 0154 22.43 $1,087.57 $556.98 $217.51
55540 T Revise hernia & sperm veins.... 0154 22.43 $1,087.57 $556.98 $217.51
55550 T Laparo ligate spermatic vein... 0131 41.81 $2,027.24 $1,089.88 $405.45
55559 T Laparo proc, spermatic cord.... 0130 25.36 $1,229.63 $659.53 $245.93
55600 C Incise sperm duct pouch........ .............. .............. .............. .............. ..............
55605 C Incise sperm duct pouch........ .............. .............. .............. .............. ..............
55650 C Remove sperm duct pouch........ .............. .............. .............. .............. ..............
55680 T Remove sperm pouch lesion...... 0183 18.26 $885.37 $448.94 $177.07
55700 T Biopsy of prostate............. 0184 4.94 $239.53 $122.96 $47.91
55705 T Biopsy of prostate............. 0184 4.94 $239.53 $122.96 $47.91
55720 T Drainage of prostate abscess... 0162 17.49 $848.04 $427.49 $169.61
55725 T Drainage of prostate abscess... 0162 17.49 $848.04 $427.49 $169.61
55801 C Removal of prostate............ .............. .............. .............. .............. ..............
55810 C Extensive prostate surgery..... .............. .............. .............. .............. ..............
55812 C Extensive prostate surgery..... .............. .............. .............. .............. ..............
55815 C Extensive prostate surgery..... .............. .............. .............. .............. ..............
55821 C Removal of prostate............ .............. .............. .............. .............. ..............
55831 C Removal of prostate............ .............. .............. .............. .............. ..............
55840 C Extensive prostate surgery..... .............. .............. .............. .............. ..............
55842 C Extensive prostate surgery..... .............. .............. .............. .............. ..............
55845 C Extensive prostate surgery..... .............. .............. .............. .............. ..............
55859 T Percut/needle insert, pros..... 0162 17.49 $848.04 $427.49 $169.61
55860 C Surgical exposure, prostate.... .............. .............. .............. .............. ..............
55862 C Extensive prostate surgery..... .............. .............. .............. .............. ..............
55865 C Extensive prostate surgery..... .............. .............. .............. .............. ..............
55870 T Electroejaculation............. 0197 2.40 $116.37 $49.55 $23.27
55899 T Genital surgery procedure...... 0164 2.17 $105.23 $33.03 $21.05
55970 E Sex transformation, M to F..... .............. .............. .............. .............. ..............
55980 E Sex transformation, F to M..... .............. .............. .............. .............. ..............
56405 T I & D of vulva/perineum........ 0192 2.38 $115.40 $35.33 $23.08
56420 T Drainage of gland abscess...... 0192 2.38 $115.40 $35.33 $23.08
56440 T Surgery for vulva lesion....... 0194 16.21 $785.98 $395.94 $157.20
56441 T Lysis of labial lesion(s)...... 0193 8.93 $432.99 $171.13 $86.60
56501 T Destruction, vulva lesion(s)... 0016 3.53 $171.16 $74.67 $34.23
56515 T Destruction, vulva lesion(s)... 0017 12.45 $603.66 $289.16 $120.73
56605 T Biopsy of vulva/perineum....... 0019 4.00 $193.95 $78.91 $38.79
[[Page 18614]]
56606 T Biopsy of vulva/perineum....... 0019 4.00 $193.95 $78.91 $38.79
56620 T Partial removal of vulva....... 0195 18.68 $905.74 $483.80 $181.15
56625 T Complete removal of vulva...... 0195 18.68 $905.74 $483.80 $181.15
56630 C Extensive vulva surgery........ .............. .............. .............. .............. ..............
56631 C Extensive vulva surgery........ .............. .............. .............. .............. ..............
56632 C Extensive vulva surgery........ .............. .............. .............. .............. ..............
56633 C Extensive vulva surgery........ .............. .............. .............. .............. ..............
56634 C Extensive vulva surgery........ .............. .............. .............. .............. ..............
56637 C Extensive vulva surgery........ .............. .............. .............. .............. ..............
56640 C Extensive vulva surgery........ .............. .............. .............. .............. ..............
56700 T Partial removal of hymen....... 0194 16.21 $785.98 $395.94 $157.20
56720 T Incision of hymen.............. 0193 8.93 $432.99 $171.13 $86.60
56740 T Remove vagina gland lesion..... 0194 16.21 $785.98 $395.94 $157.20
56800 T Repair of vagina............... 0194 16.21 $785.98 $395.94 $157.20
56805 C Repair clitoris................ .............. .............. .............. .............. ..............
56810 T Repair of perineum............. 0194 16.21 $785.98 $395.94 $157.20
57000 T Exploration of vagina.......... 0194 16.21 $785.98 $395.94 $157.20
57010 T Drainage of pelvic abscess..... 0194 16.21 $785.98 $395.94 $157.20
57020 T Drainage of pelvic fluid....... 0193 8.93 $432.99 $171.13 $86.60
57061 T Destruction vagina lesion(s)... 0194 16.21 $785.98 $395.94 $157.20
57065 T Destruction vagina lesion(s)... 0194 16.21 $785.98 $395.94 $157.20
57100 T Biopsy of vagina............... 0192 2.38 $115.40 $35.33 $23.08
57105 T Biopsy of vagina............... 0194 16.21 $785.98 $395.94 $157.20
57106 T Remove vagina wall, partial.... 0194 16.21 $785.98 $395.94 $157.20
57107 T Remove vagina tissue, part..... 0194 16.21 $785.98 $395.94 $157.20
57109 T Vaginectomy partial w/nodes.... 0194 16.21 $785.98 $395.94 $157.20
57110 C Remove vagina wall, complete... .............. .............. .............. .............. ..............
57111 C Remove vagina tissue, compl.... .............. .............. .............. .............. ..............
57112 C Vaginectomy w/nodes, compl..... .............. .............. .............. .............. ..............
57120 C Closure of vagina.............. .............. .............. .............. .............. ..............
57130 T Remove vagina lesion........... 0194 16.21 $785.98 $395.94 $157.20
57135 T Remove vagina lesion........... 0194 16.21 $785.98 $395.94 $157.20
57150 T Treat vagina infection......... 0192 2.38 $115.40 $35.33 $23.08
57160 T Insert pessary/other device.... 0191 1.19 $57.70 $17.43 $11.54
57170 T Fitting of diaphragm/cap....... 0191 1.19 $57.70 $17.43 $11.54
57180 T Treat vaginal bleeding......... 0192 2.38 $115.40 $35.33 $23.08
57200 T Repair of vagina............... 0194 16.21 $785.98 $395.94 $157.20
57210 T Repair vagina/perineum......... 0194 16.21 $785.98 $395.94 $157.20
57220 T Revision of urethra............ 0195 18.68 $905.74 $483.80 $181.15
57230 T Repair of urethral lesion...... 0194 16.21 $785.98 $395.94 $157.20
57240 T Repair bladder & vagina........ 0195 18.68 $905.74 $483.80 $181.15
57250 T Repair rectum & vagina......... 0195 18.68 $905.74 $483.80 $181.15
57260 T Repair of vagina............... 0195 18.68 $905.74 $483.80 $181.15
57265 T Extensive repair of vagina..... 0195 18.68 $905.74 $483.80 $181.15
57268 T Repair of bowel bulge.......... 0195 18.68 $905.74 $483.80 $181.15
57270 C Repair of bowel pouch.......... .............. .............. .............. .............. ..............
57280 C Suspension of vagina........... .............. .............. .............. .............. ..............
57282 C Repair of vaginal prolapse..... .............. .............. .............. .............. ..............
57284 T Repair paravaginal defect...... 0195 18.68 $905.74 $483.80 $181.15
57288 T Repair bladder defect.......... 0195 18.68 $905.74 $483.80 $181.15
57289 T Repair bladder & vagina........ 0195 18.68 $905.74 $483.80 $181.15
57291 T Construction of vagina......... 0195 18.68 $905.74 $483.80 $181.15
57292 C Construct vagina with graft.... .............. .............. .............. .............. ..............
57300 T Repair rectum-vagina fistula... 0195 18.68 $905.74 $483.80 $181.15
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............. 0194 16.21 $785.98 $395.94 $157.20
57410 T Pelvic examination............. 0194 16.21 $785.98 $395.94 $157.20
57415 T Remove vaginal foreign body.... 0194 16.21 $785.98 $395.94 $157.20
57452 T Examination of vagina.......... 0191 1.19 $57.70 $17.43 $11.54
57454 T Vagina examination & biopsy.... 0192 2.38 $115.40 $35.33 $23.08
57460 T Cervix excision................ 0193 8.93 $432.99 $171.13 $86.60
57500 T Biopsy of cervix............... 0193 8.93 $432.99 $171.13 $86.60
57505 T Endocervical curettage......... 0192 2.38 $115.40 $35.33 $23.08
57510 T Cauterization of cervix........ 0193 8.93 $432.99 $171.13 $86.60
57511 T Cryocautery of cervix.......... 0192 2.38 $115.40 $35.33 $23.08
57513 T Laser surgery of cervix........ 0193 8.93 $432.99 $171.13 $86.60
[[Page 18615]]
57520 T Conization of cervix........... 0194 16.21 $785.98 $395.94 $157.20
57522 T Conization of cervix........... 0195 18.68 $905.74 $483.80 $181.15
57530 T Removal of cervix.............. 0195 18.68 $905.74 $483.80 $181.15
57531 C Removal of cervix, radical..... .............. .............. .............. .............. ..............
57540 C Removal of residual cervix..... .............. .............. .............. .............. ..............
57545 C Remove cervix/repair pelvis.... .............. .............. .............. .............. ..............
57550 T Removal of residual cervix..... 0195 18.68 $905.74 $483.80 $181.15
57555 T Remove cervix/repair vagina.... 0195 18.68 $905.74 $483.80 $181.15
57556 T Remove cervix, repair bowel.... 0195 18.68 $905.74 $483.80 $181.15
57700 T Revision of cervix............. 0194 16.21 $785.98 $395.94 $157.20
57720 T Revision of cervix............. 0194 16.21 $785.98 $395.94 $157.20
57800 T Dilation of cervical canal..... 0193 8.93 $432.99 $171.13 $86.60
57820 T D & c of residual cervix....... 0196 14.47 $701.61 $357.98 $140.32
58100 T Biopsy of uterus lining........ 0191 1.19 $57.70 $17.43 $11.54
58120 T Dilation and curettage......... 0196 14.47 $701.61 $357.98 $140.32
58140 C Removal of uterus lesion....... .............. .............. .............. .............. ..............
58145 T Removal of uterus lesion....... 0195 18.68 $905.74 $483.80 $181.15
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..... .............. .............. .............. .............. ..............
58301 T Remove intrauterine device..... 0191 1.19 $57.70 $17.43 $11.54
58321 T Artificial insemination........ 0197 2.40 $116.37 $49.55 $23.27
58322 T Artificial insemination........ 0197 2.40 $116.37 $49.55 $23.27
58323 T Sperm washing.................. 0197 2.40 $116.37 $49.55 $23.27
58340 N Catheter for hysterography..... .............. .............. .............. .............. ..............
58345 T Reopen fallopian tube.......... 0194 16.21 $785.98 $395.94 $157.20
58350 T Reopen fallopian tube.......... 0194 16.21 $785.98 $395.94 $157.20
58400 C Suspension of uterus........... .............. .............. .............. .............. ..............
58410 C Suspension of uterus........... .............. .............. .............. .............. ..............
58520 C Repair of ruptured uterus...... .............. .............. .............. .............. ..............
58540 C Revision of uterus............. .............. .............. .............. .............. ..............
58550 T Laparo-asst vag hysterectomy... 0132 48.91 $2,371.50 $1,239.22 $474.30
58551 T Laparoscopy, remove myoma...... 0131 41.81 $2,027.24 $1,089.88 $405.45
58555 T Hysteroscopy, dx, sep proc..... 0191 1.19 $57.70 $17.43 $11.54
58558 T Hysteroscopy, biopsy........... 0190 17.85 $865.49 $443.89 $173.10
58559 T Hysteroscopy, lysis............ 0190 17.85 $865.49 $443.89 $173.10
58560 T Hysteroscopy, resect septum.... 0190 17.85 $865.49 $443.89 $173.10
58561 T Hysteroscopy, remove myoma..... 0190 17.85 $865.49 $443.89 $173.10
58562 T Hysteroscopy, remove fb........ 0190 17.85 $865.49 $443.89 $173.10
58563 T Hysteroscopy, ablation......... 0190 17.85 $865.49 $443.89 $173.10
58578 T Laparo proc, uterus............ 0190 17.85 $865.49 $443.89 $173.10
58579 T Hysteroscope procedure......... 0190 17.85 $865.49 $443.89 $173.10
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)...... .............. .............. .............. .............. ..............
58660 T Laparoscopy, lysis............. 0131 41.81 $2,027.24 $1,089.88 $405.45
58661 T Laparoscopy, remove adnexa..... 0131 41.81 $2,027.24 $1,089.88 $405.45
58662 T Laparoscopy, excise lesions.... 0131 41.81 $2,027.24 $1,089.88 $405.45
58670 T Laparoscopy, tubal cautery..... 0131 41.81 $2,027.24 $1,089.88 $405.45
58671 T Laparoscopy, tubal block....... 0131 41.81 $2,027.24 $1,089.88 $405.45
58672 T Laparoscopy, fimbrioplasty..... 0131 41.81 $2,027.24 $1,089.88 $405.45
58673 T Laparoscopy, salpingostomy..... 0131 41.81 $2,027.24 $1,089.88 $405.45
58679 T Laparo proc, oviduct-ovary..... 0130 25.36 $1,229.63 $659.53 $245.93
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....... .............. .............. .............. .............. ..............
[[Page 18616]]
58800 T Drainage of ovarian cyst(s).... 0195 18.68 $905.74 $483.80 $181.15
58805 C Drainage of ovarian cyst(s).... .............. .............. .............. .............. ..............
58820 T Drain ovary abscess, open...... 0195 18.68 $905.74 $483.80 $181.15
58822 C Drain ovary abscess, percut.... .............. .............. .............. .............. ..............
58823 C Drain pelvic abscess, percut... .............. .............. .............. .............. ..............
58825 C Transposition, ovary(s)........ .............. .............. .............. .............. ..............
58900 T Biopsy of ovary(s)............. 0195 18.68 $905.74 $483.80 $181.15
58920 T Partial removal of ovary(s).... 0195 18.68 $905.74 $483.80 $181.15
58925 T Removal of ovarian cyst(s)..... 0195 18.68 $905.74 $483.80 $181.15
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............ 0194 16.21 $785.98 $395.94 $157.20
58974 T Transfer of embryo............. 0197 2.40 $116.37 $49.55 $23.27
58976 T Transfer of embryo............. 0197 2.40 $116.37 $49.55 $23.27
58999 T Genital surgery procedure...... 0019 4.00 $193.95 $78.91 $38.79
59000 T Amniocentesis.................. 0198 1.34 $64.97 $33.03 $12.99
59012 T Fetal cord puncture, prenatal.. 0198 1.34 $64.97 $33.03 $12.99
59015 T Chorion biopsy................. 0198 1.34 $64.97 $33.03 $12.99
59020 T Fetal contract stress test..... 0198 1.34 $64.97 $33.03 $12.99
59025 T Fetal non-stress test.......... 0198 1.34 $64.97 $33.03 $12.99
59030 T Fetal scalp blood sample....... 0198 1.34 $64.97 $33.03 $12.99
59050 T Fetal monitor w/report......... 0198 1.34 $64.97 $33.03 $12.99
59051 E Fetal monitor/interpret only... .............. .............. .............. .............. ..............
59100 C Remove uterus lesion........... .............. .............. .............. .............. ..............
59120 C Treat ectopic pregnancy........ .............. .............. .............. .............. ..............
59121 C Treat ectopic pregnancy........ .............. .............. .............. .............. ..............
59130 C Treat ectopic pregnancy........ .............. .............. .............. .............. ..............
59135 C Treat ectopic pregnancy........ .............. .............. .............. .............. ..............
59136 C Treat ectopic pregnancy........ .............. .............. .............. .............. ..............
59140 C Treat ectopic pregnancy........ .............. .............. .............. .............. ..............
59150 T Treat ectopic pregnancy........ 0131 41.81 $2,027.24 $1,089.88 $405.45
59151 T Treat ectopic pregnancy........ 0131 41.81 $2,027.24 $1,089.88 $405.45
59160 T D & c after delivery........... 0196 14.47 $701.61 $357.98 $140.32
59200 T Insert cervical dilator........ 0191 1.19 $57.70 $17.43 $11.54
59300 T Episiotomy or vaginal repair... 0194 16.21 $785.98 $395.94 $157.20
59320 T Revision of cervix............. 0194 16.21 $785.98 $395.94 $157.20
59325 C Revision of cervix............. .............. .............. .............. .............. ..............
59350 C Repair of uterus............... .............. .............. .............. .............. ..............
59400 E Obstetrical care............... .............. .............. .............. .............. ..............
59409 T Obstetrical care............... 0199 11.20 $543.06 $157.83 $108.61
59410 E Obstetrical care............... .............. .............. .............. .............. ..............
59412 T Antepartum manipulation........ 0199 11.20 $543.06 $157.83 $108.61
59414 T Deliver placenta............... 0199 11.20 $543.06 $157.83 $108.61
59425 E Antepartum care only........... .............. .............. .............. .............. ..............
59426 E Antepartum care only........... .............. .............. .............. .............. ..............
59430 E Care after delivery............ .............. .............. .............. .............. ..............
59510 E Cesarean delivery.............. .............. .............. .............. .............. ..............
59514 C Cesarean delivery only......... .............. .............. .............. .............. ..............
59515 E Cesarean delivery.............. .............. .............. .............. .............. ..............
59525 C Remove uterus after cesarean... .............. .............. .............. .............. ..............
59610 E Vbac delivery.................. .............. .............. .............. .............. ..............
59612 T Vbac delivery only............. 0199 11.20 $543.06 $157.83 $108.61
59614 E Vbac care after delivery....... .............. .............. .............. .............. ..............
59618 E Attempted vbac delivery........ .............. .............. .............. .............. ..............
59620 C Attempted vbac delivery only... .............. .............. .............. .............. ..............
59622 E Attempted vbac after care...... .............. .............. .............. .............. ..............
59812 T Treatment of miscarriage....... 0201 13.00 $630.33 $329.65 $126.07
59820 T Care of miscarriage............ 0201 13.00 $630.33 $329.65 $126.07
59821 T Treatment of miscarriage....... 0201 13.00 $630.33 $329.65 $126.07
59830 C Treat uterus infection......... .............. .............. .............. .............. ..............
59840 T Abortion....................... 0200 13.89 $673.49 $373.23 $134.70
59841 T Abortion....................... 0200 13.89 $673.49 $373.23 $134.70
59850 C Abortion....................... .............. .............. .............. .............. ..............
59851 C Abortion....................... .............. .............. .............. .............. ..............
59852 C Abortion....................... .............. .............. .............. .............. ..............
59855 C Abortion....................... .............. .............. .............. .............. ..............
59856 C Abortion....................... .............. .............. .............. .............. ..............
59857 C Abortion....................... .............. .............. .............. .............. ..............
59866 C Abortion (mpr)................. .............. .............. .............. .............. ..............
[[Page 18617]]
59870 T Evacuate mole of uterus........ 0201 13.00 $630.33 $329.65 $126.07
59871 T Remove cerclage suture......... 0194 16.21 $785.98 $395.94 $157.20
59898 T Laparo proc, ob care/deliver... 0130 25.36 $1,229.63 $659.53 $245.93
59899 T Maternity care procedure....... 0198 1.34 $64.97 $33.03 $12.99
60000 T Drain thyroid/tongue cyst...... 0253 12.02 $582.81 $284.00 $116.56
60001 T Aspirate/inject thyriod cyst... 0002 0.62 $30.06 $17.66 $6.01
60100 T Biopsy of thyroid.............. 0004 1.84 $89.22 $32.57 $17.84
60200 T Remove thyroid lesion.......... 0114 19.56 $948.41 $493.78 $189.68
60210 T Partial thyroid excision....... 0114 19.56 $948.41 $493.78 $189.68
60212 C Parital thyroid excision....... .............. .............. .............. .............. ..............
60220 T Partial removal of thyroid..... 0114 19.56 $948.41 $493.78 $189.68
60225 T Partial removal of thyroid..... 0114 19.56 $948.41 $493.78 $189.68
60240 T Removal of thyroid............. 0114 19.56 $948.41 $493.78 $189.68
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 lesion..... 0114 19.56 $948.41 $493.78 $189.68
60281 T Remove thyroid duct lesion..... 0114 19.56 $948.41 $493.78 $189.68
60500 T Explore parathyroid glands..... 0256 25.40 $1,231.57 $623.05 $246.31
60502 C Re-explore parathyroids........ .............. .............. .............. .............. ..............
60505 C Explore parathyroid glands..... .............. .............. .............. .............. ..............
60512 C Autotransplant parathyroid..... .............. .............. .............. .............. ..............
60520 C Removal of thymus gland........ .............. .............. .............. .............. ..............
60521 C Removal of thymus gland........ .............. .............. .............. .............. ..............
60522 C Removal of thymus gland........ .............. .............. .............. .............. ..............
60540 C Explore adrenal gland.......... .............. .............. .............. .............. ..............
60545 C Explore adrenal gland.......... .............. .............. .............. .............. ..............
60600 C Remove carotid body lesion..... .............. .............. .............. .............. ..............
60605 C Remove carotid body lesion..... .............. .............. .............. .............. ..............
60650 C Laparoscopy adrenalectomy...... .............. .............. .............. .............. ..............
60659 T Laparo proc, endocrine......... 0130 25.36 $1,229.63 $659.53 $245.93
60699 T Endocrine surgery procedure.... 0004 1.84 $89.22 $32.57 $17.84
61000 T Remove cranial cavity fluid.... 0212 3.64 $176.49 $88.78 $35.30
61001 T Remove cranial cavity fluid.... 0212 3.64 $176.49 $88.78 $35.30
61020 T Remove brain cavity fluid...... 0212 3.64 $176.49 $88.78 $35.30
61026 T Injection into brain canal..... 0212 3.64 $176.49 $88.78 $35.30
61050 T Remove brain canal fluid....... 0212 3.64 $176.49 $88.78 $35.30
61055 T Injection into brain canal..... 0212 3.64 $176.49 $88.78 $35.30
61070 T Brain canal shunt procedure.... 0212 3.64 $176.49 $88.78 $35.30
61105 C Twist drill hole............... .............. .............. .............. .............. ..............
61107 C Drill skull for implantation... .............. .............. .............. .............. ..............
61108 C Drill skull for drainage....... .............. .............. .............. .............. ..............
61120 C Burr hole for puncture......... .............. .............. .............. .............. ..............
61140 C Pierce skull for biopsy........ .............. .............. .............. .............. ..............
61150 C Pierce skull for drainage...... .............. .............. .............. .............. ..............
61151 C Pierce skull for drainage...... .............. .............. .............. .............. ..............
61154 C Pierce skull & remove clot..... .............. .............. .............. .............. ..............
61156 C Pierce skull for drainage...... .............. .............. .............. .............. ..............
61210 C Pierce skull, implant device... .............. .............. .............. .............. ..............
61215 T Insert brain-fluid device...... 0222 25.48 $1,235.45 $780.07 $247.09
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 T Decompress eye socket.......... 0256 25.40 $1,231.57 $623.05 $246.31
61332 C Explore/biopsy eye socket...... .............. .............. .............. .............. ..............
61333 C Explore orbit/remove lesion.... .............. .............. .............. .............. ..............
61334 C Explore orbit/remove object.... .............. .............. .............. .............. ..............
61340 C Relieve cranial pressure....... .............. .............. .............. .............. ..............
61343 C Incise skull (press relief).... .............. .............. .............. .............. ..............
61345 C Relieve cranial pressure....... .............. .............. .............. .............. ..............
61440 C Incise skull for surgery....... .............. .............. .............. .............. ..............
61450 C Incise skull for surgery....... .............. .............. .............. .............. ..............
61458 C Incise skull for brain wound... .............. .............. .............. .............. ..............
61460 C Incise skull for surgery....... .............. .............. .............. .............. ..............
[[Page 18618]]
61470 C Incise skull for surgery....... .............. .............. .............. .............. ..............
61480 C Incise skull for surgery....... .............. .............. .............. .............. ..............
61490 C Incise skull for surgery....... .............. .............. .............. .............. ..............
61500 C Removal of skull lesion........ .............. .............. .............. .............. ..............
61501 C Remove infected skull bone..... .............. .............. .............. .............. ..............
61510 C Removal of brain lesion........ .............. .............. .............. .............. ..............
61512 C Remove brain lining lesion..... .............. .............. .............. .............. ..............
61514 C Removal of brain abscess....... .............. .............. .............. .............. ..............
61516 C Removal of brain lesion........ .............. .............. .............. .............. ..............
61518 C Removal of brain lesion........ .............. .............. .............. .............. ..............
61519 C Remove brain lining lesion..... .............. .............. .............. .............. ..............
61520 C Removal of brain lesion........ .............. .............. .............. .............. ..............
61521 C Removal of brain lesion........ .............. .............. .............. .............. ..............
61522 C Removal of brain abscess....... .............. .............. .............. .............. ..............
61524 C Removal of brain lesion........ .............. .............. .............. .............. ..............
61526 C Removal of brain lesion........ .............. .............. .............. .............. ..............
61530 C Removal of brain lesion........ .............. .............. .............. .............. ..............
61531 C Implant brain electrodes....... .............. .............. .............. .............. ..............
61533 C Implant brain electrodes....... .............. .............. .............. .............. ..............
61534 C Removal of brain lesion........ .............. .............. .............. .............. ..............
61535 C Remove brain electrodes........ .............. .............. .............. .............. ..............
61536 C Removal of brain lesion........ .............. .............. .............. .............. ..............
61538 C Removal of brain tissue........ .............. .............. .............. .............. ..............
61539 C Removal of brain tissue........ .............. .............. .............. .............. ..............
61541 C Incision of brain tissue....... .............. .............. .............. .............. ..............
61542 C Removal of brain tissue........ .............. .............. .............. .............. ..............
61543 C Removal of brain tissue........ .............. .............. .............. .............. ..............
61544 C Remove & treat brain lesion.... .............. .............. .............. .............. ..............
61545 C Excision of brain tumor........ .............. .............. .............. .............. ..............
61546 C Removal of pituitary gland..... .............. .............. .............. .............. ..............
61548 C Removal of pituitary gland..... .............. .............. .............. .............. ..............
61550 C Release of skull seams......... .............. .............. .............. .............. ..............
61552 C Release of skull seams......... .............. .............. .............. .............. ..............
61556 C Incise skull/sutures........... .............. .............. .............. .............. ..............
61557 C Incise skull/sutures........... .............. .............. .............. .............. ..............
61558 C Excision of skull/sutures...... .............. .............. .............. .............. ..............
61559 C Excision of skull/sutures...... .............. .............. .............. .............. ..............
61563 C Excision of skull tumor........ .............. .............. .............. .............. ..............
61564 C Excision of skull tumor........ .............. .............. .............. .............. ..............
61570 C Remove foreign body, brain..... .............. .............. .............. .............. ..............
61571 C Incise skull for brain wound... .............. .............. .............. .............. ..............
61575 C Skull base/brainstem surgery... .............. .............. .............. .............. ..............
61576 C Skull base/brainstem surgery... .............. .............. .............. .............. ..............
61580 C Craniofacial approach, skull... .............. .............. .............. .............. ..............
61581 C Craniofacial approach, skull... .............. .............. .............. .............. ..............
61582 C Craniofacial approach, skull... .............. .............. .............. .............. ..............
61583 C Craniofacial approach, skull... .............. .............. .............. .............. ..............
61584 C Orbitocranial approach/skull... .............. .............. .............. .............. ..............
61585 C Orbitocranial approach/skull... .............. .............. .............. .............. ..............
61586 C Resect nasopharynx, skull...... .............. .............. .............. .............. ..............
61590 C Infratemporal approach/skull... .............. .............. .............. .............. ..............
61591 C Infratemporal approach/skull... .............. .............. .............. .............. ..............
61592 C Orbitocranial approach/skull... .............. .............. .............. .............. ..............
61595 C Transtemporal approach/skull... .............. .............. .............. .............. ..............
61596 C Transcochlear approach/skull... .............. .............. .............. .............. ..............
61597 C Transcondylar approach/skull... .............. .............. .............. .............. ..............
61598 C Transpetrosal approach/skull... .............. .............. .............. .............. ..............
61600 C Resect/excise cranial lesion... .............. .............. .............. .............. ..............
61601 C Resect/excise cranial lesion... .............. .............. .............. .............. ..............
61605 C Resect/excise cranial lesion... .............. .............. .............. .............. ..............
61606 C Resect/excise cranial lesion... .............. .............. .............. .............. ..............
61607 C Resect/excise cranial lesion... .............. .............. .............. .............. ..............
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 18619]]
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....... .............. .............. .............. .............. ..............
61720 C Incise skull/brain surgery..... .............. .............. .............. .............. ..............
61735 C Incise skull/brain surgery..... .............. .............. .............. .............. ..............
61750 C Incise skull/brain biopsy...... .............. .............. .............. .............. ..............
61751 C Brain biopsy w/ct/mr guide..... .............. .............. .............. .............. ..............
61760 C Implant brain electrodes....... .............. .............. .............. .............. ..............
61770 C Incise skull for treatment..... .............. .............. .............. .............. ..............
61790 T Treat trigeminal nerve......... 0220 13.96 $676.88 $326.21 $135.38
61791 C Treat trigeminal tract......... .............. .............. .............. .............. ..............
61793 E Focus radiation beam........... .............. .............. .............. .............. ..............
61795 C Brain surgery using computer... .............. .............. .............. .............. ..............
61850 C Implant neuroelectrodes........ .............. .............. .............. .............. ..............
61860 C Implant neuroelectrodes........ .............. .............. .............. .............. ..............
61862 C Implant neurostimul, subcort... .............. .............. .............. .............. ..............
61870 C Implant neuroelectrodes........ .............. .............. .............. .............. ..............
61875 C Implant neuroelectrodes........ .............. .............. .............. .............. ..............
61880 C Revise/remove neuroelectrode... .............. .............. .............. .............. ..............
61885 T Implant neurostim one array.... 0222 25.48 $1,235.45 $780.07 $247.09
61886 C Implant neurostim arrays....... .............. .............. .............. .............. ..............
61888 C Revise/remove neuroreceiver.... .............. .............. .............. .............. ..............
62000 C Treat skull fracture........... .............. .............. .............. .............. ..............
62005 C Treat skull fracture........... .............. .............. .............. .............. ..............
62010 C Treatment of head injury....... .............. .............. .............. .............. ..............
62100 C Repair brain fluid leakage..... .............. .............. .............. .............. ..............
62115 C Reduction of skull defect...... .............. .............. .............. .............. ..............
62116 C Reduction of skull defect...... .............. .............. .............. .............. ..............
62117 C Reduction of skull defect...... .............. .............. .............. .............. ..............
62120 C Repair skull cavity lesion..... .............. .............. .............. .............. ..............
62121 C Incise skull repair............ .............. .............. .............. .............. ..............
62140 C Repair of skull defect......... .............. .............. .............. .............. ..............
62141 C Repair of skull defect......... .............. .............. .............. .............. ..............
62142 C Remove skull plate/flap........ .............. .............. .............. .............. ..............
62143 C Replace skull plate/flap....... .............. .............. .............. .............. ..............
62145 C Repair of skull & brain........ .............. .............. .............. .............. ..............
62146 C Repair of skull with graft..... .............. .............. .............. .............. ..............
62147 C Repair of skull with graft..... .............. .............. .............. .............. ..............
62180 C Establish brain cavity shunt... .............. .............. .............. .............. ..............
62190 C Establish brain cavity shunt... .............. .............. .............. .............. ..............
62192 C Establish brain cavity shunt... .............. .............. .............. .............. ..............
62194 T Replace/irrigate catheter...... 0121 2.36 $114.43 $52.53 $22.89
62200 C Establish brain cavity shunt... .............. .............. .............. .............. ..............
62201 C Establish brain cavity shunt... .............. .............. .............. .............. ..............
62220 C Establish brain cavity shunt... .............. .............. .............. .............. ..............
62223 C Establish brain cavity shunt... .............. .............. .............. .............. ..............
62225 T Replace/irrigate catheter...... 0121 2.36 $114.43 $52.53 $22.89
62230 T Replace/revise brain shunt..... 0224 15.94 $772.88 $374.61 $154.58
62256 C Remove brain cavity shunt...... .............. .............. .............. .............. ..............
62258 C Replace brain cavity shunt..... .............. .............. .............. .............. ..............
62263 T Lysis epidural adhesions....... 0212 3.64 $176.49 $88.78 $35.30
62268 T Drain spinal cord cyst......... 0212 3.64 $176.49 $88.78 $35.30
62269 T Needle biopsy, spinal cord..... 0005 5.41 $262.32 $119.75 $52.46
62270 T Spinal fluid tap, diagnostic... 0210 3.00 $145.46 $62.40 $29.09
62272 T Drain spinal fluid............. 0210 3.00 $145.46 $62.40 $29.09
62273 T Treat epidural spine lesion.... 0212 3.64 $176.49 $88.78 $35.30
62280 T Treat spinal cord lesion....... 0212 3.64 $176.49 $88.78 $35.30
62281 T Treat spinal cord lesion....... 0212 3.64 $176.49 $88.78 $35.30
62282 T Treat spinal canal lesion...... 0212 3.64 $176.49 $88.78 $35.30
62284 N Injection for myelogram........ .............. .............. .............. .............. ..............
62287 T Percutaneous diskectomy........ 0220 13.96 $676.88 $326.21 $135.38
62290 N Inject for spine disk x-ray.... .............. .............. .............. .............. ..............
[[Page 18620]]
62291 N Inject for spine disk x-ray.... .............. .............. .............. .............. ..............
62292 T Injection into disk lesion..... 0212 3.64 $176.49 $88.78 $35.30
62294 T Injection into spinal artery... 0212 3.64 $176.49 $88.78 $35.30
62310 T Inject spine c/t............... 0212 3.64 $176.49 $88.78 $35.30
62311 T Inject spine l/s (cd).......... 0212 3.64 $176.49 $88.78 $35.30
62318 T Inject spine w/cath, c/t....... 0212 3.64 $176.49 $88.78 $35.30
62319 T Inject spine w/cath l/s (cd)... 0212 3.64 $176.49 $88.78 $35.30
62350 T Implant spinal canal cath...... 0223 6.34 $307.41 $153.24 $61.48
62351 C Implant spinal canal cath...... .............. .............. .............. .............. ..............
62355 T Remove spinal canal catheter... 0223 6.34 $307.41 $153.24 $61.48
62360 T Insert spine infusion device... 0222 25.48 $1,235.45 $780.07 $247.09
62361 T Implant spine infusion pump.... 0222 25.48 $1,235.45 $780.07 $247.09
62362 T Implant spine infusion pump.... 0222 25.48 $1,235.45 $780.07 $247.09
62365 T Remove spine infusion device... 0224 15.94 $772.88 $374.61 $154.58
62367 S Analyze spine infusion pump.... 0102 0.45 $21.82 $12.62 $4.36
62368 S Analyze spine infusion pump.... 0102 0.45 $21.82 $12.62 $4.36
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...... .............. .............. .............. .............. ..............
[[Page 18621]]
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 lesion...... 0220 13.96 $676.88 $326.21 $135.38
63610 T Stimulation of spinal cord..... 0220 13.96 $676.88 $326.21 $135.38
63615 T Remove lesion of spinal cord... 0220 13.96 $676.88 $326.21 $135.38
63650 T Implant neuroelectrodes........ 0224 15.94 $772.88 $374.61 $154.58
63655 C Implant neuroelectrodes........ .............. .............. .............. .............. ..............
63660 T Revise/remove neuroelectrode... 0224 15.94 $772.88 $374.61 $154.58
63685 T Implant neuroreceiver.......... 0222 25.48 $1,235.45 $780.07 $247.09
63688 T Revise/remove neuroreceiver.... 0224 15.94 $772.88 $374.61 $154.58
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 shunt....... 0224 15.94 $772.88 $374.61 $154.58
63746 T Removal of spinal shunt........ 0223 6.34 $307.41 $153.24 $61.48
64400 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64402 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64405 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64408 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64410 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64412 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64413 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64415 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64417 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64418 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64420 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64421 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64425 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64430 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64435 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64445 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64450 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64470 T Inj paravertebral c/t.......... 0211 3.32 $160.98 $74.78 $32.20
64472 T Inj paravertebral c/t add-on... 0211 3.32 $160.98 $74.78 $32.20
64475 T Inj paravertebral l/s.......... 0211 3.32 $160.98 $74.78 $32.20
64476 T Inj paravertebral l/s add-on... 0211 3.32 $160.98 $74.78 $32.20
64479 T Inj foramen epidural c/t....... 0211 3.32 $160.98 $74.78 $32.20
64480 T Inj foramen epidural add-on.... 0211 3.32 $160.98 $74.78 $32.20
64483 T Inj foramen epidural l/s....... 0211 3.32 $160.98 $74.78 $32.20
64484 T Inj foramen epidural add-on.... 0211 3.32 $160.98 $74.78 $32.20
64505 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64508 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64510 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64520 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
64530 T Injection for nerve block...... 0211 3.32 $160.98 $74.78 $32.20
[[Page 18622]]
64550 A Apply neurostimulator.......... .............. .............. .............. .............. ..............
64553 T Implant neuroelectrodes........ 0225 3.43 $166.31 $64.46 $33.26
64555 T Implant neuroelectrodes........ 0225 3.43 $166.31 $64.46 $33.26
64560 T Implant neuroelectrodes........ 0225 3.43 $166.31 $64.46 $33.26
64565 T Implant neuroelectrodes........ 0225 3.43 $166.31 $64.46 $33.26
64573 T Implant neuroelectrodes........ 0225 3.43 $166.31 $64.46 $33.26
64575 T Implant neuroelectrodes........ 0225 3.43 $166.31 $64.46 $33.26
64577 T Implant neuroelectrodes........ 0225 3.43 $166.31 $64.46 $33.26
64580 T Implant neuroelectrodes........ 0225 3.43 $166.31 $64.46 $33.26
64585 T Revise/remove neuroelectrode... 0225 3.43 $166.31 $64.46 $33.26
64590 T Implant neuroreceiver.......... 0222 25.48 $1,235.45 $780.07 $247.09
64595 T Revise/remove neuroreceiver.... 0225 3.43 $166.31 $64.46 $33.26
64600 T Injection treatment of nerve... 0211 3.32 $160.98 $74.78 $32.20
64605 T Injection treatment of nerve... 0211 3.32 $160.98 $74.78 $32.20
64610 T Injection treatment of nerve... 0211 3.32 $160.98 $74.78 $32.20
64612 T Destroy nerve, face muscle..... 0211 3.32 $160.98 $74.78 $32.20
64613 T Destroy nerve, spine muscle.... 0211 3.32 $160.98 $74.78 $32.20
64620 T Injection treatment of nerve... 0211 3.32 $160.98 $74.78 $32.20
64622 T Destr paravertebrl nerve l/s... 0211 3.32 $160.98 $74.78 $32.20
64623 T Destr paravertebral n add-on... 0211 3.32 $160.98 $74.78 $32.20
64626 T Destr paravertebrl nerve c/t... 0211 3.32 $160.98 $74.78 $32.20
64627 T Destr paravertebral n add-on... 0211 3.32 $160.98 $74.78 $32.20
64630 T Injection treatment of nerve... 0211 3.32 $160.98 $74.78 $32.20
64640 T Injection treatment of nerve... 0211 3.32 $160.98 $74.78 $32.20
64680 T Injection treatment of nerve... 0211 3.32 $160.98 $74.78 $32.20
64702 T Revise finger/toe nerve........ 0220 13.96 $676.88 $326.21 $135.38
64704 T Revise hand/foot nerve......... 0220 13.96 $676.88 $326.21 $135.38
64708 T Revise arm/leg nerve........... 0220 13.96 $676.88 $326.21 $135.38
64712 T Revision of sciatic nerve...... 0220 13.96 $676.88 $326.21 $135.38
64713 T Revision of arm nerve(s)....... 0220 13.96 $676.88 $326.21 $135.38
64714 T Revise low back nerve(s)....... 0220 13.96 $676.88 $326.21 $135.38
64716 T Revision of cranial nerve...... 0220 13.96 $676.88 $326.21 $135.38
64718 T Revise ulnar nerve at elbow.... 0220 13.96 $676.88 $326.21 $135.38
64719 T Revise ulnar nerve at wrist.... 0220 13.96 $676.88 $326.21 $135.38
64721 T Carpal tunnel surgery.......... 0220 13.96 $676.88 $326.21 $135.38
64722 T Relieve pressure on nerve(s)... 0220 13.96 $676.88 $326.21 $135.38
64726 T Release foot/toe nerve......... 0220 13.96 $676.88 $326.21 $135.38
64727 T Internal nerve revision........ 0220 13.96 $676.88 $326.21 $135.38
64732 T Incision of brow nerve......... 0220 13.96 $676.88 $326.21 $135.38
64734 T Incision of cheek nerve........ 0220 13.96 $676.88 $326.21 $135.38
64736 T Incision of chin nerve......... 0220 13.96 $676.88 $326.21 $135.38
64738 T Incision of jaw nerve.......... 0220 13.96 $676.88 $326.21 $135.38
64740 T Incision of tongue nerve....... 0220 13.96 $676.88 $326.21 $135.38
64742 T Incision of facial nerve....... 0220 13.96 $676.88 $326.21 $135.38
64744 T Incise nerve, back of head..... 0220 13.96 $676.88 $326.21 $135.38
64746 T Incise diaphragm nerve......... 0220 13.96 $676.88 $326.21 $135.38
64752 C Incision of vagus nerve........ .............. .............. .............. .............. ..............
64755 C Incision of stomach nerves..... .............. .............. .............. .............. ..............
64760 C Incision of vagus nerve........ .............. .............. .............. .............. ..............
64761 T Incision of pelvis nerve....... 0220 13.96 $676.88 $326.21 $135.38
64763 C Incise hip/thigh nerve......... .............. .............. .............. .............. ..............
64766 C Incise hip/thigh nerve......... .............. .............. .............. .............. ..............
64771 T Sever cranial nerve............ 0220 13.96 $676.88 $326.21 $135.38
64772 T Incision of spinal nerve....... 0220 13.96 $676.88 $326.21 $135.38
64774 T Remove skin nerve lesion....... 0220 13.96 $676.88 $326.21 $135.38
64776 T Remove digit nerve lesion...... 0220 13.96 $676.88 $326.21 $135.38
64778 T Digit nerve surgery add-on..... 0220 13.96 $676.88 $326.21 $135.38
64782 T Remove limb nerve lesion....... 0220 13.96 $676.88 $326.21 $135.38
64783 T Limb nerve surgery add-on...... 0220 13.96 $676.88 $326.21 $135.38
64784 T Remove nerve lesion............ 0220 13.96 $676.88 $326.21 $135.38
64786 T Remove sciatic nerve lesion.... 0221 18.36 $890.22 $463.62 $178.04
64787 T Implant nerve end.............. 0220 13.96 $676.88 $326.21 $135.38
64788 T Remove skin nerve lesion....... 0220 13.96 $676.88 $326.21 $135.38
64790 T Removal of nerve lesion........ 0220 13.96 $676.88 $326.21 $135.38
64792 T Removal of nerve lesion........ 0221 18.36 $890.22 $463.62 $178.04
64795 T Biopsy of nerve................ 0220 13.96 $676.88 $326.21 $135.38
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...... .............. .............. .............. .............. ..............
64831 T Repair of digit nerve.......... 0221 18.36 $890.22 $463.62 $178.04
64832 T Repair nerve add-on............ 0221 18.36 $890.22 $463.62 $178.04
[[Page 18623]]
64834 T Repair of hand or foot nerve... 0221 18.36 $890.22 $463.62 $178.04
64835 T Repair of hand or foot nerve... 0221 18.36 $890.22 $463.62 $178.04
64836 T Repair of hand or foot nerve... 0221 18.36 $890.22 $463.62 $178.04
64837 T Repair nerve add-on............ 0221 18.36 $890.22 $463.62 $178.04
64840 T Repair of leg nerve............ 0221 18.36 $890.22 $463.62 $178.04
64856 T Repair/transpose nerve......... 0221 18.36 $890.22 $463.62 $178.04
64857 T Repair arm/leg nerve........... 0221 18.36 $890.22 $463.62 $178.04
64858 T Repair sciatic nerve........... 0221 18.36 $890.22 $463.62 $178.04
64859 T Nerve surgery.................. 0221 18.36 $890.22 $463.62 $178.04
64861 T Repair of arm nerves........... 0221 18.36 $890.22 $463.62 $178.04
64862 T Repair of low back nerves...... 0221 18.36 $890.22 $463.62 $178.04
64864 T Repair of facial nerve......... 0221 18.36 $890.22 $463.62 $178.04
64865 T Repair of facial nerve......... 0221 18.36 $890.22 $463.62 $178.04
64866 C Fusion of facial/other nerve... .............. .............. .............. .............. ..............
64868 C Fusion of facial/other nerve... .............. .............. .............. .............. ..............
64870 T Fusion of facial/other nerve... 0221 18.36 $890.22 $463.62 $178.04
64872 T Subsequent repair of nerve..... 0221 18.36 $890.22 $463.62 $178.04
64874 T Repair & revise nerve add-on... 0221 18.36 $890.22 $463.62 $178.04
64876 T Repair nerve/shorten bone...... 0221 18.36 $890.22 $463.62 $178.04
64885 T Nerve graft, head or neck...... 0221 18.36 $890.22 $463.62 $178.04
64886 T Nerve graft, head or neck...... 0221 18.36 $890.22 $463.62 $178.04
64890 T Nerve graft, hand or foot...... 0221 18.36 $890.22 $463.62 $178.04
64891 T Nerve graft, hand or foot...... 0221 18.36 $890.22 $463.62 $178.04
64892 T Nerve graft, arm or leg........ 0221 18.36 $890.22 $463.62 $178.04
64893 T Nerve graft, arm or leg........ 0221 18.36 $890.22 $463.62 $178.04
64895 T Nerve graft, hand or foot...... 0221 18.36 $890.22 $463.62 $178.04
64896 T Nerve graft, hand or foot...... 0221 18.36 $890.22 $463.62 $178.04
64897 T Nerve graft, arm or leg........ 0221 18.36 $890.22 $463.62 $178.04
64898 T Nerve graft, arm or leg........ 0221 18.36 $890.22 $463.62 $178.04
64901 T Nerve graft add-on............. 0221 18.36 $890.22 $463.62 $178.04
64902 T Nerve graft add-on............. 0221 18.36 $890.22 $463.62 $178.04
64905 T Nerve pedicle transfer......... 0221 18.36 $890.22 $463.62 $178.04
64907 T Nerve pedicle transfer......... 0221 18.36 $890.22 $463.62 $178.04
64999 T Nervous system surgery......... 0211 3.32 $160.98 $74.78 $32.20
65091 T Revise eye..................... 0242 23.70 $1,149.14 $597.36 $229.83
65093 T Revise eye with implant........ 0241 16.60 $804.89 $384.47 $160.98
65101 T Removal of eye................. 0242 23.70 $1,149.14 $597.36 $229.83
65103 T Remove eye/insert implant...... 0242 23.70 $1,149.14 $597.36 $229.83
65105 T Remove eye/attach implant...... 0242 23.70 $1,149.14 $597.36 $229.83
65110 T Removal of eye................. 0242 23.70 $1,149.14 $597.36 $229.83
65112 T Remove eye/revise socket....... 0242 23.70 $1,149.14 $597.36 $229.83
65114 T Remove eye/revise socket....... 0242 23.70 $1,149.14 $597.36 $229.83
65125 T Revise ocular implant.......... 0240 13.47 $653.12 $315.31 $130.62
65130 T Insert ocular implant.......... 0241 16.60 $804.89 $384.47 $160.98
65135 T Insert ocular implant.......... 0241 16.60 $804.89 $384.47 $160.98
65140 T Attach ocular implant.......... 0242 23.70 $1,149.14 $597.36 $229.83
65150 T Revise ocular implant.......... 0241 16.60 $804.89 $384.47 $160.98
65155 T Reinsert ocular implant........ 0242 23.70 $1,149.14 $597.36 $229.83
65175 T Removal of ocular implant...... 0240 13.47 $653.12 $315.31 $130.62
65205 S Remove foreign body from eye... 0231 2.64 $128.01 $59.87 $25.60
65210 S Remove foreign body from eye... 0231 2.64 $128.01 $59.87 $25.60
65220 S Remove foreign body from eye... 0231 2.64 $128.01 $59.87 $25.60
65222 S Remove foreign body from eye... 0231 2.64 $128.01 $59.87 $25.60
65235 T Remove foreign body from eye... 0232 6.04 $292.86 $134.66 $58.57
65260 T Remove foreign body from eye... 0237 33.96 $1,646.62 $852.68 $329.32
65265 T Remove foreign body from eye... 0237 33.96 $1,646.62 $852.68 $329.32
65270 T Repair of eye wound............ 0240 13.47 $653.12 $315.31 $130.62
65272 T Repair of eye wound............ 0232 6.04 $292.86 $134.66 $58.57
65273 C Repair of eye wound............ .............. .............. .............. .............. ..............
65275 T Repair of eye wound............ 0233 13.79 $668.64 $331.60 $133.73
65280 T Repair of eye wound............ 0233 13.79 $668.64 $331.60 $133.73
65285 T Repair of eye wound............ 0234 20.64 $1,000.77 $502.16 $200.15
65286 T Repair of eye wound............ 0232 6.04 $292.86 $134.66 $58.57
65290 T Repair of eye socket wound..... 0243 17.99 $872.28 $431.39 $174.46
65400 T Removal of eye lesion.......... 0232 6.04 $292.86 $134.66 $58.57
65410 T Biopsy of cornea............... 0233 13.79 $668.64 $331.60 $133.73
65420 T Removal of eye lesion.......... 0233 13.79 $668.64 $331.60 $133.73
65426 T Removal of eye lesion.......... 0233 13.79 $668.64 $331.60 $133.73
65430 S Corneal smear.................. 0231 2.64 $128.01 $59.87 $25.60
65435 T Curette/treat cornea........... 0239 6.26 $303.53 $123.42 $60.71
65436 T Curette/treat cornea........... 0232 6.04 $292.86 $134.66 $58.57
65450 T Treatment of corneal lesion.... 0232 6.04 $292.86 $134.66 $58.57
65600 T Revision of cornea............. 0240 13.47 $653.12 $315.31 $130.62
[[Page 18624]]
65710 T Corneal transplant............. 0244 32.88 $1,594.26 $851.42 $318.85
65730 T Corneal transplant............. 0244 32.88 $1,594.26 $851.42 $318.85
65750 T Corneal transplant............. 0244 32.88 $1,594.26 $851.42 $318.85
65755 T Corneal transplant............. 0244 32.88 $1,594.26 $851.42 $318.85
65760 E Revision of cornea............. .............. .............. .............. .............. ..............
65765 E Revision of cornea............. .............. .............. .............. .............. ..............
65767 E Corneal tissue transplant...... .............. .............. .............. .............. ..............
65770 T Revise cornea with implant..... 0244 32.88 $1,594.26 $851.42 $318.85
65771 E Radial keratotomy.............. .............. .............. .............. .............. ..............
65772 T Correction of astigmatism...... 0232 6.04 $292.86 $134.66 $58.57
65775 T Correction of astigmatism...... 0233 13.79 $668.64 $331.60 $133.73
65800 T Drainage of eye................ 0232 6.04 $292.86 $134.66 $58.57
65805 T Drainage of eye................ 0233 13.79 $668.64 $331.60 $133.73
65810 T Drainage of eye................ 0233 13.79 $668.64 $331.60 $133.73
65815 T Drainage of eye................ 0233 13.79 $668.64 $331.60 $133.73
65820 T Relieve inner eye pressure..... 0232 6.04 $292.86 $134.66 $58.57
65850 T Incision of eye................ 0234 20.64 $1,000.77 $502.16 $200.15
65855 T Laser surgery of eye........... 0247 4.89 $237.10 $112.86 $47.42
65860 T Incise inner eye adhesions..... 0247 4.89 $237.10 $112.86 $47.42
65865 T Incise inner eye adhesions..... 0233 13.79 $668.64 $331.60 $133.73
65870 T Incise inner eye adhesions..... 0233 13.79 $668.64 $331.60 $133.73
65875 T Incise inner eye adhesions..... 0233 13.79 $668.64 $331.60 $133.73
65880 T Incise inner eye adhesions..... 0232 6.04 $292.86 $134.66 $58.57
65900 T Remove eye lesion.............. 0232 6.04 $292.86 $134.66 $58.57
65920 T Remove implant from eye........ 0233 13.79 $668.64 $331.60 $133.73
65930 T Remove blood clot from eye..... 0233 13.79 $668.64 $331.60 $133.73
66020 T Injection treatment of eye..... 0232 6.04 $292.86 $134.66 $58.57
66030 T Injection treatment of eye..... 0232 6.04 $292.86 $134.66 $58.57
66130 T Remove eye lesion.............. 0233 13.79 $668.64 $331.60 $133.73
66150 T Glaucoma surgery............... 0233 13.79 $668.64 $331.60 $133.73
66155 T Glaucoma surgery............... 0234 20.64 $1,000.77 $502.16 $200.15
66160 T Glaucoma surgery............... 0234 20.64 $1,000.77 $502.16 $200.15
66165 T Glaucoma surgery............... 0234 20.64 $1,000.77 $502.16 $200.15
66170 T Glaucoma surgery............... 0234 20.64 $1,000.77 $502.16 $200.15
66172 T Incision of eye................ 0234 20.64 $1,000.77 $502.16 $200.15
66180 T Implant eye shunt.............. 0234 20.64 $1,000.77 $502.16 $200.15
66185 T Revise eye shunt............... 0234 20.64 $1,000.77 $502.16 $200.15
66220 T Repair eye lesion.............. 0236 6.70 $324.86 $147.96 $64.97
66225 T Repair/graft eye lesion........ 0234 20.64 $1,000.77 $502.16 $200.15
66250 T Follow-up surgery of eye....... 0233 13.79 $668.64 $331.60 $133.73
66500 T Incision of iris............... 0232 6.04 $292.86 $134.66 $58.57
66505 T Incision of iris............... 0232 6.04 $292.86 $134.66 $58.57
66600 T Remove iris and lesion......... 0233 13.79 $668.64 $331.60 $133.73
66605 T Removal of iris................ 0233 13.79 $668.64 $331.60 $133.73
66625 T Removal of iris................ 0232 6.04 $292.86 $134.66 $58.57
66630 T Removal of iris................ 0233 13.79 $668.64 $331.60 $133.73
66635 T Removal of iris................ 0233 13.79 $668.64 $331.60 $133.73
66680 T Repair iris & ciliary body..... 0233 13.79 $668.64 $331.60 $133.73
66682 T Repair iris & ciliary body..... 0233 13.79 $668.64 $331.60 $133.73
66700 T Destruction, ciliary body...... 0232 6.04 $292.86 $134.66 $58.57
66710 T Destruction, ciliary body...... 0232 6.04 $292.86 $134.66 $58.57
66720 T Destruction, ciliary body...... 0232 6.04 $292.86 $134.66 $58.57
66740 T Destruction, ciliary body...... 0233 13.79 $668.64 $331.60 $133.73
66761 T Revision of iris............... 0247 4.89 $237.10 $112.86 $47.42
66762 T Revision of iris............... 0247 4.89 $237.10 $112.86 $47.42
66770 T Removal of inner eye lesion.... 0247 4.89 $237.10 $112.86 $47.42
66820 T Incision, secondary cataract... 0232 6.04 $292.86 $134.66 $58.57
66821 T After cataract laser surgery... 0247 4.89 $237.10 $112.86 $47.42
66825 T Reposition intraocular lens.... 0233 13.79 $668.64 $331.60 $133.73
66830 T Removal of lens lesion......... 0232 6.04 $292.86 $134.66 $58.57
66840 T Removal of lens material....... 0245 26.55 $1,287.33 $623.85 $257.47
66850 T Removal of lens material....... 0245 26.55 $1,287.33 $623.85 $257.47
66852 T Removal of lens material....... 0245 26.55 $1,287.33 $623.85 $257.47
66920 T Extraction of lens............. 0245 26.55 $1,287.33 $623.85 $257.47
66930 T Extraction of lens............. 0245 26.55 $1,287.33 $623.85 $257.47
66940 T Extraction of lens............. 0245 26.55 $1,287.33 $623.85 $257.47
66983 T Remove cataract/insert lens.... 0246 26.55 $1,287.33 $623.85 $257.47
66984 T Remove cataract/insert lens.... 0246 26.55 $1,287.33 $623.85 $257.47
66985 T Insert lens prosthesis......... 0246 26.55 $1,287.33 $623.85 $257.47
66986 T Exchange lens prosthesis....... 0246 26.55 $1,287.33 $623.85 $257.47
66999 T Eye surgery procedure.......... 0247 4.89 $237.10 $112.86 $47.42
67005 T Partial removal of eye fluid... 0237 33.96 $1,646.62 $852.68 $329.32
67010 T Partial removal of eye fluid... 0237 33.96 $1,646.62 $852.68 $329.32
[[Page 18625]]
67015 T Release of eye fluid........... 0237 33.96 $1,646.62 $852.68 $329.32
67025 T Replace eye fluid.............. 0237 33.96 $1,646.62 $852.68 $329.32
67027 T Implant eye drug system........ 0237 33.96 $1,646.62 $852.68 $329.32
67028 T Injection eye drug............. 0236 6.70 $324.86 $147.96 $64.97
67030 T Incise inner eye strands....... 0236 6.70 $324.86 $147.96 $64.97
67031 T Laser surgery, eye strands..... 0247 4.89 $237.10 $112.86 $47.42
67036 T Removal of inner eye fluid..... 0237 33.96 $1,646.62 $852.68 $329.32
67038 T Strip retinal membrane......... 0237 33.96 $1,646.62 $852.68 $329.32
67039 T Laser treatment of retina...... 0237 33.96 $1,646.62 $852.68 $329.32
67040 T Laser treatment of retina...... 0237 33.96 $1,646.62 $852.68 $329.32
67101 T Repair detached retina......... 0236 6.70 $324.86 $147.96 $64.97
67105 T Repair detached retina......... 0248 4.19 $203.16 $94.05 $40.63
67107 T Repair detached retina......... 0237 33.96 $1,646.62 $852.68 $329.32
67108 T Repair detached retina......... 0237 33.96 $1,646.62 $852.68 $329.32
67110 T Repair detached retina......... 0236 6.70 $324.86 $147.96 $64.97
67112 T Rerepair detached retina....... 0237 33.96 $1,646.62 $852.68 $329.32
67115 T Release encircling material.... 0236 6.70 $324.86 $147.96 $64.97
67120 T Remove eye implant material.... 0236 6.70 $324.86 $147.96 $64.97
67121 T Remove eye implant material.... 0237 33.96 $1,646.62 $852.68 $329.32
67141 T Treatment of retina............ 0235 2.94 $142.55 $78.91 $28.51
67145 T Treatment of retina............ 0248 4.19 $203.16 $94.05 $40.63
67208 T Treatment of retinal lesion.... 0235 2.94 $142.55 $78.91 $28.51
67210 T Treatment of retinal lesion.... 0248 4.19 $203.16 $94.05 $40.63
67218 T Treatment of retinal lesion.... 0237 33.96 $1,646.62 $852.68 $329.32
67220 T Treatment of choroid lesion.... 0237 33.96 $1,646.62 $852.68 $329.32
67227 T Treatment of retinal lesion.... 0235 2.94 $142.55 $78.91 $28.51
67228 T Treatment of retinal lesion.... 0248 4.19 $203.16 $94.05 $40.63
67250 T Reinforce eye wall............. 0240 13.47 $653.12 $315.31 $130.62
67255 T Reinforce/graft eye wall....... 0237 33.96 $1,646.62 $852.68 $329.32
67299 T Eye surgery procedure.......... 0248 4.19 $203.16 $94.05 $40.63
67311 T Revise eye muscle.............. 0243 17.99 $872.28 $431.39 $174.46
67312 T Revise two eye muscles......... 0243 17.99 $872.28 $431.39 $174.46
67314 T Revise eye muscle.............. 0243 17.99 $872.28 $431.39 $174.46
67316 T Revise two eye muscles......... 0243 17.99 $872.28 $431.39 $174.46
67318 T Revise eye muscle(s)........... 0243 17.99 $872.28 $431.39 $174.46
67320 T Revise eye muscle(s) add-on.... 0243 17.99 $872.28 $431.39 $174.46
67331 T Eye surgery follow-up add-on... 0243 17.99 $872.28 $431.39 $174.46
67332 T Rerevise eye muscles add-on.... 0243 17.99 $872.28 $431.39 $174.46
67334 T Revise eye muscle w/suture..... 0243 17.99 $872.28 $431.39 $174.46
67335 T Eye suture during surgery...... 0243 17.99 $872.28 $431.39 $174.46
67340 T Revise eye muscle add-on....... 0243 17.99 $872.28 $431.39 $174.46
67343 T Release eye tissue............. 0243 17.99 $872.28 $431.39 $174.46
67345 T Destroy nerve of eye muscle.... 0238 2.80 $135.76 $58.96 $27.15
67350 S Biopsy eye muscle.............. 0231 2.64 $128.01 $59.87 $25.60
67399 T Eye muscle surgery procedure... 0243 17.99 $872.28 $431.39 $174.46
67400 T Explore/biopsy eye socket...... 0241 16.60 $804.89 $384.47 $160.98
67405 T Explore/drain eye socket....... 0241 16.60 $804.89 $384.47 $160.98
67412 T Explore/treat eye socket....... 0241 16.60 $804.89 $384.47 $160.98
67413 T Explore/treat eye socket....... 0241 16.60 $804.89 $384.47 $160.98
67414 T Explr/decompress eye socket.... 0242 23.70 $1,149.14 $597.36 $229.83
67415 T Aspiration, orbital contents... 0239 6.26 $303.53 $123.42 $60.71
67420 T Explore/treat eye socket....... 0242 23.70 $1,149.14 $597.36 $229.83
67430 T Explore/treat eye socket....... 0242 23.70 $1,149.14 $597.36 $229.83
67440 T Explore/drain eye socket....... 0242 23.70 $1,149.14 $597.36 $229.83
67445 T Explr/decompress eye socket.... 0242 23.70 $1,149.14 $597.36 $229.83
67450 T Explore/biopsy eye socket...... 0242 23.70 $1,149.14 $597.36 $229.83
67500 S Inject/treat eye socket........ 0231 2.64 $128.01 $59.87 $25.60
67505 T Inject/treat eye socket........ 0238 2.80 $135.76 $58.96 $27.15
67515 T Inject/treat eye socket........ 0239 6.26 $303.53 $123.42 $60.71
67550 T Insert eye socket implant...... 0242 23.70 $1,149.14 $597.36 $229.83
67560 T Revise eye socket implant...... 0241 16.60 $804.89 $384.47 $160.98
67570 T Decompress optic nerve......... 0242 23.70 $1,149.14 $597.36 $229.83
67599 T Orbit surgery procedure........ 0239 6.26 $303.53 $123.42 $60.71
67700 T Drainage of eyelid abscess..... 0238 2.80 $135.76 $58.96 $27.15
67710 T Incision of eyelid............. 0239 6.26 $303.53 $123.42 $60.71
67715 T Incision of eyelid fold........ 0240 13.47 $653.12 $315.31 $130.62
67800 T Remove eyelid lesion........... 0238 2.80 $135.76 $58.96 $27.15
67801 T Remove eyelid lesions.......... 0239 6.26 $303.53 $123.42 $60.71
67805 T Remove eyelid lesions.......... 0238 2.80 $135.76 $58.96 $27.15
67808 T Remove eyelid lesion(s)........ 0240 13.47 $653.12 $315.31 $130.62
67810 T Biopsy of eyelid............... 0238 2.80 $135.76 $58.96 $27.15
67820 T Revise eyelashes............... 0238 2.80 $135.76 $58.96 $27.15
67825 T Revise eyelashes............... 0238 2.80 $135.76 $58.96 $27.15
[[Page 18626]]
67830 T Revise eyelashes............... 0239 6.26 $303.53 $123.42 $60.71
67835 T Revise eyelashes............... 0240 13.47 $653.12 $315.31 $130.62
67840 T Remove eyelid lesion........... 0239 6.26 $303.53 $123.42 $60.71
67850 T Treat eyelid lesion............ 0239 6.26 $303.53 $123.42 $60.71
67875 T Closure of eyelid by suture.... 0239 6.26 $303.53 $123.42 $60.71
67880 T Revision of eyelid............. 0232 6.04 $292.86 $134.66 $58.57
67882 T Revision of eyelid............. 0240 13.47 $653.12 $315.31 $130.62
67900 T Repair brow defect............. 0240 13.47 $653.12 $315.31 $130.62
67901 T Repair eyelid defect........... 0240 13.47 $653.12 $315.31 $130.62
67902 T Repair eyelid defect........... 0240 13.47 $653.12 $315.31 $130.62
67903 T Repair eyelid defect........... 0240 13.47 $653.12 $315.31 $130.62
67904 T Repair eyelid defect........... 0240 13.47 $653.12 $315.31 $130.62
67906 T Repair eyelid defect........... 0240 13.47 $653.12 $315.31 $130.62
67908 T Repair eyelid defect........... 0240 13.47 $653.12 $315.31 $130.62
67909 T Revise eyelid defect........... 0240 13.47 $653.12 $315.31 $130.62
67911 T Revise eyelid defect........... 0240 13.47 $653.12 $315.31 $130.62
67914 T Repair eyelid defect........... 0240 13.47 $653.12 $315.31 $130.62
67915 T Repair eyelid defect........... 0239 6.26 $303.53 $123.42 $60.71
67916 T Repair eyelid defect........... 0240 13.47 $653.12 $315.31 $130.62
67917 T Repair eyelid defect........... 0240 13.47 $653.12 $315.31 $130.62
67921 T Repair eyelid defect........... 0240 13.47 $653.12 $315.31 $130.62
67922 T Repair eyelid defect........... 0239 6.26 $303.53 $123.42 $60.71
67923 T Repair eyelid defect........... 0240 13.47 $653.12 $315.31 $130.62
67924 T Repair eyelid defect........... 0240 13.47 $653.12 $315.31 $130.62
67930 T Repair eyelid wound............ 0240 13.47 $653.12 $315.31 $130.62
67935 T Repair eyelid wound............ 0240 13.47 $653.12 $315.31 $130.62
67938 T Remove eyelid foreign body..... 0238 2.80 $135.76 $58.96 $27.15
67950 T Revision of eyelid............. 0240 13.47 $653.12 $315.31 $130.62
67961 T Revision of eyelid............. 0240 13.47 $653.12 $315.31 $130.62
67966 T Revision of eyelid............. 0240 13.47 $653.12 $315.31 $130.62
67971 T Reconstruction of eyelid....... 0241 16.60 $804.89 $384.47 $160.98
67973 T Reconstruction of eyelid....... 0241 16.60 $804.89 $384.47 $160.98
67974 T Reconstruction of eyelid....... 0241 16.60 $804.89 $384.47 $160.98
67975 T Reconstruction of eyelid....... 0240 13.47 $653.12 $315.31 $130.62
67999 T Revision of eyelid............. 0240 13.47 $653.12 $315.31 $130.62
68020 T Incise/drain eyelid lining..... 0240 13.47 $653.12 $315.31 $130.62
68040 T Treatment of eyelid lesions.... 0239 6.26 $303.53 $123.42 $60.71
68100 T Biopsy of eyelid lining........ 0232 6.04 $292.86 $134.66 $58.57
68110 S Remove eyelid lining lesion.... 0231 2.64 $128.01 $59.87 $25.60
68115 T Remove eyelid lining lesion.... 0239 6.26 $303.53 $123.42 $60.71
68130 T Remove eyelid lining lesion.... 0233 13.79 $668.64 $331.60 $133.73
68135 T Remove eyelid lining lesion.... 0239 6.26 $303.53 $123.42 $60.71
68200 S Treat eyelid by injection...... 0230 0.98 $47.52 $22.48 $9.50
68320 T Revise/graft eyelid lining..... 0240 13.47 $653.12 $315.31 $130.62
68325 T Revise/graft eyelid lining..... 0242 23.70 $1,149.14 $597.36 $229.83
68326 T Revise/graft eyelid lining..... 0241 16.60 $804.89 $384.47 $160.98
68328 T Revise/graft eyelid lining..... 0241 16.60 $804.89 $384.47 $160.98
68330 T Revise eyelid lining........... 0233 13.79 $668.64 $331.60 $133.73
68335 T Revise/graft eyelid lining..... 0241 16.60 $804.89 $384.47 $160.98
68340 T Separate eyelid adhesions...... 0240 13.47 $653.12 $315.31 $130.62
68360 T Revise eyelid lining........... 0234 20.64 $1,000.77 $502.16 $200.15
68362 T Revise eyelid lining........... 0234 20.64 $1,000.77 $502.16 $200.15
68399 T Eyelid lining surgery.......... 0239 6.26 $303.53 $123.42 $60.71
68400 T Incise/drain tear gland........ 0238 2.80 $135.76 $58.96 $27.15
68420 T Incise/drain tear sac.......... 0240 13.47 $653.12 $315.31 $130.62
68440 T Incise tear duct opening....... 0238 2.80 $135.76 $58.96 $27.15
68500 T Removal of tear gland.......... 0241 16.60 $804.89 $384.47 $160.98
68505 T Partial removal, tear gland.... 0241 16.60 $804.89 $384.47 $160.98
68510 T Biopsy of tear gland........... 0240 13.47 $653.12 $315.31 $130.62
68520 T Removal of tear sac............ 0241 16.60 $804.89 $384.47 $160.98
68525 T Biopsy of tear sac............. 0240 13.47 $653.12 $315.31 $130.62
68530 T Clearance of tear duct......... 0240 13.47 $653.12 $315.31 $130.62
68540 T Remove tear gland lesion....... 0241 16.60 $804.89 $384.47 $160.98
68550 T Remove tear gland lesion....... 0242 23.70 $1,149.14 $597.36 $229.83
68700 T Repair tear ducts.............. 0241 16.60 $804.89 $384.47 $160.98
68705 T Revise tear duct opening....... 0238 2.80 $135.76 $58.96 $27.15
68720 T Create tear sac drain.......... 0242 23.70 $1,149.14 $597.36 $229.83
68745 T Create tear duct drain......... 0241 16.60 $804.89 $384.47 $160.98
68750 T Create tear duct drain......... 0242 23.70 $1,149.14 $597.36 $229.83
68760 T Close tear duct opening........ 0238 2.80 $135.76 $58.96 $27.15
68761 S Close tear duct opening........ 0231 2.64 $128.01 $59.87 $25.60
68770 T Close tear system fistula...... 0240 13.47 $653.12 $315.31 $130.62
68801 S Dilate tear duct opening....... 0231 2.64 $128.01 $59.87 $25.60
[[Page 18627]]
68810 S Probe nasolacrimal duct........ 0231 2.64 $128.01 $59.87 $25.60
68811 T Probe nasolacrimal duct........ 0240 13.47 $653.12 $315.31 $130.62
68815 T Probe nasolacrimal duct........ 0240 13.47 $653.12 $315.31 $130.62
68840 S Explore/irrigate tear ducts.... 0231 2.64 $128.01 $59.87 $25.60
68850 N Injection for tear sac x-ray... .............. .............. .............. .............. ..............
68899 S Tear duct system surgery....... 0231 2.64 $128.01 $59.87 $25.60
69000 T Drain external ear lesion...... 0006 2.00 $96.97 $33.95 $19.39
69005 T Drain external ear lesion...... 0007 3.68 $178.43 $72.03 $35.69
69020 T Drain outer ear canal lesion... 0006 2.00 $96.97 $33.95 $19.39
69090 E Pierce earlobes................ .............. .............. .............. .............. ..............
69100 T Biopsy of external ear......... 0019 4.00 $193.95 $78.91 $38.79
69105 T Biopsy of external ear canal... 0253 12.02 $582.81 $284.00 $116.56
69110 T Remove external ear, partial... 0020 6.51 $315.65 $130.53 $63.13
69120 T Removal of external ear........ 0253 12.02 $582.81 $284.00 $116.56
69140 T Remove ear canal lesion(s)..... 0254 12.45 $603.66 $272.41 $120.73
69145 T Remove ear canal lesion(s)..... 0020 6.51 $315.65 $130.53 $63.13
69150 C Extensive ear canal surgery.... .............. .............. .............. .............. ..............
69155 C Extensive ear/neck surgery..... .............. .............. .............. .............. ..............
69200 X Clear outer ear canal.......... 0340 1.04 $50.43 $12.85 $10.09
69205 T Clear outer ear canal.......... 0022 12.49 $605.60 $292.94 $121.12
69210 X Remove impacted ear wax........ 0340 1.04 $50.43 $12.85 $10.09
69220 T Clean out mastoid cavity....... 0012 0.53 $25.70 $9.18 $5.14
69222 T Clean out mastoid cavity....... 0253 12.02 $582.81 $284.00 $116.56
69300 T Revise external ear............ 0254 12.45 $603.66 $272.41 $120.73
69310 T Rebuild outer ear canal........ 0256 25.40 $1,231.57 $623.05 $246.31
69320 T Rebuild outer ear canal........ 0256 25.40 $1,231.57 $623.05 $246.31
69399 T Outer ear surgery procedure.... 0252 5.18 $251.16 $114.24 $50.23
69400 T Inflate middle ear canal....... 0251 1.68 $81.46 $27.99 $16.29
69401 N Inflate middle ear canal....... .............. .............. .............. .............. ..............
69405 T Catheterize middle ear canal... 0252 5.18 $251.16 $114.24 $50.23
69410 T Inset middle ear (baffle)...... 0252 5.18 $251.16 $114.24 $50.23
69420 T Incision of eardrum............ 0252 5.18 $251.16 $114.24 $50.23
69421 T Incision of eardrum............ 0253 12.02 $582.81 $284.00 $116.56
69424 T Remove ventilating tube........ 0252 5.18 $251.16 $114.24 $50.23
69433 T Create eardrum opening......... 0252 5.18 $251.16 $114.24 $50.23
69436 T Create eardrum opening......... 0253 12.02 $582.81 $284.00 $116.56
69440 T Exploration of middle ear...... 0253 12.02 $582.81 $284.00 $116.56
69450 T Eardrum revision............... 0256 25.40 $1,231.57 $623.05 $246.31
69501 T Mastoidectomy.................. 0256 25.40 $1,231.57 $623.05 $246.31
69502 C Mastoidectomy.................. .............. .............. .............. .............. ..............
69505 T Remove mastoid structures...... 0256 25.40 $1,231.57 $623.05 $246.31
69511 T Extensive mastoid surgery...... 0256 25.40 $1,231.57 $623.05 $246.31
69530 T Extensive mastoid surgery...... 0256 25.40 $1,231.57 $623.05 $246.31
69535 C Remove part of temporal bone... .............. .............. .............. .............. ..............
69540 T Remove ear lesion.............. 0253 12.02 $582.81 $284.00 $116.56
69550 T Remove ear lesion.............. 0256 25.40 $1,231.57 $623.05 $246.31
69552 T Remove ear lesion.............. 0256 25.40 $1,231.57 $623.05 $246.31
69554 C Remove ear lesion.............. .............. .............. .............. .............. ..............
69601 T Mastoid surgery revision....... 0256 25.40 $1,231.57 $623.05 $246.31
69602 T Mastoid surgery revision....... 0256 25.40 $1,231.57 $623.05 $246.31
69603 T Mastoid surgery revision....... 0256 25.40 $1,231.57 $623.05 $246.31
69604 T Mastoid surgery revision....... 0256 25.40 $1,231.57 $623.05 $246.31
69605 T Mastoid surgery revision....... 0256 25.40 $1,231.57 $623.05 $246.31
69610 T Repair of eardrum.............. 0253 12.02 $582.81 $284.00 $116.56
69620 T Repair of eardrum.............. 0253 12.02 $582.81 $284.00 $116.56
69631 T Repair eardrum structures...... 0256 25.40 $1,231.57 $623.05 $246.31
69632 T Rebuild eardrum structures..... 0256 25.40 $1,231.57 $623.05 $246.31
69633 T Rebuild eardrum structures..... 0256 25.40 $1,231.57 $623.05 $246.31
69635 T Repair eardrum structures...... 0256 25.40 $1,231.57 $623.05 $246.31
69636 T Rebuild eardrum structures..... 0256 25.40 $1,231.57 $623.05 $246.31
69637 T Rebuild eardrum structures..... 0256 25.40 $1,231.57 $623.05 $246.31
69641 T Revise middle ear & mastoid.... 0256 25.40 $1,231.57 $623.05 $246.31
69642 T Revise middle ear & mastoid.... 0256 25.40 $1,231.57 $623.05 $246.31
69643 T Revise middle ear & mastoid.... 0256 25.40 $1,231.57 $623.05 $246.31
69644 T Revise middle ear & mastoid.... 0256 25.40 $1,231.57 $623.05 $246.31
69645 T Revise middle ear & mastoid.... 0256 25.40 $1,231.57 $623.05 $246.31
69646 T Revise middle ear & mastoid.... 0256 25.40 $1,231.57 $623.05 $246.31
69650 T Release middle ear bone........ 0254 12.45 $603.66 $272.41 $120.73
69660 T Revise middle ear bone......... 0256 25.40 $1,231.57 $623.05 $246.31
69661 T Revise middle ear bone......... 0256 25.40 $1,231.57 $623.05 $246.31
69662 T Revise middle ear bone......... 0256 25.40 $1,231.57 $623.05 $246.31
69666 T Repair middle ear structures... 0256 25.40 $1,231.57 $623.05 $246.31
69667 T Repair middle ear structures... 0256 25.40 $1,231.57 $623.05 $246.31
[[Page 18628]]
69670 T Remove mastoid air cells....... 0256 25.40 $1,231.57 $623.05 $246.31
69676 T Remove middle ear nerve........ 0256 25.40 $1,231.57 $623.05 $246.31
69700 T Close mastoid fistula.......... 0256 25.40 $1,231.57 $623.05 $246.31
69710 E Implant/replace hearing aid.... .............. .............. .............. .............. ..............
69711 T Remove/repair hearing aid...... 0256 25.40 $1,231.57 $623.05 $246.31
69720 T Release facial nerve........... 0256 25.40 $1,231.57 $623.05 $246.31
69725 T Release facial nerve........... 0256 25.40 $1,231.57 $623.05 $246.31
69740 T Repair facial nerve............ 0256 25.40 $1,231.57 $623.05 $246.31
69745 T Repair facial nerve............ 0256 25.40 $1,231.57 $623.05 $246.31
69799 T Middle ear surgery procedure... 0253 12.02 $582.81 $284.00 $116.56
69801 T Incise inner ear............... 0256 25.40 $1,231.57 $623.05 $246.31
69802 T Incise inner ear............... 0256 25.40 $1,231.57 $623.05 $246.31
69805 T Explore inner ear.............. 0256 25.40 $1,231.57 $623.05 $246.31
69806 T Explore inner ear.............. 0256 25.40 $1,231.57 $623.05 $246.31
69820 T Establish inner ear window..... 0256 25.40 $1,231.57 $623.05 $246.31
69840 T Revise inner ear window........ 0256 25.40 $1,231.57 $623.05 $246.31
69905 T Remove inner ear............... 0256 25.40 $1,231.57 $623.05 $246.31
69910 T Remove inner ear & mastoid..... 0256 25.40 $1,231.57 $623.05 $246.31
69915 T Incise inner ear nerve......... 0256 25.40 $1,231.57 $623.05 $246.31
69930 T Implant cochlear device........ 0257 115.31 $5,591.04 $3,498.58 $1,118.21
69949 T Inner ear surgery procedure.... 0253 12.02 $582.81 $284.00 $116.56
69950 C Incise inner ear nerve......... .............. .............. .............. .............. ..............
69955 T Release facial nerve........... 0256 25.40 $1,231.57 $623.05 $246.31
69960 T Release inner ear canal........ 0256 25.40 $1,231.57 $623.05 $246.31
69970 C Remove inner ear lesion........ .............. .............. .............. .............. ..............
69979 T Temporal bone surgery.......... 0252 5.18 $251.16 $114.24 $50.23
69990 N Microsurgery add-on............ .............. .............. .............. .............. ..............
70010 S Contrast x-ray of brain........ 0274 4.83 $234.19 $128.12 $46.84
70015 S Contrast x-ray of brain........ 0274 4.83 $234.19 $128.12 $46.84
70030 X X-ray eye for foreign body..... 0260 0.79 $38.30 $22.02 $7.66
70100 X X-ray exam of jaw.............. 0260 0.79 $38.30 $22.02 $7.66
70110 X X-ray exam of jaw.............. 0260 0.79 $38.30 $22.02 $7.66
70120 X X-ray exam of mastoids......... 0260 0.79 $38.30 $22.02 $7.66
70130 X X-ray exam of mastoids......... 0260 0.79 $38.30 $22.02 $7.66
70134 X X-ray exam of middle ear....... 0261 1.38 $66.91 $38.77 $13.38
70140 X X-ray exam of facial bones..... 0260 0.79 $38.30 $22.02 $7.66
70150 X X-ray exam of facial bones..... 0260 0.79 $38.30 $22.02 $7.66
70160 X X-ray exam of nasal bones...... 0260 0.79 $38.30 $22.02 $7.66
70170 X X-ray exam of tear duct........ 0263 1.68 $81.46 $45.88 $16.29
70190 X X-ray exam of eye sockets...... 0260 0.79 $38.30 $22.02 $7.66
70200 X X-ray exam of eye sockets...... 0260 0.79 $38.30 $22.02 $7.66
70210 X X-ray exam of sinuses.......... 0260 0.79 $38.30 $22.02 $7.66
70220 X X-ray exam of sinuses.......... 0260 0.79 $38.30 $22.02 $7.66
70240 X X-ray exam, pituitary saddle... 0260 0.79 $38.30 $22.02 $7.66
70250 X X-ray exam of skull............ 0260 0.79 $38.30 $22.02 $7.66
70260 X X-ray exam of skull............ 0261 1.38 $66.91 $38.77 $13.38
70300 X X-ray exam of teeth............ 0262 0.40 $19.39 $10.90 $3.88
70310 X X-ray exam of teeth............ 0262 0.40 $19.39 $10.90 $3.88
70320 X Full mouth x-ray of teeth...... 0262 0.40 $19.39 $10.90 $3.88
70328 X X-ray exam of jaw joint........ 0260 0.79 $38.30 $22.02 $7.66
70330 X X-ray exam of jaw joints....... 0260 0.79 $38.30 $22.02 $7.66
70332 S X-ray exam of jaw joint........ 0275 2.74 $132.85 $72.26 $26.57
70336 S Magnetic image, jaw joint...... 0284 8.02 $388.87 $257.39 $77.77
70350 X X-ray head for orthodontia..... 0260 0.79 $38.30 $22.02 $7.66
70355 X Panoramic x-ray of jaws........ 0260 0.79 $38.30 $22.02 $7.66
70360 X X-ray exam of neck............. 0260 0.79 $38.30 $22.02 $7.66
70370 X Throat x-ray & fluoroscopy..... 0273 2.49 $120.73 $61.02 $24.15
70371 X Speech evaluation, complex..... 0272 1.40 $67.88 $39.00 $13.58
70373 X Contrast x-ray of larynx....... 0263 1.68 $81.46 $45.88 $16.29
70380 X X-ray exam of salivary gland... 0260 0.79 $38.30 $22.02 $7.66
70390 X X-ray exam of salivary duct.... 0263 1.68 $81.46 $45.88 $16.29
70450 S CAT scan of head or brain...... 0283 4.89 $237.10 $179.39 $47.42
70460 S Contrast CAT scan of head...... 0283 4.89 $237.10 $179.39 $47.42
70470 S Contrast CAT scans of head..... 0283 4.89 $237.10 $179.39 $47.42
70480 S CAT scan of skull.............. 0283 4.89 $237.10 $179.39 $47.42
70481 S Contrast CAT scan of skull..... 0283 4.89 $237.10 $179.39 $47.42
70482 S Contrast CAT scans of skull.... 0283 4.89 $237.10 $179.39 $47.42
70486 S Cat scan of face/jaw........... 0282 2.38 $115.40 $94.51 $23.08
70487 S Contrast CAT scan, face/jaw.... 0283 4.89 $237.10 $179.39 $47.42
70488 S Contrast cat scans, face/jaw... 0283 4.89 $237.10 $179.39 $47.42
70490 S CAT scan of neck tissue........ 0283 4.89 $237.10 $179.39 $47.42
70491 S Contrast CAT of neck tissue.... 0283 4.89 $237.10 $179.39 $47.42
70492 S Contrast CAT of neck tissue.... 0283 4.89 $237.10 $179.39 $47.42
[[Page 18629]]
70540 S Magnetic image, face/neck...... 0284 8.02 $388.87 $257.39 $77.77
70541 S Magnetic image, head (MRA)..... 0284 8.02 $388.87 $257.39 $77.77
70551 S Magnetic image, brain (MRI).... 0284 8.02 $388.87 $257.39 $77.77
70552 S Magnetic image, brain (MRI).... 0284 8.02 $388.87 $257.39 $77.77
70553 S Magnetic image, brain (mri).... 0284 8.02 $388.87 $257.39 $77.77
71010 X Chest x-ray.................... 0260 0.79 $38.30 $22.02 $7.66
71015 X Chest x-ray.................... 0260 0.79 $38.30 $22.02 $7.66
71020 X Chest x-ray.................... 0260 0.79 $38.30 $22.02 $7.66
71021 X Chest x-ray.................... 0260 0.79 $38.30 $22.02 $7.66
71022 X Chest x-ray.................... 0260 0.79 $38.30 $22.02 $7.66
71023 X Chest x-ray and fluoroscopy.... 0272 1.40 $67.88 $39.00 $13.58
71030 X Chest x-ray.................... 0260 0.79 $38.30 $22.02 $7.66
71034 X Chest x-ray and fluoroscopy.... 0272 1.40 $67.88 $39.00 $13.58
71035 X Chest x-ray.................... 0260 0.79 $38.30 $22.02 $7.66
71036 X X-ray guidance for biopsy...... 0273 2.49 $120.73 $61.02 $24.15
71040 X Contrast x-ray of bronchi...... 0263 1.68 $81.46 $45.88 $16.29
71060 X Contrast x-ray of bronchi...... 0263 1.68 $81.46 $45.88 $16.29
71090 X X-ray & pacemaker insertion.... 0273 2.49 $120.73 $61.02 $24.15
71100 X X-ray exam of ribs............. 0260 0.79 $38.30 $22.02 $7.66
71101 X X-ray exam of ribs/chest....... 0260 0.79 $38.30 $22.02 $7.66
71110 X X-ray exam of ribs............. 0260 0.79 $38.30 $22.02 $7.66
71111 X X-ray exam of ribs/chest....... 0261 1.38 $66.91 $38.77 $13.38
71120 X X-ray exam of breastbone....... 0260 0.79 $38.30 $22.02 $7.66
71130 X X-ray exam of breastbone....... 0260 0.79 $38.30 $22.02 $7.66
71250 S Cat scan of chest.............. 0283 4.89 $237.10 $179.39 $47.42
71260 S Contrast CAT scan of chest..... 0283 4.89 $237.10 $179.39 $47.42
71270 S Contrast CAT scans of chest.... 0283 4.89 $237.10 $179.39 $47.42
71550 S Magnetic image, chest (mri).... 0284 8.02 $388.87 $257.39 $77.77
71555 E Magnetic image, chest (mra).... .............. .............. .............. .............. ..............
72010 X X-ray exam of spine............ 0261 1.38 $66.91 $38.77 $13.38
72020 X X-ray exam of spine............ 0260 0.79 $38.30 $22.02 $7.66
72040 X X-ray exam of neck spine....... 0260 0.79 $38.30 $22.02 $7.66
72050 X X-ray exam of neck spine....... 0261 1.38 $66.91 $38.77 $13.38
72052 X X-ray exam of neck spine....... 0261 1.38 $66.91 $38.77 $13.38
72069 X X-ray exam of trunk spine...... 0260 0.79 $38.30 $22.02 $7.66
72070 X X-ray exam of thoracic spine... 0260 0.79 $38.30 $22.02 $7.66
72072 X X-ray exam of thoracic spine... 0260 0.79 $38.30 $22.02 $7.66
72074 X X-ray exam of thoracic spine... 0260 0.79 $38.30 $22.02 $7.66
72080 X X-ray exam of trunk spine...... 0260 0.79 $38.30 $22.02 $7.66
72090 X X-ray exam of trunk spine...... 0260 0.79 $38.30 $22.02 $7.66
72100 X X-ray exam of lower spine...... 0260 0.79 $38.30 $22.02 $7.66
72110 X X-ray exam of lower spine...... 0261 1.38 $66.91 $38.77 $13.38
72114 X X-ray exam of lower spine...... 0261 1.38 $66.91 $38.77 $13.38
72120 X X-ray exam of lower spine...... 0260 0.79 $38.30 $22.02 $7.66
72125 S CAT scan of neck spine......... 0283 4.89 $237.10 $179.39 $47.42
72126 S Contrast CAT scan of neck...... 0283 4.89 $237.10 $179.39 $47.42
72127 S Contrast CAT scans of neck..... 0283 4.89 $237.10 $179.39 $47.42
72128 S CAT scan of thorax spine....... 0283 4.89 $237.10 $179.39 $47.42
72129 S Contrast CAT scan of thorax.... 0283 4.89 $237.10 $179.39 $47.42
72130 S Contrast CAT scans of thorax... 0283 4.89 $237.10 $179.39 $47.42
72131 S CAT scan of lower spine........ 0283 4.89 $237.10 $179.39 $47.42
72132 S Contrast CAT of lower spine.... 0283 4.89 $237.10 $179.39 $47.42
72133 S Contrast cat scans, low spine.. 0283 4.89 $237.10 $179.39 $47.42
72141 S Magnetic image, neck spine..... 0284 8.02 $388.87 $257.39 $77.77
72142 S Magnetic image, neck spine..... 0284 8.02 $388.87 $257.39 $77.77
72146 S Magnetic image, chest spine.... 0284 8.02 $388.87 $257.39 $77.77
72147 S Magnetic image, chest spine.... 0284 8.02 $388.87 $257.39 $77.77
72148 S Magnetic image, lumbar spine... 0284 8.02 $388.87 $257.39 $77.77
72149 S Magnetic image, lumbar spine... 0284 8.02 $388.87 $257.39 $77.77
72156 S Magnetic image, neck spine..... 0284 8.02 $388.87 $257.39 $77.77
72157 S Magnetic image, chest spine.... 0284 8.02 $388.87 $257.39 $77.77
72158 S Magnetic image, lumbar spine... 0284 8.02 $388.87 $257.39 $77.77
72159 E Magnetic image, spine (mra).... .............. .............. .............. .............. ..............
72170 X X-ray exam of pelvis........... 0260 0.79 $38.30 $22.02 $7.66
72190 X X-ray exam of pelvis........... 0260 0.79 $38.30 $22.02 $7.66
72192 S CAT scan of pelvis............. 0283 4.89 $237.10 $179.39 $47.42
72193 S Contrast CAT scan of pelvis.... 0283 4.89 $237.10 $179.39 $47.42
72194 S Contrast CAT scans of pelvis... 0283 4.89 $237.10 $179.39 $47.42
72196 S Magnetic image, pelvis......... 0284 8.02 $388.87 $257.39 $77.77
72198 E Magnetic image, pelvis (mra)... .............. .............. .............. .............. ..............
72200 X X-ray exam sacroiliac joints... 0260 0.79 $38.30 $22.02 $7.66
72202 X X-ray exam sacroiliac joints... 0260 0.79 $38.30 $22.02 $7.66
72220 X X-ray exam of tailbone......... 0260 0.79 $38.30 $22.02 $7.66
[[Page 18630]]
72240 S Contrast x-ray of neck spine... 0274 4.83 $234.19 $128.12 $46.84
72255 S Contrast x-ray, thorax spine... 0274 4.83 $234.19 $128.12 $46.84
72265 S Contrast x-ray, lower spine.... 0274 4.83 $234.19 $128.12 $46.84
72270 S Contrast x-ray of spine........ 0274 4.83 $234.19 $128.12 $46.84
72275 S Epidurography.................. 0274 4.83 $234.19 $128.12 $46.84
72285 S X-ray c/t spine disk........... 0274 4.83 $234.19 $128.12 $46.84
72295 S X-ray of lower spine disk...... 0274 4.83 $234.19 $128.12 $46.84
73000 X X-ray exam of collar bone...... 0260 0.79 $38.30 $22.02 $7.66
73010 X X-ray exam of shoulder blade... 0260 0.79 $38.30 $22.02 $7.66
73020 X X-ray exam of shoulder......... 0260 0.79 $38.30 $22.02 $7.66
73030 X X-ray exam of shoulder......... 0260 0.79 $38.30 $22.02 $7.66
73040 S Contrast x-ray of shoulder..... 0275 2.74 $132.85 $72.26 $26.57
73050 X X-ray exam of shoulders........ 0260 0.79 $38.30 $22.02 $7.66
73060 X X-ray exam of humerus.......... 0260 0.79 $38.30 $22.02 $7.66
73070 X X-ray exam of elbow............ 0260 0.79 $38.30 $22.02 $7.66
73080 X X-ray exam of elbow............ 0260 0.79 $38.30 $22.02 $7.66
73085 S Contrast x-ray of elbow........ 0275 2.74 $132.85 $72.26 $26.57
73090 X X-ray exam of forearm.......... 0260 0.79 $38.30 $22.02 $7.66
73092 X X-ray exam of arm, infant...... 0260 0.79 $38.30 $22.02 $7.66
73100 X X-ray exam of wrist............ 0260 0.79 $38.30 $22.02 $7.66
73110 X X-ray exam of wrist............ 0260 0.79 $38.30 $22.02 $7.66
73115 S Contrast x-ray of wrist........ 0275 2.74 $132.85 $72.26 $26.57
73120 X X-ray exam of hand............. 0260 0.79 $38.30 $22.02 $7.66
73130 X X-ray exam of hand............. 0260 0.79 $38.30 $22.02 $7.66
73140 X X-ray exam of finger(s)........ 0260 0.79 $38.30 $22.02 $7.66
73200 S CAT scan of arm................ 0283 4.89 $237.10 $179.39 $47.42
73201 S Contrast CAT scan of arm....... 0283 4.89 $237.10 $179.39 $47.42
73202 S Contrast CAT scans of arm...... 0283 4.89 $237.10 $179.39 $47.42
73220 S Magnetic image, arm/hand....... 0284 8.02 $388.87 $257.39 $77.77
73221 S Magnetic image, joint of arm... 0284 8.02 $388.87 $257.39 $77.77
73225 E Magnetic image, upper (mra).... .............. .............. .............. .............. ..............
73500 X X-ray exam of hip.............. 0260 0.79 $38.30 $22.02 $7.66
73510 X X-ray exam of hip.............. 0260 0.79 $38.30 $22.02 $7.66
73520 X X-ray exam of hips............. 0260 0.79 $38.30 $22.02 $7.66
73525 S Contrast x-ray of hip.......... 0275 2.74 $132.85 $72.26 $26.57
73530 X X-ray exam of hip.............. 0261 1.38 $66.91 $38.77 $13.38
73540 X X-ray exam of pelvis & hips.... 0260 0.79 $38.30 $22.02 $7.66
73542 S X-ray exam, sacroiliac joint... 0275 2.74 $132.85 $72.26 $26.57
73550 X X-ray exam of thigh............ 0260 0.79 $38.30 $22.02 $7.66
73560 X X-ray exam of knee, 1 or 2..... 0260 0.79 $38.30 $22.02 $7.66
73562 X X-ray exam of knee, 3.......... 0260 0.79 $38.30 $22.02 $7.66
73564 X X-ray exam, knee, 4 or more.... 0260 0.79 $38.30 $22.02 $7.66
73565 X X-ray exam of knees............ 0260 0.79 $38.30 $22.02 $7.66
73580 S Contrast x-ray of knee joint... 0275 2.74 $132.85 $72.26 $26.57
73590 X X-ray exam of lower leg........ 0260 0.79 $38.30 $22.02 $7.66
73592 X X-ray exam of leg, infant...... 0261 1.38 $66.91 $38.77 $13.38
73600 X X-ray exam of ankle............ 0260 0.79 $38.30 $22.02 $7.66
73610 X X-ray exam of ankle............ 0260 0.79 $38.30 $22.02 $7.66
73615 S Contrast x-ray of ankle........ 0275 2.74 $132.85 $72.26 $26.57
73620 X X-ray exam of foot............. 0260 0.79 $38.30 $22.02 $7.66
73630 X X-ray exam of foot............. 0260 0.79 $38.30 $22.02 $7.66
73650 X X-ray exam of heel............. 0260 0.79 $38.30 $22.02 $7.66
73660 X X-ray exam of toe(s)........... 0260 0.79 $38.30 $22.02 $7.66
73700 S CAT scan of leg................ 0283 4.89 $237.10 $179.39 $47.42
73701 S Contrast CAT scan of leg....... 0283 4.89 $237.10 $179.39 $47.42
73702 S Contrast CAT scans of leg...... 0283 4.89 $237.10 $179.39 $47.42
73720 S Magnetic image, leg/foot....... 0284 8.02 $388.87 $257.39 $77.77
73721 S Magnetic image, joint of leg... 0284 8.02 $388.87 $257.39 $77.77
73725 E Magnetic image/lower (mra)..... .............. .............. .............. .............. ..............
74000 X X-ray exam of abdomen.......... 0260 0.79 $38.30 $22.02 $7.66
74010 X X-ray exam of abdomen.......... 0260 0.79 $38.30 $22.02 $7.66
74020 X X-ray exam of abdomen.......... 0260 0.79 $38.30 $22.02 $7.66
74022 X X-ray exam series, abdomen..... 0261 1.38 $66.91 $38.77 $13.38
74150 S CAT scan of abdomen............ 0283 4.89 $237.10 $179.39 $47.42
74160 S Contrast CAT scan of abdomen... 0283 4.89 $237.10 $179.39 $47.42
74170 S Contrast CAT scans, abdomen.... 0283 4.89 $237.10 $179.39 $47.42
74181 S Magnetic image/abdomen (mri)... 0284 8.02 $388.87 $257.39 $77.77
74185 E Magnetic image/abdomen (MRA)... .............. .............. .............. .............. ..............
74190 X X-ray exam of peritoneum....... 0263 1.68 $81.46 $45.88 $16.29
74210 S Contrast x-ray exam of throat.. 0276 1.79 $86.79 $49.78 $17.36
74220 S Contrast x-ray, esophagus...... 0276 1.79 $86.79 $49.78 $17.36
74230 S Cinema x-ray, throat/esoph..... 0276 1.79 $86.79 $49.78 $17.36
74235 S Remove esophagus obstruction... 0296 3.57 $173.10 $100.25 $34.62
[[Page 18631]]
74240 S X-ray exam, upper gi tract..... 0276 1.79 $86.79 $49.78 $17.36
74241 S X-ray exam, upper gi tract..... 0276 1.79 $86.79 $49.78 $17.36
74245 S X-ray exam, upper gi tract..... 0277 2.47 $119.76 $69.28 $23.95
74246 S Contrast x-ray uppr gi tract... 0276 1.79 $86.79 $49.78 $17.36
74247 S Contrast x-ray uppr gi tract... 0276 1.79 $86.79 $49.78 $17.36
74249 S Contrast x-ray uppr gi tract... 0277 2.47 $119.76 $69.28 $23.95
74250 S X-ray exam of small bowel...... 0276 1.79 $86.79 $49.78 $17.36
74251 S X-ray exam of small bowel...... 0277 2.47 $119.76 $69.28 $23.95
74260 S X-ray exam of small bowel...... 0277 2.47 $119.76 $69.28 $23.95
74270 S Contrast x-ray exam of colon... 0276 1.79 $86.79 $49.78 $17.36
74280 S Contrast x-ray exam of colon... 0277 2.47 $119.76 $69.28 $23.95
74283 S Contrast x-ray exam of colon... 0276 1.79 $86.79 $49.78 $17.36
74290 S Contrast x-ray, gallbladder.... 0276 1.79 $86.79 $49.78 $17.36
74291 S Contrast x-rays, gallbladder... 0276 1.79 $86.79 $49.78 $17.36
74300 C X-ray bile ducts/pancreas...... .............. .............. .............. .............. ..............
74301 C X-rays at surgery add-on....... .............. .............. .............. .............. ..............
74305 X X-ray bile ducts/pancreas...... 0263 1.68 $81.46 $45.88 $16.29
74320 X Contrast x-ray of bile ducts... 0264 3.83 $185.71 $108.97 $37.14
74327 S X-ray bile stone removal....... 0296 3.57 $173.10 $100.25 $34.62
74328 X X-ray bile duct endoscopy...... 0264 3.83 $185.71 $108.97 $37.14
74329 X X-ray for pancreas endoscopy... 0264 3.83 $185.71 $108.97 $37.14
74330 X X-ray bile/panc endoscopy...... 0264 3.83 $185.71 $108.97 $37.14
74340 X X-ray guide for GI tube........ 0272 1.40 $67.88 $39.00 $13.58
74350 X X-ray guide, stomach tube...... 0264 3.83 $185.71 $108.97 $37.14
74355 X X-ray guide, intestinal tube... 0264 3.83 $185.71 $108.97 $37.14
74360 S X-ray guide, GI dilation....... 0296 3.57 $173.10 $100.25 $34.62
74363 S X-ray, bile duct dilation...... 0297 6.13 $297.23 $172.51 $59.45
74400 S Contrast x-ray, urinary tract.. 0278 2.85 $138.19 $81.67 $27.64
74410 S Contrast x-ray, urinary tract.. 0278 2.85 $138.19 $81.67 $27.64
74415 S Contrast x-ray, urinary tract.. 0278 2.85 $138.19 $81.67 $27.64
74420 S Contrast x-ray, urinary tract.. 0278 2.85 $138.19 $81.67 $27.64
74425 S Contrast x-ray, urinary tract.. 0278 2.85 $138.19 $81.67 $27.64
74430 S Contrast x-ray, bladder........ 0278 2.85 $138.19 $81.67 $27.64
74440 S X-ray, male genital tract...... 0278 2.85 $138.19 $81.67 $27.64
74445 S X-ray exam of penis............ 0278 2.85 $138.19 $81.67 $27.64
74450 S X-ray, urethra/bladder......... 0278 2.85 $138.19 $81.67 $27.64
74455 S X-ray, urethra/bladder......... 0278 2.85 $138.19 $81.67 $27.64
74470 X X-ray exam of kidney lesion.... 0264 3.83 $185.71 $108.97 $37.14
74475 S X-ray control, cath insert..... 0297 6.13 $297.23 $172.51 $59.45
74480 S X-ray control, cath insert..... 0297 6.13 $297.23 $172.51 $59.45
74485 S X-ray guide, GU dilation....... 0296 3.57 $173.10 $100.25 $34.62
74710 X X-ray measurement of pelvis.... 0260 0.79 $38.30 $22.02 $7.66
74740 X X-ray, female genital tract.... 0264 3.83 $185.71 $108.97 $37.14
74742 X X-ray, fallopian tube.......... 0264 3.83 $185.71 $108.97 $37.14
74775 S X-ray exam of perineum......... 0278 2.85 $138.19 $81.67 $27.64
75552 S Magnetic image, myocardium..... 0284 8.02 $388.87 $257.39 $77.77
75553 S Magnetic image, myocardium..... 0284 8.02 $388.87 $257.39 $77.77
75554 S Cardiac MRI/function........... 0284 8.02 $388.87 $257.39 $77.77
75555 S Cardiac MRI/limited study...... 0284 8.02 $388.87 $257.39 $77.77
75556 E Cardiac MRI/flow mapping....... .............. .............. .............. .............. ..............
75600 S Contrast x-ray exam of aorta... 0280 14.98 $726.34 $380.12 $145.27
75605 S Contrast x-ray exam of aorta... 0280 14.98 $726.34 $380.12 $145.27
75625 S Contrast x-ray exam of aorta... 0280 14.98 $726.34 $380.12 $145.27
75630 S X-ray aorta, leg arteries...... 0280 14.98 $726.34 $380.12 $145.27
75650 S Artery x-rays, head & neck..... 0280 14.98 $726.34 $380.12 $145.27
75658 S Artery x-rays, arm............. 0280 14.98 $726.34 $380.12 $145.27
75660 S Artery x-rays, head & neck..... 0279 6.30 $305.47 $174.57 $61.09
75662 S Artery x-rays, head & neck..... 0279 6.30 $305.47 $174.57 $61.09
75665 S Artery x-rays, head & neck..... 0280 14.98 $726.34 $380.12 $145.27
75671 S Artery x-rays, head & neck..... 0280 14.98 $726.34 $380.12 $145.27
75676 S Artery x-rays, neck............ 0280 14.98 $726.34 $380.12 $145.27
75680 S Artery x-rays, neck............ 0280 14.98 $726.34 $380.12 $145.27
75685 S Artery x-rays, spine........... 0279 6.30 $305.47 $174.57 $61.09
75705 S Artery x-rays, spine........... 0279 6.30 $305.47 $174.57 $61.09
75710 S Artery x-rays, arm/leg......... 0280 14.98 $726.34 $380.12 $145.27
75716 S Artery x-rays, arms/legs....... 0280 14.98 $726.34 $380.12 $145.27
75722 S Artery x-rays, kidney.......... 0280 14.98 $726.34 $380.12 $145.27
75724 S Artery x-rays, kidneys......... 0280 14.98 $726.34 $380.12 $145.27
75726 S Artery x-rays, abdomen......... 0280 14.98 $726.34 $380.12 $145.27
75731 S Artery x-rays, adrenal gland... 0280 14.98 $726.34 $380.12 $145.27
75733 S Artery x-rays, adrenals........ 0280 14.98 $726.34 $380.12 $145.27
75736 S Artery x-rays, pelvis.......... 0280 14.98 $726.34 $380.12 $145.27
75741 S Artery x-rays, lung............ 0279 6.30 $305.47 $174.57 $61.09
[[Page 18632]]
75743 S Artery x-rays, lungs........... 0280 14.98 $726.34 $380.12 $145.27
75746 S Artery x-rays, lung............ 0279 6.30 $305.47 $174.57 $61.09
75756 S Artery x-rays, chest........... 0279 6.30 $305.47 $174.57 $61.09
75774 S Artery x-ray, each vessel...... 0280 14.98 $726.34 $380.12 $145.27
75790 S Visualize A-V shunt............ 0281 4.40 $213.34 $115.16 $42.67
75801 X Lymph vessel x-ray, arm/leg.... 0264 3.83 $185.71 $108.97 $37.14
75803 X Lymph vessel x-ray, arms/legs.. 0264 3.83 $185.71 $108.97 $37.14
75805 X Lymph vessel x-ray, trunk...... 0264 3.83 $185.71 $108.97 $37.14
75807 X Lymph vessel x-ray, trunk...... 0264 3.83 $185.71 $108.97 $37.14
75809 X Nonvascular shunt, x-ray....... 0264 3.83 $185.71 $108.97 $37.14
75810 S Vein x-ray, spleen/liver....... 0279 6.30 $305.47 $174.57 $61.09
75820 S Vein x-ray, arm/leg............ 0281 4.40 $213.34 $115.16 $42.67
75822 S Vein x-ray, arms/legs.......... 0281 4.40 $213.34 $115.16 $42.67
75825 S Vein x-ray, trunk.............. 0279 6.30 $305.47 $174.57 $61.09
75827 S Vein x-ray, chest.............. 0279 6.30 $305.47 $174.57 $61.09
75831 S Vein x-ray, kidney............. 0279 6.30 $305.47 $174.57 $61.09
75833 S Vein x-ray, kidneys............ 0279 6.30 $305.47 $174.57 $61.09
75840 S Vein x-ray, adrenal gland...... 0279 6.30 $305.47 $174.57 $61.09
75842 S Vein x-ray, adrenal glands..... 0279 6.30 $305.47 $174.57 $61.09
75860 S Vein x-ray, neck............... 0279 6.30 $305.47 $174.57 $61.09
75870 S Vein x-ray, skull.............. 0279 6.30 $305.47 $174.57 $61.09
75872 S Vein x-ray, skull.............. 0279 6.30 $305.47 $174.57 $61.09
75880 S Vein x-ray, eye socket......... 0279 6.30 $305.47 $174.57 $61.09
75885 S Vein x-ray, liver.............. 0279 6.30 $305.47 $174.57 $61.09
75887 S Vein x-ray, liver.............. 0280 14.98 $726.34 $380.12 $145.27
75889 S Vein x-ray, liver.............. 0279 6.30 $305.47 $174.57 $61.09
75891 S Vein x-ray, liver.............. 0279 6.30 $305.47 $174.57 $61.09
75893 N Venous sampling by catheter.... .............. .............. .............. .............. ..............
75894 S X-rays, transcath therapy...... 0297 6.13 $297.23 $172.51 $59.45
75896 S X-rays, transcath therapy...... 0297 6.13 $297.23 $172.51 $59.45
75898 X Follow-up angiogram............ 0264 3.83 $185.71 $108.97 $37.14
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 x-ray exam bile duct.. 0297 6.13 $297.23 $172.51 $59.45
75982 S Contrast x-ray exam bile duct.. 0297 6.13 $297.23 $172.51 $59.45
75984 S X-ray control catheter change.. 0296 3.57 $173.10 $100.25 $34.62
75989 X Abscess drainage under x-ray... 0273 2.49 $120.73 $61.02 $24.15
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........ 0272 1.40 $67.88 $39.00 $13.58
76001 X Fluoroscope exam, extensive.... 0273 2.49 $120.73 $61.02 $24.15
76003 X Needle localization by x-ray... 0272 1.40 $67.88 $39.00 $13.58
76005 X Fluoroguide for spine inject... 0273 2.49 $120.73 $61.02 $24.15
76006 X X-ray stress view.............. 0261 1.38 $66.91 $38.77 $13.38
76010 X X-ray, nose to rectum.......... 0260 0.79 $38.30 $22.02 $7.66
76020 X X-rays for bone age............ 0261 1.38 $66.91 $38.77 $13.38
76040 X X-rays, bone evaluation........ 0260 0.79 $38.30 $22.02 $7.66
76061 X X-rays, bone survey............ 0261 1.38 $66.91 $38.77 $13.38
76062 X X-rays, bone survey............ 0261 1.38 $66.91 $38.77 $13.38
76065 X X-rays, bone evaluation........ 0261 1.38 $66.91 $38.77 $13.38
76066 X Joint(s) survey, single film... 0260 0.79 $38.30 $22.02 $7.66
76070 E CT scan, bone density study.... .............. .............. .............. .............. ..............
76075 X Dual energy x-ray study........ 0261 1.38 $66.91 $38.77 $13.38
76076 X Dual energy x-ray study........ 0261 1.38 $66.91 $38.77 $13.38
76078 X Photodensitometry.............. 0261 1.38 $66.91 $38.77 $13.38
76080 X X-ray exam of fistula.......... 0263 1.68 $81.46 $45.88 $16.29
76086 X X-ray of mammary duct.......... 0263 1.68 $81.46 $45.88 $16.29
76088 X X-ray of mammary ducts......... 0263 1.68 $81.46 $45.88 $16.29
76090 S Mammogram, one breast.......... 0271 0.70 $33.94 $19.50 $6.79
76091 S Mammogram, both breasts........ 0271 0.70 $33.94 $19.50 $6.79
[[Page 18633]]
76092 A Mammogram, screening........... .............. .............. .............. .............. ..............
76093 S Magnetic image, breast......... 0284 8.02 $388.87 $257.39 $77.77
76094 S Magnetic image, both breasts... 0284 8.02 $388.87 $257.39 $77.77
76095 X Stereotactic breast biopsy..... 0264 3.83 $185.71 $108.97 $37.14
76096 X X-ray of needle wire, breast... 0263 1.68 $81.46 $45.88 $16.29
76098 X X-ray exam, breast specimen.... 0260 0.79 $38.30 $22.02 $7.66
76100 X X-ray exam of body section..... 0261 1.38 $66.91 $38.77 $13.38
76101 X Complex body section x-ray..... 0263 1.68 $81.46 $45.88 $16.29
76102 X Complex body section x-rays.... 0264 3.83 $185.71 $108.97 $37.14
76120 X Cinematic x-rays............... 0261 1.38 $66.91 $38.77 $13.38
76125 X Cinematic x-rays add-on........ 0261 1.38 $66.91 $38.77 $13.38
76140 E X-ray consultation............. .............. .............. .............. .............. ..............
76150 X X-ray exam, dry process........ 0260 0.79 $38.30 $22.02 $7.66
76350 N Special x-ray contrast study... .............. .............. .............. .............. ..............
76355 S CAT scan for localization...... 0283 4.89 $237.10 $179.39 $47.42
76360 S CAT scan for needle biopsy..... 0283 4.89 $237.10 $179.39 $47.42
76365 S CAT scan for cyst aspiration... 0283 4.89 $237.10 $179.39 $47.42
76370 S CAT scan for therapy guide..... 0282 2.38 $115.40 $94.51 $23.08
76375 S 3D/holograph reconstr add-on... 0282 2.38 $115.40 $94.51 $23.08
76380 S CAT scan follow-up study....... 0282 2.38 $115.40 $94.51 $23.08
76390 S Mr spectroscopy................ 0284 8.02 $388.87 $257.39 $77.77
76400 S Magnetic image, bone marrow.... 0284 8.02 $388.87 $257.39 $77.77
76499 X Radiographic procedure......... 0260 0.79 $38.30 $22.02 $7.66
76506 S Echo exam of head.............. 0266 1.79 $86.79 $57.35 $17.36
76511 S Echo exam of eye............... 0266 1.79 $86.79 $57.35 $17.36
76512 S Echo exam of eye............... 0266 1.79 $86.79 $57.35 $17.36
76513 S Echo exam of eye, water bath... 0265 1.17 $56.73 $38.08 $11.35
76516 S Echo exam of eye............... 0266 1.79 $86.79 $57.35 $17.36
76519 S Echo exam of eye............... 0266 1.79 $86.79 $57.35 $17.36
76529 S Echo exam of eye............... 0265 1.17 $56.73 $38.08 $11.35
76536 S Echo exam of head and neck..... 0265 1.17 $56.73 $38.08 $11.35
76604 S Echo exam of chest............. 0266 1.79 $86.79 $57.35 $17.36
76645 S Echo exam of breast(s)......... 0265 1.17 $56.73 $38.08 $11.35
76700 S Echo exam of abdomen........... 0266 1.79 $86.79 $57.35 $17.36
76705 S Echo exam of abdomen........... 0266 1.79 $86.79 $57.35 $17.36
76770 S Echo exam abdomen back wall.... 0266 1.79 $86.79 $57.35 $17.36
76775 S Echo exam abdomen back wall.... 0266 1.79 $86.79 $57.35 $17.36
76778 S Echo exam kidney transplant.... 0266 1.79 $86.79 $57.35 $17.36
76800 S Echo exam spinal canal......... 0266 1.79 $86.79 $57.35 $17.36
76805 S Echo exam of pregnant uterus... 0266 1.79 $86.79 $57.35 $17.36
76810 S Echo exam of pregnant uterus... 0265 1.17 $56.73 $38.08 $11.35
76815 S Echo exam of pregnant uterus... 0265 1.17 $56.73 $38.08 $11.35
76816 S Echo exam follow-up/repeat..... 0265 1.17 $56.73 $38.08 $11.35
76818 S Fetal biophysical profile...... 0266 1.79 $86.79 $57.35 $17.36
76825 S Echo exam of fetal heart....... 0269 4.40 $213.34 $114.01 $42.67
76826 S Echo exam of fetal heart....... 0269 4.40 $213.34 $114.01 $42.67
76827 S Echo exam of fetal heart....... 0269 4.40 $213.34 $114.01 $42.67
76828 S Echo exam of fetal heart....... 0269 4.40 $213.34 $114.01 $42.67
76830 S Echo exam, transvaginal........ 0266 1.79 $86.79 $57.35 $17.36
76831 S Echo exam, uterus.............. 0266 1.79 $86.79 $57.35 $17.36
76856 S Echo exam of pelvis............ 0266 1.79 $86.79 $57.35 $17.36
76857 S Echo exam of pelvis............ 0265 1.17 $56.73 $38.08 $11.35
76870 S Echo exam of scrotum........... 0266 1.79 $86.79 $57.35 $17.36
76872 S Echo exam, transrectal......... 0266 1.79 $86.79 $57.35 $17.36
76873 S Echograp trans r, pros study... 0266 1.79 $86.79 $57.35 $17.36
76880 S Echo exam of extremity......... 0266 1.79 $86.79 $57.35 $17.36
76885 S Echo exam, infant hips......... 0266 1.79 $86.79 $57.35 $17.36
76886 S Echo exam, infant hips......... 0266 1.79 $86.79 $57.35 $17.36
76930 X Echo guide for heart sac tap... 0268 2.23 $108.13 $69.51 $21.63
76932 X Echo guide for heart biopsy.... 0268 2.23 $108.13 $69.51 $21.63
76934 X Echo guide for chest tap....... 0268 2.23 $108.13 $69.51 $21.63
76936 X Echo guide for artery repair... 0268 2.23 $108.13 $69.51 $21.63
76938 X Echo exam for drainage......... 0268 2.23 $108.13 $69.51 $21.63
76941 X Echo guide for transfusion..... 0268 2.23 $108.13 $69.51 $21.63
76942 X Echo guide for biopsy.......... 0268 2.23 $108.13 $69.51 $21.63
76945 X Echo guide, villus sampling.... 0268 2.23 $108.13 $69.51 $21.63
76946 X Echo guide for amniocentesis... 0268 2.23 $108.13 $69.51 $21.63
76948 X Echo guide, ova aspiration..... 0268 2.23 $108.13 $69.51 $21.63
76950 X Echo guidance radiotherapy..... 0268 2.23 $108.13 $69.51 $21.63
76960 X Echo guidance radiotherapy..... 0268 2.23 $108.13 $69.51 $21.63
76965 X Echo guidance radiotherapy..... 0268 2.23 $108.13 $69.51 $21.63
76970 S Ultrasound exam follow-up...... 0265 1.17 $56.73 $38.08 $11.35
76975 S GI endoscopic ultrasound....... 0266 1.79 $86.79 $57.35 $17.36
[[Page 18634]]
76977 S Us bone density measure........ 0265 1.17 $56.73 $38.08 $11.35
76986 S Echo exam at surgery........... 0266 1.79 $86.79 $57.35 $17.36
76999 S Echo examination procedure..... 0266 1.79 $86.79 $57.35 $17.36
77261 E Radiation therapy planning..... .............. .............. .............. .............. ..............
77262 E Radiation therapy planning..... .............. .............. .............. .............. ..............
77263 E Radiation therapy planning..... .............. .............. .............. .............. ..............
77280 X Set radiation therapy field.... 0304 1.49 $72.25 $41.52 $14.45
77285 X Set radiation therapy field.... 0305 4.06 $196.86 $97.50 $39.37
77290 X Set radiation therapy field.... 0305 4.06 $196.86 $97.50 $39.37
77295 X Set radiation therapy field.... 0310 13.98 $677.85 $339.05 $135.57
77299 E Radiation therapy planning..... .............. .............. .............. .............. ..............
77300 X Radiation therapy dose plan.... 0304 1.49 $72.25 $41.52 $14.45
77305 X Radiation therapy dose plan.... 0304 1.49 $72.25 $41.52 $14.45
77310 X Radiation therapy dose plan.... 0304 1.49 $72.25 $41.52 $14.45
77315 X Radiation therapy dose plan.... 0305 4.06 $196.86 $97.50 $39.37
77321 X Radiation therapy port plan.... 0305 4.06 $196.86 $97.50 $39.37
77326 X Radiation therapy dose plan.... 0305 4.06 $196.86 $97.50 $39.37
77327 X Radiation therapy dose plan.... 0305 4.06 $196.86 $97.50 $39.37
77328 X Radiation therapy dose plan.... 0305 4.06 $196.86 $97.50 $39.37
77331 X Special radiation dosimetry.... 0304 1.49 $72.25 $41.52 $14.45
77332 X Radiation treatment aid(s)..... 0303 2.83 $137.22 $69.28 $27.44
77333 X Radiation treatment aid(s)..... 0303 2.83 $137.22 $69.28 $27.44
77334 X Radiation treatment aid(s)..... 0303 2.83 $137.22 $69.28 $27.44
77336 X Radiation physics consult...... 0311 1.32 $64.00 $31.66 $12.80
77370 X Radiation physics consult...... 0311 1.32 $64.00 $31.66 $12.80
77399 X External radiation dosimetry... 0311 1.32 $64.00 $31.66 $12.80
77401 S Radiation treatment delivery... 0300 1.98 $96.00 $47.72 $19.20
77402 S Radiation treatment delivery... 0300 1.98 $96.00 $47.72 $19.20
77403 S Radiation treatment delivery... 0300 1.98 $96.00 $47.72 $19.20
77404 S Radiation treatment delivery... 0300 1.98 $96.00 $47.72 $19.20
77406 S Radiation treatment delivery... 0300 1.98 $96.00 $47.72 $19.20
77407 S Radiation treatment delivery... 0300 1.98 $96.00 $47.72 $19.20
77408 S Radiation treatment delivery... 0300 1.98 $96.00 $47.72 $19.20
77409 S Radiation treatment delivery... 0300 1.98 $96.00 $47.72 $19.20
77411 S Radiation treatment delivery... 0301 2.21 $107.16 $52.53 $21.43
77412 S Radiation treatment delivery... 0301 2.21 $107.16 $52.53 $21.43
77413 S Radiation treatment delivery... 0301 2.21 $107.16 $52.53 $21.43
77414 S Radiation treatment delivery... 0300 1.98 $96.00 $47.72 $19.20
77416 S Radiation treatment delivery... 0301 2.21 $107.16 $52.53 $21.43
77417 X Radiology port film(s)......... 0260 0.79 $38.30 $22.02 $7.66
77427 E Radiation tx management, x5.... .............. .............. .............. .............. ..............
77431 E Radiation therapy management... .............. .............. .............. .............. ..............
77432 E Stereotactic radiation trmt.... .............. .............. .............. .............. ..............
77470 S Special radiation treatment.... 0302 8.21 $398.08 $216.55 $79.62
77499 E Radiation therapy management... .............. .............. .............. .............. ..............
77520 S Proton beam delivery........... 0301 2.21 $107.16 $52.53 $21.43
77523 S Proton beam delivery........... 0301 2.21 $107.16 $52.53 $21.43
77600 S Hyperthermia treatment......... 0314 5.88 $285.10 $150.95 $57.02
77605 S Hyperthermia treatment......... 0314 5.88 $285.10 $150.95 $57.02
77610 S Hyperthermia treatment......... 0314 5.88 $285.10 $150.95 $57.02
77615 S Hyperthermia treatment......... 0314 5.88 $285.10 $150.95 $57.02
77620 S Hyperthermia treatment......... 0314 5.88 $285.10 $150.95 $57.02
77750 S Infuse radioactive materials... 0301 2.21 $107.16 $52.53 $21.43
77761 S Radioelement application....... 0312 4.09 $198.31 $109.65 $39.66
77762 S Radioelement application....... 0312 4.09 $198.31 $109.65 $39.66
77763 S Radioelement application....... 0312 4.09 $198.31 $109.65 $39.66
77776 S Radioelement application....... 0312 4.09 $198.31 $109.65 $39.66
77777 S Radioelement application....... 0312 4.09 $198.31 $109.65 $39.66
77778 S Radioelement application....... 0312 4.09 $198.31 $109.65 $39.66
77781 S High intensity brachytherapy... 0313 7.89 $382.56 $164.02 $76.51
77782 S High intensity brachytherapy... 0313 7.89 $382.56 $164.02 $76.51
77783 S High intensity brachytherapy... 0313 7.89 $382.56 $164.02 $76.51
77784 S High intensity brachytherapy... 0313 7.89 $382.56 $164.02 $76.51
77789 S Radioelement application....... 0300 1.98 $96.00 $47.72 $19.20
77790 N Radioelement handling.......... .............. .............. .............. .............. ..............
77799 S Radium/radioisotope therapy.... 0313 7.89 $382.56 $164.02 $76.51
78000 S Thyroid, single uptake......... 0290 1.94 $94.06 $55.51 $18.81
78001 S Thyroid, multiple uptakes...... 0290 1.94 $94.06 $55.51 $18.81
78003 S Thyroid suppress/stimul........ 0290 1.94 $94.06 $55.51 $18.81
78006 S Thyroid imaging with uptake.... 0291 3.15 $152.73 $93.14 $30.55
78007 S Thyroid image, mult uptakes.... 0291 3.15 $152.73 $93.14 $30.55
78010 S Thyroid imaging................ 0290 1.94 $94.06 $55.51 $18.81
78011 S Thyroid imaging with flow...... 0290 1.94 $94.06 $55.51 $18.81
[[Page 18635]]
78015 S Thyroid met imaging............ 0291 3.15 $152.73 $93.14 $30.55
78016 S Thyroid met imaging/studies.... 0292 4.36 $211.40 $126.63 $42.28
78018 S Thyroid met imaging, body...... 0292 4.36 $211.40 $126.63 $42.28
78020 S Thyroid met uptake............. 0292 4.36 $211.40 $126.63 $42.28
78070 S Parathyroid nuclear imaging.... 0292 4.36 $211.40 $126.63 $42.28
78075 S Adrenal nuclear imaging........ 0292 4.36 $211.40 $126.63 $42.28
78099 S Endocrine nuclear procedure.... 0290 1.94 $94.06 $55.51 $18.81
78102 S Bone marrow imaging, ltd....... 0291 3.15 $152.73 $93.14 $30.55
78103 S Bone marrow imaging, mult...... 0292 4.36 $211.40 $126.63 $42.28
78104 S Bone marrow imaging, body...... 0292 4.36 $211.40 $126.63 $42.28
78110 S Plasma volume, single.......... 0291 3.15 $152.73 $93.14 $30.55
78111 S Plasma volume, multiple........ 0291 3.15 $152.73 $93.14 $30.55
78120 S Red cell mass, single.......... 0291 3.15 $152.73 $93.14 $30.55
78121 S Red cell mass, multiple........ 0291 3.15 $152.73 $93.14 $30.55
78122 S Blood volume................... 0292 4.36 $211.40 $126.63 $42.28
78130 S Red cell survival study........ 0292 4.36 $211.40 $126.63 $42.28
78135 S Red cell survival kinetics..... 0292 4.36 $211.40 $126.63 $42.28
78140 S Red cell sequestration......... 0292 4.36 $211.40 $126.63 $42.28
78160 S Plasma iron turnover........... 0292 4.36 $211.40 $126.63 $42.28
78162 S Iron absorption exam........... 0292 4.36 $211.40 $126.63 $42.28
78170 S Red cell iron utilization...... 0292 4.36 $211.40 $126.63 $42.28
78172 S Total body iron estimation..... 0292 4.36 $211.40 $126.63 $42.28
78185 S Spleen imaging................. 0291 3.15 $152.73 $93.14 $30.55
78190 S Platelet survival, kinetics.... 0291 3.15 $152.73 $93.14 $30.55
78191 S Platelet survival.............. 0291 3.15 $152.73 $93.14 $30.55
78195 S Lymph system imaging........... 0292 4.36 $211.40 $126.63 $42.28
78199 S Blood/lymph nuclear exam....... 0290 1.94 $94.06 $55.51 $18.81
78201 S Liver imaging.................. 0291 3.15 $152.73 $93.14 $30.55
78202 S Liver imaging with flow........ 0291 3.15 $152.73 $93.14 $30.55
78205 S Liver imaging (3D)............. 0292 4.36 $211.40 $126.63 $42.28
78206 S Liver image (3D) w/flow........ 0292 4.36 $211.40 $126.63 $42.28
78215 S Liver and spleen imaging....... 0291 3.15 $152.73 $93.14 $30.55
78216 S Liver & spleen image/flow...... 0291 3.15 $152.73 $93.14 $30.55
78220 S Liver function study........... 0292 4.36 $211.40 $126.63 $42.28
78223 S Hepatobiliary imaging.......... 0292 4.36 $211.40 $126.63 $42.28
78230 S Salivary gland imaging......... 0291 3.15 $152.73 $93.14 $30.55
78231 S Serial salivary imaging........ 0291 3.15 $152.73 $93.14 $30.55
78232 S Salivary gland function exam... 0291 3.15 $152.73 $93.14 $30.55
78258 S Esophageal motility study...... 0291 3.15 $152.73 $93.14 $30.55
78261 S Gastric mucosa imaging......... 0291 3.15 $152.73 $93.14 $30.55
78262 S Gastroesophageal reflux exam... 0291 3.15 $152.73 $93.14 $30.55
78264 S Gastric emptying study......... 0292 4.36 $211.40 $126.63 $42.28
2 78267 T Breath tst attain/anal c-14.... 0971 1.55 $75.16 .............. $15.03
2 78268 T Breath test analysis, c-14..... 0970 0.52 $25.21 .............. $5.04
78270 S Vit B-12 absorption exam....... 0290 1.94 $94.06 $55.51 $18.81
78271 S Vit B-12 absorp exam, IF....... 0290 1.94 $94.06 $55.51 $18.81
78272 S Vit B-12 absorp, combined...... 0291 3.15 $152.73 $93.14 $30.55
78278 S Acute GI blood loss imaging.... 0292 4.36 $211.40 $126.63 $42.28
78282 S GI protein loss exam........... 0290 1.94 $94.06 $55.51 $18.81
78290 S Meckel's divert exam........... 0291 3.15 $152.73 $93.14 $30.55
78291 S Leveen/shunt patency exam...... 0292 4.36 $211.40 $126.63 $42.28
78299 S GI nuclear procedure........... 0290 1.94 $94.06 $55.51 $18.81
78300 S Bone imaging, limited area..... 0291 3.15 $152.73 $93.14 $30.55
78305 S Bone imaging, multiple areas... 0292 4.36 $211.40 $126.63 $42.28
78306 S Bone imaging, whole body....... 0292 4.36 $211.40 $126.63 $42.28
78315 S Bone imaging, 3 phase.......... 0292 4.36 $211.40 $126.63 $42.28
78320 S Bone imaging (3D).............. 0292 4.36 $211.40 $126.63 $42.28
78350 X Bone mineral, single photon.... 0261 1.38 $66.91 $38.77 $13.38
78351 E Bone mineral, dual photon...... .............. .............. .............. .............. ..............
78399 S Musculoskeletal nuclear exam... 0290 1.94 $94.06 $55.51 $18.81
78414 S Non-imaging heart function..... 0292 4.36 $211.40 $126.63 $42.28
78428 S Cardiac shunt imaging.......... 0292 4.36 $211.40 $126.63 $42.28
78445 S Vascular flow imaging.......... 0291 3.15 $152.73 $93.14 $30.55
78455 S Venous thrombosis study........ 0291 3.15 $152.73 $93.14 $30.55
78456 S Acute venous thrombus image.... 0291 3.15 $152.73 $93.14 $30.55
78457 S Venous thrombosis imaging...... 0291 3.15 $152.73 $93.14 $30.55
78458 S Ven thrombosis images, bilat... 0291 3.15 $152.73 $93.14 $30.55
78459 E Heart muscle imaging (PET)..... .............. .............. .............. .............. ..............
78460 S Heart muscle blood, single..... 0286 7.28 $352.99 $200.04 $70.60
78461 S Heart muscle blood, multiple... 0286 7.28 $352.99 $200.04 $70.60
78464 S Heart image (3D), single....... 0286 7.28 $352.99 $200.04 $70.60
78465 S Heart image (3D), multiple..... 0286 7.28 $352.99 $200.04 $70.60
78466 S Heart infarct image............ 0292 4.36 $211.40 $126.63 $42.28
[[Page 18636]]
78468 S Heart infarct image (ef)....... 0292 4.36 $211.40 $126.63 $42.28
78469 S Heart infarct image (3D)....... 0292 4.36 $211.40 $126.63 $42.28
78472 S Gated heart, planar, single.... 0286 7.28 $352.99 $200.04 $70.60
78473 S Gated heart, multiple.......... 0286 7.28 $352.99 $200.04 $70.60
78478 S Heart wall motion add-on....... 0286 7.28 $352.99 $200.04 $70.60
78480 S Heart function add-on.......... 0286 7.28 $352.99 $200.04 $70.60
78481 S Heart first pass, single....... 0286 7.28 $352.99 $200.04 $70.60
78483 S Heart first pass, multiple..... 0286 7.28 $352.99 $200.04 $70.60
78491 E Heart image (pet), single...... .............. .............. .............. .............. ..............
78492 E Heart image (pet), multiple.... .............. .............. .............. .............. ..............
78494 S Heart image, spect............. 0296 3.57 $173.10 $100.25 $34.62
78496 S Heart first pass add-on........ 0296 3.57 $173.10 $100.25 $34.62
78499 S Cardiovascular nuclear exam.... 0292 4.36 $211.40 $126.63 $42.28
78580 S Lung perfusion imaging......... 0291 3.15 $152.73 $93.14 $30.55
78584 S Lung V/Q image single breath... 0292 4.36 $211.40 $126.63 $42.28
78585 S Lung V/Q imaging............... 0292 4.36 $211.40 $126.63 $42.28
78586 S Aerosol lung image, single..... 0292 4.36 $211.40 $126.63 $42.28
78587 S Aerosol lung image, multiple... 0292 4.36 $211.40 $126.63 $42.28
78588 S Perfusion lung image........... 0292 4.36 $211.40 $126.63 $42.28
78591 S Vent image, 1 breath, 1 proj... 0291 3.15 $152.73 $93.14 $30.55
78593 S Vent image, 1 proj, gas........ 0292 4.36 $211.40 $126.63 $42.28
78594 S Vent image, mult proj, gas..... 0292 4.36 $211.40 $126.63 $42.28
78596 S Lung differential function..... 0292 4.36 $211.40 $126.63 $42.28
78599 S Respiratory nuclear exam....... 0291 3.15 $152.73 $93.14 $30.55
78600 S Brain imaging, ltd static...... 0292 4.36 $211.40 $126.63 $42.28
78601 S Brain imaging, ltd w/flow...... 0292 4.36 $211.40 $126.63 $42.28
78605 S Brain imaging, complete........ 0291 3.15 $152.73 $93.14 $30.55
78606 S Brain imaging, compl w/flow.... 0292 4.36 $211.40 $126.63 $42.28
78607 S Brain imaging (3D)............. 0292 4.36 $211.40 $126.63 $42.28
78608 E Brain imaging (PET)............ .............. .............. .............. .............. ..............
78609 E Brain imaging (PET)............ .............. .............. .............. .............. ..............
78610 S Brain flow imaging only........ 0291 3.15 $152.73 $93.14 $30.55
78615 S Cerebral blood flow imaging.... 0292 4.36 $211.40 $126.63 $42.28
78630 S Cerebrospinal fluid scan....... 0292 4.36 $211.40 $126.63 $42.28
78635 S CSF ventriculography........... 0292 4.36 $211.40 $126.63 $42.28
78645 S CSF shunt evaluation........... 0292 4.36 $211.40 $126.63 $42.28
78647 S Cerebrospinal fluid scan....... 0292 4.36 $211.40 $126.63 $42.28
78650 S CSF leakage imaging............ 0292 4.36 $211.40 $126.63 $42.28
78655 S ............................... 0292 4.36 $211.40 $126.63 $42.28
78660 S Nuclear exam of tear flow...... 0291 3.15 $152.73 $93.14 $30.55
78699 S Nervous system nuclear exam.... 0292 4.36 $211.40 $126.63 $42.28
78700 S Kidney imaging, static......... 0291 3.15 $152.73 $93.14 $30.55
78701 S Kidney imaging with flow....... 0291 3.15 $152.73 $93.14 $30.55
78704 S Imaging renogram............... 0292 4.36 $211.40 $126.63 $42.28
78707 S Kidney flow/function image..... 0292 4.36 $211.40 $126.63 $42.28
78708 S Kidney flow/function image..... 0292 4.36 $211.40 $126.63 $42.28
78709 S Kidney flow/function image..... 0292 4.36 $211.40 $126.63 $42.28
78710 S Kidney imaging (3D)............ 0292 4.36 $211.40 $126.63 $42.28
78715 S Renal vascular flow exam....... 0291 3.15 $152.73 $93.14 $30.55
78725 S Kidney function study.......... 0291 3.15 $152.73 $93.14 $30.55
78730 S Urinary bladder retention...... 0291 3.15 $152.73 $93.14 $30.55
78740 S Ureteral reflux study.......... 0291 3.15 $152.73 $93.14 $30.55
78760 S Testicular imaging............. 0291 3.15 $152.73 $93.14 $30.55
78761 S Testicular imaging/flow........ 0291 3.15 $152.73 $93.14 $30.55
78799 S Genitourinary nuclear exam..... 0292 4.36 $211.40 $126.63 $42.28
78800 S Tumor imaging, limited area.... 0292 4.36 $211.40 $126.63 $42.28
78801 S Tumor imaging, mult areas...... 0292 4.36 $211.40 $126.63 $42.28
78802 S Tumor imaging, whole body...... 0292 4.36 $211.40 $126.63 $42.28
78803 S Tumor imaging (3D)............. 0292 4.36 $211.40 $126.63 $42.28
78805 S Abscess imaging, ltd area...... 0292 4.36 $211.40 $126.63 $42.28
78806 S Abscess imaging, whole body.... 0292 4.36 $211.40 $126.63 $42.28
78807 S Nuclear localization/abscess... 0292 4.36 $211.40 $126.63 $42.28
78810 E Tumor imaging (PET)............ .............. .............. .............. .............. ..............
78890 N Nuclear medicine data proc..... .............. .............. .............. .............. ..............
78891 N Nuclear med data proc.......... .............. .............. .............. .............. ..............
78990 N Provide diag radionuclide(s)... .............. .............. .............. .............. ..............
78999 S Nuclear diagnostic exam........ 0291 3.15 $152.73 $93.14 $30.55
79000 S Init hyperthyroid therapy...... 0294 5.13 $248.74 $144.06 $49.75
79001 S Repeat hyperthyroid therapy.... 0294 5.13 $248.74 $144.06 $49.75
79020 S Thyroid ablation............... 0294 5.13 $248.74 $144.06 $49.75
79030 S Thyroid ablation, carcinoma.... 0294 5.13 $248.74 $144.06 $49.75
79035 S Thyroid metastatic therapy..... 0294 5.13 $248.74 $144.06 $49.75
79100 S Hematopoetic nuclear therapy... 0294 5.13 $248.74 $144.06 $49.75
[[Page 18637]]
79200 S Intracavitary nuclear trmt..... 0295 19.85 $962.47 $609.17 $192.49
79300 S Interstitial nuclear therapy... 0294 5.13 $248.74 $144.06 $49.75
79400 S Nonhemato nuclear therapy...... 0295 19.85 $962.47 $609.17 $192.49
79420 S Intravascular nuclear ther..... 0295 19.85 $962.47 $609.17 $192.49
79440 S Nuclear joint therapy.......... 0294 5.13 $248.74 $144.06 $49.75
79900 N Provide ther radiopharm(s)..... .............. .............. .............. .............. ..............
79999 S Nuclear medicine therapy....... 0294 5.13 $248.74 $144.06 $49.75
80048 A Basic metabolic panel.......... .............. .............. .............. .............. ..............
80050 A General health panel........... .............. .............. .............. .............. ..............
80051 A Electrolyte panel.............. .............. .............. .............. .............. ..............
80053 A Comprehen metabolic panel...... .............. .............. .............. .............. ..............
80055 A Obstetric panel................ .............. .............. .............. .............. ..............
80061 A Lipid panel.................... .............. .............. .............. .............. ..............
80069 A Renal function panel........... .............. .............. .............. .............. ..............
80072 A Arthritis panel................ .............. .............. .............. .............. ..............
80074 A Acute hepatitis panel.......... .............. .............. .............. .............. ..............
80076 A Hepatic function panel......... .............. .............. .............. .............. ..............
80090 A Torch antibody panel........... .............. .............. .............. .............. ..............
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 of carbamazepine......... .............. .............. .............. .............. ..............
80158 A Assay of cyclosporine.......... .............. .............. .............. .............. ..............
80160 A Assay of desipramine........... .............. .............. .............. .............. ..............
80162 A Assay of digoxin............... .............. .............. .............. .............. ..............
80164 A Assay, dipropylacetic acid..... .............. .............. .............. .............. ..............
80166 A Assay of doxepin............... .............. .............. .............. .............. ..............
80168 A Assay of ethosuximide.......... .............. .............. .............. .............. ..............
80170 A Assay of gentamicin............ .............. .............. .............. .............. ..............
80172 A Assay of gold.................. .............. .............. .............. .............. ..............
80174 A Assay of imipramine............ .............. .............. .............. .............. ..............
80176 A Assay of lidocaine............. .............. .............. .............. .............. ..............
80178 A Assay of lithium............... .............. .............. .............. .............. ..............
80182 A Assay of nortriptyline......... .............. .............. .............. .............. ..............
80184 A Assay of phenobarbital......... .............. .............. .............. .............. ..............
80185 A Assay of phenytoin, total...... .............. .............. .............. .............. ..............
80186 A Assay of phenytoin, free....... .............. .............. .............. .............. ..............
80188 A Assay of primidone............. .............. .............. .............. .............. ..............
80190 A Assay of procainamide.......... .............. .............. .............. .............. ..............
80192 A Assay of procainamide.......... .............. .............. .............. .............. ..............
80194 A Assay of quinidine............. .............. .............. .............. .............. ..............
80196 A Assay of salicylate............ .............. .............. .............. .............. ..............
80197 A Assay of tacrolimus............ .............. .............. .............. .............. ..............
80198 A Assay of theophylline.......... .............. .............. .............. .............. ..............
80200 A Assay of tobramycin............ .............. .............. .............. .............. ..............
80201 A Assay of topiramate............ .............. .............. .............. .............. ..............
80202 A Assay of vancomycin............ .............. .............. .............. .............. ..............
80299 A Quantitative assay, drug....... .............. .............. .............. .............. ..............
80400 A Acth stimulation panel......... .............. .............. .............. .............. ..............
80402 A Acth stimulation panel......... .............. .............. .............. .............. ..............
80406 A Acth stimulation panel......... .............. .............. .............. .............. ..............
80408 A Aldosterone suppression eval... .............. .............. .............. .............. ..............
80410 A Calcitonin stimul panel........ .............. .............. .............. .............. ..............
80412 A CRH stimulation panel.......... .............. .............. .............. .............. ..............
80414 A Testosterone response.......... .............. .............. .............. .............. ..............
80415 A Estradiol response panel....... .............. .............. .............. .............. ..............
80416 A Renin stimulation panel........ .............. .............. .............. .............. ..............
80417 A Renin stimulation panel........ .............. .............. .............. .............. ..............
80418 A Pituitary evaluation panel..... .............. .............. .............. .............. ..............
80420 A Dexamethasone panel............ .............. .............. .............. .............. ..............
80422 A Glucagon tolerance panel....... .............. .............. .............. .............. ..............
80424 A Glucagon tolerance panel....... .............. .............. .............. .............. ..............
80426 A Gonadotropin hormone panel..... .............. .............. .............. .............. ..............
80428 A Growth hormone panel........... .............. .............. .............. .............. ..............
80430 A Growth hormone panel........... .............. .............. .............. .............. ..............
80432 A Insulin suppression panel...... .............. .............. .............. .............. ..............
80434 A Insulin tolerance panel........ .............. .............. .............. .............. ..............
80435 A Insulin tolerance panel........ .............. .............. .............. .............. ..............
80436 A Metyrapone panel............... .............. .............. .............. .............. ..............
[[Page 18638]]
80438 A TRH stimulation panel.......... .............. .............. .............. .............. ..............
80439 A TRH stimulation panel.......... .............. .............. .............. .............. ..............
80440 A TRH stimulation panel.......... .............. .............. .............. .............. ..............
80500 X Lab pathology consultation..... 0343 0.45 $21.82 $12.16 $4.36
80502 X Lab pathology consultation..... 0343 0.45 $21.82 $12.16 $4.36
81000 A Urinalysis, nonauto w/scope.... .............. .............. .............. .............. ..............
81001 A Urinalysis, auto w/scope....... .............. .............. .............. .............. ..............
81002 A Urinalysis nonauto w/o scope... .............. .............. .............. .............. ..............
81003 A Urinalysis, auto, w/o scope.... .............. .............. .............. .............. ..............
81005 A Urinalysis..................... .............. .............. .............. .............. ..............
81007 A Urine screen for bacteria...... .............. .............. .............. .............. ..............
81015 A Microscopic exam of urine...... .............. .............. .............. .............. ..............
81020 A Urinalysis, glass test......... .............. .............. .............. .............. ..............
81025 A Urine pregnancy test........... .............. .............. .............. .............. ..............
81050 A Urinalysis, volume measure..... .............. .............. .............. .............. ..............
81099 A Urinalysis test procedure...... .............. .............. .............. .............. ..............
82000 A Assay of blood acetaldehyde.... .............. .............. .............. .............. ..............
82003 A Assay of acetaminophen......... .............. .............. .............. .............. ..............
82009 A Test for acetone/ketones....... .............. .............. .............. .............. ..............
82010 A Acetone assay.................. .............. .............. .............. .............. ..............
82013 A Acetylcholinesterase assay..... .............. .............. .............. .............. ..............
82016 A Acylcarnitines, qual........... .............. .............. .............. .............. ..............
82017 A Acylcarnitines, quant.......... .............. .............. .............. .............. ..............
82024 A Assay of acth.................. .............. .............. .............. .............. ..............
82030 A Assay of adp & amp............. .............. .............. .............. .............. ..............
82040 A Assay of serum albumin......... .............. .............. .............. .............. ..............
82042 A Assay of urine albumin......... .............. .............. .............. .............. ..............
82043 A Microalbumin, quantitative..... .............. .............. .............. .............. ..............
82044 A Microalbumin, semiquant........ .............. .............. .............. .............. ..............
82055 A Assay of ethanol............... .............. .............. .............. .............. ..............
82075 A Assay of breath ethanol........ .............. .............. .............. .............. ..............
82085 A Assay of aldolase.............. .............. .............. .............. .............. ..............
82088 A Assay of aldosterone........... .............. .............. .............. .............. ..............
82101 A Assay of urine alkaloids....... .............. .............. .............. .............. ..............
82103 A Alpha-1-antitrypsin, total..... .............. .............. .............. .............. ..............
82104 A Alpha-1-antitrypsin, pheno..... .............. .............. .............. .............. ..............
82105 A Alpha-fetoprotein, serum....... .............. .............. .............. .............. ..............
82106 A Alpha-fetoprotein, amniotic.... .............. .............. .............. .............. ..............
82108 A Assay of aluminum.............. .............. .............. .............. .............. ..............
82120 A Amines, vaginal fluid qual..... .............. .............. .............. .............. ..............
82127 A Amino acid, single qual........ .............. .............. .............. .............. ..............
82128 A Amino acids, mult qual......... .............. .............. .............. .............. ..............
82131 A Amino acids, single quant...... .............. .............. .............. .............. ..............
82135 A Assay, aminolevulinic acid..... .............. .............. .............. .............. ..............
82136 A Amino acids, quant, 2-5........ .............. .............. .............. .............. ..............
82139 A Amino acids, quan, 6 or more... .............. .............. .............. .............. ..............
82140 A Assay of ammonia............... .............. .............. .............. .............. ..............
82143 A Amniotic fluid scan............ .............. .............. .............. .............. ..............
82145 A Assay of amphetamines.......... .............. .............. .............. .............. ..............
82150 A Assay of amylase............... .............. .............. .............. .............. ..............
82154 A Androstanediol glucuronide..... .............. .............. .............. .............. ..............
82157 A Assay of androstenedione....... .............. .............. .............. .............. ..............
82160 A Assay of androsterone.......... .............. .............. .............. .............. ..............
82163 A Assay of angiotensin II........ .............. .............. .............. .............. ..............
82164 A Angiotensin I enzyme test...... .............. .............. .............. .............. ..............
82172 A Assay of apolipoprotein........ .............. .............. .............. .............. ..............
82175 A Assay of arsenic............... .............. .............. .............. .............. ..............
82180 A Assay of ascorbic acid......... .............. .............. .............. .............. ..............
82190 A Atomic absorption.............. .............. .............. .............. .............. ..............
82205 A Assay of barbiturates.......... .............. .............. .............. .............. ..............
82232 A Assay of beta-2 protein........ .............. .............. .............. .............. ..............
82239 A Bile acids, total.............. .............. .............. .............. .............. ..............
82240 A Bile acids, cholylglycine...... .............. .............. .............. .............. ..............
82247 A Bilirubin, total............... .............. .............. .............. .............. ..............
82248 A Bilirubin, direct.............. .............. .............. .............. .............. ..............
82251 A Assay of bilirubin............. .............. .............. .............. .............. ..............
82252 A Fecal bilirubin test........... .............. .............. .............. .............. ..............
82261 A Assay of biotinidase........... .............. .............. .............. .............. ..............
82270 A Test for blood, feces.......... .............. .............. .............. .............. ..............
82273 A Test for blood, other source... .............. .............. .............. .............. ..............
82286 A Assay of bradykinin............ .............. .............. .............. .............. ..............
82300 A Assay of cadmium............... .............. .............. .............. .............. ..............
82306 A Assay of vitamin D............. .............. .............. .............. .............. ..............
[[Page 18639]]
82307 A Assay of vitamin D............. .............. .............. .............. .............. ..............
82308 A Assay of calcitonin............ .............. .............. .............. .............. ..............
82310 A Assay of calcium............... .............. .............. .............. .............. ..............
82330 A Assay of calcium............... .............. .............. .............. .............. ..............
82331 A Calcium infusion test.......... .............. .............. .............. .............. ..............
82340 A Assay of calcium in urine...... .............. .............. .............. .............. ..............
82355 A Calculus (stone) analysis...... .............. .............. .............. .............. ..............
82360 A Calculus (stone) assay......... .............. .............. .............. .............. ..............
82365 A Calculus (stone) assay......... .............. .............. .............. .............. ..............
82370 A X-ray assay, calculus.......... .............. .............. .............. .............. ..............
82374 A Assay, blood carbon dioxide.... .............. .............. .............. .............. ..............
82375 A Assay, blood carbon monoxide... .............. .............. .............. .............. ..............
82376 A Test for carbon monoxide....... .............. .............. .............. .............. ..............
82378 A Carcinoembryonic antigen....... .............. .............. .............. .............. ..............
82379 A Assay of carnitine............. .............. .............. .............. .............. ..............
82380 A Assay of carotene.............. .............. .............. .............. .............. ..............
82382 A Assay, urine catecholamines.... .............. .............. .............. .............. ..............
82383 A Assay, blood catecholamines.... .............. .............. .............. .............. ..............
82384 A Assay, three catecholamines.... .............. .............. .............. .............. ..............
82387 A Assay of cathepsin-d........... .............. .............. .............. .............. ..............
82390 A Assay of ceruloplasmin......... .............. .............. .............. .............. ..............
82397 A Chemiluminescent assay......... .............. .............. .............. .............. ..............
82415 A Assay of chloramphenicol....... .............. .............. .............. .............. ..............
82435 A Assay of blood chloride........ .............. .............. .............. .............. ..............
82436 A Assay of urine chloride........ .............. .............. .............. .............. ..............
82438 A Assay, other fluid chlorides... .............. .............. .............. .............. ..............
82441 A Test for chlorohydrocarbons.... .............. .............. .............. .............. ..............
82465 A Assay of serum cholesterol..... .............. .............. .............. .............. ..............
82480 A Assay, serum cholinesterase.... .............. .............. .............. .............. ..............
82482 A Assay, rbc cholinesterase...... .............. .............. .............. .............. ..............
82485 A Assay, chondroitin sulfate..... .............. .............. .............. .............. ..............
82486 A Gas/liquid chromatography...... .............. .............. .............. .............. ..............
82487 A Paper chromatography........... .............. .............. .............. .............. ..............
82488 A Paper chromatography........... .............. .............. .............. .............. ..............
82489 A Thin layer chromatography...... .............. .............. .............. .............. ..............
82491 A Chromotography, quant, sing.... .............. .............. .............. .............. ..............
82492 A Chromotography, quant, mult.... .............. .............. .............. .............. ..............
82495 A Assay of chromium.............. .............. .............. .............. .............. ..............
82507 A Assay of citrate............... .............. .............. .............. .............. ..............
82520 A Assay of cocaine............... .............. .............. .............. .............. ..............
82523 A Collagen crosslinks............ .............. .............. .............. .............. ..............
82525 A Assay of copper................ .............. .............. .............. .............. ..............
82528 A Assay of corticosterone........ .............. .............. .............. .............. ..............
82530 A Cortisol, free................. .............. .............. .............. .............. ..............
82533 A Total cortisol................. .............. .............. .............. .............. ..............
82540 A Assay of creatine.............. .............. .............. .............. .............. ..............
82541 A Column chromotography, qual.... .............. .............. .............. .............. ..............
82542 A Column chromotography, quant... .............. .............. .............. .............. ..............
82543 A Column chromotograph/isotope... .............. .............. .............. .............. ..............
82544 A Column chromotograph/isotope... .............. .............. .............. .............. ..............
82550 A Assay of ck (cpk).............. .............. .............. .............. .............. ..............
82552 A Assay of cpk in blood.......... .............. .............. .............. .............. ..............
82553 A Creatine, MB fraction.......... .............. .............. .............. .............. ..............
82554 A Creatine, isoforms............. .............. .............. .............. .............. ..............
82565 A Assay of creatinine............ .............. .............. .............. .............. ..............
82570 A Assay of urine creatinine...... .............. .............. .............. .............. ..............
82575 A Creatinine clearance test...... .............. .............. .............. .............. ..............
82585 A Assay of cryofibrinogen........ .............. .............. .............. .............. ..............
82595 A Assay of cryoglobulin.......... .............. .............. .............. .............. ..............
82600 A Assay of cyanide............... .............. .............. .............. .............. ..............
82607 A Vitamin B-12................... .............. .............. .............. .............. ..............
82608 A B-12 binding capacity.......... .............. .............. .............. .............. ..............
82615 A Test for urine cystines........ .............. .............. .............. .............. ..............
82626 A Dehydroepiandrosterone......... .............. .............. .............. .............. ..............
82627 A Dehydroepiandrosterone......... .............. .............. .............. .............. ..............
82633 A Desoxycorticosterone........... .............. .............. .............. .............. ..............
82634 A Deoxycortisol.................. .............. .............. .............. .............. ..............
82638 A Assay of dibucaine number...... .............. .............. .............. .............. ..............
82646 A Assay of dihydrocodeinone...... .............. .............. .............. .............. ..............
82649 A Assay of dihydromorphinone..... .............. .............. .............. .............. ..............
82651 A Assay of dihydrotestosterone... .............. .............. .............. .............. ..............
82652 A Assay of dihydroxyvitamin d.... .............. .............. .............. .............. ..............
82654 A Assay of dimethadione.......... .............. .............. .............. .............. ..............
[[Page 18640]]
82657 A Enzyme cell activity........... .............. .............. .............. .............. ..............
82658 A Enzyme cell activity, ra....... .............. .............. .............. .............. ..............
82664 A Electrophoretic test........... .............. .............. .............. .............. ..............
82666 A Assay of epiandrosterone....... .............. .............. .............. .............. ..............
82668 A Assay of erythropoietin........ .............. .............. .............. .............. ..............
82670 A Assay of estradiol............. .............. .............. .............. .............. ..............
82671 A Assay of estrogens............. .............. .............. .............. .............. ..............
82672 A Assay of estrogen.............. .............. .............. .............. .............. ..............
82677 A Assay of estriol............... .............. .............. .............. .............. ..............
82679 A Assay of estrone............... .............. .............. .............. .............. ..............
82690 A Assay of ethchlorvynol......... .............. .............. .............. .............. ..............
82693 A Assay of ethylene glycol....... .............. .............. .............. .............. ..............
82696 A Assay of etiocholanolone....... .............. .............. .............. .............. ..............
82705 A Fats/lipids, feces, qual....... .............. .............. .............. .............. ..............
82710 A Fats/lipids, feces, quant...... .............. .............. .............. .............. ..............
82715 A Assay of fecal fat............. .............. .............. .............. .............. ..............
82725 A Assay of blood fatty acids..... .............. .............. .............. .............. ..............
82726 A Long chain fatty acids......... .............. .............. .............. .............. ..............
82728 A Assay of ferritin.............. .............. .............. .............. .............. ..............
82731 A Assay of fetal fibronectin..... .............. .............. .............. .............. ..............
82735 A Assay of fluoride.............. .............. .............. .............. .............. ..............
82742 A Assay of flurazepam............ .............. .............. .............. .............. ..............
82746 A Blood folic acid serum......... .............. .............. .............. .............. ..............
82747 A Assay of folic acid, rbc....... .............. .............. .............. .............. ..............
82757 A Assay of semen fructose........ .............. .............. .............. .............. ..............
82759 A Assay of rbc galactokinase..... .............. .............. .............. .............. ..............
82760 A Assay of galactose............. .............. .............. .............. .............. ..............
82775 A Assay galactose transferase.... .............. .............. .............. .............. ..............
82776 A Galactose transferase test..... .............. .............. .............. .............. ..............
82784 A Assay of gammaglobulin igm..... .............. .............. .............. .............. ..............
82785 A Assay of gammaglobulin ige..... .............. .............. .............. .............. ..............
82787 A Igg 1, 2, 3 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 of gastric acid.......... .............. .............. .............. .............. ..............
82928 A Assay of gastric acid.......... .............. .............. .............. .............. ..............
82938 A Gastrin test................... .............. .............. .............. .............. ..............
82941 A Assay of gastrin............... .............. .............. .............. .............. ..............
82943 A Assay of glucagon.............. .............. .............. .............. .............. ..............
82946 A Glucagon tolerance test........ .............. .............. .............. .............. ..............
82947 A Assay of glucose, quant........ .............. .............. .............. .............. ..............
82948 A Reagent strip/blood glucose.... .............. .............. .............. .............. ..............
82950 A Glucose test................... .............. .............. .............. .............. ..............
82951 A Glucose tolerance test (GTT)... .............. .............. .............. .............. ..............
82952 A GTT-added samples.............. .............. .............. .............. .............. ..............
82953 A Glucose-tolbutamide test....... .............. .............. .............. .............. ..............
82955 A Assay of g6pd enzyme........... .............. .............. .............. .............. ..............
82960 A Test for G6PD enzyme........... .............. .............. .............. .............. ..............
82962 A Glucose blood test............. .............. .............. .............. .............. ..............
82963 A Assay of glucosidase........... .............. .............. .............. .............. ..............
82965 A Assay of gdh enzyme............ .............. .............. .............. .............. ..............
82975 A Assay of glutamine............. .............. .............. .............. .............. ..............
82977 A Assay of GGT................... .............. .............. .............. .............. ..............
82978 A Assay of glutathione........... .............. .............. .............. .............. ..............
82979 A Assay, rbc glutathione......... .............. .............. .............. .............. ..............
82980 A Assay of glutethimide.......... .............. .............. .............. .............. ..............
82985 A Glycated protein............... .............. .............. .............. .............. ..............
83001 A Gonadotropin (FSH)............. .............. .............. .............. .............. ..............
83002 A Gonadotropin (LH).............. .............. .............. .............. .............. ..............
83003 A Assay, growth hormone (hgh).... .............. .............. .............. .............. ..............
83008 A Assay of guanosine............. .............. .............. .............. .............. ..............
83010 A Assay of haptoglobin, quant.... .............. .............. .............. .............. ..............
83012 A Assay of haptoglobins.......... .............. .............. .............. .............. ..............
83013 A H pylori breath tst analysis... .............. .............. .............. .............. ..............
83014 A H pylori drug admin/collect.... .............. .............. .............. .............. ..............
83015 A Heavy metal screen............. .............. .............. .............. .............. ..............
83018 A Quantitative screen, metals.... .............. .............. .............. .............. ..............
83020 A Hemoglobin electrophoresis..... .............. .............. .............. .............. ..............
83021 A Hemoglobin chromotography...... .............. .............. .............. .............. ..............
83026 A Hemoglobin, copper sulfate..... .............. .............. .............. .............. ..............
[[Page 18641]]
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 of plasma hemoglobin..... .............. .............. .............. .............. ..............
83055 A Blood sulfhemoglobin test...... .............. .............. .............. .............. ..............
83060 A Blood sulfhemoglobin assay..... .............. .............. .............. .............. ..............
83065 A Assay of hemoglobin heat....... .............. .............. .............. .............. ..............
83068 A Hemoglobin stability screen.... .............. .............. .............. .............. ..............
83069 A Assay of urine hemoglobin...... .............. .............. .............. .............. ..............
83070 A Assay of hemosiderin, qual..... .............. .............. .............. .............. ..............
83071 A Assay of hemosiderin, quant.... .............. .............. .............. .............. ..............
83080 A Assay of b hexosaminidase...... .............. .............. .............. .............. ..............
83088 A Assay of histamine............. .............. .............. .............. .............. ..............
83150 A Assay of for hva............... .............. .............. .............. .............. ..............
83491 A Assay of corticosteroids....... .............. .............. .............. .............. ..............
83497 A Assay of 5-hiaa................ .............. .............. .............. .............. ..............
83498 A Assay of progesterone.......... .............. .............. .............. .............. ..............
83499 A Assay of progesterone.......... .............. .............. .............. .............. ..............
83500 A Assay, free hydroxyproline..... .............. .............. .............. .............. ..............
83505 A Assay, total hydroxyproline.... .............. .............. .............. .............. ..............
83516 A Immunoassay, nonantibody....... .............. .............. .............. .............. ..............
83518 A Immunoassay, dipstick.......... .............. .............. .............. .............. ..............
83519 A Immunoassay, nonantibody....... .............. .............. .............. .............. ..............
83520 A Immunoassay, RIA............... .............. .............. .............. .............. ..............
83525 A Assay of insulin............... .............. .............. .............. .............. ..............
83527 A Assay of insulin............... .............. .............. .............. .............. ..............
83528 A Assay of intrinsic factor...... .............. .............. .............. .............. ..............
83540 A Assay of iron.................. .............. .............. .............. .............. ..............
83550 A Iron binding test.............. .............. .............. .............. .............. ..............
83570 A Assay of idh enzyme............ .............. .............. .............. .............. ..............
83582 A Assay of ketogenic steroids.... .............. .............. .............. .............. ..............
83586 A Assay 17-ketosteroids.......... .............. .............. .............. .............. ..............
83593 A Fractionation, ketosteroids.... .............. .............. .............. .............. ..............
83605 A Assay of lactic acid........... .............. .............. .............. .............. ..............
83615 A Lactate (LD) (LDH) enzyme...... .............. .............. .............. .............. ..............
83625 A Assay of ldh enzymes........... .............. .............. .............. .............. ..............
83632 A Placental lactogen............. .............. .............. .............. .............. ..............
83633 A Test urine for lactose......... .............. .............. .............. .............. ..............
83634 A Assay of urine for lactose..... .............. .............. .............. .............. ..............
83655 A Assay of lead.................. .............. .............. .............. .............. ..............
83661 A Assay of l/s ratio............. .............. .............. .............. .............. ..............
83662 A L/S ratio, foam stability...... .............. .............. .............. .............. ..............
83670 A Assay of lap enzyme............ .............. .............. .............. .............. ..............
83690 A Assay of lipase................ .............. .............. .............. .............. ..............
83715 A Assay of blood lipoproteins.... .............. .............. .............. .............. ..............
83716 A Assay of blood lipoproteins.... .............. .............. .............. .............. ..............
83718 A Assay of lipoprotein........... .............. .............. .............. .............. ..............
83719 A Assay of blood lipoprotein..... .............. .............. .............. .............. ..............
83721 A Assay of blood lipoprotein..... .............. .............. .............. .............. ..............
83727 A Assay of lrh hormone........... .............. .............. .............. .............. ..............
83735 A Assay of magnesium............. .............. .............. .............. .............. ..............
83775 A Assay of md enzyme............. .............. .............. .............. .............. ..............
83785 A Assay of manganese............. .............. .............. .............. .............. ..............
83788 A Mass spectrometry qual......... .............. .............. .............. .............. ..............
83789 A Mass spectrometry quant........ .............. .............. .............. .............. ..............
83805 A Assay of meprobamate........... .............. .............. .............. .............. ..............
83825 A Assay of mercury............... .............. .............. .............. .............. ..............
83835 A Assay of metanephrines......... .............. .............. .............. .............. ..............
83840 A Assay of methadone............. .............. .............. .............. .............. ..............
83857 A Assay of methemalbumin......... .............. .............. .............. .............. ..............
83858 A Assay of methsuximide.......... .............. .............. .............. .............. ..............
83864 A Mucopolysaccharides............ .............. .............. .............. .............. ..............
83866 A Mucopolysaccharides screen..... .............. .............. .............. .............. ..............
83872 A Assay synovial fluid mucin..... .............. .............. .............. .............. ..............
83873 A Assay of csf protein........... .............. .............. .............. .............. ..............
83874 A Assay of myoglobin............. .............. .............. .............. .............. ..............
83883 A Assay, nephelometry not spec... .............. .............. .............. .............. ..............
83885 A Assay of nickel................ .............. .............. .............. .............. ..............
83887 A Assay of nicotine.............. .............. .............. .............. .............. ..............
83890 A Molecule isolate............... .............. .............. .............. .............. ..............
83891 A Molecule isolate nucleic....... .............. .............. .............. .............. ..............
[[Page 18642]]
83892 A Molecular diagnostics.......... .............. .............. .............. .............. ..............
83893 A Molecule dot/slot/blot......... .............. .............. .............. .............. ..............
83894 A Molecule gel electrophor....... .............. .............. .............. .............. ..............
83896 A Molecular diagnostics.......... .............. .............. .............. .............. ..............
83897 A Molecule nucleic transfer...... .............. .............. .............. .............. ..............
83898 A Molecule nucleic ampli......... .............. .............. .............. .............. ..............
83901 A Molecule nucleic ampli......... .............. .............. .............. .............. ..............
83902 A Molecular diagnostics.......... .............. .............. .............. .............. ..............
83903 A Molecule mutation scan......... .............. .............. .............. .............. ..............
83904 A Molecule mutation identify..... .............. .............. .............. .............. ..............
83905 A Molecule mutation identify..... .............. .............. .............. .............. ..............
83906 A Molecule mutation identify..... .............. .............. .............. .............. ..............
83912 A Genetic examination............ .............. .............. .............. .............. ..............
83915 A Assay of nucleotidase.......... .............. .............. .............. .............. ..............
83916 A Oligoclonal bands.............. .............. .............. .............. .............. ..............
83918 A Assay, organic acids quant..... .............. .............. .............. .............. ..............
83919 A Assay, organic acids qual...... .............. .............. .............. .............. ..............
83925 A Assay of opiates............... .............. .............. .............. .............. ..............
83930 A Assay of blood osmolality...... .............. .............. .............. .............. ..............
83935 A Assay of urine osmolality...... .............. .............. .............. .............. ..............
83937 A Assay of osteocalcin........... .............. .............. .............. .............. ..............
83945 A Assay of oxalate............... .............. .............. .............. .............. ..............
83970 A Assay of parathormone.......... .............. .............. .............. .............. ..............
83986 A Assay of body fluid acidity.... .............. .............. .............. .............. ..............
83992 A Assay for phencyclidine........ .............. .............. .............. .............. ..............
84022 A Assay of phenothiazine......... .............. .............. .............. .............. ..............
84030 A Assay of blood pku............. .............. .............. .............. .............. ..............
84035 A Assay of phenylketones......... .............. .............. .............. .............. ..............
84060 A Assay acid phosphatase......... .............. .............. .............. .............. ..............
84061 A Phosphatase, forensic exam..... .............. .............. .............. .............. ..............
84066 A Assay prostate phosphatase..... .............. .............. .............. .............. ..............
84075 A Assay alkaline phosphatase..... .............. .............. .............. .............. ..............
84078 A Assay alkaline phosphatase..... .............. .............. .............. .............. ..............
84080 A Assay alkaline phosphatases.... .............. .............. .............. .............. ..............
84081 A Amniotic fluid enzyme test..... .............. .............. .............. .............. ..............
84085 A Assay of rbc pg6d enzyme....... .............. .............. .............. .............. ..............
84087 A Assay phosphohexose enzymes.... .............. .............. .............. .............. ..............
84100 A Assay of phosphorus............ .............. .............. .............. .............. ..............
84105 A Assay of urine phosphorus...... .............. .............. .............. .............. ..............
84106 A Test for porphobilinogen....... .............. .............. .............. .............. ..............
84110 A Assay of porphobilinogen....... .............. .............. .............. .............. ..............
84119 A Test urine for porphyrins...... .............. .............. .............. .............. ..............
84120 A Assay of urine porphyrins...... .............. .............. .............. .............. ..............
84126 A Assay of feces porphyrins...... .............. .............. .............. .............. ..............
84127 A Assay of feces porphyrins...... .............. .............. .............. .............. ..............
84132 A Assay of serum potassium....... .............. .............. .............. .............. ..............
84133 A Assay of urine potassium....... .............. .............. .............. .............. ..............
84134 A Assay of prealbumin............ .............. .............. .............. .............. ..............
84135 A Assay of pregnanediol.......... .............. .............. .............. .............. ..............
84138 A Assay of pregnanetriol......... .............. .............. .............. .............. ..............
84140 A Assay of pregnenolone.......... .............. .............. .............. .............. ..............
84143 A Assay of 17-hydroxypregneno.... .............. .............. .............. .............. ..............
84144 A Assay of progesterone.......... .............. .............. .............. .............. ..............
84146 A Assay of prolactin............. .............. .............. .............. .............. ..............
84150 A Assay of prostaglandin......... .............. .............. .............. .............. ..............
84153 A Assay of psa, total............ .............. .............. .............. .............. ..............
84154 A Assay of psa, free............. .............. .............. .............. .............. ..............
84155 A Assay of protein............... .............. .............. .............. .............. ..............
84160 A Assay of serum protein......... .............. .............. .............. .............. ..............
84165 A Assay of serum proteins........ .............. .............. .............. .............. ..............
84181 A Western blot test.............. .............. .............. .............. .............. ..............
84182 A Protein, western blot test..... .............. .............. .............. .............. ..............
84202 A Assay RBC protoporphyrin....... .............. .............. .............. .............. ..............
84203 A Test RBC protoporphyrin........ .............. .............. .............. .............. ..............
84206 A Assay of proinsulin............ .............. .............. .............. .............. ..............
84207 A Assay of vitamin b-6........... .............. .............. .............. .............. ..............
84210 A Assay of pyruvate.............. .............. .............. .............. .............. ..............
84220 A Assay of pyruvate kinase....... .............. .............. .............. .............. ..............
84228 A Assay of quinine............... .............. .............. .............. .............. ..............
84233 A Assay of estrogen.............. .............. .............. .............. .............. ..............
84234 A Assay of progesterone.......... .............. .............. .............. .............. ..............
84235 A Assay of endocrine hormone..... .............. .............. .............. .............. ..............
84238 A Assay, nonendocrine receptor... .............. .............. .............. .............. ..............
[[Page 18643]]
84244 A Assay of renin................. .............. .............. .............. .............. ..............
84252 A Assay of vitamin b-2........... .............. .............. .............. .............. ..............
84255 A Assay of selenium.............. .............. .............. .............. .............. ..............
84260 A Assay of serotonin............. .............. .............. .............. .............. ..............
84270 A Assay of sex hormone globul.... .............. .............. .............. .............. ..............
84275 A Assay of sialic acid........... .............. .............. .............. .............. ..............
84285 A Assay of silica................ .............. .............. .............. .............. ..............
84295 A Assay of serum sodium.......... .............. .............. .............. .............. ..............
84300 A Assay of urine sodium.......... .............. .............. .............. .............. ..............
84305 A Assay of somatomedin........... .............. .............. .............. .............. ..............
84307 A Assay of somatostatin.......... .............. .............. .............. .............. ..............
84311 A Spectrophotometry.............. .............. .............. .............. .............. ..............
84315 A Body fluid specific gravity.... .............. .............. .............. .............. ..............
84375 A Chromatogram assay, sugars..... .............. .............. .............. .............. ..............
84376 A Sugars, single, qual........... .............. .............. .............. .............. ..............
84377 A Sugars, multiple, qual......... .............. .............. .............. .............. ..............
84378 A Sugars single quant............ .............. .............. .............. .............. ..............
84379 A Sugars multiple quant.......... .............. .............. .............. .............. ..............
84392 A Assay of urine sulfate......... .............. .............. .............. .............. ..............
84402 A Assay of testosterone.......... .............. .............. .............. .............. ..............
84403 A Assay of total testosterone.... .............. .............. .............. .............. ..............
84425 A Assay of vitamin b-1........... .............. .............. .............. .............. ..............
84430 A Assay of thiocyanate........... .............. .............. .............. .............. ..............
84432 A Assay of thyroglobulin......... .............. .............. .............. .............. ..............
84436 A Assay of total thyroxine....... .............. .............. .............. .............. ..............
84437 A Assay of neonatal thyroxine.... .............. .............. .............. .............. ..............
84439 A Assay of free thyroxine........ .............. .............. .............. .............. ..............
84442 A Assay of thyroid activity...... .............. .............. .............. .............. ..............
84443 A Assay thyroid stim hormone..... .............. .............. .............. .............. ..............
84445 A Assay of tsi................... .............. .............. .............. .............. ..............
84446 A Assay of vitamin e............. .............. .............. .............. .............. ..............
84449 A Assay of transcortin........... .............. .............. .............. .............. ..............
84450 A Transferase (AST) (SGOT)....... .............. .............. .............. .............. ..............
84460 A Alanine amino (ALT) (SGPT)..... .............. .............. .............. .............. ..............
84466 A Assay of transferrin........... .............. .............. .............. .............. ..............
84478 A Assay of triglycerides......... .............. .............. .............. .............. ..............
84479 A Assay of thyroid (t3 or t4).... .............. .............. .............. .............. ..............
84480 A Assay, triiodothyronine (t3)... .............. .............. .............. .............. ..............
84481 A Free assay (FT-3).............. .............. .............. .............. .............. ..............
84482 A T3 reverse..................... .............. .............. .............. .............. ..............
84484 A Assay of troponin, quant....... .............. .............. .............. .............. ..............
84485 A Assay duodenal fluid trypsin... .............. .............. .............. .............. ..............
84488 A Test feces for trypsin......... .............. .............. .............. .............. ..............
84490 A Assay of feces for trypsin..... .............. .............. .............. .............. ..............
84510 A Assay of tyrosine.............. .............. .............. .............. .............. ..............
84512 A Assay of troponin, qual........ .............. .............. .............. .............. ..............
84520 A Assay of urea nitrogen......... .............. .............. .............. .............. ..............
84525 A Urea nitrogen semi-quant....... .............. .............. .............. .............. ..............
84540 A Assay of urine/urea-n.......... .............. .............. .............. .............. ..............
84545 A Urea-N clearance test.......... .............. .............. .............. .............. ..............
84550 A Assay of blood/uric acid....... .............. .............. .............. .............. ..............
84560 A Assay of urine/uric acid....... .............. .............. .............. .............. ..............
84577 A Assay of feces/urobilinogen.... .............. .............. .............. .............. ..............
84578 A Test urine urobilinogen........ .............. .............. .............. .............. ..............
84580 A Assay of urine urobilinogen.... .............. .............. .............. .............. ..............
84583 A Assay of urine urobilinogen.... .............. .............. .............. .............. ..............
84585 A Assay of urine vma............. .............. .............. .............. .............. ..............
84586 A Assay of vip................... .............. .............. .............. .............. ..............
84588 A Assay of vasopressin........... .............. .............. .............. .............. ..............
84590 A Assay of vitamin a............. .............. .............. .............. .............. ..............
84597 A Assay of vitamin k............. .............. .............. .............. .............. ..............
84600 A Assay of volatiles............. .............. .............. .............. .............. ..............
84620 A Xylose tolerance test.......... .............. .............. .............. .............. ..............
84630 A Assay of zinc.................. .............. .............. .............. .............. ..............
84681 A Assay of c-peptide............. .............. .............. .............. .............. ..............
84702 A Chorionic gonadotropin test.... .............. .............. .............. .............. ..............
84703 A Chorionic gonadotropin assay... .............. .............. .............. .............. ..............
84830 A Ovulation tests................ .............. .............. .............. .............. ..............
84999 A Clinical chemistry test........ .............. .............. .............. .............. ..............
85002 A Bleeding time test............. .............. .............. .............. .............. ..............
85007 A Differential WBC count......... .............. .............. .............. .............. ..............
85008 A Nondifferential WBC count...... .............. .............. .............. .............. ..............
85009 A Differential WBC count......... .............. .............. .............. .............. ..............
[[Page 18644]]
85013 A Hematocrit..................... .............. .............. .............. .............. ..............
85014 A Hematocrit..................... .............. .............. .............. .............. ..............
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............. .............. .............. .............. .............. ..............
85031 A Manual hemogram, cbc........... .............. .............. .............. .............. ..............
85041 A Red blood cell (RBC) count..... .............. .............. .............. .............. ..............
85044 A Reticulocyte count............. .............. .............. .............. .............. ..............
85045 A Reticulocyte count............. .............. .............. .............. .............. ..............
85046 A Reticyte/hgb concentrate....... .............. .............. .............. .............. ..............
85048 A White blood cell (WBC) count... .............. .............. .............. .............. ..............
85060 X Blood smear interpretation..... 0342 0.26 $12.61 $8.03 $2.52
85095 T Bone marrow aspiration......... 0003 0.98 $47.52 $27.99 $9.50
85097 X Bone marrow interpretation..... 0344 0.79 $38.30 $23.63 $7.66
85102 T Bone marrow biopsy............. 0003 0.98 $47.52 $27.99 $9.50
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....... .............. .............. .............. .............. ..............
[[Page 18645]]
85547 A RBC mechanical fragility....... .............. .............. .............. .............. ..............
85549 A Muramidase..................... .............. .............. .............. .............. ..............
85555 A RBC osmotic fragility.......... .............. .............. .............. .............. ..............
85557 A RBC osmotic fragility.......... .............. .............. .............. .............. ..............
85576 A Blood platelet aggregation..... .............. .............. .............. .............. ..............
85585 A Blood platelet estimation...... .............. .............. .............. .............. ..............
85590 A Platelet count, manual......... .............. .............. .............. .............. ..............
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, nonautomated..... .............. .............. .............. .............. ..............
85652 A Rbc sed rate, automated........ .............. .............. .............. .............. ..............
85660 A RBC sickle cell test........... .............. .............. .............. .............. ..............
85670 A Thrombin time, plasma.......... .............. .............. .............. .............. ..............
85675 A Thrombin time, titer........... .............. .............. .............. .............. ..............
85705 A Thromboplastin inhibition...... .............. .............. .............. .............. ..............
85730 A Thromboplastin time, partial... .............. .............. .............. .............. ..............
85732 A Thromboplastin time, partial... .............. .............. .............. .............. ..............
85810 A Blood viscosity examination.... .............. .............. .............. .............. ..............
85999 A Hematology procedure........... .............. .............. .............. .............. ..............
86000 A Agglutinins, febrile........... .............. .............. .............. .............. ..............
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 service... 0343 0.45 $21.82 $12.16 $4.36
86078 X Physician blood bank service... 0344 0.79 $38.30 $23.63 $7.66
86079 X Physician blood bank service... 0344 0.79 $38.30 $23.63 $7.66
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 Counterimmunoelectrophoresis... .............. .............. .............. .............. ..............
86215 A Deoxyribonuclease, antibody.... .............. .............. .............. .............. ..............
86225 A DNA antibody................... .............. .............. .............. .............. ..............
86226 A DNA antibody, single strand.... .............. .............. .............. .............. ..............
86235 A Nuclear antigen antibody....... .............. .............. .............. .............. ..............
86243 A Fc receptor.................... .............. .............. .............. .............. ..............
86255 A Fluorescent antibody, screen... .............. .............. .............. .............. ..............
86256 A Fluorescent antibody, titer.... .............. .............. .............. .............. ..............
86277 A Growth hormone antibody........ .............. .............. .............. .............. ..............
86280 A Hemagglutination inhibition.... .............. .............. .............. .............. ..............
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............ .............. .............. .............. .............. ..............
[[Page 18646]]
86343 A Leukocyte histamine release.... .............. .............. .............. .............. ..............
86344 A Leukocyte phagocytosis......... .............. .............. .............. .............. ..............
86353 A Lymphocyte transformation...... .............. .............. .............. .............. ..............
86359 A T cells, total count........... .............. .............. .............. .............. ..............
86360 A T cell, absolute count/ratio... .............. .............. .............. .............. ..............
86361 A T cell, absolute count......... .............. .............. .............. .............. ..............
86376 A Microsomal antibody............ .............. .............. .............. .............. ..............
86378 A Migration inhibitory factor.... .............. .............. .............. .............. ..............
86382 A Neutralization test, viral..... .............. .............. .............. .............. ..............
86384 A Nitroblue tetrazolium dye...... .............. .............. .............. .............. ..............
86403 A Particle agglutination test.... .............. .............. .............. .............. ..............
86406 A Particle agglutination test.... .............. .............. .............. .............. ..............
86430 A Rheumatoid factor test......... .............. .............. .............. .............. ..............
86431 A Rheumatoid factor, quant....... .............. .............. .............. .............. ..............
86485 X Skin test, candida............. 0341 0.13 $6.30 $3.67 $1.26
86490 X Coccidioidomycosis skin test... 0341 0.13 $6.30 $3.67 $1.26
86510 X Histoplasmosis skin test....... 0341 0.13 $6.30 $3.67 $1.26
86580 X TB intradermal test............ 0341 0.13 $6.30 $3.67 $1.26
86585 X TB tine test................... 0341 0.13 $6.30 $3.67 $1.26
86586 X Skin test, unlisted............ 0341 0.13 $6.30 $3.67 $1.26
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 antibody....... .............. .............. .............. .............. ..............
86677 A Helicobacter pylori............ .............. .............. .............. .............. ..............
86682 A Helminth antibody.............. .............. .............. .............. .............. ..............
86684 A Hemophilus influenza........... .............. .............. .............. .............. ..............
86687 A Htlv-i antibody................ .............. .............. .............. .............. ..............
86688 A Htlv-ii antibody............... .............. .............. .............. .............. ..............
86689 A HTLV/HIV confirmatory test..... .............. .............. .............. .............. ..............
86692 A Hepatitis, delta agent......... .............. .............. .............. .............. ..............
86694 A Herpes simplex test............ .............. .............. .............. .............. ..............
86695 A Herpes simplex test............ .............. .............. .............. .............. ..............
86698 A Histoplasma.................... .............. .............. .............. .............. ..............
86701 A HIV-1.......................... .............. .............. .............. .............. ..............
86702 A HIV-2.......................... .............. .............. .............. .............. ..............
86703 A HIV-1/HIV-2, single assay...... .............. .............. .............. .............. ..............
86704 A Hep b core antibody, igg/igm... .............. .............. .............. .............. ..............
86705 A Hep b core antibody, igm....... .............. .............. .............. .............. ..............
86706 A Hep b surface antibody......... .............. .............. .............. .............. ..............
86707 A Hep be antibody................ .............. .............. .............. .............. ..............
86708 A Hep a antibody, igg/igm........ .............. .............. .............. .............. ..............
86709 A Hep a antibody, igm............ .............. .............. .............. .............. ..............
[[Page 18647]]
86710 A Influenza virus antibody....... .............. .............. .............. .............. ..............
86713 A Legionella antibody............ .............. .............. .............. .............. ..............
86717 A Leishmania antibody............ .............. .............. .............. .............. ..............
86720 A Leptospira antibody............ .............. .............. .............. .............. ..............
86723 A Listeria monocytogenes ab...... .............. .............. .............. .............. ..............
86727 A Lymph choriomeningitis ab...... .............. .............. .............. .............. ..............
86729 A Lympho venereum antibody....... .............. .............. .............. .............. ..............
86732 A Mucormycosis antibody.......... .............. .............. .............. .............. ..............
86735 A Mumps antibody................. .............. .............. .............. .............. ..............
86738 A Mycoplasma antibody............ .............. .............. .............. .............. ..............
86741 A Neisseria meningitidis......... .............. .............. .............. .............. ..............
86744 A Nocardia antibody.............. .............. .............. .............. .............. ..............
86747 A Parvovirus antibody............ .............. .............. .............. .............. ..............
86750 A Malaria antibody............... .............. .............. .............. .............. ..............
86753 A Protozoa antibody nos.......... .............. .............. .............. .............. ..............
86756 A Respiratory virus antibody..... .............. .............. .............. .............. ..............
86759 A Rotavirus antibody............. .............. .............. .............. .............. ..............
86762 A Rubella antibody............... .............. .............. .............. .............. ..............
86765 A Rubeola antibody............... .............. .............. .............. .............. ..............
86768 A Salmonella antibody............ .............. .............. .............. .............. ..............
86771 A Shigella antibody.............. .............. .............. .............. .............. ..............
86774 A Tetanus antibody............... .............. .............. .............. .............. ..............
86777 A Toxoplasma antibody............ .............. .............. .............. .............. ..............
86778 A Toxoplasma antibody, igm....... .............. .............. .............. .............. ..............
86781 A Treponema pallidum, confirm.... .............. .............. .............. .............. ..............
86784 A Trichinella antibody........... .............. .............. .............. .............. ..............
86787 A Varicella-zoster antibody...... .............. .............. .............. .............. ..............
86790 A Virus antibody nos............. .............. .............. .............. .............. ..............
86793 A Yersinia antibody.............. .............. .............. .............. .............. ..............
86800 A Thyroglobulin antibody......... .............. .............. .............. .............. ..............
86803 A Hepatitis c ab test............ .............. .............. .............. .............. ..............
86804 A Hep c ab test, confirm......... .............. .............. .............. .............. ..............
86805 A Lymphocytotoxicity assay....... .............. .............. .............. .............. ..............
86806 A Lymphocytotoxicity assay....... .............. .............. .............. .............. ..............
86807 A Cytotoxic antibody screening... .............. .............. .............. .............. ..............
86808 A Cytotoxic antibody screening... .............. .............. .............. .............. ..............
86812 A HLA typing, A, B, or C......... .............. .............. .............. .............. ..............
86813 A HLA typing, A, B, or C......... .............. .............. .............. .............. ..............
86816 A HLA typing, DR/DQ.............. .............. .............. .............. .............. ..............
86817 A HLA typing, DR/DQ.............. .............. .............. .............. .............. ..............
86821 A Lymphocyte culture, mixed...... .............. .............. .............. .............. ..............
86822 A Lymphocyte culture, primed..... .............. .............. .............. .............. ..............
86849 A Immunology procedure........... .............. .............. .............. .............. ..............
86850 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/stem cell prep..... .............. .............. .............. .............. ..............
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............... .............. .............. .............. .............. ..............
[[Page 18648]]
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.......... .............. .............. .............. .............. ..............
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, bact...... .............. .............. .............. .............. ..............
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......... .............. .............. .............. .............. ..............
[[Page 18649]]
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............. .............. .............. .............. .............. ..............
87332 A Cytomegalovirus ag, eia........ .............. .............. .............. .............. ..............
87335 A E coli 0157 ag, eia............ .............. .............. .............. .............. ..............
87338 A Hpylori, stool, eia............ .............. .............. .............. .............. ..............
87340 A Hepatitis b surface ag, eia.... .............. .............. .............. .............. ..............
87350 A Hepatitis be ag, eia........... .............. .............. .............. .............. ..............
87380 A Hepatitis delta ag, eia........ .............. .............. .............. .............. ..............
87385 A Histoplasma capsul ag, eia..... .............. .............. .............. .............. ..............
87390 A Hiv-1 ag, eia.................. .............. .............. .............. .............. ..............
87391 A Hiv-2 ag, eia.................. .............. .............. .............. .............. ..............
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.... .............. .............. .............. .............. ..............
[[Page 18650]]
87556 A M.tuberculo, dna, amp probe.... .............. .............. .............. .............. ..............
87557 A M.tuberculo, dna, quant........ .............. .............. .............. .............. ..............
87560 A M.avium-intra, dna, dir prob... .............. .............. .............. .............. ..............
87561 A M.avium-intra, dna, amp prob... .............. .............. .............. .............. ..............
87562 A M.avium-intra, dna, quant...... .............. .............. .............. .............. ..............
87580 A M.pneumon, dna, dir probe...... .............. .............. .............. .............. ..............
87581 A M.pneumon, dna, amp probe...... .............. .............. .............. .............. ..............
87582 A M.pneumon, dna, quant.......... .............. .............. .............. .............. ..............
87590 A N.gonorrhoeae, dna, dir prob... .............. .............. .............. .............. ..............
87591 A N.gonorrhoeae, dna, amp prob... .............. .............. .............. .............. ..............
87592 A N.gonorrhoeae, dna, quant...... .............. .............. .............. .............. ..............
87620 A Hpv, dna, dir probe............ .............. .............. .............. .............. ..............
87621 A Hpv, dna, amp probe............ .............. .............. .............. .............. ..............
87622 A Hpv, dna, quant................ .............. .............. .............. .............. ..............
87650 A Strep a, dna, dir probe........ .............. .............. .............. .............. ..............
87651 A Strep a, dna, amp probe........ .............. .............. .............. .............. ..............
87652 A Strep a, dna, quant............ .............. .............. .............. .............. ..............
87797 A Detect agent nos, dna, dir..... .............. .............. .............. .............. ..............
87798 A Detect agent nos, dna, amp..... .............. .............. .............. .............. ..............
87799 A Detect agent nos, dna, quant... .............. .............. .............. .............. ..............
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.......... 0343 0.45 $21.82 $12.16 $4.36
88106 X Cytopathology, fluids.......... 0343 0.45 $21.82 $12.16 $4.36
88107 X Cytopathology, fluids.......... 0343 0.45 $21.82 $12.16 $4.36
88108 X Cytopath, concentrate tech..... 0343 0.45 $21.82 $12.16 $4.36
88125 X Forensic cytopathology......... 0343 0.45 $21.82 $12.16 $4.36
88130 A Sex chromatin identification... .............. .............. .............. .............. ..............
88140 A Sex chromatin identification... .............. .............. .............. .............. ..............
88141 N Cytopath, c/v, interpret....... .............. .............. .............. .............. ..............
88142 A Cytopath, c/v, thin layer...... .............. .............. .............. .............. ..............
88143 A Cytopath c/v thin layer redo... .............. .............. .............. .............. ..............
88144 A Cytopath, c/v thin lyr redo.... .............. .............. .............. .............. ..............
88145 A Cytopath, c/v thin lyr sel..... .............. .............. .............. .............. ..............
88147 A Cytopath, c/v, automated....... .............. .............. .............. .............. ..............
88148 A Cytopath, c/v, auto rescreen... .............. .............. .............. .............. ..............
88150 A Cytopath, c/v, manual.......... .............. .............. .............. .............. ..............
88152 A Cytopath, c/v, auto redo....... .............. .............. .............. .............. ..............
88153 A Cytopath, c/v, redo............ .............. .............. .............. .............. ..............
88154 A Cytopath, c/v, select.......... .............. .............. .............. .............. ..............
88155 A Cytopath, c/v, index add-on.... .............. .............. .............. .............. ..............
88160 X Cytopath smear, other source... 0342 0.26 $12.61 $8.03 $2.52
88161 X Cytopath smear, other source... 0343 0.45 $21.82 $12.16 $4.36
88162 X Cytopath smear, other source... 0343 0.45 $21.82 $12.16 $4.36
88164 A Cytopath tbs, c/v, manual...... .............. .............. .............. .............. ..............
88165 A Cytopath tbs, c/v, redo........ .............. .............. .............. .............. ..............
88166 A Cytopath tbs, c/v, auto redo... .............. .............. .............. .............. ..............
88167 A Cytopath tbs, c/v, select...... .............. .............. .............. .............. ..............
88170 T Fine needle aspiration......... 0002 0.62 $30.06 $17.66 $6.01
88171 T Fine needle aspiration......... 0002 0.62 $30.06 $17.66 $6.01
88172 X Evaluation of smear............ 0343 0.45 $21.82 $12.16 $4.36
88173 X Interpretation of smear........ 0343 0.45 $21.82 $12.16 $4.36
88180 X Cell marker study.............. 0344 0.79 $38.30 $23.63 $7.66
88182 X Cell marker study.............. 0344 0.79 $38.30 $23.63 $7.66
[[Page 18651]]
88199 X Cytopathology procedure........ 0342 0.26 $12.61 $8.03 $2.52
88230 A Tissue culture, lymphocyte..... .............. .............. .............. .............. ..............
88233 A Tissue culture, skin/biopsy.... .............. .............. .............. .............. ..............
88235 A Tissue culture, placenta....... .............. .............. .............. .............. ..............
88237 A Tissue culture, bone marrow.... .............. .............. .............. .............. ..............
88239 A Tissue culture, tumor.......... .............. .............. .............. .............. ..............
88240 A Cell cryopreserve/storage...... .............. .............. .............. .............. ..............
88241 A Frozen cell preparation........ .............. .............. .............. .............. ..............
88245 A Chromosome analysis, 20-25..... .............. .............. .............. .............. ..............
88248 A Chromosome analysis, 50-100.... .............. .............. .............. .............. ..............
88249 A Chromosome analysis, 100....... .............. .............. .............. .............. ..............
88261 A Chromosome analysis, 5......... .............. .............. .............. .............. ..............
88262 A Chromosome analysis, 15-20..... .............. .............. .............. .............. ..............
88263 A Chromosome analysis, 45........ .............. .............. .............. .............. ..............
88264 A Chromosome analysis, 20-25..... .............. .............. .............. .............. ..............
88267 A Chromosome analys, placenta.... .............. .............. .............. .............. ..............
88269 A Chromosome analys, amniotic.... .............. .............. .............. .............. ..............
88271 A Cytogenetics, dna probe........ .............. .............. .............. .............. ..............
88272 A Cytogenetics, 3-5.............. .............. .............. .............. .............. ..............
88273 A Cytogenetics, 10-30............ .............. .............. .............. .............. ..............
88274 A Cytogenetics, 25-99............ .............. .............. .............. .............. ..............
88275 A Cytogenetics, 100-300.......... .............. .............. .............. .............. ..............
88280 A Chromosome karyotype study..... .............. .............. .............. .............. ..............
88283 A Chromosome banding study....... .............. .............. .............. .............. ..............
88285 A Chromosome count, additional... .............. .............. .............. .............. ..............
88289 A Chromosome study, additional... .............. .............. .............. .............. ..............
88291 A Cyto/molecular report.......... .............. .............. .............. .............. ..............
88299 A Cytogenetic study.............. .............. .............. .............. .............. ..............
88300 X Surgical path, gross........... 0342 0.26 $12.61 $8.03 $2.52
88302 X Tissue exam by pathologist..... 0342 0.26 $12.61 $8.03 $2.52
88304 X Tissue exam by pathologist..... 0343 0.45 $21.82 $12.16 $4.36
88305 X Tissue exam by pathologist..... 0343 0.45 $21.82 $12.16 $4.36
88307 X Tissue exam by pathologist..... 0344 0.79 $38.30 $23.63 $7.66
88309 X Tissue exam by pathologist..... 0344 0.79 $38.30 $23.63 $7.66
88311 X Decalcify tissue............... 0342 0.26 $12.61 $8.03 $2.52
88312 X Special stains................. 0343 0.45 $21.82 $12.16 $4.36
88313 X Special stains................. 0342 0.26 $12.61 $8.03 $2.52
88314 X Histochemical stain............ 0343 0.45 $21.82 $12.16 $4.36
88318 X Chemical histochemistry........ 0343 0.45 $21.82 $12.16 $4.36
88319 X Enzyme histochemistry.......... 0342 0.26 $12.61 $8.03 $2.52
88321 X Microslide consultation........ 0342 0.26 $12.61 $8.03 $2.52
88323 X Microslide consultation........ 0343 0.45 $21.82 $12.16 $4.36
88325 X Comprehensive review of data... 0343 0.45 $21.82 $12.16 $4.36
88329 X Pathology consult in surgery... 0343 0.45 $21.82 $12.16 $4.36
88331 X Pathology consult in surgery... 0343 0.45 $21.82 $12.16 $4.36
88332 X Pathology consult in surgery... 0343 0.45 $21.82 $12.16 $4.36
88342 X Immunocytochemistry............ 0344 0.79 $38.30 $23.63 $7.66
88346 X Immunofluorescent study........ 0343 0.45 $21.82 $12.16 $4.36
88347 X Immunofluorescent study........ 0344 0.79 $38.30 $23.63 $7.66
88348 X Electron microscopy............ 0344 0.79 $38.30 $23.63 $7.66
88349 X Scanning electron microscopy... 0344 0.79 $38.30 $23.63 $7.66
88355 X Analysis, skeletal muscle...... 0344 0.79 $38.30 $23.63 $7.66
88356 X Analysis, nerve................ 0344 0.79 $38.30 $23.63 $7.66
88358 X Analysis, tumor................ 0344 0.79 $38.30 $23.63 $7.66
88362 X Nerve teasing preparations..... 0343 0.45 $21.82 $12.16 $4.36
88365 X Tissue hybridization........... 0344 0.79 $38.30 $23.63 $7.66
88371 A Protein, western blot tissue... .............. .............. .............. .............. ..............
88372 A Protein analysis w/probe....... .............. .............. .............. .............. ..............
88399 X Surgical pathology procedure... 0342 0.26 $12.61 $8.03 $2.52
89050 A Body fluid cell count.......... .............. .............. .............. .............. ..............
89051 A Body fluid cell count.......... .............. .............. .............. .............. ..............
89060 A Exam, synovial fluid crystals.. .............. .............. .............. .............. ..............
89100 X Sample intestinal contents..... 0361 3.53 $171.16 $88.09 $34.23
89105 X Sample intestinal contents..... 0360 1.38 $66.91 $34.75 $13.38
89125 A Specimen fat stain............. .............. .............. .............. .............. ..............
89130 X Sample stomach contents........ 0360 1.38 $66.91 $34.75 $13.38
89132 X Sample stomach contents........ 0360 1.38 $66.91 $34.75 $13.38
89135 X Sample stomach contents........ 0360 1.38 $66.91 $34.75 $13.38
89136 X Sample stomach contents........ 0360 1.38 $66.91 $34.75 $13.38
89140 X Sample stomach contents........ 0360 1.38 $66.91 $34.75 $13.38
89141 X Sample stomach contents........ 0361 3.53 $171.16 $88.09 $34.23
89160 A Exam feces for meat fibers..... .............. .............. .............. .............. ..............
89190 A Nasal smear for eosinophils.... .............. .............. .............. .............. ..............
[[Page 18652]]
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....... .............. .............. .............. .............. ..............
89264 A Identify sperm tissue.......... .............. .............. .............. .............. ..............
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 collection..... 0344 0.79 $38.30 $23.63 $7.66
89355 A Exam feces for starch.......... .............. .............. .............. .............. ..............
89360 X Collect sweat for test......... 0344 0.79 $38.30 $23.63 $7.66
89365 A Water load test................ .............. .............. .............. .............. ..............
89399 X Pathology lab procedure........ 0343 0.45 $21.82 $12.16 $4.36
90281 E Human ig, im................... .............. .............. .............. .............. ..............
90283 E Human ig, iv................... .............. .............. .............. .............. ..............
90287 X Botulinum antitoxin............ 0357 1.85 $89.70 $38.31 $17.94
90288 E Botulism ig, iv................ .............. .............. .............. .............. ..............
90291 E Cmv ig, iv..................... .............. .............. .............. .............. ..............
90296 X Diphtheria antitoxin........... 0357 1.85 $89.70 $38.31 $17.94
90371 X Hep b ig, im................... 0356 0.36 $17.46 $4.82 $3.49
90375 X Rabies ig, im/sc............... 0357 1.85 $89.70 $38.31 $17.94
90376 X Rabies ig, heat treated........ 0357 1.85 $89.70 $38.31 $17.94
90378 X Rsv ig, im..................... 0357 1.85 $89.70 $38.31 $17.94
90379 X Rsv ig, iv..................... 0357 1.85 $89.70 $38.31 $17.94
90384 X Rh ig, full-dose, im........... 0357 1.85 $89.70 $38.31 $17.94
90385 X Rh ig, minidose, im............ 0357 1.85 $89.70 $38.31 $17.94
90386 X Rh ig, iv...................... 0357 1.85 $89.70 $38.31 $17.94
90389 X Tetanus ig, im................. 0356 0.36 $17.46 $4.82 $3.49
90393 X Vaccina ig, im................. 0357 1.85 $89.70 $38.31 $17.94
90396 X Varicella-zoster ig, im........ 0356 0.36 $17.46 $4.82 $3.49
90399 E Immune globulin................ .............. .............. .............. .............. ..............
90471 N Immunization admin............. .............. .............. .............. .............. ..............
90472 N Immunization admin, each add... .............. .............. .............. .............. ..............
90476 X Adenovirus vaccine, type 4..... 0356 0.36 $17.46 $4.82 $3.49
90477 X Adenovirus vaccine, type 7..... 0356 0.36 $17.46 $4.82 $3.49
90581 X Anthrax vaccine, sc............ 0357 1.85 $89.70 $38.31 $17.94
90585 X Bcg vaccine, percut............ 0356 0.36 $17.46 $4.82 $3.49
90586 X Bcg vaccine, intravesical...... 0356 0.36 $17.46 $4.82 $3.49
90632 X Hep a vaccine, adult im........ 0356 0.36 $17.46 $4.82 $3.49
90633 X Hep a vacc, ped/adol, 2 dose... 0356 0.36 $17.46 $4.82 $3.49
90634 X Hep a vacc, ped/adol, 3 dose... 0356 0.36 $17.46 $4.82 $3.49
90636 X Hep a/hep b vacc, adult im..... 0357 1.85 $89.70 $38.31 $17.94
90645 X Hib vaccine, hboc, im.......... 0355 0.19 $9.21 $5.05 $1.84
90646 X Hib vaccine, prp-d, im......... 0355 0.19 $9.21 $5.05 $1.84
90647 X Hib vaccine, prp-omp, im....... 0355 0.19 $9.21 $5.05 $1.84
90648 X Hib vaccine, prp-t, im......... 0355 0.19 $9.21 $5.05 $1.84
90657 X Flu vaccine, 6-35 mo, im....... 0355 0.19 $9.21 $5.05 $1.84
90658 X Flu vaccine, 3 yrs, im......... 0355 0.19 $9.21 $5.05 $1.84
90659 X Flu vaccine, whole, im......... 0355 0.19 $9.21 $5.05 $1.84
90660 X Flu vaccine, nasal............. 0355 0.19 $9.21 $5.05 $1.84
90665 X Lyme disease vaccine, im....... 0357 1.85 $89.70 $38.31 $17.94
90669 X Pneumococcal vaccine, ped...... 0357 1.85 $89.70 $38.31 $17.94
90675 X Rabies vaccine, im............. 0357 1.85 $89.70 $38.31 $17.94
90676 X Rabies vaccine, id............. 0357 1.85 $89.70 $38.31 $17.94
90680 X Rotovirus vaccine, oral........ 0356 0.36 $17.46 $4.82 $3.49
90690 X Typhoid vaccine, oral.......... 0356 0.36 $17.46 $4.82 $3.49
90691 X Typhoid vaccine, im............ 0356 0.36 $17.46 $4.82 $3.49
90692 X Typhoid vaccine, h-p, sc/id.... 0356 0.36 $17.46 $4.82 $3.49
90693 X Typhoid vaccine, akd, sc....... 0356 0.36 $17.46 $4.82 $3.49
90700 X Dtap vaccine, im............... 0355 0.19 $9.21 $5.05 $1.84
90701 X Dtp vaccine, im................ 0356 0.36 $17.46 $4.82 $3.49
90702 X Dt vaccine, im................. 0355 0.19 $9.21 $5.05 $1.84
[[Page 18653]]
90703 X Tetanus vaccine, im............ 0356 0.36 $17.46 $4.82 $3.49
90704 X Mumps vaccine, sc.............. 0355 0.19 $9.21 $5.05 $1.84
90705 X Measles vaccine, sc............ 0357 1.85 $89.70 $38.31 $17.94
90706 X Rubella vaccine, sc............ 0358 6.98 $338.44 $126.74 $67.69
90707 X Mmr vaccine, sc................ 0356 0.36 $17.46 $4.82 $3.49
90708 X Measles-rubella vaccine, sc.... 0358 6.98 $338.44 $126.74 $67.69
90709 X Rubella & mumps vaccine, sc.... 0358 6.98 $338.44 $126.74 $67.69
90710 X Mmrv vaccine, sc............... 0356 0.36 $17.46 $4.82 $3.49
90712 X Oral poliovirus vaccine........ 0356 0.36 $17.46 $4.82 $3.49
90713 X Poliovirus, ipv, sc............ 0355 0.19 $9.21 $5.05 $1.84
90716 X Chicken pox vaccine, sc........ 0355 0.19 $9.21 $5.05 $1.84
90717 X Yellow fever vaccine, sc....... 0356 0.36 $17.46 $4.82 $3.49
90718 X Td vaccine, im................. 0356 0.36 $17.46 $4.82 $3.49
90719 X Diphtheria vaccine, im......... 0357 1.85 $89.70 $38.31 $17.94
90720 X Dtp/hib vaccine, im............ 0355 0.19 $9.21 $5.05 $1.84
90721 X Dtap/hib vaccine, im........... 0355 0.19 $9.21 $5.05 $1.84
90725 X Cholera vaccine, injectable.... 0358 6.98 $338.44 $126.74 $67.69
90727 X Plague vaccine, im............. 0355 0.19 $9.21 $5.05 $1.84
90732 X Pneumococcal vaccine, adult.... 0355 0.19 $9.21 $5.05 $1.84
90733 X Meningococcal vaccine, sc...... 0357 1.85 $89.70 $38.31 $17.94
90735 X Encephalitis vaccine, sc....... 0357 1.85 $89.70 $38.31 $17.94
90744 X Hep b vaccine, ped/adol, im.... 0356 0.36 $17.46 $4.82 $3.49
90746 X Hep b vaccine, adult, im....... 0356 0.36 $17.46 $4.82 $3.49
90747 X Hep b vaccine, ill pat, im..... 0356 0.36 $17.46 $4.82 $3.49
90748 X Hep b/hib vaccine, im.......... 0358 6.98 $338.44 $126.74 $67.69
90749 X Vaccine toxoid................. 0355 0.19 $9.21 $5.05 $1.84
90780 E IV infusion therapy, 1 hour.... .............. .............. .............. .............. ..............
90781 E IV infusion, additional hour... .............. .............. .............. .............. ..............
90782 X Injection, sc/im............... 0359 0.96 $46.55 $9.31 $9.31
90783 X Injection, ia.................. 0359 0.96 $46.55 $9.31 $9.31
90784 X Injection, iv.................. 0359 0.96 $46.55 $9.31 $9.31
90788 X Injection of antibiotic........ 0359 0.96 $46.55 $9.31 $9.31
90799 X Ther/prophylactic/dx inject.... 0359 0.96 $46.55 $9.31 $9.31
90801 S Psy dx interview............... 0323 1.85 $89.70 $22.48 $17.94
90802 S Intac psy dx interview......... 0323 1.85 $89.70 $22.48 $17.94
90804 S Psytx, office, 20-30 min....... 0322 1.32 $64.00 $14.22 $12.80
90805 S Psytx, off, 20-30 min w/e&m.... 0322 1.32 $64.00 $14.22 $12.80
90806 S Psytx, off, 45-50 min.......... 0323 1.85 $89.70 $22.48 $17.94
90807 S Psytx, off, 45-50 min w/e&m.... 0323 1.85 $89.70 $22.48 $17.94
90808 S Psytx, office, 75-80 min....... 0323 1.85 $89.70 $22.48 $17.94
90809 S Psytx, off, 75-80, w/e&m....... 0323 1.85 $89.70 $22.48 $17.94
90810 S Intac psytx, off, 20-30 min.... 0322 1.32 $64.00 $14.22 $12.80
90811 S Intac psytx, 20-30, w/e&m...... 0322 1.32 $64.00 $14.22 $12.80
90812 S Intac psytx, off, 45-50 min.... 0323 1.85 $89.70 $22.48 $17.94
90813 S Intac psytx, 45-50 min w/e&m... 0323 1.85 $89.70 $22.48 $17.94
90814 S Intac psytx, off, 75-80 min.... 0323 1.85 $89.70 $22.48 $17.94
90815 S Intac psytx, 75-80 w/e&m....... 0323 1.85 $89.70 $22.48 $17.94
90816 S Psytx, hosp, 20-30 min......... 0322 1.32 $64.00 $14.22 $12.80
90817 S Psytx, hosp, 20-30 min w/e&m... 0322 1.32 $64.00 $14.22 $12.80
90818 S Psytx, hosp, 45-50 min......... 0323 1.85 $89.70 $22.48 $17.94
90819 S Psytx, hosp, 45-50 min w/e&m... 0323 1.85 $89.70 $22.48 $17.94
90821 S Psytx, hosp, 75-80 min......... 0323 1.85 $89.70 $22.48 $17.94
90822 S Psytx, hosp, 75-80 min w/e&m... 0323 1.85 $89.70 $22.48 $17.94
90823 S Intac psytx, hosp, 20-30 min... 0322 1.32 $64.00 $14.22 $12.80
90824 S Intac psytx, hsp 20-30 w/e&m... 0322 1.32 $64.00 $14.22 $12.80
90826 S Intac psytx, hosp, 45-50 min... 0323 1.85 $89.70 $22.48 $17.94
90827 S Intac psytx, hsp 45-50 w/e&m... 0323 1.85 $89.70 $22.48 $17.94
90828 S Intac psytx, hosp, 75-80 min... 0323 1.85 $89.70 $22.48 $17.94
90829 S Intac psytx, hsp 75-80 w/e&m... 0323 1.85 $89.70 $22.48 $17.94
90845 S Psychoanalysis................. 0323 1.85 $89.70 $22.48 $17.94
90846 S Family psytx w/o patient....... 0324 1.87 $90.67 $20.19 $18.13
90847 S Family psytx w/patient......... 0324 1.87 $90.67 $20.19 $18.13
90849 S Multiple family group psytx.... 0325 1.55 $75.16 $19.96 $15.03
90853 S Group psychotherapy............ 0325 1.55 $75.16 $19.96 $15.03
90857 S Intac group psytx.............. 0325 1.55 $75.16 $19.96 $15.03
90862 X Medication management.......... 0374 1.17 $56.73 $13.08 $11.35
90865 S Narcosynthesis................. 0323 1.85 $89.70 $22.48 $17.94
90870 S Electroconvulsive therapy...... 0320 3.68 $178.43 $80.06 $35.69
90871 S Electroconvulsive therapy...... 0320 3.68 $178.43 $80.06 $35.69
90875 E Psychophysiological therapy.... .............. .............. .............. .............. ..............
90876 E Psychophysiological therapy.... .............. .............. .............. .............. ..............
90880 S Hypnotherapy................... 0323 1.85 $89.70 $22.48 $17.94
90882 E Environmental manipulation..... .............. .............. .............. .............. ..............
[[Page 18654]]
90885 N Psy evaluation of records...... .............. .............. .............. .............. ..............
90887 N Consultation with family....... .............. .............. .............. .............. ..............
90889 N Preparation of report.......... .............. .............. .............. .............. ..............
90899 S Psychiatric service/therapy.... 0322 1.32 $64.00 $14.22 $12.80
90901 S Biofeedback train, any meth.... 0321 1.26 $61.09 $29.25 $12.22
90911 S Biofeedback peri/uro/rectal.... 0321 1.26 $61.09 $29.25 $12.22
90918 A ESRD related services, month... .............. .............. .............. .............. ..............
90919 A ESRD related services, month... .............. .............. .............. .............. ..............
90920 A ESRD related services, month... .............. .............. .............. .............. ..............
90921 A ESRD related services, month... .............. .............. .............. .............. ..............
90922 A ESRD related services, day..... .............. .............. .............. .............. ..............
90923 A Esrd related services, day..... .............. .............. .............. .............. ..............
90924 A Esrd related services, day..... .............. .............. .............. .............. ..............
90925 A Esrd related services, day..... .............. .............. .............. .............. ..............
90935 S Hemodialysis, one evaluation... 0170 6.68 $323.89 $72.26 $64.78
90937 E Hemodialysis, repeated eval.... .............. .............. .............. .............. ..............
90945 S Dialysis, one evaluation....... 0170 6.68 $323.89 $72.26 $64.78
90947 E Dialysis, repeated eval........ .............. .............. .............. .............. ..............
90989 E Dialysis training, complete.... .............. .............. .............. .............. ..............
90993 E Dialysis training, incompl..... .............. .............. .............. .............. ..............
90997 E Hemoperfusion.................. .............. .............. .............. .............. ..............
90999 E Dialysis procedure............. .............. .............. .............. .............. ..............
91000 X Esophageal intubation.......... 0361 3.53 $171.16 $88.09 $34.23
91010 X Esophagus motility study....... 0361 3.53 $171.16 $88.09 $34.23
91011 X Esophagus motility study....... 0361 3.53 $171.16 $88.09 $34.23
91012 X Esophagus motility study....... 0361 3.53 $171.16 $88.09 $34.23
91020 X Gastric motility............... 0361 3.53 $171.16 $88.09 $34.23
91030 X Acid perfusion of esophagus.... 0360 1.38 $66.91 $34.75 $13.38
91032 X Esophagus, acid reflux test.... 0361 3.53 $171.16 $88.09 $34.23
91033 X Prolonged acid reflux test..... 0361 3.53 $171.16 $88.09 $34.23
91052 X Gastric analysis test.......... 0361 3.53 $171.16 $88.09 $34.23
91055 X Gastric intubation for smear... 0360 1.38 $66.91 $34.75 $13.38
91060 X Gastric saline load test....... 0361 3.53 $171.16 $88.09 $34.23
91065 X Breath hydrogen test........... 0360 1.38 $66.91 $34.75 $13.38
91100 X Pass intestine bleeding tube... 0360 1.38 $66.91 $34.75 $13.38
91105 X Gastric intubation treatment... 0360 1.38 $66.91 $34.75 $13.38
91122 T Anal pressure record........... 0165 3.89 $188.61 $91.76 $37.72
91299 X Gastroenterology procedure..... 0360 1.38 $66.91 $34.75 $13.38
92002 V Eye exam, new patient.......... 0601 1.00 $48.49 $9.70 $9.70
92004 V Eye exam, new patient.......... 0602 1.66 $80.49 $16.29 $16.10
92012 V Eye exam established pat....... 0601 1.00 $48.49 $9.70 $9.70
92014 V Eye exam & treatment........... 0602 1.66 $80.49 $16.29 $16.10
92015 E Refraction..................... .............. .............. .............. .............. ..............
92018 S New eye exam & treatment....... 0231 2.64 $128.01 $59.87 $25.60
92019 S Eye exam & treatment........... 0231 2.64 $128.01 $59.87 $25.60
92020 S Special eye evaluation......... 0230 0.98 $47.52 $22.48 $9.50
92060 S Special eye evaluation......... 0230 0.98 $47.52 $22.48 $9.50
92065 S Orthoptic/pleoptic training.... 0230 0.98 $47.52 $22.48 $9.50
92070 N Fitting of contact lens........ .............. .............. .............. .............. ..............
92081 S Visual field examination(s).... 0230 0.98 $47.52 $22.48 $9.50
92082 S Visual field examination(s).... 0230 0.98 $47.52 $22.48 $9.50
92083 S Visual field examination(s).... 0230 0.98 $47.52 $22.48 $9.50
92100 N Serial tonometry exam(s)....... .............. .............. .............. .............. ..............
92120 S Tonography & eye evaluation.... 0230 0.98 $47.52 $22.48 $9.50
92130 S Water provocation tonography... 0230 0.98 $47.52 $22.48 $9.50
92135 S Opthalmic dx imaging........... 0231 2.64 $128.01 $59.87 $25.60
92140 S Glaucoma provocative tests..... 0231 2.64 $128.01 $59.87 $25.60
92225 S Special eye exam, initial...... 0230 0.98 $47.52 $22.48 $9.50
92226 S Special eye exam, subsequent... 0231 2.64 $128.01 $59.87 $25.60
92230 S Eye exam with photos........... 0231 2.64 $128.01 $59.87 $25.60
92235 S Eye exam with photos........... 0231 2.64 $128.01 $59.87 $25.60
92240 S Icg angiography................ 0231 2.64 $128.01 $59.87 $25.60
92250 S Eye exam with photos........... 0230 0.98 $47.52 $22.48 $9.50
92260 S Ophthalmoscopy/dynamometry..... 0230 0.98 $47.52 $22.48 $9.50
92265 S Eye muscle evaluation.......... 0230 0.98 $47.52 $22.48 $9.50
92270 S Electro-oculography............ 0230 0.98 $47.52 $22.48 $9.50
92275 S Electroretinography............ 0216 2.87 $139.16 $64.69 $27.83
92283 S Color vision examination....... 0230 0.98 $47.52 $22.48 $9.50
92284 S Dark adaptation eye exam....... 0231 2.64 $128.01 $59.87 $25.60
92285 S Eye photography................ 0230 0.98 $47.52 $22.48 $9.50
92286 S Internal eye photography....... 0231 2.64 $128.01 $59.87 $25.60
92287 T Internal eye photography....... 0231 2.64 $128.01 $59.87 $25.60
92310 E Contact lens fitting........... .............. .............. .............. .............. ..............
[[Page 18655]]
92311 X Contact lens fitting........... 0362 0.51 $24.73 $9.63 $4.95
92312 X Contact lens fitting........... 0362 0.51 $24.73 $9.63 $4.95
92313 X Contact lens fitting........... 0362 0.51 $24.73 $9.63 $4.95
92314 E Prescription of contact lens... .............. .............. .............. .............. ..............
92315 X Prescription of contact lens... 0362 0.51 $24.73 $9.63 $4.95
92316 X Prescription of contact lens... 0362 0.51 $24.73 $9.63 $4.95
92317 X Prescription of contact lens... 0362 0.51 $24.73 $9.63 $4.95
92325 X Modification of contact lens... 0362 0.51 $24.73 $9.63 $4.95
92326 X Replacement of contact lens.... 0362 0.51 $24.73 $9.63 $4.95
92330 S Fitting of artificial eye...... 0230 0.98 $47.52 $22.48 $9.50
92335 N Fitting of artificial eye...... .............. .............. .............. .............. ..............
92340 E Fitting of spectacles.......... .............. .............. .............. .............. ..............
92341 E Fitting of spectacles.......... .............. .............. .............. .............. ..............
92342 E Fitting of spectacles.......... .............. .............. .............. .............. ..............
92352 X Special spectacles fitting..... 0362 0.51 $24.73 $9.63 $4.95
92353 X Special spectacles fitting..... 0362 0.51 $24.73 $9.63 $4.95
92354 X Special spectacles fitting..... 0362 0.51 $24.73 $9.63 $4.95
92355 X Special spectacles fitting..... 0362 0.51 $24.73 $9.63 $4.95
92358 X Eye prosthesis service......... 0362 0.51 $24.73 $9.63 $4.95
92370 E Repair & adjust spectacles..... .............. .............. .............. .............. ..............
92371 X Repair & adjust spectacles..... 0362 0.51 $24.73 $9.63 $4.95
92390 E Supply of spectacles........... .............. .............. .............. .............. ..............
92391 E Supply of contact lenses....... .............. .............. .............. .............. ..............
92392 E Supply of low vision aids...... .............. .............. .............. .............. ..............
92393 E Supply of artificial eye....... .............. .............. .............. .............. ..............
92395 E Supply of spectacles........... .............. .............. .............. .............. ..............
92396 E Supply of contact lenses....... .............. .............. .............. .............. ..............
92499 S Eye service or procedure....... 0230 0.98 $47.52 $22.48 $9.50
92502 T Ear and throat examination..... 0251 1.68 $81.46 $27.99 $16.29
92504 N Ear microscopy examination..... .............. .............. .............. .............. ..............
92506 A Speech/hearing evaluation...... .............. .............. .............. .............. ..............
92507 A Speech/hearing therapy......... .............. .............. .............. .............. ..............
92508 A Speech/hearing therapy......... .............. .............. .............. .............. ..............
92510 A Rehab for ear implant.......... .............. .............. .............. .............. ..............
92511 T Nasopharyngoscopy.............. 0071 0.55 $26.67 $14.22 $5.33
92512 X Nasal function studies......... 0363 2.83 $137.22 $53.22 $27.44
92516 X Facial nerve function test..... 0363 2.83 $137.22 $53.22 $27.44
92520 X Laryngeal function studies..... 0363 2.83 $137.22 $53.22 $27.44
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 test..... 0363 2.83 $137.22 $53.22 $27.44
92542 X Positional nystagmus test...... 0363 2.83 $137.22 $53.22 $27.44
92543 X Caloric vestibular test........ 0363 2.83 $137.22 $53.22 $27.44
92544 X Optokinetic nystagmus test..... 0363 2.83 $137.22 $53.22 $27.44
92545 X Oscillating tracking test...... 0363 2.83 $137.22 $53.22 $27.44
92546 X Sinusoidal rotational test..... 0363 2.83 $137.22 $53.22 $27.44
92547 X Supplemental electrical test... 0363 2.83 $137.22 $53.22 $27.44
92548 X Posturography.................. 0363 2.83 $137.22 $53.22 $27.44
92551 E Pure tone hearing test, air.... .............. .............. .............. .............. ..............
92552 X Pure tone audiometry, air...... 0364 0.68 $32.97 $13.31 $6.59
92553 X Audiometry, air & bone......... 0364 0.68 $32.97 $13.31 $6.59
92555 X Speech threshold audiometry.... 0364 0.68 $32.97 $13.31 $6.59
92556 X Speech audiometry, complete.... 0364 0.68 $32.97 $13.31 $6.59
92557 X Comprehensive hearing test..... 0365 1.47 $71.28 $22.48 $14.26
92559 E Group audiometric testing...... .............. .............. .............. .............. ..............
92560 E Bekesy audiometry, screen...... .............. .............. .............. .............. ..............
92561 X Bekesy audiometry, diagnosis... 0365 1.47 $71.28 $22.48 $14.26
92562 X Loudness balance test.......... 0365 1.47 $71.28 $22.48 $14.26
92563 X Tone decay hearing test........ 0365 1.47 $71.28 $22.48 $14.26
92564 X Sisi hearing test.............. 0365 1.47 $71.28 $22.48 $14.26
92565 X Stenger test, pure tone........ 0365 1.47 $71.28 $22.48 $14.26
92567 X Tympanometry................... 0364 0.68 $32.97 $13.31 $6.59
92568 X Acoustic reflex testing........ 0365 1.47 $71.28 $22.48 $14.26
92569 X Acoustic reflex decay test..... 0365 1.47 $71.28 $22.48 $14.26
92571 X Filtered speech hearing test... 0365 1.47 $71.28 $22.48 $14.26
92572 X Staggered spondaic word test... 0365 1.47 $71.28 $22.48 $14.26
92573 X Lombard test................... 0365 1.47 $71.28 $22.48 $14.26
92575 X Sensorineural acuity test...... 0365 1.47 $71.28 $22.48 $14.26
92576 X Synthetic sentence test........ 0365 1.47 $71.28 $22.48 $14.26
[[Page 18656]]
92577 X Stenger test, speech........... 0365 1.47 $71.28 $22.48 $14.26
92579 X Visual audiometry (vra)........ 0365 1.47 $71.28 $22.48 $14.26
92582 X Conditioning play audiometry... 0365 1.47 $71.28 $22.48 $14.26
92583 X Select picture audiometry...... 0365 1.47 $71.28 $22.48 $14.26
92584 X Electrocochleography........... 0363 2.83 $137.22 $53.22 $27.44
92585 S Auditory evoked potential...... 0216 2.87 $139.16 $64.69 $27.83
92587 X Evoked auditory test........... 0363 2.83 $137.22 $53.22 $27.44
92588 X Evoked auditory test........... 0363 2.83 $137.22 $53.22 $27.44
92589 X Auditory function test(s)...... 0365 1.47 $71.28 $22.48 $14.26
92590 E Hearing aid exam, one ear...... .............. .............. .............. .............. ..............
92591 E Hearing aid exam, both ears.... .............. .............. .............. .............. ..............
92592 E Hearing aid check, one ear..... .............. .............. .............. .............. ..............
92593 E Hearing aid check, both ears... .............. .............. .............. .............. ..............
92594 E Electro hearng aid test, one... .............. .............. .............. .............. ..............
92595 E Electro hearng aid tst, both... .............. .............. .............. .............. ..............
92596 X Ear protector evaluation....... 0365 1.47 $71.28 $22.48 $14.26
92597 A Oral speech device eval........ .............. .............. .............. .............. ..............
92598 A Modify oral speech device...... .............. .............. .............. .............. ..............
92599 X ENT procedure/service.......... 0364 0.68 $32.97 $13.31 $6.59
92950 S Heart/lung resuscitation cpr... 0094 4.51 $218.68 $105.29 $43.74
92953 S Temporary external pacing...... 0094 4.51 $218.68 $105.29 $43.74
92960 S Cardioversion electric, ext.... 0094 4.51 $218.68 $105.29 $43.74
92961 S Cardioversion, electric, int... 0094 4.51 $218.68 $105.29 $43.74
92970 C Cardioassist, internal......... .............. .............. .............. .............. ..............
92971 C Cardioassist, external......... .............. .............. .............. .............. ..............
92975 C Dissolve clot, heart vessel.... .............. .............. .............. .............. ..............
92977 C Dissolve clot, heart vessel.... .............. .............. .............. .............. ..............
92978 C Intravasc us, heart add-on..... .............. .............. .............. .............. ..............
92979 C Intravasc us, heart add-on..... .............. .............. .............. .............. ..............
92980 T Insert intracoronary stent..... 0083 45.79 $2,220.22 $1,322.95 $444.04
92981 T Insert intracoronary stent..... 0083 45.79 $2,220.22 $1,322.95 $444.04
92982 T Coronary artery dilation....... 0083 45.79 $2,220.22 $1,322.95 $444.04
92984 T Coronary artery dilation....... 0083 45.79 $2,220.22 $1,322.95 $444.04
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 T Coronary atherectomy........... 0082 40.34 $1,955.97 $859.56 $391.19
92996 T Coronary atherectomy add-on.... 0082 40.34 $1,955.97 $859.56 $391.19
92997 C Pul art balloon repr, percut... .............. .............. .............. .............. ..............
92998 C Pul art balloon repr, percut... .............. .............. .............. .............. ..............
93000 E Electrocardiogram, complete.... .............. .............. .............. .............. ..............
93005 X Electrocardiogram, tracing..... 0366 0.38 $18.43 $15.60 $3.69
93010 E Electrocardiogram report....... .............. .............. .............. .............. ..............
93012 S Transmission of ECG............ 0099 0.38 $18.43 $14.68 $3.69
93014 E Report on transmitted ECG...... .............. .............. .............. .............. ..............
93015 E Cardiovascular stress test..... .............. .............. .............. .............. ..............
93016 E Cardiovascular stress test..... .............. .............. .............. .............. ..............
93017 S Cardiovascular stress test..... 0097 1.62 $78.55 $62.40 $15.71
93018 E Cardiovascular stress test..... .............. .............. .............. .............. ..............
93024 S Cardiac drug stress test....... 0097 1.62 $78.55 $62.40 $15.71
93040 E Rhythm ECG with report......... .............. .............. .............. .............. ..............
93041 X Rhythm ECG, tracing............ 0366 0.38 $18.43 $15.60 $3.69
93042 E Rhythm ECG, report............. .............. .............. .............. .............. ..............
93224 E ECG monitor/report, 24 hrs..... .............. .............. .............. .............. ..............
93225 S ECG monitor/record, 24 hrs..... 0100 1.70 $82.43 $71.57 $16.49
93226 S ECG monitor/report, 24 hrs..... 0100 1.70 $82.43 $71.57 $16.49
93227 E ECG monitor/review, 24 hrs..... .............. .............. .............. .............. ..............
93230 E ECG monitor/report, 24 hrs..... .............. .............. .............. .............. ..............
93231 S ECG monitor/record, 24 hrs..... 0100 1.70 $82.43 $71.57 $16.49
93232 S ECG monitor/report, 24 hrs..... 0100 1.70 $82.43 $71.57 $16.49
93233 E ECG monitor/review, 24 hrs..... .............. .............. .............. .............. ..............
93235 E ECG monitor/report, 24 hrs..... .............. .............. .............. .............. ..............
93236 S ECG monitor/report, 24 hrs..... 0100 1.70 $82.43 $71.57 $16.49
93237 E ECG monitor/review, 24 hrs..... .............. .............. .............. .............. ..............
93268 S ECG record/review.............. 0100 1.70 $82.43 $71.57 $16.49
93270 S ECG recording.................. 0099 0.38 $18.43 $14.68 $3.69
93271 S ECG/monitoring and analysis.... 0100 1.70 $82.43 $71.57 $16.49
93272 E ECG/review, interpret only..... .............. .............. .............. .............. ..............
93278 S ECG/signal-averaged............ 0099 0.38 $18.43 $14.68 $3.69
93303 S Echo transthoracic............. 0269 4.40 $213.34 $114.01 $42.67
93304 S Echo transthoracic............. 0269 4.40 $213.34 $114.01 $42.67
[[Page 18657]]
93307 S Echo exam of heart............. 0269 4.40 $213.34 $114.01 $42.67
93308 S Echo exam of heart............. 0269 4.40 $213.34 $114.01 $42.67
93312 S Echo transesophageal........... 0270 5.55 $269.10 $150.26 $53.82
93313 S Echo transesophageal........... 0270 5.55 $269.10 $150.26 $53.82
93314 N Echo transesophageal........... .............. .............. .............. .............. ..............
93315 S Echo transesophageal........... 0270 5.55 $269.10 $150.26 $53.82
93316 S Echo transesophageal........... 0270 5.55 $269.10 $150.26 $53.82
93317 N Echo transesophageal........... .............. .............. .............. .............. ..............
93320 S Doppler echo exam, heart....... 0269 4.40 $213.34 $114.01 $42.67
93321 S Doppler echo exam, heart....... 0269 4.40 $213.34 $114.01 $42.67
93325 S Doppler color flow add-on...... 0269 4.40 $213.34 $114.01 $42.67
93350 S Echo transthoracic............. 0269 4.40 $213.34 $114.01 $42.67
93501 T Right heart catheterization.... 0080 25.77 $1,249.51 $713.89 $249.90
93503 T Insert/place heart catheter.... 0080 25.77 $1,249.51 $713.89 $249.90
93505 T Biopsy of heart lining......... 0080 25.77 $1,249.51 $713.89 $249.90
93508 N Cath placement, angiography.... .............. .............. .............. .............. ..............
93510 T Left heart catheterization..... 0080 25.77 $1,249.51 $713.89 $249.90
93511 T Left heart catheterization..... 0080 25.77 $1,249.51 $713.89 $249.90
93514 T Left heart catheterization..... 0080 25.77 $1,249.51 $713.89 $249.90
93524 T Left heart catheterization..... 0080 25.77 $1,249.51 $713.89 $249.90
93526 T Rt & Lt heart catheters........ 0080 25.77 $1,249.51 $713.89 $249.90
93527 T Rt & Lt heart catheters........ 0080 25.77 $1,249.51 $713.89 $249.90
93528 T Rt & Lt heart catheters........ 0080 25.77 $1,249.51 $713.89 $249.90
93529 T Rt, Lt heart catheterization... 0080 25.77 $1,249.51 $713.89 $249.90
93530 T Rt heart cath, congenital...... 0080 25.77 $1,249.51 $713.89 $249.90
93531 T R & l heart cath, congenital... 0080 25.77 $1,249.51 $713.89 $249.90
93532 T R & l heart cath, congenital... 0080 25.77 $1,249.51 $713.89 $249.90
93533 T R & l heart cath, congenital... 0080 25.77 $1,249.51 $713.89 $249.90
93536 T Insert circulation assi........ 0080 25.77 $1,249.51 $713.89 $249.90
93539 N Injection, cardiac cath........ .............. .............. .............. .............. ..............
93540 N Injection, cardiac cath........ .............. .............. .............. .............. ..............
93541 N Injection for lung angiogram... .............. .............. .............. .............. ..............
93542 N Injection for heart x-rays..... .............. .............. .............. .............. ..............
93543 N Injection for heart x-rays..... .............. .............. .............. .............. ..............
93544 N Injection for aortography...... .............. .............. .............. .............. ..............
93545 N Inject for coronary x-rays..... .............. .............. .............. .............. ..............
93555 N Imaging, cardiac cath.......... .............. .............. .............. .............. ..............
93556 N Imaging, cardiac cath.......... .............. .............. .............. .............. ..............
93561 N Cardiac output measurement..... .............. .............. .............. .............. ..............
93562 N Cardiac output measurement..... .............. .............. .............. .............. ..............
93571 N Heart flow reserve measure..... .............. .............. .............. .............. ..............
93572 N Heart flow reserve measure..... .............. .............. .............. .............. ..............
93600 S Bundle of His recording........ 0087 9.53 $462.08 $214.72 $92.42
93602 S Intra-atrial recording......... 0087 9.53 $462.08 $214.72 $92.42
93603 S Right ventricular recording.... 0087 9.53 $462.08 $214.72 $92.42
93607 S Left ventricular recording..... 0087 9.53 $462.08 $214.72 $92.42
93609 S Mapping of tachycardia......... 0087 9.53 $462.08 $214.72 $92.42
93610 S Intra-atrial pacing............ 0087 9.53 $462.08 $214.72 $92.42
93612 S Intraventricular pacing........ 0087 9.53 $462.08 $214.72 $92.42
93615 S Esophageal recording........... 0087 9.53 $462.08 $214.72 $92.42
93616 S Esophageal recording........... 0087 9.53 $462.08 $214.72 $92.42
93618 S Heart rhythm pacing............ 0087 9.53 $462.08 $214.72 $92.42
93619 S Electrophysiology evaluation... 0085 27.06 $1,312.06 $654.48 $262.41
93620 S Electrophysiology evaluation... 0085 27.06 $1,312.06 $654.48 $262.41
93621 S Electrophysiology evaluation... 0085 27.06 $1,312.06 $654.48 $262.41
93622 S Electrophysiology evaluation... 0085 27.06 $1,312.06 $654.48 $262.41
93623 S Stimulation, pacing heart...... 0087 9.53 $462.08 $214.72 $92.42
93624 S Electrophysiologic study....... 0087 9.53 $462.08 $214.72 $92.42
93631 S Heart pacing, mapping.......... 0087 9.53 $462.08 $214.72 $92.42
93640 S Evaluation heart device........ 0084 10.70 $518.81 $177.79 $103.76
93641 S Electrophysiology evaluation... 0084 10.70 $518.81 $177.79 $103.76
93642 S Electrophysiology evaluation... 0084 10.70 $518.81 $177.79 $103.76
93650 S Ablate heart dysrhythm focus... 0086 47.62 $2,308.95 $1,265.37 $461.79
93651 S Ablate heart dysrhythm focus... 0086 47.62 $2,308.95 $1,265.37 $461.79
93652 S Ablate heart dysrhythm focus... 0086 47.62 $2,308.95 $1,265.37 $461.79
93660 S Tilt table evaluation.......... 0101 4.47 $216.74 $128.84 $43.35
93720 E Total body plethysmography..... .............. .............. .............. .............. ..............
93721 S Plethysmography tracing........ 0096 2.06 $99.88 $61.48 $19.98
93722 E Plethysmography report......... .............. .............. .............. .............. ..............
93724 S Analyze pacemaker system....... 0100 1.70 $82.43 $71.57 $16.49
93727 S Analyze ilr system............. 0102 0.45 $21.82 $12.62 $4.36
93731 S Analyze pacemaker system....... 0102 0.45 $21.82 $12.62 $4.36
93732 S Analyze pacemaker system....... 0102 0.45 $21.82 $12.62 $4.36
[[Page 18658]]
93733 S Telephone analy, pacemaker..... 0102 0.45 $21.82 $12.62 $4.36
93734 S Analyze pacemaker system....... 0102 0.45 $21.82 $12.62 $4.36
93735 S Analyze pacemaker system....... 0102 0.45 $21.82 $12.62 $4.36
93736 S Telephone analy, pacemaker..... 0102 0.45 $21.82 $12.62 $4.36
93737 S Analyze cardio/defibrillator... 0102 0.45 $21.82 $12.62 $4.36
93738 S Analyze cardio/defibrillator... 0102 0.45 $21.82 $12.62 $4.36
93740 S Temperature gradient studies... 0096 2.06 $99.88 $61.48 $19.98
93741 S Analyze ht pace device sngl.... 0102 0.45 $21.82 $12.62 $4.36
93742 S Analyze ht pace device sngl.... 0102 0.45 $21.82 $12.62 $4.36
93743 S Analyze ht pace device dual.... 0102 0.45 $21.82 $12.62 $4.36
93744 S Analyze ht pace device dual.... 0102 0.45 $21.82 $12.62 $4.36
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 S Cardiac rehab.................. 0095 0.64 $31.03 $16.98 $6.21
93798 S Cardiac rehab/monitor.......... 0095 0.64 $31.03 $16.98 $6.21
93799 S Cardiovascular procedure....... 0096 2.06 $99.88 $61.48 $19.98
93875 S Extracranial study............. 0096 2.06 $99.88 $61.48 $19.98
93880 S Extracranial study............. 0267 2.72 $131.88 $80.06 $26.38
93882 S Extracranial study............. 0267 2.72 $131.88 $80.06 $26.38
93886 S Intracranial study............. 0267 2.72 $131.88 $80.06 $26.38
93888 S Intracranial study............. 0267 2.72 $131.88 $80.06 $26.38
93922 S Extremity study................ 0096 2.06 $99.88 $61.48 $19.98
93923 S Extremity study................ 0096 2.06 $99.88 $61.48 $19.98
93924 S Extremity study................ 0096 2.06 $99.88 $61.48 $19.98
93925 S Lower extremity study.......... 0267 2.72 $131.88 $80.06 $26.38
93926 S Lower extremity study.......... 0267 2.72 $131.88 $80.06 $26.38
93930 S Upper extremity study.......... 0267 2.72 $131.88 $80.06 $26.38
93931 S Upper extremity study.......... 0267 2.72 $131.88 $80.06 $26.38
93965 S Extremity study................ 0096 2.06 $99.88 $61.48 $19.98
93970 S Extremity study................ 0267 2.72 $131.88 $80.06 $26.38
93971 S Extremity study................ 0267 2.72 $131.88 $80.06 $26.38
93975 S Vascular study................. 0267 2.72 $131.88 $80.06 $26.38
93976 S Vascular study................. 0267 2.72 $131.88 $80.06 $26.38
93978 S Vascular study................. 0267 2.72 $131.88 $80.06 $26.38
93979 S Vascular study................. 0267 2.72 $131.88 $80.06 $26.38
93980 S Penile vascular study.......... 0267 2.72 $131.88 $80.06 $26.38
93981 S Penile vascular study.......... 0267 2.72 $131.88 $80.06 $26.38
93990 S Doppler flow testing........... 0267 2.72 $131.88 $80.06 $26.38
94010 X Breathing capacity test........ 0367 0.83 $40.24 $20.65 $8.05
94014 X Patient recorded spirometry.... 0369 2.34 $113.46 $58.50 $22.69
94015 X Patient recorded spirometry.... 0369 2.34 $113.46 $58.50 $22.69
94016 X Review patient spirometry...... 0369 2.34 $113.46 $58.50 $22.69
94060 X Evaluation of wheezing......... 0368 1.66 $80.49 $42.44 $16.10
94070 X Evaluation of wheezing......... 0369 2.34 $113.46 $58.50 $22.69
94150 N Vital capacity test............ .............. .............. .............. .............. ..............
94200 X Lung function test (MBC/MVV)... 0367 0.83 $40.24 $20.65 $8.05
94240 X Residual lung capacity......... 0368 1.66 $80.49 $42.44 $16.10
94250 X Expired gas collection......... 0367 0.83 $40.24 $20.65 $8.05
94260 X Thoracic gas volume............ 0368 1.66 $80.49 $42.44 $16.10
94350 X Lung nitrogen washout curve.... 0368 1.66 $80.49 $42.44 $16.10
94360 X Measure airflow resistance..... 0368 1.66 $80.49 $42.44 $16.10
94370 X Breath airway closing volume... 0368 1.66 $80.49 $42.44 $16.10
94375 X Respiratory flow volume loop... 0367 0.83 $40.24 $20.65 $8.05
94400 X CO2 breathing response curve... 0367 0.83 $40.24 $20.65 $8.05
94450 X Hypoxia response curve......... 0367 0.83 $40.24 $20.65 $8.05
94620 X Pulmonary stress test/simple... 0368 1.66 $80.49 $42.44 $16.10
94621 X Pulm stress test/complex....... 0369 2.34 $113.46 $58.50 $22.69
94640 S Airway inhalation treatment.... 0077 0.43 $20.85 $12.62 $4.17
94642 S Aerosol inhalation treatment... 0078 1.34 $64.97 $29.13 $12.99
94650 S Pressure breathing (IPPB)...... 0077 0.43 $20.85 $12.62 $4.17
94651 S Pressure breathing (IPPB)...... 0077 0.43 $20.85 $12.62 $4.17
94652 C Pressure breathing (IPPB)...... .............. .............. .............. .............. ..............
94656 S Initial ventilator mgmt........ 0079 3.18 $154.19 $107.70 $30.84
94657 S Continued ventilator mgmt...... 0079 3.18 $154.19 $107.70 $30.84
94660 S Pos airway pressure, CPAP...... 0079 3.18 $154.19 $107.70 $30.84
94662 S Neg press ventilation, cnp..... 0079 3.18 $154.19 $107.70 $30.84
94664 S Aerosol or vapor inhalations... 0077 0.43 $20.85 $12.62 $4.17
94665 S Aerosol or vapor inhalations... 0077 0.43 $20.85 $12.62 $4.17
[[Page 18659]]
94667 S Chest wall manipulation........ 0077 0.43 $20.85 $12.62 $4.17
94668 S Chest wall manipulation........ 0077 0.43 $20.85 $12.62 $4.17
94680 X Exhaled air analysis, o2....... 0367 0.83 $40.24 $20.65 $8.05
94681 X Exhaled air analysis, o2/co2... 0368 1.66 $80.49 $42.44 $16.10
94690 X Exhaled air analysis........... 0367 0.83 $40.24 $20.65 $8.05
94720 X Monoxide diffusing capacity.... 0367 0.83 $40.24 $20.65 $8.05
94725 X Membrane diffusion capacity.... 0368 1.66 $80.49 $42.44 $16.10
94750 X Pulmonary compliance study..... 0368 1.66 $80.49 $42.44 $16.10
94760 N Measure blood oxygen level..... .............. .............. .............. .............. ..............
94761 N Measure blood oxygen level..... .............. .............. .............. .............. ..............
94762 C Measure blood oxygen level..... .............. .............. .............. .............. ..............
94770 X Exhaled carbon dioxide test.... 0367 0.83 $40.24 $20.65 $8.05
94772 X Breath recording, infant....... 0369 2.34 $113.46 $58.50 $22.69
94799 X Pulmonary service/procedure.... 0367 0.83 $40.24 $20.65 $8.05
95004 X Allergy skin tests............. 0370 0.57 $27.64 $11.81 $5.53
95010 X Sensitivity skin tests......... 0370 0.57 $27.64 $11.81 $5.53
95015 X Sensitivity skin tests......... 0370 0.57 $27.64 $11.81 $5.53
95024 X Allergy skin tests............. 0370 0.57 $27.64 $11.81 $5.53
95027 X Skin end point titration....... 0370 0.57 $27.64 $11.81 $5.53
95028 X Allergy skin tests............. 0370 0.57 $27.64 $11.81 $5.53
95044 X Allergy patch tests............ 0370 0.57 $27.64 $11.81 $5.53
95052 X Photo patch test............... 0370 0.57 $27.64 $11.81 $5.53
95056 X Photosensitivity tests......... 0370 0.57 $27.64 $11.81 $5.53
95060 X Eye allergy tests.............. 0370 0.57 $27.64 $11.81 $5.53
95065 X Nose allergy test.............. 0370 0.57 $27.64 $11.81 $5.53
95070 X Bronchial allergy tests........ 0369 2.34 $113.46 $58.50 $22.69
95071 X Bronchial allergy tests........ 0369 2.34 $113.46 $58.50 $22.69
95075 X Ingestion challenge test....... 0361 3.53 $171.16 $88.09 $34.23
95078 X Provocative testing............ 0370 0.57 $27.64 $11.81 $5.53
95115 X Immunotherapy, one injection... 0371 0.32 $15.52 $3.67 $3.10
95117 X Immunotherapy injections....... 0371 0.32 $15.52 $3.67 $3.10
95120 E Immunotherapy, one injection... .............. .............. .............. .............. ..............
95125 E Immunotherapy, many antigens... .............. .............. .............. .............. ..............
95130 E Immunotherapy, insect venom.... .............. .............. .............. .............. ..............
95131 E Immunotherapy, insect venoms... .............. .............. .............. .............. ..............
95132 E Immunotherapy, insect venoms... .............. .............. .............. .............. ..............
95133 E Immunotherapy, insect venoms... .............. .............. .............. .............. ..............
95134 E Immunotherapy, insect venoms... .............. .............. .............. .............. ..............
95144 X Antigen therapy services....... 0371 0.32 $15.52 $3.67 $3.10
95145 X Antigen therapy services....... 0371 0.32 $15.52 $3.67 $3.10
95146 X Antigen therapy services....... 0371 0.32 $15.52 $3.67 $3.10
95147 X Antigen therapy services....... 0371 0.32 $15.52 $3.67 $3.10
95148 X Antigen therapy services....... 0371 0.32 $15.52 $3.67 $3.10
95149 X Antigen therapy services....... 0371 0.32 $15.52 $3.67 $3.10
95165 X Antigen therapy services....... 0371 0.32 $15.52 $3.67 $3.10
95170 X Antigen therapy services....... 0371 0.32 $15.52 $3.67 $3.10
95180 X Rapid desensitization.......... 0370 0.57 $27.64 $11.81 $5.53
95199 X Allergy immunology services.... 0370 0.57 $27.64 $11.81 $5.53
95805 S Multiple sleep latency test.... 0213 11.15 $540.63 $290.42 $108.13
95806 S Sleep study, unattended........ 0213 11.15 $540.63 $290.42 $108.13
95807 S Sleep study, attended.......... 0213 11.15 $540.63 $290.42 $108.13
95808 S Polysomnography, 1-3........... 0213 11.15 $540.63 $290.42 $108.13
95810 S Polysomnography, 4 or more..... 0213 11.15 $540.63 $290.42 $108.13
95811 S Polysomnography w/cpap......... 0213 11.15 $540.63 $290.42 $108.13
95812 S Electroencephalogram (EEG)..... 0213 11.15 $540.63 $290.42 $108.13
95813 S Electroencephalogram (EEG)..... 0213 11.15 $540.63 $290.42 $108.13
95816 S Electroencephalogram (EEG)..... 0214 2.32 $112.49 $58.50 $22.50
95819 S Electroencephalogram (EEG)..... 0214 2.32 $112.49 $58.50 $22.50
95822 S Sleep electroencephalogram..... 0214 2.32 $112.49 $58.50 $22.50
95824 S Electroencephalography......... 0214 2.32 $112.49 $58.50 $22.50
95827 S Night electroencephalogram..... 0213 11.15 $540.63 $290.42 $108.13
95829 S Surgery electrocorticogram..... 0214 2.32 $112.49 $58.50 $22.50
95830 E Insert electrodes for EEG...... .............. .............. .............. .............. ..............
95831 N Limb muscle testing, manual.... .............. .............. .............. .............. ..............
95832 N Hand muscle testing, manual.... .............. .............. .............. .............. ..............
95833 N Body muscle testing, manual.... .............. .............. .............. .............. ..............
95834 N Body muscle testing, manual.... .............. .............. .............. .............. ..............
95851 N Range of motion measurements... .............. .............. .............. .............. ..............
95852 N Range of motion measurements... .............. .............. .............. .............. ..............
95857 S Tensilon test.................. 0215 1.15 $55.76 $30.05 $11.15
95858 S Tensilon test & myogram........ 0215 1.15 $55.76 $30.05 $11.15
95860 S Muscle test, one limb.......... 0215 1.15 $55.76 $30.05 $11.15
95861 S Muscle test, two limbs......... 0215 1.15 $55.76 $30.05 $11.15
[[Page 18660]]
95863 S Muscle test, 3 limbs........... 0216 2.87 $139.16 $64.69 $27.83
95864 S Muscle test, 4 limbs........... 0215 1.15 $55.76 $30.05 $11.15
95867 S Muscle test, head or neck...... 0216 2.87 $139.16 $64.69 $27.83
95868 S Muscle test, head or neck...... 0216 2.87 $139.16 $64.69 $27.83
95869 S Muscle test, thor paraspinal... 0215 1.15 $55.76 $30.05 $11.15
95870 S Muscle test, nonparaspinal..... 0215 1.15 $55.76 $30.05 $11.15
95872 S Muscle test, one fiber......... 0215 1.15 $55.76 $30.05 $11.15
95875 S Limb exercise test............. 0217 5.87 $284.62 $156.68 $56.92
95900 S Motor nerve conduction test.... 0215 1.15 $55.76 $30.05 $11.15
95903 S Motor nerve conduction test.... 0215 1.15 $55.76 $30.05 $11.15
95904 S Sense/mixed n conduction tst... 0215 1.15 $55.76 $30.05 $11.15
95920 C Intraop nerve test add-on...... .............. .............. .............. .............. ..............
95921 S Autonomic nerv function test... 0216 2.87 $139.16 $64.69 $27.83
95922 S Autonomic nerv function test... 0216 2.87 $139.16 $64.69 $27.83
95923 S Autonomic nerv function test... 0216 2.87 $139.16 $64.69 $27.83
95925 S Somatosensory testing.......... 0216 2.87 $139.16 $64.69 $27.83
95926 S Somatosensory testing.......... 0216 2.87 $139.16 $64.69 $27.83
95927 S Somatosensory testing.......... 0216 2.87 $139.16 $64.69 $27.83
95930 S Visual evoked potential test... 0216 2.87 $139.16 $64.69 $27.83
95933 S Blink reflex test.............. 0215 1.15 $55.76 $30.05 $11.15
95934 S H-reflex test.................. 0215 1.15 $55.76 $30.05 $11.15
95936 S H-reflex test.................. 0216 2.87 $139.16 $64.69 $27.83
95937 S Neuromuscular junction test.... 0215 1.15 $55.76 $30.05 $11.15
95950 S Ambulatory eeg monitoring...... 0217 5.87 $284.62 $156.68 $56.92
95951 S EEG monitoring/videorecord..... 0213 11.15 $540.63 $290.42 $108.13
95953 S EEG monitoring/computer........ 0213 11.15 $540.63 $290.42 $108.13
95954 S EEG monitoring/giving drugs.... 0213 11.15 $540.63 $290.42 $108.13
95955 S EEG during surgery............. 0214 2.32 $112.49 $58.50 $22.50
95956 N Eeg monitoring, cable/radio.... .............. .............. .............. .............. ..............
95957 N EEG digital analysis........... .............. .............. .............. .............. ..............
95958 S EEG monitoring/function test... 0213 11.15 $540.63 $290.42 $108.13
95961 C Electrode stimulation, brain... .............. .............. .............. .............. ..............
95962 C Electrode stim, brain add-on... .............. .............. .............. .............. ..............
95970 S Analyze neurostim, no prog..... 0102 0.45 $21.82 $12.62 $4.36
95971 S Analyze neurostim, simple...... 0102 0.45 $21.82 $12.62 $4.36
95972 S Analyze neurostim, complex..... 0102 0.45 $21.82 $12.62 $4.36
95973 S Analyze neurostim, complex..... 0102 0.45 $21.82 $12.62 $4.36
95974 S Cranial neurostim, complex..... 0102 0.45 $21.82 $12.62 $4.36
95975 S Cranial neurostim, complex..... 0102 0.45 $21.82 $12.62 $4.36
95999 N Neurological procedure......... .............. .............. .............. .............. ..............
96100 X Psychological testing.......... 0373 3.21 $155.64 $44.96 $31.13
96105 X Assessment of aphasia.......... 0373 3.21 $155.64 $44.96 $31.13
96110 X Developmental test, lim........ 0373 3.21 $155.64 $44.96 $31.13
96111 X Developmental test, extend..... 0373 3.21 $155.64 $44.96 $31.13
96115 X Neurobehavior status exam...... 0373 3.21 $155.64 $44.96 $31.13
96117 X Neuropsych test battery........ 0373 3.21 $155.64 $44.96 $31.13
96400 E Chemotherapy, sc/im............ .............. .............. .............. .............. ..............
96405 E Intralesional chemo admin...... .............. .............. .............. .............. ..............
96406 E Intralesional chemo admin...... .............. .............. .............. .............. ..............
96408 E Chemotherapy, push technique... .............. .............. .............. .............. ..............
96410 E Chemotherapy, infusion method.. .............. .............. .............. .............. ..............
96412 E Chemo, infuse method add-on.... .............. .............. .............. .............. ..............
96414 E Chemo, infuse method add-on.... .............. .............. .............. .............. ..............
96420 E Chemotherapy, push technique... .............. .............. .............. .............. ..............
96422 E Chemotherapy, infusion method.. .............. .............. .............. .............. ..............
96423 E Chemo, infuse method add-on.... .............. .............. .............. .............. ..............
96425 E Chemotherapy, infusion method.. .............. .............. .............. .............. ..............
96440 E Chemotherapy, intracavitary.... .............. .............. .............. .............. ..............
96445 E Chemotherapy, intracavitary.... .............. .............. .............. .............. ..............
96450 E Chemotherapy, into CNS......... .............. .............. .............. .............. ..............
96520 E Pump refilling, maintenance.... .............. .............. .............. .............. ..............
96530 E Pump refilling, maintenance.... .............. .............. .............. .............. ..............
96542 E Chemotherapy injection......... .............. .............. .............. .............. ..............
96545 E Provide chemotherapy agent..... .............. .............. .............. .............. ..............
96549 E Chemotherapy, unspecified...... .............. .............. .............. .............. ..............
96570 T Photodynamic tx, 30 min........ 0075 18.55 $899.44 $467.29 $179.89
96571 T Photodynamic tx, addl 15 min... 0075 18.55 $899.44 $467.29 $179.89
96900 S Ultraviolet light therapy...... 0001 0.47 $22.79 $8.49 $4.56
96902 N Trichogram..................... .............. .............. .............. .............. ..............
96910 S Photochemotherapy with UV-B.... 0001 0.47 $22.79 $8.49 $4.56
96912 S Photochemotherapy with UV-A.... 0001 0.47 $22.79 $8.49 $4.56
96913 S Photochemotherapy, UV-A or B... 0001 0.47 $22.79 $8.49 $4.56
96999 S Dermatological procedure....... 0001 0.47 $22.79 $8.49 $4.56
[[Page 18661]]
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.......... .............. .............. .............. .............. ..............
97112 A Neuromuscular reeducation...... .............. .............. .............. .............. ..............
97113 A Aquatic therapy/exercises...... .............. .............. .............. .............. ..............
97116 A Gait training therapy.......... .............. .............. .............. .............. ..............
97124 A Massage therapy................ .............. .............. .............. .............. ..............
97139 A Physical medicine procedure.... .............. .............. .............. .............. ..............
97140 A Manual therapy................. .............. .............. .............. .............. ..............
97150 A Group therapeutic procedures... .............. .............. .............. .............. ..............
97504 A Orthotic training.............. .............. .............. .............. .............. ..............
97520 A Prosthetic training............ .............. .............. .............. .............. ..............
97530 A Therapeutic activities......... .............. .............. .............. .............. ..............
97535 A Self care mngment training..... .............. .............. .............. .............. ..............
97537 A Community/work reintegration... .............. .............. .............. .............. ..............
97542 A Wheelchair mngment training.... .............. .............. .............. .............. ..............
97545 A Work hardening................. .............. .............. .............. .............. ..............
97546 A Work hardening add-on.......... .............. .............. .............. .............. ..............
97703 A Prosthetic checkout............ .............. .............. .............. .............. ..............
97750 A Physical performance test...... .............. .............. .............. .............. ..............
97770 A Cognitive skills development... .............. .............. .............. .............. ..............
97780 E Acupuncture w/o stimul......... .............. .............. .............. .............. ..............
97781 E Acupuncture w/stimul........... .............. .............. .............. .............. ..............
97799 A Physical medicine procedure.... .............. .............. .............. .............. ..............
98925 S Osteopathic manipulation....... 0060 0.77 $37.34 $7.80 $7.47
98926 S Osteopathic manipulation....... 0060 0.77 $37.34 $7.80 $7.47
98927 S Osteopathic manipulation....... 0060 0.77 $37.34 $7.80 $7.47
98928 S Osteopathic manipulation....... 0060 0.77 $37.34 $7.80 $7.47
98929 S Osteopathic manipulation....... 0060 0.77 $37.34 $7.80 $7.47
98940 S Chiropractic manipulation...... 0060 0.77 $37.34 $7.80 $7.47
98941 S Chiropractic manipulation...... 0060 0.77 $37.34 $7.80 $7.47
98942 S Chiropractic manipulation...... 0060 0.77 $37.34 $7.80 $7.47
98943 E Chiropractic manipulation...... .............. .............. .............. .............. ..............
99000 E Specimen handling.............. .............. .............. .............. .............. ..............
99001 E Specimen handling.............. .............. .............. .............. .............. ..............
99002 E Device handling................ .............. .............. .............. .............. ..............
99024 E Postop follow-up visit......... .............. .............. .............. .............. ..............
99025 E Initial surgical evaluation.... .............. .............. .............. .............. ..............
99050 E Medical services after hrs..... .............. .............. .............. .............. ..............
99052 E Medical services at night...... .............. .............. .............. .............. ..............
99054 E Medical servcs, unusual hrs.... .............. .............. .............. .............. ..............
99056 E Non-office medical services.... .............. .............. .............. .............. ..............
99058 E Office emergency care.......... .............. .............. .............. .............. ..............
99070 E Special supplies............... .............. .............. .............. .............. ..............
99071 E Patient education materials.... .............. .............. .............. .............. ..............
99075 E Medical testimony.............. .............. .............. .............. .............. ..............
99078 E Group health education......... .............. .............. .............. .............. ..............
99080 E Special reports or forms....... .............. .............. .............. .............. ..............
99082 E Unusual physician travel....... .............. .............. .............. .............. ..............
99090 E Computer data analysis......... .............. .............. .............. .............. ..............
99100 E Special anesthesia service..... .............. .............. .............. .............. ..............
99116 E Anesthesia with hypothermia.... .............. .............. .............. .............. ..............
99135 E Special anesthesia procedure... .............. .............. .............. .............. ..............
99140 E Emergency anesthesia........... .............. .............. .............. .............. ..............
99141 N Sedation, iv/im or inhalant.... .............. .............. .............. .............. ..............
[[Page 18662]]
99142 N Sedation, oral/rectal/nasal.... .............. .............. .............. .............. ..............
99170 T Anogenital exam, child......... 0192 2.38 $115.40 $35.33 $23.08
99173 N Visual screening test.......... .............. .............. .............. .............. ..............
99175 N Induction of vomiting.......... .............. .............. .............. .............. ..............
99183 S Hyperbaric oxygen therapy...... 0031 3.00 $145.46 $140.85 $29.09
99185 N Regional hypothermia........... .............. .............. .............. .............. ..............
99186 N Total body hypothermia......... .............. .............. .............. .............. ..............
99190 C Special pump services.......... .............. .............. .............. .............. ..............
99191 C Special pump services.......... .............. .............. .............. .............. ..............
99192 C Special pump services.......... .............. .............. .............. .............. ..............
99195 X Phlebotomy..................... 0372 0.43 $20.85 $10.09 $4.17
99199 E Special service/proc/report.... .............. .............. .............. .............. ..............
99201 V Office/outpatient visit, new... 0600 0.98 $47.52 $9.50 $9.50
99202 V Office/outpatient visit, new... 0600 0.98 $47.52 $9.50 $9.50
99203 V Office/outpatient visit, new... 0601 1.00 $48.49 $9.70 $9.70
99204 V Office/outpatient visit, new... 0602 1.66 $80.49 $16.29 $16.10
99205 V Office/outpatient visit, new... 0602 1.66 $80.49 $16.29 $16.10
99211 V Office/outpatient visit, est... 0600 0.98 $47.52 $9.50 $9.50
99212 V Office/outpatient visit, est... 0600 0.98 $47.52 $9.50 $9.50
99213 V Office/outpatient visit, est... 0601 1.00 $48.49 $9.70 $9.70
99214 V Office/outpatient visit, est... 0602 1.66 $80.49 $16.29 $16.10
99215 V Office/outpatient visit, est... 0602 1.66 $80.49 $16.29 $16.10
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............ 0600 0.98 $47.52 $9.50 $9.50
99242 V Office consultation............ 0600 0.98 $47.52 $9.50 $9.50
99243 V Office consultation............ 0601 1.00 $48.49 $9.70 $9.70
99244 V Office consultation............ 0602 1.66 $80.49 $16.29 $16.10
99245 V Office consultation............ 0602 1.66 $80.49 $16.29 $16.10
99251 C Initial inpatient consult...... .............. .............. .............. .............. ..............
99252 C Initial inpatient consult...... .............. .............. .............. .............. ..............
99253 C Initial inpatient consult...... .............. .............. .............. .............. ..............
99254 C Initial inpatient consult...... .............. .............. .............. .............. ..............
99255 C Initial inpatient consult...... .............. .............. .............. .............. ..............
99261 C Follow-up inpatient consult.... .............. .............. .............. .............. ..............
99262 C Follow-up inpatient consult.... .............. .............. .............. .............. ..............
99263 C Follow-up inpatient consult.... .............. .............. .............. .............. ..............
99271 V Confirmatory consultation...... 0600 0.98 $47.52 $9.50 $9.50
99272 V Confirmatory consultation...... 0600 0.98 $47.52 $9.50 $9.50
99273 V Confirmatory consultation...... 0601 1.00 $48.49 $9.70 $9.70
99274 V Confirmatory consultation...... 0602 1.66 $80.49 $16.29 $16.10
99275 V Confirmatory consultation...... 0602 1.66 $80.49 $16.29 $16.10
99281 V Emergency dept visit........... 0610 1.34 $64.97 $20.65 $12.99
99282 V Emergency dept visit........... 0610 1.34 $64.97 $20.65 $12.99
99283 V Emergency dept visit........... 0611 2.11 $102.31 $36.47 $20.46
99284 V Emergency dept visit........... 0612 3.19 $154.67 $54.14 $30.93
99285 V Emergency dept visit........... 0612 3.19 $154.67 $54.14 $30.93
99288 E Direct advanced life support... .............. .............. .............. .............. ..............
99291 S Critical care, first hour...... 0620 8.60 $416.99 $152.78 $83.40
99292 N Critical care, addl 30 min..... .............. .............. .............. .............. ..............
99295 C Neonatal critical care......... .............. .............. .............. .............. ..............
99296 C Neonatal critical care......... .............. .............. .............. .............. ..............
99297 C Neonatal critical care......... .............. .............. .............. .............. ..............
99298 C Neonatal critical care......... .............. .............. .............. .............. ..............
99301 E Nursing facility care.......... .............. .............. .............. .............. ..............
99302 E Nursing facility care.......... .............. .............. .............. .............. ..............
99303 E Nursing facility care.......... .............. .............. .............. .............. ..............
99311 E Nursing fac care, subseq....... .............. .............. .............. .............. ..............
99312 E Nursing fac care, subseq....... .............. .............. .............. .............. ..............
99313 E Nursing fac care, subseq....... .............. .............. .............. .............. ..............
[[Page 18663]]
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, est pat....... .............. .............. .............. .............. ..............
99332 E Rest home visit, est pat....... .............. .............. .............. .............. ..............
99333 E Rest home visit, est pat....... .............. .............. .............. .............. ..............
99341 E Home visit, new patient........ .............. .............. .............. .............. ..............
99342 E Home visit, new patient........ .............. .............. .............. .............. ..............
99343 E Home visit, new patient........ .............. .............. .............. .............. ..............
99344 E Home visit, new patient........ .............. .............. .............. .............. ..............
99345 E Home visit, new patient........ .............. .............. .............. .............. ..............
99347 E Home visit, est patient........ .............. .............. .............. .............. ..............
99348 E Home visit, est patient........ .............. .............. .............. .............. ..............
99349 E Home visit, est patient........ .............. .............. .............. .............. ..............
99350 E Home visit, est patient........ .............. .............. .............. .............. ..............
99354 N Prolonged service, office...... .............. .............. .............. .............. ..............
99355 N Prolonged service, office...... .............. .............. .............. .............. ..............
99356 C Prolonged service, inpatient... .............. .............. .............. .............. ..............
99357 C Prolonged service, inpatient... .............. .............. .............. .............. ..............
99358 N Prolonged serv, w/o contact.... .............. .............. .............. .............. ..............
99359 N Prolonged serv, w/o contact.... .............. .............. .............. .............. ..............
99360 E Physician standby services..... .............. .............. .............. .............. ..............
99361 E Physician/team conference...... .............. .............. .............. .............. ..............
99362 E Physician/team conference...... .............. .............. .............. .............. ..............
99371 E Physician phone consultation... .............. .............. .............. .............. ..............
99372 E Physician phone consultation... .............. .............. .............. .............. ..............
99373 E Physician phone consultation... .............. .............. .............. .............. ..............
99374 E Home health care supervision... .............. .............. .............. .............. ..............
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 Prev visit, new, infant........ .............. .............. .............. .............. ..............
99382 E Prev visit, new, age 1-4....... .............. .............. .............. .............. ..............
99383 E Prev visit, new, age 5-11...... .............. .............. .............. .............. ..............
99384 E Prev visit, new, age 12-17..... .............. .............. .............. .............. ..............
99385 E Prev visit, new, age 18-39..... .............. .............. .............. .............. ..............
99386 E Prev visit, new, age 40-64..... .............. .............. .............. .............. ..............
99387 E Prev visit, new, 65 & over..... .............. .............. .............. .............. ..............
99391 E Prev visit, est, infant........ .............. .............. .............. .............. ..............
99392 E Prev visit, est, age 1-4....... .............. .............. .............. .............. ..............
99393 E Prev visit, est, age 5-11...... .............. .............. .............. .............. ..............
99394 E Prev visit, est, age 12-17..... .............. .............. .............. .............. ..............
99395 E Prev visit, est, age 18-39..... .............. .............. .............. .............. ..............
99396 E Prev visit, est, age 40-64..... .............. .............. .............. .............. ..............
99397 E Prev visit, est, 65 & over..... .............. .............. .............. .............. ..............
99401 E Preventive counseling, indiv... .............. .............. .............. .............. ..............
99402 E Preventive counseling, indiv... .............. .............. .............. .............. ..............
99403 E Preventive counseling, indiv... .............. .............. .............. .............. ..............
99404 E Preventive counseling, indiv... .............. .............. .............. .............. ..............
99411 E Preventive counseling, group... .............. .............. .............. .............. ..............
99412 E Preventive counseling, group... .............. .............. .............. .............. ..............
99420 E Health risk assessment test.... .............. .............. .............. .............. ..............
99429 E Unlisted preventive service.... .............. .............. .............. .............. ..............
99431 N Initial care, normal newborn... .............. .............. .............. .............. ..............
99432 N Newborn care, not in hosp...... .............. .............. .............. .............. ..............
99433 C Normal newborn care/hospital... .............. .............. .............. .............. ..............
99435 E Newborn discharge day hosp..... .............. .............. .............. .............. ..............
99436 N Attendance, birth.............. .............. .............. .............. .............. ..............
99440 S Newborn resuscitation.......... 0094 4.51 $218.68 $105.29 $43.74
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...... .............. .............. .............. .............. ..............
[[Page 18664]]
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..... .............. .............. .............. .............. ..............
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...... .............. .............. .............. .............. ..............
[[Page 18665]]
A4256 A Calibrator solution/chips...... .............. .............. .............. .............. ..............
A4258 A Lancet device each............. .............. .............. .............. .............. ..............
A4259 A Lancets per box................ .............. .............. .............. .............. ..............
A4260 E Levonorgestrel implant......... .............. .............. .............. .............. ..............
A4261 E Cervical cap contraceptive..... .............. .............. .............. .............. ..............
A4262 N Temporary tear duct plug....... .............. .............. .............. .............. ..............
A4263 A Permanent tear duct plug....... .............. .............. .............. .............. ..............
A4265 A Paraffin....................... .............. .............. .............. .............. ..............
A4270 A Disposable endoscope sheath.... .............. .............. .............. .............. ..............
A4280 A Brst prsths adhsv attchmnt..... .............. .............. .............. .............. ..............
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......... .............. .............. .............. .............. ..............
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............. .............. .............. .............. .............. ..............
A4364 A Ostomy/cath adhesive........... .............. .............. .............. .............. ..............
A4365 A Ostomy adhesive remover wipe... .............. .............. .............. .............. ..............
A4367 A Ostomy belt.................... .............. .............. .............. .............. ..............
A4368 A Ostomy filter.................. .............. .............. .............. .............. ..............
A4369 A Skin barrier liquid per oz..... .............. .............. .............. .............. ..............
A4370 A Skin barrier paste per oz...... .............. .............. .............. .............. ..............
A4371 A Skin barrier powder per oz..... .............. .............. .............. .............. ..............
A4372 A Skin barrier solid 4x4 equiv... .............. .............. .............. .............. ..............
A4373 A Skin barrier with flange....... .............. .............. .............. .............. ..............
A4374 A Skin barrier extended wear..... .............. .............. .............. .............. ..............
A4375 A Drainable plastic pch w fcpl... .............. .............. .............. .............. ..............
A4376 A Drainable rubber pch w fcplt... .............. .............. .............. .............. ..............
A4377 A Drainable plstic pch w/o fp.... .............. .............. .............. .............. ..............
A4378 A Drainable rubber pch w/o fp.... .............. .............. .............. .............. ..............
A4379 A Urinary plastic pouch w fcpl... .............. .............. .............. .............. ..............
A4380 A Urinary rubber pouch w fcplt... .............. .............. .............. .............. ..............
A4381 A Urinary plastic pouch w/o fp... .............. .............. .............. .............. ..............
A4382 A Urinary hvy plstc pch w/o fp... .............. .............. .............. .............. ..............
A4383 A Urinary rubber pouch w/o fp.... .............. .............. .............. .............. ..............
A4384 A Ostomy faceplt/silicone ring... .............. .............. .............. .............. ..............
A4385 A Ost skn barrier sld ext wear... .............. .............. .............. .............. ..............
A4386 A Ost skn barrier w flng ex wr... .............. .............. .............. .............. ..............
A4387 A Ost clsd pouch w att st barr... .............. .............. .............. .............. ..............
A4388 A Drainable pch w ex wear barr... .............. .............. .............. .............. ..............
A4389 A Drainable pch w st wear barr... .............. .............. .............. .............. ..............
A4390 A Drainable pch ex wear convex... .............. .............. .............. .............. ..............
[[Page 18666]]
A4391 A Urinary pouch w ex wear barr... .............. .............. .............. .............. ..............
A4392 A Urinary pouch w st wear barr... .............. .............. .............. .............. ..............
A4393 A Urine pch w ex wear bar conv... .............. .............. .............. .............. ..............
A4394 A Ostomy pouch liq deodorant..... .............. .............. .............. .............. ..............
A4395 A Ostomy pouch solid deodorant... .............. .............. .............. .............. ..............
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............ .............. .............. .............. .............. ..............
A4483 A Moisture exchanger............. .............. .............. .............. .............. ..............
A4490 E Above knee surgical stocking... .............. .............. .............. .............. ..............
A4495 E Thigh length surg stocking..... .............. .............. .............. .............. ..............
A4500 E Below knee surgical stocking... .............. .............. .............. .............. ..............
A4510 E Full length surg stocking...... .............. .............. .............. .............. ..............
A4550 E Surgical trays................. .............. .............. .............. .............. ..............
A4554 E Disposable underpads........... .............. .............. .............. .............. ..............
A4556 A Electrodes, pair............... .............. .............. .............. .............. ..............
A4557 A Lead wires, pair............... .............. .............. .............. .............. ..............
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................ .............. .............. .............. .............. ..............
A4614 A Hand-held PEFR meter........... .............. .............. .............. .............. ..............
A4615 A Cannula nasal.................. .............. .............. .............. .............. ..............
A4616 A Tubing (oxygen) per foot....... .............. .............. .............. .............. ..............
A4617 A Mouth piece.................... .............. .............. .............. .............. ..............
A4618 A Breathing circuits............. .............. .............. .............. .............. ..............
A4619 A Face tent...................... .............. .............. .............. .............. ..............
A4620 A Variable concentration mask.... .............. .............. .............. .............. ..............
A4621 A Tracheotomy mask or collar..... .............. .............. .............. .............. ..............
A4622 A Tracheostomy or larngectomy.... .............. .............. .............. .............. ..............
A4623 A Tracheostomy inner cannula..... .............. .............. .............. .............. ..............
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............ .............. .............. .............. .............. ..............
A4636 A Handgrip for cane etc.......... .............. .............. .............. .............. ..............
A4637 A Repl tip cane/crutch/walker.... .............. .............. .............. .............. ..............
A4640 A Alternating pressure pad....... .............. .............. .............. .............. ..............
A4641 N Diagnostic imaging agent....... .............. .............. .............. .............. ..............
3 A4642 X Satumomab pendetide per dose... 0704 .............. .............. .............. $63.13
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............ .............. .............. .............. .............. ..............
[[Page 18667]]
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............. .............. .............. .............. .............. ..............
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 Disk/foam pad +or- adhesive.... .............. .............. .............. .............. ..............
A5131 A Appliance cleaner.............. .............. .............. .............. .............. ..............
A5149 A Incontinence/ostomy supply..... .............. .............. .............. .............. ..............
A5200 A Percutaneous catheter anchor... .............. .............. .............. .............. ..............
[[Page 18668]]
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..... .............. .............. .............. .............. ..............
A5508 A Diabetic deluxe 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..... .............. .............. .............. .............. ..............
A6200 A Compos drsg =16 no border...... .............. .............. .............. .............. ..............
A6201 A Compos drsg >16=48 no bdr...... .............. .............. .............. .............. ..............
A6202 A Compos drsg >48 no border...... .............. .............. .............. .............. ..............
A6203 A Composite drsg = 16 sq in...... .............. .............. .............. .............. ..............
A6204 A Composite drsg >16=48 sq in.... .............. .............. .............. .............. ..............
A6205 A Composite drsg > 48 sq in...... .............. .............. .............. .............. ..............
A6206 A Contact layer = 16 sq in....... .............. .............. .............. .............. ..............
A6207 A Contact layer >16= 48 sq in.... .............. .............. .............. .............. ..............
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.... .............. .............. .............. .............. ..............
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... .............. .............. .............. .............. ..............
[[Page 18669]]
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... .............. .............. .............. .............. ..............
A7000 A Disposable canister for pump... .............. .............. .............. .............. ..............
A7001 A Nondisposable pump canister.... .............. .............. .............. .............. ..............
A7002 A Tubing used w suction pump..... .............. .............. .............. .............. ..............
A7003 A Nebulizer administration set... .............. .............. .............. .............. ..............
A7004 A Disposable nebulizer sml vol... .............. .............. .............. .............. ..............
A7005 A Nondisposable nebulizer set.... .............. .............. .............. .............. ..............
A7006 A Filtered nebulizer admin set... .............. .............. .............. .............. ..............
A7007 A Lg vol nebulizer disposable.... .............. .............. .............. .............. ..............
A7008 A Disposable nebulizer prefill... .............. .............. .............. .............. ..............
A7009 A Nebulizer reservoir bottle..... .............. .............. .............. .............. ..............
A7010 A Disposable corrugated tubing... .............. .............. .............. .............. ..............
A7011 A Nondispos corrugated tubing.... .............. .............. .............. .............. ..............
A7012 A Nebulizer water collec devic... .............. .............. .............. .............. ..............
A7013 A Disposable compressor filter... .............. .............. .............. .............. ..............
A7014 A Compressor nondispos filter.... .............. .............. .............. .............. ..............
A7015 A Aerosol mask used w nebulize... .............. .............. .............. .............. ..............
A7016 A Nebulizer dome & mouthpiece.... .............. .............. .............. .............. ..............
A7017 A Nebulizer not used w oxygen.... .............. .............. .............. .............. ..............
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.... .............. .............. .............. .............. ..............
3 A9502 X Technetium TC99M tetrofosmin... 0705 .............. .............. .............. $71.08
A9503 N Technetium TC 99m medronate.... .............. .............. .............. .............. ..............
A9504 N Technetium tc 99m apcitide..... .............. .............. .............. .............. ..............
A9505 N Thallous chloride TL 201/mci... .............. .............. .............. .............. ..............
A9507 N Indium/111 capromab pendetid... .............. .............. .............. .............. ..............
3 A9600 X Strontium-89 chloride.......... 0701 .............. .............. .............. $84.76
3 A9605 X Samarium sm153 lexidronamm..... 0702 .............. .............. .............. $139.06
A9900 E Supply/accessory/service....... .............. .............. .............. .............. ..............
A9901 E Delivery/set up/dispensing..... .............. .............. .............. .............. ..............
B4034 A Enter feed supkit syr by day... .............. .............. .............. .............. ..............
B4035 A Enteral feed supp pump per d... .............. .............. .............. .............. ..............
B4036 A Enteral feed sup kit grav by... .............. .............. .............. .............. ..............
B4081 A Enteral ng tubing w/stylet..... .............. .............. .............. .............. ..............
B4082 A Enteral ng tubing w/o stylet... .............. .............. .............. .............. ..............
B4083 A Enteral stomach tube levine.... .............. .............. .............. .............. ..............
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... .............. .............. .............. .............. ..............
[[Page 18670]]
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 evaluation... 0330 1.51 $73.22 $14.64 $14.64
D0160 E Extensv oral eval prob focus... .............. .............. .............. .............. ..............
D0170 E Re-eval, est pt, problem focus. .............. .............. .............. .............. ..............
D0210 E Intraor complete film series... .............. .............. .............. .............. ..............
D0220 E Intraoral periapical first f... .............. .............. .............. .............. ..............
D0230 E Intraoral periapical ea add.... .............. .............. .............. .............. ..............
D0240 S Intraoral occlusal film........ 0330 1.51 $73.22 $14.64 $14.64
D0250 S Extraoral first film........... 0330 1.51 $73.22 $14.64 $14.64
D0260 S Extraoral ea additional film... 0330 1.51 $73.22 $14.64 $14.64
D0270 S Dental bitewing single film.... 0330 1.51 $73.22 $14.64 $14.64
D0272 S Dental bitewings two films..... 0330 1.51 $73.22 $14.64 $14.64
D0274 S Dental bitewings four films.... 0330 1.51 $73.22 $14.64 $14.64
D0277 E Vert bitewings-sev to eight.... .............. .............. .............. .............. ..............
D0290 E Dental film skull/facial bon... .............. .............. .............. .............. ..............
D0310 E Dental saliography............. .............. .............. .............. .............. ..............
D0320 E Dental tmj arthrogram incl i... .............. .............. .............. .............. ..............
D0321 E Dental other tmj films......... .............. .............. .............. .............. ..............
D0322 E Dental tomographic survey...... .............. .............. .............. .............. ..............
D0330 E Dental panoramic film.......... .............. .............. .............. .............. ..............
D0340 E Dental cephalometric film...... .............. .............. .............. .............. ..............
D0350 E Oral/facial images............. .............. .............. .............. .............. ..............
D0415 E Bacteriologic study............ .............. .............. .............. .............. ..............
D0425 E Caries susceptibility test..... .............. .............. .............. .............. ..............
D0460 S Pulp vitality test............. 0330 1.51 $73.22 $14.64 $14.64
D0470 E Diagnostic casts............... .............. .............. .............. .............. ..............
D0472 E Gross exam, prep & report...... .............. .............. .............. .............. ..............
D0473 E Micro exam, prep & report...... .............. .............. .............. .............. ..............
D0474 E Micro w exam of surg margins... .............. .............. .............. .............. ..............
D0480 E Cytopath smear prep & report... .............. .............. .............. .............. ..............
D0501 S Histopathologic examinations... 0330 1.51 $73.22 $14.64 $14.64
D0502 S Other oral pathology procedu... 0330 1.51 $73.22 $14.64 $14.64
D0999 S Unspecified diagnostic proce... 0330 1.51 $73.22 $14.64 $14.64
D1110 E Dental prophylaxis adult....... .............. .............. .............. .............. ..............
D1120 E Dental prophylaxis child....... .............. .............. .............. .............. ..............
D1201 E Topical fluor w prophy child... .............. .............. .............. .............. ..............
D1203 E Topical fluor w/o prophy chi... .............. .............. .............. .............. ..............
D1204 E Topical fluor w/o prophy adu... .............. .............. .............. .............. ..............
D1205 E Topical fluoride w/prophy a.... .............. .............. .............. .............. ..............
D1310 E Nutri counsel-control caries... .............. .............. .............. .............. ..............
D1320 E Tobacco counseling............. .............. .............. .............. .............. ..............
D1330 E Oral hygiene instruction....... .............. .............. .............. .............. ..............
D1351 E Dental sealant per tooth....... .............. .............. .............. .............. ..............
D1510 S Space maintainer fxd unilat.... 0330 1.51 $73.22 $14.64 $14.64
D1515 S Fixed bilat space maintainer... 0330 1.51 $73.22 $14.64 $14.64
D1520 S Remove unilat space maintain... 0330 1.51 $73.22 $14.64 $14.64
D1525 S Remove bilat space maintain.... 0330 1.51 $73.22 $14.64 $14.64
D1550 S Recement space maintainer...... 0330 1.51 $73.22 $14.64 $14.64
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... .............. .............. .............. .............. ..............
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.......... .............. .............. .............. .............. ..............
D2337 E Compo resin crown ant-perm..... .............. .............. .............. .............. ..............
D2380 E Resin one surf poster primar... .............. .............. .............. .............. ..............
[[Page 18671]]
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... .............. .............. .............. .............. ..............
D2388 E Resin four/more, post perm..... .............. .............. .............. .............. ..............
D2410 E Dental gold foil one surface... .............. .............. .............. .............. ..............
D2420 E Dental gold foil two surface... .............. .............. .............. .............. ..............
D2430 E Dental gold foil three surfa... .............. .............. .............. .............. ..............
D2510 E Dental inlay metalic 1 surf.... .............. .............. .............. .............. ..............
D2520 E Dental inlay metallic 2 surf... .............. .............. .............. .............. ..............
D2530 E Dental inlay metl 3/more sur... .............. .............. .............. .............. ..............
D2542 E Dental onlay metallic 2 surf... .............. .............. .............. .............. ..............
D2543 E Dental onlay metallic 3 surf... .............. .............. .............. .............. ..............
D2544 E Dental onlay metl 4/more sur... .............. .............. .............. .............. ..............
D2610 E Inlay porcelain/ceramic 1 su... .............. .............. .............. .............. ..............
D2620 E Inlay porcelain/ceramic 2 su... .............. .............. .............. .............. ..............
D2630 E Dental onlay porc 3/more sur... .............. .............. .............. .............. ..............
D2642 E Dental onlay porcelin 2 surf... .............. .............. .............. .............. ..............
D2643 E Dental onlay porcelin 3 surf... .............. .............. .............. .............. ..............
D2644 E Dental onlay porc 4/more sur... .............. .............. .............. .............. ..............
D2650 E Inlay composite/resin one su... .............. .............. .............. .............. ..............
D2651 E Inlay composite/resin two su... .............. .............. .............. .............. ..............
D2652 E Dental inlay resin 3/mre sur... .............. .............. .............. .............. ..............
D2662 E Dental onlay resin 2 surface... .............. .............. .............. .............. ..............
D2663 E Dental onlay resin 3 surface... .............. .............. .............. .............. ..............
D2664 E Dental onlay resin 4/mre sur... .............. .............. .............. .............. ..............
D2710 E Crown resin laboratory......... .............. .............. .............. .............. ..............
D2720 E Crown resin w/high noble me.... .............. .............. .............. .............. ..............
D2721 E Crown resin w/base metal....... .............. .............. .............. .............. ..............
D2722 E Crown resin w/noble metal...... .............. .............. .............. .............. ..............
D2740 E Crown porcelain/ceramic subs... .............. .............. .............. .............. ..............
D2750 E Crown porcelain w/h noble m.... .............. .............. .............. .............. ..............
D2751 E Crown porcelain fused base m... .............. .............. .............. .............. ..............
D2752 E Crown porcelain w/noble met.... .............. .............. .............. .............. ..............
D2780 E Crown 3/4 cast hi noble met.... .............. .............. .............. .............. ..............
D2781 E Crown 3/4 cast base metal...... .............. .............. .............. .............. ..............
D2782 E Crown 3/4 cast noble metal..... .............. .............. .............. .............. ..............
D2783 E Crown 3/4 porcelain/ceramic.... .............. .............. .............. .............. ..............
D2790 E Crown full cast high noble m... .............. .............. .............. .............. ..............
D2791 E Crown full cast base metal..... .............. .............. .............. .............. ..............
D2792 E Crown full cast noble metal.... .............. .............. .............. .............. ..............
D2799 E Provisional crown.............. .............. .............. .............. .............. ..............
D2910 E Dental recement inlay.......... .............. .............. .............. .............. ..............
D2920 E Dental recement crown.......... .............. .............. .............. .............. ..............
D2930 E Prefab stnlss steel crwn pri... .............. .............. .............. .............. ..............
D2931 E Prefab stnlss steel crown pe... .............. .............. .............. .............. ..............
D2932 E Prefabricated resin crown...... .............. .............. .............. .............. ..............
D2933 E Prefab stainless steel crown... .............. .............. .............. .............. ..............
D2940 E Dental sedative filling........ .............. .............. .............. .............. ..............
D2950 E Core build-up incl any pins.... .............. .............. .............. .............. ..............
D2951 E Tooth pin retention............ .............. .............. .............. .............. ..............
D2952 E Post and core cast + crown..... .............. .............. .............. .............. ..............
D2953 E Each addtnl cast post.......... .............. .............. .............. .............. ..............
D2954 E Prefab post/core + crown....... .............. .............. .............. .............. ..............
D2955 E Post removal................... .............. .............. .............. .............. ..............
D2957 E Each addtnl prefab post........ .............. .............. .............. .............. ..............
D2960 E Laminate labial veneer......... .............. .............. .............. .............. ..............
D2961 E Lab labial veneer resin........ .............. .............. .............. .............. ..............
D2962 E Lab labial veneer porcelain.... .............. .............. .............. .............. ..............
D2970 S Temporary-fractured tooth...... 0330 1.51 $73.22 $14.64 $14.64
D2980 E Crown repair................... .............. .............. .............. .............. ..............
D2999 S Dental unspec restorative pr... 0330 1.51 $73.22 $14.64 $14.64
D3110 E Pulp cap direct................ .............. .............. .............. .............. ..............
D3120 E Pulp cap indirect.............. .............. .............. .............. .............. ..............
D3220 E Therapeutic pulpotomy.......... .............. .............. .............. .............. ..............
D3221 E Gross pulpal debridement....... .............. .............. .............. .............. ..............
D3230 E Pulpal therapy anterior prim... .............. .............. .............. .............. ..............
D3240 E Pulpal therapy posterior pri... .............. .............. .............. .............. ..............
D3310 E Anterior....................... .............. .............. .............. .............. ..............
D3320 E Root canal therapy 2 canals.... .............. .............. .............. .............. ..............
D3330 E Root canal therapy 3 canals.... .............. .............. .............. .............. ..............
D3331 E Non-surg tx root canal obs..... .............. .............. .............. .............. ..............
[[Page 18672]]
D3332 E Incomplete endodontic tx....... .............. .............. .............. .............. ..............
D3333 E Internal root repair........... .............. .............. .............. .............. ..............
D3346 E Retreat root canal anterior.... .............. .............. .............. .............. ..............
D3347 E Retreat root canal bicuspid.... .............. .............. .............. .............. ..............
D3348 E Retreat root canal molar....... .............. .............. .............. .............. ..............
D3351 E Apexification/recalc initial... .............. .............. .............. .............. ..............
D3352 E Apexification/recalc interim... .............. .............. .............. .............. ..............
D3353 E Apexification/recalc final..... .............. .............. .............. .............. ..............
D3410 E Apicoect/perirad surg anter.... .............. .............. .............. .............. ..............
D3421 E Root surgery bicuspid.......... .............. .............. .............. .............. ..............
D3425 E Root surgery molar............. .............. .............. .............. .............. ..............
D3426 E Root surgery ea add root....... .............. .............. .............. .............. ..............
D3430 E Retrograde filling............. .............. .............. .............. .............. ..............
D3450 E Root amputation................ .............. .............. .............. .............. ..............
D3460 S Endodontic endosseous implan... 0330 1.51 $73.22 $14.64 $14.64
D3470 E Intentional replantation....... .............. .............. .............. .............. ..............
D3910 E Isolation-tooth w rubb dam..... .............. .............. .............. .............. ..............
D3920 E Tooth splitting................ .............. .............. .............. .............. ..............
D3950 E Canal prep/fitting of dowel.... .............. .............. .............. .............. ..............
D3999 S Endodontic procedure........... 0330 1.51 $73.22 $14.64 $14.64
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.... .............. .............. .............. .............. ..............
D4245 E Apically positioned flap....... .............. .............. .............. .............. ..............
D4249 E Crown lengthen hard tissue..... .............. .............. .............. .............. ..............
D4260 S Osseous surgery per quadrant... 0330 1.51 $73.22 $14.64 $14.64
D4263 S Bone replce graft first site... 0330 1.51 $73.22 $14.64 $14.64
D4264 S Bone replce graft each add..... 0330 1.51 $73.22 $14.64 $14.64
D4266 E Guided tiss regen resorble..... .............. .............. .............. .............. ..............
D4267 E Guided tiss regen nonresorb.... .............. .............. .............. .............. ..............
D4268 E Surgical revision procedure.... .............. .............. .............. .............. ..............
D4270 S Pedicle soft tissue graft pr... 0330 1.51 $73.22 $14.64 $14.64
D4271 S Free soft tissue graft proc.... 0330 1.51 $73.22 $14.64 $14.64
D4273 S Subepithelial tissue graft..... 0330 1.51 $73.22 $14.64 $14.64
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......... 0330 1.51 $73.22 $14.64 $14.64
D4381 S Localized chemo delivery....... 0330 1.51 $73.22 $14.64 $14.64
D4910 E Periodontal maint procedures... .............. .............. .............. .............. ..............
D4920 E Unscheduled dressing change.... .............. .............. .............. .............. ..............
D4999 E Unspecified periodontal proc... .............. .............. .............. .............. ..............
D5110 E Dentures complete maxillary.... .............. .............. .............. .............. ..............
D5120 E Dentures complete mandible..... .............. .............. .............. .............. ..............
D5130 E Dentures immediat maxillary.... .............. .............. .............. .............. ..............
D5140 E Dentures immediat mandible..... .............. .............. .............. .............. ..............
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..... .............. .............. .............. .............. ..............
[[Page 18673]]
D5750 E Denture reln cmplt max lab..... .............. .............. .............. .............. ..............
D5751 E Denture reln cmplt mand lab.... .............. .............. .............. .............. ..............
D5760 E Denture reln part maxil lab.... .............. .............. .............. .............. ..............
D5761 E Denture reln part mand lab..... .............. .............. .............. .............. ..............
D5810 E Denture interm cmplt maxill.... .............. .............. .............. .............. ..............
D5811 E Denture interm cmplt mandbl.... .............. .............. .............. .............. ..............
D5820 E Denture interm part maxill..... .............. .............. .............. .............. ..............
D5821 E Denture interm part mandbl..... .............. .............. .............. .............. ..............
D5850 E Denture tiss conditn maxill.... .............. .............. .............. .............. ..............
D5851 E Denture tiss condtin mandbl.... .............. .............. .............. .............. ..............
D5860 E Overdenture complete........... .............. .............. .............. .............. ..............
D5861 E Overdenture partial............ .............. .............. .............. .............. ..............
D5862 E Precision attachment........... .............. .............. .............. .............. ..............
D5867 E Replacement of precision att... .............. .............. .............. .............. ..............
D5875 E Prosthesis modification........ .............. .............. .............. .............. ..............
D5899 E Removable prosthodontic proc... .............. .............. .............. .............. ..............
D5911 S Facial moulage sectional....... 0330 1.51 $73.22 $14.64 $14.64
D5912 S Facial moulage complete........ 0330 1.51 $73.22 $14.64 $14.64
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................. .............. .............. .............. .............. ..............
D5983 S Radiation applicator........... 0330 1.51 $73.22 $14.64 $14.64
D5984 S Radiation shield............... 0330 1.51 $73.22 $14.64 $14.64
D5985 S Radiation cone locator......... 0330 1.51 $73.22 $14.64 $14.64
D5986 E Fluoride applicator............ .............. .............. .............. .............. ..............
D5987 S Commissure splint.............. 0330 1.51 $73.22 $14.64 $14.64
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......... .............. .............. .............. .............. ..............
D6056 E Prefabricated abutment......... .............. .............. .............. .............. ..............
D6057 E Custom abutment................ .............. .............. .............. .............. ..............
D6058 E Abutment supported crown....... .............. .............. .............. .............. ..............
D6059 E Abutment supported mtl crown... .............. .............. .............. .............. ..............
D6060 E Abutment supported mtl crown... .............. .............. .............. .............. ..............
D6061 E Abutment supported mtl crown... .............. .............. .............. .............. ..............
D6062 E Abutment supported mtl crown... .............. .............. .............. .............. ..............
D6063 E Abutment supported mtl crown... .............. .............. .............. .............. ..............
D6064 E Abutment supported mtl crown... .............. .............. .............. .............. ..............
D6065 E Implant supported crown........ .............. .............. .............. .............. ..............
D6066 E Implant supported mtl crown.... .............. .............. .............. .............. ..............
D6067 E Implant supported mtl crown.... .............. .............. .............. .............. ..............
D6068 E Abutment supported retainer.... .............. .............. .............. .............. ..............
D6069 E Abutment supported retainer.... .............. .............. .............. .............. ..............
[[Page 18674]]
D6070 E Abutment supported retainer.... .............. .............. .............. .............. ..............
D6071 E Abutment supported retainer.... .............. .............. .............. .............. ..............
D6072 E Abutment supported retainer.... .............. .............. .............. .............. ..............
D6073 E Abutment supported retainer.... .............. .............. .............. .............. ..............
D6074 E Abutment supported retainer.... .............. .............. .............. .............. ..............
D6075 E Implant supported retainer..... .............. .............. .............. .............. ..............
D6076 E Implant supported retainer..... .............. .............. .............. .............. ..............
D6077 E Implant supported retainer..... .............. .............. .............. .............. ..............
D6078 E Implnt/abut suprtd fixd dent... .............. .............. .............. .............. ..............
D6079 E Implnt/abut suprtd fixd dent... .............. .............. .............. .............. ..............
D6080 E Implant maintenance............ .............. .............. .............. .............. ..............
D6090 E Repair implant................. .............. .............. .............. .............. ..............
D6095 E Odontics repr abutment......... .............. .............. .............. .............. ..............
D6100 E Removal of implant............. .............. .............. .............. .............. ..............
D6199 E Implant procedure.............. .............. .............. .............. .............. ..............
D6210 E Prosthodont high noble metal... .............. .............. .............. .............. ..............
D6211 E Bridge base metal cast......... .............. .............. .............. .............. ..............
D6212 E Bridge noble metal cast........ .............. .............. .............. .............. ..............
D6240 E Bridge porcelain high noble.... .............. .............. .............. .............. ..............
D6241 E Bridge porcelain base metal.... .............. .............. .............. .............. ..............
D6242 E Bridge porcelain nobel metal... .............. .............. .............. .............. ..............
D6245 E Bridge porcelain/ceramic....... .............. .............. .............. .............. ..............
D6250 E Bridge resin w/high noble...... .............. .............. .............. .............. ..............
D6251 E Bridge resin base metal........ .............. .............. .............. .............. ..............
D6252 E Bridge resin w/noble metal..... .............. .............. .............. .............. ..............
D6519 E Inlay/onlay porce/ceramic...... .............. .............. .............. .............. ..............
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....... .............. .............. .............. .............. ..............
D6548 E Porcelain/ceramic retainer..... .............. .............. .............. .............. ..............
D6720 E Retain crown resin w hi nble... .............. .............. .............. .............. ..............
D6721 E Crown resin w/base metal....... .............. .............. .............. .............. ..............
D6722 E Crown resin w/noble metal...... .............. .............. .............. .............. ..............
D6740 E Crown porcelain/ceramic........ .............. .............. .............. .............. ..............
D6750 E Crown porcelain high noble..... .............. .............. .............. .............. ..............
D6751 E Crown porcelain base metal..... .............. .............. .............. .............. ..............
D6752 E Crown porcelain noble metal.... .............. .............. .............. .............. ..............
D6780 E Crown 3/4 high noble metal..... .............. .............. .............. .............. ..............
D6781 E Crown 3/4 cast based metal..... .............. .............. .............. .............. ..............
D6782 E Crown 3/4 cast noble metal..... .............. .............. .............. .............. ..............
D6783 E Crown 3/4 porcelain/ceramic.... .............. .............. .............. .............. ..............
D6790 E Crown full high noble metal.... .............. .............. .............. .............. ..............
D6791 E Crown full base metal cast..... .............. .............. .............. .............. ..............
D6792 E Crown full noble metal cast.... .............. .............. .............. .............. ..............
D6920 S Dental connector bar........... 0330 1.51 $73.22 $14.64 $14.64
D6930 E Dental recement bridge......... .............. .............. .............. .............. ..............
D6940 E Stress breaker................. .............. .............. .............. .............. ..............
D6950 E Precision attachment........... .............. .............. .............. .............. ..............
D6970 E Post & core plus retainer...... .............. .............. .............. .............. ..............
D6971 E Cast post bridge retainer...... .............. .............. .............. .............. ..............
D6972 E Prefab post & core plus reta... .............. .............. .............. .............. ..............
D6973 E Core build up for retainer..... .............. .............. .............. .............. ..............
D6975 E Coping metal................... .............. .............. .............. .............. ..............
D6976 E Each addtnl cast post.......... .............. .............. .............. .............. ..............
D6977 E Each addtl prefab post......... .............. .............. .............. .............. ..............
D6980 E Bridge repair.................. .............. .............. .............. .............. ..............
D6999 E Fixed prosthodontic proc....... .............. .............. .............. .............. ..............
D7110 S Oral surgery single tooth...... 0330 1.51 $73.22 $14.64 $14.64
D7120 S Each add tooth extraction...... 0330 1.51 $73.22 $14.64 $14.64
D7130 S Tooth root removal............. 0330 1.51 $73.22 $14.64 $14.64
D7210 S Rem imp tooth w mucoper flp.... 0330 1.51 $73.22 $14.64 $14.64
D7220 S Impact tooth remov soft tiss... 0330 1.51 $73.22 $14.64 $14.64
D7230 S Impact tooth remov part bony... 0330 1.51 $73.22 $14.64 $14.64
D7240 S Impact tooth remov comp bony... 0330 1.51 $73.22 $14.64 $14.64
D7241 S Impact tooth rem bony w/comp... 0330 1.51 $73.22 $14.64 $14.64
D7250 S Tooth root removal............. 0330 1.51 $73.22 $14.64 $14.64
D7260 S Oral antral fistula closure.... 0330 1.51 $73.22 $14.64 $14.64
D7270 E Tooth reimplantation........... .............. .............. .............. .............. ..............
D7272 E Tooth transplantation.......... .............. .............. .............. .............. ..............
D7280 E Exposure impact tooth orthod... .............. .............. .............. .............. ..............
D7281 E Exposure tooth aid eruption.... .............. .............. .............. .............. ..............
[[Page 18675]]
D7285 E Biopsy of oral tissue hard..... .............. .............. .............. .............. ..............
D7286 E Biopsy of oral tissue soft..... .............. .............. .............. .............. ..............
D7290 E Repositioning of teeth......... .............. .............. .............. .............. ..............
D7291 S Transseptal fiberotomy......... 0330 1.51 $73.22 $14.64 $14.64
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... .............. .............. .............. .............. ..............
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............. .............. .............. .............. .............. ..............
D7471 E Rem exostosis any site......... .............. .............. .............. .............. ..............
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 Closd rductn splint alveolus... .............. .............. .............. .............. ..............
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..... .............. .............. .............. .............. ..............
D7871 E Lysis + lavage w catheters..... .............. .............. .............. .............. ..............
D7872 E Tmj diagnostic arthroscopy..... .............. .............. .............. .............. ..............
D7873 E Tmj arthroscopy lysis adhesn... .............. .............. .............. .............. ..............
D7874 E Tmj arthroscopy disc reposit... .............. .............. .............. .............. ..............
D7875 E Tmj arthroscopy synovectomy.... .............. .............. .............. .............. ..............
D7876 E Tmj arthroscopy discectomy..... .............. .............. .............. .............. ..............
D7877 E Tmj arthroscopy debridement.... .............. .............. .............. .............. ..............
D7880 E Occlusal orthotic appliance.... .............. .............. .............. .............. ..............
D7899 E Tmj unspecified therapy........ .............. .............. .............. .............. ..............
D7910 E Dent sutur recent wnd to 5cm... .............. .............. .............. .............. ..............
D7911 E Dental suture wound to 5 cm.... .............. .............. .............. .............. ..............
D7912 E Suture complicate wnd > 5 cm... .............. .............. .............. .............. ..............
D7920 E Dental skin graft.............. .............. .............. .............. .............. ..............
D7940 S Reshaping bone orthognathic.... 0330 1.51 $73.22 $14.64 $14.64
D7941 E Bone cutting ramus closed...... .............. .............. .............. .............. ..............
D7943 E Cutting ramus open w/graft..... .............. .............. .............. .............. ..............
D7944 E Bone cutting segmented......... .............. .............. .............. .............. ..............
[[Page 18676]]
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................. .............. .............. .............. .............. ..............
D7981 E Excision of salivary gland..... .............. .............. .............. .............. ..............
D7982 E Sialodochoplasty............... .............. .............. .............. .............. ..............
D7983 E Closure of salivary fistula.... .............. .............. .............. .............. ..............
D7990 E Emergency tracheotomy.......... .............. .............. .............. .............. ..............
D7991 E Dental coronoidectomy.......... .............. .............. .............. .............. ..............
D7995 E Synthetic graft facial bones... .............. .............. .............. .............. ..............
D7996 E Implant mandible for augment... .............. .............. .............. .............. ..............
D7997 E Appliance removal.............. .............. .............. .............. .............. ..............
D7999 E Oral surgery procedure......... .............. .............. .............. .............. ..............
D8010 E Limited dental tx primary...... .............. .............. .............. .............. ..............
D8020 E Limited dental tx transition... .............. .............. .............. .............. ..............
D8030 E Limited dental tx adolescent... .............. .............. .............. .............. ..............
D8040 E Limited dental tx adult........ .............. .............. .............. .............. ..............
D8050 E Intercep dental tx primary..... .............. .............. .............. .............. ..............
D8060 E Intercep dental tx transitn.... .............. .............. .............. .............. ..............
D8070 E Compre dental tx transition.... .............. .............. .............. .............. ..............
D8080 E Compre dental tx adolescent.... .............. .............. .............. .............. ..............
D8090 E Compre dental tx adult......... .............. .............. .............. .............. ..............
D8210 E Orthodontic rem appliance tx... .............. .............. .............. .............. ..............
D8220 E Fixed appliance therapy habt... .............. .............. .............. .............. ..............
D8660 E Preorthodontic tx visit........ .............. .............. .............. .............. ..............
D8670 E Periodic orthodontc tx visit... .............. .............. .............. .............. ..............
D8680 E Orthodontic retention.......... .............. .............. .............. .............. ..............
D8690 E Orthodontic treatment.......... .............. .............. .............. .............. ..............
D8691 E Repair ortho appliance......... .............. .............. .............. .............. ..............
D8692 E Replacement retainer........... .............. .............. .............. .............. ..............
D8999 E Orthodontic procedure.......... .............. .............. .............. .............. ..............
D9110 N Tx dental pain minor proc...... .............. .............. .............. .............. ..............
D9210 E Dent anesthesia w/o surgery.... .............. .............. .............. .............. ..............
D9211 E Regional block anesthesia...... .............. .............. .............. .............. ..............
D9212 E Trigeminal block anesthesia.... .............. .............. .............. .............. ..............
D9215 E Local anesthesia............... .............. .............. .............. .............. ..............
D9220 E General anesthesia............. .............. .............. .............. .............. ..............
D9221 E General anesthesia ea ad 15m... .............. .............. .............. .............. ..............
D9230 N Analgesia...................... .............. .............. .............. .............. ..............
D9241 E Intravenous sedation........... .............. .............. .............. .............. ..............
D9242 E IV sedation ea ad 30 m......... .............. .............. .............. .............. ..............
D9248 E Sedation (non-iv).............. .............. .............. .............. .............. ..............
D9310 E Dental consultation............ .............. .............. .............. .............. ..............
D9410 E Dental house call.............. .............. .............. .............. .............. ..............
D9420 E Hospital call.................. .............. .............. .............. .............. ..............
D9430 E Office visit during hours...... .............. .............. .............. .............. ..............
D9440 E Office visit after hours....... .............. .............. .............. .............. ..............
D9610 E Dent therapeutic drug inject... .............. .............. .............. .............. ..............
D9630 S Other drugs/medicaments........ 0330 1.51 $73.22 $14.64 $14.64
D9910 E Dent appl desensitizing med.... .............. .............. .............. .............. ..............
D9911 E Appl desensitizing resin....... .............. .............. .............. .............. ..............
D9920 E Behavior management............ .............. .............. .............. .............. ..............
D9930 S Treatment of complications..... 0330 1.51 $73.22 $14.64 $14.64
D9940 S Dental occlusal guard.......... 0330 1.51 $73.22 $14.64 $14.64
D9941 E Fabrication athletic guard..... .............. .............. .............. .............. ..............
D9950 S Occlusion analysis............. 0330 1.51 $73.22 $14.64 $14.64
D9951 S Limited occlusal adjustment.... 0330 1.51 $73.22 $14.64 $14.64
D9952 S Complete occlusal adjustment... 0330 1.51 $73.22 $14.64 $14.64
D9970 E Enamel microabrasion........... .............. .............. .............. .............. ..............
D9971 E Odontoplasty 1-2 teeth......... .............. .............. .............. .............. ..............
D9972 E Extrnl bleaching per arch...... .............. .............. .............. .............. ..............
D9973 E Extrnl bleaching per tooth..... .............. .............. .............. .............. ..............
D9974 E Intrnl bleaching per tooth..... .............. .............. .............. .............. ..............
D9999 E Adjunctive procedure........... .............. .............. .............. .............. ..............
E0100 A Cane adjust/fixed with tip..... .............. .............. .............. .............. ..............
E0105 A Cane adjust/fixed quad/3 pro... .............. .............. .............. .............. ..............
[[Page 18677]]
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... .............. .............. .............. .............. ..............
E0144 A Enclosed walker w rear seat.... .............. .............. .............. .............. ..............
E0145 A Walker whled seat/crutch att... .............. .............. .............. .............. ..............
E0146 A Folding walker wheels w seat... .............. .............. .............. .............. ..............
E0147 A Walker variable wheel resist... .............. .............. .............. .............. ..............
E0153 A Forearm crutch platform atta... .............. .............. .............. .............. ..............
E0154 A Walker platform attachment..... .............. .............. .............. .............. ..............
E0155 A Walker wheel attachment, pair.. .............. .............. .............. .............. ..............
E0156 A Walker seat attachment......... .............. .............. .............. .............. ..............
E0157 A Walker crutch attachment....... .............. .............. .............. .............. ..............
E0158 A Walker leg extenders set of4... .............. .............. .............. .............. ..............
E0159 A Brake for wheeled walker....... .............. .............. .............. .............. ..............
E0160 A Sitz type bath or equipment.... .............. .............. .............. .............. ..............
E0161 A Sitz bath/equipment w/faucet... .............. .............. .............. .............. ..............
E0162 A Sitz bath chair................ .............. .............. .............. .............. ..............
E0163 A Commode chair stationry fxd.... .............. .............. .............. .............. ..............
E0164 A Commode chair mobile fixed a... .............. .............. .............. .............. ..............
E0165 A Commode chair stationry det.... .............. .............. .............. .............. ..............
E0166 A Commode chair mobile detach.... .............. .............. .............. .............. ..............
E0167 A Commode chair pail or pan...... .............. .............. .............. .............. ..............
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... .............. .............. .............. .............. ..............
[[Page 18678]]
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..... .............. .............. .............. .............. ..............
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... .............. .............. .............. .............. ..............
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.... .............. .............. .............. .............. ..............
E0590 A Dispensing fee dme neb drug.... .............. .............. .............. .............. ..............
E0600 A Suction pump portab hom modl... .............. .............. .............. .............. ..............
E0601 A Cont airway pressure device.... .............. .............. .............. .............. ..............
E0602 A Breast pump.................... .............. .............. .............. .............. ..............
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... .............. .............. .............. .............. ..............
[[Page 18679]]
E0610 A Pacemaker monitr audible/vis... .............. .............. .............. .............. ..............
E0615 A Pacemaker monitr digital/vis... .............. .............. .............. .............. ..............
E0616 A Cardiac event recorder......... .............. .............. .............. .............. ..............
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/... .............. .............. .............. .............. ..............
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........................ .............. .............. .............. .............. ..............
E0779 A Amb infusion pump mechanical... .............. .............. .............. .............. ..............
E0780 A Mech amb infusion pump 8hrs.... .............. .............. .............. .............. ..............
E0781 A External ambulatory infus pu... .............. .............. .............. .............. ..............
E0782 A Non-programble infusion pump... .............. .............. .............. .............. ..............
E0783 A Programmable infusion pump..... .............. .............. .............. .............. ..............
E0784 A Ext amb infusn pump insulin.... .............. .............. .............. .............. ..............
E0785 A Replacement impl pump cathet... .............. .............. .............. .............. ..............
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....................... .............. .............. .............. .............. ..............
[[Page 18680]]
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... .............. .............. .............. .............. ..............
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.... .............. .............. .............. .............. ..............
[[Page 18681]]
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 976 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... .............. .............. .............. .............. ..............
E1390 A Oxygen concentrator............ .............. .............. .............. .............. ..............
E1399 A Durable medical equipment mi... .............. .............. .............. .............. ..............
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..... .............. .............. .............. .............. ..............
E1900 A Speech communication device.... .............. .............. .............. .............. ..............
[[Page 18682]]
G0001 A Drawing blood for specimen..... .............. .............. .............. .............. ..............
G0002 N Temporary urinary catheter..... .............. .............. .............. .............. ..............
G0004 S ECG transm phys review & int... 0100 1.70 $82.43 $71.57 $16.49
G0005 S ECG 24 hour recording.......... 0099 0.38 $18.43 $14.68 $3.69
G0006 S ECG transmission & analysis.... 0100 1.70 $82.43 $71.57 $16.49
G0007 N ECG phy review & interpret..... .............. .............. .............. .............. ..............
2 G0008 X Admin influenza virus vac...... 0354 0.13 $6.19 .............. ..............
G0009 N Admin pneumococcal vaccine..... .............. .............. .............. .............. ..............
G0010 N Admin hepatitis b vaccine...... .............. .............. .............. .............. ..............
G0015 S Post symptom ECG tracing....... 0099 0.38 $18.43 $14.68 $3.69
G0016 N Post symptom ECG md review..... .............. .............. .............. .............. ..............
G0025 X Collagen skin test kit......... 0343 0.45 $21.82 $12.16 $4.36
G0026 A Fecal leukocyte examination.... .............. .............. .............. .............. ..............
G0027 A Semen analysis................. .............. .............. .............. .............. ..............
G0030 S PET imaging prev PET single.... 0285 15.06 $730.22 $415.21 $146.04
G0031 S PET imaging prev PET multple... 0285 15.06 $730.22 $415.21 $146.04
G0032 S PET follow SPECT 78464 singl... 0285 15.06 $730.22 $415.21 $146.04
G0033 S PET follow SPECT 78464 mult.... 0285 15.06 $730.22 $415.21 $146.04
G0034 S PET follow SPECT 76865 singl... 0285 15.06 $730.22 $415.21 $146.04
G0035 S PET follow SPECT 78465 mult.... 0285 15.06 $730.22 $415.21 $146.04
G0036 S PET follow cornry angio sing... 0285 15.06 $730.22 $415.21 $146.04
G0037 S PET follow cornry angio mult... 0285 15.06 $730.22 $415.21 $146.04
G0038 S PET follow myocard perf sing... 0285 15.06 $730.22 $415.21 $146.04
G0039 S PET follow myocard perf mult... 0285 15.06 $730.22 $415.21 $146.04
G0040 S PET follow stress echo singl... 0285 15.06 $730.22 $415.21 $146.04
G0041 S PET follow stress echo mult.... 0285 15.06 $730.22 $415.21 $146.04
G0042 S PET follow ventriculogm sing... 0285 15.06 $730.22 $415.21 $146.04
G0043 S PET follow ventriculogm mult... 0285 15.06 $730.22 $415.21 $146.04
G0044 S PET following rest ECG singl... 0285 15.06 $730.22 $415.21 $146.04
G0045 S PET following rest ECG mult.... 0285 15.06 $730.22 $415.21 $146.04
G0046 S PET follow stress ECG singl.... 0285 15.06 $730.22 $415.21 $146.04
G0047 S PET follow stress ECG mult..... 0285 15.06 $730.22 $415.21 $146.04
G0050 S Residual urine by ultrasound... 0265 1.17 $56.73 $38.08 $11.35
G0101 V CA screen; pelvic/breast exam.. 0601 1.00 $48.49 $9.70 $9.70
G0102 E Prostate ca screening; dre..... .............. .............. .............. .............. ..............
G0103 E Psa, total screening........... .............. .............. .............. .............. ..............
1 G0104 S CA screen; flexi sigmoidscope.. 0158 7.98 $386.93 .............. $96.73
1 G0105 S Colorectal scrn; hi risk ind... 0159 2.83 $137.22 .............. $34.31
2 G0106 S Colon CA screen; barium enema.. 0157 1.79 $86.79 .............. $17.36
G0107 A CA screen; fecal blood test.... .............. .............. .............. .............. ..............
G0108 A Diab manage trn per indiv...... .............. .............. .............. .............. ..............
G0109 A Diab manage trn ind/group...... .............. .............. .............. .............. ..............
G0110 A Nett pulm-rehab educ; ind...... .............. .............. .............. .............. ..............
G0111 A Nett pulm-rehab educ; group.... .............. .............. .............. .............. ..............
G0112 A Nett; nutrition guid, initial.. .............. .............. .............. .............. ..............
G0113 A Nett; nutrition guid, subseqnt. .............. .............. .............. .............. ..............
G0114 A Nett; psychosocial consult..... .............. .............. .............. .............. ..............
G0115 A Nett; psychological testing.... .............. .............. .............. .............. ..............
G0116 A Nett; psychosocial counsel..... .............. .............. .............. .............. ..............
2 G0120 S Colon ca scrn; barium enema.... 0157 1.79 $86.79 .............. $17.36
G0121 E Colon ca scrn not hi rsk ind... .............. .............. .............. .............. ..............
G0122 E Colon ca scrn; barium enema.... .............. .............. .............. .............. ..............
G0123 E Screen cerv/vag thin layer..... .............. .............. .............. .............. ..............
G0124 E Screen c/v thin layer by MD.... .............. .............. .............. .............. ..............
2 G0125 T Lung image (PET)............... 0980 38.67 $1,875.00 .............. $375.00
2 G0126 T Lung image (PET) staging....... 0980 38.67 $1,875.00 .............. $375.00
G0127 T Trim nail(s)................... 0009 0.74 $35.88 $9.63 $7.18
G0128 E CORF skilled nursing service... .............. .............. .............. .............. ..............
G0129 P Partial hosp prog service...... 0033 4.17 $202.19 $48.17 $40.44
G0130 X Single energy x-ray study...... 0261 1.38 $66.91 $38.77 $13.38
G0131 X CT scan, bone density study.... 0261 1.38 $66.91 $38.77 $13.38
G0132 X CT scan, bone density study.... 0261 1.38 $66.91 $38.77 $13.38
G0141 E Scr c/v cyto, autosys and md... .............. .............. .............. .............. ..............
G0143 E Scr c/v cyto, thinlayer, rescr. .............. .............. .............. .............. ..............
G0144 E Scr c/v cyto, thinlayer, rescr. .............. .............. .............. .............. ..............
G0145 E Scr c/v cyto, thinlayer, rescr. .............. .............. .............. .............. ..............
G0147 E Scr c/v cyto, automated sys.... .............. .............. .............. .............. ..............
G0148 E Scr c/v cyto, autosys, rescr... .............. .............. .............. .............. ..............
G0151 E HHCP-serv of pt, ea 15 min..... .............. .............. .............. .............. ..............
G0152 E HHCP-serv of ot, ea 15 min..... .............. .............. .............. .............. ..............
G0153 E HHCP-svs of s/l path, ea 15mn.. .............. .............. .............. .............. ..............
G0154 E HHCP-svs of rn, ea 15 min...... .............. .............. .............. .............. ..............
G0155 E HHCP-svs of csw, ea 15 min..... .............. .............. .............. .............. ..............
[[Page 18683]]
G0156 E HHCP-svs of aide, ea 15 min.... .............. .............. .............. .............. ..............
G0159 T Perc declot dialysis graft..... 0088 26.49 $1,284.42 $678.68 $256.88
G0160 C Cryo. ablation, prostate....... .............. .............. .............. .............. ..............
G0161 X Echo guide for cryo probes..... 0268 2.23 $108.13 $69.51 $21.63
2 G0163 T Pet for rec of colorectal ca... 0980 38.67 $1,875.00 .............. $375.00
2 G0164 T Pet for lymphoma staging....... 0980 38.67 $1,875.00 .............. $375.00
2 G0165 T Pet, rec of melanoma/met ca.... 0980 38.67 $1,875.00 .............. $375.00
2 G0166 T Extrnl counterpulse, per tx.... 0972 3.09 $149.83 .............. $29.97
G0167 S Hyperbaric oz tx; no md reqrd.. 0031 3.00 $145.46 $140.85 $29.09
G0168 T Wound closure by adhesive...... 0026 12.11 $587.18 $277.92 $117.44
G0169 T Removal tissue; no anesthsia... 0026 12.11 $587.18 $277.92 $117.44
G0170 T Skin biograft.................. 0026 12.11 $587.18 $277.92 $117.44
G0171 T Skin biograft add-on........... 0026 12.11 $587.18 $277.92 $117.44
G0172 P Partial hosp prog service...... 0033 4.17 $202.19 $48.17 $40.44
G0173 S Stereotactic, one session...... 0302 8.21 $398.08 $216.55 $79.62
G0174 S Stereotactic, mult session..... 0302 8.21 $398.08 $216.55 $79.62
G0175 V Multidisciplinary team visit... 0603 1.66 $80.49 $16.29 $16.10
J0120 N Tetracyclin injection.......... .............. .............. .............. .............. ..............
J0130 N Abciximab injection............ .............. .............. .............. .............. ..............
2 J0150 X Injection adenosine 6 MG....... 0917 0.36 $17.46 .............. $3.49
J0151 E Adenosine injection............ .............. .............. .............. .............. ..............
J0170 N Adrenalin epinephrin inject.... .............. .............. .............. .............. ..............
J0190 N Inj biperiden lactate/5 mg..... .............. .............. .............. .............. ..............
J0200 N Alatrofloxacin mesylate........ .............. .............. .............. .............. ..............
3 J0205 X Alglucerase injection.......... 0900 .............. .............. .............. $5.14
3 J0207 X Amifostine..................... 7000 .............. .............. .............. $41.99
J0210 N Methyldopate hcl injection..... .............. .............. .............. .............. ..............
3 J0256 X Alpha 1 proteinase inhibitor... 0901 .............. .............. .............. $15.22
J0270 E Alprostadil for injection...... .............. .............. .............. .............. ..............
J0275 E Alprostadil urethral suppos.... .............. .............. .............. .............. ..............
J0280 N Aminophyllin 250 MG inj........ .............. .............. .............. .............. ..............
J0285 N Amphotericin B................. .............. .............. .............. .............. ..............
3 J0286 X Amphotericin B lipid complex... 7001 .............. .............. .............. $12.12
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.......... .............. .............. .............. .............. ..............
J0395 N Arbutamine HCl injection....... .............. .............. .............. .............. ..............
J0400 N Inj trimethaphan camsylate..... .............. .............. .............. .............. ..............
J0456 N Azithromycin................... .............. .............. .............. .............. ..............
J0460 N Atropine sulfate injection..... .............. .............. .............. .............. ..............
J0470 N Dimecaprol injection........... .............. .............. .............. .............. ..............
J0475 N Baclofen 10 MG injection....... .............. .............. .............. .............. ..............
3 J0476 X Baclofen intrathecal trial..... 7021 .............. .............. .............. $.10
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.... .............. .............. .............. .............. ..............
3 J0585 X Botulinum toxin a per unit..... 0902 .............. .............. .............. $56.05
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........... .............. .............. .............. .............. ..............
3 J0640 X Leucovorin calcium injection... 0725 .............. .............. .............. $1.07
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... .............. .............. .............. .............. ..............
[[Page 18684]]
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.... .............. .............. .............. .............. ..............
3 J0735 X Clonidine hydrochloride........ 7002 .............. .............. .............. $4.17
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...... .............. .............. .............. .............. ..............
J0780 N Prochlorperazine injection..... .............. .............. .............. .............. ..............
J0800 N Corticotropin injection........ .............. .............. .............. .............. ..............
J0810 N Cortisone injection............ .............. .............. .............. .............. ..............
J0835 N Inj cosyntropin per 0.25 MG.... .............. .............. .............. .............. ..............
3 J0850 X Cytomegalovirus imm IV/vial.... 0903 .............. .............. .............. $54.11
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 Dexamethasone sodium phos...... .............. .............. .............. .............. ..............
J1110 N Inj dihydroergotamine mesylt... .............. .............. .............. .............. ..............
J1120 N Acetazolamid sodium injectio... .............. .............. .............. .............. ..............
J1160 N Digoxin injection.............. .............. .............. .............. .............. ..............
J1165 N Phenytoin sodium injection..... .............. .............. .............. .............. ..............
J1170 N Hydromorphone injection........ .............. .............. .............. .............. ..............
J1180 N Dyphylline injection........... .............. .............. .............. .............. ..............
3 J1190 X Dexrazoxane HCl injection...... 0726 .............. .............. .............. $18.81
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....... .............. .............. .............. .............. ..............
2 J1245 X Dipyridamole injection......... 0917 0.36 $17.46 .............. $3.49
J1250 N Inj dobutamine HCL/250 mg...... .............. .............. .............. .............. ..............
3 J1260 X Dolasetron mesylate............ 0750 .............. .............. .............. $1.94
J1320 N Amitriptyline injection........ .............. .............. .............. .............. ..............
3 J1325 X Epoprostenol injection......... 7003 .............. .............. .............. $2.23
J1327 N Eptifibatide 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 X Etidronate disodium inj........ 0727 .............. .............. .............. $9.31
J1438 N Etanercept injection........... .............. .............. .............. .............. ..............
3 J1440 X Filgrastim 300 mcg injeciton... 0728 .............. .............. .............. $25.21
J1441 E Filgrastim 480 mcg injection... .............. .............. .............. .............. ..............
J1450 N Fluconazole.................... .............. .............. .............. .............. ..............
J1455 N Foscarnet sodium injection..... .............. .............. .............. .............. ..............
J1460 N Gamma globulin 1 CC inj........ .............. .............. .............. .............. ..............
J1470 E Gamma globulin 2 CC inj........ .............. .............. .............. .............. ..............
J1480 E Gamma globulin 3 CC inj........ .............. .............. .............. .............. ..............
J1490 E Gamma globulin 4 CC inj........ .............. .............. .............. .............. ..............
J1500 E Gamma globulin 5 CC inj........ .............. .............. .............. .............. ..............
J1510 E Gamma globulin 6 CC inj........ .............. .............. .............. .............. ..............
[[Page 18685]]
J1520 E Gamma globulin 7 CC inj........ .............. .............. .............. .............. ..............
J1530 E Gamma globulin 8 CC inj........ .............. .............. .............. .............. ..............
J1540 E Gamma globulin 9 CC inj........ .............. .............. .............. .............. ..............
J1550 E Gamma globulin 10 CC inj....... .............. .............. .............. .............. ..............
J1560 E Gamma globulin > 10 CC inj..... .............. .............. .............. .............. ..............
3 J1561 X Immune globulin 500 mg......... 0905 .............. .............. .............. $6.40
3 J1562 X Immune globulin 5 gms.......... 7004 .............. .............. .............. $45.48
3 J1565 X RSV-ivig....................... 0906 .............. .............. .............. $85.53
2 J1570 X Ganciclovir sodium injection... 0907 0.51 $24.73 .............. $4.95
J1580 N Garamycin gentamicin inj....... .............. .............. .............. .............. ..............
J1600 N Gold sodium thiomaleate inj.... .............. .............. .............. .............. ..............
J1610 N Glucagon hydrochloride/1 MG.... .............. .............. .............. .............. ..............
3 J1620 X Gonadorelin hydroch/100 mcg.... 7005 .............. .............. .............. $9.12
3 J1626 X Granisetron HCl injection...... 0764 .............. .............. .............. $2.33
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.......... .............. .............. .............. .............. ..............
2 J1670 X Tetanus immune globulin inj.... 0908 0.90 $43.64 .............. $8.73
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... .............. .............. .............. .............. ..............
3 J1745 X Infliximab injection........... 7043 .............. .............. .............. $6.89
J1750 N Iron dextran................... .............. .............. .............. .............. ..............
3 J1785 X Injection imiglucerase/unit.... 0916 .............. .............. .............. $.58
J1790 N Droperidol injection........... .............. .............. .............. .............. ..............
J1800 N Propranolol injection.......... .............. .............. .............. .............. ..............
J1810 N Droperidol/fentanyl inj........ .............. .............. .............. .............. ..............
J1820 N Insulin injection.............. .............. .............. .............. .............. ..............
3 J1825 X Interferon beta-1a............. 0909 .............. .............. .............. $28.70
3 J1830 X Interferon beta-1b/.25 MG...... 0910 .............. .............. .............. $8.44
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........... .............. .............. .............. .............. ..............
3 J1950 X Leuprolide acetate/3.75 MG..... 0800 .............. .............. .............. $68.56
J1955 E Inj levocarnitine per 1 gm..... .............. .............. .............. .............. ..............
J1956 N Levofloxacin injection......... .............. .............. .............. .............. ..............
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.... .............. .............. .............. .............. ..............
2 J2260 X Inj milrinone lactate/5 ML..... 7007 0.47 $22.79 .............. $4.56
J2270 N Morphine sulfate injection..... .............. .............. .............. .............. ..............
J2271 N Morphine so4 injection 100mg... .............. .............. .............. .............. ..............
3 J2275 X Morphine sulfate injection..... 7010 .............. .............. .............. $.68
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... .............. .............. .............. .............. ..............
3 J2352 N Octreotide acetate injection... 7031 .............. .............. .............. $5.43
[[Page 18686]]
3 J2355 X Oprelvekin injection........... 7011 .............. .............. .............. $30.35
J2360 N Orphenadrine injection......... .............. .............. .............. .............. ..............
J2370 N Phenylephrine hcl injection.... .............. .............. .............. .............. ..............
J2400 N Chloroprocaine hcl injection... .............. .............. .............. .............. ..............
3 J2405 X Ondansetron hcl injection...... 0768 .............. .............. .............. $.87
J2410 N Oxymorphone hcl injection...... .............. .............. .............. .............. ..............
3 J2430 X Pamidronate disodium/30 MG..... 0730 .............. .............. .............. $30.93
J2440 N Papaverin hcl injection........ .............. .............. .............. .............. ..............
J2460 N Oxytetracycline injection...... .............. .............. .............. .............. ..............
J2480 N Hydrochlorides of opium inj.... .............. .............. .............. .............. ..............
J2500 N Paricalcitol................... .............. .............. .............. .............. ..............
J2510 N Penicillin g procaine inj...... .............. .............. .............. .............. ..............
J2512 N Inj pentagastrin per 2 ML...... .............. .............. .............. .............. ..............
J2515 N Pentobarbital sodium inj....... .............. .............. .............. .............. ..............
J2540 N Penicillin g potassium inj..... .............. .............. .............. .............. ..............
J2543 N Piperacillin/tazobactam........ .............. .............. .............. .............. ..............
3 J2545 X Pentamidine isethionte/300mg... 7012 .............. .............. .............. $8.73
J2550 N Promethazine hcl injection..... .............. .............. .............. .............. ..............
J2560 N Phenobarbital sodium inj....... .............. .............. .............. .............. ..............
J2590 N Oxytocin injection............. .............. .............. .............. .............. ..............
J2597 E 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..... .............. .............. .............. .............. ..............
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....... .............. .............. .............. .............. ..............
3 J2765 X Metoclopramide hcl injection... 0754 .............. .............. .............. $.19
J2780 N Ranitidine hydrochloride inj... .............. .............. .............. .............. ..............
3 J2790 X Rho d immune globulin inj...... 0884 .............. .............. .............. $3.78
J2792 N Rho(D) immune globulin h, sd... .............. .............. .............. .............. ..............
J2800 N Methocarbamol injection........ .............. .............. .............. .............. ..............
J2810 N Inj theophylline per 40 MG..... .............. .............. .............. .............. ..............
3 J2820 X Sargramostim injection......... 0731 .............. .............. .............. $16.97
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... .............. .............. .............. .............. ..............
2 J2994 X Reteplase double bolus......... 0914 38.20 $1,852.21 .............. $370.44
2 J2995 X Inj streptokinase/250000 IU.... 0911 1.64 $79.69 .............. $15.94
2 J2996 X Alteplase recombinant inj...... 0915 5.85 $283.70 .............. $56.74
J3000 N Streptomycin injection......... .............. .............. .............. .............. ..............
3 J3010 X Fentanyl citrate injeciton..... 7014 .............. .............. .............. $.19
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.......... .............. .............. .............. .............. ..............
2 J3245 X Tirofiban hydrochloride........ 7041 0.02 $.97 .............. $.19
J3250 N Trimethobenzamide hcl inj...... .............. .............. .............. .............. ..............
J3260 N Tobramycin sulfate injection... .............. .............. .............. .............. ..............
J3265 N Injection torsemide 10 mg/ml... .............. .............. .............. .............. ..............
J3270 N Imipramine hcl injection....... .............. .............. .............. .............. ..............
3 J3280 X Thiethylperazine maleate inj... 0755 .............. .............. .............. $.68
J3301 N Triamcinolone acetonide inj.... .............. .............. .............. .............. ..............
J3302 N Triamcinolone diacetate inj.... .............. .............. .............. .............. ..............
J3303 N Triamcinolone hexacetonl inj... .............. .............. .............. .............. ..............
3 J3305 X Inj trimetrexate glucoronate... 7045 .............. .............. .............. $8.15
J3310 N Perphenazine injeciton......... .............. .............. .............. .............. ..............
[[Page 18687]]
J3320 N Spectinomycn di-hcl inj........ .............. .............. .............. .............. ..............
J3350 N Urea injection................. .............. .............. .............. .............. ..............
J3360 N Diazepam injection............. .............. .............. .............. .............. ..............
J3364 N Urokinase 5000 IU injection.... .............. .............. .............. .............. ..............
2 J3365 X Urokinase 250,000 IU inj....... 7036 0.73 $35.40 .............. $7.08
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..... .............. .............. .............. .............. ..............
3 J7190 X Factor viii.................... 0925 .............. .............. .............. $.19
3 J7191 X Factor VIII (porcine).......... 0926 .............. .............. .............. $.19
3 J7192 X Factor viii recombinant........ 0927 .............. .............. .............. $.19
3 J7194 X Factor ix complex.............. 0928 .............. .............. .............. $.08
3 J7197 X Antithrombin iii injection..... 0930 .............. .............. .............. $.19
3 J7198 X Anti-inhibitor................. 0929 .............. .............. .............. $.27
J7199 E Hemophilia clot factor noc..... .............. .............. .............. .............. ..............
J7300 E Intraut copper contraceptive... .............. .............. .............. .............. ..............
3 J7310 X Ganciclovir long act implant... 0913 .............. .............. .............. $701.51
J7315 N Sodium hyaluronate injection... .............. .............. .............. .............. ..............
J7320 N Hylan G-F 20 injection......... .............. .............. .............. .............. ..............
2 J7500 X Azathioprine oral 50mg......... 0886 0.02 $.97 .............. $.19
2 J7501 X Azathioprine parenteral........ 0887 1.40 $67.88 .............. $13.58
2 J7502 X Cyclosporine oral 100 mg....... 0888 0.08 $3.88 .............. $.78
2 J7504 X Lymphocyte immune globulin..... 0890 3.79 $183.77 .............. $36.75
3 J7505 E Monoclonal antibodies.......... 7038 .............. .............. .............. $89.60
J7506 N Prednisone oral................ .............. .............. .............. .............. ..............
2 J7507 X Tacrolimus oral per 1 MG....... 0891 3.15 $152.73 .............. $30.55
J7508 E Tacrolimus oral per 5 MG....... .............. .............. .............. .............. ..............
J7509 N Methylprednisolone oral........ .............. .............. .............. .............. ..............
J7510 N Prednisolone oral per 5 mg..... .............. .............. .............. .............. ..............
J7513 X Daclizumab, parenteral......... .............. .............. .............. .............. ..............
J7515 N Cyclosporine oral 25 mg........ .............. .............. .............. .............. ..............
2 J7516 X Cyclosporin parenteral 250mg... 0889 0.36 $17.46 .............. $3.49
J7517 N Mycophenolate mofetil oral..... .............. .............. .............. .............. ..............
J7599 E Immunosuppressive drug noc..... .............. .............. .............. .............. ..............
J7608 A Acetylcysteine inh sol u d..... .............. .............. .............. .............. ..............
J7610 A Acetylcysteine 10% injection... .............. .............. .............. .............. ..............
J7615 A Acetylcysteine 20% injection... .............. .............. .............. .............. ..............
J7618 A Albuterol inh sol con.......... .............. .............. .............. .............. ..............
J7619 A Albuterol inh sol u d.......... .............. .............. .............. .............. ..............
J7620 A Albuterol sulfate .083%/ml..... .............. .............. .............. .............. ..............
J7625 A Albuterol sulfate .5% inj...... .............. .............. .............. .............. ..............
J7627 A Bitolterolmesylate inhal sol... .............. .............. .............. .............. ..............
J7628 A Bitolterol mes inhal sol con... .............. .............. .............. .............. ..............
J7629 A Bitolterol mes inh sol u d..... .............. .............. .............. .............. ..............
J7630 A Cromolyn sodium injeciton...... .............. .............. .............. .............. ..............
J7631 A Cromolyn sodium inh sol u d.... .............. .............. .............. .............. ..............
J7635 A Atropine inhal sol con......... .............. .............. .............. .............. ..............
J7636 A Atropine inhal sol unit dose... .............. .............. .............. .............. ..............
J7637 A Dexamethasone inhal sol con.... .............. .............. .............. .............. ..............
J7638 A Dexamethasone inhal sol u d.... .............. .............. .............. .............. ..............
[[Page 18688]]
J7639 A Dornase alpha inhal sol u d.... .............. .............. .............. .............. ..............
J7640 A Epinephrine injection.......... .............. .............. .............. .............. ..............
J7642 A Glycopyrrolate inhal sol con... .............. .............. .............. .............. ..............
J7643 A Glycopyrrolate inhal sol u d... .............. .............. .............. .............. ..............
J7644 A Ipratropium brom inh sol u d... .............. .............. .............. .............. ..............
J7645 A Ipratropium bromide .02%/ml.... .............. .............. .............. .............. ..............
J7648 A Isoetharine hcl inh sol con.... .............. .............. .............. .............. ..............
J7649 A Isoetharine hcl inh sol u d.... .............. .............. .............. .............. ..............
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......... .............. .............. .............. .............. ..............
J7658 A Isoproterenolhcl inh sol con... .............. .............. .............. .............. ..............
J7659 A Isoproterenol hcl inh sol ud... .............. .............. .............. .............. ..............
J7660 A Isoproterenol hcl .5% inj...... .............. .............. .............. .............. ..............
J7665 A Isoproterenol hcl 1% inj....... .............. .............. .............. .............. ..............
J7668 A Metaproterenol inh sol con..... .............. .............. .............. .............. ..............
J7669 A Metaproterenol inh sol u d..... .............. .............. .............. .............. ..............
J7670 A Metaproterenol sulfate .4%..... .............. .............. .............. .............. ..............
J7672 A Metaproterenol sulfate .6%..... .............. .............. .............. .............. ..............
J7675 A Metaproterenol sulfate 5%...... .............. .............. .............. .............. ..............
J7680 A Terbutaline so4 inh sol con.... .............. .............. .............. .............. ..............
J7681 A Terbutaline so4 inh sol u d.... .............. .............. .............. .............. ..............
J7682 A Tobramycin inhalation sol...... .............. .............. .............. .............. ..............
J7683 A Triamcinolone inh sol con...... .............. .............. .............. .............. ..............
J7684 A Triamcinolone inh sol u d...... .............. .............. .............. .............. ..............
J7699 A Inhalation solution for DME.... .............. .............. .............. .............. ..............
J7799 A Non-inhalation drug for DME.... .............. .............. .............. .............. ..............
3 J7913 X Daclizumab, Parenteral, 25 m... 0892 .............. .............. .............. $54.11
J8499 E Oral prescrip drug non chemo... .............. .............. .............. .............. ..............
3 J8510 X Oral busulfan.................. 7015 .............. .............. .............. $.19
3 J8520 X Capecitabine, oral, 150 mg..... 7042 .............. .............. .............. $.19
J8521 N Capecitabine, oral, 500 mg..... .............. .............. .............. .............. ..............
3 J8530 X Cyclophosphamide oral 25 MG.... 0801 .............. .............. .............. $.19
3 J8560 X Etoposide oral 50 MG........... 0802 .............. .............. .............. $3.10
3 J8600 X Melphalan oral 2 MG............ 0803 .............. .............. .............. $.19
3 J8610 X Methotrexate oral 2.5 MG....... 0826 .............. .............. .............. $.29
J8999 E Oral prescription drug chemo... .............. .............. .............. .............. ..............
3 J9000 X Doxorubic hcl 10 MG vl chemo... 0847 .............. .............. .............. $2.81
3 J9001 X Doxorubicin hcl liposome inj... 7046 .............. .............. .............. $39.18
3 J9015 X Aldesleukin/single use vial.... 0807 .............. .............. .............. $65.07
3 J9020 X Asparaginase injection......... 0814 .............. .............. .............. $8.34
3 J9031 X Bcg live intravesical vac...... 0809 .............. .............. .............. $19.78
3 J9040 X Bleomycin sulfate injection.... 0857 .............. .............. .............. $48.29
3 J9045 X Carboplatin injection.......... 0811 .............. .............. .............. $13.96
3 J9050 X Carmus bischl nitro inj........ 0812 .............. .............. .............. $10.57
3 J9060 X Cisplatin 10 MG injeciton...... 0813 .............. .............. .............. $4.56
J9062 E Cisplatin 50 MG injeciton...... .............. .............. .............. .............. ..............
3 J9065 X Inj cladribine per 1 MG........ 0858 .............. .............. .............. $8.24
3 J9070 X Cyclophosphamide 100 MG inj.... 0815 .............. .............. .............. $.48
J9080 E Cyclophosphamide 200 MG inj.... .............. .............. .............. .............. ..............
J9090 E Cyclophosphamide 500 MG inj.... .............. .............. .............. .............. ..............
J9091 E Cyclophosphamide 1.0 grm inj... .............. .............. .............. .............. ..............
J9092 E Cyclophosphamide 2.0 grm inj... .............. .............. .............. .............. ..............
3 J9093 X Cyclophosphamide lyophilized... 0816 .............. .............. .............. $1.16
J9094 E Cyclophosphamide lyophilized... .............. .............. .............. .............. ..............
J9095 E Cyclophosphamide lyophilized... .............. .............. .............. .............. ..............
J9096 E Cyclophosphamide lyophilized... .............. .............. .............. .............. ..............
J9097 E Cyclophosphamide lyophilized... .............. .............. .............. .............. ..............
3 J9100 X Cytarabine hcl 100 MG inj...... 0817 .............. .............. .............. $.68
J9110 E Cytarabine hcl 500 MG inj...... .............. .............. .............. .............. ..............
3 J9120 X Dactinomycin actinomycin d..... 0818 .............. .............. .............. $1.75
3 J9130 X Dacarbazine 10 MG inj.......... 0819 .............. .............. .............. $1.26
J9140 E Dacarbazine 200 MG inj......... .............. .............. .............. .............. ..............
3 J9150 X Daunorubicin................... 0820 .............. .............. .............. $11.64
3 J9151 X Daunorubicin citrate liposom... 0821 .............. .............. .............. $7.76
3 J9165 X Diethylstilbestrol injection... 0822 .............. .............. .............. $2.13
3 J9170 X Docetaxel...................... 0823 .............. .............. .............. $34.72
3 J9181 X Etoposide 10 MG inj............ 0824 .............. .............. .............. $.58
J9182 E Etoposide 100 MG inj........... .............. .............. .............. .............. ..............
3 J9185 X Fludarabine phosphate inj...... 0842 .............. .............. .............. $30.84
[[Page 18689]]
3 J9190 X Fluorouracil injection......... 0859 .............. .............. .............. $.19
3 J9200 X Floxuridine injection.......... 0827 .............. .............. .............. $18.81
3 J9201 X Gemcitabine HCl................ 0828 .............. .............. .............. $9.31
3 J9202 X Goserelin acetate implant...... 0810 .............. .............. .............. $59.74
3 J9206 X Irinotecan injection........... 0830 .............. .............. .............. $14.16
3 J9208 X Ifosfomide injection........... 0831 .............. .............. .............. $13.58
3 J9209 X Mesna injection................ 0732 .............. .............. .............. $2.42
3 J9211 X Idarubicin hcl injeciton....... 0832 .............. .............. .............. $46.45
3 J9212 X Interferon alfacon-1........... 0833 .............. .............. .............. $.19
3 J9213 X Interferon alfa-2a inj......... 0834 .............. .............. .............. $3.20
3 J9214 X Interferon alfa-2b inj......... 0836 .............. .............. .............. $1.36
3 J9215 X Interferon alfa-n3 inj......... 0865 .............. .............. .............. $1.07
3 J9216 X Interferon gamma 1-b inj....... 0838 .............. .............. .............. $22.79
J9217 E Leuprolide acetate suspnsion... .............. .............. .............. .............. ..............
3 J9218 X Leuprolide acetate injeciton... 0861 .............. .............. .............. $19.39
3 J9230 X Mechlorethamine hcl inj........ 0839 .............. .............. .............. $1.65
3 J9245 X Inj melphalan hydrochl 50 MG... 0840 .............. .............. .............. $44.71
3 J9250 X Methotrexate sodium inj........ 0841 .............. .............. .............. $.10
J9260 E Methotrexate sodium inj........ .............. .............. .............. .............. ..............
3 J9265 X Paclitaxel injection........... 0863 .............. .............. .............. $30.16
3 J9266 X Pegaspargase/singl dose vial... 0843 .............. .............. .............. $178.72
3 J9268 X Pentostatin injection.......... 0844 .............. .............. .............. $133.73
3 J9270 X Plicamycin (mithramycin) inj... 0860 .............. .............. .............. $1.36
3 J9280 X Mitomycin 5 MG inj............. 0862 .............. .............. .............. $19.88
J9290 E Mitomycin 20 MG inj............ .............. .............. .............. .............. ..............
J9291 E Mitomycin 40 MG inj............ .............. .............. .............. .............. ..............
3 J9293 X Mitoxantrone hydrochl/5 MG..... 0864 .............. .............. .............. $25.80
3 J9310 X Rituximab cancer treatment..... 0849 .............. .............. .............. $51.40
3 J9320 X Streptozocin injection......... 0850 .............. .............. .............. $14.64
3 J9340 X Thiotepa injection............. 0851 .............. .............. .............. $9.50
3 J9350 X Topotecan...................... 0852 .............. .............. .............. $73.22
J9355 N Trastuzumab.................... .............. .............. .............. .............. ..............
J9357 N Valrubicin, 200 mg............. .............. .............. .............. .............. ..............
3 J9360 X Vinblastine sulfate inj........ 0853 .............. .............. .............. $.39
3 J9370 X Vincristine sulfate 1 MG inj... 0854 .............. .............. .............. $2.23
J9375 E Vincristine sulfate 2 MG inj... .............. .............. .............. .............. ..............
J9380 E Vincristine sulfate 5 MG inj... .............. .............. .............. .............. ..............
3 J9390 X Vinorelbine tartrate/10 mg..... 0855 .............. .............. .............. $9.60
3 J9600 X Porfimer sodium................ 0856 .............. .............. .............. $34.62
J9999 E Chemotherapy drug.............. .............. .............. .............. .............. ..............
K0001 A Standard wheelchair............ .............. .............. .............. .............. ..............
K0002 A Stnd hemi (low seat) whlchr.... .............. .............. .............. .............. ..............
K0003 A Lightweight wheelchair......... .............. .............. .............. .............. ..............
K0004 A High strength ltwt whlchr...... .............. .............. .............. .............. ..............
K0005 A Ultralightweight wheelchair.... .............. .............. .............. .............. ..............
K0006 A Heavy duty wheelchair.......... .............. .............. .............. .............. ..............
K0007 A Extra heavy duty wheelchair.... .............. .............. .............. .............. ..............
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 Manual fully reclining back.... .............. .............. .............. .............. ..............
K0029 A Reinforced seat upholstery..... .............. .............. .............. .............. ..............
K0030 A Solid plnr seat sngl dnsfoam... .............. .............. .............. .............. ..............
K0031 A Safety belt/pelvic strap....... .............. .............. .............. .............. ..............
K0032 A Seat uphols lgtwt whlchr....... .............. .............. .............. .............. ..............
K0033 A Seat upholstery other whlchr... .............. .............. .............. .............. ..............
[[Page 18690]]
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......... .............. .............. .............. .............. ..............
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 Pwr wheelchair front caster.... .............. .............. .............. .............. ..............
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................ .............. .............. .............. .............. ..............
[[Page 18691]]
K0107 A Wheelchair tray................ .............. .............. .............. .............. ..............
K0108 A W/c component-accessory NOS.... .............. .............. .............. .............. ..............
K0112 A Trunk vest supprt innr frame... .............. .............. .............. .............. ..............
K0113 A Trunk vest suprt w/o inr frm... .............. .............. .............. .............. ..............
K0114 A Whlchr back suprt inr frame.... .............. .............. .............. .............. ..............
K0115 A Back module orthotic system.... .............. .............. .............. .............. ..............
K0116 A Back & seat modul orthot sys... .............. .............. .............. .............. ..............
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..... .............. .............. .............. .............. ..............
K0195 A Elevating whlchair leg rests... .............. .............. .............. .............. ..............
K0268 A Humidifier nonheated w PAP..... .............. .............. .............. .............. ..............
K0269 A Aerosol compressor cpap dev.... .............. .............. .............. .............. ..............
K0270 A Ultrasonic generator w nebul... .............. .............. .............. .............. ..............
K0280 A Extension drainage tubing...... .............. .............. .............. .............. ..............
K0281 A Lubricant catheter insertion... .............. .............. .............. .............. ..............
K0283 A Saline solution dispenser...... .............. .............. .............. .............. ..............
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...... .............. .............. .............. .............. ..............
K0415 E RX antiemetic drg, oral NOS.... .............. .............. .............. .............. ..............
K0416 E Rx antiemetic drg, rectal NOS.. .............. .............. .............. .............. ..............
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............ .............. .............. .............. .............. ..............
K0455 A Pump uninterrupted infusion.... .............. .............. .............. .............. ..............
K0456 A Heavyduty/xtra wide hosp bed... .............. .............. .............. .............. ..............
K0457 A Heavyduty/wide commode chair... .............. .............. .............. .............. ..............
K0458 A Heavyduty walker no wheels..... .............. .............. .............. .............. ..............
K0459 A Heavy duty wheeled walker...... .............. .............. .............. .............. ..............
K0460 A WC power add-on joystick....... .............. .............. .............. .............. ..............
K0461 A WC power add-on tiller cntrl... .............. .............. .............. .............. ..............
K0462 A Temporary replacement eqpmnt... .............. .............. .............. .............. ..............
K0501 A Aerosol compressor for svneb... .............. .............. .............. .............. ..............
K0529 A Sterile H20 or nss w lv neb.... .............. .............. .............. .............. ..............
K0531 A Heated humidifier used w pap... .............. .............. .............. .............. ..............
K0532 A Noninvasive assist wo backup... .............. .............. .............. .............. ..............
K0533 A Noninvasive assist w backup.... .............. .............. .............. .............. ..............
K0534 A Invasive assist w backup....... .............. .............. .............. .............. ..............
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... .............. .............. .............. .............. ..............
[[Page 18692]]
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.... .............. .............. .............. .............. ..............
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...... .............. .............. .............. .............. ..............
[[Page 18693]]
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.... .............. .............. .............. .............. ..............
L1680 A Pelvic & hip control thigh c... .............. .............. .............. .............. ..............
L1685 A Post-op hip abduct custom fa... .............. .............. .............. .............. ..............
L1686 A HO post-op hip abduction....... .............. .............. .............. .............. ..............
L1690 A Combination bilateral HO....... .............. .............. .............. .............. ..............
L1700 A Leg perthes orth toronto typ... .............. .............. .............. .............. ..............
L1710 A Legg perthes orth newington.... .............. .............. .............. .............. ..............
L1720 A Legg perthes orthosis trilat... .............. .............. .............. .............. ..............
L1730 A Legg perthes orth scottish r... .............. .............. .............. .............. ..............
L1750 A Legg perthes sling............. .............. .............. .............. .............. ..............
L1755 A Legg perthes patten bottom t... .............. .............. .............. .............. ..............
L1800 A Knee orthoses elas w stays..... .............. .............. .............. .............. ..............
L1810 A Ko elastic with joints......... .............. .............. .............. .............. ..............
L1815 A Elastic with condylar pads..... .............. .............. .............. .............. ..............
L1820 A Ko elas w/condyle pads & jo.... .............. .............. .............. .............. ..............
L1825 A Ko elastic knee cap............ .............. .............. .............. .............. ..............
L1830 A Ko immobilizer canvas longit... .............. .............. .............. .............. ..............
L1832 A KO adj jnt pos rigid support... .............. .............. .............. .............. ..............
L1834 A Ko w/0 joint rigid molded to... .............. .............. .............. .............. ..............
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... .............. .............. .............. .............. ..............
L1847 A KO adjustable w air chambers... .............. .............. .............. .............. ..............
L1850 A Ko swedish type................ .............. .............. .............. .............. ..............
L1855 A Ko plas doub upright jnt mol... .............. .............. .............. .............. ..............
L1858 A Ko polycentric pneumatic pad... .............. .............. .............. .............. ..............
L1860 A Ko supracondylar socket mold... .............. .............. .............. .............. ..............
L1870 A Ko doub upright lacers molde... .............. .............. .............. .............. ..............
L1880 A Ko doub upright cuffs/lacers... .............. .............. .............. .............. ..............
L1885 A Knee upright w/resistance...... .............. .............. .............. .............. ..............
L1900 A Afo sprng wir drsflx calf bd... .............. .............. .............. .............. ..............
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..... .............. .............. .............. .............. ..............
[[Page 18694]]
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...... .............. .............. .............. .............. ..............
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... .............. .............. .............. .............. ..............
[[Page 18695]]
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... .............. .............. .............. .............. ..............
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... .............. .............. .............. .............. ..............
[[Page 18696]]
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... .............. .............. .............. .............. ..............
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. .............. .............. .............. .............. ..............
L3675 A Canvas vest SO................. .............. .............. .............. .............. ..............
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... .............. .............. .............. .............. ..............
L3807 A Whfo w inflatable airchamber... .............. .............. .............. .............. ..............
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............. .............. .............. .............. .............. ..............
[[Page 18697]]
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.... .............. .............. .............. .............. ..............
L3969 A Monosuspension arm/hand supp... .............. .............. .............. .............. ..............
L3970 A Elevat proximal arm support.... .............. .............. .............. .............. ..............
L3972 A Offset/lat rocker arm w/ela.... .............. .............. .............. .............. ..............
L3974 A Mobile arm support supinator... .............. .............. .............. .............. ..............
L3980 A Upp ext fx orthosis humeral.... .............. .............. .............. .............. ..............
L3982 A Upper ext fx orthosis rad/ul... .............. .............. .............. .............. ..............
L3984 A Upper ext fx orthosis wrist.... .............. .............. .............. .............. ..............
L3985 A Forearm hand fx orth w/wr h.... .............. .............. .............. .............. ..............
L3986 A Humeral rad/ulna wrist fx or... .............. .............. .............. .............. ..............
L3995 A Sock fracture or equal each.... .............. .............. .............. .............. ..............
L3999 A Upper limb orthosis NOS........ .............. .............. .............. .............. ..............
L4000 A Repl girdle milwaukee orth..... .............. .............. .............. .............. ..............
L4010 A Replace trilateral socket br... .............. .............. .............. .............. ..............
L4020 A Replace quadlat socket brim.... .............. .............. .............. .............. ..............
L4030 A Replace socket brim cust fit... .............. .............. .............. .............. ..............
L4040 A Replace molded thigh lacer..... .............. .............. .............. .............. ..............
L4045 A Replace non-molded thigh lac... .............. .............. .............. .............. ..............
L4050 A Replace molded calf lacer...... .............. .............. .............. .............. ..............
L4055 A Replace non-molded calf lace... .............. .............. .............. .............. ..............
L4060 A Replace high roll cuff......... .............. .............. .............. .............. ..............
L4070 A Replace prox & dist upright.... .............. .............. .............. .............. ..............
L4080 A Repl met band kafo-afo prox.... .............. .............. .............. .............. ..............
L4090 A Repl met band kafo-afo calf/... .............. .............. .............. .............. ..............
L4100 A Repl leath cuff kafo prox th... .............. .............. .............. .............. ..............
L4110 A Repl leath cuff kafo-afo cal... .............. .............. .............. .............. ..............
L4130 A Replace pretibial shell........ .............. .............. .............. .............. ..............
L4205 A Ortho dvc repair per 15 min.... .............. .............. .............. .............. ..............
L4210 A Orth dev repair/repl minor p... .............. .............. .............. .............. ..............
L4350 A Pneumatic ankle cntrl splint... .............. .............. .............. .............. ..............
L4360 A Pneumatic walking splint....... .............. .............. .............. .............. ..............
L4370 A Pneumatic full leg splint...... .............. .............. .............. .............. ..............
L4380 A Pneumatic knee splint.......... .............. .............. .............. .............. ..............
L4392 A Replace AFO soft interface..... .............. .............. .............. .............. ..............
L4394 A Replace foot drop spint........ .............. .............. .............. .............. ..............
L4396 A Static AFO..................... .............. .............. .............. .............. ..............
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.... .............. .............. .............. .............. ..............
[[Page 18698]]
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.... .............. .............. .............. .............. ..............
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... .............. .............. .............. .............. ..............
[[Page 18699]]
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...... .............. .............. .............. .............. ..............
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...... .............. .............. .............. .............. ..............
L5968 A Multiaxial ankle w dorsiflex... .............. .............. .............. .............. ..............
[[Page 18700]]
L5970 A Foot external keel sach foot... .............. .............. .............. .............. ..............
L5972 A Flexible keel foot............. .............. .............. .............. .............. ..............
L5974 A Foot single axis ankle/foot.... .............. .............. .............. .............. ..............
L5975 A Combo ankle/foot prosthesis.... .............. .............. .............. .............. ..............
L5976 A Energy storing foot............ .............. .............. .............. .............. ..............
L5978 A Ft prosth multiaxial ankl/ft... .............. .............. .............. .............. ..............
L5979 A Multi-axial ankle/ft prosth.... .............. .............. .............. .............. ..............
L5980 A Flex foot system............... .............. .............. .............. .............. ..............
L5981 A Flex-walk sys low ext prosth... .............. .............. .............. .............. ..............
L5982 A Exoskeletal axial rotation u... .............. .............. .............. .............. ..............
L5984 A Endoskeletal axial rotation.... .............. .............. .............. .............. ..............
L5985 A Lwr ext dynamic prosth pylon... .............. .............. .............. .............. ..............
L5986 A Multi-axial rotation unit...... .............. .............. .............. .............. ..............
L5987 A Shank ft w vert load pylon..... .............. .............. .............. .............. ..............
L5988 A Vertical shock reducing pylo... .............. .............. .............. .............. ..............
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..... .............. .............. .............. .............. ..............
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..... .............. .............. .............. .............. ..............
[[Page 18701]]
L6672 A Harness chest/shlder saddle.... .............. .............. .............. .............. ..............
L6675 A Harness figure of 8 sing con... .............. .............. .............. .............. ..............
L6676 A Harness figure of 8 dual con... .............. .............. .............. .............. ..............
L6680 A Test sock wrist disart/bel e... .............. .............. .............. .............. ..............
L6682 A Test sock elbw disart/above.... .............. .............. .............. .............. ..............
L6684 A Test socket shldr disart/tho... .............. .............. .............. .............. ..............
L6686 A Suction socket................. .............. .............. .............. .............. ..............
L6687 A Frame typ socket bel elbow/w... .............. .............. .............. .............. ..............
L6688 A Frame typ sock above elb/dis... .............. .............. .............. .............. ..............
L6689 A Frame typ socket shoulder di... .............. .............. .............. .............. ..............
L6690 A Frame typ sock interscap-tho... .............. .............. .............. .............. ..............
L6691 A Removable insert each.......... .............. .............. .............. .............. ..............
L6692 A Silicone gel insert or equal... .............. .............. .............. .............. ..............
L6693 A Lockingelbow forearm cntrbal... .............. .............. .............. .............. ..............
L6700 A Terminal device model #3....... .............. .............. .............. .............. ..............
L6705 A Terminal device model #5....... .............. .............. .............. .............. ..............
L6710 A Terminal device model #5x...... .............. .............. .............. .............. ..............
L6715 A Terminal device model #5xa..... .............. .............. .............. .............. ..............
L6720 A Terminal device model #6....... .............. .............. .............. .............. ..............
L6725 A Terminal device model #7....... .............. .............. .............. .............. ..............
L6730 A Terminal device model #7lo..... .............. .............. .............. .............. ..............
L6735 A Terminal device model #8....... .............. .............. .............. .............. ..............
L6740 A Terminal device model #8x...... .............. .............. .............. .............. ..............
L6745 A Terminal device model #88x..... .............. .............. .............. .............. ..............
L6750 A Terminal device model #10p..... .............. .............. .............. .............. ..............
L6755 A Terminal device model #10x..... .............. .............. .............. .............. ..............
L6765 A Terminal device model #12p..... .............. .............. .............. .............. ..............
L6770 A Terminal device model #99x..... .............. .............. .............. .............. ..............
L6775 A Terminal device model #555..... .............. .............. .............. .............. ..............
L6780 A Terminal device model #ss555... .............. .............. .............. .............. ..............
L6790 A Hooks-accu hook or equal....... .............. .............. .............. .............. ..............
L6795 A Hooks-2 load or equal.......... .............. .............. .............. .............. ..............
L6800 A Hooks-aprl vc or equal......... .............. .............. .............. .............. ..............
L6805 A Modifier wrist flexion unit.... .............. .............. .............. .............. ..............
L6806 A Trs grip vc or equal........... .............. .............. .............. .............. ..............
L6807 A Term device grip 1/2 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... .............. .............. .............. .............. ..............
[[Page 18702]]
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.............. .............. .............. .............. .............. ..............
L8015 A Ext breastprosthesis garment... .............. .............. .............. .............. ..............
L8020 A Mastectomy form................ .............. .............. .............. .............. ..............
L8030 A Breast prosthesis silicone/e... .............. .............. .............. .............. ..............
L8035 A Custom breast prosthesis....... .............. .............. .............. .............. ..............
L8039 A Breast prosthesis NOS.......... .............. .............. .............. .............. ..............
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... .............. .............. .............. .............. ..............
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... .............. .............. .............. .............. ..............
L8195 A Gc stocking waistlngth 30-40... .............. .............. .............. .............. ..............
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..... .............. .............. .............. .............. ..............
[[Page 18703]]
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......... .............. .............. .............. .............. ..............
L9900 A O&P supply/accessory/service... .............. .............. .............. .............. ..............
M0064 X Visit for drug monitoring...... 0374 1.17 $56.73 $13.08 $11.35
M0075 E Cellular therapy............... .............. .............. .............. .............. ..............
M0076 E Prolotherapy................... .............. .............. .............. .............. ..............
M0100 E Intragastric hypothermia....... .............. .............. .............. .............. ..............
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 E Screening pap smear by phys.... .............. .............. .............. .............. ..............
P7001 E Culture bacterial urine........ .............. .............. .............. .............. ..............
2 P9010 S Whole blood for transfusion.... 0950 2.08 $101.02 .............. $20.20
P9011 S Blood split unit............... .............. .............. .............. .............. ..............
2 P9012 S Cryoprecipitate each unit...... 0952 0.70 $33.92 .............. $6.78
2 P9013 S Unit/s blood fibrinogen........ 0953 0.48 $23.27 .............. $4.65
2 P9016 S Leukocyte poor blood, unit..... 0954 2.83 $137.21 .............. $27.44
2 P9017 S One donor fresh frozn plasma... 0955 2.26 $109.35 .............. $21.87
2 P9018 S Plasma protein fract, unit..... 0956 1.26 $61.09 .............. $12.22
2 P9019 S Platelet concentrate unit...... 0957 0.98 $47.46 .............. $9.49
2 P9020 S Platelet rich plasma unit...... 0958 1.16 $56.25 .............. $11.25
2 P9021 S Red blood cells unit........... 0959 2.04 $99.04 .............. $19.81
2 P9022 S Washed red blood cells unit.... 0960 3.81 $184.53 .............. $36.91
2 P9023 S Frozen plasma, pooled, sd...... 0949 3.49 $169.22 .............. $33.84
P9603 A One-way allow prorated miles... .............. .............. .............. .............. ..............
P9604 A One-way allow prorated trip.... .............. .............. .............. .............. ..............
P9612 N Catheterize for urine spec..... .............. .............. .............. .............. ..............
P9615 N Urine specimen collect mult.... .............. .............. .............. .............. ..............
2 0034 X Admin of influenza vaccine..... 0354 0.13 $6.19 .............. ..............
Q0035 X Cardiokymography............... 0366 0.38 $18.43 $15.60 $3.69
Q0081 S Infusion ther other than che... 0120 1.66 $80.49 $42.67 $16.10
Q0082 P Activity therapy w/partial h... 0033 4.17 $202.19 $48.17 $40.44
Q0083 S Chemo by other than infusion... 0116 2.34 $113.46 $22.69 $22.69
Q0084 S Chemotherapy by infusion....... 0117 1.84 $89.22 $71.80 $17.84
Q0085 S Chemo by both infusion and o... 0118 2.90 $140.61 $72.03 $28.12
Q0086 A Physical therapy evaluation/... .............. .............. .............. .............. ..............
Q0091 T Obtaining screen pap smear..... 0191 1.19 $57.70 $17.43 $11.54
Q0092 N Set up port x-ray 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........ .............. .............. .............. .............. ..............
3 Q0136 X Non esrd epoetin alpha inj..... 0733 .............. .............. .............. $1.75
Q0144 E Azithromycin dihydrate, oral... .............. .............. .............. .............. ..............
2 Q0156 X Human albumin 5%............... 0961 2.77 $134.31 .............. $26.86
2 Q0157 X Human albumin 25%.............. 0962 1.38 $66.91 .............. $13.38
3 Q0160 X Factor IX non-recombinant...... 0931 .............. .............. .............. $.04
3 Q0161 X Factor IX recombinant.......... 0932 .............. .............. .............. $.10
3 Q0163 X Diphenhydramine HCl 50mg....... 0761 .............. .............. .............. $.10
3 Q0164 X Prochlorperazine maleate 5mg... 0761 .............. .............. .............. $.10
Q0165 E Prochlorperazine maleate10mg... .............. .............. .............. .............. ..............
3 Q0166 X Granisetron HCl 1 mg oral...... 0765 .............. .............. .............. $3.20
3 Q0167 X Dronabinol 2.5mg oral.......... 0762 .............. .............. .............. $.48
Q0168 E Dronabinol 5mg oral............ .............. .............. .............. .............. ..............
3 Q0169 X Promethazine HCl 12.5mg oral... 0761 .............. .............. .............. $.10
Q0170 E Promethazine HCl 25 mg oral.... .............. .............. .............. .............. ..............
[[Page 18704]]
3 Q0171 X Chlorpromazine HCl 10mg oral... 0761 .............. .............. .............. $.10
Q0172 E Chlorpromazine HCl 25mg oral... .............. .............. .............. .............. ..............
3 Q0173 X Trimethobenzamide HCl 250mg.... 0761 .............. .............. .............. $.10
3 Q0174 X Thiethylperazine maleate10mg... 0761 .............. .............. .............. $.10
3 Q0175 X Perphenazine 4mg oral.......... 0761 .............. .............. .............. $.10
Q0176 E Perphenazine 8mg oral.......... .............. .............. .............. .............. ..............
3 Q0177 X Hydroxyzine pamoate 25mg....... 0761 .............. .............. .............. $.10
Q0178 E Hydroxyzine pamoate 50mg....... .............. .............. .............. .............. ..............
3 Q0179 X Ondansetron HCl 8mg oral....... 0769 .............. .............. .............. $2.62
3 Q0180 X Dolasetron mesylate oral....... 0763 .............. .............. .............. $8.53
Q0181 E Unspecified oral anti-emetic... .............. .............. .............. .............. ..............
Q0183 N Nonmetabolic active tissue..... .............. .............. .............. .............. ..............
Q0184 N Metabolically active tissue.... .............. .............. .............. .............. ..............
Q0185 N Metabolic active D/E tissue.... .............. .............. .............. .............. ..............
Q0186 E Paramedic intercept, rural..... .............. .............. .............. .............. ..............
3 Q0187 X Factor viia recombinant........ 0929 .............. .............. .............. $.27
Q1001 E Ntiol category 1............... .............. .............. .............. .............. ..............
Q1002 E Ntiol category 2............... .............. .............. .............. .............. ..............
Q1003 E Ntiol category 3............... .............. .............. .............. .............. ..............
Q1004 E Ntiol category 4............... .............. .............. .............. .............. ..............
Q1005 E Ntiol category 5............... .............. .............. .............. .............. ..............
Q2001 E Cabergoline, 0.5 mg, oral...... .............. .............. .............. .............. ..............
3 Q2002 X Elliot's B solution............ 7022 .............. .............. .............. $19.20
3 Q2003 X Aprotinin, 10,000 kiu.......... 7019 .............. .............. .............. $2.42
3 Q2004 X Treatment for bladder calcul... 7023 .............. .............. .............. $4.46
3 Q2005 X Corticorelin ovine triflutat... 7024 .............. .............. .............. $45.77
3 Q2006 X Digoxin immune FAB (Ovine),.... 7025 .............. .............. .............. $14.06
3 Q2007 X Ethanolamine oleate, 1000 ml... 7026 .............. .............. .............. $2.13
3 Q2008 X Fomepizole, 1.5 G.............. 7027 .............. .............. .............. $141.29
3 Q2009 X Fosphenytoin, 50 mg............ 7028 .............. .............. .............. $.78
3 Q2010 X Glatiramer acetate, 25 mgeny... 7029 .............. .............. .............. $3.59
3 Q2011 X Hemin, 1 mg.................... 7030 .............. .............. .............. $.10
3 Q2012 X Pegademase bovine inj 25 I.U... 7039 .............. .............. .............. $1.16
3 Q2013 X Pentastarch 10% inj, 100 ml.... 7040 .............. .............. .............. $2.04
3 Q2014 X Sermorelin acetate, 0.5 mg..... 7032 .............. .............. .............. $53.34
3 Q2015 X Somatrem, 5 mg................. 7033 .............. .............. .............. $28.03
3 Q2016 X Somatropin, 1 mg............... 7034 .............. .............. .............. $5.04
3 Q2017 X Teniposide, 50 mg.............. 7035 .............. .............. .............. $20.85
3 Q2018 X Urofollitropin, 75 I.U......... 7037 .............. .............. .............. $8.24
3 Q3001 S Brachytherapy Seeds............ 0918 .............. .............. .............. $9.99
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.... .............. .............. .............. .............. ..............
[[Page 18705]]
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... .............. .............. .............. .............. ..............
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... .............. .............. .............. .............. ..............
[[Page 18706]]
V2531 A Contact lens gas permeable..... .............. .............. .............. .............. ..............
V2599 A Contact lens/es other type..... .............. .............. .............. .............. ..............
V2600 A Hand held low vision aids...... .............. .............. .............. .............. ..............
V2610 A Single lens spectacle mount.... .............. .............. .............. .............. ..............
V2615 A Telescop/othr compound lens.... .............. .............. .............. .............. ..............
V2623 A Plastic eye prosth custom...... .............. .............. .............. .............. ..............
V2624 A Polishing artifical eye........ .............. .............. .............. .............. ..............
V2625 A Enlargemnt of eye prosthesis... .............. .............. .............. .............. ..............
V2626 A Reduction of eye prosthesis.... .............. .............. .............. .............. ..............
V2627 A Scleral cover shell............ .............. .............. .............. .............. ..............
V2628 A Fabrication & fitting.......... .............. .............. .............. .............. ..............
V2629 A Prosthetic eye other type...... .............. .............. .............. .............. ..............
V2630 N Anter chamber intraocul lens... .............. .............. .............. .............. ..............
V2631 N Iris support intraoclr lens.... .............. .............. .............. .............. ..............
V2632 N Post chmbr intraocular lens.... .............. .............. .............. .............. ..............
V2700 A Balance lens................... .............. .............. .............. .............. ..............
V2710 A Glass/plastic slab off prism... .............. .............. .............. .............. ..............
V2715 A Prism lens/es.................. .............. .............. .............. .............. ..............
V2718 A Fresnell prism press-on lens... .............. .............. .............. .............. ..............
V2730 A Special base curve............. .............. .............. .............. .............. ..............
V2740 A Rose tint plastic.............. .............. .............. .............. .............. ..............
V2741 A Non-rose tint plastic.......... .............. .............. .............. .............. ..............
V2742 A Rose tint glass................ .............. .............. .............. .............. ..............
V2743 A Non-rose tint glass............ .............. .............. .............. .............. ..............
V2744 A Tint photochromatic lens/es.... .............. .............. .............. .............. ..............
V2750 A Anti-reflective coating........ .............. .............. .............. .............. ..............
V2755 A UV lens/es..................... .............. .............. .............. .............. ..............
V2760 A Scratch resistant coating...... .............. .............. .............. .............. ..............
V2770 A Occluder lens/es............... .............. .............. .............. .............. ..............
V2780 A Oversize lens/es............... .............. .............. .............. .............. ..............
V2781 A Progressive lens per lens...... .............. .............. .............. .............. ..............
V2785 A 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............ .............. .............. .............. .............. ..............
--------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------
CPT codes and descriptions only are copyright American Medical
Association. All Rights Reserved. Applicable FARS/DFARS Apply.
Copyright American Dental Association. All rights reserved.
\1\ Not subject to national coinsurance. Minimum unadjusted coinsurance
is 25% of the payment rate. The payment rate is the lower of the HOPD
payment rate or the Ambulatory Surgical Center payment.
\2\ Not subject to national coinsurance.
\3\ Eligible for pass-through payments. See Preamble for payment rate
determination. See Addendum K for complete list of pass-through codes.
Addendum C.--Proposed Hospital Outpatient Department (HOPD) Payment for Procedures by APC
----------------------------------------------------------------------------------------------------------------
National Minimum
APC CPT/ HCPCS Description Status Relative Payment Unadjusted Unadjusted
HCPCS Indicator Weight Rate Coinsurance Coinsurance
----------------------------------------------------------------------------------------------------------------
0001 Photochemotherapy S 0.47 $22.79 $8.49 $4.56
[[Page 18707]]
96900 Ultraviolet light
therapy
96910 Photochemotherapy
with UV-B
96912 Photochemotherapy
with UV-A
96913 Photochemotherapy,
UV-A or B
96999 Dermatological
procedure
0002 Fine needle Biopsy/Aspiration T 0.62 $30.06 $17.66 $6.01
60001 Aspirate/inject
thyriod cyst
88170 Fine needle
aspiration
88171 Fine needle
aspiration
0003 Bone Marrow Biopsy/Aspiration T 0.98 $47.52 $27.99 $9.50
85095 Bone marrow
aspiration
85102 Bone marrow biopsy
0004 Level I Needle Biopsy/ T 1.84 $89.22 $32.57 $17.84
Aspiration Except Bone Marrow
17999 Skin tissue
procedure
19000 Drainage of breast
lesion
19001 Drain breast lesion
add-on
20615 Treatment of bone
cyst
42400 Biopsy of salivary
gland
54800 Biopsy of epididymis
55000 Drainage of
hydrocele
60100 Biopsy of thyroid
60699 Endocrine surgery
procedure
0005 Level II Needle Biopsy/ T 5.41 $262.32 $119.75 $52.46
Aspiration Except Bone Marrow
19100 Biopsy of breast
20206 Needle biopsy,
muscle
32400 Needle biopsy chest
lining
32405 Biopsy, lung or
mediastinum
38505 Needle biopsy, lymph
nodes
47000 Needle biopsy of
liver
47399 Liver surgery
procedure
48102 Needle biopsy,
pancreas
48999 Pancreas surgery
procedure
49180 Biopsy, abdominal
mass
50200 Biopsy of kidney
50390 Drainage of kidney
lesion
54500 Biopsy of testis
62269 Needle biopsy,
spinal cord
0006 Level I Incision & Drainage T 2.00 $96.97 $33.95 $19.39
10040 Acne surgery of skin
abscess
10060 Drainage of skin
abscess
10061 Drainage of skin
abscess
10080 Drainage of
pilonidal cyst
10120 Remove foreign body
10160 Puncture drainage of
lesion
20000 Incision of abscess
26010 Drainage of finger
abscess
69000 Drain external ear
lesion
69020 Drain outer ear
canal lesion
0007 Level II Incision & Drainage T 3.68 $178.43 $72.03 $35.69
10081 Drainage of
pilonidal cyst
10140 Drainage of hematoma/
fluid
10180 Complex drainage,
wound
26011 Drainage of finger
abscess
69005 Drain external ear
lesion
0008 Level III Incision & Drainage T 6.15 $298.20 $113.67 $59.64
19020 Incision of breast
lesion
20950 Fluid pressure,
muscle
21501 Drain neck/chest
lesion
21700 Revision of neck
muscle
21720 Revision of neck
muscle
21725 Revision of neck
muscle
23030 Drain shoulder
lesion
23031 Drain shoulder bursa
23930 Drainage of arm
lesion
23931 Drainage of arm
bursa
27301 Drain thigh/knee
lesion
27603 Drain lower leg
lesion
28001 Drainage of bursa of
foot
38300 Drainage, lymph node
lesion
38305 Drainage, lymph node
lesion
38999 Blood/lymph system
procedure
51080 Drainage of bladder
abscess
54015 Drain penis lesion
[[Page 18708]]
54115 Treatment of penis
lesion
55100 Drainage of scrotum
abscess
0009 Nail Procedures T 0.74 $35.88 $9.63 $7.18
11719 Trim nail(s)
11720 Debride nail, 1-5
11721 Debride nail, 6 or
more
11740 Drain blood from
under nail
G0127 Trim nail(s)
0010 Level I Destruction of Lesion T 0.55 $26.67 $9.86 $5.33
17000 Destroy benign/
premal lesion
17003 Destroy lesions, 2-
14
17110 Destruct lesion, 1-
14
0011 Level II Destruction of T 2.72 $131.88 $50.01 $26.38
Lesion
17004 Destroy lesions, 15
or more
17106 Destruction of skin
lesions
17107 Destruction of skin
lesions
17108 Destruction of skin
lesions
17111 Destruct lesion, 15
or more
0012 Level I Debridement & T 0.53 $25.70 $9.18 $5.14
Destruction
11732 Remove nail plate,
add-on
11900 Injection into skin
lesions
15852 Dressing change, not
for burn
17340 Cryotherapy of skin
69220 Clean out mastoid
cavity
0013 Level II Debridement & T 0.91 $44.12 $17.66 $8.82
Destruction
11300 Shave skin lesion
11301 Shave skin lesion
11305 Shave skin lesion
11306 Shave skin lesion
11310 Shave skin lesion
11311 Shave skin lesion
11730 Removal of nail
plate
11901 Added skin lesions
injection
15786 Abrasion, lesion,
single
15788 Chemical peel, face,
epiderm
15850 Removal of sutures
15851 Removal of sutures
17260 Destruction of skin
lesions
17261 Destruction of skin
lesions
17262 Destruction of skin
lesions
17263 Destruction of skin
lesions
17271 Destruction of skin
lesions
17272 Destruction of skin
lesions
54050 Destruction, penis
lesion(s)
54056 Cryosurgery, penis
lesion(s)
0014 Level III Debridement & T 1.50 $72.73 $24.55 $14.55
Destruction
11302 Shave skin lesion
11307 Shave skin lesion
16025 Treatment of burn(s)
17250 Chemical cautery,
tissue
46917 Laser surgery, anal
lesions
0015 Level IV Debridement & T 1.77 $85.82 $31.20 $17.16
Destruction
11000 Debride infected
skin
11001 Debride infected
skin add-on
11040 Debride skin,
partial
11041 Debride skin, full
11055 Trim skin lesion
11056 Trim skin lesions, 2
to 4
11057 Trim skin lesions,
over 4
11200 Removal of skin tags
11201 Remove skin tags add-
on
11303 Shave skin lesion
11308 Shave skin lesion
11312 Shave skin lesion
11765 Excision of nail
fold, toe
15783 Abrasion treatment
of skin
15789 Chemical peel, face,
dermal
16000 Initial treatment of
burn(s)
16010 Treatment of burn(s)
16020 Treatment of burn(s)
16030 Treatment of burn(s)
17264 Destruction of skin
lesions
17270 Destruction of skin
lesions
[[Page 18709]]
17273 Destruction of skin
lesions
17274 Destruction of skin
lesions
17276 Destruction of skin
lesions
17280 Destruction of skin
lesions
17281 Destruction of skin
lesions
17282 Destruction of skin
lesions
17283 Destruction of skin
lesions
0016 Level V Debridement & T 3.53 $171.16 $74.67 $34.23
Destruction
11042 Debride skin/tissue
11043 Debride tissue/
muscle
11313 Shave skin lesion
15787 Abrasion, lesions,
add-on
15792 Chemical peel,
nonfacial
15793 Chemical peel,
nonfacial
15810 Salabrasion
17266 Destruction of skin
lesions
17284 Destruction of skin
lesions
17286 Destruction of skin
lesions
17360 Skin peel therapy
17380 Hair removal by
electrolysis
46900 Destruction, anal
lesion(s)
46910 Destruction, anal
lesion(s)
46916 Cryosurgery, anal
lesion(s)
54055 Destruction, penis
lesion(s)
56501 Destruction, vulva
lesion(s)
0017 Level VI Debridement & T 12.45 $603.66 $289.16 $120.73
Destruction
11044 Debride tissue/
muscle/bone
16015 Treatment of burn(s)
46922 Excision of anal
lesion(s)
46924 Destruction, anal
lesion(s)
54057 Laser surg, penis
lesion(s)
54060 Excision of penis
lesion(s)
54065 Destruction, penis
lesion(s)
56515 Destruction, vulva
lesion(s)
0018 Biopsy Skin, Subcutaneous T 0.94 $45.58 $17.66 $9.12
Tissue or Mucous Membrane
11100 Biopsy of skin
lesion
11101 Biopsy, skin add-on
0019 Level I Excision/Biopsy T 4.00 $193.95 $78.91 $38.79
11400 Removal of skin
lesion
11401 Removal of skin
lesion
11402 Removal of skin
lesion
11420 Removal of skin
lesion
11421 Removal of skin
lesion
11422 Removal of skin
lesion
11440 Removal of skin
lesion
11441 Removal of skin
lesion
11442 Removal of skin
lesion
11600 Removal of skin
lesion
11601 Removal of skin
lesion
11602 Removal of skin
lesion
11620 Removal of skin
lesion
11621 Removal of skin
lesion
11622 Removal of skin
lesion
11640 Removal of skin
lesion
11641 Removal of skin
lesion
11642 Removal of skin
lesion
11750 Removal of nail bed
11755 Biopsy, nail unit
11976 Removal of
contraceptive cap
20220 Bone biopsy, trocar/
needle
20520 Removal of foreign
body
21550 Biopsy of neck/chest
23330 Remove shoulder
foreign body
24200 Removal of arm
foreign body
27086 Remove hip foreign
body
28190 Removal of foot
foreign body
56605 Biopsy of vulva/
perineum
56606 Biopsy of vulva/
perineum
58999 Genital surgery
procedure
69100 Biopsy of external
ear
0020 Level II Excision/Biopsy T 6.51 $315.65 $130.53 $63.13
10121 Remove foreign body
11403 Removal of skin
lesion
[[Page 18710]]
11404 Removal of skin
lesion
11406 Removal of skin
lesion
11423 Removal of skin
lesion
11424 Removal of skin
lesion
11443 Removal of skin
lesion
11444 Removal of skin
lesion
11603 Removal of skin
lesion
11604 Removal of skin
lesion
11623 Removal of skin
lesion
11624 Removal of skin
lesion
11643 Removal of skin
lesion
11644 Removal of skin
lesion
16035 Incision of burn
scab
17304 Chemosurgery of skin
lesion
17305 2nd stage
chemosurgery
17306 3rd stage
chemosurgery
17307 Followup skin lesion
therapy
17310 Extensive skin
chemosurgery
20200 Muscle biopsy
20225 Bone biopsy, trocar/
needle
21920 Biopsy soft tissue
of back
24065 Biopsy arm/elbow
soft tissue
24066 Biopsy arm/elbow
soft tissue
25065 Biopsy forearm soft
tissues
25075 Removal of forearm
lesion
26320 Removal of implant
from hand
27613 Biopsy lower leg
soft tissue
28193 Removal of foot
foreign body
37609 Temporal artery
procedure
37799 Vascular surgery
procedure
54100 Biopsy of penis
69110 Remove external ear,
partial
69145 Remove ear canal
lesion(s)
0021 Level III Excision/Biopsy T 10.49 $508.63 $236.51 $101.73
11606 Removal of skin
lesion
11770 Removal of pilonidal
lesion
20205 Deep muscle biopsy
20670 Removal of support
implant
23000 Removal of calcium
deposits
23065 Biopsy shoulder
tissues
23075 Removal of shoulder
lesion
24075 Remove arm/elbow
lesion
24201 Removal of arm
foreign body
27040 Biopsy of soft
tissues
27323 Biopsy, thigh soft
tissues
27618 Remove lower leg
lesion
28043 Excision of foot
lesion
28192 Removal of foot
foreign body
54105 Biopsy of penis
0022 Level IV Excision/Biopsy T 12.49 $605.60 $292.94 $121.12
11010 Debride skin, fx
11011 Debride skin/muscle,
fx
11012 Debride skin/muscle/
bone, fx
11426 Removal of skin
lesion
11446 Removal of skin
lesion
11450 Removal, sweat gland
lesion
11451 Removal, sweat gland
lesion
11462 Removal, sweat gland
lesion
11463 Removal, sweat gland
lesion
11470 Removal, sweat gland
lesion
11471 Removal, sweat gland
lesion
11626 Removal of skin
lesion
11646 Removal of skin
lesion
11752 Remove nail bed/
finger tip
11771 Removal of pilonidal
lesion
11772 Removal of pilonidal
lesion
11971 Remove tissue
expander(s)
15780 Abrasion treatment
of skin
15781 Abrasion treatment
of skin
15782 Abrasion treatment
of skin
15811 Salabrasion
15838 Excise excessive
skin tissue
15920 Removal of tail bone
ulcer
[[Page 18711]]
15931 Remove sacrum
pressure sore
15933 Remove sacrum
pressure sore
15940 Remove hip pressure
sore
15941 Remove hip pressure
sore
15950 Remove thigh
pressure sore
15951 Remove thigh
pressure sore
15999 Removal of pressure
sore
20240 Bone biopsy,
excisional
20245 Bone biopsy,
excisional
20525 Removal of foreign
body
20680 Removal of support
implant
21555 Remove lesion, neck/
chest
21556 Remove lesion, neck/
chest
21925 Biopsy soft tissue
of back
21930 Remove lesion, back
or flank
21935 Remove tumor, back
22900 Remove abdominal
wall lesion
22999 Abdomen surgery
procedure
23066 Biopsy shoulder
tissues
23076 Removal of shoulder
lesion
23077 Remove tumor of
shoulder
23331 Remove shoulder
foreign body
24076 Remove arm/elbow
lesion
24077 Remove tumor of arm/
elbow
25066 Biopsy forearm soft
tissues
25076 Removal of forearm
lesion
25077 Remove tumor,
forearm/wrist
26115 Removal of hand
lesion
26116 Removal of hand
lesion
26117 Remove tumor, hand/
finger
27041 Biopsy of soft
tissues
27047 Remove hip/pelvis
lesion
27048 Remove hip/pelvis
lesion
27049 Remove tumor, hip/
pelvis
27324 Biopsy, thigh soft
tissues
27327 Removal of thigh
lesion
27328 Removal of thigh
lesion
27329 Remove tumor, thigh/
knee
27372 Removal of foreign
body
27614 Biopsy lower leg
soft tissue
27619 Remove lower leg
lesion
69205 Clear outer ear
canal
0023 Exploration Penetrating Wound T 1.98 $96.00 $40.37 $19.20
20100 Explore wound, neck
20103 Explore wound,
extremity
0024 Level I Skin Repair T 2.43 $117.82 $44.50 $23.56
11760 Repair of nail bed
11762 Reconstruction of
nail bed
11920 Correct skin color
defects
11921 Correct skin color
defects
11922 Correct skin color
defects
11950 Therapy for contour
defects
11951 Therapy for contour
defects
11952 Therapy for contour
defects
11954 Therapy for contour
defects
12001 Repair superficial
wound(s)
12002 Repair superficial
wound(s)
12004 Repair superficial
wound(s)
12005 Repair superficial
wound(s)
12006 Repair superficial
wound(s)
12007 Repair superficial
wound(s)
12011 Repair superficial
wound(s)
12013 Repair superficial
wound(s)
12014 Repair superficial
wound(s)
12015 Repair superficial
wound(s)
12016 Repair superficial
wound(s)
12017 Repair superficial
wound(s)
12018 Repair superficial
wound(s)
12020 Closure of split
wound
12021 Closure of split
wound
12031 Layer closure of
wound(s)
12032 Layer closure of
wound(s)
12034 Layer closure of
wound(s)
[[Page 18712]]
12035 Layer closure of
wound(s)
12036 Layer closure of
wound(s)
12041 Layer closure of
wound(s)
12042 Layer closure of
wound(s)
12044 Layer closure of
wound(s)
12045 Layer closure of
wound(s)
12046 Layer closure of
wound(s)
12051 Layer closure of
wound(s)
12052 Layer closure of
wound(s)
12053 Layer closure of
wound(s)
12054 Layer closure of
wound(s)
12055 Layer closure of
wound(s)
12056 Layer closure of
wound(s)
0025 Level II Skin Repair T 3.74 $181.34 $70.66 $36.27
13100 Repair of wound or
lesion
13101 Repair of wound or
lesion
13102 Repair wound/lesion
add-on
13120 Repair of wound or
lesion
13121 Repair of wound or
lesion
13122 Repair wound/lesion
add-on
13131 Repair of wound or
lesion
13132 Repair of wound or
lesion
13133 Repair wound/lesion
add-on
13151 Repair of wound or
lesion
13152 Repair of wound or
lesion
13153 Repair wound/lesion
add-on
43870 Repair stomach
opening
0026 Level III Skin Repair T 12.11 $587.18 $277.92 $117.44
11960 Insert tissue
expander(s)
11970 Replace tissue
expander
12037 Layer closure of
wound(s)
12047 Layer closure of
wound(s)
12057 Layer closure of
wound(s)
13150 Repair of wound or
lesion
13160 Late closure of
wound
14000 Skin tissue
rearrangement
14001 Skin tissue
rearrangement
14020 Skin tissue
rearrangement
14021 Skin tissue
rearrangement
14040 Skin tissue
rearrangement
14041 Skin tissue
rearrangement
14060 Skin tissue
rearrangement
14061 Skin tissue
rearrangement
14300 Skin tissue
rearrangement
14350 Skin tissue
rearrangement
15000 Skin graft
15001 Skin graft add-on
15050 Skin pinch graft
15100 Skin split graft
15101 Skin split graft add-
on
15120 Skin split graft
15121 Skin split graft add-
on
15200 Skin full graft
15201 Skin full graft add-
on
15220 Skin full graft
15221 Skin full graft add-
on
15240 Skin full graft
15241 Skin full graft add-
on
15260 Skin full graft
15261 Skin full graft add-
on
15350 Skin homograft
15351 Skin homograft add-
on
15400 Skin heterograft
15401 Skin heterograft add-
on
15570 Form skin pedicle
flap
15572 Form skin pedicle
flap
15574 Form skin pedicle
flap
15576 Form skin pedicle
flap
15600 Skin graft
15610 Skin graft
15620 Skin graft
15630 Skin graft
15650 Transfer skin
pedicle flap
[[Page 18713]]
15775 Hair transplant
punch grafts
15776 Hair transplant
punch grafts
15819 Plastic surgery,
neck
15820 Revision of lower
eyelid
15821 Revision of lower
eyelid
15822 Revision of upper
eyelid
15823 Revision of upper
eyelid
15825 Removal of neck
wrinkles
15829 Removal of skin
wrinkles
15835 Excise excessive
skin tissue
20101 Explore wound, chest
20102 Explore wound,
abdomen
20910 Remove cartilage for
graft
20912 Remove cartilage for
graft
20920 Removal of fascia
for graft
20922 Removal of fascia
for graft
20926 Removal of tissue
for graft
23921 Amputation follow-up
surgery
25929 Amputation follow-up
surgery
33222 Revise pocket,
pacemaker
33223 Revise pocket,
pacing-defib
44312 Revision of
ileostomy
44340 Revision of
colostomy
G0168 Wound closure by
adhesive
G0169 Removal tissue; no
anesthsia
G0170 Skin biograft
G0171 Skin biograft add-on
0027 Level IV Skin Repair T 15.80 $766.10 $383.10 $153.22
15732 Muscle-skin graft,
head/neck
15734 Muscle-skin graft,
trunk
15736 Muscle-skin graft,
arm
15738 Muscle-skin graft,
leg
15740 Island pedicle flap
graft
15750 Neurovascular
pedicle graft
15760 Composite skin graft
15770 Derma-fat-fascia
graft
15824 Removal of forehead
wrinkles
15826 Removal of brow
wrinkles
15828 Removal of face
wrinkles
15831 Excise excessive
skin tissue
15832 Excise excessive
skin tissue
15833 Excise excessive
skin tissue
15834 Excise excessive
skin tissue
15836 Excise excessive
skin tissue
15837 Excise excessive
skin tissue
15839 Excise excessive
skin tissue
15840 Graft for face nerve
palsy
15841 Graft for face nerve
palsy
15842 Graft for face nerve
palsy
15845 Skin and muscle
repair, face
15876 Suction assisted
lipectomy
15877 Suction assisted
lipectomy
15878 Suction assisted
lipectomy
15879 Suction assisted
lipectomy
15922 Removal of tail bone
ulcer
15934 Remove sacrum
pressure sore
15935 Remove sacrum
pressure sore
15936 Remove sacrum
pressure sore
15937 Remove sacrum
pressure sore
15944 Remove hip pressure
sore
15945 Remove hip pressure
sore
15946 Remove hip pressure
sore
15952 Remove thigh
pressure sore
15953 Remove thigh
pressure sore
15956 Remove thigh
pressure sore
15958 Remove thigh
pressure sore
0029 Incision/Excision Breast T 12.85 $623.06 $303.50 $124.61
19101 Biopsy of breast
19110 Nipple exploration
19112 Excise breast duct
fistula
19120 Removal of breast
lesion
19125 Excision, breast
lesion
19126 Excision, addl
breast lesion
[[Page 18714]]
19140 Removal of breast
tissue
19290 Place needle wire,
breast
19291 Place needle wire,
breast
19396 Design custom breast
implant
19499 Breast surgery
procedure
0030 Breast Reconstruction/ T 20.19 $978.95 $523.95 $195.79
Mastectomy
19160 Removal of breast
tissue
19162 Remove breast
tissue, nodes
19180 Removal of breast
19182 Removal of breast
19316 Suspension of breast
19318 Reduction of large
breast
19324 Enlarge breast
19325 Enlarge breast with
implant
19328 Removal of breast
implant
19330 Removal of implant
material
19340 Immediate breast
prosthesis
19342 Delayed breast
prosthesis
19350 Breast
reconstruction
19355 Correct inverted
nipple(s)
19357 Breast
reconstruction
19366 Breast
reconstruction
19370 Surgery of breast
capsule
19371 Removal of breast
capsule
19380 Revise breast
reconstruction
0031 Hyperbaric Oxygen S 3.00 $145.46 $140.85 $29.09
99183 Hyperbaric oxygen
therapy
G0167 Hyperbaric oz tx; no
md reqrd
0032 Placement Transvenous T 5.40 $261.83 $119.52 $52.37
Catheters/Arterial Cutdown
36420 Establish access to
vein
36425 Establish access to
vein
36488 Insertion of
catheter, vein
36489 Insertion of
catheter, vein
36490 Insertion of
catheter, vein
36491 Insertion of
catheter, vein
36493 Repositioning of cvc
36640 Insertion catheter,
artery
0033 Partial Hospitalization P 4.17 $202.19 $48.17 $40.44
G0129 Partial hosp prog
service
G0172 Partial hosp prog
service
Q0082 Activity therapy w/
partial h
0040 Arthrocentesis & Ligament/ T 2.11 $102.31 $40.60 $20.46
Tendon Injection
20550 Inject tendon/
ligament/cyst
20600 Drain/inject, joint/
bursa
20605 Drain/inject, joint/
bursa
20610 Drain/inject, joint/
bursa
0041 Arthroscopy T 24.57 $1,191.33 $592.08 $238.27
29800 Jaw arthroscopy/
surgery
29804 Jaw arthroscopy/
surgery
29815 Shoulder arthroscopy
29819 Shoulder arthroscopy/
surgery
29820 Shoulder arthroscopy/
surgery
29821 Shoulder arthroscopy/
surgery
29822 Shoulder arthroscopy/
surgery
29823 Shoulder arthroscopy/
surgery
29825 Shoulder arthroscopy/
surgery
29826 Shoulder arthroscopy/
surgery
29830 Elbow arthroscopy
29834 Elbow arthroscopy/
surgery
29835 Elbow arthroscopy/
surgery
29836 Elbow arthroscopy/
surgery
29837 Elbow arthroscopy/
surgery
29838 Elbow arthroscopy/
surgery
29840 Wrist arthroscopy
29843 Wrist arthroscopy/
surgery
29844 Wrist arthroscopy/
surgery
29845 Wrist arthroscopy/
surgery
29846 Wrist arthroscopy/
surgery
29847 Wrist arthroscopy/
surgery
29848 Wrist endoscopy/
surgery
29860 Hip arthroscopy, dx
29861 Hip arthroscopy/
surgery
29862 Hip arthroscopy/
surgery
[[Page 18715]]
29863 Hip arthroscopy/
surgery
29870 Knee arthroscopy, dx
29871 Knee arthroscopy/
drainage
29874 Knee arthroscopy/
surgery
29875 Knee arthroscopy/
surgery
29876 Knee arthroscopy/
surgery
29877 Knee arthroscopy/
surgery
29879 Knee arthroscopy/
surgery
29880 Knee arthroscopy/
surgery
29881 Knee arthroscopy/
surgery
29882 Knee arthroscopy/
surgery
29883 Knee arthroscopy/
surgery
29884 Knee arthroscopy/
surgery
29886 Knee arthroscopy/
surgery
29887 Knee arthroscopy/
surgery
29891 Ankle arthroscopy/
surgery
29894 Ankle arthroscopy/
surgery
29895 Ankle arthroscopy/
surgery
29897 Ankle arthroscopy/
surgery
29898 Ankle arthroscopy/
surgery
29909 Arthroscopy of joint
0042 Arthroscopically-Aided T 29.22 $1,416.79 $804.74 $283.36
Procedures
29850 Knee arthroscopy/
surgery
29851 Knee arthroscopy/
surgery
29855 Tibial arthroscopy/
surgery
29856 Tibial arthroscopy/
surgery
29885 Knee arthroscopy/
surgery
29888 Knee arthroscopy/
surgery
29889 Knee arthroscopy/
surgery
29892 Ankle arthroscopy/
surgery
0043 Closed Treatment Fracture T 1.64 $79.52 $25.46 $15.90
Finger/Toe/Trunk
21800 Treatment of rib
fracture
21820 Treat sternum
fracture
22305 Treat spine process
fracture
22310 Treat spine fracture
22315 Treat spine fracture
22899 Spine surgery
procedure
23500 Treat clavicle
fracture
23505 Treat clavicle
fracture
23520 Treat clavicle
dislocation
23525 Treat clavicle
dislocation
23540 Treat clavicle
dislocation
23545 Treat clavicle
dislocation
23570 Treat shoulder blade
fx
23575 Treat shoulder blade
fx
23650 Treat shoulder
dislocation
23929 Shoulder surgery
procedure
26700 Treat knuckle
dislocation
26720 Treat finger
fracture, each
26725 Treat finger
fracture, each
26740 Treat finger
fracture, each
26750 Treat finger
fracture, each
26755 Treat finger
fracture, each
26770 Treat finger
dislocation
26989 Hand/finger surgery
27200 Treat tail bone
fracture
27299 Pelvis/hip joint
surgery
28490 Treat big toe
fracture
28495 Treat big toe
fracture
28510 Treatment of toe
fracture
28515 Treatment of toe
fracture
28630 Treat toe
dislocation
28660 Treat toe
dislocation
28899 Foot/toes surgery
procedure
0044 Closed Treatment Fracture/ T 2.17 $105.22 $38.08 $21.04
Dislocation Except Finger/Toe/
Trunk
23600 Treat humerus
fracture
23605 Treat humerus
fracture
23620 Treat humerus
fracture
23625 Treat humerus
fracture
23665 Treat dislocation/
fracture
23675 Treat dislocation/
fracture
24500 Treat humerus
fracture
24505 Treat humerus
fracture
[[Page 18716]]
24530 Treat humerus
fracture
24535 Treat humerus
fracture
24560 Treat humerus
fracture
24565 Treat humerus
fracture
24576 Treat humerus
fracture
24577 Treat humerus
fracture
24600 Treat elbow
dislocation
24620 Treat elbow fracture
24640 Treat elbow
dislocation
24650 Treat radius
fracture
24655 Treat radius
fracture
24670 Treat ulnar fracture
24675 Treat ulnar fracture
24999 Upper arm/elbow
surgery
25500 Treat fracture of
radius
25505 Treat fracture of
radius
25520 Treat fracture of
radius
25530 Treat fracture of
ulna
25535 Treat fracture of
ulna
25560 Treat fracture
radius & ulna
25565 Treat fracture
radius & ulna
25600 Treat fracture
radius/ulna
25605 Treat fracture
radius/ulna
25622 Treat wrist bone
fracture
25624 Treat wrist bone
fracture
25630 Treat wrist bone
fracture
25635 Treat wrist bone
fracture
25650 Treat wrist bone
fracture
25660 Treat wrist
dislocation
25675 Treat wrist
dislocation
25680 Treat wrist fracture
25690 Treat wrist
dislocation
25999 Forearm or wrist
surgery
26600 Treat metacarpal
fracture
26605 Treat metacarpal
fracture
26607 Treat metacarpal
fracture
26641 Treat thumb
dislocation
26645 Treat thumb fracture
26670 Treat hand
dislocation
26706 Pin knuckle
dislocation
26742 Treat finger
fracture, each
27193 Treat pelvic ring
fracture
27220 Treat hip socket
fracture
27230 Treat thigh fracture
27238 Treat thigh fracture
27246 Treat thigh fracture
27250 Treat hip
dislocation
27256 Treat hip
dislocation
27265 Treat hip
dislocation
27500 Treatment of thigh
fracture
27501 Treatment of thigh
fracture
27502 Treatment of thigh
fracture
27503 Treatment of thigh
fracture
27508 Treatment of thigh
fracture
27510 Treatment of thigh
fracture
27516 Treat thigh fx
growth plate
27517 Treat thigh fx
growth plate
27520 Treat kneecap
fracture
27530 Treat knee fracture
27532 Treat knee fracture
27538 Treat knee
fracture(s)
27550 Treat knee
dislocation
27560 Treat kneecap
dislocation
27599 Leg surgery
procedure
27750 Treatment of tibia
fracture
27752 Treatment of tibia
fracture
27760 Treatment of ankle
fracture
27762 Treatment of ankle
fracture
27780 Treatment of fibula
fracture
27781 Treatment of fibula
fracture
27786 Treatment of ankle
fracture
27788 Treatment of ankle
fracture
27808 Treatment of ankle
fracture
[[Page 18717]]
27810 Treatment of ankle
fracture
27816 Treatment of ankle
fracture
27818 Treatment of ankle
fracture
27824 Treat lower leg
fracture
27825 Treat lower leg
fracture
27830 Treat lower leg
dislocation
27840 Treat ankle
dislocation
27899 Leg/ankle surgery
procedure
28400 Treatment of heel
fracture
28405 Treatment of heel
fracture
28430 Treatment of ankle
fracture
28435 Treatment of ankle
fracture
28450 Treat midfoot
fracture, each
28455 Treat midfoot
fracture, each
28470 Treat metatarsal
fracture
28475 Treat metatarsal
fracture
28530 Treat sesamoid bone
fracture
28540 Treat foot
dislocation
28570 Treat foot
dislocation
28600 Treat foot
dislocation
0045 Bone/Joint Manipulation Under T 11.02 $534.33 $277.12 $106.87
Anesthesia
22505 Manipulation of
spine
23655 Treat shoulder
dislocation
23700 Fixation of shoulder
24605 Treat elbow
dislocation
26675 Treat hand
dislocation
26705 Treat knuckle
dislocation
26775 Treat finger
dislocation
27194 Treat pelvic ring
fracture
27252 Treat hip
dislocation
27257 Treat hip
dislocation
27275 Manipulation of hip
joint
27552 Treat knee
dislocation
27562 Treat kneecap
dislocation
27570 Fixation of knee
joint
27831 Treat lower leg
dislocation
27842 Treat ankle
dislocation
27860 Fixation of ankle
joint
28545 Treat foot
dislocation
28575 Treat foot
dislocation
28605 Treat foot
dislocation
28635 Treat toe
dislocation
28665 Treat toe
dislocation
0046 Open/Percutaneous Treatment T 22.29 $1,080.78 $535.76 $216.16
Fracture or Dislocation
21336 Treat nasal septal
fracture
21805 Treatment of rib
fracture
23515 Treat clavicle
fracture
23530 Treat clavicle
dislocation
23532 Treat clavicle
dislocation
23550 Treat clavicle
dislocation
23552 Treat clavicle
dislocation
23585 Treat scapula
fracture
23615 Treat humerus
fracture
23616 Treat humerus
fracture
23630 Treat humerus
fracture
23660 Treat shoulder
dislocation
23670 Treat dislocation/
fracture
23680 Treat dislocation/
fracture
24515 Treat humerus
fracture
24516 Treat humerus
fracture
24538 Treat humerus
fracture
24545 Treat humerus
fracture
24546 Treat humerus
fracture
24566 Treat humerus
fracture
24575 Treat humerus
fracture
24579 Treat humerus
fracture
24582 Treat humerus
fracture
24586 Treat elbow fracture
24587 Treat elbow fracture
24615 Treat elbow
dislocation
24635 Treat elbow fracture
24665 Treat radius
fracture
24666 Treat radius
fracture
[[Page 18718]]
24685 Treat ulnar fracture
25515 Treat fracture of
radius
25525 Treat fracture of
radius
25526 Treat fracture of
radius
25545 Treat fracture of
ulna
25574 Treat fracture
radius & ulna
25575 Treat fracture
radius/ulna
25611 Treat fracture
radius/ulna
25620 Treat fracture
radius/ulna
25628 Treat wrist bone
fracture
25645 Treat wrist bone
fracture
25670 Treat wrist
dislocation
25676 Treat wrist
dislocation
25685 Treat wrist fracture
25695 Treat wrist
dislocation
26608 Treat metacarpal
fracture
26615 Treat metacarpal
fracture
26650 Treat thumb fracture
26665 Treat thumb fracture
26676 Pin hand dislocation
26685 Treat hand
dislocation
26686 Treat hand
dislocation
26715 Treat knuckle
dislocation
26727 Treat finger
fracture, each
26735 Treat finger
fracture, each
26746 Treat finger
fracture, each
26756 Pin finger fracture,
each
26765 Treat finger
fracture, each
26776 Pin finger
dislocation
26785 Treat finger
dislocation
27202 Treat tail bone
fracture
27509 Treatment of thigh
fracture
27556 Treat knee
dislocation
27566 Treat kneecap
dislocation
27615 Remove tumor, lower
leg
27756 Treatment of tibia
fracture
27758 Treatment of tibia
fracture
27759 Treatment of tibia
fracture
27766 Treatment of ankle
fracture
27784 Treatment of fibula
fracture
27792 Treatment of ankle
fracture
27814 Treatment of ankle
fracture
27822 Treatment of ankle
fracture
27823 Treatment of ankle
fracture
27826 Treat lower leg
fracture
27827 Treat lower leg
fracture
27828 Treat lower leg
fracture
27829 Treat lower leg
joint
27832 Treat lower leg
dislocation
27846 Treat ankle
dislocation
27848 Treat ankle
dislocation
28406 Treatment of heel
fracture
28415 Treat heel fracture
28420 Treat/graft heel
fracture
28436 Treatment of ankle
fracture
28445 Treat ankle fracture
28456 Treat midfoot
fracture
28465 Treat midfoot
fracture, each
28476 Treat metatarsal
fracture
28485 Treat metatarsal
fracture
28496 Treat big toe
fracture
28505 Treat big toe
fracture
28525 Treat toe fracture
28531 Treat sesamoid bone
fracture
28546 Treat foot
dislocation
28555 Repair foot
dislocation
28576 Treat foot
dislocation
28585 Repair foot
dislocation
28606 Treat foot
dislocation
28615 Repair foot
dislocation
28636 Treat toe
dislocation
28645 Repair toe
dislocation
28666 Treat toe
dislocation
[[Page 18719]]
28675 Repair of toe
dislocation
0047 Arthroplasty without T 22.09 $1,071.08 $537.03 $214.22
Prosthesis
24360 Reconstruct elbow
joint
24365 Reconstruct head of
radius
25332 Revise wrist joint
25447 Repair wrist
joint(s)
25449 Remove wrist joint
implant
26530 Revise knuckle joint
26535 Revise finger joint
27266 Treat hip
dislocation
27437 Revise kneecap
27440 Revision of knee
joint
27441 Revision of knee
joint
27442 Revision of knee
joint
27443 Revision of knee
joint
27700 Revision of ankle
joint
0048 Arthroplasty with Prosthesis T 29.06 $1,409.03 $725.94 $281.81
24361 Reconstruct elbow
joint
24362 Reconstruct elbow
joint
24363 Replace elbow joint
24366 Reconstruct head of
radius
25441 Reconstruct wrist
joint
25442 Reconstruct wrist
joint
25443 Reconstruct wrist
joint
25444 Reconstruct wrist
joint
25445 Reconstruct wrist
joint
25446 Wrist replacement
26531 Revise knuckle with
implant
26536 Revise/implant
finger joint
27438 Revise kneecap with
implant
0049 Level I Musculoskeletal T 15.04 $729.25 $356.95 $145.85
Procedures Except Hand and
Foot
20005 Incision of deep
abscess
20250 Open bone biopsy
20251 Open bone biopsy
20650 Insert and remove
bone pin
20693 Adjust bone fixation
device
20694 Remove bone fixation
device
20975 Electrical bone
stimulation
20979 Us bone stimulation
23100 Biopsy of shoulder
joint
23140 Removal of bone
lesion
23935 Drain arm/elbow bone
lesion
24100 Biopsy elbow joint
lining
24105 Removal of elbow
bursa
24110 Remove humerus
lesion
24120 Remove elbow lesion
24310 Revision of arm
tendon
24925 Amputation follow-up
surgery
25000 Incision of tendon
sheath
25020 Decompression of
forearm
25028 Drainage of forearm
lesion
25031 Drainage of forearm
bursa
25035 Treat forearm bone
lesion
25085 Incision of wrist
capsule
25100 Biopsy of wrist
joint
25110 Remove wrist tendon
lesion
25115 Remove wrist/forearm
lesion
25116 Remove wrist/forearm
lesion
25248 Remove forearm
foreign body
25295 Release wrist/
forearm tendon
25907 Amputation follow-up
surgery
25922 Amputate hand at
wrist
26990 Drainage of pelvis
lesion
26991 Drainage of pelvis
bursa
27000 Incision of hip
tendon
27050 Biopsy of sacroiliac
joint
27052 Biopsy of hip joint
27060 Removal of ischial
bursa
27062 Remove femur lesion/
bursa
27065 Removal of hip bone
lesion
27087 Remove hip foreign
body
27305 Incise thigh tendon
& fascia
27306 Incision of thigh
tendon
[[Page 18720]]
27307 Incision of thigh
tendons
27340 Removal of kneecap
bursa
27345 Removal of knee cyst
27347 Remove knee cyst
27380 Repair of kneecap
tendon
27381 Repair/graft kneecap
tendon
27385 Repair of thigh
muscle
27386 Repair/graft of
thigh muscle
27390 Incision of thigh
tendon
27391 Incision of thigh
tendons
27392 Incision of thigh
tendons
27496 Decompression of
thigh/knee
27497 Decompression of
thigh/knee
27498 Decompression of
thigh/knee
27499 Decompression of
thigh/knee
27594 Amputation follow-up
surgery
27600 Decompression of
lower leg
27601 Decompression of
lower leg
27602 Decompression of
lower leg
27604 Drain lower leg
bursa
27606 Incision of achilles
tendon
27607 Treat lower leg bone
lesion
27630 Removal of tendon
lesion
27656 Repair leg fascia
defect
27658 Repair of leg
tendon, each
27659 Repair of leg
tendon, each
27664 Repair of leg
tendon, each
27675 Repair lower leg
tendons
27704 Removal of ankle
implant
27707 Incision of fibula
27884 Amputation follow-up
surgery
27892 Decompression of leg
27893 Decompression of leg
27894 Decompression of leg
28002 Treatment of foot
infection
28003 Treatment of foot
infection
0050 Level II Musculoskeletal T 21.13 $1,024.53 $513.86 $204.91
Procedures Except Hand and
Foot
20690 Apply bone fixation
device
20692 Apply bone fixation
device
20900 Removal of bone for
graft
20902 Removal of bone for
graft
20924 Removal of tendon
for graft
21502 Drain chest lesion
21600 Partial removal of
rib
21610 Partial removal of
rib
23040 Exploratory shoulder
surgery
23044 Exploratory shoulder
surgery
23101 Shoulder joint
surgery
23105 Remove shoulder
joint lining
23106 Incision of
collarbone joint
23107 Explore treat
shoulder joint
23145 Removal of bone
lesion
23146 Removal of bone
lesion
23150 Removal of humerus
lesion
23155 Removal of humerus
lesion
23156 Removal of humerus
lesion
23170 Remove collar bone
lesion
23172 Remove shoulder
blade lesion
23174 Remove humerus
lesion
23180 Remove collar bone
lesion
23182 Remove shoulder
blade lesion
23184 Remove humerus
lesion
23190 Partial removal of
scapula
23405 Incision of tendon &
muscle
23406 Incise tendon(s) &
muscle(s)
24000 Exploratory elbow
surgery
24006 Release elbow joint
24101 Explore/treat elbow
joint
24102 Remove elbow joint
lining
24115 Remove/graft bone
lesion
24116 Remove/graft bone
lesion
24125 Remove/graft bone
lesion
24126 Remove/graft bone
lesion
[[Page 18721]]
24130 Removal of head of
radius
24134 Removal of arm bone
lesion
24136 Remove radius bone
lesion
24138 Remove elbow bone
lesion
24140 Partial removal of
arm bone
24145 Partial removal of
radius
24147 Partial removal of
elbow
24160 Remove elbow joint
implant
24164 Remove radius head
implant
24301 Muscle/tendon
transfer
24305 Arm tendon
lengthening
24350 Repair of tennis
elbow
24351 Repair of tennis
elbow
24352 Repair of tennis
elbow
24354 Repair of tennis
elbow
24356 Revision of tennis
elbow
24400 Revision of humerus
24410 Revision of humerus
24495 Decompression of
forearm
25023 Decompression of
forearm
25040 Explore/treat wrist
joint
25101 Explore/treat wrist
joint
25105 Remove wrist joint
lining
25107 Remove wrist joint
cartilage
25118 Excise wrist tendon
sheath
25119 Partial removal of
ulna
25120 Removal of forearm
lesion
25125 Remove/graft forearm
lesion
25126 Remove/graft forearm
lesion
25130 Removal of wrist
lesion
25135 Remove & graft wrist
lesion
25136 Remove & graft wrist
lesion
25145 Remove forearm bone
lesion
25150 Partial removal of
ulna
25151 Partial removal of
radius
25230 Partial removal of
radius
25240 Partial removal of
ulna
25250 Removal of wrist
prosthesis
25251 Removal of wrist
prosthesis
25260 Repair forearm
tendon/muscle
25263 Repair forearm
tendon/muscle
25265 Repair forearm
tendon/muscle
25270 Repair forearm
tendon/muscle
25272 Repair forearm
tendon/muscle
25274 Repair forearm
tendon/muscle
25280 Revise wrist/forearm
tendon
25290 Incise wrist/forearm
tendon
25300 Fusion of tendons at
wrist
25301 Fusion of tendons at
wrist
25360 Revision of ulna
25365 Revise radius & ulna
25400 Repair radius or
ulna
25415 Repair radius & ulna
27001 Incision of hip
tendon
27003 Incision of hip
tendon
27066 Removal of hip bone
lesion
27067 Remove/graft hip
bone lesion
27080 Removal of tail bone
27097 Revision of hip
tendon
27098 Transfer tendon to
pelvis
27310 Exploration of knee
joint
27330 Biopsy, knee joint
lining
27331 Explore/treat knee
joint
27332 Removal of knee
cartilage
27333 Removal of knee
cartilage
27334 Remove knee joint
lining
27335 Remove knee joint
lining
27350 Removal of kneecap
27355 Remove femur lesion
27356 Remove femur lesion/
graft
27357 Remove femur lesion/
graft
27358 Remove femur lesion/
fixation
27360 Partial removal, leg
bone(s)
[[Page 18722]]
27393 Lengthening of thigh
tendon
27394 Lengthening of thigh
tendons
27396 Transplant of thigh
tendon
27403 Repair of knee
cartilage
27425 Lateral retinacular
release
27610 Explore/treat ankle
joint
27612 Exploration of ankle
joint
27620 Explore/treat ankle
joint
27625 Remove ankle joint
lining
27626 Remove ankle joint
lining
27635 Remove lower leg
bone lesion
27637 Remove/graft leg
bone lesion
27638 Remove/graft leg
bone lesion
27641 Partial removal of
fibula
27665 Repair of leg
tendon, each
27676 Repair lower leg
tendons
27680 Release of lower leg
tendon
27681 Release of lower leg
tendons
27685 Revision of lower
leg tendon
27686 Revise lower leg
tendons
27687 Revision of calf
tendon
27695 Repair of ankle
ligament
27696 Repair of ankle
ligaments
27698 Repair of ankle
ligament
27709 Incision of tibia &
fibula
27730 Repair of tibia
epiphysis
27732 Repair of fibula
epiphysis
27734 Repair lower leg
epiphyses
27740 Repair of leg
epiphyses
27889 Amputation of foot
at ankle
0051 Level III Musculoskeletal T 27.76 $1,346.00 $675.24 $269.20
Procedures Except Hand and
Foot
20150 Excise epiphyseal
bar
23020 Release shoulder
joint
23120 Partial removal,
collar bone
23130 Remove shoulder
bone, part
23415 Release of shoulder
ligament
23480 Revision of collar
bone
23485 Revision of collar
bone
23490 Reinforce clavicle
23491 Reinforce shoulder
bones
23800 Fusion of shoulder
joint
23802 Fusion of shoulder
joint
24155 Removal of elbow
joint
24320 Repair of arm tendon
24330 Revision of arm
muscles
24331 Revision of arm
muscles
24340 Repair of biceps
tendon
24341 Repair arm tendon/
muscle
24342 Repair of ruptured
tendon
24420 Revision of humerus
24430 Repair of humerus
24435 Repair humerus with
graft
24470 Revision of elbow
joint
24498 Reinforce humerus
24800 Fusion of elbow
joint
24802 Fusion/graft of
elbow joint
25310 Transplant forearm
tendon
25312 Transplant forearm
tendon
25315 Revise palsy hand
tendon(s)
25316 Revise palsy hand
tendon(s)
25320 Repair/revise wrist
joint
25335 Realignment of hand
25337 Reconstruct ulna/
radioulnar
25350 Revision of radius
25355 Revision of radius
25370 Revise radius or
ulna
25375 Revise radius & ulna
25425 Repair/graft radius
or ulna
25426 Repair/graft radius
& ulna
25440 Repair/graft wrist
bone
25450 Revision of wrist
joint
25455 Revision of wrist
joint
25490 Reinforce radius
[[Page 18723]]
25491 Reinforce ulna
25492 Reinforce radius and
ulna
25800 Fusion of wrist
joint
25805 Fusion/graft of
wrist joint
25810 Fusion/graft of
wrist joint
25830 Fusion, radioulnar
jnt/ulna
27033 Exploration of hip
joint
27100 Transfer of
abdominal muscle
27105 Transfer of spinal
muscle
27110 Transfer of
iliopsoas muscle
27111 Transfer of
iliopsoas muscle
27395 Lengthening of thigh
tendons
27397 Transplants of thigh
tendons
27400 Revise thigh muscles/
tendons
27405 Repair of knee
ligament
27407 Repair of knee
ligament
27409 Repair of knee
ligaments
27418 Repair degenerated
kneecap
27420 Revision of unstable
kneecap
27422 Revision of unstable
kneecap
27424 Revision/removal of
kneecap
27430 Revision of thigh
muscles
27435 Incision of knee
joint
27640 Partial removal of
tibia
27647 Extensive ankle/heel
surgery
27650 Repair achilles
tendon
27652 Repair/graft
achilles tendon
27654 Repair of achilles
tendon
27690 Revise lower leg
tendon
27691 Revise lower leg
tendon
27692 Revise additional
leg tendon
27705 Incision of tibia
27742 Repair of leg
epiphyses
27745 Reinforce tibia
27870 Fusion of ankle
joint
27871 Fusion of
tibiofibular joint
0052 Level IV Musculoskeletal T 36.16 $1,753.29 $930.91 $350.66
Procedures Except Hand and
Foot
23410 Repair of tendon(s)
23412 Repair of tendon(s)
23420 Repair of shoulder
23430 Repair biceps tendon
23450 Repair shoulder
capsule
23455 Repair shoulder
capsule
23460 Repair shoulder
capsule
23462 Repair shoulder
capsule
23465 Repair shoulder
capsule
23466 Repair shoulder
capsule
24935 Revision of
amputation
27427 Reconstruction, knee
27428 Reconstruction, knee
27429 Reconstruction, knee
0053 Level I Hand Musculoskeletal T 11.32 $548.87 $253.49 $109.77
Procedures
25111 Remove wrist tendon
lesion
25112 Reremove wrist
tendon lesion
25820 Fusion of hand bones
26020 Drain hand tendon
sheath
26025 Drainage of palm
bursa
26030 Drainage of palm
bursa(s)
26034 Treat hand bone
lesion
26035 Decompress fingers/
hand
26037 Decompress fingers/
hand
26055 Incise finger tendon
sheath
26060 Incision of finger
tendon
26070 Explore/treat hand
joint
26075 Explore/treat finger
joint
26080 Explore/treat finger
joint
26100 Biopsy hand joint
lining
26105 Biopsy finger joint
lining
26110 Biopsy finger joint
lining
26130 Remove wrist joint
lining
26140 Revise finger joint,
each
26145 Tendon excision,
palm/finger
26160 Remove tendon sheath
lesion
[[Page 18724]]
26170 Removal of palm
tendon, each
26180 Removal of finger
tendon
26185 Remove finger bone
26200 Remove hand bone
lesion
26210 Removal of finger
lesion
26215 Remove/graft finger
lesion
26230 Partial removal of
hand bone
26235 Partial removal,
finger bone
26236 Partial removal,
finger bone
26250 Extensive hand
surgery
26260 Extensive finger
surgery
26261 Extensive finger
surgery
26262 Partial removal of
finger
26410 Repair hand tendon
26418 Repair finger tendon
26432 Repair finger tendon
26433 Repair finger tendon
26437 Realignment of
tendons
26440 Release palm/finger
tendon
26445 Release hand/finger
tendon
26450 Incision of palm
tendon
26455 Incision of finger
tendon
26460 Incise hand/finger
tendon
26471 Fusion of finger
tendons
26474 Fusion of finger
tendons
26476 Tendon lengthening
26477 Tendon shortening
26478 Lengthening of hand
tendon
26479 Shortening of hand
tendon
26500 Hand tendon
reconstruction
26508 Release thumb
contracture
26520 Release knuckle
contracture
26525 Release finger
contracture
26540 Repair hand joint
26542 Repair hand joint
with graft
26560 Repair of web finger
26587 Reconstruct extra
finger
26593 Release muscles of
hand
26951 Amputation of finger/
thumb
26952 Amputation of finger/
thumb
0054 Level II Hand Musculoskeletal T 19.66 $953.26 $472.33 $190.65
Procedures
25210 Removal of wrist
bone
25215 Removal of wrist
bones
25825 Fuse hand bones with
graft
26040 Release palm
contracture
26045 Release palm
contracture
26121 Release palm
contracture
26123 Release palm
contracture
26125 Release palm
contracture
26135 Revise finger joint,
each
26205 Remove/graft bone
lesion
26255 Extensive hand
surgery
26350 Repair finger/hand
tendon
26352 Repair/graft hand
tendon
26356 Repair finger/hand
tendon
26357 Repair finger/hand
tendon
26358 Repair/graft hand
tendon
26370 Repair finger/hand
tendon
26372 Repair/graft hand
tendon
26373 Repair finger/hand
tendon
26390 Revise hand/finger
tendon
26392 Repair/graft hand
tendon
26412 Repair/graft hand
tendon
26415 Excision, hand/
finger tendon
26416 Graft hand or finger
tendon
26420 Repair/graft finger
tendon
26426 Repair finger/hand
tendon
26428 Repair/graft finger
tendon
26434 Repair/graft finger
tendon
26442 Release palm &
finger tendon
26449 Release forearm/hand
tendon
26480 Transplant hand
tendon
26483 Transplant/graft
hand tendon
[[Page 18725]]
26485 Transplant palm
tendon
26489 Transplant/graft
palm tendon
26490 Revise thumb tendon
26492 Tendon transfer with
graft
26494 Hand tendon/muscle
transfer
26496 Revise thumb tendon
26497 Finger tendon
transfer
26498 Finger tendon
transfer
26499 Revision of finger
26502 Hand tendon
reconstruction
26504 Hand tendon
reconstruction
26510 Thumb tendon
transfer
26516 Fusion of knuckle
joint
26517 Fusion of knuckle
joints
26518 Fusion of knuckle
joints
26541 Repair hand joint
with graft
26545 Reconstruct finger
joint
26546 Repair nonunion hand
26548 Reconstruct finger
joint
26550 Construct thumb
replacement
26555 Positional change of
finger
26561 Repair of web finger
26562 Repair of web finger
26565 Correct metacarpal
flaw
26567 Correct finger
deformity
26568 Lengthen metacarpal/
finger
26580 Repair hand
deformity
26585 Repair finger
deformity
26590 Repair finger
deformity
26591 Repair muscles of
hand
26596 Excision
constricting tissue
26597 Release of scar
contracture
26820 Thumb fusion with
graft
26841 Fusion of thumb
26842 Thumb fusion with
graft
26843 Fusion of hand joint
26844 Fusion/graft of hand
joint
26850 Fusion of knuckle
26852 Fusion of knuckle
with graft
26860 Fusion of finger
joint
26861 Fusion of finger
jnt, add-on
26862 Fusion/graft of
finger joint
26863 Fuse/graft added
joint
26910 Amputate metacarpal
bone
0055 Level I Foot Musculoskeletal T 15.47 $750.10 $355.34 $150.02
Procedures
27605 Incision of achilles
tendon
28005 Treat foot bone
lesion
28008 Incision of foot
fascia
28010 Incision of toe
tendon
28011 Incision of toe
tendons
28020 Exploration of foot
joint
28022 Exploration of foot
joint
28024 Exploration of toe
joint
28045 Excision of foot
lesion
28046 Resection of tumor,
foot
28050 Biopsy of foot joint
lining
28052 Biopsy of foot joint
lining
28054 Biopsy of toe joint
lining
28080 Removal of foot
lesion
28086 Excise foot tendon
sheath
28088 Excise foot tendon
sheath
28090 Removal of foot
lesion
28092 Removal of toe
lesions
28100 Removal of ankle/
heel lesion
28104 Removal of foot
lesion
28108 Removal of toe
lesions
28111 Part removal of
metatarsal
28112 Part removal of
metatarsal
28113 Part removal of
metatarsal
28114 Removal of
metatarsal heads
28116 Revision of foot
28118 Removal of heel bone
28119 Removal of heel spur
[[Page 18726]]
28120 Part removal of
ankle/heel
28122 Partial removal of
foot bone
28124 Partial removal of
toe
28126 Partial removal of
toe
28130 Removal of ankle
bone
28140 Removal of
metatarsal
28150 Removal of toe
28153 Partial removal of
toe
28160 Partial removal of
toe
28171 Extensive foot
surgery
28173 Extensive foot
surgery
28175 Extensive foot
surgery
28200 Repair of foot
tendon
28208 Repair of foot
tendon
28210 Repair/graft of foot
tendon
28220 Release of foot
tendon
28222 Release of foot
tendons
28225 Release of foot
tendon
28226 Release of foot
tendons
28230 Incision of foot
tendon(s)
28232 Incision of toe
tendon
28234 Incision of foot
tendon
28240 Release of big toe
28270 Release of foot
contracture
28272 Release of toe
joint, each
28280 Fusion of toes
28285 Repair of hammertoe
28286 Repair of hammertoe
28310 Revision of big toe
28312 Revision of toe
28313 Repair deformity of
toe
28315 Removal of sesamoid
bone
28340 Resect enlarged toe
tissue
28341 Resect enlarged toe
28737 Revision of foot
bones
28750 Fusion of big toe
joint
28755 Fusion of big toe
joint
28810 Amputation toe &
metatarsal
28820 Amputation of toe
28825 Partial amputation
of toe
29893 Scope, plantar
fasciotomy
0056 Level II Foot Musculoskeletal T 17.30 $838.83 $405.81 $167.77
Procedures
28060 Partial removal,
foot fascia
28062 Removal of foot
fascia
28070 Removal of foot
joint lining
28072 Removal of foot
joint lining
28102 Remove/graft foot
lesion
28103 Remove/graft foot
lesion
28106 Remove/graft foot
lesion
28107 Remove/graft foot
lesion
28202 Repair/graft of foot
tendon
28238 Revision of foot
tendon
28250 Revision of foot
fascia
28260 Release of midfoot
joint
28261 Revision of foot
tendon
28262 Revision of foot and
ankle
28264 Release of midfoot
joint
28288 Partial removal of
foot bone
28289 Repair hallux
rigidus
28300 Incision of heel
bone
28302 Incision of ankle
bone
28304 Incision of midfoot
bones
28305 Incise/graft midfoot
bones
28306 Incision of
metatarsal
28307 Incision of
metatarsal
28308 Incision of
metatarsal
28309 Incision of
metatarsals
28320 Repair of foot bones
28322 Repair of
metatarsals
28344 Repair extra toe(s)
28345 Repair webbed toe(s)
28360 Reconstruct cleft
foot
28705 Fusion of foot bones
[[Page 18727]]
28715 Fusion of foot bones
28725 Fusion of foot bones
28730 Fusion of foot bones
28735 Fusion of foot bones
28740 Fusion of foot bones
28760 Fusion of big toe
joint
0057 Bunion Procedures T 21.00 $1,018.23 $496.65 $203.65
28110 Part removal of
metatarsal
28290 Correction of bunion
28292 Correction of bunion
28293 Correction of bunion
28294 Correction of bunion
28296 Correction of bunion
28297 Correction of bunion
28298 Correction of bunion
28299 Correction of bunion
0058 Level I Strapping and Cast S 1.09 $52.85 $19.27 $10.57
Application
29505 Application, long
leg splint
29515 Application lower
leg splint
29520 Strapping of hip
29530 Strapping of knee
29540 Strapping of ankle
29550 Strapping of toes
29580 Application of paste
boot
29590 Application of foot
splint
29700 Removal/revision of
cast
29705 Removal/revision of
cast
29710 Removal/revision of
cast
29715 Removal/revision of
cast
29720 Repair of body cast
29730 Windowing of cast
29740 Wedging of cast
29750 Wedging of clubfoot
cast
29799 Casting/strapping
procedure
0059 Level II Strapping and Cast S 1.74 $84.37 $29.59 $16.87
Application
29000 Application of body
cast
29010 Application of body
cast
29015 Application of body
cast
29020 Application of body
cast
29025 Application of body
cast
29035 Application of body
cast
29040 Application of body
cast
29044 Application of body
cast
29046 Application of body
cast
29049 Application of
figure eight
29055 Application of
shoulder cast
29058 Application of
shoulder cast
29065 Application of long
arm cast
29075 Application of
forearm cast
29085 Apply hand/wrist
cast
29105 Apply long arm
splint
29125 Apply forearm splint
29126 Apply forearm splint
29130 Application of
finger splint
29131 Application of
finger splint
29200 Strapping of chest
29220 Strapping of low
back
29240 Strapping of
shoulder
29260 Strapping of elbow
or wrist
29280 Strapping of hand or
finger
29305 Application of hip
cast
29325 Application of hip
casts
29345 Application of long
leg cast
29355 Application of long
leg cast
29358 Apply long leg cast
brace
29365 Application of long
leg cast
29405 Apply short leg cast
29425 Apply short leg cast
29435 Apply short leg cast
29440 Addition of walker
to cast
29445 Apply rigid leg cast
29450 Application of leg
cast
0060 Manipulation Therapy S 0.77 $37.34 $7.80 $7.47
[[Page 18728]]
98925 Osteopathic
manipulation
98926 Osteopathic
manipulation
98927 Osteopathic
manipulation
98928 Osteopathic
manipulation
98929 Osteopathic
manipulation
98940 Chiropractic
manipulation
98941 Chiropractic
manipulation
98942 Chiropractic
manipulation
0070 Thoracentesis/Lavage T 3.64 $176.49 $79.60 $35.30
Procedures
32000 Drainage of chest
32002 Treatment of
collapsed lung
32005 Treat lung lining
chemically
32020 Insertion of chest
tube
32420 Puncture/clear lung
32960 Therapeutic
pneumothorax
32999 Chest surgery
procedure
33010 Drainage of heart
sac
33011 Repeat drainage of
heart sac
33999 Cardiac surgery
procedure
49080 Puncture, peritoneal
cavity
49081 Removal of abdominal
fluid
0071 Level I Endoscopy Upper T 0.55 $26.67 $14.22 $5.33
Airway
31231 Nasal endoscopy, dx
31575 Diagnostic
laryngoscopy
92511 Nasopharyngoscopy
0072 Level II Endoscopy Upper T 1.26 $61.09 $41.52 $12.22
Airway
31233 Nasal/sinus
endoscopy, dx
31505 Diagnostic
laryngoscopy
31511 Remove foreign body,
larynx
31520 Diagnostic
laryngoscopy
31700 Insertion of airway
catheter
31720 Clearance of airways
0073 Level III Endoscopy Upper T 4.11 $199.28 $91.07 $39.86
Airway
31513 Injection into vocal
cord
31577 Remove foreign body,
larynx
31579 Diagnostic
laryngoscopy
31717 Bronchial brush
biopsy
31730 Intro, windpipe wire/
tube
0074 Level IV Endoscopy Upper T 13.61 $659.91 $347.54 $131.98
Airway
31235 Nasal/sinus
endoscopy, dx
31237 Nasal/sinus
endoscopy, surg
31238 Nasal/sinus
endoscopy, surg
31240 Nasal/sinus
endoscopy, surg
31510 Laryngoscopy with
biopsy
31512 Removal of larynx
lesion
31515 Laryngoscopy for
aspiration
31525 Diagnostic
laryngoscopy
31526 Diagnostic
laryngoscopy
31528 Laryngoscopy and
dilatation
31529 Laryngoscopy and
dilatation
31576 Laryngoscopy with
biopsy
31578 Removal of larynx
lesion
0075 Level V Endoscopy Upper T 18.55 $899.44 $467.29 $179.89
Airway
31239 Nasal/sinus
endoscopy, surg
31254 Revision of ethmoid
sinus
31255 Removal of ethmoid
sinus
31256 Exploration
maxillary sinus
31267 Endoscopy, maxillary
sinus
31276 Sinus endoscopy,
surgical
31287 Nasal/sinus
endoscopy, surg
31288 Nasal/sinus
endoscopy, surg
31527 Laryngoscopy for
treatment
31530 Operative
laryngoscopy
31531 Operative
laryngoscopy
31535 Operative
laryngoscopy
31536 Operative
laryngoscopy
31540 Operative
laryngoscopy
31541 Operative
laryngoscopy
31560 Operative
laryngoscopy
31561 Operative
laryngoscopy
31570 Laryngoscopy with
injection
31571 Laryngoscopy with
injection
96570 Photodynamic tx, 30
min
[[Page 18729]]
96571 Photodynamic tx,
addl 15 min
0076 Endoscopy Lower Airway T 8.06 $390.81 $197.05 $78.16
31615 Visualization of
windpipe
31622 Dx bronchoscope/wash
31623 Dx bronchoscope/
brush
31624 Dx bronchoscope/
lavage
31625 Bronchoscopy with
biopsy
31628 Bronchoscopy with
biopsy
31629 Bronchoscopy with
biopsy
31630 Bronchoscopy with
repair
31631 Bronchoscopy with
dilation
31635 Remove foreign body,
airway
31640 Bronchoscopy &
remove lesion
31641 Bronchoscopy, treat
blockage
31643 Diag bronchoscope/
catheter
31645 Bronchoscopy, clear
airways
31646 Bronchoscopy,
reclear airway
31656 Bronchoscopy, inj
for x-ray
31899 Airways surgical
procedure
32601 Thoracoscopy,
diagnostic
32602 Thoracoscopy,
diagnostic
32603 Thoracoscopy,
diagnostic
32604 Thoracoscopy,
diagnostic
32605 Thoracoscopy,
diagnostic
32606 Thoracoscopy,
diagnostic
39400 Visualization of
chest
0077 Level I Pulmonary Treatment S 0.43 $20.85 $12.62 $4.17
94640 Airway inhalation
treatment
94650 Pressure breathing
(IPPB)
94651 Pressure breathing
(IPPB)
94664 Aerosol or vapor
inhalations
94665 Aerosol or vapor
inhalations
94667 Chest wall
manipulation
94668 Chest wall
manipulation
0078 Level II Pulmonary Treatment S 1.34 $64.97 $29.13 $12.99
94642 Aerosol inhalation
treatment
0079 Ventilation Initiation and S 3.18 $154.19 $107.70 $30.84
Management
94656 Initial ventilator
mgmt
94657 Continued ventilator
mgmt
94660 Pos airway pressure,
CPAP
94662 Neg press
ventilation, cnp
0080 Diagnostic Cardiac T 25.77 $1,249.51 $713.89 $249.90
Catheterization
93501 Right heart
catheterization
93503 Insert/place heart
catheter
93505 Biopsy of heart
lining
93510 Left heart
catheterization
93511 Left heart
catheterization
93514 Left heart
catheterization
93524 Left heart
catheterization
93526 Rt & Lt heart
catheters
93527 Rt & Lt heart
catheters
93528 Rt & Lt heart
catheters
93529 Rt, Lt heart
catheterization
93530 Rt heart cath,
congenital
93531 R & l heart cath,
congenital
93532 R & l heart cath,
congenital
93533 R & l heart cath,
congenital
93536 Insert circulation
assi
0081 Non-Coronary Angioplasty or T 19.36 $938.71 $434.25 $187.74
Atherectomy
35180 Repair blood vessel
lesion
35184 Repair blood vessel
lesion
35190 Repair blood vessel
lesion
35201 Repair blood vessel
lesion
35206 Repair blood vessel
lesion
35226 Repair blood vessel
lesion
35231 Repair blood vessel
lesion
35236 Repair blood vessel
lesion
35256 Repair blood vessel
lesion
35261 Repair blood vessel
lesion
35266 Repair blood vessel
lesion
35286 Repair blood vessel
lesion
35321 Rechanneling of
artery
35459 Repair arterial
blockage
[[Page 18730]]
35460 Repair venous
blockage
35470 Repair arterial
blockage
35471 Repair arterial
blockage
35472 Repair arterial
blockage
35473 Repair arterial
blockage
35474 Repair arterial
blockage
35475 Repair arterial
blockage
35476 Repair venous
blockage
35484 Atherectomy, open
35485 Atherectomy, open
35490 Atherectomy,
percutaneous
35491 Atherectomy,
percutaneous
35492 Atherectomy,
percutaneous
35493 Atherectomy,
percutaneous
35494 Atherectomy,
percutaneous
35495 Atherectomy,
percutaneous
35500 Harvest vein for
bypass
37204 Transcatheter
occlusion
37205 Transcatheter stent
37206 Transcatheter stent
add-on
37207 Transcatheter stent
37208 Transcatheter stent
add-on
37209 Exchange arterial
catheter
37250 Iv us first vessel
add-on
37251 Iv us each add
vessel add-on
37565 Ligation of neck
vein
37600 Ligation of neck
artery
0082 Coronary Atherectomy T 40.34 $1,955.97 $859.56 $391.19
92995 Coronary atherectomy
92996 Coronary atherectomy
add-on
0083 Coronary Angiosplasty T 45.79 $2,220.22 $1,322.95 $444.04
92980 Insert intracoronary
stent
92981 Insert intracoronary
stent
92982 Coronary artery
dilation
92984 Coronary artery
dilation
0084 Level I Electrophysiologic S 10.70 $518.81 $177.79 $103.76
Evaluation
93640 Evaluation heart
device
93641 Electrophysiology
evaluation
93642 Electrophysiology
evaluation
0085 Level II Electrophysiologic S 27.06 $1,312.06 $654.48 $262.41
Evaluation
93619 Electrophysiology
evaluation
93620 Electrophysiology
evaluation
93621 Electrophysiology
evaluation
93622 Electrophysiology
evaluation
0086 Ablate Heart Dysrhythm Focus S 47.62 $2,308.95 $1,265.37 $461.79
93650 Ablate heart
dysrhythm focus
93651 Ablate heart
dysrhythm focus
93652 Ablate heart
dysrhythm focus
0087 Cardiac Electrophysiologic S 9.53 $462.08 $214.72 $92.42
Recording/Mapping
93600 Bundle of His
recording
93602 Intra-atrial
recording
93603 Right ventricular
recording
93607 Left ventricular
recording
93609 Mapping of
tachycardia
93610 Intra-atrial pacing
93612 Intraventricular
pacing
93615 Esophageal recording
93616 Esophageal recording
93618 Heart rhythm pacing
93623 Stimulation, pacing
heart
93624 Electrophysiologic
study
93631 Heart pacing,
mapping
0088 Thrombectomy T 26.49 $1,284.42 $678.68 $256.88
34101 Removal of artery
clot
34111 Removal of arm
artery clot
34201 Removal of artery
clot
34203 Removal of leg
artery clot
34471 Removal of vein clot
34490 Removal of vein clot
34501 Repair valve,
femoral vein
34510 Transposition of
vein valve
34520 Cross-over vein
graft
34530 Leg vein fusion
[[Page 18731]]
35188 Repair blood vessel
lesion
35207 Repair blood vessel
lesion
35875 Removal of clot in
graft
35876 Removal of clot in
graft
35879 Revise graft w/vein
35881 Revise graft w/vein
36821 Av fusion direct any
site
36825 Artery-vein graft
36830 Artery-vein graft
36831 Av fistula excision
36832 Av fistula revision
36833 Av fistula revision
G0159 Perc declot dialysis
graft
0089 Level I Implantation/Removal/ T 6.49 $314.68 $130.07 $62.94
Revision of Pacemaker, AICD
or Vascular Device
33210 Insertion of heart
electrode
33211 Insertion of heart
electrode
33220 Revise eltrd pacing-
defib
33241 Remove pulse
generator
36261 Revision of infusion
pump
36262 Removal of infusion
pump
36299 Vessel injection
procedure
36531 Revision of infusion
pump
36532 Removal of infusion
pump
36534 Revision of access
device
36535 Removal of access
device
37203 Transcatheter
retrieval
0090 Level II Implantation/Removal/ T 20.96 $1,016.29 $573.04 $203.26
Revision of Pacemaker, AICD
or Vascular Device
33206 Insertion of heart
pacemaker
33207 Insertion of heart
pacemaker
33208 Insertion of heart
pacemaker
33212 Insertion of pulse
generator
33213 Insertion of pulse
generator
33214 Upgrade of pacemaker
system
33216 Revise eltrd pacing-
defib
33217 Revise eltrd pacing-
defib
33218 Revise eltrd pacing-
defib
33233 Removal of pacemaker
system
33234 Removal of pacemaker
system
33235 Removal pacemaker
electrode
33240 Insert pulse
generator
33244 Remove eltrd,
transven
33249 Eltrd/insert pace-
defib
36860 External cannula
declotting
36861 Cannula declotting
0091 Level I Vascular Ligation T 14.79 $717.12 $348.23 $143.42
30915 Ligation, nasal
sinus artery
37605 Ligation of neck
artery
37606 Ligation of neck
artery
37615 Ligation of neck
artery
37650 Revision of major
vein
37700 Revise leg vein
37760 Revision of leg
veins
37780 Revision of leg vein
37785 Revise secondary
varicosity
0092 Level II Vascular Ligation T 20.21 $979.92 $505.37 $195.98
30920 Ligation, upper jaw
artery
37607 Ligation of a-v
fistula
37720 Removal of leg vein
37730 Removal of leg veins
37735 Removal of leg veins/
lesion
0093 Vascular Repair/Fistula T 17.95 $870.34 $422.33 $174.07
Construction
36260 Insertion of
infusion pump
36530 Insertion of
infusion pump
36533 Insertion of access
device
36800 Insertion of cannula
36810 Insertion of cannula
36815 Insertion of cannula
36819 Av fusion by basilic
vein
36835 Artery to vein shunt
0094 Resuscitation and S 4.51 $218.68 $105.29 $43.74
Cardioversion
31500 Insert emergency
airway
92950 Heart/lung
resuscitation cpr
92953 Temporary external
pacing
[[Page 18732]]
92960 Cardioversion
electric, ext
92961 Cardioversion,
electric, int
99440 Newborn
resuscitation
0095 Cardiac Rehabilitation S 0.64 $31.03 $16.98 $6.21
93797 Cardiac rehab
93798 Cardiac rehab/
monitor
0096 Non-Invasive Vascular Studies S 2.06 $99.88 $61.48 $19.98
93721 Plethysmography
tracing
93740 Temperature gradient
studies
93799 Cardiovascular
procedure
93875 Extracranial study
93922 Extremity study
93923 Extremity study
93924 Extremity study
93965 Extremity study
0097 Cardiovascular Stress Test S 1.62 $78.55 $62.40 $15.71
93017 Cardiovascular
stress test
93024 Cardiac drug stress
test
0098 Injection of Sclerosing T 1.19 $57.70 $20.88 $11.54
Solution
36468 Injection(s), spider
veins
36469 Injection(s), spider
veins
36470 Injection therapy of
vein
36471 Injection therapy of
veins
45520 Treatment of rectal
prolapse
0099 Continuous Cardiac Monitoring S 0.38 $18.43 $14.68 $3.69
93012 Transmission of ecg
93270 ECG recording
93278 ECG/signal-averaged
G0005 ECG 24 hour
recording
G0015 Post symptom ECG
tracing
0100 Continuous ECG S 1.70 $82.43 $71.57 $16.49
93225 ECG monitor/record,
24 hrs
93226 ECG monitor/report,
24 hrs
93231 Ecg monitor/record,
24 hrs
93232 ECG monitor/report,
24 hrs
93236 ECG monitor/report,
24 hrs
93268 ECG record/review
93271 Ecg/monitoring and
analysis
93724 Analyze pacemaker
system
G0004 ECG transm phys
review & int
G0006 ECG transmission &
analysis
0101 Tilt Table Evaluation S 4.47 $216.74 $128.84 $43.35
93660 Tilt table
evaluation
0102 Electronic Analysis of S 0.45 $21.82 $12.62 $4.36
Pacemakers/other Devices
62367 Analyze spine
infusion pump
62368 Analyze spine
infusion pump
93727 Analyze ilr system
93731 Analyze pacemaker
system
93732 Analyze pacemaker
system
93733 Telephone analy,
pacemaker
93734 Analyze pacemaker
system
93735 Analyze pacemaker
system
93736 Telephone analy,
pacemaker
93737 Analyze cardio/
defibrillator
93738 Analyze cardio/
defibrillator
93741 Analyze ht pace
device sngl
93742 Analyze ht pace
device sngl
93743 Analyze ht pace
device dual
93744 Analyze ht pace
device dual
95970 Analyze neurostim,
no prog
95971 Analyze neurostim,
simple
95972 Analyze neurostim,
complex
95973 Analyze neurostim,
complex
95974 Cranial neurostim,
complex
95975 Cranial neurostim,
complex
0109 Bone Marrow Harvesting and S 4.13 $200.25 $40.05 $40.05
Bone Marrow/Stem Cell
Transplant
38230 Bone marrow
collection
38240 Bone marrow/stem
transplant
38241 Bone marrow/stem
transplant
0110 Transfusion S 5.83 $282.68 $122.73 $56.54
36430 Blood transfusion
service
36440 Blood transfusion
service
36450 Exchange transfusion
service
[[Page 18733]]
36455 Exchange transfusion
service
36460 Transfusion service,
fetal
0111 Blood Product Exchange S 14.17 $687.06 $300.74 $137.41
36520 Plasma and/or cell
exchange
36521 Apheresis w/adsorp/
reinfuse
38231 Stem cell collection
0112 Extracorporeal Photopheresis S 39.60 $1,920.09 $663.65 $384.02
36522 Photopheresis
0113 Excision Lymphatic System T 13.89 $673.49 $326.55 $134.70
38308 Incision of lymph
channels
38500 Biopsy/removal,
lymph nodes
38510 Biopsy/removal,
lymph nodes
38520 Biopsy/removal,
lymph nodes
38525 Biopsy/removal,
lymph nodes
38530 Biopsy/removal,
lymph nodes
38550 Removal, neck/armpit
lesion
0114 Thyroid/Lymphadenectomy T 19.56 $948.41 $493.78 $189.68
Procedures
38542 Explore deep
node(s), neck
38555 Removal, neck/armpit
lesion
38720 Removal of lymph
nodes, neck
38740 Remove armpit lymph
nodes
38745 Remove armpit lymph
nodes
38760 Remove groin lymph
nodes
60200 Remove thyroid
lesion
60210 Partial thyroid
excision
60220 Partial removal of
thyroid
60225 Partial removal of
thyroid
60240 Removal of thyroid
60280 Remove thyroid duct
lesion
60281 Remove thyroid duct
lesion
0116 Chemotherapy Administration S 2.34 $113.46 $22.69 $22.69
by Other Technique Except
Infusion
Q0083 Chemo by other than
infusion
0117 Chemotherapy Administration S 1.84 $89.22 $71.80 $17.84
by Infusion Only
Q0084 Chemotherapy by
infusion
0118 Chemotherapy Administration S 2.90 $140.61 $72.03 $28.12
by Both Infusion and Other
Technique
Q0085 Chemo by both
infusion and o
0120 Infusion Therapy Except S 1.66 $80.49 $42.67 $16.10
Chemotherapy
36680 Insert needle, bone
cavity
Q0081 Infusion ther other
than che
0121 Level I Tube changes and T 2.36 $114.43 $52.53 $22.89
Repositioning
31502 Change of windpipe
airway
43760 Change gastrostomy
tube
43761 Reposition
gastrostomy tube
43999 Stomach surgery
procedure
47530 Revise/reinsert bile
tube
47999 Bile tract surgery
procedure
49999 Abdomen surgery
procedure
50688 Change of ureter
tube
51705 Change of bladder
tube
51710 Change of bladder
tube
62194 Replace/irrigate
catheter
62225 Replace/irrigate
catheter
0122 Level II Tube changes and T 5.04 $244.37 $114.93 $48.88
Repositioning
47525 Change bile duct
catheter
50398 Change kidney tube
0123 Level III Tube changes and T 13.89 $673.49 $350.75 $134.70
Repositioning
49422 Remove perm cannula/
catheter
49429 Removal of shunt
0130 Level I Laparoscopy T 25.36 $1,229.63 $659.53 $245.93
38129 Laparoscope proc,
spleen
38589 Laparoscope proc,
lymphatic
43289 Laparoscope proc,
esoph
43659 Laparoscope proc,
stom
44209 Laparoscope proc,
intestine
44970 Laparoscopy,
appendectomy
44979 Laparoscope proc,
app
47560 Laparoscopy w/
cholangio
47561 Laparo w/cholangio/
biopsy
47579 Laparoscope proc,
biliary
49320 Diag laparo separate
proc
49321 Laparoscopy, biopsy
49322 Laparoscopy,
aspiration
49323 Laparo drain
lymphocele
[[Page 18734]]
49329 Laparo proc, abdm/
per/oment
50549 Laparoscope proc,
renal
54699 Laparoscope proc,
testis
55559 Laparo proc,
spermatic cord
58679 Laparo proc, oviduct-
ovary
59898 Laparo proc, ob care/
deliver
60659 Laparo proc,
endocrine
0131 Level II Laparoscopy T 41.81 $2,027.24 $1,089.88 $405.45
38120 Laparoscopy,
splenectomy
38570 Laparoscopy, lymph
node biop
38572 Laparoscopy,
lymphadenectomy
43653 Laparoscopy,
gastrostomy
44200 Laparoscopy,
enterolysis
44201 Laparoscopy,
jejunostomy
47562 Laparoscopic
cholecystectomy
47563 Laparo
cholecystectomy/
graph
47564 Laparo
cholecystectomy/
explr
47570 Laparo
cholecystoenterosto
my
49650 Laparo hernia repair
initial
49651 Laparo hernia repair
recur
49659 Laparo proc, hernia
repair
50541 Laparo ablate renal
cyst
50544 Laparoscopy,
pyeloplasty
50945 Laparoscopy
ureterolithotomy
51990 Laparo urethral
suspension
54690 Laparoscopy,
orchiectomy
55550 Laparo ligate
spermatic vein
58551 Laparoscopy, remove
myoma
58660 Laparoscopy, lysis
58661 Laparoscopy, remove
adnexa
58662 Laparoscopy, excise
lesions
58670 Laparoscopy, tubal
cautery
58671 Laparoscopy, tubal
block
58672 Laparoscopy,
fimbrioplasty
58673 Laparoscopy,
salpingostomy
59150 Treat ectopic
pregnancy
59151 Treat ectopic
pregnancy
0132 Level III Laparoscopy T 48.91 $2,371.50 $1,239.22 $474.30
38571 Laparoscopy,
lymphadenectomy
43280 Laparoscopy,
fundoplasty
43651 Laparoscopy, vagus
nerve
43652 Laparoscopy, vagus
nerve
50548 Laparo-asst remove k/
ureter
51992 Laparo sling
operation
54692 Laparoscopy,
orchiopexy
58550 Laparo-asst vag
hysterectomy
0140 Esophageal Dilation without T 4.74 $229.83 $107.24 $45.97
Endoscopy
43450 Dilate esophagus
43453 Dilate esophagus
43456 Dilate esophagus
43458 Dilate esophagus
43499 Esophagus surgery
procedure
0141 Upper GI Procedures T 7.15 $346.68 $184.67 $69.34
43200 Esophagus endoscopy
43202 Esophagus endoscopy,
biopsy
43204 Esophagus endoscopy
& inject
43205 Esophagus endoscopy/
ligation
43215 Esophagus endoscopy
43216 Esophagus endoscopy/
lesion
43217 Esophagus endoscopy
43219 Esophagus endoscopy
43220 Esoph endoscopy,
dilation
43226 Esoph endoscopy,
dilation
43227 Esoph endoscopy,
repair
43228 Esoph endoscopy,
ablation
43234 Upper GI endoscopy,
exam
43235 Uppr gi endoscopy,
diagnosis
43239 Upper GI endoscopy,
biopsy
43241 Upper GI endoscopy
with tube
43243 Upper gi endoscopy &
inject
43244 Upper GI endoscopy/
ligation
43245 Operative upper GI
endoscopy
43246 Place gastrostomy
tube
[[Page 18735]]
43247 Operative upper GI
endoscopy
43248 Uppr gi endoscopy/
guide wire
43249 Esoph endoscopy,
dilation
43250 Upper GI endoscopy/
tumor
43251 Operative upper GI
endoscopy
43255 Operative upper GI
endoscopy
43258 Operative upper GI
endoscopy
43259 Endoscopic
ultrasound exam
43600 Biopsy of stomach
43750 Place gastrostomy
tube
43830 Place gastrostomy
tube
43831 Place gastrostomy
tube
44100 Biopsy of bowel
0142 Small Intestine Endoscopy T 7.45 $361.23 $162.42 $72.25
44360 Small bowel
endoscopy
44361 Small bowel
endoscopy/biopsy
44363 Small bowel
endoscopy
44364 Small bowel
endoscopy
44365 Small bowel
endoscopy
44366 Small bowel
endoscopy
44369 Small bowel
endoscopy
44372 Small bowel
endoscopy
44373 Small bowel
endoscopy
44376 Small bowel
endoscopy
44377 Small bowel
endoscopy/biopsy
44378 Small bowel
endoscopy
44380 Small bowel
endoscopy
44382 Small bowel
endoscopy
44799 Intestine surgery
procedure
0143 Lower GI Endoscopy T 7.98 $386.93 $199.12 $77.39
44385 Endoscopy of bowel
pouch
44386 Endoscopy, bowel
pouch/biop
44388 Colon endoscopy
44389 Colonoscopy with
biopsy
44390 Colonoscopy for
foreign body
44391 Colonoscopy for
bleeding
44392 Colonoscopy &
polypectomy
44393 Colonoscopy, lesion
removal
44394 Colonoscopy w/snare
45355 Surgical colonoscopy
45378 Diagnostic
colonoscopy
45379 Colonoscopy
45380 Colonoscopy and
biopsy
45382 Colonoscopy/control
bleeding
45383 Lesion removal
colonoscopy
45384 Colonoscopy
45385 Lesion removal
colonoscopy
0144 Diagnostic Anoscopy T 2.23 $108.13 $49.32 $21.63
46604 Anoscopy and
dilation
46608 Anoscopy/remove for
body
0145 Therapeutic Anoscopy T 7.46 $361.71 $179.39 $72.34
46606 Anoscopy and biopsy
46610 Anoscopy/remove
lesion
46611 Anoscopy
46612 Anoscopy/remove
lesions
46614 Anoscopy/control
bleeding
46615 Anoscopy
0146 Level I Sigmoidoscopy T 2.83 $137.22 $65.15 $27.44
45300 Proctosigmoidoscopy
45303 Proctosigmoidoscopy
45305 Proctosigmoidoscopy
& biopsy
45307 Proctosigmoidoscopy
45317 Proctosigmoidoscopy
45330 Diagnostic
sigmoidoscopy
45331 Sigmoidoscopy and
biopsy
45332 Sigmoidoscopy
0147 Level II Sigmoidoscopy T 6.26 $303.53 $149.11 $60.71
45308 Proctosigmoidoscopy
45309 Proctosigmoidoscopy
45315 Proctosigmoidoscopy
45320 Proctosigmoidoscopy
45321 Proctosigmoidoscopy
45333 Sigmoidoscopy &
polypectomy
[[Page 18736]]
45334 Sigmoidoscopy for
bleeding
45337 Sigmoidoscopy &
decompress
45338 Sigmoidoscopy
45339 Sigmoidoscopy
0148 Level I Anal/Rectal Procedure T 2.34 $113.46 $43.59 $22.69
45005 Drainage of rectal
abscess
45900 Reduction of rectal
prolapse
45915 Remove rectal
obstruction
45999 Rectum surgery
procedure
46040 Incision of rectal
abscess
46050 Incision of anal
abscess
46070 Incision of anal
septum
46083 Incise external
hemorrhoid
46221 Ligation of
hemorrhoid(s)
46320 Removal of
hemorrhoid clot
46500 Injection into
hemorrhoids
46934 Destruction of
hemorrhoids
46935 Destruction of
hemorrhoids
46945 Ligation of
hemorrhoids
46946 Ligation of
hemorrhoids
0149 Level II Anal/Rectal T 12.86 $623.54 $293.06 $124.71
Procedure
45000 Drainage of pelvic
abscess
45020 Drainage of rectal
abscess
45100 Biopsy of rectum
45905 Dilation of anal
sphincter
45910 Dilation of rectal
narrowing
46030 Removal of rectal
marker
46080 Incision of anal
sphincter
46210 Removal of anal
crypt
46220 Removal of anal tab
46230 Removal of anal tabs
46754 Removal of suture
from anus
46936 Destruction of
hemorrhoids
46940 Treatment of anal
fissure
46942 Treatment of anal
fissure
46999 Anus surgery
procedure
0150 Level III Anal/Rectal T 17.68 $857.25 $437.12 $171.45
Procedure
45108 Removal of anorectal
lesion
45150 Excision of rectal
stricture
45160 Excision of rectal
lesion
45170 Excision of rectal
lesion
45190 Destruction, rectal
tumor
45500 Repair of rectum
45505 Repair of rectum
45560 Repair of rectocele
46045 Incision of rectal
abscess
46060 Incision of rectal
abscess
46200 Removal of anal
fissure
46211 Removal of anal
crypts
46250 Hemorrhoidectomy
46255 Hemorrhoidectomy
46257 Remove hemorrhoids &
fissure
46258 Remove hemorrhoids &
fistula
46260 Hemorrhoidectomy
46261 Remove hemorrhoids &
fissure
46262 Remove hemorrhoids &
fistula
46270 Removal of anal
fistula
46275 Removal of anal
fistula
46280 Removal of anal
fistula
46285 Removal of anal
fistula
46288 Repair anal fistula
46700 Repair of anal
stricture
46750 Repair of anal
sphincter
46753 Reconstruction of
anus
46760 Repair of anal
sphincter
46761 Repair of anal
sphincter
46762 Implant artificial
sphincter
46937 Cryotherapy of
rectal lesion
46938 Cryotherapy of
rectal lesion
0151 Endoscopic Retrograde T 10.53 $510.57 $245.46 $102.11
Cholangio-Pancreatography
(ERCP)
43260 Endo
cholangiopancreatog
raph
43261 Endo
cholangiopancreatog
raph
43262 Endo
cholangiopancreatog
raph
[[Page 18737]]
43263 Endo
cholangiopancreatog
raph
43264 Endo
cholangiopancreatog
raph
43265 Endo
cholangiopancreatog
raph
43267 Endo
cholangiopancreatog
raph
43268 Endo
cholangiopancreatog
raph
43269 Endo
cholangiopancreatog
raph
43271 Endo
cholangiopancreatog
raph
43272 Endo
cholangiopancreatog
raph
0152 Percutaneous Biliary T 8.22 $398.56 $207.38 $79.71
Endoscopic Procedures
47510 Insert catheter,
bile duct
47511 Insert bile duct
drain
47552 Biliary endoscopy
thru skin
47553 Biliary endoscopy
thru skin
47554 Biliary endoscopy
thru skin
47555 Biliary endoscopy
thru skin
47556 Biliary endoscopy
thru skin
47630 Remove bile duct
stone
0153 Peritoneal and Abdominal T 19.62 $951.32 $496.31 $190.26
Procedures
49085 Remove abdomen
foreign body
49250 Excision of
umbilicus
49420 Insert abdominal
drain
49421 Insert abdominal
drain
49423 Exchange drainage
catheter
49426 Revise abdomen-
venous shunt
0154 Hernia/Hydrocele Procedures T 22.43 $1,087.57 $556.98 $217.51
49495 Repair inguinal
hernia, init
49496 Repair inguinal
hernia, init
49500 Repair inguinal
hernia
49501 Repair inguinal
hernia, init
49505 Repair inguinal
hernia
49507 Repair inguinal
hernia
49520 Rerepair inguinal
hernia
49521 Repair inguinal
hernia, rec
49525 Repair inguinal
hernia
49540 Repair lumbar hernia
49550 Repair femoral
hernia
49553 Repair femoral
hernia, init
49555 Repair femoral
hernia
49557 Repair femoral
hernia, recur
49560 Repair abdominal
hernia
49561 Repair incisional
hernia
49565 Rerepair abdominal
hernia
49566 Repair incisional
hernia
49568 Hernia repair w/mesh
49570 Repair epigastric
hernia
49572 Repair epigastric
hernia
49580 Repair umbilical
hernia
49582 Repair umbilical
hernia
49585 Repair umbilical
hernia
49587 Repair umbilical
hernia
49590 Repair abdominal
hernia
49600 Repair umbilical
lesion
51500 Removal of bladder
cyst
54530 Removal of testis
54550 Exploration for
testis
54640 Suspension of testis
55040 Removal of hydrocele
55041 Removal of
hydroceles
55535 Revise spermatic
cord veins
55540 Revise hernia &
sperm veins
2 0157 Colorectal Cancer Screening: S 1.79 $86.79 $17.36
Barium Enema
G0106 Colon CA screen;
barium enema
G0120 Colon ca scrn;
barium enema
1 0158 Colorectal Cancer Screening: S 7.98 $386.93 $96.73
Colonoscopy
G0104 CA screen; flexi
sigmoidscope
1 0159 Colorectal Cancer Screening: S 7.98 $137.22 $34.31
Flexible Sigmoidoscopy
G0105 Colorectal scrn; hi
risk ind
0160 Level I Cystourethroscopy and T 5.43 $263.28 $110.11 $52.66
other Genitourinary
Procedures
50392 Insert kidney drain
50393 Insert ureteral tube
50395 Create passage to
kidney
52000 Cystoscopy
52265 Cystoscopy and
treatment
[[Page 18738]]
0161 Level II Cystourethroscopy T 10.94 $530.45 $249.36 $106.09
and other Genitourinary
Procedures
50551 Kidney endoscopy
50553 Kidney endoscopy
50555 Kidney endoscopy &
biopsy
50557 Kidney endoscopy &
treatment
50559 Renal endoscopy/
radiotracer
50561 Kidney endoscopy &
treatment
52005 Cystoscopy & ureter
catheter
52007 Cystoscopy and
biopsy
52010 Cystoscopy & duct
catheter
52204 Cystoscopy
52214 Cystoscopy and
treatment
52224 Cystoscopy and
treatment
52260 Cystoscopy and
treatment
52270 Cystoscopy & revise
urethra
52275 Cystoscopy & revise
urethra
52276 Cystoscopy and
treatment
52281 Cystoscopy and
treatment
52283 Cystoscopy and
treatment
52285 Cystoscopy and
treatment
52290 Cystoscopy and
treatment
52300 Cystoscopy and
treatment
52301 Cystoscopy and
treatment
52305 Cystoscopy and
treatment
52310 Cystoscopy and
treatment
52315 Cystoscopy and
treatment
52327 Cystoscopy, inject
material
52510 Dilation prostatic
urethra
53605 Dilate urethra
stricture
0162 Level III Cystourethroscopy T 17.49 $848.04 $427.49 $169.61
and other Genitourinary
Procedures
50951 Endoscopy of ureter
50953 Endoscopy of ureter
50955 Ureter endoscopy &
biopsy
50957 Ureter endoscopy &
treatment
50959 Ureter endoscopy &
tracer
50961 Ureter endoscopy &
treatment
51020 Incise & treat
bladder
51030 Incise & treat
bladder
51040 Incise & drain
bladder
51045 Incise bladder/drain
ureter
51050 Removal of bladder
stone
51065 Removal of ureter
stone
51520 Removal of bladder
lesion
51880 Repair of bladder
opening
52234 Cystoscopy and
treatment
52235 Cystoscopy and
treatment
52250 Cystoscopy and
radiotracer
52277 Cystoscopy and
treatment
52282 Cystoscopy, implant
stent
52317 Remove bladder stone
52318 Remove bladder stone
52320 Cystoscopy and
treatment
52325 Cystoscopy, stone
removal
52330 Cystoscopy and
treatment
52332 Cystoscopy and
treatment
52334 Create passage to
kidney
52335 Endoscopy of urinary
tract
52336 Cystoscopy, stone
removal
52337 Cystoscopy, stone
removal
52338 Cystoscopy and
treatment
52339 Cystoscopy and
treatment
52340 Cystoscopy and
treatment
52450 Incision of prostate
52500 Revision of bladder
neck
52606 Control postop
bleeding
52640 Relieve bladder
contracture
52700 Drainage of prostate
abscess
55720 Drainage of prostate
abscess
55725 Drainage of prostate
abscess
55859 Percut/needle
insert, pros
0163 Level IV Cystourethroscopy T 28.98 $1,405.16 $792.58 $281.03
and other Genitourinary
Procedures
50080 Removal of kidney
stone
50081 Removal of kidney
stone
[[Page 18739]]
52240 Cystoscopy and
treatment
52601 Prostatectomy (TURP)
52612 Prostatectomy, first
stage
52614 Prostatectomy,
second stage
52620 Remove residual
prostate
52630 Remove prostate
regrowth
52647 Laser surgery of
prostate
52648 Laser surgery of
prostate
0164 Level I Urinary and Anal T 2.17 $105.23 $33.03 $21.05
Procedures
51005 Drainage of bladder
51700 Irrigation of
bladder
51736 Urine flow
measurement
51741 Electro-
uroflowmetry, first
51784 Anal/urinary muscle
study
51785 Anal/urinary muscle
study
51795 Urine voiding
pressure study
51797 Intraabdominal
pressure test
53600 Dilate urethra
stricture
53601 Dilate urethra
stricture
53621 Dilate urethra
stricture
53660 Dilation of urethra
53661 Dilation of urethra
53675 Insert urinary
catheter
54235 Penile injection
54240 Penis study
55899 Genital surgery
procedure
0165 Level II Urinary and Anal T 3.89 $188.61 $91.76 $37.72
Procedures
50396 Measure kidney
pressure
50686 Measure ureter
pressure
51000 Drainage of bladder
51010 Drainage of bladder
51720 Treatment of bladder
lesion
51725 Simple
cystometrogram
51726 Complex
cystometrogram
51772 Urethra pressure
profile
51792 Urinary reflex study
53620 Dilate urethra
stricture
53899 Urology surgery
procedure
54200 Treatment of penis
lesion
54220 Treatment of penis
lesion
54231 Dynamic
cavernosometry
54250 Penis study
54450 Preputial stretching
91122 Anal pressure record
0166 Level I Urethral Procedures T 10.17 $493.11 $218.73 $98.62
53000 Incision of urethra
53010 Incision of urethra
53020 Incision of urethra
53025 Incision of urethra
53040 Drainage of urethra
abscess
53060 Drainage of urethra
abscess
53080 Drainage of urinary
leakage
53200 Biopsy of urethra
53250 Removal of urethra
gland
53260 Treatment of urethra
lesion
53265 Treatment of urethra
lesion
53275 Repair of urethra
defect
53442 Remove perineal
prosthesis
53502 Repair of urethra
injury
53510 Repair of urethra
injury
53665 Dilation of urethra
54000 Slitting of prepuce
54001 Slitting of prepuce
0167 Level II Urethral Procedures T 21.06 $1,021.14 $555.84 $204.23
51715 Endoscopic injection/
implant
53270 Removal of urethra
gland
53505 Repair of urethra
injury
0168 Level III Urethral Procedures T 24.94 $1,209.27 $536.11 $241.85
53210 Removal of urethra
53215 Removal of urethra
53220 Treatment of urethra
lesion
53230 Removal of urethra
lesion
53235 Removal of urethra
lesion
[[Page 18740]]
53240 Surgery for urethra
pouch
53400 Revise urethra,
stage 1
53405 Revise urethra,
stage 2
53410 Reconstruction of
urethra
53420 Reconstruct urethra,
stage 1
53425 Reconstruct urethra,
stage 2
53430 Reconstruction of
urethra
53447 Remove artificial
sphincter
53449 Correct artificial
sphincter
53450 Revision of urethra
53460 Revision of urethra
53515 Repair of urethra
injury
53520 Repair of urethra
defect
0169 Lithotripsy T 46.72 $2,265.32 $1,384.20 $453.06
50590 Fragmenting of
kidney stone
0170 Dialysis for Other Than ESRD S 6.68 $323.89 $72.26 $64.78
Patients
90935 Hemodialysis, one
evaluation
90945 Dialysis, one
evaluation
0180 Circumcision T 13.62 $660.39 $304.87 $132.08
54150 Circumcision
54152 Circumcision
54160 Circumcision
54161 Circumcision
0181 Penile Procedures T 32.37 $1,569.53 $906.36 $313.91
37790 Penile venous
occlusion
54110 Treatment of penis
lesion
54111 Treat penis lesion,
graft
54112 Treat penis lesion,
graft
54120 Partial removal of
penis
54205 Treatment of penis
lesion
54300 Revision of penis
54304 Revision of penis
54308 Reconstruction of
urethra
54312 Reconstruction of
urethra
54316 Reconstruction of
urethra
54318 Reconstruction of
urethra
54322 Reconstruction of
urethra
54324 Reconstruction of
urethra
54326 Reconstruction of
urethra
54328 Revise penis/urethra
54340 Secondary urethral
surgery
54344 Secondary urethral
surgery
54348 Secondary urethral
surgery
54352 Reconstruct urethra/
penis
54360 Penis plastic
surgery
54380 Repair penis
54385 Repair penis
54402 Remove penis
prosthesis
54407 Remove multi-comp
prosthesis
54409 Revise penis
prosthesis
54420 Revision of penis
54435 Revision of penis
54440 Repair of penis
0182 Insertion of Penile T 52.11 $2,526.66 $1,525.05 $505.33
Prosthesis
53440 Correct bladder
function
53445 Correct urine flow
control
54400 Insert semi-rigid
prosthesis
54401 Insert self-contd
prosthesis
54405 Insert multi-comp
prosthesis
0183 Testes/Epididymis Procedures T 18.26 $885.37 $448.94 $177.07
54505 Biopsy of testis
54510 Removal of testis
lesion
54520 Removal of testis
54600 Reduce testis
torsion
54620 Suspension of testis
54660 Revision of testis
54670 Repair testis injury
54680 Relocation of
testis(es)
54700 Drainage of scrotum
54820 Exploration of
epididymis
54830 Remove epididymis
lesion
54840 Remove epididymis
lesion
54860 Removal of
epididymis
[[Page 18741]]
54861 Removal of
epididymis
54900 Fusion of spermatic
ducts
54901 Fusion of spermatic
ducts
55060 Repair of hydrocele
55110 Explore scrotum
55120 Removal of scrotum
lesion
55150 Removal of scrotum
55175 Revision of scrotum
55180 Revision of scrotum
55200 Incision of sperm
duct
55250 Removal of sperm
duct(s)
55400 Repair of sperm duct
55450 Ligation of sperm
duct
55500 Removal of hydrocele
55520 Removal of sperm
cord lesion
55530 Revise spermatic
cord veins
55680 Remove sperm pouch
lesion
0184 Prostate Biopsy T 4.94 $239.53 $122.96 $47.91
55700 Biopsy of prostate
55705 Biopsy of prostate
0190 Surgical Hysteroscopy T 17.85 $865.49 $443.89 $173.10
58558 Hysteroscopy, biopsy
58559 Hysteroscopy, lysis
58560 Hysteroscopy, resect
septum
58561 Hysteroscopy, remove
myoma
58562 Hysteroscopy, remove
fb
58563 Hysteroscopy,
ablation
58578 Laparo proc, uterus
58579 Hysteroscope
procedure
0191 Level I Female Reproductive T 1.19 $57.70 $17.43 $11.54
Procedures
57160 Insert pessary/other
device
57170 Fitting of diaphragm/
cap
57452 Examination of
vagina
58100 Biopsy of uterus
lining
58301 Remove intrauterine
device
58555 Hysteroscopy, dx,
sep proc
59200 Insert cervical
dilator
Q0091 Obtaining screen pap
smear
0192 Level II Female Reproductive T 2.38 $115.40 $35.33 $23.08
Procedures
56405 I & D of vulva/
perineum
56420 Drainage of gland
abscess
57100 Biopsy of vagina
57150 Treat vagina
infection
57180 Treat vaginal
bleeding
57454 Vagina examination &
biopsy
57505 Endocervical
curettage
57511 Cryocautery of
cervix
99170 Anogenital exam,
child
0193 Level III Female Reproductive T 8.93 $432.99 $171.13 $86.60
Procedures
56441 Lysis of labial
lesion(s)
56720 Incision of hymen
57020 Drainage of pelvic
fluid
57460 Cervix excision
57500 Biopsy of cervix
57510 Cauterization of
cervix
57513 Laser surgery of
cervix
57800 Dilation of cervical
canal
0194 Level IV Female Reproductive T 16.21 $785.98 $395.94 $157.20
Procedures
56440 Surgery for vulva
lesion
56700 Partial removal of
hymen
56740 Remove vagina gland
lesion
56800 Repair of vagina
56810 Repair of perineum
57000 Exploration of
vagina
57010 Drainage of pelvic
abscess
57061 Destruction vagina
lesion(s)
57065 Destruction vagina
lesion(s)
57105 Biopsy of vagina
57106 Remove vagina wall,
partial
57107 Remove vagina
tissue, part
57109 Vaginectomy partial
w/nodes
57130 Remove vagina lesion
57135 Remove vagina lesion
[[Page 18742]]
57200 Repair of vagina
57210 Repair vagina/
perineum
57230 Repair of urethral
lesion
57400 Dilation of vagina
57410 Pelvic examination
57415 Remove vaginal
foreign body
57520 Conization of cervix
57700 Revision of cervix
57720 Revision of cervix
58345 Reopen fallopian
tube
58350 Reopen fallopian
tube
58970 Retrieval of oocyte
59300 Episiotomy or
vaginal repair
59320 Revision of cervix
59871 Remove cerclage
suture
0195 Level V Female Reproductive T 18.68 $905.74 $483.80 $181.15
Procedures
56620 Partial removal of
vulva
56625 Complete removal of
vulva
57220 Revision of urethra
57240 Repair bladder &
vagina
57250 Repair rectum &
vagina
57260 Repair of vagina
57265 Extensive repair of
vagina
57268 Repair of bowel
bulge
57284 Repair paravaginal
defect
57288 Repair bladder
defect
57289 Repair bladder &
vagina
57291 Construction of
vagina
57300 Repair rectum-vagina
fistula
57522 Conization of cervix
57530 Removal of cervix
57550 Removal of residual
cervix
57555 Remove cervix/repair
vagina
57556 Remove cervix,
repair bowel
58145 Removal of uterus
lesion
58800 Drainage of ovarian
cyst(s)
58820 Drain ovary abscess,
open
58900 Biopsy of ovary(s)
58920 Partial removal of
ovary(s)
58925 Removal of ovarian
cyst(s)
0196 Dilatation & Curettage T 14.47 $701.61 $357.98 $140.32
57820 D & c of residual
cervix
58120 Dilation and
curettage
59160 D & c after delivery
0197 Infertility Procedures T 2.40 $116.37 $49.55 $23.27
55870 Electroejaculation
58321 Artificial
insemination
58322 Artificial
insemination
58323 Sperm washing
58974 Transfer of embryo
58976 Transfer of embryo
0198 Pregnancy and Neonatal Care T 1.34 $64.97 $33.03 $12.99
Procedures
59000 Amniocentesis
59012 Fetal cord puncture,
prenatal
59015 Chorion biopsy
59020 Fetal contract
stress test
59025 Fetal non-stress
test
59030 Fetal scalp blood
sample
59050 Fetal monitor w/
report
59899 Maternity care
procedure
0199 Vaginal Delivery T 11.20 $543.06 $157.83 $108.61
59409 Obstetrical care
59412 Antepartum
manipulation
59414 Deliver placenta
59612 Vbac delivery only
0200 Therapeutic Abortion T 13.89 $673.49 $373.23 $134.70
59840 Abortion
59841 Abortion
0201 Spontaneous Abortion T 13.00 $630.33 $329.65 $126.07
59812 Treatment of
miscarriage
59820 Care of miscarriage
59821 Treatment of
miscarriage
59870 Evacuate mole of
uterus
[[Page 18743]]
0210 Spinal Tap T 3.00 $145.46 $62.40 $29.09
62270 Spinal fluid tap,
diagnostic
62272 Drain spinal fluid
0211 Level I Nervous System T 3.32 $160.98 $74.78 $32.20
Injections
64400 Injection for nerve
block
64402 Injection for nerve
block
64405 Injection for nerve
block
64408 Injection for nerve
block
64410 Injection for nerve
block
64412 Injection for nerve
block
64413 Injection for nerve
block
64415 Injection for nerve
block
64417 Injection for nerve
block
64418 Injection for nerve
block
64420 Injection for nerve
block
64421 Injection for nerve
block
64425 Injection for nerve
block
64430 Injection for nerve
block
64435 Injection for nerve
block
64445 Injection for nerve
block
64450 Injection for nerve
block
64470 Inj paravertebral c/
t
64472 Inj paravertebral c/
t add-on
64475 Inj paravertebral l/
s
64476 Inj paravertebral l/
s add-on
64479 Inj foramen epidural
c/t
64480 Inj foramen epidural
add-on
64483 Inj foramen epidural
l/s
64484 Inj foramen epidural
add-on
64505 Injection for nerve
block
64508 Injection for nerve
block
64510 Injection for nerve
block
64520 Injection for nerve
block
64530 Injection for nerve
block
64600 Injection treatment
of nerve
64605 Injection treatment
of nerve
64610 Injection treatment
of nerve
64612 Destroy nerve, face
muscle
64613 Destroy nerve, spine
muscle
64620 Injection treatment
of nerve
64622 Destr paravertebrl
nerve l/s
64623 Destr paravertebral
n add-on
64626 Destr paravertebrl
nerve c/t
64627 Destr paravertebral
n add-on
64630 Injection treatment
of nerve
64640 Injection treatment
of nerve
64680 Injection treatment
of nerve
64999 Nervous system
surgery
0212 Level II Nervous System T 3.64 $176.49 $88.78 $35.30
Injections
61000 Remove cranial
cavity fluid
61001 Remove cranial
cavity fluid
61020 Remove brain cavity
fluid
61026 Injection into brain
canal
61050 Remove brain canal
fluid
61055 Injection into brain
canal
61070 Brain canal shunt
procedure
62263 Lysis epidural
adhesions
62268 Drain spinal cord
cyst
62273 Treat epidural spine
lesion
62280 Treat spinal cord
lesion
62281 Treat spinal cord
lesion
62282 Treat spinal canal
lesion
62292 Injection into disk
lesion
62294 Injection into
spinal artery
62310 Inject spine c/t
62311 Inject spine l/s
(cd)
62318 Inject spine w/cath,
c/t
62319 Inject spine w/cath
l/s (cd)
0213 Extended EEG Studies and S 11.15 $540.63 $290.42 $108.13
Sleep Studies
95805 Multiple sleep
latency test
95806 Sleep study,
unattended
95807 Sleep study,
attended
95808 Polysomnography, 1-3
[[Page 18744]]
95810 Polysomnography, 4
or more
95811 Polysomnography w/
cpap
95812 Electroencephalogram
(EEG)
95813 Electroencephalogram
(EEG)
95827 Night
electroencephalogra
m
95951 EEG monitoring/
videorecord
95953 EEG monitoring/
computer
95954 EEG monitoring/
giving drugs
95958 EEG monitoring/
function test
0214 Electroencephalogram S 2.32 $112.49 $58.50 $22.50
95816 Electroencephalogram
(EEG)
95819 Electroencephalogram
(EEG)
95822 Sleep
electroencephalogra
m
95824 Electroencephalograp
hy
95829 Surgery
electrocorticogram
95955 EEG during surgery
0215 Level I Nerve and Muscle S 1.15 $55.76 $30.05 $11.15
Tests
95857 Tensilon test
95858 Tensilon test &
myogram
95860 Muscle test, one
limb
95861 Muscle test, two
limbs
95864 Muscle test, 4 limbs
95869 Muscle test, thor
paraspinal
95870 Muscle test,
nonparaspinal
95872 Muscle test, one
fiber
95900 Motor nerve
conduction test
95903 Motor nerve
conduction test
95904 Sense/mixed n
conduction tst
95933 Blink reflex test
95934 H-reflex test
95937 Neuromuscular
junction test
0216 Level II Nerve and Muscle S 2.87 $139.16 $64.69 $27.83
Tests
92275 Electroretinography
92585 Auditory evoked
potential
95863 Muscle test, 3 limbs
95867 Muscle test, head or
neck
95868 Muscle test, head or
neck
95921 Autonomic nerv
function test
95922 Autonomic nerv
function test
95923 Autonomic nerv
function test
95925 Somatosensory
testing
95926 Somatosensory
testing
95927 Somatosensory
testing
95930 Visual evoked
potential test
95936 H-reflex test
0217 Level III Nerve and Muscle S 5.87 $284.62 $156.68 $56.92
Tests
95875 Limb exercise test
95950 Ambulatory eeg
monitoring
0220 Level I Nerve Procedures T 13.96 $676.88 $326.21 $135.38
27315 Partial removal,
thigh nerve
27320 Partial removal,
thigh nerve
28030 Removal of foot
nerve
28035 Decompression of
tibia nerve
61790 Treat trigeminal
nerve
62287 Percutaneous
diskectomy
63600 Remove spinal cord
lesion
63610 Stimulation of
spinal cord
63615 Remove lesion of
spinal cord
64702 Revise finger/toe
nerve
64704 Revise hand/foot
nerve
64708 Revise arm/leg nerve
64712 Revision of sciatic
nerve
64713 Revision of arm
nerve(s)
64714 Revise low back
nerve(s)
64716 Revision of cranial
nerve
64718 Revise ulnar nerve
at elbow
64719 Revise ulnar nerve
at wrist
64721 Carpal tunnel
surgery
64722 Relieve pressure on
nerve(s)
64726 Release foot/toe
nerve
64727 Internal nerve
revision
64732 Incision of brow
nerve
64734 Incision of cheek
nerve
[[Page 18745]]
64736 Incision of chin
nerve
64738 Incision of jaw
nerve
64740 Incision of tongue
nerve
64742 Incision of facial
nerve
64744 Incise nerve, back
of head
64746 Incise diaphragm
nerve
64761 Incision of pelvis
nerve
64771 Sever cranial nerve
64772 Incision of spinal
nerve
64774 Remove skin nerve
lesion
64776 Remove digit nerve
lesion
64778 Digit nerve surgery
add-on
64782 Remove limb nerve
lesion
64783 Limb nerve surgery
add-on
64784 Remove nerve lesion
64787 Implant nerve end
64788 Remove skin nerve
lesion
64790 Removal of nerve
lesion
64795 Biopsy of nerve
0221 Level II Nerve Procedures T 18.36 $890.22 $463.62 $178.04
64786 Remove sciatic nerve
lesion
64792 Removal of nerve
lesion
64831 Repair of digit
nerve
64832 Repair nerve add-on
64834 Repair of hand or
foot nerve
64835 Repair of hand or
foot nerve
64836 Repair of hand or
foot nerve
64837 Repair nerve add-on
64840 Repair of leg nerve
64856 Repair/transpose
nerve
64857 Repair arm/leg nerve
64858 Repair sciatic nerve
64859 Nerve surgery
64861 Repair of arm nerves
64862 Repair of low back
nerves
64864 Repair of facial
nerve
64865 Repair of facial
nerve
64870 Fusion of facial/
other nerve
64872 Subsequent repair of
nerve
64874 Repair & revise
nerve add-on
64876 Repair nerve/shorten
bone
64885 Nerve graft, head or
neck
64886 Nerve graft, head or
neck
64890 Nerve graft, hand or
foot
64891 Nerve graft, hand or
foot
64892 Nerve graft, arm or
leg
64893 Nerve graft, arm or
leg
64895 Nerve graft, hand or
foot
64896 Nerve graft, hand or
foot
64897 Nerve graft, arm or
leg
64898 Nerve graft, arm or
leg
64901 Nerve graft add-on
64902 Nerve graft add-on
64905 Nerve pedicle
transfer
64907 Nerve pedicle
transfer
0222 Implantation of Neurological T 25.48 $1,235.45 $780.07 $247.09
Device
61215 Insert brain-fluid
device
61885 Implant neurostim
one array
62360 Insert spine
infusion device
62361 Implant spine
infusion pump
62362 Implant spine
infusion pump
63685 Implant
neuroreceiver
64590 Implant
neuroreceiver
0223 Level I Revision/Removal T 6.34 $307.41 $153.24 $61.48
Neurological Device
62350 Implant spinal canal
cath
62355 Remove spinal canal
catheter
63746 Removal of spinal
shunt
0224 Level II Revision/Removal T 15.94 $772.88 $374.61 $154.58
Neurological Device
62230 Replace/revise brain
shunt
62365 Remove spine
infusion device
63650 Implant
neuroelectrodes
63660 Revise/remove
neuroelectrode
63688 Revise/remove
neuroreceiver
[[Page 18746]]
63744 Revision of spinal
shunt
0225 Implantation of T 3.43 $166.31 $64.46 $33.26
Neurostimulator Electrodes
64553 Implant
neuroelectrodes
64555 Implant
neuroelectrodes
64560 Implant
neuroelectrodes
64565 Implant
neuroelectrodes
64573 Implant
neuroelectrodes
64575 Implant
neuroelectrodes
64577 Implant
neuroelectrodes
64580 Implant
neuroelectrodes
64585 Revise/remove
neuroelectrode
64595 Revise/remove
neuroreceiver
0230 Level I Eye Tests S 0.98 $47.52 $22.48 $9.50
68200 Treat eyelid by
injection
92020 Special eye
evaluation
92060 Special eye
evaluation
92065 Orthoptic/pleoptic
training
92081 Visual field
examination(s)
92082 Visual field
examination(s)
92083 Visual field
examination(s)
92120 Tonography & eye
evaluation
92130 Water provocation
tonography
92225 Special eye exam,
initial
92250 Eye exam with photos
92260 Ophthalmoscopy/
dynamometry
92265 Eye muscle
evaluation
92270 Electro-oculography
92283 Color vision
examination
92285 Eye photography
92330 Fitting of
artificial eye
92499 Eye service or
procedure
0231 Level II Eye Tests S 2.64 $128.01 $59.87 $25.60
65205 Remove foreign body
from eye
65210 Remove foreign body
from eye
65220 Remove foreign body
from eye
65222 Remove foreign body
from eye
65430 Corneal smear
67350 Biopsy eye muscle
67500 Inject/treat eye
socket
68110 Remove eyelid lining
lesion
68761 Close tear duct
opening
68801 Dilate tear duct
opening
68810 Probe nasolacrimal
duct
68840 Explore/irrigate
tear ducts
68899 Tear duct system
surgery
92018 New eye exam &
treatment
92019 Eye exam & treatment
92135 Opthalmic dx imaging
92140 Glaucoma provocative
tests
92226 Special eye exam,
subsequent
92230 Eye exam with photos
92235 Eye exam with photos
92240 Icg angiography
92284 Dark adaptation eye
exam
92286 Internal eye
photography
92287 Internal eye
photography
0232 Level I Anterior Segment Eye T 6.04 $292.86 $134.66 $58.57
65235 Remove foreign body
from eye
65272 Repair of eye wound
65286 Repair of eye wound
65400 Removal of eye
lesion
65436 Curette/treat cornea
65450 Treatment of corneal
lesion
65772 Correction of
astigmatism
65800 Drainage of eye
65820 Relieve inner eye
pressure
65880 Incise inner eye
adhesions
65900 Remove eye lesion
66020 Injection treatment
of eye
66030 Injection treatment
of eye
66500 Incision of iris
66505 Incision of iris
66625 Removal of iris
[[Page 18747]]
66700 Destruction, ciliary
body
66710 Destruction, ciliary
body
66720 Destruction, ciliary
body
66820 Incision, secondary
cataract
66830 Removal of lens
lesion
67880 Revision of eyelid
68100 Biopsy of eyelid
lining
0233 Level II Anterior Segment Eye T 13.79 $668.64 $331.60 $133.73
65275 Repair of eye wound
65280 Repair of eye wound
65410 Biopsy of cornea
65420 Removal of eye
lesion
65426 Removal of eye
lesion
65775 Correction of
astigmatism
65805 Drainage of eye
65810 Drainage of eye
65815 Drainage of eye
65865 Incise inner eye
adhesions
65870 Incise inner eye
adhesions
65875 Incise inner eye
adhesions
65920 Remove implant from
eye
65930 Remove blood clot
from eye
66130 Remove eye lesion
66150 Glaucoma surgery
66250 Follow-up surgery of
eye
66600 Remove iris and
lesion
66605 Removal of iris
66630 Removal of iris
66635 Removal of iris
66680 Repair iris &
ciliary body
66682 Repair iris &
ciliary body
66740 Destruction, ciliary
body
66825 Reposition
intraocular lens
68130 Remove eyelid lining
lesion
68330 Revise eyelid lining
0234 Level III Anterior Segment T 20.64 $1,000.77 $502.16 $200.15
Eye Procedures
65285 Repair of eye wound
65850 Incision of eye
66155 Glaucoma surgery
66160 Glaucoma surgery
66165 Glaucoma surgery
66170 Glaucoma surgery
66172 Incision of eye
66180 Implant eye shunt
66185 Revise eye shunt
66225 Repair/graft eye
lesion
68360 Revise eyelid lining
68362 Revise eyelid lining
0235 Level I Posterior Segment Eye T 2.94 $142.55 $78.91 $28.51
Procedures
67141 Treatment of retina
67208 Treatment of retinal
lesion
67227 Treatment of retinal
lesion
0236 Level II Posterior Segment T 6.70 $324.86 $147.96 $64.97
Eye Procedures
66220 Repair eye lesion
67028 Injection eye drug
67030 Incise inner eye
strands
67101 Repair detached
retina
67110 Repair detached
retina
67115 Release encircling
material
67120 Remove eye implant
material
0237 Level III Posterior Segment T 33.96 $1,646.62 $852.68 $329.32
Eye Procedures
65260 Remove foreign body
from eye
65265 Remove foreign body
from eye
67005 Partial removal of
eye fluid
67010 Partial removal of
eye fluid
67015 Release of eye fluid
67025 Replace eye fluid
67027 Implant eye drug
system
67036 Removal of inner eye
fluid
67038 Strip retinal
membrane
67039 Laser treatment of
retina
67040 Laser treatment of
retina
67107 Repair detached
retina
[[Page 18748]]
67108 Repair detached
retina
67112 Rerepair detached
retina
67121 Remove eye implant
material
67218 Treatment of retinal
lesion
67220 Treatment of choroid
lesion
67255 Reinforce/graft eye
wall
0238 Level I Repair and Plastic T 2.80 $135.76 $58.96 $27.15
Eye Procedures
67345 Destroy nerve of eye
muscle
67505 Inject/treat eye
socket
67700 Drainage of eyelid
abscess
67800 Remove eyelid lesion
67805 Remove eyelid
lesions
67810 Biopsy of eyelid
67820 Revise eyelashes
67825 Revise eyelashes
67938 Remove eyelid
foreign body
68400 Incise/drain tear
gland
68440 Incise tear duct
opening
68705 Revise tear duct
opening
68760 Close tear duct
opening
0239 Level II Repair and Plastic T 6.26 $303.53 $123.42 $60.71
Eye Procedures
65435 Curette/treat cornea
67415 Aspiration, orbital
contents
67515 Inject/treat eye
socket
67599 Orbit surgery
procedure
67710 Incision of eyelid
67801 Remove eyelid
lesions
67830 Revise eyelashes
67840 Remove eyelid lesion
67850 Treat eyelid lesion
67875 Closure of eyelid by
suture
67915 Repair eyelid defect
67922 Repair eyelid defect
68040 Treatment of eyelid
lesions
68115 Remove eyelid lining
lesion
68135 Remove eyelid lining
lesion
68399 Eyelid lining
surgery
0240 Level III Repair and Plastic T 13.47 $653.12 $315.31 $130.62
Eye Procedures
65125 Revise ocular
implant
65175 Removal of ocular
implant
65270 Repair of eye wound
65600 Revision of cornea
67250 Reinforce eye wall
67715 Incision of eyelid
fold
67808 Remove eyelid
lesion(s)
67835 Revise eyelashes
67882 Revision of eyelid
67900 Repair brow defect
67901 Repair eyelid defect
67902 Repair eyelid defect
67903 Repair eyelid defect
67904 Repair eyelid defect
67906 Repair eyelid defect
67908 Repair eyelid defect
67909 Revise eyelid defect
67911 Revise eyelid defect
67914 Repair eyelid defect
67916 Repair eyelid defect
67917 Repair eyelid defect
67921 Repair eyelid defect
67923 Repair eyelid defect
67924 Repair eyelid defect
67930 Repair eyelid wound
67935 Repair eyelid wound
67950 Revision of eyelid
67961 Revision of eyelid
67966 Revision of eyelid
67975 Reconstruction of
eyelid
67999 Revision of eyelid
68020 Incise/drain eyelid
lining
68320 Revise/graft eyelid
lining
68340 Separate eyelid
adhesions
68420 Incise/drain tear
sac
[[Page 18749]]
68510 Biopsy of tear gland
68525 Biopsy of tear sac
68530 Clearance of tear
duct
68770 Close tear system
fistula
68811 Probe nasolacrimal
duct
68815 Probe nasolacrimal
duct
0241 Level IV Repair and Plastic T 16.60 $804.89 $384.47 $160.98
Eye Procedures
65093 Revise eye with
implant
65130 Insert ocular
implant
65135 Insert ocular
implant
65150 Revise ocular
implant
67400 Explore/biopsy eye
socket
67405 Explore/drain eye
socket
67412 Explore/treat eye
socket
67413 Explore/treat eye
socket
67560 Revise eye socket
implant
67971 Reconstruction of
eyelid
67973 Reconstruction of
eyelid
67974 Reconstruction of
eyelid
68326 Revise/graft eyelid
lining
68328 Revise/graft eyelid
lining
68335 Revise/graft eyelid
lining
68500 Removal of tear
gland
68505 Partial removal,
tear gland
68520 Removal of tear sac
68540 Remove tear gland
lesion
68700 Repair tear ducts
68745 Create tear duct
drain
0242 Level V Repair and Plastic T 23.70 $1,149.14 $597.36 $229.83
Eye Procedures
65091 Revise eye
65101 Removal of eye
65103 Remove eye/insert
implant
65105 Remove eye/attach
implant
65110 Removal of eye
65112 Remove eye/revise
socket
65114 Remove eye/revise
socket
65140 Attach ocular
implant
65155 Reinsert ocular
implant
67414 Explr/decompress eye
socket
67420 Explore/treat eye
socket
67430 Explore/treat eye
socket
67440 Explore/drain eye
socket
67445 Explr/decompress eye
socket
67450 Explore/biopsy eye
socket
67550 Insert eye socket
implant
67570 Decompress optic
nerve
68325 Revise/graft eyelid
lining
68550 Remove tear gland
lesion
68720 Create tear sac
drain
68750 Create tear duct
drain
0243 Strabismus/Muscle Procedures T 17.99 $872.28 $431.39 $174.46
65290 Repair of eye socket
wound
67311 Revise eye muscle
67312 Revise two eye
muscles
67314 Revise eye muscle
67316 Revise two eye
muscles
67318 Revise eye muscle(s)
67320 Revise eye muscle(s)
add-on
67331 Eye surgery follow-
up add-on
67332 Rerevise eye muscles
add-on
67334 Revise eye muscle w/
suture
67335 Eye suture during
surgery
67340 Revise eye muscle
add-on
67343 Release eye tissue
67399 Eye muscle surgery
procedure
0244 Corneal Transplant T 32.88 $1,594.26 $851.42 $318.85
65710 Corneal transplant
65730 Corneal transplant
65750 Corneal transplant
65755 Corneal transplant
65770 Revise cornea with
implant
0245 Cataract Procedures without T 26.55 $1,287.33 $623.85 $257.47
IOL Insert
66840 Removal of lens
material
[[Page 18750]]
66850 Removal of lens
material
66852 Removal of lens
material
66920 Extraction of lens
66930 Extraction of lens
66940 Extraction of lens
0246 Cataract Procedures with IOL T 26.55 $1,287.33 $623.85 $257.47
Insert
66983 Remove cataract/
insert lens
66984 Remove cataract/
insert lens
66985 Insert lens
prosthesis
66986 Exchange lens
prosthesis
0247 Laser Eye Procedures Except T 4.89 $237.10 $112.86 $47.42
Retinal
65855 Laser surgery of eye
65860 Incise inner eye
adhesions
66761 Revision of iris
66762 Revision of iris
66770 Removal of inner eye
lesion
66821 After cataract laser
surgery
66999 Eye surgery
procedure
67031 Laser surgery, eye
strands
0248 Laser Retinal Procedures T 4.19 $203.16 $94.05 $40.63
67105 Repair detached
retina
67145 Treatment of retina
67210 Treatment of retinal
lesion
67228 Treatment of retinal
lesion
67299 Eye surgery
procedure
0250 Nasal Cauterization/Packing T 2.21 $107.16 $38.54 $21.43
30901 Control of nosebleed
30903 Control of nosebleed
30905 Control of nosebleed
30906 Repeat control of
nosebleed
42960 Control throat
bleeding
42970 Control nose/throat
bleeding
0251 Level I ENT Procedures T 1.68 $81.46 $27.99 $16.29
21450 Treat lower jaw
fracture
21480 Reset dislocated jaw
30000 Drainage of nose
lesion
30020 Drainage of nose
lesion
30300 Remove nasal foreign
body
30560 Release of nasal
adhesions
30999 Nasal surgery
procedure
31000 Irrigation,
maxillary sinus
40800 Drainage of mouth
lesion
40804 Removal, foreign
body, mouth
40806 Incision of lip fold
40808 Biopsy of mouth
lesion
40818 Excise oral mucosa
for graft
40830 Repair mouth
laceration
41005 Drainage of mouth
lesion
41009 Drainage of mouth
lesion
41250 Repair tongue
laceration
41599 Tongue and mouth
surgery
41800 Drainage of gum
lesion
42000 Drainage mouth roof
lesion
42180 Repair palate
42280 Preparation, palate
mold
42299 Palate/uvula surgery
42310 Drainage of salivary
gland
42320 Drainage of salivary
gland
42700 Drainage of tonsil
abscess
42809 Remove pharynx
foreign body
69400 Inflate middle ear
canal
92502 Ear and throat
examination
0252 Level II ENT Procedures T 5.18 $251.16 $114.24 $50.23
20500 Injection of sinus
tract
21400 Treat eye socket
fracture
21493 Treat hyoid bone
fracture
21494 Treat hyoid bone
fracture
21899 Neck/chest surgery
procedure
30100 Intranasal biopsy
30124 Removal of nose
lesion
30210 Nasal sinus therapy
30220 Insert nasal septal
button
30801 Cauterization, inner
nose
[[Page 18751]]
31002 Irrigation, sphenoid
sinus
31299 Sinus surgery
procedure
40490 Biopsy of lip
40801 Drainage of mouth
lesion
40805 Removal, foreign
body, mouth
40812 Excise/repair mouth
lesion
40819 Excise lip or cheek
fold
40899 Mouth surgery
procedure
41015 Drainage of mouth
lesion
41100 Biopsy of tongue
41108 Biopsy of floor of
mouth
41820 Excision, gum, each
quadrant
41821 Excision of gum flap
42100 Biopsy roof of mouth
42140 Excision of uvula
42325 Create salivary cyst
drain
42326 Create salivary cyst
drain
42330 Removal of salivary
stone
42650 Dilation of salivary
duct
42660 Dilation of salivary
duct
42800 Biopsy of throat
42999 Throat surgery
procedure
69399 Outer ear surgery
procedure
69405 Catheterize middle
ear canal
69410 Inset middle ear
(baffle)
69420 Incision of eardrum
69424 Remove ventilating
tube
69433 Create eardrum
opening
69979 Temporal bone
surgery
0253 Level III ENT Procedures T 12.02 $582.81 $284.00 $116.56
21031 Remove exostosis,
mandible
21032 Remove exostosis,
maxilla
21040 Removal of jaw bone
lesion
21085 Prepare face/oral
prosthesis
21089 Prepare face/oral
prosthesis
21282 Revision of eyelid
21295 Revision of jaw
muscle/bone
21299 Cranio/maxillofacial
surgery
21300 Treatment of skull
fracture
21310 Treatment of nose
fracture
21315 Treatment of nose
fracture
21320 Treatment of nose
fracture
21325 Treatment of nose
fracture
21337 Treat nasal septal
fracture
21401 Treat eye socket
fracture
21440 Treat dental ridge
fracture
21452 Treat lower jaw
fracture
21485 Reset dislocated jaw
21497 Interdental wiring
21499 Head surgery
procedure
30110 Removal of nose
polyp(s)
30115 Removal of nose
polyp(s)
30117 Removal of
intranasal lesion
30120 Revision of nose
30130 Removal of turbinate
bones
30140 Removal of turbinate
bones
30200 Injection treatment
of nose
30310 Remove nasal foreign
body
30320 Remove nasal foreign
body
30802 Cauterization, inner
nose
30930 Therapy, fracture of
nose
31020 Exploration,
maxillary sinus
31585 Treat larynx
fracture
31599 Larynx surgery
procedure
31612 Puncture/clear
windpipe
31820 Closure of windpipe
lesion
40500 Partial excision of
lip
40520 Partial excision of
lip
40650 Repair lip
40652 Repair lip
40799 Lip surgery
procedure
40810 Excision of mouth
lesion
40814 Excise/repair mouth
lesion
[[Page 18752]]
40816 Excision of mouth
lesion
40820 Treatment of mouth
lesion
40831 Repair mouth
laceration
41000 Drainage of mouth
lesion
41006 Drainage of mouth
lesion
41007 Drainage of mouth
lesion
41008 Drainage of mouth
lesion
41010 Incision of tongue
fold
41016 Drainage of mouth
lesion
41017 Drainage of mouth
lesion
41018 Drainage of mouth
lesion
41105 Biopsy of tongue
41110 Excision of tongue
lesion
41112 Excision of tongue
lesion
41113 Excision of tongue
lesion
41115 Excision of tongue
fold
41116 Excision of mouth
lesion
41251 Repair tongue
laceration
41252 Repair tongue
laceration
41500 Fixation of tongue
41510 Tongue to lip
surgery
41520 Reconstruction,
tongue fold
41805 Removal foreign
body, gum
41806 Removal foreign
body, jawbone
41822 Excision of gum
lesion
41823 Excision of gum
lesion
41825 Excision of gum
lesion
41826 Excision of gum
lesion
41827 Excision of gum
lesion
41828 Excision of gum
lesion
41830 Removal of gum
tissue
41850 Treatment of gum
lesion
41870 Gum graft
41872 Repair gum
41874 Repair tooth socket
41899 Dental surgery
procedure
42104 Excision lesion,
mouth roof
42106 Excision lesion,
mouth roof
42160 Treatment mouth roof
lesion
42260 Repair nose to lip
fistula
42281 Insertion, palate
prosthesis
42300 Drainage of salivary
gland
42305 Drainage of salivary
gland
42335 Removal of salivary
stone
42340 Removal of salivary
stone
42405 Biopsy of salivary
gland
42408 Excision of salivary
cyst
42409 Drainage of salivary
cyst
42450 Excise sublingual
gland
42600 Closure of salivary
fistula
42665 Ligation of salivary
duct
42699 Salivary surgery
procedure
42720 Drainage of throat
abscess
42802 Biopsy of throat
42804 Biopsy of upper nose/
throat
42806 Biopsy of upper nose/
throat
42808 Excise pharynx
lesion
42810 Excision of neck
cyst
42900 Repair throat wound
42972 Control nose/throat
bleeding
60000 Drain thyroid/tongue
cyst
69105 Biopsy of external
ear canal
69120 Removal of external
ear
69222 Clean out mastoid
cavity
69421 Incision of eardrum
69436 Create eardrum
opening
69440 Exploration of
middle ear
69540 Remove ear lesion
69610 Repair of eardrum
69620 Repair of eardrum
69799 Middle ear surgery
procedure
69949 Inner ear surgery
procedure
0254 Level IV ENT Procedures T 12.45 $603.66 $272.41 $120.73
[[Page 18753]]
21010 Incision of jaw
joint
21015 Resection of facial
tumor
21030 Removal of face bone
lesion
21076 Prepare face/oral
prosthesis
21110 Interdental fixation
21120 Reconstruction of
chin
21121 Reconstruction of
chin
21122 Reconstruction of
chin
21123 Reconstruction of
chin
21125 Augmentation, lower
jaw bone
21137 Reduction of
forehead
21181 Contour cranial bone
lesion
21235 Ear cartilage graft
21296 Revision of jaw
muscle/bone
21330 Treatment of nose
fracture
21335 Treatment of nose
fracture
21338 Treat nasoethmoid
fracture
21339 Treat nasoethmoid
fracture
21345 Treat nose/jaw
fracture
21421 Treat mouth roof
fracture
21445 Treat dental ridge
fracture
21451 Treat lower jaw
fracture
21454 Treat lower jaw
fracture
30118 Removal of
intranasal lesion
30430 Revision of nose
30630 Repair nasal septum
defect
31040 Exploration behind
upper jaw
31070 Exploration of
frontal sinus
31600 Incision of windpipe
31601 Incision of windpipe
31603 Incision of windpipe
31605 Incision of windpipe
31610 Incision of windpipe
31611 Surgery/speech
prosthesis
31613 Repair windpipe
opening
31825 Repair of windpipe
defect
31830 Revise windpipe scar
40510 Partial excision of
lip
40525 Reconstruct lip with
flap
40527 Reconstruct lip with
flap
40530 Partial removal of
lip
40654 Repair lip
40840 Reconstruction of
mouth
40842 Reconstruction of
mouth
40843 Reconstruction of
mouth
41114 Excision of tongue
lesion
42107 Excision lesion,
mouth roof
42145 Repair palate,
pharynx/uvula
42235 Repair palate
42500 Repair salivary duct
42950 Reconstruction of
throat
42955 Surgical opening of
throat
43020 Incision of
esophagus
69140 Remove ear canal
lesion(s)
69300 Revise external ear
69650 Release middle ear
bone
0256 Level V ENT Procedures T 25.40 $1,231.57 $623.05 $246.31
21025 Excision of bone,
lower jaw
21026 Excision of facial
bone(s)
21029 Contour of face bone
lesion
21034 Removal of face bone
lesion
21041 Removal of jaw bone
lesion
21044 Removal of jaw bone
lesion
21050 Removal of jaw joint
21060 Remove jaw joint
cartilage
21070 Remove coronoid
process
21077 Prepare face/oral
prosthesis
21079 Prepare face/oral
prosthesis
21080 Prepare face/oral
prosthesis
21081 Prepare face/oral
prosthesis
21082 Prepare face/oral
prosthesis
21083 Prepare face/oral
prosthesis
21084 Prepare face/oral
prosthesis
[[Page 18754]]
21086 Prepare face/oral
prosthesis
21087 Prepare face/oral
prosthesis
21088 Prepare face/oral
prosthesis
21100 Maxillofacial
fixation
21127 Augmentation, lower
jaw bone
21138 Reduction of
forehead
21139 Reduction of
forehead
21198 Reconstruct lower
jaw bone
21206 Reconstruct upper
jaw bone
21208 Augmentation of
facial bones
21209 Reduction of facial
bones
21210 Face bone graft
21215 Lower jaw bone graft
21230 Rib cartilage graft
21240 Reconstruction of
jaw joint
21242 Reconstruction of
jaw joint
21243 Reconstruction of
jaw joint
21244 Reconstruction of
lower jaw
21245 Reconstruction of
jaw
21246 Reconstruction of
jaw
21248 Reconstruction of
jaw
21249 Reconstruction of
jaw
21260 Revise eye sockets
21261 Revise eye sockets
21263 Revise eye sockets
21267 Revise eye sockets
21270 Augmentation, cheek
bone
21275 Revision,
orbitofacial bones
21280 Revision of eyelid
21340 Treatment of nose
fracture
21355 Treat cheek bone
fracture
21406 Treat eye socket
fracture
21407 Treat eye socket
fracture
21453 Treat lower jaw
fracture
21461 Treat lower jaw
fracture
21462 Treat lower jaw
fracture
21465 Treat lower jaw
fracture
21470 Treat lower jaw
fracture
21490 Repair dislocated
jaw
30125 Removal of nose
lesion
30150 Partial removal of
nose
30160 Removal of nose
30400 Reconstruction of
nose
30410 Reconstruction of
nose
30420 Reconstruction of
nose
30435 Revision of nose
30450 Revision of nose
30460 Revision of nose
30462 Revision of nose
30520 Repair of nasal
septum
30540 Repair nasal defect
30545 Repair nasal defect
30580 Repair upper jaw
fistula
30600 Repair mouth/nose
fistula
30620 Intranasal
reconstruction
31030 Exploration,
maxillary sinus
31032 Explore sinus,
remove polyps
31050 Exploration,
sphenoid sinus
31051 Sphenoid sinus
surgery
31075 Exploration of
frontal sinus
31080 Removal of frontal
sinus
31081 Removal of frontal
sinus
31084 Removal of frontal
sinus
31085 Removal of frontal
sinus
31086 Removal of frontal
sinus
31087 Removal of frontal
sinus
31090 Exploration of
sinuses
31200 Removal of ethmoid
sinus
31201 Removal of ethmoid
sinus
31205 Removal of ethmoid
sinus
31300 Removal of larynx
lesion
31320 Diagnostic incision,
larynx
31375 Partial removal of
larynx
[[Page 18755]]
31400 Revision of larynx
31420 Removal of
epiglottis
31580 Revision of larynx
31586 Treat larynx
fracture
31588 Revision of larynx
31590 Reinnervate larynx
31595 Larynx nerve surgery
31614 Repair windpipe
opening
31750 Repair of windpipe
31755 Repair of windpipe
40700 Repair cleft lip/
nasal
40701 Repair cleft lip/
nasal
40702 Repair cleft lip/
nasal
40720 Repair cleft lip/
nasal
40761 Repair cleft lip/
nasal
40844 Reconstruction of
mouth
40845 Reconstruction of
mouth
41120 Partial removal of
tongue
42120 Remove palate/lesion
42182 Repair palate
42200 Reconstruct cleft
palate
42205 Reconstruct cleft
palate
42210 Reconstruct cleft
palate
42215 Reconstruct cleft
palate
42220 Reconstruct cleft
palate
42225 Reconstruct cleft
palate
42226 Lengthening of
palate
42227 Lengthening of
palate
42410 Excise parotid gland/
lesion
42415 Excise parotid gland/
lesion
42420 Excise parotid gland/
lesion
42425 Excise parotid gland/
lesion
42440 Excise submaxillary
gland
42505 Repair salivary duct
42507 Parotid duct
diversion
42508 Parotid duct
diversion
42509 Parotid duct
diversion
42510 Parotid duct
diversion
42725 Drainage of throat
abscess
42815 Excision of neck
cyst
42844 Extensive surgery of
throat
42890 Partial removal of
pharynx
42892 Revision of
pharyngeal walls
42962 Control throat
bleeding
60500 Explore parathyroid
glands
61330 Decompress eye
socket
69310 Rebuild outer ear
canal
69320 Rebuild outer ear
canal
69450 Eardrum revision
69501 Mastoidectomy
69505 Remove mastoid
structures
69511 Extensive mastoid
surgery
69530 Extensive mastoid
surgery
69550 Remove ear lesion
69552 Remove ear lesion
69601 Mastoid surgery
revision
69602 Mastoid surgery
revision
69603 Mastoid surgery
revision
69604 Mastoid surgery
revision
69605 Mastoid surgery
revision
69631 Repair eardrum
structures
69632 Rebuild eardrum
structures
69633 Rebuild eardrum
structures
69635 Repair eardrum
structures
69636 Rebuild eardrum
structures
69637 Rebuild eardrum
structures
69641 Revise middle ear &
mastoid
69642 Revise middle ear &
mastoid
69643 Revise middle ear &
mastoid
69644 Revise middle ear &
mastoid
69645 Revise middle ear &
mastoid
69646 Revise middle ear &
mastoid
69660 Revise middle ear
bone
[[Page 18756]]
69661 Revise middle ear
bone
69662 Revise middle ear
bone
69666 Repair middle ear
structures
69667 Repair middle ear
structures
69670 Remove mastoid air
cells
69676 Remove middle ear
nerve
69700 Close mastoid
fistula
69711 Remove/repair
hearing aid
69720 Release facial nerve
69725 Release facial nerve
69740 Repair facial nerve
69745 Repair facial nerve
69801 Incise inner ear
69802 Incise inner ear
69805 Explore inner ear
69806 Explore inner ear
69820 Establish inner ear
window
69840 Revise inner ear
window
69905 Remove inner ear
69910 Remove inner ear &
mastoid
69915 Incise inner ear
nerve
69955 Release facial nerve
69960 Release inner ear
canal
0257 Implantation of Cochlear T 115.31 $5,591.04 $3,498.58 $1,118.21
Device
69930 Implant cochlear
device
0258 Tonsil and Adenoid Procedures T 18.62 $902.83 $462.81 $180.57
42820 Remove tonsils and
adenoids
42821 Remove tonsils and
adenoids
42825 Removal of tonsils
42826 Removal of tonsils
42830 Removal of adenoids
42831 Removal of adenoids
42835 Removal of adenoids
42836 Removal of adenoids
42860 Excision of tonsil
tags
42870 Excision of lingual
tonsil
0260 Level I Plain Film Except X 0.79 $38.30 $22.02 $7.66
Teeth
70030 X-ray eye for
foreign body
70100 X-ray exam of jaw
70110 X-ray exam of jaw
70120 X-ray exam of
mastoids
70130 X-ray exam of
mastoids
70140 X-ray exam of facial
bones
70150 X-ray exam of facial
bones
70160 X-ray exam of nasal
bones
70190 X-ray exam of eye
sockets
70200 X-ray exam of eye
sockets
70210 X-ray exam of
sinuses
70220 X-ray exam of
sinuses
70240 X-ray exam,
pituitary saddle
70250 X-ray exam of skull
70328 X-ray exam of jaw
joint
70330 X-ray exam of jaw
joints
70350 X-ray head for
orthodontia
70355 Panoramic x-ray of
jaws
70360 X-ray exam of neck
70380 X-ray exam of
salivary gland
71010 Chest x-ray
71015 Chest x-ray
71020 Chest x-ray
71021 Chest x-ray
71022 Chest x-ray
71030 Chest x-ray
71035 Chest x-ray
71100 X-ray exam of ribs
71101 X-ray exam of ribs/
chest
71110 X-ray exam of ribs
71120 X-ray exam of
breastbone
71130 X-ray exam of
breastbone
72020 X-ray exam of spine
72040 X-ray exam of neck
spine
72069 X-ray exam of trunk
spine
72070 X-ray exam of
thoracic spine
[[Page 18757]]
72072 X-ray exam of
thoracic spine
72074 X-ray exam of
thoracic spine
72080 X-ray exam of trunk
spine
72090 X-ray exam of trunk
spine
72100 X-ray exam of lower
spine
72120 X-ray exam of lower
spine
72170 X-ray exam of pelvis
72190 X-ray exam of pelvis
72200 X-ray exam
sacroiliac joints
72202 X-ray exam
sacroiliac joints
72220 X-ray exam of
tailbone
73000 X-ray exam of collar
bone
73010 X-ray exam of
shoulder blade
73020 X-ray exam of
shoulder
73030 X-ray exam of
shoulder
73050 X-ray exam of
shoulders
73060 X-ray exam of
humerus
73070 X-ray exam of elbow
73080 X-ray exam of elbow
73090 X-ray exam of
forearm
73092 X-ray exam of arm,
infant
73100 X-ray exam of wrist
73110 X-ray exam of wrist
73120 X-ray exam of hand
73130 X-ray exam of hand
73140 X-ray exam of
finger(s)
73500 X-ray exam of hip
73510 X-ray exam of hip
73520 X-ray exam of hips
73540 X-ray exam of pelvis
& hips
73550 X-ray exam of thigh
73560 X-ray exam of knee,
1 or 2
73562 X-ray exam of knee,
3
73564 X-ray exam, knee, 4
or more
73565 X-ray exam of knees
73590 X-ray exam of lower
leg
73600 X-ray exam of ankle
73610 X-ray exam of ankle
73620 X-ray exam of foot
73630 X-ray exam of foot
73650 X-ray exam of heel
73660 X-ray exam of toe(s)
74000 X-ray exam of
abdomen
74010 X-ray exam of
abdomen
74020 X-ray exam of
abdomen
74710 X-ray measurement of
pelvis
76010 X-ray, nose to
rectum
76040 X-rays, bone
evaluation
76066 Joint(s) survey,
single film
76098 X-ray exam, breast
specimen
76150 X-ray exam, dry
process
76499 Radiographic
procedure
77417 Radiology port
film(s)
0261 Level II Plain Film Except X 1.38 $66.91 $38.77 $13.38
Teeth Including Bone Density
Measurement
70134 X-ray exam of middle
ear
70260 X-ray exam of skull
71111 X-ray exam of ribs/
chest
72010 X-ray exam of spine
72050 X-ray exam of neck
spine
72052 X-ray exam of neck
spine
72110 X-ray exam of lower
spine
72114 X-ray exam of lower
spine
73530 X-ray exam of hip
73592 X-ray exam of leg,
infant
74022 X-ray exam series,
abdomen
76006 X-ray stress view
76020 X-rays for bone age
76061 X-rays, bone survey
76062 X-rays, bone survey
76065 X-rays, bone
evaluation
76075 Dual energy x-ray
study
76076 Dual energy x-ray
study
76078 Photodensitometry
[[Page 18758]]
76100 X-ray exam of body
section
76120 Cinematic x-rays
76125 Cinematic x-rays add-
on
78350 Bone mineral, single
photon
G0130 Single energy x-ray
study
G0131 CT scan, bone
density study
G0132 CT scan, bone
density study
0262 Plain Film of Teeth X 0.40 $19.39 $10.90 $3.88
70300 X-ray exam of teeth
70310 X-ray exam of teeth
70320 Full mouth x-ray of
teeth
0263 Level I Miscellaneous X 1.68 $81.46 $45.88 $16.29
Radiology Procedures
70170 X-ray exam of tear
duct
70373 Contrast x-ray of
larynx
70390 X-ray exam of
salivary duct
71040 Contrast x-ray of
bronchi
71060 Contrast x-ray of
bronchi
74190 X-ray exam of
peritoneum
74305 X-ray bile ducts/
pancreas
76080 X-ray exam of
fistula
76086 X-ray of mammary
duct
76088 X-ray of mammary
ducts
76096 X-ray of needle
wire, breast
76101 Complex body section
x-ray
0264 Level II Miscellaneous X 3.83 $185.71 $108.97 $37.14
Radiology Procedures
74320 Contrast x-ray of
bile ducts
74328 X-ray bile duct
endoscopy
74329 X-ray for pancreas
endoscopy
74330 X-ray bile/panc
endoscopy
74350 X-ray guide, stomach
tube
74355 X-ray guide,
intestinal tube
74470 X-ray exam of kidney
lesion
74740 X-ray, female
genital tract
74742 X-ray, fallopian
tube
75801 Lymph vessel x-ray,
arm/leg
75803 Lymph vessel x-ray,
arms/legs
75805 Lymph vessel x-ray,
trunk
75807 Lymph vessel x-ray,
trunk
75809 Nonvascular shunt, x-
ray
75898 Follow-up angiogram
76095 Stereotactic breast
biopsy
76102 Complex body section
x-rays
0265 Level I Diagnostic Ultrasound S 1.17 $56.73 $38.08 $11.35
Except Vascular
76513 Echo exam of eye,
water bath
76529 Echo exam of eye
76536 Echo exam of head
and neck
76645 Echo exam of
breast(s)
76810 Echo exam of
pregnant uterus
76815 Echo exam of
pregnant uterus
76816 Echo exam follow-up/
repeat
76857 Echo exam of pelvis
76970 Ultrasound exam
follow-up
76977 Us bone density
measure
G0050 Residual urine by
ultrasound
0266 Level II Diagnostic S 1.79 $86.79 $57.35 $17.36
Ultrasound Except Vascular
76506 Echo exam of head
76511 Echo exam of eye
76512 Echo exam of eye
76516 Echo exam of eye
76519 Echo exam of eye
76604 Echo exam of chest
76700 Echo exam of abdomen
76705 Echo exam of abdomen
76770 Echo exam abdomen
back wall
76775 Echo exam abdomen
back wall
76778 Echo exam kidney
transplant
76800 Echo exam spinal
canal
76805 Echo exam of
pregnant uterus
76818 Fetal biophysical
profile
76830 Echo exam,
transvaginal
76831 Echo exam, uterus
76856 Echo exam of pelvis
76870 Echo exam of scrotum
[[Page 18759]]
76872 Echo exam,
transrectal
76873 Echograp trans r,
pros study
76880 Echo exam of
extremity
76885 Echo exam, infant
hips
76886 Echo exam, infant
hips
76975 GI endoscopic
ultrasound
76986 Echo exam at surgery
76999 Echo examination
procedure
0267 Vascular Ultrasound S 2.72 $131.88 $80.06 $26.38
93880 Extracranial study
93882 Extracranial study
93886 Intracranial study
93888 Intracranial study
93925 Lower extremity
study
93926 Lower extremity
study
93930 Upper extremity
study
93931 Upper extremity
study
93970 Extremity study
93971 Extremity study
93975 Vascular study
93976 Vascular study
93978 Vascular study
93979 Vascular study
93980 Penile vascular
study
93981 Penile vascular
study
93990 Doppler flow testing
0268 Guidance Under Ultrasound X 2.23 $108.13 $69.51 $21.63
76930 Echo guide for heart
sac tap
76932 Echo guide for heart
biopsy
76934 Echo guide for chest
tap
76936 Echo guide for
artery repair
76938 Echo exam for
drainage
76941 Echo guide for
transfusion
76942 Echo guide for
biopsy
76945 Echo guide, villus
sampling
76946 Echo guide for
amniocentesis
76948 Echo guide, ova
aspiration
76950 Echo guidance
radiotherapy
76960 Echo guidance
radiotherapy
76965 Echo guidance
radiotherapy
G0161 Echo guide for cryo
probes
0269 Echocardiogram Except S 4.40 $213.34 $114.01 $42.67
Transesophageal
76825 Echo exam of fetal
heart
76826 Echo exam of fetal
heart
76827 Echo exam of fetal
heart
76828 Echo exam of fetal
heart
93303 Echo transthoracic
93304 Echo transthoracic
93307 Echo exam of heart
93308 Echo exam of heart
93320 Doppler echo exam,
heart
93321 Doppler echo exam,
heart
93325 Doppler color flow
add-on
93350 Echo transthoracic
0270 Transesophageal S 5.55 $269.10 $150.26 $53.82
Echocardiogram
93312 Echo transesophageal
93313 Echo transesophageal
93315 Echo transesophageal
93316 Echo transesophageal
0271 Mammography S 0.70 $33.94 $19.50 $6.79
76090 Mammogram, one
breast
76091 Mammogram, both
breasts
0272 Level I Fluoroscopy X 1.40 $67.88 $39.00 $13.58
70371 Speech evaluation,
complex
71023 Chest x-ray and
fluoroscopy
71034 Chest x-ray and
fluoroscopy
74340 X-ray guide for GI
tube
76000 Fluoroscope
examination
76003 Needle localization
by x-ray
0273 Level II Fluoroscopy X 2.49 $120.73 $61.02 $24.15
70370 Throat x-ray &
fluoroscopy
71036 X-ray guidance for
biopsy
71090 X-ray & pacemaker
insertion
[[Page 18760]]
75989 Abscess drainage
under x-ray
76001 Fluoroscope exam,
extensive
76005 Fluoroguide for
spine inject
0274 Myelography S 4.83 $234.19 $128.12 $46.84
70010 Contrast x-ray of
brain
70015 Contrast x-ray of
brain
72240 Contrast x-ray of
neck spine
72255 Contrast x-ray,
thorax spine
72265 Contrast x-ray,
lower spine
72270 Contrast x-ray of
spine
72275 Epidurography
72285 X-ray c/t spine disk
72295 X-ray of lower spine
disk
0275 Arthrography S 2.74 $132.85 $72.26 $26.57
70332 X-ray exam of jaw
joint
73040 Contrast x-ray of
shoulder
73085 Contrast x-ray of
elbow
73115 Contrast x-ray of
wrist
73525 Contrast x-ray of
hip
73542 X-ray exam,
sacroiliac joint
73580 Contrast x-ray of
knee joint
73615 Contrast x-ray of
ankle
0276 Level I Digestive Radiology S 1.79 $86.79 $49.78 $17.36
74210 Contrst x-ray exam
of throat
74220 Contrast x-ray,
esophagus
74230 Cinema x-ray, throat/
esoph
74240 X-ray exam, upper gi
tract
74241 X-ray exam, upper gi
tract
74246 Contrst x-ray uppr
gi tract
74247 Contrst x-ray uppr
gi tract
74250 X-ray exam of small
bowel
74270 Contrast x-ray exam
of colon
74283 Contrast x-ray exam
of colon
74290 Contrast x-ray,
gallbladder
74291 Contrast x-rays,
gallbladder
0277 Level II Digestive Radiology S 2.47 $119.76 $69.28 $23.95
74245 X-ray exam, upper gi
tract
74249 Contrst x-ray uppr
gi tract
74251 X-ray exam of small
bowel
74260 X-ray exam of small
bowel
74280 Contrast x-ray exam
of colon
0278 Diagnostic Urography S 2.85 $138.19 $81.67 $27.64
74400 Contrst x-ray,
urinary tract
74410 Contrst x-ray,
urinary tract
74415 Contrst x-ray,
urinary tract
74420 Contrst x-ray,
urinary tract
74425 Contrst x-ray,
urinary tract
74430 Contrast x-ray,
bladder
74440 X-ray, male genital
tract
74445 X-ray exam of penis
74450 X-ray, urethra/
bladder
74455 X-ray, urethra/
bladder
74775 X-ray exam of
perineum
0279 Level I Diagnostic S 6.30 $305.47 $174.57 $61.09
Angiography and Venography
Except Extremity
75660 Artery x-rays, head
& neck
75662 Artery x-rays, head
& neck
75685 Artery x-rays, spine
75705 Artery x-rays, spine
75741 Artery x-rays, lung
75746 Artery x-rays, lung
75756 Artery x-rays, chest
75810 Vein x-ray, spleen/
liver
75825 Vein x-ray, trunk
75827 Vein x-ray, chest
75831 Vein x-ray, kidney
75833 Vein x-ray, kidneys
75840 Vein x-ray, adrenal
gland
75842 Vein x-ray, adrenal
glands
75860 Vein x-ray, neck
75870 Vein x-ray, skull
75872 Vein x-ray, skull
75880 Vein x-ray, eye
socket
75885 Vein x-ray, liver
[[Page 18761]]
75889 Vein x-ray, liver
75891 Vein x-ray, liver
0280 Level II Diagnostic S 14.98 $726.34 $380.12 $145.27
Angiography and Venography
Except Extremity
75600 Contrast x-ray exam
of aorta
75605 Contrast x-ray exam
of aorta
75625 Contrast x-ray exam
of aorta
75630 X-ray aorta, leg
arteries
75650 Artery x-rays, head
& neck
75658 Artery x-rays, arm
75665 Artery x-rays, head
& neck
75671 Artery x-rays, head
& neck
75676 Artery x-rays, neck
75680 Artery x-rays, neck
75710 Artery x-rays, arm/
leg
75716 Artery x-rays, arms/
legs
75722 Artery x-rays,
kidney
75724 Artery x-rays,
kidneys
75726 Artery x-rays,
abdomen
75731 Artery x-rays,
adrenal gland
75733 Artery x-rays,
adrenals
75736 Artery x-rays,
pelvis
75743 Artery x-rays, lungs
75774 Artery x-ray, each
vessel
75887 Vein x-ray, liver
0281 Venography of Extremity S 4.40 $213.34 $115.16 $42.67
75790 Visualize A-V shunt
75820 Vein x-ray, arm/leg
75822 Vein x-ray, arms/
legs
0282 Level I Computerized Axial S 2.38 $115.40 $94.51 $23.08
Tomography
70486 Cat scan of face/jaw
76370 CAT scan for therapy
guide
76375 3d/holograph
reconstr add-on
76380 CAT scan follow-up
study
0283 Level II Computerized Axial S 4.89 $237.10 $179.39 $47.42
Tomography
70450 CAT scan of head or
brain
70460 Contrast CAT scan of
head
70470 Contrast CAT scans
of head
70480 CAT scan of skull
70481 Contrast CAT scan of
skull
70482 Contrast CAT scans
of skull
70487 Contrast CAT scan,
face/jaw
70488 Contrast cat scans,
face/jaw
70490 CAT scan of neck
tissue
70491 Contrast CAT of neck
tissue
70492 Contrast CAT of neck
tissue
71250 Cat scan of chest
71260 Contrast CAT scan of
chest
71270 Contrast CAT scans
of chest
72125 CAT scan of neck
spine
72126 Contrast CAT scan of
neck
72127 Contrast CAT scans
of neck
72128 CAT scan of thorax
spine
72129 Contrast CAT scan of
thorax
72130 Contrast CAT scans
of thorax
72131 CAT scan of lower
spine
72132 Contrast CAT of
lower spine
72133 Contrst cat scans,
low spine
72192 CAT scan of pelvis
72193 Contrast CAT scan of
pelvis
72194 Contrast CAT scans
of pelvis
73200 CAT scan of arm
73201 Contrast CAT scan of
arm
73202 Contrast CAT scans
of arm
73700 CAT scan of leg
73701 Contrast CAT scan of
leg
73702 Contrast CAT scans
of leg
74150 CAT scan of abdomen
74160 Contrast CAT scan of
abdomen
74170 Contrast CAT scans,
abdomen
76355 CAT scan for
localization
76360 CAT scan for needle
biopsy
76365 CAT scan for cyst
aspiration
0284 Magnetic Resonance Imaging S 8.02 $388.87 $257.39 $77.77
[[Page 18762]]
70336 Magnetic image, jaw
joint
70540 Magnetic image, face/
neck
70541 Magnetic image, head
(MRA)
70551 Magnetic image,
brain (MRI)
70552 Magnetic image,
brain (MRI)
70553 Magnetic image,
brain (mri)
71550 Magnetic image,
chest (mri)
72141 Magnetic image, neck
spine
72142 Magnetic image, neck
spine
72146 Magnetic image,
chest spine
72147 Magnetic image,
chest spine
72148 Magnetic image,
lumbar spine
72149 Magnetic image,
lumbar spine
72156 Magnetic image, neck
spine
72157 Magnetic image,
chest spine
72158 Magnetic image,
lumbar spine
72196 Magnetic image,
pelvis
73220 Magnetic image, arm/
hand
73221 Magnetic image,
joint of arm
73720 Magnetic image, leg/
foot
73721 Magnetic image,
joint of leg
74181 Magnetic image/
abdomen (mri)
75552 Magnetic image,
myocardium
75553 Magnetic image,
myocardium
75554 Cardiac MRI/function
75555 Cardiac MRI/limited
study
76093 Magnetic image,
breast
76094 Magnetic image, both
breasts
76390 Mr spectroscopy
76400 Magnetic image, bone
marrow
0285 Positron Emission Tomography S 15.06 $730.22 $415.21 $146.04
(PET)
G0030 PET imaging prev PET
single
G0031 PET imaging prev PET
multple
G0032 PET follow SPECT
78464 singl
G0033 PET follow SPECT
78464 mult
G0034 PET follow SPECT
76865 singl
G0035 PET follow SPECT
78465 mult
G0036 PET follow cornry
angio sing
G0037 PET follow cornry
angio mult
G0038 PET follow myocard
perf sing
G0039 PET follow myocard
perf mult
G0040 PET follow stress
echo singl
G0041 PET follow stress
echo mult
G0042 PET follow
ventriculogm sing
G0043 PET follow
ventriculogm mult
G0044 PET following rest
ECG singl
G0045 PET following rest
ECG mult
G0046 PET follow stress
ECG singl
G0047 PET follow stress
ECG mult
0286 Myocardial Scans S 7.28 $352.99 $200.04 $70.60
78460 Heart muscle blood,
single
78461 Heart muscle blood,
multiple
78464 Heart image (3d),
single
78465 Heart image (3d),
multiple
78472 Gated heart, planar,
single
78473 Gated heart,
multiple
78478 Heart wall motion
add-on
78480 Heart function add-
on
78481 Heart first pass,
single
78483 Heart first pass,
multiple
0290 Standard Non-Imaging Nuclear S 1.94 $94.06 $55.51 $18.81
Medicine
78000 Thyroid, single
uptake
78001 Thyroid, multiple
uptakes
78003 Thyroid suppress/
stimul
78010 Thyroid imaging
78011 Thyroid imaging with
flow
78099 Endocrine nuclear
procedure
78199 Blood/lymph nuclear
exam
78270 Vit B-12 absorption
exam
78271 Vit B-12 absorp
exam, IF
78282 GI protein loss exam
78299 GI nuclear procedure
78399 Musculoskeletal
nuclear exam
[[Page 18763]]
0291 Level I Diagnostic Nuclear S 3.15 $152.73 $93.14 $30.55
Medicine Excluding Myocardial
Scans
78006 Thyroid imaging with
uptake
78007 Thyroid image, mult
uptakes
78015 Thyroid met imaging
78102 Bone marrow imaging,
ltd
78110 Plasma volume,
single
78111 Plasma volume,
multiple
78120 Red cell mass,
single
78121 Red cell mass,
multiple
78185 Spleen imaging
78190 Platelet survival,
kinetics
78191 Platelet survival
78201 Liver imaging
78202 Liver imaging with
flow
78215 Liver and spleen
imaging
78216 Liver & spleen image/
flow
78230 Salivary gland
imaging
78231 Serial salivary
imaging
78232 Salivary gland
function exam
78258 Esophageal motility
study
78261 Gastric mucosa
imaging
78262 Gastroesophageal
reflux exam
78272 Vit B-12 absorp,
combined
78290 Meckel's divert exam
78300 Bone imaging,
limited area
78445 Vascular flow
imaging
78455 Venous thrombosis
study
78456 Acute venous
thrombus image
78457 Venous thrombosis
imaging
78458 Ven thrombosis
images, bilat
78580 Lung perfusion
imaging
78591 Vent image, 1
breath, 1 proj
78599 Respiratory nuclear
exam
78605 Brain imaging,
complete
78610 Brain flow imaging
only
78660 Nuclear exam of tear
flow
78700 Kidney imaging,
static
78701 Kidney imaging with
flow
78715 Renal vascular flow
exam
78725 Kidney function
study
78730 Urinary bladder
retention
78740 Ureteral reflux
study
78760 Testicular imaging
78761 Testicular imaging/
flow
78999 Nuclear diagnostic
exam
0292 Level II Diagnostic Nuclear S 4.36 $211.40 $126.63 $42.28
Medicine Excluding Myocardial
Scans
78016 Thyroid met imaging/
studies
78018 Thyroid met imaging,
body
78020 Thyroid met uptake
78070 Parathyroid nuclear
imaging
78075 Adrenal nuclear
imaging
78103 Bone marrow imaging,
mult
78104 Bone marrow imaging,
body
78122 Blood volume
78130 Red cell survival
study
78135 Red cell survival
kinetics
78140 Red cell
sequestration
78160 Plasma iron turnover
78162 Iron absorption exam
78170 Red cell iron
utilization
78172 Total body iron
estimation
78195 Lymph system imaging
78205 Liver imaging (3D)
78206 Liver image (3d) w/
flow
78220 Liver function study
78223 Hepatobiliary
imaging
78264 Gastric emptying
study
78278 Acute GI blood loss
imaging
78291 Leveen/shunt patency
exam
78305 Bone imaging,
multiple areas
78306 Bone imaging, whole
body
78315 Bone imaging, 3
phase
78320 Bone imaging (3D)
[[Page 18764]]
78414 Non-imaging heart
function
78428 Cardiac shunt
imaging
78466 Heart infarct image
78468 Heart infarct image
(ef)
78469 Heart infarct image
(3D)
78499 Cardiovascular
nuclear exam
78584 Lung V/Q image
single breath
78585 Lung V/Q imaging
78586 Aerosol lung image,
single
78587 Aerosol lung image,
multiple
78588 Perfusion lung image
78593 Vent image, 1 proj,
gas
78594 Vent image, mult
proj, gas
78596 Lung differential
function
78600 Brain imaging, ltd
static
78601 Brain imaging, ltd w/
flow
78606 Brain imaging, compl
w/flow
78607 Brain imaging (3D)
78615 Cerebral blood flow
imaging
78630 Cerebrospinal fluid
scan
78635 CSF ventriculography
78645 CSF shunt evaluation
78647 Cerebrospinal fluid
scan
78650 CSF leakage imaging
78699 Nervous system
nuclear exam
78704 Imaging renogram
78707 Kidney flow/function
image
78708 Kidney flow/function
image
78709 Kidney flow/function
image
78710 Kidney imaging (3D)
78799 Genitourinary
nuclear exam
78800 Tumor imaging,
limited area
78801 Tumor imaging, mult
areas
78802 Tumor imaging, whole
body
78803 Tumor imaging (3D)
78805 Abscess imaging, ltd
area
78806 Abscess imaging,
whole body
78807 Nuclear localization/
abscess
0294 Level I Therapeutic Nuclear S 5.13 $248.74 $144.06 $49.75
Medicine
79000 Init hyperthyroid
therapy
79001 Repeat hyperthyroid
therapy
79020 Thyroid ablation
79030 Thyroid ablation,
carcinoma
79035 Thyroid metastatic
therapy
79100 Hematopoetic nuclear
therapy
79300 Interstitial nuclear
therapy
79440 Nuclear joint
therapy
79999 Nuclear medicine
therapy
0295 Level II Therapeutic Nuclear S 19.85 $962.47 $609.17 $192.49
Medicine
79200 Intracavitary
nuclear trmt
79400 Nonhemato nuclear
therapy
79420 Intravascular
nuclear ther
0296 Level I Therapeutic S 3.57 $173.10 $100.25 $34.62
Radiologic Procedures
74235 Remove esophagus
obstruction
74327 X-ray bile stone
removal
74360 X-ray guide, GI
dilation
74485 X-ray guide, GU
dilation
75984 X-ray control
catheter change
78494 Heart image, spect
78496 Heart first pass add-
on
0297 Level II Therapeutic S 6.13 $297.23 $172.51 $59.45
Radiologic Procedures
74363 X-ray, bile duct
dilation
74475 X-ray control, cath
insert
74480 X-ray control, cath
insert
75894 X-rays, transcath
therapy
75896 X-rays, transcath
therapy
75980 Contrast x-ray exam
bile duct
75982 Contrast x-ray exam
bile duct
0300 Level I Radiation Therapy S 1.98 $96.00 $47.72 $19.20
77401 Radiation treatment
delivery
77402 Radiation treatment
delivery
77403 Radiation treatment
delivery
77404 Radiation treatment
delivery
[[Page 18765]]
77406 Radiation treatment
delivery
77407 Radiation treatment
delivery
77408 Radiation treatment
delivery
77409 Radiation treatment
delivery
77414 Radiation treatment
delivery
77789 Radioelement
application
0301 Level II Radiation Therapy S 2.21 $107.16 $52.53 $21.43
77411 Radiation treatment
delivery
77412 Radiation treatment
delivery
77413 Radiation treatment
delivery
77416 Radiation treatment
delivery
77520 Proton beam delivery
77523 Proton beam delivery
77750 Infuse radioactive
materials
0302 Level III Radiation Therapy S 8.21 $398.08 $216.55 $79.62
77470 Special radiation
treatment
G0173 Stereotactic, one
session
G0174 Stereotactic, mult
session
0303 Treatment Device Construction X 2.83 $137.22 $69.28 $27.44
77332 Radiation treatment
aid(s)
77333 Radiation treatment
aid(s)
77334 Radiation treatment
aid(s)
0304 Level I Therapeutic Radiation X 1.49 $72.25 $41.52 $14.45
Treatment Preparation
77280 Set radiation
therapy field
77300 Radiation therapy
dose plan
77305 Radiation therapy
dose plan
77310 Radiation therapy
dose plan
77331 Special radiation
dosimetry
0305 Level II Therapeutic X 4.06 $196.86 $97.50 $39.37
Radiation Treatment
Preparation
77285 Set radiation
therapy field
77290 Set radiation
therapy field
77315 Radiation therapy
dose plan
77321 Radiation therapy
port plan
77326 Radiation therapy
dose plan
77327 Radiation therapy
dose plan
77328 Radiation therapy
dose plan
0310 Level III Therapeutic X 13.98 $677.85 $339.05 $135.57
Radiation Treatment
Preparation
77295 Set radiation
therapy field
0311 Radiation Physics Services X 1.32 $64.00 $31.66 $12.80
77336 Radiation physics
consult
77370 Radiation physics
consult
77399 External radiation
dosimetry
0312 Radioelement Applications S 4.09 $198.31 $109.65 $39.66
77761 Radioelement
application
77762 Radioelement
application
77763 Radioelement
application
77776 Radioelement
application
77777 Radioelement
application
77778 Radioelement
application
0313 Brachytherapy S 7.89 $382.56 $164.02 $76.51
77781 High intensity
brachytherapy
77782 High intensity
brachytherapy
77783 High intensity
brachytherapy
77784 High intensity
brachytherapy
77799 Radium/radioisotope
therapy
0314 Hyperthermic Therapies S 5.88 $285.10 $150.95 $57.02
77600 Hyperthermia
treatment
77605 Hyperthermia
treatment
77610 Hyperthermia
treatment
77615 Hyperthermia
treatment
77620 Hyperthermia
treatment
0320 Electroconvulsive Therapy S 3.68 $178.43 $80.06 $35.69
90870 Electroconvulsive
therapy
90871 Electroconvulsive
therapy
0321 Biofeedback and Other S 1.26 $61.09 $29.25 $12.22
Training
90901 Biofeedback train,
any meth
90911 Biofeedback peri/uro/
rectal
0322 Brief Individual S 1.32 $64.00 $14.22 $12.80
Psychotherapy
90804 Psytx, office, 20-30
min
90805 Psytx, off, 20-30
min w/e&m
90810 Intac psytx, off, 20-
30 min
90811 Intac psytx, 20-30,
w/e&m
90816 Psytx, hosp, 20-30
min
[[Page 18766]]
90817 Psytx, hosp, 20-30
min w/e&m
90823 Intac psytx, hosp,
20-30 min
90824 Intac psytx, hsp 20-
30 w/e&m
90899 Psychiatric service/
therapy
0323 Extended Individual S 1.85 $89.70 $22.48 $17.94
Psychotherapy
90801 Psy dx interview
90802 Intac psy dx
interview
90806 Psytx, off, 45-50
min
90807 Psytx, off, 45-50
min w/e&m
90808 Psytx, office, 75-80
min
90809 Psytx, off, 75-80, w/
e&m
90812 Intac psytx, off, 45-
50 min
90813 Intac psytx, 45-50
min w/e&m
90814 Intac psytx, off, 75-
80 min
90815 Intac psytx, 75-80 w/
e&m
90818 Psytx, hosp, 45-50
min
90819 Psytx, hosp, 45-50
min w/e&m
90821 Psytx, hosp, 75-80
min
90822 Psytx, hosp, 75-80
min w/e&m
90826 Intac psytx, hosp,
45-50 min
90827 Intac psytx, hsp 45-
50 w/e&m
90828 Intac psytx, hosp,
75-80 min
90829 Intac psytx, hsp 75-
80 w/e&m
90845 Psychoanalysis
90865 Narcosynthesis
90880 Hypnotherapy
0324 Family Psychotherapy S 1.87 $90.67 $20.19 $18.13
90846 Family psytx w/o
patient
90847 Family psytx w/
patient
0325 Group Psychotherapy S 1.55 $75.16 $19.96 $15.03
90849 Multiple family
group psytx
90853 Group psychotherapy
90857 Intac group psytx
0330 Dental Procedures S 1.51 $73.22 $14.64 $14.64
D0150 Comprehensve oral
evaluation
D0240 Intraoral occlusal
film
D0250 Extraoral first film
D0260 Extraoral ea
additional film
D0270 Dental bitewing
single film
D0272 Dental bitewings two
films
D0274 Dental bitewings
four films
D0460 Pulp vitality test
D0501 Histopathologic
examinations
D0502 Other oral pathology
procedu
D0999 Unspecified
diagnostic proce
D1510 Space maintainer fxd
unilat
D1515 Fixed bilat space
maintainer
D1520 Remove unilat space
maintain
D1525 Remove bilat space
maintain
D1550 Recement space
maintainer
D2970 Temporary-fractured
tooth
D2999 Dental unspec
restorative pr
D3460 Endodontic
endosseous implan
D3999 Endodontic procedure
D4260 Osseous surgery per
quadrant
D4263 Bone replce graft
first site
D4264 Bone replce graft
each add
D4270 Pedicle soft tissue
graft pr
D4271 Free soft tissue
graft proc
D4273 Subepithelial tissue
graft
D4355 Full mouth
debridement
D4381 Localized chemo
delivery
D5911 Facial moulage
sectional
D5912 Facial moulage
complete
D5983 Radiation applicator
D5984 Radiation shield
D5985 Radiation cone
locator
D5987 Commissure splint
D6920 Dental connector bar
D7110 Oral surgery single
tooth
D7120 Each add tooth
extraction
D7130 Tooth root removal
D7210 Rem imp tooth w
mucoper flp
[[Page 18767]]
D7220 Impact tooth remov
soft tiss
D7230 Impact tooth remov
part bony
D7240 Impact tooth remov
comp bony
D7241 Impact tooth rem
bony w/comp
D7250 Tooth root removal
D7260 Oral antral fistula
closure
D7291 Transseptal
fiberotomy
D7940 Reshaping bone
orthognathic
D9630 Other drugs/
medicaments
D9930 Treatment of
complications
D9940 Dental occlusal
guard
D9950 Occlusion analysis
D9951 Limited occlusal
adjustment
D9952 Complete occlusal
adjustment
0340 Minor Ancillary Procedures X 1.04 $50.43 $12.85 $10.09
69200 Clear outer ear
canal
69210 Remove impacted ear
wax
0341 Immunology Tests X 0.13 $6.30 $3.67 $1.26
86485 Skin test, candida
86490 Coccidioidomycosis
skin test
86510 Histoplasmosis skin
test
86580 TB intradermal test
86585 TB tine test
86586 Skin test, unlisted
0342 Level I Pathology X 0.26 $12.61 $8.03 $2.52
85060 Blood smear
interpretation
88160 Cytopath smear,
other source
88199 Cytopathology
procedure
88300 Surgical path, gross
88302 Tissue exam by
pathologist
88311 Decalcify tissue
88313 Special stains
88319 Enzyme
histochemistry
88321 Microslide
consultation
88399 Surgical pathology
procedure
0343 Level II Pathology X 0.45 $21.82 $12.16 $4.36
80500 Lab pathology
consultation
80502 Lab pathology
consultation
86077 Physician blood bank
service
88104 Cytopathology,
fluids
88106 Cytopathology,
fluids
88107 Cytopathology,
fluids
88108 Cytopath,
concentrate tech
88125 Forensic
cytopathology
88161 Cytopath smear,
other source
88162 Cytopath smear,
other source
88172 Evaluation of smear
88173 Interpretation of
smear
88304 Tissue exam by
pathologist
88305 Tissue exam by
pathologist
88312 Special stains
88314 Histochemical stain
88318 Chemical
histochemistry
88323 Microslide
consultation
88325 Comprehensive review
of data
88329 Pathology consult in
surgery
88331 Pathology consult in
surgery
88332 Pathology consult in
surgery
88346 Immunofluorescent
study
88362 Nerve teasing
preparations
89399 Pathology lab
procedure
G0025 Collagen skin test
kit
0344 Level III Pathology X 0.79 $38.30 $23.63 $7.66
85097 Bone marrow
interpretation
86078 Physician blood bank
service
86079 Physician blood bank
service
88180 Cell marker study
88182 Cell marker study
88307 Tissue exam by
pathologist
88309 Tissue exam by
pathologist
88342 Immunocytochemistry
88347 Immunofluorescent
study
88348 Electron microscopy
[[Page 18768]]
88349 Scanning electron
microscopy
88355 Analysis, skeletal
muscle
88356 Analysis, nerve
88358 Analysis, tumor
88365 Tissue hybridization
89350 Sputum specimen
collection
89360 Collect sweat for
test
2 0354 Administration of Influenza X 0.13 $6.19 .............. ..............
Vaccine
G0008 Admin influenza
virus vac
Q0034 Admin of influenza
vaccine
0355 Level I Immunizations X 0.19 $9.21 $5.05 $1.84
90645 Hib vaccine, hboc,
im
90646 Hib vaccine, prp-d,
im
90647 Hib vaccine, prp-
omp, im
90648 Hib vaccine, prp-t,
im
90657 Flu vaccine, 6-35
mo, im
90658 Flu vaccine, 3 yrs,
im
90659 Flu vaccine, whole,
im
90660 Flu vaccine, nasal
90700 Dtap vaccine, im
90702 Dt vaccine, im
90704 Mumps vaccine, sc
90713 Poliovirus, ipv, sc
90716 Chicken pox vaccine,
sc
90720 Dtp/hib vaccine, im
90721 Dtap/hib vaccine, im
90727 Plague vaccine, im
90732 Pneumococcal
vaccine, adult
90749 Vaccine toxoid
0356 Level II Immunizations X 0.36 $17.46 $4.82 $3.49
90371 Hep b ig, im
90389 Tetanus ig, im
90396 Varicella-zoster ig,
im
90476 Adenovirus vaccine,
type 4
90477 Adenovirus vaccine,
type 7
90585 Bcg vaccine, percut
90586 Bcg vaccine,
intravesical
90632 Hep a vaccine, adult
im
90633 Hep a vacc, ped/
adol, 2 dose
90634 Hep a vacc, ped/
adol, 3 dose
90680 Rotovirus vaccine,
oral
90690 Typhoid vaccine,
oral
90691 Typhoid vaccine, im
90692 Typhoid vaccine, h-
p, sc/id
90693 Typhoid vaccine,
akd, sc
90701 Dtp vaccine, im
90703 Tetanus vaccine, im
90707 Mmr vaccine, sc
90710 Mmrv vaccine, sc
90712 Oral poliovirus
vaccine
90717 Yellow fever
vaccine, sc
90718 Td vaccine, im
90744 Hep b vaccine, ped/
adol, im
90746 Hep b vaccine,
adult, im
90747 Hep b vaccine, ill
pat, im
0357 Level III Immunizations X 1.85 $89.70 $38.31 $17.94
90287 Botulinum antitoxin
90296 Diphtheria antitoxin
90375 Rabies ig, im/sc
90376 Rabies ig, heat
treated
90378 Rsv ig, im
90379 Rsv ig, iv
90384 Rh ig, full-dose, im
90385 Rh ig, minidose, im
90386 Rh ig, iv
90393 Vaccina ig, im
90581 Anthrax vaccine, sc
90636 Hep a/hep b vacc,
adult im
90665 Lyme disease
vaccine, im
90669 Pneumococcal
vaccine, ped
90675 Rabies vaccine, im
90676 Rabies vaccine, id
90705 Measles vaccine, sc
[[Page 18769]]
90719 Diphtheria vaccine,
im
90733 Meningococcal
vaccine, sc
90735 Encephalitis
vaccine, sc
0358 Level IV Immunizations X 6.98 $338.44 $126.74 $67.69
90706 Rubella vaccine, sc
90708 Measles-rubella
vaccine, sc
90709 Rubella & mumps
vaccine, sc
90725 Cholera vaccine,
injectable
90748 Hep b/hib vaccine,
im
0359 Injections X 0.96 $46.55 $9.31 $9.31
90782 Injection, sc/im
90783 Injection, ia
90784 Injection, iv
90788 Injection of
antibiotic
90799 Ther/prophylactic/dx
inject
0360 Level I Alimentary Tests X 1.38 $66.91 $34.75 $13.38
89105 Sample intestinal
contents
89130 Sample stomach
contents
89132 Sample stomach
contents
89135 Sample stomach
contents
89136 Sample stomach
contents
89140 Sample stomach
contents
91030 Acid perfusion of
esophagus
91055 Gastric intubation
for smear
91065 Breath hydrogen test
91100 Pass intestine
bleeding tube
91105 Gastric intubation
treatment
91299 Gastroenterology
procedure
0361 Level II Alimentary Tests X 3.53 $171.16 $88.09 $34.23
89100 Sample intestinal
contents
89141 Sample stomach
contents
91000 Esophageal
intubation
91010 Esophagus motility
study
91011 Esophagus motility
study
91012 Esophagus motility
study
91020 Gastric motility
91032 Esophagus, acid
reflux test
91033 Prolonged acid
reflux test
91052 Gastric analysis
test
91060 Gastric saline load
test
95075 Ingestion challenge
test
0362 Fitting of Vision Aids X 0.51 $24.73 $9.63 $4.95
92311 Contact lens fitting
92312 Contact lens fitting
92313 Contact lens fitting
92315 Prescription of
contact lens
92316 Prescription of
contact lens
92317 Prescription of
contact lens
92325 Modification of
contact lens
92326 Replacement of
contact lens
92352 Special spectacles
fitting
92353 Special spectacles
fitting
92354 Special spectacles
fitting
92355 Special spectacles
fitting
92358 Eye prosthesis
service
92371 Repair & adjust
spectacles
0363 Otorhinolaryngologic Function X 2.83 $137.22 $53.22 $27.44
Tests
92512 Nasal function
studies
92516 Facial nerve
function test
92520 Laryngeal function
studies
92541 Spontaneous
nystagmus test
92542 Positional nystagmus
test
92543 Caloric vestibular
test
92544 Optokinetic
nystagmus test
92545 Oscillating tracking
test
92546 Sinusoidal
rotational test
92547 Supplemental
electrical test
92548 Posturography
92584 Electrocochleography
92587 Evoked auditory test
92588 Evoked auditory test
0364 Level I Audiometry X 0.68 $32.97 $13.31 $6.59
92552 Pure tone
audiometry, air
[[Page 18770]]
92553 Audiometry, air &
bone
92555 Speech threshold
audiometry
92556 Speech audiometry,
complete
92567 Tympanometry
92599 ENT procedure/
service
0365 Level II Audiometry X 1.47 $71.28 $22.48 $14.26
92557 Comprehensive
hearing test
92561 Bekesy audiometry,
diagnosis
92562 Loudness balance
test
92563 Tone decay hearing
test
92564 Sisi hearing test
92565 Stenger test, pure
tone
92568 Acoustic reflex
testing
92569 Acoustic reflex
decay test
92571 Filtered speech
hearing test
92572 Staggered spondaic
word test
92573 Lombard test
92575 Sensorineural acuity
test
92576 Synthetic sentence
test
92577 Stenger test, speech
92579 Visual audiometry
(vra)
92582 Conditioning play
audiometry
92583 Select picture
audiometry
92589 Auditory function
test(s)
92596 Ear protector
evaluation
0366 Electrocardiogram (ECG) X 0.38 $18.43 $15.60 $3.69
93005 Electrocardiogram,
tracing
93041 Rhythm ECG, tracing
Q0035 Cardiokymography
0367 Level I Pulmonary Test X 0.83 $40.24 $20.65 $8.05
94010 Breathing capacity
test
94200 Lung function test
(MBC/MVV)
94250 Expired gas
collection
94375 Respiratory flow
volume loop
94400 CO2 breathing
response curve
94450 Hypoxia response
curve
94680 Exhaled air
analysis, o2
94690 Exhaled air analysis
94720 Monoxide diffusing
capacity
94770 Exhaled carbon
dioxide test
94799 Pulmonary service/
procedure
0368 Level II Pulmonary Tests X 1.66 $80.49 $42.44 $16.10
94060 Evaluation of
wheezing
94240 Residual lung
capacity
94260 Thoracic gas volume
94350 Lung nitrogen
washout curve
94360 Measure airflow
resistance
94370 Breath airway
closing volume
94620 Pulmonary stress
test/simple
94681 Exhaled air
analysis, o2/co2
94725 Membrane diffusion
capacity
94750 Pulmonary compliance
study
0369 Level III Pulmonary Tests X 2.34 $113.46 $58.50 $22.69
94014 Patient recorded
spirometry
94015 Patient recorded
spirometry
94016 Review patient
spirometry
94070 Evaluation of
wheezing
94621 Pulm stress test/
complex
94772 Breath recording,
infant
95070 Bronchial allergy
tests
95071 Bronchial allergy
tests
0370 Allergy Tests X 0.57 $27.64 $11.81 $5.53
95004 Allergy skin tests
95010 Sensitivity skin
tests
95015 Sensitivity skin
tests
95024 Allergy skin tests
95027 Skin end point
titration
95028 Allergy skin tests
95044 Allergy patch tests
95052 Photo patch test
95056 Photosensitivity
tests
95060 Eye allergy tests
95065 Nose allergy test
[[Page 18771]]
95078 Provocative testing
95180 Rapid
desensitization
95199 Allergy immunology
services
0371 Allergy Injections X 0.32 $15.52 $3.67 $3.10
95115 Immunotherapy, one
injection
95117 Immunotherapy
injections
95144 Antigen therapy
services
95145 Antigen therapy
services
95146 Antigen therapy
services
95147 Antigen therapy
services
95148 Antigen therapy
services
95149 Antigen therapy
services
95165 Antigen therapy
services
95170 Antigen therapy
services
0372 Therapeutic Phlebotomy X 0.43 $20.85 $10.09 $4.17
99195 Phlebotomy
0373 Neuropsychological Testing X 3.21 $155.64 $44.96 $31.13
96100 Psychological
testing
96105 Assessment of
aphasia
96110 Developmental test,
lim
96111 Developmental test,
extend
96115 Neurobehavior status
exam
96117 Neuropsych test
battery
0374 Monitoring Psychiatric Drugs X 1.17 $56.73 $13.08 $11.35
90862 Medication
management
M0064 Visit for drug
monitoring
0600 Low Level Clinic Visits V 0.98 $47.52 $9.50 $9.50
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
0601 Mid Level Clinic Visits V 1.00 $48.49 $9.70 $9.70
92002 Eye exam, new
patient
92012 Eye exam established
pat
99203 Office/outpatient
visit, new
99213 Office/outpatient
visit, est
99243 Office consultation
99273 Confirmatory
consultation
G0101 CA screen; pelvic/
breast exam
0602 High Level Clinic Visits V 1.66 $80.49 $16.29 $16.10
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
0603 Interdisciplinary Team V 1.66 $80.49 $16.29 $16.10
Conference
G0175 Multidisciplinary team visit
0610 Low Level Emergency Visits V 1.34 $64.97 $20.65 $12.99
99281 Emergency dept visit
99282 Emergency dept visit
0611 Mid Level Emergency Visits V 2.11 $102.31 $36.47 $20.46
99283 Emergency dept visit
0612 High Level Emergency Visits V 3.19 $154.67 $54.14 $30.93
99284 Emergency dept visit
99285 Emergency dept visit
0620 Critical Care S 8.60 $416.99 $152.78 $83.40
99291 Critical care, first
hour
3 0701 Strontium X $84.76
A9600 Strontium-89
chloride
3 0702 Samariam X $139.06
A9605 Samarium sm153
lexidronamm
3 0704 Satumomab Pendetide X $63.13
A4642 Satumomab pendetide
per dose
3 0705 Tc99 Tetrofosmin X $71.08
[[Page 18772]]
A9502 Technetium TC99M
tetrofosmin
3 0725 Leucovorin Calcium X $1.07
J0640 Leucovorin calcium
injection
3 0726 Dexrazoxane Hydrochloride X $18.81
J1190 Dexrazoxane HCl
injection
3 0727 Injection, Etidronate X $9.31
Disodium
J1436 Etidronate disodium
inj
3 0728 Filgrastim (G-CSF) X $25.21
J1440 Filgrastim 300 mcg
injection
3 0730 Pamidronate Disodium X $30.93
J2430 Pamidronate disodium/
30 MG
3 0731 Sargramostim (GM-CSF) X $16.97
J2820 Sargramostim
injection
3 0732 Mesna X $2.42
J9209 Mesna injection
3 0733 Epoetin Alpha X $1.75
Q0136 Non esrd epoetin
alpha inj
3 0750 Dolasetron Mesylate 10 mg X $1.94
J1260 Dolasetron mesylate
3 0754 Metoclopramide HCL X $0.19
J2765 Metoclopramide hcl
injection
3 0755 Thiethylperazine Maleate X $0.68
J3280 Thiethylperazine
maleate inj
3 0761 Oral Substitute for IV X $0.10
Antiemtic
Q0163 Diphenhydramine HCl
50mg
Q0164 Prochlorperazine
maleate 5mg
Q0169 Promethazine HCl
12.5mg oral
Q0171 Chlorpromazine HCl
10mg oral
Q0173 Trimethobenzamide
HCl 250mg
Q0174 Thiethylperazine
maleate10mg
Q0175 Perphenazine 4mg
oral
Q0177 Hydroxyzine pamoate
25mg
3 0762 Dronabinol X $0.48
Q0167 Dronabinol 2.5mg
oral
3 0763 Dolasetron Mesylate 100 mg X $8.53
Oral
Q0180 Dolasetron mesylate
oral
3 0764 Granisetron HCL, 100 mcg X $2.33
J1626 Granisetron HCl
injection
3 0765 Granisetron HCL, 1mg Oral X $3.20
Q0166 Granisetron HCl 1 mg
oral
3 0768 Ondansetron Hydrochloride per X $0.87
1 mg Injection
J2405 Ondansetron hcl
injection
3 0769 Ondansetron Hydrochloride 8 X $2.62
mg oral
Q0179 Ondansetron HCl 8mg
oral
3 0800 Leuprolide Acetate per 3.75 X $68.56
mg
J1950 Leuprolide acetate/
3.75 MG
3 0801 Cyclophosphamide X $.19
J8530 Cyclophosphamide
oral 25 MG
3 0802 Etoposide X $3.10
J8560 Etoposide oral 50 MG
3 0803 Melphalan X $0.19
J8600 Melphalan oral 2 MG
3 0807 Aldesleukin single use vial X $65.07
J9015 Aldesleukin/single
use vial
3 0809 BCG (Intravesical) one vial X $19.78
J9031 Bcg live
intravesical vac
3 0810 Goserelin Acetate Implant, X $59.74
per 3.6 mg
J9202 Goserelin acetate
implant
3 0811 Carboplatin 50 mg X $13.96
J9045 Carboplatin
injection
3 0812 Carmustine 100 mg X $10.57
J9050 Carmus bischl nitro
inj
3 0813 Cisplatin 10 mg X $4.56
J9060 Cisplatin 10 MG
injeciton
3 0814 Asparaginase, 10,000 units X $8.34
J9020 Asparaginase
injection
3 0815 Cyclophosphamide 100 mg X $0.48
J9070 Cyclophosphamide 100
MG inj
3 0816 Cyclophosphamide, Lyophilized X $1.16
100 mg
J9093 Cyclophosphamide
lyophilized
3 0817 Cytrabine 100 mg X $0.68
J9100 Cytarabine hcl 100
MG inj
3 0818 Dactinomycin 0.5 mg X $1.75
[[Page 18773]]
J9120 Dactinomycin
actinomycin d
3 0819 Dacarbazine 100 mg X $1.26
J9130 Dacarbazine 10 MG
inj
3 0820 Daunorubicin HCI 10 mg X $11.64
J9150 Daunorubicin
3 0821 Daunorubicin Citrate, X $7.76
Liposomal Formulation, 10 mg
J9151 Daunorubicin citrate
liposom
3 0822 Diethylstibestrol Diphosphate X $2.13
250 mg
J9165 Diethylstilbestrol
injection
3 0823 Docetaxel 20 mg X $34.72
J9170 Docetaxel
3 0824 Etoposide 10 mg X $.58
J9181 Etoposide 10 MG inj
3 0826 Methotrexate Oral 2.5 mg X $.29
J8610 Methotrexate oral
2.5 MG
3 0827 Floxuridine 500 mg X $18.81
J9200 Floxuridine
injection
3 0828 Gemcitabine HCL 200 mg X $9.31
J9201 Gemcitabine HCl
3 0830 Irinotecan 20 mg X $14.16
J9206 Irinotecan injection
3 0831 Ifosfamide per 1 gram X $13.58
J9208 Ifosfomide injection
3 0832 Idarubicin Hydrochloride 5 mg X $46.45
J9211 Idarubicin hcl
injeciton
3 0833 Interferon Alfacon-1, X $0.19
Recombinant, 1 mcg
J9212 Interferon alfacon-1
3 0834 Interferon, Alfa-2A, X $3.20
Recombinant 3 million units
J9213 Interferon alfa-2a
inj
3 0836 Interferon, Alfa-2B, X $1.36
Recombinant, 1 million units
J9214 Interferon alfa-2b
inj
3 0838 Interferon, Gamma 1-B, 3 X $22.79
million units
J9216 Interferon gamma 1-b
inj
3 0839 Mechlorethamine HCI 10 mg X $1.65
J9230 Mechlorethamine hcl
inj
3 0840 Melphalan HCI 50 mg X $44.71
J9245 Inj melphalan
hydrochl 50 MG
3 0841 Methotrexate Sodium 5 mg X $.10
J9250 Methotrexate sodium
inj
3 0842 Fludarabine Phosphate 50 mg X $30.84
J9185 Fludarabine
phosphate inj
3 0843 Pegaspargase per single dose X $178.72
vial
J9266 Pegaspargase/singl
dose vial
3 0844 Pentostatin 10 mg X $133.73
J9268 Pentostatin
injection
3 0847 Doxorubicin HCL 10 mg X $2.81
J9000 Doxorubic hcl 10 MG
vl chemo
3 0849 Rituximab, 100 mg X $51.40
J9310 Rituximab cancer
treatment
3 0850 Streptozocin 1 gm X $14.64
J9320 Streptozocin
injection
3 0851 Thiotepa 15 mg X $9.50
J9340 Thiotepa injection
3 0852 Topotecan 4 mg X $73.22
J9350 Topotecan
3 0853 Vinblastine Sulfate 1 mg X $.39
J9360 Vinblastine sulfate
inj
3 0854 Vincristine Sulfate 1 mg X $2.23
J9370 Vincristine sulfate
1 MG inj
3 0855 Vinorelbine Tartrate per 10 X $9.60
mg
J9390 Vinorelbine tartrate/
10 mg
3 0856 Porfimer Sodium 75 mg X $34.62
J9600 Porfimer sodium
3 0857 Bleomycin Sulfate 15 units X $48.29
J9040 Bleomycin sulfate
injection
3 0858 Cladribine, 1mg X $8.24
J9065 Inj cladribine per 1
MG
3 0859 Fluorouracil X $0.19
J9190 Fluorouracil
injection
3 0860 Plicamycin 2.5 mg X $1.36
J9270 Plicamycin
(mithramycin) inj
3 0861 Leuprolide Acetate 1 mg X $19.39
J9218 Leuprolide acetate
injeciton
[[Page 18774]]
3 0862 Mitomycin, 5mg X $19.88
J9280 Mitomycin 5 MG inj
3 0863 Paclitaxel, 30mg X $30.16
J9265 Paclitaxel injection
3 0864 Mitoxantrone HCl, per 5mg X $25.80
J9293 Mitoxantrone
hydrochl/5 MG
3 0865 Interferon alfa-N3, 250,000 X $1.07
IU
J9215 Interferon alfa-n3
inj
3 0884 Rho (D) Immune Globulin, X $3.78
Human one dose pack
J2790 Rho d immune
globulin inj
2 0886 Azathioprine, 50 mg oral X 0.02 $.97 $0.19
J7500 Azathioprine oral
50mg
2 0887 Azathioprine, Parenteral 100 X 1.40 $67.88 $13.58
mg, 20 ml each injection
J7501 Azathioprine
parenteral
2 0888 Cyclosporine, Oral 100 mg X 0.08 $3.88 $0.78
J7502 Cyclosporine oral
100 mg
2 0889 Cyclosporine, Parenteral X 0.36 $17.46 $3.49
J7516 Cyclosporin
parenteral 250mg
2 0890 Lymphocyte Immune Globulin 50 X 3.79 $183.77 $36.75
mg/ml, 5 ml each
J7504 Lymphocyte immune
globulin
2 0891 Tacrolimus per 1 mg oral X 3.15 $152.73 $30.55
J7507 Tacrolimus oral per
1 MG
3 0892 Daclizumab, Parenteral, 25 mg X $54.11
J7913 Daclizumab,
Parenteral, 25 m
3 0900 Injection, Alglucerase per 10 X $5.14
units
J0205 Alglucerase
injection
3 0901 Alpha I, Proteinase X $15.22
Inhibitor, Human per 10mg
J0256 Alpha 1 proteinase
inhibitor
3 0902 Botulinum Toxin, Type A per X $56.05
unit
J0585 Botulinum toxin a
per unit
3 0903 CMV Immune Globulin X $54.11
J0850 Cytomegalovirus imm
IV/vial
3 0905 Immune Globulin per 500 mg X $6.40
J1561 Immune globulin 500
mg
3 0906 RSV Immune Globulin X $85.53
J1565 RSV-ivig
2 0907 Ganciclovir Sodium 500 mg X 0.51 $24.73 $4.95
injection
J1570 Ganciclovir sodium
injection
2 0908 Tetanus Immune Globulin, X 0.90 $43.64 $8.73
Human, up to 250 units
J1670 Tetanus immune
globulin inj
3 0909 Interferon Beta-1a 33 mcg X $28.70
J1825 Interferon beta-1a
3 0910 Interferon Beta-1b 0.25 mg X $8.44
J1830 Interferon beta-1b/
.25 MG
2 0911 Streptokinase per 250,000 iu X 1.64 $79.69 $15.94
J2995 Inj streptokinase/
250000 IU
3 0913 Ganciclovir 4.5 mg, Implant X $701.51
J7310 Ganciclovir long act
implant
2 0914 Reteplase, 37.6 mg (Two X 38.20 $1,852.21 $370.44
Single Use Vials)
J2994 Reteplase double
bolus
2 0915 Alteplase recombinant, 10mg X 5.85 $283.70 $56.74
J2996 Alteplase
recombinant inj
3 0916 Imiglucerase per unit X $0.58
J1785 Injection
imiglucerase/unit
2 0917 Dipyridamole, 10 mg/Adenosine X 0.36 $17.46 $3.49
6MG
J0150 Injection adenosine
6 MG
J1245 Dipyridamole
injection
3 0918 Brachytherapy Seeds, Any S $9.99
type, Each
Q3001 Brachytherapy Seeds
3 0925 Factor VIII (Antihemophilic X $0.19
Factor, Human) per iu
J7190 Factor viii
3 0926 Factor VIII (Antihemophilic X $0.19
Factor, Porcine) per iu
J7191 Factor VIII
(porcine)
3 0927 Factor VIII (Antihemophilic X $0.19
Factor, Recombinant) per iu
J7192 Factor viii
recombinant
3 0928 Factor IX, Complex X $0.08
J7194 Factor ix complex
3 0929 Other Hemophilia Clotting X $0.27
Factors per iu
J7198 Anti-inhibitor
Q0187 Factor viia
recombinant
3 0930 Antithrombin III (Human) per X $0.19
iu
J7197 Antithrombin iii
injection
3 0931 Factor IX (Antihemophilic X $0.04
Factor, Purified, Non-
Recombinant)
[[Page 18775]]
Q0160 Factor IX non-
recombinant
3 0932 Factor IX (Antihemophilic X $0.10
Factor, Recombinant)
Q0161 Factor IX
recombinant
2 0949 Plasma, Pooled Multiple S 3.49 $169.22 $33.84
Donor, Solvent/Detergent
Treated, Frozen
P9023 Frozen plasma,
pooled, sd
2 0950 Blood (Whole) For Transfusion S 2.08 $101.02 $20.20
P9010 Whole blood for
transfusion
2 0952 Cryoprecipitate S 0.70 $33.92 $6.78
P9012 Cryoprecipitate each
unit
2 0953 Fibrinogen Unit S 0.48 $23.27 $4.65
P9013 Unit/s blood
fibrinogen
2 0954 Leukocyte Poor Blood S 2.83 $137.21 $27.44
P9016 Leukocyte poor
blood, unit
2 0955 Plasma, Fresh Frozen S 2.26 $109.35 $21.87
P9017 One donor fresh
frozn plasma
2 0956 Plasma Protein Fraction S 1.26 $61.09 $12.22
P9018 Plasma protein
fract, unit
2 0957 Platelet Concentrate S 0.98 $47.46 $9.49
P9019 Platelet concentrate
unit
2 0958 Platelet Rich Plasma S 1.16 $56.25 $11.25
P9020 Platelet rich plasma
unit
2 0959 Red Blood Cells S 2.04 $99.04 $19.81
P9021 Red blood cells unit
2 0960 Washed Red Blood Cells S 3.81 $184.53 $36.91
P9022 Washed red blood
cells unit
2 0961 Infusion, Albumin (Human) 5%, X 2.77 $134.31 $26.86
500 ml
Q0156 Human albumin 5%
2 0962 Infusion, Albumin (Human) X 1.38 $66.91 $13.38
25%, 50 ml
Q0157 Human albumin 25%
2 0970 New Technology - Level I ($0- T 0.52 $25.21 $5.04
$50)
78268 Breath test
analysis, c-14
2 0971 New Technology - Level II S 1.55 $75.16 $15.03
($50-$100)
78267 Breath tst attain/
anal c-14
2 0972 New Technology - Level III T 3.09 $149.83 $29.97
($100-$200)
G0166 Extrnl counterpulse,
per tx
2 0980 New Technology - Level XI S 38.67 $1,875.00 $375.00
($1750-$2000)
53850 Prostatic microwave
thermotx
53852 Prostatic rf
thermotx
G0125 Lung image (PET)
G0126 Lung image (PET)
staging
G0163 Pet for rec of
colorectal ca
G0164 Pet for lymphoma
staging
G0165 Pet, rec of melanoma/
met ca
3 7000 Amifostine, 500 mg X $41.99
J0207 Amifostine
3 7001 Amphotericin B lipid complex, X $12.12
50 mg, Inj
J0286 Amphotericin B lipid
complex
3 7002 Clonidine, HCl, 1 MG X $4.17
J0735 Clonidine
hydrochloride
3 7003 Epoprostenol, 0.5 MG, inj X $2.23
J1325 Epoprostenol
injection
3 7004 Immune globulin intravenous X $45.48
human 5g, inj
J1562 Immune globulin 5
gms
3 7005 Gonadorelin hcI, 100 mcg X $9.12
J1620 Gonadorelin hydroch/
100 mcg
2 7007 Milrinone lacetate, per 5 ml, X 0.47 $22.79 $4.56
inj
J2260 Inj milrinone
lactate/5 ML
3 7010 Morphine sulfate concentrate X $.68
(preservative free) per 10 mg
J2275 Morphine sulfate
injection
3 7011 Oprelevekin, inj, 5 mg X $30.35
J2355 Oprelvekin injection
3 7012 Pentamidine isethionate, 300 X $8.73
mg
J2545 Pentamidine
isethionte/300mg
3 7014 Fentanyl citrate, inj, up to X $.19
2 ml
J3010 Fentanyl citrate
injeciton
3 7015 Busulfan, oral 2 mg X $0.19
J8510 Oral busulfan
3 7019 Aprotinin, 10,000 kiu X $2.42
Q2003 Aprotinin, 10,000
kiu
3 7021 Baclofen, intrathecal, 50 mcg X $0.10
J0476 Baclofen intrathecal
trial
3 7022 Elliotts B Solution, per ml X $19.20
Q2002 Elliot's B solution
[[Page 18776]]
3 7023 Treatment for bladder X $4.46
calculi, I.e. Renacidin per
500 ml
Q2004 Treatment for
bladder calcul
3 7024 Corticorelin ovine X $45.77
triflutate, 0.1 mg
Q2005 Corticorelin ovine
triflutat
3 7025 Digoxin immune FAB (Ovine), X $14.06
10 mg
Q2006 Digoxin immune FAB
(Ovine),
3 7026 Ethanolamine oleate, 1000 ml X $2.13
Q2007 Ethanolamine oleate,
1000 ml
3 7027 Fomepizole, 1.5 G X $141.29
Q2008 Fomepizole, 1.5 G
3 7028 Fosphenytoin, 50 mg X $0.78
Q2009 Fosphenytoin, 50 mg
3 7029 Glatiramer acetate, 25 mg X $3.59
Q2010 Glatiramer acetate,
25 mgeny
3 7030 Hemin, 1 mg X $0.10
Q2011 Hemin, 1 mg
3 7031 Octreotide Acetate, 500 mcg X $5.43
J2352 Octreotide acetate
injection
3 7032 Sermorelin acetate, 0.5 mg X $53.34
Q2014 Sermorelin acetate,
0.5 mg
3 7033 Somatrem, 5 mg X $28.03
Q2015 Somatrem, 5 mg
3 7034 Somatropin, 1 mg X $5.04
Q2016 Somatropin, 1 mg
3 7035 Teniposide, 50 mg X $20.85
Q2017 Teniposide, 50 mg
2 7036 Urokinase, inj, IV, 250,000 X 0.73 $35.40 $7.08
I.U.
J3365 Urokinase 250,000 IU
inj
3 7037 Urofollitropin, 75 I.U. X $8.24
Q2018 Urofollitropin, 75
I.U.
3 7038 Muromonab-CD3, 5 mg X $89.60
J7505 Monoclonal
antibodies
3 7039 Pegademase bovine inj 25 I.U. X $1.16
Q2012 Pegademase bovine
inj 25 I.U
3 7040 Pentastarch 10% inj, 100 ml X $2.04
Q2013 Pentastarch 10% inj,
100 ml
2 7041 Tirofiban HCL, 0.5 mg X 0.02 $.97 $0.19
J3245 Tirofiban
hydrochloride
3 7042 Capecitabine, oral 150 mg X $0.19
J8520 Capecitabine, oral,
150 mg
3 7043 Infliximab, 10 MG X $6.89
J1745 Infliximab injection
3 7045 Trimetrexate Glucoronate X $8.15
J3305 Inj trimetrexate
glucoronate
3 7046 Doxorubicin Hcl Liposome X $39.18
J9001 Doxorubicin hcl
liposome inj
----------------------------------------------------------------------------------------------------------------
--------------------
CPT codes and descriptions only are copyright American Medical
Association. All Rights Reserved. Applicable FARS/DFARS Apply.
Copyright American Dental Association. All rights reserved.
Addendum D.--1996 HCPC Codes Used To Calculate Pay
------------------------------------------------------------------------
Termination
CPT/HCPCS Date
------------------------------------------------------------------------
00420................................................... 12/31/1999
01000................................................... 12/31/1999
01110................................................... 12/31/1999
01240................................................... 12/31/1999
01300................................................... 12/31/1999
01460................................................... 12/31/1999
01600................................................... 12/31/1999
01700................................................... 12/31/1999
01800................................................... 12/31/1999
01900................................................... 12/31/1999
01902................................................... 12/31/1999
11050................................................... 12/31/1997
11051................................................... 12/31/1997
11052................................................... 12/31/1997
11700................................................... 12/31/1996
11701................................................... 12/31/1996
11710................................................... 12/31/1996
11711................................................... 12/31/1996
11731................................................... 12/31/1998
13300................................................... 12/31/1999
15580................................................... 12/31/1999
15625................................................... 12/31/1999
15755................................................... 12/31/1996
16040................................................... 12/31/1998
16041................................................... 12/31/1998
16042................................................... 12/31/1998
17001................................................... 12/31/1997
17002................................................... 12/31/1997
17010................................................... 12/31/1997
17100................................................... 12/31/1997
17101................................................... 12/31/1997
17102................................................... 12/31/1997
17104................................................... 12/31/1997
17105................................................... 12/31/1997
17200................................................... 12/31/1997
17201................................................... 12/31/1997
20960................................................... 12/31/1996
20971................................................... 12/31/1996
25330................................................... 12/31/1996
25331................................................... 12/31/1996
26552................................................... 12/31/1996
26557................................................... 12/31/1996
26558................................................... 12/31/1996
26559................................................... 12/31/1996
32001................................................... 12/31/1999
33242................................................... 12/31/1999
33247................................................... 12/31/1999
42880................................................... 12/31/1996
[[Page 18777]]
53640................................................... 12/31/1996
56300................................................... 12/31/1999
56301................................................... 12/31/1999
56302................................................... 12/31/1999
56303................................................... 12/31/1999
56304................................................... 12/31/1999
56305................................................... 12/31/1999
56306................................................... 12/31/1999
56307................................................... 12/31/1999
56308................................................... 12/31/1999
56309................................................... 12/31/1999
56310................................................... 12/31/1999
56311................................................... 12/31/1999
56312................................................... 12/31/1999
56313................................................... 12/31/1999
56314................................................... 12/31/1999
56315................................................... 12/31/1999
56316................................................... 12/31/1999
56317................................................... 12/31/1999
56318................................................... 12/31/1999
56320................................................... 12/31/1999
56321................................................... 12/31/1999
56322................................................... 12/31/1999
56323................................................... 12/31/1999
56324................................................... 12/31/1999
56340................................................... 12/31/1999
56341................................................... 12/31/1999
56342................................................... 12/31/1999
56343................................................... 12/31/1999
56344................................................... 12/31/1999
56345................................................... 12/31/1999
56346................................................... 12/31/1999
56347................................................... 12/31/1999
56348................................................... 12/31/1999
56349................................................... 12/31/1999
56350................................................... 12/31/1999
56351................................................... 12/31/1999
56352................................................... 12/31/1999
56353................................................... 12/31/1999
56354................................................... 12/31/1999
56355................................................... 12/31/1999
56356................................................... 12/31/1999
56360................................................... 12/31/1996
56361................................................... 12/31/1996
56362................................................... 12/31/1999
56363................................................... 12/31/1999
56399................................................... 12/31/1999
57108................................................... 12/31/1998
61106................................................... 12/31/1998
61130................................................... 12/31/1998
61712................................................... 12/31/1998
61855................................................... 12/31/1999
61865................................................... 12/31/1999
62274................................................... 12/31/1999
62275................................................... 12/31/1999
62276................................................... 12/31/1999
62277................................................... 12/31/1999
62278................................................... 12/31/1999
62279................................................... 12/31/1999
62288................................................... 12/31/1999
62289................................................... 12/31/1999
62298................................................... 12/31/1999
63690................................................... 12/31/1998
63691................................................... 12/31/1998
64440................................................... 12/31/1999
64441................................................... 12/31/1999
64442................................................... 12/31/1999
64443................................................... 12/31/1999
64830................................................... 12/31/1998
68800................................................... 12/31/1996
68820................................................... 12/31/1996
68825................................................... 12/31/1996
68830................................................... 12/31/1996
71038................................................... 12/31/1998
74405................................................... 12/31/1998
77380................................................... 12/31/1999
77381................................................... 12/31/1999
77419................................................... 12/31/1999
77420................................................... 12/31/1999
77425................................................... 12/31/1999
77430................................................... 12/31/1999
78017................................................... 12/31/1998
78726................................................... 12/31/1997
78727................................................... 12/31/1997
80002................................................... 12/31/1997
80003................................................... 12/31/1997
80004................................................... 12/31/1997
80005................................................... 12/31/1997
80006................................................... 12/31/1997
80007................................................... 12/31/1997
80008................................................... 12/31/1997
80009................................................... 12/31/1997
80010................................................... 12/31/1997
80011................................................... 12/31/1997
80012................................................... 12/31/1997
80016................................................... 12/31/1997
80018................................................... 12/31/1997
80019................................................... 12/31/1997
80049................................................... 12/31/1999
80054................................................... 12/31/1999
80058................................................... 12/31/1999
80059................................................... 12/31/1999
80091................................................... 12/31/1999
80092................................................... 12/31/1999
82130................................................... 12/31/1998
82250................................................... 12/31/1998
83019................................................... 12/31/1998
83717................................................... 12/31/1998
85029................................................... 12/31/1998
85030................................................... 12/31/1998
86287................................................... 12/31/1997
86289................................................... 12/31/1997
86290................................................... 12/31/1997
86291................................................... 12/31/1997
86293................................................... 12/31/1997
86295................................................... 12/31/1997
86296................................................... 12/31/1997
86299................................................... 12/31/1997
86302................................................... 12/31/1997
86303................................................... 12/31/1997
86306................................................... 12/31/1997
86311................................................... 12/31/1997
86313................................................... 12/31/1997
86315................................................... 12/31/1997
86588................................................... 12/31/1999
87178................................................... 12/31/1997
87179................................................... 12/31/1997
88151................................................... 12/31/1997
88156................................................... 12/31/1998
88157................................................... 12/31/1997
88158................................................... 12/31/1998
88250................................................... 12/31/1998
88260................................................... 12/31/1998
90592................................................... 12/31/1999
90711................................................... 12/31/1998
90714................................................... 12/31/1998
90724................................................... 12/31/1998
90726................................................... 12/31/1998
90728................................................... 12/31/1998
90730................................................... 12/31/1998
90737................................................... 12/31/1998
90741................................................... 12/31/1998
90742................................................... 12/31/1998
90745................................................... 12/31/1999
90820................................................... 12/31/1997
90825................................................... 12/31/1997
90835................................................... 12/31/1997
90841................................................... 12/31/1997
90842................................................... 12/31/1997
90843................................................... 12/31/1997
90844................................................... 12/31/1997
90855................................................... 12/31/1997
90900................................................... 12/31/1996
90902................................................... 12/31/1996
90904................................................... 12/31/1996
90906................................................... 12/31/1996
90908................................................... 12/31/1996
90910................................................... 12/31/1996
90915................................................... 12/31/1996
93201................................................... 12/31/1996
93202................................................... 12/31/1996
93204................................................... 12/31/1996
93205................................................... 12/31/1996
93208................................................... 12/31/1996
93209................................................... 12/31/1996
93210................................................... 12/31/1996
93220................................................... 12/31/1996
93221................................................... 12/31/1996
93222................................................... 12/31/1996
94160................................................... 12/31/1996
97122................................................... 12/31/1998
97250................................................... 12/31/1998
97260................................................... 12/31/1998
97261................................................... 12/31/1998
97265................................................... 12/31/1998
97500................................................... 12/31/1996
97501................................................... 12/31/1996
97521................................................... 12/31/1996
99351................................................... 12/31/1997
99352................................................... 12/31/1997
99353................................................... 12/31/1997
99376................................................... 12/31/1997
A2000................................................... 12/31/1997
A4190................................................... 12/31/1996
A4200................................................... 12/31/1996
A4202................................................... 12/31/1996
A4203................................................... 12/31/1996
A4204................................................... 12/31/1996
A4205................................................... 12/31/1996
A4363................................................... 12/31/1999
A4581................................................... 12/31/1996
A4610................................................... 12/31/1996
D0471................................................... 12/31/1999
D2210................................................... 12/31/1999
D2810................................................... 12/31/1999
D3960................................................... 12/31/1999
D4250................................................... 12/31/1999
D7470................................................... 12/31/1999
[[Page 18778]]
D7942................................................... 12/31/1999
D9240................................................... 12/31/1999
E0237................................................... 12/31/1996
E0452................................................... 12/31/1999
E0453................................................... 12/31/1999
E1350................................................... 12/31/1996
E1400................................................... 12/31/1999
E1401................................................... 12/31/1999
E1402................................................... 12/31/1999
E1403................................................... 12/31/1999
E1404................................................... 12/31/1999
G0051................................................... 12/31/1997
G0052................................................... 12/31/1997
G0053................................................... 12/31/1997
G0054................................................... 09/30/1996
G0055................................................... 09/30/1996
G0056................................................... 09/30/1996
G0057................................................... 09/30/1996
G0058................................................... 12/31/1997
G0059................................................... 12/31/1997
G0060................................................... 12/31/1997
G0061................................................... 12/31/1996
G0062................................................... 12/31/1997
G0063................................................... 12/31/1997
G0064................................................... 12/31/1997
G0065................................................... 12/31/1997
G0066................................................... 12/31/1997
G0071................................................... 12/31/1997
G0072................................................... 12/31/1997
G0073................................................... 12/31/1997
G0074................................................... 12/31/1997
G0075................................................... 12/31/1997
G0076................................................... 12/31/1997
G0077................................................... 12/31/1997
G0078................................................... 12/31/1997
G0079................................................... 12/31/1997
G0080................................................... 12/31/1997
G0081................................................... 12/31/1997
G0082................................................... 12/31/1997
G0083................................................... 12/31/1997
G0084................................................... 12/31/1997
G0085................................................... 12/31/1997
G0086................................................... 12/31/1997
G0087................................................... 12/31/1997
G0088................................................... 12/31/1997
G0089................................................... 12/31/1997
G0090................................................... 12/31/1997
G0091................................................... 12/31/1997
G0092................................................... 12/31/1997
G0093................................................... 12/31/1997
G0094................................................... 12/31/1997
G0095................................................... 12/31/1997
G0096................................................... 12/31/1997
G0097................................................... 12/31/1997
G0098................................................... 12/31/1997
G0100................................................... 12/31/1997
G0133................................................... 12/31/1998
H5300................................................... 12/31/1997
J1625................................................... 12/31/1997
J1760................................................... 12/31/1999
J1770................................................... 12/31/1999
J1780................................................... 12/31/1999
J2050................................................... 12/31/1996
J3005................................................... 12/31/1997
J7140................................................... 12/31/1996
J7150................................................... 12/31/1996
J7196................................................... 12/31/1999
J7503................................................... 12/31/1999
J9010................................................... 12/31/1996
K0109................................................... 09/30/1999
K0110................................................... 12/31/1996
K0111................................................... 12/31/1996
K0119................................................... 12/31/1999
K0120................................................... 12/31/1999
K0121................................................... 12/31/1999
K0122................................................... 12/31/1999
K0123................................................... 12/31/1999
K0124................................................... 12/31/1996
K0125................................................... 12/31/1996
K0126................................................... 12/31/1996
K0127................................................... 12/31/1996
K0128................................................... 12/31/1996
K0129................................................... 12/31/1996
K0130................................................... 12/31/1996
K0137................................................... 12/31/1999
K0138................................................... 12/31/1999
K0139................................................... 12/31/1999
K0140................................................... 03/31/1997
K0141................................................... 03/31/1997
K0142................................................... 03/31/1997
K0143................................................... 03/31/1997
K0144................................................... 03/31/1997
K0145................................................... 03/31/1997
K0146................................................... 03/31/1997
K0152................................................... 12/31/1996
K0154................................................... 12/31/1996
K0163................................................... 12/31/1996
K0168................................................... 12/31/1999
K0169................................................... 12/31/1999
K0170................................................... 12/31/1999
K0171................................................... 12/31/1999
K0172................................................... 12/31/1999
K0173................................................... 12/31/1999
K0174................................................... 12/31/1999
K0175................................................... 12/31/1999
K0176................................................... 12/31/1999
K0177................................................... 12/31/1999
K0178................................................... 12/31/1999
K0179................................................... 12/31/1999
K0180................................................... 12/31/1999
K0181................................................... 12/31/1999
K0190................................................... 12/31/1999
K0191................................................... 12/31/1999
K0192................................................... 12/31/1999
K0193................................................... 09/30/1999
K0194................................................... 09/30/1999
K0196................................................... 12/31/1996
K0197................................................... 12/31/1996
K0198................................................... 12/31/1996
K0199................................................... 12/31/1996
K0203................................................... 12/31/1996
K0204................................................... 12/31/1996
K0205................................................... 12/31/1996
K0206................................................... 12/31/1996
K0207................................................... 12/31/1996
K0208................................................... 12/31/1996
K0209................................................... 12/31/1996
K0210................................................... 12/31/1996
K0211................................................... 12/31/1996
K0212................................................... 12/31/1996
K0213................................................... 12/31/1996
K0214................................................... 12/31/1996
K0215................................................... 12/31/1996
K0216................................................... 12/31/1996
K0217................................................... 12/31/1996
K0218................................................... 12/31/1996
K0219................................................... 12/31/1996
K0220................................................... 12/31/1996
K0221................................................... 12/31/1996
K0222................................................... 12/31/1996
K0223................................................... 12/31/1996
K0224................................................... 12/31/1996
K0228................................................... 12/31/1996
K0229................................................... 12/31/1996
K0230................................................... 12/31/1996
K0234................................................... 12/31/1996
K0235................................................... 12/31/1996
K0236................................................... 12/31/1996
K0237................................................... 12/31/1996
K0238................................................... 12/31/1996
K0239................................................... 12/31/1996
K0240................................................... 12/31/1996
K0241................................................... 12/31/1996
K0242................................................... 12/31/1996
K0243................................................... 12/31/1996
K0244................................................... 12/31/1996
K0245................................................... 12/31/1996
K0246................................................... 12/31/1996
K0247................................................... 12/31/1996
K0248................................................... 12/31/1996
K0249................................................... 12/31/1996
K0250................................................... 12/31/1996
K0251................................................... 12/31/1996
K0252................................................... 12/31/1996
K0253................................................... 12/31/1996
K0254................................................... 12/31/1996
K0255................................................... 12/31/1996
K0256................................................... 12/31/1996
K0257................................................... 12/31/1996
K0258................................................... 12/31/1996
K0259................................................... 12/31/1996
K0260................................................... 12/31/1996
K0261................................................... 12/31/1996
K0262................................................... 12/31/1996
K0263................................................... 12/31/1996
K0264................................................... 12/31/1996
K0265................................................... 12/31/1996
K0266................................................... 12/31/1996
K0271................................................... 06/30/1996
K0272................................................... 06/30/1996
K0273................................................... 06/30/1996
K0274................................................... 06/30/1996
K0275................................................... 06/30/1996
K0276................................................... 06/30/1996
K0277................................................... 12/31/1999
K0278................................................... 12/31/1999
K0279................................................... 12/31/1999
K0284................................................... 12/31/1999
K0285................................................... 12/31/1996
K0400................................................... 12/31/1999
K0401................................................... 12/31/1999
K0402................................................... 12/31/1996
K0403................................................... 12/31/1996
K0404................................................... 12/31/1996
K0405................................................... 12/31/1996
K0406................................................... 12/31/1996
K0412................................................... 12/31/1999
K0413................................................... 12/31/1997
[[Page 18779]]
K0414................................................... 12/31/1997
K0417................................................... 12/31/1999
K0418................................................... 12/31/1999
K0419................................................... 12/31/1999
K0420................................................... 12/31/1999
K0421................................................... 12/31/1999
K0422................................................... 12/31/1999
K0423................................................... 12/31/1999
K0424................................................... 12/31/1999
K0425................................................... 12/31/1999
K0426................................................... 12/31/1999
K0427................................................... 12/31/1999
K0428................................................... 12/31/1999
K0429................................................... 12/31/1999
K0430................................................... 12/31/1999
K0431................................................... 12/31/1999
K0432................................................... 12/31/1999
K0433................................................... 12/31/1999
K0434................................................... 12/31/1999
K0435................................................... 12/31/1999
K0436................................................... 12/31/1999
K0437................................................... 12/31/1999
K0438................................................... 12/31/1999
K0439................................................... 12/31/1999
K0453................................................... 12/31/1998
K0454................................................... 12/31/1997
K0503................................................... 12/31/1999
K0504................................................... 12/31/1999
K0505................................................... 12/31/1999
K0506................................................... 12/31/1999
K0507................................................... 12/31/1999
K0508................................................... 12/31/1999
K0509................................................... 12/31/1999
K0511................................................... 12/31/1999
K0512................................................... 12/31/1999
K0513................................................... 12/31/1999
K0514................................................... 12/31/1999
K0515................................................... 12/31/1999
K0516................................................... 12/31/1999
K0518................................................... 12/31/1999
K0519................................................... 12/31/1999
K0520................................................... 12/31/1999
K0521................................................... 12/31/1999
K0522................................................... 12/31/1999
K0523................................................... 12/31/1999
K0524................................................... 12/31/1999
K0525................................................... 12/31/1999
K0526................................................... 12/31/1999
K0527................................................... 12/31/1999
K0528................................................... 12/31/1999
K0530................................................... 12/31/1999
L4200................................................... 12/31/1996
L4310................................................... 12/31/1998
L4320................................................... 12/31/1998
L4390................................................... 12/31/1998
L7160................................................... 12/31/1996
L7165................................................... 12/31/1996
L8605................................................... 12/31/1997
L8611................................................... 12/31/1997
L8615................................................... 12/31/1997
L8616................................................... 12/31/1997
L8617................................................... 12/31/1997
L8618................................................... 12/31/1997
L8620................................................... 12/31/1997
L8621................................................... 12/31/1997
L8622................................................... 12/31/1997
L8623................................................... 12/31/1997
L8624................................................... 12/31/1997
L8625................................................... 12/31/1997
L8626................................................... 12/31/1997
L8627................................................... 12/31/1997
L8628................................................... 12/31/1997
L8629................................................... 12/31/1997
L8640................................................... 12/31/1997
L8655................................................... 12/31/1997
L8656................................................... 12/31/1997
L8657................................................... 12/31/1997
L8680................................................... 12/31/1997
L8690................................................... 12/31/1997
L9999................................................... 12/31/1996
M0005................................................... 12/31/1997
M0006................................................... 12/31/1997
M0007................................................... 12/31/1997
M0008................................................... 12/31/1997
M0101................................................... 12/31/1998
P9014................................................... 12/31/1998
P9015................................................... 12/31/1998
P9610................................................... 12/31/1998
Q0068................................................... 12/31/1999
Q0103................................................... 12/31/1997
Q0104................................................... 12/31/1997
Q0109................................................... 12/31/1997
Q0110................................................... 12/31/1997
Q0116................................................... 09/30/1996
Q0132................................................... 12/31/1999
Q0158................................................... 12/31/1997
Q0159................................................... 12/31/1998
Q0162................................................... 12/31/1998
Q0182................................................... 12/31/1998
------------------------------------------------------------------------
--------------------
CPT codes and descriptions only are copyright American Medical
Association. All Rights Reserved. Applicable FARS/DFARS Apply.
Copyright American Dental Association. All rights reserved.
Addendum E.--CPT Codes Which Would Be Paid Only As Inpatient Procedures
------------------------------------------------------------------------
CPT/
HCPCS 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, lwr leg 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, uppr arm embolectomy
01782 C Anesth, uppr arm vein repair
01842 C Anesth, lwr arm embolectomy
01852 C Anesth, lwr arm vein repair
01904 C Anesth, skull x-ray inject
01990 C Support for organ donor
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
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
[[Page 18780]]
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
20962 C Other bone graft, microvasc
20969 C Bone/skin graft, microvasc
20970 C Bone/skin graft, iliac crest
20972 C Bone/skin graft, metatarsal
20973 C Bone/skin graft, great toe
21045 C Extensive jaw surgery
21141 C Reconstruct midface, lefort
21142 C Reconstruct midface, lefort
21143 C Reconstruct midface, lefort
21145 C Reconstruct midface, lefort
21146 C Reconstruct midface, lefort
21147 C Reconstruct midface, lefort
21150 C Reconstruct midface, lefort
21151 C Reconstruct midface, lefort
21154 C Reconstruct midface, lefort
21155 C Reconstruct midface, lefort
21159 C Reconstruct midface, lefort
21160 C Reconstruct midface, lefort
21172 C Reconstruct orbit/forehead
21175 C Reconstruct orbit/forehead
21179 C Reconstruct entire forehead
21180 C Reconstruct entire forehead
21182 C Reconstruct cranial bone
21183 C Reconstruct cranial bone
21184 C Reconstruct cranial bone
21188 C Reconstruction of midface
21193 C Reconstruct lower jaw bone
21194 C Reconstruct lower jaw bone
21195 C Reconstruct lower jaw bone
21196 C Reconstruct lower jaw bone
21247 C Reconstruct lower jaw bone
21255 C Reconstruct lower jaw bone
21256 C Reconstruction of orbit
21268 C Revise eye sockets
21343 C Treatment of sinus fracture
21344 C Treatment of sinus fracture
21346 C Treat nose/jaw fracture
21347 C Treat nose/jaw fracture
21348 C Treat nose/jaw fracture
21356 C Treat cheek bone fracture
21360 C Treat cheek bone fracture
21365 C Treat cheek bone fracture
21366 C Treat cheek bone fracture
21385 C Treat eye socket fracture
21386 C Treat eye socket fracture
21387 C Treat eye socket fracture
21390 C Treat eye socket fracture
21395 C Treat eye socket fracture
21408 C Treat eye socket fracture
21422 C Treat mouth roof fracture
21423 C Treat mouth roof fracture
21431 C Treat craniofacial fracture
21432 C Treat craniofacial fracture
21433 C Treat craniofacial fracture
21435 C Treat craniofacial fracture
21436 C Treat craniofacial fracture
21495 C Treat hyoid bone fracture
21510 C Drainage of bone lesion
21557 C Remove tumor, neck/chest
21615 C Removal of rib
21616 C Removal of rib and nerves
21620 C Partial removal of sternum
21627 C Sternal debridement
21630 C Extensive sternum surgery
21632 C Extensive sternum surgery
21705 C Revision of neck muscle/rib
21740 C Reconstruction of sternum
21750 C Repair of sternum separation
21810 C Treatment of rib fracture(s)
21825 C Treat sternum fracture
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
22318 C Treat odontoid fx w/o graft
22319 C Treat odontoid fx w/graft
22325 C Treat spine fracture
22326 C Treat neck spine fracture
22327 C Treat thorax spine fracture
22328 C Treat each add spine fx
22548 C Neck spine fusion
22554 C Neck spine fusion
22556 C Thorax spine fusion
22558 C Lumbar spine fusion
22585 C Additional spinal fusion
22590 C Spine & skull spinal fusion
22595 C Neck spinal fusion
22600 C Neck spine fusion
22610 C Thorax spine fusion
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 or more
22830 C Exploration of spinal fusion
22840 C Insert spine fixation device
22841 C Insert spine fixation device
22842 C Insert spine fixation device
22843 C Insert spine fixation device
22844 C Insert spine fixation device
22845 C Insert spine fixation device
22846 C Insert spine fixation device
22847 C Insert spine fixation device
22848 C Insert pelv fixation device
22849 C Reinsert spinal fixation
22850 C Remove spine fixation device
22851 C Apply spine prosth device
22852 C Remove spine fixation device
22855 C Remove spine fixation device
23035 C Drain shoulder bone lesion
23125 C Removal of collar bone
23195 C Removal of head of humerus
23200 C Removal of collar bone
23210 C Removal of shoulder blade
23220 C Partial removal of humerus
23221 C Partial removal of humerus
23222 C Partial removal of humerus
23332 C Remove shoulder foreign body
23395 C Muscle transfer, shoulder/arm
23397 C Muscle transfers
23400 C Fixation of shoulder blade
23440 C Remove/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
24940 C Revision of upper arm
25170 C Extensive forearm surgery
25390 C Shorten radius or ulna
25391 C Lengthen radius or 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
26553 C Single transfer, toe-hand
26554 C Double transfer, toe-hand
26556 C Toe joint transfer
26992 C Drainage of bone lesion
27005 C Incision of hip tendon
27006 C Incision of hip tendons
27025 C Incision of hip/thigh fascia
27030 C Drainage of hip joint
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 femur ridge
27146 C Incision of hip bone
27147 C Revision of hip bone
[[Page 18781]]
27151 C Incision of hip bones
27156 C Revision of hip bones
27158 C Revision of pelvis
27161 C Incision of neck of femur
27165 C Incision/fixation of femur
27170 C Repair/graft femur head/neck
27175 C Treat slipped epiphysis
27176 C Treat slipped epiphysis
27177 C Treat slipped epiphysis
27178 C Treat slipped epiphysis
27179 C Revise head/neck of femur
27181 C Treat slipped epiphysis
27185 C Revision of femur epiphysis
27187 C Reinforce hip bones
27215 C Treat pelvic fracture(s)
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 thigh fracture
27235 C Treat thigh fracture
27236 C Treat thigh fracture
27240 C Treat thigh fracture
27244 C Treat thigh fracture
27245 C Treat thigh fracture
27248 C Treat thigh fracture
27253 C Treat hip dislocation
27254 C Treat hip dislocation
27258 C Treat hip dislocation
27259 C Treat hip dislocation
27280 C Fusion of sacroiliac joint
27282 C Fusion of pubic bones
27284 C Fusion of hip joint
27286 C Fusion of hip joint
27290 C Amputation of leg at hip
27295 C Amputation of leg at hip
27303 C Drainage of bone lesion
27365 C Extensive leg surgery
27445 C Revision of knee joint
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/replace knee joint
27487 C Revise/replace knee joint
27488 C Removal of knee prosthesis
27495 C Reinforce thigh
27506 C Treatment of thigh fracture
27507 C Treatment of thigh fracture
27511 C Treatment of thigh fracture
27513 C Treatment of thigh fracture
27514 C Treatment of thigh fracture
27519 C Treat thigh fx growth plate
27524 C Treat kneecap fracture
27535 C Treat knee fracture
27536 C Treat knee fracture
27540 C Treat knee fracture
27557 C Treat knee dislocation
27558 C Treat knee dislocation
27580 C Fusion of knee
27590 C Amputate leg at thigh
27591 C Amputate leg at thigh
27592 C Amputate leg at thigh
27596 C Amputation follow-up surgery
27598 C Amputate lower leg at knee
27645 C Extensive lower leg surgery
27646 C Extensive lower leg surgery
27702 C Reconstruct ankle joint
27703 C Reconstruction, ankle joint
27712 C Realignment of lower leg
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
31380 C Partial removal of larynx
31382 C Partial removal of larynx
31390 C Removal of larynx & pharynx
31395 C Reconstruct larynx & pharynx
31582 C Revision of larynx
31584 C Treat larynx fracture
31587 C Revision of larynx
31725 C Clearance of airways
31760 C Repair of windpipe
31766 C Reconstruction of windpipe
31770 C Repair/graft of bronchus
31775 C Reconstruct bronchus
31780 C Reconstruct windpipe
31781 C Reconstruct windpipe
31785 C Remove windpipe lesion
31786 C Remove windpipe lesion
31800 C Repair of windpipe injury
31805 C Repair of windpipe injury
32035 C Exploration of chest
32036 C Exploration of chest
32095 C Biopsy through chest wall
32100 C Exploration/biopsy of chest
32110 C Explore/repair chest
32120 C Re-exploration of chest
32124 C Explore chest free adhesions
32140 C Removal of lung lesion(s)
32141 C Remove/treat lung lesions
32150 C Removal of lung lesion(s)
32151 C Remove lung foreign body
32160 C Open chest heart massage
32200 C Drain, open, lung lesion
32201 C Drain, percut, 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
32650 C Thoracoscopy, surgical
32651 C Thoracoscopy, surgical
32652 C Thoracoscopy, surgical
32653 C Thoracoscopy, surgical
32654 C Thoracoscopy, surgical
32655 C Thoracoscopy, surgical
32656 C Thoracoscopy, surgical
32657 C Thoracoscopy, surgical
32658 C Thoracoscopy, surgical
32659 C Thoracoscopy, surgical
32660 C Thoracoscopy, surgical
32661 C Thoracoscopy, surgical
32662 C Thoracoscopy, surgical
32663 C Thoracoscopy, surgical
32664 C Thoracoscopy, surgical
32665 C Thoracoscopy, surgical
32800 C Repair lung hernia
32810 C Close chest after drainage
32815 C Close bronchial fistula
32820 C Reconstruct injured chest
32850 C Donor pneumonectomy
32851 C Lung transplant, single
32852 C Lung transplant with bypass
32853 C Lung transplant, double
32854 C Lung transplant with bypass
32900 C Removal of rib(s)
32905 C Revise & repair chest wall
32906 C Revise & repair chest wall
32940 C Revision of lung
32997 C Total lung lavage
33015 C Incision of heart sac
33020 C Incision of heart sac
33025 C Incision of heart sac
33030 C Partial removal of heart sac
33031 C Partial removal of heart sac
33050 C Removal of heart sac lesion
33120 C Removal of heart lesion
33130 C Removal of heart lesion
33140 C Heart revascularize (tmr)
33200 C Insertion of heart pacemaker
33201 C Insertion of heart pacemaker
33236 C Remove electrode/thoracotomy
33237 C Remove electrode/thoracotomy
33238 C Remove electrode/thoracotomy
33243 C Remove eltrd/thoracotomy
33245 C Insert epic eltrd pace-defib
33246 C Insert epic eltrd/generator
33250 C Ablate heart dysrhythm focus
33251 C Ablate heart dysrhythm focus
33253 C Reconstruct atria
[[Page 18782]]
33261 C Ablate heart dysrhythm focus
33282 C Implant pat-active ht record
33284 C Remove pat-active ht record
33300 C Repair of heart wound
33305 C Repair of heart wound
33310 C Exploratory heart surgery
33315 C Exploratory heart surgery
33320 C Repair major blood vessel(s)
33321 C Repair major vessel
33322 C Repair major blood vessel(s)
33330 C Insert major vessel graft
33332 C Insert major vessel graft
33335 C Insert major vessel graft
33400 C Repair of aortic valve
33401 C Valvuloplasty, open
33403 C Valvuloplasty, w/cp bypass
33404 C Prepare heart-aorta conduit
33405 C Replacement of aortic valve
33406 C Replacement of aortic valve
33410 C Replacement of aortic valve
33411 C Replacement of aortic valve
33412 C Replacement of aortic valve
33413 C Replacement of aortic valve
33414 C Repair of aortic valve
33415 C Revision, subvalvular tissue
33416 C Revise ventricle muscle
33417 C Repair of aortic valve
33420 C Revision of mitral valve
33422 C Revision of mitral valve
33425 C Repair of mitral valve
33426 C Repair of mitral valve
33427 C Repair of mitral valve
33430 C Replacement of mitral valve
33460 C Revision of tricuspid valve
33463 C Valvuloplasty, tricuspid
33464 C Valvuloplasty, tricuspid
33465 C Replace tricuspid valve
33468 C Revision of tricuspid valve
33470 C Revision of pulmonary valve
33471 C Valvotomy, pulmonary valve
33472 C Revision of pulmonary valve
33474 C Revision of pulmonary valve
33475 C Replacement, pulmonary valve
33476 C Revision of heart chamber
33478 C Revision of heart chamber
33496 C Repair, prosth valve clot
33500 C Repair heart vessel fistula
33501 C Repair heart vessel fistula
33502 C Coronary artery correction
33503 C Coronary artery graft
33504 C Coronary artery graft
33505 C Repair artery w/tunnel
33506 C Repair artery, translocation
33510 C CABG, vein, single
33511 C CABG, vein, two
33512 C CABG, vein, three
33513 C CABG, vein, four
33514 C CABG, vein, five
33516 C Cabg, vein, six or more
33517 C CABG, artery-vein, single
33518 C CABG, artery-vein, two
33519 C CABG, artery-vein, three
33521 C CABG, artery-vein, four
33522 C CABG, artery-vein, five
33523 C Cabg, art-vein, six or more
33530 C Coronary artery, bypass/reop
33533 C CABG, arterial, single
33534 C CABG, arterial, two
33535 C CABG, arterial, three
33536 C Cabg, arterial, four or more
33542 C Removal of heart lesion
33545 C Repair of heart damage
33572 C Open coronary endarterectomy
33600 C Closure of valve
33602 C Closure of valve
33606 C Anastomosis/artery-aorta
33608 C Repair anomaly w/conduit
33610 C Repair by enlargement
33611 C Repair double ventricle
33612 C Repair double ventricle
33615 C Repair, simple fontan
33617 C Repair, 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 aortic graft
33861 C Ascending aortic graft
33863 C Ascending aortic graft
33870 C Transverse aortic arch graft
33875 C Thoracic aortic graft
33877 C Thoracoabdominal graft
33910 C Remove lung artery emboli
33915 C Remove lung artery emboli
33916 C Surgery of great vessel
33917 C Repair pulmonary artery
33918 C Repair pulmonary atresia
33919 C Repair pulmonary atresia
33920 C Repair pulmonary atresia
33922 C Transect pulmonary artery
33924 C Remove pulmonary shunt
33930 C Removal of donor heart/lung
33935 C Transplantation, heart/lung
33940 C Removal of donor heart
33945 C Transplantation of heart
33960 C External circulation assist
33961 C External circulation assist
33968 C Remove aortic assist device
33970 C Aortic circulation assist
33971 C Aortic circulation assist
33973 C Insert balloon device
33974 C Remove intra-aortic balloon
33975 C Implant ventricular device
33976 C Implant ventricular device
33977 C Remove ventricular device
33978 C Remove ventricular device
34001 C Removal of artery clot
34051 C Removal of artery clot
34151 C Removal of artery clot
34401 C Removal of vein clot
34421 C Removal of vein clot
34451 C Removal of vein clot
34502 C Reconstruct vena cava
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
35152 C Repair artery rupture, knee
35161 C Repair defect of artery
35162 C Repair artery rupture
35182 C Repair blood vessel lesion
35189 C Repair blood vessel lesion
35211 C Repair blood vessel lesion
35216 C Repair blood vessel lesion
35221 C Repair blood vessel lesion
35241 C Repair blood vessel lesion
35246 C Repair blood vessel lesion
35251 C Repair blood vessel lesion
35271 C Repair blood vessel lesion
35276 C Repair blood vessel lesion
35281 C Repair blood vessel lesion
35301 C Rechanneling of artery
35311 C Rechanneling of artery
35331 C Rechanneling of artery
35341 C Rechanneling of artery
35351 C Rechanneling of artery
[[Page 18783]]
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
35480 C Atherectomy, open
35481 C Atherectomy, open
35482 C Atherectomy, open
35483 C Atherectomy, open
35501 C Artery bypass graft
35506 C Artery bypass graft
35507 C Artery bypass graft
35508 C Artery bypass graft
35509 C Artery bypass graft
35511 C Artery bypass graft
35515 C Artery bypass graft
35516 C Artery bypass graft
35518 C Artery bypass graft
35521 C Artery bypass graft
35526 C Artery bypass graft
35531 C Artery bypass graft
35533 C Artery bypass graft
35536 C Artery bypass graft
35541 C Artery bypass graft
35546 C Artery bypass graft
35548 C Artery bypass graft
35549 C Artery bypass graft
35551 C Artery bypass graft
35556 C Artery bypass graft
35558 C Artery bypass graft
35560 C Artery bypass graft
35563 C Artery bypass graft
35565 C Artery bypass graft
35566 C Artery bypass graft
35571 C Artery bypass graft
35582 C Vein bypass graft
35583 C Vein bypass graft
35585 C Vein bypass graft
35587 C Vein bypass graft
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
35682 C Composite bypass graft
35683 C Composite bypass graft
35691 C Arterial transposition
35693 C Arterial transposition
35694 C Arterial transposition
35695 C Arterial transposition
35700 C Reoperation, bypass graft
35701 C Exploration, carotid artery
35721 C Exploration, femoral artery
35741 C Exploration popliteal artery
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
36550 C Declot vascular device
36660 C Insertion catheter, artery
36822 C Insertion of cannula(s)
36823 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
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
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
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
39499 C Chest procedure
39501 C Repair diaphragm laceration
39502 C Repair paraesophageal hernia
39503 C Repair of diaphragm hernia
39520 C Repair of diaphragm hernia
39530 C Repair of diaphragm hernia
39531 C Repair of diaphragm hernia
39540 C Repair of diaphragm hernia
39541 C Repair of diaphragm hernia
39545 C Revision of diaphragm
39560 C Resect diaphragm, simple
39561 C Resect diaphragm, complex
39599 C Diaphragm surgery procedure
41130 C Partial removal of tongue
41135 C Tongue and neck surgery
41140 C Removal of tongue
41145 C Tongue removal, neck surgery
41150 C Tongue, mouth, jaw surgery
41153 C Tongue, mouth, neck surgery
41155 C Tongue, jaw, & neck surgery
42426 C Excise parotid gland/lesion
42842 C Extensive surgery of throat
42845 C Extensive surgery of throat
42894 C Revision of pharyngeal walls
42953 C Repair throat, esophagus
42961 C Control throat bleeding
42971 C Control nose/throat bleeding
43030 C Throat muscle surgery
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 of stomach, partial
[[Page 18784]]
43633 C Removal of stomach, partial
43634 C Removal of stomach, partial
43635 C Removal of stomach, partial
43638 C Removal of stomach, partial
43639 C Removal of stomach, partial
43640 C Vagotomy & pylorus repair
43641 C Vagotomy & pylorus repair
43800 C Reconstruction of pylorus
43810 C Fusion of stomach and bowel
43820 C Fusion of stomach and bowel
43825 C Fusion of stomach and bowel
43832 C Place gastrostomy tube
43840 C Repair of stomach lesion
43842 C Gastroplasty for obesity
43843 C Gastroplasty for obesity
43846 C Gastric bypass for obesity
43847 C Gastric bypass for obesity
43848 C Revision gastroplasty
43850 C Revise stomach-bowel fusion
43855 C Revise stomach-bowel fusion
43860 C Revise stomach-bowel fusion
43865 C Revise stomach-bowel fusion
43880 C Repair stomach-bowel fistula
44005 C Freeing of bowel adhesion
44010 C Incision of small bowel
44015 C Insert needle cath bowel
44020 C 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/ileostomy
44156 C Removal of colon/ileostomy
44160 C Removal of colon
44202 C Laparo, resect intestine
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, percut
44950 C Appendectomy
44955 C Appendectomy add-on
44960 C Appendectomy
45110 C Removal of rectum
45111 C Partial removal of rectum
45112 C Removal of rectum
45113 C Partial proctectomy
45114 C Partial removal of rectum
45116 C Partial removal of rectum
45119 C Remove rectum w/reservoir
45120 C Removal of rectum
45121 C Removal of rectum and colon
45123 C Partial proctectomy
45126 C Pelvic exenteration
45130 C Excision of rectal prolapse
45135 C Excision of rectal prolapse
45540 C Correct rectal prolapse
45541 C Correct rectal prolapse
45550 C Repair rectum/remove sigmoid
45562 C Exploration/repair of rectum
45563 C Exploration/repair of rectum
45800 C Repair rect/bladder fistula
45805 C Repair fistula w/colostomy
45820 C Repair rectourethral fistula
45825 C Repair fistula w/colostomy
46705 C Repair of anal stricture
46715 C Repair of anovaginal fistula
46716 C Repair of anovaginal fistula
46730 C Construction of absent anus
46735 C Construction of absent anus
46740 C Construction of absent anus
46742 C Repair of imperforated anus
46744 C Repair of cloacal anomaly
46746 C Repair of cloacal anomaly
46748 C Repair of cloacal anomaly
46751 C Repair of anal sphincter
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
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 Drain, open, abdom abscess
49041 C Drain, percut, abdom abscess
49060 C Drain, open, retrop abscess
49061 C Drain, percut, retroper absc
49062 C Drain to peritoneal cavity
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
[[Page 18785]]
50020 C Renal abscess, open drain
50021 C Renal abscess, percut drain
50040 C Drainage of kidney
50045 C Exploration of kidney
50060 C Removal of kidney stone
50065 C Incision of kidney
50070 C Incision of kidney
50075 C Removal of kidney stone
50100 C Revise kidney blood vessels
50120 C Exploration of kidney
50125 C Explore and drain kidney
50130 C Removal of kidney stone
50135 C Exploration of kidney
50205 C Biopsy of kidney
50220 C 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
50546 C Laparoscopic nephrectomy
50547 C Laparo removal donor 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
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
57110 C Remove vagina wall, complete
57111 C Remove vagina tissue, compl
57112 C Vaginectomy w/nodes, compl
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 Drain ovary abscess, percut
58823 C Drain pelvic abscess, percut
58825 C Transposition, ovary(s)
58940 C Removal of ovary(s)
58943 C Removal of ovary(s)
58950 C Resect ovarian malignancy
58951 C Resect ovarian malignancy
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
59325 C Revision of cervix
[[Page 18786]]
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 (mpr)
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
60502 C Re-explore parathyroids
60505 C Explore parathyroid glands
60512 C Autotransplant parathyroid
60520 C Removal of thymus gland
60521 C Removal of thymus gland
60522 C Removal of thymus gland
60540 C Explore adrenal gland
60545 C Explore adrenal gland
60600 C Remove carotid body lesion
60605 C Remove carotid body lesion
60650 C Laparoscopy adrenalectomy
61105 C Twist drill hole
61107 C Drill skull for implantation
61108 C Drill skull for drainage
61120 C Burr hole for puncture
61140 C Pierce skull for biopsy
61150 C Pierce skull for drainage
61151 C Pierce skull for drainage
61154 C Pierce skull & remove clot
61156 C Pierce skull for drainage
61210 C Pierce skull, implant device
61250 C Pierce skull & explore
61253 C Pierce skull & explore
61304 C Open skull for exploration
61305 C Open skull for exploration
61312 C Open skull for drainage
61313 C Open skull for drainage
61314 C Open skull for drainage
61315 C Open skull for drainage
61320 C Open skull for drainage
61321 C Open skull for drainage
61332 C Explore/biopsy eye socket
61333 C Explore orbit/remove lesion
61334 C Explore orbit/remove object
61340 C Relieve cranial pressure
61343 C Incise skull (press relief)
61345 C Relieve cranial pressure
61440 C Incise skull for surgery
61450 C Incise skull for surgery
61458 C Incise skull for brain wound
61460 C Incise skull for surgery
61470 C Incise skull for surgery
61480 C Incise skull for surgery
61490 C Incise skull for surgery
61500 C Removal of skull lesion
61501 C Remove infected skull bone
61510 C Removal of brain lesion
61512 C Remove brain lining lesion
61514 C Removal of brain abscess
61516 C Removal of brain lesion
61518 C Removal of brain lesion
61519 C Remove brain lining lesion
61520 C Removal of brain lesion
61521 C Removal of brain lesion
61522 C Removal of brain abscess
61524 C Removal of brain lesion
61526 C Removal of brain lesion
61530 C Removal of brain lesion
61531 C Implant brain electrodes
61533 C Implant brain electrodes
61534 C Removal of brain lesion
61535 C Remove brain electrodes
61536 C Removal of brain lesion
61538 C Removal of brain tissue
61539 C Removal of brain tissue
61541 C Incision of brain tissue
61542 C Removal of brain tissue
61543 C Removal of brain tissue
61544 C Remove & treat brain lesion
61545 C Excision of brain tumor
61546 C Removal of pituitary gland
61548 C Removal of pituitary gland
61550 C Release of skull seams
61552 C Release of skull seams
61556 C Incise skull/sutures
61557 C Incise skull/sutures
61558 C Excision of skull/sutures
61559 C Excision of skull/sutures
61563 C Excision of skull tumor
61564 C Excision of skull tumor
61570 C Remove foreign body, brain
61571 C Incise skull for brain wound
61575 C Skull base/brainstem surgery
61576 C Skull base/brainstem surgery
61580 C Craniofacial approach, skull
61581 C Craniofacial approach, skull
61582 C Craniofacial approach, skull
61583 C Craniofacial approach, skull
61584 C Orbitocranial approach/skull
61585 C Orbitocranial approach/skull
61586 C Resect nasopharynx, skull
61590 C Infratemporal approach/skull
61591 C Infratemporal approach/skull
61592 C Orbitocranial approach/skull
61595 C Transtemporal approach/skull
61596 C Transcochlear approach/skull
61597 C Transcondylar approach/skull
61598 C Transpetrosal approach/skull
61600 C Resect/excise cranial lesion
61601 C Resect/excise cranial lesion
61605 C Resect/excise cranial lesion
61606 C Resect/excise cranial lesion
61607 C Resect/excise cranial lesion
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
61720 C Incise skull/brain surgery
61735 C Incise skull/brain surgery
61750 C Incise skull/brain biopsy
61751 C Brain biopsy w/ct/mr guide
61760 C Implant brain electrodes
61770 C Incise skull for treatment
61791 C Treat trigeminal tract
61795 C Brain surgery using computer
61850 C Implant neuroelectrodes
61860 C Implant neuroelectrodes
61862 C Implant neurostimul, subcort
61870 C Implant neuroelectrodes
61875 C Implant neuroelectrodes
61880 C Revise/remove neuroelectrode
61886 C Implant neurostim arrays
61888 C Revise/remove neuroreceiver
62000 C Treat skull fracture
62005 C Treat skull fracture
62010 C Treatment of head injury
62100 C Repair brain fluid leakage
62115 C Reduction of skull defect
62116 C Reduction of skull defect
62117 C Reduction of skull defect
62120 C Repair skull cavity lesion
62121 C Incise skull repair
62140 C Repair of skull defect
62141 C Repair of skull defect
62142 C Remove skull plate/flap
62143 C Replace skull plate/flap
62145 C Repair of skull & brain
62146 C Repair of skull with graft
62147 C Repair of skull with graft
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 canal cath
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
[[Page 18787]]
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
65273 C Repair of eye wound
69150 C Extensive ear canal surgery
69155 C Extensive ear/neck surgery
69502 C Mastoidectomy
69535 C Remove part of temporal bone
69554 C Remove ear lesion
69950 C Incise inner ear nerve
69970 C Remove inner ear lesion
74300 C X-ray bile ducts/pancreas
74301 C X-rays at surgery add-on
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 Intravasc us, heart add-on
92979 C Intravasc us, heart add-on
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
92997 C Pul art balloon repr, percut
92998 C Pul art balloon repr, percut
94652 C Pressure breathing (IPPB)
94762 C Measure blood oxygen level
95920 C Intraop nerve test add-on
95961 C Electrode stimulation, brain
95962 C Electrode stim, brain add-on
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
99298 C Neonatal critical care
99356 C Prolonged service, inpatient
99357 C Prolonged service, inpatient
99433 C Normal newborn care/hospital
G0160 C Cryo. ablation, prostate
------------------------------------------------------------------------
Federal Register / Vol. 65, No. 68 / Friday, April 7, 2000 / Rules
and Regulations
Addendum F.--Status Indicators: How Various Services Are Treated Under Outpatient PPS
----------------------------------------------------------------------------------------------------------------
Indicator Service Status
----------------------------------------------------------------------------------------------------------------
A...................... Pulmonary Rehabilitation Not Paid Under PPS
Clinical Trial.
C...................... Inpatient Procedures..... Admit Patient; Bill as Inpatient
A...................... Durable Medical DMEPOS Fee Schedule
Equipment, Prosthetics
and.
E...................... Non-Covered Items and Non-paid
Services.
A...................... Physical, Occupational Rehabilitation Fee Schedule
and SpeechTherapy.
A...................... Ambulance................ Ambulance Fee Schedule
A...................... EPO for ESRD Patients.... National Rate
A...................... Clinical Diagnostic Laboratory Fee Schedule
Laboratory Services.
A...................... Physican Services for Not Paid Under PPS
ESRD Patients.
A...................... Screening Mammography.... National Rate
N...................... Incidental Services, Packaged
packaged into APC Rat.
P...................... Partial Hospitalization.. Paid Per Diem APC
S...................... Significant Procedure, Paid
Not Discounted When.
T...................... Procedure, Multiple When Paid
Discount Applies.
V...................... Visit to Clinic or Paid
Emergency Department.
X...................... Ancillary Service........ Paid
----------------------------------------------------------------------------------------------------------------
[[Page 18788]]
Addendum G.--Service Mix Indices by Hospital
------------------------------------------------------------------------
Hospital SMI
------------------------------------------------------------------------
010001.......................................................... 3.13
010004.......................................................... 1.77
010005.......................................................... 2.17
010006.......................................................... 3.08
010007.......................................................... 1.70
010008.......................................................... 1.86
010009.......................................................... 1.69
010010.......................................................... 2.44
010011.......................................................... 2.56
010012.......................................................... 2.21
010015.......................................................... 2.29
010016.......................................................... 2.55
010018.......................................................... 6.45
010019.......................................................... 2.41
010021.......................................................... 1.74
010022.......................................................... 2.02
010023.......................................................... 2.85
010024.......................................................... 2.88
010025.......................................................... 2.14
010027.......................................................... 1.10
010029.......................................................... 3.22
010031.......................................................... 2.04
010032.......................................................... 1.28
010033.......................................................... 1.53
010034.......................................................... 2.69
010035.......................................................... 3.05
010036.......................................................... 2.72
010038.......................................................... 4.48
010039.......................................................... 2.19
010040.......................................................... 2.62
010043.......................................................... 2.32
010044.......................................................... 2.21
010045.......................................................... 2.00
010046.......................................................... 2.09
010047.......................................................... 1.67
010049.......................................................... 3.06
010050.......................................................... 1.93
010051.......................................................... 1.60
010052.......................................................... 1.60
010053.......................................................... 2.00
010054.......................................................... 1.88
010055.......................................................... 2.86
010056.......................................................... 2.70
010058.......................................................... 1.25
010059.......................................................... 1.90
010061.......................................................... 2.62
010062.......................................................... 1.81
010064.......................................................... 3.43
010065.......................................................... 2.41
010066.......................................................... 1.42
010068.......................................................... 1.39
010069.......................................................... 2.34
010072.......................................................... 2.61
010073.......................................................... 2.61
010078.......................................................... 2.55
010079.......................................................... 2.52
010080.......................................................... 1.08
010083.......................................................... 2.25
010084.......................................................... 4.17
010087.......................................................... 2.71
010089.......................................................... 2.61
010090.......................................................... 2.43
010091.......................................................... 1.63
010092.......................................................... 2.55
010094.......................................................... 2.50
010095.......................................................... 1.50
010097.......................................................... 2.07
010098.......................................................... 1.75
010099.......................................................... 2.14
010100.......................................................... 2.79
010101.......................................................... 2.38
010102.......................................................... 1.32
010103.......................................................... 2.38
010104.......................................................... 2.66
010108.......................................................... 1.95
010109.......................................................... 2.24
010110.......................................................... 1.20
010112.......................................................... 1.87
010113.......................................................... 2.85
010114.......................................................... 2.48
010115.......................................................... 1.47
010118.......................................................... 2.56
010119.......................................................... 2.13
010120.......................................................... 2.04
010123.......................................................... 3.11
010124.......................................................... 3.42
010125.......................................................... 1.44
010126.......................................................... 2.11
010127.......................................................... 3.32
010128.......................................................... 1.40
010129.......................................................... 1.84
010130.......................................................... 1.67
010131.......................................................... 2.80
010134.......................................................... 1.56
010137.......................................................... 1.57
010138.......................................................... 1.32
010139.......................................................... 2.72
010143.......................................................... 2.02
010144.......................................................... 2.70
010145.......................................................... 1.61
010146.......................................................... 3.10
010148.......................................................... 1.94
010149.......................................................... 2.84
010150.......................................................... 2.15
010152.......................................................... 2.14
010155.......................................................... 1.63
013025.......................................................... 1.64
013027.......................................................... 1.11
013028.......................................................... 0.93
013300.......................................................... 1.48
014002.......................................................... 1.41
020001.......................................................... 2.78
020002.......................................................... 2.30
020004.......................................................... 1.92
020005.......................................................... 1.07
020006.......................................................... 2.04
020007.......................................................... 0.87
020008.......................................................... 2.33
020009.......................................................... 1.05
020010.......................................................... 0.58
020011.......................................................... 1.02
020012.......................................................... 3.41
020013.......................................................... 1.89
020014.......................................................... 1.78
020017.......................................................... 3.41
020024.......................................................... 1.84
020025.......................................................... 1.06
024001.......................................................... 1.65
030001.......................................................... 2.73
030002.......................................................... 2.64
030003.......................................................... 2.15
030004.......................................................... 0.86
030006.......................................................... 2.79
030007.......................................................... 2.55
030009.......................................................... 1.43
030010.......................................................... 2.87
030011.......................................................... 3.75
030012.......................................................... 1.90
030013.......................................................... 2.56
030014.......................................................... 3.09
030016.......................................................... 1.86
030017.......................................................... 2.92
030018.......................................................... 3.33
030019.......................................................... 2.49
030022.......................................................... 1.73
030023.......................................................... 2.74
030024.......................................................... 3.70
030025.......................................................... 1.79
030027.......................................................... 1.63
030030.......................................................... 3.06
030033.......................................................... 2.60
030034.......................................................... 1.39
030035.......................................................... 3.18
030036.......................................................... 2.49
030037.......................................................... 4.59
030038.......................................................... 3.33
030040.......................................................... 1.99
030041.......................................................... 1.30
030043.......................................................... 2.57
030044.......................................................... 2.07
030047.......................................................... 1.68
030049.......................................................... 0.78
030054.......................................................... 0.83
030055.......................................................... 2.47
030059.......................................................... 2.66
030060.......................................................... 2.25
030061.......................................................... 2.09
030062.......................................................... 2.47
030064.......................................................... 2.59
030065.......................................................... 3.18
030067.......................................................... 1.59
030068.......................................................... 2.56
030069.......................................................... 3.02
030080.......................................................... 2.74
030083.......................................................... 2.58
030085.......................................................... 2.55
030086.......................................................... 2.27
030087.......................................................... 3.66
030088.......................................................... 2.22
030089.......................................................... 2.78
030092.......................................................... 2.94
030093.......................................................... 1.63
030094.......................................................... 2.11
030095.......................................................... 3.28
030099.......................................................... 2.09
033025.......................................................... 1.82
033026.......................................................... 2.18
033028.......................................................... 1.64
034004.......................................................... 1.58
034008.......................................................... 3.05
034009.......................................................... 1.55
034010.......................................................... 1.55
034013.......................................................... 1.57
034019.......................................................... 1.52
040001.......................................................... 2.42
040002.......................................................... 2.24
040003.......................................................... 1.98
040004.......................................................... 3.62
040005.......................................................... 2.05
040007.......................................................... 4.24
040008.......................................................... 1.31
040010.......................................................... 3.21
040011.......................................................... 2.11
040014.......................................................... 2.81
040015.......................................................... 1.77
040016.......................................................... 2.02
040017.......................................................... 2.57
040018.......................................................... 2.87
040019.......................................................... 2.10
040020.......................................................... 3.01
040021.......................................................... 3.28
040022.......................................................... 2.43
040024.......................................................... 1.80
[[Page 18789]]
040025.......................................................... 1.76
040026.......................................................... 2.63
040027.......................................................... 3.19
040028.......................................................... 2.17
040029.......................................................... 3.57
040030.......................................................... 1.37
040032.......................................................... 0.92
040035.......................................................... 1.17
040036.......................................................... 3.29
040037.......................................................... 2.01
040039.......................................................... 2.51
040040.......................................................... 1.35
040041.......................................................... 3.36
040042.......................................................... 2.13
040044.......................................................... 1.40
040045.......................................................... 1.65
040047.......................................................... 1.77
040048.......................................................... 2.46
040050.......................................................... 2.88
040051.......................................................... 2.07
040053.......................................................... 1.60
040054.......................................................... 3.26
040055.......................................................... 2.81
040058.......................................................... 2.42
040060.......................................................... 1.45
040062.......................................................... 2.58
040064.......................................................... 1.41
040066.......................................................... 3.53
040067.......................................................... 1.19
040070.......................................................... 1.77
040072.......................................................... 2.31
040074.......................................................... 2.91
040075.......................................................... 1.74
040076.......................................................... 1.79
040077.......................................................... 1.77
040078.......................................................... 2.74
040080.......................................................... 1.87
040081.......................................................... 0.93
040082.......................................................... 1.77
040084.......................................................... 3.12
040085.......................................................... 1.90
040088.......................................................... 3.29
040090.......................................................... 1.43
040091.......................................................... 1.73
040093.......................................................... 1.37
040100.......................................................... 2.39
040105.......................................................... 1.29
040106.......................................................... 2.06
040107.......................................................... 1.59
040109.......................................................... 2.02
040114.......................................................... 5.13
040116.......................................................... 2.93
040118.......................................................... 2.82
040119.......................................................... 3.14
040124.......................................................... 2.53
040126.......................................................... 1.95
040132.......................................................... 0.96
043026.......................................................... 1.30
043027.......................................................... 0.85
043028.......................................................... 1.17
043029.......................................................... 1.86
043031.......................................................... 0.82
043032.......................................................... 3.76
043300.......................................................... 1.57
044004.......................................................... 1.54
044005.......................................................... 1.57
044006.......................................................... 1.64
044010.......................................................... 1.65
044012.......................................................... 1.59
050002.......................................................... 2.06
050006.......................................................... 2.44
050007.......................................................... 2.29
050009.......................................................... 2.97
050013.......................................................... 3.22
050014.......................................................... 2.86
050015.......................................................... 2.38
050016.......................................................... 2.13
050017.......................................................... 5.03
050018.......................................................... 2.55
050021.......................................................... 2.26
050022.......................................................... 2.85
050024.......................................................... 2.28
050025.......................................................... 2.34
050026.......................................................... 2.34
050028.......................................................... 2.52
050029.......................................................... 2.32
050030.......................................................... 1.88
050032.......................................................... 3.20
050033.......................................................... 2.24
050036.......................................................... 2.67
050038.......................................................... 1.49
050039.......................................................... 2.85
050042.......................................................... 3.26
050043.......................................................... 2.85
050045.......................................................... 3.17
050046.......................................................... 2.32
050047.......................................................... 3.05
050051.......................................................... 1.60
050054.......................................................... 1.75
050055.......................................................... 1.93
050056.......................................................... 3.46
050057.......................................................... 3.51
050058.......................................................... 2.74
050060.......................................................... 2.11
050061.......................................................... 5.22
050063.......................................................... 2.75
050065.......................................................... 2.53
050066.......................................................... 2.43
050067.......................................................... 1.93
050068.......................................................... 2.71
050069.......................................................... 2.78
050077.......................................................... 3.23
050078.......................................................... 2.67
050079.......................................................... 2.20
050080.......................................................... 2.13
050081.......................................................... 1.14
050082.......................................................... 2.90
050084.......................................................... 2.44
050088.......................................................... 1.44
050089.......................................................... 2.10
050090.......................................................... 2.52
050091.......................................................... 2.57
050092.......................................................... 1.87
050093.......................................................... 3.76
050095.......................................................... 3.98
050096.......................................................... 3.94
050097.......................................................... 3.79
050099.......................................................... 2.27
050100.......................................................... 2.75
050101.......................................................... 2.80
050102.......................................................... 2.14
050103.......................................................... 3.29
050104.......................................................... 2.27
050107.......................................................... 2.69
050108.......................................................... 2.76
050109.......................................................... 2.26
050110.......................................................... 3.28
050111.......................................................... 5.30
050112.......................................................... 2.67
050113.......................................................... 1.35
050114.......................................................... 2.76
050115.......................................................... 2.18
050116.......................................................... 2.99
050117.......................................................... 3.02
050118.......................................................... 2.63
050121.......................................................... 3.26
050122.......................................................... 2.54
050124.......................................................... 2.32
050125.......................................................... 3.20
050126.......................................................... 2.94
050127.......................................................... 2.04
050128.......................................................... 2.45
050129.......................................................... 2.73
050131.......................................................... 2.45
050132.......................................................... 2.98
050133.......................................................... 2.08
050135.......................................................... 1.59
050136.......................................................... 2.67
050144.......................................................... 2.46
050145.......................................................... 2.76
050146.......................................................... 1.41
050148.......................................................... 2.31
050149.......................................................... 2.40
050150.......................................................... 2.44
050152.......................................................... 2.31
050153.......................................................... 2.58
050155.......................................................... 2.14
050158.......................................................... 3.58
050159.......................................................... 1.48
050167.......................................................... 1.42
050168.......................................................... 3.40
050169.......................................................... 2.78
050170.......................................................... 2.83
050172.......................................................... 1.89
050173.......................................................... 2.82
050174.......................................................... 3.38
050175.......................................................... 3.37
050177.......................................................... 1.89
050179.......................................................... 2.63
050180.......................................................... 2.32
050183.......................................................... 1.30
050186.......................................................... 1.96
050188.......................................................... 3.77
050189.......................................................... 2.48
050191.......................................................... 2.69
050192.......................................................... 1.60
050193.......................................................... 1.89
050194.......................................................... 2.70
050195.......................................................... 2.38
050196.......................................................... 2.39
050197.......................................................... 2.76
050204.......................................................... 3.22
050205.......................................................... 2.35
050207.......................................................... 3.48
050208.......................................................... 2.09
050211.......................................................... 2.71
050213.......................................................... 1.28
050214.......................................................... 2.05
050215.......................................................... 3.07
050217.......................................................... 2.15
050219.......................................................... 1.98
050222.......................................................... 2.61
050224.......................................................... 2.71
050225.......................................................... 2.28
050226.......................................................... 2.85
050228.......................................................... 1.17
050230.......................................................... 2.91
050231.......................................................... 3.44
050232.......................................................... 2.92
050233.......................................................... 3.37
050234.......................................................... 1.67
050235.......................................................... 2.64
050236.......................................................... 2.17
[[Page 18790]]
050238.......................................................... 2.14
050239.......................................................... 2.64
050240.......................................................... 2.66
050241.......................................................... 2.55
050242.......................................................... 2.23
050243.......................................................... 2.05
050245.......................................................... 1.24
050248.......................................................... 1.49
050251.......................................................... 2.23
050253.......................................................... 2.29
050254.......................................................... 3.23
050256.......................................................... 1.39
050257.......................................................... 1.90
050260.......................................................... 1.38
050261.......................................................... 2.11
050262.......................................................... 2.22
050264.......................................................... 2.24
050267.......................................................... 2.80
050270.......................................................... 2.61
050272.......................................................... 2.14
050274.......................................................... 1.56
050276.......................................................... 1.32
050277.......................................................... 2.59
050278.......................................................... 2.70
050279.......................................................... 1.93
050280.......................................................... 2.70
050281.......................................................... 3.99
050282.......................................................... 2.17
050283.......................................................... 1.16
050286.......................................................... 1.02
050289.......................................................... 2.76
050290.......................................................... 2.40
050291.......................................................... 1.73
050292.......................................................... 1.41
050293.......................................................... 1.42
050295.......................................................... 2.63
050296.......................................................... 2.45
050298.......................................................... 2.08
050299.......................................................... 3.08
050300.......................................................... 2.95
050301.......................................................... 2.95
050302.......................................................... 2.87
050305.......................................................... 2.12
050307.......................................................... 3.67
050308.......................................................... 2.42
050309.......................................................... 3.00
050310.......................................................... 2.96
050312.......................................................... 2.71
050313.......................................................... 3.15
050315.......................................................... 1.20
050317.......................................................... 1.84
050320.......................................................... 1.26
050324.......................................................... 3.46
050325.......................................................... 1.73
050327.......................................................... 2.36
050328.......................................................... 2.69
050329.......................................................... 1.93
050331.......................................................... 2.12
050333.......................................................... 1.10
050334.......................................................... 3.36
050335.......................................................... 1.34
050336.......................................................... 2.48
050337.......................................................... 1.78
050342.......................................................... 2.84
050343.......................................................... 3.36
050348.......................................................... 1.87
050349.......................................................... 1.17
050350.......................................................... 2.25
050351.......................................................... 3.35
050352.......................................................... 2.05
050353.......................................................... 2.61
050355.......................................................... 0.98
050357.......................................................... 2.47
050359.......................................................... 3.58
050360.......................................................... 3.42
050366.......................................................... 2.09
050367.......................................................... 1.90
050369.......................................................... 2.41
050377.......................................................... 0.95
050378.......................................................... 2.89
050379.......................................................... 1.56
050380.......................................................... 3.91
050382.......................................................... 2.62
050388.......................................................... 1.03
050390.......................................................... 2.90
050391.......................................................... 2.02
050392.......................................................... 1.48
050393.......................................................... 2.93
050394.......................................................... 3.37
050396.......................................................... 4.28
050397.......................................................... 1.44
050401.......................................................... 2.30
050404.......................................................... 1.55
050406.......................................................... 1.36
050407.......................................................... 2.93
050410.......................................................... 1.05
050414.......................................................... 2.65
050417.......................................................... 3.03
050418.......................................................... 1.29
050419.......................................................... 2.69
050420.......................................................... 2.12
050421.......................................................... 2.38
050423.......................................................... 2.49
050424.......................................................... 2.95
050426.......................................................... 2.60
050427.......................................................... 0.76
050430.......................................................... 1.38
050431.......................................................... 3.90
050432.......................................................... 2.60
050433.......................................................... 1.55
050434.......................................................... 1.37
050435.......................................................... 2.38
050436.......................................................... 1.58
050438.......................................................... 2.65
050440.......................................................... 1.53
050441.......................................................... 2.19
050443.......................................................... 1.62
050444.......................................................... 2.31
050446.......................................................... 1.43
050447.......................................................... 1.60
050448.......................................................... 3.14
050454.......................................................... 1.78
050455.......................................................... 3.70
050456.......................................................... 5.49
050457.......................................................... 2.23
050459.......................................................... 2.44
050468.......................................................... 1.71
050469.......................................................... 1.68
050470.......................................................... 2.22
050471.......................................................... 3.14
050476.......................................................... 2.73
050477.......................................................... 4.61
050478.......................................................... 1.57
050481.......................................................... 2.80
050482.......................................................... 1.06
050483.......................................................... 3.44
050485.......................................................... 3.44
050486.......................................................... 2.39
050488.......................................................... 2.21
050491.......................................................... 2.52
050492.......................................................... 2.39
050494.......................................................... 3.25
050496.......................................................... 2.55
050497.......................................................... 1.04
050498.......................................................... 2.58
050502.......................................................... 3.66
050503.......................................................... 3.44
050506.......................................................... 2.44
050516.......................................................... 3.39
050517.......................................................... 2.78
050522.......................................................... 2.46
050523.......................................................... 2.22
050526.......................................................... 2.04
050528.......................................................... 2.12
050531.......................................................... 3.41
050534.......................................................... 2.45
050535.......................................................... 2.86
050537.......................................................... 2.76
050539.......................................................... 2.31
050542.......................................................... 2.06
050543.......................................................... 3.65
050545.......................................................... 0.99
050546.......................................................... 0.94
050547.......................................................... 1.12
050548.......................................................... 0.81
050549.......................................................... 2.87
050550.......................................................... 2.38
050551.......................................................... 2.61
050552.......................................................... 1.32
050557.......................................................... 2.30
050559.......................................................... 2.89
050560.......................................................... 2.10
050564.......................................................... 2.61
050565.......................................................... 2.02
050566.......................................................... 1.55
050567.......................................................... 2.31
050568.......................................................... 2.82
050569.......................................................... 2.55
050570.......................................................... 3.36
050571.......................................................... 3.32
050573.......................................................... 2.43
050577.......................................................... 4.54
050579.......................................................... 2.39
050580.......................................................... 2.36
050581.......................................................... 2.45
050583.......................................................... 3.40
050584.......................................................... 2.20
050585.......................................................... 2.85
050586.......................................................... 3.12
050588.......................................................... 2.72
050589.......................................................... 3.13
050590.......................................................... 3.28
050591.......................................................... 2.53
050592.......................................................... 3.06
050593.......................................................... 1.95
050594.......................................................... 3.76
050597.......................................................... 2.92
050599.......................................................... 1.65
050601.......................................................... 2.91
050607.......................................................... 1.80
050608.......................................................... 1.91
050613.......................................................... 0.75
050615.......................................................... 2.77
050616.......................................................... 2.60
050618.......................................................... 1.32
050624.......................................................... 2.96
050625.......................................................... 2.60
050630.......................................................... 2.33
050633.......................................................... 2.71
050636.......................................................... 3.18
050638.......................................................... 1.47
050641.......................................................... 2.70
050644.......................................................... 2.58
[[Page 18791]]
050660.......................................................... 1.47
050661.......................................................... 1.54
050662.......................................................... 1.05
050663.......................................................... 2.23
050667.......................................................... 1.07
050668.......................................................... 1.18
050676.......................................................... 0.91
050678.......................................................... 3.03
050680.......................................................... 1.56
050682.......................................................... 1.29
050684.......................................................... 2.07
050685.......................................................... 2.62
050688.......................................................... 1.75
050689.......................................................... 2.53
050693.......................................................... 2.19
050694.......................................................... 2.25
050695.......................................................... 1.71
050696.......................................................... 3.37
050697.......................................................... 4.88
050699.......................................................... 2.68
050700.......................................................... 2.52
050701.......................................................... 2.18
050702.......................................................... 0.93
050704.......................................................... 2.10
050709.......................................................... 2.93
050713.......................................................... 3.24
052031.......................................................... 1.13
053026.......................................................... 1.62
053027.......................................................... 1.03
053028.......................................................... 1.25
053029.......................................................... 1.40
053030.......................................................... 0.97
053031.......................................................... 1.25
053032.......................................................... 0.83
053033.......................................................... 1.14
053034.......................................................... 1.85
053035.......................................................... 1.41
053036.......................................................... 1.39
053037.......................................................... 1.42
053300.......................................................... 1.47
053301.......................................................... 2.09
053302.......................................................... 1.70
053305.......................................................... 1.00
054001.......................................................... 1.55
054003.......................................................... 2.23
054009.......................................................... 1.56
054012.......................................................... 1.60
054032.......................................................... 1.55
054050.......................................................... 1.85
054053.......................................................... 1.66
054055.......................................................... 1.32
054060.......................................................... 1.55
054064.......................................................... 1.32
054065.......................................................... 1.53
054069.......................................................... 1.55
054074.......................................................... 1.55
054078.......................................................... 2.06
054085.......................................................... 1.55
054087.......................................................... 1.55
054091.......................................................... 1.82
054093.......................................................... 2.49
054094.......................................................... 1.59
054095.......................................................... 1.55
054096.......................................................... 1.58
054097.......................................................... 1.57
054098.......................................................... 1.32
054099.......................................................... 1.69
054104.......................................................... 2.67
054105.......................................................... 1.55
054106.......................................................... 1.56
054108.......................................................... 1.45
054110.......................................................... 1.55
054111.......................................................... 1.55
054113.......................................................... 1.55
054115.......................................................... 1.55
054116.......................................................... 1.57
054119.......................................................... 1.55
054122.......................................................... 1.05
054123.......................................................... 1.58
054125.......................................................... 1.83
054126.......................................................... 1.55
054130.......................................................... 1.61
054131.......................................................... 1.85
054133.......................................................... 0.72
060001.......................................................... 3.12
060003.......................................................... 3.01
060004.......................................................... 1.51
060006.......................................................... 2.24
060007.......................................................... 1.59
060008.......................................................... 2.16
060009.......................................................... 2.35
060010.......................................................... 2.53
060011.......................................................... 1.32
060012.......................................................... 1.94
060013.......................................................... 1.91
060014.......................................................... 2.56
060015.......................................................... 1.84
060016.......................................................... 2.15
060018.......................................................... 2.30
060020.......................................................... 2.29
060022.......................................................... 1.85
060023.......................................................... 2.62
060024.......................................................... 1.62
060027.......................................................... 2.23
060028.......................................................... 2.77
060029.......................................................... 1.10
060030.......................................................... 2.93
060031.......................................................... 2.37
060032.......................................................... 2.92
060033.......................................................... 1.69
060034.......................................................... 2.06
060036.......................................................... 1.88
060037.......................................................... 1.48
060038.......................................................... 1.46
060041.......................................................... 0.99
060042.......................................................... 1.65
060043.......................................................... 1.29
060044.......................................................... 2.43
060046.......................................................... 3.04
060047.......................................................... 0.95
060049.......................................................... 2.79
060050.......................................................... 2.00
060052.......................................................... 1.79
060053.......................................................... 1.78
060054.......................................................... 2.64
060056.......................................................... 1.10
060057.......................................................... 2.11
060058.......................................................... 1.34
060060.......................................................... 1.27
060062.......................................................... 1.52
060063.......................................................... 0.78
060064.......................................................... 3.29
060065.......................................................... 2.34
060068.......................................................... 1.25
060070.......................................................... 1.32
060071.......................................................... 2.19
060073.......................................................... 1.33
060075.......................................................... 2.68
060076.......................................................... 1.96
060085.......................................................... 1.17
060087.......................................................... 2.10
060088.......................................................... 1.53
060090.......................................................... 1.60
060096.......................................................... 2.09
060100.......................................................... 2.06
060103.......................................................... 4.46
060104.......................................................... 2.40
060107.......................................................... 1.34
062009.......................................................... 0.80
062011.......................................................... 2.22
063026.......................................................... 1.58
063027.......................................................... 1.58
063030.......................................................... 2.31
063301.......................................................... 1.51
063302.......................................................... 1.41
064007.......................................................... 1.55
064009.......................................................... 1.39
064010.......................................................... 1.61
064012.......................................................... 1.52
064016.......................................................... 2.18
064020.......................................................... 1.55
070001.......................................................... 2.88
070002.......................................................... 2.63
070003.......................................................... 2.19
070004.......................................................... 2.36
070005.......................................................... 2.09
070006.......................................................... 2.48
070007.......................................................... 2.92
070008.......................................................... 2.12
070009.......................................................... 2.79
070010.......................................................... 2.68
070011.......................................................... 2.12
070012.......................................................... 2.27
070015.......................................................... 2.25
070016.......................................................... 2.15
070017.......................................................... 2.56
070018.......................................................... 2.28
070019.......................................................... 2.96
070020.......................................................... 2.24
070021.......................................................... 2.61
070022.......................................................... 2.69
070024.......................................................... 2.52
070025.......................................................... 3.27
070026.......................................................... 2.20
070027.......................................................... 2.35
070028.......................................................... 2.28
070029.......................................................... 2.48
070030.......................................................... 2.60
070031.......................................................... 2.23
070033.......................................................... 2.12
070035.......................................................... 2.48
070036.......................................................... 2.07
070039.......................................................... 1.17
072003.......................................................... 1.05
072004.......................................................... 0.87
072008.......................................................... 1.85
073025.......................................................... 1.16
074000.......................................................... 1.50
074007.......................................................... 1.55
074008.......................................................... 1.78
080001.......................................................... 3.31
080002.......................................................... 2.32
080003.......................................................... 2.90
080004.......................................................... 2.55
080005.......................................................... 2.95
080006.......................................................... 2.52
080007.......................................................... 2.26
083300.......................................................... 3.78
084002.......................................................... 1.67
090001.......................................................... 3.61
090002.......................................................... 1.92
090003.......................................................... 1.81
090004.......................................................... 2.59
[[Page 18792]]
090006.......................................................... 2.60
090007.......................................................... 1.28
090008.......................................................... 2.52
090010.......................................................... 2.06
090011.......................................................... 2.49
090015.......................................................... 0.75
092002.......................................................... 0.80
093025.......................................................... 1.08
093300.......................................................... 2.05
094004.......................................................... 1.33
100001.......................................................... 1.62
100002.......................................................... 2.75
100004.......................................................... 1.94
100006.......................................................... 2.43
100007.......................................................... 3.08
100008.......................................................... 3.40
100009.......................................................... 2.57
100010.......................................................... 2.79
100012.......................................................... 3.06
100014.......................................................... 2.68
100015.......................................................... 2.69
100017.......................................................... 2.75
100018.......................................................... 2.01
100019.......................................................... 3.36
100020.......................................................... 3.14
100022.......................................................... 1.43
100023.......................................................... 2.70
100024.......................................................... 3.07
100025.......................................................... 2.33
100026.......................................................... 2.86
100027.......................................................... 1.58
100028.......................................................... 2.94
100029.......................................................... 2.61
100030.......................................................... 3.15
100032.......................................................... 2.22
100034.......................................................... 2.49
100035.......................................................... 2.62
100038.......................................................... 2.39
100039.......................................................... 2.94
100040.......................................................... 3.26
100043.......................................................... 2.46
100044.......................................................... 2.58
100045.......................................................... 2.36
100046.......................................................... 2.41
100047.......................................................... 2.06
100048.......................................................... 1.71
100049.......................................................... 2.76
100050.......................................................... 2.35
100051.......................................................... 2.67
100052.......................................................... 4.07
100053.......................................................... 2.62
100054.......................................................... 2.09
100055.......................................................... 2.32
100056.......................................................... 3.65
100057.......................................................... 3.13
100060.......................................................... 2.58
100061.......................................................... 2.80
100062.......................................................... 3.23
100063.......................................................... 2.34
100067.......................................................... 2.59
100068.......................................................... 2.16
100069.......................................................... 2.65
100070.......................................................... 2.58
100071.......................................................... 2.27
100072.......................................................... 2.44
100073.......................................................... 2.03
100075.......................................................... 2.32
100076.......................................................... 2.55
100077.......................................................... 3.36
100078.......................................................... 1.17
100079.......................................................... 1.77
100080.......................................................... 2.43
100081.......................................................... 1.91
100082.......................................................... 2.40
100084.......................................................... 2.18
100085.......................................................... 2.40
100086.......................................................... 2.52
100087.......................................................... 4.08
100088.......................................................... 3.46
100090.......................................................... 2.89
100093.......................................................... 2.95
100098.......................................................... 1.56
100099.......................................................... 2.99
100102.......................................................... 2.09
100103.......................................................... 1.25
100105.......................................................... 2.85
100106.......................................................... 2.89
100107.......................................................... 2.72
100108.......................................................... 2.15
100109.......................................................... 2.87
100110.......................................................... 2.33
100112.......................................................... 1.04
100113.......................................................... 2.91
100114.......................................................... 2.71
100117.......................................................... 3.23
100118.......................................................... 1.99
100121.......................................................... 2.91
100122.......................................................... 2.77
100124.......................................................... 1.97
100125.......................................................... 2.46
100126.......................................................... 2.26
100127.......................................................... 2.97
100128.......................................................... 2.50
100129.......................................................... 3.40
100130.......................................................... 2.33
100131.......................................................... 3.08
100132.......................................................... 2.39
100134.......................................................... 1.61
100135.......................................................... 4.27
100137.......................................................... 2.28
100138.......................................................... 1.27
100139.......................................................... 1.51
100140.......................................................... 2.57
100142.......................................................... 2.03
100144.......................................................... 2.86
100145.......................................................... 2.34
100146.......................................................... 2.04
100147.......................................................... 1.85
100150.......................................................... 2.63
100151.......................................................... 4.07
100154.......................................................... 3.38
100156.......................................................... 2.44
100157.......................................................... 3.67
100159.......................................................... 1.51
100160.......................................................... 2.03
100161.......................................................... 2.32
100162.......................................................... 2.24
100165.......................................................... 2.22
100167.......................................................... 4.26
100168.......................................................... 2.54
100169.......................................................... 2.75
100170.......................................................... 2.92
100172.......................................................... 2.44
100173.......................................................... 3.21
100174.......................................................... 2.18
100175.......................................................... 1.94
100176.......................................................... 1.96
100177.......................................................... 2.98
100179.......................................................... 3.31
100180.......................................................... 2.10
100181.......................................................... 4.55
100183.......................................................... 2.80
100187.......................................................... 2.46
100189.......................................................... 2.75
100191.......................................................... 2.47
100199.......................................................... 3.39
100200.......................................................... 4.10
100203.......................................................... 2.22
100204.......................................................... 2.51
100206.......................................................... 2.51
100208.......................................................... 2.24
100209.......................................................... 2.61
100210.......................................................... 2.68
100211.......................................................... 2.02
100212.......................................................... 2.45
100213.......................................................... 1.93
100217.......................................................... 3.59
100220.......................................................... 3.22
100221.......................................................... 2.58
100222.......................................................... 1.66
100223.......................................................... 2.21
100224.......................................................... 2.34
100225.......................................................... 2.65
100226.......................................................... 1.90
100228.......................................................... 2.19
100229.......................................................... 2.01
100230.......................................................... 1.87
100231.......................................................... 2.31
100232.......................................................... 2.67
100234.......................................................... 2.30
100235.......................................................... 2.21
100236.......................................................... 2.19
100237.......................................................... 2.92
100238.......................................................... 3.13
100240.......................................................... 5.17
100241.......................................................... 2.57
100242.......................................................... 3.00
100243.......................................................... 2.12
100244.......................................................... 2.54
100246.......................................................... 3.15
100248.......................................................... 1.94
100249.......................................................... 2.45
100252.......................................................... 2.42
100253.......................................................... 2.76
100254.......................................................... 2.22
100255.......................................................... 2.31
100256.......................................................... 2.25
100258.......................................................... 2.48
100259.......................................................... 2.80
100260.......................................................... 3.68
100262.......................................................... 3.20
100263.......................................................... 2.45
100264.......................................................... 2.11
100265.......................................................... 2.41
100266.......................................................... 2.85
100267.......................................................... 2.70
100268.......................................................... 2.33
100269.......................................................... 2.74
100270.......................................................... 1.21
100271.......................................................... 1.86
100275.......................................................... 2.38
100276.......................................................... 3.07
100277.......................................................... 0.95
100279.......................................................... 2.11
100280.......................................................... 1.90
100281.......................................................... 2.17
100282.......................................................... 1.72
102009.......................................................... 0.94
102013.......................................................... 3.59
103026.......................................................... 0.50
103027.......................................................... 1.15
103028.......................................................... 1.41
103030.......................................................... 0.81
[[Page 18793]]
103031.......................................................... 1.52
103032.......................................................... 1.73
103034.......................................................... 1.36
103300.......................................................... 7.02
103301.......................................................... 2.56
104008.......................................................... 1.72
104015.......................................................... 1.55
104016.......................................................... 1.53
104017.......................................................... 1.55
104024.......................................................... 1.75
104026.......................................................... 1.55
104029.......................................................... 1.55
104034.......................................................... 1.56
104036.......................................................... 1.58
104037.......................................................... 1.55
104038.......................................................... 1.68
104041.......................................................... 1.81
104045.......................................................... 1.69
104046.......................................................... 1.55
104047.......................................................... 1.55
104052.......................................................... 1.56
104054.......................................................... 1.57
104056.......................................................... 1.54
104060.......................................................... 1.43
110001.......................................................... 2.73
110002.......................................................... 1.75
110003.......................................................... 2.69
110004.......................................................... 2.62
110005.......................................................... 2.65
110006.......................................................... 3.33
110007.......................................................... 2.64
110008.......................................................... 2.44
110009.......................................................... 1.15
110010.......................................................... 3.09
110011.......................................................... 2.39
110013.......................................................... 1.55
110014.......................................................... 1.70
110015.......................................................... 1.76
110016.......................................................... 3.17
110017.......................................................... 1.28
110018.......................................................... 2.22
110020.......................................................... 3.19
110023.......................................................... 2.44
110024.......................................................... 3.80
110025.......................................................... 2.85
110026.......................................................... 1.76
110027.......................................................... 1.62
110028.......................................................... 2.89
110029.......................................................... 2.10
110030.......................................................... 3.04
110031.......................................................... 2.55
110032.......................................................... 2.72
110033.......................................................... 2.97
110034.......................................................... 1.43
110035.......................................................... 2.93
110036.......................................................... 2.93
110037.......................................................... 1.63
110038.......................................................... 2.20
110039.......................................................... 2.96
110040.......................................................... 2.05
110041.......................................................... 2.04
110042.......................................................... 3.56
110043.......................................................... 3.18
110044.......................................................... 2.66
110045.......................................................... 2.47
110046.......................................................... 2.26
110048.......................................................... 1.63
110049.......................................................... 1.30
110050.......................................................... 1.78
110051.......................................................... 1.91
110052.......................................................... 1.04
110054.......................................................... 2.16
110056.......................................................... 1.26
110059.......................................................... 2.38
110061.......................................................... 1.25
110062.......................................................... 0.97
110063.......................................................... 1.50
110064.......................................................... 2.05
110065.......................................................... 1.13
110066.......................................................... 2.56
110069.......................................................... 2.55
110070.......................................................... 1.84
110071.......................................................... 1.29
110072.......................................................... 1.55
110073.......................................................... 2.16
110074.......................................................... 2.78
110075.......................................................... 2.39
110076.......................................................... 2.79
110078.......................................................... 2.95
110079.......................................................... 1.23
110080.......................................................... 1.97
110082.......................................................... 3.62
110083.......................................................... 3.30
110086.......................................................... 1.97
110087.......................................................... 2.75
110088.......................................................... 0.94
110089.......................................................... 2.39
110091.......................................................... 3.09
110092.......................................................... 1.71
110093.......................................................... 1.48
110094.......................................................... 1.01
110095.......................................................... 2.97
110096.......................................................... 1.48
110097.......................................................... 1.32
110098.......................................................... 1.77
110100.......................................................... 1.27
110101.......................................................... 1.56
110103.......................................................... 1.28
110104.......................................................... 2.20
110105.......................................................... 2.49
110107.......................................................... 2.05
110108.......................................................... 0.81
110109.......................................................... 1.61
110111.......................................................... 1.68
110112.......................................................... 1.52
110113.......................................................... 1.41
110114.......................................................... 1.60
110115.......................................................... 2.62
110118.......................................................... 0.76
110120.......................................................... 1.15
110121.......................................................... 4.84
110122.......................................................... 2.79
110124.......................................................... 2.19
110125.......................................................... 3.21
110127.......................................................... 1.59
110128.......................................................... 2.41
110129.......................................................... 2.94
110130.......................................................... 1.82
110132.......................................................... 2.04
110134.......................................................... 1.23
110135.......................................................... 4.68
110140.......................................................... 2.41
110141.......................................................... 1.22
110142.......................................................... 1.50
110143.......................................................... 3.07
110144.......................................................... 1.92
110146.......................................................... 1.72
110149.......................................................... 1.57
110150.......................................................... 2.56
110152.......................................................... 1.77
110153.......................................................... 2.02
110155.......................................................... 1.35
110156.......................................................... 1.52
110161.......................................................... 3.52
110163.......................................................... 3.22
110164.......................................................... 2.47
110165.......................................................... 2.62
110166.......................................................... 2.82
110168.......................................................... 2.47
110169.......................................................... 7.21
110171.......................................................... 2.37
110172.......................................................... 3.25
110174.......................................................... 1.87
110176.......................................................... 2.69
110177.......................................................... 2.47
110178.......................................................... 8.34
110179.......................................................... 2.22
110181.......................................................... 1.14
110183.......................................................... 2.32
110184.......................................................... 2.16
110185.......................................................... 1.45
110186.......................................................... 3.32
110187.......................................................... 2.45
110188.......................................................... 2.91
110189.......................................................... 1.99
110190.......................................................... 1.73
110191.......................................................... 3.54
110192.......................................................... 2.42
110193.......................................................... 3.14
110194.......................................................... 1.47
110195.......................................................... 1.20
110198.......................................................... 2.98
110200.......................................................... 4.48
110201.......................................................... 2.34
110203.......................................................... 1.35
110205.......................................................... 1.77
110207.......................................................... 1.28
110208.......................................................... 1.59
110211.......................................................... 1.00
110212.......................................................... 1.99
112000.......................................................... 1.04
112003.......................................................... 1.69
112004.......................................................... 0.79
113026.......................................................... 1.40
113027.......................................................... 0.40
113300.......................................................... 2.36
114000.......................................................... 1.55
114003.......................................................... 1.55
114008.......................................................... 1.55
114010.......................................................... 1.67
114016.......................................................... 1.54
114017.......................................................... 1.61
114022.......................................................... 1.55
114023.......................................................... 1.59
114024.......................................................... 1.57
114027.......................................................... 1.55
114030.......................................................... 1.67
114032.......................................................... 1.55
114033.......................................................... 1.54
114034.......................................................... 1.55
120001.......................................................... 2.95
120002.......................................................... 2.93
120003.......................................................... 2.15
120004.......................................................... 2.18
120005.......................................................... 3.21
120006.......................................................... 2.09
120007.......................................................... 3.17
120009.......................................................... 1.26
120010.......................................................... 2.69
120012.......................................................... 1.32
120014.......................................................... 2.83
120018.......................................................... 0.71
120019.......................................................... 2.58
[[Page 18794]]
120022.......................................................... 1.31
120024.......................................................... 0.86
120025.......................................................... 0.77
120026.......................................................... 3.08
120027.......................................................... 1.96
120028.......................................................... 3.33
123025.......................................................... 1.65
123300.......................................................... 1.76
124001.......................................................... 1.53
130001.......................................................... 1.60
130002.......................................................... 3.18
130003.......................................................... 3.14
130005.......................................................... 3.43
130006.......................................................... 2.12
130007.......................................................... 3.65
130008.......................................................... 1.94
130009.......................................................... 2.56
130010.......................................................... 0.93
130011.......................................................... 2.46
130012.......................................................... 1.61
130013.......................................................... 2.69
130014.......................................................... 3.03
130015.......................................................... 1.20
130016.......................................................... 2.06
130017.......................................................... 1.93
130018.......................................................... 3.31
130019.......................................................... 1.83
130021.......................................................... 1.09
130022.......................................................... 2.48
130024.......................................................... 2.89
130025.......................................................... 1.91
130026.......................................................... 3.68
130027.......................................................... 1.60
130028.......................................................... 2.30
130029.......................................................... 2.10
130030.......................................................... 0.89
130031.......................................................... 2.34
130034.......................................................... 1.61
130035.......................................................... 2.08
130036.......................................................... 3.90
130037.......................................................... 1.90
130043.......................................................... 1.68
130044.......................................................... 1.57
130045.......................................................... 1.65
130048.......................................................... 1.30
130049.......................................................... 2.59
130054.......................................................... 0.71
130056.......................................................... 0.76
130060.......................................................... 2.73
130061.......................................................... 1.55
133025.......................................................... 1.47
134002.......................................................... 1.55
134009.......................................................... 1.60
140001.......................................................... 2.21
140002.......................................................... 2.35
140003.......................................................... 1.61
140005.......................................................... 1.45
140007.......................................................... 2.57
140008.......................................................... 2.49
140010.......................................................... 2.35
140011.......................................................... 1.78
140012.......................................................... 2.22
140013.......................................................... 2.76
140014.......................................................... 2.41
140015.......................................................... 2.82
140016.......................................................... 1.95
140018.......................................................... 1.94
140019.......................................................... 1.65
140024.......................................................... 1.81
140025.......................................................... 1.53
140026.......................................................... 2.30
140027.......................................................... 1.84
140029.......................................................... 2.17
140030.......................................................... 2.97
140031.......................................................... 1.64
140032.......................................................... 3.04
140033.......................................................... 2.61
140034.......................................................... 2.39
140035.......................................................... 1.66
140036.......................................................... 2.69
140037.......................................................... 1.44
140038.......................................................... 1.59
140040.......................................................... 2.32
140041.......................................................... 2.20
140042.......................................................... 1.64
140043.......................................................... 2.70
140045.......................................................... 1.65
140046.......................................................... 2.43
140047.......................................................... 1.40
140048.......................................................... 2.18
140049.......................................................... 2.02
140051.......................................................... 2.56
140052.......................................................... 2.79
140053.......................................................... 3.25
140054.......................................................... 2.63
140055.......................................................... 1.58
140058.......................................................... 2.30
140059.......................................................... 2.50
140061.......................................................... 1.71
140062.......................................................... 2.16
140063.......................................................... 2.29
140064.......................................................... 3.76
140065.......................................................... 2.44
140066.......................................................... 2.17
140067.......................................................... 2.63
140068.......................................................... 1.77
140069.......................................................... 1.89
140070.......................................................... 2.00
140074.......................................................... 1.21
140075.......................................................... 2.41
140077.......................................................... 1.66
140079.......................................................... 2.44
140080.......................................................... 2.19
140081.......................................................... 1.66
140082.......................................................... 1.94
140083.......................................................... 1.45
140084.......................................................... 2.94
140086.......................................................... 2.09
140087.......................................................... 2.41
140088.......................................................... 1.65
140089.......................................................... 2.96
140090.......................................................... 2.57
140091.......................................................... 5.51
140093.......................................................... 2.71
140094.......................................................... 2.24
140095.......................................................... 1.93
140097.......................................................... 1.37
140100.......................................................... 2.74
140101.......................................................... 2.02
140102.......................................................... 1.99
140103.......................................................... 1.62
140105.......................................................... 2.70
140107.......................................................... 1.67
140108.......................................................... 2.82
140109.......................................................... 1.69
140110.......................................................... 2.28
140112.......................................................... 1.85
140113.......................................................... 2.49
140114.......................................................... 2.42
140115.......................................................... 2.07
140116.......................................................... 2.63
140117.......................................................... 2.67
140118.......................................................... 2.83
140119.......................................................... 2.96
140120.......................................................... 2.46
140121.......................................................... 2.64
140122.......................................................... 2.48
140125.......................................................... 2.18
140127.......................................................... 4.46
140128.......................................................... 1.79
140129.......................................................... 2.14
140130.......................................................... 2.50
140132.......................................................... 2.85
140133.......................................................... 2.17
140135.......................................................... 2.78
140137.......................................................... 1.67
140138.......................................................... 2.05
140139.......................................................... 1.69
140140.......................................................... 1.76
140141.......................................................... 2.22
140143.......................................................... 2.24
140144.......................................................... 1.68
140145.......................................................... 2.04
140146.......................................................... 1.62
140147.......................................................... 2.31
140148.......................................................... 2.95
140150.......................................................... 1.61
140151.......................................................... 1.34
140155.......................................................... 2.43
140158.......................................................... 1.73
140160.......................................................... 3.21
140161.......................................................... 2.48
140162.......................................................... 2.30
140164.......................................................... 2.77
140165.......................................................... 2.25
140166.......................................................... 1.91
140167.......................................................... 2.59
140168.......................................................... 1.97
140170.......................................................... 1.62
140171.......................................................... 1.37
140172.......................................................... 1.61
140173.......................................................... 1.23
140174.......................................................... 2.18
140176.......................................................... 2.67
140177.......................................................... 2.11
140179.......................................................... 2.60
140180.......................................................... 2.01
140181.......................................................... 1.95
140182.......................................................... 2.00
140184.......................................................... 1.93
140185.......................................................... 2.35
140186.......................................................... 2.10
140187.......................................................... 2.10
140188.......................................................... 1.37
140189.......................................................... 2.21
140190.......................................................... 1.82
140191.......................................................... 2.08
140193.......................................................... 2.51
140197.......................................................... 1.99
140199.......................................................... 1.78
140200.......................................................... 1.94
140202.......................................................... 2.55
140203.......................................................... 2.43
140205.......................................................... 4.24
140206.......................................................... 2.22
140207.......................................................... 2.12
140208.......................................................... 2.47
140209.......................................................... 2.71
140210.......................................................... 2.15
140211.......................................................... 2.35
140212.......................................................... 1.38
140213.......................................................... 2.63
140215.......................................................... 1.32
[[Page 18795]]
140217.......................................................... 2.32
140218.......................................................... 1.94
140220.......................................................... 1.82
140223.......................................................... 2.80
140224.......................................................... 2.33
140228.......................................................... 2.34
140230.......................................................... 1.15
140231.......................................................... 2.40
140233.......................................................... 2.59
140234.......................................................... 2.40
140236.......................................................... 1.38
140239.......................................................... 2.79
140240.......................................................... 2.09
140242.......................................................... 2.83
140245.......................................................... 1.83
140246.......................................................... 1.75
140250.......................................................... 1.98
140251.......................................................... 3.00
140252.......................................................... 2.01
140253.......................................................... 3.53
140258.......................................................... 2.37
140271.......................................................... 2.10
140275.......................................................... 2.53
140276.......................................................... 2.47
140280.......................................................... 2.60
140281.......................................................... 2.61
140285.......................................................... 2.21
140286.......................................................... 2.15
140288.......................................................... 2.00
140289.......................................................... 2.39
140290.......................................................... 3.26
140291.......................................................... 2.60
140292.......................................................... 2.47
140294.......................................................... 2.57
140297.......................................................... 1.61
140300.......................................................... 1.25
142006.......................................................... 1.37
143025.......................................................... 1.33
143026.......................................................... 1.34
143027.......................................................... 1.50
143300.......................................................... 1.82
143301.......................................................... 3.19
144005.......................................................... 1.64
144025.......................................................... 1.55
144026.......................................................... 1.55
144031.......................................................... 2.28
144033.......................................................... 1.55
144034.......................................................... 1.54
144036.......................................................... 1.57
150001.......................................................... 2.13
150002.......................................................... 2.14
150003.......................................................... 2.39
150004.......................................................... 2.20
150005.......................................................... 2.41
150006.......................................................... 2.80
150007.......................................................... 2.44
150008.......................................................... 2.61
150009.......................................................... 2.79
150011.......................................................... 1.92
150012.......................................................... 2.78
150013.......................................................... 2.18
150014.......................................................... 2.23
150015.......................................................... 2.76
150018.......................................................... 3.00
150019.......................................................... 2.19
150020.......................................................... 2.70
150022.......................................................... 2.63
150023.......................................................... 2.63
150024.......................................................... 1.31
150026.......................................................... 2.75
150027.......................................................... 1.74
150029.......................................................... 3.77
150030.......................................................... 2.56
150031.......................................................... 1.68
150033.......................................................... 2.41
150034.......................................................... 2.79
150036.......................................................... 1.92
150037.......................................................... 2.58
150038.......................................................... 1.73
150039.......................................................... 2.16
150042.......................................................... 2.75
150043.......................................................... 1.93
150044.......................................................... 2.38
150045.......................................................... 1.67
150046.......................................................... 2.72
150047.......................................................... 1.89
150049.......................................................... 1.94
150050.......................................................... 1.76
150051.......................................................... 2.17
150052.......................................................... 2.37
150053.......................................................... 1.99
150054.......................................................... 1.72
150057.......................................................... 2.23
150058.......................................................... 3.07
150059.......................................................... 1.88
150060.......................................................... 1.65
150061.......................................................... 2.02
150062.......................................................... 2.18
150063.......................................................... 1.49
150064.......................................................... 2.03
150065.......................................................... 2.37
150066.......................................................... 1.54
150067.......................................................... 2.12
150069.......................................................... 2.68
150070.......................................................... 1.93
150071.......................................................... 1.58
150072.......................................................... 1.97
150073.......................................................... 1.99
150074.......................................................... 2.46
150075.......................................................... 2.12
150076.......................................................... 2.07
150078.......................................................... 1.80
150079.......................................................... 1.71
150084.......................................................... 3.60
150086.......................................................... 2.32
150089.......................................................... 2.57
150090.......................................................... 1.89
150091.......................................................... 1.90
150092.......................................................... 1.54
150094.......................................................... 2.25
150095.......................................................... 2.28
150096.......................................................... 2.12
150097.......................................................... 2.03
150098.......................................................... 1.75
150099.......................................................... 2.46
150100.......................................................... 2.70
150101.......................................................... 2.03
150102.......................................................... 1.68
150103.......................................................... 1.32
150104.......................................................... 2.03
150105.......................................................... 1.94
150106.......................................................... 1.93
150109.......................................................... 3.35
150110.......................................................... 1.52
150111.......................................................... 1.74
150112.......................................................... 2.58
150114.......................................................... 1.61
150115.......................................................... 2.82
150122.......................................................... 2.07
150123.......................................................... 1.29
150125.......................................................... 2.42
150126.......................................................... 2.68
150127.......................................................... 1.22
150128.......................................................... 2.62
150129.......................................................... 2.02
150130.......................................................... 1.39
150132.......................................................... 2.65
150133.......................................................... 2.30
150134.......................................................... 1.80
150136.......................................................... 2.61
152007.......................................................... 0.59
152009.......................................................... 0.55
153025.......................................................... 2.03
153027.......................................................... 2.31
153029.......................................................... 1.35
153030.......................................................... 1.78
154009.......................................................... 1.69
154011.......................................................... 1.85
154013.......................................................... 1.51
154014.......................................................... 1.44
154026.......................................................... 1.65
154027.......................................................... 1.73
154028.......................................................... 1.37
154031.......................................................... 1.62
154032.......................................................... 1.79
154035.......................................................... 1.59
154036.......................................................... 1.53
154037.......................................................... 1.66
154038.......................................................... 1.71
154042.......................................................... 1.66
160001.......................................................... 3.30
160002.......................................................... 2.13
160003.......................................................... 1.84
160005.......................................................... 2.00
160007.......................................................... 1.19
160008.......................................................... 2.28
160009.......................................................... 2.03
160012.......................................................... 1.62
160013.......................................................... 3.05
160014.......................................................... 1.71
160016.......................................................... 3.06
160018.......................................................... 1.55
160020.......................................................... 1.65
160021.......................................................... 2.56
160023.......................................................... 1.68
160024.......................................................... 2.78
160026.......................................................... 1.91
160027.......................................................... 1.96
160028.......................................................... 2.46
160029.......................................................... 3.39
160030.......................................................... 3.47
160031.......................................................... 1.59
160032.......................................................... 2.35
160033.......................................................... 3.02
160034.......................................................... 2.31
160035.......................................................... 0.98
160036.......................................................... 2.10
160037.......................................................... 2.01
160039.......................................................... 1.65
160040.......................................................... 3.64
160041.......................................................... 1.49
160043.......................................................... 1.68
160044.......................................................... 2.29
160045.......................................................... 2.87
160046.......................................................... 2.22
160047.......................................................... 2.33
160048.......................................................... 1.72
160049.......................................................... 1.08
160050.......................................................... 2.49
160051.......................................................... 1.84
160052.......................................................... 1.95
160054.......................................................... 1.97
160055.......................................................... 2.09
[[Page 18796]]
160056.......................................................... 1.68
160057.......................................................... 2.59
160058.......................................................... 1.63
160060.......................................................... 1.89
160061.......................................................... 2.10
160062.......................................................... 1.74
160063.......................................................... 1.61
160064.......................................................... 3.14
160065.......................................................... 2.01
160066.......................................................... 2.40
160067.......................................................... 2.42
160068.......................................................... 1.88
160069.......................................................... 3.27
160070.......................................................... 1.70
160072.......................................................... 2.23
160073.......................................................... 1.35
160074.......................................................... 1.46
160075.......................................................... 1.79
160076.......................................................... 2.64
160077.......................................................... 1.83
160079.......................................................... 3.44
160080.......................................................... 2.72
160081.......................................................... 1.92
160082.......................................................... 3.36
160083.......................................................... 2.89
160085.......................................................... 1.61
160086.......................................................... 1.33
160088.......................................................... 1.65
160089.......................................................... 2.80
160090.......................................................... 1.59
160091.......................................................... 1.75
160092.......................................................... 1.82
160093.......................................................... 1.40
160094.......................................................... 2.93
160095.......................................................... 1.16
160097.......................................................... 2.12
160098.......................................................... 1.38
160099.......................................................... 1.74
160101.......................................................... 1.22
160102.......................................................... 2.85
160103.......................................................... 1.30
160104.......................................................... 2.24
160106.......................................................... 3.18
160107.......................................................... 1.49
160108.......................................................... 2.35
160109.......................................................... 1.62
160110.......................................................... 2.28
160111.......................................................... 1.64
160112.......................................................... 2.48
160113.......................................................... 1.34
160114.......................................................... 2.75
160115.......................................................... 2.45
160116.......................................................... 1.98
160117.......................................................... 2.86
160118.......................................................... 1.80
160120.......................................................... 0.95
160122.......................................................... 2.30
160124.......................................................... 2.14
160126.......................................................... 1.82
160129.......................................................... 2.98
160130.......................................................... 1.42
160131.......................................................... 1.61
160134.......................................................... 1.13
160135.......................................................... 1.78
160138.......................................................... 1.34
160140.......................................................... 1.69
160142.......................................................... 1.41
160143.......................................................... 1.92
160145.......................................................... 1.64
160146.......................................................... 2.96
160147.......................................................... 1.66
160151.......................................................... 1.39
160152.......................................................... 1.41
160153.......................................................... 2.76
164002.......................................................... 4.09
170001.......................................................... 3.29
170004.......................................................... 1.61
170006.......................................................... 2.01
170008.......................................................... 2.18
170009.......................................................... 2.47
170010.......................................................... 2.83
170012.......................................................... 3.18
170013.......................................................... 3.53
170014.......................................................... 1.86
170015.......................................................... 2.47
170016.......................................................... 2.73
170017.......................................................... 2.59
170018.......................................................... 1.74
170019.......................................................... 3.41
170020.......................................................... 3.81
170022.......................................................... 2.57
170023.......................................................... 5.62
170024.......................................................... 2.36
170025.......................................................... 2.06
170026.......................................................... 3.15
170027.......................................................... 3.18
170030.......................................................... 1.56
170031.......................................................... 2.04
170032.......................................................... 1.63
170033.......................................................... 2.67
170034.......................................................... 1.90
170035.......................................................... 1.52
170036.......................................................... 1.04
170037.......................................................... 3.34
170038.......................................................... 1.02
170039.......................................................... 1.64
170041.......................................................... 1.43
170043.......................................................... 1.17
170044.......................................................... 1.58
170045.......................................................... 1.74
170049.......................................................... 3.00
170051.......................................................... 1.06
170052.......................................................... 1.53
170053.......................................................... 1.02
170054.......................................................... 1.71
170055.......................................................... 1.80
170056.......................................................... 1.04
170057.......................................................... 1.62
170060.......................................................... 2.49
170061.......................................................... 2.07
170063.......................................................... 1.28
170064.......................................................... 1.61
170066.......................................................... 1.17
170067.......................................................... 2.08
170068.......................................................... 3.51
170070.......................................................... 2.26
170072.......................................................... 1.32
170073.......................................................... 1.38
170074.......................................................... 2.26
170075.......................................................... 1.03
170076.......................................................... 2.02
170077.......................................................... 1.94
170080.......................................................... 1.59
170081.......................................................... 1.39
170082.......................................................... 2.08
170084.......................................................... 1.79
170085.......................................................... 1.62
170086.......................................................... 3.38
170088.......................................................... 1.48
170089.......................................................... 1.28
170090.......................................................... 1.26
170092.......................................................... 1.36
170093.......................................................... 1.58
170094.......................................................... 2.00
170095.......................................................... 2.90
170097.......................................................... 1.89
170098.......................................................... 2.58
170099.......................................................... 2.27
170100.......................................................... 0.80
170101.......................................................... 1.45
170102.......................................................... 1.80
170103.......................................................... 4.48
170104.......................................................... 3.66
170105.......................................................... 2.02
170106.......................................................... 1.20
170109.......................................................... 1.99
170110.......................................................... 1.70
170112.......................................................... 1.48
170113.......................................................... 2.29
170114.......................................................... 2.46
170115.......................................................... 1.89
170116.......................................................... 2.91
170117.......................................................... 0.91
170119.......................................................... 1.37
170120.......................................................... 3.12
170122.......................................................... 2.74
170123.......................................................... 3.90
170124.......................................................... 2.13
170126.......................................................... 1.20
170128.......................................................... 1.96
170131.......................................................... 1.93
170133.......................................................... 3.64
170134.......................................................... 1.84
170137.......................................................... 2.80
170139.......................................................... 0.72
170142.......................................................... 3.08
170143.......................................................... 3.11
170144.......................................................... 3.09
170145.......................................................... 2.18
170146.......................................................... 3.03
170147.......................................................... 1.44
170148.......................................................... 2.58
170150.......................................................... 3.35
170151.......................................................... 1.95
170152.......................................................... 1.46
170160.......................................................... 1.49
170164.......................................................... 1.69
170166.......................................................... 1.42
170171.......................................................... 1.39
170175.......................................................... 4.34
170176.......................................................... 2.71
170182.......................................................... 3.37
170183.......................................................... 9.35
171304.......................................................... 0.79
171305.......................................................... 0.38
171310.......................................................... 0.32
172004.......................................................... 0.68
173025.......................................................... 1.55
173027.......................................................... 2.17
173028.......................................................... 1.16
174003.......................................................... 1.35
174006.......................................................... 0.83
174012.......................................................... 1.55
174014.......................................................... 1.79
174016.......................................................... 1.46
174018.......................................................... 1.56
180001.......................................................... 2.22
180004.......................................................... 1.97
180005.......................................................... 2.23
180006.......................................................... 1.20
180007.......................................................... 2.91
180009.......................................................... 2.80
180010.......................................................... 2.69
[[Page 18797]]
180011.......................................................... 2.33
180012.......................................................... 2.60
180013.......................................................... 2.86
180014.......................................................... 3.17
180015.......................................................... 1.74
180016.......................................................... 2.32
180017.......................................................... 2.53
180018.......................................................... 2.71
180019.......................................................... 2.90
180021.......................................................... 1.92
180023.......................................................... 1.82
180024.......................................................... 2.06
180025.......................................................... 2.13
180026.......................................................... 2.07
180027.......................................................... 3.08
180030.......................................................... 1.42
180031.......................................................... 1.58
180032.......................................................... 1.34
180033.......................................................... 1.83
180034.......................................................... 1.97
180035.......................................................... 2.67
180036.......................................................... 2.73
180037.......................................................... 2.60
180038.......................................................... 2.25
180040.......................................................... 3.61
180041.......................................................... 2.44
180042.......................................................... 1.92
180043.......................................................... 1.43
180044.......................................................... 2.50
180045.......................................................... 2.60
180046.......................................................... 2.24
180047.......................................................... 1.66
180048.......................................................... 2.39
180049.......................................................... 3.18
180051.......................................................... 2.98
180054.......................................................... 2.22
180055.......................................................... 1.99
180056.......................................................... 2.49
180058.......................................................... 1.42
180059.......................................................... 1.54
180060.......................................................... 0.81
180063.......................................................... 1.48
180064.......................................................... 2.22
180065.......................................................... 1.37
180066.......................................................... 2.49
180067.......................................................... 2.63
180070.......................................................... 1.79
180072.......................................................... 1.70
180075.......................................................... 1.82
180078.......................................................... 2.22
180079.......................................................... 1.77
180080.......................................................... 3.22
180087.......................................................... 2.94
180088.......................................................... 3.54
180092.......................................................... 2.19
180093.......................................................... 2.72
180094.......................................................... 1.54
180095.......................................................... 1.97
180099.......................................................... 1.75
180101.......................................................... 1.73
180102.......................................................... 2.84
180103.......................................................... 2.88
180104.......................................................... 2.58
180105.......................................................... 1.70
180106.......................................................... 1.50
180108.......................................................... 1.47
180115.......................................................... 1.63
180116.......................................................... 2.41
180117.......................................................... 2.43
180118.......................................................... 1.53
180120.......................................................... 1.55
180121.......................................................... 2.48
180122.......................................................... 1.68
180123.......................................................... 2.77
180124.......................................................... 3.14
180126.......................................................... 1.44
180127.......................................................... 2.80
180128.......................................................... 1.97
180129.......................................................... 1.25
180130.......................................................... 2.83
180132.......................................................... 2.66
180133.......................................................... 2.33
180134.......................................................... 1.92
180136.......................................................... 4.43
180137.......................................................... 1.76
180138.......................................................... 2.11
180139.......................................................... 1.47
180140.......................................................... 1.19
180141.......................................................... 2.02
182001.......................................................... 2.05
183027.......................................................... 1.32
183028.......................................................... 1.51
184000.......................................................... 1.97
184002.......................................................... 0.78
184007.......................................................... 1.55
184008.......................................................... 1.66
184009.......................................................... 1.64
184011.......................................................... 1.81
184015.......................................................... 0.87
190003.......................................................... 2.15
190004.......................................................... 2.45
190007.......................................................... 1.87
190008.......................................................... 2.74
190013.......................................................... 1.83
190014.......................................................... 2.81
190015.......................................................... 2.42
190017.......................................................... 2.18
190018.......................................................... 2.35
190019.......................................................... 1.89
190020.......................................................... 2.64
190025.......................................................... 2.15
190026.......................................................... 2.24
190027.......................................................... 2.06
190029.......................................................... 2.05
190033.......................................................... 1.17
190034.......................................................... 2.07
190036.......................................................... 2.73
190037.......................................................... 1.00
190039.......................................................... 2.12
190040.......................................................... 2.44
190041.......................................................... 2.55
190043.......................................................... 1.14
190044.......................................................... 2.08
190045.......................................................... 2.22
190046.......................................................... 1.93
190048.......................................................... 2.14
190049.......................................................... 2.69
190050.......................................................... 2.08
190053.......................................................... 1.57
190054.......................................................... 2.26
190059.......................................................... 1.78
190060.......................................................... 2.85
190064.......................................................... 4.30
190065.......................................................... 2.35
190071.......................................................... 1.49
190077.......................................................... 0.88
190078.......................................................... 3.17
190079.......................................................... 2.06
190081.......................................................... 1.07
190083.......................................................... 1.30
190086.......................................................... 2.84
190088.......................................................... 2.36
190089.......................................................... 1.77
190090.......................................................... 1.77
190092.......................................................... 1.88
190095.......................................................... 2.00
190098.......................................................... 1.55
190099.......................................................... 1.42
190102.......................................................... 3.14
190103.......................................................... 0.98
190106.......................................................... 1.71
190109.......................................................... 2.29
190110.......................................................... 1.51
190111.......................................................... 3.47
190112.......................................................... 2.78
190113.......................................................... 3.09
190114.......................................................... 1.72
190115.......................................................... 4.85
190116.......................................................... 2.27
190118.......................................................... 1.80
190120.......................................................... 1.57
190124.......................................................... 2.30
190125.......................................................... 2.21
190128.......................................................... 2.36
190130.......................................................... 1.76
190131.......................................................... 1.51
190133.......................................................... 1.54
190134.......................................................... 1.16
190135.......................................................... 2.45
190136.......................................................... 1.05
190138.......................................................... 7.09
190140.......................................................... 1.77
190142.......................................................... 1.06
190144.......................................................... 2.68
190145.......................................................... 1.54
190146.......................................................... 1.99
190147.......................................................... 1.98
190148.......................................................... 1.16
190149.......................................................... 1.71
190151.......................................................... 1.90
190152.......................................................... 2.85
190155.......................................................... 1.50
190156.......................................................... 0.90
190158.......................................................... 2.36
190160.......................................................... 2.76
190162.......................................................... 1.68
190164.......................................................... 2.43
190167.......................................................... 1.96
190170.......................................................... 1.02
190173.......................................................... 2.12
190175.......................................................... 2.53
190176.......................................................... 1.64
190177.......................................................... 2.46
190178.......................................................... 1.25
190182.......................................................... 2.24
190184.......................................................... 1.12
190185.......................................................... 2.75
190186.......................................................... 1.25
190189.......................................................... 0.98
190190.......................................................... 1.48
190191.......................................................... 2.21
190196.......................................................... 2.45
190197.......................................................... 2.63
190200.......................................................... 2.63
190201.......................................................... 2.19
190202.......................................................... 1.98
190203.......................................................... 2.82
190204.......................................................... 2.44
190205.......................................................... 2.47
190206.......................................................... 2.06
190207.......................................................... 3.10
190208.......................................................... 1.18
190218.......................................................... 2.41
[[Page 18798]]
190231.......................................................... 4.55
190236.......................................................... 3.56
192004.......................................................... 1.30
192006.......................................................... 1.78
192016.......................................................... 3.50
192020.......................................................... 0.79
193027.......................................................... 1.77
193028.......................................................... 1.84
193034.......................................................... 1.22
193038.......................................................... 1.62
193041.......................................................... 0.89
193044.......................................................... 2.62
193300.......................................................... 1.52
194000.......................................................... 3.15
194004.......................................................... 1.32
194014.......................................................... 1.53
194019.......................................................... 1.57
194022.......................................................... 1.32
194023.......................................................... 1.52
194024.......................................................... 1.40
194027.......................................................... 1.56
194031.......................................................... 1.63
194036.......................................................... 1.47
194044.......................................................... 1.54
194058.......................................................... 1.55
200001.......................................................... 2.71
200002.......................................................... 2.25
200003.......................................................... 1.96
200006.......................................................... 1.43
200007.......................................................... 1.64
200008.......................................................... 2.14
200009.......................................................... 2.23
200012.......................................................... 1.69
200013.......................................................... 2.05
200015.......................................................... 2.19
200016.......................................................... 1.92
200017.......................................................... 2.72
200018.......................................................... 2.23
200019.......................................................... 2.23
200020.......................................................... 2.32
200021.......................................................... 2.52
200023.......................................................... 1.08
200024.......................................................... 2.50
200025.......................................................... 2.47
200026.......................................................... 1.83
200027.......................................................... 1.77
200028.......................................................... 1.83
200031.......................................................... 1.84
200032.......................................................... 1.99
200033.......................................................... 2.24
200034.......................................................... 2.74
200037.......................................................... 1.95
200038.......................................................... 2.48
200039.......................................................... 2.55
200040.......................................................... 2.89
200041.......................................................... 2.42
200043.......................................................... 1.29
200050.......................................................... 2.80
200051.......................................................... 2.73
200052.......................................................... 1.79
200055.......................................................... 1.47
200062.......................................................... 1.46
200063.......................................................... 2.52
200066.......................................................... 2.16
204005.......................................................... 1.68
204006.......................................................... 1.54
220001.......................................................... 2.29
220003.......................................................... 2.21
220004.......................................................... 2.30
220006.......................................................... 2.26
220008.......................................................... 2.19
220010.......................................................... 2.68
220011.......................................................... 1.67
220015.......................................................... 2.19
220016.......................................................... 2.31
220017.......................................................... 2.13
220019.......................................................... 2.43
220020.......................................................... 1.82
220021.......................................................... 2.13
220023.......................................................... 2.01
220024.......................................................... 2.35
220025.......................................................... 1.85
220028.......................................................... 2.02
220029.......................................................... 2.15
220030.......................................................... 1.57
220031.......................................................... 1.87
220033.......................................................... 2.15
220035.......................................................... 2.37
220038.......................................................... 2.07
220041.......................................................... 2.29
220042.......................................................... 2.16
220046.......................................................... 2.57
220049.......................................................... 2.46
220050.......................................................... 2.20
220051.......................................................... 2.52
220052.......................................................... 2.08
220053.......................................................... 2.05
220055.......................................................... 2.53
220057.......................................................... 2.30
220058.......................................................... 2.07
220060.......................................................... 2.36
220062.......................................................... 1.78
220063.......................................................... 2.16
220064.......................................................... 2.33
220065.......................................................... 1.92
220066.......................................................... 2.62
220067.......................................................... 2.39
220068.......................................................... 1.42
220070.......................................................... 2.08
220071.......................................................... 1.88
220073.......................................................... 2.06
220074.......................................................... 2.06
220075.......................................................... 2.83
220076.......................................................... 1.93
220077.......................................................... 2.11
220079.......................................................... 1.89
220080.......................................................... 2.09
220081.......................................................... 1.92
220082.......................................................... 2.28
220083.......................................................... 1.87
220084.......................................................... 2.57
220086.......................................................... 1.93
220088.......................................................... 2.06
220089.......................................................... 2.12
220090.......................................................... 2.05
220092.......................................................... 2.22
220094.......................................................... 2.04
220095.......................................................... 1.92
220098.......................................................... 2.29
220100.......................................................... 1.96
220101.......................................................... 2.23
220104.......................................................... 1.44
220105.......................................................... 2.21
220106.......................................................... 2.17
220107.......................................................... 2.34
220108.......................................................... 2.11
220111.......................................................... 2.34
220116.......................................................... 1.72
220119.......................................................... 1.92
220123.......................................................... 1.81
220126.......................................................... 2.32
220128.......................................................... 1.99
220135.......................................................... 2.20
220162.......................................................... 1.56
220163.......................................................... 1.59
220171.......................................................... 1.62
222000.......................................................... 1.54
222002.......................................................... 1.04
222006.......................................................... 1.10
222008.......................................................... 0.98
222024.......................................................... 2.57
222026.......................................................... 1.01
222027.......................................................... 1.01
222029.......................................................... 1.24
222035.......................................................... 1.30
222041.......................................................... 0.45
222043.......................................................... 1.10
222044.......................................................... 1.10
223026.......................................................... 1.14
223027.......................................................... 1.49
223028.......................................................... 1.62
223029.......................................................... 1.05
223030.......................................................... 1.52
223032.......................................................... 1.26
223302.......................................................... 1.99
224007.......................................................... 1.75
224018.......................................................... 1.64
224021.......................................................... 1.54
224022.......................................................... 2.67
224034.......................................................... 1.57
224035.......................................................... 1.31
230001.......................................................... 1.98
230002.......................................................... 3.04
230003.......................................................... 1.99
230004.......................................................... 2.85
230005.......................................................... 2.32
230006.......................................................... 2.20
230007.......................................................... 2.85
230012.......................................................... 1.22
230013.......................................................... 2.28
230015.......................................................... 2.20
230017.......................................................... 2.90
230019.......................................................... 3.09
230020.......................................................... 3.32
230021.......................................................... 3.02
230022.......................................................... 2.25
230024.......................................................... 2.94
230027.......................................................... 1.97
230029.......................................................... 2.37
230030.......................................................... 2.80
230031.......................................................... 2.57
230032.......................................................... 3.42
230034.......................................................... 2.13
230035.......................................................... 2.21
230036.......................................................... 2.62
230037.......................................................... 2.46
230038.......................................................... 2.97
230040.......................................................... 2.66
230041.......................................................... 2.56
230042.......................................................... 2.04
230046.......................................................... 2.04
230047.......................................................... 3.03
230053.......................................................... 1.46
230054.......................................................... 2.58
230055.......................................................... 2.07
230056.......................................................... 1.77
230058.......................................................... 2.77
230059.......................................................... 3.12
230060.......................................................... 2.39
230062.......................................................... 1.78
230063.......................................................... 2.18
230065.......................................................... 2.69
230066.......................................................... 2.62
[[Page 18799]]
230068.......................................................... 2.96
230069.......................................................... 2.29
230070.......................................................... 3.47
230071.......................................................... 13.46
230072.......................................................... 2.32
230075.......................................................... 2.74
230076.......................................................... 4.83
230077.......................................................... 3.51
230078.......................................................... 2.17
230080.......................................................... 3.55
230081.......................................................... 2.66
230082.......................................................... 2.17
230085.......................................................... 2.65
230086.......................................................... 1.79
230087.......................................................... 2.14
230089.......................................................... 2.65
230092.......................................................... 2.76
230093.......................................................... 2.99
230095.......................................................... 2.79
230096.......................................................... 2.47
230097.......................................................... 3.23
230099.......................................................... 2.22
230100.......................................................... 1.66
230101.......................................................... 2.22
230103.......................................................... 2.22
230104.......................................................... 2.53
230105.......................................................... 3.58
230106.......................................................... 1.97
230107.......................................................... 1.39
230108.......................................................... 2.30
230110.......................................................... 2.55
230111.......................................................... 1.83
230113.......................................................... 1.20
230114.......................................................... 7.32
230115.......................................................... 1.87
230116.......................................................... 2.04
230117.......................................................... 2.64
230118.......................................................... 2.16
230119.......................................................... 2.20
230120.......................................................... 2.77
230121.......................................................... 2.57
230122.......................................................... 3.37
230124.......................................................... 2.26
230125.......................................................... 1.91
230128.......................................................... 3.39
230130.......................................................... 2.88
230132.......................................................... 2.37
230133.......................................................... 2.44
230134.......................................................... 2.45
230135.......................................................... 2.66
230137.......................................................... 2.40
230141.......................................................... 2.47
230142.......................................................... 2.53
230143.......................................................... 2.75
230144.......................................................... 2.44
230145.......................................................... 2.35
230146.......................................................... 2.11
230147.......................................................... 1.91
230149.......................................................... 1.62
230151.......................................................... 2.11
230153.......................................................... 2.20
230154.......................................................... 1.52
230155.......................................................... 1.61
230156.......................................................... 2.46
230157.......................................................... 2.73
230159.......................................................... 2.74
230162.......................................................... 1.04
230165.......................................................... 3.20
230167.......................................................... 2.97
230169.......................................................... 2.72
230171.......................................................... 1.61
230172.......................................................... 1.86
230174.......................................................... 2.13
230175.......................................................... 1.55
230176.......................................................... 2.96
230178.......................................................... 1.91
230180.......................................................... 2.02
230184.......................................................... 5.45
230186.......................................................... 1.92
230188.......................................................... 2.38
230189.......................................................... 1.41
230190.......................................................... 1.28
230191.......................................................... 2.01
230193.......................................................... 2.22
230194.......................................................... 1.22
230195.......................................................... 2.84
230197.......................................................... 3.63
230199.......................................................... 2.25
230201.......................................................... 2.58
230204.......................................................... 2.72
230205.......................................................... 2.62
230207.......................................................... 2.22
230208.......................................................... 2.41
230211.......................................................... 0.91
230212.......................................................... 2.15
230213.......................................................... 1.35
230216.......................................................... 2.08
230217.......................................................... 2.66
230219.......................................................... 2.46
230221.......................................................... 2.13
230222.......................................................... 2.66
230223.......................................................... 2.86
230227.......................................................... 2.69
230230.......................................................... 2.88
230232.......................................................... 1.16
230235.......................................................... 2.24
230236.......................................................... 2.79
230239.......................................................... 2.40
230241.......................................................... 2.58
230244.......................................................... 2.53
230253.......................................................... 2.64
230254.......................................................... 2.61
230257.......................................................... 5.56
230259.......................................................... 2.83
230264.......................................................... 3.02
230269.......................................................... 2.85
230270.......................................................... 3.10
230273.......................................................... 1.95
230275.......................................................... 1.90
230276.......................................................... 1.34
230277.......................................................... 2.81
230278.......................................................... 1.84
230279.......................................................... 1.59
230280.......................................................... 2.00
233025.......................................................... 1.26
233026.......................................................... 1.09
233027.......................................................... 1.24
233300.......................................................... 3.39
234006.......................................................... 1.63
234011.......................................................... 1.71
234029.......................................................... 1.46
234030.......................................................... 1.64
240001.......................................................... 3.26
240002.......................................................... 2.84
240004.......................................................... 1.30
240005.......................................................... 1.12
240006.......................................................... 2.89
240007.......................................................... 2.92
240008.......................................................... 2.88
240009.......................................................... 1.53
240010.......................................................... 3.69
240011.......................................................... 2.58
240013.......................................................... 2.49
240014.......................................................... 2.65
240016.......................................................... 3.00
240017.......................................................... 3.88
240018.......................................................... 3.20
240019.......................................................... 2.95
240020.......................................................... 2.08
240021.......................................................... 1.94
240022.......................................................... 2.29
240023.......................................................... 2.46
240025.......................................................... 2.01
240027.......................................................... 2.68
240028.......................................................... 2.16
240029.......................................................... 2.97
240030.......................................................... 3.11
240031.......................................................... 2.26
240036.......................................................... 2.44
240037.......................................................... 1.93
240038.......................................................... 3.13
240040.......................................................... 2.51
240041.......................................................... 2.49
240043.......................................................... 3.30
240044.......................................................... 2.56
240045.......................................................... 2.04
240047.......................................................... 3.16
240048.......................................................... 3.81
240049.......................................................... 1.87
240050.......................................................... 3.12
240051.......................................................... 1.95
240052.......................................................... 2.17
240053.......................................................... 3.27
240056.......................................................... 3.03
240057.......................................................... 2.35
240058.......................................................... 1.44
240059.......................................................... 3.44
240061.......................................................... 4.55
240063.......................................................... 2.66
240064.......................................................... 3.06
240065.......................................................... 1.73
240066.......................................................... 4.22
240069.......................................................... 3.56
240071.......................................................... 2.37
240072.......................................................... 2.79
240073.......................................................... 1.65
240075.......................................................... 2.45
240076.......................................................... 2.75
240077.......................................................... 2.34
240078.......................................................... 3.66
240079.......................................................... 1.91
240080.......................................................... 2.09
240082.......................................................... 1.86
240083.......................................................... 2.36
240084.......................................................... 2.83
240085.......................................................... 1.53
240086.......................................................... 2.09
240087.......................................................... 2.23
240088.......................................................... 1.90
240089.......................................................... 1.37
240090.......................................................... 3.29
240093.......................................................... 2.68
240094.......................................................... 1.66
240096.......................................................... 1.46
240097.......................................................... 6.54
240098.......................................................... 2.05
240099.......................................................... 1.53
240100.......................................................... 2.83
240101.......................................................... 2.00
240102.......................................................... 1.70
240103.......................................................... 1.87
240104.......................................................... 2.68
240105.......................................................... 1.33
[[Page 18800]]
240106.......................................................... 1.44
240107.......................................................... 1.69
240108.......................................................... 2.55
240109.......................................................... 1.82
240110.......................................................... 2.39
240111.......................................................... 2.28
240112.......................................................... 1.98
240114.......................................................... 1.84
240115.......................................................... 3.13
240116.......................................................... 1.61
240117.......................................................... 1.29
240119.......................................................... 1.19
240121.......................................................... 1.94
240122.......................................................... 1.45
240123.......................................................... 2.37
240124.......................................................... 2.36
240125.......................................................... 1.91
240127.......................................................... 2.25
240128.......................................................... 2.55
240129.......................................................... 2.38
240130.......................................................... 3.06
240132.......................................................... 2.75
240133.......................................................... 3.45
240137.......................................................... 3.54
240138.......................................................... 1.42
240139.......................................................... 2.01
240141.......................................................... 2.49
240142.......................................................... 1.80
240143.......................................................... 1.54
240144.......................................................... 2.78
240145.......................................................... 1.37
240146.......................................................... 2.11
240148.......................................................... 1.64
240152.......................................................... 2.60
240153.......................................................... 1.82
240154.......................................................... 1.44
240155.......................................................... 2.59
240157.......................................................... 2.46
240160.......................................................... 2.58
240161.......................................................... 1.77
240162.......................................................... 2.16
240163.......................................................... 1.89
240166.......................................................... 3.66
240169.......................................................... 2.39
240170.......................................................... 1.83
240171.......................................................... 2.87
240172.......................................................... 2.01
240173.......................................................... 2.63
240179.......................................................... 1.84
240184.......................................................... 1.71
240187.......................................................... 3.42
240193.......................................................... 2.12
240200.......................................................... 0.91
240207.......................................................... 2.75
240210.......................................................... 2.78
240211.......................................................... 1.04
242004.......................................................... 1.59
243300.......................................................... 1.41
243301.......................................................... 1.45
243302.......................................................... 6.10
244009.......................................................... 3.31
250001.......................................................... 2.17
250002.......................................................... 1.57
250003.......................................................... 1.07
250004.......................................................... 2.27
250005.......................................................... 0.94
250006.......................................................... 2.22
250007.......................................................... 1.98
250008.......................................................... 1.07
250009.......................................................... 2.99
250010.......................................................... 1.62
250012.......................................................... 1.46
250015.......................................................... 2.25
250017.......................................................... 1.36
250018.......................................................... 0.66
250019.......................................................... 2.28
250020.......................................................... 1.40
250021.......................................................... 0.75
250023.......................................................... 0.70
250024.......................................................... 0.90
250025.......................................................... 2.05
250027.......................................................... 1.72
250029.......................................................... 1.62
250030.......................................................... 1.06
250031.......................................................... 2.52
250032.......................................................... 1.96
250033.......................................................... 1.70
250034.......................................................... 3.67
250035.......................................................... 1.84
250036.......................................................... 1.88
250037.......................................................... 1.50
250038.......................................................... 1.35
250039.......................................................... 1.02
250040.......................................................... 2.53
250042.......................................................... 2.37
250043.......................................................... 1.84
250044.......................................................... 1.99
250045.......................................................... 1.77
250048.......................................................... 3.17
250049.......................................................... 1.44
250050.......................................................... 2.13
250051.......................................................... 1.22
250057.......................................................... 2.41
250058.......................................................... 2.59
250059.......................................................... 1.87
250060.......................................................... 1.04
250061.......................................................... 1.51
250063.......................................................... 1.43
250065.......................................................... 1.46
250066.......................................................... 1.13
250067.......................................................... 1.45
250068.......................................................... 1.54
250069.......................................................... 3.53
250071.......................................................... 1.19
250072.......................................................... 2.38
250076.......................................................... 0.67
250077.......................................................... 1.38
250078.......................................................... 2.73
250079.......................................................... 1.17
250081.......................................................... 3.27
250082.......................................................... 2.32
250083.......................................................... 1.27
250084.......................................................... 2.89
250085.......................................................... 1.35
250088.......................................................... 1.99
250089.......................................................... 1.70
250093.......................................................... 1.88
250094.......................................................... 3.86
250095.......................................................... 2.03
250096.......................................................... 1.97
250097.......................................................... 2.14
250098.......................................................... 1.33
250099.......................................................... 3.06
250100.......................................................... 2.80
250101.......................................................... 1.10
250102.......................................................... 2.82
250104.......................................................... 3.29
250105.......................................................... 1.35
250107.......................................................... 1.21
250109.......................................................... 1.25
250112.......................................................... 1.25
250117.......................................................... 1.42
250119.......................................................... 1.66
250120.......................................................... 2.27
250122.......................................................... 2.74
250123.......................................................... 3.13
250124.......................................................... 1.39
250125.......................................................... 2.27
250126.......................................................... 1.23
250128.......................................................... 1.77
250131.......................................................... 1.65
250136.......................................................... 2.92
250138.......................................................... 3.33
250141.......................................................... 2.99
250145.......................................................... 1.32
250146.......................................................... 1.31
250148.......................................................... 2.33
250149.......................................................... 1.26
252003.......................................................... 0.50
253025.......................................................... 1.93
254001.......................................................... 1.55
254002.......................................................... 1.50
260001.......................................................... 2.41
260002.......................................................... 2.38
260003.......................................................... 1.52
260004.......................................................... 1.40
260005.......................................................... 2.56
260006.......................................................... 2.13
260008.......................................................... 1.17
260009.......................................................... 2.66
260011.......................................................... 2.37
260012.......................................................... 1.48
260013.......................................................... 2.16
260014.......................................................... 2.52
260015.......................................................... 2.36
260017.......................................................... 2.87
260018.......................................................... 1.11
260019.......................................................... 1.77
260020.......................................................... 2.41
260021.......................................................... 2.14
260022.......................................................... 2.47
260023.......................................................... 2.33
260024.......................................................... 1.73
260025.......................................................... 3.53
260027.......................................................... 2.51
260029.......................................................... 2.18
260030.......................................................... 1.38
260031.......................................................... 2.62
260032.......................................................... 2.44
260034.......................................................... 1.35
260035.......................................................... 1.51
260036.......................................................... 1.87
260039.......................................................... 1.61
260040.......................................................... 2.57
260044.......................................................... 1.97
260047.......................................................... 2.11
260048.......................................................... 1.99
260050.......................................................... 2.60
260052.......................................................... 2.22
260053.......................................................... 1.82
260054.......................................................... 2.34
260055.......................................................... 1.72
260057.......................................................... 1.70
260059.......................................................... 2.45
260061.......................................................... 2.72
260062.......................................................... 2.48
260063.......................................................... 2.01
260064.......................................................... 2.46
260065.......................................................... 2.51
260066.......................................................... 1.99
260067.......................................................... 1.26
260068.......................................................... 2.91
260070.......................................................... 1.31
[[Page 18801]]
260073.......................................................... 1.81
260074.......................................................... 1.74
260077.......................................................... 2.60
260078.......................................................... 2.61
260079.......................................................... 1.56
260080.......................................................... 2.08
260081.......................................................... 2.08
260082.......................................................... 1.60
260085.......................................................... 2.75
260086.......................................................... 1.77
260091.......................................................... 2.98
260094.......................................................... 2.39
260095.......................................................... 2.22
260096.......................................................... 3.19
260097.......................................................... 3.14
260100.......................................................... 1.86
260102.......................................................... 1.11
260103.......................................................... 1.96
260104.......................................................... 2.36
260105.......................................................... 2.69
260107.......................................................... 3.54
260108.......................................................... 2.38
260109.......................................................... 2.03
260110.......................................................... 2.51
260113.......................................................... 2.30
260115.......................................................... 1.73
260116.......................................................... 2.40
260119.......................................................... 2.68
260120.......................................................... 2.17
260122.......................................................... 2.04
260123.......................................................... 1.31
260127.......................................................... 1.90
260128.......................................................... 1.42
260129.......................................................... 2.18
260131.......................................................... 2.05
260134.......................................................... 2.38
260137.......................................................... 3.09
260138.......................................................... 2.50
260141.......................................................... 2.03
260142.......................................................... 2.64
260143.......................................................... 1.28
260147.......................................................... 1.76
260148.......................................................... 1.29
260158.......................................................... 1.69
260159.......................................................... 2.08
260160.......................................................... 1.74
260162.......................................................... 2.75
260163.......................................................... 1.89
260164.......................................................... 1.69
260166.......................................................... 2.33
260172.......................................................... 2.00
260173.......................................................... 1.31
260175.......................................................... 2.92
260176.......................................................... 2.60
260177.......................................................... 3.33
260178.......................................................... 3.53
260179.......................................................... 2.42
260180.......................................................... 2.28
260183.......................................................... 2.77
260186.......................................................... 2.66
260188.......................................................... 2.21
260189.......................................................... 0.89
260190.......................................................... 2.65
260191.......................................................... 2.69
260193.......................................................... 2.34
260195.......................................................... 2.21
260197.......................................................... 2.35
260198.......................................................... 2.50
260200.......................................................... 1.98
262001.......................................................... 1.00
262011.......................................................... 0.81
263025.......................................................... 1.49
263026.......................................................... 2.37
263300.......................................................... 1.85
263301.......................................................... 1.61
263302.......................................................... 1.62
264004.......................................................... 0.98
264005.......................................................... 0.98
264008.......................................................... 0.98
264011.......................................................... 1.51
264016.......................................................... 2.48
264017.......................................................... 1.84
264021.......................................................... 1.55
264024.......................................................... 1.55
270002.......................................................... 2.36
270003.......................................................... 2.63
270004.......................................................... 3.29
270006.......................................................... 0.62
270007.......................................................... 1.03
270009.......................................................... 1.65
270011.......................................................... 2.64
270012.......................................................... 3.44
270013.......................................................... 2.67
270014.......................................................... 3.11
270016.......................................................... 1.15
270017.......................................................... 2.02
270019.......................................................... 1.17
270021.......................................................... 1.95
270023.......................................................... 2.88
270024.......................................................... 1.06
270026.......................................................... 1.72
270027.......................................................... 1.40
270028.......................................................... 2.43
270029.......................................................... 1.91
270032.......................................................... 2.61
270033.......................................................... 0.91
270035.......................................................... 1.65
270036.......................................................... 1.13
270039.......................................................... 1.94
270040.......................................................... 1.88
270041.......................................................... 1.49
270044.......................................................... 2.58
270046.......................................................... 1.26
270048.......................................................... 1.91
270049.......................................................... 1.88
270050.......................................................... 1.95
270051.......................................................... 2.84
270052.......................................................... 1.06
270053.......................................................... 0.98
270057.......................................................... 2.29
270058.......................................................... 1.70
270059.......................................................... 0.71
270060.......................................................... 1.01
270063.......................................................... 1.17
270068.......................................................... 2.25
270072.......................................................... 0.64
270073.......................................................... 1.28
270079.......................................................... 1.52
270080.......................................................... 2.01
270081.......................................................... 1.07
270082.......................................................... 1.01
270083.......................................................... 1.36
270084.......................................................... 1.59
271225.......................................................... 0.72
271226.......................................................... 1.06
271228.......................................................... 0.89
271229.......................................................... 1.04
271231.......................................................... 1.00
271232.......................................................... 0.94
271233.......................................................... 1.00
271234.......................................................... 1.56
280001.......................................................... 2.04
280005.......................................................... 2.57
280009.......................................................... 3.52
280010.......................................................... 1.15
280011.......................................................... 1.53
280012.......................................................... 2.09
280013.......................................................... 2.00
280014.......................................................... 1.81
280015.......................................................... 2.04
280017.......................................................... 1.92
280018.......................................................... 1.67
280020.......................................................... 2.38
280021.......................................................... 2.74
280022.......................................................... 1.21
280023.......................................................... 2.78
280024.......................................................... 1.53
280025.......................................................... 1.09
280026.......................................................... 1.69
280028.......................................................... 2.26
280029.......................................................... 1.49
280030.......................................................... 2.19
280031.......................................................... 1.42
280032.......................................................... 3.03
280033.......................................................... 1.60
280034.......................................................... 2.54
280035.......................................................... 1.59
280037.......................................................... 1.21
280038.......................................................... 2.20
280039.......................................................... 2.21
280040.......................................................... 3.15
280041.......................................................... 1.34
280042.......................................................... 1.26
280043.......................................................... 1.87
280045.......................................................... 1.87
280046.......................................................... 1.56
280047.......................................................... 2.12
280048.......................................................... 1.58
280049.......................................................... 1.41
280050.......................................................... 2.15
280051.......................................................... 2.61
280052.......................................................... 2.53
280054.......................................................... 2.00
280055.......................................................... 1.75
280056.......................................................... 1.45
280057.......................................................... 1.69
280058.......................................................... 1.89
280060.......................................................... 2.26
280061.......................................................... 3.72
280062.......................................................... 1.90
280064.......................................................... 2.28
280065.......................................................... 2.36
280066.......................................................... 1.67
280068.......................................................... 1.42
280070.......................................................... 2.01
280073.......................................................... 1.79
280074.......................................................... 1.63
280075.......................................................... 2.76
280076.......................................................... 1.80
280077.......................................................... 2.61
280079.......................................................... 1.19
280080.......................................................... 1.52
280081.......................................................... 2.64
280082.......................................................... 1.53
280083.......................................................... 1.88
280084.......................................................... 1.69
280085.......................................................... 2.61
280088.......................................................... 3.10
280089.......................................................... 1.91
280090.......................................................... 1.24
280091.......................................................... 2.42
280092.......................................................... 1.65
280094.......................................................... 1.80
[[Page 18802]]
280097.......................................................... 1.57
280098.......................................................... 1.09
280101.......................................................... 1.12
280102.......................................................... 1.60
280104.......................................................... 1.97
280105.......................................................... 2.63
280106.......................................................... 2.20
280107.......................................................... 2.17
280108.......................................................... 3.91
280109.......................................................... 1.20
280110.......................................................... 2.61
280111.......................................................... 2.00
280114.......................................................... 1.49
280115.......................................................... 2.04
280117.......................................................... 2.23
280118.......................................................... 1.79
280125.......................................................... 2.66
283025.......................................................... 1.13
283301.......................................................... 2.09
284007.......................................................... 3.05
290001.......................................................... 2.20
290002.......................................................... 0.80
290003.......................................................... 2.93
290005.......................................................... 3.18
290006.......................................................... 1.70
290007.......................................................... 1.48
290008.......................................................... 2.80
290009.......................................................... 2.15
290010.......................................................... 2.20
290011.......................................................... 1.11
290012.......................................................... 2.61
290013.......................................................... 1.04
290014.......................................................... 2.15
290015.......................................................... 1.38
290016.......................................................... 2.15
290019.......................................................... 2.42
290020.......................................................... 0.94
290021.......................................................... 2.36
290022.......................................................... 2.77
290027.......................................................... 1.27
290032.......................................................... 2.34
290038.......................................................... 1.70
290039.......................................................... 2.60
292002.......................................................... 1.01
293027.......................................................... 2.09
294003.......................................................... 1.57
294004.......................................................... 1.56
294005.......................................................... 2.31
300001.......................................................... 2.65
300003.......................................................... 1.80
300005.......................................................... 2.43
300006.......................................................... 1.57
300007.......................................................... 2.44
300008.......................................................... 2.59
300009.......................................................... 2.10
300010.......................................................... 1.75
300011.......................................................... 2.21
300013.......................................................... 1.65
300014.......................................................... 2.30
300015.......................................................... 2.49
300016.......................................................... 2.08
300017.......................................................... 1.97
300018.......................................................... 2.48
300019.......................................................... 2.25
300021.......................................................... 1.87
300022.......................................................... 2.33
300023.......................................................... 1.99
300024.......................................................... 2.11
300028.......................................................... 1.65
300029.......................................................... 2.86
300033.......................................................... 1.52
303026.......................................................... 1.85
303027.......................................................... 0.47
304001.......................................................... 11.15
304003.......................................................... 1.55
310001.......................................................... 1.98
310002.......................................................... 2.01
310005.......................................................... 2.33
310006.......................................................... 2.74
310008.......................................................... 2.88
310009.......................................................... 2.59
310010.......................................................... 1.99
310011.......................................................... 2.95
310013.......................................................... 2.30
310015.......................................................... 2.26
310016.......................................................... 2.52
310017.......................................................... 2.70
310018.......................................................... 2.16
310019.......................................................... 2.49
310020.......................................................... 2.39
310021.......................................................... 2.29
310022.......................................................... 2.52
310024.......................................................... 2.45
310025.......................................................... 2.33
310026.......................................................... 2.09
310027.......................................................... 2.40
310028.......................................................... 2.05
310029.......................................................... 3.53
310031.......................................................... 2.24
310032.......................................................... 2.20
310034.......................................................... 2.75
310036.......................................................... 1.93
310037.......................................................... 2.32
310039.......................................................... 2.77
310041.......................................................... 2.33
310042.......................................................... 2.58
310043.......................................................... 2.81
310044.......................................................... 2.19
310045.......................................................... 2.63
310047.......................................................... 2.62
310048.......................................................... 2.55
310050.......................................................... 1.91
310051.......................................................... 2.79
310052.......................................................... 2.08
310054.......................................................... 2.34
310056.......................................................... 1.89
310057.......................................................... 2.44
310058.......................................................... 1.31
310060.......................................................... 3.24
310061.......................................................... 2.89
310063.......................................................... 2.27
310064.......................................................... 2.39
310067.......................................................... 2.57
310069.......................................................... 2.66
310070.......................................................... 2.43
310072.......................................................... 2.98
310073.......................................................... 1.92
310074.......................................................... 1.47
310076.......................................................... 2.40
310077.......................................................... 2.66
310078.......................................................... 2.28
310081.......................................................... 2.40
310083.......................................................... 1.69
310084.......................................................... 2.17
310086.......................................................... 2.33
310088.......................................................... 1.84
310090.......................................................... 2.29
310091.......................................................... 2.73
310092.......................................................... 2.38
310093.......................................................... 2.56
310096.......................................................... 2.69
310105.......................................................... 1.47
310111.......................................................... 2.02
310112.......................................................... 2.37
310113.......................................................... 2.47
310115.......................................................... 2.02
310116.......................................................... 2.54
310118.......................................................... 2.36
310120.......................................................... 1.73
312014.......................................................... 0.98
313025.......................................................... 1.23
313026.......................................................... 1.19
313027.......................................................... 1.24
313029.......................................................... 1.64
313030.......................................................... 1.05
313032.......................................................... 0.90
314001.......................................................... 1.71
314010.......................................................... 1.72
314011.......................................................... 1.56
314012.......................................................... 2.07
314021.......................................................... 1.70
314022.......................................................... 1.53
320001.......................................................... 1.50
320002.......................................................... 1.78
320003.......................................................... 2.47
320004.......................................................... 2.43
320005.......................................................... 2.98
320006.......................................................... 2.87
320009.......................................................... 2.44
320011.......................................................... 1.76
320012.......................................................... 2.54
320013.......................................................... 2.15
320014.......................................................... 1.79
320016.......................................................... 2.94
320017.......................................................... 2.03
320018.......................................................... 2.95
320019.......................................................... 1.21
320021.......................................................... 1.80
320022.......................................................... 3.20
320023.......................................................... 1.33
320030.......................................................... 2.00
320031.......................................................... 1.27
320032.......................................................... 1.44
320033.......................................................... 2.26
320035.......................................................... 1.18
320037.......................................................... 2.32
320038.......................................................... 2.61
320046.......................................................... 2.17
320048.......................................................... 1.53
320063.......................................................... 2.36
320065.......................................................... 2.27
320067.......................................................... 1.21
320068.......................................................... 2.33
320069.......................................................... 1.96
320074.......................................................... 2.12
320079.......................................................... 2.29
322002.......................................................... 3.05
322003.......................................................... 0.68
323027.......................................................... 0.58
323028.......................................................... 1.76
323029.......................................................... 1.43
324003.......................................................... 1.56
324004.......................................................... 1.59
324007.......................................................... 1.68
324010.......................................................... 1.85
330001.......................................................... 2.13
330002.......................................................... 2.29
330003.......................................................... 2.40
330004.......................................................... 2.49
330005.......................................................... 2.32
330006.......................................................... 2.27
330007.......................................................... 2.26
330008.......................................................... 2.47
[[Page 18803]]
330010.......................................................... 2.17
330011.......................................................... 1.70
330012.......................................................... 2.20
330013.......................................................... 2.59
330014.......................................................... 1.92
330016.......................................................... 1.90
330023.......................................................... 2.50
330024.......................................................... 2.41
330025.......................................................... 1.87
330027.......................................................... 0.92
330028.......................................................... 2.00
330029.......................................................... 1.55
330030.......................................................... 2.54
330033.......................................................... 1.59
330034.......................................................... 1.09
330036.......................................................... 2.29
330037.......................................................... 2.61
330038.......................................................... 1.88
330039.......................................................... 1.19
330041.......................................................... 3.15
330043.......................................................... 1.95
330044.......................................................... 2.25
330045.......................................................... 2.79
330046.......................................................... 2.01
330047.......................................................... 2.35
330048.......................................................... 2.82
330049.......................................................... 2.37
330053.......................................................... 1.93
330055.......................................................... 2.49
330056.......................................................... 1.96
330057.......................................................... 2.38
330058.......................................................... 1.81
330059.......................................................... 2.21
330061.......................................................... 2.74
330062.......................................................... 1.41
330064.......................................................... 2.38
330065.......................................................... 2.46
330066.......................................................... 2.06
330067.......................................................... 2.40
330072.......................................................... 1.95
330073.......................................................... 1.90
330074.......................................................... 2.96
330075.......................................................... 2.05
330078.......................................................... 2.35
330079.......................................................... 2.09
330084.......................................................... 2.26
330085.......................................................... 1.75
330086.......................................................... 1.96
330088.......................................................... 1.68
330090.......................................................... 2.37
330091.......................................................... 2.31
330092.......................................................... 1.22
330094.......................................................... 2.09
330095.......................................................... 2.49
330096.......................................................... 2.30
330097.......................................................... 1.80
330100.......................................................... 5.13
330101.......................................................... 2.50
330102.......................................................... 2.92
330103.......................................................... 2.74
330104.......................................................... 2.04
330106.......................................................... 2.65
330107.......................................................... 2.39
330108.......................................................... 2.31
330111.......................................................... 1.94
330114.......................................................... 0.90
330115.......................................................... 2.41
330116.......................................................... 2.02
330118.......................................................... 2.57
330119.......................................................... 2.61
330121.......................................................... 1.33
330122.......................................................... 2.87
330125.......................................................... 1.89
330126.......................................................... 2.28
330132.......................................................... 1.47
330133.......................................................... 2.88
330135.......................................................... 2.39
330136.......................................................... 1.25
330140.......................................................... 2.32
330141.......................................................... 2.43
330144.......................................................... 2.39
330148.......................................................... 1.69
330151.......................................................... 2.05
330152.......................................................... 2.43
330153.......................................................... 2.23
330154.......................................................... 2.17
330157.......................................................... 1.99
330158.......................................................... 2.47
330159.......................................................... 2.38
330160.......................................................... 2.09
330161.......................................................... 1.35
330162.......................................................... 3.96
330163.......................................................... 2.58
330164.......................................................... 1.88
330166.......................................................... 2.04
330167.......................................................... 3.17
330169.......................................................... 2.19
330171.......................................................... 2.56
330175.......................................................... 2.10
330177.......................................................... 1.91
330179.......................................................... 1.23
330180.......................................................... 1.95
330181.......................................................... 2.22
330182.......................................................... 3.70
330183.......................................................... 2.02
330184.......................................................... 2.37
330185.......................................................... 1.70
330186.......................................................... 0.62
330188.......................................................... 2.57
330189.......................................................... 7.27
330191.......................................................... 2.18
330193.......................................................... 2.64
330194.......................................................... 2.22
330195.......................................................... 2.31
330197.......................................................... 2.05
330198.......................................................... 2.35
330203.......................................................... 4.09
330205.......................................................... 2.12
330208.......................................................... 2.09
330209.......................................................... 2.27
330211.......................................................... 2.07
330212.......................................................... 2.39
330213.......................................................... 1.69
330214.......................................................... 2.42
330215.......................................................... 2.59
330218.......................................................... 1.87
330219.......................................................... 1.90
330221.......................................................... 2.14
330222.......................................................... 2.72
330223.......................................................... 1.98
330224.......................................................... 2.49
330225.......................................................... 2.34
330226.......................................................... 2.40
330229.......................................................... 2.03
330230.......................................................... 2.36
330232.......................................................... 2.08
330235.......................................................... 2.81
330236.......................................................... 2.04
330238.......................................................... 2.25
330239.......................................................... 2.16
330241.......................................................... 2.09
330245.......................................................... 2.24
330246.......................................................... 2.60
330249.......................................................... 2.04
330250.......................................................... 2.32
330252.......................................................... 1.16
330254.......................................................... 2.10
330258.......................................................... 1.48
330259.......................................................... 2.37
330261.......................................................... 2.47
330263.......................................................... 2.78
330264.......................................................... 2.34
330265.......................................................... 1.66
330267.......................................................... 2.16
330268.......................................................... 1.40
330270.......................................................... 1.94
330273.......................................................... 2.53
330275.......................................................... 1.99
330276.......................................................... 1.77
330277.......................................................... 2.31
330279.......................................................... 2.75
330285.......................................................... 2.09
330286.......................................................... 2.29
330288.......................................................... 1.01
330290.......................................................... 1.96
330293.......................................................... 1.61
330304.......................................................... 2.62
330306.......................................................... 1.92
330307.......................................................... 2.53
330308.......................................................... 2.77
330314.......................................................... 2.63
330316.......................................................... 3.26
330327.......................................................... 1.71
330331.......................................................... 2.29
330332.......................................................... 3.39
330333.......................................................... 3.09
330336.......................................................... 2.09
330338.......................................................... 2.72
330339.......................................................... 2.11
330340.......................................................... 2.53
330350.......................................................... 2.13
330353.......................................................... 2.88
330354.......................................................... 1.74
330357.......................................................... 2.06
330359.......................................................... 0.95
330372.......................................................... 2.87
330381.......................................................... 2.05
330386.......................................................... 1.99
330389.......................................................... 1.74
330390.......................................................... 1.39
330393.......................................................... 2.43
330394.......................................................... 2.50
330395.......................................................... 2.27
330397.......................................................... 1.48
330398.......................................................... 2.93
330399.......................................................... 1.38
331300.......................................................... 0.79
332012.......................................................... 1.34
332022.......................................................... 1.08
333025.......................................................... 1.23
333027.......................................................... 1.19
333028.......................................................... 0.89
333300.......................................................... 1.87
334002.......................................................... 1.55
334048.......................................................... 2.24
334055.......................................................... 1.59
340001.......................................................... 1.76
340002.......................................................... 3.52
340003.......................................................... 2.17
340004.......................................................... 2.78
340005.......................................................... 2.27
340006.......................................................... 1.85
340007.......................................................... 1.89
[[Page 18804]]
340008.......................................................... 2.17
340010.......................................................... 2.97
340011.......................................................... 1.80
340012.......................................................... 2.23
340013.......................................................... 1.88
340014.......................................................... 1.55
340015.......................................................... 2.89
340016.......................................................... 3.02
340017.......................................................... 2.73
340018.......................................................... 2.38
340019.......................................................... 1.73
340020.......................................................... 2.03
340021.......................................................... 2.55
340022.......................................................... 2.01
340023.......................................................... 1.95
340024.......................................................... 2.16
340025.......................................................... 2.66
340027.......................................................... 2.93
340028.......................................................... 2.42
340030.......................................................... 2.25
340031.......................................................... 2.08
340032.......................................................... 2.37
340035.......................................................... 2.22
340036.......................................................... 1.70
340037.......................................................... 1.77
340038.......................................................... 3.18
340039.......................................................... 2.57
340040.......................................................... 2.88
340041.......................................................... 1.93
340042.......................................................... 2.35
340044.......................................................... 1.73
340045.......................................................... 1.26
340047.......................................................... 2.39
340049.......................................................... 7.04
340050.......................................................... 2.41
340051.......................................................... 2.60
340052.......................................................... 1.84
340053.......................................................... 3.14
340054.......................................................... 2.59
340055.......................................................... 1.98
340060.......................................................... 2.27
340061.......................................................... 1.97
340063.......................................................... 1.40
340064.......................................................... 2.13
340065.......................................................... 2.01
340067.......................................................... 2.52
340068.......................................................... 2.46
340069.......................................................... 2.33
340070.......................................................... 2.66
340071.......................................................... 2.02
340072.......................................................... 2.29
340073.......................................................... 3.16
340075.......................................................... 2.12
340080.......................................................... 1.71
340084.......................................................... 1.83
340085.......................................................... 2.18
340087.......................................................... 2.01
340088.......................................................... 3.10
340089.......................................................... 1.58
340090.......................................................... 2.03
340091.......................................................... 2.88
340093.......................................................... 1.99
340094.......................................................... 3.53
340096.......................................................... 2.50
340097.......................................................... 2.52
340098.......................................................... 2.42
340099.......................................................... 2.05
340101.......................................................... 2.58
340104.......................................................... 1.67
340105.......................................................... 3.75
340106.......................................................... 1.71
340107.......................................................... 2.92
340109.......................................................... 3.44
340111.......................................................... 2.10
340112.......................................................... 1.77
340113.......................................................... 2.38
340114.......................................................... 2.00
340115.......................................................... 2.50
340116.......................................................... 2.78
340119.......................................................... 2.31
340120.......................................................... 1.91
340121.......................................................... 2.15
340123.......................................................... 2.13
340125.......................................................... 3.76
340126.......................................................... 2.61
340127.......................................................... 1.99
340129.......................................................... 2.51
340130.......................................................... 2.48
340131.......................................................... 2.69
340132.......................................................... 2.04
340133.......................................................... 1.57
340141.......................................................... 2.73
340142.......................................................... 2.13
340143.......................................................... 2.77
340144.......................................................... 2.72
340145.......................................................... 2.45
340146.......................................................... 1.90
340147.......................................................... 3.03
340148.......................................................... 4.19
340151.......................................................... 2.44
340153.......................................................... 3.95
340155.......................................................... 2.38
340158.......................................................... 2.82
340159.......................................................... 1.51
340160.......................................................... 2.47
340164.......................................................... 2.00
340166.......................................................... 2.10
340171.......................................................... 2.70
340173.......................................................... 2.50
341302.......................................................... 1.46
342003.......................................................... 1.39
342012.......................................................... 0.79
343025.......................................................... 1.71
344005.......................................................... 1.55
344006.......................................................... 1.55
344014.......................................................... 0.79
344015.......................................................... 1.55
344019.......................................................... 1.55
344020.......................................................... 1.55
350001.......................................................... 1.09
350002.......................................................... 3.66
350003.......................................................... 2.36
350004.......................................................... 3.95
350005.......................................................... 2.06
350006.......................................................... 1.99
350007.......................................................... 2.75
350008.......................................................... 1.73
350009.......................................................... 3.26
350010.......................................................... 3.09
350011.......................................................... 3.23
350012.......................................................... 2.13
350013.......................................................... 1.93
350014.......................................................... 2.06
350015.......................................................... 3.37
350016.......................................................... 1.18
350017.......................................................... 2.65
350018.......................................................... 2.58
350019.......................................................... 3.33
350020.......................................................... 1.45
350021.......................................................... 2.55
350023.......................................................... 2.01
350024.......................................................... 2.03
350025.......................................................... 1.13
350027.......................................................... 1.30
350029.......................................................... 1.36
350030.......................................................... 2.77
350033.......................................................... 2.00
350034.......................................................... 1.89
350035.......................................................... 0.85
350038.......................................................... 2.02
350039.......................................................... 2.08
350041.......................................................... 1.51
350042.......................................................... 3.25
350043.......................................................... 3.06
350044.......................................................... 1.70
350047.......................................................... 1.95
350049.......................................................... 2.14
350050.......................................................... 1.55
350051.......................................................... 1.58
350053.......................................................... 1.33
350055.......................................................... 1.22
350056.......................................................... 1.96
350058.......................................................... 1.71
350060.......................................................... 0.79
350061.......................................................... 2.56
360001.......................................................... 2.87
360002.......................................................... 2.52
360003.......................................................... 1.95
360006.......................................................... 3.15
360007.......................................................... 1.98
360008.......................................................... 2.28
360009.......................................................... 2.47
360010.......................................................... 2.48
360011.......................................................... 2.00
360012.......................................................... 2.85
360013.......................................................... 2.27
360014.......................................................... 2.61
360016.......................................................... 1.93
360017.......................................................... 3.43
360018.......................................................... 2.52
360019.......................................................... 2.10
360020.......................................................... 2.20
360021.......................................................... 5.55
360024.......................................................... 2.41
360025.......................................................... 2.09
360026.......................................................... 1.80
360027.......................................................... 2.46
360028.......................................................... 4.56
360029.......................................................... 2.63
360030.......................................................... 2.31
360031.......................................................... 2.13
360032.......................................................... 2.59
360034.......................................................... 1.96
360035.......................................................... 2.10
360036.......................................................... 2.35
360037.......................................................... 2.27
360039.......................................................... 2.26
360040.......................................................... 2.08
360041.......................................................... 2.24
360042.......................................................... 2.23
360044.......................................................... 2.19
360045.......................................................... 1.93
360046.......................................................... 2.34
360047.......................................................... 1.60
360048.......................................................... 2.31
360049.......................................................... 2.78
360050.......................................................... 1.54
360051.......................................................... 3.04
360052.......................................................... 2.41
360054.......................................................... 2.70
360055.......................................................... 2.55
360056.......................................................... 2.63
360057.......................................................... 1.74
[[Page 18805]]
360058.......................................................... 2.16
360059.......................................................... 1.67
360062.......................................................... 2.77
360063.......................................................... 1.73
360064.......................................................... 2.65
360065.......................................................... 2.22
360066.......................................................... 2.59
360067.......................................................... 1.77
360068.......................................................... 2.50
360069.......................................................... 1.86
360070.......................................................... 2.00
360071.......................................................... 2.46
360074.......................................................... 2.21
360075.......................................................... 2.27
360076.......................................................... 2.58
360077.......................................................... 2.38
360078.......................................................... 2.63
360079.......................................................... 2.90
360080.......................................................... 2.18
360081.......................................................... 2.32
360082.......................................................... 2.84
360083.......................................................... 2.23
360084.......................................................... 2.47
360085.......................................................... 2.81
360086.......................................................... 2.46
360087.......................................................... 2.34
360088.......................................................... 1.96
360089.......................................................... 2.20
360090.......................................................... 3.47
360091.......................................................... 2.34
360092.......................................................... 1.84
360093.......................................................... 3.05
360094.......................................................... 2.00
360095.......................................................... 2.72
360096.......................................................... 2.37
360098.......................................................... 3.04
360099.......................................................... 2.32
360100.......................................................... 2.58
360101.......................................................... 3.13
360102.......................................................... 2.70
360103.......................................................... 2.15
360106.......................................................... 1.68
360107.......................................................... 2.19
360108.......................................................... 1.72
360109.......................................................... 2.35
360112.......................................................... 2.63
360113.......................................................... 2.64
360114.......................................................... 2.18
360115.......................................................... 2.16
360116.......................................................... 1.88
360118.......................................................... 2.26
360121.......................................................... 2.88
360123.......................................................... 2.22
360125.......................................................... 1.75
360126.......................................................... 1.92
360127.......................................................... 2.27
360128.......................................................... 1.65
360129.......................................................... 1.77
360130.......................................................... 2.00
360131.......................................................... 2.25
360132.......................................................... 2.43
360133.......................................................... 2.66
360134.......................................................... 2.53
360136.......................................................... 1.62
360137.......................................................... 2.29
360140.......................................................... 1.73
360141.......................................................... 2.77
360142.......................................................... 1.99
360143.......................................................... 2.23
360144.......................................................... 2.68
360145.......................................................... 2.60
360147.......................................................... 2.27
360148.......................................................... 2.21
360149.......................................................... 2.65
360150.......................................................... 3.15
360151.......................................................... 2.60
360152.......................................................... 2.65
360153.......................................................... 1.88
360154.......................................................... 1.61
360155.......................................................... 2.64
360156.......................................................... 2.36
360159.......................................................... 2.16
360161.......................................................... 2.35
360162.......................................................... 1.75
360163.......................................................... 2.90
360164.......................................................... 1.72
360165.......................................................... 1.84
360166.......................................................... 1.67
360170.......................................................... 2.09
360172.......................................................... 2.93
360174.......................................................... 2.57
360175.......................................................... 2.58
360176.......................................................... 1.80
360177.......................................................... 1.52
360178.......................................................... 2.58
360179.......................................................... 2.31
360180.......................................................... 2.68
360184.......................................................... 1.65
360185.......................................................... 1.85
360186.......................................................... 1.54
360187.......................................................... 2.58
360188.......................................................... 1.82
360189.......................................................... 2.44
360192.......................................................... 2.28
360193.......................................................... 2.49
360194.......................................................... 2.25
360195.......................................................... 2.67
360197.......................................................... 1.98
360200.......................................................... 1.78
360203.......................................................... 2.43
360204.......................................................... 1.94
360210.......................................................... 2.67
360211.......................................................... 2.20
360212.......................................................... 2.03
360213.......................................................... 2.01
360218.......................................................... 2.40
360230.......................................................... 2.88
360231.......................................................... 1.46
360234.......................................................... 2.16
360236.......................................................... 2.41
360239.......................................................... 2.61
360241.......................................................... 1.27
360242.......................................................... 1.72
360243.......................................................... 1.55
360244.......................................................... 1.55
360245.......................................................... 1.58
362004.......................................................... 1.97
362007.......................................................... 0.47
362009.......................................................... 1.59
362014.......................................................... 7.33
362015.......................................................... 1.48
363300.......................................................... 1.97
363303.......................................................... 2.62
363305.......................................................... 1.94
363306.......................................................... 1.34
364003.......................................................... 1.64
364017.......................................................... 1.97
364029.......................................................... 1.64
364038.......................................................... 1.85
370001.......................................................... 3.25
370002.......................................................... 2.74
370004.......................................................... 2.77
370005.......................................................... 1.46
370006.......................................................... 2.59
370007.......................................................... 1.79
370008.......................................................... 2.75
370011.......................................................... 1.95
370012.......................................................... 1.29
370013.......................................................... 2.96
370014.......................................................... 2.86
370015.......................................................... 1.85
370016.......................................................... 2.53
370017.......................................................... 1.88
370018.......................................................... 3.22
370019.......................................................... 2.37
370020.......................................................... 2.21
370021.......................................................... 1.40
370022.......................................................... 2.97
370023.......................................................... 2.42
370025.......................................................... 2.44
370026.......................................................... 3.08
370028.......................................................... 3.11
370029.......................................................... 2.34
370030.......................................................... 1.95
370032.......................................................... 3.62
370033.......................................................... 2.56
370034.......................................................... 2.57
370035.......................................................... 1.78
370036.......................................................... 0.76
370037.......................................................... 3.69
370038.......................................................... 1.47
370039.......................................................... 1.91
370040.......................................................... 3.03
370041.......................................................... 1.70
370042.......................................................... 1.40
370043.......................................................... 1.12
370045.......................................................... 1.56
370046.......................................................... 2.02
370047.......................................................... 2.41
370048.......................................................... 1.96
370049.......................................................... 2.95
370051.......................................................... 1.31
370054.......................................................... 2.51
370056.......................................................... 2.70
370057.......................................................... 1.98
370059.......................................................... 1.02
370060.......................................................... 2.17
370063.......................................................... 1.38
370064.......................................................... 1.45
370065.......................................................... 2.50
370071.......................................................... 1.48
370072.......................................................... 1.33
370076.......................................................... 2.46
370077.......................................................... 1.96
370078.......................................................... 3.60
370079.......................................................... 1.78
370080.......................................................... 1.83
370082.......................................................... 1.29
370083.......................................................... 2.31
370084.......................................................... 1.53
370085.......................................................... 1.79
370086.......................................................... 2.26
370089.......................................................... 2.25
370091.......................................................... 3.07
370092.......................................................... 2.21
370093.......................................................... 4.35
370094.......................................................... 3.00
370095.......................................................... 1.37
370097.......................................................... 2.07
370099.......................................................... 2.06
370100.......................................................... 1.27
370103.......................................................... 1.60
370105.......................................................... 3.08
[[Page 18806]]
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370108.......................................................... 1.62
370112.......................................................... 1.52
370113.......................................................... 2.06
370114.......................................................... 3.04
370121.......................................................... 2.51
370122.......................................................... 0.92
370123.......................................................... 2.45
370125.......................................................... 1.86
370126.......................................................... 1.38
370131.......................................................... 1.27
370133.......................................................... 1.83
370138.......................................................... 2.30
370139.......................................................... 1.62
370140.......................................................... 1.92
370141.......................................................... 1.89
370146.......................................................... 2.19
370148.......................................................... 2.26
370149.......................................................... 2.90
370153.......................................................... 2.47
370154.......................................................... 2.61
370156.......................................................... 2.47
370158.......................................................... 1.66
370159.......................................................... 2.44
370163.......................................................... 1.25
370166.......................................................... 1.99
370169.......................................................... 1.88
370176.......................................................... 2.14
370177.......................................................... 1.53
370178.......................................................... 2.10
370179.......................................................... 1.49
370183.......................................................... 2.08
370186.......................................................... 2.55
370190.......................................................... 2.49
370192.......................................................... 2.87
372004.......................................................... 0.74
373025.......................................................... 0.87
373026.......................................................... 1.03
374008.......................................................... 1.84
374012.......................................................... 1.50
374013.......................................................... 1.36
374020.......................................................... 1.63
380001.......................................................... 2.80
380002.......................................................... 3.93
380004.......................................................... 3.63
380005.......................................................... 5.17
380006.......................................................... 2.75
380007.......................................................... 3.08
380008.......................................................... 1.66
380009.......................................................... 2.18
380010.......................................................... 1.76
380011.......................................................... 2.28
380013.......................................................... 1.59
380014.......................................................... 2.69
380017.......................................................... 3.80
380018.......................................................... 2.58
380019.......................................................... 1.83
380020.......................................................... 3.61
380021.......................................................... 2.54
380022.......................................................... 2.71
380023.......................................................... 2.43
380025.......................................................... 2.73
380026.......................................................... 2.33
380027.......................................................... 1.96
380029.......................................................... 2.14
380031.......................................................... 1.63
380033.......................................................... 3.16
380035.......................................................... 2.96
380036.......................................................... 2.44
380037.......................................................... 2.28
380038.......................................................... 2.93
380039.......................................................... 1.89
380040.......................................................... 2.17
380042.......................................................... 1.87
380047.......................................................... 3.63
380048.......................................................... 2.14
380050.......................................................... 2.51
380051.......................................................... 3.02
380052.......................................................... 2.57
380056.......................................................... 1.51
380060.......................................................... 2.44
380061.......................................................... 2.63
380062.......................................................... 0.92
380063.......................................................... 1.81
380064.......................................................... 1.96
380065.......................................................... 1.84
380066.......................................................... 2.92
380068.......................................................... 1.49
380069.......................................................... 1.80
380070.......................................................... 1.93
380071.......................................................... 3.34
380072.......................................................... 1.77
380075.......................................................... 3.14
380078.......................................................... 1.85
380081.......................................................... 0.99
380082.......................................................... 2.58
380083.......................................................... 2.44
380084.......................................................... 2.05
380087.......................................................... 2.42
380088.......................................................... 2.32
380089.......................................................... 2.73
380090.......................................................... 3.04
384006.......................................................... 1.63
390001.......................................................... 2.47
390002.......................................................... 2.56
390003.......................................................... 1.74
390004.......................................................... 2.56
390005.......................................................... 2.28
390006.......................................................... 1.65
390007.......................................................... 3.19
390008.......................................................... 1.94
390009.......................................................... 2.49
390010.......................................................... 2.64
390011.......................................................... 2.41
390012.......................................................... 2.54
390013.......................................................... 2.84
390015.......................................................... 1.97
390016.......................................................... 2.16
390017.......................................................... 2.14
390018.......................................................... 2.79
390019.......................................................... 2.23
390022.......................................................... 2.76
390023.......................................................... 1.75
390024.......................................................... 3.14
390025.......................................................... 1.03
390026.......................................................... 1.96
390028.......................................................... 3.01
390029.......................................................... 2.74
390030.......................................................... 2.19
390031.......................................................... 2.12
390032.......................................................... 2.28
390035.......................................................... 2.56
390036.......................................................... 2.57
390037.......................................................... 2.74
390039.......................................................... 2.41
390040.......................................................... 1.90
390041.......................................................... 2.86
390042.......................................................... 2.29
390043.......................................................... 3.02
390044.......................................................... 2.65
390045.......................................................... 2.41
390046.......................................................... 1.97
390047.......................................................... 2.50
390048.......................................................... 2.31
390049.......................................................... 2.71
390050.......................................................... 3.05
390051.......................................................... 2.65
390054.......................................................... 1.97
390055.......................................................... 2.73
390056.......................................................... 2.07
390057.......................................................... 2.39
390058.......................................................... 3.14
390060.......................................................... 1.70
390061.......................................................... 2.26
390062.......................................................... 2.85
390063.......................................................... 3.48
390065.......................................................... 2.31
390066.......................................................... 2.15
390067.......................................................... 2.55
390068.......................................................... 1.83
390069.......................................................... 2.13
390070.......................................................... 3.25
390071.......................................................... 2.72
390072.......................................................... 2.25
390073.......................................................... 2.60
390074.......................................................... 2.69
390075.......................................................... 3.05
390076.......................................................... 2.58
390078.......................................................... 2.98
390079.......................................................... 3.00
390080.......................................................... 2.35
390083.......................................................... 1.81
390084.......................................................... 1.68
390086.......................................................... 2.21
390088.......................................................... 2.14
390090.......................................................... 2.91
390091.......................................................... 2.29
390093.......................................................... 1.95
390095.......................................................... 2.40
390096.......................................................... 1.84
390097.......................................................... 2.39
390100.......................................................... 2.55
390101.......................................................... 1.69
390102.......................................................... 2.83
390103.......................................................... 2.11
390104.......................................................... 1.97
390106.......................................................... 2.06
390107.......................................................... 2.54
390108.......................................................... 2.53
390109.......................................................... 1.55
390110.......................................................... 2.16
390111.......................................................... 1.93
390112.......................................................... 2.21
390113.......................................................... 2.49
390114.......................................................... 2.33
390115.......................................................... 2.35
390116.......................................................... 2.31
390118.......................................................... 2.79
390119.......................................................... 2.51
390121.......................................................... 2.47
390122.......................................................... 2.04
390123.......................................................... 2.99
390125.......................................................... 2.33
390127.......................................................... 2.58
390128.......................................................... 2.85
390130.......................................................... 2.18
390131.......................................................... 2.60
390132.......................................................... 2.08
390133.......................................................... 2.68
390135.......................................................... 2.13
390136.......................................................... 3.85
390137.......................................................... 2.44
390138.......................................................... 2.22
[[Page 18807]]
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390142.......................................................... 1.93
390145.......................................................... 2.38
390146.......................................................... 2.04
390147.......................................................... 2.44
390150.......................................................... 1.94
390151.......................................................... 2.55
390153.......................................................... 1.96
390154.......................................................... 2.36
390155.......................................................... 1.31
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390157.......................................................... 2.50
390158.......................................................... 2.42
390160.......................................................... 2.91
390161.......................................................... 2.26
390162.......................................................... 2.25
390163.......................................................... 2.38
390164.......................................................... 2.12
390166.......................................................... 1.76
390167.......................................................... 2.18
390168.......................................................... 2.13
390169.......................................................... 3.11
390173.......................................................... 2.08
390174.......................................................... 2.42
390176.......................................................... 2.22
390178.......................................................... 2.55
390179.......................................................... 2.33
390180.......................................................... 2.38
390181.......................................................... 2.39
390183.......................................................... 2.61
390184.......................................................... 1.63
390185.......................................................... 2.85
390189.......................................................... 2.30
390191.......................................................... 3.17
390192.......................................................... 2.03
390193.......................................................... 2.60
390194.......................................................... 2.57
390195.......................................................... 2.89
390196.......................................................... 2.16
390197.......................................................... 3.10
390198.......................................................... 1.87
390199.......................................................... 1.79
390200.......................................................... 1.50
390201.......................................................... 2.23
390203.......................................................... 2.59
390204.......................................................... 2.50
390205.......................................................... 2.42
390206.......................................................... 2.05
390209.......................................................... 2.00
390211.......................................................... 2.74
390213.......................................................... 1.07
390215.......................................................... 2.28
390217.......................................................... 2.20
390219.......................................................... 1.91
390222.......................................................... 2.84
390223.......................................................... 2.25
390224.......................................................... 1.69
390225.......................................................... 2.31
390226.......................................................... 2.31
390228.......................................................... 2.24
390231.......................................................... 2.19
390233.......................................................... 2.03
390235.......................................................... 1.87
390236.......................................................... 2.15
390237.......................................................... 2.25
390238.......................................................... 2.43
390242.......................................................... 2.48
390244.......................................................... 1.01
390245.......................................................... 2.18
390246.......................................................... 2.44
390247.......................................................... 1.13
390249.......................................................... 1.13
390256.......................................................... 1.87
390258.......................................................... 2.45
390260.......................................................... 3.75
390262.......................................................... 2.73
390263.......................................................... 3.02
390265.......................................................... 1.57
390266.......................................................... 3.04
390267.......................................................... 2.67
390268.......................................................... 2.66
390270.......................................................... 2.58
390277.......................................................... 1.31
390279.......................................................... 2.40
392024.......................................................... 1.64
392025.......................................................... 1.76
392026.......................................................... 1.18
393025.......................................................... 1.38
393026.......................................................... 1.77
393027.......................................................... 1.99
393031.......................................................... 1.67
393032.......................................................... 0.55
393035.......................................................... 0.94
393037.......................................................... 1.55
393038.......................................................... 1.90
393039.......................................................... 1.10
393040.......................................................... 3.59
393041.......................................................... 2.26
393042.......................................................... 1.77
393043.......................................................... 0.98
393301.......................................................... 1.73
393302.......................................................... 1.58
394006.......................................................... 1.55
394007.......................................................... 1.84
394008.......................................................... 3.26
394020.......................................................... 1.36
394023.......................................................... 1.57
394027.......................................................... 1.48
394034.......................................................... 1.56
394040.......................................................... 1.32
394041.......................................................... 1.32
400001.......................................................... 1.65
400002.......................................................... 3.95
400003.......................................................... 1.58
400004.......................................................... 2.04
400005.......................................................... 1.76
400006.......................................................... 2.56
400007.......................................................... 1.11
400009.......................................................... 1.87
400011.......................................................... 2.39
400012.......................................................... 1.22
400013.......................................................... 1.42
400014.......................................................... 4.78
400016.......................................................... 1.87
400017.......................................................... 2.13
400018.......................................................... 1.39
400019.......................................................... 3.28
400021.......................................................... 1.94
400022.......................................................... 1.95
400027.......................................................... 0.88
400028.......................................................... 1.61
400029.......................................................... 1.12
400032.......................................................... 1.18
400094.......................................................... 1.13
400098.......................................................... 1.40
400102.......................................................... 2.07
400106.......................................................... 1.60
400109.......................................................... 2.06
400111.......................................................... 1.37
400113.......................................................... 1.87
400114.......................................................... 1.46
400115.......................................................... 1.22
400117.......................................................... 2.22
400118.......................................................... 1.89
400120.......................................................... 2.38
400122.......................................................... 0.96
400123.......................................................... 3.95
400124.......................................................... 7.82
404002.......................................................... 2.72
410001.......................................................... 2.29
410004.......................................................... 2.02
410005.......................................................... 2.79
410006.......................................................... 2.27
410007.......................................................... 2.55
410008.......................................................... 2.54
410009.......................................................... 3.00
410010.......................................................... 1.89
410011.......................................................... 2.36
410012.......................................................... 2.67
410013.......................................................... 2.56
413025.......................................................... 1.27
414000.......................................................... 2.21
420002.......................................................... 2.54
420004.......................................................... 1.95
420005.......................................................... 2.12
420006.......................................................... 1.29
420007.......................................................... 2.64
420009.......................................................... 2.81
420010.......................................................... 2.45
420011.......................................................... 1.83
420014.......................................................... 1.46
420015.......................................................... 2.47
420016.......................................................... 1.79
420018.......................................................... 1.96
420019.......................................................... 1.99
420020.......................................................... 2.50
420023.......................................................... 3.02
420026.......................................................... 3.87
420027.......................................................... 2.27
420030.......................................................... 2.23
420031.......................................................... 1.44
420033.......................................................... 1.98
420036.......................................................... 2.60
420037.......................................................... 1.83
420038.......................................................... 1.72
420039.......................................................... 1.93
420042.......................................................... 1.80
420043.......................................................... 2.20
420048.......................................................... 2.30
420049.......................................................... 2.77
420051.......................................................... 2.47
420053.......................................................... 2.35
420054.......................................................... 1.72
420055.......................................................... 1.70
420056.......................................................... 2.74
420057.......................................................... 1.84
420059.......................................................... 1.59
420061.......................................................... 1.94
420062.......................................................... 2.34
420064.......................................................... 1.64
420065.......................................................... 2.89
420066.......................................................... 2.05
420067.......................................................... 3.28
420068.......................................................... 2.98
420069.......................................................... 1.67
420070.......................................................... 2.46
420071.......................................................... 2.61
420072.......................................................... 1.34
420073.......................................................... 2.64
420074.......................................................... 1.17
420075.......................................................... 1.89
420078.......................................................... 2.77
420079.......................................................... 1.83
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420082.......................................................... 2.46
420083.......................................................... 3.56
420085.......................................................... 2.11
420086.......................................................... 2.53
420087.......................................................... 2.67
420088.......................................................... 2.69
420089.......................................................... 2.78
420091.......................................................... 2.90
420093.......................................................... 1.72
423025.......................................................... 2.87
423026.......................................................... 1.85
424006.......................................................... 1.55
424008.......................................................... 1.55
424010.......................................................... 1.72
430004.......................................................... 1.93
430005.......................................................... 2.85
430007.......................................................... 2.59
430008.......................................................... 2.76
430010.......................................................... 2.44
430011.......................................................... 3.17
430012.......................................................... 3.67
430013.......................................................... 3.09
430014.......................................................... 2.74
430015.......................................................... 3.04
430016.......................................................... 2.68
430018.......................................................... 1.52
430022.......................................................... 1.19
430023.......................................................... 1.38
430024.......................................................... 1.09
430026.......................................................... 1.24
430027.......................................................... 3.97
430028.......................................................... 2.58
430029.......................................................... 1.96
430031.......................................................... 1.74
430033.......................................................... 1.72
430034.......................................................... 1.42
430036.......................................................... 2.00
430037.......................................................... 1.34
430038.......................................................... 2.55
430040.......................................................... 2.03
430041.......................................................... 1.71
430043.......................................................... 2.19
430044.......................................................... 1.45
430047.......................................................... 1.89
430048.......................................................... 2.33
430049.......................................................... 1.38
430051.......................................................... 1.03
430054.......................................................... 1.91
430056.......................................................... 1.34
430057.......................................................... 1.61
430060.......................................................... 1.05
430062.......................................................... 1.79
430064.......................................................... 1.98
430065.......................................................... 1.41
430066.......................................................... 1.16
430073.......................................................... 1.69
430076.......................................................... 1.05
430077.......................................................... 3.25
430079.......................................................... 1.00
430087.......................................................... 1.15
434004.......................................................... 1.77
440001.......................................................... 1.78
440002.......................................................... 3.88
440003.......................................................... 2.91
440006.......................................................... 3.43
440007.......................................................... 1.27
440008.......................................................... 2.51
440009.......................................................... 3.09
440010.......................................................... 1.83
440011.......................................................... 2.47
440012.......................................................... 1.94
440014.......................................................... 1.65
440015.......................................................... 3.03
440016.......................................................... 2.08
440017.......................................................... 2.53
440018.......................................................... 1.62
440019.......................................................... 2.59
440020.......................................................... 2.08
440023.......................................................... 1.65
440024.......................................................... 3.03
440025.......................................................... 2.28
440026.......................................................... 0.96
440029.......................................................... 3.02
440030.......................................................... 3.03
440031.......................................................... 2.41
440032.......................................................... 1.55
440033.......................................................... 1.95
440034.......................................................... 2.66
440035.......................................................... 2.55
440039.......................................................... 2.24
440040.......................................................... 1.63
440041.......................................................... 1.78
440046.......................................................... 2.60
440047.......................................................... 1.87
440048.......................................................... 3.27
440049.......................................................... 2.65
440050.......................................................... 2.49
440051.......................................................... 1.73
440052.......................................................... 1.62
440053.......................................................... 3.01
440054.......................................................... 2.09
440056.......................................................... 1.86
440057.......................................................... 1.98
440058.......................................................... 3.01
440059.......................................................... 2.48
440060.......................................................... 1.61
440061.......................................................... 2.13
440063.......................................................... 2.77
440064.......................................................... 1.83
440065.......................................................... 2.45
440067.......................................................... 2.80
440068.......................................................... 2.52
440070.......................................................... 1.77
440071.......................................................... 2.56
440072.......................................................... 2.79
440073.......................................................... 2.64
440078.......................................................... 1.68
440081.......................................................... 2.03
440082.......................................................... 2.82
440083.......................................................... 1.67
440084.......................................................... 1.44
440090.......................................................... 1.66
440091.......................................................... 3.29
440100.......................................................... 1.89
440102.......................................................... 1.95
440103.......................................................... 2.48
440104.......................................................... 2.70
440105.......................................................... 6.65
440109.......................................................... 2.02
440110.......................................................... 2.05
440111.......................................................... 1.34
440114.......................................................... 1.96
440115.......................................................... 1.91
440120.......................................................... 3.52
440125.......................................................... 2.79
440130.......................................................... 2.95
440131.......................................................... 2.77
440132.......................................................... 2.22
440133.......................................................... 3.04
440135.......................................................... 2.23
440137.......................................................... 2.14
440141.......................................................... 1.11
440142.......................................................... 1.45
440143.......................................................... 1.64
440144.......................................................... 3.94
440145.......................................................... 1.38
440147.......................................................... 7.20
440148.......................................................... 2.45
440149.......................................................... 1.54
440150.......................................................... 3.46
440151.......................................................... 1.93
440152.......................................................... 1.65
440153.......................................................... 2.05
440156.......................................................... 3.10
440157.......................................................... 1.61
440159.......................................................... 2.28
440161.......................................................... 3.68
440162.......................................................... 1.33
440166.......................................................... 2.69
440168.......................................................... 2.48
440173.......................................................... 4.08
440174.......................................................... 2.07
440175.......................................................... 2.60
440176.......................................................... 3.06
440178.......................................................... 2.28
440180.......................................................... 1.76
440181.......................................................... 1.99
440182.......................................................... 2.30
440183.......................................................... 3.34
440184.......................................................... 3.08
440185.......................................................... 2.49
440186.......................................................... 2.23
440187.......................................................... 1.94
440189.......................................................... 3.47
440192.......................................................... 1.80
440193.......................................................... 3.20
440194.......................................................... 2.14
440197.......................................................... 2.76
440200.......................................................... 2.02
440203.......................................................... 1.96
440205.......................................................... 1.46
440206.......................................................... 1.95
440211.......................................................... 1.50
442007.......................................................... 0.93
443025.......................................................... 1.69
443026.......................................................... 1.27
443029.......................................................... 3.28
444003.......................................................... 1.36
444004.......................................................... 1.56
444006.......................................................... 1.50
444010.......................................................... 1.47
444011.......................................................... 1.70
444012.......................................................... 1.48
450002.......................................................... 2.42
450004.......................................................... 1.82
450005.......................................................... 2.10
450007.......................................................... 2.96
450008.......................................................... 1.81
450010.......................................................... 2.54
450011.......................................................... 2.92
450014.......................................................... 1.79
450015.......................................................... 1.30
450016.......................................................... 3.15
450018.......................................................... 1.54
450020.......................................................... 2.19
450021.......................................................... 1.91
450023.......................................................... 2.67
450024.......................................................... 1.59
450025.......................................................... 2.88
450028.......................................................... 2.44
450029.......................................................... 2.05
450031.......................................................... 2.15
[[Page 18809]]
450032.......................................................... 1.58
450033.......................................................... 2.00
450034.......................................................... 2.20
450037.......................................................... 2.45
450039.......................................................... 1.15
450040.......................................................... 2.06
450042.......................................................... 2.28
450044.......................................................... 2.42
450046.......................................................... 2.83
450047.......................................................... 2.39
450050.......................................................... 1.32
450051.......................................................... 1.88
450052.......................................................... 1.52
450053.......................................................... 2.39
450054.......................................................... 3.44
450055.......................................................... 1.76
450056.......................................................... 3.27
450058.......................................................... 3.45
450059.......................................................... 2.75
450063.......................................................... 0.93
450064.......................................................... 2.96
450065.......................................................... 1.66
450068.......................................................... 2.03
450072.......................................................... 2.31
450073.......................................................... 1.43
450076.......................................................... 1.74
450078.......................................................... 1.20
450079.......................................................... 2.85
450080.......................................................... 3.06
450081.......................................................... 1.93
450082.......................................................... 1.66
450083.......................................................... 3.49
450085.......................................................... 1.74
450087.......................................................... 1.92
450090.......................................................... 2.50
450092.......................................................... 1.92
450094.......................................................... 2.64
450096.......................................................... 1.90
450097.......................................................... 3.26
450098.......................................................... 1.14
450099.......................................................... 2.07
450101.......................................................... 2.56
450102.......................................................... 3.28
450104.......................................................... 2.89
450107.......................................................... 2.09
450108.......................................................... 1.34
450109.......................................................... 1.62
450111.......................................................... 2.55
450112.......................................................... 2.73
450113.......................................................... 2.75
450118.......................................................... 3.27
450119.......................................................... 2.49
450121.......................................................... 2.67
450123.......................................................... 1.81
450124.......................................................... 2.19
450126.......................................................... 1.79
450128.......................................................... 1.96
450130.......................................................... 3.66
450131.......................................................... 1.87
450132.......................................................... 2.27
450133.......................................................... 2.37
450135.......................................................... 2.53
450137.......................................................... 2.28
450140.......................................................... 1.45
450142.......................................................... 2.07
450143.......................................................... 1.77
450144.......................................................... 1.72
450145.......................................................... 1.28
450146.......................................................... 0.96
450147.......................................................... 1.94
450148.......................................................... 2.31
450149.......................................................... 2.01
450150.......................................................... 1.68
450151.......................................................... 1.53
450152.......................................................... 2.31
450153.......................................................... 2.31
450154.......................................................... 1.65
450155.......................................................... 1.62
450157.......................................................... 1.35
450160.......................................................... 1.92
450162.......................................................... 2.04
450163.......................................................... 1.73
450164.......................................................... 1.25
450165.......................................................... 1.80
450166.......................................................... 0.89
450170.......................................................... 1.58
450176.......................................................... 2.39
450177.......................................................... 2.15
450178.......................................................... 1.45
450181.......................................................... 1.30
450184.......................................................... 3.00
450185.......................................................... 1.48
450187.......................................................... 2.15
450188.......................................................... 1.85
450190.......................................................... 2.93
450191.......................................................... 2.63
450192.......................................................... 1.73
450193.......................................................... 3.90
450194.......................................................... 2.36
450196.......................................................... 2.70
450200.......................................................... 2.44
450201.......................................................... 2.12
450203.......................................................... 1.91
450209.......................................................... 1.87
450210.......................................................... 1.70
450211.......................................................... 2.35
450213.......................................................... 1.41
450214.......................................................... 2.68
450217.......................................................... 1.03
450219.......................................................... 2.18
450221.......................................................... 1.26
450222.......................................................... 2.43
450224.......................................................... 1.98
450229.......................................................... 2.67
450231.......................................................... 2.88
450234.......................................................... 1.46
450235.......................................................... 2.06
450236.......................................................... 2.65
450237.......................................................... 1.91
450239.......................................................... 1.44
450241.......................................................... 1.30
450243.......................................................... 1.51
450246.......................................................... 1.41
450249.......................................................... 1.26
450250.......................................................... 1.24
450253.......................................................... 2.53
450258.......................................................... 1.10
450259.......................................................... 2.23
450264.......................................................... 0.95
450269.......................................................... 1.27
450270.......................................................... 1.51
450271.......................................................... 1.29
450272.......................................................... 2.97
450276.......................................................... 1.49
450278.......................................................... 1.31
450280.......................................................... 1.89
450283.......................................................... 1.44
450286.......................................................... 1.18
450288.......................................................... 1.62
450289.......................................................... 1.10
450292.......................................................... 1.86
450293.......................................................... 1.74
450296.......................................................... 2.21
450299.......................................................... 2.38
450303.......................................................... 1.01
450306.......................................................... 3.74
450307.......................................................... 0.96
450309.......................................................... 1.55
450315.......................................................... 2.78
450320.......................................................... 1.95
450321.......................................................... 1.19
450322.......................................................... 0.95
450324.......................................................... 2.31
450327.......................................................... 0.99
450330.......................................................... 1.72
450334.......................................................... 1.11
450337.......................................................... 1.43
450340.......................................................... 2.59
450341.......................................................... 1.92
450346.......................................................... 2.03
450347.......................................................... 2.42
450348.......................................................... 1.19
450351.......................................................... 4.30
450352.......................................................... 2.28
450353.......................................................... 1.76
450355.......................................................... 1.19
450358.......................................................... 2.70
450362.......................................................... 2.54
450369.......................................................... 1.65
450370.......................................................... 4.89
450371.......................................................... 2.14
450372.......................................................... 2.85
450373.......................................................... 1.30
450374.......................................................... 1.01
450376.......................................................... 2.42
450378.......................................................... 1.88
450379.......................................................... 2.51
450388.......................................................... 2.86
450389.......................................................... 1.82
450393.......................................................... 1.90
450395.......................................................... 1.59
450399.......................................................... 1.01
450400.......................................................... 1.84
450403.......................................................... 1.86
450411.......................................................... 1.60
450417.......................................................... 1.87
450419.......................................................... 1.63
450423.......................................................... 2.53
450424.......................................................... 2.48
450429.......................................................... 0.92
450431.......................................................... 3.06
450438.......................................................... 2.81
450446.......................................................... 1.56
450447.......................................................... 3.17
450451.......................................................... 2.28
450457.......................................................... 3.06
450460.......................................................... 1.80
450462.......................................................... 2.18
450464.......................................................... 1.52
450465.......................................................... 3.29
450467.......................................................... 1.51
450469.......................................................... 2.86
450473.......................................................... 1.18
450475.......................................................... 2.34
450484.......................................................... 2.35
450488.......................................................... 1.99
450489.......................................................... 1.16
450497.......................................................... 1.87
450498.......................................................... 2.36
450508.......................................................... 1.98
450514.......................................................... 2.23
450517.......................................................... 1.38
450518.......................................................... 2.21
[[Page 18810]]
450523.......................................................... 2.86
450530.......................................................... 2.51
450534.......................................................... 1.19
450535.......................................................... 2.43
450537.......................................................... 1.99
450538.......................................................... 1.73
450539.......................................................... 2.51
450544.......................................................... 2.04
450545.......................................................... 3.67
450547.......................................................... 1.58
450550.......................................................... 2.14
450551.......................................................... 2.35
450558.......................................................... 2.15
450559.......................................................... 1.17
450561.......................................................... 2.38
450563.......................................................... 2.67
450565.......................................................... 2.26
450570.......................................................... 1.54
450571.......................................................... 2.72
450573.......................................................... 1.71
450574.......................................................... 0.86
450575.......................................................... 1.23
450578.......................................................... 0.99
450580.......................................................... 2.31
450583.......................................................... 1.05
450584.......................................................... 1.81
450586.......................................................... 1.68
450587.......................................................... 2.02
450591.......................................................... 2.79
450596.......................................................... 2.40
450597.......................................................... 1.62
450603.......................................................... 1.13
450604.......................................................... 2.50
450605.......................................................... 2.09
450609.......................................................... 1.13
450610.......................................................... 2.61
450614.......................................................... 1.50
450615.......................................................... 2.10
450617.......................................................... 2.32
450620.......................................................... 1.54
450623.......................................................... 1.90
450626.......................................................... 1.25
450628.......................................................... 1.23
450630.......................................................... 2.13
450631.......................................................... 2.35
450632.......................................................... 0.82
450633.......................................................... 2.66
450634.......................................................... 2.74
450638.......................................................... 3.03
450639.......................................................... 2.56
450641.......................................................... 1.78
450643.......................................................... 2.22
450644.......................................................... 2.61
450646.......................................................... 2.30
450647.......................................................... 3.16
450648.......................................................... 1.81
450649.......................................................... 1.41
450651.......................................................... 2.23
450652.......................................................... 1.56
450653.......................................................... 2.45
450654.......................................................... 1.13
450656.......................................................... 2.67
450658.......................................................... 1.99
450659.......................................................... 2.45
450661.......................................................... 3.17
450662.......................................................... 1.88
450665.......................................................... 1.72
450666.......................................................... 2.05
450668.......................................................... 2.88
450669.......................................................... 2.34
450670.......................................................... 2.50
450672.......................................................... 2.85
450673.......................................................... 1.27
450675.......................................................... 2.26
450677.......................................................... 2.45
450678.......................................................... 2.78
450683.......................................................... 2.31
450684.......................................................... 1.97
450686.......................................................... 2.30
450688.......................................................... 2.14
450690.......................................................... 1.61
450694.......................................................... 2.52
450696.......................................................... 10.88
450697.......................................................... 2.05
450698.......................................................... 0.96
450700.......................................................... 1.29
450702.......................................................... 2.40
450703.......................................................... 1.31
450704.......................................................... 2.26
450706.......................................................... 2.28
450709.......................................................... 3.05
450711.......................................................... 2.54
450712.......................................................... 1.58
450713.......................................................... 2.33
450715.......................................................... 1.66
450716.......................................................... 2.68
450717.......................................................... 2.11
450718.......................................................... 2.38
450723.......................................................... 1.91
450724.......................................................... 3.75
450725.......................................................... 1.74
450727.......................................................... 1.83
450730.......................................................... 2.19
450733.......................................................... 2.48
450735.......................................................... 0.61
450742.......................................................... 2.28
450743.......................................................... 2.99
450746.......................................................... 1.40
450747.......................................................... 2.66
450749.......................................................... 1.10
450750.......................................................... 1.49
450754.......................................................... 1.70
450755.......................................................... 1.77
450757.......................................................... 1.05
450758.......................................................... 2.25
450760.......................................................... 2.56
450761.......................................................... 1.23
450763.......................................................... 1.79
450766.......................................................... 5.91
450769.......................................................... 1.09
450770.......................................................... 1.31
450771.......................................................... 2.19
450774.......................................................... 5.04
450775.......................................................... 2.38
450776.......................................................... 1.42
450777.......................................................... 1.59
450779.......................................................... 2.04
450780.......................................................... 6.29
450788.......................................................... 1.88
450795.......................................................... 0.95
450797.......................................................... 9.66
450798.......................................................... 0.52
450801.......................................................... 2.59
450802.......................................................... 3.03
450803.......................................................... 1.09
450804.......................................................... 6.10
450809.......................................................... 2.33
450811.......................................................... 4.24
450813.......................................................... 0.96
452013.......................................................... 0.96
452019.......................................................... 2.02
452022.......................................................... 0.50
452033.......................................................... 0.99
452036.......................................................... 0.68
452038.......................................................... 1.47
452039.......................................................... 2.99
452043.......................................................... 0.99
453025.......................................................... 1.24
453028.......................................................... 0.80
453029.......................................................... 1.16
453031.......................................................... 1.67
453033.......................................................... 0.76
453034.......................................................... 1.11
453035.......................................................... 2.14
453036.......................................................... 1.94
453037.......................................................... 1.55
453038.......................................................... 1.38
453040.......................................................... 1.31
453041.......................................................... 0.98
453042.......................................................... 1.12
453044.......................................................... 2.33
453047.......................................................... 1.22
453048.......................................................... 1.07
453052.......................................................... 1.56
453053.......................................................... 1.56
453054.......................................................... 1.70
453055.......................................................... 1.15
453056.......................................................... 1.64
453057.......................................................... 1.41
453059.......................................................... 0.79
453065.......................................................... 3.51
453070.......................................................... 1.94
453071.......................................................... 1.31
453072.......................................................... 0.83
453074.......................................................... 1.48
453300.......................................................... 1.36
453302.......................................................... 1.48
453304.......................................................... 1.75
453305.......................................................... 1.03
454012.......................................................... 1.55
454018.......................................................... 1.55
454026.......................................................... 1.50
454028.......................................................... 1.56
454029.......................................................... 2.26
454030.......................................................... 1.55
454031.......................................................... 1.46
454032.......................................................... 1.41
454034.......................................................... 1.19
454038.......................................................... 1.55
454042.......................................................... 1.54
454043.......................................................... 1.55
454045.......................................................... 1.61
454046.......................................................... 1.55
454050.......................................................... 1.55
454051.......................................................... 1.55
454056.......................................................... 1.85
454057.......................................................... 1.59
454058.......................................................... 1.55
454063.......................................................... 1.43
454064.......................................................... 1.55
454065.......................................................... 1.60
454066.......................................................... 1.57
454069.......................................................... 3.09
454072.......................................................... 1.55
454073.......................................................... 2.07
454078.......................................................... 1.55
454086.......................................................... 1.64
454089.......................................................... 1.59
460001.......................................................... 3.01
460003.......................................................... 3.25
460004.......................................................... 2.54
460005.......................................................... 2.52
460006.......................................................... 3.82
[[Page 18811]]
460007.......................................................... 2.96
460008.......................................................... 2.63
460010.......................................................... 2.49
460011.......................................................... 2.23
460013.......................................................... 2.78
460014.......................................................... 1.34
460015.......................................................... 2.90
460016.......................................................... 1.45
460017.......................................................... 3.22
460018.......................................................... 1.64
460019.......................................................... 2.15
460020.......................................................... 1.91
460021.......................................................... 2.21
460022.......................................................... 1.38
460023.......................................................... 3.19
460024.......................................................... 1.13
460026.......................................................... 2.02
460027.......................................................... 1.60
460029.......................................................... 1.95
460030.......................................................... 1.97
460033.......................................................... 1.71
460035.......................................................... 1.25
460036.......................................................... 2.22
460037.......................................................... 2.00
460039.......................................................... 1.74
460041.......................................................... 2.92
460042.......................................................... 2.75
460044.......................................................... 2.19
460047.......................................................... 1.87
460050.......................................................... 2.05
463025.......................................................... 1.62
463301.......................................................... 2.49
464003.......................................................... 1.55
464010.......................................................... 1.49
470001.......................................................... 2.03
470003.......................................................... 2.64
470004.......................................................... 1.61
470005.......................................................... 2.36
470006.......................................................... 2.57
470008.......................................................... 1.91
470010.......................................................... 1.97
470011.......................................................... 2.35
470012.......................................................... 2.92
470015.......................................................... 2.00
470018.......................................................... 2.08
470020.......................................................... 1.21
470023.......................................................... 2.58
470024.......................................................... 2.14
474001.......................................................... 1.00
480001.......................................................... 1.71
480002.......................................................... 2.28
490001.......................................................... 1.65
490002.......................................................... 1.67
490004.......................................................... 2.35
490005.......................................................... 2.56
490006.......................................................... 2.26
490007.......................................................... 2.58
490009.......................................................... 1.92
490011.......................................................... 2.79
490012.......................................................... 1.55
490013.......................................................... 2.66
490014.......................................................... 1.99
490015.......................................................... 3.19
490017.......................................................... 2.89
490018.......................................................... 2.98
490019.......................................................... 2.31
490020.......................................................... 2.71
490021.......................................................... 4.47
490022.......................................................... 2.51
490023.......................................................... 2.38
490024.......................................................... 2.41
490027.......................................................... 1.99
490030.......................................................... 2.72
490031.......................................................... 1.99
490032.......................................................... 1.79
490033.......................................................... 1.86
490035.......................................................... 2.24
490037.......................................................... 2.53
490038.......................................................... 2.45
490040.......................................................... 3.17
490041.......................................................... 3.49
490042.......................................................... 2.44
490043.......................................................... 2.05
490044.......................................................... 2.36
490045.......................................................... 2.18
490046.......................................................... 3.14
490047.......................................................... 1.54
490048.......................................................... 2.50
490050.......................................................... 2.83
490052.......................................................... 2.52
490053.......................................................... 3.03
490054.......................................................... 1.53
490057.......................................................... 2.55
490059.......................................................... 3.37
490060.......................................................... 2.50
490063.......................................................... 3.91
490066.......................................................... 2.69
490067.......................................................... 2.92
490069.......................................................... 1.47
490071.......................................................... 3.11
490073.......................................................... 3.88
490074.......................................................... 4.12
490075.......................................................... 2.71
490077.......................................................... 2.70
490079.......................................................... 2.29
490084.......................................................... 2.34
490085.......................................................... 2.06
490088.......................................................... 2.76
490089.......................................................... 1.66
490090.......................................................... 2.56
490091.......................................................... 2.51
490092.......................................................... 2.40
490093.......................................................... 2.47
490094.......................................................... 1.80
490095.......................................................... 2.26
490097.......................................................... 2.14
490098.......................................................... 2.23
490099.......................................................... 1.15
490100.......................................................... 3.77
490101.......................................................... 2.60
490107.......................................................... 3.12
490110.......................................................... 3.44
490111.......................................................... 2.35
490112.......................................................... 2.51
490113.......................................................... 2.59
490114.......................................................... 1.71
490115.......................................................... 2.14
490116.......................................................... 2.10
490117.......................................................... 1.36
490118.......................................................... 2.66
490119.......................................................... 2.87
490120.......................................................... 2.67
490122.......................................................... 2.96
490123.......................................................... 2.48
490124.......................................................... 2.04
490126.......................................................... 2.43
490127.......................................................... 1.71
490130.......................................................... 2.18
490131.......................................................... 1.76
490132.......................................................... 1.35
492001.......................................................... 0.79
493025.......................................................... 1.33
493026.......................................................... 0.95
493027.......................................................... 2.22
493301.......................................................... 1.92
494001.......................................................... 1.55
494002.......................................................... 2.09
494011.......................................................... 1.32
494012.......................................................... 1.32
494016.......................................................... 1.61
494018.......................................................... 1.58
494020.......................................................... 1.55
494022.......................................................... 1.54
494023.......................................................... 1.49
494025.......................................................... 1.51
494026.......................................................... 1.56
494028.......................................................... 1.55
500001.......................................................... 2.76
500002.......................................................... 2.28
500003.......................................................... 2.52
500005.......................................................... 2.36
500007.......................................................... 3.32
500008.......................................................... 1.76
500011.......................................................... 2.06
500012.......................................................... 2.89
500014.......................................................... 2.81
500015.......................................................... 2.18
500016.......................................................... 2.18
500019.......................................................... 2.86
500021.......................................................... 2.40
500023.......................................................... 2.26
500024.......................................................... 4.42
500025.......................................................... 3.38
500026.......................................................... 2.35
500027.......................................................... 3.25
500028.......................................................... 1.40
500029.......................................................... 1.05
500030.......................................................... 2.75
500031.......................................................... 2.22
500033.......................................................... 2.86
500036.......................................................... 2.81
500037.......................................................... 1.78
500039.......................................................... 3.11
500041.......................................................... 2.44
500042.......................................................... 3.48
500043.......................................................... 1.89
500044.......................................................... 2.71
500045.......................................................... 2.58
500048.......................................................... 1.78
500049.......................................................... 3.44
500050.......................................................... 2.66
500051.......................................................... 2.50
500053.......................................................... 2.46
500054.......................................................... 2.75
500055.......................................................... 1.92
500057.......................................................... 2.86
500058.......................................................... 2.71
500059.......................................................... 2.44
500060.......................................................... 2.27
500061.......................................................... 1.20
500062.......................................................... 1.05
500064.......................................................... 1.39
500065.......................................................... 2.77
500068.......................................................... 1.20
500069.......................................................... 1.37
500071.......................................................... 3.26
500072.......................................................... 2.47
500073.......................................................... 1.53
500074.......................................................... 2.55
500077.......................................................... 2.36
500079.......................................................... 1.88
500080.......................................................... 1.24
500084.......................................................... 2.51
[[Page 18812]]
500085.......................................................... 1.80
500086.......................................................... 2.16
500088.......................................................... 3.09
500089.......................................................... 1.95
500090.......................................................... 0.72
500092.......................................................... 1.86
500094.......................................................... 0.90
500096.......................................................... 1.92
500097.......................................................... 1.37
500098.......................................................... 1.55
500101.......................................................... 1.28
500102.......................................................... 1.87
500104.......................................................... 2.26
500106.......................................................... 0.74
500107.......................................................... 1.59
500108.......................................................... 2.82
500110.......................................................... 3.07
500118.......................................................... 2.65
500119.......................................................... 1.90
500122.......................................................... 2.64
500123.......................................................... 0.91
500124.......................................................... 2.31
500125.......................................................... 1.49
500129.......................................................... 2.22
500132.......................................................... 1.55
500138.......................................................... 1.18
500139.......................................................... 2.80
500141.......................................................... 3.36
500146.......................................................... 2.38
502002.......................................................... 3.92
503025.......................................................... 0.98
503300.......................................................... 2.92
504002.......................................................... 2.30
510001.......................................................... 2.30
510002.......................................................... 2.52
510004.......................................................... 1.11
510005.......................................................... 1.58
510006.......................................................... 3.16
510007.......................................................... 2.23
510008.......................................................... 2.53
510012.......................................................... 2.16
510013.......................................................... 1.65
510015.......................................................... 1.20
510016.......................................................... 1.25
510018.......................................................... 1.83
510020.......................................................... 1.28
510022.......................................................... 2.50
510023.......................................................... 2.47
510024.......................................................... 3.34
510026.......................................................... 1.65
510027.......................................................... 1.74
510028.......................................................... 1.53
510029.......................................................... 2.69
510030.......................................................... 2.36
510031.......................................................... 3.42
510033.......................................................... 2.25
510038.......................................................... 1.72
510039.......................................................... 2.54
510043.......................................................... 1.04
510046.......................................................... 2.15
510047.......................................................... 2.69
510048.......................................................... 1.50
510050.......................................................... 2.35
510053.......................................................... 1.65
510055.......................................................... 2.34
510058.......................................................... 2.55
510059.......................................................... 8.87
510060.......................................................... 1.67
510063.......................................................... 1.27
510065.......................................................... 1.25
510066.......................................................... 2.08
510067.......................................................... 2.57
510068.......................................................... 2.41
510070.......................................................... 3.32
510071.......................................................... 2.27
510072.......................................................... 1.53
510077.......................................................... 2.18
510081.......................................................... 1.38
510082.......................................................... 1.71
510084.......................................................... 1.51
510085.......................................................... 1.82
510086.......................................................... 1.23
511300.......................................................... 1.44
511302.......................................................... 1.06
511303.......................................................... 0.83
511304.......................................................... 0.76
513026.......................................................... 0.85
513027.......................................................... 1.46
513028.......................................................... 1.85
513030.......................................................... 1.62
514001.......................................................... 3.01
514007.......................................................... 6.63
514008.......................................................... 2.21
520002.......................................................... 2.77
520003.......................................................... 2.36
520004.......................................................... 2.74
520006.......................................................... 2.33
520007.......................................................... 1.68
520008.......................................................... 2.45
520009.......................................................... 2.18
520010.......................................................... 2.42
520011.......................................................... 3.20
520013.......................................................... 2.03
520014.......................................................... 2.43
520015.......................................................... 2.52
520016.......................................................... 1.89
520017.......................................................... 2.13
520018.......................................................... 2.14
520019.......................................................... 2.31
520021.......................................................... 2.83
520024.......................................................... 1.93
520025.......................................................... 2.07
520026.......................................................... 2.20
520028.......................................................... 3.51
520029.......................................................... 1.40
520030.......................................................... 3.48
520031.......................................................... 4.15
520032.......................................................... 1.98
520033.......................................................... 2.12
520034.......................................................... 2.48
520035.......................................................... 3.09
520037.......................................................... 2.90
520038.......................................................... 3.33
520039.......................................................... 1.83
520040.......................................................... 2.06
520041.......................................................... 2.05
520042.......................................................... 2.08
520044.......................................................... 3.29
520045.......................................................... 2.41
520047.......................................................... 2.14
520048.......................................................... 2.38
520049.......................................................... 3.14
520053.......................................................... 1.79
520054.......................................................... 1.65
520057.......................................................... 3.07
520058.......................................................... 2.94
520059.......................................................... 2.95
520060.......................................................... 1.75
520062.......................................................... 2.61
520063.......................................................... 3.04
520064.......................................................... 1.94
520066.......................................................... 3.17
520068.......................................................... 1.77
520069.......................................................... 2.12
520070.......................................................... 2.50
520074.......................................................... 1.63
520075.......................................................... 2.66
520076.......................................................... 2.70
520077.......................................................... 1.23
520078.......................................................... 2.04
520082.......................................................... 2.99
520083.......................................................... 1.84
520084.......................................................... 2.26
520087.......................................................... 1.35
520088.......................................................... 2.57
520089.......................................................... 3.53
520090.......................................................... 2.03
520091.......................................................... 3.78
520092.......................................................... 2.09
520094.......................................................... 2.16
520095.......................................................... 2.78
520096.......................................................... 2.59
520097.......................................................... 2.39
520098.......................................................... 1.53
520100.......................................................... 2.57
520101.......................................................... 1.56
520102.......................................................... 2.55
520103.......................................................... 2.61
520107.......................................................... 1.94
520109.......................................................... 2.11
520110.......................................................... 1.80
520111.......................................................... 2.23
520112.......................................................... 3.43
520113.......................................................... 2.74
520114.......................................................... 2.15
520115.......................................................... 2.08
520116.......................................................... 2.63
520117.......................................................... 1.88
520118.......................................................... 1.11
520120.......................................................... 1.09
520121.......................................................... 1.82
520122.......................................................... 1.47
520123.......................................................... 1.74
520124.......................................................... 1.94
520130.......................................................... 2.26
520131.......................................................... 2.07
520132.......................................................... 2.57
520134.......................................................... 1.61
520135.......................................................... 1.93
520136.......................................................... 2.43
520138.......................................................... 2.56
520139.......................................................... 2.66
520140.......................................................... 2.57
520141.......................................................... 2.06
520142.......................................................... 1.24
520144.......................................................... 2.29
520145.......................................................... 1.66
520146.......................................................... 2.38
520148.......................................................... 1.87
520149.......................................................... 1.20
520151.......................................................... 2.64
520152.......................................................... 2.15
520153.......................................................... 1.47
520154.......................................................... 2.30
520156.......................................................... 3.30
520157.......................................................... 1.65
520159.......................................................... 1.39
520160.......................................................... 2.79
520161.......................................................... 2.36
520170.......................................................... 3.01
520171.......................................................... 1.86
520173.......................................................... 2.91
520177.......................................................... 2.45
[[Page 18813]]
520178.......................................................... 2.40
523025.......................................................... 1.73
523026.......................................................... 1.64
523300.......................................................... 2.75
524000.......................................................... 1.64
524003.......................................................... 1.42
524017.......................................................... 0.47
524034.......................................................... 1.54
524038.......................................................... 1.80
524040.......................................................... 1.66
530002.......................................................... 2.28
530003.......................................................... 1.36
530004.......................................................... 1.89
530005.......................................................... 1.75
530006.......................................................... 2.21
530007.......................................................... 2.02
530008.......................................................... 2.57
530009.......................................................... 2.04
530010.......................................................... 2.43
530011.......................................................... 2.24
530012.......................................................... 2.33
530014.......................................................... 2.79
530015.......................................................... 2.27
530016.......................................................... 2.03
530017.......................................................... 2.10
530018.......................................................... 1.65
530019.......................................................... 1.56
530022.......................................................... 2.09
530023.......................................................... 1.65
530025.......................................................... 2.01
530026.......................................................... 1.52
530027.......................................................... 1.58
530029.......................................................... 1.01
530031.......................................................... 1.02
530032.......................................................... 2.22
534003.......................................................... 1.56
650001.......................................................... 2.01
------------------------------------------------------------------------
--------------------
\1\ Large Urban Area
\2\ Hospitals geographically located in the area are assigned the
statewide rural wage index for FY 2000.
Addendum H.--Wage Index for Urban Areas
------------------------------------------------------------------------
Wage
Urban Code Urban Area (Constituent Counties) Index
------------------------------------------------------------------------
0040....................... Abilene, TX Taylor, TX............ 0.8179
0060....................... 2 Aguadilla, PR Aguada, PR 0.4249
Aguadilla, PR Moca, PR.
0080....................... Akron, OH Portage, OH Summit, OH.. 1.0163
0120....................... Albany, GA Dougherty, GA Lee, GA.. 1.0372
0160....................... Albany-Schenectady-Troy, NY 0.8754
Albany, NY Montgomery, NY
Rensselaer, NY Saratoga, NY
Schenectady, NY Schoharie, NY.
0200....................... Albuquerque, NM Bernalillo, NM 0.8499
Sandoval, NM Valencia, NM.
0220....................... Alexandria, LA Rapides, LA........ 0.7910
0240....................... Allentown-Bethlehem-Easton, PA 0.9550
Carbon, PA Lehigh, PA
Northampton, PA.
0280....................... Altoona, PA Blair, PA............. 0.9342
0320....................... Amarillo, TX Potter, TX Randall, 0.8435
TX.
0380....................... Anchorage, AK Anchorage, AK....... 1.3009
0440....................... Ann Arbor, MI Lenawee, MI 1.1483
Livingston, MI Washtenaw, MI.
0450....................... Anniston, AL Calhoun, AL.......... 0.8462
0460....................... Appleton-Oshkosh-Neenah, WI 0.8913
Calumet, WI Outagamie, WI
Winnebago, WI.
0470....................... Arecibo, PR Arecibo, PR Camuy, PR 0.4815
Hatillo, PR.
0480....................... Asheville, NC Buncombe, NC 0.8884
Madison, NC.
0500....................... Athens, GA Clarke, GA Madison, GA 0.9800
Oconee, GA.
0520....................... 1 Atlanta, GA Barrow, GA Bartow, 1.0050
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.
0560....................... Atlantic-Cape May, NJ Atlantic, NJ 1.1050
Cape May, NJ.
0580....................... Auburn-Opelika, AL Lee, AL........ 0.7748
0600....................... Augusta-Aiken, GA-SC Columbia, GA 0.9013
McDuffie, GA Richmond, GA Aiken,
SC Edgefield, SC.
0640....................... 1 Austin-San Marcos, TX Bastrop, 0.9081
TX Caldwell, TX Hays, TX Travis,
TX Williamson, TX.
0680....................... 2 Bakersfield, CA Kern, CA........ 0.9951
0720....................... 1 Baltimore, MD Anne Arundel, MD 0.9891
Baltimore, MD Baltimore City, MD
Carroll, MD Harford, MD Howard,
MD Queen Anne's, MD.
0733....................... Bangor, ME Penobscot, ME.......... 0.9609
0743....................... Barnstable-Yarmouth, MA 1.3302
Barnstable, MA.
0760....................... Baton Rouge, LA Ascension, LA East 0.8707
Baton Rouge, LA Livingston, LA
West Baton Rouge, LA.
0840....................... Beaumont-Port Arthur, TX Hardin, 0.8624
TX Jefferson, TX Orange, TX.
0860....................... Bellingham, WA Whatcom, WA........ 1.1394
0870....................... 2 Benton Harbor, MI Berrien, MI... 0.8831
0875....................... 1 Bergen-Passaic, NJ Bergen, NJ 1.1833
Passaic, NJ.
0880....................... Billings, MT Yellowstone, MT...... 1.0038
0920....................... Biloxi-Gulfport-Pascagoula, MS 0.7949
Hancock, MS Harrison, MS Jackson,
MS.
0960....................... Binghamton, NY Broome, NY Tioga, 0.8750
NY.
1000....................... Birmingham, AL Blount, AL 0.8994
Jefferson, AL St. Clair, AL
Shelby, AL.
1010....................... Bismarck, ND Burleigh, ND Morton, 0.7893
ND.
1020....................... Bloomington, IN Monroe, IN........ 0.8593
1040....................... Bloomington-Normal, IL McLean, IL. 0.8993
1080....................... Boise City, ID Ada, ID Canyon, ID. 0.9086
1123....................... 1 2 Boston-Worcester-Lawrence- 1.1369
Lowell-Brockton, MA-NH (MA
Hospitals) Bristol, MA Essex, MA
Middlesex, MA Norfolk, MA
Plymouth, MA Suffolk, MA
Worcester, MA Hillsborough, NH
Merrimack, NH Rockingham, NH
Strafford, NH.
1123....................... 1 Boston-Worcester-Lawrence-Lowell- 1.1358
Brockton, MA-NH (NH Hospitals)
Bristol, MA Essex, MA Middlesex,
MA Norfolk, MA Plymouth, MA
Suffolk, MA Worcester, MA
Hillsborough, NH Merrimack, NH
Rockingham, NH Strafford, NH.
[[Page 18814]]
1125....................... Boulder-Longmont, CO Boulder, CO.. 0.9944
1145....................... Brazoria, TX Brazoria, TX......... 0.8516
1150....................... Bremerton, WA Kitsap, WA.......... 1.1011
1240....................... Brownsville-Harlingen-San Benito, 0.9212
TX Cameron, TX.
1260....................... Bryan-College Station, TX Brazos, 0.8501
TX.
1280....................... 1 Buffalo-Niagara Falls, NY Erie, 0.9604
NY Niagara, NY.
1303....................... Burlington, VT Chittenden, VT 1.0558
Franklin, VT Grand Isle, VT.
1310....................... Caguas, PR Caguas, PR Cayey, PR 0.4561
Cidra, PR Gurabo, PR San Lorenzo,
PR.
1320....................... 2 Canton-Massillon, OH Carroll, OH 0.8649
Stark, OH.
1350....................... Casper, WY Natrona, WY............ 0.9199
1360....................... Cedar Rapids, IA Linn, IA......... 0.9018
1400....................... Champaign-Urbana, IL Champaign, IL 0.9163
1440....................... Charleston-North Charleston, SC 0.8988
Berkeley, SC Charleston, SC
Dorchester, SC.
1480....................... Charleston, WV Kanawha, WV Putnam, 0.9095
WV.
1520....................... 1 Charlotte-Gastonia-Rock Hill, NC- 0.9433
SC Cabarrus, NC Gaston, NC
Lincoln, NC Mecklenburg, NC
Rowan, NC Stanly, NC Union, NC
York, SC.
1540....................... Charlottesville, VA Albemarle, VA 1.0573
Charlottesville City, VA
Fluvanna, VA Greene, VA.
1560....................... Chattanooga, TN-GA Catoosa, GA 0.9731
Dade, GA Walker, GA Hamilton, TN
Marion, TN.
1580....................... 2 Cheyenne, WY Laramie, WY........ 0.8859
1600....................... 1 Chicago, IL Cook, IL DeKalb, IL 1.0872
DuPage, IL Grundy, IL Kane, IL
Kendall, IL Lake, IL McHenry, IL
Will, IL.
1620....................... Chico-Paradise, CA Butte, CA...... 1.0390
1640....................... 1 Cincinnati, OH-KY-IN Dearborn, 0.9434
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 0.8283
Christian, KY Montgomery, TN.
1680....................... 1 Cleveland-Lorain-Elyria, OH 0.9688
Ashtabula, OH Cuyahoga, OH
Geauga, OH Lake, OH Lorain, OH
Medina, OH.
1720....................... Colorado Springs, CO El Paso, CO.. 0.9218
1740....................... Columbia, MO Boone, MO............ 0.8904
1760....................... Columbia, SC Lexington, SC 0.9357
Richland, SC.
1800....................... Columbus, GA-AL Russell, AL 0.8510
Chattahoochee, GA Harris, GA
Muscogee, GA.
1840....................... 1 Columbus, OH Delaware, OH 0.9907
Fairfield, OH Franklin, OH
Licking, OH Madison, OH Pickaway,
OH.
1880....................... Corpus Christi, TX Nueces, TX San 0.8702
Patricio, TX.
1890....................... Corvallis, OR Benton, OR.......... 1.1087
1900....................... Cumberland, MD-WV (Maryland 0.8801
Hospitals) Allegany, MD Mineral,
WV.
1920....................... 1 Dallas, TX Collin, TX Dallas, TX 0.9589
Denton, TX Ellis, TX Henderson,
TX Hunt, TX Kaufman, TX Rockwall,
TX.
1950....................... Danville, VA Danville City, VA 0.9061
Pittsylvania, VA.
1960....................... Davenport-Moline-Rock Island, IA- 0.8706
IL Scott, IA Henry, IL Rock
Island, IL.
2000....................... Dayton-Springfield, OH Clark, OH 0.9336
Greene, OH Miami, OH Montgomery,
OH.
2020....................... 2 Daytona Beach, FL Flagler, FL 0.8986
Volusia, FL.
2030....................... Decatur, AL Lawrence, AL Morgan, 0.8679
AL.
2040....................... Decatur, IL Macon, IL............. 0.8321
2080....................... 1 Denver, CO Adams, CO Arapahoe, 1.0197
CO Denver, CO Douglas, CO
Jefferson, CO.
2120....................... Des Moines, IA Dallas, IA Polk, IA 0.8754
Warren, IA.
2160....................... 1 Detroit, MI Lapeer, MI Macomb, 1.0421
MI Monroe, MI Oakland, MI St.
Clair, MI Wayne, MI.
2180....................... Dothan, AL Dale, AL Houston, AL... 0.7836
2190....................... Dover, DE Kent, DE................ 0.9335
2200....................... Dubuque, IA Dubuque, IA........... 0.8520
2240....................... Duluth-Superior, MN-WI St. Louis, 1.0165
MN Douglas, WI.
2281....................... Dutchess County, NY Dutchess, NY.. 0.9872
2290....................... Eau Claire, WI Chippewa, WI Eau 0.8957
Claire, WI.
2320....................... El Paso, TX El Paso, TX........... 0.8947
2330....................... Elkhart-Goshen, IN Elkhart, IN.... 0.9379
2335....................... 2 Elmira, NY Chemung, NY.......... 0.8636
2340....................... Enid, OK Garfield, OK............. 0.7953
2360....................... Erie, PA Erie, PA................. 0.9023
2400....................... Eugene-Springfield, OR Lane, OR... 1.0765
2440....................... 2 Evansville-Henderson, IN-KY (IN 0.8396
Hospitals) Posey, IN Vanderburgh,
IN Warrick, IN Henderson, KY.
2440....................... Evansville-Henderson, IN-KY (KY 0.8303
Hospitals) Posey, IN Vanderburgh,
IN Warrick, IN Henderson, KY.
2520....................... Fargo-Moorhead, ND-MN Clay, MN 0.8620
Cass, ND.
2560....................... Fayetteville, NC Cumberland, NC... 0.8494
2580....................... Fayetteville-Springdale-Rogers, AR 0.7773
Benton, AR Washington, AR.
2620....................... Flagstaff, AZ-UT Coconino, AZ 1.0348
Kane, UT.
2640....................... Flint, MI Genesee, MI............. 1.1020
2650....................... Florence, AL Colbert, AL 0.7927
Lauderdale, AL.
2655....................... Florence, SC Florence, SC......... 0.8618
2670....................... Fort Collins-Loveland, CO Larimer, 1.0302
CO.
2680....................... 1 Ft. Lauderdale, FL Broward, FL.. 1.0172
2700....................... 2 Fort Myers-Cape Coral, FL Lee, 0.8986
FL.
[[Page 18815]]
2710....................... Fort Pierce-Port St. Lucie, FL 1.0109
Martin, FL St. Lucie, FL.
2720....................... Fort Smith, AR-OK Crawford, AR 0.7844
Sebastian, AR Sequoyah, OK.
2750....................... 2 Fort Walton Beach, FL Okaloosa, 0.8986
FL.
2760....................... Fort Wayne, IN Adams, IN Allen, IN 0.9096
De Kalb, IN Huntington, IN Wells,
IN Whitley, IN.
2800....................... 1 Forth Worth-Arlington, TX Hood, 0.9835
TX Johnson, TX Parker, TX
Tarrant, TX.
2840....................... Fresno, CA Fresno, CA Madera, CA.. 1.0262
2880....................... Gadsden, AL Etowah, AL............ 0.8754
2900....................... Gainesville, FL Alachua, FL....... 1.0102
2920....................... Galveston-Texas City, TX 0.9732
Galveston, TX.
2960....................... Gary, IN Lake, IN Porter, IN...... 0.9369
2975....................... 2 Glens Falls, NY Warren, NY 0.8636
Washington, NY.
2980....................... Goldsboro, NC Wayne, NC........... 0.8333
2985....................... Grand Forks, ND-MN Polk, MN Grand 0.9097
Forks, ND.
2995....................... Grand Junction, CO Mesa, CO....... 0.9188
3000....................... 1 Grand Rapids-Muskegon-Holland, 1.0135
MI Allegan, MI Kent, MI Muskegon,
MI Ottawa, MI.
3040....................... Great Falls, MT Cascade, MT....... 1.0459
3060....................... Greeley, CO Weld, CO.............. 0.9722
3080....................... Green Bay, WI Brown, WI........... 0.9215
3120....................... 1 Greensboro-Winston-Salem-High 0.9037
Point, NC Alamance, NC Davidson,
NC Davie, NC Forsyth, NC
Guilford, NC Randolph, NC Stokes,
NC Yadkin, NC.
3150....................... Greenville, NC Pitt, NC........... 0.9500
3160....................... Greenville-Spartanburg-Anderson, 0.9188
SC Anderson, SC Cherokee, SC
Greenville, SC Pickens, SC
Spartanburg, SC.
3180....................... Hagerstown, MD Washington, MD..... 0.8853
3200....................... Hamilton-Middletown, OH Butler, OH 0.8989
3240....................... Harrisburg-Lebanon-Carlisle, PA 0.9917
Cumberland, PA Dauphin, PA
Lebanon, PA Perry, PA.
3283....................... 1 2 Hartford, CT Hartford, CT 1.2413
Litchfield, CT Middlesex, CT
Tolland, CT.
3285....................... 2 Hattiesburg, MS Forrest, MS 0.7306
Lamar, MS.
3290....................... Hickory-Morganton-Lenoir, NC 0.9148
Alexander, NC Burke, NC Caldwell,
NC Catawba, NC.
3320....................... Honolulu, HI Honolulu, HI......... 1.1479
3350....................... Houma, LA Lafourche, LA 0.7837
Terrebonne, LA.
3360....................... 1 Houston, TX Chambers, TX Fort 0.9387
Bend, TX Harris, TX Liberty, TX
Montgomery, TX Waller, TX.
3400....................... Huntington-Ashland, WV-KY-OH Boyd, 0.9757
KY Carter, KY Greenup, KY
Lawrence, OH Cabell, WV Wayne, WV.
3440....................... Huntsville, AL Limestone, AL 0.8822
Madison, AL.
3480....................... 1 Indianapolis, IN Boone, IN 0.9792
Hamilton, IN Hancock, IN
Hendricks, IN Johnson, IN
Madison, IN Marion, IN Morgan, IN
Shelby, IN.
3500....................... Iowa City, IA Johnson, IA......... 0.9607
3520....................... Jackson, MI Jackson, MI........... 0.8840
3560....................... Jackson, MS Hinds, MS Madison, MS 0.8387
Rankin, MS.
3580....................... Jackson, TN Madison, TN Chester, 0.8600
TN.
3600....................... 1 2 Jacksonville, FL Clay, FL 0.8986
Duval, FL Nassau, FL St. Johns,
FL.
3605....................... 2 Jacksonville, NC Onslow, NC..... 0.8290
3610....................... 2 Jamestown, NY Chautauqua, NY.... 0.8636
3620....................... Janesville-Beloit, WI Rock, WI.... 0.9656
3640....................... Jersey City, NJ Hudson, NJ........ 1.1674
3660....................... Johnson City-Kingsport-Bristol, TN- 0.8894
VA Carter, TN Hawkins, TN
Sullivan, TN Unicoi, TN
Washington, TN Bristol City, VA
Scott, VA Washington, VA.
3680....................... 2 Johnstown, PA Cambria, PA 0.8524
Somerset, PA.
3700....................... Jonesboro, AR Craighead, AR....... 0.7251
3710....................... 2 Joplin, MO Jasper, MO Newton, MO 0.7723
3720....................... Kalamazoo-Battlecreek, MI Calhoun, 0.9981
MI Kalamazoo, MI Van Buren, MI.
3740....................... Kankakee, IL Kankakee, IL......... 0.8598
3760....................... 1 Kansas City, KS-MO Johnson, KS 0.9322
Leavenworth, KS Miami, KS
Wyandotte, KS Cass, MO Clay, MO
Clinton, MO Jackson, MO
Lafayette, MO Platte, MO Ray, MO.
3800....................... Kenosha, WI Kenosha, WI........... 0.9033
3810....................... Killeen-Temple, TX Bell, TX 0.9932
Coryell, TX.
3840....................... Knoxville, TN Anderson, TN Blount, 0.9199
TN Knox, TN Loudon, TN Sevier, TN
Union, TN.
3850....................... Kokomo, IN Howard, IN Tipton, IN.. 0.8984
3870....................... La Crosse, WI-MN Houston, MN La 0.8933
Crosse, WI.
3880....................... Lafayette, LA Acadia, LA 0.8397
Lafayette, LA St. Landry, LA St.
Martin, LA.
3920....................... Lafayette, IN Clinton, IN 0.8809
Tippecanoe, IN.
3960....................... Lake Charles, LA Calcasieu, LA.... 0.7966
3980....................... 2 Lakeland-Winter Haven, FL Polk, 0.8986
FL.
4000....................... Lancaster, PA Lancaster, PA....... 0.9255
4040....................... Lansing-East Lansing, MI Clinton, 0.9977
MI Eaton, MI Ingham, MI.
4080....................... Laredo, TX Webb, TX............... 0.8323
4100....................... Las Cruces, NM Dona Ana, NM....... 0.8590
4120....................... 1 Las Vegas, NV-AZ Mohave, AZ 1.1258
Clark, NV Nye, NV.
[[Page 18816]]
4150....................... Lawrence, KS Douglas, KS.......... 0.8222
4200....................... Lawton, OK Comanche, OK........... 0.9532
4243....................... Lewiston-Auburn, ME Androscoggin, 0.8899
ME.
4280....................... Lexington, KY Bourbon, KY Clark, 0.8552
KY Fayette, KY Jessamine, KY
Madison, KY Scott, KY Woodford,
KY.
4320....................... Lima, OH Allen, OH Auglaize, OH... 0.9108
4360....................... Lincoln, NE Lancaster, NE......... 0.9670
4400....................... Little Rock-North Little Rock, AR 0.8614
Faulkner, AR Lonoke, AR Pulaski,
AR Saline, AR.
4420....................... Longview-Marshall, TX Gregg, TX 0.8738
Harrison, TX Upshur, TX.
4480....................... 1 Los Angeles-Long Beach, CA Los 1.2085
Angeles, CA.
4520....................... Louisville, KY-IN Clark, IN Floyd, 0.9381
IN Harrison, IN Scott, IN
Bullitt, KY Jefferson, KY Oldham,
KY.
4600....................... Lubbock, TX Lubbock, TX........... 0.8411
4640....................... Lynchburg, VA Amherst, VA Bedford, 0.8814
VA Bedford City, VA Campbell, VA
Lynchburg City, VA.
4680....................... Macon, GA Bibb, GA Houston, GA 0.8530
Jones, GA Peach, GA Twiggs, GA.
4720....................... Madison, WI Dane, WI.............. 0.9729
4800....................... 2 Mansfield, OH Crawford, OH 0.8649
Richland, OH.
4840....................... Mayaguez, PR Anasco, PR Cabo Rojo, 0.4674
PR Hormigueros, PR Mayaguez, PR
Sabana Grande, PR San German, PR.
4880....................... McAllen-Edinburg-Mission, TX 0.8120
Hidalgo, TX.
4890....................... Medford-Ashland, OR Jackson, OR... 1.0492
4900....................... Melbourne-Titusville-Palm Bay, FL 0.9296
Brevard, Fl.
4920....................... 1 Memphis, TN-AR-MS Crittenden, AR 0.8244
DeSoto, MS Fayette, TN Shelby, TN
Tipton, TN.
4940....................... Merced, CA Merced, CA............. 1.0509
5000....................... 1 Miami, FL Dade, FL.............. 1.0233
5015....................... 1 Middlesex-Somerset-Hunterdon, NJ 1.0876
Hunterdon, NJ Middlesex, NJ
Somerset, NJ.
5080....................... 1 Milwaukee-Waukesha, WI 0.9845
Milwaukee, WI Ozaukee, WI
Washington, WI Waukesha, WI.
5120....................... 1 Minneapolis-St. Paul, MN-WI 1.0929
Anoka, MN Carver, MN Chisago, MN
Dakota, MN Hennepin, MN Isanti,
MN Ramsey, MN Scott, MN
Sherburne, MN Washington, MN
Wright, MN Pierce, WI St. Croix,
WI.
5140....................... Missoula, MT Missoula, MT......... 0.9085
5160....................... Mobile, AL Baldwin, AL Mobile, AL. 0.8267
5170....................... Modesto, CA Stanislaus, CA........ 1.0111
5190....................... 1 Monmouth-Ocean, NJ Monmouth, NJ 1.1258
Ocean, NJ.
5200....................... Monroe, LA Ouachita, LA........... 0.8221
5240....................... Montgomery, AL Autauga, AL Elmore, 0.7724
AL Montgomery, AL.
5280....................... Muncie, IN Delaware, IN........... 1.0834
5330....................... Myrtle Beach, SC Horry, SC........ 0.8529
5345....................... Naples, FL Collier, FL............ 0.9839
5360....................... 1 Nashville, TN Cheatham, TN 0.9449
Davidson, TN Dickson, TN
Robertson, TN Rutherford TN
Sumner, TN Williamson, TN Wilson,
TN.
5380....................... 1 Nassau-Suffolk, NY Nassau, NY 1.4074
Suffolk, NY.
5483....................... 1 New Haven-Bridgeport-Stamford- 1.2417
Waterbury-Danbury, CT Fairfield,
CT New Haven, CT.
5523....................... New London-Norwich, CT New London, 1.2428
CT.
5560....................... 1 New Orleans, LA Jefferson, LA 0.9089
Orleans, LA Plaquemines, LA St.
Bernard, LA St. Charles, LA St.
James, LA St. John The Baptist,
LA St. Tammany, LA.
5600....................... 1 New York, NY Bronx, NY Kings, NY 1.4517
New York, NY Putnam, NY Queens,
NY Richmond, NY Rockland, NY
Westchester, NY.
5640....................... 1 Newark, NJ Essex, NJ Morris, NJ 1.0772
Sussex, NJ Union, NJ Warren, NJ.
5660....................... Newburgh, NY-PA Orange, NY Pike, 1.0908
PA.
5720....................... 1 Norfolk-Virginia Beach-Newport 0.8442
News, VA-NC 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 C.
5775....................... 1 Oakland, CA Alameda, CA Contra 1.5095
Costa, CA.
5790....................... Ocala, FL Marion, FL.............. 0.9615
5800....................... Odessa-Midland, TX Ector, TX 0.8873
Midland, TX.
5880....................... 1 Oklahoma City, OK Canadian, OK 0.8589
Cleveland, OK Logan, OK McClain,
OK Oklahoma, OK Pottawatomie, OK.
5910....................... Olympia, WA Thurston, WA.......... 1.0932
5920....................... Omaha, NE-IA Pottawattamie, IA 1.0455
Cass, NE Douglas, NE Sarpy, NE
Washington, NE.
5945....................... 1 Orange County, CA Orange, CA.... 1.1592
5960....................... 1 Orlando, FL Lake, FL Orange, FL 0.9806
Osceola, FL Seminole, FL.
5990....................... Owensboro, KY Daviess, KY......... 0.8104
6015....................... Panama City, FL Bay, FL........... 0.9169
6020....................... Parkersburg-Marietta, WV-OH (WV 0.8414
Hospitals) Washington, OH Wood,
WV.
6020....................... 2 Parkersburg-Marietta, WV-OH (OH 0.8649
Hospitals) Washington, OH Wood,
WV.
6080....................... 2 Pensacola, FL Escambia, FL Santa 0.8986
Rosa, FL.
6120....................... Peoria-Pekin, IL Peoria, IL 0.8399
Tazewell, IL Woodford, IL.
6160....................... 1 Philadelphia, PA-NJ Burlington, 1.1186
NJ Camden, NJ Gloucester, NJ
Salem, NJ Bucks, PA Chester, PA
Delaware, PA Montgomery, PA
Philadelphia, PA.
6200....................... 1 Phoenix-Mesa, AZ Maricopa, AZ 0.9464
Pinal, AZ.
6240....................... Pine Bluff, AR Jefferson, AR...... 0.7697
[[Page 18817]]
6280....................... 1 Pittsburgh, PA Allegheny, PA 0.9634
Beaver, PA Butler, PA Fayette, PA
Washington, PA Westmoreland, PA.
6323....................... 2 Pittsfield, MA Berkshire, MA.... 1.1369
6340....................... Pocatello, ID Bannock, ID......... 0.8973
6360....................... Ponce, PR Guayanilla, PR Juana 0.4971
Diaz, PR Penuelas, PR Ponce, PR
Villalba, PR Yauco, PR.
6403....................... Portland, ME Cumberland, ME 0.9487
Sagadahoc, ME York, ME.
6440....................... 1 Portland-Vancouver, OR-WA 1.0996
Clackamas, OR Columbia, OR
Multnomah, OR Washington, OR
Yamhill, OR Clark, WA.
6483....................... 1 Providence-Warwick-Pawtucket, RI 1.0690
Bristol, RI Kent, RI Newport, RI
Providence, RI Washington, RI.
6520....................... Provo-Orem, UT Utah, UT........... 0.9818
6560....................... Pueblo, CO Pueblo, CO............. 0.8853
6580....................... Punta Gorda, FL Charlotte, FL..... 0.9508
6600....................... Racine, WI Racine, WI............. 0.9216
6640....................... 1 Raleigh-Durham-Chapel Hill, NC 0.9544
Chatham, NC Durham, NC Franklin,
NC Johnston, NC Orange, NC Wake,
NC.
6660....................... Rapid City, SD Pennington, SD..... 0.8363
6680....................... Reading, PA Berks, PA............. 0.9436
6690....................... Redding, CA Shasta, CA............ 1.1263
6720....................... Reno, NV Washoe, NV............... 1.0655
6740....................... Richland-Kennewick-Pasco, WA 1.1224
Benton, WA Franklin, WA.
6760....................... Richmond-Petersburg, VA Charles 0.9545
City County, VA Chesterfield, VA
Colonial Heights City, VA
Dinwiddie, VA Goochland, VA
Hanover, VA Henrico, VA Hopewell
City, VA New Kent, VA Petersburg
City, VA Powhatan, VA Prince
George, VA Richmond City, V.
6780....................... 1 Riverside-San Bernardino, CA 1.1061
Riverside, CA San Bernardino, CA.
6800....................... Roanoke, VA Botetourt, VA Roanoke, 0.8142
VA Roanoke City, VA Salem City,
VA.
6820....................... Rochester, MN Olmsted, MN......... 1.1429
6840....................... 1 Rochester, NY Genesee, NY 0.9184
Livingston, NY Monroe, NY
Ontario, NY Orleans, NY Wayne, NY.
6880....................... Rockford, IL Boone, IL Ogle, IL 0.8783
Winnebago, IL.
6895....................... Rocky Mount, NC Edgecombe, NC 0.8735
Nash, NC.
6920....................... 1 Sacramento, CA El Dorado, CA 1.2284
Placer, CA Sacramento, CA.
6960....................... Saginaw-Bay City-Midland, MI Bay, 0.9294
MI Midland, MI Saginaw, MI.
6980....................... St. Cloud, MN Benton, MN Stearns, 0.9608
MN.
7000....................... St. Joseph, MO Andrew, MO 0.8943
Buchanan, MO.
7040....................... 1 St. Louis, MO-IL Clinton, IL 0.9052
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 Marion, OR Polk, OR..... 0.9949
7120....................... Salinas, CA Monterey, CA.......... 1.4710
7160....................... 1 Salt Lake City-Ogden, UT Davis, 0.9854
UT Salt Lake, UT Weber, UT.
7200....................... San Angelo, TX Tom Green, TX...... 0.7845
7240....................... 1 San Antonio, TX Bexar, TX Comal, 0.8318
TX Guadalupe, TX Wilson, TX.
7320....................... 1 San Diego, CA San Diego, CA..... 1.1955
7360....................... 1 San Francisco, CA Marin, CA San 1.3784
Francisco, CA San Mateo, CA.
7400....................... 1 San Jose, CA Santa Clara, CA.... 1.3492
7440....................... 1 San Juan-Bayamon, PR Aguas 0.4657
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 Lug.
7460....................... San Luis Obispo-Atascadero-Paso 1.0470
Robles, CA San Luis Obispo, CA.
7480....................... Santa Barbara-Santa Maria-Lompoc, 1.0819
CA Santa Barbara, CA.
7485....................... Santa Cruz-Watsonville, CA Santa 1.3927
Cruz, CA.
7490....................... Santa Fe, NM Los Alamos, NM Santa 1.0437
Fe, NM.
7500....................... Santa Rosa, CA Sonoma, CA......... 1.3000
7510....................... Sarasota-Bradenton, FL Manatee, FL 0.9905
Sarasota, FL.
7520....................... Savannah, GA Bryan, GA Chatham, GA 0.9953
Effingham, GA.
7560....................... 2 Scranton--Wilkes-Barre-- 0.8524
Hazleton, PA Columbia, PA
Lackawanna, PA Luzerne, PA
Wyoming, PA.
7600....................... 1 Seattle-Bellevue-Everett, WA 1.1289
Island, WA King, WA Snohomish, WA.
7610....................... 2 Sharon, PA Mercer, PA........... 0.8524
7620....................... 2 Sheboygan, WI Sheboygan, WI..... 0.8759
7640....................... Sherman-Denison, TX Grayson, TX... 0.9329
7680....................... Shreveport-Bossier City, LA 0.9049
Bossier, LA Caddo, LA Webster, LA.
7720....................... Sioux City, IA-NE Woodbury, IA 0.8549
Dakota, NE.
7760....................... Sioux Falls, SD Lincoln, SD 0.8776
Minnehaha, SD.
7800....................... South Bend, IN St. Joseph, IN..... 0.9793
7840....................... Spokane, WA Spokane, WA........... 1.0799
7880....................... Springfield, IL Menard, IL 0.8684
Sangamon, IL.
7920....................... Springfield, MO Christian, MO 0.7991
Greene, MO Webster, MO.
8003....................... 2 Springfield, MA Hampden, MA 1.1369
Hampshire, MA.
8050....................... State College, PA Centre, PA...... 0.9138
8080....................... 2 Steubenville-Weirton, OH-WV (OH 0.8649
Hospitals) Jefferson, OH Brooke,
WV Hancock, WV.
8080....................... Steubenville-Weirton, OH-WV (WV 0.8614
Hospitals) Jefferson, OH Brooke,
WV Hancock, WV.
8120....................... Stockton-Lodi, CA San Joaquin, CA. 1.0518
[[Page 18818]]
8140....................... 2 Sumter, SC Sumter, SC........... 0.8264
8160....................... Syracuse, NY Cayuga, NY Madison, 0.9441
NY Onondaga, NY Oswego, NY.
8200....................... Tacoma, WA Pierce, WA............. 1.1631
8240....................... 2 Tallahassee, FL Gadsden, FL 0.8986
Leon, FL.
8280....................... 1 Tampa-St. Petersburg-Clearwater, 0.9119
FL Hernando, FL Hillsborough, FL
Pasco, FL Pinellas, FL.
8320....................... Terre Haute, IN Clay, IN 0.8570
Vermillion, IN Vigo, IN.
8360....................... Texarkana, AR-Texarkana, TX 0.8174
Miller, AR Bowie, TX.
8400....................... Toledo, OH Fulton, OH Lucas, OH 0.9593
Wood, OH.
8440....................... Topeka, KS Shawnee, KS............ 0.9326
8480....................... Trenton, NJ Mercer, NJ............ 0.9955
8520....................... Tucson, AZ Pima, AZ............... 0.8742
8560....................... Tulsa, OK Creek, OK Osage, OK 0.8086
Rogers, OK Tulsa, OK Wagoner, OK.
8600....................... Tuscaloosa, AL Tuscaloosa, AL..... 0.8064
8640....................... Tyler, TX Smith, TX............... 0.9369
8680....................... 2 Utica-Rome, NY Herkimer, NY 0.8636
Oneida, NY.
8720....................... Vallejo-Fairfield-Napa, CA Napa, 1.2655
CA Solano, CA.
8735....................... Ventura, CA Ventura, CA........... 1.0952
8750....................... Victoria, TX Victoria, TX......... 0.8378
8760....................... Vineland-Millville-Bridgeton, NJ 1.0517
Cumberland, NJ.
8780....................... Visalia-Tulare-Porterville, CA 1.0411
Tulare, CA.
8800....................... Waco, TX McLennan, TX............. 0.8075
8840....................... 1 Washington, DC-MD-VA-WV 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,.
8920....................... Waterloo-Cedar Falls, IA Black 0.8841
Hawk, IA.
8940....................... Wausau, WI Marathon, WI........... 0.9445
8960....................... 1 West Palm Beach-Boca Raton, FL 0.9909
Palm Beach, FL.
9000....................... 2 Wheeling, WV-OH (WV Hospitals) 0.8068
Belmont, OH Marshall, WV Ohio, WV.
9000....................... 2 Wheeling, WV-OH (OH Hospitals) 0.8649
Belmont, OH Marshall, WV Ohio, WV.
9040....................... Wichita, KS Butler, KS Harvey, KS 0.9421
Sedgwick, KS.
9080....................... Wichita Falls, TX Archer, TX 0.7652
Wichita, TX.
9140....................... 2 Williamsport, PA Lycoming, PA... 0.8524
9160....................... Wilmington-Newark, DE-MD New 1.1274
Castle, DE Cecil, MD.
9200....................... Wilmington, NC New Hanover, NC 0.9707
Brunswick, NC.
9260....................... 2 Yakima, WA Yakima, WA........... 1.0446
9270....................... Yolo, CA Yolo, CA................. 1.0485
9280....................... York, PA York, PA................. 0.9309
9320....................... Youngstown-Warren, OH Columbiana, 0.9996
OH Mahoning, OH Trumbull, OH.
9340....................... Yuba City, CA Sutter, CA Yuba, CA. 1.0662
9360....................... Yuma, AZ Yuma, AZ................. 0.9924
------------------------------------------------------------------------
--------------------
\1\ All counties within state are classified as urban.
Addendum I.--Wage Index for Rural Areas
------------------------------------------------------------------------
Wage
Nonurban Area Index
------------------------------------------------------------------------
Alabama........................................................ 0.7390
Alaska......................................................... 1.2057
Arizona........................................................ 0.8544
Arkansas....................................................... 0.7236
California..................................................... 0.9951
Colorado....................................................... 0.8813
Connecticut.................................................... 1.2413
Delaware....................................................... 0.9166
Florida........................................................ 0.8986
Georgia........................................................ 0.8094
Hawaii......................................................... 1.0726
Idaho.......................................................... 0.8651
Illinois....................................................... 0.8047
Indiana........................................................ 0.8396
Iowa........................................................... 0.7926
Kansas......................................................... 0.7460
Kentucky....................................................... 0.8043
Louisiana...................................................... 0.7486
Maine.......................................................... 0.8639
Maryland....................................................... 0.8631
Massachusetts.................................................. 1.1369
Michigan....................................................... 0.8831
Minnesota...................................................... 0.8669
Mississippi.................................................... 0.7306
Missouri....................................................... 0.7723
Montana........................................................ 0.8398
Nebraska....................................................... 0.8007
Nevada......................................................... 0.9097
New Hampshire.................................................. 0.9905
1 New Jersey................................................... .......
New Mexico..................................................... 0.8378
New York....................................................... 0.8636
North Carolina................................................. 0.8290
North Dakota................................................... 0.7647
Ohio........................................................... 0.8649
Oklahoma....................................................... 0.7255
Oregon......................................................... 0.9873
Pennsylvania................................................... 0.8524
Puerto Rico.................................................... 0.4249
1 Rhode Island................................................. .......
South Carolina................................................. 0.8264
South Dakota................................................... 0.7576
Tennessee...................................................... 0.7650
Texas.......................................................... 0.7471
Utah........................................................... 0.8906
Vermont........................................................ 0.9427
Virginia....................................................... 0.7916
Washington..................................................... 1.0446
West Virginia.................................................. 0.8068
Wisconsin...................................................... 0.8759
Wyoming........................................................ 0.8859
------------------------------------------------------------------------
[[Page 18819]]
Federal Register / Vol. 65, No. 68 / Friday, April 7, 2000 / Rules
and Regulations
Addendum J.--Wage Index for Hospitals That Are Reclassified
------------------------------------------------------------------------
Wage
Area Index
------------------------------------------------------------------------
Abilene, TX.................................................... 0.8179
Akron, OH...................................................... 0.9981
Albany, GA..................................................... 0.9544
Alexandria, LA................................................. 0.7910
Amarillo, TX................................................... 0.8435
Anchorage, AK.................................................. 1.3009
Ann Arbor, MI.................................................. 1.1343
Atlanta, GA.................................................... 1.0050
Austin-San Marcos, TX.......................................... 0.9081
Baltimore, MD.................................................. 0.9891
Baton Rouge, LA................................................ 0.8707
Beaumont-Port Arthur, TX....................................... 0.8624
Benton Harbor, MI.............................................. 0.8831
Bergen-Passaic, NJ............................................. 1.1833
Billings, MT................................................... 1.0038
Biloxi-Gulfport-Pascagoula, MS................................. 0.7949
Binghamton, NY................................................. 0.8750
Birmingham, AL................................................. 0.8994
Bismarck, ND................................................... 0.7893
Boise City, ID................................................. 0.9086
Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH............... 1.1358
Burlington, VT................................................. 1.0122
Caguas, PR..................................................... 0.4561
Champaign-Urbana, IL........................................... 0.9163
Charleston-North Charleston, SC................................ 0.8988
Charleston, WV................................................. 0.8861
Charlotte-Gastonia-Rock Hill, NC-SC............................ 0.9433
Chattanooga, TN-GA............................................. 0.9453
Chicago, IL.................................................... 1.0872
Cincinnati, OH-KY-IN........................................... 0.9434
Clarksville-Hopkinsville, TN-KY................................ 0.8283
Cleveland-Lorain-Elyria, OH.................................... 0.9688
Columbia, MO................................................... 0.8736
Columbia, SC................................................... 0.9215
Columbus, GA-AL................................................ 0.8318
Columbus, OH................................................... 0.9728
Corpus Christi, TX............................................. 0.8599
Dallas, TX..................................................... 0.9589
Danville, VA................................................... 0.8706
Davenport-Moline-Rock Island, IA-IL............................ 0.8606
Dayton-Springfield, OH......................................... 0.9231
Denver, CO..................................................... 1.0197
Des Moines, IA................................................. 0.8754
Dothan, AL..................................................... 0.7836
Dover, DE...................................................... 1.0511
Duluth-Superior, MN-WI......................................... 1.0165
Elkhart-Goshen, IN............................................. 0.9379
Eugene-Springfield, OR......................................... 1.0765
Evansville-Henderson, IN-KY.................................... 0.8396
Fargo-Moorhead, ND-MN (ND and SD Hospitals).................... 0.8620
Fargo-Moorhead, ND-MN (MN Hospital)............................ 0.8669
Fayetteville, NC............................................... 0.8494
Flagstaff, AZ-UT............................................... 0.9860
Flint, MI...................................................... 1.0918
Fort Collins-Loveland, CO...................................... 1.0197
Fort Pierce-Port St. Lucie, FL................................. 1.0109
Fort Smith, AR-OK.............................................. 0.7696
Fort Walton Beach, FL.......................................... 0.8713
Forth Worth-Arlington, TX...................................... 0.9835
Fresno, CA..................................................... 1.0262
Gadsden, AL.................................................... 0.8754
Gainesville, FL................................................ 0.9963
Goldsboro, NC.................................................. 0.8333
Grand Forks, ND-MN............................................. 0.9097
Grand Rapids-Muskegon-Holland, MI.............................. 1.0017
Great Falls, MT................................................ 1.0459
Greeley, CO.................................................... 0.9449
Green Bay, WI.................................................. 0.9215
Greensboro-Winston-Salem-High Point, NC........................ 0.9037
Greenville, NC................................................. 0.9237
Greenville-Spartanburg-Anderson, SC............................ 0.9188
Hagerstown, MD................................................. 0.8853
Harrisburg-Lebanon-Carlisle, PA................................ 0.9793
Hartford, CT................................................... 1.1715
Hickory-Morganton-Lenoir, NC................................... 0.9148
Honolulu, HI................................................... 1.1479
Houston, TX.................................................... 0.9387
Huntington-Ashland, WV-KY-OH................................... 0.9436
Huntsville, AL................................................. 0.8608
Indianapolis, IN............................................... 0.9792
Iowa City, IA.................................................. 0.9460
Jackson, MS.................................................... 0.8268
Jackson, TN.................................................... 0.8447
Jacksonville, FL............................................... 0.8957
Johnson City-Kingsport-Bristol, TN-VA.......................... 0.8894
Jonesboro, AR.................................................. 0.7251
Joplin, MO..................................................... 0.7678
Kalamazoo-Battlecreek, MI...................................... 0.9981
Kansas City, KS-MO............................................. 0.9322
Knoxville, TN.................................................. 0.9199
Kokomo, IN..................................................... 0.8984
Lafayette, LA.................................................. 0.8397
Lansing-East Lansing, MI....................................... 0.9834
Las Vegas, NV-AZ............................................... 1.1258
Lexington, KY.................................................. 0.8552
Lima, OH....................................................... 0.9108
Lincoln, NE.................................................... 0.9451
Little Rock-North Little Rock, AR.............................. 0.8432
Longview-Marshall, TX.......................................... 0.8541
Los Angeles-Long Beach, CA..................................... 1.2085
Louisville, KY-IN.............................................. 0.9381
Macon, GA...................................................... 0.8530
Madison, WI.................................................... 0.9729
Mansfield, OH.................................................. 0.8649
Memphis, TN-AR-MS.............................................. 0.8244
Merced, CA..................................................... 1.0509
Milwaukee-Waukesha, WI......................................... 0.9845
Minneapolis-St. Paul, MN-WI.................................... 1.0929
Missoula, MT................................................... 0.9085
Monmouth-Ocean, NJ............................................. 1.1258
Monroe, LA..................................................... 0.8062
Montgomery, AL................................................. 0.7724
Myrtle Beach, SC............................................... 0.8357
Nashville, TN.................................................. 0.9254
New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT............ 1.2417
New London-Norwich, CT......................................... 1.2328
New Orleans, LA................................................ 0.9089
New York, NY................................................... 1.4399
Newark, NJ..................................................... 1.0772
Newburgh, NY-PA................................................ 1.0837
Norfolk-Virginia Beach-Newport News, VA-NC..................... 0.8442
Oakland, CA.................................................... 1.5095
Oklahoma City, OK.............................................. 0.8589
Omaha, NE-IA................................................... 1.0455
Orange County, CA.............................................. 1.1592
Orlando, FL.................................................... 0.9806
Peoria-Pekin, IL............................................... 0.8399
Philadelphia, PA-NJ............................................ 1.1186
Phoenix-Mesa, AZ............................................... 0.9464
Pittsburgh, PA................................................. 0.9496
Pocatello, ID.................................................. 0.8651
Portland, ME................................................... 0.9487
Portland-Vancouver, OR-WA...................................... 1.0996
Provo-Orem, UT................................................. 0.9818
Raleigh-Durham-Chapel Hill, NC................................. 0.9544
Roanoke, VA.................................................... 0.8142
Rockford, IL................................................... 0.8783
Sacramento, CA................................................. 1.2284
Saginaw-Bay City-Midland, MI................................... 0.9294
St. Cloud, MN.................................................. 0.9608
St. Louis, MO-IL............................................... 0.9052
Salt Lake City-Ogden, UT....................................... 0.9854
San Diego, CA.................................................. 1.1955
Santa Fe, NM................................................... 0.9911
Santa Rosa, CA................................................. 1.3000
Seattle-Bellevue-Everett, WA................................... 1.1289
Sharon, PA..................................................... 0.8524
Sherman-Denison, TX............................................ 0.8833
Sioux City, IA-NE.............................................. 0.8549
South Bend, IN................................................. 0.9692
Springfield, IL................................................ 0.8684
Springfield, MO................................................ 0.7991
Syracuse, NY................................................... 0.9441
Tallahassee, FL................................................ 0.8274
Tampa-St. Petersburg-Clearwater, FL............................ 0.9119
Texarkana, AR-Texarkana, TX.................................... 0.8174
Toledo, OH..................................................... 0.9593
Topeka, KS..................................................... 0.9326
Tulsa, OK...................................................... 0.7931
Tuscaloosa, AL................................................. 0.8064
Tyler, TX...................................................... 0.9199
Vallejo-Fairfield-Napa, CA..................................... 1.2167
Victoria, TX................................................... 0.8378
Waco, TX....................................................... 0.8075
Washington, DC-MD-VA-WV........................................ 1.1053
Waterloo-Cedar Falls, IA....................................... 0.8841
Wausau, WI..................................................... 0.9445
Wichita, KS.................................................... 0.9082
Rural Colorado................................................. 0.8813
Rural Florida.................................................. 0.8986
Rural Illinois................................................. 0.8047
Rural Louisiana................................................ 0.7486
Rural Michigan................................................. 0.8831
Rural Minnesota................................................ 0.8669
Rural Missouri................................................. 0.7723
Rural Montana.................................................. 0.8398
Rural Oregon................................................... 0.9873
Rural Tennessee................................................ 0.7650
Rural Texas.................................................... 0.7471
Rural Virginia (KY Hospital)................................... 0.8043
Rural Washington............................................... 1.0333
Rural Wyoming.................................................. 0.8859
------------------------------------------------------------------------
--------------------
CPT codes and descriptions only are copyright American Medical
Association. All Rights Reserved. Applicable FARS/DFARS Apply.
Copyright American Dental Association. All rights reserved.
[[Page 18820]]
Addendum K.--Codes Eligible for Pass-Through Payment
------------------------------------------------------------------------
CPT/
HCPCS Description
------------------------------------------------------------------------
A4642 Satumomab pendetide per dose
A9502 Technetium TC99M tetrofosmin
A9600 Strontium-89 chloride
A9605 Samarium sm153 lexidronamm
J0205 Alglucerase injection
J0207 Amifostine
J0256 Alpha 1 proteinase inhibitor
J0286 Amphotericin B lipid complex
J0476 Baclofen intrathecal trial
J0585 Botulinum toxin a per unit
J0640 Leucovorin calcium injection
J0735 Clonidine hydrochloride
J0850 Cytomegalovirus imm IV/vial
J1190 Dexrazoxane HCl injection
J1260 Dolasetron mesylate
J1325 Epoprostenol injection
J1436 Etidronate disodium inj
J1440 Filgrastim 300 mcg injeciton
J1561 Immune globulin 500 mg
J1562 Immune globulin 5 gms
J1565 RSV-ivig
J1620 Gonadorelin hydroch/100 mcg
J1626 Granisetron HCl injection
J1745 Infliximab injection
J1785 Injection imiglucerase/unit
J1825 Interferon beta-1a
J1830 Interferon beta-1b/.25 MG
J1950 Leuprolide acetate/3.75 MG
J2275 Morphine sulfate injection
J2352 Octreotide acetate injection
J2355 Oprelvekin injection
J2405 Ondansetron hcl injection
J2430 Pamidronate disodium/30 MG
J2545 Pentamidine isethionte/300mg
J2765 Metoclopramide hcl injection
J2790 Rho d immune globulin inj
J2820 Sargramostim injection
J3010 Fentanyl citrate injeciton
J3280 Thiethylperazine maleate inj
J3305 Inj trimetrexate glucoronate
J7190 Factor viii
J7191 Factor VIII (porcine)
J7192 Factor viii recombinant
J7194 Factor ix complex
J7197 Antithrombin iii injection
J7198 Anti-inhibitor
J7310 Ganciclovir long act implant
J7505 Monoclonal antibodies
J7913 Daclizumab, Parenteral, 25 m
J8510 Oral busulfan
J8520 Capecitabine, oral, 150 mg
J8530 Cyclophosphamide oral 25 MG
J8560 Etoposide oral 50 MG
J8600 Melphalan oral 2 MG
J8610 Methotrexate oral 2.5 MG
J9000 Doxorubic hcl 10 MG vl chemo
J9001 Doxorubicin hcl liposome inj
J9015 Aldesleukin/single use vial
J9020 Asparaginase injection
J9031 Bcg live intravesical vac
J9040 Bleomycin sulfate injection
J9045 Carboplatin injection
J9050 Carmus bischl nitro inj
J9060 Cisplatin 10 MG injeciton
J9065 Inj cladribine per 1 MG
J9070 Cyclophosphamide 100 MG inj
J9093 Cyclophosphamide lyophilized
J9100 Cytarabine hcl 100 MG inj
J9120 Dactinomycin actinomycin d
J9130 Dacarbazine 10 MG inj
J9150 Daunorubicin
J9151 Daunorubicin citrate liposom
J9165 Diethylstilbestrol injection
J9170 Docetaxel
J9181 Etoposide 10 MG inj
J9185 Fludarabine phosphate inj
J9190 Fluorouracil injection
J9200 Floxuridine injection
J9201 Gemcitabine HCl
J9202 Goserelin acetate implant
J9206 Irinotecan injection
J9208 Ifosfomide injection
J9209 Mesna injection
J9211 Idarubicin hcl injeciton
J9212 Interferon alfacon-1
J9213 Interferon alfa-2a inj
J9214 Interferon alfa-2b inj
J9215 Interferon alfa-n3 inj
J9216 Interferon gamma 1-b inj
J9218 Leuprolide acetate injeciton
J9230 Mechlorethamine hcl inj
J9245 Inj melphalan hydrochl 50 MG
J9250 Methotrexate sodium inj
J9265 Paclitaxel injection
J9266 Pegaspargase/singl dose vial
J9268 Pentostatin injection
J9270 Plicamycin (mithramycin) inj
J9280 Mitomycin 5 MG inj
J9293 Mitoxantrone hydrochl/5 MG
J9310 Rituximab cancer treatment
J9320 Streptozocin injection
J9340 Thiotepa injection
J9350 Topotecan
J9360 Vinblastine sulfate inj
J9370 Vincristine sulfate 1 MG inj
J9390 Vinorelbine tartrate/10 mg
J9600 Porfimer sodium
Q0136 Non esrd epoetin alpha inj
Q0160 Factor IX non-recombinant
Q0161 Factor IX recombinant
Q0163 Diphenhydramine HCl 50mg
Q0164 Prochlorperazine maleate 5mg
Q0166 Granisetron HCl 1 mg oral
Q0167 Dronabinol 2.5mg oral
Q0169 Promethazine HCl 12.5mg oral
Q0171 Chlorpromazine HCl 10mg oral
Q0173 Trimethobenzamide HCl 250mg
Q0174 Thiethylperazine maleate10mg
Q0175 Perphenazine 4mg oral
Q0177 Hydroxyzine pamoate 25mg
Q0179 Ondansetron HCl 8mg oral
Q0180 Dolasetron mesylate oral
Q0187 Factor viia recombinant
Q2002 Elliot's B solution
Q2003 Aprotinin, 10,000 kiu
Q2004 Treatment for bladder calcul
Q2005 Corticorelin ovine triflutat
Q2006 Digoxin immune FAB (Ovine),
Q2007 Ethanolamine oleate, 1000 ml
Q2008 Fomepizole, 1.5 G
Q2009 Fosphenytoin, 50 mg
Q2010 Glatiramer acetate, 25 mgeny
Q2011 Hemin, 1 mg
Q2012 Pegademase bovine inj 25 I.U
Q2013 Pentastarch 10% inj, 100 ml
Q2014 Sermorelin acetate, 0.5 mg
Q2015 Somatrem, 5 mg
Q2016 Somatropin, 1 mg
Q2017 Teniposide, 50 mg
Q2018 Urofollitropin, 75 I.U.
Q3001 Brachytherapy Seeds
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[FR Doc. 00-8215 Filed 3-31-00 11:00 am]
BILLING CODE 4120-01-P